Successful management of chylous ascite after removal of residual mass in non-seminomatous germ cell tumours following chemotherapy: A single-center experience and review of the literature

INTRODUCTION

Chylous ascites is a rare but morbid condition following removal of residual mass in non-seminomatous germ cell tumours following chemotherapy.

CASE PRESENTATION

We hereby present the case of a 20-year-old man who had undergone RPLND with complete surgical excision. A lesion of the Cisterna chyli complicated the operation. The post-operative course was marked by the appearance of chylous ascites. The conservative management strategy for this complication was successful, but only after a month.

CLINICAL DISCUSSION

Chylous ascites is a rare but morbid condition following removal of residual mass in non-seminomatous germ cell tumours following chemotherapy. Conservative management based on a high-protein diet with fat restriction and medium-chain triglyceride supplementation, and somatostatine are usually successful. Surgery should be reserved for situations that are refractory to treatment.

CONCLUSIONS

We report our successful management and, we also analysed the different management protocols using our experience and review of the literature.

Pre-Transplant Marital Status and Hematopoietic Cell Transplantation Outcomes

Background

Evidence about the impact of marital status before hematopoietic cell transplantation (hct) on outcomes after hct is conflicting.

Methods

We identified patients 40 years of age and older within the Center for International Blood and Marrow Transplant Research registry who underwent hct between January 2008 and December 2015. Marital status before hct was declared as one of: married or living with a partner, single (never married), separated or divorced, and widowed. We performed a multivariable analysis to determine the association of marital status with outcomes after hct.

Results

We identified 10,226 allogeneic and 5714 autologous hct cases with, respectively, a median follow-up of 37 months (range: 1-102 months) and 40 months (range: 1-106 months). No association between marital status and overall survival was observed in either the allogeneic (p = 0.58) or autologous (p = 0.17) setting. However, marital status was associated with grades 2-4 acute graft-versus-host disease (gvhd), p < 0.001, and chronic gvhd, p = 0.04. The risk of grades 2-4 acute gvhd was increased in separated compared with married patients [hazard ratio (hr): 1.13; 95% confidence interval (ci): 1.03 to 1.24], and single patients had a reduced risk of grades 2-4 acute gvhd (hr: 0.87; 95% ci: 0.77 to 0.98). The risk of chronic gvhd was lower in widowed compared with married patients (hr: 0.82; 95% ci: 0.67 to 0.99).

Conclusions

Overall survival after hct is not influenced by marital status, but associations were evident between marital status and grades 2-4 acute and chronic gvhd. To better appreciate the effects of marital status and social support, future research should consider using validated scales to measure social support and patient and caregiver reports of caregiver commitment, and to assess health-related quality of life together with health care utilization.

Secondary solid cancer screening following hematopoietic cell transplantation

Hematopoietic stem cell transplant (HCT) recipients have a substantial risk of developing secondary solid cancers, particularly beyond 5 years after HCT and without reaching a plateau overtime. A working group was established through the Center for International Blood and Marrow Transplant Research and the European Group for Blood and Marrow Transplantation with the goal to facilitate implementation of cancer screening appropriate to HCT recipients. The working group reviewed guidelines and methods for cancer screening applicable to the general population and reviewed the incidence and risk factors for secondary cancers after HCT. A consensus approach was used to establish recommendations for individual secondary cancers. The most common sites include oral cavity, skin, breast and thyroid. Risks of cancers are increased after HCT compared with the general population in skin, thyroid, oral cavity, esophagus, liver, nervous system, bone and connective tissues. Myeloablative TBI, young age at HCT, chronic GVHD and prolonged immunosuppressive treatment beyond 24 months were well-documented risk factors for many types of secondary cancers. All HCT recipients should be advised of the risks of secondary cancers annually and encouraged to undergo recommended screening based on their predisposition. Here we propose guidelines to help clinicians in providing screening and preventive care for secondary cancers among HCT recipients.

