The Role of Arthroscopy in the Treatment of Gouty Arthritis of the Knee Case presentation

2018 ◽  
Vol 69 (8) ◽  
pp. 2236-2239
Author(s):  
Marius Moga ◽  
Mark Edward Pogarasteanu ◽  
Dumitru Ferechide ◽  
Antoine Edu ◽  
Chen Feng Ifrim
Keyword(s):  
Gouty Arthritis ◽  
Surgical Techniques ◽  
Term Treatment ◽  
Clinical Aspects ◽  
Associated Lesions ◽  
Number Of Patients ◽  
Long Term Treatment ◽  
Functional Scores ◽  
Urate Crystals

Gout is a metabolic disease involving the impregnation of joints and other tissues with urate crystals. The onset is often brutal, and it manifests itself with pain and inflammation in the affected joint. The treatment usually involves rest, ice, NSAIDs and anti-gout medication. The long-term treatment involves medication and dietary changes. In the joint, urate crystals are deposited in the synovial, in the cartilage and in the menisci. In the arthroscopic practice, the gouty knee is a rare occurrence. We present a relevant case, that of a 57 years old patient without a prior gout diagnosis where we found urate crystal deposits covering the synovium, cartilage and meniscus, and we discuss the current and recent year Pub Med indexed literature in order to evaluate the possibilities for arthroscopic treatment of this pathology. We looked at the number of patients involved, their characteristics, and the surgical techniques used. We also looked at the temporal relation of the arthroscopic intervention to the recent gout attacks, and at the described lesions that were found. Also, we evaluated the papers for joint liquid analysis, gout drug treatment, and description of clinical aspects involved and associated lesions. Finally, we looked at the follow-up, at the functional scores used to monitor the patient�s evolution, at the associated medication and at the long-term outcomes, if described. We have found opinions to vary. In the end, we draw conclusions pertaining to the practical short-term and long-term use of knee arthroscopy in the treatment of gout.

Engineering non-covalently assembled protein nanoparticles for long-acting gouty arthritis therapy

2021 ◽  
Author(s):  
Jinrui Zhang ◽  
Yao Sun ◽  
Qian Qu ◽  
Bo Li ◽  
Lili Zhang ◽  
...  
Keyword(s):  
Metabolic Disease ◽  
Gouty Arthritis ◽  
Term Treatment ◽  
Interleukin 1Β ◽  
Long Term Treatment ◽  
Protein Nanoparticles ◽  
Long Acting ◽  
Dosage Administration

As an incurable metabolic disease, gouty arthritis (GA) requires long-term treatment with frequent dosage administration several times per day. In comparison to non-specific small organic medications, interleukin-1β (IL-1β) blocking therapies,...

Good Safety and Tolerance Profiles of Long Term Treatment of Advanced Multiple Myeloma (MM) with Bortezomib.

Blood ◽  
2007 ◽  
Vol 110 (11) ◽  
pp. 4811-4811
Author(s):  
Jean El-Cheikh ◽  
Anne-Marie Stoppa ◽  
Reda Bouabdallah ◽  
Diane Coso ◽  
Jean-Marc Schiano de Collela ◽  
...  
Keyword(s):  
Dose Reduction ◽  
Term Treatment ◽  
Term Therapy ◽  
Cycle Duration ◽  
Disease Response ◽  
Number Of Patients ◽  
Long Term Treatment ◽  
Grade 3

