The effect of lithium on renal haemodynamic function

1983 ◽  
Vol 13 (1) ◽  
pp. 61-69 ◽  
Author(s):  
S. P. Tyrer ◽  
R. G. Schacht ◽  
M. J. McCarthy ◽  
K. N. Menard ◽  
S. Leong ◽  
...  
Keyword(s):  
Lithium Treatment ◽  
Urine Osmolality ◽  
Term Therapy ◽  
Cortical Function ◽  
Water Excretion ◽  
History Of ◽  
Pah Clearance ◽  
Renal Tubular ◽  
Long Term Therapy ◽  
Renal Concentrating Capacity

SynopsisRenal concentrating capacity following 18 hours of fluid deprivation was measured in 75 patients receiving prophylactic lithium therapy, and in 30 affectively ill subjects receiving other drugs. The lithium-treated patients had significantly lower urine osmolality and higher serum osmolality than the control subjects. Older subjects, patients maintained at higher serum lithium levels and those with a history of previous neurotoxicity showed the most impairment. Ten patients with urine osmolalities of less than 700 mOsm/l following this test were investigated further. Inulin and para-amino hippurate (PAH) clearance rates were determined and the effect of a subpressor challenge of dopamine on these measures was observed. Half of the patients showed some reduction in inulin and PAH clearance, which was greatest in those patients who had been taking lithium for over 10 years. However, all of the patients tested showed the expected increase in renal blood flow and sodium and water excretion in response to dopamine. Six additional patients had clearance estimations made before starting lithium treatment which were repeated after a period of 3–6 months on the drug. No consistent changes in haemodynamics were observed.Lithium clearly reduces renal concentrating capacity, but other measures of renal tubular function were well preserved in patients receiving long-term therapy. Glomerular function may be slightly reduced in patients taking lithium for long periods. The results show that prophylactic lithium treatment does not affect renal cortical function adversely in the majority of patients, but impaired renal concentrating ability is a common accompaniment.

Familial Reye-Like Syndrome: A Presentation of Medium-Chain Acyl-Coenzyme A Dehydrogenase Deficiency

PEDIATRICS ◽  
1987 ◽  
Vol 79 (3) ◽  
pp. 382-385
Author(s):  
Bruce Taubman ◽  
Daniel E. Hale ◽  
Richard I. Kelley
Keyword(s):  
Dehydrogenase Deficiency ◽  
Coenzyme A ◽  
Term Therapy ◽  
Reye Syndrome ◽  
Medium Chain ◽  
Chain Acyl ◽  
History Of ◽  
Acyl Coenzyme A ◽  
Long Term Therapy

A 20-month-old girl with a family history of two siblings who died of an encephalopathy diagnosed as Reye syndrome presented to an emergency room in hypoglycemic coma and was found to have medium-chain acyl-coenzyme A dehydrogenase deficiency. The salient clinical and biochemical features of this newly described inborn error of fatty acid metabolism are described and contrasted to those of classical Reye syndrome. Important clues that should lead the clinician to suspect this disorder, methods of diagnosis, and appropriate acute and long-term therapy are also discussed.

Persistent venous leg ulcers complicated by linear morphea: a case report

2020 ◽  
Vol 29 (Sup9) ◽  
pp. S14-S20
Author(s):  
Georgeanne Cornell ◽  
Martin Kade Hardy ◽  
Jonathon Wilson
Keyword(s):  
Venous Insufficiency ◽  
Wound Care ◽  
Venous Stasis ◽  
Term Therapy ◽  
Leg Ulcers ◽  
Common Condition ◽  
Venous Ulcers ◽  
History Of ◽  
Long Term Therapy

Soft tissue ulceration resulting from chronic venous insufficiency is a common condition that requires standardised long-term therapy, which has been thoroughly established. We report a patient with a five-year history of persistent venous stasis ulcers despite treatment consistent with traditional wound care. Resolution of the ulcers began only upon deviation from conventional therapy. This report considers non-standard treatments in patients with venous ulcers that do not progress.

