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Takeuchi Y, Inatomi Y, Nakajima M, Yonehara T. [Guillain-Barré syndrome with refractory optic neuropathy]. Rinsho Shinkeigaku 2019; 59:652-658. [PMID: 31564705 DOI: 10.5692/clinicalneurol.cn-001329] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
A 60-year-old woman with a 3-day history of ataxic gait, blurred vision, and upper extremity paresthesia was admitted to our hospital. She presented with severe visual disturbances (finger counting), ophthalmoplegia, neck weakness, and sensory ataxia. Serum anti-GQ1b antibody, anti-GM3 antibody, and anti-GD3 antibody were strongly positive, which might contribute to the pathogenesis. Since we suspected Guillain-Barré syndrome (GBS), intravenous immunoglobulin therapy (IVIg) and high-dose steroid therapy were administered; however, improvements in her visual acuity were minimal. Additional IVIg and high-dose steroid therapy resulted in limited visual acuity improvements. Therapeutic strategies for patients with GBS and refractory optic neuropathy remain controversial.
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Affiliation(s)
- Yosuke Takeuchi
- Department of Neurology, Saiseikai Kumamoto Hospital
- Department of Neurology, National Hospital Organization Kumamotominami National Hospital
| | | | - Makoto Nakajima
- Department of Neurology, Graduate School of Medical Sciences, Kumamoto University
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Kee JXL, Choo JCJ, Takano AM, Ahmed SS, Mok IYJ, Lim CC. Abnormal Chest Radiograph in Rapidly Progressive Glomerulonephritis-Not the Usual Pulmonary-Renal Syndrome. Am J Med 2019; 132:1163-1165. [PMID: 30998914 DOI: 10.1016/j.amjmed.2019.03.038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2018] [Revised: 01/10/2019] [Accepted: 03/28/2019] [Indexed: 11/19/2022]
Affiliation(s)
- Jamie X L Kee
- Department of Internal Medicine, Singapore General Hospital, Singapore
| | - Jason C J Choo
- Department of Renal Medicine, Singapore General Hospital, Singapore
| | - Angela M Takano
- Department of Anatomical Pathology, Singapore General Hospital, Singapore
| | - Syed S Ahmed
- Department of Anatomical Pathology, Singapore General Hospital, Singapore
| | - Irene Y J Mok
- Department of Renal Medicine, Singapore General Hospital, Singapore
| | - Cynthia C Lim
- Department of Renal Medicine, Singapore General Hospital, Singapore.
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103
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Young SM, Lim AYN, Lang SS, Lee KO, Sundar G. Efficacy and safety of pulsed intravenous methylprednisolone in early active thyroid eye disease. Orbit 2019; 38:362-369. [PMID: 30540214 DOI: 10.1080/01676830.2018.1553189] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2018] [Accepted: 11/23/2018] [Indexed: 06/09/2023]
Abstract
Introduction: The mainstay of therapy for active inflammatory phase of thyroid eye disease (TED) is immunosuppression. Patients in our centre with early active TED are treated with pulsed intravenous methylprednisolone (IVMP). Two different protocols are offered in our centre: High dose (1g/day for 3 days, monthly for 6 months), or EUGOGO protocol (500 mg weekly for six weeks, followed by 250 mg weekly for the next 6 weeks). Methods: A prospective cohort study of patients undergoing the two IVMP protocols was performed from January 2009 to May 2015. Main outcome measures were improvement of Clinical Activity Score (CAS) and International Thyroid Eye Disease (ITEDS) - VISA Inflammatory Index. Results: We had a total of 63 patients. Mean age was 43.1 ± 13.1years, females comprised 49.2% (n = 31), and 31 (49.2%) had a positive smoking history. Following IVMP, 65.0% (n = 41) had good response, 31.7% (n = 20) partial, and 3.3% (n = 2) poor. There were significant differences (p < 0.001) in CAS and ITEDS scores between pre-IVMP and post-IVMP visits, for both protocols. A higher proportion of patients receiving the modified EUGOGO protocol (58.3%) had persistent activity and required additional immunosuppression compared to those who underwent the high dose protocol (33.3%). Mild side effects were experienced by 5 (7.9%) and 3 (4.8%) patients at 3 and 6 months, respectively. There were no severe side effects, cardiovascular events or liver failure. Conclusion: With adequate screening and follow-up, six repeated cycles of high dose pulsed IVMP is an effective treatment for TED and can significantly reduce the morbidity associated with this debilitating condition. None of the 51 patients from the high dose protocol met with any serious side effects.
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Affiliation(s)
- Stephanie M Young
- Division of Orbit & Oculofacial Surgery, Department of Ophthalmology, National University Hospital , Singapore , Singapore
| | - Anita Y N Lim
- Division of Rheumatology, Department of Medicine, National University Hospital , Singapore , Singapore
| | - Stephanie S Lang
- Clinical Audit, Singapore National Eye Centre , Singapore , Singapore
| | - Kok Onn Lee
- Division of Endocrinology, Department of Medicine, National University Hospital , Singapore , Singapore
| | - Gangadhara Sundar
- Division of Orbit & Oculofacial Surgery, Department of Ophthalmology, National University Hospital , Singapore , Singapore
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Jaćević V, Wu Q, Nepovimova E, Kuča K. Efficacy of methylprednisolone on T-2 toxin-induced cardiotoxicity in vivo: A pathohistological study. Environ Toxicol Pharmacol 2019; 71:103221. [PMID: 31365892 DOI: 10.1016/j.etap.2019.103221] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/11/2019] [Revised: 07/11/2019] [Accepted: 07/15/2019] [Indexed: 06/10/2023]
Abstract
Our aim was to compare the protective efficacy of two different formulations of methylprednisolone in T-2 toxin-induced cardiomyopathy. Methylprednisolone (soluble form, Lemod-solu® and/or depot form, Lemod-depo®, a total single dose of 40 mg/kg im) was given immediately after T-2 toxin (1 LD50 0.23 mg/kg sc). The myocardial tissue samples were examinated by using histopathology, semiquantitative and imaging analyses on day 1, 7, 14, 21, 28 and 60 of the study. Therapeutic application of Lemod-solu® significantly decreased the intensity of myocardial degeneration and haemorrhages, distribution of glycogen granules in the endo- and perimysium, a total number of mast cells and the degree of their degranulation was in correlation with the reversible heart structural lesions (p < 0.01 vs. T-2 toxin). These changes were completely abolished by the therapeutic use of Lemod-solu® plus Lemod-depo® (p < 0.001 vs. T-2 toxin). Our results show that a significant cardioprotective efficacy of methylprednisolone is mediated by its anti-inflammatory activity.
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Affiliation(s)
- Vesna Jaćević
- National Poison Control Centre, Military Medical Academy, 17 Crnotravska St, 11000, Belgrade, Serbia; Medical Faculty of the Military Medical Academy, University of Defence, 1 Pavla Jurišića-Šturma St, 11000, Belgrade, Serbia; Department of Chemistry, Faculty of Science, University of Hradec Kralove, Rokitanského 62, 500 03, Hradec Králové, Czechia
| | - Qinghua Wu
- College of Life Science, Yangtze University, 1 Nanhuan Road, 434023, Jingzhou, Hubei, China; Department of Chemistry, Faculty of Science, University of Hradec Kralove, Rokitanského 62, 500 03, Hradec Králové, Czechia
| | - Eugenie Nepovimova
- Department of Chemistry, Faculty of Science, University of Hradec Kralove, Rokitanského 62, 500 03, Hradec Králové, Czechia
| | - Kamil Kuča
- Department of Chemistry, Faculty of Science, University of Hradec Kralove, Rokitanského 62, 500 03, Hradec Králové, Czechia; Malaysia-Japan International Institute of Technology (MJIIT), University Teknologi Malaysia, Jalan Sultan Yahya Petra, 54100, Kuala Lumpur, Malaysia.
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105
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Cao D, Chen Y, Liao J, Nariai H, Li L, Zhu Y, Zhao X, Hu Y, Wen F, Zhai Q. Scalp EEG high frequency oscillations as a biomarker of treatment response in epileptic encephalopathy with continuous spike-and-wave during sleep (CSWS). Seizure 2019; 71:151-157. [PMID: 31351306 DOI: 10.1016/j.seizure.2019.05.023] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2019] [Revised: 04/28/2019] [Accepted: 05/29/2019] [Indexed: 02/08/2023] Open
Abstract
PURPOSE We investigated whether the presence of interictal scalp EEG high frequency oscillations (HFOs) in children with epileptic encephalopathy with continuous spike-and-wave during sleep (CSWS) can predict seizure and cognitive outcome after steroid therapy. METHODS Twenty-two children with CSWS were prospectively enrolled and received methylprednisolone therapy. Interictal scalp HFOs, spike wave index (SWI) and intelligence quotient (IQ) were assessed before and after the treatment. The children were divided into two groups based on the early seizure reduction ratio at 2 weeks (≥50%, "response group"; otherwise "non-response group"). The "response group" was further divided into two subgroups ("relapse" and "non-relapse" subgroups) according to the late seizure outcome (after 3 months). RESULTS Interictal HFOs and electrical status epilepticus in sleep (ESES) (defined as SWI ≥ 85%) were detected in all children at the baseline. In the response with relapse group (n = 11), the detection ratio of HFOs was significantly higher than that of ESES at 2 weeks (81.2 vs. 27.3%), 3 months (90.9 vs. 36.4%), and 6 months (100 vs. 54.5%) post-therapy. In the non-response group (n = 4), both HFOs and ESES persisted in all children. The average IQ improved significantly only in the response with non-relapse group. The persistence of HFOs negatively correlated with both the average IQ, yet the persistence of ESES did not. CONCLUSION Interictal scalp HFOs may be a favorable non-invasive biomarker of predicting seizure and cognitive outcome in CSWS.
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Affiliation(s)
- Dezhi Cao
- Second Clinical Medical College, Southern Medical University, Guangzhou, Guangdong, China; Neurology Department, Shenzhen Children's Hospital, Guangdong, China; Guangdong Academy of Medical Sciences, Guangdong General Hospital, Guangzhou, China
| | - Yan Chen
- Neurology Department, Shenzhen Children's Hospital, Guangdong, China
| | - Jianxiang Liao
- Neurology Department, Shenzhen Children's Hospital, Guangdong, China
| | - Hiroki Nariai
- Division of Pediatric Neurology, UCLA Mattel Children's Hospital, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, USA
| | - Lin Li
- Department of Neurology, University of California Los Angeles, Los Angeles, CA, USA
| | - Yanwei Zhu
- Neurology Department, Shenzhen Children's Hospital, Guangdong, China
| | - Xia Zhao
- Neurology Department, Shenzhen Children's Hospital, Guangdong, China
| | - Yan Hu
- Neurology Department, Shenzhen Children's Hospital, Guangdong, China
| | - Feiqiu Wen
- Neurology Department, Shenzhen Children's Hospital, Guangdong, China
| | - Qiongxiang Zhai
- Second Clinical Medical College, Southern Medical University, Guangzhou, Guangdong, China; Guangdong Academy of Medical Sciences, Guangdong General Hospital, Guangzhou, China.
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106
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Wang S, Yin HY, Zhu YF, Tao P, Zhang R, Ma YH, Wei JR. Management of an Adult with Goodpasture's Syndrome Following Brain Trauma with Extracorporeal Membrane Oxygenation: A Case Report. Chin Med Sci J 2019; 34:226-229. [PMID: 31601306 DOI: 10.24920/003478] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
A 22-year-old man suffered from acute pulmonary hemorrhage and deteriorated renal function occurred within 3 days after traumatic brain injury. Mechanical ventilation cannot correct his severe hypoxemia, therefore, venoarterial extracorporeal membrane oxygenation (VA-ECMO) support was initiated and finally resolved his hypoxemia. Concomitantly, continuous renal replacement therapy was performed to improve his kidney function. Although no anti-glomerular basement membrane (anti-GBM) antibody was detected in serum, Goodpasture's syndrome was considered. After treated with methylprednisolone pulse therapy and plasmapheresis, his renal function was significantly improved. ECMO was eventually discontinued after 60 hours of treatment and extubated on day 10. He was discharged home with normal pulmonary and renal functions.
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Affiliation(s)
- Shan Wang
- Department of Intensive Care Unit, Guangzhou Red Cross Hospital, Medical College, Jinan University, Guangzhou 510220, China
| | - Hai-Yan Yin
- Department of Intensive Care Unit, Guangzhou Red Cross Hospital, Medical College, Jinan University, Guangzhou 510220, China
| | - You-Feng Zhu
- Department of Intensive Care Unit, Guangzhou Red Cross Hospital, Medical College, Jinan University, Guangzhou 510220, China
| | - Pei Tao
- Department of Intensive Care Unit, Guangzhou Red Cross Hospital, Medical College, Jinan University, Guangzhou 510220, China
| | - Rui Zhang
- Department of Intensive Care Unit, Guangzhou Red Cross Hospital, Medical College, Jinan University, Guangzhou 510220, China
| | - Yong-Hui Ma
- Department of Intensive Care Unit, Guangzhou Red Cross Hospital, Medical College, Jinan University, Guangzhou 510220, China
| | - Jian-Rui Wei
- Institute of Clinical Nutrition, Guangzhou Red Cross Hospital, Medical College, Jinan University, Guangzhou 510220, China
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Rymuza J, Popow M, Bednarczuk T, Miśkiewicz P. High dose intravenous methylprednisolone pulse therapy causes transient increase of serum calcium and phosphate levels. Pol Merkur Lekarski 2019; 47:91-94. [PMID: 31557136] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
UNLABELLED High and very high doses of intravenous methylprednisolone (IVMP) administered in pulses are the first-line treatment for active, moderateto- severe, as well as sight-threatening Graves' orbitopathy (GO). However, glucocorticoid therapy is associated with side effects, among others, it affects bone metabolism. AIM The aim of study was to assess the acute effects of high and very high doses of IVMP on calcium (Ca) and phosphate (P) balance in euthyroid patients with moderate-to-severe GO and sight-threatening GO due to dysthyroid optic neuropathy (DON). MATERIALS AND METHODS Thirty-six patients with active, moderate-tosevere GO were treated with twelve once-weekly pulses (with cumulative dose of 4.5 g IVMP) and 11 patients with DON received 3 intravenous pulses of 1.0 g IVMP on three consecutive days. We measured serum levels of Ca and P at baseline and on the following days after the beginning of the IVMP therapy. RESULTS We observed a significant increase in serum Ca level on the next day after the 1st IVMP pulse both in patients with moderate-tosevere GO and with DON. Then, on the day 3, the decrease of serum Ca was noticed. In patients with moderate-to-severe GO, on the day 2 serum P showed a significant increase and then, it returned to basal level on the day 3. CONCLUSIONS We observed a significant increase in serum Ca level on the next day after the 1st IVMP pulse both in patients with moderate-tosevere GO and with DON. Then, on the day 3, the decrease of serum Ca was noticed. In patients with moderate-to-severe GO, on the day 2 serum P showed a significant increase and then, it returned to basal level on the day 3.
