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Sample records for non-surgical treatment options

  1. Barriers and Facilitators Associated with Non-Surgical Treatment Use for Osteoarthritis Patients in Orthopaedic Practice

    PubMed Central

    Hofstede, Stefanie N.; Marang-van de Mheen, Perla J.; Vliet Vlieland, Thea P. M.; van den Ende, Cornelia H. M.; Nelissen, Rob G. H. H.; van Bodegom-Vos, Leti

    2016-01-01

    Introduction International evidence-based guidelines for the management of patients with hip and knee osteoarthritis (OA) recommend to start with (a combination of) non-surgical treatments, and using surgical intervention only if a patient does not respond sufficiently to non-surgical treatment options. Despite these recommendations, there are strong indications that non-surgical treatments are not optimally used in orthopaedic practice. To improve the adoption of non-surgical treatments, more insight is needed into barriers and facilitators of these treatments. Therefore, this study assessed which barriers and facilitators are associated with the use and prescription of different non-surgical treatments before hip and knee OA in orthopaedic practice among patients and orthopaedic surgeons in the Netherlands. Materials and Methods We performed two internet-based surveys among 172 orthopaedic surgeons and 174 OA patients. Univariate association and multivariable regression techniques are used to identify barriers and facilitators associated with the use of non-surgical treatments. Results Most barriers and facilitators among patients were associated with the use of physical therapy, lifestyle advice and dietary therapy. Among orthopaedic surgeons, most were associated with prescription of acetaminophen, dietary therapy and physical therapy. Examples of barriers and facilitators among patients included “People in my environment had positive experiences with a surgery” (facilitator for education about OA), and “Advice of people in my environment to keep on moving” (facilitator for lifestyle and dietary advice). For orthopaedic surgeons, examples were “Lack of knowledge about guideline” (barrier for lifestyle advice), “Agreements/ deliberations with primary care” and “Easy communication with a dietician” (facilitators for dietary therapy). Also the belief in the efficacy of these treatments was associated with increased prescription. Conclusions Strategies to improve non-surgical treatment use in orthopaedic practice should be targeted at changing the beliefs of orthopedic surgeons, communication with other OA care providers and involving patient’s environment in OA treatment. PMID:26799974

  2. Surgical and non-surgical treatment of frozen shoulder. Survey on surgeons treatment preferences

    PubMed Central

    Kwaees, Tariq Adam; Charalambous, Charalambos P.

    2014-01-01

    Summary Background: frozen shoulder is a common condition and its management can be surgical or non-surgical. The aim was to determine current trends in the management of frozen shoulder amongst surgical members of the British Elbow and Shoulder Society (BESS). Methods: a single electronic questionnaire was emailed to surgical members of the BESS. Participants were asked about their surgical and non-surgical treatments of choice and the reasoning behind that, as well as which components of arthroscopic arthrolysis they favoured. Results: 87 BESS members completed the questioner. The majority of respondents used physiotherapy as their preferred means of non-surgical management while arthroscopic arthrolysis was the most frequently used surgical intervention. A substantial proportion of surgeons based their choice on personal experience and training rather than published evidence. Conclusions: management of frozen shoulder amongst surgeons varies substantially and is highly based on personal experience and training rather than strong evidence. Arthroscopic arthrolysis is a heterogeneous procedure with a wide variation in the use of its various components. Our results highlight the need for high quality clinical trials to compare the management options available. PMID:25767778

  3. Peyronies disease: A contemporary review of non-surgical treatment

    PubMed Central

    Levine, Laurence A.

    2013-01-01

    In this review I discuss the current non-surgical treatment options for Peyronies disease (PD), which remains a therapeutic dilemma for the treating physician. This is despite a large array of treatments that have been used since the time of de la Peyronie in the mid-18th century. Part of the problem with finding an effective treatment is the incomplete understanding of the aetiopathophysiology of this scarring disorder. Published articles in peer-reviewed journals were assessed, recognising that most of the reported trials are compromised by being single-centre studies with no placebo control. Various treatment options have emerged, most with limited and unreliable benefit, but a few treatments have shown a consistent, albeit incomplete, response rate. Currently the only scientifically sensible oral agents appear to be pentoxifylline, l-arginine, and possibly the phosphodiesterase type-5 inhibitors. The current intralesional injection treatment options include verapamil and interferon, with a reported benefit in reducing deformity and improving sexual function. Intralesional clostridial collagenase is in the midst of phase-3 trial analysis by the USA Food and Drug Administration. External mechanical traction therapy has recently emerged as a technique to reduce the curvature, recover lost length, and possibly obviate surgery. Currently there is no clear, reliable and effective non-surgical treatment for PD, but it appears that several of the available treatments can reduce the deformity and improve sexual function, and might at least stabilise the disease process. PMID:26558093

  4. Variation in use of non-surgical treatments among osteoarthritis patients in orthopaedic practice in the Netherlands

    PubMed Central

    Hofstede, Stefanie N; Vliet Vlieland, Thea P M; van den Ende, Cornelia H M; Nelissen, Rob G H H; Marang-van de Mheen, Perla J; van Bodegom-Vos, Leti

    2015-01-01

    Objectives National and international evidence-based guidelines for hip and knee osteoarthritis (OA) recommend to start with non-surgical treatments, followed by surgical intervention if a patient does not respond sufficiently to non-surgical treatments, but there are indications that these are not optimally used. The aim of this study was to assess the extent to which all recommended non-surgical treatments were used by patients with hip or knee OA who receive(d) a total hip or knee replacement, as reported by patients and orthopaedic surgeons. Setting We performed two cross-sectional internet-based surveys among patients and orthopaedic surgeons throughout the Netherlands. Participants 195 OA patients either have undergone total knee arthroplasty or total hip arthroplasty no longer than 12 months ago or being on the waiting list for surgery with a confirmed date within 3 months and 482 orthopaedic surgeons were invited to participate. Primary and secondary outcome measures The use of recommended non-surgical treatments including education about OA/treatment options, lifestyle advice, dietary therapy, physical therapy, acetaminophen, NSAIDs and glucocorticoid injections. Results 174 OA patients (93%) and 172 orthopaedic surgeons (36%) completed the surveys. Most recommended non-surgical treatments were given to the majority of patients (eg, 80% education about OA, 73% physical therapy, 72% acetaminophen, 80% NSAIDs). However, only 6% of patients and 10% of orthopaedic surgeons reported using a combination of all recommended treatments. Dietary therapy was used least frequently. Only 11% of overweight and 30% of obese participants reported having received dietary therapy and 28% of orthopaedic surgeons reported to prescribe dietary therapy to overweight patients. Conclusions While most recommended non-surgical treatments were used frequently as single therapy, the combination is used in only a small percentage of OA patients. Especially, use of dietary therapy may be improved to help patients manage their symptoms, and potentially delay the need for joint arthroplasty. PMID:26353874

  5. Peyronies disease: contemporary review of non-surgical treatment

    PubMed Central

    2013-01-01

    Background Peyronies disease (PD) remains a therapeutic dilemma for the treating physician. This is in spite of a large array of treatments which have been used since the time of de la Peyronie in the mid 18th century. Part of this problem is due to an incomplete understanding of the etiopathophysiology of this scarring disorder. Having a better understanding of the how and why the scarring occurs may help prevent progression, but ultimately reversing the existing scar remains the real challenge. Methods This review discusses the current non-surgical treatment options for Peyronies disease. Published articles in peer-reviewed journals are used, recognizing that the majority of the published trials are compromised by being single-center studies without a placebo control. Results A variety of treatments options have emerged, most with limited and unreliable benefit, but a few treatments have shown a consistent albeit incomplete response rate. Could this suggest that all PD is not the same and that the heterogeneous nature of this scarring disorder may account for why some patients respond and others do not? Further investigation of this diverse response rate may yield insights into the pathophysiology of PD. In the meantime, there have been many oral treatments offered for PD. Currently the only scientifically sensible treatments appear to be pentoxifylline, L-arginine, and possibly the phosphodiesterase type-5 inhibitors. Intralesional injection has been used for many years. The current treatment options include verapamil and interferon, with reported benefit with respect to reduced deformity and improved sexual function. Intralesional clostridial collagenase is in the midst of phase 3 trial analysis by the FDA in the USA and may become the newest and only FDA approved treatment for Peyronies disease. External mechanical traction therapy has also recently emerged as a technique to reduce curvature, recover lost length, enhance girth, and possibly obviate surgery. Conclusions It appears at this time that there is no clear, reliable and effective non-surgical treatment for Peyronies disease, but it does appear from the published literature that several of the available treatments can result in reduction of deformity, improved sexual function, and may at a minimum stabilize the disease process so that deformity does not get worse particularly during the acute phase of this scarring disorder. Combination therapy in an effort to create a synergy between the chemical effects of oral and injectable drugs with the mechanical effects of external traction therapy may provide the best opportunity today for reduction of deformity in the man with Peyronies disease.

  6. Non-surgical treatment of post-surgical bile duct injury: Clinical implications and outcomes

    PubMed Central

    Eum, Young Ook; Park, Joo Kyung; Chun, Jaeyoung; Lee, Sang-Hyub; Ryu, Ji Kon; Kim, Yong-Tae; Yoon, Yong-Bum; Yoon, Chang Jin; Han, Ho-Seong; Hwang, Jin-Hyeok

    2014-01-01

    AIM: To investigate the prognostic factors determining the success rate of non-surgical treatment in the management of post-operative bile duct injuries (BDIs). METHODS: The study patients were enrolled from the pancreatobiliary units of a tertiary teaching hospital for the treatment of BDIs after hepatobiliary tract surgeries, excluding operations for liver transplantation and malignancies, from January 1999 to August 2010. A total of 5167 patients underwent operations, and 77 patients had BDIs following surgery. The primary end point was the treatment success rate according to different types of BDIs sustained using endoscopic or percutaneous hepatic approaches. The type of BDI was defined using one of the following diagnostic tools: endoscopic retrograde cholangiography, percutaneous transhepatic cholangiography, computed tomography scan, and magnetic resonance cholangiography. Patients with a final diagnosis of BDI underwent endoscopic and/or percutaneous interventions for the treatment of bile leak and/or stricture if clinically indicated. Patient consent was obtained, and study approval was granted by the Institutional Review Board in accordance with the legal regulations of the Human Clinical Research Center at the Seoul National University Hospital in Seoul, South Korea. RESULTS: A total of 77 patients were enrolled in the study. They were divided into three groups according to type of BDI. Among them, 55 patients (71%) underwent cholecystectomy. Thirty-six patients (47%) had bile leak only (type 1), 31 patients had biliary stricture only (type 2), and 10 patients had both bile leak and biliary stricture (type 3). Their initial treatment modalities were non-surgical. The success rate of non-surgical treatment in each group was as follows: BDI type 1: 94%; type 2: 71%; and type 3: 30%. Clinical parameters such as demographic factors, primary disease, operation method, type of operation, non-surgical treatment modalities, endoscopic procedure steps, type of BDI, time to diagnosis and treatment duration were evaluated to evaluate the prognostic factors affecting the success rate. The type of BDI was a statistically significant prognostic factor in determining the success rate of non-surgical treatment. In addition, a shorter time to diagnosis of BDI after the operation correlated significantly with higher success rates in the treatment of type 1 BDIs. CONCLUSION: Endoscopic or percutaneous hepatic approaches can be used as an initial treatment in type 1 and 2 BDIs. However, surgical intervention is a treatment of choice in type 3 BDI. PMID:24944484

  7. Three Cases of Non-Surgical Treatment of Stent Loss During Percutaneous Coronary Intervention

    PubMed Central

    Shim, Byung-Ju; Lee, Seung-Jae; Kim, Sung Sik; Lee, Dong-Hyeon; Shin, Woo-Seung; Yu, Ji-Han; Gil, Sang Hyun

    2010-01-01

    Percutaneous coronary intervention with stenting is widely used for ischemic heart disease. Because stent loss, which occurs rarely during the procedure, might have dire consequences, such as bleeding, stent embolism, acute myocardial infarction, emergency coronary artery bypass graft, and death, appropriate treatment is needed as soon as stent loss occurs. We report three cases of stent loss which were successfully treated with three different non-surgical methods. PMID:21088758

  8. Modifiable Prognostic Factors of Hepatocellular Carcinoma in Patients with Non-Surgical Treatment

    PubMed Central

    Yeh, Jen-Hao; Hung, Chao-Hung; Wang, Jing-Houng; Chen, Chien-Hung; Kee, Kwong-Ming; Kuo, Chung-Mou; Yen, Yi-Hao; Cheng, Yu-Fan; Chen, Yen-Yang; Hsu, Hsuan-Chi; Lu, Sheng-Nan

    2015-01-01

    Background & aims Current hepatocellular carcinoma (HCC) staging systems only use baseline characteristics to predict outcome. We aimed to explore modifiable factors of the prognosis in HCC cases had undergone non-surgical treatment. Methods All HCC cases in Kaohsiung Chang Gung Memorial hospital in southern Taiwan from 2002 to 2012 must met all below criteria: (1) met international diagnostic guidelines, (2) underwent the initial treatments in our hospital (3) treated by non-surgical treatment modalities and (4) survived more than two years, with follow-up time longer than five years. Results A total 698 patients were enrolled: 451 (24.6%, group A) survivied between 2 to 5 years, and 247 (13.5%, group B) had survived > 5 years. Aside from liver function reserve and BCLC stages, four interventional factors: initial treatment modality, outcomes of 1st or 2nd treatment, and anti-viral therapy to chronic viral hepatitis were associated with prognosis. After propensity score matching, multiple logistic regression of 223 well-matched pairs showed that recurrence within one year after 1st treatment (OR: 2.17, 95% CI: 1.353.48), incomplete 2nd treatment (2.01, 1.273.17) and absence of anti-viral agents (1.68, 1.092.59) were independent poor prognostic factors. Conclusion Complete treatment and anti-viral agents to chronic hepatitis were both independent modifiable prognostic factors of HCC patients had undergone non-surgical treatment. Based on these findings, timely treatment to achieve maximal locoregional control and anti-viral treatment should be provided as possible. PMID:26661388

  9. Life Space Assessment in Older Women Undergoing Non-Surgical Treatment for Urinary Incontinence

    PubMed Central

    Wheeler, Thomas L.; Illston, Jana D.; Markland, Alayne D.; Goode, Patricia S.; Richter, Holly E.

    2014-01-01

    Objectives Urinary incontinence (UI) impacts all aspects of life activities. This study aims to characterize change in mobility within the community utilizing the Life Space Assessment (LSA) questionnaire in women undergoing non-surgical UI treatment. Design Prospective cohort study, performed from July 2007 to March 2009, which followed women seeking non-surgical UI treatment and assessed their mobility and symptoms using LSA, Urogenital Distress Inventory (UDI-6), and Incontinence Impact Questionnaire (IIQ-7) at baseline and 2, 6, and 12 months post-treatment. Estimated Percent Improvement (EPI) and Patient Satisfaction Question (PSQ) were obtained post-treatment. Setting Outpatient tertiary-care clinic. Participants 70 ambulatory, community-dwelling women, aged 65 years or older, seeking non-surgical care for UI. Intervention Multi-component behavioral and/or pharmacologic therapies. Measurements We hypothesized LSA would improve with treatment. Repeated measures analysis with Tukeys HSD and backwards selection linear regression model were performed. Results LSA score decreased from baseline to 2 months (meanSD; 6329 to 5628, p<0.001) and was sustained at 6 and 12 months (5428, 5428). UDI scores improved from 3623 to 2524, p<0.001, at 2 months, and improvement persisted at 6 and 12 months (2222, 2124). Improvements in UDI and patient perceived improvement in UI were not associated with LSA change. Age, race, and depression impacted LSA, which decreased 1-point for each additional year of age (p=0.004), 6-points for each point higher on the Geriatric Depression Scale (GDS) (p=0.002), and 6-points for African American race (p=0.048). Conclusion Decreased mobility represented by LSA was related to age, depression, and race, but not UI symptom improvement. PMID:25525562

  10. Randomised study of three non?surgical treatments in mild to moderate obstructive sleep apnoea

    PubMed Central

    Lam, Bing; Sam, Kim; Mok, Wendy YW; Cheung, Man Tat; Fong, Daniel YT; Lam, Jamie CM; Lam, David C L; Yam, Loretta YC

    2007-01-01

    Background Patients with mild to moderate obstructive sleep apnoea (OSA) may be managed with different treatment options. This study compared the effectiveness of three commonly used non?surgical treatment modalities. Methods Subjects with mild to moderate OSA were randomised to one of three treatment groups for 10?weeks: conservative measures (sleep hygiene) only, continuous positive airways pressure (CPAP) in addition to conservative measures or an oral appliance in addition to conservative measures. All overweight subjects were referred to a weight?reduction class. OSA was assessed by polysomnography. Blood pressure was recorded in the morning and evening in the sleep laboratory. Daytime sleepiness was assessed with the Epworth Sleepiness Scale. Health?related quality of life (HRQOL) was assessed with the 36?Item Short?Form Health Survey (SF?36) and Sleep Apnoea Quality of Life Index (SAQLI). Results 101 subjects with a mean (SEM) apnoeahypopnoea index (AHI) of 21.4 (1.1) were randomised to one of the three groups. The severity of sleep?disordered breathing was decreased in the CPAP and oral appliance groups compared with the conservative measures group, and the CPAP group was significantly better than the oral appliance group. Relief from sleepiness was significantly better in the CPAP group. CPAP was also better than the oral appliance or conservative measures in improving the bodily pain domain, and better than conservative measures in improving the physical function domain of SF?36. Both CPAP and the oral appliance were more effective than conservative measures in improving the SAQLI, although no difference was detected between the CPAP and oral appliance groups. CPAP and the oral appliance significantly lowered the morning diastolic blood pressure compared with baseline values, but there was no difference in the changes in blood pressure between the groups. There was also a linear relationship between the changes in AHI and body weight. Conclusion CPAP produced the best improvement in terms of physiological, symptomatic and HRQOL measures, while the oral appliance was slightly less effective. Weight loss, if achieved, resulted in an improvement in sleep parameters, but weight control alone was not uniformly effective. PMID:17121868

  11. Non-surgical instrumentation associated with povidone-iodine in the treatment of interproximal furcation involvements

    PubMed Central

    RIBEIRO, rica Del Peloso; BITTENCOURT, Sandro; SALLUM, Enilson Antnio; SALLUM, Antnio Wilson; NOCITI JNIOR, Francisco Humberto; CASATI, Mrcio Zaffalon

    2010-01-01

    Objective The aim of this controlled clinical trial was to evaluate the effect of topically applied povidone-iodine (PVP-I) used as an adjunct to non-surgical treatment of interproximal class II furcation involvements. Material and methods Thirty-two patients presenting at least one interproximal class II furcation involvement that bled on probing with probing pocket depth (PPD) ?5 mm were recruited. Patients were randomly chosen to receive either subgingival instrumentation with an ultrasonic device using PVP-I (10%) as the cooling liquid (test group) or identical treatment using distilled water as the cooling liquid (control group). The following clinical outcomes were evaluated: visible plaque index, bleeding on probing (BOP), position of the gingival margin, relative attachment level (RAL), PPD and relative horizontal attachment level (RHAL). BAPNA (N-benzoyl-Larginine-p-nitroanilide) testing was used to analyze trypsin-like activity in dental biofilm. All parameters were evaluated at baseline and 1, 3 and 6 months after non-surgical subgingival instrumentation. Results Six months after treatment, both groups had similar means of PPD reduction, RAL and RHAL gain (p>0.05). These variables were, respectively, 2.201.10 mm, 1.271.02 mm and 1.330.85 mm in the control group and 2.671.21 mm, 1.501.09 mm and 1.560.93 mm in the test group. No difference was observed between groups at none of the posttreatment periods, regarding the number of sites showing clinical attachment gain ?2 mm. However, at 6 months posttreatment, the test group presented fewer sites with PPD ?5 mm than the control group. Also at 6 months the test group had lower BAPNA values than control group. Conclusion The use of PVP-I as an adjunct in the non-surgical treatment of interproximal class II furcation involvements provided limited additional clinical benefits. PMID:21308291

  12. The lived experience of dysphagia following non-surgical treatment for head and neck cancer.

    PubMed

    Nund, Rebecca L; Ward, Elizabeth C; Scarinci, Nerina A; Cartmill, Bena; Kuipers, Pim; Porceddu, Sandro V

    2014-06-01

    The prevalence and severity of dysphagia in people treated non-surgically for primary head and neck cancer (HNC) is well documented. However, few studies have looked beyond the physiological impairment to explore the lived experience of dysphagia in the post-treatment period of HNC. The current study adopted a person-centred, qualitative approach to describe the experiences of people living with dysphagia in the months and years following non-surgical treatment for HNC. Using maximum variation sampling, 24 participants who had undergone radiotherapy treatment for HNC were recruited. Individual interviews were conducted to explore the impact of dysphagia on participants' everyday lives. The themes identified included: (1) physical changes related to swallowing; (2) emotions evoked by living with dysphagia; (3) altered perceptions and changes in appreciation of food; and (4) personal and lifestyle impacts. The data revealed the breadth and significance of the impact of dysphagia on the lives of people treated curatively for HNC. Assessment and management in the post-treatment period must be sufficiently holistic to address both the changing physical states and the psychosocial needs of people with dysphagia following HNC. Rehabilitation services which focus only on impairment-based management will fail to fully meet the support needs of this clinical population. PMID:24345002

  13. Systemic moxifloxacin vs amoxicillin/metronidazole adjunct to non-surgical treatment in generalized aggressive periodontitis

    PubMed Central

    Gurgan, Cem-Abdulkadir

    2015-01-01

    Background The objective of this randomized clinical study was to evaluate the effect of systemic administration of moxifloxacin compared to amoxicillin and metronidazole, combined with non-surgical treatment in patients with generalized aggressive periodontitis (GAgP) in a 6-month follow-up. Material and Methods A total of 39 systemically healthy patients with GAgP were evaluated in this randomized clinical trial. Periodontal parameters were recorded at the baseline during the 1st, 3rd and 6th month. Patients received either 400 mg of moxifloxacin per os once daily or 500 mg of metronidazole and 500 mg amoxicillin per os three times daily for 7 days consecutively. Results No significant differences between groups were found in any parameters at the baseline. Both groups led to a statistically significant decrease in all clinical periodontal parameters compared to the baseline (PI, p<0.001 and GI, PD, BOP, CAL, p<0.01). There were no differences between the 1st and 3rd months or the 3rd and 6th months for clinical parameters in the groups. Also, no intergroup difference was observed in any parameters at any time, except the gingival index at 6th months. Conclusions Systemic administration of moxifloxacin as an adjunct to non-surgical treatment significantly improves clinical outcomes and provides comparable clinical improvement with less adverse events to that of combination of amoxicillin and metronidazole in the treatment of GAgP. Key words: Aggressive periodontitis, amoxicillin, metronidazole, moxifloxacin, nonsurgical periodontal debridement. PMID:26034931

  14. Non-surgical treatment of pulmonary and extra-pulmonary metastases.

    PubMed

    Anderson, Pete

    2009-01-01

    Studies have demonstrated that chemotherapy alone is usually unsuccessful as exclusive therapy for osteosarcoma (Cancer 95:2202-2201, 2002). Information will be presented for situations where non-surgical alternatives could be considered as useful, if not necessary, adjuncts to chemotherapy. In the thorax these include treatment of pleural effusions, chest wall lesions, central lung or mediastinal osteosarcoma, as well as recurrences in patients with limited pulmonary reserve. Other situations include too many metastases to easily resect, axial osteosarcomas, bone metastases, liver and brain metastases. Non-surgical local control measures include radiation with chemotherapy for radiosensitization, bone-seeking radioisotopes (e.g., 153Sm-EDTMP, 223Ra), bisphosphonates, heat (radiofrequency ablation), freezing and thawing (cryoablation), and intracavitary or regional (aerosol) therapy. Because of the predictable and common pattern of pulmonary metastases in osteosarcoma, aerosol therapy also offers an attractive regional treatment strategy. Principles and use of aerosol cytokines (e.g., GM-CSF, IL-2), and aerosol chemotherapy with gemcitabin will be discussed. Individual cases illustrating strategy and techniques will be presented. PMID:20213392

  15. Non-surgical alternative in the treatment of skeletal Class III problems.

    PubMed

    Jefferson, Y

    1995-01-01

    The dental profession is not static, but dynamic. New research findings, along with medical and technological advances, necessitate constant re-examination of treatment philosophies and techniques. What were acceptable treatment techniques in the past may not necessarily be the most effective and best techniques for our patients today. Currently, many practitioners feel that the only treatment for the correction of a skeletal Class III abnormality is via orthognathic surgery in older patients. In some cases it may be the only treatment option. But in most cases today, there are more conservative, non-surgical treatment alternatives in correcting Class III problems in younger aged children. In treating facial-skeletal problems, it must be emphasized that the human face is a biological masterpiece of form and function. Its importance has been documented in arts and sciences since the beginning of modern civilization. It is important enough so that individuals who are blessed with attractive features are afforded greater opportunities in our society. Attractive faces are associated with intelligence, honesty and good work ethics. With the advent of orthognathic surgery, functional appliance, functional regulator, and myofunctional therapy, the dental profession has the capability of leveling out the playing field for many individuals in our society. It does so by being able to correct problems closely associated with the human psyche--the human face. The ability to change facial features brings tremendous prestige to our profession. Along with this prestige comes greater responsibility. Our ability to change facial features entails greater understanding of facial balance and harmony. Ricketts states that the face must conform to stringent proportions known as the "divine proportion" in order for it to be esthetically pleasing. Also, our ability to move facial-skeletal structures entails greater understanding of the biomechanics of the human face. Without this knowledge practitioners can cause iatrogenic problems, such as temporomandibular disorders. Conversely, correcting facial-skeletal abnormalities have been found to alleviate many medical problems, such as chronic headaches, neck-back-shoulder pain, respiratory disorders, auditory disorders, etc. As more and more information is gathered, it is becoming clear that the physical, emotional and psychological health of a human being is intimately related to craniomandibular anatomy. In fact, the jaw and dental structures (with the exception of the tooth enamel) is formed from the neural crest cells along with the endocrine system, while the central nervous system is formed from the neural tube. The entire nervous system, the endocrine system and the dental system are formed from common tissue origin. This can explain why many facial-skeletal corrections are often accompanied by alleviation of many medical and physiological problems. These are exciting times for our profession. However, if we wish to address the needs of our patients well into the next century, we must continue to seek greater and greater knowledge in the area of the craniomandibular anatomy relative to the rest of the human body. It has much to do with facial esthetics, physiologic and psychologic harmony, and TMJ health. This knowledge will enable our profession to have the power to change human lives in a very positive way. As doctors, there can be no greater personal and professional satisfaction than to realize that, through our professional intervention, we are able to offer our patients the possibility of achieving greater happiness and quality of life. PMID:9520715

  16. Complications related to midfacial fractures: operative versus non-surgical treatment.

    PubMed

    Kloss, F R; Stigler, R G; Brandsttter, A; Tuli, T; Rasse, M; Laimer, K; Hchl, O L; Gassner, R

    2011-01-01

    The treatment of midfacial fractures depends on the dislocation of the fracture and patient-related limitations. Surgical treatment risks iatrogenic complications. In 740 patients with midfacial fractures, the age, sex, fracture type, concomitant injuries, cause of accident and the decision to use operative or non-surgical treatment were recorded. Follow-up was performed 6 and 12 months after the injury. In 41% the fractures were isolated; they were multiple in 59%. Initially, hypaesthesia of the infraorbital nerve was present in 10% of the single and 16% of the multiple fracture patients. Surgical treatment was performed in 57% of the single and in 75% of the multiple fracture patients. Women underwent surgical treatment considerably less frequently than men. After 6 and 12 months, significantly more complications were present in the surgically treated cohort. Nerve disturbances and 'meteorosensitivity' were most prominent. These results, together with previous findings, indicate that there is a need for prospective clinical investigations that fulfil the criteria of evidence-based medicine to generate guidelines for decision making in trauma surgery. In the meantime, the decision to use surgical treatment for midfacial fractures has to be made carefully. PMID:20870393

  17. NON-SURGICAL TREATMENT OF A PROFESSIONAL HOCKEY PLAYER WITH THE SIGNS AND SYMPTOMS OF SPORTS HERNIA: A CASE REPORT

    PubMed Central

    Woodward, J. Scott; Parker, Andrew; MacDonald, Robert M.

    2012-01-01

    Study Design: Case Report Background: Injury or weakness of lower abdominal attachments and the posterior inguinal wall can be symptoms of a sports hernia and an underlying source of groin pain. Although several authors note conservative treatment as the initial step in the management of this condition, very little has been written on the specific description of non-surgical measures. Most published articles favoring operative care describe poor results related to conservative management; however they fail to report what treatment techniques comprise non-operative management. Case Presentation: The subject of this case report is a professional ice hockey player who sustained an abdominal injury in a game, which was diagnosed as a sports hernia. Following the injury, structured conservative treatment emphasized core control and stability with progressive peripheral demand challenges. Intrinsic core control emphasis continued throughout the treatment progression and during the functional training prior to return to sport. Outcome: The player completed his recovery with return to full competition seven weeks post injury, and continues to compete in the NHL seven years later. Discussion: Surgical intervention has been shown to be effective in the treatment of the sports hernia. However it is the authors' opinion that conservative care emphasizing evaluation of intrinsic core muscular deficits and rehabilitation directed at addressing these deficits is an appropriate option, and should be considered prior to surgical intervention. PMID:22319682

  18. Non surgical laser and light in the treatment of chronic diseases: a review based on personal experiences

    NASA Astrophysics Data System (ADS)

    Longo, L.

    2010-11-01

    Since many years some effects of non surgical laser and light on biological tissue have been demonstrated, in vitro and in vivo. This review is based on the results obtained by me and my colleagues/follower in Italy. Aim of our study is to verify the anti-inflammatory and regenerative effects of non surgical laser and light therapy on patients with chronic diseases not good treatable with traditional therapies, as diabetes, and central nervous system injuries. In addition, many clinical data have emerged from double-blind trials on laser treatment of rheumatic diseases and in sports medicine. So, we would like to do a review on the state of the art of non surgical laser treatment in medicine, included aesthetic laser and light therapy field. We discuss the indications and limitations of aesthetic laser medicine, as concluded from the data analysis of the published literature and from over thirty years of personal experiences.

  19. Orthotics Compared to Conventional Therapy and Other Non-Surgical Treatments for Plantar Fasciitis

    PubMed Central

    Lewis, Rebecca D.; Wright, Paul; McCarthy, Laine H.

    2016-01-01

    Clinical Question In adults with acute plantar fasciitis whose symptoms have not been relieved with the conventional regimen of NSAIDS, stretching and lifestyle modification, do the addition of orthotics (prefabricated or custom fitted) reduce pain and improve function compared with other non-surgical treatments (manipulative chiropractic, physical therapy and/or heel steroid injections)? Answer Yes. Studies have shown that orthotics, both prefabricated and custom fitted, reduce pain and improve function in adults with acute plantar fasciitis with few risks or side effects. Used alone or in addition to conventional therapy (NSAIDs, stretching, lifestyle modification), orthotics are effective and well tolerated by patients for short-term pain relief and improved function. Prefabricated orthotics are less costly and provide similar relief to more expensive custom orthotics. Level of Evidence of the Answer A Search Terms Plantar fasciitis, heel pain, treatment, orthotics, Limits Adult, human, English, Review, Randomized-Control Trials, Systematic Reviews, adults age 18 or more, publication dates 2004 to present. Date Search was Conducted January 16, 2014; updated January 20, 2015 Inclusion Criteria Recent published systematic reviews, randomized controlled, meta-analyses; adults with confirmed acute or recent diagnosis of plantar fasciitis. Exclusion Criteria Studies older than 10 years, children, adolescents less than 18 years of age, chronic or recalcitrant plantar fasciitis. PMID:26855444

  20. Drinking Hydrogen-Rich Water Has Additive Effects on Non-Surgical Periodontal Treatment of Improving Periodontitis: A Pilot Study

    PubMed Central

    Azuma, Tetsuji; Yamane, Mayu; Ekuni, Daisuke; Kawabata, Yuya; Kataoka, Kota; Kasuyama, Kenta; Maruyama, Takayuki; Tomofuji, Takaaki; Morita, Manabu

    2015-01-01

    Oxidative stress is involved in the pathogenesis of periodontitis. A reduction of oxidative stress by drinking hydrogen-rich water (HW) might be beneficial to periodontal health. In this pilot study, we compared the effects of non-surgical periodontal treatment with or without drinking HW on periodontitis. Thirteen patients (3 women, 10 men) with periodontitis were divided into two groups: The control group (n = 6) or the HW group (n = 7). In the HW group, participants consumed HW 45 times/day for eight weeks. At two to four weeks, all participants received non-surgical periodontal treatment. Oral examinations were performed at baseline, two, four and eight weeks, and serum was obtained at these time points to evaluate oxidative stress. At baseline, there were no significant differences in periodontal status between the control and HW groups. The HW group showed greater improvements in probing pocket depth and clinical attachment level than the control group at two, four and eight weeks (p < 0.05). The HW group also exhibited an increased serum level of total antioxidant capacity at four weeks, compared to baseline (p < 0.05). Drinking HW enhanced the effects of non-surgical periodontal treatment, thus improving periodontitis. PMID:26783840

  1. Treatment Options for Pediatric Obstructive Sleep Apnea.

    PubMed

    Cielo, Christopher M; Gungor, Anil

    2016-01-01

    There are a variety of therapies available for the treatment of pediatric obstructive sleep apnea syndrome (OSAS). In children with enlarged adenoids or tonsils, adenotonsillectomy (AT) is the preferred treatment, but other surgical options include partial tonsillectomy and lingual tonsillectomy. In specific populations, craniofacial or bariatric surgery may be indicated, and tracheostomy should be reserved for cases where there is no other therapeutic option. Positive airway pressure (PAP) is the most effective non-surgical therapy for OSAS as it can be successfully used in even cases of severe OSAS. Nasal steroids and leukotriene receptor antagonists may be used in the treatment of mild or moderate OSAS. Rapid maxillary expansion and dental appliances may be effective in select populations with dental problems. Other non-surgical therapies, such as positional therapy, supplemental oxygen, and weight loss have not been shown to be effective in most pediatric populations. PMID:26597557

  2. Concrescence of permanent maxillary second and third molars: case report of non-surgical root canal treatment.

    PubMed

    Foran, Denise; Komabayashi, Takashi; Lin, Louis M

    2012-03-01

    Concrescence is a rare developmental anomaly with an overall incidence of 0.8% in the permanent dentition. While many case reports describe the treatment of concrescence with extraction, there are few reports of non-surgical root canal treatment (NSRCT), due to the atypical root form, canal morphology, and technical difficulties involved in concrescence. This unique case report describes a technical modification of NSRCT that can retain joined posterior maxillary teeth to maintain natural posterior occlusion without surgical intervention or dental implants, thereby avoiding the risk of damage to a large portion of the alveolar bone near the maxillary sinus. PMID:22466898

  3. [Non-surgical treatment of osteoarthritis of large joints - new aspects].

    PubMed

    Wagner, Ernst

    2009-01-01

    A large number of treatment options exist for osteoarthritis of the knee and hip. The choice of therapy depends on clinical symptomatology, preexisting risk factors (e.g. obesity), and disease stage. This review includes the novel aspects of symptomatic conservative treatment (physical medicine and drugs), especially pain management (electrotherapy), and rehabilitational aspects. Rehabilitation is essential, as osteoarthritis is a chronic condition, that requires lifelong intervention, and a causal cure has not been identified yet. New aspects of hyaluronic acid, slow-acting symptomatic drugs in osteoarthritis (chondroitin sulfate, glucosamine sulfate, and diacerein), and experimental drugs, which claim the properties of disease modification in osteoarthritis (bisphosphonates, calcitonin, and interleukin-1 antagonists), are discussed. PMID:19247594

  4. Defining and predicting outcomes of non-surgical periodontal treatment: a 1-yr follow-up study.

    PubMed

    Baelum, Vibeke; López, Rodrigo

    2016-02-01

    This study reports on 1-yr outcomes of non-surgical periodontal therapy and compares predictive models resulting from different definitions of treatment success. A total of 149 participants, 30-70 yr of age, provided clinical periodontal data and data on sociodemographic status, health status, symptoms, and oral health-care behaviors at baseline. One week later, clinical attachment level and probing pocket depth were recorded again in 148 patients. Participants underwent non-surgical periodontal therapy, including scaling and root planing, during three to four clinical sessions. Three and 12 months later, clinical attachment level, probing pocket depth, and bleeding on probing (BOP) were recorded in 141 and 137 participants, respectively. Using test-retest data, patients were classified as having 'downhill', 'stable', or 'improved' results on three clinical attachment level and three probing pocket depth outcomes, and their classification was found to vary considerably according to outcome. Although the predictors of treatment outcome varied depending on the variable chosen to represent the treatment outcome, some predictors were more commonly noted as predicting improvement, namely a high baseline percentage of sites with subgingival calculus and the presence of suppuration at baseline. The latter was, however, also predictive for tooth loss during the study. Our findings underline the need for uniformity in defining the outcomes in trials of periodontal therapy. PMID:26714428

  5. Effectiveness of mechanical traction as a non-surgical treatment for carpal tunnel syndrome compared to care as usual: study protocol for a randomized controlled trial

    PubMed Central

    2014-01-01

    Background Carpal tunnel syndrome (CTS) is a common condition (prevalence of 4%) where the median nerve is compressed within the carpal tunnel resulting in numbness, tingling, and pain in the hand. Current non-surgical treatment options (oral medication, corticosteroid injections, splinting, exercise, and mobilization) show limited effects, especially in the long-term. Carpal tunnel release (CTR) surgery is effective in 70 to 75% of patients, but is relatively invasive and can be accompanied by complications. In an observational study, mechanical traction proved to be effective in up to 70% of patients directly after treatment and in 60% after two years follow-up. This randomized controlled trial (RCT) will examine the effectiveness of mechanical traction compared to care as usual in CTS. Methods/Design Patients diagnosed with CTS will be recruited from an outpatient neurology clinic and randomly assigned to the intervention group (mechanical traction) or the control group (care as usual). Participants in the intervention group will receive 12 treatments with mechanical traction during six consecutive weeks. Primary outcome is symptom severity and functional status, which are measured with the Boston Carpel Tunnel Questionnaire (BCTQ). Secondary outcomes are quality of life (WHOQOL-BREF), health related resource utilization, and absenteeism from work. Outcomes will be assessed at baseline, and at 3, 6, and 12 months after inclusion. Linear mixed effect models will be used to determine the change from baseline at 12 months on the BCTQ, WHOQOL-BREF, absenteeism from work and health related resource utilization. The baseline measurement, change from baseline at three and six months, as well as duration of symptoms until inclusion, age, gender, and co-morbidity will be included as covariates The Pearson’s correlation coefficient will be generated to assess the correlation between depression and anxiety and treatment outcome. Discussion Since current non-surgical treatment options are not effective long-term and CTR is relatively invasive, there is a need for an effective and non-invasive treatment option. Mechanical traction is a safe treatment option that may provide a good alternative for the usual care. Considering the prevalence of CTS, the study is of great clinical value to a large patient population. Trial registration Clinical Trials NL44692.008.13 (registered on 19 September 2013). PMID:24886455

  6. Comparison of non-surgical treatment methods for patients with lumbar spinal stenosis: protocol for a randomized controlled trial

    PubMed Central

    2014-01-01

    Background Lumbar spinal stenosis is the most common reason for spinal surgery in older adults. Previous studies have shown that surgery is effective for severe cases of stenosis, but many patients with mild to moderate symptoms are not surgical candidates. These patients and their providers are seeking effective non-surgical treatment methods to manage their symptoms; yet there is a paucity of comparative effectiveness research in this area. This knowledge gap has hindered the development of clinical practice guidelines for non-surgical treatment approaches for lumbar spinal stenosis. Methods/design This study is a prospective randomized controlled clinical trial that will be conducted from November 2013 through October 2016. The sample will consist of 180 older adults (>60years) who have both an anatomic diagnosis of stenosis confirmed by diagnostic imaging, and signs/symptoms consistent with a clinical diagnosis of lumbar spinal stenosis confirmed by clinical examination. Eligible subjects will be randomized into one of three pragmatic treatment groups: 1) usual medical care; 2) individualized manual therapy and rehabilitative exercise; or 3) community-based group exercise. All subjects will be treated for a 6-week course of care. The primary subjective outcome is the Swiss Spinal Stenosis Questionnaire, a self-reported measure of pain/function. The primary objective outcome is the Self-Paced Walking Test, a measure of walking capacity. The secondary objective outcome will be a measurement of physical activity during activities of daily living, using the SenseWear Armband, a portable device to be worn on the upper arm for one week. The primary analysis will use linear mixed models to compare the main effects of each treatment group on the changes in each outcome measure. Secondary analyses will include a responder analysis by group and an exploratory analysis of potential baseline predictors of treatment outcome. Discussion Our study should provide evidence that helps to inform patients and providers about the clinical benefits of three non-surgical approaches to the management of lumbar spinal stenosis symptoms. Trial registration ClinicalTrials.gov identifier: NCT01943435 PMID:24872875

  7. A non-surgical uterine lavage technique in large cats intended for treatment of uterine infection-induced infertility.

    PubMed

    Hildebrandt, T B; Gritz, F; Boardman, W; Strike, T; Strauss, G; Jewgenow, K

    2006-10-01

    This paper presents the successful use of a non-surgical, transcervical uterine lavage technique for the treatment of uterine infection-induced infertility in three female large cats. We developed a non-surgical uterine lavage technique, which allowed repeated flushing of the uterine lumen and installation of therapeutic antibiotics. The entire procedure was performed under general anaesthesia (duration of anesthesia ranged from 40 to 70 min). It was successfully applied in a Sumatran tiger (Panthera tigris sumatrae), a Corbett tiger (Panthera tigris corbetti) and an Amur leopard (Panthera pardus orientalis). The tigers were treated only once, whereas the leopard received four uterine treatments, due to re-infection after mating. Decisions to conduct uterine treatments were based on detection of uterine fluid during previous transrectal ultrasound examinations. The catheter was guided into the vagina, with the aid of an endoscope, passing the urethra, and then into the uterus, with the aid of transrectal ultrasonography. Both uterine horns were separately flushed with approximately 300 mL of cell medium M199, followed by an antibiotic infusion. Upon ultrasonographic re-examination, the topical uterine treatments resulted in an apparent decline in the inflammatory and/or degenerative processes. The Corbett tiger had the most severe uterine alterations, in addition to an aseptic pyometra. As a result, she was treated 1 month prior to ovariohysterectomy (in order to reduce the surgical risk). The Sumatran tiger was artificially inseminated twice after hormone-induced estrus, and the Amur leopard expressed a spontaneous estrus and re-initiated mating behaviour. PMID:16530816

  8. Surgical Versus Non-Surgical Treatment for Vertebral Compression Fracture with Osteopenia: A Systematic Review and Meta-Analysis

    PubMed Central

    Chen, Bing-Lin; Xie, Bin; Zhang, Wen-Yi; Yang, Yu-Jie; Yue, Yu-Shan; Wang, Xue-Qiang

    2015-01-01

    Background Surgical and non-surgical interventions are the two categories for treatment of vertebral compression fractures (VCFs). However, there is clinical uncertainty over optimal management. This study aimed to examine the safety and effectiveness of surgical management for treatment of VCFs with osteopenia compared with non-surgical treatment. Methods We conducted a systematic search through electronic databases from inception to June 2014, with no limits on study data or language. Randomized controlled trials (RCTs) evaluating surgical versus non-surgical interventions for treatment of patients with VCFs due to osteopenia were considered. Primary outcomes were pain and adverse effects. A random-effects model was used to calculate the pooled mean difference (MD) or risk ratios with 95% confidence interval (CI). Results Sixteen reports (11 studies) met the inclusion criteria, and provided data for the meta-analysis with a total of 1,401 participants. Compared with conservative treatment, surgical treatment was more effective in reducing pain (short-term: MD -2.05, 95% CI -3.55 to -0.56, P=0.007; mid-term: MD -1.70, 95% CI -2.78 to -0.62, P=0.002; long-term: MD -1.24, 95% CI -2.20 to -0.29, P=0.01) and disability on the RolandMorris Disability score (short-term: MD -4.97, 95% CI -8.71 to -1.23, P=0.009), as well as improving quality of life on the Short-Form 36 Physical Component Summary score (short-term: MD 5.53, 95% CI 1.45 to 9.61, P=0.008) and the Quality of Life Questionnaire of the European Foundation for Osteoporosis score (short-term: MD -5.01, 95% CI -8.11 to -1.91, P=0.002). Indirect comparisons between vertebroplasty and kyphoplasty found no evidence that the treatment effect differed across the two interventions for any outcomes assessed. Compared with the sham procedure, surgical treatment showed no evidence of improvement in pain relief and physical function. Based on these two comparisons, no significant difference between groups was noted in the pooled results for adverse events. Conclusion Compared to conservative treatment, surgical treatment was more effective in decreasing pain in the short,mid and long terms. However, no significant mid- and long-term differences in physical function and quality of life was observed. Little good evidence is available for surgical treatment compared with that for sham procedure. PV and BK are currently used to treat VCFs with osteopenia, with little difference in treatment effects. Evidence of better quality and from a larger sample size is required before a recommendation can be made. Systematic Review Registration http://www.crd.york.ac.uk/PROSPERO PROSPERO registration number: CRD42013005142. PMID:26020950

  9. Non-surgical periodontal treatment of peri-implant diseases with the adjunctive use of diode laser: preliminary clinical study.

    PubMed

    Lerario, Francesco; Roncati, Marisa; Gariffo, Annalisa; Attorresi, Enrica; Lucchese, Alessandra; Galanakis, Alexandros; Palaia, Gaspare; Romeo, Umberto

    2016-01-01

    Peri-implant diseases present in two forms: peri-implant mucositis and peri-implantitis. The prevalence of peri-implant complications is significantly rising. The aim of this study was to compare conventional treatment of inflamed peri-implant tissues with conventional treatment together with diode laser application. Twenty-seven patients (age 36 to 67, 15 women and 12 men, 12 smokers and 15 non-smokers) requiring treatment for mucositis or peri-implantitis were taken into account for this preliminary study. Plaque index (PI), pocket depth (PD), and bleeding on probing (BoP) were recorded at baseline evaluation. Patients in control group (CG) received conventional non-surgical periodontal treatment. Patients in test group received conventional non-surgical periodontal treatment together with diode laser application (810nm, 30s, 1W, 50Hz, t on?=?100ms, t off?=?100ms, energy density?=?24.87J/cm(2)). Paired t test was used to evaluate the difference in repeated measurements of considered indexes at T 0 and T 1 (1year) in both groups. A total of 606 sites were taken into account in the test group (TG) and 144 in the CG. PD mean variation in the TG was 2.66mm??1.07, while mean PD variation in the CG was 0.94??1.13mm. Paired t testing of the variation in PD in CG and TG revealed a statistically significant difference between the two groups (p?treatment. PMID:26188854

  10. Non-Surgical Procedure Is Effective Treatment for Painful Ovarian Varicose Veins

    MedlinePLUS

    ... About Us Patient Section Who Are Interventional Radiologists? Multimedia Insurance Coverage IR Treatments Abdominal aortic aneurysms Angiography ... radiology Interventional radiology case studies Developed by ACR Multimedia gallery Multimedia Archive Pelvic Congestion Syndrome - Chronic Pelvic ...

  11. Non surgical treatment of a Class II malocclusion with skeletal hyperdivergency and anterior open bite.

    PubMed

    Rodriguez Flores, Jose Ma

    2009-01-01

    The malocclusions with hyperdivergent vertical growth patterns are more difficult to treat without a combined approach, including orthodontics and orthodontic surgery. The goal of this article is to describe a nonsurgical approach of a Class II malocclusion on an adult patient presenting a skeletal hyperdivergency. Fundamental criteria must be respected including proper diagnosis, proper treatment timing to maximize growth potential, patient cooperation, etc. These factors are critical in the favorable treatment outcome of any jaw discrepancy. PMID:19438108

  12. Clinical and Microbiological Effects of Photodynamic Therapy Associated with Non-surgical Treatment in Aggressive Periodontitis

    PubMed Central

    Chitsazi, Mohammad Taghi; Shirmohammadi, Adileh; Pourabbas, Reza; Abolfazli, Nader; Farhoudi, Ilnaz; Daghigh Azar, Behrouz; Farhadi, Farrokh

    2014-01-01

    Background and aims. The aim of this study was to compare the effectiveness of adjunctive photodynamic therapy (PDT) in the treatment of aggressive periodontitis. Materials and methods. A total of 24 patients with clinical diagnosis of aggressive periodontitis received scaling and root planing (SRP) for periodontal treatment. In a split-mouth design study, the teeth of one quadrant of each arch with ?4 mm of probing depth were selected randomly for additional treatment with PDT (test group). PDT was performed with a diode laser beam with a wavelength of 670-690 nm and a power of 75 Mw. The control group consisted of selected teeth of the contralateral quadrant (SRP only). Before any treatment, subgingival plaque samples were collected by an endodontic paper cone for microbiological analysis by real-time polymerase chain reaction (PCR) for detection of Aggregatibacter actinomycetecommitans. Clinical parameters including clinical attachment loss (CAL) as primary outcome, plaque index (PI), bleeding on probing (BOP), probing depth (PD) and gingival recession (REC) were measured at baseline and after 90 days. Inter-group and intra-group statistical analyses were performed. Results. Treatment groups showed an improvement in all the clinical parameters and a significant reduction in the counts of A. actinomycetecommitans at 90 days compared to baseline (P < 0.05). None of the periodontal parameters exhibited significant differences between the two groups (P > 0.05). Conclusion. Within the limitations of this study, the results did not show additional benefits from PDT as an adjunctive treatment for patients with aggressive periodontitis. PMID:25346834

  13. AB20. Non-surgical treatment of peyronies disease: a 2014 update

    PubMed Central

    Lue, Tom F.

    2014-01-01

    Peyronient of Urology, Schoolaracterized by the formation of fibrous plaque in the tunica albuginea of the penis. The patient usually complains of penile deformities in the form of curvature, palpable plaques, hourglass deformity, shortening or indentation with or without pain. The patient might also suffer from erectile dysfunction. The disease is associated with significant mental morbidity as 48% of the patients are clinically depressed. In addition, several comorbidities were found to be associated with the disease, such as diabetes mellitus, hypertension, erectile dysfunction, low testosterone, obesity, and smoking. Furthermore, 20% of patients were found to have Dupuytren by the formation. This presentation summarizes the current literature pertaining to all pharmacotherapies (oral, intralesional, iontophoresis, and topical) and minimally invasive treatments available for PD (vacuum, traction device, shock wave therapy, and radiation treatment). Special emphasis will be on the recently FDA approved collagenase (Xiaflex). Clostridial collagenases ability to digest native, triple-helical types I, II, and III collagens into a mixture of small peptides is its primary distinguishing factor. This is accomplished by making multiple scissions in the triple helix. Digestion is completed by hydrolyzing those fragments into a mixture of small peptides. Conversely, vertebrate collagenases initiate collagenolysis by making a single scission across all three alpha chains after which attack on those alpha chains is very limited. Two phase 3 studies: IMPRESS (Investigation for Maximal Peyronies Reduction Efficacy and Safety Studies) I (417 men) and II (415 men) confirm the efficacy and safety. Men treated with collagenase clostridium histolyticum (CCH) showed a mean 34% improvement in penile curvature, representing a -17.0 14.8 degree change per subject, compared with a mean 18.2% improvement in placebo treated men, representing a -9.313.6 degree change per subject (P<0.0001). The mean change in Peyronie disease symptom bother score was significantly improved in treated men vs men on placebo (-2.83.8 vs. -1.83.5, P=0.0037). Three serious adverse events (corporeal rupture) were surgically repaired. We currently employ CCH in our practice as a first line therapy for stable PD with dorsal or dorsal-lateral

  14. Early radiographic diagnosis of peri-implantitis enhances the outcome of peri-implantitis treatment: a 5-year retrospective study after non-surgical treatment

    PubMed Central

    Chang, Hee-Yung; Park, Shin-Young; Kim, Jin-Ah; Kim, Young-Kyun

    2015-01-01

    Purpose This retrospective study evaluated the relationship between the timing of peri-implantitis diagnosis and marginal bone level after a 5-year follow-up of non-surgical peri-implantitis treatment. Methods Thirty-three patients (69 implants) were given peri-implantitis diagnosis in 2008-2009 in Seoul National University Bundang Hospital. Among them, 31 implants from 16 patients were included in this study. They were treated non-surgically in this hospital, and came for regular maintenance visits for at least 5 years after peri-implantitis treatment. Radiographic marginal bone levels at each interval were measured and statistical analysis was performed. Results Timing of peri-implantitis was one of the significant factors affecting initial bone loss and total bone loss not additional bone after peri-implantitis diagnosis. Patients with cardiovascular disease and diabetic mellitus were positively influenced on both initial bone loss and total bone loss. Patients who needed periodontal treatment after implant placement showed a negative effect on bone loss compared to those who needed periodontal treatment before implant placement during entire periods. Implant location also significantly influenced on amounts of bone loss. Mandibular implants showed less bone loss than maxillary implants. Among surgical factors, combined use of autogenous and xenogenic bone graft materials showed a negative effect on bone loss compared to autogenous bone graft materials. Use of membrane negatively affected on initial bone loss but positively on additional bone loss and total bone loss. Thread exposure showed positive effects on initial bone loss and total bone loss. Conclusions Early peri-implantitis diagnosis led to early non-surgical intervention for peri-implantitis treatment, which resulted in the maintenance of the bone level as well as preservation of the implant. Graphical Abstract PMID:26131368

  15. Taking Control: Non-Surgical Treatment Options for Urinary Incontinence in Women

    MedlinePLUS

    ... two types of UI that are common in women: Stress incontinence: You cannot "hold" your urine when coughing, sneezing, exercising, or lifting something. The result is leaking or ... urine leaks. Some women have both kinds of incontinence. This is called " ...

  16. The international, prospective Glanzmann Thrombasthenia Registry: treatment modalities and outcomes of non-surgical bleeding episodes in patients with Glanzmann thrombasthenia.

    PubMed

    Di Minno, Giovanni; Zotz, Rainer B; d'Oiron, Roseline; Bindslev, Niels; Di Minno, Matteo Nicola Dario; Poon, Man-Chiu

    2015-08-01

    Standard treatment for Glanzmann thrombasthenia is platelet transfusion. Recombinant activated factor VII has been shown to be successful in patients with Glanzmann thrombasthenia with platelet antibodies or who are refractory to platelet transfusions. The Glanzmann Thrombasthenia Registry prospectively collected worldwide information on the effectiveness and safety of platelet transfusion, recombinant activated factor VII and/or antifibrinolytics for the treatment of bleeds in patients with Glanzmann thrombasthenia. Data relating to 829 non-surgical bleeding episodes were entered into the Glanzmann Thrombasthenia Registry (severe/moderate: 216/613; spontaneous/post-traumatic: 630/199). Recombinant activated factor VII alone was used in 124/829 bleeds, recombinant activated factor VII+antifibrinolytics in 107/829, plateletsantifibrinolytics in 312/829, antifibrinolytics alone in 219/829, and recombinant activated factor VII+plateletsantifibrinolytics in 67/829. The proportion of successful treatments to stop bleeding was 91.0% in cases treated with recombinant activated factor VII only, 82.7% for recombinant activated factor VII+antifibrinolytics, 72.7% for treatment with recombinant activated factor VII+plateletsantifibrinolytics, 78.8% for plateletsantifibrinolytics and 84.7% for antifibrinolytics alone. Treatment failure was documented in 18 bleeding events (2% of the total treatments), the majority of which were in patients receiving treatment with antifibrinolytics; bleeding re-started in 6% of bleeds after initial effective treatment. Thirty-five adverse events were reported, none of which was a thromboembolic event. Among treatments that included recombinant activated factor VII, only one patient reported three possibly drug-related non-serious adverse events (nausea, dyspnea and headache). To conclude, non-surgical bleeds were common and often severe in Glanzmann thrombasthenia; both platelets and recombinant activated factor VII appeared to be effective, and with good safety profiles, for the treatment of non-surgical bleeds. This trial was registered at clinicaltrials.gov identifier: NCT01476423. PMID:26001793

  17. Hemorrhoids and varicose veins: a review of treatment options.

    PubMed

    MacKay, D

    2001-04-01

    Hemorrhoids and varicose veins are common conditions seen by general practitioners. Both conditions have several treatment modalities for the physician to choose from. Varicose veins are treated with mechanical compression stockings. There are several over-the-counter topical agents available for hemorrhoids. Conservative therapies for both conditions include diet, lifestyle changes, and hydrotherapy which require a high degree of patient compliance to be effective. When conservative hemorrhoid therapy is ineffective, many physicians may choose other non-surgical modalities: injection sclerotherapy, cryotherapy, manual dilation of the anus, infrared photocoagulation, bipolar diathermy, direct current electrocoagulation, or rubber band ligation. Injection sclerotherapy is the non-surgical treatment for primary varicose veins. Non-surgical modalities require physicians to be specially trained, own specialized equipment, and assume associated risks. If a non-surgical approach fails, the patient is often referred to a surgeon. The costly and uncomfortable nature of treatment options often lead a patient to postpone evaluation until aggressive intervention is necessary. Oral dietary supplementation is an attractive addition to the traditional treatment of hemorrhoids and varicose veins. The loss of vascular integrity is associated with the pathogenesis of both hemorrhoids and varicose veins. Several botanical extracts have been shown to improve microcirculation, capillary flow, and vascular tone, and to strengthen the connective tissue of the perivascular amorphous substrate. Oral supplementation with Aesculus hippocastanum, Ruscus aculeatus, Centella asiatica, Hamamelis virginiana, and bioflavonoids may prevent time-consuming, painful, and expensive complications of varicose veins and hemorrhoids. PMID:11302778

  18. ARSENIC TREATMENT OPTIONS

    EPA Science Inventory

    The PPT presentation will provide information on the drinking water treatment options for small utilities to remove arsenic from ground water. The discussion will include information on the EPA BAT listed processes and on some of the newer technologies, such as the iron based ad...

  19. Achilles Tendinosis: Treatment Options

    PubMed Central

    Lopez, Roberto Gabriel L.

    2015-01-01

    Athletes usually complain of an ongoing or chronic pain over the Achilles tendon, but recently even non-athletes are experiencing the same kind of pain which affects their daily activities. Achilles tendinosis refers to a degenerative process of the tendon without histologic or clinical signs of intratendinous inflammation. Treatment is based on whether to stimulate or prevent neovascularization. Thus, until now, there is no consensus as to the best treatment for this condition. This paper aims to review the common ways of treating this condition from the conservative to the surgical options. PMID:25729512

  20. A Biofilm Pocket Model to Evaluate Different Non-Surgical Periodontal Treatment Modalities in Terms of Biofilm Removal and Reformation, Surface Alterations and Attachment of Periodontal Ligament Fibroblasts

    PubMed Central

    Hägi, Tobias T.; Klemensberger, Sabrina; Bereiter, Riccarda; Nietzsche, Sandor; Cosgarea, Raluca; Flury, Simon; Lussi, Adrian; Sculean, Anton; Eick, Sigrun

    2015-01-01

    Background and Aim There is a lack of suitable in vitro models to evaluate various treatment modalities intending to remove subgingival bacterial biofilm. Consequently, the aims of this in vitro-study were: a) to establish a pocket model enabling mechanical removal of biofilm and b) to evaluate repeated non-surgical periodontal treatment with respect to biofilm removal and reformation, surface alterations, tooth hard-substance-loss, and attachment of periodontal ligament (PDL) fibroblasts. Material and Methods Standardized human dentin specimens were colonized by multi-species biofilms for 3.5 days and subsequently placed into artificially created pockets. Non-surgical periodontal treatment was performed as follows: a) hand-instrumentation with curettes (CUR), b) ultrasonication (US), c) subgingival air-polishing using erythritol (EAP) and d) subgingival air-polishing using erythritol combined with chlorhexidine digluconate (EAP-CHX). The reduction and recolonization of bacterial counts, surface roughness (Ra and Rz), the caused tooth substance-loss (thickness) as well as the attachment of PDL fibroblasts were evaluated and statistically analyzed by means of ANOVA with Post-Hoc LSD. Results After 5 treatments, bacterial reduction in biofilms was highest when applying EAP-CHX (4 log10). The lowest reduction was found after CUR (2 log10). Additionally, substance-loss was the highest when using CUR (128±40 µm) in comparison with US (14±12 µm), EAP (6±7 µm) and EAP-CHX (11±10) µm). Surface was roughened when using CUR and US. Surfaces exposed to US and to EAP attracted the highest numbers of PDL fibroblasts. Conclusion The established biofilm model simulating a periodontal pocket combined with interchangeable placements of test specimens with multi-species biofilms enables the evaluation of different non-surgical treatment modalities on biofilm removal and surface alterations. Compared to hand instrumentation the application of ultrasonication and of air-polishing with erythritol prevents from substance-loss and results in a smooth surface with nearly no residual biofilm that promotes the reattachment of PDL fibroblasts. PMID:26121365

  1. Achalasia: current treatment options.

    PubMed

    Familiari, Pietro; Greco, Santi; Volkanovska, Ance; Gigante, Giovanni; Cali, Anna; Bokoski, Ivo; Costamagna, Guido

    2015-01-01

    Achalasia is a rare esophageal motility disorder, characterized by impaired swallow-induced, lower esophageal sphincter (LES) relaxation and defective esophageal peristalsis. Unfortunately, there are no etiological therapies for achalasia. Patients present with dysphagia, chest pain and regurgitation of undigested food, often leading to weight loss. The currently available treatments have the common aim of relieving symptoms by decreasing the pressure of the LES. This can be achieved with some medications, by inhibiting the cholinergic innervation (botulinum toxin), by stretching (endoscopic dilation) or cutting (surgery) the LES. Recently, other therapeutic options, including per-oral endoscopic myotomy have been developed and are gaining international consensus. The authors report on the benefits and weaknesses of the different therapies and provide an updated approach to the management of achalasia. PMID:26186641

  2. Evaluation of Effect of Astringent on Oral Mucosa as a Non-surgical Preprosthetic Treatment Modality in Edentulous Patients: An In Vivo Study.

    PubMed

    Radke, Usha; Kahar, Anita; Zade, Prajakta; Lambade, Dipti; Deshpande, Saee; Radke, Pranjal

    2014-12-01

    Preprosthetic treatments are advocated in edentulous patients to enhance the denture bearing areas for good denture support. Most of the times the preprosthetic treatments are considered only in a surgical way. Ideally every edentulous patient undergoing complete denture treatment needs a non-surgical preprosthetic treatment. So that, the denture bearing area will be properly prepared before the denture construction. The present study was conducted on thirty completely edentulous male patients who had visited to our Institute for the treatment. Each patient was asked to massage with astringent gel on the denture bearing mucosa over a 4weeks period. Exfoliative cytology was used to collect the surface cells from the palatal mucosa. First scrape was taken before the stimulation treatment was started. The second and third scrape was taken after the stimulation treatment with astringent gel for each patient. In this way total 90 scrapes were made and the each smear was stained with the Papanicolaou's technique to examine under light microscope. About 100 cells were counted from each stained smear. The number of parabasal cells, intermediate cells and superficial cells were recorded to calculate the degree of keratinization. Statistical analysis was performed. A significant difference (p<0.001) in keratinization levels was found. The mean percentage of superficial cells before the stimulation treatment was 79.80%; this percentage was gradually increased to 84.60and 90.57% after the 2 and 4weeks period of stimulation treatment respectively with astringent gel. PMID:26199497

  3. Pelvic radiation disease: Updates on treatment options

    PubMed Central

    Frazzoni, Leonardo; La Marca, Marina; Guido, Alessandra; Morganti, Alessio Giuseppe; Bazzoli, Franco; Fuccio, Lorenzo

    2015-01-01

    Pelvic cancers are among the most frequently diagnosed neoplasms and radiotherapy represents one of the main treatment options. The irradiation field usually encompasses healthy intestinal tissue, especially of distal large bowel, thus inducing gastrointestinal (GI) radiation-induced toxicity. Indeed, up to half of radiation-treated patients say that their quality of life is affected by GI symptoms (e.g., rectal bleeding, diarrhoea). The constellation of GI symptoms - from transient to long-term, from mild to very severe - experienced by patients who underwent radiation treatment for a pelvic tumor have been comprised in the definition of pelvic radiation disease (PRD). A correct and evidence-based therapeutic approach of patients experiencing GI radiation-induced toxicity is mandatory. Therapeutic non-surgical strategies for PRD can be summarized in two broad categories, i.e., medical and endoscopic. Of note, most of the studies have investigated the management of radiation-induced rectal bleeding. Patients with clinically significant bleeding (i.e., causing chronic anemia) should firstly be considered for medical management (i.e., sucralfate enemas, metronidazole and hyperbaric oxygen); in case of failure, endoscopic treatment should be implemented. This latter should be considered the first choice in case of acute, transfusion requiring, bleeding. More well-performed, high quality studies should be performed, especially the role of medical treatments should be better investigated as well as the comparative studies between endoscopic and hyperbaric oxygen treatments. PMID:26677440

  4. Pelvic radiation disease: Updates on treatment options.

    PubMed

    Frazzoni, Leonardo; La Marca, Marina; Guido, Alessandra; Morganti, Alessio Giuseppe; Bazzoli, Franco; Fuccio, Lorenzo

    2015-12-10

    Pelvic cancers are among the most frequently diagnosed neoplasms and radiotherapy represents one of the main treatment options. The irradiation field usually encompasses healthy intestinal tissue, especially of distal large bowel, thus inducing gastrointestinal (GI) radiation-induced toxicity. Indeed, up to half of radiation-treated patients say that their quality of life is affected by GI symptoms (e.g., rectal bleeding, diarrhoea). The constellation of GI symptoms - from transient to long-term, from mild to very severe - experienced by patients who underwent radiation treatment for a pelvic tumor have been comprised in the definition of pelvic radiation disease (PRD). A correct and evidence-based therapeutic approach of patients experiencing GI radiation-induced toxicity is mandatory. Therapeutic non-surgical strategies for PRD can be summarized in two broad categories, i.e., medical and endoscopic. Of note, most of the studies have investigated the management of radiation-induced rectal bleeding. Patients with clinically significant bleeding (i.e., causing chronic anemia) should firstly be considered for medical management (i.e., sucralfate enemas, metronidazole and hyperbaric oxygen); in case of failure, endoscopic treatment should be implemented. This latter should be considered the first choice in case of acute, transfusion requiring, bleeding. More well-performed, high quality studies should be performed, especially the role of medical treatments should be better investigated as well as the comparative studies between endoscopic and hyperbaric oxygen treatments. PMID:26677440

  5. Non-Surgical Breast-Conserving Treatment (KORTUC-BCT) Using a New Radiosensitization Method (KORTUC II) for Patients with Stage I or II Breast Cancer

    PubMed Central

    Ogawa, Yasuhiro; Kubota, Kei; Aoyama, Nobutaka; Yamanishi, Tomoaki; Kariya, Shinji; Hamada, Norihiko; Nogami, Munenobu; Nishioka, Akihito; Onogawa, Masahide; Miyamura, Mitsuhiko

    2015-01-01

    The purpose of the present study was to establish a non-surgical breast-conserving treatment (BCT) using KORTUC II radiosensitization treatment. A new radiosensitizing agent containing 0.5% hydrogen peroxide and 0.83% sodium hyaluronate (a CD44 ligand) has been developed for intra-tumoral injection into various tumors. This new method, named KORTUC II, was approved by our local ethics committee for the treatment of breast cancer and metastatic lymph nodes. A total of 72 early-stage breast cancer patients (stage 0, 1 patient; stage I, 23; stage II, 48) were enrolled in the KORTUC II trial after providing fully informed consent. The mean age of the patients was 59.7 years. A maximum of 6 mL (usually 3 mL for tumors of less than approximately 3 cm in diameter) of the agent was injected into breast tumor tissue twice a week under ultrasonographic guidance. For radiotherapy, hypofraction radiotherapy was administered using a tangential fields approach including an ipsilateral axillary region and field-in-field method; the energy level was 4 MV, and the total radiation dose was 44 Gy administered as 2.75 Gy/fraction. An electron boost of 3 Gy was added three times. Treatment was well tolerated with minimal adverse effects in all 72 patients. No patients showed any significant complications other than mild dermatitis. A total of 24 patients under 75 years old with stage II breast cancer underwent induction chemotherapy (EC and/or taxane) prior to KORTUC II treatment, and 58 patients with estrogen receptor-positive tumors also received hormonal therapy following KORTUC II. The mean duration of follow-up as of the end of September 2014 was 51.1 months, at which time 68 patients were alive without any distant metastases. Only one patient had local recurrence and died of cardiac failure at 6.5 years. Another one patient had bone metastases. For two of the 72 patients, follow-up ended after several months following KORTUC II treatment. In conclusion, non-surgical BCT can be performed using KORTUC II, which has three major characteristics: imaging guidance; enzyme-targeting; and targeting of breast cancer stem cells via the CD44 receptor. PMID:26593948

  6. Is photodynamic therapy with adjunctive non-surgical periodontal therapy effective in the treatment of periodontal disease under immunocompromised conditions?

    PubMed

    Javed, Fawad; Qadri, Talat; Ahmed, Hameeda Bashir; Al-Hezaimi, Khalid; Corbet, Francis Esmonde; Romanos, Georgios E

    2013-10-01

    The aim was to assess whether or not photodynamic therapy (PDT) with adjunctive scaling-and-root-planing (SRP) is effective in the treatment of periodontitis under immunocompromised conditions. PubMed/Medline and Google-Scholar databases were searched from 1967 to May 2013 using various key words. Six studies (five experimental and one clinical) were included. In the clinical study, SRP with PDT was reported to be ineffective in treating chronic periodontitis in T2DM patients. All experimental studies reported significantly less bone loss in periodontal defects treated with SRP+PDT than those treated with SRP alone. Efficacy of PDT+SRP in the treatment of periodontal disease under immunocompromised conditions remains unclear. PMID:24112260

  7. Use of a water-vapour permeable polyurethane film (omiderm) in the non-surgical treatment of aplasia cutis congenita.

    PubMed

    Canter, Halil Ibrahim; Vargel, Ibrahim; Nasir, Serdar; Kayikcioglu, Aycan

    2004-01-01

    Aplasia cutis congenita is characterised by congenital absence of all layers of skin, and most commonly affects the scalp. It is often associated with absence of the bone and dura underlining the defective scalp. In this report, we present the result of use of a water-vapour permeable polyurethane film (Omiderm) together with absorbant fine mesh gauze impregnated with 3% bismuth tribromophenate (Xeroform) in the treatment of a cranial defect in a newborn baby of low birth weight, who could not be operated on because of associated medical problems. PMID:15370806

  8. Treatment Option Overview (Vulvar Cancer)

    MedlinePLUS

    ... in other parts of the body. Treatment Option Overview Key Points There are different types of treatment for patients with vulvar cancer. Four types of standard treatment are used: Surgery Radiation therapy Chemotherapy Biologic therapy New types of treatment are being tested ...

  9. Treatment Option Overview (Endometrial Cancer)

    MedlinePLUS

    ... in other parts of the body. Treatment Option Overview Key Points There are different types of treatment for patients with endometrial cancer. Five types of standard treatment are used: Surgery Radiation therapy Chemotherapy Hormone therapy Biologic therapy New types of treatment are being tested ...

  10. Treatment Options for Actinic Keratosis

    MedlinePLUS

    ... that is not helped by lip balm or petroleum jelly . Tests or procedures that examine the skin ... and is not helped by lip balm or petroleum jelly . Treatment Option Overview Key Points There are ...

  11. IBS Treatment Options

    MedlinePLUS

    ... center. These specialty centers are usually connected with universities. Start right IBS treatment starts with getting your facts straight. Learn all you can about IBS. Here are some things you need to know. What it's not: IBS . . . ...

  12. PTSD Treatment Options

    MedlinePLUS

    ... are often considered alternative to typical medical practices. Acupuncture is often considered a CAM treatment. There is some evidence that acupuncture may improve PTSD symptoms and acupuncture may be ...

  13. Porphyria Treatment Options

    MedlinePLUS

    ... of treatment. All information and content on this Web site are protected by copyright. All rights are reserved. Users are prohibited from modifying, copying, distributing, transmitting, displaying, publishing, selling, licensing, creating derivative works, or using any information available ...

  14. Spasmodic Torticollis: Treatment Options

    MedlinePLUS

    ... Events Photo Galleries Support Group Announcements NSTA Guest Speakers Contact Contact NSTA Today Request for Information Treatment ... Dystonia Advocacy Network Support Groups Announcements NSTA Guest Speakers Patient Support Photo Galleries Contact NSTA NSTA Message ...

  15. Treatment Option Overview (Melanoma)

    MedlinePLUS

    ... Treatment for more information.) Unusual moles, exposure to sunlight, and health history can affect the risk of ... Red or blond hair. Being exposed to natural sunlight or artificial sunlight (such as from tanning beds) ...

