Plasmapheresis reverses all side-effects of a cisplatin overdose – a case report and treatment recommendation

BACKGROUND: Cisplatin is widely used as an antineoplastic agent since it is effective against a broad spectrum of different tumours. Nevertheless, it has several potential side effects affecting different organ systems and an overdose may lead to life-threatening complications and even death. CASE PRESENTATION: We report on a 46-year old woman with non-small cell lung cancer who accidentally received 225 mg/m(2 )of cisplatin, which was threefold the dose as scheduled, within a 3-day period. Two days later, the patient presented with hearing loss, severe nausea and vomiting, acute renal failure as well as elevated liver enzymes. In addition, she developed a severe myelodepression. After plasmapheresis on two consecutive days and vigorous supportive treatment, the toxicity-related symptoms improved and the patient recovered without any sequelae. CONCLUSION: To date, no general accepted guidelines for the treatment of cisplatin overdoses are available. Along with the experience from other published cases, our report shows that plasmapheresis is capable of lowering cisplatin plasma and serum levels efficiently. Therefore, plasma exchange performed as soon as possible can ameliorate all side effects of a cisplatin overdose and be a potential tool for clinicians for treatment. However, additional intensive supportive treatment-modalities are necessary to control all occurring side effects

Comparison of Adverse Events Between Cervical Disc Arthroplasty and Anterior Cervical Discectomy and Fusion: A 10-year Follow-up.

BACKGROUND CONTEXT: Cervical disc arthroplasty (CDA) has been advocated as an alternative to anterior cervical discectomy and fusion (ACDF) with the added potential to reduce the risk of adjacent level disc degeneration and segmental instability. However, the long-term adverse events of arthroplasty have yet to be fully reported. PURPOSE: To investigate the 10 year follow-up adverse events rates between CDA and ACDF. STUDY DESIGN/SETTING: The study was a randomized, prospective, multicenter Investigational Device Exemption (IDE) trial and its continued follow-up as a post-approval study (PAS). Single level surgeries were performed for cervical disc pathologies between May 2002 and October 2004. PATIENT SAMPLE: n=463 patients. OUTCOME MEASURES: Adverse events comparison of CDA and ACDF from self-reported and physiologic measures. METHODS: At each evaluation time point, subjects were queried for adverse events since their last visit; and all adverse events were documented, regardless of whether or not they appeared related to the surgery or device. Adverse events were recorded, categorized, and assessed for severity and relationship to the study device and/or surgical procedure. The 10-year cumulative rates for each type of adverse events were summarized using a life-table method for the time-to-event analysis. A log-rank test was used to compare the two treatment groups. RESULTS: A total of 242 patients received CDA and 221 patients received ACDF. At 10 years follow up, 54% (130/242) of CDA patients and 47% (104/221) of the ACDF subjects were evaluated. At up to 10-year follow-up, 231 patients in the CDA group (cumulative rate 98.4%) and 199 patients in the ACDF group (cumulative rate 98.7%) had at least one adverse event. Overall, the difference in the cumulative rate of all adverse events over 10 years was not statistically different (p = 0.166). The cumulative rates of the following adverse events were not different between the two groups for cancer, cardiovascular, death, dysphonia/dysphagia, gastrointestinal, infection, urogenital, respiratory, implant displacement/loosening, implant malposition, neck and arm pain, neurological, other pain, spinal events, urogenital and intraoperative vascular injury. However, there were more adverse events in the CDA group resulting from trauma (p = 0.012) and more spinal events at the index level (p = 0.006). The ACDF group had significantly more non-union events (p = 0.019), and non-union outcome pending (p = 0.034), adjacent level spinal events (p = 0.033), and events that fell into the other category (p = 0.015). CONCLUSIONS: The cumulative rates of patients who had any adverse events were not different between the artificial cervical disc and the anterior cervical arthrodesis groups. In addition, the cumulative rates were not different between the two groups for the majority of categories as well

117. Ten-year BRYAN cervical disc arthroplasty: does change in angular motion have an effect on changes in patient-reported outcomes?

