ABSTRACT
We performed a randomized comparison of pre-emptive and empiric antibiotic therapy for adult patients undergoing allogeneic or autologous stem cell transplantation. One hundred and fifty-three patients were randomized to receive cefepime either pre-emptively on the day that neutropenia (ANC<1.0 x 10(9) cells/l) developed irrespective of the presence of fever, or at onset of fever and neutropenia (empiric). Although there was no difference between the two arms in the proportion of patients developing fever or in the median number of days of fever, the time to onset of fever was a mean of 1 day longer in each patient on the pre-emptive arm (log rank P<0.001). The number of patients with bloodstream infections was significantly reduced in those receiving pre-emptive therapy (16/75) compared to the empiric arm (31/76) (P<0.01) but this did not translate into an appreciable clinical benefit as measured by days of hospitalization, time to engraftment, use of additional antimicrobial agents or mortality at 30 days. This study does not support the use of pre-emptive intravenous antibiotic therapy in adult stem cell transplant recipients.
Subject(s)
Anti-Bacterial Agents/administration & dosage , Hematopoietic Stem Cell Transplantation/methods , Adult , Anti-Bacterial Agents/therapeutic use , Bacteremia/drug therapy , Bacteremia/etiology , Bacteremia/prevention & control , Bacterial Infections/drug therapy , Bacterial Infections/etiology , Bacterial Infections/prevention & control , Cefepime , Cephalosporins/administration & dosage , Cephalosporins/therapeutic use , Female , Fever/drug therapy , Fever/etiology , Hematopoietic Stem Cell Transplantation/adverse effects , Humans , Male , Neutropenia/drug therapy , Neutropenia/etiology , Time Factors , Transplantation, Autologous , Transplantation, Homologous , Treatment OutcomeABSTRACT
The features and management of two adult patients with ophthalmoplegic migraine and longlasting sixth nerve palsies are described. Both had had previous shorter episodes of diplopia following migraine-like headaches. One recovered following an injection of botulinum toxin to the medial rectus of her affected eye 11 months after the onset of diplopia. The other patient had previously had surgery for a consecutive divergent squint and required further squint surgery to realign his eyes 1 year after the onset of his sixth nerve palsy. Both botulinum toxin and squint surgery may be useful in the management of longstanding sixth nerve palsy in patients with ophthalmoplegic migraine. The aetiology of ophthalmoplegic migraine is discussed.
Subject(s)
Abducens Nerve Diseases/etiology , Abducens Nerve Diseases/therapy , Eye Diseases/therapy , Migraine Disorders/etiology , Migraine Disorders/prevention & control , Ophthalmoplegia/complications , Ophthalmoplegia/therapy , Adult , Female , Humans , Male , Treatment OutcomeABSTRACT
Autoantibody production following allogeneic stem-cell transplantation is common and is often ascribed to the immune dysregulation associated with graft-versus-host disease. Recent data suggests that donor-memory B cells can be reactivated on exposure to antigen and result in antibody production in the recipient identical to that seen in the donor. Here we describe the production of autoantibodies in a recipient of bone marrow from a donor with systemic lupus erythematosus and antiphospholipid syndrome. Autoantibody appearance was precipitated by the onset of graft-versus-host disease, was identical to that of the donor, and ultimately lead to cerebrovascular thrombosis, which was successfully treated with antiplatelet and anticoagulant therapy.
Subject(s)
Antiphospholipid Syndrome/etiology , Bone Marrow Transplantation , Graft vs Host Disease/immunology , Leukemia, Myelogenous, Chronic, BCR-ABL Positive/therapy , Adult , Antiphospholipid Syndrome/immunology , Autoantibodies/analysis , Autoantibodies/immunology , B-Lymphocytes/immunology , Bone Marrow Transplantation/immunology , Humans , Immunologic Memory , Lymphocyte Activation/immunology , Male , Tissue Donors , Transplantation, HomologousABSTRACT
Gastrointestinal stromal tumors (GIST) are the most common mesenchymal neoplasms of gastrointestinal tract. The tumors express the cell surface transmembrane receptor KIT that has a tyrosine kinase activity and is a protein product of KIT protoeoncogene. These tumors occur in the whole of Gastrointestinal tract. Treatment includes surgical resection for localized tumors. For metastatic disease treatment options include systemic chemotherapy, radiation therapy, with a response rate of less than 10%. Presently Imatinib; a tyrosine kinase inhibitor has shown promising result with response rates upto 59-69% in phase II results in metastatic setting; and ongoing phase II & phase III trials in adjuvant setting will help to establish its role as an adjuvant to surgery. We have treated eleven patients of metastatic GIST with Imatinib and we hereby present these cases.
