scholarly journals Desperate Times Call for Desperate Measures: Use of Continuous Subcutaneous 1-34 PTH Infusion for Postsurgical Hypoparathyroidism

2021 ◽  
Vol 2021 ◽  
pp. 1-4
Author(s):  
Adnan Haider ◽  
Oksana Symczyk ◽  
Yadel Couso ◽  
Taylor Cater ◽  
Sheree Bryan
Keyword(s):  
Clinical Presentation ◽  
Medication Compliance ◽  
Calcium Supplementation ◽  
Graves Disease ◽  
Biochemical Control ◽  
Subcutaneous Infusion ◽  
Continuous Subcutaneous Infusion ◽  
Before And After ◽  
Daily Serving

Objective. This case highlights use of 1-34 PTH continuous infusion in a patient with postsurgical hypoparathyroidism. Method. Clinical presentation and biochemical profile were monitored before and after 1-34 PTH infusion, with notable reduction in pill burden in a patient with postsurgical hypoparathyroidism. Results. We present a case of postsurgical hypoparathyroidism following thyroidectomy for Graves disease. The patient was requiring a total of 34 pills daily and, despite medication compliance, her clinical and biochemical control was unsatisfactory. Following initiation of 1-34 PTH in the form of a subcutaneous pump, we were able to stop all calcium supplementation and reduce calcitriol to 0.5 mcg daily. Her current biochemical control as well as quality of life improved significantly on CSPI, calcitriol, and a daily serving of dietary calcium. Conclusion. This case highlights the use of 1-34 PTH either as twice-daily dosing or continuous subcutaneous infusion for adult patients with hypoparathyroidism.

Clinical Study of Percutaneous Puncture Radiofrequency Ablation Guided by CT Image Information Technology in Patients with Secondary Hyperparathyroidism of Uremia

2021 ◽  
Vol 11 (1) ◽  
pp. 174-178
Author(s):  
Chunqin Pan ◽  
Xuecai Zhou ◽  
Wenzhong Sun ◽  
Dou Fu ◽  
Jie Liu
Keyword(s):  
Radiofrequency Ablation ◽  
Secondary Hyperparathyroidism ◽  
Clinical Symptoms ◽  
Calcium Supplementation ◽  
Percutaneous Radiofrequency Ablation ◽  
Ct Guided ◽  
Before And After ◽  
Preoperative Ct ◽  
Renal Bone Disease

Objective: To investigate the effectiveness and safety of CT-guided percutaneous radiofrequency ablation for the treatment of secondary hyperparathyroidism (SHPT) in chronic renal failure. Methods: Thirty patients with SHPT in our hospital were selected as the study subjects. Preoperative CT examinations confirmed that there were 1 to 4 hyperplastic parathyroid tissues. Under the guidance of CT, radiofrequency ablation of the hyperplastic parathyroid tissues was performed to detect ablation The levels of PTH, blood Ca, and blood P before and after 10 min, 1 d, 1 week, 1 month, 6 months, and 1 year of ablation were observed to observe the improvement of clinical symptoms and the occurrence of complications. Results: First, the patients' blood PTH levels at 10 min, 1 d, 1 week, 1 month, 6 months, and 1 year after ablation were significantly lower than those before the ablation (P < 0.05); 10 min, 1 d, Blood Ca levels at 1 week, 1 month, 6 months, and 1 year were significantly lower than those before ablation (P < 0.05); 10 min, 1 d, 1 week, 1 month, 6 months, and 1 month after ablation The blood P level in 2015 was significantly lower than that before ablation (P < 0.05). Second, the symptoms of bone pain, itching of the skin, muscle weakness, and anorexia were significantly improved after ablation, and hoarseness occurred in 3 cases. The rate was 10%, all of which remitted spontaneously within 1 week after operation; 2 cases of severe hypocalcemia occurred with a rate of 6.6%. All patients had remission after timely calcium supplementation, and all patients did not relapse. Conclusion: CT-guided percutaneous radiofrequency ablation is a safe and effective method for the treatment of SHPT, which can significantly improve the symptoms of renal bone disease and improve the quality of life.

