scholarly journals Carcinoid Syndrome and Hyperinsulinemic Hypoglycemia Associated with Neuroendocrine Neoplasms: A Critical Review on Clinical and Pharmacological Management

2021 ◽  
Vol 14 (6) ◽  
pp. 539
Author(s):  
Francesca Spada ◽  
Roberta E. Rossi ◽  
Elda Kara ◽  
Alice Laffi ◽  
Sara Massironi ◽  
...  
Keyword(s):  
Carcinoid Syndrome ◽  
Treatment Options ◽  
Therapeutic Strategies ◽  
Hyperinsulinemic Hypoglycemia ◽  
Neuroendocrine Neoplasms ◽  
Pharmacological Management ◽  
Serotonin Secretion ◽  
Clinical Syndromes ◽  
Pancreatic Insulinoma

The carcinoid syndrome (CS) and hyperinsulinemic hypoglycemia (HH) represent two of the most common clinical syndromes associated with neuroendocrine neoplasms (NENs). The former is mainly related to the serotonin secretion by a small bowel NEN, whereas the latter depends on an insulin hypersecretion by a pancreatic insulinoma. Both syndromes/conditions can affect prognosis and quality of life of patients with NENs. They are often diagnosed late when patients become strongly symptomatic. Therefore, their early detection and management are a critical step in the clinical management of NEN patients. A dedicated and experienced multidisciplinary team with appropriate therapeutic strategies is needed and should be encouraged to optimize clinical outcomes. This review aims to critically analyze clinical features, evidence and treatment options of CS and HH and therefore to improve their management.

scholarly journals Physical approach for prevention and treatment of osteoporosis

2010 ◽  
Vol 54 (2) ◽  
pp. 171-178 ◽  
Author(s):  
Ana Paula Rebucci Lirani-Galvão ◽  
Marise Lazaretti-Castro
Keyword(s):  
Pharmacological Treatment ◽  
Treatment Options ◽  
Mineral Density ◽  
Management Options ◽  
Pharmacological Management ◽  
Treatment Of Osteoporosis ◽  
Specific Strength ◽  
Positive Effects ◽  
Coordination Training

Osteoporosis and its consequent fractures are a major problem in public health. To complement the conventional pharmacological treatment for this metabolic disease, non-pharmacological treatment options have been developed in the last decades. Several studies demonstrate that physical exercise programs including impact exercises, specific strength training, balance and coordination training may maintain or increase spine and hip bone mineral density as well as decrease the frequency of falls among osteoporotic and osteopenic patients. Furthermore, some physical agents such as vibratory platforms, low intensity electrical stimulation, laser therapy and ultrasound show positive effects on osteoporotic tissue as well. Consequently, while planning treatment for an osteoporotic patient, non-pharmacological management options should be considered and integrated to the conventional treatment in order to maximize its effects and improve the quality of life of these patients.

Neuroendocrine tumour of the ampulla of Vater: a rare neoplasm at an atypical site

2020 ◽  
pp. 1-10
Author(s):  
Abrar Zahid ◽  
Danish Ali ◽  
Muhammad Zubair ◽  
Irfan Ahmed ◽  
Tauseef Fatima ◽  
...  
Keyword(s):  
Weight Loss ◽  
Immunohistochemical Staining ◽  
Poor Prognosis ◽  
Carcinoid Syndrome ◽  
Neuroendocrine Tumour ◽  
Carcinoid Tumour ◽  
Treatment Options ◽  
Ampulla Of Vater ◽  
Neuroendocrine Neoplasms ◽  
Late Event

Abstract The periampullary neuroendocrine tumour is an infrequently occurring tumour. Its prevalence among gastrointestinal neuroendocrine neoplasms is less than 0.3%, and less than 2% out of periampullary tumours. These neoplasms have relatively poor prognosis. Jaundice and pain in the abdomen are the early and most commonly occurring symptoms with weight loss being a late event. The carcinoid syndrome presents infrequently in periampullary neuroendocrine tumour and happens only if hepatic metastasis occurs. In this scenario, histopathology plays a paramount role in the diagnosis. Specific immunohistochemical staining is used for diagnosis while the treatment options are local excision, endoscopic excision and pancreaticoduodenectomy. Here is a case report of a 42-year-old patient who presented with complaint of obstructive jaundice for one month. Periampullary carcinoid tumour was diagnosed on biopsy, and she underwent Pancreaticoduodenectomy as treatment. Continuou...  

