Frequency and time to relapse after discontinuing 6-month therapy with IVIg or pulsed methylprednisolone in CIDP

Background: We reported that 6-month therapy with intravenous immunoglobulin (IVIg) was more frequently effective or tolerated than intravenous methylprednisolone (IVMP) in patients with chronic inflammatory demyelinating polyradiculoneuropathy (CIDP). We now retrospectively compared the proportion of patients who eventually worsened after discontinuing therapy and the median time to clinical worsening. Methods: By March 2013, data were available from 41 of the 45 patients completing the trial with a median follow-up after therapy discontinuation of 42 months (range 1-60). Three patients withdrew during the original study and one failed to respond to either of the therapies. No patient received a diagnosis alternative to CIDP during the follow-up. Results: Twenty-eight of the 32 patients treated with IVIg (as primary or secondary therapy after failing to respond to IVMP) improved after therapy (87.5%) as compared with 13 of the 24 patients treated with IVMP as primary or secondary therapy (54.2%). After a median follow-up of 42 months (range 1-57), 24 out of 28 patients responsive to IVIg (85.7%) worsened after therapy discontinuation. The same occurred in 10 out of 13 patients (76.9%) responsive to IVMP (p=0.659) after a median follow-up of 43 months (range 7-60). Worsening occurred 1-24 months (median 4.5) after IVIg discontinuation and 1-31 months (median 14) after IVMP discontinuation (p=0.0126). Conclusions: A similarly high proportion of patients treated with IVIg or IVMP eventually relapse after therapy discontinuation but the median time to relapse was significantly longer after IVMP than IVIg. This difference may help to balance the more frequent response to IVIg than to IVMP in patients with CIDP

Bilateral spike-and-wave dicharges in a hemi-deafferented cortex

We studied a patient with a history of absence attacks in childhood in whom an absence status with bilateral spike-and-wave discharges developed after a top-of-the-basilar syndrome. Surprisingly, even though the ischemic lesion involved the left thalamus alone, spike-and-wave discharges were recorded from the two hemispheres. Three days after antiepileptic treatment (sodium valproate 500 mg 3 times a day) began, electroenceplalographic recordings and consciousness became normal. (C) 2002 Elsevier Science Ireland Ltd. All rights reserved

Rare cause of delayed upper gastrointestinal bleeding after pancreaticoduodenectomy

Context Luminal bleeding after pancreaticoduodenectomy can be present in various degrees of acuity in up to 30% of patients. Case report In this report, we describe a rare and uncommon cause of gastrointestinal bleeding after pancreaticoduodenectomy and review of the literature. Conclusions Multiple biliary procedures with common complications increase the difficulty making the correct diagnosis and therefore all possible etiologies of a complication must be evaluated

Thalidomide sensory neurotoxicity: A prospective study in patients with multiple myeloma

Background: Peripheral neuropathy (PN), the most common complication during thalidomide (TD) treatment, remains incompletely characterized with regard to incidence, anatomic features, risk factors and optimum management Aim of tiffs study is to characterize TD-neuropathy and to assess correlations between PN and TD dose in a series of patients treated for multiple myeloma (MM). Method: We followed for up to 19 months, 25 patients (M/F -- 11/14, mean age 58 ± 10.8 yrs) without evidence of PN at baseline, with onemonthly neurological exanffnations (Neurologic Symptom Score, MRC score, Reflex score) and neurophysiological studies (NCW and SNAP amplitude of sural and ulnar nerves). Patients received a 298 ± 86 mg mean daily TD dose. Median time to PN was calculated with Kaplan-Meier method. Multiple logistic-regression analysis was used for statistics. Significance level < 0.05. Results: Eighteen patients (M/F -- 5/13, mean age 58,17 ± 10.5 yrs) developed a sensory axonal PN. Median time to PN was 8 months (95%CI 6,3-9,7 months). 95% of patients developed PN after 3 months. Twelve patients (48%) showed a SNAP reduction > 50% at PN onset. TD daily mean dose was 295 ± 85 mg, mean cumulative dose was 61.44 ± 29.5 g and mean cumulative dose/body mass index was 2.56 ± 1.2 g. Clinical characteristics and TD doses were similar to those of patients without PN. Demograplffc characteristics were not correlated with PN. Conclusion: 72% of our patients on TD for MM developed a sensory mxonal PN, which occurred in the majority of cases after 3 months. Both cumulative and daily dose of TD did not influence the occurrence of PN