scholarly journals Treatment of Childhood Psoriasis with Phototherapy and Photochemotherapy

2013 ◽  
Vol 7 ◽  
pp. CMPed.S8045 ◽  
Author(s):  
Irene Lara Corrales ◽  
Sabrina Ramnahne ◽  
Perla Lansang
Keyword(s):  
Literature Search ◽  
Pediatric Patients ◽  
Safety Data ◽  
Treatment Modalities ◽  
Pediatric Populations ◽  
Good Improvement

Phototherapy and photochemotherapy are well-described treatment modalities for psoriasis in adults. Like many other treatments, the experience and long-term safety of their use in children is limited. We conducted a literature search and identified publications reporting the use of phototherapy and photochemotherapy in pediatric populations. This article summarizes the existing literature on this topic. Although many studies report good improvement with these treatment modalities, long-term safety data on their use is lacking for pediatric patients.

scholarly journals Therapeutic Options of Chondrodermatitis Nodularis Helicis

2016 ◽  
Vol 2016 ◽  
pp. 1-12 ◽  
Author(s):  
Lea Juul Nielsen ◽  
Caroline Holkmann Olsen ◽  
Jørgen Lock-Andersen
Keyword(s):  
Surgical Treatment ◽  
Surgical Procedures ◽  
Inflammatory Process ◽  
Literature Search ◽  
Therapeutic Options ◽  
Treatment Modalities ◽  
Conservative Approach ◽  
And Cartilage ◽  
Long Term Studies

Chondrodermatitis Nodularis Helicis is a benign inflammatory process affecting the skin and cartilage of the ear. It typically presents as a painful nodule surrounded by an area of erythema and often prevents the patient from sleeping on the affected side. Many treatments have been described in the literature, but the condition is prone to recurrence. A literature search was performed in order to identify the best possible treatment. Fifty-eight articles were included, describing and investigating nonsurgical as well as surgical treatment modalities. Large prospective, controlled, and randomised long-term studies are lacking, but based on the available literature, we recommend starting with a conservative approach using decompression devices. Simple surgical procedures should only be used if conservative measures fail.

Long-Term Efficacy and Safety with Deferasirox (Exjade®, ICL670), a Once-Daily Oral Iron Chelator, in Pediatric Patients.

Blood ◽  
2007 ◽  
Vol 110 (11) ◽  
pp. 2774-2774 ◽  
Author(s):  
Antonio Piga ◽  
Elliott Vichinsky ◽  
Gian Luca Forni ◽  
Yurdanur Kilinc ◽  
Henry Maseruka ◽  
...  
Keyword(s):  
Clinical Trials ◽  
Sexual Development ◽  
Safety Profile ◽  
Pediatric Patients ◽  
Negative Impact ◽  
Safety Data ◽  
Efficacy And Safety ◽  
Old Patients ◽  
Term Efficacy

Abstract Background: Children with transfusion-dependent anemias will usually require lifelong iron chelation therapy. Establishing the long-term efficacy and safety profile of deferasirox is critically important in children. Presented here are cumulative long-term efficacy and safety data from a cohort of children treated with deferasirox in ongoing clinical trials. Methods: Pediatric patients (<16 years old) with β-thalassemia, sickle cell disease or other transfusion-dependent anemias were enrolled in 4 clinical trials and treated for 1 year with deferasirox (studies 106/108) or randomized to either deferasirox or deferoxamine (DFO; 107/109). Study treatment was extended for 4 years (extension phases); patients either continued deferasirox (deferasirox cohort) or crossed over from DFO to deferasirox (crossover cohort). Doses in the extensions were adjusted based on efficacy and safety parameters. Efficacy was monitored via serum ferritin (SF); safety was assessed by the incidence and type of AEs. Growth and sexual development were evaluated every 6 months. Results: 434 patients aged 2–<16 years (n=289 deferasirox cohort; n=145 crossover cohort) entered the extensions. In the deferasirox and crossover cohorts, respectively, 50 and 20 pediatric patients were ≥2–<6 years old, 123 and 69 were 6–<12 years old, and 116 and 56 were ≥12–<16 years old. Patients in the deferasirox cohort have received treatment for a median 3.5 years. Mean (SD) doses were 9.5 (1.6), 19.5 (2.6) and 29.6 (2.5) mg/kg/d in the 5/10, 20 and 30 mg/kg/d groups at month 1, respectively, and 22.9 (7.7), 24.6 (7.6) and 26.3 (9.5) mg/kg/d at month 42. Until month 12, median SF levels were maintained in the 20 mg/kg/d cohort, decreased in the 30 mg/kg/d cohort and increased in the 5/10 mg/kg/d cohort. After dose escalations at month 12, median SF levels fell below baseline at month 42 in all cohorts (Table). 390 (90%) children continue to receive deferasirox. Of 43 discontinuations, 22 were due to AEs. Two deaths, both considered unrelated to treatment, occurred in the deferasirox cohort. The most common drug-related AEs, including vomiting (n=26), nausea (n=25), abdominal pain (n=21), diarrhea (n=19) and mild/moderate skin rash (n=35), occurred mainly in the core phases. There were no significant changes in markers of liver function in the extension phases and no cases of progressive increases in serum creatinine. Physical and sexual development proceeded normally in all children. Conclusions: Over a median period of 3.5 years, treatment with deferasirox provided dose dependent overall reduction in iron burden in transfusion-dependent children, as measured by SF levels. Deferasirox had a manageable safety profile in children, which was similar to that observed in the 1-year core trials. There was no negative impact on growth and sexual development. Median SF values (ng/mL) in children (deferasirox cohort) Initial dose, mg/kg/d Month 5/10 20 30 All n=129 n=89 n=74 n=292 *Dose adjustments Baseline 2126 2504 3491 2420 1 2041 2488 2976 2451 6 2394 2724 2678 2460 12* 2653 2602 2608 2618 18 3037 2480 2271 2771 24 2929 2651 2106 2522 30 2747 2404 2007 2440 36 1967 1916 2008 1970 42 1830 1812 1889 1831

