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Long-term Side-effects (long-term + side-effect)
Selected AbstractsHow to succeed in using dopamine agonists in Parkinson's diseaseEUROPEAN JOURNAL OF NEUROLOGY, Issue 2000L. M. Shulman Dopamine receptor agonists are assuming increased importance in the treatment of both early and advanced symptoms of Parkinson's disease (PD). However, tolerability of these drugs can be a problem. Identifying patients who are at increased risk of adverse effects is central to using dopamine agonists in PD. The newer agonists, pramipexole and ropinirole, are generally adequate without levodopa for early symptoms and carry the hope for a more acceptable profile of long-term side-effects. In the patient with advanced disease, all four dopamine agonists significantly augment the response to levodopa, which reduces the problems of motor fluctuations and drug related dyskinesia. Understanding the common pitfalls when prescribing these drugs will facilitate their safety and efficacy. [source] Dressing-related pain in patients with chronic wounds: an international patient perspectiveINTERNATIONAL WOUND JOURNAL, Issue 2 2008Patricia E Price Abstract This cross-sectional international survey assessed patients' perceptions of their wound pain. A total of 2018 patients (57% female) from 15 different countries with a mean age of 68·6 years (SD = 15·4) participated. The wounds were categorised into ten different types with a mean wound duration of 19·6 months (SD = 51·8). For 2018 patients, 3361 dressings/compression systems were being used, with antimicrobials being reported most frequently (n= 605). Frequency of wound-related pain was reported as 32·2%, ,never' or ,rarely', 31·1%, ,quite often' and 36·6%, ,most' or ,all of the time', with venous and arterial ulcers associated with more frequent pain (P= 0·002). All patients reported that ,the wound itself' was the most painful location (n= 1840). When asked if they experienced dressing-related pain, 286 (14·7%) replied ,most of the time' and 334 (17·2%) reported pain ,all of the time'; venous, mixed and arterial ulcers were associated with more frequent pain at dressing change (P < 0·001). Eight hundred and twelve (40·2%) patients reported that it took <1 hour for the pain to subside after a dressing change, for 449 (22·2%) it took 1,2 hours, for 192 (9·5%) it took 3,5 hours and for 154 (7·6%) patients it took more than 5 hours. Pain intensity was measured using a visual analogue scale (VAS) (0,100) giving a mean score of 44·5 (SD = 30·5, n= 1981). Of the 1141 who reported that they generally took pain relief, 21% indicated that they did not feel it was effective. Patients were asked to rate six symptoms associated with living with a chronic wound; ,pain' was given the highest mean score of 3·1 (n= 1898). In terms of different types of daily activities, ,overdoing things' was associated with the highest mean score (mean = 2·6, n= 1916). During the stages of the dressing change procedure; ,touching/handling the wound' was given the highest mean score of 2·9, followed by cleansing and dressing removal (n= 1944). One thousand four hundred and eighty-five (80·15%) patients responded that they liked to be actively involved in their dressing changes, 1141 (58·15%) responded that they were concerned about the long-term side-effects of medication, 790 (40·3%) of patient indicated that the pain at dressing change was the worst part of living with a wound. This study adds substantially to our knowledge of how patients experience wound pain and gives us the opportunity to explore cultural differences in more detail. [source] Toxicology and health risks of hydroquinone in skin lightening formulationsJOURNAL OF THE EUROPEAN ACADEMY OF DERMATOLOGY & VENEREOLOGY, Issue 7 2006TJ Kooyers ABSTRACT Background, Hydroquinone has been used for decades as a skin lightening agent. As a result of concerns about mid-term effects like leukomelanoderma en confetti and exogenous ochronosis, its use in cosmetics has been banned since January 2001. Objective, Until recently no attention was paid to potential long-term side-effects, despite the fact that there are indications that these may exist. It was decided that a clearer picture of these potential long term effects was needed. Methods, A literature search was conducted with an emphasis on the biochemistry and toxicology of hydroquinone, benzene and related molecules. Results, It appeared that since 1996 an enormous amount of articles have been published on the carcinogenicity of hydroquinone, benzene and related molecules. The literature search on hydroquinone as a skin lightening agent suggests that possible long-term effects like carcinogenesis may be expected. Conclusion, The risks of long-term effects (cancer) of topically applied hydroquinone may no longer be ignored. Based on recent evidence of the potential risks, which are higher than has been assumed up until now, we plead that the use of hydroquinone as a skin lightening agent will be stopped completely. [source] UVB in the management of early stage mycosis fungoidesJOURNAL OF THE EUROPEAN ACADEMY OF DERMATOLOGY & VENEREOLOGY, Issue 5 2006F Pavlotsky Background, Several options for treatment of early mycosis fungoides (MF) offer similar success rates. Previous small studies have shown UVB to be at least as effective as PUVA. Objective, To summarize our experience with UVB treatment of early MF. Methods, A retrospective analysis of early-stage MF patients treated by narrow band (NB) or broad band (BB) UVB in our institution between 1996 and 2002. Most patients achieving complete response (CR) were put on maintenance until natural sun exposure was possible and followed up every 3,6 months. The results were compared to those previously reported regarding PUVA. Results, Sixty-eight and 43 patients were treated by NB and BB UVB, respectively. Eighty-six per cent (84 and 89% in NB and BB UVB groups, respectively) of IA and 71% (78 and 44% in NB and BB UVB groups, respectively) of IB patients achieved CR within a mean of 12.8 and 10.6 weeks, respectively. When maintenance was stopped, 65 and 30% had not relapsed after an average follow up of 27 and 222 weeks, respectively. Non-relapse rate was 33 and 48% for those having had vs. those not having had maintenance, respectively. Conclusions, Our results are comparable to all previously reported for skin-targeted treatments, including PUVA and, to our belief, reflect