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INTRODUCTION: Rapid desensitization allows secure administration of a drug and is indicated when there is no therapeutic alternative. CASE REPORT: We report a 49-year-old patient who presented with a hypersensitivity reaction following an infusion of rituximab (375mg/m(2)) in the context of a Castleman's syndrome. After a clinical flare (splenomegaly, adenopathies) despite treatment with tocilizumab, anakinra and valganciclovir, the reintroduction of rituximab was decided, according to the rapid desensitization protocol. Four full dose desensitizations were successfully performed allowing immediate clinical improvement (apyrexia, loss of sweating and lymphadenopathy, splenomegaly partial regression) and biological (negativation of HHV8 viral load, and disappearance of neutropenia, anemia and thrombocytopenia). CONCLUSION: Rapid desensitization is a promising method for the pursuit of rituximab therapy after a hypersensitivity reaction and should be considered in patients with no acceptable therapeutic alternative.
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Enfermedad de Castleman/diagnóstico , Desensibilización Inmunológica , Hipersensibilidad a las Drogas/terapia , Rituximab/efectos adversos , Enfermedad de Castleman/tratamiento farmacológico , Enfermedad de Castleman/inmunología , Diagnóstico Diferencial , Hipersensibilidad a las Drogas/etiología , Humanos , Masculino , Persona de Mediana EdadRESUMEN
The authors discuss the various roles of 18F-FDG PET/CT in the management of breast cancer. Roles of new tracers such as F-18 fluoro-L-thymidine (a marker of cell proliferation), 18-fluoro-17-B-estradiol (marker of estrogen receptor) and sodium fluoride (marker of bone matrix) are also mentioned. There is little justification for the use of FDG-PET/CT in patient with clinically T1 (< or = 2 cm) N0 tumours. Notably, it cannot be used as a substitute to SLNB "sentinel lymph node biopsy" for axillary staging due to limited sensitivity for the detection of small metastases. The case is different in higher risk patients, and especially so in patients with locally advanced disease. FDG-PET/CT in these patients might depict lymph node involvement in the level III of Berg or in supraclavicular or internal mammary basins. It might also uncover occult distant metastases, notably, early osteomedullary infiltration. Thus, for these tumors, initial PET/CT can enable better intramodality treatment planning or a change in treatment. PET/CT as a whole-body examination is also very efficient in case of suspicion of recurrence. On the other hand, many studies show that this functional imaging could be used to assess early response to neoadjuvant chemotherapy or to chemotherapy of metastatic disease. 18FDG-PET/CT could thus become an unavoidable modality to answer various clinical situations.
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Neoplasias de la Mama/diagnóstico por imagen , Tomografía de Emisión de Positrones/métodos , Radiofármacos , Neoplasias de la Mama/patología , Neoplasias de la Mama/terapia , Carcinoma Ductal de Mama/diagnóstico por imagen , Carcinoma Ductal de Mama/patología , Carcinoma Ductal de Mama/terapia , Didesoxinucleósidos , Estradiol/análogos & derivados , Femenino , Fluorodesoxiglucosa F18 , Humanos , Escisión del Ganglio Linfático , Recurrencia Local de Neoplasia/diagnóstico por imagen , Fluoruro de Sodio , Resultado del TratamientoRESUMEN
Data from three comparative slaughter experiments with individually fed Nellore bulls (n = 31) and steers (n = 66) were utilized to determine their NEm and NEg requirements when fed high-forage diets. The experimental design provided ranges in ME intake, BW, and ADG for the development of regression equations to predict NEm and NEg requirements. The Nellore bulls (Trial 1) were divided into two intake levels (ad libitum and 65% of the ad libitum). The steers (Trials 2 and 3) were allocated to three intake levels (ad libitum and 55 and 70% of the ad libitum). In both trials, there were three slaughter groups within each intake level. The three end points for the bulls were different days on treatment (100, 150, and 190 d and 130, 180, and 200 d, respectively, for older and younger animal subgroups). The steers were slaughtered when animals of the ad libitum treatment reached 400, 440, and 480 kg shrunk BW (SBW) on average for the first, second, and third group, respectively. For all body composition determinations, whole empty body components were weighed, ground, and subsampled for chemical analysis. In each of the trials, initial body composition was determined with equations developed from a baseline slaughter group, using SBW and empty BW (EBW), fat (EBF), and protein (EBP) as variables. The NEm was similar for bulls and steers; NEm averaged 77.2 kcal/ kg0.75 EBW. However, the efficiency of conversion of ME to net energy for maintenance was greater for steers than for bulls (68.8 and 65.6%, respectively), indicating that bulls had a greater ME requirement for maintenance than steers (5.4%; P < 0.05). Our analyses do not support the NRC (2000) conclusion that Nellore, a Bos indicus breed, has a lower net energy requirement for maintenance than Bos taurus breeds. An equation developed with the pooled data to predict retained energy (RE) was similar to the NRC (2000) equation. A second equation was developed to predict RE adjusted for degree of maturity (u): RE = (6.45 - 2.58/u) x EWG x e(0.469) x u), where u = current EBW/final EBW in which final EBW was 365 kg for steers and younger bulls and 456 kg for older bulls at 22% EBF, respectively.
