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Ann Intern Med. 2002 Dec 3;137(11):884-8.
Reversal of warfarin-induced excessive anticoagulation with recombinant human factor VIIa concentrate.
Deveras RA, Kessler CM.
Division of Hematology and Oncology, Georgetown University Medical Center, 3800 Reservoir Road NW, Washington, DC 20007-2197, USA. raeorgetown.edu
BACKGROUND: Bleeding associated with warfarin anticoagulation correlates directly to duration and degree of international normalized ratio (INR) elevation above the therapeutic range. Safe and rapid reversal of excessive anticoagulation is occasionally needed to treat or avoid hemorrhagic complications. OBJECTIVE: To evaluate the efficacy and safety of human recombinant factor VIIa (rFVIIa) concentrate in persons requiring rapid reversal of the effects of warfarin. DESIGN: Uncontrolled case series. SETTING: Academic medical center. PATIENTS: 13 patients with critically increased INRs requiring immediate reversal of warfarin-induced anticoagulation. MEASUREMENTS: Prothrombin time and INR were measured before and after administration of varying doses of rFVIIa. RESULTS: Critically prolonged INR and bleeding complications were treated successively and rapidly in all patients, regardless of rFVIIa dose (range, 15 to 90 microg/kg of body weight). Indications for use of rFVIIa included an INR greater than 10 in high-risk persons (n = 5), clinical hemorrhage (n = 4), and diagnostic or therapeutic procedures (n = 4). CONCLUSION: Safe, rapid, and effective administration of rFVIIa corrects critically prolonged INRs and can avert or reverse bleeding associated with warfarin anticoagulation.
Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=12458988&dopt=Abstract hemorrhage
Int J Radiat Oncol Biol Phys. 2002 Dec 1;54(5):1430-7.
Cognitive function in patients with cerebral arteriovenous malformations after radiosurgery: prospective long-term follow-up.
Steinvorth S, Wenz F, Wildermuth S, Essig M, Fuss M, Lohr F, Debus J, Wannenmacher M, Hacke W.
Department of Neurology, University of Heidelberg, Heidelberg, Germany.
PURPOSE: To evaluate the long-term cognitive function of patients with cerebral arteriovenous malformations (AVMs) after radiosurgery. METHODS AND MATERIALS: The data of 95 AVM patients were prospectively assessed up to 3 years after radiosurgery. Of these patients, 39 had a follow-up of at least 2 years. Radiosurgery was performed using a modified linear accelerator (minimal doses to the target volume 15-22 Gy, median dose 20). The neuropsychological evaluation included testing of intelligence, attention, and memory. The effect of a preexisting intracranial hemorrhage, as well as AVM occlusion, on cognitive functions was analyzed after 1 and 2 years. RESULTS: No cognitive declines were observed during follow-up. Instead significant improvements occurred in intelligence (1 year, +6.1 IQ points; 2 years, +5.1 IQ points), memory (1 year, +18.3 percentile score; 2 years, +12.2 percentile score), and attention (1 year, +19 percentile score; 2 years, +18 percentile score). Patients without previous intracranial hemorrhage improved more than patients with intracranial hemorrhage, although this difference was not statistically significant. The role of AVM occlusion on cognitive function is not clear at present. CONCLUSION: Radiosurgery does not induce measurable deterioration of cognitive function in patients with cerebral AVMs.
Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=12459366&dopt=Abstract hemorrhage
Dermatol Surg. 2002 Nov;28(11):1088-91.
Vitreous floaters following use of dermatologic lasers.
Alam M, Chaudhry NA, Goldberg LH.
Department of Dermatology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois 60611, USA. muralam.com
BACKGROUND: Laser eye protection has been designed to protect operators and patients from severe eye injuries. OBJECTIVE: To describe two cases in which lasers used for cutaneous therapy may have been associated with the induction of vitreous floaters, a subacute eye injury, in physicians operating these devices, and to review the theoretical feasibility of such injuries, prior reports of the same, and strategies for minimizing risk. METHODS: Report of two cases and review of the literature. RESULTS: Given the circumstantial evidence, it is possible that subacute vitreous injuries may be sustained by the operators of dermatologic lasers. Ex vivo experiments and previous case reports have demonstrated the possibility of laser-induced vitreous injury, including changes in vitreous conformation and vitreous hemorrhage, in the absence of permanent retinal deficits. It may be speculated that vitreous floaters are a milder manifestation of such subacute injuries. CONCLUSION: To the extent that vitreous floaters can multiply and presage the onset of severe retinal injury, the risk of their induction by dermatologic lasers should be minimized. Simple strategies and further research can help achieve this goal.
Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=12460311&dopt=Abstract hemorrhage
Ther Apher. 2002 Dec;6(6):443-9.
Cytapheresis for the treatment of myeloperoxidase antineutrophil cytoplasmic antibody-associated vasculitis: report of five cases.
Hasegawa M, Kawamura N, Kasugai M, Koide S, Murase M, Asano S, Toba T, Kushimoto H, Murakami K, Tomita M, Shikano M, Sugiyama S.
Department of Nephrology, Fujita Health University School of Medicine, Aichi, Japan. mhasujita-hu.ac.jp
To minimize the adverse effects of high-dose administration of steroids and cyclophosphamide in patients with myeloperoxidase (MPO) antineutrophil cytoplasmic antibody (ANCA), granulocytapheresis (GCAP) or leukocytapheresis (LCAP) was performed to reduce inflammation. Four patients with rapidly progressive glomerulonephritis (RPGN) and one patient with pulmonary hemorrhage due to MPO-ANCA-associated vasculitis were treated by cytapheresis. The prednisolone (PSL) dose was 0.28 +/- 0.15 mg/kg/day (mean +/- SD) (range 0.18-0.50 g/kg/day). In the 4 RPGN patients, the peak serum creatinine level was 3.7 +/- 1.9 mg/dl (range 1.7 to 5.6 mg/dl). GCAP was performed in 3 RPGN patients and in 1 pulmonary hemorrhage patient. LCAP was performed in 1 RPGN patient. In the 4 RPGN patients, renal function improved after combined therapy with cytapheresis and corticosteroids. In the pulmonary hemorrhage patient, evidence of pulmonary hemorrhage on chest computed tomography scanning diminished after combined therapy with cytapheresis and corticosteroids. Cytapheresis, when combined with a low-dose or intermediate-dose PSL regimen, is effective in the treatment of ANCA-associated vasculitis.
Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=12460408&dopt=Abstract hemorrhage
Jpn J Cancer Res. 2002 Nov;93(11):1237-43.
Incorporation of the anticancer agent KRN5500 into polymeric micelles diminishes the pulmonary toxicity.
Mizumura Y, Matsumura Y, Yokoyama M, Okano T, Kawaguchi T, Moriyasu F, Kakizoe T.
Department of Medicine, National Cancer Center, Tsukiji, Chuo-ku, Tokyo 104-0045, Japan.
KRN5500 is a highly active new semi-synthetic water-insoluble anticancer agent. The only mechanism of anticancer activity of KRN5500 described so far is an inhibitory effect on protein synthesis. At the time of writing, a phase I clinical trial is under way at the National Cancer Center Hospital, Tokyo, and at the National Cancer Institute in the USA. Although preclinical data did not indicate lung toxicity, some cases of severe pulmonary disorder were reported in the phase I clinical trials. This study has been conducted to examine whether incorporation of KRN5500 into polymeric micelles (KRN/m) could reduce the toxic effects caused by the current formulation of KRN5500. The in vitro and in vivo antitumor activities of KRN5500 and KRN/m were compared. Pulmonary toxicity of KRN5500 and KRN/m was studied using a bleomycin (BLM)-induced lung injury rat model. In BLM-rats, extensive pulmonary hemorrhage with diapedesis was observed with KRN5500 i.v. bolus injection at the dose of 3 mg/kg, which is equivalent to 21.0 mg/m2 (level 5) of the Japanese phase I trial. However, toxicity was not observed when rats were administered KRN / m at the equivalent dose to KRN5500 in potency. Electron microscopy of the lung treated with KRN5500 showed disruption of the alveolar type II membrane with release of lamellar debris. Furthermore, in vivo, KRN/m showed similar antitumor activity to KRN5500. These results indicate that KRN/m may be useful for reducing the pulmonary toxicity associated with the current formulation of KRN5500, while fully maintaining its antitumor activity.
Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=12460465&dopt=Abstract hemorrhage
Beautiful, dense hair is a dream for many people.
Hair growth is a sophisticated biological process, which has not yet been understood.
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