Site Of Extravasation Research Articles

Paclitaxel-induced "recall" soft tissue injury occurring at the site of previous extravasation with subsequent intravenous treatment in a different limb.

Paclitaxel-induced "recall" soft tissue injury occurring at the site of previous extravasation with subsequent intravenous treatment in a different limb.

Case Report of Taxol Administration via Central Vein Producing a Recall Reaction at a Site of Prior Taxol Extravasation

Case Report of Taxol Administration via Central Vein Producing a Recall Reaction at a Site of Prior Taxol Extravasation

Antitumor Agents

We discuss our experience with antineoplastic drug extravasation. Between December 1988 and December 1990, 40 patients with cytostatic extravasation with lesions of varying seriousness were observed. In these patients, whenever possible, depending on the amount of time that elapsed since the accident and on the severity of the lesion, conservative therapy was done. The procedure consisted of local injection of a considerable amount of saline solution (20-90 ml, depending on the site of extravasation) and topical occlusive applications of corticosteroids locally. In all patients this was sufficient to avoid tissue necrosis. Treatment of a few patients deviated from these procedures because surgery was performed that ranged from the simple excision of infiltrated tissue to a more complex procedure of free flaps. On the basis of our experience, we discuss the role of early surgery when preventive measures and drug therapy are insufficient because of drug effects at the tissue level. In this series we did not perform early surgery.

Microcatheter Embolization of Non-neurologic Traumatic Vascular Lesions

The authors report their experience over a 28-month period with embolization of 23 non-neurologic traumatic vascular lesions in 21 patients with use of a coaxial microcatheter coil delivery system. The injuries included pseudoaneurysms (n = 17), arteriovenous fistulas (n = 3), and sites of extravasation (n = 3) and were caused by gunshot, shotgun, and stab wounds, as well as motor vehicle accidents and iatrogenic trauma. All microcatheter embolizations except one were performed with 2.2-F Tracker-18 catheters inserted coaxially through 5.0-5.5-F guiding catheters. In one case, a coaxial 3-F Teflon catheter was used. In all cases platinum microcoils (almost all non-fibril) and/or straight platinum embolization wires (with fibrils) were used. Twenty-one (91%) of 23 vascular lesions were successfully occluded with use of the microcatheter system. The two cases in which microcatheter embolization failed were successfully managed by using larger catheters and steel coils. Two patients with hepatic vascular lesions (one site of extravasation and a pseudoaneurysm) and one patient with a lower extremity arteriovenous fistula required two procedures each for successful treatment. Procedures were life-saving in at least two patients. Two lesions recurred during follow-up ranging from 3 days to 17 months. Both of these recurrences were successfully treated with transcatheter embolization, in one case with use of microcatheters. Microcatheter embolization with platinum coils and wires is an effective means for treating traumatic vascular lesions. A coaxial microcatheter system allows for easier, more rapid coil/wire delivery to smaller, spasm-prone arteries in such cases.

Differential expression of the HECA-452 antigen (cutaneous lymphocyte associated antigen, CLA) in cutaneous and non-cutaneous T-cell lymphomas.

The monoclonal antibody HECA-452 identifies an antigen that is primarily expressed on high endothelial venules, the preferred site of lymphocyte extravasation in lymphoid tissues, and also on a subpopulation of myelomonocytic cells and some T-cells. We investigated the expression of the HECA-452 antigen, also called the cutaneous lymphocyte associated antigen, in primary cutaneous and primary non-cutaneous T-cell non-Hodgkin's lymphomas. The tumour cells of cutaneous T-cell non-Hodgkin's lymphomas were positive in 53% of cases, while only 5% of the non-cutaneous lymphomas were positive. These differences were also present in morphologically identical tumours. Thus, the tumour cells in six out of 10 primary cutaneous anaplastic large cell T-cell lymphomas were positive, while they were positive in none of 24 primary non-cutaneous anaplastic large cell T-cell lymphomas. In general, primary cutaneous and primary nasal T-cell non-Hodgkin's lymphomas were devoid of HECA-452 positive high endothelial venules, whereas most nodal T-cell non-Hodgkin's lymphomas contained HECA-452 positive high endothelial venules. These observations suggest that the HECA-452 antigen might be related to a skin-associated type of lymphoid tissue and to lymphomas originating in the skin. However, the results of HECA-452 expression in secondary sites, and the clinical data of the primary cutaneous large cell lymphomas did not support the concept that HECA-452 is functionally involved in homing to the skin, or that loss of the HECA-452 antigen is related to tumour progression of primary cutaneous T-cell lymphomas.(ABSTRACT TRUNCATED AT 250 WORDS)

