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
Kümmell's disease is the current eponym of avascular osteonecrosis (AVN) of a vertebral body leading to a delayed non-healing vertebral compression fracture (VCF) and thus pseudo-arthrosis. AVN is characterized by production of gas that outlines a radiolucent zone in the vertebral body, called vacuum cleft sign (VCS) or "Kümmell's sign". This sign has been observed in up to one-third of VCFs and is often associated with osteoporosis and never with malignant or inflammatory diseases. Generally, treatment strategies are conservative management and percutaneous vertebroplasty. Teriparatide (rhPTH [1-34]) is an osteoanabolic agent approved for treatment of osteoporosis and helpful in fracture's healing too. Here, we describe the case of an 81-year-old osteoporotic woman presented with a 1-year history of persistent low back pain onset after a trauma. A lumbar spine Computer Tomography (CT) scan performed 2 months after the injury (November 2006) showed the VCS within a VCF of the first lumbar vertebra; a control CT scan 1 year later showed persistence of the finding. After 12 months of treatment with teriparatide 20 mcg/day, symptoms disappeared and vacuum was significantly reduced. In conclusion, Kümmell's disease may be hypothesized in patients with chronic spinal symptoms, especially in the presence of osteoporosis. Moreover in this condition, osteoanabolic treatment may be used in patients with Kümmell's disease to enhance vertebral fracture's healing and contribute to back pain relief. PMID:20306047
Fabbriciani, Gianluigi; Pirro, Matteo; Floridi, Piero; Callarelli, Laura; Manfredelli, Maria Rosaria; Scarponi, Anna Maria; Mannarino, Elmo
There are many treatment modalities for temporomandibular disorders (TMD), most of which are effective in controlling symptoms, at least in the short term. The non-surgical treatment of temporomandibular disorders continues to be the most effective way of managing over 80 per cent of patients who present with symptoms of temporomandibular pain and dysfunction. In this, the second article in the series, a general overview of the current non-surgical treatment strategies for TMD will be presented. PMID:8615742
Dimitroulis, G; Gremillion, H A; Dolwick, M F; Walter, J H
... Congestion Syndrome - Chronic Pelvic Pain in Women Non-surgical Procedure Is Effective Treatment for Painful Ovarian Varicose ... stop may be helpful in controlling her symptoms. Surgical options include a hysterectomy with removal of ovaries, ...
A wide variety of non-surgical therapies can result in clinical responses in patients with hepatocellular carcinoma. Two recent studies have suggested that transarterial chemoembolisation can, in highly selected patients with good liver function, result in an improvement in survival. No other approaches have, to date, demonstrated convincing evidence of survival advantage.
Summary The modalities for the non-surgical treatment of gallstones include oral dissolution by bile salts, local dissolution by methyl-tert-butyl-ether\\u000a (MTBE), extracorporeal shockwave lithotripsy (ESWL) and percutaneous gallstone clearance. The results of oral bile salt therapy\\u000a for cholesterol stones have been disappointing, and the only indication for this treatment is after ESWL. The high efficacy\\u000a initially reported for MTBE has not been
A. Cuschieri; George Berci; Eddie Reddick; Jacques Perissat
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
The modalities for the non-surgical treatment of gallstones include oral dissolution by bile salts, local dissolution by methyl-tert-butyl-ether (MTBE), extracorporeal shockwave lithotripsy (ESWL) and percutaneous gallstone clearance. The results of oral bile salt therapy for cholesterol stones have been disappointing, and the only indication for this treatment is after ESWL. The high efficacy initially reported for MTBE has not been confirmed by subsequent experience in other centres: this therapy is toxic and best confined to specialized centres. ESWL, though effective in noncalcified stones, has limited overall applicability (approx. 15%) and is frequently followed by recurrence despite maintenance therapy with oral bile salts. Percutaneous gallstone clearance (radiologic or laparoscopic) has been superseded by laparoscopic cholecystectomy. This offers definitive treatment in a single session and has significant advantages over open cholecystectomy in terms of short hospital stay and accelerated recovery with early return to work or full activity. Destruction of the gallbladder by sclerosant agents (chemical cholecystectomy) requires further experimental evaluation before its introduction to clinical practice. PMID:2148441
Eagle's syndrome is a disease without a clear lesion that is associated with repeated episodes of pharyngalgia, odynophagia, the sensation of a foreign body in the pharynx, tinnitus, and otalgia in which patients displaying these types of symptoms must be given a differential diagnosis. It is known to be characterized by styloid process elongation or increasing compression to adjacent anatomical structures through stylohyoid ligament calcification. In serious cases, continuous pressure to the carotid artery can lead to a stroke. Diagnosis is confirmed through clinical symptoms, radiological findings, and physical examinations. The most common type of treatment consists of a surgical excision of elongated styloid process. Nonetheless, this study presents a case of treating Eagle's syndrome with conservative management.
Han, Min Kyu; Yang, Jong Yeun
Eagle's syndrome is a disease without a clear lesion that is associated with repeated episodes of pharyngalgia, odynophagia, the sensation of a foreign body in the pharynx, tinnitus, and otalgia in which patients displaying these types of symptoms must be given a differential diagnosis. It is known to be characterized by styloid process elongation or increasing compression to adjacent anatomical structures through stylohyoid ligament calcification. In serious cases, continuous pressure to the carotid artery can lead to a stroke. Diagnosis is confirmed through clinical symptoms, radiological findings, and physical examinations. The most common type of treatment consists of a surgical excision of elongated styloid process. Nonetheless, this study presents a case of treating Eagle's syndrome with conservative management. PMID:23614080
Han, Min Kyu; Kim, Do Wan; Yang, Jong Yeun
The purpose of this paper is to report the experience acquired in pneumatic dilatation in achalasia of the esophagus up to 1990. Two hundred and six patients were studied in that period (X 50, 7 years, M/F 1:1). According to X Rays the distribution was: grade I 17.4%, grade II 54.8%, grade III 14% and grade IV 13.5%. The associated esophageal pathology was: hiatus hernia 9.7%, esophagitis 5.8%, benign stenosis 2.4%, cancer 1.4%, ulcer and diverticula 0.9% and Schatzki's ring and leiomyoma 0.4% respectively Serology for Chagas disease was positive in 23% Chagasic megacolon was more frequent than chagasic heart disease (4.3% Vs. 1.4%). Out of these, one hundred and twenty patients were treated by pneumatic dilatation. To this group we shall refer in more detail. One hundred ant two patients were dilated once and the remaining 18 twice. Esophageal manometry showed a vigorous pattern in 7.7%. The LES' pressure pre-treatment was 24.5 mm Hg and post-dilatation 13.7 mm Hg in 75.8% of the cases the result was good. The morbidity was 5% and the mortality 0.7%. Relapse was seen in 25.8% of the cases. The follow-up was X 38 months. We conclude that pneumatic dilatation is the election procedure in the treatment of achalasia since it offers good results with low morbimortality. Surgery is indicated after failure of 2 dilatations, in children, and association with esophageal neoplasms, hiatus hernia and esophageal diverticula. PMID:1811399
Salis, G B; Chiocca, J C; Perissé, E; Acosta, E; Mazure, P A
Between 1990 and 2001, 292 patients with acute Achilles tendon rupture were admitted to our institution. Depending on the day of admission patients were allocated either to the Department of Trauma Surgery or to the Department of Orthopaedics. Two hundred and twelve patients (mean age 37+/-9.4 years) were treated with surgical suture followed by plaster for 6 weeks. Eighty patients were treated non-surgically with splinting for 12 weeks. For both groups mean follow-up was 6+/-3 years. There were 14 re-ruptures, ten after surgical repair and four after non-surgical treatment. In the surgical group there were seven major wound problems, 11 minor wound complications and six patients with complaints from the sural nerve. In the non-surgical group one patient suffered a pulmonary embolism after a re-rupture, 3 months after the initial rupture. There was no difference in mean ankle score and patient-satisfaction score between groups. Only 52% regained their original sports activity level, slightly better in the surgically treated group. With a non-significant difference in re-rupture rate but relatively more complications after surgical repair, non-surgical treatment is preferred. With a slightly better recovery of sports activity after surgical repair, this might be used as an argument for surgical treatment in young athletes. PMID:15241626
van der Linden-van der Zwaag, Henrica M J; Nelissen, Rob G H H; Sintenie, Jan B
Background: The purpose of the present study is to investigate the potential link between maternal periodontitis and pregnancy outcomes, including preterm birth (<37 weeks) and low birth weight (<2,500 g). Methods: Ninety nine pregnant females with mild/moderate periodontitis were randomly allocated to a control (n = 50) or test (n = 49) group. Test group participants received intrapregnancy non-surgical periodontal treatment, whereas this was deferred until after delivery for controls. Demographic and baseline clinical data were obtained for all participants at initial assessment pretreatment. Clinical data were rerecorded for test participants at review 8 weeks after treatment. Birth outcomes were completed at delivery by midwives who also collected cord blood samples when possible; the latter were analyzed to determine the presence/levels of cytokines interleukin (IL)-1?, IL-6, and IL-8. All data were analyzed on an intention-to-treat basis using appropriate statistical tests. Results: Random allocation of participants resulted in well-balanced control and test groups. All test group participants and all but one control participant gave birth to a live infant. No significant differences were detected between control and test groups with regard to birth outcome measures of birth weight and gestational age or in relation to cytokine prevalence/levels. Conclusion: Intrapregnancy non-surgical periodontal treatment, completed at 20 to 24 weeks, did not reduce the risk of preterm, low-birth-weight delivery in this population. PMID:23237583
Pirie, Martina; Linden, Gerard; Irwin, Christopher
Objective: To examine the application of a modified fixed reverse twin-block appliance (TBA) in adults with an Angle Class III malocclusion and anterior crossbite. Participants: Thirty-two adults with an Angle III malocclusion were recruited. An associated temporomandibular disorder (TMD) was found in 18 patients, laterognathism in 21, and both conditions in the remaining 12 patients. Methods: A modified fixed reverse TBA was used to posture the mandible back, divert bite force and centre the dentition. The malocclusion, laterognathism and temporomandibular disorders were concurrently treated. The outcome was evaluated radiographically and the findings were analyzed via Electronic Measurement Scale software. Results: Treatment was shown to be effective and could significantly shorten the course of treatment and avoid orthognathic surgery. The average course of treatment was 14 months, during which time, the mandible was postured back and the dentition was successfully aligned and levelled. Most patients achieved an edge-to-edge occlusion of the anterior teeth after 7-10 days of appliance wear. Most symptoms of TMD were relieved after 1 month and the laterognathism resolved in 4-5 months. Conclusion: A modified fixed reverse TBA was an effective non-surgical strategy for the treatment of selected Angle Class III malocclusions with an anterior crossbite in adults.
Liu, Hong; Li, Jian-Xue
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
Dens invaginatus is a rare developmental malformation of teeth showing a deep infolding of enamel and dentine which may extend deep into the root. To date, conventional root canal therapy, endodontic surgery and extraction have been reported as treatment modalities, when the pulpo-dentinal complex of such teeth is affected. In the present report, non-surgical endodontic treatment of three maxillary lateral incisors with invaginatus (DI) is discussed. The Tri Auto ZX rotary system was used for shaping the root canals of two affected teeth and the Profile system was used in the third. Teeth with periradicular lesions received calcium hydroxide as an interim therapy. Two teeth were obturated with gutta percha points and AH Plus sealer using cold lateral compaction. In the third case, obturation was accomplished using a coated carrier system (Thermafil) due to the specific shape of the root canal system. Twelve months postoperatively all teeth were asymptomatic with resolution of the periapical radiolucency on two affected teeth, as confirmed radiographically. Healing was achieved without any need for further surgical intervention. PMID:16515008
Cengiz, Sevi Burcak; Korasli, Deniz; Ziraman, Fatmagul; Orhan, Kaan
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).
Objective With growing antibiotics failure due to emerging resistance of bacteria, non-surgical management of pediatric UTI plays a\\u000a more important role because of its non-invasive characteristics and little adverse effects.\\u000a \\u000a \\u000a \\u000a \\u000a Methods We searched the Pubmed for management of UTI in children other than surgical correction and antibiotics using terms: risk\\u000a factor, prepuce\\/phimosis, steroid cream\\/steroid, behavioral therapy, urotherapy, biofeedback\\/pelvic floor exercise, adrenergic\\u000a antagonist,
Stephen Shei-Dei Yang; I-Ni Chiang; Chia-Da Lin; Shang-Jen Chang
Non-surgical vaginal dilation is a safe and effective method for the creation of neovagina in the patient with vaginal agenesis. Compared to surgical methods, non-surgical vaginal dilation has the advantage of low morbidity, the creation of a more physiologic vaginal milieu, and no surgical scarring. To overcome some technical limitations of original Frank's method, in 1981 Ingram proposed a modification of the technique that used dilators of gradually increasing size mounted on a bicycle seat stool. Although several studies have shown satisfactory outcomes using Ingram's method, there are some practical difficulties in making and handling the bicycle seat stool. This article reports a case of a 24-year-old woman with Mayer-Rokitansky-Küster-Hauser syndrome whose vaginal agenesis is successfully treated with a simplified version of Ingram's method. This method uses dilators of gradually increasing size mounted on an ordinary chair instead of a bicycle seat stool. When necessary, the patient may use a fulcrum under the dilator. PMID:17191323
Purpose The present study was performed to compare the treatment outcomes of non-surgical periodontal treatment according to the distribution of attachment loss of a given patient. Methods Forty-five patients with moderate to severe periodontitis were divided in two subgroups; Group I patients with teeth manifesting attachment loss of ?6 mm at one or more sites on the buccal/labial aspect while maintaining an attachment level ?5 mm at the lingual/palatal aspect, Group II patients with teeth manifesting an attachment level ?6 mm at more than one site on the lingual/palatal aspect while maintaining an attachment level ?5 mm at the buccal/labial aspect. The probing pocket depth, probing attachment level, tooth mobility, and chewing discomfort were recorded at baseline and 6 months examinations following non-surgical periodontal therapy. Results The buccal/labial surfaces of teeth with moderate to severe periodontitis in Group I patients demonstrated a greater amount of pocket reduction, gain of attachment level, and tooth mobility reduction than the lingual/palatal aspects of teeth examined in Group II patients. Conclusions Within the limits of the present study, the patients demonstrating attachment loss ?6 mm at buccal/labial surfaces responded better to the nonsurgical periodontal therapy than those demonstrating comparable attachment loss at lingual/palatal surfaces.
Lee, Ju-Min; Kim, Joo-Hee; Kwon, Eun-Young; Kim, Yi-Kyeong; Lee, Ju-Yeon; Kim, Sung-Jo
We investigated the long-term outcome of 100 patients 15 years after having been randomly allocated to primary repair (augmented or non-augmented) or non-surgical treatment of an anterior cruciate ligament (ACL) rupture. The subjective outcome was similar between the groups, with no difference regarding activity level and knee-injury and osteoarthritis outcome score but with a slightly lower Lysholm score for the non-surgically treated group. This difference was attributed to more instability symptoms. The radiological osteoarthritis (OA) frequency did not differ between surgically or non-surgically treated patients, but if a meniscectomy was performed, two-thirds of the patients showed OA changes regardless of initial treatment of the ACL. There were significantly more meniscus injuries in patients initially treated non-surgically. One-third of the patients in the non-surgically treated group underwent secondary ACL reconstruction due to instability problems. In this study, ACL repair itself could not reduce the risk of OA nor increase the subjective outcome scores. However, one-third of the non-surgical treated patients were later ACL reconstructed due to instability. The status of the menisci was found to be the most important predictor of developing OA. Early ACL repair and also ACL reconstruction can reduce the risk of secondary meniscus tears. Indirectly this supports the hypothesis that early stabilization of the knee after ACL injury is advantageous for the long-term outcome. PMID:17501866
Meunier, A; Odensten, M; Good, L
BACKGROUND: While it is widely held that non-surgical management should be the first line of approach in patients with lumbar spinal stenosis (LSS), little is known about the efficacy of non-surgical treatments for this condition. Data are needed to determine the most efficacious and safe non-surgical treatment options for patients with LSS. The purpose of this paper is to describe
Donald R Murphy; Eric L Hurwitz; Amy A Gregory; Ronald Clary
... Tips Medication Bowel Management Dealing with Anal Discomfort Biofeedback Surgical Treatments Newer Treatment Options Talking to Your ... changes Dietary changes Medication Bowel management/retraining program Biofeedback therapy Surgical treatments Newer procedures or devices Talking ...
Whole brain radiotherapy (WBRT) is the standard non-surgical treatment for brain metastatic disease, but rarely eradicates bulky metastases from most common cancers. Recent literature has demonstrated the safety and efficacy of delivering very high focal doses of radiation (by radiosurgical techniques) to the gross tumour volume of bulky brain metastases, thereby obtaining more certain local control than is achieved by WBRT. In this paper we report a study of 11 patients with bulky brain metastases in whom an intensity-modulated radiation therapy (IMRT) facility has been used to concomitantly boost the gross tumour volume of bulky brain metastatic disease (to 40 Gy) during a standard 30 Gy in 10 fractions WBRT schedule. No acute or subacute morbidity was encountered, and good early control data were noted. We discuss the perceived advantages of such a technique.
Edwards, A A; Keggin, E; Plowman, P N
Numerous randomized trials have been published investigating the effectiveness of treatments for non-specific low-back pain (LBP) either by trials comparing interventions with a no-treatment group or comparing different interventions. In trials comparing two interventions, often no differences are found and it raises questions about the basic benefit of each treatment. To estimate the effect sizes of treatments for non-specific LBP compared to no-treatment comparison groups, we searched for randomized controlled trials from systematic reviews of treatment of non-specific LBP in the latest issue of the Cochrane Library, issue 2, 2005 and available databases until December 2005. Extracted data were effect sizes estimated as Standardized Mean Differences (SMD) and Relative Risk (RR) or data enabling calculation of effect sizes. For acute LBP, the effect size of non-steroidal anti-inflammatory drugs (NSAIDs) and manipulation were only modest (ES: 0.51 and 0.40, respectively) and there was no effect of exercise (ES: 0.07). For chronic LBP, acupuncture, behavioral therapy, exercise therapy, and NSAIDs had the largest effect sizes (SMD: 0.61, 0.57, and 0.52, and RR: 0.61, respectively), all with only a modest effect. Transcutaneous electric nerve stimulation and manipulation had small effect sizes (SMD: 0.22 and 0.35, respectively). As a conclusion, the effect of treatments for LBP is only small to moderate. Therefore, there is a dire need for developing more effective interventions.
Hayden, J.; Bombardier, C.; van Tulder, M.
The malocclusions with hyperdivergent vertical growth patterns are more difficult to treat without a combined approach, including orthodontics and orthodontic surgery. The goal of this article is to describe a nonsurgical approach of a Class II malocclusion on an adult patient presenting a skeletal hyperdivergency. Fundamental criteria must be respected including proper diagnosis, proper treatment timing to maximize growth potential, patient cooperation, etc. These factors are critical in the favorable treatment outcome of any jaw discrepancy. PMID:19438108
Rodriguez Flores, Jose Ma
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
... Copyright 2010 American Academy of Orthopaedic Surgeons Cervical Radiculopathy: Surgical Treatment Options When symptoms of cervical radiculopathy persist or worsen despite nonsurgical treatments, surgical options ...
Several studies have suggested an increase of cardiovascular disease (CVD) risk on periodontitis patients. An enhancement has been demonstrated on both platelet activation and oxidative stress on periodontitis patients, which may contribute for this association. Therefore, the aim of this study was to evaluate the effects of non-surgical periodontal treatment on the l-arginine-nitric oxide (NO)-cyclic guanosine monophosphate (cGMP) pathway and oxidative status in platelets. A total of eight periodontitis patients and eight controls were included in this study. Clinical, laboratory and experimental evaluations were performed on baseline and 90 days after periodontal treatment (except for western blot analysis). The clinical periodontal evaluation included measurements of probing pocket depth (PPD), clinical attachment loss (CAL), % of sites with plaque and % of sites with bleeding on probing. We evaluated: l-[(3)H]arginine influx; nitric oxide synthase (NOS) and arginase enzymes activity and expression; expression of guanylate cyclase and phosphodiesterase-5 enzymes; cGMP levels; platelet aggregation; oxidative status through superoxide dismutase (SOD) and catalase activities, and measurement of reactive oxygen species (ROS) levels and C-reactive protein (CRP) levels. The initial results showed an activation of both l-arginine influx and via system y?(+?)L associated with reduced intraplatelet cGMP levels in periodontitis patients and increased systemic levels of CRP. After periodontal treatment, there was a significant reduction of the % of sites with PPD 4-5mm, % of sites with CAL 4-5?mm, and an enhancement in cGMP levels and SOD activity. Moreover, CRP levels were reduced after treatment. Therefore, alterations in the intraplatelet l-arginine-NO-cGMP pathway and oxidant-antioxidant balance associated with a systemic inflammatory response may lead to platelet dysfunction, which may contribute to a higher risk of CVD in periodontitis. PMID:23918883
Siqueira, Mariana Alves de Sá; Fischer, Ricardo Guimarães; Pereira, Natália Rodrigues; Martins, Marcela Anjos; Moss, Monique Bandeira; Mendes-Ribeiro, Antônio Cláudio; Figueredo, Carlos Marcelo da Silva; Brunini, Tatiana Marlowe Cunha
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...
Hemorrhoids and varicose veins are common conditions seen by general practitioners. Both conditions have several treatment modalities for the physician to choose from. Varicose veins are treated with mechanical compression stockings. There are several over-the-counter topical agents available for hemorrhoids. Conservative therapies for both conditions include diet, lifestyle changes, and hydrotherapy which require a high degree of patient compliance to be effective. When conservative hemorrhoid therapy is ineffective, many physicians may choose other non-surgical modalities: injection sclerotherapy, cryotherapy, manual dilation of the anus, infrared photocoagulation, bipolar diathermy, direct current electrocoagulation, or rubber band ligation. Injection sclerotherapy is the non-surgical treatment for primary varicose veins. Non-surgical modalities require physicians to be specially trained, own specialized equipment, and assume associated risks. If a non-surgical approach fails, the patient is often referred to a surgeon. The costly and uncomfortable nature of treatment options often lead a patient to postpone evaluation until aggressive intervention is necessary. Oral dietary supplementation is an attractive addition to the traditional treatment of hemorrhoids and varicose veins. The loss of vascular integrity is associated with the pathogenesis of both hemorrhoids and varicose veins. Several botanical extracts have been shown to improve microcirculation, capillary flow, and vascular tone, and to strengthen the connective tissue of the perivascular amorphous substrate. Oral supplementation with Aesculus hippocastanum, Ruscus aculeatus, Centella asiatica, Hamamelis virginiana, and bioflavonoids may prevent time-consuming, painful, and expensive complications of varicose veins and hemorrhoids. PMID:11302778
Recent preclinical and clinical data have suggested the potential benefit of photodynamic therapy (PDT) in the treatment of periodontitis. However, currently, there are very limited data from controlled clinical trials evaluating the effect of PDT in the treatment of periodontitis. The aim of the present study was to evaluate the clinical and microbiological effects of the adjunctive use of PDT in non-surgical periodontal treatment in patients receiving supportive periodontal therapy. Twenty-four patients receiving regularly supportive periodontal therapy were randomly treated with either subgingival scaling and root planing followed by a single episode of PDT (test) or subgingival scaling and root planing alone (control). The following parameters were evaluated at baseline and at 3 months and 6 months after therapy: full mouth plaque score (FMPS), full mouth bleeding score (FMBS), bleeding on probing (BOP) at experimental sites, probing pocket depth (PPD), gingival recession (REC), and clinical attachment level (CAL). Primary outcome variables were changes in PPD and CAL. Microbiological evaluation of Aggregatibacter actinomycetemcomitans (A.a.), Porphyromonas gingivalis (P.g.), Prevotella intermedia (P.i.), Tannerella forsythensis (T.f.), Treponema denticola (T.d.), Peptostreptococcus micros (P.m.), Fusobacterium nucleatum (F.n.), Campylobacter rectus (C.r.), Eubacterium nodatum (E.n.), Eikenella corrodens (E.c.), and Capnocytophaga species (C.s.) was also performed at baseline and at 3 months and 6 months after therapy, using a commercially available polymerase chain reaction test. No differences in any of the investigated parameters were observed at baseline between the two groups. At 3 months and 6 months after treatment, there were no statistically significant differences between the groups in terms of PPD, CAL and FMPS. At 3 months and 6 months, a statistically significantly higher improvement of BOP was found in the test group. At 3 months after therapy, the microbiological analysis showed a statistically significant reduction of F.n. and E.n. in the test group. At 6 months, statistically significantly higher numbers of E.c. and C.s. were detected in the test group. The additional application of a single episode of PDT to scaling and root planing failed to result in an additional improvement in terms of PPD reduction and CAL gain, but it resulted in significantly higher reduction of bleeding scores than following scaling and root planing alone. PMID:18465191
Chondros, Panos; Nikolidakis, Dimitris; Christodoulides, Nicos; Rössler, Ralf; Gutknecht, Norbert; Sculean, Anton
Hyperhidrosis is a disorder of excessive sweating beyond what is expected for thermoregulatory needs and environmental conditions. Primary hyperhidrosis has an estimated prevalence of nearly 3% and is associated with significant medical and psychosocial consequences. Most cases of hyperhidrosis involve areas of high eccrine density, particularly the axillae, palms, and soles, and less often the craniofacial area. Multiple therapies are available for the treatment of hyperhidrosis. Options include topical medications (most commonly aluminum chloride), iontophoresis, botulinum toxin injections, systemic medications (including glycopyrrolate and clonidine), and surgery (most commonly endoscopic thoracic sympathectomy [ETS]). The purpose of this article is to comprehensively review the literature on the subject, with a focus on new and emerging treatment options. Updated therapeutic algorithms are proposed for each commonly affected anatomic site, with practical procedural guidelines. For axillary and palmoplantar hyperhidrosis, topical treatment is recommended as first-line treatment. For axillary hyperhidrosis, botulinum toxin injections are recommended as second-line treatment, oral medications as third-line treatment, local surgery as fourth-line treatment, and ETS as fifth-line treatment. For palmar and plantar hyperhidrosis, we consider a trial of oral medications (glycopyrrolate 1-2 mg once or twice daily preferred to clonidine 0.1 mg twice daily) as second-line therapy due to the low cost, convenience, and emerging literature supporting their excellent safety and reasonable efficacy. Iontophoresis is considered third-line therapy for palmoplantar hyperhidrosis; efficacy is high although so are the initial levels of cost and inconvenience. Botulinum toxin injections are considered fourth-line treatment for palmoplantar hyperhidrosis; efficacy is high though the treatment remains expensive, must be repeated every 3-6 months, and is associated with pain and/or anesthesia-related complications. ETS is a fifth-line option for palmar hyperhidrosis but is not recommended for plantar hyperhidrosis due to anatomic risks. For craniofacial hyperhidrosis, oral medications (either glycopyrrolate or clonidine) are considered first-line therapy. Topical medications or botulinum toxin injections may be useful in some cases and ETS is an option for severe craniofacial hyperhidrosis. PMID:21714579
Walling, Hobart W; Swick, Brian L
PURPOSE: Fecal incontinence is a socially devastating disorder which affects at least 2.2 percent of community dwelling adults and 45 percent of nursing home residents. Most incontinent patients can be helped, but physicians are poorly informed about treatment options. The aim of this study was to develop a consensus on treatment options by convening a conference of surgeons, gastroenterologists, nurses,
William E. Whitehead; Arnold Wald; Nancy J. Norton
The frequency of sleep disruption and the degree to which insomnia significantly affects daytime function determine the need for evaluation and treatment. Physicians may initiate treatment of insomnia at an initial visit; for patients with a clear acute stressor such as grief, no further evaluation may be indicated. However, if insomnia is severe or long-lasting, a thorough evaluation to uncover
KALYANAKRISHNAN RAMAKRISHNAN; DEWEY C. SCHEID
... with OAB who reduce their daily fluid and water-containing food intake by 25% have improved episodes of urgency, frequency, and nocturia. Treatment Options: Behavioral Treatment: dietary changes , fluid management , pelvic muslce exercises , biofeedback , bladder retraining Over the ...
... early CBT and Exposure-based treatments as an early intervention. Interventions such as these may decrease the likelihood of persons developing PTSD after traumatic exposures; however, additional research is needed to demonstrate this. Conversely, Critical Incident ...
Following the seminal trial conducted by the European Organisation for Research and Treatment of Cancer (EORTC) and the National Cancer Institute of Canada (NCIC), concurrent temozolomide and radiotherapy has become the new standard of care for patients with newly diagnosed glioblastoma multiforme (GBM). Investigation of emerging therapies (which are now used as salvage therapy) such as small-molecule inhibitors (for example, epidermal growth factor receptor inhibitors) and convection-enhanced delivery (CED) of targeted toxins (for example, interleukin-13/pseudomonas exotoxin) is likely to build on the EORTC/NCIC treatment platform and will, it is hoped, improve survival rates in patients with GBM. The majority of adjuvant Phase I and II trials being conducted by the brain tumor consortia are based on the EORTC/NCIC treatment platform and have added a targeted therapy in an effort to find a promising synergistic treatment. Furthermore, researchers in the consortia are continuing to explore treatments for recurrent GBM, not otherwise eligible for local therapies, such as CED. The treatments under study include novel cytotoxic chemotherapy as well as small-molecule inhibitors; these are being assessed in a variety of Phase I or II trials. PMID:16709025
Chamberlain, Marc C
... that cannot be completely removed with surgery. The side effects of chemotherapy depend on the individual, the type of drug, ... hair loss, loss of appetite, and diarrhea. These side effects usually go away once ... chemotherapy and preparing for treatment . The medications used to ...
Following the seminal trial conducted by the European Organisation for Research and Treatment of Cancer (EORTC) and the National Cancer Institute of Canada (NCIC), concurrent temozolomide and radiotherapy has become the new standard of care for patients with newly diagnosed glioblastoma multiforme (GBM). Investigation of emerging thera- pies (which are now used as salvage therapy) such as small-molecule inhibitors (for
Marc C. Chamberlain
At least half of women migraineurs experience menstrual migraine (MM), suggesting a hormonal explanation for the incidence\\u000a of these headaches. Basic science efforts suggest a relationship between estrogen and the neurotransmitters and neuronal structures\\u000a critical in the pathophysiology of migraine. The notion that MM is more severe, longer in duration, and more resistant to\\u000a treatment than headaches occurring at other
Katherine A. Henry; Carl I. Cohen
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
Opinions differ widely on the various treatment protocols for sustained increase in intracranial pressure (ICP). This review fo- cuses on the physiological volume regulation of the intracranial compartments. Based on these mechanisms we describe a proto- col called 'volume-targeted' ('Lund concept') for treatment of increased ICP. The driving force for transcapillary fluid exchange is deter- mined by the balance between
P.-O. GRÄNDE; B. A SGEIRSSON; C.-H. NORDSTRÖM
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
The aim was to assess whether or not photodynamic therapy (PDT) with adjunctive scaling-and-root-planing (SRP) is effective in the treatment of periodontitis under immunocompromised conditions. PubMed/Medline and Google-Scholar databases were searched from 1967 to May 2013 using various key words. Six studies (five experimental and one clinical) were included. In the clinical study, SRP with PDT was reported to be ineffective in treating chronic periodontitis in T2DM patients. All experimental studies reported significantly less bone loss in periodontal defects treated with SRP+PDT than those treated with SRP alone. Efficacy of PDT+SRP in the treatment of periodontal disease under immunocompromised conditions remains unclear. PMID:24112260
Javed, Fawad; Qadri, Talat; Ahmed, Hameeda Bashir; Al-Hezaimi, Khalid; Corbet, Francis Esmonde; Romanos, Georgios E
Endogenous Cushing’s syndrome is a grave disease that requires a multidisciplinary and individualized treatment approach for each patient. Approximately 80% of all patients harbour a corticotroph pituitary adenoma (Cushing’s disease) with excessive secretion of adrenocorticotropin-hormone (ACTH) and, consecutively, cortisol. The goals of treatment include normalization of hormone excess, long-term disease control and the reversal of comorbidities caused by the underlying pathology. The treatment of choice is neurosurgical tumour removal of the pituitary adenoma. Second-line treatments include medical therapy, bilateral adrenalectomy and radiation therapy. Drug treatment modalities target at the hypothalamic/pituitary level, the adrenal gland and at the glucocorticoid receptor level and are commonly used in patients in whom surgery has failed. Bilateral adrenalectomy is the second-line treatment for persistent hypercortisolism that offers immediate control of hypercortisolism. However, this treatment option requires a careful individualized evaluation, since it has the disadvantage of permanent hypoadrenalism which requires lifelong glucocorticoid and mineralocorticoid replacement therapy and bears the risk of developing Nelson’s syndrome. Although there are some very promising medical therapy options it clearly remains a second-line treatment option. However, there are numerous circumstances where medical management of CD is indicated. Medical therapy is frequently used in cases with severe hypercortisolism before surgery in order to control the metabolic effects and help reduce the anestesiological risk. Additionally, it can help to bridge the time gap until radiotherapy takes effect. The aim of this review is to analyze and present current treatment options in Cushing’s disease.
Rizk, Ahmed; Honegger, Juergen; Milian, Monika; Psaras, Tsambika
Optional statement The initial treatment of patients with acute pulmonary embolism has traditionally involved unfractionated heparin. Given the\\u000a more predictable pharmacodynamic and pharmacokinetic properties of low molecular weight heparins, their simpler (fixed) dosing\\u000a regimens, and few or no laboratory monitoring requirements, low molecular weight heparins are gradually replacing heparin\\u000a for the initial treatment of most patients diagnosed with acute pulmonary embolism,
Marc Meysman; Patrick Haentjens
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
Gastroparesis is a disorder of gastric emptying that occurs in the absence of mechanical obstruction. Its cardinal features include nausea, vomiting, bloating, early satiety and discomfort. Weight loss, dehydration, electrolyte disturbances and malnutrition may develop in severe cases. The majority of cases is idiopathic, long standing diabetes mellitus is responsible for about 25-30% of cases. Diabetic gastroparesis may render glucose control extremely difficult, its treatment represents a major challenge. Besides frequent, small meals and psychological support, several drug options are available, however, their efficacy is limited and only a few randomized studies have been performed to date. Prokinetic agents (erythromycin, domperidone, metoclopramide) and antiemetics (phenothiazines, serotonin antagonists, butyrophenones) are the most wide-spread medicaments. Among the novel, recently developed agents, 5-HT4 serotonin receptor agonists and dopamine D2 receptor antagonists are the most promising. Injection of botulinum toxin into the pyloric sphincter resulted in faster gastric emptying and symptom alleviation in some studies. Gastric electric stimulation appears to be one of the most effective options, both low and high-frequency stimulation may alleviate symptoms. Gastrostomy/jejunostomy and other surgical interventions are considered as "last resort". PMID:18292033
Igaz, Péter; Tulassay, Zsolt
Fractures of the coronoid process are uncommon and can easily be missed. The purpose of this study was to classify the fracture patterns and explore the treatment options. This retrospective study included 39 patients with fractures of the mandibular coronoid process. Treatment protocols were developed based on the time of fracture, degree of mouth opening, location of the coronoid fracture, types of fracture, and other concomitant fractures. All patients were followed up for 12-60 months. Sixteen patients underwent conservative management and four of these patients developed progressive trismus, which improved significantly after removal of the coronoid process. Twenty-three patients underwent open reduction and internal fixation (ORIF) via the modified retromandibular approach. Follow-up data showed significant improvement in maximum mouth opening and symptoms (diet and pain) compared to their preoperative status. In summary, conservative management is first recommended for fractures of the coronoid process with minimal displacement or restriction of mouth opening. For patients with significant fracture displacement and limited mouth opening, or with concomitant fractures of the zygoma, zygomatic arch, or mandibular ramus, ORIF via the modified retromandibular approach through the anterior border of the parotid gland is an alternative treatment method. PMID:23602277
Shen, L; Li, J; Li, P; Long, J; Tian, W; Tang, W
Dens invaginatus is a morphological abnormality of the tooth in which the coronal tooth enamel and dentin fold inwards towards the pulp cavity. Dens invaginatus type III (Oehlers: 1957) is characterized by infolding of the enamel and dentin as far as the root apex. This report describes a case of surgical and non-surgical endodontic therapy for a maxillary lateral incisor with type III dens invaginatus, necrotic pulp, and an associated large periradicular lesion. The patient was a 16-year-old man. Periapical radiographs suggested the presence of an untreated area of invagination. Cone beam computed tomography (CBCT) was then used for three-dimensional observation of the morphological details of this area. The CBCT scans revealed invagination and its relationship with the pulp chamber. A dental operating microscope was used to access two primary root canals and the area of invagination. The root canals were then localized, negotiated, enlarged, and filled with calcium hydroxide. Two months later, the canal and invagination were obturated with core-based gutta-percha (FlexPoint Neo: FP core-carrier technique) and restored. Cone beam computed tomography and microscopic techniques allow even complicated cases of dens invaginatus to be diagnosed and treated using non-surgical root canal management. PMID:23903581
During the past 25 years, the incidence of ectopic pregnancy has progressively increased while the morbidity and mortality have substantialy decreased, and the treatment has progressed from salpingectomy by laparotomy to conservative surgery by laparoscopy and more recently to medical therapy with Methotrexate or expectant management. This therapeutic transition from surgical emergency to non surgical managment has been attributed to early diagnosis through the use of sensitive assays for hCG and the high definition of vaginal ultrasound. By using these sensitive diagnostic tools, we are now able to select those patients who are most likely to respond to expectant or medical managment versus those who are at high risk of rupture and require surgery. We have reviewed the scientific literature on ectopic pregnancy published over the past 20 years, with the aim to assess the value of non surgical managment of etopic pregnancy. Predictor factors of expectant managment are discussed. Medical therapy with methotrexate: results, indications, Unpleasant side effects and complications are detailed. Several protocols are defined and therapeutic supervision is etablished. The authors offred several recommandations for OB/GY wich will optimize the effectivness of non invasive methods for treatment of ectopic pregnancy. PMID:17042204
The objective of this effort was to identify treatment options for 20,000 gallons of low-level radioactively contaminated zinc bromide solution currently stored in C-Area. These options will be relevant when the solutions are declared waste.