Cervical disc arthroplasty (CDA) has been advocated as an alternative to anterior cervical discectomy and fusion with the added potential benefit of maintaining angular motion. The BRYAN cervical disc has been studied with over 10 years of data currently reported. The purpose of the study was to report the correlation between change in range of motion (ROM) and change in patient-reported outcomes. This was a prospective, randomized multicenter Investigational Device Exemption (IDE) trial with surgeries performed between May 2002 and October 2004. A 10-year analyses of patient-reported outcomes, using BRYAN cervical disc arthroplasty at a single level, was performed. A total of 242 patients received BRYAN CDA (110=male, and 132=female). Using Neck Disability Index (NDI), neck pain and arm pain scores and ROM to determine the correlation between change in ROM and change in patient-reported clinical outcomes. Eligible patients were ≥21 years of age with symptomatic cervical disc disease who had failed conservative care for at least 6 weeks. We documented patients' preoperative and postoperative follow-ups completed at regular intervals; clinical outcomes (NDI, neck pain and arm pain); and ROM were used for analysis. A correlation analysis was done, between change in ROM from preoperative to postoperative (regular follow-ups) and change in clinical outcomes from preoperative to postoperative. The analysis was performed using the Pearson correlation coefficient. A total of 242 patients received BRYAN CDA (110=male, and 132=female) with a mean age of 44.4 years. There was no significant difference in the mean of ROM from preoperative (6.54°) to 3-month postoperative (6.3°). However, the mean change of ROM, from preoperative to all visits after 3 months, was statistically significant throughout the follow-up at 10 years with the mean change of ROM at the 10-year follow-up being 2.1° and the mean of ROM being 8.69°. NDI, neck pain and arm pain scores improved significantly by 38.3, 54.3 and 58.1 (p <0.001, p <0.001, p <0.001), respectively at 10-year follow-up with the mean scores being (13, 20.9, 14.1), respectively at that follow-up visit. No meaningful correlation between change in ROM and change in patient reported outcomes was noticed at follow-ups. The ROM did not change significantly; however, NDI, neck and arm pain scores improved significantly after 3 months postoperatively. ROM was maintained and clinical outcomes were further improved in the follow-ups. The change in range of motion had no effect on change in clinical outcomes. With 10 years of data, there was no meaningful correlation between change in range of motion and change in patient reported clinical outcomes with BRYAN cervical disc arthroplasty. BRYAN cervical disc (Approved for this indication)

New Insights into the Rare Earth Element Mineralization of the Storkwitz Carbonatite, Germany

This is the final version. Available from the Mineralogical Association of Canada via the DOI in this recordSupplementary Data are available from the Depository of Unpublished Data on the MAC website (http://mineralogicalassociation.ca/), document “REE Mineralisation of the Storkwitz Carbonatite, CM60, 21-00061”From January 2023 the title of the journal is The Canadian Journal of Mineralogy and PetrologyThe Storkwitz carbonatite breccia, located near Delitzsch, Germany, is one of the few European domestic rare earth elements (REE) deposits, but is relatively understudied owing to more than 100 m of Cenozoic sedimentary cover. We present the results of a petrological investigation of the recently acquired ∼700 m-deep SES 1/2012 borehole. The Storkwitz breccia is composed of clasts of country rock and carbonatite ranging from <1 mm to ∼30 cm in size, cemented by ankeritic carbonatite. Extensive fenitization and biotitization mainly affects clasts of coarse-grained granitoids and medium-grained dolomite-calcite-carbonatites. An intersection of Storkwitz breccia at 425 m to 542 m contains local REE enrichment up to ∼1.7 wt.%. total rare earth oxides, which is predominantly contained in a REE-fluorcarbonate bearing mineral assemblage. The assemblage locally forms irregularly shaped vug-like features and rare hexagonal pseudomorphs in clasts of fine-grained ankerite-carbonatite. The REE-fluorcarbonate mineral assemblage formed prior to brecciation in the ankerite-carbonatite, which paragenetically fits with recent experimental and fluid inclusion data demonstrating the importance of late magmatic processes in forming carbonatite-hosted REE mineralization, possibly from an evolved ‘brine-melt' phase. Our findings indicate that minor REE recrystallization and redistribution occurred during late-stage hydrothermal or supergene processes, without leading to significant REE enrichment in the upper part of the breccia compared to the lower part. Cross-cutting faults represent the last deformation event and post-date carbonatite intrusion and fenitization. They may represent important conduits for late-stage hydrothermal or supergene fluids responsible for recrystallization of the breccia matrix to a cryptocrystalline oxide mineral assemblage. Our findings highlight the importance of REE enrichment in late-stage ‘brine-melt' phases through magmatic fractionation and in situ hydrothermal replacement.Natural Environment Research Council (NERC)Helmholtz Institute Freiberg for Resource Technolog

