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1.
Cancer Med ; 13(4): e6839, 2024 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-38457231

RESUMO

BACKGROUND: Mannitol is exclusively recommended in the National Comprehensive Cancer Network guidelines for diuresis in cisplatin (CDDP)-based chemotherapy. The utility of furosemide, a widely used and convenient diuretic, thus requires clarification. METHODS: This is a prospective, single-centered, open-label, noninferiority phase II study. Patients with thoracic malignancies who planned to receive CDDP-based chemotherapy were randomly assigned to receive either mannitol (arm A) or furosemide (arm B). The primary end point was set as the proportion of patients who experienced any grade of "creatinine (Cr) increased" based on the upper limit of the normal range (ULN) during the first cycle as assessed by Common Terminology Criteria for Adverse Events Version 4.0. Secondary end points were Cr increased based on the baseline value during the first cycle, Cr increased after the completion of CDDP, and the proportion of patients with phlebitis. RESULTS: Between April 2018 and March 2022, 115 patients were enrolled and 106 were analyzed. Any grade of Cr increased based on the ULN during the first cycle was 17.3% (arm A) and 24.1% (arm B), respectively (p = 0.34). Therefore, the primary end point was not met. After completion of chemotherapy, any grade of Cr increased was observed in 23.1% (arm A) and 31.5% (arm B), respectively. However, the actual serum Cr level and Cr clearance during the courses were not different between the arms. Phlebitis occurred more frequently in arm A (28.8%) than arm B (16.7%). CONCLUSIONS: Mannitol should remain the standard diuresis in CDDP-based chemotherapy assessed by conventional CTCAE grading, but furosemide can be room for consideration when assessed by actual serum Cr level and Cr clearance.


Assuntos
Flebite , Neoplasias Torácicas , Humanos , Cisplatino/efeitos adversos , Furosemida/efeitos adversos , Manitol/efeitos adversos , Flebite/induzido quimicamente , Flebite/tratamento farmacológico , Estudos Prospectivos
2.
BMJ Open ; 13(12): e073557, 2023 12 07.
Artigo em Inglês | MEDLINE | ID: mdl-38149412

RESUMO

OBJECTIVES: Whether the glucose-insulin-potassium (GIK) should be used as an adjuvant therapy for ischaemic myocardial disease remains controversial nowadays reperfusion era. This meta-analysis aimed to assess the effects of preinitiated GIK for patients undergoing planned percutaneous coronary intervention (PCI). DESIGN: Systematic review and meta-analysis. DATA SOURCES: PubMed, Web of science, MEDLINE, Embase, Cochrane Library and ClinicalTrials.gov were searched through 27 November 2022. ELIGIBILITY CRITERIA: Only randomised controlled trials involving participants preinitiated with GIK or placebo before planned PCI were included. DATA EXTRACTION AND SYNTHESIS: Two independent reviewers used standardised methods to search, screen and code included trials. Risk of bias was assessed with the Cochrane tool. Pooled analysis was conducted using random or effects models according to the heterogeneity. Subgroup analyses were carried out for dosage of GIK and if with ongoing myocardial ischaemia. RESULTS: 13 randomised controlled trials (RCTs) including 3754 participants were evaluated. We found patients preconditioned with GIK before PCI showed a significant increase in Thrombolysis in Myocardial Infarction 3 flow events after angioplasty (OR 1.59, 95% CI 1.03 to 2.46, p=0.04), also revealed improved in-hospital left ventricular ejection fraction (weighed mean difference, WMD 1.62, 95% CI 0.21 to 3.03, p=0.02) and myocardial salvage index (WMD 0.09, 95% CI 0.01 to 0.16, p=0.03). Nevertheless, no benefit was observed in all-cause mortality neither on 30-day (OR 0.81, 95% CI 0.59 to 1.11, p=0.18) nor 6 months (OR 1.02, 95% CI 0.42 to 2.46, p=0.97). Furthermore, GIK intervention was associated with higher occurrences of complications such as phlebitis (OR 10.13, 95% CI 1.74 to 59.00, p=0.01) and hypoglycaemia (OR 10.43, 95% CI 1.32 to 82.29, p=0.03), but not hyperkalaemia (OR 9.36, 95% CI 0.50 to 175.27, p=0.13), liquid overload (OR 1.02, 95% CI 0.25 to 4.13, p=0.98) or in-hospital heart failure (OR 0.42, 95% CI 0.06 to 2.96, p=0.39). CONCLUSIONS: Our study shows preconditioning GIK exhibits myocardial reperfusion and cardiac function benefits for patients planning to receive PCI intervention, while also some complications such as phlebitis and hypoglycaemia accompany. PROSPERO REGISTRATION NUMBER: CRD42022326334.


