Sample records for non-surgical treatment options

  1. Review of non-surgical treatment options for Peyronie's disease.

    PubMed

    Larsen, S M; Levine, L A

    2012-01-01

    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 review the latest guidelines for the management of PD from the International Committee on Sexual Medicine, which conveyed its findings in July 2009. At this time, it appears that a combination of oral agents and/or intralesional injection with traction therapy may provide a synergy between the chemical effects of the drugs and the mechanical effects of traction. Until a reliable treatment emerges, it does appear that some of the non-surgical treatments discussed can be used to stabilize the scarring process and may result in some reduction of deformity with improved sexual function. PMID:21918530

  2. The Non-Surgical Treatment of Peyronie Disease: 2013 Update

    PubMed Central

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

    2013-01-01

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

  3. The non-surgical treatment of peyronie disease: 2013 update.

    PubMed

    Shaw, Eric James; Mitchell, Gregory Clyde; Tan, Ronny B; Sangkum, Premsant; Hellstrom, Wayne John G

    2013-12-01

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

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

    PubMed Central

    Kwaees, Tariq Adam; Charalambous, Charalambos P.

    2014-01-01

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

  5. Non-surgical options to autologous finger transplants.

    PubMed

    Zeman, B D; Wood, H

    2000-08-01

    This case report describes the rehabilitation path of a man who sustained severe burns to his body and extremities as a result of a bushfire. The fingers of both hands were amputated except the thumbs and although he was a candidate for autologous transplant, declined this option for various reasons. Bilateral prostheses were made and resulted in a significant improvement in functional outcome without the need for surgery. Prostheses are practical alternatives to surgery and should be considered in selected patients. PMID:11061204

  6. Non-surgical treatment of early breast cancer: techniques on the way.

    PubMed

    Hamza, Alaa; Elrefaey, Shymaa

    2014-08-01

    Trials are still on the way to evaluate different non-surgical techniques to treat early breast cancer with achieving maximum oncological control and aesthetic outcome. Also these techniques can help old patients to bypass surgical and radiation complications and facilitate the treatment of early breast cancer with minimum side effects. PMID:25207205

  7. Non-surgical treatment of early breast cancer: techniques on the way

    PubMed Central

    Elrefaey, Shymaa

    2014-01-01

    Trials are still on the way to evaluate different non-surgical techniques to treat early breast cancer with achieving maximum oncological control and aesthetic outcome. Also these techniques can help old patients to bypass surgical and radiation complications and facilitate the treatment of early breast cancer with minimum side effects. PMID:25207205

  8. Surgical versus non-surgical treatment of mandibular condylar fractures: a meta-analysis.

    PubMed

    Chrcanovic, B R

    2015-02-01

    The aim of the present study was to test whether there is a significant difference in the clinical outcomes between surgical and non-surgical treatment of mandibular condylar fractures. An electronic search was undertaken in February 2014. Eligibility criteria included clinical human studies, either randomized or not. The search strategy resulted in 36 publications. The estimates of an intervention were expressed as the risk ratio (RR) and mean difference (MD) in millimetres. A statistically significant effect was observed for the outcome of post-treatment malocclusion (RR 0.46, P<0.00001), lateral deviation during maximum inter-incisal opening (RR 0.56, P=0.0001, dichotomous; MD -0.75, P=0.002, continuous), protrusion (MD 0.68, P=0.01), and laterotrusion (MD 0.53, P=0.03) favouring surgical treatment, and for infection (RR 3.43, P=0.03) favouring non-surgical treatment. There was no statistically significant effect on temporomandibular joint pain (RR 0.81, P=0.46) or noise (RR 1.44, P=0.24), or maximum inter-incisal opening (MD 2.24, P=0.14). The test for overall effect showed that the difference between the procedures significantly affected the incidence of post-treatment complications, favouring surgical treatment, when all dichotomous and continuous outcomes were analysed (RR 0.70, P=0.006 and MD 1.17, P=0.0006, respectively). PMID:25457827

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

    PubMed Central

    RIBEIRO, Érica Del Peloso; BITTENCOURT, Sandro; SALLUM, Enilson Antônio; SALLUM, Antônio Wilson; NOCITI JÚNIOR, Francisco Humberto; CASATI, Márcio Zaffalon

    2010-01-01

    Objective The aim of this controlled clinical trial was to evaluate the effect of topically applied povidone-iodine (PVP-I) used as an adjunct to non-surgical treatment of interproximal class II furcation involvements. Material and methods Thirty-two patients presenting at least one interproximal class II furcation involvement that bled on probing with probing pocket depth (PPD) ?5 mm were recruited. Patients were randomly chosen to receive either subgingival instrumentation with an ultrasonic device using PVP-I (10%) as the cooling liquid (test group) or identical treatment using distilled water as the cooling liquid (control group). The following clinical outcomes were evaluated: visible plaque index, bleeding on probing (BOP), position of the gingival margin, relative attachment level (RAL), PPD and relative horizontal attachment level (RHAL). BAPNA (N-benzoyl-Larginine-p-nitroanilide) testing was used to analyze trypsin-like activity in dental biofilm. All parameters were evaluated at baseline and 1, 3 and 6 months after non-surgical subgingival instrumentation. Results Six months after treatment, both groups had similar means of PPD reduction, RAL and RHAL gain (p>0.05). These variables were, respectively, 2.20±1.10 mm, 1.27±1.02 mm and 1.33±0.85 mm in the control group and 2.67±1.21 mm, 1.50±1.09 mm and 1.56±0.93 mm in the test group. No difference was observed between groups at none of the posttreatment periods, regarding the number of sites showing clinical attachment gain ?2 mm. However, at 6 months posttreatment, the test group presented fewer sites with PPD ?5 mm than the control group. Also at 6 months the test group had lower BAPNA values than control group. Conclusion The use of PVP-I as an adjunct in the non-surgical treatment of interproximal class II furcation involvements provided limited additional clinical benefits. PMID:21308291

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

    Microsoft Academic Search

    T. B. Hildebrandt; F. Göritz; W. Boardman; T. Strike; G. Strauss; K. Jewgenow

    2006-01-01

    This paper presents the successful use of a non-surgical, transcervical uterine lavage technique for the treatment of uterine infection-induced infertility in three female large cats. We developed a non-surgical uterine lavage technique, which allowed repeated flushing of the uterine lumen and installation of therapeutic antibiotics. The entire procedure was performed under general anaesthesia (duration of anesthesia ranged from 40 to

  11. Sexual function before and after non-surgical treatment for stress urinary incontinence

    PubMed Central

    Handa, Victoria L.; Whitcomb, Emily; Weidner, Alison C.; Nygaard, Ingrid; Brubaker, Linda; Bradley, Catherine S.; Paraiso, Marie Fidela R.; Schaffer, Joseph; Zyczynski, Halina M.; Zhang, Min; Richter, Holly E.

    2011-01-01

    Objectives (1) to describe sexual function in women seeking treatment of stress urinary incontinence (SUI); (2) to compare the impact on sexual function of three SUI treatments; and (3) to investigate whether non-surgical treatment of SUI is associated with improved sexual function. Methods Women with SUI were randomized to continence pessary, behavioral therapy (pelvic floor muscle training and continence strategies), or combination therapy. Sexual function was assessed at baseline and 3-months using short forms of the Pelvic Organ Prolapse-Urinary Incontinence Sexual Function Questionnaire (PISQ-12) and the Personal Experiences Questionnaire (SPEQ). Successful treatment of SUI was assessed with a patient global impression of improvement. ANOVA was used to compare scores between groups. Results At baseline, sexual function was worse among women with mixed incontinence compared to those with pure SUI. After therapy, successful treatment of SUI was associated with greater improvement in PISQ-12 score (2.26 ± 3.24 versus 0.48 ± 3.76, p=0.0007), greater improvement in incontinence with sexual activity (0.45 ± 0.84 versus 0.01 ± 0.71, p=0.0002), and greater reduction in restriction in sexual activity related to fear of incontinence (0.32 ± 0.76 versus ?0.06 ± 0.78, p=0.0008). Among those successfully treated for SUI, improvement in continence during sexual activity was greater in both the combined therapy group (p=0.019) and the behavioral group (p=0.02) compared to the pessary group. Conclusions Successful non-surgical treatment of SUI is associated with improvements in incontinence-specific measures of sexual function. Behavioral therapy may be preferred to pessary for treatment of SUI among women whose incontinence interferes with sexual function. PMID:21572534

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

    PubMed Central

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

    2012-01-01

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

  13. Hospital type- and volume-outcome relationships in esophageal cancer patients receiving non-surgical treatments

    PubMed Central

    Hsu, Po-Kuei; Chen, Hui-Shan; Wang, Bing-Yen; Wu, Shiao-Chi; Liu, Chao-Yu; Shih, Chih-Hsun; Liu, Chia-Chuan

    2015-01-01

    AIM: To study the “hospital type-outcome” and “volume-outcome” relationships in patients with esophageal cancer who receive non-surgical treatments. METHODS: A total of 6106 patients with esophageal cancer diagnosed between 2008 and 2011 were identified from a national population-based cancer registry in Taiwan. The hospital types were defined as medical center and non-medical center. The threshold for high-volume hospitals was based on a median volume of 225 cases between 2008 and 2011 (annual volume, > 56 cases) or an upper quartile (> 75%) volume of 377 cases (annual volume > 94 cases). Cox regression analyses were used to determine the effects of hospital type and volume outcome on patient survival. RESULTS: A total of 3955 non-surgically treated patients were included in the survival analysis. In the unadjusted analysis, the significant prognostic factors included cT, cN, cM stage, hospital type and hospital volume (annual volume, > 94 vs ? 94). The 1- and 3-year overall survival rates in the non-medical centers (36.2% and 13.2%, respectively) were significantly higher than those in the medical centers (33.5% and 11.3%, respectively; P = 0.027). The 1- and 3-year overall survival rates in hospitals with an annual volume of ? 94 (35.3% and 12.6%, respectively) were significantly higher than those with an annual volume of > 94 (31.1% and 9.4%, respectively; P = 0.001). However, in the multivariate analysis, the hospital type was not statistically significant. Only cT, cN, and cM stages and hospital volume (annual volume > 94 vs ? 94) were independent prognostic factors. CONCLUSION: Whether the treatment occurs in medical centers is not a significant prognostic factor. High-volume hospitals were not associated with better survival rates compared with low-volume hospitals. PMID:25632197

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

    NASA Astrophysics Data System (ADS)

    Longo, L.

    2010-11-01

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

  15. [Review of non-surgical treatment of avascular necrosis of the femoral head].

    PubMed

    Gómez-García, F

    2013-01-01

    Avascular necrosis of the femoral head is a frequent condition with an insidious presentation; it is initially asymptomatic and thus it is seldom diagnosed at the early stages. The purpose of this review is to update the status of the diagnosis and non-surgical treatment of avascular necrosis of the femoral head. This paper analyzes the natural history of the disease as well as the prognostic importance of early diagnosis and the identification of the extension and location of osteonecrosis. It also discusses the different nonsurgical treatment methods such as: high energy extracorporeal shock waves, electromagnetic pulsed fields, hyperbaric oxygen therapy, drugs, physical therapy, and regenerative medicine. The conclusion is that no method is effective in the advanced stages and there is great hope of treating this condition without surgery; however, progress needs to be made in research, particularly in the use of external biophysical agents and regenerative medicine. The gold standard of treatment is still surgical decompression of the femoral head at the stages in which no collapse has occurred. The prognosis apparently improves with the use of biophysical and regenerative medicine adjuvants. PMID:24707618

  16. Antimicrobial photodynamic therapy in the non-surgical treatment of aggressive periodontitis: microbiological profile.

    PubMed

    Novaes, Arthur B; Schwartz-Filho, Humberto O; de Oliveira, Rafael R; Feres, Magda; Sato, Sandra; Figueiredo, Luciene C

    2012-03-01

    The aim of this trial was to investigate changes occurring in the subgingival microbiological composition of subjects with aggressive periodontitis, treated with antimicrobial photodynamic therapy (aPDT), in a single episode, or scaling and root planing (SRP), in a split-mouth design on -7, 0, and +90 days. Ten patients were randomly assigned to either aPDT using a laser source in conjunction with a photosensitizer or SRP with hand instruments. Subgingival plaque samples were collected and the counts of 40 subgingival species were determined using checkerboard DNA-DNA hybridization. The data were analyzed using the method of generalized estimating equations (GEE) to test the associations between treatments, evaluated parameters, and experimental times (? = .05). The results indicated that aPDT and SRP affects different bacterial species, with aPDT being effective in reducing numbers of A. actinomycetemcomitans than SRP. On the other hand, SRP was more efficient than aPDT in reducing the presence of periodontal pathogens of the Red Complex. Additionally, a recolonization in the sites treated by aPDT was observed, especially for T. forsythia and P. gingivalis. Under our experimental conditions, this trial demonstrates that aPDT and SRP affected different groups of bacteria, suggesting that their association may be beneficial for the non-surgical treatment of aggressive periodontitis. PMID:21399951

  17. Non-surgical treatment of peri-implantitis with the adjunctive use of an 810-nm diode laser.

    PubMed

    Roncati, Marisa; Lucchese, Alessandra; Carinci, Francesco

    2013-11-01

    An 810-nm diode laser was used to non-surgically treat a 7-mm pocket around an implant that had five threads of bone loss, BoP+, and exudate, and the patient was followed up for 5 years. Non-surgical treatment, home care reinforcement, clinical indices records, and radiographic examination were completed in two consecutive 1-h appointments within 24 h. The patient was monitored frequently for the first 3 months. Subsequently, maintenance debridement visits were scheduled at 3-month intervals. The patient had a decreased probing pocket depth and a negative BoP index compared to initial clinical data, and the results were stable after 1 year. After 5 years of follow-up visits, there appeared to be rebound of the bone level radiographically. Within the limits of this case report, conventional non-surgical periodontal therapy with the adjunctive use of an 810-nm diode laser may be a feasible alternative approach for the management of peri-implantitis. The 5-year clinical and radiographic outcomes indicated maintenance of the clinical improvement. PMID:24554897

  18. Treatment Options

    MedlinePLUS

    ... amount of FFP needed can overload the circulatory system and stress the heart. Other complications of treatment ... XI deficiency. They are also used to help control excessive menstrual bleeding. Antifibrinolytic drugs can be administered ...

  19. Surgical vs. non-surgical treatment in women with pelvic floor dysfunction: Patient-centered goals at one year

    PubMed Central

    Hullfish, Kathie L.; Bovbjerg, Viktor E.; Gurka, Matthew J.; Steers, William D.

    2009-01-01

    Objective In women with pelvic floor dysfunction (PFD), we assessed the degree to which treatment (surgical vs. non-surgical) was associated with achievement of patient-centered goals, satisfaction with care, and quality of life. Study design Prospective cohort. Between September 2003 and December 2004 we recruited women during their first referral visit for PFD treatment at our outpatient Urogynecology Clinic. At the first visit, women enumerated up to five personal treatment goals, and “anchored” each goal by anticipating best and worst possible outcomes. At 12 month follow-up, women were asked to indicate their level of goal attainment (?2, worst outcome; +2, best outcome). At baseline and follow-up, women completed short forms of the Incontinence Impact Questionnaire (IIQ-7) and Urogenital Distress Inventory (UDI-6) (range 0–100, high scores indicating greater impact or distress). Patients indicated level of treatment satisfaction on a 4 level ordinal scale. Results Of the 127 study participants with complete data, 46 (36.2 %) were managed surgically and 81 (63.8%) non surgically. There were no major demographic differences between the two groups in terms of age, race, weight, prior PFD surgery, and vaginal parity. The surgical group was more likely to have received baseline diagnosis of pelvic organ prolapse (80 % vs 60 %, p = 0.0259), and be post-menopausal (89 % vs 72 %, p = 0.0261). There were no significant differences in the distribution of goal type (symptom relief, activity, self image, general health) by treatment status (p = 0.1074). Using logistic regression to adjust for age and baseline diagnosis, surgically managed patients at one year were significantly more likely to report complete primary goal attainment (odds ratio (OR) = 4.42; p = 0.0154) and complete treatment satisfaction (OR = 6.12; p = 0.0109). For all participants, one-year IIQ-7 and UDI-6 scores were significantly correlated with primary goal attainment scores. Conclusions In this non-randomized, prospective analysis, surgically managed patients with PFD had higher one-year self-described complete goal attainment and satisfaction scores compared with non-surgically managed patients. Goal attainment scores correlated with disease-specific quality of life. Patient-centered outcomes should be incorporated in multi-center prospective research trials for pelvic floor disorders, and incorporated into clinical practice to inform treatment plans. PMID:18423762

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

    PubMed Central

    2014-01-01

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

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

    PubMed

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

    2006-10-01

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

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

    MedlinePLUS

    Patient Section Who Are Interventional Radiologists? Multimedia Insurance Coverage IR Treatments Abdominal aortic aneurysms Angiography Angioplasty and stent placement Cancer - bone Cancer - breast Cancer - kidney Cancer - liver Cancer - lung ...

  3. Incontinence Treatment: Newer Treatment Options

    MedlinePLUS

    ... Personal Stories Who We Are Contact Us Donate Incontinence Treatment: Newer Treatment Options Jump to Topic Lifestyle changes Dietary changes Medication Bowel management/retraining program Biofeedback therapy Surgical treatments Newer procedures ...

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

    PubMed

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

    2014-01-01

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

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

    PubMed Central

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

    2014-01-01

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

  6. Update and perspectives on non-surgical treatment of salivary gland malignancies.

    PubMed

    Airoldi, M; Cortesina, G; Giordano, C; Pedani, F; Cavalot, A; Marcato, P; Beatrice, F; Bumma, C

    2003-10-01

    Surgery is the treatment of choice for major and minor salivary gland malignancies. Herein, the role of radiation and medical treatment in the multidisciplinary management of salivary gland tumours is discussed. Neutron irradiation and hyperfractionated external beam mega voltage irradiation improve local control. Combination of three dimensional conformal radiotherapy and intensive-modulated radiation therapy provide better local tumour delineation, better field design to encompass the tumour allowing dose escalation to target while sparing the surrounding normal tissue. Cisplatin-based chemotherapy provides a response rate > or = 45%, in a palliative setting. Concomitant chemo-radiotherapy could improve local control. Recent studies evaluated the expression of molecular targets in salivary gland carcinomas (c-kit = 53-90%, EGFR = 25-85%, c-erb-B2 = 11-58%, p53 = 11-67%, H ras = 18%); these targets are very important since new targeted drugs are now available. Anti-androgen therapy might have a role in the management of patients with ductal carcinoma. These new targeted drugs could be integrated with chemotherapy and radiotherapy in the treatment of locally advanced/metastatic salivary gland malignancies. PMID:15108487

  7. Novel Operative Treatment Options

    Microsoft Academic Search

    D. N. J. Ricketts; N. B. Pitts

    2009-01-01

    There are an increasing number of more novel options available for operative intervention. This chapter outlines a series of operative treatment options which are available to the modern clinician to select from once a decision has been made to treat a carious lesion operatively. A series of novel methods of caries removal have been described; including chemomechanical caries removal, air

  8. Brain Aneurysm: Treatment Options

    MedlinePLUS

    ... Brain Aneurysm Statistics and Facts Seeking Medical Attention Pediatric Aneurysms Brain Aneurysm Causes and Risk Factors Family History Early Detection and Screening Unruptured Brain Aneurysms Subarachnoid Hemorrhage Treatment Options Clipping Occlusion and ...

  9. Porphyria Treatment Options

    MedlinePLUS

    ... only. For treatment options for Porphyria Cutanea Tarda (PCT) , Congenital Erythropoietic Protoporphyria (CEP) and Hepatoerythropoietic Porphyria (HEP) ... Contact Us About Porphyria AIP VP HCP ADP PCT EPP CEP HEP Diet and Nutrition History of ...

  10. Is surgical intervention more effective than non-surgical treatment for carpal tunnel syndrome? a systematic review

    Microsoft Academic Search

    Qiyun Shi; Joy C MacDermid

    2011-01-01

    Background  Carpal tunnel syndrome is a common disorder in hand surgery practice. Both surgical and conservative interventions are utilized\\u000a for the carpal tunnel syndrome. Although certain indications would specifically indicate the need for surgery, there is a\\u000a spectrum of patients for whom either treatment option might be selected. The purpose of this systematic review was to compare\\u000a the efficacy of surgical

  11. ARSENIC TREATMENT OPTIONS

    EPA Science Inventory

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

  12. Treatment Options in Psoriasis

    PubMed Central

    Dantow, James E.

    1992-01-01

    Psoriasis is a common skin disease with a variety of clinical presentations. Fortunately, many treatment options are available to the patient and to the physician. Topical, systemic, and physical therapies can be tailored to the patient's needs. Patient compliance and a knowledgeable, caring physician are vital to successful control of the disease. Continuing research offers hope for the chronically disabled. PMID:21221381

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

    MedlinePLUS

    ... both kinds of incontinence. This is called "mixed incontinence." Having UI can affect how you feel about yourself. It can limit your ability to enjoy work or other activities. Untreated UI can lead to skin rashes and urinary tract infections. The good news is ...

  14. Treatment options for hyperhidrosis.

    PubMed

    Walling, Hobart W; Swick, Brian L

    2011-10-01

    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

  15. Achilles Tendinosis: Treatment Options

    PubMed Central

    Lopez, Roberto Gabriel L.

    2015-01-01

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

  16. Treatment Options for Malignant Mesothelioma

    MedlinePLUS

    ... Dictionary Search for Clinical Trials NCI Publications Español Malignant Mesothelioma Treatment (PDQ®) Treatment Options for Malignant Mesothelioma Localized Malignant Mesothelioma (Stage I) If malignant ...

  17. Treatment Options for Actinic Keratosis

    MedlinePLUS

    ... Skin Cancer Treatment (PDQ®) Treatment Options for Actinic Keratosis Actinic keratosis is not cancer but is treated because it may develop into cancer. Treatment of actinic keratosis may include the following: Topical chemotherapy . Topical biologic ...

  18. Explore Your Treatment Options

    MedlinePLUS

    ... Share Their Stories Get More Info Glossary Your quality of life depends on knowing your options Just one food ... may help improve your health care and your quality of life. This site has tips to help you talk ...

  19. Treatment Option Overview (Neuroblastoma)

    MedlinePLUS

    ... are different types of treatment for patients with neuroblastoma. Different types of treatment are available for patients ... patients who have not started treatment. Children with neuroblastoma should have their treatment planned by a team ...

  20. Treatment Option Overview (Retinoblastoma)

    MedlinePLUS

    ... larger tumors. This treatment is a type of laser therapy. Chemotherapy Chemotherapy is a cancer treatment that uses ... chemoreduction, other treatments may include radiation therapy, cryotherapy, laser therapy , or regional chemotherapy . Systemic chemotherapy may also be ...

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

    PubMed Central

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

    2014-01-01

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

  2. Treatment Option Overview (Melanoma)

    MedlinePLUS

    ... a high risk that the cancer will come back. A clinical trial of new types of treatment to be used ... a high risk that the cancer will come back. A clinical trial of new kinds of treatments to be used ...

  3. Treatment Options for Insomnia

    Microsoft Academic Search

    KALYANAKRISHNAN RAMAKRISHNAN; DEWEY C. SCHEID

    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

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

    PubMed Central

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

    2014-01-01

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

  5. PTSD: Treatment Options

    MedlinePLUS

    ... patients with PTSD. Cognitive behavioral therapy (CBT) for insomnia is a very effective approach for treating sleep ... and may be particularly helpful for treatment of insomnia in PTSD. Trazodone is also used to treat ...

  6. The Questionnaire for Urinary Incontinence Diagnosis (QUID): Validity and Responsiveness to Change in Women Undergoing Non-Surgical Therapies for Treatment of Stress Predominant Urinary Incontinence

    PubMed Central

    Bradley, Catherine S.; Rahn, David D.; Nygaard, Ingrid E.; Barber, Matthew D.; Nager, Charles W.; Kenton, Kimberly S.; Siddiqui, Nazema Y.; Abel, Robert B.; Spino, Cathie; Richter, Holly E.

    2009-01-01

    Aims The Questionnaire for Urinary Incontinence Diagnosis (QUID), a 6-item urinary incontinence (UI) symptom questionnaire, was developed and validated to distinguish stress and urge UI. This study’s objective was to evaluate QUID validity and responsiveness when used as a clinical trial outcome measure. Methods Participants enrolled in a multi-center trial of non-surgical therapy (continence pessary, pelvic floor muscle training or combined) for stress-predominant UI completed baseline and 3-month diaries, the Urinary Distress Inventory (UDI) and QUID. Data from all treatment groups were pooled. QUID internal consistency (Cronbach’s ?) and convergent/discriminant validity (Pearson correlations) were evaluated. Responsiveness to change was assessed with 3-month score outcomes and distribution-based measurements. Results 444 women (mean age 50) were enrolled with stress (N=200) and mixed (N=244) UI; 344 had 3-month data. Baseline QUID Stress and Urge scores (both scaled 0-15, larger values indicating worse UI) were 8.4 ± 3.2 and 4.5 ± 3.3, respectively. Internal consistency of QUID Total, Stress and Urge scores was 0.75, 0.64 and 0.87, respectively. QUID Stress scores correlated moderately with UDI-Stress scores (r=0.68, p<0.0001) and diary stress UI episodes (r=0.41, p<0.0001). QUID Urge scores correlated moderately with UDI-Irritative scores (r=0.68, p<0.0001) and diary urge UI episodes (r=0.45, p<0.0001). 3-month QUID Stress and Urge scores improved (4.1 ± 3.4 and 2.2 ± 2.7, both p<0.0001). QUID Stress score Effect Size (1.3) and Standardized Response Mean (1.2) suggested a large change after therapy. Conclusion The QUID has acceptable psychometric characteristics and may be used as a UI outcome measure in clinical trials. PMID:19787711

  7. [Treatment options for nystagmus].

    PubMed

    Tegetmeyer, H

    2015-02-01

    The goal of treatment for nystagmus is to reduce or to abolish the typical symptoms associated with nystagmus. These are (i) reduction of visual acuity (and amblyopia in infantile nystagmus), (ii) abnormal head posture (with possible secondary changes of cervical spine) and (iii) oscillopsia (often connected with vertigo and disorders of gait and orientation). Treatment strategies include pharmacological treatment, surgical therapy and optical devices. Choice of treatment depends on the type of nystagmus and its characteristics. Surgical therapy: The following surgical procedures were successfully used as treatment of selected symptoms: (i) unilateral recess-resect surgery of the dominant eye in infantile esotropia with latent nystagmus for the relief of abnormal head posture, (ii) Kestenbaum operation of both eyes in infantile nystagmus syndrome with excentric null zone and abnormal head posture, (iii) recess-resect surgery to produce artificial exophoria in infantile nystagmus syndrome. Pharmacological treatment: Depending on the pathophysiology of different types of nystagmus, several drugs were effective in clinical application (off-label use): (i) gabapentin (non-selective GABAergic and anti-glutamatergic effect): up to 2400?mg/d in infantile nystagmus, acquired pendular nystagmus and oculopalatal tremor, (ii) nemantine (anti-glutamatergic effect): dosage up to 40?mg/d in infantile nystagmus, also in acquired pendular nystagmus and oculopalatal tremor, (iii) baclofen (GABA-B-receptor agonist): 3?×?5-10?mg/d in periodic alternating nystagmus and in upbeat nystagmus, (iv) 4-aminopyridine (non-selective blocker of voltage-gated potassium channels): 3?×?5?mg/d or 1-2?×?10?mg Fampridin in downbeat nystagmus and upbeat nystagmus, (v) acetazolamide (carbonic anhydrase inhibitor): in hereditary episodic ataxia type 2. Optical devices: (i) Contact lenses are used in infantile nystagmus in order to overcome negative effects of eye glasses in abnormal head posture, lateral gaze, and higher refractive errors, (ii) spectacle prisms are useful to induce an artificial exophoria (base-out prisms) or to shift an excentric null zone (base in direction of head posture) of infantile nystagmus with abnormal head posture, (iii) low vision aids may be necessary and should be prescribed according to magnification requirements. PMID:25121801

  8. Perimenstrual headache: Treatment options

    Microsoft Academic Search

    Katherine A. Henry; Carl I. Cohen

    2009-01-01

    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

  9. Treatment Options for Rotator Cuff Tears: A Guide for Adults

    MedlinePLUS

    ... or health care provider about what kind of rehabilitation therapy is best for you. Making a Decision Ask your doctor Given my tear, what benefits and harms for using non-surgical or surgical treatments should I consider? If ...

  10. Hyperphosphataemia: treatment options.

    PubMed

    Malberti, Fabio

    2013-05-01

    Hyperphosphataemia can be induced by three main conditions: a massive acute phosphate load, a primary increase in renal phosphate reabsorption, and an impaired renal phosphate excretion due to acute or chronic renal insufficiency. Renal excretion is so efficient in normal subjects that balance can be maintained with only a minimal rise in serum phosphorus concentration even for a large phosphorus load. Therefore, acute hyperphosphataemia usually resolves within few hours if renal function is intact. The most frequent cause of chronic hyperphosphataemia is chronic renal failure. Hyperphosphataemia in chronic kidney disease (CKD) is associated with increased cardiovascular morbidity and mortality. Lowering the phosphate load and maintaining serum phosphorus levels within the normal range are considered important therapeutic goals to improve clinical outcomes in CKD patients. Treatment consists of diminishing intestinal phosphate absorption by a low phosphate diet and phosphate binders. In CKD patients on dialysis an efficient dialysis removal of phosphate should be ensured. Dietary restriction of phosphorus while maintaining adequate protein intake is not sufficient to control serum phosphate levels in most CKD patients; therefore, the prescription of a phosphate binder is required. Aluminium-containing agents are efficient but no longer widely used because of their toxicity. Calcium-based salts are inexpensive, effective and most widely used, but there is now concern about their association with hypercalcaemia, parathyroid gland suppression, adynamic bone disease, and vascular and extraosseous calcification. The average daily dose of calcium acetate or carbonate prescribed in the randomised controlled trials to control hyperphosphataemia in dialysis patients ranges between 1.2 and 2.3 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

  11. Lewy Body Disease Treatment Options

    MedlinePLUS

    ... a plan for careful withdrawal. Non-Medical Treatments Physical therapy options include cardiovascular, strengthening, and flexibility exercises, as ... as gait training. Physicians may also recommend general physical fitness programs ... exercise. Speech therapy may be helpful for low voice volume and ...

  12. Treatment Options for Adult Acute Myeloid Leukemia

    MedlinePLUS

    ... Clinical Trials NCI Publications Español Adult Acute Myeloid Leukemia Treatment (PDQ®) Treatment Options for Adult Acute Myeloid Leukemia Untreated Adult Acute Myeloid Leukemia Standard treatment of ...

  13. Treatment Options by Stage (Chronic Lymphocytic Leukemia)

    MedlinePLUS

    ... for Clinical Trials NCI Publications Español Chronic Lymphocytic Leukemia Treatment (PDQ®) Treatment Options by Stage Stage 0 Chronic Lymphocytic Leukemia Treatment of stage 0 chronic lymphocytic leukemia is ...

  14. Treatment Options for Adult Hodgkin Lymphoma

    MedlinePLUS

    ... Search for Clinical Trials NCI Publications Español Adult Hodgkin Lymphoma Treatment (PDQ®) Treatment Options for Adult Hodgkin Lymphoma Early Favorable Hodgkin Lymphoma Treatment of early favorable ...

  15. Treatment Options by Stage (Breast Cancer)

    MedlinePLUS

    ... Dictionary Search for Clinical Trials NCI Publications Español Breast Cancer Treatment (PDQ®) Treatment Options for Inflammatory Breast Cancer Treatment of inflammatory breast cancer may include the ...

  16. Treatment Options for Chronic Myeloproliferative Neoplasms

    MedlinePLUS

    Treatment Options for Chronic Myeloproliferative Neoplasms Chronic Myelogenous Leukemia See the PDQ summary about Chronic Myelogenous Leukemia Treatment for information. Polycythemia Vera The purpose of treatment ...

  17. Treatment Options for Nonmelanoma Skin Cancer

    MedlinePLUS

    ... Dictionary Search for Clinical Trials NCI Publications Español Skin Cancer Treatment (PDQ®) Treatment Options for Nonmelanoma Skin Cancer Basal Cell Carcinoma Treatment of basal cell carcinoma ...

  18. Treatment Options for Recurrent Salivary Gland Cancer

    MedlinePLUS

    ... for Clinical Trials NCI Publications Español Salivary Gland Cancer Treatment (PDQ®) Treatment Options for Recurrent Salivary Gland Cancer Treatment of recurrent salivary gland cancer may include the ...

  19. Treatment Options by Stage (Nasopharyngeal Cancer)

    MedlinePLUS

    ... Search for Clinical Trials NCI Publications Español Nasopharyngeal Cancer Treatment (PDQ®) Treatment Options by Stage Stage I Nasopharyngeal Cancer Treatment of stage I nasopharyngeal cancer is usually radiation ...

  20. Chronic migraine - new treatment options.

    PubMed

    Roceanu, Adina; Antochi, Florina; Bajenaru, Ovidiu

    2014-12-01

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

  1. Chronic Migraine – New Treatment Options

    PubMed Central

    ROCEANU, Adina; ANTOCHI, Florina; BAJENARU, Ovidiu

    2014-01-01

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

  2. Treatment Options for Myelodysplastic/Myeloproliferative Neoplasms

    MedlinePLUS

    Treatment Options for Myelodysplastic/ Myeloproliferative Neoplasms Chronic Myelomonocytic Leukemia Treatment of chronic myelomonocytic leukemia (CMML) may include the following: Chemotherapy with one or more agents. Stem ...

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

    Cancer.gov

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

  4. Treatment Options for Childhood Hodgkin Lymphoma

    MedlinePLUS

    ... Search for Clinical Trials NCI Publications Español Childhood Hodgkin Lymphoma Treatment (PDQ®) Treatment Options for Children and Adolescents with Hodgkin Lymphoma Low-Risk Classical Childhood Hodgkin Lymphoma Treatment ...

  5. Treatment Options by Stage (Merkel Cell Carcinoma)

    MedlinePLUS

    ... Search for Clinical Trials NCI Publications Español Merkel Cell Carcinoma Treatment (PDQ®) Treatment Options by Stage Stage I and Stage II Merkel Cell Carcinoma Treatment of stage I and stage II ...

  6. Treatment Options for Extrahepatic Bile Duct Cancer

    MedlinePLUS

    ... Clinical Trials NCI Publications Español Extrahepatic Bile Duct Cancer Treatment (PDQ®) Treatment Options for Extrahepatic Bile Duct Cancer Localized Extrahepatic Bile Duct Cancer Treatment of localized extrahepatic bile duct cancer may include ...

  7. Treatment Options for Small Intestine Cancer

    MedlinePLUS

    ... for Clinical Trials NCI Publications Español Small Intestine Cancer Treatment (PDQ®) Treatment Options for Small Intestine Cancer Small ... from the NCI Web site . Recurrent Small Intestine Cancer Treatment of recurrent small intestine cancer that has spread ...

  8. Treatment Options by Stage (Ovarian Epithelial Cancer)

    MedlinePLUS

    ... Español Ovarian Epithelial, Fallopian Tube, and Primary Peritoneal Cancer Treatment (PDQ®) Treatment Options by Stage Early Ovarian Epithelial, Fallopian Tube, and Primary Peritoneal Cancer Treatment of early (stage I) ovarian epithelial cancer , fallopian ...

