scholarly journals Treatment of Congenital Chylothorax Using High-Dose Octreotide

2020 ◽  
Vol In Press (In Press) ◽  
Author(s):  
Jinkyung Seo ◽  
Sook Kyung Yum
Keyword(s):  
Treatment Options ◽  
Medium Chain Triglyceride ◽  
Intestinal Secretion ◽  
Bottle Feeding ◽  
High Dose ◽  
Optimal Dosage ◽  
Severe Respiratory Distress ◽  
Threatening Condition ◽  
Octreotide Therapy ◽  
Congenital Chylothorax

Introduction: Neonatal chylothorax is a rare and potentially life-threatening condition with a reported incidence of 1 in 5,800 - 24,000 and a high mortality rate of up to 64%. Octreotide is one of the treatment options available to reduce both the splanchnic blood flow and the intestinal secretion of electrolytes and water. However, there is no uniform guideline for the optimal dosage of octreotide in the treatment of congenital chylothorax. Case Presentation: We present the case of a neonate diagnosed with congenital chylothorax. At birth, the neonate manifested severe respiratory distress warranting cardiopulmonary resuscitation for 25 min. During admission, intravenous octreotide treatment was initiated and feeding was changed from breast milk to a medium-chain triglyceride-enriched formula. Bilateral hilar enlargement and diffusely increased opacities waxed and waned, and we gradually increased the octreotide dosage daily by 1 ~ 2 mcg/kg/h. After 3 days of octreotide administration at the rate of 20 mcg/kg/h, chest x-ray showed regression of pleural effusion. The patient was discharged with full bottle feeding achieved. Conclusions: High-dose octreotide therapy (with doses up to 20 mcg/kg/h) may be recommended for patients with idiopathic congenital chylothorax. However, patients should be carefully monitored for side-effects such as hyperglycemia, necrotizing enterocolitis, transient hypothyroidism, and ileus.

scholarly journals Successful treatment of congenital chylothorax with skimmed milk and long course octreotide

2018 ◽  
Vol 11 (1) ◽  
pp. bcr-2018-226347 ◽  
Author(s):  
Tanushree Sahoo ◽  
Mukul Kumar Mangla ◽  
Amanpreet Sethi ◽  
Anu Thukral
Keyword(s):  
Management Strategies ◽  
Newborn Infants ◽  
Medium Chain Triglyceride ◽  
High Dose ◽  
Safe Alternative ◽  
Prolonged Duration ◽  
Congenital Chylothorax ◽  
Skimmed Milk ◽  
Multimodal Management ◽  
Long Course

Congenital chylothorax (CC) is a rare entity in neonatal period requiring multimodal management strategies. Despite optimum treatment, some cases remain refractory posing significant challenge to the treating physician. We here describe a 33-week preterm neonate presenting with refractory congenital chylothorax who needed treatment with combination of skimmed milk, high dose and prolonged duration octreotide for resolution. This case highlighted that octreotide has a good safety profile in newborn infants with congenital chylothorax and locally available skimmed milk fortified with medium chain triglyceride (MCT) oil is a cheap and safe alternative.

Chylothorax: A Stepwise Approach to Diagnosis and Treatment

2021 ◽  
Vol 40 (6) ◽  
pp. 386-392
Author(s):  
Shaniquewa Jackson ◽  
Amy J. Jnah
Keyword(s):  
Pleural Cavity ◽  
Neonatal Period ◽  
Treatment Options ◽  
Medium Chain Triglyceride ◽  
Current Evidence ◽  
Thoracic Duct Ligation ◽  
Duct Ligation ◽  
Octreotide Therapy ◽  
Bowel Rest ◽  
Enteral Feedings

Chylothorax, a lymphatic flow disorder characterized by an abnormal circulation of lymph fluid into the pleural cavity, is the most common cause of pleural effusions during the neonatal period. This condition affects 1/15,000 neonates every year. Affected neonates often manifest with respiratory distress, electrolyte imbalances, sepsis, and even immunodeficiencies. Mortality risk is highest among neonates undergoing cardiac surgery as well as those with associated hydrops fetalis. Conservative treatment options include bowel rest with administration of parenteral nutrition, followed with medium-chain triglyceride enteral feedings, and octreotide therapy. Severe or persistent cases require surgical intervention. This can involve a unilateral or bilateral pleurectomy and thoracic duct ligation, with or without pleurodesis. Early identification and successful treatment of this condition is contingent upon awareness of the most current evidence and a timely cross-disciplinary approach to care.

