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Presse Medicale (Paris, France : 1983) Apr 2020IgG4-related disease (IgG4-RD) has been accepted as a distinct entity in various fields. It is being increasingly diagnosed and treated in routine practice. However,... (Review)
Review
IgG4-related disease (IgG4-RD) has been accepted as a distinct entity in various fields. It is being increasingly diagnosed and treated in routine practice. However, difficulties are still associated with the diagnostic process. Serum IgG4 elevations and imaging studies are useful, but not entirely diagnostic for this condition. Therefore, a pathological examination still plays an important role. Three characteristic microscopic changes are dense lymphoplasmacytic infiltration, storiform fibrosis, and obliterative phlebitis. IgG4 immunostaining reveals many IgG4-positive plasma cells and an IgG4/IgG-positive cell ratio of more than 40%. In addition to the number and ratio of IgG4-positive plasma cells, the diffuse distribution of positive plasma cells needs to be confirmed because IgG4-positive plasma cells may focally aggregate in many other conditions. In small biopsy samples, it is important to recognize not only characteristic findings, but also microscopic changes that are unlikely to occur in IgG4-RD because the identification of the latter findings leads to the exclusion of this condition. Another challenging field regards the diagnosis of long-standing disease. Along with disease progression, inflammatory infiltrate decreases, while storiform fibrosis and obliterative phlebitis are suspected to persistently exist. Therefore, the recognition of the latter two findings will be a diagnostic clue. Given the general suspicion that IgG4-RD has recently been over-diagnosed, precise tissue examinations based on the proposed standards and close clinicopathological correlations are crucial.
Topics: B-Lymphocytes; Biopsy; Castleman Disease; Diagnosis, Differential; Fibrosis; Histiocytosis, Sinus; Humans; Immunoglobulin G; Immunoglobulin G4-Related Disease; Immunohistochemistry; Phlebitis; Plasma Cells; T-Lymphocytes
PubMed: 32234381
DOI: 10.1016/j.lpm.2020.104014 -
Drugs in R&D Mar 2021Intravenous drug administration is associated with potential complications, such as phlebitis. The physiochemical characteristics of the infusate play a very important...
BACKGROUND
Intravenous drug administration is associated with potential complications, such as phlebitis. The physiochemical characteristics of the infusate play a very important role in some of these problems.
AIM
The aim of this study was to standardize the dilutions of intravenous drugs most commonly used in hospitalized adult patients and to characterize their pH, osmolarity and cytotoxic nature to better guide the selection of the most appropriate vascular access.
METHODS
The project was conducted in three phases: (i) standardization of intravenous therapy, which was conducted using a modified double-round Delphi method; (ii) characterization of the dilutions agreed on in the previous phase by means of determining the osmolarity and pH of each of the agreed concentrations, and recording the vesicant nature based on the information in literature; and (iii) algorithm proposal for selecting the most appropriate vascular access, taking into account the information gathered in the previous phases.
RESULTS
In total, 112 drugs were standardized and 307 different admixtures were assessed for pH, osmolarity and vesicant nature. Of these, 123 admixtures (40%), had osmolarity values >600 mOsm/L, pH < 4 or > 9, or were classified as vesicants. In these cases, selection of the most suitable route of infusion and vascular access device is crucial to minimize the risk of phlebitis-type complications.
CONCLUSIONS
Increasing safety of intravenous therapy should be a priority in the healthcare settings. Knowing the characteristics of drugs to assess the risk involved in their administration related to their physicochemical nature may be useful to guide decision making regarding the most appropriate vascular access and devices.
Topics: Adult; Algorithms; Delphi Technique; Humans; Hydrogen-Ion Concentration; Infusions, Intravenous; Inpatients; Irritants; Osmolar Concentration; Phlebitis; Spain; Vascular Access Devices
PubMed: 33346878
DOI: 10.1007/s40268-020-00329-w -
The American Journal of Medicine Mar 2020
Topics: Adult; Cannula; Humans; Phlebitis; Splints
PubMed: 31442390
DOI: 10.1016/j.amjmed.2019.07.047 -
Phlebology Oct 2022
Topics: Humans; Thrombophlebitis; Veins
PubMed: 35980278
DOI: 10.1177/02683555221122640 -
Deutsches Arzteblatt International Feb 2020
Topics: Aged, 80 and over; Humans; Male; Thrombophlebitis
PubMed: 32181733
DOI: 10.3238/arztebl.2020.0125 -
Cleveland Clinic Journal of Medicine Apr 2020
Topics: Aged; Humans; Leg; Male; Thrombophlebitis
PubMed: 32238373
DOI: 10.3949/ccjm.87a.19086 -
Rheumatology (Oxford, England) Dec 2020
Topics: Adult; Humans; Male; Phlebitis; Takayasu Arteritis
PubMed: 32617559
DOI: 10.1093/rheumatology/keaa333 -
Tidsskrift For Den Norske Laegeforening... May 2018
Topics: Aged; Breast Diseases; Conservative Treatment; Female; Humans; Middle Aged; Thrombophlebitis; Veins
PubMed: 29808659
DOI: 10.4045/tidsskr.18.0091 -
Journal of Vascular Surgery. Venous and... Jul 2020
Topics: Cyanoacrylates; Humans; Phlebitis; Saphenous Vein
PubMed: 32553656
DOI: 10.1016/j.jvsv.2020.02.009 -
Mayo Clinic Proceedings Dec 2023
Topics: Humans; Cannabis; Arteritis; Phlebitis; Thrombophlebitis
PubMed: 38043999
DOI: 10.1016/j.mayocp.2023.06.013