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Tang M, Dang P, Liu T, Yang K, Wang Y, Tse G, Liu H, Liu Y, Chan JSK, Liu C, Li G. Risk factors and outcomes of pericardial effusion in cancer patients receiving PD-1 inhibitors. Int J Cardiol 2024; 407:132029. [PMID: 38583590 DOI: 10.1016/j.ijcard.2024.132029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2023] [Revised: 03/21/2024] [Accepted: 04/04/2024] [Indexed: 04/09/2024]
Abstract
BACKGROUND Programmed cell death 1 (PD-1) inhibitors can induce various adverse reactions associated with immunity, of which cardiotoxicity is a serious complication. Limited research exists on the link between PD-1 inhibitor use and pericardial effusion (PE) occurrence and outcomes. METHODS We conducted a retrospective study at the First Affiliated Hospital of Xi'an Jiaotong University from 2017 to 2019, comparing cancer patients who developed PE within 2 years after PD-1 inhibitor therapy to those who did not. Our primary outcome was the all-cause mortality rate at one year. We applied the Kaplan-Meier method for survival analysis. Multivariate logistic regression was utilized to identify PE risk factors, adjusting for potential confounders. RESULTS A total of 91 patients were finally included, of whom 39 patients had PE. Compared to non-PE group, one-year all-cause mortality was nearly 5 times higher in PE group (64.10% vs. 13.46%, P < 0.001). Patients who developed PE within 2 years of taking PD-1 inhibitors were significantly associated with increased all-cause mortality compared with those who did not (HR: 6.26, 95%CI: 2.70-14.53, P < 0.001). Multivariable logistic regression showed that use of sintilimab (OR: 14.568, 95%CI: 3.431-61.857, P < 0.001), history of lung cancer (OR: 15.360, 95%CI: 3.276-72.017, P = 0.001), and history of hypocalcemia (OR: 7.076, 95%CI: 1.879-26.649, P = 0.004) were independent risk factors of PE development in patients received PD-1 inhibitors therapy. CONCLUSIONS In cancer patients receiving PD-1 inhibitors, PE was associated with higher one-year mortality. Use of sintilimab, and history of lung cancer or hypocalcemia were linked to PE occurrence.
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Affiliation(s)
- Manyun Tang
- Key Laboratory of Surgical Critical Care and Life Support (Xi'an Jiaotong University), Ministry of Education, China; Department of Hepatobiliary Surgery and Liver Transplantation, The Second Affiliated Hospital of Xi'an Jiaotong University, China
| | - Peizhu Dang
- Department of Cardiovascular Medicine, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Tong Liu
- Key Laboratory of Surgical Critical Care and Life Support (Xi'an Jiaotong University), Ministry of Education, China; Department of Hepatobiliary Surgery and Liver Transplantation, The Second Affiliated Hospital of Xi'an Jiaotong University, China
| | - Kun Yang
- Key Laboratory of Surgical Critical Care and Life Support (Xi'an Jiaotong University), Ministry of Education, China; Department of Hepatobiliary Surgery and Liver Transplantation, The Second Affiliated Hospital of Xi'an Jiaotong University, China
| | - Yifei Wang
- Key Laboratory of Surgical Critical Care and Life Support (Xi'an Jiaotong University), Ministry of Education, China; Department of Hepatobiliary Surgery and Liver Transplantation, The Second Affiliated Hospital of Xi'an Jiaotong University, China
| | - Gary Tse
- Tianjin Key Laboratory of Ionic-Molecular Function of Cardiovascular Disease, Department of Cardiology, Tianjin Institute of Cardiology, Second Hospital of Tianjin Medical University, Tianjin, China; Epidemiology Research Unit, Cardiovascular Analytics Group, PowerHealth Limited, Hong Kong, China; School of Nursing and Health Studies, Hong Kong Metropolitan University, Hong Kong, China
| | - Hui Liu
- Biobank of The First Affiliated Hospital of Xian Jiaotong University, Xi'an, China
| | - Yufeng Liu
- Biobank of The First Affiliated Hospital of Xian Jiaotong University, Xi'an, China
| | - Jeffrey Shi Kai Chan
- Cardio-Oncology Research Unit, Cardiovascular Analytics Group, PowerHealth Research Institute, Hong Kong, China
| | - Chang Liu
- Key Laboratory of Surgical Critical Care and Life Support (Xi'an Jiaotong University), Ministry of Education, China; Department of Hepatobiliary Surgery and Liver Transplantation, The Second Affiliated Hospital of Xi'an Jiaotong University, China.
| | - Guoliang Li
- Department of Cardiovascular Medicine, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China.
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2
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Lew MJ, Amato J. Minoxidil-associated pericardial effusion and impending tamponade. JAAPA 2023; 36:21-23. [PMID: 37989166 DOI: 10.1097/01.jaa.0000944608.70893.b3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2023]
Abstract
ABSTRACT A patient with a large pericardial effusion and impending tamponade exhibited clinical improvement with urgent pericardiocentesis. Further workup ruled minoxidil to be the likely cause of the effusion. After discontinuation of minoxidil, the effusion did not recur.
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Affiliation(s)
- Michelle J Lew
- Michelle J. Lew and Jordan Amato practice in the Department of Pharmacy at Scripps Memorial Hospital in La Jolla, Calif. The authors have disclosed no potential conflicts of interest, financial or otherwise
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3
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Yang C, Tsang MY, Zypchen LN, Luong C. Pericardial effusion and systemic capillary leak syndrome late post-SARS-CoV-2 vaccination. BMJ Case Rep 2023; 16:e256527. [PMID: 37813549 PMCID: PMC10565171 DOI: 10.1136/bcr-2023-256527] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/17/2023] [Indexed: 10/13/2023] Open
Abstract
We report an interesting case of pericardial effusion associated with idiopathic systemic capillary leak syndrome (ISCLS) following administration of SARS-CoV-2 vaccine. This patient initially presented with dyspnoea and chest pain, with non-pitting oedema and clear lung fields. The diagnosis of ISCLS was made based on the clinical syndrome and laboratory evidence of polycythaemia and hypoalbuminaemia. An enlarging pericardial effusion was diagnosed on transthoracic echocardiogram. Daily point-of-care ultrasound (POCUS)-guided volume management and serial transthoracic echocardiograms contributed to avoidance of refractory shock, cardiac tamponade and critical care admission.
