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PubMed1991

A case report of a 9-year old boy with polyarteritis nodosa in which a combination therapy of corticosteroids and a photosensitive dye platonin was effective.

Polyarteritis nodosa (PN), characterized by vasculitis of medium and small sized arteries, is uncommon in children. This disease is thought to be concerned with some abnormal immune responses. Platonin (4,4'-dimethyl-3,3'-di-n-heptyl-8-[2-(4-methyl-3-n-heptylthiazole) ]-2,2'- dicarbocyanine diiodine) is one of the photosensitive dyes of trithiazole pentamethine cyanine. It has been reported that platonin stimulated suppressor/cytotoxic T cells, but suppressed B cells. In clinical observations, platonin is shown to be efficacious for rheumatoid arthritis and juvenile rheumatoid arthritis. In this study, a Japanese boy (9-year-old) with PN was given platonin in combination with prednisolone. Prednisolone was gradually tapered under a cover of platonin. As a result, the relapse has not been exhibited for a long time (72 months). There were no adverse side effects during long term administration of medication.

Adrenal Cortex Hormones↗
PubMed2006

The frequency and distribution of minocycline induced hyperpigmentation in a rheumatoid arthritis population.

OBJECTIVE: Minocycline is particularly useful in patients with rheumatoid arthritis (RA) with previous major sepsis, where anti-tumor necrosis factor is relatively contraindicated. Pigmentation is a documented side effect, but predisposing factors in an RA population have not been established. We investigated minocycline induced pigmentation in a population with RA to determine whether skin type and eye color influence predisposition to this side effect. METHODS: Patients with RA attending a rheumatology unit who had received minocycline were contacted by telephone and some were also interviewed in the clinic. Those receiving therapy for more than 3 months were assessed. Hair color, eye color, tendency to burn in the sun, and dose and duration of therapy were documented. The frequency, type, and distribution of pigmentation were established. RESULTS: Of 37 patients identified, 10 were excluded because the duration of therapy was less than 3 months. Of the remaining 27 patients, 85% were female, with median age 64 years (range 44-88) and median disease duration 23.5 years (range 4-51). Eleven patients (41%) developed pigmentation after a median of 12 months. Four of the 11 stopped their minocycline due to pigmentation. Hair color, eye color, and tendency to burn in the sun did not predict patients who developed pigmentation. CONCLUSION: Pigmentation is a common side effect in patients receiving minocycline therapy for more than 3 months. Most patients do not stop therapy due to pigmentation. Those who stop are more likely to be female, less than 70 years of age, and have facial pigmentation.

Adult↗
PubMed2006

Remodeling of the vascular channels in retinal angiomatous proliferations treated with intravitreal triamcinolone acetonide and photodynamic therapy.

BACKGROUND: The objective was to describe the remodeling of the vascular channels in stage II retinal angiomatous proliferation (RAP) treated by intravitreal injections of triamcinolone acetonide (TA) and subsequent photodynamic therapy (PDT). METHODS: Stage II RAP secondary to age-related macular degeneration was documented by dynamic digital fluorescein and indocyanine green angiography in 3 consecutive patients (3 eyes). All eyes were treated with intravitreal injection of TA (4 mg, 0.1 ml) followed by PDT 5-10 days later. RESULTS: Indocyanine green angiography (ICGA) revealed a complete remodeling of the vascular structure of the three RAPs after treatment. The feeding retinal artery, which shunted a major part of the blood flow from the original arteriole toward the intraretinal neovascular complex before treatment, regained a normal appearance after treatment. With RAP closure, the blood flow was again directed through the original retinal arteriole, and the connection to the RAP was no longer visible. CONCLUSIONS: Stage II RAPs are difficult lesions to treat. A real remodeling of the vascular lesion is achieved with the combined use of intravitreal TA and PDT. This finding corroborates the need for randomized clinical trials currently under way to evaluate this combination treatment in wet, age-related macular degeneration.