  9. Treatment Options by Stage (Pancreatic Cancer)

    MedlinePLUS

    ... Search for Clinical Trials NCI Publications Español Pancreatic Cancer Treatment (PDQ®) Treatment Options by Stage Stages I and II Pancreatic Cancer Treatment of stage I and stage II pancreatic cancer ...

  10. Treatment Options by Stage (Vulvar Cancer)

    MedlinePLUS

    ... Search for Clinical Trials NCI Publications Español Vulvar Cancer Treatment (PDQ®) Treatment Options by Stage Vulvar Intraepithelial Neoplasia ( ... Biologic therapy with topical imiquimod . Stage I Vulvar Cancer Treatment of stage I vulvar cancer may include the ...

  11. Treatment Options by Stage (Rectal Cancer)

    MedlinePLUS

    ... Search for Clinical Trials NCI Publications Español Rectal Cancer Treatment (PDQ®) Treatment Options by Stage Stage 0 (Carcinoma ... from the NCI Web site . Stage I Rectal Cancer Treatment of stage I rectal cancer may include the ...

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

    PubMed Central

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

    2014-01-01

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

  13. Treatment Options for AIDS-Related Lymphoma

    MedlinePLUS

    ... Dictionary Search for Clinical Trials NCI Publications Español AIDS-Related Lymphoma Treatment (PDQ®) Treatment Options for AIDS-Related Lymphoma AIDS-Related Peripheral/Systemic Lymphoma There ...

  14. Treatment Option Overview (Malignant Mesothelioma)

    MedlinePLUS

    ... are different types of treatment for patients with malignant mesothelioma. Different types of treatments are available for patients with malignant mesothelioma . Some treatments are standard (the currently used ...

  15. Treatment Option Overview (Gastric Cancer)

    MedlinePLUS

    ... are different types of treatment for patients with gastric cancer. Different types of treatments are available for patients with gastric cancer . Some treatments are standard (the currently used ...

  16. Treatment Option Overview (Adrenocortical Carcinoma)

    MedlinePLUS

    ... who have not started treatment. Three types of standard treatment are used: Surgery Surgery to remove the ... are safe and effective or better than the standard treatment . Many of today's standard treatments for cancer ...

  17. Treatment Option Overview (Thyroid Cancer)

    MedlinePLUS

    ... who have not started treatment. Five types of standard treatment are used: Surgery Surgery is the most ... are safe and effective or better than the standard treatment . Many of today's standard treatments for cancer ...

  18. Treatment Option Overview (Laryngeal Cancer)

    MedlinePLUS

    ... who have not started treatment. Three types of standard treatment are used: Radiation therapy Radiation therapy is ... are safe and effective or better than the standard treatment . Many of today's standard treatments for cancer ...

  19. Treatment Option Overview (Uterine Sarcoma)

    MedlinePLUS

    ... who have not started treatment. Four types of standard treatment are used: Surgery Surgery is the most ... are safe and effective or better than the standard treatment . Many of today's standard treatments for cancer ...

  20. Treatment Option Overview (Hypopharyngeal Cancer)

    MedlinePLUS

    ... who have not started treatment. Three types of standard treatment are used: Surgery Surgery (removing the cancer ... are safe and effective or better than the standard treatment . Many of today's standard treatments for cancer ...

  1. Treatment Option Overview (Vulvar Cancer)

    MedlinePLUS

    ... who have not started treatment. Four types of standard treatment are used: Surgery Surgery is the most ... are safe and effective or better than the standard treatment . Many of today's standard treatments for cancer ...

  2. Treatment Option Overview (Vaginal Cancer)

    MedlinePLUS

    ... who have not started treatment. Three types of standard treatment are used: Surgery Surgery is the most ... are safe and effective or better than the standard treatment . Many of today's standard treatments for cancer ...

  3. Treatment Option Overview (Colon Cancer)

    MedlinePLUS

    ... are different types of treatment for patients with colon cancer. Different types of treatment are available for patients with colon cancer . Some treatments are standard (the currently used treatment), ...

  4. Treatment Option Overview (Kaposi Sarcoma)

    MedlinePLUS

    ... may be needed. There are different types of treatment for patients with Kaposi sarcoma. Different types of ... only to patients who have not started treatment. Treatment of epidemic Kaposi sarcoma combines treatment for Kaposi ...

  5. Treatment Option Overview (Anal Cancer)

    MedlinePLUS

    ... are different types of treatment for patients with anal cancer. Different types of treatments are available for ... the human immunodeficiency virus can affect treatment of anal cancer. Cancer therapy can further damage the already ...

  6. Treatment Option Overview (Esophageal Cancer)

    MedlinePLUS

    ... may be needed. There are different types of treatment for patients with esophageal cancer. Different types of ... started treatment. Patients have special nutritional needs during treatment for esophageal cancer. Many people with esophageal cancer ...

  7. Treatment Option Overview (Childhood Ependymoma)

    MedlinePLUS

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

  8. Treatment Option Overview (Childhood Craniopharyngioma)

    MedlinePLUS

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

  9. Treatment Option Overview (Parathyroid Cancer)

    MedlinePLUS

    ... treatment. Treatment includes control of hypercalcemia (too much calcium in the blood) in patients who have an ... is being made and control the level of calcium in the blood , as much of the tumor ...

  10. Helicobacter pylori Infection: Treatment Options

    Microsoft Academic Search

    Xavier Calvet

    2006-01-01

    After two decades of progress the best current approach to treatment of Helicobacter pylori infection is a strategy that combines two consecutive complementary treatments. Current guidelines recommend a first-line triple therapy – 7–10 days of a proton-pump inhibitor (PPI), clarithromycin and amoxicillin – followed by a quadruple therapy combining a PPI, metronidazole, tetracycline and a bismuth salt for treatment failures.

  11. The use of povidone–iodine and hydrogen peroxide mixture as an adjunct to non-surgical treatment of slight to moderate chronic periodontitis

    PubMed Central

    Al-Saeed, Mohammed Y.; Babay, Nadir

    2009-01-01

    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. PMID:23960471

  12. Treatment Options for Childhood Rhabdomyosarcoma

    MedlinePLUS

    ... are given first to shrink the tumor. If cancer cells remain after chemotherapy and radiation therapy, the tumor is removed by surgery. Surgery may ... Treatment may include chemotherapy with or without radiation therapy . Sometimes ... cancer cells . For tumors of the cervix : Treatment may include ...

  13. Treatment options in odontogenic infection.

    PubMed

    Maestre-Vera, Juan Ramón

    2004-01-01

    Most infections of the oral cavity are primary, odontogenic infections, with dental caries, gingivitis, and periodontitis the most common. Treating these infections will encompass odontologic, antimicrobial, surgical or combined treatment. Antimicrobial treatment includes the use of betalactams, macrolydes, tetracyclins, metronidazole, clindamycin, or combined treatment. The most commonly used ones are administered orally. PK/ PD parameters predict THE clinical and microbiological efficacy of the antibiotic. The three indices that are generally used to measure clinical efficacy are: T >MIC (time during which the concentration is above the minimum inhibitory concentration), Cmax/ MIC (ratio between peak concentration and the minimum inhibitory concentration) and AUC/ MIC (ratio between the area under the curve and the minimum inhibitory concentration). Amoxicillin/ clavulanic acid is one of the antibiotics recommended for the treatment of odontogenic infections due to its wide spectrum, low incidence of resistance, pharmacokinetic profile, tolerance and dosage. PMID:15580134

  14. Treatment Options for Childhood Astrocytomas

    MedlinePLUS

    ... about clinical trials is available from the NCI Web site . Recurrent Childhood Low-Grade Astrocytomas Before more cancer treatment is given, imaging tests , biopsy , or surgery are done to find out ...

  15. Treatment Option Overview (Oropharyngeal Cancer)

    MedlinePLUS

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

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

    PubMed

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

    2014-04-01

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

  17. Treatment Option Overview (Ewing Sarcoma)

    MedlinePLUS

    ... carry drugs, toxins , or radioactive material directly to cancer cells. Kinase inhibitor therapy is another type of targeted therapy being studied in the treatment of recurrent Ewing sarcoma. Kinase inhibitors are drugs that block a ... needed for cancer cells to divide. Patients may want to think about ...

  18. Treatment Option Overview (Childhood Rhabdomyosarcoma)

    MedlinePLUS

    ... be given chemotherapy after surgery to kill any cancer cells that are left. Radiation therapy may also be given. Treatment given after the ... rays or other types of radiation to kill cancer cells or stop them from growing. ... therapy. External radiation therapy uses a machine outside the ...

  19. Pseudotumor cerebri: An update on treatment options

    PubMed Central

    Dave, Sarita B; Subramanian, Prem S

    2014-01-01

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

  20. Cyclic vomiting syndrome: treatment options.

    PubMed

    Hejazi, Reza A; McCallum, Richard W

    2014-08-01

    Cyclic vomiting syndrome is a disorder characterized by recurrent episodes of severe nausea and vomiting separated by symptom-free periods. Our aims were to review treatments of adult cyclic vomiting syndrome as well as to identify areas for further clinical research and the unanswered questions in this field. We conducted a PubMed search using such keywords as "cyclic vomiting syndrome," "nausea," "vomiting," "treatment," "trigger factors" and "tricyclic antidepressants" and combined this information with the knowledge and clinical research from the authors. Available data show that in adult cyclic vomiting syndrome, there is an impressive and sustained response to high-dose tricyclic antidepressants. In up to 13% who are regarded as poor responders to tricyclic antidepressants, a predictable profile can be identified related to coexisting psychological disorders, marijuana use, poorly controlled migraine headache or chronic narcotic use. Cyclic vomiting syndrome in adults is being an increasingly recognized entity. Tricyclic antidepressants are the main treatment for controlling symptoms. Eliminating and addressing trigger factors are an essential part of management. PMID:24862509

  1. Non Surgical Treatment of Sacral Osteosarcoma

    PubMed Central

    Aledavood, S A; Amirabadi, A; Memar, B

    2012-01-01

    Osteosarcoma may rarely originate from the axial bones such as pelvis or vertebrae. In some pelvic and most vertebral primary tumors, resection often is not possible completely. In general, these tumors cannot be resected with negative margins so they need additional radiotherapy and chemotherapy, but results are unfavourable because of poor local control and high incidence of distant metastases. This is a case report of sacral osteosarcoma which was treated successfully with chemotherapy and radiation therapy. The patient is a 14-year-old boy with a large osteosarcoma tumor in the first sacral vertebral body, with extra skeletal extension. The patient took radiotherapy (6000 centigray) plus chemotherapy regimen consisting of doxorubicin and cisplatin. In the last follow up 48 months later, the patient was completely asymptomatic with normal performance and there was not any evidence of local progression or distant metastasis.

  2. Chronic constipation: Current treatment options

    PubMed Central

    Liu, Louis Wing Cheong

    2011-01-01

    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. PMID:22114754

  3. Chronic constipation: current treatment options.

    PubMed

    Liu, Louis Wing Cheong

    2011-10-01

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

  4. Treatment Options in Cushing’s Disease

    PubMed Central

    Rizk, Ahmed; Honegger, Juergen; Milian, Monika; Psaras, Tsambika

    2012-01-01

    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. PMID:22346367

  5. 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

    Microsoft Academic Search

    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

    2009-01-01

    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.

  6. Treatment Options for Recurrent Lip and Oral Cavity Cancer

    MedlinePLUS

    ... Dictionary Search for Clinical Trials NCI Publications Español Lip and Oral Cavity Cancer Treatment (PDQ®) Treatment Options for Recurrent Lip and Oral Cavity Cancer Treatment of recurrent lip ...

  7. Novel treatment options for ulcerative colitis

    PubMed Central

    Vaughn, Byron P; Moss, Alan C

    2014-01-01

    The approved treatment options for patients with ulcerative colitis (UC) are currently limited to mesalamine or immunosuppressants. Patients who do not respond to mesalamine-based therapy can be treated with immunomodulators or anti-TNF antibody therapy. Failure or adverse reactions to these medications leaves the patient with little choice other than colectomy. However, novel insights into the pathogenic drivers of UC have led to new developments in drugs that promise clinical efficacy via modulation of targeted pathways. Given the impending expansion of therapeutic options for patients with UC, clinicians and researchers should be familiar with these mechanisms of action. In addition, the typical ‘step-up’ treatment paradigm for UC will likely need to be reshaped to allow for a more personalized approach to treating UC. PMID:24533177

  8. Treatment Options for Brachial Plexus Injuries

    PubMed Central

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

    2014-01-01

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

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

    PubMed

    Zindel, Joel; Inglin, Roman; Brügger, Lukas

    2014-12-01

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

  10. Chronic rhinosinusitis and emerging treatment options

    PubMed Central

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

    2013-01-01

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

  11. Current treatment options for Dientamoeba fragilis infections.

    PubMed

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

    2012-12-01

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

  12. [Irritable bowel syndrome: current treatment options].

    PubMed

    Ducrotté, Philippe

    2007-11-01

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

  13. Current treatment options for Dientamoeba fragilis infections

    PubMed Central

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

    2012-01-01

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

  14. Emerging treatment options for meibomian gland dysfunction

    PubMed Central

    Qiao, Jing; Yan, Xiaoming

    2013-01-01

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

  15. Fibroid growth and medical options for treatment.

    PubMed

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

    2014-09-01

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

  16. Brachial plexus injury: treatment options and outcomes.

    PubMed

    Arzillo, Samantha; Gishen, Kriya; Askari, Morad

    2014-07-01

    The brachial plexus is a series of nerves formed by roots of cervical segments 5 to 8 (C5-C8) as well as the first thoracic nerve (T1). It functions to provide sensation and motor innervation to the skin and muscles of the chest and upper limb. It does so through different segments: roots, trunks, divisions, and cords. Injuries to the brachial plexus occur relatively frequently and are due mainly to traumatic accidents that lead to traction or compression of the nerve roots. When considering the etiology and treatment of such injuries, it is important to make a distinction between adult versus obstetric brachial plexus injury. Although several surgical treatment options are described and used for patients with brachial plexus injury, no perfect remedy currently exists. Prevention and safety should be the focus. At the same time, high-quality studies and new technology and techniques are needed to determine more effective treatments for this group. PMID:25006897

  17. Treatment Options to Manage Wound Biofilm

    PubMed Central

    Jones, Curtis E.; Kennedy, John P.

    2012-01-01

    Background Bioburden is an accepted barrier to chronic wound healing. Defining the significance, phenotype, clinical classification, and treatment guidelines has been historically lacking of evidence and based on paradigms that do not represent the scientific or clinical reality. The Problem Chronic wound bioburden is typically abundant, polymicrobial, and extremely diverse. These microbes naturally adopt biofilm phenotypes, which are quite often viable but not culturable, thereby going undetected. The failures of culture-based detection have led to abandonment of routine bioburden evaluation and aggressive treatment or, worse, to assume bioburden is not a significant barrier. Predictably, treatment regimens to address biofilm phenotypes lagged behind our diagnostic tools and understanding. Basic/Clinical Science Advances Microbial DNA-based diagnostic tools and treatment regimens have emerged, which provide and leverage objective information, resulting in a dramatic impact on outcomes. Relevance to Clinical Care Modern medicine demands decisions based on objective evidence. The diagnostic and treatment protocols reviewed herein empower clinicians to practice modern medicine with regard to bioburden, with DNA level certainty. Conclusion Bioburden is a significant barrier to healing for all chronic wounds. Molecular diagnostics provide the first objective means of assessing wound bioburden. The accuracy and comprehensive data from such diagnostic methodologies provide clinicians with the ability to employ patient-specific treatment options, targeted to each patient's microbial wound census. Based on current outcomes data, the most effective therapeutic options are topical (TPL) antibiofilm agents (ABF) combined with TPL antibiotics (ABX). In specific patients, systemic ABX and selective biocides are also appropriate, but not exclusive of ABF combined with TPL ABX. PMID:24527291

  18. [New surgical treatment options for bone tumors].

    PubMed

    Andreou, D; Henrichs, M P; Gosheger, G; Nottrott, M; Streitbürger, A; Hardes, J

    2014-11-01

    Primary bone neoplasms can be classified into benign, locally/aggressive and rarely metastasizing and malignant tumors. Patients with benign tumors usually undergo surgical treatment in cases of local symptoms, mainly consisting of pain or functional deficits due to compression of important anatomical structures, such as nerves or blood vessels. Locally/aggressive and rarely metastasizing tumors exhibit an infiltrative growth pattern, so that surgical treatment is necessary to prevent further destruction of bone leading to local instability. Finally, the surgical treatment of malignant tumors is, with few exceptions, considered to be a prerequisite for long-term survival, either alone or in combination with systemic chemotherapy. Whereas the main objective of surgery in the treatment of benign tumors is relief of local symptoms with a minimum amount of damage to healthy tissue and minimizing the risk of local recurrence while ensuring bone stability in locally aggressive and rarely metastasizing tumors, the primary goal in the operative treatment of bone sarcomas is the resection of the tumor with clear surgical margins followed by defect reconstruction and the preservation of function. This review examines the current developments in the surgical treatment of primary bone neoplasms with respect to the management of the tumors and novel reconstructive options. PMID:25394971

  19. A safe treatment option for esophageal bezoars

    PubMed Central

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

    2012-01-01

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

  20. ARSENIC REMOVAL TREATMENT OPTIONS FOR SINGLE FAMILY HOMES

    EPA Science Inventory

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

  1. Treatment Options for Stress Urinary Incontinence

    PubMed Central

    Rovner, Eric S; Wein, Alan J

    2004-01-01

    Treatment options for stress urinary incontinence (SUI) in women are designed to prevent the involuntary loss of urine from the urethra during increases in intraabdominal pressure that occur during physical activity, coughing, or sneezing. Effective nonsurgical therapies include behavioral therapy (eg, bladder training, fluid and dietary modification) and drug therapy. Surgical therapy for this condition has existed for well over 100 years. Currently, approximately 200 different surgical procedures have been described. Because of the physiologic risks inherent in surgical procedures, the cost of hospitalization, and the loss of productivity during convalescence, surgeons continue to modify their techniques to improve efficacy, safety, and cost-effectiveness, and to minimize invasiveness. No single procedure or intervention is optimal for all patients. Having a variety of treatment options offers the possibility of tailoring therapy to the desires and needs of the individual patient. The key to an optimal therapeutic outcome is an accurate diagnosis combined with the selection of an appropriate intervention that is acceptable to the patient after balancing multiple factors. PMID:16985862

  2. Current treatment options for latent tuberculosis infection.

    PubMed

    Bocchino, Marialuisa; Matarese, Alessandro; Sanduzzi, Alessandro

    2014-05-01

    Treatment of latent tuberculosis infection (LTBI) is a key component in TB control strategies worldwide. However, as people with LTBI are neither symptomatic nor contagious, any screening decision should be weighed carefully against the potential benefit of preventing active disease in those who are known to be at higher risk and are willing to accept therapy for LTBI. This means that a targeted approach is desirable to maximize cost effectiveness and to guarantee patient adherence. We focus on LTBI treatment strategies in patient populations at increased risk of developing active TB, including candidates for treatment with tumor necrosis factor-? blockers. In the last 40 years, isoniazid (INH) has represented the keystone of LTBI therapy across the world. Although INH remains the first therapeutic option, alternative treatments that are effective and associated with increased adherence and economic savings are available. Current recommendations, toxicity, compliance, and cost issues are discussed in detail in this review. A balanced relationship between the patient and healthcare provider could increase adherence, while cost-saving treatment strategies with higher effectiveness, fewer side effects, and of shorter duration should be offered as preferred. PMID:24789003

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

    EPA Science Inventory

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

  4. Treatment Options by Stage (Small Cell Lung Cancer)

    MedlinePLUS

    ... Search for Clinical Trials NCI Publications Español Small Cell Lung Cancer Treatment (PDQ®) Treatment Options by Stage Limited-Stage Small Cell Lung Cancer Treatment of limited-stage small cell ...

  5. Treatment Options By Stage (Ovarian Germ Cell Tumors)

    MedlinePLUS

    Treatment Options By Stage Stage I Ovarian Germ Cell Tumors Treatment depends on whether the tumor is ... the NCI Web site . Stage II Ovarian Germ Cell Tumors Treatment depends on whether the tumor is ...

  6. Understanding Bone Marrow Transplantation as a Treatment Option

    MedlinePLUS

    ... icio.us Digg Facebook Google Bookmarks Understanding Transplantation as a Treatment Option When you are diagnosed with ... you have had, and your overall health. Transplant as a Treatment When a bone marrow or cord ...

  7. Treatment Options for Osteosarcoma and Malignant Fibrous Histiocytoma of Bone

    MedlinePLUS

    ... for Clinical Trials NCI Publications Español Osteosarcoma and Malignant Fibrous Histiocytoma of Bone Treatment (PDQ®) Treatment Options for Osteosarcoma and Malignant Fibrous Histiocytoma of Bone Localized Osteosarcoma and Malignant ...

  8. College Student Receptiveness to Various Alcohol Treatment Options

    ERIC Educational Resources Information Center

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

    2009-01-01

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

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

    PubMed Central

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

    2015-01-01

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

  10. Treatment Option Overview (Adult Acute Lymphoblastic Leukemia)

    MedlinePLUS

    ... different types of treatment for patients with adult ALL. Different types of treatment are available for patients ... have not started treatment. The treatment of adult ALL usually has two phases. The treatment of adult ...

  11. Treatment Option Overview (AIDS Related-Lymphoma)

    MedlinePLUS

    ... are different types of treatment for patients with AIDS-related lymphoma. Different types of treatment are available ... patients who have not started treatment. Treatment of AIDS-related lymphoma combines treatment of the lymphoma with ...

  12. Treatment Option Overview (Childhood Liver Cancer)

    MedlinePLUS

    ... different types of treatment for patients with childhood liver cancer. Different types of treatments are available for ... patients who have not started treatment. Children with liver cancer should have their treatment planned by a ...

  13. Treatment Option Overview (Merkel Cell Carcinoma)

    MedlinePLUS

    ... who have not started treatment. Three types of standard treatment are used: Surgery One or more of ... are safe and effective or better than the standard treatment . Many of today's standard treatments for cancer ...

  14. Treatment Option Overview (Carcinoma of Unknown Primary)

    MedlinePLUS

    ... who have not started treatment. Four types of standard treatment are used: Surgery Surgery is a common ... are safe and effective or better than the standard treatment . Many of today's standard treatments for cancer ...

  15. Treatment Option Overview (Thymoma and Thymic Carcinoma)

    MedlinePLUS

    ... who have not started treatment. Four types of standard treatment are used: Surgery Surgery to remove the ... are safe and effective or better than the standard treatment . Many of today's standard treatments for cancer ...

  16. Treatment Option Overview (Childhood Acute Lymphoblastic Leukemia)

    MedlinePLUS

    ... types of treatment for childhood acute lymphoblastic leukemia (ALL). Different types of treatment are available for children ... patients who have not started treatment. Children with ALL should have their treatment planned by a team ...

  17. Treatment Option Overview (Small Cell Lung Cancer)

    MedlinePLUS

    ... types of treatment for patients with small cell lung cancer. Different types of treatment are available for patients with small cell lung cancer . Some treatments are standard (the currently used treatment), ...

  18. Treatment Option Overview (Chronic Myeloproliferative Neoplasms)

    MedlinePLUS

    ... different types of treatment for patients with chronic myeloproliferative neoplasms. Different types of treatments are available for patients with chronic myeloproliferative neoplasms . Some treatments are standard (the currently used treatment), ...

  19. Treatment Option Overview (Hairy Cell Leukemia)

    MedlinePLUS

    ... types of treatment for patients with hairy cell leukemia. Different types of treatment are available for patients with hairy cell leukemia . Some treatments are standard (the currently used treatment), ...

  20. Therapeutic options in the treatment of benign prostatic hyperplasia

    PubMed Central

    Sandhu, Jaspreet S

    2009-01-01

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

  1. Treatment Options for Adult Primary Liver Cancer

    MedlinePLUS

    ... types of treatment for patients with adult primary liver cancer. Different types of treatments are available for ... patients who have not started treatment. Patients with liver cancer are treated by a team of specialists ...

  2. Treatment Option Overview (Male Breast Cancer)

    MedlinePLUS

    ... are different types of treatment for men with breast cancer. Different types of treatment are available for men ... standard treatment are used to treat men with breast cancer: Surgery Surgery for men with breast cancer is ...

  3. Treatment Option Overview (Unusual Cancers of Childhood)

    MedlinePLUS

    ... clinical trials before, during, or after starting their cancer treatment. Some clinical trials only include patients who have ... up tests or check-ups. Some cancers and cancer treatments cause side effects months or years after treatment ...

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

    MedlinePLUS

    ... 2013 Treatment Options When Your SSRI Antidepressant Is Not Working Well Formats View PDF (PDF) 417 kB ... make you feel content. Why did an SSRI not work well for me? Depression symptoms go away ...

  5. Treatment Options for Adult Soft Tissue Sarcoma

    MedlinePLUS

    ... Soft Tissue Sarcoma That Has Not Spread to Lymph Nodes Treatment of stage II adult soft tissue sarcoma ... Adult Soft Tissue Sarcoma That Has Spread to Lymph Nodes (Advanced) Treatment of stage III adult soft tissue ...

  6. Treatment Options for Childhood Acute Lymphoblastic Leukemia

    MedlinePLUS

    ... regimens with or without targeted therapy . Infants with ALL The treatment of infants with ALL during the ... Children 10 years and older and teenagers with ALL The treatment of ALL in children and teenagers ( ...

  7. Treatment Options by Stage (Gastric Cancer)

    MedlinePLUS

    ... available from the NCI Web site . Stage I Gastric Cancer Treatment of stage I gastric cancer may ... available from the NCI Web site . Stage II Gastric Cancer Treatment of stage II gastric cancer may ...

  8. Treatment Option Overview (Chronic Lymphocytic Leukemia)

    MedlinePLUS

    ... attack specific cancer cells without harming normal cells. Monoclonal antibody therapy and tyrosine kinase inhibitor therapy are types of ... used in the treatment of chronic lymphocytic leukemia. Monoclonal antibody therapy is a cancer treatment that uses antibodies made ...

  9. College Student Receptiveness to Various Alcohol Treatment Options

    PubMed Central

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

    2009-01-01

    Objective Heavy episodic drinking remains a significant problem on college campuses. Although most interventions for college students are behavioral, pharmacological treatments, such as naltrexone, could provide additional options. Participants The authors evaluated receptivity to various alcohol treatment options in a general population of college student drinkers (N = 2,084), assessed in 2005. Methods The authors asked participants to indicate which of 8 treatment options (ie, sell-help book, self-help computer program, self-help group, group therapy, individual therapy, monthly injection, targeted oral medication, or daily oral medication) they would be willing to consider if they were going to cut down on or stop drinking. Results Over 50% of drinkers expressed receptiveness to self-help options or psychotherapy options, and over 25% of drinkers expressed receptiveness to medication options. Conclusions Increasing treatment options for students interested in reducing or stopping drinking by offering pharmacological interventions such as naltrexone could provide an important unmet need among college students. PMID:19592350

  10. Treatment options for the replacement of missing mandibular incisors.

    PubMed

    Fleigel, Jeffrey D; Salmon, Cade A; Piper, James M

    2011-07-01

    The replacement of a mandibular incisor is a dental treatment warranting special consideration. Some of the challenges associated with the anterior mandible are limited space, challenging surrounding anatomy, and tough esthetic requirements. Proper diagnosis and treatment planning may require a multidisciplinary approach to successfully meet the demands of replacing a missing tooth in this sextant. Several treatment options currently exist for mandibular incisor replacement. These options include (1) resin-bonded fixed dental prostheses (RBFDPs), (2) orthodontic treatment, (3) full-veneer fixed dental prostheses (FDPs), (4) dental implants for single-tooth replacement, (5) possible extraction of one or more incisors and restoration with implant-supported FDPs, (6) possible extraction of one or more teeth and restoration with FDPs from #22 to 27, (7) possible extraction of one or more teeth and restoration with removable dental prostheses (RDPs). This manuscript outlines the various treatment options for the replacement of mandibular incisors and discusses benefits and drawbacks of each. PMID:21631631

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

    PubMed Central

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

    2014-01-01

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

  12. Treatment Options by Stage (Thyroid Cancer)

    MedlinePLUS

    ... cancer, but can relieve symptoms and improve the quality of life . Treatment may include the following: For tumors that ... palliative therapy to relieve symptoms and improve the quality of life for patients whose cancer has recurred in the ...

  13. Treatment Options for Childhood Soft Tissue Sarcoma

    MedlinePLUS

    ... followed by adjuvant chemotherapy . Blood Vessel Tumors Angiosarcoma (deep) Treatment of angiosarcoma may include the following: Surgery ... about clinical trials is available from the NCI Web site . Recurrent and Progressive Childhood Soft Tissue Sarcoma ...

  14. Treatment Option Overview (Adult Brain Tumors)

    MedlinePLUS

    ... therapy uses a radioactive substance sealed in needles, seeds , wires, or catheters that are placed directly into ... by the disease or its treatment and improves quality of life . For brain tumors, supportive care includes ...

  15. Treatment Option Overview (Chronic Myelogenous Leukemia)

    MedlinePLUS

    ... a blood vessel in the chest. Donor lymphocyte infusion (DLI) Donor lymphocyte infusion (DLI) is a cancer treatment that may be ... given to the patient through one or more infusions. The lymphocytes see the patient’s cancer cells as ...

  16. Treatment Options for Renal Cell Cancer

    MedlinePLUS

    ... cancer may include the following: Surgery ( radical nephrectomy , simple nephrectomy , or partial nephrectomy ). Radiation therapy as palliative ... by using other search features, such as the location of the trial, the type of treatment, or ...

  17. Treatment Option Overview (Childhood Soft Tissue Sarcoma)

    MedlinePLUS

    ... be used to help block the growth of cancer cells. Targeted therapy Targeted therapy is a type of treatment that uses drugs or other substances to attack cancer cells. Targeted therapies usually cause less harm to normal cells than ...

  18. Treatment Options by Stage (Salivary Gland Cancer)

    MedlinePLUS

    ... lumps or anything else that seems unusual. A history of the patient's health habits and past illnesses and ... oncologist . Dentist . Speech therapist . Dietitian . Psychologist . Rehabilitation specialist . Plastic surgeon . Three types of standard treatment are used: Surgery Surgery (removing the ...

  19. Treatment Options for Congenital Pigmented Nevus

    MedlinePLUS

    ... Read more about nevus removal here. What about LASER Treatment? We all want to think modern medicine has miracles to offer us. Although use of lasers are successful for many superficial skin imperfections, lasers ...

  20. Treatment options in childhood pontine gliomas

    Microsoft Academic Search

    Sabine Wagner; Monika Warmuth-Metz; Angela Emser; Astrid-K. Gnekow; Ronald Sträter; Stefan Rutkowski; Norbert Jorch; Hans-J. Schmid; Frank Berthold; Norbert Graf; Rolf-D. Kortmann; Thorsten Pietsch; Norbert Sörensen; Ove Peters; Johannes E. A. Wolff

    2006-01-01

    SummaryBackground  Pontine gliomas are the subgroup of brainstem gliomas with the worst prognosis. Controversial treatment approaches are discussed.Patients and methods  Data of children with pontine gliomas treated in different prospective multi-center studies who were registered in the HIT-GBM database were pooled and analyzed addressing prognostic factors and the relevance of intensive treatment using contingency tables, Kaplan–Meier curves and Cox regression analyses.Results  From 1983

  1. [Insomnias. II. Pharmacological and psychotherapeutic treatment options].

    PubMed

    Riemann, Dieter; Hajak, Göran

    2009-11-01

    The administration of benzodiazepine receptor agonists for periods of 3-4 weeks can be considered as evidence based for the treatment of insomnia. The off-label treatment of insomnia with sedating antidepressants or antipsychotics up to now has been subjected to far less rigorous evidence-based testing. In the meantime several randomized double-blind placebo-controlled studies indicate the effectiveness of sedating antidepressants for insomnia. Alternative medical treatments like the administration of melatonin or valerian are characterized by a heterogeneous database. On the contrary, cognitive behavioural therapy for insomnia (including psycho-education, relaxation, stimulus control, sleep restriction, cognitive therapy) is supported by an extensive database. This database indicates that cognitive behavioural methods are effective in the long term, thus emphasizing the importance of these strategies in the treatment of insomnia. Studies on the combination treatment of insomnia with hypnotics and cognitive behavioural therapy up to now were not able to show a superiority of the combination treatment versus monotreatment with behavioural therapy or hypnotics. PMID:19506825

  2. ORIGINAL ARTICLE Composting is an effective treatment option for

    E-print Network

    California at Berkeley, University of

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

  3. Treatment options for atypical optic neuritis

    PubMed Central

    Malik, Amina; Ahmed, Maryam; Golnik, Karl

    2014-01-01

    Context: Optic neuritis (ON) is defined as inflammation of the optic nerve and can have various etiologies. The most common presentation in the US is demyelinating, or “typical” ON, usually associated with multiple sclerosis. This is in contrast to “atypical” causes of ON, which differ in their clinical presentation, management, and prognosis. These atypical cases are characterized by lack of eye pain, exudates, and hemorrhages on exam, very severe, bilateral or progressive visual loss, or with failure to recover vision. Aims: The aim was to describe the clinical presentations of atypical ON and their treatments. Settings and Design: Review article. Materials and Methods: Literature review. Results: Types of atypical ON identified include neuromyelitis optica, autoimmune optic neuropathy, chronic relapsing inflammatory optic neuropathy, idiopathic recurrent neuroretinitis, and optic neuropathy associated with systemic diseases. Atypical ON usually requires corticosteroid treatment and often will require aggressive immunosuppression. Conclusions: Unlike demyelinating ON, atypical ON requires treatment to preserve vision. PMID:25449930

  4. Treatment Option Overview (Extragonadal Germ Cell Tumors)

    MedlinePLUS

    ... the NCI Web site . High-dose chemotherapy with stem cell transplant High-dose chemotherapy with stem cell transplant is a method of giving high doses ... blood -forming cells destroyed by the cancer treatment. Stem cells (immature blood cells) are removed from the blood ...

  5. New Treatment Options in Status Epilepticus

    PubMed Central

    Dobesberger, Judith

    2009-01-01

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

  6. Treatment Options for Children with Undescended Testicles

    MedlinePLUS

    ... What activities should my child avoid right after surgery? Sources The information in this summary comes from the report Evaluation and Treatment of Cryptorchidism , December 2012. The report was produced by the Vanderbilt Evidence-Based Practice Center through funding by the Agency for ...

  7. Treatment Option Overview (Gastrointestinal Carcinoid Tumors)

    MedlinePLUS

    ... flow of blood to the liver helps kill cancer cells growing there. Radiation therapy Radiation therapy is a cancer treatment that uses ... rays or other types of radiation to kill cancer cells. There are two types of radiation therapy. External radiation therapy uses a machine outside the ...

  8. Treatment Option Overview (Pheochromocytoma and Paraganglioma)

    MedlinePLUS

    ... of blood to the adrenal glands helps kill cancer cells growing there. Targeted therapy Targeted therapy is a treatment that uses drugs or other substances to identify and attack specific cancer cells without harming ... are used to treat metastatic and recurrent pheochromocytoma. ...