Assuntos
Hipoglicemia , Insulinas , Intervenção Coronária Percutânea , Flebite , Humanos , Potássio/uso terapêutico , Glucose/uso terapêutico , Hipoglicemia/tratamento farmacológico , Flebite/tratamento farmacológico , Ensaios Clínicos Controlados Aleatórios como Assunto
3.
Zhonghua Kou Qiang Yi Xue Za Zhi ; 58(8): 815-820, 2023 Aug 09.
Artigo em Chinês | MEDLINE | ID: mdl-37550042

RESUMO

Objective: To analyze the clinicopathological characteristics of IgG4-related sialadenitis (IgG4-RS). Methods: A total of 40 cases diagnosed with IgG4-RS were collected from the Department of Oral Pathology, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine from January 2019 to December 2022. Among them, there were 26 males and 14 females. The age range was 29-77 years old [(59.4±11.8) years old], with 23 patients being older than 60 years. The lesion site, imaging manifestations, histopathological features, serological test and treatment information of patients were collected. The expression of IgG4 and IgG proteins was detected by immunohistochemistry. Results: Submandibular region swelling was the most common initial symptom of IgG4-RS (38/40, 95.0%). All the patients having serum IgG4 levels> 1.35 g/L. Serum IgG4 levels were significantly increased in patients aged>60 years (Z=-2.45, P=0.014) and those involving multiple glands (Z=-2.04, P=0.042). Thirty six cases received major salivary gland biopsy, and all the cases showed dense lymphocyte and plasma cell infiltration. Lymphoid follicle, storiform fibrosis and obliterative phlebitis were seen in 88.9% (32/36), 63.9% (23/36), 30.6% (11/36) of the cases, respectively. Twenty one cases received labial salivary gland biopsy, 66.7% (14/21) showed lymphocyte and plasma cell infiltration, 19.0% (4/21) had lymphoid follicle structures, and 33.3% (7/21) showed no obvious histological abnormalities. No signs of fibrosis or obliterative phlebitis were observed in all labial salivary gland biopsies. And 95.0% (38/40) of cases had IgG4 positive plasma cell>10/HPF, 82.5% (33/40) of cases had IgG4/IgG positive plasma cell ratio>40%. All the patients had a decrease in serum IgG4 levels after glucocorticoid treatment, but only 21.4% (6/28) of cases had reduced to normal levels (≤1.35 g/L), and there were still significant fluctuations in serum IgG4 levels thereafter. Conclusions: IgG4-RS has a predilection for middle-aged and elderly male patients, and serum IgG4 levels are significantly related to the patient's age and whether multiple glands are involved. Labial salivary gland biopsy cannot replace submandibular gland for histopathological evaluation. It is a common phenomenon that serum IgG4 levels cannot restored to normal levels after glucocorticoid treatment. This study provides certain assistance for clinical and pathological diagnosis of IgG4-RS. This study is beneficial for further understanding IgG4-RS and improving the clinical and pathological diagnosis of the disease.


Assuntos
Flebite , Sialadenite , Pessoa de Meia-Idade , Idoso , Feminino , Humanos , Masculino , Adulto , Glucocorticoides , Imunoglobulina G/uso terapêutico , China , Sialadenite/diagnóstico , Sialadenite/patologia , Inflamação/tratamento farmacológico , Fibrose , Flebite/tratamento farmacológico
4.
Eur J Oncol Nurs ; 64: 102322, 2023 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-37141665

RESUMO

OBJECTIVE: To establish the incidence and severity of chemotherapy-induced phlebitis (CIP) following administration of epirubicin chemotherapy using a volumetric infusion pump (Hospira Plum 360), compared to a previous study of manual injection of epirubicin. Also the study aimed to gain insight into staff perceptions of ease of use and safety of infusion pump administration. METHODS: An observational study of women with breast cancer (n = 47) receiving epirubicin via volumetric infusion pump. Phlebitis was reported through a participant self-assessment questionnaire and graded by clinical assessment three weeks after each chemotherapy cycle. Staff perceptions were explored using questionnaires. RESULTS: Infusion pump administration delivered a significantly higher concentration of epirubicin (p < 0.001), a significantly higher rate of grade 3 and 4 participant reported CIP between cycles (p = 0.003) but demonstrated no significant difference in grade 3 and 4 CIP when assessed clinically three weeks after treatment (p = 0.157). CONCLUSION: Peripheral epirubicin administration will result in severe CIP being experienced by a proportion of patients irrespective of whether infusion pump or manual injection method is used. Those at high risk of severe CIP should be informed of the risk and offered a central line. For those with a lower risk of severe phlebitis use of the infusion pump appears to be a safe option.