scholarly journals TNF-Alpha Inhibitors for Chronic Urticaria: Experience in 20 Patients

2013 ◽  
Vol 2013 ◽  
pp. 1-4 ◽  
Author(s):  
Freja Lærke Sand ◽  
Simon Francis Thomsen
Keyword(s):  
Side Effects ◽  
Chronic Urticaria ◽  
Treatment Options ◽  
Significant Proportion ◽  
Response Duration ◽  
Immunosuppressive Drugs ◽  
Tnf Alpha ◽  
High Dose ◽  
Duration Of Treatment ◽  
Durable Response

Patients with severe chronic urticaria may not respond to antihistamines, and other systemic treatment options may either be ineffective or associated with unacceptable side effects. We present data on efficacy and safety of adalimumab and etanercept in 20 adult patients with chronic urticaria. Twelve (60%) patients obtained complete or almost complete resolution of urticaria after onset of therapy with either adalimumab or etanercept. Further three patients (15%) experienced partial response. Duration of treatment ranged between 2 and 39 months. Those responding completely or almost completely had a durable response with a mean of 11 months. Six patients (30%) experienced side effects and five patients had mild recurrent upper respiratory infections, whereas one patient experienced severe CNS toxicity that could be related to treatment with TNF-alpha inhibitor. Adalimumab and etanercept may be effective and relatively safe treatment options in a significant proportion of patients with chronic urticaria who do not respond sufficiently to high-dose antihistamines or in whom standard immunosuppressive drugs are ineffective or associated with unacceptable side effects.

scholarly journals Reduced dose folinic acid rescue after rapid high-dose methotrexate clearance is not associated with increased toxicity in a pediatric cohort

2021 ◽  
Author(s):  
Riitta Niinimäki ◽  
Henri Aarnivala ◽  
Joanna Banerjee ◽  
Tytti Pokka ◽  
Kaisa Vepsäläinen ◽  
...  
Keyword(s):  
Folinic Acid ◽  
Lymphoblastic Leukemia ◽  
High Dose ◽  
Optimal Dosage ◽  
High Dose Methotrexate ◽  
Reduced Dose ◽  
Dose Methotrexate ◽  
Antileukemic Effect ◽  
Folinic Acid Rescue ◽  
High Doses

Abstract Purpose Low doses of folinic acid (FA) rescue after high-dose methotrexate (HD-MTX) have been associated with increased toxicity, whereas high doses may be related to a decreased antileukemic effect. The optimal dosage and duration of FA rescue remain controversial. This study was designed to investigate, whether a shorter duration of FA rescue in the setting of rapid HD-MTX clearance is associated with increased toxicity. Methods We reviewed the files of 44 children receiving a total of 350 HD-MTX courses during treatment for acute lymphoblastic leukemia according to the NOPHO ALL-2000 protocol. Following a 5 g/m2 HD-MTX infusion, pharmacokinetically guided FA rescue commenced at hour 42. As per local guidelines, the patients received only one or two 15 mg/m2 doses of FA in the case of rapid MTX clearance (serum MTX ≤ 0.2 μmol/L at hour 42 or hour 48, respectively). Data on MTX clearance, FA dosing, inpatient time, and toxicities were collected. Results Rapid MTX clearance was observed in 181 courses (51.7%). There was no difference in the steady-state MTX concentration, nephrotoxicity, hepatotoxicity, neutropenic fever, or neurotoxicity between courses followed by rapid MTX clearance and those without. One or two doses of FA after rapid MTX clearance resulted in a 7.8-h shorter inpatient time than if a minimum of three doses of FA would have been given. Conclusion A pharmacokinetically guided FA rescue of one or two 15 mg/m2 doses of FA following HD-MTX courses with rapid MTX clearance results in a shorter hospitalization without an increase in toxic effects.

High dose Indium-III octreotide therapy for disseminated carcinoid tumour

2000 ◽  
Vol 118 (4) ◽  
pp. A516
Author(s):  
Martyn E. Caplin ◽  
A.J. Hilson ◽  
D. Hochhauser ◽  
A.K. Burroughs ◽  
J. Tibbals ◽  
...  
Keyword(s):  
Carcinoid Tumour ◽  
High Dose ◽  
Octreotide Therapy

Bradyarrhythmias

2016 ◽  
Author(s):  
Inna Leybell ◽  
Liliya Abrukin
Keyword(s):  
Atrioventricular Block ◽  
Sinus Bradycardia ◽  
Sinus Node ◽  
Treatment Options ◽  
Presenting Symptoms ◽  
Threatening Condition ◽  
Node Disease ◽  
Life Threatening ◽  
Sinus Node Disease ◽  
Sinoatrial Block

