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OUTPATIENT TREATMENT OF DEEP VEIN THROMBOSIS (DVT) IN ONCOLOGIC PATIENTS UNDERGOING CHEMOTHERAPY
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Abstracts from 10th Congress of the European Federation of Internal Medicine/European Journal of Internal Medicine 22S (2011) S1–S112
cian. The data were collected using a standardised proforma and analysed using Microsoft Excel. Results: The number of patients admitted during each hour period is shown in Figure1. 6% of patients were seen by a competent decision maker within 30 minutes of referral to acute medical team. The mean waiting time for medical assessment was 166.5 minutes (median 128 minutes, range 0-465 minutes). The maximum waiting time was noted between 14:00 and 18:00 hours. 19% of patients were reviewed by consultant within 12 hours of admission. The mean review time was 13.8 hours (median 14.15 hours, range 0-20.6 hours). Conclusion: Restructuring of junior doctors’ working pattern, with staggered start times across the day matching with peak admissions period, plus extended consultant presence is necessary to ensure AMU manage acutely unwell medical patients in line with recommendations. OUTPATIENT TREATMENT OF DEEP VEIN THROMBOSIS (DVT) IN ONCOLOGIC PATIENTS UNDERGOING CHEMOTHERAPY Dafni Koumoutsea1, Vasilios Tsiligiris2, Christos Poziopoulos1, Pantelis Kapralos1, Panagiota Thalassinou3, Evangelos Nanos2, Nikolaos Filiotis4, Ioannis Angelakas2, Charalambos Christophyllakis1, Ioannis Koutandos1, Dimitrios Patsios1. 1First Department of Internal Medicine and Division of Oncology and Chemotherapy, 401 General Military Hospital of Athens, Greece; 2Department of General and Vascular Surgery 401 General Military Hospital of Athens, Greece; 3Sixth IKA Oncologic Hospital, Athens, Greece; 4 Department of Oncology, University Hospital of Bari, Italy Background/Aim: Outpatient treatment of deep vein thrombosis (DVT) has generally become a common practice nowadays. However, in some oncologic centers, oncologic patients with DVT are usually excluded from home treatment because they have a higher risk of active bleeding and recurrent DVT. We performed a retrospective review of clinical practice patterns, so as to assess the rate of oncologic patients undergoing chemotherapy, who were deemed eligible for outpatient (home) treatment of their DVT. Materials - Methods: All oncologic patients with clinically manifested and objectively documented DVT were treated as outpatients, unless there was an urgent need of admission for other reason, such as active bleeding, recurrent cancer pain that required parenteral analgesia or other medical problems related to the underlying disease. Outpatient treatment consisted of low-molecular-weight heparin (LMWH) followed by warfarin/acenocoumarol or with LMWH alone. Results: Over a long-lasting period of almost eight years, there were 225 oncologic patients undergoing chemotherapy, 54,22% of whom had metastatic disease. The most frequent locations of solid tumors were the urogenital tract (38,22%), the gastrointestinal tract (35,11%) and the breast (22,22%). Treatment with LMWH and warfarin/acenocoumarol was prescribed to 67,11% and LMWH alone to 32,89%. In total 69,33% (>2/3) of oncologic patients were fully treated at home. There were no differences between patients treated at home and hospitalized patients with regard to gender, age, location of solid tumor, presence of metastases and treatment. After a three-month period, recurrent thromboembolism occurred in 5,12% of oncologic patients treated at home and in 4,34% of hospitalized patients. In addition, major bleeding occurred in 1,28% and 5,79% respectively. Furthermore, 47,55% of oncologic patients died from another cause than recurrent thromboembolism and major bleeding, 55,14% in the outpatient treatment group and 44,86% of the hospitalized patients. Conclusions: According to the above data our results demonstrate that home treatment of DVT in oncologic patients undergoing chemotherapy apprears to be well tolerated as well as safe and feasible in more than two-thirds (>2/3) of cases. Outpatient management of antithrombotic treatment does not increase the rate of adverse events, even if the stage of the underlying disease (cancer) is advanced. DIARRHEA IN PATIENTS WITH MULTIPLE MYELOMA RECEIVING LENALIDOMIDE: BEWARE OF CLOSTRIDIUM DIFFICILE Ioasaf Karafotias, Christos Charalampopoulos, Christis Rotos, Demetrios Chrysis, Efstathia Soroli, Andreas Papakyriakou, Constantinos Christopoulos. First Department of Internal Medicine, “Amalia Fleming” General Hospital, Athens, Greece Background: Lenalidomide (Revlimid®) is a thalidomide analogue with proven efficacy in all stages of multiple myeloma. Diarrhea is reported to occur in up