Plasmaexchange in the Treatment of Myasthenia Gravis Associated with Thymoma

2003 ◽  
Vol 26 (2) ◽  
pp. 170-173 ◽  
Author(s):  
L. Gogovska ◽  
R. Ljapcev ◽  
M. Polenakovic ◽  
L. Stojkovski ◽  
M. Popovska ◽  
...  
Keyword(s):  
Myasthenia Gravis ◽  
Cholinesterase Inhibitors ◽  
Immunosuppressive Agents ◽  
Ventilatory Support ◽  
Term Therapy ◽  
First Year ◽  
Myasthenic Crisis ◽  
History Of ◽  
Long Term Therapy

Background All patients with thymomatous Myasthenia Gravis (MG) should undergo early and total thymectomy, but controversy abounds in the choice of chronic immunosuppressive agents. The value of plasmaexchange (PE) in MG has been clearly estabilshed in preoperative preparation and treatment of myasthenic crisis. Whether PE may be used in the chronic long-term therapy of patients with thymomatous MG in addition to conventional immunosuppressive agents and cholinesterase inhibitors is yet to be answered. Case history We present a 40-year old woman with an 11 year history of MG. Thymectomy was done during the first year of the disease and the histopathologic finding was thymoma. To sustain clinical remission after thymectomy she continued with immunosuppression with methylprednisolone and cyclosporin A (or azathioprine) in addition to cholinesterase inhibitors. Despite the almost continuous immunosuppression, the disease course continued with fluctuating myasthenic weakness which few times progressed to myasthenic crisis requiring mechanical ventilation. During myasthenic crisis we performed 6–8 plasmapheresis at 2–3 day intervals in addition to conventional immunosuppressive therapy. The disease rapidly worsened in January 2000 and we started with intermittent plasmapheresis (3–6 procedures at 2–3 day intervals, every 6–8 weeks) in order to sustain remission. With this therapeutic protocol, during 20 months follow-up we managed to prevent myasthenic crisis and to avoid ventilatory support. Conclusions Plasmaexchange could be used as a successful and safe therapeutic tool in chronic long-term therapy in addition to conventional immunosuppressive agents to sustain remission in patients with MG. This is particularly important in the treatment of patients with thymomatous MG because they have an increased frequency of myasthenic crisis and often respond poorly an to immunosuppression with steroids or other immunosuppressants.

Follow-up of patients with prolactinomas after discontinuation of long-term therapy with bromocriptine

1983 ◽  
Vol 104 (2) ◽  
pp. 139-142 ◽  
Author(s):  
Arturo Zárate ◽  
Elías S. Canales ◽  
Carlos Cano ◽  
Carlos J. Pilonieta
Keyword(s):  
Sella Turcica ◽  
Ct Scanning ◽  
Serum Levels ◽  
Primary Treatment ◽  
Term Therapy ◽  
History Of ◽  
Permanent Cure ◽  
Long Term Therapy

Abstract. The effects of bromocriptine discontinuation after a 2 year course of therapy on prolactin (Prl) serum levels and the radiological size of the sella turcica were investigated in 16 women with amenorrhoea-galactorrhoea due to prolactinoma. During therapy, all but 2 patients had normalized serum Prl levels, and 4 women with macroprolactinomas exhibited a reduction in the size of the tumour as documented by CT-scanning and tomography of the sellae. After bromocriptine withdrawal and follow-up during 2 additional years, Prl levels remained normal in 6 patients, 2 of them with microprolactinomas and 4 with macroprolactinoma. The remaining 10 women developed hyperprolactinaemia associated with amenorrhoea and galactorrhoea within 3 months after discontinuation of therapy. No tumour expansion was observed in any case during the 4 year observation period. In the present study bromocriptine treatment seemed to result in permanent cure in 6 out of 16 cases of prolactinomas; nevertheless it is difficult to justify an indefinite medical treatment since the natural history of prolactinoma remains unknown. We presently feel that bromocriptine is more appropriate than neurosurgical transsphenoidal exploration for the primary treatment of prolactinomas. Further investigation is needed before a more definitive conclusion regarding the management of prolactinomas can be reached.