  16. Advances in non-surgical management of primary liver cancer

    PubMed Central

    Chen, Xiao; Liu, Hai-Peng; Li, Mei; Qiao, Liang

    2014-01-01

    Hepatocellular carcinoma (HCC) is the fifth most common cancer and the third most common cause of cancer-related death worldwide. There have been great improvements in the diagnosis and treatment of HCC in recent years, but the problems, including difficult diagnosis at early stage, quick progression, and poor prognosis remain unsolved. Surgical resection is the mainstay of the treatment for HCC. However, 70%-80% of HCC patients are diagnosed at an advanced stage when most are ineligible for potentially curative therapies such as surgical resection and liver transplantation. In recent years, non-surgical management for unrespectable HCC, such as percutaneous ethanol injection, percutaneous microwave coagulation therapy, percutaneous radiofrequency ablation, transcatheter arterial chemoembolization, radiotherapy, chemotherapy, biotherapy, and hormonal therapy have been developed. These therapeutic options, either alone or in combination, have been shown to control tumor growth, prolong survival time, and improve quality of life to some extent. This review covers the current status and progress of non-surgical management for HCC. PMID:25469032

  17. Hyperphosphataemia: treatment options.

    PubMed

    Malberti, Fabio

    2013-05-01

    Hyperphosphataemia can be induced by three main conditions: a massive acute phosphate load, a primary increase in renal phosphate reabsorption, and an impaired renal phosphate excretion due to acute or chronic renal insufficiency. Renal excretion is so efficient in normal subjects that balance can be maintained with only a minimal rise in serum phosphorus concentration even for a large phosphorus load. Therefore, acute hyperphosphataemia usually resolves within few hours if renal function is intact. The most frequent cause of chronic hyperphosphataemia is chronic renal failure. Hyperphosphataemia in chronic kidney disease (CKD) is associated with increased cardiovascular morbidity and mortality. Lowering the phosphate load and maintaining serum phosphorus levels within the normal range are considered important therapeutic goals to improve clinical outcomes in CKD patients. Treatment consists of diminishing intestinal phosphate absorption by a low phosphate diet and phosphate binders. In CKD patients on dialysis an efficient dialysis removal of phosphate should be ensured. Dietary restriction of phosphorus while maintaining adequate protein intake is not sufficient to control serum phosphate levels in most CKD patients; therefore, the prescription of a phosphate binder is required. Aluminium-containing agents are efficient but no longer widely used because of their toxicity. Calcium-based salts are inexpensive, effective and most widely used, but there is now concern about their association with hypercalcaemia, parathyroid gland suppression, adynamic bone disease, and vascular and extraosseous calcification. The average daily dose of calcium acetate or carbonate prescribed in the randomised controlled trials to control hyperphosphataemia in dialysis patients ranges between 1.2 and 2.3g of elemental calcium. Such doses are greater than the recommended dietary calcium intake and can lead to a positive calcium balance. Although large amounts of calcium salts should probably be avoided, modest doses (<1g of elemental calcium) may represent a reasonable initial approach to reduced serum phosphorus levels. A non-calcium-based binder can then be added when large doses of binder are required. At present, there are three types of non-calcium-based phosphate binders available: sevelamer, lanthanum carbonate and magnesium salts. Each of these compounds is as effective as calcium salts in lowering serum phosphorus levels depending on an adequate prescribed dose and adherence of the patient to treatment. Sevelamer is the only non-calcium-containing phosphate binder that does not have potential for systemic accumulation and presents pleiotropic effects that may impact on cardiovascular disease. In contrast, lanthanum carbonate and magnesium salts are absorbed in the gut and their route of excretion is biliary for lanthanum and urinary for magnesium. There are insufficient data to establish the comparative superiority of non-calcium binding agents over calcium salts for such important patient-level outcomes as all-cause mortality and cardiovascular end points. Moreover, full adoption of sevelamer and lanthanum by government drug reimbursement agencies in place of calcium salts would lead to a large increase in health-care expenditure. Therefore, the choice of phosphate binder should be individualised, considering the clinical context, the costs, and the individual tolerability the concomitant effects on other parameters of mineral metabolism, such as serum calcium and parathyroid hormone, besides those on serum phosphorus. PMID:23625273

  18. Wastewater treatment plant cogeneration options

    SciTech Connect

    Stringfield, J.G.

    1995-12-31

    This paper reviews municipal sewage cogeneration and digester gas utilization options available to wastewater treatment plants, and will focus on utilizing the digester gas in combustion turbines and engine-generator systems. Defining the digestion and gas generation process is crucial to understanding the best gas utilization system. In municipal wastewater treatment plants biosolids (sludge) reduction is accomplished using aerobic or anaerobic digestion. The basic process of treating sewage solids with digestion is not new and has been practiced as far back as the nineteenth century. High energy usage consumed by aerobic blow systems supplying air to the process and the potential ``free`` energy generated by anaerobic digesters sometimes sways designers to select anaerobic over aerobic digestion. The following areas will be covered in this paper: gas utilization and cogeneration; definition of digestion process; sizing the cogeneration system and reviewing the systems components; emissions requirements and options; and capital, and O and M cost analysis.

  19. [Non surgical management of ectopic pregnancy].

    PubMed

    Kdous, Moez

    2006-06-01

    During the past 25 years, the incidence of ectopic pregnancy has progressively increased while the morbidity and mortality have substantialy decreased, and the treatment has progressed from salpingectomy by laparotomy to conservative surgery by laparoscopy and more recently to medical therapy with Methotrexate or expectant management. This therapeutic transition from surgical emergency to non surgical managment has been attributed to early diagnosis through the use of sensitive assays for hCG and the high definition of vaginal ultrasound. By using these sensitive diagnostic tools, we are now able to select those patients who are most likely to respond to expectant or medical managment versus those who are at high risk of rupture and require surgery. We have reviewed the scientific literature on ectopic pregnancy published over the past 20 years, with the aim to assess the value of non surgical managment of etopic pregnancy. Predictor factors of expectant managment are discussed. Medical therapy with methotrexate: results, indications, Unpleasant side effects and complications are detailed. Several protocols are defined and therapeutic supervision is etablished. The authors offred several recommandations for OB/GY wich will optimize the effectivness of non invasive methods for treatment of ectopic pregnancy. PMID:17042204

  20. Chronic Migraine New Treatment Options

    PubMed Central

    ROCEANU, Adina; ANTOCHI, Florina; BAJENARU, Ovidiu

    2014-01-01

    Chronic migraine (CM) is defined as headache occurring more than fifteen days/month for at least three consecutive months, with headache having the clinical features of migraine without aura for at least eight days per month. Recently, new treatment options became available in chronic migraine patients. Topiramate is effective in chronic migraine, in the presence or absence of medication overuse, and/or other migraine prophylaxis. Efficacy of onabotulinumtoxin A as a preventive treatment of chronic migraine has been shown in the PREEMPT studies. Occipital nerve stimulation (ONS) is an invasive treatment for refractory chronic headaches. ONS has encouraging results in refractory chronic migraine patients in commercially funded, multi-centre randomized trials. PMID:25705314

  1. The effectiveness of relaxation training in reducing treatment-related symptoms and improving emotional adjustment in acute non-surgical cancer treatment: a meta-analytical review

    Cancer.gov

    Cancer patients often have to deal with severe side effects and psychological distress during cancer treatment, which have a substantial impact on their quality of life. Among psychosocial interventions for reducing treatment-related side effects, relaxation and imagery were most investigated in controlled trials.

  2. Zenker's diverticulum: exploring treatment options.

    PubMed

    Bizzotto, A; Iacopini, F; Landi, R; Costamagna, G

    2013-08-01

    Zenker's diverticulum is an acquired sac-like outpouching of the mucosa and submucosa layers located dorsally at the pharyngoesophageal junction through Killian's dehiscence. It is the most common type of oesophageal diverticula with a reported prevalence ranging between 0.01 to 0.11% and typically occurs in middle-aged and elderly patients. Predominant symptoms are dysphagia and regurgitation. Treatment is recommended for symptomatic patients and considering the aetiopathogenesis of the disease demands myotomy of the cricopharyngeal muscle. Myotomy may be pursued through either open surgical or endoscopic techniques. Management of Zenker's diverticulum has dramatically progressed during past decades. Open surgery with cricopharyngeal myotomy has long been the conventional treatment with satisfactory results, but is associated with high complication rates. Since Zenker's diverticulum mainly affects frail elderly patients, less invasive treatments are indicated. In recent years, endoscopic repair of Zenker's diverticulum has been found to be a viable safe and effective alternative to surgery and gained widespread acceptance. Endoscopic stapled diverticulotomy is generally the preferred approach, but flexible endoscopy is a valuable option, particularly for high-risk patients. The literature is mainly based on retrospective case series or comparative case series, and the optimal treatment modality has not yet been established. The choice between the different approaches depends on local expertise and preferences. Based on retrospective literature results, appropriate technique selection dictated by the size of the diverticulum and the patient's conditions is however desirable. PMID:24043908

  3. Non-surgical and non-chemical attempts to treat echinococcosis: do they work?

    PubMed Central

    Tamarozzi, Francesca; Vuitton, Lucine; Brunetti, Enrico; Vuitton, Dominique Angèle; Koch, Stéphane

    2014-01-01

    Cystic echinococcosis (CE) and alveolar echinococcosis (AE) are chronic, complex and neglected diseases. Their treatment depends on a number of factors related to the lesion, setting and patient. We performed a literature review of curative or palliative non-surgical, non-chemical interventions in CE and AE. In CE, some of these techniques, like radiofrequency thermal ablation (RFA), were shelved after initial attempts, while others, such as High-Intensity Focused Ultrasound, appear promising but are still in a pre-clinical phase. In AE, RFA has never been tested, however, radiotherapy or heavy-ion therapies have been attempted in experimental models. Still, application to humans is questionable. In CE, although prospective clinical studies are still lacking, therapeutic, non-surgical drainage techniques, such as PAIR (puncture, aspiration, injection, re-aspiration) and its derivatives, are now considered a useful option in selected cases. Finally, palliative, non-surgical drainage techniques such as US- or CT-guided percutaneous biliary drainage, centro-parasitic abscesses drainage, or vascular stenting were performed successfully. Recently, endoscopic retrograde cholangiopancreatography (ERCP)-associated techniques have become increasingly used to manage biliary fistulas in CE and biliary obstructions in AE. Development of pre-clinical animal models would allow testing for AE techniques developed for other indications, e.g. cancer. Prospective trials are required to determine the best use of PAIR, and associated procedures, and the indications and techniques of palliative drainage. PMID:25531730

  4. Treatment options for hepatic cystic echinococcosis.

    PubMed

    Smego, Raymond A; Sebanego, Peter

    2005-03-01

    A number of surgical and non-surgical options exist to treat cystic echinococcosis of the liver. For decades, surgical excision via a conservative or radical approach was the recommended approach for hepatic hydatid cysts. The availability of chemotherapeutic agents with significant activity against Echinococcus granulosis has made it possible to undertake ultrasound- or computed tomography-guided transhepatic percutaneous drainage (termed puncture, aspiration, injection, and re-aspiration (PAIR)) of hydatid cysts. Pre- and post-intervention chemotherapy with albendazole or mebendazole offers the advantage of reducing the risk of disease recurrence and intraperitoneal seeding of infection that may develop via cyst rupture and spillage occurring spontaneously or during surgery or needle drainage. PAIR appears to have greater clinical efficacy (i.e. a higher incidence of cure), lower rates of major and minor complications, mortality, and disease recurrence, and fewer days of hospitalization compared to patients treated surgically. For patients who fail drug therapy alone, PAIR is a safe and effective procedure of choice for patients with hepatic echinococcosis, and perhaps other anatomic sites of infection such as lung, peritoneum, kidney, and other viscera. Surgery should be reserved for patients with hydatid cysts refractory to PAIR because of secondary bacterial infection or for those with difficult-to-manage cyst-biliary communication or obstruction. PMID:15708321

  5. Treatment Options for Childhood Astrocytomas

    MedlinePLUS

    ... before the cancer is diagnosed and continue for months or years. Signs or symptoms caused by the ... after treatment. Some cancer treatments cause side effects months or years after treatment has ended. Side effects ...

  6. Treatment Options by Stage (Endometrial Cancer)

    MedlinePLUS

    ... in other parts of the body. Treatment Option Overview Key Points There are different types of treatment for patients with endometrial cancer. Five types of standard treatment are used: Surgery Radiation therapy Chemotherapy Hormone therapy Biologic therapy New types of treatment are being tested ...

  7. Treatment Options by Stage (Vulvar Cancer)

    MedlinePLUS

    ... in other parts of the body. Treatment Option Overview Key Points There are different types of treatment for patients with vulvar cancer. Four types of standard treatment are used: Surgery Radiation therapy Chemotherapy Biologic therapy New types of treatment are being tested ...

  8. EVerT2—needling versus non-surgical debridement for the treatment of verrucae: study protocol for a single-centre randomised controlled trial

    PubMed Central

    Hashmi, Farina; Torgerson, David; Fairhurst, Caroline; Cockayne, Sarah; Bell, Kerry; Cullen, Michelle; Harrison-Blount, Michael

    2015-01-01

    Introduction Verrucae are extremely common, and are experienced by most people at some time during their lives. Although most verrucae will spontaneously disappear without treatment, many patients seek treatment, often because they have persisted for many years, are unsightly or painful or prevent them from doing sports or other activities. There are many different treatments available; including the Falknor's needling procedure. To date, there has only been one small trial evaluating the clinical effectiveness of this treatment and no health economic analysis has been undertaken. The Effective Verruca Treatments (EVerT2) trial aims to evaluate the clinical and cost-effectiveness of the needling procedure for the treatment of verrucae. Methods and analysis This single-centre randomised controlled trial will recruit 58 participants (aged 18 years and over with a plantar verruca) from Salford Podiatry Clinic patient lists and the surrounding area. If the participant presents with multiple verrucae, an ‘index’ verruca (largest and thickest lesion) will be identified and patients will be randomised 1:1 to the intervention group to receive the needling treatment or the control group to have the callus overlying the verruca debrided. The primary outcome is complete clearance of the index verruca at 12 weeks after randomisation. Secondary outcomes include clearance and recurrence of the treated verruca, clearance of all verrucae, number of verrucae remaining, change in size of the index verruca, pain, and participant satisfaction. A cost-effectiveness analysis of the needling versus callus debridement will be carried out from the perspective of health services over a time horizon of 12 weeks. Ethics and dissemination Ethical approval has been obtained from the University of Salford, Department of Health Sciences Ethical Approval Committee (HSCR15/24) and the University of York, Department of Health Sciences Research Governance Committee (HSRGC/2014/98/B). Findings will be disseminated through publication and conference presentations. Trial registration number ISRCTN16429440. PMID:26603251

  9. Treatment Option Overview (Childhood Acute Lymphoblastic Leukemia)

    MedlinePLUS

    ... recovery) and treatment options. Childhood acute lymphoblastic leukemia (ALL) is a type of cancer in which the ... genetic conditions affect the risk of having childhood ALL. Anything that increases your risk of getting a ...

  10. Treatment Option Overview (Adult Acute Lymphoblastic Leukemia)

    MedlinePLUS

    ... recovery) and treatment options. Adult acute lymphoblastic leukemia (ALL) is a type of cancer in which the ... to radiation may increase the risk of developing ALL. Anything that increases your risk of getting a ...

  11. Treatment Options for Adult Acute Lymphoblastic Leukemia

    MedlinePLUS

    ... recovery) and treatment options. Adult acute lymphoblastic leukemia (ALL) is a type of cancer in which the ... to radiation may increase the risk of developing ALL. Anything that increases your risk of getting a ...

  12. Treatment Options for Childhood Acute Lymphoblastic Leukemia

    MedlinePLUS

    ... recovery) and treatment options. Childhood acute lymphoblastic leukemia (ALL) is a type of cancer in which the ... genetic conditions affect the risk of having childhood ALL. Anything that increases your risk of getting a ...

  13. Treatment Options for Nonmelanoma Skin Cancer

    MedlinePLUS

    ... that is not helped by lip balm or petroleum jelly . Tests or procedures that examine the skin ... and is not helped by lip balm or petroleum jelly . Treatment Option Overview Key Points There are ...

  14. The Effect of Race on Outcomes of Surgical or Non-surgical Treatment of Patients in the Spine Patient Outcomes Research Trial (SPORT)

    PubMed Central

    Schoenfeld, Andrew J.; Lurie, Jon D.; Zhao, Wenyan; Bono, Christopher M.

    2012-01-01

    Study Design Retrospective review of the data collected prospectively through the Spine Patient Outcomes Research Trial (SPORT). Objective Determine the effect that race or ethnicity had on outcomes following spine surgery in the three arms of SPORT. Summary of Background Data There is a dearth of research regarding the effect of race or ethnicity on outcome following treatment for spinal disorders. Methods All participants from the three arms of the SPORT were evaluated in an as-treated analysis with patients categorized as white, black, or other. Baseline and operative characteristics of the groups were compared using the chi-square test and ANOVA. Differences in the changes between baseline and 1-, 2-, 3-, and 4-year time-points in the operative and non-operative treatments were evaluated with a mixed effects longitudinal regression model and differences between racial groups were compared with a multiple degrees of freedom Wald test. Results Included were 2,427 patients (85% white, 8% black, 7% other). Surgery was performed on 67% of white patients, 54% of blacks, and 68% of others. Whites and others were significantly more likely to undergo surgery than blacks (67% and 68% vs 54%, p=0.003). Complications and the risk of additional surgeries were not significantly different between racial groups. Regardless of race, all patients improved more with surgical management than with nonoperative treatment for all outcome measures at all time-points. The average 4-year area- under-the-curve results revealed surgical and non-operative treatment resulted in statistically significant improvement in whites relative to blacks for BP (p<0.001), SF (p<0.001), and ODI (p<0.001). No significant differences were appreciated in treatment effect for primary outcome measures or self-rated progress across racial groups. Conclusion These results illustrate important differences between racial groups in terms of response to spine care. While there were quantitative differences between groups, these findings are not necessarily indications of healthcare disparities. PMID:22842539

  15. Treatment Option Overview (Breast Cancer)

    MedlinePLUS

    ... and Young Adults with Cancer Reports, Research, and Literature Quiz Cancers by Body Location/System Childhood Cancers Late Effects of Childhood Cancer Treatment Pediatric Supportive Care Unusual ...

  16. Non-surgical treatment of deep wounds triggered by harmful physical and chemical agents: a successful combined use of collagenase and hyaluronic acid.

    PubMed

    Onesti, Maria G; Fino, Pasquale; Ponzo, Ida; Ruggieri, Martina; Scuderi, Nicolò

    2016-02-01

    Some chronic ulcers often occur with slough, not progressing through the normal stages of wound healing. Treatment is long and other therapies need to be performed in addition to surgery. Patients not eligible for surgery because of ASA class (American Society of Anesthesiologists class) appear to benefit from chemical therapy with collagenase or hydrocolloids in order to prepare the wound bed, promoting the healing process. We describe four cases of traumatic, upper limb deep wounds caused by different physical and chemical agents, emphasising the effectiveness of treatment based on topical application of collagenase and hyaluronic acid (HA) before standardised surgical procedures. We performed careful disinfection of lesions combined with application of topical cream containing hyaluronic acid, bacterial fermented sodium hyaluronate (0·2%w/w) salt, and bacterial collagenase obtained from non-pathogenic Vibrio alginolyticus (>2·0 nkat1/g). In one patient a dermo-epidermal graft was used to cover the wide loss of substance. In two patients application of a HA-based dermal substitute was done. We obtained successful results in terms of wound healing, with satisfactory aesthetic result and optimal recovery of the affected limb functionality. Topical application of collagenase and HA, alone or before standardised surgical procedures allows faster wound healing. PMID:24698215

  17. Treatment Option Overview (Anal Cancer)

    MedlinePLUS

    ... tumors, not anal cancer . Being infected with the human papillomavirus (HPV) increases the risk of developing anal ... bag is attached to the stoma. Having the human immunodeficiency virus can affect treatment of anal cancer. ...

  18. Radiation Therapy: Additional Treatment Options

    MedlinePLUS

    ... go through the bloodstream to the entire body. Immunotherapy Some treatments are designed to help your own ... fights off infections. This is refered to as immunotherapy . Intraoperative Radiation Therapy Radiation therapy given during surgery ...

  19. Treatment Option Overview (Oropharyngeal Cancer)

    MedlinePLUS

    ... adjuvant therapy . New types of surgery, including transoral robotic surgery , are being studied for the treatment of oropharyngeal cancer. Transoral robotic surgery may be used to remove cancer from ...

  20. Treatment Option Overview (Testicular Cancer)

    MedlinePLUS

    ... may wish to have children should consider sperm banking before having treatment. Sperm banking is the process of freezing sperm and storing ... use this content on your website or other digital platform? Our syndication services page shows you how. ...

  1. Treatment Options by Stage (Melanoma)

    MedlinePLUS

    ... Treatment for more information.) Unusual moles, exposure to sunlight, and health history can affect the risk of ... Red or blond hair. Being exposed to natural sunlight or artificial sunlight (such as from tanning beds) ...

  2. Treatment Options for Wilms Tumor

    MedlinePLUS

    ... New types of treatment are being tested in clinical trials. Information about clinical trials is available from ... want to think about taking part in a clinical trial. For some patients, taking part in a ...

  3. Ultramorphology of the root surface subsequent to hand-ultrasonic simultaneous instrumentation during non-surgical periodontal treatments. An in vitro study

    PubMed Central

    D. ASPRIELLO, Simone; PIEMONTESE, Matteo; LEVRINI, Luca; SAURO, Salvatore

    2011-01-01

    Objective The purpose of this study was to investigate the ultramorphology of the root surfaces induced by mechanical instrumentation performed using conventional curettes or piezoelectric scalers when used single-handedly or with a combined technique. Material and Methods Thirty single-rooted teeth were selected and divided into 3 groups: Group A, instrumentation with curettes; Group B instrumentation with titanium nitride coated periodontal tip mounted in a piezoelectric handpiece; Group C, combined technique with curette/ultrasonic piezoelectric instrumentation. The specimens were processed and analyzed using confocal and scanning electron microscopy. Differences between the different groups of instrumentation were determined using Pearsons ? 2 with significance predetermined at ?=0.001. Results Periodontal scaling and root planing performed with curettes, ultrasonic or combined instrumentation induced several morphological changes on the root surface. The curettes produced a compact and thick multilayered smear layer, while the morphology of the root surfaces after ultrasonic scaler treatment appeared irregular with few grooves and a thin smear layer. The combination of curette/ultrasonic instrumentation showed exposed root dentin tubules with a surface morphology characterized by the presence of very few grooves and slender remnants of smear layer which only partially covered the root dentin. In some cases, it was also possible to observe areas with exposed collagen fibrils. Conclusion The curette-ultrasonic simultaneous instrumentation may combine the beneficial effects of each instrument in a single technique creating a root surface relatively free from the physical barrier of smear layer and dentin tubules orifices partial occlusion. PMID:21437474

  4. Anesthetic efficacy of Oraqix® versus Hurricaine® and placebo for pain control during non-surgical periodontal treatment

    PubMed Central

    Mayor-Subirana, Gemma; Yagüe-García, José; Arnabat-Domínguez, Josep; Berini-Aytés, Leonardo; Gay-Escoda, Cosme

    2014-01-01

    Objectives: To evaluate the efficacy of Oraqix® during scaling and root planing (SRP) in comparison with 20% benzocaine and placebo. Study Design: 15 patients requiring 4 sessions of SRP were enrolled. For each patient, Oraqix®, Hurricaine®, vaseline or no anesthetic product were randomly assigned each to a quadrant. Treatment pain was evaluated on a 100 mm Visual Analog Scale (VAS) and on a Verbal Rating Scale (VRS). The amount of product administered, the need to re-anesthetise, patient and operator satisfaction and the onset of side-effects were also recorded. Results: Oraqix® was significantly better than nothing, with a reduction of VAS score to 13.3 units, but without significant differences with Vaseline or Hurricaine®. Oraqix® was better in VRS reduction than not using any anesthetic (p=0.001) or using vaseline (p=0.024), but similar to Hurricaine® (p=0.232). Conclusions: Oraqix® effectively controls pain in SRP procedures, with few side-effects and a good acceptance on the part of patients and clinicians. Key words:Controlled clinical trial, topical anesthetic, scaling and root planing. PMID:24316699

  5. Treatment Option Overview (Ewing Sarcoma)

    MedlinePLUS

    ... of recurrent Ewing sarcoma. High-dose chemotherapy with stem cell rescue High-dose chemotherapy with stem cell rescue is a way of giving high doses ... replacing blood -forming cells destroyed by cancer treatment. Stem cells (immature blood cells) are removed from the blood ...

  6. Treatment options for hepatic encephalopathy.

    PubMed

    Schiano, Thomas D

    2010-05-01

    Few formal treatment guidelines exist for managing hepatic encephalopathy. The nonabsorbable disaccharide, lactulose, is considered the first-line therapeutic agent for treating hepatic encephalopathy. Acidification of the gastrointestinal tract is the principal mechanism by which the drug inhibits production of ammonia by coliform bacteria. Elevated ammonia levels are seen in more than 80% of patients with hepatic encephalopathy. Systemic antibiotics, primarily neomycin, have also been employed to reduce bacterial production of ammonia, but associated adverse events limit their use in patients with hepatic encephalopathy. The semisynthetic, nonsystemic antibiotic, rifaximin, was approved in March 2010 by the United States Food and Drug Administration for the treatment of overt hepatic encephalopathy. Rifaximin decreases intestinal production and absorption of ammonia by altering gastrointestinal flora and is almost completely excreted unchanged in the feces. Rifaximin has been effective in improving behavioral, laboratory, mental, and intellectual abnormalities in patients with hepatic encephalopathy. The drug was compared with lactulose in well-designed clinical studies in patients with hepatic encephalopathy. Rifaximin was generally found to be equal or superior to lactulose in these studies. Although dosages have varied, most medical centers use a dosage of rifaximin 400 mg 3 times/day for hepatic encephalopathy. Recent clinical trials have used 550 mg twice/day in order to improve patient compliance. Additional clinical trials are being undertaken to further define the efficacy and safety of rifaximin in hepatic encephalopathy. PMID:20412036

  7. Pseudotumor cerebri: An update on treatment options

    PubMed Central

    Dave, Sarita B; Subramanian, Prem S

    2014-01-01

    Aims: The aim was to identify Pseudotumor cerebri treatment options and assess their efficacy. Setting and Design: Review article. Materials and Methods: Existing literature and the authors experience were reviewed. Results: Treatment options range from observation to surgical intervention. Weight loss and medical treatment may be utilized in cases without vision loss or in combination with surgical treatment. Cerebrospinal fluid shunting procedures and/or optic nerve sheath decompression is indicated for severe vision loss or headache unresponsive to medical management. The recent use of endovascular stenting of transverse sinus stenoses has also demonstrated benefit in patients with pseudotumor cerebri. Conclusion: While each treatment form may be successful individually, a multimodal approach is typically utilized with treatments selected on a case-by-case basis. PMID:25449933

  8. Chronic constipation: current treatment options.

    PubMed

    Liu, Louis Wing Cheong

    2011-10-01

    Constipation is a common functional gastrointestinal disorder that affects patients of all ages. In 2007, a consensus group of 10 Canadian gastroenterologists developed a set of recommendations pertaining to the management of chronic constipation and constipation dominant irritable bowel syndrome. Since then, tegaserod has been withdrawn from the Canadian market. A new, highly selective serotonin receptor subtype 4 agonist, prucalopride, has been examined in several large, randomized, placebo-controlled trials demonstrating its efficacy and safety in the management of patients with chronic constipation. Additional studies evaluating the use of stimulant laxatives, polyethylene glycol and probiotics in the management of chronic constipation have also been published. The present review summarizes the previous recommendations and new evidence supporting different treatment modalities - namely, diet and lifestyle, bulking agents, stool softeners, osmotic and stimulant laxatives, prucalopride and probiotics in the management of chronic constipation. A brief summary of lubiprostone and linaclotide is also presented. The quality of evidence is presented by adopting the Grading of Recommendations, Assessment, Development and Evaluation system. Finally, a management pyramid for patients with chronic constipation is proposed based on the quality of evidence, impact of each modality on constipation and on general health, and their availabilities in Canada. PMID:22114754

  9. New Labor Pain Treatment Options.

    PubMed

    Koyyalamudi, Veerandra; Sidhu, Gurleen; Cornett, Elyse M; Nguyen, Viet; Labrie-Brown, Carmen; Fox, Charles J; Kaye, Alan D

    2016-01-01

    Presently, the gold standard for pain control in laboring patients is neuraxial blockade, which includes a spinal, epidural, or a combined spinal-epidural technique. In conjunction with neuraxial blockade or by itself, some of the other agents employed related to labor pain include opioids, non-opioids, nitrous oxide, patient-controlled analgesia (PCA), and distraction therapy. Alternative treatments include acupuncture, hypnotism, yoga, exercise during pregnancy, hydrotherapy, transcutaneous electronic nerve stimulation, massage, and relaxation techniques. This review will focus on current updates and recent trends in labor pain management. Neuraxial management, pharmacotherapy, and newer alternative methods to mitigate labor pain are reviewed. Newer techniques in epidural analgesia include the dural puncture epidural technique, which needs further evaluation. There are limited published data on the use of acupuncture, hypnotism, yoga, exercise during pregnancy, hydrotherapy, transcutaneous electronic nerve stimulation, massage, and relaxation techniques in the alleviation of labor pain. These alternative therapies maybe considered as an adjuvant as the analgesic efficiency is inferior to that provided by typical standard pharmacotherapy. Future studies are warranted to evaluate the role of immersion virtual reality in alleviating labor pain. PMID:26780039

  10. Thromboprophylaxis in non-surgical cancer patients.

    PubMed

    Cohen, Alexander T; Gurwith, Meredith M P; Dobromirski, Mark

    2012-04-01

    Acutely ill medical patients with cancer and cancer patients requiring non-surgical therapy are considered as non-surgical cancer patients and are at moderate to high risk of venous thromboembolism (VTE): approximately 10-30% of these patients may develop asymptomatic or symptomatic deep-vein thrombosis (DVT) or pulmonary embolism (PE), and the latter is a leading contributor to deaths in hospital. Other medical conditions associated with a high risk of VTE include cardiac disease, respiratory disease, inflammatory bowel disease, rheumatological and infectious diseases. Pre-disposing risk factors in non-surgical cancer patients include a history of VTE, immobilisation, history of metastatic malignancy, complicating infections, increasing age, obesity hormonal or antiangiogenic therapies, thalidomide and lenalidomide therapy. Heparins, both unfractionated (UFH) and low molecular weight heparin (LMWH) and fondaparinux have been shown to be effective agents in prevention of VTE in the medical setting with patients having a history of cancer. UFH and LMWH along with semuloparin also have a role in outpatients with cancer receiving chemotherapy. However, it has not yet been possible to demonstrate a significant effect on mortality rates in this population. UFH has a higher rate of bleeding complications than LMWH. Thromboprophylaxis has been shown to be effective in medical patients with cancer and may have an effect on cancer outcomes. Thromboprophylaxis in patients receiving chemotherapy remains controversial and requires further investigation. There is no evidence for the use of aspirin, warfarin or mechanical methods. We recommend either LMWH, or fondaparinux for the prevention of VTE in cancer patients with acute medical illnesses and UFH for those with significant severe renal impairment. For ambulatory cancer patients undergoing chemotherapy we recommend LMWH or semuloparin. These are safe and effective agents in the thromboprophylaxis of non-surgical cancer patients. PMID:22682125

  11. Emerging treatment options for early mycosis fungoides

    PubMed Central

    Fernandez-Guarino, Montserrat

    2013-01-01

    Mycosis fungoides is a candidate for skin-directed therapies in its initial stages. In recent years, therapeutic options outside of the normal treatment recommendations such as topical imiquimod, topical tazarotene, topical methotrexate, excimer light sources, and photodynamic therapy have been published with variable results. These alternatives have been useful in cases of localized mycosis fungoides that do not respond to routine treatments; nevertheless, more studies on these methods are still needed. This article summarizes the literature and data that are known so far about these treatments. PMID:23450851

  12. Current Treatment Options in Vestibular Migraine

    PubMed Central

    Obermann, Mark; Strupp, Michael

    2014-01-01

    Approximately 1% of the general population in western industrialized countries suffers from vestibular migraine. However, it remains widely unknown and often under diagnosed despite the recently published diagnostic criteria for vestibular migraine. Treatment trials that specialize on vestibular migraine are scarce and systematic randomized controlled clinical trials are now only emerging. This review summarizes the knowledge on the currently available treatment options that were tested specifically for vestibular migraine and gives an evidence-based, informed treatment recommendation with all its limitations. To date only two randomized controlled treatment trials provide limited evidence for the use of rizatriptan and zolmitriptan for the treatment of vestibular migraine attacks because of methodological shortcomings. There is an ongoing multicenter randomized placebo-controlled trial testing metoprolol 95?mg vs. placebo (PROVEMIG-trial). Therefore, the therapeutic recommendations for the prophylactic treatment of vestibular migraine are currently widely based on the guidelines of migraine with and without aura as well as expert opinion. PMID:25538676

  13. Treatment options for brachial plexus injuries.

    PubMed

    Sakellariou, Vasileios I; Badilas, Nikolaos K; Stavropoulos, Nikolaos A; Mazis, George; Kotoulas, Helias K; Kyriakopoulos, Stamatios; Tagkalegkas, Ioannis; Sofianos, Ioannis P

    2014-01-01

    The incidence of brachial plexus injuries is rapidly growing due to the increasing number of high-speed motor-vehicle accidents. These are devastating injuries leading to significant functional impairment of the patients. The purpose of this review paper is to present the available options for conservative and operative treatment and discuss the correct timing of intervention. Reported outcomes of current management and future prospects are also analysed. PMID:24967125

  14. Treatment Options for Brachial Plexus Injuries

    PubMed Central

    Sakellariou, Vasileios I.; Badilas, Nikolaos K.; Stavropoulos, Nikolaos A.; Mazis, George; Kotoulas, Helias K.; Kyriakopoulos, Stamatios; Tagkalegkas, Ioannis; Sofianos, Ioannis P.

    2014-01-01

    The incidence of brachial plexus injuries is rapidly growing due to the increasing number of high-speed motor-vehicle accidents. These are devastating injuries leading to significant functional impairment of the patients. The purpose of this review paper is to present the available options for conservative and operative treatment and discuss the correct timing of intervention. Reported outcomes of current management and future prospects are also analysed. PMID:24967125

  15. Fibromyalgia Pathogenesis and Treatment Options Update.

    PubMed

    Chinn, Steven; Caldwell, William; Gritsenko, Karina

    2016-03-01

    This review article presents and summarizes up-to-date literature on the clinical manifestations, diagnosis, pathophysiological mechanisms, and treatment options for fibromyalgia patients. First, the most recent diagnostic criteria for fibromyalgia, as put forth by the American College of Rheumatology will be summarized. Clinical features, including chronic widespread pain, hyperalgesia, mood disorders, anxiety, and disturbed sleep patterns will be explored in-depth. The pathogenesis and pathophysiology of fibromyalgia involves alterations in multiple ascending and descending central nervous system pathways, as well as peripheral pathways, leading to heightened pain sensitivity. Risk factors have been studied extensively, and the most recent research focuses on various genetic influences and the contributions of stress and poor sleep. Lastly, the discussion in this article focuses on treatment options for fibromyalgia; some have been mainstay options for many years. Pharmacological agents include tricyclic antidepressants, anti-epileptic drugs, selective serotonin reuptake inhibitors, norepinephrine/serotonin reuptake inhibitors, as well as some investigational agents. The evidence behind non-pharmacologic treatments, including massage therapy, exercise, and acupuncture, are discussed. PMID:26922414

  16. [Necessary and unnecessary treatment options for hemorrhoids].

    PubMed

    Zindel, Joel; Inglin, Roman; Brgger, Lukas

    2014-12-01

    Up to one third of the general population suffers from symptoms caused by hemorrhoids. Conservative treatment comes first unless the patient presents with an acute hemorrhoidal prolapse or a thrombosis. A fiber enriched diet is the primary treatment option, recommended in the perioperative period as well as a long-term prophylaxis. A timely limited application of topical ointments or suppositories and/or flavonoids are further treatment options. When symptoms persist interventional procedures for grade I-II hemorrhoids, and surgery for grade III-IV hemorrhoids should be considered. Rubber band ligation is the interventional treatment of choice. A comparable efficacy using sclerosing or infrared therapy has not yet been demonstrated. We therefore do not recommend these treatment options for the cure of hemorrhoids. Self-treatment by anal insertion of bougies is of lowrisk and may be successful, particularly in the setting of an elevated sphincter pressure. Anal dilation, sphincterotomy, cryosurgery, bipolar diathermy, galvanic electrotherapy, and heat therapy should be regarded as obsolete given the poor or missing data reported for these methods. For a long time, the classic excisional hemorrhoidectomy was considered to be the gold standard as far as surgical procedures are concerned. Primary closure (Ferguson) seems to be superior compared to the "open" version (Milligan Morgan) with respect to postoperative pain and wound healing. The more recently proposed stapled hemorrhoidopexy (Longo) is particularly advisable for circular hemorrhoids. Compared to excisional hemorrhoidectomy the Longo-operation is associated with reduced postoperative pain, shorter operation time and hospital stay as well as a faster recovery, with the disadvantage though of a higher recurrence rate. Data from Hemorrhoidal Artery Ligation (HAL)-, if appropriate in combination with a Recto-Anal Repair (HAL/RAR)-, demonstrates a similar trend towards a better tolerance of the procedure at the expense of a higher recurrence rate. These relatively "new" procedures equally qualify for the treatment of grade III and IV hemorrhoids, and, in the case of stapled hemorrhoidopexy, may even be employed in the emergency situation of an acute anal prolapse. While under certain circumstances different treatment options are equivalent, there is a clear specificity with respect to the application of those procedures in other situations. The respective pros and cons need to be discussed separately with every patient. According to their own requirements a treatment strategy has to be defined according to their individual requirements. PMID:25447089

  17. Chronic rhinosinusitis and emerging treatment options

    PubMed Central

    Piromchai, Patorn; Kasemsiri, Pornthep; Laohasiriwong, Supawan; Thanaviratananich, Sanguansak

    2013-01-01

    This review describes the epidemiology and various treatments in chronic rhinosinusitis (CRS) with nasal polyps (CRSwNP) and CRS without nasal polyps (CRSsNP). Evidence for short-term use of systemic corticosteroids has been shown to be favorable in CRSwNP, but still limited in CRSsNP. Topical corticosteroids improve symptom scores in both CRS subgroups. The role of microbes in CRS is still controversial. Culture-directed antibiotics are recommended for CRSsNP with exacerbation. Long-term use of low dosage antibiotics is recommended for CRSsNP for their anti-inflammatory effects. Other emerging treatment options are also discussed. PMID:23785241

  18. [New treatment options in chronic hepatitis B].

    PubMed

    Mondelli, Mario

    2008-03-01

    To date, four different nucleoside/nucleotide analogues are available in the treatment of chronic hepatitis B (CHB): lamivudine, adefovir dipivoxil and entecavir; telbivudine, a deoxythymidine analogue that specifically inhibits polymerase-DNA of HBV, approved by the European Medicines Agency (EMEA), has recently become obtainable in Italy. Lamivudine, the first antiviral drug to be used in the treatment of chronic hepatitis B, shows an excellent bioavailability, a virtual absence of significant adverse drug reactions, and a high efficacy in reducing the viral load. Such good pharmacological features are not paralleled by a high genetic barrier. Adefovir dipivoxil, a nucleotide analogue, is considered an effective alternative option to lamivudine, due to the better genetic barrier (almost 30 percent of resistant mutants after 5 years of treatment). However, at the therapeutic approved doses (10 mg/die), adefovir demonstrates sub-optimal efficacy in suppressing viral replication. By contrast, it has proved highly effective against viral strains resistant to lamivudine. Entecavir, the nucleoside analogue most recently introduced in Italy, exhibits a substantial inhibition of viral replication and a high genetic barrier both in naive patients (< 1% of resistant mutants after three years), and in patients resistant to lamivudine treatment. Telbivudine appears a new, promising antiviral agent, characterised by a rapid and sustained virologic response, together with a good genetic barrier. Its excellent tolerability and safety profile (FDA Pregnancy Category B), specific mechanism of activity (no activity against HIV) and efficacy characteristics make telbivudine a first choice therapeutic option for treatment of patients affected by CHB. PMID:18367877

  19. Emerging treatment options for meibomian gland dysfunction

    PubMed Central

    Qiao, Jing; Yan, Xiaoming

    2013-01-01

    Meibomian gland dysfunction (MGD) is one of the most common diseases observed in clinics; it influences a great number of people, and is the leading cause of evaporative dry eye. Given the increased recognition of the importance of MGD, a great amount of attention has been paid to therapies targeting this condition. The traditional treatments of MGD consist of warm compresses and lid hygiene for removing an obstructed meibum, as well as antibiotics and anti-inflammatory agents to improve the quality of the meibum. However, each of these treatments has a different shortcoming and the treatment of MGD remains challenging. Despite the numerous possible treatment options for MGD, it is still difficult to obtain complete relief of signs and symptoms. This review focuses on current emerging treatment options for MGD including intraductal meibomian gland probing, emulsion eye drops containing lipids, the LipiFlow® thermal pulsation system, N-acetyl-cysteine, azithromycin, oral supplementation with omega-3 essential fatty acids, and cyclosporine A. PMID:24043929

  20. Current treatment options for Dientamoeba fragilis infections.

    PubMed

    Nagata, Noriyuki; Marriott, Deborah; Harkness, John; Ellis, John T; Stark, Damien

    2012-12-01

    Dientamoeba fragilis belongs to the trichomonad group of protozoan parasites and it has been implicated as a cause of gastrointestinal disease with world-wide prevalences ranging from 0.5% to 16%. The majority of patients with dientamoebiasis present with gastrointestinal complaints. Chronic symptoms are common with up to a third of patients exhibiting persistent diarrhoea. Numerous studies have successfully demonstrated parasite clearance, coupled with complete resolution of clinical symptoms following treatment with various antiparasitic compounds. Treatments reported to be successful for dientamoebiasis include carbarsone, diphetarsone, tetracyclines, paromomycin, erythromycin, hydroxyquinolines and the 5-nitroimidazoles, including metronidazole, secnidazole, tinidazole and ornidazole. It is of note that most current treatment data is based only on small number of case reports. No large scale double blind randomised placebo controlled trials testing the efficacy of antimicrobial agents against D. fragilis has been undertaken highlighting the need for further study. In addition there is very little in vitro susceptibility data available for the organism making some current treatment options questionable. The aim of this review is to critically discuss all treatment options currently available for dientamoebiasis. PMID:24533282

  1. Current treatment options for Dientamoeba fragilis infections

    PubMed Central

    Nagata, Noriyuki; Marriott, Deborah; Harkness, John; Ellis, John T.; Stark, Damien

    2012-01-01

    Dientamoeba fragilis belongs to the trichomonad group of protozoan parasites and it has been implicated as a cause of gastrointestinal disease with world-wide prevalences ranging from 0.5% to 16%. The majority of patients with dientamoebiasis present with gastrointestinal complaints. Chronic symptoms are common with up to a third of patients exhibiting persistent diarrhoea. Numerous studies have successfully demonstrated parasite clearance, coupled with complete resolution of clinical symptoms following treatment with various antiparasitic compounds. Treatments reported to be successful for dientamoebiasis include carbarsone, diphetarsone, tetracyclines, paromomycin, erythromycin, hydroxyquinolines and the 5-nitroimidazoles, including metronidazole, secnidazole, tinidazole and ornidazole. It is of note that most current treatment data is based only on small number of case reports. No large scale double blind randomised placebo controlled trials testing the efficacy of antimicrobial agents against D. fragilis has been undertaken highlighting the need for further study. In addition there is very little in vitro susceptibility data available for the organism making some current treatment options questionable. The aim of this review is to critically discuss all treatment options currently available for dientamoebiasis. PMID:24533282

  2. Evolving treatment options for melanoma brain metastases.

    PubMed

    Ajithkumar, Thankamma; Parkinson, Christine; Fife, Kate; Corrie, Pippa; Jefferies, Sarah

    2015-10-01

    Melanoma is a leading cause of lost productivity due to premature cancer mortality. Melanoma frequently spreads to the brain and is associated with rapid deterioration in quality and quantity of life. Until now, treatment options have been restricted to surgery and radiotherapy, although neither modality has been well studied in clinical trials. However, the new immune checkpoint inhibitors and molecularly targeted agents that have been introduced for treatment of metastatic melanoma are active against brain metastases and offer new opportunities to improve disease outcomes. New challenges arise, including how to integrate or sequence multiple treatment modalities, and current practice varies widely. In this Review, we summarise evidence for the treatment of melanoma brain metastases, and discuss the rationale and evidence for combination modalities, highlighting areas for future research. PMID:26433822

  3. [Options in the treatment of hepatic encephalopathy].

    PubMed

    Petersen, Karl-Uwe

    2015-05-01

    Hepatic encephalopathy is a result of insufficient liver function, with grave consequences for the patients. It is primarily caused by disturbed hepatic elimination of the neurotoxin, ammonia (NH3). Aside from dietetic measures, treatment rests on drugs designed to reduce the NH3 burden. The primary options, lactulose and the practically unabsorbable antibiotic rifaximin are suitable to decrease the bacterial NH3 generation in the intestine. Other antibiotics like neomycin at best have a place in acute treatment. L-ornithine-L-aspartate (LOLA) and branched-chain amino acids (valine, leucine, isoleucine) aim at supporting the scavenge of NH3 in glutamine; however, the final balance of this pathway is unfavourable. In addition, the constituents of LOLA enhance the capacity of the urea cycle and, ultimately, the elimination of NH3. As the evidence from available studies--is not unequivocal in each case, the current place of LOLA in treatment is that of an option for patients, who do not respond to standard therapy. PMID:26364405

  4. Treatment in juvenile rheumatoid arthritis and new treatment options

    PubMed Central

    Kasapopur, zgr; Barut, Kenan

    2015-01-01

    Juvenile idiopathic arthritis (JIA) is the most common chronic rheumatic disease of the childhood with the highest risk of disability. Active disease persists in the adulthood in a significant portion of children with juvenile rheumatoid arthritis despite many developments in the diagnosis and treatment. Therefore, initiation of efficient treatment in the early period of the disease may provide faster control of the inflammation and prevention of long-term harms. In recent years, treatment options have also increased in children with juvenile idiopathic arthritis owing to biological medications. All biological medications used in children have been produced to target the etiopathogenesis leading to disease including anti-tumor necrosis factor, anti-interleukin 1 and anti-interleukin 6 drugs. In this review, scientific data about biological medications used in the treatment of rheumatoid arthritis and new treatment options will be discussed. PMID:26078691

  5. Non-surgical cosmetic procedures: older women's perceptions and experiences.

    PubMed

    Hurd Clarke, Laura; Repta, Robin; Griffin, Meridith

    2007-01-01

    This paper analyzes findings from in-depth interviews with 44 women aged 50-70 regarding their perceptions of and experiences with non-surgical cosmetic procedures such as Botox injections, laser hair removal, chemical peels, microdermabrasion, and injectable fillers. While 21 of the women had used a range of non-surgical cosmetic procedures, 23 women had not. The data are discussed in light of feminist theorizing on cosmetic surgery which has tended to ignore the experiences of older women and has been divided in terms of the portrayal of cosmetic surgery as either oppressive or liberating. We found that some of the women used the procedures to increase their physical attractiveness and self-esteem, others viewed the procedures as excessively risky, and still others argued that the procedures stemmed from the social devaluation of later life. Treatments that involved the alteration of the surface of the body tended to be viewed as less risky than the injection of foreign substances into the body. PMID:18032254

  6. Triaging early-stage lung cancer patients into non-surgical pathways: who, when, and what?

    PubMed Central

    Kong, Feng-Ming (Spring)

    2015-01-01

    More lung cancer patients are being diagnosed at an earlier stage due to improved diagnostic imaging techniques, a trend that is expected to accelerate with the dissemination of lung cancer screening. Surgical resection has always been considered the standard treatment for patients with early-stage non-small cell lung cancer (NSCLC). However, non-surgical treatment options for patients with early-stage NSCLC have evolved significantly over the past decade with many new and exciting alternative treatments now available. These alternative treatments include radiofrequency ablation (RFA), microwave ablation (MWA), percutaneous cryoablation therapy (PCT), photodynamic therapy (PDT) and external beam radiation therapy (EBRT), including stereotactic body radiation therapy (SBRT) and accelerated hypofractionated radiation therapy. We describe the established alternatives to surgical resection, their advantages and disadvantages, potential complications and efficacy. We then describe the optimal treatment approach for patients with early-stage NSCLC based on tumor operability, size and location. Finally, we discuss future directions and whether any alternative therapies will challenge surgical resection as the treatment of choice for patients with operable early-stage lung cancer. PMID:26380185

  7. A safe treatment option for esophageal bezoars

    PubMed Central

    Yaqub, Sheraz; Shafique, Muhammad; Kjæstad, Erik; Thorsen, Yngve; Lie, Erik S.; Dahl, Vegard; Bakka, Njål; Røkke, Ola

    2012-01-01

    INTRODUCTION Bezoar in the esophagus is a rare condition and associated with structural or functional abnormalities of the esophagus. Endoscopy is the main tool for diagnosis and treatment for bezoar in the esophagus. PRESENTATION OF CASE Here we present a case where an endoscopic evacuation of an esophageal bezoar was unsuccessful. We treated the bezoar through a nasogastric tube using a cocktail composed of pancreatic enzymes dissolved in Coca-Cola. DISCUSSION Endoscopy is regarded as the mainstay for the diagnosis and treatment of esophageal bezoars. However, when this approach fails, other treatment options include dissolution therapy, and surgical exploration and removal of the bezoar. Surgical removal of an esophageal bezoar is associated with a high risk of morbidity and mortality. We advocate that dissolving therapy should be the first choice of treatment when endoscopic evacuation is not possible. CONCLUSION This is the first report describing a successful treatment of an esophageal bezoar with a cocktail of Coca-Cola and pancreatic enzymes. It is an effective, inexpensive, and worldwide available treatment and should be considered when endoscopic evacuation fails. PMID:22609703

  8. Minimally invasive treatment options in fixed prosthodontics.

    PubMed

    Edelhoff, Daniel; Liebermann, Anja; Beuer, Florian; Stimmelmayr, Michael; Güth, Jan-Frederik

    2016-01-01

    Minimally invasive treatment options have become increasingly feasible in restorative dentistry, due to the introduction of the adhesive technique in combination with restorative materials featuring translucent properties similar to those of natural teeth. Mechanical anchoring of restorations via conventional cementation represents a predominantly subtractive treatment approach that is gradually being superseded by a primarily defect-oriented additive method in prosthodontics. Modifications of conventional treatment procedures have led to the development of an economical approach to the removal of healthy tooth structure. This is possible because the planned treatment outcome is defined in a wax-up before the treatment is commenced and this wax-up is subsequently used as a reference during tooth preparation. Similarly, resin- bonded FDPs and implants have made it possible to preserve the natural tooth structure of potential abutment teeth. This report describes a number of clinical cases to demonstrate the principles of modern prosthetic treatment strategies and discusses these approaches in the context of minimally invasive prosthetic dentistry. PMID:26925471

  9. Treatment options for polycystic ovary syndrome

    PubMed Central

    Badawy, Ahmed; Elnashar, Abubaker

    2011-01-01

    Polycystic ovary syndrome (PCOS) is the most common endocrine disorder in women. The clinical manifestation of PCOS varies from a mild menstrual disorder to severe disturbance of reproductive and metabolic functions. Management of women with PCOS depends on the symptoms. These could be ovulatory dysfunction-related infertility, menstrual disorders, or androgen-related symptoms. Weight loss improves the endocrine profile and increases the likelihood of ovulation and pregnancy. Normalization of menstrual cycles and ovulation could occur with modest weight loss as little as 5% of the initial weight. The treatment of obesity includes modifications in lifestyle (diet and exercise) and medical and surgical treatment. In PCOS, anovulation relates to low follicle-stimulating hormone concentrations and the arrest of antral follicle growth in the final stages of maturation. This can be treated with medications such as clomiphene citrate, tamoxifen, aromatase inhibitors, metformin, glucocorticoids, or gonadotropins or surgically by laparoscopic ovarian drilling. In vitro fertilization will remain the last option to achieve pregnancy when others fail. Chronic anovulation over a long period of time is also associated with an increased risk of endometrial hyperplasia and carcinoma, which should be seriously investigated and treated. There are androgenic symptoms that will vary from patient to patient, such as hirsutism, acne, and/or alopecia. These are troublesome presentations to the patients and require adequate treatment. Alternative medicine has been emerging as one of the commonly practiced medicines for different health problems, including PCOS. This review underlines the contribution to the treatment of different symptoms. PMID:21339935

  10. ARSENIC REMOVAL TREATMENT OPTIONS FOR SINGLE FAMILY HOMES

    EPA Science Inventory

    The presentation provides information on POU and POE arsenic removal drinking water treatment systems. The presentation provides information on the arsenic rule, arsenic chemistry and arsenic treatment. The arsenic treatment options proposed for POU and POE treatment consist prim...

  11. Investigational treatment options in microscopic colitis.

    PubMed

    Madisch, Ahmed; Morgner, Andrea; Stolte, Manfred; Miehlke, Stephan

    2008-12-01

    Collagenous and lymphocytic colitis are the two recognized major presentations of microscopic colitis. Both diseases present with chronic watery diarrhea and a chronic inflammatory infiltrate in the colonic mucosa without specific endoscopic abnormalities, and hence diagnosis is established by histology. Recent epidemiological studies suggest that microscopic colitis may affect as many patients as Crohn's disease or ulcerative colitis. The cause of these diseases is unknown; however, several lines of evidence support the hypothesis of mucosal injury from an unknown agent in the fecal stream. Due to the lack of disease causality, therapeutic management of microscopic colitis is now directed primarily at symptoms' resolution or improvement. Based on current evidence, oral budesonide represents an effective treatment option for patients with microscopic colitis to achieve and maintain remission. Other anti-inflammatory drugs such as mesalazine or bismuth subsalicylate are now under evaluation. The optimal long-term management strategy of microscopic colitis, however, remains an unsolved issue. PMID:19012499

  12. [Health anxiety - increased knowledge and treatment options].

    PubMed

    Davidsdottir, Soley Drofn; Sveinsson, Olafur Arni

    2010-12-01

    Patients with hypochondriasis are preoccupied with the fear or belief that they have a serious, undiagnosed disease. This concern derives from misinterpretations of benign physical sensations, and persists despite appropriate reassurance to the contrary. They have, on average, disproportionately high rates of visits to physicians, specialty consultations, laboratory tests, and surgical procedures, as well as high health care costs. Despite this extensive medical attention, they find their care unsatisfactory, which is understandable, as convincing alternative explanations to their ailments are repeatedly delayed. Physicians, in turn, may feel discouraged and frustrated in relation to these individuals where their best efforts to help often prove ineffective or are even rejected. Recent scientific studies have shown that cognitive behavioural therapy (CBT) and selective serotonin reuptake inhibitors (SSRI) are effective treatment options for health anxiety as demonstrated in clinical trials. PMID:21149871

  13. Autogenous Tooth Transplantation as a Treatment Option

    PubMed Central

    Aggarwal, Rashmi; Chugh, Vinay Kumar; Wadhwa, Puneet; Kohli, Munish

    2012-01-01

    ABSTRACT Autogenous tooth transplantation is the surgical movement of a tooth from one location in the mouth to another in the same individual. Though done for years but it has achieved variable success rates. Although the indications for autotransplantation are narrow, careful patient selection coupled with an appropriate technique can lead to exceptional esthetic and functional results. This article discusses the reviews of previous works done and highlights the criteria and factors influencing the success of autotransplant along with reports of two cases of transplantation of impacted and malposed canine. How to cite this article: Chugh A, Aggarwal R, Chugh VK, Wadhwa P, Kohli M. Autogenous Tooth Transplantation as a Treatment Option. Int J Clin Pediatr Dent 2012;5(1):87-92. PMID:25206143

  14. Therapeutic options for treatment-resistant depression.

    PubMed

    Shelton, Richard C; Osuntokun, Olawale; Heinloth, Alexandra N; Corya, Sara A

    2010-02-01

    Treatment-resistant depression (TRD) presents major challenges for both patients and clinicians. There is no universally accepted definition of TRD, but results from the US National Institute of Mental Health's (NIMH) STAR*D (Sequenced Treatment Alternatives to Relieve Depression) programme indicate that after the failure of two treatment trials, the chances of remission decrease significantly. Several pharmacological and nonpharmacological treatments for TRD may be considered when optimized (adequate dose and duration) therapy has not produced a successful outcome and a patient is classified as resistant to treatment. Nonpharmacological strategies include psychotherapy (often in conjunction with pharmacotherapy), electroconvulsive therapy and vagus nerve stimulation. The US FDA recently approved vagus nerve stimulation as adjunctive therapy (after four prior treatment failures); however, its benefits are seen only after prolonged (up to 1 year) use. Other nonpharmacological options, such as repetitive transcranial stimulation, deep brain stimulation or psychosurgery, remain experimental and are not widely available. Pharmacological treatments of TRD can be grouped in two main categories: 'switching' or 'combining'. In the first, treatment is switched within and between classes of compounds. The benefits of switching include avoidance of polypharmacy, a narrower range of treatment-emergent adverse events and lower costs. An inherent disadvantage of any switching strategy is that partial treatment responses resulting from the initial treatment might be lost by its discontinuation in favour of another medication trial. Monotherapy switches have also been shown to have limited effectiveness in achieving remission. The advantage of combination strategies is the potential to build upon achieved improvements; they are generally recommended if partial response was achieved with the current treatment trial. Various non-antidepressant augmenting agents, such as lithium and thyroid hormones, are well studied, although not commonly used. There is also evidence of efficacy and increasing use of atypical antipsychotics in combination with antidepressants, for example, olanzapine in combination with fluoxetine (OFC) or augmentation with aripiprazole. The disadvantages of a combination strategy include multiple medications, a broader range of treatment-emergent adverse events and higher costs. Several experimental pharmaceutical treatment alternatives for TRD are also being explored in combination with antidepressants or as monotherapy. These less studied alternative compounds include pindolol, inositol, CNS stimulants, hormones, herbal supplements, omega-3 fatty acids, S-adenosyl-L-methionine, folic acid, lamotrigine, modafinil, riluzole and topiramate. In summary, despite an increasing variety of choices for the treatment of TRD, this condition remains universally undefined and represents an area of unmet medical need. There are few known approved pharmacological agents for TRD (aripiprazole and OFC) and overall outcomes remain poor. This might be an indication that depression itself is a heterogeneous condition with a great diversity of pathologies, highlighting the need for careful evaluation of individuals with depressive symptoms who are unresponsive to treatment. Clearly, more research is needed to provide clinicians with better guidance in making those treatment decisions--especially in light of accumulating evidence that the longer patients are unsuccessfully treated, the worse their long-term prognosis tends to be. PMID:20088620

  15. EVALUATION OF ON-SITE WASTEWATER TREATMENT AND DISPOSAL OPTIONS

    EPA Science Inventory

    A literature review of published and unpublished data was conducted to identify all conceivable alternative on-site systems, including wastewater manipulation, treatment and disposal options. Wastewater manipulation options included flow reduction, wasteload reduction and waste s...

  16. Lung cancer: Biology and treatment options.

    PubMed

    Lemjabbar-Alaoui, Hassan; Hassan, Omer Ui; Yang, Yi-Wei; Buchanan, Petra

    2015-12-01

    Lung cancer remains the leading cause of cancer mortality in men and women in the U.S. and worldwide. About 90% of lung cancer cases are caused by smoking and the use of tobacco products. However, other factors such as radon gas, asbestos, air pollution exposures, and chronic infections can contribute to lung carcinogenesis. In addition, multiple inherited and acquired mechanisms of susceptibility to lung cancer have been proposed. Lung cancer is divided into two broad histologic classes, which grow and spread differently: small-cell lung carcinomas (SCLCs) and non-small cell lung carcinomas (NSCLCs). Treatment options for lung cancer include surgery, radiation therapy, chemotherapy, and targeted therapy. Therapeutic-modalities recommendations depend on several factors, including the type and stage of cancer. Despite the improvements in diagnosis and therapy made during the past 25 years, the prognosis for patients with lung cancer is still unsatisfactory. The responses to current standard therapies are poor except for the most localized cancers. However, a better understanding of the biology pertinent to these challenging malignancies, might lead to the development of more efficacious and perhaps more specific drugs. The purpose of this review is to summarize the recent developments in lung cancer biology and its therapeutic strategies, and discuss the latest treatment advances including therapies currently under clinical investigation. PMID:26297204

  17. Overactive bladder syndrome pharmacotherapy: future treatment options

    PubMed Central

    2015-01-01

    Overactive bladder syndrome (OAB) is a lifestyle disease and its incidence increases with age. Although it is not a life-threatening disease, it is known to have a significant impact on the quality of life. The first-choice pharmacological treatment of OAB is antimuscarinics. However, their limited clinical effectiveness and unsatisfactory tolerance profile, combined with the advancement of knowledge on the aetiopathogenesis of the disease, have inspired research on new pharmacotherapy options for OAB. Basic research has provided foundations for the development of new OAB treatments, which seem very promising and can be applied in clinical practice. The mechanisms of the studied compounds are based on their effect on certain receptors and neurotransmitters that contribute to regulating the micturition reflex. These compounds are not only more receptor-specific as compared to currently used drugs, but also some of them are organ-specific. Some of such compounds have already passed the proof-of-concept stage of development and have the therapeutic potential to determine the future of OAB pharmacotherapy. This review focuses on the mechanisms of substances that are now undergoing pre-clinical and clinical tests and their effects on the micturition cycle, while also identifying opportunities for using them with specific groups of patients. Due to the fact that OAB is a disease of symptoms and its aetiopathogenesis is complex, it seems that modern treatment methods should be tailor-made and based on the pathophysiological mechanisms that induce disease symptoms, rather than only treating the symptoms by inhibiting the contractility of the urinary bladder. PMID:26848291

  18. College Student Receptiveness to Various Alcohol Treatment Options

    ERIC Educational Resources Information Center

    Epler, Amee J.; Sher, Kenneth J.; Loomis, Tiffany B.; O'Malley, Stephanie S.

    2009-01-01

    Objective: Heavy episodic drinking remains a significant problem on college campuses. Although most interventions for college students are behavioral, pharmacological treatments, such as naltrexone, could provide additional options. Participants: The authors evaluated receptivity to various alcohol treatment options in a general population of

  19. Treatment Options for Myelodysplastic/Myeloproliferative Neoplasms

    MedlinePLUS

    ... Myeloproliferative Neoplasms Treatment Myelodysplastic/ Myeloproliferative Neoplasms Treatment Myelodysplastic/ Myeloproliferative Neoplasms Treatment–Patient Version (PDQ®) General Information About Myelodysplastic/ ...

  20. Treatment Option Overview (Myelodysplastic/Myeloproliferative Neoplasms)

    MedlinePLUS

    ... Myeloproliferative Neoplasms Treatment Myelodysplastic/ Myeloproliferative Neoplasms Treatment Myelodysplastic/ Myeloproliferative Neoplasms Treatment–Patient Version (PDQ®) General Information About Myelodysplastic/ ...

  1. Sacroiliac Joint Fusion Using Triangular Titanium Implants vs. Non-Surgical Management: Six-Month Outcomes from a Prospective Randomized Controlled Trial

    PubMed Central

    Whang, Peter; Polly, David; Frank, Clay; Lockstadt, Harry; Glaser, John; Limoni, Robert; Sembrano, Jonathan

    2015-01-01

    Background Sacroiliac (SI) joint pain is a prevalent, underdiagnosed cause of lower back pain. SI joint fusion can relieve pain and improve quality of life in patients who have failed nonoperative care. To date, no study has concurrently compared surgical and non-surgical treatments for chronic SI joint dysfunction. Methods We conducted a prospective randomized controlled trial of 148 subjects with SI joint dysfunction due to degenerative sacroiliitis or sacroiliac joint disruptions who were assigned to either minimally invasive SI joint fusion with triangular titanium implants (N=102) or non-surgical management (NSM, n=46). SI joint pain scores, Oswestry Disability Index (ODI), Short-Form 36 (SF-36) and EuroQol-5D (EQ-5D) were collected at baseline and at 1, 3 and 6 months after treatment commencement. Six-month success rates, defined as the proportion of treated subjects with a 20-mm improvement in SI joint pain in the absence of severe device-related or neurologic SI joint-related adverse events or surgical revision, were compared using Bayesian methods. Results Subjects (mean age 51, 70% women) were highly debilitated at baseline (mean SI joint VAS pain score 82, mean ODI score 62). Six-month follow-up was obtained in 97.3%. By 6 months, success rates were 81.4% in the surgical group vs. 23.9% in the NSM group (difference of 56.6%, 95% posterior credible interval 41.4-70.0%, posterior probability of superiority >0.999). Clinically important (≥15 point) ODI improvement at 6 months occurred in 75% of surgery subjects vs. 27.3% of NSM subjects. At six months, quality of life improved more in the surgery group and satisfaction rates were high. The mean number of adverse events in the first six months was slightly higher in the surgical group compared to the non-surgical group (1.3 vs. 1.0 events per subject, p=0.1857). Conclusions Six-month follow-up from this level 1 study showed that minimally invasive SI joint fusion using triangular titanium implants was more effective than non-surgical management in relieving pain, improving function and improving quality of life in patients with SI joint dysfunction due to degenerative sacroiliitis or SI joint disruptions. Clinical relevance Minimally invasive SI joint fusion is an acceptable option for patients with chronic SI joint dysfunction due to degenerative sacroiliitis and sacroiliac joint disruptions unresponsive to non-surgical treatments. PMID:25785242

  2. Salivary Visfatin Concentration in Response to Non-surgical Periodontal Therapy

    PubMed Central

    Tabari, Zahra Alizadeh; Azadmehr, Abbas; Nohekhan, Ali; Tabrizi, Mohammad Amir Alizadeh; Ardakani, Mohammad Reza Talebi; Naddafpour, Nima

    2015-01-01

    Introduction: Visfatin is a pro-inflammatory cytokine that has been associated with several immunomodulating processes. The relationship between visfatin and periodontitis has been the subject of a few studies that have described visfatin as an inflammatory marker for periodontitis. However, studies on visfatin as a potential therapeutic target in periodontal diseases are scarce. In the present study, we evaluated the alterations in salivary visfatin levels in response to non-surgical periodontal treatment. Materials and Methods: Twenty individuals with moderate to severe chronic periodontitis and twenty periodontally healthy individuals were selected for this study according to clinical parameters. Patients with chronic periodontitis were treated by non-surgical periodontal therapy. Clinical parameters were recorded and saliva samples were obtained from the control group and test group before (T1 group) and one month after periodontal treatment (T2 group). Salivary visfatin concentrations were measured by standard enzyme-linked immunosorbent assay (ELISA). Statistical analysis was performed with the statistical software SPSS, version 18. Results: Visfatin was detectable in all samples. T1 and control groups were significantly different in terms of clinical parameters and visfatin levels. Visfatin concentrations were reduced significantly after non-surgical periodontal therapy. Periodontal treatment also resulted in significant reductions of all clinical parameters with the exception of clinical attachment level. Conclusion: The results demonstrated that salivary levels of visfatin are reduced after non-surgical periodontal therapy to the levels comparable with those found in healthy individuals. Therefore, the salivary visfatin level may have the potential to be a target marker for assessment of responses to non-surgical periodontal therapy. However, more studies with larger sample sizes are necessary to validate these findings. PMID:26023633

  3. Treatment Options for Hairy Cell Leukemia

    MedlinePLUS

    ... Childhood ALL Treatment Childhood AML Treatment Research Hairy Cell Leukemia Treatment–Patient Version (PDQ®) General Information About Hairy Cell Leukemia Key Points Hairy cell leukemia is a ...

  4. Therapeutic options in the treatment of benign prostatic hyperplasia

    PubMed Central

    Sandhu, Jaspreet S

    2009-01-01

    Current theraputic options for the treatment of symptomatic benign prostatic hyperplasia (BPH) are reviewed. Therapeutic options for mild lower urinary tract symptoms (LUTS), as defined by the American Urological Association, are generally treated medically. Moderate to severe LUTS can be treated medically or with surgical therapy. Current medical and surgical treatments for LUTS secondary to BPH are reviewed and evolving treatments are explored. PMID:19936164

  5. Current and future treatment options in SIADH

    PubMed Central

    Zietse, Robert; van der Lubbe, Nils; Hoorn, Ewout J.

    2009-01-01

    The treatment of hyponatraemia due to SIADH is not always as straightforward as it seems. Although acute treatment with hypertonic saline and chronic treatment with fluid restriction are well established, both approaches have severe limitations. These limitations are not readily overcome by addition of furosemide, demeclocycline, lithium or urea to the therapy. In theory, vasopressin-receptor antagonists would provide a more effective method to treat hyponatraemia, by virtue of their ability to selectively increase solute-free water excretion by the kidneys (aquaresis). In this review we explore the limitations of the current treatment of SIADH and describe emerging therapies for the treatment of SIADH-induced hyponatraemia. PMID:19881932

  6. Understanding Bone Marrow Transplantation as a Treatment Option

    MedlinePLUS

    ... icio.us Digg Facebook Google Bookmarks Understanding Transplantation as a Treatment Option When you are diagnosed with a ... Transplant Talking with Your Doctor Diseases Treatable with a Bone Marrow Transplant or Cord Blood Transplant A ...

  7. For Some Breast Cancers, New Drug May Be Treatment Option

    Cancer.gov

    Results from an international clinical trial suggest that women with metastatic, HER2-positive breast cancer that is no longer responding to the targeted therapy trastuzumab (Herceptin) may soon have a new treatment option.

  8. Treatment Options by Stage (Anal Cancer)

    MedlinePLUS

    ... tumors, not anal cancer . Being infected with the human papillomavirus (HPV) increases the risk of developing anal ... bag is attached to the stoma. Having the human immunodeficiency virus can affect treatment of anal cancer. ...

  9. Treatment Options by Stage (Testicular Cancer)

    MedlinePLUS

    ... New types of treatment are being tested in clinical trials. Information about clinical trials is available from ... want to think about taking part in a clinical trial. For some patients, taking part in a ...

  10. Opioid Dependence Treatment: Options In Pharmacotherapy

    PubMed Central

    Stotts, Angela L.; Dodrill, Carrie L.; Kosten, Thomas R.

    2010-01-01

    The development of effective treatments for opioid dependence is of great importance given the devastating consequences of the disease. Pharmacotherapies for opioid addiction include opioid agonists, partial agonists, opioid antagonists, and alpha-2-adrenergic agonists, which are targeted toward either detoxification or long-term agonist maintenance. Agonist maintenance therapy is currently the recommended treatment for opioid dependence due to its superior outcomes relative to detoxification. Detoxification protocols have limited long term efficacy and patient discomfort remains a significant therapy challenge. Buprenorphines effectiveness relative to methadone remains a controversy and may be most appropriate for patients in need of low doses of agonist treatment. Buprenorphine appears superior to alpha-2 agonists, however, and office-based treatment with buprenorphine in the US is gaining support. Studies of sustained-release formulations of naltrexone suggest improved effectiveness for retention and sustained abstinence, however, randomized clinical trials are needed. PMID:19538000

  11. Treatment Option Overview (Extragonadal Germ Cell Tumors)

    MedlinePLUS

    ... Professional Extragonadal Germ Cell Tumors Treatment Extragonadal Germ Cell Tumors Treatment–Patient Version (PDQ®) General Information About Extragonadal Germ Cell Tumors Key Points Extragonadal germ cell tumors form ...

  12. Treatment Options by Stage (Salivary Gland Cancer)

    MedlinePLUS

    ... does not go away. Tests that examine the head, neck, and the inside of the mouth are used ... team of doctors who are experts in treating head and neck cancer. Your treatment will be overseen by a ...

  13. Treatment Option Overview (Salivary Gland Cancer)

    MedlinePLUS

    ... does not go away. Tests that examine the head, neck, and the inside of the mouth are used ... team of doctors who are experts in treating head and neck cancer. Your treatment will be overseen by a ...

  14. Treatment Option Overview (Carcinoma of Unknown Primary)

    MedlinePLUS

    ... Diagnosed Carcinoma of Unknown Primary Cervical (Neck) Lymph Nodes Cancer found in cervical (neck) lymph nodes may ... Cancer Treatment for more information. Isolated Axillary Lymph Node Metastasis Cancer found only in the axillary (armpit) ...

  15. Treatment Options for Childhood Brain Stem Glioma

    MedlinePLUS

    ... than usual. Changes in behavior. Trouble learning in school. Tests that examine the brain are used to ... Radiation therapy is a cancer treatment that uses high-energy x-rays or other types of radiation ...

  16. Treatment Option Overview (Primary CNS Lymphoma)

    MedlinePLUS

    ... therapy Steroids are hormones made naturally in the body. They can also be made in a laboratory and used as drugs. Glucocorticoids are steroid drugs that have an anticancer effect in lymphomas . New types of treatment are being ...

  17. Treatment Options for Primary CNS Lymphoma

    MedlinePLUS

    ... therapy Steroids are hormones made naturally in the body. They can also be made in a laboratory and used as drugs. Glucocorticoids are steroid drugs that have an anticancer effect in lymphomas . New types of treatment are being ...

