Anaphylactic shock: are we doing enough and with the right timing and order?

Abstract Anaphylactic shock became, unfortunately, a common presence in Romanian mass-media, due to some fatal cases in the last months. The coincidence that in December 2014 the American Academy of Allergy, Asthma and Immunology, the American College of Allergy, Asthma and Immunology, and the Joint Council of Allergy Asthma and Immunology released Practice parameters offers a good opportunity to renew for all practitioners what is now considered the “golden standard” of good practice. Epinephrine must be considered the cornerstone and the most urgent measure to be applied in these cases, immediately after the diagnosis. A very important notice is to forget the administration of antihistamines or corticosteroids as first line therapy instead of epinephrine. Proper positioning of the subjects and quick fluid replacement (1-2 l of normal saline in a few minutes) are also mandatory.

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Choosing the Right Treatment Option for the Right R/M HNSCC Patient: Should We Adhere to PFE for First-Line Therapy?

Frontiers in Oncology ◽

10.3389/fonc.2021.715297 ◽

2021 ◽

Vol 11 ◽

Author(s):

Katharina Lübbers ◽

Mykola Pavlychenko ◽

Theresa Wald ◽

Susanne Wiegand ◽

Andreas Dietz ◽

...

Keyword(s):

Cox Regression ◽

First Line ◽

First Line Therapy ◽

Line Therapy ◽

Kaplan Meier ◽

Real World Evidence ◽

Consumption Benefit ◽

Outcome Differences ◽

The Right ◽

High Level

BackgroundThe landmark EXTREME trial established cisplatin, 5-fluorouracil and cetuximab (PFE) as first-line chemotherapy (1L-ChT) for recurrent/metastatic head and neck squamous cell carcinoma (R/M HNSCC). We were interested in outcome differences of R/M HNSCC in 1L-ChT and factors influencing outcome in certain subgroups, especially patients receiving PFE, and the value of PFE compared to other 1L-ChT regimens to provide real world evidence (RWE).MethodsFor this retrospective monocentric study, 124 R/M HNSCC patients without curative surgical or radiotherapy options receiving at least one cycle of 1L-ChT were eligible. We analyzed their outcome using Kaplan-Meier plot and Cox regression to identify predictors for prolonged survival.ResultsSubgroups benefiting significantly from PFE were patients suffering from an index HNSCC outside the oropharynx. The PFE regimen proved to be superior to all other 1L-ChT regimens in clinical routine. Significant outcome differences between PFE treatment within or outside controlled trials were not seen.ConclusionThis retrospective analysis provides RWE for factors linked to improved outcome. Subgroup analyses highlight the lasting value of PFE among the growing spectrum of 1L-ChT. Importantly, fit smokers with high level alcohol consumption benefit from PFE; considering the patient’s lifestyle factors, PFE should not be ignored in decision-making.

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Testicular Metastasis from Renal Cell Carcinoma: A Case Report and Review of the Literature

Case Reports in Oncology ◽

10.1159/000473698 ◽

2017 ◽

Vol 10 (1) ◽

pp. 388-391 ◽

Cited By ~ 3

Author(s):

Keren Rouvinov ◽

Endre Z. Neulander ◽

Elena Kan ◽

Murad Asali ◽

Samuel Ariad ◽

...

Keyword(s):

Renal Cell Carcinoma ◽

Cell Carcinoma ◽

Renal Cell ◽

Lung Metastases ◽

First Line ◽

Testicular Metastasis ◽

First Line Therapy ◽

Line Therapy ◽

The Right ◽

Testicular Metastases

Testicular metastases from renal cell carcinoma (RCC) are extremely rare. To the best of our knowledge, only 33 cases have been described in the literature. Most of the reported cases are of unilateral testicular metastasis from RCC. We report a case of metachronous ipsilateral testicular metastasis from RCC in a 78-year-old man 6 years after nephrectomy. Scrotal ultrasonography showed a 4 × 5 cm mass in the right testis. Right inguinal orchiectomy was performed for diagnosis. Computed tomography revealed liver and lung metastases. First-line therapy with sunitinib was started in November 2016 for metastatic RCC.