to 48% of patients on long-term therapy with lenalidomide. Clostridium difficile colitis in immunosuppressed patients may present atypically and follow a fulminant course. Methods: We examined the medical records of two patients with refractory myeloma on long-term lenalidomide therapy who were admitted to a General Medical Department with diarrhea. Results: Case 1: A 54-year-old male taking lenalidomide, methylprednisolone and prophylactic co-trimoxazole developed diarrheic episodes attributed to lenalidomide and treated symptomatically with loperamide. Following a 4-day episode of massive diarrhea, he was admitted in a state of circulatory collapse with a laboratory profile of profound electrolyte imbalance, acuteon-chronic renal failure and pancytopenia. Abdominal imaging revealed colonic dilatation compatible with toxic megacolon. Despite intensive treatment including broad spectrum antibiotics plus oral and intravenous metronidazole and vancomycin combined with probiotics, his condition deteriorated and he died of multi-organ failure. Case 2: A 62-year-old male on lenalidomide and acyclovir presented with a 7-day history of diarrhea and low-grade fever. Laboratory investigations demonstrated dehydration and severe pancytopenia. Administration of metronidazole p.o. resulted in complete resolution of the diarrhea. Stool examination for C. difficile toxin A employing a qualitative immunochromatographic assay was positive in both cases. Conclusion: Symptomatic treatment of diarrhea in patients with myeloma on lenalidomide may have devastating consequences in the presence of C. difficile infection. Timely diagnosis and treatment of the latter is mandatory in this clinical setting. HEALTH-RELATED QUALITY OF LIFE IN PATIENTS WITH CHRONIC HEPATITIS C. THE IMPACT OF ANTIVIRAL THERAPY Vasilios Papastergiou1, Lamprini Skorda2, Phillipos Lisgos1, Mihail Hletsos3, Ioannis Ketikoglou4, Christos Zamanis5, Stylianos Karatapanis1. 1Liver Clinic, First Department of Internal Medicine, General Hospital of Rhodes; 2Department of Internal Medicine, “Konstantopoulio” Hospital of Athens; 3Hellenic Open University of Patras; 4Department of Internal Medicine, “Ippokration” General Hospital of Athens; 5Department of Internal Medicine, “West Attica” General Hospital, Athens, Greece Background: Chronic hepatitis C (CHC) is a systemic disease with many extrahepatic manifestations that may result in poor health-related-quality of life (HRQoL). This study aimed to assess the impact of CHC to HRQoL and the influence of antiviral treatment to that outcome. Methods: Ninety patients with CHC (group-A), 90 healthy-controls (group-B) and 90 previously treated patients who had achieved sustained viral response (SVR) (group-C) were evaluated. In group-A, ALT, viral load, HCV genotype, and BMI were determined and the HQLQ-questionnaire (QualityMetric Inc, USA) was used to assess HRQoL at baseline, and 3 months after initiation of combined antiviral therapy according to current protocol. The HQLQquestionnaire was also completed by all subjects in group-B and group-C. Results: In group-A, HRQoL was found to be below that of group-B in all SF-36 scales. Significant differences were detected in 4 concepts (role-physical, general-health, social-functioning and role-emotional). A further significant reduction was detected in 7/12 scales of the HQLQ-questionnaire, 3 months after initiation of therapy. HRQoL in group-C was significantly better as compared with group-A in 7/12 HQLQ scales. Multiple linear regression analysis showed that a history of drug abuse seemed to play a significant role in bodily pain and general health, as well as age in vitality and mental health. Conclusion: HRQoL is significantly impaired in CHC patients as compared to healthy controls. HRQoL further deteriorates during antiviral treatment but achievement of SVR results in a significant improvement that seems to exceed pre-treatment levels. Drug-abuse/age can independently influence HRQoL in CHC patients. THE EXPERIENCE OF TREATMENT OF UNCOMPLICATED HYPERTENSIVE CRISES WITH DRUGS FOR TRANSMUCOSAL APPLICATION Svyatoslav Kechyn1, Igor Kechyn2. 1Kiev National Medical Universyty, Ukraine; Zaporozye,s State Medical Universyty, Ukraine
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Background: The transmucosal application of drugs allows to increase the absolute delivery of the effective substance by decreasing its liver biotransformation.The intranasal introduction facilitates the passing by the histoen-
