scholarly journals Oxaliplatin Induced Digital Ischemia and Necrosis

2015 ◽  
Vol 2015 ◽  
pp. 1-3 ◽  
Author(s):  
Kubilay Karabacak ◽  
Murat Kadan ◽  
Erkan Kaya ◽  
Baris Durgun ◽  
Gokhan Arslan ◽  
...  
Keyword(s):  
Rare Complication ◽  
Symptomatic Relief ◽  
Endothelial Damage ◽  
Vascular Toxicity ◽  
Right Hand ◽  
Digital Ischemia ◽  
Immunologic Effect ◽  
Chemotherapy Protocol ◽  
Ulcerative Lesions ◽  
New Generation

Introduction. Digital ischemia is a rare complication of several chemotherapeutic medications. We aimed to present a patient with digital ischemia, secondary to a new generation chemotherapeutic drug, oxaliplatin.Case Report. 62-year-old woman presented to our department with severe pain, paresthesia, and distal acrocyanosis on her right hand fingertips. Her complaints started five days after the third cycle of a chemotherapy protocol consisting of 5-fluorourasil (5-FU), folinic acid, and oxaliplatin due to advanced colon carcinoma. On physical examination, hemorrhagic and partly ulcerative lesions were detected at her right hand fingertips. Radial and ulnar pulses were absent at affected side. Digital subtraction angiography revealed severe vascular resistance in the affected extremity. Iloprost trometamol treatment was started with the dosage of 1 ng/kg/min. In addition, low-molecule-weight heparin was used for preventing possible microemboli. Symptomatic relief was provided after five days, and patient was discharged on 7th day of treatment.Discussion. The pathogenesis of oxaliplatin induced vascular toxicity remains unclear. Endothelial damage, increased adherence of platelets, deposition of immune complexes as an immunologic effect of oxaliplatin, and hypercoagulable state may be the reason for arterial thrombosis, digital microemboli, possible digital ischemia, and their several consequences.

Ameliorative Effects of Quercetin in Cyclophosphamide-Induced Vascular Toxicity in Rats

2021 ◽  
Author(s):  
EMİN ŞENGÜL ◽  
VOLKAN GELEN ◽  
SEMİN GEDİKLİ ◽  
ELİF ERBAS ◽  
ASLIHAN ATASEVER
Keyword(s):  
Superoxide Dismutase ◽  
Single Dose ◽  
Corn Oil ◽  
Endothelial Damage ◽  
Control Group ◽  
High Dose ◽  
Protective Effects ◽  
Vascular Toxicity ◽  
Relaxation Responses

Abstract Cyclophosphamide (CYP) causes vascular toxicity and endothelial damage. In this study aimed the determination of the protective effects of Quercetin (Q) in the CYP-induced vascular toxicity in rats. The rats were randomly divided into the following five groups: Control, CYP, Q50+CYP, Q100+CYP and Q100. The control group was given intragastric (i.g.) corn oil for seven days. The CYP group received i.g. corn oil for seven days and a single dose (200 mg/kg) of CYP via intraperitoneal (i.p.) injection on the seventh day. The rats in the three Q-treated groups received Q for seven days. On the seventh day after the Q treatment, the Q50+CYP, and Q100+CYP groups were injected to single dose (200 mg/kg, i.p.) of CYP. The CYP-treatment both worsen the Phenylephrine (PE)-induced contractions and acetylcholine (ACh)-induced relaxation responses in isolated thoracic aorta of rats, and the application of Q corrected these responses. The malondialdehyde (MDA) levels were significantly higher in the CYP-treated groups. The both dose of Q decreased the MDA level. Superoxide dismutase (SOD) and glutathione (GSH) activities were significantly decreased in the CYP group, whereas the high dose of Q increased SOD and GSH activities. Q treatment attenuated CYP-induced pathologies, and endothelial damage. According to results, Q has protective effects against CYP-induced vascular toxicity in rats.

scholarly journals Oral cavity lymphoma as secondary AIDS-defining neoplasm in a patient on HAART with immune reconstitution

2007 ◽  
Vol 40 (5) ◽  
pp. 582-584 ◽  
Author(s):  
Marcelo Corti ◽  
Rubén Solari ◽  
Diana Cangelosi ◽  
Luis De Carolis ◽  
Ricardo Schtirbu ◽  
...  
Keyword(s):  
Oral Cavity ◽  
Highly Active Antiretroviral Therapy ◽  
Immune Reconstitution ◽  
Rare Complication ◽  
Clinical Appearance ◽  
Highly Active ◽  
Undetectable Plasma ◽  
Ulcerative Lesions ◽  
Undetectable Plasma Viral Load ◽  
Oral Soft Tissue

