Intensivmedizin und Notfallmedizin

, Volume 44, Issue 2, pp 74–87

Akuttherapie onkologischer Notfälle

ÜBERSICHT

Zusammenfassung

Maligne Erkrankungen können direkt Symptome verursachen, die einer raschen Diagnostik und Therapie bedürfen. Beispiele sind die obere Einflussstauung oder der maligne Perikarderguss. Auch paraneoplastische endokrine Störungen können Ursache eines akuten Notfalls in der Onkologie werden. Die tumorbedingte Hyperkalzämie kann paraneoplastisch, aber auch direkt durch eine Knochenfilialisierung ausgelöst sein. Auch hier muss bei symptomatischen Patienten unverzüglich eine effektive Behandlung eingeleitet werden. Gelegentlich machen Nebenwirkungen der Tumortherapie eine rasche, konsequente Therapie notwendig. Beispiele hierfür sind direkte bedrohliche Nebenwirkungen von Tumortherapeutika wie z. B. allergische Reaktionen auf Zytostatika oder die 5-FU induzierte Myokardischämie. Das Tumorlyse-Syndrom entsteht dagegen meist aus dem Zusammenwirken des endogen bereits erhöhten Zellumsatzes mit dem Zellzerfall bei Beginn der Tumortherapie. Die häufigste Komplikation bei Tumorpatienten ist das Fieber in der Neutropenie als Ausdruck eines Infektes bei einer verminderten Abwehr von Mikroorganismen unter der therapiebedingten Knochenmarkssuppression. Diese Übersicht befasst sich mit diesen onkologischen Notfällen und ihrer Therapie.

Schlüsselwörter

Onkologischer Notfall Obere Einflussstauung Maligner Perikarderguss Paraneoplastische Störung Tumorlyse-Syndrom 

Therapy of oncological emergencies

Abstract

Malignancies can cause symptoms which need rapid and adequate diagnosis and therapy. Examples are superior vena cava syndrome or malignant pericardial effusions. Paraneoplastic endocrine disorders are rarely responsible for acute emergencies in oncology. Tumor-related hypercalcemia may require rapid treatment. It can be caused by paraneoplastic phenomena or bone metastasis. At times, adverse effects of antineoplastic therapy can present as an emergency requiring rapid and directed therapy. Examples include the tumor lysis syndrome or acute, severe side effects of antineoplastic agents, e. g., allergic reactions to antibody treatment or 5-fluorouracil induced myocardial ischemia. Neutropenic fever is observed more frequently. It is a consequence of impaired antimicrobial defence during drug induced bone marrow suppression. This review summarizes these oncological emergencies and their therapy.

Key words

Oncological emergency vena cava superior syndrome malignant pericardial effusion paraneoplastic disease tumor lysis syndrome 

