BACKGROUND:Polycythemia vera is defined as a chronic myeloproliferative disorder characterized by increased red blood cell count.There have been no reports on mesenteric thrombosis resulting from iatrogenic polycythem...BACKGROUND:Polycythemia vera is defined as a chronic myeloproliferative disorder characterized by increased red blood cell count.There have been no reports on mesenteric thrombosis resulting from iatrogenic polycythemia.METHODS:We present a patient with a history of non-small cell lung cancer undergoing maintenance oral chemotherapy on tarceva and adjunctive use of procrit.The patient presented to our emergency department with an acute abdomen and was found to have ischemic bowel from unmonitored procrit,which lead to hyperviscosity of blood and mesenteric infarction.RESULTS:The patient remained intubated with ventilator support.He refused a tracheostomy.He continued on feeding through the J port of the nasojejunal tube.His white cell count,and hematocrit and creatinine levels remained normal.Procrit use and chemotherapy were not restarted.He was transferred to a subacute nursing facility for further treatment.CONCLUSIONS:Procrit and other erythropoiesis stimulating drugs can cause significant morbidity and mortality with an increased risk of cardiovascular events,gastrointestinal bleeding,thromboembolism and stroke.This case report suggests that without closely monitoring hematocrit levels,epoetin may also be associated with an increased risk of mesenteric infarction.展开更多
Spontaneous bacterial peritonitis is a complication of ascitic patients with end-stage liver disease(ESLD); spontaneous fungal peritonitis(SFP) is a complication of ESLD less known and described. ESLD is associated to...Spontaneous bacterial peritonitis is a complication of ascitic patients with end-stage liver disease(ESLD); spontaneous fungal peritonitis(SFP) is a complication of ESLD less known and described. ESLD is associated to immunodepression and the resulting increased susceptibility to infections. Recent perspectives of the management of the critically ill patient with ESLD do not specify the rate of isolation of fungi in critically ill patients,not even the antifungals used for the prophylaxis,neither optimal treatment. We reviewed,in order to focus the epidemiology,characteristics,and,considering the high mortality rate of SFP,the use of optimal empirical antifungal therapy the current literature.展开更多
文摘BACKGROUND:Polycythemia vera is defined as a chronic myeloproliferative disorder characterized by increased red blood cell count.There have been no reports on mesenteric thrombosis resulting from iatrogenic polycythemia.METHODS:We present a patient with a history of non-small cell lung cancer undergoing maintenance oral chemotherapy on tarceva and adjunctive use of procrit.The patient presented to our emergency department with an acute abdomen and was found to have ischemic bowel from unmonitored procrit,which lead to hyperviscosity of blood and mesenteric infarction.RESULTS:The patient remained intubated with ventilator support.He refused a tracheostomy.He continued on feeding through the J port of the nasojejunal tube.His white cell count,and hematocrit and creatinine levels remained normal.Procrit use and chemotherapy were not restarted.He was transferred to a subacute nursing facility for further treatment.CONCLUSIONS:Procrit and other erythropoiesis stimulating drugs can cause significant morbidity and mortality with an increased risk of cardiovascular events,gastrointestinal bleeding,thromboembolism and stroke.This case report suggests that without closely monitoring hematocrit levels,epoetin may also be associated with an increased risk of mesenteric infarction.
文摘Spontaneous bacterial peritonitis is a complication of ascitic patients with end-stage liver disease(ESLD); spontaneous fungal peritonitis(SFP) is a complication of ESLD less known and described. ESLD is associated to immunodepression and the resulting increased susceptibility to infections. Recent perspectives of the management of the critically ill patient with ESLD do not specify the rate of isolation of fungi in critically ill patients,not even the antifungals used for the prophylaxis,neither optimal treatment. We reviewed,in order to focus the epidemiology,characteristics,and,considering the high mortality rate of SFP,the use of optimal empirical antifungal therapy the current literature.