Study Design. Prospective randomized controlled trial.Objective. To study the outcome of anterior cervical decompression and fusion (ACDF) combined with a structured physiotherapy program compared to the same physiotherapy program alone for patients with cervical radiculopathy.Summary of Background Data. Knowledge concerning the effects of interventions for patients with cervical radiculopathy is scarce due to a lack of randomized studies.Methods. 63 patients were randomized to surgery with postoperative physiotherapy (n = 31) or physiotherapy alone (n = 32). The surgical group was treated with ACDF. The physiotherapy program included general/specific exercises and pain coping strategies. The outcome measures were disability (Neck Disability Index, NDI), neck- and arm-pain intensity (VAS) and the patient's global assessment. Patients were followed for 24 months.Results. The result from the repeated-measures ANOVA showed no significant between group difference for NDI (p = 0.23).For neck-pain intensity, the repeated-measures ANOVA showed a significant between group difference over the study period in favor of the surgical group (p = 0.039).For arm-pain intensity, no significant between group differences was found according to the repeated-measures ANOVA (p = 0.580).87% of the patients in the surgical group rated their symptoms as "better/much better" at the 12-month follow-up, compared to 62% in the non-surgical group (p<0.05). At 24 months the corresponding figures were 81% and 69% (p = 0.28). The difference was significant only at the 12-month follow-up in favor of the surgical group.Significant reduction in NDI, neck-pain and arm-pain compared to baseline was seen in both groups (p<0.001).Conclusion. In this prospective, randomized study of patients with cervical radiculopathy, it was shown that surgery with physiotherapy resulted in a more rapid improvement during the first postoperative year, with significantly greater improvement in neck pain and the patient's global assessment compared to physiotherapy alone, but the differences between the groups decreased after two years. Structured physiotherapy should be tried before surgery is chosen. PMID:24042715
Engquist, Markus; Löfgren, Håkan; Oberg, Birgitta; Holtz, Anders; Peolsson, Anneli; Söderlund, Anne; Vavruch, Ludek; Lind, Bengt
Pharmacological management of obsessive-compulsive disorder (OCD) is achieved using drugs that inhibit the synaptic uptake of serotonin, such as clomipramine, a tricyclic antidepressant, and the selective serotonin reuptake inhibitors (SSRIs). Recent studies suggest that the improved tolerability profile of the SSRIs relative to clomipramine may offer a more suitable treatment choice. Escitalopram, the therapeutically active S- enantiomer of citalopram, is
Naomi A. Fineberg
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
Chronic constipation is a common functional gastrointestinal disorder that affects patients of all ages. In 2007, a consensus group of 10 Canadian gastroenterologists developed a set of recommendations pertaining to the management of chronic constipation and constipation-dominant irritable bowel syndrome. Since then, tegaserod has been withdrawn from the Canadian market. A new, highly selective serotonin receptor subtype 4 agonist, prucalopride, has been examined in several large, randomized, placebo-controlled trials demonstrating its efficacy and safety in the management of patients with chronic constipation. Additional studies evaluating the use of stimulant laxatives, polyethylene glycol and probiotics in the management of chronic constipation have also been published. The present review summarizes the previous recommendations and new evidence supporting different treatment modalities – namely, diet and lifestyle, bulking agents, stool softeners, osmotic and stimulant laxatives, prucalopride and probiotics in the management of chronic constipation. A brief summary of lubiprostone and linaclotide is also presented. The quality of evidence is presented by adopting the Grading of Recommendations, Assessment, Development and Evaluation system. Finally, a management pyramid for patients with chronic constipation is proposed based on the quality of evidence, impact of each modality on constipation and on general health, and their availabilities in Canada.
Liu, Louis Wing Cheong
Constipation is a common functional gastrointestinal disorder that affects patients of all ages. In 2007, a consensus group of 10 Canadian gastroenterologists developed a set of recommendations pertaining to the management of chronic constipation and constipation dominant irritable bowel syndrome. Since then, tegaserod has been withdrawn from the Canadian market. A new, highly selective serotonin receptor subtype 4 agonist, prucalopride, has been examined in several large, randomized, placebo-controlled trials demonstrating its efficacy and safety in the management of patients with chronic constipation. Additional studies evaluating the use of stimulant laxatives, polyethylene glycol and probiotics in the management of chronic constipation have also been published. The present review summarizes the previous recommendations and new evidence supporting different treatment modalities - namely, diet and lifestyle, bulking agents, stool softeners, osmotic and stimulant laxatives, prucalopride and probiotics in the management of chronic constipation. A brief summary of lubiprostone and linaclotide is also presented. The quality of evidence is presented by adopting the Grading of Recommendations, Assessment, Development and Evaluation system. Finally, a management pyramid for patients with chronic constipation is proposed based on the quality of evidence, impact of each modality on constipation and on general health, and their availabilities in Canada. PMID:22114754
Liu, Louis Wing Cheong
Craniopharyngioma are the most common non-glial tumors in childhood. The results of different studies indicate that radical excision surgery is not an appropriate treatment strategy for childhood craniopharyngioma with hypothalamic involvement. Stereotactic neurosurgery provides save, minimal invasive and cost-efficient options in the treatment of childhood craniopharyngioma. In this review a summary of the contribution of the stereotactic neurosurgery in the interdisciplinary treatment regime of childhood craniopharyngioma will be given and discussed in detail.
Trippel, Michael; Nikkhah, Guido
A case of solitary bone metastasis from breast cancer, where MRI assessment of treatment response was inaccurate and whole-body fluorodeoxyglucose (18FDG) positron emission tomography with computed tomography (PET-CT) proved more reliable and objective, is presented.
Correa, Peter Denzil; Shrimali, Raj Kumar; Han, Sai; Rizwanullah, Mohammed
Objective The aim of this study was to evaluate the clinical effects of the adjunctive use of povidone–iodine with or without hydrogen peroxide as coolant and disinfectant during ultrasonic scaling and root planing in the treatment of chronic periodontitis. Materials and methods Sixteen patients initially participated in the study. Thirteen patients (8 males and 5 females) completed the 3-month follow-up period. Their mean (±SD) age was 42.92 ± 7.55 years. In each experimental subject, the mouth was split into four quadrants. A randomly selected quadrant was chosen to receive one of the three treatment group modalities which were: Group 1 – ultrasonic scaling and root planing plus irrigation with 1% povidone–iodine and 3.0% hydrogen peroxide mixture; Group 2 – ultrasonic scaling and root planing plus irrigation with 1% povidone–iodine; Group 3 – ultrasonic scaling and root planing plus irrigation with normal saline. The fourth quadrant served as a control group. Results At the 3-month evaluation, there was no significant difference between the three treatment groups in terms of probing depth reduction, clinical attachment gain, gingival recession increase, reduction in the bleeding upon probing or plaque score reduction (P > 0.05). However, the three treatment groups had statistically significant higher mean reduction in the probing depth, gain in the clinical attachment level and reduction in the bleeding upon probing than the control group (P < 0.05). Conclusion There were no added benefits of using a mixture of povidone–iodine and hydrogen peroxide or povidone–iodine as disinfectants during ultrasonic scaling and root planing in the treatment of chronic periodontitis.
Al-Saeed, Mohammed Y.; Babay, Nadir
The anorexia–cachexia syndrome (ACS) occurs in many chronic illnesses, such as cancer, AIDS, and chronic obstructive pulmonary\\u000a disease in addition to chronic congestive heart failure (CHF). Comparable to other chronic states, the ACS complicates CHF\\u000a and impacts its prognosis; however, the available treatment options for this syndrome remain unsatisfactory. This review article\\u000a focuses on the complex pathophysiology of cardiac anorexia.
Marat Fudim; Gabriel Wagman; Rebecca Altschul; Evin Yucel; Michelle Bloom; Timothy J. Vittorio
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.
Maehana, Takeshi; Tanaka, Toshiaki; Itoh, Naoki; Masumori, Naoya; Tsukamoto, Taiji
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.
Venugopal, Anilrudh A.; Johnson, Stuart
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
Bovine embryos obtained from donors six to nine days after oestrus were transferred non-surgically at a rate of one per recipient using a sterile insemination instrument, protected from contamination by the vagina with a plastic sheath. The percentage of recipients pregnant increased with the age of embryo transferred and for day 6 and 7 embryos was 33% compared to 58%
AO Trounson; LE Rowson; SM Willadsen
A rational approach to the treatment of chronic myocardial ischemia requires an appreciation of the pathophysiology of coronary artery disease and the treatment options available. Any factor that causes an imbalance between myocardial oxygen supply and demand can provoke ischemia. Myocardial oxygen requirements rise with increases in heart rate, contractility, or left ventricular wall stress. Myocardial oxygen supply is determined
Peter F. Cohn
Cervical nerve root compression, in contrast to nerve root irritation, results in an objective neurologic deficit of the affected nerve root. The purpose of this article is to highlight current diagnostic and treatment options that have proven efficient and safe in managing cervical root compression. The natural history of cervical disc disease and the clinical patterns and causes of cervical radiculopathy are reviewed. Electromyography and reformatted mutiplanar CT scans in addition to MRI are valuable diagnostic modalities. Although anterior cervical discectomy and interbody fusion remains the gold standard of treatment, microendoscopic foraminotomies and discectomies done from posterior and anterior approaches are effective and safe. The role of disc arthroplasty in the treatment of radiculopathy is evolving. PMID:19327260
Nasca, Richard J
Periodontitis is a complex disease that has both oral and systemic consequences. The treatment of periodontitis may be both surgical and non-surgical but, in recent years, there has been a shift towards managing disease non-surgically in preference to surgery. Fundamental to all types of therapy is the patient's role in disease control, in the form of self-performed plaque control, and it is important that the patient understands this. Non-surgical periodontal therapy has a long history and has traditionally been carried out using a variety of hand and powered instruments, the objective being root surface disinfection by the removal of plaque, calculus and contaminated root cementum. However, over the last 30 years or so, it has become apparent that calculus does not cause disease, cementum does not become significantly infected and bacteria and their toxins are only loosely adherent to the diseased root surface. This has led to the development of less invasive instrumentation principles which may be better for patients, more cost-effective and more easily applied in different clinical settings. Clinical Relevance: This paper aims to describe and justify a minimally-invasive approach to the management of the diseased root surface in periodontitis, to clarify the terminology used and to suggest how these principles may be applied in general practice. PMID:23829010
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
INTRODUCTION Bezoar in the esophagus is a rare condition and associated with structural or functional abnormalities of the esophagus. Endoscopy is the main tool for diagnosis and treatment for bezoar in the esophagus. PRESENTATION OF CASE Here we present a case where an endoscopic evacuation of an esophageal bezoar was unsuccessful. We treated the bezoar through a nasogastric tube using a cocktail composed of pancreatic enzymes dissolved in Coca-Cola. DISCUSSION Endoscopy is regarded as the mainstay for the diagnosis and treatment of esophageal bezoars. However, when this approach fails, other treatment options include dissolution therapy, and surgical exploration and removal of the bezoar. Surgical removal of an esophageal bezoar is associated with a high risk of morbidity and mortality. We advocate that dissolving therapy should be the first choice of treatment when endoscopic evacuation is not possible. CONCLUSION This is the first report describing a successful treatment of an esophageal bezoar with a cocktail of Coca-Cola and pancreatic enzymes. It is an effective, inexpensive, and worldwide available treatment and should be considered when endoscopic evacuation fails.
Yaqub, Sheraz; Shafique, Muhammad; Kjaestad, Erik; Thorsen, Yngve; Lie, Erik S.; Dahl, Vegard; Bakka, Njal; R?kke, Ola
Protocol for the ProFHER (PROximal Fracture of the Humerus: Evaluation by Randomisation) trial: a pragmatic multi-centre randomised controlled trial of surgical versus non-surgical treatment for proximal fracture of the humerus in adults
BACKGROUND: Proximal humeral fractures, which occur mainly in older adults, account for approximately 4 to 5% of all fractures. Approximately 40% of these fractures are displaced fractures involving the surgical neck. Management of this group of fractures is often challenging and the outcome is frequently unsatisfactory. In particular it is not clear whether surgery gives better outcomes than non-surgical management.
Helen Handoll; Stephen Brealey; Amar Rangan; David Torgerson; Laura Dennis; Alison Armstrong; Ling-Hsiang Chuang; Ben Cross; Jo Dumville; Sarah Gardner; Lorna Goodchild; Sharon Hamilton; Catherine Hewitt; Rajan Madhok; Nicola Maffulli; Lucy Micklewright; Valerie Wadsworth; Angus Wallace; John Williams; Gill Worthy
Patellar tendinopathy is a painful knee injury due to overuse common among jumping athletes. Because rest from sport is neither a feasible nor an effective treatment for patellar tendinopathy in elite athletes, active treatment options are needed. Treatment may be conservative, injection-based, or surgical. This review synthesizes findings from 32 studies of varying quality published between 2001 and 2011. Painful eccentric squats using a 25°-decline board is supported as a first-line treatment. Extracorporeal shock wave therapy is no more effective than placebo. Sclerosing injections seem to be effective, but the evidence is not definitive. Shaving of abnormal tissue via arthroscopic surgery with real-time ultrasound guidance is superior to sclerosing injections. Steroid injections are inferior to exercise interventions and are not recommended. Injections of autologous blood, platelet-rich plasma, and hyperosmolar dextrose are unproven and experimental. Clinicians need to have a comprehensive knowledge of the evidence in the literature, as well as training and experience, when treating patellar tendinopathy. PMID:23531972
Gaida, James E; Cook, Jill
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...
Treatment-resistant depression (TRD) presents major challenges for both patients and clinicians. There is no universally accepted definition of TRD, but results from the US National Institute of Mental Health's (NIMH) STAR*D (Sequenced Treatment Alternatives to Relieve Depression) programme indicate that after the failure of two treatment trials, the chances of remission decrease significantly. Several pharmacological and nonpharmacological treatments for TRD may be considered when optimized (adequate dose and duration) therapy has not produced a successful outcome and a patient is classified as resistant to treatment. Nonpharmacological strategies include psychotherapy (often in conjunction with pharmacotherapy), electroconvulsive therapy and vagus nerve stimulation. The US FDA recently approved vagus nerve stimulation as adjunctive therapy (after four prior treatment failures); however, its benefits are seen only after prolonged (up to 1 year) use. Other nonpharmacological options, such as repetitive transcranial stimulation, deep brain stimulation or psychosurgery, remain experimental and are not widely available. Pharmacological treatments of TRD can be grouped in two main categories: 'switching' or 'combining'. In the first, treatment is switched within and between classes of compounds. The benefits of switching include avoidance of polypharmacy, a narrower range of treatment-emergent adverse events and lower costs. An inherent disadvantage of any switching strategy is that partial treatment responses resulting from the initial treatment might be lost by its discontinuation in favour of another medication trial. Monotherapy switches have also been shown to have limited effectiveness in achieving remission. The advantage of combination strategies is the potential to build upon achieved improvements; they are generally recommended if partial response was achieved with the current treatment trial. Various non-antidepressant augmenting agents, such as lithium and thyroid hormones, are well studied, although not commonly used. There is also evidence of efficacy and increasing use of atypical antipsychotics in combination with antidepressants, for example, olanzapine in combination with fluoxetine (OFC) or augmentation with aripiprazole. The disadvantages of a combination strategy include multiple medications, a broader range of treatment-emergent adverse events and higher costs. Several experimental pharmaceutical treatment alternatives for TRD are also being explored in combination with antidepressants or as monotherapy. These less studied alternative compounds include pindolol, inositol, CNS stimulants, hormones, herbal supplements, omega-3 fatty acids, S-adenosyl-L-methionine, folic acid, lamotrigine, modafinil, riluzole and topiramate. In summary, despite an increasing variety of choices for the treatment of TRD, this condition remains universally undefined and represents an area of unmet medical need. There are few known approved pharmacological agents for TRD (aripiprazole and OFC) and overall outcomes remain poor. This might be an indication that depression itself is a heterogeneous condition with a great diversity of pathologies, highlighting the need for careful evaluation of individuals with depressive symptoms who are unresponsive to treatment. Clearly, more research is needed to provide clinicians with better guidance in making those treatment decisions--especially in light of accumulating evidence that the longer patients are unsuccessfully treated, the worse their long-term prognosis tends to be. PMID:20088620
Shelton, Richard C; Osuntokun, Olawale; Heinloth, Alexandra N; Corya, Sara A
Non-surgical removal of plaque and calculus has been part of the initial phase of the management of patients with gingivitis and periodontitis for decades. It consists of patient motivation and oral hygiene instruction as well as mechanical removal of supra and subgingival plaque deposits. The purpose of this review was to assess recent changes. The article reports on changes in our understanding of plaque as a biofilm, developments in patient plaque control, chemical plaque control and scaling instruments. It also comments on full-mouth disinfection, the use of lasers and host modulation. Modern technology has made removal of microbial deposits by the patient and dental professionals more efficient. However, other advancements need to be used in conjunction with mechanical debridement at this time. PMID:19737271
This paper analyzes findings from in-depth interviews with 44 women aged 50-70 regarding their perceptions of and experiences with non-surgical cosmetic procedures such as Botox injections, laser hair removal, chemical peels, microdermabrasion, and injectable fillers. While 21 of the women had used a range of non-surgical cosmetic procedures, 23 women had not. The data are discussed in light of feminist theorizing on cosmetic surgery which has tended to ignore the experiences of older women and has been divided in terms of the portrayal of cosmetic surgery as either oppressive or liberating. We found that some of the women used the procedures to increase their physical attractiveness and self-esteem, others viewed the procedures as excessively risky, and still others argued that the procedures stemmed from the social devaluation of later life. Treatments that involved the alteration of the surface of the body tended to be viewed as less risky than the injection of foreign substances into the body. PMID:18032254
Hurd Clarke, Laura; Repta, Robin; Griffin, Meridith
Objective: Heavy episodic drinking remains a significant problem on college campuses. Although most interventions for college students are behavioral, pharmacological treatments, such as naltrexone, could provide additional options. Participants: The authors evaluated receptivity to various alcohol treatment options in a general population of…
Epler, Amee J.; Sher, Kenneth J.; Loomis, Tiffany B.; O'Malley, Stephanie S.
|Objective: Heavy episodic drinking remains a significant problem on college campuses. Although most interventions for college students are behavioral, pharmacological treatments, such as naltrexone, could provide additional options. Participants: The authors evaluated receptivity to various alcohol treatment options in a general population of…
Epler, Amee J.; Sher, Kenneth J.; Loomis, Tiffany B.; O'Malley, Stephanie S.
This paper concerns on the review between the surgical and non-surgical method of active control of a prosthetic hand. For active prosthetic hand, there are two standard methods for signal extraction namely surgical and non-surgical. Active prosthetic hands which are based on Surface Electromyography (sEMG) and Targeted Muscle Reinnervation (TMR) are selected for a comparison between non-surgical and surgical type
Mohd Hanif Mohd Zaini; Siti A. Ahmad
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
Embryos collected surgically from donors superovulated with PMSG and synchronized with either prostaglandin F(2)alpha or progestagen impregnated sponges were transferred non-surgically to prostaglandin or progestagen synchronized recipients. One embryo was transferred to the uterine horn ipsilateral to the corpus luteum either through a flexible catheter introduced through a steel tube and passed to the uterine tip, or through a Cassou inseminating gun passed approximately 6 cm into the horn. Of 16 recipients receiving 5 or 6 day old embryos through the catheter (1976), 6 (38%) were palpated pregnant at 42 days and 4 (25%) subsequently calved. Of 16 recipients receiving 7 or 8 day old embryos through the straw and 16 through the catheter (1977), 10 (63%) and 3 (19%), respectively, were palpated pregnant (P<0.05) and 8 (50%) and 3 (19%), respectively, had normal embryos at slaughter 4 to 29 days after palpation (P reverse similar0.10 ). Forty 7 to 9 day old embryos were transferred through the straw in 1978. Eighteen (45%) of the recipients were palpated pregnant and 16 (40%) had normal embryos at slaughter 98 to 168 days after palpation. The success of the transfers in 1978 was affected by embryo quality [good vs poor embryos; 64% vs 22% recipients pregnant (P<0.01) and 59% vs 17% embryos surviving to slaughter (P<0.05)]. Also, in 1978, pregnancy rate was affected by the time taken to transfer the embryo with the highest rate achieved with the fastest transfers (P<0.10, b = -0.47). Injection of Indomethacin near the time of transfer, synchronization between donor and recipient onset of estrus and embryo age did not affect pregnancy rates. The pregnancy rate achieved after the transfer of good quality embryos by the straw technique was equal to that expected from surgical techniques. PMID:16725455
Tervit, H R; Cooper, M W; Goold, P G; Haszard, G M
Non-surgical therapy and radiologic assessment of stage I breast cancer treatment with novel enzyme-targeting radiosensitization: Kochi Oxydol-Radiation Therapy for Unresectable Carcinomas, type II (KORTUC II)
The new enzyme-targeting radiosensitization treatment, Kochi Oxydol-Radiation Therapy for Unresectable Carcinomas, type II (KORTUC II), markedly enhances the radiotherapeutic effect of treatment for various types of locally advanced malignant neoplasms. Patients who had declined surgical treatment and systemic chemotherapy, as well as a total of 14 stage I breast cancer patients, were enrolled. A maximum of 6 ml of KORTUC II was injected into tumor tissue twice a week under ultrasonographic guidance, immediately prior to each administration of radiation therapy. The median observation period was 21.6 months with a range of 4–48 months, and the therapy was well tolerated. Contrast-enhanced magnetic resonance imaging and [18F]-fluorodeoxyglucose positron emission computed tomography revealed that all primary breast tumors completely responded, and none of the subjects experienced local recurrence during the observation period. Ultrasonography depicted tumor-like findings in 2/14 cases after therapy. The intratumoral flow signal on color-Doppler sonography was positive in 4/14 cases before therapy, and the signal disappeared from all cases after therapy. The absence of a flow signal after therapy suggested that the tumor-like findings on ultrasonography were from scar tissue. Excellent local control based on accurate radiological evaluation implies that KORTUC II has the potential to replace surgery as a therapeutic option for stage I breast cancer. Precise evaluation by various radiological modalities helped to gage the success of this therapy.
HITOMI, JIRO; KUBOTA, KEI; OGAWA, YASUHIRO; HAMADA, NORIHIKO; MURATA, YORIKO; NISHIOKA, AKIHITO
... Digg Facebook Google Bookmarks Yahoo MyWeb 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 ...
Background While it is widely held that non-surgical management should be the first line of approach in patients with lumbar spinal stenosis (LSS), little is known about the efficacy of non-surgical treatments for this condition. Data are needed to determine the most efficacious and safe non-surgical treatment options for patients with LSS. The purpose of this paper is to describe the clinical outcomes of a novel approach to patients with LSS that focuses on distraction manipulation (DM) and neural mobilization (NM). Methods This is a prospective consecutive case series with long term follow up (FU) of fifty-seven consecutive patients who were diagnosed with LSS. Two were excluded because of absence of baseline data or failure to remain in treatment to FU. Disability was measured using the Roland Morris Disability Questionnaire (RM) and pain intensity was measured using the Three Level Numerical Rating Scale (NRS). Patients were also asked to rate their perceived percentage improvement. Results The mean patient-rated percentage improvement from baseline to the end to treatment was 65.1%. The mean improvement in disability from baseline to the end of treatment was 5.1 points. This was considered to be clinically meaningful. Clinically meaningful improvement in disability from baseline to the end of treatment was seen in 66.7% of patients. The mean improvement in "on average" pain intensity was 1.6 points. This did not reach the threshold for clinical meaningfulness. The mean improvement in "at worst" pain was 3.1 points. This was considered to be clinically meaningful. The mean duration of FU was 16.5 months. The mean patient-rated percentage improvement from baseline to long term FU was 75.6%. The mean improvement in disability was 5.2 points. This was considered to be clinically meaningful. Clinically meaningful improvement in disability was seen in 73.2% of patients. The mean improvement in "on average" pain intensity from baseline to long term FU was 3.0 points. This was considered to be clinically meaningful. The mean improvement in "at worst" pain was 4.2 points. This was considered to be clinically meaningful. Only two patients went on to require surgery. No major complications to treatment were noted. Conclusion A treatment approach focusing on DM and NM may be useful in bringing about clinically meaningful improvement in disability in patients with LSS.
Murphy, Donald R; Hurwitz, Eric L; Gregory, Amy A; Clary, Ronald
ThetreatmentofhyponatraemiaduetoSIADHisnotalways as straightforward as it seems. Although acute treatment with hypertonic saline and chronic treatment with fluid re- striction are well established, both approaches have severe limitations. These limitations are not readily overcome by addition of furosemide, demeclocycline, lithium or urea to the therapy. In theory, vasopressin-receptor antagonists would provide a more effective method to treat hypona- traemia, by virtue
Robert Zietse; Nils van der Lubbe; Ewout J. Hoorn
Pervasive drug enforcement efforts and new federal sentencing guidelines have led to an increase in substance abusers entering the federal prisons. Although the Federal Bureau of Prisons (BOP) has been committed to providing substance abuse treatment since the 1960s, a comprehensive expansion of its programs was necessary so that quality services could be provided for the growing drug-offender population. This article describes the BOP's six-part drug treatment strategy, which includes screening, education, residential treatment, nonresidential treatment, transitional treatment, and evaluation. The programs entail a biopsychosocial model and a multiphasic approach to comply with the BOP's goal of preparing inmates for a successful reentry into the community, free from criminal and substance-abusing behaviors. PMID:7602433
Arcidiacono, A; Saum, C A
The development of effective treatments for opioid dependence is of great importance given the devastating consequences of the disease. Pharmacotherapies for opioid addiction include opioid agonists, partial agonists, opioid antagonists, and alpha-2-adrenergic agonists, which are targeted toward either detoxification or long-term agonist maintenance. Agonist maintenance therapy is currently the recommended treatment for opioid dependence due to its superior outcomes relative to detoxification. Detoxification protocols have limited long term efficacy and patient discomfort remains a significant therapy challenge. Buprenorphine’s effectiveness relative to methadone remains a controversy and may be most appropriate for patients in need of low doses of agonist treatment. Buprenorphine appears superior to alpha-2 agonists, however, and office-based treatment with buprenorphine in the US is gaining support. Studies of sustained-release formulations of naltrexone suggest improved effectiveness for retention and sustained abstinence, however, randomized clinical trials are needed.
Stotts, Angela L.; Dodrill, Carrie L.; Kosten, Thomas R.
The management of narcolepsy is presently at a turning point. Three main avenues are considered in this review: 1) Two tendencies characterize the conventional treatment of narcolepsy. Modafinil has replaced methylphenidate and amphetamine as the first-line treatment of excessive daytime sleepiness (EDS) and sleep attacks, based on randomized, double blind, placebo-controlled clinical trials of modafinil, but on no direct comparison of modafinil versus traditional stimulants. For cataplexy, sleep paralysis, and hypnagogic hallucinations, new antidepressants tend to replace tricyclic antidepressants and selective serotonin reuptake inhibitors (SSRIs) in spite of a lack of randomized, double blind, placebo-controlled clinical trials of these compounds; 2) The conventional treatment of narcolepsy is now challenged by sodium oxybate, the sodium salt of gammahydroxybutyrate, based on a series of randomized, double-blind, placebo-controlled clinical trials and a long-term open label study. This treatment has a fairly good efficacy and is active on all symptoms of narcolepsy. Careful titration up to an adequate level is essential both to obtain positive results and avoid adverse effects; 3) A series of new treatments are currently being tested, either in animal models or in humans, They include novel stimulant and anticataplectic drugs, endocrine therapy, and, more attractively, totally new approaches based on the present state of knowledge of the pathophysiology of narcolepsy with cataplexy, hypocretine-based therapies, and immunotherapy.
Rapid granular media filters are widely used in drinking water treatment to remove particulate and microbial contaminants prior to disinfection. In order to function properly, these filters must be backwashed regularly to remove accumulated deposits. Experience has shown that whenever filter influent is pretreated with coagulants (sometimes also referred to as flocculants), especially polymers, upflow water wash alone is insufficient
B. M. Brouckaert; A. Amirtharajah; R. Rajagopaul; P. Thompson
Interesting prospects of a urine-based product exist as a fertilizer in agricultural applications in developing countries. However, removal of pharmaceutical residues is essential to prevent long-termenvironmental hazards. In this paper, the perspectives of urine collection and treatment are discussed with a perspective of the developing countries. Scenarios are drawn up and discussed around the processes of electrodialysis, precipitation and evaporation.
W. Pronk; D. Koné
Diabetes mellitus has become a major health concern worldwide and its incidence is projected to increase. Diabetic macular edema (DME) and proliferative diabetic retinopathy (PDR) are considered the most sight-threatening ocular complications in these patients. Pivotal studies, such as the Early Treatment Diabetic Retinopathy Study (ETDRS) and the Diabetic Retinopathy Study (DRS), have established macular and pan-retinal laser as the gold-standard of treatment for these complications. The recent discovery of the vascular endothelial growth factor (VEGF) and its role in the development of proliferative disease, has led to a movement towards treating PDR and DME with anti-angiogenic medications alone or in conjunction with the gold-standard of care. Due to the severity of the diabetic ocular complications and the rising incidence of diabetes worldwide, it is important for the non-ophthalmologist care provider to be informed of the new treatments available for these conditions in an effort to better guide their patients. In this review, I will discuss the importance of these new methods of treatment as well as the significance of systemic glucose control, vitreous surgery and laser photocoagulation. PMID:22352446
Giuliari, Gian P
Aim To characterize the in-hospital mortality and the actuarial survival of surgical and non-surgical therapy regimen in the\\u000a treatment of chronic thromboembolic pulmonary hypertension (CTEPH). Methods A retrospective cohort study was conducted in 504 patients with CTEPH, who were treated surgically (n = 360), or non-surgically (n = 144) in Anzhen Hospital from February 1989 to August 2007. The patients in surgical group received
Hui-Li Gan; Jian-Qun Zhang; Ping Bo; Qi-Wen Zhou; Sheng-Xun Wang
Helicobacter plays a central role in the pathogenesis of several gastric diseases and its eradication has a therapeutic or prophylactic effect in many clinical situations. However, treatment of Helicobacter infection can be challenging and the frequently recommended clarithromycin based triple therapy fails in more than 20% of patients. Reasons for treatment failure include antibiotic resistances and bacterial persistence in an acidic stomach, for instance due to rapid metabolization of the proton pump inhibitor by the host. Therapeutic efficiency can be improved by a therapy tailored for an individual patient and the respective pathogen. In an alternative approach the antibiotic therapy can be intensified leading to a sequential or concomitant therapy. These and other strategies tested only in single studies can achieve eradication in 90?% and up to over 95?% of patients, respectively, and should be used more often in clinical practice. PMID:21732262
Misselwitz, B; Kaiser, P; Bauerfeind, P; Vavricka, S R
Atrial fibrillation is the commonest sustained cardiac arrhythmia. It accounts for >35% of all hospital admissions for cardiac arrhythmias in the United States. The presence of atrial fibrillation increases the mortality of a population by up to twofold. The risk of stroke increases from 1.5% in patients with atrial fibrillation from 50–59 years of age to up to 23.5% for such patients aged 80–89 years. Although the diagnosis of atrial fibrillation is usually straightforward, effective treatment is not. This article will discuss how rhythm control of atrial fibrillation can best be achieved, the controversy over the rhythm versus rate control, the maintenance of sinus rhythm with antiarrhythmic drugs after cardioversion, and prevention of thromboembolism. Finally, the recent advances in various non-pharmacological approaches for the treatment of atrial fibrillation will be highlighted.
Lairikyengbam, S; Anderson, M; Davies, A
Most lymphomas that involve the ocular adnexal structure are low grade, B cell, non-Hodgkin’s lymphomas. The treatment depends upon the grade and stage of the disease. High grade lymhoma requires treatment with systemic chemotherapy whereas the localized low grade (extranodal marginal zone lymphoma) can be successfully managed with local radiotherapy. Chlamydia psittaci infection is associated with low grade ocular lymphoma; however there is wide geographic variation in the strength of this association. Blanket antibiotic therapy is not advised unless there is proof of an infective agent. The monoclonal antibody, rituximab, may be successful for CD20 positive lymphoma, although it is likely that rituximab will have better long-term results when used in combination with systemic chemotherapy.
Cohen, Victoria Mary Lendrum
Opinion statement Melanoma, diagnosed and treated at its earliest stages, can be successfully cured by surgery alone. However, when metastatic\\u000a beyond the regional nodes, it is almost uniformly deadly. Adjuvant therapy targeted toward the treatment of microscopic residual\\u000a disease after surgical resection is the subject of intense scientific investigation because this is the stage at which it\\u000a is possible to have
Alicia Terando; Michael S. Sabel; Vernon K. Sondak
Treatment of the superficial femoral artery (SFA) has been among the least effective of all endovascular procedures in terms\\u000a of long-term patency. The relatively small vessel lumen, in conjunction with a high plaque burden, slow flow, and a high frequency\\u000a of primary occlusions, contributes to a considerable rate of acute technical failures. Because of these technical limitations\\u000a a much effort
Gunnar Tepe; Jörg Schmehl; Stephan Heller; Benjamin Wiesinger; Claus D. Claussen; Stephan H. Duda
Much controversy exists regarding the best diagnostic method for acute sinusitis, the efficacy of antibiotics, the best choice\\u000a of antibiotics, the most appropriate duration of therapy, and the efficacy of ancillary measures and nasal corticosteroids.\\u000a The therapeutic goal is to identify those children who are more likely to have bacterial sinusitis and unlikely to resolve\\u000a spontaneously, who may require treatment
Despina G. Contopoulos-Ioannidis; John P. A. Ioannidis
Diabetic retinopathy (DR) is the leading cause of vision loss in working-age adults, and diabetic macular edema (DME) is the most common cause of visual impairment in individuals with DR. This review focuses on the pathophysiology, previous treatment paradigms, and emerging treatment options in the management of DME.
Jain, Atul; Varshney, Neeta; Smith, Colin
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.
Adhvaryu, Meghna; Vakharia, Bhasker
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
This paper analyzes findings from in-depth interviews with 44 women aged 50–70 regarding their perceptions of and experiences with non-surgical cosmetic procedures such as Botox injections, laser hair removal, chemical peels, microdermabrasion, and injectable fillers. While 21 of the women had used a range of non-surgical cosmetic procedures, 23 women had not. The data are discussed in light of feminist
Laura Hurd Clarke; Robin Repta; Meridith Griffin
Objective The aim of the study was to evaluate clinical characteristics of ureteroceles particularly for diagnostic and treatment challenges. Methods Data about patients treated for ureterocele in the two hospital clinics during 1996- 2009 are retrospectively evaluated. Findings There were 12 girls and 7 boys. Symptomatic urinary tract infection was found in twelve cases. Ureterocele was associated with duplex systems in eleven cases. Vesicoureteral reflux was detected in 4 patients. Bladder diverticulum complicated with ureterocele in 1 patient. Ultrasonography diagnosed ureterocele in 12 patients. Renal scarring was detected in 6 patients at the side of ureterocele. Fifteen patients showed varying degrees of hydro-ureteronephrosis. Surgical therapy included upper pole nephrectomy in 3 cases. Bladder level reconstruction was performed in 11 cases. Five patients were treated only by endoscopic incision. In the follow up period 4 patients showed long term urinary tract infections whereas 3 of them were treated endoscopically. Postoperative reflux was still present in two patients who were treated by endoscopic incision. Conclusion Ureterocele diagnosis and treatment show challenges. Urinary tract infection is important marker for urinary system evaluation. Preoperative management generally depends on a combination of diagnostic methods. Endoscopic incision needs serious follow up for postoperative problems.
Gunsar, Cuneyt; Mir, Erol; Sencan, Aydin; Ertan, Pelin; Ozcan, Cansu Unden
Currently a wide range of drugs efficient in osteoporotic fractures are on disposal. Bisfosphonates are the most important group, which are currently administered in a weekly dosage: Alendronate dose 70mg and Risedronate - 35mg. Since few months a therapy once a month with Ibandronate 150mg is also available. Apart from antyresorptive therapy there are also other groups of medications. Strontium Ranelate not only decreases bone resorption but also increases bone formation. Parathyroid hormone subcutaneous strongly promotes bone formation. Denosumab given subcutaneous once in half a year elevates bone mineral density. Hormone Replacement Therapy is not applied in prevention of osteoporotic fracture, however, it is still in use in treatment of disorders of menopause. In countries with correct health policy the doctors have complete possibility to adjust appropriate medications according to the patient's health state. PMID:17597679
Cryptococcosis is a fungal infection that is usually caused by Cryptococcus neoformans. Given the decreasing number of cases in HIV-infected patients in developed countries, infections in other patient populations, such as solid organ transplant recipients, patients with chronic organ diseases or even patients without immunodeficiency gain more attention. Due to a possible involvement of many organs, the clinical presentation varies from localized infections of the respiratory tract and the skin, to the characteristic meningoencephalitis or other organs after hematogenous dissemination. Sensitive laboratory tests allow a rapid diagnosis in patients with disseminated infection. Crucial therapeutic decisions depend on the underlying patient condition and the particular organ involvement. The induction therapy of disseminated infections or severe localised infections is based on amphotericin B in combination with 5-flucytosine. In non-severe localised infections and after induction therapy, antifungal treatment with fluconazole is indicated. Echinocandins are not effective in cryptococcosis. PMID:23860684
Mischnik, A; Klein, S; Tintelnot, K; Zimmermann, S; Rickerts, V
This review summarizes ongoing research aimed at finding novel drugs as alternatives to traditional antibiotics. Anti-virulence approaches, phage therapy and therapeutic antibodies are strategies that may yield drugs with high specificity and narrow spectra. Several candidates are currently being evaluated in clinical trials, mostly for topical applications, but so far, none have been approved for market authorization. Candidates based on antimicrobial peptides (natural, semisynthetic and synthetic) are also being tested in clinical trials, mostly for the topical treatment of chronic infections. An alternative to the development of new antibiotics is to find potentiators of traditional antibiotics; in this respect, beta-lactamase inhibitors are already in clinical use. Novel variants are under investigation as well as efflux pump inhibitors. PMID:21367651
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.