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Literatur

  1. 1.
    Abid SH, Malhotra V, Perry MC (2001) Radiation-induced and chemotherapy-induced pulmonary injury. Curr Opin Oncol 13:242–248PubMedCrossRefGoogle Scholar
  2. 2.
    Abraham KP, Reddy V, Gattuso P (1990) Neoplasms metastatic to the heart: review of 3314 consecutive autopsies. Am J Cardiovasc Pathol 3:195–198PubMedGoogle Scholar
  3. 3.
    Adelstein DJ, Hines JD, Carter SG, Sacco D (1988) Thromboembolic events in patients with superior vena cava syndrome and the role of anticoagulation. Cancer 62:2258–2262PubMedCrossRefGoogle Scholar
  4. 4.
    Allen KB, Faber LP, Warren WH, Shaar CJ (1999) Pericardial effusion: subxiphoid pericardiostomy versus percutaneous catheter drainage. Ann Thorac Surg 67:437–440PubMedCrossRefGoogle Scholar
  5. 5.
    Anand AJ (1994) Fluorouracil cardiotoxicity. Ann Pharmacother 28:374–37PubMedGoogle Scholar
  6. 6.
    Averbuch SD, Steakley CS, Young RC, Gelmann EP, Goldstein DS, Stull R, Keiser HR (1998) Malignant pheochromocytoma: effective treatment with a combination of cyclophosphamide, vincristin, and dacarbazine. Ann Intern Med 109:267–273Google Scholar
  7. 7.
    Benson AB, Ajani JA, Catalano RB, Engelking C, Kornblau SM, Martenson JA, McCallum R, Mitchell EP, O'Dorisio TM, Vokes EE, Wadler S (2004) Recommended guidelines for the treatment of cancer treatment-induced diarrhea. J Clin Oncol 22:2918–2926PubMedCrossRefGoogle Scholar
  8. 8.
    Berenson JR (2002) Treatment of hypercalcemia of malignancy with bisphosphonates. Semin Oncol 29 (6 Suppl 21):12–18PubMedCrossRefGoogle Scholar
  9. 9.
    Bishiniotis TS, Antoniadou S, Katseas G, Mouratidou D, Litos AG, Balamoutsos N (2000) Malignant cardiac tamponade in womenwith breast cancer treated by pericardiocentesis and intrapericardial administration of triethylenethipophosphoramide (thiotepa). Am J Cardiol 86:362–364PubMedCrossRefGoogle Scholar
  10. 10.
    Bishiniotis TS, Lafaras CT, Platogiannis DN, Moldovan L, Barbetakis NG, Kasteas GP (2005) Intrapericardial cisplatin administration after pericardiocentesis in patients with lung adenocarcinoma and malignant cardiac tamponade. Hellenic J Cardiol 46:324–329Google Scholar
  11. 11.
    Cairo MS, Bishop M (2004) Tumour lysis syndrome: new therapeutic strategies and classification. Br J Haematol 127:3–11PubMedCrossRefGoogle Scholar
  12. 12.
    Colleoni M, Martinelli G, Beretta F, Marone C, Gallino A, Fontana M, Graffeo R, Zampino G, De Pas T, Cipolla G, Martinoni C, Goldhirsch A (1998) Intracavitary chemotherapy with thiotepa in malignant pericardial effusions: an active and well-tolerated regimen. J Clin Oncol 16:2371–2376PubMedGoogle Scholar
  13. 13.
    Cullinane CA, Paz IB, Smith D, Carter N, Grannis FW (2004) Prognostic factors in the surgical management of pericardial effusion in the patient with concurrent malignancy. Chest 125:1328–1334PubMedCrossRefGoogle Scholar
  14. 14.
    Davis S, Rambotti P, Grignani F (1984) Intrapericardial tetracycline sclerosis in the treatment of malignant pericardial effusion: an analysis of thirty-three cases. J Clin Oncol 2:631–636PubMedGoogle Scholar
  15. 15.
    Deftos LJ, First BP (1981) Calcitonin as a drug. Ann Intern Med 95:192–197PubMedGoogle Scholar
  16. 16.
