Asunto(s)
Anticuerpos Monoclonales Humanizados , Antineoplásicos Inmunológicos , Neoplasias Hepáticas , Melanoma , Neoplasias Cutáneas , Humanos , Anticuerpos Monoclonales Humanizados/efectos adversos , Anticuerpos Monoclonales Humanizados/uso terapéutico , Melanoma/tratamiento farmacológico , Melanoma/patología , Melanoma/secundario , Neoplasias Cutáneas/tratamiento farmacológico , Neoplasias Cutáneas/patología , Neoplasias Hepáticas/secundario , Neoplasias Hepáticas/tratamiento farmacológico , Antineoplásicos Inmunológicos/efectos adversos , Melanoma Cutáneo Maligno , Masculino , Rotura Espontánea/inducido químicamente , Femenino , Resultado Fatal , Persona de Mediana Edad , AncianoRESUMEN
Monoclonal antibodies against programmed cell death protein 1 (PD-1) and PD-1 ligand 1 (PD-L1) are the main representatives in the field of immunotherapy and their indications are constantly increasing in medical oncology and hematology during the last decade. They are associated with long-lasting responses and an acceptable toxicity profile, although they may infrequently cause life-threatening complications requiring prolonged hospitalization or urgent interventions. With the current report, we present the case of a 75-year-old woman diagnosed with stage IV lung adenocarcinoma, who developed acute abdominal pain without preceding symptomatology while on pembrolizumab-pemetrexed maintenance treatment. A contained rupture of the appendix was found, for which she was managed conservatively. Subsequent endoscopic as well as histopathological findings from biopsies obtained via colonoscopy associated the clinical and imaging findings with grade 4 immune-mediated colitis. Interestingly, high-grade colitis is more frequent with anti-CTLA-4 agents in comparison to anti-PD-1 agents; moreover, most cases of anti-PD-1-mediated colitis present with preceding symptomatology (like diarrhea or vomiting), while cases or colonic perforation are extremely rare if ever described.
Asunto(s)
Anticuerpos Monoclonales Humanizados/efectos adversos , Antineoplásicos Inmunológicos/efectos adversos , Apendicitis/inducido químicamente , Pemetrexed/uso terapéutico , Rotura Espontánea/inducido químicamente , Adenocarcinoma del Pulmón/tratamiento farmacológico , Anciano , Anticuerpos Monoclonales Humanizados/uso terapéutico , Antineoplásicos Inmunológicos/uso terapéutico , Femenino , Humanos , Neoplasias Pulmonares/tratamiento farmacológico , Estadificación de Neoplasias , Receptor de Muerte Celular Programada 1/antagonistas & inhibidoresRESUMEN
BACKGROUND: Uterine rupture in pregnancy is associated with severe maternal and fetal complications. Although it is a rare event, uterine rupture has been associated with certain risk factors. Glucocorticoids are known to weaken skeletal muscles; however, there have been no studies on the effects of chronic steroid use on the uterine myometrium. CASE: We present the case of a 40-year-old multigravid woman who experienced a posterior uterine wall rupture on an unscarred uterus. She was on chronic glucocorticoids for the treatment of psoriatic arthritis. We hypothesize that the catabolic effects of glucocorticoids on skeletal muscles also weakened the uterine myometrium, leading to a higher risk of uterine rupture. CONCLUSION: Uterine rupture may be associated with chronic use of corticosteroids. Identifying the different risk factors for uterine rupture can lead to more prompt diagnosis and management of uterine rupture, resulting in better maternal and fetal outcomes.
Asunto(s)
Artritis Psoriásica/tratamiento farmacológico , Glucocorticoides/efectos adversos , Rotura Espontánea/inducido químicamente , Rotura Uterina/inducido químicamente , Adulto , Femenino , Glucocorticoides/uso terapéutico , Humanos , Embarazo , Mujeres Embarazadas , Esteroides , ÚteroRESUMEN
A 59-year-old man who was receiving lenvatinib as a third-line tyrosine kinase inhibitor to treat hepatocellular carcinoma and multiple bone metastases complained of general fatigue four months after starting lenvatinib. A blood examination showed unexpectedly elevated serum C-reactive protein (CRP) levels. Computed tomography (CT) revealed rupture of the gallbladder wall, indicating gallbladder perforation. After conservative treatment, the patient received lenvatinib again under informed consent; however, one month later, CT revealed repeated rupture of the gallbladder wall. Gallbladder perforation had again been induced by lenvatinib. For this reason, lenvatinib is strongly considered a causative drug for gallbladder perforation.
