Toxic cardiogenic shock in a patient receiving weekly 24-h infusion of high-dose 5-fluorouracil and leucovorin

A 54-year-old man was treated with weekly 24-h infusion of high-dose 5-fluorouracil (2600 mg/m2) and leucovorin (100 mg/m2) for metastatic colon cancer. At first, he tolerated the treatment well and no significant toxicity was identified. After a total of eight courses of treatment, a stable disease was observed, but mild shortness of breath was found on occasion. The patient had no previous history of cardiac disease and the heart performance assessed by left ventricular ejection fraction before treatment was normal. Unfortunately, acute pulmonary edema with lethal cardiogenic shock occurred during the ninth course of treatment, in spite of intensive medical treatment. The chest X-ray showed extreme cardiomegaly. Repeated assessment of his heart function by echocardiogram and ventricular ejection fraction revealed a very poor cardiac performance. Toxic cardiogenic shock during weekly 24-h infusion of high-dose 5-fluorouracil and leucovorin is extremely rare. To the best of our knowledge, no case has been reported in the English literature. We report a case and the relevant literature about the incidence, clinical picture and possible pathophysiology on 5-fluorouracil-related cardioxicity is reviewed.      

Child Abuse and Disability in an Ontario Community Sample: Does Social Capital Matter?

Researchers have established a link between abuse and disability, but most abused individuals do not experience disability. While some survivors are severely harmed by their experiences of abuse, other survivors of similar exposure appear to have no long-term health problems. Can the presence of social capital account for these differences? Cross-sectional data from the Ontario Health Supplement were used to assess the association between child abuse, age, social capital (social connections and disruptions in living circumstances and relationships), cultural capital (education and occupation) and financial capital (money) and disability in a female community sample (n=4238). The results suggest that abuse (physical and sexual) and financial capital are associated with disability, but not social capital.     

Type a Behavior and Cardiovascular Recovery from a Psychosocial Stressor

Abstract

The present study examined heart rate responses of Type A and Type B individuals during and after performance on the Stroop perceptual conflict task. The student version of the Jenkins Activity Survey was administered to thirty-two male Caucasians, who then performed the Stroop task for six minutes under conditions that emphasized time urgency and competition. Results showed that Type A's recovered significantly slower than Type B's after task completion. Type A's, compared to Type B's reported feeling more angry, time pressured, and impatient. The notion that Type A individuals may be at higher risk for coronary heart disease because of maladaptively prolonged cardiovascular arousal was discussed.