Treatment Of Hyper Research Articles

The role of thromboelastometry in the assessment and treatment of coagulopathy in liver transplant patients.

ABSTRACTPerioperative monitoring of coagulation is vital to assess bleeding risks, diagnose deficiencies associated with hemorrhage, and guide hemostatic therapy in major surgical procedures, such as liver transplantation. Routine static tests demand long turnaround time and do not assess platelet function; they are determined on plasma at a standard temperature of 37°C; hence these tests are ill-suited for intraoperative use. In contrast, methods which evaluate the viscoelastic properties of whole blood, such as thromboelastogram and rotational thromboelastometry, provide rapid qualitative coagulation assessment and appropriate guidance for transfusion therapy. These are promising tools for the assessment and treatment of hyper- and hypocoagulable states associated with bleeding in liver transplantation. When combined with traditional tests and objective assessment of the surgical field, this information provides ideal guidance for transfusion strategies, with potential improvement of patient outcomes.

Combination of ultrasound guided percutaneous micro wave ablation and radioiodine therapy for treatment of hyper- and hypofunctioning thyroid nodules

Combination of ultrasound guided percutaneous microwave ablation and radioiodine therapy for treatment of hyper- and hypofunctioning thyroid nodules -

The impact of oral vitamin A derivatives on lipid metabolism – What recommendations can be derived for dealing with this issue in the daily dermatological practice?

Retinoids and vitamin A derivatives have been widely used topically and systemically in the treatment of hyper- and parakeratotic skin diseases, genodermatoses, severe acne, autoimmune diseases (i. e. lupus erythematosus) or cutaneous T-cell lymphoma for more than 30 years. In addition to the desired proliferation-inhibiting, differentiation-inducing and antiinflammatory or sebo-suppressive effects, vitamin A derivatives also affect lipid metabolism. This is shown primarily by an increase of transaminases, triglycerides or cholesterol levels which vary in intensity from patient to patient. The degree of impact on the different parameters of lipid metabolism depends on the nature of the vitamin A derivative on the one hand due to different receptor specific binding interactions (RAR/RXR), while on the other hand posttranslational processes also play a major role. This review paper gives a brief, concise overview of the vitamin A derivatives and possible effects on lipid metabolism that can be expected. Additionally it contains a recommendation for secure handling of abnormal laboratory values before, during and after oral therapy with vitamin A derivatives. The aim of this article is to provide practical help and confidence in dealing with vitamin A derivatives in daily clinical practice. The publication was created in cooperation with the Deutsche Dermatologische Gesellschaft (DDG) and Deutsche Gesellschaft zur Bekämpfung von Fettstoffwechselstörungen und ihren Folgeerkrankungen (DGFF [Lipid-Liga] e. V.).

Gatifloxacin Tied to Hospitalizations for Treatment of Hyper- and Hypoglycemia

Gatifloxacin Tied to Hospitalizations for Treatment of Hyper- and Hypoglycemia

EARLY CHANGES IN PARAMETERS OF BONE AND MINERAL METABOLISM DURING THERAPY FOR HYPER- AND HYPOTHYROIDISM

The effects of thyroid hormones on various organs and metabolic systems have been the focus of intensive research. In this study we investigated the mechanisms of the changes in some parameters of bone and mineral metabolism before and during treatment of hyper- and hypothyroidism. Our study groups were as follows; 1) Untreated hyperthyroid patients (n = 38), 2) Hyperthyroid patients treated for three months (n = 21), 3) Untreated hypothyroid patients (n = 27), 4) Hypothyroid patients treated for three months (n = 20), and 5) Euthyroid control subjects (age, weight, sex and menopausal status matched) (n = 47). As expected, the mean serum calcium (Ca), phosphorus (P), alkaline phosphatase (ALP), and urinary Ca/creatinine and deoxypyridinoline (D-Pyr)/creatinine levels were higher in group-1 than in the control group. Serum PTH level was lower in group-1 than in group-5. However, after treatment for three months (group-2) we found that the serum and urinary levels of these parameters (except ALP) were not different than in the control group. Group-3 and group-4 did not show any differences in these parameters compared with group-5. Covariance analysis showed that urinary D-Pyr excretion had a positive, independent relationship to the serum free T3 level and age (P < 0.001 and P = 0.02, respectively). These results suggest that both bone formation and resorption markers increase in hyperthyroid patients, and with the treatment, particularly, in the period of first three months the bone resorption markers decrease rapidly. If the treatment is maintained the decrease slows, becoming more gradual. However, bone formation markers like ALP remain high in hyperthyroid patients during the treatment. In the light of this data, it is possible to conclude that osteoblastic activity lasts longer in hyperthyroidism. On the other hand, we demonstrated that these bone formation and resorption markers do not seem to be different in hypothyroid patients, even during the treatment, compared to the euthyroid controls.

