scholarly journals Ropivacaine Plasma Concentrations after 192-Hour High Dose Epidural Ropivacaine Infusion in a Pediatric Patient without Side Effects

2018 ◽  
Vol 2018 ◽  
pp. 1-3
Author(s):  
Glenn van de Vossenberg ◽  
Selina van der Wal ◽  
Andrea Müller ◽  
Edward Tan ◽  
Kris Vissers
Keyword(s):  
Case Report ◽  
Side Effects ◽  
Trauma Patient ◽  
Pediatric Patient ◽  
Plasma Concentrations ◽  
High Dose ◽  
Epidural Administration ◽  
Venous Sampling ◽  
Arterial Sampling

This case report discusses continuous epidural administration of ropivacaine 0.56 mg kg−1 h −1 for 8 days in a 7-year-old trauma patient to prevent pain, after performing a lower right and upper left leg guillotine amputation. Venous sampling after 8 days revealed bound and unbound ropivacaine concentrations of 1.1 mg/l and 0.06 mg/l in plasma, respectively. Arterial sampling for bound and unbound ropivacaine was 1.2 mg/l and 0.05 mg/l in plasma, respectively. In this case report, long-term high dose epidural infiltration of ropivacaine did not result in severe side effects or complications. Further studies are needed to explore safety of these concentrations in larger populations of children.

Lack of Significant Skeletal Changes after Long-Term, Low-Dose Retinoid Therapy: Case Report and Review of the Literature

2006 ◽  
Vol 10 (6) ◽  
pp. 291-299 ◽  
Author(s):  
Caroline P. Halverstam ◽  
Joshua Zeichner ◽  
Mark Lebwohl
Keyword(s):  
Case Report ◽  
Side Effects ◽  
Low Dose ◽  
Diffuse Idiopathic Skeletal Hyperostosis ◽  
High Dose ◽  
Review Of The Literature ◽  
Radiologic Findings ◽  
Skeletal Changes ◽  
Retinoid Therapy

Background: Long-term systemic retinoid therapy has been associated with skeletal side effects. There have been reports of diffuse idiopathic skeletal hyperostosis (DISH) syndrome, calcification of ligaments, and osteoporosis, as well as premature fusion of epiphyses and modeling abnormalities of long bones, occurring in patients on chronic high-dose isotretinoin, etretinate, and acitretin therapy. Low-dose acitretin has been used for many years as monotherapy or in combination with other systemic therapies for psoriasis. Evidence to date suggests that the frequency of symptomatic bony effects is quite low in these patients. Objective: To present the radiologic findings of a patient on long-term, low-dose acitretin and etretinate and to review the literature on the radiologic evidence of skeletal side effects during retinoid therapy. Methods: Case report and literature search. Results: A patient on low-dose acitretin had no significant radiologic abnormalities associated with retinoid use after 9 years of treatment. A review of the literature revealed conflicting reports on the incidence of radiologic abnormalities in patients on retinoid treatment. Conclusion: The evidence to date does not substantiate a clear link between radiologic skeletal abnormalities and long-term, low-dose acitretin or etretinate therapy.

Long-term side effects following pneumonectomy: A case report and review of the literature

2019 ◽  
Author(s):  
BA Högerle ◽  
EL Bulut ◽  
L Klotz ◽  
F Eichhorn ◽  
M Eichhorn ◽  
...  
Keyword(s):  
Case Report ◽  
Side Effects ◽  
Review Of The Literature

Long-Term Side Effects after High Dose Radioiodine Therapy in Thyroid Carcinoma Patients

1999 ◽  
pp. 375-378
Author(s):  
C. Alexander ◽  
B. Sax ◽  
J. B. Bader ◽  
D. Hellwig ◽  
C. Finke ◽  
...  
Keyword(s):  
Side Effects ◽  
Thyroid Carcinoma ◽  
Radioiodine Therapy ◽  
High Dose

scholarly journals Acute onset clozapine-induced hyperglycaemia: A case report

2019 ◽  
Vol 32 (2) ◽  
pp. e100045 ◽  
Author(s):  
Pradeep Kumar ◽  
Dheerendra Kumar Mishra ◽  
Nimisha Mishra ◽  
Sunil Ahuja ◽  
Gyanendra Raghuvanshi ◽  
...  
Keyword(s):  
Metabolic Syndrome ◽  
Case Report ◽  
Side Effects ◽  
Atypical Antipsychotic ◽  
Time Frame ◽  
Acute Onset ◽  
Antipsychotic Medications ◽  
Pathophysiological Mechanisms ◽  
Hypoglycaemic Agent