Asunto(s)
Carcinoma Hepatocelular/tratamiento farmacológico , Enfermedades de la Vesícula Biliar/inducido químicamente , Neoplasias Hepáticas/tratamiento farmacológico , Compuestos de Fenilurea/efectos adversos , Inhibidores de Proteínas Quinasas/efectos adversos , Quinolinas/efectos adversos , Rotura Espontánea/inducido químicamente , Vesícula Biliar/patología , Humanos , Masculino , Persona de Mediana Edad , Compuestos de Fenilurea/uso terapéutico , Inhibidores de Proteínas Quinasas/uso terapéutico , Quinolinas/uso terapéutico , Tomografía Computarizada por Rayos XRESUMEN
Simple hepatic cysts are usually asymptomatic but can rarely result in life-threatening complications such as haemoperitoneum secondary to rupture. A 70-year-old woman with known simple hepatic cyst presented with acute chest pain and dyspnoea. The initial diagnosis was pulmonary embolism, and anticoagulation was commenced. However, she subsequently collapsed with haemodynamic instability. CT revealed a large hepatic cyst haematoma with rupture into the peritoneal cavity. The patient underwent emergency laparotomy, haemostasis and partial deroofing of the cyst. Retrospective review of CT scans suggested that the bleed had begun on presentation but was exacerbated by anticoagulation. To our knowledge, this is the first report of haemorrhagic hepatic cyst associated with acute anticoagulation. We discuss several important clinical lessons including cyst rupture as a possible cause of chest pain, the need for careful review of imaging and the choice of anticoagulation in patients with known simple hepatic cyst.
Asunto(s)
Anticoagulantes/efectos adversos , Hemoperitoneo/etiología , Rotura Espontánea/inducido químicamente , Anciano , Dolor en el Pecho , Quistes/diagnóstico por imagen , Quistes/cirugía , Diagnóstico Diferencial , Disnea , Femenino , Hemoperitoneo/diagnóstico por imagen , Hemoperitoneo/cirugía , Humanos , Hepatopatías/diagnóstico por imagen , Hepatopatías/cirugía , Rotura Espontánea/diagnóstico por imagen , Rotura Espontánea/cirugíaRESUMEN
INTRODUCTION: According to SIOP criteria, every patient presenting with preoperative Wilms tumor (WT) rupture must receive abdominal radiotherapy. Neoadjuvant chemotherapy reduces tumor volume and is responsible for the development of peritumoral capsule formation, which can mask tumor rupture on histological analysis, while it was clinically or radiologically obvious at diagnosis. Yet, there are no protocol recommendations for this particular presentation. OBJECTIVES: Study the agreement between clinicoradiological signs and histological confirmation after neoadjuvant chemotherapy of suspected WT rupture and describe the therapeutic choices arising in consequence. METHODS: Descriptive retrospective study on a monocentric series of patients with WT between June 1991 and August 2017. RESULTS: Out of 71 patients, 28 presented with suspected tumor rupture. We observed good agreement between clinical and radiological signs of suspected rupture (κ coefficient: 0.67). However, we assessed poor agreement between these signs and histological conclusions after neoadjuvant chemotherapy (κ coefficient: 0.27). Only five patients with clinicoradiological signs were overtreated with radiotherapy while tumor rupture had been refuted after histological review. The notion of abdominal trauma and the presence of intraperitoneal effusion seemed to guide collegial decision to overtreat these patients. No statistical difference in survival between patients with and without suspicion of tumor rupture at diagnosis was observed. CONCLUSION: This study highlights the need for recommendations in case of discrepancy between radiological and histological signs of rupture at diagnosis and after neoadjuvant chemotherapy. A study with stronger statistical power is necessary to define criteria that would lead to optimization of treatment in this context.
