Platelet to lymphocyte ratio (PLR) retains independent prognostic significance in advanced stage marginal zone lymphoma patients treated with rituximab, cyclophosphamide, vincristine, and prednisone combination chemotherapy (R-CVP): Consortium for Improvi

BACKGROUND: Rituximab plus cyclophosphamide, vincristine, and prednisone (R-CVP) is one of the effective chemotherapeutic regimens for patients with advanced stage marginal zone lymphoma (MZL). However, prognostic factors that affect the outcome of treatment for MZL are not well understood. METHODS: Between August 2006 and June 2013, patients with newly diagnosed stage III and IV MZL treated with R-CVP as a first-line therapy from 15 institutions were retrospectively analyzed. Patients' clinical and laboratory data at diagnosis were collected by review of medical records. RESULTS: A total of 80 patients were analyzed. Bone marrow involvement was observed in 30% cases. Twelve patients (15%) had nodal MZL, and 41.3% patients exhibited multiple mucosa-associated lymphoma tissue sites. Overall response rate was 91.3%, including 73.8% achieving complete response. Advanced MZL patients treated with R-CVP showed a 3-year progression-free survival (PFS) rate of 69.6%. Prognostic markers significantly affecting PFS in univariate analysis were platelet to lymphocyte ratio (PLR, 3.9 g/dL, P=0.008), and the International Prognostic Index (IPI) score (1 vs. 2–4, P=0.032). In multivariate analysis, only PLR (<95 vs. ≥95, HR 0.367, 95% CI, 0.139–0.971, P=0.043) was an independent risk factor for PFS. CONCLUSION: PLR ≥95 at diagnosis is an independent prognostic marker for PFS in advanced stage MZL patients treated with R-CVP. This marker may aid clinicians in predicting the response to R-CVP chemotherapy in stage III and IV MZL patients.

Percepción de la calidad de vida de los médicos residentes de neurologíay neuropediatría en Colombia / Perception of quality of life in neurology and neuropediatrics residents in Colombia

Tanto las entidades públicas en salud como las asociaciones médicas se preocupan por mejorar la calidad deprestación de sus servicios olvidando que uno de los factores condicionantes básicos de la productividad es elgrado de complacencia que los profesionales tienen con su trabajo.Fue un estudio observacional descriptivo, de corte transversal, realizado a través del Cuestionario de calidadde vida profesional (CVP-35), validado en español, que consta de treinta y cinco ítems.Se llevó a cabo un total de veinticinco encuestas, edad media: 29 años. Los resultados en la encuesta de calidadde vida revelan en el ítem “Trabajo que tengo” que el 100% está en valores > 5 (Bastante a Mucho); en “Satisfaccióncon el tipo de trabajo” el 72% está distribuido en valores > 5 (Bastante a Mucho); en “Satisfaccióncon el sueño”, 72% fueron calificados con valores < 5 (Algo o Nada); en “Calidad de vida percibida” 4% lacalificó como “Nada”, 40% “Algo”, 44% “Bastante” y 12% “Mucho”; y en la variable “Estrés emocional”,76% puntuó valores > 5 (Bastante a Mucho).El estudio de calidad de vida profesional medida por el cuestionario CVP-35 mostró que la mayoría de residentesviven en estrato socioeconómico 3 y 68% no tienen vivienda propia. Una gran cantidad de residentes trabajanmás de cuarenta y ocho horas semanales. Llama la atención que el 40% reportó sufrir de alguna patología. Lashoras de sueño diarias son siete en promedio, lo cual es aceptable, sin embargo 72% no están satisfechos conlas horas de sueño; pese a que 76% refieren tener una gran cantidad de trabajo y presentar estrés emocional,72% están satisfechos con el tipo de trabajo y más de la mitad de los residentes consideran tener una buenacalidad de vida.

