scholarly journals Short-Term Treatment With Teriparatide Restores Independent Ambulation in a Patient With Glucocorticoid-Induced Osteonecrosis of the Knees and Ankles

2021 ◽  
Vol 5 (Supplement_1) ◽  
pp. A222-A222
Author(s):  
Xin Chen ◽  
Mizuho Mimoto
Keyword(s):  
Weight Bearing ◽  
Distal Tibia ◽  
Viral Myocarditis ◽  
Osteonecrosis Of The Jaw ◽  
Term Treatment ◽  
Short Term Treatment ◽  
Left Femur ◽  
Independent Ambulation ◽  
One Year ◽  
The Right

Abstract Teriparatide is a well-established treatment for osteoporosis. It is emerging as a promising treatment for osteonecrosis of the jaw and may be superior to alendronate for treating glucocorticoid-induced osteonecrosis of the femoral head and reduce collapse progression. However, few studies have investigated its efficacy in treating steroid-induced osteonecrosis affecting other sites such as the knee and ankle. Osteonecrosis treatment at these sites in early stages is limited to protected weight bearing and pain management. Surgical management is required for advanced stages. This case describes an unusual presentation of steroid-induced osteonecrosis in the bilateral lower extremities and illustrates the potential benefit of teriparatide as an alternative to surgery in managing this debilitating condition. A 25-year-old male with a history of a heart transplant for viral myocarditis was admitted to the hospital for severe bilateral lower extremity pain. His post-transplant course was complicated by giant cell myocarditis, treated with a prednisone taper from 80 mg to 7.5 mg daily over the course of one year. MRI showed diffuse osteonecrosis in the distal femora, medial femoral condyles, bilateral proximal tibias, left distal tibia, and bilateral ankles. A bone density test showed only mildly low bone mass with Z-scores of -0.8 at the right femur, -1.3 at the left femur and -1.3 at the lumbar spine. Due to progressive osteonecrosis on imaging and a decline in functional status over the next two months, following a discussion of risks, benefits and alternatives, he was started on daily teriparatide injections. Prior to therapy, he was using a walker and had difficulty ambulating more than a few feet. Within a month of teriparatide initiation, he reported improvement in both pain and mobility, and was able to walk independently into clinic. MRI two months later demonstrated no new lesions and significant improvement in previously necrotic areas. Our case highlights the importance of considering osteonecrosis at atypical locations in patients on chronic glucocorticoid therapy. It also demonstrates a promising role for teriparatide in treating steroid-induced osteonecrosis atypical sites and without concurrent osteoporosis.

scholarly journals Mitochondrial and Oxidative Impacts of Short and Long-term Administration of HAART on HIV Patients

2020 ◽  
Vol 15 (2) ◽  
pp. 110-124
Author(s):  
Joy E. Ikekpeazu ◽  
Oliver C. Orji ◽  
Ikenna K. Uchendu ◽  
Lawrence U.S. Ezeanyika
Keyword(s):  
Treatment Group ◽  
Term Treatment ◽  
Short Term ◽  
Short Term Treatment ◽  
Hiv Patients ◽  
Long Term Treatment ◽  
Term Administration ◽  
Short And Long Term ◽  
One Year

Background and Objective: There may be a possible link between the use of HAART and oxidative stress-related mitochondrial dysfunction in HIV patients. We evaluated the mitochondrial and oxidative impacts of short and long-term administration of HAART on HIV patients attending the Enugu State University Teaching (ESUT) Hospital, Enugu, Nigeria following short and long-term therapy. Methods: 96 patients categorized into four groups of 24 individuals were recruited for the study. Group 1 comprised of age-matched, apparently healthy, sero-negative individuals (the No HIV group); group 2 consisted of HIV sero-positive individuals who had not started any form of treatment (the Treatment naïve group). Individuals in group 3 were known HIV patients on HAART for less than one year (Short-term treatment group), while group 4 comprised of HIV patients on HAART for more than one year (Long-term treatment group). All patients were aged between 18 to 60 years and attended the HIV clinic at the time of the study. Determination of total antioxidant status (TAS in nmol/l), malondialdehyde (MDA in mmol/l), CD4+ count in cells/μl, and genomic studies were all done using standard operative procedures. Results: We found that the long-term treatment group had significantly raised the levels of MDA, as well as significantly diminished TAS compared to the Short-term treatment and No HIV groups (P<0.05). In addition, there was significantly elevated variation in the copy number of mitochondrial genes (mtDNA: D-loop, ATPase 8, TRNALEU uur) in the long-term treatment group. Interpretation and Conclusion: Long-term treatment with HAART increases oxidative stress and causes mitochondrial alterations in HIV patients.

