Search

Bradykinesia is the major cardinal motor sign of Parkinson’s disease (PD), but its neural underpinnings are unclear. Although impairment in PD has been linked to heightened synchrony within the beta band (13-30 Hz) in the subthalamic nucleus (STN), bradykinesia appears to be the manifestation of a network-level dysfunction including the basal ganglia, motor cortex, and possibly cerebellum. The goal of this study was to examine whether changes in bradykinesia over time following long-term STN deep brain stimulation (DBS) are linked to local STN beta dynamics or a wider bilateral network dysfunction. Twenty-one individuals with Parkinson’s disease chronically implanted with sensing neurostimulators (Activa® PC+S, Medtronic, PLC) in the STN participated in a longitudinal ‘washout’ therapy study every three to six months for an average of three years. At each visit, participants were withdrawn from medication (12/24/48 hours) and had DBS turned off (>60 minutes) prior to completing a repetitive wrist-flexion extension task, a validated quantitative assessment of bradykinesia. Synchronized local field potentials and kinematic data were recorded. Local STN beta dynamics were investigated via STN beta power and burst duration, while interhemispheric beta synchrony was assessed with STN beta coherence. Higher beta power and interhemispheric STN beta coherence, but not burst duration, were significantly associated with worse bradykinesia. Bradykinesia was found to worsen off therapy over time. Interhemispheric STN beta coherence also increased over time, whereas beta power and burst duration remained stable. The observed percent change in bradykinesia was related to the percent change in interhemispheric beta coherence, with greater increases in synchrony associated with further worsening of bradykinesia. Together, these findings implicate interhemispheric beta synchrony as a neural correlate of the progression of bradykinesia following chronic STN DBS. This could imply the existence of a pathological bilateral network contributing to bradykinesia in PD.

Background Young plasma infusions have emerged as a potential treatment for neurodegenerative disease, and convalescent plasma therapy has been used safely in the management of viral pandemics. However, the effect of plasma therapy in Parkinson's disease (PD) is unknown. Objectives The objective of this study was to determine the safety, tolerability, and feasibility of plasma infusions in people with PD. Methods A total of 15 people with clinically established PD, at least 1 cognitive complaint, and on stable therapy received 1 unit of young fresh frozen plasma twice a week for 4 weeks. Assessments and adverse effects were performed/reported on and off therapy at baseline, immediately after, and 4 weeks after the infusions ended. Adverse effects were also assessed during infusions. The primary outcomes were safety, tolerability, and feasibility. Exploratory outcomes included Unified Parkinson's Disease Rating Scale Part III off medication, neuropsychological battery, Parkinson's Disease Questionnaire‐39, inflammatory markers (tumor necrosis factor‐α, interleukin‐6), uric acid, and quantitative kinematics. Results Adherence rate was 100% with no serious adverse effects. There was evidence of improvement in phonemic fluency (P = 0.002) and in the Parkinson's Disease Questionnaire‐39 stigma subscore (P = 0.013) that were maintained at the delayed evaluation. Elevated baseline tumor necrosis factor‐α levels decreased 4 weeks after the infusions ended. Conclusions Young fresh frozen plasma was safe, feasible, and well tolerated in people with PD, without serious adverse effects and with preliminary evidence for improvements in phonemic fluency and stigma. The results of this study warrant further therapeutic investigations in PD and provide safety and feasibility data for plasma therapy in people with PD who may be at higher risk for severe complications of COVID‐19. © 2020 The Authors. Movement Disorders published by Wiley Periodicals LLC. on behalf of International Parkinson and Movement Disorder Society.

Objective. To investigate the progression of neural and motor features of Parkinson's disease in a longitudinal study, after washout of medication and bilateral subthalamic nucleus deep brain stimulation (STN DBS). Methods. Participants with clinically established Parkinson's disease underwent bilateral implantation of DBS leads (18 participants, 13 male) within the STN using standard functional frameless stereotactic technique and multi-pass microelectrode recording. Both DBS leads were connected to an implanted investigative sensing neurostimulator (Activa™ PC + S, Medtronic, PLC). Resting state STN local field potentials (LFPs) were recorded and motor disability, (the Movement Disorder Society-Unified Parkinson's Disease Rating Scale – motor subscale, MDS-UPDRS III) was assessed off therapy at initial programming, and after 6 months, 1 year, and yearly out to 5 years of treatment. The primary endpoint was measured at 3 years. At each visit, medication had been held for over 12/24 h and DBS was turned off for at least 60 min, by which time LFP spectra reached a steady state. Results. After 3 years of chronic DBS, there were no increases in STN beta band dynamics (p = 0.98) but there were increases in alpha band dynamics (p = 0.0027, 25 STNs). Similar results were observed in a smaller cohort out to 5 years. There was no increase in the MDS-UPDRS III score. Interpretation. These findings provide evidence that the beta oscillopathy does not substantially progress following combined STN DBS plus medication in moderate to advanced Parkinson's disease.

