[Unilateral acneiform rash in facial palsy]. / Éruption acnéiforme unilatérale sur paralysie faciale.

BACKGROUND: Cetuximab is a chimeric monoclonal antibody selective for epidermal growth factor receptor (EGFR). It is increasingly used in epithelial cancer, often in combination with radiotherapy or chemotherapeutic agents, since it induces a broad range of cellular responses that enhance tumour sensitivity to these therapies. However, it can cause numerous adverse effects, the most common being acneiform eruption on the face and trunk, which is generally bilateral and symmetric. PATIENTS AND METHODS: Herein we present the first case of unilateral cetuximab-induced acneiform eruption in facial palsy. DISCUSSION: To our knowledge the medical literature contains no other such cases. Our hypothesis is that lymphoedema associated with facial palsy reduces lymphatic drainage, promoting the deposition of cetuximab on EGFR and persistence of local signs.

A prospective multicentre study on the safety of long-term intensive plasmapheresis in donors (SIPLA).

BACKGROUND AND OBJECTIVES: The safety of chronic intensive donor plasmapheresis has not been determined in large prospective studies examining dropout rates, dropout reasons and predictors of withdrawals. MATERIALS AND METHODS: Twenty-one plasma centres recruited 3783 donors who were switched from a moderate to an intensive plasmapheresis programme and observed over a 3-year period. Individuals weighing < 70 kg and > or = 70 kg donated 750 ml and 850 ml of plasma per session, respectively. The maximum of annual donations was limited to 60. Total serum protein (TSP) and haemoglobin (Hb) or haematocrit (Hct) were determined at each donation, and immunoglobulin G (IgG) at every fifth donation. Dropout rates, dropout reasons and potential predictors of withdrawal were analysed. RESULTS: Dropouts were predominantly due to socioeconomic (49.2% of all donors) or medical reasons not related to plasma donations (10.4% of all donors). Sixteen per cent of donors dropped out when IgG, TSP or Hb levels fell below threshold values. Severe clinical adverse events related to plasmapheresis were observed in five subjects. The incidence in severe cardiovascular diseases was lower in donors than in the general population. The risk factors that led to dropping out as a result of low IgG, TSP or Hb levels included younger age, female gender, low initial IgG levels and a high donation frequency. Neither body weight nor the amounts of plasma donated per kilogram of body weight per session were associated with ceasing due to medical reasons, whether related or unrelated to plasma donations. Females and males within the respective lowest body weight category were not at higher risk of dropping out. CONCLUSION: Long-term intensive donor plasmapheresis under conditions investigated in this study is safe. All donors weighing > or = 70 kg are safely able to donate 850 ml of plasma in each session up to 60 times per year, provided that they are carefully monitored.

Historia de los Cuidados Paliativos en Costa Rica dentro de la Seguridad Social / History of the development of Palliative Care in Costa Rica's Social Security System

En 1991 se inician los Cuidados Paliativos en el Hospital Calderón Guardia en San José, Costa Rica. En 1994 se decidió constituir una Fundación que sería un gran soporte económico y logístico para la unidad encargada de Cuidados Paliativos: la Clínica del Dolor. Esto contribuyó a alcanzar una mejor capacidad física y de recursos humanos para la atención de los pacientes. La Clínica del Dolor aumentó su capacidad de atención y el número de disciplinas involucradas. Esto permitió atender pacientes referidos de todo el país, dar atención domiciliaria y multidisciplinaria a los pacientes. En marzo de 1999 la Clínica del Dolor y se transformó en un centro de referencia nacional: el Centro Nacional de Control del Dolor y Cuidados Paliativos (CNCDyCP). El CNCDyCP ha continuado creciendo y mejorando la atención del paciente con dolor por cáncer y otras enfermedades incurables en Costa Rica. Actualmente es también un centro de docencia e investigación. Se ha capacitado personal del área de salud a nivel nacional y se han creado veinticuatro Clínicas del Dolor en todo el país. Estas se han iniciado de acuerdo a la incidencia de cáncer de las diferentes regiones. Además cuenta con un programa de investigación consolidado

