SiR,-Clinically, Burkitt's lymphoma may present as single or as multiple tumours, usually of the ... more SiR,-Clinically, Burkitt's lymphoma may present as single or as multiple tumours, usually of the face or abdomen. The disease is already widespread when the tumour becomes clinically evident: necropsy and laparotomy findings on patients with facial tumours as the only overt manifestation usually reveal involvement of the abdominal organsl and some patients with only abdominal disease have radiographic evidence of involvement of the jaw.2
We designed a study to evaluate the fecal carrier rate of Streptococcus bovis in patients with en... more We designed a study to evaluate the fecal carrier rate of Streptococcus bovis in patients with endoscopically proven colonic polyps. Benign polyps (n = 63), i.e., hyperplastic, inflammatory, and juvenile, had a similar fecal carrier rate as the normal control colons. Colons with polyps that are at increased risk for malignant degeneration (n = 62), i.e., tubulovillous and villous adenomas, and colons with carcinoma (n = 18), had a statistically significant increase (p less than 0.05) in the fecal carrier rate for S. bovis over the benign colon group. Overall, the incidence of S. bovis carriage in all colons with polyps was intermediary between normal colons and colons with carcinoma although the numbers did not achieve statistical significance.
RATIONALE: Ocular allergy is one of the most common ocular problems in clinical practice and, alt... more RATIONALE: Ocular allergy is one of the most common ocular problems in clinical practice and, although easily identified and frequently a mild to moderate condition, is responsible for health impairment and work/school absenteeism. METHODS: A cross sectional study, based on a structured questionnaire, was performed in 16 ophthalmology departments of central or regional hospitals, in patients diagnosed with allergic conjunctivitis, during the spring of 2006. RESULTS: 220 patients were enrolled (mean age of 31.4 6 18.5 years). A quarter of these patients had >5 episodes of ocular allergy in the past year, 59.3% all year round episodes, and most presented associated co-morbidities (allergic rhinitis 45.9%, asthma 15.5%). They had a significant impairment of their overall quality of life during an acute episode (45.6% 6 in a 10 point severity scale). Only 19.4% had an appointment with the ophthalmologist as a first action and most (56.1%) started with self treatment measures. Only 37.2% had a previous allergy diagnostic evaluation. CONCLUSIONS: We found a significant impairment of the self-rated health status during an ocular allergy episode. Moreover, most patients have recurrent year round episodes, and start its management with self treatment measures.
Written as an editorial commentary regarding Kulczycki et al. Practices, Challenges, and Opportun... more Written as an editorial commentary regarding Kulczycki et al. Practices, Challenges, and Opportunities to Improving Pneumococcal Immunization in Working-Age, At-Risk Adults Through Community Pharmacies on pages 23-28 of the Journal. V accines are safe and generally very effective in alleviating the burden that many infectious diseases have on individuals as well as society as a whole. The reductions in morbidity and mortality 1 are well-documented benefits of the widespread application of vaccinations in children and adults. Recently, Ozawa and others 2 have reported on their estimates of the economic burden of adult vaccine-preventable diseases in the United States. Based on data from the Centers for Disease Control and Prevention, 58% of adults age eighteen and older did not receive an influenza vaccine in 2015 to 2016. Influenza was the most costly illness of the vaccine preventable diseases in that season, adding up to nearly 5.8 billion dollars in 2015. Pneumococcal infections accounted for 1.86 billion dollars in vaccine-preventable diseases in that same year. In all, 7.1 billion dollars of the total of 8.95 billion dollars was attributable to 10 vaccine-preventable diseases in the Ozawa article. These costs were estimated in terms of deaths, disabilities, doctor visits, hospital admissions and lost income. These estimates did not include the broader potential benefits to society, such as childhood development, household behavior, and macroeconomic indicators. 3 Pneumococcal vaccination rates in adults in the United States are low, particularly in high-risk adults between 18 and 64 years of age (less than 22%) and far below the Health People 2020 targets of 60%. 4,5 In this issue of Infectious Diseases in Clinical Practice, Kulczycki et al 6 report on the results of a study carried out by using semistructured interviews with pharmacists at 12 independently owned community pharmacies (none were retail chains) in Alabama in the spring of 2015. Most of these pharmacies were in physician shortage areas of Alabama, and listed as underserved by primary health care providers by the Health Resources Service Administration. 