Both public health institutions and medical associations concerned about improving prevision of heathcare, forgetting that one of the basic conditioning factors of productivity is the degree of complacency that professionals have with their workIt was a descriptive study, cross-sectional, conducted through the questionnaire of quality of professional life (CVP-35), validated in spanish, consisting of thirty- five items.A total of twenty survey was conducted, mean age: 29 years. The results in quality of life survey reveal in item "Work I have" that 100% values is > 5 (Quite to Much); In "Satisfaction with the type of work" 72% is distributed in values > 5 (Quite to Much); In "Satisfaction with sleep" 72 % were rated with values < 5 (Something or Nothing); In "Perceived quality of life" 4% qualify as "Nothing", 40% "Something", 44% "Quite" and 12% "Much"; and in the variable "Emotional stress" 76 % scored values > 5 (Quite to Much).The study of professional quality of life measured by the CVP -35 questionnaire showed that most residents live in socioeconomic stratum 3 and 68% not have their own housing. A lot of residents work more than forty- eight hours per week. It is striking that 40 % reported suffering from some pathology. The average of daily hours of sleep is seven, which it is acceptable, however 72 % are dissatisfied with the sleep hours. Although 76 % reported having a lot of work and present emotional stress, 72 % are satisfied with the type of work and more than half of residents believe they have a good quality of life.

The Effect of Rituximab, Cyclophosphamide, Vincristine, and Prednisolone (R-CVP) Chemotherapy in Patients with Ocular Adnexal Extranodal Marginal Zone B Cell Lymphoma of the Mucosa-Associated Lymphoid Tissue (MALT) Lymphoma

PURPOSE: To report the effectiveness of rituximab, cyclophosphamide, vincristine, and prednisolone (R-CVP) combination chemotherapy in patients with ocular adnexal mucosa-associated lymphoid tissue (MALT) lymphoma (OAML). METHODS: R-CVP chemotherapy was performed in 7 patients (8 eyes) with a confirmed histopathological diagnosis of OAML from January 2012 to December 2012. A total of 6 cycles were administered at a 3-4 week interval and 2 cycles of rituximab were added at the third week. Response evaluation was performed 3 times, with the first evaluation 3 weeks after the third cycle, the second 3 weeks after the sixth cycle, and the last after the second rituximab cycle. RESULTS: In all 7 patients (8 eyes) with R-CVP, symptoms were improved, and the mass was markedly resolved based on orbit CT and MRI scan at first response evaluation. Clinically complete remission (CR) was achieved in 6 patients and partial response (PR) in 1 patient. At final response assessment, there was no detectable mass on orbit CT or MRI. There were no severe infections or hematologic adverse effects including neutropenia or decreased immunoglobulin during the follow-up period. CONCLUSIONS: In OAML, R-CVP combination chemotherapy is considered an effective, safe and important therapeutic approach, reducing the limitations of classic localized radiotherapy and combination chemotherapy and improving the remission rate.

Comparison of the central venous pressure from internal jugular vein and the pressure measured from the peripherally inserted antecubital central catheter (PICCP) in liver transplantation recipients / 대한마취과학회지

BACKGROUND: Unlike its use during stable conditions, central venous pressure (CVP) monitoring from a peripherally inserted central venous catheter (PICC) has not often been used in surgeries with significant hemodynamic alterations. The aim of this study was to evaluate the feasibility of measuring PICC pressure (PICCP) as an alternative to measuring centrally inserted central catheter pressure (CICCP) in adult liver transplantation (LT) patients. METHODS: We measured PICCP and CICCP simultaneously during each main surgical period in adult LT. Statistical analysis was performed using simple linear regression analysis to observe whether changes in PICCP paralleled by simultaneous changes in CICCP. Correlation analysis and Bland-Altman analysis were used to determine the degree of agreement between the two devices. Differences were considered statistically significant when P values were less than 0.05. RESULTS: A total of 1342 data pairs were collected from 35 patients. The PICCPs and CICCPs were highly correlated overall (r = 0.970, P < 0.001) as well as at each period measured. The differences among each period were not clinically significant (0.33 mmHg for pre-anhepatic, 0.32 mmHg for anhepatic, -0.15 mmHg for reperfusion, and -0.10 mmHg for neohepatic periods). The overall mean difference was 0.14 mmHg (95% confidence interval: 0.09-0.19) and PICCP tended to give a higher reading by between 0.09 and 0.19 mmHg overall. The limit of agreement was -1.74 to 2.02 overall. CONCLUSIONS: These findings suggest that PICCP can be a reasonable alternative to CICCP in situations of dynamic systemic compliance and preload, as well as under stable hemodynamic conditions.

