Abstract:
:Prompt and appropriate management measures are critical in order to achieve a favorable outcome after a major overdose of intrathecally (IT) administered methotrexate (MTX). Published information available to guide clinicians in the immediate management of this medical emergency is scant. Herein we describe a 6-year-old boy with acute lymphoblastic leukemia who received an inadvertent overdose of 600 mg of IT administered MTX instead of the intended dose of 12 mg. Severe acute neurotoxicity developed rapidly. Lumbar puncture and drainage of 15 mL of cerebrospinal fluid 2 hours after administration resulted in removal of 32% of the administered drug. Ventriculolumbar perfusion with 240 mL of warmed isotonic saline through ventricular and lumbar catheters for 3 hours resulted in removal of a total of 90% of the drug within 8 1/2 hours after administration. IT administration of 2,000 U of carboxypeptidase G2 (CPDG2), an enzyme that inactivates MTX, resulted in a further 150-fold reduction in cerebrospinal fluid MTX concentration. The patient experienced complete recovery. To our knowledge, this is the first reported case of the use of IT instillation of CPDG2 for the treatment of an overdose of IT administered MTX in a human, and it is only the second reported favorable outcome after an IT overdose of more than 500 mg of MTX. Minor IT overdoses of MTX can be managed by immediate lumbar drainage alone. Major overdoses may also necessitate prompt ventriculolumbar perfusion, IT instillation of CPDG2, and further supportive measures for a successful outcome after this infrequent but potentially catastrophic event.
journal_name
Mayo Clin Procjournal_title
Mayo Clinic proceedingsauthors
O'Marcaigh AS,Johnson CM,Smithson WA,Patterson MC,Widemann BC,Adamson PC,McManus MJdoi
10.4065/71.2.161subject
Has Abstractpub_date
1996-02-01 00:00:00pages
161-5issue
2eissn
0025-6196issn
1942-5546pii
S0025-6196(11)64508-4journal_volume
71pub_type
杂志文章abstract:OBJECTIVE:To obtain pilot prospective data regarding the efficacy and tolerability of gabapentin for alleviating hot flashes. PATIENTS AND METHODS:This prospective single-arm clinical trial was conducted between July 26, 2001, and November 30, 2001. Patients underwent a baseline week and then 4 weeks of gabapentin tre...
journal_title:Mayo Clinic proceedings
pub_type: 临床试验,杂志文章
doi:10.4065/77.11.1159
更新日期:2002-11-01 00:00:00
abstract::Stereotactic ventralis lateralis thalamotomy can be performed in selected patients with medically intractable parkinsonian tremor and rigidity. New technology, including computed tomography-based stereotaxis and microelectrode recording techniques, provides a data base for precise localization of thalamic lesions tail...
journal_title:Mayo Clinic proceedings
pub_type: 杂志文章
doi:10.1016/s0025-6196(12)65215-x
更新日期:1987-08-01 00:00:00
abstract:OBJECTIVE:To compare health care usage between suicide decedents and living controls in the year before suicide in a large representative US population. PATIENTS AND METHODS:Cases (n=1221) and controls (n=3663) belonged to an integrated health care system from January 1, 2009, through December 31, 2014. Cases and cont...
journal_title:Mayo Clinic proceedings
pub_type: 杂志文章
doi:10.1016/j.mayocp.2019.04.037
更新日期:2019-10-01 00:00:00
abstract::Many misconceptions continue to persist in both the lay and the professional literature regarding the proper approach to the diagnosis and treatment of hypoglycemia. Often, patients with a symptom complex suggestive of hypoglycemia have normal levels of plasma glucose in association with these symptoms. The major diag...
journal_title:Mayo Clinic proceedings
pub_type: 杂志文章,评审
doi:10.1016/s0025-6196(12)64790-9
更新日期:1985-12-01 00:00:00
abstract::During the past 20 years, the diagnosis and treatment of ectopic pregnancy have improved considerably. With the current diagnostic modalities, patients at risk for ectopic pregnancy can be followed expectantly, and the diagnosis can be made within a few days of the time of anticipated menses. An enhanced understanding...