Effects of glucocorticoid and chemotherapy on the peritumoral edema and astrocytic reaction in experimental brain tumor.

To study the effects of glucocorticoids and chemotherapeutic agents on the pathophysiology of the tumor-induced brain edema, the site of Evans blue-albumin extravasation, the distribution of extravasated serum albumin, and the extent of local astrocytic reaction were examined in a rat model of implanted brain tumor. Experimental brain tumors were produced by implanting small pellets of Walker 256 carcinosarcoma into the cerebral cortex of Wistar rats. In the steroid group, rats were administered with intraperitoneal methylprednisolone succinate (15 mg/kg) daily on and after the 6th day postimplantation, and sacrificed on the 14th day. In the chemotherapy group, rats were given an intravenous injection of cyclophosphamide (30 mg/kg) on the 14th day, and sacrificed on the 21st day. Rats in the untreated group were sacrificed on the 14th day without any therapy. Each animal was sacrificed by the transcardiac perfusion with paraformaldehyde 30 min after intravenous injection of Evans blue. Firstly, coronal blocks of the brain were examined for Evans blue staining macroscopically. Paraffin embedded sections were studied for the Evans blue fluorescence and for the immunohistochemical reaction to serum albumin and GFAP. The examination of Evans blue demonstrated that the origin of extravasation of serum albumin was the tumor and the adjacent brain with dense tumor cell infiltration in any group of rats. The extravasated serum albumin distributed widely and the astrocytic reaction was prominent in the brain of the untreated group. A positive correlation was observed between the intensity of albumin immunoreaction and the degree of astrocytic proliferation. Chemotherapy effectively decreased the size of tumor and reduced the extravasation of serum albumin. The astrocytic reaction was however, not reduced.(ABSTRACT TRUNCATED AT 250 WORDS)

Pyridoxine: A Potential Local Antidote for Mitomycin-C Extravasation

Two cases are presented which suggest that pyridoxine injected into a Mitomycin-C extravasation site may slow or prevent necrosis, and may decrease the pain associated with the chronic ulceration of extravasation.

A prospective study of topical dimethyl sulfoxide for treating anthracycline extravasation.

Twenty patients with extravasation of anthracyclines were treated on a single-arm pilot study with topical 99% dimethyl sulfoxide (DMSO) and observed for 3 months with regular examinations and photographs. DMSO was applied to approximately twice the area affected by the extravasation and allowed to air dry. This was repeated every six hours for 14 days. The initial signs of extravasation included swelling in 17 patients, erythema in 15, and pain in 12. The median area of damage was 8.25 cm2 and a median of 25 minutes elapsed between extravasation and application of DMSO with one patient not treated until seven days postextravasation. Sixteen patients were observed for 3 months, two died of disease earlier after receiving 2 weeks of DMSO and three days of DMSO, respectively, and two were lost to follow-up having received one day and five days of DMSO. In no patient did extravasation progress to ulceration or require surgical intervention, suggesting with 95% confidence a true ulceration rate of between 1% and 17%. At 3 months there was no sign of residual damage in six patients, while a pigmented indurated area remained in ten. Two patients had a recall reaction with increased pain at the extravasation site when further intravenous (IV) doxorubicin was administered. The only toxicities of DMSO included a burning feeling on application subsequently associated with itch, erythema, and mild scaling. Blisters occurred in four patients. Six patients reported a characteristic breath odor associated with DMSO. Topical DMSO appears to be a safe and effective treatment for anthracycline extravasation.

