scholarly journals Adjunct Treatment of Recalcitrant Hand Plaques in Nephrogenic Systemic Fibrosis After Imatinib Therapy

2019 ◽  
Vol 3 (6) ◽  
pp. 438-442
Author(s):  
James Foshee ◽  
Thomas Griffin ◽  
Kristin Cam ◽  
Michael Rivlin ◽  
Matthew Keller
Keyword(s):  
Nephrogenic Systemic Fibrosis ◽  
Functional Limitation ◽  
Lower Extremities ◽  
Functional Improvement ◽  
Adjunct Treatment ◽  
Joint Contractures ◽  
Intralesional Corticosteroid ◽  
Initial Improvement ◽  
Effective Adjunct ◽  
Corticosteroid Injections

Nephrogenic systemic fibrosis (NSF) is a sclerotic disorder presenting with painful indurated plaques and skin thickening involving the trunk and extremities, which can lead to tethering and joint contractures.  NSF most commonly affects patients with renal insufficiency who have been exposed to gadolinium. We present a case of NSF involving the bilateral hands, knees, and lower extremities developing over 10 years after gadolinium exposure.  Initial improvement was noted in the lower extremities after initiation of imatinib mesylate therapy, but recalcitrant, thickened hand plaques caused persistent pain and functional limitation. Adjunct intralesional corticosteroid injections produced durable softening of the recalcitrant lesions with considerable functional improvement in hand mobility. Based on our experience, intralesional corticosteroid injections appear to be an effective adjunct treatment in patients with incomplete response to anti-fibrotic therapies.

scholarly journals Lower-Dose, Intravenous Chlorothiazide Is an Effective Adjunct Diuretic to Furosemide Following Pediatric Cardiac Surgery

2020 ◽  
Vol 25 (1) ◽  
pp. 31-38
Author(s):  
Ryan J. Carpenter ◽  
Shaghig Kouyoumjian ◽  
David Y. Moromisato ◽  
Phuong Lieu ◽  
Rambod Amirnovin
Keyword(s):  
Fluid Balance ◽  
Urine Output ◽  
Heart Defects ◽  
High Dose ◽  
Total Fluid Intake ◽  
Adjunct Treatment ◽  
Negative Fluid Balance ◽  
Poor Outcomes ◽  
Neonates And Infants ◽  
Effective Adjunct

OBJECTIVES Postoperative fluid overload is ubiquitous in neonates and infants following operative intervention for congenital heart defects; ineffective diuresis is associated with poor outcomes. Diuresis with furosemide is widely used, yet there is often resistance at higher doses. In theory, furosemide resistance may be overcome with chlorothiazide; however, its efficacy is unclear, especially in lower doses and in this population. We hypothesized the addition of lower-dose, intravenous chlorothiazide following surgery in patients on high-dose furosemide would induce meaningful diuresis with minimal side effects. METHODS This was a retrospective, cohort study. Postoperative infants younger than 6 months, receiving high-dose furosemide, and given lower-dose chlorothiazide (1–2 mg/kg every 6–12 hours) were identified. Diuretic doses, urine output, fluid balance, vasoactive-inotropic scores, total fluid intake, and electrolyte levels were recorded. RESULTS There were 73 patients included. The addition of lower-dose chlorothiazide was associated with a significant increase in urine output (3.8 ± 0.18 vs 5.6 ± 0.27 mL/kg/hr, p < 0.001), more negative fluid balance (16.1 ± 4.2 vs −25.0 ± 6.3 mL/kg/day, p < 0.001), and marginal changes in electrolytes. Multivariate analysis was performed, demonstrating that increased urine output and more negative fluid balance were independently associated with addition of chlorothiazide. Subgroup analysis of 21 patients without a change in furosemide dose demonstrated the addition of chlorothiazide significantly increased urine output (p = 0.03) and reduced fluid balance (p < 0.01), further validating the adjunct effects of chlorothiazide. CONCLUSION Lower-dose, intravenous chlorothiazide is an effective adjunct treatment in postoperative neonates and infants younger than 6 months following cardiothoracic surgery.

