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Sample records for electroconvulsive therapy patients

  1. Electroconvulsive therapy in patient with psychotic depression and multiple sclerosis.

    PubMed

    Urban-Kowalczyk, Małgorzata; Rudecki, Tomasz; Wróblewski, Dariusz; Smigielski, Janusz; Kałużyńska, Olga; Rabe-Jabłońska, Jolanta

    2014-08-01

    Safety of electroconvulsive therapy (ECT) in depressive patients with multiple sclerosis (MS) is still discussed and based solely on case reports. This kind of therapy was used in both unipolar depression and depression in bipolar disorder. It was suggested that ECT might cause the deterioration of neurological state (new MS lesions in magnetic resonance imaging). Moreover, there were also data indicating some anesthesiological complications and difficulties in patients with MS. We have presented a case of a patient who was treated with ECT and developed grand mal seizure after 14th electroconvulsive treatment.

  2. Electroconvulsive therapy in Parkinson's disease.

    PubMed

    Calderón-Fajardo, Humberto; Cervantes-Arriaga, Amin; Llorens-Arenas, Rodrigo; Ramírez-Bermudez, Jesús; Ruiz-Chow, Ángel; Rodríguez-Violante, Mayela

    2015-10-01

    Purpose To analyze the effectiveness of electroconvulsive therapy for the management of depression and/or psychosis refractory to drug therapy in patients with Parkinson disease.Methods A retrospective study was carried out including patients treated with electroconvulsive therapy during the period between 2002 and 2013. A review of the literature was performed.Results A total of 27 patients were included. In regards to the neuropsychiatric diagnosis, 14 patients had major depression, 12 patients had both psychosis and depression, and only one patient had isolated psychosis. The mean number of electroconvulsive therapy sessions was 12 ± 2.8. After electroconvulsive therapy, all patients showed a statistically significant improvement in the Brief Psychiatric Rating scale (reduction of 52% points) and Hamilton Depression Rating Scale (reduction of 50% points) independent of the presence of psychosis, depression or both.Conclusion Electroconvulsive therapy is effective for the treatment of refractory neuropsychiatric symptoms in Parkinson's disease.

  3. Electroconvulsive therapy

    MedlinePlus

    Shock treatment; Shock therapy; ECT; Depression - ECT; Bipolar - ECT ... ECT is a highly effective treatment for depression, most commonly ... who: Are having delusions or other psychotic symptoms with ...

  4. Evaluation of Oxidative Status in Patients Treated with Electroconvulsive Therapy

    PubMed Central

    Şenyurt, Mahmut; Aybek, Hulya; Herken, Hasan; Kaptanoglu, Bunyamin; Korkmaz, Ali

    2017-01-01

    Objective Electroconvulsive therapy (ECT) is used in the treatment of many psychiatric diseases and this therapy may be effective on antioxidant defence system. In this study, we aimed to evaluate the effects of ECT on oxidative stress. Methods Fourteen major depression, 11 schizophrenia and 8 bipolar affective disorder patients diagnosed and received ECT treatment, and 37 healthy volunteers enrolled in the study. ECT was applied to all patients. Before ECT, after the first and last ECTs, serum samples were obtained. Serum total antioxidant status (TAS), total oxidant status (TOS), and calculated oxidative stress index (OSI) were measured in patients before and after ECTs. Results TOS values before ECT were higher in major depression (p=0.005) and schizophrenia (p=0.001) groups compared to the control group. TAS values were lower in major depression (p=0.0001), schizophrenia (p=0.004), bipolar affective disorder (p=0.004) groups compared to the controls. Also OSI values were higher in major depression (p=0.0001), schizophrenia (p=0.001), bipolar affective disorder (p=0.009) groups compared to healthy group. After the last ECT, TOS values were significantly lower compared to TOS values before ECT in major depression (p=0.004) and schizophrenia patients (p=0.004). TAS values after the first ECT were higher compared to values before ECT in major depression patients (p=0.004). After last ECT, OSI values were significantly lower compared to before ECT in schizophrenia patients (p=0.006). Conclusion As a result, it can be said that ECT did not increase oxidative stress. However, further studies with more patients are needed. PMID:28138109

  5. Electroconvulsive Therapy in Multiple Sclerosis.

    PubMed

    Steen, Katie; Narang, Puneet; Lippmann, Steven

    2015-01-01

    We performed a literature search regarding the safety and efficacy of electroconvulsive therapy in patients with multiple sclerosis and comorbid psychiatric symptoms. Literature review was conducted via PubMed databases. Of the cases we reviewed, most subjects with multiple sclerosis reported significant psychiatric symptom relief, with only a handful reporting neurologic deterioration. There was some evidence that active white matter lesions may be predictive of neurologic deterioration when electroconvulsive therapy is used in patients with multiple sclerosis. A brief description of the pathophysiology and effects of depression in patients with multiple sclerosis is also provided. Although no clinical recommendations or meaningful conclusions can be drawn without further investigation, the literature suggests that electroconvulsive therapy for treatment of psychiatric illnesses in patients with multiple sclerosis is safe and efficacious.

  6. Electroconvulsive therapy in catatonic patients: Efficacy and predictors of response

    PubMed Central

    Luchini, Federica; Medda, Pierpaolo; Mariani, Michela Giorgi; Mauri, Mauro; Toni, Cristina; Perugi, Giulio

    2015-01-01

    Recent evidence favors the view of catatonia as an autonomous syndrome, frequently associated with mood disorders, but also observed in neurological, neurodevelopmental, physical and toxic conditions. From our systematic literature review, electroconvulsive therapy (ECT) results effective in all forms of catatonia, even after pharmacotherapy with benzodiazepines has failed. Response rate ranges from 80% to 100% and results superior to those of any other therapy in psychiatry. ECT should be considered first-line treatment in patients with malignant catatonia, neuroleptic malignant syndrome, delirious mania or severe catatonic excitement, and in general in all catatonic patients that are refractory or partially responsive to benzodiazepines. Early intervention with ECT is encouraged to avoid undue deterioration of the patient’s medical condition. Little is known about the long-term treatment outcomes following administration of ECT for catatonia. The presence of a concomitant chronic neurologic disease or extrapyramidal deficit seems to be related to ECT non-response. On the contrary, the presence of acute, severe and psychotic mood disorder is associated with good response. Severe psychotic features in responders may be related with a prominent GABAergic mediated deficit in orbitofrontal cortex, whereas non-responders may be characterized by a prevalent dopaminergic mediated extrapyramidal deficit. These observations are consistent with the hypothesis that ECT is more effective in “top-down” variant of catatonia, in which the psychomotor syndrome may be sustained by a dysregulation of the orbitofrontal cortex, than in “bottom-up” variant, in which an extrapyramidal dysregulation may be prevalent. Future research should focus on ECT response in different subtype of catatonia and on efficacy of maintenance ECT in long-term prevention of recurrent catatonia. Further research on mechanism of action of ECT in catatonia may also contribute to the development of

  7. Electroconvulsive Therapy and Suicide.

    ERIC Educational Resources Information Center

    Tanney, Bryan L.

    1986-01-01

    When the effectiveness and mortality-morbidity of electroconvulsive therapy (ECT) are compared with those of drug therapies, it appears that ECT is an effective and preferred treatment strategy. It remains underutilized as a modality of suicide prevention. Addresses controversies that presently limit the use of this treatment. (Author/ABB)

  8. Successful and rapid response to electroconvulsive therapy of a suicidal patient with comorbid bipolar I disorder and histrionic personality disorder.

    PubMed

    Rapinesi, Chiara; Serata, Daniele; Del Casale, Antonio; Simonetti, Alessio; Milioni, Mara; Mazzarini, Lorenzo; Scatena, Paola; Fensore, Claudio; Carbonetti, Paolo; Kotzalidis, Giorgio D; Tatarelli, Roberto; Pompili, Maurizio; Girardi, Paolo

    2012-03-01

    A woman with bipolar disorder I, histrionic personality disorder, and suicidal ideation with repeated suicide attempts, who had been treated for 2 years with mood stabilizers, antipsychotics, and benzodiazepines, received a total of 8 bitemporal-biparietal electroconvulsive therapy sessions. Her suicidal ideation and self-harm behavior disappeared immediately after the first session and her psychopathology soon after. This supports the existence of a relatively independent suicidal syndrome and confirms data on its immediate responsiveness to electroconvulsive therapy. Electroconvulsive therapy must not be long withheld from patients with such characteristics to reduce unnecessary sufferance and suicidality.

  9. Use of electroconvulsive therapy in a patient with chorea neuroacanthocytosis and prominent delusions.

    PubMed

    Rutherford, Michael

    2012-06-01

    A middle-aged white man with a diagnosis of chorea neuroacanthocytosis developed progressive and distressing persecutory delusions with an obsessional component. Pharmacotherapy was ineffective in controlling the symptoms or halting their progression. Electroconvulsive therapy was attempted with very limited success but had to be discontinued owing to mild elation and increased irritability. The patient's distress was only improved after his transfer to a nursing home specializing in Huntington disease.

  10. Electroconvulsive therapy and Klinefelter syndrome.

    PubMed

    Wei, Qiang; Xie, Xinhui; Chen, Yang; Tian, Yanghua; Wang, Honghao; Wang, Keyong; Wang, Kai

    2013-09-01

    Klinefelter syndrome is a common sex chromosome disorder characterized by the presence of 1 or more extra X chromosomes, and the most prevalent karyotype is 47,XXY. Epidemiological studies have showed that patients with Klinefelter syndrome had a significantly increased risk of psychosis. We presented a case of a patient with Klinefelter syndrome who was characterized by psychiatric symptoms. The patients had been refractory to clozapine and sodium valproate, but a remarkable improvement occurred after a cycle of 11 sessions of modified electroconvulsive therapy.

  11. Anesthetic considerations for pediatric electroconvulsive therapy.

    PubMed

    Franklin, Andrew D; Sobey, Jenna H; Stickles, Eric T

    2017-02-17

    Electroconvulsive therapy is being used more frequently in the treatment of many chronic and acute psychiatric illnesses in children. The most common psychiatric indications for pediatric electroconvulsive therapy are refractory depression, bipolar disorder, schizophrenia, catatonia, and autism. In addition, a relatively new indication is the treatment of pediatric refractory status epilepticus. The anesthesiologist may be called upon to assist in the care of this challenging and vulnerable patient population. Unique factors for pediatric electroconvulsive therapy include the potential need for preoperative anxiolytic and inhalational induction of anesthesia, which must be weighed against the detrimental effects of anesthetic agents on the evoked seizure quality required for a successful treatment. Dexmedetomidine is likely the most appropriate preoperative anxiolytic as oral benzodiazepines are relatively contraindicated. Methohexital, though becoming less available at many institutions, remains the gold standard for induction of anesthesia for pediatric electroconvulsive therapy though ketamine, propofol, and sevoflurane are becoming increasingly viable options. Proper planning and communication between the multidisciplinary teams involved in the care of children presenting for electroconvulsive therapy treatments is vital to mitigating risks and achieving the greatest therapeutic benefit.

  12. The use of electroconvulsive therapy in a patient with juvenile systemic lupus erythematosus and catatonia.

    PubMed

    Mon, T; L'ecuyer, S; Farber, N B; White, A J; Baszis, K W; Hearn, J K; Spiegel, T E; French, A R; Kitcharoensakkul, M

    2012-12-01

    Catatonia is a rare manifestation in patients with systemic lupus erythematosus (SLE). As catatonia can be associated with both psychiatric and organic conditions, this could create a diagnostic dilemma once this occurs in SLE patients. The report describes a 15-year-old female with SLE who developed catatonia three days after the diagnosis of SLE was made. Her catatonia was refractory to the treatment with immunosuppressive therapy, which included pulse methylprednisolone, intravenous cyclophosphamide, rituximab, intravenous immunoglobulin (IVIG) and plasmapheresis. Given her persistent catatonia, electroconvulsive therapy (ECT) was initiated three months after the onset of her symptoms. After the third ECT treatment, her mental status dramatically improved and returned nearly to baseline while she was continued on the immunosuppression. This is the first report of a successful ECT therapy in catatonic lupus in children.

  13. Clinical profile and outcome of bipolar disorder patients receiving electroconvulsive therapy: A study from north India

    PubMed Central

    Bharadwaj, Vineet; Grover, Sandeep; Chakrabarti, Subho; Avasthi, Ajit; Kate, Natasha

    2012-01-01

    Background: Although electroconvulsive therapy (ECT) is used quite frequently among the bipolar patients in developing countries, very little data are available with regard to its effectiveness from the developing countries. Aim: A retrospective case note review was carried out of bipolar disorder patients who were given ECT. Materials and Methods: Details of demographic and clinical profile, indications for ECT, response patterns, adverse effects, etc. were recorded. Results: Among all the patients who received ECT, 18% were diagnosed to have bipolar disorder. ECT was administered most commonly for mania with psychotic symptoms, followed by severe depression with psychotic symptoms. Comorbid physical problems were seen in many patients. Nearly 90% of patients in both the subgroups showed more than 50% response (based on reduction in the standardized rating scales) with ECT. Few patients (22%) reported some kind of side effects. Conclusions: ECT is useful in the management of acute phase of mania and depression. PMID:22556436

  14. Medication management during electroconvulsant therapy

    PubMed Central

    Zolezzi, Monica

    2016-01-01

    Electroconvulsive therapy (ECT) has demonstrated to be highly effective and safe, even life saving for many psychiatric disorders such as major depression, bipolar disorder and schizophrenia. Most patients who require ECT are also on concurrent pharmacotherapy. As such, the objective of this article is to provide a review of the most recent literature focusing on the medications used during an ECT procedure and on the effects of concurrent psychiatric and non-psychiatric medications on the effectiveness and safety of ECT. The review also attempts to summarize the recommendations derived from existing documents to guide pharmacotherapy decisions for patients undergoing ECT. For this purpose, using electronic databases, an extensive search of the current literature was made using ECT and medications or drug classes as keywords. PMID:27143894

  15. [Cardiac safety of electroconvulsive therapy in an elderly patient--a case report].

    PubMed

    Karakuła-Juchnowicz, Hanna; Próchnicki, Michał; Kiciński, Paweł; Olajossy, Marcin; Pelczarska-Jamroga, Agnieszka; Dzikowski, Michał; Jaroszyński, Andrzej

    2015-10-01

    Since electroconvulsive therapy (ECT) was introduced as treatment for psychiatric disorders in 1938, it has remained one of the most effective therapeutic methods. ECT is often used as a "treatment of last resort" when other methods fail, and a life-saving procedure in acute clinical states when a rapid therapeutic effect is needed. Mortality associated with ECT is lower, compared to the treatment with tricyclic antidepressants, and comparable to that observed in so-called minor surgery. In the literature, cases of effective and safe electroconvulsive therapy have been described in patients of advanced age, with a burden of many somatic disorders. However, cases of acute cardiac episodes have also been reported during ECT. The qualification of patients for ECT and the selection of a group of patients at the highest risk of cardiovascular complications remains a serious clinical problem. An assessment of the predictive value of parameters of standard electrocardiogram (ECG), which is a simple, cheap and easily available procedure, deserves special attention. This paper reports a case of a 74-year-old male patient treated with ECT for a severe depressive episode, in the context of cardiologic safety. Both every single ECT session and the full course were assessed to examine their impact on levels of troponin T, which is a basic marker of cardiac damage, and selected ECG parameters (QTc, QRS). In the presented case ECT demonstrated its high general and cardiac safety with no negative effect on cardiac troponin (TnT) levels, corrected QT interval (QTc) duration, or other measured ECG parameters despite initially increased troponin levels, the patient's advanced age, the burden of a severe somatic disease and its treatment (anticancer therapy).

  16. Life-saving electroconvulsive therapy in a patient with near-lethal catatonia.

    PubMed

    Girardi, Paolo; Rapinesi, Chiara; Cuomo, Ilaria; Kotzalidis, Giorgio D; Del Casale, Antonio; Serata, Daniele; Campi, Sandra; Caloro, Matteo; De Chiara, Lavinia; Tamorri, Stefano Maria; Scatena, Paola; Caccia, Federica; Bersani, Francesco Saverio; Carbonetti, Paolo; Vento, Alessandro; Dimitri-Valente, Giorgia; Tatarelli, Roberto; Fensore, Claudio; Ferracuti, Stefano; Angeletti, Gloria

    2012-01-01

    A young woman with bipolar I disorder and comorbid catatonia on enteral nutrition from several months, developed a form of near-lethal catatonia with weight loss, pressure sores, muscle atrophy, electrolyte imbalance, and depression of vital signs. A compulsory treatment was necessary, and informed consent was obtained from her mother for electroconvulsive therapy (ECT). After 7 ECT sessions, the patient recovered and resumed feeding. ECT may save the life of a patient with catatonia provided that legal obstacles are overcome. Clinicians should carefully evaluate patients with near-lethal catatonia, taking into account the risk of pulmonary embolism and other fatal events. The medical-legal issues, which vary across state regulations, should be addressed in detail to avoid unnecessary and potentially harmful delay in intervention.

  17. [Myotonic dystrophy as a contraindication for electroconvulsive therapy?].

    PubMed

    Wynhoven, L M L; Scherders, M J W T; van Suijlekom, J A

    2009-01-01

    A 57-year-old woman with medication-resistant major depression was referred to our clinic for electroconvulsive therapy. After an extensive evaluation of our patient's condition we concluded that in this case the comorbid myotonic dystrophy was a contraindication for the performance of electroconvulsive therapy. However, in the current Dutch Psychiatric Association guidelines this illness is not mentioned as a possible contraindication for electroconvulsive therapy. This raises the question of whether myotonic dystrophy should now be incorporated in these guidelines and makes us wonder to what extent our conclusion could have consequences for the treatment of other neuromuscular illnesses.

  18. Early improvement predicts outcome of major depressive patients treated with electroconvulsive therapy.

    PubMed

    Lin, Ching-Hua; Chen, Ming-Chao; Yang, Wei-Cheng; Lane, Hsien-Yuan

    2016-02-01

    The aim of this study was to test whether early symptom improvement predicts final response and remission for patients with major depressive disorder (MDD) receiving electroconvulsive therapy (ECT). MDD inpatients (N=130) requiring ECT were recruited. ECT was generally performed for a maximum of 12 sessions. Symptom severity was assessed using the 17-item Hamilton Depression Rating Scale (HAMD-17) before ECT, after every 3 ECT sessions, and after the last ECT. Early improvement was defined as a reduction in the HAMD-17 score by at least 20%, 25%, or 30% after 3 and 6 ECT sessions. Response was defined as 60% HAMD-17 score reduction, while remission was defined as an end point HAMD-17 score of ≦7. Receiver operating characteristic (ROC) curves were used to determine whether 3 or 6 ECT sessions had better discriminative capacity. Sensitivity, specificity and predictive values were calculated for the different definitions of early improvement. Of the 105 patients entering the analysis, 85.7% (n=90) and 70.5% (n=74) were classified as responders and remitters, respectively. Early improvement after 6 ECT sessions showed better discriminative capacity, with areas under the ROC curve at least 0.8. It had high sensitivity and high negative predictive value for all cutoffs in predicting response and remission. High response and remission rates were observed. Final response and remission could be predicted by early improvement after 6 ECT sessions. Patients without early improvement were unlikely to reach response and remission.

  19. Electroconvulsive therapy exerts mainly acute molecular changes in serum of major depressive disorder patients.

    PubMed

    Stelzhammer, Viktoria; Guest, Paul C; Rothermundt, Matthias; Sondermann, Carina; Michael, Nikolaus; Schwarz, Emanuel; Rahmoune, Hassan; Bahn, Sabine

    2013-10-01

    Electroconvulsive therapy (ECT) is mainly used to treat medication resistant major depressive disorder (MDD) patients, with a remission rate of up to 90%. However, little is known about the serum molecular changes induced by this treatment. Understanding the mechanisms of action of ECT at the molecular level could lead to identification of response markers and potential new drug targets for more effective antidepressant treatments. We have carried out a pilot study which analysed serum samples of MDD patients who received a series of ECT treatments over 4 weeks. Patients received only ECT treatments over the first two weeks and a combination of ECT and antidepressant drugs (AD) over the subsequent two weeks. Blood serum analyses were carried out using a combination of multiplex Human MAP® immunoassay and liquid-chromatography mass spectrometry (LC-MS(E)) profiling. This showed that ECT had a predominant acute effect on the levels of serum proteins and small molecules, with changes at the beginning of ECT treatment and after administration of the ECT+AD combination treatment. This suggested a positive interaction between the two types of treatment. Changed molecules included BDNF, CD40L, IL-8, IL-13, EGF, IGF-1, pancreatic polypeptide, SCF, sortilin-1 and others which have already been implicated in MDD pathophysiology. We conclude that ECT appears to exert mainly acute effects on serum molecules.

  20. [Indications for electroconvulsive therapy].

    PubMed

    Boiteux, J; Roubaud, L; Gandelet, N; Nezelof, S; Vittouris, N; Bonin, B; Sechter, D; Bizouard, P

    1997-06-01

    ECT, in which first experiments were made by the italian Cerletti more than half a century ago, underwent, in the seventies, a definite decline, as it was less and less applied to patients, a result of the influence of anti psychiatry. During the last fifteen years, there has been a legitimate renewal of the interest for this therapy; its indications seem now well codified and its techniques and practises have evolved considerably. Actually, in order to carry out ECT under general anaesthesia, it is necessary to have a pluridisciplinary team, assembling nurses, anaesthesists and psychiatrists that will use more and more effective appliances and adequate anaesthetics. Many of the parameters able to influence ECT's effectiveness are now well known and can be used and adapted according the individual characteristics of each patient. These parameters are: the lateralisation of the electrodes, the intensity of the electric current, the duration of the epileptic fit, the modification that appear in electroencephalography and the frequence of the sessions. According to different investigations, it seems that we must systematically question the medical treatments we associate to ECT. For instance, it is highly recommended not to prescribe with ECT benzodiazepines or antiepileptic mood stabilizers, while antidepressants or neuroleptics do not seem to exert any influence on the effectiveness of the treatment. Some authors think caffeine and triiodothyronin (T3) could have an interesting effect when combined with ECT. As to the indications of shock therapy, they can be now more and more precisely defined making of this treatment an indispensable instrument in the cure of depressive disorders. But ECT is also appropriate in maniac disorders once neuroleptic treatment has failed or else in the very beginning in highly acute cases, and mainly in mixed episodes for which medical treatment is often difficult to adapt. In schizophrenia, ECT can also be prescribed in definite

  1. Electroconvulsive therapy: Promoting awareness among primary care physicians.

    PubMed

    Sicher, Sarah; Gedzior, Joanna

    2016-04-01

    This article aims to promote awareness among primary care providers and support electroconvulsive therapy as a generally well-tolerated, effective therapeutic modality to treat specific psychiatric conditions in appropriately selected patients. There seem to be several potential barriers to treatment with electroconvulsive therapy including stigma, lack of providers who preform it, and lack of awareness among providers referring patients who may be appropriate candidates. The article provides a brief overview of electroconvulsive therapy principles and topics and includes a case report to illustrate clinical utility. The article proposes the concept that a potential way to overcome barriers to treatment with electroconvulsive therapy may be to promote education and awareness of it as a viable treatment modality among primary care providers.

  2. The Incidence and Predictors of Headache and Myalgia in Patients After Electroconvulsive Therapy (ECT)

    PubMed Central

    Haghighi, Mohammad; Sedighinejad, Abbas; Naderi Nabi, Bahram; Emiralavi, Cyrus; Biazar, Gelareh; Mirmozaffari, Kaveh; Zahedan, Cyrus; Jafari, Mehdi

    2016-01-01

    Background: Electroconvulsive therapy (ECT) is a safe and effective mode of therapy for a wide variety of psychiatric disorders. However, it is associated with some disturbing side effects, such as nausea and vomiting, dental and tongue injury, confusion, dizziness, headache, and myalgia. Objectives: The present study focused on the evaluation of myalgia and headache and their predictors after ECT. Patients and Methods: A prospective analytical descriptive study was conducted from October 2014 to January 2015, in an academic hospital in northern Iran. Before sampling, the study was approved by the ethics committee of Guilan University of Medical Sciences. 621 patients with psychiatric disorders who were referred to Shafa hospital enrolled in the study. They were evaluated based on a verbal rating scale (4 point scales) 6 hours after ECT, regarding headache and myalgia side effects. Results: 6 hours after ECT, 126 patients (21.9%) reported headaches, and 56 patients (9%) reported myalgia. The presence of headache or myalgia 6 hours after ECT was not correlated to the duration of convulsion, treatment sessions, sex, or age. But myalgia at 2 hours after treatment was correlated with sex (0.04). Sex, age, duration of seizure, and treatment sessions were not predictors of headache and myalgia 6 hours after ECT (log regression, enter mode). The intensity and frequency of headaches decreased during 6 hours after ECT (P = 0.0001 and P = 0.0001, respectively), and myalgia frequency decreased (P = 0.062) but the intensity increased (P = 0.87). Conclusions: The results of the present study demonstrate that headache after ECT procedures was more common than myalgia, but it was mild, tolerable, and decreased within 6 hours of the treatment. It is also notable that we did not found any predictors for post-ECT headache and myalgia. PMID:27761416

  3. Cerebellar volume change in response to electroconvulsive therapy in patients with major depression.

    PubMed

    Depping, Malte S; Nolte, Henrike M; Hirjak, Dusan; Palm, Elisa; Hofer, Stefan; Stieltjes, Bram; Maier-Hein, Klaus; Sambataro, Fabio; Wolf, Robert C; Thomann, Philipp A

    2017-02-06

    Electroconvulsive therapy (ECT) is remarkably effective in severe major depressive disorder (MDD). Growing evidence has accumulated for brain structural and functional changes in response to ECT, primarily within cortico-limbic regions that have been considered in current neurobiological models of MDD. Despite increasing evidence for important cerebellar contributions to affective, cognitive and attentional processes, investigations on cerebellar effects of ECT in depression are yet lacking. In this study, using cerebellum-optimized voxel-based analysis methods, we investigated cerebellar volume in 12 MDD patients who received right-sided unilateral ECT. 16 healthy controls (HC) were included. Structural MRI data was acquired before and after ECT and controls were scanned once. Baseline structural differences in MDD compared to HC were located within the "cognitive cerebellum" and remained unchanged with intervention. ECT led to gray matter volume increase of left cerebellar area VIIa crus I, a region ascribed to the "affective/limbic cerebellum". The effects of ECT on cerebellar structure correlated with overall symptom relief. These findings provide preliminary evidence that structural change of the cerebellum in response to ECT may be related to the treatment's antidepressant effects.

  4. Electroconvulsive therapy for major depressive disorder in a patient with a permanent skull defect: a case report.

    PubMed

    Roh, Jihyun; Kang, Min-Hee; Kim, Chul-Eung; Lee, Jeong-Seop; Bae, Jae-Nam

    2014-12-01

    Electroconvulsive therapy (ECT) is an effective and safe treatment method for a variety of psychiatric disorders, including major depressive disorder. Although there is no absolute contraindication to ECT, clinicians often hesitate to apply this method to patients with a skull defect. We report a case of ECT performed on a major depressive disorder patient with an open wound after craniectomy. We summarize successful ECT cases of patients with a permanent skull defect and discuss various factors that may influence ECT outcomes in patients with a skull defect, including electrode placement, benzodiazepines, and anticonvulsants.

  5. Neurochemical correlates of rapid treatment response to electroconvulsive therapy in patients with major depression

    PubMed Central

    Njau, Stephanie; Joshi, Shantanu H.; Espinoza, Randall; Leaver, Amber M.; Vasavada, Megha; Marquina, Antonio; Woods, Roger P.; Narr, Katherine L.

    2017-01-01

    Background Electroconvulsive therapy (ECT) is a highly effective brain stimulation treatment for severe depression. Identifying neurochemical changes linked with ECT may point to biomarkers and predictors of successful treatment response. Methods We used proton magnetic resonance spectroscopy (1H-MRS) to measure longitudinal changes in glutamate/glutamine (Glx), creatine (Cre), choline (Cho) and N-acetylaspartate (NAA) in the dorsal (dACC) and subgenual anterior cingulate cortex (sgACC) and bilateral hippocampus in patients receiving ECT scanned at baseline, after the second ECT session and after the ECT treatment series. Patients were compared with demographically similar controls at baseline. Controls were assessed twice to establish normative values and variance. Results We included 50 patients (mean age 43.78 ± 14 yr) and 33 controls (mean age 39.33 ± 12 yr) in our study. Patients underwent a mean of 9 ± 4.1 sessions of ECT. At baseline, patients showed reduced Glx in the sgACC, reduced NAA in the left hippocampus and increased Glx in the left hippocampus relative to controls. ECT was associated with significant increases in Cre in the dACC and sgACC and decreases in NAA in the dACC and right hippocampus. Lower NAA levels in the dACC at baseline predicted reductions in depressive symptoms. Both ECT and symptom improvement were associated with decreased Glx in the left hippocampus and increased Glx in the sgACC. Limitations Attrition and clinical heterogeneity may have masked more subtle findings. Conclusion ECT elicits robust effects on brain chemistry, impacting Cre, NAA and Glx, which suggests restorative and neurotrophic processes. Differential effects of Glx in the sgACC and hippocampus, which approach control values with treatment, may reflect previously implicated underactive cortical and overactive subcortical limbic circuitry in patients with major depression. NAA levels at baseline are predictive of therapeutic outcome and could inform future

  6. Supportive Nursing Care and Satisfaction of Patients Receiving Electroconvulsive Therapy: A Randomized Controlled Clinical Trial

    PubMed Central

    Navidian, Ali; Ebrahimi, Hossein; Keykha, Roghaieh

    2015-01-01

    Background: Patient satisfaction is the most important criterion in evaluating the quality of care. Besides, its assessment in patients with severe mental disorder treated by electroconvulsive therapy (ECT) is highly appropriate. The ECT is accompanied by lower satisfaction and may exacerbate the patients’ condition. Objectives: The current study aimed to determine the effect of supportive nursing care on the satisfaction of patients receiving ECT. Patients and Methods: This randomized controlled trial was conducted in the education center of Baharan psychiatric hospital, Zahedan, Iran. Seventy hospitalized patients receiving ECT were randomly divided into two groups of control (n = 35) and intervention (n = 35).The socio-personal and Webster Satisfaction Questionnaire were used as data collection tools. The intervention group received supportive nursing care by nurses trained in informational, emotional, and physical aspects. The control group received only regular nursing care. The levels of satisfaction were measured and compared between groups, before and after the intervention. Data were analyzed using the SPSS software, and Chi-square, independent and paired t tests, as well as covariance analysis were performed. Results: The results showed similarities in socio-personal characteristics of both groups. However, there was a significant difference (P < 0.001) between the means of satisfaction in the groups, predominantly for the intervention group. In other words, a significant difference (P < 0.001) was observed between the means of satisfaction of the intervention (54.71 ± 5.27) and control (36.28 ± 7.00) groups after intervention by controlling the effect of socio-personal variables. Conclusions: Results of the current study confirmed the effect of supportive nursing care on increasing the level of satisfaction in ECT receiving patients, recommending the use of this therapeutic method. PMID:26473077

  7. Patients with schizophrenia or schizoaffective disorder who receive multiple electroconvulsive therapy sessions: characteristics, indications, and results

    PubMed Central

    Iancu, Iulian; Pick, Nimrod; Seener-Lorsh, Orit; Dannon, Pinhas

    2015-01-01

    Background While electroconvulsive therapy (ECT) has been used for many years, there is insufficient research regarding the indications for continuation/maintenance (C/M)-ECT, its safety and efficacy, and the characteristics of patients with schizophrenia or schizoaffective disorder who receive multiple ECT sessions. The aims of this study were to characterize a series of patients who received 30 ECT sessions or more, to describe treatment regimens in actual practice, and to examine the results of C/M-ECT in terms of safety and efficacy, especially the effect on aggression and functioning. Methods We performed a retrospective chart review of 20 consecutive patients (mean age 64.6 years) with schizophrenia (n=16) or schizoaffective disorder (n=4) who received at least 30 ECT sessions at our ECT unit, and also interviewed the treating physician and filled out the Clinical Global Impression-Severity, Global Assessment of Functioning, and the Staff Observation Aggression Scale-Revised. Results Patients received a mean of 91.3 ECT sessions at a mean interval of 2.6 weeks. All had been hospitalized for most or all of the previous 3 years. There were no major adverse effects, and cognitive side effects were relatively minimal (cognitive deficit present for several hours after treatment). We found that ECT significantly reduced scores on the Staff Observation Aggression Scale-Revised subscales for verbal aggression and self-harm, and improved Global Assessment of Functioning scores. There were reductions in total aggression scores, subscale scores for harm to objects and to others, and Clinical Global Impression-Severity scores, these were not statistically significant. Conclusion C/M-ECT is safe and effective for chronically hospitalized patients. It improves general functioning and reduces verbal aggression and self-harm. More research using other aggression tools is needed to determine its effects and to reproduce our findings in prospective and controlled studies. PMID

  8. The Psychiatric Patient as a Health Resource Consumer: Costs Associated with Electroconvulsive Therapy

    PubMed Central

    Selva-Sevilla, Carmen; Gonzalez-Moral, Maria Luisa; Tolosa-Perez, Maria Teresa

    2016-01-01

    Background: Clinical practice protocols should consider both the psychological criteria related to a patient’s satisfaction as a consumer of health services and the economic criteria to allocate resources efficiently. An electroconvulsive therapy (ECT) program was implemented in our hospital to treat psychiatric patients. The main objective of this study was to determine the cost associated with the ECT sessions implemented in our hospital between 2008 and 2014. A secondary objective was to calculate the cost of sessions that were considered ineffective, defined as those sessions in which electrical convulsion did not reach the preset threshold duration, in order to identify possible ways of saving money and improving satisfaction among psychiatric patients receiving ECT. Methods: A descriptive analysis of the direct health costs related to ECT from the perspective of the public health system between 2008 and 2014 was performed using a retrospective chart review. All of the costs are in euros (2011) and were discounted at a rate of 3%. Based on the base case, a sensitivity analysis of the changes of those variables showing the greatest uncertainty was performed. Results: Seventy-six patients received 853 sessions of ECT. The cumulative cost of these sessions was €1409528.63, and 92.9% of this cost corresponded to the hospital stay. A total of €420732.57 (29.8%) was inefficiently spent on 269 ineffective sessions. A sensitivity analysis of the economic data showed stable results to changes in the variables of uncertainty. Conclusion: The efficiency of ECT in the context outlined here could be increased by discerning a way to shorten the associated hospital stay and by reducing the number of ineffective sessions performed. PMID:27303347

  9. Symptom predictors of response to electroconvulsive therapy in older patients with treatment-resistant depression

    PubMed Central

    Tominaga, Keiichiro; Okazaki, Mioto; Higuchi, Hisashi; Utagawa, Itaru; Nakamura, Etsuko; Yamaguchi, Noboru

    2011-01-01

    Background: Electroconvulsive therapy (ECT) has been used for treatment-resistant depression. However, predictors of response to ECT have not been adequately studied using the Montgomery and Åsberg Depression Rating Scale, especially in older patients with treatment-resistant depression. Methods: This study included 18 Japanese patients who fulfilled the Diagnostic and Statistical Manual of Mental Disorders Fourth Edition Text Revision criteria for a diagnosis of major depressive disorder or bipolar disorder with a current major depressive episode, and met the definition of treatment-resistant depression outlined by Thase and Rush, scoring ≥21 on the Montgomery and Åsberg Depression Rating Scale. The three-factor model of the Montgomery and Åsberg Depression Rating Scale was used for analysis. Factor 1 was defined by three items, factor 2 by four items, and factor 3 by three items, representing dysphoria, retardation, and vegetative symptoms, respectively. ECT was performed twice a week for a total of six sessions using a Thymatron System IV device with the brief pulse technique. Clinical responses were defined on the basis of a ≥50% decrease in total pretreatment Montgomery and Åsberg Depression Rating Scale scores. Results: The mean pretreatment factor 2 score for responders (n = 7) was significantly lower than that for nonresponders (n = 11). Furthermore, a significant difference in mean factor 3 score between responders and nonresponders was observed one week after six sessions of ECT, indicating a time lag of response. No significant differences were observed for age, number of previous episodes, and duration of the current episode between responders and nonresponders. Conclusion: This study suggests that a low pretreatment factor 2 score is a good predictor of response to ECT in older patients with major depression. PMID:21845058

  10. Sudden cardiac death after modified electroconvulsive therapy.

    PubMed

    Wang, Zhihui; Wang, Jiyu

    2015-10-01

    Sudden deaths associated with the use of electroconvulsive therapy are rare. In this case report a 58-year-old male with a 20-year history of bipolar disorder and no history or signs of cardiac illness died from cardiac arrest within one hour of receiving an initial session of modified electroconvulsive therapy (MECT) to treat a recurrent episode of non-psychotic mania. The patient regained consciousness and was medically stable immediately after the MECT session (which did not produce a convulsion) but deteriorated rapidly after transfer to the recovery room. It was not possible to conduct an autopsy, but the authors surmise that the most probable cause was that the use of haloperidol 17 hours prior to MECT exacerbated the cardiac effects of nonconvulsive MECT. The case highlights the need for a thorough cardiac work-up on patients being considered for MECT (possibly including assessment of cardiac enzymes in older individuals) and careful consideration of the concurrent use of antipsychotic medications and MECT.

  11. Electroconvulsive Therapy Part II: A Biopsychosocial Perspective

    PubMed Central

    Payne, Nancy A.; Prudic, Joan

    2011-01-01

    The myths surrounding electroconvulsive therapy (ECT) and the misconceptions held by the general public, clinicians, and patients have interfered with acceptance of this treatment throughout its history. Misunderstandings surrounding ECT, and its consequent stigmatization, are reviewed, including negative depictions of ECT in film, print media, and on the Internet. Clinicians involved in the delivery of ECT benefit from gaining an understanding of how ECT may be perceived by patients and other mental health professionals; they can play a vital role in educating patients and helping ensure the delivery of a successful course of ECT. Guidance is provided for clinicians on how to support patients and families through the ECT process using a model team approach. Anxiety reduction, meeting individual needs, patient and family psychoeducation, assessment of psychosocial supports, and discharge planning are discussed. PMID:19820554

  12. 21 CFR 882.5940 - Electroconvulsive therapy device.

    Code of Federal Regulations, 2013 CFR

    2013-04-01

    ... 21 Food and Drugs 8 2013-04-01 2013-04-01 false Electroconvulsive therapy device. 882.5940 Section 882.5940 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES... Electroconvulsive therapy device. (a) Identification. An electroconvulsive therapy device is a device used...

  13. 21 CFR 882.5940 - Electroconvulsive therapy device.

    Code of Federal Regulations, 2014 CFR

    2014-04-01

    ... 21 Food and Drugs 8 2014-04-01 2014-04-01 false Electroconvulsive therapy device. 882.5940 Section 882.5940 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES... Electroconvulsive therapy device. (a) Identification. An electroconvulsive therapy device is a device used...

  14. 21 CFR 882.5940 - Electroconvulsive therapy device.

    Code of Federal Regulations, 2012 CFR

    2012-04-01

    ... 21 Food and Drugs 8 2012-04-01 2012-04-01 false Electroconvulsive therapy device. 882.5940 Section 882.5940 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES... Electroconvulsive therapy device. (a) Identification. An electroconvulsive therapy device is a device used...

  15. 21 CFR 882.5940 - Electroconvulsive therapy device.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... 21 Food and Drugs 8 2010-04-01 2010-04-01 false Electroconvulsive therapy device. 882.5940 Section 882.5940 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES... Electroconvulsive therapy device. (a) Identification. An electroconvulsive therapy device is a device used...

  16. 21 CFR 882.5940 - Electroconvulsive therapy device.

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ... 21 Food and Drugs 8 2011-04-01 2011-04-01 false Electroconvulsive therapy device. 882.5940 Section 882.5940 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES... Electroconvulsive therapy device. (a) Identification. An electroconvulsive therapy device is a device used...

  17. Electroconvulsive Therapy in the Elderly: New Findings in Geriatric Depression.

    PubMed

    Geduldig, Emma T; Kellner, Charles H

    2016-04-01

    This paper reviews recent research on the use of electroconvulsive therapy (ECT) in elderly depressed patients. The PubMed database was searched for literature published within the past 4 years, using the search terms: "electroconvulsive elderly," "electroconvulsive geriatric," "ECT and elderly," and "ECT elderly cognition." The studies in this review indicate excellent efficacy for ECT in geriatric patients. Adverse cognitive effects of ECT in this population are usually transient and not typically severe. In addition, continuation/maintenance ECT (C/M-ECT) may be a favorable strategy for relapse prevention in the elderly after a successful acute course of ECT. ECT is an important treatment option for depressed geriatric patients with severe and/or treatment-resistant illness. New data add to the evidence demonstrating that ECT is a highly effective, safe, and well-tolerated antidepressant treatment option for geriatric patients.

  18. Effectiveness of left anterior right temporal electrode placement in electroconvulsive therapy: 3 case reports.

    PubMed

    Weiss, Alan Micheal; Hansen, Shane Michael; Safranko, Ivan; Hughes, Pequita

    2015-03-01

    Unilateral and bitemporal electrode placement has been the dominant mode of delivery in electroconvulsive therapy. We report 3 patients receiving maintenance electroconvulsive therapy where the use of dominant electrode placements was ineffective. Changing to left anterior right temporal electrode placement resulted in marked clinical improvement. This supports the limited literature on this electrode placement.

  19. Effect of electroconvulsive therapy on hematological parameters.

    PubMed

    Chaturvedi, S; Chadda, R K; Rusia, U; Jain, N

    2001-11-30

    Although a complete blood count is part of the evaluation before the use of electroconvulsive therapy (ECT), there are no known hematological contraindications for the procedure. A preliminary study was done on 31 randomly selected psychiatric patients (chronic schizophrenia, n=10; acute depression, n=8; acute mania, n=6; acute psychosis, n=6; delusional disorder, n=1) receiving ECT to study its hematological effects. Blood samples were drawn just before and 0, 1 and 2 h after ECT. Hemoglobin (Hb%), total and differential leukocyte count (TLC and DLC), red blood cell (RBC) count, mean corpuscular volume (MCV), mean corpuscular hemoglobin (MCH), mean corpuscular hemoglobin concentration (MCHC) and platelet count were measured on a fully automated hematology analyzer (Sysmex K-1000). Significant changes were found in TLC, percentage of polymorphs and lymphocytes, and Hb%. Changes in other parameters were not statistically significant. More such studies are needed to substantiate these observations and to understand the mechanism and implication of these effects.

  20. Electroconvulsive therapy with S-ketamine anesthesia for catatonia in coexisting depression and dementia.

    PubMed

    Litvan, Zsuzsa; Bauer, Martin; Kasper, Siegfried; Frey, Richard

    2017-02-22

    Information on efficacy and safety of electroconvulsive therapy in patients with dementia is sparse. The current case report describes a patient suffering from severe depression and dementia who received electroconvulsive therapy with S-ketamine anesthesia at our psychiatric intensive care unit for the treatment of her therapy-resistant catatonic stupor. The patient's condition improved remarkably through the treatment. By the end of 16 electroconvulsive therapy sessions, her catatonic symptoms remitted entirely, her affect was brighter and she performed markedly better at the cognitive testing.

  1. Pivotal role of tissue plasminogen activator in the mechanism of action of electroconvulsive therapy.

    PubMed

    Hoirisch-Clapauch, Silvia; Mezzasalma, Marco A U; Nardi, Antonio E

    2014-02-01

    Electroconvulsive therapy is an important treatment option for major depressive disorders, acute mania, mood disorders with psychotic features, and catatonia. Several hypotheses have been proposed as electroconvulsive therapy's mechanism of action. Our hypothesis involves many converging pathways facilitated by increased synthesis and release of tissue-plasminogen activator. Human and animal experiments have shown that tissue-plasminogen activator participates in many mechanisms of action of electroconvulsive therapy or its animal variant, electroconvulsive stimulus, including improved N-methyl-D-aspartate receptor-mediated signaling, activation of both brain-derived neurotrophic factor and vascular endothelial growth factor, increased bioavailability of zinc, purinergic release, and increased mobility of dendritic spines. As a result, tissue-plasminogen activator helps promote neurogenesis in limbic structures, modulates synaptic transmission and plasticity, improves cognitive function, and mediates antidepressant effects. Notably, electroconvulsive therapy seems to influence tissue-plasminogen activator metabolism. For example, electroconvulsive stimulus increases the expression of glutamate decarboxylase 65 isoform in γ-aminobutyric acid-releasing neurons, which enhances the release of tissue-plasminogen activator, and the expression of p11, a protein involved in plasminogen and tissue-plasminogen activator assembling. This paper reviews how electroconvulsive therapy correlates with tissue-plasminogen activator. We suggest that interventions aiming at increasing tissue-plasminogen activator levels or its bioavailability - such as daily aerobic exercises together with a carbohydrate-restricted diet, or normalization of homocysteine levels - be evaluated in controlled studies assessing response and remission duration in patients who undergo electroconvulsive therapy.

  2. Maintenance electroconvulsive therapy in autistic catatonia: a case series review.

    PubMed

    Wachtel, Lee E; Hermida, Adriana; Dhossche, Dirk M

    2010-05-30

    The usage of electroconvulsive therapy for the acute resolution of catatonia in autistic children and adults is a novel area that has received increased attention over the past few years. Reported length of the acute ECT course varies among these patients, and there is no current literature on maintenance ECT in autism. The maintenance ECT courses of three patients with autism who developed catatonia are presented. Clinical, research, legal, and administrative implications for ECT treatment in this special population are discussed.

  3. Significant treatment effect of add-on ketamine anesthesia in electroconvulsive therapy in depressive patients: A meta-analysis.

    PubMed

    Li, Dian-Jeng; Wang, Fu-Chiang; Chu, Che-Sheng; Chen, Tien-Yu; Tang, Chia-Hung; Yang, Wei-Cheng; Chow, Philip Chik-Keung; Wu, Ching-Kuan; Tseng, Ping-Tao; Lin, Pao-Yen

    2017-01-01

    Add-on ketamine anesthesia in electroconvulsive therapy (ECT) has been studied in depressive patients in several clinical trials with inconclusive findings. Two most recent meta-analyses reported insignificant findings with regards to the treatment effect of add-on ketamine anesthesia in ECT in depressive patients. The aim of this study is to update the current evidence and investigate the role of add-on ketamine anesthesia in ECT in depressive patients via a systematic review and meta-analysis. We performed a thorough literature search of the PubMed and ScienceDirect databases, and extracted all relevant clinical variables to compare the antidepressive outcomes between add-on ketamine anesthesia and other anesthetics in ECT. Total 16 articles with 346 patients receiving add-on ketamine anesthesia in ECT and 329 controls were recruited. We found that the antidepressive treatment effect of add-on ketamine anesthesia in ECT in depressive patients was significantly higher than that of other anesthetics (p<0.001). This significance persisted in both short-term (1-2 weeks) and moderate-term (3-4 weeks) treatment courses (all p<0.05). However, the side effect profiles and recovery time profiles were significantly worse in add-on ketamine anesthesia group than in control group. Our meta-analysis highlights the significantly higher antidepressive treatment effect of add-on ketamine in depressive patients receiving ECT compared to other anesthetics. However, clinicians need to take undesirable side effects into consideration when using add-on ketamine anesthesia in ECT in depressive patients.

  4. Reversal of cerebral glucose hypometabolism on positron emission tomography with electroconvulsive therapy in an elderly patient with a psychotic episode.

    PubMed

    Hassamal, Sameer; Jolles, Paul; Pandurangi, Ananda

    2016-11-01

    AB, a 74-year-old Caucasian woman, was admitted for acute onset of psychosis, anxiety, and cognitive impairment. Pharmacotherapy was unsuccessful and the patient was referred for electroconvulsive therapy (ECT). Pre-ECT, (18) F-fluorodeoxyglucose-positron emission tomography (PET)/computed tomography showed extensive frontal, parietal, and temporal cortical hypometabolism suggestive of a neurodegenerative disease. After eight ECT sessions, the psychotic and anxiety symptoms as well as the cognitive impairment resolved. The rapid improvement in symptoms was more suggestive of a psychotic episode rather than dementia. Two days after the ECT course, (18) F-fluorodeoxyglucose-PET/computed tomography showed improvements in cerebral cortical hypometabolism, especially in the left parietal cortex, left temporal/occipital cortex. and bifrontal regions. At a follow-up visit 2 months after the ECT course, the psychotic episode was still in remission, and (18) F-fluorodeoxyglucose-PET/computed tomography continued to show improved cerebral cortical hypometabolism in these areas. This case illustrated the effect of ECT in reversing cerebral glucose hypometabolism on PET. The improvement in cerebral glucose hypometabolism may represent the neurophysiological mechanism of ECT in the treatment of a psychotic episode. Improved cerebral glucose hypometabolism was present 2 months post-ECT, which suggests that ECT caused sustained functional neural changes.

  5. Severe anorexia nervosa, co-occurring major depressive disorder and electroconvulsive therapy as maintenance treatment: a case report

    PubMed Central

    2009-01-01

    Introduction It is difficult to treat patients who, in addition to having severe anorexia nervosa, also have severe symptoms of major depressive disorder and a tendency for impulsive acting out behaviour. Our case report considers the feasibility of maintenance electroconvulsive therapy in such complicated cases. Case presentation This is a case report of a woman with anorexia nervosa and co-morbid severe major depressive disorder who was treated with electroconvulsive therapy as a maintenance treatment. The maintenance electroconvulsive therapy was conducted without immediate complications. It had a positive effect on the patient's depressive symptoms and lability and her general wellbeing, although some cognitive deficits were observed. Conclusion The maintenance electroconvulsive therapy seemed to support recovery in a case of refractory anorexia nervosa and a tendency for labile mood. The symptoms of co-occurring major depressive disorder were partly relieved and maintenance electroconvulsive therapy had some positive effect on weight gain. PMID:20062609

  6. Gilles de la Tourette syndrome: response to electroconvulsive therapy.

    PubMed

    Karadenizli, Demet; Dilbaz, Nesrin; Bayam, Goksel

    2005-12-01

    Tourette syndrome is a chronic disease characterized by vocal and motor ticks. Self-injurious behavior is observed in one third of the patients and can be life-threatening. Current medical therapy includes dopamine receptor antagonists and atypical antipsychotics. In certain cases, there has been some evidence about the efficacy of electroconvulsive therapy (ECT). The case study below is a Tourette syndrome patient with self-injurious behavior and psychotic features and poor response to medical therapy. Two years of remission was achieved after 7 sessions of ECT and carbamezapine maintance therapy. In conclusion, ECT can be used as an efficacious treatment modality for Tourette patients with self-injurious behavior, psychotic features, or for those that are unresponsive to traditional methods.

  7. Current electroconvulsive therapy practice and research in the geriatric population

    PubMed Central

    Kerner, Nancy; Prudic, Joan

    2014-01-01

    SUMMARY Electroconvulsive therapy (ECT) is utilized worldwide for various severe and treatment-resistant psychiatric disorders. Research studies have shown that ECT is the most effective and rapid treatment available for elderly patients with depression, bipolar disorder and psychosis. For patients who suffer from intractable catatonia and neuroleptic malignant syndrome, ECT can be life saving. For elderly patients who cannot tolerate or respond poorly to medications and who are at a high risk for drug-induced toxicity or toxic drug interactions, ECT is the safest treatment option. Organic causes are frequently associated with late-life onset of neuropsychiatric conditions, such as parkinsonism, dementia and stroke. ECT has proven to be efficacious even when these conditions are present. During the next decade, research studies should focus on the use of ECT as a synergistic therapy, to enhance other biological and psychological treatments, and prevent symptom relapse and recurrence. PMID:24778709

  8. Anesthesia for electroconvulsive therapy in early pregnancy.

    PubMed

    Lovas, András; Almos, Péter Z; Peto, Zoltán; Must, Anita; Horváth, Szatmár

    2011-12-01

    Pharmacological treatment of major psychiatric conditions (eg, schizophrenia, bipolar disorder) is exceptionally difficult during pregnancy. Despite all efforts, medication-resistant life-threatening mental deterioration can emerge with the urgent need for rapid and effective intervention. In these cases, electroconvulsive therapy (ECT) may represent the only valid and safe therapeutic option. Here, we present the challenging medical case of a 31-year-old primigravida with a general medical history of obesity and hypertension, previously diagnosed with bipolar affective disorder, now presenting with severe, therapy-resistant manic agitation. Full symptomatic remission was achieved and preserved with ECT given between the 7th and 22nd gestational weeks, the pregnancy reached full term, and a healthy child was born by cesarean delivery performed because of preeclampsia. Although it is unusual to start ECT this early in pregnancy, with the thorough assessment of potential risk factors and preventive measures taken, it can be the most effective and presumably the least risky treatment approach. By delineating key aspects of both the psychiatric and anesthetic management of this case, we aim to highlight the importance of a close cooperation between all medical fields involved in clinical practice.

  9. Takotsubo cardiomyopathy following electroconvulsive therapy: an increasingly recognised phenomenon

    PubMed Central

    Narayanan, A; Russell, M D; Sundararaman, S; Shankar, K K; Artman, B

    2014-01-01

    Treatment of patients with severe depressive illnesses requiring electroconvulsive therapy (ECT) is challenging. This is compounded by the presence of physical comorbidities and potential complications. We report the case of a patient, on long-term bisoprolol, who developed acute epigastric pain and dyspnoea shortly after receiving ECT for treatment-refractory depression. An ECG showed new-onset ischaemic changes and a troponin-I level was elevated at 12 h. A diagnosis of Takotsubo cardiomyopathy was reached following angiography, which demonstrated left ventricular hypokinesia in the absence of coronary artery disease. With supportive treatment the patient made a good recovery. This report highlights the risk of developing Takotsubo cardiomyopathy following ECT despite β-adrenergic receptor blockade, and adds to a growing number of cases reporting this complication. Clinicians involved in the care of patients undergoing ECT must be aware of this complication and should consider Takotsubo cardiomyopathy in patients who develop atypical chest pain after ECT. PMID:25425252

  10. Electroconvulsive therapy for catatonia in juvenile neuropsychiatric lupus.

    PubMed

    Leon, T; Aguirre, A; Pesce, C; Sanhueza, P; Toro, P

    2014-09-01

    Neuropsychiatric manifestations are serious and frequent complications of systemic lupus erythematous (SLE). Catatonia is a neuropsychiatric disorder characterized by motor disturbance (including waxy flexibility and catalepsy), stupor, excitement, negativism, mutism, echopraxia and echolalia. Catatonia associated with SLE has been only rarely reported, especially in children. Here we present a case of a 14-year-old patient encountered in consultation-liaison psychiatry who presented catatonia associated with SLE. Her catatonia was refractory to treatment with pulse methylprednisolone, intravenous cyclophosphamide and rituximab. The patient responded to a combined therapy of electroconvulsive therapy and benzodiazepines. The present case suggests that although rarely reported, catatonia seen in the background of SLE should be promptly identified and treated to reduce the morbidity.

  11. [Contemporary place of the electroconvulsive therapy. Part 2. Clinical aspect].

    PubMed

    Zyssi, Tomasz; Rachel, Wojciech; Datka, Wojciech; Hese, Robert T; Gorczyca, Piotr; Szwajca, Krzysztof; Piekoszewski, Wojciech; Zięba, Andrzej

    2015-01-01

    Electroconvulsive therapy (ECT) is an important method of biological treatment in serious psychic disturbances. Similarly to drug therapy it is marked by a determined schematics of applying including the list of indications, contraindications, procedures of the performance, as well as the list of adverse invents. Applying defined schemas allows for minimizing the risk and influences the final effectiveness of therapy.

  12. [Use of electroconvulsive therapy in the adolescent].

    PubMed

    Cohen, D; Dubos, P F; Basquin, M

    1997-01-01

    Despite the progress of pharmocotherapy, electroconvulsive therapy (ECT) is still used in a majority of countries to treat severe intractable mental disorders of the youth, yet few studies have been conducted to assess its use for individuals under 20-year-old. Efficacy, indications, side effects, technical characteristics and outcome are uncertain. A review of the 96 cases reported in the literature shows that: 1) its average frequency in adolescent psychiatric practice is similar throughout western nations and can be estimated around one ECT every year per million people; 2) intractable mood disorders, both manic and depressive episodes, are its main indications, since ECT treated more than 90% of the 66 cases reported; ECT can also offer an interesting alternative in some schizoaffective and schizophrenic episodes, in particular catatonic ones; 3) tolerance appears to be good, although secondary effects may occur. The most serious ones are infrequent spontaneous seizures and more common memory loss. Although no prospective studies are available on the evolution of cognitive side effects, they seem to disappear within a few weeks.

  13. A Case of Treatment- resistant Depression and Body Dysmorphic Disorder: The Role of Electroconvulsive Therapy Revisited.

    PubMed

    Mahato, Ram S; San Gabriel, Maria Chona P; Longshore, Carrol T; Schnur, David B

    2016-01-01

    Body dysmorphic disorder is a common, often disabling condition, and is frequently comorbid with major depressive disorder. Selective serotonin reuptake inhibitors constitute first line set of somatic interventions but the management of refractory patients remains challenging. Electroconvulsive therapy, an often highly beneficial treatment for medication resistant-depression, is not considered an effective therapeutic alternative for treatment refractory body dysmorphic disorder. Here we present a 50-year-old woman with body dysmorphic disorder and comorbid major depressive disorder who remained incapacitated and suicidal despite several trials with selective serotonin reuptake inhibitors and antipsychotic medication. Depressive and dysmorphic symptoms appeared to resolve with electroconvulsive therapy, and remission was sustained for two months. Electroconvulsive therapy has an important place in the management of treatment- resistant depression associated with body dysmorphic disorder, and, in select cases, may be effective for dysmorphic symptoms as well.

  14. [Assessment of individual clinical outcomes: regarding an electroconvulsive therapy case].

    PubMed

    Iraurgi, Ioseba; Gorbeña, Susana; Martínez-Cubillos, Miren-Itxaso; Escribano, Margarita; Gómez-de-Maintenant, Pablo

    2015-01-01

    Evaluation of therapeutic results and of the efficacy and effectiveness of treatments is an area of interest both for clinicians and researchers. In general, randomized controlled trial designs have been used as the methodology of choice in which intergroup comparisons are made having a minimum of participants in each arm of treatment. However, these procedures are seldom used in daily clinical practice. Despite this fact, the evaluation of treatment results for a specific patient is important for the clinician in order to address if therapeutic goals have been accomplished both in terms of statistical significance and clinical meaningfulness. The methodology based on the reliable change index (Jacobson y Truax)1 provides an estimate of these two criteria. The goal of this article is to propose a procedure to apply the methodology with a single case study of a woman diagnosed with major depression and treated with electroconvulsive therapy.

  15. Comparison between neurostimulation techniques repetitive transcranial magnetic stimulation vs electroconvulsive therapy for the treatment of resistant depression: patient preference and cost-effectiveness

    PubMed Central

    Magnezi, Racheli; Aminov, Emanuel; Shmuel, Dikla; Dreifuss, Merav; Dannon, Pinhas

    2016-01-01

    Objectives Major depressive disorder (MDD) is a common disorder, widely distributed in the population, and is often associated with severe symptoms and functional impairment. It has been estimated that 30% of MDD patients do not benefit adequately from therapeutic interventions, including pharmacotherapy and psychotherapy. Treatment-resistant depression (TRD) is generally defined as a failure to achieve remission, despite therapeutic interventions. Aim The most effective treatment alternatives for TRD are hospitalization, electroconvulsive therapy (ECT), and transcranial magnetic stimulation (TMS). Here we compared the clinical effectiveness of ECT and TMS, including success rates, patient responses, side-effect profiles, and financial worthiness. Results We found that ECT (P<0.0001) was more effective than TMS (P<0.012) (not statistically significant in group effect) in TRD patients. However, ECT patients reported a higher percentage of side effects (P<0.01) and the TMS treatment scored better in terms of patient preference. The cost benefit of ECT was higher than that of TMS (US$2075 vs US$814). Patient’s preferences for treatment could be more intense in the TMS, if the TMS is included in the Health Maintenance Organization’s service list. Conclusion We propose that both of these treatment options should be available in psychiatric wards, thus expanding the therapeutic toolkit for TRD. PMID:27536079

  16. Electroconvulsive Therapy. Consensus Development Conference Statement, Vol. 5, No. 11.

    ERIC Educational Resources Information Center

    National Institutes of Health (DHHS), Bethesda, MD.

    Electroconvulsive therapy (ECT), a treatment for severe mental illness in which a brief application of electric stimulus is used to produce a generalized seizure, has been in use for over 45 years. Controversies still exist today concerning the use of ECT. In 1985, the National Institutes of Health and the National Institute of Mental Health held…

  17. Electroconvulsive Therapy: A Primer for Mental Health Counselors.

    ERIC Educational Resources Information Center

    Leinbaugh, Tracy C.

    2001-01-01

    Electroconvulsive therapy is the treatment of choice for severe depressive episodes. Although little definitive research exists to explain its effectiveness, since its development in 1938 it has proven effective for the treatment of depression with psychotic features and suicidal ideation. Explains the procedure and discusses implications for the…

  18. Practice Parameter for Use of Electroconvulsive Therapy with Adolescents

    ERIC Educational Resources Information Center

    Ghaziuddin, Neera; Kutcher, Stanley P.; Knapp, Penelope

    2004-01-01

    Electroconvulsive therapy (ECT) may be an effective treatment for adolescents with severe mood disorders and other Axis I psychiatric disorders when more conservative treatments have been unsuccessful. ECT may be considered when there is a lack of response to two or more trials of pharmacotherapy or when the severity of symptoms precludes waiting…

  19. Achieving Competency in Electroconvulsive Therapy: A Model Curriculum

    ERIC Educational Resources Information Center

    Dolenc, Tamara J.; Philbrick, Kemuel L.

    2007-01-01

    Objective: This article illustrates a model electroconvulsive therapy (ECT) curriculum with specific parameters of both practice-based learning and medical knowledge. Method: The authors review the recommendations of the APA Task Force on ECT as they relate to training in ECT in psychiatry residency programs, and discuss diverse educational…

  20. Efficacy of Memoral Herbal on Prevention of Electroconvulsive Therapy-Induced Memory Impairment in Mood Disorder Patients (Isfahan – Iran 2011)

    PubMed Central

    Mousavi, Seyed Ghafur; Mohsen, Ghasemi; Reza, Maracy M; Amrollah, Ebrahimi; Majid, Barekatain; Fariba, Noori

    2012-01-01

    Background: Electroconvulsive therapy (ECT) is one of the most efficacious treatment for major depressive disorder (MDD), it is also used as a rapid and efficacious treatment for other psychiatric disorders, especially treatment resistant ones. The cognitive impairment is one of the most important side effects of ECT. This study examined the Memoral herbal efficacy in prevention of ECT-induced memory impairment. Methods: In a randomized clinical trial, 70 patients with mood disorders who were candidates for ECT enrolled in either Memoral or Control group, and received either Memoral or placebo. The memory was assessed by Addenbrook Cognitive Examination (ACE), and the findings were analyzed by ANOVA under SPSS18. Results: The Memoral group patients showed significantly higher total ACE scores than placebo group (P < 0.001). The scores of attention and orientation, verbal fluency and memory subscales not only never decreased during the study in Memoral group, but also increased. There was no significant difference between these scores of Memoral and placebo groups for the subscales of language and visuospacial ability. Conclusion: The Memoral herbal is an efficacious and safe choice in prevention of ECT- induced cognitive impairment. PMID:22891152

  1. Effectiveness of Electroconvulsive Therapy Augmentation on Clozapine-Resistant Schizophrenia

    PubMed Central

    Kim, Hye Sung; Kim, Se Hyun; Lee, Nam Young; Youn, Tak; Lee, Jeoung Hyuk; Chung, Seunghyun; Kim, Yong Sik

    2017-01-01

    Objective This retrospective case series study of the effectiveness of electroconvulsive therapy (ECT) augmentation on clozapine-resistant schizophrenia was conducted by EMR review. Methods Clozapine-resistance was defined as persistent psychotic symptoms despite at least 12 weeks of clozapine administration with blood levels over 350 ng/mL in order to rule out pseudo-resistance. Seven in-patients who were taking clozapine and treated with ECT were selected. We analyzed the psychopathology and subscales changed by ECT. Results The average number of ECT sessions was 13.4 (±4.6). Total Positive and Negative Syndrome Scale (PANSS) score was significantly reduced by 17.9 (±12.8) points (p=0.0384) on average, which represented a reduction of 25.5% (±14.3). 71.4% (5/7) of patients were identified as clinical remission, with at least a 20% reduction in PANSS score. PANSS reduction was associated with number of ECT sessions, stimulus level in the final session, and blood clozapine levels before ECT. However, the negative subscale on the PANSS were not reduced by ECT in any patient. We did not observe any persistent adverse cognitive effects. Conclusion This study supports that ECT augmentation on clozapine-resistant schizophrenia reveals clinically effective and safe. Further research should be done involving a larger number of patients to investigate the effectiveness of clozapine/ECT combination therapy. PMID:28096876

  2. How bad was unmodified electroconvulsive therapy! A retrospective study

    PubMed Central

    Ray, Anindya Kumar

    2016-01-01

    “Unmodified”-electroconvulsive therapy (ECT) being considered unethical remained away from the scientific literature, but continued in practice in many parts of the world. The Mental Health Care Bill, 2011, proposed for its banning in India. The aim of this study is to retrospectively observe “how bad was unmodified-ECT” to the patients in a naturalistic setting. The study was done at the Central Institute of Psychiatry, India. Files of patients receiving unmodified ECT during 1990–1995 were retrospectively reviewed. Outcome was evaluated in terms of desired effectiveness and the side effects as noted in the files by the treating team. Six hundred and thirty-seven patients (6.94% of total admission) received ECT with meticulous standard-of-care except provision of anesthesia. Satisfactory improvement was noted in 95.45% patients with no noticeable/reported complication in 89.05%. Premature termination of ECT for complications occurred in 2.19% patients. “Unmodified”-ECT, though unethical, still could ensure favorable outcome with proper case selection and meticulous standard-of-care. PMID:27385857

  3. Electroconvulsive therapy, the placebo effect and informed consent.

    PubMed

    Blease, Charlotte Rosalind

    2013-03-01

    Major depressive disorder is not only the most widespread mental disorder in the world, it is a disorder on the rise. In cases of particularly severe forms of depression, when all other treatment options have failed, the use of electroconvulsive therapy (ECT) is a recommended treatment option for patients. ECT has been in use in psychiatric practice for over 70 years and is now undergoing something of a restricted renaissance following a sharp decline in its use in the 1970s. Despite its success in treating severe depression there is continued debate as to the effectiveness of ECT: in some studies, it is argued that ECT is marginally more effective than sham ECT. In addition, there is still no clear explanation of how ECT works; among the range of hypotheses proposed it is claimed that ECT may work by harnessing placebo effects. In light of the uncertainties over the mechanism of action of ECT and given the risk of serious side effects that ECT may produce, I contend that the process of informed consent must include comprehensive accounts of these uncertainties. I examine the possible consequences of providing adequate information to potential ECT patients, including the consideration that ECT may still prove to be effective even if physicians are open about the possibility of it working as a placebo. I conclude that if we value patient autonomy as well as the professional reputation of medical practitioners, a fuller description of ECT must be provided to patients and their carers.

  4. Onset of catatonia at puberty: electroconvulsive therapy response in two autistic adolescents.

    PubMed

    Ghaziuddin, Neera; Gih, Daniel; Barbosa, Virginia; Maixner, Daniel F; Ghaziuddin, Mohammad

    2010-12-01

    Catatonia is a syndrome of motor and behavioral disturbance. It is a poorly understood condition, which is underrecognized and may go untreated despite intensive medical workup and numerous unsuccessful medication trials. However, with treatments known to be effective, such as benzodiazepines and/or electroconvulsive therapy, patients may return to their baseline functioning. Autism and catatonia have been previously reported together. We report 2 patients with autism and mental retardation who developed catatonic symptoms at the onset of puberty. Both patients experienced persistent symptoms over several years and presented with a history of motor disturbance, functional decline, and episodic aggression. Both patients were treated with electroconvulsive therapy resulting in a positive response and functional improvement. Catatonia may persist as a chronic condition, lasting over several months or years, if not recognized and treated.

  5. Electroconvulsive therapy and/or plasmapheresis in autoimmune encephalitis?

    PubMed Central

    Gough, Jessica L; Coebergh, Jan; Chandra, Brunda; Nilforooshan, Ramin

    2016-01-01

    Autoimmune encephalitis is a poorly understood condition that can present with a combination of neurological and psychiatric symptoms, either of which may predominate. There are many autoantibodies associated with a variety of clinical syndromes - anti-N-Methyl-D-Aspartate receptor (NMDAR) is the commonest. Currently, the most widely used therapy is prompt plasmapheresis and steroid treatment (and tumour resection if indicated), followed by second line immunosuppression if this fails. Given the growing awareness of autoimmune encephalitis as an entity, it is increasingly important that we consider it as a potential diagnosis in order to provide timely, effective treatment. We discuss several previously published case reports and one new case. These reports examined the effects of electroconvulsive therapy (ECT) on patients with autoimmune encephalitis, particularly those in whom psychiatric symptoms are especially debilitating and refractory to standard treatment. We also discuss factors predicting good outcome and possible mechanisms by which ECT may be effective. Numerous cases, such as those presented by Wingfield, Tsutsui, Florance, Sansing, Braakman and Matsumoto, demonstrate effective use of ECT in anti-NMDAR encephalitis patients with severe psychiatric symptoms such as catatonia, psychosis, narcolepsy and stupor who had failed to respond to standard treatments alone. We also present a new case of a 71-year-old female who presented to a psychiatric unit initially with depression, which escalated to catatonia, delusions, nihilism and auditory hallucinations. After anti-NMDAR antibodies were isolated, she was treated by the neurology team with plasmapheresis and steroids, with a partial response. She received multiple sessions of ECT and her psychiatric symptoms completely resolved and she returned to her premorbid state. For this reason, we suggest that ECT should be considered, particularly in those patients who are non-responders to standard therapies. PMID

  6. Is there a decline in cognitive functions after combined electroconvulsive therapy and antipsychotic therapy in treatment-refractory schizophrenia?

    PubMed

    Pawełczyk, Agnieszka; Kołodziej-Kowalska, Emilia; Pawełczyk, Tomasz; Rabe-Jabłońska, Jolanta

    2015-03-01

    An analysis of literature shows that there is still little evidence concerning the efficacy of electroconvulsive therapy (ECT) combined with antipsychotic therapy in a group of treatment-resistant schizophrenia patients. More precisely, its influence on cognitive functions is still equivocal. The aim of this study was to assess the influence of ECT combined with antipsychotic therapy on working memory, attention, and executive functions in a group of treatment-refractory schizophrenia patients. Twenty-seven patients completed the study: 14 men and 13 women, aged 21 to 55 years (mean age, 32.8 years), diagnosed with treatment-resistant schizophrenia. Each patient underwent a course of ECT sessions and was treated with antipsychotic medications. Before the ECT and within 3 days after the last ECT session, the participants were assessed with the following neuropsychological tests: Trail Making Test (TMT) and Wisconsin Cart Sorting Test (WCST). There were no significant differences in the TMT and WCST results after combined ECT and antipsychotic therapy in treatment-refractory schizophrenia patients. According to the results of the neuropsychological tests, there was no decline in attention, executive functions, or working memory. The current study shows no significant difference in attention, working memory, or executive functions after treatment with a combination of electroconvulsive and antipsychotic therapy. This suggests that combined electroconvulsive therapy may not have a negative influence on the neuropsychological functioning of patients with treatment resistant schizophrenia.

