1/22. Topical DMSO treatment for pegylated liposomal doxorubicin-induced palmar-plantar erythrodysesthesia.PURPOSE: Chemotherapeutic regimens that utilize fluorouracil, cytarabine, and doxorubicin have been shown to cause a dermatologic syndrome known as hand-foot syndrome, or palmar-plantar erythrodysesthesia syndrome (PPES). Pegylated liposomal doxorubicin has proven effective in the treatment of AIDS-related Kaposi's sarcoma, ovarian cancer refractory to platinum and paclitaxel therapies, and metastatic breast cancer. In a study of the treatment of refractory epithelial cell ovarian cancers with lipozomal doxorubicin utilizing intravenous doses of 50 mg/m(2) every 3 weeks, grade 3 PPES was observed in 29% of patients (10/35) and required dose reductions and/or dose delay after a median of three therapy cycles. methods: Current methods to prevent pegylated liposomal doxorubicin-induced PPES include dose reduction, lengthening of the drug administration interval and ultimately, drug withdrawal. Topical 99% dimethylsulfoxide (DMSO) also has shown strong activity in treating tissue extravasation reactions during intravenous administration of doxorubicin. RESULTS: Two patients undergoing chemotherapy with pegylated liposomal doxorubicin, 50 mg/m(2) every 4 weeks, developed grade 3 PPE after three cycles. Their PPES resolved over a period of 1 to 3 weeks while receiving topical 99% DMSO four times daily for 14 days. CONCLUSIONS: While these results are promising, patients must be treated in a prospective study of this topical DMSO formulation to definitively document its therapeutic efficacy.- - - - - - - - - - ranking = 1keywords = palm (Clic here for more details about this article) |
2/22. Ulnar conduction block at the wrist.Two cases of ulnar nerve lesions at the wrist are reported. The lesions had an acute onset and exclusively impaired the ulnar motor deep branch. The coexistence of carpal tunnel syndrome in each case allowed an early diagnosis but was somewhat misleading. In both cases, the use of classic motor and sensory conduction studies did not provide clear abnormalities that would have precisely determined the site of the nerve lesion. In both cases, only palmar stimulation of the ulnar motor deep branch showed an important conduction block. This electrodiagnostic finding showed definitively the site of the ulnar nerve lesion at the wrist and excluded proximal ulnar nerve lesions or C8-T1 radiculopathy. In both cases recovery occurred without surgery.- - - - - - - - - - ranking = 0.2keywords = palm (Clic here for more details about this article) |
3/22. Palmar-plantar erythrodysesthesia syndrome associated with liposomal daunorubicin.daunorubicin and doxorubicin are anthracyclines that have efficacy against malignancies such as breast cancer, lung cancer, lymphoma, and leukemia. Their adverse effects are similar. The most serious is cardiotoxicity, which often limits the total cumulative dose that can be administered. Introduction of a liposomal formulation for both agents allows tumor selectivity by accumulating the drug in tumor tissue, thus increasing the tolerated dose. Liposomal doxorubicin is commonly associated with palmar-plantar erythrodysesthesia syndrome (PPES), although no reports of PPES were found in the literature related to liposomal daunorubicin (L-DNR). Two patients developed PPES while receiving high-dose L-DNR. The symptoms were self-limiting and resolved within a few weeks.- - - - - - - - - - ranking = 0.2keywords = palm (Clic here for more details about this article) |
4/22. Fibrolipoma of the median nerve: a case report and review of the literature.A 38 year-old patient presented with right median nerve distribution paresthesias. Electrodiagnostic studies confirmed severe carpal tunnel syndrome. A palmar mass prompted a magnetic resonance imaging scan, which suggested a fibrolipoma of the median nerve. Carpal tunnel release resulted in resolution of preoperative pain and paresthesias. We review the literature dealing with this primary nerve tumor.- - - - - - - - - - ranking = 0.2keywords = palm (Clic here for more details about this article) |
5/22. Pegylated liposomal doxorubicin: tolerability and toxicity.We evaluated the tolerability and toxicity attributed to pegylated liposomal doxorubicin (PL-DOX) in women with recurrent or refractory ovarian cancer, and reviewed procedures to prevent or treat toxicity induced by the agent. medical records of 13 women who received PL-DOX between October 1997 and December 2000 were reviewed. patients 1-8 received PL-DOX once it was added to the hospital formulary in 1997. patients 9-13 received it after medical staff education. Data on premedications, number of cycles, dosage, length of infusion, tolerability, side effects, and indicators for response were collected. The median number of cycles and cumulative dose/patient of PL-DOX were higher (6 and 420 mg) in the second group than in the first group (2 and 240 mg). Patient factors such as duration of disease and number of chemotherapy cycles influenced tolerability. One patient experienced a life-threatening adverse reaction within minutes of receiving the first dose. Treatment was discontinued, and she was resuscitated successfully. Other dose- or treatment-limiting complications (neutropenia, stomatitis, plantar-palmar erythrodysesthesia) were documented. Toxicity management consisted of dosage reduction or treatment delay; treatment often was discontinued. patients with recent disease tolerated more cycles of PL-DOX when given early in recurrence compared with heavily pretreated women with long-standing disease. Tolerability was not necessarily indicative of response. The agent is simple to administer, but its tolerability and lack of uniform toxicity management remain concerns.- - - - - - - - - - ranking = 0.2keywords = palm (Clic here for more details about this article) |
