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 determine whether a simple clinical score, which was shown previously to predict the likelihood of severe coronary artery disease (CAD) in patients referred for coronary angiography, could predict prognosis in a separate cohort of patients with normal or mildly abnormal findings on their resting electrocar...
journal_title：Mayo Clinic proceedings
pub_type： 杂志文章
doi：10.4065/77.6.515
更新日期：2002-06-01 00:00:00
abstract：:In the last 20 years, the treatment of mood disorders has advanced immeasurably. We now have relatively safe and effective agents for the treatment of depression and mania. This review discusses two types of agents that elevate mood--tricyclic antidepressants and monoamine oxidase inhibitors--including the indications...
journal_title：Mayo Clinic proceedings
pub_type： 杂志文章,评审
doi：
更新日期：1979-05-01 00:00:00
abstract：:Six insulin-requiring chronically hyperglycemic diabetic patients underwent glucose control for 72 hours with an artificial endocrine pancreas, the Biostator Glucose Controller. Euglycemia was within 4 hours and was maintained (110 leads to 2 mg/dl) thereafter. The concentration of hemoglobin A (HbA) was elevated, at ...
journal_title：Mayo Clinic proceedings
pub_type： 杂志文章
doi：
更新日期：1981-06-01 00:00:00
abstract：OBJECTIVE:To evaluate the efficacy and tolerability of extended-release oxybutynin in combination with the alpha1-blocker tamsulosin in reducing lower urinary tract symptoms in men. PATIENTS AND METHODS:In this multicenter, double-blind trial performed between March 29, 2004, and June 22, 2005, 420 men aged 45 years o...
journal_title：Mayo Clinic proceedings
pub_type： 杂志文章,多中心研究,随机对照试验
doi：10.4065/83.9.1002
更新日期：2008-09-01 00:00:00
abstract：:Skin cancer has become the most common neoplasm in the United States. With early diagnosis and appropriate management, most skin cancers have an overall 5-year survival rate of 95%. Cutaneous malignant melanoma (CMM), however, has a significantly higher morbidity and mortality, resulting in 65% of all skin cancer deat...
journal_title：Mayo Clinic proceedings
pub_type： 杂志文章,评审
doi：10.4065/81.4.500
更新日期：2006-04-01 00:00:00
abstract：:Catastrophic infarcts of the cerebral hemisphere often involve occlusion of the middle cerebral artery. In approximately 50% of these patients, consciousness declines because of brain swelling. Management includes prevention of further systemic complications, and recent studies have suggested that decompressive hemicr...
journal_title：Mayo Clinic proceedings
pub_type： 杂志文章,评审
doi：10.4065/75.9.945
更新日期：2000-09-01 00:00:00
abstract：:Understanding the sequence of events responsible for pressure-related natriuresis and their pathophysiologic alterations may be useful in distinguishing various types of essential hypertension of renal origin. The perturbation of a distal step in the sequence is likely to be reflected in a simple physiologic defect. F...
journal_title：Mayo Clinic proceedings
pub_type： 杂志文章,评审
doi：10.1016/s0025-6196(12)65384-1
更新日期：1989-11-01 00:00:00
abstract：:The first generation of multicenter randomized controlled trials of coronary artery bypass surgery vs medical treatment in the 1970s found survival advantage only in patients with left main coronary artery disease or with multiple risk factors. Over time, these results have remained reproducible and biologically plaus...
journal_title：Mayo Clinic proceedings
pub_type：
doi：10.4065/77.1.72
更新日期：2002-01-01 00:00:00
abstract：OBJECTIVE:To compare the indications for hospital admission between current, former, and never smokers and to compare their costs per hospital admission, testing the hypothesis that the cost per hospital admission would be higher for smokers than for former and never smokers. PATIENTS AND METHODS:This study used a ret...
journal_title：Mayo Clinic proceedings
pub_type： 杂志文章
doi：10.1016/j.mayocp.2018.02.022
更新日期：2018-08-01 00:00:00
abstract：:Drugs that target G protein-coupled receptors (GPCRs) represent the primary treatment strategy for patients with acute and chronic pain; however, there is substantial individual variability in both the efficacy and adverse effects associated with these drugs. Variability in drug responses is due, in part, to individua...