Neubert, Thorsten; Lehmann, Percy
Diabetes mellitus is a growing global epidemic. Patients with this disease present with a variety of health conditions, including a number of ocular complications that threaten vision, such as proliferative diabetic retinopathy and macular edema. Diabetic papillopathy, another potential ocular complication from diabetes, is a self-limiting, sometimes bilateral disease that may affect both type 1 and type 2 diabetics. It is characterized by optic disc swelling caused by vascular leakage and axonal edema in and around the optic nerve head. Occasionally, it may be accompanied by intraretinal hemorrhages and hard exudates. Diabetic papillopathy tends to be mild and is usually associated with good visual prognosis; however, there are some cases in which permanent visual impairment can develop. The pathogenesis remains largely unknown, but there has been evidence suggestive of its associations with a small cup/disc ratio and rapid reduction in glycemia. There is no validated therapy for diabetic papillopathy; however, current case reports have shown promising results after local injections of corticosteroids as well as bevacizumab (Avastin), a potent monoclonal antibody that has been employed for the treatment of ocular vaso-proliferative diseases such as choroidal neovascular membranes associated with age-related macular degeneration and proliferative diabetic retinopathy. PMID:21418004
Giuliari, Gian P; Sadaka, Ama; Chang, Peter Y; Cortez, Rafael T
Hypoactive sexual desire disorder is the most common cause of sexual dysfunction in women. According to a national survey, approximately a third of all women experience low sexual desire. The etiology of the disorder is often multifactorial. Research in treatment options for hypoactive sexual desire disorder is limited. In this article, treatment options including sex therapy, hormone therapy (estrogen, testosterone, dehydroepiandrosterone, tibolone), non-hormonal medical therapies (buproprion, buspirone, phosphodiesterase-5 inhibitors, amantadine and apomorphine) and herbal therapies (Avlimil(R), Arginmax(R), Zestra(R), yohimbine and Ginkgo biloba) are reviewed. PMID:19803843
Bolour, Sheila Y; Braunstein, Glenn D
Increasing interest in shoulder pathology during the last decades has considerably diversified the possible treatment options of full thickness rotator cuff tears. This review of the recent literature combined with information gathered during recent European shoul- der meetings attempts to summarize present trends. Every full thickness cuff tear, except for the acute traumatic tear in younger patients, should always benefit
F. W. J. HANDELBERG
Penetrating gunshot wounds (GSWs) to the abdominal aorta are frequently lethal. Alternative management options for treatment of traumatic pseudoaneurysms of the abdominal aorta are illustrated by three patient case histories. Patient A sustained two GSWs to the abdomen (midepigastrium, right subcostal region). He was hypotensive in the field. Emergent laparotomy was undertaken with suture ligature of a celiac injury and
Sonny Tucker Jr.; Vincent L. Rowe; Rajeev Rao; Douglas B. Hood; Donald Harrell; Fred A. Weaver
Bone metastases, especially to the spine, are frequently encountered during the course of a malignancy. Due to a worldwide increase of cancer incidence and to a longer life expectancy of patients with cancer, a rise in incidence of bone metastases is observed. A brief historical overview is the base of a review of current treatment options. Despite new developments in
R. H. M. A. Bartels; Y. M. van der Linden
Bone metastases, especially to the spine, are frequently encountered during the course of a malignancy. Due to a worldwide increase of cancer incidence and to a longer life expectancy of patients with cancer, a rise in incidence of bone metastases is observed. A brief historical overview is the base of a review of current treatment options. Despite new develop- ments
M. A. Bartels; Yvette M. van der Linden
: Acne vulgaris is a disorder of the sebaceous follicle. The cause is multifactorial, and both adolescents and adults can be affected. Acne is associated with a significant financial burden and considerable psychological distress. Treatment options are reviewed, including over-the-counter medications, prescription medications, and in-office procedures. PMID:24048347
Tricuspid valve endocardititis is treated surgically by total valve excision or valve replacement. Both procedures are controversial with regard to the hemodynamic consequences and to the long-term prognosis. In the following, results of tricuspid valve repair in acute infective endocarditis are reported and discussed as an additional treatment option. Between January 1988 and December 1993, 118 patients were operated on
R. Lange; R. De Simone; R. Bauernschmitt; A. Tanzeem; C. Schmidt; S. Hagl
Recent advances in angiographic technique have raised our awareness of the presence of unruptured intracranial aneurysms (UIAs). However, the appropriate management for these lesions remains controversial. To optimize patient outcomes, the physician must weigh aneurysmal rupture risk associated with observation against the complication risks associated with intervention. In the case that treatment is chosen, the two available options are surgical clipping and endovascular coiling. Our paper summarizes the current body of literature in regards to the natural history of UIAs, the evolution of the lesion if it progresses uninterrupted, as well as the safety and efficacy of both treatment options. The risks and benefits of treatment and conservative management need to be evaluated on an individual basis and are greatly effected by both patient-specific and aneurysm-specific factors, which are presented in this paper. Ultimately, this body of data has led to multiple sets of treatment guidelines, which we have summated and presented in this paper.
Loewenstein, Joshua E.; Gayle, Shaneze C.; Duffis, E. Jesus; Prestigiacomo, Charles J.; Gandhi, Chirag D.
Pancreatic cancer is the fourth leading cause of cancer-related deaths in the USA. The high mortality rate is partly due to\\u000a lack of effective treatments. This review summarizes the pathobiology and current treatment options for pancreatic cancer.\\u000a Moreover, the review discusses the opportunities of developing novel therapies for pancreatic cancer provided by the progress\\u000a in understanding the genetic mutations, tumor
Jing Li; M. Guillaume Wientjes; Jessie L.-S. Au
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
Painful bladder syndrome (PBS) and interstitial cystitis (IC) are associated with bladder pain, increased urinary frequency, urgency and reduced quality of life. The cause is still unknown, although there are several possible hypotheses. PBS/IC may significantly impact all areas of a patient's life as they try to manage their symptoms. Treatment options usually involve diet and fluid modifications, oral medications, intravesical therapy or as a last resort, surgery. The bladder is protected by a mucous layer known as the GAG layer and is thought to protect the underlying urothelium from coming into contact with potassium ions and other irritants contained in urine. Due to research suggesting that sufferers of PBS/IC have dysfunctional GAG layers, there is rationale for intravesical GAG replacement therapy as a treatment option in reducing PBS/IC symptoms such as pain, frequency and urgency. Early diagnosis and treatment may lead to better long-term outcomes. PMID:23752572
Articular cartilage injuries can produce significant musculoskeletal morbidity for both young and active aging patient populations. The complex and highly specialized composition of normal hyaline cartilage makes treatment of focal chondral injuries a formidable challenge for the basic scientist, surgeon, and physical therapist. The current array of surgical treatment options offers palliative, reparative, and restorative treatment strategies. Palliative options include simple arthroscopic debridement. Reparative strategies utilize marrow stimulation techniques to induce formation of fibrocartilage within the chondral defect. Restorative tactics attempt to replace damaged cartilage with hyaline or hyaline-like tissue using osteochondral or chondrocyte transplantation. Furthermore, while treatment success is obviously dependent on good surgical selection and technique, the importance of sound, compliant postoperative rehabilitation cannot be understated. The purpose of this article is to review the basic science of articular cartilage, current treatment options available, and outline the clinical decision making involved when using these procedures by presenting the algorithm used at our institution for treating focal cartilage lesions. PMID:17063834
Lewis, Paul B; McCarty, L Pearce; Kang, Richard W; Cole, Brian J
Well- to moderately differentiated neuroendocrine tumors (NET) are a heterogeneous group of malignancies for which a range of therapeutic options have been employed. For patients with localized NET, surgical resection remains the mainstay of treatment. Surgical resection of hepatic metastases or hepatic artery embolization may also be beneficial in patients with hepatic-predominant metastatic disease. Symptoms of hormonal excess, such as carcinoid syndrome and syndromes associated with functional pancreatic NET, can be effectively treated with somatostatin analogs. Systemic treatment options for patients with advanced NET have been limited. Treatment with the somatostatin analog octreotide has been shown to improve progression-free survival in patients with advanced midgut carcinoid tumors, and the potential antiproliferative effect of somatostatin analogs in patients with other NET subtypes is currently under investigation. Patients with advanced pancreatic NET may also respond to treatment with streptozocin or temozolomide-based therapy. In patients with advanced pancreatic NET, randomized, placebo-controlled studies have recently demonstrated that treatment with the tyrosine kinase inhibitor sunitinib or with the mTOR inhibitor everolimus is associated with improved progression-free survival. Based on these studies, sunitinib or everolimus should now be considered as therapeutic options in patients with advanced pancreatic NET. Initial phase II studies have also suggested activity associated with VEGF pathway and mTOR inhibitors in patients with advanced carcinoid tumors. Future studies will likely further define the role of these agents in the advanced carcinoid patient population. PMID:21437592
Chan, Jennifer A; Kulke, Matthew H
Purpose We aimed to explore operational definitions of mixed urinary incontinence (MUI) for use in incontinence outcomes research for non-surgical patient populations. Methods A secondary analysis of women with urge incontinence or urge predominant MUI enrolled in the Urinary Incontinence Treatment Network BE-DRI randomized clinical trial was performed. Subjects were characterized at baseline for urinary incontinence severity and incontinence subtype (stress or urge) using the Medical, Epidemiologic and Social Aspects of Aging (MESA) questionnaire, the Urogenital Distress Inventory, and a 7-day urinary diary. Various different definitions of MUI, ranging from low to high threshold, were created using a combination of these baseline incontinence measures. Prevalence of MUI based on each definition was described and compared to treatment response. Logistic regression analysis was used to estimate the association between the study outcomes and the different definitions of MUI. Results The 307 participants in the BE-DRI study had a mean age of 56.9 (± 13.9) years with a mean total MESA score of 21.7 (± 8.9) and a mean total UDI score of 120.5 (± 49.6). The proportion of women diagnosed with MUI varied significantly by definition ranging from (63.5%) to (96.4%). Low threshold symptom-based definitions resulted in nearly universal diagnosis of MUI. No strict cut-off value for these baseline measures was identified to predict clinical outcomes. Conclusions Current MUI definitions do not adequately categorize clinically relevant UI subgroups. For research purposes we believe it necessary to describe the severity of each incontinence subtype separately in subjects with MUI.
Brubaker, Linda; Lukacz, Emily S.; Burgio, Kathryn; Zimmern, Philippe; Norton, Peggy; Leng, Wendy; Johnson, Harry; Kraus, Stephen; Stoddard, Anne
Currently, a remarkable selection of alternatives to cholecystectomy is available. These new techniques undoubtedly will expand management without laparotomy of both common bile duct and gallbladder disease. Endoscopic sphincterotomy with stone removal has gained wide acceptance for retained or recurrent common bile duct stones. Chenodiol and Ursodiol are save and effective agents, either alone or in combination for the medical dissolution of gallbladder stones in selected patients. Infusion of methyl tert-butyl ether, which is liquid at body temperature, via a catheter into the gallbladder allows rapid dissolution of cholesterol gallstones. Extracorporal shock-wave lithotripsy (ESWL), which has already revolutionized therapy of urolithiasis, has been introduced as another promising nonoperative treatment for selected patients with gallbladder stones. Again ESWL has been reported useful in patients with bile duct stones not amenable to manipulative, endoscopic measures. The choice of appropriate therapy for individual patients depends on different factors, i.e. medical condition of the patient, chemical composition of the stones and availability of lithotriptors, respectively. The appropriate therapy will depend on these factors and the patients preference. PMID:2047638
Parents of seriously ill children face difficult decisions when standard therapies are limited or ineffective. In their search for information, they may turn to websites created by other parents facing similar experiences. We conducted a qualitative content analysis of 21 websites created by families with children affected by cancer or genetic disease, two serious conditions with a range of treatment and clinical trial options. Our research questions address how parent authors portray serious pediatric illness, available options, parties to decision making, and sources of influence. In addition, we examine what these sites reveal about family vulnerability to various risks, particularly the risk of misunderstanding the distinction between standard treatment and research and the risk of overestimating the likely benefits of research participation, as well as whether vulnerability varies by type of condition. Our results demonstrate typically favorable views on research, but with inadequate distinctions between research and treatment and a complex set of trade-offs in consideration of research risks and potential benefits. While portraits of vulnerability emerge for both parents and children, so do portraits of strength and resilience. As a result, parents describe frustration with both under- and over-protection from research participation. Our discussion of these findings clarifies the potential for parent-authored websites to inform and influence families considering research and treatment options for their seriously ill children.
Schaffer, Rebecca; Henderson, Gail E.; Churchill, Larry R.; King, Nancy M. P.; Rothschild, Barbra B.; Lohser, Sara; Davis, Arlene M.
...Microbial toolbox options for meeting Cryptosporidium treatment requirements. 141.715...REGULATIONS Enhanced Treatment for Cryptosporidium Requirements for Microbial Toolbox...Microbial toolbox options for meeting Cryptosporidium treatment requirements....
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.
Enweluzo, Chijioke; Aziz, Fahad
Opinion statement Well- to moderately differentiated neuroendocrine tumors (NET) are a heterogeneous group of malignancies for which a range\\u000a of therapeutic options have been employed. For patients with localized NET, surgical resection remains the mainstay of treatment.\\u000a Surgical resection of hepatic metastases or hepatic artery embolization may also be beneficial in patients with hepatic-predominant\\u000a metastatic disease. Symptoms of hormonal excess, such
Jennifer A. Chan; Matthew H. Kulke
Summary Renal cell cancer (RCC) accounts for 2% of all malignancies. RCC shows a rising incidence and overall mortality is the highest\\u000a among all urologic malignancies. In localised disease, radical cancer surgery remains the only potential curative treatment\\u000a option. Indications for nephron-sparing surgery include renal tumours 4 cm or less in diameter and patients with solitary\\u000a kidneys or bilateral synchronous RCC.
A. P. Berger; A. Hobisch
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).
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
The Hazardous and Solid Waste Amendments (HSWA) to the Resource Conservation and Recovery Act (RCRA) govern the manner in which hazardous materials are managed. Disposing RCRA hazardous wastes on or in the land is no longer an accepted remedial option. This land disposal restriction requires that all listed and characteristic hazardous wastes must be treated according to specified standards before they are disposed. These treatment standards define technologies and concentration limits. Hazardous wastes that do not meet the standards are prohibited from being disposed on land, such as in landfills, surface impoundments, land treatment units, injection wells, and mines or caves.
Indelicato, G.J. [CURA Inc., Dallas, TX (United States); Tipton, G.A. [Tipton (Gary A.), Houston, TX (United States)
Adjuvant radiotherapy, surveillance, and single-agent carboplatin chemotherapy are all accepted treatment options for clinical\\u000a stage (CS) I seminoma with cure rates approaching 100%. Low-dose (25–35 Gy) adjuvant radiotherapy to the retroperitoneum and\\u000a ipsilateral pelvis has been the mainstay of treatment for decades and is associated with excellent long-term survival and\\u000a acceptable short-term toxicity. The use of lower radiation doses (20 Gy) and
Andrew J. Stephenson
Vitamin D as a topical treatment has become one of the mainstays for treatment of psoriasis vulgaris. Oral vitamin D on the other hand has for the most part become a forgotten option. But a review of the literature on oral vitamin D as a treatment for psoriasis reveals that this treatment is efficacious. The main side effect of this therapy is hypercalcemia, which appears to be easily monitored and avoidable with proper dosing and monitoring. The literature also suggests a correlation between low levels of serum vitamin D in this patient population associated with increased severity of disease involvement. In addition, oral vitamin D improves psoriatic arthropathy. Moreover, vitamin D has been proven to have many health benefits such as prevention of cancer, improved cardiovascular health among many others. Psoriatic patients as a population are at increased risk of developing adverse health complications such as cardiovascular disease, and oral vitamin D may prove to be of benefit in this population. Oral vitamin D is inexpensive and easily available. It is still a viable option and should not be forgotten as a possible treatment for psoriasis. PMID:22103655
Kamangar, Faranak; Koo, John; Heller, Misha; Lee, Eric; Bhutani, Tina
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.
Moreno-Aspitia, Alvaro; Perez, Edith A.
Echinococcus granulosus and Echinococcus multilocularis are cestode parasites, of which the metacestode (larval) stages cause the diseases cystic echinococcosis (CE) and alveolar echinococcosis (AE), respectively. Albendazole and mebendazole are presently used for chemotherapeutical treatment. However, these benzimidazoles do not appear to be parasiticidal in vivo against AE. In addition, failures in drug treatments as well as the occurrence of side-effects have been reported. New drugs are needed to cure AE and CE, which are considered to be neglected diseases. Strategies currently being implemented to identify novel chemotherapeutical treatment options include (i) conventional primary in vitro testing of broad-spectrum anti-infective drugs, either in parallel with, or followed by, animal experimentation; (ii) studies of drugs which interfere with the proliferation of cancer cells and of Echinococcus metacestodes; (iii) exploitation of the similarities between the parasite and mammalian signalling machineries, with a special focus on targeting specific signalling receptors; (iv) in silico approaches, employing the current Echinococcus genomic database information to search for suitable targets for compounds with known modes of action. In the present article, we review the efforts toward obtaining better anti-parasitic compounds which have been undertaken to improve chemotherapeutical treatment of echinococcosis, and summarize the achievements in the field of host-parasite interactions which may also lead to new immuno-therapeutical options. PMID:17631693
Hemphill, A; Spicher, M; Stadelmann, B; Mueller, J; Naguleswaran, A; Gottstein, B; Walker, M
In this article, we focus on the current and emerging treatments in nasopharyngeal cancer (NPC). A detailed evolution of the current standard of care, and new techniques and treatment options will be reviewed. Intergroup 0099 established the role for chemoradiotherapy (chemo-RT) in the treatment of nasopharyngeal carcinoma. Multiple randomized Phase III trials have shown the benefit of chemo-RT; however, none of these studies utilized modern radiotherapy (RT) techniques of intensity-modulated radiation therapy (IMRT). IMRT has the ability to deliver high doses of radiation to the target structures while sparing adjacent bystander healthy tissues, and has now become the preferred RT treatment modality. Chemotherapy also has had a shifting paradigm of induction and/or adjuvant chemotherapy combined with RT alone, to the investigation with concurrent chemo-RT. New treatment options including targeted monoclonal antibodies and small molecule tyrosine kinase inhibitors are being studied in NPC. These new biologic therapies have promising in vitro activity for NPC, and emerging clinical studies are beginning to define their role. RT continues to expand its capabilities, and since IMRT and particle therapy, specifically intensity-modulated proton therapy (IMPT), has reports of impressive dosimetric efficacy in-silica. Adaptive RT is attempting to reduce toxicity while maintaining treatment efficacy, and the clinical results are still in their youth. Lastly, Epstein– Barr virus (EBV) DNA has recently been studied for prediction of tumor response and its use as a biomarker is increasingly promising to aid in early detection as well as supplementing the current staging system. RT with or without chemotherapy remains the standard of care for nasopharyngeal carcinoma. Advances in RT technique, timing of chemotherapy, biologically targeted agents, particle therapy, adaptive RT, and the incorporation of EBV DNA as a biomarker may aid in the current and future treatment of nasopharyngeal cancer.
Spratt, Daniel E; Lee, Nancy
Sclerosing osteomyelitis of Garré continues to be a puzzling entity, with a nonspecific clinical description and course, an obscure pathogenesis, and no consensus on a predictable and helpful method of treatment. The proposed treatment options according to the literature are observation, analgesics and NSAIDs, and bone curettage. Here we present a 15-year-old girl treated by resection of a 12 cm-long lesion after failed conservative treatment, followed by bone transport using a circular external fixator. This treatment method has not been described previously for this condition. The duration of bone transport was 3 months, and the total duration of the frame treatment was 12 months. After hardware removal, and at 2.5-year follow-up, the patient was asymptomatic and achieved good functional results. To the best of our knowledge, this is the first description of bone resection and transport for the treatment of this condition, even though it is well described for the treatment of chronic osteomyelitis and other conditions necessitating bone resection. On the basis of this case we suggest that resection and bone transport using a circular external fixator for the treatment of sclerosing osteomyelitis of Garré might be an effective and safe method. Of course, being a rare entity, large cohorts are difficult to obtain, and more data and longer follow-up are required to form a convincing recommendation. Level IV evidence. PMID:23812085
Nikomarov, David; Zaidman, Michael; Katzman, Alexander; Keren, Yaniv; Eidelman, Mark
Depression is found in about 30%–40% of all patients with Parkinson’s disease (PD), but only a small percentage (about 20%) receive treatment. As a consequence, many PD patients suffer with reduced health-related quality of life. To address quality of life in depressed PD patients, we reviewed the literature on the health correlates of depression in PD (eg, cognitive function), etiology of depression in PD, and treatment options (ie, antidepressants, electroconvulsive therapy, and psychotherapy). The current review is unique in its focus on psychosocial aspects, as well as neuropathological factors, of depression in PD. Overall, we conclude that neurochemical (eg, serotonin) and psychosocial factors (eg, coping style, self-esteem, and social support) contribute to the affective disturbances found in this neuropsychiatric population. Therefore, we recommend that a multidisciplinary (eg, pharmacotherapeutic, psychoeducational, and/or psychotherapeutic) approach to treatment be taken with depressed PD patients.
Frisina, Pasquale G; Borod, Joan C; Foldi, Nancy S; Tenenbaum, Harriet R
Childhood tuberculosis (TB) continues to be a neglected disease in areas where limited resources restrict the focus of national TB control programmes to only the most infectious sputum smear-positive cases. However, appreciation that children contribute a significant proportion to the global TB disease burden and suffer severe TB-related morbidity and mortality is growing. The World Health Organization (WHO) published guidelines on the management of paediatric TB in 2006 and child friendly drug formulations have been made available to deserving nations via the Global Drug Facility (GDF) since 2008. These advances also served to emphasize the considerable programmatic barriers that remain in resource-limited settings. This review provides an overview of current treatment practices, presenting the authors personal perspectives on issues related to the treatment of childhood TB, together with a brief synopsis of potential future treatment options. PMID:21406050
Marais, B J; Schaaf, H S; Donald, P R
Depression is found in about 30%-40% of all patients with Parkinson's disease (PD), but only a small percentage (about 20%) receive treatment. As a consequence, many PD patients suffer with reduced health-related quality of life. To address quality of life in depressed PD patients, we reviewed the literature on the health correlates of depression in PD (eg, cognitive function), etiology of depression in PD, and treatment options (ie, antidepressants, electroconvulsive therapy, and psychotherapy). The current review is unique in its focus on psychosocial aspects, as well as neuropathological factors, of depression in PD. Overall, we conclude that neurochemical (eg, serotonin) and psychosocial factors (eg, coping style, self-esteem, and social support) contribute to the affective disturbances found in this neuropsychiatric population. Therefore, we recommend that a multidisciplinary (eg, pharmacotherapeutic, psychoeducational, and/or psychotherapeutic) approach to treatment be taken with depressed PD patients. PMID:18728814
Frisina, Pasquale G; Borod, Joan C; Foldi, Nancy S; Tenenbaum, Harriet R
Sleep disturbances are extremely common in the early stages of recovery from alcohol dependence and may persist for several months despite continued abstinence. Studies indicate that sleep disturbances independently increase the risk for relapse to alcohol, suggesting that targeting these problems during recovery may support continued abstinence. However, there is limited information in the addiction literature about available and effective treatments for sleep disturbances in recovering alcoholic patients. The primary goals of this article are to describe the phenomenology of sleep disturbances during recovery from alcohol dependence, to outline the evidence linking sleep problems with alcohol relapse, and to describe available pharmacological and nonpharmacological treatment options, including the evidence regarding their efficacy in recovering alcoholic patients. Recommendations for future research are provided along with special considerations for treating insomnia in this population, including avoiding cross-dependent sedatives, such as benzodiazepines and benzodiazepine receptor agonists (BzRAs).
Arnedt, J. Todd; Conroy, Deirdre A.; Brower, Kirk J.
Cardiovascular diseases are the most common cause of death in the world. The development of heart failure is mainly due to the loss of cardiomyocytes following myocardial infarction and the absence of endogenous myocardial repair. Numerous studies have focused on cardiac stem cells (CSCs) due to their therapeutic benefit, particularly in the treatment of heart failure. It has previously been demonstrated that CSCs are able to promote the regeneration of cardiomyocytes in animals following myocardial infarction. However, the underlying mechanism(s) remain unclear. This review mainly discusses the cardioprotective effect of CSCs and the effect of CSCs on the function of cardiomyocytes, and compares the efficacies of CSCs from rats, mice and humans, thereby contributing to an improved understanding of CSCs as a promising treatment option for heart failure.
ZHAO, XIAOHUI; HUANG, LAN
Cardiovascular diseases are the most common cause of death in the world. The development of heart failure is mainly due to the loss of cardiomyocytes following myocardial infarction and the absence of endogenous myocardial repair. Numerous studies have focused on cardiac stem cells (CSCs) due to their therapeutic benefit, particularly in the treatment of heart failure. It has previously been demonstrated that CSCs are able to promote the regeneration of cardiomyocytes in animals following myocardial infarction. However, the underlying mechanism(s) remain unclear. This review mainly discusses the cardioprotective effect of CSCs and the effect of CSCs on the function of cardiomyocytes, and compares the efficacies of CSCs from rats, mice and humans, thereby contributing to an improved understanding of CSCs as a promising treatment option for heart failure. PMID:23407679
Zhao, Xiaohui; Huang, Lan
Chronic rejection is a poorly understood entity albeit a frequent cause of graft failure. Despite the advent of new immunosuppressive agents, neither the slope of graft destruction nor the frequency is ameliorated. There are a number of hypothesis which try to explain the conundrum of chronic graft destruction: ongoing rejection, antibody-mediated rejection, poor choice of organs, hyperfiltration, calcineurin inhibitors (CNI) nephrotoxicity and non-compliance among them. None of these hypotheses can explain all features of the process, thus, it is likely that they act in combination. What seems to be clear is a beneficial effect of early angiotensin-converting enzyme (ACE)/AT1 blocker treatment. It is less clear, however, whether a reduction or a switch from CNIs to other immunosuppressants prolongs graft survival. This review highlights the pathophysiological aspects that are important for the development of chronic allograft damage in the context of possible treatment options. PMID:23625970
Heemann, Uwe; Lutz, Jens
The current standard-of-care treatment for chronic hepatitis C virus (HCV) infection, peginterferon plus ribavirin, results in a sustained virological response in 39–46% of genotype 1 patients, based on published reports and recently re-affirmed by findings in the IDEAL trial. While several directly targeted oral antiviral medications in development appear promising to decrease genotype 1 treatment failure, these agents are not yet approved for general clinical use, and their contribution to the management of relapsed or refractory HCV patients is uncertain. Other re-treatment approaches may include “watch and wait” or other strategies such as the use of consensus interferon plus ribavirin. Consensus interferon, a wholly synthetic interferon, was developed based on the most commonly represented amino acid sequence of the 14 different subtypes of interferon-? and has been shown in clinical trials to produce sustained virological responses in up to one-third of patients who do not respond to initial therapy and up to 50% of those that relapse after treatment with peginterferon plus ribavirin. In this monograph, the benefits and challenges of each of these available and future treatment options will be discussed with an eye toward optimizing therapy for an individual patient.
Pearlman, Brian L.; Sjogren, Maria H.
The circadian nature of melatonin (MLT) secretion, coupled with the localization of MLT receptors to the suprachiasmatic nucleus, has led to numerous studies of the role of MLT in modulation of the sleep-wake cycle and circadian rhythms in humans. Although much more needs to be understood about the various functions exerted by MLT and its mechanisms of action, three therapeutic agents (ramelteon, prolonged-release MLT, and agomelatine) are already in use, and MLT receptor agonists are now appearing as new promising treatment options for sleep and circadian-rhythm related disorders. In this review, emphasis has been placed on medicinal chemistry strategies leading to MLT receptor agonists, and on the evidence supporting therapeutic efficacy of compounds undergoing clinical evaluation. A wide range of clinical trials demonstrated that ramelteon, prolonged-release MLT and tasimelteon have sleep-promoting effects, providing an important treatment option for insomnia and transient insomnia, even if the improvements of sleep maintenance appear moderate. Well-documented effects of agomelatine suggest that this MLT agonist offers an attractive alternative for the treatment of depression, combining efficacy with a favorable side effect profile. Despite a large number of high affinity nonselective MLT receptor agonists, only limited data on MT? or MT? subtype-selective compounds are available up to now. Administration of the MT?-selective agonist IIK7 to rats has proved to decrease NREM sleep onset latency, suggesting that MT? receptor subtype is involved in the acute sleep-promoting action of MLT; rigorous clinical studies are needed to demonstrate this hypothesis. Further clinical candidates based on selective activation of MT? or MT? receptors are expected in coming years. PMID:21554566
Spadoni, Gilberto; Bedini, Annalida; Rivara, Silvia; Mor, Marco
Limits of treatment in chronic inflammatory demyelinating poly(radiculo)neuropathies (CIDP) patients are better known thanks to recent Cochrane reviews. (1) Randomized controlled trials have only focused on short-term effects, but most patients need long-term therapy, (2) There are three proven effective treatments available (prednisone; intravenous immunoglobulin or IVIg and plasma exchange or PE) which are useful in more than 60 p. 100 of patients, (3) New open studies indicated possible efficacy for mycophenolate, rituximab, etanercept, ciclosporine and interferons, and (4) Whether CIDP variants need specific treatment is still unknown. Many CIDP patients need treatment for years. The fear of side effects during long-term steroid treatment, the high costs of IVIg, the necessity for specialized equipment and the invasive nature of PE, are important factors determining the choice for one of these treatments. In most up-to-date treatment options, patients are initially treated with IVIg at a dosage of 2 g/kg administered for 25 days, clinical improvement can be judged within 10 days. The percentage of patients responding seems to be approximately 70 percent, with a very high chance (approximately 85 percent) that repeated administration of IVIg will be necessary, explaining why most neurologists add an immunosuppressive drug at this stage, but there is no consensus concerning the best drug to be used. Combinations of drugs are most likely to be useful in the next future, using IVIg, prednisone, and a immunosuppressor agent, such as mycophenolate, rituximab, etanercept, or ciclosporine. General measures to rehabilitate patients and to manage symptoms like fatigue and other residual findings are important. PMID:16585918
Echinococcus granulosus and Echinococcus multilocularis are cestode parasites, of which the metacestode (larval) stages cause the neglected diseases cystic echinococcosis (CE) and alveolar echinococcosis (AE), respectively. The benzimidazoles albendazole and mebendazole are presently used for the chemotherapeutical treatment, alone or prior to and after surgery. However, in AE these benzimidazoles do not appear to be parasiticidal in vivo. In addition, failures in drug treatments as well as the occurrence of side-effects have been reported, leading to discontinuation of treatment or to progressive disease. Therefore, new drugs are needed to cure AE and CE. Strategies that are currently employed in order to identify novel chemotherapeutical treatment options include in vitro and in vivo testing of broad-spectrum anti-infective drugs or drugs that interfere with unlimited proliferation of cancer cells. The fact that the genome of E. multilocularis has recently been sequenced has opened other avenues, such as the selection of novel drugs that interfere with the parasite signalling machinery, and the application of in silico approaches by employing the Echinococcus genome information to search for suitable targets for compounds of known mode of action. PMID:19296876
Hemphill, A; Müller, J
Background: Periodontal debridement has an impact on the vascular thrombotic markers in healthy individuals. This study aimed to investigate changes in several vascular thrombotic markers after surgical and non-surgical periodontal debridement in hypertensives with periodontitis. Materials and Methods: 40 hypertensives, 27 males and 13 females, 37-68 year old, mean 51.2 years, with moderate to severe periodontitis, were divided into two groups, (n = 20 for each); the first received comprehensive one session non-surgical periodontal debridement, (pockets 4-6 mm), while the second received comprehensive supragingival scaling with surgical debridement at one quadrant, (Pockets > 6 mm). Periodontal parameters included; plaque index (PI), gingival inflammation (GI), bleeding on probing (BOP), pocket probing depth (PPD). Vascular thrombotic tests included; platelets count (Plt), fibrinogen (Fib), Von Willebrand factor antigen activity (vWF:Ag), and D-dimers (DD). Results: PI, GI, BOP, PPD, decreased significantly (P = 0.001) after 6 weeks of periodontal debridement in both groups, while BOP and PPD remained higher in the surgical one (P < 0.05). Thrombotic vascular markers changes through the three-time intervals were significant in each group (P = 0.001), and time-group interception effect was significant for vWF:Ag (P = 0.005), while no significant differences between groups after treatment (P > 0.05). Conclusion: Periodontal debridement, surgical and non-surgical, improved the periodontal status in hypertensives. Periodontal treatment activated the coagulation system in hypertensives and recessed later while the treatment modality did not affect the degree of activation.
Albush, Muhammad M.; Razan, Khattab K.; Raed, Al Dieri M.
Tobacco use is a global pandemic that poses a substantial and costly health burden. There are some treatment options are available, but currently marketed smoking-cessation drugs lack high levels of efficacy, particularly in real-life settings. Consequently, there is a compelling need for more effective pharmacotherapies to aid smokers in maintaining long-term abstinence. Advances in the understanding of the mechanisms involved in nicotine dependence have recently been translated into new medications and vaccines that interfere with nicotine signaling, many of which are currently at an advanced stage of development. In the present article we review current and emerging pharmacotherapies for tobacco dependence, focusing on the mechanistic rationale for their potential anti-addiction efficacy, major findings in preclinical and clinical studies, and future research directions. PMID:21256603
Polosa, Riccardo; Benowitz, Neal L
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
The aim of this study was to provide data on the prognosis and treatment options of headache associated with sexual activity (HSA). Sixty patients diagnosed with HSA between 1996 and 2004 were followed up between 2003 and 2006 at least 12 months after the first interview. The further course of the disease and their contentedness with therapy were requested. On average, the second interview was performed 35.9 months after the first examination. Of the 45 patients who had suffered from single attacks or bouts prior to baseline examination, 37 had no further attacks. Seven patients suffered from at least one further bout with an average duration of 2.1 months. One patient developed a chronic course of the disease after an episodic start. Of the 15 patients with chronic disease at the first examination, seven were in remission and five had ongoing attacks at follow-up. Ten patients received indomethacin for preemptive therapy, with good results in nine patients. Eighteen patients received beta-blockers for prophylaxis, with good results in 15 patients. Episodic HSA occurs in approximately three-quarters and chronic HSA in approximately one-quarter of patients. Even in chronic HAS, the prognosis is favourable, with remission rates of 69% during an observation period of 3 years. For patients with longer-lasting bouts or with chronic HSA, prophylactic treatment with beta-blockers or preemptive therapy with indomethacin are often successful. PMID:17919305
Frese, A; Rahmann, A; Gregor, N; Biehl, K; Husstedt, I-W; Evers, S
Radioiodine, antithyroid drugs and surgery have been well established therapies for Graves’ hyperthyroidism for several decades. However there remain large variations in practice among physicians in the preferred modality and the method of administration. Patient choice and perceptions also play a big role in the choice of treatment. Radioiodine may be given using fixed high doses or by calculated doses following uptake studies. The risks of radioiodine including eye disease and the role of prophylactic steroid therapy are discussed. The commonly used antithyroid drugs include carbimazole, methimazole and propylthiouracil; however a number of other agents have been tried in special situations or in combination with these drugs. The antithyroid drugs may be given in high (using additional levothyroxine in a block–replace regimen) or low doses (in a titration regimen). This review examines the current evidence and relative benefits for these options as well as looking at emerging therapies including immunomodulatory treatments such as rituximab which have come into early clinical trials. The use of antithyroid therapies in special situations is also discussed as well as clinical practice issues which may influence the choices.
