Idiopathic Edema Research Articles

An Innovative Ayurveda Approach to treat the Idiopathic Edema: A case report

Background: Idiopathic edema is a complex medical condition with limited understanding and challenging choices for treatment. Regarding the Ayurvedic care of idiopathic edema, there aren't many published case reports or clinical trials on PubMed despite the disease's widespread prevalence. In this case report, we propose an important Ayurvedic perspective that takes into consideration the exact location of the manifestation in addition to its origin while selecting methods to treat idiopathic edema. Methods: A 63-year-old male patient complained of persistent right leg edema and blackish discoloration for 18 months while he visited the outpatient department of Kayachikitsa Government Ayurved College & Hospital, Nagpur. In previous times, the patient had sought treatment from doctors who practiced modern medicine without receiving any improvement. The patient was diagnosed as having idiopathic edema after a comprehensive investigation of all possible causes and was then treated according to the Ayurvedic concept of Shoth, which is linked to the origin of Pakwashaya (gut). Along with oral medications, the treatment included Basti (a medicated enema). Results: Interestingly, the patient's quality of life significantly improved, and the edema completely disappeared after the course of treatment. Conclusion: This case study provides insightful information on the importance of disease origin and manifestation sites in the Ayurvedic management of idiopathic edema. It also emphasizes the significance of further research on the role that the gut plays in the pathophysiology of idiopathic edema.

A Review of Clinical Studies for Chinese Medicine Treatment of Idiopathic Edema Using the CNKI Database

Objectives: This study investigated the latest clinical studies on Korean medicine treatment of idiopathic edema in the Chinese National Knowledge Infrastructure Database (CNKI).Methods: We searched the last 9 years of clinical studies discussing Oriental medicine-based treatments for idiopathic edema in the CNKI database. The search focused on the authors, publication year, type of study, purposes of study, method and duration of treatment, evaluation criteria, and results of the selected articles.Results: The search identified 7 randomized controlled trials (RCTs) and 9 others. All studies used oral herbal medicine for treatment. The most commonly used herbs were Poria Sclerotium (茯苓), Atractylodis Rhizoma Alba (白朮), and Alismatis Rhizoma (澤瀉), which are the constituent herbs of Oryeong-san (五苓散). All 16 studies confirmed the efficacy of Oriental medicine treatments.Conclusion: More varied and scientifically designed clinical studies are required to develop treatments for idiopathic edema. The results of this study could be used as basic data for further studies on idiopathic edema.

Evaluation on Effect of Acupoint Application to Treat Idiopathic Edema of Perimenopausal Women Using the Segmentation Dictionary Learning Algorithm.

This study aimed to explore the effect of ultrasound imaging in the diagnosis and evaluation of acupoint application in the treatment of idiopathic edema. In this study, an ultrasound imaging diagnosis based on the segmentation dictionary learning (S-DL) algorithm was proposed. In addition, the autoencoding algorithm (ASE) was compared with the traditional dictionary learning (DL) algorithm. The treatment effect, associated quantitative integral, and quality of life score of patients in two groups were compared. The results showed that the peak signal-to-noise ratio (PSNR), root mean square error (RMSE), and structural similarity (SSIM) of the S-DL algorithm were 32.45 dB, 0.654, and 0.0012, respectively, which were quite different compared to the ASE and DL algorithms, showing statistical significance (P < 0.05). As the noise level increased, the image reconstruction quality gradually decreased, but the S-DL algorithm obtained better image quality than the DL and ASE algorithms, and the difference was statistically great (P < 0.05). There was no significant difference in the average age and average course of the disease between the experimental group and the control group (P > 0.05). The overall treatment effect of patients in the experimental group was 96.77%, while that in the control group was 45.16%, and the difference between the two was statistically significant (P < 0.05). After treatment, the semiquantitative scores of fatigue, dizziness, palpitation, frequent urination, urgent urination, and dyspepsia of the experimental group were 1.18, 0.39, 0.72, 1.21, and 0.87, respectively, which were much lower than those of the control group statistically (P < 0.05). The score of quality of life of the experimental group of patients after treatment was 91.27 points, and that of the control group was 82.35 points, showing statistically great difference (P < 0.05). It showed that the algorithm performance of S-DL was relatively good, and the acupoint application therapy was better than traditional western medicine in the treatment of idiopathic edema, which reduces the discomfort of patients to a certain extent and improves the quality of life of patients.

