POSSIBILITIES OF PROTON THERAPY IN THE TREATMENT OF PEDIATRIC SKULL BASE CHORDOMAS: A CASE SERIES REPORT

2021 ◽  
Vol 100 (3) ◽  
pp. 272-279
Author(s):  
N.A. Vorobyov ◽  
◽  
N.I. Martynova ◽  
D.A. Antipin ◽  
K.F. Boiko ◽  
...  
Keyword(s):  
Proton Therapy ◽  
Malignant Tumors ◽  
Case Reports ◽  
Case Series ◽  
Photon Radiation ◽  
High Dose ◽  
Primary Bone Tumors ◽  
Case Series Report ◽  
High Doses ◽  
Skull Base Chordomas

Chordomas are rare malignant tumors that account for no more than 4% of primary bone tumors. The incidence of chordomas in children does not exceed 5%. Tumor removal is the primary method of treatment, however, due to the high frequency of non-radical surgery, most patients require an adjuvant course of radiotherapy. Photon radiation therapy in doses of 50–60 Gy does not provide the required antitumor effect. At the same time, the use of a proton beam allows delivering a dose of 72 Gy or more with low toxicity. The article presents 4 clinical case reports of base-skull chordoma in children describing their own experience with proton therapy. An analysis of radiation exposure plans was carried out, with an evaluation of the main qualitative indicators characterizing the high-dose coverage of tumours and the radiation load on healthy tissues. The case reports described confirm that the technique of proton irradiation with a pencil beam makes it possible to safely administer ultra-high doses of radiation in close proximity to healthy tissues, including in children. Further improvement of the irradiation planning technique is required, which will improve the target coverage with a high dose of ionizing radiation.

scholarly journals Analysis of Corticosteroids in Immune Checkpoint Inhibitor(ICE)Induced Myocarditis-A Systematic Review of 352 Screened Articles

2021 ◽  
Author(s):  
Mona Sheikh ◽  
Saumil Patel ◽  
Shavy Nagpal ◽  
Zeynep Yulkselen ◽  
Samina Zahid ◽  
...  
Keyword(s):  
English Language ◽  
Cardiac Myocyte ◽  
Checkpoint Inhibitors ◽  
Case Reports ◽  
Single Agent ◽  
Treatment Guideline ◽  
Case Series ◽  
High Dose ◽  
Combination Regimen ◽  
High Doses

Introduction:Immune Checkpoint Inhibitors(ICI)is used as a single agent or as a combination therapies for early or late-stage malignancies.The common malignancies that ICI targets include the following:melanoma, lung cancer, renal cell carcinoma, and hematological malignancies such as Hodgkin lymphoma.ICI use is associated with many immune-related adverse events, and ICI-induced myocarditis is one of the rare and most severe AE with a high mortality rate. There is no consensus evidence-based treatment guideline; the expert recommendation is to use high-dose steroids. We aim in this review to assess the effectiveness of steroids in treating ICI-induced myocarditis. Methods: We searched the following database Pubmed, Scopus, Cinhale, and Google Scholar, using the following keywords: ICI-induced myocarditis, treatment, steroid. We included articles in the English language, case reports, case series, and published in the last five years. Results: 352 articles were screened using PRISMA guidelines. After excluding the articles that were duplicate, irrelevant, and did not meet inclusion criteria, 35 articles with a total number of 50 patients were included. All patients treated with ICI either as a single or combination regimen. The onset of symptoms post-initiation varied from one day to a year. 46 out of the 50 cases received high doses of Intravenous steroids as a loading dose followed by an oral or intravenous maintenance dose. Out of 50 patients 14 patients (28 %) died but 34 (68 %) patients survived, and 2 (4 %) patients data were not available. The mean age of the patients was 66.31+/-14.071 (range 23-88 years), 29 were male (58%), 21 were female (42%). Most of the cases were from the USA (42%), followed by Australia (20 %), Japan (14%), Germany, France, and China (4%), Switzerland, Canada, and Spain (2%), and for (6%) cases. A total of 23 patients had cardiovascular comorbidities (46%), which were HTN (14 patients, 60.87%), hyperlipidemia (5 patients, 21.73%), and less than 1 % of patients had myocardial ischemia, congestive heart failure, atrial fibrillation, and peripheral vascular disease. While 26 patients (52%) had normal basal cardiac status. Conclusion: Our results showed that high doses of steroids were effective in controlling cardiac myocyte inflammation and mortality by 28%. The race was not included in the analysis as it was not reported. More in depth studies are needed to provide a broader representation of steroids in myocarditis.

