Anthracyline-reduced sequential combination chemotherapy for younger patients with good-prognosis aggressive B-cell non-Hodgkin's lymphoma.

INTRODUCTION: Anthracyline-based chemotherapy is the treatment of choice for patients with aggressive B-cell non-Hodgkin's lymphoma (NHL). However, anthracyclines have been associated with long-term cardiac toxicity. METHODS: We conducted a study using a sequential combination chemotherapy with a reduced cumulative dose of anthracyclines in younger patients with good-prognosis aggressive NHL. Chemotherapy consisted of one cycle of vincristine, ifosfamide, etoposide, and dexamethasone, followed by three cycles of epirubicin, cyclophosphamide, vincristine, and dexamethasone, and a fifth cycle containing carboplatin, etoposide, and dexamethasone. 86 patients were treated, 65 without and 21 with additional rituximab. Consolidating involved-field irradiation was applied in patients with stage I/II, bulky disease, or localized residual lymphoma. RESULTS: Complete and partial remissions were achieved in 67 and 27% of patients, respectively, and the 3-year event-free and overall survival estimates were 75 and 87%. The survival estimates were substantially better in patients who received rituximab. Main toxicity was grade 3/4 leukocytopenia in 89% patients with neutropenic fever in 30%. Two patients died of septic shock. CONCLUSION: The treatment appears to be effective in this group of patients. The hematological toxicities, particularly after the first and fifth cycle, require the use of G-CSF and/or a dose reduction in selected patients.

[Pseudoaneurysm with associated arteriovenous fistula after transfemoral puncture]. / Pseudoaneurysma mit daraus hervorgehender AV-Fistel nach transfemoraler Punktion.

BACKGROUND: Local vascular complications after transfemoral cardiac catheterization occur with an incidence of 5%. Most commonly these lesions are pseudoaneurysms, av-fistulas, arterial dissections or direct vascular injuries. Undiagnosed vascular lesions can lead to fatal consequences especially in patients with chronic heart failure by av-fistula with significant shunt volume. CASE REPORT: We report a vascular complication of combined pseudoaneurysm and av-fistula originated from the pseudoaneurysm. The lesion was diagnosed by color Doppler ultrasound. CONCLUSION: The suspicion of a vascular lesion after vascular catheterization should immediately lead to color Doppler ultrasound. Noninvasive duplexsonography will lead to early diagnosis of vascular complications and prompt further surgical or conservative intervention with reduction of long-term sequela and morbidity.

Radiological features of the visceral and skeletal involvement of hemochromatosis.

Hemochromatosis is a multisystem disorder produced by the excessive accumulation of iron in visceral organs and the musculoskeletal system. Clinically the disease may be silent, but characteristic radiological features may point to the diagnosis. The increased iron stores in the organs involved, especially in the liver and pancreas, result in an increased attenuation at unenhanced CT and an decreased signal intensity at MR imaging. Hemochromatosis arthropathy includes degenerative osteoarthritis and chondrocalcinosis. The distribution of the arthropathy is distinctive, but not unique, frequently affecting the second and third metacarpophalangeal joints of the hand.

Lead dislodgment of a permanent pacemaker due to removal of a temporary pacing electrode.

A 63-year-old male received a transvenous temporary pacemaker for bradyarrhythmia following mitral valve replacement and tricuspid valve annuloplasty. A transvenous permanent pacemaker was implanted the following day due to persistence of the bradyarrythmia and pacemaker dependency of the patient. Later the same day during removal of the temporary pacing electrode the permanent pacing lead was dislodged and had to be operatively repositioned. To avoid this complication, the position of pacemaker leads should be checked postoperatively with a frontal and lateral chest radiograph, and fluoroscopy should be used during removal of a temporary lead.