The Value of measuring plasma B-natriure peptide Levels in elderly patients with Left ventricular dysfunction / 中国实用内科杂志

Objective To evaluate the serum Level of B-natriure peptide(BNP)in elderly patients with Left Ventricular dysfunction and to determine the correlation between the BNPand hemodynamic Variable.Methods According to New York Heart Association(NYHA)class.51 patients with Left Ventricular dysfunction and 28 without Left Ventricular dysfunction(control group)were measured.BNP Levels were obtained,Left ventricular ejection fraction(LVEF)was assessed by echocardiography,center vein pressure(CVP)was determined in NYHA Class Ⅲ-Ⅳ groups.Results BNP were (39.32?5.51)ng/L in control group,respectively(265.94?63.13)ng/L in NYHA ClassⅡgroup(n=18),(569.93?109.17)ng/L 、CVP was(9.67?1.23)cmH_2O in NYHA class Ⅲ group,(2 764.33?1 020.53)、CVP was(19.61?4.57)cmH_2O in NYHA class Ⅳ.The difference of BNP and CVP in groups were scegnificant(all P

Subclavian Vein Catheterization by Using 24-Gauge Peripheral Angiocatheter in Pediatric Cadiovascular Surgical Patients / 대한구급학회지

BACKGROUND: Central venous catheterization (CVP) often leads to unacceptable complications, especially in pediatrics. To reduce these complications, we modified the venipucture by using 24-gauge peripheral angiocatheter (24-AG) in pediatric patients. METHODS: A 24-AG attached to a 3 cc syringe instead of a thin-wall steel needle in the commercial CVP kit was inserted and advanced in the direction of the inmominate vein with 45degrees angle. When blood was observed in the syrige, the 24-AG was more advanced into the subclavian vein and the 24-AG stylet was removed. A J-guide wire was inserted through lumen of the angiocather. The following procedure was the same as the Sheldinger technique. RESULTS: 202 pediatric patients received subclavian venipuncture by the method mentioned above. The overall success rate was 96.5%. The rate of success for the first attempt was 85.6% and the average number of venipuncture was 1.3+/-0.1. The overall complications was 6.4%, including hematoma formation (1.5%), pneumothorax (1.5%), bleeding at the puncture site (1.0%), mild hemothorax (0.5%) and pleural puncture without pneumothorax (2.0%). CONCLUSIONS: The subclavian venepuncture by using 24-gauge peripheral angiocatheter was reliable and useful technique in pediatric patients. The overall complications by this method was reduced compared to other reports.

Fluid Management in Kidney Transplantation: Central Venous Pressure Guided vs Esophageal Doppler Monitoring / 대한마취과학회지

BACKGROUND: Maximizing renal blood flow during reperfusion of the transplanted kidney could be the key factor to prevent acute tubular necrosis (ATN). To achieve such a goal, augmentation of circulating blood volume is necessary. We evaluated stroke volume monitored or CVP guided volume expansion method and, which method would be better for the outcome. METHODS: Forty three patients (Group I) of 79 patients received maximum hydration guided by CVP maintaining 12-15 mmHg, other 36 patients (Group II) received fluid to achieve maximum SV using esophageal doppler monitor. All patients received albumin (maximal dose < 1 g/kg), mannitol (20%, 200 ml), and furosemide (40 mg) before renal artery reperfusion. Postoperative tests for evaluation of renal function, incidence of ATN and morbidity and hospital stay in patient were investigated. RESULTS: Amount of fluid infused were 3,891 +/- 1,145 ml in Group I and 2,981 +/- 936.4 ml in Group II. Incidence of ATN (Group I; 9.3% and Group II; 8.3%), tests for renal function were not statistically significant in both Group, but two patients in Group I was administered in intensive care unit (ICU). CONCLUSIONS: Lesser fluid was administered in the Group used with SV augmentation than conventional CVP guided group and there was no difference in the incidence of ATN between two group. In kidney transplantation, esophageal doppler monitoring may be better in fluid management than CVP monitoring.

The Influence of Central Venous Pressure on Blood Loss during Spinal Fusion in Prone Position

OBJECTIVE: The central venous pressure(CVP) could affect the vertebral venous pressure, which in turn may influence blood loss during lumbar spinal surgery. The authors perform prospective clinical study to investigate the influence of the CVP on the amount of intra-operative blood loss and operating time. METHODS: Total 134 patients having various degenerative lumbar spinal pathology were treated by laminectomy and spinal fusion using posterior lumbar interbody fusion with cages and pedicle screws. The CVP was measured after prone positioning in all the patients. The correlation between the CVP and intra-operative blood loss and operating time were analyzed. RESULTS: The mean CVP after prone positioning was 10 cmH2O(5-18). The mean amount of intra-operative blood loss and operating time were 1884 cc and 213 minutes, respectively. The amount of blood loss and operating time significantly increased with the extent of spinal fusion. The CVP was significantly correlated with intra-operative blood loss and operating time(p<0.05). CONCLUSION: With increased CVP on prone position, there is a tendency of increasing amount of blood loss and operating time. The measurement of CVP is useful in determining the position providing a bloodless field during spinal fusion.

