Disagreement between nurses and doctors was frequent with respect to their judgment of futility of medical interventions. Disagreements most often concerned the most severely ill patients. Nurses, being more pessimistic in general, were more often correct than doctors in the judgment of dying patients but proposed treatment withdrawal in some very sick patients who survived. Future quality of life cannot reliably be predicted either by doctors or by nurses.
Two cases of pneumococcal necrotizing fasciitis (NF) occurred after intramuscular injections of nonsteroidal anti-inflammatory drugs; another 5 cases reported in the literature fulfilled the criteria for NF involving Streptococcus pneumoniae. Conditions associated with alterations of immune function could be identified in 6 of the 7 cases; 2 patients died despite surgical and antimicrobial treatment.
Background: We report the case of a patient who experienced
a severe neurologic complication after treatment
of diffuse large B-cell lymphoma. Case Report: A 62-yearold
patient was diagnosed with a diffuse large B-cell lymphoma
and treated with rituximab, cyclophosphamide,
doxorubicin, vincristine, and prednisone under prophylactic
G-CSF substitution. After the second cycle she developed
severe neurologic complications with generalized
seizures and soporous condition. The MRI showed
bilateral areas of signal hyperintensity in the subcortical
and cortical regions in both hemispheres, consistent with
the diagnosis of a reversible posterior leukoencephalopathy
syndrome. The patient was under surveillance in
intensive care, and a meticulous control of the blood
pressure was performed. She fully recovered within a
few days, and MRI changes normalized. Antineoplastic
treatment had to be continued, and we chose a combination
of rituximab, doxorubicin, etoposide, and prednisone.
Conclusions: The reversible posterior leukoencephalopathy
syndrome is believed to be the result of altered
cerebral autoregulation with impaired blood flow
control and resultant endothelial damage caused by different
situations and agents. Several chemotherapy
agents have been described in association with the syndrome.
However, little is known about the prevalence of
the syndrome and the follow-up of these patients, especially
their further treatment.
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