journal_title:Mayo Clinic proceedings
pub_type: 杂志文章
doi:10.1016/s0025-6196(12)61764-9
更新日期:1989-07-01 00:00:00
abstract::In this article, we report a case of Leuconostoc bacteremia in a 7-month-old infant who had short-gut syndrome after a gastroschisis repair and who was dependent on total parenteral nutrition through a central venous catheter. The organism was initially misidentified as viridans group streptococcus. Detection of vanco...
journal_title:Mayo Clinic proceedings
pub_type: 杂志文章,评审
doi:10.4065/71.12.1171
更新日期:1996-12-01 00:00:00
abstract:OBJECTIVE:To describe the differences in clinical characteristics and outcome between adult- and childhood-onset biopsy-proven IgA vasculitis (IgAV) in North America. PATIENTS AND METHODS:Patients with IgAV diagnosed from January 1, 1997, through December 31, 2016, were retrospectively identified. Data were abstracted...
journal_title:Mayo Clinic proceedings
pub_type: 杂志文章
doi:10.1016/j.mayocp.2019.04.034
更新日期:2019-09-01 00:00:00
abstract::Iatrogenic injury-injury caused unintentionally by medical treatment-breaks the oldest and most famous rule of medical ethics: primum non nocere, or above all, do no harm. Medical malpractice law, however, focuses on whether an injury was caused by negligence, not on whether an injury was iatrogenic. Iatrogenic injury...
journal_title:Mayo Clinic proceedings
pub_type: 传,历史文章,杂志文章,评审
doi:10.1016/j.mayocp.2014.05.004
更新日期:2014-09-01 00:00:00
abstract:OBJECTIVE:To document our evolving surgical management of colonoscopic perforation and examine factors crucial to the improvement of patient care. DESIGN:We conducted a computer-based retrospective analysis of medical records (1980 through 1995). MATERIAL AND METHODS:Among 57,028 colonoscopic procedures performed, 43...
journal_title:Mayo Clinic proceedings
pub_type: 杂志文章
doi:10.1016/S0025-6196(11)63592-1
更新日期:1997-08-01 00:00:00
abstract:OBJECTIVE:To evaluate the treatment strategies for primary and secondary management of malignancy-related pericardial effusions. PATIENTS AND METHODS:Retrospective review of Mayo Clinic Rochester charts and external records of patients with pericardial effusion associated with malignant disease who required treatment ...
journal_title:Mayo Clinic proceedings
pub_type: 杂志文章
doi:10.4065/75.3.248
更新日期:2000-03-01 00:00:00
abstract:OBJECTIVE:To assess the predictive value of a series of demographic and clinical variables for stroke and survival in a population after a first transient ischemic attack (TIA). DESIGN:Cox proportional hazards regression analysis was used to determine the association of various demographic and clinical factors with su...
journal_title:Mayo Clinic proceedings
pub_type: 杂志文章
doi:10.1016/s0025-6196(12)61635-8
更新日期:1994-05-01 00:00:00
abstract::Type I anti-neuronal nuclear autoantibodies (ANNA-I, also known as "Hu") are a distinctive serologic marker of small cell lung carcinoma (SCLC) in patients who have peripheral neuropathies or encephalomyeloradiculopathies. A tumor antigen reactive with these antibodies has been identified by other investigators by Wes...
journal_title:Mayo Clinic proceedings
pub_type: 杂志文章
doi:10.1016/s0025-6196(12)62471-9
更新日期:1991-12-01 00:00:00
abstract::Guidelines for the use of antibiotics in infants and children must take into account drug absorption, distribution, metabolism, and excretion. In the developing human being, these factors may differ significantly from those in the adult, and so there are differences in therapeutic efficacy and toxicity. Certain drugs ...
