Suspected Carboplatin Extravasation Reactions in Seven Dogs

2018 ◽  
Vol 54 (6) ◽  
pp. 360-367
Author(s):  
Kristina Bowles Miller ◽  
Amandine Lejeune ◽  
Rebecca Regan ◽  
Anna Szivek ◽  
Kevin Kow
Keyword(s):  
Medical Management ◽  
Chemotherapeutic Agent ◽  
Case Series ◽  
Surgical Debridement ◽  
Local Complication

ABSTRACT Carboplatin is a platinum chemotherapeutic agent commonly used in veterinary oncology that is currently classified as an irritant to local tissues when extravasated. To the authors’ knowledge, there are no reports of vesicant injuries associated with carboplatin administration reported in the veterinary literature. In this case series, seven dogs are described to have experienced injuries following a suspected carboplatin extravasation resembling vesicant injuries a median of 7 days after carboplatin administration (range 4–15 days). Wounds healed with a variety of treatments, including medical management and/or surgical debridement, a median of 25.5 days (range 7–49 days) after observation of the suspected extravasation injury. There were no obvious similarities involving carboplatin administration among patients to explain why these reactions occurred. Extravasation injury should be considered a possible local complication associated with carboplatin chemotherapy.

Medical management of ectopic pregnancy in a family planning clinic: a case series

Contraception ◽  
2022 ◽  
Author(s):  
Anna K Cardall ◽  
Janet C Jacobson ◽  
Sarah Prager ◽  
Anne N Flynn ◽  
Jennefer Russo
Keyword(s):  
Family Planning ◽  
Ectopic Pregnancy ◽  
Medical Management ◽  
Case Series ◽  
Family Planning Clinic

scholarly journals P.101 Conservative management of meningiomas with a moderate to high peritumoral brain edema index: a single-institution report

2019 ◽  
Vol 46 (s1) ◽  
pp. S40
Author(s):  
H Yan ◽  
B Karmur ◽  
D Jeong ◽  
M Bernstein
Keyword(s):  
Brain Edema ◽  
Medical Management ◽  
Case Series ◽  
Imaging Features ◽  
Retrospective Case ◽  
Patient Morbidity ◽  
Large Spread ◽  
Peritumoral Brain Edema ◽  
Mri Scans

Background: Meningiomas are the most commonly occurring benign intracranial tumors. When presenting with peritumoral brain edema (PTBE), surgical treatment can lead to patient morbidity. This retrospective case series aims to describe the conservative medical management of moderate to large meningiomas with large PTBE. Methods: Patients with suspected meningiomas greater than 2.0cm and edema index greater than 2.0 were identified by screening 3345 MRI scans between 2012-2017. Imaging analysis included MR imaging features of suspected meningiomas and clinical data was gathered from the electronic patient record (patient age, sex, patient symptoms, follow-up duration, and follow-up symptoms). Results: We report on 31 patients who received conservative medical management. Presenting complaints included headache, seizure, weakness; many presented asymptomatically. The average follow-up time was 3.96 years. At the final follow-up appointment, 19 (61%) patients were asymptomatic. Among symptomatic patients, seizures were the most common complaint. There was no mortality reported in our cohort and the average tumor progression was 7.04cm3/year. Conclusions: In this retrospective report of meningioma patients with high edema index, we found that most patients remained asymptomatic or had stable symptoms after at least 1-yr follow up after medical treatment. This study provides insight around the surgical decision-making for meningiomas with large spread of edema.

scholarly journals 785. Treatment of Mycobacterium immunogenum Skin and Soft-Tissue Infections: A Case in a Peritoneal Dialysis Patient

2018 ◽  
Vol 5 (suppl_1) ◽  
pp. S281-S281
Author(s):  
Walid El-Nahal ◽  
Abhishek Shenoy ◽  
McCall Walker ◽  
Tushar Chopra ◽  
Greg Townsend ◽  
...  
Keyword(s):  
Peritoneal Dialysis ◽  
Soft Tissue ◽  
Case Series ◽  
Peritoneal Dialysis Patient ◽  
Empiric Therapy ◽  
Human Infection ◽  
Surgical Debridement ◽  
Nontuberculous Mycobacterium ◽  
Peritoneal Dialysis Catheter ◽  
Soft Tissue Infections

