There is no index for this so if you want to find something, press the Ctrl-F keys at the same time and type in the word you want to find in the find box! If someone would like to help make an index for this, let us know

MISCELLANEOUS

THIS CATEGORY IS FOR THINGS WHICH DO NOT SEEM TO FIT INTO THE GENERAL CATEGORIES ABOVE:

TREATMENT OF CONTRAST MEDIATED REACTIONS:

bronchospasm:

0.3 cc of 1:1000 epinephrine SQ; may be repeated q 15 min to a total of 1 cc

severe reactions:

1 cc of 1: 10,000 epinephrine IV q 2-3 min up to 3 cc

CONTRAINDICATIONS FOR USE OF 153SAMARIUM IN THE TREATMENT OF PAINFUL BONE METS:

this agent has several uses. One such use is in the treatment of multiple myeloma. Another use is in the treatment of painful bone mets. These are some of the contraindications which would prevent this from being used in the treatment of MM:

MULTIPLE MYELOMA:

Mayo clinic eligibility summary for patients to receive Samarium 153:
Required Characteristics 
-- Age greater than or equal to 18 years of age. 

-- Multiple myeloma requiring treatment (Durie-Salmon greater than or equal to I). 

-- Laboratory values obtained less than or equal to 14 days prior to registration: direct bilirubin less than or equal to 2.0 mg/dL; alkaline phosphatase less than or equal to 750 U/L; Creatinine less than or equal to 3.0 mg/dL. 

-- Ejection fraction greater than or equal to 45% for all patients 

-- Patients may or may not have received prior chemotherapy. The PBSC harvest will have been done prior to the patient receiving greater than 140 mg melphalan (exceptions allowed as long as greater than or equal to 2 x 10-6 CD34 cells/kg have been collected). ECOG PS 0, 1, or 2 (exceptions made for patients with PS greater than 2 if secondary to neuropathy or acute bone event). 

-- Willingness to return to Mayo Clinic-Rochester for follow-up. 

-- No bisphosphonate drugs allowed less than or equal to 2 weeks prior to treatment; they may be resumed one month after treatment. 

Contraindications 

-- DLCO of greater than 50% on PFTs 

-- FVC less than 50% 

-- FEV-1 less than 50% 

-- Active malignancy with the exception of non-melanoma skin cancer. 

-- Uncontrolled infection 

-- Chemotherapy within prior 3 weeks or biologic therapy within prior 4 weeks 

-- New York Heart Association classification III or IV. 

-- Pregnant women; nursing women; men or women of childbearing potential who are unwilling to employ adequate contraception (condoms, diaphragm, birth control pills, injections, intrauterine device [IUD], or abstinence, etc.) for 6 months

PAINFUL BONE METS:

For bone pain from metastatic disease, this is what Berlex has to say:

Before Quadramet is administered, consideration should be given to the patient’s current clinical and hematologic status and bone marrow response history to treatment with myelotoxic agents. Metastatic prostate and other cancers can be associated with disseminated intravascular coagulation (DIC); caution should be exercised in treating cancer patients whose platelet counts are falling or who have other clinical or laboratory findings suggesting DIC. Because of the unknown potential for additive effects on bone marrow, Quadramet should not be given concurrently with chemotherapy or external beam radiation therapy unless the clinical benefits outweigh the risks. Use of Quadramet in patients with evidence of compromised bone marrow reserve from previous therapy or disease involvement is not recommended unless the potential benefits of the treatment outweigh the risks. Blood counts should be monitored weekly for at least 8 weeks, or until recovery of adequate bone marrow function.

Pregnancy: As with other radiopharmaceutical drugs, Quadramet can cause fetal harm when administered to a pregnant woman. Adequate and well controlled studies have not been conducted in animals or pregnant women. Women of childbearing age should have a negative pregnancy test before administration of Quadramet. If this drug is used during pregnancy, or if a patient becomes pregnant after taking this drug, the patient should be apprised of the potential hazard to the fetus. Women of childbearing potential should be advised to avoid becoming pregnant soon after receiving Quadramet. Men and women patients should be advised to use an effective method of contraception after the administration of Quadramet.

