Prophylaxis and reversal of ifosfamide encephalopathy with methylene-blue

Küpfer, A; Aeschlimann, Christian; Wermuth, B.; Cerny, Thomas

doi:10.1016/s0140-6736(94)91839-2

Cited by 165 publications

(90 citation statements)

References 6 publications

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“…MB itself has been used in medical practice for more than 100 years and is recognized as having very low tissue toxicity. Clinical uses of MB include the treatment of ifosfamide encephalopathy, methemoglobinemia, urolithiasis, and cyanide poisoning [22,23]. Even intravenous administration of MB is FDA approved for methemoglobinemia.…”

Section: Discussionmentioning

confidence: 99%

Methylene blue‐mediated photodynamic therapy: A possible alternative treatment for oral lichen planus

et al. 2006

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Background and Objectives: In this study, methylene blue-mediated photodynamic therapy (MB-PDT) was used as a possible alternative method for the treatment of oral lichen planus (OLP). Study Design/Materials and Methods: Thirteen patients with 26 OLP lesions were enrolled in this study. Patients were instructed to gargle a 5% methylene blue solution in water for 5 minutes. Ten minutes later, irradiation was performed by laser light (l ¼ 632 nm, light exposure dose ¼ 120 J/cm 2 ). Lesions were evaluated pre and post-operatively and at follow-up sessions by changes in sign and symptom (pain) scores, and size of lesions. Results: Improvement in sign scores was achieved in 16 lesions. Four keratotic lesions disappeared completely. There was a statistically significant decrease in sign and symptom scores 1 week after treatment and at follow-up sessions up to 12 weeks. Average reduction in size of lesions was 44.3%. Conclusion: MB-PDT seems to be an effective alternative treatment for control of OLP. In our opinion, this preliminary result warrant further studies in order to show the efficacy of MB-PDT in control of OLP for a longer period of time.

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Section: Discussionmentioning

confidence: 99%

Methylene blue‐mediated photodynamic therapy: A possible alternative treatment for oral lichen planus

et al. 2006

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“…Methylene blue was then administered as an i.v. bolus of 50 mg repeated at the same dose every 2 h, or as continuous infusion at 200 mg day À1 diluted in 5% dextrose, until the event resolved (Küpfer et al, 1994).…”

Section: Study Design and Treatment Planmentioning

confidence: 99%

Treatment of advanced soft-tissue sarcomas using a combined strategy of high-dose ifosfamide, high-dose doxorubicin and salvage therapies

Leyvraz

Herrmann

Guillou³

et al. 2006

Br J Cancer

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Having determined in a phase I study the maximum tolerated dose of high-dose ifosfamide combined with high-dose doxorubicin, we now report the long-term results of a phase II trial in advanced soft-tissue sarcomas. Forty-six patients with locally advanced or metastatic soft-tissue sarcomas were included, with age o60 years and all except one in good performance status (0 or 1). The chemotherapy treatment consisted of ifosfamide 10 g m À2 (continuous infusion for 5 days), doxorubicin 30 mg m À2 day À1 Â 3 (total dose 90 mg m À2 ), mesna and granulocyte-colony stimulating factor. Cycles were repeated every 21 days. A median of 4 (1 -6) cycles per patient was administered. Twenty-two patients responded to therapy, including three complete responders and 19 partial responders for an overall response rate of 48% (95% CI: 33 -63%). The response rate was not different between localised and metastatic diseases or between histological types, but was higher in grade 3 tumours. Median overall survival was 19 months. Salvage therapies (surgery and/or radiotherapy) were performed in 43% of patients and found to be the most significant predictor for favourable survival (exploratory multivariate analysis). Haematological toxicity was severe, including grade X3 neutropenia in 59%, thrombopenia in 39% and anaemia in 27% of cycles. Three patients experienced grade 3 neurotoxicity and one patient died of septic shock. This high-dose regimen is toxic but nonetheless feasible in multicentre settings in non elderly patients with good performance status. A high response rate was obtained. Prolonged survival was mainly a function of salvage therapies.

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“…Little is known about the toxicologic effects of glutaric acid. Elevated glutarate levels in the urine or blood have been described in patients with certain metabolic disorders (e.g., glutaric acidosis and glutaric aciduria) and after ifosfamide overdose [14][15][16][17][18]. In glutaric acidosis, an autosomal recessive disorder characterized by macrocephaly, dyskinesia, dystonia, opisthotonos, choreoathetoid movements, and delayed development, severe metabolic acidosis results from glutaric acid accumulation due deficiency of glutaryl-CoA dehydrogenase [19,20].…”

Section: Discussionmentioning

confidence: 99%

“…In glutaric acidosis, an autosomal recessive disorder characterized by macrocephaly, dyskinesia, dystonia, opisthotonos, choreoathetoid movements, and delayed development, severe metabolic acidosis results from glutaric acid accumulation due deficiency of glutaryl-CoA dehydrogenase [19,20]. After ifosfamide overdose, excessive urinary excretion of glutaric acid and sarcosine may occur, leading to defective mitochondrial fatty acid oxidation and acidemia [18]. Unfortunately, we were unable to obtain qualitative or quantitative confirmation of glutaraldehyde or its metabolites in this case, as laboratory facilities to measure these chemicals were not available.…”

Section: Discussionmentioning

confidence: 99%

Laryngeal edema and metabolic acidosis after Omnicide® ingestion

Perera¹,

Kularathne²,

Gawarammana³

2008

Clinical Toxicology

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Introduction. Glutaraldehyde and quaternary ammonium compounds are widely used as disinfectants and sterilizing agents. Glutaraldehyde is irritating to the eyes and upper respiratory tract, and has been associated with occupational asthma. Acute oral ingestion of a concentrated solution has not been previously reported in humans. Case Report. A 19-year-old woman presented after deliberate ingestion of a biocide containing glutaraldehyde and a quaternary ammonium compound. She developed respiratory distress and severe metabolic acidosis 10 hours after admission. Marked laryngeal edema was noted when she was being intubated. She eventually improved following supportive care and was discharged alive after 9 hospital days. Discussion. There are no reports of acute ingestions of both glutaraldehyde and quaternary ammonium compounds. As both these substances are known to cause metabolic acidosis, localized edema, erosion and sensitization of both the respiratory and alimentary tract. The clinical effect may be additive or synergistic. Conclusions. Omnicide ingestion should be closely monitored for metabolic acidosis and laryngeal edema which may progress to upper airway obstruction requiring urgent airway stabilization.

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Prophylaxis and reversal of ifosfamide encephalopathy with methylene-blue

Cited by 165 publications

References 6 publications

Methylene blue‐mediated photodynamic therapy: A possible alternative treatment for oral lichen planus

Methylene blue‐mediated photodynamic therapy: A possible alternative treatment for oral lichen planus

Treatment of advanced soft-tissue sarcomas using a combined strategy of high-dose ifosfamide, high-dose doxorubicin and salvage therapies

Laryngeal edema and metabolic acidosis after Omnicide® ingestion

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