Double Bence Jones proteinuria

We have recently observed an unusual case of multiple myeloma with double Bence Jones proteinuria. Immunofixation clearly demonstrated monoclonal light chains of both kappa and lambda type in the urine. By double immunofluorescence staining, 11% of myeloma cells were found to be double producers. The marginal portion of cytoplasmic Russell bodies was stained with anti-lambda, while the core was diffusely stained with anti-kappa. Our results indicated that cells of common clonal origin produced Bence Jones proteins of both kappa and lambda type. No reference is found in the literature to such a finding in double Bence Jones proteinuria. In this article, in addition to the summary of nine cases of double Bence Jones proteinuria, possible explanations for this rare phenomenon are described to give a better understanding of this entity.     

Prognostic significance of occult tumor cells in the apheresis products of patients with advanced breast cancer receiving high-dose chemotherapy and autologous hematopoietic progenitor cell support.

We prospectively evaluated the prognostic significance of occult tumor cells (OTCs) contaminating the peripheral blood progenitor cell apheresis products of patients with advanced breast cancer receiving high-dose chemotherapy. Immunocytochemistry of peripheral blood progenitor cells was performed in 242 patients with high-risk primary breast cancer (HRPBC) and in 111 patients with metastatic breast cancer (MBC). OTCs were detected in 6.6% of HRPBC patients and in 16.2% of MBC patients (P = .005). In HRPBC, OTCs correlated with worse prognostic scores and larger tumor sizes, but not with axillary nodal status, hormone receptors, or HER2. In the MBC group, OTCs correlated with bone marrow involvement and with disease status at transplantation. The number of apheresis procedures was not associated with the risk of contamination. In HRPBC patients, at a median follow-up of 7 years (range, 1.5-11 years), the presence of OTCs correlated with worse event-free survival (P = .007) and overall survival (P = .002). In the MBC group, OTCs correlated with worse event-free survival (P = .04), but not overall survival (P = .2). In multivariate analyses, the presence of OTCs had an independent adverse effect on outcome in HRPBC, but not MBC. Our observations imply a direct role of OTCs in posttransplantation relapse in HRPBC.     

Meal Effects Confound Attempts to Counteract Rabeprazole-Induced Hypochlorhydria Decreases in Atazanavir Absorption

Purpose

Clinically relevant pharmacokinetic interactions exist between gastric acid-reducing agents and certain weakly basic drugs that rely on acidic environments for optimal oral absorption. In this study, we examine whether the administration of betaine hydrochloride under fed conditions can enhance the absorption of atazanavir, an HIV-1 protease inhibitor, during pharmacologically-induced hypochlorhydria.

Methods

In this randomized, single-dose, 3 period, crossover study healthy volunteers received ritonavir-boosted atazanavir (atazanavir/ritonavir 300/100 mg) alone, following pretreatment with the proton pump inhibitor rabeprazole (20 mg twice daily), and with 1500 mg of betaine HCl after rabeprazole pretreatment. Atazanavir was administered with a light meal and gastric pH was monitored using the Heidelberg Capsule.

Results

Pretreatment with rabeprazole resulted in significant reductions in atazanavir C_max (p?<?0.01) and AUC_0-last (p?<?0.001) (71 and 70%, respectively), and modest decreases in ritonavir C_max and AUC_last (p?<?0.01) (40% and 41%, respectively). The addition of betaine HCl restored 13% of ATV C_max and 12% of AUC_last lost due to rabeprazole.

Conclusions

The co-administration of rabeprazole with atazanavir resulted in significant decreases in atazanavir exposure. The addition of betaine HCl did not sufficiently mitigate the loss of ATV exposure observed during RAB-induced hypochlorhydria. Meal effects lead to a marked difference in the outcome of betaine HCl on atazanavir exposure than we previously reported for dasatanib under fasting conditions.

     

Non-contrast transoesophageal echo-guided transapical transcatheter aortic valve replacement: 10-year experience of a renoprotective strategy

Open in a separate window OBJECTIVESThis study aims to evaluate the efficacy, safety and long-term outcomes of a renoprotective non-contrast, transoesophageal echocardiography-guided transapical (TA) transcatheter aortic valve replacement (TAVR) strategy with a balloon-expandable prosthesis, as well as to determine its impact on renal function.METHODSBetween 2009 and 2019, 200 consecutive patients underwent a non-contrast, transoesophageal echocardiography-guided TA TAVR with a balloon-expandable prosthesis.RESULTSThe device success rate was 95.5%. Transoesophageal echocardiography-guided deployment demonstrated a low rate of procedure-related complications: 9.5% of acute kidney injury, 8% postoperative bleeding, 6% low-cardiac output, 4.5% postprocedural aortic regurgitation ≥+2, 4% implantation of permanent pacemaker and 2% stroke. There were no significant differences between preoperative and on discharge estimated glomerular filtration rate (53.9 ± 22.2 vs 54.3 ± 22.9 ml/min/1.73 m², P = 0.60). Logistic regression analysis confirmed postoperative bleeding as an independent predictor for acute kidney injury (odds ratio (OR) 11.148, 95% confidence interval 3.537–35.140, P < 0.001). In-hospital mortality was 7.5%. The mean follow-up was 48.5 ± 39.9 months. Renal function and patient’s chronic kidney disease stage did not significantly vary during follow-up. Long-term cumulative survival at 1, 5 and 10 years was 84.2 ± 0.027%, 42.9 ± 0.038% and 32.5 ± 0.044%, respectively. Renal function affected on neither in-hospital mortality nor long-term survival.CONCLUSIONSNon-contrast, transoesophageal echocardiography-guided TA TAVR is a safe and reproducible technique with a low incidence of periprocedural complications that avoids the use of contrast and mitigates the incidence of acute kidney injury.     