7 The authors explored, for the first time, the practice experiences, challenges, and potential opportunities of such pharmacists with the goal of improving pneumococcal vaccination rates in those adults, 18 to 65 years of age, who have comorbid conditions, as defined by the Advistory Committee on Immunization Practices. When I originally read this article, I could not help recalling the picture of the small town "pharmacist" by Normal Rockwell on the cover of the March 18, 1939, Saturday Evening Post. Those were simpler times in pre-World War II America, and vaccinations for adults were essentially a nonissue. In the current climate, multiple barriers to meeting population vaccination goals have been identified including cost, apathy, mistrust of authority (physicians, public health officials), accessibility, inconvenience, and denial of need. 8-11 The expanding role of pharmacists in the past 20 years has helped to improve access to care for adults seeking vaccinations. 12,13 Kulczycki et al, attempted to assess the knowledge and experience of these community-based pharmacists in regard to pneumococcal vaccinations of adults younger than 65 years, but their experience with adults older than 65 years raised additional concerns. Despite the fact that all of these pharmacists had completed immunization training with the American Pharmacists Association Pharmacy-Based Immunization Delivery Program 14 (a program recommended by the Centers for Disease Control and Prevention), few of them had administered the PPSV-23 vaccine to adults, 18 to 64 years of age, 2 had never administered pneumococcal vaccine at all, 5 had never provided the PCV-13 vaccine, and only 1 of them used the Alabama State Immunization Registry. None of them routinely gave copies of vaccine records to the patients or sent reports to the primary care physicians. Despite these shortcomings, the expanded hours of pharmacies compared to most physician offices, the convenient locations closer to home, the ability to avoid making an appointment with a physician
Histoplasma capsulatum is a rare cause of fungal endocarditis that affects both native and prosth... more Histoplasma capsulatum is a rare cause of fungal endocarditis that affects both native and prosthetic valves. It is associated with a high mortality rate if not diagnosed early and treated with a combination of antifungal therapy and surgical intervention. We present a case of a 47-year-old man with histoplasmosis infective endocarditis. He was successfully treated with antifungal therapy and surgical replacement of the infected bioprosthetic aortic valve. Our systemic literature review includes 52 articles encompassing 60 individual cases of H. capsulatum infective endocarditis from 1940 to 2020. Patient presentations, diagnostic laboratory testing accuracy, treatment modalities, and patient outcomes comparing and contrasting native and prosthetic valve infection are described.
The Journal of Allergy and Clinical Immunology, Feb 1, 2015
RATIONALE: X-linked Hyper IgM Syndrome (HIGM) is rare disorder due to a mutation in the gene that... more RATIONALE: X-linked Hyper IgM Syndrome (HIGM) is rare disorder due to a mutation in the gene that encodes for CD40 ligand (CD40L), resulting in defective class-switch recombination. Autoimmune complications such as colitis can be seen in a subset of these patients, which can be challenging to manage. We present an adolescent male with X-linked HIGM who developed severe colitis refractory to standard treatment. Successful treatment with an unconventional regimen consisting of rituximab and 6-mercaptopurine (6-MP) induced remission. METHODS: This 17-year-old male, also with a history of autoimmune neutropenia, developed an 8-month history of severe secretory diarrhea of 3 liters daily with subsequent profound weight loss. Infectious studies and tissue pathology were unrevealing for common and opportunistic pathogens, coexisting inflammatory bowel disease, or autoimmune enteropathy. Treatment with high dose systemic corticosteroids, a tumor necrosis factor blocker infliximab, and high dose oral immunoglobulin failed to yield any improvement. RESULTS: Given his immune dysregulation thought still to be autoimmune in nature, a B cell depleting regimen with rituximab at 375 mg/m 2 once weekly for 4 doses was initiated in addition to 6-MP at 50 mg daily. His diarrhea completely resolved within 4 weeks of his last treatment with rituximab. CONCLUSIONS: This is the first reported case of an adolescent with Xlinked HIGM complicated by severe refractory colitis managed successfully with a unique regimen of rituximab and 6-mercaptopurine. This treatment protocol may prove to be helpful in other HIGM individuals with a similar and challenging complication.
