ABSTRACT
Disseminated intravascular coagulation (DIC) is a complex abnormality of hemostasis with dramatic consequences and long described as associated with tumors. Yet the diagnosis and management of paraneoplastic DIC are poorly defined. The purpose of this paper is to review DIC associated with solid tumors, at the pathophysiological and therapeutic levels in particular. We also report data from a recent retrospective series of patients with DIC in the context of a solid tumor, to illustrate the epidemiological, clinical and prognostic.
Subject(s)
Disseminated Intravascular Coagulation , Neoplasms/blood , Paraneoplastic Syndromes , Anticoagulants/therapeutic use , Blood Coagulation/physiology , Coagulants/therapeutic use , Disseminated Intravascular Coagulation/blood , Disseminated Intravascular Coagulation/diagnosis , Disseminated Intravascular Coagulation/epidemiology , Disseminated Intravascular Coagulation/etiology , Disseminated Intravascular Coagulation/physiopathology , Disseminated Intravascular Coagulation/therapy , Factor VIIa/therapeutic use , Humans , Neoplasms/pathology , Neoplasms/therapy , Paraneoplastic Syndromes/blood , Paraneoplastic Syndromes/diagnosis , Paraneoplastic Syndromes/etiology , Paraneoplastic Syndromes/physiopathology , Paraneoplastic Syndromes/therapy , Platelet Transfusion , Prognosis , Recombinant Proteins/therapeutic use , Risk FactorsABSTRACT
Axitinib is an oral second-generation selective inhibitor of vascular endothelial growth factor receptors recently approved for the treatment of advanced renal cell carcinoma. Numerous cases of acute pancreatitis have been reported after treatment with nonselective tyrosine kinase inhibitors such as sorafenib and sunitinib. We present the first report of a patient under axitinib treatment presenting with acute pancreatitis for which no other etiology has been found. The patient was a 29-year-old woman treated for renal cell carcinoma. The patient had no history of chronic illness, gallstone-related disease, or alcohol consumption. She had been previously treated with sunitinib and everolimus. Four months after the onset of axitinib treatment she was hospitalized for acute pancreatitis. Symptoms and blood lipase levels normalized within a few days after axitinib was withheld. We believe that acute pancreatitis should be recognized as a potential axitinib-related adverse event.
Subject(s)
Antineoplastic Agents/adverse effects , Carcinoma, Renal Cell/drug therapy , Imidazoles/adverse effects , Indazoles/adverse effects , Kidney Neoplasms/drug therapy , Pancreatitis/chemically induced , Protein Kinase Inhibitors/adverse effects , Acute Disease , Adult , Antineoplastic Agents/therapeutic use , Axitinib , Female , Humans , Imidazoles/therapeutic use , Indazoles/therapeutic use , Protein Kinase Inhibitors/therapeutic useABSTRACT
Cystic echinococcosis is a world wild zoonosis caused by Echinococcus granulosus, leading to hepatic and lung cysts with a usually slight growth rate. We report the case of an 82year-old Algerian woman with hepatic and lung cystic echinococcosis with a 10-fold size increase in 6months.
Subject(s)
Echinococcosis/pathology , Aged, 80 and over , Albendazole/administration & dosage , Albendazole/therapeutic use , Algeria/epidemiology , Animals , Anticestodal Agents/administration & dosage , Anticestodal Agents/therapeutic use , Echinococcosis/drug therapy , Echinococcosis/epidemiology , Echinococcus granulosus/isolation & purification , Female , Humans , Liver/parasitology , Liver/pathology , Lung Diseases, Parasitic/drug therapy , Lung Diseases, Parasitic/parasitology , Lung Diseases, Parasitic/pathologyABSTRACT
Primary biliary cirrhosis (PBC) is an autoimmune liver disease characterised by chronic cholestasis usually associated with antimitochondrial antibodies. Moreover, several types of antinuclear antibodies have been associated with primary biliary cirrhosis. We describe an 83-year-old man, in whom the exploration of a chronic cholestasis led to the diagnosis of primary biliary cirrhosis despite negative antimitochondrial antibodies, regarding the presence of anti-gp210 antibodies. Found in 25% of patients, these antinuclear antibodies must be sought before a strong suspicion of primary biliary cirrhosis with antimitochondrial antibodies negative, as they are highly specific of the disease. They are generally associated with a more aggressive form of PBC.
Subject(s)
Antibodies, Antinuclear/immunology , Liver Cirrhosis, Biliary/diagnosis , Nuclear Pore Complex Proteins/immunology , Aged, 80 and over , Humans , Liver Cirrhosis, Biliary/immunology , MaleABSTRACT
RATIONALE: The role of biomarkers such as troponin in risk stratification of sepsis is still debated. The aim of this meta-analysis is to assess the relation between troponin elevation in sepsis and mortality. METHODS: All observational studies from Embase, Medline and those manually searched up to September 2010 were included. Studies identified were those which reported on patients with a diagnosis of sepsis and if a 2 × 2 table could be constructed based on troponins and death. We pooled the relative risk (RR) and odds-ratio (OR) using the inverse variance method in studies that conducted univariate and multivariable (adjusted) analysis. MAIN RESULTS: Thirteen studies encompassing 1,227 patients were included. The prevalence of elevated troponin was 61 % ([95 %] CI 58-64 %). Elevated troponin was significantly associated with all-cause mortality (RR 1.91; CI 1.63-2.24), with homogeneity across studies. In adjusted analysis (four studies comprising 791 patients) according to prognostic scores, elevated troponin was associated with an increased risk of death (OR 1.92; CI 1.35-2.74). The area under the ROC curve was 0.68 (CI 0.63-0.71). Pooled sensitivity and specificity were 77 % (CI 61-88) and 47 % (CI 30-64) with heterogeneity across studies. It corresponded to positive and negative likelihood ratios of 1.50 (95 % CI: 1.20-1.90) and 0.49 (CI 0.38-0.64), respectively. CONCLUSIONS: Elevated troponin identifies a subset of patients with sepsis at higher risk of death. Further studies are needed to define the precise role of troponins and their optimal cut-offs.