the nature of early MF, in which CR can probably be achieved in most of the patients. Among the responding patients there is no relapse during prolonged follow-up in about one third of the cases. Thus, we believe treatment should be stopped completely following first CR induction and maintenance treatment should be considered for relapsing patients only. Both broad and narrow UVB options are good and future choices should be made on the basis of short- and long-term side-effects. [source] Topical class I corticosteroids in 10 patients with bullous pemphigoid: correlation of the outcome with the severity degree of the disease and review of the literatureJOURNAL OF THE EUROPEAN ACADEMY OF DERMATOLOGY & VENEREOLOGY, Issue 2 2004A Stockman ABSTRACT Background, Treatment of bullous pemphigoid (BP) with systemic immunosuppressive agents, in particular with systemic corticosteroids, has many long-term side-effects. A dozen reports were published regarding the efficacy of topical corticosteroids in the treatment of bullous pemphigoid. Objective, To evaluate the efficacy of potent class I topical corticosteroids in relation to the affected body surface area (BSA) in patients with bullous pemphigoid and to review the literature. Methods, An open prospective trial with 10 patients with BP with measurement of the affected BSA. Treatment protocol consisted of three steps: potent class I topical corticosteroid treatment, systemic tetracyclines and systemic corticosteroids. Follow-up period was between 24 and 72 months. Results, Our study suggests a correlation between the success rate of topical corticosteroid treatment and the body surface area initially affected: all patients with an affected BSA of less than 20% healed with topical treatment only. The patients with more than 40% affected BSA needed systemic treatment with steroids. Conclusion, Topical class I corticosteroids seem to be effective in healing lesions of BP, especially if less than 20% of the BSA is affected. This study comprises only 10 patients, making further studies necessary to draw definite conclusions. [source] Botulinum toxin A for palmar hyperhidrosisJOURNAL OF THE EUROPEAN ACADEMY OF DERMATOLOGY & VENEREOLOGY, Issue 6 2001U Wollina Abstract Objective We evaluated the efficacy and safety of intracutaneous injections of botulinum toxin A on severe palmar hyperhidrosis. Methods Ten patients with recalcitrant palmar hyperhidrosis were treated with intercutaneous injections of botulinum toxin A (Botox; 200 U for each hand). Patients were followed up to 23 months (mean ± SD: 12.1 ± 6.2 months). Results Botulinum toxin significantly reduced abnormal sweating within 1 week in 100% of the patients. In six patients with a follow-up of 12 months or more the antisudorific effect lasted 12.3 ± 5.5 months. The longest response duration was 22 months. Repeated treatment was performed in five patients with unchanged clinical efficacy. The only side-effect was tolerable pain from the intracutaneous injections in patients where a nerve block was not performed. Conclusions Botulinum toxin A (200 U Botox per palm) was able to induce long-term remission in palmar hyperhidrosis without significant acute and long-term side-effects. Strictly intracutaneous injection of small volumes is recommended. So far, response to repeated treatments did not show evidence of neutralizing antibody induction. [source] Chronic bilateral subthalamic deep brain stimulation in a patient with homozygous deletion in the Parkin geneMOVEMENT DISORDERS, Issue 12 2004Marianna Capecci MD Abstract Chronic subthalamic nucleus deep brain stimulation (STN-DBS) is an efficacious treatment for idiopathic Parkinson's disease (PD) that cannot be further improved by medical therapy. We present a case of an individual with juvenile parkinsonism caused by homozygous deletion of exon 3 in the parkin gene with disabling long-term side-effects from levodopa who underwent bilateral STN neuromodulation. Parkin-linked parkinsonism may show clinical features different from sporadic PD, yet it shares levodopa responsiveness. Because levodopa responsiveness is a predictor of STN-DBS efficacy, we argued that this kind of surgical approach might be efficacious in hereditary parkin-linked juvenile parkinsonism. We evaluated clinical and functional assessment before and 12 months after surgery. The results showed that the Unified Parkinson Disease Rating Scales Motor score improved by 84% in our patient, the levodopa equivalent daily dose medication (LEDD) was reduced by 66%, and, finally, disabling and severe dyskinesias disappeared. © 2004 Movement Disorder Society [source] Classifying the medulloblastoma: insights from morphology and molecular geneticsNEUROPATHOLOGY & APPLIED NEUROBIOLOGY, Issue 4 2002D. Ellison Significant advances in the treatment of the medulloblastoma (MB) have been made in the last 30 years, reducing mortality by 2-fold. Further improvements in the cure rate require an increased understanding of the biology of MBs, and this will translate into refinements in their classification. Scrutiny of the cytological variation found among MBs has recently led to the concept of the anaplastic MB, which overlaps the large-cell variant and appears to share its poor prognosis. In contrast, the MB with extensive nodularity, a distinctive nodular/desmoplastic variant occurring in infants, has a better outcome than most MBs in these young patients. Building on cytogenetic studies that have drawn attention to abnormalities on chromosome 17 in over a third of MBs, research shows non-random losses on chromosomes 8, 9, 10, 11 and 16, and gains on chromosomes 1, 7 and 9. Overexpression of ErbB2 receptors and losses on chromosome 17p have been proposed as independent indicators of aggressive behaviour, while high TrkC receptor expression indicates a favourable outcome. There is a strong association between anaplastic/large-cell tumours and MYC amplification, which has previously been linked with aggressive disease, but associations between abnormalities on chromosome 17 and anaplastic/large-cell MBs and between abnormalities in the shh/PTCH pathway and the desmoplastic variant are more controversial. Classification of the MB histopathologically and according to profiles of molecular abnormalities will help both to rationalize approaches to therapy, increasing the cure rate and reducing long-term side-effects, and to suggest novel treatments. [source] | ||||||||||||||||||||||