Plasmapheresis reverses all side-effects of a cisplatin overdose – a case report and treatment recommendation

BACKGROUND: Cisplatin is widely used as an antineoplastic agent since it is effective against a broad spectrum of different tumours. Nevertheless, it has several potential side effects affecting different organ systems and an overdose may lead to life-threatening complications and even death. CASE PRESENTATION: We report on a 46-year old woman with non-small cell lung cancer who accidentally received 225 mg/m(2 )of cisplatin, which was threefold the dose as scheduled, within a 3-day period. Two days later, the patient presented with hearing loss, severe nausea and vomiting, acute renal failure as well as elevated liver enzymes. In addition, she developed a severe myelodepression. After plasmapheresis on two consecutive days and vigorous supportive treatment, the toxicity-related symptoms improved and the patient recovered without any sequelae. CONCLUSION: To date, no general accepted guidelines for the treatment of cisplatin overdoses are available. Along with the experience from other published cases, our report shows that plasmapheresis is capable of lowering cisplatin plasma and serum levels efficiently. Therefore, plasma exchange performed as soon as possible can ameliorate all side effects of a cisplatin overdose and be a potential tool for clinicians for treatment. However, additional intensive supportive treatment-modalities are necessary to control all occurring side effects

Splenectomy and/or cyclophosphamide as salvage therapies in thrombotic thrombocytopenic purpura: the French TMA Reference Center experience: SALVAGE THERAPIES IN SEVERE TTP

BACKGROUND: The objective was to assess the efficacy and safety of splenectomy and cyclophosphamide as salvage therapies in severe thrombotic thrombocytopenic purpura (TTP).STUDY DESIGN AND METHODS: During a 10-year period, patients who did not improve with plasma exchanges, steroids, vincristine, and/or rituximab were considered for splenectomy or cyclophosphamide. Patients with a documented severe (<10% of normal value) acquired ADAMTS13 deficiency are reported here. RESULTS: Eighteen patients with a severe acquired ADAMTS13 deficiency required a salvage therapy. Thirteen patients had a splenectomy 19 (interquartile range [IQR], 10-51) days after TTP diagnosis. One patient died the day after splenectomy. The remaining patients improved platelets (PLTs) until Day 6, along with a rapid and major lactate dehydrogenase improvement. Six patients, however, subsequently experienced a transient worsening. Durable PLT count recovery in survivors was observed within 13 (IQR, 11.5-25.5) days. Postoperative complications included thromboembolic events (two cases) and infections (five cases). Five patients received pulses of cyclophosphamide 12 (IQR, 12-15) days after TTP diagnosis. All patients recovered PLTs 10 (IQR, 9-24) days after the first pulse and two experienced a transient worsening. Three patients experienced infections. Three relapses occurred 5 months, 2.5 years, and 4.5 years after splenectomy and one relapse occurred 3.5 years after cyclophosphamide. After a 2.5 (IQR, 0.75-6.2)-year follow-up, the overall survival was 94%. CONCLUSION: Cyclophosphamide and splenectomy provide comparable high remission rates in severe TTP with acceptable side effects and should be considered in the more severe patients who do not improve with other therapies

Temporisation des dents absentes pendant et après le traitement orthodontique

Les traitements avec des dents manquantes antérieures ou bien les contentions chez l’adolescent sont, dans certains cas comme les agénésies de latérales, des maintiens difficiles à planifier jusqu’à la pose des implants ou autres prothèses. Diverses propositions sont à notre disposition dont certaines comme des dents artificielles sur des mini-vis peuvent apporter du bien-être au patient et plus de sérénité pour le praticien. La méthodologie sera décrite

L’apport de la CFAO dans la réalisation des contentions orthodontiques collées

La contention a pour objectif de maintenir les dents dans leur position corrigée après la fin du traitement orthodontique. Les fils collés sont façonnés au plus proche de la surface linguale des dents à la mandibule et/ou au maxillaire et le collage est réalisé de manière directe ou indirecte. Le recul clinique et les nombreuses études sur le sujet ont montré l’existence de complications liées à ces contentions collées (décollements, mouvements indésirables des dents, problèmes parodontaux). À l’heure où le numérique se développe dans nos cabinets d’orthodontie, la CFAO (Conception et fabrication assistée par ordinateur), déjà présente dans de nombreux autres domaines, pourrait être une solution aux problèmes inhérents à ces contentions collées. Elle offre un positionnement très précis, une adaptation parfaite sur la surface linguale des dents et une passivité totale de la contention collée. La réalisation des fils de contention en CFAO (Memotain®) présente un intérêt majeur dans les cas complexes, lorsque les contentions collées classiques atteignent leurs limites. Utilisées aujourd’hui de manière exceptionnelle, elles ouvrent indéniablement de nouvelles perspectives pour notre pratique orthodontique

Implementing clinical pharmacy services in France: One of the key points to minimise the effect of the shortage of pharmaceutical products in anaesthesia or intensive care units?

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