  9. Treatment Option Overview (Ovarian Epithelial Cancer)

    MedlinePLUS

    ... the tissue under a microscope to look for cancer cells . Radiation therapy Radiation therapy is a cancer treatment that uses ... drugs that block DNA repair and may cause cancer cells to die. PARP inhibitor therapy is being studied in treating ovarian epithelial cancer ...

  10. Treatment Option Overview (Primary CNS Lymphoma)

    MedlinePLUS

    ... that uses drugs or other substances to attack cancer cells. Targeted therapies usually cause less harm to normal cells than ... the treatment of primary CNS lymphoma. Monoclonal antibody therapy is a cancer ... system cell. These antibodies can identify substances on cancer cells ...

  11. Urinary Incontinence: Management and Treatment Options

    ERIC Educational Resources Information Center

    Griebling, Tomas L.

    2009-01-01

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

  12. Treatment Options for Pheochromocytoma and Paraganglioma

    MedlinePLUS

    ... the tumor . If the tumor is in the adrenal gland , the entire adrenal gland is removed. Check for U.S. clinical trials from ... Lindau (VHL) syndrome , tumors often form in both adrenal glands . The tumors are usually benign . Treatment for inherited ...

  13. Bowen’s disease – a review of newer treatment options

    PubMed Central

    Neubert, Thorsten; Lehmann, Percy

    2008-01-01

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

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

    MedlinePLUS

    ... are different types of treatment for children with brain stem glioma. Different types of treatment are available ... patients who have not started treatment. Children with brain stem glioma should have their treatment planned by ...

  15. Present treatment options for atrial fibrillation

    PubMed Central

    Lairikyengbam, S; Anderson, M; Davies, A

    2003-01-01

    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. PMID:12612318

  16. Diarrhea: new treatment option from Shaman.

    PubMed

    James, J S

    1999-08-01

    A drug for diarrhea treatment, obtained from a tree in the Amazon rain forest and used for centuries, is now available from Shaman Botanicals as a nutritional supplement. The product, "Shaman Botanicals--Normal Stool Formula", is believed to work differently from other diarrhea treatments, perhaps by preventing the abnormal flow of water into the gut. Results from abbreviated clinical trials suggest it is effective within 4 days for AIDS-related diarrhea (2 days for travelers diarrhea). The adult dosage is one tablet every 6 hours, costing $3.60 per day. Because the product has not been approved by the FDA it may not be reimbursable by health plans, although there is an increasing trend by the industry to pay for supplements that have been supported by clinical data. Contact information is provided. PMID:11366574

  17. Melanoma: Adjuvant therapy and other treatment options

    Microsoft Academic Search

    Alicia Terando; Michael S. Sabel; Vernon K. Sondak

    2003-01-01

    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

  18. Emerging Treatment Options for Benign Prostatic Obstruction

    Microsoft Academic Search

    Brian A. Parsons; Hashim Hashim

    2011-01-01

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

  19. Post-Treatment Options for the Anaerobic Treatment of Domestic Wastewater

    Microsoft Academic Search

    C. A. L. Chernicharo

    2006-01-01

    This paper focuses on the post-treatment options for the anaerobic treatment of domestic wastewater. Initially, the main limitations\\u000a of anaerobic systems regarding carbon, nutrients and pathogen removal are presented. In sequence, the advantages of combined\\u000a anaerobic\\/aerobic treatment and the main \\u0009post-treatment options currently in use are discussed, including the presentation\\u000a of flowsheets and a comparison between various post-treatment systems. Lastly,

  20. Treatment options for obstructive sleep apnea.

    PubMed

    Abad, Vivien C; Guilleminault, Christian

    2009-09-01

    Sleep apnea is a major public health problem that afflicts 9% of women and 24% of men 30 to 60 years of age. It is highly treatable, but when untreated, it has been associated with (but not necessarily linked to) increased probability of cerebral and coronary vascular disease, congestive heart failure, metabolic dysfunction, cognitive dysfunction, excessive daytime sleepiness, motor vehicle accidents, reduced productivity, and decreased quality of life. The gold standard for treatment in adults is positive airway pressure (PAP) therapy: continuous PAP (CPAP), bilevel PAP, autotitrating CPAP, or autotitrating bilevel PAP. Measures to increase compliance with PAP therapy include medical or surgical treatment of any underlying nasal obstruction, setting appropriate pressure level and airflow, mask selection and fitting, heated humidification, desensitization for claustrophobia, patient and partner education, regular follow-up with monitoring of compliance software, and attendance of support groups (eg, AWAKE). Adjunctive treatment modalities include lifestyle or behavioral measures and pharmacologic therapy. Patients with significant upper airway obstruction who are unwilling or unable to tolerate PAP therapy may benefit from surgery. Multilevel surgery of the upper airway addresses obstruction of the nose, oropharynx, and hypopharynx. A systematic approach may combine surgery of the nose, pharynx, and hypopharynx in phase 1, whereas skeletal midface advancement or tracheotomy constitutes phase 2. Clinical outcomes are reassessed through attended diagnostic polysomnogram performed 3 to 6 months after surgery. Oral appliances can be used for patients with symptomatic mild or moderate sleep apnea who prefer them to PAP therapy or for whom PAP therapy has failed or cannot be tolerated. Oral appliances also may be used for patients with severe obstructive sleep apnea who are unable or unwilling to undertake PAP therapy or surgery. For children, the main treatment modality is tonsillectomy and adenoidectomy, with or without turbinate surgery. Children with craniofacial abnormalities resulting in maxillary or mandibular insufficiency may benefit from palatal expansion or maxillary/mandibular surgery. PAP therapy may be used for children who are not surgical candidates or if surgery fails. PMID:19744402

  1. Pediatric Ureteroceles: Diagnosis, Management and Treatment Options

    PubMed Central

    Gün?ar, Cüneyt; Mir, Erol; ?encan, Aydin; Ertan, Pelin; Özcan, Cansu Ünden

    2010-01-01

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

  2. New treatment options for patients with metastatic prostate cancer.

    PubMed

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

    2013-01-01

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

  3. The epidemiological characteristics of zygomatic complex fractures: A comparison between the surgically and non-surgically treated patients

    PubMed Central

    Salentijn, Erik Gerrit; Boffano, Paolo; Boverhoff, Jolanda; van den Bergh, Bart; Forouzanfar, Tymour

    2013-01-01

    Introduction: This retrospective study is aimed at the documentation of a more complete view of epidemiological data with particular focus on the characteristics of the surgically and non-surgically treated patients with zygomatic complex fractures. Materials and Methods: A total of 133 surgically and 150 non-surgically patients were treated with zygomatic complex fractures in VU University medical center Amsterdam from January 2007 to January 2012 were analyzed. These patient groups were further subdivided into displaced or non-displaced fractures and compared with each other according to age, gender and trauma etiology. Results: The mean age of all 286 patients was 42.8 years (standard deviation [SD: ±19.8]). Surgically and non-surgically treated patients differed in presentation with a significantly overall higher age of females, especially within the non-surgically treated patient group with displaced fractures (mean age of 59.5 years, SD: ±27.4). The mean ages of males from the different subgroups were more consistent with the overall mean age. The main causes were traffic accidents, whereas the contribution of falls and assaults depended on age group, gender, treatment management and even fracture displacement. Conclusions: This report provides us important epidemiological data of all patients with zygomatic complex fractures. The non-surgically treated patient group contained patients of higher age, more females and a fall-related cause, compared to the surgically treated patient group. The surgically treated patient group showed the same epidemiological characteristics as were demonstrated in previous studies. PMID:24665179

  4. Nonsurgical treatment options for internal hemorrhoids.

    PubMed

    Pfenninger, J L; Surrell, J

    1995-09-01

    Rectal pain and/or bleeding are common complaints among the general population. Hemorrhoids are the most common etiology for these complaints, but the family physician should always be alert to the possibility of other pathologic explanations, such as fissure, abscess, fistula, condyloma or cancer. Feelings of embarrassment or apprehension about surgery may make patients reluctant to discuss anorectal symptoms with their physician. A variety of outpatient methods is available to treat internal hemorrhoids. Rubber band ligation is widely used in the treatment of all grades of internal hemorrhoids. Infrared coagulation uses high-intensity light to treat grade I, grade II and some grade III internal hemorrhoids. Bipolar electrocoagulation is useful in all cases, while low-voltage direct current is useful in cases of more advanced hemorrhoids. Proper anal hygiene and correction of chronic constipation or diarrhea are essential to prevent recurrence of hemorrhoids. PMID:7653423

  5. Hilar cholangiocarcinoma: diagnosis, treatment options, and management

    PubMed Central

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

    2014-01-01

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

  6. Emerging treatment options for nasopharyngeal carcinoma

    PubMed Central

    Zhang, Lu; Chen, Qiu-Yan; Liu, Huai; Tang, Lin-Quan; Mai, Hai-Qiang

    2013-01-01

    Nasopharyngeal carcinoma is endemic in Asia and is etiologically associated with Epstein–Barr virus. Radiotherapy is the primary treatment modality. The role of systemic therapy has become more prominent. Based on multiple phase III studies and meta-analyses, concurrent cisplatin-based chemoradiotherapy is the current standard of care for locally advanced disease (American Joint Committee on Cancer manual [7th edition] stages II–IVb). The reported failure-free survival rates from phase II trials are encouraging for induction + concurrent chemoradiotherapy. Data from ongoing phase III trials comparing induction + concurrent chemoradiotherapy with concurrent chemoradiotherapy will validate the results of these phase II studies. Intensity-modulated radiotherapy techniques are recommended if the resources are available. Locoregional control exceeding 90% and reduced xerostomia-related toxicities can now be achieved using intensity-modulated radiotherapy, although distant control remains the most pressing research problem. The promising results of targeted therapy and Epstein–Barr virus-specific immunotherapy from early clinical trials should be validated in phase III clinical trials. New technology, more effective and less toxic chemotherapy regimens, and targeted therapy offer new opportunities for treating nasopharyngeal carcinoma. PMID:23403548

  7. Birdshot uveitis: current and emerging treatment options.

    PubMed

    Menezo, Victor; Taylor, Simon Rj

    2014-01-01

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

  8. Birdshot uveitis: current and emerging treatment options

    PubMed Central

    Menezo, Victor; Taylor, Simon RJ

    2014-01-01

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

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

    PubMed Central

    P?aszewski, Maciej; Bettany-Saltikov, Josette

    2014-01-01

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

  10. The Natural History and Treatment Options for Unruptured Intracranial Aneurysms

    PubMed Central

    Loewenstein, Joshua E.; Gayle, Shaneze C.; Duffis, E. Jesus; Prestigiacomo, Charles J.; Gandhi, Chirag D.

    2012-01-01

    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. PMID:22500236

  11. Drinking water treatment options for taste and odor control

    Microsoft Academic Search

    Erika E. Hargesheimer; Susan B. Watson

    1996-01-01

    The effectiveness of drinking water treatment options for eliminating seasonal taste and odor events caused by phytoplankton blooms in the source water were evaluated. Dissolved air flotation (DAF), conventional gravity sedimentation (CGS), ozonation and granulated activated carbon (GAC) filtration processes were studied in pilot plant-scale experiments. Clarification by DAF consistently produced water with lower turbidity and particle counts (NP >

  12. TAILORx (Trial Assigning IndividuaLized Options for Treatment)

    Cancer.gov

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

  13. Treatment Options for Primary Refractory/Recurrent Hodgkin Lymphoma in Children and Adolescents

    MedlinePLUS

    ... Search for Clinical Trials NCI Publications Español Childhood Hodgkin Lymphoma Treatment (PDQ®) Treatment Options for Primary Refractory/Recurrent Hodgkin Lymphoma in Children and Adolescents Treatment of primary ...

  14. Second and third line treatment options for Helicobacter pylori eradication

    PubMed Central

    Song, Mingjun; Ang, Tiing Leong

    2014-01-01

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

  15. Gastroparesis: a review of current and emerging treatment options.

    PubMed

    Enweluzo, Chijioke; Aziz, Fahad

    2013-01-01

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

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

    Cancer.gov

    Results from an international clinical trial suggest that women with metastatic, HER2-positive breast cancer that is no longer responding to the targeted therapy trastuzumab (Herceptin) may soon have a new treatment option. Women who received the investigational drug trastuzumab emtansine (T-DM1) lived more than 3 months longer without their tumors progressing than women who received the chemotherapy drug capecitabine (Xeloda) and the targeted drug lapatinib (Tykerb).

  17. Carotid Stump Syndrome: Pathophysiology and Endovascular Treatment Options

    SciTech Connect

    Lakshminarayan, Raghuram; Scott, Paul M.; Robinson, Graham J.; Ettles, Duncan F., E-mail: duncan.ettles@hey.nhs.uk [Hull Royal Infirmary, Department of Radiology (United Kingdom)

    2011-02-15

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

  18. Treatment options for dysfunctional uterine bleeding: evaluation of clinical results

    Microsoft Academic Search

    George Pados; Dimitrios Athanatos; Dimitrios Tsolakidis; Panagiotis Stamatopoulos; Basil Tarlatzis

    Abnormal uterine bleeding is one of the most common problems in women of reproductive age, and dysfunctional uterine bleeding\\u000a (DUB) accounts for about half the cases. The aim of this review is to present all treatment options for women suffering from\\u000a DUB and to evaluate their effectiveness. A detailed search strategy on electronic databases was carried out to identify trials

  19. Curative treatment of oesophageal carcinoma: current options and future developments

    Microsoft Academic Search

    Maria C Wolf; Michael Stahl; Bernd J Krause; Luigi Bonavina; Christiane Bruns; Claus Belka; Franz Zehentmayr

    2011-01-01

    Since the 1980s major advances in surgery, radiotherapy and chemotherapy have established multimodal approaches as curative\\u000a treatment options for oesophageal cancer. In addition the introduction of functional imaging modalities such as PET-CT created\\u000a new opportunities for a more adequate patient selection and therapy response assessment.\\u000a \\u000a \\u000a The majority of oesophageal carcinomas are represented by two histologies: squamous cell carcinoma and adenocarcinoma.

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

    PubMed

    Ho, Lionel; Sawade, Emma; Newcombe, Gayle

    2012-04-01

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

  1. Effect of surgical and non-surgical periodontal debridement on vascular thrombotic markers in hypertensives

    PubMed Central

    Albush, Muhammad M.; Razan, Khattab K.; Raed, Al Dieri M.

    2013-01-01

    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. PMID:24049332

  2. Treatment options for high-grade squamous intraepithelial lesions.

    PubMed

    Long, Stephanie; Leeman, Lawrence

    2013-06-01

    The introduction of testing for high-risk HPV types and P16 immunostaining of CIN2 histologic specimens allows for determination of the risk of progression versus regression for a woman with a particular cytologic or histologic specimen. Observation with serial cytological or colposcopic examinations is now appropriate for women with low-grade histologic lesions as well as pregnant and young women with certain high-grade histologic lesions. Current recommendations for management of high-grade lesions, the efficacy of treatment options (cryotherapy and LEEP), and the immediate (bleeding, infection) and longer term complications (cervical incompetence, preterm delivery) of cervical dysplasia treatment are presented. PMID:23732033

  3. Oral vitamin D, still a viable treatment option for psoriasis.

    PubMed

    Kamangar, Faranak; Koo, John; Heller, Misha; Lee, Eric; Bhutani, Tina

    2013-08-01

    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

  4. Intracranial Aneurysms: Review of Current Treatment Options and Outcomes

    PubMed Central

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

    2011-01-01

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

  5. Innovative chemotherapeutical treatment options for alveolar and cystic echinococcosis.

    PubMed

    Hemphill, A; Spicher, M; Stadelmann, B; Mueller, J; Naguleswaran, A; Gottstein, B; Walker, M

    2007-11-01

    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

  6. Managing AVN following internal fixation: Treatment options and clinical results.

    PubMed

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

    2015-03-01

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

  7. Current and emerging treatment options for nasopharyngeal carcinoma.

    PubMed

    Spratt, Daniel E; Lee, Nancy

    2012-01-01

    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. PMID:23118544

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

    PubMed

    Ihler, Friedrich; Canis, Martin

    2015-01-01

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

  9. Rheumatoid forefoot deformity: pathophysiology, evaluation and operative treatment options.

    PubMed

    Louwerens, Jan Willem K; Schrier, Joost C M

    2013-09-01

    Despite recent advances in pharmacological management of rheumatoid arthritis, forefoot deformity, with its symptoms, remains a common problem, often requiring operative treatment. Typical deformities in these patients comprise hallux valgus and deformity of the lesser metatarsophalangeal (MTP) joints and toes. With regard to the lesser rays the standard operative procedure, advocated for the disabling forefoot pain in these patients, remains metatarsal head resection. It should be considered that with increasing success of pharmacological treatment the degree of forefoot deformity in these patients is becoming less and that resection of the lesser MTP joints is becoming more and more superfluous. This supports a trend towards metatarsal head-preserving surgery. The optimal treatment of the hallux deformity remains unclear. Fusion of the first MTP joint is, generally, recommended. This article will discuss the current surgical options in rheumatoid forefoot pathology. PMID:23892468

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

    PubMed Central

    2013-01-01

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

  11. Microorganism-earthworm Integrated Biological Treatment Process - a Sewage Treatment Option for Rural Settlements

    Microsoft Academic Search

    XING Meiyan; YANG Jian

    Condensed abstract: The microorganism-earthworm integrated biological treatment process was an option for decentralized wastewater treatment, especially for rural settlements. The experimental results show that when the hydraulic retention time of the anaerobic reactor varies from 6h to 9h and the hydraulic loading of the earthworm reactor varies from 2 to 3 m 3 \\/(m 2 ·d), the removal efficiencies were

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

    PubMed

    Rosenkranz, Stephan

    2015-03-01

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

  13. Modern treatment options for elderly patients with multiple myeloma.

    PubMed

    Görner, Martin; Späth-Schwalbe, Ernst

    2008-06-01

    Multiple myeloma, an incurable malignancy of plasma cells, is a disease of the elderly. In younger patients, significant therapeutic progress has been achieved, but survival outcomes remain unacceptably low in older adults with multiple myeloma. Diverse factors, including comorbidity, performance status, decreased physiologic reserve, and potential undertreatment, contribute to these poor outcomes. Unfortunately, many clinical trials are designed to exclude elderly patients with coexisting diseases, so only limited data are available and no guidelines exist on how to treat this challenging and growing myeloma population. A broader range of therapeutic options has become available within the last few years, including chemotherapy with either established or newly available drugs, immunomodulators, and high-dose treatment with stem cell support (autologous as well as allogeneic). In this review, we discuss the data available from clinical trials investigating antineoplastic treatment of elderly multiple myeloma patients. PMID:18547977

  14. [Surgical treatment options in end-stage heart failure].

    PubMed

    Grapow, Martin T R; Carrel, Thierry P; Eckstein, Friedrich S

    2011-02-01

    Despite significant improvements in pharmacological therapy heart failure is still one of the leading causes for death in the Western World. The gold standard treatment of end-stage heart failure remains cardiac transplantation, but there is a great excess of eligible candidates compared with the low number of suitable donor organs. The variety of surgical organ preserving treatment strategies has significantly increased during the last 20 years, intenting either to delay or even to prevent the need for cardiac transplantation. An individually tailored surgical concept should be considered as an alternative in any heart failure patient who has reached the limits of pharmacologic therapy. This article gives an overview about current and potential future therapeutic options in end-stage heart failure. PMID:21271540

  15. Tear trough deformity: review of anatomy and treatment options.

    PubMed

    Stutman, Ross L; Codner, Mark A

    2012-05-01

    The lower eyelid can be a challenging area in facial rejuvenation. While lower eyelid bags are commonly the reason that patients present for lower eyelid rejuvenation, a separate entity known as a tear trough deformity may occur in conjunction with lower eyelid bags or alone. In this article, the authors outline the current understanding of the tear trough anatomy; describe multiple classification systems, which provide an objective means of evaluating the deformity and aid the surgeon in choosing appropriate treatment options; and review surgical and nonsurgical techniques for correcting the tear trough deformity. Treatment options include hyaluronic acid filler, fat grafting, skeletal implants, and fat transposition. Each procedure is associated with advantages and disadvantages, and each should be considered more complex than traditional lower blepharoplasty alone. While lower blepharoplasty removes excess fat and may tighten the anterior lamella, tear trough procedures require the addition of volume to the underlying depression. These procedures requiring release of the ligamentous structures and orbicularis (of which the tear trough is composed), as well as fat transposition or fat grafting, are associated with additional complications, which are also reviewed. PMID:22523096

  16. Desmoid Tumors: Clinical Features and Treatment Options for Advanced Disease

    PubMed Central

    Ströbel, Philipp; Hohenberger, Peter

    2011-01-01

    Desmoid tumors describe a rare monoclonal, fibroblastic proliferation characterized by a variable and often unpredictable clinical course. Although histologically benign, desmoids are locally invasive and associated with a high local recurrence rate, but lack metastatic potential. On the molecular level, desmoids are characterized by mutations in the ?-catenin gene, CTNNB1, or the adenomatous polyposis coli gene, APC. Proof of a CTNNB1 mutation may be useful when the pathological differential diagnosis is difficult and location might be predictive for disease recurrence. Many issues regarding the optimal treatment of patients with desmoids remain controversial; however, surgery is the therapeutic mainstay, except if mutilating and associated with considerable function loss. Postoperative radiotherapy reduces the local recurrence rate, in cases of involved surgical margins. Because of the heterogeneity of the biological behavior of desmoids, including long periods of stable disease or even spontaneous regression, treatment needs to be individualized to optimize local tumor control and preserve patients' quality of life. Therefore, the application of a multidisciplinary assessment with multimodality treatment forms the basis of care for these patients. Watchful waiting may be the most appropriate management in selected asymptomatic patients. Patients with desmoids located at the mesentery or in the head and neck region could present with life-threatening complications and often need more aggressive treatment. This review describes treatment options and management strategies for patients with desmoid tumors with a focus on advanced disease. PMID:21478276

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

    PubMed

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

    2011-12-01

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

  18. Current and emerging treatment options for Peyronie's disease.

    PubMed

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

    2013-01-01

    Peyronie's disease (PD) is a condition of the penis, characterized by the presence of localized fibrotic plaque in the tunica albuginea. PD is not an uncommon disorder, with recent epidemiologic studies documenting a prevalence of 3-9% of adult men affected. The actual prevalence of PD may be even higher. It is often associated with penile pain, anatomical deformities in the erect penis, and difficulty with intromission. As the definitive pathophysiology of PD has not been completely elucidated, further basic research is required to make progress in the understanding of this enigmatic condition. Similarly, research on effective therapies is limited. Currently, nonsurgical treatments are used for those men who are in the acute stage of PD, whereas surgical options are reserved for men with established PD who cannot successfully penetrate. Intralesional treatments are growing in clinical popularity as a minimally invasive approach in the initial treatment of PD. A surgical approach should be considered when men with PD do not respond to conservative, medical, or minimally invasive therapies for approximately 1 year and cannot have satisfactory sexual intercourse. As scientific breakthroughs in the understanding of the mechanisms of this disease process evolve, novel treatments for the many men suffering with PD are anticipated. PMID:24400231

  19. Current and emerging treatment options for Peyronie’s disease

    PubMed Central

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

    2013-01-01

    Peyronie’s disease (PD) is a condition of the penis, characterized by the presence of localized fibrotic plaque in the tunica albuginea. PD is not an uncommon disorder, with recent epidemiologic studies documenting a prevalence of 3–9% of adult men affected. The actual prevalence of PD may be even higher. It is often associated with penile pain, anatomical deformities in the erect penis, and difficulty with intromission. As the definitive pathophysiology of PD has not been completely elucidated, further basic research is required to make progress in the understanding of this enigmatic condition. Similarly, research on effective therapies is limited. Currently, nonsurgical treatments are used for those men who are in the acute stage of PD, whereas surgical options are reserved for men with established PD who cannot successfully penetrate. Intralesional treatments are growing in clinical popularity as a minimally invasive approach in the initial treatment of PD. A surgical approach should be considered when men with PD do not respond to conservative, medical, or minimally invasive therapies for approximately 1 year and cannot have satisfactory sexual intercourse. As scientific breakthroughs in the understanding of the mechanisms of this disease process evolve, novel treatments for the many men suffering with PD are anticipated. PMID:24400231

  20. Non-Surgical Repair of Internal Resorption with MTA: A Case Report.

    PubMed

    Mohammadi, Zahed; Yazdizadeh, Mohammad; Shalavi, Sousan

    2012-01-01

    Internal resorption is rare in permanent teeth. Treatment is usually performed through warm gutta-percha technique. If the resorptive process perforates the root, treatment may be more difficult and is usually performed via surgical approach. Non-surgical repair of a perforating internal root resorption with MTA was conducted in this case. Before repairing the resorption, a master gutta-percha point was placed in the canal to maintain negotiability of the original canal path. Then, MTA was prepared and applied with a small carrier in the resorption area and compacted. Thereafter gutta-percha was retrieved and the access cavity was closed with a temporary filling material. In the second visit, the root canal was obturated with gutta-percha and AH26 sealer using lateral compaction technique and subsequently, the crown was restored. The symptoms and signs ceased and the result was satisfactory at the 18 month follow-up visit. PMID:23130082

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

    PubMed Central

    Wang, Sean K; Chang, Robert T

    2014-01-01

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

  2. Treatment of nicotine addiction: present therapeutic options and pipeline developments.

    PubMed

    Polosa, Riccardo; Benowitz, Neal L

    2011-05-01

    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

  3. Respiratory syncytial virus: current and emerging treatment options

    PubMed Central

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

    2014-01-01

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

  4. Current and Emerging Treatment Options for Fecal Incontinence

    PubMed Central

    2014-01-01

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

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

    PubMed Central

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

    2013-01-01

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

  6. Managing the patent ductus arteriosus: current treatment options.

    PubMed

    Heuchan, Anne Marie; Clyman, Ronald I

    2014-09-01

    Optimal management of the patent ductus arteriosus (PDA) in the premature infant remains controversial. Despite considerable historical and physiological data indicating that a persistent PDA may be harmful, robust evidence of long-term benefits or harms from treatment is lacking. This has been equated to a lack of benefit but is also a reflection of the fact that most clinical trials were designed to assess the effects of short-term (2-8?days) rather than prolonged exposure to a PDA. No clinical trials have been designed to assess the effects of prolonged exposure of persistent PDA on morbidity and mortality of very premature infants in the era of antenatal corticosteroids, surfactant and non-invasive respiratory support. Further research is required, but new insights and novel therapies are evolving, which will allow greater individual patient assessment, understanding of risk and optimisation of treatment. In this paper, we review the current literature, evidence for treatment options, including a non-interventional approach, and research directions for infants <28?weeks' gestational age. PMID:24903455

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

    PubMed Central

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

    2014-01-01

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

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

    PubMed

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

    2006-03-01

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

  9. How multidrug resistance in typhoid fever affects treatment options.

    PubMed

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

    2014-09-01

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

  10. Yokukansan and its ingredients as possible treatment options for schizophrenia

    PubMed Central

    Yu, Chuan-Hsun; Ishii, Ryouhei; Yu, Shun-Chieh; Takeda, Masatoshi

    2014-01-01

    Schizophrenia is a debilitating psychotic mental disorder that affects almost the entire range of human mental function. The devastating effect of the illness is usually long-lasting and requires lifelong treatment. Despite an evolved psychopharmacological understanding, the overall therapeutic effect of antipsychotics is still not satisfactory. The choice of proper medication presents a clinical dilemma between efficacy and safety. As a result, searching for comparable treatment options with safer profiles is very important. Yokukansan (TJ-54), also called yi-gan san in Chinese, is a traditional herbal medicine with evident therapeutic effect for neuropsychiatric disorders. There are several open-label clinical studies upholding the possibility of using yokukansan to treat schizophrenia or schizophrenia-like psychosis. Evidence from animal studies and neurobiology also sheds light on the antipsychotic implications of yokukansan and its ingredients. Nevertheless, correlations between the experimental environment and clinical settings may be complicated by a number of confounders. Clinical trials with more sophisticated designs are required to fill the gap between the experimental environment and clinical settings. PMID:25210456

  11. Current and emerging treatment options for Graves’ hyperthyroidism

    PubMed Central

    Abraham, Prakash; Acharya, Shamasunder

    2010-01-01

    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. PMID:20169034

  12. Pregnancy-associated breast cancer: optimal treatment options

    PubMed Central

    Cardonick, Elyce

    2014-01-01

    Cancer is diagnosed approximately once per 1,000 pregnancies; most commonly due to the reproductive age of the women, these include breast, cervical, melanoma, thyroid, and Hodgkin’s lymphoma diagnoses. As a single diagnosis, breast cancer is the most common cancer diagnosed during pregnancy. Cancer is expected to complicate pregnancy more often due to the trend for women to delay child bearing to later maternal ages. Delayed first birth is itself a risk factor for breast cancer. Termination of pregnancy has not been shown to afford a survival benefit. While protecting the interests of mother and unborn fetus, breast cancer can be safely diagnosed, staged, and treated during pregnancy with good outcomes for both. Some modification of the protocols used for nonpregnant women with suspicious palpable breast masses is required. This article reviews the challenges for physicians in making the diagnosis of breast cancer during pregnancy and upon diagnosis, counseling patients about treatment options. The consequences of diagnostic investigations and cancer treatment for the exposed fetus are also addressed. PMID:25395871

  13. Treatment Options for Childhood Central Nervous System Embryonal Tumors and Childhood Pineoblastoma

    MedlinePLUS

    Treatment Options for Childhood Central Nervous System Embryonal Tumors and Childhood Pineoblastoma Newly Diagnosed Childhood Medulloblastoma In newly diagnosed childhood medulloblastoma , the tumor itself has not been treated. ...

  14. Single wavelength micro-endoscopy in non-surgical vascular lesion diagnosis & characterization.

    PubMed

    Papagatsia, Z; Tappuni, A; Watson, T F; Cook, R J

    2008-05-01

    Malignant and dysplastic epithelial lesions have often been reported to excite vascular responses by histopathological characterization. Little is reported concerning in vivo real-time imaging of vascular patterns and flow in health or disease but the development of miniature imaging instrumentation has now allowed such developments. We describe the application of a selective wavelength (540 nm) epi-illumination Hopkins pattern endoscopic imaging system to image vascular tissues and capillary blood flow in vivo. The contrast mechanism in such imaging was characterized, haemoglobin acting as a chromatic transmission filter despite endoscopy being a non-invasive and therefore principally reflection mode imaging system. In vivo adrenergic vascular responses, capillary flow rate variations over time and variations in normal capillary architecture around the oral cavity were recorded; demonstrating that simple imaging systems can be used for non-surgical diagnosis and characterization of vascular lesions, tumours and treatment responses. PMID:18445148

  15. Periodontal Treatments and Procedures

    MedlinePLUS

    ... Comprehensive Periodontal Evaluation Periodontal Treatments and Procedures Non-Surgical Periodontal Treatments Gum Graft Surgery Laser Treatment for Gum Disease Regenerative Procedures Dental Crown ...

  16. Arsenic Contaminated Groundwater and Its Treatment Options in Bangladesh

    PubMed Central

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

    2012-01-01

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

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

    SciTech Connect

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

    1995-09-01

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

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

    PubMed

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

    2013-01-01

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

  19. Novel Treatment Options for Waldenström’s Macroglobulinemia

    PubMed Central

    Leblebjian, Houry; Agarwal, Amit; Ghobrial, Irene

    2013-01-01

    Waldenström’s macroglobulinemia first described by Jan Waldenström in 1944 is a lymphoplasmacytic lymphoma characterized by the presence of an immunoglobulin M (IgM) monoclonal gammopathy in the blood and monoclonal small lymphocytes and lymphoplasmacytoid cells in the bone marrow. WM is a rare and indolent disease but remains incurable. In this review we discuss the pathogenesis of Waldenström macroglobulinemia and focus on novel treatment options that target pathways deregulated in this disease. Recent studies have helped us identify specific genetic mutations that are commonly seen in WM and may prove to be important therapeutic targets in the future. We discuss the role of epigenetics and the changes in the bone marrow microenvironment that are important in the pathogenesis of WM. The commonly used drugs are discussed with a focus on novel agents that are currently being used as single agents or in combinations to treat WM. We finally focus on some agents that have shown preclinical efficacy and may be available in the near future. PMID:24290218

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

    PubMed Central

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

    2014-01-01

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

  1. Treatment Options for Childhood Acute Myeloid Leukemia, Myelodysplastic Syndromes, and Juvenile Myelomonocytic Leukemia

    MedlinePLUS

    Treatment Options for Childhood Acute Myeloid Leukemia, Childhood Chronic Myelogenous Leukemia, Juvenile Myelomonocytic Leukemia, and Myelodysplastic Syndromes Newly Diagnosed Childhood Acute Myeloid Leukemia Treatment of newly diagnosed childhood acute ...

  2. Thromboprophylaxis in non-surgical patients: who, when and how?

    PubMed

    Gallus, A S; Nurmohamed, M; Nurmohammed, M; Kearon, C; Prins, M

    1998-01-01

    Because of the serious lack of useable, relevant information, most recommendations for prevention of thrombosis in non-surgical patients are extrapolations from much larger clinical trials experienced in surgery. Directly relevant evidence comes predominantly from very small randomized trials, many of them open label and carried out more than 20 years before the introduction of more recent and important changes in clinical care that may have substantially reduced the baseline thrombosis risk. In these early studies, low-dose heparin and low-molecular-weight heparins prevented subclinical deep vein thrombosis in ischaemic stroke, myocardial infarction and among elderly medical inpatients. Although it is likely that these drugs also prevent subclinical deep vein thrombosis after spinal cord injury or other major trauma, and when patients require intensive medical care, the supporting evidence in these circumstances comes mainly from cohort studies and poorly controlled comparisons. In contrast, the heparins have not reduced mortality or demonstrably prevented pulmonary embolism after ischaemic stroke or among elderly medical inpatients in large and well-conducted clinical endpoint trials, from which no clinically important benefit could be demonstrated. From analyses it is suggested that such benefit is probably more difficult to demonstrate for medical than for surgical patients. In the absence of sufficient information that is specific to medical patients, various forms of prophylaxis known to be effective in surgery will continue to be applied in high-risk individuals. After venous thromboembolism, it now appears that the best duration of oral anticoagulant therapy to prevent a recurrence is determined to a greater extent by whether the thrombotic episode was idiopathic or triggered by a clinically recognizable cause, whether it was transient or continuing, and whether the deep vein thrombosis was extensive, limited to the calf veins or was a first or recurrent event. PMID:10069765

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

    PubMed Central

    Arvold, Nils D; Reardon, David A

    2014-01-01

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

  4. Cardioversion for atrial fibrillation: treatment options and advances.

    PubMed

    Reiffel, James A

    2009-08-01

    Atrial fibrillation (AF) is associated with significant morbidity and mortality. There are two basic approaches to managing AF: slowing the ventricular rate, while allowing the arrhythmia to continue (the rate-control approach), and restoring and maintaining sinus rhythm (the rhythm-control approach) with antiarrhythmic drugs (AADs) and/or ablation, electrical cardioversion (CV), if needed, or both. Strategy trials comparing rate and rhythm control have found no survival advantage of one approach over the other, but other considerations, such as symptom reduction, often necessitate pursuit of rhythm control. Electrical, or direct current, CV is a widely used and effective method for termination of nonparoxysmal AF, although its success can be affected by patient- and technique-related variables. Pharmacological CV options also exist and are preferable in specific circumstances. Both pharmacological and electrical CV are associated with the risk of proarrhythmia. Many AADs are under development for both CV and maintenance of sinus rhythm. Some are atrioselective, such as vernakalant, and target ion channels in the atria, with little or no effects in the ventricle. Vernakalant, currently under Food and Drug Administration review, appears to offer a safer profile than current CV agents and is likely to expand the role of pharmacological CV. Other new AADs that provide increased efficacy or safety while maintaining normal sinus rhythm may also be better than current drugs; if so, rate-rhythm comparisons will differ from those of previous studies. In conclusion, further trials should clarify the long-term safety profiles of new atrioselective agents and other investigational drugs and define their role in the treatment of AF. PMID:19659629

  5. ESPEN Guidelines on Parenteral Nutrition: non-surgical oncology.

    PubMed

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

    2009-08-01

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

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

    MedlinePLUS

    ... are different types of treatment for children with brain and spinal cord tumors. Different types of treatment ... patients who have not started treatment. Children with brain or spinal cord tumors should have their treatment ...