    DeLellis RA, Xia L (2003) Paraneoplastic endocrine syndromes: a review. Endocr Pathol 14:303–317PubMedCrossRefGoogle Scholar
  17. 17.
    Dempke W, Firusian N (1999) Treatment of malignant pericardial effusion with 32P-colloid. Br J Cancer 80:1955–1957PubMedCrossRefGoogle Scholar
  18. 18.
    Dinkel HP, Mettke B, Schmid F, Baumgartner I, Triller J, Do DD (2003) Endovascular treatment of malignant superior vena cava syndrome: is bilateral wallstent placement superior to unilateral placement? J Endovasc Ther 10:788–797PubMedCrossRefGoogle Scholar
  19. 19.
    Dosios T, Theakos N, Angouras D, Asimacopoulos P (2003) Risk factors affecting the survival of patients with pericardial effusion submitted to subxiphoid pericardiostomy. Chest 124:242–246PubMedCrossRefGoogle Scholar
  20. 20.
    Dumon JC, Magritte A, Body JJ (1992) Nasal human calcitonin for tumor-induced hypercalcemia. Calcif Tissue Int 51:18–19PubMedCrossRefGoogle Scholar
  21. 21.
    Esbrit P, Egido J (2000) The emerging role of parathyroid hormone-related protein as a renal regulating factor. Nephrol Dial Transplant 15:1109–1111PubMedCrossRefGoogle Scholar
  22. 22.
    Gornik HL, Gerhard-Herman M, Beckman JA (2005) Abnormal cytology predicts poor prognosis in cancer patients with pericardial effusion. J Clin Oncol 23:5211–5216PubMedCrossRefGoogle Scholar
  23. 23.
    Gray BH, Olin JW, Graor RA, Young JR, Bartholomew JR, Ruschhaupt WF (1991) Safety and efficacy of thrombolytic therapy for superior vena cava syndrome. Chest 99:54–59PubMedGoogle Scholar
  24. 24.
    Hilbert G, Gruson D, Vargas F, Valentino R, Gbikpi-Benissan G, Dupon M, Reiffers J, Cardinaud JP (2001) Noninvasive ventilation in immunosuppressed patients with pulmonary infiltrates, fever, and acute respiratory failure. N Engl J Med 344:481–487PubMedCrossRefGoogle Scholar
  25. 25.
    Hughes WT, Armstrong D, Bodey GP, Bow EJ, Brown AE, Calandra T, Feld R, Pizzo PA, Rolston KV, Shenep JL, Young LS (2002) 2002 guidelines for the use of antimicrobial agents in neutropenic patients with cancer. Clin Infect Dis 34:730–751PubMedCrossRefGoogle Scholar
  26. 26.
    Hutcherson DA, Gammon DC, Bhatt MS, Faneuf M (2006) Reduced-dose rasburicase in the treatment of adults with hyperuricemia associated with malignancy. Pharmacotherapy 26:242–247PubMedCrossRefGoogle Scholar
  27. 27.
    Imazio M, Demichelis B, Parrini I, Favro E, Beqaraj F, Cecchi E, Pomari F, Demarie D, Ghisio A, Belli R, Bobbio M, Trinchero R (2005) Relation of acute pericardial disease to malignancy. Am J Cardiol 95:1393–1394PubMedCrossRefGoogle Scholar
  28. 28.
    Kaira K, Takise A, Kobayashi G, Utsugi M, Horie T, Mori T, Imai H, Inazawa M, Mori M (2005) Management of malignant pericardial effusion with instillation of mitomycin C in non-small cell lung cancer. Jpn J Clin Oncol 35:57–60PubMedCrossRefGoogle Scholar
  29. 29.
    Kern WV, Cometta A, De Bock R, Langenaeken J, Paesmans M, Gaya H (1999) Oral versus intravenous empirical antimicrobial therapy for fever in patients with granulocytopenia who are receiving cancer chemotherapy. International Antimicrobial Therapy Cooperative Group of the European Organization for Research and Treatment of Cancer. N Engl J Med 341:312–318PubMedCrossRefGoogle Scholar
  30. 30.