Rupture of the quadriceps tendon

2009 ◽  
Vol 22 (01) ◽  
pp. 74-80 ◽  
Author(s):  
T. Dembour ◽  
H. Gallois Bride ◽  
J. L. Chancrin ◽  
F. Arnault
Keyword(s):  
Tendon Rupture ◽  
Systemic Disease ◽  
Weight Bearing ◽  
Quadriceps Tendon ◽  
Drill Hole ◽  
Quadriceps Tendon Rupture ◽  
Loop Pattern ◽  
Traumatic Origin ◽  
One Year ◽  
The Right

SummaryA five-month-old, male, 16 kg, mixed breed dog was presented for an acute non-weight bearing lameness of the right hind limb. A subtotal avulsion of the quadriceps tendon at its patellar insertion was diagnosed through radiography and ultrasonography. Two nylon sutures secured with a stainless steel crimp were placed in a locking loop pattern in the quadriceps tendon and through a transverse 2.7 mm drill-hole in the patella. No external coaptation was used postoperatively. A full functional recovery was observed, and was followed for one year postoperatively. Quadriceps tendon rupture has not been described in the veterinary literature to our knowledge; in humans, quadriceps tendon rupture is a well known entity, often due to systemic disease resulting in weakening of the tendinous structures. In the case presented herein, the dog’s history, young age and location, without underlying biochemical abnormalities, led us to believe that the observed lesion was of traumatic origin. The surgical treatment performed was based on that performed in humans and also that which has been investigated experimentally in the dog.

scholarly journals Effectiveness of a Short-Term Treatment of Oxygen-Ozone Therapy into Healing in a Posttraumatic Wound

2016 ◽  
Vol 2016 ◽  
pp. 1-5 ◽  
Author(s):  
Irene Degli Agosti ◽  
Elena Ginelli ◽  
Bruno Mazzacane ◽  
Gabriella Peroni ◽  
Sandra Bianco ◽  
...  
Keyword(s):  
Oxygen Free Radicals ◽  
Antibacterial Properties ◽  
Term Treatment ◽  
Ozone Therapy ◽  
Short Term ◽  
Short Term Treatment ◽  
Case Presentation ◽  
Appropriate Treatment ◽  
The Right ◽  
Free Radicals Scavenging

Introduction. A number of studies suggest that oxygen-ozone therapy may have a role in the treatment of chronic, nonhealing, or ischemic wounds for its disinfectant and antibacterial properties. Nonhealing wounds are a significant cause of morbidity. Here we present a case of subcutaneous oxygen-ozone therapy used to treat a nonhealing postoperative wound in a young man during a period of 5 weeks.Case Presentation. A 46-year-old man had a motorcycle accident and underwent amputation of the right tibia and fibula. At the discharge he came to our attention to start rehabilitation treatment. At that time the wound was ulcerated but it was afebrile with no signs of inflammation and negativity to blood tests. At 2 months from the trauma despite appropriate treatment and dressing, the wound was slowly improving and the patient complained of pain. For this reason in addition to standard dressing he underwent oxygen-ozone therapy. After 5 weeks of treatment the wound had healed.Conclusion. In patients with nonhealing wounds, oxygen-ozone therapy could be helpful in speeding the healing and reducing the pain thanks to its disinfectant property and by the increase of endogenous oxygen free radicals’ scavenging properties. Compared to standard dressing and other treatments reported in the literature it showed a shorter time of action.

Treatment of Probable Vogt-Koyanagi-Harada with Single Intravitreal Triamcinolone Acetonide

2020 ◽  
Author(s):  
Meghana Kalavar ◽  
Nimesh A Patel ◽  
Hasenin Al-Khersan ◽  
Anibal Ale ◽  
Nicolas A Yannuzzi ◽  
...  
Keyword(s):  
Triamcinolone Acetonide ◽  
Subretinal Fluid ◽  
Term Treatment ◽  
Short Term Treatment ◽  
Intravitreal Triamcinolone ◽  
Full Field ◽  
Intravitreal Triamcinolone Acetonide ◽  
Ocular Manifestations ◽  
History Of ◽  
The Right

