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Effective Treatment (effective + treatment)
Kinds of Effective Treatment Terms modified by Effective Treatment Selected AbstractsEffective Treatment of Leg Vein Telangiectasia with a New 940 nm Diode LaserDERMATOLOGIC SURGERY, Issue 2 2001Peter Kaudewitz MD Background. A variety of lasers have been used in an attempt to treat leg vein telangiectasia Objective. To evaluate the feasibility of a new 940 nm diode laser for the treatment of leg vein telangiectasia. Methods. Thirty-one patients with leg vein telangiectasia were treated with a diode laser; 26 of these with 940 nm, 300,350 J/cm2, 40,70 msec, 1.0 mm handpiece, one pass, and 5 of these with 940 nm, 815 J/cm2, 50 msec, 0.5 mm handpiece, one pass. Each subject had three treatments of the same site at 4-week intervals. Photographs taken before and 4 weeks after the last treatment were evaluated by two independent observers for vessel clearance. Results. In those 26 patients treated with a fluence of 300,350 J/cm2, a vessel clearance of greater than 50% was achieved in 20 patients (76%), 12 of these patients had clearance rates greater than 75%. A clearance rate of less than 50% was obtained in six patients, with three of these patients showing responses of less than 25%. In five patients treated with a fluence of 815 J/cm2 a clearance rate of more than 75% was observed. Conclusions. In this preliminary study a 940 nm diode laser was shown to be safe and effective for the treatment of leg vein telangiectasia. [source] An Effective Treatment of Dark Lip by Frequency-Doubled Q-Switched Nd:YAG LaserDERMATOLOGIC SURGERY, Issue 1 2001Somyos Kunachak MD Background. Dark lip is a common cosmetic problem in Southeast Asia. There is no known effective treatment. Objective. To propose an effective method for treating dark lips of varying causes with frequency-doubled Q-switched Nd:YAG laser. Methods. Seventy patients with dark lip, of which 22 were congenital, 24 acquired, and 24 of uncertain cause, were treated by frequency-doubled Q-switched Nd:YAG laser at a fluence of 2,3.5 J/cm2 (mode 2.5 J/cm2) after application of topical anesthesia. The endpoint of treatment was complete clearance of the pigment. Follow-up time was 24,36 months (mean 29 months). Results. All patients attained complete clearance of the lesion after an average of 2.5 treatments in the congenital group, 2.2 treatments in the acquired group, and 1.8 treatments in the group with uncertain etiology. The mean (±SD) number of treatments required by the whole group was 2.1 ± 1.4. Recurrence was observed in one case of congenital origin 3 months after the last treatment. In the remaining cases, results persisted up to the time of follow-up. Herpes simplex reactivation was noted in one case 3 days after treatment. There was no dyschromia, scar formation, or change of skin texture. Conclusion. Dark lip can be effectively treated by frequency-doubled Q-switched Nd:YAG laser without major adverse effects. [source] Modeling Effective Treatment of Psychoses in the Elderly: A Focus on Avoiding Movement DisordersJOURNAL OF AMERICAN GERIATRICS SOCIETY, Issue 2004Richard M. Trosch MD No abstract is available for this article. [source] Tolterodine: A Safe and Effective Treatment for Older Patients with Overactive BladderJOURNAL OF AMERICAN GERIATRICS SOCIETY, Issue 6 2001James G. Malone-Lee MD OBJECTIVE: To investigate the clinical safety and efficacy of two dosages of tolterodine in older patients with symptoms attributable to overactive bladder. DESIGN: Randomized, double-blind, placebo-controlled, parallel-group, multinational, phase III study. SETTING: Incontinence, older care, urological, and urogynecological clinics in the United Kingdom, France, and the Republic of Ireland. PARTICIPANTS: One hundred and seventy-seven older patients (age ,65 years) with symptoms of urinary urgency, increased frequency of micturition (,8 micturitions/24 hours), and/or urge incontinence (,1 episode/24 hours). INTERVENTION: Tolterodine 1 mg or 2 mg twice daily (bid), or placebo, for 4 weeks. MEASUREMENTS: Safety and tolerability were evaluated through spontaneously reported adverse events, electrocardiogram, and blood pressure measurements. Efficacy was assessed using micturition diary variables: mean change from baseline in frequency