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1

Review of non-surgical treatment options for Peyronie's Disease  

Microsoft Academic Search

Non-surgical treatment of Peyronie's disease (PD) has come a long way since it was first described in 1743. A myriad of treatment options are currently available, including oral, intralesional and external energy therapies. The purpose of this article is to review the contemporary literature on non-surgical therapies for PD, and where possible, focus on randomized, placebo-controlled trials, as well as

S M Larsen; L A Levine

2012-01-01

2

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

MedlinePLUS

... Non-surgical Treatment Options for Urinary Incontinence in Women What is UI? “Taking Control” (5-minute video) “ ... video in a new window) Are there other women like me? (8-minute video) Urinary incontinence happens ...

3

The Non-Surgical Treatment of Peyronie Disease: 2013 Update  

PubMed Central

Peyronie disease is a common cause of penile deformity and sexual dysfunction. Although surgery is regarded as the definitive management for this condition, there are many medical and minimally invasive therapies available, with widely varying efficacy reported in the literature. The purpose of this review is to describe the current state-of-the-art for each of the most commonly used as well as several developing non-surgical treatments. Further, we hope to offer perspectives that will aid practitioners in deciding among these treatments that are either already in use or have the potential to be used as alternatives to surgery in the management of this frustrating disease. PMID:24459651

Shaw, Eric James; Mitchell, Gregory Clyde; Tan, Ronny B.; Sangkum, Premsant

2013-01-01

4

Metatarsus adductus: development of a non-surgical treatment pathway.  

PubMed

Metatarsus adductus (MA) occurs in one to two cases per 1000 births and is the most common congenital foot deformity in newborns. The appearance is that of a curved or adducted forefoot with a normal hindfoot. A systematic literature review was conducted to answer the following question: For a child who presents with MA, what is the most evidence-based conservative treatment option? Thirteen articles were reviewed using the National Health and Medical Research Council levels of evidence and guidelines for clinical practice. Conservative treatment options reported on included the following: no treatment, stretching, splinting, serial casting, sitting and sleeping positions and footwear/orthotics. There was strong evidence supporting no treatment in the case of flexible MA. Some limited evidence was found for the treatment of semi-rigid MA. Clinicians should use these recommendations together with clinical experience when advising parents on treatment of MA. PMID:23647850

Williams, Cylie M; James, Alicia M; Tran, Ton

2013-09-01

5

Non-Surgical Treatments for Urinary Incontinence: A Review of the Research for Women  

MedlinePLUS

... Treatments for Urinary Incontinence: A Review of the Research for Women" /> Consumer Summary – Apr. 9, 2012 Non-surgical Treatments for Urinary Incontinence: A Review of the Research for Women Formats View PDF (PDF) 433 kB ...

6

Non-surgical treatment of skeletal class III malocclusion.  

PubMed

The incidence of skeletal class III malocclusion has a mean of 3% in the Caucasian population, 5% in African-American adolescents and about 14% in the Asian population. In India, the incidence of class III malocclusion is reported to be 3.4%. A patient having class III malocclusion shows findings ranging from edge-to-edge bite to large reverse overjet, with extreme variations of underlying skeletal jaw bases and craniofacial form. This is a case report of a 20-year-old man having skeletal class III malocclusion with concave profile, anterior crossbite and a negative overjet of 3 mm treated non-surgically with extraction of only one lower left first premolar. PMID:24722711

Kapadia, Romina M; Shah, Adit P; Diyora, Shamil D; Rathva, Vandana J

2014-01-01

7

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

PubMed Central

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

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

8

Isokinetic muscle assessment after treatment of pectoralis major muscle rupture using surgical or non-surgical procedures  

PubMed Central

INTRODUCTION: Rupture of the pectoralis major muscle appears to be increasing in athletes. However, the optimal treatment strategy has not yet been established. OBJECTIVES: To compare the isokinetic shoulder performance after surgical treatment to that after non-surgical treatment for pectoralis major muscle rupture. METHODS: We assessed 33 pectoralis major muscle ruptures (18 treated non-surgically and 15 treated surgically). Horizontal abduction and adduction as well as external and internal rotation at 60 and 120 degrees/s were tested in both upper limbs. Peak torque, total work, contralateral deficiency, and the peak torque agonist-to-antagonist ratio were measured. RESULTS: Contralateral muscular deficiency did not differ between the surgical and non-surgical treatment modalities. However, the surgical group presented twice the number of athletes with clinically acceptable contralateral deficiency (<20%) for internal rotators compared to the non-surgical group. The peak torque ratio between the external and internal rotator muscles revealed a similar deficit of the external rotation in both groups and on both sides (surgical, 61.60% and 57.80% and non-surgical, 62.06% and 54.06%, for the dominant and non-dominant sides, respectively). The peak torque ratio revealed that the horizontal adduction muscles on the injured side showed similar weakness in both groups (surgical, 86.27%; non-surgical, 98.61%). CONCLUSIONS: This study included the largest single series of athletes reported to date for this type of injury. A comparative analysis of muscular strength and balance showed no differences between the treatment modalities for pectoralis major muscle rupture. However, the number of significant clinical deficiencies was lower in the surgical group than in the non-surgical group, and both treatment modalities require greater attention to the rehabilitation process, especially for the recovery of muscle strength and balance. PMID:21484052

Fleury, Anna Maria; da Silva, Antonio Carlos; de Castro Pochini, Alberto; Ejnisman, Benno; de Lira, Claudio Andre Barbosa; dos Santos Andrade, Marilia

2011-01-01

9

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

PubMed Central

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

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

2012-01-01

10

A Comparison of Eating Disorders among Patients Receiving Surgical vs Non-surgical Weight-loss Treatments  

Microsoft Academic Search

Background  Little is known about differences between patients in surgical and non-surgical weight-loss treatments (WLT) regarding eating\\u000a disorders, level of general psychopathology, and health-related quality of life (HRQL). Such differences could indicate different\\u000a clinical needs in the management of surgical compared to non-surgical WLT patients.\\u000a \\u000a \\u000a \\u000a Methods  Participants were a subset of 100 patients from a Swedish study investigating the long-term effects of

Joakim de Man Lapidoth; Ata Ghaderi; Claes Norring

2008-01-01

11

The effectiveness of non-surgical interventions in the treatment of Charcot foot.  

PubMed

Background? Charcot neuropathic osteoarthropathy is commonly known as 'Charcot foot'. It is a serious foot complication of diabetes mellitus that can frequently lead to foot ulceration, gangrene, hospital admission and foot amputation. A multidisciplinary approach to the management of Charcot foot is taken involving medical and allied health professionals. The management approach may also differ between different countries. To date, there is no systematic review of the literature undertaken to identify the clinical effectiveness of non-operative interventions in the treatment of acute Charcot foot. Objective? The objective of this review was to identify the effectiveness of non-surgical interventions with reducing lesions, ulceration, the rate of surgical intervention, reducing hospital admissions and improve the quality of life of subjects with Charcot foot. Search strategy? A comprehensive search strategy was undertaken on databases available from University of South Australia from their inception to November 2006. Selection criteria? Randomised controlled trials or clinical controlled trials were primarily sought. Critical appraisal of study quality and data extraction was undertaken using Joanna Briggs Institute instruments. Review Manager software was used to calculate comparative statistics. Results? This review identified 11 trials and five trials were included in the review. Three trials involved the use of bisphosphonate, a pharmacological agent. Two experimental treatments were also included, evaluating palliative radiology and magnetic fields. No trials were found using immobilisation and off-loading interventions for acute Charcot foot. The overall methodological quality score of the five studies was moderate. Owing to heterogeneous data, meta-analysis could not be performed. The trials did not report on reducing lesions, ulceration, rate of surgical intervention, hospital admissions and the quality of life of subjects with Charcot foot. The trials evaluating bisphosphonates reported greater reduction in foot temperature and disease activity for intervention subjects compared with controls. Another outcome of this review indicated additional beneficial effects of bisphosphonates in reducing pain and discomfort. The trial evaluating palliative radiotherapy found no difference between groups on any outcome. A significant reduction in the amount of deformity and reduced healing time to consolidation was found after treatment in the group receiving magnetic therapy treatment. Discussion? There is a lack of clinical trials evaluating the effectiveness of non-operative interventions for the management of Charcot foot (immobilisation, removable cast walkers, advice/dispensing of footwear and prescribing of orthotics). Bisphosphonates may be useful adjuncts to standard management of Charcot foot by improved healing demonstrated by a reduction in disease activity indicated by skin temperature and bone destruction. Magnetic therapy may reduce deformity, joint destruction and improve mobility. Conclusion? There is a lack of evidence supporting the use of pharmacological or non-surgical interventions with reducing lesions, ulceration, rate of surgical intervention, hospital admissions and improving the quality of life of subjects with Charcot foot. Bisphosphonates may improve the healing of Charcot foot by reducing skin temperature and disease activity of Charcot foot, when applied in addition to standard interventions to control the position and shape of the foot. PMID:21631804

Smith, Caroline; Kumar, Saravana; Causby, Ryan

2007-12-01

12

Surgical versus non-surgical treatment of chronic low back pain: a meta-analysis of randomised trials  

Microsoft Academic Search

We performed a meta-analysis of randomised controlled trials to investigate the effectiveness of surgical fusion for the treatment\\u000a of chronic low back pain compared to non-surgical intervention. Several electronic databases (MEDLINE, EMBASE, CINAHL and\\u000a Science Citation Index) were searched from 1966 to 2005. The meta-analysis comparison was based on the mean difference in\\u000a Oswestry Disability Index (ODI) change from baseline

T. Ibrahim; I. M. Tleyjeh; O. Gabbar

2008-01-01

13

Bariatric surgery versus non-surgical treatment for obesity: a systematic review and meta-analysis of randomised controlled trials  

PubMed Central

Objective To quantify the overall effects of bariatric surgery compared with non-surgical treatment for obesity. Design Systematic review and meta-analysis based on a random effects model. Data sources Searches of Medline, Embase, and the Cochrane Library from their inception to December 2012 regardless of language or publication status. Eligibility criteria Eligible studies were randomised controlled trials with ?6 months of follow-up that included individuals with a body mass index ?30, compared current bariatric surgery techniques with non-surgical treatment, and reported on body weight, cardiovascular risk factors, quality of life, or adverse events. Results The meta-analysis included 11 studies with 796 individuals (range of mean body mass index at baseline 30-52). Individuals allocated to bariatric surgery lost more body weight (mean difference ?26 kg (95% confidence interval ?31 to ?21)) compared with non-surgical treatment, had a higher remission rate of type 2 diabetes (relative risk 22.1 (3.2 to 154.3) in a complete case analysis; 5.3 (1.8 to 15.8) in a conservative analysis assuming diabetes remission in all non-surgically treated individuals with missing data) and metabolic syndrome (relative risk 2.4 (1.6 to 3.6) in complete case analysis; 1.5 (0.9 to 2.3) in conservative analysis), greater improvements in quality of life and reductions in medicine use (no pooled data). Plasma triglyceride concentrations decreased more (mean difference ?0.7 mmol/L (?1.0 to ?0.4) and high density lipoprotein cholesterol concentrations increased more (mean difference 0.21 mmol/L (0.1 to 0.3)). Changes in blood pressure and total or low density lipoprotein cholesterol concentrations were not significantly different. There were no cardiovascular events or deaths reported after bariatric surgery. The most common adverse events after bariatric surgery were iron deficiency anaemia (15% of individuals undergoing malabsorptive bariatric surgery) and reoperations (8%). Conclusions Compared with non-surgical treatment of obesity, bariatric surgery leads to greater body weight loss and higher remission rates of type 2 diabetes and metabolic syndrome. However, results are limited to two years of follow-up and based on a small number of studies and individuals. Systematic review registration PROSPERO CRD42012003317 (www.crd.york.ac.uk/PROSPERO). PMID:24149519

2013-01-01

14

Current developments, problems and solutions in the non-surgical treatment of pancreatic cancer  

PubMed Central

Pancreatic cancer is a common malignant neoplasm of the pancreas with an increasing incidence, a low early diagnostic rate and a fairly poor prognosis. To date, the only curative therapy for pancreatic cancer is surgical resection, but only about 20% patients have this option at the time of diagnosis and the mean 5-year survival rate after resection is only 10%-25%. Therefore, developing new treatments to improve the survival rate has practical significance for patients with this disease. This review deals with a current unmet need in medical oncology: the improvement of the treatment outcome of patients with pancreatic cancer. We summarize and discuss the latest systemic chemotherapy treatments (including adjuvant, neoadjuvant and targeted agents), radiotherapy, interventional therapy and immunotherapy. Besides discussing the current developments, we outline some of the main problems, solutions and prospects in this field. PMID:23556053

Guo, Xiao-Zhong; Cui, Zhong-Min; Liu, Xu

2013-01-01

15

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

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

2014-01-01

16

Nonsurgical Treatment Options for Basal Cell Carcinoma  

PubMed Central

Basal cell carcinoma (BCC) remains the most common form of nonmelanoma skin cancer (NMSC) in Caucasians, with perhaps as many as 2 million new cases expected to occur in the United States in 2010. Many treatment options, including surgical interventions and nonsurgical alternatives, have been utilized to treat BCC. In this paper, two non-surgical options, imiquimod therapy and photodynamic therapy (PDT), will be discussed. Both modalities have demonstrated acceptable disease control rates, cosmetically superior outcomes, and short-term cost-effectiveness. Further studies evaluating long-term cure rates and long-term cost effectiveness of imiquimod therapy and PDT are needed. PMID:21274437

Lien, Mary H.; Sondak, Vernon K.

2011-01-01

17

Breast Cancer: Treatment Options  

MedlinePLUS

... Breast Cancer: Treatment Options Request Permissions Download PDF Breast Cancer: Treatment Options This section has been reviewed and ... Cancer - About Clinical Trials › f t g e + Breast Cancer Guide Cancer.Net Guide Breast Cancer Overview Statistics ...

18

Effect sizes of non-surgical treatments of non-specific low-back pain  

Microsoft Academic Search

Numerous randomized trials have been published investigating the effectiveness of treatments for non-specific low-back pain\\u000a (LBP) either by trials comparing interventions with a no-treatment group or comparing different interventions. In trials comparing\\u000a two interventions, often no differences are found and it raises questions about the basic benefit of each treatment. To estimate\\u000a the effect sizes of treatments for non-specific LBP

A. Keller; J. Hayden; C. Bombardier; M. van Tulder

2007-01-01

19

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

PubMed Central

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

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

2014-01-01

20

Non-surgical functional treatment for displaced olecranon fractures in the elderly.  

PubMed

We retrospectively evaluated the clinical and radiological outcomes of a consecutive cohort of patients aged > 70 years with a displaced fracture of the olecranon, which was treated non-operatively with early mobilisation. We identified 28 such patients (27 women) with a mean age of 82 years (71 to 91). The elbow was initially immobilised in an above elbow cast in 90° of flexion of the elbow for a mean of five days. The cast was then replaced by a sling. Active mobilisation was encouraged as tolerated. No formal rehabilitation was undertaken. At a mean follow-up of 16 months (12 to 26), the mean ranges of flexion and extension were 140° and 15° respectively. On a visual analogue scale of 1 (no pain) to 10, the mean pain score was 1 (0 to 8). Of the original 28 patients 22 developed nonunion, but no patients required surgical treatment. We conclude that non-operative functional treatment of displaced olecranon fractures in the elderly gives good results and a high rate of satisfaction. PMID:24692623

Gallucci, G L; Piuzzi, N S; Slullitel, P A I; Boretto, J G; Alfie, V A; Donndorff, A; De Carli, P

2014-04-01

21

Successful treatment, despite a non-surgical approach, of severe infective endocarditis.  

PubMed

A 60-year-old man with a history of Child-Pugh class B cirrhosis was admitted to the hospital with 4-5 days of nausea, vomiting and altered mental status. Following the development of fever in the intensive care unit and methicillin-sensitive Staphylococcus aureus bacteraemia, a large (15 mm) vegetation was discovered on the anterolateral papillary muscle of the mitral valve. Following a thorough multidisciplinary evaluation, the patient was considered to be a poor surgical candidate due to the significant perioperative complications associated with Child-Pugh class B cirrhosis. The patient was treated with 6 weeks intravenous nafcillin as an outpatient. Echocardiography following the treatment course revealed that the vegetation had completely resolved without any valvular dysfunction. This case report emphasises that medical management remains an effective alternative to surgery in complicated cases of infective endocarditis. PMID:24114549

Boulos, Peter K; Jeong, Mark Y

2013-01-01

22

Radiologically determined orthodontically induced external apical root resorption in incisors after non-surgical orthodontic treatment of class II division 1 malocclusion: a systematic review.  

PubMed

This study aims to critically evaluate orthodontically induced external apical root resorption (OIEARR) in incisors of patients undergoing non-surgical orthodontic treatment of class II division 1 malocclusion by a systematic review of the published data. An electronic search of two databases was performed; the bibliographies of relevant articles were also reviewed. Studies were included if they examined the amount of OIEARR in incisors produced during non-surgical orthodontic treatment of individuals with class II division I malocclusion in the permanent dentition. Individuals had no previous history of OIEARR, syndromes, pathologies, or general diseases. Study selections, risk of bias assessment, and data extraction were performed in duplicate. Eight studies of moderate methodological quality were finally included. An increased prevalence (65.6% to 98.1%) and mild to moderate severity of OIEARR (<4 mm and <1/3 original root) were reported. No sex difference in root resorption was found. For the maxillary incisors, there was no evidence that either the central or lateral incisor was more susceptible to OIEARR. A weak to moderate positive correlation between treatment duration and root resorption, and anteroposterior apical displacement and root resorption was found. Current limited evidence suggests that non-surgical comprehensive orthodontic treatment to correct class II division 1 malocclusions causes increased prevalence and severity of OIEARR the more the incisor roots are displaced and the longer this movement takes. PMID:25139200

Tieu, Long D; Saltaji, Humam; Normando, David; Flores-Mir, Carlos

2014-01-01

23

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...

24

Embryo retrieval after hormonal treatment to control ovarian function and non-surgical artificial insemination in African lions (Panthera leo).  

PubMed

Assisted reproduction technologies are essential for propagating endangered wild felids. Artificial insemination (AI) has been reported in several wild feline species, but pregnancy rates are low, partially owing to failures of current hormonal stimulation protocols. Therefore, this study describes the application of reliable methods to monitor ovarian activity and the development of an effective hormonal protocol to induce oestrus and ovulation in African lions. Application of porcine FSH and porcine LH was shown to be effective for inducing follicular growth and ovulation, and this regimen appeared to be superior to protocols described earlier in terms of ovulation and fertilization rates. Furthermore, non-surgical AI was performed successfully in lions, and uterine-stage embryos were collected and cryopreserved. African lions may serve as a valuable model to develop assisted reproduction for propagation of relic zoo populations in the critically endangered Asian lion or Barbary lion. PMID:23279488

Goeritz, F; Painer, J; Jewgenow, K; Hermes, R; Rasmussen, K; Dehnhard, M; Hildebrandt, T B

2012-12-01

25

Novel operative treatment options.  

PubMed

There are an increasing number of more novel options available for operative intervention. This chapter outlines a series of operative treatment options which are available to the modern clinician to select from once a decision has been made to treat a carious lesion operatively. A series of novel methods of caries removal have been described; including chemomechanical caries removal, air abrasion, sono-abrasion, polymer rotary burs and lasers. There are also novel approaches to ensure complete caries removal and novel approaches for the management of deep caries. A novel question increasingly asked by clinicians is: does all the caries need to be removed? Operative management options here include: therapeutic fissure sealants, ultraconservative caries removal, stepwise excavation and the Hall technique. In conclusion, there is now a growing wealth of evidence that questions the traditional methods of caries removal and restoring the tooth. In parallel, there is a growing movement exploring the merits of therapeutically sealing caries into the tooth. This philosophy is alien to many of today's dentists and, until further randomized controlled trials are carried out in primary care, prudent caution must be exercised with this promising approach. Research is required into techniques which will allow monitoring of sealed caries to detect any rare, but insidious, failures. These novel techniques are an alternative way of managing the later stages of the caries process from a sounder biological basis and have marked potential benefits to patients from treatment, pain and outcome perspectives. PMID:19494685

Ricketts, D N J; Pitts, N B

2009-01-01

26

Thinking About Treatment Options  

Cancer.gov

Active surveillance, surgery, and radiation therapy are the standard therapy choices for men with early-stage prostate cancer (see Types of Treatment). Each has benefits (how treatments can help) and risks (problems treatment may cause). There is seldom just one right treatment choice.

27

OCD Treatment Options  

MedlinePLUS

... Stress Disorder (PTSD) Social Anxiety Disorder Specific Phobias Depression Stress Suicide Related Illnesses DSM-5 Changes Myth-Conceptions Treatment ... if I also have other anxiety disorders or depression? What causes OCD? Does it run in families? What kind ...

28

Treatment Options for Photodamaged Skin  

Microsoft Academic Search

Photodamage of the skin can be a detriment to physical and psychological health with a consequent negative impact on both personal and professional life. Medical treatments for photodamaged skin include topical all-trans-retinoic acid (tretinoin) as well as moisturizers, chemical peels, dermabrasion, ? hydroxy acids and cosmetic surgery. Of these treatment options, only tretinoin has been subjected to large-scale, controlled studies

Christopher E. M. Griffiths

1997-01-01

29

Hyperphosphataemia: treatment options.  

PubMed

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 2.3 g 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 (<1 g 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

Malberti, Fabio

2013-05-01

30

Current status in the treatment options for esophageal achalasia  

PubMed Central

Recent advances in the treatment of achalasia include the use of high-resolution manometry to predict the outcome of patients and the introduction of peroral endoscopic myotomy (POEM). The first multicenter randomized, controlled, 2-year follow-up study conducted by the European Achalasia Trial group indicated that laparoscopic Heller myotomy (LHM) was not superior to pneumatic dilations (PD). Publications on the long-term success of laparoscopic surgery continue to emerge. In addition, laparoscopic single-site surgery is applicable to advanced laparoscopic operations such as LHM and anterior fundoplication. The optimal treatment option is an ongoing matter of debate. In this review, we provide an update of the current progress in the treatment of esophageal achalasia. Unless new conclusive data prove otherwise, LHM is considered the most durable treatment for achalasia at the expense of increased reflux-associated complications. However, PD is the first choice for non-surgical treatment and is more cost-effective. Repeated PD according to an “on-demand” strategy based on symptom recurrence can achieve long-term remission. Decision making should be based on clinical evidence that identifies a subcategory of patients who would benefit from specific treatment options. POEM has shown promise but its long-term efficacy and safety need to be assessed further. PMID:24023484

Chuah, Seng-Kee; Chiu, Chien-Hua; Tai, Wei-Chen; Lee, Jyong-Hong; Lu, Hung-I; Changchien, Chi-Sin; Tseng, Ping-Huei; Wu, Keng-Liang

2013-01-01

31

Wastewater treatment plant cogeneration options  

SciTech Connect

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.

Stringfield, J.G. [Black and Veatch, Kansas City, MO (United States)

1995-12-31

32

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.

33

Mayer-Rokitansky-Kuster-Hauser syndrome: complications, diagnosis and possible treatment options: a review.  

PubMed

Mayer-Rokitansky-Kuster-Hauser (MRKH) syndrome is a disorder in women that presents as Mullerian agenesis. These patients present internal genitalia abnormalities that include the absence of a uterus and the upper two-thirds of the vagina. In this review, current diagnostic methods, accompanying complications (congenital and psychological) and non-surgical and surgical treatments are summarized. Ultrasound and MRI have been the most documented options in MRKH syndrome diagnosis. Many women with MRKH syndrome have renal, skeletal, hearing or cardiac congenital anomalies and increased levels of psychological distress. Non-surgical interventions can be used to create a sexually functional neovagina through vaginal dilation, and surgical interventions provide alternate methods of creating a neovagina. Additionally, vaginal tissue engineering and gene therapy might provide more effective approaches in solving MRKH syndrome. PMID:24948340

Bombard, David S; Mousa, Shaker A

2014-09-01

34

Treatment outcome following use of the erbium, chromium:yttrium, scandium, gallium, garnet laser in the non-surgical management of peri-implantitis: a case series.  

PubMed

Aim To date there is no consensus on the appropriate usage of lasers in the management of peri-implantitis. Our aim was to conduct a retrospective clinical analysis of a case series of implants treated using an erbium, chromium:yttrium, scandium, gallium, garnet laser.Materials and methods Twenty-eight implants with peri-implantitis in 11 patients were treated with an Er,Cr:YSGG laser (68 sites >4 mm), using a 14 mm, 500 ?m diameter, 60° (85%) radial firing tip (1.5 W, 30 Hz, short (140 ?s) pulse, 50 mJ/pulse, 50% water, 40% air). Probing depths were recorded at baseline after 2 months and 6 months, along with the presence of bleeding on probing.Results The age range was 27-69 years (mean 55.9); mean pocket depth at baseline was 6.64 ± SD 1.48 mm (range 5-12 mm),with a mean residual depth of 3.29 ± 1.02 mm (range 1-6 mm) after 2 months, and 2.97 ± 0.7 mm (range 1-9 mm) at 6 months. Reductions from baseline to both 2 and 6 months were highly statistically significant (P <0.001). Patient level reduction in bleeding from baseline to both 2 and 6 months were statistically significant (P <0.001).Conclusion In view of the positive findings in this pilot study, well-designed randomised controlled trials of the use of Er,Cr:YSGG laser in the non-surgical management of peri-implantitis are required to validate our clinical findings. PMID:25342356

Al-Falaki, R; Cronshaw, M; Hughes, F J

2014-10-24

35

New treatment options for onychomycosis.  

PubMed

Abstract Onychomycosis is the most common nail disorder. The causative pathogens are not only dermatophytes in the majority of cases (Trichophyton rubrum and T. mentagrophytes), but also yeasts of the genus Candida and molds. A wide variety of topical antifungal agents are proposed for first-line treatment of superficial onychomycosis, when the matrix is not involved. New treatment options using light were recently introduced, such as thermal lasers, non-thermal lasers, and photodynamic therapy. For thermal lasers, a temperature increase in the nail of around 50°C seems to be a prerequisite for success. For non-thermal lasers, the clinical data are very debatable and their mechanism of action still remains mysterious. For photodynamic therapy, 5-aminolevulinic acid is used. The therapy consists of exciting protoporphyrin IX with red light that penetrates relatively deeply. Further clinical studies of larger series of patients and with longer follow-up are still needed to reach a definitive conclusion on the value of these devices. PMID:25148411

Mordon, Serge R; Betrouni, Nacim; Trelles, Mario A; Leclère, Franck Marie

2014-12-01

36

Novel treatment options for fecal incontinence.  

PubMed

Fecal incontinence (FI) is a devastating condition affecting a substantial portion of the population. The etiologies of FI are wide ranging, as are the treatment options. When conservative measures fail, often surgical intervention is required. As in any area where a wide range of treatment options exist, there is no one perfect solution. Fortunately, novel treatment options for FI are becoming available, namely, posterior tibial nerve stimulation, magnetic anal sphincter, stem cell transplant, pyloric transplantation, and acupuncture. PMID:25320572

Barker, Adam; Hurley, Jefferson

2014-09-01

37

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

PubMed Central

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 Pearson’s ? 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

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

2011-01-01

38

Clinical outcomes of surgical treatment and longitudinal non-surgical observation of patients with subclinical Cushing's syndrome and nonfunctioning adrenocortical adenoma  

PubMed Central

Aims: To investigate the outcomes of the surgical management and longitudinal assessment of patients with subclinical Cushing's syndrome (SCS) and nonfunctioning adrenocortical adenoma (NFA). Materials and Methods: Between the years 1995 and 2008, 73 patients with asymptomatic adrenocortical adenoma were enrolled. They were informed of the risks and benefits of adrenalectomy and conservative management, and then chose the treatment. Results: SCS was observed in 13 patients (17.8%) and NFA in 60 patients (82.2%). Tumor size in SCS was significantly larger than that in NFA (34.6 ± 9.7 mm vs. 24.5 ± 8.0 mm in diameter, P=0.001). Of the SCS patients, 7 also suffered from hypertension (HT), 2 from diabetes mellitus (DM) and 3 from hyperlipidemia (HL). After adrenalectomy, the insulin dose could be reduced in 2 (100%) patients with DM, in 5 (71.4%) of those with HT and in 2 (66.7%) of those with HL. In the NFA surveillance group, 1 (2.6%) case developed into SCS 3 years after the initial presentation and an increase in size of the tumor was observed in 1 (2.6%), with a mean follow-up of 51.2 months. Conclusions: Surgical resection may be beneficial for the control of SCS and is likely to provide improvement of concomitant HT, DM and HL. Although NFA can be managed conservatively, its size and hormonal activities may change longitudinally. Thus, long-term follow-up is necessary for NFA. PMID:22919134

Maehana, Takeshi; Tanaka, Toshiaki; Itoh, Naoki; Masumori, Naoya; Tsukamoto, Taiji

2012-01-01

39

New options for uveitis treatment  

PubMed Central

Uveitis is one of the most important causes of blindness worldwide. Its etiology and pathogenesis are complicated and have not been well understood. The treatment for uveitis is predominantly based on steroids and immunosuppressants. However, systemic side effects limit their clinical application. With the advancement of molecular biology, some intravitreal implants and biologic agents have been used for the treatment of uveitis. Additionally, novel techniques such as gene therapy and RNA interference are being studied for using as uveitis therapy. This paper reviews recent advances in uveitis treatment. PMID:24195053

He, Yu; Jia, Song-Bai; Zhang, Wei; Shi, Jing-Ming

2013-01-01

40

Treatment Option Overview (Vaginal Cancer)  

MedlinePLUS

... examine the vagina and other organs in the pelvis are used to detect (find) and diagnose vaginal ... patient has had past radiation treatment to the pelvis . Stages of Vaginal Cancer After vaginal cancer has ...

41

Treatment Option Overview (Childhood Rhabdomyosarcoma)  

MedlinePLUS

... recurred. Stages of Childhood Rhabdomyosarcoma After childhood rhabdomyosarcoma has been diagnosed, treatment is based on the stage ... it is in the body, and whether it has spread to other parts of the body: Stage ...

42

Pediatric Obesity Epidemic: Treatment Options  

Microsoft Academic Search

The increasing prevalence of overweight youth in the United States and the associated increase in medical comorbidities has created a growing need for effective weight-management interventions. The recommended treatment for an overweight child to achieve a more healthful weight uses four primary behavioral strategies: (a) reduce energy intake while maintaining optimal nutrient intake to protect growth and development, (b) increase

Shelley Kirk; Barbara J. Scott; Stephen R. Daniels

2005-01-01

43

Treatment options for primary constipation  

Microsoft Academic Search

Opinion statement  Patients suffering from primary constipation often show symptom improvement with increased intake of fiber. Bulk laxatives\\u000a are a core component of treatment if dietary fiber is unsuccessful in alleviating symptoms. Although there are a number of\\u000a commercial laxative preparations available, only polyethylene glycol (PEG), an osmotic laxative, should be used on a daily\\u000a basis. For the elderly, saline laxatives

Vijayamalini Pampati; Ronald Fogel

2004-01-01

44

Emerging treatment options for early mycosis fungoides  

PubMed Central

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

Fernandez-Guarino, Montserrat

2013-01-01

45

Treatment options for benign prostatic hyperplasia.  

PubMed Central

OBJECTIVE: To examine current treatment options for benign prostatic hyperplasia with emphasis on randomized, clinical trials and our current management approach. QUALITY OF EVIDENCE: Benign prostatic hyperplasia remains difficult to define clinically or measure objectively. As a result, research has been fairly weak. With newer treatments, however, more definitive studies have been reported. MAIN FINDINGS: Transurethral resection of the prostate remains the criterion standard for severe disease. Watchful waiting, medical management, or early surgical intervention are all valid options for moderate disease and should be tailored to the characteristics and desires of individual patients. Recent minimally invasive surgical techniques, such as microwave and laser surgery, have not yet achieved the quality of evidence to be generally recommended. CONCLUSIONS: Management of benign prostatic hyperplasia should be individualized to patients' circumstances and personal choices. PMID:9266125

Portis, A. J.; Mador, D. R.

1997-01-01

46

Current state of Clostridium difficile treatment options.  

PubMed

Recent reports of reduced response to standard therapies for Clostridium difficile infection (CDI) and the risk for recurrent CDI that is common with all currently available treatment agents have posed a significant challenge to clinicians. Current recommendations include metronidazole for treatment of mild to moderate CDI and vancomycin for severe CDI. Results from small clinical trials suggest that nitazoxanide and teicoplanin may be alternative options to standard therapies, whereas rifaximin has demonstrated success in uncontrolled trials for the management of multiple recurrences. Anecdotal reports have also suggested that tigecycline might be useful as an adjunctive agent for the treatment of severe complicated CDI. Reports of resistance will likely limit the clinical use of fusidic acid and bacitracin and, possibly, rifaximin if resistance to this agent becomes widespread. Treatment of patients with multiple CDI recurrences and those with severe complicated CDI is based on limited clinical evidence, and new treatments or strategies are needed. PMID:22752868

Venugopal, Anilrudh A; Johnson, Stuart

2012-08-01

47

Acne and its treatment options: a review.  

PubMed

Acne vulgaris is an extremely common condition affecting more than 80-90% of adolescents and young adults. It typically starts in late childhood or early teens, but onset may be delayed in some people well into their 20s and 30s. The incidence rate of acne is roughly the same in males and females but, males tend to have more serious conditions. Common therapies that are used for the treatment of acne include topical, systemic, herbal and combination therapies. This review is an attempt to trace out the causes of acne, to know its treatment options and precautions to be taken to prevent it. PMID:21864255

Sathish, D; Shayeda; Rao, Y Madhusudan

2011-11-01

48

[Osteoporotic treatment options in geriatric patients].  

PubMed

Due to the demographic changes of the last few decades, there has been a significant increase in the number of osteoporotic fractures. After a fracture, geriatric patients are at particularly high risk for an increase of their functional impairments as well as a loss of independence and quality of life. In spite of the severe medical and socioeconomic consequences of fragility fractures, osteoporotic treatment and prevention are still insufficient. Based on the current literature, the pharmacological and nonpharmacological treatment options as well as new surgical techniques for geriatric patients are reviewed. PMID:22714901

Gosch, M; Kammerlander, C; Pils, K; Lechleitner, M; Benvenuti-Falger, U; Roth, T; Joosten-Gstrein, B; Pietschmann, P

2012-07-01

49

Current treatment options for Dientamoeba fragilis infections.  

PubMed

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

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

2012-12-01

50

[Irritable bowel syndrome: current treatment options].  

PubMed

Relieving abdominal pain is the principal treatment objective for patients with irritable bowel syndrome. No single drug stands out in the treatment strategy for this illness. Antispasmodics, magnesium aluminum silicates, and alverine citrate drugs all remain initial options for treatment, although their prescription is impeded by the fact that an increasing number are no longer approved for reimbursement. Increased dietary fibers often have a harmful effect on symptoms. Some patients are probably intolerant to some foods but there is no satisfactory proof on which to base a restrictive diet. Improved knowledge of the pathophysiology of irritable bowel syndrome has made it possible to diversify treatments that act first on one of the key pathophysiologic elements, visceral hypersensitivity. Antidepressants (especially tricyclics) can be used at low doses. Among the serotonergic drugs, serotonin 5-HT4 receptors agonists (tegaserod) may be available soon, but the development of 5-HT3 antagonists (alosetron, cilansetron) has been stopped for safety reasons (ischemic colitis and severe constipation). Non-drug options such as hypnosis, psychotherapy, relaxation, or yoga, may also be proposed to some patients. Probiotics are a possible treatment in the future. PMID:17490849

Ducrotté, Philippe

2007-11-01

51

Current treatment options for Dientamoeba fragilis infections  

PubMed Central

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

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

2012-01-01

52

Fibroid growth and medical options for treatment.  

PubMed

Although fibroids are common benign tumors, their impact on women's quality of life can be considerable. The most frequent symptoms are uterine bleeding, resulting in anemia, and pelvic pain. Fibroids can be of genetic or hormonal origin or arise from intrauterine events. Current options for medical treatment include control of estradiol and progesterone production or action and are discussed in this review. Although curative treatment of fibroids relies on surgical strategies, the current trend is for uterine-sparing treatment to preserve fertility and avoid unnecessary surgery. Currently approved medical treatments include intrauterine progestin delivery to reduce uterine bleeding, GnRH analogues, and, more recently, selective progesterone receptor modulators to control uterine bleeding and reduce fibroid volume. PMID:25171950

Chabbert-Buffet, Nathalie; Esber, Nathalie; Bouchard, Philippe

2014-09-01

53

Treatment options in otitis media with effusion.  

PubMed

Secretary Otitis media with effusion (OME) is the accumulation of mucus in the middle ear and sometimes in the mastoid air cell system. The main etiological factor is alteration in mucociliary system of middle ear secondary to ET malfunction which may be primary or secondary. OME is the cause of concern due to its occurance in paediatric age group, highest at 2 years of age, presenting as impairment of hearing leading to delayed speech and language development, poor academic performance and behavioral problems. In spite of this there are no confirmed guidelines of treatment to overcome. Many treatment options are available medical as well as surgical. Prospective study conducted to evaluate various treatment options revealed that auto inflation of ET is the main stay of treatment. If the ET malfunction is due to any reasons like adenoids, deviated nasal septum, hypertrophied turbinates or any other cause surgical intervention of the same gives 100% results. Medical management gives good results but recurrence is equally common. PMID:24533382

Upadhya, Ila; Datar, J

2014-01-01

54

Sacral perineural cysts: imaging and treatment options.  

PubMed

Perineural cysts are an uncommon radiological finding and a rare cause of radicular leg pain. We report the clinical findings, imaging and operative appearances of a patient who presented with radicular leg and perineal pain, which was found to be associated with multiple sacral perineural cysts. The diagnostic and treatment options are explored. In particular, the use of percutaneous fine-needle cyst drainage as a guide to the value of surgery is discussed. Postoperative complications, such as pseudomeningocoele can occur, but may be effectively treated with lumbar drainage. PMID:12046741

Landers, J; Seex, K

2002-04-01

55

Tackling sleeplessness: Psychological treatment options for insomnia  

PubMed Central

The purpose of the present paper is to review and summarize the research supporting nonpharmacologic treatment options for insomnia. The different treatment approaches are described followed by a review of both original research articles and meta-analyses. Meta-analytic reviews suggest that common nonpharmacologic approaches exert, on average, medium to large effect sizes on SOL, WASO, NWAK, SQR, and SE while smaller effects are seen for TST. Stimulus control therapy, relaxation training, and CBT-I are considered standard treatments for insomnia by the American Academy of Sleep Medicine (AASM). Sleep restriction, multicomponent therapy without cognitive therapy, paradoxical intention, and biofeedback approaches have received some levels of support by the AASM. Sleep hygiene, imagery training, and cognitive therapy did not receive recommendation levels as single (standalone) therapies by the AASM due to lack of empirical evidence. Less common approaches have been introduced (Internet-based interventions, bright light treatment, biofeedback, mindfulness, acupuncture, and intensive sleep retraining) but require further research. Brief and group treatments have been shown to be as efficacious as longer and individually-administered treatments. Considerations are presented for special populations, including older adults, children and teens, individuals from diverse cultural backgrounds, insomnia comorbid with other disorders, and individuals who are taking hypnotics. PMID:23616696

Dautovich, Natalie D; McNamara, Joseph; Williams, Jacob M; Cross, Natalie J; McCrae, Christina S

2010-01-01

56

A treatment algorithm for managing Achilles tendinopathy: new treatment options  

PubMed Central

Achilles tendinopathy affects athletes, recreational exercisers and even inactive people. The pathology is not inflammatory; it is a failed healing response. The source of pain in tendinopathy could be related to the neurovascular ingrowth seen in the tendon's response to injury. The treatment of Achilles tendinopathy is primarily conservative with an array of effective treatment options now available to the primary care practitioner. If conservative treatment is not successful, then surgery relieves pain in the majority of cases. Directing a patient through the algorithm presented here will maximise positive treatment outcomes. PMID:17311806

Alfredson, Håkan; Cook, J

2007-01-01

57

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...

58

Pectus excavatum: history, hypotheses and treatment options  

PubMed Central

Pectus excavatum and pectus carinatum represent the most frequent chest wall deformations. However, the pathogenesis is still poorly understood and research results remain inconsistent. To focus on the recent state of knowledge, we summarize and critically discuss the pathological concepts based on the history of these entities, beginning with the first description in the sixteenth century. Based on the early clinical descriptions, we review and discuss the different pathogenetic hypotheses. To open new perspectives for the potential pathomechanisms, the embryonic and foetal development of the ribs and the sternum is highlighted following the understanding that the origin of these deformities is given by the disruption in the maturation of the parasternal region. In the second, different therapeutical techniques are highlighted and based on the pathogenetic hypotheses and the embryological knowledge potential new biomaterial-based perspectives with interesting insights for tissue engineering-based treatment options are presented. PMID:22394989

Brochhausen, Christoph; Turial, Salmai; Muller, Felix K.P.; Schmitt, Volker H.; Coerdt, Wiltrud; Wihlm, Jean-Marie; Schier, Felix; Kirkpatrick, C. James

2012-01-01

59

Parkinson Disease Treatment Options - Medications (Beyond the Basics)  

MedlinePLUS

... Tolcapone Trihexyphenidyl Patient information: Parkinson disease treatment options — medications (Beyond the Basics) Author Daniel Tarsy, MD Section ... available for Parkinson disease (PD). Medical treatment includes medications, education, support, exercise, physical and speech therapy, and ...

60

Treatment Options by Stage (Breast Cancer)  

MedlinePLUS

... effective or better than the standard treatment . Many of today's standard treatments for cancer are based on earlier ... used in women who have a high risk of getting breast cancer. Most surgeons believe that this is a more aggressive treatment ...

61

Current treatment options for the metabolic syndrome  

Microsoft Academic Search

Optional statement  The metabolic syndrome is defined as a condition characterized by a set of clinical criteria: insulin resistance, visceral\\u000a obesity, atherogenic dyslipidemia, and hypertension. The major risk factors leading to the epidemic of this syndrome in the\\u000a United States are visceral obesity, physical inactivity, and an atherogenic diet. The available current evidence suggests\\u000a that the first step in management of

Prakash C. Deedwania; Natalia Volkova

2005-01-01

62

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 ...

63

Review of treatment options for nonalcoholic fatty liver disease.  

PubMed

Although the future of NAFLD and NASH treatment has many promising agents, clinicians are currently faced with limited options with an emphasis on lifestyle modification. Figs. 1 and 2 summarize current practices for the diagnosis and treatment of NAFLD with the understanding that each patient's treatment must be customized to their comorbidities, exercise tolerance, and willingness to comply with therapy. PMID:24266914

Corrado, Richele L; Torres, Dawn M; Harrison, Stephen A

2014-01-01

64

An expanding landscape. Osteoporosis. Treatment options today.  

PubMed

Choices for osteoporosis therapy have expanded within the past 5 years. This article provides an overview of currently available therapy options. Exogenous estrogen can prevent and treat osteoporosis and is available in several delivery routes. Calcitonin is also designed to reduce bone loss in osteoporosis. Bisphosphonates such as alendronate prevent bone resorption by inhibiting osteoclasts and causing increased osteoclast cell death. Raloxifene is a selective estrogen receptor modulator and is the newest osteoporosis medication on the market. It may also have beneficial effects on breast cancer risk. All postmenopausal women should obtain 1,000 mg to 1,500 mg of calcium and 400 IU to 800 IU of vitamin D every day--regardless of any prescription therapy regimen for osteoporosis. They should also perform weight-bearing exercise, such as walking, for 20 to 30 minutes every day or for 1 hour three times a week. PMID:10476099

Meiner, S E

1999-07-01

65

Non-surgical periodontal therapy assisted by potassium–titanyl–phosphate laser: a pilot study  

Microsoft Academic Search

As the American Academy of Periodontology indicates, the treatment of chronic periodontitis should be achieved in the least\\u000a invasive manner through non-surgical periodontal therapy. However, complete removal of subgingival plaque and calculus is\\u000a hindered with increasing probing depth (PD) and furcation involvement using hand, sonic or ultrasonic instruments. Many authors\\u000a have suggested that the use of laser as an adjunct

Umberto Romeo; Gaspare Palaia; Ricciarda Botti; Valentina Leone; Jean-Paul Rocca; Antonella Polimeni

2010-01-01

66

Femoral nonunion: risk factors and treatment options.  