Abstracts from 10th Congress of the European Federation of Internal Medicine/European Journal of Internal Medicine 22S (2011) S1–S112
cian. The data were collected using a standardised proforma and analysed using Microsoft Excel. Results: The number of patients admitted during each hour period is shown in Figure1. 6% of patients were seen by a competent decision maker within 30 minutes of referral to acute medical team. The mean waiting time for medical assessment was 166.5 minutes (median 128 minutes, range 0-465 minutes). The maximum waiting time was noted between 14:00 and 18:00 hours. 19% of patients were reviewed by consultant within 12 hours of admission. The mean review time was 13.8 hours (median 14.15 hours, range 0-20.6 hours). Conclusion: Restructuring of junior doctors’ working pattern, with staggered start times across the day matching with peak admissions period, plus extended consultant presence is necessary to ensure AMU manage acutely unwell medical patients in line with recommendations. OUTPATIENT TREATMENT OF DEEP VEIN THROMBOSIS (DVT) IN ONCOLOGIC PATIENTS UNDERGOING CHEMOTHERAPY Dafni Koumoutsea1, Vasilios Tsiligiris2, Christos Poziopoulos1, Pantelis Kapralos1, Panagiota Thalassinou3, Evangelos Nanos2, Nikolaos Filiotis4, Ioannis Angelakas2, Charalambos Christophyllakis1, Ioannis Koutandos1, Dimitrios Patsios1. 1First Department of Internal Medicine and Division of Oncology and Chemotherapy, 401 General Military Hospital of Athens, Greece; 2Department of General and Vascular Surgery 401 General Military Hospital of Athens, Greece; 3Sixth IKA Oncologic Hospital, Athens, Greece; 4 Department of Oncology, University Hospital of Bari, Italy Background/Aim: Outpatient treatment of deep vein thrombosis (DVT) has generally become a common practice nowadays. However, in some oncologic centers, oncologic patients with DVT are usually excluded from home treatment because they have a higher risk of active bleeding and recurrent DVT. We performed a retrospective review of clinical practice patterns, so as to assess the rate of oncologic patients undergoing chemotherapy, who were deemed eligible for outpatient (home) treatment of their DVT. Materials - Methods: All oncologic patients with clinically manifested and objectively documented DVT were treated as outpatients, unless there was an urgent need of admission for other reason, such as active bleeding, recurrent cancer pain that required parenteral analgesia or other medical problems related to the underlying disease. Outpatient treatment consisted of low-molecular-weight heparin (LMWH) followed by warfarin/acenocoumarol or with LMWH alone. Results: Over a long-lasting period of almost eight years, there were 225 oncologic patients undergoing chemotherapy, 54,22% of whom had metastatic disease. The most frequent locations of solid tumors were the urogenital tract (38,22%), the gastrointestinal tract (35,11%) and the breast (22,22%). Treatment with LMWH and warfarin/acenocoumarol was prescribed to 67,11% and LMWH alone to 32,89%. In total 69,33% (>2/3) of oncologic patients were fully treated at home. There were no differences between patients treated at home and hospitalized patients with regard to gender, age, location of solid tumor, presence of metastases and treatment. After a three-month period, recurrent thromboembolism occurred in 5,12% of oncologic patients treated at home and in 4,34% of hospitalized patients. In addition, major bleeding occurred in 1,28% and 5,79% respectively. Furthermore, 47,55% of oncologic patients died from another cause than recurrent thromboembolism and major bleeding, 55,14% in the outpatient treatment group and 44,86% of the hospitalized patients. Conclusions: According to the above data our results demonstrate that home treatment of DVT in oncologic patients undergoing chemotherapy apprears to be well tolerated as well as safe and feasible in more than two-thirds (>2/3) of cases. Outpatient management of antithrombotic treatment does not increase the rate of adverse events, even if the stage of the underlying disease (cancer) is advanced. DIARRHEA IN PATIENTS WITH MULTIPLE MYELOMA RECEIVING LENALIDOMIDE: BEWARE OF CLOSTRIDIUM DIFFICILE Ioasaf Karafotias, Christos Charalampopoulos, Christis Rotos, Demetrios Chrysis, Efstathia Soroli, Andreas Papakyriakou, Constantinos Christopoulos. First Department of Internal Medicine, “Amalia Fleming” General Hospital, Athens, Greece Background: Lenalidomide (Revlimid®) is a thalidomide analogue with proven efficacy in all stages of multiple myeloma. Diarrhea is reported to occur in up