of micturition and number of incontinence episodes/24 hours. RESULTS: The mean age of the patient population was 75 years. Overall, ,87% of patients completed the study. Neither dosage of tolterodine was associated with serious drug-related adverse events during the study. No cardiac arrythmogenic events were noted. Dry mouth (mild to moderate intensity) was the most common adverse event in both the placebo and tolterodine treatment groups. Three percent of patients in the tolterodine 2 mg bid group discontinued treatment because of dry mouth, compared with 2% of placebo-treated patients. Compared with placebo, statistically significant decreases in micturition frequency were apparent in both tolterodine treatment groups. Furthermore, patients treated with tolterodine 2 mg bid had statistically significant decreases in urge incontinence episodes/24 hours and increases in volume voided per micturition compared with placebo. CONCLUSION: Tolterodine (taken for 4 weeks) is safe and shows efficacy, particularly at a dosage of 2 mg bid, in the treatment of older patients with urinary symptoms attributable to overactive bladder. J Am Geriatr Soc 49:700,705, 2001. [source] Effective Treatment of Hypertension Without Medication: Is It Possible?JOURNAL OF CLINICAL HYPERTENSION, Issue 5 2004Marvin Moser MD Editor in Chief No abstract is available for this article. [source] In Search of an Effective Treatment for Combat-Related Post-Traumatic Stress Disorder (PTSD): Can the Stellate Ganglion Block Be the Answer?PAIN PRACTICE, Issue 4 2010Eugene Lipov MD No abstract is available for this article. [source] Effective Treatments for PTSD: Practice Guidelines from the International Society for Traumatic Stress Studies.PSYCHO-ONCOLOGY, Issue 1 2003Edited by Edna B. Foa, Matthew J. Friedman., Terence M. Keane No abstract is available for this article. [source] Nonablative Acne Scar Reduction after a Series of Treatments with a Short-Pulsed 1,064-nm Neodymium:YAG LaserDERMATOLOGIC SURGERY, Issue 8 2006GRAEME M. LIPPER MD BACKGROUND Effective treatment of facial acne scarring presents a major challenge. Nonablative lasers and radiofrequency devices work by thermally stimulating dermal collagen remodeling, thereby softening acne scars in a minimally invasive fashion. One such laser, a 1,064-nm short-pulsed Nd:YAG, uses rapidly scanned low-energy infrared pulses to heat the dermis selectively through the normal dermal microvasculature. OBJECTIVE In this pilot study, the safety and efficacy of a novel short-pulsed Nd:YAG laser were investigated for the treatment of moderate to severe facial acne scarring. MATERIALS AND METHODS Nine of 10 enrolled patients with moderate to severe facial acne scarring received eight sequential 1,064-nm Nd:YAG treatments (laser parameters 14 J/cm2, 0.3 milliseconds, 5-mm spot size, 7-Hz pulse rate, 2,000 pulses per side of face). Patients were graded for the presence and severity of three scar morphologies: superficial (rolling), medium-depth (boxcar), and deep (ice pick). Outcome measures included blinded evaluation of before and after photographs by three physician observers (scar severity score) and patient self-assessment. RESULTS Acne scarring improved in 100% of the nine patients completing the study. Scar severity scores improved by a mean of 29.36% (95% confidence interval, 16.93%,41.79%; p=.006); 89% of patients noted greater than 10% scar improvement. No treatment-related adverse events were seen. CONCLUSION Our findings support the use of a short-pulsed, low-fluence 1,064-nm Nd:YAG laser as a safe, effective treatment for facial acne scarring. Scar improvement was noted in all treated subjects with minimal discomfort and no downtime. This protocol appears to be most effective at reducing scar depth and softening scar contours. [source] Clinical dental examinations of 357 donkeys in the UK.EQUINE VETERINARY JOURNAL, Issue 4 2009Part 2: Epidemiological studies on the potential relationships between different dental disorders, between dental disease, systemic disorders Summary Reasons for performing study: Dental disease has been shown to be a risk factor for weight loss and colic in horses. No extensive clinical studies in donkeys have investigated the potential relationship between different dental disorders, or between dental disease and systemic