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Role of bisphosphonates in the management of acute Charcot foot

World Journal of Diabetes 2018年第7期9卷 115-126页

作者： Harsh Durgia Jayaprakash Sahoo Sadishkumar Kam-alanathan Rajan Palui kalyani sridharan Henith Raj Department of Endocrinology Jawaharlal Institute of Postgraduate Medical Education and Research

Diabetes mellitus is the most common cause of Charcot neuropathy affecting foot and ankle. Acute Charcot foot(CF) presents with a red and swollen foot in co-ntrast to the painless deformed one of chronic CF. En-hanced osteoclastogenesis plays a central role in the pathogenesis of acute CF. Many studies have shown elevated levels of bone turnover markers in patients with acute CF confirming it. These findings have led cl-inicians to use anti-resorptive agents [bisphosphonates(BP), calcitonin, and denosumab] along with immobi-lization and offloading in acute CF patients. The ma-ximum evidence among all anti-resorptive agents is available for BPs, although its quality is low. Pamidronate has been shown to reduce the markers of activity of CF like raised skin temperature, pain, edema, and bone turnover markers in the majority of studies. Intravenous BPs are known to cause acute phase reactions leading to flu-like illness following their first infusion, which can be ameliorated by oral acetaminophen. Alendronate is the only oral BP used in these patients. It needs to be taken on an empty stomach with a full glass of water to avoid esophagitis. The side-effects and contraindications to BPs should be kept in mind while treating acute CF patients with them.

关键词： Charcot foot Diabetes mellitus Charcot neuroarthropathy Bisphosphonates Pamidronate

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Growth hormone and gastrointestinal malignancy:An intriguing link

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World Journal of Gastrointestinal Pathophysiology 2023年第1期14卷 1-11页

作者： Rajan Palui kalyani sridharan Sadishkumar Kamalanathan Jayaprakash Sahoo Dukhabandhu Naik Department of Endocrinology The Mission HospitalDurgapur 713212West BengalIndia Department of Endocrinology All India Institute of Medical ScienceRishikesh 249203UttarakhandIndia Department of Endocrinology Jawaharlal Institute of Postgraduate Medical Education and ResearchPuducherry 605006India

Growth hormone(GH)excess is associated with several systemic complications,one of which is the increased risk of neoplastic processes particularly of the gastrointestinal(GI)*** the GI neoplasms,the most reported association is with benign and malignant neoplasms of the *** the majority of published literature,an increased incidence of GI neoplasms,both colonic adenomas as well as colorectal carcinoma is ***,the studies on colon cancer-specific mortality rate are conflicting with recent studies reporting similar cancer-specific mortality rates in comparison to *** studies have reported an association of colorectal neoplasms with GH *** mechanisms put forward to explain this association of GH excess and GI neoplasms primarily involve the increased GH-insulin-like growth factor 1(IGF-1)*** GH and IGF-1 have proliferative,anti-apoptotic,and angiogenic effects on the systemic tissues leading to cellular *** contributing factors to the increased risk of GI neoplasms include slow intestinal transit with a redundant large bowel,altered bile acids,deranged local immune response,shared genetic susceptibility factors and *** view of the increased risk association,most guidelines for the care of acromegaly patients recommend an initial screening *** for further follow-up colonoscopy differ but broadly,the guidelines agree that it depends on the findings at first colonoscopy and state of remission of GH *** the concern about the risk of colorectal cancers in patients receiving recombinant GH therapy,most cohort studies do not show an increased risk.

关键词： Acromegaly Colonoscopy Colorectal carcinoma Recombinant growth hormone

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