  7. Treatment Option Overview (Ovarian Low Malignant Potential Tumors)

    MedlinePLUS

    ... types of treatment for patients with ovarian low malignant potential tumor. Different types of treatment are available for patients with ovarian low malignant potential tumor . Some treatments are standard (the currently ...

  8. Treatment Option Overview (Wilms Tumor and Other Childhood Kidney Tumors)

    MedlinePLUS

    ... Rehabilitation specialist . Pediatric nurse specialist . Social worker . Some cancer treatments cause side effects months or years after treatment ... clinical trials before, during, or after starting their cancer treatment. Some clinical trials only include patients who have ...

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

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ...2010-04-01 false Treatment of foreign futures or foreign options secured...organization; (v) A member of any foreign board of trade; or (vi) Such member or clearing...property are held for or on behalf of foreign futures and foreign options...

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

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ...2011-04-01 false Treatment of foreign futures or foreign options secured...organization; (v) A member of any foreign board of trade; or (vi) Such member or clearing...property are held for or on behalf of foreign futures and foreign options...

  11. Treatment Options for GERD or Acid Reflux Disease: A Review of the Research for Adults

    MedlinePLUS

    ... Sept. 23, 2011 Treatment Options for GERD or Acid Reflux Disease: A Review of the Research for ... chest and throat (heartburn). GERD is also called “acid reflux disease.” You want to know what research ...

  12. Conservative treatment options for carpal tunnel syndrome: a systematic review of randomised controlled trials

    Microsoft Academic Search

    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

    2002-01-01

    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,

  13. Anterior Femoroacetabular Impingement: A Diverse Disease with Evolving Treatment Options

    PubMed Central

    Zebala, Lukas P; Schoenecker, Perry L; Clohisy, John C

    2007-01-01

    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. PMID:17907434

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

    PubMed Central

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

    2014-01-01

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

  15. Treatment Options for Childhood Extracranial Germ Cell Tumors

    MedlinePLUS

    ... trials is available from the NCI Web site . Malignant Gonadal Germ Cell Tumors Malignant Testicular Germ Cell Tumors Treatment of malignant testicular ... trials is available from the NCI Web site . Malignant Ovarian Germ Cell Tumors Dysgerminomas Treatment of stage ...

  16. Onshore ballast water treatment: a viable option for major ports.

    PubMed

    Pereira, Newton Narciso; Brinati, Hernani Luiz

    2012-11-01

    Ballast water treatment consists of the elimination of exotic species. Currently, the development of alternative methods for this process is directed toward treatment onboard ships. However, we present onshore treatment as a viable alternative for ballast water treatment. We investigated onshore treatment in two iron ore ports with movement capacities of 25 and 90 million tons annually (Mta) that receive 7.5 and 25 million cubic meters annually (Mm(3)) of ballast water, respectively. Discrete event simulation was used as the method of analysis, considering the processes of arrival, berthing, ship loading and capture and treatment of ballast water. We analyzed data from 71 ships operating in these ports to validate our simulation model. We were able to demonstrate that onshore treatment does not impact the cargo capacity, occupation rate or average queuing time of ships at these ports. We concluded that implementation of onshore ballast water treatment may be practicable in ports that receive high volumes of ballast water. PMID:22920715

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

    MedlinePLUS

    ... skin. High-dose chemotherapy and radiation therapy with stem cell transplant This treatment is a method of giving ... blood-forming cells destroyed by the cancer treatment. Stem cells (immature blood cells) are removed from the bone ...

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

    MedlinePLUS

    ... for the treatment of triple-negative breast cancer . Monoclonal antibody therapy is a cancer treatment that uses antibodies made ... Chemotherapy with or without hormone therapy . Hormone therapy. Monoclonal antibody therapy with trastuzumab combined with chemotherapy. A clinical trial ...

  19. Fertility-Preserving Treatment Options in Patients with Malignant Hematological Diseases

    PubMed Central

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

    2012-01-01

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

  20. Current treatment options for management of anal intraepithelial neoplasia

    PubMed Central

    Weis, Stephen E

    2013-01-01

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

  1. Treatment Options by Stage (Non-Small Cell Lung Cancer)

    MedlinePLUS

    Occult Non-Small Cell Lung Cancer Treatment of occult non-small cell lung cancer depends on the stage of the disease. Occult tumors ... the NCI Web site . Stage I Non-Small Cell Lung Cancer Treatment of stage I non-small ...

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

    Microsoft Academic Search

    Charles FS Locke; John Dooley; Jonathan Gerber

    2005-01-01

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

  3. Treatment Options for Wilms Tumor and Other Childhood Kidney Tumors

    MedlinePLUS

    ... NCI Web site . Stage V Wilms Tumor and patients at high risk of developing bilateral Wilms tumor Treatment of stage V Wilms tumor may be different for each patient and may include: Combination chemotherapy to shrink the ...

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

    MedlinePLUS

    ... therapy uses a radioactive substance sealed in needles, seeds , wires, or catheters that are placed directly into ... by the disease or its treatment, and improves quality of life . Supportive care is given to treat ...

  5. Treatment Options for Childhood Non-Hodgkin Lymphoma

    MedlinePLUS

    ... Web site . Lymphoproliferative Disease Associated with a Weakened Immune System Treatment of lymphoproliferative disease in children and adolescents with weakened immune systems may include the following: Surgery with or without ...

  6. Ballast water treatment technologies: hydrocyclonic a viable option

    Microsoft Academic Search

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

    2011-01-01

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

  7. No treatment option for liver metastases from colorectal adenocarcinoma

    Microsoft Academic Search

    Michael Palmer; Nicholas J. Petrelli; Lemuel Herrera

    1989-01-01

    After an explanation of alternative treatment modalities, 30 patients with unresectable liver metastases from colorectal adenocarcinoma\\u000a chose to have no treatment. Fourteen patients (47 percent) had synchronous liver metastases and 16 (53 percent) had metachronous\\u000a lesions. Thirteen of the 30 patients (43 percent) had histologic documentation of liver metastases, with the remaining 17\\u000a patients diagnosed by liver scan, ultrasonography, or

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

    PubMed

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

    2013-11-01

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

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

    NSDL National Science Digital Library

    Robert W. Grossman

    2002-01-01

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

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

    PubMed Central

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

    2014-01-01

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

  11. Cryptosporidium and Giardia: treatment options and prospects for new drugs.

    PubMed

    Rossignol, Jean-François

    2010-01-01

    Cryptosporidium species and Giardia intestinalis are the most common enteric protozoan pathogens affecting humans worldwide. In recent years, nitazoxanide has been licensed in the United States for the treatment of cryptosporidiosis in non-immunodeficient children and adults, becoming the first drug approved for treating this disease. There is a need for a highly effective treatment for cryptosporidiosis in immunodeficient patients, but the quest for such a drug has proven to be elusive. While not effective against Cryptosporidium, nitroimidazoles such as metronidazole or tinidazole are effective treatments for giardiasis and can be administered as a single dose. Albendazole and nitazoxanide are effective against giardiasis but require multiple doses. Nitazoxanide is the first new drug developed for treating giardiasis in more than 20years. New potentially promising drug targets in Cryptosporidium and Giardia have been identified, but there appears to be little activity toward clinical development of new drugs. PMID:19632225

  12. [Results-adapted operative treatment options for spinal metastases].

    PubMed

    Heyde, C E; Gulow, J; von der Höh, N; Völker, A; Jeszenszky, D; Weber, U

    2013-09-01

    The current operative approaches and technical possibilities in the operative treatment of spinal metastases are manifold which enables an individual operative strategy adapted to the patient's condition. Maintaining quality of life is the primary goal in the treatment of these patients. The therapeutic goals, such as pain control, avoidance of neurological deficits and the achievement of spinal stability have to be attained with as little morbidity as possible. From this perspective the available operative techniques ranging from minimally invasive approaches to complex reconstructive surgery will be addressed and discussed in this article. PMID:23989591

  13. Pretibial Myxedema: Case Presentation and Review of Treatment Options.

    PubMed

    Kim, Whan B; Mistry, Nisha; Alavi, Afsaneh; Sibbald, Cathryn; Sibbald, Ronald G

    2014-05-01

    Pretibial myxedema (PM) is a rare autoimmune manifestation of Graves' disease, which commonly presents as diffuse, nonpitting edema of shins and less often as plaques, nodules, or elephantiasis lesions mimicking lymphedema. We present a 57-year-old woman with 12-month history of PM, which occurred a year after treatment of Graves' disease and improved with topical corticosteroids, support stockings, and intralesional steroid injections until recurrence with local erythema and woody edema. A literature review was undertaken of the evidence-based treatment modalities for symptomatic PM: although commonly asymptomatic and self-limited, severe cases of PM may be treated with topical corticosteroid, compressive therapy, and intralesional corticosteroid injections. PMID:24807996

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

    PubMed

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

    2014-11-01

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

  15. Treatment of autoimmune liver disease: current and future therapeutic options

    PubMed Central

    Trivedi, Palak J.

    2013-01-01

    Autoimmune liver disease spans three predominant processes, from the interface hepatitis of autoimmune hepatitis to the lymphocytic cholangitis of primary biliary cirrhosis, and finally the obstructive fibrosing sclerotic cholangiopathy of primary sclerosing cholangitis. Although all autoimmune in origin, they differ in their epidemiology, presentation and response to immunosuppressive therapy and bile acid based treatments. With an ongoing better appreciation of disease aetiology and pathogenesis, treatment is set ultimately to become more rational. We provide an overview of current and future therapies for patients with autoimmune liver disease, with an emphasis placed on some of the evidence that drives current practice. PMID:23634279

  16. Hypertension in pregnancy: natural history and treatment options.

    PubMed

    Foo, L; Tay, J; Lees, C C; McEniery, C M; Wilkinson, I B

    2015-05-01

    Hypertensive disorders of pregnancy affect approximately 5-10 % of all maternities and are major contributors of maternal and neonatal morbidity and mortality worldwide. This group of disorders encompasses chronic hypertension, as well as conditions that arise de novo in pregnancy: gestational hypertension and pre-eclampsia. The latter group is thought to be part of the same continuum but with arbitrary division. Research into the aetiology of hypertension in pregnancy have largely been focused on pre-eclampsia, with a majority of studies exploring either pregnancy-associated factors such as placental-derived or immunologic responses to pregnancy tissue, or maternal constitutional factors such as cardiovascular health and endothelial dysfunction. The evidence base for the pathophysiology and progression of hypertensive disorders in pregnancy, particularly pre-eclampsia, is reviewed. Clinical algorithms and pharmacological agents for the management of hypertension in pregnancy are summarised, with a brief focus on post-partum considerations and long-term health implications. Novel therapeutic options for the management of pre-eclampsia are also explored. PMID:25833457

  17. New treatment options for lupus – a focus on belimumab

    PubMed Central

    Chiche, Laurent; Jourde, Noémie; Thomas, Guillemette; Bardin, Nathalie; Bornet, Charleric; Darque, Albert; Mancini, Julien

    2012-01-01

    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

  18. Combined antiviral options for the treatment of chronic hepatitis C

    Microsoft Academic Search

    Jesús Medina; Luisa Garc??a-Buey; José A. Moreno-Monteagudo; Mar??a Trapero-Marugán; Ricardo Moreno-Otero

    2003-01-01

    In the absence of antiviral treatment, chronic hepatitis C virus (HCV) infection is a liver disease characterized by the development of necroinflammatory changes and progressive liver fibrosis, leading to cirrhosis, end-stage liver disease and hepatocellular carcinoma (HCC). The approval of ribavirin in combination therapy regimens with interferon (IFN) dramatically improved therapy. Another advance was the introduction of pegylated IFNs, which

  19. When indomethacin fails: additional treatment options for "indomethacin responsive headaches".

    PubMed

    Zhu, Shuhan; McGeeney, Brian

    2015-04-01

    Indomethacin has been used for the treatment of headache disorders since the 1960's, shortly after it was introduced as a treatment for pain and joint swelling in rheumatologic conditions. A subgroup of primary headache disorders, often refractory to other pharmacologic treatment such as triptans and the usual non-steroidal anti-inflammatories, was noted to be exquisitely and absolutely responsive to the analgesic effects of indomethacin. These disorders have been better characterized over the past decade and classified into primary headache disorders of paroxysmal hemicrania (PH) and hemicrania continua (HC). Since the current ICHD-3 beta requires response to indomethacin as a diagnostic criterion, studies on alternative treatments in HC and PH generally occur in patients with intolerance to its gastro-intestinal side effects rather than loss of analgesia effectiveness. More rarely, the development of new headaches have been reported in chronic indomethacin use. In these settings, other classes of medications such as selective cyclooxygenase-2 inhibitors (celecoxib), anti-epileptic agents (topiramate), calcium channel blockers (verapamil, flunarizine), melatonin, and local nerve blocks with anesthetic and steroids have been shown to be effective in case reports and series. We review the literature and provide our clinical recommendations on alternative therapies for the "indomethacin-responsive headaches". PMID:25754595

  20. Treatment Option Overview (Paranasal Sinus and Nasal Cavity Cancer)

    MedlinePLUS

    ... large amount of tissue or bone around the paranasal sinuses or nasal cavity is taken out, plastic surgery may be done to repair or rebuild the ... Three types of standard treatment are used: Surgery Surgery ... for all stages of paranasal sinus and nasal cavity cancer. A doctor may remove ...

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

    MedlinePLUS

    ... paranasal sinuses or nasal cavity is taken out, plastic surgery may be done to repair or rebuild the ... Neurologist . Oral surgeon or head and neck surgeon . Plastic ... types of standard treatment are used: Surgery Surgery (removing the cancer in an operation) is ...

  2. Treatment Options for Ovarian Low Malignant Potential Tumors

    MedlinePLUS

    ... epithelial-stromal tumor and stage II borderline ovarian surface epithelial-stromal tumor . For more specific results, refine the search by using other search features, such as the location of the trial, the type of treatment, or the name of the drug. Talk with ...

  3. Treatment Options by Stage (Lip and Oral Cavity Cancer)

    MedlinePLUS

    ... will be felt for swollen lymph nodes . A history of the patient’s health habits and past illnesses and ... oncologist . Dentist . Speech therapist . Dietitian . Psychologist . Rehabilitation specialist . Plastic surgeon . Two types of standard treatment are used: Surgery Surgery (removing the ...

  4. Treatment options for symptomatic carotid stenosis: timing and approach.

    PubMed

    Vavra, Ashley K; Eskandari, Mark K

    2015-02-01

    Stroke is a major cause of morbidity and mortality and up to 15-20% of ischemic strokes can be attributed to atherosclerotic internal carotid artery disease. The treatment of carotid artery disease has been the subject of a wealth of literature in the past twenty years since the publication of the landmark randomized controlled trials, the North American Symptomatic Carotid Endarterectomy Trial and the European Carotid Surgery Trial, in the early 1990s. Although these landmark trials have helped establish the current guidelines for treatment of patients with symptomatic carotid artery disease, there have since been major advancements in the medical treatment of cardiovascular disease and there still remains a great deal of controversy regarding the timing and technical approach to carotid revascularization. In particular, there has been a wealth of literature to determine whether carotid endarterectomy or carotid stenting should be used for revascularization and when this revascularization should occur following onset of symptoms. This update offers an overview of the standards for diagnosis and medical treatment of patients with symptomatic carotid artery disease, the indications for surgical revascularization and a review of the most pertinent literature as it pertains to the more controversial issues of technical approach and timing of surgical revascularization following onset of symptoms in patients with carotid artery disease. PMID:25439169

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

    MedlinePLUS

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

  6. Treatment Option Overview (Childhood Central Nervous System Embryonal Tumors)

    MedlinePLUS

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

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

    PubMed Central

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

    2014-01-01

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

  8. Current treatment options in the management of chronic prostatitis

    PubMed Central

    Duclos, Alain Jean; Lee, Chun-Te; Shoskes, Daniel Arthur

    2007-01-01

    Chronic prostatitis is a disease with an unknown etiology that affects a large number of men. The optimal management for category III chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS) is unknown. The recent years have seen a significant increase in research efforts to understand, classify and treat CP/CPPS. Standard treatment usually consists of prolonged courses of antibiotics, even though well-designed clinical trials have failed to demonstrate their efficacy. Recent treatment strategies with some evidence of efficacy include: alpha-blockers, anti-inflammatory agents, hormonal manipulation, phytotherapy (quercetin, bee pollen), physiotherapy and chronic pain therapy. A stepwise, multimodal approach can be successful for the majority of patients who present with this difficult condition. PMID:18472971

  9. Options for radiotherapy in the treatment of liver metastases.

    PubMed

    Gasent Blesa, Joan Manel; Dawson, Laura A

    2008-10-01

    Technologic advances have provided the means to deliver tumoricidal doses of radiation therapy (RT) to patients with unresectable colorectal liver metastases, while avoiding critical normal tissues, providing the opportunity to use RT for curative intent treatment of metastatic disease. For the current report, the expanded role of RT, with its different techniques in the setting of metastatic colorectal cancer, from palliation to cure was reviewed. PMID:18940744

  10. Current treatment options for depression after mild traumatic brain injury

    Microsoft Academic Search

    Esther Bay

    2009-01-01

    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

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

    SciTech Connect

    Josephson, W.S.

    1995-10-16

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

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

    SciTech Connect

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

    1984-09-01

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

  13. Current and Emerging Treatment Options for Patients with Relapsed Myeloma

    PubMed Central

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

    2013-01-01

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

  14. Emerging pharmacologic treatment options for fragile X syndrome

    PubMed Central

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

    2015-01-01

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

  15. Aneurysmal bone cysts of the spine: treatment options and considerations.

    PubMed

    Boriani, Stefano; Lo, Sheng-fu L; Puvanesarajah, Varun; Fisher, Charles G; Varga, Peter P; Rhines, Laurence D; Germscheid, Niccole M; Luzzati, Alessandro; Chou, Dean; Reynolds, Jeremy J; Williams, Richard P; Zadnik, Patti; Groves, Mari; Sciubba, Daniel M; Bettegowda, Chetan; Gokaslan, Ziya L

    2014-10-01

    Aneurysmal bone cysts (ABCs) are benign bone lesions with annual incidences ranging from 1.4 to 3.2 cases per million people. Approximately, 10-30% of ABCs are found in the spine. Such lesions are traditionally treated with curettage or other intralesional techniques. Because ABCs can be locally aggressive, intralesional resection can be incomplete and result in recurrence. This has led to increased use of novel techniques, including selective arterial embolization (SAE). This study aims to: (1) compare outcomes based on extent of surgical resection, and (2) compare the efficacy of SAE versus surgical resection. Clinical data pertaining to 71 cases of spinal ABCs were ambispectively collected from nine institutions in Europe, North America, and Australia. Twenty-two spinal ABCs were treated with surgery, 32 received preoperative embolization and surgery, and 17 were treated with SAE. Most tumors were classified as Enneking stage 2 (n = 29, 41%) and stage 3 (n = 29, 41%). Local recurrence and survival were investigated and a significant difference was not observed between treatment groups. However, all three local recurrences occurred following surgical resection. Surgical resection was further categorized based on Enneking appropriateness. Recurrences only occurred following intralesional Enneking inappropriate (EI) resections (P = 0.10), a classification that characterized 47% of all surgical resections. Furthermore, 56% of intralesional resections were EI, compared to only 10% of en bloc resections (P = 0.01). Although SAE treatment did not result in any local recurrences, 35% involved more than five embolization procedures. Spinal ABCs can be effectively treated with intralesional resection, en bloc resection, or SAE. Preoperative embolization should be considered before intralesional resection to limit intraoperative bleeding. Treatment plans must be guided by lesion characteristics and clinical presentation. PMID:25059450

  16. Pretubulysin: a new option for the treatment of metastatic cancer.

    PubMed

    Braig, S; Wiedmann, R M; Liebl, J; Singer, M; Kubisch, R; Schreiner, L; Abhari, B A; Wagner, E; Kazmaier, U; Fulda, S; Vollmar, A M

    2014-01-01

    Tubulin-binding agents such as taxol, vincristine or vinblastine are well-established drugs in clinical treatment of metastatic cancer. However, because of their highly complex chemical structures, the synthesis and hence the supply issues are still quite challenging. Here we set on stage pretubulysin, a chemically accessible precursor of tubulysin that was identified as a potent microtubule-binding agent produced by myxobacteria. Although much simpler in chemical structure, pretubulysin abrogates proliferation and long-term survival as well as anchorage-independent growth, and also induces anoikis and apoptosis in invasive tumor cells equally potent to tubulysin. Moreover, pretubulysin posseses in vivo efficacy shown in a chicken chorioallantoic membrane (CAM) model with T24 bladder tumor cells, in a mouse xenograft model using MDA-MB-231 mammary cancer cells and finally in a model of lung metastasis induced by 4T1 mouse breast cancer cells. Pretubulysin induces cell death via the intrinsic apoptosis pathway by abrogating the expression of pivotal antiapoptotic proteins, namely Mcl-1 and Bcl-xL, and shows distinct chemosensitizing properties in combination with TRAIL in two- and three-dimensional cell culture models. Unraveling the underlying signaling pathways provides novel information: pretubulysin induces proteasomal degradation of Mcl-1 by activation of mitogen-activated protein kinase (especially JNK (c-Jun N-terminal kinase)) and phosphorylation of Mcl-1, which is then targeted by the SCF(Fbw7) E3 ubiquitin ligase complex for ubiquitination and degradation. In sum, we designate the microtubule-destabilizing compound pretubulysin as a highly promising novel agent for mono treatment and combinatory treatment of invasive cancer. PMID:24434509

  17. Pretubulysin: a new option for the treatment of metastatic cancer

    PubMed Central

    Braig, S; Wiedmann, R M; Liebl, J; Singer, M; Kubisch, R; Schreiner, L; Abhari, B A; Wagner, E; Kazmaier, U; Fulda, S; Vollmar, A M

    2014-01-01

    Tubulin-binding agents such as taxol, vincristine or vinblastine are well-established drugs in clinical treatment of metastatic cancer. However, because of their highly complex chemical structures, the synthesis and hence the supply issues are still quite challenging. Here we set on stage pretubulysin, a chemically accessible precursor of tubulysin that was identified as a potent microtubule-binding agent produced by myxobacteria. Although much simpler in chemical structure, pretubulysin abrogates proliferation and long-term survival as well as anchorage-independent growth, and also induces anoikis and apoptosis in invasive tumor cells equally potent to tubulysin. Moreover, pretubulysin posseses in vivo efficacy shown in a chicken chorioallantoic membrane (CAM) model with T24 bladder tumor cells, in a mouse xenograft model using MDA-MB-231 mammary cancer cells and finally in a model of lung metastasis induced by 4T1 mouse breast cancer cells. Pretubulysin induces cell death via the intrinsic apoptosis pathway by abrogating the expression of pivotal antiapoptotic proteins, namely Mcl-1 and Bcl-xL, and shows distinct chemosensitizing properties in combination with TRAIL in two- and three-dimensional cell culture models. Unraveling the underlying signaling pathways provides novel information: pretubulysin induces proteasomal degradation of Mcl-1 by activation of mitogen-activated protein kinase (especially JNK (c-Jun N-terminal kinase)) and phosphorylation of Mcl-1, which is then targeted by the SCFFbw7 E3 ubiquitin ligase complex for ubiquitination and degradation. In sum, we designate the microtubule-destabilizing compound pretubulysin as a highly promising novel agent for mono treatment and combinatory treatment of invasive cancer. PMID:24434509

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

    PubMed Central

    Arslan, Cagatay

    2014-01-01

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

  19. Circadian rhythm disorders among adolescents: assessment and treatment options.

    PubMed

    Bartlett, Delwyn J; Biggs, Sarah N; Armstrong, Stuart M

    2013-10-21

    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

  20. Surgical treatment options for patella tendon rupture, part II: chronic.

    PubMed

    Greis, Patrick E; Lahav, Amit; Holmstrom, Michael C

    2005-08-01

    Patella tendon rupture is a debilitating injury that often occurs in the setting of preexisting tendon degeneration. Prompt diagnosis and treatment is essential to prevent retraction of the patella with subsequent adhesions and quadriceps contractures. In the setting of a chronic rupture, augmentation with hamstring tendons or allograft reconstruction generally is necessary. Patients who undergo delayed repair are at risk for a compromised result secondary to loss of full knee flexion and decreased quadriceps strength, although a functional extensor mechanism is likely to be reestablished. Overall the results of chronic repair are less satisfactory than the acute repair, but still provide an extensor mechanism for the patient and thus provide function. PMID:16119741

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

    PubMed

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

    2015-05-01

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

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

    PubMed Central

    Lindahl, Sarah H

    2014-01-01

    Background Vaginal atrophy is a chronic condition with symptoms that include vaginal dryness, pain during sex, itching, irritation, burning, and discharge, as well as various urinary problems. Up to 45% of postmenopausal women may be affected, but it often remains underreported and undertreated. This article aims to review the current recommendations for treatment of vaginal atrophy, and current data on the effectiveness and safety of local vaginal estrogen therapies. Methods Literature regarding vaginal atrophy (2007–2012) was retrieved from PubMed and summarized, with emphasis on data related to the treatment of vaginal atrophy with local vaginal estrogen therapy. Results Published data support the effectiveness and endometrial safety of low-dose local estrogen therapies. These results further support the general recommendation by the North American Menopause Society that a progestogen is not needed for endometrial protection in patients using low-dose local vaginal estrogen. Benefits of long-term therapy for vaginal atrophy include sustained relief of symptoms as well as physiological improvements (eg, decreased vaginal pH and increased blood flow, epithelial thickness, secretions). Conclusion Currently available local vaginal estrogen therapies are well tolerated and effective in relieving symptoms of vaginal atrophy. Recent data support the endometrial safety of low-dose regimens for up to 1 year. PMID:24648775

  3. [Contemporary options and perspectives in the treatment of acromegaly].

    PubMed

    Marek, Josef

    2014-01-01

    Acromegaly, if untreated, leads to numerous complications and premature death of patients. In recent years, significant changes in the treatment of acromegaly were achieved. The surgical approach was innovated, what allows completely selective removal of most microadenomas without any damage of the pituitary and safe debulking of the tumor mass in macroadenomas. Radiosurgery took the first place among irradiation methods, in our conditions it is the irradiation by the Leksell gamma knife. It allows selective irradiation of an adenoma without damaging the surrounding tissue. However, its effect on the secretory activity of the adenoma remains to be long lasting. Before this effect is attained, it is necessary to suppress the secretory activity pharmacologically. The infrequently effective, but economically advantageous and comfortable for patients is cabergoline, which is administered in tablet form. If cabergolin is not efficient, depot injections of somatostatin analogues - octreotide LAR and lanreotide autogel or their combination with cabergoline are used. The most efficient but financially costly is pegvisomant, blocking the receptors for growth hormone. In our conditions it is reserved for patients unresponsive to other treatments. With sufficient dosage it is possible to normalize hormonal activity of acromegly in 95 % of patients. New forms of the drugs as octreotide implants, oral octreotide octreolin or a new blocker of growth hormone receptors ATL-1103 are in the development. PMID:24968290

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

    SciTech Connect

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

    2012-03-01

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

  5. Incontinence-associated dermatitis in the elderly: treatment options.

    PubMed

    Corcoran, Eleanor; Woodward, Sue

    Incontinence-associated dermatitis (IAD) is a common problem in older people. However, it is frequently misdiagnosed and poorly treated. There is often uncertainty about which product to use to prevent and treat IAD; the different types, brands and how to apply them. This literature review looks specifically at the use of barrier products in the prevention and treatment of IAD. A systematic search found six primary research papers that analysed the effectiveness of various barrier products; they will be compared and contrasted in this review. There is a lack of evidence to recommend any one barrier product over another for use in a standardised skin care protocol such as the regimen suggested by Gray et al (2012). More research needs to be conducted to establish the most effective barrier products on the market. More research is also needed on the efficacy of barrier products in the prevention and treatment solely of IAD rather than combined studies looking at IAD with pressure ulcers. PMID:23905225

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

    Microsoft Academic Search

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

    2009-01-01

    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

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

    PubMed

    Salhofer-Polanyi, S; Leutmezer, F

    2014-05-01

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

  8. Surgical treatment options for patella tendon rupture, Part I: Acute.

    PubMed

    Greis, Patrick E; Holmstrom, Michael C; Lahav, Amit

    2005-07-01

    Patella tendon rupture is a debilitating injury. Prompt diagnosis and treatment is essential to prevent retraction of the patella with subsequent adhesions and quadriceps contractures. In a young patient with an acute rupture, primary repair usually is possible with various methods described to protect the repair. In acute injuries with inadequate tissue, augmentation with hamstring tendons or allograft generally is necessary. Because of the different types of rupture and the possibility for poor quality tissue, the surgeon should always be prepared to combine different techniques to obtain tthe best repair. Continuous passive motion generally can be initiated early with a secure repair. In patients with a patella tendon ruptured that is promptly diagnosed, securely repaired, and followed closely through their rehabilitation, good results can be expected. PMID:16119282

  9. Subacute sclerosing panencephalitis : diagnosis and drug treatment options.

    PubMed

    Anlar, B

    1997-02-01

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

  10. Treatment Options: Biological Basis of Regenerative Endodontic Procedures

    PubMed Central

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

    2013-01-01

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

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

    PubMed Central

    Camilleri, Michael

    2011-01-01

    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

  12. Evaluation of treatment options for mercury/PCB contaminated soil

    SciTech Connect

    Camacho, J.M. [EPA/Environmental Response Team Center, Edison, NJ (United States); Tobia, R.J. [Roy F. Weston, Inc./REAC, Edison, NJ (United States); Peronard, P. [EPA/Region IV, Atlanta, GA (United States)

    1996-12-31

    The purpose of this project was to evaluate treatment alternatives for soil contaminated with mercury and polychlorinated biphenyl (PCB) aroclor 1268 at the LCP site, a former chlor-alkali plant, in Brunswick, GA. The site was operated as a petroleum refinery from 1919 to 1930. Based on past experience and a literature search, soil washing and thermal desorption were deemed to be the most promising technologies. A bulk soil sample was collected from the south process area and analyzed to have 190 mg/kg mercury and 405 mg/kg of PCB aroclor 1268. The soil was screened to {1/4} treatability tests. Testing was performed in three parts consisting of a round of geophysical and chemical analyses to determine matrix characteristics; thermal desorption tests at temperatures ranging from 100 C to 700 C to determine the volatility of mercury and PCB aroclor 1268; and a soil-washing study matrix to evaluate the effect of chemical additives such as acids, oxidizers, and surfactants to physically and chemically remove contaminants from the soil matrix.

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

    SciTech Connect

    Lee, Hom-Ti [Oak Ridge Associated Universities, Inc., TN (United States); Bostick, W.D. [Oak Ridge K-25 Site, TN (United States)

    1996-04-01

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

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

    PubMed Central

    Kim, Won; Kim, Dong Joon

    2014-01-01

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

  15. Targeting metastatic colorectal cancer – present and emerging treatment options

    PubMed Central

    Ciombor, Kristen K; Berlin, Jordan

    2014-01-01

    Metastatic colorectal cancer is a significant cause of morbidity and mortality in the US and around the world. While several novel cytotoxic and biologic therapies have been developed and proven efficacious in the past two decades, their optimal use in terms of patient selection, drug combinations, and regimen sequences has yet to be defined. Recent investigations regarding anti-epidermal growth factor receptor therapies include the comparison of single-agent panitumumab and cetuximab, the benefit of adding cetuximab to chemotherapy in the conversion therapy setting, the comparison of cetuximab and bevacizumab when added to first-line chemotherapy, and predictive biomarkers beyond KRAS exon 2 (codons 12 and 13) mutations. With respect to anti-vascular endothelial growth factor therapies, new data on continuing bevacizumab beyond disease progression on a bevacizumab-containing chemotherapy regimen, the addition of bevacizumab to triplet chemotherapy in the first-line setting, maintenance therapy with bevacizumab plus either capecitabine or erlotinib, the addition of aflibercept to chemotherapy, and regorafenib as monotherapy have emerged. Recent scientific and technologic advances in the field of metastatic colorectal cancer promise to elucidate the biological underpinnings of this disease and its therapies for the goal of improving personalized treatments for patients with metastatic colorectal cancer. PMID:25045279

  16. Ebola virus: Melatonin as a readily available treatment option.

    PubMed

    Anderson, George; Maes, Michael; Markus, Regina P; Rodriguez, Moses

    2015-04-01

    There is currently an urgent need for a viable, cheap, and readily available treatment for the Ebola virus outbreak in West Africa. Here, it is proposed that melatonin may have significant utility in helping the management of this outbreak. Optimizing natural killer (NK) cell responses seems crucial to surviving Ebola virus infection. Melatonin increases NK cell cytotoxicity significantly, suggesting efficacy in managing the Ebola virus. Under conditions of challenge, melatonin increases heme oxygenase-1 (HO-1), which inhibits Ebola virus replication. Melatonin also has protective effects in cases of septic shock, which, although bacterial, has similar end-point presentations involving blood vessel leakage. Melatonin's effects on haemorrhage are mediated primarily by a decrease in pro-inflammatory cytokines. By optimizing the appropriate immune response, melatonin is likely to afford protection to those at high risk of Ebola viral infection, as well as having direct impacts on the course of infection per se. Although no direct data pertain to the utility of melatonin in the management of the Ebola virus, convergent bodies of data suggest its utility, which is reviewed in this article. J. Med. Virol. 87:537-543, 2015. © 2015 Wiley Periodicals, Inc. PMID:25611054

  17. Distal biceps tendon injuries--current treatment options.

    PubMed

    Quach, Tony; Jazayeri, Reza; Sherman, Orrin H; Rosen, Jeffrey E

    2010-01-01

    Three percent of all biceps tendon ruptures occur at the distal aspect, where the tendon inserts into the radial tuberosity. Distal bicep tendon ruptures typically occur in middle-aged males after an eccentric extension load is applied to the elbow. Patients usually complain of a sudden, sharp, and painful tearing sensation in the antecubital region, with a palpable defect. The biceps squeeze and hook tests are specific maneuvers by which to diagnose distal biceps ruptures on physical examination. Magnetic resonance imaging (MRI) or ultrasound maybe be helpful to distinguish between partial and complete tears. Anatomic studies suggest there are two distinct insertions for the short and long heads of the distal biceps. The short head may be a more powerful flexor, and the long head may be a more powerful supinator. Nonoperative treatment typically results in loss of flexion and supination strength and endurance. Early anatomic re-attachment is the goal. Surgical approaches include one- or two-incision techniques, and tendon fixation methods include the use of suture anchors, bone tunnels, an endobutton, or biotenodesis screws. Biomechanical studies have shown that endobuttons have higher load-to-failure strengths, compared to the other fixation methods. However, clinical studies have demonstrated that patients do well regardless of surgical approach or fixation method. Possible complications include nerve injuries, heterotopic ossification, postoperative fracture, tendon rerupture, complex regional pain syndrome, and wound infection. Partial ruptures are significantly less common and initially can be treated conservatively. Chronic tears are more difficult to treat because of possible tendon retraction and poor tissue quality. Tendon grafts using semitendinosus, fascia lata, hamstring, Achilles (calcaneal), or flexor carpi radialis have been successfully used for length restoration in these cases. PMID:20632985

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

    PubMed Central

    Shrivastava, Alankar; Gupta, Vipin B.

