Home About us Contact
|
Home About us Contact | ||
|
|
||
Therapeutic Options Available (therapeutic + option_available)
Selected AbstractsFulminant hepatic failure: Wilson's disease or autoimmune hepatitis?PEDIATRIC TRANSPLANTATION, Issue 1 2005Implications for transplantation Abstract:, Fulminant hepatic failure (FHF) accounts for 10,15% of pediatric liver transplants in the USA annually. Because the onset of FHF may be the first presentation of Wilson's disease (WD) and autoimmune hepatitis (AIH) in previously asymptomatic adolescents, determination of the etiology of FHF is critical as treatment and prognosis differ between these two entities. Patients with AIH may be salvaged by medical treatment. On the contrary, liver transplantation is currently the only life saving therapeutic option available for patients with WD who present with fulminant liver failure. To establish the diagnosis of WD and AIH in the setting of FHF remains challenging for diagnosticians and decisions regarding liver transplantation may be necessary before a diagnosis is firmly established. We report a previously asymptomatic patient who presented with FHF and clinical and laboratory features suggestive of both WD and AIH and who underwent successful therapeutic liver transplantation before the diagnosis of WD could be confirmed. [source] Quality of life in patients with atopic dermatitis: Impact of tacrolimus ointmentINTERNATIONAL JOURNAL OF DERMATOLOGY, Issue 6 2006Makoto Kawashima MD Background, Atopic dermatitis (AD), a significant problem in Japan, has a major impact on health-related quality of life (QOL). The development of steroid phobia in patients with AD may restrict the therapeutic options available to these patients. Tacrolimus ointment is a safe and effective nonsteroid treatment for AD. It may be an appropriate alternative for patients with AD and steroid phobia. The aim of this study was to determine the impact of AD on QOL and to investigate the effect of tacrolimus ointment on QOL in patients with steroid phobia. Methods, Firstly, QOL scores were investigated in patients with AD and steroid phobia using the World Health Organization Quality of Life instrument, WHOQOL-26, and were compared with QOL scores from a previous study in volunteers from Tokyo, Japan. Secondly, patients with steroid phobia received tacrolimus ointment treatment for 12 weeks. Quality of life scores were assessed using WHOQOL-26 at baseline and study end. Results, The overall mean QOL score of 106 patients with AD was significantly lower than that of 708 volunteers (3.1 ± 0.5 vs. 3.3 ± 0.5, P < 0.001). The overall QOL score improved from 2.9 ± 0.4 at baseline to 3.3 ± 0.4 following 12 weeks' tacrolimus ointment treatment in 35 patients with AD and steroid phobia (P < 0.001). Conclusions, Atopic dermatitis significantly lowers QOL. Tacrolimus ointment is associated with a significant improvement in QOL in patients with steroid phobia, indicating that it is an effective alternative to topical corticosteroids in these patients. [source] A Review of Sympathetically Maintained Pain Syndromes in the Cancer Pain Population:PAIN PRACTICE, Issue 4 2001The spectrum of ambiguous entities of RSD, other pain states related to the sympathetic nervous system Abstract: Accepted wisdom contends that sympathetically maintained pain is rare in cancer pain syndromes. But this may be more of an artifact of how we diagnose this condition than a reflection of its true prevalence. One area in which one might suspect this to be true is in postsurgical states. While there are case reports of sympathetically maintained pain occurring after radical neck dissection, orbital and maxillary exenteration, it has not been reported in the more common areas of postsurgical pain. For instance, although one should suspect that the nerve damage that accompanies post-thoracotomy and postmastectomy pain syndromes would bring into being a certain incidence of sympathetically maintained pain, it is difficult to find collaborative reports. This may have more to do with the difficulty inherent in diagnosing sympathetically maintained pain than its actual contribution to these persistent cancer pain syndromes. The reason that it is more commonly reported in limb amputation is less comprehensible since blocking the sympathetic fibers that travel to an extremity is