disorders. Objectives: To determine possible associations between dental disease and body condition score, weight loss, the need for supplemental feeding and prevalence of colic in donkeys of all ages, and to gain a better understanding of the pathogenesis of dental disease by the determination of associations between different dental disorders. Methods: A prospective cross-sectional analysis of clinical dental examinations of 357 donkeys in The Donkey Sanctuary, Sidmouth was performed. Other epidemiological factors such as estimated age group, body condition score, weight loss, medical history and supplemental feeding were also recorded, and multiple regression analyses were performed to determine possible associations. Results: Donkeys from older age groups were more likely to have dental disease, poor body condition score and suffered previous colic episodes. The presence of dental disease was also significantly associated with weight loss, colic, low body condition score and the need for supplemental feeding. The presence of diastemata, periodontal disease, wave mouth, smooth mouth and step mouth are frequently associated with the presence of other dental disorders. Conclusions: In addition to oral-related pain, dental disease can cause significant systemic disorders and so has increased welfare implications in donkeys. Some dental disorders promote the development of other types of dental abnormalities and thus increase the severity of dental disease in individual animals. Potential significance: Effective treatment of dental disorders slows down the progression of dental disease and decreases the risk of developing some medical disorders such as colic and weight loss that are associated with dental disease. [source] Effective treatment of erosive lichen planus with thalidomide and topical tacrolimusINTERNATIONAL JOURNAL OF DERMATOLOGY, Issue 10 2006Haritini Petropoulou MD No abstract is available for this article. [source] Treatment of irritable bowel syndrome with osteopathy: Results of a randomized controlled pilot studyJOURNAL OF GASTROENTEROLOGY AND HEPATOLOGY, Issue 9 2007Henry WC Hundscheid Abstract Background and Aim:, Effective treatment for irritable bowel syndrome (IBS) is not yet available. Osteopathy is a manual treatment which relies on mobilizing and manipulating procedures in order to relieve complaints. In the present study, a randomized controlled trial was carried out to evaluate the effects of osteopathic treatment for IBS. Methods:, Eligible IBS patients were randomized between osteopathy and standard care. Follow-up was 6 months and validated means of follow-up were used. After 1, 3 and 6 months an overall assessment of symptoms was noted and a symptom score was obtained on a 5-point Likert scale. Quality of life (QOL) was scored with the standardized IBSQOL 2000 questionnaire and the Functional Bowel Disorder Severity Index was used. Results:, Twenty patients were randomized into the osteopathy group (OG) and 19 patients were included in the standard care group (SCG). Sixty-eight percent of patients in the OG noted definite overall improvement in symptoms and 27% showed slight improvement. One patient (5%) was free of symptoms at the end of the study. In the SCG, 18% noted definite improvement, 59% showed slight improvement, and in 17% worsening of symptoms was present. The difference in change in overall symptomatic improvement was statistically significant in favor of the osteopathic treatment (P < 0.006). Mean Functional Bowel Disorder Severity Index (FBDSI) score in the OG decreased from 174 to 74 at 6 months (P < 0.0001). Also, a significant decrease was noted in the SCG from 171 to 119 (P < 0.0001). However, the decrease in the OG was significantly higher compared with the standard treatment (P = 0.02). Mean symptom score in the OG decreased from 9.1 to 6.8 but this did not reach statistical significance. In the SCG, no change in symptom score occurred (8.7 vs 10). At 6 months, the score in the OG was significantly lower (6.8 vs 10; P = 0.02). The QOL score increased in the OG at 111 versus 129 (P < 0.009). In the SCG an increase was also noted, but this was not statistically significant (109 vs 121). Conclusion:, Osteopathic therapy is a promising alternative in the treatment of patients with IBS. Patients treated with osteopathy