6/22. Chemotherapy-induced palmar-plantar erythrodysesthesia syndrome--recall following different chemotherapy agents.radiation recall is a phenomenon commonly seen in patients receiving chemotherapy treatment who have previously been exposed to radiation. A phenomenon not clearly described is that of a side effect induced by one chemotherapy agent and later recalled when the patient is given a different chemotherapy regimen. Troxacitabine is an anti-leukemic agent which can be associated with palmar-plantar erythrodysesthesia syndrome (PPES). Here, we report six cases of troxacitabine-induced PPES that was later recalled by various chemotherapy regimens. The recall PPES was mild to moderate and self-limiting in all cases. All of these patients recovered from the recall side effects with minimal medical intervention. We conclude that a recall phenomenon similar to that described after radiotherapy might occur after certain chemotherapy agents. This phenomenon should be considered when evaluating toxicity from chemotherapy, particularly when using new and investigational agents.- - - - - - - - - - ranking = 1keywords = palm (Clic here for more details about this article) |
7/22. Recurrent palmar-plantar erythrodysaesthesia following high-dose cytarabine treatment for acute lymphoblastic leukemia.Palmar-plantar erythrodysaesthesia (PPE) is an uncommon cutaneous complication of cytotoxic chemotherapy which generally presents as a painful erythema involving the palms and soles. It has been suggested that PPE caused by cytarabine does not recur with subsequent cytarabine re-challenge. We report a patient with recurrent, increasingly severe episodes of PPE, ultimately complicated by a severe bullous eruption, following successive cycles of high-dose cytarabine for the treatment of acute lymphoblastic leukaemia. Contrary to previous recommendations, our experience cautions against the further use of high-dose cytarabine in patients who develop PPE, and is a timely reminder of the potential toxicity of this agent, which is now increasingly being used as first-line treatment in the management of haematologic malignancies.- - - - - - - - - - ranking = 1keywords = palm (Clic here for more details about this article) |
8/22. Serious hand-and-foot syndrome in black patients treated with capecitabine: report of 3 cases and review of the literature.Hand-and-foot syndrome (HFS) is one of the well-known adverse events associated with capecitabine, a prodrug of 5-fluorouracil (5-FU). HFS, also known as erythrodysesthesia, manifests as acral erythema with swelling and dysesthesia of the palms and plantar aspects of the feet, and, in the absence of dosage reduction or stoppage of the drug, progresses to moist desquamation and ulceration with serious infections and loss of function. In black patients, we observed that capecitabine given in the recommended dosage leads to hyperpigmentation of the palms and soles, followed by a distinct keratodermalike thickening not seen in white patients. Furthermore, in patients with a precarious peripheral vasculature, this condition evolves rapidly into grade 3 HFS, with ulceration and infection. We report our experience with capecitabine in 3 black patients and contrast it to that of 2 white patients. A brief review of the literature on fluoropyrimidines and HFS follows.- - - - - - - - - - ranking = 0.4keywords = palm (Clic here for more details about this article) |
9/22. Cheiro-oral-pedal syndrome.The cheiro-oral syndrome is a well-known peculiar sensory disturbance seen around the corner of the mouth and in the palm of the hand on the same side. However, sensory disturbance around the corner of the mouth, in the palm of the hand and in the foot on the same side (cheiro-oral-pedal syndrome) has not been reported until now. We examined 2 cases of cheiro-oral-pedal syndrome; the lesion responsible was confirmed by magnetic resonance imaging to be in the medial lemniscus and in the ventral ascending tract of the trigeminal nerve.- - - - - - - - - - ranking = 0.4keywords = palm (Clic here for more details about this article) |
10/22. Chemotherapy-induced palmer planter erythrodysesthesia.We report a case of palmar plantar erythrodysesthesia (PPE) in a case of acute lymphoblastic leukemia treated with VALP regime. The treating physician must be aware of this uncommon complication of chemotherapeutic agents to avoid unnecessary investigations.- - - - - - - - - - ranking = 1keywords = palm (Clic here for more details about this article) |
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