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[Prevention of cardiovascular accidents during locoregional anesthesia].

Cardiovascular complications can be divided into 2 big categories involving the cardiovascular system in locoregional anaesthesia: those of local anaesthetics with direct effect on sympathetic fibres, which regulate the cardiovascular activity and those who derives from alteration of the normal cardiac function due to the toxic effect of the drugs. While the first are referred to the extension of a central block, the second considers the overdose caused by accidental intravenous injection. This is more frequent in peripheral blocks then in central blocks. The use of catheters in both central a

Novel local anaesthetics and novel indications for local anaesthetics.

Research into local anaesthetic mechanisms over the past few years has focused on two main issues. First, attention has focused on development of compounds with fewer side effects, better sensory/motor separation and longer duration of action; this has resulted in the introduction of ropivacaine and levobupivacaine into clinical practice. These agents have a lesser cardiotoxic effect than older compounds, and ropivacaine may in addition offer better sensory/motor separation. Several other compounds, including tonicaine and sameridine, are under investigation. In addition, the local anaesthetic

Paclitaxel: a new antimitotic chemotherapeutic agent.

Paclitaxel, a compound derived from the bark of the Pacific yew, Taxus brevifolia, is an antimitotic cytotoxic agent with a mechanism of action different from other antimitotics such as vincristine and vinblastine. Instead of causing disassembly of microtubules, paclitaxel forms extremely stable and nonfunctional microtubules, which causes inhibition of many cell functions and the interruption of the cell cycle. Procurement of paclitaxel has raised environmental concerns, leading researchers to explore a variety of approaches to obtain the drug: extraction from yew needles of a paclitaxel prec

Fatal complications of intramuscular and intra-articular injections.

Four fatalities related to intramuscular and intra-articular injections are reported. In two of these cases a Staphylococcus aureus sepsis d … ilatation and drop in blood pressure caused by the chlorpromazine could have had some effect, while cardiotoxicity of other psychotropic drugs with which he had been treated cannot be ruled out.

Effects of alcohol on the heart: current views.

Chronic and heavy alcohol consumption has deleterious effects upon the cardiovascular system and may cause congestive cardiomyopathy. Evidence of cardiac malfunction has been found in chronic alcoholics without overt heart failure by invasive and noninvasive methods. Ethanol is the incriminated factor having a direct cardiotoxic effect. Electron microscopy and cardiac muscle biopsies show that ethanol may cause changes on plasmalemmal, mitochondrial, and sarcoplasmic membranes. The clinical picture and general management of alcoholic cardiomyopathy do not differ substantially from those of con

Influence of the diabetic state on isoproterenol-induced cardiac necrosis.

Isoproterenol-induced myocardial necrosis was examined in male mice with alloxan-induced and genetically transmitted diabetes. Ten days after alloxan treatment, mice exhibited an elevation in blood glucose concentrations, weight loss, polyuria and decreased heart rates (510 +/- 15 v. 675 +/- 11 beats/min) compared with matched control mice. Similarly, genetically diabetic mice exhibited lower heart rates than the corresponding age-matched controls (383 +/- 30 v. 603 +/- 30 beats/min). In comparison to matched controls, both groups of diabetic mice had a significant decrease in the severity of

Therapeutic activity of 4-demethoxydauno-rubicin (idarubicin) in adult acute leukemia.

Twenty-six patients affected by acute leukemia were treated with 4-demethoxydaunorubicin (idarubicin), a new anthracycline compound which in experimental leukemias showed an antitumoral activity superior to daunorubicin (DNR) and doxorubicin (DX), with a higher ratio of active to cardiotoxic doses. A group of 16 patients in relapse received idarubicin at a dosage of 5-6 mg/m2/day for 3 consecutive days; a second group of 6 relapsing and 4 previously untreated cases was treated with a sequential combination of idarubicin and arabinosyl cytosine. In all patients, a significant fall of bone marro

Metallothionein rescues doxorubicin cardiomyopathy via mitigation of cuproptosis.