Aged↗
PubMed2000

The occurrence of the post-thrombotic changes after an acute deep venous thrombosis. A prospective two-year follow-up study.

BACKGROUND: The aim of the study is to investigate the development of subjective and objective findings during the first two years after DVT (deep venous thrombosis). METHODS: This prospective two-year follow-up study was established in Tampere University Hospital in Finland. Twenty-six patients with a two-year follow-up after a phlebographically confirmed DVT were followed. Patients were treated conventionally with heparin and warfarin. Phlebography was repeated 7 months after DVT. Color-flow duplex imaging (CFDI) was performed in both legs 7 and 20 months after DVT. The subjective symptoms in both legs were recorded at the beginning and at the end of the follow-up. The development of venous reflux, obstruction and subjective symptoms after DVT were studied. RESULTS: 50% of the legs with DVT had a pathological (deep reflux or obstructive change) CFDI-finding in the popliteal segment after a 20-month follow-up. The pathological findings in the control legs were rare. The rate of recanalisation was high. There was no difference between calf and more proximal DVTs. Pain (62%), oedema (46%) and pigmentation (35%) were common and only 27% of the legs with DVT were asymptomatic. CONCLUSIONS: The development of the post-thrombotic syndrome begins quite early. The frequency of the subjective symptoms is high. Calf DVT may lead to postthrombotic sequelae in the popliteal segment.

Acute Disease↗
PubMed1982

Gestalt therapy with the dying patient: integrative work using clay, poetry therapy, and creative media.

This is a report on death therapy with a 36-year-old cancer patient. Gestalt therapy and creative media (clay, poetry, and colors) were used to facilitate an integration of life and to give the person a sense of balance with life. The author tries to communicate his thoughts and feelings as they were during the course of the therapy, to show that counseling the dying means walking along a stretch of the path together. The companion-therapist cannot avoid his own perplexity and confusion by simply falling back on his professional role. Once he has become involved in an interpersonal relationship, he does not treat the patient as some kind of object. With the aid of transcripts taken from tape recordings, the integrating effect of using gestalt dialogue, and fantasy work becomes evident.

Art Therapy↗
PubMed1999

The clinical efficacy of paremyd with and without dapiprazole in subjects with light and dark brown irides.

BACKGROUND: Paremyd, a mydriatic formulation of 0.25% tropicamide and 1.0% hydroxyamphetamine hydrobromide provides adequate dilation for binocular indirect ophthalmoscopy in young Caucasians. We studied the clinical effectiveness of Paremyd in dilating heavily pigmented eyes by comparing its mydriatic efficacy in Blacks, Asians and Caucasians with light and dark brown irides. We also evaluated the efficacy of one drop of dapiprazole (Rev-Eyes) in reversing Paremyd-induced mydriasis in our subject sample. METHODS: In a masked, randomized, controlled experimental design, several visual functions which included pupillary dilation, near visual acuity, amplitude of accommodation, ocular hyperemia, and discomfort glare were measured at 30-min intervals, for a total of 300 min, in subjects dilated with a single drop of Paremyd in each eye. Ease of binocular indirect ophthalmoscopy was also assessed. A 3-way analysis of variance was used to assess changes in these measures as function of irides color/pigmentation (designated as light or dark brown iris color), presence or absence of dapiprazole, and test time interval. RESULTS: We found that subjects in our light brown irides group (mainly Caucasians) dilated faster than subjects in our dark brown irides group (mainly Blacks). Dapiprazole increased the speed of recovery from pupillary dilation for all subjects, but more so for those with light rather than dark brown irides. Similarly, subjects with light rather than dark brown irides recovered accommodative function more quickly. Although neither the use of dapiprazole nor the degree of iris color/pigmentation was significantly related to visual acuity or glare discomfort, there was a clear trend that these visual measures were affected to a greater degree in subjects with dark brown (primarily Blacks) rather than light brown irides. Overall, Paremyd provided adequate dilation for binocular indirect ophthalmoscopy in all subjects irrespective of iris color/pigmentation. CONCLUSIONS: Our data indicate that a single drop of Paremyd provides adequate mydriasis, without significant side effects, for routine fundus examination of all subjects, independent of iris color/pigmentation. Furthermore, a single drop of dapiprazole was effective in speeding the return of pupillary dilation in most subjects, but had no significant effect on accommodation, near visual acuity or glare discomfort. Side effects such as stinging upon instillation, conjunctival hyperemia, and a few instances of ptosis, with possible additional cost to patients, appear to lessen its overall clinical benefit.

