Intralesional anti-CD20 antibody for low-grade primary cutaneous B-cell lymphoma: Adverse reactions correlate with favorable clinical outcome.

BACKGROUND AND OBJECTIVES: Intralesional injection of anti-CD20 antibody (rituximab) has been described as effective therapeutic option for patients with indolent primary cutaneous B-cell lymphoma (PCBL). To date, no parameters that reproducibly predict favorable clinical outcome of this treatment have been identified. The study aims to evaluate the clinical response and adverse effects as well as patients' self-perception of intralesional injection of anti-CD20 antibody for treatment of indolent PCBL compared to other treatment modalities. PATIENTS AND METHODS: Eleven patients with PCBL, namely primary cutaneous follicle center lymphoma (n = 9) and primary cutaneous marginal zone lymphoma (n = 2), treated with intralesional anti-CD20 antibody were retrospectively evaluated for response rate and adverse events as well as their self-perception of anti-CD20 antibody therapy and other therapies of PCBL. RESULTS: Patients treated with intralesional anti-CD20 antibody for PCBL showed complete response or partial response in 45 % or 27 % of patients, respectively. Particularly, patients with marked flu-like symptoms after intralesional injection of rituximab responded very well to rituximab. The majority of patients considered rituximab as best therapy compared to other therapies such as excision or radiotherapy. CONCLUSIONS: Intralesional rituximab is an effective therapy with high patient satisfaction. Strong therapy induced side effects of fever, chills and headache after administration of rituximab might be used as indicator for favorable response.

Comparación de la eficacia de dexmedetomidina, meperidina y ketamina en la prevención de escalofrío postoperatorio / Comparison of the effectiveness of dexmedetomidine, meperidine and ketamine in the prevention of postoperative shivering

Objetivo. Comparar la eficacia de la dexmedetomidina, meperidina y ketamina profiláctica en el tratamiento del temblor postoperatorio. Materiales y métodos. Ensayo clínico, aleatorizado, controlado y de doble ciego. El estudio incluyó 160 pacientes (ASA I-II) bajo anestesia general mayor a 1h de duración. Se asignaron aleatoriamente a 4 grupos para recibir dosis única intravenosa: dexmedetomidina 1μg/kg (grupo A, n=33), meperidina 0,4mg/kg (grupo B, n=38), ketamina 0,5mg/kg (grupoC, n=40), o solución salina 0,9% (grupo D, n=45), administrados 20min antes de la sutura de piel. Para evitar sesgos, se estandarizó la técnica de inducción y mantenimiento anestésico así como el seguimiento postoperatorio. Resultados. Para cualquier grado de escalofrío, la mayor incidencia se presentó en el grupo placebo (47%) (p<0,01). La mayor incidencia para escalofrío (grados 3 y 4) se presentó en el grupo placebo (22 y 18% respectivamente). Para los grados 3 y 4 en todos los momentos de seguimiento no se presentó ningún caso de escalofrío en el grupo de meperidina (p<0,01). El grupo placebo (38%) fue el que mayor proporción de pacientes requirió tratamiento de rescate para escalofrío postoperatorio (p<0,01). Conclusión. La meperidina en dosis única de 0,4mg/kg intravenosa es una medida útil para la prevención del escalofrío postoperatorio (AU)

Objective. To compare the prophylactic effectiveness of dexmedetomidine, meperidine, and ketamine for postoperative shivering. Materials and methods. A randomized, controlled, double-blind, clinical trial, including 160 patients (ASA I - II) undergoing surgical procedures under general anaesthesia for longer than one hour. They were randomly assigned to four groups to receive a single intravenous dose: Dexmedetomidine 1ug/kg (group A, n=33), meperidine 0.4mg/kg (group B, n=38), ketamine 0.5mg/kg (groupC, n=40), or 0.9% saline solution (group D, n=45), administered 20min before the skin suture. To avoid bias, the anaesthetic induction and maintenance technique, as well as postoperative follow-up was standardised. Results. For any level of shivering, the greatest incidence was observed in the placebo group (47%) (P<.01). The greatest effect on shivering level 3 and 4 occurred in the placebo group (22% and 18%, respectively). For levels 3 and 4 during follow-up, there was not a single case of shivering at any time in the meperidine group (P<.01). The placebo group (38%) had the highest proportion of patients requiring treatment for post-operative shivering (P<.01). Conclusion. Meperidine given intravenously in a single dose of 0.4mg/kg is a useful means for preventing postoperative shivering (AU)

Spectrum of intradialytic complications during hemodialysis and its management: a single-center experience.

