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Oedema, Haemorrhage and Thrombosis
Published in Jeremy R. Jass, Understanding Pathology, 2020
Thrombi formed in the fast-moving arterial system tend to be small, friable, pale and platelet-rich. Those developing within aneurysms (left ventricular or aortic) show well-developed lines of Zahn. These are pale, platelet-rich lines alternating with fibrin-rich lines that contain admixed red blood cells. Those developing in the relatively sluggish venous system (phlebothrombosis) are composed mainly of fibrin and admixed red blood cells but will still be firmer and drier than a postmortem blood clot. Furthermore, small numbers of platelets will be seen microscopically. Postmortem blood clot is soft, jelly-like and is never firmly adherent to the vessel wall in which it forms. It may be composed largely of yellow coagulated plasma, when it has been likened to ‘chicken fat’. The distinction is important when trying to decide at a postmortem examination if a mass within the pulmonary artery is embolised thrombus (see Chapter 18) or merely postmortem blood clot.
Unexplained Fever In Hematologic Disorders
Published in Benedict Isaac, Serge Kernbaum, Michael Burke, Unexplained Fever, 2019
An important cause of otherwise ‘‘unexplained” fever may be thrombosis and thrombophlebitis. Mesenteric, hepatic portal, and splenic vein thrombosis may occur in patients in whom the disease has not been adequately controlled. Phlebothrombosis with pulmonary embolism is quite common. Splenic infarction may occur.
Thromboembolic Disease in the Obstetric Patient: Evaluation, Diagnosis, and Treatment
Published in Hau C. Kwaan, Meyer M. Samama, Clinical Thrombosis, 2019
Anticoagulation is rarely necessary for the treatment of superficial thrombophlebitis or phlebothrombosis, since the risk of an embolus is negligible and the risk of therapy is not. Moist heat applications to the affected vessel four times a day coupled with elevation of the involved extremity should aid symptomatic recovery. Absolute bedrest is usually unnecessary. Ambulation should be minimized only until the inflammation has begun to resolve. Healing occurs within 1 to 3 weeks. In resistant cases, aspirin may provide symptomatic relief.
Efficacy and safety of ixazomib maintenance therapy for patients with multiple myeloma: a meta-analysis
Published in Hematology, 2021
Huixian Chen, Yongjing Wang, Chunchun Shao, Chenxi Sun, Chengyun Zheng
Maintenance treatment following ASCT or remission is beneficial to eliminate the minimal residual disease (MRD) further and prolong survival in patients with MM [3,4]. At present, the common drugs in maintenance treatment include glucocorticoid, interferon, IMiD, PI, etc. Long-term use of the first two is often limited by severe adverse reactions such as infection, mood change, myalgia and hematological toxicity [5]. IMiDs mainly act on myeloma cells and bone marrow hematopoietic microenvironment, thus playing a dual role of killing tumor cells and immune regulation. Maintenance therapy based on thalidomide, lenalidomide and other IMiDs can significantly prolong the progression-free survival (PFS) of patients, while the improvement of the overall survival (OS) is controversial [6,7]. Additionally, IMiDs have several limitations, including the toxic risk of peripheral neuropathy, phlebothrombosis, shorter OS in patients with recurrence and the increased risk of developing second primary malignancies. Myeloma cells naturally synthesize more proteins to meet the needs of rapid growth and secretion, so that PIs are more specific for them. Bortezomib is the first PI approved by the US Food and Drug Administration (FDA). By reducing the expression levels of IGF, TNF-α, and IL-6, it can promote the apoptosis of myeloma cells and reduce their resistance to the glucocorticoid, thus avoiding the occurrence of the second tumor [8]. Nevertheless, bortezomib is not well suited for long-term use given the risk of peripheral neuropathy and need for parenteral administration which brings a lot of inconvenience to MM patients.
Assessment of suspected adverse drug reactions in elderly patients with diabetes mellitus based on a Portuguese spontaneous reporting database: analysis of reporting from 2008 to 2018
Published in Expert Opinion on Drug Safety, 2021
Cristina Monteiro, Samuel Silvestre, Ana Paula Duarte, Gilberto Alves
The causality assessment attributed by the regulatory authority was analyzed in the 19 cases with fatal outcome. According to the WHO system for standardized case causality assessment [20], only 2 cases were classified as certain and the drugs involved were digoxin and levothyroxine; in the first case, an elevated plasmatic digoxin level was reported, and in the second case phlebothrombosis and retroperitoneal hematoma was ascribed to levothyroxine. It is important to mention that these two fatal cases where not caused by drugs used to treat diabetes. Among the remaining reports, 3 were classified as probable and the other 14 were classified as possible, as unlikely, or had no causality attributed.
Clinical Effects of Posterior Limited Long-Segment Pedicle Instrumentation for the Treatment of Thoracolumbar Fractures
Published in Journal of Investigative Surgery, 2020
Chengmin Liang, Bin Liu, Wei Zhang, Haiyang Yu, Jie Cao, Wen Yin
Antibiotics were routinely administered for 1 or 2 days after the operation. To prevent development of phlebothrombosis, patients were asked to complete both active and passive exercises of both lower limbs, and low-molecular-weight heparin calcium was administered. The drainage was removed 1 or 2 days after the operation, sutures were removed on the 14th day, and off-bed activity with the help of braces was performed for 6–8 weeks.