RESUMO
Background: Bevacizumab is commonly used to manage cerebral edema associated with brain tumors. However, its long half-life poses challenges for patients requiring urgent surgery due to wound complications. We present a case of utilizing therapeutic plasma exchange (TPE) to remove bevacizumab in a patient with recurrent glioblastoma requiring urgent surgery. Methods: A 58-year-old male with recurrent glioblastoma, IDH-wildtype, presented with clinical and radiographic concern for ventriculitis requiring urgent wound washout only 4 days after his last bevacizumab infusion. TPE was performed for 3 sessions after surgery using a centrifugation-based cell separator. Replacement fluids included normal serum albumin, normal saline, and fresh frozen plasma. Bevacizumab levels were quantified using an enzyme-linked immunoabsorbent assay before and after each TPE session. Results: TPE effectively removed bevacizumab, enabling safe surgery without new complications. Plasma bevacizumab levels decreased from 1087.63 to 145.35 ng/mL (13.4% of original) by the end of the last TPE session. This decline is consistent with nearly 3 half-lives, which compares favorably to the expected timeline of natural decline given the 21-day half-life. Conclusions: We report a complex clinical scenario of a patient requiring urgent wound washout 4 days after last bevacizumab infusion for CNS infection. Surgery was successfully performed without new complications with use of TPE to remove bevacizumab immediately following surgery. This case highlights the feasibility of this approach, which may be utilized effectively in patients requiring surgery after having recently received bevacizumab.
RESUMO
The muzzle imprint mark characteristically associated with contact or near contact entrance gunshot wounds exemplifies one of the most informative external findings in forensic medical practice. The presence of the muzzle imprint mark on the body's surface proves ballistic trauma, point of entry, and range of fire. Moreover, its appearance and configuration may indicate the type of the involved weapon and the way the firearm had been positioned and held at the time of discharge. In this paper, we present the contact shot wound pattern of an 83-year-old man who committed suicide with a Frommer Stop 12â¯M autoloading pistol of caliber 7.65â¯mm Browning. Initially, the muzzle imprint mark configuration in relation to the entrance gunshot defect in the victim's right temple indicated an unusual application or orientation of the pistol's barrel during discharge, thus, strongly suggesting a non-suicidal act. However, a critical confrontation of postmortem findings along with the results of ballistic expertise provided a clear explanation, which comprised the remarkable construction and unique muzzle design of the used handgun.