overall did better, with respect to symptom score and QOL. [source] Effective treatment for dermatophytoses of the foot: effect on restoration of depressed cell-mediated immunityJOURNAL OF THE EUROPEAN ACADEMY OF DERMATOLOGY & VENEREOLOGY, Issue 8 2007M-H Schmid-Wendtner Abstract Superficial infections caused by dermatophyte fungi are highly prevalent throughout the world. Modern antimycotic agents like the azole itraconazole or the synthetic allylamine terbinafine greatly improved treatment outcomes in comparison with former therapeutic options with griseofulvin or older azole preparations like ketoconazole or fluconazole. In randomized trials involving patients with dermotophytoses, a great effectiveness has been shown especially for terbinafine. Oral terbinafine in general is well tolerated, has a low potential for drug interactions and, therefore, may be the most often used therapeutic agent for dermatophyte onychomycosis. However, there is a group of patients suffering from chronic dermatophytoses or early reinfections after antifungal therapy. For these patients, a depression of the delayed-type hypersensitivity reactivity was postulated. Just recently, effective antimycotic treatment, in particular with terbinafine, was shown to enhance and restore cell-mediated immunity, which potentially improves the therapeutic outcome even for this group of patients. [source] Effective treatment of papular acantholytic dyskeratosis with oral isotretinoinJOURNAL OF THE EUROPEAN ACADEMY OF DERMATOLOGY & VENEREOLOGY, Issue 3 2007H Larangeira De Almeida Jr [source] Efficacy and safety of a new single-dose terbinafine 1% formulation in patients with tinea pedis (athlete's foot): a randomized, double-blind, placebo-controlled studyJOURNAL OF THE EUROPEAN ACADEMY OF DERMATOLOGY & VENEREOLOGY, Issue 10 2006JP Ortonne Abstract Background, Tinea pedis is a common dermatophyte infection with frequent recurrences. Terbinafine (presently used as a 1-week topical treatment of tinea pedis) is now available in a novel topical solution (film-forming solution , FFS), developed to allow single application. Objectives, To demonstrate the efficacy and safety of terbinafine 1% FFS in a randomized, double-blind, placebo-controlled, phase III trial, and to determine relapse or re-infection rate of tinea pedis at 12 weeks. Patients/methods, Fifty-four centres (27 in France; 27 in Germany) enrolled 273 evaluable patients (2 : 1 randomization). Patients applied terbinafine 1% FFS or placebo only once between, under and over the toes, soles and sides of both feet. Efficacy assessments included direct microscopy, mycological culture, and clinical signs and symptoms at baseline, and at weeks 1, 6 and 12 after the single drug application. Results, Effective treatment (negative mycology plus absent/minimal symptoms) at week 6 in the terbinafine 1% FFS group was 63%; vehicle was 17% (P 0.0001). Mycological cure was 72% in the terbinafine group and 21% in the placebo (P 0.0001) at week 6. Clinical signs/symptoms decreased significantly in the active group compared to the placebo. The self-assessment of itching and burning sensation by the patient showed a clear reduction in symptoms starting 15 min after treatment application (this could be attributed to the cooling effect of the FFS). Recurrence (positive culture at 3 months) occurred in 12.5% of the effectively treated patients at week 6 in the terbinafine group. FFS was well tolerated. Conclusion, Terbinafine 1% FFS, single dose application is an effective, safe and convenient treatment for tinea pedis. The relapse/re-infection rate 3 months after the end of single-dose therapy is similar to that previously demonstrated in a study using terbinafine 1% cream for 7 days. [source] Effective treatment of refractory severe heat urticaria with omalizumabALLERGY, Issue 7 2010U. Bullerkotte First page of article [source] Life-threatening hemophagocytic syndromes: Current outcomes with hematopoietic stem cell transplantationPEDIATRIC TRANSPLANTATION, Issue 2005Alexandra H. Filipovich Abstract:, Life-threatening hemophagocytic syndromes represent a subset of genetic disorders of inflammation. Many are rapidly lethal and can only be definitively treated at the present time with allogeneic hematopoietic stem cell transplantation (HSCT). In this report, current results