    Kinney MA, Warner ME, van Heerden JA, Horlocker TT, Young WF Jr, Schroeder DR, Maxson PM, Warner MA (2000) Perianesthetic risks and outcomes of pheochromocytoma and paraganglioma resection. Anesth Analg 91:1118–1123PubMedCrossRefGoogle Scholar
  31. 31.
    Klastersky J, Paesmans M, Rubenstein EB, Boyer M, Elting L, Feld R, Gallagher J, Herrstedt J, Rapoport B, Rolston K, Talcott J (2000) The multinational association for supportive care in cancer risk index: a multinational scoring system for identifying lowrisk febrile neutropenic cancer patients. J Clin Oncol 18:3038–3051PubMedGoogle Scholar
  32. 32.
    Kleiman NS, Lehane DE, Geyer CE, Pratt CM, Young JB (1987) Prinzmetal's angina during 5-fluorouracil chemotherapy. Am J Med 82:566–568PubMedCrossRefGoogle Scholar
  33. 33.
    Kopecky SL, Callahan JA, Tajik AJ, Seward JB (1986) Percutaneous pericardial catheter drainage: report of 42 consecutive cases. Am J Cardiol 58:633–635PubMedCrossRefGoogle Scholar
  34. 34.
    Laham RJ, Cohen DJ, Kuntz RE, Baim DS, Lorell BH, Simons M (1996) Pericardial effusion in patients with cancer: outcome with contemporary management strategies. Heart 75:67–71PubMedGoogle Scholar
  35. 35.
    Lam KY, Dickens P, Chan AC (1993) Tumors of the heart. A 20-year experience with a review of 12485 consecutive autopsies. Arch Pathol Lab Med 117:1027–1031PubMedGoogle Scholar
  36. 36.
    Lashevsky I, Ben Yosef R, Rinkevich D, Reisner S, Markiewicz W (1996) Intrapericardial minocycline sclerosis for malignant pericardial effusion. Chest 109:1452–1454PubMedGoogle Scholar
  37. 37.
    Lebuffe G, Dosseh ED, Tek G, Tytgat H, Moreno S, Tavernier B, Vallet B, Proye CA (2005) The effect of calcium channel blockers on outcome following the surgical treatment of phaeochromocytomas and paragangliomas. Anaesthesia 60:439–444PubMedCrossRefGoogle Scholar
  38. 38.
    Lenders JWM, Eisenhofer G, Mannelli M, Pacak K (2005) Phaeochromocytoma. Lancet 366:665–675PubMedCrossRefGoogle Scholar
  39. 39.
    Lenders JW, Pacak K, Walther MM, Linehan WM, Mannelli M, Friberg P, Keiser HR, Goldstein DS, Eisenhofer G (2002) Biochemical diagnosis of pheochromocytoma: which test is best? JAMA 387:1427–1434CrossRefGoogle Scholar
  40. 40.
    Le Roith D, Roberts CT (2003) The insulin-like growth factor system and cancer. Cancer Lett 195:127–137Google Scholar
  41. 41.
    Leyland-Jones B (2004) Treating cancer-related hypercalcemia with gallium nitrate. J Support Oncol 2:509–516PubMedGoogle Scholar
  42. 42.
    Liu G, Crump M, Goss PE, Dancey J, Shepherd FA (1996) Prospective comparison of the sclerosing agents doxycycline and bleomycin for the primary management of malignant pericardial effusion and cardiac tamponade. J Clin Oncol 14:3141–3147PubMedGoogle Scholar
  43. 43.
    Luo JC, Hwang SJ, Wu JC, Lai CR, Li CP, Chang FY, Chiang JH, Lui WY, Chu CW, Lee SD (2002) Clinical characteristics and prognosis of hepatocellular carcinoma patients with paraneoplastic syndromes. Hepatogastroenterology 49:1315–1319PubMedGoogle Scholar
  44. 44.
    Maher EA, Shepherd FA, Todd TJ (1996) Pericardial sclerosis as the primary management of malignant pericardial effusion and cardiac tamponade. J Thorac Cardiovasc Surg 112:637–643PubMedCrossRefGoogle Scholar
  45. 45.
