Oxaliplatin (OHP) is the most recent platinum compound entering the clinical practice. It is an alkylating agent on DNA and forms DACH-platinum DNA adducts more hydrophobic than those formed by cisplatin (CDDP) and carboplatin (CBDCA). It is effective in advanced colorectal cancer both as a first-line therapy and in 5-fluorouracil (5-FU) refractory patients (Bertheault-Cvitkovic et al, 1996; De Gramont et al, 1997; Andre' et al, 1999; Maindrault-Goebel et al, 1999).

Hypersensitivity reactions related to oxaliplatin (OHP)

Pulmonary toxicity from novel antineoplastic agents

Bronchoalveolar lavage in drug-induced lung disease

The diagnosis of infiltrative diffuse lung disease may require invasive procedures after all noninvasive tools have failed. The clinical context in which these diseases develop and the radiological patterns are crucial for defining the timing and the methods to be used. Immunocompromised hosts are usually acutely ill with fever, cough, shortness of breath, and often with progressive hypoxemia. In this context a prompt diagnosis is necessary to decrease mortality. Bronchoalveolar lavage [especially in cases that show ground-glass attenuation or alveolar opacification in high-resolution CT scan (HRCT)] is the most important invasive procedure allowing the identification of infectious agents, neoplastic elements and characteristic cytological and phenotypical profiles (for drug injury) in the majority of cases. Less frequently transbronchial lung biopsy, transbronchial needle aspiration and biopsy or surgical lung biopsy are necessary. In immunocompetent patients the clinical spectrum of diffuse lung disease is quite broad. Furthermore, in the last two decades HRCT, used in conjunction with clinical and other noninvasive investigative modalities, has increased the accuracy of diagnosis for some diseases without the need of surgical biopsy. Also in these patients bronchoalveolar lavage, frequently in combination with transbronchial lung biopsy, is sufficient to achieve a definitive diagnosis in the majority of cases. Surgical lung biopsy is, however, still relevant in cases with idiopathic interstitial pneumonias. In this article invasive diagnostic procedures in patients with diffuse lung infiltrates are discussed from the perspective of their clinical context and their imaging characteristics.

Diagnostic Invasive Procedures in Diffuse Infiltrative Lung Diseases

Background: Oxaliplatin has become one of the major cytotoxic agents for the treatment of gastrointestinal tumors. As a result, several cases of the so-called oxaliplatin-associated

Clinical Features of Hypersensitivity Reactions to Oxaliplatin: A 10-Year Experience

Diarrhoea, T-CD4+ lymphopenia and bilateral patchy pulmonary infiltrates developed in a male 60 yrs of age, who was treated with oxaliplatinum and 5-fluorouracil for unresectable rectum carcinoma. The findings from transbronchial lung biopsy and bronchoalveolar lavage (BAL) were consistent with an organizing diffuse alveolar damage pattern. Once extensive microbiological studies proved negative, corticosteroids were given and a complete remission of clinical and radiological abnormalities was achieved. It is concluded that the aforementioned pathological manifestations were due to chemotherapy and included a pulmonary adverse reaction, a feature never previously associated with oxaliplatinum and 5-fluorouracil regimens.

https://erj.ersjournals.com/content/erj/18/1/243.full.pdf

Acute lung injury associated with 5-fluorouracil and oxaliplatinum combined chemotherapy.

Background and aim of the work The studies on late-onset non-infectious respiratory complications after allogeneic bone marrow transplantation (allo-BMT) have been mainly focused on bronchiolitis obliterans to date. The aim of this work was to analyze the incidence, clinico-pathologic characteristics and outcome of the entire spectrum of entities falling into the group of delayed non-infectious lung disease (DLD). Methods Retrospective chart review was carried out of 112 patients who underwent allo-BMT for hematologic malignancies between April 1995 and November 1998 at a single Institution. The categorization of the pulmonary disease was made by analyzing clinical data, bronchoalveolar lavage (BAL), high-resolution computed tomography (HRCT) and histology when possible. Results DLD occurred in 10 (10%) out of 97 recipients who survived at least 100 days following allo-BMT and was defined as bronchiolitis obliterans (BO; 4 cases), acute lung injury (ALI; 1 case) and subacute cellular interstitial pneumonia (SCIP; 5 cases). The BAL-profile was characterized by a marked increase of the neutrophil percentage in BO cases and of the lymphocyte (predominantly CD8+) percentage in parenchymal DLDs (SCIP, ALI). HRCT proved to be helpful to correctly identify BO cases, whereas histology was always needed to better define DLD presenting with an interstitial and/or alveolar pattern. The predominant airway involvement as well as the acute-onset of a respiratory illness with histological evidence of diffuse alveolar damage were associated with a worse prognosis because of a poor response to the immunosuppressive treatment. Conclusions DLDs represent a group of entities heterogeneous in regard to variables such as onset and clinical behaviour (acute, subacute or chronic), predominant pattern of lung involvement (airway or parenchymal), response to treatment. Although immunopathologic mechanisms related to c-GVHD probably have a relevant pathogenic importance in this setting, the possible role of associated events (eg, drug toxicity and infections) at least in priming the lung damage need to be better clarified for its therapeutical implications.

Delayed non-infectious lung disease in allogeneic bone marrow transplant recipients.

Airway stent insertion is a procedure increasingly used in patients with complex post-intubation tracheal stenosis (PITS) who are unfit for or refuse surgery [1-3]. Very recently, a new self-expanding metallic stent (Alveolus TB-STSTM, Alveolus Inc., Charlotte, NC, USA) which is supposed to be easy to remove and for which indication for the treatment of benign tracheobronchial conditions has been obtained from the FDA, has been put on the market and is under evaluation. We report on a very unusual complication of an Alveolus tracheal stent in a patient with PITS.

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Collapse of a new type of self-expanding metallic tracheal stent.

The role of endoscopic techniques in the diagnosis and treatment of respiratory diseases has been well established for some time. These techniques involve the use of sophisticated instruments, some disposable and sterile, others costly, complex and reusable such as fiberoptic bronchoscopes and most of the accessory instruments. The aims are to: – Impede, in patients who undergo endoscopic procedures, the onslaught of infections caused by the transmission of micro-organisms from patient to patient, or due to environmental contamination of instruments. – Impede the false positivity of the samples caused by the external contamination of the specimens (pseudo-infections). The specific procedures which permit the reprocessing of the instruments must also guarantee: – Protection for technicians responsible for the cleaning of the instruments, both because of the risk derived from professional exposure and because of infected material and toxic substances. – Maximum maintenance of the instruments. As a rule it must be assumed that all patients undergoing an endoscopic examination should be considered potentially afflicted by infections transmittable by blood and by secretions. It therefore follows that reprocessing adopted procedures must always be the same both for instruments used on patients with infectious diseases and those used on patients considered to be free of infectious diseases [1-5].

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L. Lazzari Agli

Papers

Acute lung injury associated with 5-fluorouracil and oxaliplatinum combined chemotherapy.

Delayed non-infectious lung disease in allogeneic bone marrow transplant recipients.

Collapse of a new type of self-expanding metallic tracheal stent.

Instruments and Maintenance