Bradyarrhythmias can present as an incidental electrocardiographic (ECG) finding or a life-threatening condition requiring immediate intervention. They are caused by sinus node disease or atrioventricular block. This review covers pathophysiology, stabilization and assessment, diagnosis and treatment options, and disposition and outcomes for patients with bradycardia. Figures in the review demonstrate characteristic ECG tracings. Tables list classifications of sinus node dysfunction as well as of sinoatrial and atrioventricular blocks, presenting symptoms, important information to elicit on history taking, various causes of bradycardia, and specific interventions for toxicologic etiologies. Key words: atrioventricular block, atropine, bradyarrhythmia, bradycardia, first-degree atrioventricular block, second-degree atrioventricular block, sinoatrial block, sinus bradycardia, sinus node disease, tachycardia-bradycardia syndrome, third-degree atrioventricular block This review contains 9 highly rendered figures, 7 tables, and 92 references.

scholarly journals Successful Treatment of Vaccine-Induced Immune Thrombotic Thrombocytopenia in a 26-Year-Old Female Patient

2021 ◽  
pp. 1-4
Author(s):  
Marcel Kemper ◽  
Georg Lenz ◽  
Rolf Michael Mesters
Keyword(s):  
Female Patient ◽  
Treatment Options ◽  
Anticoagulation Therapy ◽  
Intravenous Immunoglobulins ◽  
High Dose ◽  
Severe Thrombocytopenia ◽  
Vein Thrombosis ◽  
Medical Facilities ◽  
Deep Vein ◽  
Improve Patient

Vaccine-induced immune thrombotic thrombocytopenia (VITT) has already been described after vaccination with ChAdOx2 nCov-19 (AstraZeneca) and Ad26.COV2.S (Johnson & Johnson/Janssen). However, less knowledge so far has been gained about optimal therapeutic regimens in VITT-suspected patients. Here, we report the case of a 26-year-old female patient, who developed bilateral deep vein thrombosis in the lower legs and severe thrombocytopenia after ChAdOx2 nCov-19 vaccination. After initial anticoagulation therapy regimens including fondaparinux, apixaban, and danaparoid failed, the patient was successfully treated with high-dose intravenous immunoglobulins in combination with parental anticoagulation therapy with argatroban. As vaccination against severe acute respiratory syndrome coronavirus 2 affects billions of people worldwide, medical facilities and hospitals have to be prepared and provide effective treatment options in VITT-suspected patients, including rapid application of high-dose intravenous immunoglobulins, to improve patient outcomes.

scholarly journals Optimal dose of aripiprazole for augmentation therapy of antidepressant-refractory depression: preliminary findings based on a systematic review and dose–effect meta-analysis

2021 ◽  
pp. 1-8
Author(s):  
Yuki Furukawa ◽  
Tasnim Hamza ◽  
Andrea Cipriani ◽  
Toshi A. Furukawa ◽  
Georgia Salanti ◽  
...  
Keyword(s):  
Meta Analysis ◽  
Dose Range ◽  
Drop Out ◽  
Dose Effect ◽  
High Dose ◽  
Optimal Dosage ◽  
Inadequate Response ◽  
Augmentation Therapy ◽  
Refractory Depression ◽  
Significant Difference

Background Aripiprazole augmentation is proven effective for antidepressant-refractory depression, but its licensed dose range is wide and optimal dosage remains unclear. Aims To find the optimal dosage of aripiprazole augmentation. Method Multiple electronic databases were searched (from inception to 16 February 2021) to identify all assessor-masked randomised controlled trials evaluating aripiprazole augmentation therapy in adults (≥18 years old, both genders) with major depressive disorder showing inadequate response to at least one antidepressant treatment. A random-effects, one-stage dose–effect meta-analysis with restricted cubic splines was conducted. Outcomes were efficacy (treatment response: ≥50% reduction in depression severity), tolerability (drop-out due to adverse effects) and acceptability (drop-out for any reason) after 8 weeks of treatment (range 4–12 weeks). Results Ten studies met the inclusion criteria. All were individually randomised, placebo-controlled, multi-centre, parallel studies including 2625 participants in total. The maximum target dose–efficacy curve showed an increase up to doses between 2 mg (odds ratio OR = 1.46, 95% CI 1.15–1.85) and 5 mg (OR = 1.93, 95% CI 1.33–2.81), and then a non-increasing trend through the higher licensed doses up to 20 mg (OR = 1.90, 95% CI 1.52–2.37). Tolerability showed a similar trend with greater uncertainty. Acceptability showed no significant difference through the examined dose range. Certainty of evidence was low to moderate. Conclusions Low-dose aripiprazole as augmentation treatment might achieve the optimal balance between efficacy, tolerability and acceptability in the acute treatment of antidepressant-refractory depression. However, the small number of included studies and the overall moderate to high risk of bias seriously compromise the reliability of the results. Further research is required to investigate the benefits of low versus high dose.

