scholarly journals Clinical Use of Diuretics in Heart Failure, Cirrhosis, and Nephrotic Syndrome

2015 ◽  
Vol 2015 ◽  
pp. 1-9 ◽  
Author(s):  
Ahmed Hassaan Qavi ◽  
Rida Kamal ◽  
Robert W. Schrier
Keyword(s):  
Nephrotic Syndrome ◽  
Cardiac Failure ◽  
Fluid Overload ◽  
Treatment Options ◽  
The Body ◽  
Clinical Use ◽  
Failure Treatment ◽  
Principles Of Treatment ◽  
Current Guidelines ◽  
Primary Agent

Diuretics play significant role in pharmacology and treatment options in medicine. This paper aims to review and evaluate the clinical use of diuretics in conditions that lead to fluid overload in the body such as cardiac failure, cirrhosis, and nephrotic syndrome. To know the principles of treatment it is essential to understand the underlying pathophysiological mechanisms that cause the need of diuresis in the human body. Various classes of diuretics exist, each having a unique mode of action. A systemic approach for management is recommended based on the current guidelines, starting from thiazides and proceeding to loop diuretics. The first condition for discussion in the paper is cardiac failure. Treatment of ascites in liver cirrhosis with spironolactone as the primary agent is highlighted with further therapeutic options. Lastly, management choices for nephrotic syndrome are discussed and recommended beginning from basic sodium restriction to combined diuretic therapies. Major side effects are discussed.

Fluid balance

2014 ◽  
Author(s):  
Anthea Hatfield
Keyword(s):  
Pulmonary Oedema ◽  
Cardiac Failure ◽  
Fluid Balance ◽  
Fluid Overload ◽  
The Body ◽  
Electrolyte Balance ◽  
Fluid Deficit ◽  
Different Types ◽  
Extra Cellular Fluid ◽  
Fluid Compartments

This chapter will tell you how surgery affects fluid balance and how the body controls fluids. Fluid compartments in the body and the nature of fluids are described. Disorders of fluid balance, the use of fluids to restore blood volume, and extra cellular fluid volume are all discussed. Management of fluid deficit, fluid overload, and pulmonary oedema and how to correct electrolyte balance are all clearly set out. Recommendations for fluids after different types of surgery and fluids for patients with renal and cardiac failure are given.

scholarly journals SAT-505 Non-Adherence to Levothyroxine Treatment, a Condition Not to Be Ignored nor Forgotten, Should Be Assessed by Thyroxine Absorption Test

2020 ◽  
Vol 4 (Supplement_1) ◽  
Author(s):  
Grigorios Effraimidis ◽  
Marianne C Klose ◽  
Aase Krogh Rasmussen ◽  
Ulla Feldt-Rasmussen
Keyword(s):  
Nephrotic Syndrome ◽  
Total Thyroidectomy ◽  
Treatment Options ◽  
Rapid Test ◽  
Pernicious Anaemia ◽  
The Body ◽  
Loading Dose ◽  
Absorption Test ◽  
Free T4 ◽  
Autoimmune Hypothyroidism