The Palliative Care in Costa Rica began in 1991 in the Pain Clinic in the Calderón Guardia Hospital. In 1994 more health workers became interested in this field and began to work in Palliative Care. In that same year, the Foundation Pro-Pain Clinic was created. The Foundation became an important support for the Pain Clinic in the economical and administrative field. The Clinic continued growing and the material and human resources increased. The Clinic was able to give support to patients from all over the country and give attention to the patients at their home. Some other professional disciplines were included, in order to form a multidisciplinary team. In March 1999, the Pain Clinic was transformed in to the National Center of Pain Control and Palliative Care (CNCDyCP). Now the CNCDyCP has grown abruptly. It is in charge of the educational part in Palliative Care in Costa Rica. It has prepared people from all the country in order to form Pain Clinics in distant cities. These twenty four Pain Clinics are arranged accordingly to the national incidence of cancer. Also, the CNCDyCP has an organized department of investigation (AU)

[Adenocarcinomas of the ethmoid sinuses. Epidemiological data]. / Les adénocarcinomes de l'ethmoïde.

OBJECTIVE: The relationship between adenocarcinomas of the ethmoid (ADKE) and wood-dust exposure has been well established. Sino-nasal cancer in wood-workers has been added to the list of occupational disorders in France, as prescribed disease number 47-Bq. PATIENTS AND METHODS: Our data set consisted of 207 cases with sino-nasal cancer (from January 1985 to January 2001). Among these cases, 67.1% were adenocarcinoma. A wood dust exposure has been reported in 96.4% cases. The mean duration of wood dust exposure was 30 years. The mean latency between the end of the exposure and the diagnostic was 10.6 years. RESULTS: Our epidemiological data confirmed those from the biomedical literature. The occupations at greatest risk are furniture workers, sawmill workers, carpentry workers, and other wood product workers. Two components of exposure - duration and average level - contributed independently to the overall elevated risk. The risk is greater among men who were employed in jobs with the highest wood dust exposure and increases with the duration of exposure. CONCLUSIONS: The preinvasive stages of ADKE (mucostasis/cuboïd metaplasia/dysplasia) are still an unverified hypothesis. ADKE were observed in workers who use "hard" woods. The chemical nature of the carcinogenic factor(s) in wood dust is not known. The factors responsible for induction of ADKE in hard wood-workers probably exist in the wood-dust itself. Tannins were suggested as possible contributing agents to induction of ADKE. In addition to wood dust, exposures may include formaldehyde. Given these facts, it should be possible to define preventive measures, so that incidence of ADKE in professional wood and leather workers should decrease.

DNA-coated carbon adsorbents experimental assessment and results of severe psoriasis treatment.

Newly developed combined adsorbents, containing from 1 to 8 mg of thymic DNA per 1 g of the granulated or the fibrous carbonic matrix, demonstrated good biocompatibility and selectivity for DNA- and DNP-binding substances. In a group of 14 patients with severe psoriasis (uncontrol trial) a single hemoperfusion procedure through DNA-coated granulated synthetic carbons (perfusion volume was 2.5-3.1 L, sorbent quantity was 30 g) resulted in complete remission in 6 patients and in substantial improvement of clinical status in 6 other patients. A positive effect was observed in 4 patients during 7-11 months; in 8 patients it is being observed for more than 29-33 months. The double-blind tests in the group of patients subjected to hemoperfusion through the DNA-coated charcoal (27 people) and uncoated charcoal (9 people) showed the full-scale remission in 55.5% and 11.2% respectively. The authors believe that the DNA-coated activated carbons can be an effective therapeutic procedure for treatment of numerous immuno-dependent diseases and states associated with disorders in the kinetics of cell division.

Immunoadsorption and plasma exchange in multiple sclerosis: complement and plasma protein behaviour.