  18. Treatment Options by Stage (Oropharyngeal Cancer)

    MedlinePLUS

    ... adjuvant therapy . New types of surgery, including transoral robotic surgery , are being studied for the treatment of oropharyngeal cancer. Transoral robotic surgery may be used to remove cancer from ...

  19. Treatment Options for Pancreatic Neuroendocrine Tumors

    MedlinePLUS

    ... pump inhibitor drugs such as omeprazole , lansoprazole , or pantoprazole. Histamine blocking drugs such as cimetidine , ranitidine, or ... with drugs taken by mouth or insulin by injection . New types of treatment are being tested in ...

  20. Patellofemoral pain: epidemiology, pathophysiology, and treatment options.

    PubMed

    Rothermich, Marcus A; Glaviano, Neal R; Li, Jiacheng; Hart, Joe M

    2015-04-01

    Patients with anterior knee pain present a complex and common problem to health care providers. The diagnosis and treatment of these patients often involve a comprehensive evaluation that includes assessing the chronicity of the pain, the specific location of the complaint, and the previous treatment modalities attempted by the patient. This common diagnosis includes a wide variety of different pathologic abnormalities that can be present independently or concomitantly and cause a spectrum of disabilities for the patient. PMID:25818716

  1. Narcolepsy: current treatment options and future approaches.

    PubMed

    Billiard, Michel

    2008-06-01

    The management of narcolepsy is presently at a turning point. Three main avenues are considered in this review: 1) Two tendencies characterize the conventional treatment of narcolepsy. Modafinil has replaced methylphenidate and amphetamine as the first-line treatment of excessive daytime sleepiness (EDS) and sleep attacks, based on randomized, double blind, placebo-controlled clinical trials of modafinil, but on no direct comparison of modafinil versus traditional stimulants. For cataplexy, sleep paralysis, and hypnagogic hallucinations, new antidepressants tend to replace tricyclic antidepressants and selective serotonin reuptake inhibitors (SSRIs) in spite of a lack of randomized, double blind, placebo-controlled clinical trials of these compounds; 2) The conventional treatment of narcolepsy is now challenged by sodium oxybate, the sodium salt of gammahydroxybutyrate, based on a series of randomized, double-blind, placebo-controlled clinical trials and a long-term open label study. This treatment has a fairly good efficacy and is active on all symptoms of narcolepsy. Careful titration up to an adequate level is essential both to obtain positive results and avoid adverse effects; 3) A series of new treatments are currently being tested, either in animal models or in humans, They include novel stimulant and anticataplectic drugs, endocrine therapy, and, more attractively, totally new approaches based on the present state of knowledge of the pathophysiology of narcolepsy with cataplexy, hypocretine-based therapies, and immunotherapy. PMID:18830438

  2. Non-surgical abortion: who's for methotrexate?

    PubMed

    Potts, M

    1995-09-01

    When offered a choice of abortion through surgery or treatment with RU486, 60-70% of women choose RU486. Use of RU486 is, however, limited by the cost of the drug and the conservative marketing policy of Roussel Uclaf, holders of the patent. Methotrexate is a drug registered in many countries for several indications, including cancer therapy and psoriasis. In 1993, Creinin and Darney described its use as an abortifacient. Methotrexate when combined with prostaglandins works almost as well as mifepristone (RU486). It is inexpensive, off patent, and readily available in many parts of the world. Moreover, the US Food and Drug Administration has no jurisdiction over the off-label use of methotrexate as an abortifacient and an investigational new drug application is not required. Early trials to determine dosage are now being followed by larger studies of efficacy and side-effects. All of the experimental protocols have used a similar dosage regimen of methotrexate (approximately 80 mg) given intramuscularly, followed by 800 mcg of misoprostol per vagina 5-7 days later. Used before 56-63 days after the last menstruation, the regimen is 88-97% effective, and before 42 days methotrexate may be effective without misoprostol. Uterine emptying can take as long as two weeks and the decidua must be shed spontaneously, as with a spontaneous abortion. Even so, 90% of study participants reported that they would choose the method again if needed. Some investigators use a second dose of misoprostol, while the one in twenty aspiration procedures which seem to be needed with methotrexate abortion could be carried out as for any other minor operation by a trained person. Methotrexate together with the misoprostol costs less than US$7.00, even in the US. The author notes that while methotrexate is teratogenic in animals, and use before conception has been associated with spina bifida, use after conception has not been shown to be harmful and there in reassuring evidence of no long-term adverse effects upon subsequent pregnancies. PMID:7658816

  3. [Myocarditis and inflammatory cardiomyopathy - current treatment options].

    PubMed

    Tschpe, Carsten; Khl, Uwe

    2016-01-01

    Myocarditis is a cardiac inflammatory disease mainly caused by autoimmune processes and/or viral infections. Despite the advances of non-invasive diagnostic tests, endomyocardial biopsies (EMBs) remains the gold standard diagnostic technique for myocarditis and inflammatory cardiomyopathy. If the immune response fails to eliminate the infectious agent or inflammatory process does not resolve, only EMB can elucidate the cause and the status of the disease. Such tissue analyses are the prerequisite for an initiation of a specific antiviral or an anti-inflammatory treatment in addition to basic heart failure therapy. Other conditions such as giant cell myocarditis or cardiac sarcoidosis benefit from an anti-inflammatory treatment during the acute phase, so EMB has an important role both in acute and chronic settings. Despite the promising results with immunosuppressive or antiviral therapy in specific clinical scenarios according to published data, larger randomized studies are warranted in order to detect the effect of these treatments in strong clinical endpoints. PMID:26800069

  4. Treatment options for Duchenne muscular dystrophy.

    PubMed

    Ciafaloni, Emma; Moxley, Richard T

    2008-03-01

    The main goal in the treatment of Duchenne muscular dystrophy (DMD) is to maintain ambulation for as long as possible and to anticipate and manage the associated complications, such as joint contractures, scoliosis, cardiomyopathy, respiratory insufficiency, and weight gain. Cognitive and behavioral symptoms occur in about one third of patients, and it is important to recognize and manage them promptly, developing an individualized plan at school and at home to maximize the patient's cognitive abilities. In the late phase of the disease, palliative care is of paramount importance. Corticosteroid therapy (prednisone and deflazacort) is the only effective pharmacologic treatment for DMD. Daily prednisone treatment increases muscle strength and function, improves pulmonary function, and significantly slows the progression of weakness. Deflazacort has a similar effect on muscle strength, but it is not available in the United States. Treatment with corticosteroid should be offered to all patients with DMD, but the beneficial effects and potential adverse effects should be fully discussed before treatment begins. The optimal dose of prednisone is 0.75 mg/kg per day, up to a maximum of 40 mg/d. If adverse effects occur, a decrease in dosage is appropriate. Monitoring of muscle function and adverse effects by a neurologist or neuromuscular specialist is strongly recommended. Physical and occupational therapists should be involved early in the treatment of patients with DMD to develop a program that includes heel cord stretching and exercise. In the later phases, these therapists can recommend adaptive equipment and maximize independence. Orthopedic consultation is important in monitoring and managing scoliosis and joint contractures in the nonambulatory phase of the disease. Pulmonary evaluation for ventilatory care is important; pulmonary consultation is essential when vital capacity declines. The use of assistive cough devices, nasal bilevel positive airway pressure, and tracheostomy must be discussed with patients and their families. For all patients with DMD, particularly those receiving prednisone, consultation with a dietitian is very helpful to control weight and maintain a healthy diet. PMID:18334131

  5. A Treatment Option for Esophageal Intramural Pseudodiverticulosis.

    PubMed

    Tyberg, Amy; Jodorkovsky, Daniela

    2014-04-01

    Esophageal intramural pseudodiverticulosis (EIPD) is a rare condition often presenting with esophageal strictures. Treatment is often limited to endoscopic dilatation and treatment of the underlying esophageal pathology. We present a case of a patient with longstanding GERD on famotidine (she experienced anaphylaxis with proton pump inhibitors [PPIs]) who presented with dysphagia and weight loss. Work-up revealed a diagnosis of EIPD with a 5-mm mid-esophageal stricture. Therapy with dilatation was unsuccessful until the addition of sucralfate, after which dilatation was successful and symptoms resolved. In patients who are unable to take PPIs, the addition of sucralfate may enhance the success of dilatations of esophageal strictures and EIPD. PMID:26157852

  6. New Treatment Options in Status Epilepticus

    PubMed Central

    Dobesberger, Judith

    2009-01-01

    The effectiveness of Levetiracetam (LEV) in the treatment of focal and generalised epilepsies is well established. LEV has a wide spectrum of action, good tolerability and a favourable pharmacokinetic profile. An injectable formulation has been released as an intravenous (IV) infusion in 2006 for patients with epilepsy when oral administration is temporarily not feasible. Bioequivalence to the oral preparation has been demonstrated with good tolerability and safety enabling a smooth transition from oral to parenteral formulation and vice versa. Although IV LEV is not licensed for treatment of status epilepticus (SE), open-label experience in retrospective case series is accumulating. Until now (August 2008) 156 patients who were treated with IV LEV for various forms of SE have been reported with an overall success rate of 65.4%. The most often used initial dose was 2000-3000 mg over 15 minutes. Adverse events were reported in 7.1%, and were mild and transient. Although IV LEV is an interesting alternative for the treatment of SE due to the lack of centrally depressive effects and low potential of drug interactions, one has to be aware of the nonrandomised retrospective study design, the heterogenous patient population and treatment protocols, and the publication bias inherent in these type of studies. Only a large randomised controlled trial with an adequate comparator will reveal the efficacy and effectiveness of this promising new IV formulation. PMID:21180643

  7. Urinary Incontinence: Management and Treatment Options

    ERIC Educational Resources Information Center

    Griebling, Tomas L.

    2009-01-01

    Urinary incontinence, defined as the involuntary leakage of urine, is a common health problem in both women and men. Children may also suffer from this condition. Management and treatment of urinary incontinence depends primarily on the specific type of incontinence and the underlying problem causing the leakage for a given patient. Because

  8. Alcohol use disorder: pathophysiology, effects, and pharmacologic options for treatment

    PubMed Central

    Wackernah, Robin C; Minnick, Matthew J; Clapp, Peter

    2014-01-01

    Alcohol use disorders (AUD) continue to be a concerning health issue worldwide. Harmful alcohol use leads to 2.5 million deaths annually worldwide. Multiple options exist for the management of dependence on alcohol, not all of which are approved by drug-regulating agencies. Current practice in treating AUD does not reflect the diversity of pharmacologic options that have potential to provide benefit, and guidance for clinicians is limited. Few medications are approved for treatment of AUD, and these have exhibited small and/or inconsistent effects in broad patient populations with diverse drinking patterns. The need for continued research into the treatment of this disease is evident in order to provide patients with more specific and effective options. This review describes the neurobiological mechanisms of AUD that are amenable to treatment and drug therapies that target pathophysiological conditions of AUD to reduce drinking. In addition, current literature on pharmacologic (both approved and non-approved) treatment options for AUD offered in the United States and elsewhere are reviewed. The aim is to inform clinicians regarding the options for alcohol abuse treatment, keeping in mind that not all treatments are completely successful in reducing craving or heavy drinking or increasing abstinence. PMID:24648792

  9. Perinatal depression: treatment options and dilemmas

    PubMed Central

    Pearlstein, Teri

    2008-01-01

    The treatment of depression during pregnancy and the postpartum period raises unique concerns about safety for the developing fetus and the infant. An increasing number of studies suggest adverse effects from untreated stress, anxiety and depression as well as adverse effects from antidepressant and other psychotropic medications. Even when studies suggest a lack of short-term adverse effects with some medications, the paucity of systematic longitudinal follow-up studies investigating the development of children exposed to medications during pregnancy and breastfeeding causes apprehension. This review's objective is to highlight what is currently known about the negative effects of untreated disease and exposure to psychotropic medication, the treatment dilemmas confronting women with perinatal depression and issues that future studies should address so that a woman with perinatal depression can make an optimally informed decision. PMID:18592032

  10. Claudication: treatment options for femoropopliteal disease.

    PubMed

    Schillinger, Martin; Minar, Erich

    2011-01-01

    Intermittent claudication due to chronic femoropopliteal obstruction is a common disease, and patients are potentially severely disabled by the painful limitation of walking capacity. Despite major advances in pharmacological therapy of atherosclerosis, effective medication specifically for treatment of intermittent claudication is still not available. Training programs work well for patients with mild to moderate symptoms but frequently fail in patients with very compromised walking capacity. Patients with severe symptoms and markedly reduced quality of life therefore are candidates for revascularization. The preferred method of revascularization is endovascular treatment; this includes simple balloon angioplasty, debulking techniques, stent implantation, and, more recently, drug eluting technologies. Selected patients are candidates for surgery which encompasses endarterectomy of focal common femoral lesions as well as femoropopliteal bypass surgery in patients with very extensive disease or after failed endovascular approaches. The following article reviews current aspects of the management of femoropopliteal disease in patients with intermittent claudication. PMID:21722786

  11. Perinatal depression: treatment options and dilemmas.

    PubMed

    Pearlstein, Teri

    2008-07-01

    The treatment of depression during pregnancy and the postpartum period raises unique concerns about safety for the developing fetus and the infant. An increasing number of studies suggest adverse effects from untreated stress, anxiety and depression as well as adverse effects from antidepressant and other psychotropic medications. Even when studies suggest a lack of short-term adverse effects with some medications, the paucity of systematic longitudinal follow-up studies investigating the development of children exposed to medications during pregnancy and breastfeeding causes apprehension. This review's objective is to highlight what is currently known about the negative effects of untreated disease and exposure to psychotropic medication, the treatment dilemmas confronting women with perinatal depression and issues that future studies should address so that a woman with perinatal depression can make an optimally informed decision. PMID:18592032

  12. Treatment options for hyponatremia in heart failure.

    PubMed

    Goldsmith, Steven R

    2010-07-01

    Hyponatremia is independently associated with adverse outcomes in patients with congestive heart failure (CHF). The primary cause of hyponatremia in CHF is the inappropriate secretion of the antidiuretic hormone arginine vasopressin (AVP). The binding of AVP to V(2) receptors in the renal collecting duct promotes water retention, a process that can lead to dilutional hyponatremia as well as increased ventricular preload. Conventional treatment of hyponatremia in CHF is largely based on water restriction, which is neither effective nor well-tolerated. V(2)- and dual V(1a)/V(2)-receptor antagonists offer physiologically based treatment for dilutional hyponatremia. Clinical trials in patients with hyponatremia including those with CHF using both selective and nonselective vasopressin antagonists have demonstrated the effectiveness and safety of these agents in correcting this common electrolyte abnormality. PMID:20653706

  13. Treatment options for postdissection aortic aneurysms.

    PubMed

    Sobocinski, Jonathan; Patterson, Benjamin O; Clough, Rachel E; Spear, Rafaelle; Martin-Gonzalez, Teresa; Azzaoui, Richard; Hertault, Adrien; Haulon, Stéphan

    2016-04-01

    Aortic dissection is one of the most devastating catastrophes that can affect the aorta. Surgical treatment is proposed only when complications such as rupture or malperfusion occur. No clear consensus has been reached regarding the best therapy to prevent aortic rupture after the acute phase. We have performed a thorough review of the most recent literature on the strategies to treat patients in the chronic phase of aortic dissection. PMID:26771869

  14. Current options to surgical treatment in osteoporotic fractures.

    PubMed

    Marongiu, G; Mastio, M; Capone, A

    2013-10-01

    Treatment of osteoporotic fractures leads to significant challenges for the surgeon, including poor implant fixation related to low bone quality and compromised capacity of fracture healing. This article reviews the osteosynthesis and arthroplasty results in the surgical treatment of proximal femur, proximal humerus and wrist fractures to define the current options to decrease failure in fragility fracture management. PMID:24046046

  15. Drug-resistant tuberculosis: emerging treatment options

    PubMed Central

    Adhvaryu, Meghna; Vakharia, Bhasker

    2011-01-01

    Multidrug-resistant tuberculosis has emerged worldwide, with an increasing incidence due to failure of implementation of apparently effective first-line antituberculous therapy as well as primary infection with drug-resistant strains. Failure of current therapy is attributed to a long duration of treatment leading to nonadherence and irregular therapy, lack of patient education about the disease, poverty, irregular supply by care providers, drug–drug interactions in patients coinfected with human immunodeficiency virus (HIV), inadequate regulations causing market overlap and irresponsible drug usage in the private sector, and lack of research, with no addition of new drugs in the last four decades. Present standards of care for the treatment of drugsusceptible tuberculosis, multidrug-resistant tuberculosis, tuberculosis-HIV coinfection, and latent tuberculosis infection are all unsatisfactory. Since 2000, the World Health Organization (WHO) has focused on drug development for tuberculosis, as well as research in all relevant aspects to discover new regimens by 2015 and to eliminate tuberculosis as a public health concern by 2050. As a result, some 20 promising compounds from 14 groups of drugs have been discovered. Twelve candidates from eight classes are currently being evaluated in clinical trials. Ongoing research should prioritize identification of novel targets and newer application of existing drugs, discovery of multitargeted drugs from natural compounds, strengthening host factors by immunopotentiation with herbal immunomodulators, as well as protective vaccines before and after exposure, consideration of surgical measures when indicated, development of tools for rapid diagnosis, early identification of resistant strains, and markers for adequacy of treatment and an integrative approach to fulfill WHO goals. However, regulatory control over the drug market, as well as public-private partnership to use health program facilities to track patients and ensure completion of adequate therapy will be necessary to exploit fully the potential of the newer regimens to eliminate tuberculosis. PMID:22287857

  16. Acquired hemophilia A: emerging treatment options.

    PubMed

    Janbain, Maissaa; Leissinger, Cindy A; Kruse-Jarres, Rebecca

    2015-01-01

    Acquired hemophilia A is a rare autoimmune disorder caused by an autoantibody (inhibitor) to factor VIII (FVIII) that interferes with its coagulant function and predisposes to severe, potentially life-threatening hemorrhage. Disease management focuses on controlling bleeding, primarily with the use of bypassing therapy and recombinant porcine FVIII, and permanently eradicating the autoantibody using various immunosuppressants. Treatment challenges include delayed diagnosis, difficulty achieving hemostasis and durable remissions, and complications associated with the use of hemostatic and immunosuppressive therapy in a primarily older patient population. PMID:26056504

  17. Acquired hemophilia A: emerging treatment options

    PubMed Central

    Janbain, Maissaa; Leissinger, Cindy A; Kruse-Jarres, Rebecca

    2015-01-01

    Acquired hemophilia A is a rare autoimmune disorder caused by an autoantibody (inhibitor) to factor VIII (FVIII) that interferes with its coagulant function and predisposes to severe, potentially life-threatening hemorrhage. Disease management focuses on controlling bleeding, primarily with the use of bypassing therapy and recombinant porcine FVIII, and permanently eradicating the autoantibody using various immunosuppressants. Treatment challenges include delayed diagnosis, difficulty achieving hemostasis and durable remissions, and complications associated with the use of hemostatic and immunosuppressive therapy in a primarily older patient population. PMID:26056504

  18. Current and future treatment options for HCV.

    PubMed

    Kronenberger, Bernd; Zeuzem, Stefan

    2009-01-01

    Aim of antiviral therapy of patients with chronic hepatitis C is the sustained elimination of the hepatitis C virus (HCV). The standard of care (SOC) is peginterferon alfa-2a/-2b with ribavirin for 48 weeks or 24 weeks in patients infected with HCV genotype 1 or 2/3, respectively. Overall, approximately half of the patients can be cured by SOC. Based on baseline viral load and the speed of virologic response during treatment, individualization of treatment duration is possible. However, this approach is not sufficient to substantially improve the sustained virologic response (SVR) rates. This goal can be achieved with new HCV specific inhibitors against the NS3/4A polymerase and the NS5B polymerase. Recent trials reported SVR rates in the order of 67-69% and 67-75% for the combination of SOC with the protease inhibitors telaprevir and boceprevir, respectively, in patients with HCV genotype 1 infection. Several new HCV specific inhibitors such as protease inhibitors, nucleoside and non-nucleoside polymerase inhibitors as well as non HCV specific compounds with anti-HCV activity such as cyclophilin inhibitors, silibinin, and nitazoxanide are currently in clinical evaluation. The review describes recent developments and discusses limitations posed by resistance development and drug toxicity. PMID:19502651

  19. Pediatric Ureteroceles: Diagnosis, Management and Treatment Options

    PubMed Central

    Günşar, Cüneyt; Mir, Erol; Şencan, Aydin; Ertan, Pelin; Özcan, Cansu Ünden

    2010-01-01

    Objective The aim of the study was to evaluate clinical characteristics of ureteroceles particularly for diagnostic and treatment challenges. Methods Data about patients treated for ureterocele in the two hospital clinics during 1996- 2009 are retrospectively evaluated. Findings There were 12 girls and 7 boys. Symptomatic urinary tract infection was found in twelve cases. Ureterocele was associated with duplex systems in eleven cases. Vesicoureteral reflux was detected in 4 patients. Bladder diverticulum complicated with ureterocele in 1 patient. Ultrasonography diagnosed ureterocele in 12 patients. Renal scarring was detected in 6 patients at the side of ureterocele. Fifteen patients showed varying degrees of hydro-ureteronephrosis. Surgical therapy included upper pole nephrectomy in 3 cases. Bladder level reconstruction was performed in 11 cases. Five patients were treated only by endoscopic incision. In the follow up period 4 patients showed long term urinary tract infections whereas 3 of them were treated endoscopically. Postoperative reflux was still present in two patients who were treated by endoscopic incision. Conclusion Ureterocele diagnosis and treatment show challenges. Urinary tract infection is important marker for urinary system evaluation. Preoperative management generally depends on a combination of diagnostic methods. Endoscopic incision needs serious follow up for postoperative problems. PMID:23056740

  20. [Options of stress management in obesity treatment].

    PubMed

    Czeglédi, Edit

    2016-02-01

    Overeating and physical inactivity are of great importance in the etiology of obesity. Psychological factors are often found in the background of life style. Chronic stress can contribute to physical inactivity and behaviors that hinder the keeping of a diet (e.g., irregular eating pattern, emotional eating). Results of randomized controlled trials show that relaxation can reduce emotional eating, improve cognitive restraint, and thereby reduce weight. However, stress management is more than relaxation. It consists of adaptive emotion-focused and problem-focused coping strategies and skills to improve relationships. Deflection skills may help in replacing emotional eating with other behaviors. Cognitive restructuring, saying no, and problem solving help to prevent or manage conflicts and difficulties otherwise would result in overeating due to distress. Developing stress management skills may result in greater compliance with the treatment. The techniques presented in the study can be easily applied by general practitioners or specialists, and provide tools for optimizing obesity treatment. Orv. Hetil., 2016, 157(7), 260-267. PMID:26853727

  1. Treatment options for hyponatremia in heart failure.

    PubMed

    Goldsmith, Steven R

    2009-06-01

    Hyponatremia is independently associated with adverse outcomes in patients with congestive heart failure (CHF). The primary cause of hyponatremia in CHF is the inappropriate secretion of the antidiuretic hormone, arginine vasopressin (AVP). The binding of AVP to V(2) receptors in the renal collecting duct promotes water retention, a process that can lead to dilutional hyponatremia as well as increased ventricular preload. AVP could also exacerbate the course of CHF by interacting with V(1A) receptors on vascular smooth muscle cells and myocytes. Conventional treatment of hyponatremia in CHF is based largely on water restriction, which is neither effective nor well tolerated. Current research is exploring V(2)- and dual V(1A)/V(2)-receptor antagonism for the treatment of hyponatremia, as well as for the congestion and edema associated with CHF, since AVP-receptor antagonists may offer benefits in comparison to conventional loop diuretics. Clinical trials in patients with hyponatremia and CHF using both selective and nonselective vasopressin antagonists have demonstrated the effectiveness of these agents in correcting this common electrolyte abnormality. PMID:18777208

  2. Future treatment options for human African trypanosomiasis.

    PubMed

    Jones, Amy J; Avery, Vicky M

    2015-12-01

    Over the past 17 years, the number of reported cases of human African trypanosomiasis (HAT) has declined by over 90%, a significant result since the disease was highlighted as a public health problem by the WHO in 1995. However, if the goal of eliminating HAT by 2020 is to be achieved, then new treatments need to be identified and developed. A plethora of compound collections has been screened against Trypanosoma brucei spp, the etiological agents of HAT, resulting in three compounds progressing to clinical development. However, due to the high attrition rates in drug discovery, it is essential that research continues to identify novel molecules. Failure to do so, will result in the absence of molecules in the pipeline to fall back on should the current clinical trials be unsuccessful. This could seriously compromise control efforts to date, resulting in a resurgence in the number of HAT cases. PMID:26414688

  3. Treatment options in hepatocellular carcinoma today.

    PubMed

    Livraghi, T; Mäkisalo, H; Line, P-D

    2011-01-01

    Hepatocellular carcinoma (HCC) is the third most common cause of cancer related death worldwide. As over 90% of HCCs arise in cirrhotic livers preventive methods and surveillance policies have been adopted in most countries with high prevalence of hepatitis B or C infected people. Poor prognosis of HCC has shown some improvement during the last years. Targeted therapy with radiofrequency ablation (RFA), hepatic resection (HR), liver transplantation (LT), and transcatheter arterial chemoembolisation (TACE) seems to have an influence on this development. The heterogeneity of cirrhotic patients with HCC is still a big challenge. A patient with a small tumour in a cirrhotic liver may have a worse prognosis than a patient with a large tumor in a relatively preserved liver after "curative" HR. The choice of the treatment modality depends on the size and the number of tumours, the stage and the cause of cirrhosis and finally on the availability of various modalities in each centre. PMID:21482502

  4. Chronic constipation and treatment options (Review).

    PubMed

    El-Salhy, Magdy; Svensen, Rune; Hatlebakk, Jan Gunnar; Gilja, Odd-Helge; Hausken, Trygve

    2014-01-01

    Chronic constipation (CC) is a highly prevalent heterogeneous disorder. Although CC is not known to be associated with the development of serious disease or with excess mortality, it considerably reduces the patients quality of life. In addition, it represents an economic burden to patients and society. The majority of patients with CC successfully manage the disorder by dietary management and the use of laxatives. Patients with functional CC (slow‑transit and non‑slow transit constipation) do not respond to laxatives and are a small fraction of the total population complaining of constipation. Regardless of the low number of these patients, the intractability of their symptoms causes psychological and social stress and greatly impairs their quality of life. Furthermore, these patients consume a disproportionate quantity of medical resources. It appears that these patients have a disturbance in the serotonin transmission system, which results in a cascade of alterations in a number of gut neuroendocrine hormones/transmitters. The effect of prucalopride, a serotonin receptor agonist, in this category of patients appears to be not only a pharmacological prokinetic action, but also a correction of a pre‑existing disturbance. Linaclotide, a member of the guanylin peptide family, binds to the ligand‑binding region of guanylate cyclase‑C on the luminal surface of gastrointestinal epithelia resulting in increased fluid secretion. This drug has also been found to be effective for the treatment of functional CC. In addition, biofeedback and sacral nerve stimulation are effective in the treatment of CC caused by pelvic floor disorders. PMID:24189940

  5. Treatment options in Cheyne-Stokes respiration.

    PubMed

    Randerath, Winfried J

    2010-12-01

    About half of the patients suffering from heart failure present with sleep-disordered breathing. In most cases obstructive and central breathing disturbances (including Cheyne-Stokes respiration [CSR]) coexist. CSR is defined by a waxing and waning pattern of the tidal volume. While its pathophysiology has not been elucidated completely, increased ventilatory sensitivity for CO(2) and therefore an imbalance of the respiratory drive and effort, a chronic hyperventilatory state, and changes of the apnoeic threshold are considered to play a relevant role. However, CSR in heart failure impairs survival and quality of life of the patients and is therefore a major challenge of respiratory sleep medicine. If CSR persists despite optimal medical and interventional therapy of the underlying cardiac disorder, oxygen supply, continuous positive airway pressure (CPAP), and bilevel pressure are often trialled. However, there is insufficient evidence to recommend oxygen or bilevel treatment. CPAP has proven to improve left ventricular function. In addition, retrospective analyses suggested a reduction of mortality under CPAP in heart failure patients with CSR. However, these findings could not be reproduced in the prospective controlled CanPAP trial. More recently, adaptive servoventilation (ASV) has been introduced for treatment of CSR or coexisting sleep-related breathing disorders. ASV devices aim at counterbalancing the ventilatory overshoot and undershoot by applying variable pressure support with higher tidal volume (TV) during hypoventilation and reduced TV during hyperventilation. ASV has proven to be superior to CPAP but the long-term efficacy and the influences on cardiac parameters and survival are still under investigation. PMID:20713506

  6. Pretibial myxedema: pathophysiology and treatment options.

    PubMed

    Fatourechi, Vahab

    2005-01-01

    Pretibial myxedema or localized myxedema or thyroid dermopathy is an autoimmune manifestation of Graves' disease. It also occasionally occurs in Hashimoto's thyroiditis. Lesions of thyroid dermopathy are usually asymptomatic and have only cosmetic importance. Advanced forms of dermopathy are associated with elephantiasis or thyroid acropachy. Almost all cases of thyroid dermopathy are associated with relatively severe ophthalmopathy. Usually ophthalmopathy appears first and dermopathy much later. All patients with localized myxedema have high serum concentrations of thyroid-stimulating hormone receptor antibodies, indicating the severity of the autoimmune condition. Occurrence of thyroid dermopathy in areas other than pretibial skin indicates a systemic process. Similar to Graves' ophthalmopathy, thyroid-stimulating hormone receptors in the connective tissue may be the antigen responsible for the immune process. Both humoral and cellular immune mechanisms are involved in the stimulation of fibroblasts and the production of large amounts of glycosaminoglycans. Localization in the pretibial area relates to mechanical factors and dependent position. Diagnosis of thyroid dermopathy is based on signs and typical pretibial skin lesions in association with a history of Graves' hyperthyroidism and ophthalmopathy. In some cases, skin biopsy is needed for confirmation. The lesions are usually mild and are overshadowed by more symptomatic ophthalmopathy. Most cases of thyroid dermopathy do not require any therapy. In mildly severe symptomatic cases and when there is cosmetic concern, topical corticosteroids applied under occlusive dressing are beneficial. In more severe cases, systemic immunomodulation may be necessary; however, conclusive evidence for long-term efficacy of these modalities is lacking. When significant edema and elephantiasis are present, local compressive therapy may have added benefit. In mild cases that do not require treatment, 50% of patients achieve complete remission after several years. Severe cases that receive topical corticosteroids or other therapies do not have a better outcome than untreated milder cases. Current treatment modalities for thyroid dermopathy and acropachy are at best palliative. Better and safer means of immunomodulation are needed. PMID:16252929

  7. Bowens disease a review of newer treatment options

    PubMed Central

    Neubert, Thorsten; Lehmann, Percy

    2008-01-01

    Bowens disease (squamous cell carcinoma in situ) has a 3%5% risk to develop into invasive squamous cell carcinoma. Non-melanoma skin cancer is the most common cancer among Caucasians and its incidence has increased during the last decades dramatically. Multiple treatment options for Bowens disease have been described and are established with advantages and disadvantages. Bowens disease occurs more often in elderly patients (with a higher risk of comorbidities) and is frequently located on body sites with poor wound healing. Therefore there is need for non-invasive/non-destructive but effective treatment options. We would like to give an overview of established therapies and more detailed information about the newer treatment options for Bowens disease with topical diclofenac, topical imiquimod and photodynamic therapy. PMID:19209288

  8. Naegleria fowleri: pathogenesis, diagnosis, and treatment options.

    PubMed

    Grace, Eddie; Asbill, Scott; Virga, Kris

    2015-11-01

    Naegleria fowleri has generated tremendous media attention over the last 5 years due to several high-profile cases. Several of these cases were followed very closely by the general public. N. fowleri is a eukaryotic, free-living amoeba belonging to the phylum Percolozoa. Naegleria amoebae are ubiquitous in the environment, being found in soil and bodies of freshwater, and feed on bacteria found in those locations. While N. fowleri infection appears to be quite rare compared to other diseases, the clinical manifestations of primary amoebic meningoencephalitis are devastating and nearly always fatal. Due to the rarity of N. fowleri infections in humans, there are no clinical trials to date that assess the efficacy of one treatment regimen over another. Most of the information regarding medication efficacy is based on either case reports or in vitro studies. This review will discuss the pathogenesis, diagnosis, pharmacotherapy, and prevention of N. fowleri infections in humans, including a brief review of all survivor cases in North America. PMID:26259797

  9. [Diagnosis and treatment options in vertigo syndromes].

    PubMed

    Strupp, M; Dieterich, M; Zwergal, A; Brandt, T

    2015-10-01

    The key to diagnosing vertigo and balance disorders is systematic analysis of case history with clinical examination of the vestibular, oculomotor, and cerebral systems in particular. Important criteria for differentiating between the various vertigo syndromes are 1) the time course of symptoms, 2) the type of symptoms, 3) modulating factors, and 4) associated symptoms. For clinical examination of the vestibular system, six important tests are available: assessment of spontaneous nystagmus, head impulse test, dynamic visual acuity, subjective visual verticality, positioning manoeuvre, and the Romberg test/gait analysis with eyes open and closed. On the basis of five clinical signs (vertical divergence, central fixation nystagmus, gaze-evoked nystagmus, saccades, normal head impulse test), the clinical examination is able to differentiate between acute central and peripheral vestibular syndromes with a sensitivity and specificity of over 90%. The most relevant laboratory examinations are caloric irrigation and the video head-impulse test for canal function and the vestibular evoked myogenic potentials for otolith function. Finally, treatment is based upon four therapeutic principles: physiotherapy, pharmacotherapy, psychotherapy, and in rare cases, surgery. PMID:26440631

  10. Update on Treatment Options for Gonococcal Infections.

    PubMed

    Lancaster, Jason W; Mahoney, Monica V; Mandal, Sana; Lawrence, Kenneth R

    2015-09-01

    The incidence of Neisseria gonorrhoeae infections in the United States has grown over the past decade. The most recent data provided by the Centers for Disease Control and Prevention (CDC) indicate that reported cases have increased by almost 10% over the last 5 years. In conjunction with this rise, the presence of multidrug-resistant strains of N. gonorrhoeae has also emerged. The 2015 CDC guidelines recommend dual therapy with intramuscular ceftriaxone and oral azithromycin as first-line treatment, although components of this regimen are met with a high level of resistance. Although ceftriaxone resistance has not yet been reported in the United States, it is only a matter of time before such isolates are detected, thus ushering in a new era of difficult-to-manage uncomplicated gonococcal infection. The potential public health crisis and patient-associated sequelae (e.g., pelvic inflammatory disease, epididymitis, and human immunodeficiency virus infection) linked with untreatable gonorrhea are cause for great concern. To try to stem this tide, a number of new agents targeted against N. gonorrhoeae are being investigated in clinical trials. In this article, we review the various agents, both currently available and under clinical investigation, and provide recommendations for the management of gonococcal infections. PMID:26343813

  11. Treatment options for nonalcoholic fatty liver disease

    PubMed Central

    Lam, Brian; Younossi, Zobair M.

    2010-01-01

    Nonalcoholic fatty liver disease (NAFLD) has become increasingly recognized as the most common cause of abnormal liver enzymes in the last few decades and is among the most common forms of chronic liver disease in the Western world and across the globe. With the growing epidemic of obesity and diabetes, NAFLD is estimated to affect about one-quarter of the US population. Although most patients with NAFLD have nonprogressive bland steatosis, a minority of patients develop the histological subtype of nonalcoholic steatohepatitis (NASH), which may progress to cirrhosis, hepatocellular carcinoma, and liver-related death. This is especially true when NASH patients have type 2 diabetes. Treatment of NAFLD should therefore be directed towards patients with established NASH. Sustained weight loss seems to improve insulin resistance and associated NASH. In fact, weight loss with bariatric surgery leads to biochemical and histological improvement in morbidly obese patients with NASH. Several pharmacologic agents have been studied in an effort to improve insulin resistance and pro-inflammatory mediators potentially responsible for the development and progression of NASH. While some studies have shown initial promise, none has established long-term efficacy using randomized clinical trials. This paper briefly reviews the epidemiology, natural history, and pathophysiology of NAFLD and NASH and then focuses on the clinical trials of various therapeutic modalities for NAFLD. These include weight loss agents, bariatric surgery, insulin-sensitizing agents, lipid-lowering agents, antioxidants, probiotics, anti-tumor necrosis factor agents, cytoprotective and other novel agents. PMID:21180596

  12. Proposed HWIR alters waste treatment, disposal options

    SciTech Connect

    Hill, M.; Robinson, C.

    1996-04-01

    In what it has called its most important change to the hazardous waste rules since 1980, the Environmental Protection Agency has proposed the Hazardous Waste Identification Rule for process wastes that currently are regulated by the hazardous waste provisions in the Resource Conservation and Recovery Act, or RCRA Subtitle C. The rule addresses wastes that EPA has individually listed as hazardous, as well as wastes that are mixed with, derived from or contain listed hazardous wastes. The HWIR sets constituent-specific exit levels that would let low-risk process wastes escape the rigorous regulations of Subtitle C. EPA also proposes changes to RCRA`s land disposal restrictions so that some wastes that currently must be treated according to strict universal treatment standards may not have to be treated at all -- or could be treated in a less expensive manner -- before disposal. The proposed rule is important to virtually every company that is subject to RCRA`s hazardous waste regulations and raises many issues on which companies may want to comment.

  13. Current treatment options in smoking cessation.

    PubMed

    Crain, Dominique; Bhat, Abid

    2010-02-01

    Cigarette smoking is the most important modifiable risk factor for premature mortality. Many common and serious diseases, including coronary artery disease, chronic obstructive lung disease, stroke, and cancer, are strongly linked to cigarette smoking. Smoking cessation is difficult due to nicotine addiction and withdrawal symptoms. Comprehensive programs for tobacco control can substantially reduce the frequency of tobacco use. Physicians can improve screening and increase cessation rates by asking patients about tobacco use at every office visit. The spectrum of available smoking cessation interventions ranges from simple advice to intensive behavioral support and pharmacological treatment. Medications currently approved by the US Food and Drug Administration for smoking cessation include nicotine replacement therapy (patch, gum, lozenge, inhaler, and nasal spray), bupropion, and varenicline. Nortriptyline and clonidine have been used in patients who do not tolerate first-line agents. New drug therapies, such as nicotine vaccines, are being developed. The US Public Health Service Guideline, published in 2008, recommends a combination of behavioral support and pharmacologic therapy. In summary, smoking cessation should be based on a patient's coexisting medical conditions, level of smoking, compliance, previous experience with cessation agents, and the cost of therapy. PMID:20469625

  14. An overview of treatment options for urinary stones

    PubMed Central

    Shafi, Hamid; Moazzami, Bobak; Pourghasem, Mohsen; Kasaeian, Aliakbar

    2016-01-01

    Urolithiasis has become a worldwide problem with the prevalence of the disease increasing over the past few decades. While various treatment modalities have evolved over the years, discrepancies exist regarding the clinical indications and the efficacy of each of these treatment options. In the present review, we aim to review the current treatment modalities for urinary tract stones to provide a better understanding on the therapeutic approaches as well as their clinical indications. PMID:26958325

  15. Birdshot uveitis: current and emerging treatment options

    PubMed Central

    Menezo, Victor; Taylor, Simon RJ

    2014-01-01

    Birdshot chorioretinopathy is a relatively uncommon subtype of idiopathic posterior uveitis with distinct clinical characteristics and a strong genetic association with the Human Leukocyte Antigen (HLA)-A29 allele. The diagnosis remains clinical and is based on the presence of typical clinical features, including multiple, distinctive, hypopigmented choroidal lesions throughout the fundus. The long-term visual prognosis of this disorder, however, remains guarded central visual acuity can be preserved until late in the disease and it is not uncommon for patients to receive inadequate immunosuppressive treatment, leading to a poor long-term outcome in which peripheral retinal damage eventually leads to visual deterioration. Birdshot chorioretinopathy has proven a particularly attractive area of study within the field of uveitis, as it is a relatively easily defined disease with an associated human leukocyte antigen haplotype. Despite this, however, the immune mechanisms involved in its pathogenesis remain unclear, and some patients continue to lose retinal function despite therapy with corticosteroids and conventional immunosuppressive agents. Laboratory research continues to investigate the underlying mechanisms of disease, and clinical research is now being driven to improve the phenotyping and monitoring of this condition as, in the era of so-called personalized medicine, it is becoming increasingly important to identify patients at risk of visual loss early so that they can be treated more aggressively with targeted therapies such as the newer biological agents. This approach requires the formation of collaborative groups, as the relative rarity of the condition makes it difficult for one center to accumulate enough patients for worthwhile studies. Nevertheless, results obtained with newer therapies, such as biological agents directed against particular cytokines or cell-surface receptors, demonstrate ever improving control of the inflammation in refractory cases, providing hope that the outlook for visual function in this condition can only improve. PMID:24379650

  16. Hypercalcemia of malignancy and new treatment options

    PubMed Central

    Sternlicht, Hillel; Glezerman, Ilya G

    2015-01-01

    Hypercalcemia of malignancy affects up to one in five cancer patients during the course of their disease. It is associated with both liquid malignancies, commonly multiple myeloma, leukemia, and non-Hodgkins lymphoma and solid cancers, particularly breast and renal carcinomas as well as squamous cell carcinomas of any organ. The clinical manifestations of hypercalcemia are generally constitutional in nature and not specific to the inciting malignancy. Such physical manifestations can range from malaise to lethargy and confusion. Constipation and anorexia are common. Acute kidney injury is likely the most frequently encountered manifestation of end organ damage. Symptomatology is closely linked to both the absolute elevation of serum calcium levels and the rapidity of calcium rise. The majority of cases are humoral in etiology and related to parathyroid hormone-related protein (PTHrP). Approximately 20% of cases are the result of direct bone metastasis with extra-renal 1,25-dihydroxyvitamin D (calcitriol) and ectopic parathyroid hormone production likely accounting for less than 1% of cases. The diagnosis of hypercalcemia of malignancy is confirmed either by an elevated PTHrP or by an evidence of bone metastasis in the appropriate clinical setting. Treatment is predicated on the patient’s symptoms and absolute serum calcium level. Interventions are aimed at lowering the serum calcium concentration by inhibiting bone resorption and increasing urinary calcium excretion, the former accomplished via bisphosphonate therapy and the latter with aggressive hydration. Novel therapies for refractory disease include denosumab, a monoclonal antibody against the receptor activator of nuclear factor κB ligand, and the calcimimetic cinacalcet. Finally, anti-PTHrP antibodies have been successfully deployed in animal models of disease. Despite the efficacy of the above therapies, hypercalcemia of malignancy portends an ominous prognosis, indicating advanced and often refractory cancer with survival on the order of months. PMID:26675713

  17. Update on treatment options for spinal brucellosis.

    PubMed

    Ulu-Kilic, A; Karakas, A; Erdem, H; Turker, T; Inal, A S; Ak, O; Turan, H; Kazak, E; Inan, A; Duygu, F; Demiraslan, H; Kader, C; Sener, A; Dayan, S; Deveci, O; Tekin, R; Saltoglu, N; Aydın, M; Horasan, E S; Gul, H C; Ceylan, B; Kadanalı, A; Karabay, O; Karagoz, G; Kayabas, U; Turhan, V; Engin, D; Gulsun, S; Elaldı, N; Alabay, S

    2014-02-01

    We evaluated the efficacy and tolerability of antibiotic regimens and optimal duration of therapy in complicated and uncomplicated forms of spinal brucellosis. This is a multicentre, retrospective and comparative study involving a total of 293 patients with spinal brucellosis from 19 health institutions. Comparison of complicated and uncomplicated spinal brucellosis was statistically analysed. Complicated spinal brucellosis was diagnosed in 78 (26.6%) of our patients. Clinical presentation was found to be significantly more acute, with fever and weight loss, in patients in the complicated group. They had significantly higher leukocyte and platelet counts, erythrocyte sedimentation rates and C-reactive protein levels, and lower haemoglobulin levels. The involvement of the thoracic spine was significantly more frequent in complicated cases. Spondylodiscitis was complicated, with paravertebral abscess in 38 (13.0%), prevertebral abscess in 13 (4.4%), epidural abscess in 30 (10.2%), psoas abscess in 10 (3.4%) and radiculitis in 8 (2.7%) patients. The five major combination regimens were: doxycycline 200 mg/day, rifampicin 600 mg/day and streptomycin 1 g/day; doxycycline 200 mg/day, rifampicin 600 mg/day and gentamicin 5 mg/kg; doxycycline 200 mg/day and rifampicin 600 mg/day; doxycycline 200 mg/day and streptomycin 1 g/day; and doxycycline 200 mg/day, rifampicin 600 mg/day and ciprofloxacin 1 g/day. There were no significant therapeutic differences between these antibiotic groups; the results were similar regarding the complicated and uncomplicated groups. Patients were mostly treated with doxycycline and rifampicin with or without an aminoglycoside. In the former subgroup, complicated cases received antibiotics for a longer duration than uncomplicated cases. Early recognition of complicated cases is critical in preventing devastating complications. Antimicrobial treatment should be prolonged in complicated spinal brucellosis in particular. PMID:24118178

  18. Cervical dystonia pathophysiology and treatment options.

    PubMed

    Velickovic, M; Benabou, R; Brin, M F

    2001-01-01

    Dystonia is a syndrome of sustained involuntary muscle contractions, frequently causing twisting and repetitive movements or abnormal posturing. Cervical dystonia (CD) is a form of dystonia that involves neck muscles. However, CD is not the only cause of neck rotation. Torticollis may be caused by orthopaedic, musculofibrotic, infectious and other neurological conditions that affect the anatomy of the neck, and structural causes. It is estimated that there are between 60,000 and 90,000 patients with CD in the US. The majority of the patients present with a combination of neck rotation (rotatory torticollis or rotatocollis), flexion (anterocollis), extension (retrocollis), head tilt (laterocollis) or a lateral or sagittal shift. Neck posturing may be either tonic, clonic or tremulous, and may result in permanent and fixed contractures. Sensory tricks ('geste antagonistique') often temporarily ameliorate dystonic movements and postures. Commonly used sensory tricks by patients with CD include touching the chin, back of the head or top of the head. Patients with CD are classified according to aetiology into two groups: primary CD (idiopathic--may be genetic or sporadic) or secondary CD (symptomatic). Patients with primary CD have no evidence by history, physical examination or laboratory studies (except primary dystonia gene) of any secondary cause for the dystonic symptoms. CD is a part of either generalised or focal dystonic syndrome which may have a genetic basis, with an identifiable genetic association. Secondary or symptomatic CD may be caused by central or peripheral trauma, exposure to dopamine receptor antagonists (tardive), neurodegenerative disease, and other conditions associated with abnormal functioning of the basal ganglia. In the majority of patients with CD, the aetiology is not identifiable and the disorder is often classified as primary. Unless the aetiological investigation reveals a specific therapeutic intervention, therapy for CD is symptomatic. It includes supportive therapy and counselling, physical therapy, pharmacotherapy, chemodenervation [botulinum toxin (BTX), phenol, alcohol], and central and peripheral surgical therapy. The most widely used and accepted therapy for CD is local intramuscular injections of BTX-type A. Currently, both BTX type A and type B are commercially available, and type F has undergone testing. Pharmacotherapy, including anticholinergics, dopaminergic depleting and blocking agents, and other muscle relaxants can be used alone or in combination with other therapeutic interventions. Surgery is usually reserved for patients with CD in whom other forms of treatment have failed. PMID:11708764

  19. Non-Surgical Interventions for Adolescents with Idiopathic Scoliosis: An Overview of Systematic Reviews

    PubMed Central

    Płaszewski, Maciej; Bettany-Saltikov, Josette

    2014-01-01

    Background Non-surgical interventions for adolescents with idiopathic scoliosis remain highly controversial. Despite the publication of numerous reviews no explicit methodological evaluation of papers labeled as, or having a layout of, a systematic review, addressing this subject matter, is available. Objectives Analysis and comparison of the content, methodology, and evidence-base from systematic reviews regarding non-surgical interventions for adolescents with idiopathic scoliosis. Design Systematic overview of systematic reviews. Methods Articles meeting the minimal criteria for a systematic review, regarding any non-surgical intervention for adolescent idiopathic scoliosis, with any outcomes measured, were included. Multiple general and systematic review specific databases, guideline registries, reference lists and websites of institutions were searched. The AMSTAR tool was used to critically appraise the methodology, and the Oxford Centre for Evidence Based Medicine and the Joanna Briggs Institute’s hierarchies were applied to analyze the levels of evidence from included reviews. Results From 469 citations, twenty one papers were included for analysis. Five reviews assessed the effectiveness of scoliosis-specific exercise treatments, four assessed manual therapies, five evaluated bracing, four assessed different combinations of interventions, and one evaluated usual physical activity. Two reviews addressed the adverse effects of bracing. Two papers were high quality Cochrane reviews, Three were of moderate, and the remaining sixteen were of low or very low methodological quality. The level of evidence of these reviews ranged from 1 or 1+ to 4, and in some reviews, due to their low methodological quality and/or poor reporting, this could not be established. Conclusions Higher quality reviews indicate that generally there is insufficient evidence to make a judgment on whether non-surgical interventions in adolescent idiopathic scoliosis are effective. Papers labeled as systematic reviews need to be considered in terms of their methodological rigor; otherwise they may be mistakenly regarded as high quality sources of evidence. Protocol registry number CRD42013003538, PROSPERO PMID:25353954

  20. Treatment Options for Carbapenem-Resistant Enterobacteriaceae Infections

    PubMed Central

    Morrill, Haley J.; Pogue, Jason M.; Kaye, Keith S.; LaPlante, Kerry L.

    2015-01-01

    This article provides a comprehensive review of currently available treatment options for infections due to carbapenem-resistant Enterobacteriaceae (CRE). Antimicrobial resistance in Gram-negative bacteria is an emerging and serious global public health threat. Carbapenems have been used as the last-line treatment for infections caused by resistant Enterobacteriaceae, including those producing extended spectrum -lactamases. However, Enterobacteriaceae that produce carbapenemases, which are enzymes that deactivate carbapenems and most other -lactam antibiotics, have emerged and are increasingly being reported worldwide. Despite this increasing burden, the most optimal treatment for CRE infections is largely unknown. For the few remaining available treatment options, there are limited efficacy data to support their role in therapy. Nevertheless, current treatment options include the use of older agents, such as polymyxins, fosfomycin, and aminoglycosides, which have been rarely used due to efficacy and/or toxicity concerns. Optimization of dosing regimens and combination therapy are additional treatment strategies being explored. Carbapenem-resistant Enterobacteriaceae infections are associated with poor outcomes and high mortality. Continued research is critically needed to determine the most appropriate treatment. PMID:26125030

  1. NON-SURGICAL MANAGEMENT OF HEAVY MENSTRUAL BLEEDING: A SYSTEMATIC REVIEW AND PRACTICE GUIDELINES

    PubMed Central

    Matteson, Kristen A.; Rahn, David D.; Wheeler, Thomas L.; Casiano, Elizabeth; Siddiqui, Nazema Y.; Harvey, Heidi S.; Mamik, Mamta M.; Balk, Ethan M.; Sung, Vivian W.

    2015-01-01

    Objective To compare the effectiveness of non-surgical abnormal uterine bleeding (AUB) treatments for bleeding control, quality of life, pain, sexual health, patient satisfaction, additional treatments needed, and adverse events. Data Sources MEDLINE and Cochrane databases from inception to May 2012. We included randomized controlled trials of non-surgical treatments for AUB. Interventions included the levonorgestrel intrauterine system, combined oral contraceptives, progestins, nonsteroidal anti-inflammatory drugs, and antifibrinolytics. Gonadotropin releasing hormone agonists, danazol, and placebo were allowed as comparators. Study selection Two reviewers independently screened the 5846 citations and extracted eligible trials. Studies were assessed for quality and strength of evidence. Tabulation, Integration, and Results Twenty-six trials of eight different interventions met inclusion criteria. For the reduction of menstrual bleeding in women with AUB-E, the levonorgestrel intrauterine system, combined oral contraceptives, extended cycle oral progestins, tranexamic acid, and nonsteroidal anti-inflammatory drugs were all effective treatments. The levonorgestrel intrauterine system, combined oral contraceptives, and antifibrinolytics were all superior to luteal phase progestins. The levonorgestrel intrauterine system was superior to combined oral contraceptives and nonsteroidal anti-inflammatory drugs. Antifibrinolytics were superior to nonsteroidal anti-inflammatory drugs for menstrual bleeding reduction. Data were limited on other important outcomes for women with AUB-E and on women with AUB-O. Conclusion Many non-surgical treatments for AUB are effective for reducing menstrual bleeding in women with AUB-E. Additional research is necessary to determine the effectiveness of treatments for other essential quality of life outcomes, and for other populations, including women with AUB-O. PMID:23635628

  2. Waste battery treatment options: comparing their environmental performance.

    PubMed

    Briffaerts, K; Spirinckx, C; Van der Linden, A; Vrancken, K

    2009-08-01

    Waste consumer batteries are recycled using different routes based on hydrometallurgical and pyrometallurgical processes. Two hydrometallurgical and two pyrometallurgical treatment scenarios are compared starting from an average composition of Belgian waste batteries. The environmental performance is compared using life cycle analysis (LCA). The recycling rate is studied through mass balance calculation. Each treatment scenario results in a specific recycling rate. The environmental impact and benefits also vary between the treatment options. There is no such thing as a typical hydrometallurgical or pyrometallurgical treatment. When applying a hydrometallurgical treatment scenario, the focus lies on zinc and iron recycling. When allowing manganese recycling, the energy demand of the hydrometallurgical process increases considerably. Both pyrometallurgical options recycle zinc, iron and manganese. According to the LCA, none of the treatment scenarios performs generally better or worse than the others. Each option has specific advantages and disadvantages. The Batteries Directive 2006/66/EC sets out a recycling rate of 50% for consumer waste batteries. Based on metal recycling alone, the mass balances show that the target is difficult to obtain. PMID:19386482

  3. Effluent treatment options for nuclear thermal propulsion system ground tests

    SciTech Connect

    Shipers, L.R.; Brockmann, J.E.

    1992-10-16

    A variety of approaches for handling effluent from nuclear thermal propulsion system ground tests in an environmentally acceptable manner are discussed. The functional requirements of effluent treatment are defined and concept options are presented within the framework of these requirements. System concepts differ primarily in the choice of fission-product retention and waste handling concepts. The concept options considered range from closed cycle (venting the exhaust to a closed volume or recirculating the hydrogen in a closed loop) to open cycle (real time processing and venting of the effluent). This paper reviews the strengths and weaknesses of different methods to handle effluent from nuclear thermal propulsion system ground tests.

  4. Lack of tolerable treatment options for patients with schizophrenia

    PubMed Central

    Citrome, Leslie; Eramo, Anna; Francois, Clement; Duffy, Ruth; Legacy, Susan N; Offord, Steve J; Krasa, Holly B; Johnston, Stephen S; Guiraud-Diawara, Alice; Kamat, Siddhesh A; Rohman, Patricia

    2015-01-01

    Purpose Atypical antipsychotics (AAs), an effective treatment for schizophrenia, have a range of pharmacologic properties leading to differences in tolerability as well as heterogeneity in treatment response. Individual patient characteristics must be considered when making treatment choices, especially from an adverse event (AE) or tolerability perspective. Despite the availability of numerous AAs, after appraising patient characteristics at the time of treatment selection, physicians may quickly run out of tolerable treatment options. Patients and methods AE risk factors, defined as having either a prior history of an AE or a risk factor for that AE, were determined for Medicaid-insured and Commercially insured patients using database analysis. Patients receiving AA treatment between January 1, 2010 and December 31, 2012 defined the index date of first observed AA prescription during this period. Nine AAs were evaluated for association with AE risk factors as informed by drug prescribing information from the different manufacturers and published meta-analyses. The proportion of patients with pre-index AE risk factors prescribed an AA associated with that risk factor was then determined. Results A high proportion of patients (>80%) were prescribed an AA associated with extrapyramidal symptoms or akathisia despite experiencing extrapyramidal symptoms or akathisia prior to AA treatment initiation. Similar trends were observed among patients with diabetes (>60%) and obesity (>40%). From the nine treatment options available, the number of optimal choices for individual patient segments were limited based on their prior history, including those with cardiometabolic and cardiovascular comorbidities (four); experiencing prolactin elevation-related problems (seven); needing to avoid excessive sedation (four); or at risk of extrapyramidal symptoms or akathisia (two). Options were then further restricted among patients in more than one segment when multiple pre-index AE risk factors were combined. Conclusion When combining patient risk profile with antipsychotic AE profile, physicians may quickly run out of tolerable treatment options for individual patients, despite the availability of many AAs, suggesting a need for additional treatment options with better tolerability and without compromising efficacy. PMID:26719694

  5. The ProFHER (PROximal Fracture of the Humerus: Evaluation by Randomisation) trial - a pragmatic multicentre randomised controlled trial evaluating the clinical effectiveness and cost-effectiveness of surgical compared with non-surgical treatment for proximal fracture of the humerus in adults.

    PubMed Central

    Handoll, Helen; Brealey, Stephen; Rangan, Amar; Keding, Ada; Corbacho, Belen; Jefferson, Laura; Chuang, Ling-Hsiang; Goodchild, Lorna; Hewitt, Catherine; Torgerson, David

    2015-01-01

    BACKGROUND Proximal humeral fractures account for 5-6% of all fractures in adults. There is considerable variation in whether or not surgery is used in the management of displaced fractures involving the surgical neck. OBJECTIVE To evaluate the clinical effectiveness and cost-effectiveness of surgical compared with non-surgical treatment of the majority of displaced fractures of the proximal humerus involving the surgical neck in adults. DESIGN A pragmatic parallel-group multicentre randomised controlled trial with an economic evaluation. Follow-up was for 2 years. SETTING Recruitment was undertaken in the orthopaedic departments of 33 acute NHS hospitals in the UK. Patient care pathways included outpatient and community-based rehabilitation. PARTICIPANTS Adults (aged ≥ 16 years) presenting within 3 weeks of their injury with a displaced fracture of the proximal humerus involving the surgical neck. INTERVENTIONS The choice of surgical intervention was left to the treating surgeons, who used techniques with which they were experienced. Non-surgical treatment was initial sling immobilisation followed by active rehabilitation. Provision of rehabilitation was comparable in both groups. MAIN OUTCOME MEASURES The primary outcome was the Oxford Shoulder Score (OSS) assessed at 6, 12 and 24 months. Secondary outcomes were the 12-item Short Form health survey, surgical and other shoulder fracture-related complications, secondary surgery to the shoulder or increased/new shoulder-related therapy, medical complications during inpatient stay and mortality. European Quality of Life-5 Dimensions data and treatment costs were also collected. RESULTS The mean age of the 250 trial participants was 66 years and 192 (77%) were female. Independent assessment using the Neer classification identified 18 one-part fractures, 128 two-part fractures and 104 three- or four-part fractures. OSS data were available for 215 participants at 2 years. We found no statistically or clinically significant differences in OSS scores between the two treatment groups (scale 0-48, with a higher score indicating a better outcome) over the 2-year period [difference of 0.75 points in favour of the surgery group, 95% confidence interval (CI) -1.33 to 2.84; p = 0.479; data from 114 surgery and 117 non-surgery participants] or at individual time points. We found no statistically significant differences between surgical and non-surgical group participants in SF-12 physical or mental component summary scores; surgical or shoulder fracture-related complications (30 vs. 23 respectively); those undergoing further shoulder-related therapy, either surgery (11 vs. 11 respectively) or other therapy (seven vs. four respectively); or mortality (nine vs. five respectively). The base-case economic analysis showed that, at 2 years, the cost of surgical intervention was, on average, £1780.73 more per patient (95% CI £1152.71 to £2408.75) than the cost of non-surgical intervention. It was also slightly less beneficial in terms of utilities, although this difference was not statistically significant. The net monetary benefit associated with surgery is negative. There was only a 5% probability of surgery achieving the criterion of costing < £20,000 to gain a quality-adjusted life-year, which was confirmed by extensive sensitivity analyses. CONCLUSIONS Current surgical practice does not result in a better outcome for most patients with displaced fractures of the proximal humerus involving the surgical neck and is not cost-effective in the UK setting. Two areas for future work are the setting up of a national database of these fractures, including the collection of patient-reported outcomes, and research on the best ways of informing patients with these and other upper limb fractures about initial self-care. TRIAL REGISTRATION Current Controlled Trials ISRCTN50850043. FUNDING This project was funded by the NIHR Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 19, No. 24. See the NIHR Journals Library website for further project information. PMID:25822598

  6. Parents Online Portrayals of Pediatric Treatment and Research Options

    PubMed Central

    Schaffer, Rebecca; Henderson, Gail E.; Churchill, Larry R.; King, Nancy M. P.; Rothschild, Barbra B.; Lohser, Sara; Davis, Arlene M.

    2012-01-01

    Parents of seriously ill children face difficult decisions when standard therapies are limited or ineffective. In their search for information, they may turn to websites created by other parents facing similar experiences. We conducted a qualitative content analysis of 21 websites created by families with children affected by cancer or genetic disease, two serious conditions with a range of treatment and clinical trial options. Our research questions address how parent authors portray serious pediatric illness, available options, parties to decision making, and sources of influence. In addition, we examine what these sites reveal about family vulnerability to various risks, particularly the risk of misunderstanding the distinction between standard treatment and research and the risk of overestimating the likely benefits of research participation, as well as whether vulnerability varies by type of condition. Our results demonstrate typically favorable views on research, but with inadequate distinctions between research and treatment and a complex set of trade-offs in consideration of research risks and potential benefits. While portraits of vulnerability emerge for both parents and children, so do portraits of strength and resilience. As a result, parents describe frustration with both under- and over-protection from research participation. Our discussion of these findings clarifies the potential for parent-authored websites to inform and influence families considering research and treatment options for their seriously ill children. PMID:19754237

  7. Non-surgical stem cell delivery strategies and in vivo cell tracking to injured myocardium.

    PubMed

    van der Spoel, Tycho I G; Lee, Joe Chun-Tsu; Vrijsen, Krijn; Sluijter, Joost P G; Cramer, Maarten Jan M; Doevendans, Pieter A; van Belle, Eric; Chamuleau, Steven A J

    2011-03-01

    Heart failure is a major economic and public health problem. Despite the recent advances in drug therapy and coronary revascularization, the lost cardiomyocytes due to necrosis and apoptosis are not replaced by new myocardial tissue. Cell therapy is an interesting therapeutic option as it potentially improves contractility and restores regional ventricular function. Early clinical data demonstrated that cell transplantation, mainly delivered through non-surgical methods, is safe and feasible. However, several important issues need to be elucidated. This includes, next to determining the best cell type, the optimal delivery strategy, the biodistribution and the survival of implanted stem cells after transplantation. In this view, pre-clinical animal experiments are indispensable. Reporter genes, magnetic or radioactive labeling of stem cells have been developed to observe the fate and the distribution of transplanted cells using non-invasive imaging techniques. Several studies have demonstrated that these direct and non-direct labeling techniques may become an important tool in cell therapy. Integration of cell delivery and cell tracking will probably be a key for the success of cell therapy in patients. This review will provide a comprehensive overview on the various cell tracking and non-surgical cell delivery techniques, which are highly important in view of experimental and clinical studies. PMID:20577813

  8. Treatment Option Overview (Childhood Brain Stem Glioma Treatment)

    MedlinePLUS

    ... than usual. Changes in behavior. Trouble learning in school. Tests that examine the brain are used to ... Radiation therapy is a cancer treatment that uses high-energy x-rays or other types of radiation ...

  9. Carotid Stump Syndrome: Pathophysiology and Endovascular Treatment Options

    SciTech Connect

    Lakshminarayan, Raghuram; Scott, Paul M.; Robinson, Graham J.; Ettles, Duncan F.

    2011-02-15

    Carotid stump syndrome is one of the recognised causes of recurrent ipsilateral cerebrovascular events after occlusion of the internal carotid artery. It is believed that microemboli arising from the stump of the occluded internal carotid artery or the ipsilateral external carotid artery can pass into the middle cerebral artery circulation as a result of patent external carotid-internal carotid anastomotic channels. Different pathophysiologic causes of this syndrome and endovascular options for treatment are discussed.

  10. Complementary and Alternative Medicine Treatment Options for Otitis Media

    PubMed Central

    Marom, Tal; Marchisio, Paola; Tamir, Sharon Ovnat; Torretta, Sara; Gavriel, Haim; Esposito, Susanna

    2016-01-01

    Abstract Otitis media (OM) has numerous presentations in children. Together with conventional medical therapies aimed to prevent and/or treat OM, a rising number of complementary and alternative medicine (CAM) treatment options can be offered. Since OM is common in children, parents may ask healthcare professionals about possible CAM therapies. Many physicians feel that their knowledge is limited regarding these therapies, and that they desire some information. Therefore, we conducted a literature review of CAM therapies for OM, taking into account that many of these treatments, their validity and efficacy and have not been scientifically demonstrated. We performed a search in MEDLINE (accessed via PubMed) using the following terms: “CAM” in conjunction with “OM” and “children. Retrieved publications regarding treatment of OM in children which included these terms included randomized controlled trials, prospective/retrospective studies, and case studies. The following CAM options for OM treatment in children were considered: acupuncture, homeopathy, herbal medicine/phytotherapy, osteopathy, chiropractic, xylitol, ear candling, vitamin D supplement, and systemic and topical probiotics. We reviewed each treatment and described the level of scientific evidence of the relevant publications. The therapeutic approaches commonly associated with CAM are usually conservative, and do not include drugs or surgery. Currently, CAM is not considered by physicians a potential treatment of OM, as there is limited supporting evidence. Further studies are warranted in order to evaluate the potential value of CAM therapies for OM. PMID:26871802

  11. Management and treatment of stalkers: problems, options, and solutions.

    PubMed

    MacKenzie, Rachel D; James, David V

    2011-01-01

    Legal sanctions alone are often ineffective in preventing stalking because, in the absence of treatment, the fundamental problems driving the stalker remain unresolved. Criminal justice interventions can be problematic because of difficulties in framing anti-stalking legislation and inconsistencies in their application. Civil remedies in the form of restraining orders may be ineffective or counterproductive. Treatment of stalkers involves pharmacotherapy when mental illness is present, but the mainstays of treatment for non-psychotic stalkers are programmes of psychological intervention. These depend on accurate assessment of the risks inherent in stalking and on the identification of psychological deficits, needs, and responsivity factors specific to the individual. Treatment can then be tailored to suit the stalker, thereby enhancing therapeutic efficacy. Developing a framework for identifying the risk factors and shaping the delivery of treatment is crucial. Two service innovations developed specifically to work with stalkers are presented as options to overcome current management deficiencies. PMID:21351137

  12. Biological treatment options for cyanobacteria metabolite removal--a review.

    PubMed

    Ho, Lionel; Sawade, Emma; Newcombe, Gayle

    2012-04-01

    The treatment of cyanobacterial metabolites can consume many resources for water authorities which can be problematic especially with the recent shift away from chemical- and energy-intensive processes towards carbon and climate neutrality. In recent times, there has been a renaissance in biological treatment, in particular, biological filtration processes, for cyanobacteria metabolite removal. This in part, is due to the advances in molecular microbiology which has assisted in further understanding the biodegradation processes of specific cyanobacteria metabolites. However, there is currently no concise portfolio which captures all the pertinent information for the biological treatment of a range of cyanobacterial metabolites. This review encapsulates all the relevant information to date in one document and provides insights into how biological treatment options can be implemented in treatment plants for optimum cyanobacterial metabolite removal. PMID:22133838

  13. Vaginitis: Making Sense of Over-the-Counter Treatment Options

    PubMed Central

    B. Angotti, Lauren; C. Lambert, Lara; E. Soper, David

    2007-01-01

    Background. The FDA approved over-the-counter (OTC) use of vaginal antifungals in 1990. Subsequently, a plethora of OTC products have become available to women on drugstore shelves. Objectives. The purpose of this study was to determine the availability of OTC products marketed for the treatment of vaginitis and to determine if their efficacy had been confirmed by published prospective randomized control trials (RCTs). Materials and methods. The authors chose four retail locations frequented by women seeking vaginitis treatment. All products deemed a viable treatment option were purchased. Results. All intravaginal imidazoles purchased, regardless of treatment duration or active ingredient, were found to be of proven efficacy. We were unable to find an RCT confirming the effectiveness of vaginal anti-itch creams and homeopathic treatments for vaginitis. Conclusion. 45% of products available to women in the feminine hygiene section of the stores surveyed could not be confirmed to be effective for treating infectious vaginitis. PMID:18253469

  14. Chemical fixation increases options for hazardous waste treatment

    SciTech Connect

    Indelicato, G.J.; Tipton, G.A.

    1996-05-01

    The Hazardous and Solid Waste Amendments (HSWA) to the Resource Conservation and Recovery Act (RCRA) govern the manner in which hazardous materials are managed. Disposing RCRA hazardous wastes on or in the land is no longer an accepted remedial option. This land disposal restriction requires that all listed and characteristic hazardous wastes must be treated according to specified standards before they are disposed. These treatment standards define technologies and concentration limits. Hazardous wastes that do not meet the standards are prohibited from being disposed on land, such as in landfills, surface impoundments, land treatment units, injection wells, and mines or caves.

  15. Current treatment options in (peri)myocarditis and inflammatory cardiomyopathy.

    PubMed

    Maisch, B; Pankuweit, S

    2012-09-01

    In inflammatory dilated cardiomyopathy and myocarditis there is--apart from heart failure and antiarrhythmic therapies--no alternative to an aetiologically driven specific treatment. Prerequisite are noninvasive and invasive biomarkers including endomyocardial biopsy and PCR on cardiotropic agents. This review deals with the different etiologies of myocarditis and inflammatory cardiomyopathy including the genetic background, the predisposition for heart failure and inflammation. It analyses the epidemiologic shift in pathogenetic agents in the last 20 years, the role of innate and aquired immunity including the T- and B-cell driven immune responses. The phases and clinical faces of myocarditis are summarized. Up-to-date information on current treatment options starting with heart failure and antiarrhythmic therapy are provided. Although inflammation can resolve spontaneously, specific treatment directed to the causative aetiology is often required. For fulminant, acute and chronic autoreactive myocarditis immunosuppressive treatment is beneficial, while for viral cardiomyopathy and myocarditis ivIg can resolve inflammation and is as successful as interferon therapy in enteroviral and adenoviral myocarditis. For Parvo B19 and HHV6 myocarditis eradication of the virus is still a problem by any of these treatment options. Finally, the potential of stem cell therapy has to be tested in future trials. In virus-negative, autoreactive perimyocardial disease a locoregional approach with intrapericardial instillation of high local doses of triamcinolone acetate has been shown to be highly efficient and with few systemic side-effects. PMID:22996288

  16. Eosinophilic pustular folliculitis: a comprehensive review of treatment options.

    PubMed

    Ellis, Elliot; Scheinfeld, Noah

    2004-01-01

    Eosinophilic pustular folliculitis (EPF), also known as Ofuji disease, is a disease that manifests with follicular papules or pustules. Its variants include a classic type that occurs most commonly in Japan, an HIV-associated type, an infantile type, a type that occurs on the palms and soles, a rare medication-associated variant, and a rare neoplasia-associated variant.A wide range of medications has been used to treat EPF. Topical corticosteroids are the first-line treatment option for EPF. Topical tacrolimus seems to be useful initial therapy as well. Oral indometacin (50-75 mg/day) is an effective treatment of classic EPF although it can induce peptic ulcers. For treatment of HIV-associated EPF when topical corticosteroids and indometacin do not work, various other treatments should be considered. These treatment options include cetirizine 20-40 mg/day, metronidazole 250 mg three times a day, itraconazole starting at a dosage of 200 mg/day and increasing to 300-400 mg/day, and topical permethrin. If these treatments do not work phototherapy with UVB is the 'gold standard' of treatment and is often curative. Treatments with less certain risk-benefit ratios but with some efficacy include PUVA (psoralen + UVA) photochemotherapy, oral corticosteroids, synthetic retinoids (i.e. isotretinoin 1 mg/kg/day), and acitretin (0.5 mg/kg/day), oral cyclosporine (ciclosporine) 5 mg/kg/day, interferon (IFN)-alpha-2b, and IFNgamma. Minocycline 100mg twice daily and dapsone 50-100mg twice daily have been used with some effect. The use of highly active antiretroviral therapy for HIV has resulted in the amelioration of EPF as CD4 cell counts rise above 250/mm(3). The diversity of clinical presentations and affected populations make it seem that EPF is a reaction pattern as much as a disease and that therapy should be tailored to the variant of EPF and the underlying etiology. PMID:15186198

  17. Managing AVN following internal fixation: treatment options and clinical results.

    PubMed

    Hoskinson, Simon; Morison, Zachary; Shahrokhi, Shahram; Schemitsch, Emil H

    2015-03-01

    Avascular necrosis (AVN) after internal fixation of intracapsular hip fractures is a progressive multifactorial disease that ultimately results in local ischemia with ensuing osteocyte necrosis and structural compromise. This disease can cause significant clinical morbidity and affects patients of any age, including young and active patients. Effective treatment of this condition among young adults is challenging due to their high functional demands. The aim of managing AVN is to relieve pain, preserve range of movement and improve function. Treatment methods vary depending on the stage of the disease and can be broadly categorised into two options, hip preserving surgery and hip arthroplasty. Although, hip preserving techniques are attractive in the young adult, they may alter the morphology of the proximal femur and make subsequent arthroplasty more challenging. Conversely, arthroplasty in the young adult may require repeat revision procedures throughout the patient's life. Current evidence suggests that modifications of prevailing treatments, in addition to new technologies, have led to the development of management strategies that may be able to alter the course of femoral head osteonecrosis. This review aims to summarise the options available for treatment of AVN in the young adult and review the clinical results. PMID:25548114

  18. [Traumatic thoracic aorta rupture: preclinical assessment, diagnosis and treatment options].

