scholarly journals Type B Lactic Acidosis Secondary to Malignancy: Case Report, Review of Published Cases, Insights into Pathogenesis, and Prospects for Therapy

2011 ◽  
Vol 11 ◽  
pp. 1316-1324 ◽  
Author(s):  
Juan P. Ruiz ◽  
Ashok Singh ◽  
Peter Hart
Keyword(s):  
Lactic Acidosis ◽  
English Language ◽  
Case Reports ◽  
Treatment Options ◽  
Hematologic Malignancies ◽  
Future Research ◽  
Type B ◽  
Therapeutic Modalities ◽  
Mesh Terms ◽  
Pubmed Database

Most of the information about type B lactic acidosis associated with cancer is derived from case reports and there are no randomized controlled trials to compare different therapeutic modalities. Previous reviews of cases only refer to hematologic malignancies. We present a patient with non-Hodgkin's lymphoma who developed type B lactic acidosis. We performed a search of the PUBMED database using the MESH terms “neoplasms” AND “acidosis, lactic”, limited to the English language, and written between the years 2000 and 2010. A total of 31 cases were retrieved. These cases were identified and reviewed. The possible pathophysiologic mechanisms and treatment options are discussed. Type B lactic acidosis is most commonly seen in patients with lymphoma or leukemia. Although formal prospective trials are lacking, type B lactic acidosis in patients with cancer seems to be a marker of poor prognosis regardless of the treatment offered and may be invariably fatal. Future research should focus on potential therapy based on the pathogenic mechanisms that lead to type B lactic acidosis in cancer patients.

scholarly journals Fish Bone Foreign Body: The Role of Imaging

2018 ◽  
Vol 23 (01) ◽  
pp. 110-115 ◽  
Author(s):  
Ayala Klein ◽  
Sharon Ovnat-Tamir ◽  
Tal Marom ◽  
Ofer Gluck ◽  
Naomi Rabinovics ◽  
...  
Keyword(s):  
Foreign Body ◽  
English Language ◽  
Case Reports ◽  
Fish Bone ◽  
Upper Aerodigestive Tract ◽  
Imaging Studies ◽  
Medical Subject Headings ◽  
Mesh Terms ◽  
Pubmed Database ◽  
Rigid Esophagoscopy

Introduction Fish bone foreign body (FFB) impaction in the upper aerodigestive tract is a common cause for emergency department referral. Its management varies in both diagnosis and treatment paradigms. Fish bone foreign bodies are more commonly found in the oropharynx in cases of patients < 40 years old, and in the esophagus in cases of patients > 40 years old. Symptoms are typically non-indicative for the location of the FFB, with the exception of foreign body sensation at/superior to the cervical esophagus. A lack of findings during the physical examination is routinely followed by imaging, with computed tomography (CT) being the preferred modality. In practice, many patients undergo unnecessary imaging studies, including CT scans. Objectives To identify patients with suspected fish bone impaction who do not require CT imaging and can be safely discharged. Data Synthesis We have searched the PubMed database for the following medical subject headings (MeSH) terms: fish bone, fish foreign body AND oropharynx, hypopharynx, esophagus, flexible esophagoscopy, and rigid esophagoscopy. Our search in the English language yielded 32 papers. Case reports were included, since they highlighted rare and serious complications. Conclusion In patients > 40 years old suspected of fish bone impaction, non-contrast CT is recommended and should be urgently performed, even in the presence of ambiguous symptoms. However, in patients < 40 years old presenting within 24 hours from ingestion, imaging has little diagnostic value due to the low probability of esophageal fish bones. For this specific subgroup, in the absence of clinical findings, discharge without imaging studies may be considered safe.

scholarly journals Type B Lactic Acidosis in a Solid-Tumour Malignancy Without Liver Metastases

2021 ◽  
Vol 16 (2) ◽  
pp. 38-42
Author(s):  
Beatrice Preti ◽  
Jasna Deluce ◽  
Siddhartha Srivastava
Keyword(s):  
Lactic Acidosis ◽  
Case Reports ◽  
Metastatic Breast ◽  
Hematologic Malignancies ◽  
Type B ◽  
Medical Treatments ◽  
Patients With Cancer ◽  
Tumeurs Malignes ◽  
Cancer Du Sein Métastatique ◽  
Traitements Médicaux