Assuntos
Antineoplásicos , Neoplasias da Mama , Flebite , Humanos , Feminino , Epirubicina/efeitos adversos , Neoplasias da Mama/tratamento farmacológico , Neoplasias da Mama/complicações , Flebite/induzido quimicamente , Flebite/epidemiologia , Flebite/tratamento farmacológico , Bombas de Infusão/efeitos adversos , Antineoplásicos/efeitos adversos , Protocolos de Quimioterapia Combinada Antineoplásica/efeitos adversos
5.
Asian Pac J Cancer Prev ; 24(4): 1113-1117, 2023 Apr 01.
Artigo em Inglês | MEDLINE | ID: mdl-37116130

RESUMO

BACKGROUND: Phlebitis is a severe inflammatory response in patients undergoing chemotherapy that can lead to complications and increased length of hospitalization. OBJECTIVE: This study was conducted to examine the effects of sesame oil and nitroglycerin ointment on the incidence of chemotherapy-induced phlebitis in patients with cancer.  Methods: This clinical trial study involved 138 cancer patients who were randomly assigned into three groups. The three groups received nitroglycerin ointment, sesame oil, or betadine alcoholic solution that were applied on the distal catheter area at a length of 1.5 centimeters and width of 2 × 4 cm using graded paper. The site was then dressed and fixed with anti-allergenic adhesives. The research samples were examined for 72 hours for the incidence of phlebitis. RESULTS: No statistically significant difference was observed between the incidence of phlebitis in the sesame oil, nitroglycerin ointment and alcohol-betadine groups in the first 24 hours (p=0.2), the second 24 hours (p=0.13) and the third 24 hours (p=0.13). CONCLUSION: External use of both sesame oil and nitroglycerin is effective in reducing chemotherapy-induced phlebitis. Due to its anti-inflammatory effect and low cost, however, using sesame oil is recommended.


Assuntos
Antineoplásicos , Flebite , Humanos , Nitroglicerina/efeitos adversos , Óleo de Gergelim , Incidência , Pomadas , Povidona-Iodo , Método Simples-Cego , Administração Tópica , Flebite/induzido quimicamente , Flebite/tratamento farmacológico , Flebite/epidemiologia , Antineoplásicos/uso terapêutico
6.
J Oncol Pharm Pract ; 29(8): 1944-1950, 2023 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-36872649

RESUMO

INTRODUCTION: Chemotherapy is an integral part of cancer management which is associated with phlebitis in around 70% of patients receiving intravenous chemotherapy infusion. Thus, we aimed to estimate the incidence, severity, and management of phlebitis associated with chemotherapy infusion among cancer patients. METHODS: A prospective study was conducted among 145 patients receiving intravenous chemotherapy for the duration of six months in the oncology department. The relevant data for phlebitis was obtained and assessed using Phlebitis Grading Scale and Visual Analogue Scale for the assessment of severity and pain due to phlebitis, respectively. RESULTS: Out of 145 patients, female (56.6%) patients predominated over male patients (43.5%) with a mean age of 53.5 ± 11.82 years. Phlebitis was encountered in 30.34% of patients among whom 22.8% (33) were females followed by 7.6% were males and the majority of patients (13.1%) were from the 46 to 60 years age group. Phlebitis was observed frequently among stage 2 (11%) and satge 4 (11%) patients. The highest incidence of phlebitis was seen among hypertensive (34.09%) and diabetic patients (27.27%) followed by those receiving chemotherapy through the 20-gauge intravenous cannula (22.8%) and 22-gauge (6.9%). Platinum compounds (56.8%) were commonly associated with phlebitis, followed by cyclophosphamide (20.5%). Heparin and benzyl nicotinate topical gel were used to treat phlebitis. CONCLUSION: Platinum and cyclophosphamide are commonly associated with phlebitis which can be managed by topical heparin plus benzyl nicotinate. Phlebitis shouldn't be ignored as it has a high incidence, affects the quality of life, and increases the treatment burden.


Assuntos
Neoplasias , Flebite , Humanos , Masculino , Feminino , Adulto , Pessoa de Meia-Idade , Idoso , Estudos Prospectivos , Qualidade de Vida , Infusões Intravenosas , Heparina/uso terapêutico , Neoplasias/tratamento farmacológico , Neoplasias/complicações , Ciclofosfamida , Flebite/induzido quimicamente , Flebite/epidemiologia , Flebite/tratamento farmacológico
7.
BMJ Case Rep ; 15(12)2022 Dec 13.
Artigo em Inglês | MEDLINE | ID: mdl-36524262

RESUMO

A man in his 40s presented with a 7-day history of fever and abdominal pain after polypectomy of the sigmoid colon. On physical examination, he had mild tenderness on deep palpation of the left lower abdominal quadrants without guarding, rigidity or rebound tenderness. Contrast-enhanced CT revealed the thrombosis of the inferior mesenteric vein and the portal vein. Blood cultures were positive for Escherichia coli We diagnosed him with pylephlebitis after colonic polypectomy, as a rare complication. He was started on cefmetazole and heparin. Antibiotic and anticoagulation therapy were initiated. He had a complete recovery within 17 days. The patient had no evidence of underlying hypercoagulable condition, and no signs of recurrence at a 3-month follow-up. Pylephlebitis after colonic polypectomy is extremely rare. Although bacteraemia after colonoscopy was a rare complication, phlebitis should be considered in the differential diagnosis of patients who present with persisted fever and abdominal pain after polypectomy.