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Affiliation(s)
- Cathevine Yang
- Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Michael Yc Tsang
- Department of Medicine, Division of Cardiology, University of British Columbia, Vancouver, British Columbia, Canada
| | - Leslie N Zypchen
- Department of Medicine, Division of Hematology, University of British Columbia, Vancouver, British Columbia, Canada
| | - Christina Luong
- Department of Medicine, Division of Cardiology, University of British Columbia, Vancouver, British Columbia, Canada
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Huang J, Cai J, Ye Q, Jiang Q, Lin H, Wu L. Fluid retention-associated adverse events in patients treated with BCR::ABL1 inhibitors based on FDA Adverse Event Reporting System (FAERS): a retrospective pharmacovigilance study. BMJ Open 2023; 13:e071456. [PMID: 37536976 PMCID: PMC10401248 DOI: 10.1136/bmjopen-2022-071456] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/29/2022] [Accepted: 07/19/2023] [Indexed: 08/05/2023] Open
Abstract
OBJECTIVES This study aimed to conduct a thorough analysis of fluid retention-associated adverse events (AEs) associated with BCR::ABL inhibitors. DESIGN A retrospective pharmacovigilance study. SETTING Food and Drug Administration Adverse Event Reporting System (FAERS) database for BCR::ABL inhibitors was searched from 1 January 2004 to 30 September 2021. MAIN OUTCOME MEASURES Reporting OR (ROR) and 95% CI were used to detect the signals. ROR was calculated by dividing the odds of fluid retention event reporting for the target drug by the odds of fluid retention event reporting for all other drugs. The signal was considered positive if the lower limit of 95% CI of ROR was >1. The analysis was run only considering coupled fluid retention events/BCR::ABL inhibitors with at least three cases. RESULTS A total of 97 823 reports were identified in FAERS. Imatinib had the most fluid retention signals, followed by dasatinib and nilotinib, while bosutinib and ponatinib had fewer signals. Periorbital oedema (ROR=24.931, 95% CI 22.404 to 27.743), chylothorax (ROR=161.427, 95% CI 125.835 to 207.085), nipple swelling (ROR=48.796, 95% CI 26.270 to 90.636), chylothorax (ROR=35.798, 95% CI 14.791 to 86.642) and gallbladder oedema (ROR=77.996, 95% CI 38.286 to 158.893) were the strongest signals detected for imatinib, dasatinib, nilotinib, bosutinib and ponatinib, respectively. Pleural effusion, pericardial effusion and pulmonary oedema were detected for all BCR::ABL inhibitors, with dasatinib having the highest RORs for pleural effusion (ROR=37.424, 95% CI 35.715 to 39.216), pericardial effusion (ROR=14.146, 95% CI 12.649 to 15.819) and pulmonary oedema (ROR=11.217, 95% CI 10.303 to 12.213). Patients aged ≥65 years using dasatinib, imatinib, nilotinib or bosutinib had higher RORs for pleural effusion, pericardial effusion and pulmonary oedema. Patients aged ≥65 years and females using imatinib had higher RORs for periorbital oedema, generalised oedema and face oedema. CONCLUSIONS This pharmacovigilance study serves as a clinical reminder to physicians to be more vigilant for fluid retention-associated AEs with BCR::ABL inhibitors.
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Affiliation(s)
- Jing Huang
- Department of Pharmacy, The First Affiliated Hospital of Ningbo University, Ningbo, Zhejiang, China
| | - Juanjuan Cai
- Department of Pharmacy, The First Affiliated Hospital of Ningbo University, Ningbo, Zhejiang, China
| | - Qingqing Ye
- Department of Pharmacy, The First Affiliated Hospital of Ningbo University, Ningbo, Zhejiang, China
| | - Qiaoying Jiang
- Department of Pharmacy, The First Affiliated Hospital of Ningbo University, Ningbo, Zhejiang, China
| | - Huan Lin
- Department of Pharmacy, The First Affiliated Hospital of Ningbo University, Ningbo, Zhejiang, China
| | - Lun Wu
- Department of Pharmacy, The First Affiliated Hospital of Ningbo University, Ningbo, Zhejiang, China
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Donovan DJ, Siskind T, Thanjan MT, Holzer RJ, Dayton JD, Carroll SJ. Chylous pericardial effusion with cardiac tamponade in a child treated with imatinib. Cardiol Young 2023; 33:1217-1219. [PMID: 36503590 DOI: 10.1017/s104795112200381x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Chylous pericardial effusions are extremely rare outside of thoracic and cardiac surgery patients. We report the case of an 8-year-old girl with history of recurrent benign giant cell granulomas who developed a large chylous pericardial effusion with cardiac tamponade soon after beginning therapy with imatinib. In this article, we discuss the presentation, diagnosis, and management and review the published literature of this rarely reported side effect of this medication.
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Affiliation(s)
- Denis J Donovan
- Division of Pediatric Cardiology, Department of Pediatrics, Columbia University Vagelos College of Physicians and Surgeons, NewYork-Presbyterian Morgan Stanley Children's Hospital, New York, NY, USA
| | - Tamar Siskind
- Division of Pediatric Cardiology, Department of Pediatrics, Columbia University Vagelos College of Physicians and Surgeons, NewYork-Presbyterian Morgan Stanley Children's Hospital, New York, NY, USA
| | - Maria T Thanjan
- Division of Pediatric Cardiology, Department of Pediatrics, NewYork-Presbyterian Queens, Weill Cornell Medical Center, Queens, NY, USA
| | - Ralf J Holzer
- Division of Pediatric Cardiology, Department of Pediatrics, NewYork-Presbyterian Komansky Children's Hospital, Weill Cornell Medicine, New York, NY, USA
| | - Jeffrey D Dayton
- Division of Pediatric Cardiology, Department of Pediatrics, NewYork-Presbyterian Komansky Children's Hospital, Weill Cornell Medicine, New York, NY, USA
| | - Sheila J Carroll
- Division of Pediatric Cardiology, Department of Pediatrics, NewYork-Presbyterian Komansky Children's Hospital, Weill Cornell Medicine, New York, NY, USA
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Janchevska A, Jovanovska V, Jordanova O, Beqiri-Jashari A, Krstevska-Konstantinova M, Tasic V, Gucev ZS. Peripheral Insulin Edema and Pericardial Effusion in a 12-Year-Old Newly Diagnosed Girl with Type 1 Diabetes. Pril (Makedon Akad Nauk Umet Odd Med Nauki) 2023; 44:171-174. [PMID: 37453114 DOI: 10.2478/prilozi-2023-0037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/18/2023]
Abstract
Introduction: Insulin induced edema (IIE) is a rare condition, usually found in newly diagnosed diabetes patients, either after insulin treatment initiation or after dose increment. It is a self-limited process, rarely associated with serosal effusions. Teenage girls with type 1 diabetes (T1DM) are most commonly affected. Patient and Methods: A 12-year-old girl was diagnosed with ketoacidosis (DKA). Seven days after initiation of the insulin treatment, at a stable total daily dose of insulin (TDDI) of 0.55 IU/kg, she came with two kilograms weight gain in only two days and edema of the feet and calves. Ultrasound of the heart found a 7 mm pericardial effusion. The diagnostic workout included clinical examination, biochemical, hormonal, allergen analyses and imaging which excluded other known causes of swelling. Conclusions: We describe an adolescent girl with newly diagnosed T1DM and a rare association of peripheral insulin-induced edema and pericardial effusion. Short-term diuretic treatment and salt restriction resolved this rare complication of insulin treatment.
