Home About us Contact
|
Home About us Contact | ||
|
|
||
Severe Attacks (severe + attack)
Selected AbstractsAcute intermittent porphyria in women: clinical expression, use and experience of exogenous sex hormones.JOURNAL OF INTERNAL MEDICINE, Issue 2 2003A population-based study in northern Sweden Abstract., Andersson C, Innala E, Bäckström T (University Hospital, Umeå, Sweden). Acute intermittent porphyria in women: clinical expression, use and experience of exogenous sex hormones. A population-based study in northern Sweden. J Intern Med 2003; 254: 176,183. Objective., To describe the clinical expression of acute intermittent porphyria (AIP) in women, their use of exogenous sex hormones, and the effects on AIP. Design., A retrospective population-based study. Subjects., All women aged ,18 years (n = 190) with DNA-diagnosed AIP in northern Sweden. Results., A total of 166 women (87%) participated; 91 (55%) had manifest AIP. Severe attacks were reported by 82%; 39% reported recurrent premenstrual AIP attacks and 22% reported chronic AIP symptoms. Oral hormonal contraceptives had been used by 58% of all these women and by 50 with manifest AIP (57%). Twelve women (24%) associated oral contraceptives as precipitating AIP attacks; in nine cases their first attack. One woman experienced relief from AIP symptoms. On commencing their treatment, 72% of the women with manifest AIP had not yet suffered their first attack. Twenty-two women (25%) aged ,45 years had used hormonal replacement therapy (HRT) at menopause to remedy climacteric symptoms (the percutaneous route was most frequently used); no AIP attack was precipitated. HRT to remedy vaginal dryness was used by 26 women (28%) aged ,45 years without triggering an AIP attack. Miscarriages were more frequent in women with manifest AIP (50%) than in the latent group (30%, P = 0.014). Conclusions., About half of the women with AIP had used oral hormonal contraceptives. As 25% of women with manifest AIP reported attacks associated with such drugs, caution must still be recommended. Menopausal HRT only rarely affected the disorder. Miscarriage was more common amongst women with manifest AIP. [source] Solidarity put to the test.INTERNATIONAL JOURNAL OF SOCIAL WELFARE, Issue 4 2000Health, social care in the UK As welfare states experience challenges from ideological and funding sources, the position of the United Kingdom represents an important case study. Apparently under severe attack for its perceived failures to deliver efficiency, effectiveness and social justice, there remains a continued high level of public support for `nationalised' health and social care. The paper explores the nature of the fissures in the systems and the data which indicates enduring solidarity. [source] Atypical attack of acute intermittent porphyria , paresis but no abdominal painJOURNAL OF INTERNAL MEDICINE, Issue 3 2002C. Andersson Abstract.,Andersson C, Nilsson A, Bäckström T (University Hospital, Umeå, Sweden; and Primary Health Care Centre, Arvidsjaur). Atypical attack of acute intermittent porphyria , paresis but no abdominal pain (Case report). J Intern Med 2002; 252: 265,270. We report a case of acute intermittent porphyria (AIP) in a 45-year-old woman. Her first attack occurred at the age of 38. Because of escalating cyclical premenstrual attacks, the following 2 years, depletion of the endogenous sex hormone was considered as haeme arginate treatment proved insufficient. Gonadotropin releasing hormone agonist treatment with low-dose oestradiol add back was quite successful initially but was abandoned after 18 months when progesterone add back precipitated a severe attack. Following hysterectomy and oophorectomy at age 42 and oestradiol add back, a remarkable monthly regularity of attacks ensured periodically but with milder symptoms. Two years after surgery, preceded by six attack-free months, a puzzling symptom-shift occurred, from abdominal pain, back and thigh pain during the attacks, to solely severe distal extensor paresis in the arms. Haeme arginate treatment interrupted the progress of the paresis almost immediately and motor function improved considerably up to the 9-month follow-up. Electrophysiological examination revealed only motor neuropathy, consistent with axonal degeneration. Subsequently the symptoms changed yet again, to sensory disturbances with numbness and dysesthesia as the primary expression followed by rather mild abdominal pain. However, cyclical attacks occurred, despite absence of endogenous ovarial hormone production, possibly attributable to impaired oestrogen metabolism in the liver, or adrenal oestrogen production. Treatment comprising oophorectomy, low-dose oestradiol add back and haeme arginate infusion for 2 days on the appearance of early AIP symptoms is now quite successful affording improvement in life quality. [source] An Integrative Approach for Treating Postherpetic Neuralgia,A Case ReportPAIN