Doxorubicin (DOX), a chemotherapeutic agent utilized in the management of cancer, provokes cardiotoxicity although effective remedy is lacking. Given that DOX provokes oxidative stress and cell death in cardiomyocytes, this study evaluated the possible involvement of cuproptosis, a newly identified form of cell death, in DOX-instigated cardiac remodeling and contractile dysfunction, alongside the impact of the heavy metal scavenger metallothionein (MT) on DOX cardiomyopathy. Cardiac-specific MT transgenic and wild-type (WT) mice were treated with DOX (5 mg/kg/wk., i.p., for 4 wks) prior to ass…

Selective serotonin reuptake inhibitors induce cardiac toxicity through dysfunction of mitochondria and sarcomeres.

The administration of selective serotonin reuptake inhibitors (SSRIs) during pregnancy can increase the odds of congenital heart defects in babies. The present study aims to explore the toxic effects of SSRIs on the cardiac systems and the underlying mechanism. We apply human pluripotent stem cells to establish 2D-monolayer cardiomyocyte and 3D-cardiac organoid models to evaluate the effects of three SSRIs (fluoxetine, paroxetine, and sertraline) on cardiac development. We observe that SSRIs exposure inhibited ATP production and mitochondrial respiration and disrupted mitochondrial homeostasis

Starch based hydrogel NPs loaded by anthocyanins might treat glycogen storage at cardiomyopathy in animal fibrotic model.

Many reports have been published recently confirmed the limitation of cargo molecules delivered into the heart. This failure is mostly associated with lymphatic or vascular channels washing or to the immune system recognition. Delivery of anthocyanins by encapsulation may augment it retention in the heart at early time points as the capsules are too large to wash out by lymphatic or venous channels and the physical structure of the capsule may shield the anthocyanins from immunoglobulins and cellular components of the immune system. In the current study, the cardiac dysfunction was induced by

Meeting Challenges in the Long-Term Care of Children, Adolescents, and Young Adults with Acute Lymphoblastic Leukemia.

PURPOSE OF REVIEW: To discuss the long-term view of treating and following pediatric, adolescent, and young adult patients with acute lympho … these patients, the late effects of treatment can be life-threatening, such as secondary cancers or cardiotoxicity, or life-altering with respect to quality of life. The goal of this paper is to review the current literature, research, and surveillance guidelines regarding the late effects of ALL therapy, to outline what can be done to mitigate the toxic effects …

New prospects for the management of cardiovascular effects of tyrosine kinase inhibitors in patients with chronic myeloid leukemia.

The use of tyrosine kinase inhibitors (TKIs) for the treatment of chronic myeloid leukemia has significantly altered the prognosis of this disease, enabling close to normal life expectancy. Despite their undeniable benefits, the use of TKIs is associated with an increased risk of side effects on the cardiovascular system, particularly of atherothrombotic events. It is therefore necessary to understand and prevent the adverse effects of these drugs, in order to enable antileukemic therapy to continue and to minimize patients' toxic exposure. This multidisciplinary consensus document, developed

Effect of ghrelin on VEGF-B and connexin-43 in a rat model of doxorubicin-induced cardiomyopathy.

Background Since their discovery in the early 1960s, doxorubicin (DOX) remains the most effective anticancer drug. However, this drug has confirmed to be a double-edged sword because it causes a cardiomyopathy that leads to congestive heart failure. Ghrelin, a multi-functional peptide, plays an important role in cardiovascular protection. Therefore, we investigated the effects of ghrelin on vascular endothelial growth factor-beta (VEGF-B) and connexin-43 (Cx43) expression in DOX-induced cardiomyopathy. Methods Forty adult male rats were divided randomly into four groups: normal, normal + ghrel

Early safety and efficacy of fingolimod treatment in Denmark.

BACKGROUND: Initiation of fingolimod treatment is associated with a transient decrease of heart rate, and atrioventricular (AV) conduction block may occur. OBJECTIVE: To evaluate the therapeutic effect and safety of fingolimod treatment in MS patients in Denmark with focus on cardiac and pulmonary side effects at treatment onset. MATERIALS & METHODS: We analysed data from the first 496 fingolimod-treated Danish patients, observed for at least 3 months. In a subset of 204 patients, we monitored cardiac and pulmonary adverse effects following treatment initiation. RESULTS: The overall annuali

Three-dimensional reconfigurable magnetic microswarms with boundary-transcending capabilities.