  7. Electroconvulsive therapy increases temporal gray matter volume and cortical thickness.

    PubMed

    Sartorius, Alexander; Demirakca, Traute; Böhringer, Andreas; Clemm von Hohenberg, Christian; Aksay, Suna Su; Bumb, Jan Malte; Kranaster, Laura; Ende, Gabriele

    2016-03-01

    Electroconvulsive therapy (ECT) is a treatment of choice for severe and therapy resistant forms of major depressive episodes (MDE). Temporal brain volume alterations in MDE have been described for more than two decades. In our prospective study we aimed to investigate individual pre-post ECT treatment whole brain gray matter (GM) volume changes (quantified with voxel-based morphometry) in a sample of 18 patients with MDE. In addition, we studied the effect of ECT on voxel-based cortical thickness in cortical brain regions. The most prominent longitudinal GM increases (significant at a whole brain corrected level) occurred in temporal lobe regions. Within specific region of interest analyses we detected highly significant increases of GM in the hippocampus and the amygdala and to a lesser extent in the habenula (left p=0.003, right p=0.032). A voxel based cortical thickness analysis revealed an increase in cortical temporal regions (basically temporal pole and insula) further corroborating our cortical voxel-based morphometry results. Neither GM decreases or white matter increases nor correlations of GM changes with basic psychopathological parameters were detected. We corroborate earlier findings of hippocampal and amygdala GM volume increase following an acute ECT series in patients with MDE. Temporal GM volume increase was significant on a whole brain level and further corroborated by a cortical thickness analysis. Our data widely exclude white matter loss as an indirect cause of GM growth. Our data add further evidence to the hypothesis that ECT enables plasticity falsifying older ideas of ECT induced "brain damaging".

  8. Catatonia associated with hyponatremia treated with electroconvulsive therapy.

    PubMed

    Grover, Sandeep; Kattharaghatta Girigowda, Vijay; Aggarwal, Munish; Malhotra, Nidhi

    2012-09-01

    Catatonia has been reported to occur in various brain pathologies and systemic conditions. We present a case of catatonia associated with hyponatremia treated with a course of electroconvulsive therapy. A 48-year-old woman presented with catatonia and, upon investigation, was found to have persistent/recurrent hyponatremia. Upon investigation also, she was found to have adrenal insufficiency. Her symptoms of catatonia did not respond to correction of hyponatremia, a course of lorazepam, after which she was treated with ECT, with which her catatonia improved.

  9. Postpartum catatonia treated with electroconvulsive therapy: a case report.

    PubMed

    Strain, Angela Katherine; Meltzer-Brody, Samantha; Bullard, Elizabeth; Gaynes, Bradley N

    2012-01-01

    Catatonia is a rare syndrome that occurs in mood and psychotic disorders, and general medical conditions. Postpartum depression affects 10%-15% of women within 6 months after delivery. Postpartum psychosis affects 0.1%-0.5% of women within weeks after delivery, though it can occur within hours; it carries risk for suicide and infanticide. There is limited evidence available to guide treatment. We review a case of postpartum psychosis that presented with catatonia and was resistant to medications, but responded to electroconvulsive therapy.

  10. Contemporary use and practice of electroconvulsive therapy worldwide

    PubMed Central

    Leiknes, Kari Ann; Jarosh-von Schweder, Lindy; Høie, Bjørg

    2012-01-01

    To explore contemporary (from 1990) utilization and practice of electroconvulsive therapy (ECT) worldwide. Systematic search (limited to studies published 1990 and after) was undertaken in the databases Medline, Embase, PsycINFO, SveMed, and EBSCO/Cinahl. Primary data-based studies/surveys with reported ECT utilization and practice in psychiatric institutions internationally, nationally, and regionally; city were included. Two reviewers independently checked study titles and abstracts according to inclusion criteria, and extracted ECT utilization and practice data from those retrieved in full text. Seventy studies were included, seven from Australia and New Zealand, three Africa, 12 North and Latin America, 33 Europe, and 15 Asia. Worldwide ECT differences and trends were evident, average number ECTs administered per patient were eight; unmodified (without anesthesia) was used in Asia (over 90%), Africa, Latin America, Russia, Turkey, Spain. Worldwide preferred electrode placement was bilateral, except unilateral at some places (Europe and Australia/New Zealand). Although mainstream was brief-pulse wave, sine-wave devices were still used. Majority ECT treated were older women with depression in Western countries, versus younger men with schizophrenia in Asian countries. ECT under involuntary conditions (admissions), use of ambulatory-ECT, acute first line of treatment, as well as administered by other professions (geriatricians, nurses) were noted by some sites. General trends were only some institutions within the same country providing ECT, training inadequate, and guidelines not followed. Mandatory reporting and overall country ECT register data were sparse. Many patients are still treated with unmodified ECT today. Large global variation in ECT utilization, administration, and practice advocates a need for worldwide sharing of knowledge about ECT, reflection, and learning from each other's experiences. PMID:22741102

  11. Efficacy and safety of treating patients with refractory schizophrenia with antipsychotic medication and adjunctive electroconvulsive therapy: a systematic review and meta-analysis

    PubMed Central

    WANG, Wenzheng; PU, Chengcheng; JIANG, Jiangling; CAO, Xinyi; WANG, Jijun; ZHAO, Min; LI, Chunbo

    2015-01-01

    Background The efficacy and safety of the combined treatment of refractory schizophrenia with antipsychotic medications and electroconvulsive therapy (ECT) remain uncertain. Aims Conduct systematic review and meta-analysis of available literature in English and Chinese about ECT in the treatment of refractory schizophrenia. Methods English and Chinese databases were searched for studies published prior to May 20, 2015 regarding the efficacy and safety of the combined treatment of refractory schizophrenia with antipsychotic medications and ECT. Two researchers selected and evaluated studies independently using pre-defined criteria. Review Manager 5.3 software was used for data analysis. Results A total of 22 randomized control studies, 18 of which were conducted in mainland China, were included in the analysis. Meta-analysis of data from 18 of the 22 studies with a pooled sample of 1394 individuals found that compared to treatment with antipsychotic medications alone, combined treatment with antipsychotic medications and ECT had significantly higher rates of achieving study-specific criteria of ‘clinical improvement’ (RR=1.25, 95%CI=1.14-1.37). Based on the Grades of Recommendation, Assessment, Development, and Evaluation (GRADE) criteria, the quality of evidence for this assessment of efficacy was ‘moderate’. However, the proportion of participants who experienced headache during the treatment was significantly higher in the combined treatment group (RR=9.10, 95%CI=3.97-20.86, based on a pooled sample of 517 from 8 studies) and the proportion who experienced memory impairment was also higher in the combined treatment group (RR=6.48, 95%CI=3.54-11.87, based on a pooled sample of 577 from 7 studies). The quality of evidence about these adverse events was rated as ‘very low’. Conclusions There are very few high quality randomized controlled clinical trials about the combination of antipsychotic medications and ECT in the treatment of refractory

  12. Beta-blocking agents during electroconvulsive therapy: a review.

    PubMed

    Boere, E; Birkenhäger, T K; Groenland, T H N; van den Broek, W W

    2014-07-01

    Electroconvulsive therapy (ECT) is associated with at least transient episodes of hypertension and tachycardia. Beta-blocking agents may be indicated to prevent cardiovascular complications and may shorten seizure duration. This review evaluates studies that used beta-blocking agents during ECT to determine which agent has the most favourable outcomes on cardiovascular variables and seizure duration. A Medline database search was made using the combined keywords 'adrenergic beta-antagonists' and 'electroconvulsive therapy'. The search was restricted to double-blind randomized controlled trials and yielded 29 original studies. With the use of esmolol, significant attenuating effects were found on cardiovascular parameters in the first 5 min after stimulation; its shortening effects on seizure duration may be dose-related. With the use of labetalol, findings on cardiovascular effects were inconsistent during the first minutes after stimulation but were significant after 5 min and thereafter; seizure duration was scarcely studied. Landiolol attenuates heart rate but with inconsistent findings regarding arterial pressure (AP); seizure duration was mostly unaffected. Esmolol appears to be effective in reducing the cardiovascular response, although seizure duration may be affected with higher dosages. Landiolol can be considered a suitable alternative, but effects on AP need further investigation. Labetalol has been studied to a lesser extent and may have prolonged cardiovascular effects. The included studies varied in design, methodology, and the amount of exact data provided in the publications. Further study of beta-blocking agents in ECT is clearly necessary.

  13. Alteration of Immune Markers in a group of Melancholic Depressed patients and their Response to Electroconvulsive Therapy

    PubMed Central

    Rush, Gavin; O’Donovan, Aoife; Nagle, Laura; Conway, Catherine; McCrohan, AnnMaria; O’Farrelly, Cliona; Lucey, James V.; Malone, Kevin M.

    2017-01-01

    Background Immune system dysfunction is implicated in the pathophysiology of major depression, and is hypothesized to normalize with successful treatment. We aimed to investigate immune dysfunction in melancholic depression and its response to ECT. Methods 55 melancholic depressed patients and 26 controls participated. 33 patients (60%) were referred for ECT. Blood samples were taken at baseline, one hour after the first ECT session, and 48 hours after ECT series completion. Results At baseline, melancholic depressed patients had significantly higher levels of the pro-inflammatory cytokine IL-6, and lower levels of the regulatory cytokine TGF-β than controls. A significant surge in IL-6 levels was observed one hour after the first ECT session, but neither IL-6 nor TGF-β levels normalized after completion of ECT series. Seventy per cent (n=23) of ECT recipients showed clinical response and 42% (n=10) reached remission. Neither IL-6 nor TGF-β changes correlated with clinical improvement following ECT. No significant changes in IL-10, TNF-α and CRP levels were found in relation to melancholia or response to ECT. Limitations As a naturalistic study, some potential confounders could not be eliminated or controlled, including medication use. Conclusions Melancholic depressed patients demonstrated a peripheral increase in IL-6 and reduction in TGF-β, which did not normalize despite clinical response to ECT. These findings may be consistent with emerging hypotheses of the role of inflammation in mediating neurotropin expression. The implications of chronic inflammation in the melancholic depressed population for future medical health, particularly cardiovascular risk, are largely unknown and warrant further investigation. PMID:27414954

  14. The Use of Electroconvulsive Therapy in Atypical Psychotic Presentations

    PubMed Central

    Vasu, Devi

    2007-01-01

    Convulsive therapy and its progeny, electroconvulsive therapy (ECT), were originally used for the treatment of catatonic schizophrenia, and there is little doubt that ECT remains an effective intervention for the treatment of schizophrenia. However, current practice tends to favor the use of ECT in severe or treatment refractory affective disorders, and its use in schizophrenia and other nonaffective (atypical) psychotic disorders has become controversial. Case reports have suggested a role for ECT in two specific atypical psychotic disorders: Cotard's syndrome and cycloid psychosis. In this article, we review the atypical psychotic disorders and report a series of five case examples that signify the role of ECT in atypical psychotic presentations, particularly when the symptoms resemble those found in Cotard's syndrome and cycloid psychosis. PMID:20428309

  15. Prevalence and correlates of electroconvulsive therapy delivery in 1001 obsessive-compulsive disorder outpatients.

    PubMed

    Dos Santos-Ribeiro, Samara; Lins-Martins, Natália M; Frydman, Ilana; Conceição do Rosário, Maria; Ferrão, Ygor A; Shavitt, Roseli G; Yücel, Murat; Miguel, Euripedes C; Fontenelle, Leonardo F

    2016-05-30

    Individuals with obsessive-compulsive disorder (OCD) who sought treatment in seven different specialized centers (n=1001) were evaluated with a structured assessment battery. Thirteen OCD patients (1.3% of the sample) reported having been treated with electroconvulsive therapy (ECT) in the past. They were older and exhibited higher global severity of OCD symptoms, but were less likely to display symmetry/ordering and contamination/washing symptoms. They also had greater suicidality and increased rates of psychosis. Finally, OCD patients exposed to ECT were more frequently treated with antipsychotics, although they did not differ in terms of responses to adequate trials with serotonin reuptake inhibitors.

  16. Rocuronium-sugammadex for electroconvulsive therapy management in neuroleptic malignant syndrome: A case report.

    PubMed

    Casas Reza, P; Gestal Vázquez, M; Outeiro Rosato, Á; López Álvarez, S; Diéguez García, P

    2017-02-01

    Neuroleptics are a group of drugs widely used in the treatment of psychotic symptoms. Among their adverse effects is the ability to trigger a neuroleptic malignant syndrome (NMS). The diagnosis of NMS is determined by exclusion, and its initial therapeutic management should be the withdrawal of neuroleptics, the administration of benzodiazepines, and electroconvulsive therapy (ECT). ECT is an effective treatment in these patients, and in those cases with a poor response to treatment with antipsychotic drugs. A review is presented on the treatment options and anaesthetic implications of ECT used to handle a patient diagnosed with paranoid schizophrenia in the context of NMS.

  17. Electroconvulsive therapy during high-risk pregnancy.

    PubMed

    Walker, R; Swartz, C M

    1994-09-01

    Pregnancy increases the risk of injury associated with mental illness. The varieties of malnutrition, substance abuse, and aggression that may accompany mental illness can injure the unborn child in more severe ways than the patient herself. Dangers associated with illness-related behavior can outweight the risks of pharmacotherapy, but no psychotropic drug is approved for use during pregnancy. Failure to produce a prompt or lasting remission of psychiatric symptoms also is a significant possibility with medication. The morbidity from continued illness and the incompletely described adverse effects of psychotropic drugs increases the attractiveness of ECT for severely depressed pregnant patients, especially with associated high-risk conditions. This paper discusses physiologic changes occurring during pregnancy and ECT and reviews contemporary monitors of maternal and fetal well-being. Guidelines are suggested for ECT during regular and high-risk pregnancies. The authors conclude that using additional precautions with high-risk pregnant patients permits ECT to be given with relative safety; medical and obstetric risk factors need not prevent its use.

  18. A review of longitudinal electroconvulsive therapy: neuroimaging investigations.

    PubMed

    Abbott, Christopher C; Gallegos, Patrick; Rediske, Nathan; Lemke, Nicholas T; Quinn, Davin K

    2014-03-01

    Electroconvulsive therapy (ECT) is the most effective treatment for a depressive episode but the mechanism of action and neural correlates of response are poorly understood. Different theories have suggested that anticonvulsant properties or neurotrophic effects are related to the unique mechanism of action of ECT. This review assessed longitudinal imaging investigations (both structural and functional) associated with ECT response published from 2002 to August 2013. We identified 26 investigations that used a variety of different imaging modalities and data analysis methods. Despite these methodological differences, we summarized the major findings of each investigation and identified common patterns that exist across multiple investigations. The ECT response is associated with decreased frontal perfusion, metabolism, and functional connectivity and increased volume and neuronal chemical metabolites. The general collective of longitudinal neuroimaging investigations support both the anticonvulsant and the neurotrophic effects of ECT. We propose a conceptual framework that integrates these seemingly contradictory hypotheses.

  19. [Will electroconvulsive therapy disappear in the near future?].

    PubMed

    Motohashi, Nobutaka

    2012-01-01

    Electroconvulsive therapy (ECT) has been widely used, with some modification of its methods, for the treatment of refractory mental disorders. In Japan, brief-pulse ECT was approved in 2002 under conditions that well-trained psychiatrists should administer ECT and that modified ECT is mandatory. However, unmodified ECT is still often performed in Japan. We have to improve safety of ECT further. Major indications for ECT are depression and catatonia. Mechanisms of ECT are still unknown, but the neurogenesis hypothesis is promising. Furthermore, several brain stimulation techniques without seizure induction, such as transcranial magnetic stimulation, vagus nerve stimulation, deep brain stimulation and transcranial direct current stimulation, have been introduced for the treatment of refractory mental disorders. Ethical criteria must be determined for further research and treatment with these techniques.

  20. Management of poor postictal suppression during electroconvulsive therapy with propofol anesthesia: a report of two cases.

    PubMed

    Stewart, Jonathan T

    2012-12-01

    There is increasing evidence that a greater degree of postictal suppression (the abruptness and magnitude of the EEG voltage drop at the end of the seizure) may be associated with better clinical response to electroconvulsive therapy. Retrospective studies have shown better postictal suppression when propofol is used for induction rather than the more commonly used methohexital. We report two patients in whom poor postictal suppression was rectified by switching from methohexital to propofol. The clinical significance of this improvement in postictal suppression is unclear, and prospective studies will be needed to clarify any clinical benefits.

  1. Treatment of post-electroconvulsive therapy delirium and agitation with donepezil.

    PubMed

    Logan, Christopher J; Stewart, Jonathan T

    2007-03-01

    Delirium and agitation are commonly encountered after administration of electroconvulsive therapy (ECT). Management is generally fairly straightforward, although some patients may have a severe, prolonged, or refractory course. We recently cared for a 65-year-old man who consistently developed severe and very prolonged post-ECT delirium that did not respond to typical pharmacological agents; the duration of delirium was dramatically shortened by the addition of donepezil. Cholinesterase inhibitors may have a place in mitigating severe and prolonged post-ECT delirium.

  2. [Electroconvulsive therapy in the third trimester of pregnancy: a case report].

    PubMed

    Prieto Martin, R M; Palomero Rodriguez, M A; de Miguel Fernandez, P; Yusta Martin, G; Alonso Borrego, B; Muriel Villoria, C

    2006-12-01

    Electroconvulsive or electroshock therapy is an effective psychiatric treatment. The need for effective psychotherapy in the pregnant patient and the need to limit application of psychotropic drugs have encouraged the use of electroshock therapy in the past 50 years. We report the case of a 35-year-old woman at 30 weeks' gestation who was hospitalized with severe depression. When her condition worsened after initiation of medical treatment, electroshock therapy was considered. She received a total of 9 sessions (3 per week). During treatments the patient received general anesthesia with propofol and succinylcholine with insertion of a tracheal tube. Significant variations in the hemodynamic variables of mother and fetus were not observed; nor were there signs of fetal distress. The patient experienced clear improvement and 2 days after the last treatment spontaneous labor commenced. A healthy boy was born by vaginal delivery.

  3. Electroconvulsive therapy use in adolescents: a systematic review

    PubMed Central

    2013-01-01

    Background Considered as a moment of psychological vulnerability, adolescence is remarkably a risky period for the development of psychopathologies, when the choice of the correct therapeutic approach is crucial for achieving remission. One of the researched therapies in this case is electroconvulsive therapy (ECT). The present study reviews the recent and classical aspects regarding ECT use in adolescents. Methods Systematic review, performed in November 2012, conformed to the PRISMA statement. Results From the 212 retrieved articles, only 39 were included in the final sample. The reviewed studies bring indications of ECT use in adolescents, evaluate the efficiency of this therapy regarding remission, and explore the potential risks and complications of the procedure. Conclusions ECT use in adolescents is considered a highly efficient option for treating several psychiatric disorders, achieving high remission rates, and presenting few and relatively benign adverse effects. Risks can be mitigated by the correct use of the technique and are considered minimal when compared to the efficiency of ECT in treating psychopathologies. PMID:23718899

  4. A case of catatonia in a 14-year-old girl with schizophrenia treated with electroconvulsive therapy.

    PubMed

    Häßler, Frank; Reis, Olaf; Weirich, Steffen; Höppner, Jacqueline; Pohl, Birgit; Buchmann, Johannes

    2013-01-01

    This article presents a case of a 14-year-old female twin with schizophrenia who developed severe catatonia following treatment with olanzapine. Under a combined treatment with amantadine, electroconvulsive therapy (ECT), and (currently) ziprasidone alone she improved markedly. Severity and course of catatonia including treatment response were evaluated with the Bush-Francis Catatonia Rating Scale (BFCRS). This case report emphasizes the benefit of ECT in the treatment of catatonic symptoms in an adolescent patient with schizophrenic illness.

  5. Position statement and guidelines on unmodified electroconvulsive therapy

    PubMed Central

    Andrade, Chittaranjan; Shah, N.; Tharyan, P.; Reddy, M. S.; Thirunavukarasu, M.; Kallivayalil, R. A.; Nagpal, R.; Bohra, N. K.; Sharma, A.; Mohandas, E.

    2012-01-01

    Background: In modern day psychiatric practice, it is assumed as a matter of fact that when electroconvulsive therapy (ECT) is administered, it will be administered under anesthesia and with succinylcholine (or its equivalent) modification. Yet, as surveys indicate, there is considerable practice of unmodified ECT in developing countries and, to a small extent, in the developed world, as well. Materials and Methods: This document examines historical and recent literature on the geographical practice, physiology, efficacy, and adverse effects of unmodified ECT. Particular attention is paid to musculoskeletal risks. Results: Although almost all the research is of poor methodological quality, there is a good reason to accept that unmodified ECT is associated with a wide range of adverse consequences, important among which are musculoskeletal complications, pre-ECT anxiety, and post-ECT confusion. However, it appears from recent data that these risks are not as large as historically portrayed. Possibly explanations are suggested, with seizure modification using parenteral benzodiazepines as a special possibility. Conclusions: Under exceptional circumstances, if ECT is strongly indicated and seizure modification with succinylcholine is not feasible, unmodified ECT, especially benzodiazepine-modified ECT, may be a viable option. A detailed set of recommendations for such use of unmodified ECT is proposed along with necessary checks and balances. This document has been approved by the Indian Psychatric Society, the Indian Association of Biological Psychiatry, and the Indian Association of Private Psychiatry (which commissioned the preparation of the document). PMID:22988318

  6. Electroconvulsive Therapy Use in Youth in the Province of Quebec

    PubMed Central

    Loiseau, Annie; Harrisson, Marie-Claude; Beaudry, Vincent; Patry, Simon

    2017-01-01

    Objectives Electroconvulsive therapy’s (ECT) safety and tolerability is well-established in the treatment of severe psychiatric disorders in adults, but has been less studied in youth. The aim of the present study was to describe the use of ECT in youth in Quebec City and obtain Child and Adolescent Psychiatrists’ (CAP) perceptions in the province of Quebec. Methods The authors reviewed charts of minors who received ECT treatment in the Quebec City metropolitan area between 1995 and 2014 (part 1). Data was also collected on CAP perceptions and experience of ECT use in youth by means of a survey (part 2). Results Part 1 included four girls and two boys, aged between 15 and 17. The main diagnoses were: mood disorders and schizoaffective disorder. Patients received between four and twelve ECT sessions. Five patients responded to treatment, whereas one did not. Treatment and side effects are presented. For part 2, 53 CAP answered the survey. Forty-eight (91%) thought ECT is a good treatment option after failure of other therapeutic modalities and 12 (23%) had prescribed it. All respondents wished to receive additional training regarding ECT use in youth. Conclusion Our results are consistent with the notion that ECT use in youth with a refractory and complex disease is a safe and effective treatment, although rarely used. The majority of psychiatrists treating children and adolescents in Quebec favor ECT when all available therapeutic modalities have failed, but wished they had more training regarding its use. PMID:28331498

  7. Comparable seizure characteristics in magnetic seizure therapy and electroconvulsive therapy for major depression.

    PubMed

    Kayser, Sarah; Bewernick, Bettina H; Hurlemann, René; Soehle, Martin; Schlaepfer, Thomas E

    2013-11-01

    Electroconvulsive therapy (ECT) is highly effective for treatment-resistant depression (TRD); however, its use for less severe forms of depression is somewhat limited by a lack of control over current spreading to medial temporal lobe memory structures, resulting in various cognitive side effects. In contrast, magnetic seizure therapy (MST), which uses high frequency repetitive transcranial magnetic stimulation (rTMS) for local seizure induction, has been associated with reduced cognitive side effects. To assess whether different characteristics of seizures induced by both methods are responsible for the differences in neuropsychological side-effect profile, we studied seven TRD-patients undergoing both MST and ECT in an open-label, within subject, controlled crossover pilot study. Comparison parameters included seizure-related ictal characteristics, including motor activity, electromyogram (EMG), electroencephalogram (EEG), and postictal recovery and reorientation times.Our results showed no differences in motor activity or EMG and EEG characteristics, thus implicating similar electrophysiological processes in seizure induction with MST and ECT. In line with previous studies, we observed shorter postictal recovery and reorientation times following MST.The ictal characteristics of induced seizures were found similar with ECT and MST suggesting that the more focal seizure induction associated with MST may account for the more beneficial neuropsychological side effect profile of MST.

  8. Autism-Like Behavior in BTBR Mice Is Improved by Electroconvulsive Therapy.

    PubMed

    Hagen, Eunice; Shprung, Dana; Minakova, Elena; Washington, James; Kumar, Udaya; Shin, Don; Sankar, Raman; Mazarati, Andrey

    2015-07-01

    Autism is a developmental disorder characterized by impairments in social and communication abilities, as well as by restricted and repetitive behaviors. Incidence of autism is higher than earlier estimates, and treatments have limited efficacy and are costly. Limited clinical and experimental evidence suggest that patients with autism may benefit from electroconvulsive therapy (ECT). We examined the therapeutic potential of ECT in BTBR T+ tf/j mice, which represent a validated model of autism. A series of 13 electroconvulsive shocks (ECS) delivered twice a day over 7 days reversed core autism-like behavioral abnormalities-impaired sociability, social novelty, and repetitive behavior-when the animals were tested 24 h after the last ECS. The effect lasted up to 2 weeks after ECT. Neither single ECS nor a series of 6 ECS modified animals' behavior. Chronic infusion into the lateral brain ventricle of a preferential oxytocin receptor blocker (2S)-2-Amino-N-[(1S,2S,4R)-7,7-dimethyl-1-[[[4-(2-methylphenyl)-1-piperazinyl]sulfonyl]methyl]bicyclo[2.2.1]hept-2-yl]-4-(methylsulfonyl)butanamide hydrochloride abolished ECT-induced improvement of sociability and mitigated improvement of social novelty but did not affect ECT-induced reversal of repetitive behavior. These proof-of-principle experiments suggest that ECT may, indeed, be useful in the treatment of autism, and that its therapeutic effects may be mediated, in part, by central oxytocin signaling.

  9. A new method to model electroconvulsive therapy in rats with increased construct validity and enhanced translational value.

    PubMed

    Theilmann, Wiebke; Löscher, Wolfgang; Socala, Katarzyna; Frieling, Helge; Bleich, Stefan; Brandt, Claudia

    2014-06-01

    Electroconvulsive therapy is the most effective therapy for major depressive disorder (MDD). The remission rate is above 50% in previously pharmacoresistant patients but the mechanisms of action are not fully understood. Electroconvulsive stimulation (ECS) in rodents mimics antidepressant electroconvulsive therapy (ECT) in humans and is widely used to investigate the underlying mechanisms of ECT. For the translational value of findings in animal models it is essential to establish models with the highest construct, face and predictive validity possible. The commonly used model for ECT in rodents does not meet the demand for high construct validity. For ECT, cortical surface electrodes are used to induce therapeutic seizures whereas ECS in rodents is exclusively performed by auricular or corneal electrodes. However, the stimulation site has a major impact on the type and spread of the induced seizure activity and its antidepressant effect. We propose a method in which ECS is performed by screw electrodes placed above the motor cortex of rats to closely simulate the clinical situation and thereby increase the construct validity of the model. Cortical ECS in rats induced reliably seizures comparable to human ECT. Cortical ECS was more effective than auricular ECS to reduce immobility in the forced swim test. Importantly, auricular stimulation had a negative influence on the general health condition of the rats with signs of fear during the stimulation sessions. These results suggest that auricular ECS in rats is not a suitable ECT model. Cortical ECS in rats promises to be a valid method to mimic ECT.

  10. Electroconvulsive therapy in a man with comorbid severe obesity, binge eating disorder, and bipolar disorder.

    PubMed

    Rapinesi, Chiara; Del Casale, Antonio; Serata, Daniele; Caccia, Federica; Di Pietro, Simone; Scatena, Paola; Carbonetti, Paolo; Fensore, Claudio; Angeletti, Gloria; Tatarelli, Roberto; Kotzalidis, Georgios D; Girardi, Paolo

    2013-06-01

    A 41-year-old man with comorbid binge-eating disorder, severe obesity, and bipolar disorder since the age of 20 years, resistant to drug and psychotherapy combinations, worsened progressively. Relentless weight gain forced him to immobility and dependence on others. He was hospitalized for a mixed-mood episode with anxiety, mystical delusions, and auditory hallucinations. To overcome treatment resistance, we suggested electroconvulsive therapy. After 1 electroconvulsive therapy cycle, psychological symptoms promptly improved. He received clozapine and lithium. After 2 years, he reached normal weight and fair psychopathological compensation.

  11. Electroconvulsive therapy for the treatment of organic catatonia due to viral encephalitis.

    PubMed

    Shukla, Lekhansh; Narayanaswamy, Janardhanan C; Gopinath, Srinath; Math, Suresh Bada

    2012-09-01

    Catatonia is a common presentation to psychiatric services in developing countries. Medical causes of catatonia are common and are difficult to treat. A 20-year-old woman presented with an acute illness consisting of fever, delirium, perceptual abnormalities, and catatonic state. After trials with antiviral medications, benzodiazepines, and atypical antipsychotic medications, she was treated with 6 sessions of electroconvulsive therapy with complete recovery and no complications. Catatonia arising in the background of organic pathology can be treated on similar lines as in other psychiatric disorders. Electroconvulsive therapy can be a safe option that needs consideration in such cases after ruling out the contraindications.

  12. Treatment of Catatonia With Ultrabrief Right Unilateral Electroconvulsive Therapy: A Case Series.

    PubMed

    Kugler, Joseph L; Hauptman, Aaron J; Collier, Samuel J; Walton, Amy E; Murthy, Smitha; Funderburg, Linda G; Garcia, Keith S

    2015-09-01

    Catatonia is a syndrome heterogeneous with regard to presentation and etiology. Electroconvulsive therapy (ECT) remains the first-line treatment for catatonia. Literature review reveals only a few published case reports on the use of right unilateral (RUL) ECT in catatonia, 1 case report on ultrabrief RUL ECT, and an absence of evidence on the relative effectiveness and tolerability of RUL versus bilateral ECT in treating catatonia. In contrast, there are multiple reports in the literature of robustly dosed bilateral ECT, often administered on consecutive days. Reasons for choosing this intervention over the better-tolerated RUL treatment include assumptions about its relative speed and/or breadth of efficacy. Here we present a case series of 13 catatonic patients treated in an academic center over the course of the last 3 years. Our experience suggests that ultrabrief RUL ECT can rapidly and effectively treat catatonia from diverse etiologies.

  13. Maintenance electroconvulsive therapy for aggression and self-injurious behavior in two adolescents with autism and catatonia.

    PubMed

    Haq, Aazaz U; Ghaziuddin, Neera

    2014-01-01

    Frequent aggression toward others and repetitive self-injurious behaviors (SIB) can be features of catatonia in patients with autism. Similar to catatonia secondary to other etiologies, catatonia associated with autism responds well to treatment with benzodiazepines and/or electroconvulsive therapy (ECT). The authors report here on two adolescent patients with autism who presented with severe aggression, one of whom also engaged in repetitive SIB. With ongoing treatment with maintenance ECT, dramatic reduction in aggression and SIB were noted, allowing both patients a reasonable quality of life in their own homes. Attempts to taper off ECT coincided with return of aggression symptoms, although not SIB.

  14. Brief Report: Electroconvulsive Therapy for Malignant Catatonia in an Autistic Adolescent

    ERIC Educational Resources Information Center

    Wachtel, Lee Elizabeth; Griffin, Margaret Merrie; Dhossche, Dirk Marcel; Reti, Irving Michael

    2010-01-01

    A 14-year-old male with autism and mild mental retardation developed malignant catatonia characterized by classic symptoms of catatonia, bradycardia and hypothermia. Bilateral electroconvulsive therapy and lorazepam were required for resolution. The case expands the occurrence of catatonia in autism into its malignant variant.

  15. Summary of the Practice Parameter for the Use of Electroconvulsive Therapy with Adolescents

    ERIC Educational Resources Information Center

    Ghaziuddin, N.; Kutcher, S. P.; Knapp, P.

    2004-01-01

    Electroconvulsive therapy (ECT) may be an effective treatment for adolescents with severe mood disorders and other Axis I psychiatric disorders when more conservative treatments have been unsuccessful. ECT may be considered when there is a lack of response to two or more trials of pharmacotherapy or when the severity of symptoms precludes waiting…

  16. Teaching Electroconvulsive Therapy to Medical Students: Effects of Instructional Method on Knowledge and Attitudes

    ERIC Educational Resources Information Center

    Warnell, Ronald L.; Duk, Anthony D.; Christison, George W.; Haviland, Mark G.

    2005-01-01

    Objective: To compare the effects of learning about electroconvulsive therapy (ECT) via live observation to learning via an instructional videotape. Method: During their psychiatry clerkship, 122 medical students were randomized using these two educational methods, and their ECT knowledge and attitudes were assessed during the first and last weeks…

  17. Effectiveness of Electroconvulsive Therapy in Persistent Methamphetamine Psychosis: A Pilot Study

    PubMed Central

    Ziaaddini, Hassan; Roohbakhsh, Toktam; Nakhaee, Nouzar; Ghaffari-Nejad, Alireza

    2015-01-01

    Background Persistent methamphetamine (METH) psychosis is a psychotic state beyond 1-month after abstinence, for which there is no effective treatment. This study aimed to evaluate the effectiveness of electroconvulsive therapy (ECT) in persistent METH psychosis patients hospitalized at Shahid Beheshti Hospital, Kerman, Iran, from 6 September 2012 until 6 September 2013, who were not remitted after treatment with olanzapine. Methods This research was a pilot study on hospitalized patients. After 4 weeks of treatment with olanzapine, 10 out of 71 studied patients did not show complete remission of psychotic symptoms despite their response to the treatment. The mentioned 10 patients were divided into 2 groups by random digit numbers. 5 patients had continued olanzapine and other 5 received 6 sessions of bilateral ECT every other day in addition to olanzapine. Findings Remission rate of patients in the initial 4 weeks was 78.7%. Reduction in total brief psychiatric rating scale (BPRS) scale at the end of 1-week compared with the next week demonstrated improvement in the symptoms until the end of the study. There was no significant difference in BPRS scores between weeks 4 and 6 in the two groups. Conclusion This research demonstrated that few sessions of ECT in persistent METH psychosis will not lead to remission in all patients. PMID:26322206

  18. Electroconvulsive therapy for depression following acute coronary syndromes: a concern for the anesthesiologist.

    PubMed

    Pourafkari, Nosratollah; Pourafkari, Leili; Nader, Nader D

    2016-06-01

    The prevalence of depression in patients with cardiovascular disease is higher than general population and especially following an acute coronary syndrome (ACS), a significant number of patients report a wide spectrum of behavioral and mood changes attributable to clinical depression. Treatment of depression following ACS event is particularly challenging since most of the therapeutic modalities are associated with increasing the systemic sympathetic tone from neurogenic or pharmacologic sources. Increased activity of the adrenergic and catecholamine activity may further deter the myocardial oxygen supply and demand therefore treating depression should be carefully evaluated for its risk benefit ratio. Electroconvulsive therapy (ECT) is recommended for patients with severe depression, in whom behavioral and pharmacologic treatments have failed. Patients who refuse to take medications or present with any psychological emergency such as harming self or others, are also candidates for ECT. ECT is also associated with sudden surges of catecholamines and may cause recurrent myocardial ischemia and fatal dysrhythmias in patients convalescing from an ACS event. Herein, we provide an overview and practical guidelines for management of patients presented for ECT following ACS.

  19. Clinical experience with electroconvulsive therapy at the Instituto Mexicano de Psiquiatría.

    PubMed

    Sánchez de Carmona Luna Y Parra, M; Páez Agraz, F; Nicolini Sánchez, H

    1996-01-01

    Electroconvulsive therapy (ECT) is a useful option for the treatment of certain psychiatric illnesses. Its efficacy and few side effects make it an important therapeutic alternative in the management of the patient with major depression. This study describes the clinical experience with ECT at the Instituto Mexicano de Psiquiatría. We retrospectively evaluated the clinical records of patients treated with ECT during the period of April 1990 to June 1994. A total of 55 patients were included in the analysis, the mean age was 42.4 +/- 17.2 years old. Diagnostic categories treated were major depression (43.6%), non-affective psychotic disorders (30.9%), mania (12.7%) and other diagnoses (12.7%). A positive response to ECT was found in 74.5% of patients. Subjects with major depression and mania responded significantly better than the rest of the patients (p < 0.01). Psychotic depression was not a predictor of better response. Only 18.1% of subjects had minor complications, all transitory. ECT is a highly effective therapeutic option in the treatment of psychiatric illness, especially in major depression and mania. The use of ECT in a tertiary psychiatric unit in Mexico reflects similar results as described in the international literature.

  20. Influence of GRIK4 genetic variants on the electroconvulsive therapy response.

    PubMed

    Minelli, Alessandra; Congiu, Chiara; Ventriglia, Mariacarla; Bortolomasi, Marco; Bonvicini, Cristian; Abate, Maria; Sartori, Riccardo; Gainelli, Giulio; Gennarelli, Massimo

    2016-07-28

    Several lines of evidence have shown the involvement of the glutamatergic system in the function of electroconvulsive therapy (ECT). In particular, patients with treatment resistant depression (TRD) and chronic depression have lower levels of glutamate/glutamine than controls, and ECT can reverse this deficit. Genetic factors might contribute to modulating the mechanisms underlying ECT. This study aimed to evaluate the relationship between three polymorphisms (rs1954787, rs4936554 and rs11218030) of the glutamate receptor ionotropic kainate 4 (GRIK4) gene and responsiveness to ECT treatment in a sample of one hundred individuals, TRD or depressive Bipolar Disorder patients resistant to pharmacological treatments. The results revealed that GRIK4 variants were significantly associated with the response to ECT. In particular, we found that patients carrying the G allele of the GRIK4 rs11218030 had a significantly poorer response to ECT (p=2.71×10(-4)), showing five times the risk of relapse after ECT compared to the AA homozygotes. Analogously, patients carrying the GG rs1954787 genotype and rs4936554A allele carriers presented a double risk of lack of response after ECT (p=0.013 and p=0.040, respectively). In conclusion, the current study provides new evidence, indicating that some GRIK4 variants modulate the response to ECT in patients with depression resistant to treatment, suggesting a role for kainate receptor modulation.

  1. Electroconvulsive Therapy-Induced Brain Structural and Functional Changes in Major Depressive Disorders: A Longitudinal Study

    PubMed Central

    Qiu, Haitang; Li, Xirong; Zhao, Wenjing; Du, Lian; Huang, Peiyu; Fu, Yixiao; Qiu, Tian; Xie, Peng; Meng, Huaqing; Luo, Qinghua

    2016-01-01

    Background This study aimed to study the brain structural and functional changes after 8 courses of electroconvulsive therapy (ECT) on patients with major depressive disorder (MDD). Material/Methods MRI scans were performed on 12 depressive patients before and after 8 courses of ECT and compared with those of 15 normal controls. Data were analyzed by voxel-based morphometry (VBM) using SPM8 software. Functional MRI (fMRI) and regional homogeneity (ReHo) analyses were used to assess the functional changes after ECT. Results Grey matter volumes were smaller in the right cingulate gyrus of depressive patients before ECT compared with normal controls. After false discovery rate (FDR) correction, post-ECT grey matter volumes were increased in bilateral amygdala and hippocampus compared with pre-ECT. Resting-state ReHo maps showed significant differences in brain activity pre- and post-ECT. Compared with healthy controls, MDD patients treated with 8 courses of ECT showed higher ReHo values in the bilateral frontal lobe, bilateral parietal lobe, and right caudate nucleus. Decreased ReHo values were observed in the right medial temporal gyrus, right superior temporal gyrus, right cingulate gyrus, and left anterior cerebellar lobe. Conclusions Results suggested that there were both structural and functional differences between the brains of MDD patients and healthy controls. After ECT, both structural and functional changes occurred, but without complete recovery to normal. ECT may display effects through regulating other brain regions to compensate for the original defects. PMID:27888657

  2. Non-cardiogenic pulmonary edema complicating electroconvulsive therapy: short review of the pathophysiology and diagnostic approach.

    PubMed

    Manne, Janaki R; Kasirye, Yusuf; Epperla, Narendranath; Garcia-Montilla, Romel J

    2012-08-01

    Acute pulmonary edema complicating electroconvulsive therapy is an extremely uncommon event that has rarely been described in the literature. Different theories, including one suggesting a cardiogenic component, have been proposed to explain its genesis. The present report describes a classic presentation of this condition with review of its potential mechanisms and diagnostic approach. After successful completion of a session of electroconvulsive therapy, a 42-year-old woman with major depressive disorder developed acute systemic high blood pressure, shortness of breath, and hemoptysis. A chest radiograph demonstrated diffuse bilateral pulmonary infiltrates. Initially cardiogenic pulmonary edema was presumed, but an extensive diagnostic work-up demonstrated normal systolic and diastolic left ventricular function, and with only supportive measures, a complete clinical and radiographic recovery was achieved within 48 hours. The present case does not support any cardiogenic mechanism in the genesis of this condition.

  3. Investigation of cerebral dominance in 'left-handers' and 'right-handers' using unilateral electroconvulsive therapy.

    PubMed Central

    Fleminger, J J; Bunce, L

    1975-01-01

    Twenty-four patients receiving unilateral electroconvulsive therapy for depression were given the first treatment with electrodes on the left or right side of the head and the second treatment with electrodes on the opposite side. They were tested with the Word Associate Learning subtest of the Wechsler Memory Scale when fully responsive after the first ECT and after the same time interval following the second ECT. Twelve were left-handed and 12 were right-handed writers. In both groups, better scores were usually obtained after right-sided treatment. Redistribution of patients into sinistral, mixed, and dextral groups showed that this difference between the effects of left and right-sided ECT was significant only in dextrals. Only two right-handed writers had scores indicating right-sided dominance for speech; both were 'shifted sinistrals'. Left hemisphere dominance was indicated in 67% of all non-dextrals. Eight of nine patients in whom testing was repeated after a second pair of treatments on alternate sides obtained scores favouring the same side in both pairs of testing. Findings indicate the need for closer inquiry into handedness than is often made before unilateral ECT is prescribed. Further development of unilateral ECT for establishing cerebral dominance in individuals is supported by the results. PMID:1151421

  4. Response rate of catatonia to electroconvulsive therapy and its clinical correlates.

    PubMed

    Raveendranathan, Dhanya; Narayanaswamy, Janardhanan C; Reddi, Senthil V

    2012-08-01

    Electroconvulsive therapy (ECT) is an important treatment for catatonia. We aimed to study the response rate of catatonia treated with ECT and its clinical correlates in a large sample of inpatients. The ECT parameters of all patients (n = 63) admitted with catatonia between the months of January and December 2007 were examined. The number of ECTs administered, seizure threshold, failure to achieve adequate seizures and clinical signs pertaining to catatonia were analyzed. Response was considered as complete resolution of catatonic symptoms with Bush Francis Catatonia Rating Scale (BFCRS) score becoming zero. ECT was mostly started after failed lorazepam treatment except in 6 patients where ECT was the first choice. Patients who responded in 4 ECT sessions were considered fast responders (mean session number for response is 4 sessions) and response with 5 or more ECTs was considered slow response. Fast responders had significantly lower duration of catatonia (19.67 ± 21.66 days, P = 0.02) and higher BFCRS score at presentation (17.25 ± 6.21, P = 0.03). Presence of waxy flexibility and gegenhalten (22.60% vs. 0%, P = 0.01) predicted faster response, whereas presence of echophenomena (3.2% vs. 24.0%) predicted slow response. The response rate to catatonia appears to be associated with the severity and duration of catatonia, and the presence of certain catatonic signs.

  5. Treatment-resistant, five-year long, postpartum-onset Capgras episode resolving after electroconvulsive therapy.

    PubMed

    Rapinesi, Chiara; Kotzalidis, Georgios D; Del Casale, Antonio; Ferri, Vittoria Rachele; Di Pietro, Simone; Scatena, Paola; Serata, Daniele; Danese, Emanuela; Sani, Gabriele; Koukopoulos, Alexia E; Angeletti, Gloria; Girardi, Paolo

    2015-01-01

    Postpartum psychosis, which rarely presents with Capgras syndrome (delusional misidentification), requires rapid symptom resolution. First-line drugs have important drawbacks, such as delayed onset of clinical response and secretion in breast milk. In this report, we report successful treatment of a treatment-resistant woman presenting with treatment-resistant Capgras syndrome, with onset during postpartum. A 36-year-old woman had presented with Capgras syndrome during postpartum. For more than five years, she believed her son and other family members were substituted by impostors. All adequately administrated treatments were unsuccessful. We suggested electroconvulsive therapy to overcome treatment resistance. After six electroconvulsive therapy sessions, delusions of doubles subsided and other symptoms improved. She was discharged two weeks later with a mood stabilizer and low-dose atypical antipychotic combination and is well at the one-and-a-half-year follow-up. Electroconvulsive therapy followed by a mood stabilizer-antipsychotic drug combination showed rapid, permanent, and effective control of long-standing Capgras syndrome in a young woman.

  6. The Relationship Between Cortical Inhibition and Electroconvulsive Therapy in the Treatment of Major Depressive Disorder

    PubMed Central

    Voineskos, Daphne; Levinson, Andrea J.; Sun, Yinming; Barr, Mera S.; Farzan, Faranak; Rajji, Tarek K.; Fitzgerald, Paul B.; Blumberger, Daniel M.; Daskalakis, Zafiris J.

    2016-01-01

    Dysfunctional cortical inhibition (CI) is postulated as a key neurophysiological mechanism in major depressive disorder. Electroconvulsive therapy (ECT) is the treatment of choice for resistant depression and ECT has been associated with enhanced CI. The objective of this study was to evaluate the relationship between CI and ECT response in resistant depression. Twenty-five patients with treatment resistant depression underwent an acute course of ECT. CI was indexed by the cortical silent period (CSP) and short-interval cortical inhibition (SICI), through TMS-EMG. CI and clinical response was measured prior to beginning an acute ECT course and within 48 hours of the last ECT treatment in the course. Clinical response to ECT was assessed by HDRS-17 before and after an acute course of ECT. We found that there was a significant difference in CSP at baseline between responder and non-responder groups (p = 0.044). Baseline CSP predicted therapeutic response to ECT with sensitivity of 80% and specificity of 60%. There were no changes in CSP or SICI after administration of the ECT course. Our findings suggest that duration of pre-treatment CSP may be a useful predictor of therapeutic response to ECT in patients with TRD. PMID:27934881

  7. The Relationship Between Cortical Inhibition and Electroconvulsive Therapy in the Treatment of Major Depressive Disorder.

    PubMed

    Voineskos, Daphne; Levinson, Andrea J; Sun, Yinming; Barr, Mera S; Farzan, Faranak; Rajji, Tarek K; Fitzgerald, Paul B; Blumberger, Daniel M; Daskalakis, Zafiris J

    2016-12-09

    Dysfunctional cortical inhibition (CI) is postulated as a key neurophysiological mechanism in major depressive disorder. Electroconvulsive therapy (ECT) is the treatment of choice for resistant depression and ECT has been associated with enhanced CI. The objective of this study was to evaluate the relationship between CI and ECT response in resistant depression. Twenty-five patients with treatment resistant depression underwent an acute course of ECT. CI was indexed by the cortical silent period (CSP) and short-interval cortical inhibition (SICI), through TMS-EMG. CI and clinical response was measured prior to beginning an acute ECT course and within 48 hours of the last ECT treatment in the course. Clinical response to ECT was assessed by HDRS-17 before and after an acute course of ECT. We found that there was a significant difference in CSP at baseline between responder and non-responder groups (p = 0.044). Baseline CSP predicted therapeutic response to ECT with sensitivity of 80% and specificity of 60%. There were no changes in CSP or SICI after administration of the ECT course. Our findings suggest that duration of pre-treatment CSP may be a useful predictor of therapeutic response to ECT in patients with TRD.

  8. Electroconvulsive Therapy Part I: A Perspective on the Evolution and Current Practice of ECT

    PubMed Central

    Payne, Nancy A.; Prudic, Joan

    2010-01-01

    The concept of inducing convulsions, mainly through chemical means, to promote mental wellness has existed since the 16th century. In 1938, Italian scientists first applied electrically induced therapeutic seizures. Although electroconvulsive therapy (ECT) is employed in the treatment of several psychiatric disorders, it is most frequently used today to treat severe depressive episodes and remains the most effective treatment available for those disorders. Despite this, ECT continues to be the most stigmatized treatment available in psychiatry, resulting in restrictions on and reduced accessibility to a helpful and potentially life-saving treatment. The psychiatric and psychosocial ramifications of this stigmatization may include the exacerbation of the increasingly serious, global health problem of major depressive disorders as well as serious consequences for individual patients who may not be offered, or may refuse, a potentially beneficial treatment. The goal of this first article in this two-part series is to provide an overview of ECT's historical development and discuss the current state of knowledge about ECT, including technical aspects of delivery, patient selection, its side-effect profile, and factors that may contribute to underuse of ECT. PMID:19820553

  9. Electroconvulsive therapy as a treatment for refractory neuropsychiatric lupus with catatonia: three case studies and literature review.

    PubMed

    Bica, B E R G; Moro, A L D; Hax, V; Nicol, N A; Campos, G S; Rivera, L M S; da Costa, A F C; Xavier, R M; Monticielo, O A

    2015-10-01

    Neuropsychiatric disorders associated with systemic lupus erythematosus are very common. Treatment generally consists of glucocorticoids and immunosuppressive therapy; however, some cases are unresponsive. Electroconvulsive therapy (ECT) is a recognized treatment modality in psychiatry and is an option for refractory cases of neuropsychiatric lupus. This report describes three cases of neuropsychiatric lupus that improved with ECT after failure of antipsychotics and immunosuppressive therapy. All cases met DSM-5 criteria for catatonia (case 1: agitation, stereotypies, and grimacing; case 2: stupor, mutism, and grimacing; case 3: agitation, mutism, and stereotypies); therefore, ECT was indicated. This case series shows that ECT can be a therapeutic option in patients with neuropsychiatric lupus, especially when associated with catatonia and unresponsive to conventional treatment.

  10. Cognitive Impairment and Electroconvulsive Therapy in Geriatric Depression, What Could be the Role of Rivastigmine? A Case Series.

    PubMed

    van Schaik, Audrey Monica; Rhebergen, Didi; Henstra, Marieke Jantien; Kadouch, Daniel J; van Exel, Eric; Stek, Maximilianus Lourentius

    2015-09-28

    Electroconvulsive therapy (ECT), albeit highly effective in treating depression, is frequently associated with cognitive impairment, either temporary or more persistent. Especially in older patients, who generally respond even better, serious cognitive impairment during the course of ECT may lead to premature termination of ECT. Treatment of this cognitive impairment is of utmost importance. In this case series report, we present the effect of rivastigmine, an acetylcholinesterase inhibitor, on cognitive impairment in three older, severely depressed patients during or after a course of ECT. An improvement of cognitive functioning, in particular a decline of confusional symptoms, was observed in two patients with structural brain alterations associated with aging. In the other patient, who suffered primarily from amnesia, no effect of rivastigmine was observed. These preliminary results emphasize the need for detailed profiling of cognitive impairment when developing a research design to study the potential benefits of rivastigmine in the prevention or treatment of cognitive impairment in severely depressed patients treated with ECT.

  11. Expanded Safety and Efficacy Data for a New Method of Performing Electroconvulsive Therapy

    PubMed Central

    Sahlem, Gregory L.; Short, E. Baron; Kerns, Suzanne; Snipes, Jon; DeVries, William; Fox, James B.; Burns, Carol; Schmidt, Matthew; Nahas, Ziad H.; George, Mark S.; Sackeim, Harold A.

    2016-01-01

    Objective Electroconvulsive therapy (ECT) is the most rapid and effective antidepressant treatment but with concerns about cognitive adverse effects. A new form of ECT, focal electrically administered seizure therapy (FEAST), was designed to increase the focality of stimulation and better match stimulus parameters with neurophysiology. We recently reported on the safety and feasibility of FEAST in a cohort (n = 17) of depressed patients. We now report on the safety, feasibility, preliminary efficacy, and cognitive effects of FEAST in a new cohort. Methods Open-label FEAST was administered to 20 depressed adults (6 men; 3 with bipolar disorder; age 49.1 ± 10.6 years). Clinical and cognitive assessments were obtained at baseline and end of course. Time to orientation recovery was assessed at each treatment. Nonresponders switched to conventional ECT. Results Participants tolerated the treatment well with no dropouts. Five patients (25%) transitioned from FEAST to conventional ECT due to inadequate response. After FEAST (mean, 9.3 ± 3.5 sessions; range, 4–14), there was a 58.1% ± 36.0% improvement in Hamilton Rating Scale for Depression scores compared with that in the baseline (P < 0.0001); 13 (65%) of 20 patients met response criteria, and 11 (55%) of 20 met remission criteria. Patients achieved reorientation (4 of 5 items) in 4.4 ± 3.0 minutes (median, 4.5 minutes), timed from eyes opening. There was no deterioration in neuropsychological measures. Conclusions These findings provide further support for the safety and efficacy of FEAST. The remission and response rates were in the range found using conventional ECT, and the time to reorientation may be quicker. However, without a randomized comparison group, conclusions are tentative. PMID:27379790

  12. Electric field characteristics of electroconvulsive therapy with individualized current amplitude: a preclinical study.

    PubMed

    Lee, Won Hee; Lisanby, Sarah H; Laine, Andrew F; Peterchev, Angel V

    2013-01-01

    This study examines the characteristics of the electric field induced in the brain by electroconvulsive therapy (ECT) with individualized current amplitude. The electric field induced by bilateral (BL), bifrontal (BF), right unilateral (RUL), and frontomedial (FM) ECT electrode configurations was computed in anatomically realistic finite element models of four nonhuman primates (NHPs). We generated maps of the electric field strength relative to an empirical neural activation threshold, and determined the stimulation strength and focality at fixed current amplitude and at individualized current amplitudes corresponding to seizure threshold (ST) measured in the anesthetized NHPs. The results show less variation in brain volume stimulated above threshold with individualized current amplitudes (16-36%) compared to fixed current amplitude (30-62%). Further, the stimulated brain volume at amplitude-titrated ST is substantially lower than that for ECT with conventional fixed current amplitudes. Thus individualizing the ECT stimulus current could compensate for individual anatomical variability and result in more focal and uniform electric field exposure across different subjects compared to the standard clinical practice of using high, fixed current for all patients.

  13. Ketamine as the anaesthetic for electroconvulsive therapy: the KANECT randomised controlled trial.

    PubMed

    Fernie, Gordon; Currie, James; Perrin, Jennifer S; Stewart, Caroline A; Anderson, Virginica; Bennett, Daniel M; Hay, Steven; Reid, Ian C

    2017-03-02

    BackgroundKetamine has recently become an agent of interest as an acute treatment for severe depression and as the anaesthetic for electroconvulsive therapy (ECT). Subanaesthetic doses result in an acute reduction in depression severity while evidence is equivocal for this antidepressant effect with anaesthetic or adjuvant doses. Recent systematic reviews call for high-quality evidence from further randomised controlled trials (RCTs).AimsTo establish if ketamine as the anaesthetic for ECT results in fewer ECT treatments, improvements in depression severity ratings and less memory impairment than the standard anaesthetic.MethodDouble-blind, parallel-design, RCT of intravenous ketamine (up to 2 mg/kg) with an active comparator, intravenous propofol (up to 2.5 mg/kg), as the anaesthetic for ECT in patients receiving ECT for major depression on an informal basis. (Trial registration: European Clinical Trials Database (EudraCT): 2011-000396-14 and clinicalTrials.gov: NCT01306760)ResultsNo significant differences were found on any outcome measure during, at the end of or 1 month following the ECT course.ConclusionsKetamine as an anaesthetic does not enhance the efficacy of ECT.

  14. Reorganization of Anatomical Connectome following Electroconvulsive Therapy in Major Depressive Disorder

    PubMed Central

    Zeng, Jinkun; Luo, Qinghua; Du, Lian; Liao, Wei; Li, Yongmei; Liu, Haixia; Liu, Dan; Fu, Yixiao; Qiu, Haitang; Li, Xirong; Qiu, Tian; Meng, Huaqing

    2015-01-01

    Objective. Electroconvulsive therapy (ECT) is considered one of the most effective and fast-acting treatment options for depressive episodes. Little is known, however, about ECT's enabling brain (neuro)plasticity effects, particular for plasticity of white matter pathway. Materials and Methods. We collected longitudinal diffusion tensor imaging in the first-episode, drug-naïve major depressive disorder (MDD) patients (n = 24) before and after a predefined time window ECT treatment. We constructed large-scale anatomical networks derived from white matter fiber tractography and evaluated the topological reorganization using graph theoretical analysis. We also assessed the relationship between topological reorganization with improvements in depressive symptoms. Results. Our investigation revealed three main findings: (1) the small-worldness was persistent after ECT series; (2) anatomical connections changes were found in limbic structure, temporal and frontal lobes, in which the connection changes between amygdala and parahippocampus correlate with depressive symptom reduction; (3) significant nodal strength changes were found in right paralimbic network. Conclusions. ECT elicits neuroplastic processes associated with improvements in depressive symptoms that act to specific local ventral frontolimbic circuits, but not small-world property. Overall, ECT induced topological reorganization in large-scale brain structural network, opening up new avenues to better understand the mode of ECT action in MDD. PMID:26770836

  15. Unilateral electroconvulsive therapy and cerebral dominance: effect of right- and left-sided electrode placement on verbal memory

    PubMed Central

    Fleminger, J. J.; Horne, D. J. de L.; Nott, P. N.

    1970-01-01

    Unilateral electroconvulsive therapy was given to 32 right-handed patients for relief of depression. Sixteen patients received electrode placement on the right side for the first treatment and on the left side for the second treatment. For the other 16 patients the order of sides was reversed. The word Associate Learning subtest of the Wechsler Memory Scale was administered about 20 minutes after each treatment (Wechsler, 1945). Results supported the hypothesis that performance on this test would be better when the electrodes were applied over the right than when they were applied over the right than when they were applied over the left cerebral hemisphere. It is suggested that investigation along these lines could assist in establishing the cerebral dominance of individual patients. PMID:5431728

  16. Near-infrared spectroscopy of the human brain during electroconvulsive therapy

    NASA Astrophysics Data System (ADS)

    Fantini, Sergio; Fabbri, Francesco; Nadgir, Shalini; Henry, Michael E.; Renshaw, Perry F.; Franceschini, Maria-Angela

    2003-07-01

    We report non-invasive, bilateral measurements of cerebral oxygenation performed with near-infrared spectroscopy (NIRS) on ten patients undergoing right unilateral electro-convulsive therapy (ECT). Right unilateral ECT consists of delivering an electrical current through the right brain hemisphere to induce a seizure, which is associated with significant changes in systemic and regional physiological parameters. In this work, we have examined the regional cerebral oxygenation (StO2) measured with NIRS on the right and left sides of the frontal brain region, and the systemic arterial oxygenation (SaO2) measured with pulse oximetry. On the ten patients examined, we have found that the decrease in the cerebral oxygenation on the side ipsilateral to the ECT electrical discharge (ΔStO2(ipsi)) is consistently stronger than the decrease on the contralateral side (ΔStO2(contra)). The average and standard deviation for the ipsilateral and contralateral oxygenation changes across the ten patients are ΔStO2(ipsi) = -22 +/- 10% and ΔStO2(contra) = -6 +/- 10%, respectively. By contrast, we observed two distinct behaviors in the arterial saturation; in five patients, SaO2 did not significantly change during the ECT procedure, and in three patients, SaO2 decreased by -16+/- 6%, an intermediate value with respect to the changes observed in StO2(ipsi) and StO2(contra) (we do not have the SaO2 recording in the remaining two patients for technical reasons). These results indicate that NIRS monitoring of the cerebral oxygenation during ECT has the potential of being a valuable addition to the standard monitoring of arterial saturation with pulse oximetry.

  17. Effects of electroconvulsive therapy and desipramine on neuroendocrine responses to the clonidine challenge test.

    PubMed Central

    Coote, M; Wilkins, A; Werstiuk, E S; Steiner, M

    1998-01-01

    OBJECTIVE: To investigate responses to the clonidine challenge test in depression, and after electroconvulsive therapy (ECT) or desipramine treatment for depression, in order to determine the usefulness of noradrenergic responses to clonidine as a state or trait marker in depression. PATIENTS: Twenty-six patients with depression and 15 control subjects. SETTING: The psychiatric ward of St. Joseph's Hospital in Hamilton. INTERVENTIONS: In the patients with depression: clonidine challenge pre- and post-treatment with ECT or desipramine. In the controls: 2 clonidine challenge tests 4 to 8 weeks apart. OUTCOME MEASURES: The primary measure was the growth hormone response to the clonidine challenge. Plasma norepinephrine, 3-methoxy-4-hydroxyphenylglycol (MHPG), cortisol, blood pressure, pulse and sedation levels were examined in subgroups of participants as secondary measures. RESULTS: The pre-treatment growth hormone response to clonidine was significantly more blunted in patients than in controls (p = 0.02). This response improved in both treatment groups after therapy and, although it remained decreased, there was no longer a significant difference in response between the patients and the controls. In the patients, a decreased growth hormone response to clonidine at baseline was correlated with response to treatment. Of the secondary measures, patient baseline norepinephrine levels were significantly elevated pre- and post-treatment, although there were no significant group-by-time challenge effects. MHPG levels were not significantly different pre- and post-treatment between patients and controls. Baseline blood pressure and pulse were elevated in the patients pre- and post-treatment. These differences were not statistically significant and did not change after treatment. Sedation levels were not significantly different among the groups at baseline. Clonidine-induced sedation occurred significantly earlier in the patients pretreatment and improved to the range of

  18. Electroconvulsive therapy and structural neuroplasticity in neocortical, limbic and paralimbic cortex

    PubMed Central

    Pirnia, T; Joshi, S H; Leaver, A M; Vasavada, M; Njau, S; Woods, R P; Espinoza, R; Narr, K L

    2016-01-01

    Electroconvulsive therapy (ECT) is a highly effective and rapidly acting treatment for severe depression. To understand the biological bases of therapeutic response, we examined variations in cortical thickness from magnetic resonance imaging (MRI) data in 29 patients scanned at three time points during an ECT treatment index series and in 29 controls at two time points. Changes in thickness across time and with symptom improvement were evaluated at high spatial resolution across the cortex and within discrete cortical regions of interest. Patients showed increased thickness over the course of ECT in the bilateral anterior cingulate cortex (ACC), inferior and superior temporal, parahippocampal, entorhinal and fusiform cortex and in distributed prefrontal areas. No changes across time occurred in controls. In temporal and fusiform regions showing significant ECT effects, thickness differed between patients and controls at baseline and change in thickness related to therapeutic response in patients. In the ACC, these relationships occurred in treatment responders only, and thickness measured soon after treatment initiation predicted the overall ECT response. ECT leads to widespread neuroplasticity in neocortical, limbic and paralimbic regions and changes relate to the extent of antidepressant response. Variations in ACC thickness, which discriminate treatment responders and predict response early in the course of ECT, may represent a biomarker of overall clinical outcome. Because post-mortem studies show focal reductions in glial density and neuronal size in patients with severe depression, ECT-related increases in thickness may be attributable to neuroplastic processes affecting the size and/or density of neurons and glia and their connections. PMID:27271858

  19. Use of modified electroconvulsive therapy in a case of polymyositis presenting with delusion of nihilism of proxy (Odysseus syndrome).

    PubMed

    Shah, Ruchita; Grover, Sandeep; Krishna, Kodakandla; Singh, Dharminder

    2011-03-01

    We present a case of psychotic depression with polymyositis presenting with the distinct phenomenon of nihilism by proxy, which was treated with electroconvulsive therapy (ECT). A female patient with polymyositis was initially treated with pharmacotherapy. After initial response, there was deterioration in her mental state and hence, after careful consideration, neurological, and anaesthetic consultations, modified ECT was given with close monitoring. The mental state of the patient improved with a course of ECT, which proceeded without any complications. Her depressive symptoms including the delusion of nihilism by proxy responded to ECT. To the best of our knowledge, the use of ECT has not been reported in a case of polymyositis before, and this case shows that modified ECT can be given successfully in patients with polymyositis.

  20. Cognitive training to improve memory in individuals undergoing electroconvulsive therapy: Negative findings.

    PubMed

    Choi, Jimmy; Wang, Yuanjia; Feng, Tianshu; Prudic, Joan

    2017-03-24

    Although electroconvulsive therapy (ECT) remains the most effective treatment for severe depression, some patients report persistent memory problems following ECT that impact their quality of life and their willingness to consent to further ECT. While cognitive training has been shown to improve memory performance in various conditions, this approach has never been applied to help patients regain their memory after ECT. In a double-blind study, we tested the efficacy of a new cognitive training program called Memory Training for ECT (Mem-ECT), specifically designed to target anterograde and retrograde memory that can be compromised following ECT. Fifty-nine patients with treatment-resistant depression scheduled to undergo ultra-brief right unilateral ECT were randomly assigned to either: (a) Mem-ECT, (b) active control comprised of nonspecific mental stimulation, or (c) treatment as usual. Participants were evaluated within one week prior to the start of ECT and then again within 2 weeks following the last ECT session. All three groups improved in global function, quality of life, depression, and self-reported memory abilities without significant group differences. While there was a decline in verbal delayed recall and mental status, there was no decline in general retrograde memory or autobiographical memory in any of the groups, with no significant memory or clinical benefit for the Mem-ECT or active control conditions compared to treatment as usual. While we report negative findings, these results continue to promote the much needed discussion on developing effective strategies to minimize the adverse memory side effects of ECT, in hopes it will make ECT a better and more easily tolerated treatment for patients with severe depression who need this therapeutic option.

  1. Repeated dose titration versus age-based method in electroconvulsive therapy: a pilot study.

    PubMed

    Aten, Jan Jaap; Oudega, Mardien; van Exel, Eric; Stek, Max L; van Waarde, Jeroen A

    2015-06-01

    In electroconvulsive therapy (ECT), a dose titration method (DTM) was suggested to be more individualized and therefore more accurate than formula-based dosing methods. A repeated DTM (every sixth session and dose adjustment accordingly) was compared to an age-based method (ABM) regarding treatment characteristics, clinical outcome, and cognitive functioning after ECT. Thirty-nine unipolar depressed patients dosed using repeated DTM and 40 matched patients treated with ABM were compared. Montgomery-Åsberg Depression Rating Scale (MADRS) and Mini-Mental State Examination (MMSE) were assessed at baseline and at the end of the index course, as well as the total number of ECT sessions. Both groups were similar regarding age, sex, psychotic features, mean baseline MADRS, and median baseline MMSE. At the end of the index course, the two methods showed equal outcome (mean end MADRS, 11.6 ± 8.3 in DTM and 9.5 ± 7.6 in ABM (P = 0.26); median end MMSE, 28 (25-29) and 28 (25-29.8), respectively (P = 0.81). However, the median number of all ECT sessions differed 16 (11-22) in DTM versus 12 (10-14.8) in ABM; P = 0.02]. Using regression analysis, dosing method and age were independently associated with the total number of ECT sessions, with less sessions needed in ABM (P = 0.02) and in older patients (P = 0.001). In this comparative cohort study, ABM and DTM showed equal outcome for depression and cognition. However, the median ECT course duration in repeated DTM appeared longer. Additionally, higher age was associated with shorter ECT courses regardless of the dosing method. Further prospective studies are needed to confirm these findings.

  2. Catatonia and autism: a historical review, with implications for electroconvulsive therapy.

    PubMed

    Dhossche, Dirk M; Reti, Irving M; Wachtel, Lee E

    2009-03-01

    Current autism research is historically separated from catatonia and other childhood psychotic disorders, although catatonia and autism share several common symptoms (mutism, echolalia, stereotypic speech and repetitive behaviors, posturing, grimacing, rigidity, mannerisms, and purposeless agitation). Electroconvulsive therapy (ECT) effectively treats catatonia and catatonia-related conditions of intractable compulsions, tics, and self-injury in people with autism. We assess the incidence of catatonic symptoms in autism, examine emerging ECT indications in people with autism and related developmental disorders, and encourage ethical debate and legal-administrative action to assure equal access to ECT for people with autism.

  3. Balance and gait in older electroconvulsive therapy recipients: a pilot study

    PubMed Central

    Plakiotis, Chris; Barson, Fay; Vengadasalam, Bharathi; Haines, Terry P; O’Connor, Daniel W

    2013-01-01

    Background Electroconvulsive therapy (ECT) is commonly used to treat depression in older adults. Despite its efficacy in this regard, an associated increase in the risk of falls in this population is a downside of treatment. ECT research has focused on the incidence of falls, but its effect on balance and gait – intrinsic factors in instability and falls – has not been studied. Our aim was to examine changes in balance and gait among older adults before and after a single ECT session and explore the effect of patient-related and treatment factors on any changes found. Methods Participants were 21 older adults requiring ECT for depression in public psychiatric services. Patients with clinically overt mobility problems (impairing test participation or increasing the risk of falls) were excluded. Balance and gait testing 1 hour pre-ECT and 1, 2 and 3 hours post-ECT included: (1) steady standing test; (2) perturbation of standing balance by self-initiated movements; (3) perturbation of standing balance by an external perturbation; and (4) timed up and go test. Results No deterioration in test performance was found, using one-way repeated measures analysis of variance. Conclusion Balance and gait did not deteriorate immediately after ECT. Exclusion of participants with clinically overt mobility problems and falls being better attributable to factors unrelated to balance and gait (such as post-ECT confusion) may account for our findings. This research does not repudiate the occurrence of ECT-related falls but calls into question the utility of introducing routine balance and gait assessment among older ECT recipients without pre-existing mobility problems as a means of preventing them. PMID:23766650

  4. Remifentanil in electroconvulsive therapy: a systematic review and meta-analysis of randomized controlled trials.

    PubMed

    Takekita, Yoshiteru; Suwa, Taro; Sunada, Naotaka; Kawashima, Hirotsugu; Fabbri, Chiara; Kato, Masaki; Tajika, Aran; Kinoshita, Toshihiko; Furukawa, Toshi A; Serretti, Alessandro

    2016-12-01

    In electroconvulsive therapy (ECT), remifentanil is often used concurrently with anesthetics. The objective of this study was to provide an up-to-date and comprehensive review on how the addition of remifentanil to anesthetics affects seizure duration and circulatory dynamics in mECT. We performed a meta-analysis of RCTs that investigated seizure duration and circulatory dynamics in patients treated with ECT using anesthetics alone (non-remifentanil group) and with anesthetics plus remifentanil (remifentanil group). A total of 13 RCTs (380 patients and 1024 ECT sessions) were included. The remifentanil group showed a significantly prolonged seizure duration during ECT compared to the non-remifentanil group [motor: 9 studies, SMD = 1.25, 95 % CI (0.21, 2.29), p = 0.02; electroencephalogram: 8 studies, SMD = 0.98, 95 % CI (0.14, 1.82), p = 0.02]. The maximum systolic blood pressure (SBP) was significantly reduced in the remifentanil group compared to the non-remifentanil group [7 studies, SMD = -0.36, 95 % CI (-0.65, 0.07), p = 0.02]. Substantial heterogeneity was observed for meta-analyses for seizure durations, but a pre-planned subgroup analysis revealed that seizure duration was prolonged only when the use of the anesthetic dose was reduced in the remifentanil group. The results of our study suggest that addition of remifentanil to anesthesia in ECT may lead to prolonged seizure duration when it allows the use of reduced anesthetic doses. Further, the addition of remifentanil was associated with reduced maximum SBP.

