Use of proton pump inhibitors in hematopoietic stem cell transplantation does not increase the frequency of febrile neutropenia

OBJECTIVE

Despite the fact that proton pump inhibitor (PPI) use is a risk factor for infections in heterogeneous groups of patients, there are only a limited data related to PPI use and febrile neutropenic episodes (FNEs) in hematopoietic stem cell transplantation (HSCT) patients.

PATIENTS AND METHODS

In a 7-year period, we retrospectively reviewed 145 HSCT data to identify a risk factor for PPI use for febrile neutropenia. The follow-up process of 125 (86.2%) of the HSCTs was complicated with FNEs.

RESULTS

A multivariate analysis indicated that PPI use was not significantly associated with FNEs (Odds ratio [OR]: 0.46; 95% Confidence Interval [CI] 0.12-2.16; p = 0.24) or bacterial culture positivity (OR: 1.37; 95% CI 0.45-4.18; p = 0.58).

CONCLUSIONS

Our study revealed that PPI use does not appear to be a risk factor for FNE or bacterial culture positivity for HSCT patients but further studies are needed.

The association between COX-2 expression and survival in myeloma patients

BACKGROUND

Increased cyclooxygenase-2 (COX-2) expression has been associated with poor prognosis in multiple myeloma (MM).

AIM

This study examined the relationship between COX-2 expression in bone marrow and prognosis in MM patients.

PATIENTS AND METHODS

Bone marrow biopsy samples of 67 newly diagnosed MM patients were examined immunohistochemically for COX-2 expression. Mean age of the patients was 52.69 years (52.69 ± 9.17) and median follow-up time was 99.5 months (range: 6-170 months).

RESULTS

Of all patients, 30 (44.8%) were COX-2 positive and 37 (55.2%) were COX-2 negative. Median overall survival (OS) was 78 months (range: 54.07-101.92 months) among all patients, 75 months (range: 45.61-104.38 months) in COX-2-positive patients, and 98 months (range: 50.36-145.63 months) in COX-2-negative patients. Median progression-free survival (PFS) was 30 months (range: 3-134 months) in all, 29.5 months (range: 3-68 months) in COX-2-positive and 35 months (range: 3-134 months) in COX-2-negative patients. Statistically significant differences in OS and PFS between COX-2-positive and COX-2-negative patients were not observed (p = 0.84 and p = 0.22, respectively). Differences between the COX-2-positive and COX-2-negative patients in gender, hemoglobin, β2-microglobulin (β2M), creatinine, albumin, and disease stage were not statistically significant.

CONCLUSIONS

COX-2 expression neither had a role in prognosis nor significantly affected OS and PFS. We conclude that stem cell transplantation might eliminate the detrimental effects of COX-2 positivity. Larger series of patients are needed to investigate this observation.

Syndrome of inappropriate antidiuretic hormone secretion refractory to treatment in a newborn with alobar holoprosencephaly

Alobar holoprosencephaly (AHP) is a serious malformation of the central nervous system characterized by complete failure of cleavage of the prosencephalon resulting in fusion of the cerebral hemispheres and a massive single ventricular midline fluid collection. Secretion of inappropriate antidiuretic hormone syndrome (SIADH) is a disorder of fluid-electrolyte balance caused by the inability to suppress the secretion of antidiuretic hormone (ADH) resulting in the development of hyponatremia. Coexistence of both of these entities has not been described in the literature. We report a newborn infant with AHP who had resistant SIADH refractory to treatment, to draw attention to the coexistence of these entities and to contribute to the literature with the management of this challenging condition.

Vascular catheterization is difficult in infants with Down syndrome

BACKGROUND

Our aim was to compare difficulties in vascular access interventions in infants with and without Down Syndrome (DS) undergoing congenital heart surgery.

METHODS

The anesthesia records of infants with DS undergoing congenital heart surgery (Group DS, n=61) were reviewed and matched with records of infants without DS (Group ND, n=61). Vascular cannulation sites, the experience of the anesthesiologists performing each procedure, the number of clinicians who attempted each procedure until it was successfully performed, and the number of attempts for each catheterization were recorded.

RESULTS

The rate of unsuccessful peripheral venous cannulation in any of the four extremities was higher in Group DS (P=0.026). The success rate of radial artery cannulation was lower in Group DS (P=0.048). Although the total number of attempts for arterial cannulation was higher in Group DS, the difference was not statistically significant (P=0.058). However, in Group DS, the clinician who was able to cannulate the artery successfully required a significantly higher number of attempts at cannulation (P=0.011). For central venous catheterization, cannulation site and the number of attempts required before success was achieved were similar in both groups. The specialist-to-resident ratio was higher in Group DS (P=0.037).

