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canada goose coats The most worrying effects of all the 17 alkylated androgens, including danazol and stanazolol, are canada goose outlet 2015 those on liver metabolism, in particular cholestatic jaundice,53 peliosis hepatis,54 canada goose outlet kokemuksia and hepatocellular carcinoma.55 58 The recently observed first cases of hepatocellular adenomas developing in patients with HAE on long term prophylaxis with danazol have caused particular concern.59 A dose of 200 mg once or twice a day will usually suffice in adults, but because of the wide variations between individuals with this condition up to 400 mg twice a day may be required.Long term prophylaxis of attacks in childrenThis is a relatively unexplored issue,18,19 and most references state that the use of antifibrinolytics and androgens is not recommended because of the serious side effects of these drugs.28,60 Because severe or life threatening attacks of HAE are less common during childhood, it is rarely necessary to start long term prophylaxis in children.8,23 Long term prophylaxis is justified only in severely affected children, defined by frequent attacks of laryngeal oedema (one or more attacks each month) and/or frequent, recurrent attacks of colicky abdominal pain causing distress and disability. In this situation, antifibrinolytics are preferred to androgens.17 19 The individual minimal effective dose, irrespective of serum concentrations of C4 and/or C1 esterase canada goose outlet online uk inhibitor, for both antifibrinolytics and/or androgens used for canada goose premium outlet long term prophylaxis has to be established and careful clinical and laboratory follow up of hepatic and renal functions and blood coagulation is mandatory.8,14,17,18,23,30,35,36,39,41,42,47,61 65 However, benefit of long term administration of high dose aminocaproic acid (12 24 g/day) in children was associated with side effects in all, but with the dose adjusted for each child’s need (6 g/day and 12 g/day for 11 year olds, respectively), the canada goose outlet 80 off control of symptoms was still satisfactory without unpleasant side effects.18 Tranexamic acid at a dose of 50 mg/kg/day17 or 1.5 g/day23,41 has been used long term with similar benefit and no side effects. The use of danazol in children66,67 is a cause for concern, even when canada goose outlet online store used with caution.68,69 The finding of an increased incidence of arterial hypertension in patients with HAE treated with danazol long term64,65 further highlights the theoretical possibility of canada goose outlet michigan an increased risk of arteriosclerosis because the long term use of androgens has been reported to decrease the concentration of high density lipoproteins.8,70 72 However, it has been proposed that the long term use of antifibrinolytics, by plasmin inhibition, could also predispose to arteriosclerosis.18,73 This is of particular interest if long term prophylaxis is to be started during childhood because several decades of treatment may be needed.C1 inhibitor concentrate has been used successfully for long term replacement in selected adult patients,74 and more recently it has been shown to be superior to a placebo in a double canada goose coats uk blind controlled study.60 Based on the clinical benefit seen in these patients, a role for C1 inhibitor concentrate in long term prophylaxis for children has been suggested,60 supporting the few earlier proposals.8,75 The psychological benefit to both the children and their parents by the possibility of home availability of the concentrate, or canada goose outlet website legit even of treatment at the earliest sign of an attack involving the upper airway is an important advantage of replacement treatment with C1 inhibitor concentrate,60,75,76 although the disadvantages and major obstacles to this approach to the management are expense69 and the possibility of viral transmission, even with the use of heat treated preparations of C1 inhibitor concentrate.77Treatment of acute attacksThis depends on their severity canada goose coats.