    Maisch B, Ristic AD, Pankuweit S, Neubauer A, Moll R (2002) Neoplastic pericardial effusion. Efficacy and safety of intrapericardial treatment with cisplatin. Eur Heart J 23:1625–1631PubMedCrossRefGoogle Scholar
  46. 46.
    Martinoni A, Cipolla CM, Cardinale D, Civelli M, Lamantia G, Colleoni M, Fiorentini C (2004) Long-term results of intrapericardial chemotherapeutic treatment of malignant pericardial effusions with thiotepa. Chest 126:1412–1416PubMedCrossRefGoogle Scholar
  47. 47.
    Maschmeyer G, Beinert T, Buchheidt D, Einsele H, Heussel CP, Kiehl M, Lorenz J (2003) Diagnosis and antimicrobial therapy of pulmonary infiltrates in febrile neutropenic patients-guidelines of the Infectious Diseases Working Party (AGIHO) of the German Society of Hematology and Oncology (DGHO). Ann Hematol 82 (Suppl 2):S118–S126PubMedGoogle Scholar
  48. 48.
    Mc Donald JM, Meyers BF, Guthrie TJ, Battafarano RJ, Cooper JD, Patterson GA (2003) Comparison of open suxiphoid pericardial drainage with percutaneous catheter drainage for symptomatic pericardial effusion. Ann Thorac Surg 76:811–815CrossRefGoogle Scholar
  49. 49.
    Meyers DG, Meyers RE, Prendergast TW (1997) The usefulness of diagnostic tests on pericardial fluid. Chest 111:1213–1221PubMedGoogle Scholar
  50. 50.
    Moriya T, Takiguchi Y, Tabeta H, Watanabe R, Kiumra H, Nagao K, Kuriyama T (2000) Controlling malignant pericardial effusion by intrapericardial carboplatin administration in patients with primary non-small-cell lung cancer. Br J Cancer 83:858–862PubMedCrossRefGoogle Scholar
  51. 51.
    Moses AM, Scheinman SJ (1991) Ectopic secretion of neurohypophyseal peptides in patients with malignancy. Endocrinol Metab Clin North Am 20:489–506PubMedGoogle Scholar
  52. 52.
    Musch E, Gremmler B, Nitsch J, Rieger J, Malek M, Chrissafidou A (2003) Intrapericardial instillation of mitoxantrone in palliative therapy of malignant pericardial effusion. Onkologie 26:135–139PubMedCrossRefGoogle Scholar
  53. 53.
    Nicholson AA, Ettles DF, Arnold A, Greenstone M, Dyet JF (1997) Treatment of malignant superior vena cava obstruction: metal stents or radiation therapy. J Vasc Interv Radiol 8:781–788PubMedCrossRefGoogle Scholar
  54. 54.
    Norum J, Lunde P, Aasebo U, Himmelmann A (1998) Mitoxantrone in malignant pericardial effusion. J Chemother 10:399–404PubMedGoogle Scholar
  55. 55.
    Ozer H, Armitage JO, Bennett CL, Crawford J, Demetri GD, Pizzo PA, Schiffer CA, Smith TJ, Somlo G, Wade JC, Wade JL, Winn RJ, Wozniak AJ, Somerfield MR (2000) 2000 update of recommendations for the use of hematopoietic colony-stimulating factors: evidence-based, clinical practice guidelines. American Society of Clinical Oncology Growth Factors Expert Panel. J Clin Oncol 18:3558–3585PubMedGoogle Scholar
  56. 56.
    Parish JM, Marschke RF, Dines DE, Lee RE (1981) Etiologic considerations in superior vena cava syndrome. Mayo Clin Proc 56:407–413PubMedGoogle Scholar
  57. 57.
    Park JS, Rentschler R, Wilbur D (1991) Surgical management of pericardial effusion in patients with malignancies. Comparison of subxiphoid window versus pericardiectomy. Cancer 67:76–80PubMedCrossRefGoogle Scholar
  58. 58.
    Patel PN (2006) Methylene blue for management of Ifosfamide-induced encephalopathy. Ann Pharmacother 40:299–303PubMedCrossRefGoogle Scholar
  59. 59.