Abstract Hypothyroidism due to non-compliance with levothyroxine (LT4) treatment is not infrequent (pseudomalabsorption). It should be considered in patients with persistent severe clinical and biochemical hypothyroidism even after excessive LT4 dose. The diagnosis can be confirmed by LT4 Absorption Test. We present 4 female patients (age range 21-44 years) with suspicion of (pseudo)malabsorption who underwent absorption test (3 patients with autoimmune hypothyroidism and one patient with hypothyroidism after total thyroidectomy due to Graves’ disease). They presented with persistent hypothyroidism (TSH 30 to >100 mU/L) even after gradual increase to excessive LT4 dose (400-700 μg daily). All denied non-compliance; drug and dietary interference with LT4 absorption and nephrotic syndrome were excluded. Two patients with autoimmune hypothyroidism underwent absorption test with their last daily LT4 dose as loading dose (700 and 200 μg) followed by hourly free T4 (fT4) determination for 6 hours, after an overnight fast. In one fT4 remained stable during the test (maximum fT4 increase +10% from baseline levels) indicating true malabsorption. New absorption test with combination of LT4 and ascorbic acid resulted in a fT4 raise +139% and further investigation revealed achlorhydria due to pernicious anaemia. The patient was treated with LT4 400μg x 2, Liothyronine 40μg x 2 and vitamin C in high doses. In the other patient, fT4 rose to maximum +71% from baseline 6 hours after the loading dose intake. She was diagnosed with pseudomalabsorption and became compliant and biochemically euthyroid with 150 μg/day LT4. Another two patients (1 with autoimmune, 1 with hypothyroidism after total thyroidectomy) underwent absorption test with a weight-adjusted weekly fasting LT4 dose (1,6 μg/kg of the body weight X 7) followed by hourly fT4 measurement for 5 hours. Peak fT4 reached a level of +290% and +309% of the baseline fT4 levels, respectively, 3 hours after administration of the dose. Both patients had pseudomalabsorption. They continued to deny non-compliance and were treated with once weekly supervised weight-adjusted LT4 over 6 consecutive weeks, resulting in TSH normalization. Pseudomalabsorption should be ruled out with LT4 absorption test in patients suspected of non-compliance with LT4 treatment, after drug/dietary interference, nephrotic syndrome and intestinal malabsorption are excluded. Different absorption protocols have been suggested with different loading doses (standard or weight-adjusted) and different duration (rapid 2-6 hours, long 5 weeks). An LT4 absorption peak with >70% increase in fT4 levels in 3 hours with a linear increase of fT4 in the first 1-1.5 hour is expected in the rapid test. In the long test normalization of TSH and fT4 is anticipated week 6 (1 week after the final dose). In case the patient remains non-compliant, treatment options include a single supervised weekly LT4 dose.

Fluid balance

2020 ◽  
pp. 353-362
Author(s):  
Anne Craig ◽  
Anthea Hatfield
Keyword(s):  
Pulmonary Oedema ◽  
Blood Volume ◽  
Cardiac Failure ◽  
Fluid Balance ◽  
Fluid Overload ◽  
The Body ◽  
Electrolyte Balance ◽  
Fluid Deficit ◽  
Extra Cellular Fluid ◽  
Fluid Compartments

This chapter will tell you how surgery affects fluid balance and how the body controls fluids. Fluid compartments in the body and the nature of fluids are described. Disorders of fluid balance, the use of fluids to restore blood volume, and extra cellular fluid volume are all discussed. Management of fluid deficit, fluid overload, and pulmonary oedema and how to correct electrolyte balance are all clearly set out. Recommendations for fluids after different types of surgery and fluids for patients with renal and cardiac failure are given.

Confronting the practice of surgery on differentiated thyroid cancer with current guidelines in Germany

2005 ◽  
Vol 44 (05) ◽  
pp. 185-191 ◽  
Author(s):  
H. Wieler ◽  
S. Birtel ◽  
E. Ostwald-Lenz ◽  
K. P. Kaiser ◽  
H. P. Becker ◽  
...  
Keyword(s):  
Thyroid Cancer ◽  
Differentiated Thyroid Cancer ◽  
Survival Rates ◽  
Perioperative Morbidity ◽  
Referral Hospitals ◽  
Principles Of Treatment ◽  
Current Guidelines ◽  
Papillary Microcarcinomas ◽  
Retrospective Multicenter Study