Abraham, Prakash; Acharya, Shamasunder
Since the 1980s major advances in surgery, radiotherapy and chemotherapy have established multimodal approaches as curative treatment options for oesophageal cancer. In addition the introduction of functional imaging modalities such as PET-CT created new opportunities for a more adequate patient selection and therapy response assessment.The majority of oesophageal carcinomas are represented by two histologies: squamous cell carcinoma and adenocarcinoma. In recent years an epidemiological shift towards the latter was observed. From a surgical point of view, adenocarcinomas, which are usually located in the distal third of the oesophagus, may be treated with a transhiatal resection, whereas squamous cell carcinomas, which are typically found in the middle and the upper third, require a transthoracic approach. Since overall survival after surgery alone is poor, multimodality approaches have been developed. At least for patients with locally advanced tumors, surgery alone can no longer be advocated as routine treatment. Nowadays, scientific interest is focused on tumor response to induction radiochemotherapy. A neoadjuvant approach includes the early and accurate assessment of clinical response, optimally performed by repeated PET-CT imaging and endoscopic ultrasound, which may permit early adaption of the therapeutic concept. Patients with SCC that show clinical response by PET CT are considered to have a better prognosis, regardless of whether surgery will be performed or not. In non-responding patients salvage surgery improves survival, especially if complete resection is achieved. PMID:21615894
Wolf, Maria C; Stahl, Michael; Krause, Bernd J; Bonavina, Luigi; Bruns, Christiane; Belka, Claus; Zehentmayr, Franz
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
Gastrointestinal (GI) dysfunction is a common but underestimated feature in Parkinson's disease (PD). Out of the multimodal spectrum of treatment options, there currently are only a few pharmacological treatments available to improve gastrointestinal motility and symptoms. Because enteric nervous function is mainly regulated by transmitters different from those involved in the brain, dopamine replacement is not a treatment option in
D. Woitalla; O. Goetze
The purpose of this study was to elicit relative preferences for common treatment options of relapsed follicular lymphoma, and their associated attributes, amongst lymphoma patients in Alberta, and lymphoma-treating physicians in Canada, using a discrete choice experiment (DCE). Treatment administration, toxicity, survival free of relapse and cost were the attributes evaluated for four treatment options: standard chemotherapy (CT), radioimmunotherapy (RIT),
M Shafey; S M Lupichuk; C Owen; D A Stewart
The US Department of Energy (DOE), Office of Technology Development, established the Resource Recovery Project (RRP) in 1992 as a five-year effort to evaluate and demonstrate multiple technologies for recovering water, metals, and other industrial resources from contaminated surface and groundwater. Natural water resources located throughout the DOE complex and the and western states have been rendered unusable because of contamination from heavy metals. The Berkeley Pit, a large, inactive, open pit copper mine located in Butte, Montana, along with its associated groundwater system, has been selected by the RRP for use as a feedstock for a test bed facility located there. The test bed facility provides the infrastructure needed to evaluate promising technologies at the pilot plant scale. Data obtained from testing these technologies was used to assess their applicability for similar mine drainage water applications throughout the western states and at DOE. The objective of the Clean Option project is to develop strategies that provides a comprehensive and integrated approach to resource recovery using the Berkeley Pit water as a feedstock. The strategies not only consider the immediate problem of resource recovery from the contaminated water, but also manage the subsequent treatment of all resulting process streams. The strategies also employ the philosophy of waste minimization to optimize reduction of the waste volume requiring disposal, and the recovery and reuse of processing materials.
Gerber, M.A.; Orth, R.J.; Elmore, M.R.; Monzyk, B.F.
A significant percentage of patients demonstrate a poor antiplatelet response to clopidogrel. With the emergence of testing for genetic variations in drug-metabolizing enzyme function and testing for platelet function, it is becoming more common to identify patients as poor responders to clopidogrel. This leaves the clinician in a difficult situation when confronted with a patient deemed to be a poor clopidogrel responder as there is no clear therapeutic strategy for treating these patients. In this situation, a number of alternatives to conventional dosing of clopidogrel have been investigated, including increasing the dosage of clopidogrel, switching from clopidogrel to either prasugrel or ticagrelor, or adding cilostazol to clopidogrel therapy. All of these options have demonstrated pharmacologic benefit in terms of greater antiplatelet effects compared with standard clopidogrel dosing in patients with high on-treatment platelet reactivity or a genetic loss-of-function variant of CYP2C19, the main enzyme responsible for clopidogrel activation. However, the impact of each of these alternative therapies on clinical outcomes is poorly understood. Early studies have not shown a clinical benefit by increasing the clopidogrel dosage or switching to prasugrel although there is still much to be discovered in this area. Of the alternatives to standard dosing of clopidogrel, switching to either prasugrel or ticagrelor has the most potential benefit, but again, there is limited evidence to support this practice in patients who demonstrate high on-treatment platelet reactivity while on clopidogrel although the evidence is somewhat more supportive in patients who have a CYP2C19 loss-of-function variant allele. The evidence for increasing the dosage of clopidogrel or adding cilostazol is the least supportive, making these alternatives difficult to justify. Given the limited evidence to support switching treatments, some providers may simply opt to continue standard dosing of clopidogrel pending the results of ongoing trials. Much research is needed and is currently underway in this area, which will be helpful in establishing future treatment protocols for patients with poor clopidogrel response. PMID:24096929
Roberts, Daniela I; Nawarskas, James J
The term Excited Delirium Syndrome (ExDS) has traditionally been used in the forensic literature to describe findings in a subgroup of patients with delirium who suffered lethal consequences from their untreated severe agitation.(1-5) Excited delirium syndrome, also known as agitated delirium, is generally defined as altered mental status and combativeness or aggressiveness. Although the exact signs and symptoms are difficult to define precisely, clinical findings often include many of the following: tolerance to significant pain, rapid breathing, sweating, severe agitation, elevated temperature, delirium, non-compliance or poor awareness to direction from police or medical personnel, lack of fatiguing, unusual or superhuman strength, and inappropriate clothing for the current environment. It has become increasingly recognized that individuals displaying ExDS are at high risk for sudden death, and ExDS therefore represents a true medical emergency. Recently the American College of Emergency Physicians (ACEP) published the findings of a white paper on the topic of ExDS to better find consensus on the issues of definition, diagnosis, and treatment.(6) In so doing, ACEP joined the National Association of Medical Examiners (NAME) in recognizing ExDS as a medical condition. For both paramedics and physicians, the difficulty in diagnosing the underlying cause of ExDS in an individual patient is that the presenting clinical signs and symptoms of ExDS can be produced by a wide variety of clinical disease processes. For example, agitation, combativeness, and altered mental status can be produced by hypoglycemia, thyroid storm, certain kinds of seizures, and these conditions can be difficult to distinguish from those produced by cocaine or methamphetamine intoxication.(7) Prehospital personnel are generally not expected to differentiate between the multiple possible causes of the patient's presentation, but rather simply to recognize that the patient has a medical emergency and initiate appropriate stabilizing treatment. ExDS patients will generally require transfer to an emergency department (ED) for further management, evaluation, and definitive care. In this paper, we present a typical ExDS case and then review existing literature for current treatment options. PMID:22390995
Vilke, Gary M; Bozeman, William P; Dawes, Donald M; Demers, Gerard; Wilson, Michael P
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
Background The choice between surgical versus non-surgical treatment options is a fundamental decision for men with local stage prostate cancer because of differences in risks of genitourinary side effects among available treatments. Objectives We assessed whether preexisting genitourinary symptoms at the time of diagnosis influenced men’s preferences for surgery versus other management options. Methods We recruited 593 patients with newly diagnosed local stage prostate cancer prior to initiating treatment from an integrated health care system, an academic urology center, and community urology clinics. Using logistic regression we compared whether men had a preference for non-surgical options or only preferred surgery. Results Nearly 60% indicated they were considering non-surgical options. Age and clinical characteristics but not preexisting genitourinary symptoms influenced the decision between preferences for surgical or non-surgical options. A total of 62% of men reported side effects as a main factor in their treatment decision. Men with more aggressive tumor types were less likely to consider side effects, however, men who reported poor ability to have an erection were more likely to consider side effects (p<0.001). Conclusion Sexual dysfunction at time of diagnosis, but not other genitourinary symptoms, is associated with men considering treatment-related side effects when considering surgery versus other options. Men who are not experiencing sexual dysfunction at diagnosis may discount the risks of side effects in the decision making process.
Zeliadt, Steven B.; Ramsey, Scott D.; Potosky, Arnold L.; Arora, Neeraj K.; Blough, David K.; Oakley-Girvan, Ingrid; Hamilton, Ann S.; Van Den Eeden, Stephen K.; Penson, David F.
Methods of transferring one bovine embryo to the ipsilateral uterine horn have been compared. In heifers mid-ventral surgical laparotomy under general anaesthesia (n=22) was compared with flank surgery with paravertebral anaesthesia (n=21). Pregnancy rate was higher with a midventral approach (P less than 0.05) (77.3 per cent of 42.9 per cent respectively). In heifers mid-ventral surgery (n=36) was compared with two methods of non-surgical transfer either using the Cassou insemination gun (n=36) or a modification of it (n=39) with embryos collected on days 7, 8 or 10 after oestrus. There were no differences in pregnancy rate between methods or different ages of embryos (methods: 55.6, 55.6, 43.6 per cent respectively; Day: 48.8, 55.8, 48.1 per cent respectively) but the condition score of recipients affected success (P less than 0.05). Of 10 cows which each received an embryo using the modified Cassou gun eight became pregnant. PMID:532048
Gastrointestinal (GI) dysfunction is a common but underestimated feature in Parkinson's disease (PD). Out of the multimodal spectrum of treatment options, there currently are only a few pharmacological treatments available to improve gastrointestinal motility and symptoms. Because enteric nervous function is mainly regulated by transmitters different from those involved in the brain, dopamine replacement is not a treatment option in PD patients. This article focuses on the known regulative mechanism of GI function and presents known and upcoming treatment options for GI dysfunction in PD. PMID:21798561
Woitalla, D; Goetze, O
The detrimental effects of cancer on male fertility are multi- factorial and may be secondary to the disease process itself or to therapeutic interventions. Patients and their doctors need to be better informed about the options men with cancer have to preserve their fertility status. Sperm banking is a safe and effective means of storing sperm before chemotherapy, radiotherapy, or
David Shin; Kirk C. Lo; Larry I. Lipshultz
The presence of a vertebral fracture increases the risk of a new fracture within a year by at least five times and the risk further increases in case of recurrent fractures (domino effect).The pain and fracture kyphosis can compromise respiratory function. Many patients sustain serious cardiovascular, musculoskeletal, metabolic, and immune complications related to immobility and bedrest. This study is a clinical and radiological assessment of a consecutive cohort of 50 patients with vertebral fractures. We made comparison of 25 vertebral compression fractures treated with surgical (kyphoplasty) or non surgical approach.Systematic reviews of this procedure have shown significantly improved back pain and quality of life compared to conservative therapy. When performed by a well-trained practitioner in appropriately selected patients, kyphoplasty is a safe and effective treatment for fresh vertebral compression fractures. PMID:23289035
Giannotti, Stefano; Carmassi, Fabio; Bottai, Vanna; Dell'osso, Giacomo; Gazzarri, Francesco; Guido, Giulio
Summary The presence of a vertebral fracture increases the risk of a new fracture within a year by at least five times and the risk further increases in case of recurrent fractures (domino effect). The pain and fracture kyphosis can compromise respiratory function. Many patients sustain serious cardiovascular, musculoskeletal, metabolic, and immune complications related to immobility and bedrest. This study is a clinical and radiological assessment of a consecutive cohort of 50 patients with vertebral fractures. We made comparison of 25 vertebral compression fractures treated with surgical (kyphoplasty) or non surgical approach. Systematic reviews of this procedure have shown significantly improved back pain and quality of life compared to conservative therapy. When performed by a well-trained practitioner in appropriately selected patients, kyphoplasty is a safe and effective treatment for fresh vertebral compression fractures.
Giannotti, Stefano; Carmassi, Fabio; Bottai, Vanna; Dell'Osso, Giacomo; Gazzarri, Francesco; Guido, Giulio
Multiple colonic polyps, almost guaranteed colorectal cancer by the age of forty-five and an increased risk of non-colonic cancers characterise the autosomal dominant condition Familial Adenomatous Polyposis (FAP) . The patients and families faced with such a diagnosis present many difficult management challenges, both surgical and non-surgical. We discuss the current surgical options for treatment of the more significant manifestations of FAP arising in the colorectum and duodenum as well as desmoid disease
Patients with severe alcoholic hepatitis (AH) need to be treated with specific treatment for better outcome. Currently available specific treatment modalities are use of corticosteroids or pentoxifylline. However, the response rate to these drugs is only about 50%-60%. Hence, there is an urgent need for better and more effective treatment options. Tumor necrosis factor plays an important role in the pathogenesis of AH. However, agents blocking the action of tumor necrosis factor have not been found to be effective. Rather the randomized studies evaluating these agents showed an adverse effect and more infections in treated patients. Critical role of tumor necrosis factor in hepatic regeneration explaining this contrast is discussed. Oxidative stress and inflammation derived from gut bacteria ate two main components in the pathogenesis of AH laying foundation for the role of antioxidants, probiotics, and antibiotics in the management of AH. This article reviews the current data and status of these newer agents for the treatment of AH. Of the various options available, Vitamin E and N-acetylcysteine (NAC) have shown great promise for clinical use as adjunct to corticosteroids. With these encouraging data, future well designed studies are suggested to assess Vitamin E and NAC before their routine use in clinical practice in the management of AH.
Reep, Gabriel L; Soloway, Roger D
Anterior femoroacetabular impingement (FAI) is a major etiologic factor in the pathogenesis of hip arthritis. In this condition, mechanical abnormalities of the hip joint lead to early hip dysfunction, inflammation, cartilage injury, and eventual joint degradation. FAI is now more commonly diagnosed and there is an increasing need for a thorough understanding of the broad spectrum of clinical presentation for the disease as well as more precise definition of the possible surgical options.
Zebala, Lukas P; Schoenecker, Perry L; Clohisy, John C
Viral infections of the skin can cause significant distress and embarrassment for people who are affected. This article explores four specific viral infections that manifest on the skin: herpes simplex, herpes zoster, viral warts and molluscum contagiosum. It describes the presentation and appearance of the virus as it affects the skin and what can be done to minimise the spread of the virus. Management options are considered, although many of these conditions are self-limiting. PMID:23980989
Background Traction therapy has been utilized in the treatment of low back pain for decades. The most recent incarnation of traction therapy is non-surgical spinal decompression therapy which can cost over $100,000. This form of therapy has been heavily marketed to manual therapy professions and subsequently to the consumer. The purpose of this paper is to initiate a debate pertaining to the relationship between marketing claims and the scientific literature on non-surgical spinal decompression. Discussion Only one small randomized controlled trial and several lower level efficacy studies have been performed on spinal decompression therapy. In general the quality of these studies is questionable. Many of the studies were performed using the VAX-D® unit which places the patient in a prone position. Often companies utilize this research for their marketing although their units place the patient in the supine position. Summary Only limited evidence is available to warrant the routine use of non-surgical spinal decompression, particularly when many other well investigated, less expensive alternatives are available.
Daniel, Dwain M
The objectives of the research were to (1) develop an innovative CDSS that will enable women to integrate the information available to them, understand diagnoses, treatment options, and risks associated with treatment options, construct and structure thei...
D. H. Gustafson
The acute respiratory distress syndrome (ARDS) is a clinical syndrome with primarily supportive management options. Despite extensive basic and clinical investigations, multiple pharmacological and nonpharmacological modalities have been unsuccessful in decreasing mortality. Nonetheless, these efforts have substantially heightened our understanding of ARDS pathophysiology. Investigators continue to create new and more complex therapeutic strategies that may have significant clinical impact. Several pharmacological agents for ARDS are in development and have shown either great promise or are at most, under phase II evaluation. The order in which therapeutic options are presented in this review highlights therapeutic options other than the anti-inflammatory approach. In addition to the anti-inflammatory category, vasodilators, surfactant therapy, immunonutrition and partial liquid ventilation are all being evaluated. Within the anti-inflammatory category. new mechanistic approaches include the 'anti-inflammatory nature' of interleukin-10, the inhibitory aspects of lysophosphatidic acid on endothelial cell permeability, and the use of recombinant human anti-coagulant proteins (activated protein C and tissue factor pathway inhibitor) to reduce the inflammatory cycle that contributes to microvascular thrombi. Previous work with surfactant in ARDS had its limitations, however, these trials were of sufficient success to spawn 2 new synthetic compounds. These new synthetic surfactants incorporate mixtures of phosphatidylcholine and phosphatidylglycerol (the key phospholipids within endogenous surfactant) and either recombinant surfactant protein C or an analogue of surfactant protein B. Recently, the ARDS Network's low tidal volume study has broken the cycle of decades of negative ARDS trials and demonstrated an improvement in mortality. Through better mechanistic approach and study design, investigator compliance with exclusion criteria, and better understanding of the complexities of patient management, the next pharmacological ARDS trials will hopefully be successful and lead to further reductions in patient mortality. PMID:11434447
Hite, R D; Morris, P E
... medical and surgical treatments available for Parkinson disease (PD). Medical treatment includes medications, education, support, exercise, physical ... Beyond the Basics)" .) The symptoms and diagnosis of PD are also discussed separately. (See "Patient information: Parkinson ...
... 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 ...
Patients with metastatic breast cancer frequently undergo aggressive therapies that have an uncertain quality-adjusted survival advantage. Framing theory suggests that individuals may not maximize their expected utility if presented with treatment options...
K. A. Schulman K. R. Yabroff K. F. Gold N. J. Meropol L. E. Rubenstein
Background: The standard treatment of chylothorax in pediatric intensive care today includes conservative therapy with fat-free nutrition, total parenteral nutrition and, if this is not successful, operative treatment (pleurodesis, ligation of the duct, pleuroperitoneal shunt). Patients: We describe four patients who were not in a suitable condition for operative treatment and who were treated with continuous infusion of somatostatin. Results:
V. Buettiker; M. Hug; R. Burger; O. Baenziger
Carpal tunnel syndrome (CTS) is a common disorder, for which various conservative treatment options are available. The objective\\u000a of this study is to determine the efficacy of the various conservative treatment options for relieving the symptoms of CTS.\\u000a Computer-aided searches of MEDLINE (1\\/1966 to 3\\/2000), EMBASE (1\\/1988 to 2\\/2000) and the Cochrane Controlled Trials Register\\u000a (2000, issue 1) were conducted,
Annette A. M. Gerritsen; Marc C. T. F. M. de Krom; Margaretha A. Struijs; Rob J. P. M. Scholten; Henrica C. W. de Vet; Lex M. Bouter
Psychotherapy and antidepressant medications are the two preeminent treatment choices for depression. This article puts each\\u000a of these treatments into perspective by presenting an overview of what is currently known about their effectiveness either\\u000a singly or in combination. Discussion of placebos, common factors among therapies, relapse rates, depression severity, patient\\u000a treatment preferences and exaggerations in pharmaceutical advertising provide guidance for
Roger P. Greenberg; Elizabeth Davis Goldman
With the aromatase inhibitors (AIs) replacing tamoxifen as the first-line treatment for postmenopausal women with hormone receptor-positive early and advanced breast cancer, there is a need to evaluate appropriate endocrine treatment options following AI failure. However, until recently, there were no Phase III trial data in this area. Fulvestrant (Faslodex™) is an oestrogen receptor antagonist utilised for the treatment of
Stephen Chia; William Gradishar
Anal squamous cell cancer is an uncommon malignancy caused by infection with oncogenic strains of Human papilloma virus. Anal cancer is much more common in immunocompromised persons, including those infected with Human immunodeficiency virus. High-grade anal intraepithelial neoplasia (HGAIN), the precursor of anal cancer, is identified by clinicians providing care for patients with anorectal disease, and is increasingly being identified during screening of immunosuppressed patients for anal dysplasia. The traditional treatment for HGAIN has been excision of macroscopic disease with margins. This approach is effective for patients with small unifocal HGAIN lesions. Patients with extensive multifocal HGAIN frequently have recurrence of HGAIN after excision, and may have postoperative complications of anal stenosis or fecal incontinence. This led to the suggestion by some that treatment for HGAIN should be delayed until patients developed anal cancer. Alternative approaches in identification and treatment have been developed to treat patients with multifocal or extensive HGAIN lesions. High-resolution anoscopy combines magnification with anoscopy and is being used to identify HGAIN and determine treatment margins. HGAIN can then be ablated with a number of modalities, including infrared coagulation, CO2 laser, and electrocautery. These methods for HGAIN ablation can be performed with local anesthesia on outpatients and are relatively well tolerated. High-resolution anoscopy-directed HGAIN ablation is evolving into a standard approach for initial treatment and then subsequent monitoring of a disease which should be expected to be recurrent. Another treatment approach for HGAIN is topical treatment, principally with 5-fluorouracil or imiquimod. Topical therapies have the advantage of being nonsurgical and are well suited for treating widespread multifocal disease. Topical treatments have the disadvantage of requiring extended treatment courses and causing a symptomatic inflammatory response. Successful treatment requires adherence to a regime that is uncomfortable at best and at worst painful. Topical treatments can be successful in motivated adherent patients willing to accept these side effects.
Weis, Stephen E
... the groin and/or pelvis are treated with external beam radiation therapy. Stage II The usual treatment is radiation , using ... Stage III or IVA The usual treatment is radiation therapy , often with both brachytherapy and external beam radiation. Curative surgery is generally not attempted. Chemo ...
Postpartum depression (PPD) is the most common complication of childbirth and affects one out of seven childbearing women. While conventional pharmacological and psychotherapeutic antidepressant treatments are effective for PPD, a natural alternative may be preferred by postpartum women, especially those who breastfeed their infants. The treatment of PPD with synthetic forms of naturally occurring estrogen is mechanistically appealing because PPD occurs in the context of estrogen withdrawal at parturition. Preliminary evidence suggests that PPD is a disorder of hormone-related mood dysregulation (similar to perimenopausal depression) that can be effectively treated with estrogen. This review provides the basic science and clinical background as well as safety considerations to support the application of transdermal estradiol as a treatment for PPD. We conclude that estradiol treatment for PPD requires confirmation of efficacy in a randomized clinical trial prior to routine clinical use as monotherapy. Additional data regarding maternal tolerability of cyclic progestins, long-term safety of estradiol treatment, estradiol passage into breastmilk and infants, and interdisciplinary collaboration among psychiatrists and gynecologists is also needed before estradiol is used in women who decline or fail to respond to first-line antidepressant treatments, or as an augmentation of conventional antidepressant treatment.
Moses-Kolko, Eydie L.; Berga, Sarah L.; Kalro, Brinda; Sit, Dorothy K.Y.; Wisner, Katherine L.
Clinical opinions regarding treatment of intermittent exotropia (IXT) vary widely and there is controversy as to which treatment modality is most successful. This paper reviews the clinical literature related to five different treatment modalities used for IXT: overminus lens therapy, prism therapy, occlusion therapy, extraocular muscle surgery, and orthoptic vision therapy. Based upon review of 59 studies of treatment of IXT, and using each author's stated criteria for success, the following pooled success rates were revealed: over-minus lens therapy (N = 215), 28%; prism therapy (N = 201), 28%; occlusion therapy (N = 170), 37%; extraocular muscle surgery (N = 2530), 46%; and orthoptic vision therapy (N = 740), 59%. Success rates for IXT surgery differed depending upon whether a functional (43%) or cosmetic (61%) criterion was used to evaluate treatment success. These pooled success rates must be viewed carefully because nearly all the studies suffer from serious scientific flaws such as small sample sizes, selection bias, inadequately defined treatments and success criteria, absence of statistical analysis, and results reported in a manner that makes interpretation difficult. These problems indicate the need for a careful, circumscribed, and well controlled clinical trial to study the efficacy of different treatment modalities in remediating IXT. PMID:1594200
Coffey, B; Wick, B; Cotter, S; Scharre, J; Horner, D
Opinion statement Multiple factors support treatment of hepatitis C virus (HCV) infection in children. These factors include the anticipated\\u000a long duration of infection after early acquisition, relatively good tolerance of antiviral medications, and avoidance of social\\u000a stigmatization. Nevertheless, careful selection of appropriate candidates for therapy is important. If a contraindication\\u000a to current therapeutic agents is present, treatment should be withheld until
Aymin Delgado-Borrego; Maureen M. Jonas
Opinion statement It seems clear that thermal-based therapies of prostate cancer have the potential to completely eradicate the prostate gland.\\u000a Technical modifications continue to improve our ability to use these modalities more effectively, which can be seen in the\\u000a ever decreasing morbidity from damage to adjacent structures. These treatments offer potential major advantages over surgery\\u000a and radiation-based treatment modalities.
Michael O. Koch; Thomas A. Gardner
Belimumab is the first biologic approved for patients with systemic lupus erythematosus (SLE). Belimumab is the first of a new class of drug targeting B cell-stimulating factors or their receptors to reach the market. Its target, BLyS, also known as BAFF (B cell-activating factor from the tumor necrosis factor family), is a type II transmembrane protein that exists in both membrane-bound and soluble forms. Additionally to a robust rational from murine experiments conducted in lupus prone mice, BLyS circulating levels are increased in SLE patients. After the negative results of a Phase II trial, two Phase III trials met their primary endpoints. Some SLE patients are still refractory to the standard options of care or necessitate prolonged high-dose corticotherapy and/or long-term immunosuppressive regimens. However, some experts still feel that the effect of this biologic might not be clinically relevant and blame the use of the new systemic lupus response index as well as the discrepancies between both trials and the noninclusion of the severe form of the disease as nephritis. In this review, we aim to discuss the characteristics of belimumab, critically evaluate the different steps of its development, and consider its future place in the arsenal against SLE, taking into account the patients' perspectives. PMID:22346356
Chiche, Laurent; Jourde, Noémie; Thomas, Guillemette; Bardin, Nathalie; Bornet, Charleric; Darque, Albert; Mancini, Julien
Belimumab is the first biologic approved for patients with systemic lupus erythematosus (SLE). Belimumab is the first of a new class of drug targeting B cell-stimulating factors or their receptors to reach the market. Its target, BLyS, also known as BAFF (B cell-activating factor from the tumor necrosis factor family), is a type II transmembrane protein that exists in both membrane-bound and soluble forms. Additionally to a robust rational from murine experiments conducted in lupus prone mice, BLyS circulating levels are increased in SLE patients. After the negative results of a Phase II trial, two Phase III trials met their primary endpoints. Some SLE patients are still refractory to the standard options of care or necessitate prolonged high-dose corticotherapy and/or long-term immunosuppressive regimens. However, some experts still feel that the effect of this biologic might not be clinically relevant and blame the use of the new systemic lupus response index as well as the discrepancies between both trials and the noninclusion of the severe form of the disease as nephritis. In this review, we aim to discuss the characteristics of belimumab, critically evaluate the different steps of its development, and consider its future place in the arsenal against SLE, taking into account the patients’ perspectives.
Chiche, Laurent; Jourde, Noemie; Thomas, Guillemette; Bardin, Nathalie; Bornet, Charleric; Darque, Albert; Mancini, Julien
Peritoneal carcinomatosis (PC) is one manifestation of metastatic colorectal cancer (CRC). Tumor growth on intestinal surfaces and associated fluid accumulation eventually result in bowel obstruction and incapacitating levels of ascites, which profoundly affect the quality of life for affected patients. PC appears resistant to traditional 5-fluorouracil-based chemotherapy, and surgery was formerly reserved for palliative purposes only. In the absence of effective treatment, the historical prognosis for these patients was extremely poor, with an invariably fatal outcome. These poor outcomes likely explain why PC secondary to CRC has received little attention from oncologic researchers. Thus, data are lacking regarding incidence, clinical disease course, and accurate treatment evaluation for patients with PC. Recently, population-based studies have revealed that PC occurs relatively frequently among patients with CRC. Risk factors for developing PC have been identified: right-sided tumor, advanced T-stage, advanced N-stage, poor differentiation grade, and younger age at diagnosis. During the past decade, both chemotherapeutical and surgical treatments have achieved promising results in these patients. A chance for long-term survival or even cure may now be offered to selected patients by combining radical surgical resection with intraperitoneal instillation of heated chemotherapy. This combined procedure has become known as hyperthermic intraperitoneal chemotherapy. This editorial outlines recent advancements in the medical and surgical treatment of PC and reviews the most recent information on incidence and prognosis of this disease. Given recent progress, treatment should now be considered in every patient presenting with PC.
Klaver, Yvonne LB; Lemmens, Valery EPP; Nienhuijs, Simon W; Luyer, Misha DP; de Hingh, Ignace HJT
Faropenem medoxomil is the first oral penem in a new class of beta-lactam antibiotics. Faropenem medoxomil has excellent in vitro activity against Streptococcus pneumoniae, Haemophilus influenzae and other key pathogens implicated in acute bacterial rhinosinusitis. Clinical studies have demonstrated that, in the treatment of acute bacterial rhinosinusitis in adults, 7 days of treatment with faropenem medoxomil is as clinically and bacteriologically effective as 10 days of treatment with cefuroxime axetil. One study showed faropenem medoxomil to be superior to cefuroxime axetil. Overall, the safety profile of faropenem medoxomil is similar to that of most comparators. Specifically, the minimal impact of faropenem medoxomil on the gastrointestinal flora leads to less diarrhea and other adverse events than coamoxicillin-clavulanate. Faropenem medoxomil has almost no drug-drug interactions and little requirement for dosage adjustments in the typical acute rhinosinusitis population. PMID:17181408
Hadley, James A; Tillotson, Glenn S; Tosiello, Robert; Echols, Roger M
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
Postpartum depression (PPD) is a common complication of childbearing, and has increasingly been identified as a major public health problem. Untreated maternal depression has multiple potential negative effects on maternal-infant attachment and child development. Screening for depression in the perinatal period is feasible in multiple primary care or obstetric settings, and can help identify depressed mothers earlier. However, there are multiple barriers to appropriate treatment, including concerns about medication effects in breastfeeding infants. This article reviews the literature and recommendations for the treatment of postpartum depression, with a focus on the range of pharmacological, psychotherapeutic, and other nonpharmacologic interventions.
Fitelson, Elizabeth; Kim, Sarah; Baker, Allison Scott; Leight, Kristin
Intoeing, a common entrance complaint in infants, toddlers, and young children, is best defined as internal rotation of the long axis of the foot to the line of progression. Intoeing may be caused by primary deformities within the foot, issues with tibial torsion, and femoral antetorsion (anteversion). Problems within the foot include hallux varus, metatarsus adductus, talipes equinovarus, and pes cavus, each of which has specific treatments available. Treatment must be individualized, and the risks and complications weighed against the predictable morbidity of intoeing. PMID:24075135
... and how long treatment may take. Treating your rotator cuff tear without surgery Rotator cuff tears are treated without surgery in ... when you should start feeling better. Repairing your rotator cuff tear with surgery How long do I wait before choosing surgery? ...
Percutaneous vertebral augmentation, with percutaneous vertebroplasty (PVP) as its most widely used variant, is currently the only intervention for painful osteoporotic compression fractures. This procedure offers immediate and substantial pain relief in over 80% of treated patients with a low reported complication rate (< 1.6%). A large number of studies have shown promising results and the superiority of this treatment over conservative treatment has been established. Results of the first two, long-awaited, placebo-controlled trials were unexpected: improvement after PVP was similar to improvement after placebo treatment. Limitations in the design of both trials prevented widespread implementation of the results. We believe that PVP cannot be regarded as an obsolete treatment as long as patients are carefully selected. Patients with persistent (over 2 months) and painful osteoporotic vertebral fractures have been shown to benefit from vertebroplasty and are therefore suitable candidates for this procedure, which, in these cases, can prevent complications due to long-term disabling pain. PMID:20719017
Nieuwenhuijse, Marc J; Dijkstra, P D Sander
Renal angiomyolipomas (AMLs) are benign renal masses that are often asymptomatic and detected incidentally. However, treatment might be necessary in symptomatic presentations or when the mass exceeds 4 cm in size. While the goal of management for renal AMLs is to relieve symptoms and prevent hemorrhage, a priority is renal function preservation, especially given the propensity of these lesions to recur. The traditional treatment for renal AMLs is renal angioembolization or surgical excision of the lesion. With advancements in minimally invasive surgery, several other modalities have now emerged for nephron sparing approaches. These include angioembolization, laparoscopic and percutaneous ablative therapies such as radiofrequency ablation, cryoablation and microwave ablation, and pure or robot-assisted laparoscopic partial nephrectomy. Given the relatively low frequency of renal AMLs requiring treatment, much of the available literature on these minimally invasive approaches is largely extrapolative, based on series on small renal masses, i.e. renal cell carcinoma (RCC). This report is based on a thorough review of the published literature to date on the minimally invasive treatment and outcomes of renal AMLs. PMID:23378161
Sivalingam, Sri; Nakada, Stephen Y
Context: Low back pain is one of the most common medical presentations in the general population. It is a common source of pain in athletes, leading to significant time missed and disability. The general categories of treatment for low back pain are medications and therapies. Evidence acquisition: Relevant studies were identified through a literature search of MEDLINE and the Cochrane Database from 1990 to 2010. A manual review of reference lists of identified sources was also performed. Results: It is not clear whether athletes experience low back pain more often than the general public. Because of a aucity of trials with athlete-specific populations, recommendations on treatments must be made from reviews of treatments for the general population. Several large systemic reviews and Cochrane reviews have compiled evidence on different modalities for low back pain. Superficial heat, spinal manipulation, nonsteroidal anti-inflammatory medications, and skeletal muscle relaxants have the strongest evidence of benefit. Conclusions: Despite the high prevalence of low back pain and the significant burden to the athletes, there are few clearly superior treatment modalities. Superficial heat and spinal manipulation therapy are the most strongly supported evidence-based therapies. Nonsteroidal anti-inflammatory medications and skeletal muscle relaxants have benefit in the initial management of low back pain; however, both have considerable side effects that must be considered. Athletes can return to play once they have recovered full range of motion and have the strength to prevent further injury.
Petering, Ryan C.; Webb, Charles
As people grow old, their need for medications increases dramatically because of the higher incidence of chronic pain, diabetes mellitus, cardiovascular and neurological diseases in the elderly population. Furthermore, the elderly require special consideration with respect to drug delivery, drug interactions and adherence. In particular, patients with chronic neurological diseases often require multiple administration of drugs during the day to maintain constant plasma medication levels, which in turn increases the likelihood of poor adherence. Consequently, several attempts have been made to develop pharmacological preparations that can achieve a constant rate of drug delivery. For example, transdermal lisuride and apomorphine have been shown to reduce motor fluctuations and duration of 'off' periods in advanced Parkinson's disease, while rotigotine allows significant down-titration of levodopa without severe adverse effects. Thus, parkinsonian patients with long-term levodopa syndrome or motor disorders during sleep could benefit from use of transdermal lisuride and apomorphine. Moreover, transdermal dopaminergic drugs, particularly rotigotine, seem the ideal treatment for patients experiencing restless legs syndrome or periodic limb movement disorder during sleep, disorders that are quite common in elderly people or in association with neurodegenerative diseases. Unlike dopaminergic drugs, transdermal treatments for the management of cognitive and behavioural dysfunction in patients with Parkinson's disease and Alzheimer's disease have inconsistent effects and no clearly established role. Nevertheless, because of their favourable pharmacological profile and bioavailability, the cholinesterase inhibitors tacrine and rivastigmine are expected to show at least the same benefits as oral formulations of these drugs, but with fewer severe adverse effects. Transdermal delivery systems play an important role in the management of neuropathic pain. The transdermal lidocaine (lignocaine) patch is recommended as first-line therapy for the treatment of postherpetic neuralgia. Furthermore, in patients with severe persistent pain, transdermal delivery systems using the opioids fentanyl and buprenorphine are able to achieve satisfactory analgesia with good tolerability, comparable to the benefits seen with oral formulations. Transdermal administration is the ideal therapeutic approach for chronic neurological disorders in elderly people because it provides sustained therapeutic plasma levels of drugs, is simple to use, and may reduce systemic adverse effects. Several transdermal delivery systems are currently under investigation for the treatment of Parkinson's disease, Alzheimer's disease and neuropathic pain. Although most transdermal delivery systems treatments cannot be considered as first-line therapy at present, some of them provide clear advantages compared with other routes of administration and may become the preferred treatment in selected patients. In general, however, most transdermal treatments still require long-term evaluation in large patient groups in order to optimise dosages and evaluate the actual incidence of local and systemic adverse effects. PMID:16823990
Priano, Lorenzo; Gasco, Maria Rosa; Mauro, Alessandro
Study design:?Systematic reviewObjective:?To compare the safety and effectiveness of fusion versus denervation for chronic sacroiliac joint pain after failed conservative management.Summary of background:?Methods of confirming the sacroiliac joint as a pain source have been extensively studied and reported in the literature. After confirmation of the origin of the pain by positive local anesthetic blocks, chronic sacroiliac joint pain is usually managed with a combination of medication, physical therapies, and injections. We have chosen to compare two alternative treatments for sacroiliac pain that was refractory to conservative therapies.Methods:?A systematic review of the English-language literature was undertaken for articles published between 1970 and June 2010. Electronic databases and reference lists of key articles were searched to identify studies evaluating fusion or denervation for chronic sacroiliac joint pain after failed conservative management. Studies involving only conservative treatment or traumatic onset of injury were excluded. Two independent reviewers assessed the level of evidence quality using the grading of recommendations assessment, development and evaluation (GRADE) system, and disagreements were resolved by consensus.Results:?We identified eleven articles (six fusion, five denervation) meeting our inclusion criteria. The majority of patients report satisfaction after both treatments. Both treatments reported mean improvements in pain and functional outcome. Rates of complications were higher among fusion studies (13.7%) compared to denervation studies (7.3%). Only fusion studies reported infections (5.3%). No infections were reported among denervation patients. The evidence for all findings were very low to low; therefore, the relative efficacy or safety of one treatment over another cannot be established.Conclusions:?Sacroiliac joint fusion or denervation can reduce pain for many patients. Whether a true arthrodesis of the joint is achieved by percutaneous techniques is open to question and whether denervation of the joint gives durable pain relief is not clear. Further comparative studies of these two techniques may provide the answers. PMID:22956926
Ashman, Bryan; Norvell, Daniel C; Hermsmeyer, Jeffrey T
Study design:?Systematic review Objective:?To compare the safety and effectiveness of fusion versus denervation for chronic sacroiliac joint pain after failed conservative management. Summary of background:?Methods of confirming the sacroiliac joint as a pain source have been extensively studied and reported in the literature. After confirmation of the origin of the pain by positive local anesthetic blocks, chronic sacroiliac joint pain is usually managed with a combination of medication, physical therapies, and injections. We have chosen to compare two alternative treatments for sacroiliac pain that was refractory to conservative therapies. Methods:?A systematic review of the English-language literature was undertaken for articles published between 1970 and June 2010. Electronic databases and reference lists of key articles were searched to identify studies evaluating fusion or denervation for chronic sacroiliac joint pain after failed conservative management. Studies involving only conservative treatment or traumatic onset of injury were excluded. Two independent reviewers assessed the level of evidence quality using the grading of recommendations assessment, development and evaluation (GRADE) system, and disagreements were resolved by consensus. Results:?We identified eleven articles (six fusion, five denervation) meeting our inclusion criteria. The majority of patients report satisfaction after both treatments. Both treatments reported mean improvements in pain and functional outcome. Rates of complications were higher among fusion studies (13.7%) compared to denervation studies (7.3%). Only fusion studies reported infections (5.3%). No infections were reported among denervation patients. The evidence for all findings were very low to low; therefore, the relative efficacy or safety of one treatment over another cannot be established. Conclusions:?Sacroiliac joint fusion or denervation can reduce pain for many patients. Whether a true arthrodesis of the joint is achieved by percutaneous techniques is open to question and whether denervation of the joint gives durable pain relief is not clear. Further comparative studies of these two techniques may provide the answers.