Abstract Background Mycobacterium immunogenum is a somewhat recently identified species of rapidly growing nontuberculous mycobacteria, genetically related to M. abscessus and M. chelonae. Resistance patterns of rapidly growing nontuberculous mycobacterium species can make them difficult to treat. This is particularly true of M. immunogenum, in part due to the infrequency of reported cases of human infection and limited data to guide therapy. Methods We present here a case of M. immunogenum skin and soft-tissue infection at the site of insertion of a peritoneal dialysis catheter in a patient with end-stage renal disease. He initially presented with nodular subcutaneous lesions around his catheter site that progressed through oral antibiotics. This led to sampling which confirmed the diagnosis of M. immunogenum. We conducted a review of the literature to identify previously reported cases of M. immunogenum, including skin and soft-tissue infections, and used these data to guide management. Results We reviewed 11 reports (cases and case series) of Mycobacterium immunogenum in the literature. Susceptibilities often take weeks to return, and so empiric therapy is based on case series, and then later adjusted based on susceptibilities. Patients received combined antimicrobial regimens with durations of 2 weeks to 12 months, with variable outcomes. Several required surgical debridement, as was the case with our patient. His PD catheter was removed and he was treated empirically with amikacin, azithromycin, and tigecycline intravenous induction. His ultimate long-term regimen was later switched to azithromycin, clofazimine, and tedizolid due to side effects and the eventually available susceptibility profile. Conclusion The treatment of M. immunogenum remains a challenge due to the relative scarcity of data to guide treatment, and consequent lack of systemic approach to therapy. Most reported cases involve the use of a macrolide, often in combination with an aminoglycoside or a fluoroquinolone. Several started with intravenous induction, followed by transition to oral therapy on the order of weeks to months. Others also require surgical debridement. More data are required to develop a standardized approach to the treatment of M. immunogenum. Disclosures All authors: No reported disclosures.

scholarly journals Peripheral Nerve Stimulation for Trigeminal Neuropathic Pain

2012 ◽  
Vol 1;15 (1;1) ◽  
pp. 27-33 ◽  
Author(s):  
David A. Stidd
Keyword(s):  
Neuropathic Pain ◽  
Peripheral Nerve ◽  
Nerve Stimulation ◽  
Medical Management ◽  
Facial Pain ◽  
Case Series ◽  
Peripheral Nerve Stimulation ◽  
Intractable Pain ◽  
Safe Procedure ◽  
Trigeminal Neuropathic Pain

Facial pain is a complex disease with a number of possible etiologies. Trigeminal neuropathic pain (TNP) is defined as pain caused by a lesion or disease of the trigeminal branch of the peripheral nervous system resulting in chronic facial pain over the distribution of the injured nerve. First line treatment of TNP includes management with anticonvulsant medication (carbamazepine, phenytoin, gabapentin, etc.), baclofen, and analgesics. TNP, however, can be a condition difficult to adequately treat with medical management alone. Patients with TNP can suffer from significant morbidity as a result of inadequate treatment or the side effects of pharmacologic therapy. TNP refractory to medical management can be considered for treatment with a growing number of invasive procedures. Peripheral nerve stimulation (PNS) is a minimally invasive option that has been shown to effectively treat medically intractable TNP. We present a case series of common causes of TNP successfully treated with PNS with up to a 2 year follow-up. Only one patient required implantation of new electrode leads secondary to electrode migration. The patients in this case series continue to have significant symptomatic relief, demonstrating PNS as an effective treatment option for intractable TNP. Though there are no randomized trials, peripheral neuromodulation has been shown to be an effective means of treating TNP refractory to medical management in a growing number of case series. PNS is a safe procedure that can be performed even on patients that are not optimal surgical candidates and should be considered for patients suffering from TNP that have failed medical management. Key words: Trigeminal neuropathic pain, peripheral nerve stimulation, neuromodulation, intractable pain, facial trauma, postherpetic neuralgia

scholarly journals Massive Soft Tissue Haemophilic Pseudotumor in Limbs: Lessons Learnt from an Extremely Rare Problem

2021 ◽  
pp. 1-4
Author(s):  
C F Munson ◽  
C F Munson ◽  
A N Morritt
Keyword(s):  
Soft Tissue ◽  
Minimally Invasive ◽  
Medical Management ◽  
Case Reports ◽  
Case Series ◽  
Lessons Learnt ◽  
The World ◽  
The Future ◽  
Extensive Surgery ◽  
Future Management

