Increasingly, stents that release a drug that prevents recurrent narrowing of the coronary stents are used, and may cause numbness and tingling in some patients.
Paclitaxel-eluting stents (PESs) are commonly used to delivery the drug directly to the wall of the coronary artery and limit the growth of scar within the stents. Paclitaxel is a microtubule-stabilizing agent also used in the treatment of ovarian and breast cancer and its principal adverse effect is a sensory neuropathy.
A 65-year old man presented with symmetric numbness in all his extremities. In 2003 he had angioplasty and two PESs were deployed for angina. Three days later he noticed paresthesiae in his hands and feet. He had further angina and had four more PESs inserted in 2005 and 2006. His tingling worsened a few days subsequent to each stent placement. Neurological examination demonstrated normal muscle strength, mild vibration loss distally in his feet, and moderate, symmetric temperature and pinprick loss in his legs below his groin and in his hands below the elbows. Muscle stretch reflexes were symmetric and his gait was normal. Nerve conduction studies revealed findings suggestive of a generalized sensory ganglionopathy.
Neuropathy is seen in about 10% of patients receiving paclitaxel for cancer. It is postulated that in this patient, who had multiple PES over a 3-year period there may have been sufficient systemic release of paclitaxel resulting in sensory neuropathy. ???Patients and physicians should be aware of this rare complication of a paclitaxel-eluting stent,??? said lead author, Dr. Jayashri Srinivasan of Lahey Clinic in Burlington, Massachusetts.
The complete findings and results of this study are being presented at the American Association of Neuromuscular & Electrodiagnostic Medicine (AANEM) 54th Annual Meeting in Phoenix, AZ, at the JW Marriott Desert Ridge, October 14-17, 2007. The AANEM is the largest organization worldwide, with over 5000 members dedicated to advancing neuromuscular, musculoskeletal, and electrodiagnostic medicine.
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The researchers stressed that sunlight is not the only source of vitamin D, which can be obtained from multivitamins, fatty fish and fortified foods such as milk, certain cereals and fruit juices. Women should not try to reduce their risk of breast cancer by sunbathing because of the risks of sun-induced skin cancer, they said.
???If future studies continue to show reductions in breast cancer risk associated with sun exposure, increasing vitamin D intake from diet and supplements may be the safest solution to achieve adequate levels of vitamin D,??? said Gary Schwartz, Ph.D., a co-researcher from the Comprehensive Cancer Center at Wake Forest University School of Medicine.
???Since many risk factors for breast cancer are not modifiable, our finding that a modifiable factor, vitamin D, may reduce risk is important,??? said Sue Ingles, Ph.D., a co-researcher from University of Southern California Keck School of Medicine.
The researchers compared 1,788 breast cancer patients in the San Francisco Bay area with a matched control group of 2,129 women who did not have breast cancer. They included non-Hispanic white, Hispanic and African-American women, thus women with a wide range of natural skin color and a wide range of capacity to produce vitamin D in the body. Skin color is an important factor that determines how much vitamin D is produced in the body after sun exposure. Dark-skinned individuals produce up to 10 times less vitamin D than light-skinned individuals for the same amount of time spent in the sun. People with darker skin are also more likely to be vitamin D deficient than people with lighter skin.
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