Vigorous Supportive Treatment Research Articles

A rare case of acute promyelocytic leukemia with ider(17)(q10)t(15;17)(q22;q21) and favorable outcome

BackgroundChromosomal rearrangements in addition to t(15;17) have been reported in 25-40% of APL patients, with a large predominance of trisomy 8. Other abnormalities are far less frequent, particularly as ider(17), and the prognostic significance is still unclear.Case presentationWe present the case of a patient with t(15;17)(q22;q21), der(15)t(15;17) and ider(17)(q10)t(15;17)(q22;q21). In particular, the RT-PCR result for PML-RARA of this patient was a false negative and mutational analysis of AML-related genes showed SNP rs2454206 in the TET2 gene and yielded negative findings in other genes including AML1, ASXL1, CEBPA, DNMT3A, FLT3, KIT, NPM1, TP53, and U2AF1. After the early usage of arsenic trioxide combinated with ATRA and vigorous supportive treatment to maintain PLT ≥30×109/L and FIB >1500 mg/L, this patient was under MMR and HCR without any clinical symptoms or signs until now.ConclusionFalse negative reslults of RT-PCR analysis for PML-RARA are rare in APL and ider(17) is even more infrequent. To our knowledge, this is the first reported case of APL with ider(17) and false negative RT-PCR analysis results. The role of ider(17) in APL is still an ongoing investigation and limited by the small number of published cases. The patient reported here benefited from vigorous supportive treatment during the combination of ATRA and arsenic trioxide in induction chemotherapy and the clinical outcome was favorable.

Plasmapheresis reverses all side-effects of a cisplatin overdose – a case report and treatment recommendation

BackgroundCisplatin is widely used as an antineoplastic agent since it is effective against a broad spectrum of different tumours. Nevertheless, it has several potential side effects affecting different organ systems and an overdose may lead to life-threatening complications and even death.Case presentationWe report on a 46-year old woman with non-small cell lung cancer who accidentally received 225 mg/m2 of cisplatin, which was threefold the dose as scheduled, within a 3-day period. Two days later, the patient presented with hearing loss, severe nausea and vomiting, acute renal failure as well as elevated liver enzymes. In addition, she developed a severe myelodepression. After plasmapheresis on two consecutive days and vigorous supportive treatment, the toxicity-related symptoms improved and the patient recovered without any sequelae.ConclusionTo date, no general accepted guidelines for the treatment of cisplatin overdoses are available. Along with the experience from other published cases, our report shows that plasmapheresis is capable of lowering cisplatin plasma and serum levels efficiently. Therefore, plasma exchange performed as soon as possible can ameliorate all side effects of a cisplatin overdose and be a potential tool for clinicians for treatment. However, additional intensive supportive treatment-modalities are necessary to control all occurring side effects.

Adaptation to severe chronic hypokalemia in anorexia nervosa: A plea for conservative management

Severe hypokalemia may constitute a life-threatening medical emergency. In the group of purging eating disorder patients, potassium blood levels tend to be chronically low while physical signs and symptoms may be absent. Nevertheless, these patients are frequently subjected to vigorous supportive treatment and often an aggressive diagnostic workup. We present a chronic purging anorexia nervosa patient in whom potassium blood levels reach a low of 1.6 mmol/L in the absence of physical symptoms. Purging eating disorder patients adapt to chronic hypokalemia. We believe the clinical/medical approach to this electrolyte disturbance in chronic eating disorder patients should be different from the approach to patients suffering from acute hypokalemia.

A Suspected Case of Trimethoprim/Sulfonamide-Induced Localized Exfoliation

A variety of skin reactions have been associated with the use of sulfonamides. Most of the reactions are uneventful and abate with drug discontinuation. Rare but severe skin reactions can occur and include the Stevens-Johnson syndrome and exfoliative dermatitis. Dermal reactions appear to be the most commonly reported adverse effect in children. Drug continuance following the development of a mild skin rash may be associated with the development of a more severe dermal reaction. This report summarizes a case involving a six-year-old white girl who developed exfoliative dermatitis confined to the feet following a course of oral trimethoprim/sulfamethoxazole (TMP/SMX) for otitis media. Exfoliation is an uncommon cutaneous manifestation following sulfonamide use. Although usually a generalized process, it is unusual to find it confined to the feet. Unfortunately there is no useful diagnostic method that could specifically elucidate the cause of a dermatologic eruption. Available evidence suggest that TMP/SMX was the probable cause of our patient's rash. Adjunctive antihistamines and corticosteroids are often useful when pruritus is present. Severe reactions require vigorous supportive treatment.