PubMed

Despite advances in surgical technique, fracture fixation alternatives, and adjuncts to healing, femoral nonunion continues to be a significant clinical problem. Femoral fractures may fail to unite because of the severity of the injury, damage to the surrounding soft tissues, inadequate initial fixation, and demographic characteristics of the patient, including nicotine use, advanced age, and medical comorbidities. Femoral nonunion is a functional and economical challenge for the patient, as well as a treatment dilemma for the surgeon. Surgeons should understand the various treatment alternatives and their role in achieving the goals of deformity correction, infection management, and optimization of muscle strength and rehabilitation. Used appropriately, nail dynamization, exchange nailing, and plate osteosynthesis can help minimize pain and disability by promoting osseous union. A review of the potential risk factors and treatment alternatives should provide insight into the etiology and required treatment of femoral nonunion. PMID:18252839

Lynch, Joseph R; Taitsman, Lisa A; Barei, David P; Nork, Sean E

2008-02-01

67

Current Treatment Options for Pancreatic Carcinoma  

Microsoft Academic Search

Pancreas cancer is a significant cause of cancer mortality; therefore, the development of early diagnostic strategies and\\u000a effective treatment is essential. Improvements in imaging technology, as well as use of biomarkers such as CA 19–9, are changing\\u000a the way that pancreas cancer is diagnosed and staged. Although progress in treatment for pancreas cancer has been incremental,\\u000a development of combination therapies

Emily Castellanos; Jordan Berlin; Dana Backlund Cardin

2011-01-01

68

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

PubMed

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

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

2014-01-01

69

Tinea corporis/cruris: new treatment options.  

PubMed

We undertook a prospective, multicentre, double-blind, placebo controlled, randomised, parallel-group study to evaluate the efficacy and safety of the topical 1% emulsion gel formulation of Lamisil in the treatment of tinea corporis/cruris. Eighty-three patients with clinically and mycologically confirmed tinea corporis/cruris were enrolled from 6 dermatology practices. Of the 62 patients in the intent-to-treat population, 29 were randomised to 1% Lamisil emulsion gel (23 male, 6 female; mean age 42 years, range 19-79 years) and 33 to placebo (25 male, 8 female; mean age 36 years, range 16-73 years). The gels were applied once daily for 1 week. Mycological cure (negative microscopy and culture results) and effectiveness of treatment (mycological cure plus no or minimal signs and symptoms) were measured on day 7, weeks 2, 4 and 8, and at the end of the study. At the study end, rates mycological cure were 83% for Lamisil 1% emulsion gel and 27% for placebo gel (p < 0.001), with respective rates for effective treatment of 83 and 21% (p < 0.001). Complete cure was recorded for 59% of patients receiving Lamisil 1% emulsion gel and 13% of patient receiving placebo gel (p < 0.001). We conclude that a 1-week course of Lamisil 1% emulsion gel is significantly more effective in the treatment of tinea corporis/cruris than placebo gel in respect of complete cure, mycological cure and effective treatment. PMID:9154395

van Heerden, J S; Vismer, H F

1997-01-01

70

Subtrochanteric fractures. A review of treatment options.  

PubMed

Subtrochanteric fractures of the femur were originally grouped with comminuted intertrochanteric fractures. However, they pose their own distinct management problems mainly due to biomechanical differences in stability and are now considered separately. There are several classification systems but the most widely accepted is the one proposed by Seinsheimer in 1978. Many different methods have been employed in the management of this group of fractures with varying rates of success. The management has altered as new implants have been developed to try to overcome the shortfalls of the existing implants. This study is a review of the literature and was carried out using Medline and the Cochrane Library to look at the management methods employed in the past and today. Most of the published articles are retrospective uncontrolled reports of the results of management and it is difficult to suggest management principles from them. The other main shortcoming is that, although there are several devices available on the market for the management of these fractures, most of the literature concerns one or two of them. The results reported examine union rates and failure of implants leading to reoperation. This is a crude outcome measure, and there is very little in the literature regarding patient function. In order to provide evidence-based advice on the best management options for these difficult fractures, future studies should be designed as randomized controlled trials and place more emphasis on studying patients' outcomes. PMID:11759576

Craig, N J; Sivaji, C; Maffulli, N

2001-01-01

71

Fibromyalgia syndrome: the pharmacological treatment options.  

PubMed

Pharmacological treatment has been gradually enriched by a variety of compounds; however, no single drug is capable of fully managing the constellation of fibromyalgia (FM) symptoms. Currently, it is not possible to draw definite conclusions concerning the best pharmacological approach to managing FM because results of randomized clinical trials present methodological limitations and therapeutic programs are too heterogeneous for adequate comparison. However, a variety of pharmacological treatments including antidepressants, nonsteroidal anti-inflammatory drugs (NSAIDS), opioids, sedatives, muscle relaxants and antiepileptics have been used to treat FM with varying results. In this review, we will evaluate those pharmacological therapies that have produced the most significant clinical results in treating FM patients. The nature of FM suggests that an individualized, multimodal approach that includes both pharmacologic and nonpharmacologic therapies seems to be the most appropriate treatment strategy to date. PMID:18852908

Sarzi-Puttini, P; Torta, R; Marinangeli, F; Biasi, G; Spath, M; Buskila, D; Gracely, R H; Giamberardino, M A; Bazzichi, L; Cazzola, M; Di Franco, M; Stisi, S; Salaffi, F; Casale, R; Leardini, G; Gorla, R; Marsico, A; Carignola, R; Altomonte, L; Ceccherelli, F; Cassisi, G; Arioli, G; Alciati, A; Atzeni, F

2008-01-01

72

ORIGINAL ARTICLE Composting is an effective treatment option for  

E-print Network

ORIGINAL ARTICLE Composting is an effective treatment option for sanitization of Phytophthora of California, Berkeley, CA, USA 2 Sonoma Compost, Sonoma, CA, USA 3 McEvoy Ranch, Marin, CA, USA Introduction.1111/j.1365-2672.2006.03008.x Abstract Aims: To determine the effects of heat and composting treatments

California at Berkeley, University of

73

Emerging Treatment Options for Benign Prostatic Obstruction  

Microsoft Academic Search

Benign prostatic obstruction (BPO) affects an increasing number of men with age. It can cause troublesome lower urinary tract\\u000a symptoms, can have a negative impact on quality of life, and may be associated with significant morbidity. Currently available\\u000a medication and surgical treatments are limited by adverse events, invasiveness, and patient compliance. This has driven research\\u000a into the pathogenesis of benign

Brian A. Parsons; Hashim Hashim

2011-01-01

74

Non-surgical myocardial reduction for hypertrophic obstructive cardiomyopathy  

Microsoft Academic Search

Surgery has been the only therapeutic option in patients with hypertrophic obstructive cardiomyopathy who are resistant to drug treatment and sequential pacemaker therapy. I describe a novel catheter-based technique that may replace surgical myocardial reduction in some patients. The technique aims at selective destruction of the hypertrophied part of the left side of the intraventricular septum. If temporary occlusion of

U Sigwart

1995-01-01

75

Drug-resistant tuberculosis: emerging treatment options  

PubMed Central

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

Adhvaryu, Meghna; Vakharia, Bhasker

2011-01-01

76

Bowen's disease - a review of newer treatment options  

PubMed Central

Bowen’s 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 Bowen’s disease have been described and are established with advantages and disadvantages. Bowen’s 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 Bowen’s disease with topical diclofenac, topical imiquimod and photodynamic therapy. PMID:19209288

Neubert, Thorsten; Lehmann, Percy

2008-01-01

77

Treatment options in hepatocellular carcinoma today.  

PubMed

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

Livraghi, T; Mäkisalo, H; Line, P-D

2011-01-01

78

Treatment options in Cheyne-Stokes respiration.  

PubMed

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

Randerath, Winfried J

2010-12-01

79

Hilar cholangiocarcinoma: diagnosis, treatment options, and management  

PubMed Central

Hilar cholangiocarcinoma (HC) is a rare disease with a poor prognosis which typically presents in the 6th decade of life. Of the 3,000 cases seen annually in the United States, less than one half of these tumors are resectable. A variety of risk factors have been associated with HC, most notably primary sclerosing cholangitis (PSC), biliary stone disease and parasitic liver disease. Patients typically present with abdominal pain, pruritis, weight loss, and jaundice. Computed topography (CT), magnetic resonance imaging (MRI), and ultrasound (US) are used to characterize biliary lesions. Endoscopic retrograde cholangiopancreatography (ERCP) and percutaneous transhepatic cholangiography (PTC) assess local ductal extent of the tumor while allowing for therapeutic biliary drainage. MRCP has demonstrated similar efficacies to PTC and ERCP in identifying anatomic extension of tumors with less complications. Treatment consists of surgery, radiation, chemotherapy and photodynamic therapy. Biliary drainage of the future liver remnant should be performed to decrease bilirubin levels thereby facilitating future liver hypertrophy. Standard therapy consists of surgical margin-negative (R0) resection with extrahepatic bile duct resection, hepatectomy and en bloc lymphadenectomy. Local resection should not be undertaken. Lymph node invasion, tumor grade and negative margins are important prognostic indicators. In instances where curative resection is not possible, liver transplantation has demonstrated acceptable outcomes in highly selected patients. Despite the limited data, chemotherapy is indicated for patients with unresectable tumors and adequate functional status. Five-year survival after surgical resection of HC ranges from 10% to 40% however, recurrence can be as high as 50-70% even after R0 resection. Due to the complexity of this disease, a multi-disciplinary approach with multimodal treatment is recommended for this complex disease. PMID:24696835

Soares, Kevin C.; Kamel, Ihab; Cosgrove, David P.; Herman, Joseph M.

2014-01-01

80

Degenerative meniscus: Pathogenesis, diagnosis, and treatment options  

PubMed Central

The symptomatic degenerative meniscus continues to be a source of discomfort for a significant number of patients. With vascular penetration of less than one-third of the adult meniscus, healing potential in the setting of chronic degeneration remains low. Continued hoop and shear stresses upon the degenerative meniscus results in gross failure, often in the form of complex tears in the posterior horn and midbody. Patient history and physical examination are critical to determine the true source of pain, particularly with the significant incidence of simultaneous articular pathology. Joint line tenderness, a positive McMurray test, and mechanical catching or locking can be highly suggestive of a meniscal source of knee pain and dysfunction. Radiographs and magnetic resonance imaging are frequently utilized to examine for osteoarthritis and to verify the presence of meniscal tears, in addition to ruling out other sources of pain. Non-operative therapy focused on non-steroidal anti-inflammatory drugs and physical therapy may be able to provide pain relief as well as improve mechanical function of the knee joint. For patients refractory to conservative therapy, arthroscopic partial meniscectomy can provide short-term gains regarding pain relief, especially when combined with an effective, regular physiotherapy program. Patients with clear mechanical symptoms and meniscal pathology may benefit from arthroscopic partial meniscectomy, but surgery is not a guaranteed success, especially with concomitant articular pathology. Ultimately, the long-term outcomes of either treatment arm provide similar results for most patients. Further study is needed regarding the short and long-term outcomes regarding conservative and surgical therapy, with a particular focus on the economic impact of treatment as well.

Howell, Richard; Kumar, Neil S; Patel, Nimit; Tom, James

2014-01-01

81

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

PubMed Central

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

Plaszewski, Maciej; Bettany-Saltikov, Josette

2014-01-01

82

New treatment options for patients with metastatic prostate cancer.  

PubMed

Prostate cancer is one of the most common cancers in men. When metastasised (40% of patients), classic anti-androgen therapy is the first-line treatment. Usually, this treatment becomes ineffective when castration-resistant prostate cancer (CRPC) develops. Thus far, docetaxel was the only chemotherapeutic option that has shown to be able to extend overall survival and improve quality of life in these patients. Recently, cabazitaxel and abiraterone have shown significant survival benefits for patients progressive on or after docetaxel treatment, as did enzalutamide and radium-223. In North America, immune therapy (sipuleucel-T) became available for a subgroup of CRPC patients. These new treatment options will change the treatment paradigm of patients with metastatic castration resistant prostate cancer. A multidisciplinary approach by both medical oncologists and urologists seems mandatory. PMID:23956309

Snoeks, L L; Ogilvie, A C; van Haarst, E P; Siegert, C E H

2013-01-01

83

Update on treatment options for spinal brucellosis.  

PubMed

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

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; Ayd?n, M; Horasan, E S; Gul, H C; Ceylan, B; Kadanal?, A; Karabay, O; Karagoz, G; Kayabas, U; Turhan, V; Engin, D; Gulsun, S; Elald?, N; Alabay, S

2014-02-01

84

Trial Suggests New Treatment Option for Hodgkin Lymphoma  

Cancer.gov

Intermediate results from a phase II clinical trial presented at the 2010 American Society of Hematology annual meeting indicate that an investigational agent called brentuximab vedotin may be an effective alternative for some patients with Hodgkin lymphoma who have few viable treatment options.

85

TAILORx (Trial Assigning IndividuaLized Options for Treatment)  

Cancer.gov

A fact sheet about TAILORx -- the Trial Assigning IndividuaLized Options for Treatment (Rx) -- which was designed to determine whether adjuvant hormonal therapy alone is as effective as adjuvant hormonal therapy in combination with chemotherapy for certain women with early-stage breast cancer.

86

Waste battery treatment options: comparing their environmental performance.  

PubMed

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

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

2009-08-01

87

Effluent treatment options for nuclear thermal propulsion system ground tests  

SciTech Connect

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.

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

1992-10-16

88

Second and third line treatment options for Helicobacter pylori eradication  

PubMed Central

Helicobacter pylori is a highly successful bacterium with a high global prevalence and the infection carries significant disease burden. It is also becoming increasingly difficult to eradicate and the main reason for this is growing primary antibiotic resistance rates in a world where antibiotics are frequently prescribed and readily available. Despite knowing much more about the bacterium since its discovery, such as its genomic makeup and pathogenesis, we have seen declining treatment success. Therefore, clinicians today must be prepared to face one, two or even multiple treatment failures, and should be equipped with sufficient knowledge to decide on the appropriate salvage therapy when this happens. This article discusses the factors contributing to treatment failure and reviews the second and third-line treatment strategies that have been investigated. Established empiric second line treatment options include both bismuth based quadruple therapy and levofloxacin based triple therapy. Antibiotic testing is recommended prior to initiating third line treatment. In the event that antibiotic susceptibility testing is unavailable, third line treatment options include rifabutin, rifaximin and sitafloxacin based therapies. PMID:24587627

Song, Mingjun; Ang, Tiing Leong

2014-01-01

89

Primarily non-surgical management of osteomyelitis of the foot in diabetes  

Microsoft Academic Search

Aims\\/hypothesis  We examined the use of surgery and assessed the response to non-surgical management of osteomyelitis of the foot in diabetic\\u000a patients.\\u000a \\u000a \\u000a \\u000a Methods  We reviewed the records of all patients presenting to a single specialist centre with osteomyelitis complicating a diabetic\\u000a foot ulcer over a 5 year period. Details were extracted on antibiotic choice and treatment duration, hospital admission, incidence\\u000a of minor and

W. J. Jeffcoate

2008-01-01

90

Gastroparesis: a review of current and emerging treatment options  

PubMed Central

Gastroparesis is a motility disorder of the stomach causing delay in food emptying from the stomach without any evidence of mechanical obstruction. The majority of cases are idiopathic. Patients need to be diagnosed properly by formal testing, and the evaluation of the severity of the gastroparesis may assist in guiding therapy. Initially, dietary modifications are encouraged, which include frequent and small semisolid-based meals. Promotility medications, like erythromycin, and antiemetics, like prochlorperazine, are offered for symptom relief. In patients who are refractory to pharmacologic treatment, more invasive options, such as intrapyloric botulinum toxin injections, placement of a jejunostomy tube, or implantation of a gastric stimulator, can be considered. Hemin therapy and gastric electric stimulation are emerging treatment options that are still at different stages of research. Regenerative medicine and stem cell-based therapies also hold promise for gastroparesis in the near future. PMID:24039443

Enweluzo, Chijioke; Aziz, Fahad

2013-01-01

91

Treatment options for patellofemoral instability in sports traumatology.  

PubMed

Patellofemoral instability not only involves lateral patellar dislocation, patellar mal-tracking or subluxation but can also cause a limiting disability for sports activities. Its underlying causes are known as morphological anomalies of the patellofemoral joint or the mechanical axis, femorotibial malrotation, variants of the knee extensor apparatus, and ligamentous insufficiencies often accompanied by poor proprioception. Athletes with such predisposing factors are either suffering from unspecific anterior knee pain or from slightly traumatic or recurrent lateral patellar dislocation Treatment options of patellar instability are vast, and need to be tailored individually depending on the athlete's history, age, complaints and physical demands. Different conservative and surgical treatment options are reviewed and discussed, especially limited expectations after surgery. PMID:24191183

M Tscholl, Philippe; P Koch, Peter; F Fucentese, Sandro

2013-01-01

92

Non-surgical collections of Addax nasamaculatus embryos  

E-print Network

Fossil Rim fellow is a veterinarian from Nepal who is studying the white rhinoceros. The first non-surgical embryo collections on the addax took place at Fossil Rim. They have also established the Pride of Texas Consortium and its annual Symposium... sperm each, resulting in two pregnancies and one live birth. Estrus was successfully controlled by both the Synchro-Mate B system per the manufacter's directions for cattle and using an IM injection of PMSG (300 IU) and PG (125 ug) on day -3 and -1...

Monk, Patricia Kay

2012-06-07

93

Interventional treatment for cluster headache: A review of the options  

Microsoft Academic Search

There is no more severe pain than that sustained by a cluster headache sufferer. Surgical treatment of cluster headache should\\u000a only be considered after a patient has exhausted all medical options or when a patient’s medical history precludes the use\\u000a of typical cluster abortive and preventive medications. Once a cluster patient is deemed a medical failure only those who\\u000a have

Todd D. Rozen

2002-01-01

94

Acrodermatitis continua of Hallopeau: evolution of treatment options.  

PubMed

Ever since its inception, acrodermatitis continua of Hallopeau, has been recognized as an uncommon clinical entity which has been sparingly reported from across the globe. The attempt to have cumulative information on prevalent nomenclature, definition, reminiscences, and clinical overtures has brought differential diagnosis and diagnosis in sharp focus, the highlights of which are outlined. Hence, it was considered important to review the evolution of treatment options available thus far including use of biologics. PMID:21950286

Sehgal, Virendra N; Verma, Prashant; Sharma, Sonal; Srivastava, Govind; Aggarwal, Ashok K; Rasool, Farhan; Chatterjee, Kingsuk

2011-10-01

95

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. Women who received the investigational drug trastuzumab emtansine (T-DM1) lived more than 3 months longer without their tumors progressing than women who received the chemotherapy drug capecitabine (Xeloda) and the targeted drug lapatinib (Tykerb).

96

Current options for the treatment of optic neuritis  

PubMed Central

Optic neuritis can be defined as typical (associated with multiple sclerosis, improving independent of steroid treatment), or atypical (not associated with multiple sclerosis, steroid-dependent improvement). Causes of atypical optic neuritis include connective tissue diseases (eg, lupus), vasculitis, sarcoidosis, or neuromyelitis optica. In this manuscript, updated treatment options for both typical and atypical optic neuritis are reviewed. Conventional treatments, such as corticosteroids, therapeutic plasma exchange, and intravenous immunoglobulin therapy are all discussed with commentary regarding evidence-based outcomes. Less commonly used treatments and novel purported therapies for optic neuritis are also reviewed. Special scenarios in the treatment of optic neuritis – pediatric optic neuritis, acute demyelinating encephalomyelitis, and optic neuritis occurring during pregnancy – are specifically examined. PMID:22927730

Pula, John H; MacDonald, Christopher J

2012-01-01

97

A critical assessment of treatment options for idiopathic pulmonary fibrosis  

PubMed Central

Background To date, no management approach has proven to be efficacious for the treatment of idiopathic pulmonary fibrosis (IPF). Consequently, therapeutic options remain controversial and confusing for many clinicians. We sought to formally review available evidence on treatment options for IPF and to have a diverse panel of physicians rate the “appropriateness,” “inappropriateness,” or “uncertainty” of some of the available therapeutic options. Methods The RAND/UCLA Appropriateness Method was used to review and rate multiple clinical scenarios for the treatment of IPF. The panel was composed of nine physicians from geographically diverse areas who received a systematic review on the risks and benefits of commonly used treatments for IPF as background. Results A total of 324 clinical scenarios were rated: 25% as appropriate; 39%, uncertain; and 36%, inappropriate. The panel disagreed about 12% of the therapy indications in the final ratings, falling from 26% in the first-round ratings. Conclusions Key themes emerged from the consensus process. Lacking evidence for a definitive therapy, it was considered most appropriate to enroll eligible patients in clinical trials and refer eligible patients for transplant evaluation. For patients without access to clinical trials, the committee was not unanimous regarding treatment recommendations. It was considered inappropriate for patients with a confident diagnosis of IPF to be treated with corticosteroids as the sole agent: corticosteroids should be used in conjunction with azathioprine. With progressive disease despite such combination use, there was agreement for the use of interferon gamma-1b in patients unwilling or unable to participate in available clinical trials. PMID:16315778

Shah, Nirav R.; Noble, Paul; Jackson, Robert M.; King, Talmadge E.; Nathan, Steven D.; Padilla, Maria; Raghu, Ganesh; Rhodes, Melissa Bruce; Schwarz, Marvin; Tino, Gregory; Dubois, Robert W.

2006-01-01

98

Current treatment options for the management of esophageal cancer  

PubMed Central

In recent years, esophageal cancer characteristics and management options have evolved significantly. There has been a sharp increase in the frequency of esophageal adenocarcinoma and a decline in the frequency of squamous cell carcinoma. A more comprehensive understanding of prognostic factors influencing outcome has also been developed. This has led to more management options for esophageal cancer at all stages than ever before. A multidisciplinary, team approach to management in a high volume center is the preferred approach. Each patient should be individually assessed based on type of cancer, local or regional involvement, and his or her own functional status to determine an appropriate treatment regimen. This review will discuss management of esophageal cancer relative to disease progression and patient functional status. PMID:23152702

Mawhinney, Mark R; Glasgow, Robert E

2012-01-01

99

Treatment Options for Breast Cancer Resistant to Anthracycline and Taxane  

PubMed Central

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

Moreno-Aspitia, Alvaro; Perez, Edith A.

2009-01-01

100

Intracranial Aneurysms: Review of Current Treatment Options and Outcomes  

PubMed Central

Intracranial aneurysms are present in roughly 5% of the population, yet most are often asymptomatic and never detected. Development of an aneurysm typically occurs during adulthood, while formation and growth are associated with risk factors such as age, hypertension, pre-existing familial conditions, and smoking. Subarachnoid hemorrhage, the most common presentation due to aneurysm rupture, represents a serious medical condition often leading to severe neurological deficit or death. Recent technological advances in imaging modalities, along with increased understanding of natural history and prevalence of aneurysms, have increased detection of asymptomatic unruptured intracranial aneurysms (UIA). Studies reporting on the risk of rupture and outcomes have provided much insight, but the debate remains of how and when unruptured aneurysms should be managed. Treatment methods include two major intervention options: clipping of the aneurysm and endovascular methods such as coiling, stent-assisted coiling, and flow diversion stents. The studies reviewed here support the generalized notion that endovascular treatment of UIA provides a safe and effective alternative to surgical treatment. The risks associated with endovascular repair are lower and incur shorter hospital stays for appropriately selected patients. The endovascular treatment option should be considered based on factors such as aneurysm size, location, patient medical history, and operator experience. PMID:21779274

Seibert, Brad; Tummala, Ramachandra P.; Chow, Ricky; Faridar, Alireza; Mousavi, Seyed A.; Divani, Afshin A.

2011-01-01

101

Future treatment options for atopic dermatitis - small molecules and beyond.  

PubMed

Atopic dermatitis (AD) is a common eczematous skin disease with a chronic and relapsing course. Current therapeutic options for moderate to severe AD in children and adults are unsatisfactory. Along with the success of basic research to define pathogenesis-related targets, novel small molecule inhibitors and biologics for the treatment of AD have been developed. These compounds focus on the specific reduction of pruritus, interfere with the pro-allergic Th2-deviation of the immune system or inhibit inflammatory pathways in the skin. Based on studies registered at ClinicalTrials.gov we present novel treatment strategies of AD, their molecular mechanisms of action, and discuss the current status of the clinical results. As many of the new compounds target pathogenesis-related traits of the disease, we face a new era in the treatment and understanding of AD. PMID:24360854

Schäkel, Knut; Döbel, Thomas; Bosselmann, Ina

2014-02-01

102

Current and emerging treatment options for uveal melanoma  

PubMed Central

Uveal melanoma (UM) is the most common primary malignant intraocular tumor in adults, with a 10-year cumulative metastatic rate of 34%. The most common site of metastasis is the liver (95%). Unfortunately, the current treatment of metastatic UM is limited by the lack of effective systemic therapy. Options for the management of the primary intraocular tumor include radical surgery as well as conservative treatments in order to preserve visual acuity. For metastatic disease, several approaches have been described with no standard method. Nevertheless, median survival after liver metastasis is poor, being around 4–6 months, with a 1-year survival of 10%–15%. In this review, the authors summarize current and promising new treatments for UM. PMID:24003303

Pereira, Patricia Rusa; Odashiro, Alexandre Nakao; Lim, Li-Anne; Miyamoto, Cristina; Blanco, Paula L; Odashiro, Macanori; Maloney, Shawn; De Souza, Dominique F; Burnier, Miguel N

2013-01-01

103

Is deep brain stimulation a treatment option for anorexia nervosa?  

PubMed Central

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

2013-01-01

104

Treatment options for vasomotor symptoms in menopause: focus on desvenlafaxine  

PubMed Central

Vasomotor symptoms (VMS), including hot flashes and night sweats, occur in as many as 68.5% of women as a result of menopause. While the median duration of these symptoms is 4 years, approximately 10% of women continue to experience VMS as many as 12 years after their final menstrual period. As such, VMS have a significant impact on the quality of life and overall physical health of women experiencing VMS, leading to their pursuance of treatment to alleviate these symptoms. Management of VMS includes lifestyle modifications, some herbal and vitamin supplements, hormonal therapies including estrogen and tibolone, and nonhormonal therapies including clonidine, gabapentin, and some of the serotonin and serotonin–norepinephrine reuptake inhibitors. The latter agents, including desvenlafaxine, have been the focus of increased research as more is discovered about the roles of serotonin and norepinephrine in the thermoregulatory control system. This review will include an overview of VMS as they relate to menopause. It will discuss the risk factors for VMS as well as the proposed pathophysiology behind their occurrence. The variety of treatment options for VMS will be discussed. Focus will be given to the role of desvenlafaxine as a treatment option for VMS management. PMID:22870045

Umland, Elena M; Falconieri, Laura

2012-01-01

105

Treatment options of inflammatory appendiceal masses in adults.  

PubMed

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

Tannoury, Jenny; Abboud, Bassam

2013-07-01

106

Surgical versus non-surgical management for primary patellar dislocations: an up-to-date meta-analysis.  

PubMed

The aim of this up-to-date meta-analysis was to compare the effects of surgical versus non-surgical treatment of patients following primary patellar dislocation and to provide the best evidence currently available. A comprehensive literature search was conducted using multiple databases, including Medline, Embase, and Cochrane Registry of Clinical Trials. All databases were searched from the earliest records to May 2013. Eligible studies were selected, and data were extracted by two independent investigators. The primary outcome variable was the frequency of recurrent patellar dislocation. The other outcomes included knee function scores, patient-rated outcomes, and radiographic examination. If appropriate, meta-analysis of these variables was performed. Nine independent trials were found to match the inclusion criteria. The pooled results demonstrated that the incidence of recurrent patellar dislocation and Hughston visual analog scale was significantly lower in the surgical treatment group than that in the non-surgical treatment group (P < 0.05). There was no statistically significant difference between the two treatment groups in frequency of subsequent surgical interventions, percentage of excellent or good subjective opinion, Kujala score, pain score on visual analog scale, and severity of patellofemoral joint osteoarthrosis (P > 0.05). This up-to-date meta-analysis indicates that surgical treatment was associated with a lower risk of recurrent patellar dislocation, but a lower Hughston VAS than non-surgical treatment for primary patellar dislocation. More large high-quality trials and further studies are needed to overcome the limitations of small sample sizes, and varieties of different surgical procedures or non-surgical management strategies adopted in the included trials. PMID:24390042

Zheng, Xiaozuo; Kang, Kai; Li, Tong; Lu, Bo; Dong, Jiangtao; Gao, Shijun

2014-12-01

107

Current options for treatment of chronic coronary artery disease  

PubMed Central

The primary issues must be discussed regarding the decision making of treating a patient with chronic coronary artery disease (CAD), are the appropriateness of revascularization and the method which will be applied. The criteria will be the symptoms, the evidence of ischemia and the anatomical complexity of the coronary bed. Main indications are persistence of symptoms, despite oral medical treatment and the prognosis of any intervention. The prognosis is based on left ventricular function, on the number of coronary arteries with significant stenosis and the ischemic burden. For patients with symptoms and no evidence of ischemia, there is no benefit from revascularization. If ischemia is proven, revascularization is beneficial. If revascularization is decided, the next important issue must be taken under consideration is the choice of the appropriate method to be applied, surgical or interventional approach. Current treatment options will be presented. PMID:24672695

Prapas, Sotirios N.; Tsakiridis, Kosmas; Katsikogiannis, Nikolaos; Tsiouda, Theodora; Sakkas, Antonios; Zarogoulidis, Konstantinos

2014-01-01

108

Migraine pathogenesis and state of pharmacological treatment options  

PubMed Central

Migraine is a largely inherited disorder of the brain characterized by a complex, but stereotypical, dysfunction of sensory processing. Often the most obvious clinical symptom is head pain, but non-headache symptoms such as photophobia, phonophobia and nausea are clearly part of the typical presentation. This review discusses the current pathophysiological concepts of migraine and migraine aura, such as a possible brainstem dysfunction and cortical spreading depression. Acute and preventive migraine treatment approaches are briefly covered with a focus on shortcomings of the currently available treatment options. A number of different receptors, such as calcitonin gene-related peptide (CGRP), TRPV1 and glutamate receptors, are currently being targeted by potential novel migraine therapeutics. The prospects of this research are exciting and are likely to improve patient care. PMID:19917094

2009-01-01

109

New treatment options for the management of restless leg syndrome.  

PubMed

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

Toro, Beatriz Elizabeth Carmona

2014-08-01

110

Current and emerging treatment options for Peyronie's disease  

PubMed Central

Peyronie’s 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 3–9% 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

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

2013-01-01

111

Treatment options in Alzheimer's disease: maximizing benefit, managing expectations.  

PubMed

Alzheimer's disease (AD) is becoming an increasingly heavy burden on the society of developed countries, and physicians now face the challenge of providing efficient treatment regimens to an ever-higher number of individuals affected by the disease. Currently approved anti-AD therapies - the cholinesterase inhibitors and the N-methyl-D-aspartate receptor antagonist memantine - offer modest symptomatic relief, which can be enhanced using combination therapy with both classes of drugs. Additionally, alternative therapies such as nonsteroidal anti-inflammatory drugs, vitamin E, selegiline, Ginkgo biloba extracts, estrogens, and statins, as well as behavioral and lifestyle changes, have been explored as therapeutic options. Until a therapy is developed that can prevent or reverse the disease, the optimal goal for effective AD management is to develop a treatment regimen that will yield maximum benefits for individual patients across multiple domains, including cognition, daily functioning, and behavior, and to provide realistic expectations for patients and caregivers throughout the course of the disease. This review provides a basic overview of approved AD therapies, discusses some pharmacologic and nonpharmacologic treatment strategies that are currently being investigated, and offers suggestions for optimizing treatment to fit the needs of individual patients. PMID:18391487

Farlow, Martin R; Miller, Michael L; Pejovic, Vojislav

2008-01-01

112

Lung transplantation in India: a possible treatment option.  

PubMed

The burden of chronic respiratory diseases in India is on the rise, accounting for nearly 1 in 10 deaths. Chronic obstructive pulmonary disease is highly prevalent in India and is projected to be the third leading cause of deaths worldwide by 2020. Improved access to healthcare and better imaging modalities have led to an increase in the diagnosis of pulmonary fibrosis and cystic fibrosis in India. For these end-stage lung diseases, lung transplantation is an effective and established treatment option in North America and Europe. The indications, techniques, outcomes and complications of lung transplantation are well documented. The criteria for recipient/donor selection are now better defined and the surgical technique has improved over the past 2 decades. Based on our experience of setting up a lung transplantation programme, we have outlined the resources required for the perioperative and postoperative management of such patients. PMID:19320322

Parekh, Kalpaj R; Adusumilli, Prasad S; Patterson, G Alexander

2008-01-01

113

An emerging treatment option for glaucoma: Rho kinase inhibitors  

PubMed Central

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

Wang, Sean K; Chang, Robert T

2014-01-01

114

Philadelphia-positive acute lymphoblastic leukemia: current treatment options.  

PubMed

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

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

2012-10-01

115

Philadelphia-Positive Acute Lymphoblastic Leukemia: Current Treatment Options  

PubMed Central

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

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

2014-01-01

116

Inflammation in suicidality: implications for novel treatment options.  

PubMed

Suicide is an increasing health problem worldwide and the most severe complication of multiple psychiatric disorders. It is also prevalent in several somatic conditions. In recent years, significant advances have been made in understanding the neurobiology of suicidal behaviors. Several lines of evidence have emerged suggesting that inflammation may contribute to the pathophysiology of suicide. Basic and clinical data indicate that the effects of inflammation on mood and behavior are likely to be mediated by the kynurenine pathway metabolites and glutamatergic neurotransmission. At the same time, the triggers of inflammatory changes observed in suicidal patients are largely unknown but may include stress, infectious agents and autoimmune diseases. As available treatment options against suicidality are only moderately effective, targeting the inflammatory system may provide novel therapeutic opportunities. For this goal to be achieved, however, we need to gain better insight into the origin, mechanisms and outcomes of inflammation in suicidal behavior. PMID:25224900

Janelidze, Shorena; Brundin, Lena

2013-01-01

117

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

PubMed Central

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

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

2014-01-01

118

Respiratory syncytial virus: current and emerging treatment options  

PubMed Central

Respiratory syncytial virus (RSV) is an important respiratory pathogen in infants and children worldwide. Although RSV typically causes mild upper respiratory infections, it frequently causes severe morbidity and mortality, especially in premature infants and children with other chronic diseases. Treatment of RSV is limited by a lack of effective antiviral treatments; however, ribavirin has been used in complicated cases, along with the addition of intravenous immune globulin in specific patients. Vaccination strategies for RSV prevention are heavily studied, but only palivizumab (Synagis®) has been approved for use in the United States in very select patient populations. Research is ongoing in developing additional vaccines, along with alternative therapies that may help prevent or decrease the severity of RSV infections in infants and children. To date, we have not seen a decrement in RSV morbidity and mortality with our current options; therefore, there is a clear need for novel RSV preventative and therapeutic strategies. In this review, we discuss the current and evolving trends in RSV treatment for infants and children. PMID:24812523

Turner, Tiffany L; Kopp, Benjamin T; Paul, Grace; Landgrave, Lindsay C; Hayes, Don; Thompson, Rohan

2014-01-01

119

Review article: current treatment options and management of functional dyspepsia  

PubMed Central

SUMMARY Background Functional dyspepsia (FD), a common functional gastrointestinal disorder, is defined by the Rome III criteria as symptoms of epigastric pain or discomfort (prevalence in FD of 89–90%), postprandial fullness (75–88%), and early satiety (50–82%) within the last 3 months with symptom onset at least 6 months earlier. Patients cannot have any evidence of structural disease to explain symptoms and predominant symptoms of gastroesophageal reflux are exclusionary. Symptoms of FD are non-specific and the pathophysiology is diverse, which explains in part why a universally effective treatment for FD remains elusive. Aim To present current management options for the treatment of FD (therapeutic gain/response rate noted when available). Results The utility of Helicobacter pylori eradication for the treatment of FD is modest (6–14% therapeutic gain), while the therapeutic efficacy of proton pump inhibitors (PPI) (7–10% therapeutic gain), histamine-type-2-receptor antagonists (8–35% therapeutic gain), prokinetic agents (18–45%), tricyclic antidepressants (TCA) (response rates of 64–70%), serotonin reuptake inhibitors (no better than placebo) is limited and hampered by inadequate data. This review discusses dietary interventions and analyses studies involving complementary and alternative medications, and psychological therapies. Conclusions A reasonable treatment approach based on current evidence is to initiate therapy with a daily PPI in H. pylori-negative FD patients. If symptoms persist, a therapeutic trial with a tricyclic antidepressant may be initiated. If symptoms continue, the clinician can possibly initiate therapy with an antinociceptive agent, a prokinetic agent, or some form of complementary and alternative medications, although evidence from prospective studies to support this approach is limited. PMID:22591037

Lacy, B. E.; Talley, N. J.; Locke, G. R.; Bouras, E. P.; DiBaise, J. K.; El-Serag, H. B.; Abraham, B. P.; Howden, C. W.; Moayyedi, P.; Prather, C.

2014-01-01

120

Pregnancy-associated breast cancer: optimal treatment options  

PubMed Central

Cancer is diagnosed approximately once per 1,000 pregnancies; most commonly due to the reproductive age of the women, these include breast, cervical, melanoma, thyroid, and Hodgkin’s lymphoma diagnoses. As a single diagnosis, breast cancer is the most common cancer diagnosed during pregnancy. Cancer is expected to complicate pregnancy more often due to the trend for women to delay child bearing to later maternal ages. Delayed first birth is itself a risk factor for breast cancer. Termination of pregnancy has not been shown to afford a survival benefit. While protecting the interests of mother and unborn fetus, breast cancer can be safely diagnosed, staged, and treated during pregnancy with good outcomes for both. Some modification of the protocols used for nonpregnant women with suspicious palpable breast masses is required. This article reviews the challenges for physicians in making the diagnosis of breast cancer during pregnancy and upon diagnosis, counseling patients about treatment options. The consequences of diagnostic investigations and cancer treatment for the exposed fetus are also addressed.

Cardonick, Elyce

2014-01-01

121

How multidrug resistance in typhoid fever affects treatment options.  

PubMed

Salmonella enterica serotype Typhi (S. Typhi) is an enteric pathogen that causes typhoid fever. The infection can be severe, with significant morbidity and mortality, requiring antimicrobial therapy. Cases of S. Typhi infection in the United States and other developed countries are often associated with travel to endemic regions. The empirical use of first-line drugs for therapy, including ampicillin, chloramphenicol, and trimethoprim/sulfamethoxazole, has resulted in transmissible multidrug resistance. With the global increase in multidrug-resistant S. Typhi, use of ciprofloxacin, with excellent oral absorption, few side effects, and cost-effectiveness, has become popular for treatment. However, decreased ciprofloxacin susceptibility due to point mutations in the S. Typhi genes gyrA and/or parC has caused treatment failures, necessitating alternative therapeutic options. S. Typhi is typically genetically homogenous, with phylogenetic and epidemiological studies showing that identical clones and diverse S. Typhi types often coexist in the same geographic region. Studies investigating point mutations have demonstrated that selective pressure from empirical use of first-line drugs and fluoroquinolones has led to the global emergence of haplotype H-58. Antibiotic resistance is subject to high selective pressure in S. Typhi and thus demands careful use of antimicrobials. PMID:25069595

Tatavarthy, Aparna; Luna, Vicki A; Amuso, Philip T

2014-09-01

122

Meticillin-resistant Staphylococcus pseudintermedius: clinical challenge and treatment options.  

PubMed

Meticillin-resistant Staphylococcus pseudintermedius (MRSP) has emerged as a major therapeutic challenge for small animal veterinarians over the past 10 years and continues to spread worryingly in many countries. This review focuses on the clinical aspects of MRSP infections seen in patients with skin disease and on currently available treatment options. In addition, it discusses the implications for in-contact people, other animals and the environment, because infection control strategies are likely to have a significant impact on treatment success and prevention of spread. There is currently no indication that MRSP is more virulent than meticillin-susceptible S. pseudintermedius, and reported infections have mostly been treated successfully, although possibly with a longer time to resolution than infections with more susceptible S. pseudintermedius. However, in vitro testing of MRSP isolates indicates resistance to most or all antibacterial agents licensed for use in pets. Based on susceptibility results, the most useful systemic antimicrobials may include chloramphenicol, rifampicin, amikacin, clindamycin and/or minocycline. Adverse effects of some of these medications may limit their usefulness. While in vitro susceptibility to vancomycin and linezolid is reported by some laboratories, use of these drugs in animals is strongly discouraged because of ethical considerations. Aggressive topical therapy has been effective as the only treatment in certain cases. Awareness, continued research and comprehensive management of infections are required by veterinary practitioners not only to help treat infected animals but also to limit the spread and prevent the establishment of this highly drug-resistant and zoonotic pathogen in veterinary facilities and in the community. PMID:22486942

Frank, Linda A; Loeffler, Anette

2012-08-01

123

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

PubMed Central

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

Damin, Daniel C; Lazzaron, Anderson R

2014-01-01

124

Arsenic Contaminated Groundwater and Its Treatment Options in Bangladesh  

PubMed Central

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

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

2012-01-01

125

ESPEN Guidelines on Parenteral Nutrition: non-surgical oncology.  

PubMed

Parenteral nutrition offers the possibility of increasing or ensuring nutrient intake in patients in whom normal food intake is inadequate and enteral nutrition is not feasible, is contraindicated or is not accepted by the patient. These guidelines are intended to provide evidence-based recommendations for the use of parenteral nutrition in cancer patients. They were developed by an interdisciplinary expert group in accordance with accepted standards, are based on the most relevant publications of the last 30 years and share many of the conclusions of the ESPEN guidelines on enteral nutrition in oncology. Under-nutrition and cachexia occur frequently in cancer patients and are indicators of poor prognosis and, per se, responsible for excess morbidity and mortality. Many indications for parenteral nutrition parallel those for enteral nutrition (weight loss or reduction in food intake for more than 7-10 days), but only those who, for whatever reason cannot be fed orally or enterally, are candidates to receive parenteral nutrition. A standard nutritional regimen may be recommended for short-term parenteral nutrition, while in cachectic patients receiving intravenous feeding for several weeks a high fat-to-glucose ratio may be advised because these patients maintain a high capacity to metabolize fats. The limited nutritional response to the parenteral nutrition reflects more the presence of metabolic derangements which are characteristic of the cachexia syndrome (or merely the short duration of the nutritional support) rather than the inadequacy of the nutritional regimen. Perioperative parenteral nutrition is only recommended in malnourished patients if enteral nutrition is not feasible. In non-surgical well-nourished oncologic patients routine parenteral nutrition is not recommended because it has proved to offer no advantage and is associated with increased morbidity. A benefit, however, is reported in patients undergoing hematopoietic stem cell transplantation. Short-term parenteral nutrition is however commonly accepted in patients with acute gastrointestinal complications from chemotherapy and radiotherapy, and long-term (home) parenteral nutrition will sometimes be a life-saving maneuver in patients with sub acute/chronic radiation enteropathy. In incurable cancer patients home parenteral nutrition may be recommended in hypophagic/(sub)obstructed patients (if there is an acceptable performance status) if they are expected to die from starvation/under nutrition prior to tumor spread. PMID:19477052

Bozzetti, F; Arends, J; Lundholm, K; Micklewright, A; Zurcher, G; Muscaritoli, M

2009-08-01

126

569. Gene Therapy of Uterine Leiomyoma: Adenovirus-Mediated Herpes Simplex Virus Thymidine Kinase\\/Ganciclovir Treatment Inhibits Growth of Human and Rat Leiomyoma Cells In Vitro and in a Nude Mouse Model  

Microsoft Academic Search

BACKGROUND: Leiomyomas (fibroids) are the most common uterine tumors that affect a high percentage of reproductive aged women. Lack of effective and safe non-surgical treatment is a challenge in the management of this disorder. Currently, hysterectomy remains the main stay treatment. However, this option is not alwaysappropriate or desirable treatment especially for women who want to preserve their fertility. Thus,

Salama A. Salama; Marwa W. Kamel; Gregory M. Christman; Hui Q. Wang; Ayman A. Al-Hendy

2006-01-01

127

Treatment options and outcomes for glioblastoma in the elderly patient  

PubMed Central

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

Arvold, Nils D; Reardon, David A

2014-01-01

128

Treatment options for chronic abdominal pain in children and adolescents.  