  5. Antidepressant Effects of Electroconvulsive Therapy Correlate With Subgenual Anterior Cingulate Activity and Connectivity in Depression

    PubMed Central

    Liu, Yi; Du, Lian; Li, Yongmei; Liu, Haixia; Zhao, Wenjing; Liu, Dan; Zeng, Jinkun; Li, Xingbao; Fu, Yixiao; Qiu, Haitang; Li, Xirong; Qiu, Tian; Hu, Hua; Meng, Huaqing; Luo, Qinghua

    2015-01-01

    Abstract The mechanisms underlying the effects of electroconvulsive therapy (ECT) in major depressive disorder (MDD) are not fully understood. Resting-state functional magnetic resonance imaging (rs-fMRI) is a new tool to study the effects of brain stimulation interventions, particularly ECT. The authors aim to investigate the mechanisms of ECT in MDD by rs-fMRI. They used rs-fMRI to measure functional changes in the brain of first-episode, treatment-naive MDD patients (n = 23) immediately before and then following 8 ECT sessions (brief-pulse square-wave apparatus, bitemporal). They also computed voxel-wise amplitude of low-frequency fluctuation (ALFF) as a measure of regional brain activity and selected the left subgenual anterior cingulate cortex (sgACC) to evaluate functional connectivity between the sgACC and other brain regions. Increased regional brain activity measured by ALFF mainly in the left sgACC following ECT. Functional connectivity of the left sgACC increased in the ipsilateral parahippocampal gyrus, pregenual ACC, contralateral middle temporal pole, and orbitofrontal cortex. Importantly, reduction in depressive symptoms were negatively correlated with increased ALFF in the left sgACC and left hippocampus, and with distant functional connectivity between the left sgACC and contralateral middle temporal pole. That is, across subjects, as depression improved, regional brain activity in sgACC and its functional connectivity increased in the brain. Eight ECT sessions in MDD patients modulated activity in the sgACC and its networks. The antidepressant effects of ECT were negatively correlated with sgACC brain activity and connectivity. These findings suggest that sgACC-associated prefrontal-limbic structures are associated with the therapeutic effects of ECT in MDD. PMID:26559309

  6. Acute effects of electroconvulsive therapy on regional cerebral blood flow (rCBF) in psychiatric disorders

    SciTech Connect

    Prohovnik, I.; Alderson, P.O.; Sackheim, H.A.; Decina, P.; Kahn, D.

    1984-01-01

    Electroconvulsive therapy (ECT) is frequently used in the treatment of major depression and other psychiatric disorders; its mechanism of action is not established, but previous evidence suggests that it is associated with postictal metabolic suppression. The authors have used measurements of rCBF as an index of cortical metabolic activity to study the acute effects of ECT. Measurements of rCBF were made in 32 cortical regions in 10 patients (pts) following one minute breathing of Xe-133 (5mCi/L); the measurements were performed 30min before and 50min after ECT. Bilateral ECT was administered to six pts (five diagnosed as major depressives and one schizophrenic) and unilateral ECT to four (all diagnosed as unipolar or bipolar affective disorder). The total rCBF material consists of 52 measurements in these pts, made before and after 16 bilateral and 10 unilateral treatments. ECT was found to cause significant reduction of rCBF. Mean hemispheric flows (using the Initial Slope Index to measure grey-matter flow) were reduced by about 5% in both hemispheres following bilateral treatment. Unilateral treatment caused a 9% reduction of flow in the treated hemisphere, but only 2% contralaterally. Regional patterns of flow decreases also differed between the two treatment modes: bilateral frontal reductions were found after bilateral treatment, whereas unilateral ECT caused a widespread flow reduction in the treated hemisphere, and almost no effect contralaterally. These results suggest that rCBF studies are useful for assessing ECT, and indicate that the acute cerebral effects of ECT vary with the mode of treatment.

  7. Effect of anatomical variability on electric field characteristics of electroconvulsive therapy and magnetic seizure therapy: a parametric modeling study.

    PubMed

    Deng, Zhi-De; Lisanby, Sarah H; Peterchev, Angel V

    2015-01-01

    Electroconvulsive therapy (ECT) and magnetic seizure therapy (MST) are conventionally applied with a fixed stimulus current amplitude, which may result in differences in the neural stimulation strength and focality across patients due to interindividual anatomical variability. The objective of this study is to quantify the effect of head anatomical variability associated with age, sex, and individual differences on the induced electric field characteristics in ECT and MST. Six stimulation modalities were modeled including bilateral and right unilateral ECT, focal electrically administered seizure therapy (FEAST), and MST with circular, cap, and double-cone coils. The electric field was computed using the finite element method in a parameterized spherical head model representing the variability in the general population. Head tissue layer thicknesses and conductivities were varied to examine the impact of interindividual anatomical differences on the stimulation strength, depth, and focality. Skull conductivity most strongly affects the ECT electric field, whereas the MST electric field is independent of tissue conductivity variation in this model but is markedly affected by differences in head diameter. Focal ECT electrode configurations such as FEAST is more sensitive to anatomical variability than that of less focal paradigms such as BL ECT. In MST, anatomical variability has stronger influence on the electric field of the cap and circular coils compared to the double-cone coil, possibly due to the more superficial field of the former. The variability of the ECT and MST electric fields due to anatomical differences should be considered in the interpretation of existing studies and in efforts to improve dosing approaches for better control of stimulation strength and focality across patients, such as individualization of the current amplitude. The conventional approach to individualizing dosage by titrating the number of pulses cannot compensate for differences in

  8. Electroconvulsive therapy in adolescents with intellectual disability and severe self-injurious behavior and aggression: a retrospective study.

    PubMed

    Consoli, Angele; Cohen, Johan; Bodeau, Nicolas; Guinchat, Vincent; Wachtel, Lee; Cohen, David

    2013-01-01

    Efficacious intervention for severe, treatment-refractory self-injurious behavior and aggression (SIB/AGG) in children and adolescents with intellectual disability and concomitant psychiatric disorders remains a complex and urgent issue. The aim of this study is to assess the efficacy of electroconvulsive therapy (ECT) on severe and treatment-resistant SIB/AGG in young people with intellectual disability and current psychiatric disorder. We reviewed the charts of all patients (N = 4) who received ECT in the context of SIB/AGG with resistance to behavioral interventions, milieu therapy and pharmacotherapy from 2007 to 2011. We scored the daily rate of SIB/AGG per patient for each hospital day. Inter rater reliability was good (intraclass correlations = 0.91). We used a mixed generalized linear model to assess whether the following explanatory variables (time, ECT) influenced the course of SIB/AGG over time, the dependant variable. The sample included two girls and two boys. The mean age at admission was 13.8 years old [range 12-14]. The patients had on average 19 ECT sessions [range 16-26] and one patient received maintenance ECT. There was no effect of time before and after ECT start. ECT was associated with a significant decrease in SIB/AGG scores (p < 0.001): mean aggression score post-ECT was half the pre-ECT value. ECT appears beneficial in severe, treatment-resistant SHBA in adolescents with intellectual disability.

  9. A case of delayed onset of threatened premature labor in association with electroconvulsive therapy in the third trimester of pregnancy.

    PubMed

    Pesiridou, Angeliki; Baquero, Giselle; Cristancho, Pilar; Wakil, Laura; Altinay, Murat; Kim, Deborah; O'Reardon, John P

    2010-09-01

    Electroconvulsive therapy (ECT) is recommended by the American Psychiatric Association Task Force on ECT as a safe and effective treatment of depression throughout pregnancy. We report here administration of ECT in the third trimester of pregnancy in a 33-year-old patient with severe bipolar depression. The patient had a good antidepressant response to ECT. She experienced, however, delayed onset premature uterine contractions at home after her sixth session of ECT (10 hours post-ECT administration). After receiving tocolytics, the patient's contractions did not progress to premature labor. In consultation with the obstetrics team, it was decided to terminate the ECT course earlier than planned. The patient is delivered of a healthy female newborn infant spontaneously at 37 weeks' gestational age. Four months after delivery, the baby's development is progressing normally. This case illustrates that premature contractions in association with ECT during the third trimester of pregnancy may be delayed in onset. Patients and treatment team need to be aware of this possibility, particularly when ECT is conducted on an outpatient basis.

  10. Monitoring daily affective symptoms and memory function using Interactive Voice Response (IVR) in outpatients receiving electroconvulsive therapy

    PubMed Central

    Fazzino, Tera L.; Rabinowitz, Terry; Althoff, Robert R.; Helzer, John E.

    2013-01-01

    Objective Recently there has been a gradual shift from inpatient-only electroconvulsive therapy (ECT) toward outpatient administration. Potential advantages include convenience and reduced cost. But providers do not have the same opportunity to monitor treatment response and side effects as they do with inpatients. This can obviate some of the potential advantages of outpatient ECT, such as tailoring treatment intervals to clinical response. Scheduling is typically algorithmic rather than empirically based. Daily monitoring through an automated telephone, interactive voice response (IVR), is a potential solution to this quandary. Methods To test feasibility of clinical monitoring via IVR, we recruited 26 patients (69% female, mean age 51 years) receiving outpatient ECT to make daily IVR reports of affective symptoms and subjective memory for 60 days. The IVR also administered a word recognition task daily to test objective memory. Every seventh day a longer IVR weekly interview included questions about suicidal ideation. Results Overall daily call compliance was high (mean=80%). Most participants (96%) did not consider the calls to be time-consuming. Longitudinal regression analysis using Generalized Estimating Equations revealed that participant objective memory functioning significantly improved during the study (p<.05). Out of 123 weekly IVR interviews, 41 reports (33%) in 14 patients endorsed suicidal ideation during the previous week. Conclusion IVR monitoring of outpatient ECT can provide more detailed clinical information than standard outpatient ECT assessment. IVR data offer providers a comprehensive, longitudinal picture of patient treatment response and side effects as a basis for treatment scheduling and ongoing clinical management. PMID:23774054

  11. Remission of persistent methamphetamine-induced psychosis after electroconvulsive therapy: presentation of a case and review of the literature.

    PubMed

    Grelotti, David J; Kanayama, Gen; Pope, Harrison G

    2010-01-01

    Illicit methamphetamine abuse represents a major problem in many countries worldwide, including the United States. Prolonged regular smoking or injection of methamphetamine can cause a psychosis, typically characterized by paranoid delusions and auditory hallucinations and often associated with disturbances in mood. These symptoms may persist long after methamphetamine is discontinued and may prove refractory to antipsychotic medications. The authors describe a patient who developed a typical methamphetamine psychosis that persisted despite months of abstinence from methamphetamine and weeks of treatment with antipsychotic medication but that responded promptly to electroconvulsive therapy (ECT) on two separate occasions: on initial presentation and again a year later when the patient relapsed into methamphetamine abuse and developed psychosis again. The authors review the large international literature on methamphetamine psychosis, much of which is from Japan and has not previously been summarized in English. Persistent methamphetamine psychosis has been widely reported in Japan for more than 50 years but is rarely discussed in the American literature, possibly because some such cases are misdiagnosed in the United States as primary psychotic disorders. Given the growing public health problem of methamphetamine abuse in the United States, the distinction between persistent methamphetamine psychosis and a primary psychotic disorder has grown increasingly important. Thus, American clinicians should be alert to the possibility of methamphetamine psychosis and may wish to consider ECT in refractory cases.

  12. Brain volumetric and metabolic correlates of electroconvulsive therapy for treatment-resistant depression: a longitudinal neuroimaging study.

    PubMed

    Cano, M; Martínez-Zalacaín, I; Bernabéu-Sanz, Á; Contreras-Rodríguez, O; Hernández-Ribas, R; Via, E; de Arriba-Arnau, A; Gálvez, V; Urretavizcaya, M; Pujol, J; Menchón, J M; Cardoner, N; Soriano-Mas, C

    2017-02-07

    Recent research suggests that neuroplastic and neuroinflammatory changes may account for the mode of action of electroconvulsive therapy (ECT), although extant data do not allow for a clear disambiguation between these two hypotheses. Multimodal neuroimaging approaches (for example, combining structural and metabolic information) may help in clarifying this issue. Here we aimed to assess longitudinal changes in (i) regional gray matter (GM) volumes and (ii) hippocampal metabolite concentrations throughout an acute course of bitemporal ECT, as well as (iii) to determine the association between imaging changes and clinical improvement. We assessed 12 patients with treatment-resistant depression (TRD) at four time points (pre-treatment, after the first ECT session, after the ninth ECT session and 15 days after ECT course completion) and 10 healthy participants at two time points, 5 weeks apart. Patients with TRD showed bilateral medial temporal lobe (MTL) and perigenual anterior cingulate cortex volume increases. Left MTL volume increase was associated with (i) a hippocampal N-acetylaspartate concentration decrease, (ii) a hippocampal Glutamate+Glutamine concentration increase and (iii) significant clinical improvement. The observed findings are, in part, compatible with both neuroplastic and neuroinflammatory changes induced by ECT. We postulate that such phenomena may be interrelated, therefore reconciling the neuroplasticity and neuroinflammatory hypotheses of ECT action.

  13. Antidepressant Effects of Electroconvulsive Therapy Unrelated to the Brain's Functional Network Connectivity alterations at an Individual Level

    PubMed Central

    Chen, Guang-Dong; Ji, Feng; Li, Gong-Ying; Lyu, Bo-Xuan; Hu, Wei; Zhuo, Chuan-Jun

    2017-01-01

    Background: Electroconvulsive therapy (ECT) can alleviate the symptoms of treatment-resistant depression (TRD). Functional network connectivity (FNC) is a newly developed method to investigate the brain's functional connectivity patterns. The first aim of this study was to investigate FNC alterations between TRD patients and healthy controls. The second aim was to explore the relationship between the ECT treatment response and pre-ECT treatment FNC alterations in individual TRD patients. Methods: This study included 82 TRD patients and 41 controls. Patients were screened at baseline and after 2 weeks of treatment with a combination of ECT and antidepressants. Group information guided-independent component analysis (GIG-ICA) was used to compute subject-specific functional networks (FNs). Grassmann manifold and step-wise forward component selection using support vector machines were adopted to perform the FNC measure and extract the functional networks' connectivity patterns (FCP). Pearson's correlation analysis was used to calculate the correlations between the FCP and ECT response. Results: A total of 82 TRD patients in the ECT group were successfully treated. On an average, 8.50 ± 2.00 ECT sessions were conducted. After ECT treatment, only 42 TRD patients had an improved response to ECT (the Hamilton scores reduction rate was more than 50%), response rate 51%. 8 FNs (anterior and posterior default mode network, bilateral frontoparietal network, audio network, visual network, dorsal attention network, and sensorimotor network) were obtained using GIG-ICA. We did not found that FCPs were significantly different between TRD patients and healthy controls. Moreover, the baseline FCP was unrelated to the ECT treatment response. Conclusions: The FNC was not significantly different between the TRD patients and healthy controls, and the baseline FCP was unrelated to the ECT treatment response. These findings will necessitate that we modify the experimental scheme to

  14. A primer for the conceptualization of the mechanism of action of electroconvulsive therapy, 2: organizing the information.

    PubMed

    Andrade, Chittaranjan

    2014-06-01

    Much literature is available on the effects of electroconvulsive therapy (ECT) in the brain. Clinicians need to know how to organize this information when they explain hypotheses about the mechanism of action of ECT to patients and caregivers. One possibility is to classify the data under the headings of delivery components, therapeutic mediators, and therapeutic processes. Delivery components are elements of the ECT procedure that modulate the efficacy and efficiency of the treatment; examples are electrical dose, electrode placement, and number and frequency of treatments administered. Therapeutic mediators are physiologic or psychological changes that in themselves are not therapeutic but that lead to the suggested therapeutic changes; examples are the occurrence of the seizure and the occurrence of blood-brain barrier breach. Therapeutic processes are the actual biological changes that compensate for or correct the biological disturbances that underlie the psychiatric illness; examples are changes in the activity of certain neurotransmitter systems and increases or decreases in neuroplasticity in different parts of the brain. Organizing information in this manner can help explain both efficacy and adverse effects of ECT. Brief explanations are provided.

  15. Effectiveness of sodium thiopentone, propofol, and etomidate as an ideal intravenous anesthetic agent for modified electroconvulsive therapy

    PubMed Central

    Mir, Altaf Hussain; Shah, Nida Farooq; Din, Mehraj Ud; Langoo, Shabir Ahmad; Reshi, Fayaz Ahmad

    2017-01-01

    Introduction: Electroconvulsive therapy (ECT) is a well-established psychiatric treatment in which seizures are electrically induced in patients for therapeutic effects. ECT can produce severe disturbances in the cardiovascular system and a marked increase in cerebral blood flow and intracranial pressure. These cardiovascular changes may be altered using various anesthetic drugs. Aim and Objectives: This study was undertaken to compare the effects of intravenous (IV) sodium thiopentone, propofol, and etomidate, used as IV anesthetic agents in modified ECT as regards, induction time and quality of anesthesia, alteration of hemodynamics, seizure duration, and recovery time. Materials and Methods: A total of 90 patients in the age group of 16–60 years of either sex, who had to undergo ECT therapy were divided randomly into three equal groups. Group A received propofol 1% - 1.5 mg/Kg, Group B received etomidate - 0.2 mg/Kg, and Group C received thiopentone 2.5% - 5 mg/Kg. All the patients were monitored for changes in heart rate, systolic blood pressure, diastolic blood pressure, and oxygen saturation at basal, after induction and 1 min, 2 min, 3 min, 5 min, 10 min, 20 min, and 30 min following ECT. Quality of anesthesia, seizure duration, and recovery times were also recorded. Conclusion: We found that propofol had the advantage of smooth induction, stable hemodynamic parameters and rapid recovery as compared to etomidate and thiopentone. Thiopentone had the advantage over propofol of having longer seizure duration at the cost of a relatively prolonged recovery period. Etomidate had a definite advantage of longer seizure duration. PMID:28217049

  16. Comparison of current distributions in electroconvulsive therapy and transcranial magnetic stimulation

    NASA Astrophysics Data System (ADS)

    Sekino, Masaki; Ueno, Shoogo

    2002-05-01

    We compared current density distributions in electroconvulsive therapy (ECT) and transcranial magnetic stimulation (TMS) by numerical calculations. The model consisted of an air region and three types of tissues with different conductivities representing the brain, the skull, and the scalp. In the ECT model, electric currents were applied through electrodes with a voltage of 100 V. In the TMS model, a figure-eight coil (6 cm diameter per coil) was placed on the vertex of the head model. An alternating current with a peak intensity of 3.0 kA and a frequency of 4.2 kHz was applied to the coil. The maximum current densities inside the brain in ECT (bilateral electrode position) and TMS were 234 and 322 A/m2, respectively. The results indicate that magnetic stimulators can generate comparable current densities to ECT. While the skull significantly affected current distributions in ECT, TMS efficiently induced eddy currents in the brain. In addition, TMS is more beneficial than ECT because the localized current distribution reduces the risk of adverse side effects.

  17. Electric field strength and focality in electroconvulsive therapy and magnetic seizure therapy: a finite element simulation study

    NASA Astrophysics Data System (ADS)

    Deng, Zhi-De; Lisanby, Sarah H.; Peterchev, Angel V.

    2011-02-01

    We present the first computational study comparing the electric field induced by various electroconvulsive therapy (ECT) and magnetic seizure therapy (MST) paradigms. Four ECT electrode configurations (bilateral, bifrontal, right unilateral, and focal electrically administered seizure therapy) and three MST coil configurations (circular, cap, and double cone) were modeled. The model incorporated a modality-specific neural activation threshold. ECT (0.3 ms pulse width) and MST induced the maximum electric field of 2.1-2.5 V cm-1 and 1.1-2.2 V cm-1 in the brain, corresponding to 6.2-7.2 times and 1.2-2.3 times the neural activation threshold, respectively. The MST electric field is more confined to the superficial cortex compared to ECT. The brain volume stimulated was much larger with ECT (up to 100%) than with MST (up to 8.2%). MST with the double-cone coil was the most focal, and bilateral ECT was the least focal. Our results suggest a possible biophysical explanation of the reduced side effects of MST compared to ECT. Our results also indicate that the conventional ECT pulse amplitude (800-900 mA) is much higher than necessary for seizure induction. Reducing the ECT pulse amplitude should be explored as a potential means of diminishing side effects.

  18. Outcome of Four Pretreatment Regimes on Hemodynamics during Electroconvulsive Therapy: A Double-blind Randomized Controlled Crossover Trial

    PubMed Central

    Parikh, Devangi Ashutosh; Garg, Sanchita Nitin; Dalvi, Naina Parag; Surana, Priyanka Pradip; Sannakki, Deepa; Tendolkar, Bharati Anil

    2017-01-01

    Context: Electroconvulsive therapy (ECT) is associated with tachycardia and hypertension. Aims: The aim of this study was to compare two doses of dexmedetomidine, esmolol, and lignocaine with respect to hemodynamics, seizure duration, emergence agitation (EA), and recovery profile. Methodology: Thirty patients undergoing ECT were assigned to each of the following pretreatment regimes over the course of five ECT sessions in a randomized crossover design: Group D1 (dexmedetomidine 1 μg/kg), Group D0.5 (dexmedetomidine0.5 μg/kg), Group E (esmolol 1 mg/kg), Group L (lignocaine 1 mg/kg), and Group C (saline as placebo) before induction. Heart rate (HR), mean arterial pressure (MAP), seizure duration, EA, and time to discharge were evaluated. Results: Groups D1, D0.5, and esmolol had significantly reduced response of HR, MAP compared to lignocaine and control groups at 1, 3, 5 min after ECT (P < 0.05). Motor seizure duration was comparable in all groups except Group L (P = 0.000). Peak HR was significantly decreased in all groups compared to control. Total propofol requirement was reduced in D1 (P = 0.000) and D0.5 (P = 0.001) when compared to control. Time to spontaneous breathing was comparable in all the groups (P > 0.05). Time to eye opening and time to discharge were comparable in all groups (P > 0.05) except Group D1 (P = 0.001). EA score was least in Group D1 (P = 0.000). Conclusion: Dexmedetomidine 1 μg/kg, 0.5 μg/kg, and esmolol produced significant amelioration of cardiovascular response to ECT without affecting seizure duration, results being best with dexmedetomidine 1 μg/kg. However, the latter has the shortcoming of delayed recovery. PMID:28074804

  19. Challenges in comparing the acute cognitive outcomes of high-frequency repetitive transcranial magnetic stimulation (HF-rTMS) vs. electroconvulsive therapy (ECT) in major depression: A systematic review.

    PubMed

    Kedzior, Karina Karolina; Schuchinsky, Maria; Gerkensmeier, Imke; Loo, Colleen

    2017-03-02

    The present study aimed to systematically compare the cognitive outcomes of high-frequency repetitive transcranial magnetic stimulation (HF-rTMS) and electroconvulsive therapy (ECT) in head-to-head studies with major depression (MDD) patients. A systematic literature search identified six studies with 219 MDD patients that were too heterogeneous to reliably detect meaningful differences in acute cognitive outcomes after ECT vs. HF-rTMS. Cognitive effects of brain stimulation vary depending on the timeframe and methods of assessment, stimulation parameters, and maintenance treatment. Thus, acute and longer-term differences in cognitive outcomes both need to be investigated at precisely defined timeframes and with similar instruments assessing comparable functions.

  20. A primer for the conceptualization of the mechanism of action of electroconvulsive therapy, 1: defining the question.

    PubMed

    Andrade, Chittaranjan

    2014-05-01

    With regard to the question of how electroconvulsive therapy (ECT) acts, a common answer is that the mechanism of action of the treatment is not well understood. However, this is not true. There is a great deal of information available about what ECT does in the brain, how it does it, and how these effects translate into clinical actions. The very complexity of the available data makes it necessary for the question about mechanisms to be properly defined with regard to physiologic effects, adverse effects, and efficacy in different conditions. This article presents a primer for the conceptualization of the mechanism of action of ECT with special attention to understanding why the question and answer are complex.

  1. Regional electric field induced by electroconvulsive therapy in a realistic finite element head model: Influence of white matter anisotropic conductivity

    PubMed Central

    Lee, Won Hee; Deng, Zhi-De; Kim, Tae-Seong; Laine, Andrew F.; Lisanby, Sarah H.; Peterchev, Angel V.

    2012-01-01

    We present the first computational study investigating the electric field (E-field) strength generated by various electroconvulsive therapy (ECT) electrode configurations in specific brain regions of interest (ROIs) that have putative roles in the therapeutic action and/or adverse side effects of ECT. This study also characterizes the impact of the white matter (WM) conductivity anisotropy on the E-field distribution. A finite element head model incorporating tissue heterogeneity and WM anisotropic conductivity was constructed based on structural magnetic resonance imaging (MRI) and diffusion tensor MRI data. We computed the spatial E-field distributions generated by three standard ECT electrode placements including bilateral (BL), bifrontal (BF), and right unilateral (RUL) and an investigational electrode configuration for focal electrically administered seizure therapy (FEAST). The key results are that (1) the median E-field strength over the whole brain is 3.9, 1.5, 2.3, and 2.6 V/cm for the BL, BF, RUL, and FEAST electrode configurations, respectively, which coupled with the broad spread of the BL E-field suggests a biophysical basis for observations of superior efficacy of BL ECT compared to BF and RUL ECT; (2) in the hippocampi, BL ECT produces a median E-field of 4.8 V/cm that is 1.5–2.8 times stronger than that for the other electrode configurations, consistent with the more pronounced amnestic effects of BL ECT; and (3) neglecting the WM conductivity anisotropy results in E-field strength error up to 18% overall and up to 39% in specific ROIs, motivating the inclusion of the WM conductivity anisotropy in accurate head models. This computational study demonstrates how the realistic finite element head model incorporating tissue conductivity anisotropy provides quantitative insight into the biophysics of ECT, which may shed light on the differential clinical outcomes seen with various forms of ECT, and may guide the development of novel stimulation

  2. Two decades of an indigenously developed brief-pulse electroconvulsive therapy device: A review of research work from National Institute of Mental Health and Neurosciences

    PubMed Central

    Sinha, Preeti; ShyamSundar, A.; Thirthalli, Jagadisha; Gangadhar, B. N.; Candade, Vittal S.

    2016-01-01

    In 1993, a device to administer brief-pulse electroconvulsive therapy was indigenously developed through collaboration between the National Institution for Quality and Reliability and the National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru, Karnataka, India. The additional feature of computerized recording of the electroencephalograph and electrocardiograph for both online and offline use had substantial clinical and research implications. Over the past two decades, this device has been used extensively in different academic and nonacademic settings. A considerable body of research with clinical and heuristic interest has also emanated using this device. In this paper, we present the development of this device and follow it up with a review of research conducted at NIMHANS that validate the features and potentials of this device. PMID:26985102

  3. The Normalization of Brain 18F-fluorodeoxy-D-glucose Positron Emission Tomography Hypometabolism following Electroconvulsive Therapy in a 55-year-old Woman with Treatment-resistant Late Onset Depression: A Case Report

    PubMed Central

    Bak, Jeongjae; Lee, Sang Mi; Kwon, Young-Joon; Shim, Se-Hoon; Kim, Joong Il

    2017-01-01

    Major depressive disorder, especially in later life, has heterogeneous clinical characteristics and treatment responses. Symptomatically, psychomotor retardation, lack of energy, and apathy tends to be more common in people with late-onset depression (LOD). Despite recent advances in psychopharmacologic treatments, 20% to 30% of patients with mood disorders experience inadequate responses to medication, often resulting in a trial of electroconvulsive therapy (ECT). However, the therapeutic mechanism of ECT is still unclear. By using 18F-fluorodeoxy-D-glucose positron emission tomography-computed tomography (18F-FDG PET/CT), we can obtain the status of brain metabolism in patients with neuropsychiatric disorders and changes during psychiatric treatment course. The object of this case report is evaluating the effect of ECT on brain metabolism in treatment-refractory LOD by PET/CT and understanding the mode of action of ECT. In this case report, we presented a 55-year-old female patient who suffered psychotic depression that was resistant to pharmacological treatment. Several antidepressants and atypical anti-psychotics were applied but there was no improvement in her symptoms. The patient presented not only depressed mood and behaviors but also deficit in cognitive functions. We found decreased diffuse cerebral metabolism in her brain 18F-FDG PET/CT image. ECT resulted in amelioration of the patients’ symptoms and another brain PET imaging 7 weeks after the last ECT course showed that her brain metabolism was normalized. PMID:28138119

  4. The Global ECT-MRI Research Collaboration (GEMRIC): Establishing a multi-site investigation of the neural mechanisms underlying response to electroconvulsive therapy.

    PubMed

    Oltedal, Leif; Bartsch, Hauke; Sørhaug, Ole Johan Evjenth; Kessler, Ute; Abbott, Christopher; Dols, Annemieke; Stek, Max L; Ersland, Lars; Emsell, Louise; van Eijndhoven, Philip; Argyelan, Miklos; Tendolkar, Indira; Nordanskog, Pia; Hamilton, Paul; Jorgensen, Martin Balslev; Sommer, Iris E; Heringa, Sophie M; Draganski, Bogdan; Redlich, Ronny; Dannlowski, Udo; Kugel, Harald; Bouckaert, Filip; Sienaert, Pascal; Anand, Amit; Espinoza, Randall; Narr, Katherine L; Holland, Dominic; Dale, Anders M; Oedegaard, Ketil J

    2017-01-01

    Major depression, currently the world's primary cause of disability, leads to profound personal suffering and increased risk of suicide. Unfortunately, the success of antidepressant treatment varies amongst individuals and can take weeks to months in those who respond. Electroconvulsive therapy (ECT), generally prescribed for the most severely depressed and when standard treatments fail, produces a more rapid response and remains the most effective intervention for severe depression. Exploring the neurobiological effects of ECT is thus an ideal approach to better understand the mechanisms of successful therapeutic response. Though several recent neuroimaging studies show structural and functional changes associated with ECT, not all brain changes associate with clinical outcome. Larger studies that can address individual differences in clinical and treatment parameters may better target biological factors relating to or predictive of ECT-related therapeutic response. We have thus formed the Global ECT-MRI Research Collaboration (GEMRIC) that aims to combine longitudinal neuroimaging as well as clinical, behavioral and other physiological data across multiple independent sites. Here, we summarize the ECT sample characteristics from currently participating sites, and the common data-repository and standardized image analysis pipeline developed for this initiative. This includes data harmonization across sites and MRI platforms, and a method for obtaining unbiased estimates of structural change based on longitudinal measurements with serial MRI scans. The optimized analysis pipeline, together with the large and heterogeneous combined GEMRIC dataset, will provide new opportunities to elucidate the mechanisms of ECT response and the factors mediating and predictive of clinical outcomes, which may ultimately lead to more effective personalized treatment approaches.

  5. Assessment of cognitive performance using CNS vital signs after electroconvulsive treatment of schizophrenia.

    PubMed

    Wysokiński, Adam; Dzienniak, Małgorzata; Kłoszewska, Iwona

    2014-03-01

    Little is known how electroconvulsive therapy (ECT) affects cognitive functions in subjects with schizophrenia. Assessment of cognitive functions in subjects with schizophrenia treated with ECT was performed using CNS Vital Signs computerized battery of tests. Thirteen patients treated with ECT plus antipsychotics were assessed before and after 12 to 15 bilateral ECT sessions. We did not find any important changes between pre-ECT and post-ECT cognitive performance. We also found that CNS Vital Signs is a useful computerized battery test for assessing cognitive functions of subjects treated with ECT.

  6. Augmentation of clozapine with electroconvulsive therapy in treatment resistant schizophrenia: A systematic review and meta-analysis.

    PubMed

    Lally, John; Tully, John; Robertson, Dene; Stubbs, Brendon; Gaughran, Fiona; MacCabe, James H

    2016-03-01

    The primary aim of this systematic review and meta-analysis was to assess the proportion of patients with Treatment Resistant Schizophrenia (TRS) that respond to ECT augmentation of clozapine (C+ECT). We searched major electronic databases from 1980 to July 2015. We conducted a random effects meta-analysis reporting the proportion of responders to C+ECT in RCTs and open-label trials. Five clinical trials met our eligibility criteria, allowing us to pool data from 71 people with TRS who underwent C+ ECT across 4 open label trials (n=32) and 1 RCT (n=39). The overall pooled proportion of response to C+ECT was 54%, (95% CI: 21.8-83.6%) with some heterogeneity evident (I(2)=69%). With data from retrospective chart reviews, case series and case reports, 192 people treated with C+ECT were included. All studies together demonstrated an overall response to C+ECT of 66% (95% CI: 57.5-74.3%) (83 out of 126 patients responded to C+ECT). The mean number of ECT treatments used to augment clozapine was 11.3. 32% of cases (20 out of 62 patients) with follow up data (range of follow up: 3-468weeks) relapsed following cessation of ECT. Adverse events were reported in 14% of identified cases (24 out of 166 patients). There is a paucity of controlled studies in the literature, with only one single blinded randomised controlled study located, and the predominance of open label trials used in the meta-analysis is a limitation. The data suggests that ECT may be an effective and safe clozapine augmentation strategy in TRS. A higher number of ECT treatments may be required than is standard for other clinical indications. Further research is needed before ECT can be included in standard TRS treatment algorithms.

  7. PBA regulates neurogenesis and cognition dysfunction after repeated electroconvulsive shock in a rat model.

    PubMed

    Yao, Zhao-Hui; Kang, Xiang; Yang, Liu; Niu, Yi; Lu, Ye; Nie, Li

    2015-12-15

    Electroconvulsive therapy (ECT) was widely used to treat the refractory depression. But ECT led to the cognitive deficits plaguing the depression patients. The underlying mechanisms of the cognitive deficits remain elusive. Repeated electroconvulsive shock (rECS) was used to simulate ECT and explore the mechanisms of ECT during the animal studies. Previous studies showed rECS could lead to neurogenesis and cognitive impairment. But it was well known that neurogenesis could improve the cognition. So these suggested that the mechanism of the cognitive deficit after rECS was very complex. In present study, we explored the probable mechanisms of the cognitive deficit after rECS from neurogenesis aspect. We found the cognitive deficit was reversible and neurogenesis could bring a long-term beneficial effect on cognition. Astrogliosis and NR1 down-regulation probably participated in the reversible cognitive deficits after rECS. Phenylbutyric acid (PBA), generally as an agent to investigate the roles of histone acetylation, could prevent the reversible cognitive dysfunction, but PBA could diminish the long-term effect of enhanced cognition by rECS. These suggested that ECT could possibly bring the long-term beneficial cognitive effect by regulating neurogenesis.

  8. ECT in patients with intracranial masses.

    PubMed

    Rasmussen, Keith G; Perry, Candace Lynn; Sutor, Bruce; Moore, Katherine M

    2007-01-01

    The authors describe the electroconvulsive therapy (ECT) treatment of seven patients who had intracranial masses or mass effect and one patient who was status post mass resection. None suffered any neurological deterioration during ECT. They provide recommendations for clinical practice with such patients.

  9. Brain-Derived Neurotrophic Factor and Antidepressive Effect of Electroconvulsive Therapy: Systematic Review and Meta-Analyses of the Preclinical and Clinical Literature

    PubMed Central

    Polyakova, M.; Schroeter, M. L.; Elzinga, B. M.; Holiga, S.; Schoenknecht, P.; de Kloet, E. R.; Molendijk, M. L.

    2015-01-01

    Emerging data suggest that Electro-Convulsive Treatment (ECT) may reduce depressive symptoms by increasing the expression of Brain-Derived Neurotrophic Factor (BDNF). Yet, conflicting findings have been reported. For this reason we performed a systematic review and meta-analysis of the preclinical and clinical literature on the association between ECT treatment (ECS in animals) and changes in BDNF concentrations and their effect on behavior. In addition, regional brain expression of BDNF in mouse and human brains were compared using Allen Brain Atlas. ECS, over sham, increased BDNF mRNA and protein in animal brain (effect size [Hedge’s g]: 0.38―0.54; 258 effect-size estimates, N = 4,284) but not in serum (g = 0.06, 95% CI = -0.05―0.17). In humans, plasma but not serum BDNF increased following ECT (g = 0.72 vs. g = 0.14; 23 effect sizes, n = 281). The gradient of the BDNF increment in animal brains corresponded to the gradient of the BDNF gene expression according to the Allen brain atlas. Effect-size estimates were larger following more ECT sessions in animals (r = 0.37, P < .0001) and in humans (r = 0.55; P = 0.05). There were some indications that the increase in BDNF expression was associated with behavioral changes in rodents, but not in humans. We conclude that ECS in rodents and ECT in humans increase BDNF concentrations but this is not consistently associated with changes in behavior. PMID:26529101

  10. Effect of sildenafil on the activity of some antidepressant drugs and electroconvulsive shock treatment in the forced swim test in mice.

    PubMed

    Socała, Katarzyna; Nieoczym, Dorota; Wyska, Elżbieta; Wlaź, Piotr

    2017-04-01

    Sildenafil, a potent and selective inhibitor of phosphodiesterase type 5, is used clinically to treat erectile dysfunction and pulmonary arterial hypertension. It is often taken by patients suffering from depression and receiving antidepressant drug treatment. However, its influence on the efficacy of antidepressant treatment was not sufficiently studied. Therefore, the aim of the present study was to investigate the influence of sildenafil on the anti-immobility action of several antidepressant drugs (i.e., sertraline, fluvoxamine, citalopram, maprotiline, trazodone, and agomelatine) as well as on antidepressant-like effect of electroconvulsive stimulations in the forced swim test in mice. The obtained results showed that acute sildenafil treatment enhanced the antidepressant-like activity of all of the studied drugs. The observed effects were not due to the increase in locomotor activity. The interactions between sildenafil and sertraline, maprotiline, and trazodone were pharmacodynamic in nature, as sildenafil did not affect concentrations of these drugs neither in serum nor in brain tissue. Increased concentrations of fluvoxamine, citalopram, and agomelatine in brain tissue evoked by sildenafil co-administration suggest that pharmacokinetic interactions between sildenafil and these drugs are very likely. Sildenafil injected acutely did not alter the antidepressant-like efficacy of electroconvulsive stimulations in mice, as assessed in the forced swim test. Interestingly, repeated (14 days) administration of sildenafil decreased the anti-immobility action of the electroconvulsive stimulations. In conclusion, the present study shows that sildenafil may alter the effectiveness of antidepressant treatment. Further studies are warranted to better characterize the influence of sildenafil on the activity of antidepressant drugs and electroconvulsive therapy.

  11. Comparison of the neuropsychological mechanisms of 2,6-diisopropylphenol and N-methyl-D-aspartate receptor antagonist against electroconvulsive therapy-induced learning and memory impairment in depressed rats

    PubMed Central

    LIU, GANG; LIU, CHAO; NING-ZHANG, XUE

    2015-01-01

    The present study aimed to examine the neurophysiological mechanisms of the 2,6-diisopropylphenol and N-methyl-D-aspartate (NMDA) receptor antagonist against learning and memory impairment, induced by electroconvulsive therapy (ECT). A total of 48 adult depressed rats without olfactory bulbs were randomly divided into six experimental groups: i) saline; ii) 10 mg/kg MK-801; iii) 10 mg/kg MK-801 and a course of ECT; iv) 200 mg/kg 2,6-diisopropylphenol; v) 200 mg/kg 2,6-diisopropylphenol and a course of ECT; and vi) saline and a course of ECT. The learning and memory abilities of the rats were assessed using a Morris water maze 1 day after a course of ECT. The hippocampus was removed 1 day after assessment using the Morris water maze assessment. The content of glutamate in the hippocampus was detected using high-performance liquid chromatography. The expression levels of p-AT8Ser202 and GSK-3β1H8 in the hippocampus were determined using immunohistochemical staining and western blot analysis. The results demonstrated that the 2,6-diisopropylphenol NMDA receptor antagonist, MK-801 and ECT induced learning and memory impairment in the depressed rats. The glutamate content was significantly upregulated by ECT, reduced by 2,6-diisopropylphenol, and was unaffected by the NMDA receptor antagonist in the hippocampus of the depressed rats. Tau protein hyperphosphorylation in the hippocampus was upregulated by ECT, but was reduced by 2,6-diisopropylphenol and the MK-801 NMDA receptor antagonist. It was also demonstrated that 2,6-diisopropylphenol prevented learning and memory impairment and reduced the hyperphosphorylation of the Tau protein, which was induced by eECT. GSK-3β was found to be the key protein involved in this signaling pathway. The ECT reduced the learning and memory impairment, caused by hyperphosphorylation of the Tau protein, in the depressed rats by upregulating the glutamate content. PMID:25998151

  12. Art Therapy with Laryngectomy Patients.

    ERIC Educational Resources Information Center

    Anand, Susan Ainlay; Anand, Vinod K.

    1997-01-01

    Reports on the experiences of patients with laryngeal cancer who used art therapy. Drawing on 14 years of experience and 109 laryngeal cancer patients, describes treatment results and the case material substantiating the distinct role of art therapy. Provides an overview of the special medical and therapeutic needs of this group. (RJM)

  13. Hormone therapy for transgender patients

    PubMed Central

    2016-01-01

    Many transgender men and women seek hormone therapy as part of the transition process. Exogenous testosterone is used in transgender men to induce virilization and suppress feminizing characteristics. In transgender women, exogenous estrogen is used to help feminize patients, and anti-androgens are used as adjuncts to help suppress masculinizing features. Guidelines exist to help providers choose appropriate candidates for hormone therapy, and act as a framework for choosing treatment regimens and managing surveillance in these patients. Cross-sex hormone therapy has been shown to have positive physical and psychological effects on the transitioning individual and is considered a mainstay treatment for many patients. Bone and cardiovascular health are important considerations in transgender patients on long-term hormones, and care should be taken to monitor certain metabolic indices while patients are on cross-sex hormone therapy. PMID:28078219

  14. Effects of electroconvulsive shock on noradrenergic and serotonergic receptors in rat brain.

    PubMed

    Kellar, K J

    1987-01-01

    It is likely that both noradrenalin and serotonin neurotransmission are important in the pathophysiology of depression and to its treatment. In particular, certain receptors for these neurotransmitters are altered by repeated treatment with both antidepressant drugs and electroconvulsive shock. This paper reviews the effects of electroconvulsive shock on alpha-1-adrenergic, beta-adrenergic, and serotonin-2 receptors in rat brain, and compares these effects to those produced by anti-depressant drugs. The similarities and differences in the effects of antidepressant drugs and electroconvulsive shock in rat brain may provide clues for the development of more effective treatments for depression and could single out targets for future investigation of the pathophysiology of depression in patients when safe methods are developed.

  15. A Bayesian framework systematic review and meta-analysis of anesthetic agents effectiveness/tolerability profile in electroconvulsive therapy for major depression

    PubMed Central

    Fond, Guillaume; Bennabi, Djamila; Haffen, Emmanuel; Brunel, Lore; Micoulaud-Franchi, Jean-Arthur; Loundou, Anderson; Lançon, Christophe; Llorca, Pierre-Michel; Auquier, Pascal; Boyer, Laurent

    2016-01-01

    The aim of this study was to assess the efficacy and tolerability/acceptability of 6 anesthetic agents in ECT for depressive disorders. We systematically reviewed 14 double-blind randomized controlled trials (610 participants). Efficacy was measured by the mean scores on validated depression scales at 6 ECT (or the nearest score if not available), number of responders at the end of treatment and seizure duration. The acceptability was measured by the proportion of patients who dropped out of the allocated treatment, and the tolerability by the number of serious adverse events and post-treatment cognition assessment. After excluding the trials responsible for heterogeneity, depression scores of patients who were administered methohexital were found to be significantly more improved than those who received propofol (p = 0.001). On the contrary, those who were administered propofol had lower depression scores than those with thiopental at the end of treatment (p = 0.002). Compared to propofol, methohexital was found to be significantly associated with higher seizure duration (p = 0.018). No difference was found for the acceptability profile (all p > 0.05). In summary, ketamine and methohexital may be preferred to propofol or thiopental in regard of effectiveness in depression scores and increased seizure duration. Further studies are warranted to compare ketamine and methohexital. PMID:26806849

  16. ["Shock" therapies in Nazi Germany. The example of Berlin psychiatry].

    PubMed

    Rzesnitzek, L

    2014-09-01

    The idea that "shock" therapies were introduced by "Nazi-Psychiatry" very early and used radically in a cruel way darkens the image of these therapies until today. A case analysis of patient files of psychiatric hospitals in Berlin is used to recapitulate the introduction of insulin coma, metrazol and electroconvulsive therapy during the National Socialism era. Contrary to the false assumption that these "shock" therapies would have been introduced and preferred by psychiatrists involved with the Nazi regime and "euthanasia", in the case of Berlin these therapies were delayed by them and seldom used.

  17. Genetic fate mapping of type-1 stem cell-dependent increase in newborn hippocampal neurons after electroconvulsive seizures.

    PubMed

    Weber, Tillmann; Baier, Vera; Lentz, Katharina; Herrmann, Elke; Krumm, Bertram; Sartorius, Alexander; Kronenberg, Golo; Bartsch, Dusan

    2013-12-01

    Electroconvulsive therapy (ECT) is a uniquely effective treatment for major depressive disorder. An increase in hippocampal neurogenesis is implicated in the recovery from depression. We used an inducible genetic mouse model in which only GFAP-expressing stem-like cells (type-1 cells) and their progeny are selectively labeled with the reporter protein β-galactosidase to track the process of neurogenesis in the dentate gyrus over 3 months following electroconvulsive seizures (ECS), the mouse equivalent of ECT. All ECS protocols tested induced a transient increase in type-1 cell divisions. While this led to an expansion of the type-1 cell pool after high-frequency ECS sessions for 5 consecutive days (5-ECS), asymmetric divisions drove neurogenesis by giving rise to Doublecortin (DCX)-expressing neuroblasts that matured into NeuN+ neurons. Significantly, the increase in newly generated DCX+ and NeuN+ cells after 5-ECS could be traced back to proliferating type-1 cells. Low-frequency continuation ECS (c-ECS) consisting of five single ECS sessions administered every 2 weeks resulted in a similar increase in newborn neurons as the high-frequency 5-ECS protocol. Moreover, the combination of 5-ECS and c-ECS led to a further significant increase in newborn neurons, suggesting a cellular mechanism responsible for the propitious effects of high-frequency ECT followed by continuation ECT in severely depressed patients. The ability of high- and low-frequency ECS to induce normally quiescent type-1 cells to proliferate and generate new neurons sets it apart from other antidepressant treatments and may underlie the superior clinical efficacy of ECT.

  18. Electroconvulsive stimulation, but not chronic restraint stress, causes structural alterations in adult rat hippocampus--a stereological study.

    PubMed

    Olesen, Mikkel V; Wörtwein, Gitta; Pakkenberg, Bente

    2015-01-01

    The neurobiological mechanisms underlying depression are not fully understood. Only a few previous studies have used validated stereological methods to test how stress and animal paradigms of depression affect adult hippocampal neurogenesis and whether antidepressant therapy can counteract possible changes in an animal model. Thus, in this study we applied methods that are state of the art in regard to stereological cell counting methods. Using a validated rat model of depression in combination with a clinically relevant schedule of electroconvulsive stimulation, we estimated the total number of newly formed neurons in the hippocampal subgranular zone. Also estimated were the total number of neurons and the volume of the granule cell layer in adult rats subjected to chronic restraint stress and electroconvulsive stimulation either alone or in combination. We found that chronic restraint stress induces depression-like behavior, without significantly changing neurogenesis, the total number of neurons or the volume of the hippocampus. Further, electroconvulsive stimulation prevents stress-induced depression-like behavior and increases neurogenesis. The total number of neurons and the granule cell layer volume was not affected by electroconvulsive stimulation.

  19. Enhancing radiation therapy for patients with glioblastoma.

    PubMed

    Alexander, Brian M; Ligon, Keith L; Wen, Patrick Y

    2013-05-01

    Radiation therapy has been the foundation of therapy following maximal surgical resection in patients with newly diagnosed glioblastoma for decades and the primary therapy for unresected tumors. Using the standard approach with radiation and temozolomide, however, outcomes are poor, and glioblastoma remains an incurable disease with the majority of recurrences and progression within the radiation treatment field. As such, there is much interest in elucidating the mechanisms of resistance to radiation therapy and in developing novel approaches to overcoming this treatment resistance.

  20. Effectiveness of methylphenidate as augmentation therapy after failure of adjunctive neuromodulation for patients with treatment-refractory bipolar depression: a case report.

    PubMed

    Adida, Marc; Azorin, Jean-Michel

    2014-01-01

    Adjunctive use of methylphenidate, a central stimulant, has been considered as a potential therapeutic choice for patients with refractory unipolar, geriatric, or bipolar depression, and depression secondary to medical illness. We present a case of bipolar depression in which the patient responded significantly to augmentation with methylphenidate, without any side effects, after failure of adjunctive repetitive transcranial magnetic stimulation and electroconvulsive therapy. Mr U, a 56-year-old man with bipolar I disorder, had melancholic symptoms during his sixth episode of bipolar depression. After failure of repetitive transcranial magnetic stimulation and electroconvulsive therapy, he was treated with fluoxetine 80 mg/day, duloxetine 360 mg/day, mirtazapine 60 mg/day, and sodium valproate 1,000 mg/day, with no improvement. We added methylphenidate at a dose of 10 mg/day for one week, which resulted in mild clinical improvement, and then methylphenidate extended-release 20 mg/day for one week, with significant clinical improvement. He tolerated his medications well. His clinical recovery was stable over one year. The patient's antidepressants and methylphenidate were gradually tapered and finally discontinued after one year with no withdrawal syndrome. To date, he remains well on sodium valproate as monotherapy and is being followed up at our bipolar department. This case suggests that methylphenidate augmentation might be a therapeutic option when treating highly treatment-resistant patients with bipolar depression, even if they had not responded to adjunctive neuromodulation. In these clinical situations, physicians might be interested in prescribing methylphenidate because of its efficacy and safety.

  1. Patient perceptions of voice therapy adherence.

    PubMed

    van Leer, Eva; Connor, Nadine P

    2010-07-01

    Patient perspectives of behavioral voice therapy, including perspectives of treatment adherence, have not been formally documented. Because treatment adherence is, to a large extent, determined by patient beliefs, assessment of patient perspectives is integral to the study of adherence. Fifteen patients who had undergone at least two sessions of direct voice therapy for a variety of voice disorders/complaints were interviewed about their perspectives on voice therapy, with a particular focus on adherence. Interviews were transcribed and analyzed for content according to qualitative methods. Three common content themes emerged from the transcripts: Voice Therapy is Hard, Make it Happen, and The Match Matters. Findings were compared with reports of patient experiences in other behavioral interventions, such as diet and exercise, and related to existing theoretical models of behavior change and therapeutic process. This study yields information toward the development of scales to measure adherence-related constructs and strategies to improve treatment adherence in voice therapy.

  2. Effectiveness of methylphenidate as augmentation therapy after failure of adjunctive neuromodulation for patients with treatment-refractory bipolar depression: a case report

    PubMed Central

    Adida, Marc; Azorin, Jean-Michel

    2014-01-01

    Adjunctive use of methylphenidate, a central stimulant, has been considered as a potential therapeutic choice for patients with refractory unipolar, geriatric, or bipolar depression, and depression secondary to medical illness. We present a case of bipolar depression in which the patient responded significantly to augmentation with methylphenidate, without any side effects, after failure of adjunctive repetitive transcranial magnetic stimulation and electroconvulsive therapy. Mr U, a 56-year-old man with bipolar I disorder, had melancholic symptoms during his sixth episode of bipolar depression. After failure of repetitive transcranial magnetic stimulation and electroconvulsive therapy, he was treated with fluoxetine 80 mg/day, duloxetine 360 mg/day, mirtazapine 60 mg/day, and sodium valproate 1,000 mg/day, with no improvement. We added methylphenidate at a dose of 10 mg/day for one week, which resulted in mild clinical improvement, and then methylphenidate extended-release 20 mg/day for one week, with significant clinical improvement. He tolerated his medications well. His clinical recovery was stable over one year. The patient’s antidepressants and methylphenidate were gradually tapered and finally discontinued after one year with no withdrawal syndrome. To date, he remains well on sodium valproate as monotherapy and is being followed up at our bipolar department. This case suggests that methylphenidate augmentation might be a therapeutic option when treating highly treatment-resistant patients with bipolar depression, even if they had not responded to adjunctive neuromodulation. In these clinical situations, physicians might be interested in prescribing methylphenidate because of its efficacy and safety. PMID:24729710

  3. Effectiveness and clinical predictors of response to combined ECT and antipsychotic therapy in patients with treatment-resistant schizophrenia and dominant negative symptoms.

    PubMed

    Pawełczyk, Tomasz; Kołodziej-Kowalska, Emilia; Pawełczyk, Agnieszka; Rabe-Jabłońska, Jolanta

    2014-12-15

    The effectiveness and predictors of response to electroconvulsive therapy (ECT) combined with antipsychotics (AP) in treatment-resistant schizophrenia patients with the dominance of negative symptoms (TRS-NS) have not been studied systematically so far. 29 patients aged 21-55 years diagnosed with TRS-NS underwent ECT combined with antipsychotics (ECT+AP). Prior to the ECT, the symptom profile and severity were evaluated using Positive and Negative Syndrome Scale (PANSS). Demographic and medical data was collected; ECT parameters and pharmacotherapy results were evaluated. After the combined ECT+AP therapy a significant decrease in symptom severity was found. A response to treatment was achieved by 60% of patients. The greatest reductions were obtained in general and positive PANSS subscale (median change: 11 and 7 pts.) and the smallest, but still significant, ones in negative symptoms subscale (median: 3.5 pts.). Patients who responded to ECT+AP demonstrated a significantly shorter duration of the current episode in comparison with patients who did not experience at least a 25% reduction in symptom severity (median: 4 vs. 8 months). A combination of ECT and antipsychotic therapy can provide a useful treatment option for patients with TRS-NS. The only significant predictor of response to treatment was a shorter duration of the current episode.

  4. [Treatment of psychotic patients with music therapy].

    PubMed

    Inselmann, U

    1995-01-01

    The present contribution describes the experience taken from music therapy of psychotic patients. The emotional and cognitive music perception and its possible influence on self perception and strengthening of ego are discussed. Since exercise instructions were limited the observed improvement of communication seems rather due to intra- and interpersonal effects of active improvisation than to a training process. With regard to schizophrenic patients possible effects of music therapy are discussed in the light of self-object-differentiation.

  5. Efficacy of Osteoporosis Therapies in Diabetic Patients.

    PubMed

    Schwartz, Ann V

    2017-02-01

    Diabetes is characterized by increased fracture risk and by reduced bone strength for a given density. Contributing factors may include lower bone turnover and accumulation of advanced glycation endproducts. There are concerns that the pharmacological therapies for osteoporosis, particularly anti-resorptive therapies that suppress bone turnover, may not be as effective in the setting of diabetes. This review considers clinical trials and observational studies that have assessed the efficacy of anti-resorptive and anabolic therapies in diabetic patients. Post hoc analyses of randomized trials indicate that raloxifene has similar efficacy for prevention of vertebral fractures in diabetic compared with non-diabetic patients. Evidence from randomized clinical trials is lacking for anti-fracture efficacy of other osteoporosis therapies in diabetes. However, observational studies suggest that bisphosphonates are effective in preventing fractures in diabetic patients. The great majority of diabetic patients in studies to date have been type 2, and efficacy of osteoporosis therapies in type 1 diabetic patients remains to be addressed. Further evaluation of the efficacy of osteoporosis therapies in the setting of diabetes is needed to provide optimal fracture prevention for this population.

  6. Antiplatelet therapy in patients undergoing coronary stenting

    PubMed Central

    ten Berg, J.M.; van Werkum, J.W.; Heestermans, A.A.C.M.; Jaarsma, W.; Hautvast, R.M.A.; den Heijer, P.; de Boer, M.J.

    2006-01-01

    Background Anticoagulation after coronary stenting is essential to prevent stent thrombosis. Drug-eluting stents, which are the preferred therapy, may be associated with a higher tendency for stent thrombosis. Methods Patients who underwent coronary stent placement and presented with late stent thrombosis are described. Results Eight patients with stent thrombosis are presented. Early discontinuation of the antithrombotic medication is associated with the occurrence of these complications. Conclusion Long-term antithrombotic therapy seems essential to prevent stent thrombosis, especially for patients treated with drug-eluting stents. PMID:25696663

  7. Vestibular rehabilitation therapy for the dizzy patient.

    PubMed

    Tee, L H; Chee, N W C

    2005-05-01

    A customised vestibular rehabilitation therapy (VRT) programme is an important treatment modality in patients with vestibular dysfunction resulting in motion-provoked vertigo, oscillopsia (gaze instability), disequilibrium and gait disturbances. We discuss in this paper the patient selection criteria for VRT, rehabilitation strategies for unilateral and bilateral vestibular deficits, and some of the compelling evidence to support the use of VRT in treating such patients.

  8. Rapidly-progressive catatonia responsive to zolpidem in a patient with ovarian teratoma-associated paraneoplastic encephalitis.

    PubMed

    Amorim, Edilberto; McDade, Eric M

    2016-08-01

    Psychiatric symptoms and catatonia are key components of the clinical presentation of paraneoplastic encephalitis; additionally symptoms can be long-lasting and often difficult to treat. We report a 73-year-old patient with rapidly progressive catatonia not responsive to immunotherapy, tumor resection, electroconvulsive therapy, or benzodiazepines who had significant improvement after zolpidem administration. This report suggests that zolpidem is an option in the treatment of patients with refractory catatonia and paraneoplastic encephalitis.

  9. Effectively nursing patients receiving aromatase inhibitor therapy.

    PubMed

    Wengström, Y

    2008-06-01

    Inhibiting estrogen production is a common means of preventing breast cancer recurrence. The aromatase inhibitors (AIs) are becoming the preferred treatment over tamoxifen as adjuvant therapy for postmenopausal women with hormone-sensitive early breast cancer. Like all adjuvant therapies, AIs have adverse events (AEs) associated with their use, many of which resemble symptoms common to menopause. Because of the greater efficacy of AIs in preventing breast cancer recurrence over tamoxifen, these AEs may be considered tolerable by many patients and often can be effectively managed and/or prevented. Educating patients about anticipated AEs may help them understand, accept, and cope with these AEs. This article reviews the AEs associated with different adjuvant AI treatments and highlights some strategies to manage them effectively. It also highlights the importance of patient education regarding AI therapy and involvement in treatment decisions, which may lead to better long-term adherence and ultimately to better outcomes.

  10. Acupuncture therapy for stroke patients.

    PubMed

    Li, Xin; Wang, Qiang

    2013-01-01

    Acupuncture is one of the most important parts of Traditional Chinese Medicine, has been used for more than 3000 years as prevention and treatment for various diseases in China as well as in adjacent regions, and is widely accepted in western countries in recent years. More and more clinical trials revealed that acupuncture shows positive effect in stroke, not only as a complementary and alternative medicine for poststroke rehabilitation but also as a preventive strategy which could induce cerebral ischemic tolerance, especially when combined with modern electrotherapy. Acupuncture has some unique characteristics, which include acupoint specificity and parameter-dependent effect. It also involves complicated mechanism to exert the beneficial effect on stroke. Series of clinical trials have shown that acupuncture primarily regulates the release of neurochemicals, hemorheology, cerebral microcirculation, metabolism, neuronal activity, and the function of specific brain region. Animal studies showed that the effects of acupuncture therapy on stroke were possibly via inhibition of postischemic inflammatory reaction, stimulation of neurogenesis and angiogenesis, and influence on neural plasticity. Mechanisms for its preconditioning effect include activity enhancement of antioxidant, regulation of the endocannabinoid system, and inhibition of apoptosis. Although being controversial, acupuncture is a promising preventive and treatment strategy for stroke, but further high-quality clinical trials would be needed to provide more confirmative evidence.

  11. Aquatic therapy for patients with rheumatic disease.

    PubMed

    McNeal, R L

    1990-11-01

    Aquatic therapy is justifiably a rapidly expanding, beneficial form of patient treatment. The goals established at the initial and subsequent evaluations usually are met as quickly and as sensibly as possible. Understanding the theory of water techniques is essential in implementing an aquatic therapy program. The success of the program, however, will always depend on the pleasure and benefits achieved by the patients. Remember, rheumatic patients most likely will need to modify their previous daily functioning. Patients need to be aware of the long-term ramifications of the disease process and understand how treatment and care may be altered during various stages of exacerbation and remission. Patient education is critical in ensuring individual responsibility for the changes that must be made when not supervised by a professional. Aquatic therapy is a step in molding a positive lifestyle change for the patient. The patient can be encouraged to be fitness oriented and, at the same time, exercise in a manner that is safe, effective, and biomechanically and physiologically sound. The environment, hopefully, also will be conductive to family and social interaction that ultimately encourages the compliance of long-term exercise programs.

  12. Benefits of leptin therapy in HIV patients

    PubMed Central

    Sinha, Uma; Sinharay, Keshab; Sengupta, Nilanjan; Mukhopadhyay, Prasanta

    2012-01-01

    Leptin therapy in human recombinant form has recently been used in HIV-associated lipodystrophy syndrome on experimental basis in some small short-term clinical trials. It has shown its beneficial effects only in hypoleptinemic HIV-infected patients by causing definite improvement in their insulin sensitivity, glucose tolerance, lipid status, and truncal obesity. Leptin prevents lipotoxicity and activates insulin signaling pathways through several postulated mechanisms. Central leptin insufficiency with peripheral hyperleptinemia has come out to be a significant contributor to the development of obesity and metabolic syndrome. In this article, we will review the basis of leptin therapy in HIV patients, with its promises. However, further larger clinical trials are needed to prove its long-term efficacy in the control of metabolic complications related to HIV therapy. PMID:23565500

  13. Tuberculosis: Art Therapy with Patients in Isolation.

    ERIC Educational Resources Information Center

    Rosner-David, Irene; Ilusorio, Shereen

    1995-01-01

    Tuberculosis is reappearing with increasing prevalence and presenting new treatment challenges. Art therapy, which partly originated in a tuberculosis sanatoria, again serves to assist patients in coping with their illness and confinement. Case examples illustrate aspects of the disease and related emotions and highlight the potential for such an…

  14. Temporal gene expression profile after acute electroconvulsive stimulation in the rat.

    PubMed

    Dyrvig, Mads; Christiansen, Søren H; Woldbye, David P D; Lichota, Jacek

    2014-04-10

    Electroconvulsive therapy (ECT) remains one of the most effective treatments of major depression. It has been suggested that the mechanisms of action involve gene expression. In recent decades there have been several investigations of gene expression following both acute and chronic electroconvulsive stimulation (ECS). These studies have focused on several distinct gene targets but have generally included only few time points after ECS for measuring gene expression. Here we measured gene expression of three types of genes: Immediate early genes, synaptic proteins, and neuropeptides at six time points following an acute ECS. We find significant increases for c-Fos, Egr1, Neuritin 1 (Nrn 1), Bdnf, Snap29, Synaptotagmin III (Syt 3), Synapsin I (Syn 1), and Psd95 at differing time points after ECS. For some genes these changes are prolonged whereas for others they are transient. Npy expression significantly increases whereas the gene expression of its receptors Npy1r, Npy2r, and Npy5r initially decreases. These decreases are followed by a significant increase for Npy2r, suggesting anticonvulsive adaptations following seizures. In summary, we find distinct changes in mRNA quantities that are characteristic for each gene. Considering the observed transitory and inverse changes in expression patterns, these data underline the importance of conducting measurements at several time points post-ECS.

  15. Cardiovascular therapy of neurosurgical patients.

    PubMed

    Schubert, Armin

    2007-12-01

    The causes of postoperative cardiovascular disturbances in neurosurgical patients include direct cardiac neurogenic effects, clinical situations where brain tissue is underperfused, and hyperdynamic states. EKG and echographic abnormalities are common in subarachnoid hemorrhage where cardiac troponin I is the most useful predictor of cardiac risk after SAH. Neurogenic pulmonary edema is short lived and often resolves with resolution of the neurologic problem. In traumatic brain injury, where areas of ischemia co-exist with luxury perfusion, advanced hemodynamic monitoring and prevention of jugular venous desaturation best avoid secondary brain injury and achieve optimal neurologic outcome. Induced hypertension improves blood flow through vessels compromised by cerebral stenting, angioplasty, microcatheters, thrombolysis, carotid clamping, intracranial bypass and cerebral vasospasm. Hyperdynamic lesions include vascular breakthrough after elimination of cerebral arteriovenous malformations, but also emergence hypertension and hyperemia. Pharmacologic agents and adjunctive measures are effective in controlling both the systemic and the cerebral circulation.

  16. [Dance therapy in laryngectomy patients: our experience].

    PubMed

    Peto, A C

    2000-12-01

    This study describes the first contact of laringectomized people with dance in the Group of Support to Ostomized-Laringectomized Patients. This study aimed at searching for elements about the therapeutic and educative importance of dance to them. The technique utilized was group dynamics with the participation of twenty patients. Music and body movements were resources employed for the development of therapy through dance. Results showed a good involvement of the patients in the dynamics though verbal and non-verbal language as well as a decrease in stress.

  17. Impact on Psychiatric Interns of Watching Live Electroconvulsive Treatment

    ERIC Educational Resources Information Center

    Gazdag, Gabor; Sebestyen, Gabor; Ungvari, Gabor S.; Tolna, Judit

    2009-01-01

    Objective: Watching a live electroconvulsive treatment (ECT) has both positive and negative effects on spectators. The authors aim to survey the attitude change towards ECT in interns after watching a live ECT session. Methods: A 23-item questionnaire was administered to 66 interns before and after watching ECT. Results: In five statements, the…

  18. Pneumonia in immunocompetent patients: combination antibiotic therapy.

    PubMed

    Salva, S; Borgatta, B; Rello, J

    2014-04-01

    Pneumonia's burden is still important worldwide not only because of its high incidence and mortality, but also for the elevated costs related to it. Despite the concerted efforts to reduce the incidence of sepsis-related complications, they continue to represent a major human and economic burden. The cornerstone of sepsis management is early appropriate empiric broad spectrum antibiotics, resuscitation, and source control. The association between inappropriate use of antibiotics and increased mortality is the rationale for the use of empiric antibiotic combination therapy in critically ill patients. The aim of this manuscript was to discuss recent literature regarding the management of severe pneumonia, both community-acquired and hospital-acquired/ventilator-associated, in critically ill patients. Use of combination therapy is warranted in severe infections with shock; considerations should be made on the importance of optimal antibiotic administration and adverse reactions, thus providing guidance for a rational use of antibiotics.

  19. [Combined treatment of palmoplantar syndrome in patients under antitumor therapy].

    PubMed

    Kruglova, L S; Shatokhina, E A; Elfimov, M A; Illarionov, V E; Chervinskaya, A V; Portnov, V V; Filatova, E V; Petrova, M S

    2016-01-01

    Observation covered 12 patients under various antitumor medications. Group 1 was formed of patients with developed palmoplantar syndrome varying in severity, who received complex treatment including IR-therapy and local antioxidant medication. Group 2 included patients without palmoplantar syndrome, who received preventive treatment with IR-therapy. All patients of group 1 demonstrated lower severity of palmoplantar syndrome manifestations. In group 2, 80% of the patients avoided palmoplantar syndrome development, and 20% of the patients had light course of the syndrome manifestations. Patients at high risk of palmoplantar syndrome under antitumor therapy are recommended to undergo IR-therapy and local antioxidant medication.

  20. Individualising Anticoagulant Therapy in Atrial Fibrillation Patients

    PubMed Central

    2016-01-01

    Non-vitamin K antagonist (VKA) oral anticoagulants (NOACs) have emerged as alternatives to VKAs for the prevention of stroke in patients with non-valvular atrial fibrillation. Four NOACS: dabigatran, apixaban, rivaroxaban and edoxaban, have received regulatory approval in Europe from the European Medicines Agency. Numerous factors can influence the decision to prescribe a NOAC, the most important of which are assessment of stroke and bleeding risks. Given the variation in design of the pivotal phase III clinical trials investigating the efficacy and safety of NOACs, and in the absence of head-to-head comparative data, it is impossible to recommend one NOAC over the other. However, NOACS offer the opportunity for individualised therapy based on factors such as renal function, age or patient/doctor preference for once- or twice-daily dosing regimens. Dose reduction of some NOACS should be considered in at-risk patient populations. PMID:27617088

  1. Is a fetus a non-consenting patient?

    PubMed Central

    Koren, Gideon; Selby, Peter; Kapur, Bhushan

    2004-01-01

    QUESTION: In the 1960s, Dr Cameron, a Montreal, Que, psychiatrist, experimented with drug-induced sleep and electroconvulsive therapy for psychiatric patients, believing that this method "wipes them clean of harmful memories." In 1992 the government of Canada settled lawsuits by former patients of Dr Cameron, awarding them large payments. The government rejected a similar claim by Lloyd Schrier, whose mother had been treated by Dr Cameron while she was carrying Lloyd, arguing that Lloyd was not Cameron's patient. Or was he? ANSWER: The fetus was exposed to the medications taken by his mother, (eg, barbiturates) and thus qualifies as an unconsenting patient. PMID:15508369

  2. Evolving applications of light therapy.

    PubMed

    Terman, Michael

    2007-12-01

    The psychiatric intervention, light therapy, grew from an intensive 25-year research focus on seasonal affective disorder (SAD). Dosing and timing strategies have been honed to optimize the antidepressant effect, and efficacy relative to placebo has provided the evidence base for widespread implementation. A persistent question has been whether the model system for SAD has wider utility for psychiatric disturbance, even beyond depression. The circadian phase-shifting capacity of timed light exposure is universal, and chronobiological factors are at play across the disease spectrum. Recent promising initiatives extend to light treatment for nonseasonal major depressive disorder and bipolar depression, including drug- and electroconvulsive therapy-resistant cases. With light therapy, patients with antepartum depression may find an alternative to medication during pregnancy. Cognitive improvement under light therapy has been noted in adult attention deficit hyperactivity disorder. Motor function in Parkinson's disease has improved in parallel with the antidepressant effect of light therapy. The rest-activity disturbance of elderly dementia has been partially allayed under light therapy. In a new initiative, three major chronotherapeutic inventions-light therapy, sleep deprivation (wake therapy) and sleep time displacement (sleep phase advance therapy) are being combined to snap hospitalized patients out of deep depression and maintain long-term improvement.

  3. Modified sequential therapy vs quadruple therapy as initial therapy in patients with Helicobacter infection

    PubMed Central

    Liao, Xiao-Min; Nong, Gao-Hui; Chen, Mei-Zu; Huang, Xue-Ping; Cong, Yun-Yan; Huang, Yi-Ying; Wu, Bai-He; Wei, Jin-Qi

    2015-01-01

    AIM: To evaluate the efficacy and safety of modified sequential therapy and to compare modified sequential therapy with standard quadruple therapy for Helicobacter pylori (H. pylori) eradication. METHODS: In total, 200 consecutive patients who were diagnosed with H. pylori-infected chronic gastritis by electronic endoscopy and rapid urease testing from December 2012 to October 2013 were enrolled in this study. The patients had not previously received H. pylori eradication treatment, and were randomized into two groups. The patients in Group A (n = 101) were treated with ilaprazole + bismuth potassium citrate + amoxicillin and clavulanate potassium + levofloxacin, and the patients in Group B (n = 99) were administered a modified sequential therapy composed of ilaprazole at 5 mg bid and amoxicillin and clavulanate potassium at 914 mg for the first five days followed by ilaprazole at 5 mg bid, furazolidone at 100 mg bid and levofloxacin at 500 mg qid for the next five days. Four to six weeks after the end of treatment, a 14C-urea breath test was performed for all the subjects to confirm the eradication of H. pylori. The intention-to-treat and per-protocol eradication rates were determined. RESULTS: A total of 190 of the 200 patients completed the study. All 200 patients were included in the intention-to-treat analysis, whereas 190 patients were included in the per-protocol analysis. In the intention-to-treat analysis, the rates of H. pylori eradication in Groups A and B were 85.15% (86/101) and 81.82% (81/99), respectively. In the per-protocol analysis, the H. pylori eradication rates in Groups A and B were 88.66% (86/97) and 87.09% (81/93), respectively. No significant difference was observed (χ2 = 0.109, P = 0.741) in the eradication rate between Groups A and B. The rates of adverse effects observed in the groups were similar at 6.19% (6/97) for Group A and 7.53% (7/93) for Group B (P > 0.05). No mortality or major morbidities were observed in any of the patients

  4. Post-stroke depression therapy: where are we now?

    PubMed

    Nabavi, Seyed Fazel; Turner, Alyna; Dean, Olivia; Sureda, Antoni; Mohammad, Seyed

    2014-01-01

    Post-stroke depression is an important psychological consequence of ischemic stroke, and affects around one third of stroke patients at any time post-stroke. It has a negative impact on patient morbidity and mortality, and as such development of effective post-stroke recognition and treatment strategies are very important. There are several therapeutic strategies for post-stroke depression, including both pharmacological and non-pharmacological approaches. In this review, we present evidence regarding the underlying biology of post-stroke depression, commonalities between post-stroke depression and Major Depressive Disorder and explore several treatment approaches, including antidepressant therapy, psychotherapy, surgical therapy, electroconvulsive therapy, acupuncture, music therapy and natural products. Further experimental and clinical studies are required, particularly in emerging fields such as the role of nutraceuticals in the treatment of stroke.