Ashman, Bryan; Norvell, Daniel C.; Hermsmeyer, Jeffrey T.
Adrenocortical carcinoma (ACC) is a very rare endocrine tumour, with variable prognosis, depending on tumour stage and time of diagnosis. The overall survival is five years from detection. Radical surgery is considered the therapy of choice in the first stages of ACC. However postoperative disease-free survival at 5 years is only around 30% and recurrence rates are frequent. o,p'DDD (ortho-, para'-, dichloro-, diphenyl-, dichloroethane, or mitotane), an adrenolytic drug with significant toxicity and unpredictable therapeutic response, is used in the treatment of ACC. Unfortunately, treatment for this aggressive cancer is still ineffective. Over the past years, the growing interest in ACC has contributed to the development of therapeutic strategies in order to contrast the neoplastic spread. In this paper we discuss the most promising therapies which can be used in this endocrine neoplasia.
Stigliano, Antonio; Cerquetti, Lidia; Sampaoli, Camilla; Bucci, Barbara; Toscano, Vincenzo
Treatments available for ocular inflammatory diseases and their associated complications have expanded significantly over the course of the last ten years. While corticosteroids are a mainstay of therapy for uveitis and macular edema, the methods of delivering corticosteroids have evolved. Intravitreal triamcinolone acetonide provides a local therapy for persistent cystoid macular edema (CME) and posterior uveitis. Other intravitreal therapies, such as bevacizumab and methotrexate, have also been used successfully in uveitic CME. Sustained release intravitreal implants, including the fluocinolone acetonide implant and the dexamethasone drug delivery system, offer an alternative therapy for chronic, recalcitrant posterior uveitis and CME. Their design was inspired by the ganciclovir implant, which prevented the progression of CMV retinitis in AIDS patients. Technological advances in drug delivery have supplied new treatments for patients with ocular inflammatory disease. PMID:21091013
Lobo, Ann-Marie; Sobrin, Lucia; Papaliodis, George N
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.
Sakhaee, Khashayar; Maalouf, Naim M.; Kumar, Rajiv; Pasch, Andreas; Moe, Orson W.
Opinion statement Status epilepticus treatment involves the use of several pharmacologic compounds, which are conceptually divided into three\\u000a successive and additional lines of action. Because of their rapid onset of action, benzodiazepines represent the first approach;\\u000a these are followed by classic antiepileptic drugs that are administered intravenously. In refractory episodes, pharmacologic\\u000a coma induction with an appropriate anesthetic is advocated. Apart from
Andrea O. Rossetti
Male hypogonadism is one of the most frequent, but also most underdiagnosed, endocrinopathies. However, the required testosterone treatment is simple and very effective if properly administered. Although testosterone has been available for clinical use for seven decades, until quite recently the treatment modalities were far from ideal. Subdermal testosterone pellets require minor surgery for insertion and often cause local problems. The injectable testosterone enanthate, for a long period the most frequently used mode of administration, lasts for two to four weeks, but produces supraphysiological levels initially and low levels before the next injection. The oral testosterone undecanoate has to be taken three times daily, has an uncertain absorption pattern and results in peaks and valleys of serum testosterone levels throughout the day. With the advent of transdermal testosterone preparations, the desired physiological serum levels could be achieved for the first time. Scrotal testosterone patches were the first to fulfil this requirement. These were followed by nonscrotal skin patches, which, however, cause considerable skin reactions including erythema and blisters. Recently introduced, invisible transdermal testosterone gels increased the intervals of application and are now slowly replacing other modalities. A mucoadhesive buccal testosterone tablet with sustained release is also a recent competing modality. Finally, injectable testosterone undecanoate in castor oil was made into a real depot preparation requiring only four injections per year for replacement therapy. These new preparations with a desired pharmacokinetic testosterone profile give the patient a real choice and make treatment easier. Based on pharmacogenetic considerations taking the androgen receptor polymorphism into account, treatment may be individualized for each patient in the future. PMID:16918944
Chronic constipation is a symptom complex caused by a wide variety of diseases. Primary causes of constipation, including enterocele, rectocele, rectum prolapse and intussusception, involve changes of the bowel which either delay or prevent the passage of bowel content. This condition has been termed "obstructed defaecation syndrome" (ODS).This article is based on clinical experience and a review of selected literature. The complexity of chronic constipation warrants interdisciplinary work-up and treatment. The diagnostic work-up includes taking a focus on the history of patient's complaints. This can be objectified using a standardized scoring system, e. g. Longo score. Gynaecological examinations must be performed on all female patients. Intraluminal abnormalities are best excluded by colonoscopy and rectoscopy. An abnormal score in combination with negative findings on endoscopy and gynaecologic examinations warrant a radiological assessment with a defaecogramm in symptomatic patients. Treatment is usually medical, involving changes in life style, bowel habits and the use of laxatives. Biofeedback has been shown to be effective in some patients. Surgery is indicated for selected patient who do not improve after medical treatment. A range of surgical procedures have been shown to be effective in the treatment of chronic constipation. The minimal invasive double stapled trans anal rectum resection (STARR procedure) has been proven effective in treating rectocele and rectum prolapse in selected patients. The advantages of the STARR procedure include: short hospital stay, reduced postoperative pain and an early return to work. We consider this procedure as safe and effective when performed by a well trained surgeon in selected patients. PMID:21412677
Ambe, P; Weber, S A; Esfahani, B J; Köhler, L
Opinion statement Mild traumatic brain injury (MTBI) is the most common neurologic condition in the United States; about 503 of every 100,000\\u000a persons visiting the emergency department have this diagnosis. A complex cluster of neurologic signs and symptoms are associated\\u000a with an acceleration-deceleration mechanism of injury. Unfortunately, many persons do not seek treatment for MTBI. Depression\\u000a following MTBI adds to the
Precautions: physiological changes resulting from smoking cessation, with or with- out treatment, may alter the pharmacokinetics or pharmacodynamics of some medi- cinal products, for which dosage adjustment may be necessary (examples include theophylline, warfarin and insulin); as smoking induces CYP1A2, smoking cessation may result in an increase of plasma levels of CYP1A2 substrates; smoking cessa- tion, with or without pharmacotherapy,
Steve Chaplin; Robert West
Opinion statement Sleep disturbance is an important feature of Parkinson’s disease (PD) that deserves clinical attention. Various disorders\\u000a need to be considered and treatment should be customized to the patient’s specific symptoms and lifestyle. Evaluation of a\\u000a PD patient complaining of difficulty sleeping begins with a detailed history from the patient and bed partner about the specific\\u000a problem the patient is
Mary Ann Thenganatt; Steven J. Frucht
In this issue of the Journal, an article by Pepin et al. documents the shifting sands of the modern-day Clostridium difficile epidemic as seen in Quebec. Pepin and coauthors' observation that the superior activity of vancomycin over metronidazole has been lost since the emergence there of the hypervirulent strain NAP1\\/027 in 2003 has implications for the future treatment of C.
Edie P. Shen; Christina M Surawicz; Surawicz Christina M
Many cytotoxic therapies are available for patients with metastatic breast cancer, but response rates are low and acquired or de novo resistance is virtually universal. Among the agents that are used in the treatment of pretreated metastatic breast cancer are vinorelbine, gemcitabine, nab-paclitaxel, pemetrexed, platinum salts (eg, cisplatin, carboplatin), pegylated liposomal doxorubicin, etoposide, and irinotecan. Therapies that improve overall survival in patients with anthracycline- and taxane-resistant metastatic breast cancer are needed. PMID:21600380
Cobleigh, Melody A
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.
Abu-Wasel, Bassam; Walsh, Caolan; Keough, Valerie; Molinari, Michele
Systemic lupus erythematosus (SLE) predominantly affects women in their reproductive years. Renal disease (glomerulonephritis) is one of the most frequent and serious manifestations of SLE. Of the various histological types of lupus glomerulonephritis, diffuse proliferative nephritis carries the worst prognosis. Combined with high-dose prednisone, mycophenolate mofetil (MMF) has emerged as a first-line immunosuppressive treatment, although data regarding the efficacy of MMF on the long-term preservation of renal function are forthcoming. Cyclophosphamide is reserved for more severe forms of lupus nephritis, such as crescentic glomerulonephritis with rapidly deteriorating renal function, patients with significant renal function impairment at presentation, and refractory renal disease. Evidence for the calcineurin inhibitors in the treatment of lupus nephritis is weaker, and it concerns patients who are intolerant or recalcitrant to other agents. While further controlled trials are mandatory, B cell modulation therapies, such as rituximab, belimumab and epratuzumab are confined to refractory disease. Non-immunosuppressive measures, such as angiotensin-converting enzyme inhibitors, vigorous blood pressure control, prevention and treatment of hyperlipidemia and osteoporosis, are equally important. PMID:22675266
Mok, Chi Chiu
Systemic lupus erythematosus (SLE) predominantly affects women in their reproductive years. Renal disease (glomerulonephritis) is one of the most frequent and serious manifestations of SLE. Of the various histological types of lupus glomerulonephritis, diffuse proliferative nephritis carries the worst prognosis. Combined with high-dose prednisone, mycophenolate mofetil (MMF) has emerged as a first-line immunosuppressive treatment, although data regarding the efficacy of MMF on the long-term preservation of renal function are forthcoming. Cyclophosphamide is reserved for more severe forms of lupus nephritis, such as crescentic glomerulonephritis with rapidly deteriorating renal function, patients with significant renal function impairment at presentation, and refractory renal disease. Evidence for the calcineurin inhibitors in the treatment of lupus nephritis is weaker, and it concerns patients who are intolerant or recalcitrant to other agents. While further controlled trials are mandatory, B cell modulation therapies, such as rituximab, belimumab and epratuzumab are confined to refractory disease. Non-immunosuppressive measures, such as angiotensin-converting enzyme inhibitors, vigorous blood pressure control, prevention and treatment of hyperlipidemia and osteoporosis, are equally important.
Mok, Chi Chiu
Although the proportion of the adult population in the United States that smokes has decreased steadily, the rate of successful quit attempts is still low. Smokers develop nicotine dependence that resembles other addictions, and may require multiple attempts and long-term treatment to sustain abstinence. Currently available first-line agents for smoking cessation therapy include nicotine replacement therapy, which is available in several formulations, including transdermal patch, gum, nasal spray, inhaler, and lozenge; bupropion, an atypical antidepressant; and varenicline, a partial agonist of the alpha(4)beta(2) nicotinic acetylcholine receptor that was recently developed and approved specifically for smoking cessation therapy. Second-line agents are nortriptyline, a tricyclic antidepressant agent, and clonidine, an antihypertensive drug. With the exception of varenicline, which has been shown to offer significant improvement in abstinence rates over bupropion, all of the available treatments appear similarly effective. However, the adverse event profiles of nortriptyline and clonidine make them more appropriate for second-line therapy, when first-line treatments have failed or are not tolerated. Rimonabant, a cannabinoid-1 receptor antagonist that was being developed for smoking cessation, received a nonapprovable letter from the FDA in 2006 and there is no further information as to whether development for this indication is continuing for this agent. Nicotine vaccines are under investigation and offer promise, especially for relapse prevention. Ultimately, selection of pharmacologic agent should be based on the patient's comorbidities and preferences, as well as on the agent's adverse event profile. PMID:18342163
Purpose: Low-grade mucosa-associated lymphoid tissue (MALT) lymphoma of the stomach (MLS) is often associated with the presence of Helicobacter pylori (H. pylori) bacteria. Eradication of the infection with antibiotic therapy may result in regression of the lymphoma. But when antibiotic treatment fails to reverse the malignant process or if H. pylori is absent, other treatment options should be considered. Because
Naomi R Schechter; Joachim Yahalom
SummaryBackground: To evaluate the clinical characteristics, contemporary treatment options, and outcome of prostatic duct adenocarcinoma (PDA), we initiated a Rare Cancer Network (RCN) study. Materials and Methods: Six member institutions of the RCN collected clinical data on 31 patients. Treatment consisted of definitive radiotherapy in 14 patients and radical prostatectomy in 16 patients. One patient was treated with androgen deprivation
Daphna Y. Spiegel; Jason Efstathiou; Robert C. Miller; Philip M. P. Poortmans; Sedat Koca; Sait Okkan; Anthony Zietman
Introduction: Prostate cancer is the leading malignancy in men today and an increase in detected localized prostate cancers is expected in the years to come. Even though radical prostatectomy is an effective treatment, it is associated with a considerable morbidity in some cases and efforts are made to provide minimally invasive alternative treatment options with equal efficacy but fewer side
H. P. Beerlage; S. Thüroff; A. R. Zlotta; G. Aus; Th. M. de Reijke; J. J. M. C. H. de la Rosette
Endoscopic sphincterotomy and percutaneous approaches to the biliary tract have revolutionized the treatment of bile duct stones. Both the endoscopic and transhepatic approaches are less invasive than open surgery. This is an advantage for the mostly elderly and frail patients with common bile duct stones. Other patients with intrahepatic stones, e.g. young patients with oriental lithiasis, may also profit from the non-surgical approach. In this latter group it is often difficult for the surgeon to obtain access to the stone-bearing bile ducts. Due to the anatomical situation, size or impaction of stones the non-surgical approach, including mechanical disintegration, may primarily fail. Several techniques such as intracorporeal lithotripsy using electrohydraulic probes or laser light, extracorporeal shockwave lithotripsy or direct contact dissolution are now available and often allow complete clearance of the bile ducts. If a kidney lithotripter with radiographic devices is available, it should be used after an attempt at mechanical lithotripsy has failed (Figure 1). According to the literature, experience with this method is greater than with any other 'third-step approach'. The procedure is simple, relatively safe and successful in approximately 80% of patients. However, in at least one third of patients, several sessions have to be performed and further endoscopy is frequently required for extraction of fragments. Intracorporeal techniques may become the procedure of choice in the future, at least in patients with common bile duct stones. At the moment, however, the different devices are still not fully developed and too susceptible to damage. A further major drawback, especially with high-energy electrohydraulic intracorporeal lithotripsy, is the danger of bile duct injury or even perforation, so that most procedures must be performed under optical control. The use of contact dissolution cannot generally be recommended. Treatment with mono-octanoin or modified mono-octanoin solvents takes too long, is often not successful and has a high rate of side-effects. MTBE may shorten the procedure considerably, but is suitable only for cholesterol stones, and the danger of spill-over into the intestine with absorption and systemic side-effects has to be weighed against the probability of success. PMID:1362502
Delayed sleep phase disorder (DSPD) - a circadian rhythm sleep disorder - is most commonly seen in adolescents. The differential diagnosis between DSPD and conventional psychophysiological insomnia is important for correct therapeutic intervention. Adolescent DSPD sleep duration is commonly 9 hours or more. Depression may be comorbid with DSPD. DSPD has a negative impact on adolescent academic performance. DSPD treatments include bright light therapy, chronotherapeutic regimens, and administration of melatonin as a chronobiotic (as distinct from a soporific). Attention to non-photic and extrinsic factors including healthy sleep parameters is also important to enable better sleep and mood outcomes in adolescents. PMID:24138360
Bartlett, Delwyn J; Biggs, Sarah N; Armstrong, Stuart M
Seizures in the pediatric population commonly occur, and when proper rescue medication is not administered quickly, the risk of neurologic compromise emerges. For many years, rectal diazepam has been the standard of care, but recent interest in a more cost-effective, safe alternative has led to the investigation of intranasal midazolam for this indication. Although midazolam and diazepam are both members of the benzodiazepine class, the kinetic properties of these 2 anticonvulsants vary. This paper will review available data pertaining to the efficacy, safety, cost, and pharmacokinetics of intranasal midazolam versus rectal diazepam as treatment for acute seizures for children in the prehospital, home, and emergency department settings.
Humphries, Lesley K.; Eiland, Lea S.
Patients are considered to be at high risk of cardiovascular events if they have diabetes, chronic kidney disease, stroke, established coronary artery disease, or a coronary artery disease equivalent. Blood pressure-lowering therapy has been shown to reduce cardiovascular events in these patients significantly. Identification of high-risk patients by global risk evaluation is recommended for every hypertensive patient. Treatment of hypertension in high-risk patients with an angiotensin-converting enzyme inhibitor or an angiotensin receptor antagonist, with or without addition of a dihydropyridine calcium channel antagonist, is a reasonable approach based on current clinical trials.
The eating disorders (DCA) are complex systemic diseases with high social impact, which tend to become chronic with significant medical and psychiatric comorbidities. The literature data showed that there is good evidence to suggest the use of SSRIs, particularly at high doses of fluoxetine, in the treatment of BN reducing both the crisis of binge that the phenomena compensates and reducing the episodes of binge in patients with BED in the short term. Also, the topiramate (an AED) showed a good effectiveness in reducing the frequency and magnitude of episodes of binge with body weight reduction, both in the BN that is in the therapy of BED. To date, modest data support the use of low doses of second-generation antipsychotics in an attempt to reduce the creation of polarized weight and body shapes, the obsessive component, and anxiety in patients with AN. Data in the literature on long-term drug treatment of eating disorders are still very modest. It is essential to remember that the pharmacotherapy has, however, a remarkable efficacy in treating psychiatric disorders that occur in comorbidity with eating disorders, such as mood disorders, anxiety, insomnia, and obsessive-compulsive personality disorders and behavior. PMID:23956871
Milano, W; De Rosa, M; Milano, L; Riccio, A; Sanseverino, B; Capasso, A
The sexual consequences of breast cancer and its treatments are well known and previously reviewed. Alterations in body image, with or without breast reconstruction, changes in sexual self-esteem and self-efficacy, vulvovaginal atrophy as a result of chemotherapy and/or adjuvant hormone therapy, and loss of libido secondary to dyspareunia and body image issues are common in survivors of breast cancer. Medications that are prescribed for long-term use including those in the class of aromatase inhibitors can have far-reaching implications on quality of life by contributing to vulvar and vaginal atrophic changes. While this is an important issue, there are few widely accepted treatments that have been evaluated for efficacy and safety for these sexual challenges in the breast cancer population. However, progress is being made in finding new and innovative solutions for many of the sexual problems faced by breast cancer survivors and their partners. Many institutions are now compelled to address survivorship concerns and addressing sexuality and intimacy are paramount issues in survivorship care. In this article, we present the evidence for the multimodal approach to the management of sexuality concerns in the breast cancer survivor. Pharmacologic, nonpharmacologic, and psychosocial interventions will be reviewed. PMID:22151953
Krychman, Michael L; Katz, Anne
Parapneumonic pleural empyema has been classified into different stages and classes. While the American Thoracic Society (ATS) classification is based on the natural course of the disease, Light has classified pleural empyema according to the radiological, physical and biochemical characteristics, and the American College of Chest Physician (ACCP) has categorised the patients with pleural empyema according to the risk of a poor outcome. According to this classification the management of the pleural empyema is based on the stage of the disease. Therapeutic strategies include chest tube, chest tube with fibrinolysis, thoracoscopic debridement and decortication in open or minimally invasive techniques. Primary lung abscesses develop in previously healthy lung parenchyma and are caused by aspiration. In addition, abscess formation can occur without aspiration, and important differences relate to community-acquired, nosocomial abscesses and those in the immunosuppressed host. 90 % of all lung abscesses can be cured with antibiotic treatment alone, 10 % have to be treated with an interventional catheter or chest tubes and only 1 % require thoracic surgery because of complications independent of the former conservative or interventional treatment strategies. PMID:22711325
Hecker, E; Hamouri, S; Müller, E; Ewig, S
Cluster headache (CH) is a primary headache syndrome characterized by short-lasting unilateral head pain attacks accompanied by ipsilateral oculofacial autonomic phenomena. Approximately 20% of CH patients have the chronic form and need continuous medical care. In the chronic form, attacks continue unabated for years, often on a daily basis, resulting in severe debilitation. It is a common experience that drug treatments are able to control or prevent the attacks in approximately 80% of chronic CH patients. In the remaining 20% of chronic cases, drugs are ineffective. Until recently, the etiology of CH was poorly understood and this hampered the development of new therapies. However, we have now gained a much improved understanding of the peripheral and central mechanisms giving rise to the pain in CH and this has inspired the development of new treatment approaches, which, although still in the initial phases of validation, appear to be very promising. Among these, the novel approach based on hypothalamic deep brain stimulation is one of the most promising. PMID:15361318
Trauma patients with haemorrhagic shock who only transiently respond or do not respond to fluid therapy and/or the administration of blood products have exsanguinating injuries. Recognising shock due to (exsanguinating) haemorrhage in trauma is about constructing a synthesis of trauma mechanism, injuries, vital signs and the therapeutic response of the patient. The aim of prehospital care of bleeding trauma patients is to deliver the patient to a facility for definitive care within the shortest amount of time by rapid transport and minimise therapy to what is necessary to maintain adequate vital signs. Rapid decisions have to be made using regional trauma triage protocols that have incorporated patient condition, transport times and the level of care than can be performed by the prehospital care providers and the receiving hospitals. The treatment of bleeding patients is aimed at two major goals: stopping the bleeding and restoration of the blood volume. Fluid resuscitation should allow for preservation of vital functions without increasing the risk for further (re)bleeding. To prevent further deterioration and subsequent exsanguinations 'permissive hypotension' may be the goal to achieve. Within the hospital, a sound trauma team activation system, including the logistic procedure as well as activation criteria, is essential for a fast and adequate response. After determination of haemorrhagic shock, all efforts have to be directed to stop the bleeding in order to prevent exsanguinations. A simultaneous effort is made to restore blood volume and correct coagulation. Reversal of coagulopathy with pharmacotherapeutic interventions may be a promising concept to limit blood loss after trauma. Abdominal ultrasound has replaced diagnostic peritoneal lavage for detection of haemoperitoneum. With the development of sliding-gantry based computer tomography diagnostic systems, rapid evaluation by CT-scanning of the trauma patient is possible during resuscitation. The concept of damage control surgery, the staged approach in treatment of severe trauma, has proven to be of vital importance in the treatment of exsanguinating trauma patients and is adopted worldwide. When performing 'blind' transfusion or 'damage control resuscitation', a predetermined fixed ratio of blood components may result in the administration of higher plasma and platelets doses and may improve outcome. The role of thromboelastography and thromboelastometry as point-of-care tests for coagulation in massive blood loss is emerging, providing information about actual clot formation and clot stability, shortly (10min) after the blood sample is taken. Thus, therapy guided by the test results will allow for administration of specific coagulation factors that will be depleted despite administration with fresh frozen plasma during massive transfusion of blood components. PMID:19135193
Geeraedts, L M G; Kaasjager, H A H; van Vugt, A B; Frölke, J P M
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.
Karnsakul, Wikrom; Alford, Mary Kay; Schwarz, Kathleen B
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.
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
Diabetic painful neuropathy (DPN) is one of the most common causes of neuropathic pain. The management of DPN consists of excluding other causes of painful peripheral neuropathy, maximising diabetic control and using medications to alleviate pain. The precise relationship between glycaemic control and the development and severity of DPN remains controversial. In this context, drugs such as aldose reductase inhibitors, ACE inhibitors, lipid-lowering agents and alpha-lipoic acid (thioctic acid) may have a useful role to play. There is also evidence that a successful pancreatic transplant may improve symptoms over time, but the mainstay of management continues to be symptomatic control of pain with drugs. Evidence from placebo-controlled studies has shown that opioids, antiepileptic and antidepressant drugs together with capsaicin are effective for alleviating DPN. Tramadol and oxycodone have been shown to be effective in studies of limited duration but their adverse effects, such as constipation and physical dependency, may limit their usefulness as a first-line treatment for DPN. Of the antidepressant drugs, the tricyclic antidepressants have been shown to be effective for alleviating DPN. These medications are widely used but their anticholinergic and sedative properties may not be well tolerated by patients. There is also good evidence that the serotonin-noradrenaline reuptake inhibitor antidepressant drugs venlafaxine and duloxetine are effective for treating DPN. However, venlafaxine may cause cardiac dysrhythmias, and patients using this medication require careful cardiac monitoring. Duloxetine appears to be less cardiotoxic and is licensed in the US and EU for alleviating DPN. The gabapentinoid group of drugs, gabapentin and pregabalin, appear to be the most evidence-based of the antiepileptic drugs for treating DPN. Large placebo-controlled studies have been performed with both of these agents. For many patients, it is still unclear what advantages pregabalin has over gabapentin for DPN. Until better evidence emerges, the potential availability of less expensive generic formulations of gabapentin, together with greater experience with its use, favour gabapentin as the main antiepileptic drug for alleviating DPN. Topiramate, lamotrigine, sodium valproate and oxcarbazepine have been shown to be effective in smaller studies but do not have the same evidence base as the gabapentinoid group of drugs. Of the newer antiepileptic drugs, lacosamide appears to be the most promising for alleviating DPN. Capsaicin has the best evidence base of all the topical agents, but local anaesthetic patches may also have a useful therapeutic role. It is not possible to nominate a single drug as the first-line treatment for DPN and there is evidence that a low-dose combination of two or more drugs rather than a single agent may provide better symptomatic relief with fewer adverse effects. Further studies are necessary to clarify the best combination(s) of treatment for DPN. PMID:17352515
Chong, M Sam; Hester, Joan
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
Type 1 Gaucher disease (GD) results from inherited ?-glucocerebrosidase gene mutations, leading to anemia, thrombocytopenia, splenomegaly, hepatomegaly and skeletal disease. Velaglucerase alfa is a ?-glucocerebrosidase produced by gene activation in a human cell line, and indicated for type 1 GD. A phase I/II clinical trial (TKT025; N = 12), its ongoing extension (TKT025EXT) and three phase III trials (total N = 82), showed that velaglucerase alfa is generally well tolerated in adult and pediatric patients. Many disease-related parameters improved significantly in two phase III trials in treatment-naïve patients, and were successfully maintained in imiglucerase-experienced patients in a phase II/III switch study. Ten adults in TKT025EXT sustained improvements through 5 years, including bone mineral density. Comparison with imiglucerase shows that velaglucerase alfa is an effective, generally well-tolerated alternative enzyme replacement therapy. In vitro data suggest velaglucerase alfa may be internalized into cells more efficiently and have a lower rate of seroconversion. However, these results do not necessarily correlate with clinical efficacy. PMID:22013559
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
OBJECTIVES: The first objective was to identify variations in patient management practice patterns after potentially curative lung cancer surgery. Patient management practice patterns were expected to range from intensive follow-up to no active surveillance. The second objective was to measure whether intensity of follow-up was related to patient outcomes. METHODS: An 18-month retrospective analysis was conducted of 182 patients with low TNM stage (< or = IIIA) lung cancer who were surgically treated with curative intent over the 11-year period from 1982 through 1992 at the St. Louis Department of Veterans Affairs Medical Center. RESULTS: Patients were followed for a mean of 3.3 years, until death or the end of the study. Analyses of diagnostic test and outpatient visit frequency distributions and cluster analyses facilitated the identification of 62 nonintensively followed patients and 120 intensively followed patients. Both groups were comparable at baseline, and there were no significant differences in patient outcomes attributable to intensity of follow-up. Intensively followed patients did, however, live an average of 192 days longer than nonintensively followed patients. CONCLUSIONS: Significant variations in follow-up practice patterns can exist within a single health care facility. In this analysis, variations in test and visit frequency did not result in statistically significant differences in patient outcomes, though the survival difference between groups suggests that some benefit might exist. Only well-designed prospective trials are likely to answer the question of what constitutes optimal follow-up after potentially curative lung cancer treatment.
Virgo, K S; McKirgan, L W; Caputo, M C; Mahurin, D M; Chao, L C; Caputo, N A; Naunheim, K S; Flye, M W; Gillespie, K N; Johnson, F E
Diabetic neuropathies are a heterogeneous group of disorders that include a wide range of abnormalities. They can be focal or diffuse, proximal or distal, affecting both peripheral and autonomic nervous systems, causing morbidity with significant impact on the quality of life of the person with diabetes, and can result in early death. Distal symmetric polyneuropathy, the most common form of diabetic neuropathy, usually involves small and large nerve fibers. Small-nerve-fiber neuropathy often presents with pain but without objective signs or electrophysiologic evidence of nerve damage, and is recognized as a component of the impaired glucose tolerance and metabolic syndromes. The greatest risk resulting from small-fiber neuropathy is foot ulceration and subsequent gangrene and amputation. Large-nerve-fiber neuropathies produce numbness, ataxia and uncoordination, impairing activities of daily living and causing falls and fractures. A careful history and detailed physical examination are essential for the diagnosis. Symptomatic therapy has become available and newer and better treatment modalities, based on etiologic factors, are being explored with potential for significant impact on morbidity and mortality. Preventive strategies and patient education still remain key factors in reducing complication rates and mortality. PMID:16932298
Vinik, Aaron; Ullal, Jagdeesh; Parson, Henri K; Casellini, Carolina M
Hyponatremia is the most common electrolyte abnormality in hospitalized patients and is associated with increased mortality, morbidity, and longer hospital stays. Because patients with this disorder are often asymptomatic, hyponatremia is frequently undiagnosed and untreated. Serious neurologic complications may ensue when hyponatremia develops too rapidly or the serum sodium concentration ([Na(+)]) falls below 120 mEq/l. Hypotonic dilutional hyponatremia is the most common form of this disorder, which may present as euvolemic [e.g., due to failure to suppress secretion of arginine vasopressin (AVP)] or hypervolemic (due to edema-forming conditions such as heart failure). Hypovolemic hyponatremia is due to conditions promoting renal or extrarenal sodium loss. Because AVP, which is intimately involved in regulating osmolar homeostasis, is often elevated in patients with hypervolemic and euvolemic hyponatremia, treatments that directly target the effects of this hormone may provide a more predictable correction of serum [Na(+)] than those traditionally used. The AVP receptor antagonists (conivaptan, tolvaptan, lixivaptan, and satavaptan) are a new class of agents that have been shown to normalize serum [Na(+)] by promoting aquaresis - the electrolyte-sparing excretion of free water. PMID:18434717
Ghali, Jalal K
Obesity management includes primary weight loss, prevention of weight regain, and the management of associated risk factors, such as smoking, hyperlipidaemia and hypertension. All these require lifestyle modification. The success or failure of management will depend on the characteristics of both the patient and the physician (or therapeutic team). Thus, direct statistical comparisons between methods of management may be misleading. Weight loss of 5-10% (usually 5-10 kg and equivalent to 5-10 cm waist reduction for most patients) is generally achievable within 3-4 months. Attempts to achieve weight loss over longer periods of time are usually unsuccessful. Improved clinical, symptomatic and biochemical benefits are very significant with this degree of weight loss. It is therefore unreasonable to pursue an 'ideal' bodyweight. In reported studies, the weight decrease over the first 3-4 months represents the total weight loss. Data collected after this time reflect both the initial weight loss and the ability of the patient and the programme to maintain weight loss. Many reports and study designs do not make this distinction. The principal goal of weight management, whether in primary prevention or in treatment of the obese, is weight maintenance. This goal has to be viewed in the context of a normal tendency to gain weight through adult life. In good hands, dietary and behavioural techniques can maintain significant weight loss for 1 year or longer in about 40% of patients. This increases to about 70% for patients receiving appetite modifying drugs; professional resource requirements are also lower. Surgical approaches are reserved for those with more serious clinical risks. Weight loss in individuals with non-insulin dependent diabetes mellitus (NIDDM) can be achieved in newly diagnosed patients and non-diabetics with comparable success. The goal of interventions in established NIDDM patients should be improved weight maintenance evaluated over 1-2 years, not acute loss achieved in 3 months. PMID:9792477
Lean, M E
Background: Parkinson's disease (PD) is associated with a host of nonmotor symptoms, including psychosis, cognitive impairment, depression, sleep disturbance, swallowing disorders, gastrointestinal symptoms, and autonomic dysfunction. The nonmotor symptoms of PD have the potential to be more debilitating than the motor features of the disorder.Objective: The aim of this article was to review treatment options for the nonmotor manifestations of
Lindy D. Wood; Joshua J. Neumiller; Stephen M. Setter; Erin K. Dobbins
Surgery has traditionally been regarded as the treat- ment of choice for patients with stage I non-small cell lung cancer. However, the morbidity and mortality associated with surgery in elderly patients with con- siderable comorbidity remains of concern, as are the poor 5-year survival rates. Until recently, conven- tional radiation therapy was the only alternative cur- ative treatment option for
CORNELIS J. A. HAASBEEK; SURESH SENAN; EGBERT F. SMIT; MARINUS A. PAUL; BEN J. SLOTMAN; FRANK J. LAGERWAARDa
Autosomal dominant polycystic kidney disease (ADPKD) represents a slowly progressing cystic kidney disorder which evolves into end-stage renal disease in the majority of patients. Currently, there are no established treatments to retard the progression of the disease, but several promising therapeutic options are being tested in ongoing clinical trials. An inherent dilemma for the investigation of therapies in ADPKD is
Rudolf P. Wüthrich; Andreas L. Serra; Andreas D. Kistler
There are several treatment options available for drooling; botulinum toxin injections into the major salivary glands are one. There is no consensus as to how many and which glands should be injected. A research project on this topic was terminated because of adverse effects. Individual results and the adverse effects are described and discussed in this article. Six individuals with
Hilde Nordgarden; Ingvild Østerhus; Anne Møystad; Pamela Åsten; Ulf L-H Johnsen; Kari Storhaug; Jens Øyvind Loven
Current treatment options in patients with primary and secondary hyperoxaluria are limited and do not always lead to sufficient reduction in urinary oxalate excretion. Intestinal oxalate degrading bacteria are capable of degrading oxalate to CO2 and formate, the latter being further metabolized and excreted via the feces. It is speculated, that both endogenously produced, as well as dietary oxalate can
Bernd Hoppe; Gerd von Unruh; Norbert Laube; Albrecht Hesse; Harmeet Sidhu
Medical treatment of cholesterol gall stones aims to dissolve the stones leaving the biliary tract stone-free and the gall bladder in situ. The introduction of extracorporeal shock wave lithotripsy and contact solvent therapy with methyl tert butyl ether have revolutionised the medical management of both gall bladder stones and bile duct stones which are too large to be treated by sphincterotomy. Both approaches represent a major advance over cheno- and ursodeoxycholic acid which are effective in less than 30% of cases and require prolonged therapy. All medical treatments require a functioning gall bladder and suffer from relapse rates in the order of 10% per annum. Secondary prophylaxis is expensive and the rate of compliance and long term safety have yet to be established. PMID:8339460
Keating, J J; Corrigan, O I; Chua, A; MacDonald, G S; Noonan, N; McNulty, J; Keeling, P W
The classification and incidence of diabetic neuropathy, and the therapeutic options available, are presented in the evidence-based guidelines of the German Diabetes Association for sensorimotor and autonomic neuropathy (www. AWMF.de). Treatment decisions relating basic measures (e.g. optimization of management, multifactorial medication), neuropathic pain and diabetic-neuropathic foot syndrome can be taken on the basis of a simple care pathway. More recent therapeutic options in the treatment of pain are gabapentin, pregabalin, duloxetine and other drugs. For the treatment of erectile dysfunction, the new PDE5 inhibitors vardenafil and tadalafil are now available in addition to sildenafil. A new candidate for a pathogenetically valid treatment is the PKC inhibitor ruboxistaurin. PMID:15373085
Malignant ascites affects approximately 10% of patients with recurrent epithelial ovarian cancer and is associated with troublesome symptoms, including abdominal pressure and distension, dyspnea, bloating, pelvic pain, and bowel/bladder dysfunction. To date, no effective therapy has been identified for the treatment of malignant ascites in patients with recurrent, advanced ovarian cancer. In this article, we discuss currently existing options for the treatment of ascites associated with ovarian cancer, and review the literature as it pertains to novel, targeted therapies. Specifically, preclinical and clinical trials exploring the use of the antiangiogenic agents, bevacizumab and vascular endothelial growth factor-trap, as well as the nonangiogenic agent, catumaxomab, will be reviewed. Despite current limitations in treatment, knowledge regarding management options in the palliation of ascites is critical to practicing physicians. Ultimately, as with all novel therapies, symptom relief and treatment goals must be weighed against patient discomfort and potentially significant adverse events. PMID:22927770
Eskander, Ramez N; Tewari, Krishnansu S
Malignant ascites affects approximately 10% of patients with recurrent epithelial ovarian cancer and is associated with troublesome symptoms, including abdominal pressure and distension, dyspnea, bloating, pelvic pain, and bowel/bladder dysfunction. To date, no effective therapy has been identified for the treatment of malignant ascites in patients with recurrent, advanced ovarian cancer. In this article, we discuss currently existing options for the treatment of ascites associated with ovarian cancer, and review the literature as it pertains to novel, targeted therapies. Specifically, preclinical and clinical trials exploring the use of the antiangiogenic agents, bevacizumab and vascular endothelial growth factor-trap, as well as the nonangiogenic agent, catumaxomab, will be reviewed. Despite current limitations in treatment, knowledge regarding management options in the palliation of ascites is critical to practicing physicians. Ultimately, as with all novel therapies, symptom relief and treatment goals must be weighed against patient discomfort and potentially significant adverse events.