PubMed

Chronic abdominal pain is a common feature of most functional gastrointestinal disorders in children, including functional abdominal pain (FAP) and irritable bowel syndrome (IBS). FAP can impair a child's life and often leads to significant school absences. Although the underlying mechanism is likely multifactorial, early pain experiences during a vulnerable period in the developing nervous system can cause long-term changes in the brain-gut axis and ultimately may result in altered pain pathways and visceral hyperalgesia. Care providers often feel uncomfortable managing patients with chronic abdominal pain, as the pathophysiology is poorly understood, and limited data exist regarding safety and efficacy of therapeutic options in children. The primary goal of therapy in FAP is to alleviate pain symptoms and to help the child return to normal daily activities. Treatment should be individualized and chosen based on the severity of symptoms, the existence of comorbid psychological disorders, and the impact the disorder has on the child's school attendance and normal functioning. Various psychological interventions, such as cognitive-behavioral therapy, hypnosis, and guided imagery, have been successfully used in children with chronic abdominal pain. Pharmacologic therapies such as H(2) blockers, proton-pump inhibitors, tricyclic antidepressants, and various serotonergic drugs have been used, but good controlled trials are lacking. More studies are clearly needed to investigate the benefits and safety of pharmacologic therapy in children. Newer pharmacologic agents that target specific receptors involved in nociception, stress, and neurogenic inflammation currently are being developed. Future targets for visceral hyperalgesia should not only be aimed at alleviating symptoms but also should include prevention, particularly in cases with a suspected sensitizing event such as neonatal pain and postinfectious IBS. PMID:16942666

Miranda, Adrian; Sood, Manu

2006-09-01

129

A comparison between non-surgical and laparoscopic embryo collection and transfer in goats  

E-print Network

commercial trial involving 252 angora and 84 cashmere goats. The numbers of ovulations were not known, therefore, the recovery rate was not calculated. Hays, (1988) collected goat embryos non-surgically 5 days after breeding. The flushing device was made... commercial trial involving 252 angora and 84 cashmere goats. The numbers of ovulations were not known, therefore, the recovery rate was not calculated. Hays, (1988) collected goat embryos non-surgically 5 days after breeding. The flushing device was made...

Flores-Foxworth, Ana Gabriela

2012-06-07

130

Visual Aids for Multimodal Treatment Options to Support Decision Making of Patients with Colorectal Cancer  

PubMed Central

Background A variety of multimodal treatment options are available for colorectal cancer and many patients want to be involved in decisions about their therapies. However, their desire for autonomy is limited by lack of disease-specific knowledge. Visual aids may be helpful tools to present complex data in an easy-to-understand, graphic form to lay persons. The aim of the present study was to evaluate the treatment preferences of healthy persons and patients using visual aids depicting multimodal treatment options for colorectal cancer. Methods We designed visual aids for treatment scenarios based on four key studies concerning multimodal treatment of colorectal cancer. The visual aids were composed of diagrams depicting outcome parameters and side effects of two treatment options. They were presented to healthy persons (n?=?265) and to patients with colorectal cancer (n?=?102). Results Most patients and healthy persons could make immediate decisions after seeing the diagrams (range: 88% – 100%). Patients (79%) chose the intensive-treatment option in the scenario with a clear survival benefit. In scenarios without survival benefit, all groups clearly preferred the milder treatment option (range: 78% - 90%). No preference was seen in the scenario depicting equally intense treatment options with different timing (neoadjuvant vs. adjuvant) but without survival benefit. Conclusions Healthy persons’ and patients’ decisions using visual aids seem to be influenced by quality-of-life aspects rather than recurrence rates especially in situations without survival benefit. In the future visual aids may help to improve the management of patients with colorectal cancer. PMID:23092310

2012-01-01

131

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

PubMed Central

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

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

2014-01-01

132

Treatment options in surgical management of breast cancer.  

PubMed

The surgical approach to primary operable breast cancer has changed greatly within the past millenium. In the last 20 years collaborative patient trials have generated a wealth of valuable information that now allows us the opportunity to offer women a number of surgical options where before there was only one. The long awaited results of the chemoprevention trials will almost certainly change our surgical approach even further. Many questions regarding the management of breast cancer remain unanswered. PMID:8907821

Edney, J A

1996-03-01

133

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

PubMed Central

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 ? 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

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

2010-01-01

134

Treatment Options for ADHD in Children and Teens: A Review of Research for Parents and Caregivers  

MedlinePLUS

... Consumer Summary – Jun. 26, 2012 Treatment Options for ADHD in Children and Teens: A Review of Research ... adhdtreatment.cfm . Understanding Your Child’s Condition What is attention deficit hyperactivity disorder (ADHD)? ADHD is a disorder that has three ...

135

Fertility-Preserving Treatment Options in Patients with Malignant Hematological Diseases  

PubMed Central

The number of patients of reproductive age diagnosed with various malignant hematological diseases increases every year. These patients undergo chemotherapy, radiotherapy, and various other treatments that may have gonadotoxic effects. The life expectancy of these patients is increasing rapidly due to the variety of treatment options. As such, an increasing number of patients—as well as their parents and spouses—express their concerns about the patient’s fertility post treatment. In the present review it was aimed to provide an overview of current fertility-preserving treatment options and the future of fertility preservation. PMID:24744663

Küçük, Mert; Bolaman, Ali Zahit; Yava?o?lu, ?rfan; Kad?köylü, Gürhan

2012-01-01

136

Waste battery treatment options: Comparing their environmental performance  

Microsoft Academic Search

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

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

2009-01-01

137

Femoral shaft fractures in adults: treatment options and controversies.  

PubMed

Antegrade reamed femoral nailing via the piriformis entry point is the technique of choice in treating femoral shaft fractures, with retrograde nailing as an alternative. The supine position is favored to reduce complications, especially rotational malalignment. With navigation and robotic assistance fracture reduction can be supported and the rate of rotational, axis and length malalignement can potentially further reduced. Careful reaming is the procedure of choice to optimize bony healing and reduce systemic and local complications. In multiply injured patients reamed nailing can be safely integrated in the DCO- or ETC-concept and can be performed in the majority of patients, even when additional severe chest and head injuries are present. Initial resuscitation should focus on general stabilization before definitive femur fixation. Plate osteosynthesis of the femur can be an option in selected patients. PMID:25105784

Gänsslen, A; Gösling, T; Hildebrand, F; Pape, H C; Oestern, H J

2014-01-01

138

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 ...

139

Rates of clinically apparent heparin-induced thrombocytopenia for unfractionated heparin vs. low molecular weight heparin in non-surgical patients are low and similar  

Microsoft Academic Search

With the growing use of low-molecular-weight heparins (LMWH) for the treatment and prevention of venous thromboembolism (VTE), it is important to provide an evidence-based comparison with unfractionated heparin (UFH) concerning rates of heparin-induced thrombocytopenia (HIT). Such comparisons are essential in clinical decision-making and cost-modeling. In this paper we review data regarding non-surgical (medical) patients. We conclude that the lack of

Charles FS Locke; John Dooley; Jonathan Gerber

2005-01-01

140

Current and emerging options for the drug treatment of narcolepsy.  

PubMed

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

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

2013-11-01

141

Ballast water treatment technologies: hydrocyclonic a viable option  

Microsoft Academic Search

Many governments, international maritime environmental entities and public health organizations have recognized the environmental,\\u000a economic and health threats caused by the translocation and release of ballast water. A wide variety of ballast water treatment\\u000a systems are available at both commercial and under evaluation levels. The available ballast water treatment technologies are\\u000a reviewed. This work reviews the various types of technologies

Mazen M. Abu-Khader; Omar Badran; Menwer Attarakih

2011-01-01

142

Pityriasis rubra pilaris: evolution of challenges in promising treatment options.  

PubMed

Pityriasis rubra pilaris is an uncommon inflammatory dermatosis that is well recognized across the globe. Erythroderma is a common presentation. A precise diagnosis of pityriasis rubra pilaris is based on morphologic features and is classified into 6 types: classic adult onset (type I), atypical adult (type II), classic juvenile (type III), circumscribed juvenile (type IV), atypical juvenile (type V), and human immunodeficiency virus-associated (type VI). Several conventional systemic and/or topical treatments are currently in use. Largely, their results are unsatisfactory and limited by long-term toxicity. The authors investigate the efficacy of a wide spectrum of drugs by examining historical (archive) and promising (modern) treatment modalities for the treatment of pityriasis rubra pilaris. PMID:22324172

Sehgal, Virendra N; Srivastava, Govind; Verma, Prashant

2012-01-01

143

Treatment options for second-stage gambiense human African trypanosomiasis.  

PubMed

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

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

2014-11-01

144

Ingenol mebutate: a new option for actinic keratosis treatment.  

PubMed

Actinic keratosis, one of the most common dermatological pathologies manifests as ultraviolet- or sun-induced macules, papules or plaques, and is considered a biomarker for the risk of skin cancer. Ingenol mebutate (Picato®), extracted from the sap of the Euphorbia peplus plant, is a small molecule with a unique mechanism of action involving direct cytotoxicity and immune stimulation. In 2012, ingenol mebutate was approved by the FDA and the EMA for the treatment of actinic keratosis. In phase III trials, ingenol mebutate gel applied topically once daily at 0.015% for 3 days or 0.05% for 2 days, respectively, significantly reduced head and non-head actinic keratosis lesions. Adverse events were mostly mild or moderate. Local skin responses elicited by the treatment, i.e., erythema, flaking/scaling and crusting, were transient, and resolved spontaneously without sequelae. Adherence to the therapy can be facilitated by the short duration of the treatment. PMID:23362492

Gras, J

2013-01-01

145

Relapsed small cell lung cancer: treatment options and latest developments  

PubMed Central

According to recent analyses, there was a modest yet significant improvement in median survival time and 5-year survival rate of limited stage small cell lung cancer (SCLC) in North America, Europe, Japan and other countries over the last 30 years. The median survival time of limited stage SCLC is 15–20 months and 5-year survival rate is 15% or less. In terms of extensive stage SCLC, a median survival time of 9.4–12.8 months and 2-year survival of 5.2–19.5% are still disappointing. Despite being highly sensitive to first-line chemotherapy and radiotherapy treatments, most patients with SCLC experience relapse within 2 years and die from systemic metastasis. While several clinical trials of cytotoxic chemotherapies and molecular targeting agents have been investigated in the treatment of relapsed SCLC, none showed a significant clinical activity to be able to exceed topotecan as second-line chemotherapy. There are problematic issues to address for relapsed SCLC, such as standardizing the treatment for third-line chemotherapy. Topotecan alone was the first approved therapy for second-line treatment for relapsed SCLC. Amrubicin is a promising drug and a variety of trials evaluating its efficacy have been carried out. Amrubicin has shown superiority to topotecan in a Japanese population, but was not superior in a study of western patients. There are some controversial issues for relapsed SCLC, such as treatment for older patients, third-line chemotherapy and efficacy of molecular targeting therapy. This article reviews current standard treatment, recent clinical trials and other topics on relapsed SCLC. PMID:24587832

Ohkuni, Yoshihiro; Kaneko, Norihiro; Yamaguchi, Etsuro; Kubo, Akihito

2014-01-01

146

Fungal infections of the skin and nail: new treatment options.  

PubMed

Knowledge of the currently available antifungal agents, along with clinical, microbiologic and histopathologic methods, can help the medical professional optimally manage skin and nail fungal infections. With regards to treatment of fungal disease of the skin or nail, there are a variety of systemic antifungal agents, including several newer agents that have different formulations, tolerability, adverse effect profiles and spectrum of activity. This review will highlight the clinically important fungal infections of the skin and nail and describe the activity and role of antifungal treatment. PMID:25241767

Eldridge, Matthew L; Chambers, Cindy J; Sharon, Victoria R; Thompson, George R

2014-11-01

147

Managing chronic thromboembolic pulmonary hypertension: pharmacological treatment options  

Microsoft Academic Search

Chronic thromboembolic pulmonary hypertension (CTEPH) is a life-threatening condition in which organised thrombi obstruct the pulmonary vessels, causing increased pulmonary vascular resistance, progressive pulmonary hypertension (PH) and right heart failure. The treatment of choice is pulmonary endarterectomy, which restores pulmonary haemodynamics with acceptable periprocedural mortality rates in the majority of suitable patients. However, CTEPH may be inoperable owing to surgically

I. M. Lang

2009-01-01

148

Weight-loss maintenance in successful weight losers: surgical vs non-surgical methods  

Microsoft Academic Search

Objective:As large weight losses are rarely achieved through any method except bariatric surgery, there have been no studies comparing individuals who initially lost large amounts of weight through bariatric surgery or non-surgical means. The National Weight Control Registry (NWCR) provides a resource for making such unique comparisons. This study compared the amount of weight regain, behaviors and psychological characteristics in

D S Bond; S Phelan; T M Leahey; J O Hill; R R Wing

2009-01-01

149

Multidisciplinary Treatment Options of Tooth Avulsion Considering Different Therapy Concepts  

PubMed Central

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

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

2014-01-01

150

Pharmacologic treatments for opioid dependence: detoxification and maintenance options  

PubMed Central

While opioid dependence has more treatment agents available than other abused drugs, none are curative. They can, however, markedly diminish withdrawal symptoms and craving, and block opioid effects due to lapses. The most effective withdrawal method is substituting and tapering methadone or buprenorphine, ?-2 Adrenergic agents can ameliorate untreated symptoms or substitute for agonists if not available. Shortening withdrawal by precipitating it with narcotic antagonists has been studied, but the methods are plagued by safety issues or persisting symptoms. Neither the withdrawal agents nor the methods are associated with better long-term outcome, which appears mostly related to post-detoxification treatment. Excluding those with short-term habits, the best outcome occurs with long-term maintenance on methadone or buprenorphine accompanied by appropriate psychosocial interventions. Those with strong external motivation may do well on the antagonist naltrexone. Currently, optimum duration of maintenance on either is unclear. Better agents are needed to impact the brain changes related to addiction. PMID:18286804

Kleber, Herbert D.

2007-01-01

151

Nephrolithiasis-associated bone disease: pathogenesis and treatment options  

PubMed Central

Nephrolithiasis remains a formidable health problem in the United States and worldwide. A very important but underaddressed area in nephrolithiasis is the accompanying bone disease. Epidemiologic studies have shown that osteoporotic fractures occur more frequently in patients with nephrolithiasis than in the general population. Decreased bone mineral density and defects in bone remodeling are commonly encountered in patients with calcium nephrolithiasis. The pathophysiologic connection of bone defects to kidney stones is unknown. Hypercalciuria and hypocitraturia are two important risk factors for stone disease, and treatments with thiazide diuretics and alkali, respectively, have been shown to be useful in preventing stone recurrence in small prospective trials. However, no studies have examined the efficacy of these agents or other therapies in preventing continued bone loss in calcium stone formers. This manuscript reviews the epidemiology, pathophysiology, and potential treatments of bone disease in patients with nephrolithiasis. PMID:21124301

Sakhaee, Khashayar; Maalouf, Naim M.; Kumar, Rajiv; Pasch, Andreas; Moe, Orson W.

2011-01-01

152

Patellofemoral pain: an update on diagnostic and treatment options.  

PubMed

Patellofemoral pain is a frequent and often challenging clinical problem. It affects females more than males and includes many different pathologic entities that result in pain in the anterior aspect of the knee. Diagnosis of the specific cause of pain can be difficult and requires assessment of lower extremity strength, alignment, and range of motion, as well as specific patella alignment, tracking, and mobility. The treatment for patellofemoral pain is usually conservative with anti-inflammatory medications, activity modification, and a specific physical therapy program focusing on strengthening and flexibility. Infrequently, surgical treatment may be indicated after a non-operative program fails. The outcomes of surgical management may include debridement, lateral release, and realignment of the extensor mechanism to unload the patellofemoral articulation are favorable. PMID:23456237

McCarthy, Moira M; Strickland, Sabrina M

2013-06-01

153

Lumbar spinal stenosis: treatment options for an aging population.  

PubMed

The fastest growing age group in the United States is the 45 and older population. Due to the nature of the aging lumbar spine, a significant majority of this population will experience low back pain (LBP) and symptoms associated with lumbar spinal stenosis. Accurate diagnosis and appropriate treatment is required if this particular aging group of our population is to maintain an active and productive life into their later years. PMID:23362650

Jackson, Roger P; McManus, Anne C; Moore, Jill

2012-01-01

154

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

PubMed Central

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

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

2013-01-01

155

Current treatment options for female urinary incontinence--a review.  

PubMed

Urinary incontinence is a prevalent condition that impacts many women's lives. Stress urinary incontinence (SUI), urine loss associated with exertion, typically has its onset during the reproductive years, whereas urge incontinence, urine loss associated with urgency, more frequently affects postmenopausal women. Mixed incontinence, a combination of stress and urge incontinence, affects up to 30% of incontinent women. Simple modifications such as dietary and fluid management, timed voiding, and adjustment of medications can lessen symptom severity and should be attempted prior to instituting other treatments. Physiotherapy, including pelvic floor exercises, biofeedback, and functional electrical stimulation, center on improving pelvic floor neuromuscular function, thus improving bladder and urethral function. Current pharmacologic treatments focus primarily on urge incontinence, anticholinergics being the mainstays of therapy. Local estrogen therapy may improve urethral and bladder function if a woman's incontinence is associated with urogenital atrophy. Surgery is primarily reserved for management of severe SUI. Minimally invasive sling procedures have replaced the Burch colposuspension as the most common surgeries performed for SUI, and appear to have similar success rates. Surgical therapies for refractory urge incontinence have been attempted with limited success. Many new, potentially more effective, treatments are being developed. PMID:15303311

Davila, G Willy; Guerette, Nathan

2004-01-01

156

Current and future systemic treatment options in metastatic pancreatic cancer  

PubMed Central

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

Arslan, Cagatay

2014-01-01

157

[Percutaneous vertebroplasty: option of treatment for osteoporotic vertebral fracture].  

PubMed

Percutaneous vertebroplasty (PV) is a minimally invasive procedure used to treat focal pain from compressive vertebral fracture. The PV is indicated for the treatment of debilitating vertebral pain from osteoporotic vertebral fractures, metastatic disease (osteolytic), myeloma and hemagioma. We analyzed the results of PV at 18 vertebrae of 11 patients. In 90.9% there war significant pain relief. The return to their usual activities at the first month occurred at 77.8% of the patients. According to the literature review and our study, PV is a promising therapy for selected cases. PMID:14513170

Figueiredo, Nicandro; Amaral Filho, José Carlos; Serra, Alexandre da Rocha; Nogueira, Anibal M; Garcia, Victor C Sano; Weissheimer, Fábio L

2003-09-01

158

Clostridium difficile infection: current, forgotten and emerging treatment options.  

PubMed

Clostridium difficile infection (CDI) has increased in incidence and severity, and is now among the most common nosocomial infections. Several agents are available for the initial treatment of CDI, some of which are rarely used, and none of which is clearly superior for initial clinical cure. Fidaxomicin appears to offer a benefit in terms of preventing recurrent disease, although the cost-benefit ratio is debated. Recurrent CDI is a major challenge, occurring after 15-30% of initial episodes. The treatment of recurrent CDI is difficult, with sparse evidence available to support any particular agent. Fecal microbiota therapy, also known as 'stool transplantation', appears to be highly effective, although availability is currently limited, and the regulatory environment is in flux. Synthetic stool products and an orally available fecal microbiota therapy product are both under investigation, which may address the problem of availability. As with most infectious diseases, an effective vaccine would be a welcome addition to our armamentarium, but none is currently available. PMID:25350805

Drekonja, Dimitri M

2014-09-01

159

Dosimetric Study of Current Treatment Options for Radiotherapy in Retinoblastoma  

SciTech Connect

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.

Eldebawy, Eman [Department of Radiation Oncology, McGill University Health Centre, Montreal, Quebec (Canada); Department of Radiation Oncology, Children's Cancer Hospital, Cairo (Egypt); Parker, William, E-mail: william.parker@mcgill.ca [Department of Medical Physics, McGill University Health Centre, Montreal, Quebec (Canada); Abdel Rahman, Wamied [Department of Medical Physics, McGill University Health Centre, Montreal, Quebec (Canada); Freeman, Carolyn R. [Department of Radiation Oncology, McGill University Health Centre, Montreal, Quebec (Canada)

2012-03-01

160

Managing pediatric hepatitis C: current and emerging treatment options  

PubMed Central

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

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

2009-01-01

161

Subacute sclerosing panencephalitis : diagnosis and drug treatment options.  

PubMed

Subacute sclerosing panencephalitis (SSPE) is a chronic progressive, usually fatal disease of uncertain pathogenesis that is associated with the presence of mutant measles virus in the CNS. The diagnosis is based on clinical criteria and an elevated titre of measles antibodies in the CSF. Electroencephalography, imaging studies and measles antibody synthesis rate in the CSF provide supportive laboratory data. When CSF studies are negative, a brain biopsy is indicated to assess the presence of inclusion bodies, measles virus antigens or viral RNA.Among the many drugs and methods tried in the treatment of SSPE, the highest rate of stabilisation or improvement has been obtained with intraventricular interferon-? (interferon-alfa) and oral inosine pranobex. Further research, including multicentre clinical trials, is warranted to identify more efficient therapeutic regimens. PMID:23338130

Anlar, B

1997-02-01

162

New Options for the Treatment of Fecal Incontinence  

PubMed Central

Fecal incontinence, the loss of anal sphincter control leading to the unwanted release of stool or gas, is a physical and psychological handicap that has a tremendous impact on an individual's quality of life. Although medical management is the mainstay of therapy for fecal incontinence, the main focus in this review is on invasive techniques with a goal of highlighting newer technologic and therapeutic advancements. While the standard surgical treatment for fecal incontinence still remains direct sphincter repair with an overlapping sphincteroplasty, this review concentrates specifically on biofeedback, the Procon incontinence device, local injection of synthetic materials, radio frequency energy (Secca procedure), antegrade colonic enemas, sphincteroplasty, gluteoplasty, graciloplasty both stimulated and non-stimulated, the artificial bowel sphincter, and sacral nerve stimulation. PMID:21603552

Margolin, David A.

2008-01-01

163

Treatment Options: Biological Basis of Regenerative Endodontic Procedures  

PubMed Central

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 since 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

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

2013-01-01

164

New treatment options for chronic constipation: Mechanisms, efficacy and safety  

PubMed Central

The present review has several objectives, the first of which is to review the pharmacology and selectivity of serotonergic agents to contrast the older serotonergic agents (which were withdrawn because of cardiac or vascular adverse effects) with the newer generation serotonin receptor subtype 4 agonists. Second, the chloride ion secretagogues that act through the guanylate cyclase C receptor are appraised and their pharmacology is compared with the approved medication, lubiprostone. Third, the efficacy and safety of the application of bile acid modulation to treat constipation are addressed. The long-term studies of surgically induced excess bile acid delivery to the colon are reviewed to ascertain the safety of this therapeutic approach. Finally, the new drugs for opiate-induced constipation are introduced. Assuming these drugs are approved, practitioners will have a choice; however, patient responsiveness will be based on trial and error. Nevertheless, the spectrum of mechanisms and demonstrated efficacy and safety augur well for satisfactory treatment outcomes. PMID:22114755

Camilleri, Michael

2011-01-01

165

Pramipexole Extended Release: A Novel Treatment Option in Parkinson's Disease  

PubMed Central

Pramipexole, the most commonly prescribed dopamine agonist worldwide, meanwhile serves as a reference substance for evaluation of new drugs. Based on numerous clinical data and vast experiences, efficacy and safety profiles of this non-ergoline dopamine agonist are well characterized. Since October 2009, an extended-release formulation of pramipexole has been available for symptomatic treatment of Parkinson's disease. Pramipexole administration can be cut down from three times to once a day due to the newly developed extended-release formulation. This is considerable progress in regard to minimizing pill burden and enhancing compliance. Moreover, the 24?h continuous drug release of the once-daily extended-release formulation results in fewer fluctuations in plasma concentrations over time compared to immediate-release pramipexole, given three times daily. The present study summarizes pharmacokinetics and all essential pharmacological and clinical characteristics of the extended-release formulation. In addition, it provides all study data, available so far, with regard to transition and de-novo administration of extended-release formulation for patients with Parkinson's disease. It further compares efficacy and safety data of immediate-release pramipexole with the extended-release formulation of pramipexole. PMID:21209705

Eisenreich, Wolfram; Sommer, Bernd; Hartter, Sebastian; Jost, Wolfgang H.

2010-01-01

166

Severe alcoholic hepatitis-current concepts, diagnosis and treatment options  

PubMed Central

Alcoholic hepatitis (AH) is an acute hepatic manifestation occurring from heavy alcohol ingestion. Alcoholic steatohepatitis (ASH) is histologically characterized by steatosis, inflammation, and fibrosis in the liver. Despite the wide range of severity at presentation, those with severe ASH (Maddrey’s discriminant function ? 32) typically present with fever, jaundice, and abdominal tenderness. Alcohol abstinence is the cornerstone of therapy for AH and, in the milder forms, is sufficient for clinical recovery. Severe ASH may progress to multi-organ failure including acute kidney injury and infection. Thus, infection and renal failure have a major impact on survival and should be closely monitored in patients with severe ASH. Patients with severe ASH have a reported short-term mortality of up to 40%-50%. Severe ASH at risk of early death should be identified by one of the available prognostic scoring systems before considering specific therapies. Corticosteroids are the mainstay of treatment for severe ASH. When corticosteroids are contraindicated, pentoxifylline may be alternatively used. Responsiveness to steroids should be assessed at day 7 and stopping rules based on Lille score should come into action. Strategically, future studies for patients with severe ASH should focus on suppressing inflammation based on cytokine profiles, balancing hepatocellular death and regeneration, limiting activation of the innate immune response, and maintaining gut mucosal integrity.

Kim, Won; Kim, Dong Joon

2014-01-01

167

Treatment options for refractory angina pectoris: enhanced external counterpulsation therapy.  

PubMed

Refractory angina pectoris, defined as angina refractory to maximal medical therapy and standard coronary revascularization procedures, remains a significant health problem in the United States and the world. Despite a panoply of recent therapeutic advances, patients with refractory angina pectoris are not adequately treated; therefore, scientists have been investigating new technologies to help these patients. The technique of counterpulsation, studied for almost half a century, is considered a safe, highly beneficial, low-cost, noninvasive treatment for these angina patients and now also for those with heart failure. Recent evidence suggests that enhanced external counterpulsation (EECP) therapy may improve symptoms and decrease long-term morbidity via several mechanisms, including improvement in endothelial function, promotion of collateralization, enhancement of ventricular function, improvement in oxygen consumption (Vo(2)), regression of atherosclerosis, and peripheral "training effects" similar to exercise. Numerous clinical trials in the past two decades have shown EECP therapy to be safe and effective for patients with refractory angina, with a clinical response rate averaging 70% to 80%, which is sustained up to 5 years. This review summarizes the current evidence to support EECP's use in treating refractory angina pectoris. PMID:19141261

Soran, Ozlem

2009-02-01

168

Sofosbuvir: A novel treatment option for chronic hepatitis C infection  

PubMed Central

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.

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

2014-01-01

169

Current options and new developments in the treatment of haemophilia.  

PubMed

Haemophilia A and B are X-linked bleeding disorders due to the inherited deficiency of factor VIII or factor IX, respectively. Of the approximately 1 per 5000-10000 male births affected by haemophilia, 80% are deficient in factor VIII and 20% are deficient in factor IX. Haemophilia is characterized by spontaneous and provoked joint, muscle, gastrointestinal and CNS bleeding leading to major morbidity and even mortality if left untreated or under-treated. The evolution of haemophilia management has been marked by tragedy and triumph over recent decades. Clotting factors and replacement strategies continue to evolve for patients without inhibitors. For patients with an inhibitor, factor replacement for acute bleeding episodes and immune tolerance, immune modulation and extracorporeal methods for inhibitor reduction are the cornerstone of care. In addition, adjuvant therapies such as desmopressin, antifibrinolytics and topical agents also contribute to improved outcomes for patients with and without inhibitors. The future direction of haemophilia care is promising with new longer-acting clotting factors and genetic therapies, including gene transfer and premature termination codon suppressors. With these current and future treatment modalities, the morbidity and mortality rates in patients with haemophilia certainly will continue to improve. PMID:21319868

Wong, Trisha; Recht, Michael

2011-02-12

170

Severe alcoholic hepatitis-current concepts, diagnosis and treatment options.  

PubMed

Alcoholic hepatitis (AH) is an acute hepatic manifestation occurring from heavy alcohol ingestion. Alcoholic steatohepatitis (ASH) is histologically characterized by steatosis, inflammation, and fibrosis in the liver. Despite the wide range of severity at presentation, those with severe ASH (Maddrey's discriminant function ? 32) typically present with fever, jaundice, and abdominal tenderness. Alcohol abstinence is the cornerstone of therapy for AH and, in the milder forms, is sufficient for clinical recovery. Severe ASH may progress to multi-organ failure including acute kidney injury and infection. Thus, infection and renal failure have a major impact on survival and should be closely monitored in patients with severe ASH. Patients with severe ASH have a reported short-term mortality of up to 40%-50%. Severe ASH at risk of early death should be identified by one of the available prognostic scoring systems before considering specific therapies. Corticosteroids are the mainstay of treatment for severe ASH. When corticosteroids are contraindicated, pentoxifylline may be alternatively used. Responsiveness to steroids should be assessed at day 7 and stopping rules based on Lille score should come into action. Strategically, future studies for patients with severe ASH should focus on suppressing inflammation based on cytokine profiles, balancing hepatocellular death and regeneration, limiting activation of the innate immune response, and maintaining gut mucosal integrity. PMID:25349640

Kim, Won; Kim, Dong Joon

2014-10-27

171

Evaluating the evidence on comparative effectiveness and value of management options for treatment-resistant depression.  

PubMed

Treatment-resistant depression (TRD) is a debilitating patient condition with significant clinical and economic impact. The introduction of a new treatment approach, repetitive transcranial magnetic stimulation (rTMS), created the opportunity for a multi-stakeholder initiative to examine the comparative clinical effectiveness and comparative value of the different approaches to managing patients with TRD. The New England Comparative Effectiveness Public Advisory Council (CEPAC) convened in December 2011 to discuss the evidence on management options for patients with TRD. The Council voted that rTMS was as good or better than usual care and represented a reasonable value compared with usual care. The votes and deliberation of CEPAC led to first-in-the-nation payer coverage policies allowing patients access to this new treatment option. Regional groups that examine and deliberate on the comparative effectiveness evidence for existing and emerging treatments can have a direct influence on medical policy that accelerates access to innovative treatments. PMID:24200756

Emond, Sarah K; Ollendorf, Daniel A; Colby, Jennifer A; Reed, Sarah Jane; Pearson, Steven D

2013-11-01

172

Therapeutical options for the treatment of Cheyne-Stokes respiration.  

PubMed

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

Randerath, Winfried J

2009-03-01

173

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

PubMed Central

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

Van Koughnett, Julie Ann M; Wexner, Steven D

2013-01-01

174

Zanamivir and oseltamivir: two new options for the treatment and prevention of influenza  

Microsoft Academic Search

Background: Influenza infection is responsible for thousands of hospitalizations and deaths in the United States each year. Until recently, management options were limited to vaccination or use of the antiviral agents amantadine and rimantadine. Two antiviral drugs, zanamivir and oseltamivir, have recently been approved by the US Food and Drug Administration for the treatment of influenza A and influenza B.Objective:

William B. Dreitlein; Julia Maratos; Joseph Brocavich

2001-01-01

175

Treatment of glomerulonephritis: Will we ever have options other than steroids and cytotoxics?  

Microsoft Academic Search

Treatment of glomerulonephritis: Will we ever have options other than steroids and cytotoxics? Glomerulonephritis refers to a collection of primary renal disorders and those secondary to a systemic disease, all characterized by inflammation within the glomerulus. Given the underlying immunologic nature of these disorders, they are routinely treated with corticosteriods and various cytotoxic agents. Although in many instances such therapies

BASIT JAVAID; Richard J. Quigg

2005-01-01

176

For patients with neurological disorders who have exhausted other treatment options, Chris Butson's  

E-print Network

For patients with neurological disorders who have exhausted other treatment options, Chris Butson otherwise perform basic tasks such as eating or drinking,"said Butson. One of the overarching goals of his treat disease progression," he said,"Without that detailed understanding, one is limited to treating

177

Non-pharmacological treatment options for refractory epilepsy: an overview of human treatment modalities and their potential utility in dogs.  

PubMed

Refractory epilepsy is a common disorder both in humans and dogs and treatment protocols are difficult to optimise. In humans, different non-pharmacological treatment modalities currently available include surgery, the ketogenic diet and neurostimulation. Surgery leads to freedom from seizures in 50-75% of patients, but requires strict patient selection. The ketogenic diet is indicated in severe childhood epilepsies, but efficacy is limited and long-term compliance can be problematic. In the past decade, various types of neurostimulation have emerged as promising treatment modalities for humans with refractory epilepsy. Currently, none of these treatment options are used in routine daily clinical practice to treat dogs with the condition. Since many dogs with poorly controlled seizures do not survive, the search for alternative treatment options for canine refractory epilepsy should be prioritised. This review provides an overview of non-pharmacological treatment options for human refractory epilepsy. The current knowledge and limitations of these treatments in canine refractory epilepsy is also discussed. PMID:24309438

Martlé, Valentine; Van Ham, Luc; Raedt, Robrecht; Vonck, Kristl; Boon, Paul; Bhatti, Sofie

2014-03-01

178

Ophthalmologic Findings in Patients with Non-Surgically Treated Blowout Fractures  

PubMed Central

We evaluated the ocular and visual status in a group of patients with a non-surgically treated blowout fracture. Clinical examination with refraction, test of binocular function, and tear film evaluation was performed in 23 patients. These values were statistically correlated with the orbital volume measurements and ocular finding from the patient records at presentation. About 50% of the study group was symptomatic due to low visual acuity from refractive errors and decompensated phorias as a consequence of the blowout fracture. Several patients displayed changes in tear film production. There was no strong correlation between the measured parameters and orbital volume measurements. Patients with a non-surgically treated blowout fracture often display ocular and visual changes after discharge. A routine visual exam is advocated in all patients after the ocular status has stabilized after a blowout fracture. PMID:23449855

Pansell, Tony; Alinasab, Babak; Westermark, Anders; Beckman, Mats; Abdi, Saber

2012-01-01

179

Are You Blue? What Can You Do? A Case Study on Treatment Options for Depression  

NSDL National Science Digital Library

This case study introduces students to treatment alternatives for depression using a jigsaw method in which groups of students are divided up so that each member of the “home group” becomes the “resident expert” in one of five possible treatment options. Designed for a course in abnormal psychology, this case could be adapted for courses in physiological psychology, pharmacy, and neurobiology.

Grossman, Robert W.; Pettigrew, Amy; Walsh, Linda; Boje, Kathleen

2002-01-01

180

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. ...

181

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

PubMed

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

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

2012-08-01

182

Operative and nonoperative treatment options for ACL tears in the adult patient: a conceptual review.  

PubMed

Injury to the anterior cruciate ligament (ACL) is common among athletic individuals. Both nonoperative and operative treatment options exist. The optimal treatment of an adult with an ACL tear depends on several patient-specific factors, including age, occupation, and desired activity level. In less active patients with sedentary jobs, nonoperative management, consisting of physical therapy, bracing, and activity modification can yield successful results. In active patients who want to resume participation in jumping, cutting, or pivoting sports, patients who have physically demanding occupations, or patients who fail a trial of nonoperative management, ACL reconstruction is recommended. Reconstruction utilizing autograft tissue is preferred over allograft, especially in the younger athlete, but allograft tissue is a reasonable option in the older (aged > 40 years) and less active adult, as well. Successful results have been achieved with both patellar tendon and hamstring grafts. The optimal treatment in adult patients with ACL tears should be based on careful consideration of the patient's goals for return to activity, knee-specific comorbidities, such as coexistent meniscal pathology or osteoarthritis, and his or her willingness to follow a detailed rehabilitation regimen. Our article provides an overview of current nonoperative and operative treatment options for adults with ACL tears, considers the outcomes of both nonoperative and operative strategies, and provides general recommendations as to the ideal management for a given patient. PMID:24231595

Bogunovic, Ljiljana; Matava, Matthew J

2013-11-01

183

Empiric treatment options in the management of complicated intra-abdominal infections.  

PubMed

Complicated intra-abdominal infections remain a major challenge for surgeons and internists because of their association with high morbidity and mortality. For optimal outcome, these infections require a combination of appropriate and timely surgical source control and adjunctive broad-spectrum antimicrobial therapy. This review discusses criteria for choosing empiric antimicrobial therapy, outlines available treatment options, and highlights new antimicrobial therapies for these infections. PMID:17847176

Weigelt, John A

2007-08-01

184

Arthroscopic treatment options for irreparable rotator cuff tears of the shoulder.  

PubMed

The management of patients with irreparable rotator cuff tears remains a challenge for orthopaedic surgeons with the final treatment option in many algorithms being either a reverse shoulder arthroplasty or a tendon transfer. The long term results of these procedures are however still widely debated, especially in younger patients. A variety of arthroscopic treatment options have been proposed for patients with an irreparable rotator cuff tear without the presence of arthritis of the glenohumeral joint. These include a simple debridement with or without a biceps tenotomy, partial rotator cuff repair with or without an interval slide, tuberplasty, graft interposition of the rotator cuff, suprascapular nerve ablation, superior capsule reconstruction and insertion of a biodegradable spacer (Inspace) to depress the humeral head. These options should be considered as part of the treatment algorithm in patients with an irreparable rotator cuff and could be used as either as an interim procedure, delaying the need for more invasive surgery in the physiologically young and active, or as potential definitive procedures in the medically unfit. The aim of this review is to highlight and summarise arthroscopic procedures and the results thereof currently utilised in the management of these challenging patients. PMID:25405083

Anley, Cameron M; Chan, Samuel Kl; Snow, Martyn

2014-11-18

185

Arthroscopic treatment options for irreparable rotator cuff tears of the shoulder  

PubMed Central

The management of patients with irreparable rotator cuff tears remains a challenge for orthopaedic surgeons with the final treatment option in many algorithms being either a reverse shoulder arthroplasty or a tendon transfer. The long term results of these procedures are however still widely debated, especially in younger patients. A variety of arthroscopic treatment options have been proposed for patients with an irreparable rotator cuff tear without the presence of arthritis of the glenohumeral joint. These include a simple debridement with or without a biceps tenotomy, partial rotator cuff repair with or without an interval slide, tuberplasty, graft interposition of the rotator cuff, suprascapular nerve ablation, superior capsule reconstruction and insertion of a biodegradable spacer (Inspace) to depress the humeral head. These options should be considered as part of the treatment algorithm in patients with an irreparable rotator cuff and could be used as either as an interim procedure, delaying the need for more invasive surgery in the physiologically young and active, or as potential definitive procedures in the medically unfit. The aim of this review is to highlight and summarise arthroscopic procedures and the results thereof currently utilised in the management of these challenging patients.

Anley, Cameron M; Chan, Samuel KL; Snow, Martyn

2014-01-01

186

Imiquimod therapy for extramammary Paget's disease of the vulva: a viable non-surgical alternative.  

PubMed

Extramammary Paget's disease (EMPD) is a rare intraepidermal adenocarcinoma that can affect the vulval skin. Surgical excision is the gold-standard treatment, however, recurrence rates are high and extensive excisions can produce long-lasting cosmetic and functional defects. We describe one of the largest case series to-date (n = 6) on the use of topical 5% imiquimod cream as a novel treatment option and discuss our experiences. With the addition of our six cases to the literature, there are now 29 documented cases of vulval EMPD treated with 5% imiquimod cream. Of these, 50% of primary disease cases and 73% of recurrent primary disease cases have achieved clinical resolution with 5% imiquimod therapy alone. These findings suggest that imiquimod provides a viable alternative to surgical excision for vulval EMPD. However, we acknowledge that this is a simple retrospective analysis and that treatment scheduling and follow-up needs investigation in a trial setting. PMID:23815201

Sanderson, P; Innamaa, A; Palmer, J; Tidy, J

2013-07-01

187

Current and emerging treatment options in the management of Friedreich ataxia.  

PubMed

Friedreich ataxia (FRDA) is the most common autosomal recessive ataxia. Oxidative damage within the mitochondria seems to have a key role in the disease phenotype. Therefore, FRDA treatment options have been mostly directed at antioxidant protection against mitochondrial damage. Available evidence seems to suggest that patients with FRDA should be treated with idebenone, because it is well tolerated and may reduce cardiac hypertrophy and, at higher doses, also improve neurological function, but large controlled clinical trials are still needed. Alternatively, gene-based strategies for the treatment of FRDA may involve the development of small-molecules increasing frataxin gene transcription. Animal and human studies are strongly needed to assess whether any of the potential new treatment strategies, such as iron-chelating therapies or treatment with erythropoietin or histone deacetylase inhibitors and other gene-based strategies, may translate into an effective therapy for this devastating disorder. In this review, we try to provide an answer to some questions related to current and emerging treatment options in the management of FRDA. PMID:20856912

Mancuso, Michelangelo; Orsucci, Daniele; Choub, Anna; Siciliano, Gabriele

2010-01-01

188

Bronchiolitis obliterans after allo-SCT: clinical criteria and treatment options.  

PubMed

Bronchiolitis obliterans (BO) following allogeneic haematopoietic SCT (HSCT) is a serious complication affecting 1.7-26% of the patients, with a reported mortality rate of 21-100%. It is considered a manifestation of chronic graft-versus-host disease, but our knowledge of aetiology and pathogenesis is still limited. Diagnostic criteria are being developed, and will allow more uniform and comparable research activities between centres. At present, no randomised controlled trials have been completed that could demonstrate an effective treatment. Steroids in combination with other immunosuppressive drugs still constitute the backbone of the treatment strategy, and results from our and other centres suggest that monthly infusions of high-dose pulse i.v. methylprednisolone (HDPM) might stabilise the disease and hinder progression. This article provides an overview of the current evidence regarding treatment options for BO and presents the treatment results with HDPM in a paediatric national HSCT-cohort. PMID:21874057

Uhlving, H H; Buchvald, F; Heilmann, C J; Nielsen, K G; Gormsen, M; Müller, K G

2012-08-01

189

Partial rupture of the hamstring muscle complex: a literature review on treatment options.  

PubMed

Injuries of the hamstring muscle complex (HMC) often affect athletes participating in specific sporting activities. Mild injuries that constitute a mere strain of the muscle can be managed symptomatically, while severe injuries often require surgical intervention to precipitate a return to function. Neglected injuries usually result in a long-term functional impairment. Therefore, surgical reconstruction of the HMC is advised for both partial and complete lesions. Without acute repair, a chronic lesion referred to as hamstring syndrome can result due to dysfunction of the HMC. Surgical intervention is usually recommended. A case of a chronic severe partial injury to the HMC managed conservatively in a 49-year old female is presented to illustrate the level of function that can be achieved after non-operative management. The clinical and radiological findings are presented 18 months post-injury along with a review of the current literature. There are no previous reports in the literature describing this scenario. This case indicates the need for re-evaluation in treatment options in partial hamstring muscle ruptures. A surgical treatment of partial rupture should be considered more often as an adequate treatment option and cofactors that influence the prognosis must be revealed. The indication of surgical intervention should be re-evaluated within the first months in case of conservative treatment. PMID:24077940

Horst, Klemens; Dienstknecht, T; Sellei, R M; Pape, H C

2014-04-01

190

Integrating algaculture into small wastewater treatment plants: process flow options and life cycle impacts.  

PubMed

Algaculture has the potential to be a sustainable option for nutrient removal at wastewater treatment plants. The purpose of this study was to compare the environmental impacts of three likely algaculture integration strategies to a conventional nutrient removal strategy. Process modeling was used to determine life cycle inventory data and a comparative life cycle assessment was used to determine environmental impacts. Treatment scenarios included a base case treatment plant without nutrient removal, a plant with conventional nutrient removal, and three other cases with algal unit processes placed at the head of the plant, in a side stream, and at the end of the plant, respectively. Impact categories included eutrophication, global warming, ecotoxicity, and primary energy demand. Integrating algaculture prior to activated sludge proved to be most beneficial of the scenarios considered for all impact categories; however, this scenario would also require primary sedimentation and impacts of that unit process should be considered for implementation of such a system. PMID:24834441

Steele, Muriel M; Anctil, Annick; Ladner, David A

2014-05-01

191

The best MSW treatment option by considering greenhouse gas emissions reduction: a case study in Georgia.  

