子宫动脉灌注化疗栓塞治疗宫角妊娠的临床观察

目的 探讨子宫动脉灌注甲氨喋呤加明胶海绵颗粒栓塞术对宫角妊娠治疗的临床效果.方法 回顾性分析宫角妊娠36例患者的临床资料,所有患者均经子宫动脉灌注甲氨喋呤100 mg,再予以明胶海绵颗粒栓塞阻断双侧子宫动脉血流,以及其终末端分支血流.结果 35例患者经治疗后妊娠囊自然流产或吸收,患者均未出现明显骨髓抑制和肝肾功能损害等不良反应,仅部分出现轻微的栓塞综合征.行子宫动脉灌注化疗栓塞治疗后4～11周血β-HCG降至正常,6 ～13周经阴道超声检查孕囊消失.1例患者因孕囊过大,于治疗后2周子宫内见孕囊及胎心搏动,血β-HCG为12467.7 IU/L,超声引导下孕囊内注入甲氨喋呤80 mg后2d在宫腔镜下行清宫术.结论 子宫动脉灌注甲氨喋呤化疗加明胶海绵颗粒栓塞术治疗宫角妊娠的手术创伤小,术后恢复快,可降低切除子宫的风险,较大程度上保留了患者的生育功能,是一种治疗宫角妊娠有效的保守措施.     

The Absence of HIV Mutations in Cerebrospinal Fluid and in Peripheral Blood Mononuclear Cells During a Regimen Containing Trizivir Plus Tenofovir

Abstract

Methotrexate (MTX) is widely used in the treatment of hematological diseases. The typical side-effects of high-dose MTX chemotherapy on the CNS range from asymptomatic white matter changes to severe CNS demyelination. MTX neuro - toxicity has been described to be associated with homocysteine and folate levels as well as genetic variants affecting methionine metabolism. Here we describe a case of severe, acute MTX-induced encephalopathy in a patient who was found to be homozygous for the rare missense variant methionine synthase (MTR) c.2756A>G (D919G), which may have modified the effect of MTX on homocysteine metabolism. This finding encourages further studies to determine to what extent the individual conditions of folate and methionine metabolism influence the effects or side-effects of MTX treatment.     

More than skin deep

We present the case of a woman in her 50s with past medical history significant for psoriasis treated with methotrexate on a stable dose for the past 20?years, diabetes mellitus and chronic kidney disease. In the setting of a long flight, dehydration and non steroidal anti-inflammatory drug consumption, the patient presented to the emergency department with oral mucositis and cutaneous erosions and ulcers of the psoriasis plaques. MTX levels were normal corroborated by three different measurements in 24?h. Initially the complete blood count tests were significant for macrocytic, thrombocytopenia (82.000 10³/L) and impaired kidney function. The patient was diagnosed of acute methotrexate toxicity and started on intravenous folinic acid. In 24?h the patient developed severe pancytopenia. She required treatment with colony-stimulating factors, platelet and blood transfusions. After 10?days, the CBC improved to normal levels and the cutaneous lesions resolved.     

Tc-99m diethylenetriamine pentaacetic acid (DTPA): Is it reliable for assessment of methotrexate-induced cumulative effect on renal filtration in rheumatoid arthritis patients?

Methotrexate[MTX] is commonly employed as the initial DMARD used for treatment of Rheumatoid arthritis[RA]. We aimed to contribute to the safety profile of MTX by assessing its cumulative effect on renal filtration. Fifty two RA adult females with normal base-line serum creatinine and GFR at the initial diagnosis of the disease were included. Group-1[G1] included 30 patients[mean age 40.4 ± 4.4 years] on MTX and NSAIDS, while 22 RA patients[mean age 38.5 ± 8.2 years] who received NSAIDs only served as the control group[G2]. Renal function was assessed by GFR-measurement using Technetium diethylenetriamine-pentaacetic acid[Tc-99 m-DTPA] at the point of the study time corresponding to disease duration. 21/30[70%] in G1 showed reduced GFR compared to 6/22[27.3%] in G2[P0.007] with 3.3 ± 0.5% annual reduction of GFR. Reduced GFR in G1 showed significant negative correlation with age[r = ?0.396, P = 0.005], MTX-cumulative dose[r = ?0.263, P = 0.049], MTX-intake duration[r = ?0.293, P = 0.031] and NSAID-intake duration[r = ?0.344, P = 0.014]. Low dose MTX has a slow cumulative effect on renal filtration manifested by GFR reduction over time that could be monitored by Tc-99 m DTPA.     

