Intrathecal Granuloma in a Patient Receiving High Dose Hydromorphone

2008 ◽  
Vol 3;11 (5;3) ◽  
pp. 369-373
Author(s):  
Jay S. Grider
Keyword(s):  
Intrathecal Morphine ◽  
Treatment Options ◽  
Granuloma Formation ◽  
High Dose ◽  
High Concentration ◽  
First Line ◽  
Inflammatory Mass ◽  
Current Case ◽  
Neurologic Function ◽  
Inflammatory Granuloma

Intrathecal granuloma formation has commonly been described with morphine therapy. It has been suggested that a high concentration of intrathecal morphine may be responsible for this complication. Much less commonly, intrathecal hydromorphone has been associated with intrathecal granuloma formation. In the current case we report the evaluation and management of an intrathecal granuloma in a patient receiving a relatively high concentration of intrathecal hydromorphone. A nonsurgical, conservative approach to management involves stopping the infusion and observing the patient for improvement as the granuloma mass often slowly resolves once the infusion is stopped. Cessation of the infusion or addition of clonidine to the IDDS admixture in conjunction with close clinical monitoring may be reasonable treatment options in patients with an asymptomatic or mildly symptomatic inflammatory mass. In the current study, rapidly declining neurologic function with a confirmed inflammatory mass adherent to the spinal canal necessitated urgent surgical intervention. Though use of intrathecal hydromorphone still represents an off label application, this opiate is commonly employed as an alternative first line analgesic agent. This case report highlights the potential of high-dose and high infusate concentration intrathecal hydromorphone to form an inflammatory granuloma. Key words: Intrathecal hydromorphone, intrathecal granuloma, inflamatory mass, intraspinal drug delivery

scholarly journals Management of a Patient with Metastatic Colorectal Cancer and Liver Metastases

2014 ◽  
Vol 2014 ◽  
pp. 1-4 ◽  
Author(s):  
Muhammad Wasif Saif
Keyword(s):  
Colorectal Cancer ◽  
Liver Metastases ◽  
Metastatic Colorectal Cancer ◽  
Systemic Treatment ◽  
Treatment Options ◽  
Cortical Blindness ◽  
Second Line ◽  
First Line ◽  
Current Case ◽  
Transient Cortical Blindness

Liver metastases are commonly encountered in patients presenting with metastatic colorectal cancer (mCRC); resection is the treatment of choice. A number of systemic treatment options are currently available for such patients, including the use of 5-fluorouracil-based chemotherapies and oxaliplatin (e.g., FOLFOX) in combination with biologic agents that target angiogenesis (e.g., bevacizumab). For patients with progression following first-line treatment, current second-line options include a change in chemotherapy with bevacizumab (for patients who did or did not receive prior bevacizumab) or FOLFIRI in combination with aflibercept, a more recently approved antiangiogenesis therapy. Neurotoxicity is a well-established adverse event of oxaliplatin-based therapy. The current case details an mCRC patient with liver metastases who was treated with a capecitabine and oxaliplatin regimen (XELOX), and experienced two episodes of transient cortical blindness possibly related to oxaliplatin. After disease progression, the patient was switched to a regimen of FOLFIRI and aflibercept and did well on this second-line regimen.

scholarly journals Arachnoiditis with Intrathecal Morphine 12 Months Following Implantation of an Intrathecal Pump: A Case Report

2020 ◽  
pp. 45-49
Author(s):  
Robert Chow
Keyword(s):  
Substance P ◽  
Cell Activation ◽  
Intrathecal Morphine ◽  
Treatment Options ◽  
Granuloma Formation ◽  
Mast Cell Activation ◽  
Intrathecal Catheter ◽  
Sole Agent ◽  
The Central Nervous System ◽  
Potential Risks