Abstract Background A 36-year-old woman with a history of poorly controlled diabetes was diagnosed with probable Vogt-Koyanagi-Harada (VKH). We are reporting the use of intravitreal triamcinolone acetonide (0.4 mg) to both eyes to successfully treat the ocular manifestations of VKH.Findings Nine days after injection, subretinal fluid in the right eye improved and 13 days later, the serous detachment had almost completely resolved. One month after injections, both the right and left eye showed decreased leakage and fewer punctate lesions on fluorescein angiography. Ocular examination remained stable other than development of ocular hypertension bilaterally, which was treated with topical hypertensive drops. Two years later, patient developed a cataract in the right eye, for which the patient underwent phacoemulsification. Three years after treatment, visual acuity remains 20/20 while imaging studies and bilateral full field electroretinogram remained normal.Conclusion Intravitreal steroids can be considered as treatment in VKH in situations where systemic corticosteroids are contraindicated, such as patients with a history of poorly controlled diabetes. Complications of local steroids need to be carefully considered, even after a single injection. In some patients short-term treatment of VKH with local corticosteroid may result in long-term visual stability.

Long-term cimetidine for duodenal ulceration?

1982 ◽  
Vol 20 (8) ◽  
pp. 31-32
Keyword(s):  
Standard Dose ◽  
Term Treatment ◽  
Duodenal Ulceration ◽  
Intermittent Therapy ◽  
Short Term Treatment ◽  
History Of ◽  
Symptomatic Remission ◽  
One Year ◽  
Do So

Duodenal ulceration is a chronic disease in which patients relapse with varying frequency over perhaps 10 years or so.1 Although about 70% of ulcers heal on cimetidine 1 g/day given for four to six weeks, such short-term treatment does not alter the subsequent natural history of the illness.2–4 About 65% of patients relapse within one year of stopping cimetidine as judged on symptoms alone,2 and about 80% do so if the assessment includes regular endoscopy.5 It is not yet known whether the maintenance of endoscopic, as opposed to symptomatic, remission is important, nor whether it is practicable, but it might prevent complications in patients who have already suffered a perforation or haemorrhage. The frequency of relapses cannot however be predicted. If cimetidine is to be used in the long term what regimen should be recommended? Two have been tried: (1) to give it continuously in a smaller dose to try to prevent relapse (maintenance therapy); (2) to give the standard dose for four to six weeks for each relapse and then stop (intermittent therapy).

Abstract 15082: Repolarization Vulnerability is Rarely Observed in COVID-19 Patients With Low Comorbidity Treated With a Combination of Hydroxychloroquine Azithromycin

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
David E Goldgrab ◽  
Sokol Kalaveshi ◽  
Ruifang Yang ◽  
Mauricio Gomez ◽  
Jearim Craig ◽  
...  
Keyword(s):  
Torsades De Pointes ◽  
Term Treatment ◽  
Chronic Obstructive ◽  
Healthy Population ◽  
Close Monitoring ◽  
Qtc Interval ◽  
Short Term Treatment ◽  
Obstructive Pulmonary Disease ◽  
Artery Disease ◽  
The Right

Background: Global pandemic of COVID-19 has attracted a number of proposed treatment therapies. Hydroxychloroquine/Azithromycin (HA) combination has been reported to potentially affect repolarization by prolonging the QTc and causing torsades de pointes (TdP). Methods: We prospectively followed hospitalized patients with PCR confirmed COVID-19. Hydroxychloroquine was administered 400mg twice daily on day 1 and daily for the last 4 days plus daily Azithromycin 250mg. QTc interval was measured via 12 lead ECG prior to initiation of therapy, 3 hours post second dose of hydroxychloroquine, and subsequent daily QTc evaluation via telemetry. Potassium and magnesium were checked daily and replaced accordingly. QTc prolonging medications were discontinued when possible. Results: Sixteen patients were followed for 5 days, 56% were male with average age of 67. Comorbidities were 31% coronary artery disease, 31% diabetes mellitus, 13% congestive heart failure, 69% hypertension, 19% chronic obstructive pulmonary disease, 25% atrial fibrillation, and average BMI of 29. Average Tisdale score was 11/21. Mean QTc prior to HA therapy was 442 ms, 3 hours post second dose 429 ms and on day 5 was 441 ms with a change of (-)3ms compared to prior starting therapy as seen in figures below. Fifteen patients recovered and 1 patient expired. Twenty five percent of patients required ET intubation and mechanical ventilation. Zero patients required stopping of HA therapy. Only 1 patient required 2 extra days of QTc monitoring due to 5th day QTc being 504ms. Conclusion In acutely infected COVID-19 patients with limited comorbidities, repolarization/risk for TdP appears to be low in the presence of HA. With close monitoring and the right patient population, this combination therapy for short term treatment appears to be safe in regards to QTc and the risk for TdP. Although larger published studies have shown repolarization risk, we did not find that to be the case in our relatively healthy population.

