RESUMEN
WHAT IS KNOWN AND OBJECTIVE: Amlodipine overdose is common; however, the dose and timing of intravenous lipid emulsion (ILE) therapy as a management strategy remain debatable. CASE DESCRIPTION: A 73-year-old man received a single bolus (1.5 mL/kg) of ILE therapy following massive ingestion of multiple drugs, including amlodipine. After approximately 20 hours of ILE therapy, the serum amlodipine level that had decreased from 90.2 to 49.9 ng/mL increased to 70.8 ng/mL. WHAT IS NEW AND CONCLUSION: A single bolus (1.5 mL/kg) of ILE therapy is probably insufficient to completely capture and partition serum amlodipine following amlodipine overdose.
Asunto(s)
Amlodipino/administración & dosificación , Amlodipino/sangre , Bloqueadores de los Canales de Calcio/administración & dosificación , Bloqueadores de los Canales de Calcio/sangre , Sobredosis de Droga/sangre , Emulsiones Grasas Intravenosas/administración & dosificación , Lípidos/administración & dosificación , Anciano , Humanos , MasculinoRESUMEN
Four resected specimens of hepatic angiomyolipoma in which uptake of Sonazoid was observed in the postvascular phase of Sonazoid-enhanced ultrasonography were analyzed. Macrophage localization in the tumor was revealed pathologically by immunohistochemical staining for CD68. CD68-positive cells were observed in the tumor in all cases. The density of CD68-positive cells was 100/mm2, and the ratio of CD68-positive cell density in the tumor to that in the surrounding parenchyma was 32-171%. These results suggested that the uptake of the contrast agent Sonazoid was related to the density of CD68-positive cells.
Asunto(s)
Angiomiolipoma/patología , Antígenos CD/biosíntesis , Antígenos de Diferenciación Mielomonocítica/biosíntesis , Neoplasias Hepáticas/patología , Adulto , Angiografía , Angiomiolipoma/irrigación sanguínea , Angiomiolipoma/diagnóstico por imagen , Angiomiolipoma/metabolismo , Medios de Contraste/farmacocinética , Femenino , Compuestos Férricos/farmacocinética , Humanos , Inmunohistoquímica , Hierro/farmacocinética , Neoplasias Hepáticas/irrigación sanguínea , Neoplasias Hepáticas/diagnóstico por imagen , Neoplasias Hepáticas/metabolismo , Macrófagos/metabolismo , Macrófagos/patología , Masculino , Persona de Mediana Edad , Óxidos/farmacocinéticaRESUMEN
AIM: A hyperenhanced rim (termed 'HER') in the postvascular phase is detected in some cases of liver metastasis by Sonazoid-enhanced ultrasonography (US). Here, the association of the HER with histological features was investigated to clarify the cause of this characteristic imaging pattern. SUBJECTS AND METHODS: A total of 13 hepatic nodules obtained from 11 patients with metastatic liver cancer who underwent Sonazoid-enhanced US followed by surgical resection were analyzed. The distribution density of CD68-positive cells in the tumor rim and the nontumor area was calculated and compared between the HER-positive and HER-negative groups. The relation between the pathological features of the tumor rim and the rate of necrosis within the tumor was also investigated. RESULTS: In the HER-positive group (n = 8), the distribution density of CD68-positive cells was 2.9 ± 0.9, which was significantly higher than that (1.0 ± 0.3) in the HER-negative group (p < 0.05). Inflammatory cell infiltrates, including CD8-positive lymphocytes, were detected in all the HER-positive cases in the area surrounding the tumor, while fibrosis was observed in all the HER-negative cases. The necrotic area within the tumor was significantly larger in the HER-negative group. CONCLUSION: The HER-positive sign in liver metastases could reflect an increase in Kupffer cells in the tumor rim. The presence of the HER was associated with inflammatory cell infiltrates including CD8-positive lymphocytes surrounding the metastatic liver tumor.