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Treatment of a patient with chronic renal failure with rituximab for a follicular lymphoma: safe and successful option of rituximab therapy.

A 47-yr-old woman presented a chronic renal failure for 5 yr, with a creatinine clearance of 12 mL/min. In June 2002, she had a right axillary lymph node (of 4 cm diameter). A biopsy revealed a follicular lymphoma (histology: follicular small cleaved-cell). She had Ann Arbor stage III disease, with a high tumor burden according to the GELF criteria. She received rituximab as single first-line treatment (375 mg/m2 by intravenous infusion for a total of four dosages: days 1, 8, 15 and 22). Rituximab therapy was extremely well tolerated, and we obtained a partial response, 4 wk after completing the treatment. In January 2003, she received one maintenance course of rituximab. Six weeks after maintenance therapy, a complete response was achieved.

Antibodies, Monoclonal↗

Temporal processing in the basal ganglia.

This study investigated the role of the basal ganglia in timing operations. Nondemented, medicated Parkinson's disease (PD) patients and controls were tested on 2 motor-timing tasks (paced finger tapping at a 300- or 600-ms target interval), 2 time perception tasks (duration perception wherein the interval between the standard tone pair was 300 or 600 ms), and 2 tasks that controlled for the auditory processing (frequency perception) demands of the time perception task and the movement rate (rapid tapping) in the motor-timing task. Using A.M. Wing and A.B. Kristofferson's (1973) model, the total variability in motor timing was partitioned into a clock component, which reflects central timekeeping operations, and a motor delay component, which estimates random variability due to response implementation processes. The PD group was impaired at both target intervals of the time perception and motor-timing tasks. Impaired motor timing was due to elevated clock but not motor delay variability. The findings implicate the basal ganglia and its thalamocortical connections in timing operations.

Aged↗

What can we do about acute extrapyramidal symptoms?

Antipsychotic drugs are the most effective treatment for psychotic disorders such as schizophrenia. However, they are known to cause a range of side-effects including acute extrapyramidal symptoms (EPS) that are both distressing and disabling. Mental health nurses play a critical role in both the detection and the management of these symptoms. A review of the literature was conducted to identify strategies for managing acute EPS. Despite a widely held belief that EPS are associated with noncompliance with medication, the data to support this hypothesis are weak. Although akathisia may negatively affect the treatment outcome, there was little evidence to suggest that parkinsonism or dystonia do. Whilst the use of anticholinergic medication may be helpful in treating acute parkinsonism and dystonia they were associated with their own side-effects and the benefit of long-term prophylactic treatment is doubtful. The literature suggests that logical prescribing and rapid detection and management of acute EPS will result in a substantial reduction in the incidence of these disabling side-effects.

Antipsychotic Agents↗

Physical signs associated with excessive television-game playing and sleep deprivation.

BACKGROUND: To elucidate significance of physical signs seen in excessive television-game (TVG) players complaining of unexplained persistent symptoms, a cross-sectional cohort study was designed. METHODS: A total of 1143 school children, aged between 6 and 11-years-old, and their parents were included in the study. Questionnaires were sent to guardians asking the number of hours that their children watched TV, TVG, and slept. All children were examined to check for three physical signs, black rings in the skin under the eye (BR), muscle stiffness in the shoulder (MS), and displacement of the scapula associated with muscle stiffness in the shoulder (DS/MS) by inspection and palpitation. RESULTS: The three signs, BR, MS and DS/MS, were present in 165 (14.4%), 229 (20.0%) and 72 (6.2%) children, respectively. Boys had greater frequencies of two signs than girls (BR, 19.6% vs 8.9%, P<0.01; MS, 26.1% vs 13.6%, P<0.01), respectively. Boys spent more time on TVG playing than girls (1.1+/-0.7 h/day vs 0.4+/-0.6 h/day, P<0.0001), respectively. Excessive TVG players, who spent > or = 1 h/day for TVG had greater frequencies of two signs, BR and MS, than those of non-TVG-players (18.9% vs 13.0%, P<0.05; 25.6% vs 14.4%, P<0.01), respectively. The TVG playing time correlated with two signs, BR (P=0.0143) and MS (P=0.0048). Furthermore, sleep deprivation related to three signs, BR (P=0.0078), MS (P<0.0001) and DS/MS (P=0.0290). CONCLUSIONS: Excessive TVG playing links to the occurrence of BR and MS. Other factors, which cause sleep deprivation, may underlie in the occurrence of the three signs. The amount of time spent on TVG playing should be regulated to < 1.0 h/day.