Freezing of gait (FOG), a devastating symptom of Parkinson’s disease (PD), can be refractory to current treatments such as medication and open-loop deep brain stimulation (olDBS). Recent evidence suggests that closed-loop DBS (clDBS), using beta local field potential power from the subthalamic nucleus (STN) as the control variable, can improve tremor and bradykinesia; however, no study has investigated the use of clDBS for the treatment of FOG. In this study, we provide preliminary evidence that clDBS was superior to olDBS in reducing percent time freezing and in reducing freezing behavior (gait arrhythmicity) in a person with PD and FOG. These findings warrant further investigation into the use of clDBS to treat FOG while also minimizing the total energy delivered to maintain a therapeutic effect.

BackgroundPathological bursts of neural activity in Parkinson’s disease present as exaggerated subthalamic neuronal oscillations in the 8-30 Hz frequency range and are related to motor impairment.New MethodThis study introduces a novel method for determining burst dynamics using a baseline that matches physiological 1/f spectrum activity. We used resting state local field potentials from people with Parkinson’s disease and a simulated 1/f signal to measure beta burst durations, to demonstrate how tuning parameters (i.e., bandwidth and center frequency) affect burst durations, to compare this with high power threshold methods, and to study the effect of increasing neurostimulation intensities on burst duration.ResultsBurst durations calculated using the Anderson method captured the longest and broadest distribution of burst durations in a pathological beta band compared to previous methods. Mean beta band burst durations were significantly shorter on compared to off neurostimulation (p = 0.011), and their distribution was shifted towards that of the physiological 1/f spectrum during increasing intensities of stimulation.Comparison with Existing MethodExisting methods of measuring local field potential power either lack temporal specificity to detect bursts (power spectral density diagrams and spectrograms) or include only higher power bursts and portions of the neural signal.ConclusionsWe suggest that this novel method is well suited to quantify the full range of fluctuations in beta band neural activity in the Parkinsonian brain. This method may reveal more relevant feedback biomarkers than averaged beta band power for future closed loop algorithms.HighlightsA novel method for measuring variability in subthalamic local field potential oscillations in Parkinson’s disease using a physiological baseline of power.Modeling normal brain activity using a physiological 1/f spectrum.Burst durations depend on choice of bandwidth and center frequency.Defining an inert frequency band whose mean burst duration overlap the physiological 1/f spectrum, from which the baseline was determined.Burst durations progressively shortened during increasing intensities of deep brain stimulation.

Background Pathologically prolonged bursts of neural activity in the 8−30 Hz frequency range in Parkinson’s disease have been measured using high power event detector thresholds. New method This study introduces a novel method for determining beta bursts using a power baseline based on spectral activity that overlapped a simulated 1/f spectrum. We used resting state local field potentials from people with Parkinson’s disease and a simulated 1/f signal to measure beta burst durations, to demonstrate how tuning parameters (i.e., bandwidth and center frequency) affect burst durations, to compare burst duration distributions with high power threshold methods, and to study the effect of increasing neurostimulation intensities on burst duration. Results The baseline method captured a broad distribution of resting state beta band burst durations. Mean beta band burst durations were significantly shorter on compared to off neurostimulation (p = 0.0046), and their distribution shifted towards that of the 1/f spectrum during increasing intensities of stimulation. Comparison with existing methods High power event detection methods, measure duration of higher power bursts and omit portions of the neural signal. The baseline method captured the broadest distribution of burst durations and was more sensitive than high power detection methods in demonstrating the effect of neurostimulation on beta burst duration. Conclusions The baseline method captured a broad range of fluctuations in beta band neural activity and demonstrated that subthalamic neurostimulation shortened burst durations in a dose (intensity) dependent manner, suggesting that beta burst duration is a useful control variable for closed loop algorithms.