PubMed

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

Tayyeba, Omid; Olsson, Monika; Brandt, Nils

2011-08-01

192

Antithrombotic and interventional treatment options in cardioembolic transient ischaemic attack and ischaemic stroke  

PubMed Central

Peer?reviewed data pertaining to anti?thrombotic and interventional therapy for transient ischaemic attack (TIA) or ischaemic stroke patients with non?valvular atrial fibrillation, atrial flutter, interatrial septal abnormalities, or left ventricular thrombus were reviewed. Long?term oral anticoagulant therapy with warfarin is the treatment of choice for secondary stroke prevention following TIA or minor ischaemic stroke in association with persistent or paroxysmal non?valvular atrial fibrillation or atrial flutter. If warfarin is contraindicated, long?term aspirin is a safe, but much less effective alternative treatment option in this subgroup of patients with cerebrovascular disease. Management of young patients with TIA or stroke in association with an interatrial septal defect is controversial. Various treatment options are outlined, but readers are encouraged to include these patients in one of the ongoing randomised clinical trials in this area. It is reasonable to consider empirical anticoagulation in patients with TIA or ischaemic stroke in association with left ventricular thrombus formation following myocardial infarction or in association with idiopathic dilated cardiomyopathy. If warfarin is prescribed, one should aim for a target international normalised ratio of 2.5 (range 2–3) to achieve the best balance between adequate secondary prevention of cardioembolic events and the risk of major haemorrhagic complications. PMID:17172564

McCabe, D J H; Rakhit, R D

2007-01-01

193

Options for metastatic colorectal cancer beyond the second line of treatment.  

PubMed

Colorectal cancer is the third most common cancer, with recent advances in the management of unresectable metastatic lesions. The aim of this review is to discuss the remaining options for heavily pretreated patients with unresectable metastatic colorectal cancer. Beyond second-line treatment, two epidermal growth factor receptor (EGFR) inhibitors, cetuximab and panitumumab, have a demonstrated clinical interest in patients with KRAS wild-type tumours. However, few data exist in patients pretreated with an anti-EFGR and who are being rechallenged with anti-EGFR drugs. Reintroduction of chemotherapy should be considered. In September 2012, regorafenib, a multi-kinase inhibitor was approved by the US Federal Drug Administration for patients refractory to other standard treatments. In the case of metastases limited to the liver, transarterial chemoembolization, hepatic artery infusion and radioembolization could also be discussed in selected patients. With the multiplication of therapeutic options in first-line, second-line treatment, and beyond, the concept of subsequent lines of chemotherapy should be replaced by a multiline strategy, dependent on the patient and on tumour biology. A better understanding of the tumour biology and predictive factors for the response to these therapies is needed, and further strategic trials are urgently warranted. PMID:23954144

Foubert, Fanny; Matysiak-Budnik, Tamara; Touchefeu, Yann

2014-02-01

194

All Roads Lead to Rome: Update on Rome III Criteria and New Treatment Options  

PubMed Central

The recently published Rome III criteria reflect current understanding of functional gastrointestinal disorders. These criteria include definitions of these conditions and their pathophysiologic subtypes and offer guidelines for their management. At the 2006 Annual Scientific Meeting of the American College of Gastroenterology, a panel of experts discussed these criteria as they pertain to irritable bowel syndrome, functional dyspepsia, and chronic constipation. This article reviews the panel’s findings, highlights the differences between the Rome II and III criteria, and summarizes best treatment options currently available to practitioners and their patients. PMID:21544252

Shih, David Q.; Kwan, Lola Y.

2010-01-01

195

Bronchiolitis obliterans organizing pneumonia, 25 years: a variety of causes, but what are the treatment options?  

PubMed

Bronchiolitis obliterans organizing pneumonia is an inflammatory lung disease involving the distal bronchioles, respiratory bronchioles, bronchiolar ducts and alveoli. Its cause is generally unknown, but there are several known causes and associated systemic diseases. The clinical features include cough, shortness of breath and bilateral crackles. The vital capacity is slightly decreased, and the diffusing capacity is moderately to severely decreased. The high-resolution chest CT scan shows bilateral ground-glass opacities with air bronchograms and triangular, pleura-based opacities. Corticosteroid therapy is the best treatment option. The outcome of patients suffering from bronchiolitis obliterans organizing pneumonia is good, as up to 80% of individuals will be cured. PMID:21702658

Epler, Gary R

2011-06-01

196

Impact of minimally invasive surgery in the spectrum of current achalasia treatment options.  

PubMed

Minimally invasive Heller myotomy has evolved the "gold standard" procedure for achalasia in the spectrum of current treatment options. The laparoscopic technique has proved superior to the thoracoscopic approach due to improved visualization of the esophagogastric junction. Operative controversies most recently include the length of the myotomy, especially of its fun-dic part, with respect to the balance between postoperative persistent dysphagia and development of gastroesophageal reflux, as well as the type of the added antireflux procedure. Peri-operative mortality should approach 0%, and favorable long-term results can be achieved in > 90%. PMID:21737381

Gockel, I; Sgourakis, G; Drescher, D G; Lang, H

2011-01-01

197

The Morel-Lavallée lesion: pathophysiology, clinical presentation, imaging features, and treatment options.  

PubMed

Morel-Lavallée lesions are posttraumatic hemolymphatic collections related to shearing injury and disruption of interfascial planes between subcutaneous soft tissue and muscle. We review the pathophysiology of Morel-Lavallée lesions, clinical presentation, and potential sites of involvement. Magnetic resonance imaging (MRI) is the modality of choice for characterization. We present the MRI classification and highlight the key imaging features that distinguish the different types, focusing on the three most common: seroma, subacute hematoma, and chronic organizing hematoma. Potential mimics of Morel-Lavallée lesions, such as soft tissue sarcoma and hemorrhagic prepatellar bursitis, are compared and contrasted. Treatment options and a management algorithm are also briefly discussed. PMID:23949106

Bonilla-Yoon, Iris; Masih, Sulabha; Patel, Dakshesh B; White, Eric A; Levine, Benjamin D; Chow, Kira; Gottsegen, Christopher J; Matcuk, George R

2014-02-01

198

Non-Surgical Chemotherapeutic Treatment Strategies for the Management of Periodontal Diseases  

PubMed Central

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 practitioner’s appreciation of this ever-growing field in clinical periodontics. PMID:20103470

Krayer, Joe W.; Leite, Renata S.; Kirkwood, Keith L.

2011-01-01

199

Non-surgical treatment modalities of facial photodamage: practical knowledge for the oral and maxillofacial professional  

Microsoft Academic Search

With the increasing interest in cosmetic procedures, oral and maxillofacial surgeons are being asked not only to improve oral health and aesthetics but to extend their expertise to provide advice on improving the overall appearance of the face. For the discerning patient, improving overall facial skin appearance is becoming an integral part of the process of surgical cosmetic procedures. Here,

F. Hegedus; R. Diecidue; D. Taub; J. Nyirady

2006-01-01

200

Non-surgical treatment of osteoarthritis-related pain in the elderly  

Microsoft Academic Search

Osteoarthritis (OA), the third most common diagnosis in the elderly [1], causes significant pain leading to disability and decreased quality of life in subjects 65 years and older [2]. Traditionally, clinicians have relied heavily on the use of non-steroidal anti-inflammatory drugs (NSAIDs) to treat the\\u000a pain of OA, as numerous studies have proven these agents to be effective. The cardiovascular, gastrointestinal,

Saulat Mushtaq; Rabeea Choudhary; Carla R. Scanzello

201

Non-surgical treatment of uterovaginal prolapse using double vaginal rings  

Microsoft Academic Search

A new technique of using double vaginal ring pessaries to treat uterovaginal prolapse in a group of elderly women is described. Eighteen women with a mean age of 82 years and advanced Stage III or IV uterovaginal prolapse had double vaginal rings inserted. All of them previously had used single vaginal ring pessaries or had undergone pelvic floor repair surgery.

K. Singh; W. M. N. Reid

2001-01-01

202

PTSD and comorbid AUD: a review of pharmacological and alternative treatment options  

PubMed Central

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

Ralevski, Elizabeth; Olivera-Figueroa, Lening A; Petrakis, Ismene

2014-01-01

203

Evaluation of nasal and oropharyngeal flora in patients with acne vulgaris according to treatment options.  

PubMed

The aim of this study was to evaluate changes in nasal and oropharyngeal flora in patients with acne during treatments with tetracycline and isotretinoin. Swab specimens were taken from the right and left nasal cavities and oropharynx of 55 patients with acne and 20 healthy volunteers who were admitted to the dermatology department (Etlik Educational and Research Hospital, Ankara, Turkey) before the administration of treatment and in the third month of treatment. Study participants were divided into four groups as follows: patients with acne on topical treatment only, systemic isotretinoin, and systemic tetracycline, and the control group. Of 55 patients with acne, 18 were male and 37 were female. The mean age of the patients and the control group was 22.21 ± 4.22 and 21.95 ± 7.64, respectively. Staphylococcus aureus was isolated from the nasal flora of five patients, normal flora was suppressed in the oropharyngeal cultures of seven patients, and normal flora grew in the cultures of the other 20 patients who were on tetracycline treatment. On the other hand, normal flora grew in the nasal and oropharyngeal cultures of all the patients who were on isotretinoin treatment. Treatment options and follow-up procedures for acne vulgaris may lead to the development of bacterial resistance and damage to flora. In particular, systemic tetracycline treatment leads to changes in flora of the nose and throat in patients with acne with an increased carriage of S. aureus. Therefore, careful attention should be paid to the duration of tetracycline treatment in order to not increase the risk of disturbance of microbial flora. PMID:24961291

Ozuguz, P?nar; Callioglu, Elif E; Tulaci, Kamil G; Kacar, Seval D; Balta, Ilknur; Asik, Gulsah; Karatas, Serap; Karaca, Semsettin

2014-11-01

204

Polycythemia vera disease burden: contributing factors, impact on quality of life, and emerging treatment options.  

PubMed

Polycythemia vera (PV) is a chronic myeloproliferative neoplasm characterized by clonal expansion of a hematopoietic progenitor, erythrocytosis, often leukocytosis and/or thrombocytosis, and nearly always an activating mutation in Janus kinase 2 (JAK2). The PV symptom burden can be considerable, in part driven by small or large vessel thrombotic tendency, splenomegaly, fatigue, pruritus, and a chronic risk of disease transformation to myelofibrosis or acute myeloid leukemia. In addition, patients with PV have an increased risk of mortality compared with the general population that often results from cardiovascular complications or disease transformation. Further, healthcare utilization and costs are higher in patients with PV than noncancer controls. First-line therapy options for high-risk patients may effectively manage PV in some instances; however, some patients do not receive adequate benefit from current treatment options and experience a more severe disease burden as a result. This may be especially true for those patients who are resistant to or intolerant of hydroxyurea or interferon-based therapies. New treatments currently being investigated in phase 3 clinical trials may alleviate disease burden in this patient population. PMID:25270596

Stein, Brady L; Moliterno, Alison R; Tiu, Ramón V

2014-12-01

205

Narrow-diameter implants: Are they a predictable treatment option? A literature review  

PubMed Central

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

Martinez-Gonzalez, Amparo; Garcia-Sala Bonmati, Fernando; Manes-Ferrer, Jose F.; Brotons-Oliver, Alejandro

2014-01-01

206

Hand infections: anatomy, types and spread of infection, imaging findings, and treatment options.  

PubMed

Infections of the hand are common, particularly in immunocompromised patients, and can lead to significant morbidity, including amputation, if not treated properly. Hand infection can spread far and wide from the original site of inoculation through interconnections between the synovium-lined and nonsynovial potential spaces. Because surgery is the mainstay of treatment, knowledge of the pertinent anatomy is imperative for accurately describing the presence, location, and extent of infection. The authors review the pertinent anatomy of the spaces of the hand and describe different types of infection-including cellulitis, necrotizing fasciitis, paronychia, felon, pyogenic flexor tenosynovitis, deep space infections, septic arthritis, and osteomyelitis-and common causative organisms of these infections. They also describe various modes of spread; the common radiologic appearances of hand infections, with emphasis on findings at magnetic resonance imaging and ultrasonography; and the role of radiology in the management of these infections, along with a brief overview of treatment options. ©RSNA, 2014. PMID:25384296

Patel, Dakshesh B; Emmanuel, Neelmini B; Stevanovic, Milan V; Matcuk, George R; Gottsegen, Christopher J; Forrester, Deborah M; White, Eric A

2014-01-01

207

Recurrent Labial Herpes Simplex in Pediatric Dentistry: Low-level Laser Therapy as a Treatment Option  

PubMed Central

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.

Stona, Priscila; da Silva Viana, Elizabete; dos Santos Pires, Leandro; Blessmann Weber, Joao Batista

2014-01-01

208

Treatment Options for Liquid Radioactive Waste. Factors Important for Selecting of Treatment Methods  

SciTech Connect

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.

Dziewinski, J.J.

1998-09-28

209

Treatment options in recurrent ovarian cancer: latest evidence and clinical potential  

PubMed Central

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

Luvero, Daniela; Milani, Andrea

2014-01-01

210

Treatment options in recurrent ovarian cancer: latest evidence and clinical potential.  

PubMed

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

Luvero, Daniela; Milani, Andrea; Ledermann, Jonathan A

2014-09-01

211

Options for salvage after failed initial treatment of anterior vocal commissure squamous carcinoma.  

PubMed

Persistence or recurrent cancer in the anterior commissure (AC) after primary radiotherapy may remain localized to its pretreatment anatomical site. If so, endoscopic CO(2) laser excision, in experienced hands, may achieve complete tumor excision and result in cure for many patients. Occasionally, second and third recurrences may be similarly salvaged by further endoscopic surgery. The use of the vertical hemilaryngectomy is an alternative treatment for similar localized lesions, with a higher first time surgical tumor eradication rate, but with a more protracted hospitalization and a less satisfactory voice and swallowing outcome. In both types of such surgical salvage, CT scanning must demonstrate no evidence of cartilage invasion or destruction. When there is evidence of minimal thyroid cartilage invasion, then the supracricoid partial laryngectomy is an alternative conservation option, and is likely to result in a cure, with the retention of a voicing larynx without a stoma. When the tumor has increased in size from the original pretreatment dimension and/or site, then imaging must be used to identify possible cartilage invasion, in which case the likelihood of tumor eradication by endoscopic or external vertical partial laryngectomy is highly unlikely. The indications for the routine use of total laryngectomy for the treatment of recurrent or persistent cancer involving the AC must be reviewed; there is current evidence that cure can be achieved by a less radical procedure. However, total laryngectomy may remain the only treatment option for advanced or aggressive first time recurrence, or in patients who develop subsequent recurrence following previous less aggressive surgery (endoscopic or external). PMID:16909218

Bradley, Patrick J; Ferlito, Alfio; Suárez, Carlos; Werner, Jochen A; Genden, Eric M; Shaha, Ashok R; Leemans, C René; Langendijk, Johannes A; Rinaldo, Alessandra

2006-10-01

212

A Review of Recommendations and Treatment Options Regarding the Management of HIV Infection  

PubMed Central

Purpose This review focuses on the recommendations for when to initiate antiretroviral therapy and what regimen to use in treatment-naïve patients based on the January 2011 antiretroviral guidelines released by the Department of Health and Human Services (DHHS). The evolution of recommendations over the past decade, key data supporting recent changes, and information related to management of antiretroviral therapy are discussed. Summary Treatment guidelines are updated frequently because of ongoing emergence of data demonstrating the risks and benefits of antiretroviral therapy. The DHHS guidelines strongly recommend initiating therapy in patients with certain conditions regardless of CD4 cell count and in patients with CD4 cell counts <350 cells/mm3. Although supporting data are less definitive, treatment is also recommended for patients with CD4 cell counts between 350–500 cells/mm3. Treatment for patients with CD4 cell counts >500 cells/mm3 is controversial. Although cumulative observational data and biological evidence support treatment at higher CD4 cell counts, randomized controlled trial data are not available, and the risk of antiretroviral toxicities, resistance, nonadherence, and cost should be considered in individual patients. The preferred regimens have been consolidated to four options, including a dual-nucleoside reverse transcriptase inhibitor backbone (tenofovir/emtricitabine) with a non-nucleoside reverse transcriptase inhibitor (efavirenz), a ritonavir-boosted protease inhibitor (atazanavir + ritonavir or darunavir + ritonavir), or an integrase strand transfer inhibitor (raltegravir). Regimens are classified as alternative or acceptable when they have potential safety or efficacy concerns, consist of higher pill burdens, or require more frequent dosing compared to preferred regimens. Conclusion The DHHS guidelines advocate earlier treatment initiation than recommended in recent years, yet recognize the limitations of the data supporting treatment at higher CD4 cell counts. Preferred regimens have been refined to maximize efficacy, safety, and quality of life for patients. The guidelines will continue to be updated as new data emerges. PMID:21593227

Boyd, Sarita D.

2011-01-01

213

Clostridium difficile infection: update on emerging antibiotic treatment options and antibiotic resistance  

PubMed Central

Clostridium difficile infection (CDI) is the most common cause of identifiable diarrhea in hospitalized patients. The incidence and severity of CDIs are increasing. The increased incidence and severity of the disease has sparked interest in the optimal treatment of CDI as well as the use of new therapies and drug discovery. Current treatment strategies are inadequate with decreased response rates to metronidazole, and high recurrence rates with the use of metronidazole and oral vancomycin. Although incidence rates continue to be low, in vitro resistance to antibiotics used for the treatment of CDI has been noted. Recently, important data has emerged on new anti-C. difficile antibiotics such as rifaximin, rifalazil, fidaxomicin, nitazoxanide, tigecycline and ramoplanin. The purpose of this review is to provide an update on the in vitro susceptibility and new antibiotic treatment options for CDI. This review will focus primarily on scientific studies published in the last 36 months in order to provide an up-to-date review on the topic. PMID:20455684

Shah, Dhara; Dang, Minh-Duc; Hasbun, Rodrigo; Koo, Hoonmo L; Jiang, Zhi-Dong; DuPont, Herbert L; Garey, Kevin W

2010-01-01

214

Addressing the unmet needs of patients with persistent negative symptoms of schizophrenia: emerging pharmacological treatment options  

PubMed Central

The negative symptoms of schizophrenia represent an impairment of normal emotional responses, thought processes and behaviors, and include blunting or flattening of affect, alogia/aprosody, avolition/apathy, anhedonia, and asociality. Negative symptoms contribute to a reduced quality of life, increased functional disability, increased burden of illness, and poorer long-term outcomes, to a greater degree than positive symptoms. Primary negative symptoms are prominent and persistent in up to 26% of patients with schizophrenia, and they are estimated to occur in up to 58% of outpatients at any given time. Negative symptoms respond less well to medications than positive symptoms, and to date treatment options for negative symptoms have been limited, with no accepted standard treatment. Modest benefits have been reported with a variety of different agents, including second-generation antipsychotics and add-on therapy with antidepressants and other pharmacological classes. Recent clinical research focusing on negative symptoms target novel biological systems, such as glutamatergic neurotransmission. Different approaches include: enhancing N-methyl-D-aspartate receptor function with agents that bind directly to the glycine ligand site or with glycine reuptake inhibitors; influencing the metabotropic glutamate receptor (mGluR2/3) with positive allosteric modulators; and stimulating nicotinic acetylcholine receptors. In conclusion, the lack of clearly efficacious pharmacological treatments for the management of negative symptoms represents a significant unmet need, especially considering the importance of these symptoms on patient outcomes. Hence, further research to identify and characterize novel pharmacological treatments for negative symptoms is greatly needed. PMID:24855363

Chue, Pierre; Lalonde, Justine K

2014-01-01

215

Clinical roundtable monograph: Emerging treatment options for TKI-resistant chronic myelogenous leukemia.  

PubMed

The development of tyrosine kinase inhibitors (TKIs) that inhibit signaling of the constitutive BCR-ABL protein revolutionized the treatment of chronic myelogenous leukemia (CML). These agents have dramatically changed the treatment landscape for CML, shifting the use of allogeneic stem cell transplantation to selected patients in the salvage setting. Four BCR-ABL TKIs are now commercially available for the treatment of CML: the first-generation TKI imatinib, and the second-generation TKIs dasatinib, nilotinib, and bosutinib. Continuous treatment with these agents induces durable responses in a high proportion of patients with chronic-phase CML. Research is focused on identifying which patients can discontinue therapy without a recurrence of disease. For the group of patients with resistance to TKIs, multiple alternative therapies are being evaluated. The third-generation TKI ponatinib is a BCR-ABL inhibitor that has demonstrated significant activity, including in patients with the TKI resistance mutation T315I. The homoharringtonine derivative omacetaxine mepesuccinate, which inhibits protein synthesis, has also demonstrated clinical activity in CML, including in patients with TKI resistance due to T315I and in patients who have TKI resistance despite no evidence of ABL mutations. It is essential that clinicians implement these new agents with care and change therapies only when appropriate in order to preserve as many options as possible for future use if needed. PMID:23187745

Cortes, Jorge; Radich, Jerald; Mauro, Michael J

2012-10-01

216

Options to reduce greenhouse gas emissions during wastewater treatment for agricultural use.  

PubMed

Treatment of primarily-domestic sewage wastewater involves on-site greenhouse gas (GHG) emissions due to energy inputs, organic matter degradation and biological nutrient removal (BNR). BNR causes both direct emissions and loss of fertilizer value, thus eliminating possible reduction of emissions caused by fertilizer manufacture. In this study, we estimated on-site GHG emissions under different treatment scenarios, and present options for emission reduction by changing treatment methods, avoiding BNR and by recovering energy from biogas. Given a typical Israeli wastewater strength (1050mg CODl(-1)), the direct on-site GHG emissions due to energy use were estimated at 1618 and 2102g CO(2)-eq m(-3), respectively, at intermediate and tertiary treatment levels. A potential reduction of approximately 23-55% in GHG emissions could be achieved by fertilizer preservation and VS conversion to biogas. Wastewater fertilizers constituted a GHG abatement potential of 342g CO(2)-eq m(-3). The residual component that remained in the wastewater effluent following intermediate (oxidation ponds) and enhanced (mechanical-biological) treatments was 304-254g CO(2)-eq m(-3) and 65-34g CO(2)-eq m(-3), respectively. Raw sludge constituted approximately 47% of the overall wastewater fertilizers load with an abatement potential of 150g CO(2)-eq m(-3) (385kg CO(2)-eq dry tonne(-1)). Inasmuch as anaerobic digestion reduced it to 63g CO(2)-eq m(-3) (261kg CO(2)-eq dry tonne(-1)), the GHG abatement gained through renewable biogas energy (approx. 428g CO(2)-eq m(-3)) favored digestion. However, sludge composting reduced the fertilizer value to 17g CO(2)-eq m(-3) (121kg CO(2)-eq dry tonne(-1)) or less (if emissions, off-site inputs and actual phytoavailability were considered). Taking Israel as an example, fully exploiting the wastewater derived GHG abatement potential could reduce the State overall GHG emissions by almost 1%. This demonstrates the possibility of optional carbon credits which might be exploited in the construction of new wastewater treatment facilities, especially in developing countries. PMID:22209373

Fine, Pinchas; Hadas, Efrat

2012-02-01

217

Bevacizumab as a treatment option for radiation-induced cerebral necrosis.  

PubMed

Radiation necrosis of normal CNS tissue represents one of the main risk factors of brain irradiation, occurring more frequently and earlier at higher total doses and higher doses per fraction. At present, it is believed that the necrosis results due to increasing capillary permeability caused by cytokine release leading to extracellular edema. This process is sustained by endothelial dysfunction, tissue hypoxia, and subsequent necrosis. Consequently, blocking the vascular endothelial growth factor (VEGF) at an early stage could be an option to reduce the development of radiation necrosis by decreasing the vascular permeability. This might help to reverse the pathological mechanisms, improve the symptoms and prevent further progression. A patient with radiationinduced necrosis was treated with an anti-VEGF antibody (bevacizumab), in whom neurologic signs and symptoms improved in accordance with a decrease in T1-weighted fluid-attenuated inversion recovery signals. Our case report together with the current literature suggests bevacizumab as a treatment option for patients with symptoms and radiological signs of cerebral necrosis induced by radiotherapy. PMID:21336713

Matuschek, Christiane; Bölke, Edwin; Nawatny, Jens; Hoffmann, Thomas K; Peiper, Matthias; Orth, Klaus; Gerber, Peter Arne; Rusnak, Ethelyn; Lammering, Guido; Budach, Wilfried

2011-02-01

218

The flexible Triac-Brace for conservative treatment of idiopathic scoliosis. An alternative treatment option?  

PubMed

The flexible Triac-Brace was developed to improve cosmetic appearance and wearing comfort. It was evaluated in this study with respect to primary curve correction in idiopathic scoliosis (IS). Twenty patients (15 girls, 5 boys, mean age: 12.5) with a diagnosis of IS were treated with the Triac-Brace. Lumbar curves showed an initial average Cobb angle of 26 degrees (SD = 9 degrees), thoracic curves of 25 degrees (SD = 7 degrees). After 6.2 weeks the primary curve correction was measured (Cobb). Further radiological follow-up was done every 6 months during the average wearing time of 15 months. Cosmesis and wearing comfort were assessed by a valid scoring system (Quality of Life Profile for Spine Deformities). We observed a primary correction of 41% in lumbar curves (n = 12) (significant, t-test), and 10% in thoracic curves (n = 17) (not significant, t-test). An increase in correction over time as reported by Veldhuizen et al was not seen. Curve progression was noted in five patients (average 12 degrees). The scores for cosmesis (4.2/5) and flexibility of the back (4.6/5) were high. Ninety percent of the patients reported a wearing time of 22-23 h. We do not recommend treatment of thoracic or double curves with the Triac-Brace. Larger studies are necessary to assess the effectiveness in lumbar curves. The improved wearing comfort is a potential advantage. PMID:18811036

Zeh, Alexander; Planert, Michael; Klima, Stefan; Hein, Werner; Wohlrab, David

2008-08-01

219

A review of the current management and treatment options for superficial venous insufficiency.  

PubMed

The recognition of lower extremity venous disease as a significant cause of morbidity and lower quality of life, afflicting up to 25 % of Western populations, has led to rapid and drastic improvements in treatment options as well as an increasing awareness of the disease. Superficial venous disease, a frequent medical problem encountered in clinical practices, is now a common reason for referral to providers offering a spectrum of interventions. Venous guidelines have been set forth by the American Venous Forum and Society for Vascular Surgery covering simple spider veins to chronic venous ulcerations. (Gloviczki et al. J Vas Surg 53:2S-48S, 2011) This review provides an overview of the modern management of varicose veins and venous insufficiency. PMID:24803347

Zhan, Henry T; Bush, Ruth L

2014-10-01

220

Malignant melanoma in a grey horse: case presentation and review of equine melanoma treatment options  

PubMed Central

A 15 year-old grey Thoroughbred gelding presented for investigation of chronic weight loss and recent onset of respiratory difficulty. Clinical examination confirmed tachypnoea with increased respiratory effort. Thoracic ultrasound examination detected pleural effusion. The dyspnoea was related to the large volume of pleural effusion and, following post-mortem examination, to the presence of a large mediastinal mass. Multiple pigmented masses, likely melanomas, were detected peri-anally. Thoracic radiography, cytological examination of the pleural fluid and a fine needle aspirate of a thoracic mass led to a presumptive diagnosis of malignant melanoma and this was confirmed at post mortem examination. Further metastatic spread to the central nervous system and right guttural pouch was also identified. In conclusion this case manifests the potential malignant behaviour of equine melanomas, and a review of proposed therapies for melanoma treatment highlights the therapeutic options and current areas of research. PMID:24196087

2013-01-01

221

Management of multiple sclerosis in adolescents - current treatment options and related adherence issues  

PubMed Central

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

Mah, Jean K; Thannhauser, Jennifer E

2010-01-01

222

Inflammatory nodules following soft tissue filler use: a review of causative agents, pathology and treatment options.  

PubMed

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

Ledon, Jennifer A; Savas, Jessica A; Yang, Steven; Franca, Katlein; Camacho, Ivan; Nouri, Keyvan

2013-10-01

223

Treatment of retinopathy of prematurity: a review of conventional and promising new therapeutic options  

PubMed Central

Retinopathy of prematurity (ROP), a retinal vascular disease of premature infants, continues to be a major cause of preventable childhood blindness all over the world. The incidence of ROP varies among countries, being influenced by the quality of the level of neonatal intensive care. Here, we discuss the potential treatments that are now available or will soon or probably be available for ROP. Although ablation of the avascular retina with laser photocoagulation remains the current gold standard and well established therapy for ROP, some new therapeutic options including angiostatic therapies are being explored based on our knowledge of the pathophysiology of the ROP and complications and efficacy of laser treatment. However, prevention of the development of severe ROP and screening for ROP seem to be the best strategy in avoiding visual impairment caused by ROP in premature infants. New therapeutic interventions including vascular endothelial growth factor antibody administration, gene therapy and supplemental therapies should be supported with evidence-based data for the treatment of ROP. PMID:23641347

Mutlu, Fatih Mehmet; Sarici, Serdar Umit

2013-01-01

224

Update on the biology and treatment options for hairy cell leukemia.  

PubMed

Hairy cell leukemia (HCL) is an uncommon chronic leukemia of mature B cells. Leukemic B cells of HCL exhibit a characteristic morphology and immunophenotype and coexpress multiple clonally related immunoglobulin isotypes. Precise diagnosis and detailed workup is essential, because the clinical profile of HCL can closely mimic that of other chronic B-cell lymphoproliferative disorders that are treated differently. Variants of HCL, such as HCLv and VH4-34 molecular variant, vary in the immunophenotype and specific VH gene usage, and have been more resistant to available treatments. On the contrary, classic HCL is a highly curable disease. Most patients show an excellent long-term response to treatment with single-agent cladribine or pentostatin, with or without the addition of an anti-CD20 monoclonal antibody such as rituximab. However, approximately 30-40 % of patients with HCL relapse after therapy; this can be treated with the same purine analogue that was used for the initial treatment. Advanced molecular techniques have identified distinct molecular aberrations in the Raf/MEK-ERK pathway and BRAF (V600E) mutations that drive the proliferation and survival of HCL B cells. 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. Ongoing and planned clinical trials are assessing various treatment strategies, such as the combination of purine analogues and various anti-CD20 monoclonal antibodies, recombinant immunotoxins targeting CD22 (e.g., moxetumomab pasudotox), BRAF inhibitors, such as vemurafenib, and B-cell receptor signaling inhibitors, such as ibrutinib, which is a Bruton's tyrosine kinase inhibitor. This article provides an update of our current understanding of the pathophysiology of HCL and the treatment options available for patients with classic HCL. Discussion of variant forms of HCL is beyond the scope of this manuscript. PMID:24652320

Jain, Preetesh; Pemmaraju, Naveen; Ravandi, Farhad

2014-06-01

225

Lip buccal mucosa traumatic overgrowth due to sucking habit -A 10-year follow-up of a non-surgical approach: A combination of behavioural and myofunctional therapy.  

PubMed

Abstract Objective. Traumatic lesion of the lip buccal mucosa may develop due to a repetitive lip sucking habit, secondary to a dental space which opened in the dental in adult patients. The non surgical treatment approach is based on increasing of patient's awareness to the sucking habit along with the creation of a change in the oral and dental surrounding tissues. The following case included a failure to identify a traumatic habit of lower lip sucking, resulting in a buccal mucosa overgrowth. Combined conservative periodontal and orthodontic approach will be presented to address this clinical issue without any need for surgical intervention. Material and methods. 56 year old female patient presented with a complaint of unaesthetic appearance of the intraoral right buccal mucosa of the lower lip at rest position due to an intensive repetitive sucking habit of the right lower lip segment. We initiated a non surgical treatment approach including increasing the patient's awareness to the sucking habit, controlling the periodontal disease and orthodontic treatment to align and level the dental arch and to close the residual space. Result. The soft tissue overgrowth on the lip buccal mucosa almost completely subsided spontaneously as a result of conservative dental and behavioral management without the need for any oral surgery intervention. A 10 years follow-up revealed no repetitive oral mucosa overgrowth, no spaces reopening and no sucking habit redevelopment. Conclusion. Implementation of a morphological correction will assist the patient in breaking the habit and creating an environment that may effectively prevent the reoccurrence of the habit. PMID:24931927

Aizenbud, Dror; Gutmacher, Zvi; Teich, Sorin T; Oved-Peleg, Efrat; Hazan-Molina, Hagai

2014-11-01

226

Comparison of healing rate in diabetes-related foot ulcers with low frequency ultrasonic debridement versus non-surgical sharps debridement: a randomised trial protocol  

PubMed Central

Background Foot ulceration has been reported as the leading cause of hospital admission and amputation in individuals with diabetes. Diabetes-related foot ulcers require multidisciplinary management and best practice care, including debridement, offloading, dressings, management of infection, modified footwear and management of extrinsic factors. Ulcer debridement is a commonly applied management approach involving removal of non-viable tissue from the ulcer bed. Different methods of debridement have been reported in the literature including autolytic debridement via moist wound healing, mechanical debridement utilising wet to dry dressings, theatre based sharps debridement, biological debridement, non-surgical sharps debridement and newer technology such as low frequency ultrasonic debridement. Methods People with diabetes and a foot ulcer, referred to and treated by the Podiatry Department at Monash Health and who meet the inclusion criteria will be invited to participate in this randomised controlled trial. Participants will be randomly and equally allocated to either the non-surgical sharps debridement (control) or low frequency ultrasonic debridement (intervention) group (n?=?322 ulcers/n?=?108 participants). Where participants have more than one ulcer, only the participant will be randomised, not the ulcer. An investigator not involved in participant recruitment or assessment will be responsible for preparing the random allocation sequence and envelopes. Each participant will receive weekly treatment for six months including best practice podiatric management. Each ulcer will be measured on a weekly basis by calculating total area in centimetres squared. Measurement will be undertaken by a trained research assistant to ensure outcomes are blinded from the treating podiatrist. Another member of the research team will assess the final primary outcome. Discussion The primary aim of this study is to compare healing rates for diabetes-related foot ulcers using non-surgical sharps debridement versus low frequency ultrasonic debridement over a six month period. The primary outcome measure for this study is the proportion of ulcers healed by the six month follow-up period. Secondary outcomes will include a quality of life measure, assessment of pain and health care resource use between the two treatment modalities. Trial registration Australian New Zealand Clinical Trial Registry: ACTRN12612000490875. PMID:24423411

2014-01-01

227

A new optional recycled water pre-treatment system prior to use in the household laundry.  

PubMed

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

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

228

Increased vertical dimension of occlusion: signs, symptoms, diagnosis, treatment and options.  

PubMed

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

Discacciati, José Augusto César; Lemos de Souza, Eduardo; Vasconcellos, Walison Arthuso; Costa, Sérgio Carvalho; Barros, Vinícius de Magalhães

2013-01-01

229

Nonsurgical treatment for localized hepatocellular carcinoma.  

PubMed

The most common non-surgical approaches for the treatment of localized hepatocellular carcinoma remain hepatic artery-delivered particles laden with chemotherapy (TACE), or radioactive microparticles (TARE). External beam radiotherapy has been an effective option in many parts of the world for selected HCC patients, but now has an expanded role with stereotactic and proton beam technologies. This review focuses on existing evidence and current guidance for utilizing these modalities for localized, but unresectable, non-transplantable HCC patients.x. PMID:24488546

Kennedy, Andrew S; Sangro, Bruno

2014-03-01

230

Current and emerging treatment options for the elderly patient with chronic kidney disease  

PubMed Central

The objective of this article is to review the current and emerging treatments of CKD prior to dialysis in the elderly. Worldwide, there are increasing numbers of people who are aged over 65 years. In parallel, there are increasing numbers of elderly patients presenting with chronic kidney disease (CKD), particularly in the more advanced stages. The elderly have quite different health care needs related to their associated comorbidity, frailty, social isolation, poor functional status, and cognitive decline. Clinical trials assessing treatments for CKD have usually excluded patients older than 70–75 years; therefore, it is difficult to translate current therapies recommended for younger patients with CKD across to the elderly. Many elderly people with CKD progress to end-stage kidney disease and face the dilemma of whether to undertake dialysis or accept a conservative approach supported by palliative care. This places pressure on the patient, their family, and on health care resources. The clinical trajectory of elderly CKD patients has in the past been unclear, but recent evidence suggests that many patients over 75 years of age with multiple comorbidities have greatly reduced life expectancies and quality of life, even if they choose dialysis treatment. Offering a conservative pathway supported by palliative care is a reasonable option for some patients under these circumstances. The elderly person who chooses to have dialysis will frequently have different requirements than younger patients. Kidney transplantation can still result in improved life expectancy and quality of life in the elderly, in carefully selected people. There is a genuine need for the inclusion of the elderly in CKD clinical trials in the future so we can produce evidence-based therapies for this group. In addition, new therapies to treat and slow CKD progression are needed for all age groups. PMID:24477220

Fassett, Robert G

2014-01-01

231

Prevalence of deep vein thrombosis in acutely admitted ambulatory non-surgical intensive care unit patients  

PubMed Central

Background Data on prevalence rates of venous thromboembolism (VTE) in different patient populations are scarce. Most studies on this topic focus on older patients or patients with malignancies, immobilization or thrombophilia. Less is known about the VTE risk profile of non-surgical patients presenting with a variety of medical diseases of differing severity. Aim of the present study was to investigate VTE prevalence in a pospective cohort study of ambulatory medical intensive care unit patients within 24 h after acute admission. Methods Prospective cohort study of 102 consecutive patients after acute admission to medical intensive care unit. Ultrasound compression sonography, APACHE-II-Scoring and laboratory examination was performed within 24 hours after admission.Possible determinants of a high risk of VTE were examined. In all patients with a confirmed diagnosis of DVT or suspicion of PE thoracic computer tomography (CT) was performed. Results VTE was found in 7.8% out of 102 of patients, mean APACHE-II-Score was 14 (mortality risk of about 15%). Thrombus location was femoropopliteal in 5 patients, iliacal in 2 and peroneal in 1 patient. Five VTE patients had concomitant PE (62.5% of VTE, 4.9% of all patients). No predictors of prevalent VTE were identified from univariable regression analysis although relative risk was high in patients with a history of smoking (RR 3.40), immobility (RR 2.50), and elevated D-Dimer levels (RR 3.49). Conclusions Prevalent VTE and concomitant PE were frequent in acutely admitted ICU patients. PMID:24996222

2014-01-01

232

Multidrug-resistant Gram-negative infections: what are the treatment options?  

PubMed

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

Giamarellou, Helen; Poulakou, Garyphallia

2009-10-01

233

Ureteroscopic Treatment of Ureteral Stones: Only an Auxiliary Measure of Extracorporeal Shockwave Lithotripsy or a Primary Therapeutic Option?  

Microsoft Academic Search

Both extracorporeal Shockwave lithotripsy (ESWL) and ureteroscopy are well-established methods in stone treatment; however, the therapeutic procedure in ureteral calculi, especially in the distal third of the ureter, is still controversially discussed. The aim of the present study was to examine the role of ureteroscopy as an auxiliary measure after ESWL and its importance as an alternative therapeutic option in

Avelino Hernandez Osti; Georg Hofmockel; Hubert Frohmüller

1997-01-01

234

Environmental assessment and sustainable management options of leachate and landfill gas treatment in Estonian municipal waste landfills  

Microsoft Academic Search

Purpose – The purpose of this paper is to compare various landfill gas (LFG) and leachate treatment technologies in a life-cycle perspective. Design\\/methodology\\/approach – Since a landfill causes emissions for a very long-time period, life-cycle-based environmental assessment was carried out to compare different technological options for sustainable leachate treatment and LFG collection and utilization. WAMPS, the life-cycle assessment (LCA) model

Viktoria Voronova; Harri Moora; Enn Loigu

2011-01-01

235

Neurovascular complications of ovarian hyperstimulation syndrome (OHSS): from pathophysiology to recent treatment options.  

PubMed

Ovarian hyperstimulation syndrome (OHSS) is a severe iatrogenic complication of ovulation induction, which has a very serious impact on the patient's health, as it is often associated with a high morbidity and mortality risk. Indeed, patients classified as having severe OHSS presented with liquid imbalance signs (such as rapid weight gain, tense ascites, respiratory difficulty and progressive oliguria), which are related to the fluid shift from the intravascular space to third space compartments subsequent to an increased capillary permeability. In this way, cardiovascular system findings include decreased intravascular volume, decreased blood pressure, decreased central venous perfusion, and compensatory increased heart rate and cardiac output with arterial vasodilation might be found concomitantly. Notwithstanding that venous thromboembolic phenomena are a possible complication in advanced phases of OHSS, arterial ischemia involving the cerebral circulation is a rare but recently reported problem. The pathogenesis of thromboembolism in OHSS is not fully understood, even though hemoconcentration and blood hyperviscosity seem to play a role in developing thrombotic changes into both venous and arterial system. Interestingly, the presence of cardiac abnormalities in combination with inherited or acquired hypercoagulable state seems to increase the risk of cerebral infarct in these subjects, as recently shown by our group. This review is aimed at investigating the pathomechanism and the management of neurovascular complications related to OHSS, including new treatment options. PMID:24902709

Calabro, Rocco S; Gervasi, Giuseppe; Leo, Antonino; De Luca, Rosaria; Balletta, Tina; Casella, Carmela; Triolo, Onofrio; Bramanti, Placido

2014-01-01

236

Fertility-sparing treatment of endometrial cancer: options, outcomes and pitfalls  

PubMed Central

Endometrial cancer is the most common gynecologic malignancy in the United States, with over 40,000 cases diagnosed each year. While a majority of cases are diagnosed in post-menopausal women, up to 14% of cases will be in pre-menopausal women, including 4% diagnosed in women less than 40 years of age. While hysterectomy with bilateral salpingo-oophorectomy with assessment of the retroperitoneal lymph nodes is standard initial treatment for endometrial cancer, younger women may desire fertility sparing options. The decision to proceed with conservative management in this younger patient population is associated with multiple complexities, including the inherent oncologic risks of an inadequately staged and treated endometrial cancer, the risk of a synchronous or meta-synchronous cancer, the increased risk of an inherited genetic predisposition to malignancy and the lack of uniformity in the medical management and surveillance. In this review we will discuss the conservative management of endometrial cancer, specifically the role of progestin hormonal therapy, including the risks associated with non-standard care, appropriate candidate selection and work up, expected outcomes, various progestin agents and recommended follow-up. PMID:22523629

Fanning, James

2012-01-01

237

Tapentadol immediate release: a new treatment option for acute pain management  

PubMed Central

The undertreatment of acute pain is common in many health care settings. Insufficient management of acute pain may lead to poor patient outcomes and potentially life-threatening complications. Opioids provide relief of moderate to severe acute pain; however, therapy with pure ?-opioid agonists is often limited by the prevalence of side effects, particularly opioid-induced nausea and vomiting. Tapentadol is a novel, centrally acting analgesic with 2 mechanisms of action, ?-opioid receptor agonism and norepinephrine reuptake inhibition. The analgesic effects of tapentadol are independent of metabolic activation and tapentadol has no active metabolites; therefore, in theory, tapentadol may be associated with a low potential for interindividual efficacy variations and drug–drug interactions. Previous phase 3 trials in patients with various types of moderate to severe acute pain have shown that tapentadol immediate release (IR; 50 to 100 mg every 4 to 6 hours) provides analgesia comparable to that provided by the pure ?-opioid agonist comparator, oxycodone HCl IR (10 or 15 mg every 4 to 6 hours), with a lower incidence of nausea, vomiting, and constipation. Findings suggest tapentadol may represent an improved treatment option for acute pain. PMID:21197304

Afilalo, Marc; Stegmann, Jens-Ulrich; Upmalis, David

2010-01-01

238

When is high-dose intravenous iron repletion needed? Assessing new treatment options.  

