scholarly journals Simultaneous Subconjunctival Triamcinolone and Bevacizumab Injections for Management of Blepharokeratoconjunctivitis in Children

2018 ◽  
Vol 2018 ◽  
pp. 1-4
Author(s):  
Chu Luan Nguyen ◽  
Tony S. Chen ◽  
Khoi Tran ◽  
James E. H. Smith ◽  
Noni Lewis
Keyword(s):  
Conventional Treatment ◽  
Case Series ◽  
Corneal Neovascularization ◽  
Conjunctival Injection ◽  
Management Options ◽  
Conventional Management ◽  
Palpebral Conjunctiva ◽  
Meibomian Glands ◽  
Corneal Infiltrates ◽  
Red Eyes

Purpose. To report the efficacy of subconjunctival triamcinolone (Kenalog A-40, Alcon) and bevacizumab (Avastin, Genentech) injections in fraternal twins with blepharokeratoconjunctivitis (BKC) causing progressive, bilateral corneal neovascularization and scarring. Methods. In this retrospective observational case series, two three-year-old male twins with BKC had presented with bilateral red eyes, photophobia, and frequent blinking. Examination of each child showed bilateral deep stromal and superficial corneal neovascularization, corneal infiltrates, multiple follicles on the palpebral conjunctiva bilaterally with blepharitis, and thick turbid sebum expressed from the Meibomian glands. Their disease progressed despite conventional treatment. Both twins were managed with subconjunctival triamcinolone injection and subconjunctival bevacizumab injection of each eye. Results. The treatment resulted in improvement of symptoms, and examination over an 8-10-month period postinjections showed fading stromal corneal infiltrates, partially regressed corneal neovascularization, and reduced conjunctival injection without complications. Conclusion. This case series highlights the potential vision threatening complications of BKC. In addition to conventional management options, this report is the first published use of subconjunctival triamcinolone and bevacizumab injections for BKC in children in an attempt to minimize and improve corneal neovascularization and scarring and subsequently to retain useful vision.

Treatment of chronic resistant paediatric idiopathic pericardial effusion with intrapericardial injection of corticosteroids 4-year-old girl with rapid full resolution after intrapericardial injection of corticosteroids

2021 ◽  
pp. 1-3
Author(s):  
Takhfif Othman ◽  
Osama Eldadah
Keyword(s):  
Pericardial Effusion ◽  
Conventional Therapy ◽  
Complete Resolution ◽  
Conventional Treatment ◽  
Management Options ◽  
Conventional Management ◽  
Full Resolution ◽  
Paediatric Case ◽  
Inflammatory Drugs ◽  
Anti Inflammatory

Abstract Non-steroidal anti-inflammatory drugs are the conventional treatment for pericarditis. However, some patients will still suffer from persistence pericardial effusion despite exhausting all conventional management options. A 4-year-old girl with idiopathic pericardial effusion who did not respond to 2 months of conventional therapy had complete resolution of effusion within 5 days, with no recurrence after administration of intrapericardial steroids. As far as we know, this is the first published paediatric case who has shown a similar outcome to that seen in adult studies.

scholarly journals A randomised controlled trial comparing venous stenting with conservative treatment in patients with deep venous obstruction: research protocol

BMJ Open ◽  
2017 ◽  
Vol 7 (9) ◽  
pp. e017233 ◽  
Author(s):  
Timme MAJ van Vuuren ◽  
Jorinde H H van Laanen ◽  
Maaike de Geus ◽  
Patty J Nelemans ◽  
Rick de Graaf ◽  
...  
Keyword(s):  
Conservative Treatment ◽  
Conventional Treatment ◽  
Short Form ◽  
Randomised Trial ◽  
Case Series ◽  
Interventional Treatment ◽  
Venous Obstruction ◽  
Venous Stenting ◽  
Link Type ◽  
Registration Number