Freezing of gait (FOG), a devastating symptom of Parkinson’s disease (PD), can be refractory to current treatments such as medication and open-loop deep brain stimulation (olDBS). Recent evidence suggests that closed-loop DBS (clDBS), using beta local field potential power from the subthalamic nucleus (STN) as the control variable, can improve tremor and bradykinesia; however, no study has investigated the use of clDBS for the treatment of FOG. In this study, we provide preliminary evidence that clDBS was superior to olDBS in reducing percent time freezing and in reducing freezing behavior (gait arrhythmicity) in a person with PD and FOG. These findings warrant further investigation into the use of clDBS to treat FOG while also minimizing the total energy delivered to maintain a therapeutic effect.

Introduction : La securisation du circuit du medicament (CDM) ou de la « prise en charge medicamenteuse » constituait une priorite des etablissements de sante depuis la reforme hospitaliere du plan « hopital 2007 ». Les objectifs de cette etude etaient de decrire et d’evaluer l’impact du projet SAM (Simplifier, Ameliorer et Moderniser les processus logistiques) sur la gestion des stocks, le cout, le gain en personnel dans un service de reanimation pediatrique (RP).Materiel et methodes : A partir de 2007, le service de RP du CHU de Lille se portait candidat au projet SAM. En 2008, sur la base des consommations de l’annee 2007 de tous les medicaments, solutes, DM et materiels non medicaux, une dotation etait elaboree. Apres un appel a projets, le systeme de dotation de gestion en plein-vide (SPV) dans des armoires a pharmacie et de rangement etait choisi. Une estimation du temps gagne etait effectuee.Resultats : Le stock « mort » diminuait de 69 % (94 816 €) en valeur, et de 18 % en nombre de references stockees dans le service. Le gain hebdomadaire de temps soignant (88,5 heures) en 2008 etait reinvesti dans 0,8 poste equivalent temps plein d’auxiliaire de puericulture. Les temps additionnels hebdomadaires de la pharmacie et du service logistique etaient respectivement de 9,5 et 5 heures sans creation de poste. Lors des deux enquetes, de maniere globale, le projet a ete bien accepte et adopte par les equipes de soignants et de la pharmacie. Le sentiment general etait l’amelioration de la qualite des soins et de la surveillance des patients.Conclusion : L’experience du projet SAM par systeme de gestion d’une liste de dotation en plein-vide (medicaments, DM, solutes et materiel) a montre son interet en partie grâce a la mise en œuvre d’une reorganisation spatiale du service et un transfert de tâches vers la pharmacie et les services logistiques. Ce projet a permis une reinjection de temps dans les soins directs aux patients, un sentiment d’amelioration de la qualite des soins et de la surveillance des patients, et le decloisonnement entre la pharmacie et l’unite de soins. Ce systeme apporte un debut de reponse a la reglementation et constitue un excellent tremplin en vue de l’informatisation du CDM.