PRACTICE, Issue 3 2007Shu-Ming Wang MD Abstract: This report describes the successful treatment of a patient with postherpetic neuralgia using traditional pharmacology in combination with acupuncture. Case Report: A 13-year-old girl developed postherpetic neuralgia following a severe attack of varicella zoster. Despite a 1-week course of intravenous acyclovir initiated at the onset of symptoms, the patient developed persistent left facial pain and constant nausea after lesions were healed. A comprehensive pain treatment regimen, consisting of a stellate ganglia block, medications, transcutaneous electrical nerve stimulation and hypnosis, was administered, but the patient did not gain any incremental pain relief. The acupuncture service was consulted to provide assistance with this patient's pain management. A combination of body and auricular acupuncture as well as related techniques, including acupressure and transcutaneous acupoint electrical stimulation, was added to the pain treatment regimen. After 10 complementary acupuncture treatments over a 2-month period, the patient's nausea disappeared. Her left facial pain continued to decline from a maximum of 10 to 0 as assessed by a visual analog scale over a period of 4 months following self-administered treatments of acupressure and transcutaneous acupoint electrical stimulation. The patient was then gradually weaned off all her medications and the complementary acupuncture treatment. She was discharged from the pediatric pain clinic after 5 months of the combined therapy. Conclusions: Acupuncture and its related techniques may be an effective adjunctive treatment for symptoms associated with postherpetic neuralgia and deserve further study. [source] Lifetime sexual dimorphism in Juniperus communis var. communisPLANT SPECIES BIOLOGY, Issue 1 2007LENA K. WARD Abstract The sexes of dioecious Juniperus communis were differentially affected over their lifetime in response to ecological and physiological stress in populations of different ages studied over 23 years in southern England. In a young population, the female survival rate was less than the male rate, with more females dying during a severe attack by rabbits and later with fungus disease in the roots. The sex ratio (female : male) in marked individuals was predicted by age, changing from 1:1.13 in 1983 to 1:1.32 in 2005. In an old senescing population, where two-thirds of the individuals died, the sex ratio varied, but overall became more male biased (1:1.51,1:2.10). Males had a greater resistance to terminal disease, and were slightly older than females at death (110 years compared to 106). Young females grew less than males, presumably because of greater trade-offs with reproductive effort: the mean annual shoot growth was 6.7 cm compared to 8.1 cm in males. By approximately 30 years of age, heights of the sexes were significantly different. The annual growth of old females (4.8 cm) was greater than that in males (4.3 cm), possibly because males survived longer in poor health. Sexual differences in height in the old population were progressively lost. Cone abundance in females was less than that in males and cone production had greater periodicity; the young population outperformed the old. There were slightly longer time lags in inverse correlations between growth and reproductive indices in females. [source] C1 inhibitor deficiency: consensus documentCLINICAL & EXPERIMENTAL IMMUNOLOGY, Issue 3 2005M. M. Gompels Summary We present a consensus document on the diagnosis and management of C1 inhibitor deficiency, a syndrome characterized clinically by recurrent episodes of angio-oedema. In hereditary angio-oedema, a rare autosomal dominant condition, C1 inhibitor function is reduced due to impaired transcription or production of non-functional protein. The diagnosis is confirmed by the presence of a low serum C4 and absent or greatly reduced C1 inhibitor level or function. The condition can cause fatal laryngeal oedema and features indistinguishable from gastrointestinal tract obstruction. Attacks can be precipitated by trauma, infection and other stimulants. Treatment is graded according to response and the clinical site of swelling. Acute treatment for severe attack is by infusion of C1 inhibitor concentrate and for minor attack attenuated androgens and/or tranexamic acid. Prophylactic treatment is by attenuated androgens and/or tranexamic acid. There are a number of new products in trial, including genetically engineered C1 esterase inhibitor, kallikrein inhibitor and bradykinin B2 receptor antagonist. Individual sections provide special advice with respect to diagnosis, management (prophylaxis and emergency care), special situations (childhood, pregnancy, contraception, travel and dental care) and service specification. [source] Neurophysiological tests and neuroimaging procedures in non-acute headache: guidelines and recommendationsEUROPEAN JOURNAL OF