    2012-01-01

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

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

    PubMed

    Shrivastava, Alankar; Gupta, Vipin B

    2012-01-01

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

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

    PubMed Central

    2014-01-01

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

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

    PubMed

    Al-Quliti, Khalid W

    2015-04-01

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

  2. Reactions of younger and older women to physicians' styles of presentation of breast cancer treatment options

    Microsoft Academic Search

    M. N. Butler; B. J. Hailey

    1996-01-01

    Women (n = 74) over the age of 40 viewed a videotape presentation in small group settings. There were four versions of the videotape; the version chosen to be shown to each group was determined randomly. Each videotape depicted the same actor, playing the role of physician who was presenting treatment options to a patient who had just been diagnosed

  3. Autosomal Dominant Polycystic Kidney Disease: New Treatment Options and How to Test Their Efficacy

    Microsoft Academic Search

    Rudolf P. Wüthrich; Andreas L. Serra; Andreas D. Kistler

    2009-01-01

    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

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

    Microsoft Academic Search

    BASIT JAVAID; Richard J. Quigg

    2005-01-01

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

  5. The efficacy and tolerability of pharmacologic treatment options for Lennox-Gastaut syndrome.

    PubMed

    Montouris, Georgia D; Wheless, James W; Glauser, Tracy A

    2014-09-01

    Lennox-Gastaut syndrome (LGS) is a severe epileptic encephalopathy that appears in childhood. LGS is characterized by a slow spike-wave pattern on electroencephalogram (EEG), cognitive impairment, and multiple seizure types. This mixture of seizure types, along with the need to use more than one type of medication, makes LGS one of the most complicated epilepsies to treat successfully. Recent developments in approved therapies for the treatment of LGS offer physicians more options, but also make developing a treatment strategy that minimizes adverse events more challenging. There are currently 5 treatment options for LGS: felbamate, lamotrigine, topiramate, rufinamide, and clobazam, and several others that are used off-label, each of which has benefits and limitations. There are several factors that must be considered when determining which medication to use when treating patients with LGS, including efficacy, which is assessed by seizure frequency, tolerability, and the anticipated duration of treatment. In this article, data supporting current treatment options are discussed, and important considerations about the treatment of LGS are reviewed. PMID:25284033

  6. New treatment option for an incomplete vertical root fracture--a preliminary case report.

    PubMed

    Hadrossek, Paul Henryk; Dammaschke, Till

    2014-01-01

    Instead of extraction this case report presents an alternative treatment option for a maxillary incisor with a vertical root fracture (VRF) causing pain in a 78-year-old patient. After retreatment of the existing root canal filling the tooth was stabilized with a dentine adhesive and a composite restoration. Then the tooth was extracted, the VRF gap enlarged with a small diamond bur and the existing retrograde root canal filling removed. The enlarged fracture line and the retrograde preparation were filled with a calcium-silicate-cement (Biodentine). Afterwards the tooth was replanted and a titanium trauma splint was applied for 12d. A 24 months clinical and radiological follow-up showed an asymptomatic tooth, reduction of the periodontal probing depths from 7 mm prior to treatment to 3 mm and gingival reattachment in the area of the fracture with no sign of ankylosis. Hence, the treatment of VRF with Biodentine seems to be a possible and promising option. PMID:24670232

  7. New treatment option for an incomplete vertical root fracture–a preliminary case report

    PubMed Central

    2014-01-01

    Instead of extraction this case report presents an alternative treatment option for a maxillary incisor with a vertical root fracture (VRF) causing pain in a 78-year-old patient. After retreatment of the existing root canal filling the tooth was stabilized with a dentine adhesive and a composite restoration. Then the tooth was extracted, the VRF gap enlarged with a small diamond bur and the existing retrograde root canal filling removed. The enlarged fracture line and the retrograde preparation were filled with a calcium-silicate-cement (Biodentine). Afterwards the tooth was replanted and a titanium trauma splint was applied for 12d. A 24 months clinical and radiological follow-up showed an asymptomatic tooth, reduction of the periodontal probing depths from 7 mm prior to treatment to 3 mm and gingival reattachment in the area of the fracture with no sign of ankylosis. Hence, the treatment of VRF with Biodentine seems to be a possible and promising option. PMID:24670232

  8. Current options and future possibilities for the treatment of dyskinesia and motor fluctuations in Parkinson's disease.

    PubMed

    Cenci, M A; Ohlin, K E; Odin, P

    2011-09-01

    Dyskinesia and motor fluctuations affect up to 90% of patients with Parkinson's disease (PD) within ten years of L-DOPA pharmacotherapy, and represent a major challenge to a successful clinical management of this disorder. There are currently two main treatment options for these complications, namely, deep brain electrical stimulation or continuous infusion of dopaminergic agents. The latter is achieved using either subcutaneous apomorphine infusion or enteric L-DOPA delivery. Some patients also benefit from the antidyskinetic effect of amantadine as an adjunct to L-DOPA treatment. Ongoing research in animal models of PD aims at discovering additional, novel treatment options that can either prevent or reverse dyskinesia and motor fluctuations. Alternative methods of continuous L-DOPA delivery (including gene therapy), and pharmacological agents that target nondopaminergic receptor systems are currently under intense experimental scrutiny. Because clinical response profiles show large individual variation in PD, an increased number of treatment options for dyskinesia and motor fluctuations will eventually allow for antiparkinsonian and antidyskinetic therapies to be tailor-made to the needs of different patients and/or PD subtypes. PMID:21838677

  9. Severe pulmonary arterial hypertension: treatment options and the bridge to transplantation.

    PubMed

    Corris, Paul; Degano, Bruno

    2014-12-01

    Pulmonary arterial hypertension (PAH) is a rare disease leading to right heart failure and death. Prognosis remains poor, particularly for patients with severe disease, i.e. World Health Organization functional class IV. There have been significant improvements in treatment options. Several agents are available that target the three main established PAH disease pathways, and can be combined sequentially or upfront. Strong scientific evidence supports the use of intravenous epoprostenol in severe PAH; however, despite recommendations, many patients do not receive parenteral prostanoids and there is a lack of evidence from randomised clinical trials supporting the value of other PAH medications alone in severe PAH. Lung transplantation is an important option in patients with severe PAH who have not responded sufficiently to therapy, or who have worsened despite maximal treatment. Bridging techniques are available for patients who worsen while awaiting transplantation. The type of bridging technique used depends on various factors including patient illness severity, physician experience and the anticipated waiting time for transplantation. With the aim to facilitate the treatment decision-making process, herein we review the medical treatment options available for patients with severe PAH, and the bridging techniques that may be used to sustain patients awaiting transplantation. PMID:25445947

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

    PubMed

    Bogunovic, Ljiljana; Matava, Matthew J

    2013-11-01

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

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

    PubMed

    Tempark, Therdpong; Shwayder, Tor A

    2014-04-01

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

  12. Cutaneous smooth muscle neoplasms: Clinical features, histologic findings, and treatment options

    Microsoft Academic Search

    Valerie A. Holst; Jacqueline M. Junkins-Hopkins; Rosalie Elenitsas

    2002-01-01

    Cutaneous smooth muscle is present in 3 separate locations: arrector pili muscles, blood vessel walls, and genital\\/areolar skin. Benign or malignant smooth muscle neoplasms may arise from each of these locations. This review discusses the pathogenesis, clinical manifestations, histologic findings, prognosis, treatment options, and controversial areas of cutaneous smooth muscle neoplasms. ( J Am Acad Dermatol 2002;46:477-90.) Learning objective: At

  13. Fenton oxidation: A pretreatment option for improved biological treatment of pyridine and 3-cyanopyridine plant wastewater

    Microsoft Academic Search

    K. V. Padoley; S. N. Mudliar; S. K. Banerjee; S. C. Deshmukh; R. A. Pandey

    2011-01-01

    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

  14. Study identifies highly effective treatment option for patients with HER2-positive breast cancer

    Cancer.gov

    Combining the chemotherapy drugs docetaxel and carboplatin with the HER2-targeted therapy trastuzumab was identified to be an ideal postsurgery treatment option for patients with HER2-positive breast cancer, regardless of tumor size and whether or not disease has spread to the lymph nodes, according to results from the BETH study (led by researchers from the UCLA Jonsson Comprehensive Cancer Center) presented at the 2013 San Antonio Breast Cancer Symposium, held Dec. 10-14.

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

    PubMed Central

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

    2014-01-01

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

  16. Radium-223 chloride: a new treatment option for metastatic castration-resistant prostate carcinoma.

    PubMed

    Pinto, Alvaro; Cruz, Patricia

    2012-12-01

    In the last few years, the treatment of castration-resistant prostate carcinoma (CRPC) has changed completely. The approval of docetaxel and subsequent investigation in this field have led to development of new agents that have demonstrated an improvement in overall survival in the post-docetaxel setting, such as cabazitaxel and abiraterone. Radium-223 chloride is a radioisotope that has recently shown efficacy after docetaxel and in patients unfit for docetaxel, with improvements in overall survival and the time to the first skeletal-related event, compared with placebo, without increasing toxicity. These findings have made this agent a new option for treatment of these patients in the near future. PMID:23190319

  17. Management of localized and locally advanced renal tumors. A contemporary review of current treatment options.

    PubMed

    Brookman-May, S; Langenhuijsen, J F; Volpe, A; Minervini, A; Joniau, S; Salagierski, M; Roscigno, M; Akdogan, B; Vandromme, A; Rodriguez-Faba, O; Marszalek, M

    2013-06-01

    About 70% of patients with renal cell carcinoma present with localized or locally advanced disease at primary diagnosis. Whereas these patients are potentially curable by surgical treatment alone, a further 20% to 30% of patients are diagnosed with primary metastatic disease. Although over the past years medical treatment for metastatic patients has nearly completely changed from immunotherapy to effective treatment with targeted agents, metastatic disease still represents a disease status which is not curable. Also in patients with metastatic disease, surgical treatment of the primary tumor plays an important role, since local tumor related complications can be avoided or minimized by surgery. Furthermore, also improvement of overall survival has been proven for surgery in metastatic patients when combined with cytokine treatment. Hence, surgical combined with systemic treatment as a multi-modal, adjuvant, and neo-adjuvant treatment is also required in patients with advanced or metastatic disease. A growing number of elderly and comorbid patients are currently diagnosed with small renal masses, which has led to increased attention paid to alternative ablative treatment modalities as well as active surveillance strategies, which are applied in order to avoid unnecessary overtreatment in these patients. Since surgical treatment also might enhance the risk of chronic kidney disease with consecutive cardiac disorders as well as reduced overall survival, ablative techniques and active surveillance are increasingly applied. In this review article we focus on current surgical and none-surgical treatment options for the management of patients with localized, locally advanced, and metastatic renal cell carcinoma. PMID:23748279

  18. Surgical treatment of trapeziometacarpal joint osteoarthritis

    PubMed Central

    TACCARDO, GIUSEPPE; DE VITIS, ROCCO; PARRONE, GIUSEPPE; MILANO, GIUSEPPE; FANFANI, FRANCESCO

    2013-01-01

    Trapeziometacarpal joint osteoarthritis is a common cause of radial-sided wrist pain that prevalently affects women. It is diagnosed on the basis of a thorough history, physical examination, and radiographic evaluation. While radiographs are used to determine the stage of disease, treatment is dependent on the severity of the symptoms. Non-surgical treatment frequently consists of activity modification, non-steroidal anti-inflammatory drugs, splinting and corticosteroid injections. After failure of conservative treatment, various surgical options exist depending on the stage of the disease. These options range from ligament reconstruction or osteotomy, for early painful laxity, to trapeziectomy, arthrodesis and arthroplasty for more severe osteoarthritis. This article reviews the literature supporting the various surgical treatment options and analyzes the surgical techniques most frequently used in the different disease stages. PMID:25606524

  19. Lopinavir shows greater specificity than zinc finger ejecting compounds as a potential treatment for human papillomavirus-related lesions

    Microsoft Academic Search

    Ingeborg Zehbe; Christina Richard; Kyle F. Lee; Michael Campbell; Lynne Hampson; Ian N. Hampson

    2011-01-01

    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

  20. Immune reconstitution inflammatory syndrome (IRIS): review of common infectious manifestations and treatment options

    PubMed Central

    Murdoch, David M; Venter, Willem DF; Van Rie, Annelies; Feldman, Charles

    2007-01-01

    The immune reconstitution inflammatory syndrome (IRIS) in HIV-infected patients initiating antiretroviral therapy (ART) results from restored immunity to specific infectious or non-infectious antigens. A paradoxical clinical worsening of a known condition or the appearance of a new condition after initiating therapy characterizes the syndrome. Potential mechanisms for the syndrome include a partial recovery of the immune system or exuberant host immunological responses to antigenic stimuli. The overall incidence of IRIS is unknown, but is dependent on the population studied and its underlying opportunistic infectious burden. The infectious pathogens most frequently implicated in the syndrome are mycobacteria, varicella zoster, herpesviruses, and cytomegalovirus (CMV). No single treatment option exists and depends on the underlying infectious agent and its clinical presentation. Prospective cohort studies addressing the optimal screening and treatment of opportunistic infections in patients eligible for ART are currently being conducted. These studies will provide evidence for the development of treatment guidelines in order to reduce the burden of IRIS. We review the available literature on the pathogenesis and epidemiology of IRIS, and present treatment options for the more common infectious manifestations of this diverse syndrome and for manifestations associated with a high morbidity. PMID:17488505

  1. Update of the management of chronic psoriasis: new approaches and emerging treatment options

    PubMed Central

    Laws, Philip M; Young, Helen S

    2010-01-01

    Psoriasis is a common, chronic inflammatory skin disease which is associated with a number of significant co-morbidities including: impairment of quality of life; cardiovascular disease; and a seronegative arthritis known as psoriatic arthritis. Our understanding of the pathogenesis of psoriasis has developed at a remarkable rate in recent years. These new insights have significantly changed our perception of the condition and have led to the development of several new treatment strategies. Biological agents have proved a major step forward in therapeutic options for psoriasis. The ability to clear, or almost clear, cutaneous disease has changed the outcomes and expectations of many patients with this disease. The impact on both physical and psychological health may be great. This review covers the clinical features and management of psoriasis with specific reference to new therapeutic options. PMID:21437057

  2. Four-year follow-up of surgical versus non-surgical therapy for chronic low back pain

    PubMed Central

    Brox, Jens Ivar; Nygaard, Øystein P; Holm, Inger; Keller, Anne; Ingebrigtsen, Tor; Reikerås, Olav

    2010-01-01

    Objectives To compare the long-term effectiveness of surgical and non-surgical treatment in patients with chronic low back pain. Methods Two merged randomised clinical trials compared instrumented transpedicular fusion with cognitive intervention and exercises in 124 patients with disc degeneration and at least 1 year of symptoms after or without previous surgery for disc herniation. The main outcome measure was the Oswestry disability index. Results At 4 years 14 (24%) patients randomly assigned to cognitive intervention and exercises had also undergone surgery. 15 (23%) patients assigned fusion had undergone re-surgery. The mean treatment effect for the primary outcome was 1.1; 95% CI ?5.9 to 8.2, according to the intention-to-treat analysis and ?1.6; 95% CI ?8.9 to 5.6 in the as-treated analysis. There was no difference in return to work. Conclusions Long-term improvement was not better after instrumented transpedicular fusion compared with cognitive intervention and exercises. PMID:19635718

  3. A review of treatment options for co-occurring methamphetamine use disorders and depression.

    PubMed

    Hellem, Tracy L; Lundberg, Kelly J; Renshaw, Perry F

    2015-01-01

    Co-occurring methamphetamine use and depression interferes with treatment outcomes. Female methamphetamine users are known to have higher rates of depression than male methamphetamine users, although this is also true for the general population. There are limited treatment options for the management of depression among methamphetamine users. In this integrative review, we summarize data on treatment strategies for co-occurring depression and methamphetamine use disorders. English-language articles were identified from PsychINFO, CINAHL, PubMed, and Medline as well as from reference lists of key articles. Search terms included "methamphetamine," "depression," and "treatment." Research articles describing psychological (n = 3), pharmacological (n = 6), nutritional supplement (n = 1), and psychological combined with pharmacological (n = 3) approaches for the treatment of methamphetamine use or withdrawal and/or depression are included in this review. Psychological and combination of psychological with pharmacological approaches have not been shown to be effective in treating these co-occurring conditions. Antidepressants have been determined to be ineffective and/or to introduce side effects. Gender differences with response to treatment were examined in only one of the published studies. There is a large gap in knowledge regarding treatment of co-occurring methamphetamine use disorders and depression. Considering that female methamphetamine users experience higher rates of depression than men, a focus on gender-specific treatment approaches is warranted. PMID:25761159

  4. Comparison of treatment options for removal of recalcitrant dissolved organic matter from paper mill effluent.

    PubMed

    Ciputra, Sandra; Antony, Alice; Phillips, Ross; Richardson, Des; Leslie, Greg

    2010-09-01

    Recycling paper mill effluent by conventional water treatment is difficult due to the persistence of salt and recalcitrant organics. Elimination of dissolved organic matter (DOM) from paper mill effluent was studied using three treatment options, ion exchange resin (IER), granular activated carbon (GAC) and nanofiltration (NF). The removal efficiency was analysed based on hydrophobicity, molecular weight and fluorogenic origin of the DOM fractions. For IER, GAC and NF treatments, overall removal of dissolved organic carbon was 72%, 76% and 91%, respectively. Based on the hydrophobicity, all the three treatment methods majorly removed hydrophobic acid fractions (HPhoA). Further, IER acted on all fractions, 57% of HPhoA, 44% of transphilic acid and 18% of hydrophilics, substantiating that the removal is by both ion exchange and adsorption. Based on the molecular weight, IER and GAC treatments acted majorly on the high molecular weight fractions, whereas NF eliminated all molecular weight fractions. After GAC adsorption, some amount of humic hydrolysates and low molecular weight neutrals persisted in the effluent. After IER treatment, amount of low molecular weight compounds increased due to resin leaching. Qualitative analysis of fluorescence excitation emission matrices showed that the fulvic acid-like fluorophores were more recalcitrant among the various DOM fractions, considerable amount persisted after all the three treatment methods. Three treatment methods considerably differed in terms of removing different DOM fractions; however, a broad-spectrum process like NF would be needed to achieve the maximum elimination. PMID:20630562

  5. Eating Disorders and Disordered Eating in Type 1 Diabetes: Prevalence, Screening, and Treatment Options

    PubMed Central

    Hanlan, Margo E.; Griffith, Julie; Patel, Niral

    2013-01-01

    This review is focused on the prevalence of eating disorders and disordered eating behaviors in individuals with type 1 diabetes. Recent research indicates higher prevalence rates of eating disorders among people with type 1 diabetes, as compared to their peers without diabetes. Eating disorders and disordered eating behaviors – especially insulin omission – are associated with poorer glycemic control and serious risk for increased morbidity and mortality. Screening should begin in pre-adolescence and continue through early adulthood, as many disordered eating behaviors begin during the transition to adolescence and may persist for years. Available screening tools and treatment options are reviewed. Given the complexity of diabetes management in combination with eating disorder treatment, it is imperative to screen early and often, in order to identify those most vulnerable and begin appropriate treatment in a timely manner. PMID:24022608

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

    PubMed

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

    2014-05-01

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

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

    PubMed

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

    2014-02-01

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

  8. Treatment options for renal cell carcinoma in renal allografts: a case series from a single institution.

    PubMed

    Swords, Darden C; Al-Geizawi, Samer M; Farney, Alan C; Rogers, Jeffrey; Burkart, John M; Assimos, Dean G; Stratta, Robert J

    2013-01-01

    Renal cell carcinoma (RCC) is more common in renal transplant and dialysis patients than the general population. However, RCC in transplanted kidneys is rare, and treatment has previously consisted of nephrectomy with a return to dialysis. There has been recent interest in nephron-sparing procedures as a treatment option for RCC in allograft kidneys in an effort to retain allograft function. Four patients with RCC in allograft kidneys were treated with nephrectomy, partial nephrectomy, or radiofrequency ablation. All of the patients are without evidence of recurrence of RCC after treatment. We found nephron-sparing procedures to be reasonable initial options in managing incidental RCCs diagnosed in functioning allografts to maintain an improved quality of life and avoid immediate dialysis compared with radical nephrectomy of a functioning allograft. However, in non-functioning renal allografts, radical nephrectomy may allow for a higher chance of cure without the loss of transplant function. Consequently, radical nephrectomy should be utilized whenever the allograft is non-functioning and the patient's surgical risk is not prohibitive. PMID:23419131

  9. Generalized Aggressive Periodontitis and Its Treatment Options: Case Reports and Review of the Literature

    PubMed Central

    Roshna, T.; Nandakumar, K.

    2012-01-01

    Generalized aggressive periodontitis results in rapid destruction of the periodontium and can lead to early tooth loss in the affected individuals if not diagnosed early and treated appropriately. The diagnostic features of the disease are characteristic, but the clinical presentation and patterns of destructions may vary between patients. Successful management of the disease is challenging especially if diagnosed at advanced stages of the disease, but not impossible with the current therapeutic choices for the disease. A vast array of treatment modalities is available which can be employed in the treatment of generalized aggressive periodontitis with varying success rates, but a definite guideline for the management is yet to be formulated. However, with the exponential rate of developments in periodontal research, regenerative therapy, tissue engineering, and genetic technologies, the future seems promising in regard to options at managing the disease. This paper attempts to describe the clinical and radiographic diagnostic features and the current treatment options along with a suggested protocol for comprehensive management of generalized aggressive periodontitis patients with case reports and a brief review. PMID:22291715

  10. Evolution of the treatment options of ulnar collateral ligament injuries of the elbow

    PubMed Central

    Langer, P; Fadale, P; Hulstyn, M

    2006-01-01

    Ulnar collateral ligament (UCL) insufficiency is potentially a career threatening, or even a career ending, injury, particularly in overhead throwing athletes. The evolution of treating modalities provides afflicted athletes with the opportunity to avoid premature retirement. There have been several clinical and basic science research efforts which have investigated the pathophysiology of UCL disruption, the biomechanics specific to overhead throwing, and the various types of treatment modalities. UCL reconstruction is currently the most commonly performed surgical treatment option. An in depth analysis of the present treatment options, both non?operative and operative, as well as their respective results and biomechanical evaluation, is lacking in the literature to date. This article provides a comprehensive current review and comparative analysis of these modalities. Over the last 30 years there has been an evolution of the original UCL reconstruction. Yet, despite the variability in modifications, such as the docking technique, interference screw fixation, and use of suture anchors, the unifying concepts of UCL reconstruction are that decreased dissection of the flexor?pronator mass and decreased handling of the ulnar nerve leads to improved outcomes. PMID:16488902

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

    PubMed

    Tayyeba, Omid; Olsson, Monika; Brandt, Nils

    2011-08-01

    The grave concern over climate change and new economic incentives such as the clean development mechanism (CDM) have given more weight to the potential of projects for reducing greenhouse gas (GHG) emissions. In the Adjara solid waste management project, even though the need for reductions in GHG emissions is acknowledged, it is not one of the key factors for selecting the most appropriate treatment method. This study addresses the benefit of various solid waste treatment methods that could be used in the Adjara project in terms of reducing GHG emissions. Seven different options for solid waste treatment are examined: open dumping as the baseline case, four options for landfill technology (no provision of landfill gas capture, landfill gas capture with open flare system, with enclosed flare system and with electricity generation), composting and anaerobic digestion with electricity production. CDM methodologies were used to quantify the amount of reductions for the scenarios. The study concludes sanitary landfill with capture and burning of landfill gas by an enclosed flare system could satisfy the requirements, including GHG reduction potential. The findings were tested for uncertainty and sensitivity by varying the data on composition and amount of waste and were found to be robust. PMID:21382876

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

    PubMed

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

    2014-02-01

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

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

    PubMed Central

    Shih, David Q.; Kwan, Lola Y.

    2010-01-01

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

  14. Treatment of midportion Achilles tendinopathy: an evidence-based overview.

    PubMed

    Zwiers, Ruben; Wiegerinck, Johannes I; van Dijk, C Niek

    2014-11-01

    In Achilles tendinopathy, differentiation should be made between paratendinopathy, insertional- and midportion Achilles tendinopathy. Midportion Achilles tendinopathy is clinically characterized by a combination of pain and swelling at the affected site, with impaired performance as an important consequence. The treatment of midportion Achilles tendinopathy contains both non-surgical and surgical options. Eccentric exercise has shown to be an effective treatment modality. Promising results are demonstrated for extracorporeal shockwave therapy. In terms of the surgical treatment of midportion Achilles tendinopathy, no definite recommendations can be made. LEVEL OF EVIDENCE: IV. PMID:25366192

  15. 26 CFR 1.1504-4 - Treatment of warrants, options, convertible obligations, and other similar interests.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ...parties. (B) Cash settlement options, phantom stock, stock appreciation rights, or...interests. If a cash settlement option, phantom stock, stock appreciation right...and (ii) A cash settlement option, phantom stock, stock appreciation right,...

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

    PubMed Central

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

    2014-01-01

    Background Although posttraumatic stress disorder (PTSD) and alcohol use disorders (AUD) frequently co-occur there are no specific treatments for individuals diagnosed with these comorbid conditions. The main objectives of this paper are to review the literature on pharmacological options for PTSD and comorbid AUD, and to summarize promising behavioral and alternative interventions for those with these dual diagnoses. Methods We conducted a comprehensive search on PsycINFO and MEDLINE/PubMed databases using Medical Subject Headings terms in various combinations to identify articles that used pharmacotherapy for individuals with dual diagnoses of PTSD and AUD. Similar strategies were used to identify articles on behavioral and alternative treatments for AUD and PTSD. We identified and reviewed six studies that tested pharmacological treatments for patients with PTSD and comorbid AUD. Results The literature on treatment with US Food and Drug Administration approved medications for patients with dual diagnosis of PTSD and AUD is very limited and inconclusive. Promising evidence indicates that topiramate and prazosin may be effective in reducing PTSD and AUD symptoms in individuals with comorbidity. Seeking safety has had mixed efficacy in clinical trials. The efficacy of other behavioral and alternative treatments (mindfulness-based, yoga, and acupuncture) is more difficult to evaluate since the evidence comes from small, single studies without comparison groups. Conclusion There is a clear need for more systematic and rigorous study of pharmacological, behavioral, and alternative treatments for patients with dual diagnoses of PTSD and AUD. PMID:24648794

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

    PubMed

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

    2014-11-01

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

  18. Rehabilitation Options

    MedlinePLUS

    ... Recreational therapy Neuropsychology Home Care Options Advanced Care Planning Palliative Care Hospice Care Brain Tumor Treatments Treatment Side Effects & their Management Support and Resources Caregiving Information About Us Letter ...

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

    PubMed

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

    2014-01-01

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

  20. Update on necrobiosis lipoidica: a review of etiology, diagnosis, and treatment options.

    PubMed

    Reid, Sophia D; Ladizinski, Barry; Lee, Kachiu; Baibergenova, Akerke; Alavi, Afsaneh

    2013-11-01

    Necrobiosis lipoidica (NL) is a rare chronic granulomatous disease that has historically been associated with diabetes mellitus. Debate exists regarding the etiology and pathogenesis of NL with a widely accepted theory that microangiopathy plays a significant role. NL typically presents clinically as erythematous papules on the front of the lower extremities that can coalesce to form atrophic telangiectatic plaques. NL is usually a clinical diagnosis, but if the clinical suspicion is uncertain, skin biopsy specimen can help differentiate it from sarcoidosis, necrobiotic xanthogranuloma, and granuloma annulare. NL is a difficult disease to manage despite a large armamentarium of treatment options that include topical and intralesional corticosteroids, immunomodulators, biologics, platelet inhibitors, phototherapy, and surgery. Randomized control trials are lacking to evaluate the many treatment methods and establish a standard regimen of care. Disease complications such as ulceration are common, and lesions should also be monitored for transition to squamous cell carcinoma, a less common sequelae. PMID:23969033

  1. Treatment options for community-acquired pneumonia in the elderly people.

    PubMed

    Petrosillo, Nicola; Cataldo, Maria Adriana; Pea, Federico

    2015-04-01

    Community-acquired pneumonia (CAP) represents one of the most common reasons for hospitalization in elderly people. Because older persons are the fastest growing segment of the population, a further increase of the incidence of CAP is expected in the next few years. Due to the high frequency, the different epidemiology, the atypical clinical presentation and the age-related modifications in drug metabolism that complicate the treatment, infections in the elderly people represent a major challenge for physicians. Despite the peculiarity of the management of CAP in the elderly people, no specific recommendations for antimicrobial treatment are provided in the international guidelines. The aim of this review is to give an update of the current antibiotic options for CAP in the elderly people reporting available data on the CAP etiology and risk factors, and tolerability, toxicity and pharmacokinetics/pharmacodynamic of antimicrobial agents used for elderly patients. PMID:25746632

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

    PubMed Central

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

    2014-01-01

    ABSTRACT Recurrent labial herpes simplex is a pathology of viral origin that is frequently observed in children. The signs and symptoms are uncomfortable and, in many cases, the efficacy of treatment is unproven. However, several studies have demonstrated good results from the use of low-level laser therapy (LLLT), primarily due to acceleration of the healing process and pain relief, which make it a promising resource for use with this pathology. This paper describes a clinical case of a 7-year-old patient affected by this pathology and the therapeutic resolution proposed. How to cite this article: Stona P, da Silva Viana E, dos Santos Pires L, Weber JBB, Kramer PF. Recurrent Labial Herpes Simplex in Pediatric Dentistry: Low-level Laser Therapy as a Treatment Option. Int J Clin Pediatr Dent 2014;7(2):140-143. PMID:25356015

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

    PubMed

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

    2014-12-01

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

  4. A critical appraisal of systemic treatment options for metastatic non-clear cell renal cell carcinoma.

    PubMed

    Ismail, Salima; Meskawi, Malek; Hansen, Jens; Bianchi, Marco; Tian, Zhe; Latour, Mathieu; Graefen, Markus; Montorsi, Francesco; Trinh, Quoc-Dien; Perrotte, Paul; Karakiewicz, Pierre I; Sun, Maxine

    2014-04-01

    Current guidelines provide most support for the use of temsirolimus in first line therapy for metastatic non-clear cell renal cell carcinoma (nccRCC). However, this recommendation is based on scant level 2a evidence. The objective of this review is to examine the evidence supporting first line temsirolimus use in patients with metastatic nccRCC as well as alternative first line treatment options. Six studies, that assessed the efficacy of five agents qualified for inclusion. Among recognized treatment options for metastatic nccRCC, mean weighted progression free survival values of 7.9 months for temsirolimus vs. 7.3 for sunitinib vs. 8.5 months for sorafenib vs. ?4.1 months for erlotinib were recorded based on data from 10, 74, 33 and 51 patients respectively. In conclusion, the data supporting first line temsirolimus for metastatic nccRCC are based on a small patient sample. Sunitinib's efficacy is similar to that of temsirolimus but is based on a bigger patient sample that originates from phase II studies. PMID:24411587

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

    SciTech Connect

    Dziewinski, J.J.

    1998-09-28

    The cleanup of liquid streams contaminated with radionuclides is obtained by the selection or a combination of a number of physical and chemical separations, processes or unit operations. Among those are: Chemical treatment; Evaporation; Ion exchange and sorption; Physical separation; Electrodialysis; Osmosis; Electrocoagulation/electroflotation; Biotechnological processes; and Solvent extraction.

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

    PubMed Central

    Luvero, Daniela; Milani, Andrea

    2014-01-01

    Ovarian cancer (OC) is the fifth most common cause of cancer death in women. Although significant progress has been made in the treatment of OC, the majority of patients experience disease recurrence and receive second-line and sometimes several lines of treatment. Here we review the options available for the treatment of recurrent disease and discuss how different agents are selected, combined and offered in a rationale sequence in the context of multidisciplinary care. We reviewed published work between 1990 and 2013 and meeting abstracts related to the use of chemotherapy and surgery in patients with recurrent ovarian cancer. We discuss treatment regimens, efficacy endpoints and safety profiles of the different therapies. Platinum-based drugs are the most active agents and are selected on the basis of a probability of response to retreatment. Nonplatinum-based chemotherapy regimens are usually given in the ‘platinum-resistant’ setting and have a modest effect on outcome. Molecular targeted therapy of ovarian cancer given alone or integrated with chemotherapy is showing promising results. Many patients are now receiving more than one line of therapy for recurrent disease, usually platinum based until platinum resistance emerges. The sequential use of chemotherapy regimens and the incorporation of molecularly targeted treatments, either alone or in combination with chemotherapy, have over the last decade significantly extended the median survival of patients with ovarian cancer. PMID:25342990

  7. Nitroglycerin patch for the treatment of chondrodermatitis nodularis helicis: a new therapeutic option.

    PubMed

    Garrido Colmenero, Cristina; Martínez García, Eliseo; Blasco Morente, Gonzalo; Tercedor Sánchez, Jesús

    2014-01-01

    Chondrodermatitis nodularis helicis (CNH) is an inflammatory process that affects the skin and cartilage of the ear. At present, there are many treatment options, although they are not always effective. Based on previous studies where nitroglycerin 2% gel was used, we propose the use of nitroglycerin patches. The purpose of this study was to evaluate the effectiveness of nitroglycerin patches in treating CNH. We performed a prospective study in 11 patients diagnosed with CNH treated with nitroglycerin patches 5?mg, 12 hours a day for 2 months. The therapeutic effectivity was determined by the improvement in the appearance and symptoms of the lesion. Seven of 11 patients (63.6%) had a complete response. One of 11 patients (9%) did not respond completely and surgical treatment was performed. Two of 11 patients (18.1%) stopped the treatment because of headache. One of 11 patients (9%) did not complete the treatment because the said patient forgot to apply the patch every night. Transdermal nitroglycerin has demonstrated efficacy in the treatment of the symptoms and lesional appearance of CNH noninvasive manner. The success rate is comparable with other published methods and the rate of adverse effects is acceptable. PMID:24909052

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

    MedlinePLUS

    ... in generic form. Wholesale prices of prescription UI medicines Generic Name Dose Cost of 1-Month Supply* Brand ... Supply* * Wholesale prices are from RED BOOK Online ®. Generic prices are ... The actual prices of the medicines may be higher or lower than the prices ...

