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Systemic Side-effects (systemic + side-effect)
Selected AbstractsPimecrolimus in dermatology: atopic dermatitis and beyondINTERNATIONAL JOURNAL OF CLINICAL PRACTICE, Issue 8 2005Paolo Gisondi Summary Pimecrolimus is a calcineurin inhibitor developed for the topical therapy of inflammatory skin diseases, particularly atopic dermatitis (AD). Pimecrolimus selectively targets T cells and mast cells. Pimecrolimus inhibits T-cell proliferation, as well as production and release of interleukin-2 (IL-2), IL-4, interferon-, and tumour necrosis factor-,. Moreover, pimecrolimus inhibits mast cell degranulation. In contrast to tacrolimus, pimecrolimus has no effects on the differentiation, maturation and functions of dendritic cells. In contrast to corticosteroids, pimecrolimus does not affect endothelial cells and fibroblasts and does not induce skin atrophy. Given the low capacity of pimecrolimus to permeate through the skin, it has a very low risk of systemic exposure and subsequent systemic side-effects. In different randomised controlled trials, topical pimecrolimus as cream 1% (Elidel®) has been shown to be effective, well tolerated and safe in both adults and children with mild to moderate AD. In addition, pimecrolimus has been successfully used in inflammatory skin diseases other than AD, including seborrheic dermatitis, intertriginous psoriasis, lichen planus and cutaneous lupus erythematosus. [source] Multiple eccrine hidrocystomas of the faceINTERNATIONAL JOURNAL OF DERMATOLOGY, Issue 2 2001Abdullah Alfadley MD, FRCP(C) Background Multiple eccrine hidrocystomas of the face are a rare facial dermatosis for which no recent large series of cases has been reported. Objective To describe the clinicopathologic features of five cases of multiple eccrine hidrocystoma and to emphasize their similar characteristics. Methods The clinical and histologic features of five women with multiple eccrine hidrocystomas of the face are described. Results All cases were middle-aged women with numerous, asymptomatic, skin-colored to bluish, papulonodular skin lesions, ranging from 2 to 5 mm in diameter, and mainly centrifacial in distribution. Histopathologically, all cases showed unilocular cysts in the dermis lined by two layers of cuboidal cells. Staining for S-100 protein was negative in the cyst wall in all cases. One case was treated with topical 1% atropine for 3 weeks with no significant improvement. No systemic side-effects were observed during this treatment. Conclusions Multiple eccrine hidrocystomas are a rare condition which might be confused clinically and histopathologically with apocrine hidrocystomas. To date, no effective treatment has been reported. [source] Systemic and topical corticosteroid treatment of oral lichen planus: a comparative study with long-term follow-upJOURNAL OF ORAL PATHOLOGY & MEDICINE, Issue 6 2003M. Carbone Abstract Background:, Topical corticosteroids are the mainstay treatment for oral lichen planus (OLP), but some authors suggest that systemic corticosteroid therapy is the only way to control acute presentation of OLP. Methods:, Forty-nine patients with histologically proven atrophic,erosive OLP were divided into two groups matched for age and sex. The test group (26 patients) was treated systemically with prednisone (50 mg/day), and afterwards with clobetasol ointment in an adhesive medium plus antimicotics, whereas the control group (23 patients) was only treated topically with clobetasol plus antimycotics. Results:, Complete remission of signs was obtained in 68.2% of the test group and 69.6% of the control group, respectively (P = 0.94). Similar results were obtained for symptoms. Follow-up showed no significant differences between the two groups. One-third of the patients of the test group versus none in the control group experienced systemic side-effects (P = 0.003). Conclusions:, The most suitable corticosteroid therapy in the management of OLP is the topical therapy, which is easier and more cost-effective than the systemic therapy followed by topical therapy. [source] Viability of fibroblasts in cell culture after treatment with different chemical retraction agentsJOURNAL OF ORAL REHABILITATION, Issue 1 2002I. Kopa Prior to fixed prosthodontic impression procedures, temporary horizontal retraction of the free gingival tissue should be accomplished apically to the preparation finishing line. The mechanical,chemical method using cotton retraction cords of various sizes impregnated with various retraction chemicals is the most commonly employed retraction technique. Most retraction agents have pH values from 0·8 to 0·3, and are therefore hazardous to the cut dentine and periodontal tissues. Sympathomimetic vasoconstrictors introduced recently have a pH of 5·6, and are free of systemic side-effects. The present study using the dye exclusion test, colony forming ability test and colorimetric assay was undertaken to evaluate cytotoxic effects of four chemical retraction agents on cultured