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.

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.

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.

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.

scholarly journals Serum levels of zinc and copper in epileptic children during long-term therapy with anticonvulsants

Neurosciences ◽  
2015 ◽  
Vol 20 (4) ◽  
pp. 341-345 ◽  
Author(s):  
Mohamed Talat ◽  
Anwar Ahmed ◽  
Lamia Mohammed
Keyword(s):  
Serum Levels ◽  
Term Therapy ◽  
Epileptic Children ◽  
Long Term Therapy

scholarly journals Long-term therapy with non-steroidal anti-inflammatory drugs for axial spondyloarthritis: focus on changes in liver function

2021 ◽  
pp. 152-157
Author(s):  
A. P. Rebrov ◽  
A. V. Aparkina ◽  
E. V. Kchondkaryan
Keyword(s):  
Liver Function ◽  
Liver Enzymes ◽  
Genetically Engineered ◽  
Term Therapy ◽  
Acute Liver Damage ◽  
Inflammatory Drugs ◽  
Anti Inflammatory ◽  
Long Term Therapy

The purpose of the study is to analyze the state of liver function in patients with spondyloarthritis taking non-steroidal anti-inflammatory drugs continuously for 24 months. Materials and methods of the study include 198 patients with spondyloarthritis. The prospective study involved 36 patients with spondyloarthritis who took non-steroidal anti-inflammatory drugs (NSAIDs) prescribed by a physician in the community for 24 months. The level of liver enzymes in blood serum at admission and in dynamics was studied. The increase of liver enzymes was detected in 12 (6.06%) of 198 patients with spondyloarthritis. Among them 6 (50%) patients took methotrexate, 1 (8.33%) - genetically engineered drug, 2 (16.67%) patients-sulfasalazine and 3 (25%) - nonsteroidal anti - inflammatory drugs. 19.4% of patients were registered with a periodic increase of transaminase levels on the background of NSAIDs for the last 24 months. At the same time, no cases of acute liver damage or progressive deterioration of liver function requiring discontinuation of therapy were recorded during the entire follow-up period.

Renal Toxicity of Long-Term Therapy With Tenofovir in HIV-Infected Patients

2012 ◽  
Vol 25 (5) ◽  
pp. 552-559 ◽  
Author(s):  
Maricelle O. Monteagudo-Chu ◽  
Mei H. Chang ◽  
Horatio B. Fung ◽  
Norbert Bräu
Keyword(s):  
Renal Toxicity ◽  
Care Center ◽  
Tertiary Care ◽  
Term Therapy ◽  
Kaplan Meier ◽  
Ckd Stage ◽  
Advanced Stages ◽  
Long Term Therapy

Data are sparse on long-term renal toxicity of tenofovir as measured by estimated glomerular filtration rate (eGFR) and progression to advanced stages of chronic kidney disease (CKD). The objective of the study is to determine the incidence of renal impairment associated with the use of tenofovir in HIV-infected patients, using abacavir as a control. In a single tertiary care center, all HIV-infected patients with baseline CKD stage 0 or 1 (CKD-1), who were started on either tenofovir or abacavir from 1998 to 2008 and had at least 1 follow-up eGFR measure on therapy, were included in this retrospective analysis. Progression to CKD stages 2 to 5 was compared using Kaplan-Meier analysis. Progression to CKD-2 and CKD-3 occurred more frequently in patients who received tenofovir than those receiving abacavir (CKD-2, 2-year actuarial frequency, 48.8% vs 23.7%; P < .001, log rank; CKD-3, 5.8% vs 0.0%; P = .028). Only 1 patient in the tenofovir group progressed to CKD-4 and none to CKD-5. Treatment with tenofovir was the only independent factor associated with progression to CKD-2 (hazard ratio [HR], 2.12; 95% confidence interval [CI]: 1.41-3.18; P < .001) and to CKD-3 (HR, 4.91; 95% CI, 1.02-23.7; P = .048). In HIV-infected patients, long-term therapy with tenofovir is associated with mild-to-moderate nephrotoxicity which is significantly higher than in abacavir-treated patients.

