1/8. Stereotactic radiosurgery. VIII. The classification of postradiation reactions.Postradiation reactions in the CNS are well described and catalogued in the conventional radiotherapy literature; acute, subacute and late CNS reactions are recognized. Tumours predispose to these normal tissue reactions by the oedema and pressure epiphenomena that occur in their environs, and probably by other mechanisms associated with tissue breakdown. That late normal tissue reactions (particularly permanent late sequelae--universally referred to as 'necrosis') occur in the normal nervous system is in the complication list of every radiosurgery centre. This article, for the first time, places postradiosurgery observations within or without the existing classification of reactions, and draws attention to the fact that previous 'radiosurgery risk factor' papers in the literature may be wrong to pool different 'reactions' in the formulation of risk formulae for normal brain damage following single shot radiotherapy. Acute reactions occur in the same manner as described for conventional radiotherapy, being a transient swelling phenomenon that occurs 12-48 h after therapy; they are fully reversible and do not usually augur late problems; routine administration of short duration steroids around the time of radiosurgery may prevent or delay the clinical signs. Subacute reactions occur 3-10 months later (a later time than the subacute reactions following conventionally fractionated radiotherapy), and may prove fully or partially reversible, or progress to permanent sequelae; the difference between these and late sequelae (which tend to be permanent themselves) then becomes blurred. That tumour swelling occurs in the subacute phase and is associated with oedema in the surrounding normal brain is an interesting observation (occurring in extra- and intra axial slow-growing tumours); it denotes tumour damage and has not been encountered in the conventionally-fractionated radiotherapy literature. Tumour shrinkage occurs later, with subsidence of the surrounding oedema, and this phenomenon may therefore be regarded (paradoxically) as a good prognostic sign, a point about which the referring clinician should be made aware. Similarly, contrast enhancement in the tumour perimeter at this time reflects a host reactive response and not tumour activity. Persistent clinical neurological signs and MRI changes (best seen on the T2 weighted sequences) beyond 2 years, indicate late damage or reaction. Usually, this represents scarring or coagulative necrosis without mass effect, but if there is a low signal area with mass effect and considerable surrounding oedema, liquefactive necrosis has occurred and (as in the brachytherapy literature) surgical decompression is very occasionally needed.- - - - - - - - - - ranking = 1keywords = reaction (Clic here for more details about this article) |
2/8. magnetic resonance imaging of calvarial eosinophilic granuloma with pericranial soft tissue reaction--case report.A 4-year-old girl presented with an eosinophilic granuloma in the cranial vault. Magnetic resonance (MR) imaging showed the mass as slightly low intensity on T1- and high intensity on T2-weighted images. The pericranial soft tissue was densely enhanced after gadolinium-diethylenetriaminepenta-acetic acid infusion. The mass was soft and successfully removed. Histological examination disclosed Langerhans' cell histiocytosis. MR imaging is useful for the diagnosis of calvarial eosinophilic granuloma with soft tissue involvement.- - - - - - - - - - ranking = 0.28571428571429keywords = reaction (Clic here for more details about this article) |
3/8. Lepromatous leprosy and reversal reaction in a Micronesian immigrant.A 25-year-old Micronesian man from the island of Otia developed erythematous plaques on his legs. He was diagnosed with erythema nodosum and treated with systemic prednisone. Two months later, he presented with erythematous nodules on his forehead, cheeks, and chin (Fig. 1). Examination revealed scattered violaceous papules on his chest, arms, forearms, hands, and feet, and deep purple macules on his palms and soles. Laboratory evaluation included negative serologies for human immunodeficiency virus, rapid plasma reagin, and hepatitis a, B, and C. Routine histopathology revealed nodular aggregates of