Abstract: The utilization of intrathecal pumps is increasing as more practitioners are becoming familiar with their use, and as the applications of continuous intrathecal infusions increase. There are many potential risks with intrathecal pump implantation, which include the risk of infection, bleeding, nerve damage, as well as other potential issues. After prolonged usage, granuloma formation, medication tolerance, disease progression, mechanical failure, and arachnoiditis can also occur. Arachnoiditis has been associated with spinal disease, contrast media, preservatives in medications, infectious causes, hemorrhage, and more. The potential causes of arachnoiditis are many; however, it is infrequently associated with intrathecal pump infusates. Morphine is commonly used in intrathecal pumps, either as a sole agent or in combination with other medications. Its role in arachnoiditis and catheter granuloma formation can be extrapolated from its effects on inflammation. In particular, it is well known that morphine causes mast cell activation and subsequent release of substance P and tryptase. In addition, morphine can sensitize the central nervous system to inflammatory effects as it can enhance the release of substance P from the dorsal root ganglia as well. Lastly, activation of μ receptors on lymphocytes can result in lymphocyte proliferation. When arachnoiditis occurs in the setting of an intrathecal pump, there are several important considerations. These include the appropriate diagnosis of the cause as well as evaluation of potential treatment options. We report a case of intrathecal morphine-associated arachnoiditis that was diagnosed using both clinical and magnetic resonance imaging findings. This case describes a successful exchange of intrathecal morphine for intrathecal hydromorphone, with the subsequent improvement of the patient’s symptoms of arachnoiditis. Key words: Adhesive arachnoiditis, arachnoiditis, cancer pain, complications, intrathecal catheter, intrathecal drug delivery system, intrathecal hydromorphone, intrathecal inflammation, intrathecal morphine, intrathecal pump, intrathecal opioid, intrathecal ziconitide

PROSPECTS FOR HIGH-DOSE CHEMOTHERAPY WITH AUTOLOGOUS HEMATOPOIETIC STEM CELL TRANSPLANTATION IN THE FIRST LINE OF THERAPY FOR AGGRESSIVE NON-HODGKIN’S LYMPHOMAS

2017 ◽  
Vol 63 (2) ◽  
pp. 326-328
Author(s):  
Larisa Filatova ◽  
Yevgeniya Kharchenko ◽  
Sergey Alekseev ◽  
Ilya Zyuzgin ◽  
Anna Artemeva ◽  
...  
Keyword(s):  
Stem Cell ◽  
Stem Cell Transplantation ◽  
Cell Transplantation ◽  
Therapeutic Option ◽  
B Cell Lymphoma ◽  
High Dose Chemotherapy ◽  
High Dose ◽  
First Line ◽  
Hematopoietic Stem ◽  
Hodgkin's Lymphomas

Currently there is no single approach to treatment for aggressive diffuse large-cell B-cell lymphoma (Double-HIT and Triple-HIT). Accumulated world data remain controversial and, given the unfavorable prognosis in this subgroup, high-dose chemotherapy with autologous stem cell transplantation in the first line of treatment is a therapeutic option.

Calibration Method for Elemental Quantification

2000 ◽  
Vol 6 (S2) ◽  
pp. 536-537
Author(s):  
C. B. Vartuli ◽  
F. A. Stevie ◽  
L. A. Giannuzzi ◽  
T. L. Shofner ◽  
B. M. Purcell ◽  
...  
Keyword(s):  
Mass Spectrometry ◽  
Peak Concentration ◽  
Energy Dispersive Spectrometry ◽  
Secondary Ion Mass Spectrometry ◽  
Rutherford Backscattering Spectrometry ◽  
Calibration Method ◽  
High Dose ◽  
High Concentration ◽  
Borophosphosilicate Glass ◽  
Secondary Ion

Energy Dispersive Spectrometry (EDS) is generally calibrated for quantification using elemental standards. This can introduce errors when quantifying non-elemental samples and does not provide an accurate detection limit. In addition, variations between analysis tools can lead to values that differ considerably, especially for trace elements. By creating a standard with an exact trace composition, many of the errors inherent in EDS quantification measurements can be eliminated.The standards are created by high dose ion implantation. For ions implanted into silicon, a dose of 1E16 cm-2 results in a peak concentration of approximately 1E21 cm-3 or 2% atomic. The exact concentration can be determined using other methods, such as Rutherford Backscattering Spectrometry (RBS) or Secondary Ion Mass Spectrometry (SIMS). For this study, SIMS analyses were made using a CAMECA IMS-6f magnetic sector. Measurement protocols were used that were developed for high concentration measurements, such as B and P in borophosphosilicate glass (BPSG).