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Affiliation(s)
- Aleksandra Janchevska
- 1University Children's Hospital, Skopje, RN Macedonia
- 2Medical Faculty, Skopje, RN Macedonia
| | - Valentina Jovanovska
- 1University Children's Hospital, Skopje, RN Macedonia
- 2Medical Faculty, Skopje, RN Macedonia
| | - Olivera Jordanova
- 1University Children's Hospital, Skopje, RN Macedonia
- 2Medical Faculty, Skopje, RN Macedonia
| | - Ardiana Beqiri-Jashari
- 1University Children's Hospital, Skopje, RN Macedonia
- 2Medical Faculty, Skopje, RN Macedonia
| | | | - Velibor Tasic
- 1University Children's Hospital, Skopje, RN Macedonia
- 2Medical Faculty, Skopje, RN Macedonia
| | - Zoran S Gucev
- 1University Children's Hospital, Skopje, RN Macedonia
- 2Medical Faculty, Skopje, RN Macedonia
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7
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Sawada R, Matsui Y, Uchino J, Okura N, Morimoto Y, Iwasaku M, Kaneko Y, Yamada T, Takayama K. Late-onset Pleural and Pericardial Effusion as Immune-related Adverse Events after 94 Cycles of Nivolumab. Intern Med 2021; 60:3585-3588. [PMID: 34092733 PMCID: PMC8666223 DOI: 10.2169/internalmedicine.7219-21] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
A 67-year-old man with primary lung adenocarcinoma was hospitalized due to massive bilateral pleural effusion and pericardial effusion after 94 cycles of nivolumab therapy. We were unable to identify the cause of these effusions using blood tests, cytology tests, or bacterial culture of pleural effusion and thoracoscopy. Finally, we administrated corticosteroids, which immediately improved the fluid accumulation. This case may support the introduction of corticosteroids for late-onset pleural and pericardial effusion during immune checkpoint inhibitor (ICI) treatment. However, the safety of rechallenge of ICIs after the improvement of fluid accumulation is controversial.
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Affiliation(s)
- Ryo Sawada
- Department of Pulmonary Medicine, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Japan
| | - Yohei Matsui
- Department of Pulmonary Medicine, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Japan
| | - Junji Uchino
- Department of Pulmonary Medicine, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Japan
| | - Naoko Okura
- Department of Pulmonary Medicine, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Japan
| | - Yoshie Morimoto
- Department of Pulmonary Medicine, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Japan
| | - Masahiro Iwasaku
- Department of Pulmonary Medicine, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Japan
| | - Yoshiko Kaneko
- Department of Pulmonary Medicine, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Japan
| | - Tadaaki Yamada
- Department of Pulmonary Medicine, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Japan
| | - Koichi Takayama
- Department of Pulmonary Medicine, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Japan
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9
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Abstract
A 12-year-old boy presented with central chest pain, shortness of breath and type 1 respiratory failure. He had a background of graft versus host disease (GvHD), which was currently managed with imatinib therapy. A focused bedside ultrasound scan was performed revealing a large pericardial effusion. The child was referred to a tertiary paediatric cardiology centre where he underwent emergency pericardiocentesis, draining a total of 800 mL of pericardial fluid. Fluid analysis excluded infection, and with no other concerns for a GvHD flare the diagnosis of an imatinib-induced pericardial effusion was made. On terminating the therapy, the pericardial collection did not reaccumulate. Tyrosine kinase inhibitor-induced pericardial and/or pleural effusion should be considered as a differential diagnosis in paediatric patients on this therapy presenting in a similar manner.
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Affiliation(s)
| | - Pascale Avery
- Emergency Department, Croydon Health Services NHS Trust, Croydon, UK
| | - Sarah Morton
- Anaesthetics, St Helier Hospital, Carshalton, UK
| | - Jon Aron
- Critical Care, St George's Hospital, London, UK
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10
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O’Morain N, Kumar L, O’Carroll-Lolait C, Alakkari A, Ryan B. Infliximab Induced Cardiac Tamponade. Ir Med J 2019; 3:902. [PMID: 31124350] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Aim To report the first case of cardiac tamponade related to Infliximab induction therapy in an Ulcerative Colitis patient. Methods Review of published case reports. Results This complication was likely due to a type 3 hypersensitivity immune-complex reaction resulting in a reactive pericardial effusion Discussion Though rare, this case demonstrates how autoimmune reaction to anti-TNF𝛼 therapy can initially mimic infection, as our patient presented with tachycardia, hypotension, raised inflammatory and infective markers and fever.