  9. The retina dose-area histogram: a metric for quantitatively comparing rival eye plaque treatment options

    PubMed Central

    2013-01-01

    Purpose Episcleral plaques have a history of over a half century in the delivery of radiation therapy to intraocular tumors such as choroidal melanoma. Although the tumor control rate is high, vision-impairing complications subsequent to treatment remain an issue. Notable, late complications are radiation retinopathy and maculopathy. The obvious way to reduce the risk of radiation damage to the retina is to conform the prescribed isodose surface to the tumor base and to reduce the dose delivered to the surrounding healthy retina, especially the macula. Using a fusion of fundus photography, ultrasound and CT images, tumor size, shape and location within the eye can be accurately simulated as part of the radiation planning process. In this work an adaptation of the dose-volume histogram (DVH), the retina dose-area histogram (RDAH) is introduced as a metric to help compare rival plaque designs and conformal treatment planning options with the goal of reducing radiation retinopathy. Material and methods The RDAH is calculated by transforming a digitized fundus-photo collage of the tumor into a rasterized polar map of the retinal surface known as a retinal diagram (RD). The perimeter of the tumor base is digitized on the RD and its area computed. Area and radiation dose are calculated for every pixel in the RD. Results The areal resolution of the RDAH is a function of the pixel resolution of the raster image used to display the RD and the number of polygon edges used to digitize the perimeter of the tumor base. A practical demonstration is presented. Conclusions The RDAH provides a quantitative metric by which episcleral plaque treatment plan options may be evaluated and compared in order to confirm adequate dosimetric coverage of the tumor and margin, and to help minimize dose to the macula and retina. PMID:23634152

  10. Re-irradiation and bevacizumab in recurrent high-grade glioma: an effective treatment option.

    PubMed

    Flieger, Maya; Ganswindt, Ute; Schwarz, Silke Birgit; Kreth, Friedrich-Wilhelm; Tonn, Jörg-Christian; la Fougère, Christian; Ertl, Lorenz; Linn, Jennifer; Herrlinger, Ulrich; Belka, Claus; Niyazi, Maximilian

    2014-04-01

    Re-irradiation has been shown to be a meaningful option for recurrent high-grade glioma (HGG) patients. Furthermore, bevacizumab exerts certain activity in combination with chemotherapy/as monotherapy and was safely tested in combination with radiotherapy in several previous studies. To our knowledge, this is the largest cohort of patients treated with both re-irradiation and bevacizumab to date. After receiving standard radiotherapy (with or without TMZ) patients with recurrent HGG were treated with bevacizumab (10 mg/kg intravenously at d1 and d15) during re-irradiation. Median prescribed radiation dose during re-treatment was 36 Gy, conventionally fractionated. Datasets of 71 re-irradiated patients were retrospectively analyzed. Patients either received bevacizumab (N = 57) or not (N = 14; other substances (N = 4) and sole radiation (N = 10)). In patients receiving bevacizumab, both post-recurrence survival (PRS) (median 8.6 vs. 5.7 months; p = 0.003, log-rank test) and post-recurrence progression-free survival (PR-PFS, 5.6 vs. 2.5 months; p = 0.005, log-rank test; PFS-6 42.1 % for the bevacizumab group) were significantly increased which was confirmed by multivariate analysis. KPS, re-surgery, MGMT methylation status, sex, WHO grade, tumor volume and age were no significant predictors for neither PR-PFS nor PRS (univariate analysis). Re-irradiation with bevacizumab remains a feasible and highly effective treatment schedule. Studies on further salvage strategies and timing of sequential treatment options versus observation are warranted. PMID:24504501

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

    PubMed

    Chue, Pierre; Lalonde, Justine K

    2014-01-01

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

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

    PubMed Central

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

    2010-01-01

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

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

    PubMed Central

    Chue, Pierre; Lalonde, Justine K

    2014-01-01

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

  14. A non-surgical approach for male germ cell mediated gene transmission through transgenesis

    PubMed Central

    Usmani, Abul; Ganguli, Nirmalya; Sarkar, Hironmoy; Dhup, Suveera; Batta, Suryaprakash R.; Vimal, Manoj; Ganguli, Nilanjana; Basu, Sayon; Nagarajan, P.; Majumdar, Subeer S.

    2013-01-01

    Microinjection of foreign DNA in male pronucleus by in-vitro embryo manipulation is difficult but remains the method of choice for generating transgenic animals. Other procedures, including retroviral and embryonic stem cell mediated transgenesis are equally complicated and have limitations. Although our previously reported technique of testicular transgenesis circumvented several limitations, it involved many steps, including surgery and hemicastration, which carried risk of infection and impotency. We improved this technique further, into a two step non-surgical electroporation procedure, for making transgenic mice. In this approach, transgene was delivered inside both testes by injection and modified parameters of electroporation were used for in-vivo gene integration in germ cells. Using variety of constructs, germ cell integration of the gene and its transmission in progeny was confirmed by PCR, slot blot and immunohistochemical analysis. This improved technique is efficient, requires substantially less time and can be easily adopted by various biomedical researchers. PMID:24305437

  15. Musculoskeletal Conditions of the Foot and Ankle: Assessments and Treatment Options

    PubMed Central

    Rao, Smita; Riskowski, Jody; Hannan, Marian T.

    2012-01-01

    Musculoskeletal conditions of the foot and ankle are an important public health challenge due to their increasing incidence combined with their substantial negative impact on patients’ quality of life. Non-pharmacological treatments serve as the first line of treatment and are frequently used for patients with musculoskeletal conditions of the foot and ankle. This review provides a summary of the assessments and non-invasive treatment options based upon available evidence. Recent studies show that individuals with foot and ankle pain have multiple co-existing impairments in alignment, motion, load distribution and muscle performance that may be evident in static and/or dynamic tasks. Additionally, both clinical and epidemiological studies support the inter-dependence between the foot and proximal joints. For instance, aberrant foot structure has been linked to foot osteoarthritis (OA), as well as OA and pain at the knee and hip. Most recently, advances in motion capture technology and plantar load distribution measurement offer opportunities for precise dynamic assessments of the foot and ankle. In individuals with musculoskeletal conditions of the foot and ankle, the chief objectives of treatment are to afford pain relief, restore mechanics (alignment, motion and/or load distribution) and return the patient to their desired level of activity participation. Given that most patients present with multiple impairments, combinational therapies that target foot-specific as well as global impairments have shown promising results. In particular, in individuals with rheumatoid arthritis and other rheumatic diseases, comprehensive rehabilitation strategies including early detection, foot-based interventions (such as orthoses) and wellness-based approaches for physical activity and self-management have been successful. While significant improvements have been made in the last decade to the assessment and treatment of foot and ankle conditions, few randomized clinical trials specifically have investigated patients with foot or ankle conditions to provide global insights into this area. Consequently, current recommendations vary based upon the scope of studies presented in this review as well as the strength of studies. This review indicates a need for more in-depth investigations into the components of assessment and treatment options for foot and ankle musculoskeletal conditions. PMID:22867931

  16. Getting it right for children: improving tuberculosis treatment access and new treatment options.

    PubMed

    Brigden, Grania; Furin, Jennifer; Van Gulik, Clara; Marais, Ben

    2015-04-01

    Children were often the forgotten victims of the global tuberculosis (TB) epidemic, neglected by traditional TB services as well as maternal and child health initiatives. Luckily this is changing with a greater focus on children and the issues regarding their optimal management. A common misconception is that children with TB are always difficult to diagnose and treat. New diagnostic tools are urgently needed, but most children with TB in high-burden settings can be diagnosed with available approaches and treatment outcomes are generally excellent. Increased TB awareness, appropriate training of health care workers and inclusion in integrated management of childhood illness strategies will improve the access and quality of care that children receive. This review highlights what needs to be done to ensure that no child unnecessarily dies from TB and provides a brief overview of new advances in the field. PMID:25739933

  17. Towards a complete recycling of phosphorus in wastewater treatment--options in Germany.

    PubMed

    Petzet, S; Cornel, P

    2011-01-01

    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

  18. Denosumab: a new option in the treatment of bone metastases from urological cancers

    PubMed Central

    Yuasa, Takeshi; Yamamoto, Shinya; Urakami, Shinji; Fukui, Iwao; Yonese, Junji

    2012-01-01

    Bone metastases often create serious clinical problems: they lead to poor performance status due to pathologic fractures, spinal cord compression and intractable pain, commonly referred to as skeletal-related events. The receptor activator of nuclear factor-?B (RANK), the RANK ligand (RANKL), and osteoprotegerin, a decoy receptor for RANK, regulate osteoclastogenesis and may play a key role in bone metastasis. Denosumab (XGEVA; Amgen, Thousand Oaks, CA), a fully human monoclonal antibody that binds to and neutralizes RANKL, inhibits osteoclast function, prevents generalized bone resorption and local bone destruction, and has become a therapeutic option for preventing or delaying first on-study skeletal-related events in various malignancies. In the context of urological cancer, three main Phase III clinical studies have been published in prostate cancer. This article provides a brief overview of the characteristics of bone metastasis in urological cancers, reviews the mechanisms of bone metastasis, including the RANK/RANKL/osteoprotegerin axis, the current standard of care, zoledronic acid, and describes the efficacy of the novel bone-targeted agent denosumab in bone metastasis. Denosumab is emerging as a key therapeutic option in the treatment of bone metastases from urological cancers. PMID:23055747

  19. Balloon aortic valvuloplasty as a treatment option in the era of transcatheter aortic valve implantation.

    PubMed

    Costopoulos, Charis; Sutaria, Nilesh; Ariff, Ben; Fertleman, Michael; Malik, Iqbal; Mikhail, Ghada W

    2015-05-01

    Aortic valve stenosis is the commonest encountered valvular pathology and a frequent cause of morbidity and mortality in cases of severe stenosis. Definitive treatment has traditionally been offered in the form of surgical aortic valve replacement in patients with an acceptable surgical risk and more recently with the less invasive transcatheter aortic valve implantation (TAVI) in those where surgery is not a viable option. Prior to the introduction of TAVI, inoperable patients were treated medically and where appropriate with balloon aortic valvuloplasty, a procedure which although effective only provided short-term relief and was associated with high complication rates especially during its infancy. Here we discuss whether balloon aortic valvuloplasty continues to have a role in contemporary clinical practice in an era where significant advances have been achieved in the fields of surgical aortic valve replacement, TAVI and postoperative care. PMID:25865236

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

    PubMed Central

    2013-01-01

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

  1. Expanding knowledge among Aboriginal service providers on treatment options for excessive alcohol use.

    PubMed

    Brady, M; Dawe, S; Richmond, R

    1998-03-01

    Approaches to the prevention of alcohol problems among Aboriginal people in Australia have tended to emphasize primary and tertiary prevention, while neglecting secondary prevention or early intervention. In contrast, members of the wider Australian community can now access a variety of early interventions through general practice, in hospital settings and through drug and alcohol treatment agencies. As part of a survey of the use of brief interventions, 178 agencies throughout Australia were interviewed, and findings are presented from the 29 agencies in this sample which provided services primarily for Aboriginal people. Approximately half offered a variety of approaches including brief interventions, with goals of moderation; the other half were entirely abstinence-orientated. These findings are discussed in the context of expanding the options that might be offered by Aboriginal-run agencies. PMID:16203470

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

    PubMed

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

    2008-08-01

    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

  3. Perceptions of substance use, treatment options and training needs among Iranian primary care physicians

    PubMed Central

    Shakeshaft, Anthony; Nassirimanesh, Bijan; Day, Carolyn; Dolan, Kate A

    2005-01-01

    In order to be optimally effective, continuing training programmes for health-care professionals need to be tailored so that they target specific knowledge deficits, both in terms of topic content and appropriate intervention strategies. A first step in designing tailored treatment programmes is to identify the characteristics of the relevant health-care professional group, their current levels of content and treatment knowledge, the estimated prevalence of drug and alcohol problems among their patients and their preferred options for receiving continuing education and training. This study reports the results of a survey of 53 primary care physicians working in Iran. The majority were male, had a mean age of 44 years and saw approximately 94 patients per week. In terms of their patients' drug use, primary care physicians thought most patients with a substance use problem were male, women were most likely to use tobacco (52%), opium (32%) and marijuana/hashish and young people were most likely to use tobacco, alcohol, marijuana and heroin. Counselling and nicotine patches were the treatments most commonly provided. Although the majority (55%) reported referring patients to other services, more than a third did not. Most primary care physicians reported being interested in attending further training on substance abuse issues. The implications of these data for ongoing education and training of primary care physicians in Iran are discussed. PMID:15955255

  4. Perceptions of substance use, treatment options and training needs among Iranian primary care physicians.

    PubMed

    Shakeshaft, Anthony; Nassirimanesh, Bijan; Day, Carolyn; Dolan, Kate A

    2005-06-15

    In order to be optimally effective, continuing training programmes for health-care professionals need to be tailored so that they target specific knowledge deficits, both in terms of topic content and appropriate intervention strategies. A first step in designing tailored treatment programmes is to identify the characteristics of the relevant health-care professional group, their current levels of content and treatment knowledge, the estimated prevalence of drug and alcohol problems among their patients and their preferred options for receiving continuing education and training. This study reports the results of a survey of 53 primary care physicians working in Iran. The majority were male, had a mean age of 44 years and saw approximately 94 patients per week. In terms of their patients' drug use, primary care physicians thought most patients with a substance use problem were male, women were most likely to use tobacco (52%), opium (32%) and marijuana/hashish and young people were most likely to use tobacco, alcohol, marijuana and heroin. Counselling and nicotine patches were the treatments most commonly provided. Although the majority (55%) reported referring patients to other services, more than a third did not. Most primary care physicians reported being interested in attending further training on substance abuse issues. The implications of these data for ongoing education and training of primary care physicians in Iran are discussed. PMID:15955255

  5. Life cycle assessment of wastewater treatment options for small and decentralized communities.

    PubMed

    Machado, A P; Urbano, L; Brito, A G; Janknecht, P; Salas, J J; Nogueira, R

    2007-01-01

    Sustainability has strong implications on the practice of engineering. Life cycle assessment (LCA) is an appropriate methodology for assessing the sustainability of a wastewater treatment plant design. The present study used a LCA approach for comparing alternative wastewater treatment processes for small and decentralised rural communities. The assessment was focused on two energy-saving systems (constructed wetland and slow rate infiltration) and a conventional one (activated sludge process). The low environmental impact of the energy-saving wastewater treatment plants was demonstrated, the most relevant being the global warming indicator. Options for reduction of life cycle impacts were assessed including materials used in construction and operational lifetime of the systems. A 10% extension of operation lifetime of constructed wetland and slow rate infiltration systems led to a 1% decrease in CO2 emissions, in both systems. The decrease in the abiotic depletion was 5 and 7%, respectively. Also, replacing steel with HDPE in the activated sludge tank resulted in a 1% reduction in CO2 emission and 1% in the abiotic depletion indicator. In the case of the Imhoff tank a 1% reduction in CO2 emissions and 5% in the abiotic depletion indicator were observed when concrete was replaced by HDPE. PMID:17802833

  6. HER2-directed therapy: current treatment options for HER2-positive breast cancer.

    PubMed

    Ahmed, Shahid; Sami, Amer; Xiang, Jim

    2015-03-01

    Over the past decade, the management of HER2-positive breast cancer has evolved dramatically. In addition to advances in screening, genetic testing, imaging, surgical and radiation techniques, innovations in medical therapy including widespread use of HER2-directed therapy in early and advanced breast cancer have revolutionized breast cancer care and changed the natural history of HER2-positive breast cancer. A substantial number of HER2-targeted agents are being developed including monoclonal antibodies, small molecule inhibitors, and antibody drug conjugates. Trastuzumab is the prototype HER2-directed therapy that was introduced in the late 1990s for the management of metastatic breast cancer and later showed efficacy in early stage disease. Despite the practice changing impact of trastuzumab and improvement in outcomes of women with HER2-positive breast cancer resistance to trrastuzumab is a major clinical issue, occurring in both early stage and advanced disease, and new treatment strategies are clearly required. Combining HER2-targeted agents and dual HER2 blockade has been successful in early and advanced breast cancer. Furthermore, selected delivery of potent chemotherapeutic agent coupled with HER2 inhibition promises new treatment options. This review is focused on current HER2-directed treatments for women with HER2-positive breast cancer including monoclonal antibodies, small molecule inhibitors, and antibody drug conjugates. PMID:25634227

  7. Depression and Cerebrovascular Disease: Could Vortioxetine Represent a Valid Treatment Option?

    PubMed Central

    Carta, Mauro Giovanni; Pala, Andrea Norcini; Finco, Gabriele; Musu, Mario; Moro, Maria Francesca

    2015-01-01

    Introduction : Depression and cerebrovascular atherosclerosis often occur in comorbidity showing neuropsychological impairment and poor response to antidepressant treatment. Objective is to evaluate if new antidepressant vortioxetine may be a potential treatment option. Mechanism of Action : Vortioxetine has 5-HT3, 5-HT7 and 5-HT1D antagonists, 5-HT1B partial agonist and a 5-HT1A agonist and serotonin transporter inhibitor property. Efficacy and safety in Major Depressive Disorders and in cognitive impairment : The majority of trials (one of them in older people) showed efficacy for vortioxetine against placebo and no differences against other active treatments. The Adverse Effects ranged from 15.8% more to 10.8% less than placebo. In the elderly, only nausea was found higher than placebo. Effects on arterial blood pressure and cardiac parameters including the ECG-QT segment were similar to placebo. Elderly depressive patients on vortioxetine showed improvement versus placebo and other active comparators in Auditory Verbal Learning Test and Digit Symbol Substitution Test scores. The inclusion criteria admitted cases with middle cerebrovascular disease. Conclusion : The mechanism of action, the efficacy on depression and safety profile and early data on cognitive impairment make Vortioxetine a strong candidate for use in depression associated with cerebrovascular disease. This information must be supported by future randomized controlled trials.

  8. Men at low-risk of dying from their prostate cancer increasingly opting for advanced treatment options

    Cancer.gov

    For men with a low risk of dying from their prostate cancer, advanced treatment options may offer little to no benefit, yet more and more patients are opting for these procedures. A new study from the University of Michigan Comprehensive Cancer Center examined Medicare data between 2004 and 2009 for men with prostate cancer whose disease was low-risk or those who were at a high risk to die from other causes. The researchers found that these men increasingly underwent advanced treatment options, such as intensity-modulated radiotherapy and robotic prostatectomy.

  9. Thoracic outlet syndrome: a controversial clinical condition. Part 2: non-surgical and surgical management

    PubMed Central

    Hooper, Troy L; Denton, Jeff; McGalliard, Michael K; Brismée, Jean-Michel; Sizer, Phillip S

    2010-01-01

    Background Proper management of thoracic outlet syndrome (TOS) requires an understanding of the underlying causes of the disorder. A comprehensive examination process, as described in Part 1 of this review, can reveal the bony and soft tissue abnormalities and mechanical dysfunctions contributing to an 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. PMID:21886423

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

    PubMed Central

    2014-01-01

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

  11. Articular Cartilage Degeneration in the Contralateral Non-surgical Temporomandibular Joint in Mice with a Unilateral Partial Discectomy

    PubMed Central

    Cohen, Wendy A.; Servais, Jacqueline M.; Polur, Ilona; Li, Yefu; Xu, Lin

    2014-01-01

    Summary Objective The objective was to characterize the contralateral non-surgical temporomandibular joint (TMJ) in mice that had an opposing osteoarthrosis(OA)-like joint induced by unilateral partial discectomy. Methods TMJs on one side in mice were subjected to partial discectomy. Both surgical and contralateral non-surgical TMJs were collected at 4, 8, 12 and 16 weeks post-surgery for histological examination. The morphology of the articular cartilage of the condyle was evaluated using a scoring system. Results A progression of articular cartilage degeneration was seen in the TMJs following unilateral partial discectomy, including increased proteoglycan staining in the extracellular matrix at 4 weeks, the appearance of chondrocyte clusters at 8 weeks, reduced proteoglycan staining and fibrillation at 12 weeks and the loss of articular cartilage at 16 weeks. In the contralateral non-surgical TMJs, increased proteoglycan staining occurred in the articular cartilage of the condyle at 8 weeks and continued to age. Conclusion The result indicated that OA-like changes in one TMJ by partial discectomy could initiate early onset articular cartilage degeneration in the contralateral non-surgical TMJ in mice. PMID:24044578

  12. Considerations for single tooth replacement in an esthetic zone–review of conservative treatment options

    PubMed Central

    Singh, Raghuwar Dayal; Singh, Saumyendra V; Chand, Pooran; Ramashanker

    2012-01-01

    Background This literature review aimed to identify and assess the conservative treatment options for replacing a single missing anterior tooth, for patients who cannot afford implants or traditional bridges. Materials and Methods The evidence was obtained using MEDLINE searches. A total of 19 studies met the inclusion criteria. None of these studies scored higher than 10 of 17, suggesting that all studies did not have strong evidence. Three of the studies examined resin-bonded bridges (RBBs), whereas the other three investigated removable partial dentures (RPDs). None of the studies had random patient selection. Three of these studies had controlled allocation of patients. The other three allowed new patients to enter the study throughout the study period. Placement of the prosthesis was only conducted in one study, whereas the rest of the studies examined patients with preexisting prostheses. Results and Conclusion In general, all 19 studies were weak due to poor study design, no acceptable controls, no direct comparison between RBBs and RPDs, lack of longitudinal studies and no differentiation between the anterior and posterior prostheses. Therefore, no definitive treatment conclusion can be made until studies of stronger design are conducted.

  13. Unbiased compound screening identifies unexpected drug sensitivities and novel treatment options for gastrointestinal stromal tumors.

    PubMed

    Boichuk, Sergei; Lee, Derek J; Mehalek, Keith R; Makielski, Kathleen R; Wozniak, Agnieszka; Seneviratne, Danushka S; Korzeniewski, Nina; Cuevas, Rolando; Parry, Joshua A; Brown, Matthew F; Zewe, James; Taguchi, Takahiro; Kuan, Shin-Fan; Schöffski, Patrick; Debiec-Rychter, Maria; Duensing, Anette

    2014-02-15

    Most gastrointestinal stromal tumors (GIST) are caused by oncogenic KIT or platelet-derived growth factor receptor activation, and the small molecule kinase inhibitor imatinib mesylate is an effective first-line therapy for metastatic or unresectable GIST. However, complete remissions are rare and most patients ultimately develop resistance, mostly because of secondary mutations in the driver oncogenic kinase. Hence, there is a need for novel treatment options to delay failure of primary treatment and restore tumor control in patients who progress under therapy with targeted agents. Historic data suggest that GISTs do not respond to classical chemotherapy, but systematic unbiased screening has not been performed. In screening a compound library enriched for U.S. Food and Drug Administration (FDA)-approved chemotherapeutic agents (NCI Approved Oncology Drugs Set II), we discovered that GIST cells display high sensitivity to transcriptional inhibitors and topoisomerase II inhibitors. Mechanistically, these compounds exploited the cells' dependency on continuous KIT expression and/or intrinsic DNA damage response defects, explaining their activity in GIST. Mithramycin A, an indirect inhibitor of the SP1 transcription factor, and mitoxantrone, a topoisomerase II inhibitor, exerted significant antitumor effects in mouse xenograft models of human GIST. Moreover, these compounds were active in patient-derived imatinib-resistant primary GIST cells, achieving efficacy at clinically relevant concentrations. Taken together, our findings reveal that GIST cells have an unexpectedly high and specific sensitivity to certain types of FDA-approved chemotherapeutic agents, with immediate implications for encouraging their clinical exploration. PMID:24385214

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

    PubMed

    Chen, Zhuo; Ngo, Huu Hao; Guo, Wenshan; Pham, Thi Thu Nga; Lim, Richard; Wang, Xiaochang C; Miechel, Clayton; Halloran, Kelly O'; Listowski, Andrzej; Corby, Nigel

    2014-04-01

    With a constantly growing population, water scarcity becomes the limiting factor for further social and economic growth. To achieve a partial reduction in current freshwater demands and lessen the environmental loadings, an increasing trend in the water market tends to adopt recycled water for household laundries as a new recycled water application. The installation of a small pre-treatment unit for water purification can not only further improve the recycled water quality, but also be viable to enhance the public confidence and acceptance level on recycled water consumption. Specifically, this paper describes column experiments conducted using a 550 mm length bed of zeolite media as a one-dimensional flow reactor. The results show that the zeolite filter system could be a simple low-cost pre-treatment option which is able to significantly reduce the total hardness level of recycled water via effective ion exchange. Additionally, depending on the quality of recycled water required by end users, a new by-pass controller using a three-level operation switching mechanism is introduced. This approach provides householders sufficient flexibility to respond to different levels of desired recycled water quality and increase the reliability of long-term system operation. These findings could be beneficial to the smooth implementation of new end uses and expansion of the potential recycled water market. The information could also offer sound suggestions for future research on sustainable water management and governance. PMID:24496024

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

    PubMed

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

    2013-01-01

    During the planning of oral rehabilitation, the vertical dimension of occlusion (VDO) is one of the first parameters to be measured since its improper restoration can lead to the failure of any prosthetic rehabilitation. A decreased VDO can lead to the appearance of lesions, such as angular cheilitis, facial disharmony, and temporomandibular disorders; meanwhile, an increased VDO may lead to the onset of joint and muscle pain, tension in functional speech, difficulty in swallowing, impaired chewing, tooth sensitivity due to traumatogenic forces, pathologic bone resorption, abnormal wearing of teeth, the appearance of an elongated face, and a facial expression of fatigue. Most scientific articles deal with methods and techniques for re-establishing VDO in edentulous patients or those who have lost their tooth reference due to prosthetic preparations. However, patients with increased VDO are also found in everyday practice. One treatment option for these patients is occlusal adjustment by selective tooth wear; it is still possible to perform orthodontic intrusion and/or orthognathic surgery in severe cases. The aim of this study was to discuss signs, symptoms, diagnosis, and treatment, and to report a clinical case of a patient with increased VDO. PMID:23579908

  16. Left subclavian artery stenting: an option for the treatment of the coronary-subclavian steal syndrome

    PubMed Central

    de Almeida, Bruno Lorenção; Kambara, Antonio Massamitsu; Rossi, Fabio Henrique; Moreira, Samuel Martins; de Oliveira, Eduardo Silva Jordao; Linhares Filho, Frederico Augusto de Carvalho; Metzger, Patrick Bastos; Passalacqua, Aldo Zampieri

    2014-01-01

    Introduction The subclavian steal syndrome is characterized by the vertebral artery flow inversion, due to a stenotic lesion in the origin of the subclavian artery. The Coronary-subclavian Steal Syndrome is a variation of the Subclavian Steal Syndrome and is characterized by inversion of flow in the Internal Thracic artery that has been used as conduct in a myocardial revascularization. Its diagnosis must be suspected in patients with difference in pulse and arterial pressure in the upper limbs, that present with angina pectoris and that have done a myocardial revascularization. Its treatment must be a surgical bypass or a transluminal angioplasty. Objective The objective is to show the left subclavian artery stenting as a safe and effective method to treat the coronary-subclavian steal syndrome. Methods Historical prospective, non-randomized trial, through revision of the hospital records of the patients treated with the stenting of the left subclavian artery, from January 2006 to September 2012. Results In the mentioned period, 4.291 miocardial revascularizations were performed with the use of the left mammary artery, and 16 patients were identified to have the Coronary-subclavian steal syndrome. All of them were submitted to endovascular treatment. The success rate was 100%; two patients experienced minor complications; none of them presented with major complications. Eleven of the 16 patients had ultrassonographic documentation of patent stent for at least one year; two patients lost follow up and other two died. Conclusion The stenting of the left subclavian artery is a good option for the treatment of the Coronary-subclavian Steal Syndrome, with high level of technical and clinical success. PMID:25140474

  17. A roundtable discussion on the clinical challenges and options for the treatment of glioblastoma: introducing a novel modality, TTFields.

    PubMed

    Butowski, Nicholas; Wong, Eric T; Mehta, Minesh P; Wilson, Lydia K

    2013-12-01

    Since its approval in 2011 for patients with recurrent glioblastoma (GBM), physicians have responded positively to the non-invasive nature of the NovoTTF-100A System device (NovoCure Ltd, Haifa, Israel), citing significantly less toxicity and a better quality of life profile compared to available conventional therapies. A roundtable discussion (available at: http://education.seminoncol.org/path.php?1399:0:Media:title:bxvcs) was recently convened to provide a knowledge-based perspective surrounding current treatment options for patients with GBM and the clinical challenges involved with the treatment of recurrent GBM patients who have failed prior therapies. The participating roundtable experts discussed the challenges encountered in managing GBM patients, the current approved treatment options for these patients, the efficacy and safety profile of NovoTTF therapy (TTFields), and its use as a novel treatment modality for recurrent GBM patients. PMID:24331200

  18. Locoregional Treatment for Breast Carcinoma After Hodgkin's Lymphoma: The Breast Conservation Option

    SciTech Connect

    Haberer, Sophie, E-mail: sophie.haberer@wanadoo.fr [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)

    2012-02-01

    Purpose: To report clinical and pathologic characteristics and outcome of breast cancer (BC) after irradiation for Hodgkin's lymphoma (HL) in women treated at the Institut Curie, with a special focus on the breast-conserving option. Methods and Materials: Medical records of 72 women who developed either ductal carcinoma in situ or Stage I-III invasive carcinoma of the breast after HL between 1978 and 2009 were retrospectively reviewed. Results: Median age at HL diagnosis was 23 years (range, 14-53 years). Median total dose received by the mediastinum was 40 Gy, mostly by a mantle-field technique. Breast cancers occurred after a median interval of 21 years (range, 5-40 years). Ductal invasive carcinoma and ductal carcinoma in situ represented, respectively, 51 cases (71%) and 14 cases (19%). Invasive BCs consisted of 47 cT0-2 tumors (82%), 5 cN1-3 tumors (9%), and 20 Grade 3 tumors (35%). Locoregional treatment for BCs consisted of mastectomy with (3) or without (36) radiotherapy in 39 patients and lumpectomy with (30) or without (2) adjuvant radiotherapy in 32 patients. The isocentric lateral decubitus radiation technique was used in 17 patients after breast-conserving surgery (57%). With a median follow-up of 7 years, 5-year overall survival rate and locoregional control rate were, respectively, 74.5% (95% confidence interval [CI], 64-88%) and 82% (95% CI, 72-93%) for invasive carcinoma and 100% (95% CI, 100 -100%) and 92% (95% CI, 79-100%) for in situ carcinoma. In patients with invasive tumors, the 5-year distant disease-free survival rate was 79% (95% CI, 69-91%), and 13 patients died of progressive BC. Contralateral BC was diagnosed in 10 patients (14%). Conclusions: Breast-conserving treatment can be an option for BCs that occur after HL, despite prior thoracic irradiation. It should consist of lumpectomy and adjuvant breast radiotherapy with use of adequate techniques, such as the lateral decubitus isocentric position, to protect the underlying heart and lung.

  19. Systems engineering study: tank 241-C-103 organic skimming,storage, treatment and disposal options

    SciTech Connect

    Klem, M.J.

    1996-10-23

    This report evaluates alternatives for pumping, storing, treating and disposing of the separable phase organic layer in Hanford Site Tank 241-C-103. The report provides safety and technology based preferences and recommendations. Two major options and several varations of these options were identified. The major options were: 1) transfer both the organic and pumpable aqueous layers to a double-shell tank as part of interim stabilization using existing salt well pumping equipment or 2) skim the organic to an above ground before interim stabilization of Tank 241-C-103. Other options to remove the organic were considered but rejected following preliminary evaluation.

  20. Substance P Receptor Antagonism: A Potential Novel Treatment Option for Viral-Myocarditis

    PubMed Central

    Robinson, Prema; Taffet, George E.; Engineer, Nikita; Khumbatta, Mitra; Firozgary, Bahrom; Reynolds, Corey; Pham, Thuy; Bulsara, Tushar; Firozgary, Gohar

    2015-01-01

    Viral-myocarditis is an important cause of heart failure for which no specific treatment is available. We previously showed the neuropeptide substance P (SP) is associated with the pathogenesis of murine myocarditis caused by encephalomyocarditis virus (EMCV). The current studies determined if pharmacological inhibition of SP-signaling via its high affinity receptor, NK1R and downstream G-protein, Ras homolog gene family, member-A (RhoA), will be beneficial in viral-myocarditis. Aprepitant (1.2?mg/kg), a SP-receptor antagonist, or fasudil (10?mg/kg), a RhoA inhibitor, or saline control was administered daily to mice orally for 3 days, prior to, or 5 days following, intraperitoneal infection with and without 50 PFU of EMCV, following which disease assessment studies, including echocardiogram and cardiac Doppler were performed in day 14 after infection. Pretreatment and posttreatment with aprepitant significantly reduced mortality, heart and cardiomyocyte size, and cardiac viral RNA levels (P < 0.05 all, ANOVA). Only aprepitant pretreatment improved heart functions; it significantly decreased end systolic diameter, improved fractional shortening, and increased peak aortic flow velocity (P < 0.05 all, ANOVA). Pre- or posttreatment with fasudil did not significantly impact disease manifestations. These findings indicate that SP contributes to cardiac-remodeling and dysfunction following ECMV infection via its high affinity receptor, but not through the Rho-A pathway. These studies suggest that SP-receptor antagonism may be a novel therapeutic-option for patients with viral-myocarditis.

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

    PubMed Central

    2013-01-01

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

  2. Chimeric Human Skin Substitute Tissue: A Novel Treatment Option for the Delivery of Autologous Keratinocytes

    PubMed Central

    Rasmussen, Cathy A.; Allen-Hoffmann, B. Lynn

    2012-01-01

    Background For patients suffering from catastrophic burns, few treatment options are available. Chimeric coculture of patient-derived autologous cells with a “carrier” cell source of allogeneic keratinocytes has been proposed as a means to address the complex clinical problem of severe skin loss. The Problem Currently, autologous keratinocytes are harvested, cultured, and expanded to form graftable epidermal sheets. However, epidermal sheets are thin, are extremely fragile, and do not possess barrier function, which only develops as skin stratifies and matures. Grafting is typically delayed for up to 4 weeks to propagate a sufficient quantity of the patient's cells for application to wound sites. Basic/Clinical Science Advances Fully stratified chimeric bioengineered skin substitutes could not only provide immediate wound coverage and restore barrier function, but would simultaneously deliver autologous keratinocytes to wounds. The ideal allogeneic cell source for this application would be an abundant supply of clinically evaluated, nontumorigenic, pathogen-free, human keratinocytes. To evaluate this potential cell-based therapy, mixed populations of a green fluorescent protein-labeled neonatal human keratinocyte cell line (NIKS) and unlabeled primary keratinocytes were used to model the allogeneic and autologous components of chimeric monolayer and organotypic cultures. Clinical Care Relevance Relatively few autologous keratinocytes may be required to produce fully stratified chimeric skin substitute tissue substantially composed of autologous keratinocyte-derived regions. The need for few autologous cells interspersed within an allogeneic “carrier” cell population may decrease cell expansion time, reducing the time to patient application. Conclusion This study provides proof of concept for utilizing NIKS keratinocytes as the allogeneic carrier for the generation of bioengineered chimeric skin substitute tissues capable of providing immediate wound coverage while simultaneously supplying autologous human cells for tissue regeneration. PMID:24527281

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

    PubMed Central

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

    2014-01-01

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

  4. Committee opinion no. 606: Options for prevention and management of heavy menstrual bleeding in adolescent patients undergoing cancer treatment.