scholarly journals Quality-of-Life Outcomes in Graves Disease Patients after Total Thyroidectomy

2017 ◽  
Vol 96 (4-5) ◽  
pp. E8-E9 ◽  
Author(s):  
Lukas H. Kus ◽  
Wilma M. Hopman ◽  
Ian J. Witterick ◽  
Jeremy L. FreemanFreemanFreeman
Keyword(s):  
Quality Of Life ◽  
Total Thyroidectomy ◽  
High Volume ◽  
Nonparametric Tests ◽  
Substantial Improvement ◽  
Graves Disease ◽  
Rapid Improvement ◽  
Tertiary Referral Center ◽  
Before And After

Historically, research into surgical treatment of Graves disease has assessed subtotal rather than total thyroidectomy. Most clinicians now recommend total thyroidectomy, but little information is available regarding quality-of-life (QOL) outcomes for this procedure. Our aim was to assess QOL after total thyroidectomy. This is a retrospective, pilot study of patients with Graves disease who underwent total thyroidectomy from 1991 to 2007 at a high-volume tertiary referral center in Toronto, Canada. Questionnaires addressing disease-specific symptoms and global QOL concerns were sent to 54 patients. Analyses included parametric and nonparametric tests to assess the differences between perception of symptoms and global QOL before and after surgery. Forty patients responded (response rate: 74%) at a median of 4.8 years postoperatively. On a 10-point scale, overall wellness improved from 4.1 pre-operatively to 8.7 postoperatively (p < 0.001). Patients recalled missing less work or school after surgery (7.8 vs. 1.1 days/year; p = 0.001). Overall satisfaction with the procedure was high. On average, symptoms improved within 32 days of surgery, and all symptoms showed substantial improvement. This is the first North American study to assess QOL outcomes of patients with Graves disease after total thyroidectomy. Patients experienced marked and rapid improvement in QOL postoperatively. These findings suggest that total thyroidectomy is a safe and effective treatment.

scholarly journals Continuous subcutaneous infusion of somatostatin analogues in the treatment of congenital hyperinsulinism

2020 ◽  
Vol 66 (3) ◽  
pp. 81-87
Author(s):  
Maria A. Melikyan ◽  
Diliara N. Gubaeva ◽  
Maria A. Kareva
Keyword(s):  
Quality Of Life ◽  
Pediatric Patients ◽  
Research Centre ◽  
Infusion Therapy ◽  
Congenital Hyperinsulinism ◽  
Intravenous Glucose ◽  
Subcutaneous Infusion ◽  
Number Of Patients ◽  
Continuous Subcutaneous Infusion

BACKGROUND: Congenital hyperinsulinism (CHI) is a severe disease with a high risk of development of neurological complications due to persistent hypoglycemia. The use of an analog of somatostatin (octreotide) in patients with the resistance to the first-line drug allows to avoid surgical intervention. However, the octreotide is currently used in the form of frequent fractional injections due to the short duration of its effect. We present in this article our own experience of using octreotide in continuous subcutaneous infusion in pediatric patients in order to improve the quality of life. AIM To evaluate the efficiency and safety of the regime of continuous subcutaneous infusion of octreotide with the use of micro-dispensers (pumps) in children with diazoxide-resistant course of CHI. MATERIALS AND METHODS: An observational single-centre dynamic research was carried out on the basis of the Federal State Budgetary Institution Endocrinology Research Centre of the Ministry of Health of the Russian Federation. The study included pediatric patients with CHI and proven diazoxide-resistant course who were initially treated with octreotide in the form of intermittent subcutaneous injections. The researches compared the indicants of efficiency and safety of therapy on treatment of intermittent injections and after transfer to continuous subcutaneous infusion of the drug. The duration of each method of administration was at least 2 weeks. RESULTS: 16 patients took part in the research. The median for the total duration of octreotide usage in the examined patients was 3 months. According to the results of the work, the use of micro-dispensers for continuous subcutaneous administration of octreotide allowed to reduce the number of patients with episodes of hypoglycemia for more than 4 times (13/16 vs. 3/16); p=0,001). Also, there was a significant decrease in the number of patients with hyperglycemic episodes (4/16 vs. 0/16); p=0.000) and reduced dose of intravenous glucose (6.8 vs 5.2 mg/kg/min; p=0.042) as a result of continuous therapy, which indicates the advantages of smooth continuous administration comparing to single injections. We have not detected any significant side effects of the treatment. Elevated liver enzyme levels, dyspeptic symptoms and gallstone formation in some patients did not require cancellation of therapy. There were no hormonal disorders in the form of hypothyroidism and somatotropic hormone deficiency against the background of continuous octreotide infusion. CONCLUSIONS: Thus, the use of octreotide in patients with diazoxide-resistant course of СHI in continuous subcutaneous infusion using pumps has a number of advantages over the standard method of intermittent subcutaneous injection. This method of administration allows to achieve better glycemic control and reduce the risks from infusion therapy with highly concentrated glucose solutions, which undoubtedly improves the quality of life of patients.