PubMed

High doses of intravenous iron have a role in the treatment of a number of clinical situations associated with iron deficiency, iron deficiency anemia, and blood loss. In the presence of functioning erythropoiesis, iron supplementation alone may be adequate to replenish iron stores and restore blood loss. Where hormone replacement with an erythropoiesis-stimulating agent is required, iron adequacy will optimize treatment. Intravenous iron offers a rapid means of iron repletion and is superior to oral iron in many circumstances, especially in the presence of anemia of chronic disease, where it appears to overcome the block to absorption of iron from the gastrointestinal tract and immobilization of stored iron. The clinical situations where high doses of iron are commonly required are reviewed. These include nondialysis-dependent chronic kidney disease, inflammatory bowel disease, obstetrics, menorrhagia, and anemia associated with cancer and its treatment. The literature indicates that high doses of iron are required, with levels of 1500 mg in nondialysis-dependent chronic kidney disease and up to 3600 mg in inflammatory bowel disease. New formulations of intravenous iron have recently been introduced that allow clinicians to administer high doses of iron in a single administration. Ferumoxytol is available in the US, has a maximum dose of 510 mg iron in a single administration, but is limited to use in chronic kidney disease. Ferric carboxymaltose can be rapidly administered in doses of 15 mg/kg body weight, up to a ceiling dose of 1000 mg. A test dose is not required, and it can be used more widely across a spectrum of iron deficiency and iron deficiency anemia indications. The latest introduction is iron isomaltoside 1000. Again, a test dose is not required, and it can be delivered rapidly as an infusion (in an hour), allowing even higher doses of iron to be administered in a single infusion, ie, 20 mg/kg body weight with no ceiling. This will allow clinicians to achieve high-dose repletion more frequently as a single administration. Treatment options for iron repletion have taken a major leap forward in the past two years, especially to meet the demand for high doses given as a single administration. PMID:21340038

Gozzard, David

2011-01-01

239

A rational approach for evaluation and screening of treatment and disposal options for the solar pond sludges at Rocky Flats  

SciTech Connect

This document consists of information about the treatment options for the sludge that is located in the evaporation ponds at the Rocky Flats Plant. The sludges are mixed low-level radioactive wastes whose composition and character were variable. Sludges similar to these are typically treated prior to ultimate disposal. Disposal of treated sludges includes both on-site and off-site options. The rational approach described in this paper is useful for technology evaluation and screening because it provides a format for developing objectives, listing alternatives, and weighing the alternatives against the objectives and against each other.

Dickerson, K.S.

1995-12-31

240

Granulocyte-colony stimulating factor as treatment option in patients with recurrent miscarriage.  

PubMed

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

Santjohanser, Claudia; Knieper, Catherine; Franz, Cordula; Hirv, Kaino; Meri, Osama; Schleyer, Manfred; Würfel, Wolfgang; Toth, Bettina

2013-04-01

241

Burr Hole Drainage : Could Be Another Treatment Option for Cerebrospinal Fluid Leakage after Unidentified Dural Tear during Spinal Surgery?  

PubMed Central

Authors report a rare case of acute intracranial subdural and intraventricular hemorrhage that were caused by intracranial hypotension resulted from cerebrospinal fluid leakage through an unidentified dural tear site during spinal surgery. The initial brain computed tomography image showed acute hemorrhages combined with preexisting asymptomatic chronic subdural hemorrhage. One burr hole was made over the right parietal skull to drain intracranial hemorrhages and subsequent drainage of cerebrospinal fluid induced by closure of the durotomy site. Among various methods to treat cerebrospinal fluid leakage through unidentified dural injury site, primary repair and spinal subarachnoid drainage are well known treatment options. The brain imaging study to diagnose intracranial hemorrhage should be taken before selecting the treatment method, especially for spinal subarachnoid drainage. Similar mechanism to its spinal counterpart, cranial cerebrospinal fluid drainage has not been mentioned in previous article and could be another treatment option to seal off an unidentified dural tear in particular case of drainage of intracranial hemorrhage is needed. PMID:23439677

2013-01-01

242

The Effect of Non-surgical Periodontal Therapy on Hemoglobin A1c Levels in Persons with Type 2 Diabetes and Chronic Periodontitis: A Randomized Clinical Trial  

PubMed Central

Importance Chronic periodontitis, a destructive inflammatory disorder of the supporting structures of the teeth, is prevalent in patients with diabetes. Limited evidence suggests that periodontal therapy may improve glycemic control. Objective To determine if non-surgical periodontal treatment reduces hemoglobin A1c (HbA1c) in persons with type 2 diabetes (DM) and moderate to advanced chronic periodontitis. Design, Setting and Participants The Diabetes and Periodontal Therapy Trial (DPTT) is a 6-month, single-masked, randomized, multi-center clinical trial. Participants had DM, were taking stable doses of medications, had HbA1c ?7% and <9%, and untreated periodontitis. Five hundred fourteen participants were enrolled between November 2009 and March 2012 from diabetes and dental clinics and communities affiliated with five academic medical centers. Intervention The treatment group (n=257) received scaling and root planing plus chlorhexidine oral rinse at baseline, and supportive periodontal therapy at three and six months. The control group (n=257) received no treatment for six months. Main Outcome Measure Difference in HbA1c change from baseline between groups at six months. Secondary outcomes included changes in probing pocket depths, clinical attachment loss, bleeding on probing, gingival index, fasting glucose, and the Homeostasis Model Assessment (HOMA2). Results Enrollment was stopped early due to futility. At 6 months, the periodontal therapy group increased HbA1c 0.17% (1.0) (mean (SD)) compared to 0.11% (1.0) in the control group, with no significant difference between groups based on a linear regression model adjusting for clinical site (mean difference = -0.05%; 95% Confidence Interval (CI): -0.23%, 0.12%; p=0.55). Probing depth, clinical attachment loss, bleeding on probing and gingival index measures improved in the treatment group compared to the control group at six months with adjusted between-group differences of 0.33mm (95% CI: 0.26, 0.39), 0.31mm (95% CI: 0.23, 0.39), 16.5% (95% CI: 12.9, 20.0) and 0.28 (95% CI: 0.21, 0.35), respectively; all p values <0.0001). Conclusions and Relevance Non-surgical periodontal therapy did not improve glycemic control in patients with DM and moderate to advanced chronic periodontitis. These findings do not support the use of nonsurgical periodontal treatment in patients with diabetes for the purpose of lowering HbA1c. PMID:24346989

Engebretson, Steven P.; Hyman, Leslie G.; Michalowicz, Bryan S.; Schoenfeld, Elinor R.; Gelato, Marie C.; Hou, Wei; Seaquist, Elizabeth R.; Reddy, Michael S.; Lewis, Cora E.; Oates, Thomas W.; Tripathy, Devjit; Katancik, James A.; Orlander, Philip R.; Paquette, David W.; Hanson, Naomi Q.; Tsai, Michael Y.

2014-01-01

243

Interventions for Children and Youth with Autism: Prudent Choices in a World of Exaggerated Claims and Empty Promises. Part I: Intervention and Treatment Option Review.  

ERIC Educational Resources Information Center

Discusses intervention and treatment options being used with the population of children and youth who have autism spectrum disorders. The discussion includes interventions based on relationship formation (including holding therapy, gentle teaching, options, and floor time), skill-based treatments, physiologically oriented intervention, and…

Heflin, L. Juane; Simpson, Richard L.

1998-01-01

244

Botulinum toxin-type A: could it be an effective treatment option in intractable trigeminal neuralgia?  

PubMed Central

Background Botulinum toxin type A (BTX-A) has been reported to have analgesic effects independent of its action on muscle tone, mostly by acting on neurogenic inflammatory mediators and controlling the neurotransmitter release of sensory and autonomic nerve terminals that are involved in many chronic painful conditions as chronic intractable trigeminal neuralgia (TN). The aim of our work was evaluating the efficacy, safety, and tolerability of BTX-A for the treatment of intractable idiopathic TN. Methods This was a randomized, single-blinded, placebo-control study carried out on 20 Egyptian patients with intractable TN. Patients received a one-time subcutaneous administration of BTX-A using “follow the pain” method. The primary efficacy measure was reduction in pain severity on the 10-cm VAS score as well as in paroxysms frequency from the baseline to week 12 (endpoint last observation carried forward [LOCF]). Secondary efficacy measures included QoL assessment and number of acute medications received from baseline to the endpoint. Results Pain reduction at the 12-week endpoint was significant in BTX-A group (p<0.0001); VAS scores at endpoint LOCF relative to baseline for BTX-A group showed a decrease of 6.5 compared with a decrease of 0.3 for placebo, also there was a significant decrease in the number of acute medications and an increase in QoL functioning scale. Conclusion These results indicate that BTX-A has a direct analgesic effect in patients with TN and can represent a therapeutic option for intractable cases. PMID:24251833

2013-01-01

245

Wavelet-based features for characterizing ventricular arrhythmias in optimizing treatment options.  

PubMed

Ventricular arrhythmias arise from abnormal electrical activity of the lower chambers (ventricles) of the heart. Ventricular tachycardia (VT) and ventricular fibrillation (VF) are the two major subclasses of ventricular arrhythmias. While VT has treatment options that can be performed in catheterization labs, VF is a lethal cardiac arrhythmia, often when detected the patient receives an implantable defibrillator which restores the normal heart rhythm by the application of electric shocks whenever VF is detected. The classification of these two subclasses are important in making a decision on the therapy performed. As in the case of all real world process the boundary between VT and VF is ill defined which might lead to many of the patients experiencing arrhythmias in the overlap zone (that might be predominately VT) to receive shocks by the an implantable defibrillator. There may also be a small population of patients who could be treated with anti-arrhythmic drugs or catheterization procedure if they can be diagnosed to suffer from predominately VT after objectively analyzing their intracardiac electrogram data obtained from implantable defibrillator. The proposed work attempts to arrive at a quantifiable way to scale the ventricular arrhythmias into VT, VF, and the overlap zone arrhythmias as VT-VF candidates using features extracted from the wavelet analysis of surface electrograms. This might eventually lead to an objective way of analyzing arrhythmias in the overlap zone and computing their degree of affinity towards VT or VF. A database of 24 human ventricular arrhythmia tracings obtained from the MIT-BIH arrhythmia database was analyzed and wavelet-based features that demonstrated discrimination between the VT, VF, and VT-VF groups were extracted. An overall accuracy of 75% in classifying the ventricular arrhythmias into 3 groups was achieved. PMID:22254473

Balasundaram, K; Masse, S; Nair, K; Farid, T; Nanthakumar, K; Umapathy, K

2011-01-01

246

Reproductive anatomy, manipulation of ovarian activity and non-surgical embryo recovery in suni (Neotragus moschatus zuluensis).  

PubMed

Marked disparity in the uterine horn dimensions and relative degrees of caruncle development in suni suggested that exclusive or predominant dextral implantation occurs in association with bilateral ovulatory activity. Daily urinary measurements of pregnanediol-3 alpha-glucuronide revealed an oestrous cycle of approximately 21 days in length. Ovarian activity was controlled for synchronization of oestrus by using progestagen-impregnated intravaginal sponges and multiple ovulations were induced by using exogenous gonadotrophin therapy. An effective transcervical uterine catheterization technique was developed for the non-surgical collection of embryos. The efficiency of embryo recovery performed 5 days after sponge removal was 50.0%. PMID:2325018

Loskutoff, N M; Raphael, B L; Nemec, L A; Wolfe, B A; Howard, J G; Kraemer, D C

1990-03-01

247

Greywater treatment as an option for effective wastewater management in small communities  

Microsoft Academic Search

This paper presents the results of four different investigations where greywater is treated with low technology as achieved a constructed wetland and a gravel and sand filter as well as with a high-tech option: the membrane bioreactor. The applications are perfectly suited to be operated in remote areas or small communities with tourist depending variation of discharged wastewater flows. The

René Scheumann; Fabio Masi; Bouchaib El Hamouri; Matthias Kraume

2009-01-01

248

Classification and Current TreatmentOptions of In-Stent Restenosis  

Microsoft Academic Search

Coronary stent implantation is currently performed in > 80% of percutaneous coronary interventions. Its main late complication is the development of in-stent restenosis (ISR), occurring in 10–80% of lesions treated in daily practice. The classification by Mehran et al. is most commonly used. Current therapeutic options to treat ISR include repeat balloon angioplasty, repeat stenting, cutting balloon angioplasty, directional coronary

Andrew T. L. Ong; Jiro Aoki; Eugene P. McFadden; Patrick W. Serruys

2004-01-01

249

Right atrial bypass grafting for central venous obstruction associated with dialysis access: Another treatment option  

Microsoft Academic Search

Purpose: Central venous obstruction is a common problem in patients with chronic renal failure who undergo maintenance hemodialysis. We studied the use of right atrial bypass grafting in nine cases of central venous obstruction associated with upper extremity venous hypertension. To better understand the options for managing this condition, we discuss the roles of surgery and percutaneous transluminal angioplasty with

Rafik A. El-Sabrout; J. Michael Duncan

1999-01-01

250

Cost-effectiveness of available treatment options for patients suffering from severe COPD in the UK: a fully incremental analysis  

PubMed Central

Purpose Frequent exacerbations which are both costly and potentially life-threatening are a major concern to patients with chronic obstructive pulmonary disease (COPD), despite the availability of several treatment options. This study aimed to assess the lifetime costs and outcomes associated with alternative treatment regimens for patients with severe COPD in the UK setting. Patients and methods A Markov cohort model was developed to predict lifetime costs, outcomes, and cost-effectiveness of various combinations of a long-acting muscarinic antagonist (LAMA), a long-acting beta agonist (LABA), an inhaled corticosteroid (ICS), and roflumilast in a fully incremental analysis. Patients willing and able to take ICS, and those refusing or intolerant to ICS were analyzed separately. Efficacy was expressed as relative rate ratios of COPD exacerbation associated with alternative treatment regimens, taken from a mixed treatment comparison. The analysis was conducted from the UK National Health Service (NHS) perspective. Parameter uncertainty was explored using one-way and probabilistic sensitivity analysis. Results Based on the results of the fully incremental analysis a cost-effectiveness frontier was determined, indicating those treatment regimens which represent the most cost-effective use of NHS resources. For ICS-tolerant patients the cost-effectiveness frontier suggested LAMA as initial treatment. Where patients continue to exacerbate and additional therapy is required, LAMA + LABA/ICS can be a cost-effective option, followed by LAMA + LABA/ICS + roflumilast (incremental cost-effectiveness ratio [ICER] versus LAMA + LABA/ICS: £16,566 per quality-adjusted life-year [QALY] gained). The ICER in ICS-intolerant patients, comparing LAMA + LABA + roflumilast versus LAMA + LABA, was £13,764/QALY gained. The relative rate ratio of exacerbations was identified as the primary driver of cost-effectiveness. Conclusion The treatment algorithm recommended in UK clinical practice represents a costeffective approach for the management of COPD. The addition of roflumilast to the standard of care regimens is a clinical and cost-effective treatment option for patients with severe COPD, who continue to exacerbate despite existing bronchodilator therapy. PMID:22500119

Hertel, Nadine; Kotchie, Robert W; Samyshkin, Yevgeniy; Radford, Matthew; Humphreys, Samantha; Jameson, Kevin

2012-01-01

251

Current treatment options for type 2 diabetes mellitus in youth: today's realities and lessons from the TODAY study.  

PubMed

The incidence of type 2 diabetes in children and adolescents has increased over the last 2 decades, paralleled by an increase in obesity over the same time period. Although the value of lifestyle modification in obese youth is unquestioned, scant evidence for optimal treatment of type 2 diabetes in this age group exists. Despite recent therapeutic drug trials, metformin and insulin are the only medicines currently approved by the U.S. Food and Drug Administration for the treatment of type 2 diabetes in youth. Because of recently amended pharmaceutical regulations, however, it is likely that more antidiabetic medications soon will be added to the armamentarium of therapeutic options for youth with type 2 diabetes. Additionally, the recently published TODAY study comparing safety and efficacy of three treatment regimens in maintaining glycemic control in youth with type 2 diabetes has shed new light on the problem. PMID:23065368

George, Minu M; Copeland, Kenneth C

2013-02-01

252

Stevens-Johnson syndrome and toxic epidermal necrolysis: efficacy of intravenous immunoglobulin and a review of treatment options.  

PubMed

Toxic epidermal necrolysis (TEN) is a rare, severe adverse drug reaction. Steven-Johnson syndrome (SJS) represents the milder end of the spectrum. The exact pathogenesis of TEN and SJS is still unknown and many drugs, including prednisolone, cyclosporin and intravenous immunoglobulin (IVIG), have been used in an attempt to halt the disease process. The use of IVIG in particular is controversial. We share our experience with the use of IVIG in six patients with TEN. We will also review the various proposed mechanisms underlying TEN, the mechanism of action of IVIG in TEN and summarise useful treatment options. PMID:19224081

Teo, L; Tay, Y K; Liu, T T; Kwok, C

2009-01-01

253

Oral health-related quality of life following non-surgical (routine) tooth extraction: A pilot study  

PubMed Central

Aim: The study was designed to explore the changes in oral health-related quality of life (QoL) in the immediate postoperative period following routine (non-surgical) dental extraction. Setting and Design: A prospective study carried out at the Oral and Maxillofacial Surgery clinic of the Lagos University Teaching Hospital, Nigeria. Materials and Methods: Subjects attending who required non-surgical removal of one or two teeth under local anesthesia were included in the study. A baseline QoL questionnaire (oral health impact profile-14 [OHIP-14]) was filled by each patient just before surgery, and only those who were considered to have their QoL “not affected” (total score 14 or less) were included in the study. After the extraction, each subject was given a modified form of “health related QoL” [OHIP-14]-instrument to be completed by the 3rd day-after surgery, and were given the opportunity to review the questionnaire on the 7th day postoperative review. Results: Total OHIP-14 scores ranged between 14 and 48 (mean ± SD, 26.2 ± 8.3). Majority of the subjects (60%) reported, “a little affected.” Only few subjects (5.8%) reported, “not at all affected,” and about 32% reported, “quite a lot.” Summation of OHIP-14 scores revealed that QoL was “affected” in 41 subjects (34.2%) and “not affected” in 79 subjects (65.8%). More than 30% of subjects reported that their ability to chew, ability to open the mouth and enjoyment of food were affected following tooth extraction. Few subjects (14-34%) reported deterioration in their speech and less than 20% of subjects reported that change in their appearance was “affected.” Only few subjects (12.5-15.1%) reported sleep and duty impairment. Thirty-percent of subjects reported their inability to keep social activities, and 41% were not able to continue with their favorite sports and hobbies. Multiple regression analysis revealed no significant association between age, sex, indications for extraction, duration of extraction, intra-operative complications, and deterioration in QoL (P < 0.05). Consumption of analgesics beyond postoperative day 1 (POD1) was more common in subjects with socket healing complications than those without (P = 0.000). About 33% of subjects reported, “inability to work” (1-3 days). Conclusion: About a third of subjects experienced significant deterioration in QoL. The most affected domains were eating/diet variation and speech variation. Therefore, patients should be informed of possible deterioration in their QoL following non-surgical tooth extraction. PMID:23633803

Adeyemo, Wasiu L.; Taiwo, Olanrewaju A.; Oderinu, Olabisi H.; Adeyemi, Moshood F.; Ladeinde, Akinola L.; Ogunlewe, Mobolanle O.

2012-01-01

254

Successful non-surgical deep uterine transfer of porcine morulae after 24 hour culture in a chemically defined medium.  

PubMed

Excellent fertility and prolificacy have been reported after non-surgical deep uterine transfers of fresh in vivo-derived porcine embryos. Unfortunately, when this technology is used with vitrified embryos, the reproductive performance of recipients is low. For this reason and because the embryos must be stored until they are transferred to the recipient farms, we evaluated the potential application of non-surgical deep uterine transfers with in vivo-derived morulae cultured for 24 h in liquid stage. In Experiment 1, two temperatures (25 °C and 37 °C) and two media (one fully defined and one semi-defined) were assessed. Morulae cultured in culture medium supplemented with bovine serum albumin and fetal calf serum at 38.5 °C in 5% CO2 in air were used as controls. Irrespective of medium, the embryo viability after 24 h of culture was negatively affected (P<0.05) at 25 °C but not at 37 °C compared with the controls. Embryo development was delayed in all experimental groups compared with the control group (P<0.001). Most of the embryos (95.7%) cultured at 37 °C achieved the full or expanded blastocyst stage, and unlike the controls, none of them hatched at the end of culture. In Experiment 2, 785 morulae were cultured in the defined medium at 37 °C for 24 h, and the resulting blastocysts were transferred to the recipients (n = 24). Uncultured embryos collected at the blastocyst stage (n = 750) were directly transferred to the recipients and used as controls (n = 25). No differences in farrowing rates (91.7% and 92.0%) or litter sizes (9.0 ± 0.6 and 9.4 ± 0.8) were observed between the groups. This study demonstrated, for the first time, that high reproductive performance can be achieved after non-surgical deep uterine transfers with short-term cultured morulae in a defined medium, which opens new possibilities for the sanitary, safe national and international trade of porcine embryos and the commercial use of embryo transfer in pigs. PMID:25118944

Martinez, Emilio A; Angel, Miguel Angel; Cuello, Cristina; Sanchez-Osorio, Jonatan; Gomis, Jesus; Parrilla, Inmaculada; Vila, Jordi; Colina, Ignaci; Diaz, Marta; Reixach, Josep; Vazquez, Jose Luis; Vazquez, Juan Maria; Roca, Jordi; Gil, Maria Antonia

2014-01-01

255

Optimizing long-term therapy for Parkinson disease: options for treatment-associated dyskinesia.  

PubMed

There is currently no satisfactory treatment for dyskinesia in patients with Parkinson disease because most antidyskinetic strategies have the effect of aggravating Parkinsonian symptoms, and most pharmacological strategies for reducing "off" periods have increased dyskinesia as a treatment complication. Therefore, physicians and patients often have to balance treatment of its effects on Parkinsonian symptoms and on dyskinesia. In patients with advanced Parkinson disease, it is often not possible to induce periods of good mobility without dyskinesia. PMID:18382184

Stacy, Mark; Galbreath, Andrew

2008-01-01

256

Non-surgical prevention and management of scoliosis for children with Duchenne muscular dystrophy: What is the evidence?  

PubMed

A review was performed to examine the evidence for non-surgical interventions for preventing scoliosis and the need for scoliosis surgery in children with Duchenne muscular dystrophy. Medline and Embase databases and reference lists from key articles were searched. After the inclusion and exclusion criteria were applied, 13 studies were critically appraised independently by two reviewers. The included studies examined spinal orthoses and steroid therapy. There were no studies with high levels of evidence (randomised or other controlled trials). The studies with the highest level of evidence were non-randomised experimental trials. There is some evidence that children with Duchenne muscular dystrophy who receive steroid therapy might have delayed onset of scoliosis, but more evidence is required about the long-term risks versus benefits of this intervention. There is weak evidence that spinal orthoses do not prevent and only minimally delay the onset of scoliosis. PMID:23560735

Harvey, Adrienne; Baker, Louise; Williams, Katrina

2014-10-01

257

The Epidemiology of Psychiatric Disorders Among Repeat DUI Offenders Accepting a Treatment-Sentencing Option  

Microsoft Academic Search

Psychiatric comorbidity likely contributes to driving under the influence (DUI) of alcohol among repeat offenders. This study presents one of the first descriptions of the prevalence and comorbidity of psychiatric disorders among repeat DUI offenders in treatment. Participants included all consenting eligible admissions (N = 729) to a 2-week inpatient treatment facility for court-sentenced repeat DUI offenders (i.e., offenders electing

Howard J. Shaffer; Sarah E. Nelson; Debi A. LaPlante; Richard A. LaBrie; Mark Albanese; Gabriel Caro

2007-01-01

258

Superovulation, non surgical embryo collection, transfer and rebreeding of early postpartum brangus cows  

E-print Network

Embryo Collection First and Posttreatment Estrus Pregnancy Data Embryo Transfer Results Analysis of Data Conclusions LITERATURE CI'TED VITA '. 13 13 16 18 18 22 22 24 29 LIST OF TABLES TABLE 1 PALPABLE CORPORA LUTEA AND NUMBER OF EMBRYOS... cows expressed estrus and eighty eight percent formed corpora lutea in response to treatment. Exogenous gonadotrophins or (Gn-RH) alone have also been successfully used to initiate LH increases and subse- quent elevated progesterone levels...

Stone, Guy

2012-06-07

259

LITERATURE SURVEY FOR GROUNDWATER TREATMENT OPTIONS FOR NITRATE IODINE-129 AND URANIUM 200-ZP-1 OPERABLE UNIT HANFORD SITE  

SciTech Connect

This literature review presents treatment options for nitrate, iodine-129, and uranium, which are present in groundwater at the 200-ZP-I Groundwater Operable Unit (OU) within the 200 West Area of the Hanford Site. The objective of this review is to determine available methods to treat or sequester these contaminants in place (i.e., in situ) or to pump-and-treat the groundwater aboveground (i.e., ex situ). This review has been conducted with emphasis on commercially available or field-tested technologies, but theoretical studies have, in some cases, been considered when no published field data exist. The initial scope of this literature review included only nitrate and iodine-I 29, but it was later expanded to include uranium. The focus of the literature review was weighted toward researching methods for treatment of nitrate and iodine-129 over uranium because of the relatively greater impact of those compounds identified at the 200-ZP-I OU.

BYRNES ME

2008-06-05

260

K Basin spent fuel sludge treatment alternatives study. Volume 2, Technical options  

SciTech Connect

Approximately 2100 metric tons of irradiated N Reactor fuel are stored in the KE and KW Basins at the Hanford Site, Richland, Washington. Corrosion of the fuel has led to the formation of sludges, both within the storage canisters and on the basin floors. Concern about the degraded condition of the fuel and the potential for leakage from the basins in proximity to the Columbia River has resulted in DOE`s commitment in the Tri-Party Agreement (TPA) to Milestone M-34-00-T08 to remove the fuel and sludges by a December 2002 target date. To support the planning for this expedited removal action, the implications of sludge management under various scenarios are examined. This report, Volume 2 of two volumes, describes the technical options for managing the sludges, including schedule and cost impacts, and assesses strategies for establishing a preferred path.

Beary, M.M.; Honekemp, J.R.; Winters, N. [Science Applications International Corp., Richland, WA (United States)

1995-01-01

261

Introduction: Cancer treatment and male fertility: effects of therapy and current and future management options.  

PubMed

Cancer treatments are detrimental to spermatogenesis. This series reviews effects of anticancer therapies on male fertility, current and future approaches to determine sperm health, and gives recommendations for patient management. PMID:24074753

Sigman, Mark

2013-11-01

262

Managing Behçet's disease: An update on current and emerging treatment options.  

PubMed

Behçet's disease is an autoinflammatory vasculitis of unknown origin characterized by recurrent oral and genital ulcers, uveitis, arthritis and skin lesions. Additionally, involvement of the gastrointestinal tract, central nervous system and large vessels may occur. The disease is prevalent in countries along the ancient Silk Road from Eastern Asia to the Mediterranean Basin. Many treatment modalities are currently available. The choice of treatment depends on organ involvement and severity of disease. Topical treatment with corticosteroids is often sufficient for mucocutaneous involvement, however for more severe disease with vasculitis or neurological involvement a more aggressive approach is warranted. Newer drugs (biologicals) influencing cytokines and thereby T-cell function are promising with an acceptable side effect profile. Unfortunately, reimbursement of the costs of biologicals for rare disease is still a problem in various countries. In this report we discuss the current treatment modalities for Behçet's disease. PMID:19536320

van Daele, P La; Kappen, J H; van Hagen, P M; van Laar, J Am

2009-04-01

263

Assessment of sludge management options in a waste water treatment plant  

E-print Network

This thesis is part of a larger project which began in response to a request by the Spanish water agengy, Cadagua, for advice on life cycle assessment (LCA) and environmental impacts of Cadagua operated wastewater treatment ...

Lim, Jong hyun, M. Eng. Massachusetts Institute of Technology

2012-01-01

264

Household water treatment and safe storage options for Northern Region Ghana : consumer preference and relative cost  

E-print Network

A range of household water treatment and safe storage (HWTS) products are available in Northern Region Ghana which have the potential to significantly improve local drinking water quality. However, to date, the region has ...

Green, Vanessa (Vanessa Layton)

2008-01-01

265

Therapeutic options for the treatment of infections with multiresistant grampositive bacteria in oncological patients  

Microsoft Academic Search

Summary  Infections with highly resistant grampositive bacteria are a major threat to the patients with underlying malignant diseases\\u000a and due to more aggressive treatment strategies the incidence of these infections increased over the past years. For many\\u000a years, glycopeptides such as vancomycin, have been the standard treatment for methicillin-resistant S. aureus (MRSA) and ampicillin-resistant\\u000a enterococci. However, the clinical use of vancomycin

G. Fritsche; G. Weiss

2008-01-01

266

Economic evaluation of alternative wastewater treatment plant options for pulp and paper industry.  

PubMed

Excessive water consumption in pulp and paper industry results in high amount of wastewater. Pollutant characteristics of the wastewater vary depending on the processes used in production and the quality of paper produced. However, in general, high organic material and suspended solid contents are considered as major pollutants of pulp and paper industry effluents. The major pollutant characteristics of pulp and paper industry effluents in Turkey were surveyed and means of major pollutant concentrations, which were grouped in three different pollution grades (low, moderate and high strength effluents), and flow rates within 3000 to 10,000m(3)/day range with 1000m(3)/day steps were used as design parameters. Ninety-six treatment plants were designed using twelve flow schemes which were combinations of physical treatment, chemical treatment, aerobic and anaerobic biological processes. Detailed comparative cost analysis which includes investment, operation, maintenance and rehabilitation costs was prepared to determine optimum treatment processes for each pollution grade. The most economic and technically optimal treatment processes were found as extended aeration activated sludge process for low strength effluents, extended aeration activated sludge process or UASB followed by an aeration basin for medium strength effluents, and UASB followed by an aeration basin or UASB followed by the conventional activated sludge process for high strength effluents. PMID:20870270

Buyukkamaci, Nurdan; Koken, Emre

2010-11-15

267

Treating dyspareunia caused by vaginal atrophy: a review of treatment options using vaginal estrogen therapy  

PubMed Central

Vulvovaginal atrophy (VVA) and dryness are common symptoms of the decline in endogenous production of estrogen at menopause and often result in dyspareunia. Yet while 10% to 40% of women experience discomfort due to VVA, it is estimated that only 25% seek medical help. The main goals of treatment for vaginal atrophy are to improve symptoms and to restore vaginal and vulvar anatomic changes. Treatment choices for postmenopausal dyspareunia resulting from vulvovaginal atrophy will depend on the underlying etiology and might include individualized treatment. A number of forms of vaginal estrogen and manner of delivery are currently available to treat moderate to severe dyspareunia caused by VVA. They all have been shown to be effective and are often the preferred treatment due to the targeted efficacy for urogenital tissues while resulting in only minimal systemic absorption. Both healthcare professionals and patients often find it difficult to broach the subject of sexual problems associated with VVA. However, with minimal effort to initiate a conversation about these problems, healthcare providers can provide useful information to their postmenopausal patients in order to help them each choose the optimal treatment for their needs and symptoms. PMID:21072280

Kingsberg, SA; Kellogg, S; Krychman, M

2010-01-01

268

Transvenous Approach to Intracranial Dural Arteriovenous Fistula (Cognard V): a Treatment Option  

PubMed Central

Summary The endovascular technique is the gold standard treatment in dural arteriovenous fistulas. Due to the limited number of series published it is difficult to create rigid guidelines in terms of the best endovascular treatment approach. Treatment must be tailored to each particular case, but it is important to keep in mind that the possibility of treating a type V dAVF by the transvenous approach should not be discarded. In selected cases the transvenous approach may be helpful to increase the chance of success in the endovascular treatment of type V dAVF. We describe a patient in whom the first arterial treatment failed to achieve occlusion of the fistulous point with the glue. Clinical symptoms improved due to the diminished flow at the fistula after the first embolization but as soon as collateral arteries were recruited by the fistula, spinal cord venous drainage impairment led to symptoms recurrence. Transvenous access allowed us to close the fistula completely in one only session with a complete disappearance of the pathologically inverted perimedullary venous flow. PMID:21561567

Aiuxut Lorenzo, S.; Tomasello Weitz, A.; Blasco Andaluz, J.; Sanroman Manzanera, L.; Macho Fernandez, J.M.

2011-01-01

269

Immunological Treatment Options for Locoregionally Advanced Head and Neck Squamous Cell Carcinoma  

PubMed Central

Patients with squamous cell carcinoma of the head and neck (HNSCC) are usually treated by a multimodal approach with surgery and/or radiochemotherapy as the mainstay of local–regional treatment in cases with advanced disease. Both chemotherapy and radiation therapy have the disadvantage of causing severe side effects, while the clinical outcome of patients diagnosed with HNSCC has remained essentially unchanged over the last decade. The potential of immunotherapy is still largely unexplored. Here the authors review the current status of the art and discuss the future challenges in HNSCC treatment and prevention. PMID:22251006

Mirandola, Leonardo; Bernardini, Giovanni; Cunha, Nicholas D'; Tijani, Lukman; Nguyen, Diane; Cordero, Joehassin; Jenkins, Marjorie R.; Cobos, Everardo; Kast, W. Martin; Chiriva-Internati, Maurizio

2014-01-01

270

The Epidemiology of Psychiatric Disorders among Repeat DUI Offenders Accepting a Treatment-Sentencing Option  

ERIC Educational Resources Information Center

Psychiatric comorbidity likely contributes to driving under the influence (DUI) of alcohol among repeat offenders. This study presents one of the first descriptions of the prevalence and comorbidity of psychiatric disorders among repeat DUI offenders in treatment. Participants included all consenting eligible admissions (N = 729) to a 2-week…

Shaffer, Howard J.; Nelson, Sarah E.; LaPlante, Debi A.; LaBrie, Richard A.; Albanese, Mark; Caro, Gabriel

2007-01-01

271

The Epidemiology of Psychiatric Disorders among Repeat DUI Offenders Accepting a Treatment-Sentencing Option  

ERIC Educational Resources Information Center

Psychiatric comorbidity likely contributes to driving under the influence (DUI) of alcohol among repeat offenders. This study presents one of the first descriptions of the prevalence and comorbidity of psychiatric disorders among repeat DUI offenders in treatment. Participants included all consenting eligible admissions (N=729) to a 2-week…

Shaffer, Howard J.; Nelson, Sarah E.; LaPlante, Debi A.; LaBrie, Richard A.; Albanese, Mark; Caro, Gabriel

2007-01-01

272

Impacts, recovery rates, and treatment options for spilled oil in marshes.  

PubMed

In a review of the literature on impacts of spilled oil on marshes, 32 oil spills and field experiments were identified with sufficient data to generate recovery curves and identify influencing factors controlling the rate of recovery. For many spills, recovery occurred within 1-2 growing seasons, even in the absence of any treatment. Recovery was longest for spills with the following conditions: Cold climate; sheltered settings; thick oil on the marsh surface; light refined products with heavy loading; oils that formed persistent thick residues; and intensive treatment. Recovery was shortest for spills with the following conditions: Warm climate; light to heavy oiling of the vegetation only; medium crude oils; and less-intensive treatment. Recommendations are made for treatment based on the following oiling conditions: Free-floating oil on the water in the marsh; thicker oil (>0.5 cm) on marsh surface; thinner oil (<0.5 cm) on marsh surface; heavy oil loading on vegetation; and light to moderate oil loading on vegetation. PMID:24703808

Michel, Jacqueline; Rutherford, Nicolle

2014-05-15

273

Ex utero intrapartum treatment (EXIT), a resuscitation option for intra-thoracic foetal pathologies  

Microsoft Academic Search

The ex utero intrapartum treatment (EXIT) procedure is designed to guarantee sufficient oxy- genation for a foetus at risk of airway obstruction. This is achieved by improving lung ventilation, usually by establishing an airway during caesarean delivery whilst preserving the foetal-placental cir- culation temporarily. Indications for the EXIT procedure have extended from its original use in reversing iatrogenic tracheal obstruction

Christian Kern; Michel Ange; Riccardo E. Pfister

274

Phosphate treatment of TMT rebar bundle to avoid early rusting: An option for single step process  

Microsoft Academic Search

Thermo-mechanically treated (TMT) rebars are extensively used for reinforcement of cement concrete. In a large tropical country like India, where transit times are long and moisture levels are high, the rebars get easily rusted leading to a poor appearance. The present paper documents the work done by the authors to alleviate this problem. The work involved phosphate treatment on the

M. Manna; I. Chakrabarti; N. Bandyopadhyay

2006-01-01

275

Fungal biosorption — an alternative treatment option for heavy metal bearing wastewaters: a review  

Microsoft Academic Search

The common filamentous fungi can sorb heavy metals from aqueous solutions. The sorption of heavy metals, Cu, Zn, Cd, Pb, Fe, Ni, Ag, Th, Ra and U, by fungal biomass has been observed to varying extents. Fungal biosorption largely depends on parameters such as pH, metal ion and biomass concentration, physical or chemical pre-treatment of biomass, presence of various ligands

A. Kapoor; T. Viraraghavan

1995-01-01

276

Economic importance and application options of some industrial sludge conditioned by different treatment methods  

Microsoft Academic Search

Industrial sludge was obtained from four industries: aluminium extrusion, brewery, pharmaceutical and textile processing factory and treated by aerobic, anaerobic, physicochemical, combined aerobic\\/physicochemical and combined anaerobic\\/physicochemical methods. The results showed that the final destination of the sludge would determine the type and degree of treatment required for the sludge. Physicochemical method generally increases the quantity of sludge solids, thus making

Imohimi O. Asia; K. E. Ekpo

277

Simple, easy, and still effective treatment option in severe rhinophyma: shave and paste.  

PubMed

A 74-year-old man suffering from severe rhinophyma with breathing difficulty and depression seeking for help presented to our clinic. The cauliflower-like mass was full thickness excised and a full thickness skin graft from right inguinal region was applied. An exceptionally treatment and satisfactory cosmetic result was obtained in single stage. PMID:23551373

Sarifakioglu, Nedim; Sarifakioglu, Evren

2013-01-01

278

New treatment options in the management of fi bromyalgia: role of pregabalin  

Microsoft Academic Search

Fibromyalgia (FM) is a common, chronic pain disorder with unknown etiology, characterized by widespread musculoskeletal pain and tenderness, and accompanied by several other symptoms such as sleep disturbance, fatigue, and mood disorders. Pregabalin is the fi rst drug approved for the treatment of FM. Pregabalin has analgesic, anticonvulsant, and anxiolytic activity and has earlier demonstrated effi cacy in the management

Grazyna Zareba

2008-01-01

279

Neoadjuvant Chemotherapy: An Alternative Option of Treatment for Locally Advanced Cervical Cancer  

Microsoft Academic Search

Although the incidence of cervical cancer has declined in both North America and Europe, it still represents the second most common cancer in women and the fifth most common malignancy worldwide. Most patients in the developed countries present with disease either confined to the cervix or with limited extension beyond it. Historically, the standard treatment was usually radiotherapy or radical

V. Loizzi; G. Cormio; M. Vicino; L. Selvaggi

2008-01-01

280

Selective dorsal rhizotomy as a treatment option for children with spastic cerebral palsy  

Microsoft Academic Search

Cerebral palsy is the most common motor disorder originating in childhood and spasticity is the most frequent manifestation. The treatment strategies to reduce spasticity and thereby ameliorate the attendant gait abnormalities have included physiotherapy, orthoses, antispastic medications, orthopaedic surgery and neurosurgery. Of these, the neurosurgical procedure known as selective dorsal rhizotomy has gained widespread exposure, and indeed acceptance, over the

Christopher L Vaughan; Nivedita Subramanian; Monica E Busse

1998-01-01

281

Selective dorsal rhizotomy as a treatment option for children with spastic cerebral palsy  

Microsoft Academic Search

Cerebral palsy is the most common motor disorder originating in childhood and spasticity is the most frequent manifestation. The treatment strategies to reduce spasticity and thereby ameliorate the attendant gait abnormalities have included physiotherapy, orthoses, antispastic medications, orthopaedic surgery and neurosurgery. Of these, the neurosurgical procedure known as selective dorsal rhizotomy has gained widespread exposure, and indeed acceptance, over the

Christopher L. Vaughan; Nivedita Subramanian; Monica E. Busse

282

High-Dose Intravenous Immunoglobulins: An Option in the Treatment of Systemic Lupus Erythematosus  

Microsoft Academic Search

Despite encouraging reports on the efficacy of intravenous immunoglobulin (IVIG) therapy in systemic lupus erythematosus (SLE), the clinical value of this treatment is not well established, and most of the data are based on case reports and small series of patients. IVIG has been used successfully to treat SLE patients with a broad spectrum of clinical manifestations, such as refractory

E. Toubi; A. Kessel; Y. Shoenfeld

2005-01-01

283

Aortic Neck Attachment Failure and the AneuRx Graft: Incidence, Treatment Options, and Early Results  

Microsoft Academic Search

Some investigators have reported that proximal attachment failure is a long-term complication of endovascular abdominal aortic aneurysm repair (EVAR) with the AneuRx (Medtronic, Santa Rosa, CA) device. We evaluated the need for an intervention in patients with suboptimal proximal fixation as well as the feasibility and early success of a variety of treatment strategies. From October 1999 to October 2003,

Ali Azizzadeh; Luis A. Sanchez; Brian G. Rubin; Juan C. Parodi; Christopher J. Godshall; Patrick J. Geraghty; Eric T. Choi; M. Wayne Flye; John A. Curci; Gregorio A. Sicard

2005-01-01

284

New treatment options for substance abuse from a public health viewpoint.  

PubMed

Naltrexone is the first safe and effective pharmaceutical adjunct for use in the treatment of alcohol abuse. Theoretically it could be effective also as a means for terminating methadone maintenance and in the treatment of other forms of substance abuse. Two general types of protocols have been used with naltrexone. One protocol is similar to the protocol appropriate for use with disulfiram; it is designed to preclude use of the substance while on naltrexone. The other protocol is based on preclinical research showing that opioid antagonists can cause extinction of alcohol drinking; it is designed to maximize the effects from extinction. The results from the clinical trials are consistent with the conclusion that the major benefits from naltrexone treatment, regardless of protocol, are being caused by extinction. The extinction protocol is better from the position of public health, increasing the range of patients who can be treated, reducing the total cost and allowing patients to be treated with dignity. Pharmacological extinction is a new form of medicine, shown to be highly accessible and effective in treating excessive drinking and providing interesting possibilities for the treatment of other learned behavioural disorders. PMID:9783840

Sinclair, J D

1998-08-01

285

Composting is an effective treatment option for sanitization of Phytophthora ramorum-infected plant  

Microsoft Academic Search

Aims: To determine the effects of heat and composting treatments on the viab- ility of the plant pathogen Phytophthora ramorum grown on both artificial and various natural substrates. Methods and Results: Phytophthora ramorum was grown on V8 agar, inocula- ted on bay laurel leaves (Umbellularia californica) and on woody tissues of coast live oak (Quercus agrifolia). Effects on growth, viability

S. Swain; T. Harnik; M. Mejia-Chang; K. Hayden; W. Bakx; J. Creque; M. Garbelotto

2006-01-01

286

Cartilage Restoration, Part 1Basic Science, Historical Perspective, Patient Evaluation, and Treatment Options  

Microsoft Academic Search

Surgical procedures designed to treat focal chondral lesions are evolving and are supported by basic science principles of cartilage physiology and known responses to injury. Selecting the proper treatment algorithm for a particular patient depends on careful patient evaluation, including the recognition of comorbidities such as ligamentous instability, deficient menisci, or malalignment of the mechanical limb axis or extensor mechanism.

J. Winslow Alford; Brian J. Cole

2005-01-01

287

Denosumab: a new treatment option for giant cell tumor of bone.  

PubMed

Giant cell tumor of bone (GCTB) is an osteolytic, usually benign neoplasm characterized by infiltration with osteoclast-like giant cells, and the osteoclast differentiation factor receptor activator of nuclear factor kappa-B ligand (RANKL) is heavily involved in its pathogenesis. Denosumab belongs to a new class of drugs that inhibit RANKL. Prior to denosumab, multimodality treatment in refractory, recurrent and metastatic GCTB has shown variable results. Recent phase II data have demonstrated denosumab's activity with regard to disease and symptom control, without significant adverse effects. On the basis of this data, the FDA approved denosumab for the treatment of patients whose GCTB is unresectable, or when surgery is likely to result in severe morbidity. Ongoing questions remain, including the optimal scheduling, patient selection, use in the adjuvant setting and long-term toxicity concerns. PMID:24308016

Lewin, J; Thomas, D

2013-11-01

288

Heterocyclic nitrogenous pollutants in the environment and their treatment options--an overview.  