journal_title：Mayo Clinic proceedings
pub_type： 杂志文章,评审
doi：10.1016/j.mayocp.2015.06.010
更新日期：2015-08-01 00:00:00
abstract：OBJECTIVE:To evaluate the prognostic impact of Holter findings in patients with light chain amyloidosis. PATIENTS AND METHODS:We evaluated 239 patients in whom light chain amyloidosis was diagnosed from January 1, 2010, through December 31, 2015, who underwent 24-hour Holter monitoring. RESULTS:Holter testing was don...
journal_title：Mayo Clinic proceedings
pub_type： 杂志文章
doi：10.1016/j.mayocp.2018.08.039
更新日期：2019-03-01 00:00:00
abstract：:Nine patients treated with primary signet ring cell carcinoma of the prostate were identified among 29,783 cases of prostate cancer evaluated at Mayo Clinic from January 15, 1970, until January 2, 2009. A PubMed search of the English-language literature published from January 1, 1980, to January 1, 2010, was then perf...
journal_title：Mayo Clinic proceedings
pub_type： 杂志文章,评审
doi：10.4065/mcp.2010.0463
更新日期：2010-12-01 00:00:00
abstract：OBJECTIVE:To estimate the 3-month cumulative incidence of thromboembolism (TE), bleeding, and death among consecutive patients with nonvalvular atrial fibrillation (AF) who were receiving long-term anticoagulation therapy and were referred to the Thrombophilia Center at Mayo Clinic for periprocedural anticoagulation ma...
journal_title：Mayo Clinic proceedings
pub_type： 杂志文章
doi：10.4065/83.6.639
更新日期：2008-06-01 00:00:00
abstract：:We describe two patients with diffuse non-Hodgkin's lymphoma, hypercalcemia, and increased activity of serum angiotensin-converting enzyme. A mechanism similar to that operative in sarcoidosis is speculated to have caused the hypercalcemia. A lymphokine elaborated by the malignant lymphoma may cause activated macropha...
journal_title：Mayo Clinic proceedings
pub_type： 杂志文章
doi：10.1016/s0025-6196(12)62771-2
更新日期：1986-09-01 00:00:00
abstract：:Campylobacter-like organisms (provisionally named C. pyloridis) were demonstrated in gastric biopsy specimens by histopathologic analysis and bacterial culture. C. pyloridis organisms were found in 12 of 26 patients (46%) with gastric or duodenal ulcer but in none of 10 healthy volunteers without histologic evidence o...
journal_title：Mayo Clinic proceedings
pub_type： 杂志文章
doi：10.1016/s0025-6196(12)61902-8
更新日期：1987-04-01 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：:Usual causes of intolerance to thyroxine sodium include coronary artery disease, advanced age, untreated adrenal insufficiency, and severe hypothyroidism. We describe 4 patients with iron deficiency anemia and primary hypothyroidism. After treatment with thyroxine sodium, these patients developed palpitations and feel...
journal_title：Mayo Clinic proceedings
pub_type： 杂志文章
doi：
更新日期：2000-02-01 00:00:00
abstract：:Use of amiodarone, an investigational antidysrhythmic agent, has been associated with cases of pulmonary toxicity. The mechanism of amiodarone pulmonary toxicity is unknown, and recommendations for the assessment and treatment of patients with this condition continue to evolve. In two patients with clinically diagnose...
journal_title：Mayo Clinic proceedings
pub_type： 杂志文章
doi：10.1016/s0025-6196(12)60983-5
更新日期：1985-09-01 00:00:00
abstract：:Vancomycin is a glycopeptide antibiotic that is active against staphylococci, streptococci, and other gram-positive bacteria. It is the drug of choice for the treatment of infections due to methicillin-resistant staphylococci, Corynebacterium jeikeium, and multiply resistant strains of Streptococcus pneumoniae. Vancom...
journal_title：Mayo Clinic proceedings
pub_type： 杂志文章,评审
doi：10.1016/s0025-6196(12)65799-1
更新日期：1991-11-01 00:00:00
abstract：:A 70-year-old woman was admitted to the hospital with chest discomfort after quarreling with her neighbors. Electrocardiography revealed ST-segment elevation in leads I, II, III, aVL, aVF, and V2 through V6. Coronary angiography demonstrated normal arteries, but left ventriculography showed apical akinesis and basal h...
journal_title：Mayo Clinic proceedings
pub_type： 杂志文章
doi：10.4065/79.6.821
更新日期：2004-06-01 00:00:00
abstract：:The use of pacemakers and implantable cardioverter-defibrillators continues to increase for the management of cardiac dysrhythmias and, more recently, heart failure. Long-term complications associated with their use include infection, lead failure, and spurious shocks. Although the risk of infection with intracardiac ...