T lymphocyte precursors migrate towards chemotactic peptides secreted by embryonic or juvenile thymus.

During embryonic life the thymic rudiment is extensively seeded by invading hemopoietic precursors that give rise to mature T cells (1). In birds thymus, colonization by precursor cells is limited to two defined time periods of embryonic development (2). The first hemopoietic precursor cells appear at day 5 in the thymus of quail embryos. At this stage of development the precursors were enriched in the perithymic region. These precursors are often in contact with endothelial cells of the jugular vein, a prefered site of extravasation; they are also dispersed within the mesenchymal tissue around the thymus, and adhere to the basal lamina that separates the thymus from the mesenchyme (3).

Technique for intraoperative localization of urinary leakage

Urinary leakage is an uncommon complication of renal transplantation with a near equal division occurring between ureteral and bladder origins. The diagnosis is usually entertained from a characteristic clinical course and confirmed by preoperative contrast cystography or radionuclide scanning. A technique for precise intraoperative localization of the site of urine extravasation using intracystic instillation of Intralipid has been described. It allows easy recognition without damaging or staining surrounding tissues. In addition, this technique may be applied in other situations to confirm anastomotic or hollow viscus closures.

8 Immunology of gastrointestinal lymphoma

Experimental work showing that IgA plasma cell precursors activated in gut associated lymphoid tissue (GALT) of rats and sheep migrate to the lamina propria of the gut via the regional lymphatics, mesenteric lymph node and blood, has been supported by immunohistochemical studies. In rats, immunoblasts with cytoplasmic IgA are present in the Peyer's patches in association with the high endothelial venules which is probably an important, though not the only, site of extravasation into the gut, whereas cells with cytoplasmic IgA are rarely observed in the dome regions of Peyer's patches. Immunohistochemical studies of human Peyer's patches have revealed differences between the distribution of cells with cytoplasmic IgA in man compared to rats. In man, immunoblasts with cytoplasmic IgA are not concentrated in the zone of cells containing the high endothelial venules, whereas they are present in the dome regions of the Peyer's patches. The following questions arise: Do precursors of IgA plasma cells activated in human GALT migrate to the lamina propria via the blood, but extravasate predominantly via the capillary network, rather than the high endothelial venules? or do IgA plasma cell precursors ‘mature’ in situ in the Peyer's patches of man and subsequently migrate laterally to seed the lamina propria? Three lines of evidence from studies of primary B cell lymphomas of GALT support the latter hypothesis: 1) Primary B cell lymphomas of the gut remain localized to GALT for long periods of time; 2) Histological studies of the lymphoid tissue in these lymphomas have shown a gradation of cell types, from the muscularis mucosae towards the mucosal epithelium, which strongly suggests that plasma cells develop in situ in the gut from the adjacent layers of cells; 3) Preliminary studies of DNA extracted from the blood-borne cells from patients with GALT-derived B cell lymphoma have failed to demonstrate the presence of clonal gene rearrangements. Normal and malignant human GALT contains a perifollicular population of B cells with centrocyte-like morphology which lack surface IgD. No direct equivalent can be detected in rodent Peyer's patches. Their quiescent nature and distribution in malignant GALT suggests that they are follicle centre cell-derived and precursors of immunoblasts and plasma cells. As such they may be memory B cells. Their association with epithelium is a consistent feature of normal and malignant GALT which is of unknown but undoubted significance. The function of intraepithelial T cells is still unknown. Malignant T cells in MHI may be derived from intraepithelial T cells. Further studies of these malignant T cells which are now in progress may enable a new approach to the investigation of human intraepithelial lymphocytes.