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Affiliation(s)
- Joanna Rymuza
- Department of Internal Medicine and Endocrinology, Medical University of Warsaw, Poland
| | - Michał Popow
- Department of Internal Medicine and Endocrinology, Medical University of Warsaw, Poland
| | - Tomasz Bednarczuk
- Department of Internal Medicine and Endocrinology, Medical University of Warsaw, Poland
| | - Piotr Miśkiewicz
- Department of Internal Medicine and Endocrinology, Medical University of Warsaw, Poland
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Calvo R, Negri M, Ortiz A, Roverano S, Paira S. Myositis as the initial presentation of panarteritis nodosa. Reumatol Clin (Engl Ed) 2019; 15:e24-e26. [PMID: 28755909 DOI: 10.1016/j.reuma.2017.06.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/15/2017] [Revised: 06/01/2017] [Accepted: 06/16/2017] [Indexed: 06/07/2023]
Abstract
A 47-year-old man presented with weight loss, bilateral calf pain, fever, hypertension, orchitis and oligoarthritis. Lab tests: anemia and elevated muscle enzymes. Resonance magnetic imaging: hyperintensity in gastrocnemius muscles (myositis). Histologic exam of the muscles: inflammatory infiltrate with atrophy and perifascicular regeneration. Treatment: methylprednisone (bolus) and cyclophosphamide. Muscle pain and swelling and difficulty in walking are common in panarteritis nodosa (PAN), whereas histologically demonstrated myositis is not. Even more rare is myositis as the initial presentation of this vasculitis.
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Affiliation(s)
- Romina Calvo
- Servicio de Reumatología, Hospital J.M. Cullen, Santa Fe, Argentina
| | - Melina Negri
- Servicio de Reumatología, Hospital J.M. Cullen, Santa Fe, Argentina
| | - Alberto Ortiz
- Servicio de Reumatología, Hospital J.M. Cullen, Santa Fe, Argentina
| | - Susana Roverano
- Servicio de Reumatología, Hospital J.M. Cullen, Santa Fe, Argentina
| | - Sergio Paira
- Servicio de Reumatología, Hospital J.M. Cullen, Santa Fe, Argentina.
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Morishita M, Sada KE, Matsumoto Y, Hayashi K, Asano Y, Hiramatsu Asano S, Ohashi K, Miyawaki Y, Katsuyama E, Watanabe H, Kawabata T, Wada J. Risk factors for cytomegalovirus infection in patients with antineutrophil cytoplasmic antibody-associated vasculitis. PLoS One 2019; 14:e0218705. [PMID: 31291263 PMCID: PMC6619987 DOI: 10.1371/journal.pone.0218705] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2018] [Accepted: 06/07/2019] [Indexed: 11/30/2022] Open
Abstract
Aims Cytomegalovirus (CMV) infection under immunosuppression sometimes causes death. This study aimed to elucidate risk factors for CMV infection in patients with antineutrophil cytoplasmic antibody-associated vasculitis (AAV). Methods Patients with AAV who underwent remission induction treatment at Okayama University Hospital between 2006 and 2016 were retrospectively analyzed. The primary outcome was the development of CMV infection within 3 months. Results Of the 111 patients, 13 (11.7%) patients developed CMV infection. Patients with CMV infection were older (p = 0.030) and had a higher body mass index (p = 0.029) in comparison to those without CMV infection. A higher proportion had a severe form (p = 0.001) and granulomatosis with polyangiitis (GPA) (p = 0.001), as well as a higher Birmingham Vasculitis Activity Score (p = 0.018) and C-reactive protein (p = 0.018) levels at baseline. Using logistic regression analysis, severe form and GPA were independent risk factors (odds ratio [OR] = 9.68, 95% confidence interval [CI] = 1.92–60.23, and OR = 7.46, 95% CI = 1.46–47.60, respectively). In addition, patients with CMV infection were more likely than those without infection to be glucocorticoid-related diabetes mellitus (p = 0.025). Conclusion Our study highlights disease severity and subgroups of AAV as risk factors for CMV infection.
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Affiliation(s)
- Michiko Morishita
- Department of Nephrology, Rheumatology, Endocrinology and Metabolism, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
| | - Ken-Ei Sada
- Department of Nephrology, Rheumatology, Endocrinology and Metabolism, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
- * E-mail:
| | - Yoshinori Matsumoto
- Department of Nephrology, Rheumatology, Endocrinology and Metabolism, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
| | - Keigo Hayashi
- Department of Nephrology, Rheumatology, Endocrinology and Metabolism, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
| | - Yosuke Asano
- Department of Nephrology, Rheumatology, Endocrinology and Metabolism, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
| | - Sumie Hiramatsu Asano
- Department of Nephrology, Rheumatology, Endocrinology and Metabolism, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
| | - Keiji Ohashi
- Department of Nephrology, Rheumatology, Endocrinology and Metabolism, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
| | - Yoshia Miyawaki
- Department of Nephrology, Rheumatology, Endocrinology and Metabolism, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
| | - Eri Katsuyama
- Department of Nephrology, Rheumatology, Endocrinology and Metabolism, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
| | - Haruki Watanabe
- Department of Nephrology, Rheumatology, Endocrinology and Metabolism, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
| | - Tomoko Kawabata
- Department of Nephrology, Rheumatology, Endocrinology and Metabolism, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
| | - Jun Wada
- Department of Nephrology, Rheumatology, Endocrinology and Metabolism, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
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Wang L, Li C, Yu M, Cao Y, Jing H, Li J. Long-term remarkable remission of SAPHO syndrome in response to short-term systemic corticosteroids treatment in an immunoglobulin E elevated patient: A case report. Medicine (Baltimore) 2019; 98:e16045. [PMID: 31277098 PMCID: PMC6635255 DOI: 10.1097/md.0000000000016045] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
RATIONALE Synovitis, acne, pustulosis, hyperostosis, and osteitis (SAPHO) syndrome is a rare auto-inflammatory disease with no standardized treatment. Systemic corticosteroids are only transiently effective, but long-term use would bring complications and would not bring long-term remission. Bone scintigraphy is a first-line method for systematic evaluation of osteoarticular lesions but seems to show an "imprinting" pattern. PATIENT CONCERNS A 31-year-old female patient presented significant palmoplantar pustulosis and nail lesion as well as typical tracer accumulation feature on bone scintigraphy with normal hypersensitivity C-reactive protein and erythrocyte sedimentation rate, but an elevated serum immunoglobulin E level. DIAGNOSIS The diagnosis was made by dermatological manifestations and classical sign in bone scintigraphy in accordance with the diagnostic criteria proposed in 1988. INTERVENTIONS Methylprednisolone was given with a primary dose of 40 mg/day for 1 week followed with a subsequent 20 mg/day oral prednisone for another 1 week and then reduced in a rate of 5 mg/week until the eventual cessation. OUTCOMES Long-term remarkable remission on clinical manifestations, MRI performance, and quantitative analysis of bone scintigraphy was achieved. LESSONS Identification of specific subtype of SAPHO patient according to skin and nail manifestations as well as immunoglobulin E level may guide the selection of short-term systemic corticosteroids strategy, leading to remarkable long-term remission. Besides, the lesions on bone scintigraphy can hardly disappear in SAPHO patients, and instead, the quantitative analysis of bone scintigraphy and MRI performances may better reflect the change of disease condition and serve as indicator for treatment efficiency.
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Affiliation(s)
| | - Chen Li
- Department of Traditional Chinese Medicine, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College
| | - Meiyan Yu
- Department of Radiology, Beijing Hospital of Traditional Chinese Medicine Affiliated to Capital Medical University
| | | | - Hongli Jing
- Department of Nuclear Medicine, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Junqiu Li
- Department of Radiology, Beijing Hospital of Traditional Chinese Medicine Affiliated to Capital Medical University
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Sencan S, Edipoglu IS, Bilim S, Gunduz OH. Does Coadministration of Transforaminal Epidural Steroid Injection with Sedation Improve Patient Satisfaction? A Prospective Randomized Clinical Study. Pain Physician 2019; 22:E287-E294. [PMID: 31337170] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
BACKGROUND Transforaminal epidural steroid injection (TFESI) can be administered with or without sedation in clinical practice. OBJECTIVES The aim of this study was to compare both procedures in terms of patient and physician satisfaction, preoperative anxiety level, procedural pain level, and complications. STUDY DESIGN A prospective randomized trial. SETTING A university hospital interventional pain management center. METHODS The study included patients scheduled for single-level unilateral TFESI. The patients were randomized into 2 groups. The first group underwent TFESI without sedation, whereas the second group underwent TFESI with sedation. The Likert scale was used to determine the patient and physician satisfaction, and the Numeric Rating Scale (NRS-11) was used to determine the procedural pain level. Cases in which the procedure was to be repeated, the patient was questioned if they desired to undergo the procedure with the same technique. RESULTS A total of 64 patients, (31 [48.4%] in the sedation group) were included. In the sedation group, the patient and physician satisfaction were significantly higher (P = 0.0001), the periprocedural NRS-11 scores were significantly lower (P = 0.0001), and the rate of desire to have the intervention with the same technique was higher (P = 0.001). After the regression analysis, we reported that there was a significant correlation between being in the sedation group and NRS-11 procedure scores, the desire to have the same technique, and patient and physician satisfaction (odds ratio [OR], 0.341; OR, 0.648; OR, 0.329; OR, 0.514; P = 0.0001). LIMITATIONS Both patients and physicians were unblinded. CONCLUSIONS Coadministration of TFESI with sedation improves patient and physician satisfaction. Additionally, the low periprocedural pain level results in patients' demand for the intervention to be performed with sedation in the event of repetition of the procedure. KEY WORDS Patient satisfaction, transforaminal epidural steroid injection, sedation, physician satisfaction.
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Affiliation(s)
- Savas Sencan
- Department of Physical Medicine and Rehabilitation, Division of Pain Medicine, Faculty of Medicine, Marmara University, Istanbul, Turkey
| | - Ipek Saadet Edipoglu
- Department of Physical Medicine and Rehabilitation, Division of Pain Medicine, Faculty of Medicine, Marmara University, Istanbul, Turkey
| | - Serhad Bilim
- Department of Physical Medicine and Rehabilitation, Division of Pain Medicine, Faculty of Medicine, Marmara University, Istanbul, Turkey
| | - Osman Hakan Gunduz
- Department of Physical Medicine and Rehabilitation, Division of Pain Medicine, Faculty of Medicine, Marmara University, Istanbul, Turkey
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Abubaker J, Zaina F, Siddiqui S, Zahid M, Ullah SZ, Abubaker ZJ, Karim M, Ullah S. Single Intramuscular Methylprednisolone dose in Asthma and Chronic Obstructive Pulmonary Disease Patients on Discharge. J PAK MED ASSOC 2019; 69:991-994. [PMID: 31308569] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
OBJECTIVE In this pilot study we aimed to evaluate the safety of a single intramuscular methylprednisolone (IM) injection at the time of discharge as a replacement for oral steroid therapy for patients in our population with asthma or chronic obstructive pulmonary disease (COPD). METHODS This proof-of-concept, open label clinical trial without randomisation was conducted at the Pulmonary Department of Ziauddin Hospital and University, Karachi from January 2018 to March 2018. Patients discharged after in-hospital treatment for exacerbations of either asthma or COPD were recruited for this study. Intramuscular injection of methylprednisolone was administered to these patients who were then followed-up after one week and one month. During that period, information was collected of the patients' self-report of any unscheduled emergency room visit, blood sugar and blood pressure control, symptoms suggestive of thrush, increase gastric acidity and weight gain. For the data analysis, frequency and percentages were calculated with SPSS version 21. RESULTS A total of 30 patients aged 52.83 ± 14.27 years were recruited for this pilot study. At one month follow-up, no unscheduled emergency room visits were observed in all of the study patients. Symptoms suggestive of oral thrush were recorded in only 2 (6.7%) patients and weight gain was reported by only 5 (16.7%). Controlled blood sugar and blood pressure was reported by all the patients. No incidence of nocturnal symptoms, awakening and dyspepsia were reported. CONCLUSIONS A single dose of methylprednisolone injection without any obvious side effects over one month among patients with asthma and COPD demonstrated a safe strategy for them.
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Affiliation(s)
| | - Fatima Zaina
- Dr. Ziauddin University and Hospital, Karachi, Pakistan
| | | | - Maria Zahid
- Dr. Ziauddin University and Hospital, Karachi, Pakistan
| | - Syed Zia Ullah
- National Institute of Cardiovascular Diseases, Karachi, Pakistan
| | | | - Musa Karim
- National Institute of Cardiovascular Diseases, Karachi, Pakistan
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Zhao C, Jia Y, Jia Z, Xiao X, Luo F. Pre-emptive scalp infiltration with ropivacaine plus methylprednisolone versus ropivacaine alone for relief of postoperative pain after craniotomy in children (RP/MP vs RP): a study protocol for a randomised controlled trial. BMJ Open 2019; 9:e027864. [PMID: 31230016 PMCID: PMC6596953 DOI: 10.1136/bmjopen-2018-027864] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
INTRODUCTION Pre-emptive scalp infiltration with local anaesthetics is the simplest and most effective method to prevent postoperative incisional pain. However, local infiltration of an anaesthetic only provides relatively short-term pain relief. Methylprednisolone (MP) treatment, administered as an adjuvant at the wound site, has been shown to provide satisfactory pain management after lumbar laminectomy. However, there is no evidence regarding the efficacy of MP infiltration for the relief of postoperative pain after craniotomy. Currently, postoperative pain after craniotomy in children is undertreated. Therefore, we aim to investigate whether pre-emptive scalp infiltration with ropivacaine (RP) plus MP is superior to RP alone to improve postoperative pain after craniotomy in children. METHODS AND ANALYSIS The RP/MP versus RP trial is a prospective, single-centre, randomised, parallel-group study of 100 children aged 8-18 years undergoing intracranial surgery. Participants will be randomly allocated to receive pre-emptive scalp infiltration with either RP plus MP or RP alone. The primary outcome will be the cumulative fentanyl dose administered by patient-controlled intravenous analgesia within 24 hours postoperatively. The secondary outcomes will include postoperative Numerical Rating Scale scores, pain control satisfaction scores, length of stay and adverse events. Data will be analysed by the intention-to-treat principle. ETHICAL APPROVAL AND DISSEMINATION The study protocol has been approved by the Institutional Review Board of Beijing Tiantan Hospital Affiliated to Capital Medical University (Approval Number: KY 2018-066-02). The results will be disseminated in international academic meetings and published in peer-reviewed journals. TRIAL REGISTRATION NUMBER NCT03636165; Pre-results.
