Lack of Significant Skeletal Changes after Long-Term, Low-Dose Retinoid Therapy: Case Report and Review of the Literature

2006 ◽  
Vol 10 (6) ◽  
pp. 291-299 ◽  
Author(s):  
Caroline P. Halverstam ◽  
Joshua Zeichner ◽  
Mark Lebwohl
Keyword(s):  
Case Report ◽  
Side Effects ◽  
Low Dose ◽  
Diffuse Idiopathic Skeletal Hyperostosis ◽  
High Dose ◽  
Review Of The Literature ◽  
Radiologic Findings ◽  
Skeletal Changes ◽  
Retinoid Therapy

Background: Long-term systemic retinoid therapy has been associated with skeletal side effects. There have been reports of diffuse idiopathic skeletal hyperostosis (DISH) syndrome, calcification of ligaments, and osteoporosis, as well as premature fusion of epiphyses and modeling abnormalities of long bones, occurring in patients on chronic high-dose isotretinoin, etretinate, and acitretin therapy. Low-dose acitretin has been used for many years as monotherapy or in combination with other systemic therapies for psoriasis. Evidence to date suggests that the frequency of symptomatic bony effects is quite low in these patients. Objective: To present the radiologic findings of a patient on long-term, low-dose acitretin and etretinate and to review the literature on the radiologic evidence of skeletal side effects during retinoid therapy. Methods: Case report and literature search. Results: A patient on low-dose acitretin had no significant radiologic abnormalities associated with retinoid use after 9 years of treatment. A review of the literature revealed conflicting reports on the incidence of radiologic abnormalities in patients on retinoid treatment. Conclusion: The evidence to date does not substantiate a clear link between radiologic skeletal abnormalities and long-term, low-dose acitretin or etretinate therapy.

Long-term side effects following pneumonectomy: A case report and review of the literature

2019 ◽  
Author(s):  
BA Högerle ◽  
EL Bulut ◽  
L Klotz ◽  
F Eichhorn ◽  
M Eichhorn ◽  
...  
Keyword(s):  
Case Report ◽  
Side Effects ◽  
Review Of The Literature

Maintenance Low Dose 13 Cis-Retinoic Acid and Alpha Tocopherol Improves Survival Compared to High Dose Therapy for 6 Months In LOW and INT-1/2 Stage MDS: Role for Prevention Trial

Blood ◽  
2011 ◽  
Vol 118 (21) ◽  
pp. 5053-5053
Author(s):  
Emmanuel C. Besa ◽  
Joseph Vadakara
Keyword(s):  
Retinoic Acid ◽  
Retrospective Study ◽  
Side Effects ◽  
Low Dose ◽  
Low Risk ◽  
Alpha Tocopherol ◽  
High Dose ◽  
Off Label ◽  
Stage Disease

Abstract Abstract 5053 There are no current therapies or preventative strategies other than transfusion support and possibly growth factor support for the management of low risk and INT 1 Myelodysplasia. There have been a few studies that looked into the effect of 13 cis-retinoic acid (13CRA) by itself and in combination with other drugs that showed some benefits to the use of 13CRA in MDS. A randomized blinded study failed to show any benefit of 13CRA over placebo; however in this study many of the patients discontinued therapy due to side effects of the 13CRA and significant number of the patients had advanced stage disease and either had CMML, RAEB, and RAEB-t based on the classification in use then. Other studies have suggested that the beneficial effect of 13CRA is possibly seen in early stage disease and in low risk Refractory Anemia patients. To look into the benefit that 13CRA might have on IPSS low risk, INT-1 and INT-2 MDS patients we conducted a retrospective study that looked at the effect of 13CRA given in two different doses and durations. Methods: This was a retrospective study that looked at patients with IPSS low risk and INT-1 and INT-2. The patients were divided into two groups. One group was treated with a dose of 13CRA at a dose of 100mg/m2/day for 6 months. The second cohort was treated with a dose of 40mg of 13CRA until disease progression. Disease progression was then compared in the two groups to see if there was any statistical difference in the treatment arms. One of the patients did not seem to have any side effects of 13CRA and it was later found that that patient was on alpha tocopherol, once this was realized then all the patients were given Alpha tocopherol (AT) at a dose 800mg per day along with 13CRA. Results: Twenty patients were identified in the high dose short term arm, and 29 patients in the low dose long term arm. Both groups were similar in age (mean, range) in years, male/female ratio, duration from diagnosis to treatment. IPSS scores and transfusion requirements were comparable. Responses were observed in both groups with an overall response rate of 44.8% in HDST and 75% in LDLT with similar, low AML transformation in INT-1-2 patients of 15% in LDLT and 13.7% in HDST. A better median survival was observed with 5 patients still alive at 72 months in LDLT compared to 30 months in HDST group with a difference of 42 months (3.5 years) (Log-rank p value= 0.0099). The patients who were on the LDLT arm with alpha tocopherol had a much better toxicity profile with only 5% developing skin toxicity compared to as high as 27% in HDST arm and 100% in patients who only received 13CRA, similarly triglyceride changes were seen in 5%, 20%, and 52% respectively, AST elevations were seen in 0%, 2% and 19 % respectively. This suggest that lack of toxicity and good tolerance using 13 CRA at 40 mg/d with 800 mg of AT for long term preventive measure in early phase MDS may result in prolonged survival and may be used as basis for a prospective prevention trial. Disclosures: Off Label Use: 13 cis retinoic acid is used off label.

