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Pulmonary reactions to chemotherapeutic agents: the ‘chemotherapy lung’
Published in Philippe Camus, Edward C Rosenow, Drug-induced and Iatrogenic Respiratory Disease, 2010
Fabien Maldonado, Andrew H Limper
The main complication of the treatment with retinoic acid is the development of the so-called ‘retinoic acid syndrome’ in approximately 25 per cent of patients receiving this medication.70–72 This capillary leak syndrome is heralded by the onset of shortness of breath, fever and diffuse pulmonary infiltrates resulting from non-cardiogenic pulmonary oedema. Pericardial and pleural effusions are also common, and may further impair the patient’s respiratory status. Hypotension and renal failure may be present as well. This syndrome usually occurs between 2 and 21 days after initiation of treatment. Its pathogenesis remains poorly understood, but it may involve a sudden massive release of cytokines by the newly differentiated myeloid cells and adhesion of matured granulocytes to the pulmonary endothelium. High leucocyte counts have been associated with an increased incidence of the retinoic acid syndrome, although inconsistently. No other obvious risk factors have been clearly identified. Microscopic examinations of affected lungs typically show diffuse infiltration by mature myeloid cells. An association with Sweet syndrome and diffuse alveolar haemorrhage has also been described.73 The mortality rate with ATRA-associated pulmonary toxicity may be as high as 9 per cent.
Adverse Outcome Pathway for Antimicrobial Quaternary Ammonium Compounds
Published in Journal of Toxicology and Environmental Health, Part A, 2022
Inflammatory mediators that recruit leukocytes also result in vasodilation and increased vascular permeability (Scallan, Huxley, and Korthuis 2010). These, and other secondary effects including protein infiltration into tissue, resulting in accumulation of extracellular fluid. Several investigators noted that QAC-mediated tissue injury from inhalation or intratracheal/nasal administration also induced edematous changes (Cho et al. 2000; Kuboyama, Suzuki, and Hara 1997; Ohnuma-Koyama et al. 2013). Elevated protein production, likely the result of cellular influx and potential neutralization of lung surfactants, was measured in BAL fluid of BAC-exposed rats (Larsen, Verder, and Nielsen 2012). Given sufficient exposure, influx of fluid from capillary leak syndrome resulting from elevated protein levels and LDH activity release was measured in BAL fluid (Ohnuma et al. 2011). The temporal relationship between QAC exposure and inflammatory response in mice (Ohnuma et al. 2011) is biphasic with an initial effect attributed to epithelial degeneration and a greater effect resulting later because of cell membrane disruption and upregulated inflammatory response.
Pediatric ventricular assist devices: what are the key considerations and requirements?
Published in Expert Review of Medical Devices, 2020
Roland Hetzer, Mariano Francisco del Maria Javier, Eva Maria Javier Delmo
The use of ECMO, especially postoperatively, has been shown to be lifesaving in children with myocardial failure. However, when pulmonary function is normal, ECMO is not always the optimal method for prolonged circulatory support because of complexity of equipment, bleeding complications, capillary leak syndrome, non-pulsatile flow, and the need for intensive care and the patients stay bed-ridden. The advantages of ECMO in contrast to BVAD are easier cannulation, oxygenator support in pulmonary insufficiency, and the possibility of slow reduction of circulatory support. While bleeding related to heparinization is the most common complication of ECMO, BVAD limits hemorrhagic complications as less anticoagulation with heparin is required. The advantages of BVAD are a much longer time gain to restore organ function, elimination of edema, extubation, mobilization, improvement in nutrition, and allowing the children to regain consciousness to assess neurological status. Reduced capillary leak in BVAD may be due to the pulsatile flow and to less contact with synthetic surfaces [89].