95 research outputs found
Follicular lymphoma: still six characters in search of an author?
No full textFollicular lymphoma (FL) is regarded as a distinct entity in the literature as well as in the 2008 edition of the WHO classification of tumours of haematopoietic and lymphoid tissues.Nevertheless, there are still several issues that are matters of controversy such as the grading system or the exact biological location of grade 3B FL. This makes FL somewhat like the Six characters in search of an author of Pirandello's comedy. Here, we revise the morphology and pathobiology of FL by highlighting both the areas remaining critical and future perspectives. This review was inspired by the reappraisal of Professor Lennert's personal archive that represents a unique legacy for the entire scientific community
Drugs that act on the immune system
No full textThis review of the 2010 publications on immunosuppressive and immunostimulatory or immunoenhancing drugs covers ciclosporin, cyclophosphamide, everolimus, leflunomide, methotrexate, mizoribine, mycophenolate mofetil, sirolimus, tacrolimus, temsirolimus, the thiopurines, and the immunoenhancing drugs levamisole, picibanil, and thymosin α-1; there are also special reviews on fingolimod, glatiramer, gusperimus, imexon, and semapimod.</p
Infectious complications in hematology patients: A clinical focus on prevention
Full text linkThe aim of this thesis was to contribute to infection preventive
strategies in hematology patients with prolonged neutropenia.
Invasive pulmonary aspergillosis (IPA) develops by pulmonary deposition of
conidia. A placebo-controlled trial on the efficacy of prophylactic
aerosolized liposomal amphotericin-B (L-AmB) was performed in hematology
patients during treatment-related neutropenia. For the intent-to-treat
analysis, 18 of 132 placebo patients developed IPA, versus 6 of 139 in
L-AmB patients (P=.005). Short-term prophylactic nebulization of liposomal
amphotericin B was not associated with decline in pulmonary function or
systemic adverse effects, only coughing was significantly more reported.
In a study among acute leukemia patients, the mortality rate was 26% and
16%, respectively, in patients with and without IPA (P=.08), with
corrected additional IPA-related costs of €15280 (P<.001), which makes
IPA prevention both efficacious and cost-effective.
Current guidelines advocate administration of 7-14 days of broad-spectrum
antibiotics for unexplained ferver (UF) in neutropenic hematology
patients. Effective antimicrobial prophylaxis reduces the incidence of
gram-negative infections, which may allow shorter treatment. In the
Erasmus MC, broad-spectrum antibiotics are initially administered, but
discontinued when after 72 hours no bacterial etiology is documented.
Among 166 hematology patients on selective antibiotic prophylaxis, 317
febrile episodes were observed; 56% were due to UF. Due to the restrictive
antibiotic policy, the mean treatment duration was only 3.7 days.
Overall-mortality after neutrophil recovery was 3.6% (6 of 166 patients).
No patient died from untreated bacterial infection, suggesting that
discontinuation of broad-spectrum antibiotics in this setting is safe,
provided that no infectious etiology is documented.
Diagnosing catheter-related bloodstream infection (CRBSI) often involves
tip culture, using the conventional semi-quantitative roll-plate method.
The quantitative sonication technique could have additional value, as it
may also detect endoluminal microorganisms. However, in a prospective
study of 313 tunnelled catheters from 279 hematology patients, the
diagnostic performance in patients with suspected CRBSI was equally
limited for both methods.
Finally, in a placebo-controlled trial on the efficacy of a daily
prophylactic 70%-ethanol lock on the prevention of endoluminal CRBSI in
tunneled devices, a 3.6-fold, non-significant, reduction was observed for
ethanol-treated hematology patients. Partially, the lack of significance
may reflect a lack of power. More patients receiving ethanol discontinued
lock-therapy, because of non-severe adverse events
Gele koorts in Europa
No full textVandaag de dag komt gele koorts in Europa alleen voor als importziekte bij individuele patiënten. Nog maar enkele eeuwen geleden vond nabij sommige Europese havensteden lokale transmissie van gele koorts plaats na import van besmette muggen vanuit Zuid-Amerika. De vector die voor verspreiding zorgt, de mug Aedes aegypti, was in deze periode ook in delen van Europa gevestigd. Tegenwoordig komt de mug weer voor in delen van Oost-Europa en op Madeira en is hernieuwde vestiging elders in Europa niet onmogelijk, gelet op de huidige klimaatomstandigheden. Door de uitbraken in de periode 2016-2018 in Brazilië was een stijging waarneembaar van het aantal importgevallen van gele koorts in Europa. In Brazilië bestaat de vrees voor een overgang van de gebruikelijke jungle-transmissiecyclus naar een urbane transmissiecyclus. Dit kan aanleiding geven tot grootschalige epidemieën vanwege een hoge bevolkingsdichtheid en een in sommige steden relatief lage vaccinatiegraad. Voor reizigers naar een gebied waar gele koorts endemisch is, is vaccinatie geïndiceerd, tenzij hiervoor een contra-indicatie bestaa
Drugs that act on the immune system: Immunosuppressive and immunostimulatory drugs
No full textThis review of the 2010 publications on immunosuppressive and immunostimulatory or immunoenhancing drugs covers ciclosporin, cyclophosphamide, everolimus, leflunomide, methotrexate, mizoribine, mycophenolate mofetil, sirolimus, tacrolimus, temsirolimus, the thiopurines, and the immunoenhancing drugs levamisole, picibanil, and thymosin α-1; there are also special reviews on fingolimod, glatiramer, gusperimus, imexon, and semapimod
Yellow fever in Europe
Full text linkVandaag de dag komt gele koorts in Europa alleenvoor als importziekte bij individuele patiënten. Nogmaar enkele eeuwen geleden vond nabij sommigeEuropese havensteden lokale transmissie van gelekoorts plaats na import van besmette muggen vanuitZuid-Amerika. De vector die voor verspreiding zorgt,de mug Aedes aegypti, was in deze periode ook indelen van Europa gevestigd. Tegenwoordig komt demug weer voor in delen van Oost-Europa en opMadeira en is hernieuwde vestiging elders in Europaniet onmogelijk, gelet op de huidige klimaatomstandigheden.Door de uitbraken in de periode 2016-2018 in Braziliëwas een stijging waarneembaar van het aantalimportgevallen van gele koorts in Europa. In Braziliëbestaat de vrees voor een overgang van de gebruikelijke jungle-transmissiecyclus naar een urbanetransmissiecyclus. Dit kan aanleiding geven totgrootschalige epidemieën vanwege een hoge bevolkingsdichtheid en een in sommige steden relatieflage vaccinatiegraad. Voor reizigers naar een gebiedwaar gele koorts endemisch is, is vaccinatie geïndiceerd, tenzij hiervoor een contra-indicatie bestaa
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