Malignancy-induced type B lactic acidosis is a rare, yet fascinating, cause of refractory acidosis in patients with cancer, often unresponsive to usual medical treatments. Case reports usually discuss the paraneoplastic phenomenon in hematologic malignancies; however, we present the case of a 72-year-old woman with metastatic breast cancer, who initially presented to hospital with an elevated lactate in the absence of acidosis. She appeared to improve with fluids; however, she then represented 2 weeks later with a severe metabolic acidosis and undetectable high lactate level. Ultimately, the patient did not respond well to supportive care, and the decision was made to pursue comfort-directed therapy. RésuméL’acidose lactique de type B induite par une tumeur est une cause rare, mais extrêmement intéressante, d’acidose réfractaire chez les patients cancéreux et qui, souvent, ne répond pas aux traitements médicaux habituels. Les études de cas traitent généralement du phénomène paranéoplasique des tumeurs malignes hématologiques; toutefois, nous présentons le cas d’une femme de 72 ans atteinte d’un cancer du sein métastatique, qui s’est d’abord présentée à l’hôpital pour un taux élevé de lactate dans le sang, mais sans acidose. Son état a semblé s’améliorer grâce à un apport de liquides; toutefois, elle s’est présentée de nouveau à l’hôpital deux semaines plus tard pour une acidose métabolique grave et un taux élevé de lactate indétectable. Au bout du compte, la patiente n’a pas bien répondu aux soins de soutien, et il a été décidé d’appliquer les soins de confort.

Novel Therapeutic Approaches and Targets for Treatment of Chronic Urticaria: New Insights and Promising Targets for a Challenging Disease

2020 ◽  
Vol 22 (1) ◽  
pp. 32-45
Author(s):  
Emanuela Martina ◽  
Federico Diotallevi ◽  
Tommaso Bianchelli ◽  
Matteo Paolinelli ◽  
Annamaria Offidani
Keyword(s):  
English Language ◽  
Life Experience ◽  
Case Reports ◽  
Immunosuppressive Agents ◽  
Real Life ◽  
Chronic Spontaneous Urticaria ◽  
New Targets ◽  
Current State ◽  
Pubmed Database ◽  
Novel Drugs

Background: Chronic Spontaneous Urticaria (CSU) is a disease characterized by the onset of wheals and/or angioedema over 6 weeks. The pathophysiology for CSU is very complex, involving mast cells and basophils with a multitude of inflammatory mediators. For many years the treatment of CSU has been based on the use of antihistamines, steroids and immunosuppressive agents with inconstant and frustrating results. The introduction of omalizumab, the only licensed biologic for antihistamine- refractory CSU, has changed the management of the disease. Objective: The aim of this article is to review the current state of the art of CSU, the real-life experience with omalizumab and the promising drugs that are under development. Methods:: An electronic search was performed to identify studies, case reports, guidelines and reviews focused on the new targets for the treatment of chronic spontaneous urticaria, both approved or under investigation. The search was limited to articles published in peer-reviewed journals in the English Language in the PubMed database and trials registered in Clinicaltrials.gov. Results:: Since the advent of omalizumab, the search for new therapies for chronic spontaneous urticaria has had a new impulse. Anti-IgE drugs will probably still be the cornerstone of therapy, but new targets may prove effective in syndromic urticaria or refractory cases. Conclusion:: Although omalizumab has been a breakthrough in the treatment of CSU, many patients do not completely get benefit and even require more effective treatments. Novel drugs are under investigation with promising results.

A Review and Assessment of Drug-Induced Thrombocytosis

2018 ◽  
Vol 53 (5) ◽  
pp. 523-536 ◽  
Author(s):  
Quyen T. Vo ◽  
Dennis F. Thompson
Keyword(s):  
English Language ◽  
Web Of Science ◽  
Case Reports ◽  
Data Extraction ◽  
Case Series ◽  
Search Term ◽  
Drug Induced ◽  
Reactive Thrombocytosis ◽  
All Trans Retinoic Acid ◽  
Mesh Terms

Objectives: The purpose of this article is to review the current literature on drug-induced thrombocytosis with the goal of critically assessing causality and providing a comprehensive review of the topic. Thrombopoietic growth factors, such as thrombopoietin-receptor agonists (romiplostim and eltrombopag) and erythropoietin are not included in our review. Data Sources: The literature search included published articles limited to the English language and humans in MEDLINE, EMBASE, and Web of Science databases. MEDLINE/PubMed (1966 to September 2018) was searched using the MeSH terms thrombocytosis/chemically-induced and thrombocytosis/etiology. EMBASE (1980 to September 2018) was searched using the EMTAGS thrombocytosis/side effect. Web of Science (1970 to September 2018) was searched using the search term thrombocytosis. References of all relevant articles were reviewed for additional citations and information. Study Selection and Data Extraction: Review articles, clinical trials, background data, case series, and case reports of drug-induced thrombocytosis were collected, and case reports were assessed for causality using a modified Naranjo nomogram. Data Synthesis: Drug-induced thrombocytosis, a form of reactive thrombocytosis cannot be easily differentiated from more common etiologies of reactive thrombocytosis. In all, 43 case reports of drug-induced thrombocytosis from a wide variety of drugs and drug classes were reviewed using a modified Naranjo probability scale that included criteria specific for thrombocytosis. Conclusions: Drug-induced thrombocytosis is a relatively rare adverse drug reaction. The strongest evidence of causality supports low-molecular-weight heparins and neonatal drug withdrawal. Weaker evidence exists for all-trans retinoic acid, antibiotics, clozapine, epinephrine, gemcitabine, and vinca alkaloids.