Lymphomas of the oral cavity are a rare complication of advanced HIV/AIDS disease. The clinical appearance of these neoplasms includes masses or ulcerative lesions that involve the oral soft tissue and the jaw as the predominant manifestation. We report the case of a patient with AIDS who developed diffuse large B-cell non-Hodgkin’s lymphoma of the oral cavity during highly active antiretroviral therapy, with undetectable plasma viral load and immune reconstitution.

scholarly journals Umbilical cord vascular thrombosis: literature review and two clinical cases

2020 ◽  
Author(s):  
E. Iu. Iupatov ◽  
T. E. Kurmanbaev ◽  
I. R. Galimova ◽  
A. T. Khaertdinov ◽  
R. R. Mukhametova ◽  
...  
Keyword(s):  
Risk Factors ◽  
Amniotic Fluid ◽  
Umbilical Cord ◽  
Umbilical Vein ◽  
Rare Complication ◽  
Endothelial Damage ◽  
Pregnancy And Childbirth ◽  
Vein Thrombosis ◽  
Novel Coronavirus ◽  
Intrauterine Infections

Thrombosis of the umbilical cord vessels is a rare complication of pregnancy, combined with a high level of perinatal morbidity and mortality. Among the risk factors for the development of thrombosis of the vessels of the umbilical cord are anomalies of vascular attachment (meningeal attachment), pathology of the umbilical cord (hyperspiralization, short or long umbilical cord), intrauterine infections, diabetes mellitus and preeclampsia in the mother, as well as the presence of meconium in the amniotic fluid. The article presents two clinical observations of umbilical vein thrombosis at full-term pregnancy. In both cases, during pregnancy and childbirth, there were no signs of umbilical cord pathology according to cardiotocography and Doppler, despite this, the birth of children in a state of hypoxia. Both newborns were transferred to the second stage of treatment due to suspected intrauterine pneumonia. Of the risk factors for thrombosis of the umbilical cord vessels in the above examples, it is possible to distinguish the sheathing of the umbilical cord vessels, intrauterine infections, in the second case, the presence of meconium in the amniotic fluid. During pregnancy, both patients underwent a clinically confirmed novel coronavirus infection (COVID-19) in the second trimester of gestation, and were also in contact with patients with COVID-19 in the third trimester of gestation. It is likely that endothelial damage caused by the new coronavirus SARS-CoV-2 was one of the risk factors for the development of umbilical vein thrombosis, but this issue requires further research.

scholarly journals Complement-driven anemia: more than just paroxysmal nocturnal hemoglobinuria

Hematology ◽  
2018 ◽  
Vol 2018 (1) ◽  
pp. 371-376 ◽  
Author(s):  
Samuel A. Merrill ◽  
Robert A. Brodsky
Keyword(s):  
Paroxysmal Nocturnal Hemoglobinuria ◽  
Alternative Pathway ◽  
Atypical Hemolytic Uremic Syndrome ◽  
Liver Function Tests ◽  
Endothelial Damage ◽  
Complement Inhibitors ◽  
Uremic Syndrome ◽  
Clinically Significant ◽  
Complement Regulator ◽  
New Generation

Abstract Atypical hemolytic uremic syndrome (aHUS); hemolysis, elevated liver function tests, and low platelets syndrome; and transplant-associated thrombotic microangiopathy are related conditions, in that many patients harbor germline heterozygous mutations in genes that regulate the alternative pathway of complement (APC). Penetrance is variable because development of clinically significant disease appears to require supervention of a process such as inflammation. Complement activation on the endothelial surfaces leads to endothelial damage, platelet consumption, microthrombi, and a mechanical hemolytic anemia with schistocytes. Paroxysmal nocturnal hemoglobinuria (PNH) is a clonal hematopoietic disease caused by expansion of a stem cell that harbors a somatic mutation in PIGA. PIGA mutant blood cells are deficient in the complement regulator proteins CD55 and CD59, making them susceptible to intravascular hemolysis due to a failure to regulate the APC on erythrocytes. Eculizumab is a monoclonal antibody that binds to C5 and inhibits terminal complement by interfering with the cleavage of C5 by the C5 convertases. The drug is approved by the US Food and Drug Administration for the treatment of aHUS and PNH; however, a new generation of complement inhibitors that block C5 and other components of the complement cascade is showing promise in preclinical and clinical trials.

scholarly journals Fludarabine Treatment of Patient with Chronic Lymphocytic Leukemia Induces a Digital Ischemia

2016 ◽  
Vol 2016 ◽  
pp. 1-3
Author(s):  
Utku Erdem Soyaltin ◽  
Deniz Yuce Yildirim ◽  
Mustafa Yildirim ◽  
Mehmet Can Ugur ◽  
Ferhat Ekinci ◽  
...  
Keyword(s):  
Chronic Lymphocytic Leukemia ◽  
Raynaud’S Phenomenon ◽  
Raynaud's Phenomenon ◽  
Sudden Onset ◽  
Lymphocytic Leukemia ◽  
Right Hand ◽  
Digital Ischemia ◽  
Fourth Cycle ◽  
History Of