Accommodation, Ocular↗
PubMed2003

Functional and histological changes in rat femoral arteries by HIFU exposure.

This study was an investigation of arterial contractility in response to high-intensity focused ultrasound (HIFU) and of histologic changes to the artery with various intensities of HIFU. We constructed a prototype HIFU transducer in combination with an imaging probe that provides color Doppler imaging and Doppler velocimetry. HIFU was applied through the skin to deep femoral arteries in left thighs of Sprague-Dawley rats; color images of the blood flow were used to aim the HIFU beam. Peak intensities used were 530, 1080, 2750 and 4300 W/cm2. The duration of each HIFU exposure was 5 s. HIFU was applied to five focal spots of each leg. These focal spots were aligned with a spacing of 1.0 mm so as to form a line across the artery. Blood flow occlusion was accomplished by HIFU at an intensity of 4300 W/cm2, but the flow continued with the lower intensities. Peak systolic velocities (PSVs) of blood flow as measured by Doppler velocimetry increased in the arteries to which HIFU had been applied at 1080 and 2750 W/cm2. The increase corresponded with HIFU intensity. Exposure to HIFU at 530 W/cm2 did not change the blood flow velocity. Histologic studies have demonstrated that exposure to HIFU at 2750 and 4300 W/cm2 leads to vacuolar degeneration and destruction of elastic fibers of the tunica media of the artery. Exposure at 1080 W/cm2 led to increased PSV, but did not induce histologic changes in the vessel wall. In conclusion, the response of the artery to HIFU varied with intensity. Vascular contraction without tissue degeneration occurred at low intensity; with increasing intensity, the tissue degeneration detectable in histology reduced the vascular diameter and, finally, at high intensity, the blood flow was occluded. Although these phenomena appeared to be mainly due to thermal effects, mechanical effects might have some role, particularly on vascular contraction.

Animals↗
PubMed1989

Color flow mapping to document normal pulmonary venous return in neonates with persistent pulmonary hypertension being considered for extracorporeal membrane oxygenation.

This study investigated the value of color flow mapping in documenting normal pulmonary venous return in neonates with persistent pulmonary hypertension who were candidates for extracorporeal membrane oxygenation (ECMO). Forty newborn infants with persistent pulmonary hypertension underwent conventional (two-dimensional and Doppler) echocardiography and color flow mapping. Of 25 candidates for ECMO therapy, 18 subsequently received it. Conventional echocardiography demonstrated normal pulmonary venous return in only 21 of the 40 patients. In all 40, however, color flow mapping demonstrated normal right and left pulmonary venous drainage entering the left atrium. In three other patients with total anomalous pulmonary venous return, conventional echocardiography demonstrated the anomalous pulmonary venous pathways, and color flow mapping did not show jets emanating from the left atrial wall; the left atrium was shown to fill exclusively from right to left shunting through the foramen ovale. We conclude that color flow mapping is superior to conventional echocardiography for verifying normal pulmonary venous return in neonates with persistent pulmonary hypertension.

Color↗
PubMed2006

Clinical and dermatoscopic fading of post-transplant eruptive melanocytic nevi after suspension of immunosuppressive therapy.