Introduction et but de l’etude L’instruction DGOS du 20/03/15 relative a la gestion des risques liee a l’activite de nutrition parenterale (NP) en neonatalogie et en pediatrie insiste sur le recours en premiere intention aux poches avec autorisation de mise sur le marche (AMM). En octobre 2016, Numetah® G E 13 % obtenait l’AMM pour les prematures. Cette poche tri-compartimentee permet d’administrer un melange binaire ou ternaire (emulsion lipidique [ELI] olive/soja [OS]), denue de micronutriments, pouvant etre dilue. L’objectif de ce travail etait de statuer sur l’emploi en reanimation neonatale (RNN) de l’ELI OS (rationnel scientifique, impact ligne perfusion), definir les modalites d’utilisation (binaire/ternaire, dilution) de la poche puis suivre son utilisation. Materiel et methodes Une revue de la litterature a ete menee sur l’emploi de l’ELI OS en RNN (recherche PubMed, mots cles « olive oil » & « preterm neonates »). L’impact de l’emploi d’un melange ternaire sur le circuit de perfusion a ete etudie au cours d’echanges avec l’equipe soignante et medicale. L’impact de la dilution sur les apports a ete evalue a partir des recommandations de dilution du fournisseur, en considerant un premature de 800 grammes et un debit de 160 mL/kg/jour pour lequel nous avons compare aux valeurs moyennes des recommandations de l’ESPGHAN 2005 les apports obtenus selon les volumes prescrits en fonction de la dilution. L’etude retrospective a consiste a identifier dans le logiciel de prescription l’ensemble des poches prescrites entre janvier et mars 2017 et verifier leurs modalites d’utilisation. Resultats et analyse statistique L’emploi de l’ELI OS chez les prematures est peu decrite dans la litterature, ou elle est surtout comparee aux ELI a base d’huile de poisson (HP) : absence de difference sur la croissance et la morbidite vs une ELI HP (Deshpande e t al.), taux plasmatiques en acide docosahexaenoique (DHA) plus eleves dans le groupe HP (Najm et al.), role benefique du DHA dans la retinopathie du premature dont l’incidence est diminuee chez les prematures du groupe HP (Pawlik et al). Par ailleurs l’emploi d’un melange ternaire n’est pas adapte aux procedures de montage de la ligne de perfusion du service. Les medecins ont donc decide de maintenir l’emploi de l’ELI HP administree en Y de la NP binaire. L’emploi de Numetah® non dilue mene a des apports superieurs aux recommandations : acides amines (AA) (+421 %), glucose (+281 %), sodium (+116 %) et potassium (+ 246 %). La correction par dilution avec 155 mL d’eau mene a des apports insuffisants en calcium (−10 %) et phosphore (−2 %). Les modalites d’emploi diluee et non diluee ont ete retenues au sein de notre etablissement, le choix se fondant sur l’etat clinique des patients. Ainsi, de janvier a mars 2017, 134 poches de Numetah® ont ete utilisees dont 79,9 % diluees et 20,1 % non diluees. Conclusion L’utilisation de Numetah® dans notre service de RNN se fait systematiquement en binaire avec supplementation en electrolytes et micronutriments, et dans 79,9 % des cas apres dilution, etape a risques septique et d’erreur. Nous envisageons donc la realisation de poches standardisees de composition correspondant a la version diluee et supplementee de Numetah®.

Resume Le service des urgences est a l'interface entre ville et hopital, permettant d'etudier l'ecologie bacterienne communautaire. Nous avons collecte les resultats des antibiogrammes realises sur des Escherichia coli isoles d'infections urinaires de malades consultant aux urgences en 2002 et 2004. Les antibiogrammes ont ete effectues sur le Walk Away (Dade Behring). Nous avons compare la sensibilite des souches de E. coli a l'amoxicilline (Amx), a l'amoxicilline + acide clavulanique (AMC), a l'acide nalidixique (NA), a la ciprofloxacine (Cip), au cotrimoxazole (SXT), aux furanes (Ft). Ces sensibilites ont ete comparees a celle des memes souches isolees des infections urinaires de malades hospitalises. Les sensibilites sont passees respectivement de 58 a 54 % pour Amx, de 88 a 83 % pour Na, de 96 a 89 % pour Cip, de 82 a 79 % pour SXT, de 94 a 96 % pour FT, et sont restees a 60 % pour AMC chez les externes. Elles sont passees de 52 a 46 % pour Amx, de 55 a 53 % pour AMC, de 79 a 70 % pour NA, de 87 a 79 % pour Cip, de 74 a 69 % pour SXT, de 93 a 92 % pour Ft chez les patients hospitalises. La sensibilite des souches communautaires d'Escherichia coli isolees des infections urinaires des patients consultant aux urgences ne cesse de diminuer et devient preoccupante notamment en ce qui concerne les fluoroquinolones, remettant en cause le traitement empirique des pyelonephrites aigues par les fluoroquinolones.

Resume Les pharmaciens hospitaliers ont un role specifique dans la politique nutritionnelle a l'hopital. Leurs missions definies reglementairement en font des acteurs incontournables de la gestion des nutriments et dispositifs medicaux necessaires aux techniques de nutrition artificielle. Leur expertise des questions galeniques leur permet d'assurer la preparation des melanges nutritifs de nutrition parenterale dans des conditions optimales de qualite et de securite. Le pharmacien se trouve associe a la politique nutritionnelle de l'etablissement en prenant part aux travaux du comite de liaison alimentation nutrition. Il est aussi partie prenante aux activites de nutrition artificielle a domicile lorsqu'elles existent dans l'etablissement. L'ensemble de ces roles institutionnels lui permettent d'apporter le soutien de ses connaissances dans le domaine des nutriments, des questions galeniques et des dispositifs medicaux aux equipes en charge de la nutrition, avec lesquelles une collaboration etroite est necessaire.

