Complications associated with the use of Port‐a‐Caths in patients with malignant or haematological disease: a single‐centre prospective analysis

HEIBL C., TROMMET V., BURGSTALLER S., MAYRBAEURL B., BALDINGER C., KOPLMÜLLER R., KÜHR T., WIMMER L. & THALER J. (2010) European Journal of Cancer Care 19 , 676–681 Complications associated with the use of Port‐a‐Caths in patients with malignant or haematological disease: a single‐centre prospective analysis Totally implantable central venous catheters are widely used in the management of patients with haematological or malignant disease. This paper investigates device‐related complications and compares it with the literature. A total of 143 Port‐a‐Caths (PaCs) were implanted in 140 patients at a single centre during 2004 and followed until March 2005. Indication for implantation was mainly administration of chemotherapy. High standards of care were applied through intensive training of staff. Complications were registered prospectively and cross‐checked with the medical records at the end of the observational period. The ports were in place for a total of 29 107 days (mean 204, range 3–443 days per port). A total of 25 complications were recorded. These included 13 infections [9.1% with 5 cutaneous (3.5%) and 8 systemic (5.6%) infections], one deep vein thrombosis (0.7%). In 6 patients (4.2%) the device had to be removed because of complications. No device‐related death was observed. The use of totally implantable central venous catheters for treating haemoto‐oncological patients is safe. The need for device removal due to complications was particularly low in this analysis as compared with the literature.     

Comparative Assessment of the Efficacy and Safety of Sertaconazole (2%) Cream Versus Terbinafine Cream (1%) Versus Luliconazole (1%) Cream In Patients with Dermatophytoses: A Pilot Study

Background:

Sertaconazole is a new, broad spectrum, fungicidal and fungistatic imidazole with added antipruritic and anti-inflammatory activity that would provide greater symptomatic relief and hence would be beneficial in improving the quality of life for the patient with dermatophytoses.

Aims and Objectives:

To compare efficacy and safety of sertaconazole, terbinafine and luliconazole in patients with dermatophytoses.

Materials and Methods:

83 patients with tinea corporis and tinea cruris infections were enrolled in this multicentre, randomized, open label parallel study. The initial ‘Treatment Phase’ involved three groups receiving either sertaconazole 2% cream applied topically twice daily for four weeks, terbinafine 1% cream once daily for two weeks, luliconazole 1% cream once daily for two weeks. At the end of treatment phase, there was a ‘Follow-up Phase’ at end of 2 weeks, where the patients were assessed clinically and mycologically for relapse.

Results:

Of the 83 patients, 62 completed the study, sertaconazole (n = 20), terbinafine (n = 22) and luliconazole (n = 20). The primary efficacy variables including change in pruritus, erythema, vesicle, desquamation and mycological cure were significantly improved in all the three groups, as compared to baseline, in the Treatment and Follow-up phase. Greater proportion of patients in sertaconazole group (85%) showed resolution of pruritus as compared to terbinafine (54.6%); and luliconazole (70%), (P < 0.05 sertaconazole vs terbinafine). There was a greater reduction in mean total composite score (pruritus, erythema, vesicle and desquamation) in sertaconazole group (97.1%) as compared to terbinafine (91.2%) and luliconazole (92.9%). All groups showed equal negative mycological assessment without any relapses. All three study drugs were well tolerated. Only one patient in sertaconazole group withdrew from the study due to suspected allergic contact dermatitis.

Conclusion:

Sertaconazole was better than terbinafine and luliconazole in relieving signs and symptoms during study and follow up period. At the end of ‘Treatment Phase’ and ‘Follow-up’ Phase, all patients showed negative mycological assessment in all three treatment groups suggesting no recurrence of the disease.     

Use, function, and subjective experiences of gamma-hydroxybutyrate (GHB)

Self-reported use of gamma-hydroxybutyrate (GHB) among clubbers has increased over the last decade, and is often reported in the scientific literature in association with negative events such as amnesia, overdose, and use in drug facilitated sexual assault. However, there has been relatively little work investigating the phenomenology of GHB intoxication, and the reasons underlying use. In this study, 189 individuals reporting at least one lifetime use of GHB completed an online questionnaire recording GHB use behaviours, GHB use function, and subjective GHB effects. The most frequently reported primary GHB use functions were for recreation (but not in nightclubs) (18.3%); to enhance sex (18.3%); to be sociable (13.1%); and to explore altered states of consciousness (13.1%). GHB was more commonly used within the home (67%) compared to nightlife environments (26.1%) such as clubs, although this differed on the basis of respondent's sexuality. Principle components analysis of GHB user responses to the subjective questionnaire revealed six components: general intoxication effects, positive intoxication effects, negative intoxication effects, negative physiological effects, positive sexual effects and negative sexual effects. Component scores predicted function of use.     

Pompe's Disease in Childhood: A Metabolic Myopathy

Background

Myopathy of metabolic origin in childhood occurs due to a variety of conditions. Pompe''s Disease also known as Glycogen storage disease Type II, is a rare storage disorder with clinical presentation akin to spinal muscular atrophy.

Methods

A series of patients with suspected metabolic myopathy were reviewed at a tertiary care service hospital over a period of three years. The diagnosis was confirmed by estimation of acid alpha glucosidase activity.

Result

At our centre, these cases presented with generalized hypotonia, organomegaly (hepatomegaly, cardiomegaly) and congestive cardiac failure. Infantile onset, the most severe form of Pompe''s disease, was the commonest form accounting for 75% of the cases. Four of the babies with infantile onset Pompe''s disease expired, three due to refractory heart failure and one to fulminant respiratory infection before 15 months of age.

Conclusion

Pompe''s Disease is now being increasingly diagnosed, due to definitive enzyme estimation facilities. With the recent availability of enzyme replacement therapy with Myozyme, the prognosis is likely to change for the better.Key Words: Metabolic myopathy, Pompe''s disease, Hypotonia, Cardiomegaly, Hepatomegaly, Acid alpha-glucosidase