scholarly journals Efek Pemberian Jamu Selama 45 Bulan terhadap Fungsi Ginjal pada Pasien Geriatri dengan Hipertensi dan Diabetes Mellitus di Rumah Riset Jamu Tawangmangu: Studi Kasus

2018 ◽  
Vol 1 (3) ◽  
pp. 061-066
Author(s):  
Fajar Novianto ◽  
Agus Triyono ◽  
Peristiwan R Widhi Astana
Keyword(s):  
Diabetes Mellitus ◽  
Filtration Rate ◽  
Geriatric Patients ◽  
Alternative Therapy ◽  
Vital Signs ◽  
Term Therapy ◽  
Kidney Glomerulus ◽  
History Of ◽  
Long Term Therapy

Pasien geriatri adalah pasien usia lanjut yang memiliki karakteristik multipatologi, daya faali menurun, dan dengan tanda penyakit yang tidak khas. Terapi pengobatan yang diterima pasien geriatri sangat kompleks sehingga sering menimbulkan Drug Related Problem terutama pada organ ginjal. Jamu menjadi terapi alternatif pada pasien geriatri yang memerlukan terapi jangka lama. Tujuan studi kasus ini adalah untuk melihat pengaruh pemberian jamu pada pasien geriatri yang sudah berobat dalam jangka waktu 45 bulan terhadap fungsi ginjal. Metode penelitian ini merupakan studi kasus berdasarkan data rekam medis di Rumah Riset Jamu Tawangmangu terhadap pasien geriatri yang secara rutin kontrol dan periksa ureum atau kreatinin selama 45 bulan dan masih mengkonsumsi jamu hingga bulan April 2018. Untuk melihat pengaruh jamu pada ginjal dilakukan pemeriksaan Glomerulus Filtration Rate (GFR). Hasil: Seorang laki-laki umur 61 tahun dengan keluhan tangan kanan merasa kesemutan. Pasien memiliki riwayat penyakit hipertensi dan diabetes mellitus lebih dari 15 tahun. Tekanan darah 140/90 mmHg dan tanda vital serta pemeriksaan fisik lainnya dalam batas normal. Pemeriksaan laboratorium Gula Darah Puasa (GDP) 227 mg/dL, ureum dan kreatinin diperiksa setelah bulan kelima pasien minum jamu yaitu ureum 35 mg/dL dan kreatinin 0,89 mg/dL. Selama minum jamu terjadi fluktuasi nilai GFR pasien tetapi tidak sampai menurun hingga kategori berat. Pada akhir bulan ke-45 meskipun terjadi penurunan GFR pasien dibanding pemeriksaan GFR yang pertama tetapi masih dalam kategori yang sama dengan nilai GFR pertama kali periksa (kategori ringan). Kesimpulan: Pemberian jamu dalam jangka waktu 45 bulan secara berturut-turut pada pasien geriatri tidak menyebabkan penurunan GFR signifikan.   Geriatric patients are elderly patients who have the characteristics of multi pathology, decreased physiology, and atypical symptom of a disease. Treatment received by geriatric patients is very complex so it often leads to Drug-Related Problems, especially in the kidney organs. Jamu is an alternative therapy for geriatric patients who need long-term therapy. The objective of this case study was to evaluate the effect of Jamu (herbs) on kidney function of geriatric patients who have been treated for 45 months. The research method was a case study based on the medical record of geriatric patients at Jamu Research Center in Tawangmangu who routinely control and examine for their urea or creatinine levels for 45 months and still consume herbs until April 2018. In order to evaluate the effect of jamu on the kidney, Glomerulus Filtration Rate (GFR) was examined. Results:  A 61-year-old male with a right hand feeling tingling. Patients have a medical history of hypertension and diabetes mellitus for more than 15 years. His blood pressure was 140/90 mmHg, meanwhile, the vital signs and other physical examinations were within normal levels. Laboratory tests of Fasting Blood Sugar (GDP) showed a level of 227 mg / dL, urea and creatinine levels were examined after the fifth month consumed jamu, the urea level was 35 mg / dL and creatinine level was 0.89 mg / dL. During jamu consumption there was a fluctuation in the patient's GFR but not until the severe category. At the end of the 45th month, despite a decrease in the patient's GFR compared to the first GFR examination but still in the same category as the first GFR score (mild category). Conclusion: Jamu consumption for 45 consecutive months in geriatric patients did not cause a significant reduction in GFR