    PubMed

    Kopp, R; Andrassy, J; Czerner, S; Weidenhagen, A; Weidenhagen, R; Meimarakis, G; Reiser, M; Jauch, K W

    2008-08-01

    Traumatic aortic rupture is a life-threatening injury which is frequently associated with blunt thoracic trauma or found coincidentally in heavily traumatized patients. Depending on the degree of disruption of the damaged aortic wall, vascular injury is associated with a high primary mortality rate and a significant risk of secondary aortic rupture. Early clinical signs which may indicate a ruptured thoracic aorta are left sided thoracic pain, reduced ventilation, tachycardia and dyspnoe as well as hypotension in the lower extremities. The primary aim for emergency treatment is to maintain vital organ function and to hemodynamically stabilize the patient. Surgical treatment was previously performed by either direct aortic suture or segmental alloplastic graft interposition using the clamp and sew technique with or without extra-anatomic shunts or extracorporeal circulation. However, endovascular stent graft implantation has now become another treatment option for traumatic aortic rupture. According to the reported data and our own experience there is increasing evidence that endovascular aortic repair might become the treatment of choice for patients with traumatic aortic rupture, with the option of an early, less invasive intervention thus avoiding thoracotomy. Regular follow-up is necessary to detect possible stent graft migration or leakage which could require additional endovascular or open surgical re-interventions. PMID:18463834

  19. Options and opportunities for clinical management and treatment of psoriasis.

    PubMed

    Agrawal, Udita; Gupta, Madhu; Dube, Devyani; Vyas, Suresh P

    2013-01-01

    Psoriasis is a complex, multifactorial disease that appears to be influenced by immune-mediated components. For many years the pathogenesis of psoriasis has been discordant; the clinical picture suggested that the psoriasis was secondary to abnormal keratinocyte proliferation and differentiation, but later the role of the T cell was revealed. A variety of treatment options range from topical agents (e.g., coal tar, dithranol, and emollients for milder forms) to systemic agents (i.e., methotrexate or cyclosporin), and phototherapy. Recently, biologics have been added to this list that target particular steps in the immune or inflammatory pathways. Various nanocarriers (e.g., liposomes, niosomes, and microemulsions) have been successfully exploited for the delivery of several antipsoriatic drugs. This review provides insight into various psoriasis treatment strategies-from conventional to novel-currently in use or in development as well as the novel targets that have been explored and/or investigated for anti-psoriatic therapy. The pathogenesis of psoriasis and some of the topical, systemic biological, and novel approaches currently in use or in development are reviewed here. The pros and cons of each treatment strategy are presented, as are some of the animal models used to study features reminiscent of psoriasis. This information can be used to better the understanding of treatment options for this disease. PMID:23510110

  20. Treatment Options for Breast Cancer Resistant to Anthracycline and Taxane

    PubMed Central

    Moreno-Aspitia, Alvaro; Perez, Edith A.

    2009-01-01

    Breast cancer is the most common noncutaneous malignancy among every major ethnic group of women in the United States. Anthracyclines and taxanes are the most active and widely used chemotherapeutic agents for breast cancer, but the increased use of these agents at an early stage of disease often renders tumors resistant to these drugs by the time the disease recurs, thereby reducing the number of treatment options for metastatic disease. Moreover, even when these agents can be used in the metastatic setting, treatment failure occurs in most cases, and as a result the 5-year survival rates of patients with metastatic breast cancer are low. This outcome underscores the need for new, effective treatments of metastatic breast cancer and has led to investigation of novel ways to overcome the problem of drug resistance. This article reviews the current treatment options for breast cancer resistant to anthracycline and taxane and provides recommendations for disease management. Published sources for this review were found by searching PubMed (https://www.ncbi.nlm.nih.gov/pubmed) and congress Web sites. PMID:19483170

  1. Ragweed-induced allergic rhinoconjunctivitis: current and emerging treatment options.

    PubMed

    Ihler, Friedrich; Canis, Martin

    2015-01-01

    Ragweed (Ambrosia spp.) is an annually flowering plant whose pollen bears high allergenic potential. Ragweed-induced allergic rhinoconjunctivitis has long been seen as a major immunologic condition in Northern America with high exposure and sensitization rates in the general population. The invasive occurrence of ragweed (A. artemisiifolia) poses an increasing challenge to public health in Europe and Asia as well. Possible explanations for its worldwide spread are climate change and urbanization, as well as pollen transport over long distances by globalized traffic and winds. Due to the increasing disease burden worldwide, and to the lack of a current and comprehensive overview, this study aims to review the current and emerging treatment options for ragweed-induced rhinoconjunctivitis. Sound clinical evidence is present for the symptomatic treatment of ragweed-induced allergic rhinoconjunctivitis with oral third-generation H1-antihistamines and leukotriene antagonists. The topical application of glucocorticoids has also been efficient in randomized controlled clinical trials. Combined approaches employing multiple agents are common. The mainstay of causal treatment to date, especially in Northern America, is subcutaneous immunotherapy with the focus on the major allergen, Amb a 1. Beyond this, growing evidence from several geographical regions documents the benefit of sublingual immunotherapy. Future treatment options promise more specific symptomatic treatment and fewer side effects during causal therapy. Novel antihistamines for symptomatic treatment are aimed at the histamine H3-receptor. New adjuvants with toll-like receptor 4 activity or the application of the monoclonal anti-immunoglobulin E antibody, omalizumab, are supposed to enhance conventional immunotherapy. An approach targeting toll-like receptor 9 by synthetic cytosine phosphate-guanosine oligodeoxynucleotides promises a new treatment paradigm that aims to modulate the immune response, but it has yet to be proven in clinical trials. PMID:25733916

  2. Ragweed-induced allergic rhinoconjunctivitis: current and emerging treatment options

    PubMed Central

    Ihler, Friedrich; Canis, Martin

    2015-01-01

    Ragweed (Ambrosia spp.) is an annually flowering plant whose pollen bears high allergenic potential. Ragweed-induced allergic rhinoconjunctivitis has long been seen as a major immunologic condition in Northern America with high exposure and sensitization rates in the general population. The invasive occurrence of ragweed (A. artemisiifolia) poses an increasing challenge to public health in Europe and Asia as well. Possible explanations for its worldwide spread are climate change and urbanization, as well as pollen transport over long distances by globalized traffic and winds. Due to the increasing disease burden worldwide, and to the lack of a current and comprehensive overview, this study aims to review the current and emerging treatment options for ragweed-induced rhinoconjunctivitis. Sound clinical evidence is present for the symptomatic treatment of ragweed-induced allergic rhinoconjunctivitis with oral third-generation H1-antihistamines and leukotriene antagonists. The topical application of glucocorticoids has also been efficient in randomized controlled clinical trials. Combined approaches employing multiple agents are common. The mainstay of causal treatment to date, especially in Northern America, is subcutaneous immunotherapy with the focus on the major allergen, Amb a 1. Beyond this, growing evidence from several geographical regions documents the benefit of sublingual immunotherapy. Future treatment options promise more specific symptomatic treatment and fewer side effects during causal therapy. Novel antihistamines for symptomatic treatment are aimed at the histamine H3-receptor. New adjuvants with toll-like receptor 4 activity or the application of the monoclonal anti-immunoglobulin E antibody, omalizumab, are supposed to enhance conventional immunotherapy. An approach targeting toll-like receptor 9 by synthetic cytosine phosphate–guanosine oligodeoxynucleotides promises a new treatment paradigm that aims to modulate the immune response, but it has yet to be proven in clinical trials. PMID:25733916

  3. Radiofrequency ablation for treatment of hypersplenism: A feasible therapeutic option

    PubMed Central

    Martins, Guilherme Lopes P; Bernardes, Joao Paulo G; Rovella, Marcello S; Andrade, Raphael G; Viana, Publio Cesar C; Herman, Paulo; Cerri, Giovanni Guido; Menezes, Marcos Roberto

    2015-01-01

    We present a case of a patient with hypersplenism secondary to portal hypertension due to hepato-splenic schistosomiasis, which was accompanied by severe and refractory thrombocytopenia. We performed spleen ablation and measured the total spleen and ablated volumes with contrast-enhanced computed tomography and volumetry. No major complications occurred, thrombocytopenia was resolved, and platelet levels remained stable, which allowed for early treatment of the patients underlying disease. Previous work has shown that splenic radiofrequency ablation is an attractive alternative treatment for hypersplenism induced by liver cirrhosis. We aimed to contribute to the currently sparse literature evaluating the role of radiofrequency ablation (RFA) in the management of hypersplenism. We conclude that splenic RFA appears to be a viable and promising option for the treatment of hypersplenism. PMID:26034376

  4. Is deep brain stimulation a treatment option for anorexia nervosa?

    PubMed Central

    2013-01-01

    Anorexia nervosa (AN) is a severe psychiatric disorder with high rates of morbidity, comorbidity and mortality, which in a subset of patients (21%) takes on a chronic course. Since an evidence based treatment for AN is scarce, it is crucial to investigate new treatment options, preferably focused on influencing the underlying neurobiological mechanisms of AN. The objective of the present paper was to review the evidence for possible neurobiological correlates of AN, and to hypothesize about potential targets for Deep brain stimulation (DBS) as a treatment for chronic, therapy-refractory AN. One avenue for exploring new treatment options based on the neurobiological correlates of AN, is the search for symptomatologic and neurobiologic parallels between AN and other compulsivity- or reward-related disorders. As in other compulsive disorders, the fronto-striatal circuitry, in particular the insula, the ventral striatum (VS) and the prefrontal, orbitofrontal, temporal, parietal and anterior cingulate cortices, are likely to be implicated in the neuropathogenesis of AN. In this paper we will review the few available cases in which DBS has been performed in patients with AN (either as primary diagnosis or as comorbid condition). Given the overlap in symptomatology and neurocircuitry between reward-related disorders such as obsessive compulsive disorder (OCD) and AN, and the established efficacy of accumbal DBS in OCD, we hypothesize that DBS of the nucleus accumbens (NAc) and other areas associated with reward, e.g. the anterior cingulated cortex (ACC), might be an effective treatment for patients with chronic, treatment refractory AN, providing not only weight restoration, but also significant and sustained improvement in AN core symptoms and associated comorbidities and complications. Possible targets for DBS in AN are the ACC, the ventral anterior limb of the capsula interna (vALIC) and the VS. We suggest conducting larger efficacy studies that also explore the functional effects of DBS in AN. PMID:24175936

  5. Treatment options of inflammatory appendiceal masses in adults

    PubMed Central

    Tannoury, Jenny; Abboud, Bassam

    2013-01-01

    At present, the treatment of choice for uncomplicated acute appendicitis in adults continues to be surgical. The inflammation in acute appendicitis may sometimes be enclosed by the patient’s own defense mechanisms, by the formation of an inflammatory phlegmon or a circumscribed abscess. The management of these patients is controversial. Immediate appendectomy may be technically demanding. The exploration often ends up in an ileocecal resection or a right-sided hemicolectomy. Recently, the conditions for conservative management of these patients have changed due to the development of computed tomography and ultrasound, which has improved the diagnosis of enclosed inflammation and made drainage of intra-abdominal abscesses easier. New efficient antibiotics have also given new opportunities for nonsurgical treatment of complicated appendicitis. The traditional management of these patients is nonsurgical treatment followed by interval appendectomy to prevent recurrence. The need for interval appendectomy after successful nonsurgical treatment has recently been questioned because the risk of recurrence is relatively small. After successful nonsurgical treatment of an appendiceal mass, the true diagnosis is uncertain in some cases and an underlying diagnosis of cancer or Crohn’s disease may be delayed. This report aims at reviewing the treatment options of patients with enclosed appendiceal inflammation, with emphasis on the success rate of nonsurgical treatment, the need for drainage of abscesses, the risk of undetected serious disease, and the need for interval appendectomy to prevent recurrence. PMID:23840138

  6. Tackling sleeplessness: psychological treatment options for insomnia in older adults

    PubMed Central

    Dzierzewski, Joseph M; O’Brien, Erin M; Kay, Daniel; McCrae, Christina S

    2010-01-01

    This paper provides a broad review of the extant literature involving the treatment of sleeplessness in older adults with insomnia. First, background information (including information regarding key issues in late-life insomnia and epidemiology of late-life insomnia) pertinent to achieving a general understanding of insomnia in the elderly is presented. Next, theories of insomnia in older adults are examined and discussed in relation to treatment of insomnia in late-life. With a general knowledge base provided, empirical evidence for both pharmacological (briefly) and psychological treatment options for insomnia in late-life are summarized. Recent advances in the psychological treatment of insomnia are provided and future directions are suggested. This review is not meant to be all-inclusive; however, it is meant to provide professionals across multiple disciplines (physicians; psychologists; applied and basic researchers) with a mix of breadth and depth of knowledge related to insomnia in late-life. It is our hope that readers will see the evidence in support of psychological treatments for late-life insomnia, and the utility in continuing to investigate this treatment modality. PMID:22323897

  7. The Meniscus-Deficient Knee: Biomechanics, Evaluation, and Treatment Options.

    PubMed

    Rao, Allison J; Erickson, Brandon J; Cvetanovich, Gregory L; Yanke, Adam B; Bach, Bernard R; Cole, Brian J

    2015-10-01

    Meniscal tears are the most common knee injury, and partial meniscectomies are the most common orthopaedic surgical procedure. The injured meniscus has an impaired ability to distribute load and resist tibial translation. Partial or complete loss of the meniscus promotes early development of chondromalacia and osteoarthritis. The primary goal of treatment for meniscus-deficient knees is to provide symptomatic relief, ideally to delay advanced joint space narrowing, and ultimately, joint replacement. Surgical treatments, including meniscal allograft transplantation (MAT), high tibial osteotomy (HTO), and distal femoral osteotomy (DFO), are options that attempt to decrease the loads on the articular cartilage of the meniscus-deficient compartment by replacing meniscal tissue or altering joint alignment. Clinical and biomechanical studies have reported promising outcomes for MAT, HTO, and DFO in the postmeniscectomized knee. These procedures can be performed alone or in conjunction with ligament reconstruction or chondral procedures (reparative, restorative, or reconstructive) to optimize stability and longevity of the knee. Complications can include fracture, nonunion, patella baja, compartment syndrome, infection, and deep venous thrombosis. MAT, HTO, and DFO are effective options for young patients suffering from pain and functional limitations secondary to meniscal deficiency. PMID:26779547

  8. Gastroparesis: A Review of Current Diagnosis and Treatment Options.

    PubMed

    Stein, Benjamin; Everhart, Kelly K; Lacy, Brian E

    2015-08-01

    Gastroparesis (GP) is a chronic neuromuscular disorder of the upper gastrointestinal tract. The incidence of GP is not well described; however, the number of individuals affected by symptoms of GP in the United States is estimated to be over 4 million. The etiology of GP is diverse. Approximately 25% of cases are associated with diabetes, whereas nearly 50% are classified as idiopathic; many of these latter cases likely represent a postinfectious process. Connective tissue disorders, autoimmune disorders, prior gastric surgery, ischemia, and medications make up the vast majority of the remaining cases. The pathophysiology of GP is also diverse. Abnormalities in fundic tone, antroduodenal dyscoordination, a weak antral pump, gastric dysrhythmias, and abnormal duodenal feedback all contribute to delays in gastric emptying and symptom expression. Characteristic symptoms of GP include nausea, vomiting, epigastric pain, early satiety, and weight loss. The diagnosis of GP is made using a combination of characteristic symptoms in conjunction with objective evidence of delayed gastric emptying in the absence of mechanical obstruction. Once the diagnosis is made, treatment options include dietary modification, medications to accelerate gastric emptying, antiemetic agents, gastric electrical stimulation, and surgery. In the following sections we will provide an overview of the health care impact of GP, describe the underlying pathophysiology, and review treatment options using an evidence-based approach. PMID:25874755

  9. Clinical outcomes in surgical and non-surgical management of hepatic portal venous gas

    PubMed Central

    Yoo, Soo-Kyung; Park, Jong-Hoon

    2015-01-01

    Backgrounds/Aims Hepatic portal venous gas (HPVG) is a rare condition, with poor prognosis and a mortality rate of up to 75%. Indications for surgical and non-surgical management of HPVG including associated complications and mortality remain to be clarified. Methods From January 2008 to December 2014, 18 patients with HPVG diagnosed through abdominal computed tomography (CT) imaging were retrospectively identified. Clinical symptoms, laboratory data, underlying diseases, treatment, and mortality rate were analyzed. Patients were classified into 2 groups: surgical management recommended (SR, n=10) and conservative management (CM, n=8). The SR group was further subdivided into patients who underwent surgical management (SM-SR, n=5) and those who were managed conservatively (NS-SR, n=5). Results Conditions underlying HPVG included mesenteric ischemia (38.9%), intestinal obstruction (22.2%), enteritis (22.2%), duodenal ulcer perforation (5.6%), necrotizing pancreatitis (5.6%), and diverticulitis (5.6%). In terms of mortality, 2 patients (40%) died in the SM-SR group, 1 (12.5%) in the CM group, and 100% in the NS-SR group. Higher scores from Acute Physiology and Chronic Health Evaluation (APACHE) II predicted the mortality rates of the NS-SR and CM groups. Conclusions Identification of HPVG requires careful consideration for surgical management. If surgical management is indicated, prompt laparotomy should be performed. However, even in the non-surgical management condition, aggressive laparotomy can improve survival rates for patients with high APACHE II scores. PMID:26693238

  10. Pulmonary hypertension 2015: current definitions, terminology, and novel treatment options.

    PubMed

    Rosenkranz, Stephan

    2015-03-01

    Pulmonary hypertension (PH) is a common phenomenon that may occur as a consequence of various diseases (e.g., heart failure, chronic lung diseases, and pulmonary embolism), as a distinct disease of the small pulmonary arterioles, or a combination of both. Independently from the origin, PH has important impact on patients symptoms and life expectancy. The establishment of an exact diagnosis and classification, as well as the understanding of the hemodynamic interrelations, provides the basis for often challenging treatment decisions. Recently, the 5th World Symposium on PH took place in Nice, France, where important standards and definitions were specified. Furthermore, the results of recent phase III trials have led to the approval of new targeted therapies. The most relevant developments including the rating of novel treatment options are summarized in this article. PMID:25479818

  11. New treatment options for the management of restless leg syndrome.

    PubMed

    Toro, Beatriz Elizabeth Carmona

    2014-08-01

    Restless leg syndrome (RLS), also known as Willis-Ekbom disease, is a condition that includes sensations such as crawling, tingling, or aching in the limbs and creates an urge to move. The prevalence is estimated at 3% to 15% of the population and may present as primary RLS or secondary RLS. Secondary RLS may be a result of some medications, iron deficiency, or conditions such as neuropathies, or it may be related to pregnancy. The guidelines for diagnosis, which is usually made on clinical presentation, are discussed in the article. Medication use is not always necessary in the management of RLS. Multiple options are available and are reviewed within the article. Since 2011, two medications have been approved for the treatment of RLS, and these are discussed in detail. Neupro (rotigotine) is a dopamine agonist available as a patch that has been approved for the treatment of RLS as well as Parkinson disease. One of the major issues in treating RLS with dopamine agonists is augmentation, meaning symptoms occur earlier in the day due to medication use. This rate of augmentation with use of rotigotine is significantly lower than other dopamine agonists. Horizant (gabapentin enacarbil) is the only nondopaminergic medication approved for the treatment of RLS. Bioavailability is greater in gabapentin enacarbil as compared to gabapentin. Augmentation has not been associated with gabapentin or gabapentin enacarbil. Neupro (rotigotine) and Horizant (gabapentin enacarbil) provide additional treatment options for patients with RLS who are in need of medications. Consideration of each individual patient is necessary when determining if medication is needed and in choosing the appropriate agent. PMID:24992148

  12. [Non-surgical therapy of pancreatitis complications (pseudocyst, abscesses, stenoses)].

    PubMed

    Singer, M V; Forssmann, K

    1994-08-01

    Acute and chronic pseudocysts differ. Chronic pseudocysts develop during the evolution of chronic pancreatitis unrelated to a specific bout of clinically recognizable acute pancreatitis. Acute pseudocysts arise in conjunction with an episode of acute pancreatitis. Whereas until recently surgical therapy has been the standard treatment for acute (or chronic) pancreatic pseudocysts, a range of nonsurgical options has been developed. The most important nonsurgical treatment of all is to watch and wait. Pseudocysts following acute pancreatitis should be observed when they are truly asymptomatic and less than or equal to 6 cm in diameter and left alone if not increasing in size. Only if after a six-week observation period pancreatic pseudocysts increase in diameter and become symptomatic, percutaneous needle aspiration, catheter drainage or an endoscopic drainage procedure (cystogastrostomy/cystoduodenostomy) or ultimately operative drainage procedure should be considered. Antibiotic therapy should be considered for all patients presenting with pancreatic necrosis. They should be treated with drugs administered intravenously at the maximum recommended dose as early as possible after onset of symptoms, continued throughout at least the first two weeks of the disease. Moreover, they should be treated alone and/or in combination with antibiotics that are active against gram-negative organisms of intestinal origin, commonly isolated in necrotic tissue, pseudocysts and infected pancreatic abscesses, and that are capable of penetrating into the pancreatic juice and necrotic tissue (e.g. mezlocillin, cephalosporin, metronidazole). Removal of pancreatic stones and pancreatic stenosis by endoscopic procedures in the treatment of pain in patients with chronic pancreatitis is still not an established and generally accepted treatment. Controlled trials to validate stenting and ESWL in chronic pancreatitis are needed. PMID:8091055

  13. Melatonin receptor agonists: new options for insomnia and depression treatment.

    PubMed

    Spadoni, Gilberto; Bedini, Annalida; Rivara, Silvia; Mor, Marco

    2011-12-01

    The circadian nature of melatonin (MLT) secretion, coupled with the localization of MLT receptors to the suprachiasmatic nucleus, has led to numerous studies of the role of MLT in modulation of the sleep-wake cycle and circadian rhythms in humans. Although much more needs to be understood about the various functions exerted by MLT and its mechanisms of action, three therapeutic agents (ramelteon, prolonged-release MLT, and agomelatine) are already in use, and MLT receptor agonists are now appearing as new promising treatment options for sleep and circadian-rhythm related disorders. In this review, emphasis has been placed on medicinal chemistry strategies leading to MLT receptor agonists, and on the evidence supporting therapeutic efficacy of compounds undergoing clinical evaluation. A wide range of clinical trials demonstrated that ramelteon, prolonged-release MLT and tasimelteon have sleep-promoting effects, providing an important treatment option for insomnia and transient insomnia, even if the improvements of sleep maintenance appear moderate. Well-documented effects of agomelatine suggest that this MLT agonist offers an attractive alternative for the treatment of depression, combining efficacy with a favorable side effect profile. Despite a large number of high affinity nonselective MLT receptor agonists, only limited data on MT? or MT? subtype-selective compounds are available up to now. Administration of the MT?-selective agonist IIK7 to rats has proved to decrease NREM sleep onset latency, suggesting that MT? receptor subtype is involved in the acute sleep-promoting action of MLT; rigorous clinical studies are needed to demonstrate this hypothesis. Further clinical candidates based on selective activation of MT? or MT? receptors are expected in coming years. PMID:21554566

  14. Guanfacine Extended Release: A New Pharmacological Treatment Option in Europe.

    PubMed

    Huss, Michael; Chen, Wai; Ludolph, Andrea G

    2016-01-01

    Children/adolescents with attention-deficit/hyperactivity disorder (ADHD) may have a poor or inadequate response to psychostimulants or be unable to tolerate their side-effects; furthermore, stimulants may be inappropriate because of co-existing conditions. Only one non-stimulant ADHD pharmacotherapy, the noradrenaline transporter inhibitor atomoxetine, is currently approved for use in Europe. We review recent advances in understanding of the pathophysiology of ADHD with a focus on the roles of catecholamine receptors in context of the α2A-adrenergic receptor agonist guanfacine extended release (GXR), a new non-stimulant treatment option in Europe. Neuroimaging studies of children/adolescents with ADHD show impaired brain maturation, and structural and functional anomalies in brain regions and networks. Neurobiological studies in ADHD and medication response patterns support involvement of monoaminergic neurotransmitters (primarily dopamine and noradrenaline). Guanfacine is a selective α2A-adrenergic receptor agonist that has been shown to improve prefrontal cortical cognitive function, including working memory. The hypothesized mode of action of guanfacine centres on direct stimulation of post-synaptic α2A-adrenergic receptors to enhance noradrenaline neurotransmission. Preclinical data suggest that guanfacine also influences dendritic spine growth and maturation. Clinical trials have demonstrated the efficacy of GXR in ADHD, and it is approved as monotherapy or adjunctive therapy to stimulants in Canada and the USA (for children and adolescents). GXR was approved recently in Europe for the treatment of ADHD in children and adolescents for whom stimulants are not suitable, not tolerated or have been shown to be ineffective. GXR may provide particular benefit for children/adolescents who have specific co-morbidities such as chronic tic disorders or oppositional defiant disorder (or oppositional symptoms) that have failed to respond to first-line treatment options. PMID:26585576

  15. Current and emerging treatment options for Peyronies disease

    PubMed Central

    Gokce, Ahmet; Wang, Julie C; Powers, Mary K; Hellstrom, Wayne JG

    2013-01-01

    Peyronies disease (PD) is a condition of the penis, characterized by the presence of localized fibrotic plaque in the tunica albuginea. PD is not an uncommon disorder, with recent epidemiologic studies documenting a prevalence of 39% of adult men affected. The actual prevalence of PD may be even higher. It is often associated with penile pain, anatomical deformities in the erect penis, and difficulty with intromission. As the definitive pathophysiology of PD has not been completely elucidated, further basic research is required to make progress in the understanding of this enigmatic condition. Similarly, research on effective therapies is limited. Currently, nonsurgical treatments are used for those men who are in the acute stage of PD, whereas surgical options are reserved for men with established PD who cannot successfully penetrate. Intralesional treatments are growing in clinical popularity as a minimally invasive approach in the initial treatment of PD. A surgical approach should be considered when men with PD do not respond to conservative, medical, or minimally invasive therapies for approximately 1 year and cannot have satisfactory sexual intercourse. As scientific breakthroughs in the understanding of the mechanisms of this disease process evolve, novel treatments for the many men suffering with PD are anticipated. PMID:24400231

  16. An Update on Medical Treatment Options for Hidradenitis Suppurativa.

    PubMed

    Deckers, I E; Prens, E P

    2016-02-01

    Hidradenitis suppurativa (HS) is a chronic inflammatory skin disease characterized by recurrent inflammatory nodules mostly located in the armpits and groin. Over the years multiple treatments for HS have been proposed; however, to date a cure is still lacking. In this update we provide an overview of most drug treatments reported on for HS, where possible with their mode of action and side effects. In mild cases, clindamycin lotion or resorcinol cream have proven effective. Tetracyclines are a first-line systemic option in more widespread or severe cases, followed by the combination of clindamycin and rifampicin. However, the recurrence rate is high after discontinuation of clindamycin plus rifampicin combination therapy. Long-term treatment with retinoids, especially acitretin is feasible, although teratogenicity has to be taken into account in females of reproductive age. Multiple anti-inflammatory drugs have been suggested for HS, such as dapsone, fumarates or cyclosporine. However, their effectiveness in HS is based on small case series with varying results. If most common treatments have failed, biologics (e.g., infliximab or adalimumab) are the next step. Although not addressed in this review, surgical interventions are often needed to achieve remission. PMID:26659474

  17. Current treatment options for colon cancer peritoneal carcinomatosis

    PubMed Central

    Aoyagi, Tomoyoshi; Terracina, Krista P; Raza, Ali; Takabe, Kazuaki

    2014-01-01

    Peritoneal carcinomatosis (PC), the dissemination of cancer cells throughout the lining of the abdominal cavity, is the second most common presentation of colon cancer distant metastasis. Despite remarkable advances in cytotoxic chemotherapy and targeted therapy for colon cancer over the last 15 years, it has been repeatedly shown that these therapies remain ineffective for colon cancer PC. Recently, there has been a rapid accumulation of reports that cytoreductive surgery combined with hyperthermic intraperitoneal chemotherapy (CRS-HIPEC) prolongs the life of colon cancer PC patients. Here, we will review the clinical presentation, the mechanisms of disease progression, and current treatment options for colon cancer PC, with a focus on the benefits and limitations of CRS-HIPEC. PMID:25253949

  18. Philadelphia-positive acute lymphoblastic leukemia: current treatment options.

    PubMed

    Liu-Dumlao, Theresa; Kantarjian, Hagop; Thomas, Deborah A; O'Brien, Susan; Ravandi, Farhad

    2012-10-01

    The Philadelphia chromosome (Ph), t(9;22), is seen in about 20% to 30% of adults diagnosed with acute lymphoblastic leukemia (ALL). It has been associated with poorer prognosis compared with Ph-negative ALL. Tyrosine kinase inhibitors (TKIs) targeting the BCR-ABL oncogenic protein from this translocation have been incorporated into treatment regimens used to treat patients with Ph-positive ALL. Imatinib has been the most widely used TKI with several published trials showing it produced better outcomes when combined with chemotherapy. Dasatinib, a more potent inhibitor than imatinib, has also been evaluated with promising results. However, relapses still occur at a high rate, and allogeneic stem cell transplant is considered, so far, a better curative option in first remission. Additional strategies have also included incorporation of TKIs in the post-transplant setting and the use of newer third generation TKIs. This review provides an update on emerging therapies for adults with Ph-positive ALL. PMID:22669492

  19. Philadelphia-Positive Acute Lymphoblastic Leukemia: Current Treatment Options

    PubMed Central

    Liu-Dumlao, Theresa; Kantarjian, Hagop; Thomas, Deborah A.; OBrien, Susan

    2014-01-01

    The Philadelphia chromosome (Ph), t(9;22), is seen in about 20 % to 30 % of adults diagnosed with acute lymphoblastic leukemia (ALL). It has been associated with poorer prognosis compared with Ph-negative ALL. Tyrosine kinase inhibitors (TKIs) targeting the BCR-ABL oncogenic protein from this translocation have been incorporated into treatment regimens used to treat patients with Ph-positive ALL. Imatinib has been the most widely used TKI with several published trials showing it produced better outcomes when combined with chemotherapy. Dasatinib, a more potent inhibitor than imatinib, has also been evaluated with promising results. However, relapses still occur at a high rate, and allogeneic stem cell transplant is considered, so far, a better curative option in first remission. Additional strategies have also included incorporation of TKIs in the posttransplant setting and the use of newer third generation TKIs. This review provides an update on emerging therapies for adults with Ph-positive ALL. PMID:22669492

  20. An emerging treatment option for glaucoma: Rho kinase inhibitors

    PubMed Central

    Wang, Sean K; Chang, Robert T

    2014-01-01

    Rho kinase (ROCK) inhibitors are a novel potential class of glaucoma therapeutics with multiple compounds currently in Phase II and III US Food and Drug Administration trials in the United States. These selective agents work by relaxing the trabecular meshwork through inhibition of the actin cytoskeleton contractile tone of smooth muscle. This results in increased aqueous outflow directly through the trabecular meshwork, achieving lower intraocular pressures in a range similar to prostaglandins. There are also animal studies indicating that ROCK inhibitors may improve blood flow to the optic nerve, increase ganglion cell survival, and reduce bleb scarring in glaucoma surgery. Given the multiple beneficial effects for glaucoma patients, ROCK inhibitors are certainly a highly anticipated emerging treatment option for glaucoma. PMID:24872673

  1. Current and Emerging Treatment Options for Fecal Incontinence

    PubMed Central

    2014-01-01

    Fecal incontinence (FI) is a multifactorial disorder that imposes considerable social and economic burdens. The aim of this article is to provide an overview of current and emerging treatment options for FI. A MEDLINE search was conducted for English-language articles related to FI prevalence, etiology, diagnosis, and treatment published from January 1, 1990 through June 1, 2013. The search was extended to unpublished trials on ClinicalTrials.gov and relevant publications cited in included articles. Conservative approaches, including dietary modifications, medications, muscle-strengthening exercises, and biofeedback, have been shown to provide short-term benefits. Transcutaneous electrical stimulation was considered ineffective in a randomized clinical trial. Unlike initial studies, sacral nerve stimulation has shown reasonable short-term effectiveness and some complications. Dynamic graciloplasty and artificial sphincter and bowel devices lack randomized controlled trials and have shown inconsistent results and high rates of explantation. Of injectable bulking agents, dextranomer microspheres in non-animal stabilized hyaluronic acid (NASHA Dx) has shown significant improvement in incontinence scores and frequency of incontinence episodes, with generally mild adverse effects. For the treatment of FI, conservative measures and biofeedback therapy are modestly effective. When conservative therapies are ineffective, invasive procedures, including sacral nerve stimulation, may be considered, but they are associated with complications and lack randomized, controlled trials. Bulking agents may be an appropriate alternative therapy to consider before more aggressive therapies in patients who fail conservative therapies. PMID:25014235

  2. Management of patients with resistant hypertension: current treatment options.

    PubMed

    Kumar, Nilay; Calhoun, David A; Dudenbostel, Tanja

    2013-01-01

    Resistant hypertension (RHTN) is an increasingly common clinical problem that is often heterogeneous in etiology, risk factors, and comorbidities. It is defined as uncontrolled blood pressure on optimal doses of three antihypertensive agents, ideally one being a diuretic. The definition also includes controlled hypertension with use of four or more antihypertensive agents. Recent observational studies have advanced the characterization of patients with RHTN. Patients with RHTN have higher rates of cardiovascular events and mortality compared with patients with more easily controlled hypertension. Secondary causes of hypertension, including obstructive sleep apnea, primary aldosteronism, renovascular disease, are common in patients with RHTN and often coexist in the same patient. In addition, RHTN is often complicated by metabolic abnormalities. Patients with RHTN require a thorough evaluation to confirm the diagnosis and optimize treatment, which typically includes a combination of lifestyle adjustments, and pharmacologic and interventional treatment. Combination therapy including a diuretic, a long-acting calcium channel blocker, an angiotensin-converting enzyme inhibitor, a beta blocker, and a mineralocorticoid receptor antagonist where warranted is the classic regimen for patients with treatment-resistant hypertension. Mineralocorticoid receptor antagonists like spironolactone or eplerenone have been shown to be efficacious in patients with RHTN, heart failure, chronic kidney disease, and primary aldosteronism. Novel interventional therapies, including baroreflex activation and renal denervation, have shown that both of these methods may be used to lower blood pressure safely, thereby providing exciting and promising new options to treat RHTN. PMID:24231917

  3. Non-Surgical Management of Cord Compression in Tuberculosis: A Series of Surprises

    PubMed Central

    Patil, Sanganagouda Shivanagouda; Mohite, Sheetal; Varma, Raghuprasad; Bhojraj, Shekhar Y; Nene, Abhay Madhusudan

    2014-01-01

    Study Design Prospective study. Purpose We present a series of 50 patients with tuberculous cord compression who were offered systematic non-surgical treatment, and thereby, the author proposes that clinico-radiological soft tissue cord compression is not an emergency indication for surgery. Overview of Literature Spinal cord compression whether clinical or radiological has usually been believed to be an indication for emergency surgery in spinal tuberculosis. Methods Fifty adults were prospectively studied at our clinic for spinal cord compression due to tuberculous spondylitis, between May 1993 and July 2002. The inclusion criteria were cases with clinical and/or radiological evidence of cord compression (documented soft tissue effacement of the cord with complete obliteration of the thecal sac at that level on magnetic resonance imaging scan). Exclusion criteria were lesions below the conus level, presence of bony compression, severe or progressive neurological deficit (non-surgical protocol including hospital admission, antitubercular medications, baseline somatosensory evoked potentials and a regular clinico-radiological follow-up. Results At the time of presentation, 10 patients had a motor deficit, 18 had clinically detectable hyper-reflexia and 22 had normal neurology. Forty-seven of the 50 patients responded completely to non-operative treatment and healed with no residual neurological deficit. Three patients with progressive neurological deficit while on treatment were operated on with eventual excellent recovery. Conclusions Radiological evidence of cord compression and early neurological signs need not be an emergency surgical indication in the management of spinal tuberculosis. PMID:24967045

  4. Association of Preexisting Symptoms with Treatment Decisions among Newly Diagnosed Prostate Cancer Patients

    PubMed Central

    Zeliadt, Steven B.; Ramsey, Scott D.; Potosky, Arnold L.; Arora, Neeraj K.; Blough, David K.; Oakley-Girvan, Ingrid; Hamilton, Ann S.; Van Den Eeden, Stephen K.; Penson, David F.

    2009-01-01

    Background The choice between surgical versus non-surgical treatment options is a fundamental decision for men with local stage prostate cancer because of differences in risks of genitourinary side effects among available treatments. Objectives We assessed whether preexisting genitourinary symptoms at the time of diagnosis influenced mens preferences for surgery versus other management options. Methods We recruited 593 patients with newly diagnosed local stage prostate cancer prior to initiating treatment from an integrated health care system, an academic urology center, and community urology clinics. Using logistic regression we compared whether men had a preference for non-surgical options or only preferred surgery. Results Nearly 60% indicated they were considering non-surgical options. Age and clinical characteristics but not preexisting genitourinary symptoms influenced the decision between preferences for surgical or non-surgical options. A total of 62% of men reported side effects as a main factor in their treatment decision. Men with more aggressive tumor types were less likely to consider side effects, however, men who reported poor ability to have an erection were more likely to consider side effects (p<0.001). Conclusion Sexual dysfunction at time of diagnosis, but not other genitourinary symptoms, is associated with men considering treatment-related side effects when considering surgery versus other options. Men who are not experiencing sexual dysfunction at diagnosis may discount the risks of side effects in the decision making process. PMID:20119493

  5. Diagnostic methods and treatment options for focal cortical dysplasia.

    PubMed

    Guerrini, Renzo; Duchowny, Michael; Jayakar, Prasanna; Krsek, Pavel; Kahane, Philippe; Tassi, Laura; Melani, Federico; Polster, Tilman; Andre, Véronique M; Cepeda, Carlos; Krueger, Darcy A; Cross, J Helen; Spreafico, Roberto; Cosottini, Mirco; Gotman, Jean; Chassoux, Francine; Ryvlin, Philippe; Bartolomei, Fabrice; Bernasconi, Andrea; Stefan, Hermann; Miller, Ian; Devaux, Bertrand; Najm, Imad; Giordano, Flavio; Vonck, Kristl; Barba, Carmen; Blumcke, Ingmar

    2015-11-01

    Our inability to adequately treat many patients with refractory epilepsy caused by focal cortical dysplasia (FCD), surgical inaccessibility and failures are significant clinical drawbacks. The targeting of physiologic features of epileptogenesis in FCD and colocalizing functionality has enhanced completeness of surgical resection, the main determinant of outcome. Electroencephalography (EEG)-functional magnetic resonance imaging (fMRI) and magnetoencephalography are helpful in guiding electrode implantation and surgical treatment, and high-frequency oscillations help defining the extent of the epileptogenic dysplasia. Ultra high-field MRI has a role in understanding the laminar organization of the cortex, and fluorodeoxyglucose-positron emission tomography (FDG-PET) is highly sensitive for detecting FCD in MRI-negative cases. Multimodal imaging is clinically valuable, either by improving the rate of postoperative seizure freedom or by reducing postoperative deficits. However, there is no level 1 evidence that it improves outcomes. Proof for a specific effect of antiepileptic drugs (AEDs) in FCD is lacking. Pathogenic mutations recently described in mammalian target of rapamycin (mTOR) genes in FCD have yielded important insights into novel treatment options with mTOR inhibitors, which might represent an example of personalized treatment of epilepsy based on the known mechanisms of disease. The ketogenic diet (KD) has been demonstrated to be particularly effective in children with epilepsy caused by structural abnormalities, especially FCD. It attenuates epigenetic chromatin modifications, a master regulator for gene expression and functional adaptation of the cell, thereby modifying disease progression. This could imply lasting benefit of dietary manipulation. Neurostimulation techniques have produced variable clinical outcomes in FCD. In widespread dysplasias, vagus nerve stimulation (VNS) has achieved responder rates >50%; however, the efficacy of noninvasive cranial nerve stimulation modalities such as transcutaneous VNS (tVNS) and noninvasive (nVNS) requires further study. Although review of current strategies underscores the serious shortcomings of treatment-resistant cases, initial evidence from novel approaches suggests that future success is possible. PMID:26434565

  6. Uterine artery embolization as a treatment option for uterine myomas.

    PubMed

    Marshburn, Paul B; Matthews, Michelle L; Hurst, Bradley S

    2006-03-01

    Information is still being collected on the long-term clinical responses and appropriate patient selection for UAE. Prospective RCTs have not been performed to compare the clinical results from UAE with more conventional therapies for symptomatic uterine leiomyomata. At least three attempts at conducting such RCTs have been unsuccessful because of poor patient accrual that related to differing patient expectation and desires, clinical bias, insurance coverage, and the tendency that patients who have exhausted other treatment options may be disposed more favorably to less invasive treatments. Other comparative studies have serious limitations. For example, the retrospective study that compared outcomes after abdominal myomectomy with UAE suggested that patients who received UAE were more likely to require further invasive treatment by 3 years than were recipients of myomectomy. Lack of randomization introduced a selection bias because women in the group that underwent UAEwere older and were more likely to have had previous surgeries. A prospective study of "contemporaneous cohorts," which excluded patients who had sub-mucosal and pedunculated subserosal myomas, sought to compare quality of life measures and adverse events in patients who underwent UAE or hysterectomy. The investigators concluded that both treatments resulted in marked improvement in symptoms and quality of life scores, but complications were higher in the group that underwent hysterectomy over 1 year. In this study,however, a greater proportion of patients who underwent hysterectomy had improved pelvic pain scores. Furthermore, hysterectomy eliminates uterine bleeding and the risk for recurrence of myomas. Despite the lack of controlled studies that compared UAE with conventional surgery, and despite limited extended outcome data, UAE has gained rapid acceptance, primarily because the procedure preserves the uterus, is less invasive, and has less short-term morbidity than do most surgical options. The cost of UAE varies by region, but is comparable to the charges for hysterectomy and is less expensive than abdominal myomectomy. The evaluation before UAE may entail additional fees for diagnostic testing, such as MRI, to assess the uterine size and screen for adenomyosis. Other centers have recommended pretreatment ultrasonography, laparoscopy, hysteroscopy, endometrial biopsy, and biopsy of large fibroids to evaluate sarcoma. Generally,after UAE the recovery time and time lost from work are less; however, the potential need for subsequent surgery may be greater when compared with abdominal myomectomy. Any center that offers UAE should adhere to published clinical guidelines,maintain ongoing assessment of quality improvements measures, and observe strict criteria for obtaining procedural privileges. After McLucas advocated that gynecologists learn the skill to perform UAE for managing symptomatic myomas, the Society of Interventional Radiology responded with a precautionary commentary on the level of technical proficiency that is necessary to maintain optimum results from UAE. The complexity of pelvic arterial anatomy, the skill that is required to master modern coaxial microcatheters, and the hazards of significant patient radiation exposure were cited as reasons why sound training and demonstration of expertise be obtained before clinicians are credentialed to perform UAE.A collaboration between the gynecologist and the interventional radiologist is necessary to optimize the safety and efficacy of UAE. The primary candidates for this procedure include women who have symptomatic uterine fibroids who no longer desire fertility, but wish to avoid surgery or are poor surgical risks. The gynecologist is likely to be the primary initial consultant to patients who present with complaints of symptomatic myomas. Therefore, they must be familiar with the indications, exclusions, outcome expectations, and complications of UAE in their particular center. When hysterectomy is the only option, UAE should be considered. Appropriate diagnostic testing should ai

  7. Clinical Characteristics and Treatment Options of Infantile Vascular Anomalies

    PubMed Central

    Yang, Bin; Li, Li; Zhang, Li-xin; Sun, Yu-juan; Ma, Lin

    2015-01-01

    Abstract To analyze the clinical characteristics and treatment outcomes of vascular anomalies, and determine which therapy is safe and effective. The data of vascular anomalies pediatric patients who arrived at Beijing children's Hospital from January 2001 to December 2014 were analyzed retrospectively, including the influence of gender, age, clinical manifestation, diagnosis, treatment options, and outcomes. As to infantile hemangiomas, the outcomes of different treatments and their adverse reactions were compared. As to spider angioma and cutaneous capillary malformation, the treatment effect of 595 nm pulsed dye laser (PDL) is analyzed. A total number of 6459 cases of vascular anomalies were reclassified according to the 2014 ISSVA classification system. Among them, the gender ratio is 1:1.69, head-and-neck involved is 53.3%, the onset age within the first month is 72.4%, the age of initial encounter that younger than 6 months is 60.1%. The most common anomalies were infantile hemangiomas (42.6%), congenital hemangiomas (14.1%), and capillary malformations (29.9%). In treating infantile hemangiomas, laser shows the lowest adverse reactions rate significantly. Propranolol shows a higher improvement rate than laser, glucocorticoids, glucocorticoids plus laser, and shows no significant difference with propranolol plus laser both in improvement rate and adverse reactions rate. The total improvement rate of 595 nm PDL is 89.8% in treating spider angioma and 46.7% in treating cutaneous capillary malformation. The improvement rate and excellent rate of laser in treating cutaneous capillary malformation are growing synchronously by increasing the treatment times, and shows no significant difference among different parts of lesion that located in a body. Vascular anomalies possess a female predominance, and are mostly occurred in faces. Definite diagnosis is very important before treatment. In treating infantile hemangioma, propranolol is recommended as the first-line agent, and systemic use glucocorticoids should be considered when associated with serious complications. The 595 nm PDL is effective in managing superficial vascular malformations in childhood, and could attempt to increase the treatment times to improve the outcomes. PMID:26448027

  8. Treatment options for uncomplicated diverticular disease of the colon.

    PubMed

    Rocco, Alba; Compare, Debora; Caruso, Flora; Nardone, Gerardo

    2009-10-01

    Patients affected by uncomplicated diverticular disease (DD) suffer from colicky, unexplained, recurrent, and short-lived but often debilitating abdominal pain and alteration in bowel habit. Although the goals of therapy, such as to improve symptoms and to prevent both recurrent attacks and complications, are clearly established, the standard approach remains still debated. We examined the current scientific evidence supporting the different treatment options for uncomplicated DD. An internet-based search strategy of the Medline and Science Citation Index was performed using the keywords: diverticulosis, DD, fiber, bran, diet, antibiotics, rifaximin, probiotics, prebiotics, bacteria, lactobacillus, bifidobacteria, 5-aminosalicylic acid, sulfasalazine, mesalazine, balsalazide in various combinations to select randomized trials published in the English language between January 1966 and March 2009. The use of fiber and nonabsorbable antibiotics is supported by the existence of randomized controlled studies. More recently, alternative treatments, such as probiotics and mesalazine have been proposed even if no definite data are available. Although the preliminary results seem to be promising, randomized, placebo-controlled studies are needed before new therapies can be recommended in the management of uncomplicated DD. PMID:19652620

  9. New and Emerging Treatment Options for Irritable Bowel Syndrome.

    PubMed

    Lacy, Brian E; Chey, William D; Lembo, Anthony J

    2015-04-01

    Irritable bowel syndrome (IBS) is a functional gastrointestinal disorder associated with abdominal pain, diarrhea, constipation, or a mix of symptoms. The pathophysiology of IBS is not completely understood but appears to involve genetics, the gut microbiome, immune activation, altered intestinal permeability, and brain-gut interactions. There is no gold standard for diagnosis. Several sets of symptom-based guidelines exist. Treatment strategies for IBS may include both nonpharmacologic and pharmacologic approaches. Lifestyle modifications that aim to improve exercise, sleep, diet, and stress may be warranted. Recent data suggest that a gluten-free diet and a diet low in fermentable oligosaccharides, disaccharides, monosaccharides, and polyols (FODMAPs) may benefit some patients. For patients with diarrhea-predominant IBS, treatment options include the synthetic peripheral ?-opioid receptor agonist loperamide, antispasmodic agents, antidepressants, serotonin 5-HT3 antagonists, and the gut-specific antibiotic rifaximin. Ongoing research is evaluating the use of probiotics. For patients with constipation-predominant IBS, therapeutic strategies may include dietary fiber, laxatives, and the prosecretory agents lubiprostone and linaclotide. Research is continuing to optimize the use of available agents and evaluating new approaches to further improve the care of patients with IBS. PMID:26491416

  10. Cachexia and pancreatic cancer: Are there treatment options?

    PubMed Central

    Mueller, Tara C; Burmeister, Marc A; Bachmann, Jeannine; Martignoni, Marc E

    2014-01-01

    Cachexia is frequently described in patients with pancreatic ductal adenocarcinoma (PDAC) and is associated with reduced survival and quality of life. Unfortunately, the therapeutic options of this multi-factorial and complex syndrome are limited. This is due to the fact that, despite extensive preclinical and clinical research, the underlying pathological mechanisms leading to PDAC-associated cachexia are still not fully understood. Furthermore, there is still a lack of consensus on the definition of cachexia, which complicates the standardization of diagnosis and treatment as well as the analysis of the current literature. In order to provide an efficient therapy for cachexia, an early and reliable diagnosis and consistent monitoring is required, which can be challenging especially in obese patients. Although many substances have been tested in clinical and preclinical settings, so far none of them have been proven to have a long-term effect in ameliorating cancer-associated cachexia. However, recent studies have demonstrated that multidimensional therapeutic modalities are able to alleviate pancreatic cancer-associated cachexia and ultimately improve patients’ outcome. In this current review, we propose a stepwise and pragmatic approach to facilitate and standardize the treatment of cachexia in pancreatic cancer patients. This strategy consists of nutritional, dietary, pharmacological, physical and psychological methods. PMID:25071331

  11. New and Emerging Treatment Options for Irritable Bowel Syndrome

    PubMed Central

    Lacy, Brian E.; Chey, William D.; Lembo, Anthony J.

    2015-01-01

    Irritable bowel syndrome (IBS) is a functional gastrointestinal disorder associated with abdominal pain, diarrhea, constipation, or a mix of symptoms. The pathophysiology of IBS is not completely understood but appears to involve genetics, the gut microbiome, immune activation, altered intestinal permeability, and brain-gut interactions. There is no gold standard for diagnosis. Several sets of symptom-based guidelines exist. Treatment strategies for IBS may include both nonpharmacologic and pharmacologic approaches. Lifestyle modifications that aim to improve exercise, sleep, diet, and stress may be warranted. Recent data suggest that a gluten-free diet and a diet low in fermentable oligosaccharides, disaccharides, monosaccharides, and polyols (FODMAPs) may benefit some patients. For patients with diarrhea-predominant IBS, treatment options include the synthetic peripheral μ-opioid receptor agonist loperamide, antispasmodic agents, antidepressants, serotonin 5-HT3 antagonists, and the gut-specific antibiotic rifaximin. Ongoing research is evaluating the use of probiotics. For patients with constipation-predominant IBS, therapeutic strategies may include dietary fiber, laxatives, and the prosecretory agents lubiprostone and linaclotide. Research is continuing to optimize the use of available agents and evaluating new approaches to further improve the care of patients with IBS. PMID:26491416

  12. Cachexia and pancreatic cancer: are there treatment options?

    PubMed

    Mueller, Tara C; Burmeister, Marc A; Bachmann, Jeannine; Martignoni, Marc E

    2014-07-28

    Cachexia is frequently described in patients with pancreatic ductal adenocarcinoma (PDAC) and is associated with reduced survival and quality of life. Unfortunately, the therapeutic options of this multi-factorial and complex syndrome are limited. This is due to the fact that, despite extensive preclinical and clinical research, the underlying pathological mechanisms leading to PDAC-associated cachexia are still not fully understood. Furthermore, there is still a lack of consensus on the definition of cachexia, which complicates the standardization of diagnosis and treatment as well as the analysis of the current literature. In order to provide an efficient therapy for cachexia, an early and reliable diagnosis and consistent monitoring is required, which can be challenging especially in obese patients. Although many substances have been tested in clinical and preclinical settings, so far none of them have been proven to have a long-term effect in ameliorating cancer-associated cachexia. However, recent studies have demonstrated that multidimensional therapeutic modalities are able to alleviate pancreatic cancer-associated cachexia and ultimately improve patients' outcome. In this current review, we propose a stepwise and pragmatic approach to facilitate and standardize the treatment of cachexia in pancreatic cancer patients. This strategy consists of nutritional, dietary, pharmacological, physical and psychological methods. PMID:25071331

  13. Laparoscopic Cerclage as a Treatment Option for Cervical Insufficiency

    PubMed Central

    Bolla, D.; Raio, L.; Imboden, S.; Mueller, M. D.

    2015-01-01

    Background: The traditional surgical treatment for cervical insufficiency is vaginal placement of a cervical cerclage. However, in a small number of cases a vaginal approach is not possible. A transabdominal approach can become an option for these patients. Laparoscopic cervical cerclage is associated with good pregnancy outcomes but comes at the cost of a higher risk of serious surgical complications. The aim of the present study was to evaluate intraoperative and long-term pregnancy outcomes after laparoscopic cervical cerclage, performed either as an interval procedure or during early pregnancy, using a new device with a blunt grasper and a flexible tip. Methods: All women who underwent laparoscopic cervical cerclage for cervical insufficiency in our institution using the Goldfinger® device (Ethicon Endo Surgery, Somerville, NJ, USA) between January 2008 and March 2014 were included in the study. Data were collected from the patientsʼ medical records and included complications during and after the above-described procedure. Results: Eighteen women were included in the study. Of these, six were pregnant at the time of laparoscopic cervical cerclage. Mean duration of surgery was 55 ± 10 minutes. No serious intraoperative or postoperative complications occurred. All patients were discharged at 2.6 ± 0.9 days after surgery. One pregnancy ended in a miscarriage at 12 weeks of gestation. All other pregnancies ended at term (> 37 weeks of gestation) with good perinatal and maternal outcomes. Summary: Performing a laparoscopic cervical cerclage using a blunt grasper device with a flexible tip does not increase intraoperative complications, particularly in early pregnancy. We believe that use of this device, which is characterized by increased maneuverability, could be an important option to avoid intraoperative complications if surgical access is limited due to the anatomical situation. However, because of the small sample size, further studies are needed to confirm our findings. PMID:26366003

  14. Geothermal Produced Fluids: Characteristics, Treatment Technologies, and Management Options

    SciTech Connect

    Finster, Molly; Clark, Corrie; Schroeder, Jenna; Martino, Louis

    2015-10-01

    Geothermal power plants use geothermal fluids as a resource and create waste residuals as part of the power generation process. Both the geofluid resource and the waste stream are considered produced fluids. The chemical and physical nature of produced fluids can have a major impact on the geothermal power industry and can influence the feasibility of geothermal power development, exploration approaches, power plant design, operating practices, and the reuse or disposal of residuals. In general, produced fluids include anything that comes out of a geothermal field and that subsequently must be managed on the surface. These fluids vary greatly depending on the geothermal reservoir being harnessed, power plant design, and the life cycle stage in which the fluid exists, but generally include water and fluids used to drill geothermal wells, fluids used to stimulate wells in enhanced geothermal systems, and makeup and/or cooling water used during operation of a geothermal power plant. Additional geothermal-related produced fluids include many substances that are similar to waste streams from the oil and gas industry, such as scale, flash tank solids, precipitated solids from brine treatment, hydrogen sulfide, and cooling-tower-related waste. This review paper aims to provide baseline knowledge on specific technologies and technology areas associated with geothermal power production. Specifically, this research focused on the management techniques related to fluids produced and used during the operational stage of a geothermal power plant; the vast majority of which are employed in the generation of electricity. The general characteristics of produced fluids are discussed. Constituents of interest that tend to drive the selection of treatment technologies are described, including total dissolved solids, noncondensable gases, scale and corrosion, silicon dioxide, metal sulfides, calcium carbonate, corrosion, metals, and naturally occurring radioactive material. Management options for produced fluids that require additional treatment for these constituents are also discussed, including surface disposal, reuse and recycle, agricultural industrial and domestic uses, mineral extraction and recovery, and solid waste handling.

  15. A comparative review of the options for treatment of erectile dysfunction: which treatment for which patient?

    PubMed

    Hatzimouratidis, Konstantinos; Hatzichristou, Dimitrios G

    2005-01-01

    The field of erectile dysfunction (ED) has been revolutionised over the last two decades. Several treatment options are available today, most of which are associated with high efficacy rates and favourable safety profiles. A MEDLINE search was undertaken in order to evaluate all currently available data on treatment modalities for ED. Phosphodiesterase type 5 (PDE5) inhibitors (sildenafil, tadalafil, vardenafil) are currently the first-choice of most physicians and patients for the treatment of ED. PDE5 inhibitors have differences in their pharmacological profiles, the most obvious being the long duration of action of tadalafil, but there are no data supporting superiority for any one of them in terms of efficacy or safety. Sublingual apomorphine has limited efficacy compared with the PDE5 inhibitors, and its use is limited to patients with mild ED. Treatment failures with oral drugs may be due to medication, clinician and patient issues. The physician needs to address all of these issues in order to identify true treatment failures. Patients who are truly unresponsive to oral drugs may be offered other treatment options.Intracavernous injections of alprostadil alone, or in combination with other vasoactive agents (papaverine and phentolamine), remain an excellent treatment option, with proven efficacy and safety over time. Topical pharmacotherapy is appealing in nature, but currently available formulations have limited efficacy. Vacuum constriction devices may be offered mainly to elderly patients with occasional intercourse attempts, as younger patients show limited preference because of the unnatural erection that is associated with this treatment modality. Penile prostheses are generally the last treatment option offered, because of invasiveness, cost and non-reversibility; however, they are associated with high satisfaction rates in properly selected patients. All treatment options are associated with particular strengths and weaknesses. A patient-centred approach based on patient needs and expectations is necessary for the management of ED. The clinician must educate the patient and provide a supportive environment for shared decision making. The management strategy must be supplemented by careful follow-up in order to identify changes in patient health and relationship/emotional status that may necessitate treatment optimisation. PMID:16060698

  16. Treatment options in androgen-independent prostate cancer.

    PubMed

    Lara, P N; Meyers, F J

    1999-01-01

    Metastatic prostate cancer is a leading cause of cancer-related death in men. Although most patients will respond to androgen ablation as initial systemic therapy, nearly all patients will develop androgen-independent prostate cancer (AI CaP) and will succumb to the disease. Advances in molecular biology have demonstrated mutations in and persistent expression of the human androgen receptor in metastatic disease. Furthermore, recent evidence indicates that an apoptotic block through p53 mutations or bcl-2 overexpression may have a potential role in the poor responses seen with standard chemotherapy. Presently, the six general treatment options available for AI CaP are best supportive care, radiation therapy, radioisotopes, secondline hormonal therapy, chemotherapy (single agent or combination), and investigational therapies such as monoclonal antibodies, cyclin-dependent kinase inhibitors, matrix metalloproteinase inhibitors, and antiangiogenesis agents, among others. None of these modalities have produced durable remissions, although some have demonstrated palliative benefit. The next generation of clinical trials should not consist of futile hormonal manipulations or repetitive chemotherapy. Therapeutic strategies aimed at circumventing molecular blocks to cell death or targeting unique cancer molecules and genes will be more likely to improve quality of life and longevity. Furthermore, the aggressive use of palliative care will ensure effective caring for patients and the healing of families in the absence of cure. PMID:10071598

  17. Arsenic contaminated groundwater and its treatment options in Bangladesh.

    PubMed

    Jiang, Jia-Qian; Ashekuzzaman, S M; Jiang, Anlun; Sharifuzzaman, S M; Chowdhury, Sayedur Rahman

    2013-01-01

    Arsenic (As) causes health concerns due to its significant toxicity and worldwide presence in drinking water and groundwater. The major sources of As pollution may be natural process such as dissolution of As-containing minerals and anthropogenic activities such as percolation of water from mines, etc. The maximum contaminant level for total As in potable water has been established as 10 g/L. Among the countries facing As contamination problems, Bangladesh is the most affected. Up to 77 million people in Bangladesh have been exposed to toxic levels of arsenic from drinking water. Therefore, it has become an urgent need to provide As-free drinking water in rural households throughout Bangladesh. This paper provides a comprehensive overview on the recent data on arsenic contamination status, its sources and reasons of mobilization and the exposure pathways in Bangladesh. Very little literature has focused on the removal of As from groundwaters in developing countries and thus this paper aims to review the As removal technologies and be a useful resource for researchers or policy makers to help identify and investigate useful treatment options. While a number of technological developments in arsenic removal have taken place, we must consider variations in sources and quality characteristics of As polluted water and differences in the socio-economic and literacy conditions of people, and then aim at improving effectiveness in arsenic removal, reducing the cost of the system, making the technology user friendly, overcoming maintenance problems and resolving sludge management issues. PMID:23343979

  18. Clean option: Berkeley Pit water treatment and resource recovery strategy

    SciTech Connect

    Gerber, M.A.; Orth, R.J.; Elmore, M.R.; Monzyk, B.F.

    1995-09-01

    The US Department of Energy (DOE), Office of Technology Development, established the Resource Recovery Project (RRP) in 1992 as a five-year effort to evaluate and demonstrate multiple technologies for recovering water, metals, and other industrial resources from contaminated surface and groundwater. Natural water resources located throughout the DOE complex and the and western states have been rendered unusable because of contamination from heavy metals. The Berkeley Pit, a large, inactive, open pit copper mine located in Butte, Montana, along with its associated groundwater system, has been selected by the RRP for use as a feedstock for a test bed facility located there. The test bed facility provides the infrastructure needed to evaluate promising technologies at the pilot plant scale. Data obtained from testing these technologies was used to assess their applicability for similar mine drainage water applications throughout the western states and at DOE. The objective of the Clean Option project is to develop strategies that provides a comprehensive and integrated approach to resource recovery using the Berkeley Pit water as a feedstock. The strategies not only consider the immediate problem of resource recovery from the contaminated water, but also manage the subsequent treatment of all resulting process streams. The strategies also employ the philosophy of waste minimization to optimize reduction of the waste volume requiring disposal, and the recovery and reuse of processing materials.

  19. Iliofemoral deep vein thrombosis: Percutaneous endovascular treatment options.

    PubMed

    Rich, Kathleen

    2015-06-01

    Venous thromboembolism is defined as an acute venous thrombotic event that targets two disease entities: deep vein thrombosis (DVT), pulmonary embolism, or both. The most common site of DVT origin is in the lower extremities, with 50% of patients exhibiting no symptoms. Although anticoagulation is the gold standard for DVT, early clot removal, especially of proximal iliofemoral DVT, is felt to reduce the incidence of postthrombotic syndrome (PTS) by preserving valve function. Up to one-half of all patients with an iliofemoral DVT treated only with anticoagulation subsequently develop long-term complications, including PTS. Beside anticoagulation, DVT treatment options may include pharmaceutical and/or mechanical therapies. Mechanical therapies consist of either endovascular percutaneous catheter-directed (PCD) interventions or open operative thrombectomy. There are several different PCD procedures available, consisting of catheter-directed thrombolysis, mechanical thrombectomy, combination pharmacomechanical devices, and postthrombus extraction (angioplasty and/or stenting). Endovascular therapies in the management of acute iliofemoral DVT are evolving with a variety of devices available to treat this disease entity. The purpose of this article is to provide an overview of the PCD therapies used when treating patients experiencing an acute iliofemoral DVT along with associated nursing considerations. Off-label device use is not included. PMID:26025147

  20. Nonalcoholic steatohepatitis: emerging targeted therapies to optimize treatment options

    PubMed Central

    Milic, Sandra; Mikolasevic, Ivana; Krznaric-Zrnic, Irena; Stanic, Marija; Poropat, Goran; Stimac, Davor; Vlahovic-Palcevski, Vera; Orlic, Lidija

    2015-01-01

    Diet and lifestyle changes have led to worldwide increases in the prevalences of obesity and metabolic syndrome, resulting in substantially greater incidence of nonalcoholic fatty liver disease (NAFLD). NAFLD is considered a hepatic manifestation of metabolic syndrome and is related to diabetes, insulin resistance, central obesity, hyperlipidemia, and hypertension. Nonalcoholic steatohepatitis (NASH) is an entity that describes liver inflammation due to NAFLD. Growing evidence suggests that NAFLD is a multisystem disease with a clinical burden that is not only confined to liver-related morbidity and mortality, but that also affects several extra-hepatic organs and regulatory pathways. Thus, NAFLD is considered an important public health issue, but there is currently no effective therapy for all NAFLD patients in the general population. Studies seeking optimal therapy for NAFLD and NASH have not yet led to development of a universal protocol for treating this growing problem. Several pharmacological agents have been studied in an effort to improve insulin resistance and the proinflammatory mediators that may be responsible for NASH progression. Cardiovascular risk factors are highly prevalent among NASH patients, and the backbone of treatment regimens for these patients still comprises general lifestyle interventions, including dietary changes and increased physical activity. Vitamin E and thiazolidinedione derivatives are currently the most evidence-based therapeutic options, but only limited clinical evidence is available regarding their long-term efficacy and safety. Vitamin D and renin–angiotensin–aldosterone system blockers are promising drugs that are currently being intensively investigated for use in NAFLD/NASH patients. PMID:26316717

  1. Arsenic Contaminated Groundwater and Its Treatment Options in Bangladesh

    PubMed Central

    Jiang, Jia-Qian; Ashekuzzaman, S. M.; Jiang, Anlun; Sharifuzzaman, S. M.; Chowdhury, Sayedur Rahman

    2012-01-01

    Arsenic (As) causes health concerns due to its significant toxicity and worldwide presence in drinking water and groundwater. The major sources of As pollution may be natural process such as dissolution of As-containing minerals and anthropogenic activities such as percolation of water from mines, etc. The maximum contaminant level for total As in potable water has been established as 10 µg/L. Among the countries facing As contamination problems, Bangladesh is the most affected. Up to 77 million people in Bangladesh have been exposed to toxic levels of arsenic from drinking water. Therefore, it has become an urgent need to provide As-free drinking water in rural households throughout Bangladesh. This paper provides a comprehensive overview on the recent data on arsenic contamination status, its sources and reasons of mobilization and the exposure pathways in Bangladesh. Very little literature has focused on the removal of As from groundwaters in developing countries and thus this paper aims to review the As removal technologies and be a useful resource for researchers or policy makers to help identify and investigate useful treatment options. While a number of technological developments in arsenic removal have taken place, we must consider variations in sources and quality characteristics of As polluted water and differences in the socio-economic and literacy conditions of people, and then aim at improving effectiveness in arsenic removal, reducing the cost of the system, making the technology user friendly, overcoming maintenance problems and resolving sludge management issues. PMID:23343979

  2. Evolving treatment strategies for colorectal cancer: A critical review of current therapeutic options

    PubMed Central

    Damin, Daniel C; Lazzaron, Anderson R

    2014-01-01

    Management of rectal cancer has markedly evolved over the last two decades. New technologies of staging have allowed a more precise definition of tumor extension. Refinements in surgical concepts and techniques have resulted in higher rates of sphincter preservation and better functional outcome for patients with this malignancy. Although, preoperative chemoradiotherapy followed by total mesorectal excision has become the standard of care for locally advanced tumors, many controversial matters in management of rectal cancer still need to be defined. These include the feasibility of a non-surgical approach after a favorable response to neoadjuvant therapy, the ideal margins of surgical resection for sphincter preservation and the adequacy of minimally invasive techniques of tumor resection. In this article, after an extensive search in PubMed and Embase databases, we critically review the current strategies and the most debatable matters in treatment of rectal cancer. PMID:24574762

  3. Post-traumatic epilepsy: current and emerging treatment options

    PubMed Central

    Szaflarski, Jerzy P; Nazzal, Yara; Dreer, Laura E

    2014-01-01

    Traumatic brain injury (TBI) leads to many undesired problems and complications, including immediate and long-term seizures/epilepsy, changes in mood, behavioral, and personality problems, cognitive and motor deficits, movement disorders, and sleep problems. Clinicians involved in the treatment of patients with acute TBI need to be aware of a number of issues, including the incidence and prevalence of early seizures and post-traumatic epilepsy (PTE), comorbidities associated with seizures and anticonvulsant therapies, and factors that can contribute to their emergence. While strong scientific evidence for early seizure prevention in TBI is available for phenytoin (PHT), other antiepileptic medications, eg, levetiracetam (LEV), are also being utilized in clinical settings. The use of PHT has its drawbacks, including cognitive side effects and effects on function recovery. Rates of recovery after TBI are expected to plateau after a certain period of time. Nevertheless, some patients continue to improve while others deteriorate without any clear contributing factors. Thus, one must ask, Are there any actions that can be taken to decrease the chance of post-traumatic seizures and epilepsy while minimizing potential short- and long-term effects of anticonvulsants? While the answer is probably, more evidence is needed to replace PHT with LEV on a permanent basis. Some have proposed studies to address this issue, while others look toward different options, including other anticonvulsants (eg, perampanel or other AMPA antagonists), or less established treatments (eg, ketamine). In this review, we focus on a comparison of the use of PHT versus LEV in the acute TBI setting and summarize the clinical aspects of seizure prevention in humans with appropriate, but general, references to the animal literature. PMID:25143737

  4. Antimicrobial Treatment Options for Granulomatous Mastitis Caused by Corynebacterium Species

    PubMed Central

    Dobinson, Hazel C.; Anderson, Trevor P.; Chambers, Stephen T.; Doogue, Matthew P.; Seaward, Lois

    2015-01-01

    Corynebacterium species are increasingly recognized as important pathogens in granulomatous mastitis. Currently, there are no published treatment protocols for Corynebacterium breast infections. This study describes antimicrobial treatment options in the context of other management strategies used for granulomatous mastitis. Corynebacterium spp. isolated from breast tissue and aspirate samples stored from 2002 to 2013 were identified and determined to the species level using matrix-assisted laser desorption ionization–time of flight mass spectrometry (MALDI-TOF MS), 16S RNA sequencing, and rpoB gene targets. The MICs for 12 antimicrobials were performed using Etest for each isolate. Correlations of these with antimicrobial characteristics, choice of antimicrobial, and disease outcome were evaluated. Corynebacterium spp. from breast tissue and aspirate samples were confirmed in 17 isolates from 16 patients. Based on EUCAST breakpoints, Corynebacterium kroppenstedtii isolates (n = 11) were susceptible to seven antibiotic classes but resistant to β-lactam antibiotics. Corynebacterium tuberculostearicum isolates (n = 4) were multidrug resistant. Two nonlipophilic species were isolated, Corynebacterium glucuronolyticum and Corynebacterium freneyi, both of which have various susceptibilities to antimicrobial agents. Short-course antimicrobial therapy was common (median, 6 courses per subject; range, 1 to 9 courses). Patients with C. kroppenstedtii presented with a hot painful breast mass and underwent multiple surgical procedures (median, 4 procedures; range, 2 to 6 procedures). The management of Corynebacterium breast infections requires a multidisciplinary approach and includes culture and appropriate sensitivity testing to guide antimicrobial therapy. Established infections have a poor outcome, possibly because adequate concentrations of some drugs will be difficult to achieve in lipophilic granulomata. Lipophilic antimicrobial therapy may offer a therapeutic advantage. The role of immunotherapy has not been defined. PMID:26135858

  5. Treatment options and outcomes for glioblastoma in the elderly patient

    PubMed Central

    Arvold, Nils D; Reardon, David A

    2014-01-01

    Age remains the most powerful prognostic factor among glioblastoma (GBM) patients. Half of all patients with GBM are aged 65 years or older at the time of diagnosis, and the incidence rate of GBM in patients aged over 65 years is increasing rapidly. Median survival for elderly GBM patients is less than 6 months and reflects less favorable tumor biologic factors, receipt of less aggressive care, and comorbid disease. The standard of care for elderly GBM patients remains controversial. Based on limited data, extensive resection appears to be more beneficial than biopsy. For patients with favorable Karnofsky performance status (KPS), adjuvant radiotherapy (RT) has a demonstrated survival benefit with no observed decrement in quality of life. Concurrent and adjuvant temozolomide (TMZ) along with RT to 60 Gy have not been prospectively studied among patients aged over 70 years but should be considered for patients aged 65–70 years with excellent KPS. Based on the recent NOA-08 and Nordic randomized trials, testing for O6-methylguanine-DNA-methyltransferase (MGMT) promoter methylation should be performed routinely immediately after surgery to aid in adjuvant treatment decisions. Patients aged over 70 years with favorable KPS, or patients aged 60–70 years with borderline KPS, should be considered for monotherapy utilizing standard TMZ dosing for patients with MGMT-methylated tumors, and hypofractionated RT (34 Gy in ten fractions or 40 Gy in 15 fractions) for patients with MGMT-unmethylated tumors. The ongoing European Organisation for Research and Treatment of Cancer/National Cancer Institute of Canada trial will help clarify the role for concurrent TMZ with hypofractionated RT. For elderly patients with poor KPS, reasonable options include best supportive care, TMZ alone, hypofractionated RT alone, or whole brain RT for symptomatic patients needing to start treatment urgently. Given the balance between short survival and quality of life in this patient population, optimal management of elderly GBM patients must be made individually according to patient age, MGMT methylation status, performance score, and patient preferences. PMID:24591820

  6. Polycystic ovary syndrome in adolescents: current and future treatment options.

    PubMed

    Mastorakos, George; Lambrinoudaki, Irene; Creatsas, George

    2006-01-01

    Polycystic ovary syndrome (PCOS) is a very common disorder affecting 5-10% of women of reproductive age. The pivotal endocrine abnormalities of this syndrome are insulin resistance and ovarian and, to a lesser degree, adrenal hypersensitivity to hormonal stimulation. PCOS may manifest itself as early as the first decade of life by premature pubarche or menarche. Oligoamenorrhea in the first postpubarchal years, although very common, may be an early symptom of PCOS, especially in overweight girls with hirsutism or acne. Girls with low birth weight as well as a family history of diabetes mellitus or premature cardiovascular disease are at high risk for developing PCOS. Circulating bioavailable testosterone levels are usually elevated, while total testosterone may be normal due to low levels of sex hormone-binding globulin. The typical sonographic appearance of PCOS ovaries consists of high ovarian volume (>10 mL) and the presence of 12 or more follicles in each ovary measuring 2-9 mm in diameter. However, this finding is not specific, since it may occur in >20% of healthy girls. The therapeutic goals in adolescents with PCOS is first to restore bodyweight and menses and to reduce the signs of hyperandrogenism. The reduction of bodyweight in this young age group may require the collaboration of the pediatrician, dietitian, and psychotherapist. The adolescent should be urged to adopt a healthy lifestyle with the aim to maintain a normal body mass index throughout adolescence and adult life. The choice of medical therapy depends on the clinical presentation. Oral contraceptives are a good option when acne and hirsutism are the principal complaints. Adolescents with isolated cycle irregularity may be placed on a cyclical progestin regimen to induce withdrawal bleeding. Metformin, by decreasing insulin resistance, alleviates many of the hormonal disturbances and restores menses in a considerable proportion of patients. It may be used alone or in combination with oral contraceptives. Independently of medical treatment, restoration and maintenance of bodyweight within normal range is of paramount importance. PMID:17037948

  7. 17 CFR 30.7 - Treatment of foreign futures or foreign options secured amount.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... 17 Commodity and Securities Exchanges 1 2010-04-01 2010-04-01 false Treatment of foreign futures or foreign options secured amount. 30.7 Section 30.7 Commodity and Securities Exchanges COMMODITY FUTURES TRADING COMMISSION FOREIGN FUTURES AND FOREIGN OPTIONS TRANSACTIONS § 30.7 Treatment of...