Current Treatment Recommendations for Leishmaniasis

1992 ◽  
Vol 26 (11) ◽  
pp. 1452-1455 ◽  
Author(s):  
Jeffrey T. Moss ◽  
James P. Wilson
Keyword(s):  
English Language ◽  
Clinical Presentation ◽  
Case Reports ◽  
Data Extraction ◽  
Treatment Options ◽  
Medical Personnel ◽  
Current Treatment ◽  
Treatment Modalities ◽  
Management Options ◽  
Governmental Institutions

OBJECTIVE: To review the epidemiology, clinical presentation, risk factors for transmission, and pathogenesis of leishmaniasis, as well as current treatment options for this disease. DATA SOURCES/DATA SELECTION: We reviewed unclassified medical-threat briefing material, subject-matter reviews, and case reports from the world's infectious disease literature. We concentrated on literature pertaining to the pathogenesis and management of leishmaniasis indigenous to Southwest Asia. DATA EXTRACTION: Data from subject reviews published in the English language were evaluated. Case reports and clinical trials provided supplemental data on evolving theories and management options. DATA SYNTHESIS: The clinical presentation of leishmaniasis is highly variable. Management relies heavily upon the use of parenteral antimonial drugs. Although these agents are effective in most cases, toxicity and the emergence of resistance limit the usefulness of standard therapies. Alternative treatment modalities include heat, surgical curettage, ketoconazole, metronidazole, pentamidine, rifampin, amphotericin B, aminoglycosides, allopurinol, and immunotherapy. CONCLUSIONS: Although the number of reported cases of leishmaniasis in the US has generally been low, there is a possibility that more cases may be reported in the future because of the large number of military personnel returning to this country from endemic areas. Medical personnel, particularly those working in governmental institutions, should be familiar with the pathogenesis of this unusual infection as well as potential treatment options.

scholarly journals Treatment of posttraumatic syringomyelia: evidence from a systematic review

2020 ◽  
Vol 162 (10) ◽  
pp. 2541-2556
Author(s):  
Andrea Kleindienst ◽  
Francisco Marin Laut ◽  
Verena Roeckelein ◽  
Michael Buchfelder ◽  
Frank Dodoo-Schittko
Keyword(s):  
Spinal Cord ◽  
English Language ◽  
Spinal Cord Injuries ◽  
Case Reports ◽  
Treatment Options ◽  
Sensory Function ◽  
Time Interval ◽  
Eligibility Criteria ◽  
Cord Injury ◽  
Posttraumatic Syringomyelia

Abstract Background Following spinal cord injury (SCI), the routine use of magnetic resonance imaging (MRI) resulted in an incremental diagnosis of posttraumatic syringomyelia (PTS). However, facing four decades of preferred surgical treatment of PTS, no clear consensus on the recommended treatment exists. We review the literature on PTS regarding therapeutic strategies, outcomes, and complications. Methods We performed a systematic bibliographic search on (“spinal cord injuries” [Mesh] AND “syringomyelia” [Mesh]). English language literature published between 1980 and 2020 was gathered, and case reports and articles examining syrinx due to other causes were excluded. The type of study, interval injury to symptoms, severity and level of injury, therapeutic procedure, duration of follow-up, complications, and outcome were recorded. Results Forty-three observational studies including 1803 individuals met the eligibility criteria. The time interval from SCI to the diagnosis of PTS varied between 42 and 264 months. Eighty-nine percent of patients were treated surgically (n = 1605) with a complication rate of 26%. Symptoms improved in 43% of patients postoperatively and in 2% treated conservatively. Stable disease was documented in 50% of patients postoperatively and in 88% treated conservatively. The percentage of deterioration was similar (surgery 16%, 0.8% dead; conservative 10%). Detailed analysis of surgical outcome with regard to symptoms revealed that pain, motor, and sensory function could be improved in 43 to 55% of patients while motor function deteriorated in around 25%. The preferred methods of surgery were arachnoid lysis (48%) and syrinx drainage (31%). Conclusion Even diagnosing PTS early in its evolution with MRI, to date, no satisfactory standard treatment exists, and the present literature review shows similar outcomes, regardless of the treatment modality. Therefore, PTS remains a neurosurgical challenge. Additional research is required using appropriate study designs for improving treatment options.

