Leukocyte reduction and ultraviolet B irradiation of platelets to prevent alloimmunisation and refractoriness to platelet transfusions.

Despite overwhelming evidence of its benefits, a widespread implementation of pulmonary rehabilitation (PR) is lacking and the landscape of multidisciplinary programs remains very scattered. The objective of this study is to assess how PR is organized in specialized care centres in Belgium and to identify which barriers may exist according to respiratory physicians. A telephone and online survey was developed by a Belgian expert panel and distributed among all active Belgian chest physicians (n ¼ 492). Data were obtained from 200 respondents (40%). Seventy-five percentage of the chest physicians had direct access to an ambulatory rehabilitation program in their hospital. Most of these programs are organized bi or triweekly for an average period of 3-6 months. Programs focus strongly on chronic obstructive pulmonary disease patients from secondary care, have a multidisciplinary approach and provide exercise capacity and quality of life measures as main outcomes. Yet large differences were observed in process and outcome indicators between the programs of centres with standard funding and those of specialized centres with a larger allocated budget. We conclude that multidisciplinary PR programs are available in the majority of Belgian hospitals. Differences in funding determine the quality of the team, the diversity of the interventions and the monitoring of outcomes. More resources for rehabilitation will directly improve the utilization and quality of this essential treatment option in respiratory diseases.

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Primary central nervous system (CNS) lymphoma represents less than 5% of non-Hodgkin lymphomas, mainly of the B-cell type. We recently diagnosed a relapse of primary CNS lymphoma, resulting in panhypopituitarism and diabetes insipidus. Th is complication has rarely been described in the literature. Due to the patient ' s palliative situation, treatment was adapted to the context and only minimally invasive tests were performed to make the diagnosis.A 57-year-old woman was diagnosed with a diff use large B-cell primary cerebral lymphoma. After one course of high-dose corticosteroids and two courses of high-dose intravenous cytarabine and methotrexate, whole-brain radiotherapy (39 Gy) was successfully administered. Brain magnetic resonance imaging (MRI) confi rmed a complete remission. One year after the initial diagnosis, the patient was readmitted for confusion. She had urinary incontinence with polyuria, polydypsia and a recent 2 kg weight loss, with ataxia and paresis of oculomotor nerve III. Daily medication included dexamethasone 1.5 mg. A brain computed tomography (CT) scan identifi ed a 2.7 cm left thalamo-pedoncular lesion with a mass eff ect on the left lateral and third ventricles. Th e lesion was contrastenhanced and surrounded by an important edema. MRI of the brain further identifi ed hypothalamic and probably pituitary invasion ( Figure 1). Th e history of CNS lymphoma, brain images and clinical presentation were all suggestive of brain lymphoma recurrence. Lumbar puncture showed a few lymphocytes in the cerebrospinal fl uid. Disease staging excluded other lesions. Blood analysis identifi ed hypoglycemia, a very low thyroid stimulating hormone (TSH) value at 0.02 μ IU/mL (normal [N] ϭ 0.20 -4.20) with normallow free thyroxine (T 4 ) at 8.6 pg/mL (N ϭ 7.0 -17.0) and hypernatremia at 155 mmol/L (N ϭ 135 -145). Additional antepituitary hormone levels were examined. Luteinizing hormone (LH), follicle stimulating hormone (FSH) and estradiol levels were very low. Luteinizing hormone-releasing hormone (LH-RH) and thyrotropin-releasing hormone (TRH) tests confi rmed central hypogonadotropic hypogonadism and central hypothyroidism. Th e prolactin serum level was increased fi ve-fold above the normal range, suggesting a defect in the pituitary stalk. Insulin-like growth factor-1 (IGF-1) levels were normal, but growth hormone (GH)stimulating tests were not performed. Because the patient was immediately treated with methylprednisolone, the corticotropic axis could not be investigated. Analyses exploring the post-pituitary were also performed. Th e 24 h urinary volume was 4800 mL with a low osmolality of 204 mOsm/ kg (N ϭ 50 -1200), with the patient receiving 500 mL of parenteral fl uids and drinking more than 3500 mL per day. Plasma osmolality was normal -low at 288 mOsm/kg. After administration of a nasal spray of desmopressin, the 24 h urinary volume decreased to 1800 mL. Plasma osmolality increased to 596 mOsm/kg.A diagnosis of anterior and posterior hypopituitarism was therefore proposed. Th e patient was th...