    PubMed

    2014-08-01

    Adolescents undergoing cancer treatment are at high risk of heavy menstrual bleeding, and gynecologists may be consulted either before the initiation of cancer treatment to request strategies for menstrual suppression or during an episode of severe heavy bleeding to stop the bleeding emergently. Therapy in both situations should be tailored to the patient, her cancer diagnosis and treatment plan, and her desires for contraception and fertility. Options for menstrual suppression include combined hormonal contraceptives, progestin-only therapy, and gonadotropin-releasing hormone agonists. Adolescents presenting emergently with severe uterine bleeding may benefit from hormonal therapy, antifibrinolytics or, as a last resort, surgical management. In choosing appropriate treatment, considerations such as current platelet count, course of treatment, time to expected nadir, risk of thromboembolism, and need for contraception should be considered. Because of the complex nature of cancer care, collaboration with the adolescent's oncologist is highly recommended. PMID:25050771

  5. Treatment Option Overview (Childhood Central Nervous System Atypical Teratoid/Rhabdoid Tumor)

    MedlinePLUS

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

  6. Three irradiation treatment options including radiosurgery for brain metastases from primary lung cancer

    Microsoft Academic Search

    Georges Noel; Jacques Medioni; Charles-Ambroise Valery; Gilbert Boisserie; Jean Marc Simon; Philippe Cornu; Dominique Hasboun; Dominique Ledu; Bernadette Tep; Jean-Yves Delattre; Claude Marsault; François Baillet; Jean-Jacques Mazeron

    2003-01-01

    Purpose: To determine local control and survival rates in 92 patients with 145 brain metastases treated with three options of radiotherapy including stereotactic radiosurgery (SR). Methods: Between July 1994 and August 2002, 92 consecutive patients with 145 metastases were treated with a SR, 34 with initially SR alone, 22 initially with an association of whole-brain radiotherapy (WBRT) and 36 with

  7. Management of patients with hormone receptor–positive breast cancer with visceral disease: challenges and treatment options

    PubMed Central

    Harb, Wael A

    2015-01-01

    Endocrine therapy is an important treatment option for women with hormone receptor–positive (HR+) advanced breast cancer (ABC), yet many tumors are either intrinsically resistant or develop resistance to these therapies. Treatment of patients with ABC presenting with visceral metastases, which is associated with a poor prognosis, is also problematic. There is an unmet need for effective treatments for this patient population. Although chemotherapy is commonly perceived to be more effective than endocrine therapy in managing visceral metastases, patients who are not in visceral crisis might benefit from endocrine therapy, avoiding chemotherapy-associated toxicities that might affect quality of life. To improve outcomes, several targeted therapies are being investigated in combination with endocrine therapy for patients with endocrine-resistant, HR+ ABC. Although available data have considered patients with HR+ ABC as a whole, there are promising data from a prespecified analysis of a Phase III study of everolimus (Afinitor®), a mammalian target of rapamycin (mTOR) inhibitor, in combination with exemestane (Aromasin®) in patients with visceral disease progressing after nonsteroidal aromatase inhibitor therapy. In this review, challenges and treatment options for management of HR+ ABC with visceral disease, including consideration of therapeutic approaches undergoing clinical investigation, will be assessed. PMID:25653556

  8. Postsurgical meningitis complicated by severe refractory intracranial hypertension with limited treatment options: the role of mild therapeutic hypothermia.

    PubMed

    Popugaev, Konstantin A; Savin, Ivan A; Oshorov, Andrew V; Kurdumova, Natalia V; Ershova, Olga N; Lubnin, Andrew U; Kadashev, Boris A; Kalinin, Pavel L; Kutin, Maxim A; Killeen, Tim; Cesnulis, Evaldas; Melieste, Ronald

    2014-12-01

    Intracranial hypertension is a commonly encountered neurocritical care problem. If first-tier therapy is ineffective, second-tier therapy must be initiated. In many cases, the full arsenal of established treatment options is available. However, situations occasionally arise in which only a narrow range of options is available to neurointensivists. We present a rare clinical scenario in which therapeutic hypothermia was the only available method for controlling intracranial pressure and that demonstrates the efficacy and safety of the Thermogard (Zoll, Chelmsford, Massachusetts, United States) cooling system in creating and maintaining a prolonged hypothermic state. The lifesaving effect of hypothermia was overshadowed by the unfavorable neurologic outcome observed (minimally conscious state on intensive care unit discharge). These results add further evidence to support the role of therapeutic hypothermia in managing intracranial pressure and provide motivation for finding new strategies in combination with hypothermia to improve neurologic outcomes. PMID:25485219

  9. Sexual Functioning and Sex Hormones in Persons with Extreme Obesity and Seeking Surgical and Non-Surgical Weight Loss

    PubMed Central

    Sarwer, David B.; Spitzer, Jacqueline C.; Wadden, Thomas A.; Rosen, Raymond C.; Mitchell, James E.; Lancaster, Kathy; Courcoulas, Anita; Gourash, William; Christian, Nicholas J.

    2013-01-01

    Background Many individuals with obesity are motivated to lose weight to improve weight-related comorbidities or psychosocial functioning, including sexual functioning. Few studies have documented rates of sexual dysfunction in persons with obesity. Objectives This study investigated sexual functioning, sex hormones, and relevant psychosocial constructs in individuals with obesity who sought surgical and non-surgical weight loss. Setting University based health systems. Methods One hundred forty-one bariatric surgery patients (median BMI [25th percentile, 75th percentile] 44.6 [41.4, 50.1]) and 109 individuals (BMI = 40.0 [38.0, 44.0]) who sought nonsurgical weight loss participated. Sexual functioning was assessed by the Female Sexual Function Index (FSFI) and International Index of Erectile Function (IIEF). Hormones were assessed by blood assay. Quality of life, body image, depressive symptoms and marital adjustment were assessed by validated questionnaires. Results Fifty-one percent of women presenting for bariatric surgery reported a sexual dysfunction; 36% of men presenting for bariatric surgery reported erectile dysfunction (ED). This is in contrast to 41% of women who sought nonsurgical weight loss and reported a sexual dysfunction and 20% of men who sought nonsurgical weight loss and reported ED. These differences were not statistically significant. Sexual dysfunction was strongly associated with psychosocial distress in women; these relationships were less strong and less consistent among men. Sexual dysfunction was unrelated to sex hormones, except for sex hormone binding globulin (SHGB) in women. Conclusion Women and men who present for bariatric surgery, as compared to individuals who sought non-surgical weight loss, were not significantly more likely to experience a sexual dysfunction. There were few differences in reproductive hormones and psychosocial constructs between candidates for bariatric surgery and individuals interested in non-surgical weight loss. PMID:24120985

  10. STUDY PROTOCOL Open Access Cocaine Addiction Treatments to improve Control and reduce Harm (CATCH): New Pharmacological Treatment Options for Crack-Cocaine Dependence in the Netherlands

    E-print Network

    Mascha Nuijten; Peter Blanken; Wim Van Den Brink; Vincent Hendriks

    Background: 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 is not reached by the addiction treatment system. Psychosocial interventions for cocaine dependence generally show modest results, and there are no registered pharmacological treatments to date, despite the wide range of medications tested for this type of dependence. The present study (Cocaine Addiction Treatments to improve Control and reduce Harm; CATCH) investigates the possibilities and problems associated with new pharmacological treatments for crack dependent patients. Methods/Design: The CATCH-study consists of three separate randomised controlled, open-label, parallel-group feasibility trials, conducted at three separate addiction treatment institutes in the Netherlands. Patients are either new referrals or patients already in treatment. A total of 216 eligible outpatients are randomised using prerandomisation double-consent design and receive either 12 weeks treatment with oral topiramate (n = 36; Brijder Addiction Treatment, The Hague), oral modafinil (n = 36; Arkin, Amsterdam), or oral dexamphetamine sustainedrelease

  11. Osteoradionecrosis of the jaws—a current overview—part 2: dental management and therapeutic options for treatment

    Microsoft Academic Search

    Bruno Ramos Chrcanovic; Peter Reher; Alexandre Andrade Sousa; Malcolm Harris

    2010-01-01

    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

  12. Altered breathing syndrome in heart failure: newer insights and treatment options.

    PubMed

    Tomita, Yasuhiro; Kasai, Takatoshi; Kisaka, Tomohiko; Rossiter, Harry B; Kihara, Yasuki; Wasserman, Karlman; Daida, Hiroyuki

    2015-04-01

    In patients with heart failure (HF), altered breathing patterns, including periodic breathing, Cheyne-Stokes breathing, and oscillatory ventilation, are seen in several situations. Since all forms of altered breathing cause similar detrimental effects on clinical outcomes, they may be considered collectively as an "altered breathing syndrome." Altered breathing syndrome should be recognized as a comorbid condition of HF and as a potential therapeutic target. In this review, we discuss mechanisms and therapeutic options of altered breathing while sleeping, while awake at rest, and during exercise. PMID:25576448

  13. Obesity in HIV-infected patients in France: Prevalence and surgical treatment options.

    PubMed

    Pourcher, G; Costagliola, D; Martinez, V

    2015-02-01

    Increasing rate of obesity was reported in HIV-infected patients in USA. In France, no data are available to date. Bariatric surgery is the best option for morbid obesity in general population but few data exist in HIV-infected patients. We describe the prevalence of obesity in France in HIV-infected patients. The prevalence of obesity is 15.1% in women and 5.3% in men. Moreover, we described our experience and point of view in the management of HIV infected patients with morbid obesity. Prospective studies are needed for an optimal management of HIV-infected patients with morbid obesity. PMID:25662869

  14. Endoscopic ultrasonography: an advancing option with duality in both diagnosis and treatment of gastrointestinal oncology

    PubMed Central

    2014-01-01

    Since their introduction into the clinical practices in 1980s, techniques of endoscopic ultrasonography (EUS) have been rapidly developing and are now in widespread use in gastrointestinal oncology. Evolving from the classical option, EUS today has been much innovated with addition of a variety of novel ideation which makes it a powerful tool with encouraging duality for both diagnostic and therapeutic purposes. There is a dire need for physicians in this field to understand the status quo of EUS as related to the management and detection of gastrointestinal tumors, which is globally reviewed in this paper. PMID:25561772

  15. Balloon Kyphoplasty Compared to Vertebroplasty and Non-Surgical Management in Patients Hospitalised with Acute Osteoporotic Vertebral Compression Fracture – A UK Cost-Effectiveness Analysis

    PubMed Central

    Alvares, L; Cooper, C; Marsh, D; Ström, O

    2013-01-01

    Objective To estimate the cost-effectiveness of Balloon Kyphoplasty (BKP) for the treatment of patients hospitalised with acute Osteoporotic Vertebral Compression Fracture (OVCF) compared to Percutaneous Vertebroplasty (PVP) and Non-Surgical Management (NSM) in the UK. Methods A Markov simulation model was developed to evaluate treatment with BKP, NSM and PVP in patients with symptomatic OVCF. Data on health related quality of life (HRQoL) with acute OVCF were derived from the FREE and VERTOS II Randomised Clinical Trials (RCTs) and normalized to the NSM arm in the FREE trial. Estimated differences in mortality among the treatments and costs for NSM were obtained from the literature whereas procedure costs for BKP and PVP were obtained from three NHS hospitals. It was assumed that BKP and PVP reduced hospital length of stay by six days compared to NSM. Results The incremental cost-effectiveness ratio (ICER) was estimated at GBP 2,706 per QALY and GBP 15,982 per QALY compared to NSM and PVP respectively. Sensitivity analysis showed that the cost-effectiveness of BKP vs. NSM was robust when mortality and HRQoL benefits with BKP were varied. The cost-effectiveness of BKP compared to PVP was particularly sensitive to changes in the mortality benefit. Conclusion BKP may be a cost-effective strategy for the treatment of patients hospitalised with acute OVCF in the UK compared to NSM and PVP. Additional RCT data on the benefits of BKP and PVP compared to simulated sham-surgery and further data on the mortality benefits with BKP compared to NSM and PVP would reduce uncertainty. PMID:22890362

  16. Atypical Cogan's syndrome: A case report and summary of current treatment options.

    PubMed

    Jan?atová, Debora; Zeleník, Karol; Komínek, Pavel; Matoušek, Petr

    2015-03-01

    Cogan's syndrome is a rare chronic vasculitis, characterized in its typical form by progressive sensorineural bilateral hearing loss, vestibular symptoms and non-syphilitic interstitial keratitis. Only a few cases have been reported in children, most of whom have been diagnosed with the typical form. Early diagnosis and treatment are crucial to ensure a favorable prognosis. Systemic treatment usually begins with high dosage corticosteroids. In case the initial treatment fails, other immunosuppressive drugs are used (cyclophosphamide, methotrexate, cyclosporine A and azathioprine). Additional treatment possibilities, such as plasmapheresis, TNF-alpha blockers (etanercept and infliximab), rituximab, tocilizumab and mycophenolate mofetil have been described over the past few years. PMID:25600284

  17. Opioids in the treatment of postoperative pain: old drugs with new options?

    PubMed

    Raeder, Johan

    2014-03-01

    New approved options with opioids in the postoperative setting may include new ways of administration, new combinations with other drugs and new opioid drugs. Newly approved devices for administration include sublingual sufentanil dispenser and transdermal iontophoretic fentanyl, with the purpose of almost mimicking the rapid and reliable onset of intravenous (IV) administration, without the problems of an ongoing IV cannula and cumbersome equipment. Still, potential problems of overdosing and misuse must be in focus when these devices come into use. Tapentadol is a new partial µ-receptor opioid agonist with a combined action on norepinephrine-induced analgesia, representing a promising drug in terms of less side effects at equianalgesic doses compared with pure agonists. The mixture of different opioids given together, such as oxycodone and morphine, for oral use may also have some analgesic synergy with an improved side-effect profile, although more studies are needed. Oral oxycodone is a reliable oral opioid option, but when combined with paracetamol in the same tablet or mixture, care should also be taken to avoid serious side effects from inadvertent paracetamol overdose. PMID:24437530

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

    SciTech Connect

    BYRNES ME

    2008-06-05

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

  19. Vitrification treatment options for disposal of greater-than-Class-C low-level waste in a deep geologic repository

    SciTech Connect

    Fullmer, K.S.; Fish, L.W.; Fischer, D.K.

    1994-11-01

    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).

  20. Psychopharmacological Treatment Options for Global Child and Adolescent Mental Health: The WHO Essential Medicines Lists

    ERIC Educational Resources Information Center

    Kutcher, Stan; Murphy, Andrea; Gardner, David

    2008-01-01

    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…

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

    SciTech Connect

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

    1995-01-01

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

  2. Successful Non-Surgical Deep Uterine Transfer of Porcine Morulae after 24 Hour Culture in a Chemically Defined Medium

    PubMed Central

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

    2014-01-01

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

  3. Efficacy and Tolerability of Pharmacotherapy Options for the Treatment of Medullary Thyroid Cancer

    PubMed Central

    Deshpande, H. A.; Sheth, K.; Sosa, J. A.; Roman, S.

    2012-01-01

    Metastatic and unresectable medullary thyroid carcinoma (MTC) is often difficult to treat as it is relatively unresponsive to radiation and conventional chemotherapy. This emphasizes the importance of the development of targeted therapies for advanced MTC. Vandetanib was approved by the US Food and Drug Administration for the treatment of symptomatic or progressive MTC in patients with advanced disease in April 2011. This therapy proved to be a breakthrough in the management of MTC. We review the efficacy and safety of this novel treatment and other treatments that are being evaluated in this disease. PMID:23133319

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

    E-print Network

    Green, Vanessa (Vanessa Layton)

    2008-01-01

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

  5. [Medical treatment of endometriosis: an obligation rather than a mere option!].

    PubMed

    Roman, H; Sanguin, S; Puscasiu, L

    2012-05-01

    The aim of this article is to argue the usefulness of the systematic administration of medical treatment in women managed for endometriosis, either alone or associated with the surgery. The authors dispute seven frequent objections against the medical treatment: the lack of curative effect, the lack of primary prevention and the risk of delaying the diagnostic, the contraceptive effect in women wishing to conceive, the adverse effects, the risk of occurrence of new lesions following the arrest of the treatment, the lack of proof favourable to the efficient prevention of recurrences and the cost of the treatment. The authors conclude that to date the therapeutic amenorrhea represents an indispensable tool in the management of the endometriosis, in women both benefiting or not from surgical procedures. PMID:22521988

  6. Assessment of sludge management options in a waste water treatment plant

    E-print Network

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

    2012-01-01

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

  7. An overview of conservative treatment options for diabetic Charcot foot neuroarthropathy

    PubMed Central

    Ramanujam, Crystal L.; Facaros, Zacharia

    2011-01-01

    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. PMID:22396831

  8. Care of the Stroke Patient: Routine Management to Lifesaving Treatment Options

    Microsoft Academic Search

    George A. Lopez; Arash Afshinnik; Owen Samuels

    2011-01-01

    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

  9. International clinical trials, cardiovascular disease and treatment options in the Russian Federation: Research and treatment in practice.

    PubMed

    Zvonareva, Olga; Engel, Nora; Martsevich, Sergey; de Wert, Guido; Horstman, Klasien

    2015-03-01

    The issue of balance between research and treatment in clinical trials conduct has been surrounded by controversies. Scientific characteristics of trials may compromise medical care available to participants, while conceiving research participation as having therapeutic value may foster the therapeutic misconception. However, it has also been questioned whether research can and should always be separated from medical care provision. In this paper we analyze how these concerns played out in practice settings of the three trial sites in Russia, specialized in trials in cardiovascular diseases. Using in-depth interviews with participants of phase II and III trials (n = 21) and discussions with physician-investigators (n = 7), we found that trial enrollment allowed participants to establish continuous supportive relationships with the physician-investigators. In the context of unresponsive health care, chronically ill participants received regular monitoring, treatment recommendations and help in case of problems and emergencies through such relationships. The trial designs in the three sites did not preclude the provision of individualized treatment. We suggest that debates about the research/treatment interface in trials need to become more attuned to the conditions in locations of their conduct, views and experiences of actors involved and evolving trial methodologies. Too much focus on categorical differentiation of research and treatment may obscure the fact that globalizing clinical trials proceed amidst profound health disparities, dismiss diverse concerns of people on the ground and risk attenuating responsibilities of trial organizers, sponsors and investigators towards research participants. PMID:25635372

  10. Guidance on patient consultation. Current evidence for prostate-specific antigen screening in healthy men and treatment options for men with proven localised prostate cancer.

    PubMed

    Pini, Giovannalberto; Collins, Justin; Ghadjar, Pirus; Wiklund, Peter

    2015-05-01

    The main objective of this review is to summarise, for primary and secondary care doctors, the management options and current supporting evidence for clinically localised prostate cancer. We review all aspects of management including current guidelines on early cancer detection and the importance of informed consent on PSA-based screening and assess the most common treatment options and the evidence for managing patients with low-, medium-, and high-risk disease. PMID:25773347

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

    PubMed

    Buyukkamaci, Nurdan; Koken, Emre

    2010-11-15

    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

  12. Contemporary treatment options for chronic prostatitis/chronic pelvic pain syndrome.

    PubMed

    Ismail, M; Mackenzie, K; Hashim, H

    2013-07-01

    The prostate gland, about the size a walnut, forms part of the male reproductive system and sits directly underneath the bladder surrounding the urethra. It is a fibromuscular exocrine gland that secretes a complex proteolytic fluid which constitutes one-third of the volume of the seminal fluid. Prostatitis refers to a group of disorders that affect the prostate and cause genitourinary pain, dysuria, urinary frequency and sexual dysfunction. The prevalence of prostatitis in the United States has been estimated to be around 9%, while the worldwide prevalence ranges from 2 to 10%, and 15% of men experience prostatitis-like symptoms at some point in their lives. There are a number of treatments which have been used for chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS), with only a small amount of high-level evidence. The current recommended treatment for CP/CPPS is predominantly a multimodal approach using a combination of antibiotics, ?-blockers, antimuscarinic and anti-inflammatory drugs. The response to treatment and improvement in symptoms is very variable; therefore, as the evidence evolves, it is likely that treatment will become symptom specific rather than a generic, 'one strategy fits all' treatment for CP/CPPS. PMID:23914354

  13. Antimicrobial treatment of nosocomial meticillin-resistant Staphylococcus aureus (MRSA) pneumonia: current and future options.

    PubMed

    Welte, Tobias; Pletz, Mathias W

    2010-11-01

    Meticillin-resistant Staphylococcus aureus (MRSA) is a frequent cause of nosocomial pneumonia. Inadequate or inappropriate antimicrobial therapy, often caused by antimicrobial resistance, is associated with increased mortality for these infections. Agents currently recommended for the treatment of MRSA pneumonia include vancomycin and linezolid in the USA, and vancomycin, linezolid, teicoplanin and quinupristin/dalfopristin in Europe. Antimicrobials such as tigecycline and daptomycin, although approved for the treatment of some MRSA infections, have not demonstrated efficacy equivalent to the approved agents for MRSA pneumonia. Further agents lack data from randomised controlled trials (e.g. fosfomycin, fusidic acid or rifampicin in combination with vancomycin). Antimicrobial agents that have recently been approved or are being investigated as treatments for MRSA infections include the lipoglycopeptides telavancin (approved for the treatment of complicated skin and skin-structure infections in the USA and Canada), dalbavancin and oritavancin, the cephalosporins ceftobiprole and ceftaroline, and the dihydrofolate reductase inhibitor iclaprim. To be an effective treatment for MRSA pneumonia, antimicrobial agents must have activity against antimicrobial-resistant S. aureus, penetrate well into the lung, have a low potential for resistance development and have a good safety profile. Here, the available data for current and potential future MRSA pneumonia antimicrobials are reviewed and discussed. PMID:20724119

  14. Update on the use of topical NSAIDs for the treatment of soft tissue and musculoskeletal pain: a review of recent data and current treatment options.

    PubMed

    Brewer, Alan R; McCarberg, Bill; Argoff, Charles E

    2010-06-01

    Topical nonsteroidal anti-inflammatory drugs (NSAIDs) have an emerging role in the treatment of certain types of acute pain. In addition to their convenience, efficacy, and safety, they are an attractive option, particularly when considering current concerns about the safety of traditional NSAIDs and cyclooxygenase-2 (COX-2) inhibitors (coxibs). Topical analgesics act largely within the peripheral nervous system. Studies have demonstrated that topical NSAIDs penetrate the skin and distribute to the target tissues underlying the application site. Because the pharmacologically effective dose is delivered at the site of pain, there is minimal systemic absorption and risk of related adverse events. Topical NSAIDs have been used for many years in Europe, with extensive post-marketing data available for some of the agents. Three topical NSAID formulations have recently been approved for use in the United States: the diclofenac epolamine topical patch 1.3% (DETP), diclofenac sodium 1% gel, and diclofenac sodium topical solution 1.5%. Topical NSAIDs provide a therapeutic option for treatment of acute, localized, soft tissue injuries or painful conditions in areas of the body that can be readily treated using the topical route of administration. This article reviews available data on the use of topical NSAID therapy. PMID:20631465

  15. Endovascular Treatment Options in the Management of Lower Limb Deep Venous Thrombosis

    SciTech Connect

    Nazir, Sarfraz Ahmed, E-mail: sarfraznazir@doctors.org.uk; 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)

    2009-09-15

    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.

  16. Hypoactive sexual desire disorder in women: treatment options beyond testosterone and approaches to communicating with patients on sexual health.

    PubMed

    Lodise, Nicole M

    2013-04-01

    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

  17. Adjuvant and neoadjuvant options in resectable gastric cancer: is there an optimal treatment approach?

    PubMed

    Chen, Xuguang; Eads, Jennifer R; Ammori, John B; Kumar, Aryavarta M; Biswas, Tithi; Dorth, Jennifer A

    2015-04-01

    Gastric cancer is one of the most prevalent and deadliest forms of cancer worldwide. Even though neoadjuvant, perioperative, and adjuvant chemotherapy and/or radiation therapy may improve outcomes compared with surgery alone, the optimal combination of treatment modalities remains controversial. While European and North American trials established perioperative chemotherapy and adjuvant chemoradiation regimens for gastric cancer, Asian countries have focused on the use of adjuvant chemotherapy. This review summarizes results from contemporary randomized controlled trials and meta-analyses to elucidate the relative merits of each treatment approach. PMID:25708803

  18. Near-infrared light as a possible treatment option for Parkinson's disease and laser eye injury

    NASA Astrophysics Data System (ADS)

    DeSmet, Kristina; Buchmann, Ellen; Henry, Michele; Wong-Riley, Margaret; Eells, Janis; VerHoeve, Jim; Whelan, Harry

    2009-02-01

    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 on mitochondrial metabolism in vitro and cell injury in vivo. NIR light treatment represents an innovative therapeutic approach for disease processes in which mitochondrial dysfunction is postulated to play a role including Parkinson's disease, laser eye injury and Age-related macular degeneration.

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

    PubMed Central

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

    2014-01-01

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

  20. Update on the management of chronic eczema: new approaches and emerging treatment options

    PubMed Central

    Walling, Hobart W; Swick, Brian L

    2010-01-01

    Atopic dermatitis (AD) is a common disease with worldwide prevalence, affecting up to 20% of children and 3% of adults. Recent evidence regarding pathogenesis has implicated epidermal barrier defects deriving from filagrin mutations with resulting secondary inflammation. In this report, the authors comprehensively review the literature on atopic dermatitis therapy, including topical and systemic options. Most cases of AD will benefit from emollients to enhance the barrier function of skin. Topical corticosteroids are first-line therapy for most cases of AD. Topical calcineurin inhibitors (tacrolimus ointment, pimecrolimus cream) are considered second line therapy. Several novel barrier-enhancing prescription creams are also available. Moderate to severe cases inadequately controlled with topical therapy may require phototherapy or systemic therapy. The most commonly employed phototherapy modalites are narrow-band UVB, broadband UVB, and UVA1. Traditional systemic therapies include short-term corticosteroids, cyclosporine (considered to be the gold standard), methotrexate, azathioprine, mycophenolate mofetil, and most recently leflunamide. Biologic therapies include recombinant monoclonal antibodies acting on the immunoglobulin E / interleukin-5 pathway (omalizumab, mepolizumab), acting as tumor necrosis factor-? inhibitors (infliximab, etanercept, adalimumab), and acting as T-cell (alefacept) and B-cell (rituxumab) inhibitors, as well as interferon ? and intravenous immunoglobulin. Efficacy, safety, and tolerability are reviewed for each medication. PMID:21437065

  1. STATUS AND TRENDS OF THE RESIDUAL WASTE TREATMENT OPTIONS (LANDFILLING, MECHANICAL BIOLOGICAL TREATMENT AND INCINERATION) IN BELGIUM (FLANDERS)

    Microsoft Academic Search

    Roel Vaes

    Since waste policy is a regional authority in Belgium, the Flemish and Walloon region as well as the metropolitan region of Brussels have their own waste legislation. The Flemish region is authorised with the planning and targeting of the municipal waste policy. Basic assumption of the policy is the waste treatment hierarchy in which waste prevention and re-use is followed

  2. Music performance anxiety-part 2. a review of treatment options.

    PubMed

    Brugués, Ariadna Ortiz

    2011-09-01

    Music performance anxiety (MPA) affects many individuals independent of age, gender, experience, and hours of practice. In order to prevent MPA from happening or to alleviate it when it occurs, a review of the literature about its prevention and treatment was done. Forty-four articles, meeting evidence-based medicine (EBM) criteria, were identified and analyzed. Performance repertoire should be chosen based on the musician's skill level, and it should be practiced to the point of automaticity. Because of this, the role of music teachers is essential in preventing MPA. Prevention is the most effective method against MPA. Several treatments (psychological as well as pharmacological) have been studied on subjects in order to determine the best treatment for MPA. Cognitive-behavioral therapy (CBT) seems to be the most effective, but further investigation is desired. Some musicians, in addition to CBT, also take beta-blockers; however, these drugs should only be prescribed occasionally after analyzing the situation and considering the contraindications and possible side effects. Despite these conclusions, more randomized studies with larger, homogeneous groups of subjects would be desirable (according to the EBM criteria), as well as support for the necessity of both MPA prevention and optimized methods of treatment when it does occur. PMID:21987072

  3. Chronic proctalgia and chronic pelvic pain syndromes: New etiologic insights and treatment options

    PubMed Central

    Chiarioni, Giuseppe; Asteria, Corrado; Whitehead, William E

    2011-01-01

    This systematic review addresses the pathophysiology, diagnostic evaluation, and treatment of several chronic pain syndromes affecting the pelvic organs: chronic proctalgia, coccygodynia, pudendal neuralgia, and chronic pelvic pain. Chronic or recurrent pain in the anal canal, rectum, or other pelvic organs occurs in 7% to 24% of the population and is associated with impaired quality of life and high health care costs. However, these pain syndromes are poorly understood, with little research evidence available to guide their diagnosis and treatment. This situation appears to be changing: A recently published large randomized, controlled trial by our group comparing biofeedback, electrogalvanic stimulation, and massage for the treatment of chronic proctalgia has shown success rates of 85% for biofeedback when patients are selected based on physical examination evidence of tenderness in response to traction on the levator ani muscle-a physical sign suggestive of striated muscle tension. Excessive tension (spasm) in the striated muscles of the pelvic floor appears to be common to most of the pelvic pain syndromes. This suggests the possibility that similar approaches to diagnostic assessment and treatment may improve outcomes in other pelvic pain disorders. PMID:22110274

  4. Screening of Recovery and Treatment Options for Waste Minimization Andreas A. Linninger* and Aninda Chakraborty

    E-print Network

    Linninger, Andreas A.

    , University of Illinois, Chicago. Chicago, IL 60607, U.S.A. Phone: (312) 996-2581, Fax: (312) 996-0808, email EVIEW #12;2 Keywords Waste treatment, process synthesis, pollution prevention Introduction Traditionally with a given laboratory recipe. Today, pollution prevention commands consideration of the process in its

  5. Chronic proctalgia and chronic pelvic pain syndromes: new etiologic insights and treatment options.

    PubMed

    Chiarioni, Giuseppe; Asteria, Corrado; Whitehead, William E

    2011-10-28

    This systematic review addresses the pathophysiology, diagnostic evaluation, and treatment of several chronic pain syndromes affecting the pelvic organs: chronic proctalgia, coccygodynia, pudendal neuralgia, and chronic pelvic pain. Chronic or recurrent pain in the anal canal, rectum, or other pelvic organs occurs in 7% to 24% of the population and is associated with impaired quality of life and high health care costs. However, these pain syndromes are poorly understood, with little research evidence available to guide their diagnosis and treatment. This situation appears to be changing: a recently published large randomized, controlled trial by our group comparing biofeedback, electrogalvanic stimulation, and massage for the treatment of chronic proctalgia has shown success rates of 85% for biofeedback when patients are selected based on physical examination evidence of tenderness in response to traction on the levator ani muscle--a physical sign suggestive of striated muscle tension. Excessive tension (spasm) in the striated muscles of the pelvic floor appears to be common to most of the pelvic pain syndromes. This suggests the possibility that similar approaches to diagnostic assessment and treatment may improve outcomes in other pelvic pain disorders. PMID:22110274

  6. How does obesity affect fertility in men - and what are the treatment options?

    PubMed

    Stokes, Victoria J; Anderson, Richard A; George, Jyothis T

    2015-05-01

    Adiposity is associated with reduced fertility in men. The aetiology is multifactorial, with obese men at greater risk of suffering from impaired spermatogenesis, reduced circulating testosterone levels, erectile dysfunction and poor libido. The diagnosis and treatment of reduced fertility observed in obese men therefore requires insight into the underlying pathology, which has hormonal, mechanical and psychosocial aspects. This article summarises the current epidemiological, experimental and clinical trial evidence from the perspective of a practicing clinician. The following conclusions and recommendations can be drawn: Obesity is associated with low serum testosterone concentrations, but treatment with exogenous testosterone is likely to adversely impact on fertility. It is important to discuss this with men prior to initiation of testosterone therapy. Obesity adversely affects sperm concentration and may affect sperm quality. However, whether or not weight loss will correct these factors remain to be established. Oestrogen receptor modulators (and aromatase inhibitors) are unlicensed in the treatment for male hypogonadism and/or infertility. These treatments should hence be considered experimental approach until ongoing clinical trials report their outcomes. PMID:25138694

  7. Ureteral injury during vaginal mesh excision: role of prevention and treatment options.

    PubMed

    Heisler, Christine A; Casiano, Elizabeth R; Klingele, Christopher J; Gebhart, John B; Trabuco, Emanuel C

    2012-12-01

    Vaginal mesh kits are increasingly used in vaginal prolapse repair. Mesh erosion, infection, and pain may necessitate removal, which can lead to urinary tract injury. We describe 2 cases of ureteral injury at the time of mesh excision. Surgeons must recognize the possibility of ureteral injury and treatment modalities available. PMID:22999155

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

    Microsoft Academic Search

    A. Kapoor; T. Viraraghavan

    1995-01-01

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

  9. New surgical treatment options in patients with benign prostate hyperplasia (BPH)

    NASA Astrophysics Data System (ADS)

    de Riese, Werner T. W.; Nelius, Thomas; Aronoff, David R.; Mittemeyer, Bernhard T.

    2003-06-01

    Benign prostatic hyperplasia (BPH) is a common disease in males older than 50 years of age. 75-80% of this population is considered to have some degree of BPH causing clinical symptoms and requiring urological treatment. Transurethral resection of the prostate (TUR-P) is currently the standard surgical treatment modality for BPH. In an attempt to minimize the need for hospitalization and the associated perioperative and postoperative morbidity, alternatives have been sought. Various types of Laser techniques such as interstitial Laser cogaulation and side-firing technology have been proposed. Numerous studies have shown that Laser procedures safely and effectively reduce the volume of the prostate. Intra- and postoperative bleeding are nearly unknown complications for Laser procedures, whereas this is the most relevant complication for the TUR-P. Due to significant tissue edema after Laser treatment, patients commonly show delayed time to void adequately, and therefore, catheter drainage is often necessary for 3 to 21 days. Retrograde ejaculation is reported to occur less (0 - 10%) compared to TUR-P (> 60%). Urinary tract infections are very common after interstitial laser coagulation. Although not many long-term clinical data are available, various studies have shown that BPH patients improve in symptom score, flow rate and post-void residual up to 3 years after Laser treatment. This paper presents a concise review of efficacy, advantages and disadvantages of the most frequently used Laser techniques as well as the long-term clinical data compared to TUR-P.

