Emerging Therapies in Chronic Spontaneous Urticaria

Chronic spontaneous urticaria (CSU) is characterized by typically short-lived and fleeting wheals, angioedema or both, which occur spontaneously and persist for longer than 6 weeks. This term is applied to the most common subtype of chronic urticaria. The underlying pathophysiology for CSU involves mast cell and basophil degranulation with release of histamine, leukotrienes, prostaglandins and other inflammatory mediators. Although a variety of treatments exist, many patients do not tolerate or benefit from the existing therapies and even require more effective treatments. Omalizumab is currently the only licensed biologic for antihistamine-refractory CSU, and novel drugs are under development. This article reviews its current status regarding pathogenesis and approach to treatment as well as therapeutic agents that are under development for the treatment of CSU.

Superior vena cava obstruction [SVCO] in patients with advanced non small cell lung cancer [NSCLC]

To report on prognostic and treatment factors influencing the response of SVCO and related survival outcomes in advanced non small cell lung cancer. From November 2008 through December 2011, 18 consecutively diagnosed NSCLC patients with SVCO were included in this study. The patient, tumor and treatment related factors were analyzed. Median overall survival [OS], Kaplan -Meier survival plots, T-test, Cox Proportional Hazards models were generated by multiple covariates [MVA] and analyzed on SPSS software [version 19.0; SPSS, Inc., Chicago, IL]. Thirteen patients [72%] had presented with SVCO before the pathological diagnosis of underlying lung malignancy, while 5 [28%] progressed to SVCO after initiating treatment with chemotherapy. Twelve [68%] patients achieved subjective relief from the obstruction at the completion of palliative radiation therapy. Treating oncologists preferred 4 Gy per fraction in 11 [62%], while the median biologically equivalent dose delivered was 28 Gy. Six [33%] patients received chemotherapy during the course of treatment. Median OS of the entire cohort was 3 +/- 1.85mths and 1-year survival rate of 7%. Univariate analysis confirmed that SVCO patients with good performance score [p=0.02], and partial response to chemotherapy [p= 0.001] have superior OS. However, Cox regression modeling for MVA demonstrated only good performance SVCO patients [p = 0.05] have a better OS. RT effectively relieves SVCO but overall poor survival associated in our clinical scenario needs to be improved with multimodality approach. Adjuvant chemotherapy is to be considered after initial radiation therapy in good performance patients

Induced hypotension in a smoker

@#An episode of hypoxia following the use of propranolol and sodium nitroprusside to induce hypotension in a 50-year-old male patient undergoing craniotomy for frontal meningioma is described. The importance of proper preoperative screening of lung function and intraoperative monitoring of blood gases is highlighted.