IntroductionDeep venous obstruction (DVO) has a great impact on quality of life (QoL) comparable to angina pectoris or chronic pulmonary disease. Post-thrombotic scar formation and May-Thurner syndrome (MTS) are the most common causes of DVO. Conventional treatment of DVO focuses on reducing pain or leg swelling by use of (pain) medication and therapeutic elastic stockings. In the past, a venous bypass was offered in severe post-thrombotic cases, but this procedure showed bad clinical and patency outcomes. With the introduction of percutaneous angioplasty and dedicated venous stents new opportunities were created. Deep venous stenting has been shown to be effective in retrospective case series. However, there is no prior research in which QoL after interventional treatment is compared with QoL after conventional treatment. Currently, there is a debate about the true additional value of interventional treatment. We investigate whether those patients who are treated with stenting experience a change in short form 36 (SF-36) and the Veines-QoL/Sym questionnaires compared with conventionally treated patients.Methods and analysisThis is a randomised trial comparing conservative deep venous management to interventional treatment. A total of 130 patients with post-thrombotic syndrome (PTS) or MTS, eligible for interventional percutaneous treatment, who did not have previous deep venous intervention will be included. Patients will be randomised to conservative treatment or venous stenting and stratified for the PTS or MTS subgroup. Conservative treatment consists of either one or a combination of pain medications, manual lymphatic drainage, compression stockings and regular post-thrombotic anticoagulant therapy.The primary outcome is the QoL change after 12 months compared with baseline QoL. Secondary outcomes are QoL changes at 6 weeks, clinical assessment of DVO, recurrence rate of deep venous thrombosis at 6 weeks and 12 months, and the total amount of working days lost. Intervention-specific outcomes include complications and patency.Ethics and disseminationThe protocol is approved by the Medical Ethics Committee of Academisch ziekenhuis Maastricht/Universiteit Maastricht, The Netherlands (protocol number NLNL55641.068.15 / METC 161008).We aim to publish the results of this study in a peer reviewed journal and present our findings at national or international conferences.Trial registration numberThe study protocol was registered atwww.clinicaltrials.gov(registration number:NCT03026049) on 17 January 2017.

scholarly journals Xeroderma Pigmentosum: Ocular Findings in an Isolated Brazilian Group with an Identified Genetic Cluster

2019 ◽  
Vol 2019 ◽  
pp. 1-8 ◽  
Author(s):  
Maria Claudia Schelini ◽  
Luis Fernando O. B. Chaves ◽  
Marcia C. Toledo ◽  
Francisco W. Rodrigues ◽  
Tauan de Oliveira ◽  
...  
Keyword(s):  
Ocular Surface ◽  
Xeroderma Pigmentosum ◽  
Genetic Disorder ◽  
Skin Pigmentation ◽  
Previous History ◽  
Case Series ◽  
Corneal Neovascularization ◽  
University Hospital ◽  
Ocular Symptoms ◽  
History Of

Purpose. Xeroderma pigmentosum (XP) is a rare autosomal recessive genetic disorder characterized by increased susceptibility to UV radiation- (UVR-) induced skin pigmentation, skin cancers, ocular surface disease, and, in some patients, sunburn and neurological degeneration. Eight different genes are affected, and the prevalence of the disease differs across the world. The present study describes the main ophthalmologic features and symptoms in patients with XP in this case series. Methods. Patients were examined consecutively at the University Hospital of the Federal University of Goias between January 2016 and June 2018. All patients underwent ophthalmologic examination and were asked about their ophthalmological history and the presence of ocular symptoms. Results. Twenty-one patients with genetic confirmation were evaluated. The genetic variants XPV and XPC were detected in the patients. The most prevalent findings include eyelid changes, observed in 80.9% of the patients, and ocular surface changes as punctate keratopathy, occurring in 16 patients (76.2%), corneal neovascularization, and corneal opacities. Six patients (28.5%) presented corneoconjunctival tumor. More than half of patients had previous history of treatment of ocular neoplasia. Ocular burning was the most reported symptom. Conclusions. The ocular characteristics identified in this study corroborate the existing literature, mainly related to the surface. Concerning the XP variant and the gravity of ocular signs, XPC has earlier and more severe symptoms than XPV. Due to their relative rarity, publications of XP cases are important to understand the possible damages caused by the disease in the eyes and surrounding area.