Osteoarthritis—management

2013 ◽  
pp. 1187-1196
Author(s):  
Claire Y. J. Wenham ◽  
Philip G. Conaghan
Keyword(s):  
Functional Limitation ◽  
Anatomical Site ◽  
Treatment Goals ◽  
Pain Mechanisms ◽  
Muscle Strengthening ◽  
Inflammatory Drugs ◽  
Topical Capsaicin ◽  
The Impact ◽  
Corticosteroid Injections

Osteoarthritis (OA) is a common condition which often causes pain and functional limitation, significantly impacting on a person’s quality of life. A comprehensive assessment of the impact of OA should be performed before selecting therapies and treatment goals. Current recommended therapies include a combination of pharmacological and non-pharmacological therapies, which should be considered for all people with OA, regardless of anatomical site of involvement. Non-pharmacological treatments include education, muscle strengthening and aerobic exercises, weight loss if appropriate, splints and devices, and aids. Pharmacological therapies include paracetamol, oral and topical non-steroidal anti-inflammatory drugs, topical capsaicin, intra-articular corticosteroid injections, and opioids. Many existing therapies have only a small analgesic effect size and, in the case of drug therapies, may be associated with important side effects, so an individual’s symptoms and comorbidities must be taken into account when selecting therapies. For those who do not respond to these treatments, surgery such as a total joint arthroplasty may be required. There is a strong need for new analgesic treatments for OA. As it is becoming increasingly clear that the sources of pain in OA are complex and multifactorial, future treatments for OA will need to target both peripheral and central pain mechanisms.

scholarly journals What is the role of intralesional corticosteroid injections for keloids before considering surgery?

2015 ◽  
Vol 126 (3) ◽  
pp. 549-550 ◽  
Author(s):  
Louis Insalaco ◽  
Sarah Saxon ◽  
Jeffrey H. Spiegel
Keyword(s):  
Intralesional Corticosteroid ◽  
Corticosteroid Injections

Promotion of cone and seed production in grafted and seedling Douglas-fir seed orchards by application of gibberellin A4/7 mixture

1980 ◽  
Vol 10 (4) ◽  
pp. 464-469 ◽  
Author(s):  
Stephen D. Ross ◽  
Richard P. Pharis ◽  
J. C. Heaman
Keyword(s):  
Seed Production ◽  
Seed Set ◽  
Douglas Fir ◽  
Adjunct Treatment ◽  
Seed Cone ◽  
Marked Enhancement ◽  
Napthaleneacetic Acid ◽  
Low Levels ◽  
Effective Adjunct ◽  
Filled Seeds

Both 4-year-old grafts and 6-year-old seedlings of Douglas-fir (Pseudotsugamenziesii (Mirb.) Franco) were induced to flower, and the production of seed cones and filled seeds was significantly enhanced by branch applications of gibberellin A4/7 (GA4/7) mixture.For 6-year-old seedlings, when pooled over all levels of the auxin, napthaleneacetic acid (NAA), seed cone bud differentiation, and number of filled seeds per treatment branch tended to be enhanced by GA3, GA5, and GA9, relative to controls. A more marked enhancement (although still not significant) in number of filled seeds per treatment branch was noted for GA3, GA5, and GA9 when applied in combination with GA4/7, relative to GA4/7 alone. The combination of GA9 + GA4/7 significantly increased the number of seed cone buds differentiated, relative to GA4/7 alone. Low levels of NAA, pooled over all GA treatments, significantly increased the number of seed cones per branch at maturity, and tended to increase both the number of seed cone buds differentiated and filled seeds per branch.Girdling, an effective adjunct treatment for promoting flowering, reduced filled seeds per cone for grafts, but had no effect on seedlings. Neither cone abortion nor seed set was affected by the hormone treatments, although there was a tendency in the seedlings for NAA to reduce cone abortion and increase filled seeds per cone. Seed from GA-induced cones germinated equally as well as that from controls. For grafts, GA treatments resulted in a 500% increase in per-branch yield of filled seeds; for seedlings, increases of 250 to 600% were noted.

scholarly journals Successful Treatment of Kasabach-Merritt Phenomenon With Intralesional Corticosteroid Injections