Abstract Bortezomib is a first-in-class proteasome inhibitor approved for the treatment of MM patients who have received at least one prior therapy. Classically, patients receive bortezomib 1.3 or 1.0 mg/m2 by IV bolus on days 1, 4, 8, and 11 of a 21-day cycle, associated or not to dexamethasone, for a total number of 8 cycles. Such administration schema is associated with a remarkable anti-tumor activity and response. However, a significant number of patients who are initially responders to bortezomib, will progress after drug discontinuation, raising the question of long term or maintenance treatment with bortezomib. The objective of this analysis was to evaluate the tolerance and safety profiles of long term treatment with bortezomib in a cohort of 16 patients with relapsed and/or refractory MM treated in a single institution. Eligible patients for this analysis are those who had relapsed MM, and who continued to receive bortezomib (1.3 or 1.0 mg/m2) as a long term therapy beyond the classical 8 cycles. All medical charts were uniformly reviewed in detail for assessment of toxicity, safety and response. The median age was 53 (range, 27–74) years. The majority of patients had already received at least one prior autologous or allogeneic stem cell transplantation (n=12; 75%). Also, 12 patients (75%) had received prior treatment with thalidomide at a median dose of 200 mg/day, for a median duration of 7 months. Before treatment with bortezomib, 7 patients (44%) already had some form of peripheral neuropathy (PN). With a median follow-up of 16 months from bortezomib initiation, patients from this series received a median of 10 (range, 9–16) cycles of bortezomib administered over a median period of 11 (range, 7–35) months. Overall, 6 patients had evidence of bortezomib-associated PN (38%; 4 grade 1, 1 grade 2 and 1 grade 3; sensory symptoms in all cases). Other bortezomib-related toxicities included thromobopenia (n=8; 50%; 1 grade 1, 5 grade 2, and 2 grade 3–4). General fatigue was also common and was encountered in 5 (31%) patients. Overall, bortezomib-associated toxicities led to dose reduction or increase of treatment cycle duration in 9 patients (56%), but none of the patients had to definitively discontinue treatment because of unacceptable toxicity. At last follow-up, 6 patients are still receiving bortezomib, 4 patients died from disease progression, no patient died from treatment-related causes, and the remaining 12 patients are still alive. Long term treatment with bortezomib was associated with an objective disease response rate in 87% (95%CI, 60–98%) of patients (n=14; 3 CR, 8 VGPR, 3 PR). The Kaplan-Meier estimate for overall survival is shown in the figure below. Though relatively small, results from this series suggest that long term treatment with bortezomib is feasible. Toxicity, tolerance and safety profiles of long term treatment are comparable to those observed with the standard schedule and manageable after dose reduction. Therefore, prospective studies aiming to optimize bortezomib administration schedule and duration (beyond the classical 8 cycles) are warranted, since such long term treatment can yield major objective disease response. Figure Figure

scholarly journals Advances in the management of craniopharyngioma

F1000Research ◽  
2018 ◽  
Vol 7 ◽  
pp. 1632 ◽  
Author(s):  
Lillie O'steen ◽  
Daniel J. Indelicato
Keyword(s):  
Benign Tumor ◽  
Surgical Techniques ◽  
Term Treatment ◽  
Subtotal Resection ◽  
Temporal Lobes ◽  
Long Term Treatment ◽  
Central Brain ◽  
Treatment Morbidity ◽  
Intracranial Vasculature

Craniopharyngioma is a curable benign tumor, but owing to its intimate relationship to critical structures in the central brain—such as the optic apparatus, pituitary, hypothalamus, intracranial vasculature, brain stem, and temporal lobes—its management introduces the risk of long-term treatment morbidity. Today, the most common treatment approach is conservative subtotal resection followed by radiotherapy, and the goal is to limit long-term toxicity. Many recent advances in the treatment of craniopharyngioma are attributable to improved surgical techniques and radiotherapy technologies.

Improving Survival in Lymphangioleio­myomatosis: A 16-Year Observational Study in a Large Cohort of Patients

Respiration ◽  
2021 ◽  
pp. 1-11
Author(s):  
Sergio Harari ◽  
Olga Torre ◽  
Davide Elia ◽  
Antonella Caminati ◽  
Giuseppe Pelosi ◽  
...  
Keyword(s):  
Natural History ◽  
Cumulative Incidence ◽  
Pulmonary Function Tests ◽  
Diagnostic Techniques ◽  
Term Treatment ◽  
Large Cohort ◽  
Clinical Aspects ◽  
Long Term Treatment ◽  
History Of

<b><i>Background:</i></b> Over the last 2 decades, great progress has been made in the understanding of the clinical aspects and pathogenesis of lymphangioleiomyomatosis (LAM), leading to publication of guidelines and approval of an effective therapy. <b><i>Objectives:</i></b> Aim of our study was to describe how the management and the natural history of this rare disease have changed after the publication of the ERS and American Thoracic Society/Japanese Respiratory Society guidelines and the introduction of sirolimus. <b><i>Methods:</i></b> We examined 162 LAM patients followed at our center between 2001 and 2017, reporting clinical characteristics and diagnostic approach. Response to sirolimus in patients undergoing long-term treatment and mortality risk, estimated in terms of cumulative incidence taking into account organ transplantation as a competing cause of the event, were evaluated. The difference in the cumulative incidence between the patients admitted to the observation before 2011 and after 2011, year of the publication of the MILES trial for the efficacy of sirolimus, has also been estimated. <b><i>Results:</i></b> Sixty-one patients had a histological diagnosis (22 from 2010 onward). 101 patients received a radiological diagnosis according to the guidelines criteria. Pulmonary function tests remained stable over a 3-year treatment period in patients who received sirolimus for over 12 months. The cumulative incidence of mortality after 10 years in the whole population was 25.5%. The cumulative incidence of mortality after 5 years was significantly lower in patients who entered the study since 2011 (after publication of the MILES trial) than in patients who entered the study before. <b><i>Conclusions:</i></b> We provide the data supporting the long-term efficacy of sirolimus therapy in a large cohort of patients with functional impairment and other manifestations of the disease. Our results also suggest that the advent of sirolimus and the publication of international guidelines changed the natural history of the disease lowering the mortality and reducing the need of invasive diagnostic techniques.

