scholarly journals Clinical Phenotypes in NSAID-Induced Urticaria/Angioedema

2021 ◽  
Author(s):  
Joaquin Quiralte ◽  
María del Robledo Ávila ◽  
Stefan Cimbollek ◽  
Joaquin Quiralte-Castillo
Keyword(s):  
Management Strategy ◽  
Respiratory Diseases ◽  
Correct Diagnosis ◽  
Treatment Modalities ◽  
Hypersensitivity Reactions ◽  
Nsaid Treatment ◽  
Inflammatory Drug ◽  
Diagnostic Strategies ◽  
Clinical Phenotypes ◽  
Underlying Pathophysiology

The skin clinical phenotypes of nonsteroidal anti-inflammatory drug (NSAID) hypersensitivity (NH) are very heterogeneous with several syndromes after NSAID intake, which include different symptoms, different organ involvement and different associated concomitant diseases and possibly different underlying pathophysiology and mechanisms. Making a correct diagnosis in NH is an exciting journey for any allergist. Thus, to classify these diseases properly will be pivotal for appropriate diagnostic and management strategy. Treatment modalities are depending on the clinical phenotypes of NH and they will embrace for each patient: the avoidance of culprit NSAID, the finding of well-tolerated NSAID and in certain cases, desensitization procedures when the NSAID treatment was absolutely needed as well as the control of associated diseases such as spontaneous chronic urticarial or allergic respiratory diseases. This review updates the recent evidence of classification, diagnostic strategies, and management of skin NSAID hypersensitivity reactions.

Clinical Phenotypes of Severe Cutaneous Drug Hypersensitivity Reactions

2019 ◽  
Vol 25 (36) ◽  
pp. 3840-3854 ◽  
Author(s):  
Hakan Guvenir ◽  
Tugba Arikoglu ◽  
Emine Vezir ◽  
Emine Dibek Misirlioglu
Keyword(s):  
Adverse Drug Reactions ◽  
Drug Hypersensitivity ◽  
Stevens Johnson Syndrome ◽  
Facial Oedema ◽  
Hypersensitivity Reactions ◽  
Drug Reactions ◽  
Cutaneous Manifestations ◽  
Clinical Phenotypes ◽  
Drug Eruptions ◽  
Drug Hypersensitivity Reactions

Drug hypersensitivity reactions are clinically heterogenous ranging from mild to severe. Most drug hypersensitivity reactions are accompanied by cutaneous manifestations. Fever, mucous membrane involvement, large blisters, facial oedema, pustulosis and visceral involvement are clinical features that lead to suspicion of severe adverse drug reactions. Severe cutaneous adverse drug reactions (SCARs) include Stevens-Johnson syndrome, toxic epidermal necrolysis, drug rash eosinophilia and systemic symptoms, acute generalized exanthematous pustulosis. Serum sickness like reactions, drug induced vasculitis and generalized bullous fixed drug eruptions are less severe clinical entities. SCARs are uncommon but associated with significant morbidity and mortality. Physician should be aware of specific red flags and danger signs to immediately identify these reactions. Immediate drug withdrawal is mandatory. Early diagnosis and appropriate treatment significantly affect the prognosis of the disease. The purpose of our review is to discuss clinical phenotypes of severe cutaneous drug hypersensitivity reactions.

Outcome of Nonsurgical Treatment for Plantar Fasciitis

1996 ◽  
Vol 17 (9) ◽  
pp. 527-532 ◽  
Author(s):  
Lowell H. Gill ◽  
Gary M. Kiebzak
Keyword(s):  
Clinical Diagnosis ◽  
Clinical Studies ◽  
Plantar Fasciitis ◽  
Steroid Injection ◽  
Nonsurgical Treatment ◽  
Treatment Modalities ◽  
Inflammatory Drug ◽  
Low Profile ◽  
Outcomes Study ◽  
Assessment Survey

Four hundred eleven patients with a clinical diagnosis of plantar fasciitis were assessed for predisposing factors. Each patient completed an outcomes assessment survey instrument that ranked effectiveness of various nonsurgical treatment modalities. Listed in descending order of effectiveness, the treatment modalities assessed were short leg walking cast, steroid injection, rest, ice, runner's shoe, crepe-soled shoe, aspirin or nonsteroidal anti-inflammatory drug, heel cushion, low-profile plastic heel cup, heat, and Tuli's heel cup. Treatment with a cast ranked the best. The Tuli's heel cup ranked the poorest. Most of the treatments were found to be unpredictable or minimally effective. The ineffectiveness of nonsurgical treatments noted in this outcomes study is at variance with most published clinical studies in which generally favorable results are reported after nonsurgical treatment for plantar fasciitis.

scholarly journals Integrating Systemic Therapies into the Multimodality Treatment of Resectable Colorectal Liver Metastases