  8. 17 CFR 30.7 - Treatment of foreign futures or foreign options secured amount.

    Code of Federal Regulations, 2014 CFR

    2014-04-01

    ... 17 Commodity and Securities Exchanges 1 2014-04-01 2014-04-01 false Treatment of foreign futures... FUTURES TRADING COMMISSION FOREIGN FUTURES AND FOREIGN OPTIONS TRANSACTIONS § 30.7 Treatment of foreign futures or foreign options secured amount. (a) General. Except as provided in this section, a...

  9. 17 CFR 30.7 - Treatment of foreign futures or foreign options secured amount.

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ... 17 Commodity and Securities Exchanges 1 2011-04-01 2011-04-01 false Treatment of foreign futures... FUTURES TRADING COMMISSION FOREIGN FUTURES AND FOREIGN OPTIONS TRANSACTIONS § 30.7 Treatment of foreign futures or foreign options secured amount. (a) Except as provided in this section, a futures...

  10. 17 CFR 30.7 - Treatment of foreign futures or foreign options secured amount.

    Code of Federal Regulations, 2012 CFR

    2012-04-01

    ... 17 Commodity and Securities Exchanges 1 2012-04-01 2012-04-01 false Treatment of foreign futures... FUTURES TRADING COMMISSION FOREIGN FUTURES AND FOREIGN OPTIONS TRANSACTIONS § 30.7 Treatment of foreign futures or foreign options secured amount. (a) Except as provided in this section, a futures...

  11. 17 CFR 30.7 - Treatment of foreign futures or foreign options secured amount.

    Code of Federal Regulations, 2013 CFR

    2013-04-01

    ... 17 Commodity and Securities Exchanges 1 2013-04-01 2013-04-01 false Treatment of foreign futures... FUTURES TRADING COMMISSION FOREIGN FUTURES AND FOREIGN OPTIONS TRANSACTIONS § 30.7 Treatment of foreign futures or foreign options secured amount. (a) Except as provided in this section, a futures...

  12. Effectiveness of a diode laser in addition to non-surgical periodontal therapy: study of intervention

    PubMed Central

    Crispino, Antonio; Figliuzzi, Michele Mario; Iovane, Claudio; Del Giudice, Teresa; Lomanno, Simona; Pacifico, Delfina; Fortunato, Leonzio; Del Giudice, Roberto

    2015-01-01

    Summary Background Chronic periodontitis affects 47% of adult population over the age of 30. The first phase of periodontal treatment is always represented by scaling and root planning (SRP), that is a causal, non-surgical therapy that recognizes as primary aims the control of bacterial infection and the reduction of periodontal plaque-associated inflammation. Yet, another innovative causal therapy is represented by the irradiation of periodontal pockets with laser. Aim To evaluate the effect of a 940-nm diode laser as an adjunct to SRP in patients affected by periodontitis. Materials and methods Sixty-eight adult patients with moderate-to-severe periodontitis were sequentially enrolled and undergone to periodontal examination (V1) in order to detect gingival index (GI), plaque index (PI) and probing depth (PD). The patients were randomly divided into two groups: the first (n=34) received SRP treatment alone, the control group (n=34) received SRP and 940-nm diode laser therapy. Results Data were analyzed by Student’s t-test, with two tails; for all clinical parameters, both groups reported statistically significant differences compared to basal values (p<0.0001). Both procedures were effective in improving GI, PI and PD, but the use of diode laser was associated with more evident results. Conclusions Considered the better clinical outcomes, diode laser can be routinely associated with SRP in the treatment of periodontal pockets of patients with moderate-to-severe periodontitis. PMID:26161248

  13. A Protocol-Based Decision for Choosing a Proper Surgical Treatment Option for Carotid Artery Stenosis

    PubMed Central

    Jang, E-Wook; Chung, Joonho; Seo, Kwon-Duk; Suh, Sang Hyun; Kim, Yong Bae

    2015-01-01

    Objective There are two established surgical treatment options for carotid artery stenosis. Carotid endarterectomy (CEA) has been accepted as a gold standard for surgical treatment while carotid artery stenting (CAS) has recently become an alternative option. Each treatment option has advantages and disadvantages for the treatment outcomes. We propose a protocol for selection of a proper surgical treatment option for carotid artery stenosis. Materials and Methods A total of 192 published articles on management of carotid artery stenosis were reviewed. Preoperatively considerable factors which had been repeatedly noted in those articles for the risk/benefits of CEA or CAS were selected. According to those factors, a protocol with four categories was established. Results CEA or CAS is indicated when the patient has a symptomatic stenosis ? 50%, or when the patient has an asymptomatic stenosis ? 80%. Each treatment option has absolute indications and favorable indications. Each absolute indication is scored with three points, and each favorable indication, one point. Based on the highest scores, a proper treatment option (CEA or CAS) is selected. Conclusion We have been treating patients according to this protocol and evaluating the outcomes of our protocol-based decision because this protocol might be helpful in assessment of risk/benefit for selection of a proper surgical treatment option in patients with carotid artery stenosis. PMID:26157689

  14. PATIENT VALUATION OF PRIMARY CARE-BASED TREATMENT OPTIONS FOR SUBSTANCE USE AND MENTAL HEALTH DISORDERS

    PubMed Central

    Epstein, Andrew J.; Barry, Colleen L.; Fiellin, David A.; Busch, Susan H.

    2015-01-01

    Most individuals with substance use and mental health disorders do not receive treatment. If treatment options were more attractive, treatment rates might increase. Although the advantages of novel approaches, including primary care-based treatment and collaborative care in a primary care setting, have been documented, less is known about consumers valuation of these options. Contingent valuation methods were used to assess monetary valuation of these treatment types relative to usual care in specialty treatment using a national randomized experiment. Participants valued a primary care-based treatment visit over usual care by $9.00 and a collaborative care visit over usual care by $5.85. PMID:25930049

  15. Treatment Option Overview (Childhood Brain and Spinal Cord Tumors)

    MedlinePLUS

    ... before the cancer is diagnosed and continue for months or years. Childhood brain and spinal cord tumors ... after treatment. Some cancer treatments cause side effects months or years after treatment has ended. These are ...

  16. Treatment Options in Massive and Submassive Pulmonary Embolism.

    PubMed

    Wadhera, Rishi K; Piazza, Gregory

    2016-01-01

    Pulmonary embolism (PE) is a common cardiovascular condition that represents a spectrum of disorders with a gradient of increased risk of adverse outcomes. The U.S. Surgeon General estimated that approximately 100,000 to 180,000 PE-related deaths occur in the United States annually, and that PE is the most preventable cause of death among hospitalized patients. Risk stratification is critical to identify the patients who may benefit from advanced therapy. This review will provide an overview of PE pathophysiology, evidence-based risk stratification strategies for patients with acute PE, a summary of traditional and novel oral anticoagulant options, and an in-depth discussion on the utilization of advanced therapeutic options, including systemic fibrinolysis, catheter-based pharmacomechanical therapy, and surgical embolectomy. PMID:26274535

  17. Approved and Off-Label Uses of Obesity Medications, and Potential New Pharmacologic Treatment Options

    PubMed Central

    Isidro, Maria Luisa; Cordido, Fernando

    2010-01-01

    Available anti-obesity pharmacotherapy options remain very limited and development of more effective drugs has become a priority. The potential strategies to achieve weight loss are to reduce energy intake by stimulating anorexigenic signals or by blocking orexigenic signals, and to increase energy expenditure. This review will focus on approved obesity medications, as well as potential new pharmacologic treatment options.

  18. Detoxification of Implant Surfaces Affected by Peri-Implant Disease: An Overview of Non-surgical Methods

    PubMed Central

    Valderrama, Pilar; Blansett, Jonathan A; Gonzalez, Mayra G; Cantu, Myrna G; Wilson, Thomas G

    2014-01-01

    Objective: The aim of this review is to summarize the findings of studies that have evaluated non-surgical approaches for detoxification of implant body surfaces in vitro and in vivo, and to evaluate clinical trials on the use of these methodologies for treating peri-implant disease. Materials and methods: A literature search was conducted using MEDLINE (Pubmed) from 1966 to 2013. In vitro and in vivo studies as well as clinical trials on non-surgical therapy were evaluated. The outcome variables were the ability of the therapeutic method to eliminate the biofilm and endotoxins from the implant surface, the changes in clinical parameters including probing depth, clinical attachment levels, bleeding on probing; radiographic bone fill and histological re-osseointegration. Results: From 134 articles found 35 were analyzed. The findings, advantages and disadvantages of using lasers as well as mechanical and chemical methods are discussed. Most of the in vivo and human studies used combination therapies which makes determining the efficacy of one specific method difficult. Most human studies are case series with short term longitudinal analysis without survival or failure reports. Conclusion: Complete elimination of the biofilms is difficult to achieve using these approaches. All therapies induce changes of the chemical and physical properties of the implant surface. Re-osseointegration may be difficult to achieve if not impossible without surgical access to ensure thorough debridement of the defect and detoxification of the implant surface. Combination protocols for non-surgical treatment of peri-implantitis in humans have shown some positive clinical results but long-term evaluation to evaluate the validity and reliability of the techniques is needed. PMID:24894571

  19. Treatment Options for Plasma Cell Neoplasms (Including Multiple Myeloma)

    MedlinePLUS

    ... Treatment Health Professional Plasma Cell Neoplasms Treatment Research Plasma Cell Neoplasms (Including Multiple Myeloma) Treatment–Patient Version (PDQ®) General Information About Plasma Cell Neoplasms Key Points Plasma cell neoplasms are ...

  20. Treatment Option Overview (Plasma Cell Neoplasms Including Multiple Myeloma)

    MedlinePLUS

    ... Treatment Health Professional Plasma Cell Neoplasms Treatment Research Plasma Cell Neoplasms (Including Multiple Myeloma) Treatment–Patient Version (PDQ®) General Information About Plasma Cell Neoplasms Key Points Plasma cell neoplasms are ...

  1. Potential treatment options and future research to increase hepatitis C virus treatment response rate

    PubMed Central

    TenCate, Veronica; Sainz, Bruno; Cotler, Scott J; Uprichard, Susan L

    2010-01-01

    Hepatitis C virus (HCV) is a liver-tropic blood-borne pathogen that affects more than 170 million people worldwide. Although acute infections are usually asymptomatic, up to 90% of HCV infections persist with the possibility of long-term consequences such as liver fibrosis, cirrhosis, steatosis, insulin resistance, or hepatocellular carcinoma. As such, HCV-associated liver disease is a major public health concern. Although the currently available standard of care therapy of pegylated interferon α plus ribavirin successfully treats infection in a subset of patients, the development of more effective, less toxic HCV antivirals is a health care imperative. This review not only discusses the limitations of the current HCV standard of care but also evaluates upcoming HCV treatment options and how current research elucidating the viral life cycle is facilitating the development of HCV-specific therapeutics that promise to greatly improve treatment response rates both before and after liver transplantation. PMID:21331152

  2. Treatment Options for Ductal Carcinoma In Situ (DCIS)

    MedlinePLUS

    ... and Young Adults with Cancer Reports, Research, and Literature Quiz Cancers by Body Location/System Childhood Cancers Late Effects of Childhood Cancer Treatment Pediatric Supportive Care Unusual ...

  3. Current treatment options for management of anal intraepithelial neoplasia

    PubMed Central

    Weis, Stephen E

    2013-01-01

    Anal squamous cell cancer is an uncommon malignancy caused by infection with oncogenic strains of Human papilloma virus. Anal cancer is much more common in immunocompromised persons, including those infected with Human immunodeficiency virus. High-grade anal intraepithelial neoplasia (HGAIN), the precursor of anal cancer, is identified by clinicians providing care for patients with anorectal disease, and is increasingly being identified during screening of immunosuppressed patients for anal dysplasia. The traditional treatment for HGAIN has been excision of macroscopic disease with margins. This approach is effective for patients with small unifocal HGAIN lesions. Patients with extensive multifocal HGAIN frequently have recurrence of HGAIN after excision, and may have postoperative complications of anal stenosis or fecal incontinence. This led to the suggestion by some that treatment for HGAIN should be delayed until patients developed anal cancer. Alternative approaches in identification and treatment have been developed to treat patients with multifocal or extensive HGAIN lesions. High-resolution anoscopy combines magnification with anoscopy and is being used to identify HGAIN and determine treatment margins. HGAIN can then be ablated with a number of modalities, including infrared coagulation, CO2 laser, and electrocautery. These methods for HGAIN ablation can be performed with local anesthesia on outpatients and are relatively well tolerated. High-resolution anoscopy-directed HGAIN ablation is evolving into a standard approach for initial treatment and then subsequent monitoring of a disease which should be expected to be recurrent. Another treatment approach for HGAIN is topical treatment, principally with 5-fluorouracil or imiquimod. Topical therapies have the advantage of being nonsurgical and are well suited for treating widespread multifocal disease. Topical treatments have the disadvantage of requiring extended treatment courses and causing a symptomatic inflammatory response. Successful treatment requires adherence to a regime that is uncomfortable at best and at worst painful. Topical treatments can be successful in motivated adherent patients willing to accept these side effects. PMID:23788834

  4. Bacterial meningitis: an update of new treatment options.

    PubMed

    Nau, Roland; Djukic, Marija; Spreer, Annette; Ribes, Sandra; Eiffert, Helmut

    2015-11-01

    The outcome of bacterial meningitis critically depends on the rapid initiation of bactericidal antibiotic therapy and adequate management of septic shock. In community-acquired meningitis, the choice of an optimum initial empirical antibiotic regimen depends on the regional resistance patterns. Pathogens resistant to antibacterials prevail in nosocomial bacterial meningitis. Dexamethasone is recommended as adjunctive therapy for community-acquired meningitis in developed countries. In comatose patients, aggressive measures to lower intracranial pressure <20 mmHg (in particular, external ventriculostomy, osmotherapy and temporary hyperventilation) were effective in a case-control study. Although many experimental approaches were protective in animal models, none of them has been proven effective in patients. Antibiotics, which are bactericidal but do not lyse bacteria, and inhibitors of matrix metalloproteinases or complement factor C5 appear the most promising therapeutic options. At present, vaccination is the most efficient method to reduce disease burden. Palmitoylethanolamide appears promising to enhance the resistance of the brain to infections. PMID:26293166

  5. Adult osteochondritis dissecans and focussed ESWT: A successful treatment option.

    PubMed

    Thiele, S; Thiele, R; Gerdesmeyer, L

    2015-12-01

    Extracorporeal shockwave therapy (ESWT) has gained acceptance in the medical field and in the treatment of non-unions and delayed bone healing. ESWT has been used effectively for many years as a noninvasive surgical procedure. The idea of treating Osteochondritis dissecans of knee and talus arose in the middle of the 1990's. OCD is known as a pre-arthritic factor in the long-term and still there is no consistent treatment. In the literature there is still only a small number of publications but international societies for shockwave treatment are convinced that ESWT on OCD shows to be an effective and safe method in the treatment of OCD in the early stages. We want to summarize the actual data on the treatment of OCD by ESWT. PMID:26455533

  6. Retrospective study of surgery versus non-surgical management in limited-disease small cell lung cancer

    PubMed Central

    Zhang, Jie; Li, Shaolei; Chen, Xiaoling; Han, Jindi; Nie, Jun; Dai, Ling; Hu, Weiheng; Tian, Guangming; Ma, Xiangjuan; Han, Sen; Wu, Di; Zheng, Qingfeng; Yang, Yue; Fang, Jian

    2014-01-01

    Background The role of surgery in limited small cell lung cancer (SCLC) is still controversial. To assess the role of surgery in SCLC we performed a retrospective analysis of survival in a group of limited stage patients, who were managed with trimodal therapy including surgery, or with chemotherapy and radiotherapy. Methods We performed a retrospective survival analysis in a series of 153 limited stage SCLC patients treated between 1995 and 2013. Kaplan-Meier survival analysis and Cox regression analysis were used to calculate the overall survival of the surgical and non-surgical groups. Results Median survival in all patients was 21.5 months. Median survival for surgical and non-surgical patients was 30.5 months and 16.9 months, respectively. The survival curves for the two arms are significantly different (P < 0.01). In multivariate analysis, the benefit of surgical treatment and thoracic radiotherapy varied in a time-dependent fashion. Conclusions Our results suggest that surgery added to chemotherapy and radiotherapy may be associated with a therapeutic benefit in limited SCLC.

  7. Treatment Options by Stage (Mycosis Fungoides and the Sezary Syndrome)

    MedlinePLUS

    ... type and stage of the cancer being treated. Chemotherapy Chemotherapy is a cancer treatment that uses drugs ... syndrome are types of non-Hodgkin lymphoma .) Other drug therapy Topical corticosteroids are used to relieve red, swollen, ...

  8. Treatment Options for Recurrent Mycosis Fungoides and the Sezary Syndrome

    MedlinePLUS

    ... type and stage of the cancer being treated. Chemotherapy Chemotherapy is a cancer treatment that uses drugs ... syndrome are types of non-Hodgkin lymphoma .) Other drug therapy Topical corticosteroids are used to relieve red, swollen, ...

  9. Treatment Option Overview (Mycosis Fungoides and the Sezary Syndrome)

    MedlinePLUS

    ... type and stage of the cancer being treated. Chemotherapy Chemotherapy is a cancer treatment that uses drugs ... syndrome are types of non-Hodgkin lymphoma .) Other drug therapy Topical corticosteroids are used to relieve red, swollen, ...

  10. Treatment Options When Your SSRI Antidepressant Is Not Working Well

    MedlinePLUS

    ... and Plug-ins EHC Component EPC Project Topic Title Treatment for Depression After Unsatisfactory Response to SSRIs Full Report Research Review Apr. 26, 2012 Related Products for this Topic Research Protocol Jun. 15, ...

  11. Treatment Options for Childhood Extracranial Germ Cell Tumors

    MedlinePLUS

    ... Extracranial Germ Cell Tumors Treatment Childhood Extracranial Germ Cell Tumors Treatment–Patient Version (PDQ®) General Information About Childhood Extracranial Germ Cell Tumors Key Points Childhood extracranial germ cell tumors ...

  12. Treatment Options for Metastatic Squamous Neck Cancer with Occult Primary

    MedlinePLUS

    ... Cancer Home Page Oral Complications of Chemotherapy and Head/Neck Radiation Metastatic Cancer For general cancer information and ... YYYY>. Available at: http://www.cancer.gov/types/head-and-neck/patient/metastatic-squamous-neck-treatment-pdq . Accessed

  13. Paranasal Sinus and Nasal Cavity Cancer (Treatment Options by Stage)

    MedlinePLUS

    ... a team of doctors with expertise in treating head and neck cancer. Treatment will be overseen by a medical ... Cancer Home Page Oral Complications of Chemotherapy and Head/Neck Radiation Drugs Approved for Head and Neck Cancer ...

  14. Treatment Option Overview (Metastatic Squamous Neck Cancer with Occult Primary)

    MedlinePLUS

    ... Cancer Home Page Oral Complications of Chemotherapy and Head/Neck Radiation Metastatic Cancer For general cancer information and ... YYYY>. Available at: http://www.cancer.gov/types/head-and-neck/patient/metastatic-squamous-neck-treatment-pdq . Accessed

  15. What Treatment Options Are Available for Male Infertility?

    MedlinePLUS

    ... medical procedures to deliver sperm to the woman, fertilization of the egg in a laboratory, and using ... 2 Assistive reproductive technologies, such as in vitro fertilization, can be effective if other treatments do not ...

  16. Treatment Option Overview (Pancreatic Neuroendocrine Tumors / Islet Cell Tumors)

    MedlinePLUS

    ... pump inhibitor drugs such as omeprazole , lansoprazole , or pantoprazole. Histamine blocking drugs such as cimetidine , ranitidine, or ... with drugs taken by mouth or insulin by injection . New types of treatment are being tested in ...

  17. Advanced pancreatic cancer - how to choose an adequate treatment option

    PubMed Central

    Korkeila, Eija A

    2015-01-01

    The prognosis of pancreatic adenocarcinoma is poor, making it one of the leading causes of cancer-related death. The 5-year overall survival rate remains below 5% and little progress is made during the past decade. Only about 10%-20% of patients are eligible for curative-intent surgery and the majority end up having recurring disease even after radical surgery and postoperative adjuvant chemotherapy. Chemotherapy in metastatic disease is palliative at best, aiming at disease and symptom control and prolongation of life. Treatment always causes side effects, the degree of which varies from patient to patient, depending on the patients general condition, concomitant morbidities as well as on the chosen treatment modality. Why is pancreatic cancer so resistant to treatment? How to best help the patient to reach the set treatment goals? PMID:26478662

  18. Treatment Option Overview (Childhood Central Nervous System Germ Cell Tumors)

    MedlinePLUS

    ... New types of treatment are being tested in clinical trials. Information about clinical trials is available from ... want to think about taking part in a clinical trial. For some patients, taking part in a ...

  19. Rare treatment option for a common pediatric airway problem

    PubMed Central

    Dias, Raylene; Deshmukh, Chandrahas T.; Tullu, Milind S.; Divecha, Chhaya; Karande, Sunil

    2015-01-01

    Laryngomalacia is a common cause of respiratory obstruction with stridor in infants. Although most cases resolve spontaneously, severe laryngomalacia needs surgical intervention. Tracheostomies have been the mainstay of treatment. However, this procedure was associated with high morbidity. At present, newer modalities of treatment are being tried. We discuss successful management of an infant having severe laryngomalacia (who had three failed extubation trials) with glossoepiglottopexy. PMID:26730122

  20. Current and emerging options for the drug treatment of narcolepsy.

    PubMed

    De la Herrán-Arita, Alberto K; García-García, Fabio

    2013-11-01

    Narcolepsy/hypocretin deficiency (now called type 1 narcolepsy) is a lifelong neurologic disorder with well-established diagnostic criteria and etiology. Narcolepsy is a chronic sleep disorder characterized by excessive daytime sleepiness (EDS) and symptoms of dissociated rapid eye movement sleep such as cataplexy (sudden loss of muscle tone), hypnagogic hallucinations (sensory events that occur at the transition from wakefulness to sleep), sleep paralysis (inability to perform movements upon wakening or sleep onset), and nocturnal sleep disruption. As these symptoms are often disabling, most patients need life-long treatment. The treatment of narcolepsy is well defined, and, traditionally, amphetamine-like stimulants (i.e., dopaminergic release enhancers) have been used for clinical management to improve EDS and sleep attacks, whereas tricyclic antidepressants have been used as anticataplectics. However, treatments have evolved to better-tolerated compounds such as modafinil or armodafinil (for EDS) and adrenergic/serotonergic selective reuptake inhibitors (as anticataplectics). In addition, night-time administration of a short-acting sedative, c-hydroxybutyrate (sodium oxybate), has been used for the treatment for EDS and cataplexy. These therapies are almost always needed in combination with non-pharmacologic treatments (i.e., behavioral modification). A series of new drugs is currently being tested in animal models and in humans. These include a wide variety of hypocretin agonists, melanin- concentrating hormone receptor antagonists, antigenspecific immunopharmacology, and histamine H3 receptor antagonists/inverse agonists (e.g., pitolisant), which have been proposed for specific therapeutic applications, including the treatment of Alzheimer's disease, attention-deficit hyperactivity disorder, epilepsy, and more recently, narcolepsy. Even though current treatment is strictly symptomatic, based on the present state of knowledge of the pathophysiology of narcolepsy, we expect that more pathophysiology-based treatments will be available in the near future. PMID:24122734

  1. Current options and perspectives in the treatment of diabetic neuropathy.

    PubMed

    Vrkonyi, Tams; Putz, Zsuzsanna; Keresztes, Katalin; Martos, Tmea; Lengyel, Csaba; Stirban, Alin; Jermendy, Gyrgy; Kempler, Peter

    2013-01-01

    We aimed to summarise recent advances in the therapy of diabetic neuropathy. Although all therapeutic choices in the treatment of diabetes mellitus itself are based on clear pathophysiological basis, this approach is less present in the treatment of the "forgotten complication", diabetic neuropathy. As part of pathogenetic oriented treatment, the role of glycemic control and cardiovascular risk factors are reviewed. The mode of action of benfotiamine is based on inhibition of key alternative pathways, including the polyol, hexosamine, protein-kinase-C pathways, and inhibition of advanced glycation end products formation, just as on activation of transketolase. Alpha- lipoic-acid is considered as the most potent antioxidant. Other forms of pathogenetic oriented treatment, including actovegin, will be summarised. The anticonvulsants gabapentin and pregabalin, as well as the antidepressant duloxetine represent the most important new drugs among agents for symptomatic relief. Most likely, we should offer combination treatment to our patients much more often, first of all combination of pathogenetic and symptomatic drugs. Finally, the broad spectrum of non-pharmacological treatment will be reviewed. PMID:23278494

  2. Anterior open bite--simplified non surgical technique to correct in adults.

    PubMed

    Jefferson, Yosh

    2015-01-01

    Skeletal Anterior open bite abnormality in adults is probably the most difficult to correct in orthodontics just behind Skeletal Class III abnormality. Literature research shows various techniques to correct this problem, often via orthognathic surgery, but it was difficult to find in the literatures a simplified non-surgical technique. This author propose, a simplified, non-surgical technique to correct skeletal anterior open bite in adults using non-ligating, frictionless brackets and vertical elastics. Some indications and contra-indications will be discussed PMID:25881379

  3. Treatment options in the management of Ascaris lumbricoides.

    PubMed

    Massara, Cristiano Lara; Enk, Martin Johannes

    2004-03-01

    Infection with Ascaris lumbricoides constitutes one of the most common helmintic diseases in the world, especially in tropical and subtropical regions. Transmission of this disease involves environmental contamination with eggs, and therefore, is classified as a soil-transmitted disease. The public health importance of ascariasis is made evident by the high number of infected individuals suffering its consequences, which can become severe, depending on the worm burden. Since the introduction of benzimidazoles, chemotherapy has improved significantly, offering fast and direct effects at relatively low cost, as a result of the simple and safe application of these drugs. Unfortunately, the effects are not long-lasting or permanent. The intervention with chemotherapy alone constitutes a fast and efficient way to reduce the worm burden in a population of high prevalence, but does not avoid reinfection. Therefore, the option of integrated control programmes based on chemotherapy in combination with sanitation and health education, together with strong community involvement, must be considered in order to ensure the positive long-term effects of such programmes. PMID:15013922

  4. Progressive multifocal leukoencephalopathy: current treatment options and future perspectives.

    PubMed

    Pavlovic, Dejan; Patera, Andriani C; Nyberg, Fredrik; Gerber, Marianne; Liu, Maggie

    2015-11-01

    Progressive multifocal leukoencephalopathy (PML) is a rare but debilitating and frequently fatal viral disease of the central nervous system, primarily affecting individuals with chronically and severely suppressed immune systems. The disease was relatively obscure until the outbreak of HIV/AIDS, when it presented as one of the more frequent opportunistic infections in this immune deficiency syndrome. It attracted additional attention from the medical and scientific community following the discovery of significant PML risk associated with natalizumab, a monoclonal antibody used for treatment of relapsing-remitting multiple sclerosis. This was followed by association of PML with other immunosuppressive or immunomodulating drugs. PML is currently untreatable disease with poor outcomes, so it is a significant concern when developing new immunotherapies. Current prophylaxis and treatment of PML are focused on immune reconstitution, restoration of immune responses to JC virus infection, and eventual suppression of immune reconstitution inflammatory syndrome. This approach was successful in reducing the incidence of PML and improved survival of PML patients with HIV infection. However, the outcome for the majority of PML patients, regardless of their medical history, is still relatively poor. There is a high unmet need for both prophylaxis and treatment of PML. The aim of this review is to discuss potential drug candidates for prophylaxis and treatment of PML with a critical review of previously conducted and completed PML treatment studies as well as to provide perspectives for future therapies. PMID:26600871

  5. Progressive multifocal leukoencephalopathy: current treatment options and future perspectives

    PubMed Central

    Pavlovic, Dejan; Patera, Andriani C.; Nyberg, Fredrik; Gerber, Marianne; Liu, Maggie

    2015-01-01

    Progressive multifocal leukoencephalopathy (PML) is a rare but debilitating and frequently fatal viral disease of the central nervous system, primarily affecting individuals with chronically and severely suppressed immune systems. The disease was relatively obscure until the outbreak of HIV/AIDS, when it presented as one of the more frequent opportunistic infections in this immune deficiency syndrome. It attracted additional attention from the medical and scientific community following the discovery of significant PML risk associated with natalizumab, a monoclonal antibody used for treatment of relapsing–remitting multiple sclerosis. This was followed by association of PML with other immunosuppressive or immunomodulating drugs. PML is currently untreatable disease with poor outcomes, so it is a significant concern when developing new immunotherapies. Current prophylaxis and treatment of PML are focused on immune reconstitution, restoration of immune responses to JC virus infection, and eventual suppression of immune reconstitution inflammatory syndrome. This approach was successful in reducing the incidence of PML and improved survival of PML patients with HIV infection. However, the outcome for the majority of PML patients, regardless of their medical history, is still relatively poor. There is a high unmet need for both prophylaxis and treatment of PML. The aim of this review is to discuss potential drug candidates for prophylaxis and treatment of PML with a critical review of previously conducted and completed PML treatment studies as well as to provide perspectives for future therapies. PMID:26600871

  6. Monotherapy for hepatitis B infection: a review of treatment options.

    PubMed

    Ozaras, Resat; Khodor, Hawa'a; Yetim, Nergul; Unal, Umut Kaan; Demirhan, Yunus Emre; Gultekin, Goknil; Isal, Burak

    2015-12-01

    Chronic hepatitis B (CHB) is a global health problem, causing liver failure, cirrhosis and hepatocellular carcinoma. CHB treatment aims to prevent liver-related complication. The treatment of CHB infection includes monotherapy with either interferons (IFNs) or nucleos(t)ide (NUC) analogs. IFNs have moderate antiviral effects, and their use is limited by side effects. With the availability of NUCs, IFN-intolerant and decompensated cirrhotic patients began to be treated. Lamivudine and telbivudine, nucleoside analogs, have low genetic barrier to resistance. Adefovir, a nucleotide analog, has moderate potency and potential nephrotoxicity. Entecavir and tenofovir, with their high potency, high genetic barrier to resistance and favorable safety profile are the standard of care in CHB treatment. Long-term use of NUCs with maintained viral suppression results in a decrease in liver-related complications. PMID:26414781

  7. Treatment options for second-stage gambiense human African trypanosomiasis

    PubMed Central

    Eperon, Gilles; Balasegaram, Manica; Potet, Julien; Mowbray, Charles; Valverde, Olaf; Chappuis, Franois

    2014-01-01

    Treatment of second-stage gambiense human African trypanosomiasis relied on toxic arsenic-based derivatives for over 50 years. The availability and subsequent use of eflornithine, initially in monotherapy and more recently in combination with nifurtimox (NECT), has drastically improved the prognosis of treated patients. However, NECT logistic and nursing requirements remain obstacles to its deployment and use in peripheral health structures in rural sub-Saharan Africa. Two oral compounds, fexinidazole and SCYX-7158, are currently in clinical development. The main scope of this article is to discuss the potential impact of new oral therapies to improve diagnosis-treatment algorithms and patients access to treatment, and to contribute to reach the objectives of the recently launched gambiense human African trypanosomiasis elimination program. PMID:25204360

  8. Treatment options for hypertriglyceridemia: from risk reduction to pancreatitis

    PubMed Central

    Berglund, Lars; Brunzell, John D.; Goldberg, Anne C.; Goldberg, Ira J.; Stalenhoef, Anton

    2013-01-01

    While there has been considerable focus on the role and treatment of LDL cholesterol levels, a definitive role of triglycerides in the management of cardiovascular disease has been uncertain. Notably, with increasing triglyceride levels, there is a parallel increase in cholesterol levels carried by triglyceride-rich lipoproteins, which has prompted interest in the use of non-HDL cholesterol levels as a tool guiding interventions. Recent studies have provided evidence for an independent role of triglyceride levels as a cardiovascular risk factor, and recently, an Endocrine Society guideline was published for treatment of hypertriglyceridemia. In contrast to the relative uncertainty regarding triglycerides and cardiovascular disease, a role of very high triglyceride levels as a risk factor for pancreatitis has been well known. The present paper summarizes the underlying evidence for a risk role for triglyceride levels in cardiovascular disease and pancreatitis, current treatment recommendations and areas of future research. PMID:24840268

  9. Medical Treatments of Hidradenitis Suppurativa: More Options, Less Evidence.

    PubMed

    van der Zee, Hessel H; Gulliver, Wayne P

    2016-01-01

    Hidradenitis suppurativa is a common debilitating skin disease that has been neglected by science. The disease is getting more and more attention, reflected by the rising number of scientific publications. There is a clear need for effective treatment. We are still at the beginning of improving care for these patients as demonstrated by the low levels of evidence for the medical treatments. Many of these therapies showed promising results, but are still waiting to be validated in randomized, controlled trials. Much more research is needed to strengthen the Level of Evidence for these therapies and thus improve patient care. PMID:26617362

  10. Treatment of postpartum depression: clinical, psychological and pharmacological options

    PubMed Central

    Fitelson, Elizabeth; Kim, Sarah; Baker, Allison Scott; Leight, Kristin

    2011-01-01

    Postpartum depression (PPD) is a common complication of childbearing, and has increasingly been identified as a major public health problem. Untreated maternal depression has multiple potential negative effects on maternal-infant attachment and child development. Screening for depression in the perinatal period is feasible in multiple primary care or obstetric settings, and can help identify depressed mothers earlier. However, there are multiple barriers to appropriate treatment, including concerns about medication effects in breastfeeding infants. This article reviews the literature and recommendations for the treatment of postpartum depression, with a focus on the range of pharmacological, psychotherapeutic, and other nonpharmacologic interventions. PMID:21339932

  11. [Multidrug-resistant bacteria require new treatment options].

    PubMed

    Panknin, Hardy-Thorsten

    2015-12-01

    By now multidrug-resistant bacteria are a common cause of infections, especially in immunocompromised patient. These infections have to be treated with last resort antibiotics, such as colistin for the treatment of drug-resistant enterobacteriaceae or acinetobacter spp. Additionally the prevention of infections plays an important role in protecting critically ill patients. PMID:26837160

  12. Endoscopic options for treatment of dysplasia in Barrett's esophagus.

    PubMed

    Vance, R Brooks; Dunbar, Kerry B

    2015-12-25

    Recent advances in the endoscopic treatment of dysplasia in Barrett's esophagus (BE) have allowed endoscopists to provide effective and durable eradication therapies. This review summarizes the available endoscopic eradication techniques for dysplasia in patients with BE including endoscopic mucosal resection, endoscopic submucosal dissection, photodynamic therapy, argon plasma coagulation, radiofrequency ablation and cryotherapy. PMID:26722612

  13. Medical and surgical options in the treatment of severe obesity.

    PubMed

    Fisher, Barry L; Schauer, Philip

    2002-12-01

    Weight loss programs, diets, and drug therapy have not shown long-term effectiveness in treating morbid obesity. A 1992 statement from the National Institutes of Health Consensus Development Conference affirmed the superiority of surgical over nonsurgical approaches to this condition. Bariatric surgical procedures work in 1 of 2 ways: by restricting a patient's ability to eat (restrictive procedures) or by interfering with ingested nutrient absorption (malabsorptive procedures). Many of these procedures can be performed by a laparoscopic approach, which has been shown to reduce operative morbidity. In the United States, the primary operative choice for morbidly obese patients has recently shifted from vertical banded gastroplasty (VBG) to the Roux-en-Y gastric bypass (RYGBP). VBG, a purely restrictive procedure, has fallen into disfavor because of inadequate long-term weight loss. RYGBP combines restriction and malabsorption principles, and has been shown to induce greater weight loss than VBG. Other procedures currently being offered include laparoscopic adjustable gastric banding; biliopancreatic diversion (BPD), including the duodenal switch (BPD-DS) variation; and distal gastric bypass (DGBP). Laparoscopic adjustable gastric banding with the LAP-BAND system (INAMED Health, Santa Barbara, CA), a restrictive procedure involving placement of a silicone band around the upper stomach, was introduced in the early 1990s and approved by the US Food and Drug Administration for use in the United States in June 2001. Outside the United States, LAP-BAND surgery is the most commonly performed operation for severe obesity. The BPD, BPD-DS, and DGBP are all malabsorptive procedures offered primarily by laparotomy. They have been shown to induce good long-term weight loss but have a higher rate of adverse nutritional complications. Many safe and effective surgical options for severe obesity are available. More scientific appraisals comparing different procedures and open and laparoscopic approaches are needed. PMID:12527344

  14. Central Retinal Vein Occlusion: A Review of Current Evidence-based Treatment Options

    PubMed Central

    Patel, Amy; Nguyen, Christine; Lu, Stephanie

    2016-01-01

    A central retinal vein occlusion (CRVO) can induce an ischemic and hypoxic state with resulting sequelae of macular edema and neovascularization. Many treatment options have been studied. Our review aims to investigate the safety and efficacy of the multiple treatment options of CRVO. A PubMed and Cochrane literature search was performed. Well-controlled randomized clinical trials that demonstrated strong level 1 evidence-based on the rating scale developed by the British Centre for Evidence-Based Medicine were included. Seven clinical trials met inclusion criteria to be included in this review. These included studies that investigated the safety and efficacy of retinal photocoagulation (1 study), intravitreal steroid treatment (2 studies), and antivascular endothelial growth factor treatment (4 studies) for the treatment of CRVO. In addition, studies evaluating surgical treatment options for CRVO were also included. Many treatment modalities have been demonstrated to be safe and efficacious in the treatment of CRVO. These treatment options offer therapeutic benefits for patients and clinically superior visual acuity and perhaps the quality of life after suffering from a CRVO. PMID:26957838

  15. New options for early treatment of multiple sclerosis.

    PubMed

    Tintor, Mar

    2009-02-01

    It is now possible to diagnose patients with multiple sclerosis earlier than previously due to the integration of MRI parameters into the diagnostic criteria. This provides a window of opportunity to treat patients with disease-modifying treatments before clinically-manifest tissue destruction and disability has emerged. There are a number of reasons to believe that such early treatment will be particularly beneficial. For example, immunopathological studies have shown that the irreversible axonal damage that underlies accumulation of disability occurs very early in the course of the disease. In addition, natural history studies demonstrate that frequent relapses and accumulation of a high T2 lesion load in the first years following diagnosis are predictive of long-term disability outcome. Treating patients early, after a clinically isolated neurological syndrome suggestive of multiple sclerosis, appears to have a greater impact on relapse frequency than when treatment is initiated later in the disease course. The latest data comes from the PreCISe study, a placebo-controlled randomised study of glatiramer acetate in patients with a clinically isolated syndrome. The study showed that this treatment significantly reduced the risk of conversion to clinically definite multiple sclerosis, with the quartile time for conversion being prolonged by more than one year in the glatiramer acetate cohort compared to placebo-treated patients. The safety and tolerability of glatiramer acetate in this relatively healthy and independent patient population was acceptable and consistent with its known safety profile in patients with relapsing remitting multiple sclerosis. An application for an extension of the approved indication of glatiramer acetate to the treatment of patients with a first clinical event suggestive of multiple sclerosis has been filed with the regulatory authorities. PMID:19200870

  16. Non Surgical Correction of Mandibular Deviation and Neuromuscular Coordination after Two years of Mandibular Guidance Therapy: A Case Report

    PubMed Central

    Sinha, Nidhi; Sharma, Rohit; Parekh, Narzi

    2015-01-01

    Carcinomas of the mandible may require resection of a segment of bone (continuity defect), partial removal of bone (discontinuity defect), tongue, and floor of the mouth and muscle attachments. Patients undergoing such treatment suffer from facial disfigurement, loss of muscle function, loss of neuromuscular coordination resulting in inability to masticate and swallow acceptably. Surgical reconstruction may not always be possible because of high reoccurrence rate, inability of the patient to cope with another surgery etc. The treatment of choice in non surgical cases is prosthetic rehabilitation using guiding flange prosthesis. This article describes the management of a patient who had undergone hemimandibulectomy and was not willing for a surgical reconstruction. Interim maxillary ramp prosthesis was given to the patient 15 days postoperatively followed by definitive guiding flange prosthesis for two years after which the patient was able to occlude in centric occlusal position without any aid. PMID:26673016

  17. Pulmonary Hypertension Survival Effects and Treatment Options in Cystic Fibrosis

    PubMed Central

    Tonelli, Adriano R.

    2014-01-01

    Purpose of review This review discusses the current impact of pulmonary hypertension (PH) in the outcome and treatment of cystic fibrosis (CF). Recent findings Pulmonary hypertension is commonly encountered in advanced lung diseases such as CF. The prevalence of PH in CF patients varies based on disease severity and methodology used for diagnosis. Chronic alveolar hypoxia is the most likely etiology. The majority of recent studies have shown worse survival in CF patients who develop PH. The impact of PH-specific therapies on symptomatology and outcomes in CF patients has not been well studied. Summary Pulmonary hypertension is common in patients with CF and it occurs largely because of hypoxemia. The presence of PH in patients with CF is likely associated with worse outcome; however it remains unknown whether treatment with PH-specific therapies would be beneficial. PMID:24048083

  18. Pathological fractures in children: Diagnosis and treatment options.

    PubMed

    Canavese, F; Samba, A; Rousset, M

    2016-02-01

    A fracture is defined as pathological when it arises in a bone tissue that has been modified and reshaped by a local or systemic pathological process. In children, pathological fractures can be secondary to several conditions, ranging from metabolic diseases to tumors, infections or neuromuscular pathologies. History, clinical examination and radiologic assessment are essential to making a diagnosis, to identifying the underlying cause and to planning the right treatment of a pathological fracture. Treatment must be tailored to both the fracture and the underlying cause. The objective of this work is to present the diagnostic approach and the course to follow when a child presents with a pathological fracture. The most common causes of pathological fractures, as well as their characteristics, will be described. Pathological fractures occurring in osteogenesis imperfecta and in abused children as well as stress fractures will not be discussed. PMID:26774903

  19. Multidisciplinary Treatment Options of Tooth Avulsion Considering Different Therapy Concepts

    PubMed Central

    Kostka, Eckehard; Meissner, Simon; Finke, Christian H; Mandirola, Manlio; Preissner, Saskia

    2014-01-01

    Background: Avulsion of permanent front teeth is a rare accident, mostly affecting children between seven and nine years of age. Replanted and splinted, these teeth often develop inflammation, severe resorption or ankylosis affecting alveolar bone development and have to be extracted sooner or later. Objectives: The purpose of this study was to evaluate different therapy concepts to create a structured concept for the treatment of avulsions. Results: Based on existing therapy concepts, a concept for different initial conditions (dry time, age, growth, tooth, hard and soft tissues) was developed and is presented here. Conclusion: A great deal of research has been performed during recent years and guidelines for the management of avulsions have been published. With the help of this literature it is possible to identify the best treatment procedure for each tooth. Clinical Relevance: The prognosis of avulsed teeth can be improved by considering evidence-based therapy concepts. Resorption, ankylosis and tooth loss could be minimized. PMID:25352922

  20. Treatment options for multiple sclerosis: current and emerging therapies.

    PubMed

    Gawronski, Kristen M; Rainka, Michelle M; Patel, Malti J; Gengo, Francis M

    2010-09-01

    Multiple sclerosis is a chronic autoimmune disease affecting the central nervous system, more specifically, the myelin sheath covering of nerve fibers in the brain and spinal cord. This disease requires lifelong disease-modifying therapy, and all of the currently available first-line disease-modifying agents are parenteral formulations only. To date, eight drugs have entered or completed phases II and III clinical trials, four of which are oral drugs. These include five immunomodulators--cladribine, fingolimod, laquinimod, teriflunomide, and dimethyl fumarate--and three monoclonal antibodies--alemtuzumab, daclizumab, and rituximab. Although comparing these new drugs with available therapies is difficult, they do show promise as potential first-line agents for the treatment of multiple sclerosis. This marks a new frontier in the treatment of this disease, as the advent of new oral drugs will lead to increased patient compliance and contribute to longer sustained symptom-free periods and less marked disability. PMID:20795847

  1. Standard and emerging treatment options for diabetic neuropathy.

    PubMed

    Tentolouris, Nicholas; Alexiadou, Kleopatra; Makrilakis, Konstantinos; Liatis, Stavros; Jude, Edward; Boulton, Andrew J

    2014-01-01

    Diabetic neuropathy is a common complication of diabetes mellitus affecting 30-50% of patients and is a major cause for increased costs, morbidity and mortality. Strict diabetes control prevents this complication and may restore neurologic deficits in the early stages. Several efforts have been undertaken to alter the natural history of this complication, including the use of aldose reductase and protein kinase-C inhibitors, as well as antioxidants. Available data so far do not support the use of aldose reductase inhibitors due to safety issues and efficacy. Protein kinase-C inhibitors have provided encouraging initial results but their development has been halted. Antioxidants, like a-lipoic acid, improve some neurological deficits and painful symptoms. There are effective and safe medications such as anticonvulsants, antidepressants and opioids for the management of patients with painful symptoms. In this revew we present standard and emerging treatment modalities for the etiologic and symptomatic treatment of diabetic neuropathy. PMID:24040869

  2. Dynamic optimization of chronic migraine treatment: current and future options.

    PubMed

    Mathew, Ninan T

    2009-02-01

    Comparator studies that assess treatment effects in a clinical setting have improved the understanding of the efficacy and tolerability of prophylactic treatments for chronic migraine (CM). It is premature to recommend device-based treatments, such as occipital nerve stimulation, vagal nerve stimulation, and patent foramen ovale closure for CM, because clinical trials are in the preliminary stages. Physical therapy techniques, like applying heat or cold packs, ultrasonography, and electrical stimulation, have been shown to lessen pain. Nonpharmacologic treatments, including cognitive behavioral therapy, stress management, and biofeedback, have been investigated and proved effective in some areas of pain management, including migraine. However, pharmacologic interventions may be necessary for effective, long-term prophylaxis. Several medications under investigation, including topiramate, gabapentin, tizanidine, and amitriptyline, have proved efficacious in reducing the number of migraine episodes and the pain associated with migraine, although adverse events may prevent continued use of some agents. Evidence supports the use of botulinum toxin type A (BoNT-A) for CM, with or without medication overuse, to achieve a significant reduction in headache episodes. Efficacy of BoNT-A for CM is comparable with or better than that of valproate and topiramate, with better tolerability. Predictors of response to BoNT-A for CM appear to include predominantly unilateral location of the headache and the presence of cutaneous or muscle allodynia. BoNT-A has been demonstrated to be safe and well tolerated, with rare discontinuations due to adverse events. Recent clinical trials indicate that rational combination therapy may have a place in treating refractory CM. Well-controlled multicenter trials are awaited. PMID:19188563

  3. Modern treatment options for the therapy of keratoconus.

    PubMed

    Tomalla, Mark; Cagnolati, Wolfgang

    2007-03-01

    The following case report describes the implantation of intrastromal corneal ring segments (ICRS) and the postoperative contact lens treatment in a 42-year-old patient with bilateral advanced keratoconus. The patient had a preoperative contact lens intolerance. After femtosecond laser assisted surgery and the implantation of ICRS new custom mini-scleral contact lenses were fitted. The postoperative subjective and objective contact lens tolerance was excellent. PMID:17207654

  4. Biological treatment options for consolidated tailings release waters

    SciTech Connect

    Gunter, C.P.; Nix, P.G.; Sander, B.; Knezevic, Z.

    1995-12-31

    Suncor Inc., Oil Sands Group, operates a large oil sands mining and extraction operation in northeastern Alberta. The extraction plant produces large volumes of a tailings slurry which resists dewatering and treatment, and is toxic to aquatic organisms. Consolidated tailings (CT) technology is used to treat tailings by either acid/lime or gypsum and enhances the possibility of treating residual fine tails in a ``dry`` land reclamation scenario and treating the release water in a wastewater treatment reclamation scenario. The objective was to assess the treatability of CT release water (i.e., the reduction of acute and chronic toxicities to trout, Ceriodaphnia, and bacteria) in bench-scale biological treatment systems. Microtox{reg_sign} IC20 test showed complete detoxification for the gypsum CT release water within 3 to 5 weeks compared with little reduction in toxicity for dyke drainage. Acute toxicity (fish) and chronic toxicity (Ceriodaphnia, bacterial) was removed from both CT release waters. Phosphate and aeration enhanced detoxification rates. Concentrations of naphthenic acids (an organic toxicant) were not reduced, but levels of dissolved organic compounds decreased faster than was the case for dyke drainage water, indicating that some of the organic compounds in both acid/lime and gypsum CT waters were more biodegradable. There was a pattern of increasing toxicity for dyke drainage water which confirmed observations during field-scale testing in the constructed wetlands and which was not observed for CT release waters. Acid/lime and gypsum CT water can be treated biologically in either an aeration pond, constructed wetlands, or a combination of both thereby avoiding the expense of long-term storage and/or conventional waste treatment systems.

  5. Treatment options for tank farms long-length contaminated equipment

    SciTech Connect

    Josephson, W.S.

    1995-10-16

    This study evaluated a variety of treatment and disposal technologies for mixed waste (MW) meeting the following criteria: 1. Single-Shell and Double-Shell Tank System (tank farms) equipment and other debris; 2. length greater than 12 feet; and contaminated with listed MW from the tank farms. This waste stream, commonly referred to as tank farms long-length contaminated equipment (LLCE), poses a unique and costly set of challenges during all phases of the waste management lifecycle.

  6. Current and emerging treatment options for hairy cell leukemia

    PubMed Central

    Lpez-Rubio, Montserrat; Garcia-Marco, Jose Antonio

    2015-01-01

    Hairy cell leukemia (HCL) is a lymphoproliferative B-cell disorder characterized by pancytopenia, splenomegaly, and characteristic cytoplasmic hairy projections. Precise diagnosis is essential in order to differentiate classic forms from HCL variants, such as the HCL-variant and VH4-34 molecular variant, which are more resistant to available treatments. The current standard of care is treatment with purine analogs (PAs), such as cladribine or pentostatin, which provide a high rate of long-lasting clinical remissions. Nevertheless, ~30%40% of the patients relapse, and moreover, some of these are difficult-to-treat refractory cases. The use of the monoclonal antibody rituximab in combination with PA appears to produce even higher responses, and it is often employed to minimize or eliminate residual disease. Currently, research in the field of HCL is focused on identifying novel therapeutic targets and potential agents that are safe and can universally cure the disease. The discovery of the BRAF mutation and progress in understanding the biology of the disease has enabled the scientific community to explore new therapeutic targets. Ongoing clinical trials are assessing various treatment strategies such as the combination of PA and anti-CD20 monoclonal antibodies, recombinant immunotoxins targeting CD22, BRAF inhibitors, and B-cell receptor signal inhibitors. PMID:26316784

  7. Geothermal injection treatment: process chemistry, field experiences, and design options

    SciTech Connect

    Kindle, C.H.; Mercer, B.W.; Elmore, R.P.; Blair, S.C.; Myers, D.A.

    1984-09-01

    The successful development of geothermal reservoirs to generate electric power will require the injection disposal of approximately 700,000 gal/h (2.6 x 10/sup 6/ 1/h) of heat-depleted brine for every 50,000 kW of generating capacity. To maintain injectability, the spent brine must be compatible with the receiving formation. The factors that influence this brine/formation compatibility and tests to quantify them are discussed in this report. Some form of treatment will be necessary prior to injection for most situations; the process chemistry involved to avoid and/or accelerate the formation of precipitate particles is also discussed. The treatment processes, either avoidance or controlled precipitation approaches, are described in terms of their principles and demonstrated applications in the geothermal field and, when such experience is limited, in other industrial use. Monitoring techniques for tracking particulate growth, the effect of process parameters on corrosion and well injectability are presented. Examples of brine injection, preinjection treatment, and recovery from injectivity loss are examined and related to the aspects listed above.

  8. Treatment options in renal cell carcinoma: past, present and future.

    PubMed

    Oudard, S; George, D; Medioni, J; Motzer, R

    2007-09-01

    Cytokine therapies have been the standard of care in metastatic renal cell carcinoma (RCC). However, these agents only provide clinical benefit to a small subset of patients and are associated with significant toxicity. A better understanding of the molecular biology of RCC has identified the vascular endothelial growth factor (VEGF) and platelet-derived growth factor signalling pathways as rational targets for anticancer therapy. The multitargeted receptor tyrosine kinase inhibitors sunitinib and sorafenib have both demonstrated improved efficacy as second-line therapy in patients with RCC. Sunitinib has also been shown to be effective in the first-line setting, and has recently received European Union approval as first-line treatment for advanced and/or metastatic RCC. There is also recent evidence that temsirolimus (an inhibitor of the mammalian target of rapamycin) and bevacizumab (a mAb targeted against VEGF) may provide benefits in the first-line treatment setting. These results confirm that inhibiting these tumour targets is a feasible approach to treatment and provides a more positive outlook for the future management of metastatic RCC. PMID:17761720

  9. Emerging Treatment Options in Mild to Moderate Ulcerative Colitis

    PubMed Central

    Lichtenstein, Gary R.; Hanauer, Stephen B.; Sandborn, William J.

    2015-01-01

    Ulcerative colitis (UC) is a chronic inflammatory condition associated with rectal bleeding and urgency, tenesmus, and diarrhea. Several medical therapies can be used in the treatment of UC. Aminosalicylates are widely used based on their efficacy in the induction and maintenance of remission. Although corticosteroids are effective in patients with more severe disease, systemic use is associated with significant safety concerns. The newer corticosteroid budesonide has lower systemic bioavailability and, consequently, a more favorable safety profile. A budesonide extended-release formulation allows once-daily dosing and delivers the agent locally throughout the colon. Biologic agents used for the treatment of moderate to severe UC include the tumor necrosis factor inhibitors infliximab, adalimumab, and golimumab, and the integrin inhibitor vedolizumab. Rectally administered therapy can also be useful in the treatment of UC. In October 2014, the US Food and Drug Administration approved a budesonide foam formulation for inducing remission in patients with active mild to moderate distal UC extending up to 40 cm from the anal verge. Budesonide foam rapidly distributes to the sigmoid colon and the rectum and avoids some of the drawbacks of suppositories and enemas. PMID:26491415

  10. Pathophysiology, epidemiology, classification and treatment options for polycystic liver diseases.

    PubMed

    Abu-Wasel, Bassam; Walsh, Caolan; Keough, Valerie; Molinari, Michele

    2013-09-21

    Polycystic liver diseases (PLD) represent a group of genetic disorders in which cysts occur in the liver (autosomal dominant polycystic liver disease) or in combination with cysts in the kidneys (autosomal dominant polycystic kidney disease). Regardless of the genetic mutations, the natural history of these disorders is alike. The natural history of PLD is characterized by a continuous increase in the volume and the number of cysts. Both genders are affected; however, women have a higher prevalence. Most patients with PLD are asymptomatic and can be managed conservatively. Severe symptoms can affect 20% of patients who develop massive hepatomegaly with compression of the surrounding organs. Rrarely, patients with PLD suffer from acute complications caused by the torsion of hepatic cysts, intraluminal cystic hemorrhage and infections. The most common methods for the diagnosis of PLD are cross sectional imaging studies. Abdominal ultrasound and computerized tomography are the two most frequently used investigations. Magnetic resonance imaging is more sensitive and specific, and it is a valuable test for patients with intravenous contrast allergies or renal dysfunction. Different treatment modalities are available to physicians caring for these patients. Medical treatment has been ineffective. Percutaneous sclerotherapy, trans-arterial embolization, cyst fenestration, hepatic resection and liver transplantation are indicated to specific groups of patients and have to be tailored according to the extent of disease. This review outlines the current knowledge of the pathophysiology, clinical course, diagnosis and treatment strategies of PLD. PMID:24124322

  11. Current and emerging treatment options for patients with relapsed myeloma.

    PubMed

    Castelli, Roberto; Gualtierotti, Roberta; Orofino, Nicola; Losurdo, Agnese; Gandolfi, Sara; Cugno, Massimo

    2013-01-01

    Multiple myeloma (MM) is a neoplastic disorder. It results from proliferation of clonal plasma cells in bone marrow with production of monoclonal proteins, which are detectable in serum or urine. MM is clinically characterized by destructive bone lesions, anemia, hypercalcemia and renal insufficiency. Its prognosis is severe, with a median survival after diagnosis of approximately 3 years due to frequent relapses. Treatments for patients with relapsed/refractory MM include hematopoietic cell transplantation, a rechallenge using a previous chemotherapy regimen or a trial of a new regimen. The introduction of new drugs such as thalidomide, lenalidomide and bortezomib has markedly improved MM outcomes. When relapse occurs, the clinician's challenge is to select the optimal treatment for each patient while balancing efficacy and toxicity. Patients with indolent relapse can be first treated with a 2-drug or a 3-drug combination. Patients with more aggressive relapse often require therapy with a combination of multiple active agents. Autologous stem cell transplantation should be considered as salvage therapy at first relapse for patients who have cryopreserved stem cells early in the disease course. The aim of this review is to provide an overview on the pharmacological and molecular action of treatments used for patients with relapsed/refractory multiple myeloma. PMID:24179412

  12. Three-year follow-up results for non-surgical root canal therapy of idiopathic external root resorption on a maxillary canine with MTA: a case report

    PubMed Central

    Huang, Zheng; Chen, Li-Li; Wang, Cong-Yi; Dai, Lin; Cheng, Bo; Sun, Jun; Sun, Jun

    2014-01-01

    External root resorption (ERR) is an uncommon and intractable disease. Treatment alternatives are case-dependant and aim for the repair of the resorptive lesion and long-term retention of the tooth. A forty-year-old Asian female was diagnosed with idiopathic ERR on tooth #11 (the left maxillary canine) by CBCT. Non-surgical root canal therapy was completed with the aid of an operating microscope. The apical third of the root canal was filled with warm gutta-percha and the resorption defect was filled with mineral trioxide aggregate (MTA). The periapical radiographs were taken immediately after operation, one-month follow-up, six-month follow-up and three-year follow-up, respectively. Clinically, the canine was asymptomatic, and no evidence of any further resorption was found. The six-month follow-up radiograph showed initial healing of the bony lesion, while the three-year follow-up radiograph manifested almost complete healing. MTA can be a superior material to be successfully used in the non-surgical treatment of ERR. CBCT is very useful for evaluating the true nature and severity of absorption lesions in root resorption. It is the first complete case report from China about non-surgical treatment of severe ERR along with a relatively long term follow-up. PMID:25031758

  13. Emerging pharmacologic treatment options for fragile X syndrome

    PubMed Central

    Schaefer, Tori L; Davenport, Matthew H; Erickson, Craig A

    2015-01-01

    Fragile X syndrome (FXS) is the most common single gene cause of intellectual disability and autism spectrum disorder. Caused by a silenced fragile X mental retardation 1 gene and the subsequent deficiency in fragile X mental retardation protein, patients with FXS experience a range of physical, behavioral, and intellectual debilitations. The FXS field, as a whole, has recently met with some challenges, as several targeted clinical trials with high expectations of success have failed to elucidate significant improvements in a variety of symptom domains. As new clinical trials in FXS are planned, there has been much discussion about the use of the commonly used clinical outcome measures, as well as study design considerations, patient stratification, and optimal age range for treatment. The evidence that modification of these drug targets and use of these failed compounds would prove to be efficacious in human clinical study were rooted in years of basic and translational research. There are questions arising as to the use of the mouse models for studying FXS treatment development. This issue is twofold: many of the symptom domains and molecular and biochemical changes assessed and indicative of efficacy in mouse model study are not easily amenable to clinical trials in people with FXS because of the intolerability of the testing paradigm or a lack of noninvasive techniques (prepulse inhibition, sensory hypersensitivity, startle reactivity, or electrophysiologic, biochemical, or structural changes in the brain); and capturing subtle yet meaningful changes in symptom domains such as sociability, anxiety, and hyperactivity in human FXS clinical trials is challenging with the currently used measures (typically parent/caregiver rating scales). Clinicians, researchers, and the pharmaceutical industry have all had to take a step back and critically evaluate the way we think about how to best optimize future investigations into pharmacologic FXS treatments. As new clinical trials are coming down the drug discovery pipeline, it is clear that the field is moving in a direction that values the development of molecular biomarkers, less subjective quantitative measures of symptom improvement, and rating scales developed specifically for use in FXS in conjunction with drug safety. While summarizing preclinical evidence, where applicable, and discussing challenges in FXS treatment development, this review details both completed clinical trials for the targeted and symptomatic treatment of FXS and introduces novel projects on the cusp of clinical trial investigation. PMID:25897255

  14. Treatment of Acute Seizures: Is Intranasal Midazolam a Viable Option?

    PubMed Central

    Humphries, Lesley K.; Eiland, Lea S.

    2013-01-01

    Seizures in the pediatric population commonly occur, and when proper rescue medication is not administered quickly, the risk of neurologic compromise emerges. For many years, rectal diazepam has been the standard of care, but recent interest in a more cost-effective, safe alternative has led to the investigation of intranasal midazolam for this indication. Although midazolam and diazepam are both members of the benzodiazepine class, the kinetic properties of these 2 anticonvulsants vary. This paper will review available data pertaining to the efficacy, safety, cost, and pharmacokinetics of intranasal midazolam versus rectal diazepam as treatment for acute seizures for children in the prehospital, home, and emergency department settings. PMID:23798902

  15. Urinary tract infections: epidemiology, mechanisms of infection and treatment options.

    PubMed

    Flores-Mireles, Ana L; Walker, Jennifer N; Caparon, Michael; Hultgren, Scott J

    2015-05-01

    Urinary tract infections (UTIs) are a severe public health problem and are caused by a range of pathogens, but most commonly by Escherichia coli, Klebsiella pneumoniae, Proteus mirabilis, Enterococcus faecalis and Staphylococcus saprophyticus. High recurrence rates and increasing antimicrobial resistance among uropathogens threaten to greatly increase the economic burden of these infections. In this Review, we discuss how basic science studies are elucidating the molecular details of the crosstalk that occurs at the host-pathogen interface, as well as the consequences of these interactions for the pathophysiology of UTIs. We also describe current efforts to translate this knowledge into new clinical treatments for UTIs. PMID:25853778

  16. Current and future systemic treatment options in metastatic pancreatic cancer

    PubMed Central

    Arslan, Cagatay

    2014-01-01

    Although pancreatic adenocarcinoma is the fourth leading cause of cancer death, only modest improvement has been observed in the past two decades, single agent gemcitabine has been the only standard treatment in patients with advanced disease. Recently newer agents such as nab-paclitaxel, nimotuzumab and regimens such as FOLFIRINOX have been shown to have promising activity being superior to gemcitabine as a single agent. With better understanding of tumour biology coupled with the improvements in targeted and immunotherapies, there is increasing expectation for better response rates and extended survival in pancreatic cancer. PMID:25083302

  17. New Topical Treatment Options for Actinic Keratosis: A Systematic Review.

    PubMed

    Stockfleth, Eggert; Sibbring, Gillian C; Alarcon, Ivette

    2016-01-20

    This systematic review compared the relative efficacy of 5-fluorouracil 0.5% in salicylic acid 10% (5-FU/SA), ingenol mebutate (IMB) and imiquimod 2.5%/3.75% (IMI) for actinic keratosis on the face, forehead or scalp. Only 11 publications, relating to 7 randomised controlled trials, met inclusion criteria and it was only possible to compare the effect of all 3 treatments on complete clinical clearance, and the effect of 5-FU/SA and IMB on actinic keratosis recurrence rate. Despite a higher vehicle response rate for 5-FU/SA, complete clinical clearance was higher than IMB and IMI (55.4, 42.7, and 25.0/30.6%, respectively). 5-FU/SA was also associated with lower actinic keratosis recurrence rate than IMB at 12 months post-treatment (32.7 vs. 53.9%). Although qualitative assessment suggested a numerical advantage of 5-FU/SA over IMB and IMI in terms of complete clinical clearance and sustained clearance, clinical data from longer term trials, with comparable outcome measures, are required to corroborate these findings. PMID:26068001

  18. Rhinophototherapy: gimmick or an emerging treatment option for allergic rhinitis?

    PubMed

    Leong, S C

    2011-12-01

    Photodynamic therapy has been used in treating immune-mediated dermatological conditions such as psoriasis and atopic dermatitis. There are emerging reports on the efficacy of intranasal phototherapy in allergic rhinitis. The aim of this review was to assess intranasal phototherapy in the treatment of allergic rhinitis, with particular emphasis on clinical efficacy, scientific basis and safety. A structured search of the U.S. National Library of Medicine (PubMed), the Cochrane Collaboration library, Google Scholar and ISI Web of Knowledge database was undertaken using MeSH terms `phototherapy` and `rhinitis.` Fourteen full-text articles were available for review. Three different phototherapy medical devices were assessed: (1) Bionase(TM), (2) Allergy Reliever SN206 and (3) Rhinolight(). Light wavelength used in these devices ranged from red light to ultraviolet. Clinical use of intranasal phototherapy appears to be safe and well tolerated. Most studies demonstrated symptomatic improvement and quality of life scores. No improvement in objective measures of nasal airflow was demonstrated. Beneficial effects of phototherapy on inflammatory markers remain equivocal. Phototherapy treatment results in DNA damage but does not appear to predispose to carcinogenesis. However, long-term prospective studies are required to verify this. The quality of published studies was variable and thus the current strength of recommending intranasal phototherapy is currently weak. PMID:22125778

  19. Dosimetric Study of Current Treatment Options for Radiotherapy in Retinoblastoma

    SciTech Connect

    Eldebawy, Eman; Parker, William; Abdel Rahman, Wamied; Freeman, Carolyn R.

    2012-03-01

    Purpose: To determine the best treatment technique for patients with retinoblastoma requiring radiotherapy to the whole eye. Methods and Materials: Treatment plans for 3 patients with retinoblastoma were developed using 10 radiotherapy techniques including electron beams, photon beam wedge pair (WP), photon beam three-dimensional conformal radiotherapy (3D-CRT), fixed gantry intensity-modulated radiotherapy (IMRT), photon volumetric arc therapy (VMAT), fractionated stereotactic radiotherapy, and helical tomotherapy (HT). Dose-volume analyses were carried out for each technique. Results: All techniques provided similar target coverage; conformity was highest for VMAT, nine-field (9F) IMRT, and HT (conformity index [CI] = 1.3) and lowest for the WP and two electron techniques (CI = 1.8). The electron techniques had the highest planning target volume dose gradient (131% of maximum dose received [D{sub max}]), and the CRT techniques had the lowest (103% D{sub max}) gradient. The volume receiving at least 20 Gy (V{sub 20Gy}) for the ipsilateral bony orbit was lowest for the VMAT and HT techniques (56%) and highest for the CRT techniques (90%). Generally, the electron beam techniques were superior in terms of brain sparing and delivered approximately one-third of the integral dose of the photon techniques. Conclusions: Inverse planned image-guided radiotherapy delivered using HT or VMAT gives better conformity index, improved orbital bone and brain sparing, and a lower integral dose than other techniques.

  20. Reviewing the options for local estrogen treatment of vaginal atrophy

    PubMed Central

    Lindahl, Sarah H

    2014-01-01

    Background Vaginal atrophy is a chronic condition with symptoms that include vaginal dryness, pain during sex, itching, irritation, burning, and discharge, as well as various urinary problems. Up to 45% of postmenopausal women may be affected, but it often remains underreported and undertreated. This article aims to review the current recommendations for treatment of vaginal atrophy, and current data on the effectiveness and safety of local vaginal estrogen therapies. Methods Literature regarding vaginal atrophy (20072012) was retrieved from PubMed and summarized, with emphasis on data related to the treatment of vaginal atrophy with local vaginal estrogen therapy. Results Published data support the effectiveness and endometrial safety of low-dose local estrogen therapies. These results further support the general recommendation by the North American Menopause Society that a progestogen is not needed for endometrial protection in patients using low-dose local vaginal estrogen. Benefits of long-term therapy for vaginal atrophy include sustained relief of symptoms as well as physiological improvements (eg, decreased vaginal pH and increased blood flow, epithelial thickness, secretions). Conclusion Currently available local vaginal estrogen therapies are well tolerated and effective in relieving symptoms of vaginal atrophy. Recent data support the endometrial safety of low-dose regimens for up to 1 year. PMID:24648775

  1. Lung abscess-etiology, diagnostic and treatment options

    PubMed Central

    Kuhajda, Ivan; Zarogoulidis, Konstantinos; Tsirgogianni, Katerina; Tsavlis, Drosos; Kioumis, Ioannis; Kosmidis, Christoforos; Tsakiridis, Kosmas; Mpakas, Andrew; Zissimopoulos, Athanasios; Baloukas, Dimitris; Kuhajda, Danijela

    2015-01-01

    Lung abscess is a type of liquefactive necrosis of the lung tissue and formation of cavities (more than 2 cm) containing necrotic debris or fluid caused by microbial infection. It can be caused by aspiration, which may occur during altered consciousness and it usually causes a pus-filled cavity. Moreover, alcoholism is the most common condition predisposing to lung abscesses. Lung abscess is considered primary (60%) when it results from existing lung parenchymal process and is termed secondary when it complicates another process, e.g., vascular emboli or follows rupture of extrapulmonary abscess into lung. There are several imaging techniques which can identify the material inside the thorax such as computerized tomography (CT) scan of the thorax and ultrasound of the thorax. Broad spectrum antibiotic to cover mixed flora is the mainstay of treatment. Pulmonary physiotherapy and postural drainage are also important. Surgical procedures are required in selective patients for drainage or pulmonary resection. In the current review we will present all current information from diagnosis to treatment. PMID:26366400

  2. [Pleural empyema and lung abscess: current treatment options].