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Affiliation(s)
- N O’Morain
- Department of Gastroenterology & Clinical Medicine, Tallaght University Hospital/Trinity College Dublin, Dublin 24
| | - L Kumar
- Department of Gastroenterology & Clinical Medicine, Tallaght University Hospital/Trinity College Dublin, Dublin 24
| | - C O’Carroll-Lolait
- Department of Cardiology, Tallaght University Hospital/Trinity College Dublin, Dublin 24
| | - A Alakkari
- Department of Gastroenterology & Clinical Medicine, Tallaght University Hospital/Trinity College Dublin, Dublin 24
| | - B Ryan
- Department of Gastroenterology & Clinical Medicine, Tallaght University Hospital/Trinity College Dublin, Dublin 24
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11
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Abstract
Four novel oral anticoagulant agents are currently available for the prevention and treatment of thromboembolic events in patients with nonvalvular atrial fibrillation. We present an unusual case of spontaneous hemopericardium and tamponade in an 87-year-old man with atrial fibrillation who was taking one such agent, dabigatran, as thromboprophylaxis. Our case highlights both a rare bleeding complication of dabigatran use and the effectiveness of idarucizumab, its newly approved reversal agent. Especially in elderly patients, we recommend that clinicians evaluate risk factors, closely monitor patient status, and consider alternatives to the newer anticoagulants when the risk of bleeding is high.
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12
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Lam WW, Reyes MA, Seger JJ. Plasma Exchange for Urgent Apixaban Reversal in a Case of Hemorrhagic Tamponade after Pacemaker Implantation. Tex Heart Inst J 2015; 42:377-80. [PMID: 26413023 DOI: 10.14503/thij-14-4424] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
We report the case of an 82-year-old man in whom hemorrhagic pericardial effusion occurred one week after pacemaker implantation, while he was taking apixaban. Few therapies exist for reversing the anti-Xa effect of apixaban. To reverse anticoagulation, our patient underwent plasma exchange, which facilitated pericardiocentesis and prevented possible surgical intervention. To our knowledge, this is the first report of the use of plasmapheresis to reverse the anticoagulant effect of apixaban.
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13
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Ferrusquía J, Pérez-Martínez I, Gómez de la Torre R, Fernández-Almira ML, de Francisco R, Rodrigo L, Riestra S. Gastroenterology case report of mesalazine-induced cardiopulmonary hypersensitivity. World J Gastroenterol 2015; 21:4069-4077. [PMID: 25852295 PMCID: PMC4385557 DOI: 10.3748/wjg.v21.i13.4069] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2014] [Revised: 11/27/2014] [Accepted: 01/21/2015] [Indexed: 02/06/2023] Open
Abstract
Mesalazine is a 5-aminosalicylic acid derivative that has been widely used to treat patients with inflammatory bowel disease. Accumulating evidence indicates that mesalazine has a very low rate of adverse drug reactions and is well tolerated by patients. However, a few cases of pulmonary and cardiac disease related to mesalazine have been reported in the past, though infrequently, preventing clinicians from diagnosing the conditions early. We describe the case of a 32-year-old man with ulcerative colitis who was admitted with a two-month history of persistent fever following mesalazine treatment initiated 14 mo earlier. At the time of admission, mesalazine dose was increased from 1.5 to 3.0 g/d, and antibiotic therapy was started with no improvement. Three weeks after admission, the patient developed dyspnea, non-productive cough, and chest pain. Severe eosinophilia was detected in laboratory tests, and a computed tomography scan revealed interstitial infiltrates in both lungs, as well as a large pericardial effusion. The bronchoalveolar lavage reported a CD4/CD8 ratio of 0.5, and an increased eosinophil count. Transbronchial biopsy examination showed a severe eosinophilic infiltrate of the lung tissue. Mesalazine-induced cardiopulmonary hypersensitivity was suspected after excluding other possible etiologies. Consequently, mesalazine treatment was suspended, and corticosteroid therapy was initiated, resulting in resolution of symptoms and radiologic abnormalities. We conclude that mesalazine-induced pulmonary and cardiac hypersensitivity should always be considered in the differential diagnosis of unexplained cardiopulmonary symptoms and radiographic abnormalities in patients with inflammatory bowel disease.
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14
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Pazopanib: pericardial effusion. Prescrire Int 2014; 23:268. [PMID: 25954795] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
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15
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Abstract
The importance of early thrombolysis in acute myocardial infarction has been highlighted in several large trials. The clinical decision is often taken by physicians who need to take a rapid action with the risk of misdiagnosing non-coronary events that mimic myocardial infarction. Here we describe a case of acute pericarditis in a 37-year-old man whom received thrombolysis and developed a sudden hemorrhagic pericardial effusion that evolved rapidly into a cardiac tamponade. These errors leading to lethal thrombolysis complications have been surprisingly rare; but a correct diagnosis of aortic dissection or hemorrhagic pericarditis needs to be stressed because even after obtaining the correct diagnosis, the prolonged disturbance of hemostasis prevents a rapid therapy being instigated.
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Affiliation(s)
- Osereme Irivbogbe
- Division of Cardiology, Woodhull Medical Center , Brooklyn, New York , USA
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16
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Affiliation(s)
- M A R Chamsi-Pasha
- University of Nebraska Medical Center, Division of Cardiology, 982265 Nebraska Medical Center, Omaha, NE 68198-2265, USA.
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17
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Order interrupted by text: multitasking mishap. AORN J 2013; 98:208, 115. [PMID: 23890569 DOI: 10.1016/j.aorn.2013.05.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2013] [Accepted: 05/25/2013] [Indexed: 11/20/2022]
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18
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Helsen V, Decoutere L, Spriet I, Fagard K, Boonen S, Tournoy J. Ergotamine-induced pleural and pericardial effusion successfully treated with colchicine. Acta Clin Belg 2013; 68:113-5. [PMID: 23967719 DOI: 10.2143/acb.3138] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
A 83-year-old woman was admitted to hospital with chest pain, fever, dry cough and palpitations. Chest X-ray revealed a pleural effusion, assumed to be caused by cardiac failure and respiratory infection. Despite treatment with antibiotics and diuretics, the pleural effusion increased on chest X-ray and there were signs of pleural and pericardial effusion on computed tomography (CT) scan. Treatment with non-steroidal anti-inflammatory drugs (NSAIDs) was not successful. Meanwhile patients' long-term use of ergotamine for migraine was revealed, which is associated with pleuropulmonary and cardiac fibrotic reactions. Tentative treatment with colchicine was successful, with complete resolution of pleural fluid, fever, cough and inflammatory parameters. This case highlights the importance of establishing an ergot alkaloid use registry in unexplained pleuropericardial effusions and supports the use of colchicine as a potential therapeutic approach.