histiocytes, plasma cells, and lymphocytes. histiocytes showed basophilic clusters of organisms within vacuoles, suggesting globi. Acid-fast stain revealed numerous acid-fast-positive rod-shaped organisms. The bacterial index on the Fite stain was four (bacterial index/Ridley's logarithmic scale, indicating 10-100 bacteria/high power field) (Fig. 2). An acid-fast stain obtained from a smear of tissue was positive for acid-fast bacilli, but no acid-fast bacilli were cultured. After the first day of treatment with dapsone 100 mg, rifampin 600 mg, and clofazimine 50 mg, the patient complained of burning and pain in his ankles and wrists. There was intense erythema within the lesions. Edema developed in his hands and feet. Consultation with the Gillis W. Long Hansen's disease Center in Carville, louisiana, recommended prompt treatment with corticosteroids. The edema of the hands and wrists was treated as a type I reversal reaction with prednisone 1 mg/kg/day. Subsequently, the edema and neuralgia quickly resolved in his distal extremities.- - - - - - - - - - ranking = 0.35714285714286keywords = reaction (Clic here for more details about this article) |
4/8. Prevention of hepatic infarction as acute-phase complication of TIPS by temporary balloon occlusion in a patient with primary myelofibrosis.Severe acute liver dysfunction occurred following transjugular intrahepatic portosystemic shunt (TIPS) creation in a patient with massive ascites due to portal hypertension associated with primary myelofibrosis. On US and TIPS venography, we considered that the acute liver ischemia was induced by TIPS. To avoid diffuse hepatic infarction and irreversible liver damage, a balloon catheter was inserted transjugularly into the TIPS tract and occluded it to increase portal venous flow toward the peripheral liver parenchyma. The laboratory data indicating hepatic dysfunction were improved after the procedure. We should pay attention to the possible occurrence of acute hepatic ischemia and infarction after TIPS creation even in a case of noncirrhotic portal hypertension. In such cases, temporary balloon occlusion of TIPS is an effective therapeutic method, probably as a result of inducing the development of arterial compensation through the peribiliary plexus.- - - - - - - - - - ranking = 673804.8410566keywords = acute-phase (Clic here for more details about this article) |
5/8. The acute-phase response and associated lipoprotein abnormalities accompanying lymphoma.Lipoprotein abnormalities seen in patients with inflammatory diseases are thought to develop secondary to circulating cytokines and the accompanying acute-phase response. Patient's with lymphoma may develop similar lipoprotein abnormalities but the mechanism is unclear. We report a patient with B-cell lymphoma who presented with an HDL cholesterol level of 3 mg dl-1, an ApoA level of 17.4 mg dl-1, elevated triglyceride level (272 mg dl-1) and an elevated ApoB level of 156 mg dl-1. Density gradient analysis of the patient's lipoproteins demonstrated a virtual absence of an identifiable HDL particle. serum amyloid A and c-reactive protein were also elevated. All of the lipoprotein abnormalities resolved with chemotherapy and resolution of the acute-phase response. The acute-phase response may be associated with striking lipoprotein abnormalities in a subset of patients with lymphoma. lymphoma should be included in the differential diagnosis of patients with hypertriglyceridaemia and low HDL cholesterol.- - - - - - - - - - ranking = 1179158.471849keywords = acute-phase (Clic here for more details about this article) |
6/8. Suppression of fever and the acute-phase response in a patient with juvenile chronic arthritis treated with monoclonal antibody to tumour necrosis factor-alpha (cA2).Juvenile chronic arthritis (JCA) is the commonest chronic rheumatic disorder of childhood. Although conventional therapy of JCA continues to improve, many patients experience long-term ill health as a result of their disease or treatment. In adult rheumatoid arthritis (RA), similar concerns have led to the development of therapies designed to interfere in key disease processes. One such therapy is cA2, a chimeric neutralizing monoclonal antibody to the inflammatory cytokine, tumour necrosis factor-alpha (TNF-alpha). The administration of cA2 in adult RA has