Child↗

Anaesthetic management for the child with a mediastinal mass.

Administering anaesthesia to a child with an anterior mediastinal mass may lead to respiratory or circulatory collapse, even in those without symptoms. Institutions should have algorithms to manage children with mediastinal masses. Preoperative evaluations should include computed tomography, echocardiography and flow-volume studies. Anaesthesia may be induced with inhalation agents and maintained with spontaneous respiration via facemask or laryngeal mask airway. Alternatively, positive-pressure ventilation may be used, including tracheal intubation without muscle relaxants. Rigid bronchoscopy may be life-saving in the event of tracheal or bronchial collapse under anaesthesia.

Algorithms↗

The effect of stage of Parkinson's disease at the onset of levodopa therapy on development of motor complications.

The aim of this study was to ascertain whether the stage of Parkinson's disease (PD) (according to the Hoehn and Yahr staging system) would affect the length of time between the introduction of levodopa therapy and appearance of levodopa-associated motor complications. Forty patients with clinically definite PD were studied. In all, clinical and therapeutic data were collected from the time of diagnosis to the time of levodopa-associated motor complications (i.e. dyskinesia, motor fluctuations). In 17 patients, levodopa could be started in Hoehn and Yahr stage I (H & Y-I; 16.2 months after the onset of PD), whilst in 13 patients levodopa could be started in H & Y-II (19.6 months after the onset of the disease) and in 10 in H & Y-III (45.1 months after the onset of PD). Cox proportional hazard regression model shows that the PD patients in whom the initial levodopa treatment was introduced at stage III develop both dyskinesias and motor fluctuations significantly earlier than the patients whose levodopa started in stage I and II of PD. The median interval to develop dyskinesias was 66, 72 and 24 months for patients in whom levodopa was introduced in stage I, II and III, respectively. These values were 64, 55 and 14 months for motor fluctuations. These findings add to the clinical arguments that favour an essential role of severity of PD at levodopa initiation as a risk factor for the development of levodopa-associated motor complications.

Age of Onset↗

A randomized controlled trial comparing the frequency of acute reactions to plasma-removed platelets and prestorage WBC-reduced platelets.

BACKGROUND: Removal of the plasma supernatant from platelets before transfusion is effective in preventing acute reactions to platelets caused by cytokines. Prestorage WBC reduction of platelets may be even more effective at preventing reactions as the WBCs are removed and WBC-derived cytokines do not accumulate in this component. This study evaluates the effectiveness of plasma removal and two methods of prestorage WBC reduction for preventing acute reactions to platelets. STUDY DESIGN AND METHODS: Platelets given to adults with hematologic malignancies were randomly allocated to one of three types: plasma supernatant removed and a platelet storage solution added, whole blood-derived platelets that are prestorage WBC reduced by filtration before storage, and prestorage WBC-reduced apheresis platelets. Patients were monitored before, during, and after transfusion, and the severity of reactions was graded on a Likert scale. RESULTS: A total of 129 patients from four centers were given 1190 platelet transfusions. The overall frequency of reactions was 13.6 percent (162 of 1190), 21.3 percent (36 of 169) for the plasma-removed platelets, 11.4 percent (59 of 517) for random donor WBC-reduced platelets, and 13.3 percent (67 of 504) for apheresis WBC-reduced platelets (p=0.384). The overall frequency of severe reactions was 4.1 percent with plasma-removed platelets, 1.7 percent for whole blood-derived, prestorage WBC-reduced platelets, and 1.4 percent for prestorage WBC-reduced apheresis platelets. CONCLUSION: The frequency of reactions to plasma-removed platelets and prestorage WBC-reduced platelets was not significantly different; however, the power of the study for this comparison was low. There was no difference in the frequency of reactions to the two types of prestorage WBC-reduced platelets. The frequency of severe reactions to prestorage WBC-reduced platelets is low, occurring in only 1 to 2 percent of transfusions.

Adolescent↗

Alpha-dihydroergocryptine in the long-term therapy of Parkinson's disease.