Infectious Diseases in Clinical Practice, May 1, 2018
Rationale: Recurrent idiopathic anaphylaxis represents a vexing clinical problem associated with ... more Rationale: Recurrent idiopathic anaphylaxis represents a vexing clinical problem associated with stress for patients and allergists. The cause is often not identified despite exhaustive testing. Methods: The history of a 54-year old woman with repeated bouts of unexplained anaphylaxis is reviewed. The relationship between preceding or active infection (emphasis on gastrointestinal infections) and chronic idiopathic urticaria and anaphylaxis was explored by electronic media search (PubMed, Google) and review of reference lists of published articles. The literature on the relationship of Campylobacter jejuni infection and urticaria is reviewed. Gastrointestinal infections (Giardia, Anisakis) have been better documented in such patients. Results: The patient had persistent flatulence, and looser and more frequent bowel movements for months after recovery from a bout of food poisoning. A diagnosis of "postinfectious irritable bowel syndrome" was made by a gastroenterologist. These symptoms were not related to her simultaneous diagnosis of chronic idiopathic urticaria and idiopathic anaphylaxis. After treatment with azithromycin (positive stool culture for C. jejuni), she had a systemic allergic reaction. Subsequently, the diarrhea and urticaria/anaphylaxis cleared. C. jejuni has been reported to cause chronic urticaria, but predominantly in children. A related organism, Helicobacter pylori, has been associated with chronic idiopathic urticaria. Anaphylaxis has not been related to Campylobacter infection in the past. Conclusions: Urticaria and recurrent bouts of mild unexplained anaphylaxis were triggered by C. jejuni infection. The allergic and gastrointestinal symptoms resolved after antibiotic treatment. Gastrointestinal (and other) infections should be looked for in patients with urticaria or anaphylaxis
The Journal of Allergy and Clinical Immunology, Feb 1, 2012
RATIONALE: Carboplatin is a platinum base chemotherapy agent utilized in multiple malignancies. M... more RATIONALE: Carboplatin is a platinum base chemotherapy agent utilized in multiple malignancies. Many patients have experienced either true hypersensitivity reactions or severe adverse reactions to carboplatin. Given the necessity to receive therapy, desensitization is clearly indicated in this group of patients. METHODS: This is a retrospective analysis of patients who underwent desensitization to carboplatin for clinical evidence of hypersensitivity or severe adverse reactions (non-IgE) to carboplatin from August 2005-January 2011 in our institution. A multidisciplinary team developed an institutional desensitization protocol utilizing appropriate pre-medications and an accelerating, graded increase in drug concentration. All patients were admitted to the ICU for desensitization with continuous monitoring, with a board certified allergist available. RESULTS: Twenty patients with a previously identified reaction to carboplatin underwent 38 separate desensitization procedures. Of these, 35/38 (92%) procedures were completed successfully. There were no reported symptoms in 28/38 (74%) procedures. Minor symptoms were reported in 7/38 (18%) procedures which were relieved with a single dose of diphenhydramine allowing successful completion of therapy. Only 3/38 (8%) procedures were discontinued due to adverse reactions including hypertension, generalized pruritus with shortness of breath, and a reaction to another medication prior to initiating carboplatin desensitization. There were no major events of anaphylaxis or severe reactions necessitating epinephrine use or resuscitation. CONCLUSIONS: Careful and selected desensitization in appropriate patients using a rigid protocol provides a safe opportunity for patients with documented hypersensitivity and/or severe adverse reactions to receive carboplatin. This allows completion of necessary chemotherapy at required doses without compromising cancer treatment.