NEUROLOGY, Issue 4 2004G. Sandrini The use of instrumental examinations in headache patients varies widely. In order to evaluate their usefulness, the most common instrumental procedures were evaluated, on the basis of evidence from the literature, by an EFNS Task Force (TF) on neurophysiological tests and imaging procedures in non-acute headache patients. The conclusions of the TF regarding each technique are expressed in the following guidelines for clinical use. 1Interictal electroencephalography (EEG) is not routinely indicated in the diagnostic evaluation of headache patients. Interictal EEG is, however, indicated if the clinical history suggests a possible diagnosis of epilepsy (differential diagnosis). Ictal EEG could be useful in certain patients suffering from hemiplegic and basilar migraine. 2Recording of evoked potentials is not recommended for the diagnosis of headache disorders. 3There is no evidence to justify the recommendation of autonomic tests for the routine clinical examination of headache patients. 4Manual palpation of pericranial muscles, with standardized palpation pressure, can be recommended for subdividing patient groups but not for diagnosis. Pressure algometry and electromyography (EMG) cannot be recommended as clinical diagnostic tests. 5In adult and paediatric patients with migraine, with no recent change in attack pattern, no history of seizures, and no other focal neurological signs or symptoms, the routine use of neuroimaging is not warranted. In patients with atypical headache patterns, a history of seizures and/or focal neurological signs or symptoms, magnetic resonance imaging (MRI) may be indicated. 6If attacks can be fully accounted for by the standard headache classification [International Headache Society (IHS)], a positron emission tomography (PET) or single-photon emission computerized tomography (SPECT) and scan will generally be of no further diagnostic value. 7Nuclear medicine examinations of the cerebral circulation and metabolism can be carried out in subgroups of headache patients for diagnosis and evaluation of complications, when patients experience unusually severe attacks, or when the quality or severity of attacks has changed. 8Transcranial Doppler examination is not helpful in headache diagnosis. Although many of the examinations described are of little or no value in the clinical setting, most of the tools have a vast potential for further exploring the pathophysiology of headaches and the effects of pharmacological treatment. [source] Cluster headache: aetiology, diagnosis and management.HEADACHE, Issue 3 2003K Ekbom Drugs. 2002;62(1):61-69 Cluster headache is characterised by repeated attacks of strictly unilateral pain in the orbital region associated with local autonomic symptoms or signs. The attacks are brief but of a very severe, almost excruciating intensity. For unknown reasons males are affected more often than females. Recent studies suggest that an autosomal dominant gene has a role in some families with cluster headache. Hormonal studies indicate a dysfunction in the central nervous system. Neuroimaging has revealed primary defects in the hypothalamic grey matter. Local homolateral dilatation in the intracranial segment of the internal carotid and ophthalmic arteries during attacks is the result of a generic neurovascular activation, probably mediated by trigeminal parasympathetic reflexes. Sumatriptan 6mg subcutaneously is the drug of choice in the treatment of acute attacks. Inhalation of 100% oxygen can also be recommended. In the prophylactic treatment, verapamil is the first option. Other drugs that can be considered are corticosteroids, which may induce a remission of frequent, severe attacks, and lithium. Oral ergotamine tartrate may be sufficient for patients with night attacks and/or short, rather mild to moderately severe cluster headache periods. Third line drugs are serotonin inhibitors (methysergide and pizotifen) and valproic acid. Patients should be encouraged to keep headache diaries and be carefully instructed about the nature and treatment of the headaches. Alcohol can bring on extra attacks and should not be consumed during active periods of cluster headache. Comment: A useful review of clinical options. Given the effectiveness of injectable sumatriptan and the prophylactic use of ergotamine mentioned, one might speculate that the new intranasal formulations of triptans (eg, zolmitriptan) and triptans with a longer half-life (eg, frovatriptan) may prove to be effective in the treatment of cluster headache. DSM [source] Clinical Benefits of Early Triptan Therapy for MigraineHEADACHE, Issue 2002Julio Pascual MD Although triptans have been proven effective for acute treatment of migraine, reserving them for moderate or severe pain may produce suboptimal pain relief and higher rates of recurrence. Recent evidence indicates that early intervention at the onset of pain improves