Assuntos
Colo Sigmoide , Flebite , Masculino , Humanos , Colo Sigmoide/cirurgia , Flebite/diagnóstico , Flebite/tratamento farmacológico , Flebite/etiologia , Veias Mesentéricas/diagnóstico por imagem , Veia Porta , Dor Abdominal/complicações
8.
Can J Physiol Pharmacol ; 100(4): 291-294, 2022 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-35213242

RESUMO

To evaluate the effect of two concentrations of intravenous administration of nicardipine hydrochloride on nicardipine-related phlebitis in patients with preeclampsia. A total of 100 preeclampsia patients were administered with nicardipine hydrochloride and divided into the low-concentration (LC) and high-concentration (HC) groups. The incidence and severity of phlebitis, time from treatment to onset of phlebitis, skin temperature, visual analogue scale (VAS) score, induration, and systemic adverse reactions were compared between two groups. The incidence rate of phlebitis in the LC group was 20% (10/50), significantly lower than 42% (21/50) in the HC group (P < 0.05). Ridit Analysis showed that the severity of phlebitis in the LC group was remarkably lower than that in the HC group (P < 0.05). In the LC group, the time from intravenous administration to onset of phlebitis was longer, the average skin temperature was higher, the VAS score was lower, and the indurated area was smaller than those in the HC group (all P < 0.05). Intravenous infusion of nicardipine hydrochloride with constant and low concentration reduces the incidence rate of phlebitis, prolongs the time from treatment to onset of phlebitis, alleviates the severity of phlebitis and pain, maintains skin temperature, and minimizes induration in preeclampsia patients without systemic adverse reactions.


Assuntos
Flebite , Pré-Eclâmpsia , Administração Intravenosa , Humanos , Infusões Intravenosas , Nicardipino/efeitos adversos , Flebite/induzido quimicamente , Flebite/tratamento farmacológico , Flebite/epidemiologia , Pré-Eclâmpsia/tratamento farmacológico , Resultado do Tratamento
9.
BMJ Case Rep ; 14(10)2021 Oct 13.
Artigo em Inglês | MEDLINE | ID: mdl-34645637

RESUMO

Primary phlebitis of the central nervous system (PPCNS) is a rare condition that might be a subset of primary angiitis of the CNS. In this case report, the patient was a 39-year-old man with a 2-week history of anterograde amnesia and abnormal behaviours. Black-blood MRI (BB-MRI) showed contrast enhancement of the left basilar vein and cerebral superficial veins. Angiography showed unremarkable change in arteries. After a thorough differential diagnosis, we diagnosed PPCNS and then administered methylprednisolone pulse and cyclophosphamide pulse. The neuropsychological symptoms and MRI findings gradually improved, and after 2 months, the dose of prednisolone was gradually reduced to 20 mg. No recurrence was observed. This case shows that BB-MRI may be useful for diagnosing PPCNS.


Assuntos
Flebite , Vasculite do Sistema Nervoso Central , Adulto , Sistema Nervoso Central , Humanos , Angiografia por Ressonância Magnética , Imageamento por Ressonância Magnética , Masculino , Metilprednisolona/uso terapêutico , Flebite/diagnóstico por imagem , Flebite/tratamento farmacológico , Vasculite do Sistema Nervoso Central/diagnóstico por imagem , Vasculite do Sistema Nervoso Central/tratamento farmacológico
10.
BMC Vet Res ; 17(1): 67, 2021 Feb 03.
Artigo em Inglês | MEDLINE | ID: mdl-33536012

RESUMO

BACKGROUND: Umbilical vein bacterial infections may cause liver abscesses during bacterial ascent. A single liver abscess can be surgically treated by marsupialization, but a risk of recurrence or non-healing remains. Moreover, there is no effective treatment for multiple abscesses. CASE PRESENTATION: A 17-day-old Holstein female calf exhibited reduced general condition, swelling and drainage of the umbilicus, and pressure sores in the area of the carpus, resulting in reluctance to stand up. The umbilicus showed pain at palpation; deep abdominal palpation indicated a swollen umbilical vein coursing from the umbilicus toward the liver. Ultrasonography confirmed a swollen umbilical vein with pus accumulation and multiple abscesses in the liver. Contrast-enhanced computed tomography (CT) examination confirmed that the swollen umbilical vein with fluid continued to the liver, and multiple unenhanced lesions, most likely abscesses, were confirmed in the liver. Partial hepatectomy was performed to remove as many abscesses as possible. For the resection, a vessel sealing device (LigaSureTM) was used to excise a part of the left liver lobe. As we could not remove all the abscesses in the liver during the operation, cefazolin sodium (5 mg/kg) was administered for 14 days after surgery. Post-operatively, blood accumulation was observed in the abdominal cavity, but no signs of peritonitis were found. The calf returned to the farm on day 38 after surgery. Follow-up information was obtained after 1 year, and complications were not reported. CONCLUSIONS: To our knowledge, this is the first report of partial hepatectomy using a vessel sealing device for a calf with multiple liver abscesses. This case report suggests that the combination of partial hepatectomy and long-term administration of antibacterial drugs may restore the health of calves with multiple liver abscesses.


