Background: This study assessed the feasibility and safety of outofhospital management of acute myeloid leukemia (AML) patients during consolidation therapy. Methods: 103 consolidation cycles were analyzed retrospectively. All patients received treatment as inpatients; they were discharged provided they were in a good clinical condition and then either electively readmitted or managed as outpatients during the aplastic phase. Results: In 95/103 cycles (92%), discharge was feasible after a median of 7 (6–16) days. In 45 cycles, patients were electively readmitted at the onset of chemotherapyinduced cytopenia after a median time of 12 (9–16) days. In 50 cycles, patients were managed as outpatients. In 23/50 outpatient cycles (46%), patients required rehospitalization, the main cause being neutropenic fever. There was 1 treatmentrelated death due to sepsis in a patient in the outpatient group, accounting for an overall mortality of 2%. Transfusion requirements, occurrence of grade 3–4 toxicity, and diseasefree and overall survival after a median followup of 20 months did not differ between the treatment strategies. Comparison of diagnosisrelated group (DRG) proceeds revealed a 40% reduction with the outpatient strategy. Conclusion: Outpatient management of consolidation therapy in selected AML patients appears to be feasible and safe and may reduce hospital treatment costs.
Epidemiological studies suggest a viral etiology in approximately 1% of patients presenting with acute arthritis. The arthritogenic effect of viral infections may be related to viral invasion of synovial cells, the cellular and humoral immune response to viral antigens or by induction of autoimmunity. Viral arthritis can mimic rheumatoid arthritis by presenting as a symmetrical polyarticular disease often accompanied by a rash and influenza-like symptoms. Serological testing for pathogen-specific IgM and IgG antibodies is frequently performed for establishing a viral etiology of arthritis. Virus isolation from the joints or detection of viral nucleic acids in the synovium or synovial fluid is only rarely successful and does not always provide proof of a viral origin of arthritis. While viral arthritis in most cases is self-limiting, protracted disease can occur.
The aim of the study is to investigate water compartments in patients with rheumatoid arthritis (RA). Acute inflammatory episodes such as infection stimulate water retention, chiefly implemented by the sympathetic nervous system (SNS) and hypothalamic-pituitary-adrenal (HPA) axis. This is an important compensatory mechanism due to expected water loss (sweating etc.). Since SNS and HPA axis are activated in RA, inflammation might be accompanied by water retention. Using bioimpedance analysis, body composition was investigated in 429 controls and 156 treatment-naïve RA patients between January 2008 and December 2014. A group of 34 RA patients was tested before and after 10 days of intensified therapy. Levels of pro-atrial natriuretic peptide (proANP) and expression of atrial natriuretic peptide in synovial tissue were investigated in 15 controls and 14 RA patients. Extracellular water was higher in RA patients than controls (mean ± SEM: 49.5 ± 0.3 vs. 36.7 ± 0.1, % of total body water, p < 0.0001). Plasma levels of proANP were higher in RA than controls. RA patients expressed ANP in synovial tissue, but synovial fluid levels and synovial tissue superfusate levels were much lower than plasma levels indicating systemic origin. Systolic/diastolic blood pressure was higher in RA patients than controls. Extracellular water levels did not change in RA patients despite 10 days of intensified treatment. This study demonstrates signs of intravascular overload in RA patients. Short-term intensification of anti-inflammatory therapy induced no change of a longer-lasting imprinting of water retention indicating the requirement of additional treatment. The study can direct attention to the area of volume overload.
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