ABSTRACT
BACKGROUND: Reactivation of hepatitis B virus (HBV) after rituximab-containing chemotherapy in patients with B-cell lymphoma has been recognized as a potentially serious complication in HBV immune patients. METHODS: To determine the HBV reactivation in patients treated with rituximab, a retrospective study of HBV-related markers was performed before and after rituximab-containing treatment in 261 consecutive patients with CD20-positive B-cell lymphoma. RESULTS: Of the 261 patients, 230 patients were tested for both hepatitis B surface antigen (HBsAg) and antibody to hepatitis B core antigen (anti-HBc) before treatment. Fifty-six (24.3%) of 230 patients were anti-HBc positive, and the remaining 174 (75.6%) patients were anti-HBc negative. Among the 56 anti-HBc-positive patients, 5 (8.9%) became HBsAg positive (HBV reactivation), whereas none of the 174 anti-HBc-negative patients became HBsAg positive with a median follow-up of 24 months (P = .001). Among the 5 patients with HBV reactivation, 4 were negative for antibody to HBsAg (anti-HBs), and 1 patient was positive for anti-HBs. All 5 of these patients were treated successfully with entecavir on detection of HBsAg, although 4 of the 5 patients exhibited mild to moderate elevation of alanine aminotransferase. Among 56 anti-HBc-positive patients, those negative for anti-HBs had a higher probability of developing HBV reactivation compared with those positive for anti-HBs (4 of 19; 21.1% vs 1 of 37; 2.7%, P = .014). CONCLUSIONS: Patients with isolated anti-HBc are at high risk of HBV reactivation and should be monitored closely for HBsAg, anti-HBs, HBV-DNA, and transaminase levels during and after rituximab-containing treatment. Although preemptive use of entecavir enabled successful management of HBV reactivation, mild to moderate hepatic flare was still observed. These approaches should be further evaluated in a prospective study with regard to clinical usefulness, safety, and cost-effectiveness.
Subject(s)
Antibodies, Monoclonal/adverse effects , Antigens, CD20/metabolism , Hepatitis B virus/isolation & purification , Hepatitis B/complications , Lymphoma, B-Cell/virology , Virus Activation , Adolescent , Adult , Aged , Aged, 80 and over , Antibodies, Monoclonal, Murine-Derived , DNA, Viral/analysis , Female , Hepatitis B Antibodies/analysis , Humans , Lymphoma, B-Cell/drug therapy , Lymphoma, B-Cell/immunology , Male , Middle Aged , Retrospective Studies , RituximabSubject(s)
Burkitt Lymphoma/diagnosis , Burkitt Lymphoma/therapy , Urinary Bladder Neoplasms/diagnosis , Urinary Bladder Neoplasms/therapy , Antineoplastic Combined Chemotherapy Protocols/therapeutic use , Biopsy, Needle , Combined Modality Therapy , Cord Blood Stem Cell Transplantation/methods , Cystoscopy , Diagnosis, Differential , Disease Progression , Fatal Outcome , Hematuria/diagnosis , Hematuria/etiology , Humans , Immunohistochemistry , Male , Middle Aged , Neoplasm Staging , Pyuria/diagnosis , Pyuria/etiology , Risk Assessment , Severity of Illness Index , Urinalysis , Whole-Body Irradiation/methodsABSTRACT
Robot-assisted minimally invasive surgery has become common in recent years. We used the da Vinci surgical system and managed anesthesia in 6 cases of bilateral internal mammary artery dissection and construction of a composite graft using the radial artery. To ensure vision inside the thoracic cavity, endoscopic robotic surgery employs the inflation of the thoracic cavity with carbon dioxide, producing a pneumothorax and turning the thoracic cavity into a positive pressure chamber. Thus, marked acidosis and circulatory changes manifest during anesthetic management. Although robotic surgery is considered "minimally invasive, such surgery involves a number of problems in terms of anesthetic management, and these problems must be examined.