Assuntos
Doenças dos Bovinos/cirurgia , Hepatectomia/veterinária , Abscesso Hepático/veterinária , Animais , Animais Recém-Nascidos , Antibacterianos/uso terapêutico , Infecções Bacterianas/tratamento farmacológico , Infecções Bacterianas/cirurgia , Infecções Bacterianas/veterinária , Bovinos , Doenças dos Bovinos/tratamento farmacológico , Cefazolina/uso terapêutico , Feminino , Hepatectomia/métodos , Abscesso Hepático/microbiologia , Abscesso Hepático/cirurgia , Flebite/complicações , Flebite/tratamento farmacológico , Flebite/cirurgia , Flebite/veterinária , Instrumentos Cirúrgicos , Resultado do Tratamento , Veias Umbilicais
11.
Ocul Immunol Inflamm ; 29(7-8): 1332-1337, 2021 Nov 17.
Artigo em Inglês | MEDLINE | ID: mdl-32406792

RESUMO

Purpose: To report two cases of syphilitic outer retinopathy that showed diffuse phlebitis on fluorescein angiography (FA).Methods: Retrospective chart review.Results: The two patients had presentation similar to acute zonal occult outer retinopathy (AZOOR), including hyperautofluorescence on fundus autofluorescence and ellipsoid zone disruption on optical coherence tomography. The main difference from AZOOR was the finding of diffuse phlebitis on FA. Both patients recovered well after antibiotic and steroid treatment.Conclusion: FA is especially important for differentiating syphilitic outer retinopathy from AZOOR. Timely diagnosis and treatment with penicillin and cautious use of steroid usually lead to favorable prognosis.


Assuntos
Infecções Oculares Bacterianas/diagnóstico , Flebite/diagnóstico , Veia Retiniana/patologia , Escotoma/diagnóstico , Sífilis/diagnóstico , Síndrome dos Pontos Brancos/diagnóstico , Adulto , Antibacterianos/uso terapêutico , Ceftriaxona/uso terapêutico , Doxiciclina/uso terapêutico , Eletrorretinografia , Infecções Oculares Bacterianas/tratamento farmacológico , Infecções Oculares Bacterianas/microbiologia , Feminino , Angiofluoresceinografia , Glucocorticoides/uso terapêutico , Humanos , Masculino , Pessoa de Meia-Idade , Flebite/tratamento farmacológico , Flebite/microbiologia , Prednisolona/uso terapêutico , Estudos Retrospectivos , Escotoma/tratamento farmacológico , Escotoma/microbiologia , Sífilis/tratamento farmacológico , Sífilis/microbiologia , Tomografia de Coerência Óptica , Acuidade Visual/fisiologia , Testes de Campo Visual , Campos Visuais/fisiologia , Síndrome dos Pontos Brancos/tratamento farmacológico , Síndrome dos Pontos Brancos/microbiologia
12.
Clin Oncol (R Coll Radiol) ; 33(4): 230-240, 2021 04.
Artigo em Inglês | MEDLINE | ID: mdl-33308947

RESUMO

AIMS: Anthracycline chemotherapy administered via a peripheral cannula results in severe anthracycline chemotherapy-induced phlebitis (ACIP) in about 20-30% of patients. Administering chemotherapy via a central venous catheter (CVC) prevents ACIP. However, CVCs are associated with an increased risk of thrombosis and sepsis. Our aim was to identify risk factors associated with severe ACIP and to provide evidence about the individual risk of developing symptoms. MATERIALS AND METHODS: A prospective observational study of 263 women with breast cancer receiving peripheral administration of anthracycline chemotherapy at a UK cancer centre was conducted between May 2016 and January 2018. Data were collected at baseline and every 3 weeks following each chemotherapy treatment, using both healthcare professional- and participant-reported symptom assessments. RESULTS: After three cycles of chemotherapy, 27% of participants experienced severe ACIP. Factors associated with symptom severity were identified as: arm used for chemotherapy administration, epirubicin dose, age, pre-existing hypertension, comorbidity, ethnic group and pain during chemotherapy administration. The sequence of arm used for chemotherapy administration was the single most significant factor (P < 0.001). When alternating arms were used no other risk factor was influential. Where alternating arms were not used, younger age and higher dose were associated with higher-grade symptoms, with age being more influential than dose. The cumulative effect of increasing symptom severity with repeated cycles was also identified (P < 0.001). CONCLUSION: It is recommended that a CVC is not routinely required for women with breast cancer who have not undergone an axillary node clearance and receive chemotherapy in alternate arms. The need for a CVC for women who are planned to receive all anthracycline chemotherapy cycles in the same arm should be assessed in the light of peripheral venous access assessment and the key risk factors of age, dose and number of cycles.


