Acute Left Internal Carotid Artery and Right Popliteal Artery Occlusion Related to Cisplatin-Gemcitabine Based Chemotherapy.

OBJECTIVES: The increased risk of thromboembolic complications with active cancer is well known. We present this case to highlight that chemotherapy may increase the risk of thromboembolic events even further in cancer patients. METHODS: We report a case of a 64-year-old male with Diffuse Large B-Cell Non-Hodgkin's Lymphoma who presented with left-sided headache and right calf pain two weeks after starting Rituximab/Gemcitabine/Cisplatin/Dexamethasone chemotherapy. Neurological examination was normal, but there was an absent right dorsalis pedis pulse. He subsequently developed left vision loss. CT angiogram of the head and neck revealed occlusion of his left internal carotid artery and poor opacification of the left ophthalmic artery. An angiogram of the right leg further revealed acute occlusion of the popliteal artery. RESULTS: The patient underwent intra-arterial Tissue Plasminogen Activator injection to his lower limb and was started on Low Molecular Weight Heparin. His vision gradually recovered with time. His chemotherapy regimen was changed to RICE (Rituximab, Ifosfamide, Carboplatin, Etoposide). CONCLUSION: Based on literature review, there are numerous similar presentations of arterial thromboembolism in patients on Cisplatin-based chemotherapy. A high index of suspicion for such events should be maintained for patients on chemotherapy presenting with unusual symptoms.

Rhino-orbito-cerebral mucormycosis: recovery against the odds.

A 22-year-old woman presented with diabetic ketoacidosis, acute right eye blindness and complete ophthalmoplegia. Despite early suspicion and treatment for rhino-orbito-cerebral mucormycosis, her extensive spread of infection led to right internal carotid artery occlusion and cavernous sinus thrombosis, right-sided cerebral watershed infarctions and large abscesses in her right cerebellum, temporal lobe and pons. She underwent surgical removal of her right eye, paranasal sinuses, maxilla and palate, suboccipital craniectomy and shunting for hydrocephalus. Despite the grave prognosis, she has gradually improved and has remained on antifungal treatment for the 18 months since presentation. We discuss the factors that may have influenced her recovery. The case highlights the aggressive nature of rhino-orbito-cerebral mucormycosis, the need for multiple surgeries and the ethical issues in managing such patients.

Plasma levels of B-type natriuretic Peptide in patients with unstable angina pectoris or acute myocardial infarction: prognostic significance and therapeutic implications.

Plasma B-type natriuretic peptide (BNP) levels were obtained from 146 patients with unstable angina pectoris, non-ST-segment elevation myocardial infarction (MI), or ST-segment elevation MI to determine their value in predicting the presence of new heart failure, recurrent MI or ischemia, or death 1 month after the index event. Patients with elevated plasma BNP levels (>80 pg/mL) had a significantly higher incidence of new heart failure and all-cause mortality than those with a normal plasma BNP level (