Asunto(s)
Protocolos de Quimioterapia Combinada Antineoplásica/efectos adversos , Neoplasias Renales/tratamiento farmacológico , Terapia Neoadyuvante/efectos adversos , Recurrencia Local de Neoplasia/tratamiento farmacológico , Rotura Espontánea/diagnóstico , Tomografía Computarizada por Rayos X/métodos , Tumor de Wilms/tratamiento farmacológico , Quimioterapia Adyuvante/efectos adversos , Niño , Preescolar , Femenino , Estudios de Seguimiento , Humanos , Lactante , Neoplasias Renales/secundario , Masculino , Recurrencia Local de Neoplasia/patología , Pronóstico , Estudios Retrospectivos , Rotura Espontánea/inducido químicamente , Rotura Espontánea/diagnóstico por imagen , Tasa de Supervivencia , Carga Tumoral , Tumor de Wilms/patologíaRESUMEN
In the prevention and treatment of thromboembolic disease, novel oral anticoagulants have emerged as alternatives to warfarin. A major challenge continues to be the reversal of their anticoagulant effect in the case of life-threatening haemorrhagic complications. We report a case of spontaneous splenic rupture treated by splenic artery embolisation in a 77-year-old woman who was anticoagulated with rivaroxaban.
Asunto(s)
Inhibidores del Factor Xa/efectos adversos , Rivaroxabán/efectos adversos , Rotura del Bazo/inducido químicamente , Anciano , Fibrilación Atrial/tratamiento farmacológico , Femenino , Hemorragia/etiología , Humanos , Rotura Espontánea/inducido químicamente , Arteria Esplénica/cirugía , Rotura del Bazo/diagnóstico por imagen , Rotura del Bazo/cirugíaAsunto(s)
Hepatitis C/complicaciones , Rotura Espontánea/inducido químicamente , Rotura del Bazo/diagnóstico por imagen , Rotura del Bazo/etiología , Trastornos Relacionados con Sustancias/complicaciones , Adulto , Humanos , Masculino , Rotura Espontánea/complicaciones , Rotura Espontánea/cirugía , Esplenectomía/métodos , Rotura del Bazo/patología , Rotura del Bazo/cirugía , Tomografía Computarizada por Rayos X/métodos , Ultrasonografía Doppler/métodosRESUMEN
Atraumatic spontaneous Achilles tendon ruptures sometimes occur in patients receiving oral corticosteroids. In general, these cases are treated surgically; however, delayed postoperative management can lead to impaired activities of daily living. The modified side-locking loop suture (SLLS) technique is a useful suture method for safe and early active mobilization. Three cases of spontaneous Achilles tendon ruptures were treated with the modified SLLS technique with good clinical results. The modified SLLS technique is a useful method with a short rehabilitation period for treating atraumatic spontaneous Achilles tendon rupture in patients undergoing corticosteroid therapy.
Asunto(s)
Tendón Calcáneo/cirugía , Corticoesteroides/efectos adversos , Procedimientos Ortopédicos/métodos , Técnicas de Sutura , Cicatrización de Heridas/fisiología , Corticoesteroides/uso terapéutico , Ambulación Precoz , Humanos , Imagen por Resonancia Magnética/métodos , Masculino , Persona de Mediana Edad , Dimensión del Dolor , Pronóstico , Medición de Riesgo , Rotura Espontánea/inducido químicamente , Rotura Espontánea/diagnóstico por imagen , Rotura Espontánea/cirugía , Muestreo , Resultado del TratamientoRESUMEN
OBJECTIVE: To evaluate the current evidence and to identify associated risk factors that increase the incidence of this complication. Fluoroquinolone (FQ) has been considered the first-line therapy for uncomplicated urinary infections. FQ has been associated with Achilles tendon disorders, especially during the first month of treatment. METHODS: Data sources searched included PubMed, MEDLINE, and Scopus from January 1988 to June 2017. RESULTS: A total of 79 articles were used, with ciprofloxacin representing the most common drug. CONCLUSION: We found that male gender, advanced age, normal body mass index, chronic renal failure, and concurrent use of corticosteroids increase the risk of Achilles tendon disorders.
