Emil Nyquist er seksjonsoverlege ved Hematologisk seksjon, Sykehuset i

Objectives: In Norway, initial treatment of febrile neutropenia (FN) has traditionally been benzylpenicillin plus an aminoglycoside. Internationally, FN is often treated with a broad-spectrum beta-lactam antibiotic. We aimed to compare these two regimens in a prospective, randomized, trial in patients with lymphoma or leukaemia with an expected period of neutropenia >= 7 days, and a suspected bacterial infection.Methods: Adult neutropenic patients with lymphoma or leukaemia, and a suspected bacterial infection, were randomized for treatment with benzylpenicillin plus an aminoglycoside or meropenem. The primary endpoint was clinical success, defined as no modification of antibiotics and clinical stability 72 h after randomization.Results: Among 322 randomized patients, 297 proved evaluable for analyses. Fifty-nine per cent (95% CI 51% e66%), (87/148) of the patients given benzylpenicillin plus an aminoglycoside were clinically stable, and had no antibiotic modifications 72 h after randomization, compared with 82% (95% CI 75% e87%), (122/149) of the patients given meropenem (p < 0.001). When the antibiotic therapy was stopped, 24% (95% CI 18% e32%), (36/148) of the patients given benzylpenicillin plus an aminoglycoside, compared with 52% (95% CI 44% e60%), (78/149) of the patients given meropenem, had no modifications of their regimens (p < 0.001). In the benzylpenicillin plus an aminoglycoside arm, the all-cause fatality within 30 days of randomization was 3.4% (95% CI 1.2% e7.9%), (5/148) of the patients, compared with 0% (95% CI 0.0% e3.0%), (0/149) of the patients in the meropenem arm (p 0.03).Conclusion: Clinical success was more common in FN patients randomized to meropenem compared with the patients randomized to benzylpenicillin plus an aminoglycoside. The all-cause fatality was higher among the patients given benzylpenicillin plus an aminoglycoside. (C) (C) 2016 European Society of Clinical Microbiology and Infectious Diseases. Published by Elsevier Ltd. All rights reserved.

A woman in her 60s, with known seropositive thrombocytopenic purpura (TTP), HELLP rheumatoid arthritis and three previous hospitalisations for acute pancreatitis, was admitted with abdominal pain. On admission, amylase was 1 611 U/l (< 120 U/l) and CT abdomen showed changes consistent with acute pancreatitis. She improved rapidly after intravenous fluid therapy, and was discharged after five days. Thirteen days after her discharge, she was admitted to the Department of Neurology with suspected transitory ischaemic attack (TIA) after two days of episodes of dizziness and slurred speech. She also reported slight pain in the right flank that did not resemble the pain of pancreatitis. The neurological examination yielded negative findings. CT of the head and ultrasound of the carotids were normal. Twelve years earlier, she had suffered a minor stroke, and had been using clopidogrel since then. Blood tests taken on admission revealed newly developed thrombocytopenia. Her thrombocytes had fallen from 315 · 109/l at the time of discharge 13 days earlier to 69 · 109/l (145 – 390 · 109/l). At the same time, she had a slightly prolonged activated partial thromboplastin time (APTT) of 50 seconds (< 42 sec), but a normal INR of 1.0 ( 1.1). She experienced no further episodes of dizziness or speech problems during her stay in hospital and was discharged after twenty four hours without the cause of the symptoms being found.

From 2005 to 2010, eight families with clustering of Hodgkin's lymphoma and other lymphoproliferative disorders were found: Hodgkin's lymphoma 9 cases, chronic lymphocytic leukemia 8, non-Hodgkin's lymphoma 3, and multiple myeloma 1 case. Seven cases of Hodgkin's lymphoma, all males, were seen in pleiotropic pairs of affected family members from two successive generations; two patients were sisters. Five of the seven pairs showed sign of anticipation. The 7 males with Hodgkin's lymphoma were found in 5 patrilineal pairs and 2 matrilineal pairs; 6 parent-offspring pairs and 1 uncle-nephew pair. In contrast to the matrilineal pairs, all patrilineal pairs, apart from one family with an only child, had healthy older siblings in accordance with a birth-order effect. The association among Hodgkin's lymphoma, males, and other lymphoproliferative disorders undoubtedly reflects genotypic traits of the susceptibility. A non-Mendelian segregation is discussed comprising genomic parental imprinting and incomplete penetrance susceptibility in both familial and solitary cases.