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Second Course (second + course)
Selected AbstractsCosmetic Color Improvement of the Nipple-Areola Complex by Optimal Use of Tretinoin and HydroquinoneDERMATOLOGIC SURGERY, Issue 12 2002Kotaro Yoshimura MD background. A successful treatment to improve the color of nipple-areola complex (NAC) has never been reported, although the number of women seeking the more attractively colored NAC is not small. objective. To determine the effectiveness of our bleaching protocol for cosmetic improvement of the NAC. methods. The protocol was composed of two phases: bleaching phase (4,8 weeks) and healing phase (4,6 weeks). 0.2,0.4% tretinoin aqueous gel was applied concomitantly with 5% hydroquinone, 7% lactic acid ointment for bleaching twice a day. Tretinoin was applied to the NAC with a small cotton applicator, while hydroquinone was widely applied beyond the NAC area. After obtaining sufficient improvement in NAC color, the application of tretinoin was discontinued and hydroquinone alone was continually applied in the healing phase until the reactive erythema was eliminated. Fifteen female patients were involved in this study. results. The average treatment period was 16.6 weeks. Improvement of NAC color was obtained in 12 patients (80%) by the physician's estimation, and 11 patients (73%) satisfied with their final results. The treatment was repeated after a 1-month interval of tretinoin application in 4 patients: 2 desired further improvement in color, and 2 had the second course conducted to treat the postinflammatory hyperpigmentation on the surrounding mound induced by the first course. conclusion. This approach appeared to be most effective for cosmetic improvement of NAC color among treatments available so far. [source] Intertriginous lymphomatoid drug eruptionINTERNATIONAL JOURNAL OF DERMATOLOGY, Issue 10 2010Ronni Wolf MD A 76-year-old man developed a maculopapular purpuric eruption confined to the intertriginous areas (i.e. the inguinal, gluteal, and axillary folds). Two days before the eruption appeared, he had received a second course of chemotherapy consisting of cisplatinum 40 mg and gemcitabine (Gemzar) 1700 mg for the treatment of squamous cell carcinoma of the lung stage III B. The histologic picture was of either lymphomatoid drug eruption or lymphomatoid papulosis. The antineoplastic therapy was changed to once-weekly intravenous vinorelbine (Navelbine) 50 mg, a Vinca alkaloid, and the eruption resolved completely within two weeks without any further therapy. These circumstantial evidences support the diagnosis of intertriginous drug eruption. Our case is interesting and unusual in that it demonstrated a rare clinical presentation of drug eruption, namely, intertriginous drug eruption or baboon syndrome, with a histologic picture of a lymphomatoid drug eruption that can mimic lymphoma. We are unaware of any earlier reported case of baboon syndrome with a histologic picture of lymphomatoid drug eruption. The pathomechanisms of both types of drug eruption, i.e. baboon syndrome and lymphomatoid drug eruption, are not fully understood. [source] Efficacy of glucantime in the treatment of Old World cutaneous leishmaniasisINTERNATIONAL JOURNAL OF DERMATOLOGY, Issue 7 2009Rukhsana Firdous MPhil Background, Leishmaniasis is a parasitic disease caused by protozoa of the genus Leishmania. Depending on the parasite species and host response, the disease presents itself in different clinical forms. The cutaneous form of the disease is most common in the Old World. Pentavalent antimonials in the form of an injection represent the most widely used therapy for all clinical forms of the disease. As a result of reports on the development of resistance from various parts of the world, we thought it pertinent to determine its response in our region. Methods, Two hundred and seven military personnel with cutaneous leishmaniasis, caused by Leishmania major, were treated with glucantime according to the World Health Organization (WHO) recommended protocol. All patients were nonindigenous to the area and had moved from a nonendemic area to a highly endemic area. Results, Thirty-seven per cent of patients were cured within 15 days. The cure percentage reached 81% when 20 mg/kg/day was continued to 20 days. Twenty-five patients who failed to respond were subjected to a further course of glucantime injection. Sixteen responded by the 10th day of treatment, and the remaining nine were cured by completion of