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Affiliation(s)
- Chunmei Zhao
- Department of Anesthesiology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Yitong Jia
- Department of Anesthesiology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Zipu Jia
- Department of Anesthesiology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Xiong Xiao
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Fang Luo
- Department of Pain Management, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
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Abstract
OBJECTIVE To test the safety of ublituximab, a B cell depleting agent, as add-on therapy in the acute treatment of relapses of neuromyelitis optica spectrum disorder. METHODS We conducted an open-label phase 1b safety and proof-of-concept trial in 5 subjects with aquaporin-4 (AQP4)-immunoglobulin G (IgG) seropositive neuromyelitis optica spectrum disorder (NMOSD) who presented with acute transverse myelitis and/or optic neuritis. In addition to treating with 1 g of daily intravenous methylprednisolone, we infused a single dose of 450 mg of ublituximab within 5 days of relapse onset. The primary outcome measure was safety, and the secondary efficacy measures included change in Expanded Disability Status Scale (EDSS), durability of remission and B cell counts. RESULTS Five NMOSD subjects were enrolled, 4 of whom presented with acute transverse myelitis and 1 with acute optic neuritis. Ublituximab proved to be safe in all 5 NMOSD subjects, with no serious adverse events recorded. There were no opportunistic infections in any of the subjects; however, 1 subject experienced a transient leukopenia. EDSS scores dropped from a median of 6.5 on admission to 4.0 on 90-day follow up. Two subjects did not achieve total B cell depletion and relapsed within 3 months. CONCLUSIONS Ublituximab is a safe add-on therapy for NMOSD patients presenting with acute transverse myelitis and optic neuritis. Preliminary evidence suggests a promising benefit on durability of remission when B cell depletion is achieved. A placebo-controlled trial is necessary to confirm these findings. CLASSIFICATION OF EVIDENCE This study provides Class IV evidence that for patients with NMOSD with acute transverse myelitis or optic neuritis, ublituximab is safe and may improve neurological outcome.
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Affiliation(s)
- Maureen A Mealy
- Department of Neurology, Johns Hopkins University, Baltimore, Maryland
| | - Michael Levy
- Department of Neurology, Johns Hopkins University, Baltimore, Maryland
- Department of Neurology, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts
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Son B, Park HS, Han HS, Kim HK, Baek SW, Yang Y, Lee KH, Kwon J. A Case of Acquired Amegakaryocytic Thrombocytopenia with Anti-c-mpl Autoantibody: Comparison with Idiopathic Thrombocytopenic Purpura. Acta Haematol 2019; 142:239-243. [PMID: 31132762 DOI: 10.1159/000499523] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2018] [Accepted: 03/12/2019] [Indexed: 11/19/2022]
Abstract
Acquired amegakaryocytic thrombocytopenia (AAMT) is a rare disease that causes severe bleeding. The pathogenesis and treatment of AAMT have not yet been defined. We report the case of a 60-year-old woman diagnosed with AAMT, who presented with severe thrombocytopenia, gastroin-testinal bleeding, and significantly reduced bone marrow megakaryocytes. The patient was treated with methylprednisolone, cyclosporin, and intravenous immunoglobulin. After 2 weeks of treatment, her platelet count started to increase, and her bone marrow megakaryocyte count had normalized 3 months after diagnosis. At the time of diagnosis, the patient was seropositive for anti-c-mpl antibody but was seen to be seronegative once the platelet count recovered. In contrast, anti-c-mpl antibodies were not detected in the serum of 3 patients with idiopathic thrombocytopenic purpura. This case study suggests that anti-c-mpl antibody plays an important role in the development of AAMT, and that intensive immunosuppressive treatment is required for autoantibody clearance and recovery of megakaryocyte count.
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Affiliation(s)
- Bora Son
- Department of Laboratory Medicine, Chungbuk National University Hospital, Cheongju, Republic of Korea
- Department of Laboratory Medicine, Chungbuk National University College of Medicine, Cheongju, Republic of Korea
| | - Hee Sue Park
- Department of Laboratory Medicine, Chungbuk National University Hospital, Cheongju, Republic of Korea
- Department of Laboratory Medicine, Chungbuk National University College of Medicine, Cheongju, Republic of Korea
| | - Hye Sook Han
- Department of Internal Medicine, Chungbuk National University Hospital, Cheongju, Republic of Korea
- Department of Internal Medicine, Chungbuk National University College of Medicine, Cheongju, Republic of Korea
| | - Hee Kyung Kim
- Department of Internal Medicine, Chungbuk National University Hospital, Cheongju, Republic of Korea
- Department of Internal Medicine, Chungbuk National University College of Medicine, Cheongju, Republic of Korea
| | - Seung Woo Baek
- Department of Internal Medicine, Chungbuk National University Hospital, Cheongju, Republic of Korea
- Department of Internal Medicine, Chungbuk National University College of Medicine, Cheongju, Republic of Korea
| | - Yaewon Yang
- Department of Internal Medicine, Chungbuk National University Hospital, Cheongju, Republic of Korea
- Department of Internal Medicine, Chungbuk National University College of Medicine, Cheongju, Republic of Korea
| | - Ki Hyeong Lee
- Department of Internal Medicine, Chungbuk National University Hospital, Cheongju, Republic of Korea
- Department of Internal Medicine, Chungbuk National University College of Medicine, Cheongju, Republic of Korea
| | - Jihyun Kwon
- Department of Internal Medicine, Chungbuk National University Hospital, Cheongju, Republic of Korea,
- Department of Internal Medicine, Chungbuk National University College of Medicine, Cheongju, Republic of Korea,
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Suzuki Y, Fukushima T, Iwasawa T, Nakamura G, Nanasawa S, Makino K. [Case report of acute encephalopathy caused by enterohemorrhagic Escherichia coli infection in a 24-year-old woman]. Rinsho Shinkeigaku 2019; 59:274-278. [PMID: 31061306 DOI: 10.5692/clinicalneurol.cn-001291] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Hemolytic uremic syndrome (HUS) and acute encephalopathy caused by enterohemorrhagic Escherichia coli infection occur commonly in children, whereas adult-onset disease is rare. Here we report the case of a 24-year-old woman who developed acute encephalopathy and recovered without sequelae. She initially developed abdominal pain and diarrhea. On day 6, O-157 Shiga toxin was detected in her stool and she developed HUS. On day 11, acute encephalopathy developed and she required artificial ventilation. She was treated with steroid pulse therapy and plasma exchange (PE) and then discharged on day 53 without any sequelae. Globotriaosylceramide, a Shiga toxin receptor, is more frequently present on the cellular membranes of women than on those of men. Therefore, it is conceivable that adult women are at a higher risk of developing acute encephalopathy than men. Steroid pulse therapy and PE may effectively treat acute encephalopathy by reducing inflammatory cytokine levels in the blood; therefore, these treatments should be proactively considered.
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Affiliation(s)
- Yuya Suzuki
- Department of Neurology, Niigata Prefectural Shibata Hospital
| | - Takao Fukushima
- Department of Neurology, Niigata Prefectural Shibata Hospital
| | - Takahiro Iwasawa
- Department of Gastroenterology, Niigata Prefectural Shibata Hospital
| | - Gen Nakamura
- Department of Nephrology, Niigata Prefectural Shibata Hospital
| | | | - Kunihiko Makino
- Department of Neurology, Niigata Prefectural Shibata Hospital
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Wada T, Kitaguchi H, Shindo K. [Primary angiitis of the central nervous system with cerebral infarction and spinal hemorrhage]. Rinsho Shinkeigaku 2019; 59:268-273. [PMID: 31061305 DOI: 10.5692/clinicalneurol.cn-001288] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
A 61-year-old woman presented with acute intense lower back pain and weakness in her left leg. She also presented with throbbing headache on the same day. On admission, muscle weakness in her left leg, lower left quadrantanopia and left lower extremity deep sensory disturbance were observed. Laboratory data showed no coagulopathy and autoimmune antibody was negative. Cerebrospinal fluid examination showed bloody and inflammatory findings. Brain MRI revealed cerebral infarction with multiple intracranial arterial stenosis and convexal subarachnoid hemorrhage. Spinal MRI revealed spinal hemorrhage in the cervical, thoracic, and part of the lumbar spine. Because these lesions occurred simultaneously, we made a diagnosis of vasculitis. After high dose corticosteroids therapy was undertaken, the multiple arterial stenosis improved. Primary angiitis of the central nervous system is sometimes difficult to distinguish from reversible cerebral vasoconstriction syndrome in its initial stage; although symptoms, examination findings and treatment differ in both.
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Santopietro M, Miano M, Palumbo G, Zhang K, Cardarelli L, Chiaretti S, Peragine N, Nanni M, Diverio D, Mancini F, Testi AM, Moleti ML, Foà R, Giona F. Atypical Chronic Myeloid Leukemia in a Patient with Aplastic Anemia. Acta Haematol 2019; 142:185-186. [PMID: 31112981 DOI: 10.1159/000497137] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2018] [Accepted: 01/19/2019] [Indexed: 11/19/2022]
MESH Headings
- Adolescent
- Anemia, Aplastic/diagnosis
- Anemia, Aplastic/drug therapy
- Anemia, Aplastic/genetics
- Antilymphocyte Serum/administration & dosage
- Antineoplastic Combined Chemotherapy Protocols/administration & dosage
- Cyclosporine/administration & dosage
- Cytarabine/administration & dosage
- Etoposide/administration & dosage
- Fatal Outcome
- Granulocyte Colony-Stimulating Factor/administration & dosage
- Humans
- Imidazoles/administration & dosage
- Leukemia, Myelogenous, Chronic, BCR-ABL Positive/diagnosis
- Leukemia, Myelogenous, Chronic, BCR-ABL Positive/drug therapy
- Leukemia, Myelogenous, Chronic, BCR-ABL Positive/genetics
- Male
- Methylprednisolone/administration & dosage
- Prednisolone/administration & dosage
- Pyridazines/administration & dosage
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Affiliation(s)
- Michelina Santopietro
- Hematology, Department of Translational and Precision Medicine, Sapienza University of Rome, Rome, Italy,
| | - Maurizio Miano
- Hematology Unit, IRCCS-Istituto Giannina Gaslini, Genoa, Italy
| | - Giovanna Palumbo
- Hematology, Department of Translational and Precision Medicine, Sapienza University of Rome, Rome, Italy
| | - Kejian Zhang
- Division of Human Genetics, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - Luisa Cardarelli
- Hematology, Department of Translational and Precision Medicine, Sapienza University of Rome, Rome, Italy
| | - Sabina Chiaretti
- Hematology, Department of Translational and Precision Medicine, Sapienza University of Rome, Rome, Italy
| | - Nadia Peragine
- Hematology, Department of Translational and Precision Medicine, Sapienza University of Rome, Rome, Italy
| | - Mauro Nanni
- Hematology, Department of Translational and Precision Medicine, Sapienza University of Rome, Rome, Italy
| | - Daniela Diverio
- Hematology, Department of Translational and Precision Medicine, Sapienza University of Rome, Rome, Italy
| | - Francesca Mancini
- Hematology, Department of Translational and Precision Medicine, Sapienza University of Rome, Rome, Italy
| | - Anna Maria Testi
- Hematology, Department of Translational and Precision Medicine, Sapienza University of Rome, Rome, Italy
| | - Maria Luisa Moleti
- Hematology, Department of Translational and Precision Medicine, Sapienza University of Rome, Rome, Italy
| | - Robin Foà
- Hematology, Department of Translational and Precision Medicine, Sapienza University of Rome, Rome, Italy
| | - Fiorina Giona
- Hematology, Department of Translational and Precision Medicine, Sapienza University of Rome, Rome, Italy
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Saito H, Tanaka K, Fujiwara M, Iwasaki T, Numata T, Oda A, Kanno M, Tanaka M, Eiro M, Satoh M, Kazama JJ. Pathological findings of progressive renal involvement in a patient with TAFRO syndrome. CEN Case Rep 2019; 8:239-245. [PMID: 31077056 DOI: 10.1007/s13730-019-00400-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2019] [Accepted: 04/25/2019] [Indexed: 12/26/2022] Open
Abstract
TAFRO syndrome (thrombocytopenia, anasarca, fever, reticulin fibrosis, and organomegaly) is thought of as an atypical type of idiopathic multicentric Castleman's disease. Interleukin-6, vascular endothelial growth factor (VEGF), and other cytokines are considered etiological factors. A 45-year-old woman was admitted to hospital with unknown fever and abdominal pain. She had thrombocytopenia, anasarca, proteinuria/hematuria, and slight hepatosplenomegaly. Based on her clinical course and laboratory data, she was diagnosed as having TAFRO syndrome. Kidney biopsy showed a membranoproliferative glomerulonephritis (MPGN)-like lesion containing lobulations of glomeruli, endothelial cell swelling, double contours of the glomerular basement membrane, and mesangiolysis. She was treated with methylprednisolone pulse (500 mg/day) and oral prednisolone (60 mg/day) therapy. The pleural effusion and ascites disappeared, and renal function normalized. Cyclosporine was added to prevent relapse. She went home, with no relapse 8 months after hospitalization. MPGN-like lesions were found frequently in patients with TAFRO syndrome in recent reports. However, there are few reports of pathologically confirmed cases of progressive renal involvement in TAFRO syndrome. The relationship between VEGF expression in renal tissue and the pathogenesis of renal injury in TAFRO syndrome was investigated in the present case.