scholarly journals TNF-Alpha Inhibitors for Chronic Urticaria: Experience in 20 Patients

2013 ◽  
Vol 2013 ◽  
pp. 1-4 ◽  
Author(s):  
Freja Lærke Sand ◽  
Simon Francis Thomsen
Keyword(s):  
Side Effects ◽  
Chronic Urticaria ◽  
Treatment Options ◽  
Significant Proportion ◽  
Response Duration ◽  
Immunosuppressive Drugs ◽  
Tnf Alpha ◽  
High Dose ◽  
Duration Of Treatment ◽  
Durable Response

Patients with severe chronic urticaria may not respond to antihistamines, and other systemic treatment options may either be ineffective or associated with unacceptable side effects. We present data on efficacy and safety of adalimumab and etanercept in 20 adult patients with chronic urticaria. Twelve (60%) patients obtained complete or almost complete resolution of urticaria after onset of therapy with either adalimumab or etanercept. Further three patients (15%) experienced partial response. Duration of treatment ranged between 2 and 39 months. Those responding completely or almost completely had a durable response with a mean of 11 months. Six patients (30%) experienced side effects and five patients had mild recurrent upper respiratory infections, whereas one patient experienced severe CNS toxicity that could be related to treatment with TNF-alpha inhibitor. Adalimumab and etanercept may be effective and relatively safe treatment options in a significant proportion of patients with chronic urticaria who do not respond sufficiently to high-dose antihistamines or in whom standard immunosuppressive drugs are ineffective or associated with unacceptable side effects.

Does coffee, tea and caffeine consumption reduce the risk of incident breast cancer? A systematic review and network meta-analysis

2021 ◽  
pp. 1-13
Author(s):  
Shu Wang ◽  
Xiang Li ◽  
Yue Yang ◽  
Jingping Xie ◽  
Mingyue Liu ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Systematic Review ◽  
Postmenopausal Women ◽  
Meta Analysis ◽  
High Dose ◽  
Dependent Manner ◽  
Tea Consumption ◽  
Case Control Studies ◽  
High Concentration ◽  
Coffee Intake

Abstract Objective: We aimed to evaluate the association between coffee and/or tea consumption and breast cancer (BC) risk among premenopausal and postmenopausal women and to conduct a network meta-analysis. Design: Systematic review and network meta-analysis. Setting: We conducted a systematic review of electronic publications in the last 30 years to identify case–control studies or prospective cohort studies that evaluated the effects of coffee and tea intake. Results: Forty-five studies that included more than 3 323 288 participants were eligible for analysis. Network meta-analysis was performed to determine the effects of coffee and/or tea consumption on reducing BC risk in a dose-dependent manner and differences in coffee/tea type, menopause status, hormone receptor and the BMI in subgroup and meta-regression analyses. According to the first pairwise meta-analysis, low-dose coffee intake and high-dose tea intake may exhibit efficacy in preventing ER(estrogen receptor)− BC, particularly in postmenopausal women. Then, we performed another pairwise and network meta-analysis and determined that the recommended daily doses were 2–3 cups/d of coffee or ≥5 cups/d of tea, which contained a high concentration of caffeine, particularly in postmenopausal women. Conclusions: Coffee and tea consumption is not associated with a reduction in the overall BC risk in postmenopausal women and is associated with a potentially lower risk of ER− BC. And the highest recommended dose is 2–3 cups of coffee/d or ≥5 cups of tea/d. They are potentially useful dietary protectants for preventing BC.

scholarly journals Patient profiles as an aim to optimize selection in the second line setting: the role of aflibercept

2021 ◽  
Author(s):  
B. González Astorga ◽  
F. Salvà Ballabrera ◽  
E. Aranda Aguilar ◽  
E. Élez Fernández ◽  
P. García-Alfonso ◽  
...  
Keyword(s):  
Colorectal Cancer ◽  
Therapeutic Option ◽  
Scientific Evidence ◽  
Treatment Options ◽  
Line Treatment ◽  
Second Line ◽  
First Line ◽  
Effective Therapeutic Option ◽  
Line Setting ◽  
First Line Treatment

