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Anesthesia and analgesia in pregnancy
Published in Hung N. Winn, Frank A. Chervenak, Roberto Romero, Clinical Maternal-Fetal Medicine Online, 2021
Systemic analgesics have been widely used throughout the latter half of the 20th century. The mainstay of this technique is the use of opioids, both naturally occurring and synthetic. Morphine is derived from opium and has a very long history of use. As with all opioids, it binds to mu receptors in the CNS and, in addition to providing analgesia, may also cause respiratory depression, nausea, vomiting, and sedation. Systemically administered morphine can induce histamine release and cause pruritus (15). An associated skin rash may also develop. When given intravenously (IV), its onset of action is within 3 to 5 minutes with peak effect in 20 minutes. The pharmacologic effect of morphine does not correlate well with plasma concentrations following intravenous administration. This is believed to be secondary to a delay in transfer across the blood–brain barrier since a large percentage of morphine is ionized at physiologic pH (16–18). An intramuscular (IM) injection will have an onset of 15 to 30 minutes with a peak effect of 45 to 90 minutes. Morphine undergoes hepatic metabolism. With the availability of more potent synthetic opioids such as fentanyl, remifentanil, and the agonists/antagonists nalbuphine and butorpanol, morphine is more commonly used during prelabor or the very early stages of labor and less so during active labor.
Felbamate
Published in Stanley R. Resor, Henn Kutt, The Medical Treatment of Epilepsy, 2020
Ilo E. Leppik, Harvey J. Kupferberg
Definite neurotoxicity of FBM has not been observed in patients independent of PHT or CBZ. In one study, some toxicity was observed, but in almost all patients it was reversed by reducing PHT doses and bringing the PHT levels back into the target range (7). In the Epilepsy Branch study of 56 patients, review of laboratory data indicated no significant hepatotoxicity or hematologic toxicity (7). The major symptoms reported with FBM have been nausea, weight loss, and insomnia. Some skin rashes have been reported.
Unexplained Fever Associated With Cutaneous Manifestations
Published in Benedict Isaac, Serge Kernbaum, Michael Burke, Unexplained Fever, 2019
The skin is the site of the most diverse and unforseen eruptions which sometimes may be accompanied by an unknown onset of fever, lasting during the entire evolution of the respective rash or partially disappearing a few days before or after. In order to establish a connection between the fever and the skin eruption, one should have some knowledge about the main skin disorders which tend to be associated with a febrile state. When examining the skin in such cases, it is valuable to study the form of the individual lesions, their pattern, and distribution over the body surface. Considering the individual lesions (maculae, papules, vesicles and/or bullae, pustules, nodules, ulcers, scales, crusts, atrophy, sclerosis, etc.), it is to be retained that the skin eruption may be composed sometimes either from only one type or from a combination of such elements, thus making the diagnosis more difficult. There is also a possibility that each of the respective lesions can become purpuric, so we have to deal with purpuric papules or vesicles. Therefore, it would be helpful to present a brief list of the most important cutaneous manifestations, which may be associated with fever, taking into account their classification based upon the predominant individual lesions found. Moreover, keeping in mind that many types of skin rash may be very similar in their clinical aspect, it is very important to establish, as quickly as possible, the presumptive diagnosis, in order to prevent critical eventualities. All the available diagnostic procedures should be used immediately in such cases.
Severe immunochemotherapy-induced toxicities in a patient with dyskeratosis congenita and literature review
Published in Hematology, 2022
Jiayi Geng, Menglin Zhao, Qiuyu Li
These cases are mainly young people and carry TERT and DKC1 mutations. Types of malignancy and therapy strategies are quite different in these cases. The first case had nodular sclerosing classical Hodgkin’s lymphoma and received chemotherapy. The second case had stage IV rectal cancer and received immunochemotherapy with cetuximab and OK-432. The third and fourth cases had breast cancer and tongue cancer, respectively, and they both received radiation therapy. Skin rash or mucositis are reported in most cases, while they were not observed in our case. Pneumonitis and cytopenia are reported in over half of the cases, and they could simultaneously occur, as in Agrusa’s case and our case. The outcome and prognosis of these patients are not optimistic. These cases indicate that physicians should pay close attention to skin or mucosal symptoms when treating DC patients with chemotherapy drugs or radiation therapy. Pneumonitis and cytopenia are common but severe toxicities; therefore, chest CT should be routinely performed and peripheral blood counts should be closely surveilled.
Hypereosinophilic syndromes in the precision medicine era: clinical, molecular aspects and therapeutic approaches (targeted therapies)
Published in Expert Review of Hematology, 2019
Alessandra Iurlo, Daniele Cattaneo, Umberto Gianelli
In details, FIP1L1-PDGFRA rearrangement accounts in Western countries for approximately 10–20% of patients with unexplained HE [17]. It is characterized by a male predominance, with a median age at diagnosis between 65 and 74 years [4]. At presentation, the disease may mimic other myeloid and/or lymphoid neoplasms [18,19]. Symptoms typically include skin rash and less frequently those related to pulmonary, gastrointestinal and/or cardiac involvement. The BM is usually hypercellular with increased eosinophils, including eosinophilic precursors, exhibiting various morphological abnormalities (Figure 1(b)). Spindled mast cells are often present but usually scattered and not in aggregates, with frequent aberrant expression of CD25 (around 60%), and some cases may show features fulfilling the criteria of systemic mastocytosis. The interstitial deletion of 4q12 leads to FIP1L1-PDGFRA fusion, so disrupting the autoinhibitory juxtamembrane domain of PDGFRA and leading to the TK constitutive activation. As this deletion is cryptic by conventional cytogenetics, FISH is required to identify it. In addition to dysregulation of PDGFRA by fusion to FIP1L1 or other partner genes, activating point mutations have been identified in PDGFRA in patients with HE [20]. Although there was variability in their transforming ability, injection of cells harboring these mutants in mice induced a leukemia-like disease.
Incidence and characteristics of engraftment syndrome after autologous hematopoietic cell transplantation in light chain amyloidosis
Published in Amyloid, 2019
Talha Badar, Muhammad Ali Khan, Aniko Szabo, William Drobyski, Saurabh Chhabra, Binod Dhakal, Timothy S. Fenske, Mehdi Hamadani, Parameswaran Hari, James H. Jerkins, Nirav N. Shah, Bronwen E. Shaw, Anita D'Souza
A noninfectious fever was defined as a temperature >38 °C without a microbiological culture-positive infection or other possible signs of infection such as systemic inflammatory response syndrome or hemodynamic instability. Patients with neutropenic fevers were treated with broad-spectrum antibiotics per standard institutional guidelines. Diarrhoea was defined as two or more liquid stools per day without an evidence of infection. Skin rash was defined as an erythrodermatous rash involving more than 25% of body surface area which was not due to a drug reaction or an underlying infection. Pulmonary infiltrates were defined as infiltrates confirmed by chest X-ray or computed tomography scan of the chest not due to infection or heart failure. Acute kidney injury (AKI) was defined as a serum creatinine of greater than or equal to two times the baseline creatinine on the day of administration of high dose melphalan.