CONCLUSION

Our results indicate a trend toward clinicians having more difficulty performing arterial and peripheral venous catheterizations in infants with DS compared with performing the same procedure in infants without DS. Anesthesiologists should be prepared for catheterization difficulties in this patient population. In infants with DS, we recommend that catheterizations be performed by more experienced physicians.

A comparison of pre-emptive analgesic efficacy of diflunisal and lornoxicam for postoperative pain management: a prospective, randomized, single-blind, crossover study

Diflunisal and lornoxicam are currently available non-steroidal anti-inflammatory drugs (NSAIDs) that have been shown to be effective to various degrees in pain relief when administered either pre-emptively or postoperatively. The pre-emptive analgesic efficacy of diflunisal 1000 mg was compared with that of lornoxicam 16 mg in 40 ASA I patients undergoing surgical removal of bilateral impacted third molars. The impacted third molar teeth on one side were removed at the first surgical appointment using one of the two drug regimens being assessed and the teeth on the contralateral side were removed at a second appointment using the alternate drug regimen; all operations were performed by the same surgeon. Acetaminophen up to 2000 mg daily was provided as rescue medication. The postoperative rescue analgesic consumption was recorded and pain scores were evaluated with a visual analogue scale at 2, 4, 6, 12 and 24h postoperatively. No statistically significant differences were found between groups with respect to rescue analgesic consumption and postoperative pain scores. Pre-emptive administration of both NSAIDs proved to be effective in the management of pain following the surgical removal of impacted third molar teeth.

Intra- and postoperative complications of donor nephrectomies

INTRODUCTION

Living-donor renal transplantation has become common worldwide. However, living-donor nephrectomy is not a complication-free procedure. This retrospective study reviews the intra-and postoperative risks and complications of donor nephrectomies at our institution between 1994 and 2002.

METHOD

Two hundred fifty-seven consecutive donor nephrectomy patients were evaluated using medical records and anesthetic charts.

RESULTS

The mean age of living donors was 42 +/- 12 years: 19 were older than 61 years, and 143 (55.6%) were women. Anesthesia for donor nephrectomy included general anesthesia, combined spinal-epidural anesthesia (CSE), general + CSE, and general + epidural anesthesia. We observed 51 intra- and postoperative complications in 26 patients. The minor complication rate was 10.1%. The duration of surgery was 3.56 +/- 0.26 hours (range, 2 to 5 hours). Serum creatinine levels were increased significantly (P < .05) on postoperative days 1, 3, and 5 compared with the preoperative levels (P < .05). There was no mortality.

CONCLUSIONS

Like other surgical operations, living-donor nephrectomy is associated with intra- and postoperative complications. Although these complications are minor, maximal efforts must be applied in the anesthetic approach to minimize donor complications, and donors should be informed about potential risks.

Acute myeloblastic leukemia in pregnancy: a case report and review of the literature

Leukemia is a rare event during pregnancy. The presence of leukemia during pregnancy raises several concerns about the effect of pregnancy on the prognosis of leukemia, the effect of the disease on pregnancy outcome and the teratogenic and mutagenic effect of chemotherapeutic agents on the fetus. We report a case of acute myeloblastic leukemia diagnosed during the third trimester of gestation and treated with chemotherapeutic agents before delivery. The duration of pregnancy was able to be prolonged for four weeks after clinical diagnosis of the disease and then terminated by cesarean section due to the presence of signs of fetal distress.

Activated protein C resistance in preeclampsia

OBJECTIVE

Recently. hereditary and acquired diseases that lead to thromboembolic events by changing the hemostatic balance have attracted interest as a cause of preeclampsia. In this study the incidence of activated protein C resistance (APCR) in preeclamptic women was evaluated.

METHODS

Activated protein C sensitivity ratio (APC-SR) was measured by the modified activated partial thromboplastin time (APTT) method in 19 preeclamptic and 12 healthy pregnant women and 26 normal women as the controls. Results below the levels of 2 were accepted as the presence of APCR.

RESULTS

Median APC-SR values of 2.12 and 2.01 in preeclamptic and healthy pregnant women, respectively, were found significantly lower than the normal control values of 2.31 (p = 0.0005, p = 0.001). APCR was detected in 31% of preeclamptic patients, 16.6% of healthy pregnant women and 7.6% of normal controls.

CONCLUSION

APCR was found significantly higher in preeclamptic women and it may play an important role in the pathogenesis of preeclampsia.