Assuntos
Neoplasias da Mama , Flebite , Antraciclinas/efeitos adversos , Antineoplásicos/efeitos adversos , Protocolos de Quimioterapia Combinada Antineoplásica/efeitos adversos , Neoplasias da Mama/tratamento farmacológico , Neoplasias da Mama/terapia , Quimioterapia Adjuvante , Ciclofosfamida , Feminino , Humanos , Flebite/induzido quimicamente , Flebite/tratamento farmacológico , Fatores de Risco
13.
J Thromb Thrombolysis ; 49(2): 325-331, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-31493290

RESUMO

Pylephlebitis, or suppurative thrombophlebitis of the portal vein, typically occurs in the context of an intraabdominal infection or abdominal sepsis. Antibiotics are the mainstay of treatment. The role of anticoagulation in the management of pylephlebitis is controversial, and data regarding its impact on outcomes is limited. The records of 67 consecutive patients with pylephlebitis treated at our institution over a 19 year period were retrospectively reviewed. Data was gathered regarding their baseline characteristics, presentations, management, and outcomes. Patients who did and did not receive anticoagulation were compared. Outcomes of interest included survival, portal vein thrombosis (PVT) resolution, development of chronic symptomatic portal hypertension, and major bleeding. Forty-seven patients received anticoagulation and 20 did not. The anticoagulated and non-anticoagulated groups did not differ significantly with respect to potential covariates or confounders. Anticoagulated patients had significantly higher rates of PVT resolution than non-anticoagulated patients (58% vs. 21%, p = 0.0201). This translated to lower rates of future chronic portal hypertensive symptoms among anticoagulated patients (11% vs. 47%, p = 0.0034). Anticoagulated patients had a trend toward improved survival however this improvement was not significant on multivariable analysis. There was no significant difference in rates of major bleeding between groups. Thrombophilia testing was common in this cohort however the occurrence of meaningful positive results was exceedingly low. Anticoagulation significantly improves the rate of PVT resolution, and significantly reduces the rate of chronic symptomatic portal hypertension, among patients with pylephlebitis. Treatment of pylephlebitis should incorporate the use of systemic anticoagulation whenever possible.


Assuntos
Anticoagulantes/administração & dosagem , Flebite/diagnóstico por imagem , Flebite/tratamento farmacológico , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Anticoagulantes/sangue , Estudos de Coortes , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Flebite/sangue , Veia Porta/diagnóstico por imagem , Estudos Retrospectivos , Trombofilia/sangue , Trombofilia/diagnóstico por imagem , Trombofilia/tratamento farmacológico , Resultado do Tratamento , Adulto Jovem
14.
J Vasc Surg Venous Lymphat Disord ; 7(4): 578-582, 2019 07.
Artigo em Inglês | MEDLINE | ID: mdl-31078516

RESUMO

The VenaSeal closure system is a nonthermal, nontumescent technique that was approved by the U.S. Food and Drug Administration in 2015 for the treatment of superficial venous insufficiency. Studies have demonstrated a comparable efficacy and safety profile to thermal ablation procedures. We report a case of a middle-aged woman who developed a severe, prolonged phlebitis-like reaction requiring treatment with steroids and antihistamines after cyanoacrylate adhesive embolization. This adverse reaction is uncommon but usually self-limiting and is believed to be a type IV hypersensitivity reaction to the cyanoacrylate compound. Knowledge of this potential complication and its treatment are key, because the reaction may be severe with significant morbidity.


Assuntos
Cianoacrilatos/efeitos adversos , Hipersensibilidade a Drogas/etiologia , Embolização Terapêutica/efeitos adversos , Flebite/induzido quimicamente , Veia Safena/efeitos dos fármacos , Varizes/terapia , Insuficiência Venosa/terapia , Idoso , Hipersensibilidade a Drogas/diagnóstico , Hipersensibilidade a Drogas/tratamento farmacológico , Feminino , Antagonistas dos Receptores Histamínicos/uso terapêutico , Humanos , Flebite/diagnóstico , Flebite/tratamento farmacológico , Veia Safena/diagnóstico por imagem , Índice de Gravidade de Doença , Esteroides/uso terapêutico , Resultado do Tratamento , Varizes/diagnóstico por imagem , Insuficiência Venosa/diagnóstico por imagem
15.
Complement Ther Clin Pract ; 35: 78-85, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-31003690

