scholarly journals Pharmacological Therapy of Vascular Malformations of the Gastrointestinal Tract

2006 ◽  
Vol 20 (3) ◽  
pp. 171-178 ◽  
Author(s):  
Andrew Szilagyi ◽  
Maged P Ghali
Keyword(s):  
Gastrointestinal Tract ◽  
Vascular Malformations ◽  
Case Reports ◽  
Case Series ◽  
Pharmacological Therapy ◽  
Deficiency Anemia ◽  
Recurrent Bleeding ◽  
Somatostatin Analogue ◽  
Pharmacological Agents ◽  
Prospective Trials

Vascular malformation (AVM) in the gastrointestinal tract is an uncommon, but not rare, cause of bleeding and iron deficiency anemia, especially in an aging population. While endoscopic coagulative therapy is the method of choice for controlling bleeding, a substantial number of cases require additional therapy. Adjunctive or even primary phamacotherapy may be indicated in recurrent bleeding. However, there is little evidence-based proof of efficacy for any agent. The bulk of support is derived from anecdotal reports or case series. The present review compares the outcome of AVM after no intervention, coagulative therapy or focus on pharmacological agents. Most of the literature encompasses two common AVMs, angiodysplasia and hereditary hemorrhagic telangiectasia. Similarly, the bulk of information evaluates two therapies, hormones (estrogen and progesterone) and the somatostatin analogue octreotide. Of these, the former is the only therapy evaluated in randomized trials, and the results are conflicting without clear guidelines. The latter therapy has been reported only as case reports and case series without prospective trials. In addition, other anecdotally used medications are discussed.

Evidence and the main adverse effects regarding drug therapies in the war against COVID-19

2020 ◽  
Vol 27 ◽  
Author(s):  
Mauricio Mora-Ramírez ◽  
Paulina Melgoza-Hernández ◽  
Sebastian Eduardo Toledo-Ramírez ◽  
Juan Manuel Mejía Aranguré
Keyword(s):  
Adverse Effects ◽  
Drug Targets ◽  
English Language ◽  
Randomized Clinical Trials ◽  
Case Reports ◽  
Case Series ◽  
Pharmacological Therapy ◽  
Rapid Review ◽  
Definitive Therapy ◽  
Potential Drug Targets

Background: Nowadays, the breakthrough of COVID-19 pandemic around the world is the biggest health challenge for the clinicians, and it represents an unexpected effort to identify effective treatment for those patients. No proven definitive therapies for this infection currently exist. Unfortunately, the infected patients increased in an alarming way every day, faster than medical evidence. At present, the expanding knowledge regarding SARS-COV-2 virology provides several potential drug targets. Objective: Therefore, clinicians need a rapid review and guideline about the main adverse effects regarding the most prescribed drugs and, specifically, the efficacy and potential risk of each pharmacological therapy, during hospital care. Methods: The articles review was performed using PubMed to identify relevant papers in English language reported through July 20th, 2020; a second review was performed using Web of Science until August 28th. Due to the lack of randomized clinical trials, we included case reports, case series, and reviews. We found 1606 total articles related. The authors independently reviewed the titles and abstracts for inclusion. Conclusion: At present, despite the enormous medical effort for publishing several trials or case reports, we have not yet discovered a definitive therapy against the COVID-19 infection. This brief review aims to prompt identification of risk factors and main adverse effects in a systematic view related to therapy with partial evidence proposed to date.

Management of Direct-Acting Oral Anticoagulants Surrounding Dental Procedures With Low-to-Moderate Risk of Bleeding

2017 ◽  
Vol 31 (2) ◽  
pp. 202-207 ◽  
Author(s):  
Kathleen A. Lusk ◽  
Jenna L. Snoga ◽  
Rebekah M. Benitez ◽  
G. Blair Sarbacker
Keyword(s):  
Case Reports ◽  
Oral Anticoagulants ◽  
Case Series ◽  
Inclusion Criteria ◽  
Moderate Risk ◽  
Risk Of Bleeding ◽  
Dental Procedures ◽  
Reference Sections ◽  
Prospective Trials ◽  
Direct Acting