Practical Aspects of Long-Term Treatment with Lithium

1992 ◽  
Vol 6 (2_suppl) ◽  
pp. 330-333 ◽  
Author(s):  
Iain Glen
Keyword(s):  
Lithium Treatment ◽  
Depressive Illness ◽  
Term Treatment ◽  
Term Therapy ◽  
Manic Depressive Illness ◽  
Short Term Treatment ◽  
Manic Depressive ◽  
Long Term Treatment ◽  
Long Term Therapy

There is no increase in the overall mortality of patients undergoing long-term lithium treatment compared with those receiving short-term treatment. Lithium causes a reduction in the incidence of suicide in patients suffering from manic depressive illness. Long-term treatment with lithium is more effective than treatment with imipramine or amitriptyline. Drug interactions may cause problems during long-term therapy with lithium. A reduction in plasma levels of lithium should be considered in stable patients on long-term prophylaxis. Discontinuation of therapy often results in a relapse. The toxicity of lithium is related to its effects on calcium transport.

Long-Term Prophylactic Effects of Carbamazepine in Affective Disorder

1983 ◽  
Vol 143 (4) ◽  
pp. 327-331 ◽  
Author(s):  
Akira Kishimoto ◽  
Chikara Ogura ◽  
Hidebumi Hazama ◽  
Kinuo Inoue
Keyword(s):  
Depressive Disorder ◽  
Affective Disorder ◽  
Term Therapy ◽  
Prophylactic Therapy ◽  
Manic Depressive ◽  
History Of ◽  
Long Term Therapy ◽  
Depressive Episodes ◽  
Better Than

SummaryThe prophylactic effects of carbamazepine (CBZP) were studied in 32 patients with affective disorder who were receiving long-term therapy with CBZP. Complete inhibition of both manic and depressive episodes was observed in four cases, reduced incidence of episodes or decreased intensity of symptoms in twenty, and no change in eight. CBZP was significantly more effective in cases with an onset before the age of 20, and subjects showing a continuous pattern of alternating episodes responded better than those with a more intermittent history of mania and depression. Where CBZP had an effect it was generally apparent soon after therapy started. These results suggest that in some cases CBZP is an agent suitable for long-term continuous prophylactic therapy in manic-depressive disorder.

scholarly journals Menopause and prolactin secreting tumours

2015 ◽  
Vol 21 (3) ◽  
pp. 141-145
Author(s):  
Mara Carsote ◽  
Ana Valea ◽  
Anda Dumitrascu ◽  
Cristina Capatina ◽  
Diana Paun ◽  
...  
Keyword(s):  
Fragility Fractures ◽  
Pituitary Tumour ◽  
Term Therapy ◽  
Newly Diagnosed ◽  
Secondary Amenorrhea ◽  
Clinical Presentations ◽  
History Of ◽  
Long Term Therapy ◽  
Tumour Reduction