  5. Evaluating older patients with diabetes for insulin pump therapy.

    PubMed

    Stephens, Elizabeth A; Heffner, John

    2010-06-01

    The increasing prevalence of diabetes among elderly patients underscores the importance of matching the most effective therapy for diabetes self-management with patients' cognitive and motor skills, as these diminish with advancing age. Although many geriatric patients state interest in insulin pump therapy for tight glycemic control, few studies have examined the effectiveness, safety, and feasibility of insulin pumps compared to traditional injected insulin therapy in older age groups. It is important, therefore, for physicians to recognize the indications and the age-related barriers to insulin pump therapy in geriatric patients. Indications include glucose variability, hypoglycemia, and poor glycemic control with traditional insulin regimens. Common barriers include poor vision, dexterity, and cognitive status. Successful implementation of insulin pump therapy for older patients requires an experienced diabetes management team that can assess patient needs and tailor therapy in the context of age-related disabilities.

  6. [Daptomycin therapy in patients with bacteremia].

    PubMed

    Llinares, Pedro; Iribarren, José Antonio

    2012-02-01

    Community-acquired bacteremias assciated with healthcare and, especially, those of nosocomial origin, are mainly caused by Gram-positive microorganisms. Notable among this group are Staphylococcus spp, with an incidence of methicillin resistance of approximately 30% in S. aureus and of 70% in coagulase-negative staphylococcus, which is higher in patients admitted to intensive care units. Vancomycin has been the most widely used antibiotic in these situations but its toxicity, especially in the kidney, and reports of failure when used for the treatment of methicillin-resistant S. aureus (MRSA) and with a vancomycin MIC > 1 mg/L have led to the search for other treatments. Daptomycin is a new lipopeptide antibiotic that has been shown to be not inferior to vancomycin in a pivotal clinical trial in patients with bacteremia and right endocarditis due to S. aureus. Recent guidelines and consensus documents place daptomycin as an ideal alternative in these situations, indicating its use in MRSA bacteremia with a vancomycin MIC > 1 mg/L, as well as in patients whose renal dysfunction excludes the use of vancomycin therapy. Evidence of worse prognosis in MRSA bacteremia when empirical treatment is inappropriate has led to the recommendation of daptomycin as the first-choice drug in critically ill patients with suspected Gram-positive bacteremic infection and renal dysfunction and/or in hospitals where there is a high prevalence of MRSA with a MIC > 1 mg/L. The recommended dose in severely ill patients should be higher than 6 mg/kg/day.

  7. Optimizing antimicrobial therapy in critically ill patients

    PubMed Central

    Vitrat, Virginie; Hautefeuille, Serge; Janssen, Cécile; Bougon, David; Sirodot, Michel; Pagani, Leonardo

    2014-01-01

    Critically ill patients with infection in the intensive care unit (ICU) would certainly benefit from timely bacterial identification and effective antimicrobial treatment. Diagnostic techniques have clearly improved in the last years and allow earlier identification of bacterial strains in some cases, but these techniques are still quite expensive and not readily available in all institutions. Moreover, the ever increasing rates of resistance to antimicrobials, especially in Gram-negative pathogens, are threatening the outcome for such patients because of the lack of effective medical treatment; ICU physicians are therefore resorting to combination therapies to overcome resistance, with the direct consequence of promoting further resistance. A more appropriate use of available antimicrobials in the ICU should be pursued, and adjustments in doses and dosing through pharmacokinetics and pharmacodynamics have recently shown promising results in improving outcomes and reducing antimicrobial resistance. The aim of multidisciplinary antimicrobial stewardship programs is to improve antimicrobial prescription, and in this review we analyze the available experiences of such programs carried out in ICUs, with emphasis on results, challenges, and pitfalls. Any effective intervention aimed at improving antibiotic usage in ICUs must be brought about at the present time; otherwise, we will face the challenge of intractable infections in critically ill patients in the near future. PMID:25349478

  8. Physicians' attitudes toward patients' use of alternative cancer therapies.

    PubMed Central

    Bourgeault, I L

    1996-01-01

    OBJECTIVES: To determine physicians' attitudes and reactions to their patients' use of alternative cancer therapies, factors that affect these reactions and physicians' views of how the use of such therapies affects the physician-patient relationship. DESIGN: Qualitative study involving in-depth semistructured interviews. SETTING: Toronto. PARTICIPANTS: Nineteen oncologists and 35 general practitioners (GPs) were selected by means of purposive sampling; 18 oncologists and 12 GPs agreed to participate. OUTCOME MEASURES: Attitudes and reactions to patients' use of alternative cancer therapies; factors affecting physicians' reactions to such use; and physicians' views of how the use of such therapies affects the physician-patient relationship. RESULTS: Many physicians perceived themselves to be unfamiliar with available alternative cancer therapies and indicated that their main sources of information were their patients and the lay press. Although most of the physicians viewed the efficacy of such therapies as scientifically unproven, they would respect their patients' decision to use them and encourage them to continue with standard treatment. Factors found to influence the physicians' reactions included the prognosis with standard treatments, the exclusivity of the use of alternative therapies and whether the alternative therapies were harmful. Although many of the participants felt that a patient's use of alternative cancer therapies did not affect the physician-patient relationship, a few indicated that it did cause some tension. CONCLUSION: Because many physicians lack information on alternative cancer therapies and most of these therapies have not been scientifically proven, physicians' attitudes and reactions to their use by patients are influenced to a greater degree by the efficacy or inefficacy of standard treatment and the invasiveness of the alternative therapy than by the efficacy of the alternative therapy used. PMID:8976333

  9. Anticoagulation therapy for a LVAD patient with acquired warfarin resistance.

    PubMed

    Yoshioka, Daisuke; Toda, Koichi; Hidaka, Takayuki; Yasuda, Soichiro; Saito, Shunsuke; Domae, Keitaro; Sawa, Yoshiki

    2017-03-27

    Anticoagulation therapy with warfarin is essential for postoperative management in patients with left ventricular assist device (LVAD). In this manuscript, we report the case of a patient who developed warfarin resistance after LVAD implantation. Although we administered a novel anticoagulant drug in addition to warfarin and aspirin therapy, the patient developed a major stroke. The patient needed continuous intravenous heparinization until heart transplantation for approximately 2 years. Meticulous management of anticoagulation therapy is essential for a LVAD with warfarin resistance. To our best knowledge, our case is the first case of warfarin resistance in a patient with LVAD.

  10. Efficacy of Mirror Therapy Containing Functional Tasks in Poststroke Patients

    PubMed Central

    2016-01-01

    Objective To investigate the effect of mirror therapy containing functional tasks on upper extremity function and activities of daily living in patients with subacute stroke. Methods The subjects were randomly divided into two groups: the mirror therapy group (30 patients) and the sham therapy group (30 patients). The mirror therapy group underwent a mirror therapy program together with conventional therapy for 20 minutes per day on 5 days per week for 4 weeks. The control group received a sham conventional therapy program under the same schedule as the mirror therapy group. The Fugl-Meyer Motor Function Assessment (FMA), Brunnstrom motor recovery stage, and Modified Barthel Index (MBI) were evaluated 4 weeks after the treatment. Results The upper extremity function on the affected side and ability to perform daily life activities after the intervention were significantly improved in both groups. After 4 weeks of intervention, improvements in the FMA (p=0.027) and MBI (p=0.041) were significantly greater in the mirror therapy group than the sham therapy group. Conclusion In this study, we found that the mirror therapy containing functional task was effective in terms of improving the upper extremity functions and activities of daily living in patients with subacute stroke. PMID:27606269

  11. Current perspectives on dental patients receiving coumarin anticoagulant therapy.

    PubMed

    Herman, W W; Konzelman, J L; Sutley, S H

    1997-03-01

    Despite approximately 40 years of experience with oral anticoagulant drugs, controversy still exists about the safety of dental treatment in a patient receiving this therapy. The authors review the topic in depth and offer detailed recommendations for the dental management of patients receiving coumarin anticoagulant therapy.

  12. Evaluation of patient satisfaction with physical therapy following primary THA.

    PubMed

    Issa, Kimona; Naziri, Qais; Johnson, Aaron J; Memon, Talha; Dattilo, Jonathan; Harwin, Steven F; Mont, Michael A

    2013-05-01

    Physical therapy following total hip arthroplasty (THA) is intended to maximize a patient's range of motion and function and improve the quality of life. No universally accepted standard of care exists for physical therapy among physicians or therapists. However, it may be crucial to enhance efforts to more fully elucidate contributing parameters that affect patient experiences. The purpose of this study was to evaluate various factors contributing to patient satisfaction with postoperative physical therapy. One hundred consecutive patients (110 hips) who underwent THA were prospectively surveyed for satisfaction with postoperative physical therapy. All surveys were filled out anonymously by the patients, and investigators were blinded to clinical outcomes and who was surveyed. Seventy-six percent of patients reported being satisfied with their rehabilitation experiences. Factors, including patient age and sex, duration of therapy, number of patients per session, continuity of care with the same therapist, amount of hands-on time spent with the therapist, number of patients per session, and total number of sessions completed, were significantly correlated with patient satisfaction. Co-pay amount did not significantly affect patient satisfaction. These factors may be underappreciated by physicians and physical therapists. To maximize patient satisfaction with physical therapy, physicians should identify institutions whose therapists are willing to spend adequate hands-on time during one-on-one or small-group sessions while maintaining the greatest possible continuity of care with a single provider.

  13. Three patients with mood disorders showing catatonia and frontotemporal lobes atrophy.

    PubMed

    Utumi, Yushi; Iseki, Eizo; Arai, Heii

    2013-12-01

    Here we report the cases of three patients with mood disorders showing catatonia and frontotemporal lobe atrophy. Catatonia is a syndrome linked to frontal dysfunction that most frequently occurs in patients with mood disorders. The diagnostic criteria of catatonia and frontotemporal dementia partly overlap. In the present patients, catatonia might be closely related to frontal dysfunction caused by frontotemporal lobe atrophy. With regard to therapeutics for catatonia, we found that administering a low dose of lorazepam alone or after electroconvulsive therapy may be useful for treating and preventing catatonia. We also found that administering glutaminate antagonists such as memantine may be useful for treating lorazepam-resistant catatonia.

  14. Cancer patients' interest and preferences for music therapy.

    PubMed

    Burns, Debra S; Sledge, Renata B; Fuller, Leigh Ann; Daggy, Joanne K; Monahan, Patrick O

    2005-01-01

    The reason for lack of routine integration of music therapy into healthcare may be that patients are not comfortable being involved in a music therapy intervention. Therefore, the goal of this study was to examine cancer patients' interest in and preferences for using 2 types of music therapy interventions, music-making and music listening. Sixty-five patients completed the Music Interest Survey in addition to standardized measures of coping, affect, anxiety, and fatigue. Results suggest adult cancer patients are interested in music therapy, especially music listening. Patient interest and preference were associated with negative affect, anxiety, age, perceived intervention-specific benefits, barriers, and self-efficacy. Findings highlight the need for a comprehensive assessment of patient needs and preferences prior to intervention.

  15. Occupational Therapy and Physiotherapy in Acute Stroke: Do Rural Patients Receive Less Therapy?

    PubMed Central

    Ashby, Samantha

    2016-01-01

    Objective. To assess whether acute stroke patients in rural hospitals receive less occupational therapy and physiotherapy than those in metropolitan hospitals. Design. Retrospective case-control study of health data in patients ≤10 days after stroke. Setting. Occupational therapy and physiotherapy services in four rural hospitals and one metropolitan hospital. Participants. Acute stroke patients admitted in one health district. Main Outcome Measures. Frequency and duration of face-to-face and indirect therapy sessions. Results. Rural hospitals admitted 363 patients and metropolitan hospital admitted 378 patients. Mean age was 73 years. Those in rural hospitals received more face-to-face (p > 0.0014) and indirect (p = 0.001) occupational therapy when compared to those in the metropolitan hospital. Face-to-face sessions lasted longer (p = 0.001). Patients admitted to the metropolitan hospital received more face-to-face (p > 0.000) and indirect (p > 0.000) physiotherapy when compared to those admitted to rural hospitals. Face-to-face sessions were shorter (p > 0.000). Almost all were seen within 24 hours of referral. Conclusions. Acute stroke patients in Australian rural hospital may receive more occupational therapy and less physiotherapy than those in metropolitan hospitals. The dose of therapy was lower than recommended, and the referral process may unnecessarily delay the time from admission to a patient's first therapy session. PMID:27752389

  16. [Shock therapy and psychosurgery in the early German Democratic Republic (GDR)].

    PubMed

    Rzesnitzek, L

    2015-11-01

    Patient files, textbooks and published articles of the time show that the wide range of psychiatric therapies of the 1950s and 1960s was also used in the early German Democratic Republic (GDR). The use of insulin coma therapy, cardiazol and electroconvulsive therapies and especially of leucotomy in the GDR must not only be seen in the context of the international development and debate concerning these therapies up to the introduction of psychopharmaceutic therapy but also, in a similar way as in the Federal Republic of Germany, in relation to the locally sometimes different availability of insulin and cardiazol in the post-war period, different schools of academic thought and scientific research interest and priorities of the clinics concerned.

  17. Hippocampal Neurogenesis and Antidepressive Therapy: Shocking Relations

    PubMed Central

    Rotheneichner, Peter; Lange, Simona; O'Sullivan, Anna; Marschallinger, Julia; Zaunmair, Pia; Geretsegger, Christian; Aigner, Ludwig

    2014-01-01

    Speculations on the involvement of hippocampal neurogenesis, a form of neuronal plasticity, in the aetiology of depression and the mode of action of antidepressive therapies, started to arise more than a decade ago. But still, conclusive evidence that adult neurogenesis contributes to antidepressive effects of pharmacological and physical therapies has not been generated yet. This review revisits recent findings on the close relation between the mode(s) of action of electroconvulsive therapy (ECT), a powerful intervention used as second-line treatment of major depression disorders, and the neurogenic response to ECT. Following application of electroconvulsive shocks, intricate interactions between neurogenesis, angiogenesis, and microglia activation, the hypothalamic-pituitary-adrenal axis and the secretion of neurotrophic factors have been documented. Furthermore, considering the fact that neurogenesis strongly diminishes along aging, we investigated the response to electroconvulsive shocks in young as well as in aged cohorts of mice. PMID:24967107

  18. Combined aspirin and anticoagulant therapy in patients with atrial fibrillation.

    PubMed

    So, Charlotte H; Eckman, Mark H

    2017-01-01

    The combined use of aspirin and oral anticoagulant therapy in patients with atrial fibrillation (AF) and stable coronary artery disease (CAD) has been questioned due to an increased risk of major bleeding with little to no benefit in preventing ischemic events. (1) To better understand patterns and indications for combined antiplatelet and anticoagulant therapy and identify patients who might reasonably be treated with oral anticoagulant (OAC) therapy alone. (2) To perform an updated literature review regarding the use of combined antiplatelet and OAC therapy in patients with AF and stable CAD. Retrospective review. Patients within the University of Cincinnati Health System with a diagnosis of non-valvular AF, excluding those with acute coronary syndrome or revascularization within the last 12 months. Numbers and indications for combined antiplatelet and anticoagulant therapy and sequence of events leading to the initiation of each. Of 948 patients receiving OAC, 430 (45 %) were receiving concomitant OAC and aspirin. Among patients receiving combined antiplatelet and anticoagulant therapy, 49 and 42 % of patients respectively, had CAD or DM. In a more detailed analysis including chart review of 219 patients receiving combined OAC and aspirin, 27 % had a diagnosis of CAD and 14 % had a diagnosis of DM prior to the development of AF. These patients were initially treated with aspirin. Warfarin was added when they subsequently developed AF but aspirin wasn't discontinued. A surprisingly large proportion of patients (22.8 %) had no obvious indication for dual therapy. Prior myocardial infarction, CAD, vascular disease and DM (among others) increase the likelihood of receiving combined antiplatelet and anticoagulant therapy among patients with AF. A literature review suggests this may lead to increased major bleeding with little benefit in decreasing either AF-related stroke or cardiovascular events.

  19. CAM therapies among primary care patients using opioid therapy for chronic pain

    PubMed Central

    Fleming, Sara; Rabago, David P; Mundt, Marlon P; Fleming, Michael F

    2007-01-01

    Background Complementary and alternative medicine (CAM) is an increasingly common therapy used to treat chronic pain syndromes. However; there is limited information on the utilization and efficacy of CAM therapy in primary care patients receiving long-term opioid therapy. Method A survey of CAM therapy was conducted with a systematic sample of 908 primary care patients receiving opioids as a primary treatment method for chronic pain. Subjects completed a questionnaire designed to assess utilization, efficacy and costs of CAM therapies in this population. Results Patients were treated for a variety of pain problems including low back pain (38.4%), headaches (9.9%), and knee pain (6.5%); the average duration of pain was 16 years. The median morphine equivalent opioid dose was 41 mg/day, and the mean dose was 92 mg/day. Forty-four percent of the sample reported CAM therapy use in the past 12 months. Therapies utilized included massage therapy (27.3%, n = 248), chiropractic treatment (17.8%, n = 162), acupuncture (7.6%, n = 69), yoga (6.1%, n = 55), herbs and supplements (6.8%, n = 62), and prolotherapy (5.9%, n = 54). CAM utilization was significantly related to age female gender, pain severity income pain diagnosis of neck and upper back pain, and illicit drug use. Medical insurance covered chiropractic treatment (81.8%) and prolotherapy (87.7%), whereas patients primarily paid for other CAM therapies. Over half the sample reported that one or more of the CAM therapies were helpful. Conclusion This study suggests CAM therapy is widely used by patients receiving opioids for chronic pain. Whether opioids can be reduced by introducing such therapies remains to be studied. PMID:17506893

  20. Gerson Therapy (PDQ®)—Patient Version

    Cancer.gov

    Expert-reviewed information summary about the use of the Gerson therapy as a treatment for people with cancer. Note: The information in this summary is no longer being updated and is provided for reference purposes only.

  1. [Snoezelen and animal-assisted therapy in dementia patients].

    PubMed

    Javelot, Hervé; Antoine-Bernard, Emilie; Garat, Jennifer; Javelot, Thierry; Weiner, Luisa; Mervelay, Véroníque

    2012-01-01

    A number of non medication-based methods of nursing care for geriatric patients have been developed over recent decades to treat non cognitive symptoms associated with dementia. Among these, Snoezelen rooms for multisensory behavioural therapy and animal-assisted therapy emerge as innovative strategies which could potentially complement other more frequently developed methods such as physical activity.

  2. [Intensive therapy for patients with Guillian-Barré syndrome].

    PubMed

    Buus, Lone; Tønnesen, Else K

    2014-10-13

    Guillain-Barré syndrome is the leading cause of acute flaccid paralysis in the industrialized world. Approximately 25% of the patients suffering from Guillain-Barré syndrome develop respiratory failure requiring mechanical ventilation and intensive therapy. We seek answers to when it is optimal to start respiratory supportive therapy and review various complications associated with Guillain-Barré syndrome.

  3. Exercise in Treating Hypertension: Tailoring Therapies for Active Patients.

    ERIC Educational Resources Information Center

    Chintanadilok, Jirayos

    2002-01-01

    Exercise can be definitive therapy for some, and adjunctive therapy for many, people with hypertension, though people with secondary hypertension may not derive as much benefit. Low-to- moderate-intensity aerobic exercise can help with mild hypertension and reduce drug dosages in more severe cases. For active patients requiring medication,…

  4. [Post-operative pain therapy of a chronic pain patient].

    PubMed

    Pawlik, Michael T; Ittner, Karl Peter

    2006-11-01

    Post-operative pain therapy of chronic pain patients poses a challenge. Here we report the perioperative management of a 39-year-old male under chronic therapy with oxycodon, gabapentin and tolperison. Particular the pharmacointeractions regarding premedication and postoperative dose finding of opioids with intravenous PCIA are discussed.

  5. New Therapies Offer Valuable Options for Patients with Melanoma

    Cancer.gov

    Two phase III clinical trials of new therapies for patients with metastatic melanoma presented in June at the 2011 ASCO conference confirmed that vemurafenib and ipilimumab (Yervoy™) offer valuable new options for the disease.

  6. Gestalt Therapy with the Dying Patient: Integrative Work Using Clay, Poetry Therapy, and Creative Media.

    ERIC Educational Resources Information Center

    Petzold, Hilarion G.

    1982-01-01

    Reports the use of death therapy with a cancer patient. Gestalt therapy and creative media were used to facilitate an integration of life and a sense of balance with life. Suggests that counseling the dying means walking along a stretch of the path together. (Author)

  7. Effects of thermal therapy combining sauna therapy and underwater exercise in patients with fibromyalgia.

    PubMed

    Matsumoto, Shuji; Shimodozono, Megumi; Etoh, Seiji; Miyata, Ryuji; Kawahira, Kazumi

    2011-08-01

    Fibromyalgia syndrome (FMS) is a chronic disorder that is characterized by widespread pain with localized tenderness. We aimed to investigate whether thermal therapy combining sauna therapy and underwater exercise improved pain, symptoms, and quality of life (QOL) in FMS patients. Forty-four female FMS patients who fulfilled the American College of Rheumatology (ACR) criteria received 12-week thermal therapy program comprising sauna therapy once daily for 3 days/week and underwater exercise once daily for 2 days/week. Pain, symptoms, and QOL were assessed using a pain visual analog scale (VAS), a fibromyalgia impact questionnaire (FIQ), and a short form 36-item questionnaire (SF-36), respectively. All of the patients reported significant reductions in pain and symptoms of 31-77% after the 12-week thermal therapy program, which remained relatively stable (28-68%) during the 6-month follow-up period (that is, the thermal therapy program improved both the short-term and the long-term VAS and FIQ scores). Improvements were also observed in the SF-36 score. Thermal therapy combining sauna therapy and underwater exercise improved the QOL as well as the pain and symptoms of FMS patients.

  8. Augmentative Asenapine in a Recurrent Manic Catatonic Patient with Partial Response to Clozapine

    PubMed Central

    Buoli, Massimiliano; Dobrea, Cristina; Caldiroli, Alice; Cremaschi, Laura; Altamura, A. Carlo

    2013-01-01

    Catatonia is a severe but treatable neuropsychiatric syndrome known since the middle of the nineteenth century. It has been considered for a long time as a subtype of schizophrenia, even though this association occurs only in 10% of cases. In contrast, it is frequently observed in bipolar patients. First-line treatment consists of benzodiazepines, while in case of resistance electroconvulsive therapy (ECT) and clozapine have shown positive results. In addition, recent studies reported the efficacy of some atypical antipsychotics. The present case shows the clinical response to augmentative asenapine in a catatonic manic patient with a partial response to clozapine. PMID:24171130

  9. Persistent genital arousal disorder: confluent patient history of agitated depression, paroxetine cessation, and a tarlov cyst.

    PubMed

    Eibye, Simone; Jensen, Hans Mørch

    2014-01-01

    We report a case of a woman suffering from persistent genital arousal disorder (PGAD) after paroxetine cessation. She was admitted to a psychiatric department and diagnosed with agitated depression. Physical investigation showed no gynaecological or neurological explanation; however, a pelvic MRI scan revealed a Tarlov cyst. Size and placement of the cyst could not explain the patient's symptoms; thus neurosurgical approach would not be helpful. Her depression was treated with antidepressant with little effect. Electroconvulsive therapy improved the patient's symptoms though they did not fully resolve. More awareness of PGAD and thorough interdisciplinary conferences are necessary to insure an unequivocal treatment strategy.

  10. Persistent Genital Arousal Disorder: Confluent Patient History of Agitated Depression, Paroxetine Cessation, and a Tarlov Cyst

    PubMed Central

    Jensen, Hans Mørch

    2014-01-01

    We report a case of a woman suffering from persistent genital arousal disorder (PGAD) after paroxetine cessation. She was admitted to a psychiatric department and diagnosed with agitated depression. Physical investigation showed no gynaecological or neurological explanation; however, a pelvic MRI scan revealed a Tarlov cyst. Size and placement of the cyst could not explain the patient's symptoms; thus neurosurgical approach would not be helpful. Her depression was treated with antidepressant with little effect. Electroconvulsive therapy improved the patient's symptoms though they did not fully resolve. More awareness of PGAD and thorough interdisciplinary conferences are necessary to insure an unequivocal treatment strategy. PMID:25525548

  11. Patient experience of computerised therapy for depression in primary care

    PubMed Central

    Knowles, Sarah E; Lovell, Karina; Bower, Peter; Gilbody, Simon; Littlewood, Elizabeth; Lester, Helen

    2015-01-01

    Objective To explore patient experience of computerised cognitive behaviour therapy (cCBT) for depression in a pragmatic randomised controlled trial (Randomised Evaluation of the Effectiveness and Acceptability of Computerised Therapy, REEACT). Design Qualitative semistructured interviews with 36 participants. Participants Depressed patients with a Patient Health Questionnaire 9 of 10 or above recruited into the REEACT randomised controlled trial. Setting Primary care settings in England. Results Participant experience was on a continuum, with some patients unable or unwilling to accept psychological therapy without interpersonal contact while others appreciated the enhanced anonymity and flexibility of cCBT. The majority of patients were ambivalent, recognising the potential benefits offered by cCBT but struggling with challenges posed by the severity of their illness, lack of support and limited personalisation of programme content. Low completion rates were commonly reported, although more positive patients reported greater engagement. Both positive and ambivalent patients perceived a need for monitoring or follow-up to support completion, while negative patients reported deliberate non-adherence due to dissatisfaction with the programme. Patients also reported that severity of depression impacted on engagement, and viewed cCBT as unsuitable for patients undergoing more severe depressive episodes. Conclusions The study demonstrates both the unique demands and benefits of computerised therapy. cCBT was preferred by some patients and rejected by others, but the majority of patients were ambivalent about the therapy. cCBT could be offered within a menu of options in stepped care if matched appropriately to individual patients or could be offered with enhanced support to appeal to a greater number of patients. Trial registration number ISRCTN91947481. PMID:26621513

  12. Music therapy: a novel motivational approach for dually diagnosed patients.

    PubMed

    Ross, Stephen; Cidambi, Indra; Dermatis, Helen; Weinstein, Jason; Ziedonis, Douglas; Roth, Serena; Galanter, Marc

    2008-01-01

    Co-occurring mental illness and addiction is very common and results in worse treatment outcomes compared to singly diagnosed addicted individuals. Integrated treatment for co-occurring disorders is associated with better treatment outcomes; however there is a wide range of what is included in integrated treatment. Due to patient and staff interests, integrated treatment often includes complementary and alternative therapies, including music and art therapy. There is a need to study how these approaches effect treatment engagement, retention, and outcome. This study was a prospective naturalistic non-randomized pilot study without a control group that sought to evaluate how participation in a music therapy program affected treatment outcomes for individuals with co-occurring mental illness and addiction. In summary, music therapy appears to be a novel motivational tool in a severely impaired inpatient sample of patients with co-occurring disorders. Future studies of music therapy in integrated co-occurring disorder setting should include a control group.

  13. Economic evaluation of resistant major depressive disorder treatment in Iranian population: a comparison between repetitive Transcranial Magnetic Stimulation with electroconvulsive

    PubMed Central

    Ghiasvand, Hesam; Moradi- Joo, Mohammad; Abolhassani, Nazanin; Ravaghi, Hamid; Raygani, Seyed Mansoor; Mohabbat-Bahar, Sahar

    2016-01-01

    Background: It is estimated that major depression disorders constitute 8.2% of years lived with disability (YLDs) globally. The repetitive Transcranial Magnetic Stimulation (rTMS) and Electroconvulsive Therapy (ECT) are two relative common interventions to treat major depressive disorders, especially for treatment resistant depression. In this study the cost- effectiveness and cost-utility of rTMS were compared with ECT in Iranian population suffering from major depressive disorder using a decision tree model. Methods: A decision tree model conducted to compare the cost-effectiveness ratio of rTMS with ECT in a health system prospective and 7 months’ time horizon. The outcome variables were: response rate, remission rate and quality-adjusted life-years (QALYs) of the rTMS and ECT as primary and secondary outcomes extracted from systematic reviews and randomized control trials. The costs were also calculated through a field study in one clinic and one hospital; the direct costs have only been considered. Results: The total cost for rTMS and ECTstrategieswere11015000Rials (373US$) and 11742700 Rials (397.7US$), respectively. Also the rTMS/ECT ratio of costs per improved patients was 1194410Rials (40.5 US$); the ratio for costs per QALYs utility was 21017139 Rials (711.72 US$). The incremental cost- effectiveness ratio of rTMS versus ECT was 1194410 Rials (40.44 US$) after treatment and maintenance courses. Conclusion: Given the current prevalence of depressive disorders in Iranian population, the ECT is more cost-effective than TMS. The sensitivity analysis showed that if the prevalence of major depressive disorders declines to below 5% or the costs of rTMS decrease (rTMS provided by public sector), then the rTMS becomes more cost-effective compared with ECT. However, efficacy of rTMS depends on the frequency of pulsed magnetic field, the location of rTMS on the head, the number of therapeutic sessions and the length of each session. PMID:27390700

  14. Outpatient antibiotic therapy for elderly patients. HIAT Study Group.

    PubMed

    Angel, J V

    1994-08-15

    The purpose of this study was to determine the safety and efficacy of outpatient intravenous (IV) therapy with a third-generation cephalosporin, cefotaxime, in patients > or = 60 years of age and to determine its effect on length of hospital stay. Subset analysis was performed with 62 patients with various infections who had been enrolled in a prospective, multicenter, open-label trial of IV cefotaxime delivered through a computerized ambulatory delivery system (ADS). Initial treatment was given in hospital if required, followed by home therapy. The overall clinical response rate among evaluable patients was 98%, and the overall bacteriologic response rate was 93%. The mean duration of inpatient therapy was 3.6 days less than the mean of 8.2 days allowed under diagnosis-related group (DRG) allotments. Outpatient therapy with cefotaxime via infusion pump is safe and effective and may reduce hospitalization requirements.

  15. Patients With Brain Tumors: Who Receives Postacute Occupational Therapy Services?

    PubMed

    Chan, Vincy; Xiong, Chen; Colantonio, Angela

    2015-01-01

    Data on the utilization of occupational therapy among patients with brain tumors have been limited to those with malignant tumors and small samples of patients outside North America in specialized palliative care settings. We built on this research by examining the characteristics of patients with brain tumors who received postacute occupational therapy services in Ontario, Canada, using health care administrative data. Between fiscal years 2004-2005 and 2008-2009, 3,199 patients with brain tumors received occupational therapy services in the home care setting after hospital discharge; 12.4% had benign brain tumors, 78.2% had malignant brain tumors, and 9.4% had unspecified brain tumors. However, patients with benign brain tumors were older (mean age=63.3 yr), and a higher percentage were female (65.2%). More than 90% of patients received in-home occupational therapy services. Additional research is needed to examine the significance of these differences and to identify factors that influence access to occupational therapy services in the home care setting.

  16. HIFU therapy for patients with high risk prostate cancer

    NASA Astrophysics Data System (ADS)

    Solovov, V. A.; Vozdvizhenskiy, M. O.; Matysh, Y. S.

    2017-03-01

    Objectives. Patients with high-risk prostate cancer undergoing radical prostatectomy, external beam radiation therapy (EBRT) combined with androgen deprivation therapy (ADT) or ADT alone. The widely accepted definition of high-risk prostate was first proposed by D'Amico based on a pretreatment Gleason score of ≥8, clinical stage T3, PSA level ≥20 ng/mL. There is no trial that compares traditional methods of treatment of such patients with HIFU therapy. Here we explored the effectiveness of the HIFU in multimodal treatment for patients with high risk prostate cancer. Materials & Methods. 701 patients with high risk prostate cancer were treated in our center between September 2007 and December 2013. Gleason score were 8-10, stage T3N0M0, age 69 (58-86) years, mean PSA before treatment 43.3 (22.1-92.9) ng/ml, mean prostate volume - 59.3 (38-123) cc. 248 patients were treated by HIFU. We compare this group of patients with patients who undertook EBRT: number 196, and ADT: number 257. Mean follow-up time 58 months (6-72). Results. The 5-year overall survival rates in patients after HIFU were 73.8 %, after EBRT - 63.0 % and after ADT - 18.1%. Conclusions. Our experience showed that HIFU therapy in combined treatment were successful for high risk prostate cancer.

  17. Radiation therapy in the management of patients with mesothelioma

    SciTech Connect

    Gordon, W. Jr.; Antman, K.H.; Greenberger, J.S.; Weichselbaum, R.R.; Chaffey, J.T.

    1982-01-01

    The results of radiation therapy in the management of 27 patients with malignant mesothelioma were reviewed. Eight patients were treated with a curative intent combining attempted surgical excision of tumor (thoracic in 6 and peritoneal in 2), aggressive radiation therapy, and combination chemotherapy using an adriamycin-containing regimen. One patient achieved a 2-year disease-free inteval followed by recurrence of tumor above the thoracic irradiation field. This patient was retreated with localized irradiation and is disease-free after 5 years of initial diagnosis. One patient has persistent abdominal disease at 18 months; the other 6 patients suffered local recurrence within 8-13 months of initiation of treatment. Radiation therapy was used in 19 other patients who received 29 courses for palliation of dyspnea, superior vena cava syndrome, dysphagia, or neurological symptoms of brain metastasis. A palliation index was used to determine the effectiveness of irradiation and revealed that relief of symptoms was complete or substantial in 5 treatment courses, moderately effective in 6 courses and inadequate in 18 treatment courses. Adequate palliation strongly correlated with a dose at or above 4,000 rad in 4 weeks. The management of patients with mesothelioma requires new and innovative approaches to increase the effectiveness of radiation therapy and minimize the significant potential combined toxicity of pulmonary irradiation and adriamycin.

  18. Cardiac resynchronization therapy in a patient with amyloid cardiomyopathy.

    PubMed

    Zizek, David; Cvijić, Marta; Zupan, Igor

    2013-06-01

    Cardiac involvement in systemic light chain amyloidosis carries poor prognosis. Amyloid deposition in the myocardium can alter regional left ventricular contraction and cause dyssynchrony. Cardiac resynchronization therapy (CRT) is an effective treatment strategy for patients with advanced heart failure and echocardiographic dyssynchrony. We report a clinical and echocardiographic response of a patient with amyloid cardiomyopathy, treated with a combination of chemotherapy and CRT.

  19. Purpuric herpes zoster in patients in therapy with clopidogrel.

    PubMed

    Veraldi, S; Vaira, F; Nazzaro, G

    2015-08-01

    Clopidogrel is an adenosine diphosphate receptor antagonist used for the prevention of vascular events in patients with atherothrombotic diseases manifested by recent myocardial infarction, ischemic stroke or peripheral arterial disease. Diarrhoea, rash and pruritus are rather common side effects of clopidogrel. Other side effects include epistaxis, nausea, abdominal pain, vomiting, gastritis, gastric and duodenal ulcer. Thrombocytopenia is the most common laboratory abnormality. Leucopenia and neutropenia are rare. We report three cases of purpuric herpes zoster in patients in therapy with clopidogrel. To our knowledge, only one case of haemorrhagic herpes zoster has been published in a patient in therapy with this drug.

  20. Abnormal contingent negative variation in HIV patients receiving antiretroviral therapy

    PubMed Central

    Chao, Linda L.; Cardenas, Valerie A.; Meyerhoff, Dieter J.; Rothlind, Johannes C.; Flenniken, Derek L.; Lindgren, Joselyn A.; Weiner, Michael W.

    2009-01-01

    The contingent negative variation, an event-related potential related to neural activity in the frontal lobe and basal ganglia, neuropsychological tests and structural MRI were used to examine CNS function and structure in HIV-positive patients receiving antiretroviral therapy. Relative to controls, HIV patients had smaller thalamic volume and reduced late contingent negative variation amplitude that correlated with caudal atrophy. Behaviorally, viremic patients were more impaired than virally suppressed patients and controls on neuropsychological measures of psychomotor speed, selective attention and mental flexibility. These results suggest that antiretroviral therapy may not be effective in protecting cortical and subcortical structures against HIV-related neuropathology, regardless of immune function. However, the benefits of antiretroviral therapy on immune function appear to facilitate neurocognitive performance. PMID:14600507

  1. Antiretroviral Therapy for HIV Infection: When to Initiate Therapy, Which Regimen to Use, and How to Monitor Patients on Therapy.

    PubMed

    Johnson, Steven C

    Antiretroviral therapy is recommended for all patients with HIV infection. The benefit of immediate antiretroviral therapy was confirmed by results from the START (Strategic Timing of Antiretroviral Treatment) trial, which showed a 57% reduction in risk for the composite end point of AIDS-related events, serious non-AIDS-related events, or death from any cause with immediate treatment in antiretroviral therapy-naive participants with CD4+ cell counts above 500/µL. Other changes in HIV care include the widespread adoption of integrase strand transfer inhibitor-based regimens. Considerations regarding when to initiate antiretroviral therapy, which initial regimens to use, and appropriate monitoring of individuals taking antiretroviral therapy are discussed. This article summarizes an IAS-USA continuing education webinar presented by Steven C. Johnson, MD, in July 2015.

  2. Emerging therapies for patients with advanced chronic lymphocytic leukaemia.

    PubMed

    Delgado, Julio; Briones, Javier; Sierra, Jorge

    2009-09-01

    Chronic lymphocytic leukaemia is a common lymphoid malignancy with a variable clinical course. While some patients never require treatment or can be managed effectively with palliative chemotherapy, others experience early disease progression and death. The development of new prognostic markers has helped in the identification of patients with high risk disease, even among those diagnosed at early stage. Recent prospective trials have established chemo-immunotherapy combinations as the new standard of care for CLL patients requiring therapy. Unfortunately, patients whose tumour cells have certain genomic aberrations, such as a chromosome 17 deletion, have a disease that is frequently refractory to conventional therapy and should have their treatment tailored accordingly. Younger patients with high risk disease should be referred for allogeneic haematopoietic cell transplantation if they have an appropriate donor. For the remaining high risk patients, a number of new compounds are emerging, which could lead to further improvement in their outcome.

  3. Psychiatric benefits of integrative therapies in patients with cancer.

    PubMed

    Cassileth, Barrie R

    2014-02-01

    Integrative oncology uses non-pharmacological adjuncts to mainstream care to manage physical, emotional, and psychological symptoms experienced by cancer survivors. Depression, anxiety, fatigue and pain are among the common, often burdensome symptoms that can occur in clusters, deplete patient morale, interfere with treatment plans, and hamper recovery. Patients already seek various modalities on their own to address a broad range of problems. Legitimate complementary therapies offered at major cancer institutions improve quality of life, speed recovery, and optimize patient support. They also augment the benefits of psychiatric interventions, due to their ability to increase self-awareness and improve physical and psychological conditioning. Further, these integrated therapies provide lifelong tools and develop skills that patients use well after treatment to develop self-care regimens. The active referral of patients to integrative therapies achieves three important objectives: complementary care is received from therapists experienced in working with cancer patients, visits become part of the medical record, allowing treatment teams to guide individuals in maximizing benefit, and patients are diverted from useless or harmful 'alternatives.' We review the reciprocal physical and psychiatric benefits of exercise, mind-body practices, massage, acupuncture, and music therapy for cancer survivors, and suggest how their use can augment mainstream psychiatric interventions.

  4. Use of animal-assisted therapy with psychiatric patients.

    PubMed

    Rossetti, Jeanette; King, Camille

    2010-11-01

    The use of animal-assisted therapy (AAT) as an adjunct treatment approach in psychiatric settings has received much attention in the literature. This article explores the use of AAT with psychiatric patients. The authors performed a literature review and found that AAT can have a significant effect on the improvement of psychiatric patients' socialization and provides a variety of psychological benefits. Nurses can benefit from learning about the potential benefits of AAT for psychiatric patients.

  5. Gallbladder perforation in a patient on steroid therapy.

    PubMed

    Andrabi, Syed Imran; Ahmad, Jawad; Rathore, Munir A; El-Hakeem, Ahmed A

    2007-08-24

    Gallbladder perforation is a serious clinical condition. A definitive diagnosis is contentious before surgery. We discuss a case where a young patient with Crohn's disease taking oral steroids presented with an acute abdomen. CT scan demonstrated a perforated gallbladder without evidence of gallstones. The patient underwent an emergency cholecystectomy and peritoneal lavage. The history and clinical findings of this patient are reviewed to highlight perforation of the gallbladder in relation to steroid therapy.

  6. [Treating patients on the court-ordered therapy programme].

    PubMed

    Cochez, Florent; Lesueur, Mélanie; Fayet, Marie; Bouchard, Jean-Pierre

    Psychologists and a psychiatrist testify to the clinical condition of people sentenced to socio-judicial supervision with court-ordered therapy. Despite the extension of the indication of the programme, this complex supervision often concerns the perpetrators of intra and/or extra familial sexual abuse. Preventing reoffending through the global treatment of the patient is a major concern both for the doctor-coordinators as well as the doctor and psychologists delivering the therapy.

  7. Proton Beam Therapy for Aged Patients With Hepatocellular Carcinoma

    SciTech Connect

    Hata, Masaharu Tokuuye, Koichi; Sugahara, Shinji; Tohno, Eriko; Nakayama, Hidetsugu; Fukumitsu, Nobuyoshi; Mizumoto, Masashi; Abei, Masato; Shoda, Junichi; Minami, Manabu; Akine, Yasuyuki

    2007-11-01

    Purpose: To investigate the safety and efficacy of proton beam therapy for aged patients with hepatocellular carcinoma (HCC). Methods and Materials: Twenty-one patients aged {>=}80 years with HCC underwent proton beam therapy. At the time of irradiation, patient age ranged from 80 to 85 years (median, 81 years). Hepatic tumors were solitary in 17 patients and multiple in 4. Tumor size ranged from 10 to 135 mm (median, 40 mm) in maximum diameter. Ten, 5, and 6 patients received proton beam irradiation with total doses of 60 Gy in 10 fractions, 66 Gy in 22 fractions, and 70 Gy in 35 fractions, respectively, according to tumor location. Results: All irradiated tumors were controlled during the follow-up period of 6-49 months (median, 16 months). Five patients showed new hepatic tumors outside the irradiated volume, 2-13 months after treatment, and 1 of them also had lung metastasis. The local progression-free and disease-free rates were 100% and 72% at 3 years, respectively. Of 21 patients, 7 died 6-49 months after treatment; 2 patients each died of trauma and old age, and 1 patient each died of HCC, pneumonia, and arrhythmia. The 3-year overall, cause-specific, and disease-free survival rates were 62%, 88%, and 51%, respectively. No therapy-related toxicity of Grade {>=} 3 but thrombocytopenia in 2 patients was observed. Conclusions: Proton beam therapy seems to be tolerable, effective, and safe for aged patients with HCC. It may contribute to prolonged survival due to tumor control.

  8. Reconstructive surgery in immunocompromised patients: evaluation and therapy

    PubMed Central

    Dunda, Sebastian E.; Bozkurt, Ahmet; Pallua, Norbert; Krapohl, Björn Dirk

    2015-01-01

    Background: An increasing number of patients undergoing reconstructive surgery are immunocompromised due to different reasons and different medical treatments. Some of the used immunosuppressive drugs may affect the process of wound healing and thereby, impair the long-term success of surgical treatment. Therefore, this retrospective analysis aimed at the evaluation of the perioperative treatment and surgical outcome of immunocompromised patients undergoing different reconstructive procedures. Methods: A retrospective review was performed of 8 immunocompromised patients with different primary diseases who needed reconstructive surgery: 2 patients with non-Hodgkin lymphoma, 1 patient with an acute myeloid leukemia, 1 patient with colitis ulcerosa, 1 patient with liver cirrhosis, 1 patient with chronic polyarthritis, and 2 patients with malignant melanoma. Results: In 7 of our 8 presented cases, multiple operations with wound debridements have been necessary to optimize the granulation of the wound bed before reconstructive surgery. 3 out of these 7 patients required further operations due to wound dehiscence or necrosis, with 2 of them as a result of increased immunosuppressive therapy. 5 out of 8 patients needed no further surgical treatment. Conclusions: Both the perioperative drug therapy and the reconstructive surgery concept need to be determined carefully in each individual case of the immunocompromised patients. Thus, the appropriate point in time of operation to achieve the best possible wound healing as well as the complexity of the procedure will require the consideration of a ‘less is more’ strategy in selected cases. PMID:26734539

  9. Effect of hope therapy on the hope of diabetic patients

    PubMed Central

    Ghazavi, Zahra; Khaledi-Sardashti, Firouz; Kajbaf, Mohamad Bagher; Esmaielzadeh, Mojtaba

    2015-01-01

    Background: Hope is the most important factor in diabetic patients’ life. The level of hope may be changing among these individuals as a result of chronic nature of diabetes and its complications. When the level of hope increases among these patients, they can resist against physical and psychological complications of diabetes more, accept the treatment better, enjoy life more, and adapt with their situations more efficiently. This study aimed to define the efficacy of hope therapy on hope among diabetic patients. Materials and Methods: This was a quasi-experimental study conducted on 38 diabetic patients referring to Sedigheh Tahereh Research and Treatment Center affiliated to Isfahan University of Medical Sciences in Iran in 2012. The subjects were selected based on the goals and inclusion criteria of the study and then were randomly assigned to study and control groups. Herth Hope Index (HHI) was completed by both groups before, after, and 1 month after intervention. In the study group, 120-min sessions of hope therapy were held twice a week for 4 weeks. Descriptive and inferential statistical tests were adopted to analyze the data through SPSS version 12. Results: Comparison of the results showed that hope therapy significantly increased hope in diabetic patients after intervention in the study group compared to control (P < 0.001). Conclusions: The results showed that hope therapy increased hope among diabetic patients. This method is suggested to be conducted for diabetic patients. PMID:25709694

  10. Myofunctional therapy in patients with orofacial dysfunctions affecting speech.

    PubMed

    Bigenzahn, W; Fischman, L; Mayrhofer-Krammel, U

    1992-01-01

    Tongue thrusting, deviate swallowing, mouth breathing, orofacial muscle imbalance, deviate mandibular movement and malocclusion are the most important orofacial dysfunctions underlying disorders of articulation. Their development is linked to early bottle feeding and sucking habits. The phoniatrician is charged with the early detection of orofacial dysfunctions affecting speech. Early correction of habits and retraining by speech therapy are important preventive measures. Case histories, phoniatric and myofunctional diagnoses and dental/orthodontic findings were compiled for a total of 103 patients aged 3-30 years (11 +/- 4 years). Forty-five patients have completed a regimen of myofunctional therapy. For these patients highly significant improvements in lip strength, lip closure, breathing and tongue placement as well as in the swallowing pattern and orofacial muscle balance have been observed. Concomitantly, two thirds of the patients (66%) attained normal articulation. Speech defects were resistant to therapy in only 2 cases. In dental/orthodontic practice myofunctional therapy is used for retraining abnormal positions and functions of the orofacial muscles so as to create a normal occlusal relationship. The results of this study show that myofunctional therapy is highly instrumental also in phoniatrics as a special form of treatment for disorders of articulation.

  11. When the Patient Believes That the Organs Are Destroyed: Manifestation of Cotard's Syndrome

    PubMed Central

    Machado, Liliane

    2016-01-01

    Cotard's Syndrome (CS) is a rare clinical event described for the first time in 1880 by the neurologist and psychiatrist Jules Cotard and characterized by negation delusions (or nihilists). Immortality and hypochondriac delusions are also typical. Nowadays, it is known that CS can be associated with many neuropsychiatric conditions. In this article, we describe the case of a patient that believed not having more organs and having the body deformed and whose CS was associated with a bigger depressive disorder. Although the electroconvulsive therapy is the most described treatment modality in the literature, the reported case had therapeutic success with association of imipramine and risperidone. PMID:28003827

  12. Survival of young patients with chronic lymphocytic leukemia failing fludarabine therapy: a basis for the use of myeloablative therapies.

    PubMed

    Seymour, J F; Robertson, L E; O'Brien, S; Lerner, S; Keating, M J

    1995-08-01

    We examined the survival of 91 young patients (< or = 55 years) with chronic lymphocytic leukemia from the time of failure of fludarabine therapy, in an attempt to identify those with a poor outcome who may benefit from investigative dose-intensive therapies. The median survival of patients unresponsive to fludarabine (n = 42) was 48 weeks, and only 11% responded to subsequent therapies. The median survival of patients relapsing following a fludarabine-induced remission (n = 49) was 87 weeks, and 83% of those who had received fludarabine as their first therapy (n = 14) responded to further fludarabine-containing therapies, with 60% alive at four years. Only 7% of those relapsing patients who had received fludarabine as salvage therapy (n = 35) responded to subsequent therapies (median survival 72 weeks). The poor outlook for these patients justifies the consideration of innovative dose-intensive therapies, such as bone marrow transplantation, with their attendant risk of toxicity.

  13. Percutaneous nephrolithotomy in patients on chronic anticoagulant/antiplatelet therapy.

    PubMed

    Nerli, R B; Reddy, M N; Devaraju, S; Hiremath, M B

    2012-08-01

    Percutaneous nephrolithotomy (PCNL) is an integral component in the management of large volume renal stone disease either as monotherapy or in combination with shock wave lithotripsy. Stone disease in patients on chronic anticoagulation/antiplatelet therapy, however, poses a difficult scenario. Bleeding is a major concern for any patient undergoing PCNL. We retrospectively analyzed our series of patients with renal calculi who were on chronic anticoagulant therapy and who underwent PCNL. We reviewed the case records of patients undergoing PCNL during the period from January 2005 to December 2011. We analyzed the changes in preoperative and postoperative hemoglobin, serum creatinine, and clotting parameters, as well as intraoperative and postoperative bleeding and thromboembolic complications. During the 5-year study period, a total of 36 patients (30 males and 6 females) with a mean age of 46.33±9.96 years (range, 29-61 years) who were on chronic anticoagulant/antiplatelet therapy underwent PCNL for urolithiasis. The mean size of the stone was 6.40±1.98 cm(2) (range, 2.8-9 cm(2)). The mean operating time was 62.08±10.10 min. The bleeding was successfully managed in all patients and the anticoagulant/antiplatelet agents were restarted after an appropriate duration. The mean rise in serum creatinine at discharge was 0.05±0.03 mg/dl and the mean fall in serum hemoglobin was 1.63±0.77 g/dl. At 3 months after surgery, the stone-free rate was 100%. With careful preoperative care and regulation of anticoagulation/antiplatelet therapy and appropriate intraoperative management, PCNL can be performed safely and successfully in properly selected patients with renal calculi who are on chronic anticoagulant/antiplatelet therapy.

  14. Thromboelastography-guided transfusion Therapy in the trauma patient.

    PubMed

    Brazzel, Charice

    2013-04-01

    This article presents thromboelastography (TEG) as an important assay to incorporate into anesthesia practice for development of evidence-based therapy of trauma patients receiving blood transfusions. The leading cause of death worldwide results from trauma. Hemorrhage is responsible for 30% to 40% of trauma mortality and accounts for almost 50% of the deaths occurring in the initial 24 hours following the traumatic incident. On admission, 25% to 35% of trauma patients present with coagulopathy, which is associated with a sevenfold increase in morbidity and mortality. The literature supports that routine plasma-based routine coagulation tests, such as prothrombin time, activated partial thromboplastin time, and international normalized ratio, are inadequate for monitoring coagulopathy and guided transfusion therapy in trauma patients. A potential solution is incorporating the use of the TEG assay into the care of trauma patients to render evidence-based therapy for patients requiring massive blood transfusions. Analysis with TEG provides a complete picture of hemostasis, which is far superior to isolated, static conventional tests. The result is a fast, well-designed, and precise diagnosis enabling more cost-effective treatment, improved clinical outcome, accurate use of blood products, and pharmaceutical therapies at the point of care.

  15. Smoking with patients: policy us therapy.

    PubMed

    Tarbuck, P

    While it is largely accepted that smoking is injurious to physical health, there is no general consensus on the value, or otherwise, of mental health nurses smoking in the company of their patients in the creation and maintenance of therapeutic relationships. This survey of key opinion-formers within medium- and high-security mental health-care facilities was designed to ascertain whether a consensus exists.

  16. Oral Complications and Management Strategies for Patients Undergoing Cancer Therapy

    PubMed Central

    2014-01-01

    With cancer survival rate climbing up over the past three decades, quality of life for cancer patients has become an issue of major concern. Oral health plays an important part in one's overall quality of life. However, oral health status can be severely hampered by side effects of cancer therapies including surgery, chemotherapy, radiotherapy, and hematopoietic stem cell transplantation. Moreover, prevention and treatment of these complications are often overlooked in clinical practice. The present paper aims at drawing health care professionals' attention to oral complications associated with cancer therapy by giving a comprehensive review. Brief comments on contemporary cancer therapies will be given first, followed by detailed description of oral complications associated with cancer therapy. Finally, a summary of preventive strategies and treatment options for common oral complications including oral mucositis, oral infections, xerostomia, and dysgeusia will be given. PMID:24511293

  17. Listening is therapy: Patient interviewing from a pain science perspective.

    PubMed

    Diener, Ina; Kargela, Mark; Louw, Adriaan

    2016-07-01

    The interview of a patient attending physical therapy is the cornerstone of the physical examination, diagnosis, plan of care, prognosis, and overall efficacy of the therapeutic experience. A thorough, skilled interview drives the objective tests and measures chosen, as well as provides context for the interpretation of those tests and measures, during the physical examination. Information from the interview powerfully influences the treatment modalities chosen by the physical therapist (PT) and thus also impacts the overall outcome and prognosis of the therapy sessions. Traditional physical therapy focuses heavily on biomedical information to educate people about their pain, and this predominant model focusing on anatomy, biomechanics, and pathoanatomy permeates the interview and physical examination. Although this model may have a significant effect on people with acute, sub-acute or postoperative pain, this type of examination may not only gather insufficient information regarding the pain experience and suffering, but negatively impact a patient's pain experience. In recent years, physical therapy treatment for pain has increasingly focused on pain science education, with increasing evidence of pain science education positively affecting pain, disability, pain catastrophization, movement limitations, and overall healthcare cost. In line with the ever-increasing focus of pain science in physical therapy, it is time for the examination, both subjective and objective, to embrace a biopsychosocial approach beyond the realm of only a biomedical approach. A patient interview is far more than "just" collecting information. It also is a critical component to establishing an alliance with a patient and a fundamental first step in therapeutic neuroscience education (TNE) for patients in pain. This article highlights the interview process focusing on a pain science perspective as it relates to screening patients, establishing psychosocial barriers to improvement, and pain

  18. Opportunistic microorganisms in patients undergoing antibiotic therapy for pulmonary tuberculosis

    PubMed Central

    Querido, Silvia Maria Rodrigues; Back-Brito, Graziella Nuernberg; dos Santos, Silvana Soléo Ferreira; Leão, Mariella Vieira Pereira; Koga-Ito, Cristiane Yumi; Jorge, Antonio Olavo Cardoso

    2011-01-01

    Antimicrobial therapy may cause changes in the resident oral microbiota, with the increase of opportunistic pathogens. The aim of this study was to compare the prevalence of Candida, Staphylococcus, Pseudomonas and Enterobacteriaceae in the oral cavity of fifty patients undergoing antibiotic therapy for pulmonary tuberculosis and systemically healthy controls. Oral rinsing and subgingival samples were obtained, plated in Sabouraud dextrose agar with chloramphenicol, mannitol agar and MacConkey agar, and incubated for 48 h at 37°C. Candida spp. and coagulase-positive staphylococci were identified by phenotypic tests, C. dubliniensis, by multiplex PCR, and coagulase-negative staphylococci, Enterobacteriaceae and Pseudomonas spp., by the API systems. The number of Candida spp. was significantly higher in tuberculosis patients, and C. albicans was the most prevalent specie. No significant differences in the prevalence of other microorganisms were observed. In conclusion, the antimicrobial therapy for pulmonary tuberculosis induced significant increase only in the amounts of Candida spp. PMID:24031759

  19. Gastrointestinal endoscopy in patients on anticoagulant therapy and antiplatelet agents

    PubMed Central

    Zullo, Angelo; Hassan, Cesare; Radaelli, Franco

    2017-01-01

    Periprocedural management of antithrombotics for gastrointestinal endoscopy is a common clinical issue, given the widespread use of these drugs for primary and secondary cardiovascular prevention. For diagnostic procedures, with or without biopsy, no adjustments in antithrombotics are usually needed. For operative procedures, balancing the risk of periprocedural hemorrhage with the continuation of antithrombotics against the chance of recurrent thromboembolic events with their discontinuation may be challenging. Oral anticoagulants need to be temporarily withheld, and consideration must be given to whether a periendoscopic “bridge” therapy, typically a low-molecular-weight heparin, should be used in order to minimize the risk of thromboembolic events. Although some emerging evidence has shown that patients receiving heparin bridging appear to be at increased risk of overall and major bleeding and at similar risk of thromboembolic events compared to controls, bridging therapy is still recommended for patients on vitamin K antagonists who are at high thrombotic risk. Conversely, bridging therapy is usually not needed for patients taking new oral agents, which are characterized by shorter half-lives, and a rapid offset and onset of action. Management of antiplatelet therapy requires special care in patients on secondary prevention, especially those with coronary stents. This review is intended to summarize the recommendations of updated International Guidelines designed to help the decision-making process in such an intricate field. PMID:28042233

  20. Reversible, strokelike migraine attacks in patients with previous radiation therapy.

    PubMed Central

    Bartleson, J. D.; Krecke, Karl N.; O'Neill, Brian P.; Brown, Paul D.

    2003-01-01

    We report 2 adults with a past history of radiation therapy to the head for malignancy (one with primary B-cell lymphoma confined to the skull and the other with multiple hemangioendotheliomas) who developed episodes consistent with migraine with and without aura. In addition to more typical migraine attacks and beginning many years after their radiation therapy, both patients have experienced infrequent, stereotyped, prolonged, reversible neurologic deficits associated with headache, occasional seizures, and striking, transient, cortical gadolinium enhancement of the posterior cerebral gyri on MRI. Interictal MRI brain scans show stable abnormalities consistent with the patients' previous radiation therapy. The neurologic deficits often progressed over a few days, sometimes lasted weeks, and completely resolved. Electroencephalograms did not show epileptiform activity. Thorough investigation showed no residual or recurrent tumor and no recognized cause for the patients' attacks. We postulate a causal relationship between the patients' remote radiation therapy and their prolonged, strokelike migraine attacks. Radiation-induced vascular changes could provoke the episodes, with or without an underlying migraine diathesis. Recognition of this syndrome can help avoid invasive testing. PMID:12672284

  1. Management of antithrombotic therapy in patients undergoing electrophysiological device surgery.

    PubMed

    Zacà, Valerio; Marcucci, Rossella; Parodi, Guido; Limbruno, Ugo; Notarstefano, Pasquale; Pieragnoli, Paolo; Di Cori, Andrea; Bongiorni, Maria Grazia; Casolo, Giancarlo

    2015-06-01

    The aim of this review is to formulate practical recommendations for the management of antithrombotic therapy in patients undergoing cardiac implantable electronic device (CIED) surgery by providing indications for a systematic approach to the problem integrating general technical considerations with patient-specific elements based on a careful evaluation of the balance between haemorrhagic and thromboembolic risk. Hundreds of thousands patients undergo implantation or replacement of CIEDs annually in Europe, and up to 50% of these subjects receive antiplatelet agents or oral anticoagulants. The rate of CIED-related complications, mainly infective, has also significantly increased so that transvenous lead extraction procedures are, consequently, often required. Cardiac implantable electronic device surgery is peculiar and portends specific intrinsic risks of developing potentially fatal haemorrhagic complications; on the other hand, the periprocedural suspension of antithrombotic therapy in patients with high thromboembolic risk cardiac conditions may have catastrophic consequences. Accordingly, the management of the candidate to CIED surgery receiving concomitant antithrombotic therapy is a topic of great clinical relevance yet controversial and only partially, if at all, adequately addressed in evidence-based current guidelines. In spite of the fact that in many procedures it seems reasonably safe to proceed with aspirin only or without interruption of anticoagulants, restricting to selected cases the use of bridging therapy with parenteral heparins, there are lots of variables that may make the therapeutic choices challenging. The decision-making process applied in this document relies on the development of a stratification of the procedural haemorrhagic risk and of the risk deriving from the suspension of antiplatelet or anticoagulant therapy combined to generate different clinical scenarios with specific indications for optimal management of periprocedural

  2. Patient-specific dosimetry in radionuclide therapy.

    PubMed

    Lyra, Maria; Lagopati, Nefeli; Charalambatou, Paraskevi; Vamvakas, Ioannis

    2011-09-01

    This study presents an attempt to compare individualised palliative treatment absorbed doses, by planar images data and Monte Carlo simulation, in two in vivo treatment cases, one of bone metastases and the other of liver lesions. Medical Internal Radiation Dose schema was employed to estimate the absorbed doses. Radiopharmaceutical volume distributions and absorbed doses in the lesions as well as in critical organs were also calculated by Monte Carlo simulation. Individualised planar data calculations remain the method of choice in internal dosimetry in nuclear medicine, but with the disadvantage of attenuation and scatter corrections lack and organ overlay. The overall error is about 7 % for planar data calculations compared with that using Monte Carlo simulation. Patient-specific three-dimensional dosimetric calculations using single-photon emission computed tomography with a parallel computed tomography study is proposed as an accurate internal dosimetry with the additional use of dose-volume histograms, which express dose distributions in cases with obvious inhomogeneity.

  3. Gestalt therapy with the dying patient: integrative work using clay, poetry therapy, and creative media.

    PubMed

    Petzold, H G

    1982-01-01

    This is a report on death therapy with a 36-year-old cancer patient. Gestalt therapy and creative media (clay, poetry, and colors) were used to facilitate an integration of life and to give the person a sense of balance with life. The author tries to communicate his thoughts and feelings as they were during the course of the therapy, to show that counseling the dying means walking along a stretch of the path together. The companion-therapist cannot avoid his own perplexity and confusion by simply falling back on his professional role. Once he has become involved in an interpersonal relationship, he does not treat the patient as some kind of object. With the aid of transcripts taken from tape recordings, the integrating effect of using gestalt dialogue, and fantasy work becomes evident.

  4. Oral anticoagulant therapy in patients undergoing dental surgery.

    PubMed

    Weibert, R T

    1992-10-01

    The literature on dental surgery in patients receiving oral anticoagulants is reviewed, and methods of managing anticoagulant therapy to minimize the risk of complications are discussed. Although blood loss during and after oral surgery in patients receiving oral anticoagulant drugs can be substantial, research indicates that most bleeding incidents are not serious and can be controlled by local measures. Studies of 241 anticoagulant-treated patients undergoing more than 500 dental extractions during the 1950s and 1960s showed that only 9 had postoperative bleeding. More recent studies indicate that continued anticoagulation can increase the frequency of prolonged bleeding and delay wound healing. An antifibrinolytic mouthwash containing tranexamic acid can effectively suppress postoperative bleeding. Gelatin sponges, oxidized cellulose, and microcrystalline collagen are other useful hemostatic agents. A reduction in the intensity of anticoagulation therapy has been recommended; the prothrombin time should be measured shortly before the procedure in such patients. In many patients the duration of subtherapeutic anticoagulation must be minimized to reduce the possibility of thromboembolism. An option for high-risk patients is to switch them to heparin. Each patient must be evaluated individually, and the level of risk of the dental procedure and the risk of thromboembolism should be taken into account. In patients taking oral anticoagulants who must undergo dental surgery, careful control of the intensity of anticoagulation and improved methods of local hemostasis can minimize the risk of hemorrhagic complications and thromboembolism.

  5. Ivacaftor Therapy in CF Patients: Single Center Experience.

    PubMed

    Mondal, Pritish; Loyson, Amber; Lascano, Jorge; Hegde, Satyanarayan

    2014-01-01

    Ivacaftor is the first novel cystic fibrosis pharmaceutical that acts at the molecular level to potentiate cystic fibrosis transmembrane conductance regulator (CFTR) function and was first approved for clinical use in 2012. We are sharing our single center experience of five patients: four from pediatric age group and one adult patient. All patients had both subjective and objective improvements in their health. Despite established lung disease, our patients had significant improvement in both their FEV1 (forced expiratory volume in 1 second) and FEF25-75 and BMI (body mass index). Larger studies demonstrated only 6.7% improvement in mean FEV1 after starting Ivacaftor therapy but their patient population had normal lung function to begin with. In contrast our case series demonstrates that, in patients with established lung disease and diminished lung function, Ivacaftor can be expected to result in much higher recovery in lung function. Mean FEV1 improved by 35% in our case series. Ivacaftor is extremely expensive, costing $300,000 per patient per year requiring lifelong therapy, hence requiring prior authorizations from most third-party payers in the USA. The knowledge shared from our experience will be useful for other clinicians to petition healthcare policymakers on behalf of their patients.

  6. Inflammatory bowel diseases activity in patients undergoing pelvic radiation therapy

    PubMed Central

    Seisen, Thomas; Klotz, Caroline; Mazeron, Renaud; Maroun, Pierre; Petit, Claire; Deutsch, Eric; Bossi, Alberto; Haie-Meder, Christine; Chargari, Cyrus; Blanchard, Pierre

    2017-01-01

    Background Few studies with contradictory results have been published on the safety of pelvic radiation therapy (RT) in patients with inflammatory bowel disease (IBD). Methods From 1989 to 2015, a single center retrospective analysis was performed including all IBD patients who received pelvic external beam radiation therapy (EBRT) or brachytherapy (BT) for a pelvic malignancy. Treatment characteristics, IBD activity and gastrointestinal (GI) toxicity were examined. Results Overall, 28 patients with Crohn’s disease (CD) (n=13) or ulcerative colitis (n=15) were included in the present study. Median follow-up time after irradiation was 5.9 years. Regarding IBD activity, only one and two patients experienced a severe episode within and after 6 months of follow-up, respectively. Grade 3/4 acute GI toxicity occurred in 3 (11%) patients, whereas one (3.6%) patient experienced late grade 3/4 GI toxicity. Only patients with rectal IBD location (P=0.016) or low body mass index (BMI) (P=0.012) experienced more severe IBD activity within or after 6 months following RT, respectively. Conclusions We report an acceptable tolerance of RT in IBD patients with pelvic malignancies. Specifically, a low risk of uncontrolled flare-up was observed. PMID:28280621

  7. Dental extraction in patients receiving dual antiplatelet therapy

    PubMed Central

    Sánchez-Palomino, Paulino; Sánchez-Cobo, Paulino; Rodriguez-Archilla, Alberto; González-Jaranay, Maximino; Moreu, Gerardo; Calvo-Guirado, José-Luis; Peñarrocha-Diago, Miguel

    2015-01-01

    Background Dual anti platelet therapy consists of administering antiplatelet (antiaggregant) drugs (clopidogrel and aspirin) to prevent thrombotic processes, as a preventative measure in patients with acute coronary disease, or in patients subjected to percutaneous coronary intervention. Objectives The purpose of this study was to evaluate the efficacy of a protocol for performing dental extraction in patients receiving dual anti platelet therapy. Material and Methods Thirty-two patients undergoing dental extractions were included in the study. The variables evaluated were: collagen-epinephrine fraction, collagen- adenosine diphosphate fraction, surgical surface, post-surgical measures, and adverse effects. Alveolar sutures and gauzes impregnated with an antifibrinolytic agent (tranexamic acid), which the patient pressed in place for 30 minutes, were applied to all patients as post-surgical measures. Descriptive statistics were calculated and analyzed with Student’s t-test to compare pairs of quantitative variables; simple regression analysis was performed using Pearson’s correlation coefficient. Statistical significance was set at p<0.05. Results Collagen/epinephrine fraction was 264.53±55.624 seconds with a range of 135 to 300 seconds, and collagen/ADP fraction was 119.41±44.216 seconds, both values being higher than normal. As a result of the post-surgical measures taken, no patients presented postoperative bleeding, hematoma or infection. Conclusions Dental extraction was safe for patients receiving dual anti-platelet therapy when using sutures and gauze impregnated with tranexamic acid, which the patient pressed in place for 30 minutes. Key words: Aspirin, clopidogrel, tranexamic acid, dental extraction, platelet function. PMID:26241454

  8. Metformin therapy in patients with chronic kidney disease.

    PubMed

    Duong, J K; Roberts, D M; Furlong, T J; Kumar, S S; Greenfield, J R; Kirkpatrick, C M; Graham, G G; Williams, K M; Day, R O

    2012-10-01

    Metformin therapy is limited in patients with chronic kidney disease (CKD) due to the potential risk of lactic acidosis. This open-label observational study investigated metformin and lactate concentrations in patients with CKD (n = 22; creatinine clearances 15-40 ml/min) and in two dialysed patients. Patients were prescribed a range of metformin doses (250-2000 mg daily) and metformin concentrations were compared with data from healthy subjects (scaled to 1500 mg twice daily). A subset of patients (n = 7) was controlled on low doses of metformin (250 or 500 mg daily). No correlation between metformin and lactate concentrations was observed. Three patients had high lactate concentrations (>2.7 mmol/l) and two had high metformin concentrations (3-5 mg/l), but none had any symptoms of lactic acidosis. Reducing metformin dosage and monitoring metformin concentrations will allow the safe use of metformin in CKD, provided that renal function is stable.

  9. [The doctor-patient relationship in intensive therapy].

    PubMed

    Szulc, Roman

    2008-01-01

    The doctor-patient and doctor-patient's family relationships require skills of interpersonal communication, which is particularly important in intensive therapy. Unfortunately, such skills are not routinely taught and inadequacies are enormous. Communication skills are essential for decision-making and outcomes of therapy. The communication-related education should be obligatory and include abilities to use the linguistic and extra-linguistic signs suitable for the given circumstances. The former ought to have linguistic, psychological and social effects. The latter should involve gestures, voice modulation, facial expressions or even silence, if need be. ITU patients and their families expect physicians to behave appropriately and to provide them with competent emotional support and cooperation.

  10. Propofol ameliorates electroconvulsive shock-induced learning and memory impairment by regulation of synaptic metaplasticity via autophosphorylation of CaMKIIa at Thr 305 in stressed rats.