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Affiliation(s)
- Hirotaka Saito
- Department of Nephrology and Hypertension, Fukushima Medical University, 1, Hikarigaoka, Fukushima, Japan
| | - Kenichi Tanaka
- Department of Nephrology and Hypertension, Fukushima Medical University, 1, Hikarigaoka, Fukushima, Japan.
| | - Momoko Fujiwara
- Department of Nephrology and Hypertension, Fukushima Medical University, 1, Hikarigaoka, Fukushima, Japan
| | - Tsuyoshi Iwasaki
- Department of Nephrology and Hypertension, Fukushima Medical University, 1, Hikarigaoka, Fukushima, Japan
| | - Tokutaro Numata
- Department of Nephrology and Hypertension, Fukushima Medical University, 1, Hikarigaoka, Fukushima, Japan
| | - Akira Oda
- Department of Nephrology and Hypertension, Fukushima Medical University, 1, Hikarigaoka, Fukushima, Japan
| | - Makoto Kanno
- Department of Nephrology and Hypertension, Fukushima Medical University, 1, Hikarigaoka, Fukushima, Japan
| | - Mizuko Tanaka
- Department of Basic Pathology, Fukushima Medical University, Fukushima, Japan
| | - Masaaki Eiro
- Department of Nephrology, Ohta Nishinouchi Hospital, Koriyama, Japan
| | - Mamoru Satoh
- Department of Nephrology, Ohta Nishinouchi Hospital, Koriyama, Japan
| | - Junichiro James Kazama
- Department of Nephrology and Hypertension, Fukushima Medical University, 1, Hikarigaoka, Fukushima, Japan
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Lin CW, Lin IH, Chen TC, Jou JR, Woung LC. Clinical Course and Treatment Response of Neuromyelitis Optica Spectrum Disease: An 8-Year Experience. Asia Pac J Ophthalmol (Phila) 2019; 8:206-210. [PMID: 30421588 DOI: 10.22608/apo.2018247] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
PURPOSE To report the clinical course and treatment response in a cohort of patients with neuromyelitis optica spectrum disorder (NMOSD) from a single referral center in Taiwan. DESIGN Case series. METHODS All NMOSD patients who received treatment and follow-up checks at National Taiwan University Hospital for at least 2 years between January 2008 and December 2016 were recruited. Demographic data and detailed characteristics of clinical course including acute episodes, maintenance therapies, and visual outcome were collected. Patients were examined every 6 months and during each episode of relapse. RESULTS A total of 96 patients were identified; of them, 68 (70.8%) had optic neuritis. Optic neuritis was the initial presentation of NMOSD in 44 patients. Among the patients with optic neuritis, 32.4% had recurrent optic neuritis within 1 year from the first episode. Compared with the group without optic neuritis, the group with optic neuritis had a younger age of presentation (34.4 ± 15.9 vs 42.4 ± 14.8 years, P = 0.02) and a higher 1-year recurrence rate (64.7% vs 17.9%, P < 0.001). Among the patients with optic neuritis, 51.5% had a final visual acuity of worse than 20/200. Multiple regression analysis showed that the presence of aquaporin-4-IgG antibodies and poor initial visual acuity were the risk factors for worse visual outcome. CONCLUSIONS In this study, patients with optic neuritis were younger and had a higher 1-year recurrence rate. Despite using steroid therapy during the acute phase and immunosuppressive agents as long-term treatment, visual prognosis was poor. Aquaporin-4-IgG antibodies and initial visual acuity were associated with final visual outcome.
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Affiliation(s)
- Chao-Wen Lin
- Department of Ophthalmology, National Taiwan University Hospital, Taipei, Taiwan
| | - I-Hung Lin
- Department of Ophthalmology, Tri-Service General Hospital, Taipei, Taiwan
| | - Ta-Ching Chen
- Department of Ophthalmology, National Taiwan University Hospital, Taipei, Taiwan
| | - Jieh-Ren Jou
- Department of Ophthalmology, National Taiwan University Hospital, Taipei, Taiwan
- Department of Ophthalmology, Changhua Christian Hospital, Changhua, Taiwan
| | - Lin-Chung Woung
- Department of Ophthalmology, Taipei City Hospital, Taipei, Taiwan
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Rymuza J, Popow M, Żurecka Z, Przedlacki J, Bednarczuk T, Miśkiewicz P. Therapy of moderate-to-severe Graves' orbitopathy with intravenous methylprednisolone pulses is not associated with loss of bone mineral density. Endocrine 2019; 64:308-315. [PMID: 30506426 PMCID: PMC6531386 DOI: 10.1007/s12020-018-1823-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2018] [Accepted: 11/21/2018] [Indexed: 12/13/2022]
Abstract
PURPOSE To evaluate the influence of intravenous methylprednisolone (IVMP) pulse administration on bone mineral density (BMD) of the lumbar spine and the femoral neck in patients with moderate-to-severe Graves' orbitopathy (GO). METHODS Thirty-five patients with GO in euthyreosis were treated with 12 IVMP pulses (6 × 0.5 g, 6 × 0.25 g on a weekly schedule). Supplementation with 1.0 g of calcium and 800 IU of vitamin D was initiated in all patients before beginning therapy. BMD of the lumbar spine (L1-L4) and the femoral neck were assessed at baseline and after the last IVMP pulse using dual-energy X-ray absorptiometry. To determine differences in BMD between values at baseline and after treatment, we used the least significant change (LSC) methodology. LSC values were calculated to be 3 and 5% for the lumbar spine and the femoral neck, respectively. Change in BMD equal to or exceeding the LSC was assessed as either increase or decrease of BMD. We then compared pre-treatment and post-treatment mean BMD values at the lumbar spine and the femoral neck. RESULTS We did not observe a decrease of BMD at any site equal to or exceeding the LSC. We found an increase of BMD in at least one measurement site equal to or exceeding the LSC value in 43% of patients, mostly in the lumbar spine (31%). Mean femoral neck BMD did not change while mean lumbar BMD increased. CONCLUSIONS IVMP given in weekly intravenous pulses does not lead to loss of BMD of the lumbar spine and the femoral neck.
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Affiliation(s)
- Joanna Rymuza
- Department of Internal Medicine and Endocrinology, Medical University of Warsaw, Banacha 1a, 02-097, Warsaw, Poland
| | - Michał Popow
- Department of Internal Medicine and Endocrinology, Medical University of Warsaw, Banacha 1a, 02-097, Warsaw, Poland
| | - Zuzanna Żurecka
- Department of Internal Medicine and Endocrinology, Medical University of Warsaw, Banacha 1a, 02-097, Warsaw, Poland
| | - Jerzy Przedlacki
- Department of Nephrology, Dialysis and Internal Medicine, Medical University of Warsaw, Banacha 1a, 02-097, Warsaw, Poland
| | - Tomasz Bednarczuk
- Department of Internal Medicine and Endocrinology, Medical University of Warsaw, Banacha 1a, 02-097, Warsaw, Poland
| | - Piotr Miśkiewicz
- Department of Internal Medicine and Endocrinology, Medical University of Warsaw, Banacha 1a, 02-097, Warsaw, Poland.
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Abstract
RATIONALE Anti-IgLON5 disease is a complex neurological illness which is characterized by progressive sleep and movement disorders and defined by specific autoantibodies to IgLON5. We here describe the first case of a patient with coexisting anti-IgLON5 as well as anti-γ-aminobutyric acid B (GABAB)-receptor antibodies and predominant clinical features of anti-IgLON5 disease. PATIENT CONCERNS The patient initially presented with subacute symptoms of severe sleep disorder, gait stability, dysarthria, cognitive impairment, depressive episode and hallucinations. DIAGNOSES The patient was diagnosed with autoimmune encephalitis, based on clinical features and positive anti-IgLON5 antibodies in serum as well as in cerebrospinal fluid and anti-GABAB-receptor antibodies in serum only. INTERVENTIONS Initially, the patient was treated with high dosages of methylprednisolone and subsequently with plasmapheresis. Due to the lack of clinical improvement immunosuppressive treatment with intravenous cyclophosphamide was initiated. OUTCOMES Following the first year of cyclophosphamide treatment, neurological examination revealed an improvement in gait instability, visual and acoustic hallucinations and sleep disorder. LESSONS The case report demonstrates that anti-IgLON5 and anti-GABAB-receptor antibodies can coexist in the same patient whereas clinical leading symptoms are determined by those antibodies that were tested positive in cerebrospinal fluid.
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Widjaja FF, Martina D, Lardo S, Wibowo SAK. Adult-onset Still's Disease as a Differential Diagnosis in Prolonged Fever: Diagnosis and Treatment Experience. Acta Med Indones 2019; 51:158-164. [PMID: 31383831] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Adult onset Still's disease is a rare systemic disease that may involve many organs and may mimick many disease such as infection, autoimmune disease, and also malignancy. The diagnostic approach and treatment strategies have not been well established due to its rarity; however, there are some diagnostic criteria that may help. We present a case of 36-year old man who experienced high prolonged fever which firstly thought as infection. He also had unilateral wrist and knee joint pain and maculopapular rash. Laboratory examination showed high leukocytes count with elevated polymorphonuclear neutrophil count, high platelet count, high ferritin level, and negative results of many infection markers (typhoid antibody, procalcitonin, malaria test, blood culture, urine culture, IgM pneumonia, ASTO, syphilis test, antiHIV, HBsAg, antiHCV, etc). Chest X-ray, joint X-ray, ultrasonography, and echocardiography showed normal result. The patient was then diagnosed with Adult-onset Still's disease and received intravenous methylprednisolone and the fever was disappeared in 3 days. Six months later the arthralgia appeared again, methotrexate was administered and the pain was then relieved.
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Affiliation(s)
- Felix F Widjaja
- Department of Internal Medicine, Faculty of Medicine Universitas Indonesia - Cipto Mangunkusumo Hospital, Jakarta, Indonesia.
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Abstract
Immunotherapy has changed the field of oncology around the world with the approval of immune checkpoint inhibitors for a number of tumor types over the last 5 years. However, immune-mediated adverse events can be challenging and difficult to treat, with one of the most dire consequences being immune-mediated pneumonitis. KEY POINTS: Rapid intervention and aggressive management for grade 3 or greater pneumonitisSlow taper of steroids and also recommend pneumocystis carinii pneumonia prophylaxisMonitor carefully for a pneumonitis flare with steroid taper, which can occur in the absence of resuming anti-programmed cell death protein 1 (PD-1) [1], and do not resume anti-PD-1 therapy until completely off steroids and no clinical or radiologic evidence of recurrenceConsider observation without anti-PD-1 resumption-in this case, durable response was maintained even without resuming anti-PD-1 therapy.
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Affiliation(s)
- Vanessa A Reed
- Columbia University Medical Center, New York New York, USA
| | - Naiyer Rizvi
- Columbia University Medical Center, New York New York, USA
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125
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Magri G, Selmin F, Cilurzo F, Fotaki N. Biorelevant release testing of biodegradable microspheres intended for intra-articular administration. Eur J Pharm Biopharm 2019; 139:115-122. [PMID: 30905777 DOI: 10.1016/j.ejpb.2019.03.019] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2018] [Revised: 02/28/2019] [Accepted: 03/21/2019] [Indexed: 01/08/2023]
Abstract
Characterization of controlled release formulations used for intra-articular (IA) drug administration is challenging. Bio-relevant synovial fluids (BSF), containing physiologically relevant amounts of hyaluronic acid, phospholipids and proteins, were recently proposed to simulate healthy and osteoarthritic conditions. This work aims to evaluate the performance of different controlled release formulations of methylprednisolone (MP) for IA administration, under healthy and disease states simulated conditions. Microspheres differed in grade of poly(lactide-co-glycolide) and in the theoretical drug content (i.e. 23 or 30% w/w). Their performance was compared with the commercially available suspension of MP acetate (MPA). Under osteoarthritic state simulated condition, proteins increased the MPA release and reduced the MPA hydrolysis rate, over 48 h. Regarding microspheres, the release patterns over 40 days were significantly influenced by the composition of BSF. The pattern of the release mechanism and the amount released was affected by the presence of proteins. Protein concentration affected the release and the concentration used is critical, particularly given the relevance of the concentrations to target patient populations, i.e. patients with osteoarthritis.
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Affiliation(s)
- Giulia Magri
- Department of Pharmaceutical Sciences, Università degli Studi di Milano, Milano, Italy
| | - Francesca Selmin
- Department of Pharmaceutical Sciences, Università degli Studi di Milano, Milano, Italy
| | - Francesco Cilurzo
- Department of Pharmaceutical Sciences, Università degli Studi di Milano, Milano, Italy
| | - Nikoletta Fotaki
- Department of Pharmacy and Pharmacology, University of Bath, Bath, UK.
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Huang J, Guo J, Li H, Huang W, Zhang T. Efficacy and safety of adjunctive corticosteroids therapy for patients with severe community-acquired pneumonia: A systematic review and meta-analysis. Medicine (Baltimore) 2019; 98:e14636. [PMID: 30921179 PMCID: PMC6456091 DOI: 10.1097/md.0000000000014636] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND The systemic use of corticosteroids for patients in severe community-acquired pneumonia (CAP) remains disputed in clinical practice. We undertook a systematic review and meta-analysis to assess the efficacy and safety of corticosteroids in patients with severe CAP. METHODS We searched MEDLINE (1946 to June 2018), EMBASE (1966 to June 2018), and the Cochrane Library database for randomized controlled trials (RCTs) conducted for severe CAP. The endpoints of the study included total mortality, length of intensive care unit (ICU) stay and mechanical ventilation. RESULTS Nine trials which contained 914 patients were included for final meta-analysis. Of the 488 patients in the corticosteroid group, there were 37 deaths (7.58%) and 56 deaths occurred in 426 patients in the control group (13.1%). Corticosteroid therapy was associated with a lower rate of all-cause mortality compared to control (odd ratio [OR] 0.63, 95% confidence interval [CI] 0.42-0.95, P = .03). Subgroup analysis was conducted to show that the drug type modified the effect of steroids for mortality rate: prednisolone or methylprednisolone therapy (OR 0.37, 95% CI 0.19-0.72) reduced total mortality, whereas hydrocortisone use did not (OR 0.90, 95% CI 0.54-1.49). We found the length of ICU stay was significantly shorter in the steroid group compared to control (MD -2.52 days, 95% CI -4.88 to -0.15; P = .04). And there was a reduction trend in the need for mechanical ventilation in corticosteroid group (OR 0.53, 95% CI 0.28-1.02; P = .06). There was no trend towards more adverse events in the corticosteroid arm compared to control (OR 0.92, 95% CI 0.58-1.47; P = .74). CONCLUSION Overall, adjunctive systemic corticosteroids therapy was effective and safe for patients with severe CAP. In addition, the effects of mortality may differ according to the type of corticosteroids.