PubMed

Heterocyclic nitrogenous bases are one of the most important class of compounds containing N as a heteroatom, like pyridine and its derivatives. These compounds are of immense concern from point view of environment since they are known for their toxic and carcinogenic properties, lethal effect on natural biogenic environment and severe odour potential. There is a need to control these compounds from getting discharged into the environment. This paper addresses the different natural/anthropogenic sources which generate these pollutants, their toxicity profile, different physico-chemical treatment methods and especially focuses on biological methods of treatment and combination of these for the efficient removal to achieve a treated effluent quality fit for disposal without causing any damage to the environment. PMID:17418565

Padoley, K V; Mudliar, S N; Pandey, R A

2008-07-01

289

Treatment options for refractory and difficult to treat seizures: focus on vigabatrin.  

PubMed

Complex partial seizures are often refractory to current pharmacological therapies. These difficult to treat seizures are typically managed using multiple antiepileptic drugs (AEDs). AEDs as a group are frequently associated with significant adverse drug effects, multiple drug interactions, and numerous potential clinical complications due to their individual pharmacokinetic profiles and unique drug properties. Recently, the approval of vigabatrin by the US Food and Drug Administration has necessitated that clinicians re-evaluate these risk-benefit relationships and determine where the drug fits within the treatment scheme for the management of complex partial seizures. This review will facilitate that re-evaluation through a brief review of AEDs used in the treatment of complex partial seizures, followed by a focused discussion on vigabatrin. PMID:21941443

Tolman, Justin A; Faulkner, Michele A

2011-01-01

290

Treatment options for refractory and difficult to treat seizures: focus on vigabatrin  

PubMed Central

Complex partial seizures are often refractory to current pharmacological therapies. These difficult to treat seizures are typically managed using multiple antiepileptic drugs (AEDs). AEDs as a group are frequently associated with significant adverse drug effects, multiple drug interactions, and numerous potential clinical complications due to their individual pharmacokinetic profiles and unique drug properties. Recently, the approval of vigabatrin by the US Food and Drug Administration has necessitated that clinicians re-evaluate these risk-benefit relationships and determine where the drug fits within the treatment scheme for the management of complex partial seizures. This review will facilitate that re-evaluation through a brief review of AEDs used in the treatment of complex partial seizures, followed by a focused discussion on vigabatrin. PMID:21941443

Tolman, Justin A; Faulkner, Michele A

2011-01-01

291

Topical treatment of onychomycosis as a realistic option to systemic therapy: a case report.  

PubMed

Onychomycosis is a very common disease, especially in podiatric medical practice. It can be associated with significant patient distress, major disability and pain, and is challenging to treat successfully. This is a case study of a 41-year-old man with distal lateral subungual onychomycosis of 5 years' duration. Forty percent of the great toenail was affected and a total of six toenails were involved. Baseline fungal cultures were positive for Trichophyton rubrum. This patient was treated with efinaconazole 10% solution, a new topical antifungal, once daily for 48 weeks. Mycological cure was noted at the first assessment period (12 weeks), and compete cure was seen at follow-up. This case study alerts physicians to a promising new topical treatment for onychomycosis under development, and to the importance of mycological cure as an early indicator of treatment success. PMID:24504588

Gupta, Aditya K

2014-01-01

292

Treatment options and flow sheets for ORNL low-level liquid waste supernate  

SciTech Connect

Low-level liquid waste (LLLW) is currently contained in ten 50,000-gal storage and process tanks at Oak Ridge National Laboratory (ORNL) and as residual heels in an number of older tanks that are no longer in active use. Plans are being formulated to treat these wastes, along with similar LLLW that will be generated in the future, to yield decontaminated effluents that can be disposed of and stable solid waste forms that can be permanently stored. The primary purpose of this report is to summarize the performance of the most promising separations processes that are appropriate for treatment of the LLLW supernate solution to remove the two dominant radionuclides, {sup 137}Cs and {sup 90}Sr; to indicate how they can be integrated into an effective flowsheet; and to estimate the expected performance of such flowsheets in comparison to waste treatment requirements.

Campbell, D.O.; Lee, D.D.

1991-12-01

293

Aggressive systemic mastocytosis and related mast cell disorders: current treatment options and proposed response criteria.  

PubMed

Aggressive systemic mastocytosis (ASM) is a clonal mast cell disease characterized by progressive growth of neoplastic cells in diverse organs leading to organopathy. The organ-systems most frequently affected are the bone marrow, skeletal system, liver, spleen, and the gastrointestinal tract. Respective clinical findings (so called C-Findings) include cytopenias, osteolysis (or osteoporosis) with pathologic fractures, hepatosplenomegaly with impaired liver function and ascites, and malabsorption. During the past decade several treatment strategies for ASM have been proposed. One promising approach may be combination treatment with interferon-alpha (IFN-alpha) and glucocorticoids. This concept has been based on the notion that systemic mastocytosis involves multilineage hematopoietic progenitors indicating a relationship with myeloproliferative disorders. However, relatively little is known about the quality of responses to IFN-alpha in ASM and the actual response rates. This may be due in part to the fact that disease criteria for ASM have only recently been established, and no response criteria are available. In the current article, we propose surrogate markers and treatment response criteria for patients with ASM. In addition, we have applied these criteria retrospectively to ASM patients described in the available literature. In these analyses, the calculated rate of major response (=complete resolution of C-Findings) in patients treated with IFN-alpha (with or without additional glucocorticoids) amounts to approximately 21%. This confirms clinical activity in some patients for this drug-combination, but also points to the need to search for more effective strategies in the treatment of patients with aggressive mast cell disorders. PMID:12681363

Valent, Peter; Akin, Cem; Sperr, Wolfgang R; Escribano, Luis; Arock, Michel; Horny, Hans-Peter; Bennett, John M; Metcalfe, Dean D

2003-07-01

294

A randomized controlled trial of treatment options for troublesome uterine bleeding in Implanon users  

PubMed Central

BACKGROUND Pilot data have indicated that both doxycycline alone and mifepristone combined with ethinyl estradiol (EE) are effective in stopping episodes of bleeding in Implanon users with troublesome bleeding. We compared four treatments against a placebo in Implanon users and tested whether repeated treatment improved subsequent bleeding patterns. METHOD Implanon users aged 18–45 years were randomized to treatment with (i) mifepristone 25 mg given twice on day 1 followed by 4 days of EE 20 µg; (ii) doxycycline 100 mg twice daily for 5 days; (iii) mifepristone 25 mg given twice on day 1 plus doxycycline 100 mg twice daily for 5 days; (iv) doxycycline 100 mg twice daily with EE 20 µg daily; and (v) placebo twice daily for 5 days. The primary end-point was the number of days of bleeding/spotting immediately following initiation of the first 5-day course of each therapy, compared with placebo. RESULTS There were 204 women assigned to treatment. Mifepristone in combination with either EE or doxycycline was significantly more effective in stopping an episode of bleeding (mean 4.0 days (CI 3.5–4.6) and 4.4 days (CI 3.8–5.2), respectively) than doxycycline alone or in combination with EE, or placebo (6.4 days (CI 4.4–9.2), 6.4 days (CI 4.8–8.6) and 6.4 days (CL 5.1–8.0), respectively). CONCLUSION Mifepristone combined with either EE or doxycycline was significantly more effective than placebo in terminating an episode of bleeding in Implanon users. However there was no improvement in subsequent bleeding patterns. Trial registration number: ACTR # 012605000206628. PMID:19369294

Weisberg, E.; Hickey, M.; Palmer, D.; O'Connor, V.; Salamonsen, L.A.; Findlay, J.K.; Fraser, I.S.

2009-01-01

295

Somatostatin or octreotide as treatment options for chylothorax in young children: a systematic review  

Microsoft Academic Search

Objective  Chylothorax is a rare but life-threatening condition in children. To date, there is no commonly accepted treatment protocol. Somatostatin and octreotide have recently been used for treating chylothorax in children. We set out to summarise the evidence on the efficacy and safety of somatostatin and octreotide in treating young children with chylothorax.Design  Systematic review: literature search (Cochrane Library, EMBASE and PubMed databases)

Charles C. Roehr; Andreas Jung; Hans Proquitté; Oliver Blankenstein; Hannes Hammer; Kokila Lakhoo; Roland R. Wauer

2006-01-01

296

New Diagnostic and Therapeutic Options for the Treatment of Multiple Sclerosis  

Microsoft Academic Search

Multiple sclerosis (MS) is a multifactorial disease and its treatment can be based on different strategies. We are presently\\u000a approaching the MS problem at three different levels: (1) Developing new carrier systems for the targeted delivery of therapeutical\\u000a and diagnostic agents to the sites of inflammation at the blood brain barrier (BBB); (2) Modulating expression and activity\\u000a of matrix metalloproteinases

Paolo Riccio; Heinrich Haas; Grazia Maria Liuzzi; Rocco Rossano

297

New treatment option for young women with hormone-sensitive breast cancer  

Cancer.gov

A drug used for treating breast cancer, known as exemestane, is more effective than a common breast cancer prevention drug, tamoxifen, in preventing breast cancer recurrence in young women who also receive post-surgical treatment to suppress ovarian function. The combined results of the Tamoxifen and Exemestane Trial and Suppression of Ovarian Function Trial were presented at the 2014 ASCO Annual Meeting in Chicago.

298

Treatment Options in Alzheimer’s Disease: Maximizing Benefit, Managing Expectations  

Microsoft Academic Search

Alzheimer’s disease (AD) is becoming an increasingly heavy burden on the society of developed countries, and physicians now face the challenge of providing efficient treatment regimens to an ever-higher number of individuals affected by the disease. Currently approved anti-AD therapies – the cholinesterase inhibitors and the N-methyl-D-aspartate receptor antagonist memantine – offer modest symptomatic relief, which can be enhanced using

Martin R. Farlow; Michael L. Miller; Vojislav Pejovic

2008-01-01

299

Patient perspectives in the management of asthma: improving patient outcomes through critical selection of treatment options  

PubMed Central

Asthma is a chronic inflammatory disorder of the airways that requires long-term treatment, the goal of which is to control clinical symptoms for extended periods with the least possible amount of drugs. International guidelines recommend the addition of an inhaled long-acting beta2-agonist (LABA) to a low- to medium-dose inhaled corticosteroid (ICS) when low doses of ICS fail to control asthma symptoms. The fixed combined administration of ICS/LABA improves patient compliance, reducing the risk of therapy discontinuation. The relative deposition pattern of the inhaled drug to the target site is the result of a complex interaction between the device used, the aerosol formulation and the patient’s adherence to therapy. Different inhalation devices have been introduced in clinical practice over time. The new hydrofluoroalkane (HFA) solution aerosols allow for the particle size to be modified, thus leading to deeper penetration of the medication into the lung. The Modulite® technology allows for the manipulation of inhaled HFA-based solution formulations, such as the fixed beclomethasone/formoterol combination, resulting in a uniform treatment of inflammation and bronchoconstriction. The success of any anti-asthmatic treatment depends on the choice of the correct device and the adherence to therapy. PMID:20165595

Scichilone, Nicola; Contino, Adele; Figlioli, Giovanni Battista; Paglino, Giuseppe; Bellia, Vincenzo

2010-01-01

300

Management of menopause-associated vasomotor symptoms: Current treatment options, challenges and future directions.  

PubMed

Hot flashes are one of the most common and distressing symptoms associated with menopause, occurring in more than 75% of postmenopausal women. They are especially problematic in breast cancer patients since some breast cancer therapies can induce hot flashes. For mild hot flashes, it is proposed that behavioral modifications are the first step in management. Hormonal therapies, including estrogens and progestogens, are the most well known effective agents in relieving hot flashes; however, the safety of these agents is controversial. There is an increasing amount of literature on nonhormonal agents for the treatment of hot flashes. The most promising data regard newer antidepressant agents such as venlafaxine, which reduces hot flashes by about 60%. Gabapentin is another nonhormonal agent that is effective in reducing hot flashes. While many complimentary therapies, including phytoestrogens, black cohosh, and dehydroepiandrosterone, have been explored for the treatment of hot flashes; none can be recommended at this time. Furthermore, there is a lack of strong evidence to support exercise, yoga, or relaxation for the treatment of hot flashes. Paced respirations and hypnosis appear to be promising enough to warrant further investigation. Another promising nonpharmacological therapy, currently under investigation, involves a stellate ganglion block. PMID:21072305

Pachman, Deirdre R; Jones, Jason M; Loprinzi, Charles L

2010-01-01

301

Treatment Options for Sexual Dysfunction in Patients with Chronic Kidney Disease: A Systematic Review of Randomized Controlled Trials  

PubMed Central

Background and objectives: Sexual dysfunction is very common in patients with chronic kidney disease (CKD), but treatment options are limited. The benefits and harms of existing interventions for treatment of sexual dysfunction were assessed in patients with CKD. Design, setting, participants, & measurements: MEDLINE (1966 to December 2008), EMBASE (1980 to December 2008), and the Cochrane Trial Registry (Issue 4 2008) were searched for parallel and crossover randomized and quasi-randomized trials. Treatment effects were summarized as mean differences (MD) or standardized mean difference (SMD) with 95% confidence intervals (CI) using a random effects model. Results: Fourteen trials (328 patients) were included. Phosphodiesterase-5 inhibitors (PDE5i) compared with placebo significantly increased the overall International Index of Erectile Function-5 (IIEF-5) score (three trials, 101 patients, MD 1.81, 95% CI 1.51 to 2.10), all of its individual domains, and the complete 15-item IIEF-5 (two trials, 80 patients, MD 10.64, 95% CI 5.32 to 15.96). End-of-treatment testosterone levels were not significantly increased by addition of zinc to dialysate (two trials, 22 patients, SMD 0.19 ng/dl, 95% CI ?2.12 to 2.50), but oral zinc improved end-of-treatment testosterone levels. There was no difference in plasma luteinizing and follicle-stimulating hormone level at the end of the study period with zinc therapy. Conclusions: PDE5i and zinc are promising interventions for treating sexual dysfunction in CKD. Evidence supporting their routine use in CKD patients is limited. There is an unmet need for studying interventions for male and female sexual dysfunction in CKD considering the significant disease burden. PMID:20498250

Vecchio, Mariacristina; Navaneethan, Sankar D.; Johnson, David W.; Lucisano, Giuseppe; Graziano, Giusi; Querques, Marialuisa; Saglimbene, Valeria; Ruospo, Marinella; Bonifati, Carmen; Jannini, Emmanuele A.

2010-01-01

302

Treatment options beyond IFN? and NUCs for chronic HBV infection: expectations for tomorrow.  

PubMed

Chronic hepatitis B virus (HBV) infection may progress to cirrhosis, hepatocellular carcinoma (HCC) and end-stage liver failure with time. Interruption of this process can only be achieved through effective antiviral treatment. This approach has so far involved the use of immunomodulators such as pegylated interferon alpha (Peg-IFN?) for a finite period of up to a year and nucleos-(t)ide analogues (NUCs) for treatment over much longer periods of time. The latter act by suppressing HBV replication at the level of DNA synthesis by inhibiting the viral reverse transcriptase/DNA polymerase and causing premature termination of DNA synthesis. The ideal treatment end point is loss of HBsAg in both HBeAg+ve and HBeAg-ve patients following monotherapy. This, however, is only achievable in a minority of patients. Secondary outcomes are durable HBeAg loss and seroconversion to anti-HBe, which occur in about 18-30% of HBeAg+ve patients depending on the antiviral used, and sustained suppression of HBV-DNA accompanied by biochemical normalization and histological improvement in non-HBeAg+ve seroconverting and HBeAg-ve patients. There is therefore a need for additional direct-acting antivirals (DAAs) targeting different stages of the life cycle of the virus, as well as immunotherapeutic approaches. Such developments may pave the way for their use either alone or more likely in combination in the fight against chronic HBV infection. Such drugs or approaches, which are currently undergoing preclinical or clinical testing, are the subject of this review. PMID:25271858

Baltayiannis, G; Karayiannis, P

2014-11-01

303

Pharmacological management of binge eating disorder: current and emerging treatment options  

PubMed Central

Growing evidence suggests that pharmacotherapy may be beneficial for some patients with binge eating disorder (BED), an eating disorder characterized by repetitive episodes of uncontrollable consumption of abnormally large amounts of food without inappropriate weight loss behaviors. In this paper, we provide a brief overview of BED and review the rationales and data supporting the effectiveness of specific medications or medication classes in treating patients with BED. We conclude by summarizing these data, discussing the role of pharmacotherapy in the BED treatment armamentarium, and suggesting future areas for research. PMID:22654518

McElroy, Susan L; Guerdjikova, Anna I; Mori, Nicole; O'Melia, Anne M

2012-01-01

304

Sodium oxybate: a potential new pharmacological option for the treatment of fibromyalgia syndrome.  

PubMed

Fibromyalgia syndrome (FMS) is a common disorder, characterized by diffuse pain and tenderness, stiffness, fatigue, affective disorders and significant sleep pathology. A new set of diagnostic criteria have been developed which should make it easier for a busy clinician to diagnose the condition. US Food and Drug Administration (FDA) approved medications for the treatment of FMS have, for the most part, been geared to modulate the pain pathways to give the patient some degree of relief. A different kind of pharmacological agent, sodium oxybate (SXB), is described that is currently approved for the treatment of excessive daytime sleepiness and cataplexy in patients with narcolepsy. SXB, an endogenous metabolite of the inhibitory neurotransmitter gamma-hydroxybutyrate, is thought to act independently as a neurotransmitter with a presumed ability to modulate numerous other central nervous system neurotransmitters. In addition SXB has been shown to robustly increase slow wave sleep and decrease sleep fragmentation. Several large clinical trials have demonstrated SXB's ability to statistically improve pain, fatigue and a wide array of quality of life measurements of patients with fibromyalgia. SXB is not FDA approved to treat fibromyalgia. PMID:22870476

Swick, Todd J

2011-08-01

305

Treatment options in patients with metastatic gastric cancer: Current status and future perspectives  

PubMed Central

Despite advances in the treatment of gastric cancer, it remains the world’s second highest cause of cancer death. As gastric cancer is often diagnosed at an advanced stage, systemic chemotherapy is the mainstay of treatment for these patients. However, no standard palliative chemotherapy regimen has been accepted for patients with metastatic gastric cancer. Palliative chemotherapy including fluoropyrimidine, platin compounds, docetaxel and epirubicin prolongs survival, and improves a high quality of life to a greater extent than best supportive care. The number of clinical investigations associated with targeted agents has recently increased. Agents targeting the epidermal growth factor receptor 1 and human epidermal growth factor receptor 2 (HER2) have been widely tested. Trastuzumab was the first target drug developed, and pivotal phase III trials showed improved survival when trastuzumab was integrated into cisplatin/fluoropyrimidine-based chemotherapy in patients with metastatic gastric cancer. Trastuzumab in combination with chemotherapy was thus approved to be a new standard of care for patients with HER2-positive advanced esophagogastric adenocarcinoma. Thus, the evaluation of HER2 status in all patients with metastatic gastroesophageal adenocarcinoma should be considered. Other agents targeting vascular endothelial growth factor, mammalian target of rapamycin, and other biological pathways have also been investigated in clinical trials, but showed little impact on the survival of patients. In this review, systemic chemotherapy and targeted therapies for metastatic gastric cancer in the first- and second-line setting are summarized in the light of recent advances. PMID:24744580

Bilici, Ahmet

2014-01-01

306

Efficacy and Tolerability of Pharmacotherapy Options for the Treatment of Irritability in Autistic Children  

PubMed Central

Children with autism have a high rate of irritability and aggressive symptoms. Irritability or self-injurious behavior can result in significant harm to those affected, as well as to marked distress for their families. This paper provides a literature review regarding the efficacy and tolerability of pharmacotherapy for the treatment of irritability in autistic children. Although antipsychotics have not yet been approved for the treatment of autistic children by many countries, they are often used to reduce symptoms of behavioral problems, including irritability, aggression, hyperactivity, and panic. However, among antipsychotics, the Food and Drug Administration has approved only risperidone and aripiprazole to treat irritability in autism. Among atypical antipsychotics, olanzapine and quetiapine are limited in their use for autism spectrum disorders in children because of high incidences of weight gain and sedation. In comparison, aripiprazole and ziprasidone cause less weight gain and sedation. However, potential QTc interval prolongation with ziprasidone has been reported. Contrary to ziprasidone, no changes were evident in the QT interval in any of the trials for aripiprazole. However, head-to-head comparison studies are needed to support that aripiprazole may be a promising drug that can be used to treat irritability in autistic children. On the other hand, risperidone has the greatest amount of evidence supporting it, including randomized controlled trials; thus, its efficacy and tolerability has been established in comparison with other agents. Further studies with risperidone as a control drug are needed. PMID:24932108

Kirino, Eiji

2014-01-01

307

Ethanol sclerotherapy: a treatment option for ovarian endometriomas before ovarian stimulation.  

PubMed

Several surgical treatment modalities have been described in cases of isolated or multiple ovarian endometriotic cysts. The aim of this preliminary study was to investigate and test the efficacy of ethanol sclerotherapy (EST) for recurrent endometriotic cysts, before ovarian stimulation in infertile patients with an adequate ovarian status. In the setting of a prospective comparative study, EST was proposed to 31 infertile patients with recurrence of ovarian endometriomas before inclusion in assisted reproduction cycles. Reproductive outcome was compared with that of patients who had previous laparoscopic cystectomy for recurrent endometriomas. The mean size of endometriomas treated with sclerotherapy was 38.6 +/- 11.2 mm in diameter. Ovarian cysts recurred in 12.9% of cases; at a mean time of 10 months after EST. Ovarian reserve and ovarian response to stimulation were better in the EST group than in the control group. Consequently, clinical and cumulative pregnancy rates of the study group were higher than those of the control group (48.3% versus 19.2%, P = 0.04; and 55.2% versus 26.9%, P = 0.03, respectively). Ethanol sclerotherapy may be a good alternative to surgical management of recurrent endometriotic cysts before assisted reproductive treatment. It could be advised for selected infertile patients. PMID:19573300

Yazbeck, C; Madelenat, P; Ayel, J P; Jacquesson, L; Bontoux, L M; Solal, P; Hazout, A

2009-07-01

308

Ranolazine as a promising treatment option for atrial fibrillation: electrophysiologic mechanisms, experimental evidence, and clinical implications.  

PubMed

Currently available agents for pharmacologic management of atrial fibrillation (AF) are limited by their suboptimal efficacy and nonnegligible proarrhythmic risk. Ranolazine (RN) is a novel antianginal agent with increasingly appreciated antiarrhythmic properties that can suppress ventricular and supraventricular arrhythmias including AF. In this review, we describe the electrophysiological properties of RN, focusing on atrial-selective inhibition of a number of ion channels implicated in the development of AF, particularly the sodium current. We further summarize evidence from experimental studies that demonstrate a potent AF-suppressing effect of RN, alone or in combination with other antiarrhythmic drugs. Of clinical relevance, we present growing evidence from preliminary clinical investigations indicating the safety and efficacy of RN for prevention and treatment of AF in various clinical settings including prevention of AF in patients with acute coronary syndromes, prevention and conversion of postoperative AF after surgical coronary revascularization, sinus rhythm maintenance in drug-resistant recurrent AF, and facilitating of electrical or pharmacological cardioversion in cardioversion-resistant patients. While current experimental and clinical evidence points to RN as a potentially promising agent for suppression of AF, well-designed, large-scale trials will be required before RN can be considered for pharmacological treatment of AF in clinical practice. PMID:25138058

Fragakis, Nikolaos; Koskinas, Konstantinos C; Vassilikos, Vassilios

2014-10-01

309

Lifestyle modification and metformin as long-term treatment options for obese adolescents: study protocol  

PubMed Central

Background Childhood obesity is a serious health concern affecting over 155 million children in developed countries worldwide. Childhood obesity is associated with significantly increased risk for development of type 2 diabetes, cardiovascular disease and psychosocial functioning problems (i.e., depression and decreased quality of life). The two major strategies for management of obesity and associated metabolic abnormalities are lifestyle modification and pharmacologic therapy. This paper will provide the background rationale and methods of the REACH childhood obesity treatment program. Methods/design The REACH study is a 2-year multidisciplinary, family-based, childhood obesity treatment program. Seventy-two obese adolescents (aged 10-16 years) and their parents are being recruited to participate in this randomized placebo controlled trial. Participants are randomized to receive either metformin or placebo, and are then randomized to a moderate or a vigorous intensity supervised exercise program for the first 12-weeks. After the 12-week exercise program, participants engage in weekly exercise sessions with an exercise facilitator at a local community center. Participants engage in treatment sessions with a dietitian and social worker monthly for the first year, and then every three months for the second year. The primary outcome measure is change in body mass index and the secondary outcome measures are changes in body composition, risk factors for type 2 diabetes and cardiovascular disease, changes in diet, physical activity, and psychosocial well-being (e.g., quality of life). It is hypothesized that participants who take metformin and engage in vigorous intensity exercise will show the greatest improvements in body mass index. In addition, it is hypothesized that participants who adhere to the REACH program will show improvements in body composition, physical activity, diet, psychosocial functioning and risk factor profiles for type 2 diabetes and cardiovascular disease. These improvements are expected to be maintained over the 2-year program. Discussion The findings from this study will advance the knowledge regarding the long-term efficacy and sustainability of interventions for childhood obesity. Trial Registration ClinicalTrials.gov number NCT00934570 PMID:19943971

2009-01-01

310

Progressive multifocal leucoencephalopathy after autologous bone marrow transplantation: a treatment option  

PubMed Central

A patient with multiple myeloma was treated with high-dose chemotherapy followed by two autologous bone marrow transplantations (ABMTs). Nine months after the second ABMT the patient complained of severe left hemiparesis, paraesthesias, left homonymous visual field defects and gait ataxia. She was diagnosed with progressive multifocal leucoencephalopathy (PML) confirmed by detection of JC virus (JCV) DNA and prescribed cidofovir every other week and mirtazapine daily. Her symptoms and signs remained stable and after 6 months the JCV DNA was undetectable in the cerebrospinal fluid. Repeated MRI scans demonstrated the stabilisation of demyelinating lesion volume; after more than 2 years of follow-up the patient’s neurological examination does not show significant variations. Combination of cidofovir and mirtazapine may be helpful in the treatment of PML in HIV-negative patients. PMID:22701032

Ripellino, P; Comi, C; Mula, M; Varrasi, C; Conconi, A; Stecco, A; Brustia, D; Nasuelli, N; Savio, K; De Paoli, L; Cantello, R; Gaidano, G; Monaco, F

2011-01-01

311

Progressive multifocal leucoencephalopathy after autologous bone marrow transplantation: a treatment option.  

PubMed

A patient with multiple myeloma was treated with high-dose chemotherapy followed by two autologous bone marrow transplantations (ABMTs). Nine months after the second ABMT the patient complained of severe left hemiparesis, paraesthesias, left homonymous visual field defects and gait ataxia. She was diagnosed with progressive multifocal leucoencephalopathy (PML) confirmed by detection of JC virus (JCV) DNA and prescribed cidofovir every other week and mirtazapine daily. Her symptoms and signs remained stable and after 6 months the JCV DNA was undetectable in the cerebrospinal fluid. Repeated MRI scans demonstrated the stabilisation of demyelinating lesion volume; after more than 2 years of follow-up the patient's neurological examination does not show significant variations. Combination of cidofovir and mirtazapine may be helpful in the treatment of PML in HIV-negative patients. PMID:22701032

Ripellino, P; Comi, C; Mula, M; Varrasi, C; Conconi, A; Stecco, A; Brustia, D; Nasuelli, N; Savio, K; De Paoli, L; Cantello, R; Gaidano, G; Monaco, F

2011-01-01

312

Degarelix 240/80 mg: a new treatment option for patients with advanced prostate cancer.  

PubMed

Gonadotrophin-releasing hormone (GnRH) receptor blockers (antagonists) are the latest addition to the hormonal therapy armamentarium for patients with prostate cancer. In contrast to the GnRH agonists, GnRH blockers have an immediate onset of action and do not cause an initial surge in testosterone levels that can lead to clinical flare in patients with advanced disease. Degarelix (Firmagon is a new GnRH blocker that has recently been approved by the EMEA and US FDA for the treatment of men with hormone-sensitive advanced prostate cancer. In this article, we briefly review the Phase III trial data for degarelix 240/80 mg (licensed dose) versus leuprolide 7.5 mg that led to these recent approvals. PMID:19954284

Boccon-Gibod, Laurent; Iversen, Peter; Persson, Bo-Eric

2009-12-01

313

Implant Supported Mandibular Overdenture: A Viable Treatment Option for Edentulous Mandible  

PubMed Central

The prosthetic management of the edentulous patient has long been a major challenge. Complete maxillary and mandibular dentures have been the traditional standard of care. However, most of the patients report problems adapting to their mandibular denture due to a lack of comfort, retention, stability and inability to masticate. Implant-supported overdentures have been a common treatment for edentulous patients for the past 20 years and predictably achieve good clinical results. Implant supported overdentures offer many practical advantages over conventional complete dentures and removable partial dentures. These include decreased bone resorption, reduced prosthesis movement, better esthetics, improved tooth position, better occlusion, increased occlusal function and maintenance of the occlusal vertical dimension. This article presents a design and fabrication technique of the implant-retained overdenture that uses four freestanding mandibular implants. PMID:24995252

Lambade, Pravin; Gundawar, Sham

2014-01-01

314

Melatonin in Aging and Disease --Multiple Consequences of Reduced Secretion, Options and Limits of Treatment  

PubMed Central

Melatonin is a pleiotropically acting regulator molecule, which influences numerous physiological functions. Its secretion by the pineal gland progressively declines by age. Strong reductions of circulating melatonin are also observed in numerous disorders and diseases, including Alzheimer’s disease, various other neurological and stressful conditions, pain, cardiovascular diseases, cases of cancer, endocrine and metabolic disorders, in particular diabetes type 2. The significance of melatonergic signaling is also evident from melatonin receptor polymorphisms associated with several of these pathologies. The article outlines the mutual relationship between circadian oscillators and melatonin secretion, the possibilities for readjustment of rhythms by melatonin and its synthetic analogs, the consequences for circadian rhythm-dependent disorders concerning sleep and mood, and limits of treatment. The necessity of distinguishing between short-acting melatonergic effects, which are successful in sleep initiation and phase adjustments, and attempts of replacement strategies is emphasized. Properties of approved and some investigational melatonergic agonists are compared. PMID:22724080

Hardeland, Rudiger

2012-01-01

315

Implant supported mandibular overdenture: a viable treatment option for edentulous mandible.  

PubMed

The prosthetic management of the edentulous patient has long been a major challenge. Complete maxillary and mandibular dentures have been the traditional standard of care. However, most of the patients report problems adapting to their mandibular denture due to a lack of comfort, retention, stability and inability to masticate. Implant-supported overdentures have been a common treatment for edentulous patients for the past 20 years and predictably achieve good clinical results. Implant supported overdentures offer many practical advantages over conventional complete dentures and removable partial dentures. These include decreased bone resorption, reduced prosthesis movement, better esthetics, improved tooth position, better occlusion, increased occlusal function and maintenance of the occlusal vertical dimension. This article presents a design and fabrication technique of the implant-retained overdenture that uses four freestanding mandibular implants. PMID:24995252

Lambade, Dipti; Lambade, Pravin; Gundawar, Sham

2014-05-01

316

New treatment options in allergic rhinitis: patient considerations and the role of ciclesonide  

PubMed Central

Allergic rhinitis (AR) is a chronic inflammatory respiratory disease affecting 5%–50% of the worldwide population and its prevalence is increasing (Herman 2007). In addition, AR is associated with asthma and other co-morbidities such as conjunctivitis and sinusitis. The main symptoms are nasal congestion, rhinorrea, sneezing, itching, and post-nasal drainage induced after allergen exposure by an IgE-mediated inflammation of the membranes lining the nose. AR is not a life-threatening disease, but it has been shown to have a significant impact on quality of life. The Allergic Rhinitis and its Impact on Asthma (ARIA) guidelines propose a classification of AR in intermittent and persistent, each graded as mild or moderate-severe, and provide a stepwise approach to the treatment. Inhaled steroids and antihistamine are the main tools in AR therapy but more safe and effective drugs are, however, needed. Inhaled steroid ciclesonide appears to be safe and effective. PMID:18728855

Braido, F; Lagasio, C; Piroddi, IMG; Baiardini, I; Canonica, GW

2008-01-01

317

Dietary Treatment Options for Depression among Diabetic Patient, Focusing on Macronutrients  

PubMed Central

There is a bidirectional adverse association between diabetes and depression. The odds for experiencing depressive symptoms in diabetic patients are two times more than nondiabetic persons, and depression is an independent predictor for the onset of diabetes. However, depression has been approximately unrecognized and untreated in two-thirds of diabetic patients, which may lead to worsened diabetes complications. A cornerstone strategy for managing depression among diabetic patients is the use of diet to improve both health problems. Because of similar pathophysiology for chronic diseases and depression, it seems that similar dietary recommendations could be useful. However, few studies have been conducted among diabetic patients. Regarding the complications of diabetes such as renal diseases and coronary heart diseases, the proper range of various macronutrients should be clarified in depressed diabetic patients as well as the proper type of each macronutrient. In this paper, we reviewed the available data on the treatment of depression in diabetic patients. PMID:24199205

Azadbakht, Leila

2013-01-01

318

Treatment options and patient perspectives in the management of fibromyalgia: future trends  

PubMed Central

Fibromyalgia (FM) is a common, complex, and difficult to treat chronic widespread pain disorder, which usually requires a multidisciplinary approach using both pharmacological and non-pharmacological (education and exercise) interventions. It is a condition of heightened generalized sensitization to sensory input presenting as a complex of symptoms including pain, sleep dysfunction, and fatigue, where the pathophysiology could include dysfunction of the central nervous system pain modulatory systems, dysfunction of the neuroendocrine system, and dysautonomia. A cyclic model of the pathophysiological processes is compatible with the interrelationship of primary symptoms and the array of postulated triggers associated with FM. Many of the molecular targets of current and emerging drugs used to treat FM have been focused to the management of discrete symptoms rather than the condition. Recently, drugs (eg, pregabalin, duloxetine, milnacipran, sodium oxybate) have been identified that demonstrate a multidimensional efficacy in this condition. Although the complexity of FM suggests that monotherapy, non-pharmacological or pharmacological, will not adequately address the condition, the outcomes from recent clinical trials are providing important clues for treatment guidelines, improved diagnosis, and condition-focused therapies. PMID:19337451

Lawson, Kim

2008-01-01

319

New treatment options in the management of fibromyalgia: role of pregabalin.  

PubMed

Fibromyalgia (FM) is a common, chronic pain disorder with unknown etiology, characterized by widespread musculoskeletal pain and tenderness, and accompanied by several other symptoms such as sleep disturbance, fatigue, and mood disorders. Pregabalin is the first drug approved for the treatment of FM. Pregabalin has analgesic, anticonvulsant, and anxiolytic activity and has earlier demonstrated efficacy in the management of neuropathic pain associated with diabetic peripheral neuropathy, postherpetic neuralgia, and as adjuvant therapy for adult patients with partial onset seizures. Pregabalin, a lipophilic gamma-aminobutyric acid (GABA) analog, is alpha(2)delta-1 ligand that binds to, and modulates, voltage-gated calcium channels. This modulation is characterized by a reduction of the excessive neurotransmitter release that is observed in certain neurological and psychotic disorders. Several randomized, double-blind, placebo-controlled studies have demonstrated that pregabalin has been effective in pain management, improving sleep quality and fatigue, as well as in several domains of health related quality of life. Because of mild to moderate adverse effects it can be considered a well-tolerated therapy for FM. PMID:19337459

Zareba, Grazyna

2008-12-01

320

Evaluation of surface water treatment and discharge options for the Weldon Spring Site Remedial Action Project  

SciTech Connect

The US Department of Energy (DOE), under its Environmental Restoration and Waste Management Program, is responsible for conducting response actions at the Weldon Spring site in St. Charles County, Missouri. The site consists of two noncontiguous areas: (1) the chemical plant area, which includes four raffinate pits and two small ponds, and (2) a 3.6-ha (9-acre) quarry located about 6.4 km (4 mi) southwest of the chemical plant area. Both of these areas became chemically and radioactively contaminated as a result of processing and disposal activities that took place from the 1940s through 1960s. The Weldon Spring site, located about 48 km (30 mi) west of St. Louis, is listed on the National Priorities List of the US Environmental Protection Agency. Nitroaromatic explosives were processed by the Army at the chemical plant area during the 1940s, and radioactive materials were processed by DOE's predecessor agency (the Atomic Energy Commission) during the 1950s and 1960s. Overall remediation of the Weldon Spring site is being addressed through the Weldon Spring Site Remedial Action Project, and it consists of several components. One component is the management of radioactively and chemically contaminated surface water impoundments at the chemical plant area -- i.e., the four raffinate pits, Frog Pond, and Ash Pond which was addressed under a separate action and documented in an engineering evaluation/cost analysis report. This report discusses the evaluation of surface water treatment at the Weldon Spring site.

Goyette, M.L.; MacDonell, M.M.

1992-01-01

321

Evaluation of surface water treatment and discharge options for the Weldon Spring Site Remedial Action Project  

SciTech Connect

The US Department of Energy (DOE), under its Environmental Restoration and Waste Management Program, is responsible for conducting response actions at the Weldon Spring site in St. Charles County, Missouri. The site consists of two noncontiguous areas: (1) the chemical plant area, which includes four raffinate pits and two small ponds, and (2) a 3.6-ha (9-acre) quarry located about 6.4 km (4 mi) southwest of the chemical plant area. Both of these areas became chemically and radioactively contaminated as a result of processing and disposal activities that took place from the 1940s through 1960s. The Weldon Spring site, located about 48 km (30 mi) west of St. Louis, is listed on the National Priorities List of the US Environmental Protection Agency. Nitroaromatic explosives were processed by the Army at the chemical plant area during the 1940s, and radioactive materials were processed by DOE`s predecessor agency (the Atomic Energy Commission) during the 1950s and 1960s. Overall remediation of the Weldon Spring site is being addressed through the Weldon Spring Site Remedial Action Project, and it consists of several components. One component is the management of radioactively and chemically contaminated surface water impoundments at the chemical plant area -- i.e., the four raffinate pits, Frog Pond, and Ash Pond which was addressed under a separate action and documented in an engineering evaluation/cost analysis report. This report discusses the evaluation of surface water treatment at the Weldon Spring site.

Goyette, M.L.; MacDonell, M.M.

1992-09-01

322

Mipomersen sodium: a new option for the treatment of familial hypercholesterolemia.  

PubMed

In collaboration with Genzyme, Isis Pharmaceuticals has developed mipomersen sodium (ISIS-310312), a synthetic second-generation 20-base phosphorothioate antisense oligonucleotide (ASO) that targets messenger RNA encoding apolipoprotein B-100 (Apo B-100). Elevated cholesterol levels, in particular low-density lipoprotein cholesterol (LDL-C) which contains a single apolipoprotein B (ApoB) molecule, have been directly correlated with the incidence of cardiovascular events. Preclinical investigations in transgenic mice have demonstrated that lowering LDL-C or ApoB can reduce aortic plaque formation associated with atherosclerosis. Mipomersen pharmacokinetics showed a wide and rapid tissue distribution and a slow prolonged elimination phase of several days in a range of species. Mipomersen displayed dose-dependent efficacy in lowering LDL-C, ApoB, triglycerides, total cholesterol and other low-density lipoproteins in healthy volunteers with mild hyperlipidemia. Similar decreases were observed in patients on stable lipid-lowering therapy for familial hypercholesterolemia with baseline LDL-C levels declining towards clinically desirable concentrations of 70 mg/dL. The efficacy of mipomersen in treating patients with severe heterozygous or homozygous familial hypercholesterolemia with cardiovascular complications has been recently assessed. There have been no serious adverse events noted with treatment and mipomersen can be administered in combination with other lipid-lowering therapies. One concern noted was an elevation in liver transaminase concentrations, although these increases were reversible. PMID:22348914

Haddley, K

2011-12-01

323

Antenatal depression and children's developmental outcomes: potential mechanisms and treatment options.  

PubMed

During the last decade there has been increased recognition of the prevalence of antenatal depression as well as an expansion in research examining the impact of maternal mood during pregnancy on offspring development. The aim of this review was to summarise the theoretical underpinnings and empirical evidence regarding the impact of antenatal depression on children's developmental outcomes. Biological mechanisms hypothesised to account for an association between antenatal depression and adverse offspring outcomes are first identified including the functioning of the prenatal Hypothalamic Pituitary Adrenal (HPA) axis and epigenetic processes. A systematic literature search is then conducted of studies examining the impact of antenatal depression on child development. In general, studies examining associations between antenatal depression and offspring temperament, cognitive and emotional outcomes reveal either no effect of the prenatal environment or small effects that often attenuate following adjustment for other antenatal and postnatal risk factors. In contrast, an independent effect of antenatal depression on children's conduct problems and antisocial behaviour is a well-replicated finding. There is emerging evidence that exposure to depression during pregnancy impacts negatively on offspring biology, although the findings are complex and require replication. Psychological and pharmacological treatments of antenatal depression are then reviewed, considering whether antidepressant medication exerts harmful effects on the foetus. We close by proposing that antenatal depression is an early marker of a developmental cascade to future mental health problems for both mothers and offspring. PMID:25037152

Waters, Cerith S; Hay, Dale F; Simmonds, Jessica R; van Goozen, Stephanie H M

2014-10-01

324

Dyspnea Review for the Palliative Care Professional: Treatment Goals and Therapeutic Options  

PubMed Central

Abstract Although dyspnea is frequently encountered in the palliative care setting, its optimal management remains uncertain. Clinical approaches begin with accurate assessment, as delineated in part one of this two-part series. Comprehensive dyspnea assessment, which encompasses the physical, emotional, social, and spiritual aspects of this complex symptom, guide the clinician in choosing therapeutic approaches herein presented as part two. Global management of dyspnea is appropriate both as complementary to disease-targeted treatments that target the underlying etiology, and as the sole focus when the symptom has become intractable, disease is maximally treated, and goals of care shift to comfort and quality of life. In this setting, current evidence supports the use of oral or parenteral opioids as the mainstay of dyspnea management, and of inhaled furosemide and anxiolytics as adjuncts. Nonpharmacologic interventions such as acupuncture and pulmonary rehabilitation have potential effectiveness, although further research is needed, and use of a simple fan warrants consideration given its potential benefit and minimal burden and cost. PMID:22268406

Kamal, Arif H.; Maguire, Jennifer M.; Wheeler, Jane L.; Currow, David C.

2012-01-01

325

Treatment of failures related to articulation material in THA. A comprehensive algorithm of surgical options and open questions.  

PubMed

Total hip arthroplasty is considered one of the greatest advances in health care of the last century. More than one million THAs are estimated to be performed annually and an increasing number of revisions are expected in the future. Osteolysis and loosening are still the main reasons for failure, justifying the use of low-wear bearings.The aim of this paper is to describe the mode of failure of the different couplings (polyethylene, cross-linked PE, metal, ceramic) and the options of treatment considering the various scenarios that the surgeon has to face nowadays in the case of failure related to articulation material. A comprehensive algorithm of treatment strategies is proposed based on the best current evidence and on the authors' experience.Periodical follow-up, indications for early revision, selection of proper surgical techniques and tribology are suggested. Nowadays, few rules are strongly recommended: trying to avoid any metal in case of failure of metal-on-metal; to avoid metal in fracture of ceramic; never to mix metals or ceramics from different manufactures. We aim to address a great number of open questions. There is still need for further research and evidences in this essential field of orthopaedic surgery. PMID:24970035

Zagra, Luigi; Maccario, Camilla; Mondini, Andrea; Bianchi, Luca

2014-01-01

326

Auditory verbal hallucinations as atypical inner speech monitoring, and the potential of neurostimulation as a treatment option?  

PubMed Central

Auditory verbal hallucinations (AVHs) are the experience of hearing voices in the absence of any speaker, often associated with a schizophrenia diagnosis. Prominent cognitive models of AVHs suggest they may be the result of inner speech being misattributed to an external or non-self source, due to atypical self- or reality monitoring. These arguments are supported by studies showing that people experiencing AVHs often show an externalising bias during monitoring tasks, and neuroimaging evidence which implicates superior temporal brain regions, both during AVHs and during tasks that measure verbal self-monitoring performance. Recently, efficacy of noninvasive neurostimulation techniques as a treatment option for AVHs has been tested. Meta-analyses show a moderate effect size in reduction of AVH frequency, but there has been little attempt to explain the therapeutic effect of neurostimulation in relation to existing cognitive models. This article reviews inner speech models of AVHs, and argues that a possible explanation for reduction in frequency following treatment may be modulation of activity in the brain regions involving the monitoring of inner speech. PMID:24125858

Moseley, Peter; Fernyhough, Charles; Ellison, Amanda

2013-01-01

327

Photodynamic Therapy Treatment to Enhance Fracture Healing.  

