Leg edema from intrathecal opiate infusions.

Leg edema from intrathecal opiate infusions.
Eur J Pain. 2000

Aldrete JA, Couto da Silva JM .
Department of Anesthesiology, University of South Florida School of Medicine, Tampa, Florida, USA. taldrete@arachnoiditis.com

Despite the increasing popularity of intrathecal infusions to treat patients with long-term non-cancer-related pain, this therapy is not without serious side-effects. Five out of 23 patients who had intrathecal infusions of opiates for longer than 24 months developed leg and feet edema. As predisposing factors, cardiovascular disease, deep venous thrombosis, peripheral vascular disease, and venous stasis of the lower extremities were considered. Every patient who developed pedal and leg edema after the implantation of an infusion pump was also found to have leg edema and venous stasis prior to the time when the pump was inserted. This complication was severe enough to limit their physical activity, and to produce lymphedema, ulcerations and hyperpigmentation of the skin. Reduction of the edema occurred when the dose of the opiate was decreased, and in two cases in which the infusion was discontinued, there was almost complete resolution of the syndrome. It appears that the pre-existence of pedal edema and of venous stasis is a relative contraindication to the long-term intrathecal infusion of opiates in patients with chronic non-cancer pain. Copyright 2000 European Federation of Chapters of the International Association for the Study of Pain.

PMID: 11124008 [PubMed - indexed for MEDLINE]

The Incidence of Arm Edema in Women with Breast Cancer

The Incidence of Arm Edema in Women with Breast Cancer

Int J Radiat Oncol Biol Phys. 2007 Oct 27

Deutsch M, Land S, Begovic M, Sharif S.
National Surgical Adjuvant Breast and Bowel Project (NSABP) Operations and Biostatistical Centers, Pittsburgh, PA; University of Pittsburgh Medical Center, Department of Radiation Oncology, Pittsburgh, PA.

PURPOSE: To determine the incidence and factors associated with the development of arm edema in women who participated in the National Surgical Adjuvant Breast and Bowel Project (NSABP) study B-04.

METHODS AND MATERIALS: Between 1971 and 1974, the NSABP protocol B-04 randomized 1,665 eligible patients with resectable breast cancer to either (1) the Halstead-type radical mastectomy; (2) total mastectomy and radiotherapy to the chest wall, axilla, supraclavicular region, and internal mammary nodes if by clinical examination axillary nodes were involved by tumor; and (3) for patients with a clinically uninvolved axilla, a third arm, total mastectomy alone. Measurements of the ipsilateral and contralateral arm circumferences were to be performed every 3 months.

RESULTS: There was at least one recorded measurement of arm circumferences for 1,457 patients (87.5% of eligible patients). There were 674 women (46.3%) who experienced arm edema at some point during the period of follow-up until February 1976. For radical mastectomy patients, total mastectomy and radiotherapy patients, and total mastectomy patients alone, arm edema was recorded at least once in 58.1%, 38.2%, and 39.1% of patients, respectively (p < .001) and at last recorded measurement in 30.7%, 14.8%, and 15.5%, respectively (p = <.001). Increasing body mass index (BMI) also showed a statistically significant correlation with arm edema at any time (p = .001) and at last assessment (p = .005).

CONCLUSIONS: Patients who undergo mastectomy, including those whose treatment plans do not include axillary dissection or postoperative radiotherapy, suffer an appreciable incidence of arm edema.

PMID: 18029105 [PubMed - as supplied by publisher]

See also:

Arm or Leg Swelling After Cancer

Complications of Breast Cancer Radiotherapy

Lymphedema After Cancer - How Serious Is It?

Persistent dyspnea and leg edema

Persistent dyspnea and leg edema
Allergy Asthma Proc. 2007 Jul-Aug

Nguyen KD, Frieri M.
New York College of Osteopathic Medicine, Old Westbury, New York 11568, USA. knguye01@nyit.edu

Abstract:

This case illustrates a complexity of confounding and overlapping symptoms that can masquerade as another diagnosis. A 56-year-old African American man with persistent dyspnea and leg edema was hospitalized three times in a period of 6 months. The patient was treated for asthma, chronic obstructive pulmonary disease, and congestive heart failure. Hypertension and peptic ulcer disease were treated also. Complete clinical improvement was not observed. A careful review of his last admission and current admission clinical presentation and laboratory evaluation revealed a systemic manifestation and laboratory findings consistent with atypical systemic lupus erythematosus.

Keywords: Asthma; atypical; chest pain; CHF; COPD; diagnosis; dyspnea; edema; problem solving case; SLE

IngentaConnect

Edema and protein-losing enteropathy complicating chronic constrictive pericarditis associated with an ascending aortic aneurysm

Edema and protein-losing enteropathy complicating chronic constrictive pericarditis associated with an ascending aortic aneurysm

Presse Med. 2007 Nov 5

Lesaffre F, Sandras R, Saade YA, Duval S, Metz D.
Département de cardiologie et pathologies vasculaires, CHU de Reims, Hôpital Robert Debré, Avenue du Général Koenig, F-51100 Reims, France.