Haemophilic pseudotumors are very rare, encapsulated haematomas forms as a result of repetitive bleeding, forming a mass of clotted blood and necrosed tissue. Reported experience in the literature is limited to case reports and case series from around the world, reporting on smaller and medium sized pseudotumors. Conflicting opinion exists following failed medical management, which includes minimally invasive interventions through extensive surgery. We present our experience with the management of two of the largest soft tissue pseudotumors reported in the literature. We also provide some guidance, based on our experiences, for the future management of massive haemophilic pseudotumors.

scholarly journals ECTOPIC PREGNANCY

2018 ◽  
Vol 25 (08) ◽  
pp. 1164-1167
Author(s):  
Fareeha Khaliq Khan ◽  
Rubina Iqbal ◽  
Zaibunnisa -
Keyword(s):  
Single Dose ◽  
Medical Treatment ◽  
Study Design ◽  
Medical Management ◽  
Case Series ◽  
First Line ◽  
Management Protocol ◽  
Baseline Levels ◽  
Β Hcg ◽  
Study Setting

Introduction: Medical treatment is the first step in the treatment of ectopicpregnancy (EP) now days. Medical treatment with Methotrexate for EP is safe and effectivemethod without the risks associated with the surgical procedure. Objectives: To determine thesuccess rate of single dose of Methotrexate for medical management of females presentingwith EP. Study Design: Quasi trial study. Setting: Department of Obstetrics & Gynaecology,Fatima Memorial hospital, Lahore. Period: 1 year from September 2014 till August 2015.Material & Methods: Study design was prospective descriptive case series in which a totalof 140 women, age 20-45 years of any parity with confirmed EP, were included. Females wereprescribed Methotrexate 50mg/m2, as a single dose. β-HCG level was measured again at 7thday. If β-HCG was decreased by >15% of baseline levels and decrease in the size of masson USG, then success was labeled. Data was entered and analyzed using computer programSPSS version 20. Results: Mean age of women in this study was 32.38±6.34 years. At 3rd daypost-treatment day, mean level of β-HCG was 2019.51 ± 293.39 and at 7th day, mean β-HCGlevel was 1127.44 ± 403.78. At 7th day, there were 125(89.3%) patients whose β-HCG level wasdecreased by >15% and success was labelled. Conclusion: Based on findings of this study itcan be concluded that Methotrexate can be used as first line management protocol for EP as itwas successful in a high percentage of patients.

Novel Technique for the Treatment of a Tongue-Type Calcaneal Fracture in the Setting of Chronic Osteomyelitis

2021 ◽  
Vol 111 (3) ◽  
Author(s):  
Mark Capuzzi ◽  
Nicholas Laco ◽  
Timothy Ford
Keyword(s):  
Chronic Osteomyelitis ◽  
Case Series ◽  
Pathologic Fracture ◽  
Calcaneal Fracture ◽  
Surgical Debridement ◽  
Antibiotic Administration ◽  
Foot And Ankle ◽  
Novel Technique ◽  
Fracture Stabilization ◽  
Aseptic Nonunion

Osteomyelitis of the calcaneus combined with a pathologic fracture is a rare and difficult presentation for any practicing foot and ankle surgeon. Treatment for achieving an aseptic nonunion involves a variety of steps, including surgical debridement, antibiotic administration, and fracture stabilization. In this case series, we report a novel technique for the treatment of a tongue-type calcaneal fracture in the setting of chronic osteomyelitis using the Biomet JuggerLoc bone-to-bone system for fixation.

Coccidioidomycosis of the First Cuneiform: Successful Treatment Utilizing Local Debridement and Long-Term Ketoconazole Therapy

Foot & Ankle ◽  
1986 ◽  
Vol 6 (6) ◽  
pp. 300-304 ◽  
Author(s):  
Steven L. Buckley ◽  
J. Kenneth Burkus
Keyword(s):  
Amphotericin B ◽  
Treatment Regimen ◽  
Clinical Guidelines ◽  
Standard Treatment ◽  
Chemotherapeutic Agent ◽  
Surgical Debridement ◽  
Tarsal Bone ◽  
Antifungal Chemotherapy ◽  
Intravenous Amphotericin

Although intravenous amphotericin B is generally considered to be the standard treatment for coccidioidomycosis, the treatment of monostotic coccidioidomycosis is controversial. Long-term intravenous and oral antifungal chemotherapy has been utilized alone and in conjunction with local surgical debridement. We present a case of coccidioidal osteomyelitis of a tarsal bone successfully treated with local surgical debridement and oral ketoconazole and propose clinical guidelines for selecting the proper chemotherapeutic agent and for following the efficacy of the treatment regimen

scholarly journals Management of cervical spine epidural abscess: a systematic review