The trial was designed as an open-label, post-authorisation safety study, aimed to complete the available information on adverse events and drug reactions to alpha-dihydroergocryptine (CAS 14271-05-7, alpha-DHEC). The study included 294 patients with idiopathic Parkinson's disease who received levodopa (CAS 59-92-7, L-DOPA) and started taking alpha-DHEC (Cripar). Adverse events were analysed descriptively, Parkinson's disease symptoms were documented using a questionnaire applied by the physicians. Patients were evaluated at study start and three and six months later, respectively. In 31 patients, 32 adverse events were observed, gastrointestinal and nervous system disorders being the most frequent. Dyskinesias, psychoses/hallucinations, sleep disturbances, and cardiovascular disorders were uncommon (< or = 1%). in total, 21 adverse events were classified as adverse drug reactions. In nearly 80 % of the cases, Parkinson symptoms had improved or completely vanished. Symptoms were unchanged in 16.7 % of patients and had worsened in 3.1%. The results confirm that the use of alpha-DHEC in combination therapy with levodopa in patients with Parkinson's disease is a well-tolerated and efficacious treatment option.

Aged↗

[Hyperekplexia -- a treatable neuropediatric disease].

Hyperekplexia (OMIM 138491) is primarily an autosomal dominant disease characterized by exaggerated startle reflex and neonatal hypertonia. If untreated it can be associated with sudden infant death from apnea or aspiration pneumonia and serious injuries. Different mutations of the alpha1-subunit of inhbitory glyzine receptor (GLRA1) could be found. Clonazepame, a gammaaminobutyric acid (GABA) receptor agonist is the therapy of choice. An early diagnose will lead to appropriate treatment and genetic counseling.

Amino Acid Sequence↗

[Incidence of rigor during treatment with flupentixol decanoate in comparison to risperidone].

STUDY OBJECTIVE: We investigated as to whether dosedependent extrapyramidal tolerance of Flupentixol decanoate is inferior to that of Risperidone. METHOD: 143 Risperidone and 177 Flupentixol decanoate treated patients were consecutively entered into this non - randomized open study and assessed with the Simpson-Angus-Scale regarding presence of rigor. Treatment comparisons of rigor frequency was done by Kaplan-Meier analysis. RESULTS: The risk of rigor increased with dose on both treatments. EPMS-risk was not increased under treatment with Flupentixol decanoate (mean dose 35.06 +/- 19.7 mg/2 weeks) compared to Risperidone (mean daily dose: 5.2 +/- 2.5 mg/kg) when comparable weight standardized Haloperidol equivalence doses (WHE) were used. CONCLUSION: This study offers limited evidence for methodological reasons. Yet, results do not support the view that EPS are more frequent on Flupentixol decanoate than on Risperidone when doses are comparable.

Adult↗

[Alterations of gait parameters under external cueing in schizophrenic patients: a switch study].

Schizophrenic disorders as well as neuroleptic treatment can affect locomotion. The study assessed the influence of neuroleptic treatment on externally triggered gait on a treadmill at three different velocities via ultrasonic topometric gait analysis. Spatial and temporal gait parameters were assessed in two groups of schizophrenic patients either under treatment with conventional neuroleptics (n = 12) or without neuroleptic treatment (n = 10) and re-assessed after treatment change to the atypical neuroleptic olanzapine in a repeated measures design. After switch from conventional neuroleptics to olanzapine patients showed an increase of step length and decrease of cadence at the low (p </= 0.01) and the intermediately low treadmill velocity (p </= 0.05), whereas the parameters remained stable at the normal gait velocity. Significant differences between the untreated state and treatment with olanzapine were not detectable. We conclude that conventional neuroleptic treatment impairs the regulation of gait parameters and that this effect can be reversed at slow gait velocities by external stimulation via treadmill walking.

Adult↗

[Interferon in chronic polyarthritis. Positive effect in clinical evaluation].

During the last two years, 80 patients with definite chronic rheumatoid arthritis were treated with interferon-gamma. Considerable improvement in the clinical picture occurred in 58, with pain decreasing rapidly and lastingly or even disappearing. Even in largely immobile patients the ability to walk and general mobility were nearly fully restored. The treatment was well tolerated in 74 patients. As the substance is administered subcutaneously it is suitable for out-patient treatment.

Analgesia↗