Primary effusion lymphoma in a patient with a good outcome on steroid alone treatment.

Same clinical entity can have different biology and can behave differently. This must be kept in mind while making therapeutic decisions. Primary effusion lymphoma is a rare and devastating disease with high fatality. Chemotherapy provides limited benefit. We describe a unique case of a good outcome with steroid alone treatment.

Adverse dose-dependent effects of morphine therapy in acute heart failure.

BACKGROUND: Morphine has been a pivotal therapy in acute heart failure (AHF) for more than a century. The evidence for morphine therapy in AHF remains controversial. This study sought to assess the therapeutic effect of morphine on patients with AHF. METHODS: The study used a cohort of 13,788 patients admitted with a primary diagnosis of AHF. Propensity-score-matching was generated using 26 clinical variables. Primary endpoints included in-hospital mortality and invasive mechanical ventilation. Secondary endpoints included non-invasive ventilation, need for inotropes and acute kidney injury (AKI). RESULTS: 761 (5.5%) patients were treated with morphine in the first day following hospital admission. Propensity score matching yielded 672 patient pairs. The incidence of invasive ventilation was higher in the morphine-treated patients (7.4%) than in matched patients in the no-morphine cohort (3.6%), OR 2.13 (95% CI 1.32-3.57, P = 0.007). In-hospital mortality was also higher in the morphine group (17.4%) than in the matched no-morphine group (13.4%), OR 1.43 (95% CI 1.05 to 1.98, P = 0.024). For both the endpoint of invasive ventilation (Ptrend = 0.005) and mortality (Ptrend = 0.004), there was a significant linear dose-response relationship for the adverse effect of morphine. Morphine was associated with a significant increase in all secondary outcomes: Non-invasive ventilation (OR 2.78, 95% CI 1.95-3.96); Inotrope use (OR 3.50, 95% CI 2.10-5.82) and AKI (OR 1.81, 95% CI 1.39-2.36). A landmark analysis demonstrated no difference in post-discharge survival between cohorts. CONCLUSIONS: Morphine administration is associated with significant dose-dependent risk for in-hospital mortality and need for mechanical ventilation.