Clinical observation of rituximab in three patients with anti-N-methyl-D-aspartate receptor encephalitis / 中华神经科杂志

Objective To investigate the efficacy and safety of rituximab in the treatment of anti-N-methyl-D-aspartate receptor (NMDAR) encephalitis.Methods Three patients with anti-NMDAR antibodies in cerebrospinal fluid and serum hospitalized from May 2012 to July 2014 were retrospectively reviewed.The clinical syndrome,investigations,and therapeutic interventions by rituximab when first line immunotherapy failed were evaluated.Results All 3 patients were females with median age of 17 years (12,17,and 22 years).One patient had ovarian teratoma.All 3 patients presented with psychiatric symptoms and movement disorders,2 of which developed into a state of unresponsiveness.Brain magnetic resonance imaging of 2 patients was unremarkable,and 1 showed T2 and FLAIR hyperintensity among the areas of medulla,pons,caudex cerebri and callosum.Fluoro-2-deoxy-D-glucose-PET showed variable multifocal cortical and subcortical abnormalities that changed during the course of the disease.Electroencephalograms were abnormal in all patients,showing non-specific,slow,and disorganised activity,1 showing extreme delta brush.The cerebrospinal fluid showed lymphocytic pleocytosis.All patients showed no response to treatment with first line immunotherapy (corticosteroids,intravenous immunoglobulin (400 mg · kg-1 · d-1 × 5 d,2-3 courses of treatment)).After the administration of rituximab,1 patient responded slower,whereas the other 2 patients who recovered dramatically (375 mg/m2 every week for 3-4 weeks) continued immunosuppression with mycophenolatemofetil for 1 year.Relapse occurred in 1 patient when the immunotherapies discontinued 6 months later.During the treatment of rituximab,2 patients had grade 3 infectious adverse events (hospitalization and intravenous administration of antibiotics).Conclusions Rituximab is effective for the patients with anti-NMDAR encephalitis who fail to respond to the first line immunotherapy.However the utility of rituximab is still a challenge due to the risk of infectious complications and off-label use.

Reduced Progression of Cardiac Allograft Vasculopathy with Routine Use of Induction Therapy with Basiliximab / Redução da Progressão da Doença Vascular do Enxerto Cardíaco com o Uso Rotineiro da Terapia de Indução com Basiliximab

AbstractIntroduction:Cardiac allograft vasculopathy (CAV) is a major limitation for long-term survival of patients undergoing heart transplantation (HT). Some immunosuppressants can reduce the risk of CAV.Objectives:The primary objective was to evaluate the variation in the volumetric growth of the intimal layer measured by intracoronary ultrasound (IVUS) after 1 year in patients who received basiliximab compared with that in a control group.Methods:Thirteen patients treated at a single center between 2007 and 2009 were analyzed retrospectively. Evaluations were performed with IVUS, measuring the volume of a coronary segment within the first 30 days and 1 year after HT. Vasculopathy was characterized by the volume of the intima of the vessel.Results:Thirteen patients included (7 in the basiliximab group and 6 in the control group). On IVUS assessment, the control group was found to have greater vessel volume (120–185.43 mm3 vs. 127.77–131.32 mm3; p = 0.051). Intimal layer growth (i.e., CAV) was also higher in the control group (27.30–49.15 mm3 [∆80%] vs. 20.23–26.69 mm3[∆33%]; p = 0.015). Univariate regression analysis revealed that plaque volume and prior atherosclerosis of the donor were not related to intima growth (r = 0.15, p = 0.96), whereas positive remodeling was directly proportional to the volumetric growth of the intima (r = 0.85, p < 0.001).Conclusion:Routine induction therapy with basiliximab was associated with reduced growth of the intima of the vessel during the first year after HT.

ResumoFundamento:A doença vascular do enxerto (DVE) constitui uma grande limitação de sobrevida a longo prazo de pacientes submetidos a transplante cardíaco (TxC). Alguns imunossupressores diminuem o aparecimento da DVE.Objetivos:O principal objetivo foi avaliar, através de ultrassonografia intracoronária (USIC), a variação do crescimento volumétrico da camada íntima e comparar, após um ano, o grupo que recebeu basiliximab com um grupo de controle.Métodos:Treze pacientes de um único centro foram analisados retrospectivamente de 2007 a 2009. As análises foram feitas através de USIC, medindo-se o volume de um segmento coronariano nos primeiros 30 dias e um ano após o TxC. A vasculopatia foi caracterizada pelo volume da camada íntima do vaso.Resultados:O estudo incluiu 13 pacientes (7 no grupo com o basiliximab e 6 no grupo de controle). A análise por USIC revelou que o grupo de controle apresentou maior crescimento volumétrico do vaso (131,32 a 127,77 mm3 x 120 a 185,43 mm3 p = 0,051). O crescimento da camada íntima (CCI) também foi maior no grupo de controle [Basiliximab: 20,23 a 26,69 mm3 (∆ 33%); Controle: 27,30 a 49,15 mm3(∆ 80% p = 0,015)]. De acordo com a regressão univariada, o volume da placa aterosclerótica prévia do doador não teve relação com o crescimento da íntima (r = 0,15, p = 0,96), enquanto que o remodelamento positivo do vaso foi diretamente proporcional ao crescimento da íntima (r = 0,85, p < 0,001).Conclusão:A terapia de indução de rotina com basiliximab está associada à redução do crescimento da camada íntima do vaso no primeiro ano após o transplante cardíaco.

ABO Incompatability in Liver Transplantation / 한양의대학술지

Despite the great potential of ABO-incompatible (ABOi) liver transplantation (LT) for expanding the donor pool, serious concern about poor outcomes in the recipients has been a major obstacle to its widespread. The use of ABOi living donors is an attractive solution for expanding the liver donor pool, and various novel strategies for desensitization of ABO incompatibility have yielded promising results. The 1st breakthrough was local graft infusion therapy introduced by the Keio and Kyoto group; a second, epochal advance was the advent of the anti-CD20 monoclonal antibody, rituximab. Since then, the risk of fulminant hepatic necrosis caused by full-blown antibody-mediated rejection (AMR) has almost disappeared, and survival outcomes of ABOi LT have increased markedly. In the Korean experience, ABOi LT accounts for 18% of all adult living donor liver transplantation, and 3-year graft and patient survival rates are 86.5 and 87.6%, respectively. ABOi living donor LT is thus having a major impact on the donor pool and the recent achievements permit us to promote a nationwide ABOi LT program. However, concern still remains about diffuse intrahepatic biliary stricture (DIHBS), which is an attenuated form of AMR. Ultimately, we need to identify risk factors and preventive measures for this.

Linfoma marginal del bazo asociado a acidosis láctica tipo B: Caso clínico / Type B lactic acidosis associated with marginal lymphoma of the spleen: Report of one case

Lactic acidosis in the absence of hypoxia or tissue hypoperfusion (type B) is very rare and is associated with the use of some drugs or malignancy. We report a 79-year-old woman, with a marginal non-Hodgkin's lymphoma of the spleen that was subjected to a splenectomy one year ago. She presented with unexplained tachypnea associated with pancytopenia and elevation of IgM to 10 times over the higher normal limit. Laboratory tests showed the presence of metabolic acidosis and high lactic acid levels in the absence of infection, tissue hypoxia or hypoperfusion. She was treated with sodium bicarbonate and steroids without obtaining a reduction in lactate levels. Twelve days after admission, a single dose of Rituximab quickly normalized lactate concentrations and platelet count. After the fourth dose of Rituximab, pancytopenia disappeared and IgM fell to 25% of its baseline concentration.