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In patients with relapsed/refractory Burkitt lymphoma (r/r BL), overall survival (OS) is poor, and effective therapies and evidence for the best therapy are lacking. The monoclonal antibody blinatumomab may represent a novel option. However, only limited data on the use of blinatumomab in r/r BL are so far available. This multi-center, retrospective case series investigated nine patients with r/r BL treated with blinatumomab. The safety of blinatumomab was assessed with respect to frequency and severity of adverse effects (AEs) infections, cytokine release syndrome (CRS) and neurotoxicity. Progression-free survival (PFS), OS and overall response rate (ORR) were analyzed to assess efficacy. No AEs > grade 2 occurred, and AEs were generally treatable and fully reversible. The best response to blinatumomab was complete remission in 3/9 patients and partial remission in 2/9, whilst 4/9 presented with progressive disease. Median PFS and OS were 2 and 6 months, respectively, ranging from 5 days to 32 months and 11 days to 32 months, respectively. Blinatumomab treatment was a successful bridging treatment to stem cell transplantation in 3/9 patients. The response to blinatumomab varied widely, and only one patient survived longer term, but activity in patients with r/r BL was evident in some patients, with its use being safe, warranting its prospective investigation.

Introduction: High cut-off dialysis, increasingly used in multiple myeloma patients, is susceptible to influence anticancer drug elimination. We report about lenalidomide disposition in a patient on high cut-off dialysis for renal failure secondary to myeloma cast nephropathy., Methods: The patient received a higher dosage of lenalidomide (5 mg b.i.d.), owing to concerns about a potential decrease in lenalidomide exposure during dialysis sessions. A set of blood samples was taken in order to develop a pharmacokinetic model accounting for lenalidomide concentrations in this setting., Results: According to our model, the area under the curve was 3273 µg h/L, i.e., 60% higher than expected under usual dosage (25 mg q.d.) with normal renal function. Despite this, the patient did not develop major hematological toxicity., Conclusions: Lenalidomide doses of 5 mg b.i.d. led to high exposure in a patient with renal failure undergoing high cut-off dialysis. Yet, the dosage of 5 mg q.d. recommended in conventional dialysis would probably be adequate in such patients.

The year 2011 was full of significant advances in all areas of medicine. Whether small or large issues, they all have an impact on daily practice in general internal medicine. For example, intravenous administration of diuretics in heart failure shows no benefit. But double dose may improve symptoms faster. Direct Xa inhibitors are emerging as alternative to anti-vitamin K. beta-blockers reduce overall mortality in COPD and do not worsen lung function significantly. Each year, the chief residents from the Department of internal medicine at the University hospital of Lausanne meet to share their readings. Twelve new therapeutic considerations of 2011 are reviewed here.

Applying knowledge acquired from recent medical studies to patient care poses a daily challenge to physicians. Chief residents from the Department of Internal Medicine at the University Hospital of Lausanne carried out a review of some of the issues they considered important. The conclusions of these various publications may have a significant impact on the daily practice of hospital-based internal medicine. Modern medicine based on scientific studies is a reminder that in spite of the essential importance of clinical experience, it is crucial to confront it with the results of relevant publications from the medical literature.

Internists must regularly adjust their patients care according to recent relevant publications. The chief residents from the Department of Internal Medicine of a university hospital present some major themes of internal medicine treated during the year 2009. Emphasis will be placed primarily on changes in the daily hospital practice induced by these recent studies. This variety of topics illustrates both the broad spectrum of the current internal medicine, and the many uncertainties associated with modern medical practice based on evidence.

Background: Many eye and brain diseases may induce a spontaneous Pulfrich phenomenon (PP), a stereoillusion leading to misjudgments of objects moving in a frontoparallel plane. Since, until now, no simple PP quantification method has been available, a computer pendulum (CP) system was developed and evaluated., Methods: In 5 normal subjects, PP was induced with different neutral density filters. The resulting retardations were measured with the gold standard (a mechanical pendulum; MP), and compared to a CP, allowing the generation of interocular image phase shifts., Results: A high correlation between MP and CP was found (r = 0.97, p < 0.001; slope 0.91, p > 0.1 for difference with slope 1.0). A multiple linear regression showed a significant influence of the filter density and the subject tested. The type of pendulum (MP or CP) and the side on which the filter was held were nonsignificant., Conclusions: A CP allowing an interocular image phase shift can be used as an alternative to a MP for quantification of a PP. Thus, this principle would allow the development of software or an Internet-based test for PP quantification. However, in some subjects, the CP will overestimate and in others underestimate the real retardation measured with the MP., (Copyright 2009 S. Karger AG, Basel.)

As a rule the diagnosis of larger focal lesions of the breast can be easily confirmed by biopsy. Intraoperative localization is more difficult, however, in lesions of below 5 mm diameter as measured by mammography or malignant alterations only indirectly indicated by mammography. Experience to date in 64 patients shows that specimen radiography provides immediate confirmation of large lesions detected by mammography and localizes the area for histologic examination. So far it has been found that precisely those biopsies that are performed as a result of indirect signs of malignancy or of small lesions are the most valuable contributing factor in the early diagnosis of breast cancer.