Clozapine is an atypical antipsychotic which is described to have higher efficacy among all available antipsychotic medications. Clozapine is reserved especially for resistant schizophrenia due to its side effects. Clozapine-induced metabolic syndrome and hyperglycaemia are common long-term side effects and are responsible for increased mortality in patients with schizophrenia. In this case, a patient with resistant schizophrenia was presented with acute-onset hyperglycaemia and delirium with the use of clozapine within a week. Withdrawal of clozapine in the patient led to the improvement in delirium and hyperglycaemia without the use of any hypoglycaemic agent. This case supports the notion that in certain cases clozapine can induce hyperglycemia through possible direct pathophysiological mechanisms within a shorter time frame.

Long-Term Monitoring of Tricyclic Antidepressant Plasma Concentrations

1980 ◽  
Vol 137 (5) ◽  
pp. 444-451 ◽  
Author(s):  
Agrégé Henry Loo ◽  
Kader Benyacoub ◽  
Vincenzo Rovei ◽  
Carlo A. Altamura ◽  
Marthe Vadrot ◽  
...  
Keyword(s):  
Drug Interaction ◽  
Side Effects ◽  
Plasma Concentrations ◽  
Antidepressant Drugs ◽  
Tricyclic Antidepressant ◽  
Self Medication ◽  
Long Term Monitoring ◽  
Term Monitoring

SummaryPlasma levels of antidepressant drugs were measured in 17 depressed patients at roughly monthly intervals over follow-up periods of three to 26 months. Good results in seven were associated with small fluctuations in level from visit to visit, while big fluctuations were associated with poor outcome. Such fluctuations were probably from poor compliance or drug interaction from self-medication. Severe side effects and cardiotoxicity were associated with high levels.

Long-term effects of cancer therapy on dental development: a case report

2004 ◽  
Vol 28 (4) ◽  
pp. 351-353 ◽  
Author(s):  
Sedat Cetiner ◽  
Cansu Alpaslan
Keyword(s):  
Case Report ◽  
Side Effects ◽  
Cancer Therapy ◽  
Dental Development ◽  
Long Term Effects ◽  
Antineoplastic Treatment ◽  
Malignant Condition

As the prognosis of malignant conditions in children improve by cancer therapy, long-term side effects due to antineoplastic treatment may be encountered. This case report demonstrates the long-term alterations on dental development in patient who had been treated for malignant condition. Alterations were observed during radiographic control 8 years after the therapy and included short, blunted, tapered and V-shaped root malformations as well as delayed and ectopic eruptions.

Maintenance Low Dose 13 Cis-Retinoic Acid and Alpha Tocopherol Improves Survival Compared to High Dose Therapy for 6 Months In LOW and INT-1/2 Stage MDS: Role for Prevention Trial

Blood ◽  
2011 ◽  
Vol 118 (21) ◽  
pp. 5053-5053
Author(s):  
Emmanuel C. Besa ◽  
Joseph Vadakara
Keyword(s):  
Retinoic Acid ◽  
Retrospective Study ◽  
Side Effects ◽  
Low Dose ◽  
Low Risk ◽  
Alpha Tocopherol ◽  
High Dose ◽  
Off Label ◽  
Stage Disease