V-79 fibroblasts, and the dependence of cytotoxicity on the agent concentration and time of exposure. Original concentrations of retraction agents produced stronger cytotoxic effects than dilutions of 1:1 and 1:10. The most aggressive agent, 25% aluminium chloride, took only 1 min to damage all cell cultures. The proportion of cells damaged after 10 min of exposure to tetrahydrozoline was 60%, which was significantly less compared with other chemicals tested. With the colony forming ability test using retraction agents diluted to 1:10 the greatest number of colonies emerged in samples treated with tetrahydrozoline (statistical significance: P < 0·01). The colorimetric assay showed equal cytotoxic effects for 25% aluminium sulphate and tetrahydrozoline. The colorimetric test used in the study has proved an ergonomic, accurate and reliable test for cytotoxicity determination. [source] Review: doxorubicin delivery systems based on chitosan for cancer therapyJOURNAL OF PHARMACY AND PHARMACOLOGY: AN INTERNATI ONAL JOURNAL OF PHARMACEUTICAL SCIENCE, Issue 2 2009Mei Lin Tan Abstract Objectives This review sheds insight into an increasingly popular polymer that has been widely explored as a potential drug delivery system. The abundant, biodegradable and biocompatible polysaccharide chitosan, with many other favourable properties, has been favoured as a drug delivery system for the purposes of encapsulating and delivery of doxorubicin with reduced side-effects. Key findings Doxorubicin is frequently used as a frontline chemotherapeutic agent against a variety of cancers. It has largely been able to demonstrate anti-tumour effects, though there are major shortfalls of doxorubicin, which include serious side-effects such as cardiomyopathy and myelosuppression, and also an ever-present danger of extravasation during drug administration. In view of this, drug delivery systems are currently being explored as alternative methods of drug delivery in a bid to more effectively direct doxorubicin to the specific lesion site and reduce its systemic side-effects. Liposomes and dendrimers have been tested as potential carriers for doxorubicin; however they are not the focus of this review. Summary Recent advancements in doxorubicin and chitosan technology have shown some preliminary though promising results for cancer therapy. [source] Acitretin and treatment of the oral leucoplakias.JOURNAL OF THE EUROPEAN ACADEMY OF DERMATOLOGY & VENEREOLOGY, Issue 6 2000A model to have an active molecules release Abstract Aims The aim of this study was to investigate the effectiveness of acitretin in a new topical formulation (mucoadhesive two-layer tablets) for the treatment of oral leucoplakias. Methods Twenty-one volunteers, 16 men, five women, with oral leucoplakia (histologically diagnosed), were included in this double-blind placebo-controlled study. Patients were randomized in three groups (A, B, C) of seven patients each. Groups A and B received tablets with different in vitro release profiles, and group C subjects (controls) received tablets without acitretin. The acitretin dose was 20 mg/day (two 10 mg tablets daily). Serum aspartate aminotransferase, alanine aminotransferase, cholesterol and triglycerides were evaluated before and after treatment. At the end of therapy the concentrations of acitretin in plasma, saliva and tissue were measured by high-performance liquid chromatography. Results At the end of the study 71% (groups A and B) of patients showed clinical remission or marked improvement. No improvement was noted in the control subjects (group C). These results were further confirmed by histological findings. There were no significant changes in laboratory values in the three groups. The acitretin concentration in plasma and tissue ranged from 0 to 50 mg with no difference between groups A and B, and it was very high in saliva (ranging from 4.9 to 43 mg) with higher concentrations in group A than in group B (due to a longer adhesion time in group A). Patients' compliance was excellent. The results show that mucoadhesive tablets of topical acitretin are efficacious in the treatment of oral leucoplakia without systemic side-effects. [source] Clinical efficacy of sublingual and subcutaneous birch pollen allergen-specific immunotherapy: a randomized, placebo-controlled, double-blind, double-dummy studyALLERGY, Issue 1 2004M. S. Khinchi Background:, Both sublingual allergen-specific immunotherapy (SLIT) and subcutaneous immunotherapy (SCIT) have a documented clinical efficacy, but only few comparative studies have been performed. Objective:, To investigate the clinical efficacy of SLIT vs SCIT and secondary to compare SLIT and SCIT with placebo and to evaluate the relative clinical efficacy in relation to systemic side-effects. Methods:, A 3-year randomized, placebo-controlled, double-blind, double-dummy study including 71 adult birch pollen hay fever patients treated for two consecutive years after a baseline year. Allocation to treatment groups was based on disease severity in the