    PubMed

    Hecker, E; Hamouri, S; Mller, E; Ewig, S

    2012-06-01

    Parapneumonic pleural empyema has been classified into different stages and classes. While the American Thoracic Society (ATS) classification is based on the natural course of the disease, Light has classified pleural empyema according to the radiological, physical and biochemical characteristics, and the American College of Chest Physician (ACCP) has categorised the patients with pleural empyema according to the risk of a poor outcome. According to this classification the management of the pleural empyema is based on the stage of the disease. Therapeutic strategies include chest tube, chest tube with fibrinolysis, thoracoscopic debridement and decortication in open or minimally invasive techniques. Primary lung abscesses develop in previously healthy lung parenchyma and are caused by aspiration. In addition, abscess formation can occur without aspiration, and important differences relate to community-acquired, nosocomial abscesses and those in the immunosuppressed host. 90 % of all lung abscesses can be cured with antibiotic treatment alone, 10 % have to be treated with an interventional catheter or chest tubes and only 1 % require thoracic surgery because of complications independent of the former conservative or interventional treatment strategies. PMID:22711325

  3. Lung abscess-etiology, diagnostic and treatment options.

    PubMed

    Kuhajda, Ivan; Zarogoulidis, Konstantinos; Tsirgogianni, Katerina; Tsavlis, Drosos; Kioumis, Ioannis; Kosmidis, Christoforos; Tsakiridis, Kosmas; Mpakas, Andrew; Zarogoulidis, Paul; Zissimopoulos, Athanasios; Baloukas, Dimitris; Kuhajda, Danijela

    2015-08-01

    Lung abscess is a type of liquefactive necrosis of the lung tissue and formation of cavities (more than 2 cm) containing necrotic debris or fluid caused by microbial infection. It can be caused by aspiration, which may occur during altered consciousness and it usually causes a pus-filled cavity. Moreover, alcoholism is the most common condition predisposing to lung abscesses. Lung abscess is considered primary (60%) when it results from existing lung parenchymal process and is termed secondary when it complicates another process, e.g., vascular emboli or follows rupture of extrapulmonary abscess into lung. There are several imaging techniques which can identify the material inside the thorax such as computerized tomography (CT) scan of the thorax and ultrasound of the thorax. Broad spectrum antibiotic to cover mixed flora is the mainstay of treatment. Pulmonary physiotherapy and postural drainage are also important. Surgical procedures are required in selective patients for drainage or pulmonary resection. In the current review we will present all current information from diagnosis to treatment. PMID:26366400

  4. The Pharmacological Options in the Treatment of Eating Disorders

    PubMed Central

    Milano, W.; De Rosa, M.; Milano, L.; Riccio, A.; Sanseverino, B.; Capasso, A.

    2013-01-01

    The eating disorders (DCA) are complex systemic diseases with high social impact, which tend to become chronic with significant medical and psychiatric comorbidities. The literature data showed that there is good evidence to suggest the use of SSRIs, particularly at high doses of fluoxetine, in the treatment of BN reducing both the crisis of binge that the phenomena compensates and reducing the episodes of binge in patients with BED in the short term. Also, the topiramate (an AED) showed a good effectiveness in reducing the frequency and magnitude of episodes of binge with body weight reduction, both in the BN that is in the therapy of BED. To date, modest data support the use of low doses of second-generation antipsychotics in an attempt to reduce the creation of polarized weight and body shapes, the obsessive component, and anxiety in patients with AN. Data in the literature on long-term drug treatment of eating disorders are still very modest. It is essential to remember that the pharmacotherapy has, however, a remarkable efficacy in treating psychiatric disorders that occur in comorbidity with eating disorders, such as mood disorders, anxiety, insomnia, and obsessive-compulsive personality disorders and behavior. PMID:23956871

  5. Contemporary treatment options for relapsing-remitting multiple sclerosis.

    PubMed

    Salhofer-Polanyi, S; Leutmezer, F

    2014-05-01

    Multiple sclerosis (MS) is an autoimmune disease of the central nervous system, encompassing both neuroinflammatory as well as prominent neurodegenerative aspects. A significant proportion of MS patients will develop neurological disability over time and up until recently licensed drugs could not satisfactorily halt this process. However, in the last years MS treatment has raised a stage of rapid progress. Several new drugs with significantly improved efficacy have entered the therapeutic field and several others are currently undergoing phase III clinical trials. In this review, we will summarize efficacy data as well as safety and tolerability issues of currently licensed drugs for relapsing-remitting MS and will give a short update on new drugs currently undergoing late-stage clinical trials. PMID:24918837

  6. Managing pediatric hepatitis C: current and emerging treatment options

    PubMed Central

    Karnsakul, Wikrom; Alford, Mary Kay; Schwarz, Kathleen B

    2009-01-01

    Since 1992, the maternal–fetal route of transmission has become the dominant route for acquisition of hepatitis C (HCV) infection by children. With increasing knowledge of antiviral treatment for HCV infection, the main goal of therapy is to achieve a sustained virological response (SVR) as defined by undetectable serum HCV RNA by polymerase chain reaction assay six months after cessation of therapy. In young children, interferon therapy is more effective than in adults with chronic HCV infection (CHC). Although children clearly have a milder degree of liver pathology, data have indicated that hepatic inflammation from HCV infection can progress to fibrosis or cirrhosis in children. Hepatocellular carcinoma has been reported in adolescents with CHC. In this article, recent improvements in therapy of children with CHC and in the clinical development of new emerging drugs with potential use in children will be reviewed. PMID:19707281

  7. Laser and light-based treatment options for hidradenitis suppurativa.

    PubMed

    Hamzavi, Iltefat H; Griffith, James L; Riyaz, Farhaad; Hessam, Schapoor; Bechara, Falk G

    2015-11-01

    Hidradenitis suppurativa (HS) is a chronic inflammatory disease that commonly develops painful, deep dermal abscesses and chronic, draining sinus tracts. Classically, pharmacologic and surgical therapies have been effective for reducing lesion activity and inflammation, but provide only modest success in the prevention of future recurrences and disease progression. Adjunctive therapies, such as laser and light-based therapies, have become more commonly used in the management of HS. These therapies work to reduce the occurrence of painful HS flare-ups by decreasing the number of hair follicles, sebaceous glands, and bacteria in affected areas, and by ablatively debulking chronic lesions. The best results are seen when treatment is individualized, taking disease severity into consideration when selecting specific energy-based approaches. This article will discuss various light-based therapies and the evidence supporting their use in the management of HS. PMID:26470622

  8. Management and treatment options for patients with open abdomen.

    PubMed

    Gurusamy, Kurinchi; Davidson, Brian

    2016-01-13

    Abdominal sepsis and trauma are the main indications for open abdomen. However, there is no robust evidence that open abdomen is better than closed in these cases. When using open abdomen, treatment goals are to control the source of infection, protect the bowel from damage, minimise adhesions between the bowel and abdominal wall, facilitate nursing care and allow permanent closure of the wound by bringing the fascial edges closer. Several temporary abdominal closure techniques exist, but are associated with high mortality and morbidity rates. There is no evidence that any specific temporary abdominal closure technique is better than others; however, negative pressure wound therapy appears to be a popular method of management of open abdomen. PMID:26758169

  9. Artificial liver support devices as treatment option for liver failure.

    PubMed

    Nevens, Frederik; Laleman, Wim

    2012-02-01

    Non-biological artificial liver support (ALS) devices aim to remove albumin-bound and water-soluble toxins arising as a result of liver failure. They do not directly improve the liver synthetic capacity. The currently most used devices combine haemodialysis with albumin dialysis (MARS) or plasma separation and filtration (Prometheus). These devices have been used as a treatment for different types of liver failure: acute liver failure, acute-on-chronic liver failure and primary non- or poor-function after liver transplantation. Overall these devices are found to be safe. The following beneficial effects have been documented: improvement of jaundice, amelioration of haemodynamic instability, reduction of portal hypertension, lowering of intracranial pressure and improvement of hepatic encephalopathy. However, recently multicentre controlled trials failed to show a beneficial effect on transplant-free survival. Therefore the use of these devices at present seems only justified as a bridge to liver transplantation. PMID:22482522

  10. Treatment options: biological basis of regenerative endodontic procedures.

    PubMed

    Hargreaves, Kenneth M; Diogenes, Anibal; Teixeira, Fabricio B

    2013-01-01

    Dental trauma occurs frequently in children and often can lead to pulpal necrosis. The occurrence of pulpal necrosis in the permanent but immature tooth represents a challenging clinical situation because the thin and often short roots increase the risk of subsequent fracture. Current approaches for treating the traumatized immature tooth with pulpal necrosis do not reliably achieve the desired clinical outcomes, consisting of healing of apical periodontitis, promotion of continued root development, and restoration of the functional competence of pulpal tissue. An optimal approach for treating the immature permanent tooth with a necrotic pulp would be to regenerate functional pulpal tissue. This review summarizes the current literature supporting a biological rationale for considering regenerative endodontic treatment procedures in treating the immature permanent tooth with pulp necrosis. PMID:23635981

  11. Treatment options: biological basis of regenerative endodontic procedures.

    PubMed

    Hargreaves, Kenneth M; Diogenes, Anibal; Teixeira, Fabricio B

    2013-03-01

    Dental trauma occurs frequently in children and often can lead to pulpal necrosis. The occurrence of pulpal necrosis in the permanent but immature tooth represents a challenging clinical situation because the thin and often short roots increase the risk of subsequent fracture. Current approaches for treating the traumatized immature tooth with pulpal necrosis do not reliably achieve the desired clinical outcomes, consisting of healing of apical periodontitis, promotion of continued root development, and restoration of the functional competence of pulpal tissue. An optimal approach for treating the immature permanent tooth with a necrotic pulp would be to regenerate functional pulpal tissue. This review summarizes the current literature supporting a biological rationale for considering regenerative endodontic treatment procedures in treating the immature permanent tooth with pulp necrosis. PMID:23439043

  12. Emergency treatment options for pediatric traumatic brain injury

    PubMed Central

    Exo, J; Smith, C; Smith, R; Bell, MJ

    2010-01-01

    Traumatic brain injury is a leading killer of children and is a major public health problem around the world. Using general principles of neurocritical care, various treatment strategies have been developed to attempt to restore homeostasis to the brain and allow brain healing, including mechanical factors, cerebrospinal fluid diversion, hyperventilation, hyperosmolar therapies, barbiturates and hypothermia. Careful application of these therapies, normally in a step-wise fashion as intracranial injuries evolve, is necessary in order to attain maximal neurological outcome for these children. It is hopeful that new therapies, such as early hypothermia or others currently in preclinical trials, will ultimately improve outcome and quality of life for children after traumatic brain injury. PMID:20191093

  13. [Low Back Pain in Pregnancy: Diagnosis, Treatment Options and Outcomes].

    PubMed

    Mühlemann, Daniel; Mühlemann, Malin B

    2015-05-20

    Low back pain in pregnancy is a common occurrence and is mainly caused by hormonal and biomechanical changes. Patients with pregnancy-induced low back pain (PILBP) frequently complain of moderate to severe and disabling pain often restricting their daily activities. In these cases, a “watch and wait” approach cannot be the best solution. On the basis of anamnesis and examination PILBP can be divided into three subgroups: pregnancy-related low back pain (PLBP), pelvic girdle pain (PGP) and the combination of PLBP and PGP. The three entities ask for different diagnostic workups and therapeutic modalities. There are many possible treatments for PLBP, however, only a few are based on sound evidence. Information and advice, exercise and training programs, acupuncture, stabilizing belts and analgesic medication can have a positive impact on pain and disability. PGP und PLBP respond well to chiropractic interventions. PMID:26098153

  14. New and emerging treatment options for biliary tract cancer

    PubMed Central

    Noel, Marcus S; Hezel, Aram F

    2013-01-01

    Biliary tract cancer (BTC) is a group of relatively rare tumors with a poor prognosis. The current standard of care consists of doublet chemotherapy (platinum plus gemcitabine); however, even with cytotoxic therapy, the median overall survival is less than 1 year. The genetic basis of BTC is now more clearly understood, allowing for the investigation of targeted therapy. Combinations of doublet chemotherapy with antiepidermal growth factor receptor agents have provided modest results in Phase II and Phase III setting, and responses with small molecule inhibitors are limited. Moving forward as we continue to characterize the genetic hallmarks of BTC, a stepwise, strategic, and cooperative approach will allow us to make progress when developing new treatments. PMID:24204165

  15. Breakthrough pain in elderly patients with cancer: treatment options.

    PubMed

    Pautex, Sophie; Vogt-Ferrier, Nicole; Zulian, Gilbert B

    2014-06-01

    The prevalence of pain is high in the elderly and increases with the occurrence of cancer. Pain treatment is challenging because of age-related factors such as co-morbidities, and over half of the patients with cancer pain experience transient exacerbation of pain that is known as breakthrough pain (BTP). As with background pain, BTP should be properly assessed before being treated. The first step to be taken is optimizing around-the-clock analgesia with expert titration of the painkiller. Rescue medication should then be provided as per the requested need, while at the same time preventing identified potential precipitating factors. In the elderly, starting treatment with a lower dose of analgesics may be justified because of age-related physiological changes such as decreased hepatic and renal function. Whenever possible, oral medication should be provided prior to a painful maneuver. In the case of unpredictable BTP, immediate rescue medication is mandatory and the subcutaneous route is preferred unless patient-controlled analgesia via continuous drug infusion is available. Recently, transmucosal preparations have appeared in the medical armamentarium but it is not yet known whether they represent a truly efficient alternative, although their rapid onset of activity is already well recognized. Adjuvant analgesics, topical analgesics, anesthetic techniques and interventional techniques are all valid methods to help in the difficult management of pain and BTP in elderly patients with cancer. However, none has reached a satisfying scientific level of evidence as to nowadays make the development of undisputed best practice guidelines possible. Further research is therefore on the agenda. PMID:24817569

  16. Oral antihyperglycemic treatment options for type 2 diabetes mellitus.

    PubMed

    Brietzke, Stephen A

    2015-01-01

    Table 3 provides an overview of the oral antihyperglycemic drugs reviewed in this article. A 2011 meta-analysis by Bennett and colleagues found low or insufficient quality of evidence favoring an initial choice of metformin, SUs, glinides, TZDs, or (table see text) DPP-4 inhibitors (alpha-glucosidase inhibitors, bromocriptine mesylate, and SGLT2 inhibitors were not included in this meta-analysis) with regard to the outcomes measures of all-cause mortality, cardiovascular events and mortality, and incidence of microvascular disease (retinopathy, nephropathy, and neuropathy) in previously healthy individuals with newly diagnosed T2DM. Likewise, the Bennett and colleagues meta-analysis judged these drugs to be of roughly equal efficacy with regard to reduction of HbA1c (1%–1.6%) from the pretreatment baseline. The ADOPT clinical trial of 3 different and, at the time, popular, oral monotherapies for T2DM provides support for the consensus recommendation of metformin as first-line therapy. The ADOPT trial showed slightly superior HbA1c reduction for rosiglitazone compared with metformin, which was in turn superior to glyburide. However, significant adverse events, including edema, weight gain, and fractures, were more common in the rosiglitazone-treated patients. The implication of this trial is that the combination of low cost, low risk, minimal adverse effects, and efficacy of metformin justifies use of this agent as the cornerstone of oral drug treatment of T2DM. Judicious use of metformin in groups formerly thought to be at high risk for lactic acidosis (ie, those with CHF, chronic kidney disease [eGFR >30 mL/min/1.73 m2], and the elderly) may be associated with mortality benefit rather than increased risk. Secondary and tertiary add-on drug therapy should be individualized based on cost, personal preferences, and overall treatment goals, taking into account the wishes and priorities of the patient. PMID:25456645

  17. Diagnostic approach and current treatment options in childhood vasculitis

    PubMed Central

    Barut, Kenan; Şahin, Sezgin; Adroviç, Amra; Kasapçopur, Özgür

    2015-01-01

    All inflammatory changes in the vessel wall are defined as vasculitis. Pediatric vasculitis may present with different clinical findings. Although Henoch-Schönlein purpura which is the most common pediatric vasculitis generally recovers spontaneously, it should be monitorized closely because of the risk of renal failure. Although Kawasaki disease is easy to diagnose with its classical findings, the diagnosis may be delayed in case of incomplete Kawasaki disease. Kawasaki disease should be considered especially in infants in case of prolonged fever even if the criteria are not fully met and intravenous immunoglobulin treatment should be administered without delay in order to prevent development of coronary artery aneurism. Reaction at the site of administration of Bacillus Calmette-Guerin (BCG) vaccine may be observed as commonly as cervical lymphadenopathy in Kawasaki disease and may be used as a valuable finding in suspicious cases. Although anti-neutrophil cytoplasmic antibody-associated vasculitides are rare in children, renal involvement is more common and progression is more severe compared to adults. Hence, efficient and aggressive treatment is required. Takayasu’s arteritis is observed commonly in young adult women and rarely in adolescent girls. Therefore, a careful physical examination and blood pressure measurement should be performed in addition to a detailed history in daily practice. In children with unexplained neurological findings, cerebral vasculitis should be considered in the absence of other systemic vasculitides and necessary radiological investigations should be performed in this regard. This review will provide an insight into the understanding of pediatric vasculitis, current diagnostic approaches and prognosis by the aid of new studies. PMID:26884688

  18. Neutrophilic dermatoses: a review of current treatment options.

    PubMed

    Cohen, Philip R

    2009-01-01

    Sweet syndrome, pyoderma gangrenosum, and subcorneal pustular dermatosis are neutrophilic dermatoses - conditions that have an inflammatory infiltrate consisting of mature polymorphonuclear leukocytes. The neutrophils are usually located within the dermis in Sweet syndrome and pyoderma gangrenosum; however, in subcorneal pustular dermatosis, they are found in the upper layers of the epidermis. Sweet syndrome, also referred to as acute febrile neutrophilic dermatosis, is characterized by pyrexia, elevated neutrophil count, painful erythematous cutaneous lesions that have an infiltrate of mature neutrophils typically located in the upper dermis, and prompt clinical improvement following the initiation of systemic corticosteroid therapy. Classical, malignancy-associated, and drug-induced variants of Sweet syndrome exist. Pyoderma gangrenosum is characterized by painful, enlarging necrotic ulcers with bluish undermined borders surrounded by advancing zones of erythema; its clinical variants include: ulcerative or classic, pustular, bullous or atypical, vegetative, peristomal, and drug-induced. Subcorneal pustular dermatosis is an uncommon relapsing symmetric pustular eruption that involves flexural and intertriginous areas; it can be idiopathic or associated with cancer, infections, medications, and systemic diseases. Since Sweet syndrome, pyoderma gangrenosum, and subcorneal pustular dermatosis share not only the same inflammatory cell but also similar associated systemic diseases, it is not surprising that the concurrent or sequential development of these neutrophilic dermatoses has been observed in the same individual. Also, it is not unexpected that several of the effective therapeutic interventions - including systemic drugs, topical agents, and other treatment modalities - for the management of these dermatoses are the same. The treatment of choice for Sweet syndrome and idiopathic pyoderma gangrenosum is systemic corticosteroids; however, for subcorneal pustular dermatosis, dapsone is the drug of choice. Yet, tumor necrosis factor-alpha antagonists are becoming the preferred choice when pyoderma gangrenosum is accompanied by inflammatory bowel disease or rheumatoid arthritis. Potassium iodide and colchicine are alternative first-line therapies for Sweet syndrome and indomethacin (indometacin), clofazimine, cyclosporine (ciclosporin), and dapsone are second-line treatments. Cyclosporine is effective in the acute management of pyoderma gangrenosum; however, when tapering the drug, additional systemic agents are necessary for maintaining the clinical response. In some patients with subcorneal pustular dermatosis, systemic corticosteroids may be effective; yet, systemic retinoids (such as etretinate and acitretin) have effectively been used for treating this neutrophilic dermatosis - either as monotherapy or in combination with dapsone or as a component of phototherapy with psoralen and UVA radiation. Topical agents can have an adjuvant role in the management of these neutrophilic dermatoses; however, high-potency topical corticosteroids may successfully treat localized manifestations of Sweet syndrome, pyoderma gangrenosum, and subcorneal pustular dermatosis. Intralesional corticosteroid therapy for patients with Sweet syndrome and pyoderma gangrenosum, hyperbaric oxygen and plasmapheresis for patients with pyoderma grangrenosum, and phototherapy for patients with subcorneal pustular dermatosis are other modalities that have been used effectively for treating individuals with these neutrophilic dermatoses. PMID:19658442

  19. A Comprehensive Review of Treatment Options for Premenstrual Syndrome and Premenstrual Dysphoric Disorder.

    PubMed

    Maharaj, Shalini; Trevino, Kenneth

    2015-09-01

    Premenstrual dysphoric disorder (PMDD) is a severe form of premenstrual syndrome that involves a combination of emotional and physical symptoms that result in significant functional impairment. Because of the debilitating nature of PMDD, multiple treatment options have been considered. This review provides a comprehensive overview of these therapeutic regimens to help health care professionals provide adequate treatment for PMDD and premenstrual syndrome. The treatments that are reviewed are organized into the following categories: psychiatric, anovulatory, supplements, herbal, nonpharmacological, and other. Selective serotonin reuptake inhibitors have been established as the first-line treatment for PMDD. Although luteal phase or continuous dosing can be used, additional research is needed to more thoroughly compare the efficacies and differential symptom response of continuous, semi-intermittent, luteal phase, and symptoms-onset dosing. The psychiatric medications venlafaxine, duloxetine, alprazolam, and buspirone have also been found to be useful treatments for PMDD. Various anovulatory-related treatments have demonstrated efficacy; however, the use of some of these treatments remains limited due to potential side effects and/or the availability of cheaper alternatives. Although a variety of supplement and herbal-related treatments have been proposed, with some warranting further research, at this time only calcium supplementation has demonstrated a consistent therapeutic benefit. In conclusion, serotoninergic antidepressants have been established as the first-line treatment option for PMDD; however, there are a variety of additional treatment options that should be considered if a patient fails to achieve an adequate therapeutic response with a selective serotonin reuptake inhibitor. PMID:26352222

  20. Options assessment report: Treatment of nitrate salt waste at Los Alamos National Laboratory

    SciTech Connect

    Robinson, Bruce Alan; Stevens, Patrice Ann

    2015-09-16

    This report documents the methodology used to select a method of treatment for the remediated nitrate salt (RNS) and unremediated nitrate salt (UNS) waste containers at Los Alamos National Laboratory (LANL). The method selected should treat the containerized waste in a manner that renders the waste safe and suitable for transport and final disposal in the Waste Isolation Pilot Plant (WIPP) repository, under specifications listed in the WIPP Waste Acceptance Criteria (DOE/CBFO, 2013). LANL recognized that the results must be thoroughly vetted with the New Mexico Environment Department (NMED) and the a modification to the LANL Hazardous Waste Facility Permit is a necessary step before implementation of this or any treatment option. Likewise, facility readiness and safety basis approvals must be received from the Department of Energy (DOE). This report presents LANL's preferred option, and the documentation of the process for reaching the recommended treatment option for RNS and UNS waste, and is presented for consideration by NMED and DOE.

  1. Korean-Americans' Knowledge about Depression and Attitudes about Treatment Options.

    PubMed

    Kim, Eunjung; Im, Eun-Ok

    2015-06-01

    The purpose of this pilot study was to explore first-generation Korean-Americans' knowledge about depression and attitudes about depression treatment options. Self-report survey data were gathered from 73 first-generation Korean-Americans (KAs) using instruments developed for this study. The data were analyzed using descriptive and inferential statistics including t-tests. Data indicated participants lacked knowledge about depression. Among all depression treatment options, exercise was the option that first-generation KAs were most willing to try and was rated as having the least shame attached to it. Taking an antidepressant was the option KAs reported being most unwilling to try and had the highest shame attached to it. No significant differences in knowledge about depression and attitudes about depression treatment options were found between low and high acculturation groups, with the exception that the high acculturation group demonstrated more agreement than the low acculturation group with the item that emotional symptoms, such as mood changes, can be depression symptoms. These results suggest that initiating depression treatment with exercise may be the most acceptable starting point in treating depression in first-generation KA immigrants. PMID:26241572

  2. Fiber-reinforced Composite Resin Bridge: A Treatment Option in Children

    PubMed Central

    Yelluri, Rama Krishna; Munshi, AK

    2015-01-01

    ABSTRACT A number of treatment options, ranging from Maryland bridges to implants, are available for the replacement of congenitally or traumatically missing permanent anterior teeth. But, there are several limitations of these therapeutic options when they have to be used before the completion of the growth, particularly in children. Reinforcement of composite resins with polyethylene fibers significantly improves their mechanical properties. Fiber-reinforced composite (FRC) bridge can offer a good alternative to conventional treatment options in replacing a missing permanent anterior tooth until a more definitive prosthesis can be provided at the end of the growth period. The purpose of this article is to present a clinical case of a single tooth replacement utilizing noninvasive and metal free fixed FRC bridge in a 13 years old child as an interim treatment option. How to cite this article: Gupta A, Yelluri RK, Munshi AK. Fiber-reinforced Composite Resin Bridge: A Treatment Option in Children. Int J Clin Pediatr Dent 2015;8(1):62-65. PMID:26124584

  3. Hand dermatitis - differential diagnoses, diagnostics, and treatment options.

    PubMed

    Mahler, Vera

    2016-01-01

    The pathogenesis of hand dermatitis is multifactorial, and includes factors such as genetic predisposition and exposure. A high incidence rate is associated with female gender, contact allergy, atopic dermatitis, and wet work. The most important risk factors for the persistence of hand dermatitis include its extent, contact allergic or atopic etiology, childhood dermatitis, and early onset (before the age of 20). The cost of illness of hand dermatitis corresponds to this seen in moderate to severe psoriasis. The diagnostic workup of hand dermatitis and its differential diagnoses requires a detailed assessment of occupational and recreational exposure. In case of possible work-related triggers, early notification of the accident insurer should be sought (via the dermatologist's report). Exposure to a contact allergen is a contributing factor in one-half of all cases of hand dermatitis. It is therefore imperative that all patients with hand dermatitis persisting for more than three months undergo patch testing. Successful and sustainable treatment of hand dermatitis starts with the proper identification and elimination of individual triggers, including the substitution of identified contact allergens and irritants, as well as optimizing preventive measures. Graded therapy taking the clinical severity into account is essential. Validated instruments may be used to monitor therapeutic efficacy. PMID:26713631

  4. Sofosbuvir: A novel treatment option for chronic hepatitis C infection

    PubMed Central

    Bhatia, Harmeet Kaur; Singh, Harmanjit; Grewal, Nipunjot; Natt, Navreet Kaur

    2014-01-01

    Hepatitis C currently infects more than 170 million people around the world, leading to significant morbidity and mortality. The current standard of care for HCV infection, including one of the two protease inhibitors, telaprevir or boceprevir, for 12-32 weeks, along with pegylated interferon alfa-2a (PEG-IFN-?) and ribavirin for up to 48 weeks, is unsatisfactory in many cases, either because of lack of efficacy or because of treatment-related adverse effects. There is an urgent need of new drugs with improved efficacy as well as a safety profile. Sofosbuvir, a recently approved nucleotide analog, is a highly potent inhibitor of the NS5B polymerase in the Hepatitis C virus (HCV), and has shown high efficacy in combination with several other drugs, with and without PEG-INF, against HCV. It offers many advantages due to its high potency, low side effects, oral administration, and high barrier to resistance. The efficacy and safety were demonstrated in many large and well-designed phase 2 and phase 3 clinical trials like NEUTRINO, PROTON, ELECTRON, ATOMIC, COSMOS, FUSION, FISSION, NUCLEAR, POSITRON, and the like. It is generally well-tolerated. Adverse events that occurred include: Headache, insomnia, fatigue, nausea, dizziness, pruritis, upper respiratory tract infections, rash, back pain, grade 1 anemia, and grade 4 lymphopenia; however, the exact safety profile can only be judged when this drug is actually used on a large scale. PMID:25422576

  5. Velaglucerase alfa: a new option for Gaucher disease treatment.

    PubMed

    Zimran, A

    2011-07-01

    Type 1 Gaucher disease (GD) results from inherited ?-glucocerebrosidase gene mutations, leading to anemia, thrombocytopenia, splenomegaly, hepatomegaly and skeletal disease. Velaglucerase alfa is a ?-glucocerebrosidase produced by gene activation in a human cell line, and indicated for type 1 GD. A phase I/II clinical trial (TKT025; N = 12), its ongoing extension (TKT025EXT) and three phase III trials (total N = 82), showed that velaglucerase alfa is generally well tolerated in adult and pediatric patients. Many disease-related parameters improved significantly in two phase III trials in treatment-nave patients, and were successfully maintained in imiglucerase-experienced patients in a phase II/III switch study. Ten adults in TKT025EXT sustained improvements through 5 years, including bone mineral density. Comparison with imiglucerase shows that velaglucerase alfa is an effective, generally well-tolerated alternative enzyme replacement therapy. In vitro data suggest velaglucerase alfa may be internalized into cells more efficiently and have a lower rate of seroconversion. However, these results do not necessarily correlate with clinical efficacy. PMID:22013559

  6. Pharmacotherapy Treatment Options for Insomnia: A Primer for Clinicians

    PubMed Central

    Asnis, Gregory M.; Thomas, Manju; Henderson, Margaret A.

    2015-01-01

    Insomnia is a prevalent disorder with deleterious effects such as decreased quality of life, and a predisposition to a number of psychiatric disorders. Fortunately, numerous approved hypnotic treatments are available. This report reviews the state of the art of pharmacotherapy with a reference to cognitive behavioral therapy for insomnia (CBT-I) as well. It provides the clinician with a guide to all the Food and Drug Administration (FDA) approved hypnotics (benzodiazepines, nonbenzodiazepines, ramelteon, low dose sinequan, and suvorexant) including potential side effects. Frequently, chronic insomnia lasts longer than 2 years. Cognizant of this and as a result of longer-term studies, the FDA has approved all hypnotics since 2005 without restricting the duration of use. Our manuscript also reviews off-label hypnotics (sedating antidepressants, atypical antipsychotics, anticonvulsants and antihistamines) which in reality, are more often prescribed than approved hypnotics. The choice of which hypnotic to choose is discussed partially being based on which segment of sleep is disturbed and whether co-morbid illnesses exist. Lastly, we discuss recent label changes required by the FDA inserting a warning about “sleep-related complex behaviors”, e.g., sleep-driving for all hypnotics. In addition, we discuss FDA mandated dose reductions for most zolpidem preparations in women due to high zolpidem levels in the morning hours potentially causing daytime carry-over effects. PMID:26729104

  7. Acinetobacter baumannii: evolution of antimicrobial resistance-treatment options.

    PubMed

    Doi, Yohei; Murray, Gerald L; Peleg, Anton Y

    2015-02-01

    The first decade of the 20th century witnessed a surge in the incidence of infections due to several highly antimicrobial-resistant bacteria in hospitals worldwide. Acinetobacter baumannii is one such organism that turned from an occasional respiratory pathogen into a major nosocomial pathogen. An increasing number of A. baumannii genome sequences have broadened our understanding of the genetic makeup of these bacteria and highlighted the extent of horizontal transfer of DNA. Animal models of disease combined with bacterial mutagenesis have provided some valuable insights into mechanisms of A. baumannii pathogenesis. Bacterial factors known to be important for disease include outer membrane porins, surface structures including capsule and lipopolysaccharide, enzymes such as phospholipase D, iron acquisition systems, and regulatory proteins. A. baumannii has a propensity to accumulate resistance to various groups of antimicrobial agents. In particular, carbapenem resistance has become commonplace, accounting for the majority of A. baumannii strains in many hospitals today. Carbapenem-resistant strains are often resistant to all other routinely tested agents. Treatment of carbapenem-resistant A. baumannii infection therefore involves the use of combinations of last resort agents such as colistin and tigecycline, but the efficacy and safety of these approaches are yet to be defined. Antimicrobial-resistant A. baumannii has high potential to spread among ill patients in intensive care units. Early recognition and timely implementation of appropriate infection control measures is crucial in preventing outbreaks. PMID:25643273

  8. Treatment options for low-level radiologically contaminated ORNL filtercake

    SciTech Connect

    Lee, Hom-Ti; Bostick, W.D.

    1996-04-01

    Water softening sludge (>4000 stored low level contaminated drums; 600 drums per year) generated by the ORNL Process Waste Treatment Plant must be treated, stabilized, and placed in safe storage/disposal. The sludge is primarily CaCO{sub 3} and is contaminated by low levels of {sup 90}Sr and {sup 137}Cs. In this study, microwave sintering and calcination were evaluated for treating the sludge. The microwave melting experiments showed promise: volume reductions were significant (3-5X), and the waste form was durable with glass additives (LiOH, fly ash). A commercial vendor using surrogate has demonstrated a melt mineralization process that yields a dense monolithic waste form with a volume reduction factor (VR) of 7.7. Calcination of the sludge at 850-900 C yielded a VR of 2.5. Compaction at 4500 psi increased the VR to 4.2, but the compressed form is not dimensionally stable. Addition of paraffin helped consolidate fines and yielded a VR of 3.5. In conclusion, microwave melting or another form of vitrification is likely to be the best method; however for immediate implementation, the calculation/compaction/waxing process is viable.

  9. PSEUDOXANTHOMA ELASTICUM: DIAGNOSTIC FEATURES, CLASSIFICATION, AND TREATMENT OPTIONS

    PubMed Central

    Uitto, Jouni; Jiang, Qiujie; Váradi, András; Bercovitch, Lionel G.; Terry, Sharon F.

    2014-01-01

    Introduction Pseudoxanthoma elasticum (PXE), a multisystem orphan disease, clinically affects the skin, the eyes, and the cardiovascular system with considerable morbidity and mortality. The clinical manifestations reflect the underlying pathology consisting of ectopic mineralization of peripheral connective tissues. Areas Covered The diagnostic criteria of PXE include characteristic clinical findings, together with histopathology of accumulation of pleiomorphic elastic structures in the dermis with progressive mineralization, and the presence of mutations in the ABCC6 gene. PXE-like cutaneous changes can also be encountered in other ectopic mineralization disorders, including generalized arterial calcification of infancy (GACI) caused by mutations in the ENPP1 gene. In some cases, overlapping clinical features of PXE/GACI, associated with mutations either in ABCC6 or ENPP1, have been noted. PXE demonstrates considerable inter- and intrafamilial heterogeneity, and consequently, accurate diagnosis is required for appropriate classification with prognostic implications. There is no effective and specific treatment for the systemic manifestations of PXE, but effective therapies to counteract the ocular complications are in current clinical use. Expert Opinion A number of observations in the murine model, the Abcc6−/− mouse, have indicated that the mineral composition of diet, particularly the magnesium content, can influence the severity of the mineralization phenotype. These observations suggest that appropriate dietary interventions, coupled with lifestyle modifications, including smoking cessation, might alleviate the symptoms and improve the quality of life of individuals affected with this, currently intractable, orphan disease. PMID:25383264

  10. Treatment options for AIDS patients with progressive multifocal leukoencephalopathy.

    PubMed

    Hernández, Beatriz; Dronda, Fernando; Moreno, Santiago

    2009-02-01

    Progressive multifocal leukoencephalopathy (PML) is a demyelinating viral disease produced by the John Cunningham (JC) virus, which is ubiquitously distributed. Up to 80% of adults seroconvert to JC virus. Classically, PML is a life-threatening AIDS-defining disease of the CNS, usually occurring in severely immunocompromised individuals. Until now, and despite several therapeutic attempts, there is no specific treatment for PML. Soon after the widespread use of combination antiretroviral therapy (CART), several studies showed prolonged survival for patients with AIDS-associated PML who were treated with CART. The outcome of PML in patients receiving CART is unpredictable at disease onset. Prognostic markers are needed. The JC virus DNA detection in cerebrospinal fluid by nucleic acid amplification techniques and the CD4+ cell count are the most promising parameters. Higher levels of CD4+ cell counts were independently associated with an improved survival in different clinical observations. A summary of the main current knowledge about AIDS-related PML is presented. The most effective strategy is to optimize CART to completely suppress HIV-1 viral load and allow the best CD4+ T-cell immune recovery. Nowadays, AIDS-related PML is no longer an ultimately fatal disease. A substantial number of HIV-1-infected patients with this condition can improve with CART. PMID:19191678

  11. Pharmacotherapy Treatment Options for Insomnia: A Primer for Clinicians.

    PubMed

    Asnis, Gregory M; Thomas, Manju; Henderson, Margaret A

    2016-01-01

    Insomnia is a prevalent disorder with deleterious effects such as decreased quality of life, and a predisposition to a number of psychiatric disorders. Fortunately, numerous approved hypnotic treatments are available. This report reviews the state of the art of pharmacotherapy with a reference to cognitive behavioral therapy for insomnia (CBT-I) as well. It provides the clinician with a guide to all the Food and Drug Administration (FDA) approved hypnotics (benzodiazepines, nonbenzodiazepines, ramelteon, low dose sinequan, and suvorexant) including potential side effects. Frequently, chronic insomnia lasts longer than 2 years. Cognizant of this and as a result of longer-term studies, the FDA has approved all hypnotics since 2005 without restricting the duration of use. Our manuscript also reviews off-label hypnotics (sedating antidepressants, atypical antipsychotics, anticonvulsants and antihistamines) which in reality, are more often prescribed than approved hypnotics. The choice of which hypnotic to choose is discussed partially being based on which segment of sleep is disturbed and whether co-morbid illnesses exist. Lastly, we discuss recent label changes required by the FDA inserting a warning about "sleep-related complex behaviors", e.g., sleep-driving for all hypnotics. In addition, we discuss FDA mandated dose reductions for most zolpidem preparations in women due to high zolpidem levels in the morning hours potentially causing daytime carry-over effects. PMID:26729104

  12. Sofosbuvir: A novel treatment option for chronic hepatitis C infection.

    PubMed

    Bhatia, Harmeet Kaur; Singh, Harmanjit; Grewal, Nipunjot; Natt, Navreet Kaur

    2014-10-01

    Hepatitis C currently infects more than 170 million people around the world, leading to significant morbidity and mortality. The current standard of care for HCV infection, including one of the two protease inhibitors, telaprevir or boceprevir, for 12-32 weeks, along with pegylated interferon alfa-2a (PEG-IFN-α) and ribavirin for up to 48 weeks, is unsatisfactory in many cases, either because of lack of efficacy or because of treatment-related adverse effects. There is an urgent need of new drugs with improved efficacy as well as a safety profile. Sofosbuvir, a recently approved nucleotide analog, is a highly potent inhibitor of the NS5B polymerase in the Hepatitis C virus (HCV), and has shown high efficacy in combination with several other drugs, with and without PEG-INF, against HCV. It offers many advantages due to its high potency, low side effects, oral administration, and high barrier to resistance. The efficacy and safety were demonstrated in many large and well-designed phase 2 and phase 3 clinical trials like NEUTRINO, PROTON, ELECTRON, ATOMIC, COSMOS, FUSION, FISSION, NUCLEAR, POSITRON, and the like. It is generally well-tolerated. Adverse events that occurred include: Headache, insomnia, fatigue, nausea, dizziness, pruritis, upper respiratory tract infections, rash, back pain, grade 1 anemia, and grade 4 lymphopenia; however, the exact safety profile can only be judged when this drug is actually used on a large scale. PMID:25422576

  13. Genetics and Treatments Options for Recurrent Acute and Chronic Pancreatitis

    PubMed Central

    Shelton, Celeste A.; Whitcomb, David C.

    2014-01-01

    Opinion Statement Worldwide research efforts demonstrate a major role of gene-environment interactions for the risk, development, and progression of most pancreatic diseases, including recurrent acute and chronic pancreatitis. New findings of pancreas disease-associated risk variants have been reported in the CPA1, GGT1, CLDN2, MMP1, MTHFR, and other genes. These risk genes and their regulatory regions must be added to the known pathogenic variants in the PRSS1, SPINK1, CFTR, CTRC, CASR, UBR1, SBDS, CEL, and CTSB genes. This new knowledge promises to improve disease management and prevention through personalized medicine. At the same time, however, knowledge of an increasing number of pathogenic variants, and their complicated effects when present in combination, results in increasing difficulty in interpretation and development of recommendations. Direct-to-consumer marketing of genetic testing results also adds complexity to disease management paradigms, especially without interpretation and, in many cases, proven accuracy. While improvements in the ability to rapidly and accurately interpret complex genetic tests are clearly needed, some results, such as pathogenic CFTR variants – including a new class of bicarbonate-defective mutations – and PRSS1 variants have immediate implications that direct management. In addition, discovery of pancreatitis-associated genetic variants in patients with glucose intolerance may suggest underlying type 3c diabetes, which also has implications for treatment and disease management. PMID:24954874

  14. Stem cells: An eventual treatment option for heart diseases.

    PubMed

    Bilgimol, Joseph C; Ragupathi, Subbareddy; Vengadassalapathy, Lakshmanan; Senthil, Nathan S; Selvakumar, Kalimuthu; Ganesan, M; Manjunath, Sadananda Rao

    2015-09-26

    Stem cells are of global excitement for various diseases including heart diseases. It is worth to understand the mechanism or role of stem cells in the treatment of heart failure. Bone marrow derived stem cells are commonly practiced with an aim to improve the function of the heart. The majority of studies have been conducted with acute myocardial infarction and a few has been investigated with the use of stem cells for treating chronic or dilated cardiomyopathy. Heterogeneity in the treated group using stem cells has greatly emerged. Ever increasing demand for any alternative made is of at most priority for cardiomyopathy. Stem cells are of top priority with the current impact that has generated among physicians. However, meticulous selection of proper source is required since redundancy is clearly evident with the present survey. This review focuses on the methods adopted using stem cells for heart diseases and outcomes that are generated so far with an idea to determine the best therapeutic possibility in order to fulfill the present demand. PMID:26435771

  15. Stem cells: An eventual treatment option for heart diseases

    PubMed Central

    Bilgimol, Joseph C; Ragupathi, Subbareddy; Vengadassalapathy, Lakshmanan; Senthil, Nathan S; Selvakumar, Kalimuthu; Ganesan, M; Manjunath, Sadananda Rao

    2015-01-01

    Stem cells are of global excitement for various diseases including heart diseases. It is worth to understand the mechanism or role of stem cells in the treatment of heart failure. Bone marrow derived stem cells are commonly practiced with an aim to improve the function of the heart. The majority of studies have been conducted with acute myocardial infarction and a few has been investigated with the use of stem cells for treating chronic or dilated cardiomyopathy. Heterogeneity in the treated group using stem cells has greatly emerged. Ever increasing demand for any alternative made is of at most priority for cardiomyopathy. Stem cells are of top priority with the current impact that has generated among physicians. However, meticulous selection of proper source is required since redundancy is clearly evident with the present survey. This review focuses on the methods adopted using stem cells for heart diseases and outcomes that are generated so far with an idea to determine the best therapeutic possibility in order to fulfill the present demand. PMID:26435771

  16. Therapeutical options for the treatment of Cheyne-Stokes respiration.

    PubMed

    Randerath, Winfried J

    2009-03-01

    The awareness of Cheyne-Stokes respiration (CSR) and of the co-existence of the obstructive sleep apnoea syndrome and central breathing disturbances has rapidly grown in recent years. CSR is defined by a waxing and waning pattern of the breathing amplitude. Sleep related breathing disorders in patients with heart failure are associated with impaired clinical outcome and survival. While continuous positive airway pressure treatment (CPAP) is widely used to treat CSR, it has failed to improve overall survival of heart failure patients. Nevertheless, it has been shown that CPAP reduces mortality if breathing disturbances were sufficiently eliminated. Therefore, optimal suppression of CSR is critical. While CPAP reduces CSR by 50% on average, adaptive servoventilation (ASV) normalises CSR in most patients. ASV devices apply different levels of pressure support: during periods of hypoventilation the inspiratory pressure is increased while it is reduced to the lowest possible level during hyperventilation. The devices deliver an expiratory pressure to overcome upper airways obstruction. Pressure support is defined by the difference between expiratory and inspiratory pressure. Thus, while pressure support is fixed in bilevel devices, it varies under ASV. However, the hypothesis that ASV might improve survival in CSR patients has to be proved in prospective studies in CPAP nonresponders. There is a lack of evidence on the use of bilevel devices in CSR. However, ASV has proven both to effectively treat CSR and to be superior to CPAP in respiratory and sleep parameters in short term and medium term studies. Nevertheless, data on the long term use and the influence on cardiac parameters are necessary. PMID:19274490

  17. Various treatment options for benign prostatic hyperplasia: A current update

    PubMed Central

    Shrivastava, Alankar; Gupta, Vipin B.

    2012-01-01

    In benign prostatic hyperplasia (BPH) there will be a sudden impact on overall quality of life of patient. This disease occurs normally at the age of 40 or above and also is associated with sexual dysfunction. Thus, there is a need of update on current medications of this disease. The presented review provides information on medications available for BPH. Phytotherapies with some improvements in BPH are also included. Relevant articles were identified through a search of the English-language literature indexed on MEDLINE, PUBMED, Sciencedirect and the proceedings of scientific meetings. The search terms were BPH, medications for BPH, drugs for BPH, combination therapies for BPH, Phytotherapies for BPH, Ayurveda and BPH, BPH treatments in Ayurveda. Medications including watchful waitings, Alpha one adrenoreceptor blockers, 5-alpha reductase inhibitors, combination therapies including tamsulosin-dutasteride, doxazosin-finasteride, terazosin-finasteride, tolterodine-tamsulosin and rofecoxib-finasteride were found. Herbal remedies such as Cernilton, Saxifraga stolonifera, Zi-Shen Pill (ZSP), Orbignya speciosa, Phellodendron amurense, Ganoderma lucidum, Serenoa Repens, pumpkin extract and Lepidium meyenii (Red Maca) have some improvements on BPH are included. Other than these discussions on Ayurvedic medications, TURP and minimally invasive therapies (MITs) are also included. Recent advancements in terms of newly synthesized molecules are also discussed. Specific alpha one adrenoreceptor blockers such as tamsulosin and alfuzosin will remain preferred choice of urologists for symptom relief. Medications with combination therapies are still needs more investigation to establish as preference in initial stage for fast symptom relief reduced prostate growth and obviously reduce need for BPH-related surgery. Due to lack of proper evidence Phytotherapies are not gaining much advantage. MITs and TURP are expensive and are rarely supported by healthcare systems. PMID:22923974

  18. Treatment options for acute uncomplicated cystitis in adults.

    PubMed

    Naber, K G

    2000-09-01

    Urinary tract infection (UTI) is classified as uncomplicated if it occurs in a patient with a structurally and functionally normal urinary tract. Acute uncomplicated cystitis is observed chiefly in women. It needs, however, to be differentiated depending on whether it occurs in premenopausal, postmenopausal or pregnant women. Only a small number of 15-50 year old, otherwise healthy men suffer acute uncomplicated cystitis. In premenopausal, non-pregnant women, single-dose antimicrobial therapy is generally less effective than the same antibiotic used for longer duration. However, most antimicrobial agents given for 3 days are as effective as those given for longer duration, and adverse events tend to be found more often with longer treatment. Trimethoprim (or co-trimoxazole) can be recommended as first-line empirical therapy only in communities with resistance rates of uropathogens to trimethoprim of < or =10-20%. Otherwise fluoroquinolones are recommended. Alternatives are fosfomycin trometamol or beta-lactams, such as second- or third-generation oral cephalosporins or pivmecillinam, especially when fluoroquinolones are contraindicated or a high proportion (>10%) of Escherichia coil strains in the community are already resistant to fluoroquinolones, as in Spain, for example. Recurrent UTIs are common among young, healthy women even though they generally have anatomically and physiologically normal urinary tracts. The following prophylactic antimicrobial regimens are recommended: (i) the use of long-term, low-dose prophylactic antimicrobials taken at bedtime; (ii) post-coital prophylaxis for women in whom episodes of infection are associated with sexual intercourse. Other prophylactic methods are not as yet as effective as antimicrobial prophylaxis. PMID:11051620

  19. Treatment options for acute uncomplicated cystitis in adults.

    PubMed

    Naber

    2000-08-01

    Urinary tract infection (UTI) is classified as uncomplicated if it occurs in a patient with a structurally and functionally normal urinary tract. Acute uncomplicated cystitis is observed chiefly in women. It needs, however, to be differentiated depending on whether it occurs in premenopausal, postmenopausal or pregnant women. Only a small number of 15-50 year old, otherwise healthy men suffer acute uncomplicated cystitis. In premenopausal, non-pregnant women, single-dose antimicrobial therapy is generally less effective than the same antibiotic used for longer duration. However, most antimicrobial agents given for 3 days are as effective as those given for longer duration, and adverse events tend to be found more often with longer treatment. Trimethoprim (or co-trimoxazole) can be recommended as first-line empirical therapy only in communities with resistance rates of uropathogens to trimethoprim of 10%) of Escherichia coli strains in the community are already resistant to fluoroquinolones, as in Spain, for example. Recurrent UTIs are common among young, healthy women even though they generally have anatomically and physiologically normal urinary tracts. The following prophylactic antimicrobial regimens are recommended: (i) the use of long-term, low-dose prophylactic antimicrobials taken at bedtime; (ii) post-coital prophylaxis for women in whom episodes of infection are associated with sexual intercourse. Other prophylactic methods are not as yet as effective as antimicrobial prophylaxis. PMID:10969048

  20. Various treatment options for benign prostatic hyperplasia: A current update.

    PubMed

    Shrivastava, Alankar; Gupta, Vipin B

    2012-01-01

    In benign prostatic hyperplasia (BPH) there will be a sudden impact on overall quality of life of patient. This disease occurs normally at the age of 40 or above and also is associated with sexual dysfunction. Thus, there is a need of update on current medications of this disease. The presented review provides information on medications available for BPH. Phytotherapies with some improvements in BPH are also included. Relevant articles were identified through a search of the English-language literature indexed on MEDLINE, PUBMED, Sciencedirect and the proceedings of scientific meetings. The search terms were BPH, medications for BPH, drugs for BPH, combination therapies for BPH, Phytotherapies for BPH, Ayurveda and BPH, BPH treatments in Ayurveda. Medications including watchful waitings, Alpha one adrenoreceptor blockers, 5-alpha reductase inhibitors, combination therapies including tamsulosin-dutasteride, doxazosin-finasteride, terazosin-finasteride, tolterodine-tamsulosin and rofecoxib-finasteride were found. Herbal remedies such as Cernilton, Saxifraga stolonifera, Zi-Shen Pill (ZSP), Orbignya speciosa, Phellodendron amurense, Ganoderma lucidum, Serenoa Repens, pumpkin extract and Lepidium meyenii (Red Maca) have some improvements on BPH are included. Other than these discussions on Ayurvedic medications, TURP and minimally invasive therapies (MITs) are also included. Recent advancements in terms of newly synthesized molecules are also discussed. Specific alpha one adrenoreceptor blockers such as tamsulosin and alfuzosin will remain preferred choice of urologists for symptom relief. Medications with combination therapies are still needs more investigation to establish as preference in initial stage for fast symptom relief reduced prostate growth and obviously reduce need for BPH-related surgery. Due to lack of proper evidence Phytotherapies are not gaining much advantage. MITs and TURP are expensive and are rarely supported by healthcare systems. PMID:22923974

  1. Pancreatic cancer: optimizing treatment options, new, and emerging targeted therapies

    PubMed Central

    Chiorean, Elena Gabriela; Coveler, Andrew L

    2015-01-01

    Pancreatic cancer is the fourth leading cause of cancer death in the US and is expected to become the second leading cause of cancer-related deaths in the next decade. Despite 5-fluorouracil/leucovorin with irinotecan and oxaliplatin (FOLFIRINOX) and gemcitabine/nab-paclitaxel significantly improving outcomes for metastatic cancer, refractory disease still poses significant challenges. Difficulties with early detection and the inherent chemo- and radio-resistant nature of this malignancy led to attempts to define the sequential biology of pancreatic cancer in order to improve survival outcomes. Pancreatic adenocarcinoma is characterized by several germline or acquired genetic mutations, the most common being KRAS (90%), CDK2NA (90%), TP53 (75%–90%), DPC4/SMAD4 (50%). In addition, the tumor microenvironment, chemoresistant cancer stem cells, and the desmoplastic stroma have been the target of some promising clinical investigations. Among the core pathways reproducibly shown to lead the development and progression of this disease, DNA repair, apoptosis, G1/S cell cycle transition, KRAS, Wnt, Notch, Hedgehog, TGF-beta, and other cell invasion pathways, have been the target of “precision therapeutics”. No single molecularly targeted therapeutic though has been uniformly successful, probably due to the tumor heterogeneity, but biomarker research is evolving and it hopes to select more patients likely to benefit. Recent reports note activity with immunotherapies such as CD40 agonists, CCR2 inhibitors, cancer vaccines, and novel combinations against the immunosuppressive tumor milieu are ongoing. While many obstacles still exist, clearly we are making progress in deciphering the heterogeneity within pancreatic cancers. Integrating conventional and immunological targeting will be the key to effective treatment of this deadly disease. PMID:26185420

  2. Unmet needs of patients with narcolepsy: perspectives on emerging treatment options

    PubMed Central

    Wozniak, Dariusz R; Quinnell, Timothy G

    2015-01-01

    The treatment options currently available for narcolepsy are often unsatisfactory due to suboptimal efficacy, troublesome side effects, development of drug tolerance, and inconvenience. Our understanding of the neurobiology of narcolepsy has greatly improved over the last decade. This knowledge has not yet translated into additional therapeutic options for patients, but progress is being made. Some compounds, such as histaminergic H3 receptor antagonists, may prove useful in symptom control of narcolepsy. The prospect of finding a cure still seems distant, but hypocretin replacement therapy offers some promise. In this narrative review, we describe these developments and others which may yield more effective narcolepsy treatments in the future. PMID:26045680

  3. Effects of non-surgical periodontal therapy on serum lipids and C-reactive protein among hyperlipidemic patients with chronic periodontitis

    PubMed Central

    Tawfig, Ahmed

    2015-01-01

    Aim: To evaluate the effect of non-surgical periodontal therapy on plasma lipid levels in hyperlipidemic patients with chronic periodontitis. Materials and Methods: After considering the inclusion and exclusion criteria, 30 hyperlipidemic patients with chronic periodontitis in the age group of 3070 years, undergoing treatment in Ahmed Gasim Cardiac and Renal transplant Centre in north Sudan were recruited for the study. Patients were randomly assigned to the study and control groups. The study group received non-surgical periodontal therapy oral hygiene instructions, scaling and root planing. The control group participants received only oral hygiene instructions. Lipid profile [total cholesterol (TC), low density lipoprotein (LDL), high density lipoprotein (HDL), triglycerides (TG)], C-reactive protein (CRP), and periodontal parameters [Plaque index (PI), Gingival index (GI), probing pocket depth (PD), and attachment loss (ATL)] were measured and compared at baseline and after 3 months of the respective intervention. Between-groups analysis was done using independent t test and within-group analysis was done using dependent t test. Results: At baseline, groups were comparable based on lipid profile and periodontal parameters. After 3 months, the control group showed significant decrease in the PI and GI scores while there was no significant change in the other parameters. However, the study group showed significant decrease in the LDL and CRP levels along with a significant decrease in PD, ATL, PI, and GI scores, compared to the baseline values. Conclusion: Local non-surgical periodontal therapy resulted in improved periodontal health, with significant decrease in the LDL and CRP levels in hyperlipidemic patients with chronic periodontitis. Hence, local non-surgical periodontal therapy may be considered as an adjunct in the control of hyperlipidemia, along with standard care. PMID:25984468

  4. Treatment Options for the Cardinal Symptoms of Disruptive Mood Dysregulation Disorder

    PubMed Central

    Tourian, Leon; LeBoeuf, Amélie; Breton, Jean-Jacques; Cohen, David; Gignac, Martin; Labelle, Réal; Guile, Jean-Marc; Renaud, Johanne

    2015-01-01

    Objective: DSM-5 has added a new developmentally appropriate child and adolescent mood disorder subtype called disruptive mood dysregulation disorder (DMDD). The core features of DMDD are temper outbursts (manifested by either verbal rages and/or physical aggression) and unrelenting irritability or anger. Currently, the literature is lacking a thorough review of the possible treatment options for the cardinal symptoms constituting DMDD. The objective of this article is to provide a thorough review of peer-reviewed studies on the subject of pharmacological treatment options for children and adolescents with the cardinal symptoms of DMDD. Methods: Relevant articles for this study were obtained through Pubmed, Medline, PsychINFO and PsychINDEXplus using the key words: “adolescents,” “children,” “paediatric,” “youth,” “irritability,” “temper outbursts,” “aggression,” “rage,” “disruptive behaviour,” “treatment,” “dysphoria,” “autism,” “mental retardation/intellectual disability,” “impulsivity,” “ADHD,” “oppositional defiant disorder,” and “conduct disorder.” A total of 823 studies were generated; only English studies focusing on pharmacological treatment were retained. Results: Currently there are no established guidelines or thorough reviews summarizing the treatment of DMDD. Pharmacotherapeutic treatment options of both aggression and chronic irritability include: antidepressants/selective norepinephrine reuptake inhibitors, mood stabilizers, psychostimulants, antipsychotics, and alpha-2 agonists. Conclusion: Treatment options of severe, persistent irritability in youth are numerous, and a consensual treatment algorithm has not yet emerged from the literature. Further studies and clinical trials are warranted to determine efficacious and safe treatment modalities. PMID:26336379

  5. Treatment Options

    MedlinePLUS

    ... rare bleeding disorders are usually made from human plasma and are treated to eliminate viruses like HIV ... made in the laboratory and not from human plasma, so they carry no risk of infectious disease. ...

  6. EMG monitoring during functional non-surgical therapy of Achilles tendon rupture.

    PubMed

    Hfner, Tobias; Wohifarth, Kai; Fink, Matthias; Thermann, H; Rollnik, Jens D

    2002-07-01

    After surgical therapy of Achilles tendon rupture, neuromuscular changes may persist, even one year after surgery. We were interested whether these changes are also evident following a non-surgical functional therapy (Variostabil therapy boot/Adidas). Twenty-one patients with complete Achilles tendon rupture were enrolled in the study (mean age 38.5 years, range 24 to 60; 18 men, three women) and followed-up clinically and with surface EMG of the gastrocnemius muscles after four, eight, 12 weeks, and one year after rupture. EMG differences between the affected and non-affected side could only be observed at baseline and after four weeks following Achilles tendon rupture. The results from our study show that EMG changes are not found following non-surgical functional therapy. PMID:12146771

  7. Peripheral Nerve Regeneration – an Appraisal of the Current Treatment Options

    PubMed Central

    CINTEZA, Dragos; PERSINARU, Iulia; MACIUCEANU ZARNESCU, Bogdan Mircea; IONESCU, Dan; LASCAR, Ioan

    2015-01-01

    During the last decades significant progress was made in the understanding of the physiopathology of the peripheral nerve regeneration. Although the evolution of therapy is not as spectacular, a series of new treatment solutions were developed. The gold standard in therapy remains the use of autografts. We present the current concepts and therapeutic options available. PMID:26225155

  8. Parkinson's Disease and Its Management: Part 3: Nondopaminergic and Nonpharmacological Treatment Options.

    PubMed

    DeMaagd, George; Philip, Ashok

    2015-10-01

    This installment of a five-part series reviews the role of nondopaminergic pharmacotherapies and adjunctive options-such as monoamine oxidase type B inhibitors, catechol-O-methyltransferase inhibitors, and anticholinergic agents-in managing Parkinson's disease. Nonpharmacological treatments are also explored. PMID:26535023

  9. Current management of fecal incontinence: Choosing amongst treatment options to optimize outcomes

    PubMed Central

    Van Koughnett, Julie Ann M; Wexner, Steven D

    2013-01-01

    The severity of fecal incontinence widely varies and can have dramatic devastating impacts on a person’s life. Fecal incontinence is common, though it is often under-reported by patients. In addition to standard treatment options, new treatments have been developed during the past decade to attempt to effectively treat fecal incontinence with minimal morbidity. Non-operative treatments include dietary modifications, medications, and biofeedback therapy. Currently used surgical treatments include repair (sphincteroplasty), stimulation (sacral nerve stimulation or posterior tibial nerve stimulation), replacement (artificial bowel sphincter or muscle transposition) and diversion (stoma formation). Newer augmentation treatments such as radiofrequency energy delivery and injectable materials, are minimally invasive tools that may be good options before proceeding to surgery in some patients with mild fecal incontinence. In general, more invasive surgical treatments are now reserved for moderate to severe fecal incontinence. Functional and quality of life related outcomes, as well as potential complications of the treatment must be considered and the treatment of fecal incontinence must be individualized to the patient. General indications, techniques, and outcomes profiles for the various treatments of fecal incontinence are discussed in detail. Choosing the most effective treatment for the individual patient is essential to achieve optimal outcomes in the treatment of fecal incontinence. PMID:24409050

  10. Second-line treatment of metastatic gastric cancer: Current options and future directions

    PubMed Central

    Kanagavel, Dheepak; Fedyanin, Mikhail; Tryakin, Alexey; Tjulandin, Sergei

    2015-01-01

    Gastric cancer remains one among the leading causes of cancer-related deaths, regardless of its decreasing incidence and newly available treatment options. Most patients present at an advanced stage and are treated with upfront systemic chemotherapy. Those patients receiving first-line therapy may initially respond to treatment, but many of them relapse over time. In such condition, second-line treatment for disease progression remains the only available option. Although there exists no standard approach in the second-line setting, several phase III trials have shown modest survival benefit in patients receiving irinotecan, taxane and ramucirumab over the best supportive care or active agents. This review analyzes the currently available treatment regimens and future directions of research in the second-line setting for metastatic gastric cancer with the best available evidence. Additionally, the prognostic factors that influence patient survival in those receiving second-line therapy are discussed. PMID:26556991

  11. Update on the pathogenic potential and treatment options for Blastocystis sp.

    PubMed

    Roberts, Tamalee; Stark, Damien; Harkness, John; Ellis, John

    2014-01-01

    Although Blastocystis is one of the most common enteric parasites, there is still much controversy surrounding the pathogenicity and potential treatment options for this parasite. In this review we look at the evidence supporting Blastocystis as an intestinal pathogen as shown by numerous case studies and several in vivo studies and the evidence against. We describe the chronic nature of some infections and show the role of Blastocystis in immunocompromised patients and the relationship between irritable bowel syndrome and Blastocystis infection. There have been several studies that have suggested that pathogenicity may be subtype related. Metronidazole is the most widely accepted treatment for Blastocystis but several cases of treatment failure and resistance have been described. Other treatment options which have been suggested include paromomycin and trimethroprim- sulfamethoxazole. PMID:24883113

  12. Update on the pathogenic potential and treatment options for Blastocystis sp

    PubMed Central

    2014-01-01

    Although Blastocystis is one of the most common enteric parasites, there is still much controversy surrounding the pathogenicity and potential treatment options for this parasite. In this review we look at the evidence supporting Blastocystis as an intestinal pathogen as shown by numerous case studies and several in vivo studies and the evidence against. We describe the chronic nature of some infections and show the role of Blastocystis in immunocompromised patients and the relationship between irritable bowel syndrome and Blastocystis infection. There have been several studies that have suggested that pathogenicity may be subtype related. Metronidazole is the most widely accepted treatment for Blastocystis but several cases of treatment failure and resistance have been described. Other treatment options which have been suggested include paromomycin and trimethroprim- sulfamethoxazole. PMID:24883113

  13. Update on neuropathic pain treatment for trigeminal neuralgia. The pharmacological and surgical options.

    PubMed

    Al-Quliti, Khalid W

    2015-04-01

    Trigeminal neuralgia is a syndrome of unilateral, paroxysmal, stabbing facial pain, originating from the trigeminal nerve. Careful history of typical symptoms is crucial for diagnosis. Most cases are caused by vascular compression of the trigeminal root adjacent to the pons leading to focal demyelination and ephaptic axonal transmission. Brain imaging is required to exclude secondary causes. Many medical and surgical treatments are available. Most patients respond well to pharmacotherapy; carbamazepine and oxcarbazepine are first line therapy, while lamotrigine and baclofen are considered second line treatments. Other drugs such as topiramate, levetiracetam, gabapentin, pregabalin, and botulinum toxin-A are alternative treatments. Surgical options are available if medications are no longer effective or tolerated. Microvascular decompression, gamma knife radiosurgery, and percutaneous rhizotomies are most promising surgical alternatives. This paper reviews the medical and surgical therapeutic options for the treatment of trigeminal neuralgia, based on available evidence and guidelines. PMID:25864062

  14. Occurrence of Deep Vein Thrombosis among Hospitalized Non-Surgical Japanese Patients

    PubMed Central

    Hanzawa, Kazuhiko; Ota, Satoshi; Nakamura, Mashio; Sato, Koichi; Ikura, Maiko; Suzuki, Takeo; Kaise, Toshihiko; Nakajima, Hiromu; Ito, Masaaki

    2015-01-01

    Objective: To estimate the frequency of deep vein thrombosis (DVT) among non-surgical inpatients, and to evaluate the D-dimer assay as a screening tool for DVT. Methods: Subjects were non-surgical inpatients aged 20 years or older who had been bedridden for at least 24 hours and had moderate-to-high risk factors for DVT. We assessed the presence of DVT by venous ultrasonography. Patients who received a diagnosis of venous thromboembolism (VTE) before admission, who had symptoms or findings of VTE at admission, or who had surgery or trauma within the past 3 months before admission were excluded. Results: DVT was confirmed in 96 of 525 patients (18.3%). In a logistic regression analysis, longer duration of hospitalization, higher D-dimer value, and history of cancer surgery were significantly associated with the occurrence of DVT. The D-dimer assay showed high sensitivity (96.1%) and high negative predictive value (97.6%). Conclusion: Non-surgical inpatients with a long-term hospitalization or history of cancer surgery have a risk for DVT, and need to be considered for added DVT preventive measures as recommended in the prevention guidelines. In addition, the D-dimer assay is beneficial for the screening of DVT in medical practice. PMID:26421068

  15. State of the art psychopharmacological treatment options in seasonal affective disorder.

    PubMed

    Yildiz, Mesut; Batmaz, Sedat; Songur, Emrah; Oral, Esat Timuçin

    2016-03-01

    Seasonal affective disorder (SAD) is defined as a subtype of mood disorders in DSM 5, and it is characterized by a seasonal onset. SAD is proposed to be related to the seasonal changes in naturally occurring light, and the use of bright light therapy for depressive symptoms has been shown to reduce them in placebo controlled trials. Cognitive behavioral therapy has also been demonstrated to be effective in SAD. This review article aims to focus on the psychopharmacological treatment options for SAD. According to clinical trial results, first line treatment options seem to be sertraline and fluoxetine, and are well tolerated by the patients. There is some evidence that other antidepressants (e.g. bupropion) might be effective as well. Although clinical trials have shown that some of these antidepressants may be of benefit, a recent review has concluded that there is not enough evidence to support the use of any of these agents for the treatment of SAD yet. Moreover, more studies are still needed to evaluate the effectiveness of other treatment options, e.g., propranolol, melatonin, hypericum, etc. In addition to the above proposed treatments, patients with seasonal depressive symptoms should thoroughly be evaluated for any cues of bipolarity, and their treatment should be planned accordingly. PMID:26938817

  16. Drooling: are botulinum toxin injections into the major salivary glands a good treatment option?

    PubMed

    Nordgarden, Hilde; sterhus, Ingvild; Mystad, Anne; Asten, Pamela; Johnsen, Ulf L-H; Storhaug, Kari; Loven, Jens yvind

    2012-04-01

    There are several treatment options available for drooling; botulinum toxin injections into the major salivary glands are one. There is no consensus as to how many and which glands should be injected. A research project on this topic was terminated because of adverse effects. Individual results and the adverse effects are described and discussed in this article. Six individuals with cerebral palsy were randomly allocated to 2 treatment groups, with five individuals receiving ultrasound-guided injections to parotid and submandibular glands and one receiving injections to the submandibular glands only. Reduction of observed drooling was registered in 3, while 4 patients reported subjective improvement (Visual Analog Scale). Two participants reported adverse effects, including dysphagia, dysarthria, and increased salivary viscosity. Injections with botulinum toxin can be a useful treatment option but there is a risk of adverse effects. Multidisciplinary evaluation and informed discussions with patients/caregivers are important factors in the decision-making process. PMID:21940695

  17. Standard and Novel Treatment Options for Metabolic Syndrome and Diabetes Mellitus

    PubMed Central

    Groves, Elliott M; Yu, Katherine; Wong, Nathan D.; Malik, Shaista

    2014-01-01

    Type II Diabetes and metabolic syndrome are two intertwined conditions that are critical to the healthcare landscape in the United States and abroad. Patients with either diabetes or metabolic syndrome can have a dramatically increased risk of developing cardiovascular disease. Numerous treatment options have existed for some time, which include non-pharmacologic and pharmacologic therapies. Additionally, within the last decade a multiple of novel treatment options have emerged for the management of hyperglycemia in particular. By targeting novel pathways beyond the secretion and supply of insulin, these new therapeutics provide a valuable adjunctive to the currently available therapies for diabetes and metabolic syndrome. Here we discuss the current guideline driven usage of standard therapies with some novel indications. In addition we discuss the novel therapies for the treatment of hyperglycemia, their mechanisms of action and appropriate therapeutic indications. PMID:24234946

  18. Piriformis syndrome: implications of anatomical variations, diagnostic techniques, and treatment options.

    PubMed

    Cassidy, Lindsey; Walters, Andrew; Bubb, Kathleen; Shoja, Mohammadali M; Tubbs, R Shane; Loukas, Marios

    2012-08-01

    Details of piriformis syndrome, including the proper diagnosis and most effective form of treatment, continue to be controversial. While the cause, diagnosis, and treatment of piriformis syndrome remain elusive, many studies have been conducted to investigate newly developed diagnostic techniques as well as various treatment options for piriformis-induced sciatica. Despite the quantity of literature, few studies have demonstrated statistically significant results that support one form of treatment over another. Thus, despite the evidence supporting the newer treatment methodologies for piriformis syndrome, research should continue. It is important not only to evaluate treatment outcomes based on associated pain relief, but also to investigate the functional and anatomical return that patients experience from these studied treatments in order to fully explore the most effective form of therapy for piriformis syndrome. PMID:22327640

  19. Treatment for infections with carbapenem-resistant Enterobacteriaceae: what options do we still have?

    PubMed Central

    2014-01-01

    The global spread of carbapenem-resistant Enterobacteriaceae (CRE) is increasingly becoming a major challenge in clinical and public health settings. To date, the treatment for serious CRE infections remains difficult. The intelligent use of antimicrobials and effective infection control strategies is crucial to prevent further CRE spread. Early consultation with experts in the treatment of infections with multidrug-resistant organisms is valuable in patient management. This brief review will focus on the current, yet limited, treatment options for CRE infections. PMID:25041592

  20. PARP Inhibitors for Recurrent Ovarian Carcinoma: Current Treatment Options and Future Perspectives

    PubMed Central

    Sehouli, J.; Braicu, E. I.; Chekerov, R.