Excess melanocytic nevi have been reported in several groups of immunosuppressed patients, including organ transplant recipients. We report the case of a 16-year-old transplant recipient whose post-transplant melanocytic nevi decreased in size and color after graft rejection and interruption of immunosuppressive therapy. This case may represent a visual example of an effective immunosurveillance system against melanocytic nevi.

Adolescent↗
PubMed2006

Transvaginal color Doppler sonographic assessment of uterus and ovaries in postmenopausal women: the effect of local estrogen treatment.

OBJECTIVE: The objective was to evaluate the effect of local estrogen treatment on the uterus and ovaries using transvaginal color Doppler sonography. MATERIALS AND METHODS: A 12-week randomized open-label study of postmenopausal women taking local estrogen treatment and controls was conducted. The study group was treated with either a 25-mum estradiol vaginal tablet or 1g of conjugated estrogen cream intravaginally each day for 2 weeks followed by twice a week for 10 weeks. The control group did not receive any type of hormone replacement therapy. All women underwent transvaginal ultrasonography and color Doppler imaging of the uterine arteries both before starting local estrogen treatment and after treatment. The uterine volume, ovarian volume, endometrial thickness, and uterine arterial blood flow of the two groups were evaluated. Statistical analysis was performed using paired and unpaired Student's t-test. A p value of <0.05 was considered statistically significant. RESULTS: Of the 53 postmenopausal women recruited to this study, 26 women received local estrogen treatment for treatment of urogenital symptoms and 27 untreated women constituted the control group. The mean age was 54.85+/-5.51 years. The uterine and ovarian volumes were not significantly different before and after treatment in either of the groups. The endometrial thickness did not change in the local estrogen treatment group (4.00+/-1.60 and 4.30+/-1.20mm) or in the control group (3.90+/-1.40 and 3.70+/-1.50mm). The mean resistance indices in the local estrogen treatment group before and after treatment (1.01+/-0.10 and 0.96+/-0.10) were not significantly different from those of the control group (0.96+/-0.15 and 0.97+/-0.10). The mean pulsatility index after 12 weeks of treatment was lower than before treatment, although not statistically significantly (3.69+/-1.32 and 4.27+/-1.49; p>0.05), and the mean pulsatility indices did not differ between the study and the control groups. CONCLUSION: The volumes of the uterus and the ovaries, including endometrial thickness, were not affected and did not show any significant influence of the 12-week local estrogen treatment. The uterine arterial blood flow did not significantly change after treatment.

Administration, Intravaginal↗
PubMed1986

Patient compliance and medication perception.

The problem of patient/client noncompliance with regimens of prescribed medication is addressed, with attention to the incidence and illogical nature of this behavior. The psychological theory of cognitive dissonance is suggested as appropriate to an understanding of some aspects of noncompliance because medicinal preparations represent stimuli that are not necessarily neutral. A medication's perceptual properties may have important and specific meanings for patients or clients that may support or detract from compliance. Recent research and empirical evidence that reflects on this concept are reviewed. With further efforts, it may be possible to enhance compliance through perceptual engineering.

Cognitive Dissonance↗
PubMed1998

Brachytherapy with iridium-192 HDR to prevent from restenosis in peripheral arteries. An update.