RESUMO

BACKGROUND AND PURPOSE: Chemotherapy-induced phlebitis (CIP) is one of the most important and common complications in patients with cancer. Currently, the use of complementary methods to prevent or alleviate phlebitis symptoms has attracted great attention. In this study, we aimed to assess the effects of topical sesame oil in reducing the pain severity of CIP. MATERIALS AND METHODS: This randomized clinical trial was conducted on 60 patients with colorectal cancer afflicted with CIP. Patients received, twice a day for seven consecutive days, a 5-min massage solely (as the control group) or with 10 drops of sesame oil (as the experimental group) within the 10 cm radius of the affected site. The pain severity was evaluated by the visual analog scale on the first, third, fifth, and seventh days of the intervention. RESULTS: Mean changes of the pain severity compared to the baseline were significant on the third (P = 0.009), fifth (P < 0.001), and seventh (P < 0.001) days of the intervention in favor of the experimental group. Also, a significant reduction in the pain severity both in the experimental and control groups was observed during the seven days (F = 720.66, Ptime < 0.001); however, the decrease was more significant in the experimental group (F = 21.46, Pgroup < 0.001). CONCLUSION: Application of massage with sesame oil as a complementary method is effective in reducing the pain severity of patients with CIP.


Assuntos
Antineoplásicos/efeitos adversos , Neoplasias Colorretais/tratamento farmacológico , Massagem/métodos , Dor/tratamento farmacológico , Flebite/tratamento farmacológico , Óleo de Gergelim/uso terapêutico , Sesamum/química , Administração Tópica , Adulto , Idoso , Antineoplásicos/uso terapêutico , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Dor/etiologia , Flebite/etiologia , Extratos Vegetais/uso terapêutico , Óleo de Gergelim/farmacologia , Índice de Gravidade de Doença
16.
BMJ Case Rep ; 12(4)2019 Apr 15.
Artigo em Inglês | MEDLINE | ID: mdl-30992283

RESUMO

Portal pyaemia or pylephlebitis is a form of septic (often suppurative) thrombophlebitis of the portal venous system. It may develop as a complication of intra-abdominal sepsis, such as diverticulitis or appendicitis. Patients typically present with a high fever that is sometimes accompanied by jaundice. We report a case of portal pyaemia associated with multiple liver abscesses and discuss the medical and surgical management of this condition.


Assuntos
Doenças do Colo/complicações , Perfuração Intestinal/complicações , Abscesso Hepático/etiologia , Flebite/etiologia , Sepse/etiologia , Antibacterianos/uso terapêutico , Anticoagulantes/uso terapêutico , Doenças do Colo/diagnóstico por imagem , Doenças do Colo/cirurgia , Humanos , Perfuração Intestinal/diagnóstico por imagem , Perfuração Intestinal/cirurgia , Masculino , Veias Mesentéricas/diagnóstico por imagem , Pessoa de Meia-Idade , Flebite/tratamento farmacológico , Sepse/tratamento farmacológico , Tomografia Computadorizada por Raios X
17.
Ann Vasc Surg ; 55: 239-245, 2019 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-30217712

RESUMO

BACKGROUND: Cyanoacrylate closure for the treatment of incompetent saphenous veins does not cause thermal damage and demonstrates satisfactory outcomes with rapid recovery. However, the characteristics of phlebitis-like abnormal reaction (PLAR), the most common adverse event after cyanoacrylate closure, have not been clarified. Moreover, it differs from typical phlebitis after thermal ablation. The objective of our study is to investigate the clinical features of PLAR after cyanoacrylate closure and to report its management. METHODS: A total of 160 patients with 271 incompetent saphenous veins (great saphenous veins, 201; small saphenous veins, 70) underwent cyanoacrylate closure with the VenaSeal™ system. We defined PLAR as any unusual skin condition that develops suddenly, such as erythema, itching, swelling, and pain/tenderness, over the treated veins several days after cyanoacrylate closure. Oral antihistamines and intravenous dexamethasone were administered to manage PLAR. RESULTS: Of the 271 treated veins, 69 experienced PLAR (25.4%). The mean time of occurrence was 13.6 ± 4.6 days after treatment. The rate of occurrence of erythema, itching, swelling, and pain/tenderness were 92.2%, 91.2%, 66.2%, and 48.5%, respectively. The occurrence of PLAR was significantly higher for great saphenous veins than for small saphenous veins (P < 0.001). Occurrences were more frequent in cases with a suprafascial great saphenous vein of length >10 cm than in cases with a subfascial great saphenous vein (P = 0.001). The proportion of patients who reported swelling decreased by more than half after the administration of oral antihistamine. The pain score on the 10th day also decreased significantly after the administration of antihistamine (P = 0.006). CONCLUSIONS: PLAR must be distinguished from classic phlebitis. We believe that PLAR is a type IV hypersensitivity reaction due to a foreign body, and in our experience, antihistamines or steroids are effective for the prevention and management of PLAR.


