Famotidine in the treatment of acute urticaria

Recent studies suggest that histamine H2-receptor antagonists may be useful in the treatment of urticaria. This study was conducted to determine whether famotidine, a H2 antagonist, is effective in the treatment of acute urticaria and compare its effect with that of the H1 antagonist diphenhydramine. In this prospective, double-blind, controlled trial, 25 patients with urticaria of less than 72 h duration were randomized to receive a single dose of either famotidine 20 mg i.m. or diphenhydramine 50 mg i.m. Prior to treatment and 30 min after treatment, patients rated pruritus and sedation using visual analogue scales, while physicians evaluated intensity of urticaria and percentage of body surface area involved by urticaria. Famotidine was found to reduce pruritus associated with acute urticaria, intensity of urticaria, and body surface area affected by urticaria without causing sedation. Famotidine was comparable to diphenhydramine in efficacy; however, there was a (nonsignificant) trend for diphenhydramine to be more effective than famotidine in the treatment of pruritus, and for famotidine to be more effective in the reduction of surface area of involvement. It is concluded that famotidine merits further investigation as a potential medication for treatment of urticaria.     

Surgery for Recurrent Ovarian Cancer: Role of Peritoneal Carcinomatosis: Exploratory Analysis of the DESKTOP I Trial About Risk Factors, Surgical Implications, and Prognostic Value of Peritoneal Carcinomatosis

Background  Almost all retrospective trials pointed out that a benefit of surgery for recurrent ovarian cancer may be limited to patients in whom a macroscopic complete resection could be achieved. Peritoneal carcinomatosis has been reported to be either a negative predictor for resectability or a negative prognostic factor, or both. The role of peritoneal carcinomatosis in a multicenter trial was investigated. Methods  Exploratory analysis of the DESKTOP I trial (multicenter trial of patients undergoing surgery for recurrent ovarian cancer, 2000 to 2003). Results  A total of 125 patients (50%) who underwent surgery for recurrent ovarian cancer had peritoneal carcinomatosis. Univariate analyses showed worse overall survival for patients with peritoneal carcinomatosis compared with patients without carcinomatosis (P < .0001). Patients with and without peritoneal carcinomatosis had a complete resection rate of 26% and 74%, respectively (P < .0001). This corresponded with the observation that patients with complete resection had a better prognosis than those with minimal residual disease of 1 to 5 mm, which commonly reflects peritoneal carcinomatosis (P = .0002). However, patients who underwent complete resection, despite peritoneal carcinomatosis, had a 2-year survival rate of 77%, which was similar to the 2-year survival rate of patients with completely debulked disease who did not have peritoneal carcinomatosis (81%) (P = .96). Analysis of prognostic factors did not show any independent effect of peritoneal carcinomatosis on survival in patients who underwent complete resection. Conclusions  Peritoneal carcinomatosis was a negative predictor for complete resection but had no effect on prognosis if complete resection could be achieved. Improving surgical skills might be one step to increase the proportion of patients who might benefit from surgery for recurrent disease.     

Successful treatment with etoposide phosphate in patients with previous etoposide hypersensitivity.

OBJECTIVE: To review the experience of treatment with etoposide phosphate in patients with acute etoposide hypersensitivity treated in a large tertiary referral center hospital specializing in curable malignancies. CASE SUMMARIES: The cases of 6 patients with advanced malignancies who experienced acute etoposide hypersensitivity are documented. There were 3 male and 3 female patients and their ages ranged from 16 to 68. Four patients had curable malignancies with trophoblast tumors or germ cell tumors and two were receiving palliative chemotherapy for other malignancies. All of the 6 patients who experienced etoposide hypersensitivity developed their symptoms in the first few minutes of the initial infusion. The most common symptoms were chest pain, facial flushing, and bronchospasm. All of the patients had emergency treatment with discontinuation of the infusion and usually the administration of hydrocortisone and chlorpheniramine, which lead to the rapid resolution of their symptoms.For the next cycle of chemotherapy each patient was rechallenged with etoposide phosphate, with steroid cover given in only two of the cases. None of the 6 patients experienced any hypersensitivity symptoms on treatment with etoposide phosphate and in one the steroids were withdrawn for all the subsequent cycles. The 4 patients with curable malignancies all remain disease free, while the 2 palliative patients obtained significant control of their disease. DISCUSSION: Etoposide is one of the most important chemotherapy drugs in the treatment of many curable malignancies but an acute hypersensitivity reaction occurs in around 1% of patients. Retreatment with etoposide in these patients is difficult and generally alternative drugs/regimens have to be used. A small number of case reports have suggested that etoposide phosphate can be safely used in these patients and 6 cases have been found in the pharmacy records where this has been done. In all of the patients, treatment with etoposide phosphate proceeded without any symptoms or the use of repeated steroid cover in 5 of the 6 patients. CONCLUSION: Etoposide hypersensitivity is a rare clinical problem and responds promptly to drug discontinuation, steroids, and chlorpheniramine. Patients with previous etoposide hypersensitivity can safely be treated with etoposide phosphate and do not need any additional hypersensitivity prophylaxis.     