scholarly journals Ropivacaine Plasma Concentrations after 192-Hour High Dose Epidural Ropivacaine Infusion in a Pediatric Patient without Side Effects

2018 ◽  
Vol 2018 ◽  
pp. 1-3
Author(s):  
Glenn van de Vossenberg ◽  
Selina van der Wal ◽  
Andrea Müller ◽  
Edward Tan ◽  
Kris Vissers
Keyword(s):  
Case Report ◽  
Side Effects ◽  
Trauma Patient ◽  
Pediatric Patient ◽  
Plasma Concentrations ◽  
High Dose ◽  
Epidural Administration ◽  
Venous Sampling ◽  
Arterial Sampling

This case report discusses continuous epidural administration of ropivacaine 0.56 mg kg−1 h −1 for 8 days in a 7-year-old trauma patient to prevent pain, after performing a lower right and upper left leg guillotine amputation. Venous sampling after 8 days revealed bound and unbound ropivacaine concentrations of 1.1 mg/l and 0.06 mg/l in plasma, respectively. Arterial sampling for bound and unbound ropivacaine was 1.2 mg/l and 0.05 mg/l in plasma, respectively. In this case report, long-term high dose epidural infiltration of ropivacaine did not result in severe side effects or complications. Further studies are needed to explore safety of these concentrations in larger populations of children.

scholarly journals The Effect of Long-Term Low-Dose Atropine on Refractive Progression in Myopic Australian School Children

2021 ◽  
Vol 10 (7) ◽  
pp. 1444
Author(s):  
William Myles ◽  
Catherine Dunlop ◽  
Sally A. McFadden
Keyword(s):  
Low Dose ◽  
High Dose ◽  
Eye Drops ◽  
Myopia Progression ◽  
At Risk Children ◽  
Slow Group ◽  
Blue Eyes ◽  
Global Population ◽  
Axial Growth

Myopia will affect half the global population by 2050 and is a leading cause of vision impairment. High-dose atropine slows myopia progression but with undesirable side-effects. Low-dose atropine is an alternative. We report the effects of 0.01% or 0.005% atropine eye drops on myopia progression in 13 Australian children aged between 2 and 18 years and observed for 2 years without and up to 5 years (mean 2.8 years) with treatment. Prior to treatment, myopia progression was either ‘slow’ (more positive than −0.5D/year; mean −0.19D/year) or ‘fast’ (more negative than −0.5D/year; mean −1.01D/year). Atropine reduced myopic progression rates (slow: −0.07D/year, fast: −0.25D/year, combined: before: −0.74, during: −0.18D/year, p = 0.03). Rebound occurred in 3/4 eyes that ceased atropine. Atropine halved axial growth in the ‘Slow’ group relative to an age-matched model of untreated myopes (0.098 vs. 0.196mm/year, p < 0.001) but was double that in emmetropes (0.051mm/year, p < 0.01). Atropine did not slow axial growth in ‘fast’ progressors compared to the age-matched untreated myope model (0.265 vs. 0.245mm/year, p = 0.754, Power = 0.8). Adverse effects (69% of patients) included dilated pupils (6/13) more common in children with blue eyes (5/7, p = 0.04). Low-dose atropine could not remove initial myopia offsets suggesting treatment should commence in at-risk children as young as possible.

Treatment options and long-term outcomes in pediatric spinal cord vascular malformations: a case report and review of the literature

2020 ◽  
Vol 36 (12) ◽  
pp. 3147-3152
Author(s):  
Helen J. Zhang ◽  
Nicole Silva ◽  
Elena Solli ◽  
Amanda C. Ayala ◽  
Luke Tomycz ◽  
...  
Keyword(s):  
Spinal Cord ◽  
Case Report ◽  
Vascular Malformations ◽  
Treatment Options ◽  
Review Of The Literature ◽  
Long Term Outcomes

Enlargement of cerebrospinal fluid spaces in long-term benzodiazepine abusers

1987 ◽  
Vol 17 (4) ◽  
pp. 869-873 ◽  
Author(s):  
C. Schmauss ◽  
J.-C. Krieg
Keyword(s):  
Low Dose ◽  
Matched Control ◽  
Control Group ◽  
High Dose ◽  
Withdrawal Therapy ◽  
The Mean ◽  
Dose Dependent ◽  
Dose Dependent Effect ◽  
Age And Sex

SynopsisIn 17 benzodiazepine (BDZ) dependent in-patients a CT scan was performed before initiation of withdrawal therapy. The evaluation of the ventricular to brain ratio (VBR) by standardized and computerized measurements revealed significantly higher mean VBRs for both high-and low-dose BDZ-dependent patients compared to the mean VBR of an age- and sex-matched control group. In addition, the mean VBR of high-dose BDZ-dependent patients (N = 8) was significantly higher than the mean VBR of low-dose BDZ-dependent patients (N = 9). This difference could not be accounted for by the age of the patients or duration of BDZ-dependency and, therefore, suggests a dose-dependent effect of BDZs on the enlargement of internal CSF-spaces. On the other hand, higher values for the width of external CSF-spaces were found to be related to increasing age of the patients and duration of BDZ-dependency.

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