The Journal of Allergy and Clinical Immunology, Feb 1, 2005
Epi-Pen is a lifesaving device, but the teaching of its use has not been properly evaluated. METH... more Epi-Pen is a lifesaving device, but the teaching of its use has not been properly evaluated. METHOD: Pediatric patients (n=224) with a history of anaphylaxis were enrolled in the study. Parents were taught 9 steps about the use of Epi-Pen, and were tested on their knowledge and skills in subsequent visits using an Epi-Pen demonstrator. The pass rate was determined for each step on each visit. RESULTS: 1). Only 22% (49 of 224) of parents passed all 9 tests in the first visit. 2). 68% (152 of 224) passed the tests on the second visit and, 94% (211 of 224) passed all of the tests after the third visit. 3). 6.5% (15 of 224) of parents failed to pass the test even after five tries. 4). The highest failure rates were for the instructions to "press until you feel the click" and to "hold the Epi-Pen firmly for 10 seconds." 5). The group carrying an Epi-Pen demonstrator had a significantly better pass rate, and 6). Children presented with insect sting allergy had a better pass rate than those with food allergy. CONCLUSION: 1). Many parents of children with history of anaphylaxis lack the skill to administer Epi-Pen effectively. 2). Staffs in allergy clinic should take an active role in teaching and continuing to explain the use of Epi-Pen. 3). Prescriptions for Epi-Pen should include a demonstrator.
The first described association of an aggressive giant-cell tumor of the tibia is reported in a y... more The first described association of an aggressive giant-cell tumor of the tibia is reported in a young female with congenital adrenal virilism (adrenogenital syndrome) who was followed for 24 years. The adrenogenital syndrome is probably transmitted by a single autosomal ...
Histoplasma capsulatum is a rare cause of fungal endocarditis that affects both native and prosth... more Histoplasma capsulatum is a rare cause of fungal endocarditis that affects both native and prosthetic valves. It is associated with a high mortality rate if not diagnosed early and treated with a combination of antifungal therapy and surgical intervention. We present a case of a 47-year-old man with histoplasmosis infective endocarditis. He was successfully treated with antifungal therapy and surgical replacement of the infected bioprosthetic aortic valve. Our systemic literature review includes 52 articles encompassing 60 individual cases of H. capsulatum infective endocarditis from 1940 to 2020. Patient presentations, diagnostic laboratory testing accuracy, treatment modalities, and patient outcomes comparing and contrasting native and prosthetic valve infection are described.
SiR,-Clinically, Burkitt's lymphoma may present as single or as multiple tumours, usually of the ... more SiR,-Clinically, Burkitt's lymphoma may present as single or as multiple tumours, usually of the face or abdomen. The disease is already widespread when the tumour becomes clinically evident: necropsy and laparotomy findings on patients with facial tumours as the only overt manifestation usually reveal involvement of the abdominal organsl and some patients with only abdominal disease have radiographic evidence of involvement of the jaw.2
We designed a study to evaluate the fecal carrier rate of Streptococcus bovis in patients with en... more We designed a study to evaluate the fecal carrier rate of Streptococcus bovis in patients with endoscopically proven colonic polyps. Benign polyps (n = 63), i.e., hyperplastic, inflammatory, and juvenile, had a similar fecal carrier rate as the normal control colons. Colons with polyps that are at increased risk for malignant degeneration (n = 62), i.e., tubulovillous and villous adenomas, and colons with carcinoma (n = 18), had a statistically significant increase (p less than 0.05) in the fecal carrier rate for S. bovis over the benign colon group. Overall, the incidence of S. bovis carriage in all colons with polyps was intermediary between normal colons and colons with carcinoma although the numbers did not achieve statistical significance.
RATIONALE: Ocular allergy is one of the most common ocular problems in clinical practice and, alt... more RATIONALE: Ocular allergy is one of the most common ocular problems in clinical practice and, although easily identified and frequently a mild to moderate condition, is responsible for health impairment and work/school absenteeism. METHODS: A cross sectional study, based on a structured questionnaire, was performed in 16 ophthalmology departments of central or regional hospitals, in patients diagnosed with allergic conjunctivitis, during the spring of 2006. RESULTS: 220 patients were enrolled (mean age of 31.4 6 18.5 years). A quarter of these patients had >5 episodes of ocular allergy in the past year, 59.3% all year round episodes, and most presented associated co-morbidities (allergic rhinitis 45.9%, asthma 15.5%). They had a significant impairment of their overall quality of life during an acute episode (45.6% 6 in a 10 point severity scale). Only 19.4% had an appointment with the ophthalmologist as a first action and most (56.1%) started with self treatment measures. Only 37.2% had a previous allergy diagnostic evaluation. CONCLUSIONS: We found a significant impairment of the self-rated health status during an ocular allergy episode. Moreover, most patients have recurrent year round episodes, and start its management with self treatment measures.