led to impressive short-term suppression of disease, with a good safety profile. Here, we report the first use of cA2 in childhood arthritis, choosing a patient with severe systemic-onset JCA, resistant to conventional therapies. The patient received two i.v. infusions of cA2, each at a dose of 10 mg/kg, separated by 1 week. The treatment was well tolerated and induced rapid control of fever, anorexia and serositis, together with downregulation of interleukin (IL)-6, soluble TNF receptors (sTNFR) and IL-1ra, and the acute-phase proteins c-reactive protein (CRP) and serum amyloid A (SAA). In contrast, we saw no significant improvement in joint pain or tenderness. Our findings suggest that TNF-alpha is a mediator of fever and other systemic aspects of disease in systemic JCA. TNF-alpha blockade as a treatment modality in JCA deserves further study.- - - - - - - - - - ranking = 842256.05132075keywords = acute-phase (Clic here for more details about this article) |
7/8. Increased interleukin-6 production during the acute phase of the syndrome of episodic angioedema and hypereosinophilia.BACKGROUND: The Gleich syndrome is rare and associates recurrent angioedema, urticaria, fever, weight gain and blood hypereosinophilia, underlying systemic and local inflammation. The pathogenesis of those symptoms remains unclear. OBJECTIVE: We wanted to address the possible implication of interleukin-6 (IL-6) in the development of those clinical features, and to identify the cells involved in its production. methods: A 26-year-old man suffering of this disease was referred in hospital. During an acute attack with weight gain, fever and a diffuse oedema, a marked increase in eosinophils count (42700/mm3 was observed. serum ECP was elevated at 47 microg/L (normal less than 16). Corticosteroid therapy administrated on the 7th day was followed by a rapid remission. blood samples were collected (before, during the attack and under corticosteroid therapy) for measurements of serum IL-6 (ELISA, Immunotech, Marseille, france) and plasma histamine (RIA, Immunotech, Marseille, france). blood monocytes and eosinophils were isolated and a skin biopsy was performed during the attack. RESULTS: The plasma histamine level was within normal range. The level of IL-6 in sera peaked to 74 pg/mL, concomitant with the peak of eosinophilia at the acute phase phase of the attack. Under corticosteroids, we observed a drop in the IL-6 serum level to 29 pg/mL, concomitant with the clinical remission. During the attack, an increase in IL-6 production was observed in 24 h blood monocyte supernatants (11.10(3) pg/mL compared with 2.4 /-0.8.10(3) pg/mL for BM from controls) as well as in skin endothelial cells but not in the blood and skin eosinophils. in vitro, when endothelial cells were incubated in eosinophils supernatants of the patient, liberation of IL-6 was observed (3.3 10(3) pg/mL compared with controls: 2.1 10(3) pg/mL) CONCLUSION: serum IL-6 elevation may be related to an increased production by blood monocytes and endothelial cells, possibly stimulated by eosinophil mediator during the acute phase of the disease, and might participate in the inflammatory reaction of this syndrome.- - - - - - - - - - ranking = 0.071428571428571keywords = reaction (Clic here for more details about this article) |
8/8. Postoperative inflammatory reaction developing focal but severe brain edema. A possible complication of topical application of Biobond-soaked oxycellulose.A 66-year-old female underwent uneventful removal of parasagittal meningioma. At surgery, a piece of Biobond-soaked oxycellulose was applied to the lateral wall of the superior sagittal sinus for hemostasis. Her early postoperative course was complicated by focal but severe brain edema, which was adjacent to the hemostatic agent. Unlike foreign body granuloma previously reported, this complication was considered to be attributed to inflammatory reaction of Biobond, because of the early onset and fulminant edema despite of small volume of the mass lesion. Although there have been no previous reports of this complication, it should be kept in mind that intracranial application of Biobond may induce fulminant inflammatory reaction as seen in this patient.- - - - - - - - - - ranking = 0.42857142857143keywords = reaction (Clic here for more details about this article) |