ABSTRACT
Objective: To report a case of intravenous etoposide hypersensitivity in patient with extragonadal germ cell tumor and successfully rechallenged with oral etoposide on the subsequent cycles.Case summary: A 16-year-old man with a diagnosis of primary mediastinal germ cell tumor was treated with bleomycin, etoposide and cisplatinum (BEP regimen). Within 15 minutes after his first etoposide infusion, he developed dyspnea, chest tightness but no hypotension or urticarial rash. Bronchospasm was revealed on the physical examination which suggested that the reaction was type I hypersensitivity reaction. Symptoms resolved within half and hour after administration of intravenous fluids, antihistamine and bronchodilators. After the patient was stabilized, intravenous etoposide was rechallenged with slower infusion rate. The patient was fully premedication before his second infusion by antihistamine and corticosteroid but again the same hypersensitivity reactions occurred. Finally the patient was treated by oral etoposide instead. The patient was well-tolerated with oral etoposide and the symptoms did not reoccurred in this cycle. The next three subsequent courses of treatment by BEP regimen with oral etopside were successfully given without any hypersensitivity reactions.Discussion: Immediate type hypersensitivity reaction can be caused by intravenous etoposide although it was founded infrequently. This reaction was supposed to be caused by polysorbate 80 which is an ingredient in the etoposide intravenous form. Because of the lack of polysorbate 80 in the oral etoposide and its good bioavailability. We suggested to switch from intravenous route to oral route if this drug is necessary to the patient who developed by antihistamine and corticosteroid premedications.
ABSTRACT
Background: Hypertension clinic, Srinagarind hospital has established since April 2003. Our aims are to teach medical students in taking care of hypertensive patients and give a comprehensive and holistic care for hypertensive. We would like to evaluate patients’ characteristics and outcome of treatment in our clinic that will be baseline data to and improve our service.Objective: To assess clinical outcome of hypertensive treated at hypertension clinic, Srinagarind hospital.Design: Descriptive studySetting: Hypertension clinic, Srinagarind hospital, Khon Kaen, ThailandPopulation: Patients diagnosed as hypertension and treated at hypertension clinic, Srinagarind hospital for at least one year.Sampling: 100 cases by simple random sampling from 200 populationsTool: Record form and out-patient department recordAnalysis: Descriptive statistics and analytical statisticsResults: There were 100 persons enrolled, 62 female. The mean ages were 59 +17.7 and 57.4 + 10.6 years old in female and male, respectively. The average duration after diagnosis as hypertension was 4.5 years. The mean BMI and mean abdominal circumference in male were 27.2 + 0.6 kg/m2 and 94.8 + 0.8 centimeters, respectively. In female group, both variables were 26.3 + 0.9 kg/m2 and 92.9 + 5.6 centimeters, respectively. The three most common anti-hypertensive drug uses were ACEI (38%), hydrochlorothiazide (35%), and beta blocker (35%). Side effects were found in 18 patients; ACEI induced cough (10%) was the most common one. Good control of hypertension was achieved in 92 patients with one or two medications. Left ventricular hypertrophy was the most common complication in our studied cases, 20 cases. According to International Diabetes Federation (IDF, 2005) criteria, there were 54 cases met metabolic syndrome criteria. Diabetes mellitus or impaired fasting glucose (IFG) was found in 45 cases. Conclusion: The control rate of hypertensive patients treated at hypertension clinic, Srinagarind hospital was 92% with one or two antihypertensive drugs. Half of cases were associated with metabolic syndrome and/or diabetes mellitus or IFG.Keywords: outcome, hypertension clinic, essential hypertension
ABSTRACT
Background: Hypertension clinic, Srinagarind hospital has established since April 2003. Our aims are to teach medical students in taking care of hypertensive patients and give a comprehensive and holistic care for hypertensive. We would like to evaluate patients’ characteristics and outcome of treatment in our clinic that will be baseline data to and improve our service.Objective: To assess clinical outcome of hypertensive treated at hypertension clinic, Srinagarind hospital.Design: Descriptive studySetting: Hypertension clinic, Srinagarind hospital, Khon Kaen, ThailandPopulation: Patients diagnosed as hypertension and treated at hypertension clinic, Srinagarind hospital for at least one year.Sampling: 100 cases by simple random sampling from 200 populationsTool: Record form and out-patient department recordAnalysis: Descriptive statistics and analytical statisticsResults: There were 100 persons enrolled, 62 female. The mean ages were 59 +17.7 and 57.4 + 10.6 years old in female and male, respectively. The average duration after diagnosis as hypertension was 4.5 years. The mean BMI and mean abdominal circumference in male were 27.2 + 0.6 kg/m2 and 94.8 + 0.8 centimeters, respectively. In female group, both variables were 26.3 + 0.9 kg/m2 and 92.9 + 5.6 centimeters, respectively. The three most common anti-hypertensive drug uses were ACEI (38%), hydrochlorothiazide (35%), and beta blocker (35%). Side effects were found in 18 patients; ACEI induced cough (10%) was the most common one. Good control of hypertension was achieved in 92 patients with one or two medications. Left ventricular hypertrophy was the most common complication in our studied cases, 20 cases. According to International Diabetes Federation (IDF, 2005) criteria, there were 54 cases met metabolic syndrome criteria. Diabetes mellitus or impaired fasting glucose (IFG) was found in 45 cases. Conclusion: The control rate of hypertensive patients treated at hypertension clinic, Srinagarind hospital was 92% with one or two antihypertensive drugs. Half of cases were associated with metabolic syndrome and/or diabetes mellitus or IFG.Keywords: outcome, hypertension clinic, essential hypertension