Asunto(s)
Tendón Calcáneo/lesiones , Fluoroquinolonas/efectos adversos , Tendinopatía/inducido químicamente , Tendinopatía/epidemiología , Infecciones Urinarias/tratamiento farmacológico , Tendón Calcáneo/patología , Adulto , Factores de Edad , Estudios de Casos y Controles , Femenino , Fluoroquinolonas/uso terapéutico , Estudios de Seguimiento , Humanos , Incidencia , Masculino , Persona de Mediana Edad , Estudios Retrospectivos , Rotura Espontánea/inducido químicamente , Rotura Espontánea/epidemiología , Índice de Severidad de la Enfermedad , Factores Sexuales , Tendinopatía/fisiopatología , Infecciones Urinarias/diagnósticoAsunto(s)
Anticoagulantes/efectos adversos , Enoxaparina/efectos adversos , Hipotensión/etiología , Choque/etiología , Rotura del Bazo/inducido químicamente , Humanos , Hipotensión/diagnóstico , Masculino , Persona de Mediana Edad , Rotura Espontánea/inducido químicamente , Choque/diagnóstico , Bazo/diagnóstico por imagen , Bazo/efectos de los fármacos , Rotura del Bazo/complicaciones , Tomografía Computarizada por Rayos X , Trombosis de la Vena/tratamiento farmacológicoRESUMEN
INTRODUCTION: Case reports and pharmacovigilance data reported cases of tendon ruptures in statin users, but evidence from observational studies is scarce and inconclusive. We aimed to assess the association between new statin use and tendon rupture. METHODS: We performed a propensity score (PS)-matched sequential cohort study, using data from the Clinical Practice Research Datalink. Patients aged ≥45 years with at least one new statin prescription between 1995 and 2014 were PS-matched within 2-year entry blocks to patients without a statin prescription during the block. We followed patients until they had a recorded Achilles or biceps tendon rupture, completed 5 years of follow-up, or were censored for change in exposure status or another censoring criterion. We calculated hazard ratios (HRs) with 95 % confidence intervals (CIs), applying Cox proportional hazard analyses in the overall cohort (crude and multivariable) and in the PS-matched cohort. We performed subgroup analyses by sex, age, treatment duration, and statin dose. RESULTS: We observed a crude HR of 1.32 (95 % CI 1.21-1.44) in the overall cohort, which attenuated after multivariable adjustment (HR 1.02, 95 % CI 0.92-1.12) and after PS-matching (HR 0.95, 95 % CI 0.84-1.08). Crude HRs were higher in women than in men, but remained around null in both sexes after multivariable adjustment and PS-matching. Subgroup analyses by age, treatment duration, and statin dose revealed null results across all subgroups. CONCLUSION: The results of this cohort study suggest that statin use does not increase the risk of tendon rupture, irrespective of gender, age, statin dose, or treatment duration.
Asunto(s)
Tendones Isquiotibiales/lesiones , Inhibidores de Hidroximetilglutaril-CoA Reductasas/efectos adversos , Sistemas de Registro de Reacción Adversa a Medicamentos , Anciano , Estudios de Cohortes , Femenino , Humanos , Masculino , Persona de Mediana Edad , Estudios Observacionales como Asunto , Puntaje de Propensión , Medición de Riesgo , Rotura Espontánea/inducido químicamente , Rotura Espontánea/epidemiología , Reino Unido/epidemiologíaAsunto(s)
Alopurinol/efectos adversos , Erupciones por Medicamentos/etiología , Síndrome de Hipersensibilidad a Medicamentos/complicaciones , Eosinofilia/inducido químicamente , Miocarditis/inducido químicamente , Músculos Papilares/lesiones , Anciano , Síndrome de Hipersensibilidad a Medicamentos/patología , Eosinofilia/patología , Femenino , Humanos , Miocarditis/patología , Músculos Papilares/patología , Rotura Espontánea/inducido químicamente , Rotura Espontánea/patologíaAsunto(s)
Anestesia General , Lesiones Oculares/etiología , Lesiones Oculares/cirugía , Reflejo Oculocardíaco , Rotura Espontánea/terapia , Anciano , Neoplasias del Colon/cirugía , Humanos , Masculino , Rotura Espontánea/inducido químicamente , Taquicardia Sinusal/complicaciones , Taquicardia Sinusal/etiología , Trastornos de la Visión/etiologíaRESUMEN
Liver cysts are commonly found incidentally from imaging scans or at autopsy. These benign neoplasms vary in size and represent a heterogeneous group of disorders, for which the demographics, risk factors, apparent inciting event, clinical presentation, and outcome are varied. Complications that can develop from a liver cyst include development of spontaneous hemorrhage, infection, and/or obstruction. Although the etiology of liver cysts varies, fatal rupture of a hemorrhagic liver cyst due to anabolic steroid use is a rare occurrence. In fact, there are few reported cases in journal literature. We report a case of a fatal liver cyst rupture with resultant hemoperitoneum in the presence of anabolic steroid (stanozolol) use.