    PubMed

    Ren, Li; Zhang, Fan; Min, Su; Hao, Xuechao; Qin, Peipei; Zhu, Xianlin

    2016-06-30

    Electroconvulsive therapy (ECT) is an effective treatment for depression, but it can induce learning and memory impairment. Our previous study found propofol (γ-aminobutyric acid (GABA) receptor agonist) could ameliorate electroconvulsive shock (ECS, an analog of ECT to animals)-induced cognitive impairment, however, the underlying molecular mechanisms remain unclear. This study aimed to investigate the effects of propofol on metaplasticity and autophosphorylation of CaMKIIa in stressed rats receiving ECS. Depressive-like behavior and learning and memory function were assessed by sucrose preference test and Morris water test respectively. LTP were tested by electrophysiological experiment, the expression of CaMKIIa, p-T305-CaMKII in hippocampus and CaMKIIα in hippocampal PSD fraction were evaluated by western blot. Results suggested ECS raised the baseline fEPSP and impaired the subsequent LTP, increased the expression of p-T305-CaMKII and decreased the expression of CaMKIIα in hippocampal PSD fraction, leading to cognitive dysfunction in stressed rats. Propofol could down-regulate the baseline fEPSP and reversed the impairment of LTP partly, decreased the expression of p-T305-CaMKII and increased the expression of CaMKIIα in hippocampal PSD fraction and alleviated ECS-induced learning and memory impairment. In conclusion, propofol ameliorates ECS-induced learning and memory impairment, possibly by regulation of synaptic metaplasticity via p-T305-CaMKII.

  11. Repeated electroconvulsive stimuli have long-lasting effects on hippocampal BDNF and decrease immobility time in the rat forced swim test.

    PubMed

    Li, Bingjin; Suemaru, Katsuya; Cui, Ranji; Araki, Hiroaki

    2007-03-27

    Electroconvulsive therapy is considered an effective treatment for severe depression. However, the mechanisms for its long-lasting antidepressant efficacy are poorly understood. In the present study, we investigated changes of the immobility time in the forced swim test and brain-derived neurotrophic factor (BDNF) protein after withdrawal from 14-day repeated electroconvulsive stimuli (ECS, 50 mA, 0.2 s) in rats. Immobility time in the forced swim test was markedly decreased 6 h after withdrawal following 14-day ECS treatment. Thereafter, prolongation of the withdrawal period gradually diminished the decreasing effect of immobility time, but significant effects persisted for up to 3 days after the withdrawal. Locomotor activity in the open-field test increased 6 h after withdrawal from the ECS treatment, and the enhanced effect persisted for at least 7 days. The BDNF protein level in the hippocampus was markedly increased 6 h after the withdrawal, and remained high for at least 7 days. These findings provide further evidence that repeated ECS has long-lasting effect on increase in BDNF and locomotor activity and decrease in immobility time in the forced swim test.

  12. Successful isavuconazole salvage therapy in a patient with invasive mucormycosis.

    PubMed

    Ervens, J; Ghannoum, M; Graf, B; Schwartz, S

    2014-04-01

    A 45-year-old male with rhinocerebral mucormycosis (Rhizopus oryzae), refractory to liposomal amphotericin B and posaconazole, received isavuconazole salvage therapy. Initial isavuconazole plasma and tissue levels were 0.76-0.86 μg/mL and 1.09-1.38 μg/g. Plasma levels increased to 1.3-3.24 μg/mL with reduced comedication. Isavuconazole was well tolerated, and the patient has remained disease-free 24 months post-antifungal therapy.

  13. Use of compression therapy in patients with lymphoedema.

    PubMed

    Hobday, Anita

    2016-03-02

    Compression therapy is an effective and common approach to the management of lymphoedema, a chronic condition requiring long-term treatment. Lymphoedema is caused by the accumulation of fluid in soft tissue, resulting in swelling of the affected limb or area. Lymphoedema may be primary, as a result of a genetic abnormality, or secondary, as a result of injury, including non-accidental injury, or following treatments such as radiotherapy and/or surgery. The condition is characterised by a high protein oedema and secondary skin changes. This article outlines features of the various types of compression therapy used to treat patients with lymphoedema, including details of their application, effectiveness, indications and contraindications.

  14. Brief Exposure to Cognitive Behavioral Therapy Reduces Side-Effect Symptoms in Patients on Antiretroviral Therapy.

    PubMed

    Doerfler, R Eric; Goodfellow, Linda

    2016-01-01

    No study has tested the effectiveness of individualized cognitive behavioral therapy (CBT) interventions to reduce persistent nausea, pain, anxiety, and fatigue in patients on continuous antiretroviral therapy (ART). Our objective was to determine if CBT could reduce nausea, pain, anxiety, and fatigue in patients with HIV on ART. Men ages 40 to 56 years on ART (n = 18) at a suburban HIV clinic were randomly assigned to a control group or the CBT intervention. Usual adherence education and side-effect management were provided to both groups. Symptoms, health perception, medication adherence, and side-effect-reducing medication use were measured at four time points over 3 months. Participants in the intervention group rated usual fatigue and worst fatigue at 60 days, and nausea duration at 90 days significantly lower than controls (p < .05). Brief CBT training may reduce fatigue and nausea in patients with HIV undergoing ART.

  15. Assessing Patients' Cognitive Therapy Skills: Initial Evaluation of the Competencies of Cognitive Therapy Scale.

    PubMed

    Strunk, Daniel R; Hollars, Shannon N; Adler, Abby D; Goldstein, Lizabeth A; Braun, Justin D

    2014-10-01

    In Cognitive Therapy (CT), therapists work to help patients develop skills to cope with negative affect. Most current methods of assessing patients' skills are cumbersome and impractical for clinical use. To address this issue, we developed and conducted an initial psychometric evaluation of self and therapist reported versions of a new measure of CT skills: the Competencies of Cognitive Therapy Scale (CCTS). We evaluated the CCTS at intake and post-treatment in a sample of 67 patients participating in CT. The CCTS correlated with a preexisting measure of CT skills (the Ways of Responding Questionnaire) and was also related to concurrent depressive symptoms. Across CT, self-reported improvements in CT competencies were associated with greater changes in depressive symptoms. These findings offer initial evidence for the validity of the CCTS. We discuss the CCTS in comparison with other measures of CT skills and suggest future research directions.

  16. Use of antiviral therapy in patients with chronic hepatitis C

    PubMed Central

    Dragomiretskaya, Natalia; Izha, Anna; Kalinichenko, Nikolay; Szark-Eckardt, Mirosława; Klimczyk, Mariusz; Cieślicka, Mirosława; Muszkieta, Radosław; Prusik, Krzysztof; Napierała, Marek; Żukowska, Hanna

    2015-01-01

    Introduction The presence of background HCV infection cannot be overestimated in view of the prevalence of chronic hepatitis C and the risk of adverse outcomes of this disease. Purpose of this study was to evaluate the effectiveness of the combined use of antiviral therapy (Roferon + Vero-Ribavirin) and resort factors in patients with chronic hepatitis C in the phase of replication. Material and methods We observed 48 patients with chronic hepatitis C; the minimum level of activity of the process defined the phase of replication. Markers of HCV infection were determined by enzyme linked immunosorbent assay (ELISA) (a-HCV and HCV-Ig M). HCV RNA was determined twice by the polymerase chain reaction (PCR). Genotyping of hepatitis C virus was performed. Biochemical blood analysis and the study of HCV infection markers were carried out four times. Results of therapy were assessed immediately after the end of the resort (spa) treatment, then at 3, 6 and 12 months after starting treatment. At 12 months after starting treatment, all the observed patients had persistent clinical and biochemical remission. Elimination of the virus from the blood was noted in 56% of the control group and 74% of patients in the study group. Conclusions For patients with moderately active HCV, the replication phase was characterized by asthenic-vegetative syndrome (100% of patients) with severe depression (22.92%), pain (77.08%) and dyspeptic syndrome (33.33%), moderate hypertransferaseemia (100%), slightly pronounced cholestasis (33% of patients), and signs of mesenchymal-inflammatory response.

  17. [From shock therapies to new neuromodulation techniques].

    PubMed

    Plaze, Marion; Krebs, Marie-Odile

    2013-01-01

    The first shock therapies date back to 1933 with the Sakel therapy. Electric induction experiments led to electroconvulsive therapy first used by Ugo Cerletti and Lucio Bini in 1938. Today, transcranial magnetic stimulation offers new therapeutic perspectives for the treatment of mental disorders. Similarly, deep brain stimulation techniques have been developed for the treatment of compulsive obsessive disorders and severe and treatment-resistant depression.

  18. [The gene therapy for a patient with ADA deficiency; report of the first gene therapy trial in Japan].

    PubMed

    Ariga, T; Kawamura, N; Sakiyama, Y

    1997-06-01

    Since the first gene therapy clinical trial for an ADA deficient patient was performed in September 1990, 10 ADA deficient patients have been enrolled in gene therapy clinical trial. We have been performing the first gene therapy trial in Japan for a 5 year boy with ADA deficiency since August 1995. Activated T cells from the patient's peripheral mononuclear cells were transduced by a retrovirus vector, LASN, which contained cDNA of human ADA gene, and re-infused to him intravenously after 7-11 days. We have already performed 10 cycles of the therapy for the patient. Here, we report the successful results of the gene therapy with laboratory and clinical evaluation. Furthermore, we overview the results of gene therapy for ADA deficient patients which were recently reported from 4 other groups.

  19. Evaluation of Low-Level Laser Therapy in TMD Patients

    PubMed Central

    Ayyildiz, Simel; Emir, Faruk; Sahin, Cem

    2015-01-01

    Light amplification by stimulated emission of radiation (laser) is one of the most recent treatment modalities in dentistry. Low-level laser therapy (LLLT) is suggested to have biostimulating and analgesic effects through direct irradiation without causing thermal response. There are few studies that have investigated the efficacy of laser therapy in temporomandibular disorders (TMD), especially in reduced mouth opening. The case report here evaluates performance of LLLT with a diode laser for temporomandibular clicking and postoperative findings were evaluated in two cases of TMD patients. First patient had a history of limited mouth opening and pain in temporomandibular joint (TMJ) region since nine months. Second patient's main complaint was his restricted mouth opening, which was progressed in one year. LLLT was performed with a 685 nm red probed diode laser that has an energy density of 6.2 J/cm2, three times a week for one month, and application time was 30 seconds (685 nm, 25 mW, 30 s, 0.02 Hz, and 6.2 J/cm2) (BTL-2000, Portative Laser Therapy Device). The treatment protocol was decided according to the literature. One year later patients were evaluated and there were no changes. This application suggested that LLLT is an appropriate treatment for TMD related pain and limited mouth opening and should be considered as an alternative to other methods. PMID:26587294

  20. Phage neutralization by sera of patients receiving phage therapy.

    PubMed

    Łusiak-Szelachowska, Marzanna; Zaczek, Maciej; Weber-Dąbrowska, Beata; Międzybrodzki, Ryszard; Kłak, Marlena; Fortuna, Wojciech; Letkiewicz, Sławomir; Rogóż, Paweł; Szufnarowski, Krzysztof; Jończyk-Matysiak, Ewa; Owczarek, Barbara; Górski, Andrzej

    2014-08-01

    The aim of our investigation was to verify whether phage therapy (PT) can induce antiphage antibodies. The antiphage activity was determined in sera from 122 patients from the Phage Therapy Unit in Wrocław with bacterial infections before and during PT, and in sera from 30 healthy volunteers using a neutralization test. Furthermore, levels of antiphage antibodies were investigated in sera of 19 patients receiving staphylococcal phages and sera of 20 healthy volunteers using enzyme-linked immunosorbent assay. The phages were administered orally, locally, orally/locally, intrarectally, or orally/intrarectally. The rate of phage inactivation (K) estimated the level of phages' neutralization by human sera. Low K rates were found in sera of healthy volunteers (K ≤ 1.73). Low K rates were detected before PT (K ≤ 1.64). High antiphage activity of sera K > 18 was observed in 12.3% of examined patients (n = 15) treated with phages locally (n = 13) or locally/orally (n = 2) from 15 to 60 days of PT. High K rates were found in patients treated with some Staphylococcus aureus, Pseudomonas aeruginosa, and Enterococcus faecalis phages. Low K rates were observed during PT in sera of patients using phages orally (K ≤ 1.04). Increased inactivation of phages by sera of patients receiving PT decreased after therapy. These results suggest that the antiphage activity in patients' sera depends on the route of phage administration and phage type. The induction of antiphage activity of sera during or after PT does not exclude a favorable result of PT.

  1. Phage Neutralization by Sera of Patients Receiving Phage Therapy

    PubMed Central

    Żaczek, Maciej; Weber-Dąbrowska, Beata; Międzybrodzki, Ryszard; Kłak, Marlena; Fortuna, Wojciech; Letkiewicz, Sławomir; Rogóż, Paweł; Szufnarowski, Krzysztof; Jończyk-Matysiak, Ewa; Owczarek, Barbara; Górski, Andrzej

    2014-01-01

    Abstract The aim of our investigation was to verify whether phage therapy (PT) can induce antiphage antibodies. The antiphage activity was determined in sera from 122 patients from the Phage Therapy Unit in Wrocław with bacterial infections before and during PT, and in sera from 30 healthy volunteers using a neutralization test. Furthermore, levels of antiphage antibodies were investigated in sera of 19 patients receiving staphylococcal phages and sera of 20 healthy volunteers using enzyme-linked immunosorbent assay. The phages were administered orally, locally, orally/locally, intrarectally, or orally/intrarectally. The rate of phage inactivation (K) estimated the level of phages' neutralization by human sera. Low K rates were found in sera of healthy volunteers (K≤1.73). Low K rates were detected before PT (K≤1.64). High antiphage activity of sera K>18 was observed in 12.3% of examined patients (n=15) treated with phages locally (n=13) or locally/orally (n=2) from 15 to 60 days of PT. High K rates were found in patients treated with some Staphylococcus aureus, Pseudomonas aeruginosa, and Enterococcus faecalis phages. Low K rates were observed during PT in sera of patients using phages orally (K≤1.04). Increased inactivation of phages by sera of patients receiving PT decreased after therapy. These results suggest that the antiphage activity in patients' sera depends on the route of phage administration and phage type. The induction of antiphage activity of sera during or after PT does not exclude a favorable result of PT. PMID:24893003

  2. Clinical Effectiveness of Cardiac Resynchronization Therapy Versus Medical Therapy Alone Among Patients With Heart Failure

    PubMed Central

    Khazanie, Prateeti; Hammill, Bradley G.; Qualls, Laura G.; Fonarow, Gregg C.; Hammill, Stephen C.; Heidenreich, Paul A.; Al-Khatib, Sana M.; Piccini, Jonathan P.; Masoudi, Frederick A.; Peterson, Pamela N.; Curtis, Jeptha P.; Hernandez, Adrian F.

    2014-01-01

    Background— Cardiac resynchronization therapy with defibrillator (CRT-D) reduces morbidity and mortality among selected patients with heart failure in clinical trials. The effectiveness of this therapy in clinical practice has not been well studied. Methods and Results— We compared a cohort of 4471 patients from the National Cardiovascular Data Registry’s Implantable Cardioverter-Defibrillator (ICD) Registry hospitalized primarily for heart failure and who received CRT-D between April 1, 2006, and December 31, 2009, to a historical control cohort of 4888 patients with heart failure without CRT-D from the Acute Decompensated Heart Failure National Registry (ADHERE) hospitalized between January 1, 2002, and March 31, 2006. Both registries were linked with Medicare claims to evaluate longitudinal outcomes. We included patients from the ICD Registry with left ventricular ejection fraction ≤35% and QRS duration ≥120 ms who were admitted for heart failure. We used Cox proportional hazards models to compare outcomes with and without CRT-D after adjustment for important covariates. After multivariable adjustment, CRT-D was associated with lower 3-year risks of death (hazard ratio, 0.52; 95% confidence interval, 0.48–0.56; P<0.001), all-cause readmission (hazard ratio, 0.69; 95% confidence interval, 0.65–0.73; P<0.001), and cardiovascular readmission (hazard ratio, 0.60; 95% confidence interval, 0.56–0.64; P<0.001). The association of CRT-D with mortality did not vary significantly among subgroups defined by age, sex, race, QRS duration, and optimal medical therapy. Conclusions— CRT-D was associated with lower risks of mortality, all-cause readmission, and cardiovascular readmission than medical therapy alone among patients with heart failure in community practice. PMID:25227768

  3. Physical and hormonal evaluation of transsexual patients during hormonal therapy.

    PubMed

    Meyer, W J; Finkelstein, J W; Stuart, C A; Webb, A; Smith, E R; Payer, A F; Walker, P A

    1981-08-01

    The optimal hormonal therapy for transsexual patients is not known. The physical and hormonal characteristics of 38 noncastrate male-to-female transsexuals and 14 noncastrate female-to-male transsexuals have been measured before and/or during therapy with various forms and dosages of hormonal therapy. All patients were hormonally and physically normal prior to therapy. Ethinyl estradiol was superior to conjugated estrogen in suppression of testosterone and gonadotropins but equal in effecting breast growth. The changes in physical and hormonal characteristics were the same for 0.1 mg/d and 0.5 mg/d of ethinyl estradiol. The female-to-male transsexuals were well managed with a dose of intramuscular testosterone cypionate of 400 mg/month, usually given 200 mg every two weeks. The maximal clitoral length reached was usually 4 cm. Higher doses of testosterone did not further increase clitoral length or suppression of gonadotropins; lower doses did not suppress the gonadotropins. Based on the information found in this study, we recommend 0.1 mg/d of ethinyl estradiol for the noncastrate male-to-female transsexual and 200 mg of intramuscular testosterone cypionate every two weeks for the noncastrate female-to-male transsexual.

  4. Herbal and plant therapy in patients with inflammatory bowel disease

    PubMed Central

    Triantafyllidi, Aikaterini; Xanthos, Theodoros; Papalois, Apostolos; Triantafillidis, John K.

    2015-01-01

    The use of herbal therapy in inflammatory bowel disease (IBD) is increasing worldwide. The aim of this study was to review the literature on the efficacy of herbal therapy in IBD patients. Studies on herbal therapy for IBD published in Medline and Embase were reviewed, and response to treatment and remission rates were recorded. Although the number of the relevant clinical studies is relatively small, it can be assumed that the efficacy of herbal therapies in IBD is promising. The most important clinical trials conducted so far refer to the use of mastic gum, tormentil extracts, wormwood herb, aloe vera, triticum aestivum, germinated barley foodstuff, and boswellia serrata. In ulcerative colitis, aloe vera gel, triticum aestivum, andrographis paniculata extract and topical Xilei-san were superior to placebo in inducing remission or clinical response, and curcumin was superior to placebo in maintaining remission; boswellia serrata gum resin and plantago ovata seeds were as effective as mesalazine, whereas oenothera biennis had similar relapse rates as ω-3 fatty acids in the treatment of ulcerative colitis. In Crohn’s disease, mastic gum, Artemisia absinthium, and Tripterygium wilfordii were superior to placebo in inducing remission and preventing clinical postoperative recurrence, respectively. Herbal therapies exert their therapeutic benefit by different mechanisms including immune regulation, antioxidant activity, inhibition of leukotriene B4 and nuclear factor-kappa B, and antiplatelet activity. Large, double-blind clinical studies assessing the most commonly used natural substances should urgently be conducted. PMID:25830661

  5. Herbal and plant therapy in patients with inflammatory bowel disease.

    PubMed

    Triantafyllidi, Aikaterini; Xanthos, Theodoros; Papalois, Apostolos; Triantafillidis, John K

    2015-01-01

    The use of herbal therapy in inflammatory bowel disease (IBD) is increasing worldwide. The aim of this study was to review the literature on the efficacy of herbal therapy in IBD patients. Studies on herbal therapy for IBD published in Medline and Embase were reviewed, and response to treatment and remission rates were recorded. Although the number of the relevant clinical studies is relatively small, it can be assumed that the efficacy of herbal therapies in IBD is promising. The most important clinical trials conducted so far refer to the use of mastic gum, tormentil extracts, wormwood herb, aloe vera, triticum aestivum, germinated barley foodstuff, and boswellia serrata. In ulcerative colitis, aloe vera gel, triticum aestivum, andrographis paniculata extract and topical Xilei-san were superior to placebo in inducing remission or clinical response, and curcumin was superior to placebo in maintaining remission; boswellia serrata gum resin and plantago ovata seeds were as effective as mesalazine, whereas oenothera biennis had similar relapse rates as ω-3 fatty acids in the treatment of ulcerative colitis. In Crohn's disease, mastic gum, Artemisia absinthium, and Tripterygium wilfordii were superior to placebo in inducing remission and preventing clinical postoperative recurrence, respectively. Herbal therapies exert their therapeutic benefit by different mechanisms including immune regulation, antioxidant activity, inhibition of leukotriene B4 and nuclear factor-kappa B, and antiplatelet activity. Large, double-blind clinical studies assessing the most commonly used natural substances should urgently be conducted.

  6. Cognitive-behavioral therapy for insomnia in patients with cancer.

    PubMed

    Woodward, Susan Crump

    2011-08-01

    Sleep-wake disturbances, particularly insomnia, are among the most prevalent and distressing symptoms experienced by patients with cancer. As a result of extensive interdisciplinary research conducted since 2000, cognitive-behavioral therapy now is considered the standard of care for the treatment of insomnia in the general population and also has been upgraded to "likely to be effective" in the Oncology Nursing Society Putting Evidence Into Practice weight of evidence category. Cognitive-behavioral therapy is a multicomponent psychological and behavioral treatment designed to eliminate the perpetuating factors of insomnia. The most frequently used strategies are stimulus control, sleep restriction and relaxation therapies, paradoxical intention, sleep hygiene, and cognitive restructuring. Although this insomnia treatment recommendation has been well publicized, the nursing literature has not effectively translated the theories and principles of cognitive-behavioral therapy into practical guidelines or considerations for use by oncology staff nurses and advanced practitioners. This article attempts to demystify cognitive-behavioral therapy and provide nurses at different levels of practice a foundation from which to evaluate and potentially deliver this promising insomnia intervention.

  7. Current evidence of antifungal prophylaxis and therapy in pediatric patients

    PubMed Central

    Giacchino, Mareva; Milano, Giuseppe Maria; Carraro, Francesca; Bezzio, Stefania; Pegoraro, Anna; Aversa, Franco; Cesaro, Simone

    2011-01-01

    Invasive fungal infections (IFI) are an important complication in pediatric haematological and oncological patients who undergo intensive chemotherapy for leukemia, solid tumour at advanced stage or relapsed, and hematopoietic stem cell transplantation. The incidence of IFI is lower than bacterial infection but mortality rate remains high. This review is designed to help paediatric oncologists in choosing the appropriate anti-fungal strategy and agents for prophylaxis, empirical, pre-emptive and specific therapy on the basis of published evidence. PMID:21647279

  8. Current evidence of antifungal prophylaxis and therapy in pediatric patients.

    PubMed

    Giacchino, Mareva; Milano, Giuseppe Maria; Carraro, Francesca; Bezzio, Stefania; Pegoraro, Anna; Aversa, Franco; Cesaro, Simone

    2011-02-24

    Invasive fungal infections (IFI) are an important complication in pediatric haematological and oncological patients who undergo intensive chemotherapy for leukemia, solid tumour at advanced stage or relapsed, and hematopoietic stem cell transplantation. The incidence of IFI is lower than bacterial infection but mortality rate remains high. This review is designed to help paediatric oncologists in choosing the appropriate anti-fungal strategy and agents for prophylaxis, empirical, pre-emptive and specific therapy on the basis of published evidence.

  9. Outcomes of Proton Therapy for Patients With Functional Pituitary Adenomas

    SciTech Connect

    Wattson, Daniel A.; Tanguturi, Shyam K.; Spiegel, Daphna Y.; Niemierko, Andrzej; Biller, Beverly M.K.; Nachtigall, Lisa B.; Bussière, Marc R.; Swearingen, Brooke; Chapman, Paul H.; Loeffler, Jay S.; Shih, Helen A.

    2014-11-01

    Purpose/Objective(s): This study evaluated the efficacy and toxicity of proton therapy for functional pituitary adenomas (FPAs). Methods and Materials: We analyzed 165 patients with FPAs who were treated at a single institution with proton therapy between 1992 and 2012 and had at least 6 months of follow-up. All but 3 patients underwent prior resection, and 14 received prior photon irradiation. Proton stereotactic radiosurgery was used for 92% of patients, with a median dose of 20 Gy(RBE). The remainder received fractionated stereotactic proton therapy. Time to biochemical complete response (CR, defined as ≥3 months of normal laboratory values with no medical treatment), local control, and adverse effects are reported. Results: With a median follow-up time of 4.3 years (range, 0.5-20.6 years) for 144 evaluable patients, the actuarial 3-year CR rate and the median time to CR were 54% and 32 months among 74 patients with Cushing disease (CD), 63% and 27 months among 8 patients with Nelson syndrome (NS), 26% and 62 months among 50 patients with acromegaly, and 22% and 60 months among 9 patients with prolactinomas, respectively. One of 3 patients with thyroid stimulating hormone—secreting tumors achieved CR. Actuarial time to CR was significantly shorter for corticotroph FPAs (CD/NS) compared with other subtypes (P=.001). At a median imaging follow-up time of 43 months, tumor control was 98% among 140 patients. The actuarial 3-year and 5-year rates of development of new hypopituitarism were 45% and 62%, and the median time to deficiency was 40 months. Larger radiosurgery target volume as a continuous variable was a significant predictor of hypopituitarism (adjusted hazard ratio 1.3, P=.004). Four patients had new-onset postradiosurgery seizures suspected to be related to generously defined target volumes. There were no radiation-induced tumors. Conclusions: Proton irradiation is an effective treatment for FPAs, and hypopituitarism remains the primary

  10. Inhaled therapies, azithromycin and Mycobacterium abscessus in cystic fibrosis patients.

    PubMed

    Catherinot, Emilie; Roux, Anne-Laure; Vibet, Marie-Anne; Bellis, Gil; Lemonnier, Lydie; Le Roux, Evelyne; Bernède-Bauduin, Claire; Le Bourgeois, Muriel; Herrmann, Jean-Louis; Guillemot, Didier; Gaillard, Jean-Louis

    2013-05-01

    Cystic fibrosis (CF) patients are at particularly high risk of developing lung disease caused by Mycobacterium abscessus complex (MABSC). Over the last 10 years, changes in CF treatment, with increasing use of inhaled therapies and low-dose azithromycin, have been accompanied by an increase in the prevalence of MABSC infections in CF patients. There is therefore some concern about the role of new CF treatments in the emergence of MABSC infections. We addressed this issue by means of a case-control study including 30 MABSC-positive cases and 60 nontuberculous mycobacteria-negative CF controls matched for age, sex and centre. We also compared practices at the CF centres with the highest prevalence of MABSC with those at the other centres. No positive association was found between MABSC lung disease and the use of inhaled therapies or low-dose azithromycin in the 4 years preceding MABSC isolation. These treatments were not significantly more frequently used at the CF centres with the highest MABSC prevalence rates. In conclusion, there is no evidence for a link between M. abscessus complex lung disease and inhaled therapies or low-dose azithromycin in patients with CF.

  11. [Antithrombotic therapy in patients with mechanical valve prostheses].

    PubMed

    Roudaut, R; Lorient-Roudaut, M F

    1996-11-01

    Mechanical valvular prostheses have the advantage of longevity but carry a risk of thrombosis which is itself dependent on many haemodynamic, haemostatic and parietal factors. Antithrombotic therapy in patients with mechanical valvular prostheses is based on vitamin-K antagonists, the optimal dosage of which should reflect the type and location of the prosthesis and the underlying pathology. The patient with a mechanical valvular prosthesis treated by oral anticoagulation must be fully informed and regularly followed up. Special situations: extracardiac surgery, dental extraction, gastrointestinal endoscopy, require specific, well established management.

  12. Dental procedures in patients receiving oral anticoagulation therapy.

    PubMed

    Saour, J N; Ali, H A; Mammo, L A; Sieck, J O

    1994-05-01

    Over a 10-year period a uniform management plan for patients receiving long term oral anticoagulation therapy for prosthetic heart valves and needing dental procedures was instituted. Those undergoing dental extraction or gum hygiene in the presence of gross gum pathology (Group A) had their oral anticoagulation discontinued two days prior to the procedure which was carried out only if the INR was 1.5 or less on the day of the procedure. Patients who needed dental fillings or gum hygiene in the absence of gross gum pathology (Group B) continued their anticoagulation therapy and had these procedures completed provided the INR was 3.0 or less. The main outcome measured were valve thrombosis, thromboembolism and excessive bleeding requiring hospitalization and/or blood transfusion. In Group A, 240 procedures were carried out; 212 dental extractions and 28 dental hygiene in the presence of gross gum pathology. They had a brief period of under-anticoagulation (3-7 days) to an INR of 1.5 or less. In Group B, 156 procedures were performed. No patient developed valve thrombosis or thromboembolism. Two patients, both in Group A needed hospitalization for observation but no blood transfusion. This management plan was easy to implement. Patients needed one extra visit to the anticoagulation clinic within one week of the procedure. It was both safe and effective.

  13. THE USE OF ANTABUS IN THE THERAPY OF ALCOHOLIC PATIENTS

    PubMed Central

    Moriarty, John D.

    1950-01-01

    Preliminary studies on the effects of antabus (tetraethylthiuram disulfide) in the therapy of alcoholic patients indicate that it is very valuable in providing a “chemical foundation” for sobriety, even in those with a severe, long term drinking problem. In the first 30 patients treated, a favorable degree of control of the alcoholism has been effected in approximately 80 per cent. When taken regularly the drug maintains in the patient a very high degree of sensitivity to alcohol, quickly producing a number of very distressing bodily reactions whenever even very small amounts of spirits are ingested. Because of its potential dangers, antabus should be used only after thorough clinical and laboratory studies in properly staffed institutions. It is contraindicated in individuals with existing major psychosis or drug addiction and must be used only with caution in patients with diabetes mellitus, cardiovascular disease, goiter, pregnancy, epilepsy, asthma, and hepatic disease. Antabus therapy should be considered only one aspect of the total treatment program for the alcoholic patient. PMID:15426987

  14. Adherence to pressure garment therapy in adult burn patients.

    PubMed

    Ripper, S; Renneberg, B; Landmann, C; Weigel, G; Germann, G

    2009-08-01

    Pressure garment therapy (PGT) is a generally accepted procedure to prevent hypertrophic scarring after severe burns. Wearing pressure garments is uncomfortable and challenging for the patient and, consequently adherence is low. In order to improve adherence, precise knowledge about the advantages and disadvantages of PGT is necessary. In this study we investigated specific aspects which inhibit or reinforce the application of PGT on the patients' part. Twenty-one patients participated in a semi-structured interview concerning their experiences with PGT. The complaints most frequently mentioned were 'physical and functional limitations' caused by the garments, 'additional effort' created by the need to care for garments and 'perceived deficiencies' of the treatment. At the same time, most of the patients reported coping strategies used to persevere with the therapy. Coping can be categorised into 'behavioural' and 'cognitive coping strategies'. Besides the 'expectation of success', 'emotional' as well as 'practical support' and experiencing 'good outcome' were motivating factors for the patients. Based on the analyses of limitations and resources, recommendations for future interventions enhancing adherence are outlined.

  15. Programmed writing and therapy with symbiotically enmeshed patients.

    PubMed

    Jordan, K B; L'Abate, L

    1995-01-01

    This paper illustrates how programmed writing lessons to be completed as homework assignments can be used in conjunction with traditional verbal psychotherapy. Each patient was involved in a symbolically enmeshed relationship. Special benefits for patients from the combination of programmed writing lessong with traditional psychotherapy were: (1) increased couple communication; (2) possibly more rapid change; (3) possibly shorter-term therapy; (4) increased forgotten trauma discovery; (5) and increased explicit and specific instructions. Patients were informed from the outset that the use of programmed writing lessons would or might: (1) help the therapist get a better idea of what was going on in regard to the development, values, rules, etc. of their symbiotic relationships; (2) decrease the time spent in therapy, and (3) encourage self-realization through self-directed assignments between sessions. For psychotherapists there are advantages of: (1) putting the responsibility for change on the shoulders of patients rather than on themselves; (2) using programs of theoretical and therapeutic approaches that may not be well known to the therapist; (3) reducing the frequency of sessions and administering written homework assignments when the therapist is on vacation; and (4) increasing the number of patients that can be seen for unit of therapist's time.

  16. Sodium Bicarbonate Therapy in Patients with Metabolic Acidosis

    PubMed Central

    Adeva-Andany, María M.; Fernández-Fernández, Carlos; Mouriño-Bayolo, David; Castro-Quintela, Elvira; Domínguez-Montero, Alberto

    2014-01-01

    Metabolic acidosis occurs when a relative accumulation of plasma anions in excess of cations reduces plasma pH. Replacement of sodium bicarbonate to patients with sodium bicarbonate loss due to diarrhea or renal proximal tubular acidosis is useful, but there is no definite evidence that sodium bicarbonate administration to patients with acute metabolic acidosis, including diabetic ketoacidosis, lactic acidosis, septic shock, intraoperative metabolic acidosis, or cardiac arrest, is beneficial regarding clinical outcomes or mortality rate. Patients with advanced chronic kidney disease usually show metabolic acidosis due to increased unmeasured anions and hyperchloremia. It has been suggested that metabolic acidosis might have a negative impact on progression of kidney dysfunction and that sodium bicarbonate administration might attenuate this effect, but further evaluation is required to validate such a renoprotective strategy. Sodium bicarbonate is the predominant buffer used in dialysis fluids and patients on maintenance dialysis are subjected to a load of sodium bicarbonate during the sessions, suffering a transient metabolic alkalosis of variable severity. Side effects associated with sodium bicarbonate therapy include hypercapnia, hypokalemia, ionized hypocalcemia, and QTc interval prolongation. The potential impact of regular sodium bicarbonate therapy on worsening vascular calcifications in patients with chronic kidney disease has been insufficiently investigated. PMID:25405229

  17. Is enteral nutrition a primary therapy in cancer patients?

    PubMed Central

    Bozzetti, F

    1994-01-01

    At present, there is limited evidence for the role of enteral nutrition as a primary therapy in cancer patients. Cachexia commonly occurs in patients with advanced cancer. A consensus view from a large number of studies suggests that cachexia cannot be fully reversed by vigorous enteral nutritional support. A review is included of the available data on the effects of enteral nutritional support on the common indices of nutritional state and on the final outcome of patients receiving enteral nutrition in conjunction with radiotherapy or chemotherapy, or both. The 'nutritional' effects are probably limited because the duration of the nutritional support in most studies consists of a few weeks while malnutrition in the cancer patients often occurs over many months. PMID:8125395

  18. 21 CFR 892.5770 - Powered radiation therapy patient support assembly.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... 21 Food and Drugs 8 2010-04-01 2010-04-01 false Powered radiation therapy patient support assembly... SERVICES (CONTINUED) MEDICAL DEVICES RADIOLOGY DEVICES Therapeutic Devices § 892.5770 Powered radiation therapy patient support assembly. (a) Identification. A powered radiation therapy patient support...

  19. 21 CFR 892.5770 - Powered radiation therapy patient support assembly.

    Code of Federal Regulations, 2013 CFR

    2013-04-01

    ... 21 Food and Drugs 8 2013-04-01 2013-04-01 false Powered radiation therapy patient support assembly... SERVICES (CONTINUED) MEDICAL DEVICES RADIOLOGY DEVICES Therapeutic Devices § 892.5770 Powered radiation therapy patient support assembly. (a) Identification. A powered radiation therapy patient support...

  20. 21 CFR 892.5770 - Powered radiation therapy patient support assembly.

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ... 21 Food and Drugs 8 2011-04-01 2011-04-01 false Powered radiation therapy patient support assembly... SERVICES (CONTINUED) MEDICAL DEVICES RADIOLOGY DEVICES Therapeutic Devices § 892.5770 Powered radiation therapy patient support assembly. (a) Identification. A powered radiation therapy patient support...

  1. 21 CFR 892.5770 - Powered radiation therapy patient support assembly.

    Code of Federal Regulations, 2012 CFR

    2012-04-01

    ... 21 Food and Drugs 8 2012-04-01 2012-04-01 false Powered radiation therapy patient support assembly... SERVICES (CONTINUED) MEDICAL DEVICES RADIOLOGY DEVICES Therapeutic Devices § 892.5770 Powered radiation therapy patient support assembly. (a) Identification. A powered radiation therapy patient support...

  2. 21 CFR 892.5770 - Powered radiation therapy patient support assembly.

    Code of Federal Regulations, 2014 CFR

    2014-04-01

    ... 21 Food and Drugs 8 2014-04-01 2014-04-01 false Powered radiation therapy patient support assembly... SERVICES (CONTINUED) MEDICAL DEVICES RADIOLOGY DEVICES Therapeutic Devices § 892.5770 Powered radiation therapy patient support assembly. (a) Identification. A powered radiation therapy patient support...

  3. Art Therapy Outcomes in the Rehabilitation Treatment of a Stroke Patient: A Case Report

    ERIC Educational Resources Information Center

    Kim, Sun-Hyun; Kim, Min-Young; Lee, Jae-Hyuk; Chun, Sae-il

    2008-01-01

    This case report discusses the potential for art therapy to aid in the recovery of early-chronic stroke patients. The patient was diagnosed with having a subarachnoid hemorrhage from a cerebral aneurysm rupture 1 year prior to hospitalization. Therapies used as part of the patient's treatment included 10 weeks of art therapy conducted twice a…

  4. Autologous bone marrow-derived cell therapy combined with physical therapy induces functional improvement in chronic spinal cord injury patients.

    PubMed

    El-Kheir, Wael Abo; Gabr, Hala; Awad, Mohamed Reda; Ghannam, Osama; Barakat, Yousef; Farghali, Haithem A M A; El Maadawi, Zeinab M; Ewes, Ibrahim; Sabaawy, Hatem E

    2014-04-01

    Spinal cord injuries (SCI) cause sensory loss and motor paralysis. They are normally treated with physical therapy, but most patients fail to recover due to limited neural regeneration. Here we describe a strategy in which treatment with autologous adherent bone marrow cells is combined with physical therapy to improve motor and sensory functions in early stage chronic SCI patients. In a phase I/II controlled single-blind clinical trial (clinicaltrials.gov identifier: NCT00816803), 70 chronic cervical and thoracic SCI patients with injury durations of at least 12 months were treated with either intrathecal injection(s) of autologous adherent bone marrow cells combined with physical therapy or with physical therapy alone. Patients were evaluated with clinical and neurological examinations using the American Spinal Injury Association (ASIA) Impairment Scale (AIS), electrophysiological somatosensory-evoked potential, magnetic resonance imaging (MRI), and functional independence measurements. Chronic cervical and thoracic SCI patients (15 AIS A and 35 AIS B) treated with autologous adherent bone marrow cells combined with physical therapy showed functional improvements over patients in the control group (10 AIS A and 10 AIS B) treated with physical therapy alone, and there were no long-term cell therapy-related side effects. At 18 months posttreatment, 23 of the 50 cell therapy-treated cases (46%) showed sustained functional improvement. Compared to those patients with cervical injuries, a higher rate of functional improvement was achieved in thoracic SCI patients with shorter durations of injury and smaller cord lesions. Therefore, when combined with physical therapy, autologous adherent bone marrow cell therapy appears to be a safe and promising therapy for patients with chronic SCI of traumatic origin. Randomized controlled multicenter trials are warranted.

  5. [Art therapy in psychosocial rehabilitation of patients with mental disorders].

    PubMed

    Apotsos, P

    2012-01-01

    Despite the use of art therapy in various psychiatric structures and articles supporting its application, in recent years very few data grounded on primary research have been published. Given the complexity of psychiatric disorders the number of people who suffer from them, and the fact that the primary treatment in psychiatric disorders remains pharmacotherapy, questions about the effectiveness of art therapy (as a complimentary treatment) remain open. The purpose of this study was to investigate the efficacy of art therapy in psychosocial rehabilitation of people with psychiatric disorders. A search of the literature and electronic databases using indexing words was conducted. The criteria for inclusion of articles were: a. studies had to be "outcome-intervention" studies, b. studies should concern only intervention in adults, and c. studies had to include patients with diagnoses according to the DSM of the American Psychiatric Association. Finally, only five articles were included in this systematic review. There is evidence for the effectiveness of art therapy in areas related to the psychosocial rehabilitation of persons suffering from psychiatric disorders, usually in combination with pharmacotherapy. The findings of the surveys reviewed are encouraging and justify the conduct of additional primary research.

  6. Positive Effects of Massage Therapy on a Patient with Narcolepsy

    PubMed Central

    Hill, Robyn; Baskwill, Amanda

    2013-01-01

    Purpose The purpose of this case report was to investigate the effects of massage therapy on the sleep patterns of a woman with narcolepsy. Participant The 23-year-old woman’s primary symptoms included excessive daytime sleepiness and periodic leg movements (PLM), which were associated with her diagnoses of both narcolepsy and cataplexy. Intervention Five 45-minute massage therapy treatments were administered over a five-week period. The patient’s sleep patterns were recorded each week before the treatment. A final measurement was recorded in the sixth week. The sleep patterns were monitored using the Leeds Sleep Evaluation Questionnaire, which included ten visual analogue scales. Results The results of this case report included an improvement in getting to sleep by 148%, an improvement in quality of sleep by 1100%, an improvement in awake following sleep by 121%, and an improvement in behaviour following wakening by 28% using the Leeds Sleep Evaluation Questionnaire. Conclusion This case report suggests that massage therapy had a positive effect on this patient with narcolepsy. Further research is needed to investigate the effects of massage therapy on narcolepsy and sleep patterns. PMID:23730398

  7. Alopecia With Endocrine Therapies in Patients With Cancer

    PubMed Central

    Saggar, Vishal; Wu, Shenhong; Dickler, Maura N.

    2013-01-01

    Background. Whereas the frequency of alopecia to cytotoxic chemotherapies has been well described, the incidence of alopecia during endocrine therapies (i.e., anti-estrogens, aromatase inhibitors) has not been investigated. Endocrine agents are widely used in the treatment and prevention of many solid tumors, principally those of the breast and prostate. Adherence to these therapies is suboptimal, in part because of toxicities. We performed a systematic analysis of the literature to ascertain the incidence and risk for alopecia in patients receiving endocrine therapies. Methods. An independent search of citations was conducted using the PubMed database for all literature as of February 2013. Phase II–III studies using the terms “tamoxifen,” “toremifene,” “raloxifene,” “anastrozole,” “letrozole,” “exemestane,” “fulvestrant,” “leuprolide,” “flutamide,” “bicalutamide,” “nilutamide,” “fluoxymesterone,” “estradiol,” “octreotide,” “megestrol,” “medroxyprogesterone acetate,” “enzalutamide,” and “abiraterone” were searched. Results. Data from 19,430 patients in 35 clinical trials were available for analysis. Of these, 13,415 patients had received endocrine treatments and 6,015 patients served as controls. The incidence of all-grade alopecia ranged from 0% to 25%, with an overall incidence of 4.4% (95% confidence interval: 3.3%–5.9%). The highest incidence of all-grade alopecia was observed in patients treated with tamoxifen in a phase II trial (25.4%); similarly, the overall incidence of grade 2 alopecia by meta-analysis was highest with tamoxifen (6.4%). The overall relative risk of alopecia in comparison with placebo was 12.88 (p < .001), with selective estrogen receptor modulators having the highest risk. Conclusion. Alopecia is a common yet underreported adverse event of endocrine-based cancer therapies. Their long-term use heightens the importance of this condition on patients' quality of life

  8. "The home infusion patient": patient profiles for the home infusion therapy market.

    PubMed

    Westbrook, K W; Powers, T

    1999-01-01

    The authors review the relevant literature regarding home health care patient profiles. An empirical analysis is provided from archival data for a home infusion company servicing patients in urban and rural areas. The results are provided as a 2 x 2 matrix for patients in urban and rural areas seeing either a specialist or primary care physicians. A series of moderated regressions indicate that type of treating physician, patient's gender, geographic residence and level of acuity are cogent in predicting the complexity of prescribed infusion therapies. Managerial implications are provided for the home care marketer in segmenting patient markets for infusion services.

  9. Loco-regional therapies for patients with hepatocellular carcinoma awaiting liver transplantation: Selecting an optimal therapy.

    PubMed

    Byrne, Thomas J; Rakela, Jorge

    2016-06-24

    Hepatocellular carcinoma (HCC) is a common, increasingly prevalent malignancy. For all but the smallest lesions, surgical removal of cancer via resection or liver transplantation (LT) is considered the most feasible pathway to cure. Resection - even with favorable survival - is associated with a fairly high rate of recurrence, perhaps since most HCCs occur in the setting of cirrhosis. LT offers the advantage of removing not only the cancer but the diseased liver from which the cancer has arisen, and LT outperforms resection for survival with selected patients. Since time waiting for LT is time during which HCC can progress, loco-regional therapy (LRT) is widely employed by transplant centers. The purpose of LRT is either to bridge patients to LT by preventing progression and waitlist dropout, or to downstage patients who slightly exceed standard eligibility criteria initially but can fall within it after treatment. Transarterial chemoembolization and radiofrequency ablation have been the most widely utilized LRTs to date, with favorable efficacy and safety as a bridge to LT (and for the former, as a downstaging modality). The list of potentially effective LRTs has expanded in recent years, and includes transarterial chemoembolization with drug-eluting beads, radioembolization and novel forms of extracorporal therapy. Herein we appraise the various LRT modalities for HCC, and their potential roles in specific clinical scenarios in patients awaiting LT.

  10. Loco-regional therapies for patients with hepatocellular carcinoma awaiting liver transplantation: Selecting an optimal therapy

    PubMed Central

    Byrne, Thomas J; Rakela, Jorge

    2016-01-01

    Hepatocellular carcinoma (HCC) is a common, increasingly prevalent malignancy. For all but the smallest lesions, surgical removal of cancer via resection or liver transplantation (LT) is considered the most feasible pathway to cure. Resection - even with favorable survival - is associated with a fairly high rate of recurrence, perhaps since most HCCs occur in the setting of cirrhosis. LT offers the advantage of removing not only the cancer but the diseased liver from which the cancer has arisen, and LT outperforms resection for survival with selected patients. Since time waiting for LT is time during which HCC can progress, loco-regional therapy (LRT) is widely employed by transplant centers. The purpose of LRT is either to bridge patients to LT by preventing progression and waitlist dropout, or to downstage patients who slightly exceed standard eligibility criteria initially but can fall within it after treatment. Transarterial chemoembolization and radiofrequency ablation have been the most widely utilized LRTs to date, with favorable efficacy and safety as a bridge to LT (and for the former, as a downstaging modality). The list of potentially effective LRTs has expanded in recent years, and includes transarterial chemoembolization with drug-eluting beads, radioembolization and novel forms of extracorporal therapy. Herein we appraise the various LRT modalities for HCC, and their potential roles in specific clinical scenarios in patients awaiting LT. PMID:27358775

  11. Effects of Progressive Muscle Relaxation Therapy in Colorectal Cancer Patients.

    PubMed

    Kim, Kyeng Jin; Na, Yeon Kyung; Hong, Hae Sook

    2016-08-01

    This study aimed to examine the effect of progressive muscle relaxation therapy (PMRT) on cortisol level, the Stress Arousal Checklist (SACL) score, blood pressure, and heart rate in colorectal cancer patients undergoing laparoscopic surgery. Forty-six patients were divided into control and experimental groups. Cortisol levels, blood pressure, and heart rate were measured before surgery and between 8:00 and 11:00 a.m. on the first, third, and fifth days after surgery. SACL score was measured before surgery and on the fifth day after surgery at the same time points. PMRT was performed twice a day for 5 days. Analyses of covariance with advanced covariate levels and t tests showed that PMRT helps colorectal cancer patients achieve a lower stress response and provides an important basis for stress control.

  12. [Combined Antihypertensive Therapy in Patients at High Risk].

    PubMed

    Lyamina, N P; Kotelnikova, E V; Nalivaeva, A V

    2015-10-01

    Presents opportunities to increase the effectiveness of combination antihypertensive therapy (AHT) in patients with arterial hypertension (AH) and high cardiovascular risk. Displaying increase in the proportion of patients with target blood pressure up to 82.4%; high commitment combined AHT (96%) and medical recommendations for lifestyle changes (54%) using the power of information computer technology (ICT) in order to carry out continuous monitoring of blood pressure and other risk factors (RF), commitment to the patients drug and non-drug assignments. Thus, ICT can be seen as a tool that can give a real idea of the scale and nature of the deviation from the medical recommendations that can serve as a basis for personalized AHT.

  13. [Improvement of parodontitis therapy of patients with HIV-infection].

    PubMed

    Soboleva, L A; Oseeva, A O; Shul'diakov, A A; Bulkina, N V

    2010-01-01

    For the purpose to determine the clinic-pathogenetic efficacy of cycloferon liniment in the combined therapy of periodontitis of patients with subclinical stage of HIV-infection medical examination and treatment of 40 patients was carried out. It was established that use of liniment cycloferon in the combined treatment of patients with subclinical stage of HIV-infection allowed to accelerate process of normalization of lipid peroxidation parameters and antioxidant potential of blood, to decrease infection load (herpes symplex virus I, Candida albicans, Staphylococcus aureus) in parodontal recess and evidence of local inflammation with reduction of activity of the tumours necrosis factor and interleukin 1beta, what provided acceleration of recuperation processes, lowering the frequency of parodontitis relapses.

  14. Progress in sensorimotor rehabilitative physical therapy programs for stroke patients

    PubMed Central

    Chen, Jia-Ching; Shaw, Fu-Zen

    2014-01-01

    Impaired motor and functional activity following stroke often has negative impacts on the patient, the family and society. The available rehabilitation programs for stroke patients are reviewed. Conventional rehabilitation strategies (Bobath, Brunnstrom, proprioception neuromuscular facilitation, motor relearning and function-based principles) are the mainstream tactics in clinical practices. Numerous advanced strategies for sensory-motor functional enhancement, including electrical stimulation, electromyographic biofeedback, constraint-induced movement therapy, robotics-aided systems, virtual reality, intermittent compression, partial body weight supported treadmill training and thermal stimulation, are being developed and incorporated into conventional rehabilitation programs. The concept of combining valuable rehabilitative procedures into “a training package”, based on the patient’s functional status during different recovery phases after stroke is proposed. Integrated sensorimotor rehabilitation programs with appropriate temporal arrangements might provide great functional benefits for stroke patients. PMID:25133141

  15. Adherence to tetrahydrobiopterin therapy in patients with phenylketonuria.

    PubMed

    Rohr, Frances; Wessel, Ann; Brown, Matthew; Charette, Kalin; Levy, Harvey L

    2015-01-01

    Phenylketonuria (PKU) is an inborn error in phenylalanine metabolism due to deficiency of the enzyme, phenylalanine hydroxylase (PAH). Treatment includes restriction of dietary phenylalanine, and in some individuals, supplementation with the PAH cofactor, tetrahydrobiopterin (sapropterin dihydrochloride). A survey was conducted among patients with PKU who had been prescribed sapropterin to assess reasons for continuing or discontinuing the drug. The primary reason that sapropterin responders discontinued the drug was because of side effects, followed by insufficient reduction of blood phenylalanine and insurance issues. Conversely, those who remained on therapy cited increased tolerance for dietary protein as the main reason for continuation, along with lower blood phenylalanine concentrations and feeling better. This study suggests that adherence to sapropterin therapy is mainly dependent upon the increase in dietary protein allowed when on the drug.

  16. Cost-effective therapy in patients with idiopathic hirsutism.

    PubMed

    Lumachi, Franco; Zulian, Elisa; Scaroni, Carla

    2004-06-01

    Hirsutism affects 10% of women. Hirsute women with normal circulating androgen levels and normal ovarian function (i.e., regular and ovulatory menstrual cycles) are defined as having idiopathic hirsutism, which may affect more than 20% of all hirsute women. In the treatment of idiopathic hirsutism, different medical therapies, alone or in combination, have been reported. The drugs currently available are oral contraceptives, cyproterone acetate androgen receptors blockers (i.e., spironolactone and flutamide), 5alpha-reductase inhibitors (e.g., finasteride [Proscar, Aventis]) and gonadotrophin-releasing hormone analogs. After 1 year of treatment, each drug may improve hirsutism and reduce the Ferriman-Gallwey score by 35-40%. This review analyses the causes of hirsutism and provides information on each therapy and the cost-effective results in patients with idiopathic hirsutism.

  17. Temozolomide therapy in patients with aggressive pituitary adenomas or carcinomas.

    PubMed

    Losa, Marco; Bogazzi, Fausto; Cannavo, Salvo; Ceccato, Filippo; Curtò, Lorenzo; De Marinis, Laura; Iacovazzo, Donato; Lombardi, Giuseppe; Mantovani, Giovanna; Mazza, Elena; Minniti, Giuseppe; Nizzoli, Maurizio; Reni, Michele; Scaroni, Carla

    2016-02-01

    Temozolomide is effective in some patients with progressive pituitary adenoma or carcinoma. We report a survey study of Italian patients treated with Temozolomide because of aggressive pituitary adenoma or carcinoma resistant to standard therapies. Italian endocrinologists were surveyed and asked to participate into the study. A questionnaire was sent to all those who agreed and had used Temozolomide in at least one patient with pituitary tumor. Database was closed in December 2013. A literature review was also performed. Thirty-one patients were included into the analysis. Mean age at start of Temozolomide treatment was 58.3 ± 1.9 years (± standard error). Six of the 31 (19.4%) Italian patients had a pituitary carcinoma. Twenty-five patients (80.6%) had disease control during Temozolomide treatment, while 6 patients (19.4%) had disease progression. Median follow-up after beginning Temozolomide was 43 months. Thirteen patients had tumor growth after stopping Temozolomide. The 2-year progression-free survival was 47.7% (95% CI 29.5-65.9%), while the 2-year disease control duration was 59.1% (95% CI 39.1-79.1%). Eleven patients died of progressive disease and other two patients of unrelated causes. The 2-year and 4-year overall survival rates were 83.9% (95% CI 70.7-97.1%) and 59.6% (95% CI 40.0-79.2%), respectively. Temozolomide is an additional effective therapeutic option for the treatment of aggressive pituitary tumors. The drug is well tolerated and causes few severe adverse effects. Recurrence of the tumor can occur after an initial positive response and usually portends a grim outcome.

  18. Perioperative management of antithrombotic therapy in cardiovascular patients.

    PubMed

    Nuttall, Marc T; Rodgers, George M

    2011-01-01

    Many patients with underlying cardiovascular disease require long-term anticoagulation. The perioperative or periprocedural management of patients who require temporary interruption of anticoagulant or antiplatelet medications is a common and often challenging clinical problem. It requires a fine balance between the risk of thromboembolic events during anticoagulant interruption and the risk of bleeding in the setting of antithrombotic therapy administered around the time of surgery. Interruption of anticoagulation is associated with an increased risk of thromboembolic events. Stratifying patients into thromboembolic risk groups may be helpful in directing anticoagulation management in the perioperative setting. Bridging anticoagulation, generally with low-molecular-weight heparin (LMWH), is often an integral part of perioperative thrombosis risk reduction. Perioperative anticoagulation management varies depending on the indication for anticoagulation and the anticoagulant or antiplatelet agent being used by the patient. In this article, we review some of the general principles involved with perioperative anticoagulation and discuss the perioperative management of patients taking vitamin K antagonists (VKAs), bridging regimens for anticoagulants and antiplatelet agents, and strategies for managing patients on the newer oral anticoagulants.

  19. Opioid therapy in patients with a history of substance abuse.

    PubMed

    Passik, Steven D; Kirsh, Kenneth L

    2004-01-01

    A range of aberrant drug-taking behaviours can occur in patients who are undergoing treatment for chronic pain, especially if opioid therapy is involved. Assessing and understanding these behaviours, and their relationship to addiction (or substance use disorder), can be difficult but it is necessary for assuring quality pain management. Aberrant drug-taking behaviour may be evident, for example, when a patient with pain is unilaterally escalating doses of opioids or using the medications to treat other symptoms or when prescriptions are being mishandled. In patients with a history of substance abuse, these are often serious developments to which a clinician must know how to react. These complex behaviours may be indicative of addiction or may be simply a reaction to under-medicated pain. The clinician therefore is challenged to understand such behaviours and plan interventions accordingly. Although it is becoming increasingly common to avoid opioid therapy in patients demonstrating such challenging behaviours for fear of regulatory scrutiny, clinical management can be tailored to address the many possibilities that might be giving rise to such behaviours. In addition, control over prescriptions can be accomplished without necessarily terminating the prescribing of controlled substances entirely. Optimal medical management of chronic pain in those patients with addiction problems or engaging in problematic behaviours involves careful, ongoing assessment by the clinician as well as a tailored management approach. This approach should use multiple structures including strict contracts, prudent drug selection and frequent follow-ups to pain and addiction treatments, including the use of urine toxicology screening, to maximise the likelihood of a good outcome.

  20. Oral surgery for patients on anticoagulant therapy: current thoughts on patient management.

    PubMed

    Doonquah, Ladi; Mitchell, Anika D

    2012-01-01

    Minor oral surgical procedures make up a significant part of the daily practice of dentistry. With the increased sophistication of medical technology and medications there is increased likelihood of performing surgery on patients who are being treated for conditions that require some type of anticoagulant therapy. These patients are at an increased risk for perioperative bleeding or thrombotic complications if anticoagulation is discontinued or the dosage is adjusted. Therefore, a fine balance needs to be obtained and adequate preparation of these patients is the key to establishing this balance. This article reviews suggested approaches to the management of such patients.

  1. Fantasies About Stem Cell Therapy in Chronic Ischemic Stroke Patients

    PubMed Central

    Kim, Young Seo; Chung, Dan-il; Choi, Hojin; Baek, Wonki; Kim, Hyun Young; Heo, Sung Hyuk; Chang, Dae-Il; Na, Hae Ri; Kim, Seung Hyun

    2013-01-01

    Stem cell therapy (SCT) has been proposed for the treatment of neurological disorders. Although there is insufficient clinical evidence to support its efficacy, unproven SCTs are being performed worldwide. In this study, we investigated the perspectives and expectations of chronic ischemic stroke patients and physicians about SCTs. A total of 250 chronic ischemic stroke patients were interviewed at 4 hospitals. Structured open and closed questions about SCT for chronic stroke were asked by trained interviewers using the conventional in-person method. In addition, 250 stroke-related physicians were randomly interviewed via an e-mail questionnaire. Of the 250 patients (mean 63 years, 70% male), 121 (46%) responded that they wanted to receive SCT in spite of its unknown side effects. Around 60% of the patients anticipated physical, emotional, and psychological improvement after SCT, and 158 (63%) believed that SCT might prevent strokes. However, physicians had much lower expectations about the effectiveness of SCTs, which was not in line with patient expectations. Multivariate analysis revealed that the male gender [odds ratio (OR): 2.00, 95% confidence interval (CI): 1.10–3.64], longer disease duration (OR: 1.01, 95% CI: 1.00–1.02), higher modified Rankin Scale score (OR: 1.30, 95% CI: 1.06–1.60), and familiarity with stem cells (OR: 1.86, 95% CI: 1.10–3.15) were independently associated with wanting SCT. The major source of information about SCT was television (68%), and the most reliable source was physicians (49%). Patients have unfounded expectations that SCT will improve their functioning. Considering our finding that the major source of information on stem cells is media channels, but not the physician, to decrease patients' inappropriate exposure, doctors should make more effort to educate patients using mass media with accurate information. PMID:22784218

  2. Drug therapy in patients with Parkinson’s disease

    PubMed Central

    2012-01-01

    Parkinson`s disease (PD) is a progressive, disabling neurodegenerative disorder with onset of motor and non-motor features. Both reduce quality of life of PD patients and cause caregiver burden. This review aims to provide a survey of possible therapeutic options for treatment of motor and non motor symptoms of PD and to discuss their relation to each other. MAO-B-Inhibitors, NMDA antagonists, dopamine agonists and levodopa with its various application modes mainly improve the dopamine associated motor symptoms in PD. This armentarium of PD drugs only partially influences the onset and occurrence of non motor symptoms. These PD features predominantly result from non dopaminergic neurodegeneration. Autonomic features, such as seborrhea, hyperhidrosis, orthostatic syndrome, salivation, bladder dysfunction, gastrointestinal disturbances, and neuropsychiatric symptoms, such as depression, sleep disorders, psychosis, cognitive dysfunction with impaired execution and impulse control may appear. Drug therapy of these non motor symptoms complicates long-term PD drug therapy due to possible occurrence of drug interactions, - side effects, and altered pharmacokinetic behaviour of applied compounds. Dopamine substituting compounds themselves may contribute to onset of these non motor symptoms. This complicates the differentiation from the disease process itself and influences therapeutic options, which are often limited because of additional morbidity with necessary concomitant drug therapy. PMID:23211041

  3. Potential drug interactions in patients given antiretroviral therapy

    PubMed Central

    dos Santos, Wendel Mombaque; Secoli, Silvia Regina; Padoin, Stela Maris de Mello

    2016-01-01

    ABSTRACT Objective: to investigate potential drug-drug interactions (PDDI) in patients with HIV infection on antiretroviral therapy. Methods: a cross-sectional study was conducted on 161 adults with HIV infection. Clinical, socio demographic, and antiretroviral treatment data were collected. To analyze the potential drug interactions, we used the software Micromedex(r). Statistical analysis was performed by binary logistic regression, with a p-value of ≤0.05 considered statistically significant. Results: of the participants, 52.2% were exposed to potential drug-drug interactions. In total, there were 218 potential drug-drug interactions, of which 79.8% occurred between drugs used for antiretroviral therapy. There was an association between the use of five or more medications and potential drug-drug interactions (p = 0.000) and between the time period of antiretroviral therapy being over six years and potential drug-drug interactions (p < 0.00). The clinical impact was prevalent sedation and cardiotoxicity. Conclusions: the PDDI identified in this study of moderate and higher severity are events that not only affect the therapeutic response leading to toxicity in the central nervous and cardiovascular systems, but also can interfere in tests used for detection of HIV resistance to antiretroviral drugs. PMID:27878224

  4. Total skin electron therapy technique for the canine patient.

    PubMed

    Rechner, Kerensa N; Weeks, Kenneth J; Pruitt, Amy F

    2011-01-01

    Cutaneous epitheliotropic T-cell lymphoma in canine patients is a radiation sensitive tumor but total skin electron therapy is used only rarely. Our purpose was to evaluate dose distribution from a total skin electron therapy technique using 6MeV electron beams. The treatment was comprised of 12 fields, with the dog in lateral recumbency in a stride position at an extended distance from the source. Uniformity, flatness and symmetry were determined for each beam. The composite percent depth dose profile for all beams was measured in solid water phantoms and skin dose was determined on a canine cadaver using thermoluminescent dosimeters. The resulting d(max) of the composite beams was 1mm and dose variation over the skin was 6.8%, with the extremities having the most uneven dose distribution. Dimensions of the fields were adequate to obtain an effective treatment profile for the entire thickness of canine epidermis and the technique was feasible for clinical application. Individual tailoring of the protocol to deal with hot and cold spots may be necessary and set up will likely involve a significant time commitment for the therapy team.

  5. Anticoagulation Therapy in Patients with Chronic Kidney Disease.

    PubMed

    Saheb Sharif-Askari, Fatemeh; Syed Sulaiman, Syed Azhar; Saheb Sharif-Askari, Narjes

    2017-01-01

    Patients with chronic kidney disease (CKD) are at increased risk for both thrombotic events and bleeding. The early stages of CKD are mainly associated with prothrombotic tendency, whereas in its more advanced stages, beside the prothrombotic state, platelets can become dysfunctional due to uremic-related toxin exposure leading to an increased bleeding tendency. Patients with CKD usually require anticoagulation therapy for treatment or prevention of thromboembolic diseases. However, this benefit could easily be offset by the risk of anticoagulant-induced bleeding. Treatment of patients with CKD should be based on evidence from randomized clinical trials, but usually CKD patients are excluded from these trials. In the past, unfractionated heparins were the anticoagulant of choice for patients with CKD because of its independence of kidney elimination. However, currently low-molecular-weight heparins have largely replaced the use of unfractionated heparins owing to fewer incidences of heparin-induced thrombocytopenia and bleeding. We undertook this review in order to explain the practical considerations for the management of anticoagulation in these high risk population.

  6. Nocturnal oxygen therapy in patients with the Eisenmenger syndrome.

    PubMed

    Sandoval, J; Aguirre, J S; Pulido, T; Martinez-Guerra, M L; Santos, E; Alvarado, P; Rosas, M; Bautista, E

    2001-11-01

    This prospective and controlled pilot study evaluates the long-term effects of nocturnal oxygen therapy (NOT) on exercise endurance, hematology variables, quality of life, and survival of 23 adult patients (mean age, 32 +/- 6 yr) with post-tricuspid congenital heart defects (ventricular septal defect = 10; patent ductus arteriosus = 13) and Eisenmenger Syndrome. All had pulmonary hypertension (mean pulmonary artery pressure = 88 +/- 20 mm Hg), severe hypoxemia (Pa(O(2)) = 44 +/- 5 mm Hg), and secondary erythrocytosis (hematocrit = 61.5 +/- 7%). Exercise endurance (6-min walk test = 380 +/- 88 m) was limited. In a random fashion, NOT was given to one group of patients (n = 12) but withheld from a comparable control group (n = 11). At 2 yr of close follow-up, two patients in the group of control patients, and three in the treatment group died. Mean survival estimates were similar in both groups (20.7 versus 20.8 mo; chi-square log-rank, 0.08; p = NS). Likewise, none of the hematology, exercise capacity, and quality of life variables examined showed statistically significant changes that were dependent on treatment regimen. We conclude that NOT does not modify the natural history of patients with advanced Eisenmenger Syndrome.

  7. Diminished GABA(A) receptor-binding capacity and a DNA base substitution in a patient with treatment-resistant depression and anxiety.

    PubMed

    Kosel, Markus; Rudolph, Uwe; Wielepp, Peter; Luginbühl, Martin; Schmitt, Wolfgang; Fisch, Hans U; Schlaepfer, Thomas E

    2004-02-01

    In this report, we describe the case of a caucasian male patient, aged 42 years, suffering from severe treatment-resistant generalized anxiety disorder with panic attacks and from severe major depression, for which he was treated with a course of electroconvulsive therapy. During electroconvulsive treatment, anesthesia was difficult to induce with etomidate and, once, propofol. Bispectral indices recordings (assessing the depth of anesthesia) revealed a much shorter duration of loss of responsiveness compared to a control patient receiving also a course of electroconvulsive therapy. Since GABA receptor-mediated regulation of cortical excitability is important with respect to general anesthesia, we investigated the density of GABA(A) receptors with (123)I-iomazenil SPECT and found a clearly diminished binding of the radiotracer in the right frontal and orbitotemporal regions compared to the recordings in a 38-year-old healthy male control. Genetic analysis of the exons 7 and 8 of the GABRB1-3 genes coding for the beta1-3 subunits of the GABA(A) receptors revealed a silent G to A substitution in the third position of amino acid 257 of the beta1-subunit. To our knowledge, this is the first report of a link between insensitivity to anesthetic agents and altered GABA(A) receptor function in a clinical case. Whereas reduced GABA(A) receptor-binding capacity has been investigated in anxiety disorders, this has not been the case in depressive disorders. This case illustrates how clinical observations in psychiatry can prompt investigation by modern techniques and potentially link clinics and basic sciences. No conclusion can, however, be made about casual links in this single case [corrected].

  8. Patients' perspective on homework assignments in cognitive-behavioural therapy.

    PubMed

    Fehm, Lydia; Mrose, Jana

    2008-01-01

    Homework assignments are an indispensable part of cognitive-behavioural therapy. During the past two decades, a growing number of studies have shed light on its characteristics and effects. However, most studies primarily consider the therapists' view, and little is known about the use of supportive strategies to implement homework assignments in psychotherapy and about patients' attitudes towards regular assignments. To fill this gap, we assessed the attitudes towards homework assignments of 80 outpatients. In addition, those who had received a task during the past session (75%) were asked to report characteristics of their task as well as therapists' behaviour strategies during the assignment of the task. One week later, therapists rated the extent of completion of the task. Results showed that the patients generally had a positive attitude towards homework and that they accomplished most of the tasks. With regard to the therapists' behaviour during the assignment of the task, there seems to be room for improvement.

  9. Cell Therapy in Patients with Critical Limb Ischemia

    PubMed Central

    Compagna, Rita; Amato, Bruno; Massa, Salvatore; Amato, Maurizio; Grande, Raffaele; Butrico, Lucia; de Franciscis, Stefano; Serra, Raffaele

    2015-01-01

    Critical limb ischemia (CLI) represents the most advanced stage of peripheral arterial obstructive disease (PAOD) with a severe obstruction of the arteries which markedly reduces blood flow to the extremities and has progressed to the point of severe rest pain and/or even tissue loss. Recent therapeutic strategies have focused on restoring this balance in favor of tissue survival using exogenous molecular and cellular agents to promote regeneration of the vasculature. These are based on stimulation of angiogenesis by extracellular and cellular components. This review article carries out a systematic analysis of the most recent scientific literature on the application of stem cells in patients with CLI. The results obtained from the detailed analysis of the recent literature data have confirmed the beneficial role of cell therapy in reducing the rate of major amputations in patients with CLI and improving their quality of life. PMID:26300924

  10. Gene Therapy in a Patient with Sickle Cell Disease.

    PubMed

    Ribeil, Jean-Antoine; Hacein-Bey-Abina, Salima; Payen, Emmanuel; Magnani, Alessandra; Semeraro, Michaela; Magrin, Elisa; Caccavelli, Laure; Neven, Benedicte; Bourget, Philippe; El Nemer, Wassim; Bartolucci, Pablo; Weber, Leslie; Puy, Hervé; Meritet, Jean-François; Grevent, David; Beuzard, Yves; Chrétien, Stany; Lefebvre, Thibaud; Ross, Robert W; Negre, Olivier; Veres, Gabor; Sandler, Laura; Soni, Sandeep; de Montalembert, Mariane; Blanche, Stéphane; Leboulch, Philippe; Cavazzana, Marina

    2017-03-02

    Sickle cell disease results from a homozygous missense mutation in the β-globin gene that causes polymerization of hemoglobin S. Gene therapy for patients with this disorder is complicated by the complex cellular abnormalities and challenges in achieving effective, persistent inhibition of polymerization of hemoglobin S. We describe our first patient treated with lentiviral vector-mediated addition of an antisickling β-globin gene into autologous hematopoietic stem cells. Adverse events were consistent with busulfan conditioning. Fifteen months after treatment, the level of therapeutic antisickling β-globin remained high (approximately 50% of β-like-globin chains) without recurrence of sickle crises and with correction of the biologic hallmarks of the disease. (Funded by Bluebird Bio and others; HGB-205 ClinicalTrials.gov number, NCT02151526 .).

  11. Effect of juggling therapy on anxiety disorders in female patients

    PubMed Central

    Nakahara, Toshihiro; Nakahara, Kazuhiko; Uehara, Miho; Koyama, Ken-ichiro; Li, Kouha; Harada, Toshiro; Yasuhara, Daisuke; Taguchi, Hikaru; Kojima, Sinya; Sagiyama, Ken-ichiro; Inui, Akio

    2007-01-01

    Aims The aim of this study was to investigate the effect of juggling therapy for anxiety disorder patients. Design and Method Subjects were 17 female outpatients who met the DSM-IV diagnostic criteria for anxiety disorders. Subjects were treated with standard psychotherapy, medication and counseling for 6 months. For the last 3 months of treatment, subjects were randomized into either a non-juggling group (n = 9) or a juggling therapy group (juggling group: n = 8). The juggling group gradually acquired juggling skills by practicing juggling beanbags (otedama in Japan) with both hands. The therapeutic effect was evaluated using scores of psychological testing (STAI: State and Trate Anxiety Inventry, POMS: Profile of Mood Status) and of ADL (FAI: Franchay Activity Index) collected before treatment, 3 months after treatment (before juggling therapy), and at the end of both treatments. Results After 6 months, an analysis of variance revealed that scores on the state anxiety, trait anxiety subscales of STAI and tension-anxiety (T-A) score of POMS were significantly lower in the juggling group than in the non-juggling group (p < 0.01). Depression, anger-hostility scores of POMS were improved more than non-jugglers. In the juggling group, activity scores on the vigor subscale of POMS and FAI score were significantly higher than those in the non juggling group (p < 0.01). Other mood scores of POMS did not differ between the two groups. Conclusion These findings suggest that juggling therapy may be effective for the treatment of anxiety disorders. PMID:17470298

  12. Treatment of Hepatitis C in Patients Undergoing Immunosuppressive Drug Therapy

    PubMed Central

    Ooka, Kohtaro; Lim, Joseph K.