Assuntos
Cianoacrilatos/efeitos adversos , Reação a Corpo Estranho/induzido quimicamente , Hipersensibilidade Tardia/induzido quimicamente , Flebite/induzido quimicamente , Veia Safena , Adesivos Teciduais/efeitos adversos , Insuficiência Venosa/terapia , Administração Intravenosa , Administração Oral , Adulto , Idoso , Dexametasona/administração & dosagem , Feminino , Reação a Corpo Estranho/diagnóstico por imagem , Reação a Corpo Estranho/tratamento farmacológico , Reação a Corpo Estranho/fisiopatologia , Glucocorticoides/administração & dosagem , Antagonistas dos Receptores Histamínicos/administração & dosagem , Humanos , Hipersensibilidade Tardia/diagnóstico por imagem , Hipersensibilidade Tardia/tratamento farmacológico , Hipersensibilidade Tardia/fisiopatologia , Masculino , Pessoa de Meia-Idade , Flebite/diagnóstico por imagem , Flebite/tratamento farmacológico , Flebite/fisiopatologia , Estudos Prospectivos , Fatores de Risco , Veia Safena/diagnóstico por imagem , Veia Safena/fisiopatologia , Fatores de Tempo , Resultado do Tratamento , Insuficiência Venosa/diagnóstico por imagem , Insuficiência Venosa/fisiopatologia , Adulto Jovem
18.
Mult Scler Relat Disord ; 17: 217-219, 2017 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-29055460

RESUMO

Visual symptoms are a common clinical manifestation of multiple sclerosis (MS) and are frequently due to acute optic neuritis (ON). However, the entire visual pathway can be involved throughout the disease course. We describe the case of a young MS patient who experienced visual symptoms that were eventually found to be caused by retinal periphlebitis, an inflammatory process of the anterior visual pathway, which is common during MS, but rarely symptomatic. This case reinforces the concept that in all MS patients complaining visual symptoms, a complete work-up should be performed in order to rule out possible ON mimicries.


Assuntos
Esclerose Múltipla Recidivante-Remitente/fisiopatologia , Flebite/fisiopatologia , Transtornos da Visão/fisiopatologia , Adulto , Olho/diagnóstico por imagem , Olho/efeitos dos fármacos , Feminino , Humanos , Esclerose Múltipla Recidivante-Remitente/tratamento farmacológico , Flebite/diagnóstico , Flebite/tratamento farmacológico , Transtornos da Visão/diagnóstico , Transtornos da Visão/tratamento farmacológico , Vias Visuais/efeitos dos fármacos , Vias Visuais/fisiopatologia
20.
Rev Gaucha Enferm ; 38(2): e58793, 2017 Jun 29.
Artigo em Português, Inglês | MEDLINE | ID: mdl-28678899

RESUMO

OBJECTIVE: to determine the incidence of phlebitis during and after the use of peripheral intravenous catheter (PIC), and analyse the association of this complication with risk factors. METHODS: cohort study with 165 adult patients admitted to a university hospital in Porto Alegre, totalling 447 accesses, from December 2014 to February 2015. Data were collected on a daily basis and analysed by means of descriptive and analytical statistics. RESULTS: The incidence of phlebitis during PIC was 7.15% and the incidence of post-infusion phlebitis was 22.9%. Phlebitis during catheter use was associated with the use of Amoxicillin + Clavulanic Acid. The grade of post-infusion phlebitis was associated with age and use of Amoxicillin + Clavulanic Acid, Tramadol Hydrochloride, and Amphotericin. CONCLUSION: The incidence of post-infusion phlebitis proved to be an important indicator to analyse the quality of the healthcare setting.


Assuntos
Infecções Relacionadas a Cateter/epidemiologia , Infecção Hospitalar/epidemiologia , Pacientes Internados/estatística & dados numéricos , Flebite/epidemiologia , Adolescente , Adulto , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Combinação Amoxicilina e Clavulanato de Potássio/uso terapêutico , Anfotericina B/uso terapêutico , Antibacterianos/uso terapêutico , Infecções Relacionadas a Cateter/tratamento farmacológico , Infecções Relacionadas a Cateter/etiologia , Cateterismo Periférico/efeitos adversos , Infecção Hospitalar/tratamento farmacológico , Infecção Hospitalar/etiologia , Feminino , Hospitais Universitários/estatística & dados numéricos , Humanos , Incidência , Infusões Intravenosas , Masculino , Pessoa de Meia-Idade , Flebite/tratamento farmacológico , Flebite/etiologia , Tramadol/uso terapêutico , Adulto Jovem
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