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Levocarnitine and vitamin B complex for the treatment of pegaspargase-induced hepatotoxicity: A case report and review of the literature.
Blackman, A, Boutin, A, Shimanovsky, A, Baker, WJ, Forcello, N
Journal of oncology pharmacy practice : official publication of the International Society of Oncology Pharmacy Practitioners. 2018;(5):393-397
Abstract
Asparaginase is a chemotherapeutic agent that is commonly used in combination with other medications for the treatment of acute lymphoblastic leukemia. An adverse effect of asparaginase includes hepatotoxicity, which can lead to severe liver failure and death. Several reports have documented successful treatment of asparaginase-induced hepatotoxicity using levocarnitine (l-carnitine) and vitamin B complex. Herein, we report a patient with acute lymphoblastic leukemia that experienced acute liver injury following pegaspargase administration. Our patient was successfully treated with l-carnitine and vitamin B complex for 8 days and achieved recovery of hepatic function. Furthermore, we review the current literature and provide a recommendation on a regimen that can be used as an option for the treatment of asparaginase-induced hepatic injury.
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2.
Administering Polyethylene Glycol Electrolyte Solution Via a Nasogastric Tube: Pulmonary Complications.
Metheny, NA, Meert, KL
American journal of critical care : an official publication, American Association of Critical-Care Nurses. 2017;(2):e11-e17
Abstract
BACKGROUND Patients sometimes require insertion of a nasogastric tube for the administration of a large volume of a polyethylene glycol electrolyte solution. If the tube is malpositioned, the risk for direct instillation of the solution into the lung increases. The risk for aspiration also increases if the infusion rate exceeds gastrointestinal tolerance. PURPOSE To review published cases of patients' experiencing adverse pulmonary events after administration of polyethylene glycol electrolyte solution via a nasogastric tube and to offer suggestions to prevent these outcomes. METHODS A search of the literature from 1993 through 2014 was performed by using the PubMed, MEDLINE, Cumulative Index to Nursing and Allied Health Literature, and Scopus databases. RESULTS In the 12 case reports located, none of the patients had radiographs to verify tube location before infusion of polyethylene glycol electrolyte solution. After symptoms developed in 3 children (ages 8-11 years), radiographs showed their tubes incorrectly positioned in the bronchus, lung, or esophagus; ports of a fourth child's tube were in the oropharynx. The remaining 8 patients (ages 5-86 years) never had radiographs to determine tube placement. Pulmonary complications from the infusions of polyethylene glycol electrolyte solution contributed to the death of 5 of the patients. CONCLUSION Relatively simple maneuvers to reduce the likelihood of adverse pulmonary events following the administration of large volumes of polyethylene glycol electrolyte solution via a nasogastric tube are well worth the cost and effort to protect patients from potential serious injury.
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PEG-asparaginase induced severe hypertriglyceridemia.
Galindo, RJ, Yoon, J, Devoe, C, Myers, AK
Archives of endocrinology and metabolism. 2016;(2):173-7
Abstract
Asparaginase (ASP) is an effective chemotherapy agent extensively used in children with acute lymphocytic leukemia (ALL). There has been a recent interest in using ASP in adults with ALL, particularly the less toxic pegylated (PEG) formulation. Hypertriglyceridemia (HTG) is a rare complication of PEG-ASP therapy. We report two cases of obese patients who developed severe HTG after receiving PEG for ALL. Both patients were incidentally found to have severe HTG (TG of 4,330 and 4,420 mg/dL). In both patients, there was no personal or family history of dyslipidemia or hypothyroidism. There was no evidence of pancreatitis or skin manifestations of HTG. Both patients were treated with PEG cessation, low-fat diet and pharmacotherapy. Both patients were re-challenged with PEG, with subsequent increase in TG but no associated complications. TG returned to baseline after discontinuing PEG and while on therapy for HTG. A literature review of PEG-induced HTG in adults demonstrated similar results: asymptomatic presentation despite very severe HTG. HTG is a rare but clinically important adverse effect of PEG. Underlying obesity and/or diabetes may represent risk factors. Clinicians should monitor TG levels during PEG therapy to avoid TG-induced pancreatitis.
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4.
Polyetheretherketone custom-made implants for craniofacial defects: Report of 14 cases and review of the literature.
Alonso-Rodriguez, E, Cebrián, JL, Nieto, MJ, Del Castillo, JL, Hernández-Godoy, J, Burgueño, M
Journal of cranio-maxillo-facial surgery : official publication of the European Association for Cranio-Maxillo-Facial Surgery. 2015;(7):1232-8
Abstract
BACKGROUND Craniofacial defects tend to carry functional and esthetic consequences for the patient. The complex shapes in this region make such reconstructions a challenging procedure and the most suitable material to be used remains controversial. METHODS We report a series of 14 patients whose craniofacial defects were reconstructed using a computer designed PEEK-PSI (Polyetheretherketone- Patient Specific Implant). We analyzed the complications and outcomes of PEEK custom-made implants and compared our results with those of other case series reported in the current literature. RESULTS Fourteen patients underwent craniofacial reconstruction using a PEEK-PSI. Three cases involved a one-step primary reconstruction and the rest of cases underwent a delayed reconstruction. Two cases (14.3 %) presented infection and only in one case was the implant definitively removed. Esthetic results were considered to be highly satisfactory. CONCLUSION With CAD-CAM techniques, it is possible to prefabricate an individual implant. The ideal material for reconstructing maxillofacial defects does not exist, but PEEK has demonstrated good outcomes. When autologous bone is not available or, in selected cases with large or complex defects in the maxillofacial area, PEEK is one of the best options to reconstruct these defects. However, further studies are needed to determine the long-term results.
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5.
Association of pancreatic autoantibodies and human leukocyte antigen haplotypes with resolution of diabetes mellitus after therapy for hepatitis C virus infection in patients with HIV infection: case report and review of literature.
Lo, YC, Chang, SY, Sheng, WH, Hung, CC, Chang, SC
European journal of gastroenterology & hepatology. 2009;(4):478-81
Abstract
Diabetes mellitus (DM) is a well known complication of interferon therapy for chronic hepatitis C virus (HCV) infection, but resolution of interferon-induced DM was rarely reported. In HIV and HCV co-infected patients, only two cases of incident DM during interferon therapy were reported and both cases required permanent insulin treatment. We report the first case of HIV/HCV co-infected patient who developed diabetic ketoacidosis during treatment for chronic HCV infection with complete resolution of DM after treatment cessation. Review of reported cases indicates that pancreatic autoantibodies and human leukocyte antigen haplotypes may predict the outcome of interferon-induced diabetes.