the second course, i.e. within 40 days. The drug was administered intramuscularly. The common side-effects noted were vertigo, headache, anorexia, temperature, and joint pain. Conclusion, Glucantime is still effective against Old World cutaneous leishmaniasis when used in the doses recommended by WHO. [source] Fatal peripheral neuropathy following FLA chemotherapyINTERNATIONAL JOURNAL OF LABORATORY HEMATOLOGY, Issue 4 2004W. L. Osborne Summary We discuss a case with significant progressive peripheral neurological deterioration following administration of both fludarabine and cytarabine as part of the FLA (fludarabine and cytarabine) regime. Of particular interest is that toxicity only occurred during the second course of FLA and sixth course of Ara-C containing chemotherapy. At this point, a new antifungal agent had been commenced, suggesting a possible drug interaction enhancing the risk of known neurological toxicity with this regime. [source] POSTIRRADIATION LUMBOSACRAL RADICULOPLEXOPATHY: IMPROVEMENT AFTER IMMUNE THERAPYJOURNAL OF THE PERIPHERAL NERVOUS SYSTEM, Issue 1 2000A. Bersano A delayed progressive impairment of peripheral nervous system including brachial and lumbosacral radiculoplexopathy is a well-known complication of local radiotherapy. No treatment for this infrequent complication is currently available. Recently, improvement after treatment with high dose immunoglobulin (IVIg) has been reported in some patients, suggesting either an immune-mediated inflammatory nerve damage induced by irradiation or a dysimmune neuropathy (CIDP-like) misdiagnosed as a postirradiation disease. We report on two patients who developed motor lumbosacral radiculoplexopathy several years after local radiotherapy. The first patient (ZA) is a 49 y.o. man developing a progressive proximal>distal weakness and hypotrophy of lower limbs, 20 years after radiotherapy of lumbosacral region for seminoma. Electrophysiological studies showed markedly reduced motor conduction velocities (CV) and prolonged F-wave latencies in lower limb nerves. The second patient (BF), is a 52 y.o. woman who developed progressive left brachial plexopathy and distal>proximal weakness and hypotrophy of lower limbs 12 years after a first course of toracoascellar and lumbar irradiation for Hodgkin lymphoma followed by a second course of cervicoclavicular irradiation for tumor recurrence 7 years later. Electrophysiological studies showed markedly reduced CMAP amplitudes and proportionally reduced CV in motor nerves. No sensory impairment was detected in both patients. CSF protein was elevated in both patients while cells were normal. On the assumption of a possible dysimmune origin of the disease, patient ZA underwent high dose intravenous steroid treatment, while patient BF, who had previously deteriorated after steroids, was treated with IVIg. After treatment, patient ZA became able to walk with less waddling, to rise from the floor and climb stairs without support, and to run. Improvement was less consistent in patient BF, whose right leg strength improved even if she still needed bilateral support to walk. The improvement observed in both patients supports the hypothesis that, at least in some patients, an immune-mediated mechanism may underlie postirradiation radiculoplexopathy. [source] Pseudohypopyon: Extramedullary relapse of acute myelogenous leukemia with poor prognosisPEDIATRIC BLOOD & CANCER, Issue 7 2009William C. Petersen MD Abstract An 11-month-old female presented to the emergency department with a 2-week history of fever, increasing fussiness, emesis, and decreased urine output. She was diagnosed with acute myelogenous leukemia. Systemic chemotherapy with intensified intrathecal cytarabine was started, and the patient achieved a clinical remission after the first course of induction. Towards the end of her second course of induction she developed pseudohypopyon in each eye on consecutive days, heralding a central nervous system relapse. Pediatr Blood Cancer 2009;52:885,887. © 2008 Wiley-Liss, Inc. [source] The effect of immunomodulators on prevention of autoimmune diabetes is stage dependent: FTY720 prevents diabetes at three different stages in the diabetes-resistant biobreeding ratPEDIATRIC DIABETES, Issue 1 2004Jadranka Popovic Abstract:, Background:, Autoimmune diabetes of the diabetes-resistant biobreeding (DRBB) rat shares similarities with diabetes in humans and has stages of diabetes that can be controlled and compared. FTY720 is an immunomodulator that has