Hand and Upper Limb Emergencies
Dorian Hobday, Ted Welman, Maxim D. Horwitz, Gurjinderpal Singh Pahal in Plastic Surgery for Trauma, 2022
Extravasation is the leaking of fluid or medication into extra vascular tissue from an intravenous device. Most commonly it is small to moderate volumes of saline or IV contrast that have been extravasated, which rarely have severe consequences, but depending on the fluid type and the volume extravasated there are the potential serious complications of full thickness skin loss and compartment syndrome. For this reason, any extravasation referrals must be urgently investigated with the following questions:What substance has been extravasated?What volume has been extravasated?Exactly what time did it occur?Any initial management?General clinical condition of patient?
Contrast enhancement agents and radiopharmaceuticals
A Stewart Whitley, Jan Dodgeon, Angela Meadows, Jane Cullingworth, Ken Holmes, Marcus Jackson, Graham Hoadley, Randeep Kumar Kulshrestha in Clark’s Procedures in Diagnostic Imaging: A System-Based Approach, 2020
Intravascular extravasation is the accidental administration of any drug into the patients surrounding tissue, either as a result of poor needle placement and a puncture of the vessel wall, or through leakage in patients with brittle vessel walls or the elderly. Extravasation is a well-recognised complication following the administration of contrast media and is reported as having a prevalence of 0.04–1.3% with automated power injectors. Most patients who experience extravasation of contrast agents only experience mild soft-tissue injury, but in some rare cases severe skin ulceration and tissue necrosis may occur. In simple terms, extravasation can either be user dependent (by incorrect needle insertion) or due to patient-related factors. These include: Obesity.Compromised venous or lymphatic drainage.Fragile/damaged veins.Inability to communicate.
Malignant Tumors and the Microcirculation
John H. Barker, Gary L. Anderson, Michael D. Menger in Clinically Applied Microcirculation Research, 2019
Convective fluid flow through the microvascular wall is defined as filtration. Morphologic characteristics of tumor microvessels suggest that the filtration coefficient should be higher than in most normal tissues. Extravasation of macromolecules, however, is poor in tumors. This is due to high interstitial fluid pressures which limit fluid extravasation.72 Recent investigations of intratumor pressure gradients show that although the interstitial pressure is elevated throughout the tumor, it drops precipitously to normal levels in the tumor’s periphery.76 As the tumor grows, the interstitial fluid pressure rises, presumably due to proliferation of tumor cells in a confined space, high vascular permeability, and the absence of lymphatic vessels.76
Ebselen oxide attenuates mechlorethamine dermatotoxicity in the mouse ear vesicant model
Published in Drug and Chemical Toxicology, 2020
Hemanta C. Rao Tumu, Benedette J. Cuffari, Maria A. Pino, Jerzy Palus, Magdalena Piętka-Ottlik, Blase Billack
Vesicants are strong cytotoxic alkylating agents that cause extensive damage to the skin, eyes, and respiratory tract. SM is the most widely studied vesicant due to its use in World War I and several other instances. It has been over 100 years since its first deployment, but no effective countermeasure is yet available to treat mustard gas toxicity. HN2 is a type of NM that shares a similar structure and toxicity profile to SM. Both SM and NMs are associated with causing oxidative stress, DNA alkylation, and blister formation (Korkmaz et al. 2006, Laskin et al. 2010). It is interesting to note that HN2 is used in anticancer therapy due to its alkylating properties; however, its use as IV chemotherapy is associated with extravasation and tissue blistering reactions. Extravasation occurs when there is an accidental infiltration of a vesicant or chemotherapeutic drug into the surrounding IV site (Cassagnol and McBride 2009). Our laboratory strives to understand the various molecular mechanisms of NM-induced cutaneous damage, as well as test various candidate compounds for their anti-vesicant activity.
Polymeric nanostructure vaccines: applications and challenges
Published in Expert Opinion on Drug Delivery, 2020
Rosana Simón-Vázquez, Mercedes Peleteiro, África González-Fernández
Albumin is the most abundant protein in human plasma and it has several advantages as nanocarrier, such as (i) long circulation time and natural degradation, (ii) capacity to bind hydrophobic and natural ligands, (iii) extravasation from leaky vessels into inflamed or tumor cells, and (iv) the preferential uptake and metabolization by rapidly growing cells, i.e. as cancer cells [69]. Moreover, albumin is easily internalized by APCs via endocytosis [70]. For that reason, albumin-based nanocarriers have been used in the last years to deliver therapeutic agents into tumor cells and for vaccine development. Besides, molecules that do not bind to albumin can also be transported by the protein forming a fusion protein with an albumin ligand. For example, Evans blue was used for the conjugation of molecular Ags (Albivax). Once injected in an animal, via s.c. administration, the conjugate was able to self-assemble with the endogenous albumin and form an albumin/Albivax nanocomplex with the capacity to drain from the injection site to the closest lymph nodes [70]. This versatile platform was able to accommodate different types of Ags such as peptides, nucleic acids, or polysaccharides, but also diverse adjuvants. Moreover, the combination with other antitumoral drugs or an immune checkpoint inhibitor promoted a synergistic antitumor response. Experiments with tumor Ags proved the efficacy of this platform to elicit an efficient cellular immune response, based on a high Ag-specific CD8+ cytotoxic T lymphocyte production, that inhibited the progression of both, primary and metastatic tumors.
Pathology of breast cancer metastasis and a view of metastasis to the brain
Published in International Journal of Neuroscience, 2023
Md Sakibuzzaman, Shahriar Mahmud, Tanzina Afroze, Sawsan Fathma, Ummul Barakat Zakia, Sabrina Afroz, Farzina Zafar, Maksuda Hossain, Amit Barua, Sabiha Akter, Hasanul Islam Chowdhury, Eram Ahsan, Shayet Hossain Eshan, Tasnuva Tarannum Fariza
Arrived CTCs undergo extravasation (the opposite process of intravasation) to establish metastasis. Extravasation involves different steps: rolling, firm adhesion, and finally, trans-endothelial migration (TEM) (luminal to the abluminal faces of the endothelium) for crossing blood-brain barriers. BCCs slowly roll along brain microvascular endothelial cells (BMVECs) surface to establish various receptor-ligand interactions with endothelial cells (ECs) [60,62]. Once the interaction is established at a suitable site of the blood-brain barrier (BBB), firm and stable adhesion between BCCs and EC takes place. E-selectin plays an important role in this step [63]. Tumor cells release VEGF to facilitate the TEM through the endothelial barrier [55,64]. TEM mostly takes place in paracellular pathways. The involvement of the transcellular pathway in the extravasation process is unclear. Tumor cells interact first with tight junctions and then with adherens junctions to allow paracellular TEM. The absence of detectable BMVECs programmed cell death or any significant disruptive changes at TEM sites suggests that transmigration of tumor cells does not lead to BBB damage [65]. Additionally, similar to the EMT of epithelial cells, ECs may undergo an endothelial-mesenchymal transition (EndMT) [66]. Anderberg et al. [67] suggested that EndMT occurs in extravasation and intravasation. This process allows the endothelial cell to acquire a mesenchymal phenotype to weaken the endothelial barrier [67]. Thus, EndMT facilitates extravasation. As such, extravasation is a potential area of therapeutic development.