Idiopathic transient osteoporosis of the knee: five cases and revision of literature

Five patients with idiopathic transient osteoporosis were examined. Bone scanning and MRI was helpful in the diagnosis to differentiate of necrosis and all patients recovered completely with conservative and symptomatic treatment. There was no history of trauma in all patients. MRI was realized previously in all cases to confirm the diagnosis and after the resolution of symptomathology.     

Combination antibiotic therapy improves survival in patients with community-acquired pneumonia and shock

OBJECTIVE: To assess whether combination antibiotic therapy improves outcome of severe community-acquired pneumonia in the subset of patients with shock. DESIGN: Secondary analysis of a prospective observational, cohort study. SETTING: Thirty-three intensive care units (ICUs) in Spain. PATIENTS: Patients were 529 adults with community-acquired pneumonia requiring ICU admission. INTERVENTIONS: None. MEASUREMENT AND MAIN RESULTS: Two hundred and seventy (51%) patients required vasoactive drugs and were categorized as having shock. The effects of combination antibiotic therapy and monotherapy on survival were compared using univariate analysis and a Cox regression model. The adjusted 28-day in-ICU mortality was similar (p = .99) for combination antibiotic therapy and monotherapy in the absence of shock. However, in patients with shock, combination antibiotic therapy was associated with significantly higher adjusted 28-day in-ICU survival (hazard ratio, 1.69; 95% confidence interval, 1.09-2.60; p = .01) in a Cox hazard regression model. Even when monotherapy was appropriate, it achieved a lower 28-day in-ICU survival than an adequate antibiotic combination (hazard ratio, 1.64; 95% confidence interval, 1.01-2.64). CONCLUSIONS: Combination antibiotic therapy does not seem to increase ICU survival in all patients with severe community-acquired pneumonia. However, in the subset of patients with shock, combination antibiotic therapy improves survival rates.     

AA-type amyloid tumor as an unsuspected cause of residual mass in a patient with large B-cell non-Hodgkin's lymphoma

Amyloidosis is a rare complication of non-Hodgkin's lymphoma (NHL). AL amyloid deposits are usually localized in areas adjacent to the lymphoma, despite the presence of circulating light chains. However, AA-type amyloidosis is extremely unfrequent as a residual mass in patients with NHL. We report a case with diffuse large B-cell non-Hodgkin's lymphoma in which a residual tumoral mass corresponding to AA-type amyloidosis was found.     

Primary myeloid sarcoma of the gynecologic tract: a report of two cases progressing to acute myeloid leukemia

Primary gynecologic myeloid sarcomas are rare, and their diagnosis is often difficult. Differential diagnosis includes lymphomas and carcinomas of the gynecologic tract. We report the clinical, morphological, immunohistochemical and cytogenetic features of two cases of chloromas of the female genital tract, which progressed to acute myeloid leukemia in spite of aggressive therapy.     

Post-transplant Burkitt's leukemia or lymphoma. Study of five cases treated with specific intensive therapy (PETHEMA ALL-3/97 trial)

Burkitt's lymphoma (BL) and Burkitt-like acute lymphoblastic leukemia (ALL) are uncommon lymphoproliferative disorders after solid organ or stem cell transplantation. Although their prognosis is considered to be poor, there are scarce data on the clinical characteristics and the response to specific therapies. We report the main clinical characteristics and the results of a specific intensive chemotherapy in 5 adult patients with postransplant BL/ALL3 included in the PETHEMA ALL3/97 protocol. Two patients died in induction, another died in consolidation phase and the remaining 2 patients are in continuous complete remission 6 and 18 months from the diagnosis.     