National Technical Information Service (NTIS)

Long bone fractures resulting from high impact trauma can result in delayed healing. Photodynamic therapy (PDT) is a non-surgical, non-ionizing minimally invasive local treatment currently used to treat cancer and skin diseases. Surprisingly, recent findi...

A. J. Yee, B. C. Wilson, C. M. Whyne, D. Nam, M. K. Akens

2012-01-01

328

Socio-economic determinants in selecting childhood diarrhoea treatment options in Sub-Saharan Africa: A multilevel model  

PubMed Central

Background Diarrhoea disease which has been attributed to poverty constitutes a major cause of morbidity and mortality in children aged five and below in most low-and-middle income countries. This study sought to examine the contribution of individual and neighbourhood socio-economic characteristics to caregiver's treatment choices for managing childhood diarrhoea at household level in sub-Saharan Africa. Methods Multilevel multinomial logistic regression analysis was applied to Demographic and Health Survey data conducted in 11 countries in sub-Saharan Africa. The unit of analysis were the 12,988 caregivers of children who were reported to have had diarrhoea two weeks prior to the survey period. Results There were variability in selecting treatment options based on several socioeconomic characteristics. Multilevel-multinomial regression analysis indicated that higher level of education of both the caregiver and that of the partner, as well as caregivers occupation were associated with selection of medical centre, pharmacies and home care as compared to no treatment. In contrast, caregiver's partners' occupation was negatively associated with selection medical centre and home care for managing diarrhoea. In addition, a low-level of neighbourhood socio-economic disadvantage was significantly associated with selection of both medical centre and pharmacy stores and medicine vendors. Conclusion In the light of the findings from this study, intervention aimed at improving on care seeking for managing diarrhoea episode and other childhood infectious disease should jointly consider the influence of both individual SEP and the level of economic development of the communities in which caregivers of these children resides. PMID:21429217

2011-01-01

329

Orthodontic Camouflage Treatment in an Adult Patient with a Class II, Division 1 Malocclusion – A Case Report  

PubMed Central

Since so many decades, various treatment modalities have been presented for the treatment for the class II, div 1 malocclusions. In recent times, we have seen enormously increasing numbers of young adults who desire the shortest, cost effective and a non surgical correction of Class II malocclusions and they accept dental camouflage as a treatment option to mask the skeletal discrepancy. This case report presents one such case of a 22 year old non-growing female who had a skeletal Class II, division 1 malocclusion with an orthognathic maxilla, a retrognathic mandible, a negative VTO and an overjet of 12mm, who did not want a surgical treatment. We considered the camouflage treatment by extracting the upper first premolars. Following the treatment, a satisfactory result was achieved with an ideal, static and a functional occlusion, facial profile, smile and lip competence and stability of the treatment results. PMID:23543878

Naragond, Appasaheb; Kenganal, Smitha; Sagarkar, Roshan; Sugaradday

2013-01-01

330

INEL Operable Unit 7-13 Retrieval/Ex Situ Thermal Treatment configuration options: INEL Buried Waste Integrated Demonstration Systems Analysis project  

SciTech Connect

The mission of the Buried Waste Integrated Demonstration (BWID) Systems Analysis project is to identify and evaluate cradle-to-grave systems for the remediation of Transuranic (TRU)Contaminated Waste Pits and Trenches within the Subsurface Disposal Area (SDA) of the Radioactive Waste Management Complex (RWMC) at the Idaho National Engineering Laboratory (INEL). The BWID program will use the results of the BWID Systems Analysis in conjunction with identified Department of Energy (DOE) Complex buried waste needs to develop a long-term strategy for improving buried waste remediation capabilities throughout the DOE system. This report presents Buried Waste Retrieval/Ex Situ Thermal Treatment configuration option concepts in the form of block diagrams. These configuration options are: Retrieval/Melter Treatment; Retrieval/Metal Sort/Thermal Treatment; Retrieval/No Sort/Incineration/Melter Treatment; Retrieval/Interim Storage/Melter Treatment; Retrieval/Interim Storage/Metal Sort/Thermal Treatment; and Retrieval/Interim Storage/No Sort/Incineration/Melter Treatment. Each option is presented as a complete end-to-end system.

Richardson, J.G.; Rudin, M.J.; O`Brien, M.C.; Morrison, J.L.; Raivo, B.

1992-07-01

331

Bilateral simultaneous facial paralysis--differential diagnosis and treatment options. A case report and review of literature.  

PubMed

Bilateral facial paralysis or paresis of peripheral origin is a rare condition and therefore represents a diagnostic challenge. We here present a case of a previously healthy woman who was hospitalized for symptoms of meningitis. On the second day of her hospital stay, she developed bilateral facial paresis. Later, the patient developed also tachycardia and dysrhythmias. A thorough diagnostic procedure including lumbar puncture, routine blood investigation with serological tests, MRI of the brain, Holter monitoring and transoesophageal echocardiographia, revealed meningitis with radiculitis, facial paresis and myocarditis. The clinical triad of meningitis, radiculitis and facial palsy is known as the Bannwarth Syndrome (Lyme disease). The patient was treated with ceftriaxone and recovered well. Despite repeatedly taken serological tests, Borrelia burgdorferi immunoglobulins were not detected. Acquired bilateral facial paralysis can occur in several diseases of infectious, neurological, idiopathic, iatrogenic, toxic, neoplastic or traumatic origin. In this article, we review the differential diagnoses and treatment options of bilateral facial paresis and present a scheme that is helpful in the diagnostic evaluation of this condition. PMID:12836471

Gevers, G; Lemkens, P

2003-01-01

332

Evaluation of Current Pharmacological Treatment Options in the Management of Rett Syndrome: From the Present to Future Therapeutic Alternatives  

PubMed Central

Neurodevelopmental disorders are a large family of conditions of genetic or environmental origin that are characterized by deficiencies in cognitive and behavioral functions. The therapeutic management of individuals with these disorders is typically complex and is limited to the treatment of specific symptoms that characterize each disorder. The neurodevelopmental disorder Rett syndrome (RTT) is the leading cause of severe intellectual disability in females. Mutations in the gene encoding the transcriptional regulator methyl-CpG-binding protein 2 (MECP2), located on the X chromosome, have been confirmed in more than 95% of individuals meeting diagnostic criteria for classical RTT. RTT is characterized by an uneventful early infancy followed by stagnation and regression of growth, motor, language, and social skills later in development. This review will discuss the genetics, pathology, and symptoms that distinguish RTT from other neurodevelopmental disorders associated with intellectual disability. Because great progress has been made in the basic and clinical science of RTT, the goal of this review is to provide a thorough assessment of current pharmacotherapeutic options to treat the symptoms associated with this disorder. Furthermore, we will highlight recent discoveries made with novel pharmacological interventions in experimental preclinical phases, and which have reversed pathological phenotypes in mouse and cell culture models of RTT and may result in clinical trials. PMID:24050745

Chapleau, Christopher A.; Lane, Jane; Pozzo-Miller, Lucas; Percy, Alan K.

2012-01-01

333

Spasmodic Torticollis: Treatment Options  

MedlinePLUS

... Join NSTA Today! NSTA Support Groups NSTA Message Forum Spasmodic Torticollis What is Spasmodic Torticollis Signs and ... Patient Support Photo Galleries Contact NSTA NSTA Message Forum Search Internet and Help NSTA Support the NSTA ...

334

Treatment Options Summary  

MedlinePLUS

... Watch and Wait Radiation Microsurgery Acoustic Neuroma Decision Tree Questions for Your Physician Questions to Ask Yourself ... Watch and Wait Radiation Microsurgery Acoustic Neuroma Decision Tree Questions for Your Physician Questions to Ask Yourself ...

335

Assessing Ammonia Treatment Options  

EPA Science Inventory

This is the second of three articles to help water system operators understand ammonia and how to monitor and control its effects at the plant and in the distribution system. The first article (Opflow, April 2012) provided an overview of ammonia's chemistry, origins, and water sy...

336

Pituitary Disorders Treatment Options  

MedlinePLUS

... or control tumor size. Editors: Anne Klibanski, MD Massachusetts General Hospital Harvard Medical School Nicholas Tritos, MD Massachusetts General Hospital Harvard Medical School Last Review: May ...

337

Keratoconus Treatment Options  

MedlinePLUS

... and bulging of the cornea. Eyeglasses or Soft Contact Lenses Eyeglasses or soft contact lenses may be ... KC vision better. Learn more … Rigid Gas Permeable Contact Lenses Rigid Gas Permeable Contact Lenses (abbreviated to ...

338

Treatment Options in IBD  

MedlinePLUS

... Crohn's & Colitis? What is Crohn's Disease What is Ulcerative Colitis Types of Medications What’s available to treat IBD ... about CCFA’s mission: to cure Crohn'sdisease and ulcerative colitis, and to improve the quality of life of ...

339

Bai-Hu-Tang, Ancient Chinese Medicine Formula, May Provide a New Complementary Treatment Option for Sepsis  

PubMed Central

Bai-Hu-Tang (BHT) has been broadly applied to treating the early stage of acute infection with systemic inflammation for two thousand years in Chinese medicine. We explore whether BHT is beneficial in treating sepsis and its effects on proinflammatory cytokine, interleukin-6, and anti-inflammatory cytokine interleukin-10, in which both play key roles in the progress of sepsis. Thirty-six male Sprague-Dawley rats were randomized into six groups, with cecal ligation and puncture (CLP) performed in all but the sham-control group. Rats in CLP + BHT-L6 and CLP + BHT-H6 groups, respectively, received a low (0.45?g/kg) and high doses (0.9?g/kg) of BHT, 6?hrs postoperatively. CLP + BHT-L12 and CLP + BHT-H12 groups, respectively, received low and high doses of BHT, 12?hrs postoperatively. Sham-control and sepsis-control groups received distilled water (1?mL) as vehicle, 6 hrs postoperatively. Serial blood samples were drawn before operation, as baseline, and at 4, 8, and 12?hrs postoperatively for IL-6 and IL-10 assay. All rats were monitored for 3 days for survival study. Rats in the CLP + BHT-H6 group had significantly higher survival rate (80%) and significantly lower levels of both IL-6 and IL-10 at 12?hrs postoperatively than those in the sepsis-control group. Results suggested that BHT may be a new complementary treatment option for sepsis. PMID:23762108

Lin, Chien-Jung; Su, Yi-Chang; Lee, Cheng-Hung; Li, Tsai-Chung; Chen, Yun-An; Lin, Sunny Jui-Shan

2013-01-01

340

New option for management of HIV-1 infection in treatment-naive patients: once-daily, fixed-dose combination of rilpivirine-emtricitabine-tenofovir  

PubMed Central

Fixed-dose combination tablets have become an important therapy option for patients infected with the human immunodeficiency virus. Fixed-dose combination rilpivirine-tenofovir-emtricitabine is a recently approved therapy option that has been extensively studied within the treatment-naïve population. When compared with efavirenz-based therapy, improved tolerability with rilpivirine-based therapy was balanced by higher rates of virologic failure to provide similar overall efficacy rates within the intention-to-treat analysis. As a result, providers will need to balance the potential for improved tolerability with fixed-dose combination rilpivirine-tenofovir-emtricitabine against a higher potential for virologic failure, particularly among patients with baseline viral loads above 100,000 copies/mL. Current treatment guidelines have recommended that fixed-dose combination rilpivirine-tenofovir-emtricitabine be an alternative therapy option for treatment-naïve patients and advise caution in those patients with high viral loads at baseline. Similar to other non-nucleoside reverse transcriptase inhibitor-based regimens, there are a number of drug interaction concerns with fixed-dose combination rilpivirine-tenofovir-emtricitabine that will necessitate monitoring and, in some cases, appropriate management. Additionally, the emergence of drug resistance to fixed-dose combination rilpivirine-tenofovir-emtricitabine has been well documented in clinical studies and close attention will be necessary in order to protect current and future therapy options. Overall, fixed-dose combination rilpivirine-tenofovir-emtricitabine is poised to provide an important therapy option for patients when appropriately applied. PMID:22570576

Patel, Nimish; Miller, Christopher D

2012-01-01

341

The culture of education in a large dialysis organization: informing patient-centered decision making on treatment options for renal replacement therapy.  

PubMed

Challenged by the observation that newly admitted dialysis patients were often unaware of their treatment options, Fresenius Medical Care, North America developed a program to improve information delivered to chronic kidney disease (CKD) patients prior to their need for renal replacement therapy. Six years ago, the Treatment Options Program (TOPs) was established utilizing a standardized approach to educate individuals with CKD Stages 3 and 4. The program education focuses on modality and vascular access options. A key component includes follow-up at predetermined intervals, offering additional education and patient reminders to continue to work with their physician in selecting a preferred renal replacement modality. Since program inception, over 73,000 individuals have been educated through TOPs. Home therapy utilization as first treatment is higher in the patient population that received TOPs education. Similarly, participants had a higher rate of permanent vascular access with decreased use of hemodialysis catheters upon admission. Avoiding hemodialysis catheter use and expanding home therapy utilization both offer potential benefits to all stakeholders: patients, providers, and payors, particularly as we move toward accountable healthcare systems. The ability to expand the TOPs program relies on seeing patients early enough to allow each patient time to process the information and work with their physician to select the modality and access that best meets their healthcare and lifestyle needs. Educating our patients facilitates empowerment and active participation in their therapy, a much coveted component of patient-centered health care for the renal provider community as we look to the future. PMID:23406257

Mollicone, Debra; Pulliam, Joseph; Lacson, Eduardo

2013-01-01

342

Option Pricing  

NSDL National Science Digital Library

This module analyzes the topic of option pricing. Binomial tree models and the Black-Scholes formulae are used to price call options on an underlying asset. . The put-call parity theorem is used to value put options. Background inFormation on options is provided as well as the theoretical implications of the models. Assessment of the models is evaluated through on an investigation of the strengths and shortcomings of the models compared with their empirical performance. The module evaluates the differences between European and American options using mathematical models. In addition, the module examines expansions of the model including adaptation to stocks that pay dividends, the market for foreign exchange, and options on portfolios such as market indices. In assessing the strengths and shortcomings of the models investigated, the existence of alternative models is introduced to allow the interested student pathways to learning after the module.

Percy, Rick

343

Public Option  

Microsoft Academic Search

American health care woes are no new phenomena, and recent history demonstrates the intensity of the concomitant debate that arises following the proposal of a new system or a special new element-namely, the public insurance option. Early in his tenure, President Clinton dared to undertake daunting reform efforts (including the creation of a public insurance option). Many argue that losing

Kristin Dolbeare; Nora Heaton; Ellen Thomas; Peter E Visser

2009-01-01

344

Pyroprocessing of Oxidized Sodium-Bonded Fast Reactor Fuel -- an Experimental Study of Treatment Options for Degraded EBR-II Fuel  

SciTech Connect

An experimental study was conducted to assess pyrochemical treatment options for degraded EBR-II fuel. As oxidized material, the degraded fuel would need to be converted back to metal to enable electrorefining within an existing electrometallurgical treatment process. A lithium-based electrolytic reduction process was studied to assess the efficacy of converting oxide materials to metal with a particular focus on the impact of zirconium oxide and sodium oxide on this process. Bench-scale electrolytic reduction experiments were performed in LiCl-Li2O at 650 °C with combinations of manganese oxide (used as a surrogate for uranium oxide), zirconium oxide, and sodium oxide. The experimental study illustrated how zirconium oxide and sodium oxide present different challenges to a lithium-based electrolytic reduction system for conversion of select metal oxides to metal.

S. D. Herrmann; L. A. Wurth; N. J. Gese

2013-09-01

345

Idiopathic recurrent pericarditis as an immune-mediated disease: current insights into pathogenesis and emerging treatment options.  

PubMed

Idiopathic recurrent pericarditis affects 30-50% of patients with a previous attack of pericarditis. The etiopathogenesis is incompletely understood and most cases remain idiopathic with a presumed immune-mediated pathogenesis. The mainstay of therapy is aspirin or a nonsteroidal anti-inflammatory drug plus colchicine and the possible adjunct of a low-to-moderate dose of a corticosteroid in more difficult cases. Colchicine as an adjunct to anti-inflammatory therapy reduces by 50% the subsequent recurrent rate. For true refractory cases with failure of standard combination therapies, new and emerging options especially include human intravenous immunoglobulins and biological agents (i.e., anakinra). The outcome of idiopathic recurrent pericarditis is good with a negligible risk of developing constrictive pericarditis. Thus, it is important to reassure patients on their prognosis, explaining the nature of the disease and the likely course. Moreover, therapeutic choices should include less toxic agents and favor cheaper drugs whenever possible. PMID:25307995

Imazio, Massimo

2014-11-01

346

Decreased ciprofloxacin susceptibility in Salmonella Typhi and Paratyphi infections in ill-returned travellers: the impact on clinical outcome and future treatment options.  

PubMed

The emergence of decreased ciprofloxacin susceptibility (DCS) in Salmonella enterica serovar Typhi and serovar Paratyphi A, B or C limits treatment options. We studied the impact of DCS isolates on the fate of travellers returning with enteric fever and possible alternative treatment options. We evaluated the clinical features, susceptibility data and efficacy of empirical treatment in patients with positive blood cultures of a DCS isolate compared to patients infected with a ciprofloxacin-susceptible (CS) isolate in the period from January 2002 to August 2008. In addition, the pharmacokinetic and pharmacodynamic parameters of ciprofloxacin, levofloxacin and gatifloxacin were determined to assess if increasing the dose would result in adequate unbound fraction of the drug 24-h area under the concentration-time curve/minimum inhibitory concentration (ƒAUC(0-24)/MIC) ratio. Patients with DCS more often returned from the Indian subcontinent and had a longer fever clearance time and length of hospital stay compared to patients in whom the initial empirical therapy was adequate. The mean ƒAUC(0-24)/MIC was 41.3?±?18.8 in the patients with DCS and 585.4?±?219 in patients with a CS isolate. For DCS isolates, the mean ƒAUC0-24/MIC for levofloxacin was 60.5?±?28.7 and for gatifloxacin, it was 97.9?±?28.0. Increasing the dose to an adequate ƒAUC(0-24)/MIC ratio will lead to conceivably toxic drug levels in 50% of the patients treated with ciprofloxacin. Emerging DCS isolates has led to the failure of empirical treatment in ill-returned travellers. We demonstrated that, in some cases, an adequate ƒAUC(0-24)/MIC ratio could be achieved by increasing the dose of ciprofloxacin or by the use of alternative fluoroquinolones. PMID:23609512

Hassing, R-J; Goessens, W H F; Mevius, D J; van Pelt, W; Mouton, J W; Verbon, A; van Genderen, P J

2013-10-01

347

Expensing options solves nothing.  

PubMed

The use of stock options for executive compensation has become a lightning rod for public anger, and it's easy to see why. Many top executives grew hugely rich on the back of the gains they made on their options, profits they've been able to keep even as the value they were supposed to create disappeared. The supposed scam works like this: Current accounting regulations let companies ignore the cost of option grants on their income statements, so they can award valuable option packages without affecting reported earnings. Not charging the cost of the grants supposedly leads to overstated earnings, which purportedly translate into unrealistically high share prices, permitting top executives to realize big gains when they exercise their options. If an accounting anomaly is the problem, then the solution seems obvious: Write off executive share options against the current year's revenues. The trouble is, Sahlman writes, expensing option grants won't give us a more accurate view of earnings, won't add any information not already included in the financial statements, and won't even lead to equal treatment of different forms of executive pay. Far worse, expensing evades the real issue, which is whether compensation (options and other-wise) does what it's supposed to do--namely, help a company recruit, retain, and provide the right people with appropriate performance incentives. Any performance-based compensation system has the potential to encourage cheating. Only ethical management, sensible governance, adequate internal control systems, and comprehensive disclosure will save the investor from disaster. If, Sahlman warns, we pass laws that require the expensing of options, thinking that's fixed the fundamental flaws in corporate America's accounting, we will have missed a golden opportunity to focus on the much more extensive defects in the present system. PMID:12510541

Sahlman, William A

2002-12-01

348

Rationale for the design of an oncology trial using a generic targeted therapy multi-drug regimen for NSCLC patients without treatment options (Review)  

PubMed Central

Despite more than 70 years of research concerning medication for cancer treatment, the disease still remains one of the leading causes of mortality worldwide. Many cancer types lead to death within a period of months to years. The original class of chemotherapeutics is not selective for tumor cells and often has limited efficacy, while treated patients suffer from adverse side-effects. To date, the concept of tumor-specific targeted therapy drugs has not fulfilled its expectation to provide a key for a cure. Today, many oncology trials are designed using a combination of chemotherapeutics with targeted therapy drugs. However, these approaches have limited outcomes in most cancer indications. This perspective review provides a rationale to combine targeted therapy drugs for cancer treatment based on observations of evolutionary principles of tumor development and HIV infections. In both diseases, the mechanisms of immune evasion and drug resistance can be compared to some extent. However, only for HIV is a breakthrough treatment available, which is the highly active antiretroviral therapy (HAART). The principles of HAART and recent findings from cancer research were employed to construct a hypothetical model for cancer treatment with a multi-drug regimen of targeted therapy drugs. As an example of this hypothesis, it is proposed to combine already marketed targeted therapy drugs against VEGFRs, EGFR, CXCR4 and COX2 in an oncology trial for non-small cell lung cancer patients without further treatment options. PMID:23877481

LANGHAMMER, STEFAN

2013-01-01

349

Report: treatment of commercial, construction and demolition waste in North Rhine-Westphalia: policy-making and operation options.  

PubMed

This paper summarizes a long-term-investigation of the mechanical treatment of commercial, construction and demolition waste materials in North Rhine-Westphalia in the light of applied operation standards and a disposal ban on untreated waste. It is shown how both the allocation of output materials from mechanical treatment plants and the subsequent treatment channels have changed since enforcement of the ban in 2005. Based on the findings of the investigation, two waste management scenarios offering alternative policies have been defined and are discussed. It is suggested that consistent enforcement of the ban affects both the diversion of waste to incineration and the recovery of materials on a regional scale. On the other hand, potential energy recovery may be fully exploited only insofar as operators of mechanical treatment plants concentrate their business on the production of refuse-derived fuel. PMID:17439054

Karavezyris, Vassilios

2007-04-01

350

Pregabalin in the treatment of inferior alveolar nerve paraesthesia following overfilling of endodontic sealer  

PubMed Central

A case of orofacial pain and inferior alveolar nerve (IAN) paraesthesia after extrusion of endodontic sealer within the mandibular canal treated with prednisone and pregabalin is described. A 36-year-old woman underwent root canal treatment of the mandibular second right premolar tooth. Post-operative panoramic radiograph revealed the presence of radiopaque canal sealer in the mandibular canal. Damage to IAN consecutive to extrusion of endodontic sealer was diagnosed. Non-surgical management was decided, including: 1 mg/kg/day prednisone 2 times/day, once-daily regimen, and 150 mg/day pregabalin, two doses per day, monitoring the progress with periodic follow-up visits. Six weeks after the incident the signs and symptoms were gone. The complete resolution of paraesthesia and the control of pain achieved suggest that a non-surgical approach, combining prednisone and the GABA analogue pregabalin, is a good option in the management of the IAN damage subsequent to endodontic sealer extrusion. Key words:Endodontics, inferior alveolar nerve, neuropathic pain, orofacial pain, paraesthesia, pregabalin. PMID:24790724

Alonso-Ezpeleta, Oscar; Martín, Pablo J.; López-López, José; Castellanos-Cosano, Lizett; Martín-González, Jenifer; Segura-Egea, Juan J.

2014-01-01

351

Chicago Board Options Exchange Understanding Stock Options  

NSDL National Science Digital Library

Understanding Stock Options by the Chicago Board Options Exchange (CBOE) provides a good non-technical introduction to options. It explains the benefits of options, differences between options and stocks, the pricing of options, and it provides some basic options strategies. Fischer Black and Myron Scholes first published their formula for valuing an option in 1973. Robert Merton independently derived an alternative method for valuing options in 1973 as well. The availability of the Black and Scholes formula for valuing options has helped the options market to grow rapidly.

1994-01-01

352

Toxicity evaluation with the microtox?? test to assess the impact of in situ oiled shoreline treatment options: Natural attenuation and sediment relocation  

USGS Publications Warehouse

Changes in the toxicity levels of beach sediment, nearshore water, and bottom sediment samples were monitored with the Microtox?? Test to evaluate the two in situ oil spill treatment options of natural attenuation (natural recovery-no treatment) and sediment relocation (surf washing). During a series of field trials, IF-30 fuel oil was intentionally sprayed onto the surface of three mixed sediment (pebble and sand) beaches on the island of Spitsbergen, Svalbard, Norway (78??56??? N, 16??45??? E). At a low wave-energy site (Site 1 with a 3-km wind fetch), where oil was stranded within the zone of normal wave action, residual oil concentrations and beach sediment toxicity levels were significantly reduced by both options in less than five days. At Site 3, a higher wave-energy site with a 40-km wind fetch, oil was intentionally stranded on the beach face in the upper intertidal/supratidal zones, above the level of normal wave activity. At this site under these experimental conditions, sediment relocation was effective in accelerating the removal of the oil from the sediments and reducing the Microtox?? Test toxicity response to background levels. In the untreated (natural attenuation) plot at this site, the fraction of residual oil remaining within the beach sediments after one year (70%) continued to generate a toxic response. Chemical and toxicological analyses of nearshore sediment and sediment-trap samples at both sites confirmed that oil and suspended mineral fines were effectively dispersed into the surrounding environment by the in situ treatments. In terms of secondary potential detrimental effects from the release of stranded oil from the beaches, the toxicity level (Microtox?? Test) of adjacent nearshore sediment samples did not exceed the Canadian regulatory limit for dredged spoils destined for ocean disposal. Crown ?? 2003 Published by Elsevier Ltd. All rights reserved.

Lee, K.; Wohlgeschaffen, G.; Thomas, Johnson B.; Sergy, G.A.; Prince, R.C.; Guenette, C.C.; Owens, E.H.; Tremblay, G.H.

2003-01-01

353

Intravenous doripenem at 500 milligrams versus levofloxacin at 250 milligrams, with an option to switch to oral therapy, for treatment of complicated lower urinary tract infection and pyelonephritis.  

PubMed

The prospective, multicenter, double-blind study presented in this report evaluated whether or not intravenous (IV) administration of doripenem, a carbapenem with bactericidal activity against gram-negative and gram-positive uropathogens, is inferior to IV administration of levofloxacin in the treatment of complicated urinary tract infection (cUTI). Patients (n = 753) with complicated lower UTI or pyelonephritis were randomly assigned to receive IV doripenem at 500 mg every 8 h (q8h) or IV levofloxacin at 250 mg q24h. Patients in both treatment arms were eligible to switch to oral levofloxacin after 3 days of IV therapy to complete a 10-day treatment course if they demonstrated significant clinical and microbiological improvements. The microbiological cure rate (primary end point) was determined at the test-of-cure (TOC) visit occurring 5 to 11 days after the last dose of antibiotic. For the microbiologically evaluable patients (n = 545), the microbiological cure rates were 82.1% and 83.4% for doripenem and levofloxacin, respectively (95% confidence interval [CI] for the difference, -8.0 to 5.5%); in the microbiological modified intent-to-treat cohort (n = 648), the cure rates were 79.2% and 78.2%, respectively. Clinical cure rates at the TOC visit were 95.1% in the doripenem arm and 90.2% in the levofloxacin arm (95% CI around the difference in cure rates [doripenem cure rate minus levofloxacin cure rate], 0.2% to 9.6%). Both treatment regimens were generally well tolerated. Doripenem was found not to be inferior to levofloxacin in terms of therapeutics and is now approved for use in the United States and Europe for the treatment of adults with cUTI, including pyelonephritis. As fluoroquinolone resistance increases, doripenem may become a more important option for successful treatment of cUTIs, including treatment of pyelonephritis. PMID:19581455

Naber, K G; Llorens, L; Kaniga, K; Kotey, P; Hedrich, D; Redman, R

2009-09-01

354

Treating the untreatable patient: current options for the management of treatment-resistant neovascular age-related macular degeneration.  

PubMed

Anti-vascular endothelial growth factor (anti-VEGF) agents represent the current standard of care for neovascular age-related macular degeneration (nAMD). Although effective in a majority of cases, a significant proportion of patients have persisting retinal exudation despite regular anti-VEGF therapy. This exudation is considered to produce poorer visual outcomes in these patients. Some of these patients may have misdiagnosed nAMD variants such as polypoidal choroidal vasculopathy; however, the majority of these eyes have what has been termed treatment-resistant nAMD. Currently, the best way to care for these patients is uncertain. Here, we review the evidence for different approaches to the management of treatment-resistant nAMD, including high-dose anti-VEGF therapy, combination regimes and switching of anti-VEGF agents, and discuss possible therapeutic approaches for patients with treatment-resistant nAMD. PMID:24925048

Broadhead, Geoffrey K; Hong, Thomas; Chang, Andrew A

2014-12-01

355

Inhibition of hepatic microsomal triglyceride transfer protein - a novel therapeutic option for treatment of homozygous familial hypercholesterolemia  

PubMed Central

Familial hypercholesterolemia (FH) is an autosomal dominant disease caused by mutations in the low-density lipoprotein (LDL)-receptor gene (LDLR). Patients with homozygous FH (hoFH) have inherited a mutated LDLR gene from both parents, and therefore all their LDL-receptors are incapable of functioning normally. In hoFH, serum LDL levels often exceed 13 mmol/L and tendon and cutaneous xanthomata appear early (under 10 years of age). If untreated, this extremely severe form of hypercholesterolemia may cause death in childhood or in early adulthood. Based on recent data, it can be estimated that the prevalence of hoFH is about 1:500,000 or even 1:400,000. Until now, the treatment of hoFH has been based on high-dose statin treatment combined with LDL apheresis. Since the LDL cholesterol-lowering effect of statins is weak in this disease, and apheresis is a cumbersome treatment and not available at all centers, alternative novel pharmaceutical therapies are needed. Lomitapide is a newly introduced drug, capable of effectively decreasing serum LDL cholesterol concentration in hoFH. It inhibits the microsomal triglyceride transfer protein (MTTP). By inhibiting in hepatocytes the transfer of triglycerides into very low density lipoprotein particles, the drug blocks their assembly and secretion into the circulating blood. Since the very low density lipoprotein particles are precursors of LDL particles in the circulation, the reduced secretion of the former results in lower plasma concentration of the latter. The greatest concern in lomitapide treatment has been the increase in liver fat, which can be, however, counteracted by strictly adhering to a low-fat diet. Lomitapide is a welcome addition to the meager selection of drugs currently available for the treatment of refractory hypercholesterolemia in hoFH patients. PMID:24851052

Vuorio, Alpo; Tikkanen, Matti J; Kovanen, Petri T

2014-01-01

356

Opioid Addiction and Abuse in Primary Care Practice: A Comparison of Methadone and Buprenorphine as Treatment Options  

PubMed Central

Opioid abuse and addiction have increased in frequency in the United States over the past 20 years. In 2009, an estimated 5.3 million persons used opioid medications nonmedically within the past month, 200 000 used heroin, and approximately 9.6% of African Americans used an illicit drug. Racial and ethnic minorities experience disparities in availability and access to mental health care, including substance use disorders. Primary care practitioners are often called upon to differentiate between appropriate, medically indicated opioid use in pain management vs inappropriate abuse or addiction. Racial and ethnic minority populations tend to favor primary care treatment settings over specialty mental health settings. Recent therapeutic advances allow patients requiring specialized treatment for opioid abuse and addiction to be managed in primary care settings. The Drug Addiction Treatment Act of 2000 enables qualified physicians with readily available short-term training to treat opioid-dependent patients with buprenorphine in an office-based setting, potentially making primary care physicians active partners in the diagnosis and treatment of opioid use disorders. Methadone and buprenorphine are effective opioid replacement agents for maintenance and/or detoxification of opioid-addicted individuals. However, restrictive federal regulations and stigmatization of opioid addiction and treatment have limited the availability of methadone. The opioid partial agonist-antagonist buprenorphine/naloxone combination has proven an effective alternative. This article reviews the literature on differences between buprenorphine and methadone regarding availability, efficacy, safety, side-effects, and dosing, identifying resources for enhancing the effectiveness of medication-assisted recovery through coordination with behavioral/psychological counseling, embedded in the context of recovery-oriented systems of care. PMID:23092049

Bonhomme, Jean; Shim, Ruth S.; Gooden, Richard; Tyus, Dawn; Rust, George

2014-01-01

357

Clinical Evaluation of Non-surgical Sterilization of Male Cats with Single Intra-testicular Injection of Calcium Chloride  

PubMed Central

Background Calcium chloride solution is an established injectable sterilant in dogs and other mammals. With cat populations a continuing problem, we sought to explore its first use in cats. Six cats per group were injected with 5%, 10% or 20% calcium chloride dihydrate in saline solution with lignocaine hydrochloride, a local anaesthetic. Results At the 60th day post-injection, cat testes were collected and showed complete testicular necrosis and replacement by fibrous tissue; very low sperm counts; and reduction of serum testosterone by at least 70% in 20% dose. Androgenic enzyme activities and their expressions were also reduced in all the treated groups along with intra-testicular testosterone concentration was also low. Increased testicular lipid peroxidation, with reduced antioxidants and mitochondrial membrane potential, were evident following calcium chloride treatments. However, there were no apparent changes in serum concentrations of cortisol, fasting blood sugar level, blood urea nitrogen, packed cell volume, or total serum protein following calcium chloride injection, suggesting that this method of sterilization is not associated with any general stress response. Conclusion Calcium chloride solution demonstrates potential for androgenesis-eliminating nonsurgical sterilization of male cats in addition to its proven efficacy in dogs and other mammals. PMID:21774835

2011-01-01

358

Interventional oncology: new options for interstitial treatments and intravascular approaches: targeting tumor metabolism via a loco-regional approach: a new therapy against liver cancer.  

PubMed

Recent research in tumor metabolism has uncovered cancer-cell-specific pathways that cancer cells depend on for energy production. 3-Bromopyruvate (3-BrPA), a specific alkylating agent and potent ATP inhibitor, has been shown both in vitro and in vivo to disrupt some of these cancer-specific metabolic pathways, thereby leading to the demise of the cancer cells through apoptosis. 3-BrPA has been successfully tested in animal models of liver cancer. For optimal results, 3-BrPA can be delivered intra-arterially, with minimal toxicity to the surrounding hepatic parenchyma. In the era of development of drugs with lower toxicity for the treatment of liver cancer, inhibition of cancer metabolism with 3-BrPA appears to be a very attractive potent novel therapeutic option. PMID:19890602

Liapi, Eleni; Geschwind, Jean-Francois

2010-07-01

359

Monitoring response to tyrosine kinase inhibitor therapy, mutational analysis, and new treatment options in chronic myelogenous leukemia.  

PubMed

Unlike in other leukemias, survival rates have climbed dramatically in early-phase chronic myelogenous leukemia (CML). This improvement in long-term prognosis is primarily the result of the tyrosine kinase inhibitor (TKI) imatinib and its second-generation cousins nilotinib and dasatinib. In his presentation at the NCCN 18th Annual Conference, Dr. Jerald P. Radich reviewed the NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines) recommendations for monitoring response to treatment with the TKIs, which center on complete cytogenetic response, and the role of mutational analysis for guiding treatment decisions in the setting of imatinib resistance. He also offered a brief mention of 2 new agents recently approved for resistant CML--ponatinib and bosutinib. PMID:23704238

Radich, Jerald P

2013-05-01

360

Resistance to Tyrosine Kinase Inhibition Therapy for Chronic Myelogenous Leukemia: A Clinical Perspective and Emerging Treatment Options  

PubMed Central

The development of tyrosine kinase inhibitors (TKIs) has led to extended lifespans for many patients with chronic myelogenous leukemia (CML). However, 20% to 30% of patients fail to respond, respond suboptimally, or experience disease relapse after treatment with imatinib. A key factor is drug resistance. The molecular mechanisms implicated in this resistance include those that involve upregulation or mutation of BCR-ABL kinase and those that are BCR-ABL independent. The clinical consequences of these molecular mechanisms of resistance for disease pathogenesis remain open for debate. This review summarizes the molecular mechanisms and clinical consequences of TKI resistance and addresses the current and future treatment approaches for patients with TKI-resistant CML. PMID:23890944

Jabbour, Elias J.; Cortes, Jorge E.; Kantarjian, Hagop M.

2014-01-01

361

Treatment Options in Patients with Prion Disease - the Role of Long Term Cerebroventricular Infusion of Pentosan Polysulphate  

Microsoft Academic Search

Prion diseases (PrD), also known as transmissible spongiform encephalopathies, are believed to be caused by accumulation of\\u000a an abnormal isoform of the prion protein (PrPSC) in the central nervous system. Creutzfeld-Jacob disease (CJD) in its sporadic and variant form is the most frequent and\\u000a clinically important PrD. At present there is no proven specific or effective treatment available for any

Nikolai G. Rainov; Ian R. Whittle; Katsumi Doh-ura

362

Radiotherapy and chemoradiotherapy as a novel option for the treatment of locally advanced inoperable gastric adenocarcinoma: A phase II study  

PubMed Central

This phase II trial aimed to evaluate the tolerance and efficacy of radical radiotherapy or chemoradiotherapy in patients with primarily inoperable gastric cancer. The analysis was based on 13 patients with primarily inoperable gastric cancer. A total of 6 (46.2%) patients refused surgery and 7 (53.8%) had contraindications to anesthesia due to cardiological or respiratory reasons (4 and 3 patients, respectively). The treatment regimen consisted of radiotherapy and chemotherapy based on 5-fluorouracil. Half of the patients were not qualified to receive chemotherapy due to the presence of comorbidities. A total dose of 45 Gy was administered in 25 fractions. Of the 13 patients who started treatment, 12 (92.3%) completed radiotherapy. Local treatment response was observed in 6/12 patients (50%), with 5/12 (41.7%) displaying clinical complete response and 1/12 (8.3%) partial response. The 1- and 3-year overall survival rates and the median survival were 59 and 48% and 17.1 months, respectively. In conclusion, radical radiotherapy, either alone or in combination with chemotherapy, is safe for patients with inoperable locally advanced gastric cancer and may prolong survival. PMID:25279214

WYDMANSKI, JERZY; GRABINSKA, KINGA; POLANOWSKI, PAWEL; NAMYSL-KALETKA, AGNIESZKA; KAWCZYNSKI, RAFAL; KRASZKIEWICZ, MALGORZATA; MAJEWSKI, WOJCIECH

2014-01-01

363

[Long-term efficiency of vagus nerve stimulation (VNS) in non-surgical refractory epilepsies in adolescents and adults].  

PubMed

Vagus Nerve Stimulation (VNS) is recognized as an efficient procedure for controlling seizures in patients with drug-refractory epilepsies. It is used as a palliative procedure as a complement to conventional treatment by antiepileptic (AE) drugs and, according to literature, 40 to 50p.cent of patients report a decrease in seizures frequency >or=50p.cent, which is usually accepted to classify patients as responders in add on AE drug trials. The objectives of this study based on retrospective analysis of 50 consecutive patients with partial (39) or generalized (11) refractory epilepsy non eligible for surgery were; firstly to evaluate the global long term VNS efficacy and secondly to identify potential predictors of the VNS effects on seizure frequency. No patient has been seizure free at any moment of the follow up (2.8+/-1.8 years, max: 6 years) and the AE has been maintained in all. During follow up 44, 66, 61 and 58p.cent of patients were classified as responders at 6 months, 1, 2 and 3 years, respectively. Logistic regression analysis showed that: the percentage of responders at 6 months of follow up and later was significantly higher than that before 6 months (p=0.002); generalized epilepsy was predictive of a better outcome as compared to partial epilepsy (p=0.03); there was a trend for a better outcome in partial epilepsies symptomatic of a focal lesion than in those with normal brain MRI (p=0.06). These results are in line with previously published data in terms of global efficiency and confirm that seizures control does not reach its maximal level before at least one year of VNS. In severe generalized epilepsies (either secondary or cryptogenic) manifesting by frequent falls due to atonic or tonic-clonic generalized seizures VNS is a useful palliative procedure, which entails much les of surgical risk than callosotomy. The better VNS effects in patients with partial epilepsy possibly reflect the high incidence in our series of Malformations of Cortical Development, which have been identified as one the few variables possibly predictive of a response over 50p.cent of seizures frequency reduction. PMID:18355464

Montavont, A; Demarquay, G; Ryvlin, P; Rabilloud, M; Guénot, M; Ostrowsky, K; Isnard, J; Fischer, C; Mauguière, F

2007-12-01

364

Changes in the clinical characteristics, treatment options, and therapy outcomes in patients with phyllodes tumor of the breast during 55 years of experience  

PubMed Central

Background Data from the literature suggests that the clinical picture of phyllodes tumor (PT) of the breast, as well as treatment options and perhaps therapy outcomes, have significantly changed. The aim of this work was to review these changes by analysis of consecutive patients with PT over a 55-year period at a single institution. Material/Methods From 1952 to 2007, 280 women with PT were treated surgically at the Maria Sk?odowska-Curie Memorial Institute of Oncology, Cancer Center in Cracow. Age, size of breast tumor, microscopic type, extent of surgery, and therapy outcomes were compared between 2 groups: 190 patients treated from 1952 to 1991 vs 90 patients treated from 1992 to 2007. Results The results show that the 1992–2007 group compared to the 1952–1991 included more patients <50 years of age, with tumor <5 cm in diameter, undergoing breast-conserving therapy, as well as no evidence of disease at 5-year survival had increased and this change was statistically significant. In addition, malignant PT cases had decreased in frequency. Conclusions The results of this study show that patients with PT are increasingly younger, the breast tumors at diagnosis are smaller, malignant PT is becoming less frequent, and BCT is now the treatment of choice. Most importantly, the general treatment outcomes are significantly better. PMID:24356679

Mitus, Jerzy Wladyslaw; Blecharz, Pawel; Reinfuss, Marian; Kulpa, Jan Kanty; Skotnicki, Piotr; Wysocki, Wojciech Maria

2013-01-01

365

Numa Option Calculator: The Original Option Webulator  

NSDL National Science Digital Library

Fischer Black and Myron Scholes first published their formula for valuing an option in 1973. Robert Merton independently derived an alternative method for valuing options in 1973 as well. The availability of the Black and Scholes formula for valuing options has helped the options market to grow rapidly. For those interested in pricing their own options, this Option Calculator, provided by Numa Financial Systems Ltd., calculates the adjusted Black-Scholes model to value European options.

1997-01-01

366

POWDERED ACTIVATED CARBON FROM NORTH DAKOTA LIGNITE: AN OPTION FOR DISINFECTION BY-PRODUCT CONTROL IN WATER TREATMENT PLANTS  

SciTech Connect

New federal drinking water regulations have been promulgated to restrict the levels of disinfection by-products (DBPs) in finished public water supplies. DBPs are suspected carcinogens and are formed when organic material is partially oxidized by disinfectants commonly used in the water treatment industry. Additional federal mandates are expected in the near future that will further affect public water suppliers with respect to DBPs. Powdered activated carbon (PAC) has traditionally been used by the water treatment industry for the removal of compounds contributing to taste and odor problems. PAC also has the potential to remove naturally occurring organic matter (NOM) from raw waters prior to disinfection, thus controlling the formation of regulated DBPs. Many small water systems are currently using PAC for taste and odor control and have the potential to use PAC for controlling DBPs. This project, a cooperative effort between the Energy & Environmental Research Center (EERC), the Grand Forks Water Treatment Plant, and the University of North Dakota Department of Civil Engineering, consists of several interrelated tasks. The objective of the research was to evaluate a cost-effective PAC produced from North Dakota lignite for removing NOM from water and reducing trihalomethane formation potential. The research approach was to develop a statistically valid testing protocol that can be used to compare dose-response relationships between North Dakota lignite-derived PAC and commercially available PAC products. A statistical analysis was performed to determine whether significant correlations exist between operating conditions, water properties, PAC properties, and dose-response behavior. Pertinent physical and chemical properties were also measured for each of the waters and each of the PACs.