Three groups of patients suffering from acute attacks or progressive multiple sclerosis (MS) are under investigation. First results revealed remarkable clinical improvements of patients with acute attacks in the groups treated by therapeutic plasma exchange (TPE) and immunoadsorption (IA). Only slight or no improvements were seen in the patients of the control group treated only with steroids. Plasma protein levels (IgG, IgM, IgA, fibrinogen) were considerably reduced in patients of the TPE group after each treatment procedure as expected. The same holds true concerning the total hemolytic capacities (THC) of the complement of the classic (CP) and the alternative (AP) pathway. On the other hand in the IA group only slight decreases of plasma proteins (about 20%) were observed, but the behaviour of THC's were quite similar than those seen in the patients of the TPE group. The THC decreases in both groups can be explained by removal of all complement factors (TPE group) or by the adsorption of single factors (IA group) of both complement pathways according to earlier in vitro investigations. The THC decreases in patients of both groups suffering from acute MS attacks could mean an "antiinflammatory" effect and could--at least partially--contribute to the clinical improvements of these patients.

A newly developed LDL-binding material.

Results of in vitro and ex vivo experiments with a newly developed LDL-binding material are presented. This material consists of macroporous bead cellulose which is capable to bind selectively LDL. LDL-cholesterol is considerably decreased after contacts of plasma or serum samples with this bead cellulose. On the other hand high density lipoproteins (HDL) and other plasma components (proteins, enzymes, electrolytes, and metabolic substances) remained high or unchanged. Triglycerides (TG)--transported by very low density lipoproteins--are also bound up to a certain degree. 1 g of the adsorbent wet mass binds at least 20 mg cholesterol. The capacity suffices to decrease two- to threefold increased cholesterol and LDL plasma levels to the low normal range following passage of the sevenfold plasma volume' through two the three LDL adsorbent columns (results of perfusion experiments). In vitro and dog experiments revealed only slight drops of the hemolytic capacities of the classic complement pathway and moderate decreases of the alternative one. But no detectable side effects were noticed in the dog experiments.

Low density lipoprotein binding by macroporous bead cellulose.

Cellulose of a certain macroporous structure is capable of binding selectively low density lipoproteins (LDL) whilst maintaining high density lipoprotein (HDL) levels. It was ascertained that the porous structure of the cellulose causes binding of LDL and that also diffusion processes play a role. To a certain extent special bindings such as hydrogen bonds between cellulose and LDL and/or hydrophobic interactions may furthermore be of importance for the LDL fixation.

In vitro studies with selectively lipid adsorbing materials.

A new synthetic material was developed by ASAHI Chemical Industry Co., Ltd., Tokyo, Japan. In vitro studies revealed selective bindings of cholesterol, LDL (low density lipids) and beta-lipoprotein by this material. Maximal bindings were reached within 1 min, and therefore, the affinities of the LDL-adsorbent to these lipid components seem to be high. In contrast to these results the plasma values of HDL (high density lipids) and apoprotein A remained nearly unchanged. Triglycerides were removed only moderately. Investigations about lipid removing capacity of the new material with the plasma of patient with familiar hypercholesterolemia and studies about interactions with the complement system were also promising. Synthetic materials which are under development in G.D.R. showed similar lipid binding capacities.

In vitro investigations with selective adsorbents for IgE and IgM.

In vitro studies were carried out with IM-T. This adsorbent consists of polyvinyl alcohol joined with tryptophan side chains and was delivered by ASAHI Medical Co., Ltd., Tokyo/Japan. It was found that IM-T binds immunoglobulins G and M and also immune complexes only moderately but IgE was adsorbed in remarkable amounts. A clear dose-dependent was adsorbed in remarkable amounts. A clear dose-dependent manner of the IgE adsorption could be stated. Kinetic studies revealed that the binding was only slow and gradual.

Adsorption of immunologically relevant molecules--its present and future.

The development of numerous adsorbents of various types oblige us to define the used terms. Adsorbents functioning on the same principle as that of the binding between antigen and antibody should be designated as specific adsorbents or immunoadsorbents. All other kinds of adsorbing materials act more or less selectively. A review is given concerning investigations about selective adsorbents. The removal of IgG antibodies is possible with adsorbents of the protein A type. Synthetic materials with IgE and IgM binding properties are presented and are under development. The blocking of the complement system by binding certain components and breakdown products can be a worthwhile feature in view of the biocompatibility of adsorbing materials.