Treatment for Livedoid Vasculopathy: A Systematic Review.
JAMA Dermatol. 2017 Nov 15;:
Authors: Micieli R, Alavi A
Importance: Livedoid vasculopathy is a painful, ulcerative condition of the lower extremities for which no established treatment exists. Current treatment paradigms rely on low levels of evidence, primarily case reports and case series.
Objective: To systematically review the treatment for livedoid vasculopathy and synthesize the available clinical data.
Evidence Review: A systematic review of the literature using Ovid MEDLINE (covering the period January 1, 1946, through June 9, 2017) and Ovid EMBASE (covering January 1, 1947, through June 9, 2017) databases was performed with a broad and inclusive search strategy along with a subsequent search of the references of retrieved articles. All case series reports published in the English language and in a peer-reviewed journal discussing the treatment for livedoid vasculopathy diagnosis were included.
Findings: A total of 29 case series reports published in the English language and in a peer-reviewed journal discussed the treatment for livedoid vasculopathy. These reports represented a total of 339 patients, of whom 230 (68%) were female and 69 (20%) were male; sex was not stated for 40 patients. Treatment with anticoagulants, antiplatelets, anabolic steroids, thrombolytics, hyperbaric oxygen, intravenous immunoglobulins, vitamin supplementation, UV light, and a combination of 1 or more of these among other therapies had a favorable outcome. Anticoagulants were the most commonly used monotherapy, achieving a favorable response in 62 of 63 patients (98%). Anabolic steroids, intravenous immunoglobulins, and antiplatelets were the second, third, and fourth most commonly used treatments, respectively. All of these therapies were associated with good clinical outcomes. Adverse events were observed in 44 patients (13%).
Conclusions and Relevance: A variety of treatments with varying degrees of success have been used to treat livedoid vasculopathy. Randomized clinical trials should be performed in the future to better establish these treatments in clinical practice.
PMID: 29141075 [PubMed - as supplied by publisher]
Hyperbaric Oxygen Therapy in the Treatment of Acute Severe Traumatic Brain Injury: a Systematic Review.
J Neurotrauma. 2017 Nov 13;:
Authors: Daly S, Thorpe M, Rockswold SB, Hubbard M, Bergman TA, Samadani U, Rockswold G
There has been no major advancement in a quarter of a century for the treatment of acute severe traumatic brain injury (TBI). This review summarizes 40 years of clinical and pre-clinical research on the treatment of acute TBI with hyperbaric oxygen therapy (HBO2) in the context of an impending National Institute of Neurologic Disorders and Stroke (NINDS)-funded, multicenter, randomized, adaptive Phase II clinical trial - the Hyperbaric Oxygen Brain Injury Treatment (HOBIT) trial. Thirty studies (8 clinical and 22 pre-clinical) that administered HBO2 within 30 days of a TBI were identified from PubMed searches. The pre-clinical studies consistently reported positive treatment effects across a variety of outcome measures with almost no safety concerns, thus providing strong proof-of-concept evidence for treating severe TBI in the acute setting. Of the 8 clinical studies reviewed, 4 were based on the senior author's (GR) investigation of HBO2 as a treatment for acute severe TBI. These studies provided evidence that HBO2 significantly improves physiologic measures without causing cerebral or pulmonary toxicity and can potentially improve clinical outcome. These results were consistent across the other 4 reviewed clinical studies, thus providing preliminary clinical data supporting the HOBIT trial. This comprehensive review demonstrates that HBO2 has the potential to be the first significant treatment in the acute phase of severe TBI.
PMID: 29132229 [PubMed - as supplied by publisher]