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At least 865 records · Page 48Linked to original sources
PubMed1987

Metastatic cancer. A relative contraindication to vena cava filter placement.

From October 1979 to November 1984, 41 patients underwent placement of vena cava filters for prevention of pulmonary emboli. After filter placement, no pulmonary emboli were documented. No patient died due to filter placement. However, 20 of these 41 patients are dead. Eighteen deaths were caused by cancer. Ten (24%) patients died within 2 months of filter placement. Five (12%) patients died prior to hospital discharge. All ten of these patients had known, widely metastatic cancer. Among the ten patients who died more than 2 months after filter placement, six had well-differentiated, slow growing tumors. Only three of these patients had brain metastases. Among the 21 survivors only two suffered from cancer. Strict adherence to accepted indications for vena cava filter placement required operative procedures on a small but significant number of patients who demonstrated no significant improvement in quality of life or time out of hospital. Filter placement in patients with aggressive cancers and proven metastases should be performed only after analysis of predicted survival and after detailed discussions with patients and referring physicians. Filter placement in patients with aggressive metastatic cancer may cause discomfort, risk, and expense with little hope for improvement of hospital course, longevity, or quality of life.

Adult↗
PubMed2003

Previous wide local excision of primary melanoma is not a contraindication for sentinel lymph node biopsy of the trunk and extremity.

BACKGROUND AND OBJECTIVES: The role of sentinel lymph node biopsy (SLNB) in patients with a previous wide local excision (WLE) was examined with case-control methodology. METHODS: A total of 168 consecutive cases of SLNB were performed in patients with truncal and extremity melanoma with tumor thickness of > or = 1 mm between October 1997 and June 2000 and were followed prospectively. For comparison, 65 of the 103 SLNB patients referred to us after their WLE (cases) were matched by tumor thickness to 65 patients who had SLNB with concurrent WLE (controls). Radiocolloid (technetium-99m sulfur colloid) was used in all cases; in addition, vital blue dye (patent blue) was used in the control group. The two groups were followed for a median of 15.4 months. RESULTS: SLNs were identified in all patients with an average of 2.1 (cases) and 2.0 (controls) SLNs excised per patient (P = 0.77). Twenty one (32.3%) of those having SLNB after previous WLE (cases) and 23 (35.4%) of those with concurrent WLE and SLNB (controls) were found to have metastatic disease in the SLN. The only false-negative in this group was detected in clinical follow-up in a patient whose truncal WLE was previously closed with a rotation flap (case). There was no significant difference in relapse-free survival (P = 0.209) and overall survival (P = 0.692) between groups. CONCLUSIONS: SLNB is feasible in patients with previous WLE for extremity and truncal melanoma. Similar rates of sentinel positivity are found when compared with those in whom their WLE was done concurrently.

Adult↗
PubMed1988

Calcium channel antagonists. Part IV: Side effects and contraindications drug interactions and combinations.

With the correct selection of drug and patient, the calcium antagonists as a group can be remarkably effective at relatively low cost of serious side effects. Almost all side effects are dose related. Minor side effects include those caused by vasodilation (flushing and headaches), constipation (verapamil), and ankle edema. Serious side effects are rare and result from improper use of these agents, as when intravenous verapamil (or diltiazem) is given to patients with sinus or atrioventricular nodal depression from drugs or disease, or nifedipine to patients with aortic stenosis. The potential of a marked negative inotropic effect is usually offset by afterload reduction, especially in the case of nifedipine which actually has the most marked negative inotropic effect. Yet caution is required when even calcium antagonists, especially verapamil, are given to patients with myocardial failure unless caused by hypertensive heart disease. Drug interactions of calcium antagonists occur with other cardiovascular agents such as alpha-adrenergic blockers, beta-adrenergic blockers, digoxin, quinidine, and disopyramide. The most marked interaction with digoxin is that with verapamil, which may raise digoxin levels by over 50%. Combination therapy of calcium antagonists with beta-blockers is increasingly common, and is probably safest in the case of dihydropyridines. Other combinations being explored are those with angiotensin-converting enzyme inhibitors and diuretics.

Calcium Channel Blockers↗
PubMed1986

Intraocular lens implants (pseudophakoi) and steelwire sutures: a contraindication for MRI?

The strong magnetic field of the super-conducting MRI (Magnetic Resonance Imaging) apparatus could cause problems in the presence of metallic foreign material, such as the metal clips and loops of intraocular lenses and steel as suturing material. If the magnetic field were to induce movement this could be dangerous for the eye. In this study these materials were tested with the 0.5 Tesla MRI and a 1.0 Tesla permanent magnet. Intraocular lenses with a platinum clip, or metallic or plastic loops, and 5 X 0/6 X 0 steelwire used as suturing material experienced no magnetic movement or change of position in the strong magnetic field. Neither did these foreign materials have any effect on the images obtained (spin-echo pulse sequence, 0.5 T Gyroscan). No artefacts were produced, the normal MRI picture of the T1-T2 calculated images, made with a special deticated eye surface coil, were obtained.

Alloys↗
PubMed1977

Side effects and contraindications of beta-receptor blocking agents.

Unwanted effects of beta-receptor blocking agents can be divided into three categories: 1. Those arising specifically from the pharmacologic, i.e., beta-blocking action. 2. Side effects not directly (or not with certainty) related to beta-blockade. 3. Adverse and potentially specific reactions to individual beta-blocking agents. Category 1 covers the majority of adverse effects (heart failure, severe bradycardia and hypotension, arterial insufficiency, increased airways resistance, gastrointestinal symptoms, hypoglycemia). These can largely be avoided by proper selection and preparation of patients. Category 2 covers cutaneous reactions (rashes, alopecia, pruritus), purpura (thrombocytopenic and nonthrombocytopenic) etc. as well as side effects attributable to the central nervous system (antianxiety effects, nightmares etc.). In the third category the "oculo-cutaneous syndrome" associated with practolol is discussed.

Adrenergic beta-Antagonists↗
PubMed1992

Severe acute myocardial infarction during a staphylococcal septicemia with meningoencephalitis. A possible contraindication to thrombolytic treatment.

We report the first case of lethal intracranial haemorrhage complicating a treatment by rt-PA in a patient presenting with a simultaneous staphylococcal septicemia with meningoencephalitis and an acute myocardial infarction with cardiogenic shock. The presence of microvascular lesions in the central nervous system seems to be important risk factor for intracranial haemorrhage and we recommend extreme caution in the use of thrombolytic treatment in septicemic patients with acute myocardial infarction, particularly when neurological symptoms are present.

Cerebral Hemorrhage↗