Summary:Aim: For the surgical therapy of differentiated thyroid cancer precise guidelines are applied by the German medical societies. In a retrospective multicenter study, we investigated the following issues: Are the current guidelines respected?. Is there a difference concerning the surgical radicalism and the outcome?. Does the perioperative morbidity increase with the higher radicalism of the procedure?. Patients, methods: Data gained from 102 patients from 17 regional referral hospitals who underwent surgery for thyroid cancer and a following radioiodine treatment (mean follow up: 42.7 [24-79] months) were analyzed. At least 71 criterias were analyzed in a SPSS file. Results: 46.1% of carcinomas were incidentally detected during goiter surgery. The thyroid cancer (papillary n = 78; follicular n = 24) occurred in 87% unilateral and in 13% bilateral. Papillary carcinomas <1 cm were detected in 25 cases; in five of these cases (20%) contralateral carcinomas <1 cm were found. There were significant differences concerning the surgical radicalism: a range from hemithyroidectomy to radical thyroidectomy with lateral neck dissection. Analysis of the histopathologic reports revealed that lymph node dissection was not performed according to guidelines in 55% of all patients. The perioperative morbidity was lower in departments with a high case load. The postoperative dysfunction of the recurrent laryngeal nerve (mean: 7.9% total / 4.9% nerves at risk) variated highly, depending on differences in radicalism and hospitals. Up to now these variations in surgical treatment have shown no differences in their outcome and survival rates, when followed by radioiodine therapy. Conclusion: Current surgical regimes did not follow the guidelines in more than 50% of all cases. This low acceptance has to be discussed. The actual discussion about principles of treatment regarding, the socalled papillary microcarcinomas (old term) has to be respected within the current guidelines.

Vorklinische Untersuchung zur Organverteilung und Strahlenbelastung von Radiojod-Jodlisurid

1991 ◽  
Vol 30 (04) ◽  
pp. 137-140
Author(s):  
H. Flade ◽  
B. Johannsen ◽  
V. Pink ◽  
U. Herold ◽  
R. Harhammer ◽  
...  
Keyword(s):  
Radiation Dose ◽  
The Body ◽  
Organ Distribution ◽  
Clinical Use ◽  
Isolated Organs

The distribution in rats of 125l-iodolisuride was studied. Three rats each were sacrificed at fixed intervals between 5 min and 24 h p. i., and the radioactivity was measured in isolated organs and parts of the body. The organ distribution and biexponential blood disappearance were similar to values for unlabeled lisuride. The radiation dose was estimated for man assuming a 123l label. The resulting doses were comparable to those from other radiopharmaceuticals in clinical use.

Immunotherapy and potential predictive biomarkers in the treatment of neuroendocrine neoplasia

2020 ◽  
Author(s):  
Guanghui Xu ◽  
Yuhao Wang ◽  
Hushan Zhang ◽  
Xueke She ◽  
Jianjun Yang
Keyword(s):  
Current Knowledge ◽  
Checkpoint Inhibitors ◽  
Treatment Options ◽  
Predictive Biomarkers ◽  
The Body ◽  
Low Grade ◽  
Ablative Therapies ◽  
Cancer Types ◽  
New Treatment ◽  
Well Differentiated

Neuroendocrine neoplasias (NENs) are a heterogeneous group of rare tumors scattered throughout the body. Surgery, locoregional or ablative therapies as well as maintenance treatments are applied in well-differentiated, low-grade NENs, whereas cytotoxic chemotherapy is usually applied in high-grade neuroendocrine carcinomas. However, treatment options for patients with advanced or metastatic NENs are limited. Immunotherapy has provided new treatment approaches for many cancer types, including neuroendocrine tumors, but predictive biomarkers of immune checkpoint inhibitors (ICIs) in the treatment of NENs have not been fully reported. By reviewing the literature and international congress abstracts, we summarize the current knowledge of ICIs, potential predicative biomarkers in the treatment of NENs, implications and efficacy of ICIs as well as biomarkers for NENs of gastroenteropancreatic system, lung NENs and Merkel cell carcinoma in clinical practice.

scholarly journals Polymer-Drug Conjugates as Nanotheranostic Agents

2021 ◽  
Vol 2 (1) ◽  
pp. 63-81
Author(s):  
Sajana Manandhar ◽  
Erica Sjöholm ◽  
Johan Bobacka ◽  
Jessica M. Rosenholm ◽  
Kuldeep K. Bansal
Keyword(s):  
Drug Delivery ◽  
Drug Release ◽  
Treatment Options ◽  
The Body ◽  
Drug Conjugates ◽  
Imaging Characteristics ◽  
Wide Range ◽  
Systemic Side Effects ◽  
Theranostic Agents ◽  
The Stability