    2016-01-01

    Abstract With 185 million people chronically infected globally, hepatitis C is a leading bloodborne infection. All-oral regimens of direct acting agents have superior efficacy compared to the historical interferon-based regimens and are significantly more tolerable. However, trials of both types of regimens have often excluded patients on immunosuppressive medications for reasons other than organ transplantation. Yet, these patients—most often suffering from malignancy or autoimmune diseases—could stand to benefit from these treatments. In this study, we systematically review the literature on the treatment of hepatitis C in these neglected populations. Research on patients with organ transplants is more robust and this literature is reviewed here non-systematically. Our systematic review produced 2273 unique works, of which 56 met our inclusion criteria and were used in our review. The quality of data was low; only 3 of the 56 studies were randomized controlled trials. Sustained virologic response was reported sporadically. Interferon-containing regimens achieved this end-point at rates comparable to that in immunocompetent individuals. Severe adverse effects and death were rare. Data on all-oral regimens were sparse, but in the most robust study, rates of sustained virologic response were again comparable to immunocompetent individuals (40/41). Efficacy and safety of interferon-containing regimens and all-oral regimens were similar to rates in immunocompetent individuals; however, there were few interventional trials. The large number of case reports and case series makes conclusions vulnerable to publication bias. While firm conclusions are challenging, given the dearth of high-quality studies, our results demonstrate that antiviral therapy can be safe and effective. The advent of all-oral regimens offers patients and clinicians greatly increased chances of cure and fewer side effects. Preliminary data reveal that these regimens may confer such benefits in

  13. Tailor systemic therapy to the patient with severe psoriasis.

    PubMed

    Van de Velde, Vanessa; Tidman, Michael J

    2016-02-01

    There is no standard definition regarding the severity of psoriasis, and a number of factors should be considered, including the extent and stability of skin disease, involvement of joints, response to treatment, and impact on quality of life. Erythrodermic psoriasis and pustular psoriasis are severe conditions and the patient may be systemically unwell and febrile. NICE recommends that four key areas should be evaluated and recorded when assessing patients: severity, using the static Physician's Global Assessment (sPGA); disease impact on physical, psychological and social wellbeing using the Dermatology Life Quality Index (DLQI); the presence of psoriatic arthritis; and comorbidities. Ideally, patients should be assessed annually for psoriatic arthritis: the Psoriasis Epidemiology Screening Tool is a validated tool to screen for psoriatic arthritis in primary and secondary care. Patients with severe psoriasis should undergo cardiovascular risk assessment at presentation and every five years, or more frequently if indicated. Referral to secondary care should be made for patients with any type of psoriasis with poor response to topical therapy (after 2 or 3 months according to SIGN) and for extensive psoriasis. Cases where the psoriasis is having a significant physical or psychological impact on an individual's quality of life warrant early referral, as do those where the diagnosis is uncertain. Patients with generalised pustular psoriasis or erythroderma should be referred urgently for same-day specialist input. Patients with acute guttate psoriasis who may require phototherapy should also be referred. Children and adolescents with any type of psoriasis should be referred to a specialist at initial presentation.

  14. Rituximab therapy in Greek patients with rheumatoid arthritis

    PubMed Central

    Tsiakalos, Aristotelis P; Avgoustidis, Nestor K; Moutsopoulos, Haralampos M

    2008-01-01

    Objective: An open-label, prospective, uncontrolled study created to investigate clinical response, serological changes and side effects in Greek patients with rheumatoid arthritis (RA), after B-cell depletion with rituximab. Methods: Patients with high disease activity (disease activity score [DAS]-28 > 5.1) were selected for treatment with rituximab and received two infusions, 1 gr each, 2 weeks apart. Different disease parameters (visual analog scale, DAS-28, C-reactive protein [CRP], erythrocyte sedimentation rate, health assessment questionnaire, complement (C3), C4, rheumatoid factor [RF], anti-cyclic citrullinated peptide antibody [anti-CCP], swollen joint count, tender joint count, immunoglobulin M [IgM], IgG, IgA) were performed at base line, 2, 4, and 6 months post-treatment. Response was defined according to the American College of Rheumatology (ACR) criteria. Results: Seventeen patients received therapy. Treatment led to a reduction in various disease parameters. ACR20 was achieved in 41.11% of patients by week 8, 52.94% by week 16, and 82.35% by week 24. ACR50 was achieved in 5.88% by week 8, 41.17% by week 16, and 64.7% by week 24. ACR70 was achieved only by week 24 in 23.52% of patients. Statistical analysis has shown no differences in clinical response, between RF positive/negative patients, and anti-CCP-positive/negative patients, while decline of RF was better correlated with reduction of DAS-28 than with anti-CCP. Conclusions: Rituximab is a well tolerated and effective treatment in RA. Response was not correlated to RF or anti-CCP positivity. Decline of RF was associated with clinical response and reduction of DAS-28 and CRP. PMID:19707469

  15. Symptomatic Pericardial Effusion After Chemoradiation Therapy in Esophageal Cancer Patients

    SciTech Connect

    Fukada, Junichi; Shigematsu, Naoyuki; Takeuchi, Hiroya; Ohashi, Toshio; Saikawa, Yoshiro; Takaishi, Hiromasa; Hanada, Takashi; Shiraishi, Yutaka; Kitagawa, Yuko; Fukuda, Keiichi

    2013-11-01

    Purpose: We investigated clinical and treatment-related factors as predictors of symptomatic pericardial effusion in esophageal cancer patients after concurrent chemoradiation therapy. Methods and Materials: We reviewed 214 consecutive primary esophageal cancer patients treated with concurrent chemoradiation therapy between 2001 and 2010 in our institute. Pericardial effusion was detected on follow-up computed tomography. Symptomatic effusion was defined as effusion ≥grade 3 according to Common Terminology Criteria for Adverse Events v4.0 criteria. Percent volume irradiated with 5 to 65 Gy (V5-V65) and mean dose to the pericardium were evaluated employing dose-volume histograms. To evaluate dosimetry for patients treated with two-dimensional planning in the earlier period (2001-2005), computed tomography data at diagnosis were transferred to a treatment planning system to reconstruct three-dimensional plans without modification. Optimal dosimetric thresholds for symptomatic pericardial effusion were calculated by receiver operating characteristic curves. Associating clinical and treatment-related risk factors for symptomatic pericardial effusion were detected by univariate and multivariate analyses. Results: The median follow-up was 29 (range, 6-121) months for eligible 167 patients. Symptomatic pericardial effusion was observed in 14 (8.4%) patients. Dosimetric analyses revealed average values of V30 to V45 for the pericardium and mean pericardial doses were significantly higher in patients with symptomatic pericardial effusion than in those with asymptomatic pericardial effusion (P<.05). Pericardial V5 to V55 and mean pericardial doses were significantly higher in patients with symptomatic pericardial effusion than in those without pericardial effusion (P<.001). Mean pericardial doses of 36.5 Gy and V45 of 58% were selected as optimal cutoff values for predicting symptomatic pericardial effusion. Multivariate analysis identified mean pericardial dose as the

  16. Does Interpersonal Therapy Help Patients with Binge Eating Disorder Who Fail to Respond to Cognitive-Behavioral Therapy?

    ERIC Educational Resources Information Center

    Agras, W. Stewart; And Others

    1995-01-01

    Examines the effectiveness of group interpersonal therapy (IPT) in treating overweight, binge-eating patients. Participants were randomly allocated to cognitive-behavioral therapy (CBT) or to an assessment-only group. After 12 weeks, those who did not respond to CBT were assigned 12 weeks of IPT. IPT led to no further improvement. (JPS)

  17. Understanding Radiation Therapy: A Guide for Patients and Families

    MedlinePlus

    ... Effects Treatment Types Radiation Therapy A Guide to Radiation Therapy You’ve been told you have cancer. ... and you and your doctor have agreed that radiation therapy is your best choice – either alone or ...

  18. Effects of ketogenic diet on electroconvulsive threshold and brain contents of adenosine nucleotides.

    PubMed

    Nakazawa, M; Kodama, S; Matsuo, T

    1983-01-01

    The anticonvulsive effect of a ketogenic diet was investigated using mice fed on a ketogenic milk powder which contained medium-chain triglycerides (MCT). Electroconvulsive shocking and determination of adenosine nucleotides in mice brain were performed on three mice groups, (1) a control group; free access to a commercially available diet, (2) a fasted group; fasted for two days, and (3) a ketotic group; fasted for two days and then fed on the ketogenic milk powder for two weeks. The maximal electroconvulsive threshold of the ketotic group was significantly higher than that of the fasted group (p less than 0.001). The maximal electroconvulsive threshold of the fasted group was significantly higher than that of the control group (p less than 0.05). The contents of adenosine triphosphate (ATP) in the brain of the ketotic group was significantly higher than that of the control group (p less than 0.01). These results suggest that chronic ketosis with the ketogenic diet increases the contents of ATP in the brain and this increase in ATP probably accounts for the neuronal stability.

  19. Nonadherence to Medication Therapy in Haemodialysis Patients: A Systematic Review

    PubMed Central

    Ghimire, Saurav; Castelino, Ronald L.; Lioufas, Nicole M.; Peterson, Gregory M.; Zaidi, Syed Tabish R.

    2015-01-01

    Background End-stage kidney disease (ESKD) patients are often prescribed multiple medications. Together with a demanding weekly schedule of dialysis sessions, increased number of medicines and associated regimen complexity pre-dispose them at high risk of medication nonadherence. This review summarizes existing literature on nonadherence and identifies factors associated with nonadherence to medication therapy in patients undergoing haemodialysis. Methods A comprehensive search of PubMed, Embase, CINAHL, PsycInfo, and Cochrane Database of Systematic Reviews covering the period from 1970 through November 2014 was performed following a predefined inclusion and exclusion criteria. Reference lists from relevant materials were reviewed. Data on study characteristics, measures of nonadherence, prevalence rates and factors associated with nonadherence were collected. The Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines was followed in conducting this systematic review. Results Of 920 relevant publications, 44 were included. The prevalence of medication nonadherence varied from 12.5% to 98.6%, with widespread heterogeneity in measures and definitions employed. Most common patient-related factors significantly associated with nonadherence were younger age, non-Caucasian ethnicity, illness interfering family life, being a smoker, and living single and being divorced or widowed. Similarly, disease-related factors include longevity of haemodialysis, recurrent hospitalization, depressive symptoms and having concomitant illness like diabetes and hypertension. Medication-related factors such as daily tablet count, total pill burden, number of phosphate binders prescribed and complexity of medication regimen were also associated with poor adherence. Conclusions A number of patient-, disease-, and medication-related factors are associated with medication nonadherence in haemodialysis patients. Clinicians should be aware of such factors so that

  20. Establishing individual metabolite patterns for patients on valproate therapy.

    PubMed

    Kreher, U; Darius, J; Wien, F

    2001-01-01

    The aim of this study was to establish individual metabolic profiles of patients receiving valproate (VPA) mono- or polytherapy in order to estimate inter- and intraindividual variability under normal conditions. Serum levels of VPA and 15 metabolites were measured by gas chromotography/mass spectrometry (GC/MS) with selected ion monitoring (SIM). Because of a huge inter-subject variability, calculating means for large epileptic populations resulted in broad and vague ranges for serum levels of VPA and its metabolites. It therefore remained difficult to recognize any significant alteration in the individual metabolic profile. Over long term periods, within-patient changes appeared to be much less intense than inherent interindividual differences. In epileptics consecutively receiving various forms of polytherapy, alterations in the metabolic profiles occurred. Therefore, integrating different kinds of co-medication into a single polytherapy group seemed to be inadequate. An adult patient on VPA monotherapy, suffering form intrahepatic metastasis and renal insufficiency, showed an extremely altered metabolic pattern, with the 4-ene and the omega-/omega1-metabolites being strongly elevated and the major beta-metabolites (E)-2-ene and (E,E)-2,3'-diene being significantly diminished. We suggest determining the individual metabolic profile, consisting of accessible major and minor metabolites, for every patient when VPA therapy has been started or been modified. The moment any clinical complications arise, the previously obtained specific pattern of the individual can be taken as reference in order to assess the possible presance of significant alterations which might indicate or even cause any severe side effects. There seems to be no need of monitoring metabolite levels of the average patient continuously except for the high risk group (e.g. infants under 3 years age receiving polytherapy) which exhibited the highest between-subject as well as within-patient

  1. Singing Therapy Can Be Effective for a Patient with Severe Nonfluent Aphasia

    ERIC Educational Resources Information Center

    Yamaguchi, Satoshi; Akanuma, Kyoko; Hatayama, Yuka; Otera, Masako; Meguro, Kenichi

    2012-01-01

    Patients with severe aphasia are rarely treated using speech therapy. We used music therapy to continue to treat a 79-year-old patient with chronic severe aphasia. Interventions 1, 2, and 3 were to practice singing a song that the patient knew, to practice singing a song with a therapist, and to practice saying a greeting using a song with lyrics,…

  2. Comparative enzyme-inducing effects of chlorpromazine and fluphenazine therapies in psychotic patients.

    PubMed

    Harman, A W; Frewin, D B; Priestly, B G

    1980-01-01

    Antipyrine elimination kinetics were measured in psychotic patients receiving either long-term chlorpromazine or fluphenazine decanoate therapy and in non-medicated control subjects. Patients receiving chlorpromazine metabolised antipyrine faster than the controls while, in patients receiving fluphenazine decanoate, there was not change. The results suggest that long-term chlorpromazine therapy induced the activity of drug-metabolising enzymes, whereas fluphenazine decanoate therapy had no effect.

  3. Thermal therapy in dialysis patients - a randomized trial.

    PubMed

    Lin, Chia-Hsien; Lee, Li-Shan; Su, Ling-Hwa; Huang, Tien-Chuan; Liu, Chi-Feng

    2011-01-01

    The aim of this study is to evaluate the effects of far-infrared (FIR) rays on the meridian in hemodialysis (HD) patients. End-stage renal disease or kidney failure is the last stage of chronic renal failure, and often implies that the renal function cannot be restored and HD or kidney transplantation is required as a life-saving measure. HD patients often feel sick, debilitated, demotivated, and sad. A quasi-experimental design was conducted using convenience sampling with 61 HD patients from a hemodialysis center. Meridian testing and Brief Fatigue Inventory-Taiwan Form (BFI-T) were used as screening test for HD. The experimental group (n = 36) received FIR irradiation on each acupoint for 30 min, thrice a week, for two months, whereas the control group (n = 25) received no intervention. The outcome measures included meridian equipment, the level of hemoglobin (Hb), albumin, blood urea nitrogen (BUN), creatinine (CRE), and BFI-T. Ryodoraku values reveal a significant increase (p < 0.05) in the left small intestine meridian, left large intestine meridian, and yin-yang ratio. Overall, the increase in the meridians of the patients of experimental group is significantly higher than that of the control group. The results establish that FIR treatment on Qihai (RN 6), Guanyuan (RN 4), Zhongji (RN 3), and Tianshu (ST 25) is effective. Based on these findings, one can believe that FIR regulates the Qi of the kidney. The findings of this study would help doctors effectively dealing with thermal therapy treatment of HD patients.

  4. Predicting virological decay in patients starting combination antiretroviral therapy

    PubMed Central

    2016-01-01

    Objective: Model trajectories of viral load measurements from time of starting combination antiretroviral therapy (cART), and use the model to predict whether patients will achieve suppressed viral load (≤200 copies/ml) within 6-months of starting cART. Design: Prospective cohort study including HIV-positive adults (UK Collaborative HIV Cohort Study). Methods: Eligible patients were antiretroviral naive and started cART after 1997. Random effects models were used to estimate viral load trends. Patients were randomly selected to form a validation dataset with those remaining used to fit the model. We evaluated predictions of suppression using indices of diagnostic test performance. Results: Of 9562 eligible patients 6435 were used to fit the model and 3127 for validation. Mean log10 viral load trajectories declined rapidly during the first 2 weeks post-cART, moderately between 2 weeks and 3 months, and more slowly thereafter. Higher pretreatment viral load predicted steeper declines, whereas older age, white ethnicity, and boosted protease inhibitor/non-nucleoside reverse transcriptase inhibitors based cART-regimen predicted a steeper decline from 3 months onwards. Specificity of predictions and the diagnostic odds ratio substantially improved when predictions were based on viral load measurements up to the 4-month visit compared with the 2 or 3-month visits. Diagnostic performance improved when suppression was defined by two consecutive suppressed viral loads compared with one. Conclusions: Viral load measurements can be used to predict if a patient will be suppressed by 6-month post-cART. Graphical presentations of this information could help clinicians decide the optimum time to switch treatment regimen during the first months of cART. PMID:27124894

  5. Fertility preservation in patients receiving cyclophosphamide therapy for renal disease.

    PubMed

    Gajjar, Radha; Miller, Steven D; Meyers, Kevin E; Ginsberg, Jill P

    2015-07-01

    Cyclophosphamide continues to have an important role in the treatment of renal disease, including nephrotic syndrome and lupus nephritis, despite known complications of gonadotoxicity and potential infertility in both male and female patients. It is important that the physician recommending this therapy mitigates the effect of the drug on fertility by adhering to recommendations on dosing limits and offering fertility-preserving strategies. In addition to well-established methods, such as sperm banking and embryo cryopreservation, advances in reproductive technology have yielded strategies such as oocyte cryopreservation, resulting in more fertility-preserving options for the pediatric patient. Despite these advances, there continues to be a significant barrier to referral and access to sperm banks and fertility specialists. These issues are further complicated by ethical issues associated with the treatment of pediatric patients. In this review we explore the development of recommended dosing limits and include a discussion of the available fertility-preserving methods, strategies for increasing access to fertility specialists, and the ethical considerations facing the pediatric healthcare provider.

  6. Yoga therapy for breast cancer patients: a prospective cohort study.

    PubMed

    Sudarshan, Monisha; Petrucci, Andrea; Dumitra, Sinziana; Duplisea, Jodie; Wexler, Sharon; Meterissian, Sarkis

    2013-11-01

    We sought to study the impact of yoga therapy on anxiety, depression and physical health in breast cancer patients. Stage I-III post-operative breast cancer patients were recruited with twelve 1-h weekly yoga sessions completed with an experienced yoga instructor. Before and after each module completion, assessments were obtained with the Hospital Anxiety and Depression scale (HADS), the Dallas pain scale and shoulder flexibility measurements. Fourteen patients completed the entire yoga session with 42.8% having a total mastectomy and 15.4% having breast reconstruction. Both right and left shoulder abduction flexibility significantly improved (p = 0.004; p = 0.015 respectively) as well as left shoulder flexion (p = 0.046). An improvement trend in scores for the HADS and Dallas questionnaires pre- and post-intervention was found, although it was not statistically significant. Our data indicates an improvement in physical function in addition to a consistent amelioration in anxiety, depression and pain symptoms after a yoga intervention.

  7. [Blood transfusion and adjunctive therapy in the bleeding trauma patient].

    PubMed

    Ozier, Y

    2008-11-01

    Uncontrolled hemorrhage is the most common cause of potentially preventable death in massive trauma. In addition to the early identification of potential bleeding sources and angiographic embolisation or surgical bleeding control, in-hospital management will aim at maintain tissue oxygenation with volume replacement using crystalloids, colloids and RBC. In general, RBC transfusion is recommended to maintain hemoglobin between 7-10g/dL. The complex combination of clotting factors and platelets consumption, loss and dilution, shock, hypothermia, acidosis and colloid-induced hemostatic alterations leads to coagulopathic bleeding. Most guidelines recommend the use of FFP in significant bleeding complicated by coagulopathy (PT, aPTT >1.5 times control). Platelets should be administered to maintain a platelet count above 50 x 10(9)/L (100 x 10(9)/L in patients with traumatic brain injury). However, standard laboratory tests have poor correlation with in vivo coagulopathy and the test results are not rapidly available. Empiric guidelines derived from mathematical hemodilution models developed in elective surgery settings may not be appropriate for trauma settings where significant bleeding may have already occurred. Moreover, coagulopathy is frequently present on admission in severely injured patients. Recent litterature suggests that FFP and platelets should be given early and more often to injured patients requiring massive transfusion. The place of adjunctive hemostatic therapy is discussed.

  8. Comparison Between Sequential Therapy and Modified Bismuth-Included Quadruple Therapy for Helicobacter pylori Eradication in Chinese Patients.

    PubMed

    Yang, Xiuhong; Tan, Pengsheng; Song, Lianying; Lu, Zhanying

    To compare the efficacy and safety of sequential therapy and modified bismuth-included quadruple therapy as a first-line Helicobacter pylori eradication in China. The patients were randomized to receive sequential therapy [n = 90; rabeprazole (20 mg twice daily) and amoxicillin (1 g twice daily) for 5 days, followed by rabeprazole (20 mg twice daily), tinidazole (500 mg twice daily) plus clarithromycin (500 mg twice daily) for another 5 days] or modified bismuth-included quadruple therapy [n = 109; rabeprazole (20 mg twice daily), levofloxacin hydrochloride (400 mg twice daily), clarithromycin (500 mg twice daily), and colloidal bismuth pectin (200 mg 3 times a day) for 7 days]. A follow-up urea breath test was applied 4 weeks later. A total of 199 patients were diagnosed with H. pylori infection. The intention-to-treat and per-protocol (PP) eradication rates were 91.7% and 92.6%, respectively, in the modified bismuth-included quadruple therapy group, and 74.4% and 76.1%, respectively, in the sequential therapy group. The eradication rates were significantly higher in the modified bismuth-included quadruple therapy group, compared with the sequential therapy group (P = 0.001 for intention to treat and P = 0.001 for PP). Adverse effects were reported by patients from both groups, but the difference did not reach significant level (P = 0.280). The modified bismuth-included quadruple therapy seemed to be superior to the sequential therapy as the first-line regimen for H. pylori eradication in Chinese patients.

  9. Pursuit and practice of complementary therapies by cancer patients receiving conventional treatment.

    PubMed Central

    Downer, S. M.; Cody, M. M.; McCluskey, P.; Wilson, P. D.; Arnott, S. J.; Lister, T. A.; Slevin, M. L.

    1994-01-01

    OBJECTIVES--To determine what proportion of oncology patients receiving conventional medical treatment also use complementary treatments; to assess which complementary treatments are the most popular and to assess patients' motivation for using them; to evaluate associated advantages and risks. DESIGN--Postal screening questionnaire followed by semistructured interview. SETTING--Two hospitals in inner London. SUBJECTS--600 unselected oncology patients aged 18 or over who had known their diagnosis of cancer for at least three months. MAIN OUTCOME MEASURES--Prevalence and demography of use of complementary therapies; patients' motivation and expectations of complementary therapies; areas of satisfaction and dissatisfaction associated with conventional and complementary therapies. RESULTS--415 (69%) patients returned the questionnaire. 16% had used complementary therapies. The most popular were healing, relaxation, visualisation, diets, homoeopathy, vitamins, herbalism, and the Bristol approach. Patients using complementary therapies tended to be younger, of higher social class, and female. Three quarters used two or more therapies. Therapies were mostly used for anticipated antitumour effect. Ill effects of diets and herb treatments were described. Satisfaction with both conventional and complementary therapies was high, although diets often caused difficulties. Patients using complementary therapies were less satisfied with conventional treatments, largely because of side effects and lack of hope of cure. Benefits of complementary therapies were mainly psychological. CONCLUSIONS--A sizeable percentage of patients receiving conventional treatments for cancer also use complementary therapies. Patient satisfaction with complementary therapies, other than dietary therapies, was high even without the hoped for anticancer effect. Patients reported psychological benefits such as hope and optimism. PMID:8038672

  10. Reduced calcium binding protein immunoreactivity induced by electroconvulsive shock indicates neuronal hyperactivity, not neuronal death or deactivation.

    PubMed

    Kim, J-E; Kwak, S-E; Kim, D-S; Won, M H; Kwon, O-S; Choi, S-Y; Kang, T-C

    2006-01-01

    Calcium-binding proteins (CBPs), such as parvalbumin and calbindin D-28k, are useful markers of specific neuronal types in the CNS. In recent studies, expression of CBPs may be indicative of a deactivated neuronal state, particularly epilepsy. However, it is controversial whether altered expression of CBPs in the hippocampus practically indicate neuronal activity. Therefore, the present study was performed to investigate the extent of profiles of expression of CBPs in the rat hippocampus affected by several episodes induced by electroconvulsive shock. In the present study, following electroconvulsive shock expression of CBPs were reduced in the hippocampus in a stimulus-dependent manner, and recovered to the control level at 6 h after electroconvulsive shock. However, paired-pulse responses of the dentate gyrus were transiently impaired by electroconvulsive shock, and immediately normalized to baseline value. In addition, effects of electroconvulsive shock on expression of CBPs and paired-pulse responses were prevented by pretreatment of vigabatrin. These findings suggest that reduced expression of CBPs induced by seizure activity may be indicative of hyperactivity of CBP positive neurons, which is a practical consequence of the abnormal discharge, and that they may play an important role in regulating seizure activity.

  11. Neurocognitive Function in HIV Infected Patients on Antiretroviral Therapy

    PubMed Central

    Winston, Alan; Arenas-Pinto, Alejandro; Stöhr, Wolfgang; Fisher, Martin; Orkin, Chloe M.; Aderogba, Kazeem; De Burgh-Thomas, Andrew; O'Farrell, Nigel; Lacey, Charles JN.; Leen, Clifford; Dunn, David; Paton, Nicholas I.

    2013-01-01

    Objective To describe factors associated with neurocognitive (NC) function in HIV-positive patients on stable combination antiretroviral therapy. Design We undertook a cross-sectional analysis assessing NC data obtained at baseline in patients entering the Protease-Inhibitor-Monotherapy-Versus-Ongoing-Triple therapy (PIVOT) trial. Main outcome measure NC testing comprised of 5 domains. Raw results were z-transformed using standard and demographically adjusted normative datasets (ND). Global z-scores (NPZ-5) were derived from averaging the 5 domains and percentage of subjects with test scores >1 standard deviation (SD) below population means in at least two domains (abnormal Frascati score) calculated. Patient characteristics associated with NC results were assessed using multivariable linear regression. Results Of the 587 patients in PIVOT, 557 had full NC results and were included. 77% were male, 68% Caucasian and 28% of Black ethnicity. Mean (SD) baseline and nadir CD4+ lymphocyte counts were 553(217) and 177(117) cells/µL, respectively, and HIV RNA was <50 copies/mL in all. Median (IQR) NPZ-5 score was −0.5 (−1.2/−0) overall, and −0.3 (−0.7/0.1) and −1.4 (−2/−0.8) in subjects of Caucasian and Black ethnicity, respectively. Abnormal Frascati scores using the standard-ND were observed in 51%, 38%, and 81%, respectively, of subjects overall, Caucasian and Black ethnicity (p<0.001), but in 62% and 69% of Caucasian and Black subjects using demographically adjusted-ND (p = 0.20). In the multivariate analysis, only Black ethnicity was associated with poorer NPZ-5 scores (P<0.001). Conclusions In this large group of HIV-infected subjects with viral load suppression, ethnicity but not HIV-disease factors is closely associated with NC results. The prevalence of abnormal results is highly dependent on control datasets utilised. Trial registry ClinicalTrials.gov, NCT01230580 PMID:23646111

  12. Couch height–based patient setup for abdominal radiation therapy

    SciTech Connect

    Ohira, Shingo; Ueda, Yoshihiro; Nishiyama, Kinji; Miyazaki, Masayoshi; Isono, Masaru; Tsujii, Katsutomo; Takashina, Masaaki; Koizumi, Masahiko; Kawanabe, Kiyoto; Teshima, Teruki

    2016-04-01

    There are 2 methods commonly used for patient positioning in the anterior-posterior (A-P) direction: one is the skin mark patient setup method (SMPS) and the other is the couch height–based patient setup method (CHPS). This study compared the setup accuracy of these 2 methods for abdominal radiation therapy. The enrollment for this study comprised 23 patients with pancreatic cancer. For treatments (539 sessions), patients were set up by using isocenter skin marks and thereafter treatment couch was shifted so that the distance between the isocenter and the upper side of the treatment couch was equal to that indicated on the computed tomographic (CT) image. Setup deviation in the A-P direction for CHPS was measured by matching the spine of the digitally reconstructed radiograph (DRR) of a lateral beam at simulation with that of the corresponding time-integrated electronic portal image. For SMPS with no correction (SMPS/NC), setup deviation was calculated based on the couch-level difference between SMPS and CHPS. SMPS/NC was corrected using 2 off-line correction protocols: no action level (SMPS/NAL) and extended NAL (SMPS/eNAL) protocols. Margins to compensate for deviations were calculated using the Stroom formula. A-P deviation > 5 mm was observed in 17% of SMPS/NC, 4% of SMPS/NAL, and 4% of SMPS/eNAL sessions but only in one CHPS session. For SMPS/NC, 7 patients (30%) showed deviations at an increasing rate of > 0.1 mm/fraction, but for CHPS, no such trend was observed. The standard deviations (SDs) of systematic error (Σ) were 2.6, 1.4, 0.6, and 0.8 mm and the root mean squares of random error (σ) were 2.1, 2.6, 2.7, and 0.9 mm for SMPS/NC, SMPS/NAL, SMPS/eNAL, and CHPS, respectively. Margins to compensate for the deviations were wide for SMPS/NC (6.7 mm), smaller for SMPS/NAL (4.6 mm) and SMPS/eNAL (3.1 mm), and smallest for CHPS (2.2 mm). Achieving better setup with smaller margins, CHPS appears to be a reproducible method for abdominal patient setup.

  13. Systemic Lupus Erythematous Presenting as Catatonia and its Response to Electroconvulie Therapy

    PubMed Central

    Hussain, Arshad; Mir, Tajamul H.; Dar, Mansoor Ahmad; Naqashbandi, Javid Iqbal; Hussain, Tajamul; Bashir, Anam; Shah, Majid Shafi; Mushtaq, Raheel; Saleem, Basharat

    2015-01-01

    Neuropsychiatric systemic lupus erythematous (SLE) encompasses various psychiatric and neurological manifestations that develop in SLE patients, secondary to involvement of central nervous system. Neuropsychiatric SLE, presenting as catatonia is very uncommon, and treatment of this condition is not well defined. Previously the role of benzodiazepines, immunosuppression, plasma exchange, and electroconvulsive therapy (ECT) has been described in its management. Here we describe a case of neuropsychiatric lupus presenting as catatonia that did not respond to benzodiazepines or immunosuppression. The symptoms of catatonia showed improvement with ECT. Furthermore, we have discussed the pathology of the disorder and the role of ECT in the treatment of cases of catatonia associated with SLE, who do not respond to benzodiazepines. PMID:26702183

  14. Optimization of epoetin therapy with intravenous iron therapy in hemodialysis patients.

    PubMed

    Besarab, A; Amin, N; Ahsan, M; Vogel, S E; Zazuwa, G; Frinak, S; Zazra, J J; Anandan, J V; Gupta, A

    2000-03-01

    Iron deficiency limits the efficacy of recombinant human erythropoietin (rhEPO) therapy in end-stage renal disease (ESRD) patients. Functional iron deficiency occurs with serum ferritin >500 ng/ml and/or transferrin saturation (TSAT) of 20 to 30%. This study examines the effects of a maintenance intravenous iron dextran (ivID) protocol that increased TSAT in ESRD hemodialysis patients from conventional levels of 20 to 30% (control group) to those of 30 to 50% (study group) for a period of 6 mo. Forty-two patients receiving chronic hemodialysis completed a 16- to 20-wk run-in period, during which maintenance ivID and rhEPO were administered in amounts to achieve average TSAT of 20 to 30% and baseline levels of hemoglobin of 9.5 to 12.0 g/dl. After the run-in period, 19 patients randomized to the control group received ivID doses of 25 to 150 mg/wk for 6 mo. Twenty-three patients randomized to the study group received four to six loading doses of ivID, 100 mg each, over a 2-wk period to achieve a TSAT >30% followed by 25 to 150 mg weekly to maintain TSAT between 30 and 50% for 6 mo. Both regimens were effective in maintaining targeted hemoglobin levels. Fifteen patients in the control group and 17 patients in the study group finished the study in which the primary outcome parameter by intention to treat analysis was the rhEPO dose needed to maintain prestudy hemoglobin levels. Maintenance ivID requirements in the study group increased from 176 to 501 mg/mo and were associated with a progressive increase in serum ferritin to 658 ng/ml. Epoetin dose requirements for the study group decreased by the third month and remained 40% lower than for the control group, resulting in an overall cost savings in managing the anemia. Secondary indicators of iron-deficient erythropoiesis were also assessed. Zinc protoporphyrin did not change in either group. Reticulocyte hemoglobin content increased only in the study group from 28.5 to 30.1 pg. It is concluded that maintenance of

  15. Changes in blood chemistry in hypertensive patients during propranolol therapy.

    PubMed

    Andreasen, F; Jakobsen, P; Kornerup, H J; Pedersen, E B; Pedersen, O L; Weeke, J

    1984-03-01

    Propranolol induced changes in blood plasma chemistry were followed in thirty hypertensive patients (WHO I-II) who were seen each week during 14-15 weeks. The initial 4 weeks were a drug free period and the next 2 weeks were a drug adjustment period. After that the patients were on an unchanged propranolol dose for 8 weeks (40, 80 or 160 mg four times daily). For all observed changes the correlation was studied to (1) dose, (2) free and total simultaneously determined plasma concentration and (3) free and total average plasma concentration of unchanged drug during the preceding 24 h period. Total protein and albumin did not change significantly. After 4 and 8 weeks on the final dose orosomucoid was increased significantly (by 10%) compared with the value from the end of the drug free period. Creatinine rose significantly during the initial 4-6 weeks therapy to remain at the same level during the last 4 weeks. Urate was increased at the two lowest dose levels. Total cholesterol fell significantly (5%) while triglycerides increased significantly (16%). T4 rose significantly, T3 fell and r-T3 rose significantly in a dose dependent way. Interindividually r-T3 was the only biochemical change showing a significant relationship to the propranolol plasma concentration. The relationship reached the highest level of significance to the average 24 h free concentration.

  16. Changes in blood chemistry in hypertensive patients during propranolol therapy.

    PubMed Central

    Andreasen, F; Jakobsen, P; Kornerup, H J; Pedersen, E B; Pedersen, O L; Weeke, J

    1984-01-01

    Propranolol induced changes in blood plasma chemistry were followed in thirty hypertensive patients (WHO I-II) who were seen each week during 14-15 weeks. The initial 4 weeks were a drug free period and the next 2 weeks were a drug adjustment period. After that the patients were on an unchanged propranolol dose for 8 weeks (40, 80 or 160 mg four times daily). For all observed changes the correlation was studied to (1) dose, (2) free and total simultaneously determined plasma concentration and (3) free and total average plasma concentration of unchanged drug during the preceding 24 h period. Total protein and albumin did not change significantly. After 4 and 8 weeks on the final dose orosomucoid was increased significantly (by 10%) compared with the value from the end of the drug free period. Creatinine rose significantly during the initial 4-6 weeks therapy to remain at the same level during the last 4 weeks. Urate was increased at the two lowest dose levels. Total cholesterol fell significantly (5%) while triglycerides increased significantly (16%). T4 rose significantly, T3 fell and r-T3 rose significantly in a dose dependent way. Interindividually r-T3 was the only biochemical change showing a significant relationship to the propranolol plasma concentration. The relationship reached the highest level of significance to the average 24 h free concentration. PMID:6712860

  17. [Imaging modalities and therapy options in patients with acute flank pain].

    PubMed

    Grosse, A; Grosse, C

    2014-07-01

    The objective of this article is the description of imaging techniques for the evaluation of patients with acute flank pain and suspicion of urolithiasis and the impact of these techniques in the therapy management of patients with calculi.

  18. Computer Modelling for Better Diagnosis and Therapy of Patients by Cardiac Resynchronisation Therapy

    PubMed Central

    Pluijmert, Marieke; Lumens, Joost; Potse, Mark; Delhaas, Tammo; Auricchio, Angelo; Prinzen, Frits W

    2015-01-01

    Mathematical or computer models have become increasingly popular in biomedical science. Although they are a simplification of reality, computer models are able to link a multitude of processes to each other. In the fields of cardiac physiology and cardiology, models can be used to describe the combined activity of all ion channels (electrical models) or contraction-related processes (mechanical models) in potentially millions of cardiac cells. Electromechanical models go one step further by coupling electrical and mechanical processes and incorporating mechano-electrical feedback. The field of cardiac computer modelling is making rapid progress due to advances in research and the ever-increasing calculation power of computers. Computer models have helped to provide better understanding of disease mechanisms and treatment. The ultimate goal will be to create patient-specific models using diagnostic measurements from the individual patient. This paper gives a brief overview of computer models in the field of cardiology and mentions some scientific achievements and clinical applications, especially in relation to cardiac resynchronisation therapy (CRT). PMID:26835103

  19. [Effects of acupuncture therapy on low back pain and/or knee pain in elderly patients].

    PubMed

    Washio, M; Takasugi, S; Arai, Y

    2001-07-01

    In April 1999, 75 elderly patients (mean age: 79 years old) with low back pain and/or knee pain visited an acupuncture and physical therapy unit in a geriatric hospital. A cross-sectional study was carried out in order to evaluate the effects of acupuncture therapy on low back pain and/or knee pain in elderly patients. Among them, 60 patients answered that their pain diminished following their therapy. The proportion of patients who were treated with acupuncture therapy were higher in these 60 patients than the other 15 patients (55.5% vs. 26.7%, p = 0.05). The result suggests that acupuncture therapy may be able to relieve low back pain and/or knee pain in elderly patients. However, 46% of the patients with acupuncture therapy were also treated with other types of physical therapy. Further studies should be recommended to confirm the effects of acupuncture therapy on low back pain and/or knee pain.

  20. Manual therapy in the management of a patient with a symptomatic Morton's Neuroma: A case report.

    PubMed

    Sault, Josiah D; Morris, Matthew V; Jayaseelan, Dhinu J; Emerson-Kavchak, Alicia J

    2016-02-01

    Patients with Morton's neuroma are rarely referred to physical therapy. This case reports the resolution of pain, increase in local pressure pain thresholds, and improvement of scores on the Lower Extremity Functional Scale and Foot and Ankle Ability Measure following a course of joint based manual therapy for a patient who had failed standard conservative medical treatment.

  1. Art Therapy and Neuroscience Blend: Working with Patients Who have Dementia

    ERIC Educational Resources Information Center

    Stewart, Ellen Greene

    2004-01-01

    This paper explores findings from the fields of neuropsychology and art therapy as they relate to treating patients with dementia. It explains the biological, physical, and psychological manifestations of dementia, and current treatment modalities. Art therapy has been shown to be beneficial to patients with dementia. Unfortunately, it is the rare…

  2. Art Therapy with a Hemodialysis Patient: A Case Analysis. Brief Report

    ERIC Educational Resources Information Center

    Nishida, Miki; Strobino, Jane

    2005-01-01

    Art therapy has been used to support the coping skills of patients with various medical illnesses. The purpose of this case study was to examine the usefulness of art therapy in promoting communication and a positive sense of well-being in a hemodialysis patient. The participant was a 57-year-old Caucasian female who had been treated with…

  3. Prokinetic Therapy Reduces Aspiration Pneumonia in Tube-Fed Patients With Severe Developmental Disabilities

    ERIC Educational Resources Information Center

    Pareek, Namita; Williams, John; Hanna, Deborah; Johnson, William D.; Minocha, Anil; Abell, Thomas L.

    2007-01-01

    To evaluate the clinical benefit of prokinetic therapy in aspiration pneumonia in patients with developmental disabilities, we conducted a retrospective study; records of 22 tube-fed patients were reviewed from December 1990 to October 1998 for a mean of 22.7 months before and 38.9 months during Cisapride therapy. Numbers of hospital admissions…

  4. High-dose fractionated radiation therapy for select patients with brain metastases

    SciTech Connect

    Pezner, R.D.; Lipsett, J.A.; Archambeau, J.O.; Fine, R.M.; Moss, W.T.

    1981-08-01

    Four patients with metastases to the brain were treated by high-dose fractionated radiation therapy. In all four cases, a complete response and prolonged disease-free survival could be documented. Unlike the standard therapy for such patients (i.e., craniotomy and postoperative irradiation), high-dose fractionated radiation therapy carries no operative risk and can encompass multiple brain metastases and metastases in deep or critical intracranial sites. The risk of radiotherapy side effects in the brain is discussed.

  5. Empirically-supported and non-empirically supported therapies for bulimia nervosa: retrospective patient ratings

    PubMed Central

    2013-01-01

    Background Empirically supported therapies for bulimia nervosa include cognitive behaviour therapy and interpersonal therapy. Whilst these treatments have been shown to be effective in multiple randomised controlled trials, little research has investigated how they are perceived by patients who receive them. This study investigated whether empirically-supported psychological therapies (ESTs) are associated with superior self-rated treatment outcomes in clients with Bulimia Nervosa (BN). Results 98 adults who had received psychological therapy for BN in the United Kingdom completed a questionnaire which retrospectively assessed the specific contents of their psychological therapy and self-rated treatment outcomes. Around half the sample, fifty three participants reported receiving an EST. Fifty of these received Cognitive Behaviour Therapy (CBT) and three Interpersonal Therapy (IPT). Where therapy met expert criteria for Cognitive Behaviour Therapy for Bulimia Nervosa (CBT-BN, an EST) participants reported superior treatment outcomes than those who appeared to receive non-specialist cognitive-behavioural therapy. However, self-rated treatment outcomes were similar overall between those whose therapy met criteria for ESTs and those whose therapy did not. Conclusions The findings offer tentative support for the perceived helpfulness of CBT-BN as evaluated in controlled research trials. Cognitive-behavioural therapies for BN, as they are delivered in the UK, may not necessarily be perceived as more beneficial by clients with BN than psychological therapies which currently have less empirical support. PMID:24999419

  6. Palliative radiation therapy in patients with metastasized pancreatic cancer - description of a rare patient group

    PubMed Central

    2014-01-01

    Background Pancreatic cancer (PAC) patients experience a high rate of locoregional recurrences and distant metastasis finally leading to their demise even after curatively-intended multidisciplinary treatment approaches including surgery, chemotherapy and radiotherapy. However, clinical reports on bone and brain metastases in PAC patients are extremely rare and thus timing and dose description are not well defined. Our work therefore summarizes a mono-institutional experience on the use of radiotherapy (RT) for PAC patients with metastatic disease with the aim of identifying overall survival and treatment response in this rarely reported patient group. Method Forty-four PAC patients with 66 metastatic lesions were treated with palliative radiotherapy (RT). Thirty-three patients (48 lesions), 7 patients (11 lesions) and 5 patients (7 lesions) with bone, liver and brain metastases analyzed respectively were analyzed; one patient had both bone and cerebral metastases and was treated for the lesions, thus including him in both subgroups. Indications for RT were pain, neurological impairment, risk of pathological fracture or imminent danger for development of any of these conditions in case of tumor progression. Median age was 64 years (range 38 to 78 years) and there were 27 male (61%) and 17 (39%) female patients. Analyses of overall survival (OS) and local control were performed. OS was calculated from the first day of RT. Results Median overall survival (mOS) of all patients after start of RT was 4.2 months. Survival rates after 1, 3 and 6 months were 79.3%, 55.3% and 30.3% respectively. Patients presenting with bone metastasis had a mOS of 3.1 months and after 1, 3 and 6 months, survival rates were 75.3%, 46.5% and 19.9% respectively. Symptomatic response to therapy was recorded in 85% of all evaluated patients with bone metastasis. Patients undergoing radiosurgery because of liver metastasis were locally controlled in all but one patient after a median follow

  7. Functional outcome in acute stroke patients with oropharyngeal Dysphagia after swallowing therapy.

    PubMed

    Huang, Kun-Ling; Liu, Ting-Yuan; Huang, Yu-Chi; Leong, Chau-Peng; Lin, Wei-Che; Pong, Ya-Ping

    2014-01-01

    Dysphagia after stroke is associated with mortality and increased pulmonary complications. Swallowing therapies may decrease pulmonary complications and improve patients' quality of life after stroke. This study used clinical swallowing assessments and videofluoroscopy (VFS) to assess the functional recovery of acute stroke patients with dysphagia after different swallowing therapies. We enrolled 29 acute stroke patients with dysphagia and randomly divided them into 3 therapy groups: traditional swallowing (TS), oropharyngeal neuromuscular electrical stimulation (NMES), and combined NMES/TS. All patients were assessed using the clinical functional oral intake scale (FOIS), 8-point penetration-aspiration scale (PAS), and functional dysphagia scale (FDS) of VFS before and after treatment. There were no differences in the clinical parameters and swallowing results of the FOIS and VFS before swallowing treatment among the 3 groups (P > .05). TS therapy and combined therapy both had significant swallowing improvement after therapy according to the FOIS and 8-point PAS (P < .05). When comparing the results of the VFS among the 3 groups, we found significant improvements in patients eating cookies and thick liquid after combined NMES/TS therapy (P < .05). In acute stroke patients with dysphagia, combined NMES/TS therapy is the most effective swallowing therapy in taking solid diets and thick liquids.

  8. [The enzyme therapy within a complex treatment of hemophthalmos in patients with diabetes mellitus].

    PubMed

    Polunin, G S; Andzhelova, D V; Kiseleva, T N

    2004-01-01

    The efficiency of the enzyme therapy was studied in patients with hemophthalmos concurrent with diabetes mellitus of different types. Sixty-eight patients received parabulbar injections of the hemase and collelizin enzymes and another 25 patients underwent the routine therapy comprising injections of dicynone, emoxipin and heparinum. The method of ultrasound B-scanning was used to determine the area of hemorrhage spread into the vitreous body. A high efficiency of the enzyme therapy, as used within the complex treatment of hemophthalmos in patients with diabetes mellitus, was demonstrated. Ultrasound B-scanning is a highly informative technique in evaluating the enzyme-therapy efficiency. The enzyme therapy can be recommended as the most effective method for the treatment of hemophthalmos in patients with diabetes mellitus.

  9. Constraint-induced movement therapy promotes brain functional reorganization in stroke patients with hemiplegia

    PubMed Central

    Wang, Wenqing; Wang, Aihui; Yu, Limin; Han, Xuesong; Jiang, Guiyun; Weng, Changshui; Zhang, Hongwei; Zhou, Zhiqiang

    2012-01-01

    Stroke patients with hemiplegia exhibit flexor spasms in the upper limb and extensor spasms in the lower limb, and their movement patterns vary greatly. Constraint-induced movement therapy is an upper limb rehabilitation technique used in stroke patients with hemiplegia; however, studies of lower extremity rehabilitation are scarce. In this study, stroke patients with lower limb hemiplegia underwent conventional Bobath therapy for 4 weeks as baseline treatment, followed by constraint-induced movement therapy for an additional 4 weeks. The 10-m maximum walking speed and Berg balance scale scores significantly improved following treatment, and lower extremity motor function also improved. The results of functional MRI showed that constraint-induced movement therapy alleviates the reduction in cerebral functional activation in patients, which indicates activation of functional brain regions and a significant increase in cerebral blood perfusion. These results demonstrate that constraint-induced movement therapy promotes brain functional reorganization in stroke patients with lower limb hemiplegia. PMID:25337108

  10. Evaluation of Helicobacter Pylori eradication in pediatric patients by triple therapy plus lactoferrin and probiotics compared to triple therapy alone

    PubMed Central

    2012-01-01

    Background To evaluate whether the addition of a probiotic could improve Helicobacter pylori (H.P.) eradication rates and reduce the side effects of treatment in children. Methods Between July 2008 and July 2011 all patients with a clinical, laboratory and endoscopic diagnosis of H.P. positive gastritis referred to our Unit were included in the study. Patients suffering from allergy to any of drugs used in the study, with previous attempts to eradicate H.P. and those who received antibiotics, PPIs or probiotics within 4 weeks were excluded from the present study. Patients were randomized into two therapy regimens (group A and B): both groups received standard triple treatment (omeprazole, amoxicillin and clarithromycin) while only group B patients were also given a probiotic (Probinul - Cadigroup). Patients compliance was evaluated at the end of the treatment. Successful eradication was defined as a negative 13 C-urea breath test (C13-ubt) result four weeks after therapy discontinuation. Results A total of 68 histopathologically proven H.P.-infection children (32 male and 36 females) were included in the study. All of the patients in both groups used more than 90% of the therapies and no patients were lost at follow up. All side effects were selflimiting and disappeared once the therapy was terminated. Epigastric pain was observed in 6 (17.6%) group A vs 2 (5.8%) group B patients (P<0.05), nausea in 3 (8.8%) group A vs 1 (2.9%) group B patients (P<0.05); vomiting and diarrhea were observed in 2(5.8%) and 8 (23.5%) group A patients, respectively and never in group B (P<0.05). There was no significant difference between the two groups in terms of constipation (5.8% in group A and B). Four weeks after the completion of therapy, 56/68 patients (82.3%) tested negative for H.P. on C13-ubt. H.P. was eradicated in 26 patients (76.4%) in group A and in 30 patients (88.2%) in group B. There was no significantly difference in the rate of H.P. eradication between group A and

  11. Risk Factors for Developing Hyponatremia in Thyroid Cancer Patients Undergoing Radioactive Iodine Therapy

    PubMed Central

    Lee, Jung Eun; Kim, Seung Kyu; Han, Kyung Hwa; Cho, Mi Ok; Yun, Gi Young; Kim, Ki Hyun; Choi, Hoon Young; Ryu, Young Hoon; Ha, Sung Kyu; Park, Hyeong Cheon

    2014-01-01

    Background Due to the alarming increase in the incidence of thyroid cancer worldwide, more patients are receiving postoperative radioactive iodine (RAI) therapy and these patients are given a low-iodine diet along with levothyroxine withdrawal to induce a hypothyroid state to maximize the uptake of RAI by thyroid tissues. Recently, the reported cases of patients suffering from life-threatening severe hyponatremia following postoperative RAI therapy have increased. This study aimed to systematically assess risk factors for developing hyponatremia following RAI therapy in post-thyroidectomy patients. Methods We reviewed the medical records of all thyroid cancer patients who underwent thyroidectomy and postoperative RAI therapy from July 2009 to February 2012. Demographic and biochemical parameters including serum sodium and thyroid function tests were assessed along with medication history. Results A total of 2229 patients (47.0±11.0 years, female 76.3%) were enrolled in the analysis. Three hundred seven patients (13.8%) of all patients developed hyponatremia; 44 patients (2.0%) developed moderate to severe hyponatremia (serum Na+≤130 mEq/L) and another 263 (11.8%) patients showed mild hyponatremia (130 mEq/Ltherapy were significantly associated with hyponatremia in patients undergoing RAI therapy after total thyroidectomy. Multivariate analysis showed that old age, female sex, use of thiazide diuretics, and hyponatremia at the initiation of RAI therapy were independent risk factors for the development of hyponatremia. Conclusion Our data suggest that age greater than 60 years, female sex, use of thiazide, and hyponatremia at the initiation of

  12. Pretreatment with betamethasone of patients with Graves' disease given radioiodine therapy: thyroid autoantibody responses and outcome of therapy

    SciTech Connect

    Gamstedt, A.; Karlsson, A. )

    1991-07-01

    The effects of betamethasone on thyroid autoantibody responses and outcome of radioiodine therapy were determined over a period of 1 yr in a prospective randomized study of 40 patients with Graves' disease. Twenty patients were given placebo tablets, and 20 patients were treated with betamethasone from 3 weeks before until 4 weeks after {sup 131}I therapy. At the time of inclusion in the study, the mean serum concentrations of TSH receptor antibodies, thyroid peroxidase antibodies, and thyroglobulin antibodies (TgAb) were increased in both groups. Three weeks of treatment with betamethasone reduced the thyroid peroxidase antibody and TgAb titers as well as the serum concentrations of thyroid hormones. A decrease in the TSH receptor antibody level was not statistically significant. After radioiodine therapy, transient increases in thyroid autoantibody levels were observed. The titers of the different antibodies generally changed in parallel. In some patients a detectable level of a given antibody was found only after the radioiodine treatment, and in two cases, TgAb did not appear at all, although the two other antibodies increased temporarily. Betamethasone delayed, but did not abolish, the {sup 131}I-induced antibody peaks. Betamethasone also caused a reduction in the total serum immunoglobulin G, a reduction which persisted throughout the study period. When the study ended, 17 patients given placebo and 9 patients given betamethasone were receiving replacement therapy due to the development of hypothyroidism. These patients at this point in time had lower antibody levels than those not requiring T4. The results of this study demonstrate that betamethasone reduces and modifies the thyroid autoantibody responses as well as the outcome of radioiodine therapy in patients with Graves' disease.

  13. Anticoagulant therapy in pregnant patients with metabolic syndrome: a review.

    PubMed

    Mierzynski, Radzisław; Poniedzialek-Czajkowska, Elzbieta; Kimber-Trojnar, Zaneta; Leszczynska-Gorzelak, Bozena; Oleszczuk, Jan

    2014-01-01

    Pregnancy is a specific state of heightened coagulability related to the increase in procoagulant agents and to the reduced fibrinolysis. Pregnancy is associated with a 4-fold increased risk of developing venous thromboembolism (VTE) and this risk still increases to 14-fold during puerperium. A correlation between the metabolic syndrome and development of cardiovascular events and cerebrovascular incidents has been described. Such a relationship is referred to a hypercoagulable state due to increased serum levels of the plasminogen activator inhibitor-1 (PAI-1), fibrinogen, factor (F) VII and VIII, von Willebrand factor and from endothelial activation, caused by increased circulating adhesion molecules. As to the risk of VTE, the probability for its association with cardiovascular incidents is increased by common underlying mechanisms such as the activation of platelets and the blood coagulation. A correlation between idiopathic VTE and the metabolic syndrome has been reported. The anticoagulant therapy may be recommended during the pregnancy for the treatment or the prophylaxis of VTE and, in women with artificial heart valves, for the prevention of the valve thrombosis and systemic embolisation. There are also specific conditions during pregnancy which benefit from anticoagulant use, such as recurrent fetal loss, thrombophilia and assisted reproductive technology. There are no published specific data about using of anticoagulant agents in pregnant patients with the metabolic syndrome except for a few articles addressing reproductive problems. The mechanisms of anticoagulant action were studied with the focus on heparinoids, because of their safety not only for the patient but also for the fetus. The new oral anticoagulants were also shortly described although they have been contraindicated during the pregnancy.

  14. Anticonvulsant activity of bone marrow cells in electroconvulsive seizures in mice

    PubMed Central

    2013-01-01

    Background Bone marrow is an accessible source of progenitor cells, which have been investigated as treatment for neurological diseases in a number of clinical trials. Here we evaluated the potential benefit of bone marrow cells in protecting against convulsive seizures induced by maximum electroconvulsive shock (MES), a widely used model for screening of anti-epileptic drugs. Behavioral and inflammatory responses were measured after MES induction in order to verify the effects promoted by transplantation of bone marrow cells. To assess the anticonvulsant effects of bone marrow cell transplantation, we measured the frequency and duration of tonic seizure, the mortality rate, the microglial expression and the blood levels of cytokine IL-1, IL-6, IL-10 and TNF-α after MES induction. We hypothesized that these behavioral and inflammatory responses to a strong stimulus such as a convulsive seizure could be modified by the transplantation of bone marrow cells. Results Bone marrow transplanted cells altered the convulsive threshold and showed anticonvulsant effect by protecting from tonic seizures. Bone marrow cells modified the microglial expression in the analyzed brain areas, increased the IL-10 and attenuate IL-6 levels. Conclusions Bone marrow cells exert protective effects by blocking the course of electroconvulsive seizures. Additionally, electroconvulsive seizures induced acute inflammatory responses by altering the pattern of microglia expression, as well as in IL-6 and IL-10 levels. Our findings also indicated that the anticonvulsant effects of these cells can be tested with the MES model following the same paradigm used for drug testing in pharmacological screening. Studies on the inflammatory reaction in response to acute seizures in the presence of transplanted bone marrow cells might open a wide range of discussions on the mechanisms relevant to the pathophysiology of epilepsies. PMID:24011127

  15. Model for monitoring the process of photodynamic therapy in patients

    NASA Astrophysics Data System (ADS)

    Yoshida, Takato O.; Kohno, Eiji; Sakurai, Takashi; Hirano, Toru; Yamamoto, Seiji; Terakawa, Susumu

    2005-07-01

    The photodynamic therapy (PDT) on tumors is quite effective and widely applied but usually carried out without an immediate evaluation of results. We measured the tumor fluorescence in mice with a fiber probe connected to a linear array spectral analyzer (PMA-11, Hamamatsu Photonics). The spectrum showed a transient change in fluorescence color from red to green during Photofrin○R-mediated PDT. In order to examine the source of green fluorescence, the mitochondria were accessed under a Nipkow disk-scanning confocal microscope in the HeLa cell in culture after labeling them with a red fluorescent protein (DsRed1-mito) and staining the cell with Photofrin○R (Axcan Scandipharm). Changes in fluorescence color from red to green were observed in the area of mitochondria upon their swelling during irradiation. This finding in vitro provided clear evidence that the change in fluorescence color from red to green observed in vivo was due to the mitochondrial destruction associated with the cell-death by PDT. This technique of spectral monitoring in tumor may be useful for detection of the cell-death signal during PDT in patients.

  16. Selection of patients with acute pulmonary embolism for thrombolytic therapy. Thrombolysis in pulmonary embolism (TIPE) patient survey. The TIPE Investigators.

    PubMed

    Terrin, M; Goldhaber, S Z; Thompson, B

    1989-05-01

    During a recent one-year period, 44 clinical centers in the United States saw 2,539 patients with diagnoses of pulmonary embolism as supported by high probability lung scans and/or positive pulmonary angiograms. In developing proposals for a clinical trial of Thrombolysis in Pulmonary Embolism (TIPE), investigators in the 44 clinical centers reviewed the 2,539 patients' medical charts for contraindications to thrombolytic therapy. Overall, 1,345 (53.5%) patients surveyed in the TIPE clinical centers would have been acceptable for treatment with thrombolytic therapy, a proportion higher than generally anticipated. Risks of major blood loss were the most frequent contraindications to thrombolytic therapy and were found in 838 (33.3%) patients. Risks to the CNS were found to contraindicate thrombolytic therapy in 453 (17.9%) patients. Risks of bleeding into special compartments were found to contraindicate thrombolytic therapy in 76 (3.0%) patients. Pulmonary embolism is underdiagnosed in most clinical settings, and even more patients than found in the TIPE survey could benefit from appropriate diagnosis and treatment. The question remains as to whether pulmonary embolism patients will benefit from thrombolytic therapy. Only a randomized clinical trial will provide a satisfactory answer.

  17. [Advances in the research of effects of music therapy on pain and anxiety in burn patients].

    PubMed

    Jinyi, Li; Yungui, Wang

    2015-06-01

    Pain and anxiety engender major psychic problems during all phases of treatment for burn patients. Analgesic alone does not allay these problems satisfactorily in these patients. Music therapy, as an important complementary and alternative therapy, has been widely used in multiple medical fields. However, its positive effect on alleviation of pain and anxiety in burn patients is undefined. The objective of this review is to summarize the feasibility, application fields, methods, and the effectiveness of music therapy in allaying pain and anxiety of burn patients during the whole course of treatment.

  18. Vitiligo patients seeking depigmentation therapy: a case report and guidelines for psychological screening.

    PubMed

    Grau, Carmen; Silverberg, Nanette B

    2013-05-01

    Vitiligo is characterized by a loss of cutaneous and mucosal pigmentation and often is associated with psychological distress. Depigmentation therapy can be used to eliminate residual pigment, thereby creating an evenly depigmented skin tone. Patients often seek depigmentation therapy to even their skin tone when a large body surface area is affected by vitiligo or when exposed areas (eg, face, hands) are affected and do not respond to repigmentation therapy. Psychological screening of patients is recommended when considering depigmentation therapy for vitiligo. We report the case of a 24-year-old man with vitiligo who sought depigmentation therapy and withheld crucial information regarding his psychiatric and medication history. We also provide guidelines for a rational approach to psychocutaneous screening of patients with vitiligo seeking depigmentation therapy.

  19. [Patients' experiences and picture processes during the art therapy in a psychosomatic day hospital].

    PubMed

    Oster, Jörg; Poetsch, Stephanie; Danner-Weinberger, Alexandra; von Wietersheim, Jörn

    2014-02-01

    The aim of this study was the examination of the experiences of patients participating in an art therapy during a psychosomatic day hospital. The data basis were 15 transliterated interviews from the end of the treatment, conducted with a presentation of the pictures painted in the art therapy sessions, as well as the digitised pictures. The evaluation was done with a qualitative analysis of the interviews and an analysis of the pictures, using a specially-developed category system. In the art therapy, most part of the pa-tients dealt with own conflicts. Nearly all pa-tients benefitted from the art therapy and indicated an improvement of their feeling. The picture processes are different; at the beginning, wishes and familiar techniques dominated. Pictures of turning points differed in their dimensions. The art therapy was seen as a part of the complete treatment in which several therapies assembled. The final interviews were experienced as helpful for further reflections.

  20. Improving adherence to hormone replacement therapy with effective patient-physician communication.

    PubMed

    Sarrel, P M

    1999-03-01

    Surgically menopausal women are 5 times more likely to begin hormone replacement therapy than are naturally menopausal women, and they continue therapy for longer periods. The primary reasons that women refuse hormone replacement are fear of cancer and perceived side effects. In contrast, withdrawal bleeding is the major reason that women discontinue hormone replacement therapy. Physician-patient communication plays an important role in a woman's decision to use hormone replacement therapy, to fill her prescription, and to adhere to the regimen. The first visit at which hormone replacement therapy is discussed is crucial to establishing an effective patient-physician relationship. At least 15 minutes, and preferably 45 minutes, should be reserved for this visit. Patient follow-up-either by phone or in person-during the first month can help improve adherence because this is when many women may have nuisance side effects and discontinue therapy.

  1. Language Discordance and Patient- Centered Care in Occupational Therapy: A Case Study.

    PubMed

    Martinez, Jenny; Leland, Natalie

    2015-04-01

    The accumulative burden of a growing non-English speaking minority population and health disparities in the United States demonstrate the urgency of examining occupational therapy practices and defining care that is timely, effective, safe, and patient-centered. In this context, we investigate an occupational therapy episode of care from the perspectives of patient, caregiver, and primary occupational therapy care provider. Treatment sessions were observed and one-on-one semistructured interviews were conducted with the participants. Several themes describing areas of concern in communication and care delivery emerged, including expectations for care, the therapy relationship, professional identity, and pragmatic constraints. The use of untrained interpreters compromised treatment effectiveness and safety. This case highlights potential areas of concern in therapy when working with a diverse patient population. Abundant opportunities exist for occupational therapy to situate itself as an equitable, responsive, valuable, and essential service.

  2. Ceiling art in a radiation therapy department: its effect on patient treatment experience

    PubMed Central

    Bonett, Jotham

    2015-01-01

    Introduction A new initiative has been implemented at the Sunshine Hospital Radiation Therapy Centre, to provide a calming and comforting environment for patients attending radiation therapy treatment. As part of this initiative, the department's computed tomography (CT) room and radiation therapy bunkers were designed to incorporate ceiling art that replicates a number of different visual scenes. The study was undertaken to determine if ceiling art in the radiation therapy treatment CT and treatment bunkers had an effect on a patient's experience during treatment at the department. Additionally, the study aimed to identify which of the visuals in the ceiling art were most preferred by patients. Methods Patients were requested to complete a 12-question survey. The survey solicited a patient's opinion/perception on the unit's unique ceiling display with emphasis on aesthetic appeal, patient treatment experience and the patient's engagement due to the ceiling display. The responses were dichotomised to ‘positive’ or ‘negative’. Every sixth patient who completed the survey was invited to have a general face-to-face discussion to provide further information about their thoughts on the displays. Results The results demonstrate that the ceiling artwork solicited a positive reaction in 89.8% of patients surveyed. This score indicates that ceiling artwork contributed positively to patients’ experiences during radiation therapy treatment. Conclusion The study suggests that ceiling artwork in the department has a positive effect on patient experience during their radiation therapy treatment at the department. PMID:26451241

  3. Ceiling art in a radiation therapy department: its effect on patient treatment experience

    SciTech Connect

    Bonett, Jotham

    2015-09-15

    A new initiative has been implemented at the Sunshine Hospital Radiation Therapy Centre, to provide a calming and comforting environment for patients attending radiation therapy treatment. As part of this initiative, the department's computed tomography (CT) room and radiation therapy bunkers were designed to incorporate ceiling art that replicates a number of different visual scenes. The study was undertaken to determine if ceiling art in the radiation therapy treatment CT and treatment bunkers had an effect on a patient's experience during treatment at the department. Additionally, the study aimed to identify which of the visuals in the ceiling art were most preferred by patients. Patients were requested to complete a 12-question survey. The survey solicited a patient's opinion/perception on the unit's unique ceiling display with emphasis on aesthetic appeal, patient treatment experience and the patient's engagement due to the ceiling display. The responses were dichotomised to ‘positive’ or ‘negative’. Every sixth patient who completed the survey was invited to have a general face-to-face discussion to provide further information about their thoughts on the displays. The results demonstrate that the ceiling artwork solicited a positive reaction in 89.8% of patients surveyed. This score indicates that ceiling artwork contributed positively to patients’ experiences during radiation therapy treatment. The study suggests that ceiling artwork in the department has a positive effect on patient experience during their radiation therapy treatment at the department.

  4. Patients' perspectives on self-testing of oral anticoagulation therapy: Content analysis of patients' internet blogs

    PubMed Central

    2011-01-01

    Background Patients on oral anticoagulant therapy (OAT) require regular testing of the prothrombin time (PT) and the international normalised ratio (INR) to monitor their blood coagulation level to avoid complications of either over or under coagulation. PT/INR can be tested by a healthcare professional or by the patient. The latter mode of the testing is known as patient self-testing or home testing. The objective of this study was to elicit patients' perspectives and experiences regarding PT/INR self-testing using portable coagulometer devices. Methods Internet blog text mining was used to collect 246 blog postings by 108 patients, mainly from the USA and the UK. The content of these qualitative data were analysed using XSight and NVivo software packages. Results The key themes in relation to self-testing of OAT identified were as follows: Patient benefits reported were time saved, personal control, choice, travel reduction, cheaper testing, and peace of mind. Equipment issues included high costs, reliability, quality, and learning how to use the device. PT/INR issues focused on the frequency of testing, INR fluctuations and individual target (therapeutic) INR level. Other themes noted were INR testing at laboratories, the interactions with healthcare professionals in managing and testing OAT and insurance companies' involvement in acquiring the self-testing equipment. Social issues included the pain and stress of taking and testing for OAT. Conclusions Patients' blogs on PT/INR testing provide insightful information that can help in understanding the nature of the experiences and perspectives of patients on self-testing of OAT. The themes identified in this paper highlight the substantial complexities involved in self-testing programmes in the healthcare system. Thus, the issues elicited in this study are very valuable for all stakeholders involved in developing effective self-testing strategies in healthcare that are gaining considerable current momentum

  5. Ovarian cancer: contribution of radiation therapy to patient management: Erskine Memorial Lecture, 1983

    SciTech Connect

    Bush, R.S.

    1984-10-01

    Ovarian cancer may be treated with radiation therapy, surgery, chemotherapy, or a combination. To evaluate the contribution of radiation therapy to patient management the cure rate must be estimated; data are presented suggesting that the 5-year survival rate provides a reasonable estimate of the cure rate. A study of patients treated since 1971 showed that stage and postoperative residuum could be used to divide patients into two subgroups, a poor prognosis group and a good prognosis group; a multifactorial grouping of patients in the good prognosis group who were treated postoperatively with radiation therapy only was further able to divide patients into low-risk, intermediate-risk, and high-risk groups. Studies of radiation therapy for different subgroups are discussed; abdominopelvic irradiation has been shown to improve survival for approximately one-third of patients with cancer of the ovary.

  6. [Features of fluor intoxication development in patients with nondifferentiated connective tissue dysplasia and physical therapy methods for these patients].

    PubMed

    Tereshina, L G; Budkar', L N; Obukhova, T Iu; Bugaeva, I V; Karpova, E A

    2013-01-01

    The article covers results of studies concerning time of fluorosis development in patients with signs of connective tissue dysplasia syndrome (CTDS). if compared with patients without CTDS, and of studies concerning hyperostosis coefficient in accordance with presence or absence of CTDS. Efficiency of physical therapy and balneotherapy for these patients are also reported by the authors.

  7. Personality Disorder Patients' Perspectives on the Introduction of Imagery within Schema Therapy: A Qualitative Study of Patients' Experiences

    ERIC Educational Resources Information Center

    ten Napel-Schutz, Marieke C.; Abma, Tineke A.; Bamelis, Lotte; Arntz, Arnoud

    2011-01-01

    A qualitative study was done on patients' perspectives on the first phases of imagery work in the context of schema therapy (ST) for personality disorders. Patients participated in a multi-center randomized controlled study of the effectiveness of ST. Patients' experiences and opinions were collected with semistructured in-depth interviews at the…

  8. Physical therapy methods in the treatment and rehabilitation of cancer patients

    NASA Astrophysics Data System (ADS)

    Kucherova, T. Ya.; Velikaya, V. V.; Gribova, O. V.; Startseva, Zh. A.; Choinzonov, E. L.; Tuzikov, S. A.; Vusik, M. V.; Doroshenko, A. V.

    2016-08-01

    The results of the effective use of magnetic laser therapy in the treatment and rehabilitation of cancer patients were presented. The effect of magnetic-laser therapy in the treatment of radiation-induced reactions in the patients with head and neck cancer and in the patients with breast cancer was analyzed. High efficiency of lymphedema and lymphorrhea treatment in the postoperative period in the patients with breast cancer was proved. The results of rehabilitation of the patients with gastric cancer after surgical treatment were presented. These data indicate a high effectiveness of different physical methods of treatment and rehabilitation of cancer patients.

  9. Patient satisfaction with single-tooth implant therapy in the esthetic zone.

    PubMed

    Hartog, Laurens; Meijer, Henny J A; Santing, Hendrick J; Vissink, Arjan; Raghoebar, Gerry M

    2014-01-01

    This prospective study assessed patient satisfaction before and after single-tooth implant therapy in the esthetic zone. Before implant therapy, patients wore an acrylic resin tissue-supported removable partial denture (RPD). A total of 153 patients were included. Self-administered questionnaires regarding function, comfort, and esthetics were used to measure patient satisfaction with the RPD and with the implant at 6 and 18 months post-implant placement. Overall satisfaction was explored with a visual analog scale. It was suggested that patient satisfaction with a single-tooth implant in the esthetic zone is high and it improved when compared with an RPD that patients wore before implant treatment.