Die juvenile myoklonische Epilepsie wird häufig inadäquat behandelt

Zusammenfassung Die juvenile myoklonische Epilepsie (JME) ist ein h?ufiges, durch generalisierte myoklonische Anf?lle gut definiertes Epilepsie-Syndrom. Trotz der typischen Symptome und EEG-Ver?nderungen wird die juvenile myoklonische Epilepsie zu selten diagnostiziert und infolgedessen h?ufig mit inad?quaten Antiepileptika (AE), Natriumkanal-Blockern wie Carbamazepin, Oxcarbazepin und Phenytoin behandelt. Wir haben retrospektiv die Behandlung von 175 JME-Patienten unserer Epilepsieambulanz analysiert. Bei Erstvorstellung in unserer Spezialambulanz wurden 24% (42 von 175) der Patienten mit Natriumkanal-blockierenden AE behandelt, worunter nur ein Patient anfallsfrei war. Nach Umstellung auf zumeist Valproat und Lamotrigin wurden 42% dieser Patienten anfallsfrei. Diese Zahlen betonen die Wichtigkeit der Syndrom-Diagnose und einer ad?quaten AE-Wahl in der Behandlung der JME.      

A randomized study of the efficacy of adjuvant local graft irradiation following renal transplantation

A prospective randomized study investigating the effectiveness of adjuvant local graft irradiation (LGI) following renal transplantation was performed at Georgetown University Hospital from 1983 until 1988. One hundred and thirty-eight patients were enrolled in the study with 117 patients receiving cadaver kidney transplantations and 21 patients receiving living related kidney transplantations. Seventy-one patients were randomized to receive adjuvant local graft irradiation consisting of 600 cGy in four fractions with chemical immunosuppression whereas the remaining 67 patients received chemical immunosuppression only (control group). The two groups were comparable at entry with respect to potentially important prognostic variables. Median follow-up for all patients was 30 months. The 3-year actuarial allograft success rate was 75% and 68% for the local graft irradiation and control groups, respectively. A nonsignificant trend favoring the irradiated group was noted. Subgroup analysis of the 21 recipients of kidneys from living related donors suggested an improvement in allograft survival for the local graft irradiation arm. Cadaver allograft survival was not significantly different between the two treatment arms. There was no apparent benefit in kidney function or time to the first rejection episode in the group receiving local graft irradiation.     

Overview of the Sixth International Symposium on Hodgkin's disease – recent advances in basic and clinical trials

Abstract:  The Sixth International Symposium on Hodgkin's disease was held in Cologne, Germany, between September 18 and 21, 2004, organized by the German Hodgkin Study Group (GHSG) and chaired by Volker Diehl. Since 1987 the international symposia were held at regular intervals in Cologne with the aim to facilitate international cooperation and to bring together new scientific and clinical results reached in the field of Hodgkin's disease. The expanding number of participants from about 300 attendees at the first symposium to almost 800 from 48 countries at the Sixth International Symposium indicates the increasing importance of this meeting. For the second time a patient seminar with more than 350 attendees has been organized. This sixth meeting was going to be unique, since the GHSG celebrated its 25th anniversary and honored Volker Diehl, the group's founder in recognition of his work during more than 25 yr. The symposium was held at the University of Cologne's main building, creating a special, scientific and familiar atmosphere. Throughout the symposia carried out by the GHSG, preclinical and clinical several topics have always been of basic interest and have provided a basis for discussion and scientific exchange.     

The age of second language acquisition determines the variability in activation elicited by narration in three languages in Broca’s and Wernicke’s area

It is generally accepted that the presence of a second language (L2) has an impact on the neuronal substrates build up and used for language processing; the influence of the age of L2 exposure, however, is not established. We tested the hypothesis that the age of L2 acquisition has an effect on the cortical representation of a multilingual repertoire in 44 multilinguals with different age of exposure to a L2 (simultaneous or covert simultaneous exposure to L1 and L2, sequential acquisition of L1 and L2 between 1 and 5 years, late learning of L2 after 9 years of age) and all fluent in a late learned L3. Regional activation in a language production task showed a high in-between-subject variability, which was higher than within-subject variability between L1, L2, and L3. We, therefore, performed a single subject analysis and calculated the within-subject variance in the numbers of activated voxels in Broca’s and Wernicke’s area. Subjects with early exposure to L2 showed low variability in brain activation in all three languages, in the two early as well as the late learned language. In contrast, late multilinguals exhibited higher variability. Thus, cerebral representation of languages is linked to the age of L2 acquisition: early exposure to more than one language gives rise to a language processing network that is activated homogeneously by early and late learned languages, while the inhomogeneous activation in late multilinguals indicates more independent access to the multilingual repertoire. Early passive exposure to L2 results in the same low variance as active bilingual upbringing. Variability in local brain activity increases progressively from the simultaneous to late L2 exposure, indicating a gradual transition from the mode of early bilingual language representation to that of late ones.