Transient oligoarthritis of the lower extremity following influenza B virus infection: Case report

A 12-year-old girl developed influenza B virus infection proven by typical symptoms and detection of the virus in a nasopharyngeal swab by culture and PCR. Two weeks later she developed an otherwise unexplained transient oligoarthritis of small joints of the left foot. Influenza viruses may be a hitherto underappreciated cause of a post-infectious arthritis

Acute and late toxicities after high-dose chemotherapy in patients with relapsed and/or progressive germ cell cancer.

Durch die Einführung der Hochdosischemotherapie (HDCT) in die Behandlung von Patienten mit rezidivierten und/oder progressiven Keimzelltumoren konnten das Überleben verbessert und die Ansprechraten gesteigert werden. Die Dosisintensivierung geht jedoch mit ausgeprägten akuten sowie auch persistierenden hämatologischen und nicht-hämatologischen Toxizitäten einher. Ziel dieser Untersuchung war es anhand eines großen Patientenkollektivs aus zwei konsekutiven PhaseI/II Studien zur HDCT die akuten Toxizitäten zu evaluieren und die Spättoxizitäten bei den Langzeitüberlebenden zu determinieren. Patienten und Methoden: Die Daten der 257 Patienten wurden retrospektiv bezüglich der Frühtoxizitäten (Nephro-, Neuro- und Ototoxizität) evaluiert. 145 Patienten hatten im Rahmen der Salvage-Therapie 2 Zyklen einer konventionellen Chemotherapie mit Cisplatin, Etoposid, Ifosfamid (PEI) gefolgt von einem Zyklus hochdosiertem Carboplatin, Etoposid und Ifosfamid (CEI) erhalten. 112 Patienten erhielten 3 Zyklen einer konventionell-dosierten Chemotherapie mit Cisplatin, Ifosfamid und Paclitaxel (TIP) gefolgt von einem Zyklus hochdosiertem Carboplatin, Etoposid und Thiotepa (CET). Die Daten zu den persistierenden Toxizitäten wurden durch Patienteninterviews sowie Zuschicken eines Fragebogens rekrutiert und evaluiert. Die Toxizitäten wurden anhand der modifzierten Kriterien der Weltgesundheitsorganisation (WHO) klassifiziert und in die Schweregrade 0-IV eingeteilt. Resultate: Akute Nephrotoxizitäten traten häufiger nach PEI/CEI als nach TIP/CET auf; dieser Unterschied war jedoch nicht signifikant. Akute Neuro- und Ototoxizitäten wurden vermehrt, jedoch ohne signifikanten Unterschied nach TIP/CET beobachtet. Im Langzeit-Follow-Up bestand für die Nephrotoxizität kein Unterschied mehr zwischen PEI/CEI und TIP/CET; die Majorität der Patienten (70 vs. 80%) wies zum Zeitpunkt des letzten Follow-Ups normale Serum- Kreatininwerte auf. Im Langzeitverlauf nimmt der Anteil der Patienten nach PEI/CEI mit höhergradigen Neurotoxizitäten (WHO°III und IV) zu, während es nach TIP/CET die Anzahl an Patienten mit Neurotoxizitäten WHO°III und IV abnehmen. Bei den Patienten beider Studienkollektive traten häufiger höhergradige Ototoxizitäten (WHO°III und IV) auf. Die Unterschiede geben eine Trend wieder, waren jedoch nicht signifikant. Schlussfolgerung: Der Therapieerfolg, der durch die HDCT in der Behandlung von Patienten mit fortgeschritten Keimzelltumoren erzielt wurde, geht mit einer erheblichen Rate an akuten Toxizitäten und Spättoxizitäten einher. Die Auswahl eines bestimmten HDCT-Regimes hat einen Einfluss auf die Frühtoxizitäten, spielt jedoch keine Rolle für das Ausmaß der Langzeittoxizitäten nach HDCT. Ein Teil der akuten Toxizitäten, insbesondere die Nephrotoxizität, sind regredient bis reversibel im Langzeitverlauf. Ziel und Zweck weiterer Studien sollte es sein, die akuten und Spättoxizitäten nach HDCT prospektiv zu untersuchen.Purpose: High-dose chemotherapy (HDCT) as consolidation after conventional- dose salvage therapy may increase the response and survival rates in patients with relapsed or refractory germ cell cancer. This dose-escalation leads to severe haematologic and non-haematologic toxicities as nephrotoxicity, hearing impairment and neurotoxicity. The aim of this study was to evaluate acute and late toxicities after HDCT for relapsed or progressive germ cell cancer (GCC). Patients and methods: Acute toxicities (nephro-, neuro- and ototoxicity) where evaluated retrospectivally in 257 patients treated with HDCT in two phase I/II multicenter studies. 145 patients were treated with 2 conventional cycles of PEI (cisplatin, etoposide and ifosfamide) followed by 1 cycle of HD-CEI (carboplatin, etoposide, ifosfamide); 112 patients were treated with 3 cycles of conventional dosed TIP (cisplatin, ifosfamide, paclitaxel) followed by 1 cylce of HD-CET (carboplatin, etoposide, thiotepa). The late toxicities were investigated by interviews and questionnaires of long-term survivors in both sudy-groups. Toxicities where classified according to the modified criteria of the World Health Organization (WHO). Results: Acute nephrotoxicity was more common after PEI/CEI than after TIP/CET, whereas acute neuro- and ototoxicity were seen more often following TIP/CET; acute toxicities did not differ significantly between the two patient groups. In long-term follow-up, the incidence of nephrotoxicity did not differ between both patient groups and almost all patients had normal serum-creatinin-values. However, patients of the PEI/CEI-regime showed a progression of high-grade neurotoxicities (WHO°III and IV) whereas we found an improvement of neurotoxicities after TIP/CET. High grade hearing impairment was common in both patient groups increasing in the long-term follow-up. Statistically, the results were not significant. Conclusion: The increased response and favorable outcome in patients with poor prognosis GCC is highly associated with acute and late toxicities after HDCT. Acute toxicities depend on the chosen HD-regime whereas late sequelae seem to be independent of the treatment-regime. Especially nephrotoxicity seems to be reversible whereas neuro- and ototoxicity may even increase.Further clinical trials should evaluate the sequelae of HDCT treatment for testicular cancer prospectively

