2 results
Treatment strategies for protein-losing enteropathy in Fontan-palliated patients
- Anastasia Schleiger, Stanislav Ovroutski, Björn Peters, Stephan Schubert, Joachim Photiadis, Felix Berger, Peter Kramer
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- Journal:
- Cardiology in the Young / Volume 30 / Issue 5 / May 2020
- Published online by Cambridge University Press:
- 04 May 2020, pp. 698-709
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Objective:
Protein-losing enteropathy is an infrequent but severe condition occurring after Fontan procedure. The multifactorial pathogenesis remains unclear and no single proposed treatment strategy has proven universally successful. Therefore, we sought to describe different treatment strategies and their effect on clinical outcome and mortality.
Material and Methods:We performed a retrospective observational study. From the total cohort of 439 Fontan patients treated in our institution during the study period 1986–2019, 30 patients (6.8%) with protein-losing enteropathy were identified. Perioperative, clinical, echocardiographic, laboratory, and invasive haemodynamic findings and treatment details were analysed.
Results:Median follow-up after disease onset was 13.1 years [interquartile range 10.6]. Twenty-five patients received surgical or interventional treatment for haemodynamic restrictions. Medical treatment, predominantly pulmonary vasodilator and/or systemic anti-inflammatory therapy with budesonide, was initiated in 28 patients. In 15 patients, a stable remission could be achieved by medical or surgical procedures (n = 3 each), by combined multimodal therapy (n = 8), or ultimately by cardiac transplantation (n = 1). Phrenic palsy, bradyarrhythmia, Fontan pathway stenosis, and absence of a fenestration were significantly associated with development of protein-losing enteropathy (p = 0.001–0.48). Ten patients (33.3%) died during follow-up; 5-year survival estimate was 96.1%. In unadjusted analysis, medical therapy with budesonide and pulmonary vasodilator therapy in combination was associated with improved survival.
Conclusions:Protein-losing enteropathy is a serious condition limiting survival after the Fontan procedure. Comprehensive assessment and individual treatment strategies are mandatory to achieve best possible outcome. Nevertheless, relapse is frequent and long-term mortality substantial. Cardiac transplantation should be considered early as treatment option.
Treatment-induced mania in bipolar depression: Identifying at-risk bipolar patients
- C. Brichant-Petitjean
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- Journal:
- European Psychiatry / Volume 28 / Issue S2 / November 2013
- Published online by Cambridge University Press:
- 16 April 2020, pp. 97-98
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The treatment of bipolar depression is still an important challenge for clinicians and the number of evidence based options is limited. Antidepressants are the most frequently prescribed drugs for bipolar depression in clinical practice, even though the relative risks and benefits of using this treatment strategy has been strongly debated over the past 25 years. One of the reasons is that several placebo-controlled studies have shown that antidepressants could induce manic or hypomanic episodes and accelerate the rate of cycling, worsening the course of the illness by increasing the number of mood episodes over time. Antidepressant-Induced Manias (AIM) have been reported in a subgroup of about 25 to 30% of bipolar patients. There is an increased risk of mood switch with tricyclic antidepressants (TCAs) and serotonin and noradrenaline reuptake inhibitors (SNRIs). The occurrence of mania during antidepressant treatment is a crucial issue in the clinical management of Bipolar Disorder (BD) since it greatly interferes with the establishment of an optimal treatment for bipolar depression. It can have substantial negative impact on overall mood and psychosocial stability in patients receiving treatment for bipolar depression, possibly leading to treatment resistance. Therefore, the identification of clinical correlates associated with AIM is essential to better identify at-risk subgroups of patients and propose specific individualized treatment strategies for bipolar depression. No risk factors has been replicated so far, mostly because studies are characterized by small sample sizes and by the absence of a consensus definition of AIM, showing conflicting results. In this study, patients were classified according to a restrictive definition, similar to that used by Rousseva et al. (2003). An AIM− group (n = 135) was compared to AIM+ patients (n = 75) for clinical and sociodemographic factors as well as for psychological dimensions.