scholarly journals Gastroesophageal Reflux Disease and Foregut Dysmotility in Children with Intestinal Failure

Nutrients ◽  
2020 ◽  
Vol 12 (11) ◽  
pp. 3536
Author(s):  
Anna Rybak ◽  
Aruna Sethuraman ◽  
Kornilia Nikaki ◽  
Jutta Koeglmeier ◽  
Keith Lindley ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Gastroesophageal Reflux ◽  
Treatment Options ◽  
Hormone Secretion ◽  
Intestinal Failure ◽  
Pharmacological Management ◽  
Gastrointestinal Dysmotility ◽  
Critical Reduction ◽  
Intestinal Pseudo Obstruction

Gastrointestinal dysmotility is a common problem in a subgroup of children with intestinal failure (IF), including short bowel syndrome (SBS) and pediatric intestinal pseudo-obstruction (PIPO). It contributes significantly to the increased morbidity and decreased quality of life in this patient population. Impaired gastrointestinal (GI) motility in IF arises from either loss of GI function due to the primary disorder (e.g., neuropathic or myopathic disorder in the PIPO syndrome) and/or a critical reduction in gut mass. Abnormalities of the anatomy, enteric hormone secretion and neural supply in IF can result in rapid transit, ineffective antegrade peristalsis, delayed gastric emptying or gastroesophageal reflux. Understanding the underlying pathophysiologic mechanism(s) of the enteric dysmotility in IF helps us to plan an appropriate diagnostic workup and apply individually tailored nutritional and pharmacological management, which might ultimately lead to an overall improvement in the quality of life and increase in enteral tolerance. In this review, we have focused on the pathogenesis of GI dysmotility in children with IF, as well as the management and treatment options.

scholarly journals Management of clozapine-induced sialorrhoea

2019 ◽  
Vol 26 (2) ◽  
pp. 106-108
Author(s):  
Sumeet Gupta ◽  
Udayan Khastgir ◽  
Matthew Croft ◽  
Sefat Roshny
Keyword(s):  
Quality Of Life ◽  
Adverse Effect ◽  
Treatment Options ◽  
Common Adverse Effect ◽  
Management Options ◽  
Limited Effect ◽  
Pharmacological Management ◽  
Off Label ◽  
Anticholinergic Medications

SUMMARYSialorrhoea (hypersalivation) is a common adverse effect of clozapine. If severe, it can affect patients' quality of life and adherence to the treatment. Clinicians therefore need to proactively manage this effect. At present, no drugs are licensed to manage clozapine-induced sialorrhoea, although there are many off-label treatment options, with variable effectiveness. Anticholinergic medications are commonly prescribed for it, but they have limited effect and can worsen constipation. This article gives a brief overview of other practical and pharmacological management options.

scholarly journals Pharmacotherapeutic and Non-Pharmacological Options for Refractory and Difficult-to-Treat Seizures

2012 ◽  
Vol 4 ◽  
pp. JCNSD.S8315 ◽  
Author(s):  
James W. Mitchell ◽  
Stefano Seri ◽  
Andrea E. Cavanna
Keyword(s):  
Refractory Epilepsy ◽  
Treatment Options ◽  
Herbal Remedies ◽  
Epilepsy Syndrome ◽  
Economic Costs ◽  
Pharmacological Management ◽  
Optimal Medical Management ◽  
Related Quality ◽  
Health Related

It is currently estimated that about 20%–30% of adults and 10%–40% of children diagnosed with epilepsy suffer from uncontrolled or poorly controlled seizures, despite optimal medical management. In addition to its huge economic costs, treatment-refractory epilepsy has a widespread impact on patients’ health-related quality of life. The present paper focuses on the concepts of refractory and difficult-to-treat seizures and their pharmacological management. Evidence on efficacy and tolerability of rational pharmacotherapy with antiepileptic drug combinations and of non-pharmacological treatment options such as epilepsy surgery, neurostimulation, metabolic treatment and herbal remedies is reviewed. The importance of early identification of the underlying etiology of the specific epilepsy syndrome is emphasized, to inform early prognosis and therapeutic strategies.