The purpose of this article is to review the available evidence regarding how to safely manage direct-acting oral anticoagulant (DOAC) therapy in patients requiring dental procedures with low-to-moderate risk of bleeding. A literature search was performed using MEDLINE and PubMed. Each author performed an independent search to ensure all pertinent articles were identified. The reference sections of each article were also reviewed. Pertinent articles were evaluated by each author for inclusion. Articles were eligible for inclusion if the participants were taking DOAC therapy surrounding a dental procedure known to have low-to-moderate risk of bleeding. Studies could be prospective or retrospective and included case reports, case series, and clinical trials. Articles were excluded if they assessed dental procedures known to carry a high risk of bleeding or were review articles. Twenty-five articles were identified, 5 of which met inclusion criteria including 2 case series, 1 retrospective study, and 2 prospective trials. Variation in the management of DOAC therapy surrounding these procedures was found. Among patients undergoing low-to-moderate risk dental procedures while receiving DOAC therapy, bleeding rates were low regardless of whether the DOAC was held or continued surrounding the procedure. Documented bleeding was mild and easily controlled by local hemostatic measures. Patients can safely continue DOAC therapy surrounding these dental procedures.

scholarly journals Endocrine tumors: Thyrotropin-secreting pituitary adenoma: a structured review of 535 adult cases.

2021 ◽  
Author(s):  
Carlien de Herdt ◽  
Eva Philipse ◽  
Christophe De Block
Keyword(s):  
Pituitary Adenoma ◽  
Cohort Studies ◽  
Case Reports ◽  
Case Series ◽  
Postoperative Treatment ◽  
Visual Field Defects ◽  
Somatostatin Analogue ◽  
Endocrine Tumors ◽  
Residual Tumour ◽  
Mesh Terms

Background and Aims: Thyrotropin-stimulating pituitary adenoma (TSHoma) are a rare entity, occurring in 1 per million people. We performed a systematic review of 535 adult cases summarizing the clinical, biochemical, hormonal and radiological characteristics of TSHoma. Furthermore, we discuss the current guidelines for diagnosis and treatment. Methods A structured research was conducted using Pubmed with the following MeSH terms: “thyrotropin secreting pituitary adenoma” OR “TSHoma” OR “thyrotropinoma”. Results Our analysis included 535 cases originating from 18 case series, 5 cohort studies and 91 case reports. Mean age at diagnosis was 46 years. At presentation 75% had symptoms of hyperthyroidism, 55.5% presented with a goitre and 24.9% had visual field defects. Median TSH at diagnosis was 5.16 (3.20-7.43) mU/L with a mean fT4 of 41.5±15.3 pmol/L. The majority (76.9%) of the TSHoma were macroadenoma. Plurihormonality was seen in 37.4% of the adenoma with a higher incidence in macroadenoma. Surgical resection of the adenoma was performed in 87.7% patients of which 33.5% had residual pituitary adenoma. Postoperative treatment with a somatostatin analogue led to a stable disease in 81.3% of the cases with residual tumour. We noticed a significant correlation between the diameter of the adenoma and residual pituitary adenoma (r=0.490, p<0.001). However, in patients pre-operatively treated with somatostatin analogue this correlation was absent. Conclusion TSHoma are a rare cause of hyperthyroidism and are frequently misdiagnosed. Based on our structured analysis of case series, cohort studies and case reports, we conclude that the majority of TSHoma are macroadenoma being diagnosed in the 5-6th decade of life and presenting with symptoms of hyperthyroidism. Plurihormonalitiy is observed in one third of TSHoma. Treatment consists of neurosurgical resection and SSA in case of surgical failure.

scholarly journals Gastrointestinal Pyogenic Granuloma (Lobular Capillary Hemangioma): An Underrecognized Entity Causing Iron Deficiency Anemia

2016 ◽  
Vol 2016 ◽  
pp. 1-8 ◽  
Author(s):  
Marshall W. Meeks ◽  
Umar M. Kamal ◽  
Muhammad B. Hammami ◽  
Jason R. Taylor ◽  
M. Louay Omran ◽  
...  
Keyword(s):  
Gastrointestinal Tract ◽  
Iron Deficiency ◽  
Case Series ◽  
Pyogenic Granuloma ◽  
Vascular Tumor ◽  
Capillary Hemangioma ◽  
Deficiency Anemia ◽  
Review Of The Literature ◽  
Lobular Capillary Hemangioma ◽  
Actual Incidence