Hemodialysis (HD) is one of the important modalities of renal replacement therapy in acute renal failure (ARF) as well as chronic renal failure (CRF). This study was performed to evaluate the various intradialytic complications that occur during HD and their management. This is a retrospective study performed in patients who underwent conventional HD during the period of 1 January 2000 to 31 December 2011 at our center. Clinical details, various complications faced and their management were retrieved from dialysis case sheets. A total of 2325 patients of renal failure (790 ARF and 1535 CRF patients) were assessed for the intradialytic complications of HD. During the study period, there were 12,785 bicarbonate dialyses performed on these patients. In the ARF patients, the common intradialytic complications were: Hypotension, seen in 1296 sessions (30.4%), nausea and vomiting seen in 1125 sessions (26.4%), fever and chills seen in 818 sessions (19.2%), headache seen in 665 sessions (15.6%), cramps seen in 85 sessions (2.0%), chest pain and back pain seen in 82 sessions (1.92%), hypoglycemia seen in 77 sessions (1.8%), first-use syndrome seen in 72 sessions (1.7%) and femoral hematoma seen in 31 sessions (0.73%). In the CRF group, common complications were hypotension in 2230 sessions (26.1%), nausea and vomiting in 1211 sessions (14.2%), fever and chills in 1228 sessions (14.4%), chest pain and back pain in 1108 cases (13.0%), hypertension in 886 sessions (10.4%), headache in 886 sessions (10.4%), cramps in 256 sessions (3.0%), hematoma in 55 sessions (0.64%), intracerebral hemorrhage in three sessions (0.03%) and catheter tip migration in three sessions (0.03%). There is a need for special attention for the diagnosis and management of intradialytic complications of HD because such complications could be managed successfully without the need for termination of the dialysis procedure.

Termorregulación y manejo perioperatorio / No disponible

El desarrollo de una hipotermia perioperatoria, generalmente moderada (34-35 °C), es frecuente si no se toman las medidas adecuadas para su prevención y tratamiento. La temperatura corporal de los pacientes puede descender de 1 a 1,5 °C durante la primera hora de anestesia general por efecto de la redistribución interna del calor. La aparición, en torno a los 34,5 °C, de la vasoconstricción termorreguladora, explica la estabilización posterior de la temperatura central. Los mismos mecanismos explican la hipotermia bajo anestesia raquídea. Las consecuencias de la hipotermia son bien conocidas: vasoconstricción periférica, incremento de los requerimientos de oxígeno, descenso del metabolismo de fármacos, alteraciones de la coagulación, deterioro de la respuesta inmunológica eisquemia miocárdica. Todo ello se traduce en un aumento de los eventos cardiológicos, infecciones de la herida quirúrgica, incremento de la pérdida de sangre y, por tanto, mayor riesgo trasfusional y retraso en el alta de los pacientes de la unidad de recuperación posanestésica. La monitorización de la temperatura durante la intervención quirúrgica es importante para detectar y limitar las complicaciones derivadas de la hipotermia y comprobar la eficacia de los sistemas de calentamiento. El precalentamiento de los pacientes con sistemas de aire forzado en la sala de espera pre quirúrgica ha demostrado reducir la redistribución del calor tras la inducción anestésica. El aislamiento pasivo reduce las pérdidas de calor pero la mayoría de pacientes precisan un calentamiento activo con aire forzado o mantas eléctricas para mantener la normotermia. Se recomienda calentar los fluidos cuando se van a administrar en grandes cantidades y como complemento al calentamiento corporal activob (AU)

The development of perioperative hypothermia, generally mildhypothermia (34-35 °C), is common if appropiate actions in prevention and treatment are not taken. Patients’ body temperature can decrease 1 to 1.5 °C during the first hour of general anaesthesia because of the internal redistribution of body heat. The appearance of thermoregulatory vasoconstriction when temperature is near 34.5 °C explains the stabilization of core temperature. The same mechanisms explains hypothermia under regional anaesthesia. The consequences of hypothermia are well known: periferal vasoconstriction, increase in oxygen requirements, abnormal drug metabolism, deranged coagulation, deteriorated inmune function and myocardial ischemia. In consequence, there is an increase incardiac events, surgical-wound infections, blood loss and highertransfusional requirements and prolongs the postoperative recovery period. The monitorization of temperature during surgical interventionis important to detect and diminish the complications of hypothermia and to verify the efficacy of warming systems. Warming patients with forced-air warming systems in a presurgical waiting room has demostrated to reduce the redistribution of heat after anaesthetic induction. Most of the patients require an active warming process with forced-air warming or electric blanket to maintainnormothermia. Fluid warming combined with active warming are recomended when high amounts of liquids are needed (AU)

Intravenous corticosteroids to reduce gemtuzumab ozogamicin infusion reactions.