Evaluation of Effect of Acupoint Sticking Therapy on Idiopathic Edema by Ultrasound Imaging Based on Deep Learning Algorithm

This study was aimed to evaluate the therapeutic effect of acupoint application therapy on specific edema by using denoising convolutional neural network (DnCNN) ultrasound images. 144 patients with idiopathic edema were selected as the research objects, and they were randomly divided into the conventional treatment group and the acupoint application group. Traditional Chinese medicine (TCM) symptom score, quality-of-life score, and adverse reactions were compared between the two groups before and after treatment. Ultrasound images based on the deep learning algorithm were used to evaluate the efficacy. The results showed that compared with conventional ultrasound, ultrasound based on DnCNN was more accurate in the diagnosis of idiopathic edema. The total effective rate of edema treatment in the acupoint application group was higher than that in the conventional treatment group (45% vs 93%, P &lt; 0.01 ). After treatment, the scores of TCM symptoms in the acupoint application group were lower than those in the conventional treatment group, and the quality-of-life score in the acupoint application group was higher than that in the conventional treatment group P &lt; 0.05 . There was no significant difference in the incidence of adverse reactions between the two groups P &gt; 0.05 . In summary, ultrasound-assisted examination based on the algorithm is accurate in the diagnosis of idiopathic edema. Acupoint application therapy has a significant effect on idiopathic edema and does not increase the incidence of adverse reactions, which has a guiding role in clinical treatment.

An Empirical Case of Chinese Medicine in the Treatment of Idiopathic Edema

Idiopathic edema is a common, challenging, and complicated clinical condition with no recognized cause that is easy to prolong and repeat. Professor Li has a lot of expertise treating this condition. This condition is associated with a yang shortage in the spleen and kidneys, as well as a mutual accumulation of water and blood stasis. Zhenwu Decoction and Guizhi Fuling tablet are added to the prescription. Ms. Li’s clinical experience in the treatment of idiopathic edema is being shared with the fellow.

P048 Cytomegalovirus retinitis in a patient with rheumatoid arthritis on tofacitinib

Abstract Background/Aims Cytomegalovirus (CMV) retinitis is one of the most common opportunistic ocular infections and has traditionally been associated with immunocompromised individuals. We present a case of CMV retinitis following 3 months of treatment with tofacitinib in conjunction with methotrexate (MTX) for rheumatoid arthritis (RA) in an elderly lady with no other co-morbidities. Methods The case is presented below. Results 69-year-old lady with long standing seronegative, anti-cyclic citrullinated peptide negative, erosive RA since 2016. She was intolerant of sulphasalazine, leflunamide, methotrexate and etanercept. Hydroxychloroquine was avoided due to idiopathic cystoid macular oedema in the right eye with a baseline visual acuity of 6/18. Baseline fundus fluorescein angiogram (FFA) was negative for any vascular, inflammatory or occlusive disease. She was escalated to tofacitinib in August 2019. Approximately 3 months later, she noticed significantly reduced vision in her right eye from 6/18 down to 6/60. She had an FFA and Indocyanine Green Angiography, which showed quite extensive retinal ischaemia and vasculitis. Her bloods revealed a raised serum ACE and a T-spot test from 2018 was reactive followed by a repeat in 2019 which was equivocal. Tofacitinib was discontinued. She was commenced on rifampicin and isoniazid as 3 months prophylaxis for latent tuberculosis (LTBI). Additionally, she was started on oral prednisolone 60mg daily for presumed sarcoid related retinal vasculitis. She failed to improve despite a week’s treatment and subsequently had a vitreous aspirate which was strongly positive for CMV PCR. Her CMV viral load was 267copies/ml. The aspirate was negative for other infectious agents. She was commenced on valganciclovir for CMV retinitis. Unfortunately, her vision remained unchanged despite the viral load becoming undetectable a few weeks later. Despite having LTBI, there was no reactivation of this with her immunosuppressive therapy. Conclusion CMV retinitis is usually associated with immunocompromised individuals and is rarely encountered related to tofacitinib therapy for rheumatoid arthritis. Tofacitinib suppresses T cell function by inhibiting STAT signalling pathways, modulating T cell activation and cytokine production. Our case highlights the preferential development of CMV retinitis over active TB in the presence of LTBI, which is a recognised risk with the use of JAK kinase inhibitors. TB risk has been associated with genetic mutations in IL-12, IFN-γ and STAT1 pathways while CMV activation may be influenced by mutations in HLA ,Toll-like receptors, immunoglobulin light chain antibodies, IFN lambda region as well as alternative transcripts of the CMV viral major immediate early genes. Disclosure K. Beharry: None. S. Kaur: None. E. Papagiannuli: None. S. Moses: None. D. De Lord: None.