Pyogenic granuloma (PG), more accurately known as lobular capillary hemangioma, is a benign vascular tumor that usually occurs in the skin or oral mucosa. This lesion is rarely reported in the gastrointestinal tract but is known to bleed if not resected. We herein describe a case series with the clinical, endoscopic, and histologic findings of four cases of gastrointestinal PG at our institution. In addition, we provide a review of the literature and summation of all reported cases of PG specific to the gastrointestinal tract. Based on our experience, we suggest that the actual incidence of gastrointestinal PG may in fact be higher than reported because PG can be unrecognized or improperly diagnosed. It is important for the clinician to properly recognize this lesion as a source of anemia and its propensity to bleed during biopsy or resection.

scholarly journals Clinical Characteristics and Prognosis of Gastrointestinal Metastases in Solid Tumor Patients: A Retrospective Study and Review of Literatures

2019 ◽  
Vol 2019 ◽  
pp. 1-7 ◽  
Author(s):  
Li Lin ◽  
Xiangyi Wang ◽  
Chuanhao Tang ◽  
Jun Liang
Keyword(s):  
Gastrointestinal Tract ◽  
Cancer Patients ◽  
Clinical Characteristics ◽  
Ductal Carcinoma ◽  
Case Reports ◽  
Case Series ◽  
Local Therapy ◽  
Breast Cancer Patients ◽  
Poor Prognostic Factor ◽  
Gastrointestinal Metastases

Background. According to the literature and our experience, patients with gastrointestinal metastases are relatively rare. Numerous case reports and literature reviews have been reported. We present one of the larger case series of gastrointestinal metastases. Objectives. To explore the clinical characteristics and prognosis of patients with gastrointestinal tract metastases, which are rare metastatic sites. Methods. Patients with gastrointestinal metastases in the setting of stage IV primary carcinomas treated at Beijing Ditan Hospital and Peking University International Hospital from November 1992 to August 2017 were included in this study. The diagnosis of gastrointestinal tract metastases was based on histopathology. Results. 30 patients (median age 56 years, 56.7% female) were included. The most common primary carcinomas associated with gastrointestinal metastases were breast (11 patients, 36.7%), stomach (9 patients, 30.0%), and lung (4 patients, 13.3%) cancer. The major pathological types were adenocarcinoma (16 patients, 53.3%) and ductal carcinoma (9 patients, 30.0%). Ten patients (33.3%) underwent local gastrointestinal treatment, and 20 patients (66.7%) underwent nonlocal treatment (involving chemotherapy alone or best supportive care). For breast cancer patients and gastric cancer patients who underwent local therapy, a significant survival advantage was observed (p=0.001 and p=0.012, respectively). The presence of other common metastases was identified as an independent poor prognostic factor through multivariate analysis with a HR (hazard ratio) of survival of 0.182 (95% confidence interval (CI) 0.11-0.523, p=0.031). Conclusion. Gastrointestinal metastases are most frequently from breast invasive ductal carcinoma. The presentation of other common metastases with gastrointestinal metastasis indicates poor prognosis, and selected patients may benefit from surgical intervention.

Gastrointestinal Tract Plasmablastic Lymphoma in HIV-Infected Adults: A Histopathological Review

2020 ◽  
Vol 28 (7) ◽  
pp. 735-748
Author(s):  
Absalom Mwazha ◽  
Gamalenkosi Bonginkosi Nhlonzi ◽  
Pedzisai Mazengenya
Keyword(s):  
Gastrointestinal Tract ◽  
B Cell ◽  
Plasma Cell ◽  
Growth Pattern ◽  
Case Reports ◽  
Case Series ◽  
B Cell Lymphoma ◽  
Plasmablastic Lymphoma ◽  
Histopathological Features ◽  
Molecular Features