journal_title:Mayo Clinic proceedings
pub_type: 杂志文章
doi:
更新日期:1977-11-01 00:00:00
abstract:OBJECTIVE:To describe the survival of a large nonobstructive hypertrophic cardiomyopathy (NO-HCM) cohort and to identify risk factors for increased mortality in this population. PATIENTS AND METHODS:Patients were identified from the Mayo Clinic HCM database from January 1, 1975, through November 30, 2006, for this ret...
journal_title:Mayo Clinic proceedings
pub_type: 杂志文章
doi:10.1016/j.mayocp.2016.01.002
更新日期:2016-03-01 00:00:00
abstract::We describe a woman with an unusual case of thromboembolism of the mesenteric artery in whom multiple thrombi were subsequently found in the aorta and right heart chambers on transesophageal echocardiography. Further evaluation revealed a deficiency of protein C and S plasma proteins, inhibitors of the clotting system...
journal_title:Mayo Clinic proceedings
pub_type: 杂志文章
doi:10.4065/76.3.319
更新日期:2001-03-01 00:00:00
abstract::Eighty-two consecutive orthopedic patients were assessed nutritionally at the time of hospital admission and then at 10-day intervals until hospital dismissal. Forty-eight percent of the patients had one or more abnormal findings suggestive of protein-calorie malnutrition. In spite of this prevalence of abnormal findi...
journal_title:Mayo Clinic proceedings
pub_type: 杂志文章
doi:
更新日期:1981-01-01 00:00:00
abstract:DESIGN:A quality-control retrospective review of medical records was conducted for cases of anaphylaxis encountered at Mayo Clinic Rochester during a 3 1/2-year period. PATIENTS:For inclusion in the study, all patients had to manifest general symptoms of mediator release such as generalized pruritus, urticaria, angioe...
journal_title:Mayo Clinic proceedings
pub_type: 杂志文章
doi:10.1016/s0025-6196(12)61606-1
更新日期:1994-01-01 00:00:00
abstract:OBJECTIVE:To examine whether the outcome of patients with primary systemic amyloidosis (AL) has improved over time and to identify predictors of early mortality in patients with AL. PATIENTS AND METHODS:We studied 2 separate cohorts of patients. The first cohort, consisting of 1998 patients with AL seen at Mayo Clinic...
journal_title:Mayo Clinic proceedings
pub_type: 杂志文章
doi:10.4065/mcp.2010.0480
更新日期:2011-01-01 00:00:00
abstract::Radionuclide angiography was used to study the effects of supine and upright bicycle exercise and handgrip exercise in 17 (12 well-trained) normal subjects before (control) and immediately after the administration of propranolol (160 mg/day for 4 days). Cardiac hemodynamic values were related to position in that contr...
journal_title:Mayo Clinic proceedings
pub_type: 杂志文章
doi:10.1016/s0025-6196(12)62411-2
更新日期:1984-09-01 00:00:00
abstract::Studies were undertaken to determine the effects of lidocaine on ischemic myocardium, which was induced by coronary artery constriction in open-chested dogs. A real-time epicardial fluorescent technique to detect in vivo-reduced nicotinamide adenine dinucleotide (NADH) during 60 seconds of ischemia was used. Blood flo...
journal_title:Mayo Clinic proceedings
pub_type: 杂志文章
doi:
更新日期:1982-07-01 00:00:00
abstract::In ancient times, the sun was venerated as a source of life in some cultures. Scientifically, the relationship between vitamin D and sunlight and the deficiency of vitamin D in patients with rickets were ultimately discovered. In 1903, Niels Finsen was awarded the Nobel Prize in medicine or physiology for his "Finsen ...
journal_title:Mayo Clinic proceedings
pub_type: 历史文章,杂志文章
doi:10.4065/72.5.461
更新日期:1997-05-01 00:00:00
abstract:OBJECTIVE:To assess whether amiodarone, as part of a strategy to achieve sinus rhythm, is safe and effective compared with a placebo or rate control drug in patients with persistent atrial fibrillation (AF) of more than 30 days' duration. METHODS:Randomized controlled trials comparing amiodarone with a placebo or rate...