Asunto(s)
Anabolizantes/efectos adversos , Quistes , Hemoperitoneo/etiología , Hepatopatías , Estanozolol/efectos adversos , Anabolizantes/administración & dosificación , Anabolizantes/sangre , Resultado Fatal , Humanos , Hígado/patología , Masculino , Rotura Espontánea/inducido químicamente , Estanozolol/administración & dosificación , Estanozolol/sangre , Adulto JovenRESUMEN
Corticosteroid injections are widely used to treat enthesopathy and tendinitis, but are also associated with possible side effects, such as tendon degeneration or rupture. However, the mechanism of tendon degeneration or rupture after corticosteroid injection remains controversial. The purpose of this study was to reveal the mechanism of tendon degeneration or rupture after injection of triamcinolone acetonide (TA) or prednisolone (PSL). Forty-two rats were divided into 3 groups: A normal saline injection group (control group), a TA injection group, and a PSL injection group; the normal saline or corticosteroid was injected around the Achilles tendon. One or 3 weeks after injection, the tendons were subjected to biomechanical testing and histological analysis. At 1 week, the biomechanical strength was significantly lower in the corticosteroid groups. Histological analysis, at 1-week post-injection, showed collagen attenuation, increased expression of MMP-3 and apoptotic cells in the corticosteroid groups. The histological changes and biomechanical weaknesses of the tendon were not seen at 3 weeks. These alterations appeared to be involved in tendon degeneration or rupture after corticosteroid injection.
Asunto(s)
Apoptosis/efectos de los fármacos , Glucocorticoides/efectos adversos , Metaloproteinasa 3 de la Matriz/genética , Traumatismos de los Tendones/inducido químicamente , Tendón Calcáneo/efectos de los fármacos , Tendón Calcáneo/patología , Animales , Apoptosis/genética , Fenómenos Biomecánicos , Glucocorticoides/administración & dosificación , Inyecciones Intraarticulares/efectos adversos , Masculino , Metaloproteinasa 3 de la Matriz/biosíntesis , Prednisolona/administración & dosificación , Prednisolona/efectos adversos , Distribución Aleatoria , Ratas , Ratas Sprague-Dawley , Rotura Espontánea/inducido químicamente , Rotura Espontánea/enzimología , Traumatismos de los Tendones/enzimología , Triamcinolona/administración & dosificación , Triamcinolona/efectos adversosAsunto(s)
Anticoagulantes/efectos adversos , Morfolinas/efectos adversos , Enfermedades del Bazo/inducido químicamente , Tiofenos/efectos adversos , Dolor Abdominal/etiología , Anciano , Anticoagulantes/uso terapéutico , Fibrilación Atrial/tratamiento farmacológico , Servicio de Urgencia en Hospital , Humanos , Masculino , Morfolinas/uso terapéutico , Rivaroxabán , Rotura Espontánea/inducido químicamente , Rotura Espontánea/complicaciones , Choque Hemorrágico/etiología , Enfermedades del Bazo/complicaciones , Accidente Cerebrovascular/prevención & control , Tiofenos/uso terapéuticoRESUMEN
A 66-year-old woman with advanced Parkinson disease (PD) was referred to our center for an adjustment of her antiparkinsonian medication. To reduce daily off-time, we introduced rasagiline 1 mg/d. Three days after starting this new treatment, she presented with intense arthralgia that symmetrically affected the shoulders, hands, and hips without myalgia. Ten days later, while walking, she experienced acute pain on the inner side of her right thigh, with the absence of any trauma. Findings of ultrasonography confirming the diagnosis of partial avulsion of the right harmstrings. Rasagiline was stopped immediately, and the arthralgia disappeared within 48 hours and did not recur. To our knowledge, this is the first reported case of a spontaneous tendon rupture possibly caused by rasagiline. Our observation emphasizes that, although often well tolerated, rasagiline may cause muscle and joint complications that could increase disability in patients with PD.