The changing role of radiotherapy in AIDS-related malignancies

OBJECTIVE

To review the current literature on the role of radiotherapy in AIDS-related malignancies published since 1997.

METHODS

A comprehensive literature review was undertaken to review the recent advances in the role of radiotherapy in the management of AIDS-related malignancies. This was combined with the clinical experience from our two London treatment centres for AIDS-related malignancies. A Medline/Pubmed search was performed for articles published since 1997, the year of the previous review, which also coincides with the widespread usage of highly active antiretroviral treatment (HAART). The MESH search terms used were 'HIV or AIDS' and 'radiotherapy'. This search yielded a total of 86 references.

CONCLUSIONS

HAART has had a major impact on the role of radiotherapy in AIDS-related malignancy. The use of HAART has led to a decline in the incidence of Kaposi's sarcoma (KS) and non-Hodgkin's lymphoma and has been associated with an improved prognosis in systemic non-Hodgkin's lymphoma in people with HIV. In addition HAART alone has been successfully used as therapy for early KS lesions. Chemoradiotherapy remains the mainstay of management for anal cancer, has a central role in cervical cancer and non-AIDS defining malignancies in this population.

Anaphylaxis during general anaesthesia: one-year survey from a British allergy clinic

INTRODUCTION

Anaphylaxis during general anaesthesia is a major concern. Early recognition and management of anaphylaxis, as well as its future prevention, remain a challenge for the anaesthetists, while for the allergists, the elucidation of the causal agents may be difficult. We aimed to describe our experience in our drug allergy clinic.

METHODS

We retrospectively reviewed 23 consecutive adult patients who presented with anaphylaxis during anaesthesia from March 1, 2005 to February 28, 2006.

RESULTS

Out of the 23 patients (12 females, 11 males) with mean age (+/- SD) of 53.1 +/- 15.8 years, 15 patients were found to have a positive skin test to at least one neuromuscular blocking agent (NMBA); all of them showed cross-sensitivity with one or more NMBA(s). Three patients had a positive skin test to opioids, two patients to gelofusine, two patients to penicillin, and one patient each to povidone-iodine and chlorhexidine. Two patients had negative test results to agents used during their anaesthesia. Four patients had double positive skin tests to different families of drugs/agents. 18 patients had severe reaction-grade 3, and 15 of them tested positive for NMBA(s). Serum tryptase levels were known in nine patients. We did not encounter any latex or hypnotics sensitisation.

CONCLUSION

NMBA was the commonest cause of anaphylaxis during general anaesthesia, occurring in 65% in our series.