The Netherlands journal of medicine
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Monoclonal antibodies (mAbs) have revolutionised the treatment of malignancies, especially non-Hodgkin's lymphoma (NHL). Antibody-based therapies target tumour cells expressing a specific antigen while sparing the majority of normal cells leading to a decrease in treatment-associated toxicity. Rituximab, a monoclonal antibody directed against CD20 on B cells, was the first monoclonal antibody to be approved by the US Food and Drug Association (FDA) in 1997 for the treatment of patients with relapsed/refractory, follicular or low-grade NHL. ⋯ This led to further attempts to improve the antitumour activity of anti-CD20 mAbs (i.e. 2nd/3rd generation anti-CD20s), and to identify additional potential targets on lymphoma cells other than CD20. A number of these antibodies directed against lymphoma cell targets other than CD20 are now undergoing development, many of which are currently in clinical trials. This manuscript focuses on an overview of these 'non-anti-CD20' novel mAbs for NHL.
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Delirium in the ICU can compromise the recovery process, prolong ICU and hospital stay and increase mortality. Therefore, recognition of delirium is of utmost importance. ⋯ In the Netherlands, delirium is considered an important problem in the ICU, although its incidence is estimated to be low by the ICU team. The diagnosis of delirium is most frequently established by a geriatrician or psychiatrist after consultation, while diagnostic instruments are infrequently used. Efforts should be undertaken to implement delirium protocols and a routinely applied diagnostic instrument in the ICU.
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Targeting the CD20 antigen on B lymphocytes with the monoclonal antibody rituximab has greatly improved the outcome of patients with B-cell malignancies. Despite the success of rituximab, resistance occurs in about half of the patients, resulting in non-response to treatment or early relapse of the original disease. A better understanding of the mechanism of rituximab resistance has lead to the development of novel, improved anti-CD20 antibodies. This review describes the development of CD20-targeted therapy from its historical background towards the next generation of anti-CD20 monoclonal antibodies and explains new strategies to overcome resistance.
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Splenic rupture is an extremely rare complication of colonoscopy. So far, less than 80 cases have been reported worldwide since 1970. We report two patients, one patient presenting with haemorrhagic shock after a therapeutic colonoscopy and another patient presenting with abdominal pain following a diagnostic colonoscopy. ⋯ One patient was treated by selective embolisation of the splenic artery; the other patient underwent a splenectomy. Because the numbers of colonoscopies performed in The Netherlands as well as in many other European countries are likely to double in the coming years as a result of the introduction of nationwide colorectal cancer screening programmes and intensive surveillance protocols after polypectomy, more splenic injuries as a complication of colonoscopy can be expected in the near future. Awareness of this complication is of great importance in early recognition and management of this potentially life-threatening injury.