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Composición Corporal/fisiología , Bovinos/fisiología , Ingestión de Energía/fisiología , Metabolismo Energético/fisiología , Animales , Peso Corporal/fisiología , Cruzamiento , Bovinos/genética , Bovinos/metabolismo , Digestión/fisiología , Metabolismo Energético/genética , Masculino , Necesidades NutricionalesRESUMEN
For reduction of radical formation during reperfusion, a lower oxygen supply by limiting the reperfusion flow rate should be beneficial for the organ. Thus, indomethacin was given prior to reperfusion for induction of temporary postischemic vasoconstriction. In an in vivo model (female Wistar rats, 200-250 g, n = 16) with portal decompression by a splenocaval shunt, hepatic ischemia was induced for 30 min by cross-clamping of the hepatoduodenal ligament followed by portal intravenous injection of indomethacin (2 mg/kg body wt) at the end of ischemia. Liver injury was assessed by serum levels of Aspartat-aminotransferase (ASAT) and Alaninaminotransferase (ALAT) that were determined prior to ischemia, on days 2, 4, 6 and 21 postoperatively. The local tissue pO2 was measured preischemically, 1 h after reperfusion and on day 21. Application of indomethacin significantly reduced the local tissue-pO2 by about 50% after 1 h of reperfusion (p < .05). The increase in serum ASAT levels on day 2 was significantly diminished after indomethacin application (p < .05). ALAT values on day 2 showed a significant increase in the control group but did not differ from baseline in the indomethacin group. These data support the hypothesis that temporarily limited reperfusion results in an amelioration of reperfusion injury, although further studies with more selectively vasoactive agents must still be performed since indomethacin also has a major effect on the eicosanoid metabolism.
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Antiinflamatorios no Esteroideos/uso terapéutico , Indometacina/uso terapéutico , Hígado/irrigación sanguínea , Daño por Reperfusión/tratamiento farmacológico , Animales , Modelos Animales de Enfermedad , Femenino , Hígado/fisiopatología , Derivación Portosistémica Quirúrgica , Ratas , Ratas Wistar , Vena Esplénica/cirugía , Vasoconstrictores/uso terapéutico , Vena Cava Inferior/cirugíaRESUMEN
OBJECTIVE: To find out if the presence of a stoma had any influence on the pathophysiology or prognosis of necrotising pancreatitis in rats. DESIGN: Randomised controlled study. MATERIAL: 112 male Wistar rats. INTERVENTIONS: Induction of pancreatitis by intraduodenal injection of 2 ml sodium taurocholate 2% with 10,000 units of trypsin; the duodenum and common bile duct were occluded for three minutes. The control group (n = 36) had no further procedure, but the remaining rats were randomised to have either caecostomy (n = 40) or colonic irrigation (n = 36). MAIN OUTCOME MEASURES: Mortality, histological grading of the pancreatitis, white cell count, serum amylase activity, and haemoglobin and endotoxin concentrations in blood. RESULTS: Operative mortality was 14% (n = 5) in the control group, 10% (n = 4) in the caecostomy group, and 8% (n = 3) in the irrigation group, leaving 31, 36, and 33 for assessment. Later mortality was 23% (n = 7), 17% (n = 6), and 9% (n = 3), respectively. The control group had a significantly higher median endotoxin concentration (219 ng/l) than both the caecostomy group (79.2 ng/l, p < 0.05) and the irrigation group (71.7 ng/l, p < 0.05). The amount of endotoxin was mirrored by the changes in the colonic mucosa in the different groups. CONCLUSION: Our results support the hypothesis that both caecostomy and colonic irrigation have a favourable effect on the outcome of necrotising pancreatitis in rats.
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Cecostomía , Colon , Pancreatitis/fisiopatología , Pancreatitis/terapia , Irrigación Terapéutica , Enfermedad Aguda , Animales , Endotoxinas/sangre , Masculino , Páncreas/patología , Pancreatitis/sangre , Pronóstico , Ratas , Ratas WistarRESUMEN
In 76 male wistar rats with a median weight of 340 g acute pancreatitis was induced by injection of 2% sodium taurocholate into a temporarily closed duodenal loop. 40 animals received an additional cecostomy (group B), the others served as controls (group A). The postoperative figures for amylase, leucocyte count, and hemoglobin were nearly identical in both groups. According to histologic criteria acute pancreatitis was comparable in both groups, too. In nine rats endotoxin was found elevated postoperatively (13.4%). Seven animals belonged to the control (22.6%) and only two to the cecostomy group (5.6%). The difference was statistically significant (p less than 0.05). Also the differences between the median serum endotoxin levels reached statistic significance (79 ng/l in group B vs. 219 ng/l in group A). Mortality was significantly increased in endotoxin-positive animals (42.9% vs. 19.4%). Additionally, among the animals of the control group alterations of the colonic mucosa were observed more frequently than in the cecostomy group. The results are in favour of a translocation of endotoxin from the gut lumen into the circulation during acute experimental pancreatitis.