Metotrexato: novedades terapéuticas

Although the first study on the efficacy of methotrexate in the treatment of psoriasis was reported in 1958, scientific evidence for this indication has been scant until quite recently. We now have new data on the pharmacokinetics and mechanism of action of methotrexate and new subcutaneous formulations that have improved the bioavailability, efficacy, and ease of administration of the drug. The results of recent clinical trials comparing methotrexate with several biologic agents have shown it to be the first-line therapy among the classic systemic treatments for psoriasis. Moreover, the incremental cost-effectiveness ratio for subcutaneous methotrexate has been shown to be superior to that of ciclosporin, adalimumab, and infliximab.     

大剂量甲氨蝶呤在急性淋巴细胞白血病应用后两种解毒方法的比较

目的探讨大剂量甲氨蝶呤(MTX)治疗急性淋巴细胞白血病的有效解救方法。方法选取我院收治的急性淋巴细胞白血病患者45例,随机分成观察组(23例)和对照组(22例)。45例患者均应用大剂量MTX进行治疗,观察组患者监测血药浓度并随时调整解救药的剂量,对照组患者应用固定剂量的解救药进行解救。比较两组患者不良反应的发生情况。结果观察组皮肤黏膜损害、胃肠道反应、肝功能损害、肾功能损害、骨髓抑制的发生率均低于对照组,且两组胃肠道反应、肝功能损害、骨髓抑制发生率的差异具有统计学意义(P<0.05)。结论在应用大剂量MTX进行治疗的过程中进行血药浓度的密切监测并及时调整解救药浓度能够达到更好的治疗效果。     

Evaluation of toxicity after acute accidental methotrexate ingestions in children under 6 years old: a 16-year multi-center review

Context: There is little data on the frequency of adverse events following acute methotrexate ingestions in pediatric patients. Likewise, recommendations for observation length, site and management strategies in this population are not well established. Therefore, most recommendations are modeled after management of chronic overdose in patients with underlying medical conditions.

Objective: The primary objective of this study is to determine the frequency of acute toxicity after acute methotrexate accidental unsupervised ingestions in patients less than six years. In addition, we describe the frequency of late toxicity and characterize the management site and approaches.

Materials and Methods: This is a retrospective cohort study of pediatric accidental unsupervised methotrexate ingestions reported to six poison centers in the United States over a 16 year period. Demographic information, exposure details, signs, symptoms, treatments, length and location of observation and outcomes were collected.

Results: 103 patients met inclusion criteria. Methotrexate dose was reported in 86 patients (84%) and ranged from 1.3?mg–75?mg. The majority of cases (97%) ingested a dose ≤20?mg. The significant majority of cases experienced no clinical effects (99 of 103 cases; 96%). Three children experienced minor outcome (3%). There were no patients with a major outcome or death.

Conclusions: The incidence of toxicity from pediatric single, acute ingestions of methotrexate is rare and when it occurs is generally limited to no or only minimally concerning effects. Because concentrations from single ingestions were consistent with low subtoxic exposures, we believe that home monitoring without hospital referral and without methotrexate specific therapy is reasonable in those with acute ingestions up to 20?mg.     

甲氨蝶呤局部注射治疗剖宫产术后子宫瘢痕妊娠的临床效果分析

目的 研究甲氨蝶呤局部注射治疗剖宫产术后子宫瘢痕妊娠的临床效果.方法 选择2007年1月～2013年12月本院收治的30例子宫瘢痕妊娠患者作为研究对象,依照患者个人意愿将其分为两组,对照组15例采用天花粉宫颈注射进行治疗,实验组15例采用甲氨蝶呤局部注射进行治疗,对比和分析两组的治疗效果.结果 实验组的治愈率为100.00％,对照组的治愈率为40.00％,实验组的临床治疗效果明显优于对照组,差异有统计学意义（P＜0.05）.实验组的HCG下降至正常时间及住院时间均短于对照组,差异有统计学意义（P＜0.05）.结论 甲氨蝶呤局部注射是一种非常有利于治疗剖宫产术后子宫瘢痕妊娠的临床手段,疗效显著,值得临床推广应用.