Risk factors, characteristics and outcomes of necrotizing enterocolitis in late preterm and term infants

OBJECTIVE

To identify the risk factors, characteristics and outcomes of necrotizing enterocolitis (NEC) at our institution.

STUDY DESIGN

A retrospective case-control analysis of the charts of all late preterm and term infants, who had NEC of Bell's stage ≥ II from 1995 to 2009, along with infants of the same gestational age. Thirty-two late preterm infants had NEC meeting criteria and 128 late preterm and term infants were chosen as matched controls.

RESULTS

The 32 NEC infants were more likely to have the following characteristics: a culture-proven sepsis (p = 0.0001), be small for their gestational age (p = 0.003), have a congenital heart disease (p = 0.007), and suffer from hypoxic- ischemic encephalopathy (p = 0.04). The presence of hypotension, metabolic acidosis, thrombocytopenia, and pneumoperitoneum was associated with a poor prognosis. Twelve of the 13 (92%) NEC infants who died had a surgical intervention.

CONCLUSION

In this study, late preterm and term infants who developed NEC had other underlying clinical diagnoses and had culture-proven sepsis. Mortality rate was high in infants who required surgical intervention, indicating that they were gravely ill from the onset. Thrombocytopenia, hypotension and metabolic acidosis in late preterm and term infant with NEC were associated with poor prognosis.

Population pharmacokinetics of free carbamazepine in adult Omani epileptic patients

OBJECTIVE

The aim of this study was to define the pharmacokinetic profile of free carbamazepine (F-CBZ) in adult Omani epileptic patients in order to improve on dosing schedules through population pharmacokinetic analysis using the NONMEM program.

METHOD

Steady-state trough F-CBZ serum concentrations, carbamazepine (CBZ) dosing history and associated information were collected prospectively.

RESULTS

Forty-eight patients with two or more available F-CBZ serum concentrations (total of 149 dose/serum concentration pairs) met our inclusion criteria. Patients were taking CBZ (200-1200 mg/day) in monotherapy. The analysis assumed a one-compartmental open model with first-order absorption and elimination. The apparent clearance (CL/F) and apparent volume of distribution (V/F) and their interindividual variabilities were estimated using the program. The population estimates for clearance (CL; modelled independently of dose) and volume of distribution were 13.2 +/- 0.6 l/h and 525 +/- 44 1, respectively. However, CL increased as a function of dosing rate and consequently was modelled as a linear function of steady-state concentration. In order to validate these results, the predictions of the population model were tested against data from 13 further patients subjected to the same inclusion criteria but who were not included in the original analysis. The predictions were good, being unbiased (P=0.31), and had an average deviation from the observed values of 18%.

CONCLUSION

In order to establish steady-state dosage regimens, a population pharmacokinetic model is proposed, based on the patient's dose, to estimate the individual CL for an Omani epileptic patient receiving CBZ in monotherapy.

Selection of a Suitable Method for Analysis of Aflatoxins in Date Fruits

Fruits of the date palm (Phoenix dactylifera L.) are a vital component of the diet in most of the Arabian countries, but whether dates in the market are contaminated with aflatoxins is unknown. As screening will depend on accurate detection, the available AOAC Methods-with slight modification-for the recovery of aflatoxins were examined. The Romer minicolumn method failed to detect any aflatoxin in contaminated date fruits. Using the HPLC and postcolumn derivatization procedure, the contaminants branch (CB) method was found to give average recoveries of 75.7 and 83.5% for date varieties Lulu and Naghal, respectively. The recovery of total aflatoxins by the Best Food (BF) extraction and purification method was about 35% less than with the CB method.