A Case of Angiocentic T-Cell Lymphoma Achieving Initial Complete Remission with CVP Chemotherapy / 대한피부과학회지

Angiocentric T-cell lymphoma is a subtype of peripheral T-cell lymphoma and histologically characterized by angiocentric and angioinvasive infiltration of lymphoid cells with varying degrees of cytological atypia, leading to angiodestruction. This disease represents the malignant end in the histological spectrum of angiocentric immunproliferative lesions. This malignancy is commonly a disease with considerable morbidity and is often fatal. However, primary cutaneous angiocentric T-cell lymphoma has a tendency to give a favorable prognosis. Epstein-Barr virus can be identified in involved tissue by immunostaining or by in situ hybridization and it is considered significant in the prognosis. We report a case of cutaneous angiocentric T-cell lymphoma, where the Epstein-Barr virus was identified within neoplastic cells. CVP(cyclophosphamide, vincristine, prednisone) chemotherapy was instigated and an initial complete remission was achieved.

The Need of Central Venous Pressure Monitoring in Patients with Severe Preeclampsia before Epidural Anesthesia / 대한마취과학회지

Most obstetric anesthesiologist now consider epidural anesthesia to be the preferred anesthetic technique for patients with preeclampsia. In the severe preeclampsia effective ciirculatory volume is usually low, so appropriate preanesthetic hydration is essential feature of safe management. We performed CVP monitoring before epidural anesthesia in nine severe preeclamptic patients undergoing cesarean section. Mean CVP of them was 2+/-1 mm Hg which was not significantly different from normal term parturient. In four patients whose CVP was less than 2 mmHg, preanesthetic hydration with Hartman's solution 500~700 rrd was performed under the monitoring of CVP until it became to rise 2~3 mmHg. Five patients out of nine whose systolic blood pressure dropped below 100 mmHg during anesthesia were IV injected ephedrine 4 mg immmediately and three of them needed repeat injection of ephedrine 4 mg. With the monitoring of CVP, the operations of all the nine severe preeclamptic patients were completed successfully without any problem during and after anesthesia. lt is important to reaUze the limitation of central venous pressure monitoring : but if used with caution in proper circumstance it can provide clinically useful information with minimal risk to the patient.

The Effects of 10 % Pentastarch Preloading for Cesarean Section Under Epidural Anesthesia / 대한마취과학회지

Epidural anesthesia is the most commonly used anesthesia for cesarean section. But preg- nant women under epidural anesthesia for cesarean section are particularly prone to arterial hypotension following sympathetic blockade. Its prevention is the most important thing to obstetric anesthetists. Forty women at term were randomly allocated to receive either 1,500ml of crystalloid (Hartmann's solution) or 500ml of colloid solution (10% pentastarch) in order to preload the circulation prior to elective cesarean section under epidural anesthesia. And to investigate the adverse effect of pentastarch on coagulation, other forty mothers undergoing cesarean section under general anesthesia were examined with computerized thrombelastograph coagulation analyzer(TEG) before and after 1,500ml of Hartmanns solution or 500ml of 10% pentastarch preloading (each group n=20). There were no differences in the incidence of hypotension, degree of hemodilution, umbilical cord blood gas tension and TEG findings between the two groups. But the serial change of the central venous pressure of the Hartmann group from fluid preloading to anesthesia and operation was significantly different from that of pentastarch group (p<0.05). The TEG findings before fluid preloading presented the hypercoagulable stste of the pregnant women at term, and no adverse effect of pentastarch on coagulation except hemodilution. It was concluded that 10% pentastarch was a good choice as a circulatory preloading agent for cesarean section under epidural anesthesia.