  10. Effects of upper limb robot-assisted therapy in the rehabilitation of stroke patients.

    PubMed

    Yoo, Doo Han; Kim, Se Yun

    2015-03-01

    [Purpose] The aim of this study was to examine the effects of upper limb robot-assisted therapy in the rehabilitation of stroke patients. [Subjects and Methods] Fifteen stroke patients with no visual or cognitive problems were enrolled. All subjects received robot-assisted therapy and comprehensive rehabilitation therapy for 30 minutes each. The experimental group received a conventional therapy and an additional half hour per weekday of robot therapy. The patients participated in a total of 20 sessions, each lasting 60 minutes (conventional therapy 30 min, robot-assisted therapy 30 min), which were held 5 days a week for 4 weeks. [Result] The patients showed a significant difference in smoothness and reach error of the point to point test, circle size and independence of the circle in the circle test, and hold deviation of the playback static test between before and after the intervention. On the other hand, no significant difference was observed in the displacement of the round dynamic test. The patients also showed significant improvement in the Fugl-Meyer Assessment and Modified Barthel Index after the intervention. [Conclusion] These kinematic factors can provide good information when analyzing the upper limb function of stroke patients in robot-assisted therapy. Nevertheless, further research on technology-based kinematic information will be necessary.

  11. Postoperative hormonal therapy prevents recovery of neurological damage after surgery in patients with breast cancer

    PubMed Central

    Sekiguchi, Atsushi; Sato, Chiho; Matsudaira, Izumi; Kotozaki, Yuka; Nouchi, Rui; Takeuchi, Hikaru; Kawai, Masaaki; Tada, Hiroshi; Ishida, Takanori; Taki, Yasuyuki; Ohuchi, Noriaki; Kawashima, Ryuta

    2016-01-01

    Cancer survivors are exposed to several risk factors for cognitive dysfunction, such as general anesthesia, surgical trauma, and adjuvant therapies. In our recent study we showed that thalamic volume reduction and attentional dysfunction occurred shortly after surgery. Here, we examined the 6-month prognosis of the 20 patients with breast cancer who underwent surgery. Seven patients did not receive any adjuvant therapy after the surgery and 13 patients received a hormonal therapy after the surgery. We assessed their attentional functions, and thalamic volumes shortly after and 6 months after surgery. We found a significant group x time interaction in the attentional functions (p = 0.033) and the right thalamus (p <  0.05, small volume correction), suggesting the thalamic volume reduction and attentional dysfunction recovered in patients without adjuvant therapy. Our findings provide a better understanding of the potential role of hormonal therapy in relation to the cognitive dysfunction of cancer survivors. PMID:27708377

  12. [The predictors of resistance to standard drug therapy in patients with hypertension and heart valve calcification].

    PubMed

    Iuzvyshyna, O V

    2013-06-01

    The article presents results of their research to identify predictors of resistance to drug therapy in patients with essential hypertension (EH) and heart valves calcifications (HVC). Presented prognostic scale for selecting patients at high risk of resistance to drug therapy, through regression analysis. Designed the certain prognostic algorithm that will provide an opportunity practitioners to properly build tactics of treatment in patients with EH and HVC.

  13. Effects of electrical stimulation therapy on the blood flow in chronic critical limb ischemia patients following regenerative therapy

    PubMed Central

    Yamabata, Shiho; Shiraishi, Hirokazu; Munechika, Mai; Fukushima, Hideki; Fukuoka, Yoshiyuki; Hojo, Tatsuya; Shirayama, Takeshi; Horii, Motoyuki; Matoba, Satoaki; Kubo, Toshikazu

    2016-01-01

    Objectives: We investigated the effects of electrical stimulation therapy on cutaneous and muscle blood flow in critical limb ischemia patients following regenerative therapy. Methods: Three groups were studied: 10 healthy young subjects, 10 elderly subjects, and 7 critical limb ischemia patients after regenerative therapy. After 5 min rest, electrical stimulation was applied at 5 Hz on the tibialis anterior muscle for 10 min. We estimated the relative changes in oxyhemoglobin and total hemoglobin compared to the basal values at rest (Δ[HbO2], Δ[Hbtot]), which reflected the blood flow in the skin and muscle layer, and we simultaneously measured the tissue O2 saturation (StO2) throughout the electrical stimulation and recovery phase by near-infrared spectroscopy. Results: The Δ[HbO2] and Δ[Hbtot] values of the muscle layer in critical limb ischemia patients increased gradually and remained significantly higher at the 5-min and 10-min recovery periods after the electrical stimulation without reducing the StO2, but there is no significant change in the other two groups. Skin blood flow was not influenced by electrical stimulation in three groups. Conclusion: This improvement of the peripheral circulation by electrical stimulation would be beneficial as the adjunctive therapy after regenerative cell therapy. PMID:27504185

  14. The long-term effects of radiation therapy on patients with ovarian dysgerminoma

    SciTech Connect

    Mitchell, M.F.; Gershenson, D.M.; Soeters, R.P.; Eifel, P.J.; Delclos, L.; Wharton, J.T. )

    1991-02-15

    A retrospective chart review and questionnaire study was undertaken to look at the long-term effects of radiation therapy in ovarian dysgerminoma patients. Forty-three patients and 55 controls responded to a questionnaire that detailed bowel, bladder, thyroid, menstrual, reproductive, sexual, and growth function. Statistically significant differences in the number of bowel movements were noticed when comparing patients with controls. The authors noticed no significant differences between cases and controls in bladder function. No thyroid disorders were attributable to mediastinal radiation therapy. Most patients with intact uteri bleed monthly on hormonal replacement. Three patients with a remaining ovary and uterus resumed menstrual function after substantial doses of abdominopelvic radiation therapy. No patients have conceived. The authors noticed a slight increase in dyspareunia in the treated group, but most patients were satisfied with their sexual function. One premenarchal patient exhibited a growth disorder.

  15. [An advanced metastatic breast cancer patient successfully treated with combination therapy including docetaxel, doxorubicin and cyclophosphamide (TAC) as salvage therapy].

    PubMed

    Sato, Yasushi; Takayama, Tetsuji; Sagawa, Tamotsu; Sato, Tsutomu; Okamoto, Kumiko; Takahashi, Shou; Abe, Seiichiro; Iyama, Satoshi; Murase, Kazuyuki; Kato, Junji; Niitsu, Yoshiro

    2008-03-01

    We reported here a case of advanced breast cancer successfully treated with combination therapy including docetaxel, doxorubicin and cyclophosphamide (TAC) as salvage therapy. A 56-year-old male was referred to our hospital for treatment of recurrent metastatic breast cancer. When he was admitted, his general condition was poor due to massive intraperitoneal metastasis. We administered TAC chemotherapy (docetaxel 75 mg/m(2), doxorubicin 50 mg/m(2), and cyclophosphamide 500 mg/m(2), every 3 weeks). During chemotherapy, he showed no major adverse effects except grade 3 neutropenia, which could be easily managed with G-CSF administration. Metastatic lesions almost disappeared after 4 cycles of TAC. TAC therapy was considered to be acceptable as salvage therapy for a metastatic male breast cancer patient.

  16. Therapy gloves for patients with rheumatoid arthritis: a review

    PubMed Central

    Troynikov, Olga; Massy-Westropp, Nicola

    2014-01-01

    Rheumatoid arthritis is a chronic inflammatory disease that causes pain, joint stiffness and swelling leading to impaired hand function and difficulty with daily activities. Wearing therapy gloves has been recommended by occupational therapists as one of the alternative treatment methods for rheumatoid arthritis. This study aims to review the available literature on the effects of wearing therapy gloves on patients’ hand function and symptoms as well as to discuss the attributes of gloves that might influence the glove performance. An electronic databases search of MEDLINE, Physiotherapy Evidence Database, Occupational Therapy Systematic Evaluation of Evidence, Wiley Online Library, ScienceDirect and Cochrane Central Register of Controlled Trial was performed. Eight articles met the inclusion criteria, and covered seven clinical trials and one case study. Seven outcome measures were identified from the included studies and were then classified into two categories: hand function and hand symptoms. The hand symptoms such as pain, stiffness and swelling improve substantially when the therapy gloves are used. However, marginal or no improvement in hand function (with the exception of grip strength) linked to the use of therapy gloves is being reported. Further research is needed to quantify the effectiveness of therapy gloves, especially in improvement of hand function and in patients’ interest in wearing therapy gloves. Furthermore, future studies should include parameters which might influence therapy gloves’ performance, such as duration of trials, interface pressure generated by the gloves on the underlying skin and tissue, glove fit and construction, as well as thermophysiological comfort. PMID:25435925

  17. Initiation of triple therapy maintenance treatment among patients with COPD in the US

    PubMed Central

    Simeone, Jason C; Luthra, Rakesh; Kaila, Shuchita; Pan, Xiaoyun; Bhagnani, Tarun D; Liu, Jieruo; Wilcox, Teresa K

    2017-01-01

    Background The Global Initiative for Chronic Obstructive Lung Disease (GOLD) recommends triple therapy (long-acting muscarinic receptor antagonists, long-acting beta-2 agonists, and inhaled corticosteroids) for patients with only the most severe COPD. Data on the proportion of COPD patients on triple therapy and their characteristics are sparse and dated. Objective 1 of this study was to estimate the proportion of all, and all treated, COPD patients receiving triple therapy. Objective 2 was to characterize those on triple therapy and assess the concordance of triple therapy use with GOLD guidelines. Patients and methods This retrospective study used claims from the IMS PharMetrics Plus database from 2009 to 2013. Cohort 1 was selected to assess Objective 1 only; descriptive analyses were conducted in Cohort 2 to answer Objective 2. A validated claims-based algorithm and severity and frequency of exacerbations were used as proxies for COPD severity. Results Of all 199,678 patients with COPD in Cohort 1, 7.5% received triple therapy after diagnosis, and 25.5% of all treated patients received triple therapy. In Cohort 2, 30,493 COPD patients (mean age =64.7 years) who initiated triple therapy were identified. Using the claims-based algorithm, 34.5% of Cohort 2 patients were classified as having mild disease (GOLD 1), 40.8% moderate (GOLD 2), 22.5% severe (GOLD 3), and 2.3% very severe (GOLD 4). Using exacerbation severity and frequency, 60.6% of patients were classified as GOLD 1/2 and 39.4% as GOLD 3/4. Conclusion In this large US claims database study, one-quarter of all treated COPD patients received triple therapy. Although triple therapy is recommended for the most severe COPD patients, spirometry is infrequently assessed, and a majority of the patients who receive triple therapy may have only mild/moderate disease. Any potential overprescribing of triple therapy may lead to unnecessary costs to the patient and health care system. PMID:28053518

  18. Monte Carlo Calculations Supporting Patient Plan Verification in Proton Therapy

    PubMed Central

    Lima, Thiago V. M.; Dosanjh, Manjit; Ferrari, Alfredo; Molineli, Silvia; Ciocca, Mario; Mairani, Andrea

    2016-01-01

    Patient’s treatment plan verification covers substantial amount of the quality assurance (QA) resources; this is especially true for Intensity-Modulated Proton Therapy (IMPT). The use of Monte Carlo (MC) simulations in supporting QA has been widely discussed, and several methods have been proposed. In this paper, we studied an alternative approach from the one being currently applied clinically at Centro Nazionale di Adroterapia Oncologica (CNAO). We reanalyzed the previously published data (Molinelli et al. (1)), where 9 patient plans were investigated in which the warning QA threshold of 3% mean dose deviation was crossed. The possibility that these differences between measurement and calculated dose were related to dose modeling (Treatment Planning Systems (TPS) vs. MC), limitations on dose delivery system, or detectors mispositioning was originally explored, but other factors, such as the geometric description of the detectors, were not ruled out. For the purpose of this work, we compared ionization chambers’ measurements with different MC simulation results. It was also studied that some physical effects were introduced by this new approach, for example, inter-detector interference and the delta ray thresholds. The simulations accounting for a detailed geometry typically are superior (statistical difference – p-value around 0.01) to most of the MC simulations used at CNAO (only inferior to the shift approach used). No real improvement was observed in reducing the current delta ray threshold used (100 keV), and no significant interference between ion chambers in the phantom were detected (p-value 0.81). In conclusion, it was observed that the detailed geometrical description improves the agreement between measurement and MC calculations in some cases. But in other cases, position uncertainty represents the dominant uncertainty. The inter-chamber disturbance was not detected for the therapeutic protons energies, and the results from the current delta

  19. Inflammatory bowel disease nurse specialists for patients on biological therapies: a nationwide Italian survey

    PubMed Central

    Guarini, Alessandra; Marinis, Francesca De; Kohn, Anna; Orzes, Nicoletta; D’Incà, Renata; Iannone, Teresa; Giaquinto, Antonella; Rivara, Cinzia; Ridola, Lorenzo; Lorenzetti, Roberto; Zullo, Angelo

    2016-01-01

    Background Management of inflammatory bowel disease (IBD) patients requires a multidisciplinary approach. Among the working team, the role of IBD nurse is expected to be particularly relevant when managing patients receiving biological therapies. We performed a survey to assess the presence of IBD nurse in centers where patients were receiving biologics. Methods For this Italian nationwide survey a specific questionnaire was prepared. IBD nurse was defined as a nurse directly involved in all phases of biological therapy, from pre-therapy screening, administration and monitoring during therapy, to follow up performed by a dedicated helpline, completed a specific training on biological therapy therapy, and observed international guidelines. Results A total of 53 Italian IBD centers participated in the survey, and 91 valid questionnaires were collected. Overall, 34 (37.4%) nurses could be classified as IBD specialists. IBD nurses had a significantly higher educational level than other nurses, they were more frequently operating in Central or Southern than in Northern Italy, they were working in an Academic center rather than in a General hospital, and in IBD centers with >25 patients on biological therapy. On the contrary, mean age, gender distribution, years of nursing, and years working in the IBD unit did not significantly differ between IBD and other nurses. Conclusions Our nationwide survey showed that the presence of an IBD nurse is still lacking in the majority of Italian IBD centers where patients receive biological therapies, suggesting a prompt implementation. PMID:27708516

  20. Depression in patients with chronic hepatitis B: an experience on individual solution- focused therapy.

    PubMed

    Arvand, Jinous; Shafiabadi, Abdollah; Falsafinejad, Mohammad Reza; Naderi, Nosratollah

    2012-01-01

    Hepatitis B, as a chronic disorder that may be associated with several psychiatric disorders, such as depression, and decrease quality of life of affected patients. One of the most important consequences of psychiatric problems is reduced patient compliance with prolonged therapeutic regimens. Psychotherapy, such as solution- focused therapy, may help these patients to resolve psychiatric problems, increase quality of life and completion of therapeutic regimens. Solution-focused therapy is effective for patients when developing effective coping responses to the stressors associated with chronic diseases. In this study, the process and effects of solution-focused therapy on depression of 2 patients with chronic hepatitis B have been described. They received solution focused therapy for 5 sessions, each session 1 hour once a week. This technique was helpful to decrease symptoms and signs of depression within 5 weeks.

  1. Anticoagulant and Antiplatelet Therapy in Patients with Atrial Fibrillation and Coronary Artery Disease

    PubMed Central

    Mischke, Karl; Knackstedt, Christian; Marx, Nikolaus

    2012-01-01

    Anticoagulation represents the mainstay of therapy for most patients with atrial fibrillation. Patients on oral anticoagulation often require concomitant antiplatelet therapy, mostly because of coronary artery disease. After coronary stent implantation, dual antiplatelet therapy is necessary. However, the combination of oral anticoagulation and antiplatelet therapy increases the bleeding risk. Risk scores such as the CHA2DS2-Vasc score and the HAS-BLED score help to identify both bleeding and stroke risk in individual patients. The guidelines of the European Society of Cardiology provide a rather detailed recommendation for patients on oral anticoagulation after coronary stent implantation. However, robust evidence is lacking for some of the recommendations, and especially for new oral anticoagulants and new antiplatelets few or no data are available. This review addresses some of the critical points of the guidelines and discusses potential advantages of new anticoagulants in patients with atrial fibrillation after stent implantation. PMID:22577538

  2. Imaging Changes in Pediatric Intracranial Ependymoma Patients Treated With Proton Beam Radiation Therapy Compared to Intensity Modulated Radiation Therapy

    SciTech Connect

    Gunther, Jillian R.; Sato, Mariko; Chintagumpala, Murali; Ketonen, Leena; Jones, Jeremy Y.; Allen, Pamela K.; Paulino, Arnold C.; Okcu, M. Fatih; Su, Jack M.; Weinberg, Jeffrey; Boehling, Nicholas S.; Khatua, Soumen; Adesina, Adekunle; Dauser, Robert; Whitehead, William E.; Mahajan, Anita

    2015-09-01

    Purpose: The clinical significance of magnetic resonance imaging (MRI) changes after radiation therapy (RT) in children with ependymoma is not well defined. We compared imaging changes following proton beam radiation therapy (PBRT) to those after photon-based intensity modulated RT (IMRT). Methods and Materials: Seventy-two patients with nonmetastatic intracranial ependymoma who received postoperative RT (37 PBRT, 35 IMRT) were analyzed retrospectively. MRI images were reviewed by 2 neuroradiologists. Results: Sixteen PBRT patients (43%) developed postradiation MRI changes at 3.8 months (median) with resolution by 6.1 months. Six IMRT patients (17%) developed changes at 5.3 months (median) with 8.3 months to resolution. Mean age at radiation was 4.4 and 6.9 years for PBRT and IMRT, respectively (P=.06). Age at diagnosis (>3 years) and time of radiation (≥3 years) was associated with fewer imaging changes on univariate analysis (odds ratio [OR]: 0.35, P=.048; OR: 0.36, P=.05). PBRT (compared to IMRT) was associated with more frequent imaging changes, both on univariate (OR: 3.68, P=.019) and multivariate (OR: 3.89, P=.024) analyses. Seven (3 IMRT, 4 PBRT) of 22 patients with changes had symptoms requiring intervention. Most patients were treated with steroids; some PBRT patients also received bevacizumab and hyperbaric oxygen therapy. None of the IMRT patients had lasting deficits, but 2 patients died from recurrent disease. Three PBRT patients had persistent neurological deficits, and 1 child died secondarily to complications from radiation necrosis. Conclusions: Postradiation MRI changes are more common with PBRT and in patients less than 3 years of age at diagnosis and treatment. It is difficult to predict causes for development of imaging changes that progress to clinical significance. These changes are usually self-limiting, but some require medical intervention, especially those involving the brainstem.

  3. [The influence of general magnetic therapy on the psychological status of the patients presenting with osteoarthrosis].

    PubMed

    Degtiarev, V K; Aleksandrov, A V; Nenasheva, N V; Cherkashina, I V; Nikitin, M V

    2013-01-01

    The present study was designed to estimate the influence of general magnetic therapy on the psychical conditions of 151 patients presenting with degenerative joint diseases including osteoarthritis (OA). It was shown that the application of general magnetic therapy for the rehabilitative treatment of osteoarthrosis promotes the improvement of the psycho-emotional state of the patients. It is concluded that prescription of general magnetic therapy to the patients with OA suffering from serious psycho-emotional disorders brings about beneficial changes in their anxiety- and depression-related personality traits.

  4. Exogenous antenatal glucocorticoid treatment reduces susceptibility for hippocampal kindled and maximal electroconvulsive seizures in infant rats.

    PubMed

    Young, Nicole A; Teskey, G Campbell; Henry, Luke C; Edwards, Heather E

    2006-04-01

    Dexamethasone (DEX) and betamethasone (BETA) are synthetic glucocorticoids used clinically to reduce morbidity and mortality in infants at risk of premature birth. While their main role is to facilitate lung development, their effect on the developing nervous system and seizure susceptibility is unclear. The present study tested the hypothesis that antenatal DEX or BETA treatment would alter seizure thresholds and spread of epileptiform activity in the brains of infant offspring. Pregnant dams received once daily injections with DEX, BETA, or vehicle on gestation days 15 to 18. Physical appearance, litter size, and weight of the pups were assessed postnatally. Seizure thresholds were determined on postnatal day 14 using electroconvulsive shock delivered through ear clips (i.e., generalized seizure) or kindling stimulation of the left hippocampus through indwelling electrodes (i.e., partial seizure). The rate of acquisition of kindled seizures was determined on postnatal days 14 and 15. Pups from dams treated with DEX and BETA were growth restricted. Antenatal BETA treatment increased seizure threshold for both models. Antenatal DEX treatment increased kindling threshold, but not electroconvulsive shock threshold. Kindling rate was unaffected by either antenatal treatment. In summary, repeated glucocorticoid treatments had adverse effects on weight, skin and litter size, raised seizure thresholds, and reduced seizure vulnerability. Although these effects are seemingly desirable with respect to seizure susceptibility, they suggest that the functional organization of the nervous system is altered with antenatal synthetic glucocorticoid treatment.

  5. [Long-term digitalis therapy of elderly patients. Is digitalization unnecessary in the majority of cases?].

    PubMed

    Häcki, M A; Angehrn, W; Cavegn, H R; Brändli, O

    1982-12-18

    More than 40% of patients hospitalized in the Wald Altitude Clinic of Zürich are already on long-term digitalis therapy upon admission. During a 6 month period long-term digoxin therapy was discontinued in 97 patients (age 74 +/- 9 years) with stable cardiac insufficiency (NYHA class I-III) and sinus rhythm. During the hospitalization (37 +/- 20 days), clinical signs and symptoms, body weight, radiological heart size, and systolic time intervals were monitored. After an observation period of one week, digoxin was discontinued in all patients. Body weight, cardio-thoracic ratio and left ventricular ejection time remained unchanged after cessation of digoxin therapy during hospitalization. The pre-ejection period showed a significant increase from 89 +/- 17 to 95 +/- 19 msec. Six patients were re-instituted on digoxin therapy, 3 due to progressive cardiac insufficiency, 2 due to atrial fibrillation, and 1 at his own request. After telephone follow-up six months later with the family physician an additional 20 patients were put back on digitalis. Among the total of 26 patients requiring further digitalization an absolute indication was found only in 12 (14%), 8 due to progressive cardiac insufficiency and 4 due to atrial fibrillation. In this study digitalis therapy could be discontinued without ill effects in 86% of elderly clinically stable patients in sinus rhythm. The authors therefore recommend a more cautious use of long-term digitalis therapy and, in already digitalized patients in sinus rhythm, a controlled trial period of discontinuation.

  6. Nomenclature for renal replacement therapy and blood purification techniques in critically ill patients: practical applications.

    PubMed

    Villa, Gianluca; Neri, Mauro; Bellomo, Rinaldo; Cerda, Jorge; De Gaudio, A Raffaele; De Rosa, Silvia; Garzotto, Francesco; Honore, Patrick M; Kellum, John; Lorenzin, Anna; Payen, Didier; Ricci, Zaccaria; Samoni, Sara; Vincent, Jean-Louis; Wendon, Julia; Zaccaria, Marta; Ronco, Claudio

    2016-10-10

    This article reports the conclusions of the second part of a consensus expert conference on the nomenclature of renal replacement therapy (RRT) techniques currently utilized to manage acute kidney injury and other organ dysfunction syndromes in critically ill patients. A multidisciplinary approach was taken to achieve harmonization of definitions, components, techniques, and operations of the extracorporeal therapies. The article describes the RRT techniques in detail with the relevant technology, procedures, and phases of treatment and key aspects of volume management/fluid balance in critically ill patients. In addition, the article describes recent developments in other extracorporeal therapies, including therapeutic plasma exchange, multiple organ support therapy, liver support, lung support, and blood purification in sepsis. This is a consensus report on nomenclature harmonization in extracorporeal blood purification therapies, such as hemofiltration, plasma exchange, multiple organ support therapies, and blood purification in sepsis.

  7. [Immunomodulator Intensification of Etioropic Therapy in Patients with Advanced Pulmonary Tuberculosis].

    PubMed

    Kolomiets, V M; Abramov, A V; Rachina, N V; Rubleva, N V

    2015-01-01

    The study was aimed at possible increase of the therapy efficacy in patients with advanced tuberculosis by including immunomodulators to the treatment schemes. The data concerning 6034 patients with advanced tuberculosis, mainly fibrocavernous tuberculosis of the lungs, were analysed. Four groups of the patients were randomized. In group 1 the management of the patients included etiotropic therapy and some treatment and rehabilitation measures with the use of Cycloferon. The group 2 patients in addition to the etiotropic therapy and some treatment and rehabilitation measures were given Omega-3. In group 3 the management included the etiotropic therapy and some treatment and rehabilitation measures. In group 4 the etioropic therapy was used alone. The analysis showed that 3419 patients had primary pulmonary tuberculosis, 340 patients had relapsing tuberculosis and 2275 patients had long-term process. The etiotropic therapy efficacy was estimated after an intensive phase of not more than 3 months. In the cases with Mycobacterium tuberculosis drug resistance and some other unfavourable factors it was estimated after a 5-month intensive phase. The results confirmed that inclusion of immunomodulators to the treatment schemes allowed to increase the therapy efficacy and the patients' adherence to the treatment, as well as to shorten the period of the bacteria carriage. Thus, the use of Cycloferon in the schemes of the treatment of the patients with fibrocavernous pulmonary tuberculosis allowed to shorten the period of the pathogen carriage (as well as the drug resistant forms) in 94.1 ± 3.33% of the patients in spite of concomitant diseases. The effect of Cycloferon in such cases was likely due to both its direct immunoprotective action and the improvement of the general state of the patients and their higher adherence to the treatment.

  8. Case Report: Exercise in a Patient with Acute Decompensated Heart Failure Receiving Positive Inotropic Therapy

    PubMed Central

    Camarda, Robert; Foley, Laura Little; Givertz, Michael M; Cahalin, Lawrence P

    2011-01-01

    Background and Purpose: The projected increase in persons with advanced heart failure and associated costs warrant the examination of exercise in patients receiving inotropic therapy. Literature supports the use of exercise and inotropic therapy in the treatment of patients with advanced heart failure. The purposes of this paper are to illustrate the use of exercise prescription and outcomes assessment with a 6-minute walk test in a patient with acute decompensated heart failure receiving tailored therapy with dobutamine and to discuss potential relationships resulting in observed improvements. Case Description: A 67-year old man was admitted to an acute care hospital with acute decompensated heart failure for tailored medical therapy including dobutamine. The patient received 14 days of tailored medical therapy, of which 12 days included exercise training by a physical therapist. Outcomes: Functional outcomes showed a clinically significant improvement in distance walked and improvement in the cardiorespiratory response. The improvement in estimated peak oxygen consumption was 7% greater than that predicted to be from tailored medical therapy. Discussion: Exercise was safely provided to a patient hospitalized with advanced heart failure on continuous inotropic therapy. The 6-minute walk test was effectively used to prescribe exercise and examine patient outcomes. PMID:21637393

  9. Survival among patients with advanced renal cell carcinoma in the pretargeted versus targeted therapy eras.

    PubMed

    Li, Pengxiang; Wong, Yu-Ning; Armstrong, Katrina; Haas, Naomi; Subedi, Prasun; Davis-Cerone, Margaret; Doshi, Jalpa A

    2016-02-01

    Between December 2005 and October 2009, FDA approved six targeted therapies shown to significantly extend survival for advanced renal cell carcinoma (RCC) patients in clinical trials. This study aimed to examine changes in survival between the pretargeted and targeted therapy periods in advanced RCC patients in a real-world setting. Utilizing the 2000-2010 SEER Research files, a pre-post study design with a contemporaneous comparison group was employed to examine differences in survival outcomes for patients diagnosed with advanced RCC (study group) or advanced prostate cancer (comparison group, for whom no significant treatment innovations happened during this period) across the pretargeted therapy era (2000-2005) and the targeted therapy era (2006-2010). RCC patients diagnosed in the targeted therapy era (N = 6439) showed improved survival compared to those diagnosed in the pretargeted therapy era (N = 7231, hazard ratio (HR) for all-cause death: 0.86, P < 0.01), while the change between the pre-post periods was not significant for advanced prostate cancer patients (HR: 0.97, P = 0.08). Advanced RCC patients had significantly larger improvements in overall survival compared to advanced prostate cancer patients (z = 4.31; P < 0.01). More detailed year-to-year analysis revealed greater survival improvements for RCC in the later years of the posttargeted period. Similar results were seen for cause-specific survival. Subgroup analyses by nephrectomy status, age, and gender showed consistent findings. Patients diagnosed with advanced RCC during the targeted therapy era had better survival outcomes than those diagnosed during the pretargeted therapy era. Future studies should examine the real-world survival improvements directly associated with targeted therapies.

  10. Variation in the Cost of Radiation Therapy Among Medicare Patients With Cancer

    PubMed Central

    Paravati, Anthony J.; Boero, Isabel J.; Triplett, Daniel P.; Hwang, Lindsay; Matsuno, Rayna K.; Xu, Beibei; Mell, Loren K.; Murphy, James D.

    2015-01-01

    Purpose: Radiation therapy represents a major source of health care expenditure for patients with cancer. Understanding the sources of variability in the cost of radiation therapy is critical to evaluating the efficiency of the current reimbursement system and could shape future policy reform. This study defines the magnitude and sources of variation in the cost of radiation therapy for a large cohort of Medicare beneficiaries. Patients and Methods: We identified 55,288 patients within the SEER database diagnosed with breast, lung, or prostate cancer between 2004 and 2009. The cost of radiation therapy was estimated from Medicare reimbursements. Multivariable linear regression models were used to assess the influence of patient, tumor, and radiation therapy provider characteristics on variation in cost of radiation therapy. Results: For breast, lung, and prostate cancers, the median cost (interquartile range) of a course of radiation therapy was $8,600 ($7,300 to $10,300), $9,000 ($7,500 to $11,100), and $18,000 ($11,300 to $25,500), respectively. For all three cancer subtypes, patient- or tumor-related factors accounted for < 3% of the variation in cost. Factors unrelated to the patient, including practice type, geography, and individual radiation therapy provider, accounted for a substantial proportion of the variation in cost, ranging from 44% with breast, 43% with lung, and 61% with prostate cancer. Conclusion: In this study, factors unrelated to the individual patient accounted for the majority of variation in the cost of radiation therapy, suggesting potential inefficiency in health care expenditure. Future research should determine whether this variability translates into improved patient outcomes for further evaluation of current reimbursement practices. PMID:26265172

  11. Bilateral Deep Brain Stimulation vs Best Medical Therapy for Patients With Advanced Parkinson Disease

    PubMed Central

    Weaver, Frances M.; Follett, Kenneth; Stern, Matthew; Hur, Kwan; Harris, Crystal; Marks, William J.; Rothlind, Johannes; Sagher, Oren; Reda, Domenic; Moy, Claudia S.; Pahwa, Rajesh; Burchiel, Kim; Hogarth, Penelope; Lai, Eugene C.; Duda, John E.; Holloway, Kathryn; Samii, Ali; Horn, Stacy; Bronstein, Jeff; Stoner, Gatana; Heemskerk, Jill; Huang, Grant D.

    2010-01-01

    Context Deep brain stimulation is an accepted treatment for advanced Parkinson disease (PD), although there are few randomized trials comparing treatments, and most studies exclude older patients. Objective To compare 6-month outcomes for patients with PD who received deep brain stimulation or best medical therapy. Design, Setting, and Patients Randomized controlled trial of patients who received either deep brain stimulation or best medical therapy, stratified by study site and patient age (<70 years vs ≥70 years) at 7 Veterans Affairs and 6 university hospitals between May 2002 and October 2005. A total of 255 patients with PD (Hoehn and Yahr stage ≥2 while not taking medications) were enrolled; 25% were aged 70 years or older. The final 6-month follow-up visit occurred in May 2006. Intervention Bilateral deep brain stimulation of the subthalamic nucleus (n=60) or globus pallidus (n=61). Patients receiving best medical therapy (n=134) were actively managed by movement disorder neurologists. Main Outcome Measures The primary outcome was time spent in the “on” state (good motor control with unimpeded motor function) without troubling dyskinesia, using motor diaries. Other outcomes included motor function, quality of life, neurocognitive function, and adverse events. Results Patients who received deep brain stimulation gained a mean of 4.6 h/d of on time without troubling dyskinesia compared with 0 h/d for patients who received best medical therapy (between group mean difference, 4.5 h/d [95% CI, 3.7-5.4 h/d]; P<.001). Motor function improved significantly (P<.001) with deep brain stimulation vs best medical therapy, such that 71% of deep brain stimulation patients and 32% of best medical therapy patients experienced clinically meaningful motor function improvements (≥5 points). Compared with the best medical therapy group, the deep brain stimulation group experienced significant improvements in the summary measure of quality of life and on 7 of 8 PD

  12. Immunosuppressive Therapy in Patients with Aplastic Anemia: A Single-Center Retrospective Study

    PubMed Central

    Jalaeikhoo, Hasan; Khajeh-Mehrizi, Ahmad

    2015-01-01

    Background Aplastic anemia (AA) is a rare disease in which hematopoietic stem cells are severely diminished resulting in hypocellular bone marrow and pancytopenia. Etiology of AA includes auto immunity, toxins, infection, ionizing radiation, drugs and rare genetic disorders, but in the majority of cases no cause can be identified. In the present study we assessed response rate, survival, relapse and clonal evolution in patients with AA treated with immunosuppressive therapy. Methods Patients with AA who received immunosuppressive therapy between May 1998 and September 2013 were included in this study. Patients with non-severe AA (NSAA) were treated with cyclosporine (CsA) and danazol while patients with severe AA (SAA) as well as patients with NSAA who progressed to SAA after beginning of the treatment, were candidates for receiving antithymocyte globulin in addition to CsA and danazol. Results Among the 63 studied patients, 29 (46%) had NSAA and 34 (54%) had SAA. Three months after treatment, overall response was 58.6% in NSAA and 12.9% in patients with SAA. Survival of all patients at 5, 10 and 15 years were 73%, 55% and 49%, respectively. Survival rates were significantly higher in patients with NSAA compared to patients with SAA as well as in patients who responded at 6 months compared to non-responders. The relapse risk was 39.7% at 10 years. Relapse occurred in patients who discontinued the therapy more than those who continued taking CsA (p value<0.01). The risk of clonal evolution was 9.9% at 10 years and 22.8% at 15 years after treatment. Conclusion This long-term retrospective study indicated that immunosuppressive therapy should be recommended to patients with AA. Also, our experience indicated that immunosuppressive therapy should not be discontinued after response to therapy in patients with both NSAA and SAA due to high risk of relapse. Low dose of CsA should be continued indefinitely. PMID:25970182

  13. [Estimation of efficiency of anti-helicobacter therapy in patients with a chronic pancreatitis combined with an erosive gastropathy].

    PubMed

    Koval', V Iu; Kotsiubniak, L A; Moskal', O M

    2014-01-01

    SUMMARY Eradikacion therapy at patients with chronic pancreatitis and combined with Helicobacter associated erosive gastropathy in a month after treatment appeared successful at 75% patients which accepted therapy of the first line--pantoprazol, amoksicillin, klaritromicin. Inclusion in antihelicobakter therapy of seknidazol in place of klaritromicin rendered a positive antihelicobakter effect at 85% patients with a chronic pancreatitis. Therapy with the use of seknidazole was better tolerated. Application of synbiotik laktiale on a background antihelicobakter therapy helped normalizations of chair and was comfortable in application, which is important in the treatment of patients. Application of synbiotika laktiale on a background antigelikobakter therapy is helped in the improvement of clinical effect.

  14. Brief Behavioral Activation and Problem-Solving Therapy for Depressed Breast Cancer Patients: Randomized Trial

    ERIC Educational Resources Information Center

    Hopko, Derek R.; Armento, Maria E. A.; Robertson, Sarah M. C.; Ryba, Marlena M.; Carvalho, John P.; Colman, Lindsey K.; Mullane, Christen; Gawrysiak, Michael; Bell, John L.; McNulty, James K.; Lejuez, Carl W.

    2011-01-01

    Objective: Major depression is the most common psychiatric disorder among breast cancer patients and is associated with substantial impairment. Although some research has explored the utility of psychotherapy with breast cancer patients, only 2 small trials have investigated the potential benefits of behavior therapy among patients with…

  15. The effects of extracorporeal shock wave therapy on stroke patients with plantar fasciitis

    PubMed Central

    Kim, Tae Gon; Bae, Sea Hyun; Kim, Gye Yeop; Kim, Kyung Yoon

    2015-01-01

    [Purpose] The purpose of this research was to analyze the efficacy of extracorporeal shock wave therapy for the treatment of stroke patients with plantar fasciitis. [Subjects and Methods] This study included 10 stroke patients diagnosed with plantar fasciitis who were administered 3 sessions of extracorporeal shock wave therapy per week. After the last session, they performed stretching exercises for their Achilles tendon and plantar fascia for 30 min/day, 5 times a week for 6 months. The following parameters were measured and compared prior to therapy, 6 weeks after therapy, and 6 months after therapy: thickness of the plantar fascia, using an ultrasonic imaging system; degree of spasticity, using a muscle tension measuring instrument; degree of pain, using the visual analogue scale; and gait ability, using the Functional Gait Assessment. [Results] Decreased plantar fascia thickness, spasticity, and pain and increased gait ability were noted after therapy. These changes were significantly greater at 6 months after therapy than at 6 weeks after therapy. [Conclusion] These results indicated that extracorporeal shock wave therapy reduced tension in the plantar fascia, relieving pain and improving gait ability in stroke patients. PMID:25729207

  16. Age Disparity in Palliative Radiation Therapy Among Patients With Advanced Cancer

    SciTech Connect

    Wong, Jonathan; Xu, Beibei; Yeung, Heidi N.; Roeland, Eric J.; Martinez, Maria Elena; Le, Quynh-Thu; Mell, Loren K.; Murphy, James D.

    2014-09-01

    Purpose/Objective: Palliative radiation therapy represents an important treatment option among patients with advanced cancer, although research shows decreased use among older patients. This study evaluated age-related patterns of palliative radiation use among an elderly Medicare population. Methods and Materials: We identified 63,221 patients with metastatic lung, breast, prostate, or colorectal cancer diagnosed between 2000 and 2007 from the Surveillance, Epidemiology, and End Results (SEER)-Medicare linked database. Receipt of palliative radiation therapy was extracted from Medicare claims. Multivariate Poisson regression analysis determined residual age-related disparity in the receipt of palliative radiation therapy after controlling for confounding covariates including age-related differences in patient and demographic covariates, length of life, and patient preferences for aggressive cancer therapy. Results: The use of radiation decreased steadily with increasing patient age. Forty-two percent of patients aged 66 to 69 received palliative radiation therapy. Rates of palliative radiation decreased to 38%, 32%, 24%, and 14% among patients aged 70 to 74, 75 to 79, 80 to 84, and over 85, respectively. Multivariate analysis found that confounding covariates attenuated these findings, although the decreased relative rate of palliative radiation therapy among the elderly remained clinically and statistically significant. On multivariate analysis, compared to patients 66 to 69 years old, those aged 70 to 74, 75 to 79, 80 to 84, and over 85 had a 7%, 15%, 25%, and 44% decreased rate of receiving palliative radiation, respectively (all P<.0001). Conclusions: Age disparity with palliative radiation therapy exists among older cancer patients. Further research should strive to identify barriers to palliative radiation among the elderly, and extra effort should be made to give older patients the opportunity to receive this quality of life-enhancing treatment at the end

  17. Last Breath: Art Therapy with a Lung Cancer Patient Facing Imminent Death

    ERIC Educational Resources Information Center

    Furman, Lisa R.

    2011-01-01

    Art therapy can be an effective way to focus on end of life issues with cancer patients facing imminent death. This viewpoint discusses ethical challenges in the treatment of a 63-year-old man with terminal lung cancer who was participating in short-term individual art therapy. Difficult issues that often surface in the final days of life may…

  18. Skills of Cognitive Therapy (SoCT): A New Measure of Patients' Comprehension and Use

    ERIC Educational Resources Information Center

    Jarrett, Robin B.; Vittengl, Jeffrey R.; Clark, Lee Anna; Thase, Michael E.

    2011-01-01

    The authors describe the development and psychometric properties of a new measure called the Skills of Cognitive Therapy (SoCT) in depressed adults and their cognitive therapists. The 8-item SoCT assesses patients' understanding and use of basic cognitive therapy (CT) skills rated from the perspectives of both observers (SoCT-O; therapists in this…

  19. A Community Day Care Programme for Psychiatric Patients: The Role of Occupational Therapy.

    ERIC Educational Resources Information Center

    Pradad, Akanksha; And Others

    1991-01-01

    This paper examines the need for and role of occupational therapy in the organization and functioning of a community day care center for psychiatric patients in India. The occupational therapy program involves client evaluation, determination of therapeutic activities, physical exercise, recreational activities, group sessions, family involvement,…

  20. An evolution in switching therapy for psoriasis patients who fail to meet treatment goals.

    PubMed

    Kerdel, Francisco; Zaiac, Martin

    2015-01-01

    Switching psoriasis treatment is a common, accepted practice that is used to improve disease management and improve patient outcomes (e.g., when patients are experiencing suboptimal efficacy and/or tolerability with a given therapy). Historically, switching treatment was often performed to limit patients' cumulative exposure to conventional systemic agents (e.g., methotrexate, cyclosporine) with the goal of reducing end-organ toxicity. However, the practice of switching treatments has evolved in recent years with the availability of highly effective and tolerable biologic agents. In current practice, near-complete skin clearance with minimal side effects should be a realistic treatment goal for most patients with moderate-to-severe psoriasis, and consideration for switching therapies has shifted to become more focused on achieving maximum possible skin clearance, enhanced quality of life, and improved patient satisfaction. This review provides a discussion of recent guidance on switching psoriasis therapies, including initial considerations for when switching therapy may be advisable and challenges associated with switching therapy, along with an overview of published clinical studies evaluating outcomes associated with switching therapy. The goal of this review is to empower dermatologists to optimally manage their patients' psoriasis by providing the tools needed to develop rational strategies for switching treatments based on the pharmacologic characteristics of available treatments and each patient's clinical needs and treatment preferences.

  1. Stereotactic Body Radiation Therapy for Patients With Lung Cancer Previously Treated With Thoracic Radiation

    SciTech Connect

    Kelly, Patrick; Balter, Peter A.; Rebueno, Neal; Sharp, Hadley J.; Liao Zhongxing; Komaki, Ritsuko; Chang, Joe Y.

    2010-12-01

    Purpose: Stereotactic body radiation therapy (SBRT) provides excellent local control with acceptable toxicity for patients with early-stage non-small cell lung cancer. However, the efficacy and safety of SBRT for patients previously given thoracic radiation therapy is not known. In this study, we retrospectively reviewed outcomes after SBRT for recurrent disease among patients previously given radiation therapy to the chest. Materials and Methods: A search of medical records for patients treated with SBRT to the thorax after prior fractionated radiation therapy to the chest at The University of Texas M. D. Anderson Cancer Center revealed 36 such cases. The median follow-up time after SBRT was 15 months. The endpoints analyzed were overall survival, local control, and the incidence and severity of treatment-related toxicity. Results: SBRT provided in-field local control for 92% of patients; at 2 years, the actuarial overall survival rate was 59%, and the actuarial progression-free survival rate was 26%, with the primary site of failure being intrathoracic relapse. Fifty percent of patients experienced worsening of dyspnea after SBRT, with 19% requiring oxygen supplementation; 30% of patients experienced chest wall pain and 8% Grade 3 esophagitis. No Grade 4 or 5 toxic effects were noted. Conclusions: SBRT can provide excellent in-field tumor control in patients who have received prior radiation therapy. Toxicity was significant but manageable. The high rate of intrathoracic failure indicates the need for further study to identify patients who would derive the most benefit from SBRT for this purpose.

  2. Effects of manual therapy on bowel function of patients with spinal cord injury.

    PubMed

    Hu, Chunying; Ye, Miao; Huang, Qiuchen

    2013-06-01

    [Purpose] The purpose of this study was to observe the effects of manual therapy on bowel function of patients with spinal cord injury. [Subjects] The participants were 20 patients with spinal cord injury. [Methods] Manual therapy was applied to the intestine and along the colon ascendens, transverse colon, colon descendens and colon sigmoidem on the surface of abdomen. The results before and after 60 sessions (5 times/week, continued for 12 weeks) of manual therapy were compared. [Results] It was found that there were significant effects both on shortening of bowel time and decreasing dosage of glycerine enema every time patients needed to excrete. [Conclusion] Manual therapy had significant effects on bowel function of patients with spinal cord injury.

  3. Antithrombotic therapy for patients with nonvalvular atrial fibrillation undergoing percutaneous coronary intervention: a review.

    PubMed

    Krasner, Andrew; Halperin, Jonathan L

    2013-07-01

    Patients with atrial fibrillation who have risk factors for thromboembolism benefit from chronic oral anticoagulation therapy, and antiplatelet therapy alone is of relatively little benefit for prevention of ischemic stroke and systemic embolism. Patients undergoing percutaneous coronary intervention with drug-eluting stents require dual antiplatelet therapy with aspirin and a thienopyridine for 3 to 12 months or more prevention of stent thrombosis and recurrent ischemic events. When patients with atrial fibrillation undergo percutaneous coronary intervention, the need to combine dual antiplatelet therapy and warfarin raises the risk of major bleeding complications considerably. Recent trials have explored the option of omitting aspirin with promising results. The introduction of novel oral anticoagulants that specifically inhibit factor IIa (dabigatran) or factor Xa (rivaroxaban, apixaban, and edoxaban) and antiplatelet agents that inhibit the P(2)Y(12) receptor (prasugrel and ticagrelor) makes management of these patients even more challenging, but future trials addressing myriad alternative regimens may identify better tolerated strategies.

  4. Comparison of High-Intensity Laser Therapy and Ultrasound Treatment in the Patients with Lumbar Discopathy

    PubMed Central

    Boyraz, Ismail; Yildiz, Ahmet; Koc, Bunyamin

    2015-01-01

    The aim of the present study was to evaluate the efficiency of high intensity laser and ultrasound therapy in patients who were diagnosed with lumbar disc herniation and who were capable of performing physical exercises. 65 patients diagnosed with lumbar disc were included in the study. The patients were randomly divided into three groups: Group 1 received 10 sessions of high intensity laser to the lumbar region, Group 2 received 10 sessions of ultrasound, and Group 3 received medical therapy for 10 days and isometric lumbar exercises. The efficacy of the treatment modalities was compared with the assessment of the patients before the therapy at the end of the therapy, and in third month after the therapy. Comparing the changes between groups, statically significant difference was observed in MH (mental health) parameter before treatment between Groups 1 and 2 and in MH parameter and VAS score in third month of the therapy between Groups 2 and 3. However, the evaluation of the patients after ten days of treatment did not show significant differences between the groups compared to baseline values. We found that HILT, ultrasound, and exercise were efficient therapies for lumbar discopathy but HILT and ultrasound had longer effect on some parameters. PMID:25883952

  5. Indomethacin sensitive suppressor cell activity in head and neck cancer patients pre- and postirradiation therapy

    SciTech Connect

    Maca, R.D.; Panje, W.R.

    1982-08-01

    The effects of the addition of indomethacin to PHA or Con A stimulated lymphocytes from patients with untreated squamous cell carcinoma of the head and neck or from patients with the disease who have just finished irradiation therapy from the disease was quantitated and compared to those of the control group. Lymphocytes from eight of 26 patients with untreated carcinoma were significantly augmented by the addition of indomethacin. The remaining eighteen patients were equal to the controls. For all 17 patients who had just finished extensive field irradiation therapy, significant enhancement of PHA and Con A reactivity by indomethacin was found, which did not appear to be solely a function of low baseline mitogen reactivity. The results of this study support the hypothesis that perhaps patients receiving irradiation therapy may benefit by the oral administration of indomethacin, an approach that needs further consideration.

  6. [Clinical care of lung cancer patients with body image changes after targeted therapy].

    PubMed

    Chan, Jui-Chun; Liao, Yu-Chien; Lee, Yun-Hsiang; Lai, Yeur-Hur

    2014-08-01

    Lung cancer has a relatively short survival prognosis and advanced disease progression. Therefore, targeted therapy has become one of the most frequent treatments of this disease. Targeted therapy has several features that effectively extend the survival period; is easy to apply and use; and has fewer side effects than chemotherapy. Therefore, this therapy approach has become the preferred choice of patients with advanced lung cancer. However, current targeted therapies like Iressa and Tarceva produce side effects such as skin dryness and acneiform eruption that may bother patients. These side effects may further cause patient concern over negative changes in their body image, and these concerns may influence their work and social lives. Additionally, some patients treated with targeted therapy worry about their chances of survival if they reduce or stop the medication to avoid the side effects. Consequently, patients may struggle with both physical and psychological impacts, and may have problems sustaining a good quality of life. This article focuses on delivering relevant information to patients receiving targeted therapy who suffer from dermatological toxicity and damage to their body image. We demonstrate an assessment tool and information to help patients cope with physical and psychosocial issues through daily skin care routines, mental / psychological supports, and cognitive behavior therapy. These measures may help patients rebuild a positive self-concept. We plan to develop further associated training to provide professionals / care providers with the appropriate knowledge and skills to care for cancer patients in a resource-limited environment so that they may improve the quality of nursing care for patients with body image changes.

  7. Neuromodulation therapies for geriatric depression.

    PubMed

    Gálvez, Verònica; Ho, Kerrie-Anne; Alonzo, Angelo; Martin, Donel; George, Duncan; Loo, Colleen K

    2015-07-01

    Depression is frequent in old age and its prognosis is poorer than in younger populations. The use of pharmacological treatments in geriatric depression is limited by specific pharmacodynamic age-related factors that can diminish tolerability and increase the risk of drug interactions. The possibility of modulating cerebral activity using brain stimulation techniques could result in treating geriatric depression more effectively while reducing systemic side effects and medication interactions. This may subsequently improve treatment adherence and overall prognosis in the older patient. Among clinically available neuromodulatory techniques, electroconvulsive therapy (ECT) remains the gold standard for the treatment of severe depression in the elderly. Studies have proven that ECT is more effective and has a faster onset of action than antidepressants in the treatment of severe, unipolar, geriatric depression and that older age is a predictor of rapid ECT response and remission. The application of novel and more tolerable forms of ECT for geriatric depression is currently being examined. Preliminary results suggest that right unilateral ultrabrief ECT (RUL-UB ECT) is a promising intervention, with similar efficacy to brief-pulse ECT and fewer adverse cognitive effects. Overall findings in repetitive transcranial magnetic stimulation (rTMS) suggest that it is a safe intervention in geriatric depression. Higher rTMS stimulation intensity and more treatments may need to be given in the elderly to achieve optimal results. There is no specific data on vagus nerve stimulation in the elderly. Transcranial direct current stimulation, magnetic seizure therapy and deep brain stimulation are currently experimental, and more data from geriatric samples is needed.

  8. Serum Glutathione in Patients with Schizophrenia in Dynamics of Antipsychotic Therapy.

    PubMed

    Ivanova, S A; Smirnova, L P; Shchigoreva, Yu G; Semke, A V; Bokhan, N A

    2015-12-01

    Serum concentrations of oxidized and reduced glutathione were measured in 73 patients with schizophrenia at admission and in dynamics of therapy with traditional and atypical antipsychotic drugs. The level of reduced glutathione in patients with schizophrenia with manifest clinical symptoms was lower than in normal subjects. Atypical neuroleptics produced virtually no effects on the glutathione system, while therapy with typical antipsychotics led to further decrease in the levels of reduced glutathione, thus aggravating the imbalance of metabolic processes typical of schizophrenia.

  9. Pediatric Glioblastoma Therapies Based on Patient-Derived Stem Cell Resources

    DTIC Science & Technology

    2013-10-01

    AD_________________ Award Number: W81XWH-11-1-0756 TITLE: Pediatric Glioblastoma Therapies Based on Patient-Derived Stem Cell Resources PRINCIPAL...TITLE AND SUBTITLE Pediatric Glioblastoma Therapies Based on Patient-Derived Stem Cell Resources 5a. CONTRACT NUMBER 5b. GRANT NUMBER W81XWH-11...TERMS Glioblastoma multiforme , glioma stem cell, brain tumor-initiating cell, pediatric brain tumor, RNAi, functional genetics 16. SECURITY

  10. Effects of music therapy on change readiness and craving in patients on a detoxification unit.

    PubMed

    Silverman, Michael J

    2011-01-01

    The purpose of this study was to determine the effect of a "rockumentary" music therapy intervention on readiness to change and craving in patients on a detoxification unit utilizing psychometric instruments in a randomized three-group design. Participants (N = 141) were randomized by group to a rockumentary music therapy intervention, verbal therapy, or recreational music therapy condition. All interventions were scripted and manualized in a posttest only design. Concerning readiness to change, results indicated there were significant between-group differences in Contemplation and Action subscales, with participants in the rockumentary and recreational music therapy conditions having higher means than participants in the verbal therapy condition. There were no differences between the two music therapy conditions concerning readiness to change variables. Although not significant, participants in both music therapy conditions tended to have lower mean craving scores than participants in the verbal therapy condition. Concerning Likert-type ratings of motivation to change, perception of helpfulness, and perception of enjoyment, participants in both music therapy conditions tended to have slightly higher mean scores than participants in the verbal therapy conditions. Participants' posttest written comments were positive, regardless of condition. Limitations of the study, suggestions for the future inquiry, and implications for clinical practice are provided.

  11. Animal-assisted therapy: evaluation and implementation of a complementary therapy to improve the psychological and physiological health of critically ill patients.

    PubMed

    DeCourcey, Mary; Russell, Anne C; Keister, Kathy J

    2010-01-01

    Animal-assisted therapy has gained widespread support in a variety of health care settings, including critical care units. This article seeks to review some of the current animal-assisted therapy, define a structured program, and evaluate the potential ability of the therapy to enhance the progress and health of our patients.

  12. The efficacy of laparoscopic cholecystectomy without discontinuation in patients on antithrombotic therapy

    PubMed Central

    Yun, Jong Hyuk; Jung, Hae Il; Lee, Hyoung Uk; Baek, Moo-Jun

    2017-01-01

    Purpose Laparoscopic cholecystectomy (LC) is one of the most commonly performed surgeries in the world today. However, there is no consensus regarding whether LC can be performed in patients with acute cholecystitis while on antithrombotic therapy. The objective of our study was to describe postoperative outcomes of patients who underwent emergent LC without interruption to antithrombotic therapy. Methods We performed a retrospective review of patients who underwent LC for acute cholecystitis while on antithrombotic therapy from 2010 to 2015 at Soonchunhyang Universtiy Cheonan Hospital. Patients were divided into 2 groups as underwent emergent LC and elective LC. Results A total of 67 patients (emergent group, 22; elective group, 45) were included in the analysis. Elective group had significantly longer duration between the admission and operation (8 [7–10] days vs. 2 [1–3] days, P < 0.001) and longer duration of antithrombotic drugs discontinuation (7 days vs. 1 [0–3] days, P < 0.001). Emergent group had significantly more postoperative anemia (6 patients vs. 0 patient, P = 0.001) and 3 of 6 patients received packed RBC transfusion in postoperative period. However, there was no significant difference in length of postoperative stays, length of intensive care unit stays and mortality rates. Conclusion Emergent LC without interruption to antithrombotic therapy was relatively safe and useful. A well-designed multicenter study is needed to confirm the safety and efficacy of LC without suspension of antithrombotic therapy and to provide a simple guideline. PMID:28289668

  13. Germline mutations in DNA repair genes may predict neoadjuvant therapy response in triple negative breast patients.

    PubMed

    Spugnesi, Laura; Gabriele, Michele; Scarpitta, Rosa; Tancredi, Mariella; Maresca, Luisa; Gambino, Gaetana; Collavoli, Anita; Aretini, Paolo; Bertolini, Ilaria; Salvadori, Barbara; Landucci, Elisabetta; Fontana, Andrea; Rossetti, Elena; Roncella, Manuela; Naccarato, Giuseppe Antonio; Caligo, Maria Adelaide

    2016-12-01

    Triple negative breast cancers (TNBCs) represent about 15-20% of all breast cancer cases and are characterized by a complex molecular heterogeneity. Some TNBCs exhibit clinical and pathological properties similar to BRCA-mutated tumors, without actually bearing a mutation in BRCA genes. This "BRCAness" phenotype may be explained by germline mutations in other genes involved in DNA repair. Although respond to chemotherapy with alkylating agents, they have a high risk of recurrence and progression. Some studies have shown the efficacy of neoadjuvant therapy in TNBC patients with DNA repair defects, but proper biomarkers of DNA repair deficiency are still needed. Here, we investigated if mutations in DNA repair genes may be correlated with anthracyclines/taxanes neoadjuvant therapy response. DNA from 19 TNBC patients undergoing neoadjuvant therapy were subjected to next generation sequencing of a panel of 24 genes in DNA repair and breast cancer predisposition. In this study, 5 of 19 patients (26%) carried a pathogenic mutation in BRCA1, PALB2, RAD51C and two patients carried a probable pathogenic missense variant. Moreover, VUS (Variants of Unknown Significance) in other genes, predicted to be deleterious by in silico tools, were detected in five patients. Germline mutations in DNA repair genes were found to be associated with the group of TNBC patients who responded to therapy. We conclude that a subgroup of TNBC patients have defects in DNA repair genes, other than BRCA1, and such patients respond favourably to neoadjuvant anthracyclines/taxanes therapy. © 2016 Wiley Periodicals, Inc.

  14. Induction therapy alters plasma fibrin clot properties in multiple myeloma patients: association with thromboembolic complications.

    PubMed

    Undas, Anetta; Zubkiewicz-Usnarska, Lidia; Helbig, Grzegorz; Woszczyk, Dariusz; Kozińska, Justyna; Dmoszyńska, Anna; Dębski, Jakub; Podolak-Dawidziak, Maria; Kuliczkowski, Kazimierz

    2015-09-01

    Induction therapy in patients with multiple myeloma increases the risk of thromboembolism. We have recently shown that multiple myeloma patients tend to form denser fibrin clots displaying poor lysability. We investigated the effect of induction therapy on fibrin clot properties in multiple myeloma patients. Ex-vivo plasma fibrin clot permeability, turbidity, susceptibility to lysis, thrombin generation, factor VIII and fibrinolytic proteins were compared in 48 multiple myeloma patients prior to and following 3 months of induction therapy, mainly with cyclophosphamide-thalidomide-dexamethasone regimen. Patients on thromboprophylaxis with aspirin or heparins were eligible. A 3-month induction therapy resulted in improved clot properties, that is higher clot permeability, compaction, shorter lag phase and higher final turbidity, along with shorter clot lysis time and higher rate of D-dimer release from fibrin clots than the baseline values. The therapy also resulted in lower thrombin generation, antiplasmin and thrombin-activatable fibrinolysis inhibitor (TAFI), but elevated factor VIII. Progressive disease was associated with lower posttreatment clot permeability and lysability. Despite thromboprophylaxis, two patients developed ischemic stroke and 10 had venous thromboembolism. They were characterized by pretreatment lower clot permeability, prolonged clot lysis time, longer lag phase, higher peak thrombin generation, TAFI and plasminogen activator inhibitor -1. Formation of denser plasma fibrin clots with reduced lysability and increased thrombin generation at baseline could predispose to thrombotic complications during induction treatment in multiple myeloma patients. We observed improved fibrin clot properties and thrombin generation in multiple myeloma patients except those with progressive disease.

  15. Lenalidomide as initial therapy of elderly patients with chronic lymphocytic leukemia.

    PubMed

    Badoux, Xavier C; Keating, Michael J; Wen, Sijin; Lee, Bang-Ning; Sivina, Mariela; Reuben, James; Wierda, William G; O'Brien, Susan M; Faderl, Stefan; Kornblau, Steven M; Burger, Jan A; Ferrajoli, Alessandra

    2011-09-29

    The best initial therapy for elderly patients with chronic lymphocytic leukemia (CLL) has not yet been defined. We investigated the activity of lenalidomide as initial therapy for elderly patients with CLL. Sixty patients with CLL 65 years of age and older received treatment with lenalidomide orally 5 mg daily for 56 days, then titrated up to 25 mg/d as tolerated. Treatment was continued until disease progression. At a median follow-up of 29 months, 53 patients (88%) are alive and 32 patients (53%) remain on therapy. Estimated 2-year progression-free survival is 60%. The overall response rate to lenalidomide therapy is 65%, including 10% complete response, 5% complete response with residual cytopenia, 7% nodular partial response, and 43% partial response. Neutropenia is the most common grade 3 or 4 treatment-related toxicity observed in 34% of treatment cycles. Major infections or neutropenic fever occurred in 13% of patients. Compared with baseline levels, we noted an increase in serum immunoglobulin levels across all classes, and a reduction in CCL3 and CCL4 plasma levels was noted in responding patients. Lenalidomide therapy was well tolerated and induced durable remissions in this population of elderly, symptomatic patients with CLL. This study was registered at www.clinicaltrials.gov as #NCT00535873.

  16. Lenalidomide as initial therapy of elderly patients with chronic lymphocytic leukemia

    PubMed Central

    Badoux, Xavier C.; Keating, Michael J.; Wen, Sijin; Lee, Bang-Ning; Sivina, Mariela; Reuben, James; Wierda, William G.; O'Brien, Susan M.; Faderl, Stefan; Kornblau, Steven M.; Burger, Jan A.

    2011-01-01

    The best initial therapy for elderly patients with chronic lymphocytic leukemia (CLL) has not yet been defined. We investigated the activity of lenalidomide as initial therapy for elderly patients with CLL. Sixty patients with CLL 65 years of age and older received treatment with lenalidomide orally 5 mg daily for 56 days, then titrated up to 25 mg/d as tolerated. Treatment was continued until disease progression. At a median follow-up of 29 months, 53 patients (88%) are alive and 32 patients (53%) remain on therapy. Estimated 2-year progression-free survival is 60%. The overall response rate to lenalidomide therapy is 65%, including 10% complete response, 5% complete response with residual cytopenia, 7% nodular partial response, and 43% partial response. Neutropenia is the most common grade 3 or 4 treatment-related toxicity observed in 34% of treatment cycles. Major infections or neutropenic fever occurred in 13% of patients. Compared with baseline levels, we noted an increase in serum immunoglobulin levels across all classes, and a reduction in CCL3 and CCL4 plasma levels was noted in responding patients. Lenalidomide therapy was well tolerated and induced durable remissions in this population of elderly, symptomatic patients with CLL. This study was registered at www.clinicaltrials.gov as #NCT00535873. PMID:21725050

  17. Clinical potential of gene-directed enzyme prodrug therapy to improve radiation therapy in prostate cancer patients.

    PubMed

    Vajda, Alice; Marignol, Laure; Foley, Ruth; Lynch, Thomas H; Lawler, Mark; Hollywood, Donal

    2011-12-01

    Despite the advances in prostate cancer diagnosis and treatment, current therapies are not curative in a significant proportion of patients. Gene-directed enzyme prodrug therapy (GDEPT), when combined with radiation therapy, could improve the outcome of treatment for prostate cancer, the second leading cause of cancer death in the western world. GDEPT involves the introduction of a therapeutic transgene, which can be targeted to the tumour cells. A prodrug is administered systemically and is converted to its toxic form only in those cells containing the transgene, resulting in cell kill. This review will discuss the clinical trials which have investigated the potential of GDEPT at various stages of prostate cancer progression. The advantages of using GDEPT in combination with radiotherapy will be examined, as well as some of the recent advances which enhance the potential utility of GDEPT.

  18. Physical therapy in critically ill adult patients: recommendations from the Brazilian Association of Intensive Care Medicine Department of Physical Therapy.

    PubMed

    França, Eduardo Ériko Tenório de; Ferrari, Francimar; Fernandes, Patrícia; Cavalcanti, Renata; Duarte, Antonio; Martinez, Bruno Prata; Aquim, Esperidião Elias; Damasceno, Marta Cristina Paulete

    2012-03-01

    Complications from immobility in intensive care unit patients contribute to functional decline, increased healthcare costs, reduced quality of life and higher post-discharge mortality. Physical therapy focuses on promoting recovery and preserving function, and it may minimize the impact of these complications. A group of Brazilian Association of Intensive Care Medicine physical therapy experts developed this document that contains minimal physical therapy recommendations appropriate to the Brazilian real-world clinical situation. Prevention and treatment of atelectasis, procedures related to the removal of secretions and treatment of conditions related to physical deconditioning and functional decline are discussed. Equally important is the consideration that prescribing and executing activities, mobilizations and exercises are roles of the physical therapist, whose diagnosis should precede any intervention.

  19. Linagliptin as add-on therapy to insulin for patients with type 2 diabetes.

    PubMed

    von Websky, Karoline; Reichetzeder, Christoph; Hocher, Berthold

    2013-01-01

    Type 2 diabetes mellitus (T2DM) is a highly prevalent, progressive disease that often is poorly controlled. The combination of an incretin-based therapy and insulin is a promising approach to optimize the management of glycemic control without hypoglycemia and weight gain. Linagliptin, a recently approved oral dipeptidyl peptidase-4 inhibitor, has a unique pharmacological profile. The convenient, once-daily dosing does not need adjustment in patients with hepatic and/or renal impairment. In clinical studies linagliptin shows an important reduction of blood glucose with an overall safety profile similar to that of placebo. So far, the combination of linagliptin and insulin has been tested in three major clinical studies in different populations. It has been shown that linagliptin is an effective and safe add-on therapy to insulin in patients with T2DM. The efficacy and safety of this combination was also shown in vulnerable, elderly T2DM patients and in patients with T2DM and renal impairment. Favorable effects regarding the counteraction of hypoglycemia make linagliptin especially interesting as an add-on therapy to insulin. This review aims to present the existing clinical studies on the efficacy and safety of linagliptin as add-on therapy to insulin in patients with T2DM in the context of current literature. Additionally, the possible advantages of linagliptin as an add-on therapy to insulin in relation to cardiovascular safety, patient-centered therapy and the prevention of hypoglycemia, are discussed.

  20. Intermittent targeted therapies and stochastic evolution in patients affected by chronic myeloid leukemia

    NASA Astrophysics Data System (ADS)

    Pizzolato, N.; Persano Adorno, D.; Valenti, D.; Spagnolo, B.

    2016-05-01

    Front line therapy for the treatment of patients affected by chronic myeloid leukemia (CML) is based on the administration of tyrosine kinase inhibitors, namely imatinib or, more recently, axitinib. Although imatinib is highly effective and represents an example of a successful molecular targeted therapy, the appearance of resistance is observed in a proportion of patients, especially those in advanced stages. In this work, we investigate the appearance of resistance in patients affected by CML, by modeling the evolutionary dynamics of cancerous cell populations in a simulated patient treated by an intermittent targeted therapy. We simulate, with the Monte Carlo method, the stochastic evolution of initially healthy cells to leukemic clones, due to genetic mutations and changes in their reproductive behavior. We first present the model and its validation with experimental data by considering a continuous therapy. Then, we investigate how fluctuations in the number of leukemic cells affect patient response to the therapy when the drug is administered with an intermittent time scheduling. Here we show that an intermittent therapy (IT) represents a valid choice in patients with high risk of toxicity, despite an associated delay to the complete restoration of healthy cells. Moreover, a suitably tuned IT can reduce the probability of developing resistance.

  1. Music Therapy as a Nonpharmacological Intervention for Anxiety in Patients with a Thought Disorder.

    PubMed

    Pavlov, Allison; Kameg, Kirstyn; Cline, Tom W; Chiapetta, Laurel; Stark, Stacy; Mitchell, Ann M

    2017-03-01

    Music therapy has been identified as a non-pharmacological adjunct therapy to treat anxiety. This QI project aimed to assess the effects of music therapy on anxiety in a sample of patients hospitalized with a thought disorder. Participants were assessed pre- and post-group using a visual analog scale for anxiety. The intervention significantly reduced VAS scores from 3.1 pre-intervention to .897 immediately post-intervention (p = 0.008). This data suggests that music therapy may be beneficial in the short term for this population and is a low risk intervention that provides positive outcomes without the risks associated with medications, seclusion, and restraint.

  2. Efficacy of music therapy in treatment for the patients with Alzheimer's disease.

    PubMed

    Fukui, H; Arai, A; Toyoshima, K

    2012-01-01

    We report that music therapy is effective in the treatment of Alzheimer's disease. We found that the secretion of 17β-estradiol and testosterone, hormones that are supposed to have preventive effects on Alzheimer's disease, is significantly increased by music therapy. During the sessions, patients with Alzheimer's disease were allowed to listen to music and songs with verbal contact from the therapist. It was found that problematic behaviors such as poriomania (fugue) had decreased. Music therapy has the potential as an alternative treatment for adverse hormone replacement therapy.

  3. Music therapy as a non-pharmacological anxiolytic for paediatric radiotherapy patients.

    PubMed

    O'Callaghan, C; Sexton, M; Wheeler, G

    2007-04-01

    Outpatient radiotherapy treatment in the paediatric cancer patient can be a traumatic and an anxiety-provoking experience for both the patient and the family. Music therapy has been widely reported to have psychosocial, educational and physical benefits for the paediatric cancer patient. Using individual case reports, this paper shows the successful use of music therapy as a non-pharmacological anxiolytic in the paediatric radiotherapy, outpatient waiting room setting, by providing the patient and the family with a means of communication, self-expression and creativity.

  4. Monday, Wednesday, and Friday dosing of rosuvastatin in patients previously intolerant to statin therapy.

    PubMed

    Mackie, Benjamin D; Satija, Sameer; Nell, Christine; Miller, Joseph; Sperling, Laurence S

    2007-01-15

    Statins are normally administered for the treatment of dyslipidemia on a daily basis. This standard dosing regimen is well tolerated by most patients. Occasionally, patients discontinue therapy secondary to side effects, most commonly myalgias. We describe 2 patients who were unable to tolerate daily atorvastatin therapy secondary to myalgias and were subsequently treated with rosuvastatin administered on Mondays, Wednesdays, and Fridays, with resolution of adverse effects. Significant reductions in serum low-density lipoprotein cholesterol levels were observed in the 2 patients despite the alternate-day dosing regimen. Rosuvastatin was chosen because of its long half-life (19 hours) and very high potency.

  5. Retrospective observational case-control study comparing prehospital thrombolytic therapy for ST-elevation myocardial infarction with in-hospital thrombolytic therapy for patients from same area

    PubMed Central

    Chittari, M; Ahmad, I; Chambers, B; Knight, F; Scriven, A; Pitcher, D

    2005-01-01

    Design: Retrospective observational case-control study comparing patients with suspected acute myocardial infarction (AMI) treated with thrombolytic therapy in the prehospital environment with patients treated in hospital. Setting: Wyre Forest District and Worcestershire Royal Hospital, UK. Participants: (A) All patients who received prehospital thrombolytic therapy for suspected AMI accompanied by electrocardiographic features considered diagnostic. (B) Patients who received thrombolytic therapy after arrival at hospital for the same indication, matched with group A by age, gender and postcode. Main outcome measures: 1. Call to needle time 2. Percentage of patients treated within one hour of calling for medical help 3. Appropriateness of thrombolytic therapy 4. Safety of thrombolytic therapy Results: 1. The median call to needle time for patients treated before arriving in hospital (n = 27) was 40 minutes with an inter-quartile range 25–112 (mean 43 minutes). Patients from the same area who were treated in hospital (n = 27) had a median time of 106 minutes with an inter-quartile range 50–285 (mean 126 minutes). This represents a median time saved by prehospital treatment of 66 minutes. 2. 60 minutes after medical contact, 96 % of patients treated before arrival in hospital had received thrombolytic therapy; this compares with 4% of patients from similar areas treated in hospital. 3. Myocardial infarction was confirmed in 92% (25/27) of patients who received prehospital thrombolytic therapy and similarly 92% (25/27) of those given in-hospital thrombolytic therapy. 4. No major bleeding occurred in either group. Group A suffered fewer in-hospital deaths than group B (1 versus 4). Cardiogenic shock (3 patients) and ventricular arrhythmia (5 patients) were seen only in group B. Conclusion: Paramedic-delivered thrombolytic therapy can be delivered appropriately, safely, and effectively. Time gains are substantial and can meet the national targets for early

  6. [Dreams and imaginations in the therapy of eating disordered patients].