journal_title：Mayo Clinic proceedings
pub_type： 杂志文章,评审
doi：10.4065/79.4.549
更新日期：2004-04-01 00:00:00
abstract：OBJECTIVE:To determine the risk of hospitalization and death in relation to preexisting depression and anxiety among patients with cardiovascular disease (CVD). PATIENTS AND METHODS:The cohort consisted of 799 Olmsted County, MN, residents diagnosed with CVD (myocardial infarction or heart failure) from January 1, 197...
journal_title：Mayo Clinic proceedings
pub_type： 杂志文章
doi：10.4065/mcp.2011.0148
更新日期：2011-11-01 00:00:00
abstract：:Glucocorticoids are potent anti-inflammatory agents that play an important role in the therapy of many patients with connective tissue diseases, including systemic lupus erythematosus, polymyalgia rheumatica, various types of vasculitis, and complications of rheumatoid arthritis. Glucocorticoids reduce the number and ...
journal_title：Mayo Clinic proceedings
pub_type： 杂志文章,评审
doi：
更新日期：1980-12-01 00:00:00
abstract：:Nasal telangiectasias, a common condition, can be caused by chronic exposure to ultraviolet light, rosacea, topically applied corticosteroids, or rhinoplasty. Use of the argon laser for 15 to 45 minutes in a continuous mode over the entire involved area can produce considerable lightening of the nasal redness and impr...
journal_title：Mayo Clinic proceedings
pub_type： 杂志文章
doi：10.1016/s0025-6196(12)62611-1
更新日期：1986-11-01 00:00:00
abstract：:Emerging preclinical and clinic evidence described herein suggests that the mechanism of action of rifaximin is not restricted to direct antibacterial effects within the gastrointestinal tract. Data from this study were derived from general and clinical trial-specific PubMed searches of English-language articles on ri...
journal_title：Mayo Clinic proceedings
pub_type： 杂志文章,评审
doi：10.1016/j.mayocp.2015.04.016
更新日期：2015-08-01 00:00:00
abstract：:The source of the membranous materials that accumulate in distal axons of rats intoxicated with p-bromophenylacetylurea (BPAU) was studied by electron microscopy. 35S-Methionine was injected into the ventral horn of the spinal cord at 2, 14, and 35 days after injection of BPAU. Three days later, samples of the deep pe...
journal_title：Mayo Clinic proceedings
pub_type： 杂志文章
doi：10.1016/s0025-6196(12)61550-x
更新日期：1992-04-01 00:00:00
abstract：OBJECTIVE:To test the hypothesis that chromosomal rearrangements (CRs) can distinguish low risk of progression (LRP) from intermediate and high risk of progression (IHRP) to prostate cancer (PCa) and if these CRs have the potential to identify men with LRP on needle biopsy that harbor IHRP PCa in the prostate gland. P...
journal_title：Mayo Clinic proceedings
pub_type： 杂志文章
doi：10.1016/j.mayocp.2018.06.028
更新日期：2019-01-01 00:00:00
abstract：:Considerable morbidity and mortality are associated with infections of vascular prosthetic grafts. Most vascular surgeons believe that once vascular prosthetic graft infections occur, any form of therapy short of removal of the prosthesis will fail. Although recent reports have noted the successful conservative treatm...
journal_title：Mayo Clinic proceedings
pub_type： 杂志文章
doi：
更新日期：1983-07-01 00:00:00
abstract：OBJECTIVE:To explore the current epidemiological profile of Marfan syndrome in a general population. PATIENTS AND METHODS:Patients who had received a diagnosis of Marfan syndrome were identified from the Taiwan National Health Insurance database records from January 1, 2000, through December 31, 2012 (average populati...
journal_title：Mayo Clinic proceedings
pub_type： 杂志文章
doi：10.1016/j.mayocp.2013.08.022
更新日期：2014-01-01 00:00:00
abstract：:The sympathetic nervous system plays a key role in regulating arterial blood pressure in humans. This review provides an overview of sympathetic neural control of the circulation and discusses the changes that occur in various disease states, including hypertension, heart failure, and obstructive sleep apnea. It focus...
journal_title：Mayo Clinic proceedings
pub_type： 杂志文章,评审
doi：10.1016/S0025-6196(11)60492-8
更新日期：2009-09-01 00:00:00
