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Shaye Kivity Yaron Zafrir Ronen Loebstein Rachel Pauzner Meir Mouallem Haim Mayan 《Autoimmunity reviews》2014,13(11):1109-1113
Objective
Low dose (10–25 mg/week) methotrexate is widely used for the management of systemic inflammatory diseases, and is considered to be relatively safe. Toxicity due to low dose MTX has been reported but is poorly characterized. We describe the clinical features, risk factors, and outcomes of low dose MTX toxicity in a large case series at our center.Patients and methods
We conducted a retrospective case series of all adult (> 18 years) patients hospitalized at Sheba Medical Center, between 2005 and 2012 for low dose MTX toxicity.Results
We identified 28 patients (age: 70.4 ± 13.7 years, range: 33–88; 20 (71%) females) hospitalized for low dose MTX toxicity. Indications for MTX therapy included: rheumatoid arthritis (39.2%), psoriasis ± arthritis (21.5%), polymyalgia rheumatica (10.8%) and other inflammatory conditions (28.5%). Pancytopenia was the most common manifestation of low dose MTX toxicity detected in 78.5% of the patients. Potential risk factors included acute renal failure, hypoalbuminemia, concurrent use of drugs known to interact with MTX, and dose errors. Serum MTX concentrations (n = 20, mean 0.04 ± 0.07 μg/mL range: 0–0.3) did not correlate with the degree of either neutropenia (r = − 0.36; p = 0.18) or thrombocytopenia (r = 0.44; p = 0.10). Seven (25%) patients died, all from pancytopenia followed by sepsis. Serum MTX concentrations did not differ between the patients who died from MTX toxicity (n = 6; mean: 0.05 ± 0.04 μg/mL) and those who survived the toxicity (n = 14 mean 0.04 ± 0.08; p = 0.45).Conclusions
Low-dose MTX toxicity can be life threatening, mainly due to myelosuppression. There is no rationale for MTX therapeutic drug monitoring in the setting of low-dose toxicity. 相似文献4.
BACKGROUND: Primary central nervous system vasculitis has traditionally been described as an aggressive condition, with significant morbidity and mortality. A subgroup of patients has been identified who have a similar clinical presentation, but with a benign course. This syndrome of BACNS is successfully treated with low-dose steroids and calcium-channel blockers. Histologic confirmation, when performed, is normal. METHODS: Intracerebral hemorrhage is a rare presenting finding in the setting of BACNS. We present 2 patients with acute onset of headache and neurologic impairment secondary to an ICH. RESULTS: Cerebral angiography showed characteristic findings of diffuse vasculitis. Both patients were subjected to biopsy and both failed to reveal evidence of vasculitis. CONCLUSION: This report is the first to document the normal histologic features of BACNS in the setting of an ICH. Although these angiographic changes are similar to vasculitis, these processes can be differentiated on clinical grounds, which is of vital importance as the treatment and clinical course of BACNS is more benign. Furthermore, the presence of an ICH in the setting of vasoconstriction seen on angiography may represent a novel feature in some patients with BACNS and is not necessarily a harbinger of the more malignant PCNSV. 相似文献
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D C De Genova P McInnes-Ledoux R Weinberg R Shaye 《American journal of orthodontics》1985,87(5):377-384
In the last 20 years, synthetic elastic modules have been introduced to the orthodontist. However, force decay of these materials has been a clinical problem and the purpose of this project was to evaluate the force decay patterns of three commercially available elastomeric products--Ormco Power Chain II, Rocky Mountain Energy Chain, and TP Elast-O Chain--in a simulated oral environment. Thermal-cycled samples experienced less force decay over a 21-day period than samples stored at 37 degrees C. Furthermore, statistical analysis confirmed that there was a highly significant difference (p less than 0.01) between the mean force exerted by short modules and long modules for each material. Overall, modules producing higher initial forces (short modules) underwent less force decay after 21 days than did modules producing lower initial force values (long modules). All materials exerted 216 to 459 grams of force initially. After 21 days of simulated tooth movement, the force exerted by the elastic modules was 70 to 230 grams--a significant reduction (p less than 0.001). 相似文献
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Lisa M. Mahakian D. Gregory Farwell Hua Zhang Jai Woong Seo Brian Poirier Steven P. Tinling Alaa M. Afify Eric M. Haynam David Shaye Katherine W. Ferrara 《Molecular imaging and biology》2014,16(2):284-292
Purpose
Currently, 2-deoxy-2-[18F]fluoro-d-glucose (18F-FDG) is the gold standard radiotracer for staging of head and neck cancer; however, the low sensitivity of this tracer can impede detection of early lesions. 64Cu-liposomes accumulate in various cancers and provide both a sensitive tracer and an indication of the biodistribution of nanotherapeutics. Here, the accumulation of 64Cu-liposomes in early and established cancers is assessed and compared with 18F-FDG in a head and neck cancer model.Methods
Lesions ranging from mild dysplasia to squamous cell carcinoma were induced in a hamster model of head and neck cancer by topical application of 7,12-dimethylbenz[a]anthracene to the buccal pouch. The hamsters were imaged with micro-positron emission tomography using 18F-FDG and 64Cu-liposomes.Results
At 24 h postinjection, 64Cu-liposome accumulation exceeded the accumulation of 18F-FDG in every pathologic grade. The lesion-to-cheek pouch (background) ratio and lesion-to-brain ratio were also higher for 64Cu-liposomes than for 18F-FDG.Conclusion
Imaging of a nanotracer such as 64Cu-liposomes can improve the visualization of head and neck tumors. Accumulation of liposomal particles in head and neck tumors over various pathologic grades averaged 3.5 %ID/cc demonstrating the potential for liposomal therapy with targeted chemotherapeutic agents. 相似文献7.
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Summary Background: Histologic immunomarkers of cell cycle proteins have been utilized for prognosis in high-grade astrocytic tumors. One such
marker, MIB1, an antibody immunoreactive throughout the cell cycle, is predictive of more aggressive disease and poorer prognosis
in astrocytomas. An independent role of MIB1 analysis for survival prediction and clinical management within histologic grades
has not been clearly proven.
Methods: This study retrospectively evaluated MIB1 reactivity in tissue samples from 116 patients with glioblastomas on initial medical
presentation. Clinical variables considered included gender, age, Karnofsky Performance Scores (KPS), extent of surgical resection,
adjuvant radiation and survival.
Results: Univariate and multivariate analyses were used to correlate these variables with MIB1 staining. MIB1 staining does not predict
overall survival or response to adjuvant therapy as an independent risk factor.
Conclusion: MIB1 labeling does not predict patient survival as an independent variable and does not predict response to additional therapies.
Patient survival with glioblastoma was predicted by KPS, age, extent of resection and use of adjuvant radiotherapy. 相似文献
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