outcomes. Post hoc analysis of a long-term, open-label European study of almotriptan 12.5 mg found that the percentage of attacks rendered pain-free at 2 hours was significantly greater when patients treated mild pain (84%) than when the intervention occurred during moderate or severe pain (53%). A similar pattern emerged with respect to the consistency of pain relief, with a significant advantage for early intervention (88% versus 56%, respectively). A difference in favor of early intervention was also seen with respect to recurrence, need for rescue medication, and adverse events. The recurrence rate was significantly lower in patients treating mild pain (28%) than in those delaying treatment until the pain became moderate or severe (33%), which suggests that achieving pain freedom results in less recurrence. These results were generally replicated in post hoc analysis of a subgroup of patients from a randomized, placebo-controlled trial (the Spectrum Study) of oral sumatriptan 50 mg in migraineurs. This analysis demonstrated that with early intervention, pain was less likely to intensify, fewer attacks required redosing, more attacks remained pain-free 24 hours postdose, and normal function returned more quickly. In sum, early intervention with triptans can improve outcomes, avoiding much of the pain and disability associated with treating moderate or severe attacks. [source] Long-term outcome of treatment with intravenous cyclosporin in patients with severe ulcerative colitisINFLAMMATORY BOWEL DISEASES, Issue 2 2004Joris Arts MD Abstract Objectives IV cyclosporin A (CSA) is an effective therapy in patients with severe ulcerative colitis (UC). It remains unclear if this treatment affects the course of the disease in the long run. We investigated the long-term efficacy and safety in 86 patients with ulcerative colitis treated with IV CSA at our center. Methods The records of all patients treated with IV CSA between 11/1992 and 11/2000 were reviewed. Results Seventy-two of 86 patients (83.7%) responded to IV CSA therapy, administered for a mean of 9 ± 2 days. Following the initial treatment, 69 patients (96%) were discharged on oral CSA with mean blood CSA concentrations of 192 ± 55 ng/mL. Azathioprine was added in 64 (89%) patients. A second treatment with CSA was necessary in 11 patients; 1 patient received three courses of IV treatment. The duration of follow-up averaged 773 ± 369 days. Patients who were responders but were still having certain symptoms at discharge had a higher incidence of colectomy during follow-up. Of all initial responders, 18 (25%) underwent colectomy after a mean interval of 178 ± 141 days. The life-table predicts that of all treated patients, 55% will avoid a colectomy during a period of 3 years. Complications of CSA treatment were mostly reversible, but 3 patients (3.5%) died of opportunistic infections (1 of Pneumocystis carinii pneumonia and 2 of Aspergillus fumigatus pneumoniae). One patient with anaphylactic shock caused by the CSA solvent was successfully resuscitated. Conclusions CSA is an effective treatment of the majority of patients with severe attacks of UC, although the toxicity and even mortality associated with its use necessitates careful evaluation, selection, and follow-up. [source] Hereditary angioedema: an update on available therapeutic optionsJOURNAL DER DEUTSCHEN DERMATOLOGISCHEN GESELLSCHAFT, Issue 9 2010Marcus Maurer Summary There is no cure for hereditary angioedema (HAE). Therapeutic approaches consist of symptomatic therapy for acute attacks, short-term prophylaxis before surgery, and long-term prophylaxis for those with frequent and severe attacks. In Germany, C1-INH concentrate and icatibant are licensed for acute therapy. C1-INH concentrate, which is obtained from human plasma, is administered intravenously to restore the deficient C1-INH activity. This therapy, which has been available for decades, is effective and well-tolerated. Batch documentation is required by German law. The synthetic decapeptide icatibant is administered subcutaneously. It competes with bradykinin, the responsible inducer of edema formation, for binding to the bradykinin B2 receptor. Icatibant is also effective and well-tolerated, even on repeated administration. An additional human C1-inhibitor, a recombinant human C1-inhibitor and the recombinant inhibitor of kallikrein ecallantide are currently under development. There are no licensed treatment options available in Germany for long- and short-term prophylaxis. Androgen derivatives are established in long-term prophylaxis. However, they are associated with many adverse effects, some of which are severe. Many drug interactions also limit their use. They are contraindicated in pregnancy, lactation, for children and in cases of prostate cancer. Antifibrinolytics have fewer adverse effects but are also less effective than androgens. They are contraindicated in thromboembolic disease and