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Choosing the right drug 1. Anticonvulsants used for first‐line therapy

In Practice ◽

10.1136/inp.f1023 ◽

2013 ◽

Vol 35 (3) ◽

pp. 106-113 ◽

Cited By ~ 1

Author(s):

Clare Rusbridge

Keyword(s):

First Line ◽

First Line Therapy ◽

Line Therapy ◽

The Right

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Vincristine and Corticosteroids as First-Line Treatment of Kasabach-Merritt Syndrome in Kaposiform Hemangioendothelioma

Journal of Cutaneous Medicine and Surgery ◽

10.2310/7750.2008.08006 ◽

2009 ◽

Vol 13 (3) ◽

pp. 155-159 ◽

Cited By ~ 21

Author(s):

Aaron M. Drucker ◽

Elena Pope ◽

Sanjay Mahant ◽

Miriam Weinstein

Keyword(s):

American Literature ◽

Line Treatment ◽

First Line ◽

Kaposiform Hemangioendothelioma ◽

The North ◽

First Line Therapy ◽

Line Therapy ◽

Systemic Corticosteroids ◽

The Right ◽

First Line Treatment

Background: Historically, patients with the consumptive coagulopathy Kasabach-Merritt syndrome (KMS) have been treated with systemic corticosteroids as first-line therapy, but many patients do not respond. Recently, there have been increasing reports of the use of the chemotherapeutic drug vincristine in these patients. Objective: To report a case of a newborn with a kaposiform hemangioendothelioma (KHE) of the right leg associated with KMS treated successfully with vincristine and oral corticosteroids. Methods: The patient's chart and the literature on the subject were reviewed using Medline and PubMed. Results: Treatment with vincristine and corticosteroids lead to sustained shrinking of the tumor and correction of the thrombocytopenia and coagulopathy through 1 year of age. We believe this is the first report in the North American literature of corticosteroids and vincristine being used concomitantly as first-line therapy for KHE with KMS. Conclusion: Vincristine and corticosteroids should be considered first-line treatment for KMS.

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Hysterectomy to the Unicornuate Uterus Suffering of Hematometra

Indonesian Journal of Obstetrics and Gynecology ◽

10.32771/inajog.v5i4.571 ◽

2017 ◽

pp. 246

Author(s):

Cepi T Pramayadi ◽

Imma Nurliana ◽

Erliana Fani

Keyword(s):

Preterm Labor ◽

Pregnancy Loss ◽

Obstet Gynecol ◽

Recurrent Pregnancy Loss ◽

Surgical Intervention ◽

First Line ◽

Unicornuate Uterus ◽

First Line Therapy ◽

Line Therapy ◽

The Right

Objective: Unicornuate uterus with rudimentary cavity is anextremely rare Mullerian duct anomaly. It is frequently misdiagnosedor under treated, since women who suffer from thiscondition tend to be asymptomatic. We aimed to report thisinteresting case and review the available background literature.Methods: Case report.Case: A thirty two-year-old nulligravid woman was presentedwith severe abdominal pain. Laparoscopic surgery demonstratedunicornuate uterus with arudimentary cavity and hematometra.Partial hysterectomy was conducted to the right rudimentaryuterus.Conclusion: Thorough diagnosis is essential to prevent thecomplications of unicornuate uterus. Unicornuate uterus withrudimentary cavity is associated with increased rate of pregnancycomplications such as preterm labor and fetal malpresentation.Pregnancy can also occurred on the rudimentary cavity and leadsto recurrent pregnancy loss. Laparoscopy is essential for confirmatorydiagnosis. Surgical intervention should be considered asthe first line therapy to avoid associated morbidity.[Indones J Obstet Gynecol 2017; 5-4: 246-249]Keywords: hematometra, hysterectomy, unicornuate uterus

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Pembrolizumab induced hyperpigmentation in a patient with lung adenocarcinoma: a case report

10.22541/au.162546820.05792179/v1 ◽

2021 ◽

Author(s):

Yulu Zhou ◽

Guolin Huang ◽

Yanzheng Wei ◽

Zaoqin Yu ◽

Jiayao Wu

Keyword(s):

Lung Adenocarcinoma ◽

Mediastinal Lymph Node ◽

Immunohistochemical Analysis ◽

Middle Lobe ◽

First Line ◽

First Line Therapy ◽

Line Therapy ◽

Metastatic Lung ◽

Right Middle Lobe ◽

The Right

Pembrolizumab is more widespread use clinically with Pembrolizumab being recommended as a first-line therapy for advanced NSCLC. At the same time, some new adverse reactions have also been discovered, including hyperpigmentation. We hereby present a 77-year-old Chinese female with primary bronchial lung cancer. Genetic testing showed negative for EGFR and ALK. Immunohistochemical analysis showed tumor proportion score (TPS) of PD-L1 was 80% on tumor cells. Then the patient received pembrolizumab 200mg every three weeks, as the first-line therapy. Two courses after initiation pembrolizumab, hyperpigmentation appeared on her face and back of the hand. The right middle lobe mass and mediastinal lymph node metastasis progressed after nine courses after initiation of pembrolizumab, and the patient’s entire face turned black. It potentially indicates that cutaneous adverse events of hyperpigmentation, might be a negative predictor of response to pembrolizumab in metastatic lung adenocarcinoma patients.

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