scholarly journals Carcinoid syndrome in neuroendocrine tumors - not easy to recognize

2013 ◽  
Vol 60 (3) ◽  
pp. 13-16
Author(s):  
Milos Bjelovic
Keyword(s):  
Neuroendocrine Tumors ◽  
Carcinoid Syndrome ◽  
Clinical Presentation ◽  
Malignant Tumors ◽  
Treatment Options ◽  
Medical Doctor ◽  
Clinical Syndromes ◽  
Potentially Malignant ◽  
The Right ◽  
Symptoms And Signs

Neuroendocrine tumors (NET) are solid potentially malignant tumors originated from the diffuse neuroendocrine system. They could origin in many organs, with highest prevalence in lungs, small intestine and rectum. Characteristics of NET are slow growth, non-specific clinical presentation causing diagnostic problems. Thus, in majority of patients diagnosis is established in the metastatic phase of the disease. Hopefully, there are new and very potent treatment options capable to successfully control the disease. Clinical presentation cause local tumor growth or para-neoplastic syndrome. Secretory active tumors produce peptides or hormones causing different clinical syndromes. In most cases NET cause carcinoid syndrome. It is often misinterpreted, because similar symptoms are present in more prevalent disorders. Symptoms are not specific and include flashing, diarrhea, abdominal pain, right heart disease, bronchoconstriction... and to establish the right diagnosis medical doctor have to think about NET as a possibility. Thus, it is very important to recognize symptoms and signs of the carcinoid syndrome, and distinguish them from other gastrointestinal disorders. Early diagnosis and treatment have significant impact in control of the disease, and overall treatment results.

scholarly journals Fishing for neuroendocrine tumors

2020 ◽  
Vol 27 (6) ◽  
pp. R163-R176
Author(s):  
Germano Gaudenzi ◽  
Silvia Carra ◽  
Alessandra Dicitore ◽  
Maria Celeste Cantone ◽  
Luca Persani ◽  
...  
Keyword(s):  
Neuroendocrine Tumors ◽  
Treatment Decision ◽  
Therapeutic Strategies ◽  
Biological Processes ◽  
Preclinical Research ◽  
Treatment Decision Making ◽  
Clinical Syndromes ◽  
Vertebrate Model ◽  
Detrimental Impact

Neuroendocrine tumors (NETs) are a class of rare and heterogeneous neoplasms that originate from the neuroendocrine system. In several cases, these neoplasms can release bioactive hormones leading to characteristic clinical syndromes and hormonal dysregulations with detrimental impact on the quality of life and survival of these patients. Only few animal models are currently available to investigate pathogenesis, progression and functional syndromes in NETs and to identify new therapeutic strategies. The tropical teleost zebrafish (Danio rerio) is a popular vertebrate model system that offers unique advantages for the study of several biological processes, ranging from embryonic development to human diseases such as cancer. In this review, we summarize recent advances on zebrafish models for NET preclinical research that take advantage of modern genetic and transplantable technologies. In the future, these tools may have a role in the treatment decision-making and tertiary prevention of NETs.

Surgery for Lung Cancer and the Consequences for the Swallow

2016 ◽  
Vol 1 (13) ◽  
pp. 162-168
Author(s):  
Pippa Hales ◽  
Corinne Mossey-Gaston
Keyword(s):  
Lung Cancer ◽  
Treatment Options ◽  
Vocal Cord Palsy ◽  
Subsequent Treatment ◽  
Physiological Reserve ◽  
Palliative Phase ◽  
And Function ◽  
The Impact ◽  
Swallow Function

Lung cancer is one of the most commonly diagnosed cancers across Northern America and Europe. Treatment options offered are dependent on the type of cancer, the location of the tumor, the staging, and the overall health of the person. When surgery for lung cancer is offered, difficulty swallowing is a potential complication that can have several influencing factors. Surgical interaction with the recurrent laryngeal nerve (RLN) can lead to unilateral vocal cord palsy, altering swallow function and safety. Understanding whether the RLN has been preserved, damaged, or sacrificed is integral to understanding the effect on the swallow and the subsequent treatment options available. There is also the risk of post-surgical reduction of physiological reserve, which can reduce the strength and function of the swallow in addition to any surgery specific complications. As lung cancer has a limited prognosis, the clinician must also factor in the palliative phase, as this can further increase the burden of an already compromised swallow. By understanding the surgery and the implications this may have for the swallow, there is the potential to reduce the impact of post-surgical complications and so improve quality of life (QOL) for people with lung cancer.

