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1.
Treatment of Severe Alcoholic Hepatitis.
Thursz, M, Morgan, TR
Gastroenterology. 2016;(8):1823-34
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Abstract
Alcoholic hepatitis (AH) is a syndrome of jaundice and liver failure that occurs in a minority of heavy consumers of alcohol. The diagnosis usually is based on a history of heavy alcohol use, findings from blood tests, and exclusion of other liver diseases by blood and imaging analyses. Liver biopsy specimens, usually collected via the transjugular route, should be analyzed to confirm a diagnosis of AH in patients with an atypical history or presentation. The optimal treatment for patients with severe AH is prednisolone, possibly in combination with N-acetyl cysteine. At present, only short-term increases in survival can be expected-no treatment has been found to increase patient survival beyond 3 months. Abstinence is essential for long-term survival. New treatment options, including liver transplantation, are being tested in trials and results eagerly are awaited.
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Unexplained childhood anaemia: idiopathic pulmonary hemosiderosis.
Siu, KK, Li, R, Lam, SY
Hong Kong medical journal = Xianggang yi xue za zhi. 2015;(2):172-4
Abstract
This report demonstrates pulmonary haemorrhage as a differential cause of anaemia. Idiopathic pulmonary hemosiderosis is a rare disease in children; it is classically described as a triad of haemoptysis, pulmonary infiltrates on chest radiograph, and iron-deficiency anaemia. However, anaemia may be the only presenting feature of idiopathic pulmonary hemosiderosis in children due to occult pulmonary haemorrhage. In addition, the serum ferritin is falsely high in idiopathic pulmonary hemosiderosis which increases the diagnostic difficulty. We recommend that pulmonary haemorrhage be suspected in any child presenting with iron-deficiency anaemia and persistent bilateral pulmonary infiltrates.
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[Current topics over updating guidelines on the management and treatment of glucocorticoid-induced osteoporosis].
Suzuki, Y
Clinical calcium. 2014;(3):417-24
Abstract
Glucocorticoids (GCs) were widely used for the treatment of various disorders. Since GC-induced bone loss is most rapid during the initial 3 - 6 months and primary prevention of bone loss is especially important, guidelines for management of GC-induced osteoporosis have been published overseas and in Japan. In response to changes in the circumstances surrounding GIO regarding fracture assessment tool and drug therapy, ACR revised recommendations incorporated FRAX®, the WHO fracture risk assessment tool and the Japanese Society of Bone and Mineral Research have finished revision work of the guidelines and the updated guideline will be published soon.
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Review article: the diagnosis and management of alcoholic hepatitis.
Cohen, SM, Ahn, J
Alimentary pharmacology & therapeutics. 2009;(1):3-13
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Abstract
BACKGROUND Alcoholic hepatitis is a severe, cholestatic liver disease occurring in patients with alcohol abuse. Mortality is substantial; however, therapies may improve clinical outcomes. AIM: To provide an updated review of the epidemiology, diagnosis, staging and treatment of alcoholic hepatitis. METHODS A MEDLINE literature search was performed to identify pertinent articles. Relevant clinical abstracts were also reviewed. RESULTS Severe alcoholic hepatitis occurs in a small fraction of patients who abuse alcohol. The 28-day mortality ranges from 30% to 50% in most series. Diagnosis is generally based on clinical features, with a limited role for liver biopsy. Beneficial treatment options include alcohol abstinence and nutritional therapy. Despite variable results in clinical trials, corticosteroids and pentoxifylline appear to provide moderate survival benefit. Anti-tumour necrosis factor agents and antioxidants have not proven beneficial, and should be limited to clinical trials. Liver transplant is not a frequent option given the active or recent alcohol use. CONCLUSIONS Severe alcoholic hepatitis is a clinically-diagnosed condition associated with significant mortality. Alcohol abstinence and nutritional therapy have been associated with improved clinical parameters and should be considered in all patients. Corticosteroid therapy and pentoxifylline therapy appear to show moderate survival benefit and should be considered as first-line therapeutic agents.
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Management of steroid sensitive nephrotic syndrome: revised guidelines.
, , Bagga, A, Ali, U, Banerjee, S, Kanitkar, M, Phadke, KD, Senguttuvan, P, Sethi, S, Shah, M
Indian pediatrics. 2008;(3):203-14
Abstract
JUSTIFICATION In 2001, the Indian Pediatric Nephrology Group formulated guidelines for management of patients with steroid sensitive nephrotic syndrome. In view of emerging scientific evidence, it was felt necessary to review the existing recommendations. PROCESS Following a preliminary meeting in March 2007, a draft statement was prepared and circulated among pediatric nephrologists in the country to arrive at a consensus on the evaluation and management of these patients. OBJECTIVES To revise and formulate recommendations for management of steroid sensitive nephrotic syndrome. RECOMMENDATIONS The need for adequate cortico-steroid therapy at the initial episode is emphasized. Guidelines regarding the initial evaluation, indications for renal biopsy and referral to a pediatric nephrologist are updated. It is proposed that patients with frequently relapsing nephrotic syndrome should, at the first instance, be treated with long-term, alternate-day prednisolone. The indications for use of alternative immunosuppressive agents, including levamisole, cyclophosphamide, mycophenolate mofetil and cyclosporin are outlined. The principles of dietary therapy, management of edema, and prevention and management of complications related to nephrotic syndrome are described. These guidelines, formulated on basis of current best practice, are aimed to familiarize physicians regarding management of children with steroid sensitive nephrotic syndrome.