Sustained Antihypertensive Response with Minizide: Long-Term Follow-Up in a Multicentre Study

1981 ◽  
Vol 9 (5) ◽  
pp. 309-314 ◽  
Author(s):  
A E Woeltjen ◽  
A J Gordon
Keyword(s):  
Treatment Compliance ◽  
Term Therapy ◽  
Once Daily ◽  
Long Term Follow Up ◽  
Antihypertensive Response ◽  
Laboratory Changes ◽  
Long Term Therapy ◽  
Toxic Potential

The safety and effectiveness of prazosin hydrochloride combined with polythiazide for the treatment of hypertension was studied in four European countries by ten investigators. One-hundred and seventy-seven adult male and female patients, 91% with essential hypertension, were treated for an average of 7 months. Reductions from placebo-controlled baseline blood pressure exceeded 15% over the 8-week short-term phase of the study with further reductions of up to 22% observed at the end of the study. Ninety-six per cent of all patients completed therapy with a diastolic blood presssure of 90 mm Hg or less. Most patients were adequately controlled on 2 tablets or less once daily. Each tablet contained 0.5 mg prazosin hydrochloride and 0.25 mg polythiazide. Long-term toleration was excellent. Side-effects were typical of those expected with antihypertensive medication and nearly all were reported during the first 8 weeks of treatment with no interruption or discontinuation of drug. Nearly all patients were followed throughout for laboratory changes. There were minimal changes consistent with the therapy and there was no pattern indicative of toxic potential. It is concluded that the drug combination, Minizide, is effective and well tolerated as initial and long-term therapy in hypertension and that the convenient dosage regimen will lead to enhanced treatment compliance for this chronic condition.

scholarly journals Clinical management of maxillary osteonecrosis associated with antiresorptive medication (MRONJ): Presentation of clinical cases

2020 ◽  
Vol 1 ◽  
pp. 63-67
Author(s):  
Eduardo A Rey ◽  
Sergio A. Rodriguez Genta ◽  
Silvana Noemi Picardo
Keyword(s):  
Monoclonal Antibodies ◽  
Osteoblastic Differentiation ◽  
Pathological Process ◽  
Term Therapy ◽  
Non Invasive ◽  
Nuclear Activation ◽  
Antiresorptive Drugs ◽  
Long Term Therapy

Antiresorptive drugs: Bisphosphonates (BPs) and Monoclonal Antibodies: Denosumab (DS) are known to suppress osteoclastic activity, affecting the expression of the RANKL (Kappa β Nuclear Activation Receptor), which corresponds to an osteoblastic differentiation factor and which is secreted by said cells, being responsible for inducing reabsorption by osteoclasts. Under certain circumstances, those medications may induce the development of Maxillary Osteonecrosis (MRONJ).The paper is aimed to share our experience of MRONJ treatment using minimally invasive therapies (including washes and antibiotics) that does not expand the necrotic bed volumetrically and provide non-recurrent resolution of the lesion. The patients we described were on long-term therapy either with BPs or DS.Conclusion: Interaction between health professional is essential for MRONJ prevention. The therapeutics consolidated in non-invasive maneuvers, and the manipulation of bone tissue with close follow up allows to avoid spread to deep planes. The pathological process could be successfully treated, and it is not necessary to suspend antiresorptive medications.

scholarly journals Splenomegaly in sarcoidosis: Frequency, treatment, prognosis and long-term follow-up

2015 ◽  
Vol 143 (5-6) ◽  
pp. 279-283 ◽  
Author(s):  
Zora Pavlovic-Popovic ◽  
Bojan Zaric ◽  
Zdravko Kosjerina ◽  
Dragana Petrovic
Keyword(s):  
Clinical Characteristics ◽  
Primary Treatment ◽  
Prospective Analysis ◽  
Real Frequency ◽  
Long Term Follow Up ◽  
Splenic Involvement ◽  
History Of ◽  
Treatment Prognosis

Introduction. The splenic involvement is common in sarcoidosis, but its real frequency is still obscure, depending doubtless on the method of splenomegaly detection. Splenomegaly may be accompanied with pain or anemia, leucopenia and thrombocytopenia. Objective. The aim of this study was to investigate the frequency of splenomegaly related to clinical characteristics of sarcoidosis and to solve the dilemma - whether to introduce medicaments, and when to perform splenectomy. Methods. The method of the study is a retrospective and prospective analysis of the patients? material. Results. The study included 540 patients with sarcoidosis in a 20-year period. Of them, 26% had splenomegaly detected by computerized tomography screening. Splenomegaly was more frequently registered in the patients with a longer history of sarcoidosis (38%), as compared to those with a shorter history of the disease (23%) (p<0.05). Splenomegaly was more frequently registered in the patients with other extrapulmonary lesions detected (33%) than in those who had no extrapulmonary manifestations of sarcoidosis (17%) (p<0.01). Indications, possible benefits and complications of splenectomy were analysed in 11 sarcoidosis patients undergoing this intervention for various reasons, of which the follow-up period ranged from one to 20 years. Conclusion. Splenomegaly was more frequent in chronic cases or in the patients with established sarcoid lesions of other extrapulmonary organs. The primary treatment of uncomplicated symptomatic splenic sarcoidosis includes medicamentous therapy. Occasionally, splenectomy is required. Prognostically, splenomegaly indicates an unfavorable course of the disease.

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