Raynaud’s phenomenon and digital ischaemia - pharmacologic approach and alternative treatment options

VASA ◽  
2016 ◽  
Vol 45 (3) ◽  
pp. 201-212 ◽  
Author(s):  
Birgit Linnemann ◽  
Matthias Erbe
Keyword(s):  
Quality Of Life ◽  
Angiotensin Receptor Blockers ◽  
Raynaud’S Phenomenon ◽  
Treatment Options ◽  
Raynaud's Phenomenon ◽  
Tissue Loss ◽  
Receptor Antagonists ◽  
Skin Ulcers ◽  
Digital Ischaemia

Abstract. The primary goal of therapy is to reduce the frequency and intensity of Raynaud’s attacks and to minimize the related morbidity rather than to cure the underlying condition. Treatment strategies depend on whether Raynaud’s phenomenon (RP) is primary or secondary. All patients should be instructed about general measures to maintain body warmth and to avoid triggers of RP attacks. Pharmacologic intervention can be useful for patients with severe and frequent RP episodes that impair the patient’s quality of life. Calcium channel blockers are currently the most prescribed and studied medications for this purpose. There has been limited evidence for the efficacy of alpha-1-adrenergic receptor antagonists, angiotensin receptor blockers, topical nitrates or fluoxetine to treat RP. The intravenously administered prostacyclin analogue iloprost can reduce the frequency and severity of RP attacks and is considered a second-line therapy in patients with markedly impaired quality of life, critical digital ischaemia and skin ulcers who are at risk for substantial tissue loss and amputation. Phosphodiesterase inhibitors (e.g., sildenafil) can also improve RP symptoms and ulcer healing whereas endothelin-1 receptor antagonists (e.g., bosentan) are mainly considered treatment options in secondary prevention for patients with digital skin ulcers related to systemic sclerosis. However, their use in clinical practice has been limited by their high cost. Antiplatelet therapy with low-dose aspirin is recommended for all patients who suffer from secondary RP due to ischaemia caused by structural vessel damage. Anticoagulant therapy can be considered during the acute phase of digital ischaemia in patients with suspected vascular occlusive disease attributed to the occurrence of new thromboses. In patients with critical digital ischaemia, consideration should be given to hospitalisation, optimisation of medical treatment in accordance with the underlying disease and evaluation for a secondary, possibly reversible process that is causing or aggravating the clinical symptoms.

Preventing Premature Weaning: Management Options for Common Lactation Conditions, Including OMT

2020 ◽  
pp. 20-25
Author(s):  
Denise Sackett ◽  
Tala Dajani ◽  
David Shoup ◽  
Uzoma Ikonne
Keyword(s):  
Postpartum Depression ◽  
Family Physician ◽  
Treatment Options ◽  
World Health ◽  
Management Options ◽  
Pharmacological Management ◽  
Control And Prevention ◽  
Lactational Mastitis ◽  
One Year ◽  
Health Organization

The benefits of breastfeeding are well established. The World Health Organization and the Centers for Disease Control and Prevention recommend that mothers breastfeed infants for at least one year, but most children are not breastfed that long because of many factors. Breastfeeding mothers face many challenges to continued breastfeeding, including medical conditions that arise during this period, such as postpartum depression and lactational mastitis. Because of a perceived lack of consistent guidance on medication safety, it can be difficult for the family physician to treat these conditions while encouraging mothers to continue breastfeeding. The purpose of the current review is to summarize and clarify treatment options for the osteopathic family physician treating lactating mothers. We specifically focus on the pharmacological management of contraception, postpartum depression, and lactational mastitis.

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