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[Case of acute interstitial pneumonia that responded to therapy but relapsed six months later].
Isobe, Z, Suga, T, Hamaguchi, S, Yamaguchi, S, Hara, K, Aoki, F, Aoki, N, Aoyagi, K, Ueno, M, Maeno, T, et al
Nihon Kokyuki Gakkai zasshi = the journal of the Japanese Respiratory Society. 2007;(10):772-8
Abstract
A 66-year-old man was admitted because of general fatigue. A chest computed tomography showed bilateral alveolar consolidation and ground glass opacities. Although we treated him with broad-spectrum antibiotics, his symptoms and chest image findings did not improve. Thoracoscopic lung biopsy (rS2, S9) was performed. The specimens showed obstructive type intraluminar organization and interstitial inflammatory thickening. Membranous organization was seen in a limited area. The etiology of the illness could not be identified. We diagnosed acute interstitial pneumonia (AIP) because the specimens showed diffuse alveolar damage pattern (DAD/P) and because of unknown etiology. The symptoms and chest image findings were improved on treatment with corticosteroid and cyclophosphamide. However, he was readmitted because of dyspnea 6 months later after the thoracoscopic lung biopsy. Chest computed tomography showed bilateral diffuse ground glass opacities and reticular opacities in both lower lobes. We employed mechanical ventilation, antibiotics, sivelestat sodium hydrate and steroid pulse therapy, but he died without any response to treatment. The findings of autopsy revealed DAD/P accompanied by a new lesion mainly composed of membranous organization and hyaline membrane. We believe this case is valuable when considering the variety of responses to treatment of AIP and prognosis.
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[Measures for osteoporosis in the dermatological field--vitamin D3 and bisphosphonate].
Okada, N
Clinical calcium. 2004;(10):145-9
Abstract
Steroid-induced osteoporosis is the most common form of osteoporosis in the dermatological diseases, but there have been only few data concerning the treatment based on clinical evidences. For management of osteoporosis, the efficacy of vitamin D(3) and bisphosphonate had been demonstrated by meta-analytic approach. Ten dermatological patients in our clinic who had received long-term oral steroids and showed bone loss were treated with 5 mg/day of alendronate for one year, and showed significant increase in the bone mineral density of the lumbar spine. In dermatological patients requiring long-term systemic steroids, administration of drugs such as vitamin D(3) or bisphosphonate should be started earlier.
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[Glucocorticoid-induced osteoporosis and bone mineral densimetry].
Tanaka, I, Oshima, H
Clinical calcium. 2004;(12):77-82
Abstract
While the diagnosis and management of primary osteoporosis have been established and widely utilized, these for glucocorticoid-induced osteoporosis (GIOP), i.e. a representative of secondary osteoporosis, are on their way. GIOP caused fractures at a higher bone mineral density (BMD) compared to primary osteoporosis. The cut off value of the BMD for prediction of fractures was around 80% of the young adult means (T-score; -1.5). As this value would give a useful diagnostic point for initiating treatments, measurements of BMD should be a significant tool for management of GIOP.
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The evaluation of corticosteroid therapy in conjunction with plasma exchange in the treatment of renal cholesterol embolic disease. A report of 5 cases.
Hasegawa, M, Kawashima, S, Shikano, M, Hasegawa, H, Tomita, M, Murakami, K, Kushimoto, H, Katsumata, H, Toba, T, Oohashi, A, et al
American journal of nephrology. 2000;(4):263-7
Abstract
In this report, we describe 5 patients with cholesterol atheroembolic renal failure. In 3 of the 5 patients, combined therapy with corticosteroids and plasma exchange was performed. These 3 patients survived, with 2 showing an improvement in renal function. The 2 remaining patients died of multifactorial causes. The literature on therapy for cholesterol atheroembolic renal failure is reviewed and the efficacy of combined therapy by use of corticosteroids and plasma exchange is evaluated.
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10.
[Treatment by corticosteroid and plasma exchange in 5 cases of renal cholesterol embolic disease].
Hasegawa, M, Kawashima, S, Shikano, M, Hasegawa, H, Tomita, M, Murakami, K, Kushimoto, H, Katsumata, H, Toba, T, Yoshikawa, H, et al
Nihon Jinzo Gakkai shi. 2000;(2):53-9
Abstract
Cholesterol arterial embolization is a systemic disease resulting from cholesterol crystal embolization to multiple organs, including the kidney, skin, brain, eye, gastrointestinal tract and extremities. In general, it is associated with high morbidity and mortality, but no optimal treatment has yet been developed. In this paper, we report five patients with cholesterol atheroembolic renal failure. In three of the five patients, combined therapy with corticosteroids and plasma exchange was performed. The three patients survived. On the other hand, the two remaining patients died of multifactorial causes. In this report, the literature on steroid therapy for cholesterol atheroembolic renal disease is reviewed and the efficacy of combined therapy by use of corticosteroids and plasma exchange is evaluated.