Disorders of Water and Sodium Balance: Hypernatremia

Hypernatremia is an electrolyte disorder most prevalent in the elderly and the critically ill, with over 60% of cases developing over the course of an inpatient stay. Characterized by elevated serum sodium concentrations, this disorder is manifested either by pure-water loss without replacement, or excessive sodium intake without appropriate water balance. Left untreated it may lead to seizures and coma. General treatment in the case of severe hypernatremia is infusion of isotonic saline followed by pure-water after the patient is stabilized. Further treatment of the underlying cause may involve diuretics, thiazides, and a variety of other medications in conjunction with dietary and lifestyle modifications. This review offers an overview of various disorders of water balance: diabetes insipidus, nephrotic syndrome, cirrhosis, idiopathic edema, and volume depletion, as well as their clinical presentations, lab tests, and management. This review contains 1 figure, 1 table, and 25 references. Key words: Hypernatremia, Edematous States , Diabetes insipidus, Volume Depletion, Cirrhosis, Diuretics

Disorders of Water and Sodium Balance: Hypernatremia

Hypernatremia is an electrolyte disorder most prevalent in the elderly and the critically ill, with over 60% of cases developing over the course of an inpatient stay. Characterized by elevated serum sodium concentrations, this disorder is manifested either by pure-water loss without replacement, or excessive sodium intake without appropriate water balance. Left untreated it may lead to seizures and coma. General treatment in the case of severe hypernatremia is infusion of isotonic saline followed by pure-water after the patient is stabilized. Further treatment of the underlying cause may involve diuretics, thiazides, and a variety of other medications in conjunction with dietary and lifestyle modifications. This review offers an overview of various disorders of water balance: diabetes insipidus, nephrotic syndrome, cirrhosis, idiopathic edema, and volume depletion, as well as their clinical presentations, lab tests, and management. This review contains 1 figure, 1 table, and 25 references. Key words: Hypernatremia, Edematous States , Diabetes insipidus, Volume Depletion, Cirrhosis, Diuretics

Disorders of Water and Sodium Balance: Hypernatremia

Hypernatremia is an electrolyte disorder most prevalent in the elderly and the critically ill, with over 60% of cases developing over the course of an inpatient stay. Characterized by elevated serum sodium concentrations, this disorder is manifested either by pure-water loss without replacement, or excessive sodium intake without appropriate water balance. Left untreated it may lead to seizures and coma. General treatment in the case of severe hypernatremia is infusion of isotonic saline followed by pure-water after the patient is stabilized. Further treatment of the underlying cause may involve diuretics, thiazides, and a variety of other medications in conjunction with dietary and lifestyle modifications. This review offers an overview of various disorders of water balance: diabetes insipidus, nephrotic syndrome, cirrhosis, idiopathic edema, and volume depletion, as well as their clinical presentations, lab tests, and management. This review contains 1 figure, 1 table, and 25 references. Key words: Hypernatremia, Edematous States , Diabetes insipidus, Volume Depletion, Cirrhosis, Diuretics

Disorders of Water and Sodium Balance: Hypernatremia

Hypernatremia is an electrolyte disorder most prevalent in the elderly and the critically ill, with over 60% of cases developing over the course of an inpatient stay. Characterized by elevated serum sodium concentrations, this disorder is manifested either by pure-water loss without replacement, or excessive sodium intake without appropriate water balance. Left untreated it may lead to seizures and coma. General treatment in the case of severe hypernatremia is infusion of isotonic saline followed by pure-water after the patient is stabilized. Further treatment of the underlying cause may involve diuretics, thiazides, and a variety of other medications in conjunction with dietary and lifestyle modifications. This review offers an overview of various disorders of water balance: diabetes insipidus, nephrotic syndrome, cirrhosis, idiopathic edema, and volume depletion, as well as their clinical presentations, lab tests, and management. This review contains 1 figure, 1 table, and 25 references. Key words: Hypernatremia, Edematous States , Diabetes insipidus, Volume Depletion, Cirrhosis, Diuretics