    Pecherstorfer M, Brenner K, Zojer N (2003) Current management strategies for hypercalcemia. Treat Endocrinol 2:273–292PubMedCrossRefGoogle Scholar
  60. 60.
    Perez-Soler R, McLaughlin P, Velasquez WS, Hagemeister FB, Zornoza J, Manning JT, Fuller LM, Cabanillas F (1984) Clinical features and results of management of superior vena cava syndrome secondary to lymphoma. J Clin Oncol 2:260–266PubMedGoogle Scholar
  61. 61.
    Piehler JM, Pluth JR, Schaff HV, Danielson GK, Orszulak TA, Puga FJ (1985) Surgical management of effusive pericardial disease. Influence of extent of pericardial resection on clinical course. J Thorac Cardiovasc Surg 90:506–516PubMedGoogle Scholar
  62. 62.
    Pink D, Schoeler D, Lindner T, Thuss-Patience PC, Kretzschmar A, Knipp H, Vanhoefer U, Reichhardt P (2005) Severe hypoglycemia caused by paraneoplastic production of IGFII in patients with advanced gastrointestinal stromal tumors: a report of two cases. J Clin Oncol 23:6809–6811PubMedCrossRefGoogle Scholar
  63. 63.
    Porte HL, Janecki-Delebecq TJ, Finzi L, Metois DG, Millaire A, Wurtz AJ (1999) Pericardoscopy for primary management of pericardial effusion in cancer patients. Eur J Cardiothorac Surg 16:287–291PubMedCrossRefGoogle Scholar
  64. 64.
    Qanadli SD, El Hajjam M, Bruckert F, Judet O, Barre O, Chagnon S, Lacombe P (1999) Helical CT phlebography of the superior vena cava: diagnosis and evaluation of venous obstruction. AJR Am J Roentgenol 172:1327–1333PubMedGoogle Scholar
  65. 65.
    Ramage JK, Davies AH, Ardill J, Bax N, Caplin M, Grossman A, Hawkins R, McNicol AM, Reed N, Sutton R, Thakker R, Aylwin S, Breen D, Britton K, Buchanan K, Corrie P, Gillams A, Lewington V, McCance D, Meeran K, Watkinson A; UKNETwork for Neuroendocrine Tumours (2005) Guidelines for the management of gastroenteropancreatic neuroendocrine (including carcinoid) tumors. Gut 54(Suppl 4):iv1–16PubMedCrossRefGoogle Scholar
  66. 66.
    Rice TW, Rodriguez RM, Light RW (2006) The superior vena cava syndrome: clinical characteristics and evolving etiology. Medicine (Baltimore) 85:37–42PubMedCrossRefGoogle Scholar
  67. 67.
    Rosol TJ, Capen CC (1992) Mechanisms of cancer-induced hypercalcemia. Lab Invest 67:680–702PubMedGoogle Scholar
  68. 68.
    Rowell NP, Gleeson FV (2002) Steroids, radiotherapy, chemotherapy and stents for superior vena caval obstruction in carcinoma of the bronchus: a systematic review. Clin Oncol 14:338–351CrossRefGoogle Scholar
  69. 69.
    Schraufnagel DE, Hill R, Leech JA, Pare JA (1981) Superior vena caval obstruction. Is it a medical emergency? Am J Med 70:1169–1174PubMedCrossRefGoogle Scholar
  70. 70.
    Schultz M, Schölmerich J, Kullmann F (2004) Management chemotherapieinduzierter Diarrhöen. Z Gastroenterol 42:527–538PubMedCrossRefGoogle Scholar
  71. 71.
    Shapiro B, Gross MD, Shulkin B (2001) Radioisotope diagnosis and therapy of malignant pheochromocytoma. Trends Endocrinol Metab 12:469–475PubMedCrossRefGoogle Scholar
  72. 72.
    Sleijfer S (2001) Bleomycin-induced pneumonitis. Chest 120:617–624PubMedCrossRefGoogle Scholar
  73. 73.
    Sunder SK, Ekong EA, Sivalingam K, Kumar A (1992) Superior vena cava thrombosis due to pacing electrodes: successful treatment with combined thrombolysis and angioplasty. Am Heart J 123:790–792PubMedCrossRefGoogle Scholar
