Rituximab administration in third trimester of pregnancy suppresses neonatal B-cell development

We describe the effect on the neonate of administration of rituximab to a woman with idiopathic thrombocytopenic purpura (ITP). Rituximab, an anti-CD20 antibody, was given weekly for 4 weeks to a woman with ITP in her third trimester of pregnancy. One month after the last rituximab administration a healthy girl was born. She had normal growth and development during the first six months. At birth, B-lymphocytes were not detectable. Rituximab levels in mother and neonate were 24000 and 6700 ng/mL, respectively. Only 7 cases of rituximab administration during pregnancy were described. No adverse events are described for fetus and neonate. We demonstrate that rituximab passes the placenta and inhibits neonatal B-lymphocyte development. However, after 6 months B-lymphocyte levels normalized and vaccination titres after 10 months were adequate. No infection-related complications occurred. Rituximab administration during pregnancy appears to be safe for the child but further studies are warranted. Copyright © 2008 D. T. Klink et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. 1

Living with interpersonal data: observability and accountability in the age of pervasive ICT

The Internet of Things, alongside existing mobile digital technologies, heralds a world in which pervasive sensing constantly captures data about us. Simultaneous with this technology programme are moves by policymakers to shore up the digital economy through the legislating of new trust-building models of data management. These moves seek to give individuals control and oversight of their personal data. Within shared settings, the consequences of these changes are the large-scale generation of interpersonal data generated by and acting on the group rather than individual. We consider how such systems create new forms of observability and hence accountability among members of the home, and draw on the work of Simmel and Goffman to explore how these demands are managed. Such management mitigates the more extreme possibilities for domestic monitoring posited by these systems, yet without careful design there remains a considerable danger of unanticipated negative consequences

Restricting digital sites of dissent: commercial social media and free expression

The widespread use of commercial social media platforms by protesters and activists has enhanced protest mobilisation and reporting but it has placed social media providers in the intermediary role as facilitators of dissent and has thereby created new challenges. Companies like Google and Facebook are increasingly restricting content that is published on or distributed through their platforms; they have been subject to obstruction by governments; and their services have been at the core of large-scale data collection and surveillance. This article analyses and categorises forms of infrastructure-based restrictions on free expression and dissent. It shows how private intermediaries have been incorporated into state-led content policies; how they set their own standards for legitimate online communication and intervene accordingly; and how state-based actions and commercial self-regulation intersect in the specific area of online surveillance. Based on a broad review of cases, it situates the role of social media in the wider trend of the privatisation of communications policy and the complex interplay between state-based regulation and commercial rule-making

Provision, protection or participation? Approaches to regulating children’s television in Arab countries

One notable feature of Arab broadcasting has been the belated emergence of free-to-air channels for children. Today, with children’s channels a still-expanding feature of the Arab satellite television landscape, the region is witnessing growth in the local animation industry alongside intensified competition for child audiences through imported content and a selective squeeze on state funds. In this context the policies and rationales that inform production and acquisition of children’s content remain far from transparent, beyond occasional public rhetoric about protecting children from material that ‘breaches cultural boundaries and values’ and providing programmes that revere a perceived ‘Arab-Islamic’ heritage and preserve literary forms of the Arabic language. Attempts at promoting children’s genuine participation in Arab television have been rare. Drawing on theoretical literature that links protection and participation in the sense that children’s safety depends on their agency, this paper explores emerging guidelines developed by Arab regulators, broadcasters and others in relation to television content for children

Metastatic Crohn's Disease of the Ear

Objective. We reported a very rare case of metastatic Crohn's disease involving the retro-auricular region. Method. A case report and a review of literature concerning metastatic Crohn's disease. Results. Metastatic Crohn's disease is an uncommon extraintestinal cutaneous manifestation of Crohn's disease and a very rare case involving the retro-auricular region is reported here. Given the limited existing literature little is known about this condition. The skin lesions appear to have a predilection for the lower trunk and genitalia regions. There is no clear association with the severity of Crohn's disease and in some cases, the cutaneous lesions predate the onset of gastrointestinal Crohn's disease. Treatment with immune-modulating medications together with the antitumour necrosis factor monoclonal antibody therapy appears to offer the best chance of remission. Conclusion. By reporting this interesting and rare condition we also hope to highlight the importance of considering underlying chronic systemic disorders, such as Crohn's disease, when presented with skin lesions resistant to simple local treatments