scholarly journals Diagnosis and Treatment of Extended-Spectrum and AmpC β-Lactamase–Producing Organisms

2007 ◽  
Vol 41 (9) ◽  
pp. 1427-1435 ◽  
Author(s):  
Katherine Yang ◽  
B Joseph Guglielmo
Keyword(s):  
Antibiotic Treatment ◽  
English Language ◽  
Randomized Clinical Trials ◽  
Case Reports ◽  
Treatment Options ◽  
False Negative ◽  
In Vitro Susceptibility ◽  
Laboratory Techniques ◽  
Extended Spectrum

Objective: To review the laboratory diagnosis of extended-spectrum β-lactamase (ESBL) and AmpC β-lactamase–producing bacteria and evaluate potential treatment options. Data Sources: A PubMed search, restricted to English-language articles, was conducted (1966–May 2007) using the search terms ESBL, AmpC, diagnosis, detection, carbapenem, ertapenem, fluoroquinolone, cephalosporin, cefepime, tigecycline, and colistin. Additional references were identified through review of bibliographies of identified articles. Study Selection and Data Extraction: All studies that evaluated laboratory methods for the detection of ESBLs and AmpC β-lactamases and/or the treatment of these organisms were reviewed. All articles that were deemed to be clinically pertinent were included and critically evaluated. Data Synthesis: Numerous laboratory techniques are available for the detection of ESBLs. In contrast, laboratory techniques for detection of AmpC β-lactamases are limited, particularly for plasmid-mediated AmpC β-lactamases. Routine microbiologic testing may not detect ESBLs or AmpC β-lactamases. Optimal antibiotic treatment options are derived from limited observational studies and case reports. Randomized clinical trials evaluating appropriate antibiotic treatment options are lacking. In vitro susceptibility does not always correlate with clinical outcomes. The use of imipenem was associated with the lowest incidence of mortality in patients with bacteremia due to ESBL-producing organisms. Conclusions: Laboratory detection of ESBLs for most organisms is possible with Clinical and Laboratory Standards Institute–recommended testing. However, these tests can be associated with both false negative and false positive results, particularly with organisms that harbor both ESBL- and plasmid-mediated AmpC β-lactamases. No established guidelines exist for the detection of AmpC β-lactamases. Imipenem and meropenem are superior to other antibiotics for the treatment of serious infections due to ESBL and AmpC β-lactamase–producing gram-negative bacteria. While in vitro data demonstrate that tigecycline, ertapenem, and colistin might be potential choices, clinical experience is lacking.

scholarly journals Using pCO2 Gap in the Differential Diagnosis of Hyperlactatemia Outside the Context of Sepsis: A Physiological Review and Case Series

2019 ◽  
Vol 2019 ◽  
pp. 1-8 ◽  
Author(s):  
Petr Waldauf ◽  
Katerina Jiroutkova ◽  
Frantisek Duska
Keyword(s):  
Cardiac Output ◽  
Lactic Acidosis ◽  
Critically Ill ◽  
Case Reports ◽  
Case Series ◽  
Type A ◽  
Physiological Data ◽  
Type B ◽  
Central Venous ◽  
Content Difference

Introduction. There is an inverse relationship between cardiac output and the central venous-arterial difference of partial pressures of carbon dioxide (pCO2 gap), and pCO2 gap has been used to guide early resuscitation of septic shock. It can be hypothesized that pCO2 gap can be used outside the context of sepsis to distinguish type A and type B lactic acidosis and thereby avoid unnecessary fluid resuscitation in patients with high lactate, but without organ hypoperfusion. Methods. We performed a structured review of the literature enlightening the physiological background. Next, we retrospectively selected a series of case reports of nonseptic critically ill patients with elevated lactate, in whom both arterial and central venous blood gases were simultaneously measured and the diagnosis of either type A or type B hyperlactataemia was conclusively known. In these cases, we calculated venous-arterial CO2 and O2 content differences and pCO2 gap. Results. Based on available physiological data, pCO2 can be considered as an acceptable surrogate of venous-arterial CO2 content difference, and it should better reflect cardiac output than central venous saturation or indices based on venous-arterial O2 content difference. In our case report of nonseptic patients, we observed that if global hypoperfusion was present (i.e., in type A lactic acidosis), pCO2 gap was elevated (>1 kPa), whilst in the absence of it (i.e., in type B lactic acidosis), pCO2 gap was low (<0.5 kPa). Conclusion. Physiological rationale and a small case series are consistent with the hypothesis that low pCO2 gap in nonseptic critically ill is suggestive of the absence of tissue hypoperfusion, mandating the search for the cause of type B lactic acidosis rather than administration of fluids or other drugs aimed at increasing cardiac output.