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Affiliation(s)
- Jing Huang
- Department of Respiratory Medicine, The Third Affiliated Hospital of Sun Yat-sen University
- Institute of Respiratory Diseases, Sun Yat-sen University
| | - Jiquan Guo
- Department of Respiratory Medicine, Guangdong General Hospital, Guangzhou, China
| | - Hongtao Li
- Department of Respiratory Medicine, The Third Affiliated Hospital of Sun Yat-sen University
- Institute of Respiratory Diseases, Sun Yat-sen University
| | - Weibin Huang
- Department of Respiratory Medicine, The Third Affiliated Hospital of Sun Yat-sen University
- Institute of Respiratory Diseases, Sun Yat-sen University
| | - Tiantuo Zhang
- Department of Respiratory Medicine, The Third Affiliated Hospital of Sun Yat-sen University
- Institute of Respiratory Diseases, Sun Yat-sen University
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Chen K, Wen L, Zong L, Liu M, Sun J, Wu X. Audiological outcomes in sudden sensorineural hearing loss with presumed inner ear hemorrhage. Am J Otolaryngol 2019; 40:274-278. [PMID: 30473168 DOI: 10.1016/j.amjoto.2018.09.017] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2018] [Revised: 09/23/2018] [Accepted: 09/25/2018] [Indexed: 11/27/2022]
Abstract
OBJECTIVE To explore the hearing outcomes and prognostic factors in patients with sudden sensorineural hearing loss resulting from inner ear hemorrhage. METHODS 42 patients (22 male and 20 female) were recruited from January 2016 to December 2017. Intravenous methylprednisolone and/or intratympanic corticosteroid were used as salvage therapy. The main measures included systemic risk factors and audiometric outcomes as proposed by American Academy of Otolaryngology-Head and Neck Surgery Hearing Loss Scale. All individuals were assessed at baseline, discharge (2 weeks post-treatment) and at 1, 3 and 6 months. RESULTS The mean ages of patients were 39.3 ± 14.8 yrs. Cardiovascular disorders were seen in 19.0-33.3% of cases. Restoration of hearing and speech discrimination abilities were assessed at the first month post-treatment versus initial levels (95.5 ± 15.5 vs. 109.2 ± 9.6 dB, p = 0.000; and 17.6 ± 24.4 vs. 1.3 ± 4.0%, p = 0.003, respectively). Word recognition scores continued to recover at month 6 (38.7 ± 35.4%, p = 0.000), whereas puretone ceased to change (90.8 ± 16.2 dB, p = 0.139). The final percentages of complete, partial and no recovery were 0%, 57.1% and 42.9% respectively. The prognosis was independent of accompanying systemic risk factors as analyzed in this study. Intratympanic intervention was associated with improved word recognition scores, although intravenous corticosteroid was not. CONCLUSIONS Profound sudden sensorineural hearing loss caused by inner ear hemorrhage often has an unsatisfactory prognosis. However, this cohort did experience partial audiological recovery with delayed onset. Immediate and effective intratympanic corticosteroid may have therapeutic potential for this intractable disease.
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MESH Headings
- Adrenal Cortex Hormones/administration & dosage
- Adult
- Auditory Perception
- Cohort Studies
- Female
- Hearing
- Hearing Loss, Sensorineural/drug therapy
- Hearing Loss, Sensorineural/etiology
- Hearing Loss, Sensorineural/physiopathology
- Hearing Loss, Sensorineural/rehabilitation
- Hearing Loss, Sudden/drug therapy
- Hearing Loss, Sudden/etiology
- Hearing Loss, Sudden/physiopathology
- Hearing Loss, Sudden/rehabilitation
- Hemorrhage/complications
- Humans
- Infusions, Intravenous
- Injection, Intratympanic
- Labyrinth Diseases/complications
- Male
- Methylprednisolone/administration & dosage
- Middle Aged
- Prognosis
- Risk Factors
- Salvage Therapy
- Treatment Outcome
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Affiliation(s)
- Kaitian Chen
- Department of Otorhinolaryngology, The First Affiliated Hospital, Sun Yat-sen University and Institute of Otorhinolaryngology, Sun Yat-sen University, Guangzhou 510080, PR China
| | - Lanying Wen
- Department of Otorhinolaryngology, The First Affiliated Hospital, Sun Yat-sen University and Institute of Otorhinolaryngology, Sun Yat-sen University, Guangzhou 510080, PR China
| | - Ling Zong
- Department of Otorhinolaryngology, The Second Affiliated Hospital of Guangzhou Medical University, Guangzhou 510260, PR China
| | - Min Liu
- Department of Otorhinolaryngology, The First Affiliated Hospital, Sun Yat-sen University and Institute of Otorhinolaryngology, Sun Yat-sen University, Guangzhou 510080, PR China
| | - Jincangjian Sun
- Department of Otorhinolaryngology, The First Affiliated Hospital, Sun Yat-sen University and Institute of Otorhinolaryngology, Sun Yat-sen University, Guangzhou 510080, PR China
| | - Xuan Wu
- Department of Otorhinolaryngology, The First Affiliated Hospital, Sun Yat-sen University and Institute of Otorhinolaryngology, Sun Yat-sen University, Guangzhou 510080, PR China.
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128
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Ikawa F, Sumi N, Nishikawa T, Maruyama H, Miyachi T. [A case of dementia with Lewy bodies and Hashimoto encephalopathy successfully treated with immunotherapy]. Rinsho Shinkeigaku 2019; 59:102-104. [PMID: 30700687 DOI: 10.5692/clinicalneurol.cn-001204] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
We report a 77-year-old woman suffering from dementia with Lewy bodies (DLB) who presented with Hashimoto encephalopathy. The patient began to mistakenly believe that another person was sleeping in her bed from approximately 70 years of age. She began to show symptoms of parkinsonism after 75 years of age. One night, the patient began to exhibit loitering behavior, and made incomprehensible comments while also exhibiting other abnormal behaviors. Clinical examination revealed rigidity and tremor of the limbs, as well as hallucination, abnormal speech and behavior. We first considered DLB. However, serum anti-thyroglobulin levels turned out to be elevated, indicating Hashimoto encephalopathy as well, and treated the patient with steroid pulse therapy. Her mental symptoms subsequently improved, but rigidity and tremor remained. 123I-ioflupane SPECT demonstrated decreased accumulation in the bilateral caudal basal ganglia. Anti NH2-terminal of α-enolase (NAE) antibody in the serum was positive. Therefore, we diagnosed the patient with the rare comorbidity of DLB and Hashimoto encephalopathy, successfully treated with immunotherapy.
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Affiliation(s)
- Fumiaki Ikawa
- Department of Neurology, Yanai Medical Center, National Hospital Organization
- Present address: Department of Clinical Neuroscience and Therapeutics, Hiroshima University Graduate School of Biomedical and Health Sciences
| | - Naoko Sumi
- Department of Neurology, Yanai Medical Center, National Hospital Organization
- Present address: Department of Neurology, Hiroshima City Hospital
| | - Tomokazu Nishikawa
- Department of Neurology, Yanai Medical Center, National Hospital Organization
| | - Hirofumi Maruyama
- Department of Clinical Neuroscience and Therapeutics, Hiroshima University Graduate School of Biomedical and Health Sciences
| | - Takafumi Miyachi
- Department of Neurology, Yanai Medical Center, National Hospital Organization
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Abstract
A 61-year-old man with squamous cell lung cancer was admitted to our hospital because of consciousness disturbance after treated with pembrolizumab. Cerebrospinal fluid examination revealed increased protein level (209.2 mg/dl) and lymphocytic pleocytosis(79/μl). He was diagnosed as a meningoencephalitis probably caused by an immune-related adverse event (irAE) of immune checkpoint inhibitors (ICIs), and was successfully treated with 1,000 mg methylprednisolone intravenously for 3 days twice and the consequent oral 1 mg/kg prednisolone. As ICIs, which activate the immune systems, are becoming important choices of the treatments against malignancies, we should keep the possibility of irAE in mind and, when needed, start the treatment as soon as possible.
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130
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Miśkiewicz P, Milczarek-Banach J, Rutkowska-Hinc B, Kondracka A, Bednarczuk T. High-dose intravenous methylprednisolone therapy in patients with Graves' orbitopathy is associated with the increased activity of factor VIII. J Endocrinol Invest 2019; 42:217-225. [PMID: 29949121 PMCID: PMC6394431 DOI: 10.1007/s40618-018-0907-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2018] [Accepted: 05/25/2018] [Indexed: 01/16/2023]
Abstract
PURPOSE Venous thromboembolic events (VTE), with their life-threatening manifestation as pulmonary embolism, are potential adverse effects of intravenous methylprednisolone (IVMP) pulse therapy, partially due to a hypercoagulable state. The aim of the study was to analyze the influence of IVMP on selected hemostatic parameters in patients with moderate-to-severe Graves' orbitopathy (GO). METHODS 26 euthyroid patients with GO were treated with 12 pulses of IVMP (6 × 0.5, 6 × 0.25 g every week). Hemostatic variables [factor (F) II, FV, FVII, FVIII, fibrinogen, antithrombin, activated partial thromboplastin time (aPTT), prothrombin time, international normalized ratio of prothrombin time, platelets and D-dimer] were analysed before, 24 and 48 h after 1st, 6th and 12th pulse. RESULTS A constant, transient trend in changes of some hemostatic variables was observed after all assessed pulses. We discovered an increase in median activity of FVIII 24 and 48 h after pulses, with a shortening of aPTT 24 h after each IVMP pulse (p < 0.00005). FVII decreased 24 h after each pulse (p < 0.0005 after 1st and 12th, p < 0.00005 after 6th). Fibrinogen level decreased 48 h after each pulse (P < 0.00005). We did not observe any statistically significant changes in hemostatic parameters in the long-term evaluation. Therapy was concluded in one patient after the 9th pulse due to pulmonary embolism. CONCLUSIONS The increase of FVIII activity is a consequence of treatment with IVMP and occurs after each pulse. In patients with additional risk factors of VTE, anticoagulation prophylaxis should be considered.
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Affiliation(s)
- P Miśkiewicz
- Department of Internal Medicine and Endocrinology, Medical University of Warsaw, Banacha 1a, 02-097, Warsaw, Poland.
| | - J Milczarek-Banach
- Department of Internal Medicine and Endocrinology, Medical University of Warsaw, Banacha 1a, 02-097, Warsaw, Poland
| | - B Rutkowska-Hinc
- Department of Internal Medicine and Endocrinology, Medical University of Warsaw, Banacha 1a, 02-097, Warsaw, Poland
| | - A Kondracka
- Department of Internal Medicine and Endocrinology, Medical University of Warsaw, Banacha 1a, 02-097, Warsaw, Poland
| | - T Bednarczuk
- Department of Internal Medicine and Endocrinology, Medical University of Warsaw, Banacha 1a, 02-097, Warsaw, Poland
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131
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Hayashi K, Machida Y, Katayama Y, Yokote H, Saito K, Masumura M, Miyashita A, Kobayashi M, Toru S. [A case of antisynthetase syndrome with anti-EJ antibody complicated by pericarditis]. Rinsho Shinkeigaku 2019; 59:21-26. [PMID: 30606993 DOI: 10.5692/clinicalneurol.cn-001140] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
A 69-year-old man was admitted with neck muscle weakness, symmetric proximal muscle weakness, skin rash and elevated serum creatine kinase levels. Muscle biopsy showed perifascicular necrosis and perimysial alkaline phosphatase activity. Chest CT revealed interstitial lung disease and colorectal cancer was diagnosed on colonoscopy. He was serologically positive for anti-EJ antibody, leading to the diagnosis of antisynthetase syndrome (ASS). After laparoscopic low anterior resection of the rectum, he received intravenous methylprednisolone (1,000 mg/d for 3 days) followed by oral prednisolone (50 mg/d). Although his muscle weakness improved after corticosteroid therapy, he developed pericardial effusion with resultant asymptomatic hypotension and arrhythmia possibly due to pericarditis. Corticosteroid monotherapy was insufficient to control the disease, and, we decided to use oral cyclosporin concurrently. After this combined therapy started, pericardial effusion and arrhythmia were improved. We should keep in mind that pericarditis can occur in patients with anti-EJ antibody-positive ASS, and early combined therapy with corticosteroid and immunosuppressive drugs for ASS may improve the patient's prognosis.