Laser-Assisted Removal of Aspirated Thumbtacks by Flexible Bronchoscopy

Background. Aspirated thumbtacks are difficult to extract as the sharp edge of the thumbtack often is well imbedded within bronchial wall and its removal is technically demanding and may cause complications such as bronchial mucosal tear and bronchial wall perforation. These sharp metal objects are commonly removed using rigid bronchoscopy since their removal through flexible bronchoscopy is considered to be dangerous. Objectives. To describe a technique for removal of sharp aspirated metal objects employing laser through flexible bronchoscopy. Methods. We report two patients in whom a new technique for removal of sharp aspirated metal objects utilizing Nd-Yag laser flexible bronchoscopy was used. Results. Successful and uncomplicated removal of the aspirated thumbpack by flexible bronchoscopy under conscious sedation was accomplished in the two patients described. Both patients were discharged within 24 hours. Conclusions. In patients with aspirated thumbtack laser-assisted breakage of the object through flexible bronchoscopy may obviate the need for rigid bronchoscopy or thoracotomy

Primary Carcinoid Tumor of the Ileal Efferent Limb of an Ileovesicostomy: A Case Report

We report on the evaluation and management of a 47-year-old white male found to have primary carcinoid tumor of the ileal segment of his diverting ileovesicostomy thirty-five months after initial creation. Subsequent to presentation with intermittent gross hematuria, CT urogram highlights an 8 mm enhancing lesion near the enterovesical junction of urinary diversion. Office cystoscopy confirms presence of a lesion that was later endoscopically resected and found to be a well-differentiated carcinoid tumor. Evaluation with serum markers, direct visualization utilizing endoscopy, and imaging was without finding of alternate primary or metastatic lesions. The patient ultimately had the proximal ileal portion of his ileovesicostomy excised and the distal portion converted into an ileal conduit. After briefly discussing the carcinoid tumor and the carcinoid syndrome it may cause, we review the literature on the incidence of carcinoid tumors in a population requiring the use of intestine in the urinary tract

Leiomyosarcoma Arising in the Pancreatic Duct: A Case Report and Review of the Current Literature

Context. Leiomyosarcomas are rare malignant smooth muscle tumors that may arise in any organ or tissue that contains smooth muscle, commonly within the gastrointestinal tract. They are most often found in the stomach, large and small intestines, and retroperitoneum. Primary pancreatic leiomyosarcoma is extremely rare, and to the best of our knowledge only 30 cases have been reported in the world literature since 1951. Our case represents the first to have a clear origin from the main pancreatic duct. Case Report. This case was diagnosed in a large, tertiary care center in Tampa, Florida. Pertinent information was obtained from chart review and interdepartmental collaboration. A mass in the tail of the pancreas was identified with large pleomorphic and spindle-shaped cells. Immunohistochemistry for vimentin, smooth muscle actin, and desmin was positive. All remaining immunohistochemical markers performed were negative. The tumor clearly originated from the pancreatic duct wall, filled and expanded the duct lumen, and was covered with a layer of benign biliary epithelium. Conclusion. Leiomyosarcoma of the pancreas is an extremely rare malignancy with few reported cases in the literature. The prognosis is poor, and treatment consists of alleviating symptoms and pain management. To our knowledge, this represents the first reported case demonstrating clear origin of a leiomyosarcoma from the pancreatic duct

Moyamoya Disease in Pregnancy: Management after Intracranial Bypass Grafting

Moyamoya disease (MD) is a chronic, progressive cerebrovascular disease distinguished by bilateral stenosis or occlusion of the arteries around the circle of Willis with resulting prominent arterial collateral circulation. We describe a pregnant woman in whom this diagnosis was confirmed by cerebral angiogram and treated with bilateral superficial temporal artery-middle cerebral artery (STA-MCA) bypass grafting prior to conception. The patient was managed with strict blood pressure monitoring and low-dose aspirin antepartum, intrapartum, and postpartum. The patient presented in spontaneous labor at term and underwent a spontaneous vaginal delivery without complications