Abstract Abstract 5053 There are no current therapies or preventative strategies other than transfusion support and possibly growth factor support for the management of low risk and INT 1 Myelodysplasia. There have been a few studies that looked into the effect of 13 cis-retinoic acid (13CRA) by itself and in combination with other drugs that showed some benefits to the use of 13CRA in MDS. A randomized blinded study failed to show any benefit of 13CRA over placebo; however in this study many of the patients discontinued therapy due to side effects of the 13CRA and significant number of the patients had advanced stage disease and either had CMML, RAEB, and RAEB-t based on the classification in use then. Other studies have suggested that the beneficial effect of 13CRA is possibly seen in early stage disease and in low risk Refractory Anemia patients. To look into the benefit that 13CRA might have on IPSS low risk, INT-1 and INT-2 MDS patients we conducted a retrospective study that looked at the effect of 13CRA given in two different doses and durations. Methods: This was a retrospective study that looked at patients with IPSS low risk and INT-1 and INT-2. The patients were divided into two groups. One group was treated with a dose of 13CRA at a dose of 100mg/m2/day for 6 months. The second cohort was treated with a dose of 40mg of 13CRA until disease progression. Disease progression was then compared in the two groups to see if there was any statistical difference in the treatment arms. One of the patients did not seem to have any side effects of 13CRA and it was later found that that patient was on alpha tocopherol, once this was realized then all the patients were given Alpha tocopherol (AT) at a dose 800mg per day along with 13CRA. Results: Twenty patients were identified in the high dose short term arm, and 29 patients in the low dose long term arm. Both groups were similar in age (mean, range) in years, male/female ratio, duration from diagnosis to treatment. IPSS scores and transfusion requirements were comparable. Responses were observed in both groups with an overall response rate of 44.8% in HDST and 75% in LDLT with similar, low AML transformation in INT-1-2 patients of 15% in LDLT and 13.7% in HDST. A better median survival was observed with 5 patients still alive at 72 months in LDLT compared to 30 months in HDST group with a difference of 42 months (3.5 years) (Log-rank p value= 0.0099). The patients who were on the LDLT arm with alpha tocopherol had a much better toxicity profile with only 5% developing skin toxicity compared to as high as 27% in HDST arm and 100% in patients who only received 13CRA, similarly triglyceride changes were seen in 5%, 20%, and 52% respectively, AST elevations were seen in 0%, 2% and 19 % respectively. This suggest that lack of toxicity and good tolerance using 13 CRA at 40 mg/d with 800 mg of AT for long term preventive measure in early phase MDS may result in prolonged survival and may be used as basis for a prospective prevention trial. Disclosures: Off Label Use: 13 cis retinoic acid is used off label.

A case report of long-term complete remission following cessation of romiplostim dosing in a previously severe ITP patient.

2012 ◽  
Vol 30 (15_suppl) ◽  
pp. e17001-e17001
Author(s):  
Allison Ashley Baxley ◽  
James N George ◽  
Deirdra Terrell ◽  
Meredith Moorman ◽  
Jennifer L. Holter
Keyword(s):  
Clinical Trial ◽  
Platelet Count ◽  
Case Report ◽  
Bleeding Complications ◽  
Drug Discontinuation ◽  
High Dose ◽  
Platelet Response ◽  
Open Label ◽  
Platelet Production

e17001 Background: Primary Immune thrombocytopenia(ITP) is a chronic autoimmune disorder characterized by low platelet counts and bleeding complications. Platelet destruction together with insufficient platelet production occur through an antibody-mediated process and early treatment options revolve around targeting antibodies and immunologic pathways. Such therapies may not produce long-term responses and may be accompanied by considerable adverse effects which can lead to complications and/or drug discontinuation. Romiplostim is a thrombopoietic agent that stimulates platelet production and offers an alternative method for treatment of patients with ITP. In clinical trials, patients have achieved durable platelet count responses without clinically important side effects. Methods: We report the case of a 44 year-old female with refractory ITP who has achieved successful remission following treatment with romiplostim. Results: As previously described in Haematologica (2008;93:1445) this patient presented with purpura, menorrhagia, and a platelet count of 7,000. Throughout 2005 she had only transient responses to high dose dexamethasone, intravenous immunoglobulin, rituximab, and splenectomy. She was placed on romiplostim in August 2005 as part of a clinical trial and received a dose of 7 mcg/kg/week for approximately 50 weeks. She was able to tolerate dose reductions and by May 2007 her dose had been de-escalated to 3 mcg/kg/week, which she continued through 2009 as part of an open-label continuation study. In January 2010, after completion of the clinical trial, she began receiving romiplostim by prescription. She was able to gradually tolerate extended dosing intervals due to sustained platelet response. Her last dose was administered on October 27, 2010 and she has maintained a platelet count above 197,000 without further therapy. Conclusions: This case represents, to our knowledge, one of the longest maintained durable responses to romiplostim therapy. Romiplostim provides an alternative approach of treatment for ITP, and as evidenced by this case report, in some patients it may also lead to disease remission and eliminate the need for further treatment.

scholarly journals The Effects of Formaldehyde on Cytochrome P450 Isoform Activity in Rats