scholarly journals Identification and Classification of Polymyalgia Rheumatica (PMR) and PMR-Like Syndromes Following Immune Checkpoint Inhibitors (ICIs) Therapy: Discussion Points and Grey Areas Emerging from a Systematic Review of Published Literature

Medicines ◽  
2020 ◽  
Vol 7 (11) ◽  
pp. 68
Author(s):  
Ciro Manzo ◽  
Marco Isetta ◽  
Maria Natale ◽  
Alberto Castagna
Keyword(s):  
Clinical Judgment ◽  
Immune Checkpoint ◽  
Polymyalgia Rheumatica ◽  
Immune Checkpoint Inhibitors ◽  
English Language ◽  
Checkpoint Inhibitors ◽  
Case Reports ◽  
Bibliographic Databases ◽  
Future Research ◽  
Free Text

Background: Polymyalgia Rheumatica (PMR) is one of the most frequent rheumatologic immune-related adverse effects (IRAEs) in cancer patients following therapy with immune checkpoint inhibitors (ICIs). Atypical findings in many patients often lead to diagnosing PMR-like syndromes. Materials and methods: The aim of our research was to review reported diagnoses of PMR and PMR-like syndromes following ICIs therapy, and assess whether they can be redefined as adverse drug reaction (ADR). In line with PRISMA guidelines, we carried out a systematic search on three main bibliographic databases, based on a combination of subject headings and free text. We included all studies and case-reports published after 2011 (when FDA approved the use of the first ICI) describing the association of PMR or PMR-like syndromes with all types of ICIs therapy. We excluded reviews, conference abstracts, comments, secondary articles, and non-English language studies. Results: We reviewed data from seven studies and eight case-reports, involving a total of 54 patients. Limitations included: the small size of all studies; only one retrospective study used validated criteria for PMR; most reports assessed IRAEs by clinical judgment only and did not seek validation through assessment scales. To date, it remains a conundrum whether IRAEs-PMR is identical to the idiopathic form of the disease, or whether it should be considered a subset of the disease or a new entity. Conclusions: Our review indicates that the relationship between PMR and ICIs therapy is yet to be clearly understood and defined and that future research should remedy the current limits in study design.

Valproic Acid in the Management of Delirium

2021 ◽  
pp. 104990912110383
Author(s):  
Carlos Fernandez Cuartas ◽  
Mellar Davis
Keyword(s):  
Valproic Acid ◽  
English Language ◽  
Retrospective Studies ◽  
Case Reports ◽  
Controlled Trial ◽  
Case Series ◽  
Open Label ◽  
Mesh Terms ◽  
Starting Dose ◽  
The Mean

Context: Antipsychotics and benzodiazepines do not improve delirium. Valproic acid (VPA) has been used recently to treat agitation in delirium. Objectives: To review the evidence for VPA in the management of Delirium. Methods: Systematic review. English language, age 19 and above, from 1946 to January 12, 2021. Mesh Terms: “Valproic acid”, “valproate”, “sodium valproate”, “delirium”, “acute mania with delirium” in PubMed and Ovid. Exclusion: Studies of VPA used for diagnoses other than delirium. Results: 21 abstracts were identified and 10 studies were included in the review (252 patients): One prospective open label study (n: 7), 2 case series (n: 22), 4 retrospective studies (n: 219) and 3 case reports (n: 4). No randomized controlled trial (RCT) evaluates the effect of VPA in delirium. 237/250 (94.8%) patients were in the ICU. Mean age was 59.7 (27-87). 153/204 (74%) were male. The mean starting dose was 733 mg/day in 148 patients and the mean dose at follow up was 1061 mg/day in 205 patients. CAM ICU was used to diagnose delirium in 6 reviews. Delirium improved in case series in 19/22 patients. Delirium improved in retrospective studies at day 3 compared to day 1. VPA levels were not consistently reported. Hyperammonemia (12-19%) and thrombocytopenia (9-13%) were the most common side effects. No deaths were attributed to VPA. Conclusion: VPA is being used more frequently for delirium. The evidence is limited to retrospective studies and case series. There is a need for RCT to evaluate the effect of VPA in delirium compared to other alternatives and placebo.

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