AN UNUSUAL BLEEDING IN THE COURSE OF HONVAN THERAPY OF PROSTATIC CANCER
REPORT OF A CASE
1964 Volume 55 Issue 6 Pages 615-620
Details
1964 Volume 55 Issue 6 Pages 615-620
The bleeding due to honvan therapy is an extremely rare side effect, and the following case is the third report following Schwerdtfeger's and Balogh's case.
S.O., a 58-year-old man. For 2 years the patient suffered from prostatic cancer and bone metastasis. Following castration, the injection of honvan was given the patient for the period from May 2, 1961 through May 26, 1962 in the following manners;
the 1st course 250mg per day 20 times,
the 2nd course 250mg per day 15 times,
the 3rd course 250mg per week 12 times.
Each course brought a good effect and the size of prostate was reduced. Besides complaints around his loin and chest became less and less, and the serum acid phosphatase, which had been high in the early stage (2.55 BL units), finally returned to the normal level.
Five months after the above injection, the patient started to complain about a mild pain in the regions, and the level of the serum acid peosphatase rose slightly again (0.80 BL units). In the 4th course, honvan 250mg per day was injected 20 times intravenously from Oct. 15, 1962. This course however did not bring any decrease fo the level of acid phosphatase (1.16 BL units). On the next day (Nov. 15, 1962) after the last injection gingival bleeding and purpura on the dorsum of his right hand appeared.
The laboratory findings were as follows; erythrocyte 426×104, hemoglobin 13.3g/dl, hematcrit 43%, thrombocyte 392×103, leucocyte 13800 with 35% band neutrophils, 46% segmented neutrophils, 0% eosinophils, 13% lymphocytes, 6% monocytes and toxic granule of leucocyte, TTT 6.6, Kunkel.
20.0, bleeding time 2min., coagulation time 11min.-18min., Rumpel-Leede (-), serum plasmin index 7min. and 30sec., and blood pressure 120/85 mmHg.
Because of the insisting high level of serum acid phosphatase (2.29 BL units), while remission of bleeding was brought without having any treatment after 3 weeks of the symptoms, the 5th course of injection was given him from Dec. 7 as follows; drip infusion of honvan 500mg every other day 6 times. On the last day (Dec. 19) of the above. injection, the bleeding at the point where the needle was inserted and the gingival bleedig started, and the former continued for 2 days, in spite of medical treatment to stop it. On Dec. 21 the patient started to vomit and came into the conditions of mist vision, and repeated the drawing of deep breaths which was followed by come. And then he was exhausted about 5 hours later.
The patients experienced episodes of bleeding mostly in the form of hypodermal or gingival bleeding. The symptom was reversible and a remission was brought in all cases but the 2nd episode of ours that drove the patient to death under the symptoms suspicious of intracranial bleeding. The Schwerdtfeger theory that toxic substances from destroyed tissue of prostatic cancer and metastasis injure liver and blood vessel and increase the bleeding tendency is generally accepted.