Written as an editorial commentary regarding Kulczycki et al. Practices, Challenges, and Opportun... more Written as an editorial commentary regarding Kulczycki et al. Practices, Challenges, and Opportunities to Improving Pneumococcal Immunization in Working-Age, At-Risk Adults Through Community Pharmacies on pages 23-28 of the Journal. V accines are safe and generally very effective in alleviating the burden that many infectious diseases have on individuals as well as society as a whole. The reductions in morbidity and mortality 1 are well-documented benefits of the widespread application of vaccinations in children and adults. Recently, Ozawa and others 2 have reported on their estimates of the economic burden of adult vaccine-preventable diseases in the United States. Based on data from the Centers for Disease Control and Prevention, 58% of adults age eighteen and older did not receive an influenza vaccine in 2015 to 2016. Influenza was the most costly illness of the vaccine preventable diseases in that season, adding up to nearly 5.8 billion dollars in 2015. Pneumococcal infections accounted for 1.86 billion dollars in vaccine-preventable diseases in that same year. In all, 7.1 billion dollars of the total of 8.95 billion dollars was attributable to 10 vaccine-preventable diseases in the Ozawa article. These costs were estimated in terms of deaths, disabilities, doctor visits, hospital admissions and lost income. These estimates did not include the broader potential benefits to society, such as childhood development, household behavior, and macroeconomic indicators. 3 Pneumococcal vaccination rates in adults in the United States are low, particularly in high-risk adults between 18 and 64 years of age (less than 22%) and far below the Health People 2020 targets of 60%. 4,5 In this issue of Infectious Diseases in Clinical Practice, Kulczycki et al 6 report on the results of a study carried out by using semistructured interviews with pharmacists at 12 independently owned community pharmacies (none were retail chains) in Alabama in the spring of 2015. Most of these pharmacies were in physician shortage areas of Alabama, and listed as underserved by primary health care providers by the Health Resources Service Administration. 7 The authors explored, for the first time, the practice experiences, challenges, and potential opportunities of such pharmacists with the goal of improving pneumococcal vaccination rates in those adults, 18 to 65 years of age, who have comorbid conditions, as defined by the Advistory Committee on Immunization Practices. When I originally read this article, I could not help recalling the picture of the small town "pharmacist" by Normal Rockwell on the cover of the March 18, 1939, Saturday Evening Post. Those were simpler times in pre-World War II America, and vaccinations for adults were essentially a nonissue. In the current climate, multiple barriers to meeting population vaccination goals have been identified including cost, apathy, mistrust of authority (physicians, public health officials), accessibility, inconvenience, and denial of need. 8-11 The expanding role of pharmacists in the past 20 years has helped to improve access to care for adults seeking vaccinations. 12,13 Kulczycki et al, attempted to assess the knowledge and experience of these community-based pharmacists in regard to pneumococcal vaccinations of adults younger than 65 years, but their experience with adults older than 65 years raised additional concerns. Despite the fact that all of these pharmacists had completed immunization training with the American Pharmacists Association Pharmacy-Based Immunization Delivery Program 14 (a program recommended by the Centers for Disease Control and Prevention), few of them had administered the PPSV-23 vaccine to adults, 18 to 64 years of age, 2 had never administered pneumococcal vaccine at all, 5 had never provided the PCV-13 vaccine, and only 1 of them used the Alabama State Immunization Registry. None of them routinely gave copies of vaccine records to the patients or sent reports to the primary care physicians. Despite these shortcomings, the expanded hours of pharmacies compared to most physician offices, the convenient locations closer to home, the ability to avoid making an appointment with a physician
Histoplasma capsulatum is a rare cause of fungal endocarditis that affects both native and prosth... more Histoplasma capsulatum is a rare cause of fungal endocarditis that affects both native and prosthetic valves. It is associated with a high mortality rate if not diagnosed early and treated with a combination of antifungal therapy and surgical intervention. We present a case of a 47-year-old man with histoplasmosis infective endocarditis. He was successfully treated with antifungal therapy and surgical replacement of the infected bioprosthetic aortic valve. Our systemic literature review includes 52 articles encompassing 60 individual cases of H. capsulatum infective endocarditis from 1940 to 2020. Patient presentations, diagnostic laboratory testing accuracy, treatment modalities, and patient outcomes comparing and contrasting native and prosthetic valve infection are described.