been efficacious in transplant and autoimmune models without inducing an immunosuppressed state. We determined the stages of diabetes that are affected by FTY720 in the DRBB rat. Methods:, Autoimmune diabetes was induced with RT6.1 T-cell-depleting antibody and polyIC starting at 4 weeks of age. FTY720 (1 mg/kg/d) was started at day 0, 5, 7, and 14 following the start of depletion. The rats that did not develop diabetes were maintained for 60 d following the last dose of FTY720 before undergoing a second course of depletion. Results:, FTY720 starting at day 0, 5, 7, and 14 of depletion prevented diabetes in 100, 100, 50, and 20% of the DRBB rats compared to 0% of the control rats. The surviving rats in the 5-, 7-, and 14-d groups developed diabetes after FTY720 treatment was stopped. Histological examination indicated insulitis in the control rats between day 7 and 11 of depletion and end-stage insulitis by day 18 of depletion compared to negligible insulitis in rats without diabetes. Redepletion in the surviving day 0 rats resulted in development of diabetes in 25% of these rats compared to none of the age-matched controls. Summary:, FTY720 can prevent autoimmune diabetes, if administered before and/or during stimulation and expansion of the autoreactive T cells or in the early stages of insulitis. The effectiveness diminishes with each successive stage of diabetes. [source] Rituximab (B-cell depleting antibody) associated lung injury (RALI): A pediatric case and systematic review of the literaturePEDIATRIC PULMONOLOGY, Issue 9 2009Martin Bitzan MD Abstract Introduction Pulmonary toxicity of delayed onset is a rare complication of B-lymphocyte depleting antibody therapy and has been almost exclusively reported in older patients with B-cell malignancies. Aims To describe a pediatric patient with rituximab-associated lung injury (RALI), to systematically analyze previous reports of pulmonary complications, and to summarize common clinico-pathological features, treatment, and outcome. Results A teenage boy with focal segmental glomerulosclerosis (FSGS) presented with progressive dyspnea, fever, hypoxemia and fatigue 18 days after the completion of a second course of rituximab infusions for calcineurin inhibitor-dependent nephrotic syndrome. Respiratory symptoms started while he received high-dose prednisone for persistent proteinuria. Bilateral, diffuse ground-glass infiltrates corresponded to the presence of inflammatory cells in the bronchioalveolar lavage fluid. Empiric antibiotic treatment including clarithromycin was given, but the microbiological work-up remained negative. Serum IgE, C3, and C4 concentrations were normal. He recovered within 3 weeks after onset. We systematically reviewed 23 reports describing 30 additional cases of rituximab-associated lung disease. Twenty eight patients had received rituximab for B-cell malignancies, one for graft-versus-host disease and one for immune thrombocytopenia. Median age was 64 years (interquartile range [IQR] 58,69 years). Seventy one percent received concomitant chemotherapy. Time to onset from the last rituximab dose was 14 days (IQR 11,22 days). Eleven of 31 patients required mechanical ventilation, and 9 died (29%). Ventilation was a significant predictor of fatal outcome (odds ratio 46.7; confidence interval 9.5,229.9). High dose glucocorticoid therapy did not improve survival or prevent severe lung disease or death. Conclusions With the expanding use of rituximab for novel indications, additional cases of RALI affecting younger age groups are expected to emerge. Mechanical ventilation predicts poor outcome. Glucocorticoids may not be protective. Pediatr Pulmonol. 2009; 44:922,934. © 2009 Wiley-Liss, Inc. [source] Pharmacokinetics of intravenous immunoglobulin and outcome in Guillain-Barré syndrome,ANNALS OF NEUROLOGY, Issue 5 2009Krista Kuitwaard MD Objective Intravenous immunoglobulin (IVIg) is the first choice treatment for Guillain-Barré syndrome (GBS). All patients initially receive the same arbitrary dose of 2g per kg body weight. Not all patients, however, show a good recovery after this standard dose. IVIg clearance may depend on disease severity and vary between individuals, implying that this dose is suboptimal for some patients. In this study, we determined whether the pharmacokinetics of IVIg is related to outcome in GBS. Methods We included 174 GBS patients who had previously participated in 2 randomized clinical trials. At entry, all patients were unable to walk unaided