Fluconazole-Induced Symptomatic Phenytoin Toxicity

1994 ◽  
Vol 28 (2) ◽  
pp. 191-195 ◽  
Author(s):  
Richard M. Cadle ◽  
Golden J. Zenon ◽  
Maria C. Rodriguez-Barradas ◽  
Richard J. Hamill
Keyword(s):  
Continuous Monitoring ◽  
Case Reports ◽  
Review Literature ◽  
High Dose ◽  
Data Synthesis ◽  
High Doses ◽  
Phenytoin Toxicity ◽  
Cytochrome P 450 ◽  
Hepatic Cytochrome

OBJECTIVE: To report two cases of fluconazole-induced symptomatic phenytoin toxicity and review literature related to this interaction. DATA SOURCES: Case reports and review articles identified by a computerized (MEDLINE) and manual ( Index Medicus) search. DATA SYNTHESIS: Fluconazole is a broad-spectrum triazole antifungal agent primarily eliminated by renal mechanisms, although hepatic cytochrome P-450 inhibition and hepatotoxicity have been observed. We report two cases of fluconazole-induced symptomatic phenytoin toxicity. Both patients received high doses of the drug; one patient developed phenytoin toxicity only after long-term coadministration. Previously reported cases have occurred primarily with high-dose fluconazole and short-term coadministration. CONCLUSIONS: Fluconazole can increase phenytoin serum concentrations leading to toxicity. Constant and continuous monitoring of serum phenytoin concentrations with fluconazole doses as low as 200 mg/d is warranted.

Extravasation Injury Associated with Low-Dose Dopamine

1998 ◽  
Vol 32 (5) ◽  
pp. 545-548 ◽  
Author(s):  
Julie L Chen ◽  
Marianne O'Shea
Keyword(s):  
Low Dose ◽  
Tissue Injury ◽  
Case Reports ◽  
Blood Perfusion ◽  
High Dose ◽  
Dopamine Infusion ◽  
Tissue Ischemia ◽  
Large Vein ◽  
High Concentrations ◽  
High Doses

OBJECTIVE: To describe the occurrence of extravasation in two patients receiving low-dose dopamine infusions. CASE SUMMARY: Intravenous dopamine was infused peripherally (in the antecubital fossa) to two patients in the cardiac intensive care unit in an attempt to enhance renal blood perfusion and urine output. Dopamine extravasation occurred in both patients while the low dose (<3 μg/kg/min) was infused. Significant local tissue injury was observed in both patients. DISCUSSION: Dopamine infusion can cause tissue ischemia or necrosis secondary to vasospasm and extravasation. Most of the case reports in the literature have occurred when relatively high doses of dopamine were infused. Only one reported extravasation-induced injury with low-dose dopamine. Although low-dose dopamine has a vasodilatory effect in selected tissues, high concentrations achieved locally as a result of extravasation can still cause severe vasoconstriction and ischemic tissue injury. CONCLUSIONS: Low-dose dopamine therapy should be administered with similar precautions as high-dose dopamine. A central intravenous access should be placed for dopamine infusion whenever possible. If this approach is not feasible, dopamine should be infused only peripherally through a long intravenous catheter into a large vein. A 5-cm angiocatheter that is 20 gauge or larger is recommended for peripheral dopamine infusion in our institution. The infusion site should be inspected frequently for early detection of extravasation, and changed to a central or a peripherally inserted central catheter as soon as possible, especially in patients at high risk for extravasation.

scholarly journals Early Intravenous Immunoglobulin as an Effective Drug for the Treatment of COVID-19: A Case Series and Case Review

2020 ◽  
Vol 15 (5) ◽  
Author(s):  
Rozita Khodashahi ◽  
Alireza Sedaghat ◽  
Mandana Khodashahi
Keyword(s):  
Public Health ◽  
Intravenous Immunoglobulin ◽  
Literature Search ◽  
Case Reports ◽  
Case Series ◽  
High Dose ◽  
Global Public Health ◽  
Case Review ◽  
Case Presentation ◽  
The Common

Introduction: The outbreak of coronavirus disease 2019 (COVID-19) should be considered a serious threat to global public health. Due to a large number of infected and dead people, the development of approaches to control the epidemic condition, as well as effective and available drugs, is very important. Case Presentation: In this study, we presented three cases with COVID-19 admitted to the Imam Reza Hospital. A high dose of intravenous immunoglobulin (IVIG) was used for patients as potent and safe treatment. Moreover, case reports and case series focusing on the patients with COVID-19 were reviewed in the present study. During the literature search, 27 patients with COVID-19 were identified in 14 studies. Fever, sore throat, dry cough, fatigue, chills, and muscle pain were the common primary complications of the patients. Kaletra, oseltamivir, ceftriaxone, hydroxychloroquine, azithromycin, and IVIG were the most prevalent drugs for the treatment of COVID-19. Conclusions: Except for the current study, IVIG was utilized in two other studies to treat patients with COVID-19, who did not respond to other therapies.