CSF Spinal Drainage Using CVP Catheter for Brain Surgery / 대한마취과학회지

Acute volume and ICP changes produce irreversible brain damage because the hard cranium is filled with soft brain tissue, blood in the intracranial vessels and cerebrsopinal fluid. Surgical manipulatins and anesthesia may also alter this delicate intracranial balance. Therefore, the control of ICP and brain volume is very importment for brain surgery. There are several known methods to decrease intracranial pressure and improve cerebral perfusion pressure such as the use of diuretics, hyperventilation and CSF drainage. The CSF spinal drainage is a method of reducing ICP and vloume to facilitate dissection and placement of clips for aneurysm surgery and reduce the incidence of aneurysm rupture. We had 207 cases of CSF spinal drainage in patients scheduled for brain surgery. CSF spinal drainage has been employed using a regular CVP intracatheter with the 14 gauze large needle. We have found that this techique is simple, economic and efficient and its conplications are minimal. CSF spinal drainage is believed to decrease the intracranial pressure and increase the cerebral perfusion pressure and to prevent development of ischemic symptoms or cerebral infarction as vasospasm.

A Case of Pulmonary Edema Developed during Cesarean Section in a Patient with Servere Preeclapmsia / 대한마취과학회지

Preeclampsia continues to represent a significant cause of morbidity and mortality in 5-10% of all pregnancies. The pathophysiology of preeclampsia can involve virtually every organ system, and in extreme cases cardiac decompensation may occur. Single epidural anesthesia for Cesarean section was performed in a patient with severe preeclampsia who already had clinical evidence of pulmonary congestion. A balanced salt solution was administered rapidly to prevent hypotension resulting from the epidural block. She started complaining of severe dizziness around 10 minutes after epidural injection of 18 ml bupivacaine. General anesthesia was substituted for epidural anesthesia because of inadequate analgesia for the operation. Chest rales and frothy sputum through the endotracheal tube were noticed to the patient and she remained unconscious after the operaion was finished. The chest X-ray revealed pulmonary edema but the brain computed tomographic scan was unremarkable. She was treated in the intensive care unit using a respirator with PEEP therapy and vasodilators. She was rapidly recovered from unconsciousness with cardiovascular instability. It was suggested that rapid hydration was one of the main contributing factors causing pulomanary edema in this patient with severe preeclampsia. The pulmonary edema possibly could be prevented by monitoring of pulmonary capillary wedge pressure with careful Swan-Ganze catheterization.

Placement of CVP Catheter by EKG / 대한마취과학회지

Measurement of Central venous pressure is very helpful to assess, the circulating blood volume, venous tone and preload of right ventricle. To obtain an accurate CVP, the correct placement of a CVP catheter is mandatory, There are many means of identifing the correct placement of a CVP catheter which was inserted through the internal jugular vein, subclavian vein and other veins. Authors have chosen the method of intracardiac EKG, which was very easy and useful clinically. The placement of a CVP catheter by intracardiac EKG using modified Lead II was verified by postoperative chest X-ray.

Comparison of Right Internal Jugular or Subclavian Pressure and Central Venous Pressure during Anethesia / 대한마취과학회지

The internal jugular and subclavian veins are considered as satisfactory intravenous routes for rapid blood and fluid replacement. To determine whether these venous pressures can be used as reliable guides for central venous pressure monitoring, simultaneous measurements of the Rt. internal jugular venous pressure and central venous pressure (CVP), or Rt. subclavian venous pressure and CVP using long 14 gauge catheter were made in 20 patients undergoing cardiac anesthesia. The results were as follows: l. Each mean value of the Rt. internal jugular venous pressure and CVP was 10.64+/-5.43 cm H2O and 10.05+/-5.55cm H2O (Mean+/-SD) respectively in first 10 patients. Pressure difference was 0.59+/-0.39cm H2O (p<0.005). 2. Each mean value of the Rt. subclavian venous pressure and VP was 7.77+/-3.37 cm H 0 and 7.05+/-3.49cm H2O (Mean+/-SD) respectively in second 10 patients. Pressure difference was 0.73+/-0.59cm H2O (p<0.005). 3. There were significant correlations between Rt. internal jugular venous pressure and CVP (r=0. 99, p<0.005) as well as between Rt. subclavian venous pressure and CVP (r=0.98, p<0.005). The results suggest that Rt. internal jugular or subclavian vein catheterized with short intravenous catheter during Anesthesia can be used as effective and reliable guides for CVP monitoring because pressure differences with CVP were small and consistant.