Delayed tissue necrosis due to mitomycin C

We report about a patient having received intravenous mitomycin C without evidence of tissue injury until three months following its extravasation. After drinking alcoholic beverages 3 months later he developed a severe ulcer at the site of the previous extravasation. There are only a few reports about such extravasation ulcers occurring a long time after the injection.

Calcinosis at the Site of Leakage from Extravasation of Calcium Disodium Edetate Intravenous Chelator Therapy in a Child with Lead Poisoning

Painful calcinosis appeared at the wrist of an eight-year-old girl with lead poisoning. Careful history revealed that calcification occurred at the site of previous extravasation of calcium disodium edetate (EDTA) used in chelation therapy. Light microscopic, ultrastructural, electron activation, and X-ray diffraction studies demonstrated apatites with some suggestion of an admixture of octacalcium phosphate.

Gastric bleeding sites: an angiographic study.

Arteriograms showing distinct points of extravasation in 103 patients with clinical gastric bleeding were reviewed. In 98% of cases there was a single point of extravasation, which was located in the proximal portion of the stomach in 92%. The left gastric artery supplied the bleeding site in 85% of patients. Angiographic and endoscopic findings agreed in 83% of patients in whom the endoscopist saw active bleeding and 72% of those in whom the bleeding site was not seen. Stress associated with major surgery, trauma, or sepsis was the underlying clinical condition in 57%, and in 95% of these patients the site of extravasation was the proximal portion of the stomach.

Management of extensive doxorubicin hydrochloride extravasation injuries

Forty patients with extensive doxorubicin hydrochloride extravasation injuries are reviewed. These injuries were located in critical anatomic areas such as the palmar aspect of the wrist, dorsum of the hand, and antecubital fossa. Contributing factors were related to local venous pathology, the mode of administration, and the lack of recognition of extravasation. Treatment of these injuries consisted of extensive debridement of all involved tissue and delayed closure by a variety of techniques. The complications and morbidity secondary to doxorubicin hydrochloride extravasation are often more disabling than the patient's primary disease. The degree of disability is related to the site of extravasation, patient's age, and delay before surgical complication. Early recognition and excision and delayed closure yield the most successful results.

The permeability alteration of brain and spinal cord vasculature to horseradish peroxidase during experimental decompression sickness as compared to the alteration in permeability induced by hyperosmolar solution.

The permeability of microvasculature in the cerebral cortex, neostriatum, and spinal cord to i.v. injected horseradish peroxidase (HRP) has been investigated in rats following experimental compression to 6.1 bars (abs.) air for 90 min, and subsequent decompression to the ambient pressure in 1 min. For comparison, 1 ml of 2.0 M urea was injected into the right common carotid artery of rats during 15 s. After exposure to compression-decompression, under the light microscope focal leaky areas were found in all the regions examined. The leakage was most prominent in the grey matter of the spinal cord, and the cerebral cortex. In decompressed rats, arterioles were most often the site of peroxidase extravasation, whereas extravasation of HRP was less frequently displayed by capillaries and venules. In urea-treated rats, capillaries and venules frequently displayed extravasation of HRP as well. Parenchymal cells accumulated the trace adjacent to the leaky areas. Under the electron microscope, the extravasation of HRP was associated with peroxidase-containing pleomorphic vesicular structures in the endothelium, both in decompressed and urea-injected rats. Moreover, in contrast to decompressed rats, the junctions between endothelial cells were penetrated by the trace in urea-treated rats. Accordingly, the results indicate that during decompression sickness the pathway for the extravasation of proteins is through vesicular transfer, whereas the injection of hyperosmolar urea induces extravasation, both through vesicular transfer and junctions between the endothelial cells.

Management of neonatal urinary ascites

Four cases of neonatal urinary ascites are added to the previous reported 46 cases. Three are males with posterior urethral valves, and one is a female whose bladder was ruptured during traumatic breech extraction. The renal site of urine extravasation was verified by retrograde pyelogram in one instance and operative exploration in another. If relief of the lower urinary tract obstruction does not resolve the ascites, percutaneous or open nephrostomy tube placement on the side of extravasation is advised. With this approach all the patients have survived and now have normal renal function.