Background. Plasmablastic lymphoma (PBL) is an aggressive B-cell lymphoma that is characterized by the expression of plasma cell antigens and loss of pan B-cell antigens. The neoplasm is extensively reported in the oral cavity and anorectal region but rarely in the gastrointestinal tract, where only isolated case reports and small case series have been reported. In the current study, morphologic, immunohistochemical, and molecular features of 17 cases of gastrointestinal tract PBL were reviewed. Methods. Ten-year retrospective study that reappraised the histomorphological and immunophenotypical profiles of HIV-associated PBLs in the gastrointestinal tract. Results. The mean age of the study patients was 41 years with a 3:1 ratio of males to females. The most common site of tumor origin was the small intestine (42%), followed by the stomach (29%) and the colon (29%). Majority of the cases showed a predominant diffuse (82%) growth pattern. Immunoblasts and plasmablasts were observed in all cases. Plasmacytic differentiation was seen in 5 (29%) cases. Additional observations not previously described or emphasized in literature includes pseudo-alveolar growth pattern, centroblast-predominance, multinucleated giant cells, and clear cell change. Immunohistochemistry revealed absence of pan B-cell antigens and expression of plasma cell antigens in all cases. Epstein-Barr virus–encoded RNA was expressed in 53% of the cases. Conclusions. This study highlights the spectrum of histopathological features seen in gastrointestinal tract PBLs. Awareness of this entity and its histopathological features in the gastrointestinal tract is essential for making a timely and accurate diagnosis and improving patient outcomes.

scholarly journals Extradigestive Manifestation of Helicobacter Pylori Infection in Children and Adolescents

2005 ◽  
Vol 19 (7) ◽  
pp. 421-424 ◽  
Author(s):  
Philip M Sherman ◽  
Frank YH Lin
Keyword(s):  
Helicobacter Pylori ◽  
Molecular Mimicry ◽  
Case Reports ◽  
Case Series ◽  
Helicobacter Pylori Infection ◽  
Deficiency Anemia ◽  
Extraintestinal Manifestations ◽  
Human Pathogen ◽  
Chronic Active Gastritis ◽  
H Pylori

Helicobacter pylori infection fulfills each of Koch's postulates as a human pathogen causing chronic active gastritis. Disease consequences that develop in a subset of infected subjects include peptic ulcerations, gastric adenocarcinoma and mucosa-associated lymphoid tissue lymphoma. More recently, multiple publications have advocated a role for H pylori infection in causing a variety of extraintestinal manifestations. Many of these reports suffer from being case reports or case series without adequate controls. As a result, purported manifestations may simply be coincidental in nature. On the other hand, increasing evidence supports H pylori infection as a cause of sideropenic (refractory iron deficiency) anemia. Moderate evidence supports H pylori gastric infection as a cause of some cases of immune thrombocytopenic purpura due to molecular mimicry. Guidelines should be adjusted in accordance with advancing knowledge in the field.

Management of inappropriate sexual behaviors in dementia: a literature review

2010 ◽  
Vol 22 (5) ◽  
pp. 683-692 ◽  
Author(s):  
Inese Tucker
Keyword(s):  
Sexual Behavior ◽  
Sexual Behaviors ◽  
Case Reports ◽  
Case Series ◽  
Pharmacological Agents ◽  
Inappropriate Sexual Behavior ◽  
Wide Range ◽  
Case Series Report ◽  
Sexual Disinhibition ◽  
Psychoactive Medications

ABSTRACTBackground: This paper reviews published literature on the pharmacological and non-pharmacological treatment of inappropriate sexual behavior in dementia.Methods: A literature search of Psychinfo and Cochrane databases was performed and data from case reports and case series were analyzed.Results: No randomized controlled trials exist for any treatment of sexual disinhibition in dementia and there are no trials comparing different pharmacological agents. Case reports and case series report a wide range of pharmacotherapies as efficacious in the treatment of inappropriate sexual behaviors in dementia. There is only one case report of non-pharmacological strategies to manage inappropriate sexual behavior.Conclusions: Inappropriate sexual behaviors in dementia can be difficult to treat. Frequently, multiple psychoactive medications are used and many pharmacotherapies are trialed prior to finding an effective agent. More research is needed to clarify the usefulness of these medications and to identify non-pharmacological strategies to prevent unnecessary use of medications.