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Affiliation(s)
- Kumiko Hayashi
- Department of Neurology, Nitobe Memorial Nakano General Hospital
| | - Yoko Machida
- Department of Neurology, Nitobe Memorial Nakano General Hospital
| | - Yuki Katayama
- Department of Neurology, Nitobe Memorial Nakano General Hospital
| | - Hiroaki Yokote
- Department of Neurology, Nitobe Memorial Nakano General Hospital
| | - Kazuyuki Saito
- Department of Neurology, Nitobe Memorial Nakano General Hospital
| | - Mayumi Masumura
- Department of Internal Medicine, Nitobe Memorial Nakano General Hospital
| | - Akiko Miyashita
- Department of Neurology and Neurological Science, Tokyo Medical and Dental University
| | - Masaki Kobayashi
- Department of Neurology and Neurological Science, Tokyo Medical and Dental University
- Department of Neurology, Yokufukai Hospital
| | - Shuta Toru
- Department of Neurology, Nitobe Memorial Nakano General Hospital
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132
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Hu S, Wang Y, He M, Zhang M, Ding X, Shi B. Factors associated with the efficacy of intravenous methylprednisolone in moderate-to-severe and active thyroid-associated ophthalmopathy: A single-centre retrospective study. Clin Endocrinol (Oxf) 2019; 90:175-183. [PMID: 30229982 DOI: 10.1111/cen.13855] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2018] [Revised: 09/10/2018] [Accepted: 09/13/2018] [Indexed: 12/13/2022]
Abstract
OBJECTIVE Intravenous methylprednisolone (IVMP) is recommended as the first-line treatment for moderate-to-severe and active thyroid-associated ophthalmopathy (TAO). This study aimed to identify potential predictors and establish a multivariable prediction model for the efficacy of IVMP therapy. DESIGN A single-centre retrospective study. PATIENTS A total of 302 consecutive patients diagnosed with moderate-to-severe and active TAO who underwent the full course of IVMP therapy were included. METHODS Participants were sequentially divided into the training set (n = 200) and the validation set (n = 102). Multivariate logistic regression analysis was used to identify the independent predictors and establish the predictive model. RESULTS In addition to the pretreatment clinical activity score (OR = 3.506, P < 0.001), elevated thyroid-stimulating hormone (TSH) levels during treatment (OR = 0.145, P = 0.005), pretreatment anti-TSH receptor antibody levels (OR = 0.061, P < 0.001) and duration of eye symptoms (OR = 0.878, P = 0.017), a significant relationship was found between therapeutic efficacy and the pretreatment triglyceride levels (OR = 0.090, P = 0.001). The prediction model showed good calibration and excellent discrimination, with an area under curve of 0.915 (P < 0.001) and 0.885 (P < 0.001) in the training and validation sets, respectively. CONCLUSIONS This study provides some novel insights into the factors associated with the efficacy of IVMP therapy. A multivariable prediction model has been established and validated to help determine the indication and prognosis of IVMP therapy. Moreover, several suggestions have been made in the management of TAO patients: early diagnosis and treatment (within 15 months); prompt restoration and maintenance of euthyroidism, especially meticulous control of TSH levels (≤5 μIU/mL); and regular monitoring of triglyceride levels.
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Affiliation(s)
- Shiqian Hu
- Department of Endocrinology, First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Yue Wang
- Department of Endocrinology, First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Mingqian He
- Department of Endocrinology, First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Meng Zhang
- Department of Endocrinology, First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Xi Ding
- Department of Endocrinology, First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Bingyin Shi
- Department of Endocrinology, First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
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133
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Abstract
We report a case of neuromyelitis optica (NMO) that was diagnosed at the age of 90. After initially developing visual loss in the right eye, a patient was diagnosed with optic neuritis. Although treatment with methylprednisolone therapy provided relief, 3 months later she developed optic neuritis on the other side. Visual activity recovered after further administration of methylprednisolone. At the age of 91, she presented with muscle weakness of her left extremities. A cervical MRI revealed myelitis with a longitudinally extensive spinal cord lesion from the second to fifth cervical vertebrae. Anti-AQP-4 antibody was detected in her serum. She was diagnosed with NMO and treated with methylprednisolone therapy. Subsequently, she repeatedly relapsed within a short period, developing myelitis once and optic neuritis three times within a year. However, during each hospitalization period, methylprednisolone therapy proved to be effective for relieving her symptoms. As NMO patients with onsets over 60 years of the age have been reported, medical practitioners should be aware that disease onset can occur at extremely older ages, such as 90 years old.
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Affiliation(s)
- Mai Kikumoto
- Department of Neurology, Hiroshima City Asa Citizens Hospital
| | - Megumi Nonaka
- Department of Neurology, Hiroshima City Asa Citizens Hospital
| | - Jun Takeshita
- Department of Neurology, Hiroshima City Asa Citizens Hospital
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134
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Martinez-Bayona A, Musso CG, de la Hoz L, Tolosa RG, Torres HG, Martinez GA. How do lupus glomerulonephritis and its treatment affect the renal reserve? Int Urol Nephrol 2018; 51:369-370. [PMID: 30515736 DOI: 10.1007/s11255-018-2042-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2018] [Accepted: 11/03/2018] [Indexed: 11/26/2022]
Affiliation(s)
- Alvaro Martinez-Bayona
- Human Physiology Department, Instituto Universitario del Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | | | - Lizhet de la Hoz
- Human Physiology Department, Instituto Universitario del Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - Raul Garcia Tolosa
- Human Physiology Department, Instituto Universitario del Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - Henry Gozalez Torres
- Human Physiology Department, Instituto Universitario del Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - Gustavo Aroca Martinez
- Human Physiology Department, Instituto Universitario del Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
- Universidad Simón Bolivar, Barranquilla, Colombia
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135
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Nakamagoe K, Yanagiha H, Miyake Z, Kondo Y, Hiyama T, Ishii A, Kaji Y, Oshika T, Sumida T, Tamaoka A. Monocular Oculomotor Nerve Disorder Manifesting as Cranial Neuropathy in Systemic Lupus Erythematosus. Intern Med 2018; 57:3445-3449. [PMID: 29984768 PMCID: PMC6306525 DOI: 10.2169/internalmedicine.1106-18] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
We herein report the case of a patient who developed peripheral neuropathy of the bilateral lower legs that later became complicated with isolated oculomotor nerve disorder and was finally diagnosed as systemic lupus erythematosus (SLE). Based on the findings for oculomotor nerve paralysis and contrast-enhanced magnetic resonance imaging findings for the oculomotor nerve in the prepontine cistern, the isolated oculomotor nerve disorder was considered to be a manifestation of peripheral neuropathy. This oculomotor nerve disorder may contribute to the diagnosis of SLE and can be effectively treated with steroid pulse therapy. Reports of SLE manifesting as isolated oculomotor nerve paralysis are rare.
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Affiliation(s)
- Kiyotaka Nakamagoe
- Department of Neurology, Division of Clinical Medicine, Faculty of Medicine, University of Tsukuba, Japan
| | - Hisami Yanagiha
- Department of Internal Medicine, Iwaki Kyoritsu Hospital, Japan
| | - Zenshi Miyake
- Department of Neurology, University of Tsukuba Hospital, Japan
| | - Yuya Kondo
- Department of Rheumatology, Division of Clinical Medicine, Faculty of Medicine, University of Tsukuba, Japan
| | - Takashi Hiyama
- Department of Radiology, University of Tsukuba Hospital, Japan
| | - Akiko Ishii
- Department of Neurology, Division of Clinical Medicine, Faculty of Medicine, University of Tsukuba, Japan
| | - Yuichi Kaji
- Department of Ophthalmology, Division of Clinical Medicine, Faculty of Medicine, University of Tsukuba, Japan
| | - Tetsuro Oshika
- Department of Ophthalmology, Division of Clinical Medicine, Faculty of Medicine, University of Tsukuba, Japan
| | - Takayuki Sumida
- Department of Rheumatology, Division of Clinical Medicine, Faculty of Medicine, University of Tsukuba, Japan
| | - Akira Tamaoka
- Department of Neurology, Division of Clinical Medicine, Faculty of Medicine, University of Tsukuba, Japan
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Trahan RA, Byron CR, Dahlgren LA, Pleasant RS, Werre SR. In vitro effects of three equimolar concentrations of methylprednisolone acetate, triamcinolone acetonide, and isoflupredone acetate on equine articular tissue cocultures in an inflammatory environment. Am J Vet Res 2018; 79:933-940. [PMID: 30153056 DOI: 10.2460/ajvr.79.9.933] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
OBJECTIVE To compare the effects of 3 equimolar concentrations of methylprednisolone acetate (MPA), triamcinolone acetonide (TA), and isoflupredone acetate (IPA) on equine articular tissue cocultures in an inflammatory environment. SAMPLE Synovial and osteochondral explants from the femoropatellar joints of 6 equine cadavers (age, 2 to 11 years) without evidence of musculoskeletal disease. PROCEDURES From each cadaver, synovial and osteochondral explants were harvested from 1 femoropatellar joint to create cocultures. Cocultures were incubated for 96 hours with (positive control) or without (negative control) interleukin (IL)-1β (10 ng/mL) or with IL-1β and MPA, TA, or IPA at a concentration of 10-4, 10-7, or 10-10M. Culture medium samples were collected from each coculture after 48 and 96 hours of incubation. Concentrations of prostaglandin E2, matrix metalloproteinase-13, lactate dehydrogenase, and glycosaminoglycan were determined and compared among treatments at each time. RESULTS In general, low concentrations (10-7 and 10-10M) of MPA, TA, and IPA mitigated the inflammatory and catabolic (as determined by prostaglandin E2 and matrix metalloproteinase-13 quantification, respectively) effects of IL-1β in cocultures to a greater extent than the high (10-4M) concentration. Mean culture medium lactate dehydrogenase concentration for the 10-4M IPA treatment was significantly greater than that for the positive control at both times, which was suggestive of cytotoxicosis. Mean culture medium glycosaminoglycan concentration did not differ significantly. CONCLUSIONS AND CLINICAL RELEVANCE Results indicated that the in vitro effects of IPA and MPA were similar to those of TA at clinically relevant concentrations (10-7 and 10-10M).
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Ebner DW, Hu M, Poterucha TH. 29-Year-Old Woman With Fever and Bilateral Lower Extremity Lesions. Mayo Clin Proc 2018; 93:1659-1663. [PMID: 30269942 DOI: 10.1016/j.mayocp.2018.02.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2017] [Revised: 01/29/2018] [Accepted: 02/08/2018] [Indexed: 10/28/2022]
Affiliation(s)
- Derek W Ebner
- Resident in Internal Medicine, Mayo Clinic School of Graduate Medical Education, Rochester, MN
| | - Marie Hu
- Resident in Internal Medicine, Mayo Clinic School of Graduate Medical Education, Rochester, MN
| | - Thomas H Poterucha
- Advisor to residents and Consultant in Community Internal Medicine, Mayo Clinic, Rochester, MN.
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138
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Cheng YF, Chu YC, Tu TY, Shiao AS, Wu SL, Liao WH. Modified Siegel's criteria for sudden sensorineural hearing loss: Reporting recovery outcomes with matched pretreatment hearing grades. J Chin Med Assoc 2018; 81:1008-1012. [PMID: 29929833 DOI: 10.1016/j.jcma.2018.03.012] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2018] [Revised: 02/24/2018] [Accepted: 03/14/2018] [Indexed: 10/28/2022] Open
Abstract
BACKGROUND Sudden sensorineural hearing loss (SSNHL) is an emergency clinical otology condition defined as hearing loss greater than 30 dB over three consecutive frequencies within 72 h. We aimed to integrate pretreatment hearing grades with reports of treatment recovery outcomes of SSNHL using the modified Siegel's criteria. METHODS This was a retrospective cohort study comprising 110 patients with SSNHL seen between January 2014 and January 2015. The patients were treated with combined systemic and intra-tympanic steroid therapy. The audiometric results were recorded using the modified Siegel's criteria, including pretreatment hearing grades 1-5 (grade 1: hearing threshold under 25 dB, grade 2: hearing threshold 26-45 dB, grade 3: hearing threshold 46-70 dB, grade 4: hearing threshold 71-90 dB, grade 5: hearing threshold over 90 dB) and hearing recovery outcomes, consisting of complete recovery (CR), partial recovery (PR), slight improvement (SI), no improvement (NI) or non-serviceable ears (NS). Patients were further assessed based on the treatment modality (initial or salvage treatment) and duration of the treatment delay. RESULTS Hearing improvements (CR + PR + SI) were seen in 56 patients. Patients with pretreatment hearing grade 3 had the highest improvement rate (88.2% or 30/34). Patients who received the combined steroid therapy as the initial modality had a better overall hearing improvement rate than did the salvage group. Treatment within the first 14 days yielded a better hearing improvement rate than did late treatments of more than 14 days, especially in patients with a pretreatment hearing grade of 5. CONCLUSION Using the modified Siegel's criteria, we report the hearing recovery outcomes with matched pretreatment hearing grades of patients with SSNHL treated with combined intra-tympanic steroid therapy. Our results show the prognostic significance of pretreatment hearing grades in patients with SSNHL.
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Affiliation(s)
- Yen-Fu Cheng
- Department of Otolaryngology-Head and Neck Surgery, Taipei Veterans General Hospital, Taipei, Taiwan, ROC; Department of Medical Research, Taipei Veterans General Hospital, Taipei, Taiwan, ROC; Department of Otolaryngology-Head and Neck Surgery, School of Medicine, National Yang-Ming University, Taipei, Taiwan, ROC; Department of Speech Language Pathology and Audiology, National Taipei University of Nursing and Health Sciences, Taipei, Taiwan, ROC
| | - Yuan-Chia Chu
- Information Management Office, Taipei Veterans General Hospital, Taipei, Taiwan, ROC; Graduate Institute of Biomedical Electronics &Bioinformatics, National Taiwan University, Taipei, Taiwan, ROC
| | - Tzong-Yang Tu
- Department of Otolaryngology-Head and Neck Surgery, Taipei Veterans General Hospital, Taipei, Taiwan, ROC; Department of Otolaryngology-Head and Neck Surgery, School of Medicine, National Yang-Ming University, Taipei, Taiwan, ROC
| | - An-Suey Shiao
- Department of Otolaryngology-Head and Neck Surgery, Taipei Veterans General Hospital, Taipei, Taiwan, ROC; Department of Otolaryngology-Head and Neck Surgery, School of Medicine, National Yang-Ming University, Taipei, Taiwan, ROC
| | - Shang-Liang Wu
- School of Medicine, Griffith University, Gold Coast, Australia
| | - Wen-Huei Liao
- Department of Otolaryngology-Head and Neck Surgery, Taipei Veterans General Hospital, Taipei, Taiwan, ROC; Department of Otolaryngology-Head and Neck Surgery, School of Medicine, National Yang-Ming University, Taipei, Taiwan, ROC.
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139
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Cochran BP, Kimbrough EO, Pagán RJ. 62-Year-Old Man With Fever and Pruritic Rash. Mayo Clin Proc 2018; 93:1654-1658. [PMID: 30269943 DOI: 10.1016/j.mayocp.2018.01.034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2017] [Revised: 01/26/2018] [Accepted: 01/31/2018] [Indexed: 10/28/2022]
Affiliation(s)
- Benjamin P Cochran
- Resident in Internal Medicine, Mayo Clinic School of Graduate Medical Education, Jacksonville, FL
| | - ErinMarie O Kimbrough
- Resident in Internal Medicine, Mayo Clinic School of Graduate Medical Education, Jacksonville, FL
| | - Ricardo J Pagán
- Advisor to residents and Consultant in Internal Medicine, Mayo Clinic, Jacksonville, FL.