Daniel J. Stepan; Thomas A. Moe; Melanie D. Hetland; Margaret L. Laumb

2001-06-01

367

Single-Incision Slings (SIS) - a New Option for the Surgical Treatment of Female Stress Urinary Incontinence  

PubMed Central

The new development of single-incision slings (SIS) for the treatment of female stress urinary incontinence offers comparable results with only minimal side effects and will find wide acceptance in modern incontinence surgery. This mini-sling is inserted over a single vaginal incision and fixed on both sides to the pelvic wall tissue with special anchors, without passing through the groin and avoiding a blind tape passage. Compared with the established sub-urethral tapes, there are comparable success rates with fewer complications. Randomised prospective studies are needed to evaluate whether, in the long run, the benefits of the single incision technique can be correlated with satisfying continence results.

Naumann, G.; Albrich, S.; Skala, C.; Laterza, R.; Kolbl, H.

2012-01-01

368

Current differential diagnoses and treatment options of vascular occlusions presenting as bilateral thalamic infarcts: a review of the literature.  

PubMed

bilateral thalamic infarctions are rare and usually caused by vascular occlusions. When symptomatic, it is important to make a distinction between different vascular etiologies in order to provide an effective and timely therapeutic response. Clinical presentations may not adequately differentiate between the vascular etiologies alone. It is therefore important to use imaging technologies to distinguish appropriately the origin of the infarct so that proper treatment can be administered. Advanced imaging techniques, such as CT angiography and MR angiography, have proved useful for distinguishing between arterial and venous causes of bithalamic infarctions. Bilateral thalamic venous infarctions can be treated with anticoagulation medication and with thrombolysis in more severe cases. Bilateral thalamic arterial infarctions may be treated with thrombolysis. PMID:22805281

Agarwal, Nitin; Tolia, Arpan; Hansberry, David Richard; Duffis, Ennis Jesus; Barrese, James C; Gandhi, Chirag D; Prestigiacomo, Charles J

2013-09-01

369

Dornase alpha inhalations as a treatment option for recurrent lower respiratory tract infections in a child with Sotos syndrome.  

PubMed

Recurrent episodes of lower respiratory tract infections (LRTIs) are a rare complication of muscular hypotonia in patients with Sotos syndrome. We report on a male child suffering from repeated LRTIs including bronchitis, pneumonia, and atelectasis during infancy despite inhalations with salbutamol and fluticasone combined with manual chest percussion therapy. After initiation of dornase alpha inhalations in addition to the current treatment, we observed an improvement in the respiratory symptoms as well as a reduction in the rate of hospitalizations and in the occurrence of LRTIs. We assume that dornase alpha inhalations, in combination with airway clearance techniques, reduced the viscosity of airway secretions and by this improved mucociliary clearance and coughing efficiency. PMID:24899541

Eickhoff, Philipp; Fazekas, Tamas; Wank, Hans; Kastner, Ulrike

2014-07-01

370

Minimally invasive treatment of urinary fistulas using N-butyl-2-cyanoacrylate: a valid first line option  

PubMed Central

Background A few single case reports and only one clinical series have been published so far about the use of N-butyl-2-cyanoacrylate in the treatment of urinary fistulas persisting after conventional urinary drainage. Case presentation We treated five patients with a mean age of 59.2 years presenting iatrogenic urinary fistulas which persisted following conventional drainage manouvres. There were 3 calyceal fistulas following open, laparoscopic and robotic removal of renal lesions respectively, one pelvic fistula after orthotopic ileal neobladder and a bilateral dehiscence of uretero-sigmoidostomy. We used open-end catheters of different sizes adopting a retrograde endoscopic approach for cyanoacrylate injection in the renal calyces, while a descending percutaneous approach via the pelvic drain tract and bilateral nephrostomies respectively was used for the pelvic fistulas. Fluoroscopic control was always used during the occlusion procedures. The amount of adhesive injected ranged between 2 and 5 cc and in one case the procedure was repeated. With a median follow-up of 11 months we observed clinical and radiological resolution in 4 cases (80%), while a recurrent and infected calyceal fistula after laparoscopic thermal renal damage during tumor enucleoresection required nephrectomy. No significant complications were documented. Conclusions In an attempt to spare further challenging surgery in patients that had been already operated on recently, minimally invasive occlusion of persistent urinary fistulas with N-butyl-2-cyanoacrylate represents a valid first line treatment, justified in cases when the urinary output is not excessive and there is a favorable ratio between the length and diameter of the fistulous tract. PMID:24152605

2013-01-01

371

From traumatic brain injury to posttraumatic epilepsy: what animal models tell us about the process and treatment options.  

PubMed

A large number of animal models of traumatic brain injury (TBI) are already available for studies on mechanisms and experimental treatments of TBI. Immediate and early seizures have been described in many of these models with focal or mixed type (both gray and white matter damage) injury. Recent long-term video-electroencephalography (EEG) monitoring studies have demonstrated that TBI produced by lateral fluid-percussion injury in rats results in the development of late seizures, that is, epilepsy. These animals develop hippocampal alterations that are well described in status epilepticus-induced spontaneous seizure models and human posttraumatic epilepsy (PTE). In addition, these rats have damage ipsilaterally in the cortical injury site and thalamus. Although studies in the trauma field provide a large amount of information about the molecular and cellular alterations corresponding to the immediate and early phases of PTE, chronic studies relevant to the epileptogenesis phase are sparse. Moreover, despite the multiple preclinical pharmacologic and cell therapy trials, there is no information available describing whether these therapeutic approaches aimed at improving posttraumatic recovery would also affect the development of lowered seizure threshold and epilepsy. To make progress, there is an obvious need for information exchange between the trauma and epilepsy fields. In addition, the inclusion of epilepsy as an outcome measure in preclinical trials aiming at improving somatomotor and cognitive recovery after TBI would provide valuable information about possible new avenues for antiepileptogenic interventions and disease modification after TBI. PMID:19187291

Pitkänen, Asla; Immonen, Riikka J; Gröhn, Olli H J; Kharatishvili, Irina

2009-02-01

372

Sensitivity of aquatic invertebrate resting eggs to SeaKleen (Menadione): a test of potential ballast tank treatment options.  

PubMed

The introduction of aquatic species in resting life stages by the release of ballast water is a less well-known but potentially important invasive species vector. Best-management practices designed to minimize transport of ballast water cannot eliminate this threat, because residual water and sediment are retained in ballast tanks after draining. To evaluate the potential efficacy of chemical treatment of residual material in ship ballast tanks, the present study examined the acute toxicity of the proposed biocide SeaKleen (menadione; Garnett, Watkinsville, GA, USA) on resting eggs of Brachionus plicatilis (a marine rotifer), a freshwater copepod, Daphnia mendotae (a freshwater cladoceran), and Artemia sp. (a marine brine shrimp). SeaKleen was toxic to resting eggs of all taxa. Daphnia mendotae resting eggs encased in protective ephippia were the least sensitive, as indicated by a 24-h lethal concentration of toxicant to 90% of organisms of 8.7 mg/L (95% confidence interval, +/- 0.1 mg/L). SeaKleen induced teratogenic effects in D. mendotae and Artemia sp. Exposure to sunlight quickly degraded SeaKleen, which lost all toxicity after 72 h outdoors. SeaKleen increased in toxicity slightly after 72 h in darkness. Burial of D. mendotae ephippia in natural lake sediment reduced SeaKleen toxicity by a factor of 20. Reduced toxicity in the presence of sediment raises serious doubts as to the potential for this, or any, chemical biocide to kill aquatic invertebrate resting stages buried in sediment retained in ship ballast tanks. PMID:16519319

Raikow, David E; Reid, David E; Maynard, Erynn E; Landrum, Peter E

2006-02-01

373

Direct oral anticoagulants as alternative treatment options for the effective long-term treatment of patients with pulmonary embolism in primary care: a review.  

PubMed

Abstract Pulmonary embolism (PE) represents a potentially life-threatening venous thromboembolic disorder, and prompt treatment is vital to prevent early mortality. However, diagnosis of PE is complicated by the range of signs and symptoms with which it presents. Clinical risk scores, imaging techniques, and laboratory tests are recommended in clinical guidelines to aid diagnosis, and risk stratification strategies can be used to inform treatment decisions. Long-term anticoagulation is key to avoid the risk of later complications of acute PE, such as recurrent venous thromboembolism and chronic thromboembolic pulmonary hypertension. Rivaroxaban is a direct oral anticoagulant that has been approved for the treatment of PE (and deep vein thrombosis) and prevention of recurrent venous thromboembolism; other direct oral anticoagulants have undergone phase III trials for these indications. These agents may provide advantages over traditional anticoagulants, such as vitamin K antagonists, because they are administered at fixed doses and do not require routine coagulation monitoring. These advantages may improve patient adherence and aid general practitioners by simplifying long-term management of PE in daily primary care. PMID:24888386

Toth, Peter P

2014-09-01

374

24 CFR 35.120 - Options.  

...Options. (a) Standard treatments. Where interim controls...is not required. Standard treatments shall then be conducted in...1335 on all applicable surfaces, including soil. Standard treatments are completed only when...

2014-04-01

375

Second-line treatment options in metastatic castration-resistant prostate cancer: a comparison of key trials with recently approved agents.  

PubMed

Standard first-line treatment for metastatic castration-resistant prostate cancer (mCRPC) is docetaxel plus prednisone; however, patients will usually experience disease progression during or after docetaxel treatment due to inherent or acquired resistance. Before 2010, second-line options for mCRPC were limited. However, cabazitaxel, abiraterone acetate and enzalutamide have since been approved for patients with mCRPC whose disease has progressed during or after receiving docetaxel, based on the Phase III trials TROPIC, COU-AA-301 and AFFIRM. In all three trials, an overall survival benefit (primary endpoint) was seen in the experimental arm compared with the control arm: 15.1 vs. 12.7months for cabazitaxel plus prednisone compared with mitoxantrone plus prednisone in TROPIC (hazard ratio [HR] 0.70; P<0.0001); 14.8 vs. 10.9months for abiraterone acetateplus prednisone compared with placebo plus prednisone in COU-AA-301 (HR 0.65; P<0.001); and 18.4 vs. 13.6months for enzalutamide compared with placebo alone in AFFIRM (0.63; P<0.001). However, differences in patient populations, comparators, and selection and/or definition of secondary endpoints make it difficult to draw direct cross-trial comparisons. Radium-223 dichloride has also been approved for patients with mCRPC with metastases to bone but not other organs. To date, no comparative trials or sequencing studies with newer agents have been performed. Without such data, treatment decisions must be based on evaluation of the existing evidence. This commentary compares and contrasts study designs and key data from each of these Phase III trials, and also discusses recent and ongoing clinical trials with new agents in the first- and second-line settings in mCRPC. PMID:23958310

Bahl, Amit; Masson, Susan; Birtle, Alison; Chowdhury, Simon; de Bono, Johann

2014-02-01

376

Novel treatment option for MUC16-positive malignancies with the targeted TRAIL-based fusion protein Meso-TR3  

PubMed Central

Background The targeted delivery of cancer therapeutics represents an ongoing challenge in the field of drug development. TRAIL is a promising cancer drug but its activity profile could benefit from a cancer-selective delivery mechanism, which would reduce potential side effects and increase treatment efficiencies. We recently developed the novel TRAIL-based drug platform TR3, a genetically fused trimer with the capacity for further molecular modifications such as the addition of tumor-directed targeting moieties. MUC16 (CA125) is a well characterized biomarker in several human malignancies including ovarian, pancreatic and breast cancer. Mesothelin is known to interact with MUC16 with high affinity. In order to deliver TR3 selectively to MUC16-expressing cancers, we investigated the possibility of targeted TR3 delivery employing the high affinity mesothelin/MUC16 ligand/receptor interaction. Methods Using genetic engineering, we designed the novel cancer drug Meso-TR3, a fusion protein between native mesothelin and TR3. The recombinant proteins were produced with mammalian HEK293T cells. Meso-TR3 was characterized for binding selectivity and killing efficacy against MUC16-positive cancer cells and controls that lack MUC16 expression. Drug efficacy experiments were performed in vitro and in vivo employing an intraperitoneal xenograft mouse model of ovarian cancer. Results Similar to soluble mesothelin itself, the strong MUC16 binding property was retained in the Meso-TR3 fusion protein. The high affinity ligand/receptor interaction was associated with a selective accumulation of the cancer drug on MUC16-expressing cancer targets and directly correlated with increased killing activity in vitro and in a xenograft mouse model of ovarian cancer. The relevance of the mesothelin/MUC16 interaction for attaching Meso-TR3 to the cancer cells was verified by competitive blocking experiments using soluble mesothelin. Mechanistic studies using soluble DR5-Fc and caspase blocking assays confirmed engagement of the extrinsic death receptor pathway. Compared to non-targeted TR3, Meso-TR3 displayed a much reduced killing potency on cells that lack MUC16. Conclusions Soluble Meso-TR3 targets the cancer biomarker MUC16 in vitro and in vivo. Following attachment to the tumor via surface bound MUC16, Meso-TR3 acquires full activation with superior killing profiles compared to non-targeted TR3, while its bioactivity is substantially reduced on cells that lack the tumor marker. This prodrug phenomenon represents a highly desirable property because it has the potential to enhance cancer killing with fewer side-effects than non-targeted TRAIL-based therapeutics. Thus, further exploration of this novel fusion protein is warranted as a possible therapeutic for patients with MUC16-positive malignancies. PMID:24447304

2014-01-01

377

The novel bladder preservation therapy BOAI-CDDP-radiation (OMC-regimen): a new treatment option for invasive bladder cancer patients with lymph node metastasis.  

PubMed

We have developed a novel bladder preservation therapy for patients with muscle-invasive bladder cancer and lymph node metastasis: balloon-occluded arterial infusion (BOAI) of cisplatin/gemcitabine, with concomitant hemodialysis and irradiation [the so-called 'OMC (Osaka Medical College) regimen']. The OMC regimen delivers an extremely high concentration of anticancer agent to the site of the tumor, as well as the pelvic area, without causing any adverse systemic effects. In this study, we investigated the efficiency of the OMC regimen in 34 patients who underwent BOAI with cisplatin (100, 200 or 300 mg) along with 60 Gy of irradiation; patients who failed to achieve CR underwent secondary BOAI with gemcitabine (1,600 mg). The overall clinical response was 73.5% (CR: 35.3%; PR: 17.6%; SD: 20.6%). The 5-year overall and progression-free survival rates were 54.4% and 52.5%, respectively. For treatment failure, N2 stage was selected as a significant risk factor by simple and multiple logistic regression analyses. Cox proportional hazards analyses showed that N2 stage, T4 stage and the presence of hydronephrosis were significant risk factors for overall survival. Indeed, 55.6% of patients with N1 stage achieved a complete response (CR) (vs. 12.5% for N2 patients, p=0.0151), and 90% (9/10) of the CR patients survived without recurrence with an intact bladder after a mean follow-up of 85 (range 7-193) weeks. The 3-year progrssion-free survival rate with an intact bladder was 65.8% (vs. 37.5% for N2, p=0.034), and the 5-year overall survival rate was 71.8% (vs. 30.6% for N2, p=0.004). No patients suffered severe toxicities of Grade II or more; the oldest patient, aged 85 years, successfully completed this therapy. In conclusion, the OMC regimen can be regarded as a new option for patients with macroscopic lymph node involvement, especially those at stage N1. Therapy will improve the feasibility of radical cure even without the need for cystectomy in patients for whom surgery after neoadjuvant chemotherapy would otherwise be necessary, and also facilitate potential cure in patients for whom, otherwise, merely palliative treatment would seem the only option. PMID:24728124

Azuma, Haruhito; Inamoto, Teruo; Takahara, Kiyoshi; Nomi, Hayahito; Hirano, Hajime; Ibuki, Naokazu; Uehara, Hiroshi; Komura, Kazumasa; Minami, Koichiro; Uchimoto, Taizo; Saito, Kenkichi; Takai, Tomoaki; Tanda, Naoki; Yamamoto, Kazuhiro; Narumi, Yoshihumi; Kiyama, Satoshi

2014-06-01

378

Adverse Events Profile of PrePex a Non-Surgical Device for Adult Male Circumcision in a Ugandan Urban Setting  

PubMed Central

Background Safe Male Circumcision is a proven approach for partial HIV prevention. Several sub Saharan African countries have plans to reach a prevalence of 80% of their adult males circumcised by 2015. These targets require out of ordinary organization, demand creation, timely execution and perhaps the use of SMC devices. Objective To profile Adverse Events rate and acceptance of PrePex, a non surgical device for adult male circumcision. Methods A prospective study, conducted at International Hospital Kampala, Uganda, between August and October 2012. Ethical approval was obtained from Uganda National Council of Science and Technology. Results Of 1,040 men received to undergo SMC, 678 opted for PrePex, 36 were excluded at an initial physical examination screening. 642 were enrolled and consented, and another 17 were excluded before device placement. 625 underwent the procedure. Average age was 24 years (±7). Twelve moderate AEs occurred among 10 participants 12/625, (1.9%). These were all reversible. Five had device displacement, one had an everted foreskin; five had bleeding after the device was removed and one had voiding difficulties. The majority (279 out of 300) of men interviewed complained of some pain within the week of placement. Mean pain score at device placement (using visual analogue scale) was 0.5, at device removal 4.5 and within 2 min of removal the pain score was 1.4. Over 70% of the devices were placed and removed by non-physician clinicians. Presented with a choice, 60% of men chose PrePex over surgical SMC. Close to 90% would recommend the device to their friends. Odour from the necrotic skin was a concern. Removals done 1–2 days earlier than day 7 were beneficial and conferred no extra risk. Conclusion AEs of a moderate or severe nature associated with PrePex were low and reversible. PrePex is feasible for mass safe male circumcision scaling up. PMID:24489754

Galukande, Moses; Duffy, Kevin; Bitega, Jean Paul; Rackara, Sam; Bbaale, Denis Sekavuga; Nakaggwa, Florence; Nagaddya, Teddy; Wooding, Nick; Dea, Monica; Coutinho, Alex

2014-01-01

379

Skills Training of Health Workers in the Use of a Non Surgical Device (PrePex) for Adult Safe Male Circumcision  

PubMed Central

Background Safe Male Circumcision (SMC) is a proven approach for partial protection of men from acquisition of HIV infection. Several sub-Saharan African countries have a target to circumcise 80% of males aged 15 to 49. The use of devices such as PrePex would aid scaling up of SMC. Since most health workers would have no prior experience with use of devices, skills training is needed. This paper explores a skills transfer model at an urban site in Uganda. Objective To assess the practicability and feasibility of rapid short duration training for safe PrePex device use. Methods A prospective study, conducted over 8 weeks (August–October 2012) at International Hospital Kampala, an urban Kampala hospital, examining the performance of various health worker cadres after training in the use of a non-surgical device (PrePex). The prospective study obtained approval from the Makerere School of Medicine Research and Ethics Committee and the Uganda National Council of Science and Technology. If eligible, and after the subject signed the informed consent form, they were enrolled into the study. Results Ten health workers were successfully trained in use of PrePex during a 3 day non-residential on-the-job training course. After the first three days of training, the trained health workers performed 561 placements and 529 device removals successfully. Over all adverse events (AE) rates were below ?2%; however, there were some differences in AE rates across the cadres trained but not significant (p>0.25 for moderate AEs). Conclusion Rapid training for safe use of the PrePex device is feasible for the range of health workers available for SMC in resource limited settings, but among those with past SMC experience. PMID:25118716

Galukande, Moses; Duffy, Kevin; Bitega, Jean Paul; Wooding, Nick

2014-01-01

380

Options Paper  

NSDL National Science Digital Library

Recently released, this options paper, one in a series of papers from the Federal Deposit Insurance Corporation, is part of a comprehensive review of the 76-year old US deposit insurance system. Because the US banking system is going through a period of healthiness, the FDIC feels that this is the best time to "address the latent flaws in the system." The paper begins with a marvelous introduction to the history and uses of the US deposit insurance system, including a lengthy overview on the need for system reform. The second section examines the pricing of deposit insurance for individual banks. Section three discusses the ways in which deposit insurance losses are funded, and the fourth section considers the extent of insurance coverage. The paper is available in its entirety in HTML format.

381

Rehabilitation Options  

MedlinePLUS

Donate Donate One Time Monthly Event Tribute For brain tumor information and support Call: 800-886-ABTA (2282) ... Menu Treatment and Care Continuum of Care A Brain Tumor Diagnosis Brain Tumor Medical Journals Your First Appointment ...

382

Treatment Option Overview (Parathyroid Cancer)  

MedlinePLUS

... a special camera that detects radioactivity. CT scan (CAT scan) : A procedure that makes a series of ... bone, heart, pancreas , or lymph nodes : CT scan (CAT scan) : A procedure that makes a series of ...

383

Treatment Option Overview (Colon Cancer)  

MedlinePLUS

... film, making a picture of areas inside the body. Surgery : A procedure to remove the tumor and see ... opening) is made on the outside of the body for waste to pass through. This ... Colon cancer surgery with colostomy. Part of the colon containing the ...

384

Treatment Option Overview (Testicular Cancer)  

MedlinePLUS

... in men 20 to 35 years old. Health history can affect the risk of developing testicular cancer. ... abnormal development of the testicles. Having a personal history of testicular cancer. Having a family history of ...

385

Chiropractic: A Safe Treatment Option  

MedlinePLUS

... procedure. While some reports have associated upper high-velocity neck manipulation with a certain kind of stroke, ... the incidence of artery injuries associated with high-velocity upper neck manipulation is extremely rare – about 1 ...

386

Antiviral options for biodefense.  

PubMed

A key to biodefense strategies is an assessment of current therapies available as well as the expedited development of new antiviral therapeutic options. Viruses make up the majority of the National Institute of Allergy and Infectious Diseases (NIAID) Category A Priority Pathogens, agents that are considered to pose the greatest risk to public health and national security, and yet there are currently no approved treatments for most of these viral biodefense threats. A review of the Category A viral biothreat agents and strategies for the development of new therapeutics are presented here. PMID:23773331

Byrd, Chelsea M; Grosenbach, Douglas W; Hruby, Dennis E

2013-10-01

387

Options Strategy Guide  

NSDL National Science Digital Library

Numa Financial Systems provide an easy-to-use Options Strategy Guide where the options strategies are categorized to the user's expectations of the stock price. Fischer Black and Myron Scholes first published their formula for valuing an option in 1973. Robert Merton independently derived an alternative method for valuing options in 1973 as well. The availability of the Black and Scholes formula for valuing options has helped the options market to grow rapidly.

1995-01-01

388

Therapeutic options for severe asthma  

PubMed Central

As the overall prevalence of asthma has escalated in the past decades, so has the population of patients with severe asthma. This condition is often difficult to manage due to the relative limitation of effective therapeutic options for the physician and the social and economic burden of the disease on the patient. Management should include an evaluation and elimination of modifiable risk factors such as smoking, allergen exposure, obesity and non-adherence, as well as therapy for co-morbidities like gastro-esophageal reflux disease and obstructive sleep apnea. Current treatment options include conventional agents such as inhalational corticosteroids, long acting ?2 agonists, leukotriene antagonists, and oral corticosteroids. Less conventional treatment options include immunotherapy with methotrexate, cyclosporine and tacrolimus, biological drugs like monoclonal antibodies, tumor necrosis factor-? blockers and oligonucleotides, phosphodiesterase inhibitors, antimicrobials and bronchial thermoplasty. PMID:23056066

Mathew, Jilcy; Chandy, Dipak

2012-01-01

389

Does Provision of Point-of-Care CD4 Technology and Early Knowledge of CD4 Levels Affect Early Initiation and Retention on Antiretroviral Treatment in HIV-Positive Pregnant Women in the Context of Option B+ for PMTCT?  

PubMed

: Evidence for Elimination (E4E) is a collaborative project established in 2012 as part of the INSPIRE (INtegrating and Scaling up PMTCT through Implementation REsearch) initiative. E4E is a cluster-randomized trial with 2 arms; Standard of care and "POC Plus" [in which point-of-care (POC) CD4 devices and related counseling support are provided]; aimed at improving retention-in-care of HIV-infected pregnant women and mothers. In November 2013, Zimbabwe adopted Option B+ for HIV-positive pregnant women under which antiretroviral treatment eligibility is no longer based on CD4 count. However, Ministry of Health and Child Care guidelines still require baseline and 6-monthly CD4 testing for treatment monitoring, until viral load testing becomes widely available. Considering the current limited capacity for viral-load testing, the significant investments in CD4 testing already made and the historical reliance on CD4 by health care workers for determining eligibility for antiretroviral treatment, E4E seeks to compare the impact of the provision of POC CD4 technology and early knowledge of CD4 levels on retention-in-care at 12 months, with the current standard of routine, laboratory-based CD4 testing. The study also compares rates of initiation and time-to-initiation between the 2 arms and according to level of maternal CD4 count, the cost of retaining HIV-positive pregnant women in care and the acceptability and feasibility of POC CD4 in the context of Option B+. Outcome measures are derived from routine health systems data. E4E will provide data on POC CD4 testing and retention-in-care associated with Option B+ and serve as an early learning platform to inform implementation of Option B+ in Zimbabwe. PMID:25310120

Mangwiro, Alexio-Zambezi; Makomva, Kudzai; Bhattacharya, Antoinette; Bhattacharya, Gaurav; Gotora, Tendai; Owen, Mila; Mushavi, Angela; Mangwanya, Douglas; Zinyowera, Sekesai; Rusakaniko, Simbarashe; Mugurungi, Owen; Zizhou, Simukai; Busumani, William; Masuka, Nyasha

2014-11-01

390

Current trends in treatment of osteoid osteoma with an emphasis on radiofrequency ablation  

Microsoft Academic Search

This article reviews current trends in the treatment of osteoid osteoma with an emphasis on the evolving use of radiofrequency thermoablation as a primary definitive treatment and for recurrent and residual lesions. In so doing, the article reviews merits and relative disadvantages of both surgical and non-surgical imaging-guided techniques in treatment. Radiofrequency ablation of osteoid osteoma is a highly effective,

Colin P. Cantwell; John Obyrne; Stephen Eustace

2004-01-01

391

Esthetic Options: Bleaching Section 8  

Microsoft Academic Search

alone44. Furthermore, the availability of several in-office whitening products and techniques has resulted in several different options for the patient seeking a whiter smile. Ultimately, the dentist is responsible for acquiring the knowledge required to determine the best treatment for each specific case. Clearly this is made difficult not only by the myriad of bleaching products on the market, but

Chris Sampair; Paul Schaus; Judy Schmidt; Eric Scotland; Katie Sealey; Ben Seldon; Rhonda Senjem; Atty Smith; Scott Stadsklev

392

The use of dynamic Lycra orthosis in the treatment of scoliosis: a case study.  

PubMed

Treatment of scoliosis has been under discussion in relation to surgical intervention since the Boston brace was presented by Hall in 1976 (Hall et al. 1976; Watts et al. 1977). The effects of rigid bracing on thoracic skeletal integrity and the possible deformation of ribs due to the high localized pressure due to prolonged wear (Biorthex 1999; Coillard et al. 1999) have been highlighted. The lack of compliance (Houghton et al. 1987) has encouraged clinicians to investigate other options for non-surgical treatment. The Spinecor and Triac bracing systems have been developed as a result of this research; however, both of these orthoses had been designed with idiopathic scoliosis in mind. Little research has been done into the effects of bracing on the neuropathic curve. The use of dynamic Lycra garments in the treatment of neurological scoliosis offers the advantage of deformity correction without the bulk and discomfort of rigid braces. Recent clinical experience has shown that the Lycra suits have a positive effect in the treatment of scoliosis. This study discusses the treatment of a child presenting with a spinal tumour and although not truly of neurological presentation indicates that the garment can be used for the different scoliotic presentations. PMID:16990228

Matthews, M; Crawford, R

2006-08-01

393

Introduction to Options  

NSDL National Science Digital Library

International Finance and Commodities Institute (IFCI) and Axone Services & Development S.A. of Switzerland have developed an on-line course on options. The course is divided into six parts: Comparing Forward, Futures and Options; Options Basics; Basic Options Pricing; Structure and Functioning of an Options Exchange; Hedging; and Trading Strategies. Many of the lessons take the form of brief introductory remarks and then interactive multiple choice questions. At the end of the course there is an interactive quiz you can take to test your knowledge. Note that some prior knowledge of options is assumed.

1995-01-01

394

Introduction to Options  

E-print Network

prices or premiums are not predetermined, but rather are determined by the interaction of option buyers and sellers at the exchange. There are several important facts to remember when trading options. Most im- Mark Welch and James Mintert* 2 portant... prices or premiums are not predetermined, but rather are determined by the interaction of option buyers and sellers at the exchange. There are several important facts to remember when trading options. Most im- Mark Welch and James Mintert* 2 portant...

Mintert, James R.; Welch, Mark

2009-01-07

395

The British Russian Option  

Microsoft Academic Search

Following the economic rationale of the British put and call option, we present a new class of lookback options (by first studying the canonical ‘Russian’ variant) where the holder enjoys the early exercise feature of American options, whereupon his payoff (deliverable immediately) is the ‘best prediction’ of the European payoff under the hypothesis that the true drift of the stock

Kristoffer Glover; Goran Peskir; Farman Samee

2010-01-01

396

The British call option  

Microsoft Academic Search

Alongside the British put option (Peskir and Samee [Appl. Math. Finance, 2011, 18, 537–563]) we present a new call option where the holder enjoys the early exercise feature of American options whereupon his payoff (deliverable immediately) is the ‘best prediction’ of the European payoff under the hypothesis that the true drift of the stock price equals a contract drift. Inherent

Goran Peskir; Farman Samee

2012-01-01

397

The British Put Option  

Microsoft Academic Search

We present a new put option where the holder enjoys the early exercise feature of American options whereupon his payoff (deliverable immediately) is the ‘best prediction’ of the European payoff under the hypothesis that the true drift of the stock price equals a contract drift. Inherent in this is a protection feature which is key to the British put option.

Goran Peskir; Farman Samee

2011-01-01

398

TANK SPACE OPTIONS REPORT  

SciTech Connect

Since this report was originally issued in 2001, several options proposed for increasing double-shell tank (DST) storage space were implemented or are in the process of implementation. Changes to the single-shell tank (SST) waste retrieval schedule, completion of DST space saving options, and the DST space saving options in progress have delayed the projected shortfall of DST storage space from the 2007-2011 to the 2018-2025 timeframe (ORP-11242, River Protection Project System Plan). This report reevaluates options from Rev. 0 and includes evaluations of new options for alleviating projected restrictions on SST waste retrieval beginning in 2018 because of the lack of DST storage space.

WILLIS WL; AHRENDT MR

2009-08-11

399

Non-surgical approach to the benign nodular goiter: new opportunities by recombinant human TSH-stimulated 131I-therapy.  

PubMed

The optimal treatment strategy in a goiter patient depends--among other factors--on goiter size, the degree of cosmetic or compressive symptoms, the age of the patient, the impact on the upper airways, the wish to maintain normal thyroid function, the ability of the thyroid gland to take up (131)I, and the possibility of thyroid malignancy. When treatment is warranted in a patient with benign goiter, the choice usually stands between surgery and (131)I-therapy. Focal destructive treatment, by ethanol sclerotherapy or interstitial laser photocoagulation, may be considered in patients with a solitary benign nodule. If thyroid hyperfunction due to nodular autonomy is the dominant problem, life-long anti-thyroid drug treatment may be relevant in elderly individuals. With the advent of recombinant human TSH (rhTSH) stimulation the goiter reduction following (131)I-therapy is significantly enhanced and this treatment is of particular benefit, as compared with conventional (131)I-therapy, in patients with a low baseline thyroid (131)I uptake and a large goiter. If the rhTSH dose does not exceed 0.1 mg the risk of temporary hyperthyroidism and acute thyroid swelling is low. Since patient satisfaction seemingly is not improved by the greater goiter reduction obtained by rhTSH-stimulated (131)I-therapy, and permanent hypothyroidism is more frequent, it may be more relevant to reduce the administered radioactivity equivalent to the rhTSH-induced increase in the thyroid (131)I uptake. Future large-scale well-controlled studies should explore this strategy, with focus on cost-benefit and quality of life. A major hindrance of widespread and routine use of rhTSH-stimulated (131)I-therapy is its present status as an off-label treatment. PMID:21971931

Bonnema, Steen Joop; Fast, Søren; Hegedüs, Laszlo

2011-12-01

400

RSS Feeds Submit Biological Cancer Therapy There is hope. Learn more about biotherapy treatment options today. CancerCenter.com/CareThatNev  

E-print Network

RSS Feeds » Submit Biological Cancer Therapy There is hope. Learn more about biotherapy treatment, efficiency Study of 90 animals' thigh bones reveals how they can efficiently carry loads Study of 90 animals

Glaser, Rainer

401

Anakinra for Difficult-to-Treat Neutrophilic Panniculitis: IL1 Blockade as a Promising Treatment Option for Neutrophil-Mediated Inflammatory Skin Disease  

Microsoft Academic Search

The treatment of neutrophilic panniculitis can be challenging. We report a patient with a difficult-to-treat neutrophilic panniculitis who had a spectacular response to a short treatment course with the IL-1 antagonist anakinra. A 61-year-woman had a 12-year history of a serious febrile neutrophilic panniculitis and a personal history of steroid- induced pancreatitis and life-threatening methemoglobinemia under antimalarials and dapsone. When

Dan Lipsker; Cécile Perrigouard; Audrey Foubert; Bernard Cribier

2010-01-01

402

Advances in Prenatal Genetic Testing: Current Options, Benefits, and Limitations  

Microsoft Academic Search

Options in prenatal testing continue to expand as technology advances. These options allow for clarification of many diagnoses, which can assist in prenatal planning from medical and family perspectives. They can provide additional information to families before the birth of their child regarding diagnosis, underlying etiology, treatment options, short-term outcomes, and long-term outcomes. Our objective was to provide an overview

Elizabeth Peach; Robert Hopkin

2007-01-01

403

OPTIONS FOR ABATING GREENHOUSE GASES FROM EXHAUST STREAMS.  

SciTech Connect

This report examines different alternatives for replacing, treating, and recycling greenhouse gases. It is concluded that treatment (abatement) is the only viable short-term option. Three options for abatement that were tested for use in semiconductor facilities are reviewed, and their performance and costs compared. This study shows that effective abatement options are available to the photovoltaic (PV) industry, at reasonable cost.

FTHENAKIS,V.

2001-12-01

404

Sustained-Release Corticosteroid Options  

PubMed Central

Sustained-release corticosteroid treatment has shown to be a promising strategy for macular edema due to retinovascular disease (i.e., diabetes and retinal vein occlusion) and for the treatment of noninfectious posterior uveitis. Clinicians now have the option of three sustained-release corticosteroid implants: Ozurdex (Allergan Inc., Irvine, CA) which releases dexamethasone and two devices that release fluocinolone acetonide, Retisert (Bausch & Lomb, Rochester, NY), and Iluvien (Alimera Science, Alpharetta, GA). Each has different physical characteristics and duration effect and has been approved for different indications. Herein we provide a summary of the current clinical knowledge regarding these implants. PMID:25140246

Cabrera, Mariana; Yeh, Steven; Albini, Thomas A.

2014-01-01

405

[The transdermal 7-day buprenorphine patch--an effective and safe treatment option, if tramadol or tilidate/naloxone is insufficient. Results of a non-interventional study].  

PubMed

The transdermal 7-day buprenorphine matrix patch provides a constant and user-friendly pain management when chronic musculoskeletal pain requires opioids. This analysis of clinical routine data evaluated the benefit of this treatment for patients previously receiving oral long-term treatment with weak opioids alone. Data of 310 patients previously treated with tramadol or tildate/naloxone and part of a multicentre observational study with 3295 patients were analyzed. In 89.7% of the 310 patients oral treatment with weak opioids was replaced by the 7-day buprenorphine patch due to insufficient analgesia. During treatment with the 7-day buprenorphine patch there was a clinically significant decrease of the mean pain intensity at rest during the day from 5.7 to 2.9, on physical effort during the day from 7.3 to 3.8 and at night from 5.2 to 2.3 (11-point NRS scale, p < or = 0.001). In addition, quality of life aspects such as mobility, self-reliance and quality of sleep improved, which are relevant for individual patient satisfaction with pain management. For patients with previous long-term tramadol or tilidate/naloxone treatment the switch to the 7-day buprenorphine matrix patch proved to be effective and safe for the management of chronic pain. The user-friendly 7-day application interval contributes to improving compliance and a reducing exposure to tablets. PMID:21591321

Schutter, U; Ritzdorf, I; Heckes, B

2010-07-01

406

A Mixed Integer Programming Analysis of Effluent Treatment Options Proposed for Pond Production of Hybrid Striped Bass, Morone chrysops X M. saxatilis  

Microsoft Academic Search

The growth of aquaculture farming has resulted in increased scrutiny by regulatory agencies. The Environmental Protection Agency (EPA) added aquaculture into the Effluent Limitation Guidelines (ELG) program that bases its rulemaking effort on technology-based standards that are economically achievable. The primary objective of this paper is to evaluate several effluent treatments that have been considered for hybrid striped bass (HSB),

Yong-Suhk Wui; Carole R. Engle

2004-01-01

407

Approximate option pricing  

SciTech Connect

As increasingly large volumes of sophisticated options (called derivative securities) are traded in world financial markets, determining a fair price for these options has become an important and difficult computational problem. Many valuation codes use the binomial pricing model, in which the stock price is driven by a random walk. In this model, the value of an n-period option on a stock is the expected time-discounted value of the future cash flow on an n-period stock price path. Path-dependent options are particularly difficult to value since the future cash flow depends on the entire stock price path rather than on just the final stock price. Currently such options are approximately priced by Monte carlo methods with error bounds that hold only with high probability and which are reduced by increasing the number of simulation runs. In this paper the authors show that pricing an arbitrary path-dependent option is {number_sign}-P hard. They show that certain types f path-dependent options can be valued exactly in polynomial time. Asian options are path-dependent options that are particularly hard to price, and for these they design deterministic polynomial-time approximate algorithms. They show that the value of a perpetual American put option (which can be computed in constant time) is in many cases a good approximation to the value of an otherwise identical n-period American put option. In contrast to Monte Carlo methods, the algorithms have guaranteed error bounds that are polynormally small (and in some cases exponentially small) in the maturity n. For the error analysis they derive large-deviation results for random walks that may be of independent interest.

Chalasani, P.; Saias, I. [Los Alamos National Lab., NM (United States); Jha, S. [Carnegie Mellon Univ., Pittsburgh, PA (United States)

1996-04-08

408

The construction of an oxalate-degrading intestinal stem cell population in mice: a potential new treatment option for patients with calcium oxalate calculus.  

PubMed

About 80% of all urological stones are calcium oxalate, mainly caused by idiopathic hyperoxaluria (IH). The increased absorption of oxalate from the intestine is the major factor underlying IH. The continuous self-renewal of the intestinal epithelium is due to the vigorous proliferation and differentiation of intestinal stem cells. If the intestinal stem cell population can acquire the ability to metabolize calcium oxalate by means of oxc and frc transgenes, this will prove a promising new therapy option for IH. In our research, the oxalate-degrading genes of Oxalobacter formigenes (Oxf)-the frc gene and oxc gene-were cloned and transfected into a cultured mouse-derived intestinal SC population to give the latter an oxalate-degrading function. Oxf was isolated and cultivated and the oxalate-degrading genes-frc and oxc-were cloned. The dicistronic eukaryotic expression vector pIRES-oxc-frc was constructed and transferred into the mouse stem cell population. After selection with G418, the expression of the genes was identified. The oxalate-degrading function of transfected cells was determined by transfection into the intestinal stem cell population of the mouse. The change in oxalate concentration was determined with an ion chromatograph. The recombinant plasmid containing oxc and frc genes was transfected into the stem cell population of the mouse and the expression of the genes found normal. The cell population had acquired an oxalate-degrading function. The oxc and frc genes could be transfected into the intestinal stem cell population of the mouse and the cells acquired an oxalate-degrading function. PMID:21892601

Chen, Zhiqiang; Liu, Guanlin; Ye, Zhangqun; Kong, Debo; Yao, Lingfang; Guo, Hui; Yang, Weimin; Yu, Xiao

2012-04-01

409

Earth Sciences Geology Option  

E-print Network

courses, core Earth Sciences courses, and focused coursework in the option. A graduation checklistEarth Sciences with Geology Option Geological sciences focus on understanding the Earth, from its composition and internal structure to its history and the processes that shape its surface. Our planet

Kurapov, Alexander

410

The British Asian Option  

Microsoft Academic Search

Following the economic rationale of Peskir and Samee (2008a,b), we present a new class of Asian options where the holder enjoys the early exercise feature of American options whereupon his payoff (deliverable immediately) is the ‘best prediction’ of the European payoff under the hypothesis that the true drift of the stock price equals a contract drift. Inherent in this is

Kristoffer Glover; Goran Peskir; Farman Samee

2010-01-01

411

The British Asian Option  

Microsoft Academic Search

Following the economic rationale of [7] and [8] we present a new class of Asian options where the holder enjoys the early exercise feature of American options whereupon his payoff (deliverable immediately) is the ‘best prediction’ of the European payoff under the hypothesis that the true drift of the stock price equals a contract drift. Inherent in this is a

Kristoffer Glover; Goran Peskir; Farman Samee

2009-01-01

412

Guanylate cyclase inhibition by methylene blue as an option in the treatment of vasoplegia after a severe burn. A medical hypothesis  

PubMed Central

Summary Today it is known that severe burns can be accompanied by the phenomenon of vasoplegic syndrome (VS), which is manifested by persistent and diffuse vasodilation, hypotension and low vascular resistance, resulting in circulatory and respiratory failure. The decrease in systemic vascular resistance observed in VS is associated with excessive production of nitric oxide (NO). In the last 2 decades, studies have reported promising results from the administration of an NO competitor, methylene blue (MB), which is an inhibitor of the soluble guanylate cyclase (sGC), in the treatment of refractory cases of vasoplegia. This medical hypothesis rationale is focused on the tripod of burns/vasoplegia catecholamine resistant/methylene blue. This article has 3 main objectives: 1) to study the guanylate cyclase inhibition by MB in burns; 2) to suggest MB as a viable, safe and useful co-adjuvant therapeutic tool of fluid resuscitation, and; 3) to suggest MB as burns hypotensive vasoplegia amine-resistant treatment. PMID:22534716

Farina, Jayme A.; Celotto, Andrea Carla; da Silva, Marcelo Felix; Evora, Paulo Roberto B.

2012-01-01

413

Clinical implications for a treatment algorithm and differential indication to hormone therapy and chemotherapy options in metastatic castrate-resistant prostate cancer: a personal view.  

PubMed

Although docetaxel is still considered a mainstay of treatment in metastatic castrate-resistant prostate cancer (mCRPC), in the last few years, new agents have been developed to improve survival in this setting and reach a possible optimal personalized treatment strategy. In this paper, we provide a personal view and an algorithm for mCRPC patients, according to available evidence, personal opinion and experience. Abiratone acetate, cabazitaxel, radium-223, sipuleucel-T and enzalutamide, together with docetaxel, have demonstrated a survival benefit in these patients. The use of rechallenge with docetaxel in mCRPC patients with disease progression after a first response has been considered. These new agents complicated the scenario and posed the challenge to move from the old sequential to a new algorithm-based approach. At this stage, the algorithm is necessarily based on experts' opinion, since the efficacy of a single agent in a specific setting has not been validated by sequential trials. PMID:25353258

Bracarda, Sergio; Sisani, Michele; Marrocolo, Francesca; Hamzaj, Alketa; Del Buono, Sabrina; Altavilla, Amelia

2014-11-01

414

Anakinra for difficult-to-treat neutrophilic panniculitis: IL-1 blockade as a promising treatment option for neutrophil-mediated inflammatory skin disease.  

PubMed

The treatment of neutrophilic panniculitis can be challenging. We report a patient with a difficult-to-treat neutrophilic panniculitis who had a spectacular response to a short treatment course with the IL-1 antagonist anakinra. A 61-year-woman had a 12-year history of a serious febrile neutrophilic panniculitis and a personal history of steroid-induced pancreatitis and life-threatening methemoglobinemia under antimalarials and dapsone. When she developed a new flare, she was treated successfully with a 15-day course of subcutaneously administered injections of 100 mg anakinra. This observation is the first report attesting the efficiency of anakinra in neutrophilic panniculitis. It expands the potential indications of IL-1 inhibition in the field of the neutrophilic dermatoses, or more generally, in neutrophil-mediated systemic diseases. It underscores the potential