    2016-01-01

    More than simply a promising management option, PARP inhibitors can be regarded as a milestone in the development of personalised treatment of recurrent ovarian carcinoma. Their mechanism of action, known as synthetic lethality, is dependent on functional differences of the DNA repair mechanisms of healthy cells and tumour cells; cells that repair DNA damage less efficiently are particularly sensitive to PARP inhibitors. Olaparib, licensed for use this year, is the best-studied PARP inhibitor used for treatment of high-grade serous ovarian carcinoma (HGSC). The efficacy of PARP inhibitors appears to be increased when used in combination with other treatments. PMID:26941449

  1. Therapeutic Success of the Ketogenic Diet as a Treatment Option for Epilepsy: a Meta-analysis

    PubMed Central

    Li, Hai-feng; Zou, Yan; Ding, Gangqiang

    2013-01-01

    Objective To systematically evaluate therapeutic success of the ketogenic diet (KD) as a treatment option for epilepsy. Methods Using MEDLINE and Google Scholar search, we searched for studies investigating the therapeutic success of ketogenic diet for epilepsy. We estimated therapeutic success rate for ketogenic diet as a treatment option for epilepsy and its 95% CIs using generic inverse variance method. Findings A total of 38 studies met the inclusion criteria. In retrospective studies, the weighted success rate of the patients who take the KD as a treatment option for epilepsy was 58.4% (95% confidence interval (95%CI)=48.7% – 69.9%) at 3 months (n=336); 42.8% (95%CI =36.3% – 50.3%) at 6 months (n=492), and 30.1% (95%CI =24.3% – 37.2%) at 12 months (n=387); in prospective studies, weighted success rate was 53.9% (95%CI 45.5% – 63.8%) at 3 months (n=474); 53.2% (95%CI =44.0% – 64.2%) at 6 months (n=321), and 55.0% (95%CI =45.9% – 65.9%) at 12 months (n=347). Conclusion This meta-analysis provides formal statistical support for the efficacy of the ketogenic diet in the treatment of epileptic patients. PMID:24910737

  2. Future pharmacological treatment options for nonexudative and exudative age-related macular degeneration.

    PubMed

    Comer, Grant M; Ciulla, Thomas A; Heier, Jeffery S; Criswell, Mark H

    2005-02-01

    Age-related macular degeneration (AMD) is the leading cause of irreversible vision loss in the industrialised world. Within the past decade, researchers have introduced many promising prevention and treatment options in an attempt to minimise the central vision loss imparted from AMD. Based on large-scale, randomised, prospective, placebo-controlled trials, a specially formulated combination of the antioxidants vitamin C, vitamin E, beta-carotene, copper and zinc is the only proven means of AMD prophylaxis. Thermal laser photocoagulation and photodynamic therapy with verteporfin are the only standard treatment options. However, efficacy is limited and treatment is only applicable to a minority of AMD patients. Thus, alternative pharmacological interventions are in all phases of clinical development. Researchers are guardedly optimistic that these advances may change the entire approach to AMD management in the near future. This review article will detail the currently accepted treatment options, as well as describe several of the more promising investigational pharmacological approaches to AMD. PMID:15757408

  3. Perioral dermatitis: a review of the condition with special attention to treatment options.

    PubMed

    Tempark, Therdpong; Shwayder, Tor A

    2014-04-01

    Perioral dermatitis is a common acneiform facial eruption found in both adults and children. Its variants are periorificial and granulomatous periorificial dermatitis. The etiology of perioral dermatitis remains unknown; however, topical corticosteroid use on the face commonly precedes the manifestation of this condition. There are an overwhelming number of treatment options for perioral dermatitis, and the options in children are slightly different from those in adults for both systemic medications and topical treatment. This article provides a literature review of the various applicable treatments available based on the level and quality of the evidence by the US Preventive Service Task Force. Oral tetracycline reveals the best valid evidence. However, if the patient is less than 8years old, then this oral therapy may not be suitable. Topical metronidazole, erythromycin, and pimecrolimus also represent effective treatment choices with good evidence. Topical corticosteroid use is common in these cases and the question of whether it is a good treatment or a cause remains unanswered. Corticosteroid cream can improve the clinical picture, but there is a risk of rebound when treatment is stopped. We propose a treatment algorithm to assist dermatologists, pediatric dermatologists, and general practitioners encountering this condition. PMID:24623018

  4. Pediatric Lichen Sclerosus: A Review of the Epidemiology and Treatment Options.

    PubMed

    Tong, Lana X; Sun, Grace S; Teng, Joyce M C

    2015-01-01

    Lichen sclerosus (LS) is a rare, chronic, inflammatory disease of the skin that primarily affects postmenopausal women but may occur in men and children as well. Approximately 7% to 15% of cases are believed to occur in children. The epidemiologic data for LS have been limited and treatment options are not well studied, particularly in children. We reviewed new developments available in the current literature on the epidemiology and management of LS for children. PMID:25940739

  5. Fully-customized lingual appliances: how lingual orthodontics became a viable treatment option.

    PubMed

    George, Richard D; Hirani, Sunil

    2013-09-01

    Despite being available for over 30 years, it is perhaps only over the past decade or so that lingual therapy has entered into the mainstream and become a viable treatment option. This paper outlines the problems encountered with traditional lingual techniques and describes how fully-customized lingual appliances have been designed to overcome many of the issues that had risked confining lingual orthodontics to the margins of clinical practice. PMID:24005954

  6. Options Assessment Report: Treatment of Nitrate Salt Waste at Los Alamos National Laboratory

    SciTech Connect

    Robinson, Bruce Alan; Stevens, Patrice Ann

    2015-12-17

    This report documents the methodology used to select a method of treatment for the remediated nitrate salt (RNS) and unremediated nitrate salt (UNS) waste containers at Los Alamos National Laboratory (LANL). The method selected should treat the containerized waste in a manner that renders the waste safe and suitable for transport and final disposal in the Waste Isolation Pilot Plant (WIPP) repository, under specifications listed in the WIPP Waste Acceptance Criteria (DOE/CBFO, 2013). LANL recognizes that the results must be thoroughly vetted with the New Mexico Environment Department (NMED) and that a modification to the LANL Hazardous Waste Facility Permit is a necessary step before implementation of this or any treatment option. Likewise, facility readiness and safety basis approvals must be received from the Department of Energy (DOE). This report presents LANL’s preferred option, and the documentation of the process for reaching the recommended treatment option for RNS and UNS waste, and is presented for consideration by NMED and DOE.

  7. The genetics of age-related macular degeneration (AMD)--Novel targets for designing treatment options?

    PubMed

    Grassmann, Felix; Fauser, Sascha; Weber, Bernhard H F

    2015-09-01

    Age-related macular degeneration (AMD) is a progressive disease of the central retina and the main cause of legal blindness in industrialized countries. Risk to develop the disease is conferred by both individual as well as genetic factors with the latter being increasingly deciphered over the last decade. Therapeutically, striking advances have been made for the treatment of the neovascular form of late stage AMD while for the late stage atrophic form of the disease, which accounts for almost half of the visually impaired, there is currently no effective therapy on the market. This review highlights our current knowledge on the genetic architecture of early and late stage AMD and explores its potential for the discovery of novel, target-guided treatment options. We reflect on current clinical and experimental therapies for all forms of AMD and specifically note a persisting lack of efficacy for treatment in atrophic AMD. We further explore the current insight in AMD-associated genes and pathways and critically question whether this knowledge is suited to design novel treatment options. Specifically, we point out that known genetic factors associated with AMD govern the risk to develop disease and thus may not play a role in its severity or progression. Treatments based on such knowledge appear appropriate rather for prevention than treatment of manifest disease. As a consequence, future research in AMD needs to be greatly focused on approaches relevant to the patients and their medical needs. PMID:25986585

  8. Complementary and Alternative Medicine Treatment Options for Otitis Media: A Systematic Review.

    PubMed

    Marom, Tal; Marchisio, Paola; Tamir, Sharon Ovnat; Torretta, Sara; Gavriel, Haim; Esposito, Susanna

    2016-02-01

    Otitis media (OM) has numerous presentations in children. Together with conventional medical therapies aimed to prevent and/or treat OM, a rising number of complementary and alternative medicine (CAM) treatment options can be offered. Since OM is common in children, parents may ask healthcare professionals about possible CAM therapies. Many physicians feel that their knowledge is limited regarding these therapies, and that they desire some information. Therefore, we conducted a literature review of CAM therapies for OM, taking into account that many of these treatments, their validity and efficacy and have not been scientifically demonstrated.We performed a search in MEDLINE (accessed via PubMed) using the following terms: "CAM" in conjunction with "OM" and "children. Retrieved publications regarding treatment of OM in children which included these terms included randomized controlled trials, prospective/retrospective studies, and case studies.The following CAM options for OM treatment in children were considered: acupuncture, homeopathy, herbal medicine/phytotherapy, osteopathy, chiropractic, xylitol, ear candling, vitamin D supplement, and systemic and topical probiotics. We reviewed each treatment and described the level of scientific evidence of the relevant publications.The therapeutic approaches commonly associated with CAM are usually conservative, and do not include drugs or surgery. Currently, CAM is not considered by physicians a potential treatment of OM, as there is limited supporting evidence. Further studies are warranted in order to evaluate the potential value of CAM therapies for OM. PMID:26871802

  9. Alternative treatment options in colorectal cancer patients with 5-fluorouracil- or capecitabine-induced cardiotoxicity.

    PubMed

    Deboever, Guido; Hiltrop, Nick; Cool, Mike; Lambrecht, Guy

    2013-03-01

    Most chemotherapy regimens in colorectal cancer treatment are 5-fluorouracil (5-FU)/leucovorin or capecitabine-based. Cardiotoxicity is a less common but potentially lethal complication of 5-FU or capecitabine treatment, and some physicians might be unfamiliar with treatment alternatives. Rechallenging should be avoided because it carries a high risk of recurrence of the cardiac symptoms and prophylactic treatment is not always protective. Possible alternative treatment options to be considered are to replace the oral capecitabine or intravenous 5-FU by a 5-FU bolus regimen, by uracil-tegafur or tegafur/gimeracil/oteracil, both oral fluoropyrimidines combining a 5-FU prodrug with a dihydropyrimidine dehydrogenase (DPD) inhibitor, or by raltitrexed, a thymidilate synthase inhibitor whose metabolism is independent of DPD. Patients with advanced colorectal cancer and fluoropyrimidine-induced cardiotoxicity can be treated with other non-fluoropyrimidine related chemotherapy, either as a single agent, combined, or in combination with biological agents. In this report we discuss the different alternative treatment options. PMID:23102544

  10. Restoration of disk height through non-surgical spinal decompression is associated with decreased discogenic low back pain: a retrospective cohort study

    PubMed Central

    2010-01-01

    Background Because previous studies have suggested that motorized non-surgical spinal decompression can reduce chronic low back pain (LBP) due to disc degeneration (discogenic low back pain) and disc herniation, it has accordingly been hypothesized that the reduction of pressure on affected discs will facilitate their regeneration. The goal of this study was to determine if changes in LBP, as measured on a verbal rating scale, before and after a 6-week treatment period with non-surgical spinal decompression, correlate with changes in lumbar disc height, as measured on computed tomography (CT) scans. Methods A retrospective cohort study of adults with chronic LBP attributed to disc herniation and/or discogenic LBP who underwent a 6-week treatment protocol of motorized non-surgical spinal decompression via the DRX9000 with CT scans before and after treatment. The main outcomes were changes in pain as measured on a verbal rating scale from 0 to 10 during a flexion-extension range of motion evaluation and changes in disc height as measured on CT scans. Paired t-test or linear regression was used as appropriate with p < 0.05 considered to be statistically significant. Results We identified 30 patients with lumbar disc herniation with an average age of 65 years, body mass index of 29 kg/m2, 21 females and 9 males, and an average duration of LBP of 12.5 weeks. During treatment, low back pain decreased from 6.2 (SD 2.2) to 1.6 (2.3, p < 0.001) and disc height increased from 7.5 (1.7) mm to 8.8 (1.7) mm (p < 0.001). Increase in disc height and reduction in pain were significantly correlated (r = 0.36, p = 0.044). Conclusions Non-surgical spinal decompression was associated with a reduction in pain and an increase in disc height. The correlation of these variables suggests that pain reduction may be mediated, at least in part, through a restoration of disc height. A randomized controlled trial is needed to confirm these promising results. Clinical trial registration number NCT00828880 PMID:20615252

  11. Environmental assessment of sewage sludge recycling options and treatment processes in Tokyo.

    PubMed

    Hara, K; Mino, T

    2008-12-01

    Tokyo has historically suffered from a shortage of final disposal sites for the treated sewage sludge. Given this situation, sludge recycling and incineration have been promoted to reduce the volume of treated sludge conveyed to the disposal site, and the recycling options have changed since the late 1990s. This study aims to revisit the sewage sludge treatment and recycling processes in Tokyo and to evaluate different recycling options (brick, aggregate, refuse derived fuel and slag) from the energy consumption perspective by clarifying the complex flow of treated sludge within Tokyo's 23 wards. The study also estimates environmental loads associated with the operation of the whole sludge management system in the area. The environmental loads include: (1) total energy consumption and (2) gas emissions (greenhouse and acidification gases). The estimation was carried out for the years 1995, 1997, 1999 and 2001, during which a drastic change in recycling options occurred. The results indicated that the production of refuse derived fuel was the most energy consuming recycling option while aggregate production is the least energy consuming. They also showed that despite the increasing sludge volume, the energy consumption associated with the operation of the whole system decreased during the period while the gas emissions increased. PMID:18439814

  12. Novel Therapeutic Options for the Treatment of Mineral Metabolism Abnormalities in End Stage Renal Disease.

    PubMed

    Kendrick, Jessica; Chonchol, Michel

    2015-01-01

    Abnormalities in mineral metabolism are a universal complication in dialysis patients and are associated with an increased risk of cardiovascular disease and mortality. Hyperphosphatemia, increased fibroblast growth factor 23 levels and secondary hyperparathyroidism are all strongly associated with adverse outcomes in end stage renal disease (ESRD) and most treatment strategies target these parameters. Over the past few years, new therapies have emerged for the treatment of abnormalities of mineral metabolism in ESRD and many are promising. This article will review these new therapeutic options including the potential advantages and disadvantages compared to existing therapies. PMID:26278462

  13. Current treatment options in squamous cell carcinoma of the oral cavity.

    PubMed

    Palme, Carsten E; Gullane, Patrick J; Gilbert, Ralph W

    2004-01-01

    Oral cavity SCC remains a significant health problem and requires a multidisciplinary approach. Treatment with surgery alone or in combination with adjuvant radiotherapy for more advanced lesions is the standard of care. Major advances have been made in surgical approaches,reconstructive options, and the rehabilitation of patients who have oral cavity SCC. These advances have significantly improved disease-specific outcome and quality of life. The future may lie in the development of treatment regimes that combine early detection with organ preservation and result in improved cure rates and quality of life. PMID:15062361

  14. Integrating current treatment options for TKI-resistant chronic myeloid leukemia.

    PubMed

    Radich, Jerald P; Shah, Neil P; Mauro, Michael J

    2014-07-01

    Chronic myeloid leukemia (CML) is a myeloproliferative disorder that accounts for approximately 10% of new cases of leukemia. The introduction of tyrosine kinase inhibitors (TKIs) has led to a reduction in mortality rates, and the estimated prevalence of CML is increasing accordingly. Most patients with CML are diagnosed in the chronic phase, and approximately 15% to 30% of these patients will meet some definition of resistance to imatinib. In the more advanced phases of disease, the rates of imatinib resistance are much higher. Both the National Comprehensive Cancer Network (NCCN) and the European LeukemiaNet (ELN) guidelines emphasize adequate monitoring of patients to ensure that they are meeting treatment milestones. Loss of response is most commonly associated with the acquisition of resistance-conferring kinase domain point mutations within BCR-ABL1. The multiple treatment options available for patients with imatinib-resistant CML include dasatinib, nilotinib, bosutinib, and ponatinib, as well as the non-TKI salvage agent omacetaxine mepesuccinate. Treatment selection is based on factors such as the patients disease state, prior therapies, comorbidities, treatment toxicity, and goals of therapy. This clinical roundtable monograph provides expert discussion on the monitoring of TKI-resistant CML, when to change therapy, and how to select the best treatment option. PMID:25768408

  15. Treatment options and neurocognitive outcome in patients with diffuse low-grade glioma.

    PubMed

    Klein, M

    2015-12-01

    In the management of patients with low-grade glioma (LGG) there still is controversy on how surgical intervention, radiotherapy, and chemotherapy contribute to an ameliorated progression-free survival, overall survival, and treatment-related neurotoxicity. With the ongoing changes in treatment options for these patients, neurocognitive functioning is an increasingly important outcome measure, because neurocognitive impairments can have a large impact on self-care, social and professional functioning, and consequently on health-related quality of life. Many factors contribute to neurocognitive outcome, such as direct and indirect tumor effects, seizures, medication, and oncological treatment. Although the role of radiotherapy has been studied extensively, the adverse effects on neurocognitive function of other treatment-related factors remain elusive. This not only holds for resective surgery, where the use of intraoperative stimulation mapping has a high potential benefit concerning survival and patient functioning, but also for the use of chemotherapy that might have some interesting new applications, like the facilitation of total resection for initially primary or recurrent diffuse LGG tumors. This paper will discuss these treatment options in LGG patients and their potential effects on neurocognitive functioning. PMID:26375636

  16. Current challenges in treatment options for visceral leishmaniasis in India: a public health perspective.

    PubMed

    Singh, Om Prakash; Singh, Bhawana; Chakravarty, Jaya; Sundar, Shyam

    2016-01-01

    Visceral leishmaniasis (VL) is a serious parasitic disease causing considerable mortality and major disability in the Indian subcontinent. It is most neglected tropical disease, particularly in terms of new drug development for the lack of financial returns. An elimination campaign has been running in India since 2005 that aim to reduce the incidence of VL to below 1 per 10,000 people at sub-district level. One of the major components in this endeavor is reducing transmission through early case detection followed by complete treatment. Substantial progress has been made during the recent years in the area of VL treatment, and the VL elimination initiatives have already saved many lives by deploying them effectively in the endemic areas. However, many challenges remain to be overcome including availability of drugs, cost of treatment (drugs and hospitalization), efficacy, adverse effects, and growing parasite resistance. Therefore, better emphasis on implementation research is urgently needed to determine how best to deliver existing interventions with available anti-leishmanial drugs. It is essential that the new treatment options become truly accessible, not simply available in endemic areas so that they may promote healing and save lives. In this review, we highlight the recent advancement and challenges in current treatment options for VL in disease endemic area, and discuss the possible strategies to improve the therapeutic outcome. PMID:26951132

  17. Association of susceptible genotypes to periodontal disease with the clinical outcome and tooth survival after non-surgical periodontal therapy: A systematic review and meta-analysis

    PubMed Central

    Doufexi, Aikaterini-Ellisavet; Kalogirou, Fotini

    2016-01-01

    Background The real clinical utility of genetic testing is the prognostic value of genetic factors in the clinical outcome of periodontal treatment and the tooth survival. A meta-analysis was undertaken to estimate the effect of a susceptible genotype to periodontitis on the clinical outcomes of non-surgical periodontal therapy and the tooth survival. Material and Methods A systematic search of MEDLINE-Pubmed, Cochrane Library and Scopus was performed. Additionally, a hand search was done in three journals. No specific language restriction was applied. Two reviewers screened independently titles and abstracts or full text copies. Quality assessment of all the included studies was held. Results Initial screening of electronic databases resulted in 283 articles. Ten studies met the inclusion criteria, nine of them examined the clinical outcome, while the other one investigated the tooth survival in susceptible individuals after non-surgical periodontal therapy. Eight of included studies were selected for the meta-analysis. IL-1 positive genotypes increase the risk of tooth loss, while no association found between the bleeding on probing (BOP), clinical attachment loss (CAL) and plaque index (PI) with the genotype status. Probing pocket depth (PPD) reduction in the first three months and in long-term results found to have a significant association with the genotype. Conclusions There is no difference in the clinical measurements after non-surgical periodontal treatment, apart from PPD. More publications are needed to identify a cause-effect relationship. Key words:Periodontal disease, periodontitis, periodontal therapy, clinical outcome, tooth loss, susceptibility, polymorphism, genotype, meta-analysis, systematic review. PMID:26595831

  18. Integrating first-line treatment options into clinical practice: what's new in advanced melanoma?

    PubMed

    Dummer, Reinhard; Schadendorf, Dirk; Ascierto, Paolo A; Larkin, James; Lebb, Celeste; Hauschild, Axel

    2015-12-01

    Melanoma remains a serious form of skin cancer in Europe and worldwide. Localized, early-stage melanomas can usually be treated with surgical excision. However, the prognosis is poorer for patients with advanced disease. Before 2011, treatment for advanced melanoma included palliative surgery and/or radiotherapy, and chemotherapy with or without immunotherapy, such as interleukin-2. As none of these treatments had shown survival benefits in patients with advanced melanoma, European guidelines had recommended that patients be entered into clinical trials. The lack of approved first-line options and varying access to clinical trials meant that European clinicians relied on experimental regimens and chemotherapy-based treatments when no other options were available. Since 2011, ipilimumab, an immuno-oncology therapy, and vemurafenib and dabrafenib, targeted agents that inhibit mutant BRAF, have been approved by the European Medicines Agency for the treatment of advanced melanoma. More recently, the MEK inhibitor, trametinib, received European marketing authorization for use in patients with BRAF mutation-positive advanced melanoma. In 2014, the anti-PD-1 antibody nivolumab was approved as a first-line therapy in Japan. Whereas nivolumab and another anti-PD-1 antibody, pembrolizumab, were approved as second-line therapies in the USA, their recent approval in Europe are for first-line use based on new clinical trial data in this setting. Together these agents are changing clinical practice and making therapeutic decisions more complex. Here, we discuss current and emerging therapeutic options for the first-line treatment of advanced melanoma, and how these therapies can be optimized to provide the best possible outcomes for patients. PMID:26426764

  19. Integrated care for chronic migraine patients: epidemiology, burden, diagnosis and treatment options.

    PubMed

    Diener, Hans-Christoph; Solbach, Kasja; Holle, Dagny; Gaul, Charly

    2015-08-01

    Migraine is a common neurological disorder, characterised by severe headaches. Epidemiological studies in the USA and Europe have identified a subgroup of migraine patients with chronic migraine. Chronic migraine is defined as ?15 headache days per month for ?3 months, in which ?8 days of the month meet criteria for migraine with or without aura, or respond to treatment specifically for migraine. Chronic migraine is associated with a higher burden of disease, more severe psychiatric comorbidity, greater use of healthcare resources, and higher overall costs than episodic migraine (<15 headache days per month). There is a strong need to improve diagnosis and therapeutic treatment of chronic migraine. Primary care physicians, as well as hospital-based physicians, are integral to the identification and treatment of these patients. The latest epidemiological data, as well as treatment options for chronic migraine patients, are reviewed here. PMID:26407383

  20. Recent understanding of cholesterol gallstone pathogenesis: implication to non-surgical therapeutic strategy.

    PubMed

    Tazuma, Susumu

    2008-10-01

    This article reviews the recent understanding of cholesterol gallstone pathogenesis in light of etiology and molecular mechanisms of the cholesterol gallstone formation process, to provide the future direction of a non-surgical therapeutic strategy. In principle, cholesterol gallstone formation, which is associated with an altered bile salt metabolism, is based primarily upon the impairment of cholesterol metabolism and homeostasis. Cholesterol is eliminated physiologically into bile; thus, the excess cholesterol induces bile metastability due to a relative insufficiency of bile salt, to initiate cholesterol crystal nucleation in the gallbladder with an impaired function. Those crystals grow to become macroscopic stones in the gallbladder mucin gel, accumulated under an arachidonate-prostanoid pathway induced-hypersecretion by the gallbladder wall. These events can be modified by bile salt supplementation, which provides a detergent action. Therefore, oral bile salt administration is a cost-effective, non-surgical therapy under certain circumstances. Understanding the pathogenesis of cholesterol gallstones attributes to the therapeutic guideline based upon scientific and clinical evidence. PMID:26193643

  1. Update of the management of chronic psoriasis: new approaches and emerging treatment options

    PubMed Central

    Laws, Philip M; Young, Helen S

    2010-01-01

    Psoriasis is a common, chronic inflammatory skin disease which is associated with a number of significant co-morbidities including: impairment of quality of life; cardiovascular disease; and a seronegative arthritis known as psoriatic arthritis. Our understanding of the pathogenesis of psoriasis has developed at a remarkable rate in recent years. These new insights have significantly changed our perception of the condition and have led to the development of several new treatment strategies. Biological agents have proved a major step forward in therapeutic options for psoriasis. The ability to clear, or almost clear, cutaneous disease has changed the outcomes and expectations of many patients with this disease. The impact on both physical and psychological health may be great. This review covers the clinical features and management of psoriasis with specific reference to new therapeutic options. PMID:21437057

  2. Treatment options of untreatable traumatized anterior maxillary teeth for future use of dental implantation.

    PubMed

    Schwartz-Arad, Devorah; Levin, Liran; Ashkenazi, Malka

    2004-03-01

    The anterior maxilla is the most traumatized region during childhood. Posttraumatic complications occasionally lead to tooth loss as well as the need for future implants. Unfortunately, it is contraindicated to place dental implants during childhood. A waiting period of approximately 8 to 10 years before completion of growth is required. For this patient to become a candidate for future dental implants, it is necessary to ensure the continuous growth and to preserve the dimensions of the alveolar process until growth has ceased from time of injury until joint maturation. To achieve these goals, it is essential to coordinate the treatment sequence at the time of trauma. After loss of a traumatized anterior permanent maxillary incisor in young adults, treatment options are limited: orthodontic closure of the gap and reshaping the adjacent teeth, or tooth extraction and maintaining the gap with a temporary restoration. Orthodontic space closure has limited indications and requires prosthetic restoration of at least 2 teeth. Extraction and temporary restoration will usually lead to bone augmentation before implantation. Other possible treatment options include orthodontic extrusion of the root remnant (in cases of untreatable root fracture or complicated crown-root fracture) and a temporary crown to serve the patient until the completion of growth and development, autogenous tooth transplantation, intentional extraction and immediate tooth replantation, distraction osteogenesis, and decoronation. Because general rules do not apply, individual treatment plans are necessary. PMID:15017299

  3. Treatment options of untreatable traumatized anterior maxillary teeth for future use of dental implantation.

    PubMed

    Schwartz-Arad, Devorah; Levin, Liran; Ashkenazi, Malka

    2004-06-01

    The anterior maxilla is the most traumatized region during childhood. Posttraumatic complications occasionally lead to tooth loss as well as the need for future implants. Unfortunately, it is contraindicated to place dental implants during childhood. A waiting period of approximately 8 to 10 years before completion of growth is required. For this patient to become a candidate for future dental implants, it is necessary to ensure the continuous growth and to preserve the dimensions of the alveolar process until growth has ceased from time of injury until joint maturation. To achieve these goals, it is essential to coordinate the treatment sequence at the time of trauma. After loss of a traumatized anterior permanent maxillary incisor in young adults, treatment options are limited: orthodontic closure of the gap and reshaping the adjacent teeth, or tooth extraction and maintaining the gap with a temporary restoration. Orthdontic space closure has limited indications and requires prosthetic restoration of at least 2 teeth. Extraction and temporary restoration will usually lead to bone augmentation before implantation. Other possible treatment options include orthodontic extrusion of the root remnant (in cases of untreatable root fracture or complicated crown-root fracture) and a temporary crown to serve the patient until the completion of growth and development, autogenous tooth transplantation, intentional extraction and immediate tooth replantation, distraction osteogenesis, and decoronation. Because general rules do not apply, individual treatment plans are necessary. PMID:15179087

  4. Ustekinumab as an Alternative Treatment Option for Chronic Pityriasis Rubra Pilaris

    PubMed Central

    Chowdhary, Mudit; Davila, Ulysses; Cohen, David J.

    2015-01-01

    Pityriasis rubra pilaris (PRP) is an exceptionally rare, chronic inflammatory dermatosis of unknown etiology. Patients classically present with small, follicular keratosis and salmon-colored plaques that begin at the head and neck and slowly progress to widespread erythroderma including the palms and soles. It is difficult to distinguish PRP from other inflammatory dermatoses; however, features that help aid in the diagnosis include islands of spared skin, orangish hue and typical findings on biopsy. There are no specific guidelines on therapy and treatment options include corticosteroids, vitamin D analogs, retinoids, methotrexate, cyclosporine, azathioprine and tumor necrosis factor alpha antagonists. Unfortunately options are limited for patients when these drugs do not work. We report a case of chronic PRP, refractory to conventional treatment, successfully treated with ustekinumab monotherapy. The patient was treated with 90 mg subcutaneous ustekinumab injections and began to show improvement within only 8 weeks. Long-term control of the disease has been attained without any significant side effects. We report this case to show that ustekinumab can be used as an alternative treatment method for patients with chronic, unremitting PRP. Treatment response is remarkably rapid and the infrequent dosing leads to patient compliance and a significantly improved quality of life. PMID:25969677

  5. SURGICAL TREATMENT OF HEMORRHOIDS: A CRITICAL APPRAISAL OF THE CURRENT OPTIONS

    PubMed Central

    CERATO, Marlise Mello; CERATO, Nilo Luiz; PASSOS, Patrcia; TREIGUE, Alberto; DAMIN, Daniel C.

    2014-01-01

    Introduction Surgical treatment of hemorrhoids is still a dilemma. New techniques have been developed leading to a lower rate of postoperative pain; however, they are associated with a greater likelihood of recurrence. Aim To review current indications as well as the results and complications of the main techniques currently used in the surgical treatment of hemorrhoidal disease. Methods A systematic search of the published data on the options for treatment of hemorrhoids up to December 2012 was conducted using Medline/PubMed, Cochrane, and UpToDate. Results Currently available surgical treatment options include procedure for prolapse and hemorrhoids (PPH), transanal hemorrhoidal dearterialization (THD), and conventional hemorrhoidectomy techniques. Excisional techniques showed similar results regarding pain, time to return to normal activities, and complication rates. PPH and THD were associated with less postoperative pain and lower complication rates; however, both had higher postoperative recurrence rates. Conclusion Conventional surgical techniques yield better long-term results. Despite good results in the immediate postoperative period, PPH and THD have not shown consistent long-term favorable results. PMID:24676303

  6. Chemoprevention and vaccines: a review of the nonsurgical options for the treatment of cervical dysplasia.

    PubMed

    Bell, M C; Alvarez, R D

    2005-01-01

    Human papillomavirus (HPV)-related disease is a significant health problem in the United States and throughout the world, especially in developing countries. Standard treatment to date has been surgical excision, but we ask the question "For what other clinically evident, virally mediated disease is the standard of treatment surgery?" The authors performed a systematic literature review and selected articles most relevant to the topic. This article reviews prevention, chemoprevention, and vaccine trials for the prevention and treatment of HPV-related disease of the genital tract. Significant advances have been made in the last decade, and the future holds promise for effective nonsurgical options for the patients with cervical dysplasia and other HPV-associated diseases. PMID:15670290

  7. Eating Disorders and Disordered Eating in Type 1 Diabetes: Prevalence, Screening, and Treatment Options

    PubMed Central

    Hanlan, Margo E.; Griffith, Julie; Patel, Niral

    2013-01-01

    This review is focused on the prevalence of eating disorders and disordered eating behaviors in individuals with type 1 diabetes. Recent research indicates higher prevalence rates of eating disorders among people with type 1 diabetes, as compared to their peers without diabetes. Eating disorders and disordered eating behaviors – especially insulin omission – are associated with poorer glycemic control and serious risk for increased morbidity and mortality. Screening should begin in pre-adolescence and continue through early adulthood, as many disordered eating behaviors begin during the transition to adolescence and may persist for years. Available screening tools and treatment options are reviewed. Given the complexity of diabetes management in combination with eating disorder treatment, it is imperative to screen early and often, in order to identify those most vulnerable and begin appropriate treatment in a timely manner. PMID:24022608

  8. Generalized Aggressive Periodontitis and Its Treatment Options: Case Reports and Review of the Literature

    PubMed Central

    Roshna, T.; Nandakumar, K.

    2012-01-01

    Generalized aggressive periodontitis results in rapid destruction of the periodontium and can lead to early tooth loss in the affected individuals if not diagnosed early and treated appropriately. The diagnostic features of the disease are characteristic, but the clinical presentation and patterns of destructions may vary between patients. Successful management of the disease is challenging especially if diagnosed at advanced stages of the disease, but not impossible with the current therapeutic choices for the disease. A vast array of treatment modalities is available which can be employed in the treatment of generalized aggressive periodontitis with varying success rates, but a definite guideline for the management is yet to be formulated. However, with the exponential rate of developments in periodontal research, regenerative therapy, tissue engineering, and genetic technologies, the future seems promising in regard to options at managing the disease. This paper attempts to describe the clinical and radiographic diagnostic features and the current treatment options along with a suggested protocol for comprehensive management of generalized aggressive periodontitis patients with case reports and a brief review. PMID:22291715

  9. Evolution of the treatment options of ulnar collateral ligament injuries of the elbow.

    PubMed

    Langer, P; Fadale, P; Hulstyn, M

    2006-06-01

    Ulnar collateral ligament (UCL) insufficiency is potentially a career threatening, or even a career ending, injury, particularly in overhead throwing athletes. The evolution of treating modalities provides afflicted athletes with the opportunity to avoid premature retirement. There have been several clinical and basic science research efforts which have investigated the pathophysiology of UCL disruption, the biomechanics specific to overhead throwing, and the various types of treatment modalities. UCL reconstruction is currently the most commonly performed surgical treatment option. An in depth analysis of the present treatment options, both non-operative and operative, as well as their respective results and biomechanical evaluation, is lacking in the literature to date. This article provides a comprehensive current review and comparative analysis of these modalities. Over the last 30 years there has been an evolution of the original UCL reconstruction. Yet, despite the variability in modifications, such as the docking technique, interference screw fixation, and use of suture anchors, the unifying concepts of UCL reconstruction are that decreased dissection of the flexor-pronator mass and decreased handling of the ulnar nerve leads to improved outcomes. PMID:16488902

  10. The best MSW treatment option by considering greenhouse gas emissions reduction: a case study in Georgia.

    PubMed

    Tayyeba, Omid; Olsson, Monika; Brandt, Nils

    2011-08-01

    The grave concern over climate change and new economic incentives such as the clean development mechanism (CDM) have given more weight to the potential of projects for reducing greenhouse gas (GHG) emissions. In the Adjara solid waste management project, even though the need for reductions in GHG emissions is acknowledged, it is not one of the key factors for selecting the most appropriate treatment method. This study addresses the benefit of various solid waste treatment methods that could be used in the Adjara project in terms of reducing GHG emissions. Seven different options for solid waste treatment are examined: open dumping as the baseline case, four options for landfill technology (no provision of landfill gas capture, landfill gas capture with open flare system, with enclosed flare system and with electricity generation), composting and anaerobic digestion with electricity production. CDM methodologies were used to quantify the amount of reductions for the scenarios. The study concludes sanitary landfill with capture and burning of landfill gas by an enclosed flare system could satisfy the requirements, including GHG reduction potential. The findings were tested for uncertainty and sensitivity by varying the data on composition and amount of waste and were found to be robust. PMID:21382876

  11. Clinical features and mutation status of EGFR, KRAS, BRAF, EML4-ALK and ROS1 between surgical resection samples and non surgical resection samples in lung cancer

    PubMed Central

    Li, Wentao; Qu, Jichen

    2015-01-01

    Background Target therapy is the first-line treatment in lung cancer. The testing of driver gene mutations is crucial for decision of treatment. Many lung cancer patients are in advanced grade, and lose the chance of operation. Methods The tissue used to perform mutation testing is only from biopsy. In order to analysis the difference between surgical resection samples (SRSs) and non-surgical resection samples (NSRSs), 1,357 surgical tissues and 145 biopsy samples histopathologically diagnosed with lung cancer were collected to detect the mutation status of EGFR, KRAS, BRAF, EML4-ALK and ROS1 in this study. Results There were no significant differences of age, gender, and histological type between the two group patients we collected; however, the significant difference was present in grade. More early stage patients were in the surgical group, but more advanced stage lung cancer patients were in non surgical group. In the mutation analysis, we also found no significant differences in all driver genes we detected between the two groups. Conclusions Both surgical resection samples and biopsy samples could be used to perform the testing the driver gene mutation. PMID:26101643

  12. Current endovascular treatment options for central retinal arterial occlusion: a review.

    PubMed

    Agarwal, Nitin; Gala, Nihar B; Karimi, Reza J; Turbin, Roger E; Gandhi, Chirag D; Prestigiacomo, Charles J

    2014-01-01

    Central retinal artery occlusion, although relatively rare, is an ophthalmological emergency. If left untreated, complete blindness will ensue. Conventional therapies have not significantly improved outcomes compared with the natural history of the disease. Several case series of more recent endovascular approaches, such as intraarterial fibrinolysis, report successful outcomes. Still other studies regarding intraarterial fibrinolysis do not demonstrate any significantly better outcomes, with some even indicating increased complication rates. Therefore, the authors present a review of the current endovascular treatment options for central retinal artery occlusion. PMID:24380484

  13. Comparative Study of Peroneal Tenosynovitis as the Complication of Intraarticular Calcaneal Fracture in Surgically and Non-Surgically Treated Patients

    PubMed Central

    Bahari Kashani, Mahmoud; Kachooei, Amir Reza; Ebrahimi, Hengameh; Peivandi, Mohammad Taghi; Amelfarzad, Sara; Bekhradianpoor, Nastoor; Azami, Mehran; Fatehi, Amirreza; Bahari Kashani, Golsa

    2013-01-01

    Background Calcaneus has the most fracture prevalence among tarsal bones. About 3/4 of calcaneal fractures are intra-articular fractures with displacement. The majority of calcaneal fractures occur in 21 - 35 year old young men, and that are mostly active people, these fractures cause complete disability for 15 months. Moreover, inappropriate treatment leads to lots of social and economical damages. Objectives In this study we compared the incidence and the severity of peroneal tenosynovitis as a complication of non-operative and operative treatment of intra-articular calcaneal fractures. In this study, some other complications of this fracture were also analyzed and the prevalence of the complication was higher in non-operated patients. Patients and Methods A total of 140 patients with intra-articular calcaneal fracture were analyzed prospectively. These patients were divided into 2 groups: operated group and non-operated group. Results In non-operated group (56 patients), 22 patients were complicated by peroneal tenosynovitis. In operated group (84 patients), 8 patients had the same complication. Statistical analysis revealed that the prevalence, and the severity of this complication in the mentioned groups had a meaningful difference. The results in operated group were much better than the non-operated one. Conclusions Although some of the orthopedic surgeons are not interested to manage these fractures surgically and most of them treat these cases conservatively (casting, etc.), in most displaced intra-articular calcaneal fractures, surgical treatment is the method of choice. Moreover, in non-surgical treatment the prevalence of these complications among the patients is more and as a result, inevitable social, occupational and familial damages occur. PMID:24693362

  14. Non-Surgical Chemotherapeutic Treatment Strategies for the Management of Periodontal Diseases

    PubMed Central

    Krayer, Joe W.; Leite, Renata S.; Kirkwood, Keith L.

    2011-01-01

    Synopsis Periodontal diseases are initiated by subgingival periodontal pathogens in susceptible periodontal sites. The host immune response towards periodontal pathogens helps to sustain periodontal disease and eventual alveolar bone loss. Numerous adjunctive therapeutic strategies have evolved to manage periodontal diseases. Systemic and local antibiotics, antiseptics, and past and future host immune modulatory agents are reviewed and discussed to facilitate the dental practitioners appreciation of this ever-growing field in clinical periodontics. PMID:20103470

  15. Non-Surgical Treatments for Urinary Incontinence: A Review of the Research for Women

    MedlinePLUS

    ... medicines do not come in generic form. Wholesale prices of prescription UI medicines Generic Name Dose Cost ... Brand Name Cost of 1-Month Supply* * Wholesale prices are from RED BOOK Online ®. Generic prices are ...

  16. Are we taking full advantage of the growing number of pharmacological treatment options for osteoporosis?

    PubMed Central

    Jepsen, Karl J.; Schlecht, Stephen H.; Kozloff, Kenneth M.

    2014-01-01

    We are becoming increasingly aware that the manner in which our skeleton ages is not uniform within and between populations. Pharmacological treatment options with the potential to combat age-related reductions in skeletal strength continue to become available on the market, notwithstanding our current inability to fully utilize these treatments by accounting for an individuals unique biomechanical needs. Revealing new molecular mechanisms that improve the targeted delivery of pharmaceuticals is important; however, this only addresses one part of the solution for differential age-related bone loss. To improve current treatment regimes, we must also consider specific biomechanical mechanisms that define how these molecular pathways ultimately impact whole bone fracture resistance. By improving our understanding of the relationship between molecular and biomechanical mechanisms, clinicians will be better equipped to take full advantage of the mounting pharmacological treatments available. Ultimately this will enable us to reduce fracture risk among the elderly more strategically, more effectively, and more economically. In this interest, the following review summarizes the biomechanical basis of current treatment strategies while defining how different biomechanical mechanisms lead to reduced fracture resistance. It is hoped that this may serve as a template for the identification of new targets for pharmacological treatments that will enable clinicians to personalize care so that fracture incidence may be globally reduced. PMID:24747363

  17. PTSD and comorbid AUD: a review of pharmacological and alternative treatment options

    PubMed Central

    Ralevski, Elizabeth; Olivera-Figueroa, Lening A; Petrakis, Ismene

    2014-01-01

    Background Although posttraumatic stress disorder (PTSD) and alcohol use disorders (AUD) frequently co-occur there are no specific treatments for individuals diagnosed with these comorbid conditions. The main objectives of this paper are to review the literature on pharmacological options for PTSD and comorbid AUD, and to summarize promising behavioral and alternative interventions for those with these dual diagnoses. Methods We conducted a comprehensive search on PsycINFO and MEDLINE/PubMed databases using Medical Subject Headings terms in various combinations to identify articles that used pharmacotherapy for individuals with dual diagnoses of PTSD and AUD. Similar strategies were used to identify articles on behavioral and alternative treatments for AUD and PTSD. We identified and reviewed six studies that tested pharmacological treatments for patients with PTSD and comorbid AUD. Results The literature on treatment with US Food and Drug Administration approved medications for patients with dual diagnosis of PTSD and AUD is very limited and inconclusive. Promising evidence indicates that topiramate and prazosin may be effective in reducing PTSD and AUD symptoms in individuals with comorbidity. Seeking safety has had mixed efficacy in clinical trials. The efficacy of other behavioral and alternative treatments (mindfulness-based, yoga, and acupuncture) is more difficult to evaluate since the evidence comes from small, single studies without comparison groups. Conclusion There is a clear need for more systematic and rigorous study of pharmacological, behavioral, and alternative treatments for patients with dual diagnoses of PTSD and AUD. PMID:24648794

  18. Sacral electrical neuromodulation as an alternative treatment option for lower urinary tract dysfunction.

    PubMed

    Grnewald, V; Hfner, K; Thon, W F; Kuczyk, M A; Jonas, U

    1999-01-01

    Temporary electrical stimulation using anal or vaginal electrodes and an external pulse generator has been a treatment modality for urinary urge incontinence for nearly three decades. In 1981 Tanagho and Schmidt introduced chronic electrical stimulation of the sacral spinal nerves using a permanently implanted sacral foramen electrode and a battery powered pulse generator for treatment of different kinds of lower urinary tract dysfunction, refractory to conservative treatment. At our department chronic unilateral electrical stimulation of the S3 sacral spinal nerve has been used for treatment of vesi-courethral dysfunction in 43 patients with a mean postoperative follow up of 43,6 months. Lasting symptomatic improvement by more than 50 % could be achieved in 13 of 18 patients with motor urge incontinence (72,2 %) and in 18 of the 21 patients with urinary retention (85,7 %). Implants offer a sustained therapeutic effect to treatment responders, which is not achieved by temporary neuromodulation. Chronic neuromodulation should be predominantly considered in patients with urinary retention. Furthermore in patients with motor urge incontinence, refusing temporary techniques or in those requiring too much effort to achieve a sustained clinical effect. Despite high initial costs chronic sacral neuromodulation is an economically reasonable treatment option in the long run, when comparing it to the more invasive remaining therapeutic alternatives. PMID:22387515

  19. Sacral electrical neuromodulation as an alternative treatment option for lower urinary tract dysfunction.

    PubMed

    Grnewald, Volker; Hfner, Klaus; Thon, Walter F.; Kuczyk, Markus A.; Jonas, Udo

    1999-01-01

    Temporary electrical stimulation using anal or vaginal electrodes and an external pulse generator has been a treatment modality for urinary urge incontinence for nearly three decades. In 1981 Tanagho and Schmidt introduced chronic electrical stimulation of the sacral spinal nerves using a permanently implanted sacral foramen electrode and a battery powered pulse generator for treatment of different kinds of lower urinary tract dysfunction, refractory to conservative treatment. At our department chronic unilateral electrical stimulation of the S3 sacral spinal nerve has been used for treatment of vesi-courethral dysfunction in 43 patients with a mean postoperative follow up of 43,6 months. Lasting symptomatic improvement by more than 50 % could be achieved in 13 of 18 patients with motor urge incontinence (72,2 %) and in 18 of the 21 patients with urinary retention (85,7 %). Implants offer a sustained therapeutic effect to treatment responders, which is not achieved by temporary neuromodulation. Chronic neuromodulation should be predominantly considered in patients with urinary retention. Furthermore in patients with motor urge incontinence, refusing temporary techniques or in those requiring too much effort to achieve a sustained clinical effect. Despite high initial costs chronic sacral neuromodulation is an economically reasonable treatment option in the long run, when comparing it to the more invasive remaining therapeutic alternatives. PMID:12671263

  20. A Study of Hair Follicular Transplantation as a Treatment Option for Vitiligo

    PubMed Central

    Thakur, Parul; Sacchidanand, S; Nataraj, HV; Savitha, AS

    2015-01-01

    Background: Repigmentation of vitiligo is closely related to hair follicles. Hence, replenishing melanocytes in vitiliginous patches utilizing undifferentiated stem cells of the hair follicles using follicular unit transplantation (FUT) is a possible treatment option. Objectives of the Study: To study the efficacy of FUT in cases of segmental/stabilized vitiligo as a treatment option for leukotrichia. Materials and Methods: Fifty patients with 63 lesions of stable vitiligo over nonglabrous areas were treated with follicular unit grafts. Reduction in the size of vitiligo patches as well as improvement in the associated leukotrichia were evaluated using subjective and objective assessments. Results: Of the 63 patches, good to excellent response was seen in 39 (61.9%), fair in 16 (25.4%), and poor in eight (12.7%) lesions. No repigmentation was seen in two (4.8%) lesions. The mean improvement seen was 61.17%. Excellent color match was observed in 44 lesions (69.8%). Repigmentation of the depigmented hairs occurred in 11 out of 46 patients with associated leukotrichia. Conclusion: FUT is a safe and effective method for treating localized and segmental vitiligo, especially on hairy parts of the skin. Though labor intensive, it was found to be associated with a quick patient recovery time, very low morbidity, and good color match.

  1. Immunotoxin – a new treatment option in patients with relapsed and refractory Hodgkin lymphoma

    PubMed Central

    Novakovic, Barbara Jezersek

    2015-01-01

    Background Even though Hodgkin lymphoma is a highly curable disease, some of the patients have either a refractory disease or experience a relapse following a successful primary therapy. Durable responses and remissions in patients with relapsed or refractory disease may be achieved in approximately one-half with salvage chemotherapy followed by high dose chemotherapy (HDT) and autologous hematopoietic cell rescue (SCT). On the other hand, patients who relapse after HDT and autologous SCT or those who have failed at least two prior multi-agent chemotherapy regimens and are not candidates for HDT have limited treatment options. Conclusions A new treatment option in this population is an immunotoxin Brentuximab vedotin composed of a CD30 directed antibody linked to the antitubulin agent monomethyl auristatin E. It has demonstrated a substantial effectiveness and an acceptable toxicity. In the pivotal study, the overall response rate was 75% with 34% of complete remissions. The median durations of response were 20.5 and 6.7 months for those with complete remission and all responding patients, respectively. The median overall survival was 40.5 months (3-years overall survival 54%) and the median progression-free survival 9.3 months. The most common non-hematologic toxicities were peripheral sensory neuropathy, nausea, and fatigue while the most common severe side effects were neutropenia, thrombocytopenia, anemia, and peripheral sensory neuropathy. PMID:26834516

  2. Preferences for different insomnia treatment options in people with schizophrenia and related psychoses: a qualitative study.

    PubMed

    Waters, Flavie; Chiu, Vivian W; Janca, Aleksandar; Atkinson, Amanda; Ree, Melissa

    2015-01-01

    Symptoms of psychosis such as hallucinations and delusions can be intrusive and unwanted and often remain treatment-resistant. Due to recent progress in basic and clinical sciences, novel approaches such as sleep-based interventions are increasingly becoming offered to address the physical and mental health issues of people with severe mental illness. While the primary outcome is to improve sleep, studies have demonstrated that interventions that target symptoms of insomnia can also produce improvements in the severity of psychotic symptoms, quality of life, and functional outcomes. This study presents qualitative data on the attitudes and preferences of people with schizophrenia and schizo-affective disorders to three different types of therapies for insomnia (standard pharmacological, melatonin-based, and cognitive and/or behavior therapy). Interviews included discussions regarding the perceived advantages and limitations of different therapies, enablers to taking up the preferred option, as well as personal strategies that have helped respondents with sleep problems in the past. Results showed that, when given the choice, these individuals prefer psychological and behavioral-type therapy to other sleep interventions because of its potential to support and empower them in taking responsibility for their own recovery. Pharmacological therapies, by contrast, are viewed as useful in managing acute sleep problems, but only as a short-term solution. Overall, the findings underscore the need for patients' active engagement when making decisions about treatment options. PMID:26236265

  3. Preferences for different insomnia treatment options in people with schizophrenia and related psychoses: a qualitative study

    PubMed Central

    Waters, Flavie; Chiu, Vivian W.; Janca, Aleksandar; Atkinson, Amanda; Ree, Melissa

    2015-01-01

    Symptoms of psychosis such as hallucinations and delusions can be intrusive and unwanted and often remain treatment-resistant. Due to recent progress in basic and clinical sciences, novel approaches such as sleep-based interventions are increasingly becoming offered to address the physical and mental health issues of people with severe mental illness. While the primary outcome is to improve sleep, studies have demonstrated that interventions that target symptoms of insomnia can also produce improvements in the severity of psychotic symptoms, quality of life, and functional outcomes. This study presents qualitative data on the attitudes and preferences of people with schizophrenia and schizo-affective disorders to three different types of therapies for insomnia (standard pharmacological, melatonin-based, and cognitive and/or behavior therapy). Interviews included discussions regarding the perceived advantages and limitations of different therapies, enablers to taking up the preferred option, as well as personal strategies that have helped respondents with sleep problems in the past. Results showed that, when given the choice, these individuals prefer psychological and behavioral-type therapy to other sleep interventions because of its potential to support and empower them in taking responsibility for their own recovery. Pharmacological therapies, by contrast, are viewed as useful in managing acute sleep problems, but only as a short-term solution. Overall, the findings underscore the need for patients’ active engagement when making decisions about treatment options. PMID:26236265

  4. Narrow-diameter implants: Are they a predictable treatment option? A literature review

    PubMed Central

    Martnez-Gonzlez, Amparo; Garca-Sala Bonmat, Fernando; Maes-Ferrer, Jos F.; Brotons-Oliver, Alejandro

    2014-01-01

    Objective: To evaluate the predictability of narrow-diameter implants as a treatment option in routine clinical practice. A literature review was performed of studies reporting clinical results obtained with these implants. Survival rates, peri-implant bone loss and related complications were evaluated. The working hypothesis was that narrow-diameter implants offer clinical results similar to those obtained with implants of greater diameter. Material and Methods: A Medline-PubMed search covering the period between 2002 and 2012 was carried out. Studies published in English and with a follow-up period of at least 12 months were considered for inclusion. A manual search was also conducted in different journals with an important impact factor. Results: Twenty-one studies meeting the screening criteria were included in the literature review. A total of 2980 narrow-diameter implants placed in 1607 patients were analyzed. Conclusions: The results obtained from the literature indicate that narrow-diameter implants are a predictable treatment option, since they afford clinical results comparable to those obtained with implants of greater diameter. Key words:Narrow implant, survival rate, peri-implant bone loss, related complications. PMID:24316701

  5. Primary Intracranial Melanoma with Early Leptomeningeal Spread: A Case Report and Treatment Options Available

    PubMed Central

    Balakrishnan, Rajesh; Porag, Rokeya; Asif, Dewan Shamsul; Satter, A. M. Rejaus; Taufiq, Md.; Gaddam, Samson S. K.

    2015-01-01

    Primary CNS melanomas are rare and they constitute about 1% of all cases of melanomas and 0.07% of all brain tumors. These tumors are aggressive in nature and may metastasise to other organs. Till date less than 25 cases have been reported in the literature. The primary treatment for local intraparenchymal tumours is complete resection and/or radiotherapy and it is associated with good survival. However once there is disease spread to leptomeninges the overall median survival is around 10 weeks. In this case report we describe a primary intracranial melanoma without any dural attachment in 16-year-old boy who had radical excision of the tumor followed by radiotherapy who eventually had rapidly developed leptomeningeal disease and review the literature with a focus on the clinic pathological, radiological, and treatment options. PMID:26294993

  6. Treatment and prevention of cryptosporidiosis: what options are there for a country like Zambia?

    PubMed

    Kelly, Paul

    2011-10-01

    Cryptosporidiosis is a major infection of humans, leading to diarrhoea and growth failure in children, diarrhoea and malnutrition in immunocompromised adults, and is associated with increased mortality in all age groups. Using the country of Zambia as an example, I review the possible approaches to treatment and prevention in a tropical setting. The current optimal therapy for cryptosporidiosis is nitazoxanide which works well in HIV uninfected children, but treatment in patients with HIV infection remains remarkably difficult. No single drug has demonstrated efficacy in a randomised trial. No vaccine is available, so the best option for prevention for the moment is filtration and clean storage of drinking water. This would be expected to reduce cryptosporidiosis dramatically, but this needs to be demonstrated directly. Water filtration would have the added benefit of protection against many other pathogens, but the paucity of alternative approaches highlights the need for a better understanding of this important human pathogen. PMID:21320387

  7. Paediatric Stroke: Review of the Literature and Possible Treatment Options, including Endovascular Approach

    PubMed Central

    Ciceri, Elisa F.; Cuccarini, Valeria; Chiapparini, Luisa; Saletti, Veronica; Valvassori, Luca

    2011-01-01

    Stroke is among the top 10 causes of death in childhood. More than half of the surviving children have long-term neurological sequelae. Ischemic stroke (IS) includes arterial ischemic stroke and cerebral venous thrombosis with venous infarction. Haemorrhagic stroke (HS) includes intracerebral haematoma or subarachnoid haemorrhage. Risk factors for stroke are different in children and in adults. 1030% of IS have no identified risk factors. However, multiple risk factors are recognizable in the majority of stroke in children; thus, a comprehensive diagnostic evaluation is crucial. Vascular abnormalities, such as arteriovenous malformations, aneurysms, vessel dissection, stenosis, and moyamoya disease, are frequently associated with both IS and HS and lead to high recurrence rates. Endovascular and surgical treatment options are sometimes indicated, performed on the basis of expert opinion, and extrapolated from the adult procedures. In the present paper, we review the recent literature and we discuss the treatment in five cases managed at our institutions. PMID:21789272

  8. Recurrent Labial Herpes Simplex in Pediatric Dentistry: Low-level Laser Therapy as a Treatment Option

    PubMed Central

    Stona, Priscila; da Silva Viana, Elizabete; dos Santos Pires, Leandro; Blessmann Weber, Joo Batista

    2014-01-01

    ABSTRACT Recurrent labial herpes simplex is a pathology of viral origin that is frequently observed in children. The signs and symptoms are uncomfortable and, in many cases, the efficacy of treatment is unproven. However, several studies have demonstrated good results from the use of low-level laser therapy (LLLT), primarily due to acceleration of the healing process and pain relief, which make it a promising resource for use with this pathology. This paper describes a clinical case of a 7-year-old patient affected by this pathology and the therapeutic resolution proposed. How to cite this article: Stona P, da Silva Viana E, dos Santos Pires L, Weber JBB, Kramer PF. Recurrent Labial Herpes Simplex in Pediatric Dentistry: Low-level Laser Therapy as a Treatment Option. Int J Clin Pediatr Dent 2014;7(2):140-143. PMID:25356015

  9. Update on necrobiosis lipoidica: a review of etiology, diagnosis, and treatment options.

    PubMed

    Reid, Sophia D; Ladizinski, Barry; Lee, Kachiu; Baibergenova, Akerke; Alavi, Afsaneh

    2013-11-01

    Necrobiosis lipoidica (NL) is a rare chronic granulomatous disease that has historically been associated with diabetes mellitus. Debate exists regarding the etiology and pathogenesis of NL with a widely accepted theory that microangiopathy plays a significant role. NL typically presents clinically as erythematous papules on the front of the lower extremities that can coalesce to form atrophic telangiectatic plaques. NL is usually a clinical diagnosis, but if the clinical suspicion is uncertain, skin biopsy specimen can help differentiate it from sarcoidosis, necrobiotic xanthogranuloma, and granuloma annulare. NL is a difficult disease to manage despite a large armamentarium of treatment options that include topical and intralesional corticosteroids, immunomodulators, biologics, platelet inhibitors, phototherapy, and surgery. Randomized control trials are lacking to evaluate the many treatment methods and establish a standard regimen of care. Disease complications such as ulceration are common, and lesions should also be monitored for transition to squamous cell carcinoma, a less common sequelae. PMID:23969033

  10. Treatment Options for Liquid Radioactive Waste. Factors Important for Selecting of Treatment Methods

    SciTech Connect

    Dziewinski, J.J.

    1998-09-28

    The cleanup of liquid streams contaminated with radionuclides is obtained by the selection or a combination of a number of physical and chemical separations, processes or unit operations. Among those are: Chemical treatment; Evaporation; Ion exchange and sorption; Physical separation; Electrodialysis; Osmosis; Electrocoagulation/electroflotation; Biotechnological processes; and Solvent extraction.

  11. High-altitude treatment: a therapeutic option for patients with severe, refractory asthma?

    PubMed

    Rijssenbeek-Nouwens, L H; Bel, E H

    2011-06-01

    High-altitude treatment has been applied for more than a century in the treatment of pulmonary diseases including asthma. Many uncontrolled and controlled studies have shown its beneficial effects in children and adolescents with house dust mite allergic asthma. A recent study also showed an improvement in markers of airway inflammation in adult patients with severe intrinsic asthma, suggesting that factors other than HDM avoidance may contribute to the beneficial influence of the high-altitude climate therapy on asthma. The dry mountain climate not only has decreased levels of mite allergens but also decreased levels of pollens, fungal spores and air pollution, as well as high exposure to UV light with immunomodulatory and anti-inflammatory effects. Treatments targeting environmental control have never been investigated systematically in severe asthma, which is surprising, as environmental factors have been recognized as important contributors to asthma severity for many years and more evidence has been accumulating ever since. Preliminary evidence shows the beneficial effects of high-altitude treatment in patients with severe refractory asthma on symptoms, lung function and oral corticosteroid requirement, irrespective of atopic status. In this narrative review, we will discuss why high-altitude treatment might be a promising therapeutic option for patients who suffer from this disabling disease. PMID:21518039

  12. Topical tretinoin in the treatment of vulvar lichen sclerosus: an advisable option?

    PubMed

    Borghi, Alessandro; Corazza, Monica; Minghetti, Sara; Virgili, Annarosa

    2015-10-01

    To assess the effectiveness and safety of a 24-week application of tretinoin 0.025% cream, with an alternate-day regimen, in achieving control of VLS signs and symptoms. 17 patients affected with VLS were included. The main efficacy parameters were the response rate, as defined by protocol parameters, the rate of patients achieving an improvement from baseline of ?75% in the subjective and objective scores, and the mean reduction in subjective and objective scores throughout the treatment. The safety of the treatment was also assessed. By the end of the 24-week treatment, 12 patients (70.6%) experienced a response; 35.3% and 17.6% of patients achieved an improvement of at least 75% in subjective and objective scores, respectively. Mean scores of itching, leukoderma (pallor) and hyperkeratosis decreased significantly in the study patients, and none presented itching-related excoriations. Erythema increased compared with baseline. Six patients (35.29%) experienced some side effects related to tretinoin, mainly mild erythema and burning. None of the subjects discontinued the treatment because of side effects. Tretinoin 0.025% cream applied for 24 weeks may represent a useful alternative option to corticosteroids in the treatment of active VLS, acting particularly on hyperkeratosis and pallor. PMID:26243060

  13. Treatment options in recurrent ovarian cancer: latest evidence and clinical potential

    PubMed Central

    Luvero, Daniela; Milani, Andrea

    2014-01-01

    Ovarian cancer (OC) is the fifth most common cause of cancer death in women. Although significant progress has been made in the treatment of OC, the majority of patients experience disease recurrence and receive second-line and sometimes several lines of treatment. Here we review the options available for the treatment of recurrent disease and discuss how different agents are selected, combined and offered in a rationale sequence in the context of multidisciplinary care. We reviewed published work between 1990 and 2013 and meeting abstracts related to the use of chemotherapy and surgery in patients with recurrent ovarian cancer. We discuss treatment regimens, efficacy endpoints and safety profiles of the different therapies. Platinum-based drugs are the most active agents and are selected on the basis of a probability of response to retreatment. Nonplatinum-based chemotherapy regimens are usually given in the platinum-resistant setting and have a modest effect on outcome. Molecular targeted therapy of ovarian cancer given alone or integrated with chemotherapy is showing promising results. Many patients are now receiving more than one line of therapy for recurrent disease, usually platinum based until platinum resistance emerges. The sequential use of chemotherapy regimens and the incorporation of molecularly targeted treatments, either alone or in combination with chemotherapy, have over the last decade significantly extended the median survival of patients with ovarian cancer. PMID:25342990

  14. Treatment options in recurrent ovarian cancer: latest evidence and clinical potential.

    PubMed

    Luvero, Daniela; Milani, Andrea; Ledermann, Jonathan A

    2014-09-01

    Ovarian cancer (OC) is the fifth most common cause of cancer death in women. Although significant progress has been made in the treatment of OC, the majority of patients experience disease recurrence and receive second-line and sometimes several lines of treatment. Here we review the options available for the treatment of recurrent disease and discuss how different agents are selected, combined and offered in a rationale sequence in the context of multidisciplinary care. We reviewed published work between 1990 and 2013 and meeting abstracts related to the use of chemotherapy and surgery in patients with recurrent ovarian cancer. We discuss treatment regimens, efficacy endpoints and safety profiles of the different therapies. Platinum-based drugs are the most active agents and are selected on the basis of a probability of response to retreatment. Nonplatinum-based chemotherapy regimens are usually given in the 'platinum-resistant' setting and have a modest effect on outcome. Molecular targeted therapy of ovarian cancer given alone or integrated with chemotherapy is showing promising results. Many patients are now receiving more than one line of therapy for recurrent disease, usually platinum based until platinum resistance emerges. The sequential use of chemotherapy regimens and the incorporation of molecularly targeted treatments, either alone or in combination with chemotherapy, have over the last decade significantly extended the median survival of patients with ovarian cancer. PMID:25342990

  15. Osteoporosis in the adult solid organ transplant population: underlying mechanisms and available treatment options.

    PubMed

    Early, C; Stuckey, L; Tischer, S

    2016-04-01

    The prevention and treatment of osteoporosis is an increasingly important topic in the solid organ transplant (SOT) population. Compared to the general population, these patients are at an elevated risk of developing osteoporosis due to progressive disease, lifelong immunosuppressant therapy, and malnutrition. As patients live longer after transplant, chronic disease management is increasingly more important. Supplementation with calcium and vitamin D is often necessary in the SOT population due to a high incidence of vitamin D deficiency. Bisphosphonate therapy is most commonly used for prevention and treatment of osteoporosis, but therapy can be limited by renal dysfunction which is common in transplant recipients. Alternative agents such as teriparatide and calcitonin have not been shown to provide a significant impact on the rate of fractures in this population. Additionally, denosumab may be a promising treatment option due to its novel mechanism of action, and is currently being studied in renal transplant patients. Timely initiation of supplementation and treatment, and minimizing glucocorticoid exposure prior to and after transplantation will aid in the prevention and proper management of osteoporosis in these patients. PMID:26475288

  16. Natural History and Current Treatment Options for Subependymal Giant Cell Astrocytoma in Tuberous Sclerosis Complex.

    PubMed

    J?wiak, Sergiusz; Mandera, Marek; M?ynarski, Wojciech

    2015-12-01

    Subependymal giant cell astrocytoma (SEGA) is a benign brain tumor associated with tuberous sclerosis complex (TSC). Since there were some discrepancies in SEGA classification, in 2012, a consensus statement defined SEGA as a lesion at the caudothalamic groove with either a size of more than 1cm in any direction or a subependymal lesion at any location that has shown serial growth on consecutive imaging regardless of size. This pointed that the documented tumor growing is an important diagnostic feature. Currently, there are 2 therapeutic options: surgical and medical with mammalian target of rapamycin (mTOR) inhibitors. Neurosurgery should consider a localization and size of the tumor, presence of hydrocephalus and surgeon's experience. Patients who are not qualified for surgery and require therapeutic intervention are subjected to mTOR inhibitors therapy. Everolimus, one of the mTOR inhibitors, has been recently approved in the US and Europe for treatment of patients with TSC and SEGA. Treatment with everolimus results in a rapid initial reduction in tumor volume, followed by a phase of slower reduction or stabilization of residual mass. mTOR inhibitor dose de-escalation strategy seems to be also logical in long-term SEGA treatment to reduce the risk of adverse effects while maintaining the therapeutic effect. However, duration of the treatment and the efficacy of dose reduction are still questionable. Thus, this review covers the various approaches that are currently being made toward improving the outcome of management of SEGA among patients with TSC. PMID:26706014

  17. An alternative treatment option for a bony defect from large odontoma using recycled demineralization at chairside.

    PubMed

    Lee, JuHyon; Lee, Eun-Young; Park, Eun-Jin; Kim, Eun-Suk

    2015-04-01

    Odontoma is the most common odontogenic benign tumor, and the treatment of choice is generally surgical removal. After excision, bone grafts may be necessary depending on the need for further treatment, or the size and location of the odontoma. Although the osteogenic capacity of a demineralized tooth was verified as early as 1967 by Urist and many other investigators, the cumbersome procedure, including a long demineralization time, may be less than comfortable for clinicians. A modified ultrasonic technology, with periodic negative pressure and temperature control, facilitated rapid and aseptic preparation of demineralized teeth for bone grafts. This approach reduces the demineralization time dramatically (≤80 minutes), so that the graft material can be prepared chairside on the same day as the extraction. The purpose of this article is to describe two cases of large compound odonotomas used as graft material prepared chairside for enucleation-induced bony defects. These two clinical cases showed favorable wound healing without complications, and good bony support for future dental implants or orthodontic treatment. Finally, this report will suggest the possibility of recycling the benign pathologic hard tissue as an alternative treatment option for conventional bone grafts in clinics. PMID:25922824

  18. An alternative treatment option for a bony defect from large odontoma using recycled demineralization at chairside

    PubMed Central

    2015-01-01

    Odontoma is the most common odontogenic benign tumor, and the treatment of choice is generally surgical removal. After excision, bone grafts may be necessary depending on the need for further treatment, or the size and location of the odontoma. Although the osteogenic capacity of a demineralized tooth was verified as early as 1967 by Urist and many other investigators, the cumbersome procedure, including a long demineralization time, may be less than comfortable for clinicians. A modified ultrasonic technology, with periodic negative pressure and temperature control, facilitated rapid and aseptic preparation of demineralized teeth for bone grafts. This approach reduces the demineralization time dramatically (≤80 minutes), so that the graft material can be prepared chairside on the same day as the extraction. The purpose of this article is to describe two cases of large compound odonotomas used as graft material prepared chairside for enucleation-induced bony defects. These two clinical cases showed favorable wound healing without complications, and good bony support for future dental implants or orthodontic treatment. Finally, this report will suggest the possibility of recycling the benign pathologic hard tissue as an alternative treatment option for conventional bone grafts in clinics. PMID:25922824

  19. Early stage squamous cell carcinoma of the pyriform sinus: a review of treatment options.

    PubMed

    Krstevska, V

    2012-01-01

    The purpose of this review of the literature was to present treatment options for early stage pyriform sinus cancer. Squamous cell carcinoma of the pyriform sinus, as the most frequent cancer arising from the hypopharynx, is rarely diagnosed in its early stage. Based on evidence from retrospective studies, conservation surgery and definitive radiotherapy are considered the available treatment modalities for patients presenting with stage T1 and T2 pyriform sinus carcinomas without clinical evidence of neck lymph node metastases, offering similar results with respect to disease control and functional organ preservation. Also, the high risk of occult metastatic nodal disease even in the earliest stage of pyriform sinus cancer entails elective neck dissection or elective neck irradiation to be considered mandatory. However, for patients with early stage pyriform sinus cancer, no level 1 study exists in which conservation surgery is compared with radiotherapy alone for the evaluation of local control or survival. Randomized multicenter controlled trials evaluating efficacy of conservation surgery and definitive radiotherapy, and correctly interpreting functional outcome for each of the treatment procedures examined are necessary to obtain sufficient evidence to influence the decision in the choice of the most effective treatment for early pyriform sinus cancer. PMID:23107977

  20. Regenerative Endodontic Treatment as a Retreatment Option for a Tooth with Open Apex - A Case Report.

    PubMed

    Miltiadous, Maria-Elpida A; Floratos, Spyros G

    2015-10-01

    Treatment of non-vital immature teeth with apical periodontitis has always been a challenge in Endodontics. Regenerative endodontic treatment (RET) has been successfully used for the management of these cases. The aim of this study is to present a case of RET used for the retreatment of a previously endodontically treated permanent tooth with an open apex. A 14-year-old boy with a poor endodontic treatment done on his maxillary right central incisor developed symptomatic apical periodontitis. Radiographically, incomplete root development with thin dentinal walls and an open apex were evident. After accessing and removing previous filling materials, the canal was copiously irrigated with 2.5% sodium hypochlorite. A triple antibiotic paste was placed inside the canal and left for 15 days. After removal of the antibiotic mixture, bleeding was induced into the canal by passing a hand file out of the apex. A collagen membrane barrier was placed over the blood clot, followed by sealing with mineral trioxide aggregate. Access was sealed with permanent filling materials. Clinical examination at 12, 24 and 36 months revealed no symptoms. Radiographic examination showed resolution of the periapical lesion and apical closure. Sensitivity tests with cold and an electric pulp test elicited a negative response at all recall periods. On the basis of long-term results, RET may be an effective option for the retreatment of an immature permanent tooth with a failed previous treatment and periapical periodontitis. PMID:26647945

  1. Different options for metal recovery after sludge decontamination at the Montreal Urban Community wastewater treatment plant.

    PubMed

    Meunier, N; Blais, J F; Louns, M; Tyagi, R D; Sasseville, J L

    2002-01-01

    The MUG (Montreal Urban Community) treatment plant produces approximately 270 tons of dry sludge daily (270 tds/day) during the physico-chemical treatment of wastewater. Recently, this treatment plant endowed a system of drying and granulation of sludge for valorization as an agricultural fertilizer having a capacity of 70 tds/day (25% of the daily sludge production). However, the metal content (mainly Cu and Cd) of the sludge surpasses the norms for biosolids valorization. In order to solve this problem, a demonstration project, from the lab scale to the industrial pilot plant, was carried out to test the Metix-AC technology for the removal of metals. A strongly metal-loaded filtrate was generated during the sludge decontamination. Tests concerned the study of the metal recovery by total precipitation and selective precipitation, as well as the use of alternative products for the metal precipitation. Other works consisted to simulate the acid filtrate recirculation from the decontaminated sludge (25% of the total volume) in the untreated sludge (75% of the total volume) intended for the incineration. The total precipitation with hydrated limeappearedeffectivefortherecoveryof metals (87% Cd, 96% Cr, 97% Cu, 98% Fe, 71% Ni, 100% Pb, 98% Zn). However, this option entails the production of an important quantity of metallic residue, which should be disposed of expensively as dangerous material. The selective iron precipitation does not appear to bean interesting option because the iron in solution within the leached sludge was principally present in the form of ferrous iron, which cannot be precipitated at pH lower than five. On the other hand, the use of commercial precipitating agents (TMT-15, CP-33Z, CP-NB and CPX) without pH adjustment of filtrate gave good results for the recovery of Cu and, to a lesser degree for the recovery of Pb. However, the efficiency for the other metals' (Cd, Cr, Fe, Ni and Zn) recovery was weaker (< 25%). Finally, the acid filtrate recirculation containing solubilised metals in untreated sludge destined for incineration appears to be the most interesting option. Metals in solution in the acid filtrate, precipitate or adsorb effectively (97% Cd, 97% Cr, 99% Cu, 82% Ni, 100% Pb and 87% Zn) on the solids of the untreated sludge. Moreover, TCLP tests were done on ashes produced during the incineration of sludge mixed with the acid filtrate produced during sludge decontamination. These tests showed that there were no significant differences, as regards the extractability of metals, between such ashes and those produced during the untreated sludge incineration without addition of filtrate. Therefore, it was predictable that this method can respect the current environmental standards required by the different governmental authorities. PMID:12479450

  2. Musculoskeletal Conditions of the Foot and Ankle: Assessments and Treatment Options

    PubMed Central

    Rao, Smita; Riskowski, Jody; Hannan, Marian T.

