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In this Phase 2 trial, 11 patients with relapsed/refractory primary central nervous system lymphoma after high-dose, methotrexate-based regimen were treated with pemetrexed 900 mg/m2 every 3 weeks, dexamethasone 4 mg bid, folate, and B12 supplementation. The treatment had an overall response rate of 55%, disease control rate of 91%, median progression free survival of 5.7 months, and median overall survival of 10.1 months. Toxicities were more than expected with the standard pemetrexed dose (500 mg/m2) and were primarily hematologic and infectious, which were easily managed. Although single-agent activity of pemetrexed in this study is novel and promising, optimal dosing and efficacy need to be studied further.
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Although current guidelines recommend delaying neuroprognostication during therapeutic hypothermia following resuscitation from cardiac arrest, this review of 55 consecutive patients so managed found that a "poor prognosis" designation was arrived at during the hypothermia period in most of them, including six patients who were eventually discharged with a favorable neurologic outlook.
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Timely recognition and treatment of myocardial infarction (MI) are crucial if we are to achieve optimal outcomes for our patients. Silent ischemia, or the absence of classical symptoms of ischemia, may delay the diagnosis.
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Infection is the second leading cause of death in hemodialysis patients, with mortality rates ranging from 12-36% in this vulnerable population.
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Two ICU patients experienced respiratory arrest while receiving polymyxin. Given the recent resurgence of use of this antibiotic and its close relative colistin to treat gram-negative infections resistant to newer agents, clinicians should be aware of this infrequent but long-known and potentially fatal adverse effect.
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More than half of patients undergoing non-cardiac surgery and polysomnography had obstructive sleep apnea, which was associated with an increased risk of perioperative complications, including hypoxemia, ICU transfer, and prolonged length of stay.
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Treatment for headache, including the migraine headache, has significantly changed in the past decade. Causes for headaches, specifically of the migraine type, are still the subject of much debate. Headaches are currently divided simply as primary and secondary. Primary headaches are described as being "idiopathic," or not due to an actual disease process or external stimulus. Secondary headaches are classified as being due to an underlying disease/illness, such as sinusitis, or due to an external stressor, for example, trauma resulting in a closed head injury.
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