Interventional pain-management techniques for chronic pain

2021 ◽  
pp. 483-493
Author(s):  
Navil F. Sethna ◽  
Walid Alrayashi ◽  
Pradeep Dinakar ◽  
Karen R. Boretsky
Keyword(s):  
Chronic Pain ◽  
Pain Management ◽  
Treatment Modalities ◽  
Multidisciplinary Management ◽  
Neuraxial Blockade ◽  
Pediatric Chronic Pain ◽  
Injection Techniques ◽  
Pediatric Populations ◽  
Interventional Pain Management

As part of the multidisciplinary management of pediatric chronic pain, interventional pain-management (IPM) techniques can play an important role when pain is unrelieved by conventional treatment modalities. Many procedures and indications are extrapolated from adult studies, and evidence for long-term efficacy in pediatric populations is limited. Interventions range from injection techniques with local anesthetic and/or corticosteroids to neuraxial blockade with implanted catheters. In selected patients, IPM procedures can serve as useful adjuncts in multidisciplinary management of chronic pain disorders.

Deferasirox (Exjade®) in Pediatric Patients with β-Thalassemia: Update of 4.7-Year Efficacy and Safety from Extension Studies

Blood ◽  
2008 ◽  
Vol 112 (11) ◽  
pp. 3883-3883 ◽  
Author(s):  
Antonio Piga ◽  
Gian Luca Forni ◽  
Antonis Kattamis ◽  
Christos Kattamis ◽  
Yesim Aydinok ◽  
...  
Keyword(s):  
Pediatric Patients ◽  
Iron Concentration ◽  
Safety Data ◽  
Iron Chelation ◽  
Dose Titration ◽  
Efficacy And Safety ◽  
Liver Iron ◽  
Long Term Treatment ◽  
Median Change

