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::Coronary artery disease (CAD) is the single most common cause of death in the developed world, responsible for about 1 in every 5 deaths. The morbidity, mortality, and socioeconomic importance of this disease make timely accurate diagnosis and cost-effective management of CAD of the utmost importance. This comprehensi...
journal_title:Mayo Clinic proceedings
pub_type: 杂志文章,评审
doi:10.4065/mcp.2009.0391
更新日期:2009-12-01 00:00:00
abstract::Myoclonus is defined as sudden, brief, shocklike, involuntary movements caused by muscular contractions or inhibitors. Myoclonic movements have now been recognized to have many possible variants and pathophysiologic features. Myoclonus may arise from several sites within the neuraxis, of which the cortex and brain ste...
journal_title:Mayo Clinic proceedings
pub_type: 杂志文章,评审
doi:10.1016/S0025-6196(11)63006-1
更新日期:1996-07-01 00:00:00
abstract::In 51 patients who had 20 different models of permanent cardiac pacemakers, we conducted transcutaneous electrical nerve stimulation studies at four anatomic sites--the lumbar area, cervical spine, left leg, and lower arm area ipsilateral to the pacemaker. With a mean stimulation of 24.7 Hz, no episodes of interferenc...
journal_title:Mayo Clinic proceedings
pub_type: 杂志文章
doi:10.1016/s0025-6196(12)65639-0
更新日期:1988-05-01 00:00:00
abstract::Dural arteriovenous malformations of the transverse sinus are relatively well localized to the occipitomastoid regions and occur predominantly in women who are more than 40 years of age. The signs and symptoms, except for pulsatile tinnitus, vary and apparently depend on the presence of impaired venous drainage, which...
journal_title:Mayo Clinic proceedings
pub_type: 杂志文章
doi:
更新日期:1979-10-01 00:00:00
abstract:OBJECTIVE:To examine the effects of interval walking training (IWT) on the estimated peak aerobic capacity (eV˙O2peak) and lifestyle-related disease (LSD) score while focusing on exercise intensity and volume in middle-aged and older people. PARTICIPANTS AND METHODS:Men and women (N=679; mean age, 65±7 SD years) compl...
journal_title:Mayo Clinic proceedings
pub_type: 杂志文章
doi:10.1016/j.mayocp.2019.04.039
更新日期:2019-12-01 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:OBJECTIVE:To assess whether patients with pancreatic cancer-associated pain living near a pain control center were more likely to undergo neurolytic celiac plexus block (NCPB) than those living at a distance and to determine the rationale of physicians at our institution for referring patients for NCPB. DESIGN:We retr...
journal_title:Mayo Clinic proceedings
pub_type: 杂志文章
doi:10.4065/72.9.831
更新日期:1997-09-01 00:00:00
abstract:OBJECTIVE:To determine the incidence and temporal trends of food allergies. PATIENTS AND METHODS:We performed a historical cohort study to describe the epidemiology of food allergies among residents of all ages in Olmsted County, Minnesota, during a 10-year period from January 2, 2002, through December 31, 2011, using...
journal_title:Mayo Clinic proceedings
pub_type: 杂志文章
doi:10.1016/j.mayocp.2018.05.031
更新日期:2018-10-01 00:00:00
abstract:OBJECTIVE:To assess the effects of glutathione on pain-free walking distance (PFWD) and hemodynamic parameters in patients with peripheral artery disease. PATIENTS AND METHODS:Forty patients with Fontaine stage II peripheral artery disease who were seen between September 2000 and March 2001 at the vascular laboratory ...
journal_title:Mayo Clinic proceedings
pub_type: 临床试验,杂志文章,随机对照试验
doi:10.4065/77.8.754
更新日期:2002-08-01 00:00:00
abstract:OBJECTIVE:To investigate presenting signs and symptoms of ovarian cancer and stage of tumor in a community cohort of women with the diagnosis of ovarian cancer. PATIENTS AND METHODS:We reviewed retrospectively the medical records of all women who sought primary and specialty care in Olmsted County, Minnesota, between ...