baseline season, gender and age. Results:, Clinical efficacy was estimated in 58 patients completing the first treatment year by subtracting baseline data and by calculating the ratio first treatment season vs baseline. SLIT diminished the median disease severity to one-half and SCIT to one-third of placebo treatment. No statistical significant difference between the two groups was observed. Both for symptoms and medication scores actively treated patients showed statistically significant and clinical relevant efficacy compared with placebo. SLIT treatment only resulted in local mild side-effects, while SCIT resulted in few serious systemic side-effects. Conclusion:, Based on the limited number of patients the clinical efficacy of SLIT was not statistically different from SCIT, and both treatments are clinically effective compared with placebo in the treatment of birch pollen rhinoconjunctivitis. The lack of significant difference between the two treatments does not indicate equivalent efficacy, but to detect minor differences necessitates investigation of larger groups. Due to the advantageous safety profile SLIT may be favored. [source] Therapeutic doses of glucocorticoids: implications for oral medicineORAL DISEASES, Issue 5 2006SK Baid Glucocorticoids can cause adverse systemic side-effects ranging from iatrogenic Cushing's syndrome during treatment, to hypothalamic,pituitary,adrenal axis suppression and clinically significant adrenal insufficiency when the agents are discontinued. While the oral route of administration is most often implicated, it is now becoming more apparent that inhaled and topical administration also can cause these effects. Given the high therapeutic value of glucocorticoids, the ability to prescribe these agents while maintaining a low risk-to-benefit ratio for patients is critical. The aim of this review is to provide oral healthcare practitioners with a practical guide to commonly used glucocorticoids, their adverse effects, and perioperative use. [source] Inhaled drugs for the prevention and treatment of bronchopulmonary dysplasiaPEDIATRIC PULMONOLOGY, Issue 8 2006T. Pantalitschka MD Abstract Bronchopulmonary dysplasia (BPD) is one of the most common long-term complications and treatment challenges in preterm infants. Theoretically, inhaled corticosteroids may suppress pulmonary inflammation without causing systemic side-effects, while bronchodilators will improve airway resistance and thereby work of breathing. This article reviews current data on these drugs in BPD prevention or treatment. Trials published to date have not demonstrated that regular bronchodilator administration influences the incidence of BPD or improves long-term outcome. Inhaled steroids started before 2 weeks of age may improve rates of successful extubation and reduce the need for rescue systemic glucocorticoids, but have not been shown to reduce the incidence of BPD. Thus, their use cannot be generally recommended. The data currently available are not sufficient to give any clearer recommendation on the use of these drugs in infants at high risk of, or established, BPD. Pediatr Pulmonol. 2006; 41: 703,708. © 2006 Wiley-Liss, Inc. [source] Intravesical alkalinized lidocaine (PSD597) offers sustained relief from symptoms of interstitial cystitis and painful bladder syndromeBJU INTERNATIONAL, Issue 7 2009J. Curtis Nickel OBJECTIVE To assess the immediate and sustained relief of the symptoms of interstitial cystitis/painful bladder syndrome (IC/PBlS) after a consecutive 5-day course of treatment with intravesical alkalinized lidocaine (PSD597), and to characterize the pharmacokinetics of single and multiple doses of intravesical PSD597 in a subgroup of patients. PATIENTS AND METHODS In all, 102 adult patients (99 women) with a clinical diagnosis of IC/PBlS were randomized from 19 centres in the USA and Canada to receive a daily intravesical instillation of PSD597 (200 mg lidocaine, alkalinized with a sequential instillation of 8.4% sodium bicarbonate solution, to a final volume of 10 mL) or placebo (double-blind), for 5 consecutive days. Patients were followed at intervals up to 29 days after the first instillation. Efficacy was assessed by changes in the Global Response Assessment (GRA), Likert scales for bladder pain, urgency and frequency, and validated O'Leary-Sant IC symptom and problem indices. RESULTS Significantly more patients treated with PSD597 rated their overall bladder symptoms as moderately or markedly improved on the GRA scale 3 days after completing the 5-day course of treatment (30% and 9.6%, respectively, for patients treated with PSD597 and placebo; P = 0.012). The treatment effects were also maintained beyond the end of treatment and are further supported by the secondary endpoints, including symptom and problem indices. The peak serum lidocaine concentration during the study was <2 µg/mL, and well below the toxic level (>5 µg/mL). CONCLUSION This preliminary study showed that PSD597 was effective for providing sustained amelioration of symptoms