Abstract Background: As pediatric patients with β-thalassemia will require lifelong iron chelation therapy, it is important to evaluate the long-term efficacy, safety and growth during treatment with any iron chelator. This analysis presents cumulative efficacy and safety data from a cohort of pediatric patients treated with the once-daily, oral chelator deferasirox during two 1-year core and 4-year extension trials. Methods: β-thalassemia patients aged 2–<16 years with transfusional iron overload were enrolled in two extension studies (107E and 108E) evaluating the long-term safety, tolerability and efficacy (by serum ferritin [SF] levels) of deferasirox; only patients who received deferasirox from the beginning of the core trial are included in this analysis. Deferasirox doses in the extension trials were initially based on end-of-core liver iron concentration, and were adjusted according to trends in SF levels. Efficacy was monitored by monthly SF levels; safety was assessed by the incidence and type of adverse events (AEs) and laboratory parameters. Results: 168 patients (153 patients from study 107 and 15 from study 108) aged 2–<6 (n=30), 6–<12 (n=74) and ≥12–<16 (n=64) years entered the extensions. To date, patients have received deferasirox for a median of 56.1 months (4.7 years) at an average daily dose of 22.5 ± 6.6 mg/kg/day. Mean iron intake during treatment was 0.4 ± 0.1 mg/kg/day. Mean actual dose at month 3 was 19.8 ± 8.8 mg/kg/day, which increased to 28.3 ± 7.3 mg/kg/day by month 54. Median SF levels at baseline were 2419 ng/mL and were maintained to around month 18, reflecting the mean dose of ~20 mg/kg/day (Figure 1). Following dose titration, SF levels began to decrease with an overall median decrease in SF by month 54 of −947 ng/mL. At the time of analysis 137 patients (81.5%) continue to receive deferasirox. Of 31 discontinuations, 13 (7.7%) were due to AEs (drug-related AEs leading to discontinuation included glycosuria [n=3] and proteinuria [n=2]), eight (4.8%) to unsatisfactory therapeutic effect, five (3.0%) to consent withdrawal and four (2.4%) to other reasons. One death (septicemia in a splenectomized patient) occurred, considered by the Program Safety Board unrelated to treatment. Over the study period, the most common drug-related (investigator-assessed) AEs were abdominal pain and vomiting (n=12, 7.1% for both), nausea (n=10, 6.0%) and rash (n=9, 5.4%). The annual frequency of drug-related AEs decreased from year to year. In total, 13 patients (7.7%) had an increase in serum creatinine >33% above baseline and the upper limit of normal (ULN) on two consecutive visits; however, there were no progressive increases. Six patients (3.6%) with a normal baseline alanine aminotransferase (ALT), and five (3.0%) with a baseline ALT >ULN had an ALT increase >10×ULN on at least one visit. Growth, as assessed by height, proceeded normally in this population. Conclusions: Over a median period of 4.7 years, deferasirox treatment provided a dose-dependent overall reduction in iron burden in transfusion-dependent children with β-thalassemia, as measured by SF levels. Deferasirox was generally well tolerated with the frequency of investigator-reported AEs decreasing over long-term treatment. Figure 1. Mean dose and median change in SF during deferasirox treatment in pediatric β-thalassemia patients Figure 1. Mean dose and median change in SF during deferasirox treatment in pediatric β-thalassemia patients

Audiology Service Models in a Family Physician Practice Setting

2010 ◽  
Vol 6 (1) ◽  
pp. 24-32 ◽  
Author(s):  
Sridhar Krishnamurti
Keyword(s):  
Pediatric Patients ◽  
Practice Patterns ◽  
Healthcare Delivery ◽  
Direct Consequence ◽  
Direct Access ◽  
Practice Setting ◽  
Pediatric Populations ◽  
Family Practice Physicians ◽  
Primary Focus ◽  
Balance Problems

This article illustrates the potential of placing audiology services in a family physician’s practice setting to increase referrals of geriatric and pediatric patients to audiologists. The primary focus of family practice physicians is the diagnosis/intervention of critical systemic disorders (e.g., cardiovascular disease, diabetes, cancer). Hence concurrent hearing/balance disorders are likely to be overshadowed in such patients. If audiologists get referrals from these physicians and have direct access to diagnose and manage concurrent hearing/balance problems in these patients, successful audiology practice patterns will emerge, and there will be increased visibility and profitability of audiological services. As a direct consequence, audiological services will move into the mainstream of healthcare delivery, and the profession of audiology will move further towards its goals of early detection and intervention for hearing and balance problems in geriatric and pediatric populations.

Therapeutic Plasma Exchange Application in Children Requires Individual Decision

2020 ◽  
Author(s):  
Gürkan Atay ◽  
Demet Demirkol
Keyword(s):  
Plasma Exchange ◽  
Vascular Access ◽  
Pediatric Patients ◽  
Demyelinating Disease ◽  
Pediatric Intensive Care ◽  
Therapeutic Plasma Exchange ◽  
Transplantation Rejection ◽  
Access Problems ◽  
Uremic Syndrome

AbstractTherapeutic plasma exchange (TPE) is a treatment administered with the aim of removing a pathogenic material or compound causing morbidity in a variety of neurologic, hematologic, renal, and autoimmune diseases. In this study, we aimed to assess the indications, efficacy, reliability, complications, and treatment response of pediatric patients for TPE. This retrospective study analyzed data from 39 patients aged from 0 to 18 years who underwent a total of 172 TPE sessions from January 2015 to April 2018 in a tertiary pediatric intensive care unit. Indications for TPE were, in order of frequency, macrophage activation syndrome (28.2%, n = 11), renal transplantation rejection (15.4%, n = 6), liver failure (15.4%, n = 6), Guillain–Barre's syndrome (15%, n = 6), hemolytic uremic syndrome (7.7%, n = 3), acute demyelinating disease (7.7%, n = 3), septic shock (5.1%, n = 2), and intoxication (5.1%, n = 2). No patient had any adverse event related to the TPE during the procedure. The TPE session was ended prematurely in one patient due to insufficient vascular access and lack of blood flow (2.6%). In the long term, thrombosis due to the indwelling central catheter occurred (5.1%, n = 2). TPE appears to be an effective first-stage or supplementary treatment in a variety of diseases, may be safely used in pediatric patients, and there are significant findings that its area of use will increase. In experienced hands and when assessed carefully, it appears that the rate of adverse reactions and vascular access problems may be low enough to be negligible.