journal_title:Mayo Clinic proceedings
pub_type: 杂志文章
doi:10.4065/79.10.1277
更新日期:2004-10-01 00:00:00
abstract::We have observed the effects of concussion on nonanesthetized rats and humans. We believe the phenomenon in both to be identical. There are four obvious stages to concussion and the recovery therefrom: fourth stage--visceral (respiratory) and somatic immobility; third stage--return of irregular visceral (respiratory) ...
journal_title:Mayo Clinic proceedings
pub_type: 杂志文章
doi:
更新日期:1977-08-01 00:00:00
abstract:UNLABELLED:Cirrhosis and liver cancer, the main causes of liver-related morbidity and mortality, result from defective repair of liver injury. This article summarizes rapidly evolving knowledge about liver myofibroblasts and progenitors, the 2 key cell types that interact to orchestrate effective repair, because deregu...
journal_title:Mayo Clinic proceedings
pub_type: 杂志文章
doi:10.1016/j.mayocp.2013.10.009
更新日期:2014-01-01 00:00:00
abstract::Waldenström macroglobulinemia is a B-cell malignancy with lymphoplasmacytic infiltration in the bone marrow or lymphatic tissue and a monoclonal immunoglobulin M protein (IgM) in the serum. It is incurable with current therapy, and the decision to treat patients as well as the choice of treatment can be complex. Using...
journal_title:Mayo Clinic proceedings
pub_type: 杂志文章,评审
doi:10.4065/mcp.2010.0304
更新日期:2010-09-01 00:00:00
abstract::Breast cancer is the most common noncutaneous malignancy among every major ethnic group of women in the United States. Anthracyclines and taxanes are the most active and widely used chemotherapeutic agents for breast cancer, but the increased use of these agents at an early stage of disease often renders tumors resist...
journal_title:Mayo Clinic proceedings
pub_type: 杂志文章,评审
doi:10.1016/S0025-6196(11)60585-5
更新日期:2009-06-01 00:00:00
abstract:OBJECTIVE:To examine the relationship of age and clinical factors to postoperative cardiovascular events in a cohort of diabetic patients undergoing peripheral vascular surgery. PATIENTS AND METHODS:In this cohort study, 316 diabetic patients were followed up prospectively after femoral-to-distal artery bypass surgery...
journal_title:Mayo Clinic proceedings
pub_type: 杂志文章
doi:10.4065/76.1.34
更新日期:2001-01-01 00:00:00
abstract:OBJECTIVE:To determine whether dehydroepiandrosterone (DHEA) replacement therapy in hypoadrenal women improves performance, muscle protein accretion, and mitochondrial functions. PARTICIPANTS AND METHODS:Thirty-three hypoadrenal women were enrolled in the study from May 1, 2002, through May 31, 2003. Twenty-eight comp...
journal_title:Mayo Clinic proceedings
pub_type: 杂志文章,随机对照试验
doi:10.4065/83.11.1218
更新日期:2008-11-01 00:00:00
abstract::Multiple regression analysis were used to investigate the relationship between blood pressure and age, sex, relative weight, antihypertensive medication, diabetes mellitus, diet (low-salt, low-cholesterol, and weight-reducing regimens), cigarette smoking, coffee drinking, and aerobic exercise among a stratified random...
journal_title:Mayo Clinic proceedings
pub_type: 杂志文章
doi:10.1016/s0025-6196(12)65532-3
更新日期:1988-07-01 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:OBJECTIVES:To describe cerebrospinal fluid (CSF) findings in patients with posterior reversible encephalopathy syndrome (PRES) and to study its association with vasogenic edema. PATIENTS AND METHODS:Retrospective review of 73 consecutive prospectively collected adults diagnosed with PRES from January 1, 2000, through ...
journal_title:Mayo Clinic proceedings
pub_type: 杂志文章
doi:10.1016/j.mayocp.2015.07.018
更新日期:2015-10-01 00:00:00
abstract::Eleven patients with Alport's syndrome had renal transplantation between 1963 and 1980. The mean follow-up is 6 years (6 months to 14 years). All 11 patients are currently alive. Ten have functioning grafts, and in nine the serum creatinine concentration is less than 2 mg/dl. Three patients received a second allograft...