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Nagata S, Nishimura Y, Mitsuo K. [A case of anti-myelin oligodendrocyte glycoprotein (MOG) and anti-N-methyl-D-aspartate (NMDA) receptor antibody-positive encephalitis with optic neuritis]. Rinsho Shinkeigaku 2018; 58:636-641. [PMID: 30270341 DOI: 10.5692/clinicalneurol.cn-001194] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
A 20-year-old female was hospitalized due to generalized seizure two weeks after an infection. She reported disorientation, neck stiffness and weakness in her legs. MRI FLAIR images and T2WI on her first visit to our hospital showed hyperintense lesions in the bilateral cingulate gyrus and the medial region of the superior frontal gyrus. Gadolinium (Gd)-enhanced T1WI showed enhancement in the upper part of the corpus callosum. Examination of her cerebrospinal fluid (CSF) revealed mildly elevated leucocytes. After the administration of high-dose intravenous methylprednisolone, her symptoms partially improved. However, MRI T2WI at 16 days after admission showed a lesion with a peripheral hypointense rim in the left side of the cingulate gyrus, which had ring enhancement on contrast CT. FLAIR images at 28 days after admission showed the hyperintense lesion spreading in the subcallosal area and the brainstem, and coronal short inversion time inversion recovery (STIR) images demonstrated bilateral optic neuritis. She was treated with steroid pulse therapy and plasma exchange. Thereafter her symptoms improved. The patient's CSF at 27 days after admission tested positive for anti-myelin oligodendrocyte glycoprotein (anti-MOG) antibodies and anti-N-methyl-D-aspartate (anti-NMDA) receptor antibodies. Encephalitis with optic neuritis in a patient with both anti-MOG and anti-NMDA receptor antibodies is very rare. Coexistence of multiple antibodies in the same patient may contribute to the diversity of autoimmune diseases associated with anti-MOG antibodies or anti-NMDA receptor antibodies.
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Affiliation(s)
- Satoshi Nagata
- Department of Neurology, National Hospital Organization Beppu Medical Center
| | - Yuji Nishimura
- Department of Neurology, National Hospital Organization Beppu Medical Center
| | - Kunihiko Mitsuo
- Department of Neurology, National Hospital Organization Beppu Medical Center
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141
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Chesterton LS, Blagojevic-Bucknall M, Burton C, Dziedzic KS, Davenport G, Jowett SM, Myers HL, Oppong R, Rathod-Mistry T, van der Windt DA, Hay EM, Roddy E. The clinical and cost-effectiveness of corticosteroid injection versus night splints for carpal tunnel syndrome (INSTINCTS trial): an open-label, parallel group, randomised controlled trial. Lancet 2018; 392:1423-1433. [PMID: 30343858 PMCID: PMC6196880 DOI: 10.1016/s0140-6736(18)31572-1] [Citation(s) in RCA: 59] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2018] [Revised: 06/27/2018] [Accepted: 07/03/2018] [Indexed: 11/30/2022]
Abstract
BACKGROUND To our knowledge, the comparative effectiveness of commonly used conservative treatments for carpal tunnel syndrome has not been evaluated previously in primary care. We aimed to compare the clinical and cost-effectiveness of night splints with a corticosteroid injection with regards to reducing symptoms and improving hand function in patients with mild or moderate carpal tunnel syndrome. METHODS We did this randomised, open-label, pragmatic trial in adults (≥18 years) with mild or moderate carpal tunnel syndrome recruited from 25 primary and community musculoskeletal clinics and services. Patients with a new episode of idiopathic mild or moderate carpal tunnel syndrome of at least 6 weeks' duration were eligible. We randomly assigned (1:1) patients (permutated blocks of two and four by site) with an online web or third party telephone service to receive either a single injection of 20 mg methylprednisolone acetate (from 40 mg/mL) or a night-resting splint to be worn for 6 weeks. Patients and clinicians could not be masked to the intervention. The primary outcome was the overall score of the Boston Carpal Tunnel Questionnaire (BCTQ) at 6 weeks. We used intention-to-treat analysis, with multiple imputation for missing data, which was concealed to treatment group allocation. The trial is registered with the European Clinical Trials Database, number 2013-001435-48, and ClinicalTrial.gov, number NCT02038452. FINDINGS Between April 17, 2014, and Dec 31, 2016, 234 participants were randomly assigned (118 to the night splint group and 116 to the corticosteroid injection group), of whom 212 (91%) completed the BCTQ at 6 weeks. The BCTQ score was significantly better at 6 weeks in the corticosteroid injection group (mean 2·02 [SD 0·81]) than the night splint group (2·29 [0·75]; adjusted mean difference -0·32; 95% CI -0·48 to -0·16; p=0·0001). No adverse events were reported. INTERPRETATION A single corticosteroid injection shows superior clinical effectiveness at 6 weeks compared with night-resting splints, making it the treatment of choice for rapid symptom response in mild or moderate carpal tunnel syndrome presenting in primary care. FUNDING Arthritis Research UK.
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Affiliation(s)
- Linda S Chesterton
- Arthritis Research UK Primary Care Centre, Research Institute for Primary Care and Health Sciences, Keele University, Keele, UK
| | - Milica Blagojevic-Bucknall
- Arthritis Research UK Primary Care Centre, Research Institute for Primary Care and Health Sciences, Keele University, Keele, UK
| | - Claire Burton
- Arthritis Research UK Primary Care Centre, Research Institute for Primary Care and Health Sciences, Keele University, Keele, UK
| | - Krysia S Dziedzic
- Arthritis Research UK Primary Care Centre, Research Institute for Primary Care and Health Sciences, Keele University, Keele, UK
| | - Graham Davenport
- Arthritis Research UK Primary Care Centre, Research Institute for Primary Care and Health Sciences, Keele University, Keele, UK
| | - Sue M Jowett
- Arthritis Research UK Primary Care Centre, Research Institute for Primary Care and Health Sciences, Keele University, Keele, UK; Health Economics Unit, Institute for Applied Health Research, University of Birmingham, Birmingham, UK
| | - Helen L Myers
- Arthritis Research UK Primary Care Centre, Research Institute for Primary Care and Health Sciences, Keele University, Keele, UK; Keele Clinical Trials Unit, Keele University, Keele, UK
| | - Raymond Oppong
- Arthritis Research UK Primary Care Centre, Research Institute for Primary Care and Health Sciences, Keele University, Keele, UK; Health Economics Unit, Institute for Applied Health Research, University of Birmingham, Birmingham, UK
| | - Trishna Rathod-Mistry
- Arthritis Research UK Primary Care Centre, Research Institute for Primary Care and Health Sciences, Keele University, Keele, UK
| | - Danielle A van der Windt
- Arthritis Research UK Primary Care Centre, Research Institute for Primary Care and Health Sciences, Keele University, Keele, UK
| | - Elaine M Hay
- Arthritis Research UK Primary Care Centre, Research Institute for Primary Care and Health Sciences, Keele University, Keele, UK; Haywood Academic Rheumatology Centre, Haywood Hospital, Staffordshire and Stoke-on-Trent Partnership NHS Trust, Stoke-on-Trent, UK
| | - Edward Roddy
- Arthritis Research UK Primary Care Centre, Research Institute for Primary Care and Health Sciences, Keele University, Keele, UK; Haywood Academic Rheumatology Centre, Haywood Hospital, Staffordshire and Stoke-on-Trent Partnership NHS Trust, Stoke-on-Trent, UK.
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142
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Saito A, Saito M, Shimoe Y, Yoshimoto T, Kawakami M, Okamoto H, Yoshikawa K, Kusunoki S, Kuriyama M. [Guillain-Barré syndrome associated with acute hepatitis A-A case report and literature review]. Rinsho Shinkeigaku 2018; 58:574-577. [PMID: 30175808 DOI: 10.5692/clinicalneurol.cn-001165] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
A 44-year-old female developed acute hepatitis A (HA) 5 weeks after ingesting raw oysters. She developed ascending motor weakness, bilateral peripheral facial nerve palsy, and bulbar symptoms. A diagnosis of demyelinating Guillain-Barré syndrome (GBS) was made on the basis of her clinical manifestations and the results of a nerve conduction study. The patient showed improvement following combination treatment with intravascular immunoglobulin and high dose methylprednisolone. No antibodies against specific gangliosides, sulfated glucuronyl paragloboside (SGPG), or sulfatide were detected. HA virus (HAV) RNA was isolated from her serum and its full-length genome sequence was determined. It revealed a homology of 99.9% or more with HAV genotype IA (HAV-IA) of the 2014 outbreak. No mutant virus RNA was detected.
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Affiliation(s)
- Akiko Saito
- Department of Neurology, Brain Attack Center, Ota Memorial Hospital
| | - Mineki Saito
- Department of Microbiology, Kawasaki Medical School
| | - Yutaka Shimoe
- Department of Neurology, Brain Attack Center, Ota Memorial Hospital
| | | | - Mari Kawakami
- Department of Internal Medicine, Okayama Saiseikai General Hospital
| | - Hiroaki Okamoto
- Division of Virology, Department of Infection and Immunity, Jichi Medical University School of Medicine
| | | | - Susumu Kusunoki
- Department of Neurology, KINDAI University School of Medicine
| | - Masaru Kuriyama
- Department of Neurology, Brain Attack Center, Ota Memorial Hospital
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Miskiewicz P, Milczarek-Banach J, Bednarczuk T, Opolski G, Glowczynska R. Blood Pressure Profile and N-Terminal-proBNP Dynamics in Response to Intravenous Methylprednisolone Pulse Therapy of Severe Graves' Orbitopathy. Int J Mol Sci 2018; 19:ijms19102918. [PMID: 30261581 PMCID: PMC6213036 DOI: 10.3390/ijms19102918] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2018] [Revised: 09/16/2018] [Accepted: 09/21/2018] [Indexed: 12/28/2022] Open
Abstract
Hypercortisolemia is associated with increased risk of hypertension. Natural and synthetic glucocorticoids (GCs) have different effects on blood pressure (BP). The effect of synthetic GCs on BP depends on the dose, treatment duration, type of GCs, and route of administration. Intravenous methylprednisolone (IVMP) pulse therapy is the first line of treatment for severe Graves' orbitopathy (GO). The aim of this study was to evaluate influence of IVMP pulses on BP and N-terminal pro-brain natriuretic peptide (NT-proBNP) dynamics. A total of 32 patients with GO were treated with one IVMP pulse every week for 12 weeks. We performed 48-h BP monitoring (24-h before and 24-h after IVMP) and measured NT-proBNP before, 24 h, and 48 h after the 1st, 6th, and 12th IVMP pulse. Mean BP did not change after any of the pulses. We did not observe an increase in maximal systolic BP or mean nocturnal BP, except after the last pulse. Additionally, the dipping phenomenon was less frequent after the last pulse. We found a significant increase in median NT-proBNP levels after all analyzed pulses. Our study suggests that IVMP may have an unfavorable cumulative effect on BP. Variation in NT-proBNP concentration indicates a compensatory effect of brain natriuretic peptide secretion.
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Affiliation(s)
- Piotr Miskiewicz
- Department of Internal Medicine and Endocrinology, Medical University of Warsaw, Banacha 1a, 02097 Warsaw, Poland.
| | - Justyna Milczarek-Banach
- Department of Internal Medicine and Endocrinology, Medical University of Warsaw, Banacha 1a, 02097 Warsaw, Poland.
| | - Tomasz Bednarczuk
- Department of Internal Medicine and Endocrinology, Medical University of Warsaw, Banacha 1a, 02097 Warsaw, Poland.
| | - Grzegorz Opolski
- First Department of Cardiology, Medical University of Warsaw, Banacha 1a, 02097 Warsaw, Poland.
| | - Renata Glowczynska
- First Department of Cardiology, Medical University of Warsaw, Banacha 1a, 02097 Warsaw, Poland.
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144
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Lee YG, Kim US. Efficacy and Safety of Low-to-Moderate Dose Oral Corticosteroid Treatment in Ocular Myasthenia Gravis. J Pediatr Ophthalmol Strabismus 2018; 55:339-342. [PMID: 30074608 DOI: 10.3928/01913913-20180620-01] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2018] [Accepted: 04/18/2018] [Indexed: 11/20/2022]
Abstract
PURPOSE To evaluate the response to corticosteroid therapy as a primary treatment for ocular myasthenia gravis. METHODS Patients diagnosed as having ocular myasthenia gravis by an acetylcholine receptor binding antibody test between January 2011 and September 2015 were included in the study and started receiving treatment with a corticosteroid. Patients with a blowout fracture, hyperthyroidism, diabetes mellitus, hypertension, cardiovascular disease, or history of strabismus surgery were excluded. Disappearance of diplopia and ptosis were considered a response to treatment. RESULTS Methylprednisolone therapy was administered to 29 patients (19 men and 10 women; average age: 49 ± 16.5 years) as an initial treatment. A total of 6 patients were lost to follow-up. Twenty-three of 29 patients (82.6%) were regarded as having presented a response to treatment. The average treatment duration was 3 weeks for patients responding to primary treatment. Eight patients complained of adverse effects from steroid therapy such as heartburn, insomnia, weight gain, and myalgia. CONCLUSIONS A corticosteroid could be considered as an initial treatment for patients diagnosed as having ocular myasthenia gravis by an acetylcholine receptor binding antibody test. [J Pediatr Ophthalmol Strabismus. 2018;55(5):339-342.].