Chronic use of PPIs as a potential cause of anemia: case reports and review of the literature

2020 ◽  
Vol 51 (2) ◽  
pp. 108-111 ◽  
Author(s):  
Martyna Podgajna ◽  
Michał Mielnik ◽  
Aneta Szudy-Szczyrek ◽  
Kinga Kuśmierczuk ◽  
Marek Hus
Keyword(s):  
Gastrointestinal Tract ◽  
Bone Fractures ◽  
Case Reports ◽  
Erosive Esophagitis ◽  
Deficiency Anemia ◽  
Peptic Ulcers ◽  
Old Patients ◽  
Risk Patients ◽  
Effective Drugs

AbstractProton pump inhibitors (PPIs) are drugs commonly used for many diseases of the gastrointestinal tract, such as gastroesophageal reflux disease, erosive esophagitis, and peptic ulcers of the stomach and duodenum. Used for about 30 years, they are currently the most effective drugs that reduce the gastric secretion of hydrochloric acid. However, a dramatic increase in their consumption has been recently observed. Very often, they are used not in accordance with the guidelines. The consequences of the long-term use of PPIs may be various, with the most common side effects being bone fractures, cardiovascular events, recurrent infections, and vitamin and mineral deficiencies. Case report: An 82-year-old and a 58-year-old patients who had been taking omeprazole, a PPI for several years, developed vitamin B12 and iron deficiency anemia. Both patients were administered PPI orally for nonspecific dyspeptic symptoms. An evaluation of the gastrointestinal tract did not reveal the evident causes of gastrointestinal blood loss. They were also screened negative for Helicobacter pylori infection. Conclusions: There are no definitive pieces of evidence that the long-term use of PPIs can induce anemia, but our cases strongly suggest this thesis. Physicians should be aware of this potential side effect and consider monitoring in high-risk patients.

The Treatment of Primary Orthostatic Hypotension

2017 ◽  
Vol 51 (5) ◽  
pp. 417-428 ◽  
Author(s):  
Genevieve M. Hale ◽  
Jose Valdes ◽  
Michael Brenner
Keyword(s):  
Orthostatic Hypotension ◽  
Case Reports ◽  
Data Extraction ◽  
Medication Management ◽  
Case Series ◽  
Medication Administration ◽  
Pharmacological Therapy ◽  
Patient Specific ◽  
Alternative Treatment Option ◽  
Adequate Hydration

Objective: To review the efficacy and safety of pharmacological and nonpharmacological strategies used to treat primary orthostatic hypotension (OH). Data Sources: A literature review using PubMed and MEDLINE databases searching hypotension, non-pharmacological therapy, midodrine, droxidopa, pyridostigmine, fludrocortisone, atomoxetine, pseudoephedrine, and octreotide was performed. Study Selection and Data Extraction: Randomized or observational studies, cohorts, case series, or case reports written in English between January 1970 and November 2016 that assessed primary OH treatment in adult patients were evaluated. Data Synthesis: Based on the chosen criteria, it was found that OH patients make up approximately 15% of all syncope patients, predominantly as a result of cardiovascular or neurological insults, or offending medication. Nonpharmacological strategies are the primary treatment, such as discontinuing offending medications, switching medication administration to bedtime, avoiding large carbohydrate-rich meals, limiting alcohol, maintaining adequate hydration, adding salt to diet, and so on. If these fail, pharmacotherapy can help ameliorate symptoms, including midodrine, droxidopa, fludrocortisone, pyridostigmine, atomoxetine, sympathomimetic agents, and octreotide. Conclusions: Midodrine and droxidopa possess the most evidence with respect to increasing blood pressure and alleviating symptoms. Pyridostigmine and fludrocortisone can be used in patients who fail to respond to these agents. Emerging evidence with low-dose atomoxetine is promising, especially in those with central autonomic failure, and may prove to be a viable alternative treatment option. Data surrounding other therapies such as sympathomimetic agents or octreotide are minimal. Medication management of primary OH should be guided by patient-specific factors, such as tolerability, adverse effects, and drug-drug and drug-disease interactions.

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