Publications

Post transplantation constrictive bronchiolitis (PTCB) is the most common pulmonary complication among long-term survivors of allogeneic hematopoietic stem cell transplantation (HSCT). It is a late manifestation of GVHD. Its treatment with high-dose systemic corticosteroids and other immunosuppressive regimens is associated with multiple side effects. Topical corticosteroids are used for the treatment of other manifestations of GVHD to minimize these side effects. We conducted a retrospective analysis of a series of adult patients to evaluate the efficacy of high-dose inhaled corticosteroids in the treatment of PTCB. Seventeen patients with new-onset airflow obstruction were diagnosed with PTCB. Their forced expiratory volume in 1 s (FEV1) declined from a median of 84% (range, 56-119) before HSCT to 53% (26-82) after HSCT. All patients received inhaled fluticasone propionate 500-940 microg two times daily. Symptoms of airway obstruction improved and FEV1 stabilized 3-6 months after treatment. We conclude that high-dose inhaled corticosteroids may be effective in the treatment of PTCB and propose a plausible mechanism of its action. A prospective evaluation of its efficacy is warranted.

BACKGROUND

Evidence suggests that fatigue may be a greater problem for cancer survivors than people without cancer. The present study sought to determine whether fatigue was greater in women who had completed treatment for early-stage breast cancer relative to a demographically matched comparison group of women with no cancer history.

METHODS

As part of a larger study, women with stage 0-II breast cancer were recruited before the start of chemotherapy and radiotherapy (n = 100) or radiotherapy only (n = 121). Fatigue was assessed at the end of treatment and 2, 4, and 6 months later. An age- and geographically matched sample of women with no history of cancer was recruited and assessed for comparison purposes.

RESULTS

Relative to comparison subjects, breast cancer survivors reported more days of fatigue in the past week at all 4 study assessments (P < .05). These differences appeared to be clinically meaningful in that a greater percentage of patients than nonpatients earned scores in the abnormal range on this measure at each assessment (P < .05). Additional analyses indicated that differences in fatigue between patients and comparison subjects were attributable primarily to heightened fatigue in women who received both chemotherapy and radiotherapy.

CONCLUSIONS

Findings suggest that fatigue is a greater problem for breast cancer survivors in the 6 months after completion of chemotherapy than for women with no cancer history. Future research should include longer-term follow-up to determine the persistence of fatigue in this population of survivors.

The Center for Disease Control and Prevention (CDC) recommends screening and surveillance of dialysis patients for hepatitis C virus (HCV), but there are limited data on the real life performance of confirmatory tests. We performed a cost-identification analysis of CDC recommendations using a large database of dialysis subjects. Screening and surveillance were performed according to CDC guidelines: enzyme immunoassay (EIA) testing upon entry then biannual surveillance. All positive EIA tests were confirmed by either polymerase chain reaction (PCR) or radioimmunoblot assay (RIBA). A total of 12,563 patients were tested from 1997 to 2004. By EIA, the prevalence of HCV was 8.4% and annual incidence was 0.96%. The prevalence after confirmation by RIBA and PCR was 5.8% and 4.8%, respectively. The annual incidence of hepatitis C confirmed by RIBA and PCR was 0.13% and 0.084%, respectively. Using Medicare reimbursement, the cost to screen and confirm one case of hepatitis C by RIBA was $372 versus $503 by PCR. However, the cost to identify an incident infection increased to $30,594 by RIBA and $48,622 by PCR. In the sensitivity analysis, the cost of identifying incident HCV infection dropped by 50% when the surveillance interval was extended to 1 year or when seroconversion rates for EIA occurred at 2%. Due to high surveillance cost, further studies are necessary to determine optimal intervals and settings.

BACKGROUND

Atrial arrhythmias are associated with inflammation. The cause and effect of the association are unknown.

OBJECTIVE

The purpose of this study was to test the hypothesis that atrial tachyarrhythmias contribute to inflammation.

METHODS

We performed a prospective observational study wherein C-reactive protein (CRP) and interleukin-6 (IL-6) levels from the femoral vein and coronary sinus (CS) were compared before curative ablation for atrial flutter (AFL; n = 59) and paroxysmal supraventricular tachycardia (SVT; n = 110). Follow-up levels were obtained at 1 and 6 months.

RESULTS

Peripheral levels of both biomarkers were significantly higher in the AFL group. After multivariate adjustment, only those in the AFL group who presented in AFL or atrial fibrillation (AF) had significantly elevated CRP levels (odds ratio 1.26; P = .033). Levels of each marker were similar in the CS and peripheral blood in the SVT group; in the AFL group, both CRP and IL-6 were significantly lower in the CS than in the periphery (P = .0076 and P = .0021, respectively). CRP was significantly lower a median of 47 days after AFL ablation (from a median of 6.28 mg/L to a median of 2.92 mg/L; P = .028) and remained reduced at second follow-up. IL-6 decreased across three time points after AFL ablation (P = .002). No reduction in inflammatory biomarkers was observed after SVT ablation.

CONCLUSIONS

CRP and IL-6 levels are elevated in patients presenting in AFL. Given the lower CS values in these patients, their origin appears to be systemic rather than cardiac. Because these levels significantly fall after ablation of AFL, the atrial tachyarrhythmia appears to be the cause (not the effect) of the inflammation.