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Affiliation(s)
- V Helsen
- Division of Gerontology and Geriatrics, Katholieke Universiteit Leuven, Leuven, Belgium
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19
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Dhar AK, Barman PK. Retinoic acid syndrome--cardiac complication. J Assoc Physicians India 2012; 60:63-65. [PMID: 23767209] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
Retinoic acid syndrome is a novel complication of therapy with all-trans retinoic acid (ATRA) in patients with acute promyelocytic leukemia (APML). Primarily the syndrome consists of fever and respiratory distress. Additional features include weight gain, oedema over lower extremities, pleural or pericardial effusion and hypotension. We report electrophysiological changes in a 16 year old patient with acute promyelocytic leukemia following treatment with ATRA. Such an unusual complication is a rarity and to the best of our knowledge has not been previously reported.
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Affiliation(s)
- A K Dhar
- Army Hospital (R&R), Delhi Cantt 110010
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Eskazan AE, Soysal T, Ongoren S, Gulturk E, Ferhanoglu B, Aydin Y. Pleural and pericardial effusions in chronic myeloid leukemia patients receiving low-dose dasatinib therapy. Haematologica 2011; 96:e15; author reply e16-7. [PMID: 21357709 DOI: 10.3324/haematol.2011.040048] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
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21
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Park C, Lim CY, Kim JH, Jang JI, Park HM. Successful therapy of coumatetralyl rodenticide induced pericardial effusion with pericardiocentesis in a dog. Can Vet J 2011; 52:165-168. [PMID: 21532823 PMCID: PMC3022455] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
A 5-year-old, intact male, golden retriever was presented with an acute onset of lethargy and respiratory distress. The dog was diagnosed as having rodenticide intoxication with pericardial effusion. Pericardiocentesis was successfully performed and was followed with a blood transfusion. This case suggests that rodenticide intoxication might cause pericardial effusion in dogs.
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Affiliation(s)
- Chul Park
- Department of Medicine and Epidemiology, School of Veterinary Medicine, University of California - Davis, Davis, California 95616, USA.
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22
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Vogl DT, Glatstein E, Carver JR, Schuster SJ, Stadtmauer EA, Luger S, Nasta SD, Porter DL, Elstrom R, Tsai DE. Gemcitabine-induced pericardial effusion and tamponade after unblocked cardiac irradiation. Leuk Lymphoma 2009; 46:1313-20. [PMID: 16109609 DOI: 10.1080/10428190500158649] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Gemcitabine therapy has been associated with radiation recall reactions when used in the treatment of carcinoma. We report four cases of hemodynamically significant pericardial effusion in patients with refractory lymphoma who were receiving gemcitabine, all of whom had a history of mediastinal radiation without subcarinal blocking. All four patients had pericardial abnormalities on echocardiography prior to receiving gemcitabine. Two patients required emergent surgical procedures. Of twenty other patients in our practice who received gemcitabine for refractory lymphoma without developing pericardial effusion, none had received prior direct radiation to the heart. The overall response rate of these 24 refractory lymphomas to gemcitabine-containing regimens was 46%. Although gemcitabine-based regimens have clear efficacy in refractory lymphoma, prior mediastinal radiation without subcarinal blocking may be a relative contraindication, especially in the presence of pericardial abnormalities on echocardiography. Physicians should be aware of the potential for developing a gemcitabine-induced radiation recall reaction resulting in hemodynamically significant pericardial effusion.
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Affiliation(s)
- Dan T Vogl
- Abramson Cancer Center, Hospital of the University of Pennsylvania, 3400 Spruce Street, Philadelphia, PA, 19104, USA
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23
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Abstract
Commonly used chemotherapeutic agents, specifically cytarabine and daunorubicin, can cause effusive-constrictive pericarditis. We describe a case of transient effusive-constrictive pericarditis in a patient with acute myelogenous leukemia. This is the first case report of a patient with transient effusive-constrictive pericarditis due to chemotherapy.
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Affiliation(s)
- T Woods
- Department of Medicine, University of Wisconsin Medical School, Madison 53792-3248, USA
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24
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Matson CW, Timme-Laragy AR, Di Giulio RT. Fluoranthene, but not benzo[a]pyrene, interacts with hypoxia resulting in pericardial effusion and lordosis in developing zebrafish. Chemosphere 2008; 74:149-54. [PMID: 18840388 PMCID: PMC2644413 DOI: 10.1016/j.chemosphere.2008.08.016] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/10/2008] [Revised: 08/04/2008] [Accepted: 08/13/2008] [Indexed: 05/02/2023]
Abstract
Previous research has documented several PAHs that interact synergistically, causing severe teratogenicity in developing fish embryos. The coexposure of CYP1A inhibitors (e.g. FL or ANF) with AHR agonists (e.g. BaP or BNF) results in a synergistic increase in toxicity. As with chemical CYP1A inhibitors, it has also been shown that CYP1A morpholinos exacerbate BNF-induced embryotoxicity. We hypothesized that a hypoxia-induced reduction in CYP1A activity in BNF or BaP-exposed zebrafish embryos would similarly enhance pericardial effusion and other developmental abnormalities. BaP, BNF, ANF, and FL exposures, both individually and as BaP+FL or BNF+ANF combinations, were performed under hypoxia and normoxia. CYP1A activity in the BaP+hypoxia and BNF+hypoxia embryos was reduced by approximately 60% relative to normoxia embryos. Although CYP1A activity was significantly reduced, we did not observe any increase in pericardial effusion in either group. An unexpected yet particularly interesting result of these experiments was the observed interaction of both FL and ANF with hypoxia. Relatively high, yet environmentally relevant concentrations of FL (100-500 microg L(-1)) interact with moderate hypoxia (7.3% DO) through an unknown mechanism, resulting in pericardial effusion and severe lordosis. Additionally, ANF exposures (100 microg L(-1)) which are not normally teratogenic caused dramatic pericardial effusion, but not lordosis, when embryos were coexposed to hypoxia. These results suggest that reduced CYP1A activity may not exclusively underlie observed developmental toxicity, and that hypoxia may exacerbate the developmental toxicity of some PAH mixtures.