with allogeneic transplantation for Hemophagocytic Lymphohistiocytosis (HLH) are described. HLH typically presents symptomatically during infancy and early childhood and can be identified by a constellation of numerous physical findings and laboratory tests indicative of overwhelming inflammation. The majority of patients with familial HLH lack natural killer (NK) cell function; in approximately 50% of cases the specific underlying genetic cause can now be discerned. Effective treatment consists of initial combination therapy with proapoptotic chemotherapy (typically etoposide) and anti-inflammatory therapies (principally steroids) in addition to aggressive supportive care, followed by allogeneic HSCT from the best available donor. Over the past 25 yr, through collaborative worldwide efforts, survival of children with HLH and related disorders has improved from 5% at 1 yr after diagnosis to greater than 50% 3,5 yr after diagnosis. [source] The challenge of multiple sclerosis: How do we cure a chronic heterogeneous disease?,,ANNALS OF NEUROLOGY, Issue 3 2009Howard L. Weiner MD Multiple sclerosis is (MS) a T-cell autoimmune disease characterized by a relapsing-remitting followed by a progressive phase. Relapses are driven by the adaptive immune system and involve waves of T helper cell 1 (Th1), Th17, and CD8 cells that infiltrate the nervous system and provoke a attack. These cells are modulated by regulatory T and B cells. Infiltration of T cells into the nervous system initiates a complex immunological cascade consisting of epitope spreading, which triggers new attacks, and activation of the innate immune system (microglia, dendritic cells, astrocytes, B cells), which leads to chronic inflammation. The secondary progressive phase is due to neurodegeneration triggered by inflammation and is driven by the innate immune system. Why a shift to the progressive stage occurs and how to prevent it is a central question in MS. Effective treatment of MS must affect multiple disease pathways: suppression of proinflammatory T cells, induction of regulatory T cells, altering traffic of cells into the nervous system, protecting axons and myelin, and controlling innate immune responses. Without biomarkers, the clinical and pathological heterogeneity of MS makes treatment difficult. Treatment is further hampered by untoward adverse effects caused by immune suppression. Nonetheless, major progress has been made in the understanding and treatment of MS. There are three definitions of cure as it applies to MS: (1) halt progression of disease, (2) reverse neurological deficits, and (3) prevent MS. Although the pathways to each of these cures are linked, each requires a unique strategy. Ann Neurol 2009;65:239,248 [source] Preterm premature rupture of membranes: diagnosis, evaluation and management strategiesBJOG : AN INTERNATIONAL JOURNAL OF OBSTETRICS & GYNAECOLOGY, Issue 2005Hyagriv N. Simhan Preterm premature rupture of the membranes (PPROM) is responsible for one-third of all preterm births and affects 120,000 pregnancies in the United States each year. Effective treatment relies on accurate diagnosis and is gestational age dependent. The diagnosis of PPROM is made by a combination of clinical suspicion, patient history and some simple tests. PPROM is associated with significant maternal and neonatal morbidity and mortality from infection, umbilical cord compression, placental abruption and preterm birth. Subclinical intrauterine infection has been implicated as a major aetiological factor in the pathogenesis and subsequent maternal and neonatal morbidity associated with PPROM. The frequency of positive cultures obtained by transabdominal amniocentesis at the time of presentation with PPROM in the absence of labour is 25,40%. The majority of amniotic fluid infection in the setting of PPROM does not produce the signs and symptoms traditionally used as diagnostic criteria for clinical chorioamnionitis. Any evidence of infection by amniocentesis should be considered carefully as an indication for delivery. Documentation of amniotic fluid infection in women who present with PPROM enables us to triage our therapeutic decision making rationally. In PPROM, the optimal interval for delivery occurs when the risks of immaturity are outweighed by the risks of pregnancy prolongation (infection, abruption