Wednesday, September 26, 2018 3:35 PM – 5:05 PM Preserving Spinal Motion: 84. Ten-year adverse events after randomization to BRYAN cervical disc arthroplasty versus anterior cervical discectomy and fusion

Cervical disc arthroplasty (CDA) has been advocated as an alternative to anterior cervical discectomy and fusion (ACDF) with the added potential benefit of an early return toward unrestricted activities.  However, the long-term adverse events of arthroplasty are yet to be fully reported.  A 10-year experience with the BRYAN disc arthroplasty trial provides the opportunity to report adverse events. To investigate the adverse events rates between BRYAN CDA and ACDF. Prospective, randomized multicenter IDE trial with surgeries performed between May 2002 and October 2004. A total of 242 patients received BRYAN CDA (110=male, and 132=female) with a mean age 44.4 years; 221 patients received ACDF (113=male, and 108=female) with a mean age of 44.7 years. Adverse events that occurred up to 10 years after the initial surgery. A 10-year analysis of outcomes following FDA investigation of patients randomized to the BRYAN cervical disc arthroplasty versus fusion at a single level was performed.  Patients were followed at regular intervals and adverse events associated with CDA and ACDF were recorded. Adverse events included: cancer, cardiovascular, carpal tunnel syndrome, death, dysphagia or dysphonia, gastrointestinal, infection, urogenital, respiratory, implant displacement/loosening, implant malposition, neck and arm pain, neurological, non-union, spinal events, other events, other pain and intraoperative vascular injury. "Other events" consisted of various events that did not fit into another category, such as rash, depression, or hypertension. Each adverse event was compared between groups for the cumulative rate up to 10 years. Time to event analysis with a log-rank test was used for analysis. At up to 10 years of follow-up, 231 patients in the CDA group (cumulative rate 98.4%) and 199 patients in the ACDF group (cumulative rate 98.7%) had at least one adverse event (p=0.166). The cumulative rates of the following adverse events were not different between the two groups for cancer (p=.860), cardiovascular (p=.653), death (p=.507), dysphonia/dysphagia (p=.341), gastrointestinal (p=.389), infection (p=.669), urogenital (p=.873), respiratory (p=.984), implant displacement/loosening (p=.200), implant malposition (p=0.179), neck and arm pain (p=.411), neurological (p=.888), other pain (p=.147), spinal events (p=.792), urogenital (p=0.873) and intraoperative vascular injury (p=.583). However, the cumulative rates were different between the CDA and ACDF groups for non-union (p=.019), other events (p=0.015) and trauma (p=0.012). The cumulative rates of patients who had any adverse events were not different between BRYAN artificial cervical disc and the anterior cervical arthrodesis group. In addition, the cumulative rates were not different between the two groups for the majority of categories as well. BRYAN cervical disc (Approved for this indication)