of IC/PBlS beyond the acute treatment phase. The drug was safe, well tolerated and devoid of the systemic side-effects often experienced with oral drug administration. Long-term studies are needed to determine the optimum regimen to maintain this favourable treatment effect. [source] Sustained beneficial effects of intraprostatic botulinum toxin type A on lower urinary tract symptoms and quality of life in men with benign prostatic hyperplasiaBJU INTERNATIONAL, Issue 5 2006Yao-Chi Chuang OBJECTIVE To present a comprehensive experience with intraprostatic botulinum toxin-type A (BoNT-A) injection in men with symptomatic benign prostatic hyperplasia (BPH) and to assess the efficacy on lower urinary tract symptoms (LUTS) and quality of life (QoL). PATIENTS AND METHODS In all, 41 men (mean age 69.1 years, sd 7.1 ) with an International Prostate Symptom Score of ,,8, peak flow rate of <12 mL/s, and who were refractory to medical treatment were injected with BoNT-A (Botox®, Allergan, Inc., CA, USA) at 100 U (21 men, for prostate volume <30 mL) or 200 U (20, for prostate volume >30 mL) into the prostate transperineally under transrectal ultrasonography guidance. Study exclusion criteria were confirmed or suspected malignancy, previous pelvic surgery or trauma and previous invasive treatment for BPH. The clinical effects were evaluated at baseline and at 1, 3 and 6 months after treatment. RESULTS There were no significant local or systemic side-effects in any men. LUTS and QoL indices improved by >30% in 31 of the 41 men (76%), and four of five men with urinary retention for >1 month could void spontaneously at 1 week to 1 month after the BoNT-A injection. In 12 of 41 men (29%) there was no change in prostate volume, yet seven of these men still had a >30% improvement in maximum flow rate, LUTS and QoL. The efficacy was sustained at 12 months. CONCLUSION BoNT-A injected into the prostate is safe and effective for men with symptomatic BPH. The mechanisms of relief of symptoms might not depend totally on the volume shrinkage; the inhibitory effect on the smooth muscle tone and aberrant sensory function might also be important. [source] Intramuscular immunoglobulin for recalcitrant suppurative diseases of the skin: a retrospective review of 63 casesBRITISH JOURNAL OF DERMATOLOGY, Issue 3 2007B. Goo Summary Background, Intramuscular human immunoglobulin (HIG) may provide a therapeutic option as an independent or combined treatment for recalcitrant suppurative skin diseases such as hidradenitis suppurativa, folliculitis decalvans, or chronic recurrent furunculosis or folliculitis. Objectives, To define the efficacy and safety of intramuscular HIG for chronic and recalcitrant suppurative skin diseases. Methods, Patients who had received HIG for hidradenitis suppurativa, folliculitis decalvans, furunculosis or folliculitis at Severance Hospital, Seoul, Korea, between January 2000 and May 2005 were identified from medical/pharmacy records. All records were analysed retrospectively. Results, Sixty-three patients were identified. After treatment, 37 patients (59%) showed overall improvement and were rated as having an ,excellent response' or ,good response' by the attending physician. No improvement or worsening was seen in only three patients (5%). A period without new lesions (PWNL) was achieved in 46 patients (73%). The number of times HIG was administered to achieve PWNL ranged from 1 to 12 (mean ± SD 2·15 ± 1·69). There was no significant difference in the rating score between the independent intramuscular HIG and the combined treatment groups. Pain at the injection site was the major side-effect, which led to the discontinuation of treatment in five patients. No other significant systemic side-effects were observed. Conclusions, Our results demonstrate that intramuscular HIG may be used for the treatment of recalcitrant suppurative skin diseases as an independent or combined treatment. [source] Can preoperative bevacizumab improve trabeculectomy outcome?ACTA OPHTHALMOLOGICA, Issue 2009Avastin-Trab study Purpose The aim of this project is to study whether peroperative intracameral bevacizumab (Avastin®) might improve the outcome of filtration surgery. Methods This study will be carried out in a prospective, placebo-controlled, double-blinded experimental setup. The effect of peroperative administration of bevacizumab on intraocular pressure, bleb characteristics and post-operative medication and surgical intervention will be investigated. The risk of systemic side-effects will minimalized by using local anti-Vascular Endothelial Growth Factor treatment. The study patients will be divided into two major groups: A) Patients with primary open angele glaucoma and B) Patients with normotensive glaucoma, in which very low IOPs are targeted. Both groups of patients will undergo a trabeculectomy. Patients in group A will not be given the antimetabolite Mitomycin C (MMC), while patients in group B will receive MMC to obtain sufficiently low IOPs. This strategy adheres to standard