Mycophenolate Mofetil for a Flare Child Lupus Nephritis: A Case Reports

2021 ◽  
Vol 2 (1) ◽  
pp. 113-118
Author(s):  
Gina Puspita ◽  
Desy Rusmawatiningtyas ◽  
Sumadiono
Keyword(s):  
Mycophenolate Mofetil ◽  
Lupus Nephritis ◽  
Lupus Erythematosus ◽  
Case Reports ◽  
High Dose ◽  
Common Complication ◽  
High Dose Corticosteroid ◽  
Steroid Dose ◽  
High Doses ◽  
Dose Corticosteroid

A B S T R A C TRenal involvement is the most common complication of systemic lupus erythematosus(SLE) and is also an important predictor of patient mortality. The incidence of flaresis estimated at 65% each year in patients with lupus nephritis. Therapy in lupusnephritis with flare also uses high doses of steroid agents and strongimmunosuppression agent. Mycophenolate mofetil (MMF) as a immunosuppressionagent tends to favor for flare in lupus nephritis. We describe a patient who had flarein lupus nephritis that resolved with high-dose steroid and MMF. The combination ofimmunosuppression agent and high-dose corticosteroid is an effective for control ofactive diseases. Cyclophosphamide as the steroid sparing agent was discontinuedbecause of adverse effect as well as hematuria. Partial remission was later achievedand maintained with MMF and corticosteroid after five month with protocol treatment.Thus, MMF while maintaining the steroid dose may induce remission for this case.

scholarly journals Gastric Emphysema a Spectrum of Pneumatosis Intestinalis: A Case Report and Literature Review

2014 ◽  
Vol 2014 ◽  
pp. 1-5 ◽  
Author(s):  
Guillermo López-Medina ◽  
Roxana Castillo Díaz de León ◽  
Alberto Carlos Heredia-Salazar ◽  
Daniel Ramón Hernández-Salcedo
Keyword(s):  
Single Case ◽  
Case Reports ◽  
Gastric Wall ◽  
Case Series ◽  
Pneumatosis Intestinalis ◽  
Assessment Method ◽  
Emphysematous Gastritis ◽  
Prognostic Implications ◽  
High Doses ◽  
Gastric Emphysema

The finding of gas within the gastric wall is not a disease by itself, rather than a sign of an underlying condition which could be systemic or gastric. We present the case of a woman identified with gastric emphysema secondary to the administration of high doses of steroids, with the purpose of differentiating emphysematous gastritis versus gastric emphysema due to the divergent prognostic implications. Gastric emphysema entails a more benign course, opposed to emphysematous gastritis which often presents as an acute abdomen and carries a worse prognosis. Owing to the lack of established diagnostic criteria, computed tomography is the assessment method of choice. Currently no guidelines are available for the management of this entity, since the evidence is limited to a few case series and a considerable number of single case reports.

scholarly journals Systemic Minoxidil Accidental Exposure in a Paediatric Population: A Case Series Study of Cutaneous and Systemic Side Effects

2021 ◽  
Vol 10 (18) ◽  
pp. 4257
Author(s):  
Manuel Sánchez-Díaz ◽  
David López-Delgado ◽  
Trinidad Montero-Vílchez ◽  
Luis Salvador-Rodríguez ◽  
Alejandro Molina-Leyva ◽  
...  
Keyword(s):  
Side Effects ◽  
Treatment Time ◽  
Case Series ◽  
Paediatric Population ◽  
High Dose ◽  
Retrospective Case ◽  
Case Series Study ◽  
High Doses ◽  
Initial Zone ◽  
Series Study