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

    ERIC Educational Resources Information Center

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

    2007-01-01

    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…

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

    ERIC Educational Resources Information Center

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

    2007-01-01

    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…

  12. Topical Pimecrolimus as a New Optional Treatment in Cutaneous Sarcoidosis of Lichenoid Type

    PubMed Central

    Tammaro, Antonella; Abruzzese, Claudia; Narcisi, Alessandra; Cortesi, Giorgia; Parisella, Francesca Romana; Di Russo, Pier Paolo; De Marco, Gabriella; Persechino, Severino

    2014-01-01

    We report the case of cutaneous sarcoidosis of lichenoid type successfully treated with pimecrolimus. For the first time in the literature, we propose the use of this topical calcineurin inhibitor for the treatment of the cases refractory to common therapy regimens. PMID:24826355

  13. Topical pimecrolimus as a new optional treatment in cutaneous sarcoidosis of lichenoid type.

    PubMed

    Tammaro, Antonella; Abruzzese, Claudia; Narcisi, Alessandra; Cortesi, Giorgia; Parisella, Francesca Romana; Di Russo, Pier Paolo; De Marco, Gabriella; Persechino, Severino

    2014-01-01

    We report the case of cutaneous sarcoidosis of lichenoid type successfully treated with pimecrolimus. For the first time in the literature, we propose the use of this topical calcineurin inhibitor for the treatment of the cases refractory to common therapy regimens. PMID:24826355

  14. Environmental and cost life cycle assessment of disinfection options for municipal wastewater treatment

    EPA Science Inventory

    This document summarizes the data collection, analysis, and results for a base case wastewater treatment (WWT) plant reference model. The base case is modeled after the Metropolitan Sewer District of Greater Cincinnati (MSDGC) Mill Creek Plant. The plant has an activated sludge s...

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

    Microsoft Academic Search

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

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

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

    Microsoft Academic Search

    Christopher L Vaughan; Nivedita Subramanian; Monica E Busse

    1998-01-01

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

  17. Emerging treatment options for recurrent ovarian cancer: the potential role of olaparib

    PubMed Central

    Shaw, Heather M; Hall, Marcia

    2013-01-01

    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. PMID:24043945

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

    PubMed

    Michel, Jacqueline; Rutherford, Nicolle

    2014-05-15

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

  19. Idiopathic chondrolysis of the hip: presentation, natural history and treatment options.

    PubMed

    Segaren, Neil; Abdul-Jabar, Hani B; Segaren, Nicholas; Hashemi-Nejad, Aresh

    2014-03-01

    Idiopathic chondrolysis of the hip is a rare disorder characterized by pain, stiffness, limp and radiological loss of joint space of the affected hip. The clinical outcome varies from complete recovery to fibrous ankylosis. Management remains controversial. We aim to outline the natural history and pathology of the disease and treatment strategies. PMID:24276116

  20. Prostate disease: management options for the primary healthcare team. Report of a working party of the British Prostate Group.

    PubMed Central

    Chisholm, G. D.; Carne, S. J.; Fitzpatrick, J. M.; George, N. J.; Gingell, J. C.; Keen, J. W.; Kirby, R. S.; Kirk, D.; O'Donoghue, E. P.; Peeling, W. B.

    1995-01-01

    The prostate gland has attracted a remarkable increase in interest in the past few years. The two most common diseases of this gland, benign prostatic hyperplasia and carcinoma of the prostate, have been brought into greater prominence by new diagnostic methods, public interest, and a wider choice of surgical and non-surgical treatments. Uncertainty about the significance of these changes has occurred because of the rapidity of change, the profusion of statements, opinions and promotions, and the relatively little guidance available from the profession. Ten urologists and two general practitioners have reviewed the relevant evidence about these two prostate diseases and the newer diagnostic methods; their conclusions are summarised here. Management options and guidance on clinical practice are also discussed. Because of a number of unresolved diagnostic and management issues, detailed requirements for practice guidelines have not been specified. PMID:7538216

  1. Coccygectomy as a Surgical Option in the Treatment of Chronic Traumatic Coccygodynia: A Single-Center Experience and Literature Review

    PubMed Central

    Antoniadis, Alexander; Ulrich, Nils Harry-Bert

    2014-01-01

    Study Design Retrospective cohort study. Purpose Trauma is the most common cause for chronic coccygodynia. The present study aims at presenting our results after complete removal of the coccyx for refractory traumatic coccygodynia in terms of pain level, complication rates, and patients' overall satisfaction. Overview of Literature There is limited extant literature describing the success rate and complications in refractory isolated traumatic coccygodynia. Methods From January 2011 to January 2012, 10 consecutive patients with posttraumatic coccygodynia (six males and four females; mean age, 42 years) were enrolled in our study. Conservative treatment of the condition had failed in all patients. The same surgeon performed a complete coccygectomy on all patients. Postoperative outcomes included measurements of pain relief and degree of patient satisfaction with the procedure's results. Results In our selected cohort, all patients indicated complete pain relief or significant pain improvement in follow up-care and would recommend this procedure. One patient developed a subcutaneous hematoma that required surgical intervention. Conclusions Our results suggest that complete removal of the coccyx relieves pain in patients with refractory chronic traumatic coccygodyniaand is therefore a reasonable treatment option after conservative treatment failure. PMID:25558311

  2. The melanocortin-4 receptor as target for obesity treatment: a systematic review of emerging pharmacological therapeutic options.

    PubMed

    Fani, L; Bak, S; Delhanty, P; van Rossum, E F C; van den Akker, E L T

    2014-02-01

    Obesity is one of the greatest public health challenges of the 21st century. Obesity is currently responsible for ?0.7-2.8% of a country's health costs worldwide. Treatment is often not effective because weight regulation is complex. Appetite and energy control are regulated in the brain. Melanocortin-4 receptor (MC4R) has a central role in this regulation. MC4R defects lead to a severe clinical phenotype with lack of satiety and early-onset severe obesity. Preclinical research has been carried out to understand the mechanism of MC4R regulation and possible effectors. The objective of this study is to systematically review the literature for emerging pharmacological obesity treatment options. A systematic literature search was performed in PubMed and Embase for articles published until June 2012. The search resulted in 664 papers matching the search terms, of which 15 papers remained after elimination, based on the specific inclusion and exclusion criteria. In these 15 papers, different MC4R agonists were studied in vivo in animal and human studies. Almost all studies are in the preclinical phase. There are currently no effective clinical treatments for MC4R-deficient obese patients, although MC4R agonists are being developed and are entering phase I and II trials. PMID:23774329

  3. Standard treatment option in stage III non-small-cell lung cancer: case against trimodal therapy and consolidation drug therapy.

    PubMed

    Jeremi?, Branislav

    2015-03-01

    Prospective randomized trials and meta-analyses established concurrent radiochemotherapy (RT-CHT) as standard treatment approach in patients with inoperable, locally advanced (stage IIIA and B) non-small-cell lung cancer (NSCLC). In patients with either clinically (c) or pathologically (p) staged disease (stage IIIA), including those with pN2 disease, trimodal therapy was also frequently practiced in the past and is currently still advocated by large cooperative groups and organizations. Similarly, consolidation CHT provided after concurrent RT-CHT was suggested to be feasible and effective in inoperable stage III NSCLC. Contrasting these practices and suggestions, there is no evidence that trimodal therapy in stage IIIA (clinically or pathologically staged) or consolidation CHT in inoperable stage III NSCLC plays any role in its treatment. In both cases, evidence clearly demonstrates that concurrent RT-CHT is of similar efficacy and less toxic, and it should be considered a standard treatment option for all patients with stage III NSCLC. PMID:25450877

  4. Recurrent Challenges for Clinicians: Emergence of Methicillin-Resistant Staphylococcus aureus, Vancomycin Resistance, and Current Treatment Options

    PubMed Central

    Tarai, Bansidhar; Das, Poonam; Kumar, Dilip

    2013-01-01

    Gram-positive pathogens mainly, Staphylococcus aureus, Enterococcus and coagulase-negative Staphylococcus, are developing increasing resistance to glycopeptides that pose a problem in treating infections caused by these pathogens. Vancomycin is the treatment of choice in treating methicillin-resistant S. aureus (MRSA). Community-acquired MRSA is associated with infections in patients without recent history of hospital admission and without the classical risk factors for MRSA carriage (including healthcare personnel). MRSA poses new threats and challenges beyond the hospital with the emergence of community-acquired MRSA. Indiscriminate use of vancomycin leads to the emergence and spread of vancomycin resistance in multidrug resistant strains is of growing concern in the recent years. Minimum Inhibitory concentration (MIC) remains an important determinant in choosing the right antibiotics. Infections caused by MRSA strains with vancomycin MIC > 4 ?g/mL leads to the vancomycin treatment failure. The Clinical Laboratory Standards Institute had also lowered the cut-off susceptibility and resistance breakpoints for vancomycin. Despite the availability of newer antimicrobial agents (Linezolid, Daptomycin, Tigecycline) for drug-resistant Gram-positive pathogens, clinicians and patients still need options for treatment of MRSA infection. There is a need to reduce the global burden of infections caused by Gram-positive pathogens and its resistant strains (mainly MRSA). Continuous efforts should be made to prevent the spread and the emergence of glycopeptide resistance by early detection of the resistant strains and using the proper infection control measures in the hospital setting. PMID:24701097

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

    PubMed Central

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

    2010-01-01

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

  6. New treatment options in the management of glioblastoma multiforme: a focus on bevacizumab

    PubMed Central

    Moustakas, Argirios; Kreisl, Teri N

    2010-01-01

    Glioblastoma multiforme (GBM) is the most common malignant primary brain tumor in adults and carries the poorest prognosis. Despite recent progress in molecular biology, neuro-imaging and neuro-surgical care, the management of patients with GBM continues to harbor significant challenges. Survival after diagnosis is poor even with the most aggressive approach using multimodality therapy. Although the etiology of malignant gliomas is not known, the dependency of tumor growth on angiogenesis has identified this pathway as a promising therapeutic target. Bevacizumab was the first antiangiogenic therapy approved for use in cancer and received accelerated Food and Drug Administration approval for the treatment of recurrent GBM in 2009, the first new drug for this disease in over a decade. This review describes the rationale behind the treatment of GBM with bevacizumab. The pharmacology, efficacy, safety and tolerability of bevacizumab will also be reviewed. PMID:20616955

  7. Novel treatment options in stage I non-small-cell lung cancer.

    PubMed

    Tarasevych, Svitlana; Lauwers, Patrick; Vandaele, Frederik; van Meerbeeck, Jan P

    2014-09-01

    In the last 5 years, the current management of stage I non-small-cell lung cancer has been challenged due to novel surgical approaches and advances in radiation technology. The outcome after a sublobar resection is promising, especially for tumors less than 2 cm. Other treatment opportunities are available for high risk patients with comorbidity and impaired pulmonary function. Stereotactic ablative body radiotherapy is a good alternative treatment to surgery, especially in elderly and comorbid patients. However, randomized evidence comparing sublobar resection and stereotactic radiotherapy is presently lacking. The most recent development in radiotherapy is hadron therapy with a presumed reduced toxicity because of its peculiar physical and biological effects. Promising thermal and microwave ablative techniques are in development and have specific niche indications. PMID:24930519

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

    SciTech Connect

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

    1991-12-01

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

  9. Intraspinal neuroblastoma: Treatment options and neurological outcome of spinal cord compression

    PubMed Central

    FAWZY, MOHAMED; EL-BELTAGY, MOHAMED; SHAFEI, MAGED EL; ZAGHLOUL, MOHAMED SAAD; KINAAI, NAGLAA AL; REFAAT, AMAL; AZMY, SARAH

    2015-01-01

    Malignant spinal cord compression (MSCC) is a common complication of cancer. Paraspinal neuroblastoma (NB) in the thoracic, abdominal and pelvic regions may extend into the neural foramina causing compression of nerve roots and even the spinal cord. The prompt initiation of specific treatment can improve the neurological outcome. The aim of the present study was to review the clinical features, the management received and the factors that may affect the outcome of patients with MSCC caused by paraspinal NB. During a period between July 2007 and December 2012, a total of 576 NB patients were treated at the Children’s Cancer Hospital (Cairo, Egypt). Intraspinal disease extension was present in 51 patients (9%). The children with intraspinal disease extension were reviewed for disease pattern, neurological manifestations and treatment outcome. Children with intraspinal disease extension had an equal male to female ratio (1:1), and approximately two-thirds of patients (34/51) had a clinically manifested cord compression. The duration of neurological manifestations was >4 weeks in 58.8% (20/34) of symptomatic patients and ?4 weeks in 41.2% (14/34). Subsequent to starting treatment, neurological manifestations showed a complete recovery in 16 patients (47.1%), partial in 11 (32.4%), and stationary course was found in 7 (20.6%). Manifestations of ?4 weeks in duration carried an improved outcome compared with longer time compression, with a complete recovery in 78.6%, versus 25% for patients with a longer symptom duration (P=0.008). The upfront treatment, patient age and site of the primary tumor did not significantly affect the neurological outcome. Spinal cord compression in NB can be effectively managed with upfront chemotherapy. Initial surgical decompression should be reserved for benign variants only, including ganglioneuroma. Neurological manifestations of <4 weeks duration upon presentation are usually reversible. PMID:25624912

  10. Evidence-based assessment of treatment options for children with IgA nephropathies

    Microsoft Academic Search

    Robert J. Wyatt; Ronald J. Hogg

    2001-01-01

    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

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

    Cancer.gov

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

  12. Partially corrected X-linked severe combined immunodeficiency: long-term problems and treatment options

    Microsoft Academic Search

    Suk See De Ravin; Harry L. Malech

    2009-01-01

    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

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

    PubMed

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

    2003-07-01

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

  14. The potential of panobinostat as a treatment option in patients with relapsed and refractory multiple myeloma

    PubMed Central

    Andreu-Vieyra, Claudia V.

    2014-01-01

    Panobinostat is an investigational and potent histone deacetylase inhibitor (HDACi) that has shown promise as an antimultiple myeloma agent in the preclinical setting. In this review, we discuss the rationale for the use of panobinostat as a combination therapy for multiple myeloma and provide an overview of recent and ongoing clinical trials testing the safety and efficacy of panobinostat for the treatment of the disease. PMID:25469210

  15. Clinical observations programme in SpA: disease parameters, treatment options and practical management issues

    Microsoft Academic Search

    Dirk Elewaut; Filip Van den Bosch; Gust Verbruggen; Filip de Keyser; Bert Vander Cruyssen; Herman Mielants

    2009-01-01

    Spondyloarthritides (SpAs) are a cluster of chronic inflammatory rheumatic diseases that typically involve inflammation of\\u000a axial and peripheral joint or tendon and ligament insertions, distinct radiographic changes and diverse extra-articular features.\\u000a Conventional treatments relieve the signs and symptoms but do not prevent disease progression. TNF? inhibitors provide clinicians\\u000a with the potential to treat the underlying pathology and to alter disease

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

    PubMed Central

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

    2010-01-01

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

  17. [Endoscopic ultrasound-guided ethanol ablation: an alternative option for the treatment of pancreatic insulinoma].

    PubMed

    Bor, Renáta; Farkas, Klaudia; Bálint, Anita; Molnár, Tamás; Nagy, Ferenc; Valkusz, Zsuzsanna; Sepp, Krisztián; Tiszlavicz, László; Hamar, Sándor; Szepes, Zoltán

    2014-10-12

    Endoscopic ultrasound is the most accurate imaging modality for the diagnosis of pancreatic cancer, and endoscopic ultrasound-guided fine needle injection has already been used for palliative interventions. Surgical resection is currently the standard treatment for pancreatic insulinoma. Medical treatment may be necessary for symptomatic patients with unresectable disease. Case reports have been published about the success of endoscopic ultrasound-guided alcoholic ablation, but it has not been reported previously in Hungarian literature. The authors present the history of an 83-year-old woman who was evaluated because of repeated hypoglycemic coma occurring during the night. Endosonographic image and laboratory findings (elevated serum insulin and chromogranin A) revealed pancreatic insulinoma. Because of severe comorbidities and high risk of surgical resection, the decision was made to ablate the insulinoma by endoscopic ultrasound-guided alcohol injection. A total of 3 mL 95% ethanol was injected into the tumor. Despite the discontinuation of the diazoxide therapy the hypoglycemic episodes disappeared. This case history confirms that endoscopic ultrasound-guided alcoholic ablation is a novel, minimal invasive alternative treatment for patients with pancreatic neuroendocrine tumors in whom surgery is not feasible. PMID:25282110

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

    PubMed Central

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

    2012-01-01

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

  19. Treatment Options for Late Type III Endoleaks after Endovascular Aneurysm Repair.

    PubMed

    Eng, Maia L; Brewer, Michael B; Rowe, Vincent L; Weaver, Fred A

    2015-04-01

    Late type III endoleaks result from complete or partial separation of endograft device components. Component separation repressurizes the aortic sac and may result in aortic rupture. We report 4 cases of late type III endoleaks after initial successful endovascular aneurysm repair for abdominal aortic aneurysm. Our cases include 3 aortic cuff separations and 1 iliac limb separation. The average time before graft separation was 3.25 years with an average aneurysm size at re-presentation of 8.2 cm. Management of these complex cases will be discussed, the literature reviewed, and recommendations for treatment offered. PMID:25597652

  20. Investigation of treatment options to minimize the effects of acid erosion on enamel.

    PubMed

    Dehghan, M; Stanley, P J; Tantbirojn, D; Versluis, A

    2014-01-01

    This in vitro study investigated 4 products (containing calcium, phosphate, and/or fluoride) and their ability to reharden enamel softened by hydrochloric acid as compared to hardening with saliva alone. Extracted human molars were embedded and polished, and baseline Vickers hardness (VH) of enamel was measured. Statistical analysis was performed with ANOVA followed by Student-Newman-Keuls post hoc tests (P = 0.05). For all groups, VH decreased significantly after immersion in hydrochloric acid. Fluoride in combination with casein phosphopeptide amorphous calcium phosphate was the most effective treatment for enamel hardness recovery. PMID:24983182

  1. Vascular rejection in heart transplantation: clinical correlation, treatment options, and future considerations.

    PubMed

    Olsen, S L; Wagoner, L E; Hammond, E H; Taylor, D O; Yowell, R L; Ensley, R D; Bristow, M R; O'Connell, J B; Renlund, D G

    1993-01-01

    Vascular rejection injures the vascular endothelium in cardiac allografts in the absence of significant intramyocardial lymphocytic infiltration. When compared with cellular rejection, vascular rejection occurs earlier after transplantation, is more resistant to immunosuppressive augmentation, causes more allograft dysfunction, and is associated with a higher frequency of allograft loss. Between January 1990 and October 1992, acute hemodynamically significant vascular rejection developed in 13 of 170 patients (8%). Endomyocardial biopsy specimens revealed the typical findings of endothelial cell activation, immune complex deposition, and interstitial fibrin deposition in the absence of significant lymphocytic infiltration. All patients had clinical evidence of allograft dysfunction. In addition to high-dose corticosteroids, all patients received cyclophosphamide as an oral pulse for 4 days and underwent plasmapheresis for 3 consecutive days. Eight patients received OKT3 (n = 6) or antilymphoblast globulin (n = 2), and nine patients underwent systemic anticoagulation. Six patients required inotropic therapy for hemodynamic instability. Although one patient died during the initial episode, rejection resolved and left ventricular function returned to normal in 12 of 13 patients. However, vascular rejection recurred in three patients, two of whom subsequently died. Two other patients died during late follow-up because of noncompliance. Eight patients remain alive with normal allograft function and angiographically normal coronary arteries. Whereas the addition of cyclophosphamide and plasmapheresis may improve the outcome of vascular rejection, the results of treatment with currently available treatment modalities remain unacceptably poor. PMID:8476883

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

    PubMed Central

    Kirino, Eiji

    2014-01-01

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

  3. Short and sticky options in the treatment of the partially dentate patient.

    PubMed

    Jepson, N J; Allen, P F

    1999-12-25

    As we move into the twenty-first century, patterns of dental disease in adults are changing. Surveys of adult dental health indicate that more people are keeping their teeth for longer in life. In many cases, the ravages of dental disease and the cumulative effect of a lifetime of restorative dentistry lead to gradual tooth loss. For many of these patients, restoration of a complete dentition may not be feasible nor desirable. In recent years, functionally oriented treatment planning has become acceptable in light of recent research findings. Using this approach, treatment efforts and resources are directed principally at retaining the 'strategic' part of the dentition in the long term, ie, the anterior and premolar teeth. This paper describes, with the aid of treated cases, a means of combining a shortened dental arch strategy with resin bonded bridgework. With the aid of recent research in this area of clinical practice, some suggestions as to the use of the technique are also described. PMID:10654439

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

    PubMed Central

    Bilici, Ahmet

    2014-01-01

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

  5. Treatment options in patients with decompensated cirrhosis, pre- and post-transplantation.

    PubMed

    Gambato, Martina; Lens, Sabela; Navasa, Miquel; Forns, Xavier

    2014-11-01

    Interferon-based treatments have a poor safety profile and limited efficacy in patients with advanced liver disease and in patients with hepatitis C (HCV) recurrence after liver transplantation (LT). Despite the recent approval of the first interferon-free regimen, which will be followed by several other interferon-free combinations in 2014 and 2015, data in patients with advanced cirrhosis and hepatitis C after LT are still limited. One study has already proven the concept that graft HCV infection can be prevented in a significant proportion of patients by treating them with sofosbuvir and ribavirin while awaiting LT. Two interferon-free regimens have also demonstrated a high efficacy in patients with hepatitis C recurrence after transplantation. Before these treatment strategies can be implemented in clinical practice, a few issues need to be addressed: (1) safety and efficacy of new antivirals in patients with decompensated cirrhosis, (2) the impact of viral clearance on liver function, (3) the potential consequences of virological failure (and the selection of multi-drug resistant HCV strains) in patients with decompensated cirrhosis or with severe hepatitis C recurrence after LT, and (4) drug-drug interactions (DDI) profiles. Finally, in the transplant setting it is also relevant to learn which strategy is most cost-effective in minimizing the negative impact of hepatitis C: preventing graft infection by treating patients before transplantation or treating hepatitis C recurrence after LT. PMID:25443340

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

    PubMed

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

    2014-10-01

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

  7. Bladder augmentation and urinary diversion in patients with neurogenic bladder: non-surgical considerations.

    PubMed

    Stein, Raimund; Schröder, Annette; Thüroff, Joachim W

    2012-04-01

    Segments from almost all parts of the bowel have been used for urinary diversion. As a result, the available absorptive surface area of the bowel is reduced, and the incorporation of bowel segments into the urinary tract may have metabolic consequences. This is an area somewhat neglected in the literature. Metabolic complications are rare, but sub-clinical metabolic disturbances are quite common. Several studies have demonstrated that some of the absorbent and secreting properties of the bowel tissue are preserved after incorporation into the urinary tract. Hyperchloraemic metabolic acidosis can occur if ileal and/or colon segments are used, as well as malabsorption of vitamin B(12) and bile acid after the use of ileal segments. These metabolic effects are not as severe as may be suspected and can be prevented by prophylactic substitution. Secondary malignancies can develop as a long-term consequence of bladder augmentation. Using colonic segments, tumours are most likely to occur at the ureteral implantation site. To prevent metabolic complications, careful patient selection and meticulous and lifelong follow up, as well as prophylactic treatment, are mandatory. Endoscopy for early detection has been recommended, starting 10 years postoperatively for patients who underwent surgery for a benign condition. PMID:21493159

  8. Evaluation of adjunctive systemic doxycycline with non-surgical periodontal therapy within type 2 diabetic patients

    PubMed Central

    Al-Nowaiser, Abeer M.; Al-Zoman, Hamad; Baskaradoss, Jagan K.; Robert, Asirvatham A.; Al-Zoman, Khalid H.; Al-Sohail, Abdulaziz M.; Al-Suwyed, Abdulaziz S.; Ciancio, Sebastian G.; Al-Mubarak, Sultan A.

    2014-01-01

    Objectives: To evaluate the effects of systemic doxycycline on clinical and microbiological parameters of diabetic subjects with chronic periodontitis. Methods: This 9-month multi-center, randomized, parallel, single-blinded study was conducted from different hospitals in Riyadh, Saudi Arabia between April 2010 and December 2010. A total of 76 diabetic subjects with chronic periodontitis were randomized into 2 groups: control group (CG) received only scaling and root planing (SRP), and the treatment group (TG) receiving systemic doxycycline during the reevaluation visit 45 days after the completion of SRP. Probing pocket depth, clinical attachment level, gingival index, plaque index, and bleeding on probing were collected at baseline, 45 days after SRP, and one, 3, and 6 months after the use of systemic doxycycline. Microbiological analysis comprised the detection of Tannerella forsythia (Tf), Aggregatibacter actinomycetemcomitans (Aa), Porphyromonas gingivalis (Pg), and Prevotella intermedia (Pi) by polymerase chain reaction method. Results: Sixty-eight (33 CG and 35 TG) subjects completed the study. Greater reduction in the population of Tf, Pg, and Pi were observed in TG compared with CG in the first month after the administration of systemic doxycycline. The TG showed a significant improvement in gingival index scores compared with the CG (p<0.05) by the end of the first and 6 months after the administration of doxycycline. Conclusion: Adjunct systemic doxycycline can be associated with a reduction of Tf, Pg, and Pi in the first month after the administration of doxycycline with an improvement in the GI. PMID:25316464

  9. Melatonin in Aging and Disease —Multiple Consequences of Reduced Secretion, Options and Limits of Treatment

    PubMed Central

    Hardeland, Rüdiger

    2012-01-01

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

  10. Should the controlled provision of heroin be a treatment option? Australian feasibility considerations.

    PubMed

    Bammer, G

    1993-04-01

    A proposal for a trial to provide heroin to dependent users in a controlled manner is currently being considered in the Australian Capital Territory. The political background to this proposal is outlined, as is the current 'drug scene'. A Stage 1 examination found that a trial of controlled provision of heroin is feasible in principle and recommended a further stage (Stage 2) of feasibility investigations to explore the practicalities. The results of the Stage 1 investigations and the proposals for Stage 2 are incorporated into discussion about three important issues: the feasibility research process, the therapeutic relationship, and social control. These considerations have wider applicability, both for treatment services for illegal drug users generally and for informing drug policy debates. Much can be learnt from the feasibility considerations, whether or not a trial of the controlled provision of heroin eventuates in Australia. PMID:8485424

  11. Spinal Drop Metastasis in Myxopapillary Ependymoma: A Case Report and a Review of Treatment Options

    PubMed Central

    Bates, James E.; Peterson, Carl R.; Yeaney, Gabrielle A.; Walter, Kevin A.; Lundquist, Thomas; Rosenzweig, Douglas; Milano, Michael T.

    2014-01-01

    Myxopapillary ependymoma (MPE) is a World Health Organization grade I ependymoma that is quite rare and generally thought to be benign. Possible drop metastasis from MPE has been reported three times in the literature; in each case there were cotemporaneous additional MPE lesions. We report the case of a man who had a piecemeal gross total resection of a MPE at L1-L3 followed by adjuvant external beam radiotherapy (EBRT) who presented sixteen months later with a lesion in the thecal sac consistent with drop metastasis. A subtotal resection and adjuvant EBRT were performed. The patient has been disease-free in follow-up 27 months from the second surgery. A review of the literature regarding the treatment for MPE showed that gross total resection is optimal initial management. Several retrospective studies supported the role of adjuvant radiotherapy in enhancing local control and progression-free survival. Chemotherapy has a minimal role in the management of MPE. PMID:25002955

  12. Cytomegalovirus in human brain tumors: Role in pathogenesis and potential treatment options.

    PubMed

    Söderberg-Nauclér, Cecilia; Johnsen, John Inge

    2015-02-20

    During the last years increasing evidence implies that human cytomegalovirus (CMV) can be attributed to human malignancies arising from numerous tissues. In this perspective, we will review and discuss the potential mechanisms through which CMV infection may contribute to brain tumors by affecting tumor cell initiation, progression and metastasis formation. Recent evidence also suggests that anti-CMV treatment results in impaired tumor growth of CMV positive xenografts in animal models and potentially increased survival in CMV positive glioblastoma patients. Based on these observations and the high tumor promoting capacity of this virus, the classical and novel antiviral therapies against CMV should be revisited as they may represent a great promise for halting tumor progression and lower cancer deaths. PMID:25699229

  13. To resume a stalled psychotherapy? Psychological testing to understand an impasse and reevaluate treatment options.

    PubMed

    Bram, Anthony D

    2015-01-01

    Clinical wisdom holds that psychological testing is a useful tool for consultation when there is a need to untangle and resolve a psychotherapeutic impasse. However, there has been a lack of empirical research in this area, and only a few cases have been published demonstrating how psychological testing can be used toward this end. In this article, the author offers a case illustration of the application of testing with a patient who sought to resume psychotherapy following a previous impasse and premature termination. Specific referral questions for the evaluation are explicated followed by discussion of the test data that answered each of them. The findings pointed not only to intrapsychic and object relational characteristics of the patient that contributed to the impasse but, importantly, alerted the author-therapist to his contributions as well. Treatment implications of the findings are also highlighted. PMID:25607826

  14. Selective microsurgical vestibular neurectomy: an option in the treatment of intractable vertigo and related microsurgical landmarks.

    PubMed

    Bademci, G; Batay, F; Yorulmaz, I; Küçük, B; Ca?lar, S

    2004-02-01

    Selective microsurgical vestibular neurectomy (SMVN) is an accepted and effective means of treating patients with intractable vertigo, a resistant component of Meniere's syndrome. Meniere's syndrome is a condition characterized by fluctuating hearing loss, tinnitus and serious vertigo attacks. Vertigo is the most disabling symptom of the disease. There may be permanent hearing loss in untreated cases and vertigo may continue after deafness. Selective microsurgical vestibular neurectomy is an elite surgical procedure providing exact relief from vertigo while protecting the preoperative hearing level. In this report, clinical results of nine patients with intractable vertigo operated in the University of Ankara Medical Faculty, Department of Neurosurgery between 1999 and 2001 are discussed. Accordingly, we aimed to represent the landmarks often required for microsurgical exposure. From this study we conclude that SMVN is an effective neurosurgical procedure for those patients who are resistant for medical treatment and require hearing preservation. PMID:15100934

  15. Tooth auto-transplantation as an alternative treatment option: A literature review

    PubMed Central

    Nim?enko, Tatjana; Omerca, Gražvydas; Varinauskas, Vaidas; Bramanti, Ennio; Signorino, Fabrizio; Cicciù, Marco

    2013-01-01

    Rapidly evolving implantation and alveolar ridge reconstruction techniques created a new area in modern dentistry where tooth loss is no longer a problem. Endless variations of implant's length, diameter, surface, and design along with autogenous, alogenous, aloplastic, or xenogenous bone substitutes made it possible to recreate physiological occlusion, esthetic and masticatory function. However, none of nowadays technologies in implant dentistry have the potential to adapt to a growth and development changes of a child's jaw. Therefore, patient's young age is a restriction for implantation and a particular challenge for a dentist willing to restore missing tooth. Thus, tooth auto-transplantation can be a good choice for treatment. The objective of this review is to underline the biologic principles required for successful auto-transplantation of teeth. Limits, indications, technique, and prognosis will be analyzed. PMID:23878556

  16. Untreated atrial fibrillation in the United States of America: Understanding the barriers and treatment options

    PubMed Central

    Verdino, Ralph J.

    2014-01-01

    Atrial fibrillation is the most commonly treated arrhythmia in the United States of America. Stroke is the most devastating consequence of atrial fibrillation. For decades, warfarin has been the most recommended treatment for patients with atrial fibrillation at risk for stroke and systemic emboli. However, many patients at risk are not treated with anticoagulants. Several reasons exist, including physician underestimation of patient stroke risk, physician overestimation of bleeding risk, and patients’ reluctance to take chronic warfarin due to the difficulties of this medication in relation to its pharmacokinetics and interactions with food and other medications. Risk scores have helped to better define patient risks and benefits from chronic anticoagulation. Novel anticoagulants (NOACs) have improved the ability for patients to be compliant with anticoagulation. PMID:25561824

  17. Untreated atrial fibrillation in the United States of America: Understanding the barriers and treatment options.

    PubMed

    Verdino, Ralph J

    2015-01-01

    Atrial fibrillation is the most commonly treated arrhythmia in the United States of America. Stroke is the most devastating consequence of atrial fibrillation. For decades, warfarin has been the most recommended treatment for patients with atrial fibrillation at risk for stroke and systemic emboli. However, many patients at risk are not treated with anticoagulants. Several reasons exist, including physician underestimation of patient stroke risk, physician overestimation of bleeding risk, and patients' reluctance to take chronic warfarin due to the difficulties of this medication in relation to its pharmacokinetics and interactions with food and other medications. Risk scores have helped to better define patient risks and benefits from chronic anticoagulation. Novel anticoagulants (NOACs) have improved the ability for patients to be compliant with anticoagulation. PMID:25561824

  18. Cytomegalovirus in human brain tumors: Role in pathogenesis and potential treatment options

    PubMed Central

    Söderberg-Nauclér, Cecilia; Johnsen, John Inge

    2015-01-01

    During the last years increasing evidence implies that human cytomegalovirus (CMV) can be attributed to human malignancies arising from numerous tissues. In this perspective, we will review and discuss the potential mechanisms through which CMV infection may contribute to brain tumors by affecting tumor cell initiation, progression and metastasis formation. Recent evidence also suggests that anti-CMV treatment results in impaired tumor growth of CMV positive xenografts in animal models and potentially increased survival in CMV positive glioblastoma patients. Based on these observations and the high tumor promoting capacity of this virus, the classical and novel antiviral therapies against CMV should be revisited as they may represent a great promise for halting tumor progression and lower cancer deaths. PMID:25699229

  19. Pre-treatment options for halophytic microalgae and associated methane production.

    PubMed

    Ward, Andrew; Lewis, David

    2015-02-01

    Methane production from lipid extracted, pre-treated disrupted and non-pretreated Tetraselmis spp. microalgae was investigated. The results demonstrated that 122 mL per g VS methane was produced for the lipid extracted Tetraselmis spp., demonstrating that lipid free Tetraselmis can be effectively digested in an anaerobic environment. A total of 252 mL per g VS and 248 mL per g VS of methane was reported for non-disrupted and pre-treated disrupted Tetraselmis sp. respectively. It was also observed that the microbial community caused cell lysis of Tetraselmis spp. during the anaerobic digestion process. Cell lyses can offer a direct conversion pathway of intact Tetraselmis spp. for energy production, thus negating the need for pre-treatment. PMID:25515151

  20. Subtotal gastrectomy with limited lymph node dissection is a feasible treatment option for patients with early gastric stump cancer.

    PubMed

    Irino, Tomoyuki; Hiki, Naoki; Nunobe, Souya; Ohashi, Manabu; Tanimura, Shinya; Sano, Takeshi; Yamaguchi, Toshiharu

    2014-08-01

    The de facto standard treatment for early gastric stump cancer (GSC) has been total gastrectomy combined with radical lymph node dissection. However, some patients could benefit if partial resection of the gastric stump is feasible. We investigated the feasibility of subtotal gastrectomy for early GSC as less invasive surgery. Subtotal gastrectomy was defined as a segmental resection of the gastric remnant including the anastomosis with limited lymph node dissection. A total of 66 patients with early GSC were enrolled and 24 patients (36.4 %) underwent subtotal gastrectomy (SG group). Clinicopathological characteristics were analyzed along with those of the other 42 patients (63.6 %) who underwent total gastrectomy (TG group). There were no significant differences between the two groups in the number of lymph nodes harvested (p = 0.880). Lymph node involvement was detected in 2 patients (8.3 %) in SG group and 5 patients (11.9 %) in TG group (p = 1.000). The previous disease (benign or malignant) and surgery (Billroth I or II) did not affect the rate of nodal involvement. The 5-year overall survival rate of SG group (94.7 %) was acceptable. Subtotal gastrectomy of the gastric remnant could be a feasible treatment option for patients with early gastric stump cancer when indicated. PMID:24944156