PRECAUTIONS: EDTMP is a chelating agent. Although the chelating effects have not been evaluated thoroughly in humans, dogs that received non-radioactive samarium EDTMP (6 times the human dose based on body weight, 3 times based on surface area) developed a variety of electrocardiographic (ECG) changes (with or without the presence of hypocalcemia). The causal relationship between the hypocalcemia and ECG changes has not been studied. Whether Quadramet causes electrocardiographic changes or arrhythmias in humans has not been studied. Caution and appropriate monitoring should be given when administering Quadramet to patients (See Laboratory Tests).

Because concomitant hydration is recommended to promote the urinary excretion of Quadramet, appropriate monitoring and consideration of additional supportive treatment should be used in patients with a history of congestive heart failure or renal insufficiency.

This drug should be used with caution in patients with compromised bone marrow reserves. See Warnings.

Skeletal: Spinal cord compression frequently occurs in patients with known metastases to the cervical, thoracic or lumbar spine. In clinical studies of Quadramet, spinal cord compression was reported in 7% of patients who received placebo and in 8.3% of patients who received 1.0 mCi/kg Quadramet. Quadramet is not indicated for treatment of spinal cord compression. Quadramet administration for pain relief of metastatic bone cancer does not prevent the development of spinal cord compression. When there is a clinical suspicion of spinal cord compression, appropriate diagnostic and therapeutic measures must be taken immediately to avoid permanent disability.

Radiopharmaceutical agents should be used only by physicians who are qualified by training and experience in the safe use and handling of radionuclides and whose experience and training have been approved by the appropriate government agency authorized to license the use of radionuclides.

Quadramet, like other radioactive drugs, must be handled with care, and appropriate safety measures must be taken to minimize radiation exposure of clinical personnel and others in the patient environment.

Special precautions, such as bladder catheterization, should be taken with incontinent patients to minimize the risk of radioactive contamination of clothing, bed linen, and the patient’s environment. Urinary excretion of radioactivity occurs over about 12 hours (with 35% occurring during the first 6 hours). Studies have not been done on the use of Quadramet in patients with renal impairment

RIGHTS AND LEFTS:

neonatal hemorrage: R>L

renal artery aneurysm: R>L

UPJ obsruction: M>F. It is L>R due to extrinsic abnormality

Primary megaureter: L>R

retrocaval ureter: S sign on theR

ureteral injury due to trauma: R>L

adrenal injury due to trauma: R>L

ovarian vein sydrome: R>L

gastroscisis: weakness on the R side of the cord

hepatoblastoma: R lobe > L

PAPVR: R>L

choroid plexus papilloma: L>R. Lateral ventrical

Transient regional osteoporosis: L>R in female

congenit hip dislocation: L>R

rheumatic effusion: R>L

CHF: L>R

Meig effusion: R>L

catamenial ptx: R>>L

scoliosis: idiopathic is 70% of cases, infantile (<4y) M>F and thoracic > lumbar to the L

juvenile (4-9y): M=F

adolescent (10-skeletal maturity): F>M, thoracolumbar to the R

CONGENITAL HEART DISEASE:

cyanotic R arch:

trunc>tof>tga>ta

neonatal cyanosis:

tga>ta>trunc>tapvr below the diaphragm

neonatal period pulm edema: tapvr below diapragm, hypoplastic L heart, cor tritriatrium

Hypertrophic pyloric stenosis: associated with Turners

Duodenal atresia and Hirshprungs: associated with Downs

T1 BRIGHT LESIONS:

thyroid, melanoma, choriocarcinoma, fat, pantopaque, gallium, methemoglobin, gallium

SICKLE CELL DISEASE:

2alpha and 2beta makes 4 chain tetramer. val--->glut in the beta chains. Sickle cells occlude vessels. Patients are prone to infection due to sluggish flow in the vessels, sequestration, and renal failure. They get interstitial lung disease, CM, osteonecrosis by adolescence, biconcave VB's (due to osteonecrosis and osteopenia secondary to marrow expansion). Lincoln log is more focal end plate depression due to end plate infarction

osteomyelitis in sicklers is usually diaphyseal. Salmonella is seen more commonly as a cause of osteomyelitis in SSd, but overall, S. Aureus is the most common organism found. Infarction is more common than osteomyelitis

strokes in SSD are due to ischemiam vasooclusive, and vasculopathy. There is intimal damage, and intimal hyperplasia. 25% of people with SSD will have a stroke (can have one as early as 12 yo)

the etiology of acute chest sydrome is due to bacteremia, fat emboli, GA, and pulm infarction