A 17-year-old woman presented with annular urticarial plaques concomitant with exacerbation of her preexisting asthma. In addition to the asthma, she had a history of nasal polyposis and recurrent sinusitis. Six months before her presentation, the patient had undergone endoscopic sinus surgery, septoplasty and adenoidectomy, which had significantly improved her nasal patency and airflow. At the same time, she had developed scattered, mildly pruritic, erythematous annular urticarial plaques on the legs and trunk. These waxed and waned over time, each lasting from a few days to a week, and their appearance correlated with her asthma flares. The patient's asthma treatment comprised montelukast, inhaled albuterol-ipratropium, fluticasone nasal spray and oral cetirizine. Her primary care physician had prescribed topical corticosteroids and antifungal cream for the eruption. Neither of these was helpful, but some improvement was seen with oral prednisone.On physical examination, numerous annular, erythematous indurated plaques, many with accentuated raised borders, were seen distributed over both thighs, both upper arms and the trunk (Fig. 1). Some erythematous macules coalescing into plaques with no scaling were also noted, and there was mild pruritus at the sites of eruption. No lymphadenopathies were present, and the reminder of the physical examination was unremarkable.Laboratory investigations identified peripheral blood eosinophilia (31%, 4.7 K ⁄ lL; normal range 0.0-0.3 K ⁄ lL) and increased serum IgE (1579.6 IU ⁄ mL; 1-170 IU ⁄ mL). Urinalysis, erythrocyte sedimentation rate, and levels of C-reactive protein, C3, C4, antinuclear antibody, anti-double-stranded DNA, rheumatoid factor, and cytoplasmic and perinuclear antineutrophil cytoplasmic antibodies (c-ANCA, p-ANCA) were within normal limits. Tests for Lyme IgM and IgG antibodies were negative.
4538 Introduction International reassessments of erythropoiesis stimulating agents (ESAs) for anemia have recently occurred. While ESAs prevent blood transfusions and, improve select quality of life domains among chronic kidney disease (CKD) patients, 8 trials individually identified increased mortality and/or tumor progression among cancer patients treated with ESAs. For CKD, one study of non-dialysis CKD patients targeted to higher versus lower hemoglobin (Hb) levels identified 34% increased relative risk (17.5% vs. 13.5%) for death, acute myocardial infarction, congestive heart failure hospitalization, or stroke with a higher Hb target. Methods Guidelines, notifications from regulatory agencies and manufacturers, reimbursement policies, and utilization for ESAs in the cancer and CKD settings within the U.S., Europe, and Canada were reviewed. Results: Cancer Setting In 2008, the Food and Drug Administration (FDA) restricted ESAs from cancer patients seeking cure. Reimbursement is limited to Hb levels < 10 g/dL. In the U.S., ESA usage increased 340% between 2001 and 2006, and decreased 60% since 2007. The European Medicines Agency (EMEA) reports that ESA benefits do not outweigh risks. In Europe, ESA reimbursement is included in global provider payments. Between 2001 and 2006, ESA use increased 51%; since 2006, use has decreased 10%. Canadian manufacturers recommend ESA usage based on patient preference. In Canada, reimbursement for myelosuppressive chemotherapy with ESAs is restricted to Hb levels of 10-11 g/dL in Alberta and 11-12.5 g/dL in British Columbia. Usage increased 20% between 2004 and 2007. CKD Setting The FDA recommends Hb levels < 12 g/dL and Medicare reimbursement is restricted to Hb levels ≥ 13 g/dL. Between 2001 and 2006, usage increased 480% (non-dialysis) and 40% (dialysis) in the U.S. Since 2007, ESA use has decreased 30% (non-dialysis) and 17% (dialysis). The EMEA recommends target Hb levels of 10-12 g/dL. In Europe, ESA usage has increased 10% since 2001. The 2009 Canadian label recommends Hb levels < 12 g/dL. Within Canada, ESA usage increased 30% since 2004. Conclusions While reassessments of ESA safety have occurred internationally, safety concerns in the U.S. have resulted in marked decrements in ESA use among cancer and CKD patients, whereas in Europe and Canada ESA use has increased over time. Disclosures: No relevant conflicts of interest to declare.
Conclusions: Early experiments with this novel technique have demonstrated a clear relationship between the changes in the MIF of fluid inoculated with a TG in a PD drainage tube using an iPhone 7 camera. We aim to calibrate this technique further using formal measures of turbidity and to develop this as a new, easily available method to assist in earlier detection of peritoneal effluent discolouration.
3990 Poster Board III-926 Background In 2005, the first ever Citizen Petition filed by a State Attorneys General, Attorney General Richard Blumenthal, requested that the FDA adopt 6 measures to improve VTE prophylaxis and patient safety of thalidomide (thal). While 4 recommendations were accepted, the FDA refused to mandate a Phase IV randomized, controlled trial designed to identify the best VTE prophylaxis stating that substantial data already existed, but no specific prophylaxis was identified. We review the progress of this safety concern pre- and post-FDA approval of thal in 2006, specifically for the use of multiple myeloma patients. Similar safety concerns apply to lenalidomide. Methods A literature search was performed from 2006 to 2009 through Pubmed and Ovid using the key words “thalidomide,” “lenalidomide,” “thrombosis,” and “multiple myeloma.” High dose thal was defined as higher than 200mg/d, low dose thal as 200mg/d or lower, and high dose dexamethasone (dex) as higher than 20mg/d and low dose dex as 20mg/d and lower. Results See table Conclusion Since 2006, we have found information on 2657 patients with no prophylaxis, 539 patients with thal/dex with prophylaxis, and 2210 patients with len/dex with prophylaxis. VTE rates remain high, except for the low dose thal and/or low dose dex group. Overall, optimal VTE prophylaxis remains an enigma. Current recommendations for VTE prophylaxis are not supported by empirical data. Against this backdrop, Blumenthal's team should consider resubmitting their safety request. Disclosures: No relevant conflicts of interest to declare.
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