Letter: Recall injury from adriamycin.

Letters1 August 1975Recall Injury from AdriamycinSTEPHEN C. COHEN, M.D., NICHOLAS J. DIBELLA, M.D., JOHN C. MICHALAK, M.D.STEPHEN C. COHEN, M.D.Search for more papers by this author, NICHOLAS J. DIBELLA, M.D.Search for more papers by this author, JOHN C. MICHALAK, M.D.Search for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/0003-4819-83-2-232_1 SectionsAboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail ExcerptWe have recently seen a 63-year-old man with mixed cell Hodgkin's disease who has been receiving multiple agent chemotherapy for difficult-to-control retroperitoneal disease. One of the agents the patient has received is adriamycin. After extravasation of adriamycin, the patient developed an erythematous lesion at the extravasation site, which ultimately necrosed, ulcerated, and slowly began to heal at about 1½ months after the accident. After this incident the patient received multiple courses of nitrogen mustard and vinblastine without apparent difficulty. Two months after the extravasation of adriamycin (at a time when the wound seemed well on its way to healing), another...Reference1. DONALDSONGLICKWILBUR SJJ: Adriamycin activating a recall phenomenon after radiation therapy. Ann Intern Med 81:407-408, 1974 LinkGoogle Scholar This content is PDF only. To continue reading please click on the PDF icon. Author, Article, and Disclosure InformationAffiliations: Department of Medicine Fitzsimons Army Medical Center Denver, CO 80240 PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetails Metrics Cited ByStravasi iatrogeni: gestione terapeuticaZytostatikainduzierte ParavasateDoxorubicinTratamiento de las extravasaciones iatrogénicas de soluciones citotóxicas o hiperosmolaresStravaso iatrogeno di soluzioni citotossiche o iperosmolari. Trattamento terapeuticoExtravasations iatrogènes de solutés cytotoxiques ou hyperosmolaires. Prise en charge thérapeutiqueDoxorubicinMeasuresHistopathologic Features Seen with Radiation Recall or Enhancement EruptionsDoxorubicinRecall Phenomenon Following EpirubicinSoft-tissue Reconstruction Following Extravasation of Chemotherapeutic AgentsBasic fibroblast growth factor in retardation of doxorubicin extravasation injuryAlterations in Wound Healing Secondary to Infusion InjuryTraitement chirurgical des ulcérations cutanées liées à la chimiothérapie anticancéreuseCutaneous complications of chemotherapeutic agentsTreatment of tissue extravasation by antitumor agentsRadiotherapy and chemotherapy in combined clinical trials: Problems and promiseClinical correlations of adriamycin pharmacologyCellular effects of combined adriamycin and x-irradiation in human tumor cellsComplications of irradiation related to apparent drug potentiation by adriamycinDaunomycin, Adriamycin, and Recall EffectDAVID BAER, M.D., LEE S. WILKINSON, M.D.Doxorubicin (z.B. Doxorubicin „Ebewe“, Adriblastin®) 1 August 1975Volume 83, Issue 2Page: 232-232KeywordsChemotherapeutic agentsChemotherapyHodgkin lymphomaLesionsUlcers Issue Published: 1 August 1975 PDF DownloadLoading ...

Paracentesis in the management of neonatal urinary ascites

A case of urinary ascites is presented, and the diagnostic criteria and literature are reviewed. Posterior urethral valves are the most common cause. The infants usually suffer with abdominal distention and respiratory distress. In this case, due to the extreme distress of the infant, paracentesis was used to relieve the abdominal distention and at the same time to relieve the pressure on the ureters. Extravasation from the bladder and kidneys is found in a significant number of cases and is the likely cause of the ascites. The exact site of extravasation is not well documented, but several sources are suggested including the relationship of the short fetal tubules.