Oral minoxidil is an approved treatment for high blood pressure which is also used as an off-label drug for alopecia. Knowledge about the effects of systemic minoxidil in the paediatric population is limited. A retrospective case series study of paediatric patients with history of systemic minoxidil intake due to contaminated sets of omeprazole was performed to describe side effects of high dose oral minoxidil intake in children. Twenty patients aged between 2 months and 13 years joined the study. They had received high doses of oral minoxidil (mean dose 0.90 mg/kg/day) during a mean time of 38.3 days. Hypertrichosis appeared in 65%, with a mean latency time of 24.31 days. Treatment time was associated with the appearance of hypertrichosis (p < 0.05). Most common initial zone of hypertrichosis was the face. Systemic effects developed in 15%, with no cases of severe disorders. The present study shows a novel insight into the side effects of high doses of oral minoxidil in children.

scholarly journals Early Toxicities After High Dose Rate Proton Therapy in Cancer Treatments

2021 ◽  
Vol 10 ◽  
Author(s):  
Jérôme Doyen ◽  
Marie-Pierre Sunyach ◽  
Fabien Almairac ◽  
Véronique Bourg ◽  
Arash O. Naghavi ◽  
...  
Keyword(s):  
Dose Rate ◽  
Proton Therapy ◽  
Malignant Tumors ◽  
Retrospective Chart Review ◽  
High Dose Rate ◽  
High Dose ◽  
Cancer Treatments ◽  
Conventional Dose ◽  
Grade 3

BackgroundThe conventional dose rate of radiation therapy is 0.01–0.05 Gy per second. According to preclinical studies, an increased dose rate may offer similar anti-tumoral effect while dramatically improving normal tissue protection. This study aims at evaluating the early toxicities for patients irradiated with high dose rate pulsed proton therapy (PT).Materials and MethodsA single institution retrospective chart review was performed for patients treated with high dose rate (10 Gy per second) pulsed proton therapy, from September 2016 to April 2020. This included both benign and malignant tumors with ≥3 months follow-up, evaluated for acute (≤2 months) and subacute (&gt;2 months) toxicity after the completion of PT.ResultsThere were 127 patients identified, with a median follow up of 14.8 months (3–42.9 months). The median age was 55 years (1.6–89). The cohort most commonly consisted of benign disease (55.1%), cranial targets (95.1%), and were treated with surgery prior to PT (56.7%). There was a median total PT dose of 56 Gy (30–74 Gy), dose per fraction of 2 Gy (1–3 Gy), and CTV size of 47.6 ml (5.6–2,106.1 ml). Maximum acute grade ≥2 toxicity were observed in 49 (38.6%) patients, of which 8 (6.3%) experienced grade 3 toxicity. No acute grade 4 or 5 toxicity was observed. Maximum subacute grade 2, 3, and 4 toxicity were discovered in 25 (19.7%), 12 (9.4%), and 1 (0.8%) patient(s), respectively.ConclusionIn this cohort, utilizing high dose rate proton therapy (10 Gy per second) did not result in a major decrease in acute and subacute toxicity. Longer follow-up and comparative studies with conventional dose rate are required to evaluate whether this approach offers a toxicity benefit.

Bronchogenic Stress Cardiomyopathy: A Case Series

Cardiology ◽  
2015 ◽  
Vol 130 (2) ◽  
pp. 106-111 ◽  
Author(s):  
Adil Rajwani ◽  
Zulfiquar Adam ◽  
James Anthony Hall
Keyword(s):  
Single Case ◽  
Case Reports ◽  
Case Series ◽  
Stress Cardiomyopathy ◽  
Chronic Obstructive ◽  
High Dose ◽  
Atypical Presentation ◽  
Agonist Therapy ◽  
Obstructive Pulmonary Disease

Despite a growing awareness of stress (takotsubo) cardiomyopathy, the diversity in precipitants beyond emotional distress remains under-appreciated. Emerging data implicate a differential influence of precipitant type on the variable presentations of stress cardiomyopathy. We outline 5 cases of stress cardiomyopathy where the precipitant was an acute exacerbation of chronic obstructive pulmonary disease treated with high-dose bronchodilator therapy. In this setting, an atypical and insidious presentation of the stress cardiomyopathy was consistently observed that was difficult to distinguish from the acute airway exacerbation itself, with an absence of chest pain in particular. Scrutiny of published single-case reports reveals a similar atypical presentation; this supports the existence of a novel bronchogenic subgroup of stress cardiomyopathy. A key role of repeat ECG evaluation in distinguishing protracted but uncomplicated bronchospasm from bronchogenic stress cardiomyopathy is highlighted. Further data are now required to examine whether high-dose β-agonist therapy is implicated in this association.

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