easier than those going to the thoracic cavity. In addition to surgically induced sympathetically maintained pain, medical patients with lymphoma and leukemia may have an element of sympathetically maintained pain when they develop postherpetic neuralgia. While the contribution of sympathetically maintained pain in these cases is not totally ignored, its involvement, as in the surgical patients mentioned above, is worthy of another analysis. This paper will discuss the topics introduced above and suggest diagnostic and therapeutic options available for this condition. [source] Extracorporeal Life Support as Ultimate Strategy for Refractory Severe Cardiogenic Shock Induced by Tako-tsubo Cardiomyopathy: A New Effective Therapeutic OptionARTIFICIAL ORGANS, Issue 10 2009Massimo Bonacchi Abstract We report a possible new therapeutic strategy, using extracorporeal cardiopulmonary support (ECLS), for severe refractory cardiogenic shock (SRCS) in a patient with Tako-tsubo cardiomyopathy (TC). TC is a syndrome characterized by left ventricular wall motion abnormalities, without coronary artery disease, mimicking the diagnosis of acute coronary syndrome. This ventricular dysfunction can be reversible; however, it can progress into refractory cardiogenic shock with limited therapeutic options available. For the first time in a Tako-tsubo patient with refractory cardiogenic shock, we used ECLS treatment in order to rest the heart, sustain circulation and end-organ perfusion, and promote potential ventricular recovery. ECLS might be the selected treatment for SRCS in patients with TC, and seems to be an effective and useful ultimate therapeutic strategy for preventing death. [source] Graves' disease in children and adolescents: Response to long-term treatmentACTA PAEDIATRICA, Issue 11 2005RAQUEL BARRIO Abstract Background: Optimal treatment of Graves' disease in paediatric patients is still a matter of controversy. Antithyroid drugs, radioiodine and thyroidectomy are the three therapeutic options available. Aim: To report our experience of long-term medical treatment and outcome of paediatric Graves' disease. Methods: A 5-y-long medical protocol was implemented in 20 children and adolescents with Graves' disease. All patients received antithyroid drugs as the first therapeutic option; patients who did not enter long-term remission received I131 and/or surgery as the definitive treatment. Results: The mean age at diagnosis was 12.1±4 y. Only two patients were males, both presenting concomitant type 1 diabetes. Mean follow-up was 13.8 ± 5.5 y. Forty per cent of patients achieved long-term remission with low antithyroid drugs doses (mean treatment time: 5.4± 1.4 y). Six patients received I131 as definitive treatment and another six underwent surgery after completing medical treatment for 6.8 ± 4.1 and 5.1 ± 2 y, respectively. No patients requiring high antithyroid drugs doses to maintain euthy-roidism reached long-term remission and needed I131 and/or surgery. Conclusion: Implementation of a long-term antithyroid drug protocol achieved 40% long-term remissions in paediatric patients with Graves' disease. Need for maintained high doses of antithyroid drugs could be considered a predictive factor for no remission. When permanent remission was not obtained by medical treatment, I131 and/or surgery allowed healing in all cases. [source] Obesity and polycystic ovary syndromeCLINICAL ENDOCRINOLOGY, Issue 2 2006T. M. Barber Summary The aetiology of Polycystic Ovary Syndrome (PCOS) is complex and multifactorial. There is much evidence, however, to suggest that adipose tissue plays an important role in the development and maintenance of PCOS pathology. There is a close correlation between adiposity and symptom severity in women with PCOS, and even modest reductions in weight generally translate into significant improvements in menstrual regularity, fertility and hyperandrogenic features. This review article considers the various mechanisms that might underlie this link between excess adiposity and PCOS , including the effects of differential insulin sensitivity, abnormal steroid hormone metabolism and adipocytokine secretion. Greater attention to the therapeutic options available to reduce the impact of excess adiposity on ovarian and metabolic function is essential to the management of PCOS. [source] | ||||||||||