The use of stents does not appreciably improve restenosis (usually resulting from intimal hyperplasia) as compared to percutaneous transluminal angioplasty (PTA) alone. The development of small-caliber probes for afterloading therapy in the biliary tract allowed us to use these for therapy in the vascular system. Using a special 9 F catheter, exact measurement of the length of the stented vascular segment and of the insertion length of the afterloading probe could be reproducibly performed. We used a Nucletron (Micro) Selectron HDR planning system version 10.10 for exact calculation, monitoring, and control of the afterloading procedure. Our source was iridium 192 (10 Ci) with a diameter of 1.1 mm. The program controls and monitors the insertion and removal of the iridium probe from the source into the special catheter through to the tip, and monitors the irradiation duration. The exposure time was around 200 seconds for a surface dose of 12 Gy. To date, a total of 40 patients have been treated with endovascular afterloading. All patients suffered from clinically relevant reocclusions or restenoses in stented vascular segments of the superficial femoral artery following successful PTA or laser treatment, within 6 to 8 months after the last therapy. In all patients it was possible to perform re-PTA treatment without remaining residual stenoses in the stented region. The additional time required as compared to PTA alone was approximately 45 minutes with most of this time spending for transportation between the cath lab and afterloading room. The follow-up period of the 40 patients ranged from 4 months to 71/2 years. In 33 patients, there was no deterioration of the clinical stage and no restenosis. One patient suffered from an acute thrombosis approximately 3 months after stent implantation, another patient had a stenosis 3 cm above the stented vascular segment 12 months after irradiation treatment. Follow-up examinations have revealed no evidence of nerve lesions following irradiation therapy. The tissue surrounding the artery showed no change following irradiation therapy, either in the CT, color-coded Doppler, endovascular ultrasonic scan or MRI. No complaints of discomfort were reported during or after irradiation. With the exceptions mentioned above, there was no evidence of any complications.

Aged↗
PubMedDate not supplied

Percutaneous treatment of iliac aneurysms and pseudoaneurysms with Cragg Endopro System 1 stent-grafts.

PURPOSE: To evaluate the feasibility and short-term follow-up results of treating iliac aneurysms by the Cragg Endopro System 1 stent-graft. METHODS: Nine lesions (two pseudoaneurysms and seven atherosclerotic aneurysms) were treated in eight patients by percutaneous implantation of a total of 10 stent-grafts. The procedure was followed by anticoagulation with heparin for 6 days, then antiplatelet therapy. Follow-up was by color Doppler ultrasound scan at 2 days and 3 months after the procedure for all patients, and by venous digital subtraction angiography and/or angio-CT up to 12 months later for four patients. RESULTS: Initial clinical success rate was 100% and there were two minor complications. In one case the delivery system was faulty resulting in failure to deploy the stent-graft. An additional device had to be used. At 3-12 months all prostheses were patent but one patient (12.5%) had a minimal pergraft leak. CONCLUSION: Percutaneous stent-grafting with this device is a safe and efficacious treatment of iliac artery aneurysms.

Aged↗
PubMed2006

Choroidal dye filling velocity in patients with Vogt-Koyanagi-Harada disease.

PURPOSE: To evaluate quantitative choroidal dye filling velocity in patients with Vogt-Koyanagi-Harada disease (VKH) before and after corticosteroid treatment using indocyanine green (ICG) angiography. METHODS: ICG angiography was performed in seven VKH patients before and after systemic corticosteroid treatment. Choroidal dye curves were obtained by image analysis software and analyzed using an exponential model. The model's time constant (tau) was used to evaluate choroidal dye filling velocity. RESULTS: Compared with controls, acute phase choroidal tau values in VKH patients were significantly longer, suggesting choroidal circulation disturbance. During the recovery phase, choroidal tau values were significantly shortened, suggesting choroidal circulatory disturbance improvement. CONCLUSION: Choroidal dye filling velocity may be useful for VKH diagnosis and verification of corticosteroid treatment effectiveness.

Adult↗
PubMed2004

Transoesophageal echocardiogram identifying the source of endoleak after combined open/endovascular repair of a type 3 thoracoabdominal aortic aneurysm.

Open repair of thoracic aortic aneurysms is associated with significant morbidity and mortality. The introduction of endovascular repair has reduced both the morbidity and mortality. However, endovascular stent repair can be complicated by endoleaks. We report here the successful treatment of a type 2 endoleak following endovascular repair of a thoracoabdominal aortic aneurysm, using transesophageal echocardiography to assist in the localization of the thoracic endoleak.

Aged↗