OBJECTIVE: To assess whether the addition of a brief course of intravenous corticosteroids reduces the incidence of infusion-related adverse events associated with gemtuzumab ozogamicin (GO) administration. METHODS: One hundred forty-three sequential patients received GO-based therapy for refractory myeloid leukemias: 110 patients received the standard regimen of acetaminophen 650 mg orally with diphenhydramine 50 mg intravenously and 33 patients received the same premedications with methylprednisolone sodium succinate 50 mg intravenous piggyback (IVPB) prior to infusion and repeated 1 hour into the infusion. RESULTS: Of 110 patients who received GO with standard premedications alone, 32 (29%) had grade 2 or above infusion-related adverse events. In 33 patients who received these premedications with methylprednisolone 50 mg IVPB prior to infusion and repeated 1 hour into the infusion, only 1 (3%) experienced any infusion-related adverse events (p = 0.0009, 95% CI 0.16 to 0.36). There was no significant difference between the patient cohorts in terms of hepatotoxicity, rate of development of hepatic venoocclusive disease, response rates, or infectious complications. CONCLUSIONS: A brief course of intravenous corticosteroids significantly reduces the incidence of GO infusion-related adverse events.

[Incidence of postoperative shivering in relation to the time of sevoflurane discontinuation]. / Incidencia de escalofríos postquirúrgicos en relación al tiempo de suspensión del sevoflurano.

OBJECTIVES: We aimed to determine whether early termination of sevoflurane administration lowers the incidence of postanesthetic shivering. MATERIAL AND METHODS: Eighty ASA I-III patients were randomized to two groups of 40 (Group A and Group B). All were premedicated with oral bromazepam. Fentanyl (2 micrograms/Kg), propofol (2.5 mg/Kg) and atracurium (0.5 mg/Kg) were used for induction. Anesthesia was maintained with sevoflurane in 60% N2O in oxygen at 1 maximum alveolar concentration, with boluses of fentanyl and atracurium on demand. Sevoflurane administration was terminated 30 minutes before awakening in group A and 10 minutes before awakening in group B. After termination, 60% N2O in oxygen was used in both groups. Mean blood pressure, heart rate and peripheral and core temperatures were measured at 5 minutes intervals during surgery. Postoperative shivering was recorded until one hour after awakening. RESULTS: Patient characteristics and duration of anesthesia were similar in both groups. The incidence of shivering was significantly lower in group A (4%) than in group B (57%). No significant differences were observed in other variables. CONCLUSIONS: The important observation in this study was that the incidence of postoperative shivering in group A was lower than in group B and lower than the incidences reported in other similar studies.

6-Methylprednisolone does not impair anti-thymocyte globulin (ATG) immunosuppressive activity in non-human primates.

BACKGROUND: Induction treatments with anti-thymocyte globulin (ATG) in solid organ transplantation may enhance the efficacy of maintenance immunosuppressive therapy. Since ATG can trigger Fas (CD95) mediated T cell apoptosis, a process antagonized in vitro by corticosteroids, an important issue is whether corticosteroids could interfere with T cell depleting and immunosuppressive activities of ATG. METHODS: MHC mismatched skin allografts were performed on cynomolgus and rhesus monkeys treated with ATG (20 mg/kg) associated or not with 6-methylprednisolone (10 mg/kg). RESULTS: There was no difference between the two immunosuppressive regimens as regards the intensity and duration of peripheral T lymphocyte depletion and the appearance of anti-ATG antibodies. Skin graft survival was increased in monkeys treated with 6-methylprednisolone as compared with ATG alone. CONCLUSIONS: In vivo, corticosteroids do not interfere with ATG ability to induce massive T cell depletion and to delay skin allograft rejection in non-human primates.