scholarly journals Malignant Pleural Effusions: Management Options

2018 ◽  
Vol 39 (06) ◽  
pp. 704-712 ◽  
Author(s):  
Jose Porcel ◽  
Najib Rahman ◽  
David McCracken
Keyword(s):  
Malignant Pleural Effusion ◽  
Conventional Treatment ◽  
Fibrinolytic Therapy ◽  
Patient Benefit ◽  
Management Options ◽  
Future Directions ◽  
Population Demographics ◽  
Health Care Burden ◽  
Significant Health

AbstractMalignant pleural effusion (MPE) represents advanced metastatic malignancy and is associated with poor median survival. Incidence remains high and continues to rise, in part due to changing population demographics. This therefore represents a significant health care burden. Management is predominantly palliative in nature and multiple interventions are available within conventional treatment paradigms, all of which are proven to result in statistically significant patient benefit. This article further explores the methods available in the management of MPE along with the pitfalls, complications, and alternatives. Recent advances within the field are discussed with an exploration of likely future directions, including the role of ultrasound as a prospective predictor and the role of intrapleural fibrinolytic therapy.

Exacerbation of SUNCT and SUNA syndromes during intravenous dihydroergotamine treatment: A case series

Cephalalgia ◽  
2015 ◽  
Vol 35 (12) ◽  
pp. 1115-1124 ◽  
Author(s):  
Giorgio Lambru ◽  
Paul Shanahan ◽  
Manjit Matharu
Keyword(s):  
Cluster Headache ◽  
Chronic Migraine ◽  
Dopamine Agonists ◽  
Dopaminergic System ◽  
De Novo ◽  
Case Series ◽  
Conjunctival Injection ◽  
Patient Reported ◽  
Marginal Improvement ◽  
New Onset

Background The management of short-lasting unilateral neuralgiform headache attacks with conjunctival injection and tearing (SUNCT) and with short-lasting unilateral neuralgiform headache attacks with autonomic symptoms (SUNA) remains challenging in view of the limited understanding of their pathophysiological mechanisms. Methods An initial observation that patients with both chronic migraine (CM) or cluster headache (CH) and SUNCT/SUNA receiving intravenous dihydroergotamine (IV DHE) had complained of dramatic worsening of the latter led to review of the case notes of patients with CM or CH and co-existent SUNCT/SUNA seen between 2008 and 2013 and who had a trial of IV DHE. Results Twenty-four patients were identified. IV DHE was ineffective for SUNCT/SUNA in 16 patients, while one patient reported a marginal improvement. Five patients reported dramatic worsening of the SUNCT/SUNA. Moreover, two patients developed new-onset SUNA during their first IV DHE infusion. Out of these seven patients, those requiring repeated courses of IV DHE consistently experienced exacerbations of SUNCT/SUNA which were suppressed with IV lidocaine. Conclusions DHE is an ineffective treatment option for SUNCT and SUNA. Physicians who intend to offer IV DHE to CH or CM patients should warn them that IV DHE could exacerbate and possibly even lead to a de novo onset of SUNCT/SUNA. In view of the reported worsening or new onset of SUNCT/SUNA in patients using dopamine agonists for the treatment of pituitary prolactinomas, we speculate that DHE might worsen or induce SUNCT and SUNA, at least in a sub-group of patients, through a perturbation in the dopaminergic system.

scholarly journals Mycophenolate Mofetil for the Treatment of Autoimmune Hepatitis in Patients Refractory to Standard Therapy

2004 ◽  
Vol 18 (5) ◽  
pp. 321-326 ◽  
Author(s):  
Shane M Devlin ◽  
Mark G Swain ◽  
Stefan J Urbanski ◽  
Kelly W Burak
Keyword(s):  
Mycophenolate Mofetil ◽  
Autoimmune Hepatitis ◽  
Alanine Aminotransferase ◽  
Standard Therapy ◽  
Conventional Treatment ◽  
Case Series ◽  
Therapeutic Options ◽  
Sparing Effect ◽  
Histological Remission ◽  
Steroid Sparing

There are limited therapeutic options available for patients with autoimmune hepatitis in whom conventional treatment fails. A case series of five patients unresponsive to or unable to take azathioprine, 6-mercaptopurine or corticosteroids who were treated with mycophenolate mofetil (MMF) is reported. While on MMF, alanine aminotransferase normalized or remained normal in all patients. MMF had a steroid-sparing effect and histological remission was demonstrated in one patient after seven months of MMF. One patient experienced an uncomplicated episode of pyelonephritis. In conclusion, MMF can effectively induce and maintain remission in refractory autoimmune hepatitis patients.