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Affiliation(s)
| | | | - Richard T Di Giulio
- Corresponding Author: Richard T. Di Giulio, Nicholas School of the Environment, Duke University, Box 90328, Durham, NC 27708, Phone: (919) 613-8024, Fax: (919) 668-1799,
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25
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Rogers JS, Zakaria S, Thom KA, Flammer KM, Kanno M, Mehra MR. Immune reconstitution inflammatory syndrome and human immunodeficiency virus-associated myocarditis. Mayo Clin Proc 2008; 83:1275-9. [PMID: 18990327 DOI: 10.4065/83.11.1275] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Myocarditis is a well-recognized cardiac manifestation of human immunodeficiency virus (HIV) infection, and alterations in the immune system likely play an important role in the pathogenesis of heart muscle disease in HIV-infected patients. Highly active antiretroviral therapy (HAART) has greatly improved survival in HIV patients but not without uncovering new and unique manifestations of disease. Immune reconstitution inflammatory syndrome is a collection of inflammatory disorders in which a pathologic inflammatory response and clinical deterioration occur during recovery of the immune system after HAART. To our knowledge, a correlation between immune reconstitution inflammatory syndrome and HIV-associated myocarditis has not been described previously. We report a case of acute myocarditis presenting with refractory ventricular arrhythmias in a patient with AIDS who experienced rapid immune recovery with the initiation of HAART. The case underscores the importance of recognizing this potential complication of AIDS treatment and calls for renewed vigilance concerning cardiac manifestations of HIV, especially during the immune reconstitution phase.
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Affiliation(s)
- Jonathan S Rogers
- Division of Cardiology, University of Maryland School of Medicine, Baltimore, MD 21201, USA
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26
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Kawashima S, Kaneto H, Sakamoto K, Yasuda T, Kuroda A, Shiraiwa T, Yamamoto K, Kasami R, Matsuoka TA, Yamasaki Y, Matsuhisa M. Acute progression of severe insulin edema accompanied by pericardial and pleural effusion in a patient with type 2 diabetes. Diabetes Res Clin Pract 2008; 81:e18-9. [PMID: 18502532 DOI: 10.1016/j.diabres.2008.04.010] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2007] [Accepted: 04/07/2008] [Indexed: 10/22/2022]
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27
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Wu YD, Jiang L, Zhou Z, Zheng MH, Zhang J, Liang Y. CYP1A/regucalcin gene expression and edema formation in zebrafish embryos exposed to 2,3,7,8-Tetrachlorodibenzo-p-dioxin. Bull Environ Contam Toxicol 2008; 80:482-486. [PMID: 18470470 DOI: 10.1007/s00128-008-9395-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/11/2007] [Accepted: 03/11/2008] [Indexed: 05/26/2023]
Abstract
In this study, zebrafish eggs were exposed to a relatively low concentration (50 pg/mL) of 2,3,7,8-Tetrachlorodibenzo-p-dioxin (TCDD) for 72 h and then transferred to vehicle/TCDD-free water for the remainder of the experiments. Mortality, heart rates, edema severity, CYP1A, and regucalcin gene expressions were investigated to study TCDD-induced toxicity in zebrafish during the early life stage. Results indicated that the 50 pg/mL TCDD caused severe and visible developmental toxicity. Further research of the long term and low concentration of TCDD exposure is required.
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Affiliation(s)
- Y D Wu
- Key Lab of Subtropical Agriculture and Environment, Ministry of Agriculture, Huazhong Agricultural University, Wuhan 430070, People's Republic of China.
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Krishnan GS, Chaudhary V, Al-Janadi A, Ramanarayanan J, D'Silva KJ. BCNU toxicity presenting with a large pericardial and pleural effusion. Ann Transplant 2008; 13:44-47. [PMID: 18344943] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2008] [Accepted: 02/22/2008] [Indexed: 05/26/2023] Open
Abstract
BACKGROUND Carmustine (BCNU), 1, 3-bis (2-chloroethyl)-1-nitosourea, is an alkylating agent which is commonly used as a part of conditioning regimen for autologous peripheral blood stem cell transplantation. Despite the widespread use of BCNU therapy in adults, cardiopulmonary toxicity presenting with cardiac tamponade has not been reported. CASE REPORT We present a patient who received BCNU as part of her conditioning regimen followed by autologous peripheral blood stem cell transplantation. This patient subsequently developed bilateral upper lobe pulmonary infiltrates with bilateral pleural effusions and a large pericardial effusion which was a result of BCNU toxicity. CONCLUSIONS Early institution of glucocorticoids for patients receiving high dose BCNU containing chemotherapeutic regimens has shown to significantly reduce BCNU induced cardio-pulmonary toxicity.
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Affiliation(s)
- Ganapathy S Krishnan
- Department of Internal Medicine, Division of Hematology and Oncology, Michigan State University, E. Lansing, MI, USA.
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29
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Hillyard RF. Delayed clinical presentation of hemorrhagic pericardial effusion in a patient receiving warfarin sodium. Am J Orthop (Belle Mead NJ) 2007; 36:E144-E147. [PMID: 18033572] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Affiliation(s)
- Robert F Hillyard
- Division of Orthopedic Surgery, LDS Hospital, Salt Lake City, UT, USA.
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30
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Vincenzi B, Santini D, Frezza AM, Rocci L, Tonini G. Docetaxel induced pericardial effusion. J Exp Clin Cancer Res 2007; 26:417-420. [PMID: 17987805] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Abstract
Docetaxel is a complex diterpene obtained from Taxus Brevifolia, and it is one of the most widely used anticancer agents. The main mechanism of citotoxic action depends on stabilization of microtubules leading to cell mitotic arrest. Independently from the schedule, the primary dose limiting toxicity of docetaxel using is neutropenia. The most common acute side effects related with docetaxel are hypersensivity reactions and dermatitis. There are also other toxicities that may be cumulative in both onset and severity; an important dose limiting side effect in patients who receive multiple cycles of the drug is fluid retention. In previous clinical trials docetaxel resulted often associated with fluid retention, even if phisiopatology of this effect is still unknown. In the majority of cases its manifestations are edema or pleural effusion. We report two cases of patients who developed repeated episodes of pericardial effusion after docetaxel infusion.
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Affiliation(s)
- B Vincenzi
- Medical Oncology, University Campus Bio-Medico, Rome, Italy.