We report a 63-year-old man with a history of chronic lymphocytic leukemia (CLL) who presented with asymmetrical Raynaud’s phenomenon of sudden onset which progressed to acral gangrene rapidly in a week. These symptoms began approximately one week after the fourth cycle of fludarabine and cyclophosphamide chemotherapy and were accompanied by pain, numbness, and cyanosis in the fingers of his right hand except the first finger. Fludarabine may play a role in acral vascular syndrome. The treatment with fludarabine in patients with evolving digital ischemia should be carried out with caution.

scholarly journals Presacral abscess as a rare complication of sacral nerve stimulator implantation

2017 ◽  
Vol 99 (3) ◽  
pp. e1-e4 ◽  
Author(s):  
A Gumber ◽  
S Ayyar ◽  
H Varia ◽  
S Pettit
Keyword(s):  
Rare Complication ◽  
Symptomatic Relief ◽  
Nerve Stimulator ◽  
Pelvic Brim ◽  
Ct Guided ◽  
Sacral Nerve ◽  
Presacral Abscess ◽  
Magnetic Resonance Imaging Mri ◽  
The Right ◽  
Invasive Techniques

A 50-year-old man with intractable anal pain attributed to proctalgia fugax underwent insertion of a sacral nerve stimulator via the right S3 vertebral foramen for pain control with good symptomatic relief. Thirteen months later, he presented with signs of sepsis. Computed tomography (CT) and magnetic resonance imaging (MRI) showed a large presacral abscess. MRI demonstrated increased enhancement along the pathway of the stimulator electrode, indicating that the abscess was caused by infection introduced at the time of sacral nerve stimulator placement. The patient was treated with broad spectrum antibiotics, and the sacral nerve stimulator and electrode were removed. Attempts were made to drain the abscess transrectally using minimally invasive techniques but these were unsuccessful and CT guided transperineal drainage was then performed. Despite this, the presacral abscess progressed, developing enlarging gas locules and extending to the pelvic brim to involve the aortic bifurcation, causing hydronephrosis and radiological signs of impending sacral osteomyelitis. MRI showed communication between the rectum and abscess resulting from transrectal drainage. In view of the progressive presacral sepsis, a laparotomy was performed with drainage of the abscess, closure of the upper rectum and formation of a defunctioning end sigmoid colostomy. Following this, the presacral infection resolved. Presacral abscess formation secondary to an infected sacral nerve stimulator electrode has not been reported previously. Our experience suggests that in a similar situation, the optimal management is to perform laparotomy with drainage of the presacral abscess together with simultaneous removal of the sacral nerve stimulator and electrode.

scholarly journals Gemcitabine-Induced Extensive Skin Necrosis

2012 ◽  
Vol 2012 ◽  
pp. 1-3 ◽  
Author(s):  
Sara D'epiro ◽  
Monica Salvi ◽  
Carlo Mattozzi ◽  
Simona Giancristoforo ◽  
Marco Campoli ◽  
...  
Keyword(s):  
Pancreatic Cancer ◽  
Skin Necrosis ◽  
Lower Limbs ◽  
Back Side ◽  
Careful Attention ◽  
Vascular Toxicity ◽  
Convincing Argument ◽  
Chemotherapy Administration ◽  
Ulcerative Lesions ◽  
Arterial Vascular Disease

An 82-year-old woman presented with oedema and extensive necrotic ulcerative lesions on the back side of her lower limbs, emerging after the second cycle of chemotherapy consisting of Gemcitabine for metastatic pancreatic cancer. The absence of any convincing argument in favor of cardiovascular or autoimmune disease led us to attribute the onset of skin necrosis to chemotherapy administration. Although skin ischemia has also been described as a paraneoplastic syndrome, in this case we could observe a temporal and causal relationship to Gemcitabine infusion. Recently, this drug has been associated with important vascular side effects; its vascular toxicity is in fact higher than previously estimated. To our knowledge, careful attention should be reserved to neoplastic patients candidated to Gemcitabine administration, especially if previously affected by arterial vascular disease, venous thromboembolism, or collagenoses.