operating procedures for filtration surgery. Results will follow Conclusion Our study will potentially shed new light on a plausible and simple method to improve the prognosis of glaucoma filtration surgery. Since this study will provide direct data on the effectiveness of a one-time treatment that might reduce the risk of bleb failure after filtration surgery, avoiding or reducing the need for long-term medication use or secondary surgical intervention, the potential clinical implications of this study are clear. Thus, our project opens exciting new perspectives for the treatment and prognosis of the blinding condition of glaucoma [source] Intravitreal bevacizumab for treatment-naïve subfoveal occult choroidal neovascularization in age-related macular degenerationACTA OPHTHALMOLOGICA, Issue 4 2009Claudio Furino Abstract. Purpose:, This study aimed to evaluate the efficacy of multiple injections of intravitreal bevacizumab for treatment-naïve subfoveal occult choroidal neovascularization (CNV) in age-related macular degeneration (AMD). Methods:, Twelve eyes of 12 patients (mean age 76 ± 6 years) with mean best corrected visual acuity (BCVA) of 20/100 and occult subfoveal CNV at fluorescein angiography (FA), indocyanine-green (ICG) angiography and optical coherence tomography (OCT), showing intra- or subretinal fluid with or without retinal pigment epithelial detachment (PED), underwent multiple intravitreal injections (mean 2.4 ± 0.7) of 1.25 mg (0.05 ml) bevacizumab. Visual acuity and OCT findings were assessed at the end of follow-up. Results:, After a mean follow-up of 5.7 ± 2 months, BCVA improved from 20/100 (range 20/50,20/303) to 20/60 (range 20/28,20/200) (p = 0.038). Five eyes (42%) increased BCVA by , 3 lines, six eyes (50%) increased BCVA by < 3 lines and one eye (8%) remained stable. Macular thickness decreased from 298 ± 71 ,m to 223 ± 72 ,m (p = 0.017). No ocular or systemic side-effects were observed. Conclusions:, Short-term results suggest that multiple intravitreal injections of 1.25 mg bevacizumab are well tolerated and associated with significant improvements in BCVA and decreased retinal thickness by OCT in most patients with treatment-naïve occult CNV. Further evaluation of intravitreal bevacizumab for the treatment of occult CNV is warranted. [source] Side-effects of allergen-specific immunotherapy.CLINICAL & EXPERIMENTAL ALLERGY, Issue 3 2006A prospective multi-centre study Summary Background and objective The safety of allergen-specific immunotherapy (SIT) is a parameter of great interest in the overall assessment of the treatment. A clinical database was developed in order to obtain early warnings of changes in the frequency and severity of side-effects and sufficient data for the evaluation of possible risk factors. Methods During a 3-year period, four allergy centres in Copenhagen, Denmark, included data from all patients initiating SIT to a common database. Information on initial allergic symptoms, allergens used for treatment, treatment regimens and systemic side-effects (SSEs) during the build-up phase was collected. Results A total of 1038 patients received treatment with 1709 allergens (timothy, birch, mugwort, house dust mite (HDM), cat, and wasp and bee venom), 23 047 injections in total. Most SIT patients completed the updosing phase without side-effects, but there was a significant difference between allergens: wasp (89%), birch (82%), HDM (81%), cat (74%) and grass (70%) (P=0.004). A total of 582 SSEs were registered in 341 patients. Most side-effects were mild grade 2 reactions (78%). A difference in severity between allergens was observed (P=0.02), with grass giving most problems. The type of allergen but not patient- or centre-related parameters seemed predictive of side-effects. Conclusions Allergen extracts differ in their tendency to produce side-effects. Multi-centre studies like the present one allow more patients to be evaluated, and thereby provide a more efficient surveillance of side-effects. Online Internet-based registration to a central national database of every allergen injection would be an even more powerful tool for evaluation of risk factors and surveillance of side-effects. [source] Bevacizumab (Avastin) for the treatment of neovascular glaucomaCLINICAL & EXPERIMENTAL OPHTHALMOLOGY, Issue 5 2007Michael N Chilov MBBS Abstract Herein three cases of angle closure secondary to neovascularization (elevated intraocular pressure in two of the cases) treated with the anti-vascular endothelial growth factor (VEGF) monoclonal antibody bevacizumab (Avastin) are reported. In all three cases there was rapid resolution of neovascularization and control of intraocular pressure. One patient with corneal anaesthesia from diabetes developed infectious keratitis, potentially as a consequence of inhibition of VEGF wound healing and neurotrophic functions. Avastin appears to have a promising role in the treatment of neovascular glaucoma but is not without potential local and systemic side-effects. [source] | |||||||||||||||||||