Mid-aortic syndrome: computed tomography angiography depicting extensive collateral circulation in an 11-year-old patient with thoracoabdominal aortic coarctation

VASA ◽  
2012 ◽  
Vol 41 (2) ◽  
pp. 132-135 ◽  
Author(s):  
Krohn ◽  
Gebauer ◽  
Hübler ◽  
Beck
Keyword(s):  
Computed Tomography ◽  
Computed Tomography Angiography ◽  
Collateral Circulation ◽  
Intestinal Ischemia ◽  
Clinical Presentation ◽  
Lower Limbs ◽  
Upper Body ◽  
Descending Aorta ◽  
Before And After ◽  
Blood Pressures

The mid-aortic syndrome is an uncommon clinical condition characterized by severe narrowing of the descending aorta, usually with involvement of its renal and visceral branches, presenting with uncontrollably elevated blood pressures of the upper body, renal and cardiac failure, intestinal ischemia, encephalopathy symptoms and claudication of the lower limbs, although clinical presentation is variable. In this article we report the case of an eleven-year-old patient with the initial diagnosis of a mid-aortic syndrome and present the computed tomography angiography pictures and reconstructions before and after surgical therapy.

Anticoagulation by Constant Subcutaneous Heparin Infusion

1982 ◽  
Vol 47 (01) ◽  
pp. 001-002 ◽  
Author(s):  
Nenita Parrilla ◽  
Jack Ansell
Keyword(s):  
Clinical Trial ◽  
Impedance Plethysmography ◽  
High Dose ◽  
Intravenous Therapy ◽  
Heparin Dose ◽  
Heparin Infusion ◽  
Subcutaneous Infusion ◽  
Subcutaneous Heparin ◽  
Therapeutic Anticoagulation ◽  
Continuous Subcutaneous Infusion

SummaryA preliminary clinical trial was conducted to determine the feasibility of achieving and regulating therapeutic anticoagulation with heparin given by continuous subcutaneous infusion. Five patients with deep venous thrombosis confirmed by impedance plethysmography and/or venography were studied. All patients received an initial heparin dose of 5000 units by IV bolus. This was followed by a continuous subcutaneous heparin infusion at a dose of 15 to 25 units per kilogram per hour. Effective levels of anticoagulation were achieved in all five patients. Regulation and maintenance of therapeutic anticoagulation were no more difficult than with intravenous therapy. No major complications were encountered during therapy.Continuous subcutaneous infusion of heparin may have advantages over standard intravenous therapy or high dose intermittent subcutaneous therapy. However, more extensive clinical evaluation is warranted.