and cord accident). Lung maturity assessment may be a useful guide when planning delivery in the 32- to 34-week interval. A gestational age approach to therapy is important and should be adjusted for each hospital's neonatal intensive care unit. Antenatal antibiotics and corticosteroid therapies have clear benefits and should be offered to all women without contraindications. During conservative management, women should be monitored closely for placental abruption, infection, labour and a non-reassuring fetal status. Women with PPROM after 32 weeks of gestation should be considered for delivery, and after 34 weeks the benefits of delivery clearly outweigh the risks. [source] Effective treatment of angiosarcoma on the nose by combination treatment with electron beam irradiation, recombinant interleukin-2 and docetaxelCLINICAL & EXPERIMENTAL DERMATOLOGY, Issue 7 2009Y. Asano No abstract is available for this article. [source] Psychosocial Treatment of Depression in Older Adults with DementiaCLINICAL PSYCHOLOGY: SCIENCE AND PRACTICE, Issue 3 2005Linda Teri Depression and dementia commonly coexist and are associated with higher rates of behavioral and functional problems. Caregivers of these individuals report higher levels of physical and mental distress, as well. Effective treatment, therefore, has the potential to help both the older adult and their caregiver. This article provides an overview of the current literature on treatment of depression in demented older adults, with particular emphasis on providing guidelines for evidence-based clinical care. Eleven randomized controlled clinical trials were identified following an extensive review of the literature. These studies are reviewed with particular attention to the methodological issues of most relevance to clinicians attempting to use the findings from these studies to guide their practice. Issues of particular relevance when working with this population are also addressed, including (a) for assessment,differential and coexistent diagnosis of depression in dementia, use of collateral informants, self-report and interviewer-obtained information; and b) for treatment,the need for caregiver involvement, individualizing of goals, and planning for future deterioration of cognitive function. [source] Teaching science problem solving: An overview of experimental workJOURNAL OF RESEARCH IN SCIENCE TEACHING, Issue 4 2001R. Taconis The traditional approach to teaching science problem solving is having the students work individually on a large number of problems. This approach has long been overtaken by research suggesting and testing other methods, which are expected to be more effective. To get an overview of the characteristics of good and innovative problem-solving teaching strategies, we performed an analysis of a number of articles published between 1985 and 1995 in high-standard international journals, describing experimental research into the effectiveness of a wide variety of teaching strategies for science problem solving. To characterize the teaching strategies found, we used a model of the capacities needed for effective science problem solving, composed of a knowledge base and a skills base. The relations between the cognitive capacities required by the experimental or control treatments and those of the model were specified and used as independent variables. Other independent variables were learning conditions such as feedback and group work. As a dependent variable we used standardized learning effects. We identified 22 articles describing 40 experiments that met the standards we deemed necessary for a meta-analysis. These experiments were analyzed both with quantitative (correlational) methods and with a systematic qualitative method. A few of the independent variables were found to characterize effective strategies for teaching science problem solving. Effective treatments all gave attention to the structure and function (the schemata) of the knowledge base, whereas attention to knowledge of strategy and the practice of problem solving turned out to have little effect. As for learning conditions, both providing the learners with guidelines and criteria they can use in judging their own problem-solving process and products, and providing immediate feedback to them were found to be important prerequisites