journal_title:Mayo Clinic proceedings
pub_type: 杂志文章
doi:
更新日期:1982-01-01 00:00:00
abstract:OBJECTIVE:To report a case of eosinophilic myocarditis with remarkable initial clinical manifestations and outcome. MATERIAL AND METHODS:A 67-year-old woman with hypertension and a history of asthma and drug hypersensitivity was referred to our institution with a diagnosis of acute myocardial infarction on the basis o...
journal_title:Mayo Clinic proceedings
pub_type: 杂志文章,评审
doi:
更新日期:1997-07-01 00:00:00
abstract::Anesthesia support for patients undergoing orthotopic liver transplantation can be complicated because of multiple medical problems in such patients and rapid hemodynamic, metabolic, and coagulation changes intraoperatively. Preoperative assessment should include careful review of the cardiovascular, respiratory, and ...
journal_title:Mayo Clinic proceedings
pub_type: 杂志文章
doi:10.1016/s0025-6196(12)65677-8
更新日期:1989-02-01 00:00:00
abstract:OBJECTIVE:To assess the current spectrum of causes and clinical features associated with hypersensitivity pneumonitis (HP). PATIENTS AND METHODS:We studied consecutive patients with HP diagnosed at the Mayo Clinic in Rochester, Minn, from January 1, 1997, through December 31, 2002. Diagnostic criteria for HP included ...
journal_title:Mayo Clinic proceedings
pub_type: 杂志文章
doi:10.4065/82.7.812
更新日期:2007-07-01 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::Type 2 diabetes mellitus is a heterogeneous disorder characterized by 2 pathogenic defects, impaired insulin secretion and insulin resistance. The resultant hyperglycemia causes microvascular and macrovascular complications that increase morbidity and mortality in patients with diabetes mellitus. Optimum glycemic cont...
journal_title:Mayo Clinic proceedings
pub_type: 杂志文章,评审
doi:
更新日期:2001-06-01 00:00:00
abstract::Reports in the popular press have suggested that exposure to diethylstilbestrol (DES) is followed by an abnormally high incidence of breast cancer. The reports were based on a reanalysis of data not considered ominous originally; and both data and analyses are summarized here. In addition, new data are presented on mo...
journal_title:Mayo Clinic proceedings
pub_type: 杂志文章
doi:
更新日期:1980-02-01 00:00:00
abstract::This report represents a retrospective analysis of preoperative echophonocardiographic studies in 118 patients who had surgery for the repair or replacement of malfunctioning prosthetic valves. A variety of prostheses implanted in the mitral, aortic, and tricuspid positions were assessed. The most frequent prosthetic ...
journal_title:Mayo Clinic proceedings
pub_type: 杂志文章
doi:
更新日期:1980-04-01 00:00:00
abstract:OBJECTIVE:To review our institution's experience with patients who failed to benefit from septal artery ablation, which necessitated subsequent septal myectomy, and to examine reasons for ablation failure and outcome of myectomy after ablation. PARTICIPANTS AND METHODS:Of 550 patients who underwent septal myectomy at ...
journal_title:Mayo Clinic proceedings
pub_type: 杂志文章
doi:10.1016/S0025-6196(11)61096-3
更新日期:2007-12-01 00:00:00
abstract:OBJECTIVE:To investigate a recent association between the use of the angiotensin receptor-blocker (ARB) olmesartan and a severe enteropathy resembling celiac disease. PATIENTS AND METHODS:We searched our endoscopy database for all outpatient esophagogastroduodenoscopy (EGD) or colonoscopy examinations in patients aged...
journal_title:Mayo Clinic proceedings
pub_type: 杂志文章
doi:10.1016/j.mayocp.2014.05.012
更新日期:2014-09-01 00:00:00
abstract::Extending a study of the period 1935-1964, we determined the incidence rates of leukemia in Olmsted County during the decade 1965-1974. In this decade, the overall crude annual incidence rate was 9.5 per 100,000. The ratio of males to females was 2.4 to 1; and the incidence rate was significantly higher among males th...
journal_title:Mayo Clinic proceedings
pub_type: 杂志文章
doi:
更新日期:1978-11-01 00:00:00