Intracerebral pneumocephalus and hemiparesis as a complication of a halo vest in a patient with multiple myeloma

2004 ◽  
Vol 100 (4) ◽  
pp. 367-371 ◽  
Author(s):  
Yasushi Hashimoto ◽  
Minoru Doita ◽  
Keiichiro Hasuda ◽  
Kazuyoshi Korosue
Keyword(s):  
Multiple Myeloma ◽  
Parietal Lobe ◽  
Late Onset ◽  
Term Treatment ◽  
Short Term Treatment ◽  
Halo Vest ◽  
Content Type ◽  
Increased Risk ◽  
Pin Site ◽  
The Right

✓ A halo orthosis is often used to immobilize the cervical spine after severe injury in patients who cannot tolerate surgery. Although complications such as pin loosening or brain abscess have been reported, there are no reported cases of hemiparesis following pneumocephalus associated with halo use. The authors report the case of a 77-year-old man with multiple myeloma who, after undergoing halo vest therapy and chemotherapy, suddenly developed hemiparesis and speech disturbance. Diagnostic neuroimaging demonstrated penetration of the inner table at the right posterior pin site and intracerebral pneumocephalus at the parietal lobe. Intraoperative inspection revealed only air and no purulent materials or cerebrospinal fluid in the cystic lesion. When a halo device is used, attention to detail in pin application, maintenance, and proper pin-site care must be undertaken to minimize complications. The tightening of the pin in cases in which late-onset loosening has occurred should not be performed. Additionally, because late loosening of the pin and pin-site infection increase the risks of complications, a halo vest should be used only as a short-term treatment, and the clinician should be aware of the possible increased risk of serious complications such as pneumocephalus or subdural abscess formation.

scholarly journals Short-Term Bisphosphonate Therapy Could Ameliorate Osteonecrosis: A Complication in Childhood Hematologic Malignancies

2010 ◽  
Vol 2010 ◽  
pp. 1-5 ◽  
Author(s):  
N. A. Greggio ◽  
M. Pillon ◽  
E. Varotto ◽  
A. Zanin ◽  
E. Talenti ◽  
...  
Keyword(s):  
Childhood Leukemia ◽  
Lymphoblastic Leukemia ◽  
Weight Bearing ◽  
Hematologic Malignancies ◽  
Term Treatment ◽  
Bisphosphonate Therapy ◽  
Cumulative Exposure ◽  
Short Term ◽  
Short Term Treatment ◽  
Femoral Head Osteonecrosis

Osteonecrosis (ON) is a critical complication in the treatment of childhood leukemia and lymphoma. It particularly affects survivors of acute lymphoblastic leukemia and non-Hodgkin lymphoma reflecting the cumulative exposure to glucocorticosteroid therapy. ON is often multiarticular and bilateral, specially affecting weight-bearing joints. A conventional approach suggests a surgical intervention even if pharmacological options have also recently been investigated. We reported two cases of long time steroid-treated patients who underwent Bone Marrow Transplantation (BMT) for hematological disease. Both patients developed femoral head osteonecrosis (ON) that was diagnosed by magnetic resonance imaging (MRI) and the ON was also accompanied with pain and a limp. Despite of the conventional strategies of therapy, we successfully started a short-term treatment with bisphosphonates in order to decrease the pain and the risk of fracture.

scholarly journals A Comparison of Short-Term Treatment Effects of Intravenous Sodium Amytal-Methedrine and LSD in the Alcoholic

1970 ◽  
Vol 15 (5) ◽  
pp. 493-497 ◽  
Author(s):  
F.G. Johnson
Keyword(s):  
Term Treatment ◽  
Short Term ◽  
Short Term Treatment ◽  
Improvement Rate ◽  
Treatment Conditions ◽  
Affective Experiences ◽  
One Year ◽  
Pronounced Reduction

Lysergic acid diethylamide (L.S.D.), given with and without a therapist present, is compared with sodium amylobarbitone-methedrine (S.A.M.), given with á therapist present, as abreactive agents in the treatment of alcoholism. Somatic, cognitive and affective experiences under the different treatment conditions are compared. L.S.D. produced a different quality of response from S.A.M. in many respects, but approximately half the patients in all categories noted a pronounced reduction of tension and depression following the experience. This short-term effect is contrasted with long-term (one year) absence of a significantly greater improvement rate with these drugs than with routine clinic treatment. The significance of these findings is discussed.

Sign in / Sign up

Export Citation Format

Share Document