Resume L'omeprazole est indique chez l'enfant de plus d'un an presentant une œsophagite par reflux gastro-œsophagien objectivee par une endoscopie. L'efficacite clinique de l'omeprazole dans le traitement des œsophagites a ete mise en evidence dans plusieurs etudes pediatriques tant sur les symptomes digestifs ou extradigestifs (manifestations ORL ou respiratoires) que sur les donnees endoscopiques. Sa tolerance demontree chez l'adulte a court comme a long terme est egalement constatee au cours d'etudes pediatriques moins nombreuses a court terme (8 semaines), mais egalement pour des durees de traitement superieures. Le traitement antisecretoire de l'œsophagite ulceree chez l'enfant consiste en la prise quotidienne de 10 mg d'omeprazole(poids inferieur a 20 kg) ou 20 mg (poids superieur a 20 kg) pendant 8 semaines. Un controle endoscopique peut etre realisea la fin du traitement. Les gelules peuvent etre ouvertes et les microgranules melangees a une boisson ou un aliment legerement acide, mais ne doivent pas etre ecrasees, pilees.

Resume Introduction L’erytheme margine rhumatismal fait partie de criteres majeurs de Jones pour le diagnostic du rhumatisme aigu poststreptococcique. Devenu peu frequent dans les pays industrialises, son diagnostic est rarement evoque chez l’adulte. Observation Nous rapportons le cas d’une femme de 30 ans qui a eu deux episodes d’une eruption annulaire du visage, associee a une fievre et a des polyarthralgies. Cette eruption est survenue chaque fois quelques jours apres une angine streptococcique. Discussion Cette observation souligne que le rhumatisme poststreptococcique n’a pas completement disparu des pays developpes. Les dermatologues ne doivent pas en meconnaitre les manifestations cutanees et doivent rester vigilants quant a ses possibles complications cardiaques.

International audience; OBJECTIVES: The aims of the study were to assess in patients with advanced HIV disease receiving antiretroviral therapy (ART) intensification with enfuvirtide (i) resistance at virological failure (VF), (ii) impact of baseline tropism on immunovirological response, and (iii) HIV-1 DNA tropism evolution during ART. METHODS: The ANRS 130 APOLLO randomized trial evaluated in naive patients the immunovirological impact of standard ART without (control arm) or with enfuvirtide. Tropism was determined on RNA and DNA by V3-loop sequencing interpreted using the Geno2Pheno algorithm. RESULTS: At baseline the median CD4 cell count was 30 cells/mm(3). Among the 170 patients assessable in this virological substudy, HIV-1 RNA tropism was as follows: 60% of viruses were R5 and 40% were R5X4/X4. HIV-1 DNA tropism was as follows: 54% were R5 and 46% were R5X4/X4. At week 24, 39% and 49% of patients experienced VF in the enfuvirtide and control arms, respectively. In the enfuvirtide arm, only resistance-associated mutations to enfuvirtide were detected. In the control arm, two patients displayed drug-resistant viruses at the time of VF. No impact of baseline tropism was observed on immunovirological response, regardless of the study arm. Among the 25 patients experiencing DNA tropism switch between baseline and week 24, 16 (64%) switched from R5 to R5X4/X4. These latter were mostly successfully suppressed patients receiving enfuvirtide and exhibiting poorer immunological response. CONCLUSIONS: Baseline RNA tropism had no impact on the immunovirological response. Drug resistance mutations were only detected for the fusion inhibitor. Finally, the mechanism of replenishment of the viral cellular reservoir with X4 viruses observed needs to be further analysed.

We report the successful control of an outbreak caused by imipenem-resistant VIM-1-producing Klebsiella pneumoniae (IR-Kp) in France. This outbreak occurred in a care centre for abdominal surgery that includes a 15-bed liver intensive care unit and performs more than 130 liver transplantations per year. The index case was a patient with acute liver failure transferred from a hospital in Greece for urgent liver transplantation who was carrying IR-Kp at admission as revealed by routine culture of a rectal swab. Infection control measures were undertaken and included contact isolation and promotion of hand hygiene with alcohol-based hand rub solution. Nevertheless, secondary IR-Kp cases were identified during the six following months from 3 December 2003 to 2 June 2004. From 2 June to 21 October, extended infection control measures were set up, such as cohorting IR-Kp carriers, contact patients and new patients in distinct sections with dedicated staff, limiting ward admission, and strict control of patient transfer. They led to a rapid control of the outbreak. The global attack rate of the IR-Kp outbreak was 2.5%, 13% in liver transplant patients and 0.4% in the other patients in the care centre (p