Eskander, Ramez N; Tewari, Krishnansu S
Low water consumption in rural areas in Jordan had resulted in the production of concentrated grey water. Average COD, BOD and TSS values were 2568mg\\/l, 1056mg\\/l and 845mg\\/l, respectively. The average grey water generation was measured to be 14L\\/c.d. Three different treatment options were selected based on certain criterions, and discussed in this article. The examined treatment systems are septic
M. Halalsheh; S. Dalahmeh; M. Sayed; W. Suleiman; M. Shareef; M. Mansour; M. Safi
Purpose: Using a cost-effectiveness analysis, to weigh the costs and benefits of the different staging and treatment options in early-stage Hodgkin’s disease.Methods: We constructed a decision-analytic model for a hypothetical cohort of 25-year-old patients with early-stage Hodgkin’s disease. Markov models were used to simulate the lifetime costs and prognosis of each staging and treatment strategy. Baseline probabilities and cost estimates
Andrea K. Ng; Karen M. Kuntz; Peter M. Mauch
We report the use of a spinal cord stimulator (SCS) for non-surgical management of superior mesenteric artery thrombosis. A 59-year-old woman with polycythaemia rubra vera presented with extensive superior mesenteric artery thrombosis not amenable to surgical or endovascular revascularisation. A SCS was implanted for analgesia thereby allowing enteral feeding to be tolerated during the acute period. Four months later the patient developed a focal ischaemic jejunal stricture and underwent resection of a short segment of small bowel with primary anastomosis that healed without complication. Spinal cord stimulation can facilitate non-surgical management of mesenteric ischaemia. PMID:23917358
Tod, Laura; Ghosh, Jonathan; Lieberman, Ilan; Baguneid, Mohamed
Plastic and reconstructive procedures for the oncological treatment of malignant tumors in the head and neck region, trunk and extremities are primarily curative. Less is known about the treatment options of plastic surgery in patients with locally advanced or incurable tumors. Therefore superficial, mostly exulcerated and superinfected tumors are treated with a palliative approach. A plethora of symptoms drastically restricts the quality of life in patients with advanced cancer. Pain, oozing of blood and bacterial superinfection with fetidness compromise the patient's general condition, self-esteem and activity. Many patients suffer from increasing isolation. A stage-adapted and plastic-reconstructive approach aiming at reducing the tumor mass and closing ulcerating wounds provides a considerable benefit especially in these patients. In this article a variety of treatment options regarding palliative resections and plastic reconstructive procedures and the disease alleviating benefits for patients with incurable tumors are presented. PMID:19949764
Vogt, P M; Jokuszies, A
Historically, basal cell carcinomas (BCCs) that are neither surgically resectable nor candidates for radiation therapy have had few treatment options. The hedgehog pathway inhibitor, vismodegib, represents a new opportunity for the treatment of such patients. Vismodegib has approval from the United States Food and Drug Administration for treatment of metastatic BCC, locally advanced BCC recurring after surgery, and BCC that is not treatable via surgery or radiation. We present the case of a patient with a BCC infiltrating the spinal column that was neither possible to fully remove surgically nor a candidate for primary treatment with radiation. Treatment with vismodegib followed by adjuvant radiation therapy resulted in complete disease clearance. Vismodegib represents a promising treatment option for patients with surgically non-resectable BCCs that are not candidates for radiation therapy. Mechanism of action, benefits, and adverse events of vismodegib are reviewed, along with a brief discussion on newer options in the hedgehog inhibitor class.
J Drugs Dermatol. 2013;12(suppl 10):s147-s150. PMID:24085060
Bayers, Stephanie; Kapp, Daniel L; Beer, Kenneth R; Slavin, Benjamin
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
Promethazine is a commonly used medication to treat nausea and motion sickness. Case reports have recently surfaced on the dangers of parenteral administration of promethazine. We present a case report of a presumed intravenous injection of promethazine into an antecubital intravenous line resulting in necrosis of the ring finger distal to the DIP joint and hypoperfusion of the digits. Peripheral sympathectomy was performed to improve nutritional flow and improve ischemic pain. However, although this novel treatment option was successful, ultimately the patient had an amputation of her ring finger at the level of her middle phalanx. Although no proven successful treatment exists, the updated treatment options following inadvertent intra-arterial or perivascular administration are presented. Given the limited success of current treatment options for intra-arterial or perivascular extravasation, the staggering medical malpractice awards in such cases, and the numerous therapeutic alternatives to promethazine, the medical community should question the safety and continued administration of promethazine by an intravenous route. PMID:24082878
Cross, Michael B; Warner, Kristin; Young, Kimberly; Weiland, Andrew J
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
The wastewater generated from pyridine and cyanopyridine manufacturing plants is highly complex in nature. It is characterized by high ammonia content, alkaline pH, and extremely high COD values (65,000 and 25,624mgL?1), making it extremely recalcitrant and virtually non-biodegradable. Therefore it is not usually feasible to directly use biological treatment (BOD:COD<0.2) for such wastes. However, with a suitable pretreatment option these
K. V. Padoley; S. N. Mudliar; S. K. Banerjee; S. C. Deshmukh; R. A. Pandey
Parkinson’s disease (PD) is one of the most frequent neurodegenerative diseases and represents a major therapeutic challenge\\u000a because of the so far missing therapeutic means to influence the ongoing loss of dopaminergic innervation to the striatum.\\u000a Cell replacement has raised hope to offer the first restorative treatment option. Clinical trials have provided “proof of\\u000a principle” that transplantation of dopamine-producing neurons
Kai Loewenbrück; Alexander Storch
BACKGROUND & AIMS: Predniso(lo)ne with or without azathioprine is considered the mainstay in the treatment of autoimmune hepatitis (AIH), but many therapeutic options are available. The primary objective of this review was to explore the published literature on the optimal induction and subsequent maintenance therapy for AIH. METHODS: We performed a systematic search on electronic databases MEDLINE (1950-07.2009), Web of
Mieke M. H. Lamers; Martijn G. H. van Oijen; Martine Pronk; Joost P. H. Drenth
Tokyo has historically suffered from a shortage of final disposal sites for the treated sewage sludge. Given this situation, sludge recycling and incineration have been promoted to reduce the volume of treated sludge conveyed to the disposal site, and the recycling options have changed since the late 1990s. This study aims to revisit the sewage sludge treatment and recycling processes in Tokyo and to evaluate different recycling options (brick, aggregate, refuse derived fuel and slag) from the energy consumption perspective by clarifying the complex flow of treated sludge within Tokyo's 23 wards. The study also estimates environmental loads associated with the operation of the whole sludge management system in the area. The environmental loads include: (1) total energy consumption and (2) gas emissions (greenhouse and acidification gases). The estimation was carried out for the years 1995, 1997, 1999 and 2001, during which a drastic change in recycling options occurred. The results indicated that the production of refuse derived fuel was the most energy consuming recycling option while aggregate production is the least energy consuming. They also showed that despite the increasing sludge volume, the energy consumption associated with the operation of the whole system decreased during the period while the gas emissions increased. PMID:18439814
Hara, K; Mino, T
ABSTRACT Postherpetic neuralgia (PHN) is a chronic and painful condition that may result in significant disturbances to normal activities and decreases in the quality of life for those affected. Despite the availability of several first- and second-line treatment options, many patients may experience refractory pain. The objectives of this review were to summarize evidence for Food and Drug Administration (FDA)-approved and off-label therapies for the treatment of PHN and to present gaps in the current literature for future research focus. Several agents, including pregabalin, gabapentin, and opioids, have been shown to significantly improve pain when compared with placebo. However, evidence regarding the comparative effectiveness of these treatment alternatives is lacking. In order to choose the optimal treatment, providers should consider issues related to efficacy, safety, and tolerability in conjunction with patient goals, preferences, and adherence issues. Evidence from randomized or observational studies that directly compare agents with each other should help to inform treatment choices. PMID:23901906
Khadem, Tina; Stevens, Vanessa
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.
Mancuso, Michelangelo; Orsucci, Daniele; Choub, Anna; Siciliano, Gabriele
This paper is part of a series of papers towards a European Core Curriculum in Cariology for undergraduate dental students. The European Core Curriculum in Cariology is the outcome of a joint workshop of the European Organisation for Caries Research (ORCA) together with the Association for Dental Education in Europe (ADEE), which was held in Berlin from 27 to 30 June 2010. The present paper covers decision-making and non-surgical treatment. In particular, it will provide some background information on this part of the European core curriculum. The dentist, on graduation, must be competent at applying the principles of prevention of dental hard tissue disease processes (primary prevention) and progression when it has manifested itself (secondary prevention). The competences should apply in differing ways to patients of all ages. Goals of prevention should be clearly defined in order for outcomes to be evaluated, and a dentist should be competent at determining these outcomes. Although this concept is recognised by many academics and experts, clinical teaching, practice and health insurance coverage frequently emphasise surgical treatment. There are many reasons and obstacles that might account for this, and this paper suggests some reasons why this might be and makes suggestions for how these can be addressed in the future. One factor that is essential in the provision of a preventive, non-surgical approach is that of communication with the patient. However, this unfortunately takes less space in the dental curricula compared with technical skills aimed at restorative procedures; this weighting needs to be more equally balanced. PMID:22023544
Bottenberg, P; Ricketts, D N J; Van Loveren, C; Rahiotis, C; Schulte, A G
Psoriasis is a common, chronic inflammatory skin disease which is associated with a number of significant co-morbidities including: impairment of quality of life; cardiovascular disease; and a seronegative arthritis known as psoriatic arthritis. Our understanding of the pathogenesis of psoriasis has developed at a remarkable rate in recent years. These new insights have significantly changed our perception of the condition and have led to the development of several new treatment strategies. Biological agents have proved a major step forward in therapeutic options for psoriasis. The ability to clear, or almost clear, cutaneous disease has changed the outcomes and expectations of many patients with this disease. The impact on both physical and psychological health may be great. This review covers the clinical features and management of psoriasis with specific reference to new therapeutic options.
Laws, Philip M; Young, Helen S
After surgical therapy of Achilles tendon rupture, neuromuscular changes may persist, even one year after surgery. We were interested whether these changes are also evident following a non-surgical functional therapy (Variostabil therapy boot/Adidas). Twenty-one patients with complete Achilles tendon rupture were enrolled in the study (mean age 38.5 years, range 24 to 60; 18 men, three women) and followed-up clinically and with surface EMG of the gastrocnemius muscles after four, eight, 12 weeks, and one year after rupture. EMG differences between the affected and non-affected side could only be observed at baseline and after four weeks following Achilles tendon rupture. The results from our study show that EMG changes are not found following non-surgical functional therapy. PMID:12146771
Hüfner, Tobias; Wohifarth, Kai; Fink, Matthias; Thermann, H; Rollnik, Jens D
Ulnar collateral ligament (UCL) insufficiency is potentially a career threatening, or even a career ending, injury, particularly in overhead throwing athletes. The evolution of treating modalities provides afflicted athletes with the opportunity to avoid premature retirement. There have been several clinical and basic science research efforts which have investigated the pathophysiology of UCL disruption, the biomechanics specific to overhead throwing, and the various types of treatment modalities. UCL reconstruction is currently the most commonly performed surgical treatment option. An in depth analysis of the present treatment options, both non?operative and operative, as well as their respective results and biomechanical evaluation, is lacking in the literature to date. This article provides a comprehensive current review and comparative analysis of these modalities. Over the last 30 years there has been an evolution of the original UCL reconstruction. Yet, despite the variability in modifications, such as the docking technique, interference screw fixation, and use of suture anchors, the unifying concepts of UCL reconstruction are that decreased dissection of the flexor?pronator mass and decreased handling of the ulnar nerve leads to improved outcomes.
Langer, P; Fadale, P; Hulstyn, M
Ulnar collateral ligament (UCL) insufficiency is potentially a career threatening, or even a career ending, injury, particularly in overhead throwing athletes. The evolution of treating modalities provides afflicted athletes with the opportunity to avoid premature retirement. There have been several clinical and basic science research efforts which have investigated the pathophysiology of UCL disruption, the biomechanics specific to overhead throwing, and the various types of treatment modalities. UCL reconstruction is currently the most commonly performed surgical treatment option. An in depth analysis of the present treatment options, both non-operative and operative, as well as their respective results and biomechanical evaluation, is lacking in the literature to date. This article provides a comprehensive current review and comparative analysis of these modalities. Over the last 30 years there has been an evolution of the original UCL reconstruction. Yet, despite the variability in modifications, such as the docking technique, interference screw fixation, and use of suture anchors, the unifying concepts of UCL reconstruction are that decreased dissection of the flexor-pronator mass and decreased handling of the ulnar nerve leads to improved outcomes. PMID:16488902
Langer, P; Fadale, P; Hulstyn, M
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
This report was written in response to a request to Veteran's Administration's (VA's) Technology Recommendations Panel (TRP) regarding treatment options for male erectile dysfunction (ED). The TRP, a national committee, is 'responsible for the evaluation ...
T. J. Wilt H. A. Fink R. MacDonald I. R. Rutks D. Schow
The objectives of the research are to: (1) develop an innovative computer-based decision support (CDSS) that will enable women with breast cancer to integrate the information available to them, understand diagnoses, treatment options and risks associated ...
D. B. Gustafson
The objectives of the research are to (1) develop an innovative computer-based decision support system (CDSS) that will enable women with breast cancer to integrate the information available to them, understand diagnoses, treatment options and risks assoc...
Background In patients with esophagectomy and gastric pull up for esophageal carcinoma anastomotic leaks are a well-known complication\\u000a and a major cause of morbidity and mortality.\\u000a \\u000a \\u000a \\u000a Objective We evaluated stent implantation as a treatment option in patients with thoracic anastomotic leaks after esophagectomy.\\u000a \\u000a \\u000a \\u000a Methods 269 patients with esophageal cancer (adenocarcinoma n = 212, squamous cell carcinoma n = 57) had undergone esophagectomy and
Werner K. H. Kauer; Hubert J. Stein; Hans-Joachim Dittler; J. Rüdiger Siewert
Necrobiosis lipoidica (NL) is a rare chronic granulomatous disease that has historically been associated with diabetes mellitus. Debate exists regarding the etiology and pathogenesis of NL with a widely accepted theory that microangiopathy plays a significant role. NL typically presents clinically as erythematous papules on the front of the lower extremities that can coalesce to form atrophic telangiectatic plaques. NL is usually a clinical diagnosis, but if the clinical suspicion is uncertain, skin biopsy specimen can help differentiate it from sarcoidosis, necrobiotic xanthogranuloma, and granuloma annulare. NL is a difficult disease to manage despite a large armamentarium of treatment options that include topical and intralesional corticosteroids, immunomodulators, biologics, platelet inhibitors, phototherapy, and surgery. Randomized control trials are lacking to evaluate the many treatment methods and establish a standard regimen of care. Disease complications such as ulceration are common, and lesions should also be monitored for transition to squamous cell carcinoma, a less common sequelae. PMID:23969033
Reid, Sophia D; Ladizinski, Barry; Lee, Kachiu; Baibergenova, Akerke; Alavi, Afsaneh
Stroke is among the top 10 causes of death in childhood. More than half of the surviving children have long-term neurological sequelae. Ischemic stroke (IS) includes arterial ischemic stroke and cerebral venous thrombosis with venous infarction. Haemorrhagic stroke (HS) includes intracerebral haematoma or subarachnoid haemorrhage. Risk factors for stroke are different in children and in adults. 10–30% of IS have no identified risk factors. However, multiple risk factors are recognizable in the majority of stroke in children; thus, a comprehensive diagnostic evaluation is crucial. Vascular abnormalities, such as arteriovenous malformations, aneurysms, vessel dissection, stenosis, and moyamoya disease, are frequently associated with both IS and HS and lead to high recurrence rates. Endovascular and surgical treatment options are sometimes indicated, performed on the basis of expert opinion, and extrapolated from the adult procedures. In the present paper, we review the recent literature and we discuss the treatment in five cases managed at our institutions.
Ciceri, Elisa F.; Cuccarini, Valeria; Chiapparini, Luisa; Saletti, Veronica; Valvassori, Luca
Cryptosporidiosis is a major infection of humans, leading to diarrhoea and growth failure in children, diarrhoea and malnutrition in immunocompromised adults, and is associated with increased mortality in all age groups. Using the country of Zambia as an example, I review the possible approaches to treatment and prevention in a tropical setting. The current optimal therapy for cryptosporidiosis is nitazoxanide which works well in HIV uninfected children, but treatment in patients with HIV infection remains remarkably difficult. No single drug has demonstrated efficacy in a randomised trial. No vaccine is available, so the best option for prevention for the moment is filtration and clean storage of drinking water. This would be expected to reduce cryptosporidiosis dramatically, but this needs to be demonstrated directly. Water filtration would have the added benefit of protection against many other pathogens, but the paucity of alternative approaches highlights the need for a better understanding of this important human pathogen. PMID:21320387
Non-convulsive status epilepticus (NCSE) is characterized by continuous or recurrent, generalized or focal epileptiform activity on the electroencephalogram and diverse clinical symptoms with alterations of mental state and vigilance. NCSE is not rare but certainly under diagnosed. There is some debate about how aggressive NCSE should be treated, as high dose anticonvulsants maybe partially responsible for the morbidity and mortality of patients with NCSE. We hypothesized that levetiracetam (LEV) as a well tolerated, highly effective new anticonvulsant, may be a safe treatment option. We retrospectively analyzed all (8) patients with NCSE who received levetiracetam from our database, compared with 11 patients with NCSE treated with conventional intravenous status medication as controls. These eight patients showed a marked clinical improvement with final cessation of ictal EEG-activity and clinical symptoms of NCSE after initiation of LEV within 3 days (mean 1.5 days). The response to conventional treatment was similarly effective but there were severe side effects whereas no relevant side effects in the LEV-treated group were noticed. A long-term follow up (6-36 months from discharge) revealed six patients with a persisting reduction in seizure frequency on medication with LEV. One patient changed the anticonvulsive medication because of inefficacy and one died from other causes than epilepsy 2 months after discharge from hospital. We found no significant differences in hospitalisation time, time in intensive care unit and outcome between the LEV group and the control group. This retrospectively acquired data suggests that LEV may be a well tolerated, effective treatment option in NCSE. This highlights the need for a prospective controlled study to further elucidate the utility of LEV in the treatment of NCSE, particularly as an intravenous formulation is now available. PMID:17161587
Rupprecht, Sven; Franke, Kerstin; Fitzek, Sabine; Witte, Otto W; Hagemann, Georg
Purpose Two common treatment options for congenital pseudarthrosis of the tibia (CPT) are intramedullary fixation following resection/shortening of the pseudarthrosis site and reconstruction with an Ilizarov external fixator following resection. We present in detail a narrative of two cases with similar degrees of tibial dysplasia associated with NF-1 treated using these different methods and followed to completion. Methods Technical issues and details of the treatment methods from case reports are discussed in depth. The eventual profoundly different outcomes are correlated to the technical variations used. Results Treatment with the Charnley–Williams rodding method and aggressive bone grafting supplemented by rh-BMP2 resulted in a normal functioning limb at maturity, while treatment with first, an ineffective version of IM rodding, followed by two sessions of bone transport using an Ilizarov fixator failed to gain useful union and eventually resulted in amputation. Conclusions Technical details, heretofore inadequately reviewed in the literature, are crucial to the success of either of these commonly utilized treatment methods for CPT.
Birch, John G.
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.
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
The MUG (Montreal Urban Community) treatment plant produces approximately 270 tons of dry sludge daily (270 tds/day) during the physico-chemical treatment of wastewater. Recently, this treatment plant endowed a system of drying and granulation of sludge for valorization as an agricultural fertilizer having a capacity of 70 tds/day (25% of the daily sludge production). However, the metal content (mainly Cu and Cd) of the sludge surpasses the norms for biosolids valorization. In order to solve this problem, a demonstration project, from the lab scale to the industrial pilot plant, was carried out to test the Metix-AC technology for the removal of metals. A strongly metal-loaded filtrate was generated during the sludge decontamination. Tests concerned the study of the metal recovery by total precipitation and selective precipitation, as well as the use of alternative products for the metal precipitation. Other works consisted to simulate the acid filtrate recirculation from the decontaminated sludge (25% of the total volume) in the untreated sludge (75% of the total volume) intended for the incineration. The total precipitation with hydrated limeappearedeffectivefortherecoveryof metals (87% Cd, 96% Cr, 97% Cu, 98% Fe, 71% Ni, 100% Pb, 98% Zn). However, this option entails the production of an important quantity of metallic residue, which should be disposed of expensively as dangerous material. The selective iron precipitation does not appear to bean interesting option because the iron in solution within the leached sludge was principally present in the form of ferrous iron, which cannot be precipitated at pH lower than five. On the other hand, the use of commercial precipitating agents (TMT-15, CP-33Z, CP-NB and CPX) without pH adjustment of filtrate gave good results for the recovery of Cu and, to a lesser degree for the recovery of Pb. However, the efficiency for the other metals' (Cd, Cr, Fe, Ni and Zn) recovery was weaker (< 25%). Finally, the acid filtrate recirculation containing solubilised metals in untreated sludge destined for incineration appears to be the most interesting option. Metals in solution in the acid filtrate, precipitate or adsorb effectively (97% Cd, 97% Cr, 99% Cu, 82% Ni, 100% Pb and 87% Zn) on the solids of the untreated sludge. Moreover, TCLP tests were done on ashes produced during the incineration of sludge mixed with the acid filtrate produced during sludge decontamination. These tests showed that there were no significant differences, as regards the extractability of metals, between such ashes and those produced during the untreated sludge incineration without addition of filtrate. Therefore, it was predictable that this method can respect the current environmental standards required by the different governmental authorities. PMID:12479450
Meunier, N; Blais, J F; Lounès, M; Tyagi, R D; Sasseville, J L
Global reserves of mineral phosphorus are finite and the recycling of phosphorus from wastewater, a significant sink for phosphorus, can contribute to a more sustainable use. In Germany, Switzerland, and the Netherlands, an increasing percentage of municipal sewage sludge is incinerated and the contained phosphorus is lost. This paper reviews current technologies and shows that a complete phosphorus recovery from wastewater is technically feasible. Depending on the composition of the sewage sludge ash (SSA), there are various options for phosphorus recovery that are presented. Iron-poor SSAs can be used directly as substitute for phosphate rock in the electrothermal phosphorus process. SSAs with low heavy metal contents can be used as fertilizer without prior metal elimination. Ashes not suitable for direct recycling can be processed by thermal processes. Operators of wastewater treatment plants can additionally influence the ash composition via the selection of precipitants and the control of (indirect) dischargers. This way, they can choose the most suitable phosphorus recovery option. For sewage sludge that is co-incinerated in power plants, municipal waste incinerators or cement kilns phosphorus recovery is not possible. The phosphorus is lost forever. PMID:22053454
Petzet, S; Cornel, P
Summary: Spinal cord injury (SCI) often leads to an impairment of the respiratory system. The more rostral the level of injury, the more likely the injury will affect ventilation. In fact, respiratory insufficiency is the number one cause of mortality and morbidity after SCI. This review highlights the progress that has been made in basic and clinical research, while noting the gaps in our knowledge. Basic research has focused on a hemisection injury model to examine methods aimed at improving respiratory function after SCI, but contusion injury models have also been used. Increasing synaptic plasticity, strengthening spared axonal pathways, and the disinhibition of phrenic motor neurons all result in the activation of a latent respiratory motor pathway that restores function to a previously paralyzed hemidiaphragm in animal models. Human clinical studies have revealed that respiratory function is negatively impacted by SCI. Respiratory muscle training regimens may improve inspiratory function after SCI, but more thorough and carefully designed studies are needed to adequately address this issue. Phrenic nerve and diaphragm pacing are options available to wean patients from standard mechanical ventilation. The techniques aimed at improving respiratory function in humans with SCI have both pros and cons, but having more options available to the clinician allows for more individualized treatment, resulting in better patient care. Despite significant progress in both basic and clinical research, there is still a significant gap in our understanding of the effect of SCI on the respiratory system.
Zimmer, M. Beth; Nantwi, Kwaku; Goshgarian, Harry G
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.
Boyd, Sarita D.
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
Advances in understanding the biology and genetics of renal-cell carcinomas have led to the development of novel targeted therapies for the treatment of metastatic renal-cell cancer. Previously the systemic approaches were limited to cytokine therapies that were modest in their clinical benefits and at the expense of significant toxicities. Investigational treatments with allogeneic bone marrow transplantation were equally toxic and resulted in significant morbidity and mortality. The development of targeted therapy has revolutionized the treatment of metastatic renal-cell cancer with more meaningful outcomes. This review aims to provide a detailed discussion of the clinical benefits of targeted therapies such as sunitinib, sorafenib, temsirolimus, everolimus, bevacizumab, and some of the newer agents in clinical trial development. The efficacy of these compounds in terms of response, survival and clinical benefit are explored as well as their toxicities. The role of surgery in metastatic renal-cell carcinoma is reviewed in the context of cytoreductive therapy and resection of solitary and oligometastatic disease. Ongoing studies in the adjuvant setting following curative resection are also reviewed. The availability of targeted therapies has led to their rapid adoption as frontline therapy over traditional cytokine therapy, thus bringing more optimistic and hopeful therapeutic options in a condition where historically, systemic treatments have been relatively unsatisfactory and disappointing. PMID:20398033
Tan, Thean Hsiang; Pranavan, Ganesalingam; Haxhimolla, Hodo Z; Yip, Desmond
Introduction: As a prevalent disease in women of childbearing age, treatment of leiomyoma is an area with many options. Hysterectomy is a common and definitive treatment but is not appropriate in women wishing to attempt pregnancy. Myomectomy surgically removes fibroids, and is the first line treatment for women wishing to preserve the uterus. Uterine Artery Embolization (UAE) is an emerging
Intravaginal culture (IVC), also called INVO (intravaginal culture of oocytes), is an assisted reproduction procedure where oocyte fertilization and early embryo development are carried out within a gas permeable air-free plastic device, placed into the maternal vaginal cavity for incubation. In the present study we assessed the outcome of the INVO procedure, using the recently designed INVOcell device, in combination with a mild ovarian stimulation protocol. A total of 125 cycles were performed. On average 6.5 oocytes per cycle were retrieved, and a mean of 4.2 were placed per INVOcell device. The cleavage rate obtained after the INVO culture was 63%. The procedure yielded 40%, 31.2%, and 24% of clinical pregnancy, live birth, and single live birth rates per cycle, respectively. Our results suggest that the INVO procedure is an effective alternative treatment option in assisted reproduction that shows comparable results to those reported for existing IVF techniques.
Lucena, Elkin; Saa, Angela M.; Navarro, Doris E.; Pulido, Carlos; Lombana, Oscar; Moran, Abby
Transient patellar dislocation is a common sports-related injury in young adults. Although patients often present to the emergency department with acute knee pain and hemarthrosis, spontaneous reduction frequently occurs, and half of cases are unsuspected clinically. Characteristic magnetic resonance imaging (MRI) findings often lead to the diagnosis. The purpose of this review is to illustrate the MRI findings of lateral patellar dislocation and concomitant injuries, such as kissing contusions of the medial patella and lateral femoral condyle; osteochondral and avulsion fractures; and injuries of the medial patellofemoral ligament/retinacular complex. This article will also briefly review patellofemoral anatomy and passive, active, and static stabilizers. Predisposing factors for patellar instability, including trochlear dysplasia, patella alta, and lateralization of the patella or tibial tuberosity and their relevant measurements will also be highlighted. Treatment options, including surgery, such as medial patellofemoral ligament reconstruction, tibial tuberosity transfer, and trochleoplasty, and their postoperative imaging appearances will also be discussed. PMID:22941569
Earhart, Christina; Patel, Dakshesh B; White, Eric A; Gottsegen, Christopher J; Forrester, Deborah M; Matcuk, George R
Breast cancer is not considered anymore a unique disease. Microarray gene expression analysis led to the identification of 4 major breast cancer "intrinsic" subtypes, including hormone receptor (HR)-positive luminal A and B, human epidermal growth receptor 2 (HER2)-positive and basal-like breast cancer (BLBC). These subtypes have distinct phenotypes, molecular profiles, clinical behaviour and response to therapy, with the BLBC carrying the worst outcome. Microarray analysis is not feasible in routine practice and therefore oncologists rely on a simpler immunohistochemical (IHC) classification to identify relevant breast cancer subtypes. Triple negative breast cancer (TNBC) is defined by the absence of oestrogen receptor, progesterone receptor and HER2 expression at IHC analysis. TNBC is strictly related to BLBC and, given the lack of common therapeutic targets, represent a major challenge for breast oncologist. In this review we will summarize the updated knowledge on TNBC, with emphasis on its current treatment and on the new therapeutic options under development. PMID:21129616
De Laurentiis, M; Cianniello, D; Caputo, R; Stanzione, B; Arpino, G; Cinieri, S; Lorusso, V; De Placido, S
Vertical transmission has become the most common mode of transmission of hepatitis C virus (HCV) in children. The rate of perinatal transmission from an HCV-infected mother to her child ranges from 2% to 5% and the prevalence of HCV in children in developed countries ranges between 0.1% and 0.4%. Spontaneous viral clearance seems to be dependent on the genotype and has been reported between 2.4%-25%. For chronically infected patients, treatment with recombinant polyethylene glycol (PEG)-interferon ?-2b and daily ribavirin has now been approved as standard treatment for children 2-17 years of age. In five large prospective studies, a total of 318 children and adolescents aged 3-17 years were treated either with subcutaneous PEG-interferon ?-2b at a dose of 1-1.5 ?g/kg or 60 ?g/m² once a week in combination with oral ribavirin (15 mg/kg per day) or PEG-interferon ?-2a with ribavirin. Subjects with genotype 1 and 4 received the medication for 48 wk and individuals with genotype 2 and 3 mainly for 24 wk. Overall sustained viral response (SVR) was achieved in 193/318 (60.7%) of treated patients. Stratified for genotype; 120/234 (51%) with genotype 1, 68/73 (93%) with genotype 2/3, and 6/11 (55%) with genotype 4 showed SVR. Relapse rate was between 7.7% and 17%. Overall, treatment was well tolerated; however, notable side effects were present in approximately 20%. According to recent experiences in the treatment of chronic hepatitis C in children and adolescents, a combination of PEG-interferon ? with ribavirin has been found to be well tolerated and highly efficacious, particularly in individuals with genotype 2/3. Thus, this treatment can be recommended as standard of care until more effective treatment options will become available for genotype 1 patients.
Conventionally poorly functioning hydronephrotic kidneys have been removed if they are symptomatic. In our unit, patients are offered renal artery embolization as an alternative treatment option. Patients and Methods: Fifteen patients (11 male, 4 female) with a mean age of 32.9 yr (20-51 yrs) have undergone renal artery embolization for symptomatic hydronephrosis with poor function. Mean follow-up was 64.13 weeks (range 14-200). All patients had loin pain and hydronephrosis. Twelve patients had primary pelvi-ureteric junction obstruction (PUJO). Two patients had poorly functioning hydronephrotic kidneys secondary to chronic calculous obstruction. One patient had chronic pain in an obstructed but reasonably functioning kidney following a previous pyeloplasty for PUJO which demanded intervention. Mean split function on renography was 11% (range 0-46%). Selective renal artery embolization was carried out under antibiotic cover using a 7 Fr balloon occlusion catheter and absolute alcohol, steel coils, and polyvinyl alcohol particles.Results: Nine patients developed post-embolization syndrome of self-limiting pain and pyrexia with no evidence of sepsis. One patient required readmission with this condition. One patient developed a hematoma at the puncture site. Mean hospital stay was 2.3 days. Fourteen patients are happy with the result and are completely pain free. One patient has minor discomfort but is delighted with the result. Nine patients have had follow-up ultrasound confirming resolution of the hydronephrosis. Conclusion: Renal artery embolization is an effective, safe, well-tolerated minimally invasive treatment option in end-stage hydronephrosis and we routinely offer it as an alternative to nephrectomy.
Mitra, Kakali; Prabhudesai, Vikramaditya [Newcastle under Lyme ST4 6QG, University Hospital of North Staffordshire NHS Trust (United Kingdom); James, R. Lester [Stafford ST16 S5A, Staffordshire General Hospital (United Kingdom); Jones, Robert W. A.; French, Michael E.; Cowling, Mark; West, David J. [Newcastle under Lyme ST4 6QG, University Hospital of North Staffordshire NHS Trust (United Kingdom)
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
Abdominal aortic aneurysm is a common vascular disease that affects elderly population. Open surgical repair is regarded as the gold standard technique for treatment of abdominal aortic aneurysm, however, endovascular aneurysm repair has rapidly expanded since its first introduction in 1990s. As a less invasive technique, endovascular aneurysm repair has been confirmed to be an effective alternative to open surgical repair, especially in patients with co-morbid conditions. Computed tomography (CT) angiography is currently the preferred imaging modality for both preoperative planning and post-operative follow-up. 2D CT images are complemented by a number of 3D reconstructions which enhance the diagnostic applications of CT angiography in both planning and follow-up of endovascular repair. CT has the disadvantage of high cummulative radiation dose, of particular concern in younger patients, since patients require regular imaging follow-ups after endovascular repair, thus, exposing patients to repeated radiation exposure for life. There is a trend to change from CT to ultrasound surveillance of endovascular aneurysm repair. Medical image visualizations demonstrate excellent morphological assessment of aneurysm and stent-grafts, but fail to provide hemodynamic changes caused by the complex stent-graft device that is implanted into the aorta. This article reviews the treatment options of abdominal aortic aneurysm, various image visualization tools, and follow-up procedures with use of different modalities including both imaging and computational fluid dynamics methods. Future directions to improve treatment outcomes in the follow-up of endovascular aneurysm repair are outlined.
The complex structure of articular cartilage allows for diverse knee function throughout range of motion and weight bearing. However, disruption to the structural integrity of the articular surface can cause significant morbidity. Due to an inherently poor regenerative capacity, articular cartilage defects present a treatment challenge for physicians and therapists. For many patients, a trial of nonsurgical treatment options is paramount prior to surgical intervention. In instances of failed conservative treatment, patients can undergo an array of palliative, restorative, or reparative surgical procedures to treat these lesions. Palliative methods include debridement and lavage, while restorative techniques include marrow stimulation. For larger lesions involving subchondral bone, reparative procedures such as osteochondral grafting or autologous chondrocyte implantation are considered. Clinical success not only depends on the surgical techniques but also requires strict adherence to rehabilitation guidelines. The purpose of this article is to review the basic science of articular cartilage and to provide an overview of the procedures currently performed at our institution for patients presenting with symptomatic cartilage lesions. PMID:22383075
Tetteh, Elizabeth S; Bajaj, Sarvottam; Ghodadra, Neil S
Surgical sterilization is the mainstay of dog and cat population control, but its use is still often limited by the costs and effort involved, especially in developing countries. An ideal non-surgical sterilant that is safe, effective, permanent, administered as a single injection and capable of being manufactured inexpensively could have a significant impact on the world-wide dog and cat overpopulation problem. One approach towards developing such an agent is the targeting of pituitary gonadotrophic cells with cytotoxic agents using gonadotropin-releasing hormone (GnRH). GnRH is a peptide that binds to high-affinity receptors selectively expressed on gonadotrophs and some types of cancers. Both small molecules and proteins have been conjugated to GnRH analogues to generate targeted cytotoxic and imaging agents. Although most of these efforts have focused on development of human cancer therapeutics, available reproductive studies in rats and dogs suggest that current compounds do not have sufficient therapeutic windows for complete gonadotroph ablation, in part owing to poor stability of peptide targeting sequences. The only reported longer-term study of gonadotroph ablation in dogs reported suppression of serum testosterone for 8 months, but endocrine function then recovered, raising important questions about the mechanism of reproductive suppression and its recovery. Although studies to date suggest that this is a potentially attractive approach to non-surgical sterilization, ideal agents are yet to be developed, and important mechanistic questions remain to be answered. PMID:22827376
Struthers, R S
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
Most clients in substance abuse treatment are referred for continuing care. However, post-treatment services vary widely in their approaches to helping individuals achieve better substance use outcomes. This study examined the attitudes of outpatient treatment staff who refer clients exclusively to 12-Step groups (12-Step subgroup) and staff who refer clients both to 12-Step groups and to other continuing care options
Morphologic features of tumour cells have long been validated for the clinical classification of breast cancers and are regularly used as a “gold standard” to ascertain prognostic outcome in patients. Identification of molecular markers such as expression of the receptors for estrogen (er) and progesterone (pgr) and the human epidermal growth factor receptor 2 (her2) has played an important role in determining targets for the development of efficacious drugs for treatment and has also offered additional predictive value for the therapeutic assessment of patients with breast cancer. More recent technical advancements in identifying several cancer-related genes have provided further opportunities to identify specific subtypes of breast cancer. Among the subtypes, tumours with triple-negative cells are identified using specific staining procedures for basal markers such as cytokeratin 5 and 6 and the absence of er, pgr, and her2 expression. Patients with triple-negative breast cancers therefore have the disadvantage of not benefiting from currently available receptor-targeted systemic therapy. Optimal conditions for the therapeutic assessment of women with triple-negative breast tumours and for the management of their disease have yet to be validated in prospective investigations. The present review discusses the differences between triple-negative breast tumours and basal-like breast tumours and also the role of mutations in the BRCA genes. Attention is also paid to treatment options available to patients with triple-negative breast tumours.