INTRODUCTION:

Chronic constrictive pericarditis is suspected on clinical and echocardiographic grounds. Its treatment is surgical. CASE: We report here the case of a 45-year-old man, admitted for edema characteristic of lymphatic obstruction. Examination revealed ascending aorta ectasia, associated with chronic constrictive pericarditis. Measurement of alpha-1 antitrypsin clearance confirmed protein-losing enteropathy. Total recovery followed pericardectomy and aneurysm resection.

DISCUSSION:

The clinical edema in this case was due to several phenomena: protein-losing enteropathy from a functional lymphatic overload, induced by chronic constrictive pericarditis and by compression of the right atrium and vena cava by an aortic aneurysm. The hypoalbuminemia induced by protein loss may also magnify edema. An association between chronic constrictive pericarditis and ascending aortic aneurysm is uncommon. No cause for this association was found.

PMID: 17988828 [PubMed - as supplied by publisher]

Perianeurysm edema with second-generation bioactive coils.

Perianeurysm edema with second-generation bioactive coils.
Surg Neurol. 2007 Oct 30

Marden FA, Putman CM.
Division of Interventional Neuroradiology, Department of Radiology, Inova Fairfax Hospital, Falls Church, VA 22042, USA; Department of Neurological Surgery, George Washington University Hospital, Washington, DC 20052, USA.

BACKGROUND: Perianeurysm edema is an uncommon complication of intracranial aneurysms, occurring mostly in giant aneurysms that suddenly thrombose.

CASE DESCRIPTION: We present the first report of an unruptured, nongiant, saccular aneurysm that developed marked perianeurysm edema after embolization with Matrix2 coils. In this case, follow-up catheter angiography showed a new coil tail protruding beyond the dome of the aneurysm in the region of the most intense edema.

CONCLUSIONS: We postulate that perianeurysm edema may occur after breakdown of the aneurysm wall accompanied by an inflammatory response to exposed bioactive coils. Clinicians should be aware of this potential complication and consider performing earlier surveillance angiography when this occurs to ensure that there has not been a shift in the coil mass and recurrence of the aneurysm.

PMID: 17976696 [PubMed - as supplied by publisher]

Bevacizumab improved vision, macular edema in study of RVO patients

Bevacizumab improved vision, macular edema in study of RVO patients

OSN SuperSite Breaking News 10/24/2007

Bevacizumab improved visual acuity and central macular edema symptoms in patients with retinal vein occlusion within 9 weeks after treatment, according to a prospective study by researchers in Germany.

Andreas Stahl, MD, and colleagues at University of Freiburg evaluated the 9-week responses to a single injection of Avastin (bevacizumab, Genentech) in 14 central retinal vein occlusion (RVO) patients and seven branch RVO patients.

At follow-up, the researchers found that mean visual acuity for the 21 patients had increased an average of 2.4 lines (P < .01) over baseline. Also, the improvement in visual acuity was in concert with a decrease in central retinal thickness, according to the study.

The best improvement in visual acuity was reached between 3 and 6 weeks post-injection and began to decrease from 6 to 9 weeks, the authors noted.

"This [visual acuity] decrease was precipitated by an increase in [central macular edema] between week 3 and 6," they said.

In subgroup analyses, patients who received a bevacizumab injection within the first 3 months of RVO showed an average four-line gain in vision, compared with an average gain of 1.8 lines in patients treated between 4 and 6 months after RVO and a gain of 2.5 lines for those treated later than 6 months after RVO onset, according to the study.

"We did not observe any short-term adverse effects during our study," the authors noted.

The study is published in the October issue of Graefe's Archive for Clinical and Experimental Ophthalmology.

The use of non-invasive ventilation in the treatment of acute cardiogenic pulmonary edema.

The use of non-invasive ventilation in the treatment of acute cardiogenic pulmonary edema.

Eur Rev Med Pharmacol Sci. 2007 May-Jun

Ursella S, Mazzone M, Portale G, Conti G, Antonelli M, Gentiloni Silveri N.
Department of Emergency Medicine, Catholic University of The Sacred Heart, Policlinico G emelli, Rome, Italy. steura@hotmail.com

The patient with acute heart failure may present with acute cardiogenic pulmonary edema (ACPE), a condition accompanied by severe respiratory distress, with crackles over the lung and orthopnea, and an O2 saturation usually less then 90% on room air, prior to treatment. Non-invasive ventilation is the delivery of assisted ventilation without the need for endotracheal intubation and an invasive artificial airway. Two techniques are used for ventilatory support: continuous positive airway pressure (CPAP) and non-invasive positive-pressure ventilation (NPPV). There is a strong consensus that one of these two techniques should be used before endotracheal intubation and mechanical ventilation because non-invasive techniques dramatically reduce the need for mechanical ventilation via endotracheal intubation and its complications. The aim of this review is to evaluate and resume the evidence for the use of non-invasive positive pressure ventilation in the treatment of acute cardiogenic pulmonary edema according recent literature in order to guide physicians in using CPAP and NPPV in patients affected by ACPE in clinical practice. Recent literature showed that CPAP and NPPV both significantly decrease the need for endotracheal intubation, and CPAP significantly decreases mortality when compared to standard medical treatment. These techniques resulted safe and there is no evidence of increased risk of acute myocardial infarction (AMI) with either of them. Although both CPAP and NPPV present similar efficacy, CPAP has been shown to be cheaper and easier to implement in clinical practice and it could be considered the preferred intervention in patients with ACPE especially in the Emergency Department setting.

Pub Med