Transient oligoarthritis of the lower extremity following influenza B virus infection: Case report

Abstract A 12-year-old girl developed influenza B virus infection proven by typical symptoms and detection of the virus in a nasopharyngeal swab by culture and PCR. Two weeks later she developed an otherwise unexplained transient oligoarthritis of small joints of the left foot. Influenza viruses may be a hitherto underappreciated cause of a post-infectious arthritis.</p

Transient oligoarthritis of the lower extremity following influenza B virus infection: Case report

Abstract A 12-year-old girl developed influenza B virus infection proven by typical symptoms and detection of the virus in a nasopharyngeal swab by culture and PCR. Two weeks later she developed an otherwise unexplained transient oligoarthritis of small joints of the left foot. Influenza viruses may be a hitherto underappreciated cause of a post-infectious arthritis

Resource utilization and costs of transitioning from pediatric to adult care for patients with chronic autoinflammatory and autoimmune disorders

Abstract Background A structured transition of adolescents and young adults with chronic autoinflammatory and autoimmune disorders from the pediatric to the adult health care system is important. To date, data on the time, processes, outcome, resources required for the necessary components of the transition process and the associated costs are lacking. Methods Evaluation of resource use and costs in a prospective cohort study of 58 adolescents with chronic autoinflammatory and autoimmune disorders, for the key elements of a structured transition pathway including (i) compilation of a summary of patient history, (ii) assessment of patients’ disease-related knowledge and needs, (iii) required education and counseling sessions, (iv) and a transfer appointment of the patient with the current pediatric and the future adult rheumatologist. Results Forty-nine of 58 enrolled patients (84.5%) completed the transition pathway and were transferred to adult care. The mean time from the decision to start the transition process to the final transfer consultation was 315 ± 147 days. Transfer consultations were performed in 49 patients, including 10 patients jointly with the future adult rheumatologist. Most consultations were performed by the multidisciplinary team with a median of three team members and lasted 65.5 ± 21.3 min. The cumulative cost of all consultation and education sessions performed including the transfer appointment was 283 ± 164 Euro per patient. In addition, the cost of coordinating the transition process was 57.3 ± 15.4 Euro. Conclusions A structured transition pathway for patients with chronic autoinflammatory and autoimmune disorders is resource and time consuming and should be adequately funded