  74. 74.
    Tauzin-Fin P, Sesay M, Gosse P, Ballanger P (2004) Effects of perioperative alpha1 block on haemodynamic control during laparoscopic surgery for phaeochromocytoma. Br J Anaesth 92:512–517PubMedCrossRefGoogle Scholar
  75. 75.
    Steinsapir J, Carr AA, Prisant LM, Bransome ED (1997) Metyrosine and pheochromocytoma. Arch Intern Med 157:901–906PubMedCrossRefGoogle Scholar
  76. 76.
    Teale JD, Wark G (2004) The effectiveness of different treatment options for non-islet cell tumor hypoglycaemia. Clin Endocrinol 60:457–460CrossRefGoogle Scholar
  77. 77.
    Ten Harkel AD, Kist-Van Holthe JE, Van Weel M, Van der Vorst MM (1998) Alkalinization and the tumor lysis syndrome. Med Pediatr Oncol 31:27–28PubMedCrossRefGoogle Scholar
  78. 78.
    Tomkowski WZ, Wisniewska J, Szturmowicz M, Kuca P, Burakowski J, Kober J, Fijalkowska A (2004) Evaluation of intrapericardial cisplatin administration in cases with recurrent malignant pericardial effusion and cardiac tamponade. Support Care Cancer 12:53–57PubMedCrossRefGoogle Scholar
  79. 79.
    Tsang TS, Seward JB, Barnes ME, Bailey KR, Sinak LJ, Urban LH, Hayes SN (2000) Outcomes of primary and secondary treatment of pericardial effusion in patients with malignancy. Mayo Clin Proc 75:248–253PubMedCrossRefGoogle Scholar
  80. 80.
    Ulchaker JC, Goldfarb DA, Bravo EL, Novick AC (1999) Successful outcomes in pheochromocytoma surgery in the modern era. J Urol 161:764–767PubMedCrossRefGoogle Scholar
  81. 81.
    Vachharajani TJ, Zaman F, Abreo KD (2003) Hyponatremia in critically ill patients. J Intensive Care Med 18:3–8PubMedCrossRefGoogle Scholar
  82. 82.
    Van Belle SJ, Volckaert A, Taeymans Y, Spapen H, Block P (1987) Treatment of malignant pericardial tamponade with sclerosis induced by instillation of bleomycin. Int J Cardiol 16:155–160PubMedCrossRefGoogle Scholar
  83. 83.
    Whalen RK, Althausen AF, Daniels GH (1992) Extra-adrenal pheochromocytoma. J Urol 147:1–10PubMedGoogle Scholar
  84. 84.
    Wiener HG, Kristensen IB, Haubek A, Kristensen B, Baandrup U (1991) The diagnostic value of pericardial cytology. An analysis of 95 cases. Acta Cytol 35:149–153PubMedGoogle Scholar
  85. 85.
    Wierecky J, Bokemeyer C (2005) Kompressionssyndrome. Internist 46:9–18PubMedCrossRefGoogle Scholar
  86. 86.
    Wudel LJ, Nesbitt JC (2001) Superior vena cava syndrome. Curr Treat Options Oncol 2:77–91PubMedGoogle Scholar
  87. 87.
    Yano T, Yokoyama H, Inoue T, Takanashi N, Asoh H, Ichinose Y (1994) A simple technique to manage malignant pericardial effusion with a local instillation of bleomycin in non-small cell carcinoma of the lung. Oncology 51:507–509PubMedCrossRefGoogle Scholar
  88. 88.
    Zayas R, Anguita M, Torres F, Gimenez D, Bergillos F, Ruiz M, Ciudad M, Gallardo A, Valles F (1995) Incidence of specific etiology and role of methods for specific etiologic diagnosis of primary acute pericarditis. Am J Cardiol 1995;75:378–382PubMedCrossRefGoogle Scholar

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© Steinkopff-Verlag 2007

Authors and Affiliations

  1. 1.Klinik und Poliklinik für Innere Medizin I und Abteilung für Hämatologie und internistische OnkologieKlinikum der Universität RegensburgRegensburgGermany

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