Disorders of Water and Sodium Balance: Hypernatremia

Hypernatremia is an electrolyte disorder most prevalent in the elderly and the critically ill, with over 60% of cases developing over the course of an inpatient stay. Characterized by elevated serum sodium concentrations, this disorder is manifested either by pure-water loss without replacement, or excessive sodium intake without appropriate water balance. Left untreated it may lead to seizures and coma. General treatment in the case of severe hypernatremia is infusion of isotonic saline followed by pure-water after the patient is stabilized. Further treatment of the underlying cause may involve diuretics, thiazides, and a variety of other medications in conjunction with dietary and lifestyle modifications. This review offers an overview of various disorders of water balance: diabetes insipidus, nephrotic syndrome, cirrhosis, idiopathic edema, and volume depletion, as well as their clinical presentations, lab tests, and management. This review contains 1 figure, 1 table, and 25 references. Key words: Hypernatremia, Edematous States , Diabetes insipidus, Volume Depletion, Cirrhosis, Diuretics

Differential diagnoses of osteonecrosis of large joints

Subchondral insufficiency fractures and idiopathic bone marrow edema syndrome are the most important differential diagnoses to be distinguished from osteonecrosis because they have a deviating and as a rule more favorable prognosis and also different therapeutic strategies. Osteochondritis dissecans represents adifferent entity in many respects, which should not be confused or unified with osteonecrosis. Based on recent knowledge intractable subchondral insufficiency fractures may be the underlying cause of rapidly destructive osteoarthritis at least in some cases. Septic involvement of bone and joints can eo ipso cause severe articular damage due to direct destruction but also secondary to septic vascular occlusion resulting in septic osteonecrosis. Whereas bone marrow infiltrating systemic diseases and the therapeutic regimens can lead to osteonecrosis, bone tumors or tumor-like diseases, rarely pose adifferential diagnostic problem with respect to the differentiation from osteonecrosis.

Sodium-glucose cotransporter 2 inhibition as a potential treatment for idiopathic oedema

Idiopathic oedema is a syndrome affecting primarily women that is characterized by frustrating intermittent fluid retention, with hallmarks of obesity, periodic oedema, anxiety, and a susceptibility to develop type 2 diabetes. Management is typically reassurance and weight control, with no known drug class proven to provide consistent relief. We hypothesise that sodium-glucose cotransporter 2 inhibition is a logical intervention in the treatment of idiopathic oedema, having effects on obesity, blood pressure, impaired glucose tolerance, sympathetic overdrive, and reduction in swelling – the most common and distressing complaint. Sodium-glucose cotransporter 2 inhibition by promoting greater electrolyte-free, but glucose driven, water clearance with preferential fluid clearance from the interstitial space, without compromising intravascular volume, may provide symptomatic relief of swelling and bloating. The consequent weight reduction secondary to caloric loss from renal glycosuria and decreased adiposity would prevent disease progression of type 2 diabetes or pre-diabetes. With diminished adrenergic output from central and peripheral autonomic influences, reduction of blood pressure occurs, and by similar mechanisms, anxiety may be reduced.

A case of idiopathic edema after opioid abuse cessation: can failed aldosterone escape be implicated?

Edema is a recognized complication of ongoing heavy opioid use, regardless of the means of delivery or the specifics of the drug in question. The mechanism responsible remains incompletely understood. Hypotheses currently offered include increased Anti-Diuretic Hormone (ADH) secretion, histamine-mediated permeability changes, independent opioid-receptor mediated fluid retention and an exacerbation of pre-existing vascular compromise. Authors report a case of a 39yr old lady in whom edema emerged 7 months after cessation of opioid abuse. All secondary causes of edema were excluded by an exhaustive battery of investigations. The edema failed to recede with loop diuretics, and resolved only on institution of spironolactone, on which she maintained improvement. This case study reinforces hypotheses of ADH likely mediating opioid associated edema and suggests that aldosterone receptor antagonists are probably a superior class of drugs in opioid-associated edema. It also suggests that the physiological changes caused by opioid use that are responsible for edema are likely stable and persist well beyond the period of actual use. Reformed opioid abusers who never received OST are a huge population whose unique physiological status is likely to yield valuable insights into not just the pathology of opioid-abuse related edema, but the pathology of opioid use as a whole.

Idiopathic "Cyclic" Edema: A Frustrating and Poorly Understood Clinical Problem.

Idiopathic Edema (IE), is a syndrome involving real or perceived weight gain secondary to the pathological retention of fluid. This syndrome of generalized edema is almost solely reported in women. The diagnosis of IE is one of exclusion and requires a careful history, physical exam, and clinical suspicion. The aim of this article is to provide a comprehensive review of the available literature in order to attempt to define IE, identify the possible causes, review the proposed pathophysiology, and discuss potential treatment options.

