Bone marrow biopsy can be omitted in the diagnostic workup of CNS lymphoma of DLBCL origin: a population-based retrospective study in the PET-CT era.

Currently, bone marrow (BM) biopsy (BMB) is recommended in the initial staging of patients with the presumed primary central nervous system (CNS) lymphoma (PCNSL). However, the added value of BMB in the era of positron emission tomography (PET-CT) has been challenged in other lymphoma subtypes. We analyzed BM findings in patients with biopsy-proven CNS lymphoma and a negative PET-CT scan for disease outside CNS. A comprehensive Danish population-based registry search was performed to identify all patients with CNS lymphoma of diffuse large B cell lymphoma (DLBCL) histology with available BMB results and staging PET-CT without systemic lymphoma. A total of 300 patients fulfilled the inclusion criteria. Of them, 16% had a previous history of lymphoma, while 84% were diagnosed with PCNSL. None of the patients had DLBCL in the BM. A minority (8.3%) had discordant BMB findings, mainly low-grade histologies that did not influence treatment choice in any case. In conclusion, the risk of overlooking concordant BM infiltration in patients with CNS lymphoma of DLBCL histology and negative PET-CT scan is negligible. As we did not find any patient with DLBCL in the BMB, our results suggest that BMB can be safely omitted in the diagnostic workup in patients with CNS lymphoma and a negative PET-CT.

The effect of short-course gentamicin therapy on kidney function in patients with bacteraemia-a retrospective cohort study.

The nephrotoxic potential of aminoglycosides is primarily correlated to the duration of therapy. However, there are discrepancies between previous studies regarding the effect of short course treatment. The aim of this study was to compare renal function, renal recovery and mortality in a large cohort of patients with bacteraemia, who were empirically treated with regimens with and without a short course (≤ 3 days) of once daily dosing of gentamicin. This was a retrospective propensity score-matched cohort study based on all patients with bacteraemia in a Danish hospital in the period 2010-2013. We included 702 patients who received gentamicin, and 702 who did not receive gentamicin. To determine the impact of gentamicin on renal function, we used a modified version of the Kidney Disease: Improving Global Outcomes (KDIGO) criteria for acute kidney injury (AKI), and the resulting data were analyzed by logistic regression. We used Cox regression analysis to compare the adjusted mortality rates between the two groups. According to the KDIGO criteria, we found no significant difference in the occurrence of AKI between the two groups (odds ratio (OR) 0.90 (95% CI 0.68-1.20)). We found that recovery of renal function was similar in the two groups, OR 1.00 (95% CI 0.63-1.60). The hazard ratio for 90-day all-cause mortality was 1.02 (95% CI 0.84-1.25). Short-course empirical gentamicin treatment of patients with bacteraemia was not associated with an increased incidence of AKI nor all-cause mortality in this study, and we observed similar reversibility of renal function.

[Septic shock in intensive care]. / Septisk shock på intensivafdeling.

INTRODUCTION: Patients in septic shock have a 33-42% 30-day mortality, but characteristics and outcome have not been assessed in Danish intensive care units (ICUs). MATERIAL AND METHODS: This is a cohort study with prospective registration over a 3-month period of all patients suffering from septic shock at six Danish ICUs. We registered admission-, disease- and treatment characteristics during the first day after the diagnosis and 30- and 90-day mortality. RESULTS: A total of 132 patients with a median age of 64 years (range 15-92 years) were included. Patients were primarily admitted from general wards (n = 56), operation- (31) and emergency rooms (25) and other hospitals (19). Most were diagnosed at ICU admittance. Abdominal focus of infection was most frequent (n = 47) followed by pneumonia (45), soft tissue (14), urinary tract (8), other (6) and unknown (11). Most patients were resuscitated with a combination of crystalloids and colloids (98) and noradrenalin (119), and 100 had broad-spectrum antibiotics prior to the diagnosis, while 27 received such medication 120 (2-450) mins. after diagnosis. Mortality at 30 and 90 days was 33 and 41%, respectively - and highest for patients with abdominal infection 42 and 55%, respectively. CONCLUSION: Patients in septic shock in Danish ICUs are admitted from different hospital locations, have abdominal or pulmonary foci, but the treatment is relatively uniform. The mortality is high, but at par with the best results from other countries.