Erythema marginatum is one of the main Jones diagnostic criteria for rheumatic fever. However, since it rarely occurs in industrialized countries, this diagnosis is seldom suspected, especially in adult patients.We report a case of an annular facial eruption associated with fever and polyarthralgia seen twice in a 30-year-old woman following episodes of streptococcal throat infection.This case report underlines the fact that the rheumatic fever has not completely disappeared in the highly developed countries. Dermatologists should be careful not to overlook its clinical manifestations and should be vigilant about potential cardiac complications.

Gastrostomy is frequently used in clinical practice for drug administration. However modalities of drug administration via a gastrostomy device have been poorly studied and remain uncodified.To assess the mode of administration of drugs as well as errors associated with the use of a gastrostomy devices for drug delivery in children.Mode of administration of drugs was studied in 109 children (mean age 8.4+/-5.5 years, 72% neurologically impaired, 41% institutionalized children). A questionnaire was filled in by parents and/or caregivers. Errors of administration were classified as follows: galenic, due to preparation, physico-chemical interaction, lack of flushing the tube. Factors influencing the occurrence of errors were studied: living at home or in an institution, underlying disease, number of drugs administered via gastrostomy device.Errors were frequently observed: galenic (47%), due to preparation (42%), physico-chemical interaction (51%), lack of flushing (10%). Errors occurred more frequently in institutionalized children compared to children living at home (78 versus 25%, P0.0005). Galenic errors were more frequent in neurologically impaired children (57 versus 30%, P0.005).Many medications are administrated via gastrostomy tube in children. Errors are frequently observed and potentially dangerous.

Pneumocystis jiroveci pneumonia (PCP) has become a rare opportunistic infection due to the efficacy of prophylactic regimens. We conducted a 6-year retrospective study at our institution. A total of 13 cases of PCP were diagnosed among 519 patients undergoing allogeneic hematopoietic stem cell transplantation (HSCT) (2.5%). In three patients, PCP occurred within the first 5 months following HSCT. These severely immunocompromised patients were receiving prophylaxis and had concomitant aspergillosis that caused rapid death in two of them. In 10 other patients, PCP occurred a median of 14.5 months after HSCT. In all these patients, PCP prophylaxis had been discontinued, mainly because of the suspected bone-marrow toxicity of the prophylactic regimen. Median CD4+ T cell count was 131/microl at diagnosis. Seven of these 10 patients were receiving immunosuppressive therapy for chronic graft versus host disease and three had a relapse of their hematological malignancy. One patient died from PCP despite high doses of cotrimoxazole. We conclude that PCP is still occurring after allogeneic HSCT, mainly as a late complication in patients in whom PCP prophylaxis had been prematurely discontinued. Long-term PCP prophylaxis should be maintained in patients receiving immunosuppressive drugs, and in those with low CD4+ T cell counts or a relapse of their hematological malignancy.

The aim of this study was to evaluate the safety and efficacy of intravenous iron saccharate administration in iron-deficient anemic children, under long-term parenteral nutrition, who are unable to tolerate oral iron supplementation or are unresponsive to oral supplementation because of gastrointestinal dysfunction or iron malabsorption. Methods: Twenty-two infants and children aged 5 months–17 years (median: 38 months) receiving long-term parenteral nutrition and presenting with iron deficiency anemia were included. Total iron to be infused was determined by the formula: total iron (mg) = 0.6× W (100 − Hb×100/12) ( W : weight, Hb: hemoglobin). Intravenous iron saccharate was given at the hospital. Each patient received a test dose of 25 mg of iron saccharate prior to the initiation of the infusion. Hemoglobin values, reticulocytes count, serum iron, and serum ferritin were determined before iron administration (day 1), as well as 15 and 45 days after iron administration. Results: Tolerance of intravenous iron saccharate was good except in one patient who developed transient exanthema and hypotension after completion of the last iron saccharate infusion. Intravenous iron led to a significative increase in hemoglobin concentration of 2.2 g/dl within 45 days (range: 0.4–4.3 g/dl). Conculsion: Intravenous iron supplementation with iron saccharate is an efficient procedure, replenishing iron body stores and significantly increasing the hemoglobin concentration. The possible occurrence of allergic reactions emphasizes the need for close medical supervision.