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145
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Dogan N, Hüsing-Kabar A, Schmidt HH, Cicinnati VR, Beckebaum S, Kabar I. Acute allograft rejection in liver transplant recipients: Incidence, risk factors, treatment success, and impact on graft failure. J Int Med Res 2018; 46:3979-3990. [PMID: 29996675 PMCID: PMC6136012 DOI: 10.1177/0300060518785543] [Citation(s) in RCA: 41] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2018] [Accepted: 06/06/2018] [Indexed: 12/12/2022] Open
Abstract
Objective This study was performed to identify risk factors for acute cellular rejection after liver transplantation (LT). Methods Consecutive LT recipients who underwent surgery in our institution from 2002 to 2015 were retrospectively evaluated. Results In total, 176 patients were eligible for statistical analysis. During a mean observation period of 61.1 ± 36.3 months, 43 episodes of acute rejection were evident. Of these, 34 (79.0%) were responsive to methylprednisolone, 3 (7.0%) were treated by adjusting the dosage of immunosuppressive agents, and 6 (14.0%) were methylprednisolone-resistant and treated using anti-thymocyte globulin. Biliary complications (odds ratio [OR] = 4.89, 95% confidence interval [CI] = 2.00-11.98); donor-negative, recipient-positive CMV mismatch (OR = 9.88, 95% CI = 1.18-82.36); sex mismatch (OR = 3.16, 95% CI = 1.31-8.10); and sex mismatch with a female donor (OR = 3.00, 95% CI = 1.10-7.58) were identified as significant risk factors for acute graft rejection after LT. Conclusion In patients who develop acute cellular rejection after LT, biliary complications should be evaluated as a potential cause. Most acute rejections after LT respond to bolus corticosteroid therapy.
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Affiliation(s)
- Nurettin Dogan
- Department of Gastroenterology and Hepatology,
University Hospital Muenster, Muenster, Germany
| | - Anna Hüsing-Kabar
- Department of Gastroenterology and Hepatology,
University Hospital Muenster, Muenster, Germany
| | - Hartmut H. Schmidt
- Department of Gastroenterology and Hepatology,
University Hospital Muenster, Muenster, Germany
| | - Vito R. Cicinnati
- Department of Gastroenterology and Hepatology,
University Hospital Muenster, Muenster, Germany
| | - Susanne Beckebaum
- Department of Gastroenterology and Hepatology,
University Hospital Muenster, Muenster, Germany
| | - Iyad Kabar
- Department of Gastroenterology and Hepatology,
University Hospital Muenster, Muenster, Germany
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Nardin C, Borot S, Beaudoin MA, Cattin F, Puzenat E, Gauthier AS, Schillo F, Borg C, Aubin F. Long-term adverse event: inflammatory orbitopathy induced by pembrolizumab in a patient with metastatic melanoma. Invest New Drugs 2018; 37:375-377. [PMID: 30145624 DOI: 10.1007/s10637-018-0659-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2018] [Accepted: 08/20/2018] [Indexed: 11/26/2022]
Abstract
The recent advent of immune checkpoint inhibitors (ICI), including anti-programmed cell death 1 protein (anti-PD-1) agents has revolutionized the therapeutic approach of metastatic malignancies. Yet, ICI can disrupt immune tolerance resulting in enhanced immune activation in normal tissues with significant toxicity. A dysregulated activation of T-cells directed to normal tissues stands as the main mechanism of immune-related adverse events (irAE). To date, only two cases of immune-related inflammatory orbitopathy related to anti-PD-1 agents have been reported. This rare immune adverse event usually occurred early after ICI initiation. Here, we report the first case of late inflammatory orbitopathy occurring in a melanoma patient treated with pembrolizumab. Consequently, the occurrence of irAE under ICI should be monitored, even late after treatment instauration.
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Affiliation(s)
- Charlée Nardin
- Service de Dermatologie, Centre Hospitalier Universitaire, 3 Boulevard Alexandre Fleming, 25030, Besançon cedex, France.
- EA 3181 Université de Franche Comté, Besançon cedex, France.
| | - Sophie Borot
- Service d'Endocrinologie, Centre Hospitalier Universitaire, Besançon, France
| | | | - Françoise Cattin
- Service de Radiologie, Centre Hospitalier Universitaire, Besançon, France
| | - Eve Puzenat
- Service de Dermatologie, Centre Hospitalier Universitaire, 3 Boulevard Alexandre Fleming, 25030, Besançon cedex, France
- EA 3181 Université de Franche Comté, Besançon cedex, France
| | | | - Franck Schillo
- Service d'Endocrinologie, Centre Hospitalier Universitaire, Besançon, France
| | - Christophe Borg
- Service d'Oncologie, Centre Hospitalier Universitaire, Besançon, France
| | - François Aubin
- Service de Dermatologie, Centre Hospitalier Universitaire, 3 Boulevard Alexandre Fleming, 25030, Besançon cedex, France
- EA 3181 Université de Franche Comté, Besançon cedex, France
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Nagao K, Nakamura T, Tateishi K, Sato H, Shimizu N, Suenaga J, Murata H, Kanno H, Yamamoto T. [Efficacy and Safety of Salvage ESHAP Chemotherapy for Recurrent/Refractory PCNSLs]. No Shinkei Geka 2018; 46:575-581. [PMID: 30049898 DOI: 10.11477/mf.1436203773] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
BACKGROUND Primary central nervous system lymphoma(PCNSL)is a primary brain tumor, which appears commonly and occupies around 4.6% of all primary brain tumors. The standard therapy for this tumor is high-dose methotrexate chemotherapy(HD-MTX)and whole-brain irradiation. No salvage therapies for HD-MTX therapy-refractory or recurrent PCNSLs have been standardized. In our institution, ESHAP therapy(high-dose cytarabine:2,000mg, cisplatin:25mg/m2, etoposide:40mg/m2, methylprednisolone:500mg)was administered as a secondary chemotherapy, and the efficiency was examined. METHODS We administered ESHAP therapy as secondary chemotherapy for patients with refractory/recurrent PCNSL after HD-MTX therapy. Patients with PCNSL who were diagnosed and treated at our institute since 1996 were retrospectively studied. Clinical evaluations were performed based on Karnofsky Performance Status and overall survival, and the effect of ESHAP therapy was evaluated using the Response Assessment in Neuro-Oncology criteria. RESULTS The number of patients with refractory/recurrent PCNSLs were 18(28-77 years of age, median age of 58.5 years). The response rate(RR)after the first course of salvage ESHAP therapy was 77.8%(14 cases), and complete response(CR)was achieved in 6 cases. The RR after the final course of ESHAP therapy was as high as 61.1%(11 cases), and 4 patients retained CR status. In patients with refractory PCNSL who were treated with HD-MTX, the RR in the final course of salvage ESHAP therapy was as high as 77.8%(7 cases), and 3 patients retained CR status during the periods. The occurrence rate of Grade 3 or higher adverse events, according to the Common Terminology Criteria for Adverse Events version 4.0, was 66.7%(12 cases);all events that were associated with blood and lymphatic system disorders were quickly alleviated, and no fatal adverse events occurred. CONCLUSION In this study, we retrospectively examined the efficacy of ESHAP therapy as a secondary chemotherapy for patients with refractory/recurrent PCNSL after receiving HD-MTX therapy. Based on our findings, we suggest that ESHAP therapy should be considered as an encouraging secondary chemotherapy for patients with refractory/recurrent PCNSL.
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Affiliation(s)
- Kagemichi Nagao
- Department of Neurosurgery, Graduate School of Medicine, Yokohama City University
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148
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Zakaria HM, Salem TA, El-Araby HA, Salama RM, Elbadry DY, Sira AM, Ali MA, Salem ME, Abd-Alaaty BM, Goda SS, Eltaras SM, Khalil FO, Abou-Zeinah SS, Sira MM. Steroid therapy in children with fulminant hepatitis A. J Viral Hepat 2018; 25:853-859. [PMID: 29397017 DOI: 10.1111/jvh.12873] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2017] [Accepted: 01/05/2018] [Indexed: 02/05/2023]
Abstract
Fulminant hepatic failure is a life-threatening disease. Hepatitis A virus (HAV) can cause fulminant hepatic failure and death in about 0.2% of cases. Extensive destruction of infected hepatocytes by immune-mediated lysis is thought to be the cause. We aimed to evaluate the use of steroid therapy in children with fulminant HAV. This study included 33 children with fulminant HAV in two groups. Steroid group: comprised of 18 children who received prednisolone (1 mg/kg/d) or its equivalent dose of methylprednisolone, and the nonsteroid group: comprised another 15 children who did not receive steroid therapy. Age and sex were matched for both groups (P > .05), and they were comparable regarding baseline clinical and laboratory characteristics. Of the steroid group, 15 patients survived and 3 died, while in the nonsteroid group, 4 patients survived and 11 died (P = .001). Of the living patients, 15 of 19 (78.9%) received steroids while only 3 of 14 (21.4%) of the dead patients received steroids (P = .001). Stepwise regression analysis showed that steroid therapy was the only independent variable associated with recovery (P = .001). Steroid therapy in children with fulminant HAV associated significantly with improved outcome and survival. Future studies on a larger population size are strongly recommended.
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Affiliation(s)
- H M Zakaria
- Pediatric Hepatology, Gastroenterology and Nutrition Department, National Liver Institute, Menofiya University, Menofiya, Egypt
- Department of Pediatrics, Quesna Central Hospital, Ministry of Health, Menofiya, Egypt
| | - T A Salem
- Pediatric Hepatology, Gastroenterology and Nutrition Department, National Liver Institute, Menofiya University, Menofiya, Egypt
| | - H A El-Araby
- Pediatric Hepatology, Gastroenterology and Nutrition Department, National Liver Institute, Menofiya University, Menofiya, Egypt
| | - R M Salama
- Pediatric Hepatology, Gastroenterology and Nutrition Department, National Liver Institute, Menofiya University, Menofiya, Egypt
| | - D Y Elbadry
- Pediatric Hepatology, Gastroenterology and Nutrition Department, National Liver Institute, Menofiya University, Menofiya, Egypt
| | - A M Sira
- Pediatric Hepatology, Gastroenterology and Nutrition Department, National Liver Institute, Menofiya University, Menofiya, Egypt
| | - M A Ali
- Pediatric Hepatology, Gastroenterology and Nutrition Department, National Liver Institute, Menofiya University, Menofiya, Egypt
| | - M E Salem
- Pediatric Hepatology, Gastroenterology and Nutrition Department, National Liver Institute, Menofiya University, Menofiya, Egypt
| | - B M Abd-Alaaty
- Pediatric Hepatology, Gastroenterology and Nutrition Department, National Liver Institute, Menofiya University, Menofiya, Egypt
| | - S S Goda
- Pediatric Hepatology, Gastroenterology and Nutrition Department, National Liver Institute, Menofiya University, Menofiya, Egypt
| | - S M Eltaras
- Pediatric Hepatology, Gastroenterology and Nutrition Department, National Liver Institute, Menofiya University, Menofiya, Egypt
| | - F O Khalil
- Department of Microbiology and Immunology, National Liver Institute, Menofiya University, Menofiya, Egypt
| | - S S Abou-Zeinah
- Pediatric Hepatology, Gastroenterology and Nutrition Department, National Liver Institute, Menofiya University, Menofiya, Egypt
| | - M M Sira
- Pediatric Hepatology, Gastroenterology and Nutrition Department, National Liver Institute, Menofiya University, Menofiya, Egypt
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149
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Yang XN, Geng ZS, Zhang XL, Zhang YH, Wang XL, Zhang XB, Cui JZ. Single intracutaneous injection of local anesthetics and steroids alleviates acute nonspecific neck pain: A CONSORT-perspective, randomized, controlled clinical trial. Medicine (Baltimore) 2018; 97:e11285. [PMID: 29995761 PMCID: PMC6076127 DOI: 10.1097/md.0000000000011285] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
Acute nonspecific neck pain is one of the major public health problems lacking efficient treatments. The present study was designed to observe the analgesic effect of intracutaneous injection of local anesthestics and steroids on acute nonspecific neck pain.Thirty-six newly diagnosed with acute nonspecific neck pain patients were randomized to receive ibuprofen (IPB group) or intracutaneous injection of local anesthetics (lidocaine and bupivacaine) and steroid (methylprednisolone) (MLB group). The pain intensity was the primary outcome and evaluated with visual analog scale (VAS). Neck disability index (NDI) and patient global impression of changes (PGIC) were monitored for overall outcomes.Following treatments, patients from the 2 groups have decreased VAS scores and NDI when compared with their baseline level at 3 hours, day 1, and day 3 time points. Interestingly, the MLB group patients have lower VAS scores and NDI than IPB group. MLB patients also had a greater PGIC than IPB group.This study indicates that single intracutaneous injection of local anesthetics and steroids is sufficient to alleviate acute nonspecific neck pain.
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Affiliation(s)
| | | | - Xiu-Li Zhang
- Department of Anesthesiology, the First People's Hospital of Lianyungang, Lianyungang, Jiangsu Province, People's Republic of China
| | - Yun-Hai Zhang
- Department of Anesthesiology, the First People's Hospital of Lianyungang, Lianyungang, Jiangsu Province, People's Republic of China
| | | | - Xiao-Bao Zhang
- Department of Anesthesiology, the First People's Hospital of Lianyungang, Lianyungang, Jiangsu Province, People's Republic of China
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150
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Matsuo K, Koga M, Honda M, Kanda T. [A case of Hashimoto's encephalopathy successfully treated with cyclophosphamide pulse therapy]. Rinsho Shinkeigaku 2018; 58:390-394. [PMID: 29863104 DOI: 10.5692/clinicalneurol.cn-001169] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Hashimoto's encephalopathy has been described as an autoimmune disorder which demonstrates favorable response to corticosteroid therapy. However, steroid-resistant cases which require additional treatment are frequently reported, and there is no consensus how such cases should be treated. We present a 69 years-old man, who progressed cognitive dysfunction in the past three months. Anti-thyroid and anti-NH2 terminal of alpha-enolase antibodies were positive. Because initial corticosteroid therapy was ineffective, cyclophosphamide (CPA) pulse therapy was added, and his cognitive function was immediately improved. He had no relapse after tapering dose of corticosteroid for three years. CPA pulse therapy should be considered for steroid-resistant Hashimoto's encephalopathy.
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Affiliation(s)
- Kinya Matsuo
- Department of Neurology and Clinical Neuroscience, Yamaguchi University Graduate School of Medicine
- Present address: Department of Neurology, Yamaguchi Prefectural Grand Medical Center
| | - Michiaki Koga
- Department of Neurology and Clinical Neuroscience, Yamaguchi University Graduate School of Medicine
| | - Masaya Honda
- Department of Neurology and Clinical Neuroscience, Yamaguchi University Graduate School of Medicine
| | - Takashi Kanda
- Department of Neurology and Clinical Neuroscience, Yamaguchi University Graduate School of Medicine
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