Low concentrations of caffeine raise intracellular calcium concentration only in the presence of extracellular calcium in cultured molluscan neurons

1. The effects of low concentrations of caffeine (100 and 300 microM) on the intracellular calcium concentration [Ca2+]i in four cultured, identified neurons of the pond snail Lymnaea stagnalis (L) were investigated. 2. Intracellular CA2+ levels in these neurons were measured with the cell-permeable Ca2+ indicator Fura-2/AM, both in the presence and absence of extracellular Ca2 (o-Ca2+/EGTA). 3. In the presence of Ca2+ in the external medium, caffeine was found to induce a substantial elevation in the free [Ca2+]i in all cell types. 4. In some cases, the rise in [Ca2+]i was found to be both time- and concentration-dependent. 5. Low doses of caffeine did not produce any appreciable rise in [Ca2+]i in the absence of Ca2+ in the external medium, but calcium was still available from stores, as clinical concentrations of halothane rose [Ca2+]i in the absence of extracellular calcium. 6. These results indicate that the actions of caffeine, when applied at low concentrations, are dependent on extracellular calcium.

Caries experience, tooth loss and oral health-related behaviours among Bangladeshi women resident in West Yorkshire, UK

Several studies have reported high levels of caries experience among young Muslim Asian children, but there has been little corresponding information on adult dental health or related health behaviours. This paper presents the results of a questionnaire together with clinical oral findings among first generation Bangladeshi women aged over 25 years. The majority chewed betel quid with tobacco, were of rural origin, used traditional oral hygiene practices and had never visited a dentist. Of the 247 examined, only one was edentulous. A very low level of caries experience was recorded, a mean DFT score of 1.87 at 25-34 years of age, with an average of 1.05 missing teeth. Coronal caries experience was found to be independent of oral hygiene methods, including the use of fluoride toothpaste, or the frequency of betel quid chewing. It was concluded that Bangladeshi adult women have considerably lower levels of caries experience and tooth loss than United Kingdom adults as represented in recent national surveys.

Dentists' perceptions of difficulties encountered in providing dental care for British Asians

British Asians represent a substantial proportion of the population in some parts of the United Kingdom, yet many fail to use dental services regularly. This study aimed to investigate dentists' concerns about providing care for this client group. Following a pilot study, a postal questionnaire was sent to general dental practitioners and community dental officers working in seven family health services authority localities. Of 1546 questionnaires circulated, 639 (41 per cent) were returned. The language barrier was most frequently identified as a major impediment to care (78 per cent), followed by patients' understanding of treatment proposed (67 per cent), while 64 per cent found difficulty obtaining medical histories. Only 20 per cent considered that gaining consent for treatment was a problem. Other issues concerned attendance as casual patients (65 per cent) and, in terms of treatment provided, difficulties with preventive (77 per cent), periodontal (66 per cent) and orthodontic care (27 per cent). The proportion of dentists identifying barriers to care reflected the English-speaking abilities of different Asian populations. Compared with the high percentage mentioning language, understanding and medical history, the small proportion of dentists who thought that consent was of concern suggests that concepts of consent may need to be questioned. Despite the low response rate, the high proportion of respondents identifying these issues implies that the present position may put patients' health at risk, restrict treatment options and offer a potential for litigation. Future initiatives to overcome barriers to appropriate care must address the perspectives of dentists treating British Asians, as well as that of the client group.

Ethnicity, health and dental care--perspectives among British Asians: 2

In some areas, Asian communities constitute a sizeable proportion of the population around a general dental practice, yet some have never been to a dentist in the whole of their lives. A significant number of others fail to visit a dentist regularly. This two-part article aims to clarify some of the issues relating to dental care of minority groups, with particular reference to Asian communities. part 1 identified dental health problems characteristic of British Asians, Part 2 now examines some of the barriers to care.

Ethnicity, health and dental care--perspectives among British Asians: 1

In some areas, Asian communities constitute a sizeable proportion of the population around a general dental practice, yet some have never been to a dentist in the whole of their lives. A significant number of others fail to visit a dentist regularly. This two-part article aims to clarify some of the issues relating to dental care of minority groups, with particular reference to Asian communities. An outline is given of some general and dental health issues which are of particular significance to dental practitioners, as they strive to provide continuous care to the whole population. Part 1 identifies dental health problems characteristic of British Asians, Part 2 will examine some of the barriers to care.