2018 ◽  
Vol 2018 ◽  
pp. 1-4 ◽  
Author(s):  
Omar Abdel-Rahman ◽  
Winson Y. Cheung
Keyword(s):  
Liver Metastases ◽  
Management Strategy ◽  
Multimodality Treatment ◽  
Treatment Modalities ◽  
Considerable Proportion ◽  
Optimal Management ◽  
Related Factors ◽  
Multiple Treatment ◽  
Current Review ◽  
Systemic Therapies

Colorectal carcinoma (CRC) is one of the most common cancers worldwide. A considerable proportion of CRC patients may present with metastatic disease either at upfront presentation (synchronous with the primary) or following diagnosis and treatment of the primary tumor (metachronous). Management of CRC liver metastases is a challenging endeavor which frequently necessitates proper assessment of patient- and disease-related factors. There is an opportunity within the management of CRC liver metastases to incorporate multiple treatment modalities (including surgery, other locoregional treatments, and systemic therapy). The current review aims to provide an updated overview on the optimal management strategy for CRC patients with liver metastases with a specific focus on the integration of systemic and/or locoregional treatments among patients with resectable or potentially resectable disease.

scholarly journals Advances in pulmonary drug delivery targeting microbial biofilms in respiratory diseases

Nanomedicine ◽  
2021 ◽  
Author(s):  
Ankur Sharma ◽  
Dhruv Kumar ◽  
Kajal Dahiya ◽  
Susan Hawthorne ◽  
Saurabh Kumar Jha ◽  
...  
Keyword(s):  
Drug Delivery ◽  
Respiratory Diseases ◽  
Pulmonary Infection ◽  
Respiratory Infections ◽  
Treatment Modalities ◽  
Pulmonary Infections ◽  
Microbial Biofilms ◽  
Effective Treatment Modality ◽  
Microbial Infections ◽  
Suitable Treatment

The increasing burden of respiratory diseases caused by microbial infections poses an immense threat to global health. This review focuses on the various types of biofilms that affect the respiratory system and cause pulmonary infections, specifically bacterial biofilms. The article also sheds light on the current strategies employed for the treatment of such pulmonary infection-causing biofilms. The potential of nanocarriers as an effective treatment modality for pulmonary infections is discussed, along with the challenges faced during treatment and the measures that may be implemented to overcome these. Understanding the primary approaches of treatment against biofilm infection and applications of drug-delivery systems that employ nanoparticle-based approaches in the disruption of biofilms are of utmost interest which may guide scientists to explore the vistas of biofilm research while determining suitable treatment modalities for pulmonary respiratory infections.

Appendix cancer mimicking ovarian cancer

2002 ◽  
Vol 12 (6) ◽  
pp. 768-772 ◽  
Author(s):  
P. A. Gehrig ◽  
J. F. Boggess ◽  
D. W. Ollila ◽  
P. A. Groben ◽  
L. Van Le
Keyword(s):  
Ovarian Cancer ◽  
Abdominal Mass ◽  
Correct Diagnosis ◽  
Disease Process ◽  
Advanced Ovarian Cancer ◽  
Stage Iv ◽  
Treatment Modalities ◽  
Primary Adenocarcinoma ◽  
Appendiceal Cancer ◽  
Tumor Debulking

Appendiceal adenocarcinoma is a rare malignancy for which there is no characteristic clinical presentation. We describe five women who presented with signs and symptoms characteristic of advanced ovarian cancer but whose final diagnosis was stage IV appendiceal cancer. Between 1998 and 1999, five women treated for presumed ovarian cancer were identified as having primary appendiceal cancer. Medical records and pathology were retrospectively reviewed. The median age was 47 years (range 36–61 years). All had elevated preoperative CA125 levels with a median value of 171 μ/ml (range 46–383). Four women underwent right hemicolectomy with two requiring radical surgical tumor debulking to render them optimally debulked. Four had postoperative chemotherapy, the most common agent used was 5-flourouracil. Median survival was 6.75 months (range 19 days-11 months). Primary adenocarcinoma of the appendix is rare; therefore, the clinical utility of radical tumor debulking and chemotherapy is not well described. Given the poor survival in our series, all efforts should be considered palliative. Although this disease process is uncommon, it should be entertained by gynecologic oncologists in the differential diagnosis of an intra-abdominal mass and ascites. The ability to make the correct diagnosis and differentiate between an ovarian and appendiceal primary is critical as the treatment modalities vary.

scholarly journals Head of the Bed Down: Paradoxical Management for Paradoxical Herniation