2012 ◽  
Vol 69 (6) ◽  
pp. 627-632 ◽  
Author(s):  
Jian-Jr Lee ◽  
Li-Ying Lin ◽  
Shun-Wen Hsieh ◽  
Ting-An Chang ◽  
Shiann-Tarng Jou ◽  
...  
Keyword(s):  
Successful Treatment ◽  
Intralesional Corticosteroid ◽  
Corticosteroid Injections

scholarly journals Intraarticular Corticosteroids for Hip Osteoarthritis: A Review

Cartilage ◽  
2020 ◽  
pp. 194760352095163
Author(s):  
Magda Choueiri ◽  
Xavier Chevalier ◽  
Florent Eymard
Keyword(s):  
Randomized Controlled Trials ◽  
Hip Osteoarthritis ◽  
Treatment Modalities ◽  
Functional Improvement ◽  
Controlled Trials ◽  
Randomized Controlled ◽  
Nonsurgical Management ◽  
Provide Pain Relief ◽  
Corticosteroid Injections ◽  
Intraarticular Corticosteroids

Introduction Hip osteoarthritis is a prevalent condition responsible for important pain and disability. Most available guidelines for nonsurgical management of hip osteoarthritis recommend a combination of nonpharmacological and pharmacological treatment modalities. Intraarticular corticosteroid injections have been used for decades, although evidence is quite scarce, and many controversies remain. Methods This article reviews the available literature from Medline and Embase and discusses the evidence for intraarticular corticosteroid injections in hip osteoarthritis, where only 5 randomized controlled trials were found in the literature. These are analyzed in this article, which also aims to explain the main characteristics and features of glucocorticoids, along with their contraindications and potential adverse effects. Results Available randomized controlled trials show that intraarticular corticosteroid injections provide pain relief and functional improvement in hip osteoarthritis. This efficacy has not been shown with intraarticular hyaluronic acid injections. Conclusion This review shows that intraarticular corticosteroid injections are efficacious in hip osteoarthritis and that this benefit can last up to 12 weeks.

scholarly journals Hidradenitis suppurativa with SAPHO syndrome maintained effectively with adalimumab, methotrexate, and intralesional corticosteroid injections

2018 ◽  
Vol 6 ◽  
pp. 2050313X1877872 ◽  
Author(s):  
Erika L Crowley ◽  
Ashley O’Toole ◽  
Melinda J Gooderham
Keyword(s):  
Hidradenitis Suppurativa ◽  
Relevant Literature ◽  
Skin Inflammation ◽  
Lifestyle Changes ◽  
Definitive Treatment ◽  
Intralesional Corticosteroid ◽  
Treatment Plans ◽  
Bone Inflammation ◽  
Pain Improvement ◽  
Corticosteroid Injections

Introduction: Hidradenitis suppurativa and synovitis, acne, pustulosis, hyperostosis, osteitis syndrome are chronic, debilitating diseases involving apocrine gland-bearing skin inflammation and bone inflammation, respectively. Although both often present with multiple comorbidities, single patient co-presentation is rare. Methods/Results: This study reports the 8-year treatment course of a 40-year-old man with hidradenitis suppurativa and synovitis, acne, pustulosis, hyperostosis, osteitis syndrome, and reviews relevant literature. Initial oral and topical antibiotics had little effect. Intralesional corticosteroid injections were effective for localized inflammatory lesions but insufficient for hidradenitis suppurativa control. Adalimumab initiation and local excision of a persistent HS lesion led to stabilization. Adalimumab provided dramatic back pain improvement. Synovitis, acne, pustulosis, hyperostosis, osteitis was diagnosed; adalimumab continuation with subsequent methotrexate addition resulted in hidradenitis suppurativa-synovitis, acne, pustulosis, hyperostosis, osteitis control. Conclusions: Literature regarding comorbid hidradenitis suppurativa and synovitis, acne, pustulosis, hyperostosis, osteitis syndrome therapy is scarce but growing. Adalimumab, methotrexate, intralesional corticosteroid, and lifestyle changes successfully maintained a severe hidradenitis suppurativa–synovitis, acne, pustulosis, hyperostosis, osteitis–syndrome case. Further studies beyond a case-based review could yield more definitive treatment plans.

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