ABSTRACTIntroduction Prolactinomas without galactorhhea may be considered menopause or not diagnosed. This is a cases series.Case1. 76-year female with menopause at age of 52 was discovered at 66 yrs with high prolactin and a pituitary micro-nodule. Bromocriptin was continued for 6 years then switched to cabergoline with constant imagery. The patient did not display at all galactorrhea. Osteoporosis was diagnosed at age of 66 with previous 2 fragility fractures.Case2. 45-year female is known with secondary amenorrhea (without galactorrhea) for the last 7 years being considered menopause. She experienced headaches thus a MRI was performed and found a pituitary tumour of 1.5cm. Low FSH with increased prolactin was revealed. Cabergoline was started. Within 2 months the menses resumed and headache mildly improved. After 3 months prolactin normalised under weekly 2 mg of cabergoline. Periodical prolactin control is necessary as well as a pituitary scan at 6 months.Case3. 39-year female had a 3 yrs history of secondary amenorrhea. A prolactin of 117ng/mL and a microprolactinoma of 0.77cm were found. Cabergoline was started and progressively increased up to 1.5mg per week. The prolactin quickly normalised up to 8ng/mL within 4 months. She was followed for 2 years and the imagery found a tumour reduction to 0.44cm.Conclusion Prolactinomas associate a great variety of clinical presentations. They interfere with menopause by mimicking it in cases without galactorrhea. Also a newly diagnosed prolactinoma during menopause needs long term therapy and followed-up for especially for bone safety.

Periprosthetic Femoral Insufficiency Fracture in a Patient on Long-term Bisphosphonate Therapy

2012 ◽  
Vol 2 (1) ◽  
pp. 66-69 ◽  
Author(s):  
Samuel S Wellman ◽  
David E Attarian ◽  
Jordan F Schaeffer
Keyword(s):  
Recent Literature ◽  
Insufficiency Fracture ◽  
Bisphosphonate Therapy ◽  
Fracture Pattern ◽  
Term Therapy ◽  
Femoral Cortex ◽  
History Of ◽  
Long Term Therapy ◽  
Cemented Total Hip Arthroplasty

ABSTRACT Recent literature shows an association between long-term bisphosphonate therapy and low-energy fractures of the subtrochanteric femur. It is thought that the pharmacology of bisphosphonates and stress characteristics of the sub-trochanteric femur predispose patients on long-term therapy to fracture. There are few reports in the literature of bisphos-phonate-associated periprosthetic fractures with the characteristic fracture pattern. We report a case in a patient with a 10- year history of sustained bisphosphonate use. The patient is a 79-year-old female that developed new thigh pain 9 years following a cemented total hip arthroplasty. Radiographs revealed lateral cortical thickening and a transverse periprosthetic stress fracture of the lateral femoral cortex at the level of the distal stem. This fracture appears consistent with a bisphosphonate-associated insufficiency fracture, demonstrating that this pattern is not isolated to nonarthroplasty patients. Schaeffer JF, Attarian DE, Wellman SS. Periprosthetic Femoral Insufficiency Fracture in a Patient on Long-term Bisphosphonate Therapy. The Duke Orthop J 2012;2(1):66-69.

scholarly journals Multiple Cerebral Infarction Associated with Neuroleptic-Induced Lupus Anticoagulant

1994 ◽  
Vol 7 (3-4) ◽  
pp. 185-187
Author(s):  
J. D. E. Laugharne
Keyword(s):  
Cerebral Infarction ◽  
Lupus Anticoagulant ◽  
Term Therapy ◽  
Neuroleptic Treatment ◽  
Cerebral Infarcts ◽  
Schizophrenic Woman ◽  
History Of ◽  
Multiple Cerebral Infarction ◽  
Long Term Therapy

A 39 year old schizophrenic woman with a 20 year history of neuroleptic treatment suffered bilateral cerebral infarcts and coagulation studies revealed a lupus anticoagulant (LA). She highlights the poorly recognized risk of thrombosis in patients on neuroleptics who develop LA. In this case the LA may have been induced by long-term therapy with haloperidol, a novel and potentially important association.

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