scholarly journals The Role of Advanced Imaging in Gout Management

2022 ◽  
Vol 12 ◽  
Author(s):  
Shuangshuang Li ◽  
Guanhua Xu ◽  
Junyu Liang ◽  
Liyan Wan ◽  
Heng Cao ◽  
...  
Keyword(s):  
Scoring Systems ◽  
Term Treatment ◽  
Advanced Imaging ◽  
Non Invasive ◽  
Long Term Treatment ◽  
High Prevalence ◽  
Magnetic Resonance Imaging Mri ◽  
Urate Crystals

Gout is a common form of inflammatory arthritis where urate crystals deposit in joints and surrounding tissues. With the high prevalence of gout, the standardized and effective treatment of gout is very important, but the long-term treatment effect of gout is not satisfied because of the poor adherence in patients to the medicines. Recently, advanced imaging modalities, including ultrasonography (US), dual-energy computed tomography (DECT), and magnetic resonance imaging (MRI), attracted more and more attention for their role on gout as intuitive and non-invasive tools for early gout diagnosis and evaluation of therapeutic effect. This review summarized the role of US, DECT, and MRI in the management of gout from four perspectives: hyperuricemia, gout attacks, chronic gout, and gout complications described the scoring systems currently used to quantify disease severity and discussed the challenges and limitations of using these imaging tools to assess response to the gout treatment.

scholarly journals LONG-TERM RESULTS OF SURGICAL TREATMENT OF DIVERTICULAR DISEASE OF COLON

2016 ◽  
Vol 175 (2) ◽  
pp. 101-104
Author(s):  
V. I. Pomazkin ◽  
V. V. Khodakov
Keyword(s):  
Diverticular Disease ◽  
Emotional Disorders ◽  
Elective Surgery ◽  
Term Treatment ◽  
Long Term Results ◽  
Number Of Patients ◽  
Sf 36 ◽  
Long Term Treatment

The work evaluated the long-term treatment results of 103 patients with complicated diverticular disease, who underwent the elective surgery in the volume of left hemicolectomy. The first group included 53 patients with recurrent diverticula. The second group consisted of 50 patients, who underwent the operation on diverticula of sigmoid colon with formation of sigmostoma on the first stage. The number of patients with functional gastro-intestinal and psyco-emotional disorders was more significant in the first group compared with the second group and it was associated with presence of these disorders before the operation. There was noted the reliable decrease of quality of life rates according to questionnaire scales MOS-SF 36 in the first group. The average indices of scales had some matching to the rates of health people in the patients of the second group. The authors came to conclusion, that indications for elective surgery should be determined very carefully in case of recurrent diverticula.

scholarly journals Long-Term Treatment of Cuban Policosanol Attenuates Abnormal Oxidative Stress and Inflammatory Response via Amyloid Plaques Reduction in 5xFAD Mice

Antioxidants ◽  
2021 ◽  
Vol 10 (8) ◽  
pp. 1321
Author(s):  
Jin-Ho Kim ◽  
Dong-Kyun Lim ◽  
Yoo-Hun Suh ◽  
Keun-A Chang
Keyword(s):  
Neurodegenerative Disorder ◽  
Lipid Peroxide ◽  
Amyloid Plaques ◽  
Term Treatment ◽  
Number Of Patients ◽  
Tnf Α ◽  
Long Term Treatment ◽  
5Xfad Mice ◽  
The Brain

Alzheimer’s disease (AD) is a progressive neurodegenerative disorder resulting in cognitive decline or dementia, the number of patients with AD is continuously increasing. Although a lot of great progress has been made in research and development of AD therapeutics, there is no fundamental cure for this disease yet. This study demonstrated the memory-improving effects of Cuban policosanol (PCO) in 5xFAD mice, which is an animal model of AD. Following 4-months of treatment with PCO in 5xFAD mice, we found that the number of amyloid plaques decreased in the brain compared to the vehicle-treated 5xFAD mice. Long-term PCO treatment in 5xFAD mice resulted in the reduction of gliosis and abnormal inflammatory cytokines level (interleukin [IL]-1β, IL-6, and tumor necrosis factor [TNF]-α) in the cortex and hippocampus. Levels of lipid peroxide (4-hydroxynonenal [4-HNE]) and superoxide dismutase (SOD1 and SOD2) levels were also recoverd in the brains of PCO-treated 5xFAD mice. Notably, PCO administration reduced memory deficits in the passive avoidance test, as well as synaptic loss (PSD-95, synaptophysin) in 5xFAD mice. Collectively, we identified the potential effects of PCO as a useful supplement to delay or prevent AD progression by inhibiting the formation of Aβ plaques in the brain.