Malignant Gastrointestinal Obstruction: Options for Decompression and Nutrition

2020 ◽  
Vol 04 (03) ◽  
pp. 311-322
Author(s):  
Robert J. Litwin ◽  
Johanna L. Chan ◽  
Steven Y. Huang
Keyword(s):  
Clinical Presentation ◽  
Practice Patterns ◽  
Patient Care Team ◽  
Therapeutic Interventions ◽  
Collaborative Approach ◽  
Malignant Bowel Obstruction ◽  
Advanced Malignancy ◽  
Gastrointestinal Obstruction ◽  
Malignant Gastrointestinal Obstruction

AbstractMalignant bowel obstruction (MBO) is a relatively common condition affecting patients with advanced malignancy. Therapeutic interventions should be aimed at maintaining quality of life. Given the lack of prospective controlled studies in this patient population, patient management is often based on local practice patterns and anecdotal experience. To foster a collaborative approach among the members of the patient care team involving internal medicine, oncology, palliative care, clinical nutrition, surgery, gastroenterology, and interventional radiology physicians, it is important to improve our understanding of MBO. The purpose of this article is to describe the clinical presentation, pathophysiology, as well as medical, surgical, and nonsurgical palliative options available to patients with MBO for purposes of decompression and nutrition.

Kepuasan Masyarakat Terhadap Pelayanan Kelurahan Setelah Pemekaran Di Tangerang Selatan

Liquidity ◽  
2018 ◽  
Vol 2 (2) ◽  
pp. 151-159
Author(s):  
Pitri Yandri
Keyword(s):  
Public Perception ◽  
Service Personnel ◽  
Urban Services ◽  
Hospitality Workers ◽  
Care Workers ◽  
Before And After ◽  
Cartesian Diagram ◽  
Better Than

The purpose of this study is (1) to analyze public perception on urban services before and after the expansion of the region, (2) analyze the level of people's satisfaction with urban services, and (3) analyze the determinants of the variables that determine what level of people's satisfaction urban services. This study concluded that first, after the expansion, the quality of urban services in South Tangerang City is better than before. Secondly, however, public satisfaction with the services only reached 48.53% (poor scale). Third, by using a Cartesian Diagram, the second priority that must be addressed are: (1) clarity of service personnel, (2) the discipline of service personnel, (3) responsibility for care workers; (4) the speed of service, (5) the ability of officers services, (6) obtain justice services, and (7) the courtesy and hospitality workers.

Strategic Role of Zakat in Multidimensional Quality of Life in Sijunjung, Indonesia

2018 ◽  
Vol 15 (1) ◽  
pp. 55-72
Author(s):  
Herlin Hamimi ◽  
Abdul Ghafar Ismail ◽  
Muhammad Hasbi Zaenal
Keyword(s):  
Quality Of Life ◽  
Positive Impact ◽  
Wealth Distribution ◽  
Absolute Poverty ◽  
Before And After ◽  
The Status ◽  
Being There ◽  
The Impact

Zakat is one of the five pillars of Islam which has a function of faith, social and economic functions. Muslims who can pay zakat are required to give at least 2.5 per cent of their wealth. The problem of poverty prevalent in disadvantaged regions because of the difficulty of access to information and communication led to a gap that is so high in wealth and resources. The instrument of zakat provides a paradigm in the achievement of equitable wealth distribution and healthy circulation. Zakat potentially offers a better life and improves the quality of human being. There is a human quality improvement not only in economic terms but also in spiritual terms such as improving religiousity. This study aims to examine the role of zakat to alleviate humanitarian issues in disadvantaged regions such as Sijunjung, one of zakat beneficiaries and impoverished areas in Indonesia. The researcher attempted a Cibest method to capture the impact of zakat beneficiaries before and after becoming a member of Zakat Community Development (ZCD) Program in material and spiritual value. The overall analysis shows that zakat has a positive impact on disadvantaged regions development and enhance the quality of life of the community. There is an improvement in the average of mustahik household incomes after becoming a member of ZCD Program. Cibest model demonstrates that material, spiritual, and absolute poverty index decreased by 10, 5, and 6 per cent. Meanwhile, the welfare index is increased by 21 per cent. These findings have significant implications for developing the quality of life in disadvantaged regions in Sijunjung. Therefore, zakat is one of the instruments to change the status of disadvantaged areas to be equivalent to other areas.

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