RESUMEN
BACKGROUND: Reactivation of hepatitis B virus (HBV) after rituximab-containing chemotherapy in patients with B-cell lymphoma has been recognized as a potentially serious complication in HBV immune patients. METHODS: To determine the HBV reactivation in patients treated with rituximab, a retrospective study of HBV-related markers was performed before and after rituximab-containing treatment in 261 consecutive patients with CD20-positive B-cell lymphoma. RESULTS: Of the 261 patients, 230 patients were tested for both hepatitis B surface antigen (HBsAg) and antibody to hepatitis B core antigen (anti-HBc) before treatment. Fifty-six (24.3%) of 230 patients were anti-HBc positive, and the remaining 174 (75.6%) patients were anti-HBc negative. Among the 56 anti-HBc-positive patients, 5 (8.9%) became HBsAg positive (HBV reactivation), whereas none of the 174 anti-HBc-negative patients became HBsAg positive with a median follow-up of 24 months (P = .001). Among the 5 patients with HBV reactivation, 4 were negative for antibody to HBsAg (anti-HBs), and 1 patient was positive for anti-HBs. All 5 of these patients were treated successfully with entecavir on detection of HBsAg, although 4 of the 5 patients exhibited mild to moderate elevation of alanine aminotransferase. Among 56 anti-HBc-positive patients, those negative for anti-HBs had a higher probability of developing HBV reactivation compared with those positive for anti-HBs (4 of 19; 21.1% vs 1 of 37; 2.7%, P = .014). CONCLUSIONS: Patients with isolated anti-HBc are at high risk of HBV reactivation and should be monitored closely for HBsAg, anti-HBs, HBV-DNA, and transaminase levels during and after rituximab-containing treatment. Although preemptive use of entecavir enabled successful management of HBV reactivation, mild to moderate hepatic flare was still observed. These approaches should be further evaluated in a prospective study with regard to clinical usefulness, safety, and cost-effectiveness.
Asunto(s)
Anticuerpos Monoclonales/efectos adversos , Antígenos CD20/metabolismo , Virus de la Hepatitis B/aislamiento & purificación , Hepatitis B/complicaciones , Linfoma de Células B/virología , Activación Viral , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Anticuerpos Monoclonales de Origen Murino , ADN Viral/análisis , Femenino , Anticuerpos contra la Hepatitis B/análisis , Humanos , Linfoma de Células B/tratamiento farmacológico , Linfoma de Células B/inmunología , Masculino , Persona de Mediana Edad , Estudios Retrospectivos , RituximabAsunto(s)
Linfoma de Burkitt/diagnóstico , Linfoma de Burkitt/terapia , Neoplasias de la Vejiga Urinaria/diagnóstico , Neoplasias de la Vejiga Urinaria/terapia , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapéutico , Biopsia con Aguja , Terapia Combinada , Trasplante de Células Madre de Sangre del Cordón Umbilical/métodos , Cistoscopía , Diagnóstico Diferencial , Progresión de la Enfermedad , Resultado Fatal , Hematuria/diagnóstico , Hematuria/etiología , Humanos , Inmunohistoquímica , Masculino , Persona de Mediana Edad , Estadificación de Neoplasias , Piuria/diagnóstico , Piuria/etiología , Medición de Riesgo , Índice de Severidad de la Enfermedad , Urinálisis , Irradiación Corporal Total/métodosRESUMEN
Robot-assisted minimally invasive surgery has become common in recent years. We used the da Vinci surgical system and managed anesthesia in 6 cases of bilateral internal mammary artery dissection and construction of a composite graft using the radial artery. To ensure vision inside the thoracic cavity, endoscopic robotic surgery employs the inflation of the thoracic cavity with carbon dioxide, producing a pneumothorax and turning the thoracic cavity into a positive pressure chamber. Thus, marked acidosis and circulatory changes manifest during anesthetic management. Although robotic surgery is considered "minimally invasive, such surgery involves a number of problems in terms of anesthetic management, and these problems must be examined.