journal_title:Mayo Clinic proceedings
pub_type: 杂志文章,meta分析
doi:10.1016/S0025-6196(11)61140-3
更新日期:2009-03-01 00:00:00
abstract::Amyotrophic lateral sclerosis is an insidiously developing, adult-onset, progressive anterior horn cell degeneration with associated degeneration of descending motor pathways. It has been recognized as an important clinical syndrome since the middle of the 19th century. Despite increasing clinical and research interes...
journal_title:Mayo Clinic proceedings
pub_type: 杂志文章,评审
doi:10.1016/s0025-6196(12)61175-6
更新日期:1991-01-01 00:00:00
abstract::The feasibility and accuracy of continuous-wave Doppler echocardiography in measuring pressure gradients across the pulmonary artery band were assessed. Simultaneous continuous-wave Doppler and catheter pressure measurements were prospectively performed in 20 patients with complex congenital heart disease and prior pu...
journal_title:Mayo Clinic proceedings
pub_type: 杂志文章
doi:10.1016/s0025-6196(12)65584-0
更新日期:1984-11-01 00:00:00
abstract::Although measurements of trunk flexibility are an important part of a clinical examination, subjective methods are usually used to assess spinal mobility. We studied three easily performed objective techniques for determining trunk flexibility (the common "fingertip-to-floor" test, the modified Schober and Moll tests,...
journal_title:Mayo Clinic proceedings
pub_type: 杂志文章
doi:10.1016/s0025-6196(12)61848-5
更新日期:1986-03-01 00:00:00
abstract:OBJECTIVE:To examine the ability of 4 published osteoporosis risk indices to identify women with low bone density. SUBJECTS AND METHODS:Subjects included postmenopausal women 45 years and older consecutively recruited from US clinics, women from general practice centers in The Netherlands (age range, 50-80 years), wom...
journal_title:Mayo Clinic proceedings
pub_type: 杂志文章
doi:10.4065/77.7.629
更新日期:2002-07-01 00:00:00
abstract:OBJECTIVE:To examine the association between specific adipose tissue depots and the risk of incident cancer in the Dallas Heart Study. PATIENTS AND METHODS:Individuals without prevalent cancer in the Dallas Heart Study underwent quantification of adipose depots: visceral adipose tissue (VAT), abdominal subcutaneous ad...
journal_title:Mayo Clinic proceedings
pub_type: 杂志文章
doi:10.1016/j.mayocp.2016.12.023
更新日期:2017-04-01 00:00:00
abstract::The penicillin family of antibiotics remains an important part of our antimicrobial armamentarium. In general, these agents have bactericidal activity, excellent distribution throughout the body, low toxicity, and efficacy against infections caused by susceptible bacteria. The initial introduction of aqueous penicilli...
journal_title:Mayo Clinic proceedings
pub_type: 杂志文章,评审
doi:10.4065/74.3.290
更新日期:1999-03-01 00:00:00
abstract:OBJECTIVE:To evaluate the safety, diagnostic yield, and therapeutic implications of flexible bronchoscopy with bronchoalveolar lavage (BAL) and transbronchial biopsy in patients with febrile neutropenia and pulmonary infiltrates. PATIENTS AND METHODS:We retrospectively reviewed the medical records of all patients with...
journal_title:Mayo Clinic proceedings
pub_type: 杂志文章
doi:10.4065/80.11.1414
更新日期:2005-11-01 00:00:00
abstract::Scleromyxedema is a disorder characterized by a typical rash due to the accumulation of mucin in the dermis. It is always associated with a monoclonal protein in the serum and can have a wide variety of systemic manifestations. We describe a 40-year-old woman who had scleromyxedema associated with a monoclonal G lambd...
journal_title:Mayo Clinic proceedings
pub_type: 杂志文章
doi:10.4065/74.5.481
更新日期:1999-05-01 00:00:00