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31
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Abstract
Warfarin is the most widely used oral anticoagulant and is indicated for many clinical conditions. Levofloxacin, a fluoroquinolone, is one of the most commonly prescribed antibiotics in clinical practice and is effective against Gram-positive, Gram-negative, and atypical bacteria. While small prospective studies have not revealed any significant drug-drug interaction between warfarin and levofloxacin, several case reports have indicated that levofloxacin may significantly potentiate the anticoagulation effect of warfarin. We report 3 cases of serious bleeding complications that appear to be the result of the interaction between warfarin and levofloxacin. Physicians should be aware of this potential interaction and use caution when prescribing levofloxacin to patients taking warfarin.
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Affiliation(s)
- Raja S Vadlamudi
- Department of Internal Medicine, Quillen College of Medicine, East Tennessee State University, Johnson City, TN 37614-0622, USA.
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32
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Gómez-Barrado JJ, Vega J, Turégano S, Marcos G. [Constrictive pericarditis after inferoposterior myocardial infarction]. Med Intensiva 2006; 30:343-4. [PMID: 17067509 DOI: 10.1016/s0210-5691(06)74541-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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33
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Affiliation(s)
- Sarah A Kremen
- Department of Neurology, UCLA Medical Center, Los Angeles, Calif. 90095, USA
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Bhatti MA, Zander J, Reeve E. Clozapine-induced pericarditis, pericardial tamponade, polyserositis, and rash. J Clin Psychiatry 2005; 66:1490-1. [PMID: 16420089] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/28/2023]
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35
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Ambrosetti M, Ageno W, Salerno M, Pedretti RFE. Postoperative pericardial effusion in patients receiving anticoagulants for deep vein thrombosis after coronary artery bypass graft surgery. J Thromb Haemost 2005; 3:2367-8. [PMID: 16194218 DOI: 10.1111/j.1538-7836.2005.01575.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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36
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Ellenbogen KA, O'Neill G, Prystowsky EN, Camm JA, Meng L, Lieu HD, Jerling M, Shreeniwas R, Belardinelli L, Wolff AA. Trial to evaluate the management of paroxysmal supraventricular tachycardia during an electrophysiology study with tecadenoson. Circulation 2005; 111:3202-8. [PMID: 15956124 DOI: 10.1161/circulationaha.104.510982] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Tecadenoson is a potent selective A1-adenosine receptor agonist with a dose-dependent negative dromotropic effect on the AV node. Tecadenoson terminates induced paroxysmal supraventricular tachycardia (PSVT) without the clinically significant side effects caused by stimulation of other adenosine receptors. This trial was designed to determine a safe and effective tecadenoson bolus for termination of electrophysiologically induced PSVT. METHODS AND RESULTS Patients with a history of symptomatic PSVT and inducible PSVT at the time of a clinically indicated electrophysiology study were randomized into a multicenter, double-blind, placebo-controlled trial. Five 2-dose tecadenoson bolus regimens were evaluated versus placebo (75/150, 150/300, 300/600, 450/900, 900 microg/900 microg). The second bolus was administered only if PSVT persisted for 1 minute after the first bolus. Each tecadenoson regimen resulted in a significant therapeutic conversion rate compared with placebo (range, 50.0% to 90.3%, analysis of all patients dosed; n=181; P<0.0005). Conversion by the first bolus was dose related (range: placebo, 3.3% to 86.7% for 900 microg/900 microg). Time to conversion was dose dependent, with a median time of <1 minute for the 3 highest dose regimens. Postconversion arrhythmias were transient, requiring no additional treatment in 4 regimens (including placebo). Transient second- and third-degree heart block occurred at higher doses (300/600, 450/900, 900 microg/900 microg) and was supported with backup pacing when needed. No effect on blood pressure was observed. Ten patients with a history of asthma or chronic obstructive pulmonary disease tolerated tecadenoson without bronchospasm. CONCLUSIONS We identified an optimal tecadenoson regimen (300 microg/600 microg) that effectively and rapidly converted 90% (28 of 31) of PSVT patients to normal sinus rhythm with no significant adverse effects.
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37
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Breccia M, D'Elia GM, D'Andrea M, Latagliata R, Alimena G. Pleural-pericardic effusion as uncommon complication in CML patients treated with Imatinib. Eur J Haematol 2005; 74:89-90. [PMID: 15613116 DOI: 10.1111/j.1600-0609.2004.00347.x] [Citation(s) in RCA: 36] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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38
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Hidalgo Correas FJ, de Andrés Morera S, Ramallal Jiménez de Llano M, Garrote Martínez FJ, García Díaz B. Pleurocarditis y neumonía eosinofílica inducida por minociclina: a propósito de un caso. Farmacia Hospitalaria 2005; 29:145-7. [PMID: 16045429 DOI: 10.1016/s1130-6343(05)73652-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
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39
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Andersen LL, Pallesen PA. [Haemopericardium in rheumatoid arthritis treated with methotrexate]. Ugeskr Laeger 2004; 166:4379-80. [PMID: 15587633] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/01/2023]
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40
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41
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42
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Lim A, Sivakumaran P, Israel M. Clozapine-associated polyserositis. N Z Med J 2003; 116:U651. [PMID: 14583809] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 04/27/2023]
Affiliation(s)
- Allen Lim
- Middlemore Hospital, Otahuhu, Auckland, New Zealand
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43
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Imperadore F, Spagnolli W, Martinelli L, Musuraca G, De Girolamo P, Maines M, Vergara G. Cardiac tamponade mimicking ventricular rupture after thrombolysis for acute myocardial infarction. Minerva Cardioangiol 2003; 51:417-8. [PMID: 12900724] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/04/2023]
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44
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Faehnrich JA, Noone RB, White WD, Leone BJ, Hilton AK, Sreeram GM, Mark JB. Effects of positive-pressure ventilation, pericardial effusion, and cardiac tamponade on respiratory variation in transmitral flow velocities. J Cardiothorac Vasc Anesth 2003; 17:45-50. [PMID: 12635060 DOI: 10.1053/jcan.2003.9] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
OBJECTIVE To determine the effects of positive-pressure ventilation and experimentally induced pericardial effusion and tamponade on transmitral flow velocities in dogs. DESIGN Descriptive. SETTING University laboratory. PARTICIPANTS Eleven tracheally intubated and mechanically ventilated dogs. INTERVENTIONS Experimental pericardial effusion and cardiac tamponade were created by pericardial injection of warm saline. MEASUREMENTS AND MAIN RESULTS Hemodynamic parameters and pericardial pressures were monitored in the 11 dogs. Pulsed-wave Doppler tracings of mitral valve flow were obtained at the leaflet tips along with hemodynamic measurements at 4 stages: control, effusion (no decrease in mean arterial pressure), tamponade (>or=40% decrease in mean arterial pressure), and tamponade relief (after evacuation of pericardial fluid). Maximal variation (36%) in transmitral flow velocity over the respiratory cycle during positive-pressure ventilation was seen in the control stage. In the effusion and tamponade stages, variation in transmitral flow velocity decreased progressively to 29% (p = 0.1804, not significant) and 16% (p < 0.0001), respectively. CONCLUSION Intrathoracic pressure and lung volume changes caused by positive-pressure ventilation influence transmitral flow velocity patterns. Respiratory variation in transvalvular flow is pronounced during standard positive-pressure mechanical ventilation, decreases in the presence of pericardial effusion, and becomes almost nonexistent when cardiac tamponade is present. These findings show that the echocardiographic criteria used to diagnose cardiac tamponade based on mitral valve inflow patterns are different during positive-pressure ventilation from spontaneously breathing subjects.