The management of incidental low-grade gliomas using magnetic resonance imaging: systematic review and optimal treatment paradigm

2011 ◽  
Vol 31 (6) ◽  
pp. E12 ◽  
Author(s):  
Ashish H. Shah ◽  
Karthik Madhavan ◽  
Deborah Heros ◽  
Daniel M. S. Raper ◽  
J. Bryan Iorgulescu ◽  
...  
Keyword(s):  
Systematic Review ◽  
Mr Imaging ◽  
Active Surveillance ◽  
Case Series ◽  
Treatment Decisions ◽  
Low Grade ◽  
Management Options ◽  
Low Grade Gliomas ◽  
Presenting Symptoms ◽  
Radiological Evidence

Object The discovery of incidental low-grade gliomas (LGGs) on MR imaging is rare, and currently there is no existing protocol for management of these lesions. Various studies have approached the dilemma of managing patients with incidental LGGs. While some advocate surgery and radiotherapy, others reserve surgery until there is radiological evidence of growth. For neurosurgeons and radiologists, determining the course of action after routine brain imaging poses not only a medical but also an ethical dilemma. The authors conducted a systematic review of case reports and case series in hopes of enhancing the current understanding of the management options for these rare lesions. Methods A PubMed search was performed to include all relevant MR imaging studies in which management of suspected incidental LGG was reported. Comparisons were made between the surgical treatment arm and the active surveillance arm in terms of outcome, mode of discovery, reasons for treatment, and histology. Results Nine studies with 72 patients were included in this study (56 in the surgical arm and 16 in the active surveillance arm). Within the surgical arm, 49% remained deficit free after treatment, 25% showed evidence of tumor progression, 13% underwent a second treatment, and 7% died. The active surveillance group resulted in no unanticipated adverse events, with serial imaging revealing no tumor growth in all cases. Lesion regression was reported in 31% of this group. The surgical arm's mortality rate was 7% compared with 0% in the active surveillance arm. Conclusions Treatment decisions for incidental LGG should be individualized based on presenting symptoms and radiological evidence of growth. The asymptomatic patient may be monitored safely with serial MR imaging and occasionally PET scanning before treatment is initiated. In patients presenting with nonspecific symptoms or concurrent symptomatic lesions, treatment may be initiated earlier to reduce potential morbidity. All treatment decisions must be tempered by patient factors and expectations of anticipated benefit.

scholarly journals Prenatal Diagnosis of Neuroblastoma

2014 ◽  
Vol 8 (3) ◽  
pp. 321-327
Author(s):  
Mona Zvanca ◽  
Cristian Andrei
Keyword(s):  
Prenatal Diagnosis ◽  
Case Reports ◽  
Case Series ◽  
Expectant Management ◽  
Individual Case ◽  
Management Options ◽  
Tertiary Center ◽  
Low Incidence ◽  
Tumor In Childhood

ABSTRACT Fetal malignancies are rare complications during pregnancies, but when they appear, they are very challenging for the perinatology team. Because of their low incidence, the information is limited, with data provided from individual case reports or small case series. Although neuroblastoma is the most frequent extracranial solid tumor in childhood, prenatal diagnosis by ultrasound is very rare and almost always discovered during routine third trimester ultrasound. Expectant management is usually indicated prenatally, with serial ultrasound examination. Delivery should be planned in a tertiary center together with pediatric oncologists and surgeons to allow appropriate postnatal management. We present two cases of neuroblastoma diagnosed at 36 and 33 weeks of gestation with multiple aspects of this tumor identified by ultrasound. Both cases needed surgery and had a favorable outcome. The key role of ultrasound in diagnosis and follow-up of neuroblastoma in pregnancy is discussed, together with the management options recommended in literature. How to cite this article Andrei C, Vladareanu R, Zvanca M, Vladareanu S. Prenatal Diagnosis of Neuroblastoma. Donald School J Ultrasound Obstet Gynecol 2014;8(3):321-327.

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