    PubMed

    Gáti, Agnes; Abrahám, Ildikó; Arkovits, Amaryl

    2009-01-01

    Recently the integrative approach has been applied in the treatment of eating disorders with multicausal origin. In order to achieve long-term therapeutic effect, the psychodynamic interpretation is often needed and favoured as a part of the personal, multimodal therapeutic strategy. The present paper focuses on body image distortion as one of the most decisive and least influenceable symptom of the disorder. The symptom is interpreted along the body image distortion-body boundaries-self boundaries-autonomy line. With illustrative therapy details of dreams, imaginations, the authors aim to demonstrate the therapeutic use of dynamically oriented therapy and dynamically oriented hypnotherapy.

  7. ESHAP therapy effective in a patient with Langerhans cell sarcoma.

    PubMed

    Yoshimi, Akihide; Kumano, Keiki; Motokura, Toru; Takazawa, Yutaka; Oota, Satoshi; Chiba, Shigeru; Takahashi, Tsuyoshi; Fukayama, Masashi; Kurokawa, Mineo

    2008-06-01

    We describe the rare case of a 53-year-old woman with systemic involvement of Langerhans cell sarcoma (LCS) who had undergone living-related liver transplantation. We chose the CHOP regimen as first-line chemotherapy, and clinical improvement of LCS was obtained. Intensive care was necessary due to the systemic involvement of LCS and severe infectious diseases. After the third cycle of CHOP therapy, however, disease progression was observed, and we administrated a modified ESHAP regimen (etoposide, carboplatin, cytarabine, methylprednisolone) as second-line therapy. A marked response was obtained after four cycles of this combination chemotherapy. Modified ESHAP may be a very effective combination chemotherapy regimen for LCS.

  8. Dental Extraction Can Be Performed Safely in Patients on Aspirin Therapy: A Timely Reminder

    PubMed Central

    2014-01-01

    Cardiac patients on aspirin therapy may require extractions for their diseased teeth. It is a common practice among physicians and treating surgeons to stop aspirin prior to tooth extraction because of fear of bleeding complications. This practice often predisposes the patient to adverse thromboembolic events. This practice is based on theoretical risk of bleeding and on isolated case reports of excessive bleeding with aspirin therapy. The current consensus and recommendations are in favor of continuing aspirin therapy during simple tooth extraction as the bleeding complication incidence is very less and if it occurs can be controlled efficiently with local hemostasis measures. PMID:25093121

  9. Managing patients with side effects and adverse events to immunoglobulin therapy.

    PubMed

    Azizi, Gholamreza; Abolhassani, Hassan; Asgardoon, Mohammad Hossein; Shaghaghi, Shiva; Negahdari, Babak; Mohammadi, Javad; Rezaei, Nima; Aghamohammadi, Asghar

    2016-01-01

    Immunoglobulin therapy has not only served as a lifesaving approach for the prevention and treatment of infections in primary and secondary immunodeficiency diseases, but has also been used as an immunomodulatory agent for autoimmune and inflammatory disorders and to provide passive immunity for some infectious diseases. Most of the adverse effects associated with immunoglobulin therapy are mild, transient and self-limiting. However, serious side effects also occur. Therefore, to minimize the adverse events of immunoglobulin therapy, specialist review of patient clinical status and immunoglobulin products, in addition to selection of appropriate treatment strategy for the management of patients with associated side effects and adverse events, are crucial.

  10. Extracorporeal liver support therapy with Prometheus in patients with liver failure in the intensive care unit.

    PubMed

    Oppert, Michael; Rademacher, Sibylle; Petrasch, Kathrin; Jörres, Achim

    2009-10-01

    Acute liver failure (ALF) and acute-on-chronic liver failure (AoCLF) are associated with a high mortality. In these patients an accumulation of both water-soluble and water-insoluble, protein-bound, metabolic waste products occurs. Conventional extracorporeal blood purification techniques based on diffusion and/or convection such as hemodialysis or hemofiltration may only eliminate small molecular weight, water-soluble compounds. In recent years, fractionated plasma separation and adsorption (FPSA) with the Prometheus system has been introduced for extracorporeal liver support therapy. To date, however, only limited data is available regarding the effect of this treatment on mortality and outcome of patients with advanced liver disease. Here we report on our experience with 23 patients with severe liver failure who were treated with Prometheus in our medical intensive care unit. Fourteen patients had AoCLF, and nine patients experienced ALF. The median bilirubin level at the start of Prometheus therapy was 30.5 mg/dL and the median Acute Physiology and Chronic Health Evaluation II (APACHE II) score was 26. During 40 individual treatment sessions lasting 5-6 h, Prometheus therapy reduced serum bilirubin levels from 23.7 mg/dL to 15.0 mg/dL (median values) (P < 0.001), and the overall survival was 26%. ALF patients had a better survival compared to AoCLF patients (44% vs. 22%; P = 0.022). Apart from one patient who developed hemodynamic instability during a treatment session, Prometheus therapy was well tolerated without relevant side-effects. In conclusion, extracorporeal liver support therapy with Prometheus is a novel and safe treatment option in patients with severe liver failure. In this series, patients with ALF showed a significantly better outcome with Prometheus therapy compared to AoCLF patients.

  11. A Systematic Review of Music Therapy Practice and Outcomes with Acute Adult Psychiatric In-Patients

    PubMed Central

    Carr, Catherine; Odell-Miller, Helen; Priebe, Stefan

    2013-01-01

    Background and Objectives There is an emerging evidence base for the use of music therapy in the treatment of severe mental illness. Whilst different models of music therapy have been developed in mental health care, none have specifically accounted for the features and context of acute in-patient settings. This review aimed to identify how music therapy is provided for acute adult psychiatric in-patients and what outcomes have been reported. Review Methods A systematic review using medical, psychological and music therapy databases. Papers describing music therapy with acute adult psychiatric in-patients were included. Analysis utilised narrative synthesis. Results 98 papers were identified, of which 35 reported research findings. Open group work and active music making for nonverbal expression alongside verbal reflection was emphasised. Aims were engagement, communication and interpersonal relationships focusing upon immediate areas of need rather than longer term insight. The short stay, patient diversity and institutional structure influenced delivery and resulted in a focus on single sessions, high session frequency, more therapist direction, flexible use of musical activities, predictable musical structures, and clear realistic goals. Outcome studies suggested effectiveness in addressing a range of symptoms, but were limited by methodological shortcomings and small sample sizes. Studies with significant positive effects all used active musical participation with a degree of structure and were delivered in four or more sessions. Conclusions No single clearly defined model exists for music therapy with adults in acute psychiatric in-patient settings, and described models are not conclusive. Greater frequency of therapy, active structured music making with verbal discussion, consistency of contact and boundaries, an emphasis on building a therapeutic relationship and building patient resources may be of particular importance. Further research is required to

  12. [Effectiveness of triple therapy to eradicate H. pylori in patients after failed therapy with omeprazole/amoxicillin].

    PubMed

    Zala, G; Schwery, S; Giezendanner, S; Flury, R; Wüst, J; Meyenberger, C; Wirth, H P

    1996-02-03

    Helicobacter pylori (H. pylori) eradication rates with omeperazole/amoxicillin range from 0-90%. The best regimen for retreatment after failure of omeprazole/amoxicillin has not been established so far. The aim of this prospective study was to evaluate the efficacy of triple therapy with bismuth, tetracycline and ornidazole in eradicating H. pylori after failure of omeprazole/amoxicillin. 79 duodenal ulcer patients with H. pylori infection were treated with oral omeprazole (40 mg bid) and amoxicillin solute (750 mg tid) for 10 days. Eradication rate was 28/79 (35%) and was distinctly lower in smokers (> 10 cigarettes/day) vs nonsmokers (10/49 [20%] vs 18/30 [60%], p < 0.001). 37 patients with persistent H. pylori infection in whom omeprazole/amoxicillin had failed agreed to retreatment with triple therapy. Persistence of H. pylori was confirmed by histology (3 antral and 2 gastric body biopsies; H&E, Giemsa), urease test (CLO) and/or H. pylori culture. Patients smoking > 10 cigarettes/day were classified as smokers. Retreatment consisted of oral bismuth-subcitrate 4 x 120 mg/d for 28 days (day 1-28), tetracycline 4 x 500 mg/d and ornidazole 3 x 500 mg/d for 10 days (day 1-10). Control endoscopy was done 30 days after the end of treatment. Criteria for H. pylori eradication was negative urease test, culture and histology. 34/37 patients (6 females/28 males; 39 [23-64] years) completed the study (24/34 smokers, 10/34 nonsmokers). 3/37 patients dropped out because of side effects (n = 1) or incompliance (n = 2). H. pylori subcultures for resistance testing were possible in 32/34 patients: H. pylori was metronidazole-sensitive in 11/32 (1 female, 10 males; 38 [24-55] years; 9 smokers, 2 nonsmokers) and metronidazole-resistant (minimal inhibitory concentration for metronidazole > 8 mg/ml) in 21/32 (5 females, 16 males; 40 [23-64] years; 13 smokers, 8 nonsmokers). The overall H. pylori eradication rate of the triple therapy was 27/34 (79%). H. pylori was eradicated in 19

  13. Effect of Unplanned Therapy on the Prognosis of Patients with Extremity Osteosarcoma

    PubMed Central

    Wang, Bing; Xu, Ming; Zheng, Kai; Yu, Xiuchun

    2016-01-01

    Unplanned therapy for extremity osteosarcoma can result in erroneous surgical procedures and lack of neoadjuvant chemotherapy before the first operation. Our aim was to compare the prognosis between patients with extremity osteosarcoma who received unplanned therapy and those who received standard treatment. This was a retrospective review of patients with extremity osteosarcoma who received appropriate surgical treatment and neoadjuvant chemotherapy (n = 79) and those who received unplanned therapy (n = 24) between June 2000 and October 2014. Survival rate, local recurrence rate and metastasis rate were compared between the two groups. We found that patients who had unplanned therapy had a higher local recurrence rate (41.7% vs. 21.5%; P = 0.049) and a shorter mean time for recurrence (8.90 vs. 14.59 months; P = 0.018). There was no significant difference between groups in the 5-year survival rate (56.3% vs.67.8%; P = 0.356), metastasis rate (45.8% vs. 30.4%; P = 0.125) and mean time to metastasis (23.18 vs.18.24 months; P = 0.396). Our findings suggest that unplanned therapy for extremity osteosarcoma can result in failure of local control. The use of supplementary interventions after unplanned therapy, such as neoadjuvant chemotherapy and limb salvage surgery, may explain the similar survival and metastasis rates between patients receiving unplanned therapy and those receiving standard treatment. PMID:27929143

  14. Bell's palsy during interferon therapy for chronic hepatitis C infection in patients with haemorrhagic disorders.

    PubMed

    Ogundipe, O; Smith, M

    2000-03-01

    Two adult patients with life-long severe haemorrhagic disorders commenced on interferon-alpha2b therapy for chronic hepatitis C infection. Both developed Bell's palsy several weeks after commencing therapy, They were started on steroids and, in addition, the first patient discontinued interferon-alpha2b therapy while the second patient elected to continue with therapy. In both cases facial paralysis improved over the ensuing weeks. Bell's palsy is often idiopathic but has been reported. in association with herpesviruses. It is not a recognised complication of chronic hepatitis B or C infection, or interferon-alpha2b therapy. However, the interferons are associated with numerous adverse reactions including various neuropsychiatric manifestations and neurological syndromes. There are several reports of nerve palsies, including optic tract neuropathy, occurring during interferon therapy, and immune-based mechanisms are thought to play a role in the aetiopathogenesis. No reports of Bell's palsy in association with interferon therapy were identified in our literature search, although one possible case has been reported to the Committee of Safety in Medicine. Although Bell's palsy in our patients may have occurred by chance, a neuropathic effect of interferon-alpha2b on the facial nerve cannot be excluded and we urge physicians using interferons to be aware of this potential side-effect.

  15. Antibody Production in Response to Staphylococcal MS-1 Phage Cocktail in Patients Undergoing Phage Therapy

    PubMed Central

    Żaczek, Maciej; Łusiak-Szelachowska, Marzanna; Jończyk-Matysiak, Ewa; Weber-Dąbrowska, Beata; Międzybrodzki, Ryszard; Owczarek, Barbara; Kopciuch, Agnieszka; Fortuna, Wojciech; Rogóż, Paweł; Górski, Andrzej

    2016-01-01

    In this study, we investigated the humoral immune response (through the release of IgG, IgA, and IgM antiphage antibodies) to a staphylococcal phage cocktail in patients undergoing experimental phage therapy at the Phage Therapy Unit, Medical Center of the Ludwik Hirszfeld Institute of Immunology and Experimental Therapy in Wrocław, Poland. We also evaluated whether occurring antiphage antibodies had neutralizing properties toward applied phages (K rate). Among 20 examined patients receiving the MS-1 phage cocktail orally and/or locally, the majority did not show a noticeably higher level of antiphage antibodies in their sera during phage administration. Even in those individual cases with an increased immune response, mostly by induction of IgG and IgM, the presence of antiphage antibodies did not translate into unsatisfactory clinical results of phage therapy. On the other hand, a negative outcome of the treatment occurred in some patients who showed relatively weak production of antiphage antibodies before and during treatment. This may imply that possible induction of antiphage antibodies is not an obstacle to the implementation of phage therapy and support our assumption that the outcome of the phage treatment does not primarily depend on the appearance of antiphage antibodies in sera of patients during therapy. These conclusions are in line with our previous findings. The confirmation of this thesis is of great interest as regards the efficacy of phage therapy in humans. PMID:27822205

  16. The effects of combined hyperbaric oxygen therapy on patients with post-stroke depression.

    PubMed

    Yan, Dong; Shan, Jin; Ze, Yu; Xiao-Yan, Zeng; Xiao-Hua, Hu

    2015-05-01

    [Purpose] To observe the effect of combined hyperbaric oxygen therapy on patients with post-stroke depression. [Subjects] Ninety patients with post-stroke depression were randomly divided into 3 groups: fluoxetine treatment group (n = 30), hyperbaric oxygen therapy group (n = 30), and hyperbaric oxygen combined treatment group (n = 30). [Methods] Fluoxetine treatment group received anti-depression drugs (fluoxetine, 20 mg/day), hyperbaric oxygen therapy group received hyperbaric oxygen (once a day, 5 days/week), hyperbaric oxygen combined treatment group received fluoxetine and hyperbaric oxygen treatments as described above. All patients received routine rehabilitation therapy. Hamilton Depression Scale (HAMD), and Scandinavian Stroke Scale (SSS) scores were evaluated before and at the end of 4th week. The total effective rate of depression release between the 3 groups was also compared at the end of study. [Results] The end scores of HAMD and SSS in the 3 groups were significantly lower than those before treatment. The total effective rate of combined hyperbaric oxygen therapy group after treatment was higher than the other two groups. [Conclusions] Combined hyperbaric oxygen therapy plays an important role in the treatment of patients with post-stroke depression. The total effective rate of combined hyperbaric oxygen therapy was higher than other routine anti post-stroke depression treatments.

  17. Chronic opioid therapy for nonmalignant pain: the patient's perspective. Part I--life before and after opioid therapy.

    PubMed

    Vallerand, April; Nowak, Luann

    2009-09-01

    Prescription of opioid analgesics for managing chronic nonmalignant pain is a highly debated treatment modality. Although opioid therapy has been shown to decrease pain intensity, improve quality of life, and enhance functioning for adults with pain, opioids are rarely used as a long-term treatment option. Limited qualitative research exists that reflects patients' perspectives regarding life with chronic nonmalignant pain. This paper reports the results of a phenomenologic study that investigated the experience of 22 adults receiving opioid therapy for chronic nonmalignant pain. Themes that emerged regarding life before and after treatment with opioid therapy are discussed in part 1 of this two-part series. Life before treatment with opioids was characterized by desperation and inability to function. Life after treatment with opioids was characterized by balancing, living a secret life, fear of losing the pain management regimen, and thankfulness for a life regained. Overall, the data reflected the fact that these individuals trade the incapacitation of chronic pain for secrecy to regain their life and improve their functional capacity and ability to perform self-care. Awareness of the life-enhancing benefits of opioid therapy in adults with chronic nonmalignant pain will enable clinicians to intervene appropriately and to act as advocates on behalf of adults using chronic opioid therapy.

  18. Vasopressin-receptor antagonist therapy in patients with hyponatraemia.

    PubMed

    Vachharajani, Tushar; Vachharajani, Vidula

    2007-07-01

    Hyponatraemia often complicates the treatment of underlying conditions in patients who are seriously ill. Arginine vasopressin receptor antagonists block the action of arginine vasopressin and correct sodium and water imbalance in patients with euvolaemic or hypervolaemic hyponatraemia.

  19. [Electroconvulsive therapy and defibrillation in the paper. An analysis of the media].

    PubMed

    Hoffmann-Richter, U; Alder, B; Finzen, A

    1998-07-01

    In our study on Psychiatry, Mass Media and Public Opinion we made a content analysis of newspaper reports on ECT and electric defibrillation. We traced only few special articles on the subject in the 1994 and 1995 CD-Rom versions of the "Der Spiegel", The "Frankfurter Allgemeine Zeitung" (FAZ), the "Neue Zürcher Zeitung" (NZZ) and the "Berliner Tageszeitung" (taz), although the word "Elektroschock" was employed 118 times. Even in high standard newspapers the style of language becomes special when they deal with ECT. The articles are strongly biased and lack informations. In contrast to Defibrillation ECT is not generally accepted. Referring to ECT horror pictures of past psychiatry are cited. The language used is biased and discriminative. Referring to Defibrillation technical details are described and the language is neutral. The social representation of ECT is completely negative.

  20. [Treatment satisfaction of patients with borderline personality disorder in inpatient schema therapy].

    PubMed

    Reiss, Neele; Vogel, Friederike; Nill, Marco; Graf-Morgenstern, Mechthild; Finkelmeier, Britta; Lieb, Klaus

    2013-02-01

    Patients with severe and chronic psychiatric disorders, such as Borderline Personality Disorder (BPD), are hospitalized frequently, but we often find a high ambivalence regarding treatment in this group of patients. 31 patients with severe BPD participated in an inpatient Schema Therapy (ST) treatment program and evaluated both the intensive ST treatment program and group therapy elements regarding their treatment -satisfaction. A high global treatment satisfaction with the ST treatment program was demonstrated and we found a higher treatment satisfaction in patients with than without BPD specific symptom reductions. Remarkable differences in treatment satisfaction showed when looking at the evaluation of group therapies. The results of the present study demonstrate treatment satisfaction of BPD patients in inpatient ST and give directions for the future development of these programs.

  1. Multiple side effects of penicillamine therapy in one patient with rheumatoid arthritis.

    PubMed Central

    Essigman, W K

    1982-01-01

    Skin rashes, proteinuria, systemic lupus erythematosus, polymyositis and myasthenia gravis have all been recorded as complications of penicillamine therapy in patients with rheumatoid arthritis. A patient who had developed all 5 is now described. The skin lesion resembled elastosis perforans serpiginosa, which has been reported as a rare side effect in patients with Wilson's disease but not in patients with rheumatoid arthritis treated with penicillamine. Images PMID:6216862

  2. Immunomodulating effect of laser therapy in patients with microbial eczema

    NASA Astrophysics Data System (ADS)

    Dudchenko, Mycola O.; Denisenko, Olga I.

    1999-11-01

    While examining 90 patients suffering the microbial eczema (ME), we revealed disorders of the immune system in the majority of them (3/4). It was established that the inclusion of percutaneous laser irradiation of the blood in a course of multimodality treatment of patients with ME caused an immunomodulating action which resulted in an improved ME course in these patients.

  3. Safety and efficacy of bone wax in patients on oral anticoagulant therapy.

    PubMed

    Krasny, Marta; Krasny, Kornel; Fiedor, Piotr

    2014-01-01

    Cardiovascular conditions, apart from neoplastic diseases, remain the major cause of death in developed countries; therefore, the number of patients receiving oral anticoagulants is constantly increasing. Anticoagulant therapy considerably reduced mortality in patients with history of myocardial infarction among others. Although many interventions may be performed without withdrawal of the anticoagulant and tooth extraction was qualified as a procedure of low hemorrhage risk, a majority of dentists refer the patient to a cardiologist several days before the elective tooth extraction to withdraw anticoagulants. The aim of the study was to evaluate the efficacy and safety of bone wax used to stop bleeding after dental procedures in a group of patients on chronic anticoagulant therapy and find an answer to a question, whether it is justified to temporarily withdraw anticoagulants for this type of procedures. The study involved 176 patients on chronic anticoagulant therapy undergoing tooth extraction (154 subjects) or surgical extraction of a retained tooth (48 subjects). After the procedure, in each case the alveolus was filled with bone wax to stop bleeding. In all patients involved in the study bleeding from the alveolus was successfully stopped during the procedure. None of the subjects reported increased bleeding from the operational site after coming back home. Bone wax is a good, efficient, and safe material to block bleeding from the alveolus following tooth extractions, also in patients on chronic anticoagulant therapy. The study demonstrated that withdrawal or adjustment of anticoagulant therapy is not necessary before an elective tooth extraction.

  4. Effect of mirror therapy on upper extremity motor function in stroke patients: a randomized controlled trial.

    PubMed

    Gurbuz, Nigar; Afsar, Sevgi Ikbali; Ayaş, Sehri; Cosar, Sacide Nur Saracgil

    2016-09-01

    [Purpose] This study aimed to evaluate the effectiveness of mirror therapy combined with a conventional rehabilitation program on upper extremity motor and functional recovery in stroke patients. [Subjects and Methods] Thirty-one hemiplegic patients were included. The patients were randomly assigned to a mirror (n=16) or conventional group (n=15). The patients in both groups underwent conventional therapy for 4 weeks (60-120 minutes/day, 5 days/week). The mirror group received mirror therapy, consisting of periodic flexion and extension movements of the wrist and fingers on the non-paralyzed side. The patients in the conventional group performed the same exercises against the non-reflecting face of the mirror. The patients were evaluated at the beginning and end of the treatment by a blinded assessor using the Brunnstrom stage, Fugl-Meyer Assessment (FMA) upper extremity score, and the Functional Independence Measure (FIM) self-care score. [Results] There was an improvement in Brunnstrom stage and the FIM self-care score in both groups, but the post-treatment FMA score was significantly higher in the mirror therapy group than in the conventional treatment group. [Conclusion] Mirror therapy in addition to a conventional rehabilitation program was found to provide additional benefit in motor recovery of the upper extremity in stroke patients.

  5. Effect of mirror therapy on upper extremity motor function in stroke patients: a randomized controlled trial

    PubMed Central

    Gurbuz, Nigar; Afsar, Sevgi Ikbali; Ayaş, Sehri; Cosar, Sacide Nur Saracgil

    2016-01-01

    [Purpose] This study aimed to evaluate the effectiveness of mirror therapy combined with a conventional rehabilitation program on upper extremity motor and functional recovery in stroke patients. [Subjects and Methods] Thirty-one hemiplegic patients were included. The patients were randomly assigned to a mirror (n=16) or conventional group (n=15). The patients in both groups underwent conventional therapy for 4 weeks (60–120 minutes/day, 5 days/week). The mirror group received mirror therapy, consisting of periodic flexion and extension movements of the wrist and fingers on the non-paralyzed side. The patients in the conventional group performed the same exercises against the non-reflecting face of the mirror. The patients were evaluated at the beginning and end of the treatment by a blinded assessor using the Brunnstrom stage, Fugl-Meyer Assessment (FMA) upper extremity score, and the Functional Independence Measure (FIM) self-care score. [Results] There was an improvement in Brunnstrom stage and the FIM self-care score in both groups, but the post-treatment FMA score was significantly higher in the mirror therapy group than in the conventional treatment group. [Conclusion] Mirror therapy in addition to a conventional rehabilitation program was found to provide additional benefit in motor recovery of the upper extremity in stroke patients. PMID:27799679

  6. Prevalence of thyroid disorders in hepatitis C virus positive patients on interferon and antiviral therapy

    PubMed Central

    Goyal, Gitanjali; Panag, KMDS; Garg, Ravinder

    2016-01-01

    Background: Hepatitis C virus (HCV) infection is common worldwide. The treatment typically involves a combination of interferon-alpha (IFN-α) and ribavirin (RBV) therapy; however, the use of IFN-α is well documented to be associated with thyroid disease, the most common autoimmune disorder associated with IFN-α. Aim: The aim of the present study was to know the prevalence of thyroid abnormality in the HCV-positive patients on IFN and antiviral therapy. Materials and Methods: Fifty known HCV positive patients were enrolled for the study. All the patients were on IFN (3 million unit subcutaneously 3 times/week) and antiviral therapy (oral RBV 1000–1200 mg/day). Thyroid function tests were performed first at the start of treatment and then after 12 weeks of treatment. Results: 13 (26%) of the patients were found to develop hypothyroidism, and 1 (2%) patient developed hyperthyroidism in the course of 12 weeks therapy. Conclusion: HCV patients on IFN and antiviral therapy have an effect on the thyroid gland, so these patients should be regularly screened for thyroid disorders and appropriately treated to maintain euthyroid status. PMID:27857890

  7. The effects of high intensity laser therapy on pain and function in patients with knee osteoarthritis.

    PubMed

    Kim, Gook-Joo; Choi, Jioun; Lee, Sangyong; Jeon, Chunbae; Lee, Kwansub

    2016-11-01

    [Purpose] The purpose of this study was to examine the effects of high intensity laser therapy (HILT) on pain and function in patients with knee osteoarthritis. [Subjects and Methods] In this study, an experiment was conducted on 20 subjects who were divided into the control group (n=10), which would receive conservative physical therapy (CPT), and the experimental group (n=10), which would receive effects of high intensity laser therapy after conservative physical therapy. All patients received their respective therapies three times each week over a four-week period. In terms of the intensity of the high intensity laser therapy, it was applied to each patient in the tibia and femoral epicondyle for five minutes while the patient's knee joint was bent at around 30° and the separation distance between the handpiece and the skin was maintained at around 1 cm. The visual analogue scale was used to measure pain, and the Korean Western Ontario and McMaster Universities Osteoarthritis Index was used for functional evaluations. [Results] The comparison of differences in the measurements taken before and after the experiment within each group showed a statistically significant decline in both the VAS and the K-WOMAC. The comparison of the two groups showed that the high intensity laser therapy group had statistically significant lower scores in both the visual analogue scale and the Korean Western Ontario and McMaster Universities Osteoarthritis Index than the conservative physical therapy group. [Conclusion] High intensity laser therapy is considered an effective non-surgical intervention for reducing pain in patients with knee osteoarthritis and helping them to perform daily activities.

  8. Electrophysiological Monitoring in Patients With Tumors of the Skull Base Treated by Carbon-12 Radiation Therapy

    SciTech Connect

    Carozzo, Simone; Schardt, Dieter; Narici, Livio; Combs, Stephanie E.; Debus, Jürgen; Sannita, Walter G.

    2013-03-15

    Purpose: To report the results of short-term electrophysiologic monitoring of patients undergoing {sup 12}C therapy for the treatment of skull chordomas and chondrosarcomas unsuitable for radical surgery. Methods and Materials: Conventional electroencephalogram (EEG) and retinal and cortical electrophysiologic responses to contrast stimuli were recorded from 30 patients undergoing carbon ion radiation therapy, within a few hours before the first treatment and after completion of therapy. Methodologies and procedures were compliant with the guidelines of the International Federation for Clinical Neurophysiology and International Society for Clinical Electrophysiology of Vision. Results: At baseline, clinical signs were reported in 56.6% of subjects. Electrophysiologic test results were abnormal in 76.7% (EEG), 78.6% (cortical evoked potentials), and 92.8% (electroretinogram) of cases, without correlation with neurologic signs, tumor location, or therapy plan. Results on EEG, but not electroretinograms and cortical responses, were more often abnormal in patients with reported clinical signs. Abnormal EEG results and retinal/cortical responses improved after therapy in 40% (EEG), 62.5% (cortical potentials), and 70% (electroretinogram) of cases. Results on EEG worsened after therapy in one-third of patients whose recordings were normal at baseline. Conclusions: The percentages of subjects whose EEG results improved or worsened after therapy and the improvement of retinal/cortical responses in the majority of patients are indicative of a limited or negligible (and possibly transient) acute central nervous system toxicity of carbon ion therapy, with a significant beneficial effect on the visual pathways. Research on large samples would validate electrophysiologic procedures as a possible independent test for central nervous system toxicity and allow investigation of the correlation with clinical signs; repeated testing over time after therapy would demonstrate, and may

  9. Intensive Insulin Therapy is Associated with Reduced Infectious Complications in Burn Patients

    PubMed Central

    Hemmila, Mark R.; Taddonio, Michael A.; Arbabi, Saman; Maggio, Paul M.; Wahl, Wendy L.

    2013-01-01

    Background Intensive insulin therapy to control blood glucose levels has reduced mortality in surgical, but not medical intensive care unit (ICU) patients. Control of blood glucose levels has also been shown to reduce morbidity in surgical ICU patients. There is very little data for use of intensive insulin therapy in the burn patient population. We sought to evaluate our experience with intensive insulin therapy in burn injured ICU patients with regard to mortality, morbidity, and use of hospital resources. Study Design Burn patients admitted to our American College of Surgeons Level 1 verified Burn Center ICU from 7/1/2004 to 6/30/2006 were studied. An intensive insulin therapy protocol was initiated for ICU patients admitted starting 7/1/2005 with a blood glucose target of 100–140 mg/dL. The two groups of patients studied were control (7/1/2004 to 6/30/2005) and intensive insulin therapy (7/1/2005 to 6/30/2006). All glucose values for the hospitalization were analyzed. Univariate and multivariate analyses were performed. Results 152 ICU patients admitted with burn injury were available for study. No difference in mortality was evident between the control and intensive insulin therapy groups. After adjusting for patient risk, the intensive insulin therapy group was found to have a decreased rate of pneumonia, ventilator-associated pneumonia, and urinary tract infection. In patients with a maximum glucose value > 140 mg/dL, the risk for an infection was significantly increased (OR 11.3, 95% CI 4–32, p-value <0.001). Presence of a maximum glucose value > 140 mg/dL was associated with a sensitivity of 91% and specificity of 62% for an infectious complication. Conclusion Intensive insulin therapy for burn injured patients admitted to the ICU was associated with a reduced incidence of pneumonia, ventilator associated pneumonia, and urinary tract infection. Intensive insulin therapy did not result in a change in mortality or length of stay when adjusting for

  10. Refusal of Curative Radiation Therapy and Surgery Among Patients With Cancer

    SciTech Connect

    Aizer, Ayal A.; Chen, Ming-Hui; Parekh, Arti; Choueiri, Toni K.; Kim, Simon P.; Martin, Neil E.; Trinh, Quoc-Dien; Nguyen, Paul L.

    2014-07-15

    Purpose: Surgery and radiation therapy represent the only curative options for many patients with solid malignancies. However, despite the recommendations of their physicians, some patients refuse these therapies. This study characterized factors associated with refusal of surgical or radiation therapy as well as the impact of refusal of recommended therapy on patients with localized malignancies. Methods and Materials: We used the Surveillance, Epidemiology, and End Results program to identify a population-based sample of 925,127 patients who had diagnoses of 1 of 8 common malignancies for which surgery and/or radiation are believed to confer a survival benefit between 1995 and 2008. Refusal of oncologic therapy, as documented in the SEER database, was the primary outcome measure. Multivariable logistic regression was used to investigate factors associated with refusal. The impact of refusal of therapy on cancer-specific mortality was assessed with Fine and Gray's competing risks regression. Results: In total, 2441 of 692,938 patients (0.4%) refused surgery, and 2113 of 232,189 patients (0.9%) refused radiation, despite the recommendations of their physicians. On multivariable analysis, advancing age, decreasing annual income, nonwhite race, and unmarried status were associated with refusal of surgery, whereas advancing age, decreasing annual income, Asian American race, and unmarried status were associated with refusal of radiation (P<.001 in all cases). Refusal of surgery and radiation were associated with increased estimates of cancer-specific mortality for all malignancies evaluated (hazard ratio [HR], 2.80, 95% confidence interval [CI], 2.59-3.03; P<.001 and HR 1.97 [95% CI, 1.78-2.18]; P<.001, respectively). Conclusions: Nonwhite, less affluent, and unmarried patients are more likely to refuse curative surgical and/or radiation-based oncologic therapy, raising concern that socioeconomic factors may drive some patients to forego potentially life-saving care.

  11. Long-term outcome of patients after a single interruption of antiretroviral therapy: a cohort study

    PubMed Central

    2012-01-01

    Background To describe the long term outcome of patients who interrupted highly active antiretroviral therapy (HAART) once, identify the variables associated with earlier need to re-start HAART, and the response when therapy was resumed. A retrospective observational cohort of 66 adult patients with HIV-1 infection who interrupted HAART with a CD4+cell count ≥350 cells/μL and undetectable viral load (VL) was performed. The pre-established CD4+ cell count for restarting therapy was 300cells/μL. Cox regression was used to analyse the variables associated with earlier HAART reinitiation. Results The median follow-up was 209 weeks (range, 64–395). Rates of HIV-related or possible HIV-related events were 0.37 (one case of acute retroviral syndrome) and 1.49 per 100 patient-years, respectively. Two patients died after re-starting therapy and having reached undetectable VL. Three patients suffered a sexually transmitted disease while off therapy. Fifty patients (76%) resumed therapy after a median of 97 weeks (range, 17–267). Age, a nadir of CD4+ <250 cells/μL, and a mean VL during interruption of >10,000 copies/ml were independent predictors for earlier re-start. The intention-to-treat success rate of the first HAART resumed regimen was 85.4%. There were no differences by regimen used, nor between regimens that were the same as or different from the one that had been interrupted. Conclusions Our data suggest highly active antiretroviral therapy may be interrupted in selected patients because in these patients, when the HAART is restarted, the viral and clinical response may be achieved. PMID:23095460

  12. Neurological adverse events in patients receiving anti-TNF therapy: a prospective imaging and electrophysiological study

    PubMed Central

    2014-01-01

    Introduction The aim was to investigate the frequency of neurological adverse events in patients with rheumatoid arthritis (RA) and spondylarthropathies (SpA) treated with tumor necrosis factor (TNF) α antagonists. Methods Seventy-seven patients eligible for anti-TNFα therapy were evaluated. There were 36 patients with RA, 41 with SpA [24 psoriatic arthritis (PsA) and 17 with ankylosing spondylitis (AS)]. All patients had a complete physical and neurological examination. Brain and cervical spine magnetic resonance imaging (MRI) and neurophysiological tests were performed in all patients before the initiation of anti-TNFα therapy and after a mean of 18 months or when clinical symptoms and signs indicated a neurological disease. Exclusion criteria included hypertension, diabetes mellitus, dyslipidemia, heart arrhythmias, atherothrombotic events, vitamin B12 and iron deficiency, head and neck trauma and neurological surgeries. Results Two patients did not receive anti-TNFα therapy because brain MRIs at baseline revealed lesions compatible with demyelinating diseases. Thus, 75 patients received anti-TNFα (38 infliximab, 19 adalimumab and 18 etanercept). Three patients developed neurological adverse events. A 35-year-old man with PsA after 8 months of infliximab therapy presented with paresis of the left facial nerve and brain MRI showed demyelinating lesions. Infliximab was discontinued and he was treated with pulses of corticosteroids recovering completely after two months. The second patient was a 45-year-old woman with RA who after 6 months of adalimumab therapy presented with optic neuritis. The third patient was a 50-year-old woman with AS, whom after 25 months of infliximab therapy, presented with tingling and numbness of the lower extremities and neurophysiological tests revealed peripheral neuropathy. In both patients anti-TNF were discontinued and they improved without treatment after 2 months. The rest of our patients showed no symptoms and MRIs

  13. The effectiveness of occupational therapy in restoring the functional state of hands in rheumatoid arthritis patients.

    PubMed

    Rapoliene, Jolita; Krisciūnas, Aleksandras

    2006-01-01

    The aim of the study was to evaluate the effectiveness of occupational therapy in rheumatoid arthritis patients with impaired hand function. Standardized Functional Independence Measure was employed in order to evaluate the functional status of the patients and impaired activities. A dynamometer was used for the measurements of muscular strength of hands and a goniometer, for the range of motion of the wrist. Totally, we have examined 120 rheumatoid arthritis patients. They were divided into two groups: 60 patients in each. Occupational therapy was applied only to the patients of the first group. The mean age of Group 1 patients was 53.4+/-1.8 years, the mean age of Group 2 patients was 52.0+/-1.9 years. The mean duration of the disease was 11.5+/-2.6 years and 12.1+/-2.4 years, respectively. The effectiveness of therapy was considered ineffective if, after the completion of the course of occupational therapy, no increase in Functional Independence Measure score for patients with rheumatoid arthritis was observed. When the score increased from 1 to 3, we considered this as moderate effectiveness; when the score increased to 4-6, we evaluated the effectiveness of occupational therapy as good, and when the score of 7 was attained, effectiveness of occupational therapy was considered as very good. In Group 1, the moderate effectiveness of occupational therapy was determined in 31.7% of patients; good effectiveness, in 61.7%; and very good effectiveness, in 3.3% of rheumatoid arthritis patients. In Group 2, the moderate effectiveness of treatment was determined in 48.3% of patients and good effectiveness, in 5% of rheumatoid arthritis patients. CONCLUSIONS. Hand function (the strength of fingers and hands, the range of motion of the wrist) significantly improved in patients with rheumatoid arthritis after completion of a course of occupational therapy (p<0.05). The improvement of hand functions in patients with rheumatoid arthritis led to increased ability to take food

  14. Experiences of wake and light therapy in patients with depression: A qualitative study.

    PubMed

    Kragh, Mette; Møller, Dorthe Norden; Wihlborg, Camilla Schultz; Martiny, Klaus; Larsen, Erik Roj; Videbech, Poul; Lindhardt, Tove

    2017-04-01

    Wake therapy can reduce depressive symptoms within days, and response rates are high. To sustain the effect, it is often combined with light therapy. Few studies have focussed on factors related to patients' adherence to the regime, and none has used qualitative methods to examine their experience of these combined interventions. Therefore, the aim of the present study was to illuminate patients' experiences with wake and light therapy and factors related to adherence. Thirteen inpatients with depression were included. They participated in an intervention consisting of three wake therapies during the first week, 30 min of daily light treatment for the entire 9 weeks, and ongoing psychoeducation regarding good sleep hygiene. Patients kept a diary, and individual semistructured interviews were conducted. Data were analysed using qualitative content analysis. The participants' overall experience with the treatment was positive. Some experienced a remarkable and rapid antidepressant effect, whereas others described more long-term benefits (e.g. improved sleep and diurnal rhythm). Yet recovery was fragile, and patients were only cautiously optimistic. Social support was important for maintaining the motivation to stay awake and receive daily light therapy. Overall, participants found the treatment worthwhile and would recommend it to others with depression. The study revealed a lack of knowledge among participants about the connection between regular sleep patterns and depression. In conclusion, this study provides insight into patients' experiences, and knowledge that can contribute to guidelines for future adherence-promoting organization of wake and light therapy.

  15. [Helpful Factors of Ambulant Art Therapy in the Group and Changes of Experiences in Psychosomatic Patients].

    PubMed

    Oster, Jörg; Moser, Anna Sophie; Danner-Weinberger, Alexandra; von Wietersheim, Jörn

    2016-02-01

    The aim of this study was to analyze the experiences of patients suffering from mostly chronic psychosomatic disorders in an ambulant art therapy in the group. Especially, the focus was on the experienced changes, helpful factors and specifics of the therapy as well as on the experienced benefit. For this, 30 patients were interviewed in a semi-standardized way. Additionally, the symptom-based strain was psychometrically recorded in a part of the patients (21) at the beginning of the therapy and after at least 6 months of participation. The evaluation of those interviews with the qualitative analysis of the therapy subjects surrendered an improvement of the health state in most of the participants. Especially group factors, art as a mean of communication, becoming aware of feelings but also diversion and fun were proved to be beneficial. The art therapy also serves for structuring the week as well as a contact point and a resource in the interpersonal communication of everyday life. Nearly all of the patients referred to some important turning point pictures. Mostly, the benefit was valued as being high. But, in contrast, the psychometric measure did not show any significant change. The results emphasize the stabilizing function of art therapy in the examined patients, whereat the classification of the psychometric result is complicated by the absence of a control group.

  16. Plasticity of the human visual system after retinal gene therapy in patients with Leber's congenital amaurosis.

    PubMed

    Ashtari, Manzar; Zhang, Hui; Cook, Philip A; Cyckowski, Laura L; Shindler, Kenneth S; Marshall, Kathleen A; Aravand, Puya; Vossough, Arastoo; Gee, James C; Maguire, Albert M; Baker, Chris I; Bennett, Jean

    2015-07-15

    Much of our knowledge of the mechanisms underlying plasticity in the visual cortex in response to visual impairment, vision restoration, and environmental interactions comes from animal studies. We evaluated human brain plasticity in a group of patients with Leber's congenital amaurosis (LCA), who regained vision through gene therapy. Using non-invasive multimodal neuroimaging methods, we demonstrated that reversing blindness with gene therapy promoted long-term structural plasticity in the visual pathways emanating from the treated retina of LCA patients. The data revealed improvements and normalization along the visual fibers corresponding to the site of retinal injection of the gene therapy vector carrying the therapeutic gene in the treated eye compared to the visual pathway for the untreated eye of LCA patients. After gene therapy, the primary visual pathways (for example, geniculostriate fibers) in the treated retina were similar to those of sighted control subjects, whereas the primary visual pathways of the untreated retina continued to deteriorate. Our results suggest that visual experience, enhanced by gene therapy, may be responsible for the reorganization and maturation of synaptic connectivity in the visual pathways of the treated eye in LCA patients. The interactions between the eye and the brain enabled improved and sustained long-term visual function in patients with LCA after gene therapy.

  17. Anti-TNF-α therapy improves Treg and suppresses Teff in patients with rheumatoid arthritis.

    PubMed

    Huang, Zhuochun; Yang, Bin; Shi, Yunying; Cai, Bei; Li, Yi; Feng, Weihua; Fu, Yang; Luo, Limei; Wang, Lanlan

    2012-09-01

    Anti-TNF-α therapies have been applied in RA treatment, but the regulatory effect of the drug on immune system is not clear. In this study, we included 33 active RA patients and divided them into two groups. One group received anti-TNF-α mAb+methotrexate for 24 weeks, the other group got placebo+methotrexate for the first 12 weeks and anti-TNF-α mAb+methotrexate for another 12 weeks. Circulatory regulatory T cell (Treg) and effector T cell (Teff) frequency was analyzed pre-therapy and week 12 and week 24 for both group patients by flowcytometry. Our results indicated significantly elevated Treg and decreased Teff at week 24 compared with pre-therapy and week 12 for both group patients, and a little higher Treg and lower Teff frequency in anti-TNF-α therapy group than in placebo therapy patients. Our results demonstrated anti-TNF-α therapy has regulatory effect on immune system of RA patients by promoting Treg proportion increase and suppressing Teff.

  18. Public versus Private Drug Insurance and Outcomes of Patients Requiring Biologic Therapies for Inflammatory Bowel Disease

    PubMed Central

    Rumman, Amir; Candia, Roberto; Sam, Justina J.; Croitoru, Kenneth; Silverberg, Mark S.; Steinhart, A. Hillary

    2017-01-01

    Background. Antitumor necrosis factor (anti-TNF) therapy is a highly effective but costly treatment for inflammatory bowel disease (IBD). Methods. We conducted a retrospective cohort study of IBD patients who were prescribed anti-TNF therapy (2007–2014) in Ontario. We assessed if the insurance type was a predictor of timely access to anti-TNF therapy and nonroutine health utilization (emergency department visits and hospitalizations). Results. There were 268 patients with IBD who were prescribed anti-TNF therapy. Public drug coverage was associated with longer median wait times to first dose than private one (56 versus 35 days, P = 0.002). After adjusting for confounders, publicly insured patients were less likely to receive timely access to anti-TNF therapy compared with those privately insured (adjusted hazard ratio, 0.66; 95% CI: 0.45–0.95). After adjustment for demographic and clinical characteristics, publicly funded subjects were more than 2-fold more likely to require hospitalization (incidence rate ratio [IRR], 2.30; 95% CI: 1.19–4.43) and ED visits (IRR 2.42; 95% CI: 1.44–4.08) related to IBD. Conclusions. IBD patients in Ontario with public drug coverage experienced greater delays in access to anti-TNF therapy than privately insured patients and have a higher rate of hospitalizations and ED visits related to IBD. PMID:28239601

  19. [Long-term effects of combined therapy in patients with beta-thalassemia major].

    PubMed

    Bagnulo, S; Giannini, A M; Moscatelli, F; Stragapede, L; Acquafredda, A; Dammacco, A

    1998-01-01

    We evaluated therapy complications in 19 beta-thalassemia major patients (mean age from 3 years/5 months and 1 years/6 months) who were followed at II Pediatric Department-University of Bari. 3 out of 19 patients underwent allogenic BMT from matched related donor; 2 out of 19 underwent splenectomy. All of them were receiving hypertransfusion therapy and continuous chelation with DFO. In all patients we performed physical examination, laboratory assays, cardiac and endocrinologic function tests, serum HBV-HCV-HIV antibodies, otoscopy and audiometric test, fundus oculi, skeletal x-ray. 1 out of 19 patients, who was under 15, had a slight dilatation of left ventricle and arythmia. All patients were HBsAb positive. 4/19 patients were HCV Ab positive (ELISA test) with an increase in ALT-AST serum levels since at least 6 months. In 3 of them we assessed RIBA test, always positive. 3 of them underwent liver biopsy (1 iron overload 2 chronic active hepatitis). All patients were HIV Ab negative. 4/15 patients revealed low GH levels after Arginina test. 13 pre-pubescent patients had normal results with GNRH test but lower results after FSH test. 1 pubescent patient had gonadotropic hypophyseal deficit. 4 patients had subclinic hypothiroidism. We couldn't find any sequelas in bone-eyes-ears. Hypertransfusion therapy, chelation, profilaxis of infections improved length and quality of life in thalassemic patients. Hypogonadotropic hypogonadism remains a serious sequela and we think it needs to be treated.

  20. Pleural Photodynamic Therapy and Surgery in Lung Cancer and Thymoma Patients with Pleural Spread.

    PubMed

    Chen, Ke-Cheng; Hsieh, Yi-Shan; Tseng, Ying-Fan; Shieh, Ming-Jium; Chen, Jin-Shing; Lai, Hong-Shiee; Lee, Jang-Ming

    2015-01-01

    Pleural spread is difficult to treat in malignancies, especially in lung cancer and thymoma. Monotherapy with surgery fails to have a better survival benefit than palliative chemotherapy, the currently accepted treatment. Photodynamic therapy utilizes a photosensitizer to target the tumor site, and the tumor is exposed to light after performing a pleurectomy and tumor resection. However, the benefits of this procedure to lung cancer or thymoma patients are unknown. We retrospectively reviewed the clinical characteristics and treatment outcomes of patients with lung cancer or thymoma with pleural seeding who underwent pleural photodynamic therapy and surgery between 2005 and 2013. Eighteen patients enrolled in this study. The mean patient age was 52.9 ± 12.2 years. Lung cancer was the inciting cancer of pleural dissemination in 10 patients (55.6%), and thymoma in 8 (44.4%). There was no procedure-related mortality. Using Kaplan-Meier survival analysis, the 3-year survival rate and the 5-year survival rate were 68.9% and 57.4%, respectively. We compared the PDT lung cancer patients with those receiving chemotherapy or target therapy (n = 51) and found that the PDT group had better survival than non-PDT patients (mean survival time: 39.0 versus 17.6 months; P = .047). With proper patient selection, radical surgical resection combined with intrapleural photodynamic therapy for pleural spread in patients with non-small cell lung cancer or thymoma is feasible and may provide a survival benefit.

  1. [Changes in prostatic circulation in response to laser therapy and magnetic therapy in patients with benign prostatic hyperplasia].

    PubMed

    2005-01-01

    The results of preoperative preparation were analysed in 59 patients with prostatic benign hyperplasia (PBH) subjected to TUR. Treatment outcomes were assessed by transrectal ultrasound (color Doppler mapping) in two groups of patients. Group 1 received combined therapy including transrectal laser radiation of the prostate, group 2--transrectal magnetotherapy. The analysis showed that laser radiation reduced insignificantly the size of the prostate and adenomatous node, improved microcirculation and circulation in the prostate. This resulted in relief of inflammation and reduction of the number of postoperative inflammatory complications. Transrectal magnetotherapy has a positive effect on vascularization and hemodynamics of the prostate, local immunity, contamination of the tissues with pathogenic flora.

  2. Outcomes and Tolerability of Chemoradiation Therapy for Pancreatic Cancer Patients Aged 75 Years or Older

    SciTech Connect

    Miyamoto, David T.; Mamon, Harvey J.

    2010-07-15

    Purpose: To review the outcomes and tolerability of full-dose chemoradiation in elderly patients aged 75 years or older with localized pancreatic cancer. Methods and Materials: We retrospectively reviewed patients aged 75 years or older with nonmetastatic pancreatic cancer treated with chemoradiation therapy at two institutions from 2002 to 2007. Patients were analyzed for treatment toxicity, local recurrences, distant metastases, and survival. Results: A total of 42 patients with a median age of 78 years (range, 75-90 years) who received chemoradiation therapy for pancreatic cancer were identified. Of the patients, 24 had locally advanced disease treated with definitive chemoradiation, and 18 had disease treated with surgery and chemoradiation. Before chemoradiotherapy, the mean Eastern Cooperative Oncology Group performance status was 1.0 {+-} 0.8, and the mean 6-month weight loss was 5.3 {+-} 3.8 kg. The mean radiation dose delivered was 48.1 {+-} 9.2 Gy. All patients received fluoropyrimidine-based chemotherapy concurrently with radiotherapy. In all, 8 patients (19%) were hospitalized, 7 (17%) had an emergency room visit, 15 (36%) required a radiation treatment break, 3 (7%) required a chemotherapy break, 9 (21%) did not complete therapy, and 22 (49%) had at least one of these adverse events. The most common toxicities were nausea, pain, and failure to thrive. Median overall survival was 8.6 months (95% confidence interval, 7.2-13.1) in patients who received definitive chemoradiation therapy and 20.6 months (95% confidence interval, 9.5-{infinity}) in patients who underwent resection and chemoradiation therapy. Conclusions: In this dataset of very elderly patients with pancreatic cancer and good Eastern Cooperative Oncology Group performance status, outcomes after chemoradiotherapy were similar to those among historic controls for patients with locally advanced and resected pancreatic cancer, although many patients experienced substantial treatment

  3. [Investigation of the compliance of cervical collar therapy in 73 patients with Hirayama disease].

    PubMed

    Fu, Y; Qin, W; Sun, Q L; Fan, D S

    2016-11-22

    Objective: To summarize the therapeutic approaches of patients with Hirayama disease and investigate the patient's compliance to cervical collar therapy and its influencing factors. Methods: This was a retrospectively study.The clinical data of 73 patients was collected from Peking university 3(rd) hospital between 2010 and 2014. Results: (1)Of the 73 patients, 10 patients received surgery, 36 patients received collar therapy , and 27 patients received other conservative therapy at first visit.(2)The mean collar wearing time was from 0.3 to 36 months (means was 7±11 months). 28 patients (77.8%) wore less than 6 months, only 8 patients (22.2%) wore for more than 1 year. (3)The influencing factors were affecting appearance (33.3%), inconvenience to work (22.2%), surgical treatment performed after the exacerbation of symptoms(14.3%), illness stabilization (9.5%), choosing other conservative therapy (9.5%), personally feeling not seriously (8%) and discomfort while wearing (3.2%). (4)The patients with younger age of onset and treatment were more likely to choose neck care, while patients with older age of onset and treatment tended to choose more conservative treatment(P<0.05). Conclusions: As Hirayama disease can cause disability, application of a cervical collar to minimize neck flexion can prevent progressive muscular weakness in the early stages of the disease. But from our study, the compliance to cervical collar therapy is unsatisfactory.Multiple factors influence the compliance.Education for patients must be enhanced, and other methods to promote the therapeutic compliance should also be developed.

  4. Induction of neuroserpin expression in rat frontal cortex after chronic antidepressant treatment and electroconvulsive treatment.

    PubMed

    Tanaka, Satoshi; Yamada, Misa; Kitahara, Sari; Higuchi, Teruhiko; Honda, Kazuo; Kamijima, Kunitoshi; Yamada, Mitsuhiko

    2006-02-01

    Using expressed sequence tag (EST) analysis, we previously identified certain molecular machinery that mediates antidepressant effects. To date, several partial cDNA fragments, termed antidepressant-related genes (ADRGs), have been isolated as ESTs from rat brain. In the present study, we identified two of the ADRGs to be rat neuroserpin. Using real-time quantitative PCR, we demonstrated increased neuroserpin mRNA expression in rat frontal cortex after chronic treatment with several classes of antidepressants, including imipramine, fluoxetine, sertraline, and venlafaxine. Electroconvulsive treatment (ECT), another therapeutic treatment for depression, also increased neuroserpin expression in rat frontal cortex. Neuroserpin is a serine protease inhibitor that is implicated in the regulation of synaptic plasticity, neuronal migration, and axogenesis in the central nervous system. In conclusion, our results support the hypothesis that neuroserpin-mediated plastic changes in frontal cortex may underlie the therapeutic action of antidepressants and ECT.

  5. Effect of CPAP Therapy in Improving Daytime Sleepiness in Indian Patients with Moderate and Severe OSA

    PubMed Central

    Battan, Gulshan; Panwar, Ajay; Atam, Virendra; Kumar, Pradeep; Gangwar, Anil; Roy, Ujjawal

    2016-01-01

    Introduction Obstructive Sleep Apnoea (OSA) is a highly prevalent disease and a major public health issue in India. Excessive daytime sleepiness is an almost ubiquitous symptom of OSA. Epworth Sleepiness Scale (ESS) score is a validated objective score to measure the degree of daytime sleepiness. Continuous Positive Airway Pressure (CPAP) therapy has been established as the gold standard treatment modality for OSA patients. A few Indian studies have reported the effectiveness of CPAP therapy in improving ESS scores after 1st month of CPAP use. Aim To observe both, short-term (one month) and long-term (three month) effects of CPAP therapy on ESS scores in moderate to severe OSA patients. Materials and Methods The patients complaining of excessive day-time sleepiness, snoring and choking episodes during sleep, consecutively presenting to medicine OPD over a period of 2 years, were subjected to Polysomnography (PSG). Seventy-three patients with apnoea-hypopnea index (AHI) ≥15 were categorised as having moderate to severe forms of OSA (moderate OSA with AHI=15-30 and severe OSA with AHI >30), and were scheduled for an initial trial of CPAP therapy. Forty-seven patients reported good tolerance to CPAP therapy after a trial period of 2 weeks and comprised the final study group. ESS scores in these patients were recorded at the baseline, and after 1st and 3rd month of CPAP therapy, and statistically analysed for significance. Results Mean ESS score at the baseline among moderate and severe OSA patients were 13.67±2.29 and 16.56 ±1.87, respectively. ESS score in both these subgroups improved significantly to 11.63±3.79, p=0.022, CI (0.3293-4.0106)} and 14.13 ±3.74, p < 0.001, CI (1.2991-4.5408), respectively after one month of CPAP therapy. Likewise, mean ESS scores among moderate and severe OSA patients improved significantly to 9.84 ±2.97, p = 0.022, CI (0.3293-4.0106) and 12.29 ±3.97, p <0.001, CI (2.9414-6.1385), respectively after three months of CPAP therapy

  6. Amniotic membrane transplantation ineffective as additional therapy in patients with aggressive Mooren’s ulcer

    PubMed Central

    2013-01-01

    Background Mooren’s ulcer is a severe ulcerative inflammation of the cornea. The exact pathogenesis remains unclear. Therefore many therapies of Mooren’s ulcer are recommended in literature. To shed more light on the ongoing question of optimal treatment of severe progressive Mooren’s ulcer, we here report on a retrospective case series of patients treated with systemic immunosuppressive therapy and additional amniotic membrane transplantation. Methods Medical records from seven patients (eleven eyes), 4 male and 3 female, with severe progressive Mooren’s ulcer were analysed retrospectively. The mean follow up was 88.4 ± 80.8 months (range 12–232 month). A HLA-typing was performed in all patients. A systemic immunosuppressive therapy was administered in all patients. The amniotic membrane was transplanted after the base of the ulcer was resected. Results Multiple amniotic membrane transplantations were necessary in six patients. The visual outcome of all patients was poor. No patient achieved a visual acuity better than 20/630 Snellen chart. Five patients were positive for HLA-DQ2 and four patients were positive for HLA-DR17(3). Conclusions The aggressive and highly inflammatory form of Mooren’s ulcer is difficult to treat and the progression of the disease is hard to influence positively even under systemic immunosuppressive therapy. Therefore, the main intention of therapy is to achieve a stable epithelialized corneal surface without the risk of perforation. Amniotic membrane transplantation is not able to cure severe forms of Mooren’s ulcer. However it supports the immunosuppressive therapy in acute situations as in critical corneal thinning. PMID:24345289

  7. Therapy recommendation "act as usual" in patients with whiplash injuries QTF I°.

    PubMed

    Dehner, Christoph; Kraus, Michael; Schöll, Hendrik; Schneider, Florian; Richter, Peter; Kramer, Michael

    2012-08-20

    Up to now no therapy study has used the classification system of the Quebec Task Force (QTF) to differentiate between patients with (QTF II°) and without functional disorders (QTF I°). This differentiation seems meaningful, as this difference may be relevant for the correct treatment planning. In this context the effect of the therapy recommendation "act as usual" has been evaluated in a homogeneous patient collective with whiplash injuries QTF I°. 470 patients with acute whiplash injuries had been catched in this study and classified according to the QTF. 359 patients (76.4%) with QTF I° injuries could be identified. Out of that 162 patients were enrolled to the study and received the therapy recommendation "act as usual" and the adapted pain treatment with non-steroidal anti-inflammatory drugs (NSAID). After six months the outcome was evaluated by phone. After injury the median pain score assessed by a visual analogue scale (VAS) was 5.4 (min = 3.3; max = 8.5). After six months 5 of the 162 patients complained intermittent pain symptoms (VAS values < 2). This is consistent with a chronification rate of 3.1%. After injury, the median pain disability index (PDI) was 3.9 (min = 1.9; max = 7.7). After six months 3 of the 162 patients stated persisting disability during sporting and physical activities (VAS values < 1). The therapy recommendation "act as usual" in combination with an adapted pain treatment is sufficient. Usually patients with whiplash injuries QTF I° do not need physical therapy. An escalation of therapy measures should be reserved to patients with complicated healing processes.

  8. [The effectiveness of music therapy in reducing physiological and psychological anxiety in mechanically ventilated patients].

    PubMed

    Wu, Shiau-Jiun; Chou, Fan-Hao

    2008-10-01

    Anxiety, a common reaction in patients receiving ventilation therapy, often impacts negatively on patient recovery. Music therapy, a non-invasion intervention, is readily accepted by patients and has been used to relieve patient anxiety with encouraging results. The purpose of this study was to investigate the effectiveness of music therapy on reducing anxiety in patients on mechanical ventilators. An experimental design was used and all cases were collected from a medical center in southern Taiwan. While the experimental group patients took a 30-minute music therapy session, control group patients were asked to rest. Both facility anxiety and anxiety visual scales were used as research tools, with other non-invasive medical instruments employed to measure heartbeat and breathing, blood pressure and blood oxygen saturation in both patient groups. When compared with the control group, patients in the experimental group showed significant improvement in sense of anxiety (Brief Anxiety Scale, BAS, t(29) = -4.80, p < .001; Visual Analogue Anxiety Scales, VAAS, t(29) = -3.38, p = .002), diastolic pressure (t(29) = -2.74, p = .002), mean arterial pressure(t(29) = -2.26, p = .031) and breathing rate (t(29) = -4.84, p < .001). In analyzing data from the two groups, we found that the sense of anxiety (BAS, t(58) = -3.21, p = .002; VAAS, t(58) = -2.90, p = .005) and breathing rate (t(58) = -3.20, p = .002) in the experimental group decreased significantly following music therapy. Study results are hoped to serve as an important reference for clinical nursing staff. Also, it is hoped that the music therapy method may help facilitate achievement of broader humanized nursing goals.

  9. Spa therapy for elderly: a retrospective study of 239 older patients with osteoarthritis

    NASA Astrophysics Data System (ADS)

    Karagülle, Mine; Kardeş, Sinan; Dişçi, Rian; Gürdal, Hatice; Karagülle, Müfit Zeki

    2016-10-01

    Very few studies tested the effectiveness of spa therapy in older patients with osteoarthritis. Therefore, we aimed to evaluate the short-term effects of spa therapy in patients aged 65 years and older with generalized, knee, hip, and cervical and lumbar spine osteoarthritis. In an observational retrospective study design at the Medical Ecology and Hydroclimatology Department of Istanbul Medical Faculty, we analyzed the records of 239 patients aged over 65 years with the diagnosis of all types of osteoarthritis who were prescribed a spa therapy course in some spa resorts in Turkey between 7 March 2002 and 31 December 2012. They travelled to a spa resort where they stayed at a thermal spa hotel and followed the usual therapy packages for 2 weeks. Patients were assessed by an experienced physician within a week before the spa journey and within a week after the completion of the spa therapy. Compared with baseline in whole sample, statistically significant improvements were observed in pain (visual analog scale, VAS), patient and physician global assessments (VAS), Health Assessment Questionnaire disability index (HAQ-DI), Lequesne algofunctional index (LAFI) for knee, Western Ontario and McMaster Universities index (WOMAC), Waddell disability index (WDI), and Neck Pain and Disability Scale (NPAD). According to Outcome Measures in Rheumatology—Osteoarthritis Research Society International (OMERACT-OARSI) Set of Responder Criteria, responder rate were 63.8 % (51/80) in generalized, 52 % (13/25) in knee, 50 % (2/4) in hip, 66.7 % (8/12) in lumbar, and 100 % (6/6) in cervical osteoarthritis subgroups. Spa therapy improved pain and physical functional status in older patients with osteoarthritis, especially generalized osteoarthritis and multiple joint osteoarthritis with involvement of knee. This improvement was clinically important in majority of the patients. To confirm the results of this preliminary study, there is a need of a randomized controlled clinical study

  10. Depression in patients with mastocytosis: prevalence, features and effects of masitinib therapy.

    PubMed

    Moura, Daniela Silva; Sultan, Serge; Georgin-Lavialle, Sophie; Pillet, Nathalie; Montestruc, François; Gineste, Paul; Barete, Stéphane; Damaj, Gandhi; Moussy, Alain; Lortholary, Olivier; Hermine, Olivier

    2011-01-01

    Depression in patients with mastocytosis is often reported but its prevalence and characteristics are not precisely described. In addition, the impact of therapies targeting mast cells proliferation, differentiation and degranulation on psychic symptoms of depression have never been investigated. Our objective was to determine the prevalence and to describe features of depression in a large cohort of mastocytosis patients (n = 288) and to investigate the therapeutic impact of the protein kinase inhibitor masitinib in depression symptoms. The description of depression was based on the analysis of a database with Hamilton scores using Principal Component Analysis (PCA). Efficacy of masitinib therapy was evaluated using non parametric Wilcoxon test for paired data within a three months period (n = 35). Our results show that patients with indolent mastocytosis present an elevated prevalence of depression (64%). Depression was moderate in 56% but severe in 8% of cases. Core symptoms (such as psychic anxiety, depressed mood, work and interests) characterized depression in mastocytosis patients. Masitinib therapy was associated with significant improvement (67% of the cases) of overall depression, with 75% of recovery cases. Global Quality of Life slightly improved after masitinib therapy and did not predicted depression improvement. In conclusion, depression is very frequent in mastocytosis patients and masitinib therapy is associated with the reduction its psychic experiences. We conclude that depression in mastocytosis may originate from processes related to mast cells activation. Masitinib could therefore be a useful treatment for mastocytosis patients with depression and anxiety symptoms.

  11. Increased Postoperative Bleeding Risk among Patients with Local Flap Surgery under Continued Clopidogrel Therapy

    PubMed Central

    Eichhorn, Wolfgang; Haase, Martina; Kluwe, Lan; Zeuch, Jürgen; Smeets, Ralf; Hanken, Henning; Wehrmann, Manfred; Gröbe, Alexander; Heiland, Max; Birkelbach, Moritz; Rendenbach, Carsten

    2015-01-01

    Purpose. The purpose of the study was to evaluate the influence of a continued antiplatelet therapy with clopidogrel on postoperative bleeding risk in patients undergoing skin tumor resection and reconstruction with local flaps or skin grafts under outpatient conditions. Patients and Methods. The authors designed and implemented a retrospective clinical cohort study at the General Hospital Balingen. The primary endpoint was the bleeding ratio in patients with clopidogrel treatment in comparison to patients without any anticoagulant or antiplatelet therapy. Wound healing was evaluated on days 1, 3, 5, 7, 10, and 14. Results. 650 procedures were performed, 123 of them under continued clopidogrel therapy. There were significantly more postoperative bleeding complications among patients with continued antiplatelet therapy. Regarding the whole study population, malignant lesions, a larger defect size, and skin grafts were accompanied by a higher rate of bleeding incidents. However, there were no significant findings in the univariate analysis of the clopidogrel group. All bleeding incidents were easily manageable. Conclusion. Despite an increased bleeding ratio among patients under continued clopidogrel therapy, the performance of simple surgical procedures can be recommended. However, cautious preparation and careful hemostasis are indispensable. PMID:26345612

  12. [Comparison of patient therapy adherence of two structural different memory clinics].

    PubMed

    Weih, M; Sulimma, A-K; Lehfeld, H; Niklewski, G; Sonnenberg, M; Richter-Schmidinger, T; Alexopoulos, P; Grässel, E; Kornhuber, J

    2009-04-01

    There are more than 100 memory clinics established in Germany, Austria and German-speaking Switzerland. We compared the impact of the structure of two German memory clinics (Erlangen and Nuremberg) on therapeutic outcome. 483 patients suffering from dementia with indication for antidementive therapy were included in this study. The data ascertainment included patient-related data, the mini mental score, comorbidity as well as psychiatric drug therapy. After a mean follow-up of 3.7 years, we performed a single cross-sectional survey covering over 90 % of patients to assess clinical course and adherence to therapy. The patients of the Erlangen University Memory Clinic were significantly younger (69.8 +/- 9.49 vs. 74.6 +/- 10.7 years; p = 0.01) and had a better mini mental score at their first presentation (20.9 +/- 9.4 vs. 19.5 +/- 5.9; p = 0.02). They showed a non-significantly faster disease progression (as measured by mini mental decline per year), than the patients from Nuremberg. Concerning the allocation of diagnosis, more late onset-dementias and dementias of a mixed type were treated at the Nuremberg clinic. At the university clinic, more dementias were of unclassified origin. Concomitant drug therapies, death rates and therapy adherence (53 %) were not different between the two clinics. The two memory clinics under investigation differed in patient age, disease severity and diagnostic assessment. Still, parameters of therapeutic outcome showed converging results.

  13. Preoperative Nutritional Therapy Reduces the Risk of Anastomotic Leakage in Patients with Crohn's Disease Requiring Resections

    PubMed Central

    Guo, Zhen; Guo, Dong; Gong, Jianfeng; Zhu, Weiming; Zuo, Lugen; Sun, Jing; Li, Ning; Li, Jieshou

    2016-01-01

    Background. The rate of anastomotic leakage is high in surgeries for Crohn's disease, and therefore a temporary diverting stoma is often needed. We conducted this study to investigate whether preoperative nutritional therapy could reduce the risk of anastomotic leakage while decreasing the frequency of temporary stoma formation. Methods. This was a retrospective study. Patients requiring bowel resections due to Crohn's disease were reviewed. The rate of anastomotic leakage and temporary diverting stoma was compared between patients who received preoperative nutritional therapy and those on a normal diet before surgery. Possible predictive factors for anastomotic leakage were also analyzed. Results. One hundred and fourteen patients undergoing 123 surgeries were included. Patients in nutritional therapy (NT) group had a significantly lower level of C-reactive protein on the day before surgery. Patients in NT group suffered less anastomotic leakage (2.3% versus 17.9%, P = 0.023) and less temporary diverting stoma (22.8% versus 40.9%, P = 0.036). Serum albumin of the day before surgery ≤35 g/L and preoperative nutritional therapy were identified as factors which independently affected the rate of anastomotic leakage. Conclusion. Preoperative nutritional therapy reduced the risk of anastomotic leakage and the frequency of temporary diverting stoma formation in patients with Crohn's disease requiring resections. PMID:26858749

  14. Integrated patient and tumor genetic testing for individualized cancer therapy.

    PubMed

    Hertz, D L; McLeod, H L

    2016-02-01

    Tumor genome analysis is transforming cancer treatment by enabling identification of specific oncogenic drivers and selection of effective targeted agents. Meanwhile, patient genome analysis is being employed across therapeutic areas to inform selection of appropriate drugs and doses for treatment safety. Integration of patient genome analysis concurrent with preemptive tumor genetic testing will enable oncologists to make informed treatment decisions to select the right dose of the right drug for each patient and their tumor.

  15. [Radiation therapy of patients with inoperable cancer of the pancreas].

    PubMed

    Ankudinov, V A; Morozov, A I; Barkanov, A I; Zverev, M P; Karleshenko, N I

    1976-01-01

    Radiotherapy was employed in 60 patients, symptomatic treatment--in 10 patients with pancreatic cancer, 9 of them had the disease in stage III. Radiotherapy, using betatron 25 Mev, was conducted by a longitudinal method, distant gammatherapy--through a wolfram and the radiation source focused grid. Single focal dosage was 150--200 rad, total--5000--8000 rad. The treatment proved to be uneffective in 31.7 per cent of patients.

  16. Ozone Therapy in the Management of Persistent Radiation-Induced Rectal Bleeding in Prostate Cancer Patients.

    PubMed

    Clavo, Bernardino; Santana-Rodriguez, Norberto; Llontop, Pedro; Gutierrez, Dominga; Ceballos, Daniel; Méndez, Charlin; Rovira, Gloria; Suarez, Gerardo; Rey-Baltar, Dolores; Garcia-Cabrera, Laura; Martínez-Sánchez, Gregorio; Fiuza, Dolores

    2015-01-01

    Introduction. Persistent radiation-induced proctitis and rectal bleeding are debilitating complications with limited therapeutic options. We present our experience with ozone therapy in the management of such refractory rectal bleeding. Methods. Patients (n = 12) previously irradiated for prostate cancer with persistent or severe rectal bleeding without response to conventional treatment were enrolled to receive ozone therapy via rectal insufflations and/or topical application of ozonized-oil. Ten (83%) patients had Grade 3 or Grade 4 toxicity. Median follow-up after ozone therapy was 104 months (range: 52-119). Results. Following ozone therapy, the median grade of toxicity improved from 3 to 1 (p < 0.001) and the number of endoscopy treatments from 37 to 4 (p = 0.032). Hemoglobin levels changed from 11.1 (7-14) g/dL to 13 (10-15) g/dL, before and after ozone therapy, respectively (p = 0.008). Ozone therapy was well tolerated and no adverse effects were noted, except soft and temporary flatulence for some hours after each session. Conclusions. Ozone therapy was effective in radiation-induced rectal bleeding in prostate cancer patients without serious adverse events. It proved useful in the management of rectal bleeding and merits further evaluation.

  17. Ozone Therapy in the Management of Persistent Radiation-Induced Re