Myocardial antioxidant status in chronic alcoholism

BACKGROUND: Excessive ethanol intake is one of the most frequent causes of acquired dilated cardiomyopathy in developed countries. The pathogenesis is multifactorial, with the antioxidant imbalance of cardiac muscle being a potential factor. The current study evaluates myocardial antioxidant status in ethanol consumers and its relation to cardiac damage. METHODS: The authors assessed superoxide dismutase, glutathione peroxidase, and glutathione reductase enzyme activities as well as the total antioxidant status capacity in myocardial samples obtained from organ donors with sudden death of traumatic or neurological origin. They studied 23 high-dose chronic alcohol consumers, 27 individuals with long-standing hypertension, and 11 healthy controls. Cardiomyopathy was defined according to standard functional and histological criteria. RESULTS: Patients with dilated cardiomyopathy, either of alcoholic or hypertensive origin, showed increased myocardial superoxide dismutase activities compared with patients without cardiomyopathy (p < 0.001, both) and controls (p < 0.05, both). Total antioxidant status capacity and the activity of glutathione peroxidase and glutathione reductase enzymes were similar in all groups. Superoxide dismutase activity was related to the presence of cardiac enlargement and the degree of cardiac histological damage. The amount and type of alcoholic beverages as well as the nutritional status of the patients were not related to myocardial antioxidant activity. CONCLUSIONS: The presence of dilated cardiomyopathy, of either alcoholic or hypertensive origin, is related to an increase in myocardial superoxide dismutase activity.     

Population pharmacokinetic/pharmacodynamic modeling of drug-induced adverse effects of a novel homocamptothecin analog, elomotecan (BN80927), in a Phase I dose finding study in patients with advanced solid tumors

Purpose

To characterize the pharmacokinetic profile of elomotecan, a novel homocamptothecin analog, evaluate the dose-limiting toxicities, and establish the relationship between exposure and toxicity in the first Phase I study in patients with advanced malignant solid tumors. Preliminary antitumor efficacy results are also provided.

Design

Elomotecan was administered as a 30-min intravenous infusion at doses ranging from 1.5 to 75?mg once every 3?weeks to 56 patients with advanced solid tumors. Plasma concentration data and adverse effects were modeled using the population approach.

Results

Elomotecan showed linear pharmacokinetics, and clearance was decreased with age. The model predicts a 47 and 61?% reduction in CL for patients aged 60 and 80?years, respectively, when compared with younger patients (30?years). Neutropenia represented the dose-limiting toxicity. The maximum tolerated dose and the recommended dose (RD) were 75 and 60?mg, respectively. Elomotecan elicited a 20, 5, 2, and 2?% severe (grade 4) neutropenia, asthenia, nausea, and vomiting at the RD, respectively. Of the subjects in the RD cohort, 41.7?% had a stable disease mean duration of 123.6?±?43.4?days.

Conclusions

The pharmacokinetic parameters and the toxicity pattern of elomotecan suggest that this novel homocamptothecin analog should be further explored in the clinical setting using a dose of 60?mg administered as a 30-min intravenous infusion, once every 3?weeks.     

Association of time elapsed since the last coronary event with health services utilization

Background: Patients with chronic illness use health services more often but little is known about the use that coronary heart disease patients make of primary care. Objective: To determine whether the time elapsed and the perceived quality of life following a major acute coronary event are associated with utilization rate of primary care services. Design: Cross-sectional, multicentre study. Setting: Twenty-three primary care health centres in Catalonia (Spain). Participants: Patients aged 30–80 years who had suffered a major coronary event in the previous 6 years. Main outcome measures: The number of consultations with the general practitioner during the year before the beginning of the study was noted and patients who consulted nine or more times were considered frequent attenders. The time elapsed since the last major coronary event was categorized using the median (2 years) as a cut-off value. The SF-12 quality of life questionnaire was administered. Results: A total of 1022 patients with coronary heart disease were included. The median number of consultations with a general practitioner within the previous year was 5 (range 0–36). Patients with a shorter time elapsed since the last coronary event were seen more often by their general practitioner. The probability of being frequent attender was 24% lower among patients with less recent coronary events (adjusted odds ratio: 0.76, 95% confidence interval: 0.69–0.85, p < 0.001). Quality of life scores were similar in frequent and non-frequent attenders. No relationship between comorbidity and frequent attendance was found. Conclusions: The shorter time elapsed since the last coronary event was an important factor related with frequent attendance in coronary heart disease patients regardless of cardiovascular comorbidity, and perceived quality of life.