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Cytarabine-5´-monophosphate is deaminated by deoxycytidylate deaminase, leading to the inactive uridine-5´-monophosphate analog. [17] Cytarabine-5´-triphosphate is a substrate for SAMHD1 . [ 18 ] Furthermore, SAMHD1 has been shown to limit the efficacy of cytarabine efficacy in patients.
Vascular myelopathy (vascular disease of the spinal cord) refers to an abnormality of the spinal cord in regard to its blood supply. [1] The blood supply is complicated and supplied by two major vessel groups: the posterior spinal arteries and the anterior spinal arteries —of which the Artery of Adamkiewicz is the largest. [ 2 ]
Myelopathy describes any neurologic deficit related to the spinal cord. [1] The most common form of myelopathy in humans, cervical spondylotic myelopathy (CSM) , [ 2 ] [ 3 ] also called degenerative cervical myelopathy , [ 4 ] results from narrowing of the spinal canal ( spinal stenosis ) ultimately causing compression of the spinal cord. [ 5 ]
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These include: Bleomycin, chlorambucil, cyclophosphamide, cytarabine, doxorubicin, lomustine, mitoxantrone, topotecan, and vincristine. [4] NEH was first described in 1982 in a patient with acute myeloid leukaemia (AML) who had received cytarabine as chemotherapy. [5] Cancer itself, infections, and other medicinal drugs also can lead to NEH.
Symptoms suggestive of cord compression are back pain, a dermatome of increased sensation, paralysis of limbs below the level of compression, decreased sensation below the level of compression, urinary and fecal incontinence and/or urinary retention. Lhermitte's sign (intermittent shooting electrical sensation) and hyperreflexia may be present.
Hyper-CVAD chemotherapy is generally reserved for use in the treatment of serious and aggressive forms of hematological malignancy. There are serious side effects and complications arising from the administration of the various agents, which require careful management in an appropriate health-care setting.
Cytarabine: SC, IM, IV, IT: DNA polymerase inhibitor, S-phase specific. Incorporates its metabolites into DNA. Acute myeloid leukaemia, acute lymphoblastic leukaemia, chronic myeloid leukaemia, lymphomas, progressive multifocal leucoencephalopathy and meningeal leukaemia