This report evaluates alternatives for pumping, storing, treating and disposing of the separable phase organic layer in Hanford Site Tank 241-C-103. The report provides safety and technology based preferences and recommendations. Two major options and several varations of these options were identified. The major options were: 1) transfer both the organic and pumpable aqueous layers to a double-shell tank as part of interim stabilization using existing salt well pumping equipment or 2) skim the organic to an above ground before interim stabilization of Tank 241-C-103. Other options to remove the organic were considered but rejected following preliminary evaluation.
Background Small intracranial aneurysms pose significant challenges to endovascular therapy. Surgical clipping is considered by many to be the preferred treatment for these lesions. We present the results of the first study comparing the 2 treatment modalities in small ruptured aneurysms. Methods and Results Between 2004 and 2011, 151 patients with small ruptured aneurysms (?3 mm) were treated in our institution: 91 (60.3%) with endovascular therapy and 60 (39.7%) with surgical clipping. The surgical and endovascular groups were generally comparable with regard to baseline demographics, with the exception of larger mean aneurysm size in the endovascular group versus the surgical group (2.8 versus 2.5 mm, respectively; P<0.001) and a higher proportion of posterior circulation aneurysms in the endovascular group. Endovascular treatment failed in 9.9% of patients. Procedure-related complications occurred in 23.3% of surgical patients versus 9.8% of endovascular patients (P=0.01). Only 3.7% of patients undergoing endovascular therapy experienced an intraprocedural aneurysm rupture. There were no procedural deaths or rehemorrhages in either group. The rates of aneurysm recanalization and retreatment after endovascular therapy were 18.2% and 12.7%, respectively. Favorable outcomes (moderate, mild, or no disability) were not statistically different between the endovascular (67.1%) and surgical (56.7%) groups (P=0.3). Conclusions Surgical clipping was associated with a higher rate of periprocedural complications, but overall disability outcomes were similar. Endovascular therapy, if technically feasible, might be a preferred option in this setting. Inclusion of patients with small aneurysms in randomized controlled trials seems feasible and will be needed to provide definitive information on the best therapeutic approach. (J Am Heart Assoc. 2012;1:e002865 doi: 10.1161/JAHA.112.002865.)
Chalouhi, Nohra; Penn, David L.; Tjoumakaris, Stavropoula; Jabbour, Pascal; Gonzalez, L. Fernando; Starke, Robert M.; Ali, Muhammad S.; Rosenwasser, Robert; Dumont, Aaron S.
Purpose: To report clinical and pathologic characteristics and outcome of breast cancer (BC) after irradiation for Hodgkin's lymphoma (HL) in women treated at the Institut Curie, with a special focus on the breast-conserving option. Methods and Materials: Medical records of 72 women who developed either ductal carcinoma in situ or Stage I-III invasive carcinoma of the breast after HL between 1978 and 2009 were retrospectively reviewed. Results: Median age at HL diagnosis was 23 years (range, 14-53 years). Median total dose received by the mediastinum was 40 Gy, mostly by a mantle-field technique. Breast cancers occurred after a median interval of 21 years (range, 5-40 years). Ductal invasive carcinoma and ductal carcinoma in situ represented, respectively, 51 cases (71%) and 14 cases (19%). Invasive BCs consisted of 47 cT0-2 tumors (82%), 5 cN1-3 tumors (9%), and 20 Grade 3 tumors (35%). Locoregional treatment for BCs consisted of mastectomy with (3) or without (36) radiotherapy in 39 patients and lumpectomy with (30) or without (2) adjuvant radiotherapy in 32 patients. The isocentric lateral decubitus radiation technique was used in 17 patients after breast-conserving surgery (57%). With a median follow-up of 7 years, 5-year overall survival rate and locoregional control rate were, respectively, 74.5% (95% confidence interval [CI], 64-88%) and 82% (95% CI, 72-93%) for invasive carcinoma and 100% (95% CI, 100 -100%) and 92% (95% CI, 79-100%) for in situ carcinoma. In patients with invasive tumors, the 5-year distant disease-free survival rate was 79% (95% CI, 69-91%), and 13 patients died of progressive BC. Contralateral BC was diagnosed in 10 patients (14%). Conclusions: Breast-conserving treatment can be an option for BCs that occur after HL, despite prior thoracic irradiation. It should consist of lumpectomy and adjuvant breast radiotherapy with use of adequate techniques, such as the lateral decubitus isocentric position, to protect the underlying heart and lung.
Haberer, Sophie, E-mail: email@example.com [Department of Radiation Oncology, Institut Curie, Paris (France); Belin, Lisa [Department of Biostatistics, Institut Curie, Paris (France); Le Scodan, Romuald; Kirova, Youlia M. [Department of Radiation Oncology, Institut Curie, Paris (France); Savignoni, Alexia; Stevens, Denise [Department of Biostatistics, Institut Curie, Paris (France); Moisson, Patricia [Department of Radiation Oncology, Institut Curie, Paris (France); Decaudin, Didier; Pierga, Jean-Yves [Department of Medical Oncology, Institut Curie, Paris (France); Reyal, Fabien [Department of Surgery, Institut Curie, Paris (France); Campana, Francois; Fourquet, Alain; Bollet, Marc A. [Department of Radiation Oncology, Institut Curie, Paris (France)
Presenting treatment options to men with localized prostate cancer is difficult because of the lack of definitive evidence and the range of treatment options available. Active surveillance and monitoring programs are now a recognized treatment option for men with low-risk localized prostate cancer, but many patients are not fully aware of the details of such programs, and most still opt for immediate radical (surgery or radiotherapy) treatment. The provision of high-quality information with decision aids has been shown to increase the acceptability of active surveillance/monitoring programs. This chapter outlines techniques for providing high-quality information about active surveillance/monitoring, based on the findings of a randomized controlled trial of treatments for localized prostate cancer. The ProtecT (Prostate testing for cancer and Treatment) trial has randomized over 1500 men between active monitoring, radical surgery, and radical radiotherapy by ensuring that information was tailored to men’s existing knowledge and views. Care was taken with the content, order, and enthusiasm of the presentation of treatments by recruitment staff, and clinicians and other health professionals were supported to feel comfortable with being open about the uncertainties in the evidence and helped to rephrase terminology likely to be misinterpreted by patients. These techniques of information provision should be added to the use of decision aids to enable patients diagnosed with clinically localized prostate cancer in routine practice to reach well-informed and reasoned decisions about their treatment, including full consideration of active surveillance and monitoring programs.
... operated unit that sends a small amount of electricity into the tube and the muscles surrounding it. ... that is inserted near the ankle. Pulses of electricity are sent into the needle to travel through ...
We present the current state of the art in the use of Methyl tertbutyl ether (MTBE) in dissolution of gallbladder cholesterol stones, as well as the use of another solvents in case of common bile duct stones. MTBE is useful, with few collateral effects and is safe but must be used cautiously by skilled and experimented personal; the cost of equipment is high; MTBE could not be used in common bile duct stones, monoctanoic acid is used instead but it needs continuous vigilance while infused. We do not recommend the use of others substances. PMID:1822010
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.
Krayer, Joe W.; Leite, Renata S.; Kirkwood, Keith L.
Diffuse retro-trochanteric pain occasionally radiating to the lower extremity could be caused by the piriformis or internal\\u000a obturator muscle syndromes. Thirteen patients, with retro-trochanteric pain were included in the study. All patients suffered\\u000a from a diffuse, but intense and often radiating hip pain. The median duration of the symptoms was 8 (1–20) years. The patients\\u000a were treated by a specific
Khaled Meknas; Jüri Kartus; Jan Inge Letto; Magne Flaten; Oddmund Johansen
Introduction and objective: Recent in vitro studies indicate that enamel matrix derivative (EMD) could modulate the growth of periodontopathogens. The aim of the presented study was an analysis of the influence of EMD on the presence of Porphyromonas and Prevotella bacteria in the periodontal pockets of patients with chronic periodontitis in non-surgical periodontal therapy. Materials and Methods: The studies were conducted on 20 patients. The condition of the periodontium was evaluated by clinical indexes: API. SBI. PD. CAL before and 3 months after the therapy in two selected quadrants. The material was collected for investigation. The periodontopathogens were cultured and identified. Two days after EMD-scaling root planing (SRP) was applied into the pockets. Results: In the group of patients under investigation before the EMD application the presence of P. gingivalis was found in 6 patients and P. intermedia in 8 patients. After root planing and EMD application no periodontopathogens were identified in those patients either in the periodontal pockets treated with EMD or in the periodontal pockets free from EMD (control). In the statistical analysis of changes in clinical indexes, the application of SRP and SRP combined with EMD was proved to significantly influence the improvement of the clinical state. However, no significant differences between the individual parameters were found in either group. Conclusions: The SRP is an effective method of limiting the development of periopathogens in periodontal pockets. The non-surgical therapy with EMD does not change the clinical parameters significantly, compared with the SRP. Simultaneously, the application of EMD inhibits the development of periopathogens, such as Porphyromonas gingivalis and Prevotella. PMID:24069844
Wyganowska-?wi?tkowska, Marzena; Szkaradkiewicz, Anna K; Karpi?ski, Tomasz M; Marcinkowski, Jerzy T
This article 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, skill-based treatments, physiologically oriented interventions, and comprehensive educational and treatment programs. In a follow-up article, court decisions related to intervention options for students with autism are discussed, along with recommendations for
L. Juane Heflin; Richard L. Simpson
Patients with type 1 diabetes mellitus and end-stage renal disease may remain on dialysis or undergo cadaveric kidney transplantation, living kidney transplantation, sequential pancreas after living kidney transplantation, or simultaneous pancreas-kid- ney transplantation. It is unclear which of these options is most effective. The objective of this study was to determine the optimal treatment strategy for type 1 diabetic patients
GREG A. KNOLL; GRAHAM NICHOL
The objectives of the research are to (1) develop an innovative computer-based decision support system (cDSS) that will enable women with breast cancer to integrate the information available to them, understand diagnoses, treatment options, and risks asso...
D. H. Gustafson
The management of early breast cancer has evolved rapidly in recent years. Consequently, the range of first-line treatment options for metastatic breast can- cer (MBC) is becoming increasingly complicated and therapy depends on a complex interaction of tumor, patient, and physician variables. Arguably one of the most important factors determining choice of first- line chemotherapy is prior adjuvant therapy. We
SUNIL VERMA; MARK CLEMONS
Parkinson's disease (PD) is one of the most frequent neurodegenerative diseases and represents a major therapeutic challenge because of the so far missing therapeutic means to influence the ongoing loss of dopaminergic innervation to the striatum. Cell replacement has raised hope to offer the first restorative treatment option. Clinical trials have provided "proof of principle" that transplantation of dopamine-producing neurons into the striatum of PD patients can achieve symptomatic relief given that the striatum is sufficiently re-innervated. Various cell sources have been tested, including fetal ventral midbrain tissue, embryonic stem cells, fetal and adult neural stem cells and, after a ground-breaking discovery, induced pluripotent stem cells. Although embryonic and induced pluripotent stem cells have emerged as the most promising candidates to overcome most of the obstacles to clinical successful cell replacement, each cell source has its unique drawbacks. This review does not only provide a comprehensive overview of the different cellular candidates, including their assets and drawbacks, but also of the various additional issues that need to be addressed in order to convert cellular replacement therapies from an experimental to a clinically relevant therapeutic alternative. PMID:21437664
Loewenbrück, Kai; Storch, Alexander
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.
Afilalo, Marc; Stegmann, Jens-Ulrich; Upmalis, David
Non-surgical, antiviral treatment options are desirable for HPV-related lesions within the genitourinary and upper digestive tract. We compared the toxicity of three zinc finger-ejecting (ZFE) compounds (4,4-dithiodimorpholine, azodicarbonamide, and diamide) to the HIV protease inhibitor lopinavir using HPV-positive SiHa, CaSki, HeLa, ME180, and HPV-negative C33A cervical carcinoma cell lines as well as primary human foreskin keratinocytes (PHFKs). Colorimetric growth assays
Ingeborg Zehbe; Christina Richard; Kyle F. Lee; Michael Campbell; Lynne Hampson; Ian N. Hampson
Low-density lipoprotein cholesterol (LDL-C) is currently the primary target in the management of dyslipidemia, and statins are first-line pharmacologic interventions. Adjunct therapy such as niacins, fibrates, bile acid sequestrants, or cholesterol absorption inhibitors may be considered to help reduce cardiovascular risk. This review discusses the need for alternative adjunct treatment options and the potential place for omega-3 fatty acids as such. The cardiovascular benefits of fish consumption are attributed to the omega-3 fatty acids eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA), and a variety of omega-3 fatty acid products are available with varied amounts of EPA and DHA. The product types include prescription drugs, food supplements, and medical foods sourced from fish, krill, algal and plant oils or purified from these oils. Two prescription omega-3 fatty acids are currently available, omega-3 fatty acid ethyl esters (contains both EPA and DHA ethyl esters), and icosapent ethyl (IPE; contains high-purity EPA ethyl ester). A pharmaceutical containing free fatty acid forms of omega-3 is currently in development. Omega-3 fatty acid formulations containing EPA and DHA have been shown to increase LDL-C levels while IPE has been shown to lower triglyceride levels without raising LDL-C levels, alone or in combination with statin therapy. In addition, recent studies have not been able to demonstrate reduced cardiovascular risk following treatment with fibrates, niacins, cholesterol absorption inhibitors, or omega-3 fatty acid formulations containing both EPA and DHA in statin-treated patients; thus, there remains a need for further cardiovascular outcomes studies for adjunct therapy. PMID:24075771
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.
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
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
Recently discovered interleukin 29 (IL-29) has antiviral properties and its production is induced by herpes viruses. This study was aimed at analyzing the effect of non-surgical periodontal treatment on IL-29 levels in gingival crevicular fluid (GCF) of chronic and aggressive periodontitis patients. A total of 60 participants were divided into healthy group (group 1; n=20), chronic periodontitis group (group 2; n=20), and aggressive periodontitis group (group 3; n=20). GCF samples collected from each subject at baseline and 6-8 weeks after scaling and root planing were quantified for IL-29 levels using ELISA. The mean IL-29 concentration in GCF was found to be highest in group 3 (92.37 pg/?l). The mean IL-29 level in group 1 and group 2 was 36.88 pg/?l and 69.35 pg/?l respectively. After scaling and root planing, the mean concentration of IL-29 in GCF was increased to 85.99 pg/?l in group 2 and to 114.64 pg/?l in group 3. Results of the present study indicate that antiviral IL-29 level was highest in GCF of aggressive periodontitis patients and least in subjects with healthy periodontium, while that of chronic periodontitis lying in between. After non-surgical periodontal therapy, IL-29 levels increased both in chronic and aggressive periodontitis patients and deserve further investigation as a potential therapeutic agent in treating periodontitis. PMID:23151616
Shivaprasad, B M; Pradeep, A R
Background Proper management of thoracic outlet syndrome (TOS) requires an understanding of the underlying causes of the disorder. A comprehensive examination process, as described in Part 1 of this review, can reveal the bony and soft tissue abnormalities and mechanical dysfunctions contributing to an individual’s TOS symptoms. Objective Part 2 of this review focuses on management of TOS. Conclusion The clinician uses clinical examination results to design a rehabilitation program that focuses on correcting specific problems that were previously identified. Disputed neurogenic TOS is best managed with a trial of conservative therapy before surgical treatment options are considered. Cases that are resistant to conservative treatment may require surgical intervention. True neurogenic TOS may require surgical intervention to relieve compression of the neural structures in the thoracic outlet. Surgical management is required for cases of vascular TOS because of the potentially serious complications that may arise from venous or arterial compromise. Post-operative rehabilitation is recommended after surgical decompression to address factors that could lead to a reoccurrence of the patient’s symptoms.
Hooper, Troy L; Denton, Jeff; McGalliard, Michael K; Brismee, Jean-Michel; Sizer, Phillip S
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.
While trapeziectomy with or without interposition arthroplasty and ligament reconstruction or suspensionplasty have been demonstrated to have a high rate of satisfactory outcomes, recent interest has focused on arthroscopy because of its perceived limited invasive nature as well as its versatility. In addition, using the arthroscope, other options are available that preserve all or part of the trapezium to limit subsidence of the thumb axis, preserve grip and pinch strength, and retain later options for joint reconstruction, should that become necessary. PMID:21871359
Adams, Julie E; Steinmann, Scott P; Culp, Randall W
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
A rapid and non-surgical method for jugular catheterization in pigs was set up in 30 piglets of 6.2 kg, 23 pigs of 46 kg and 84 kg and two lactating multiparous sows. The animal was restrained on a V-shaped table (piglets) or with a rope around the mandible (slaughter pigs and sows). The vein was located with the Vacutainer system and a wire guide was inserted into the Vacutainer needle up to the vein lumen. When the needle was removed, the catheter was inserted over the wire guide and advanced until it penetrated the skin and thereafter, the vein wall. The catheter was fixed outside by a large tape and coiled inside a patch just behind the ears. The technique utilizes readily available material and is no more risky for the animal than a single blood sampling. Moreover, it can be performed within 15 to 20 min (including animal restraint) within pens. This new approach might have important implications not only for research purposes by facilitating repeated blood samplings but also for projects which require a rapid and easy method for testing of any kind of pharmaceutical or other type of products under husbandry conditions. PMID:10780845
Matte, J J
Abnormal septal motion on M mode echocardiography was seen in eight of 16 patients soon after non-surgical closure of the ductus arteriosus. Ten to twenty-nine months after the procedure the abnormal septal motion had disappeared spontaneously. The cross section of the left ventricular cavity was circular both when septal motion was abnormal and when it was normal. Cross sectional echocardiography showed that there was an exaggerated anterior swinging motion of the heart in systole in patients with abnormal septal motion on the M mode recordings. The left ventricular end diastolic diameter before closure was significantly larger, and its reduction after closure was more pronounced in those with abnormal septal motion than in those without. This suggested that the abnormal septal motion was associated with relief of long standing left ventricular volume overload. It is suggested that acute shrinkage of the heart caused temporary laxity of the pericardium, and consequently more movement of the heart within the thorax. The return of normal septal motion suggests that the pericardium gradually shrank to accommodate the smaller heart. Images Fig 1 Fig 4
Beppu, S; Masuda, Y; Sakakibara, H; Izumi, S; Park, Y D; Nagata, S; Miyatake, K; Nimura, Y
Cocaine, particularly in its base form ('crack'), has become one of the drugs of most concern in the Netherlands, being associated with a wide range of medical, psychiatric and social problems for the individual, and with significant public order consequences for society. Available treatment options for cocaine dependent users are limited, and a substantial part of the cocaine dependent population
M. Nuijten; P. Blanken; Brink van den W; V. Hendriks
Background: Computerized provider order entry (CPOE) systems are implemented in various clinical contexts of a hospital. To identify the role of the clinical context in CPOE use, we compared the impact of a CPOE system on the medication process in both non-surgical and surgical specialties. Methods: We conducted a qualitative study of surgical and non-surgical specialties in a 1237-bed, academic hospital in the Netherlands. We interviewed the clinical end users of a computerized medication order entry system in both specialty types and analyzed the interview transcripts to elicit qualitative differences between the clinical contexts, clinicians’ attitudes, and specialty-specific requirements. Results: Our study showed that the differences in clinical contexts between non-surgical and surgical specialties resulted in a disparity between clinicians’ requirements when using CPOE. Non-surgical specialties had a greater medication workload, greater and more diverse information needs to be supported in a timely manner by the system, and thus more intensive interaction with the CPOE system. In turn these factors collectively influenced the perceived impact of the CPOE system on the clinicians’ practice. The non-surgical clinicians expressed less positive attitudes compared to the surgical clinicians, who perceived their interaction with the system to be less intensive and less problematic. Conclusion: Our study shows that clinicians’ different attitudes towards the system and the perceived impact of the system were largely grounded in the clinical context of the units. The study suggests that not merely the CPOE system, the technology itself, influences the perceptions of its users and workflow-related outcomes. The interplay between technology and clinical context of the implementation environment also matters. System design and redesigning efforts should take account of different units’ specific requirements in their particular clinical contexts.
Niazkhani, Zahra; Pirnejad, Habibollah; de Bont, Antoinette; Aarts, Jos
PURPOSE: For more than 30 years, minimally invasive surgical procedures have been available to stabilize the fractured vertebrae by cement augmentation leading to significant pain relief, a distinct improvement in quality of life and decreased mortality for patients suffering from osteoporotic vertebral compression fractures. This overview article is designed to provide information on the wide range of augmentation methods previously tested and clinically applied in surgery in an attempt to compile the clinically relevant information on safety and efficacy in the published literature. METHOD: Based on an extensive literature review on the topic of "vertebral fractures-surgical augmentation techniques" we summarized the results of published clinical trials and experimental testing which address clinically relevant questions. The selection of the publications in reference books and scientific journals covers the time period from the end of the 1970s until the present. RESULTS: The final selection of more than 50 publications with, in the opinion of the authors, clinically relevant data led to the following results, which can be of significance for clinical application. The prerequisites for the success of all augmentation methods include the earliest possible surgical intervention, optimal technical equipment and an experienced, interdisciplinary team, as well as thorough consideration of the situation of the individual patient. The selection of the material for vertebral augmentation depends on the surgical method. The material of choice remains polymethylmethacrylate (PMMA), and the best record of efficacy and safety is displayed by radiofrequency kyphoplasty with ultrahigh-viscosity cement. Regarding clinical efficacy and safety, there are many convincing documentations showing superiority of vertebroplasty and kyphoplasty in comparison with conservative therapeutic regimens. Initial results of clinical studies with additional implants indicate a trend toward further improvement in clinical success and suggest possible broader clinical possibilities of application. CONCLUSION: Modern, minimally invasive augmentation techniques represent a real alternative to conservative treatment of patients with vertebral fractures. Further technical and clinical development in this area should aim at optimizing procedural safety while continuing to achieve comparably good results to current methods. Minimizing damage to the remaining trabecular structures as well as to adjacent vertebral disks and vertebrae should be paramount of importance. Options for the treatment of vertebral fractures: Reductions in bone density and pathological changes in bone structure are associated with an elevated risk of fractures, which can lead to decisive functional impairment, pain, and a host of further comorbidities. Vertebral augmentation can be considered as an alternative conservative treatment, in order to achieve immediate and lasting pain relief as well as improvement in functional impairment. To achieve greater safety, instrumentation for transpedicular access and incorporation of radiopacifiers in PMMA for vertebroplasty were developed in mid-eighties. Balloon kyphoplasty was introduced in the end nineties, and results of prospective, randomized clinical studies have confirmed the safety and efficacy; the destruction of the remaining native spongiosa structures during balloon expansion is viewed as a disadvantage of this method. The two step method of cavity creation followed by cement delivery known as kyphoplasty has been further refined and developed by and varied by technology/procedural developments. This includes most the radiofrequency kyphoplasty (DFINE Inc., San Jose, CA, USA), in which ultrahigh-viscosity cement is delivered at a controlled delivery rate, following producing a bone sparing size and side specific cavity which minimizes loss of spongiosa, allowing for mechanical stability upon interdigitation of cement into that remaining trabecular bone. This combination has been shown to preserve vertebral structures and
Bornemann, R; Koch, E M W; Wollny, M; Pflugmacher, R
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.,
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
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
Sleep apnoea, both central and obstructive disordered breathing, commonly occurs in patients with heart failure. Obstructive sleep apnoea occurs both in systolic and diastolic heart failure and is best treated with nasal positive airway pressure devices. Central sleep apnoea occurs primarily in systolic heart failure and therapeutic options are evolving. Optimal therapy of systolic heart failure, nocturnal use of supplemental
The maxillary central incisor is the tooth most often affected by trauma, especially in the age range of 7 to 10 years, when high-impact sports are prevalent. The options for conservative treatment should be prioritized in these patients, aiming to achieve a biologic response that might provide continuity of growth of the alveolus, to provide functional and esthetic development of the affected region. This case report describes a patient with a history of trauma during the deciduous dentition with consequent intrusion, root dilaceration, and retention of the maxillary left central incisor. The treatment involved extraction of the traumatized tooth and mesial movement of the lateral incisor and posterior segments. PMID:22920706
Rizzatto, Susana Maria Deon; Closs, Luciane Quadrado; Freitas, Maria Perpétua Mota; Rizzatto, Laura Escobar
...for meeting Cryptosporidium treatment requirements. 141.715...awarded to unit process or treatment train based on a demonstration...device if supported by direct integrity testing. Specific criteria...media filtration stage if treatment train includes...
The lower urinary tract (LUT) is regulated by a complex neural network that is subject to supraspinal control. Neurological disorders, especially of the central nervous system (CNS), can rapidly lead to disruption of this control. Multiple sclerosis, Parkinson's disease, multiple system atrophy, and stroke are neurological disorders which quite frequently cause dysfunction of the LUT. With respect to the pathophysiology of bladder dysfunction in CNS diseases there are various hypotheses regarding the individual disorders: disturbances of neural communication between the frontal cortex and pontine micturition center, between the pontine micturition center and the lumbosacral parts of the spinal cord, and between the basal ganglia, thalamus, and anterior cingulate gyrus appear to play a pivotal role in the development of bladder dysfunction. The symptoms and urodynamic presentation of LUT dysfunction can vary considerably depending on the disease and disease progression and can change in the course of the disease. The incidence and prevalence of LUT dysfunctions rise with increasing progression of the underlying neurological disease.Various conservative, minimally invasive, and open surgical procedures are available to prevent harmful sequelae and to improve the quality of life of these patients. As yet, however, few data exist on most of the treatment options in cases of the above-mentioned CNS diseases. Intermittent self-catheterization and antimuscarinic medications are among the most important conservative treatment options. Injection of botulinum neurotoxin type A into the detrusor muscle and increasingly sacral or pudendal neuromodulation are among the most important minimally invasive treatment options. Surgical methods include reconstructive continent or incontinent urinary diversion.When planning therapy the patient's current needs and neurological limitations as well as possible disease progression must be taken into consideration. It is often advisable to consult with and enlist the cooperation of the attending neurologist when planning treatment. PMID:22331072
Mehnert, U; Nehiba, M
Half of patients with nephrotic syndrome caused by primary focal segmental glomerulosclerosis (FSGS) have resistance to treatment with steroids. In the case of corticosteroid resistance, the best evidence-based option has classically been treatment with calcineurin inhibitors, although recent studies indicate that mycophenolate may have similar efficacy. In patients with resistance to calcineurin inhibitors, there is no option that allows the clinical course of the disease to be modified, and this is supported by appropriately designed clinical trials, although observational studies have suggested the potential usefulness of mycophenolate, sirolimus, rituximab, apheresis or high galactose doses as treatment options. In FSGS of idiopathic origin, resistant to steroids and calcineurin inhibitors, before taking the decision whether or not to test other immunosuppressive drugs, it might be appropriate to conduct a systematic analysis that considers: 1) evaluating whether the dose and duration of treatment with steroids and calcineurin inhibitors were suitable, 2) analysing the level of P-glycoprotein expression in lymphocytes, 3) performing a new renal biopsy if there is no electron microscopic study available for the first, 4) in young patients, considering a genetic study to rule out the presence of the podocin variant pR229Q in combination with heterozygous mutations in NPHS2, and 5) evaluating the seriousness and difficulty of managing the nephrotic syndrome and the likelihood of progressive loss of renal function. Currently, there are multiple study avenues that attempt to identify the pathogenic mechanisms that cause podocyte injury and there are also several studies underway to analyse the efficacy of drugs such as adalimumab, fresolimumab, rosiglitazone, ACTH (corticotropin) or galactose at high doses, whose preliminary results have generated expectations that require confirmation in larger-scale clinical studies. In the future, it is possible that a better understanding of the pathogenic pathway or pathways that cause FSGS may allow differentiation between immunomodulable and non-immunomodulable forms, however, this continues to be a challenge currently. PMID:23897176
Segarra-Medrano, Alfonso; Jatem-Escalante, Elias; Agraz-Pamplona, Irene; Carnicer-Cáceres, Clara; Ramos-Terrades, Natalia; Ostos-Roldán, Elena; Quiles-Pérez, M Teresa; Arbós-Via, M Antonia
... are also experts in replacing missing teeth with dental implants. Non-Surgical Treatments Gum Graft Surgery Laser Treatment Regenerative Procedures Dental Crown Lengthening Dental Implants Pocket Reduction Procedures Plastic Surgery Procedures Members Only ...
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.
Hertel, Nadine; Kotchie, Robert W; Samyshkin, Yevgeniy; Radford, Matthew; Humphreys, Samantha; Jameson, Kevin
Alternative technologies and alternative strategies for dredging, transport, and disposal of contaminated dredged material are reviewed. Contaminant control/treatment during three basic operations are discussed. These include contaminant control/treatment...
M. J. Cullinane D. E. Averett R. A. Shafer
An increase in extended-spectrum-?-lactamase (ESBL)-producing Escherichia coli has been observed in outpatient settings. Consequently, 100 ESBL-positive E. coli isolates from ambulatory patients with clinically confirmed urinary tract infections were collected by a single laboratory between October 2004 and January 2008. Antimicrobial susceptibility testing was carried out using the oral antibiotics fosfomycin, pivmecillinam, and nitrofurantoin and the parenteral antibiotic ertapenem. Susceptibility rates indicate that fosfomycin (97%), nitrofurantoin (94%), and pivmecillinam (85%) could be considered important oral treatment options.
Auer, Simon; Wojna, Alexandra; Hell, Markus
Purpose The aim of this paper is to explore the current theories about pretreatment assessment and dental management of patients receiving\\u000a head and neck radiotherapy, and the therapeutic options to treat osteoradionecrosis of the jaws, based on the literature review.\\u000a \\u000a \\u000a \\u000a \\u000a Discussion Osteoradionecrosis is one of the most serious oral complications of head and neck cancer treatment. Osteoradionecrosis is\\u000a a severe delayed radiation-induced
Bruno Ramos Chrcanovic; Peter Reher; Alexandre Andrade Sousa; Malcolm Harris
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. Volume 1 of this two-volume report describes the regulatory 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)
Bladder leiomyosarcoma is a unique mesenchymal tumour, accounting for less than 0.5% of all primary bladder malignancies. Bladder leiomyosarcoma used to be treated with radical surgery in either old or young patients, often resulting in significant impact on the patients’s quality of life after surgery. We report on a case of bladder leiomyosarcoma in a 31-year-old female who was treated with partial cystectomy. Fortunately, no tumour metastasis or relapse was observed during the 7-year follow-up period and the patient now has a good quality of life. We found that partial cystectomy may be an acceptable option to treat bladder leiomyosarcoma in the low MSKCC (Memorial Sloan-Kettering Cancer Center) stage.
Xu, Yun-fei; Wang, Guang-chun; Zheng, Jun-hua; Peng, Bo
Treatment choices for cancer patients are becoming increasingly complex as medicine advances and doctors are able to offer more treatment options at the end of life. Research data shows that 22% of all Medicare patients start a new chemotherapy regimen in the last month of life. In a study released in 2004, data showed treatment within two weeks of death
Alison Snow; Jocelyn Warner; Felice Zilberfein
The Department of Energy (DOE), in keeping with their responsibility under Public Law 99-240, the Low-Level Radioactive Waste Policy Amendments Act of 1985, is investigating several disposal options for greater-than-Class C low-level waste (GTCC LLW), including emplacement in a deep geologic repository. At the present time vitrification, namely borosilicate glass, is the standard waste form assumed for high-level waste accepted into the Civilian Radioactive Waste Management System. This report supports DOE`s investigation of the deep geologic disposal option by comparing the vitrification treatments that are able to convert those GTCC LLWs that are inherently migratory into stable waste forms acceptable for disposal in a deep geologic repository. Eight vitrification treatments that utilize glass, glass ceramic, or basalt waste form matrices are identified. Six of these are discussed in detail, stating the advantages and limitations of each relative to their ability to immobilize GTCC LLW. The report concludes that the waste form most likely to provide the best composite of performance characteristics for GTCC process waste is Iron Enriched Basalt 4 (IEB4).
Fullmer, K.S.; Fish, L.W.; Fischer, D.K.
The treatment of patients with metastatic renal cell carcinoma (MRCC) continues to be disappointing. A large number of hormones, chemotherapeutic agents and combinations have been tested with poor and non-reproducible results. Among the immunological treatments investigated in MRCC, the best results have been claimed with interferons (IFNs) and interleukin-2 (IL-2) and, although no randomized studies have shown higher activity than
Luciano Canobbio; Loredana Miglietta; Francesco Boccardo
Background: Mycophenolate mofetil (MMF), an ester of mycophenolic acid (MPA), was approved by the Food and Drug Administration in 1995 and is currently primarily indicated for the prophylaxis of rejection in renal transplant patients. The drug seems also to be of value in the treatment of psoriasis and rheumatic arthritis. Recently there have been 6 reported cases of successful treatment
Marcella Grundmann-Kollmann; Hans Christian Korting; Stefanie Behrens; Peter Kaskel; Ulrike Leiter; Gertraud Krähn; Martina Kerscher; Ralf Uwe Peter
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
Craniopharyngioma is one of the leading causes of hypothalamic-pituitary dysfunction in childhood, caused either by the tumor itself or the consequences of treatment. Tumor management in terms of recurrence rate, quality of life and complications is still controversial. Sixty-six patients with craniopharyngioma at pediatric age were reviewed for symptoms, signs, types of treatment, recurrence rates, complications, and endocrinological outcome. The
E. Nazli Gonc; Nursen Yordam; Alev Ozon; Ayfer Alikasifoglu; Nurgun Kandemir
Background and purpose: The integration of a scanner for computed tomography (CT) and a treatment simulator (Sim-CT, Elekta Oncology Systems, Crawley, UK) has been studied in a clinical situation. Image quality, hounsfield units (HU) and linearity have been evaluated as well as the implications for treatment planning. The additional dose to the patient has also been highlighted.Material and methods: Image
D. Verellen; V. Vinh-Hung; P. Bijdekerke; F. Nijs; N. Linthout; A. Bel; G. Storme
|The article examines the World Health Organization's Model List of Essential Medicines (EML) and suggests modification for appropriate psychopharmacological treatment of child- and adolescent-onset mental disorders. The EML enlists few of the psychotropic medicines that are useful for the treatment of young people thereby limiting the…
Kutcher, Stan; Murphy, Andrea; Gardner, David
For many years, tamoxifen has been the ‘gold standard’ amongst anti-oestrogen therapies for breast cancer. However, the selective aromatase inhibitors (AIs), anastrozole, letrozole and exemestane, have demonstrated advantages over tamoxifen as first-line treatments for advanced disease. Anastrozole is also more effective as an adjuvant treatment in early, operable breast cancer and is being increasingly used in the adjuvant setting. Generally,
J. F. R. Robertson; S. E. Come; S. E. Jones; L. V. A. M. Beex; M. Kaufmann; A. Makris; J. W. R. Nortier; K. Possinger; L.-E. Rutqvist
Statement of problem. Although surgical reconstruction is the treatment of choice for auricular deformities that result from hemifacial microsomia, the implant-retained auricular prosthesis must be considered when surgical reconstruction is not possible. The competent and successful practitioner should be knowledgeable of the nature of this congenital disease. Purpose. This article reviewed the first and second branchial syndrome, treatment approaches, and
Russell R. Wang; Carl J. Andres
Sustainability has strong implications on the practice of engineering. Life cycle assessment (LCA) is an appropriate methodology for assessing the sustainability of a wastewater treatment plant design. The present study used a LCA approach for comparing alternative wastewater treatment processes for small and decentralised rural communities. The assessment was focused on two energy-saving systems (constructed wetland and slow rate infiltration)
A. P. Machado; L. Urbano; A. G. Brito; P. Janknecht; J. J. Salas; R. Nogueira
Although surgery still is the most important treatment modality in the management of head and neck cancer, radiotherapy is increasingly being used. Consequently, the majority of head and neck cancer patients are at risk of developing osteoradionecrosis of the jaws, which is the most serious and important complication of radiotherapy. This review presents the etiology, pathophysiology, diagnosis, classification, and prevention of osteoradionecrosis. In addition, the body of evidence regarding conservative as well as surgical treatment of osteoradionecrosis is reviewed, and studies on complications, tumor recurrence and patient survival, dental rehabilitation, and functional and aesthetic outcome after surgical treatment for osteoradionecrosis are discussed. PMID:23258622
Cheriex, Kiki C A L; Nijhuis, Tim H J; Mureau, Marc A M
Sativex® (GW Pharmaceuticals PLC, Porton Down, UK; Laboratorios Almirall, SA, Barcelona, Spain), a cannabinoid oromucosal spray containing a 1:1 ratio of 9-?-tetrahydrocannabinol and cannabidiol, has been licensed in Germany since July 2011 as add-on therapy for moderate-to-severe multiple sclerosis (MS) treatment-resistant spasticity symptoms. The 'MOVE 2' study evaluated clinical outcomes, treatment satisfaction, quality of life (QoL) and provision of care in MS patients with spasticity receiving Sativex in everyday clinical practice. Data from 300 patients were collected from 42 specialized MS centers across Germany and were available for this analysis. Assessments, including the MS spasticity 0-10 numerical rating scale, modified Ashworth scale, patients' and physicians' clinical impressions, and QoL scales were rated at baseline and at 1 and 3 months after starting treatment with Sativex. Sativex provided relief of MS-related spasticity in the majority of patients who were previously resistant to treatment. In addition, clear improvements were noted in MS spasticity-associated symptoms (e.g., sleep quality, bladder function and mobility), activities of daily living and QoL. Sativex was generally well tolerated. The majority of patients (84%) reported no adverse events, and there was only a limited risk of serious adverse reactions. Furthermore, based on data from Sativex clinical trials, a Markov model-based analysis has shown that Sativex is a cost-effective treatment option for patients with MS spasticity in Germany. PMID:23369055
...PROTECTION AGENCY (CONTINUED) WATER PROGRAMS (CONTINUED) NATIONAL PRIMARY DRINKING WATER REGULATIONS Enhanced Treatment...filtration when conducting source water monitoring must sample the...relation to UV dose table; reactor validation testing...