Changing the name of a syndrome: sympathetic neural hyperalgesia edema syndrome becomes – the increased cellular permeability syndrome

Purpose: To provide examples of other conditions that are improved following treatment with dextroamphetamine sulfate that would not involve hyperalgesia and/or edema. Thus elucidation of such conditions would demonstrate the need to change the name from the sympathetic neural hyperalgesia syndrome to a name that would cover all conditions responding to sympathomimetic amine therapy. Materials and Methods: Cases of chronic fatigue syndrome and various skin and neurologic disorders and temperature regulation conditions are provided as examples of conditions responding well to dextroamphetamine sulfate that do not involve either pain or edema. Results: Examples are provided that show that inherited permeability defects in certain tissues or inherited sympathetic nervous system hypofunction produce symptoms other than pain or swelling yet respond to dextroamphetamine sulfate. Conclusions: Though lacking "pizzazz", the new name given to this condition refers to the main hypothesized defect whether inherited or acquired, and that is increased cellular permeability. Thus, the new name is the increased cellular permeability syndrome in lieu of the sympathetic neural hyperalgesia – edema syndrome which had replaced the name idiopathic edema.

Acute Idiopathic Scrotal Oedema - Differential Diagnosis of the Acute Scrotum

Acute idiopathic scrotal edema (AISE) is regarded as a rare cause of scrotal pain, swelling and erythema. Testicular torsion, torsion of the appendage, epididymitis, hernia and hydrocele are the most common causes of acute scrotum. The clinical symptoms of AISE are usually mild and the characteristic Doppler sonography findings make it a valuable differential diagnosis, which can help to avoid unnecessary exploration.

Clinical Characteristics of Overhydration in Patients with Idiopathic Edema

Background: Idiopathic edema (IE) is a common clinical syndrome. Designing treatment plans for IE is problematic because of the difficulty in assessing volume status. We aimed to evaluate volume status, measured by bioimpedance spectroscopy (BIS), and investigated clinical parameters associated with volume overload (VO) in patients with IE. Methods: Patients with IE were defined as those with symptomatic edema and without abnormal renal function or any other apparent cause of edema. A total of 124 patients were included. Overhydration (OH) and extracellular water (ECW) were calculated using BIS. Relative hydration status (ΔHS) was defined as OH/ECW. Patients were classified into 2 groups: overhydrated group (OG; ΔHS ≥7%) and non-OG (NOG; ΔHS <7). Simple and multiple logistic regression analyses were used to assess the influence of several variables on the incidence of VO. Results: Of 124 patients, 37 (29.8%) were in the OG. The proportion of men in the OG was higher than that in the NOG (p = 0.020). Patients in the OG showed more frequent pretibial pitting edema (PTPE, p < 0.001) and had lower hemoglobin (p = 0.008) and serum albumin levels (p < 0.001). The multivariate analysis showed that the presence of PTPE (OR 10.62, 95% CI 1.98-57.1), low serum albumin level (OR 0.01, 95% CI 0.00-0.25) and lower fat tissue index (OR 0.78, 95% CI 0.63-0.97) were independent risk factors for the presence of VO. Conclusions: BIS helps to identify volume status and body composition in patients with IE.

The confounding effect of the development of idiopathic orthostatic edema and thyrotoxcosis on weight fluctuation related to effects on free water clearance in a woman with long-standing surgically induced panhypopituitarism and diabetes insipidus

To evaluate the effect of idiopathic orthostatic edema and the effect of thyrotoxicosis on weight fluctuation and fluid retention in the presence of surgically induced panhypopituitarism and diabetes insipidus controlled with hormone replacement.Dextroamphetamine sulfate was used for weight gain when no other etiologic factor was found. Methimazole was used when weight loss occurred when serum T4 and free T4 indicated thyrotoxicosis.Sympathomimetic amine therapy very effectively controlled the weight gain and methimazole controlled the weight loss.Hypopituitarism and diabetes insipidus controlled with hormone replacement do not protect against fluid retention from idiopathic edema.

A YOUNG MALE WITH DEBILITATING POLYNEUROPATHY AND MONOCLONAL GAMMOPATHY PRESENTS WITH PERICARDIAL EFFUSION AND RIGHT HEART FAILURE

The paraneoplastic disease POEMS syndrome - polyneuropathy, organomegaly, endocrinopathy, monoclonal gammopathy and skin changes - may present to cardiology as idiopathic pericardial effusion, edema and right heart failure. A 34-year-old man with two years of debilitating polyneuropathy and