AbstractColorectal cancer is the second leading cause of cancer-related death worldwide. For metastatic colorectal cancer (mCRC) patients, it is recommended, as first-line treatment, chemotherapy (CT) based on doublet cytotoxic combinations of fluorouracil, leucovorin, and irinotecan (FOLFIRI) and fluorouracil, leucovorin, and oxaliplatin (FOLFOX). In addition to CT, biological (targeted agents) are indicated in the first-line treatment, unless contraindicated. In this context, most of mCRC patients are likely to progress and to change from first line to second line treatment when they develop resistance to first-line treatment options. It is in this second line setting where Aflibercept offers an alternative and effective therapeutic option, thought its specific mechanism of action for different patient’s profile: RAS mutant, RAS wild-type (wt), BRAF mutant, potentially resectable and elderly patients. In this paper, a panel of experienced oncologists specialized in the management of mCRC experts have reviewed and selected scientific evidence focused on Aflibercept as an alternative treatment.

scholarly journals Immunotherapy in hepatocellular carcinoma: evaluation and management of adverse events associated with atezolizumab plus bevacizumab

2021 ◽  
Vol 13 ◽  
pp. 175883592110311
Author(s):  
Chiun Hsu ◽  
Lorenza Rimassa ◽  
Hui-Chuan Sun ◽  
Arndt Vogel ◽  
Ahmed O. Kaseb
Keyword(s):  
Hepatocellular Carcinoma ◽  
Adverse Events ◽  
Kinase Inhibitor ◽  
Treatment Options ◽  
Healthcare Providers ◽  
Safety Data ◽  
Standard Of Care ◽  
Antiangiogenic Agents ◽  
Efficacy And Safety ◽  
First Line

In light of positive efficacy and safety findings from the IMbrave150 trial of atezolizumab plus bevacizumab, this novel combination has become the preferred first-line standard of care for patients with unresectable hepatocellular carcinoma (HCC). Several additional trials are ongoing that combine an immune checkpoint inhibitor with another agent such as a multiple kinase inhibitor or antiangiogenic agent. Therefore, the range of first-line treatment options for unresectable HCC is likely to increase, and healthcare providers need succinct information about the use of such combinations, including their efficacy and key aspects of their safety profiles. Here, we review efficacy and safety data on combination immunotherapies and offer guidance on monitoring and managing adverse events, especially those associated with atezolizumab plus bevacizumab. Because of their underlying liver disease and high likelihood of portal hypertension, patients with unresectable HCC are at particular risk of gastrointestinal bleeding, and this risk may be exacerbated by treatments that include antiangiogenic agents. Healthcare providers also need to be alert to the risks of proteinuria and hypertension, colitis, hepatitis, and reactivation of hepatitis B or C virus infection. They should also be aware of the possibility of rarer but potentially life-threatening adverse events such as pneumonitis and cardiovascular events. Awareness of the risks associated with these therapies and knowledge of adverse event monitoring and management will become increasingly important as the therapeutic range broadens in unresectable HCC.

Refractory eosinophilic fasciitis successfully treated with infliximab: A case report

2021 ◽  
pp. 239719832110043
Author(s):  
Paulina Śmigielska ◽  
Justyna Czarny ◽  
Jacek Kowalski ◽  
Aleksandra Wilkowska ◽  
Roman J. Nowicki
Keyword(s):  
Case Report ◽  
Connective Tissue ◽  
Treatment Failure ◽  
Immunosuppressive Drugs ◽  
Unknown Etiology ◽  
High Dose ◽  
Eosinophilic Fasciitis ◽  
Line Treatment ◽  
First Line ◽  
First Line Treatment

Eosinophilic fasciitis is a rare connective tissue disease of unknown etiology. Therapeutic options include high-dose corticosteroids and other immunosuppressive drugs. We present a typical eosinophilic fasciitis case, which did not respond to first-line treatment, but improved remarkably after infliximab administration. This report demonstrates that in case of initial treatment failure, infliximab might be a relatively safe and effective way of eosinophilic fasciitis management.

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