Study of Biocompatibility of Membranes in Online Hemodiafiltration

2019 ◽  
Vol 49 (4) ◽  
pp. 400-408 ◽  
Author(s):  
Raquel Ojeda ◽  
Marta Arias-Guillén ◽  
Miquel Gómez ◽  
Manel Vera ◽  
Néstor Fontseré ◽  
...  
Keyword(s):  
Adhesion Molecules ◽  
Adhesion Molecule ◽  
High Sensitivity ◽  
Endothelial Damage ◽  
Convective Transport ◽  
Intercellular Adhesion Molecule ◽  
Intercellular Adhesion Molecule 1 ◽  
Plasminogen Activator Inhibitor 1 ◽  
Inflammatory Status ◽  
New Generation

Background: The biocompatibility of dialysis membranes is a determining factor in avoiding chronic microinflammation in patients under haemodialysis. Lower biocompatibility has been related to increased inflammatory status, which is known to be associated with cardiovascular events. Classically, cellulose membranes have been considered bioincompatible. A new-generation of asymmetric cellulose triacetate (CTA) membranes allows the performance of high convective transport techniques, but there have been no studies of their biocompatibility. The aim of the present study was to analyze and compare the biocompatibility characteristics of 4 membranes, including CTA, in online hemodiafiltration (OL-HDF) patients. Methods: We included 15 patients in ­OL-HDF. After a 2-week washout period with helixone membrane, each patient was treated with the 4 membranes (polyamide, polynephron, helixone and CTA) for 4 weeks in a randomized order. The other dialysis parameters were kept stable throughout the study. We studied changes in markers of the activation of the complement system, monocytes, platelets, and adhesion molecules with the 4 membranes, as well as inflammatory parameters. Results: Biocompatibility was similar among the membranes. There were no sustained differences in complement activation, measured by C3a and C5a levels, or in platelet activation, determined by levels of P-selectin and platelet-derived microparticles (CD41a+). No differences were observed in activated monocyte levels (CD14+/CD16+) or in plasma levels of interleukin (IL)-1, IL-6, IL-10 or high-sensitivity C-reactive protein, although tumour necrosis factor-α levels decreased when the patients were dialyzed with CTA. No significant differences were found in markers of endothelial damage, assessed by levels of plasminogen activator inhibitor-1 and adhesion molecules (intercellular adhesion molecule-1 and vascular cell adhesion molecule-1). Conclusion: The 4 membranes evaluated in this study in stable patients on OL-HDF, including the new-generation CTA, show similar biocompatibility with the methods applied.

Nicolau Syndrome Secondary to Subcutaneous Glatiramer Acetate Injection

2020 ◽  
pp. 153473462097314
Author(s):  
Caner Demircan ◽  
Neslihan Akdogan ◽  
Leyla Elmas
Keyword(s):  
Glatiramer Acetate ◽  
Rare Complication ◽  
Subcutaneous Administration ◽  
Ulcer Formation ◽  
Injectable Drugs ◽  
Nicolau Syndrome ◽  
Embolia Cutis Medicamentosa ◽  
History Of ◽  
Ulcerative Lesions ◽  
High Index Of Suspicion

Nicolau syndrome, also known as embolia cutis medicamentosa, is a rare complication of injectable drugs. Patients present with pain at injection site, followed by swelling, erythema, purple, hemorrhagic patches and lastly ulcer formation. A variety of intramuscular agents have been implicated as responsible. We report a case of a 26-year-old woman with a history of a purple lesion on her thigh who was diagnosed with Nicolau syndrome due to subcutaneous administration of glatiramer acetate. The patient was followed up with topical mupirocin. On follow-up, although the patient stated that she continued using glatiramer acetate, no new lesions appeared and the existing lesion continued to shrink. Nicolau syndrome seems to have an unpredictable and unavoidable course. This case suggests that physicians should have a high index of suspicion for the presence of Nicolau syndrome in patients presenting with necrotic or ulcerative lesions with a history of using injectable drugs.

scholarly journals Posterior Reversible Encephalopathy Syndrome Secondary to Asparaginase Associated Pancreatitis in Two Pediatric Patients with Acute Leukemia

2021 ◽  
Author(s):  
Amanda Scheuermann ◽  
Paul Harker-Murray ◽  
Lauren Pommert
Keyword(s):  
Acute Leukemia ◽  
Systemic Inflammation ◽  
Posterior Reversible Encephalopathy Syndrome ◽  
Pediatric Patients ◽  
Rare Complication ◽  
Endothelial Damage ◽  
Treatment Protocols ◽  
Posterior Reversible Encephalopathy ◽  
Leukemia Treatment ◽  
Reversible Encephalopathy

Asparaginase, a critical component of current pediatric acute leukemia treatment protocols, is associated with a number of serious side effects, one of which is pancreatitis. Pancreatitis can result in significant morbidity and mortality from necrosis, pseudocyst formation, hemorrhage, systemic inflammation, intestinal perforation and sepsis. Another rare complication of pancreatitis is posterior reversible encephalopathy syndrome (PRES), likely mediated by systemic inflammation secondary to pancreatic autodigestion and pro-inflammatory cytokine-mediated vascular endothelial damage. Here we review this association in the literature and report two pediatric patients with leukemia who developed PRES secondary to asparaginase-associated pancreatitis.

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