scholarly journals Stereotactic Ablative Radiotherapy for the Treatment of Oligometastatic Cancer: A Clinical Review as Part of a Health Technology Assessment

2021 ◽  
Vol 1 (3) ◽  
Author(s):  
Chantelle C. Lachance ◽  
Khai Tran ◽  
Elizabeth Carson ◽  
Joanne Kim ◽  
David Palma ◽  
...  
Keyword(s):  
Clinical Review ◽  
Treatment Options ◽  
Progression Free Survival ◽  
Clinical Effectiveness ◽  
Standard Of Care ◽  
The Body ◽  
Stereotactic Ablative Radiotherapy ◽  
High Dose ◽  
Normal Tissues ◽  
Oligometastatic Cancer

Oligometastatic cancer (cancer with a limited number of metastases) represents an intermediate state between cancer confined to a single location in the body and cancer that has metastasized — or spread — widely. One treatment option, for which there is growing interest, is stereotactic ablative radiotherapy, also known as SABR. SABR precisely delivers a high dose of radiation to ablate tumours at specific sites while minimizing the radiation dose to surrounding normal tissues. SABR may be used independently or alongside other treatment options in the management of oligometastatic cancer. This CADTH clinical review evaluated the evidence regarding the clinical effectiveness and safety of SABR with or without standard of care (SOC) for people with oligometastatic cancer and found the following: SABR in addition to SOC may offer a benefit in terms of overall survival (OS) and progression-free survival (PFS). The findings for the effectiveness of SABR alone compared with SOC were mixed and deemed inconclusive. There are insufficient data related to adverse events (AEs) at the present time to draw conclusions regarding the safety of SABR relative to SOC alternatives. Note that the CADTH Clinical Review Report will be updated every 3 months to ensure the findings remain up-to-date as new evidence emerges.

High Dose Indomethacin for Patent Ductus Arteriosus Closure Increases Neonatal Morbidity

2019 ◽  
Author(s):  
Salome Waldvogel ◽  
Andrew Atkinson ◽  
Mélanie Wilbeaux ◽  
Mathias Nelle ◽  
Markus R. Berger ◽  
...  
Keyword(s):  
Patent Ductus Arteriosus ◽  
Preterm Infants ◽  
Necrotizing Enterocolitis ◽  
Standard Dose ◽  
Ductus Arteriosus ◽  
Treatment Options ◽  
Univariate Analysis ◽  
High Dose ◽  
Closure Rate ◽  
Patent Ductus

Abstract Objective Symptomatic patent ductus arteriosus (sPDA) is the most common heart abnormality in preterm infants. Optimal duration and dose of medical treatment is still unclear. We assessed undesired effects and closure rate of high-dose indomethacin (HDI) for pharmacological closure of sPDA. Study Design Retrospective single center analysis of 248 preterm infants born between January 2006 and December 2015 with a birth weight <2,000 g and sPDA which was treated with indomethacin. Patients were treated with either standard dose indomethacin (SDI; n = 196) or HDI (n = 52). Undesired effects and PDA closure were compared between patients treated with SDI and HDI. Results In univariate analysis, patients receiving HDI had a significant increase in gastrointestinal hemorrhage (32.7 vs.11.7%, p = 0.001), bronchopulmonary dysplasia (BPD) (77.8 vs. 55.1%, p = 0.003), and retinopathy of prematurity (13.5 vs. 2.6%, p = 0.004). Moreover, HDI patients needed longer mechanical ventilation (2.5 vs. 1.0 days, p = 0.01). Multivariate analyses indicated that necrotizing enterocolitis (17 vs. 7%, p = 0.01) and BPD (79 vs. 55%, p = 0.02) were more frequent in HDI patients. PDA closure rate was 79.0% with HDI versus 65.3% with SDI. Conclusion HDI used for PDA closure is associated with an increase in necrotizing enterocolitis and BPD. Risks of HDI should be balanced against other treatment options.

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