scholarly journals The therapeutic potential of etoricoxib in clinical practice

2020 ◽  
Vol 14 (1) ◽  
pp. 108-117 ◽  
Author(s):  
A. E. Karateev
Keyword(s):  
Large Scale ◽  
Therapeutic Potential ◽  
Meta Analysis ◽  
Gouty Arthritis ◽  
Term Treatment ◽  
Gastrointestinal Complications ◽  
Randomized Controlled ◽  
Long Term Treatment ◽  
Inflammatory Drugs

Etoricoxib is one of the most popular representatives of a group of nonsteroidal anti-inflammatory drugs (NSAIDs), which is widely used in Russia and other countries of the world. It is a highly selective cyclooxygenase 2 inhibitor that has a rapid and pronounced analgesic effect, a high antiinflammatory potential, and an ability to affect the development of central sensitization, one of the central mechanisms for chronic pain. The therapeutic potential and safety of etoricoxib have been extensively tested in numerous large-scale randomized controlled trials (RCTs). It has proven to be an effective agent for relief of acute pain (including that in dental practice) and acute gouty arthritis, for long-term treatment of rheumatoid arthritis, ankylosing spondylitis (AS), and osteoarthritis (OA). A meta-analysis of a series of RCTs suggests that etoricoxib may be a more effective analgesic drug for AS and OA than other NSAIDs. Etoricoxib significantly less frequently cause gastrointestinal complications than non-selective NSAIDs. The cardiovascular risk associated with etoricoxib is not higher than that with non-selective NSAIDs such as diclofenac.

scholarly journals Experience with Low-Dose Sodium Valproate in Idiopathic Generalized Epilepsy Patients: A Long-Term Follow-Up Study on Selective Cohort from North India

2021 ◽  
Vol 12 (01) ◽  
pp. 046-050
Author(s):  
Deepak Goel ◽  
Manish Mittal
Keyword(s):  
Low Dose ◽  
Term Treatment ◽  
North India ◽  
High Dose ◽  
Idiopathic Generalized Epilepsy ◽  
Number Of Patients ◽  
Long Term Treatment ◽  
Generalized Epilepsy

Abstract Background Idiopathic generalized epilepsy (IGE) is found in 20 to 30% of all patients presenting with seizures. Most of the patients require lifelong drug treatment. Efficacy and tolerability are important issues while selecting the most appropriate drug for a person with IGE. Objective The aim of this study was to look for usefulness of small dose valproate (<1,000 mg/day) in long-term treatment of IGE patients. Methods Diagnosis of IGE made with standard criteria among all patients presenting with seizures. Patients put on full doses of valproate (>1,000 mg/day) in first year, then reduction started in next year in patients with full seizure remission, and finally maintained on lowest possible dose of valproate. Lowest dose was defined as the minimum dose without seizures (between 200 and 900 mg/day). Patients, who were refractory on monotherapy, were put on add-on drug and followed for remission and reduction in doses of valproate at minimum possible dose. Results IGE was diagnosed in 21% of all patients presenting with seizures. Among 420 patients of IGE 368 (87.5%) were started on high-dose valproate monotherapy, 155 (42.1%) were responsive to single drug while 213 (57.9%) had been given add-on drug either lamotrigine or clonazepam or both. After minimum 3-year follow-up, 298 (81%) could be managed on low-dose valproate (<1,000 mg) without any relapse during 12 to 80 months follow-up. Conclusion Significant number of patients with IGE can be managed on low-dose valproate with good seizure control and less side effects.

Aortic valve replacement with a pulmonary autograft: case studies of the Ross procedure

1997 ◽  
Vol 6 (6) ◽  
pp. 418-422 ◽  
Author(s):  
C Scott ◽  
M Schactman ◽  
LM Graver
Keyword(s):  
Aortic Valve ◽  
Preoperative Evaluation ◽  
Surgical Techniques ◽  
Spare Part ◽  
Postoperative Management ◽  
Term Treatment ◽  
Ross Procedure ◽  
Long Term Treatment ◽  
Attractive Option

The Ross procedure is an old surgical technique that is gaining popularity some 30 years after its introduction. The patient's own pulmonary valve is essentially used as a "spare part" to replace the diseased aortic valve. The Ross procedure has become an accepted and attractive option for patients with a life expectancy of more than 20 years and for patients in whom long-term treatment with anticoagulants is undesirable or problematic. Careful preoperative evaluation and postoperative management, as well as proficient surgical techniques, are all necessary to achieve good outcomes.

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