to 48% of patients on long-term therapy with lenalidomide. Clostridium difficile colitis in immunosuppressed patients may present atypically and follow a fulminant course. Methods: We examined the medical records of two patients with refractory myeloma on long-term lenalidomide therapy who were admitted to a General Medical Department with diarrhea. Results: Case 1: A 54-year-old male taking lenalidomide, methylprednisolone and prophylactic co-trimoxazole developed diarrheic episodes attributed to lenalidomide and treated symptomatically with loperamide. Following a 4-day episode of massive diarrhea, he was admitted in a state of circulatory collapse with a laboratory profile of profound electrolyte imbalance, acuteon-chronic renal failure and pancytopenia. Abdominal imaging revealed colonic dilatation compatible with toxic megacolon. Despite intensive treatment including broad spectrum antibiotics plus oral and intravenous metronidazole and vancomycin combined with probiotics, his condition deteriorated and he died of multi-organ failure. Case 2: A 62-year-old male on lenalidomide and acyclovir presented with a 7-day history of diarrhea and low-grade fever. Laboratory investigations demonstrated dehydration and severe pancytopenia. Administration of metronidazole p.o. resulted in complete resolution of the diarrhea. Stool examination for C. difficile toxin A employing a qualitative immunochromatographic assay was positive in both cases. Conclusion: Symptomatic treatment of diarrhea in patients with myeloma on lenalidomide may have devastating consequences in the presence of C. difficile infection. Timely diagnosis and treatment of the latter is mandatory in this clinical setting. HEALTH-RELATED QUALITY OF LIFE IN PATIENTS WITH CHRONIC HEPATITIS C. THE IMPACT OF ANTIVIRAL THERAPY Vasilios Papastergiou1, Lamprini Skorda2, Phillipos Lisgos1, Mihail Hletsos3, Ioannis Ketikoglou4, Christos Zamanis5, Stylianos Karatapanis1. 1Liver Clinic, First Department of Internal Medicine, General Hospital of Rhodes; 2Department of Internal Medicine, “Konstantopoulio” Hospital of Athens; 3Hellenic Open University of Patras; 4Department of Internal Medicine, “Ippokration” General Hospital of Athens; 5Department of Internal Medicine, “West Attica” General Hospital, Athens, Greece Background: Chronic hepatitis C (CHC) is a systemic disease with many extrahepatic manifestations that may result in poor health-related-quality of life (HRQoL). This study aimed to assess the impact of CHC to HRQoL and the influence of antiviral treatment to that outcome. Methods: Ninety patients with CHC (group-A), 90 healthy-controls (group-B) and 90 previously treated patients who had achieved sustained viral response (SVR) (group-C) were evaluated. In group-A, ALT, viral load, HCV genotype, and BMI were determined and the HQLQ-questionnaire (QualityMetric Inc, USA) was used to assess HRQoL at baseline, and 3 months after initiation of combined antiviral therapy according to current protocol. The HQLQquestionnaire was also completed by all subjects in group-B and group-C. Results: In group-A, HRQoL was found to be below that of group-B in all SF-36 scales. Significant differences were detected in 4 concepts (role-physical, general-health, social-functioning and role-emotional). A further significant reduction was detected in 7/12 scales of the HQLQ-questionnaire, 3 months after initiation of therapy. HRQoL in group-C was significantly better as compared with group-A in 7/12 HQLQ scales. Multiple linear regression analysis showed that a history of drug abuse seemed to play a significant role in bodily pain and general health, as well as age in vitality and mental health. Conclusion: HRQoL is significantly impaired in CHC patients as compared to healthy controls. HRQoL further deteriorates during antiviral treatment but achievement of SVR results in a significant improvement that seems to exceed pre-treatment levels. Drug-abuse/age can independently influence HRQoL in CHC patients. THE EXPERIENCE OF TREATMENT OF UNCOMPLICATED HYPERTENSIVE CRISES WITH DRUGS FOR TRANSMUCOSAL APPLICATION Svyatoslav Kechyn1, Igor Kechyn2. 1Kiev National Medical Universyty, Ukraine; Zaporozye,s State Medical Universyty, Ukraine
2
Background: The transmucosal application of drugs allows to increase the absolute delivery of the effective substance by decreasing its liver biotransformation.The intranasal introduction facilitates the passing by the histoen-