Long-term outcomes of lumbar microdiscectomy in the pediatric population: a large single-institution case series

2019 ◽  
Vol 24 (5) ◽  
pp. 549-557
Author(s):  
Malia McAvoy ◽  
Heather J. McCrea ◽  
Vamsidhar Chavakula ◽  
Hoon Choi ◽  
Wenya Linda Bi ◽  
...  
Keyword(s):  
Conservative Management ◽  
Functional Outcomes ◽  
Pediatric Patients ◽  
Clinical Presentation ◽  
Case Series ◽  
Csf Leak ◽  
Single Institution ◽  
The Mean

OBJECTIVEFew studies describe long-term functional outcomes of pediatric patients who have undergone lumbar microdiscectomy (LMD) because of the rarity of pediatric disc herniation and the short follow-up periods. The authors analyzed risk factors, clinical presentation, complications, and functional outcomes of a single-institution series of LMD patients over a 19-year period.METHODSA retrospective case series was conducted of pediatric LMD patients at a large pediatric academic hospital from 1998 to 2017. The authors examined premorbid risk factors, clinical presentation, physical examination findings, type and duration of conservative management, indications for surgical intervention, complications, and postoperative outcomes.RESULTSOver the 19-year study period, 199 patients underwent LMD at the authors’ institution. The mean age at presentation was 16.0 years (range 12–18 years), and 55.8% were female. Of these patients, 70.9% participated in competitive sports, and among those who did not play sports, 65.0% had a body mass index greater than 25 kg/m2. Prior to surgery, conservative management had failed in 98.0% of the patients. Only 3 patients (1.5%) presented with cauda equina syndrome requiring emergent microdiscectomy. Complications included 4 cases of postoperative CSF leak (2.0%), 1 case of a noted intraoperative CSF leak, and 3 cases of wound infection (1.5%). At the first postoperative follow-up appointment, minimal or no pain was reported by 93.3% of patients. The mean time to return to sports was 9.8 weeks. During a mean follow-up duration of 8.2 years, 72.9% of patients did not present again after routine postoperative appointments. The total risk of reoperation was a rate of 7.5% (3.5% of patients underwent reoperation for the same level; 4.5% underwent adjacent-level decompression, and one patient [0.5%] ultimately underwent a fusion).CONCLUSIONSMicrodiscectomy is a safe and effective treatment for long-term relief of pain and return to daily activities among pediatric patients with symptomatic lumbar disc disease in whom conservative management has failed.

Long-term stability of fusiform dilatation of the internal carotid artery following surgery adjacent to the circle of Willis: report of 2 cases

2020 ◽  
pp. 1-4
Author(s):  
Madeline B. Karsten ◽  
R. Michael Scott
Keyword(s):  
Carotid Artery ◽  
Internal Carotid Artery ◽  
Arachnoid Cyst ◽  
Pediatric Patients ◽  
Internal Carotid ◽  
Imaging Finding ◽  
Neurological Status ◽  
Suprasellar Region

Fusiform dilatation of the internal carotid artery (FDCA) is a known postoperative imaging finding after craniopharyngioma resection. FDCA has also been reported following surgery for other lesions in the suprasellar region in pediatric patients and is thought to be due to trauma to the internal carotid artery (ICA) wall during tumor dissection. Here, the authors report 2 cases of pediatric patients with FDCA. Case 1 is a patient in whom FDCA was visualized on follow-up scans after total resection of a craniopharyngioma; this patient’s subsequent scans and neurological status remained stable throughout a 20-year follow-up period. In case 2, FDCA appeared after resection and fenestration of a giant arachnoid cyst in a 3-year-old child, with 6 years of stable subsequent follow-up, an imaging finding that to the authors’ knowledge has not previously been reported following surgery for arachnoid cyst fenestration. These cases demonstrate that surgery involving dissection adjacent to the carotid artery wall in pediatric patients may lead to the development of FDCA. On very long-term follow-up, this imaging finding rarely changes and virtually all patients remain asymptomatic. Neurointerventional treatment of FDCA in the absence of symptoms or significant late enlargement of the arterial ectasia does not appear to be indicated.

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