NAGD regimen for the coma of drug-related overdose

A specific arousal therapy with NAGD (Naloxone, Activated Charcoal, Glucagon, Doxapram) is outlined for victims of drug overdose in comatose and semi-comatose states. Several direct benefits accrue if early awakening or lightening of such patients is safely accomplished. There are: 1) elimination of need for prolonged intubation or tracheostomy; 2) patient's ability to tell which drug(s) were taken; 3) excessively frantic and vigorous supportive treatment is obviated; and 4) the overall hospital stay is shortened. The NAGD regimen has been found to effectively, safely, and predictably reverse coma. Therapy consists of: naloxone 0.8 mg to 1.6 mg intravenously; large-bore orogastric tube instillation of 100 gm to 120 gm activated charcoal slurry; glucagon 1 mg to 2 mg intravenously; and, in selected cases, doxapram 1 mg/kg to 2 mg/kg intravenously.

Management of Fulminant Hepatitis by Vigorous Supportive Treatment

To the Editor.— Fulminant hepatitis is a highly fatal disease and, in spite of various therapies that have been tried in the last decades, viz, the administration of high doses of corticosteroids, exchange transfusion, charcoal hemoperfusion, total body washout, and cross circulation with animal or human liver, 1 the mortality has not registered any substantial decline. Auslander and Gitnick (Archives137:599-601, 1977) have reported good results with aggressive medical management without the use of corticosteroids and other special modes of therapy. We have treated 69 patients with fulminant hepatitis during the last five years in our institution. The criteria of Redker 2 were used to establish the diagnosis. Initially, 22 patients were given high doses of corticosteroids and only three (14%) of them survived. Subsequently, exchange transfusion was used in ten patients and all of them died. Septicemia, hepatorenal failure, and gastrointestinal bleeding were the major fatal complications that prompted

Fat embolism syndrome

Fat emboli are a life-threatening source of respiratory insufficiency. Whether they are of mechanical or chemical origin remains a subject of controversy. Fat embolism syndrome is most often seen after fracture of long bones, and immobilization of the fracture site may decrease risk of its development. Adequate oxygenation is the most important aspect of therapy; most patients given vigorous supportive treatment recover with no residual lung injury.

Radiation pneumonitis: Experience following a single treatment

The acute radiation pneumonitis syndrome of increasing cough with dyspnoea and characteristic radiographic changes developed in 44 of 245 patients (17.5%) treated with a single large dose of radiation. The median onset was 100 days and proved fatal in 84 percent of cases within two weeks. Because these patients with advanced cancer had a median survival of 126 days the incidence was calculated by the actuarial method. This was 83.5 and 29 percent for single uncorrected doses of 1,000 and 800 rad: the two standard deviations were 20 and 14 percent. The risk increased with previous irradiation or intrathoracic tumor. Steroids had no obvious protective effect, but in three patients withdrawal of the drug apparently precipitated the syndrome. Vigorous supportive treatment with antibiotics and prednisone reversed the process in three cases, Radiotolerance of the lung is the limiting factor in usirgradiation as a systemic treatment for cancer.

Criteria for selection of patients for mechanical circulatory support

The experience with 36 patients referred for possible mechanical circulatory assistance is reviewed. The criterion for assisted circulation in the 32 patients so treated was either cardiac arrest or a decreasing cardiac output, estimated by the indicator-dilution technique or inferred from a progressively increasing arteriovenous oxygen difference, in spite of vigorous supportive treatment. Although at present the heart-lung machine is the only method of wide clinical applicability, other promising devices are undergoing limited clinical trial. It will be necessary to identify mechanisms of preterminal cardiac failure and to select a method appropriate to the physiologic abnormality.