Two case reports of vinorelbine extravasation: management and review of the literature

Vinorelbine tartrate (Navelbine, Burroughs Wellcome Company, Research Triangle Park, NC, USA) is a semisynthetic vinca alkaloid approved in many countries for the first-line treatment of patients with advanced non-small-cell lung cancer. It is also used in the treatment of advanced breast and ovarian cancers and lymphoma. Like other vinca alkaloids, Navelbine can cause skin necrosis as a consequence of inadvertent extravasation in surrounding tissues during intravenous administration. In such cases, early treatment is strongly advocated. There is no documented case of vinorelbine extravasation in the literature. The authors herein report two cases successfully treated with hyaluronidase injections plus saline flushout under local anesthesia.     

Dialysis Treatment Using an Ethylene Vinyl Alcohol Membrane and No Anticoagulation for Chronic Uremic Patients

Abstract: Anticoagulation used in hemodialysis treatment brings with it the risk of hemorrhagic complications and the possible consequences associated with chronic heparin administration. These problems have not been satisfactorily addressed to date. This study examined a new dialysis method that does not require the administration of anticoagulants. Dialysis is performed for 3 h with a continuous infusion of 750 ml of physiological saline solution in predilution mode and using filters made of ethylene vinyl alcohol copolymer membranes. Eleven patients with chronic uremia underwent more than 2,000 dialysis treatments performed with 9 episodes of coagulation of the dialyzer or blood tubings (0.43%). An evaluation of individual treatments revealed a high degree of biocompatibility and only a scanty activation of coagulation. Blood depuration efficacy was very good as evaluated from pretreatment and posttreatment routine blood chemistries. The technique described here represents a simple and effective method for performing regular dialysis treatment and does not require anticoagulant therapy.     

Low-dose cholinesterase inhibitors do not induce delayed effects on cerebral blood flow and metabolism

The acetylcholinesterase (AChE) inhibitors sarin and pyridostigmine bromide (PB) have been proposed as causes of neurobehavioral dysfunction in Persian Gulf War veterans. To test possible delayed effects of these agents, we exposed rats to low (subsymptomatic) levels of sarin (0.5 LD₅₀ s.c. 3 times weekly) and/or PB (80 mg/L in drinking water) for 3 weeks. Controls received saline s.c. and tap water. At 2, 4 and 16 weeks after exposure, regional cerebral blood flow (rCBF) and glucose utilization (rCGU) were measured in conscious animals with the Iodo-¹⁴C-antipyrine and ¹⁴C-2 deoxyglucose methods, respectively.

Two weeks after exposure, PB+sarin caused significant rCBF elevations, but no changes in rCGU, in neocortex, with lesser effects on allocortex. Four weeks after exposure, the same general pattern was found with sarin. Only a few changes were found at 16 weeks post-treatment. The predominant effects of sarin or PB+sarin on rCBF at earlier times after treatment are consistent with the well known direct cerebral vascular effect of cholinergic agonists. The lack of changes in rCBF and rCGU observed at 16 weeks after treatment does not support the hypothesis that repeat exposure to low-dose cholinesterase inhibitors can generate permanent alterations in cerebral activity.     

Prevalence of chronic kidney disease in an urban Mexican population

BACKGROUND: The present study was primarily designed to assess the prevalence of chronic kidney disease in a Mexican urban population residing in Mexico and to evaluate certain biologic and socioeconomic conditions as risk factors for the development of renal disease. METHODS: A population-based cross-sectional survey was conducted, which included 3564 patients of either gender aged >18 years, who were randomly selected from lists of patients assigned to primary care facilities in the city of Morelia. A questionnaire about personal current health status, kidney disease, diabetes, hypertension, or heart disease in close relatives, anthropometric and blood pressure measurements, and blood and urine samples to measure glucose, blood urea nitrogen, and creatinine was obtained for each patient. Creatinine clearance (Ccr) was calculated by the Cockcroft-Gault formula. Patients were classified in 1 of the 5 Ccr categories established by the Kidney Disease Outcomes Quality Initiative guidelines. RESULTS: The prevalence rate of Ccr < 15 mL/min was 1142 per million population, and that of Ccr <60 mL/min 80,788 per million population. Alcohol and tobacco consumption, female gender, age >65 years, educational level < primary school, and income < US $4.00/day were significantly associated with reduced Ccr. CONCLUSION: Chronic kidney disease prevalence in this population is similar to that seen in industrialized countries. If these figures are similar to those of the entire Mexican population, only l out of 4 patients requiring renal replacement therapy in the country currently has access to it.     

Efficacy of a pediatric emergency department-based influenza vaccination program

BACKGROUND: Influenza vaccination effectively reduces influenza-related morbidity in children but is underused. The pediatric emergency department is a potential intervention point for increasing influenza vaccination in children. OBJECTIVE: To assess the effectiveness of a pediatric emergency department-based influenza vaccination program. DESIGN: A prospective, randomized, controlled clinical trial. PARTICIPANTS: We recruited subjects from persons seeking pediatric emergency care at a large tertiary care hospital during influenza vaccination season in 2002. Eligible subjects were themselves or had a household member at increased risk for influenza complications, according to Advisory Committee on Immunization Practices guidelines. INTERVENTIONS: We randomly assigned subjects by family to the "vaccine offered" group or the "education only" group. We educated both groups about influenza illness, the risks and benefits of influenza vaccination, and how to receive influenza vaccination outside the study. We offered influenza vaccination to the "vaccine offered" group and later obtained telephone reports of the postinfluenza-season vaccination status of both groups. RESULTS: Four hundred thirty-seven subjects completed the study (238 from the "vaccine offered" group, 199 from the "education only" group). At follow-up, the percentage of influenza-vaccinated subjects in the "vaccine offered" group was greater than in the "education only" group. This was true for pediatric patients (57% vs 36%) (relative risk, 1.59; 95% confidence interval, 1.16-2.16) as well as for their accompanying adult and child family members (75% vs 34%) (relative risk, 2.19; 95% confidence interval, 1.64-2.92). CONCLUSION: A pediatric emergency department-based influenza vaccination program increases vaccination of targeted children and family members who use the emergency department during influenza vaccination season.     

The month-of-birth pattern in narcolepsy is moderated by cataplexy severity and may be independent of HLA-DQB1*0602

OBJECTIVES: A March peak and a September trough in the birth pattern of narcolepsy patients with clear-cut cataplexy was recently reported. The objectives of the present study were to determine whether the month-of-birth pattern would (a) vary with the presence and severity of cataplexy and (b) differ for patients positive and negative for HLA-DQB1*0602. DESIGN: Cross-sectional survey with data obtained from the clinical trials assessing the safety and efficacy of modafinil in the treatment of narcolepsy. SETTING: Sleep clinics throughout the United States. PATIENTS: A group of 530 narcolepsy patients diagnosed based on the International Classification of Sleep Disorders using clinical histories, nocturnal polysomnography, and Multiple Sleep Latency Tests. INTERVENTIONS: NA. MEASUREMENTS AND RESULTS: A surplus of March births and a fall-off in September births was found in narcolepsy relative to the general population. This finding was only observed when cataplexy was moderate or severe. The month-of-birth pattern was similar for HLA-DQB1*0602 positive and negative patients. A March birth and HLA-DQB1*0602 positivity were independent risk factors in a logistic regression analysis. CONCLUSIONS: Environmental events during development may influence narcolepsy severity or the likelihood of developing the disease.