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.

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.

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 Leg Ulcer in Patient with Sickle Cell Disease on Hydroxyurea

2020 ◽  
Vol 4 (1) ◽  
pp. 13-15
Author(s):  
Jaya Manjunath ◽  
◽  
Fnu Nutan ◽  
Keyword(s):  
Sickle Cell Disease ◽  
Sickle Cell ◽  
Future Study ◽  
Alternative Treatment ◽  
Wound Care ◽  
Leg Ulcers ◽  
Cell Disease ◽  
History Of ◽  
Work Up

Leg ulcers are a painful side-effect commonly seen in patients with long-term use of hydroxyurea. We describe an ulcer in a patient with sickle cell disease (SCD) with an 8-year history of hydroxyurea use. Wound care team used cadexomer-iodine topical and collagenase to aid in healing. There are limited options for the treatment of these ulcers beside the cessation of hydroxyurea, a very effective drug in reducing painful sickle cell episodes. It is imperative to be aware of this complication to prevent expensive tests and further work up. Future study into alternative treatment of hydroxyurea-induced leg ulcers for sickle cell patients is necessary.

Skin Grafting Followed by Low-Molecular-Weight Heparin Long-Term Therapy in Chronic Venous Leg Ulcers

2012 ◽  
Vol 26 (2) ◽  
pp. 190-197 ◽  
Author(s):  
Raffaele Serra ◽  
Gianluca Buffone ◽  
Andrea de Franciscis ◽  
Diego Mastrangelo ◽  
Tiziana Vitagliano ◽  
...  
Keyword(s):  
Molecular Weight ◽  
Low Molecular Weight Heparin ◽  
Skin Grafting ◽  
Term Therapy ◽  
Low Molecular Weight ◽  
Leg Ulcers ◽  
Venous Leg Ulcers ◽  
Long Term Therapy

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.

scholarly journals Atypical presentation of Sjogren’s syndrome with MALT lymphoma mimicking chronic venous ulcers

2021 ◽  
Vol 20 ◽  
Author(s):  
Marta Wasilewska
Keyword(s):  
Cell Carcinoma ◽  
Venous Insufficiency ◽  
Marginal Zone ◽  
Delayed Diagnosis ◽  
Lower Extremities ◽  
Venous Stasis ◽  
Daily Functioning ◽  
Common Condition ◽  
Venous Ulcers ◽  
Chronic Leg Ulcers

Abstract Chronic ulcerations of the lower extremities are quite a common condition amongst adults, most often caused by chronic venous insufficiency. Irrespective of the main underlying cause, chronic limb ulcerations are usually associated with significant symptoms, impairing daily functioning. Improper or delayed diagnosis and inadequate treatment increase the risk of serious complications, including limb amputations. Malignancies can develop secondary to chronic leg ulcers. About 2.4% of ulcers arising from chronic venous stasis undergo malignant transformation. Squamous cell carcinoma is the most common type of malignancy found in chronic leg ulceration biopsies. Basal cell carcinoma, sarcoma, and melanoma have all been documented infrequently. In the case described here, we found lymphoma of the marginal zone of mucosa-associated lymphoid tissue (MALT), which is an extremely rare cutaneous neoplasm of the lower extremities, but one that may have an association with autoimmune diseases.

Limitation of Movement in the Ankle and Talo-Calcaneonavicular Joints Caused by Compression Bandages

1997 ◽  
Vol 12 (1) ◽  
pp. 25-30 ◽  
Author(s):  
A. Lentner ◽  
F. Späth ◽  
V. Wienert
Keyword(s):  
Venous Insufficiency ◽  
University Hospital ◽  
Term Therapy ◽  
Joint Mobility ◽  
Compression Stockings ◽  
Measuring Device ◽  
Compression Bandages ◽  
Restricted Mobility ◽  
Long Term Therapy

Objective: To investigate whether compression bandages cause a change in mobility, possibly a restriction in the ankle and talo-calcaneonavicular joint. Design: Comparative studies of mobility in the ankle and talo-calcaneonavicular joints using a special, graduated measuring device, both with and without compression bandages. Four different bandage systems with two different compression bandages were used in each case. Setting: University hospital. Subjects: Ten healthy volunteers. Main outcome measures: Ankle joint mobility with and without compression bandages. Results: All bandages greatly restricted mobility in both the ankle and talo-calcaneonavicular joint. The extent of this restriction depended on the bandage systems and material: thick bandages led to worse results than thin products. Conclusions: It must be assumed that long-term therapy with compression bandages may be partly responsible for the finding of ‘arthrogenic congestive syndrome’ (arthropathica ulcerosa). Because previous studies have shown that medical compression stockings cause very little restriction of mobility, patients with chronic venous insufficiency should, in the long term, be treated with compression stockings and not bandages.

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.

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