2017 ◽  
Vol 2017 ◽  
pp. 1-7 ◽  
Author(s):  
Min Xu ◽  
Huaqiao Tang ◽  
Qian Rong ◽  
Yuanli Zhang ◽  
Yinglun Li ◽  
...  
Keyword(s):  
Cytochrome P450 ◽  
Plasma Concentrations ◽  
Pharmacokinetic Parameters ◽  
Control Group ◽  
High Dose ◽  
Blood Samples ◽  
Time Points ◽  
Indoor Pollutant ◽  
Carcinogenic Effects

Formaldehyde (FA) is an occupational and indoor pollutant. Long-term exposure to FA can irritate the respiratory mucosa, with potential carcinogenic effects on the airways. The effects of acute FA poisoning on the activities of CYP450 isoforms CYP1A2, CYP2C11, CYP2E1, and CYP3A2 were assessed by determining changes in the pharmacokinetic parameters of the probe drugs phenacetin, tolbutamide, chlorzoxazone, and testosterone, respectively. Rats were randomly divided into three groups: control, low FA dose (exposure to 110 ppm for 2 h for 3 days), and high FA dose (exposure to 220 ppm for 2 h for 3 days). A mixture of the four probe drugs was injected into rats and blood samples were taken at a series of time points. Plasma concentrations of the probe drugs were measured by HPLC. The pharmacokinetic parameters t1/2, AUC(0-t), and Cmax of tolbutamide, chlorzoxazone, and testosterone increased significantly in the high dose versus control group (P<0.05), whereas the CL of chlorzoxazone and testosterone decreased significantly (P<0.05). However, t1/2, AUC(0-t), and Cmax of phenacetin decreased significantly (P<0.05), whereas the CL of phenacetin increased significantly (P<0.05) compared to controls. Thus, acute FA poisoning suppressed the activities of CYP2C11, CYP2E1, and CYP3A2 and induced the activity of CYP1A2 in rats. And the change of CYP450 activity caused by acute FA poisoning may be associated with FA potential carcinogenic effects on the airways.

scholarly journals Long term follow-up report of cardiac toxicity in patients with multiple myeloma treated with tandem autologous hematopoietic stem cell transplantation

2013 ◽  
Vol 47 (2) ◽  
pp. 161-165 ◽  
Author(s):  
Mirta Kozelj ◽  
Samo Zver ◽  
Vesna Zadnik
Keyword(s):  
Multiple Myeloma ◽  
Stem Cell ◽  
Side Effects ◽  
Hematopoietic Stem Cell Transplantation ◽  
Stem Cell Transplantation ◽  
Cell Transplantation ◽  
Hematopoietic Stem Cell ◽  
High Dose ◽  
Hematopoietic Stem

Background. Tandem autologous hematopoietic stem cell transplantation (ta-HSCT) is a standard treatment for multiple myeloma (MM). Patients receive a high-dose cyclophosphamide (CY), followed by two myeloablative cycles of melphalan (MEL). There are scarce data about long term cardiotoxicity. Patients and methods. We studied 12 patients (62.25 ± 8.55 years) six years after the completion of MM treatment with ta-HCST. Late cardiotoxic effects were evaluated clinically and echocardiographically. Results. None of the patients developed clinical signs of heart failure, all were in sinus rhythm and NT-pro BNP concentration was elevated (778 ± 902.76 pg/mL). The left ventricular (LV) size remained normal. The LV ejection fraction did not decrease (73.75 ± 5.67%, 69.27 ± 6.13%, p = NS). The LV diastolic function parameters (E, A, ratio E/A and A/a) did not change significantly. In tissue Doppler parameters we observed a nonsignificant decrease in Em (10.26 ± 2.63 cm/s, 7.57 ± 1.43 cm/s) and Sm velocities (8.7 ± 0.87 cm/s, 7.14 ± 1.17 cm/s, p = NS). The E/Em values were in an abnormal range (8.66 ± 1.05, 10.55 ± 2.03). Conclusions. The treatment of MM with ta-HSCT, during which patients receive a high dose CY followed by two myeloablative cycles of MEL, causes mild, chronic, partially reversible and clinically silent cardiotoxic side-effects. However, ta-HSCT in patients with MM is a safe regarding cardiotoxic side effects, but, because of increasing life expectancy needs long term attention.

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