Swarm behaviors are prevalent in nature and have inspired many engineering designs. However, achieving artificial swarms capable of reversibly migrating through fluids against gravity and transcending physical boundaries, such as solid-liquid and liquid-air interfaces, remains challenging. Here, we propose a strategy for generating enhanced rotating magnetic fields by synchronizing a global rotating field with a co-rotating local gradient. This enables three-dimensional (3D) movement of magnetic microparticles independent of physical boundaries and leads to reconfigurable collective behaviors,

Multifactorial Torsades de Pointes in a Multiple Myeloma Patient.

BACKGROUND: In patients with cancer, arrhythmic risk is compounded by concomitant QT interval-prolonging supportive medications, electrolyte derangements, cardiotoxic antineoplastic agents, thromboembolism, and underlying cardiac disease. CASE SUMMARY: We present a 61-year-old woman with IgG lambda multiple myeloma who, after 17 months of maintenance therapy with lenalidomide and bortezomib, experienced an out-of-hospital ventricular fibrillation arrest followed by in-hospital torsades de pointes (TdP). DISCUSSION: This case reinforces that TdP in patients with cancer is multifactorial and t

Fulminant Myocarditis Presenting With Refractory Ventricular Fibrillation During BRAF/MEK Inhibitor Therapy.

BACKGROUND: Myocarditis is a rare but potentially fatal complication of BRAF/MEK inhibitor therapy. Early detection through vigilant monitoring is crucial. CASE SUMMARY: A 35-year-old woman with stage IIIB melanoma treated with adjuvant trametinib and dabrafenib suffered a cardiac arrest due to refractory ventricular fibrillation. Coronary angiography excluded culprit lesions. Despite intensive management and extracorporeal life support, the patient exhibited irreversible multiorgan failure and died. A postmortem examination revealed massive biventricular and septal lymphohistiocytic myocardi

Thirty years from FDA approval of pegylated liposomal doxorubicin (Doxil/Caelyx): an updated analysis and future perspective.

In 2025, it will be 30 years since the initial clinical approval of pegylated liposomal doxorubicin (PLD) by the Food and Drug Administration. PLD predated the field of nanomedicine and became a model nanomedicine setting key pharmacological principles (prolonged circulation, slow drug release and the enhanced permeability and retention (EPR) effect) for clinical application of other nano-drugs in cancer therapy. The impressive reduction of cardiotoxicity conferred by PLD is the most valuable clinical asset. While PLD has gained a strong foothold in relapsed ovarian cancer and metastatic breas…

Role of Cardio-Oncology Rehabilitation in Hematopoietic Stem Cell Transplantation and Chimeric Antigen Receptor T-Cell (CAR-T) Therapy.

Allogeneic hematopoietic stem cell transplantation (allo-HSCT) and chimeric antigen receptor T-cell (CAR-T) therapy often lead to severe sarcopenia and cachexia during treatment, making it difficult to maintain exercise tolerance. Consequently, "cancer rehabilitation" programs have been implemented to sustain and improve physical activity and motor function. Hematologic malignancies often involve the use of cardiotoxic drugs. Moreover, graft-vs.-host disease associated with allo-HSCT and the cytokine release syndrome in CAR-T therapy elevate the risk of cardiovascular complications. Thus, esta

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… -tumor mechanism. 12 However, this therapeutic benefit comes with an increased risk of cardiotoxicity associated with GVHD. 13 , 14 The cardiotoxicity associated with GVHD may involve direct myocardial infiltration by donor T cells, cytokine release, and regulatory T-cell suppression, which are considered … In HSCT, cardiovascular risk factors include allo-transplantation, preexisting cardiovascular disease, multiple cardiovascular risk factors, a history of cardiotoxic cancer treatments, cardiotoxic conditioning regimens, and GVHD, all of which define high cardiovascular risk. 1 In diffuse large B-cell …

Bothrops bite and cardiac complications: A case report and review of literature.

BACKGROUND: Bothrops envenomation is a common medical emergency in tropical areas and is characterized by local and systemic complications, such as edema, coagulopathy, and tissue necrosis. Cardiovascular manifestations are rare and poorly documented, contributing to the complexity of its clinical management. CASE SUMMARY: We described a rare cardiac complication in a 65-year-old female patient, who initially presented with mild Bothrops envenomation. She experienced localized edema and erythema but with a lack of systemic symptoms. During the evaluation we detected asymptomatic sinus bradyca