Since the last decade, the polymer-drug conjugate (PDC) approach has emerged as one of the most promising drug-delivery technologies owing to several benefits like circumventing premature drug release, offering controlled and targeted drug delivery, improving the stability, safety, and kinetics of conjugated drugs, and so forth. In recent years, PDC technology has advanced with the objective to further enhance the treatment outcomes by integrating nanotechnology and multifunctional characteristics into these systems. One such development is the ability of PDCs to act as theranostic agents, permitting simultaneous diagnosis and treatment options. Theranostic nanocarriers offer the opportunity to track the distribution of PDCs within the body and help to localize the diseased site. This characteristic is of particular interest, especially among those therapeutic approaches where external stimuli are supposed to be applied for abrupt drug release at the target site for localized delivery to avoid systemic side effects (e.g., Visudyne®). Thus, with the help of this review article, we are presenting the most recent updates in the domain of PDCs as nanotheranostic agents. Different methodologies utilized to design PDCs along with imaging characteristics and their applicability in a wide range of diseases, have been summarized in this article.

The Utility of Assessing Neck Acne

2016 ◽  
Vol 21 (1) ◽  
pp. 82-83
Author(s):  
Karishma Desai ◽  
Marc Philip Frey ◽  
Jerry Tan
Keyword(s):  
Treatment Options ◽  
The Body ◽  
Essential Component ◽  
Posterior Neck ◽  
Grading Scale ◽  
Lower Neck ◽  
Grading Scales ◽  
Facial Acne

Background: Acne grading is an essential component in establishing treatment options, but little is known on how neck acne should be incorporated into grading scales. Objective: Our objective was to explore the prevalence of neck acne and determine if its own severity category on an acne global grading scale was warranted. Methods: Acne severity was assessed in 6 categories: face, chest, back, anterior upper (AUN), anterior lower neck (ALN), and posterior neck (PN). Results: The overall prevalence of neck acne was 49%. Of these, 44% had AUN acne, 18.5% had ALN acne, and 19.8% had PN acne. AUN and facial acne had a significant correlation ( r = 0.37, P < .05). No correlation was seen amongst other areas. Males presented with a significantly higher severity of AUN (mean [SD], 1.37 [1.09]) than females (mean [SD], 0.52 [0.91]), on average. Conclusions: While neck acne has proven to be common amongst those with acne on other areas of the body, facial acne can be used as a proxy for classification, as neck severity is usually milder.

scholarly journals Clostridial Spores for Cancer Therapy: Targeting Solid Tumour Microenvironment

2012 ◽  
Vol 2012 ◽  
pp. 1-8 ◽  
Author(s):  
Brittany Umer ◽  
David Good ◽  
Jozef Anné ◽  
Wei Duan ◽  
Ming Q. Wei
Keyword(s):  
Cancer Therapy ◽  
Solid Tumour ◽  
Early Stage ◽  
Treatment Options ◽  
Anaerobic Bacteria ◽  
Past Research ◽  
Tumour Microenvironment ◽  
The Body ◽  
Solid Tumours ◽  
Current Status

Solid tumour accounts for 90% of all cancers. The current treatment approach for most solid tumours is surgery, however it is limited to early stage tumours. Other treatment options such as chemotherapy and radiotherapy are non-selective, thus causing damage to both healthy and cancerous tissue. Past research has focused on understanding tumour cells themselves, and conventional wisdom has aimed at targeting these cells directly. Recent research has shifted towards understanding the tumour microenvironment and it’s differences from that of healthy cells/tissues in the body and then to exploit these differences for treatmeat of the tumour. One such approach is utilizing anaerobic bacteria. Several strains of bacteria have been shown to selectively colonize in solid tumours, making them valuable tools for selective tumour targeting and destruction. Amongst them, the anaerobicClostridiumhas shown great potential in penetration and colonization of the hypoxic and necrotic areas of the tumour microenvironment, causing significant oncolysis as well as enabling the delivery of therapeutics directly to the tumourin situ. Various strategies utilizingClostridiumare currently being investigated, and represent a novel area of emerging cancer therapy. This review provides an update review of tumour microenvironment as well as summary of the progresses and current status of Clostridial spore-based cancer therapies.

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