and received a standard dose of IVIg. Total IgG levels in serum samples obtained immediately before and 2 weeks after the start of IVIg administration were determined by turbidimetry and related to clinical outcome at 6 months. Results The increase in serum IgG (,IgG) 2 weeks after IVIg treatment varied considerably between patients (mean, 7.8g/L; standard deviation, 5.6g/L). Patients with a low ,IgG recovered significantly more slowly, and fewer reached the ability to walk unaided at 6 months (log-rank p < 0.001). In multivariate analysis adjusted for other known prognostic factors, a low ,IgG was independently associated with poor outcome (p = 0.022). Interpretation After a standard dose of IVIg treatment, GBS patients show a large variation in pharmacokinetics, which is related to clinical outcome. This may indicate that patients with a small increase in serum IgG level may benefit from a higher dosage or second course of IVIg. Ann Neurol 2009;66:597,603 [source] Refractory subacute cutaneous lupus erythematosus successfully treated with rituximabAUSTRALASIAN JOURNAL OF DERMATOLOGY, Issue 3 2009Violet Kieu ABSTRACT A 48-year-old woman presented with pruritic, scaly, annular plaques over her upper back and chest that were clinically, serologically and histologically characteristic of subacute cutaneous lupus erythematosus (SCLE). She failed to respond to conventional treatment, which included high-dose hydroxychloroquine, methotrexate, prednisolone, chloroquine, acitretin, thalidomide, dapsone and azathioprine. Subsequently treated with intravenous rituximab 375 mg/m2 weekly for 4 weeks, she remained on adjuvant oral hydrochloroquine 600 mg daily and topical clobetasol propionate 0.05% ointment as required. Clearing of annular plaques was noted 8 weeks after the initial course of rituximab. By 12 weeks there were no new lesions and only post-inflammatory hyperpigmentation remained. Both hyper- and hypopigmentation, which is more common, are consistent with SCLE lesion regression. Skin lesions recurred 11 months later; however, no further lesions occurred after re-introduction of rituximab therapy. The treatment was well tolerated. A maintenance regimen of rituximab, 375 mg/m2 every 8 weeks for 2 years, was commenced 3 months after completing the second course of treatment, with ongoing disease remission. Rituximab appears to have activity in refractory SCLE and clinical trials are required to further assess this potential therapy. [source] Cutaneous larva migrans: clinical features and management of 44 cases presenting in the returning travellerBRITISH JOURNAL OF DERMATOLOGY, Issue 3 2001V. Blackwell Background Cutaneous larva migrans (CLM) is the result of a nematode infection, and shows a characteristic creeping eruption. As travel to the tropics increases, many British citizens may be returning with this infection, which is often misdiagnosed or treated incorrectly. Objectives To perform a retrospective survey of 44 cases of CLM presenting to the Hospital for Tropical Diseases in London over the last 2 years. Methods Cases were reviewed with regard to patient characteristics, source of infection, source of referral, clinical features and therapy. Results Most infections were acquired in Africa (32%), the Caribbean (30%) and South-east Asia (25%), but also in Central and South America. There was a history of exposure to a beach in 95% of patients and the median duration of symptoms was 8 weeks (range 1,104). Lesions mainly affected the feet (39%), buttocks (18%) and abdomen (16%), but the lower leg, arm and face were also affected. Multiple lesions were seen in seven of 44 cases (16%). Laboratory abnormalities were absent in all patients. Of 44 patients seen, four needed no treatment, 28 were cured by a single course of treatment, 11 required a second course of therapy and one patient was treated three times. Thirty-one patients received oral albendazole 400 mg daily for 3,5 days and 24 were cured (77%). Five patients received 10% thiabendazole cream topically for 10 days and four were cured (80%). Four patients received oral thiabendazole 1·5 g daily for 3 days and all required further therapy. Conclusions In view of the range of treatment regimens recorded, a randomized controlled trial comparing topical and systemic therapies is warranted. [source] The effect of treatment with Campath-1H in patients with autoimmune cytopeniasBRITISH JOURNAL OF HAEMATOLOGY, Issue 4 2001F. Willis We describe 21 patients with severe and life-threatening