    2012-01-01

    Musculoskeletal conditions of the foot and ankle are an important public health challenge due to their increasing incidence combined with their substantial negative impact on patients quality of life. Non-pharmacological treatments serve as the first line of treatment and are frequently used for patients with musculoskeletal conditions of the foot and ankle. This review provides a summary of the assessments and non-invasive treatment options based upon available evidence. Recent studies show that individuals with foot and ankle pain have multiple co-existing impairments in alignment, motion, load distribution and muscle performance that may be evident in static and/or dynamic tasks. Additionally, both clinical and epidemiological studies support the inter-dependence between the foot and proximal joints. For instance, aberrant foot structure has been linked to foot osteoarthritis (OA), as well as OA and pain at the knee and hip. Most recently, advances in motion capture technology and plantar load distribution measurement offer opportunities for precise dynamic assessments of the foot and ankle. In individuals with musculoskeletal conditions of the foot and ankle, the chief objectives of treatment are to afford pain relief, restore mechanics (alignment, motion and/or load distribution) and return the patient to their desired level of activity participation. Given that most patients present with multiple impairments, combinational therapies that target foot-specific as well as global impairments have shown promising results. In particular, in individuals with rheumatoid arthritis and other rheumatic diseases, comprehensive rehabilitation strategies including early detection, foot-based interventions (such as orthoses) and wellness-based approaches for physical activity and self-management have been successful. While significant improvements have been made in the last decade to the assessment and treatment of foot and ankle conditions, few randomized clinical trials specifically have investigated patients with foot or ankle conditions to provide global insights into this area. Consequently, current recommendations vary based upon the scope of studies presented in this review as well as the strength of studies. This review indicates a need for more in-depth investigations into the components of assessment and treatment options for foot and ankle musculoskeletal conditions. PMID:22867931

  3. Surgical treatment of trapeziometacarpal joint osteoarthritis

    PubMed Central

    TACCARDO, GIUSEPPE; DE VITIS, ROCCO; PARRONE, GIUSEPPE; MILANO, GIUSEPPE; FANFANI, FRANCESCO

    2013-01-01

    Trapeziometacarpal joint osteoarthritis is a common cause of radial-sided wrist pain that prevalently affects women. It is diagnosed on the basis of a thorough history, physical examination, and radiographic evaluation. While radiographs are used to determine the stage of disease, treatment is dependent on the severity of the symptoms. Non-surgical treatment frequently consists of activity modification, non-steroidal anti-inflammatory drugs, splinting and corticosteroid injections. After failure of conservative treatment, various surgical options exist depending on the stage of the disease. These options range from ligament reconstruction or osteotomy, for early painful laxity, to trapeziectomy, arthrodesis and arthroplasty for more severe osteoarthritis. This article reviews the literature supporting the various surgical treatment options and analyzes the surgical techniques most frequently used in the different disease stages. PMID:25606524

  4. Effect of Spinal Cord Injury on the Respiratory System: Basic Research and Current Clinical Treatment Options

    PubMed Central

    Zimmer, M. Beth; Nantwi, Kwaku; Goshgarian, Harry G

    2007-01-01

    Summary: Spinal cord injury (SCI) often leads to an impairment of the respiratory system. The more rostral the level of injury, the more likely the injury will affect ventilation. In fact, respiratory insufficiency is the number one cause of mortality and morbidity after SCI. This review highlights the progress that has been made in basic and clinical research, while noting the gaps in our knowledge. Basic research has focused on a hemisection injury model to examine methods aimed at improving respiratory function after SCI, but contusion injury models have also been used. Increasing synaptic plasticity, strengthening spared axonal pathways, and the disinhibition of phrenic motor neurons all result in the activation of a latent respiratory motor pathway that restores function to a previously paralyzed hemidiaphragm in animal models. Human clinical studies have revealed that respiratory function is negatively impacted by SCI. Respiratory muscle training regimens may improve inspiratory function after SCI, but more thorough and carefully designed studies are needed to adequately address this issue. Phrenic nerve and diaphragm pacing are options available to wean patients from standard mechanical ventilation. The techniques aimed at improving respiratory function in humans with SCI have both pros and cons, but having more options available to the clinician allows for more individualized treatment, resulting in better patient care. Despite significant progress in both basic and clinical research, there is still a significant gap in our understanding of the effect of SCI on the respiratory system. PMID:17853653

  5. Thoracic outlet syndrome: a controversial clinical condition. Part 2: non-surgical and surgical management

    PubMed Central

    Hooper, Troy L; Denton, Jeff; McGalliard, Michael K; Brisme, Jean-Michel; Sizer, Phillip S

    2010-01-01

    Background Proper management of thoracic outlet syndrome (TOS) requires an understanding of the underlying causes of the disorder. A comprehensive examination process, as described in Part 1 of this review, can reveal the bony and soft tissue abnormalities and mechanical dysfunctions contributing to an individuals TOS symptoms. Objective Part 2 of this review focuses on management of TOS. Conclusion The clinician uses clinical examination results to design a rehabilitation program that focuses on correcting specific problems that were previously identified. Disputed neurogenic TOS is best managed with a trial of conservative therapy before surgical treatment options are considered. Cases that are resistant to conservative treatment may require surgical intervention. True neurogenic TOS may require surgical intervention to relieve compression of the neural structures in the thoracic outlet. Surgical management is required for cases of vascular TOS because of the potentially serious complications that may arise from venous or arterial compromise. Post-operative rehabilitation is recommended after surgical decompression to address factors that could lead to a reoccurrence of the patients symptoms. PMID:21886423

  6. Patent ductus arteriosus: are current neonatal treatment options better or worse than no treatment at all?

    PubMed Central

    Clyman, Ronald I.; Couto, Jim; Murphy, Gail M.

    2012-01-01

    Although a moderate-size PDA needs to be closed by the time a child is 12 years old, there is great uncertainty about whether it needs to be closed during the neonatal period. While 95% of neonatologists believe that a moderate-size PDA should be closed if it persists in infants (born before 28 weeks) who still require mechanical ventilation, the number that treat a PDA when it occurs in infants that do not require mechanical ventilation varies widely. Both the high likelihood of spontaneous ductus closure and the absence of RCTs, specifically addressing the risks and benefits of neonatal ductus closure, adds to the current uncertainty. New information suggests that early pharmacologic treatment has several important short-term benefits for the preterm newborn. On the other hand, ductus ligation, while eliminating the detrimental effects of a PDA on lung development, may create its own set of morbidities that counteract many of the benefits derived from ductus closure. PMID:22414883

  7. Glanzmann’s thrombasthenia: pathogenesis, diagnosis, and current and emerging treatment options

    PubMed Central

    Solh, Tia; Botsford, Ashley; Solh, Melhem

    2015-01-01

    Glanzmann’s thrombasthenia (GT) is a genetic platelet surface receptor disorder of GPIIb/IIIa (ITG αIIbβ3), either qualitative or quantitative, which results in faulty platelet aggregation and diminished clot retraction. Spontaneous mucocutaneous bleeding is common and can lead to fatal bleeding episodes. Control and prevention of bleeding among patients with GT is imperative, and remains challenging. Local measures, including anti-fibrinolytic therapy, with or without platelet transfusions, used to be the mainstay of therapy. However, in recent years the use of recombinant factor VIIa (rFVIIa) has increased significantly, with excellent response rates in treating and preventing hemorrhage among GT patients. Gene therapy and stem cell transplantation offer a potential cure of this disease, but both are costly and remain experimental at this point. This manuscript offers a comprehensive review of our understanding of GT and the available treatment options. PMID:26185478

  8. An update on the management of peripheral T-cell lymphoma and emerging treatment options

    PubMed Central

    Phillips, Adrienne A; Owens, Colette; Lee, Sangmin; Bhagat, Govind

    2011-01-01

    Peripheral T-cell lymphomas (PTCLs) comprise a rare and heterogeneous subset of non-Hodgkins lymphomas (NHLs) that arise from post-thymic T-cells or natural killer (NK)-cells at nodal or extranodal sites. Worldwide, PTCLs represent approximately 12% of all NHLs and the 2008 World Health Organization (WHO) classification includes over 20 biologically and clinically distinct T/NK-cell neoplasms that differ significantly in presentation, pathology, and response to therapy. Because of the rarity and heterogeneity of these diseases, large clinical trials have not been conducted and optimal therapy is not well defined. Most subtypes are treated with similar combination chemotherapy regimens as used for aggressive B-cell NHL, but with poorer outcomes. New treatment combinations and novel agents are currently being explored for PTCLs and this review highlights a number of options that appear promising. PMID:22287871

  9. Continual evolution of type 2 diabetes: an update on pathophysiology and emerging treatment options

    PubMed Central

    Cornell, Susan

    2015-01-01

    Diabetes is a complex and progressive disease that has a major societal and economic impact. The most common form of diabetes, type 2 diabetes mellitus (T2DM), is a multifactorial disease, the pathophysiology of which involves not only the pancreas but also the liver, skeletal muscle, adipose tissue, gastrointestinal tract, brain, and kidney. Novel therapies with mechanisms of action that are different from most existing drugs are emerging. One such class consists of compounds that inhibit renal sodium-glucose cotransporter 2, which is responsible for the bulk of glucose reabsorption by the kidneys. This new class of compounds improves glycemic control independently of insulin and promotes weight reduction, providing an additional tool to treat patients with T2DM. This review discusses the underlying pathophysiology of T2DM, clinical guidelines, and available and emerging treatment options, with particular emphasis on sodium-glucose cotransporter 2 inhibitors. PMID:25931824

  10. INVO Procedure: Minimally Invasive IVF as an Alternative Treatment Option for Infertile Couples

    PubMed Central

    Lucena, Elkin; Saa, Angela M.; Navarro, Doris E.; Pulido, Carlos; Lombana, Oscar; Moran, Abby

    2012-01-01

    Intravaginal culture (IVC), also called INVO (intravaginal culture of oocytes), is an assisted reproduction procedure where oocyte fertilization and early embryo development are carried out within a gas permeable air-free plastic device, placed into the maternal vaginal cavity for incubation. In the present study we assessed the outcome of the INVO procedure, using the recently designed INVOcell device, in combination with a mild ovarian stimulation protocol. A total of 125 cycles were performed. On average 6.5 oocytes per cycle were retrieved, and a mean of 4.2 were placed per INVOcell device. The cleavage rate obtained after the INVO culture was 63%. The procedure yielded 40%, 31.2%, and 24% of clinical pregnancy, live birth, and single live birth rates per cycle, respectively. Our results suggest that the INVO procedure is an effective alternative treatment option in assisted reproduction that shows comparable results to those reported for existing IVF techniques. PMID:22645435

  11. Continual evolution of type 2 diabetes: an update on pathophysiology and emerging treatment options.

    PubMed

    Cornell, Susan

    2015-01-01

    Diabetes is a complex and progressive disease that has a major societal and economic impact. The most common form of diabetes, type 2 diabetes mellitus (T2DM), is a multifactorial disease, the pathophysiology of which involves not only the pancreas but also the liver, skeletal muscle, adipose tissue, gastrointestinal tract, brain, and kidney. Novel therapies with mechanisms of action that are different from most existing drugs are emerging. One such class consists of compounds that inhibit renal sodium-glucose cotransporter 2, which is responsible for the bulk of glucose reabsorption by the kidneys. This new class of compounds improves glycemic control independently of insulin and promotes weight reduction, providing an additional tool to treat patients with T2DM. This review discusses the underlying pathophysiology of T2DM, clinical guidelines, and available and emerging treatment options, with particular emphasis on sodium-glucose cotransporter 2 inhibitors. PMID:25931824

  12. Constipation in palliative care: treatment options and considerations for individual patient management.

    PubMed

    Andrews, Amanda; Morgan, Gwyneth

    2013-06-01

    Constipation is an all too common symptom in palliative care patients and may be associated with a range of severe issues and experiences. Its effects on patients contribute to both physical and psychological scarring during a very distressing stage of life not only for the patient but also for their caregivers. It is during this time that, too often, the complexity of managing the condition moves the locus of control away from the patient toward the health professionals. This article considers a number of different treatment options and facets of individual management that may enable patients to move the locus of control back to a position of joint management by patients, caregivers, and health professionals. PMID:24151737

  13. Locally advanced and metastatic basal cell carcinoma: molecular pathways, treatment options and new targeted therapies.

    PubMed

    Ruiz Salas, Veronica; Alegre, Marta; Garcés, Joan Ramón; Puig, Lluis

    2014-06-01

    The hedgehog (Hh) signaling pathway has been identified as important to normal embryonic development in living organisms and it is implicated in processes including cell proliferation, differentiation and tissue patterning. Aberrant Hh pathway has been involved in the pathogenesis and chemotherapy resistance of different solid and hematologic malignancies. Basal cell carcinoma (BCC) and medulloblastoma are two well-recognized cancers with mutations in components of the Hh pathway. Vismodegib has recently approved as the first inhibitor of one of the components of the Hh pathway (smoothened). This review attempts to provide current data on the molecular pathways involved in the development of BCC and the therapeutic options available for the treatment of locally advanced and metastatic BCC, and the new targeted therapies in development. PMID:24611655

  14. Renal Artery Embolization - A First Line Treatment Option For End-Stage Hydronephrosis

    SciTech Connect

    Mitra, Kakali; Prabhudesai, Vikramaditya; James, R. Lester; Jones, Robert W. A.; French, Michael E.; Cowling, Mark; West, David J.

    2004-09-15

    Conventionally poorly functioning hydronephrotic kidneys have been removed if they are symptomatic. In our unit, patients are offered renal artery embolization as an alternative treatment option. Patients and Methods: Fifteen patients (11 male, 4 female) with a mean age of 32.9 yr (20-51 yrs) have undergone renal artery embolization for symptomatic hydronephrosis with poor function. Mean follow-up was 64.13 weeks (range 14-200). All patients had loin pain and hydronephrosis. Twelve patients had primary pelvi-ureteric junction obstruction (PUJO). Two patients had poorly functioning hydronephrotic kidneys secondary to chronic calculous obstruction. One patient had chronic pain in an obstructed but reasonably functioning kidney following a previous pyeloplasty for PUJO which demanded intervention. Mean split function on renography was 11% (range 0-46%). Selective renal artery embolization was carried out under antibiotic cover using a 7 Fr balloon occlusion catheter and absolute alcohol, steel coils, and polyvinyl alcohol particles.Results: Nine patients developed post-embolization syndrome of self-limiting pain and pyrexia with no evidence of sepsis. One patient required readmission with this condition. One patient developed a hematoma at the puncture site. Mean hospital stay was 2.3 days. Fourteen patients are happy with the result and are completely pain free. One patient has minor discomfort but is delighted with the result. Nine patients have had follow-up ultrasound confirming resolution of the hydronephrosis. Conclusion: Renal artery embolization is an effective, safe, well-tolerated minimally invasive treatment option in end-stage hydronephrosis and we routinely offer it as an alternative to nephrectomy.

  15. Management of multiple sclerosis in adolescents – current treatment options and related adherence issues

    PubMed Central

    Mah, Jean K; Thannhauser, Jennifer E

    2010-01-01

    Multiple sclerosis (MS) is a progressive inflammatory demyelinating disorder of the central nervous system that is increasingly recognized in children and adolescents. This realization comes with additional concerns about existing therapeutic options and the impact of the disease on health-related outcomes of adolescents with MS. This five-part review provides an update on management strategies relevant to the pediatric MS population. The first section gives an overview on the epidemiology and natural history of early onset MS. The second section outlines currently available MS treatments, including medications during acute relapses and long-term immunomodulatory therapies. The third section highlights adherence issues pertaining to MS, including the challenges uniquely faced by adolescents. The fourth section provides a summary of research into quality of life and psychosocial consequences of pediatric onset MS. Attention is drawn to the grief experience of affected adolescents and the importance of peer relationships. Finally, the family resilience framework is presented as a conceptual model to facilitate optimal adaptation of adolescents with MS. Healthcare professionals can promote resilience and treatment adherence by ensuring that these individuals and their families are sufficiently informed about available MS treatments, providing instrumental support for managing potential medication side effects, and addressing age-appropriate developmental needs. PMID:24600259

  16. Depression and Cerebrovascular Disease: Could Vortioxetine Represent a Valid Treatment Option?

    PubMed Central

    Carta, Mauro Giovanni; Pala, Andrea Norcini; Finco, Gabriele; Musu, Mario; Moro, Maria Francesca

    2015-01-01

    Introduction : Depression and cerebrovascular atherosclerosis often occur in comorbidity showing neuropsychological impairment and poor response to antidepressant treatment. Objective is to evaluate if new antidepressant vortioxetine may be a potential treatment option. Mechanism of Action : Vortioxetine has 5-HT3, 5-HT7 and 5-HT1D antagonists, 5-HT1B partial agonist and a 5-HT1A agonist and serotonin transporter inhibitor property. Efficacy and safety in Major Depressive Disorders and in cognitive impairment : The majority of trials (one of them in older people) showed efficacy for vortioxetine against placebo and no differences against other active treatments. The Adverse Effects ranged from 15.8% more to 10.8% less than placebo. In the elderly, only nausea was found higher than placebo. Effects on arterial blood pressure and cardiac parameters including the ECG-QT segment were similar to placebo. Elderly depressive patients on vortioxetine showed improvement versus placebo and other active comparators in Auditory Verbal Learning Test and Digit Symbol Substitution Test scores. The inclusion criteria admitted cases with middle cerebrovascular disease. Conclusion : The mechanism of action, the efficacy on depression and safety profile and early data on cognitive impairment make Vortioxetine a strong candidate for use in depression associated with cerebrovascular disease. This information must be supported by future randomized controlled trials. PMID:25893002

  17. HER2-directed therapy: current treatment options for HER2-positive breast cancer.

    PubMed

    Ahmed, Shahid; Sami, Amer; Xiang, Jim

    2015-03-01

    Over the past decade, the management of HER2-positive breast cancer has evolved dramatically. In addition to advances in screening, genetic testing, imaging, surgical and radiation techniques, innovations in medical therapy including widespread use of HER2-directed therapy in early and advanced breast cancer have revolutionized breast cancer care and changed the natural history of HER2-positive breast cancer. A substantial number of HER2-targeted agents are being developed including monoclonal antibodies, small molecule inhibitors, and antibody drug conjugates. Trastuzumab is the prototype HER2-directed therapy that was introduced in the late 1990s for the management of metastatic breast cancer and later showed efficacy in early stage disease. Despite the practice changing impact of trastuzumab and improvement in outcomes of women with HER2-positive breast cancer resistance to trrastuzumab is a major clinical issue, occurring in both early stage and advanced disease, and new treatment strategies are clearly required. Combining HER2-targeted agents and dual HER2 blockade has been successful in early and advanced breast cancer. Furthermore, selected delivery of potent chemotherapeutic agent coupled with HER2 inhibition promises new treatment options. This review is focused on current HER2-directed treatments for women with HER2-positive breast cancer including monoclonal antibodies, small molecule inhibitors, and antibody drug conjugates. PMID:25634227

  18. Life cycle assessment of wastewater treatment options for small and decentralized communities.

    PubMed

    Machado, A P; Urbano, L; Brito, A G; Janknecht, P; Salas, J J; Nogueira, R

    2007-01-01

    Sustainability has strong implications on the practice of engineering. Life cycle assessment (LCA) is an appropriate methodology for assessing the sustainability of a wastewater treatment plant design. The present study used a LCA approach for comparing alternative wastewater treatment processes for small and decentralised rural communities. The assessment was focused on two energy-saving systems (constructed wetland and slow rate infiltration) and a conventional one (activated sludge process). The low environmental impact of the energy-saving wastewater treatment plants was demonstrated, the most relevant being the global warming indicator. Options for reduction of life cycle impacts were assessed including materials used in construction and operational lifetime of the systems. A 10% extension of operation lifetime of constructed wetland and slow rate infiltration systems led to a 1% decrease in CO2 emissions, in both systems. The decrease in the abiotic depletion was 5 and 7%, respectively. Also, replacing steel with HDPE in the activated sludge tank resulted in a 1% reduction in CO2 emission and 1% in the abiotic depletion indicator. In the case of the Imhoff tank a 1% reduction in CO2 emissions and 5% in the abiotic depletion indicator were observed when concrete was replaced by HDPE. PMID:17802833

  19. [Novel therapeutic options in the treatment of BCR/ABL-negative myeloproliferative neoplasms].

    PubMed

    Dhner, K; Stegelmann, F; Schlenk, R F; Griesshammer, M

    2012-10-01

    Since the discovery of the JAK2V617F mutation in essential thrombocythemia (ET), polycythemia vera (PV) and myelofibrosis (MF) in 2005, the field of myeloproliferative neoplasms (MPN) experiences a significant gain of knowledge. Based on the novel insights in the molecular pathomechanisms of MPN many innovative drugs have been developed that are currently under investigation in clinical trials. Most data are available on the JAK inhibitors, the so called "ATP mimetics" for the treatment of MF. Recent data from two large phase-III studies showed that the JAK1?/2 inhibitor Ruxolitinib is very effective in the reduction of spleen size and the improvement of quality of life in MF patients. Beside JAK inhibitors, immunomodulatory drugs (IMiD) are currently under investigation. Here, pomalidomide showed significant activity in several phase-II studies in MF patients. In addition, other kinase inhibitors as well as histone deacetylase (HDAC) inhibitors and inhibitors of the mTOR signalling pathway are currently evaluated in clinical trials. Based on their potential synergistic action combination therapy of these substances represents another option for MPN therapy.In this review the most recently published studies using innovative treatment strategies in MPN patients are reported, and some future aspects for MPN treatment are adressed. PMID:23055361

  20. Inflammatory nodules following soft tissue filler use: a review of causative agents, pathology and treatment options.

    PubMed

    Ledon, Jennifer A; Savas, Jessica A; Yang, Steven; Franca, Katlein; Camacho, Ivan; Nouri, Keyvan

    2013-10-01

    Nodule development is a common complication following the use of fillers for soft tissue augmentation and is commonly categorized as inflammatory or non-inflammatory in nature. Inflammatory nodules may appear anywhere from days to years after treatment, whereas non-inflammatory nodules are typically seen immediately following implantation and are usually secondary to improper placement of the filler. Although inflammatory nodules are more common with permanent fillers such as silicone, inflammatory nodule development following administration of temporary fillers such as hyaluronic acid and collagen has also been reported. Treated many times with corticosteroids due to their anti-inflammatory properties, inflammatory nodules may be secondary to infection or biofilm formation, warranting the use of alternative agents. Appropriate and prompt diagnosis is important in avoiding delay of treatment or long-term complications for the patient. This paper addresses the etiology, development, and studied treatment options available for inflammatory nodules secondary to each of the major classes of fillers. With this knowledge, practitioners may expeditiously recognize and manage this common side effect and thus maximize functional and aesthetic benefit. PMID:24037757

  1. Surgical and Non-Surgical Procedures Associated with Recurrence of Periodontitis in Periodontal Maintenance Therapy: 5-Year Prospective Study

    PubMed Central

    Cota, Lus Otvio Miranda; Cyrino, Renata Magalhes; Lages, Eugnio Jos Pereira

    2015-01-01

    Background and Objective Prospective studies that investigated the influence of surgical and nonsurgical procedures in the recurrence of periodontitis and tooth loss in periodontal maintenance therapy (PMT) programs have not been previously reported. The objective of this study was to evaluate longitudinally the recurrence of periodontitis in regular compliers (RC) and irregular compliers (IC) individuals undergoing surgical and non-surgical procedures over 5 years in a program of PMT. Materials and Methods A total of 212 individuals participated in this study. Full-mouth periodontal examination including bleeding on probing, probing depth, and clinical attachment level were determined at all PMT visits over 5 years. The recurrence of periodontitis was evaluated in RC and IC individuals undergoing surgical and non-surgical procedures in PMT. The influences of risk variables of interest were tested through univariate analysis and multivariate logistic regression. Results Recurrence of periodontitis was significantly lower among RC when compared to IC. Individuals with recurrence of periodontitis and undergoing surgical procedures showed higher probing depth and clinical attachment loss than those who received non-surgical procedures. Recurrence of periodontitis was higher in individual undergoing surgical procedures and irregular compliance during PMT. Conclusions Irregular compliance and surgical procedures in individuals undergoing PMT presented higher rates of recurrence of periodontitis when compared to regular compliant patients undergoing non-surgical procedures. PMID:26496187

  2. 26 CFR 1.1504-4 - Treatment of warrants, options, convertible obligations, and other similar interests.

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ... option created by the confirmation of the plan, and any option created under the plan prior to the time..., value, or other indication of economic performance of the issuing corporation; (v) Time of exercise. The time at which, or the period of time during which, the option can be exercised; (vi) Related...

  3. Efficacy of herbal tincture as treatment option for retained placenta in dairy cows.

    PubMed

    Cui, Dongan; Li, Jianxi; Wang, Xuezhi; Xie, Jiasheng; Zhang, Kai; Wang, Xurong; Zhang, Jingyan; Wang, Lei; Qin, Zhe; Yang, Zhiqiang

    2014-02-01

    Retained placenta remains therapeutic challenge in cattle. Certain traditional medicines are believed to be able to alleviate retained placenta condition and improve overall fertility in cows. The aim of the present study was to evaluate the efficacy of an herbal tincture for treatment of retained placenta. The herbal tincture was extracted from a combination of Herba Leonuri, Angelicae Sinensis Radix, Flos Carthami, Myrrha and Rhizoma Cyperi by percolation with 70% ethanol to a concentration of 0.5g crude herb/ml. Cows diagnosed with retained placenta (n=48) were randomly divided into one of two treatment groups (A and B), with animals in group A (n=26) receiving herbal tincture orally, and cows in group B (n=22) receiving oxytetracycline infusion into the uterus. Eighty six cows with no clinically visible pathological conditions, given birth alone and with no retained placenta diagnosis were included into control group (C). Retained placenta was expelled within 72h following initial treatment in 19 cows in group A, yet no cows in group B were recorded to expel placenta in the same time. The median number of days to first service (70.0 vs. 102.5 days; P<0.05) and median number of days open (76.0 vs. 134.0 days; P<0.01) were lower in group A than in group B. Percentage of cows pregnant within 100 days postpartum was the highest for animals in group A compared to controls (61.5% vs. 39.5%, P<0.05), and for animals in group B (61.5% vs. 22.7%; P<0.01). Herbal tincture used in the present study might facilitate expulsion of retained placenta and improve subsequent fertility, thus could present effective treatment option for retained placenta in cows. PMID:24467962

  4. Functional outcomes of acutely infected knee arthroplasty: a comparison of different surgical treatment options

    PubMed Central

    Dzaja, Ivan; Howard, James; Somerville, Lyndsay; Lanting, Brent

    2015-01-01

    Background An infected total knee arthroplasty (TKA) can be treated with irrigation and dbridement with polyethylene exchange (IDPE) or a 2-staged revision (2SR). Although research has examined infection eradication rates of both treatments, patient outcomes have not been reported. We examined patient-reported outcomes following treatment compared with matched, noninfected controls. Methods We retrospectively identified patients with infected TKAs who had undergone the index procedure between May 1991 and November 2011. Patient-reported outcomes included the 12-item Short Form Health Survey, Western Ontario and McMaster Universities Arthritis Index, and Knee Society Scores as well as range of motion. Patients with noninfected primary TKAs matched by age and age-adjusted Charlson Comorbidity Index score were used as controls. Intention-to-treat groups of 2SR and IDPE were used, with the IDPE group subdivided into successful and unsuccessful groups. Results We included 145 patients with infected TKAs with mean follow-up of 64.2 months and 145 controls with a mean follow-up of 35.4 months in our analysis. Outcomes of the controls and the successful IDPE groups were equivalent. The 2SR cohort had lower scores in all categories than controls. There was a 39% success rate in eradicating infection with IDPE. Patients in whom IDPE failed had lower scores in all categories than controls. There was no difference between the failed IDPE group and the 2SR group. Conclusion Controversy regarding treatment options for acutely infected TKA has been focused on infection eradication. However, functional outcomes following treatment need to be taken into consideration. Patients whose infections were successfully treated with IDPE had equivalent outcomes to controls. PMID:26574832

  5. Increased vertical dimension of occlusion: signs, symptoms, diagnosis, treatment and options.

    PubMed

    Discacciati, Jos Augusto Csar; Lemos de Souza, Eduardo; Vasconcellos, Walison Arthuso; Costa, Srgio Carvalho; Barros, Vincius de Magalhes

    2013-01-01

    During the planning of oral rehabilitation, the vertical dimension of occlusion (VDO) is one of the first parameters to be measured since its improper restoration can lead to the failure of any prosthetic rehabilitation. A decreased VDO can lead to the appearance of lesions, such as angular cheilitis, facial disharmony, and temporomandibular disorders; meanwhile, an increased VDO may lead to the onset of joint and muscle pain, tension in functional speech, difficulty in swallowing, impaired chewing, tooth sensitivity due to traumatogenic forces, pathologic bone resorption, abnormal wearing of teeth, the appearance of an elongated face, and a facial expression of fatigue. Most scientific articles deal with methods and techniques for re-establishing VDO in edentulous patients or those who have lost their tooth reference due to prosthetic preparations. However, patients with increased VDO are also found in everyday practice. One treatment option for these patients is occlusal adjustment by selective tooth wear; it is still possible to perform orthodontic intrusion and/or orthognathic surgery in severe cases. The aim of this study was to discuss signs, symptoms, diagnosis, and treatment, and to report a clinical case of a patient with increased VDO. PMID:23579908

  6. Improving care and treatment options for women and girls with bleeding disorders.

    PubMed

    Kulkarni, Roshni

    2015-12-01

    Women and girls may experience increased bleeding symptoms as carriers of haemophilia. They can also be affected by other hereditary bleeding diatheses such as von Willebrand disease, platelet dysfunction defects or deficiencies of coagulation factors (F) such as FI, FII, FV, FVII, FX, FXI and FXIII. In addition to general bleeding symptoms, such disorders pose unique problems for women due to their impact on reproductive health. Women and adolescent girls with undiagnosed bleeding disorders frequently experience heavy menstrual bleeding (HMB; menorrhagia), leading to impairment of daily activities. Other gynaecological and obstetric manifestations, for example miscarriage, bleeding during pregnancy and postpartum haemorrhage (PPH), can occur. Treatment for HMB should consider patient wishes relating to preservation of fertility, and management options include hormonal measures, desmopressin, antifibrinolytics, platelet concentrate transfusions and clotting factor therapy. During pregnancy, monitoring clotting factor levels informs the need for prophylactic therapy; subsequent haemostatic cover can minimise PPH. Under-recognition of bleeding disorders in females may lead to inappropriate, or lack of, treatment. This may be avoided by increased disease awareness, prompt and accurate diagnosis, and a multidisciplinary approach to patient care. This review considers the range of hereditary bleeding disorders that may affect women and adolescent girls, and their evaluation and management. PMID:26679392

  7. Options for reducing oil content of sludge from a petroleum wastewater treatment plant.

    PubMed

    Kwon, Tae-Soon; Lee, Jae-Young

    2015-10-01

    Wastewater treatment plants at petroleum refineries often produce substantial quantities of sludge with relatively high concentrations of oil. Disposal of this waste is costly, in part because the high oil content requires use of secure disposal methods akin to handling of hazardous wastes. This article examines the properties of oily sludge and evaluates optional methods for reducing the oil content of this sludge to enable use of lower cost disposal methods. To reduce the oil content or break the structure of oily sludge, preliminary lab-scale experiments involving mechanical treatment, surfactant extraction, and oxidation are conducted. By applying surfactants, approximately 36% to 45% of oils are extracted from oily sludge. Of this, about 33% of oils are rapidly oxidised via radiation by an electron beam within 10?s of exposure. The Fenton reaction is effective for destruction of oily sludge. It is also found that 56% of oils were removed by reacting oily sludge with water containing ozone of 0.5?mg?l(-1) over a period of 24?h. Oxidation using ozone thus can also be effectively used as a pretreatment for oily sludge. PMID:26261236

  8. A new optional recycled water pre-treatment system prior to use in the household laundry.

    PubMed

    Chen, Zhuo; Ngo, Huu Hao; Guo, Wenshan; Pham, Thi Thu Nga; Lim, Richard; Wang, Xiaochang C; Miechel, Clayton; Halloran, Kelly O'; Listowski, Andrzej; Corby, Nigel

    2014-04-01

    With a constantly growing population, water scarcity becomes the limiting factor for further social and economic growth. To achieve a partial reduction in current freshwater demands and lessen the environmental loadings, an increasing trend in the water market tends to adopt recycled water for household laundries as a new recycled water application. The installation of a small pre-treatment unit for water purification can not only further improve the recycled water quality, but also be viable to enhance the public confidence and acceptance level on recycled water consumption. Specifically, this paper describes column experiments conducted using a 550 mm length bed of zeolite media as a one-dimensional flow reactor. The results show that the zeolite filter system could be a simple low-cost pre-treatment option which is able to significantly reduce the total hardness level of recycled water via effective ion exchange. Additionally, depending on the quality of recycled water required by end users, a new by-pass controller using a three-level operation switching mechanism is introduced. This approach provides householders sufficient flexibility to respond to different levels of desired recycled water quality and increase the reliability of long-term system operation. These findings could be beneficial to the smooth implementation of new end uses and expansion of the potential recycled water market. The information could also offer sound suggestions for future research on sustainable water management and governance. PMID:24496024

  9. Considerations for single tooth replacement in an esthetic zonereview of conservative treatment options

    PubMed Central

    Singh, Raghuwar Dayal; Singh, Saumyendra V; Chand, Pooran; Ramashanker

    2012-01-01

    Background This literature review aimed to identify and assess the conservative treatment options for replacing a single missing anterior tooth, for patients who cannot afford implants or traditional bridges. Materials and Methods The evidence was obtained using MEDLINE searches. A total of 19 studies met the inclusion criteria. None of these studies scored higher than 10 of 17, suggesting that all studies did not have strong evidence. Three of the studies examined resin-bonded bridges (RBBs), whereas the other three investigated removable partial dentures (RPDs). None of the studies had random patient selection. Three of these studies had controlled allocation of patients. The other three allowed new patients to enter the study throughout the study period. Placement of the prosthesis was only conducted in one study, whereas the rest of the studies examined patients with preexisting prostheses. Results and Conclusion In general, all 19 studies were weak due to poor study design, no acceptable controls, no direct comparison between RBBs and RPDs, lack of longitudinal studies and no differentiation between the anterior and posterior prostheses. Therefore, no definitive treatment conclusion can be made until studies of stronger design are conducted. PMID:25756015

  10. Genetics of pheochromocytoma and paraganglioma syndromes: new advances and future treatment options

    PubMed Central

    Vicha, Ales; Musil, Zdenek; Pacak, Karel

    2016-01-01

    Purpose of review To summarize the recent advances in the genetics of pheochromocytoma and paraganglioma (PHEO/PGL), focusing on the new susceptibility genes and dividing PHEOs/PGLs into two groups based on their transcription profile. Recent findings Recently, TMEM127, MYC-associated factor X, and hypoxia-inducible factor (HIF) 2? have been described in the pathogenesis of PHEOs/PGLs. Thus, now about 3040% of these tumors are linked to the germline mutations, which also include mutations in the VHL, RET, NF1, SDHx, and SDHAF2 genes. Furthermore, PHEOs/PGLs have been divided into two groups, cluster 1 (SDHx/VHL) and cluster 2 (RET/NF1), based on the transcription profile revealed by genome-wide expression microarray analysis. Summary PHEOs/PGLs are the most inherited tumors among (neuro)endocrine tumors. Future approaches in genetics, including whole-genome sequencing, will allow the discovery of additional PHEO/PGL susceptibility genes. The current division of PHEOs/PGLs into cluster 1 and 2 provides us with additional knowledge related to the pathogenesis of these tumors, including the introduction of new treatment options for patients with metastatic PHEOs/PGLs. New discoveries related to the role of the HIF-1/HIF-2? genes in the pathogenesis of almost all inherited PHEOs/PGLs may call for a new regrouping of these tumors and discoveries of new treatment targets. PMID:23481210

  11. Selenium contaminated waters: An overview of analytical methods, treatment options and recent advances in sorption methods.

    PubMed

    Santos, Slvia; Ungureanu, Gabriela; Boaventura, Rui; Botelho, Cidlia

    2015-07-15

    Selenium is an essential trace element for many organisms, including humans, but it is bioaccumulative and toxic at higher than homeostatic levels. Both selenium deficiency and toxicity are problems around the world. Mines, coal-fired power plants, oil refineries and agriculture are important examples of anthropogenic sources, generating contaminated waters and wastewaters. For reasons of human health and ecotoxicity, selenium concentration has to be controlled in drinking-water and in wastewater, as it is a potential pollutant of water bodies. This review article provides firstly a general overview about selenium distribution, sources, chemistry, toxicity and environmental impact. Analytical techniques used for Se determination and speciation and water and wastewater treatment options are reviewed. In particular, published works on adsorption as a treatment method for Se removal from aqueous solutions are critically analyzed. Recent published literature has given particular attention to the development and search for effective adsorbents, including low-cost alternative materials. Published works mostly consist in exploratory findings and laboratory-scale experiments. Binary metal oxides and LDHs (layered double hydroxides) have presented excellent adsorption capacities for selenium species. Unconventional sorbents (algae, agricultural wastes and other biomaterials), in raw or modified forms, have also led to very interesting results with the advantage of their availability and low-cost. Some directions to be considered in future works are also suggested. PMID:25847169

  12. Levosimendan as Treatment Option in Severe Verapamil Intoxication: A Case Report and Review of the Literature

    PubMed Central

    Osthoff, Mirjam; Bernsmeier, Christine; Marsch, Stephan C.; Hunziker, Patrick R.

    2010-01-01

    Cardiovascular shock due to verapamil intoxication is often refractory to standard resuscitation methods. Recommended therapy includes prevention of further absorption of the drug, inotropic therapy, calcium gluconate, and hyperinsulinemia/euglycemia therapy. Often further measures are needed such as ventricular pacing or mechanical circulatory support. Still, mortality remains high. Levosimendan, an inotropic agent, that enhances myofilament response to calcium, increases myocardial contraction and could therefore be beneficial in verapamil intoxication. Here, we report the case of a 60-year-old patient with clinically severe verapamil poisoning who presented with shock, bradycardia, and sopor. Standard therapy including high-dose inotropes failed to ameliorate the signs of intoxication. But additional therapy with levosimendan led to rapid improvement. Based on this observation, the literature is reviewed focusing on utilization of levosimendan in the treatment of calcium channel blocker overdose. We suggest to consider levosimendan as additional treatment option in patients with cardiovascular shock due to verapamil intoxication that are refractory to standard management. PMID:20814559

  13. Left subclavian artery stenting: an option for the treatment of the coronary-subclavian steal syndrome

    PubMed Central

    de Almeida, Bruno Loreno; Kambara, Antonio Massamitsu; Rossi, Fabio Henrique; Moreira, Samuel Martins; de Oliveira, Eduardo Silva Jordao; Linhares Filho, Frederico Augusto de Carvalho; Metzger, Patrick Bastos; Passalacqua, Aldo Zampieri

    2014-01-01

    Introduction The subclavian steal syndrome is characterized by the vertebral artery flow inversion, due to a stenotic lesion in the origin of the subclavian artery. The Coronary-subclavian Steal Syndrome is a variation of the Subclavian Steal Syndrome and is characterized by inversion of flow in the Internal Thracic artery that has been used as conduct in a myocardial revascularization. Its diagnosis must be suspected in patients with difference in pulse and arterial pressure in the upper limbs, that present with angina pectoris and that have done a myocardial revascularization. Its treatment must be a surgical bypass or a transluminal angioplasty. Objective The objective is to show the left subclavian artery stenting as a safe and effective method to treat the coronary-subclavian steal syndrome. Methods Historical prospective, non-randomized trial, through revision of the hospital records of the patients treated with the stenting of the left subclavian artery, from January 2006 to September 2012. Results In the mentioned period, 4.291 miocardial revascularizations were performed with the use of the left mammary artery, and 16 patients were identified to have the Coronary-subclavian steal syndrome. All of them were submitted to endovascular treatment. The success rate was 100%; two patients experienced minor complications; none of them presented with major complications. Eleven of the 16 patients had ultrassonographic documentation of patent stent for at least one year; two patients lost follow up and other two died. Conclusion The stenting of the left subclavian artery is a good option for the treatment of the Coronary-subclavian Steal Syndrome, with high level of technical and clinical success. PMID:25140474

  14. Non surgical predicting factors for patient satisfaction after third molar surgery

    PubMed Central

    Balaguer-Martí, José-Carlos; Aloy-Prósper, Amparo; Peñarrocha-Oltra, David

    2016-01-01

    Background In the third molar surgery, it is important to focus not only on surgical skills, but also on patient satisfaction. Classically studies have been focused on surgery and surgeon’s empathy, but there are non-surgical factors that may influence patient satisfaction. Material and Methods A cross-sectional study was performed on 100 patients undergoing surgical extractions of impacted mandibular third molars treated from October 2013 to July 2014 in the Oral Surgery Unit of the University of Valencia. A questionnaire (20 questions) with a 10-point Likert scale was provided. The questionnaire assessed the ease to find the center, the ease to get oriented within the center, the burocratic procedures, the time from the first visit to the date of surgical intervention, waiting time in the waiting room, the comfort at the waiting room, the administrative staff (kindness and efficiency to solve formalities), medical staff (kindness, efficiency, reliability, dedication), personal data care, clarity in the information received (about the surgery, postoperative care and resolution of the doubts), available means and state of facilities. Outcome variables were overall satisfaction, and recommendation of the center. Statistical analysis was made using the multiple linear regression analysis. Results Significant correlations were found between all variables and overall satisfaction. The multiple regression model showed that the efficiency of the surgeon and the clarity of the information were statistically significant to overall satisfaction and recommendation of the center. The kindness of the administrative staff, available means, the state of facilities and the comfort at the waiting room were statistically significant to the recommendation of the center. Conclusions Patient satisfaction directly depends on the efficiency of the surgeon and clarity of the clinical information received about the procedure. Appreciation of these predictive factors may help clinicians to provide optimal care for impacted third molar surgery patients. Key words:Patient satisfaction, third molar, questionnaire. PMID:26827054

  15. Multidrug-resistant Gram-negative infections: what are the treatment options?

    PubMed

    Giamarellou, Helen; Poulakou, Garyphallia

    2009-10-01

    The emergence of multidrug-resistant (MDR) Gram-negative bacilli creates a challenge in the treatment of nosocomial infections. While the pharmaceutical pipeline is waning, two revived old antibacterials (colistin and fosfomycin), a newer one (tigecycline) and an 'improved' member of an existing class (doripenem) are the only therapeutic options left. The class of polymyxins, known since 1947 and represented mostly by polymyxin B and polymyxin E (colistin), has recently gained a principal role in the treatment of the most problematic MDR Gram-negative pathogens (such as Pseudomonas aeruginosa, Acinetobacter baumannii, Klebsiella pneumoniae and Stenotrophomonas maltophilia). Future prospective studies are needed to answer important clinical questions, such as the possible benefit of combination with other antimicrobials versus monotherapy, the efficacy of colistin in neutropenic hosts and the role of inhaled colistin. As new pharmacokinetic data emerge, clarification of the pharmacokinetic/pharmacodynamic (PK/PD) profile of colistin as well as appropriate dosing seems urgent, while development of resistance must be carefully monitored. Fosfomycin tromethamine, a synthetic salt of fosfomycin discovered in 1969, has regained attention because of its in vitro activity against extended-spectrum beta-lactamase (ESBL)-producing Enterobacteriaceae and MDR P. aeruginosa. Although in use for decades in oral and parenteral formulations for a variety of infections without significant toxicity, its clinical utility in MDR infections remains to be explored in future studies. Tigecycline, the first representative of the new class of glycylcyclines, holds promise in infections from MDR K. pneumoniae (K. pneumoniae carbapenemase [KPC]- and ESBL-producing strains) and Enterobacteriaceae with various mechanisms of resistance. The in vitro activity of tigecycline against A. baumannii makes it a tempting option, as it is currently the most active compound against MDR strains along with colistin. However, the usual minimum inhibitory concentration values of this pathogen are approximately 2 mg/L and compromise clinical outcomes based on PK/PD issues. Its advantageous penetration into various tissues is useful in infections of the skin and soft tissues as well as intra-abdominal infections (official indications), whereas low serum concentrations compromise its use in bloodstream infections. Therefore, prospective studies with dose escalation are urgently needed, as well as clarification of its role in nosocomial pneumonia, after poor results in the study of ventilator-associated pneumonia. Finally, doripenem, the recently licensed member of the carbapenems (without significant spectrum alterations from the ascendant members) seems to possess a lower potential for resistance selection and a more favourable pharmacokinetic profile when given as an extended infusion. The latter strategy could prove helpful in overcoming low level resistance of A. baumannii and P. aeruginosa strains. PMID:19747006

  16. Locoregional Treatment for Breast Carcinoma After Hodgkin's Lymphoma: The Breast Conservation Option

    SciTech Connect

    Haberer, Sophie; Belin, Lisa; Le Scodan, Romuald; Kirova, Youlia M.; Savignoni, Alexia; Stevens, Denise; Moisson, Patricia; Decaudin, Didier; Pierga, Jean-Yves; Reyal, Fabien; Campana, Francois; Fourquet, Alain; Bollet, Marc A.

    2012-02-01

    Purpose: To report clinical and pathologic characteristics and outcome of breast cancer (BC) after irradiation for Hodgkin's lymphoma (HL) in women treated at the Institut Curie, with a special focus on the breast-conserving option. Methods and Materials: Medical records of 72 women who developed either ductal carcinoma in situ or Stage I-III invasive carcinoma of the breast after HL between 1978 and 2009 were retrospectively reviewed. Results: Median age at HL diagnosis was 23 years (range, 14-53 years). Median total dose received by the mediastinum was 40 Gy, mostly by a mantle-field technique. Breast cancers occurred after a median interval of 21 years (range, 5-40 years). Ductal invasive carcinoma and ductal carcinoma in situ represented, respectively, 51 cases (71%) and 14 cases (19%). Invasive BCs consisted of 47 cT0-2 tumors (82%), 5 cN1-3 tumors (9%), and 20 Grade 3 tumors (35%). Locoregional treatment for BCs consisted of mastectomy with (3) or without (36) radiotherapy in 39 patients and lumpectomy with (30) or without (2) adjuvant radiotherapy in 32 patients. The isocentric lateral decubitus radiation technique was used in 17 patients after breast-conserving surgery (57%). With a median follow-up of 7 years, 5-year overall survival rate and locoregional control rate were, respectively, 74.5% (95% confidence interval [CI], 64-88%) and 82% (95% CI, 72-93%) for invasive carcinoma and 100% (95% CI, 100 -100%) and 92% (95% CI, 79-100%) for in situ carcinoma. In patients with invasive tumors, the 5-year distant disease-free survival rate was 79% (95% CI, 69-91%), and 13 patients died of progressive BC. Contralateral BC was diagnosed in 10 patients (14%). Conclusions: Breast-conserving treatment can be an option for BCs that occur after HL, despite prior thoracic irradiation. It should consist of lumpectomy and adjuvant breast radiotherapy with use of adequate techniques, such as the lateral decubitus isocentric position, to protect the underlying heart and lung.

  17. Systems engineering study: tank 241-C-103 organic skimming,storage, treatment and disposal options

    SciTech Connect

    Klem, M.J.

    1996-10-23

    This report evaluates alternatives for pumping, storing, treating and disposing of the separable phase organic layer in Hanford Site Tank 241-C-103. The report provides safety and technology based preferences and recommendations. Two major options and several varations of these options were identified. The major options were: 1) transfer both the organic and pumpable aqueous layers to a double-shell tank as part of interim stabilization using existing salt well pumping equipment or 2) skim the organic to an above ground before interim stabilization of Tank 241-C-103. Other options to remove the organic were considered but rejected following preliminary evaluation.

  18. Computational Trials: Unraveling Motility Phenotypes, Progression Patterns, and Treatment Options for Glioblastoma Multiforme

    PubMed Central

    Raman, Fabio; Scribner, Elizabeth; Saut, Olivier; Wenger, Cornelia; Colin, Thierry; Fathallah-Shaykh, Hassan M.

    2016-01-01

    Glioblastoma multiforme is a malignant brain tumor with poor prognosis and high morbidity due to its invasiveness. Hypoxia-driven motility and concentration-driven motility are two mechanisms of glioblastoma multiforme invasion in the brain. The use of anti-angiogenic drugs has uncovered new progression patterns of glioblastoma multiforme associated with significant differences in overall survival. Here, we apply a mathematical model of glioblastoma multiforme growth and invasion in humans and design computational trials using agents that target angiogenesis, tumor replication rates, or motility. The findings link highly-dispersive, moderately-dispersive, and hypoxia-driven tumors to the patterns observed in glioblastoma multiforme treated by anti-angiogenesis, consisting of progression by Expanding FLAIR, Expanding FLAIR + Necrosis, and Expanding Necrosis, respectively. Furthermore, replication rate-reducing strategies (e.g. Tumor Treating Fields) appear to be effective in highly-dispersive and moderately-dispersive tumors but not in hypoxia-driven tumors. The latter may respond to motility-reducing agents. In a population computational trial, with all three phenotypes, a correlation was observed between the efficacy of the rate-reducing agent and the prolongation of overall survival times. This research highlights the potential applications of computational trials and supports new hypotheses on glioblastoma multiforme phenotypes and treatment options. PMID:26756205

  19. Current aproach to cancer pain management: Availability and implications of different treatment options

    PubMed Central

    Nersesyan, Hrachya; Slavin, Konstantin V

    2007-01-01

    Despite tremendous progress in medicine during last couple of decades, cancer still remains the most horrifying diagnosis for anybody due to its almost inevitable futility. According to American Cancer Society Statistics, it is estimated that only in the United States more than half a million people will die from cancer in 2006. For those who survive, probably the most fearsome symptom regardless of cancer type will be the pain. Although most pain specialists and oncologists worldwide are well aware of the importance to adequately treat the pain, it was yet established that more than half of cancer patients have insufficient pain control, and about quarter of them actually die in pain. Therefore, in this review article we attempted to provide the comprehensive information about different options available nowadays for treating cancer pain focusing on most widely used pharmacologic agents, surgical modalities for intractable pain control, their potential for adverse effects, and ways to increase the effectiveness of treatment maximally optimizing analgesic regimen and improving compliance. PMID:18488078

  20. Stem cell-based therapies in Parkinson's disease: future hope or current treatment option?

    PubMed

    Loewenbrck, Kai; Storch, Alexander

    2011-05-01

    Parkinson's disease (PD) is one of the most frequent neurodegenerative diseases and represents a major therapeutic challenge because of the so far missing therapeutic means to influence the ongoing loss of dopaminergic innervation to the striatum. Cell replacement has raised hope to offer the first restorative treatment option. Clinical trials have provided "proof of principle" that transplantation of dopamine-producing neurons into the striatum of PD patients can achieve symptomatic relief given that the striatum is sufficiently re-innervated. Various cell sources have been tested, including fetal ventral midbrain tissue, embryonic stem cells, fetal and adult neural stem cells and, after a ground-breaking discovery, induced pluripotent stem cells. Although embryonic and induced pluripotent stem cells have emerged as the most promising candidates to overcome most of the obstacles to clinical successful cell replacement, each cell source has its unique drawbacks. This review does not only provide a comprehensive overview of the different cellular candidates, including their assets and drawbacks, but also of the various additional issues that need to be addressed in order to convert cellular replacement therapies from an experimental to a clinically relevant therapeutic alternative. PMID:21437664

  1. 26 CFR 1.1504-4 - Treatment of warrants, options, convertible obligations, and other similar interests.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... has a fair market value of $10 and has one vote. On June 30, 1992, P issues to Corporation X an option... fair market value of the underlying stock. (d) Options—(1) Instruments treated as options. For purposes... § 1.83-3(d); and (2) Do not have a readily ascertainable fair market value as defined in §...

  2. Solar Lentigines: Evaluating Pulsed Dye Laser (PDL) as an Effective Treatment Option

    PubMed Central

    Ghaninejhadi, Hayedeh; Ehsani, Amirhooshang; Edrisi, Ladan; Gholamali, Fatemeh; Akbari, Zahra; Noormohammadpour, Pedram

    2013-01-01

    Introduction: Solar lentigines are among commonest cosmetic problems. There are many topical therapies suggested to treat these lesions including cryotherapy, chemical peeling with tri chloro acetic acid (TCA) and laser therapy with q-switched lasers as well as long pulsed lasers. Considering possible treatment side effects (PIH, scar) with cryotherapy and peeling in Iranian patients (darker skin types) it seems necessary to try to find alternative measures. The aim of the present study was to evaluate effect of long pulsed dye laser (LPDL) on lentigines via an objective method (computerized dermoscopy). Methods: Patients with pathologically confirmed lentigines were selected if they agreed to participate in the study,were not treated before, hadnt history of psoriasis, vitiligo, scar formation and were not pregnant. Letigines were dermoscopied before and after treatment with PDL (V-beam, 595nm, Candela Corp. Wayland, USA) using fluence of 10 joules,without DCD (dynamic cooling device) via extra compress lens provided with laser system.The resulting figures were compared by two academic unrelated dermatologists as well as by computerized analysis. Post laser side effects were treated with topical antibiotics and mild topical steroids. Patients were followed for six months after the end of the study to determine the rate of recurrence via dermoscopy of sites of previous lesions and also delayed side effects. Results: A total of 21 patients with the same number of lesions, were included in the study.Mean age of patients was 54.2 years (23.3) ranging from 39 to 71 years. Included patient swere 18 females and three males. From 21 treated lesions, 11 were located on the hands and 10 on the face. Comparing before and after photographs taken through dermoscopy system,revealed that approximately 57% of patients had more than 75% improvement. Mean pigment analysis score (calculated by computerized dermoscope software) was respectively 8 and 2 before and after PDL therapy, showing noticeable decrease in pigment density of lesions.Side effects were mild erythema and local irritation responding to topical mild steroids.No hypo or persistent hyper pigmentation or other delayed side effects was seen after six months follow up. One patient experienced transient hyper pigmentation of treatment site after treatment. During six months follow up, no recurrences were seen. Conclusion: In conclusion, PDL is a safe and effective option to treat lentigines if applied properly using compression method, especially in Iranian patients. However, further studies with larger sample size are required to confirm these results. PMID:25606304

  3. Granulocyte-colony stimulating factor as treatment option in patients with recurrent miscarriage.

    PubMed

    Santjohanser, Claudia; Knieper, Catherine; Franz, Cordula; Hirv, Kaino; Meri, Osama; Schleyer, Manfred; Wrfel, Wolfgang; Toth, Bettina

    2013-04-01

    In 1-5% of patients during childbearing years recurrent miscarriages (RM) occur. There are established risk factors like anatomical, endocrine and hemostatic disorders as well as immunological changes in the maternal immune system. Nevertheless, further elucidation of the pathogenesis remains a matter of debate. In addition, there are no standardized immunological treatment strategies. Recent studies indicate possible effects of tumor necrosis factor ? blocker and granulocyte-colony stimulating factor (G-CSF) concerning live birth rate (LBR) in RM patients. Therefore, we performed a retrospective cohort study in patients undergoing assisted reproductive treatment (ART) with known RM analysing the possible benefits of G-CSF application. From January 2002 to December 2010, 127 patients (199 cylces) with RM (at least 2 early miscarriages) 49 (72 cycles) receiving G-CSF and 78 (127 cycles) controls receiving either no medication (subgroup 1) or Cortisone, intravenous immunoglobulins or low molecular weight heparin (subgroup 2) undergoing ART for in vitro fertilisation/intracytoplasmic sperm injection were analysed. G-CSF was administered weekly once (34 Mill) in 11 patients, 38 patients received 2 13 Mill G-CSF per week until the 12th week of gestation. Statistical analysis was performed with SPSS for Windows (19.0), p < 0.05 significant. The mean age of the study population was 37.3 4.4 years (mean standard deviation) and differed not significantly between patients and subgroups. However, the number of early miscarriages was significantly higher in the G-CSF group as compared to the subgroups (G-CSF 2.67 1.27, subgroup 1 0.85 0.91, subgroup 2 0.64 0.74) and RM patients receiving G-CSF had significantly more often a late embryo transfer (day 5) (G-CSF 36.7%, subgroup 1 12.1%, subgroup 2 8.9%). The LBR of patients and the subgroups differed significantly (G-CSF 32%, subgroup 1 13%, subgroup 2 14%). Side effects were present in less than 10% of patients, consisting of irritation at the injection side, slight leukocytosis, rise of the temperature (<38 C), mild bone pain and hyperemesis gravidarum. None of the newborn showed any kind of malformations. According to our data, G-CSF seems to be a safe and promising immunological treatment option for RM patients. However, with regard to the retrospective setting and the possible bias of a higher rate of late embryo transfers in the G-CSF group additional studies are needed to further strengthen our results. PMID:23344173

  4. Micro-treatment options for components of organic fraction of MSW in residential areas.

    PubMed

    Chanakya, H N; Ramachandra, T V; Guruprasad, M; Devi, Vinuta

    2007-12-01

    There is a growing interest in management of MSW through micro-treatment of organic fraction of municipal solid wastes (OFMSW) in many cities of India. The OFMSW fraction is high (>80%) in many pockets within South Indian cities like Bangalore, Chikkamagalur, etc. and is largely represented by vegetable, fruit, packing and garden wastes. Among these, the last three have shown problems for easy decomposition. Fruit wastes are characterized by a large pectin supported fraction that decomposes quickly to organic acids (becomes pulpy) that eventually slow down anaerobic and aerobic decomposition processes. Paper fraction (newsprint and photocopying paper) as well as paddy straw (packing), bagasse (from cane juice stalls) and tree leaf litter (typical garden waste and street sweepings) are found in reasonably large proportions in MSW. These decompose slowly due to poor nutrients or physical state. We have examined the suitability of these substrates for micro-composting in plastic bins by tracking decomposition pattern and physical changes. It was found that fruit wastes decompose rapidly to produce organic acids and large leachate fraction such that it may need to be mixed with leachate absorbing materials (dry wastes) for good composting. Leaf litter, paddy straw and bagasse decompose to the tune of 90, 68 and 60% VS and are suitable for composting micro-treatment. Paper fractions even when augmented with 10% leaf compost failed to show appreciable decomposition in 50 days. All these feedstocks were found to have good biological methane potential (BMP) and showed promise for conversion to biogas under a mixed feed operation. Suitability of this approach was verified by operating a plug-flow type anaerobic digester where only leaf litter gathered nearby (as street sweepings) was used as feedstock. Here only a third of the BMP was realized at this scale (0.18 m(3 )biogas/kg VS 0.55 m(3)/kg in BMP). We conclude that anaerobic digestion in plug-flow like digesters appear a more suitable micro-treatment option (2-10 kg VS/day) because in addition to compost it also produces biogas for domestic use nearby. PMID:17503210

  5. [Nasal Highflow (NHF): A New Therapeutic Option for the Treatment of Respiratory Failure].

    PubMed

    Brunlich, J; Nilius, G

    2016-01-01

    The therapy of choice in hypoxemic respiratory failure (type 1) is the application of supplemental oxygen at flow rates of 1 to 15?l/min via nasal prongs or mask. Non-invasive or invasive positive pressure ventilation will be initiated when the oxygen therapy effects are not sufficient or if hypercapnic respiratory failure (type 2) is the underlying problem. Recently, an alternative therapy option is available, from the pathophysiology it can be classified between oxygen therapy and positive pressure ventilation. The therapy called Nasal High Flow (NHF) is based on the nasal application of a heated and humidified air oxygen mixture with a flow range of up to 60?l/min. The precise pathophysiological principles of NHF are only partly understood, yet various aspects are well studied already: it is possible to deliver high oxygen concentrations, airway dryness can be avoided, dead space ventilation reduced and clearance of nasal dead space is achieved. Additionally, an end expiratory positive pressure is built up, which helps to prevent airway collapse, thus resulting in an improvement of respiratory efficiency and reduction of breathing work. Current studies demonstrate improvement in gas exchange and reduction of reintubation rate when applying the NHF treatment in acute respiratory failure. Thus the NHF therapy attracts attention in intensive care medicine. The application in other fields like chronic respiratory insufficiency is less well clarified. The objectives of this review are to present the pathophysiological effects and mechanisms of NHF, as far as understood, and to give an overview over the current state of relevant studies. PMID:26789432

  6. Atrial fibrillation in Sub-Saharan Africa: epidemiology, unmet needs, and treatment options

    PubMed Central

    Stambler, Bruce Sheldon; Ngunga, Leonard M

    2015-01-01

    Health care in Sub-Saharan Africa is being challenged by a double burden of disease as lifestyle diseases common in the developed world, such as stroke and atrial fibrillation (AF), increase, while, simultaneously, health issues of the developing world in terms of communicable disease persist. The prevalence of AF is lower in Africa than in the developed world but is expected to increase significantly over the next few decades. Patients with AF in Africa tend to be younger and have a higher prevalence of rheumatic valvular heart disease than patients with AF in other regions. Permanent AF is the most prevalent type of AF in Africa, possibly due to the lower use of rhythm control strategies than in the developed world. Mortality rates of patients with AF in Africa are high, due largely to poor health care access and suboptimal therapy. The risk of stroke in AF, which is moderate to high in Africans as in the developed world, contributes to the high mortality rate. Patients with AF in Africa are often undertreated with antithrombotics, as cost and access to monitoring are major barriers. Vitamin K antagonists, including warfarin, are the most commonly available oral anticoagulants, but regular monitoring can be challenging, especially for patients in remote areas. Several non-vitamin K antagonist oral anticoagulants (NOACs) have been approved for use in countries across Sub-Saharan Africa and have the potential to reduce stroke burden. The higher cost of newer agents may be offset by the reduced need for regular monitoring, fixed dosing, and lower risk of intracranial bleeding; NOACs could provide a treatment option for patients in remote areas with limited access to regular monitoring. However, NOACs are not indicated in valvular AF. More work is needed to increase understanding of the epidemiology of AF and stroke, as well as to improve management strategies to reduce the burden of cardiovascular disease predicted for Africa. PMID:26261423

  7. Distinct neurohumoral biomarker profiles in children with hemodynamically defined orthostatic intolerance may predict treatment options.

    PubMed

    Wagoner, Ashley L; Shaltout, Hossam A; Fortunato, John E; Diz, Debra I

    2016-02-01

    Studies of adults with orthostatic intolerance (OI) have revealed altered neurohumoral responses to orthostasis, which provide mechanistic insights into the dysregulation of blood pressure control. Similar studies in children with OI providing a thorough neurohumoral profile are lacking. The objective of the present study was to determine the cardiovascular and neurohumoral profile in adolescent subjects presenting with OI. Subjects at 10-18 yr of age were prospectively recruited if they exhibited two or more traditional OI symptoms and were referred for head-up tilt (HUT) testing. Circulating catecholamines, vasopressin, aldosterone, renin, and angiotensins were measured in the supine position and after 15 min of 70 tilt. Heart rate and blood pressure were continuously measured. Of the 48 patients, 30 patients had an abnormal tilt. Subjects with an abnormal tilt had lower systolic, diastolic, and mean arterial blood pressures during tilt, significantly higher levels of vasopressin during HUT, and relatively higher catecholamines and ANG II during HUT than subjects with a normal tilt. Distinct neurohumoral profiles were observed when OI subjects were placed into the following groups defined by the hemodynamic response: postural orthostatic tachycardia syndrome (POTS), orthostatic hypotension (OH), syncope, and POTS/syncope. Key characteristics included higher HUT-induced norepinephrine in POTS subjects, higher vasopressin in OH and syncope subjects, and higher supine and HUT aldosterone in OH subjects. In conclusion, children with OI and an abnormal response to tilt exhibit distinct neurohumoral profiles associated with the type of the hemodynamic response during orthostatic challenge. Elevated arginine vasopressin levels in syncope and OH groups are likely an exaggerated response to decreased blood flow not compensated by higher norepinephrine levels, as observed in POTS subjects. These different compensatory mechanisms support the role of measuring neurohumoral profiles toward the goal of selecting more focused and mechanistic-based treatment options for pediatric patients with OI. PMID:26608337

  8. 78 FR 8060 - Treatment of Grantor of an Option on a Partnership Interest

    Federal Register 2010, 2011, 2012, 2013, 2014

    2013-02-05

    ... (noncompensatory partnership option regulations) were published in the Federal Register (68 FR 2930). Final... Tetelman of the Office of Associate Chief Counsel (Financial Institutions and Products). However, other... Part 1 Income taxes, Reporting and recordkeeping requirements. Proposed Amendments to the...

  9. Assessing Patient Preferences for Treatment Options and Process of Care in Inflammatory Bowel Disease: A Critical Review of Quantitative Data

    PubMed Central

    Bewtra, Meenakshi; Johnson, F. Reed

    2013-01-01

    Inflammatory bowel disease (IBD), consisting of both Crohns disease (CD) and ulcerative colitis (UC), are chronic inflammatory conditions of the intestinal tract. As there is no cure for either CD or UC, these patients face numerous treatment decisions regarding their disease. The aims of this review are to evaluate literature regarding quantitative studies of patient preferences in therapy for IBD with a focus on the emerging technique of stated preference and its application in IBD. Numerous simple survey-based studies have been performed evaluating IBD patients preferences for medication frequency, mode of delivery, potential adverse events etc., as well as variations in these preferences. These studies are limited, however, as they are purely descriptive in nature with limited quantitative information on the relative value of treatment alternatives. Time trade-off and standard gamble studies have also been utilized to quantify patient utility for various treatment options or outcomes. However, these types of studies suffer from inaccurate assumptions regarding patient choice behavior. Stated preference is an emerging robust methodology increasingly utilized in health care that can determine the relative utility for a therapy option as well as its specific attributes (such as efficacy or adverse side effects). Stated preference techniques have begun to be applied in IBD and offer an innovative way of examining the numerous therapy options these patients and their providers face. PMID:24127239

  10. Sexual Functioning and Sex Hormones in Persons with Extreme Obesity and Seeking Surgical and Non-Surgical Weight Loss

    PubMed Central

    Sarwer, David B.; Spitzer, Jacqueline C.; Wadden, Thomas A.; Rosen, Raymond C.; Mitchell, James E.; Lancaster, Kathy; Courcoulas, Anita; Gourash, William; Christian, Nicholas J.

    2013-01-01

    Background Many individuals with obesity are motivated to lose weight to improve weight-related comorbidities or psychosocial functioning, including sexual functioning. Few studies have documented rates of sexual dysfunction in persons with obesity. Objectives This study investigated sexual functioning, sex hormones, and relevant psychosocial constructs in individuals with obesity who sought surgical and non-surgical weight loss. Setting University based health systems. Methods One hundred forty-one bariatric surgery patients (median BMI [25th percentile, 75th percentile] 44.6 [41.4, 50.1]) and 109 individuals (BMI = 40.0 [38.0, 44.0]) who sought nonsurgical weight loss participated. Sexual functioning was assessed by the Female Sexual Function Index (FSFI) and International Index of Erectile Function (IIEF). Hormones were assessed by blood assay. Quality of life, body image, depressive symptoms and marital adjustment were assessed by validated questionnaires. Results Fifty-one percent of women presenting for bariatric surgery reported a sexual dysfunction; 36% of men presenting for bariatric surgery reported erectile dysfunction (ED). This is in contrast to 41% of women who sought nonsurgical weight loss and reported a sexual dysfunction and 20% of men who sought nonsurgical weight loss and reported ED. These differences were not statistically significant. Sexual dysfunction was strongly associated with psychosocial distress in women; these relationships were less strong and less consistent among men. Sexual dysfunction was unrelated to sex hormones, except for sex hormone binding globulin (SHGB) in women. Conclusion Women and men who present for bariatric surgery, as compared to individuals who sought non-surgical weight loss, were not significantly more likely to experience a sexual dysfunction. There were few differences in reproductive hormones and psychosocial constructs between candidates for bariatric surgery and individuals interested in non-surgical weight loss. PMID:24120985

  11. 26 CFR 1.1504-4 - Treatment of warrants, options, convertible obligations, and other similar interests.

    Code of Federal Regulations, 2012 CFR

    2012-04-01

    ... into stock, and other similar interests are treated as exercised for purposes of determining whether a... these regulations does not prevent such instrument from being treated as stock under general principles.... See § 601.601(d)(2)(ii)(b) of this chapter. (b) Options not treated as stock or as...

  12. Treatment Option Overview (Childhood Central Nervous System Atypical Teratoid/Rhabdoid Tumor)

    MedlinePLUS

    ... before the cancer is diagnosed and continue for months or years. Signs or symptoms caused by the ... after treatment. Some cancer treatments cause side effects months or years after treatment has ended. Side effects ...

  13. [Early onset scoliosis. What are the options?].

    PubMed

    Farrington, D M; Tatay-Daz, A

    2013-01-01

    The prognosis of children with progressive early onset scoliosis has improved considerably due to recent advances in surgical and non-surgical techniques and the understanding of the importance of preserving the thoracic space. Improvements in existing techniques and development of new methods have considerably improved the management of this condition. Derotational casting can be considered in children with documented progression of a <60 curve without previous surgical treatment. Both single and dual growing rods are effective, but the latter seem to offer better results. Hybrid constructs may be a better option in children who require a low-profile proximal anchor. The vertical expandable prosthetic titanium rib (VEPTR()) appears to be beneficial for patients with congenital scoliosis and fused ribs, and thoracic Insufficiency Syndrome. Children with medical comorbidities who may not tolerate repeated lengthenings should be considered for Shilla or Luque Trolley technique. Growth modulation using shape memory alloy staples or other tethers seem promising for mild curves, although more research is required to define their precise indications. PMID:24071039

  14. Banding for type IA endoleak after endovascular abdominal aortic repair: An underexposed treatment option.

    PubMed

    van Lammeren, G W; Ünlü, Ç; De Vries, Jppm

    2016-04-01

    More challenging abdominal aortic aneurysms with unfavorable proximal aortic neck anatomy are treated with endovascular means. As a consequence, proximal inadequate sealing may result in type IA endoleak, which in turn can lead to abdominal aortic aneurysm progression or rupture. The presence of type IA endoleak is an indication for secondary interventions. External aortic banding can be a good option to solve a type IA endoleak, but is underreported in literature; we present two cases and review literature. PMID:26250570

  15. Management of patients with hormone receptor-positive breast cancer with visceral disease: challenges and treatment options.

    PubMed

    Harb, Wael A

    2015-01-01

    Endocrine therapy is an important treatment option for women with hormone receptor-positive (HR+) advanced breast cancer (ABC), yet many tumors are either intrinsically resistant or develop resistance to these therapies. Treatment of patients with ABC presenting with visceral metastases, which is associated with a poor prognosis, is also problematic. There is an unmet need for effective treatments for this patient population. Although chemotherapy is commonly perceived to be more effective than endocrine therapy in managing visceral metastases, patients who are not in visceral crisis might benefit from endocrine therapy, avoiding chemotherapy-associated toxicities that might affect quality of life. To improve outcomes, several targeted therapies are being investigated in combination with endocrine therapy for patients with endocrine-resistant, HR+ ABC. Although available data have considered patients with HR+ ABC as a whole, there are promising data from a prespecified analysis of a Phase III study of everolimus (Afinitor()), a mammalian target of rapamycin (mTOR) inhibitor, in combination with exemestane (Aromasin()) in patients with visceral disease progressing after nonsteroidal aromatase inhibitor therapy. In this review, challenges and treatment options for management of HR+ ABC with visceral disease, including consideration of therapeutic approaches undergoing clinical investigation, will be assessed. PMID:25653556

  16. Endoscopic ultrasonography: an advancing option with duality in both diagnosis and treatment of gastrointestinal oncology

    PubMed Central

    2014-01-01

    Since their introduction into the clinical practices in 1980s, techniques of endoscopic ultrasonography (EUS) have been rapidly developing and are now in widespread use in gastrointestinal oncology. Evolving from the classical option, EUS today has been much innovated with addition of a variety of novel ideation which makes it a powerful tool with encouraging duality for both diagnostic and therapeutic purposes. There is a dire need for physicians in this field to understand the status quo of EUS as related to the management and detection of gastrointestinal tumors, which is globally reviewed in this paper. PMID:25561772

  17. Splinting rationale and contemporary treatment options for luxated and avulsed permanent teeth.

    PubMed

    Lambert, Douglas L

    2015-01-01

    The continued growth in athletic participation among children and adults has increased the potential incidence of sports-related dental injuries. Regardless of preventive measures, damage and injury to the oral cavity can occur during participation in sports. Luxations, root fractures, bony fractures, and avulsions involving 1 or more teeth are a possibility. Many of these injuries require specific protocols for splinting of the traumatized tooth or teeth to allow the best possible outcomes. This article identifies luxation and avulsion injuries, explains the rationale for splinting, reviews guidelines for splint duration, and discusses contemporary material options available to stabilize affected permanent dentition. PMID:26545276

  18. Can photodynamic therapy be the preferred treatment option for anal intraepithelial neoplasia? Initial results of a pilot study.

    PubMed

    Welbourn, Hannah; Duthie, Graeme; Powell, John; Moghissi, Keyvan

    2014-03-01

    Anal intra-epithelial neoplasia (AIN) is a pre-malignant condition, which over time may progress to invasive anal squamous cell carcinoma. There is no standard treatment for AIN, but one of the therapeutic options available is photodynamic therapy (PDT). There are very few published studies of the efficacy of PDT, but it has been shown to produce downgrading of high-grade dysplasia in the anal region. The aim of the study was to evaluate the role of PDT in the treatment of AIN. Fifteen patients who received anal PDT between 2004 and 2013 were identified; twelve of these had AIN, two had intra-epithelial adenocarcinoma and one had dysplasia with high-risk human papillomavirus. After a median follow-up of nineteen months, ten of these have had at least one follow-up with aceto-white staining. Six of these ten patients had a complete response to PDT, although three subsequently had some recurrence. Three further patients had a partial response to PDT. There were no major therapeutic complications. Our findings suggest that PDT is a safe and feasible treatment option for AIN, associated with reasonable response rates and relatively little morbidity. Further research into the efficacy of PDT for AIN is required. PMID:24280437

  19. Oral Treatment Options for Ambulatory Patients with Urinary Tract Infections Caused by Extended-Spectrum-β-Lactamase-Producing Escherichia coli▿

    PubMed Central

    Auer, Simon; Wojna, Alexandra; Hell, Markus

    2010-01-01

    An increase in extended-spectrum-β-lactamase (ESBL)-producing Escherichia coli has been observed in outpatient settings. Consequently, 100 ESBL-positive E. coli isolates from ambulatory patients with clinically confirmed urinary tract infections were collected by a single laboratory between October 2004 and January 2008. Antimicrobial susceptibility testing was carried out using the oral antibiotics fosfomycin, pivmecillinam, and nitrofurantoin and the parenteral antibiotic ertapenem. Susceptibility rates indicate that fosfomycin (97%), nitrofurantoin (94%), and pivmecillinam (85%) could be considered important oral treatment options. PMID:20585127

  20. Oral treatment options for ambulatory patients with urinary tract infections caused by extended-spectrum-beta-lactamase-producing Escherichia coli.

    PubMed

    Auer, Simon; Wojna, Alexandra; Hell, Markus

    2010-09-01

    An increase in extended-spectrum-beta-lactamase (ESBL)-producing Escherichia coli has been observed in outpatient settings. Consequently, 100 ESBL-positive E. coli isolates from ambulatory patients with clinically confirmed urinary tract infections were collected by a single laboratory between October 2004 and January 2008. Antimicrobial susceptibility testing was carried out using the oral antibiotics fosfomycin, pivmecillinam, and nitrofurantoin and the parenteral antibiotic ertapenem. Susceptibility rates indicate that fosfomycin (97%), nitrofurantoin (94%), and pivmecillinam (85%) could be considered important oral treatment options. PMID:20585127