2019 ◽  
Vol 3 (3) ◽  
pp. 208-210
Author(s):  
Patrick Bender ◽  
Alisha Brown
Keyword(s):  
Intracranial Pressure ◽  
Intracranial Hypertension ◽  
Management Strategy ◽  
Epidural Blood Patch ◽  
Brain Structures ◽  
Treatment Modalities ◽  
Increased Intracranial Pressure ◽  
Cerebral Herniation ◽  
Blood Patch ◽  
Head Computed Tomography

Emergency physicians are well versed in cerebral herniation, pathology that typically results from increased intracranial pressure; however, paradoxical herniation is less common and requires opposing treatments. We describe a case of paradoxical herniation following lumbar puncture in a patient with previous hemicraniectomy. The symptomatology was similar to cerebral herniation from intracranial hypertension and included lethargy, bradycardia, headache, and compression of brain structures on non-contrast head computed tomography. However, contrary to treatment modalities for intracranial hypertension, our management strategy aimed to reverse intracerebral hypotension. Treatment for paradoxical herniation involved increasing intracranial pressure using fluid resuscitation and Trendelenburg positioning. In the intensive care unit our patient received an epidural blood patch and hydration with resolution of his symptoms.

CHIVA, ASVAL and related techniques – Concepts and evidence

2015 ◽  
Vol 30 (2_suppl) ◽  
pp. 42-45 ◽  
Author(s):  
Sarah Onida ◽  
Alun H Davies
Keyword(s):  
Minimally Invasive ◽  
Varicose Veins ◽  
Disease Process ◽  
Chronic Venous Disease ◽  
Treatment Modalities ◽  
Venous Disease ◽  
Invasive Treatment ◽  
Venous Circulation ◽  
Underlying Pathophysiology

Chronic venous disease (CVD) is a highly prevalent condition with significant effects on patients’ quality of life. Despite this, the underlying pathophysiology of venous disease still remains unclear. Two schools of thought exist, explaining the development and propagation of venous disease as an “ascending” and “descending” process, respectively. The descending theory, stating that CVD is secondary to proximal disease (e.g. saphenofemoral/saphenous incompetence), is the most widely accepted when planning treatment aiming to remove or destroy the junction or truncal veins. The ascending theory, describing the disease process as developing in the lower most part of the leg and propagating cranially, aims to re-route the venous circulation via minimally invasive interventions. Classically, superficial venous insufficiency has been treated with the removal of the incompetent trunk, via open surgery or, increasingly, with endovenous interventions. Minimally invasive treatment modalities aiming to preserve the saphenous trunk, such as CHIVA and ASVAL, may also play an important role in the treatment of the patient with varicose veins.

scholarly journals Parkinson's Disease Management: Towards a New Paradigm

1999 ◽  
Vol 26 (S2) ◽  
pp. S53-S57 ◽  
Author(s):  
Mark Guttman ◽  
Oksana Suchowersky
Keyword(s):  
Parkinson’S Disease ◽  
Parkinson's Disease ◽  
Surgical Treatment ◽  
Disease Management ◽  
Management Strategy ◽  
Clinical Symptoms ◽  
Treatment Modalities ◽  
New Paradigm ◽  
The Past

Over the past decade, management of Parkinson's disease has changed significantly due to the expansion of medical and surgical treatment modalities. Neurologists now have the ability (and the challenge) of choosing from multiple medications to devise an individual management strategy for each patient depending on his/her clinical symptoms and needs. Several different surgical therapies are also available. The topics covered in this supplement have highlighted the new options that are now available, as well as the treatments that have been in clinical usage. This review attempts to synthesize the information that is currently available in an attempt to help clinical neurologists make the appropriate choice for their patients.

Hyponatraemia—Current Treatment Strategies and Perspectives for the Future

2011 ◽  
Vol 07 (02) ◽  
pp. 116
Author(s):  
Mark J Hannon ◽  
Christopher J Thompson ◽  
◽  
Keyword(s):  
Correct Diagnosis ◽  
Treatment Strategies ◽  
Current Treatment ◽  
Accurate Assessment ◽  
Electrolyte Abnormality ◽  
Management Options ◽  
New Class ◽  
New Development ◽  
Hospital Inpatients ◽  
Underlying Pathophysiology

Hyponatremia is the commonest electrolyte abnormality found in hospital inpatients and is associated with a greatly increased morbidity and mortality. The management of hyponatremia is predicated on correct diagnosis of the underlying cause, which relies on accurate assessment of the patient’s volume status. The syndrome of inappropriate antidiuresis (SIAD) is the most common cause of hyponatremia and current treatments for this syndrome are poorly effective. Hypervolemic hyponatremia is also difficult to manage. The emergence of a new class of medications—the selective vasopressin-2 receptor antagonists or vaptans—gives clinicians an opportunity to target the underlying pathophysiology of these conditions, and represent an exciting new development in the management of hyponatremia. In this article we review the differential diagnosis of hyponatremia, current treatment strategies, and emerging management options.

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