The Journal of Allergy and Clinical Immunology, Feb 1, 2015
RATIONALE: X-linked Hyper IgM Syndrome (HIGM) is rare disorder due to a mutation in the gene that... more RATIONALE: X-linked Hyper IgM Syndrome (HIGM) is rare disorder due to a mutation in the gene that encodes for CD40 ligand (CD40L), resulting in defective class-switch recombination. Autoimmune complications such as colitis can be seen in a subset of these patients, which can be challenging to manage. We present an adolescent male with X-linked HIGM who developed severe colitis refractory to standard treatment. Successful treatment with an unconventional regimen consisting of rituximab and 6-mercaptopurine (6-MP) induced remission. METHODS: This 17-year-old male, also with a history of autoimmune neutropenia, developed an 8-month history of severe secretory diarrhea of 3 liters daily with subsequent profound weight loss. Infectious studies and tissue pathology were unrevealing for common and opportunistic pathogens, coexisting inflammatory bowel disease, or autoimmune enteropathy. Treatment with high dose systemic corticosteroids, a tumor necrosis factor blocker infliximab, and high dose oral immunoglobulin failed to yield any improvement. RESULTS: Given his immune dysregulation thought still to be autoimmune in nature, a B cell depleting regimen with rituximab at 375 mg/m 2 once weekly for 4 doses was initiated in addition to 6-MP at 50 mg daily. His diarrhea completely resolved within 4 weeks of his last treatment with rituximab. CONCLUSIONS: This is the first reported case of an adolescent with Xlinked HIGM complicated by severe refractory colitis managed successfully with a unique regimen of rituximab and 6-mercaptopurine. This treatment protocol may prove to be helpful in other HIGM individuals with a similar and challenging complication.
Infectious Diseases in Clinical Practice, May 1, 2018
Rationale: Recurrent idiopathic anaphylaxis represents a vexing clinical problem associated with ... more Rationale: Recurrent idiopathic anaphylaxis represents a vexing clinical problem associated with stress for patients and allergists. The cause is often not identified despite exhaustive testing. Methods: The history of a 54-year old woman with repeated bouts of unexplained anaphylaxis is reviewed. The relationship between preceding or active infection (emphasis on gastrointestinal infections) and chronic idiopathic urticaria and anaphylaxis was explored by electronic media search (PubMed, Google) and review of reference lists of published articles. The literature on the relationship of Campylobacter jejuni infection and urticaria is reviewed. Gastrointestinal infections (Giardia, Anisakis) have been better documented in such patients. Results: The patient had persistent flatulence, and looser and more frequent bowel movements for months after recovery from a bout of food poisoning. A diagnosis of "postinfectious irritable bowel syndrome" was made by a gastroenterologist. These symptoms were not related to her simultaneous diagnosis of chronic idiopathic urticaria and idiopathic anaphylaxis. After treatment with azithromycin (positive stool culture for C. jejuni), she had a systemic allergic reaction. Subsequently, the diarrhea and urticaria/anaphylaxis cleared. C. jejuni has been reported to cause chronic urticaria, but predominantly in children. A related organism, Helicobacter pylori, has been associated with chronic idiopathic urticaria. Anaphylaxis has not been related to Campylobacter infection in the past. Conclusions: Urticaria and recurrent bouts of mild unexplained anaphylaxis were triggered by C. jejuni infection. The allergic and gastrointestinal symptoms resolved after antibiotic treatment. Gastrointestinal (and other) infections should be looked for in patients with urticaria or anaphylaxis
The Journal of Allergy and Clinical Immunology, Feb 1, 2012