impaired vision. If androgen therapy has too negative an effect on quality of life, it may be worth reducing the dose or discontinuing therapy entirely and treating attacks with acute therapy. [source] How pediatricians manage asthma in ThailandPEDIATRIC PULMONOLOGY, Issue 2 2001Pakit Vichyanond MD Abstract Currently, there is no existing information regarding prescribing practices for the management of childhood asthma among pediatricians in Thailand. In order to evaluate the management standards for childhood asthma in Thailand, 400 self-administered questionnaires were randomly mailed to nonacademic pediatricians throughout Thailand, asking questions about their preferences in the treatment of childhood asthma. One hundred and seventy-four of these 400 questionnaires were returned (a response rate of 43.5%). Data were analyzed using the descriptive module of the Epi-info 6 program. For acute asthma, 17% of the respondents used objective measures such as peak flow meters in assessing asthma severity and severity of acute asthma attacks. The drug of first choice for treating acute attacks was a nebulized beta-agonist q 20 min (81.8%). Although 93% indicated that they had used theophylline for treating acute attacks, most would reserve the drug for patients with severe symptoms. Corticosteroids were reserved for those with severe attacks (91.7% both for clinic and for in-hospital settings). Hydrocortisone was the most preferred corticosteroid preparation (59.8%). Ninety-seven percent used antibiotics in treating acute asthma, but only with appropriate indications. For chronic asthma, a strong preference was observed for oral beta-agonists as the bronchodilator of choice (88%). For moderately severe asthmatics, theophylline was still preferred by 41% of the responders. Among prophylactic agents, ketotifen was the most favored drug (90.4%), whereas inhaled steroids and cromolyn were chosen by 9.6% and 2.4%, respectively. Eighty-five percent indicated that they would prescribe prophylactic agents for 1 year or less. Forty-two percent never considered allergy evaluation as a part of a workup for childhood asthma. Certain prescribing practices of childhood asthma management in Thailand were observed among pediatricians, i.e., 1) low frequency of using objective measures in assessing asthma severity among pediatricians; 2) frequent use of theophylline and antibiotics in the treatment of acute asthma; 3) late introduction of corticosteroids in treating acute asthma; 4) preference for oral bronchodilators; and 5) preference of ketotifen as the prophylactic drug of choice. This survey provides baseline data and will aid in the evaluation of management guidelines for childhood asthma in Thailand. Pediatr Pulmonol. 2001; 32:109,114. © 2001 Wiley-Liss, Inc. [source] Naratriptan for the treatment of acute migraine: meta-analysis of randomised controlled trials,PHARMACOEPIDEMIOLOGY AND DRUG SAFETY, Issue 2 2004Darren M. Ashcroft PhD Abstract Objective To evaluate the comparative efficacy and tolerability of naratriptan in the treatment of acute attacks of migraine. Design Meta-analysis of randomised controlled trials using a random effects model. Subjects A total of 4499 patients suffering from moderate or severe attacks of acute migraine reported in ten trials. Main outcome measures Response rate ratios for headache relief, pain-free response and sustained relief (4,24 hours). Adverse events were estimated with the rate ratio (RR), risk difference and number needed to harm. Results Pooled RRs relative to placebo for pain-free response at 2 and 4 hours for naratriptan 2.5,mg were 2.52 (95%,CI: 1.78,3.57) and 2.58 (1.99,3.35). Naratriptan 2.5,mg was more effective than naratriptan 1,mg; the corresponding RRs for pain-free response at 2 and 4 hours were 1.54 (95%,CI: 1.28,1.86) and 1.35 (1.20,1.51). In contrast, naratriptan 2.5,mg was less effective in pain-free response than either rizatriptan 10,mg at 4,hours (RR: 0.68; 95%,CI: 0.55,0.85) or sumatriptan 100,mg at 4,hours (RR: 0.79; 95%,CI: 0.67,0.93). However, significantly fewer patients experienced adverse effects with naratriptan 2.5,mg than with rizatriptan 10,mg (RR: 0.73; 95%,CI: 0.56,0.97) or sumatriptan 100,mg (RR: 0.68; 95%,CI: 0.55,0.86). Conclusions Naratriptan is an effective and well-tolerated treatment for acute attacks of migraine. Head-to-head comparisons suggest that naratriptan 2.5,mg is significantly more effective than the 1,mg dose. Rizatriptan 10,mg and sumatripatn 100,mg were superior to naratriptan in terms of headache relief, while zolmitriptan 2.5,mg seemed to have comparable efficacy. Randomised controlled trials have shown that at licensed doses (1 and 2.5,mg), naratriptan is associated with a lower incidence of adverse effects than rizatriptan, sumatriptan and zolmitriptan. The incidence rates of adverse effects were similar to placebo. Copyright © 2003 John Wiley & Sons, Ltd. [source] | ||||||||||