Evidence supporting secondary prevention strategies.

Currently 14 million individuals in the United States have coronary disease. Within the next 2 decades, this number is expected to increase to 21 million persons. To minimize the excessive risk of recurrent cardiac events in these people, evidence-based, cost-effective prevention strategies must be developed. This review highlights the evidence supporting commonly used means of secondary prevention and is divided into two major sections: lifestyle modifications and pharmacologic interventions. Lifestyle changes discussed include smoking cessation, especially newer pharmacologic adjuncts; the efficacy of dietary interventions; and current inroads into the treatment of depression in recurrent events. Pharmacologic innovations include reexamination of a role for warfarin; continued advances in the treatment of hyper- and dyslipidemias, new roles for beta-blockade in congestive heart failure, and finally a view of future measures, risk and targets of risk intervention.

Sevoflurane in elderly patients

An ideal anaesthetic should allow rapid, pleasant, and predictable induction, maintenance and emergence from anaesthesia. Little information is available about sevoflurane use in elderly patients. The pharmacological profile of sevoflurane may be advantageous in geriatric patients because low solubility in the blood is a prerequisite for rapid changes in anaesthetic depth. In addition, the pharmacological profile of sevoflurane may help to reduce the total amount of drug required. Using volatile anaesthetics with low blood solubility and rapid clearance may help in an early postoperative assessment of the neurological status. Because geriatric patients show a higher intraoperative variability of haemodynamic parameters when compared to younger patients a drug such as sevoflurane with rapid uptake and elimination may be advantageous for treatment of hyper- and hypotensive states. As a consequence, the need for vasoactive drugs may be reduced. Recovery from sevoflurane anaesthesia is faster when compared with isoflurane. However, there is still controversy if the occurrence of postoperative cognitive and mental impairment is reduced in elderly patients if drugs with fast elimination characteristics are use. Few data are available on the use of sevoflurane in geriatric patients with renal impairment. Further studies are needed to clarify if the administration of sevoflurane is safe in this population of patients.

Treatment of hyper- and hypothyroidism in pregnancy.

In healthy subjects there are changes in thyroid function during pregnancy consequent on the increased synthesis of TBG and the thyroid stimulating effect of hCG. Serum thyroid hormones are elevated in the first trimester but fall during the latter half of pregnancy. Iodine deficiency may accentuate these changes. Hyperemesis gravidarum is associated with elevated thyroid hormone values due to high hCG levels in a third of patients. Hyperthyroidism in pregnancy is usually due to Graves' disease and is best managed with doses of antithyroid drugs sufficient to maintain euthyroidism. There is no evidence of damage to the fetus by this regime and breast feeding can be allowed. Beta adrenoreceptor blocking agents should not be used on a long-term basis. Hypothyroidism in pregnancy is associated with an adverse outcome in fetal health as well as an increase in obstetric complications. While treatment is eventually the same as for a non-pregnant person, there is evidence that the dose of L-thyroxine may require adjustment during pregnancy. Increasing L-thyroxine requirements, based on measurements of maternal L-T4 values have been noted by some but not all investigators. Women presenting in pregnancy with untreated hypothyroidism should be allowed to continue to term preferably with L-T4 replacement. The neonatal thyroid status should be assessed carefully in babies from mothers who have had either hyper- or hypothyroidism in pregnancy. Transplacental passage of maternal antibodies may cause neonatal hyperthyroidism or be associated with transient neonatal hypothyroidism.

Effect of thyroid dysfunction on thigh muscle efficiency.

To establish whether muscle weakness in thyroid dysfunction can be attributed solely to muscle atrophy (i.e. reduction in the total muscle cross-section) or whether the intrinsic contractile strength of the muscle is reduced per unit cross-sectional area, the ratio between thigh muscle strength and thigh muscle area was determined before and after treatment of hyper- and hypothyroidism. Midthigh muscle areas, assessed by computer tomography, increased in all seven hyperthyroid and decreased in three of four hypothyroid patients investigated after treatment of the thyroid disease. Peak torque and total work output, assessed by an isokinetic dynamometer (Cybex II), increased in both groups of patients. The muscle efficiency (total work output per cm2 muscle) increased in all patients after therapy [mean +/- SD values before vs. after therapy in hyperthyroid patients, 17.6 +/- 5.3 vs. 30.5 +/- 3.7 joules (J)/cm2 (P less than 0.001); in hypothyroid patients, 12.8 +/- 6.1 J/cm2 vs. 25.8 +/- 8.6 J/cm2 (P less than 0.05)]. Thus, the present study demonstrates that patients with thyroid dysfunction have altered muscle mass and diminished muscle efficiency.