RATIONALE: Carboplatin is a platinum base chemotherapy agent utilized in multiple malignancies. M... more RATIONALE: Carboplatin is a platinum base chemotherapy agent utilized in multiple malignancies. Many patients have experienced either true hypersensitivity reactions or severe adverse reactions to carboplatin. Given the necessity to receive therapy, desensitization is clearly indicated in this group of patients. METHODS: This is a retrospective analysis of patients who underwent desensitization to carboplatin for clinical evidence of hypersensitivity or severe adverse reactions (non-IgE) to carboplatin from August 2005-January 2011 in our institution. A multidisciplinary team developed an institutional desensitization protocol utilizing appropriate pre-medications and an accelerating, graded increase in drug concentration. All patients were admitted to the ICU for desensitization with continuous monitoring, with a board certified allergist available. RESULTS: Twenty patients with a previously identified reaction to carboplatin underwent 38 separate desensitization procedures. Of these, 35/38 (92%) procedures were completed successfully. There were no reported symptoms in 28/38 (74%) procedures. Minor symptoms were reported in 7/38 (18%) procedures which were relieved with a single dose of diphenhydramine allowing successful completion of therapy. Only 3/38 (8%) procedures were discontinued due to adverse reactions including hypertension, generalized pruritus with shortness of breath, and a reaction to another medication prior to initiating carboplatin desensitization. There were no major events of anaphylaxis or severe reactions necessitating epinephrine use or resuscitation. CONCLUSIONS: Careful and selected desensitization in appropriate patients using a rigid protocol provides a safe opportunity for patients with documented hypersensitivity and/or severe adverse reactions to receive carboplatin. This allows completion of necessary chemotherapy at required doses without compromising cancer treatment.
The Journal of Allergy and Clinical Immunology, Feb 1, 2005
Epi-Pen is a lifesaving device, but the teaching of its use has not been properly evaluated. METH... more Epi-Pen is a lifesaving device, but the teaching of its use has not been properly evaluated. METHOD: Pediatric patients (n=224) with a history of anaphylaxis were enrolled in the study. Parents were taught 9 steps about the use of Epi-Pen, and were tested on their knowledge and skills in subsequent visits using an Epi-Pen demonstrator. The pass rate was determined for each step on each visit. RESULTS: 1). Only 22% (49 of 224) of parents passed all 9 tests in the first visit. 2). 68% (152 of 224) passed the tests on the second visit and, 94% (211 of 224) passed all of the tests after the third visit. 3). 6.5% (15 of 224) of parents failed to pass the test even after five tries. 4). The highest failure rates were for the instructions to "press until you feel the click" and to "hold the Epi-Pen firmly for 10 seconds." 5). The group carrying an Epi-Pen demonstrator had a significantly better pass rate, and 6). Children presented with insect sting allergy had a better pass rate than those with food allergy. CONCLUSION: 1). Many parents of children with history of anaphylaxis lack the skill to administer Epi-Pen effectively. 2). Staffs in allergy clinic should take an active role in teaching and continuing to explain the use of Epi-Pen. 3). Prescriptions for Epi-Pen should include a demonstrator.
The first described association of an aggressive giant-cell tumor of the tibia is reported in a y... more The first described association of an aggressive giant-cell tumor of the tibia is reported in a young female with congenital adrenal virilism (adrenogenital syndrome) who was followed for 24 years. The adrenogenital syndrome is probably transmitted by a single autosomal ...
Histoplasma capsulatum is a rare cause of fungal endocarditis that affects both native and prosth... more Histoplasma capsulatum is a rare cause of fungal endocarditis that affects both native and prosthetic valves. It is associated with a high mortality rate if not diagnosed early and treated with a combination of antifungal therapy and surgical intervention. We present a case of a 47-year-old man with histoplasmosis infective endocarditis. He was successfully treated with antifungal therapy and surgical replacement of the infected bioprosthetic aortic valve. Our systemic literature review includes 52 articles encompassing 60 individual cases of H. capsulatum infective endocarditis from 1940 to 2020. Patient presentations, diagnostic laboratory testing accuracy, treatment modalities, and patient outcomes comparing and contrasting native and prosthetic valve infection are described.
Uploads
Papers by Carl Lauter