2019 ◽  
Vol 6 ◽  
pp. 204993611986394
Author(s):  
Anastasia Turner ◽  
Linlu Zhao ◽  
Paul Gauthier ◽  
Suzan Chen ◽  
Darren M. Roffey ◽  
...  
Keyword(s):  
Patient Outcomes ◽  
Medical Management ◽  
Epidural Abscess ◽  
Treatment Options ◽  
Spinal Column ◽  
Case Series ◽  
Spinal Epidural Abscess ◽  
Optimal Method ◽  
Initial Surgery ◽  
Spinal Epidural

Background: Cervical spinal epidural abscess (CSEA) is a localized infection between the thecal sac and cervical spinal column which may result in neurological deficit and death if inadequately treated. Two treatment options exist: medical management and surgical intervention. Our objective was to analyze CSEA patient outcomes in order to determine the optimal method of treatment. Methods: An electronic literature search for relevant case series and retrospective reviews was conducted through June 2016. Data abstraction and study quality assessment were performed by two independent reviewers. A lack of available data led to a post hoc decision not to perform meta-analysis of the results; study findings were synthesized qualitatively. Results: 927 studies were identified, of which 11 were included. Four studies were ranked as good quality, and seven ranked as fair quality. In total, data from 173 patients were included. Mean age was 55 years; 61.3% were male. Intravenous drug use was the most common risk factor for CSEA development. Staphylococcus aureus was the most commonly cultured pathogen. 140 patients underwent initial surgery, an additional 18 patients were surgically treated upon failure of medical management, and 15 patients were treated with antibiotics alone. Conclusion: The rates of medical management failure described in our review were much higher than those reported in the literature for thoracolumbar spinal epidural abscess patients, suggesting that CSEA patients may be at a greater risk for poor outcomes following nonoperative treatment. Thus, early surgery appears most viable for optimizing CSEA patient outcomes. Further research is needed in order to corroborate these recommendations.

scholarly journals Local Delivery of Antibiotics in the Context of Chronic Diabetic Foot Infection with Bony Involvement: A Case Series of 102 Patients

2019 ◽  
Vol 4 (4) ◽  
pp. 2473011419S0044
Author(s):  
James Widnall ◽  
David Harvey ◽  
Paul Evans ◽  
Gillian Jackson ◽  
Simon Platt
Keyword(s):  
Dead Space ◽  
Salvage Surgery ◽  
Case Series ◽  
Calcium Sulphate ◽  
Surgical Debridement ◽  
P Value ◽  
Space Management ◽  
Bony Involvement ◽  
Local Antibiotic ◽  
Antibiotic Delivery

Category: Diabetes Introduction/Purpose: Diabetic foot infection (DFI) is a devastating condition which poses risk to both life and limb. Treatment principles revolve around surgical debridement, dead space management, delivery of both local and systemic antibiotics and soft tissue cover. Dead space management and local antibiotic delivery can be achieved simultaneously by using an antibiotic loaded bone substitute. We report our retrospective case series of patients treated with surgical management involving local antibiotic delivery via calcium sulphate bone substitute (Stimulan™; Biocomposites, Keele, UK). Methods: All patients between January 2015 and June 2018 with DFI and proven bony involvement presenting to our university teaching hospital were treated via our extensive MDT approach. A total of 102 patients were included. Surgical debridement was performed along with simultaneous insertion of 10 ml calcium sulphate with 1 g vancomycin and 240 mg gentamycin. Outcome was classified as resolved, requiring prolonged treatment from other medical (endocrinologist) or surgical (plastic surgery, limb reconstruction) services or salvage surgery in the form of proximal amputation. Results: 45.1% of patients had a partial amputation at the index surgery. 52% had bony debridement and just 2.9% had soft tissue debridement in conjunction with calcium sulphate insertion. The surgical wound was primarily closed in 56.8% of patients. 7 patients had delayed wound closure and 36.2% of patients healed via secondary intention. 74 patients (72.5%) had resolution of their DFI with bony involvement following surgical intervention. 21 (20.6%) patients needed further treatment from allied specialties. 7 (6.9%) patients required salvage surgery in the form of a below knee amputation. There was no correlation between either closure type (2 p-value 0.75) or index surgery type and outcome (2 p-value 0.64). Conclusion: DFI is a difficult clinical scenario to treat effectively. An MDT approach is undoubtedly key to a good outcome. We believe that the use of calcium sulphate can be a useful adjunct at the time of surgical debridement to aid in both dead space management and allow local antibiotic delivery.

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