A complex of histamine/mouse γ-globulin preferentially inhibits allergen-induced peritoneal accumulation of eosinophils, but not neutrophils, in mice

A complex of histamine/human γ-globulin (HhG) has been widely used in Japan for more than 25 years as a nonspecific hyposensitization drug in the treatment of allergic diseases. It has been reported that HhG decreases the number of eosinophils in the nasal secretions and peripheral blood of patients with allergy. In this study we used a mouse system to explore the possibility that HhG may actively inhibit the accumulation of eosinophils at inflammation sites. A complex of 0.15 μg of histamine dihydrochloride/12 mg of mouse γ-globulin (HmG) was incubated for 2 hours in saline solution in the normal fashion for HhG. HmG at 50 to 150 mg/kg/day inhibited the peritoneal accumulation of eosinophils induced by ragweed pollen in BALB/c mice in a dose-dependent fashion when the HmG was administered subcutaneously six times during a 20-day sensitization period. The inhibitory effect of HmG on this eosinophil accumulation was significant at 24 and 48 hours after challenge, but HmG had no effect on neutrophil accumulation. Complexes of serotonin/mouse γ-globulin (mγG), glutamine/mγG, and histamine dihydrochloride (His)/mouse albumin had no inhibitory effect when administered in the same way. The optimum combination ratio was between 0.15 μg of His/12 mg of mγG and 0.015 μg of His/12 mg of mγG for this eosinophil inhibition. Moreover, a 1- to 2-hour incubation period of His and mγG was needed to induce a plateau inhibition of the eosinophil accumulation. These results in mice suggest that HhG may actively inhibit allergen-induced eosinophil accumulation, which may be therapeutically useful in the treatment of allergic disease. (J Allergy Clin Immunol 1997;100:809-16.)     

A randomized controlled trial of subcutaneous closed-suction Blake drains for the prevention of incisional surgical site infection after colorectal surgery

Background

The effects of subcutaneous closed-suction Blake drain for preventing incisional surgical site infections (SSIs) after colorectal surgery have never been evaluated in a randomized controlled trial (RCT). Thus, we performed a RCT to evaluate the clinical benefits of using a subcutaneous closed-suction Blake drain in patients undergoing colorectal surgery.

Method

Consecutive patients who underwent colorectal surgery were enrolled in this study. Patients were randomly assigned to the subcutaneous closed-suction drainage arm or the control (no subcutaneous drainage) arm. The primary endpoint was incidence rate of incisional SSIs. And, we performed logistic regression analysis to detect predictive factors for incisional SSIs after colorectal surgery.

Results

From November 2012 to September 2014, a total of 240 patients were enrolled in this study. One-hundred-seventeen patients who were treated by the control arm and 112 patients by the subcutaneous drainage arm were judged to be eligible for analysis. The incidence of incisional SSIs rate was 8.7 % in the overall patients. The incidence of incisional SSIs rate was 12.8 % in the control arm and 4.5 % in the subcutaneous drainage arm. There was significantly reduction of the incidence in the subcutaneous drainage arm than in the control arm (p = 0.025). Logistic regression analysis demonstrated that thickness of subcutaneous fat >3.0 cm, forced expiratory volume in 1 s as percent of forced vital capacity (FEV1.0 %) >70 %, and subcutaneous drain were independent predictors of postoperative incisional SSIs (p = 0.008, p = 0.004, and p = 0.017, respectively).

Conclusion

The results of our RCT suggest that a subcutaneous Blake drain is beneficial for preventing incisional SSIs in patients undergoing colorectal surgery.

     

Efficacy of methotrexate in the treatment of a HLA-B27-positive Japanease patient with reactive arthritis

We report a case of reactive arthritis in a 21-year-old man who was successfully treated with methotrexate. In July 2008, the patient experienced arthritis in the left knee 3 days after being diagnosed as having urethritis by the urology clinic. The patient was treated with loxoprofen sodium and fosfomycin calcium at an orthopedic clinic. Antibiotics induced clinical improvement of urethritis, although arthritis became worse. Even after sulphasalazine and corticosteroid were started, polyarthritis remained persistent. Finally, methtrexate was added ; thereafter, polyarthritis and elevated CRP were resolved. HLA-B270502 was positive. Methotrexate could be one of the choices for sulphasalazine-resistant reactive arthritis.     

The individual replicability of mismatch negativity at short and long inter-stimulus intervals.

OBJECTIVES: The individual replicability of the mismatch negativity (MMN) event-related brain potential (ERP) was studied at two different inter-stimulus intervals (ISIs), to establish its potential value for routine clinical evaluation of sound discrimination and auditory sensory memory. METHODS: Ten healthy young subjects were presented sequences of 3 stimulus trains, in two recording sessions approximately 1 month apart. The stimuli in the trains were delivered at an ISI of 300 ms, whereas the inter-train intervals (ITIs) were 0.4 s and 4.0 s in different blocks. ERPs were averaged to standard (75 ms) and deviant (25 ms) tones started equiprobably the stimulus trains. RESULTS: Significant Pearson product-moment correlations coefficients were found between sessions at all scalp locations for the short ITI, when the MMN was quantified as the mean amplitude in the 100-200 ms latency window around its peak. However, none of the correlations reached significance for the longer ITI. CONCLUSIONS: MMN appears to be a reliable measure for single-case assessment and follow-ups when obtained at short ISIs and quantified as an integrated window of neuroelectric activation over a temporal span.