Modifying chemotherapeutic management of a patient with Burkitt's lymphoma and pre-existing motor neurone disease.

WHAT IS KNOWN AND OBJECTIVE: Intensive chemotherapy for treatment of Burkitt's lymphoma (BL) - a high-grade lymphoproliferative disorder (LPD) - can cause neurotoxicity. An association between motor neurone disease (MND) and LPDs has previously been described, but there is a lack of recommendations available to guide management of such patients. This report aims to describe suitable management of BL in a patient with MND. CASE DESCRIPTION: A 66-year-old woman with a history of MND affecting her limbs was diagnosed with bulky, extranodal, high-risk gastric BL. Standard chemotherapy is with multiple non-cross-resistant cytotoxic agents. To avoid exacerbation of neuropathy, six cycles of a modified regimen was planned, aiming to minimize exposure to the most neurotoxic agents. A PET-FDG-negative remission was obtained at 12 months, without the signs of central neurotoxicity, peripheral neuropathy or muscle weakness. WHAT IS NEW AND CONCLUSION: High-intensity chemotherapy, minimizing known neurotoxic agents, was delivered safely and effectively in a patient with BL and pre-existing MND. More case descriptions are required to guide management decisions.

Estimation of body weight in hospitalized patients.

AIM: To examine the bias and precision of different methods of estimating body mass and height in hospitalized adult patients. METHODS: Patients were enrolled at the Alfred and Caulfield hospitals, Melbourne, Australia following verbal consent. Estimates were made using the Lorenz formula (that utilizes height, waist and hip circumference), the Crandell formula (that utilizes height and arm circumference) and visual estimation of weight based on the average results obtained by two pharmacy interns. Statistical error was calculated as the ratio of estimated to actual weight; bias was assessed as the mean error and precision as the proportion of estimates within 10 and 20% of measured weight and standard deviation of the error. RESULTS: In a 5-week period July to August 2010, 198 patients were enrolled. The median age was 64 years (range 19-91) and 52% were female. Thirty-four (17%) patients were obese (BMI >30 kg/m(2)) and 8 (4%) were underweight (BMI <18 kg/m(2)). With the Lorenz formula an estimate within 10% was obtained for 56% of patients; with the Crandell formula prediction was poor. Documentation of body weight in notes and patient self-reporting were both accurate. Seventy-two patients (43%) were prescribed one or more drugs for which dosing potentially should be adjusted for body weight. CONCLUSION: In adult hospitalized patients, the estimation of body weight by anthropomorphic measures is not accurate. This supports the need for equipment to be made widely available to accurately weigh patients directly in hospital, including in unconscious and immobile patients.

Roxithromycin-induced digoxin toxicity.

A 76-year-old women presented with digoxin toxicity four days after starting a course of roxithromycin. In 10%-15% of the population, digoxin is degraded extensively by bacteria in the gastrointestinal tract, and antibiotic-induced changes in the bacterial flora may lead to digoxin toxicity.