The use of theophylline for posttransplantation bradyarrhythmias increased heart rate and facilitated the withdrawal of chronotropic support. We conclude that theophylline offers effective and specific therapy for heart transplant patients with early bradyarrhythmias, reducing the need for implantation of a permanent pacemaker.
Summary:Patients often develop nausea, vomiting and bloating after bone marrow transplantation (BMT). These symptoms may interfere with nutrition and the ability to take oral medications. Gastroparesis is a recognized cause of these symptoms in non-transplant patients but less is known about patients who undergo BMT. Between January 1996 and March 1997, a total of 151 patients underwent BMT. Eighteen patients (12%) developed persistent symptoms suggestive of gastroparesis (persistent nausea, vomiting or bloating). Scintigraphic gastric emptying studies were performed to assess for gastroparesis. Prokinetic agents were administered at the time of study. The records on these patients were compared with those of all other patients undergoing BMT during the same time period without these symptoms. Nine patients who demonstrated delayed gastric emptying were further evaluated with esophagastroduodenoscopy and biopsy. Biopsy samples were reviewed for evidence of graft-versus-host disease (GVHD). Fourteen of 18 patients demonstrated delayed gastric emptying and most responded to prokinetic agents given at the time of study. Age, conditioning regimen, cytomegalovirus antigenemia and acute GVHD did not appear to be associated with the development of gastroparesis. Allogeneic BMT recipients were at higher risk than autologous BMT patients (26% vs 0%, P Ͻ 0.0001). Of allogeneic BMT recipients, there was a nonsignificant trend of patients receiving tacrolimus to be less likely to experience gastroparesis than those receiving cyclosporine (27% vs 48%, P = 0.08). For the nine patients undergoing upper endoscopy, GVHD on gastric biopsy was an uncommon finding and was mild when present. Gastroparesis appears to be a common cause of nausea, vomiting and bloating following allogeneic BMT. This may occur less often with tacrolimus than cyclosporine because of the former agent's prokinetic properties. Keywords: gastroparesis; hematopoietic cell transplant; gastric emptying; nausea and vomiting Following bone marrow transplantation (BMT), some patients develop persistent nausea, vomiting, bloating, early satiety and decreased tolerance to oral nutrition and medications. These symptoms frequently develop weeks after transplantation and inhibit weight gain, optimal nutrition and the transition from intravenous to oral medications.Gastroparesis is a disorder of motor function of the stomach in which gastric emptying is delayed. Patients with gastroparesis often develop symptoms of nausea, vomiting, bloating and distension. Gastroparesis has many known causes which include atrophic gastritis, diabetes, hypothyroidism, uremia, scleroderma, anticholinergics and stress. 1 Additionally, cytomegalovirus (CMV), herpes simplex virus (HSV) and other viral infections have been implicated as causes of delayed gastric emptying. 1,2 We performed gastric emptying studies on patients presenting with persistent nausea, vomiting and bloating following allogeneic or matched unrelated donor transplantation to assess for underlying gastroparesis and to as...
s vi238NEURO-ONCOLOGY • NOVEMBER 2017isocitrate dehydrogenase (IDH)-1 mutation by immunohistrochemistry and two patients had unknown IDH status. Pre-and post-operative median KPS were 90 (60-100) and 80 (40-100) respectively. Eleven patients had difficulty weaning steroids (4 patients initiated steroids peri-operatively, 7 patients prior to surgery). For rGBM post-LITT median PFS was 3.36 months (95% CI (0.21, 0.51)) and median OS was 18.48 months (95% CI (0.66,NA)) with 5 deaths. Median PFS and OS for nGBM has not been reached. Eighteen patients (86%) received post-LITT chemotherapy of which eight initiated treatment >3 weeks post-LITTdue to poor functionality (6), pregnancy (1), and patient choice (1). Among the patients receiving chemotherapy, time to initiation of chemotherapy was not associated with PFS or OS. Chemotherapy in rGBM cohort included lomustine (6), temozolomide (5), bevacizumab (3), bevacizumab + lomustine (1), lapatinib (1), and Novo-TTF (1). Median time to initiation ofi bevacizumab (4 patients) after LITT was 30.5 (17-45) days, without complications. CONCLUSIONS: LITT may be an effective cytoreductive treatment for glioblastoma. Timing of onset of chemotherapy after LITT for glioblastoma is not associated with PFS or OS. SURG-12. INTRAOPERATIVE MAGNETIC RESONANCE SPECTROSCOPY (iMRS) FOR GLIOMA SURGERY
NEURO-ONCOLOGY • JANUARY 2018brain tumor management. The target population for the PROM will be brain Tumor patients (adult and pediatric). The PROM would collect information from patients preoperatively and Post-operatively. The conceptual domains for neuro-oncology PROM will include health related quality of life (physical, mental, social and emotional), symptoms (specific to neurooncology) including weakness, memory, taste, seizure, incontinence, neurooncology specific disability and functional status. In conclusion, there is an emergent need to develop a neuro-oncological surgery PROM to address the specific unmet needs of the field of neuro-oncological surgery. The proposed framework would be beneficial in further study and development of the PROM.
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