The spine is the most common site for bone metastases. Spinal metastases can impact quality of life by causing severe pain, limitation of motion, and increased requirements for pain medication. Radiation therapy is a common form of treatment reserved for palliation of pain and for prevention or treatment of spinal cord compression. Newer approaches such as stereotactic radiosurgery (SRS) and stereotactic body radiation therapy (SBRT) have a more precise ability to customize the radiation dose to the target tissues adjacent to critical structures, thus increasing the local control of spinal column metastases. In this report, we examine the efficacy and possible advantages of single fraction SRS using a state-of-the-art tomotherapy machine in the treatment of a patient with spinal metastases from breast cancer. We also review the literature on treatment of spinal metastases using SRS, SBRT, and other modalities. PMID:19540375
Chawla, Sheema; Abu-Aita, Rami; Philip, Abraham; Lundquist, Tom; Okunieff, Paul; Milano, Michael T
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
Conservative management of Charcot foot neuroarthropathy remains efficacious for certain clinical scenarios. Treatment of the patient should take into account the stage of the Charcot neuroarthopathy, site(s) of involvement, presence or absence of ulceration, presence or absence of infection, overall medical status, and level of compliance. The authors present an overview of evidence-based non-operative treatment for diabetic Charcot neuroarthropathy with an emphasis on the most recent developments in therapy.
Ramanujam, Crystal L.; Facaros, Zacharia
Four on-site wastewater treatment systems with an end-of-pipe approach were compared for their relative environmental impacts and use of natural resources with the help of an environmental systems analysis (ESA) approach. The treatment techniques compared were infiltration, chemical precipitation, and P removal using the reactive filter media Filtra P and Filtralite® P. The chemical precipitation system attained the most favourable
Philipp Weiss; David Eveborn; Erik Kärrman; Jon Petter Gustafsson
The management of the acute ischemic stroke patient spans the time course from the emergency evaluation and treatment period\\u000a through to the eventual discharge planning phase of stroke care. In this article we evaluate the literature and describe what\\u000a have become standard treatments in the care of the stroke patient. We will review the literature that supports the use of
George A. Lopez; Arash Afshinnik; Owen Samuels
Numerous studies in the past three decades have characterised 'psychotic major depression', a subtype of major depression which is accompanied by delusions or other psychotic features. Evidence from phenomenological and neurobiological investigations indicates that this is a unique disorder with clinical and biological characteristics that are distinct from those of nonpsychotic depression and from other psychotic disorders. Treatment studies have provided evidence of small placebo effects and good responses to electroconvulsive therapy or combination treatment with an antidepressant plus an antipsychotic agent. However, until recently, there were only a few small, prospective, double-blind, controlled trials investigating the efficacy of antidepressant-antipsychotic combination pharmacotherapy, yet this constitutes the currently accepted and most universally applied 'standard of care' for psychotic depression. Treatment guidelines have been based largely on uncontrolled investigations of electroconvulsive therapy and studies using tricyclic antidepressants and first-generation antipsychotic drugs, which are not frequently chosen as first-line agents today because of concerns regarding tolerability and risks. However, recent open-label studies and large controlled trials of newer antidepressants and antipsychotics have yielded very divergent results thus far, so that the best treatment approach remains elusive. This review discusses the phenomenology and treatment of psychotic depression with a focus on the benefits and risks of various treatment approaches. Problems with this literature are highlighted, and strategies for future research are suggested. PMID:16752932
Tyrka, Audrey R; Price, Lawrence H; Mello, Marcelo F; Mello, Andrea F; Carpenter, Linda L
Ventricular assist devices (VADs) are becoming more commonplace in the hospital and community settings as the number of patients living with heart failure increases. Patients being discharged after hospitalization for heart failure rose from 399 000 in 1979 to 1 099 000 in 2004, an increase of 175%. Patients with heart failure become severely debilitated finding activities of daily living including eating, bathing, and walking a great effort. Patients with end-stage heart failure are often sent home on inotropic therapies and referred to hospice care. The use of VADs for these patients can dramatically improve both the quality and the length of life. VADs can be broadly categorized as being either continuous flow (fluid dynamic) or pulsatile (volume displacement) and either can be used as short- or long-term support devices. The critical care nurse is in a unique position to educate patients with chronic heart failure on options available to improve their quality of life including VAD therapy. VADs are available for destination therapy for those not meeting transplant criteria, offering a longer quality of life. As centers gain more experience and referrals are made earlier in the disease process, VAD patient care will be more streamlined decreasing length of stay. PMID:17873570
Stahovich, Marcia; Chillcott, Suzanne; Dembitsky, Walter P
The aim of the present study was to monitor clinical, microbiological, medical, and immunological effects of non-surgical periodontal therapy in diabetics and healthy controls. 20 IDDM (insulin dependent, n = 7) or NIDDM (non-insulin dependent, n = 13) diabetic patients (median duration 11.5 years, range of HbA1C: 4.4-10.6%) with moderate to advanced periodontal disease and 20 matched healthy control patients, were subjected to supragingival pretreatment and subsequent subgingival therapy. Periodontal examinations (API, PBI, BOP, PPD, PAL), microbiological examinations (culture), medical routine examinations, and immunological examinations (oxidative burst response of PMNs to TNF-alpha and FMLP) were performed at baseline, 2 weeks after supragingival, and 4 months after subgingival therapy. 4 months after completion of non-surgical therapy, the following compared to baseline significant (p < or = 0.05) changes (delta) of clinical parameters (median) were found in diabetic patients versus control patients: deltaAPI (30.4% versus 36.3%), deltaPBI (22.9% versus 24.2%), deltaBOP (39.5% versus 46.9%). The median % per patient of pockets with PPD > or = 4 mm decreased from 41.9% to 28.3% in diabetics, and from 41.6% to 31.8% in controls. Microbiologically, similar reductions of periopathogenic bacteria were found in diabetics and controls. Neither periodontal data nor the oxidative burst response of PMNs showed any significant difference (p > 0.05) between diabetics and control patients. In this study, periodontal therapy had no significant influence on medical data of diabetics. In conclusion, this study indicates that metabolically well-controlled diabetics might respond to non-surgical periodontal therapy as well as healthy control patients. PMID:9495610
Christgau, M; Palitzsch, K D; Schmalz, G; Kreiner, U; Frenzel, S
The burden of type 2 diabetes is increasing. The prevention of the disease, improvement of metabolic control, and more importantly reduction in mortality remain a challenge for primary care doctors, diabetologists, researchers and policymakers. In this article, the available literature is reviewed with a focus on recent developments. Comparison between medical and surgical interventions is performed using mainly head-to-head trials where possible. Weight loss surgery is effective for glycaemic control. The need for level 1 data with hard end points such as cardiovascular risk and mortality is highlighted, and the prospect of the combination of existing therapy options is emphasized. PMID:24078317
Pournaras, D J; le Roux, C W
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
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.
Aiuxut Lorenzo, S.; Tomasello Weitz, A.; Blasco Andaluz, J.; Sanroman Manzanera, L.; Macho Fernandez, J.M.
High-grade dysplasia (HGD) in Barrett’s esophagus (BE) is the critical step before invasive esophageal adenocarcinoma. Although its natural history remains unclear, an aggressive therapeutic approach is usually indicated. Esophagectomy represents the only treatment able to reliably eradicate the neoplastic epithelium. In healthy patients with reasonable life expectancy, vagal-sparing esophagectomy, with associated low mortality and low early and late postoperative morbidity, is considered the treatment of choice for BE with HGD. Patients unfit for surgery should be managed in a less aggressive manner, using endoscopic ablation or endoscopic mucosal resection of the entire BE segment, followed by lifelong surveillance. Patients eligible for surgery who present with a long BE segment, multifocal dysplastic lesions, severe reflux symptoms, a large fixed hiatal hernia or dysphagia comprise a challenging group with regard to the appropriate treatment, either surgical or endoscopic.
Lekakos, Leonidas; Karidis, Nikolaos P; Dimitroulis, Dimitrios; Tsigris, Christos; Kouraklis, Gregory; Nikiteas, Nikolaos
This study, conducted by the Pacific Northwest Laboratory (PNL) for Westinghouse Hanford Company (WHC), examines the range of secondary waste types and volumes likely to result from treatment of contaminated liquid effluents. Alternatives for treatment of these effluents were considered, taking into account the implementation of the ''best-available technology'' as assumed in current and ongoing engineering studies for treating the various liquid effluent waste streams. These treatment alternatives, and potential variations in the operating schedules for Hanford Site facilities generating contaminated liquid effluents, were evaluated to project an estimated range for the volume of each of the various secondary waste streams that are likely to be generated. The conclusions and recommendations were developed, based on these estimates. 23 refs., 34 figs., 16 tabs.
Holter, G.M.; Triplett, M.B.; Fow, C.L.; White, M.K.
Lower limb deep vein thrombosis (DVT) is a common cause of significant morbidity and mortality. Systemic anticoagulation therapy is the mainstay of conventional treatment instituted by most physicians for the management of DVT. This has proven efficacy in the prevention of thrombus extension and reduction in the incidence of pulmonary embolism and rethrombosis. Unfortunately, especially in patients with severe and extensive iliofemoral DVT, standard treatment may not be entirely adequate. This is because a considerable proportion of these patients eventually develops postthrombotic syndrome. This is characterized by chronic extremity pain and trophic skin changes, edema, ulceration, and venous claudication. Recent interest in endovascular technologies has led to the development of an assortment of minimally invasive, catheter-based strategies to deal with venous thrombus. These comprise catheter-directed thrombolysis, percutaneous mechanical thrombectomy devices, adjuvant venous angioplasty and stenting, and inferior vena cava filters. This article reviews these technologies and discusses their current role as percutaneous treatment strategies for venous thrombotic conditions.
Nazir, Sarfraz Ahmed, E-mail: firstname.lastname@example.org; Ganeshan, Arul [John Radcliffe Hospital, Department of Radiology (United Kingdom); Nazir, Sheraz [John Radcliffe Hospital, Department of Medicine (United Kingdom); Uberoi, Raman [John Radcliffe Hospital, Department of Radiology (United Kingdom)
Hereditary angioedema (HAE) results from mutations in the C1-esterase inhibitor (C1 INH) gene that decrease production of C1 INH or render it dysfunctional. HAE is characterized by recurrent, unpredictable, bradykinin-mediated edema of the extremities, face, genitalia, trunk, gastrointestinal tract, or upper airway. Attacks causing laryngeal edema can be fatal. Patients with HAE need medications for acute attacks; some also require prophylaxis. Management requires consideration of the patient's disease burden and effect on the patient's quality of life. This review examines an individualized approach to identifying HAE patients who may benefit from prophylaxis. A literature search was performed for HAE and prophylaxis. HAE guidelines, case reports, safety studies, and randomized, controlled clinical prophylaxis trials were selected. Authors provided cases demonstrating individualized prophylaxis. U.S. Food and Drug Administration-approved options for prophylaxis of HAE include attenuated androgens and nanofiltered C1 INH (C1 INH-nf). In other countries, pasteurized C1 INH and purified C1 INH are also available. Alternative therapies include fresh frozen plasma for preprocedural prophylaxis and antifibrinolytics for long-term prophylaxis. Attenuated androgens reduce attack frequency in many patients. Adverse effects include weight gain, virilization, increased hair growth, hypercholesterolemia, depression, and liver adenomas. C1 INH-nf reduces frequency of attacks and is well tolerated. Each patient with HAE has unique needs, based on the nature and frequency of past attacks, proximity to a medical center, occupation, and the patient's wishes. These factors should be used to create a patient-centered approach to management of HAE. PMID:22584192
Gower, Richard G; Lumry, William R; Davis-Lorton, Mark A; Johnston, Douglas T; Busse, Paula J
Nonalcoholic fatty liver disease is the leading cause of liver disease in western society. It is a cause of end-stage liver disease, with increased mortality secondary to cirrhosis and its complications. It is also recognized that cardiovascular disease is a significant cause of death in these patients. Significant work evaluating various treatments has been performed in recent years; however, to date, no ideal therapy exists. Lifestyle modification remains the cornerstone of management. The present article reviews the current status of various treatment modalities evaluated in nonalcoholic fatty liver disease.
Beaton, Melanie D
This article overviews future trends for the treatment of ErbB2 (HER2)-positive breast cancer. It is based on a presentation given at the ECCO 14 congress, September 2007.Novel ErbB2-targeted agents and\\/or treatment combinations have shown promise in treating ErbB2-positive metastatic breast cancer. Combinations include two agents that both inhibit ErbB2 and existing\\/novel ErbB2 inhibitors with chemotherapy and\\/or vascular endothelial growth factor
Mental depression and myocardial infarction (MI) are closely related. The current paper reviews pathophysiological mechanisms that could link depression to MI and discusses the pros and cons of different pharmacological and non-pharmacological treatment modalities that could be considered. The selective serotonin reuptake inhibitors lack arrhythmogenic effects, and have a beneficial effect in addition to depression on psychological factors, such as anxiety and mood disturbances, which are not uncommon in post-MI patients. Studies to further determine the impact of depression on the outcome of MI, and the place of different treatment modalities are in progress. PMID:9557532
Cleophas, T J
Hypoactive sexual desire disorder (HSDD) affects nearly 1 in 10 women. Thus, it is essential for pharmacists and other health care providers to be comfortable when discussing a patient's sexual health to ensure appropriate triage so that the specific causes of HSDD can be identified and potential recommendations provided. HSDD is defined as the absence or deficiency of sexual interest and/or desire, leading to significant distress and interpersonal difficulties. As health care providers, pharmacists have a critical role in assessing the presence of HSDD and providing education on available treatment options. This article will review the potential causes of HSDD and low sexual desire, the screening tools available, and the significant role of health care professionals in communicating with patients about their sexual health. An overview of the importance of behavioral modifications, the current pharmacologic options being investigated, and the use of complementary and alternative therapies will also be explored. Currently, buproprion is the primary pharmacologic agent that has shown positive results in treating patients with HSDD. The use of testosterone therapy will not be addressed in this article, as this therapy is described in greater detail elsewhere. PMID:23553810
Lodise, Nicole M
Few studies have focused on cannabis dependence as compared to other drugs more commonly acknowledged as presenting a substantial need for treatment. This paper presents findings from a 2004-2005 study of drug user treatment clients in Southern Ontario, Canada. Clients with cannabis (n = 128) or cocaine (n = 300) as their primary drug problem were compared on psychosocial and demographic characteristics, drug effects, and clinical impairment. There are more similarities than differences between groups, with DAST and DSM scores showing high rates of "dependence" and reported symptoms of "abuse." However, cannabis consistently scored lower on these items, supporting the idea of a continuum of risk on which its rank compared with other potentially misused drugs holds across a wide range of symptoms of impairment. The less disruptive nature of cannabis use-related problems poses greater challenges for drug user treatment providers guided by strict abstinence agendas. The authors call for the expansion of harm reduction treatment options and educational initiatives beyond primary prevention that acknowledge benefits of moderate controlled use when addressing cannabis misuse. PMID:19938940
Hathaway, A D; Callaghan, R C; Macdonald, S; Erickson, P G
The scabies mite is an ectoparasite able to infest humans. Its clinical presentation is typical, although in immunocompromised, mentally retarded and elderly patients the clinical presentation may be altered. Diagnosis may therefore be difficult in such patient groups, who often reside in nursing homes. Because delay in diagnosis may induce rapid spread of the scabies mite, immediate diagnosis and treatment
Milan Tjioe; Wynand H P M Vissers
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
The separation processes available for treating the more than one billion gal\\/yr of oil waste estimated to be generated in the US are described. These include flotation, centrifugal separators, emulsion breaking, filter coalescence, biological treatment, carbon adsorption, and membrane filtration. Factors to be considered in selecting the process and equipment are briefly discussed. (JSR)
R. B. Tabakin; R. Trattner; P. N. Cheremisinoff
The evidence base for the efficacy of the ketogenic diet was assessed among pediatric epileptic patients by application of a rigorous statistical meta-analysis. Nineteen studies from 392 abstracts met the inclusion criteria. The sample size was 1084 patients (mean age at initiation 5.78 ± 3.43 years). The pooled odds ratio, using a random effects model, of treatment success (> 50%
C. Beth Henderson; Francis M. Filloux; Stephen C. Alder; Joseph L. Lyon; Deirdre A. Caplin
Ixabepilone (Ixempra®; Bristol-Myers Squibb) is a novel microtubule stabilizing agent recently approved for the treatment of metastatic breast cancer (MBC). This article focuses on considerations for ixabepilone administration and adverse event (AE) management, drawing from the biomedical literature indexed in PubMed, published abstracts from the American Society of Clinical Oncology annual meetings, and the manufacturer’s prescribing information for ixabepilone. Administered as monotherapy or in combination with capecitabine in clinical studies, ixabepilone demonstrated positive clinical response rates, prolonged progression-free survival, and a favorable safety profile in patients with MBC. Treatment-related AEs were predictable and manageable with dose modification, treatment interruption, and active management. As ixabepilone undergoes development in earlier lines of breast cancer therapy and in other solid tumors, oncology nurses will encounter more and more patients receiving ixabepilone therapy. If nurses are acquainted with the unique management strategies associated with ixabepilone treatment, as detailed herein, patients are more likely to receive the full benefit of therapy.
Cobham, Marta Vallee; Donovan, Diana
Osteoradionecrosis (ORN) of the craniomaxillofacial skeleton is a serious and debilitating complication that can occur following radiation therapy in the head and neck. Patients require effective treatment, which eradicates diseased tissue and restores function with minimal additional morbidity in a single stage, a requirement fulfilled in many cases by free tissue transfer. In a 6-year period from 1994 to 1999,
E. Ang; C. Black; J. Irish; D. H. Brown; P. Gullane; B. O'Sullivan; P. C. Neligan
Despite the fact that rates of cannabis dependence have increased substantially over the past several years, there are no medications approved for the treatment of cannabis dependence. This paper reviews data from recent research on cannabinoids that may be relevant for the development of pharmacotherapies for cannabis dependence. Included in the discussion are findings from studies that have assessed the
Carl L. Hart
Oxidative stress and energy depletion are characteristic biochemical hallmarks of Alzheimer's disease (AD), thus antioxidants with positive effects on glucose metabolism such as thioctic (-lipoic) acid should exert positive effects in these patients. Therefore, 600 mg -lipoic acid was given daily to nine patients with AD and related dementias (receiving a standard treatment with acetylcholinesterase inhibitors) in an open study
Klaus Hager; Andres Marahrens; Marlene Kenklies; Peter Riederer; Gerald Munch
|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
|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
Chronic pain affects 75 million US citizens. A number of pharmacologic treatments are available for chronic pain that does not respond adequately to nonpharmacologic methods. Long the mainstay of chronic pain management, nonsteroidal anti-inflammatory drugs (NSAIDs) are known to be associated with gastrointestinal (GI) and renal toxicities, a particular problem for the elderly population, which commonly experiences chronic pain, such
Thomas J Schnitzer
The CH2M HILL Plateau Remediation Company (CHPRC) has recommended to the U.S. Department of Energy (DOE) a two phase approach for removal and storage (Phase 1) and treatment and packaging for offsite shipment (Phase 2) of the sludge currently stored withi...
Opioid dependence, manifesting as addiction to heroin and pharmaceutical opioids is increasing. Internationally, there are an estimated 15.6?million illicit opioid users. The global economic burden of opioid dependence is profound both in terms of HIV and hepatitis C virus transmission, direct healthcare costs, and indirectly through criminal activity, absenteeism and lost productivity. Opioid agonist medications, such as methadone and buprenorphine, that stabilize neuronal systems and provide narcotic blockade are the most effective treatments. Prolonged provision of these medications, defined as maintenance treatment, typically produces improved outcomes when compared with short-duration tapers and withdrawal. The benefits of opioid agonist maintenance include decreased illicit drug use, improved retention in treatment, decreased HIV risk behaviours and decreased criminal behaviour. While regulations vary by country, these medications are becoming increasingly available internationally, especially in regions experiencing rapid transmission of HIV due to injection drug use. In this review, we describe the rationale for maintenance treatment of opioid dependence, discuss emerging uses of opioid antagonists such as naltrexone and sustained-release formulations of naltrexone and buprenorphine, and provide a description of the experimental therapies. PMID:22235870
Tetrault, Jeanette M; Fiellin, David A
Bleeding of prostatic origin is usually caused by the friable hypervascularity of the prostate, the vessels of which are easily disrupted by physical activity. The condition is often ignored after the patient has been fully investigated and more serious causes for bleeding excluded and treatment is often withheld unless the bleeding becomes excessive. We analysed the clinical effect of finasteride
KM Kashif; SJ Foley; V Basketter; SAV Holmes
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
PurposeWe reviewed all available literature on early stage prostate cancer treatment in which pretreatment serum prostate specific antigen (PSA) levels were used to stratify patients. We determined if any conclusions could be reached regarding the optimal therapy of this disease.
Frank A. Vicini; Eric M. Horwitz; Jose Gonzalez; Alvaro A. Martinez
Quality of life considerations are becoming increasingly important in prostate cancer management, particularly with the trend for patients to be diagnosed at an earlier age and at an earlier stage of disease. A rising serum prostate-specific antigen (PSA) level in the absence of symptoms can cause anxiety to many patients. Patients in this situation must weigh the benefits of treatment,
Objective: To compare clinical and economic study data for docetaxel, paclitaxel and vinorelbine in the treatment of anthracycline-resistant advanced breast cancer. Study design and methods: A Markov decision-analysis model to simulate the clinical course of a `typical' patient with advanced breast cancer during salvage chemotherapy was updated with response rates and adverse effect rates from phase III clinical trial data
Ruth E. Brown; John Hutton; Anita Burrell
The treatment and disposal of sewage sludge generate considerable amounts of greenhouse gases (GHGs) and pose environmental and economic challenges to wastewater treatment in China. To achieve a more informed and sustainable sludge management, this study conducts a life cycle inventory to investigate the GHG performances of six scenarios involving various sludge treatment technologies and disposal strategies. These scenarios are landfilling (S1), mono-incineration (S2), co-incineration (S3), brick manufacturing (S4), cement manufacturing (S5), and fertilizer for urban greening (S6). In terms of GHG emissions, S2 demonstrates the best performance with its large offset from sludge incineration energy recovery, followed by S4 and S6, whereas S1 demonstrates the poorest performance primarily because of its large quantity of methane leaks. The scenario rankings are affected by the assumptions of GHG offset calculation. In most scenarios, GHG performance could be improved by using waste gas or steam from existing facilities for drying sludge. Furthermore, considering the GHG performance along with economic, health, and other concerns, S6 is recommended. We thus suggest that local governments promote the use of composted sludge as urban greening fertilizers. In addition, the use of sludge with 60% water content, in place of the current standard of 80%, in wastewater treatment plants is proposed to be the new standard for Tai Lake Watershed in China. PMID:23410857
Liu, Beibei; Wei, Qi; Zhang, Bing; Bi, Jun
Olaparib has shown promising anticancer activity as a single agent in the treatment and maintenance of recurrent ovarian cancer in early clinical trials, but it is far from standard therapy. This article outlines the problem of relapsed ovarian cancer and the mechanisms of poly(ADP-ribose) polymerase inhibitors and reviews the recent literature pertaining to olaparib in ovarian cancer.
Shaw, Heather M; Hall, Marcia
Purpose: To obtain utilities (a unit of measure of a person’s relative preferences for different health states compared with death or worst possible outcome) for uterine fibroids before and after treatment and to measure short-term utilities for the following uterine fibroid treatments: abdominal hysterectomy, magnetic resonance (MR) imaging–guided focused ultrasound surgery, and uterine artery embolization (UAE). Materials and Methods: This retrospective study was approved by the institutional review board and was HIPAA compliant. The waiting trade-off (WTO) method, a variation on the time trade-off (TTO) method, is used to obtain utilities for diagnostic procedures on the basis of the fact that people wait longer to avoid noxious tests and/or procedures. The WTO method provides short-term quality of life tolls in terms of quality-adjusted life-weeks by scaling wait times with pre- and posttreatment utilities. Utilities for uterine fibroids before and after treatment were obtained with the TTO method and a visual analog scale (VAS) by using a questionnaire administered by means of a phone interview. WTO wait times were adjusted for quality of life with VAS and TTO utilities and a transformation of VAS. Wait times were compared by using nonparametric tests. The study participants included 62 patients who had undergone abdominal hysterectomy, 74 who had undergone UAE, and 61 who had undergone MR imaging–guided focused ultrasound surgery. Results: Quality of life increased with all treatments. The median WTO wait time was higher for hysterectomy (21.6 weeks) than for UAE or MR imaging–guided focused ultrasound surgery (14.1 weeks for both) (P < .05). Quality-adjusted life-week tolls were smaller when scaled according to TTO than when scaled according to VAS or transformation of VAS. Conclusion: Quality of life increased after all fibroid treatments. WTO is feasible for assessing the quality-adjusted morbidity of treatment procedures. © RSNA, 2011 Supplemental material: http://radiology.rsna.org/lookup/suppl/doi:10.1148/radiol.11100704/-/DC1
Kong, Chung Yin; Tempany, Clare M.; Swan, J. Shannon
Gestational diabetes mellitus is one of the major medical complications of pregnancy. Untreated, the mother and the unborn child may experience morbidity and fetal death may even occur. It is important to diagnose and treat all hyperglycaemia appearing during pregnancy. Ideally, a screening and diagnostic test that identified all women at risk for hyperglycaemia-associated complications would be employed in all pregnant women. Unfortunately, there is no such test available currently. The best alternative is to administer an oral glucose challenge test to all pregnant women and then apply the best strategies for interpretation. This article discusses the limitations of our present diagnostic tools and suggests an option for the clinician until the definitive test has been elucidated. In addition, this article outlines one dietary and management strategy that has been associated with an outcome of pregnancy that is similar to the outcome of pregnancies in healthy women. This strategy includes starting with a "euglycaemic" diet (comprising < 40% carbohydrates and > or =40% fat), which can then be individualised according to the patient's glucose levels. Appropriate exercise, such as arm ergometer training, may enhance the benefits of diet control. For patients who require insulin, if the fasting glucose level is >90 mg/dL or 5 mmol/L (whole blood capillary) then NPH insulin (insulin suspension isophane) should be given before bed, beginning with dosages of 0.2 U/kg/day. If the postprandial glucose level is elevated, pre-meal rapid-acting insulin should be prescribed, beginning with a dose of 1U per 10g of carbohydrates in the meal. If both the fasting and postprandial glucose levels are elevated, or if a woman's postprandial glucose levels can only be blunted if starvation ketosis occurs, a four-injections-per-day regimen should be prescribed. The latter can be based on combinations of NPH insulin and regular human insulin, timed to provide basal and meal-related insulin boluses. The total daily insulin dose for the four-injection regimen should be adjusted according to pregnant bodyweight and gestational week (0.7-1 U/kg/day); doses may need to be increased for the morbidly obese or when there is twin gestation. There is now some evidence that insulin lispro, other insulin analogues and oral antihyperglycaemic drugs may be beneficial in gestational diabetes, and more data on these agents are awaited with interest. PMID:15212558
Men living with HIV (MLWH), especially younger MLWH, may experience sexual dysfunction in greater numbers than men without HIV infection. This manuscript describes the prevalence of two major causative factors of sexual dysfunction in MLWH: hypogonadism and erectile dysfunction. A description of assessment and evaluation is presented. Additionally, the evidence for use of pharmacological and herbal therapies is presented with recommendations for treatment. MLWH who exhibit hypogonadism and/or erectile dysfunction should receive similar care to those without HIV infection. There is evidence to support the use of testosterone replacement therapy and phosphodiesterase 5 inhibitors in this population, and there is limited evidence for the use of certain herbs such as yohimbine. The ethics of treating sexual dysfunction for MLWH are discussed. A case study follows as an example of the application of evidence-based treatments recommended for practice. PMID:23290373
Roberson, Donna W; Kosko, Debra A
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.
Tolman, Justin A; Faulkner, Michele A
Studies in our laboratory demonstrate that the action spectrum for stimulation of cytochrome oxidase activity and cellular ATP parallels the near-infrared absorption spectrum of cytochrome oxidase and that 660-680 nm irradiation upregulates cytochrome oxidase activity in cultured neurons. Treatment with nearinfrared light augments cellular energy production and neuronal viability following mitochondrial injury linking the actions of red to near-infrared light
Kristina Desmet; Ellen Buchmann; Michele Henry; Margaret Wong-Riley; Janis Eells; Jim Verhoeve; Harry Whelan
Symptomatic fibroids are one of the most common reasons women undergo surgical intervention (hysterectomy, myomectomy, endometrial ablation) or other invasive interventions (uterine artery embolization). Although pharmacologic therapy with GnRH analogues, Danazol, RU486 and NSAIDs are occasionally prescribed, rarely are oral contraceptives (OCPs) prescribed for either fibroid prevention or treatment of symptoms. It appears that OCPs are underutilized as a first-line
Khalida Sharafi; Kimberly Kunze; John L Nosher; Gloria A Bachmann
Rapid progress has been made from the identification of the molecular defects causing X-linked severe combined immune deficiency\\u000a (X-SCID) to the development of cutting-edge therapeutic approaches such as hematopoietic stem cell transplant and gene therapy\\u000a for XSCID. Successful treatment of XSCID has created a new population of patients, many of whom are now adolescents and young\\u000a adults and are facing
Suk See De Ravin; Harry L. Malech
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
Osteoarthritis is one of the most common causes of pain originating from the acromioclavicular (AC) joint. An awareness of\\u000a appropriate diagnostic techniques is necessary in order to localize clinical symptoms to the AC joint. Initial treatments\\u000a for AC joint osteoarthritis, which include non-steroidal anti-inflammatory drugs (NSAIDS) and corticosteroids, are recommended\\u000a prior to surgical interventions. Distal clavicle excision, the main surgical
Salvatore Docimo Jr; Dellene Kornitsky; Bennett Futterman; David E. Elkowitz
Only a subset of patients with primary and secondary liver tumors are eligible for surgical resection because of either the\\u000a presence of extrahepatic disease, increased number of hepatic lesions, the anatomical distribution of tumors within the liver,\\u000a and\\/or general medical inoperability. Nonsurgical, ablative tumor treatment may benefit selected patients by preserving normal\\u000a liver function. This review presents the concept and
Martin Fuss; Charles R. Thomas
We evaluated the evidence regarding the effectiveness of various treatment strategies used for 2009 H1N1 influenza by reviewing available relevant studies. In total, 22 studies (15 cohort studies involving >10 patients, 5 cohort studies with ?10 patients and 2 case reports) were included. A total of 3020 patients [1068 (35.4%) critically ill, 1722 (57.0%) hospitalised and 230 (7.6%) outpatients, including
Matthew E. Falagas; Evridiki K. Vouloumanou; Evagelia Baskouta; Petros I. Rafailidis; Kostantinos Polyzos; Jordi Rello
Although the outcome of patients with non-Hodgkin lymphoma (NHL) has, in general, improved significantly over years, treatment\\u000a failure due to drug resistance remains a problem. Recently, the focus of drug development has shifted from conventional cytotoxic\\u000a drugs to agents directed against specific molecular targets and immunotherapy. This has mainly been driven by advances in\\u000a the understanding of the molecular pathogenesis
S. Kassam; Silvia Montoto
We present an evidence-based evaluation of published data on therapy for children with various presentations of the IgA nephropathies\\u000a – idiopathic IgA nephropathy (IgAN) and Henoch-Schnlein purpura nephritis (HSPN). Particular attention has been paid to the\\u000a outcome markers used in the studies reviewed, with the best evidence provided by markers highly associated with progressive\\u000a renal failure. No treatment modality for
Robert J. Wyatt; Ronald J. Hogg
Objective-To describe clinical signs, diagnostic findings, treatment, and outcome and determine factors associated with survival time for dogs with thymoma. Design-Multi-institutional retrospective case series. Animals-116 dogs with thymoma. Procedures-Medical records were searched for information regarding signalment, physical examination findings, results of laboratory testing and diagnostic imaging, medical and surgical treatment, and survival data. Results-Of the 116 dogs with thymoma, 44 (38%) were Labrador Retrievers and Golden Retrievers. Twenty of 116 (17%) dogs had signs of myasthenia gravis (diagnosis was confirmed for 13 dogs). At the time of thymoma diagnosis, 40 (34%) dogs had hypercalcemia, 8 (7%) dogs had a concurrent immune-mediated disease, and 31 (27%) dogs had another tumor; 16 (14%) dogs developed a second nonthymic tumor at a later date. Tumor excision was performed for 84 dogs, after which 14 (17%) had tumor recurrence; prognosis was good for dogs undergoing a second surgery. Median survival time with and without surgical treatment was 635 and 76 days, respectively. Presence of another tumor at the time of thymoma diagnosis, lack of surgical excision, and higher pathological stage were significantly associated with shorter survival time. Hypercalcemia and presence of myasthenia gravis or megaesophagus at the time of thymoma diagnosis, histopathologic subtype of thymoma, or tumor development at a later date was not associated with survival time. Conclusions and Clinical Relevance-Dogs with thymoma, even those with a large tumor burden or a paraneoplastic syndrome, had a good prognosis following surgery. Surgical treatment, tumor stage, and the presence of a second tumor at diagnosis influenced survival time. PMID:24171375
Robat, Cecilia S; Cesario, Lori; Gaeta, Rachael; Miller, Mairin; Schrempp, Diane; Chun, Ruthanne
Purpose: To determine the long-term results of the DPVL for the treatment of venous impotence. Patients and methods: The long term results of DPVL in 134 patients were interviewed. The mean age was 39.2 (range 21--72). Power color doppler imaging, pharmacocavernography\\/dynamic cavernosometry were performed. Postoperatively, all the patients were controlled in the 6th month, first year and, if possible, once
M. Çakan; F. Yalçinkaya; F. Demirel; T. Özgünay; U. Altu?
Purpose: To determine the long-term results of the DPVL for the treatment ofvenous impotence.Patients and methods: The long-term results of DPVL in 134 patients wereinterviewed. The mean age was 39.2 (range 21–72). Power color doppler imaging,pharmacocavernography\\/dynamic cavernosometry were performed. Postoperatively,all the patients were controlled in the 6th month, first year and, ifpossible, once a year. The mean follow-up was 54.8
M. Çakan; F. Yalç?nkaya; F. Demirel; T. Özgünay; U. Altu?
Opinion statement Brain metastases are a common complication for patients with non-small cell lung cancer and a significant cause of morbidity\\u000a and mortality. In the past, treatment of brain metastases and lung cancer focused on symptom palliation with whole brain radiotherapy\\u000a (WBRT) and steroids because of the grim outlook for patients. However, recent advances in technology and surgical techniques\\u000a have created
Sadaf Taimur; Martin J. Edelman
Sleep apnea is an entity characterized by repetitive upper airway obstruction resulting in nocturnal hypoxia and sleep fragmentation. It is estimated that 2%–4% of the middle-aged population has sleep apnea with a predilection in men relative to women. Risk factors of sleep apnea include obesity, gender, age, menopause, familial factors, craniofacial abnormalities, and alcohol. Sleep apnea has been increasingly recognized as a major health burden associated with hypertension and increased risk of cardiovascular disease and death. Increased airway collapsibility and derangement in ventilatory control responses are the major pathological features of this disorder. Polysomnography (PSG) is the gold-standard method for diagnosis of sleep apnea and assessment of sleep apnea severity; however, portable sleep monitoring has a diagnostic role in the setting of high pretest probability sleep apnea in the absence of significant comorbidity. Positive pressure therapy is the mainstay therapy of sleep apnea. Other treatment modalities, such as upper airway surgery or oral appliances, may be used for the treatment of sleep apnea in select cases. In this review, we focus on describing the sleep apnea definition, risk factor profile, underlying pathophysiologic mechanisms, associated adverse consequences, diagnostic modalities, and treatment strategies.
Gharibeh, Tarek; Mehra, Reena
Since the introduction of HAART, there was a remarkably change in the natural history of HIV disease, leading to a notable extension of life expectancy, although prolonged metabolic imbalances could significantly act on the longterm prognosis and outcome of HIV-infected persons, and there is an increasing concern about the cardiovascular risk in this population. Current recommendations suggest that HIV-infected perons undergo evaluation and treatment on the basis of the Third National Cholesterol Education Program Expert Panel on Detection, Evaluation and Treatment of High Blood Cholesterol in Adults (NCEP ATP III) guidelines for dyslipidemia, with particular attention to potential drug interactions with antiretroviral agents and maintenance of virologic control of HIV infection. While a hypolipidemic diet and physical activity may certainly improve dyslipidemia, pharmacological treatment becomes indispensable when serum lipid are excessively high for a long time or the patient has a high cardiovascular risk, since the suspension or change of an effective antiretroviral therapy is not recommended. Moreover, the choice of a hypolipidemic drug is often a reason of concern, since expected drug-drug interactions (especially with antiretroviral agents), toxicity, intolerance, effects on concurrent HIV-related disease and decrease patient adherence to multiple pharmacological regimens must be carefully evaluated. Often the lipid goals of patients in this group are not achieved by the therapy recommended in the current lipid guidelines and in this article we describe other possibilities to treat lipid disorders in HIV-infected persons, like rosuvastatin, ezetimibe and fish oil.
da Silva, Erika Ferrari Rafael; Barbaro, Giuseppe
Alzheimer's disease (AD) is a progressive and ultimately fatal condition that causes debilitating memory loss and extensive deterioration of cognitive and functional abilities. Currently available treatments for AD (donepezil, rivastigmine, galantamine and memantine) are symptomatic and do not decelerate or prevent the progression of the disease. These therapies demonstrate modest, but particularly consistent, benefit for cognition, global status and functional ability. The search for disease-modifying intervent