autoimmune cytopenias resistant to standard immunosuppression who were treated with the monoclonal antibody Campath-1H. Four patients had autoimmune neutropenia, four had autoimmune haemolytic anaemia, four had pure red cell aplasia, one had immune thrombocytopenia purpura (ITP), three had autoimmune haemolytic anaemia and ITP (Evan's syndrome), three had autoimmune pancytopenia (ITP, autoimmune neutropenia and autoimmune haemolytic anaemia), one had ITP (associated with acquired Glanzmann's disease) and autoimmune neutropenia, and one had ITP and red cell aplasia. Campath-1H was administered at a dose of 10 mg/d as an intravenous infusion for 10 d. Responses were seen in 15 patients, which were sustained in six. Relapse occurred in eight patients after Campath-1H treatment. Patients entering the study later, received cyclosporine after Campath-1H in an attempt to reduce the incidence of relapse. Three patients received a second course of Campath-1H; all responded but later relapsed. Fourteen patients are alive at a median of 12 months (range 4,61) after Campath-1H. Campath-1H represents an alternative therapeutic option for severe, refractory autoimmune cytopenias. [source] Remarkable remission of a follicular lymphoma treated with rituximab and polychemotherapy (CHOP)CLINICAL & EXPERIMENTAL DERMATOLOGY, Issue 1 2003T. Schmook Summary We describe a 50-year-old female patient who developed extensive lymphomatous infiltrates on her forehead, scalp and face within a few months. Histology and immunohistochemistry of skin tumours revealed a CD20 positive follicular B-cell lymphoma. Subsequently, extracutaneous manifestations were detected by computed tomography scans and bone marrow biopsy. The patient suffered from a primary nodular malignant lymphoma with extraordinary cutaneous infiltration of the head. Therefore, combination treatment with a monoclonal antibody against the CD20 antigen, rituximab, and polychemotherapy (CHOP scheme) was administered every 3 weeks. After the second course of treatment a complete regression of cutaneous infiltrates was noticed. Follow-up biopsies on the forehead showed no evidence of CD20 positive lymphoma cells, now. Despite mild leucocytopaenia therapy was well tolerated. [source] Efficacy and safety of preemptive anti-CMV therapy with valganciclovir after kidney transplantationCLINICAL TRANSPLANTATION, Issue 1 2007Kai Lopau Abstract:, Background:, CMV infections still pose a potentially serious threat to kidney transplant recipients and have a significant impact on graft as well as patient survival. The antiviral agent valganciclovir (VGCV) has a greater bioavailability after oral administration than oral ganciclovir (GCV) and can be considered a substitute for GCV. The substance is approved in North America and Europe for anti-CMV prophylaxis after organ transplantation. In this pilot study, we examined if VGCV could also be administered in preemptive treatment of CMV infections. Methods:, Twenty-eight renal transplant recipients suffering from 32 asymptomatic episodes of CMV infection were treated with VGCV and followed up. CMV infection was diagnosed by routine controls of pp65-antigenemia in pre-defined intervals. All patients received sequential quadruple immunosuppression. VGCV was given for up to 12 wk in a dosage adapted to renal graft function. Efficacy and safety parameters were monitored for 16 wk. Results:, Twenty-seven episodes of CMV antigenemia, two patients progressing to CMV syndrome and three patients progressing to CMV disease were treated. Primary efficiency was 79%, Four patients relapsed and were treated with a second course resulting in serological recovery. Two patients did not respond to oral VCGV and were switched to another antiviral agent. Graft function remained stable during and after treatment. Serious side effects were seen in seven patients, four patients complained of diarrhea and gastrointestinal pain, three patients suffered from leucopenia, in one of these treatment had to be temporary paused. Fifty-nine percent of all episodes were treated in a completely ambulatory setting. Conclusions:, VGCV can be considered as an option also for preemptive treatment of CMV infections after renal transplantation. The antiviral potency seems to be adequate, potential side effects are comparable with IV GCV. Because of the improved pharmacokinetics of VGCV the substance can be used to abbreviate or even completely avoid in-hospital care of CMV infections. [source] | ||||||||||||||||||||||