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Affiliation(s)
- Jana A Faehnrich
- Department of Anesthesiology, Duke University Medical Center, and Anesthesiology Service, Veterans Affairs Medical Center, Durham, NC 27705, USA
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46
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Yamada E, Zhang Y, Davies R, Coddington W, Kerber RE. Phased-array intracardiac echocardiographic imaging of acute cardiovascular emergencies: Experimental studies in dogs. J Am Soc Echocardiogr 2002; 15:1309-14. [PMID: 12411922 DOI: 10.1067/mje.2002.122631] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
BACKGROUND We evaluated a newly developed phased-array intracardiac echocardiographic catheter. OBJECTIVE Our aim was to evaluate the imaging capability of this new ICE catheter in an animal model simulating acute cardiovascular abnormalities. METHODS ICE images were obtained from the right atrium during (1) acute left ventricular dysfunction; (2) acute coronary occlusion; (3) pericardial effusion and tamponade; and (4) pulmonary embolism. RESULTS Left ventricular dysfunction, induced experimentally by halothane inhalation, resulted in a fall in echocardiography-calculated ejection fraction from 47% +/- 11% to 25% +/- 10%, P <.01. Regional contraction abnormalities after acute coronary occlusion were identified without and with the ultrasound contrast agent Optison. Pericardial effusion produced by saline infusion into the pericardium was detected in amounts as small as 15 mL. Right ventricular and atrial compression and respiratory variation in right ventricular inflow during tamponade were demonstrated. After injection of intravenous thrombin to create venous thromboembolism, we demonstrated right ventricular dilatation and dysfunction and thrombi attached to the tricuspid and pulmonary valves and in the pulmonary artery. CONCLUSION This new phased-array ICE catheter may be a useful clinical tool for the diagnosis of heart failure, ischemia, tamponade, and pulmonary embolism.
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Affiliation(s)
- Elina Yamada
- Department of Internal Medicine, University of Iowa Hospitals & Clinics, Iowa City 52242, USA
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47
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Barton JC, Jones SC, Lamberth WC, Reymann MT, Scott VC. Cardiac tamponade associated with imatinib mesylate therapy of chronic myelogenous leukemia. Am J Hematol 2002; 71:139-40. [PMID: 12353320 DOI: 10.1002/ajh.10186] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
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Abstract
A 52-year-old man with a history of chronic hypertension presented with worsening dyspnea and leg edema. He had been on minoxidil for 10 years. The cardiac silhouette was markedly enlarged. Echocardiography and computed tomography showed a large pericardial effusion. His cardiac status was stable and he was in no cardiorespiratory distress. No attempt was made to drain the fluid. Minoxidil was discontinued, and a month later, the effusion had virtually disappeared. Cessation of minoxidil administration and conservative management may suffice, even though the pericardial effusion is large.
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Affiliation(s)
- Arsalan Shirwany
- VA Medical Center and University of Tennessee College of Medicine, Memphis, Tennessee 38104, USA
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Abstract
Myelofibrosis with myeloid metaplasia (MMM) is uniquely characterized by macroscopic bone marrow stromal changes that are believed to be both reactive and cytokine mediated. Furthermore, a prognostically detrimental increase in bone marrow angiogenesis has recently been demonstrated. These observations suggest a potential therapeutic role for agents that are inhibitory to angiogenesis as well as cytokines that are pathogenetically implicated in MMM. In a prospective study of 15 patients with MMM, thalidomide treatment, starting at a dose of 200 mg/d, resulted in increased platelet counts (12 of 15 patients), increased haemoglobin level (3 of 15), a modest decrease in spleen size (3 of 12), increased bone marrow megakaryopoiesis (5 of 9) and decreased bone marrow angiogenesis (2 of 9). Undesirable haematological effects included pericardial extramedullary haematopoiesis in one patient, marked leucocytosis in two patients and extreme thrombocytosis in three patients. The thrombocytosis occurred in both patients with post-thrombocythaemic myeloid metaplasia (PTMM) and was also associated with higher baseline levels of circulating CD34+ cells. Previously described toxicities of thalidomide were seen in the majority of patients and dose escalation to 400 mg/d was permitted in only two patients. In contrast, toxicity-related dose reductions to 50 mg/d did not appear to lessen drug efficacy. We conclude that thalidomide has both beneficial and potentially adverse biological activity in MMM. A lower dose of the drug might be more tolerable without compromising therapeutic value. Patients with PTMM and/or markedly increased circulating CD34+ cell counts might be susceptible to thalidomide-induced thrombocytosis.
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Affiliation(s)
- Michelle A Elliott
- Division of Hematology and Internal Medicine, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA.
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50
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Abstract
We report a case with typical clinical features of drug-induced lupus erythematosus, together with verrucous endocarditis and pleuropericardial effusion, due to amiodarone treatment. After cessation of amiodarone treatment, the patient recovered completely.
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