for the acquisition of problem-solving skills. Group work did not lead to positive effects unless combined with other variables, such as guidelines and feedback. © 2001 John Wiley & Sons, Inc. J Res Sci Teach 38: 442,468, 2001 [source] Clinical trial: lubiprostone in patients with constipation-associated irritable bowel syndrome , results of two randomized, placebo-controlled studiesALIMENTARY PHARMACOLOGY & THERAPEUTICS, Issue 3 2009D. A. DROSSMAN Summary Background, Effective treatments for irritable bowel syndrome with constipation (IBS-C) are lacking. Aim, To assess the efficacy and safety of lubiprostone in IBS-C. Methods, A combined analysis was performed among 1171 patients with a Rome II diagnosis of IBS-C in two phase-3 randomized trials of lubiprostone 8 mcg vs. placebo twice daily for 12 weeks. Using a balanced seven-point Likert scale ranging from significantly relieved (+3), to significantly worse (,3), patients responded on their electronic diary to the question: ,How would you rate your relief of IBS symptoms over the past week compared to how you felt before you entered the study?'. The primary efficacy endpoint was the percentage of overall responders. Results, Using an intent-to-treat analysis with last observation carried forward, a significantly higher percentage of lubiprostone-treated patients were considered overall responders compared with those treated with placebo (17.9% vs. 10.1%, P = 0.001). Patients treated with lubiprostone reported a similar incidence of adverse events to those treated with placebo. Conclusions, The percentage of overall responders based on patient-rated assessments of IBS-C symptoms was significantly improved in patients treated with lubiprostone 8 mcg twice daily compared to those treated with placebo. Lubiprostone was well tolerated with a favourable safety profile. [source] Transcatheter versus Surgical Closure of Secundum Atrial Septal Defect in Adults: Impact of Age at Intervention.CONGENITAL HEART DISEASE, Issue 3 2007A Concurrent Matched Comparative Study Abstract Objectives., To compare the short- and mid-term outcomes of surgical (SUR) vs. transcatheter closure of secundum atrial septal defect (ASD) using Amplatzer septal occluder (ASO) in adults with a very similar spectrum of the disease; and to identify predictors for the primary end point. Design., Single-center, concurrent comparative study. Surgically treated patients were randomly matched (2:1) by age, sex, date of procedure, ASD size, and hemodynamic profile. Setting., Tertiary referral center. Patients., One hundred sixty-two concurrent patients with ASD submitted to ASO (n = 54) or SUR closure (n = 108) according with their preferences. Main Outcome Measures., Primary end point was a composite index of major events including failure of the procedure, important bleeding, critical arrhythmias, serious infections, embolism, or any major cardiovascular intervention-related complication. Predictors of these major events were investigated. Results., Atrial septal defects were successfully closed in all patients, and there was no mortality. The primary event rate was 13.2% in ASO vs. 25.0% in SUR (P = .001). Multivariate analysis showed that higher rate of events was significantly associated with age >40 years; systemic/pulmonary output ratio <2.1; and systolic pulmonary arterial pressure >50 mm Hg; while in the ASO group the event rate was only associated with the ASD size (>15 cm2/m2; relative risk = 1.75, 95% confidence interval 1.01,8.8). There were no differences in the event-free survival curves in adults with ages <40 years. Conclusions., The efficacy for closure ASD was similar in both groups. The higher morbidity observed in SUR group was observed only in the patients submitted to the procedure with age >40 years. The length of hospital stay was shorter in the ASO group. Surgical closure is a safe and effective treatment, especially in young adults. There is certainly nothing wrong with continuing to do surgery in countries where the resources are limited. [source] Cosmetic Use of Poly- l -Lactic Acid: A Retrospective Study of 130 PatientsDERMATOLOGIC SURGERY, Issue 2 2010MELANIE D. PALM MD BACKGROUND Poly- l -lactic acid (PLLA) is an effective treatment for patients seeking to correct volume loss due to aging. Although the Food and Drug Administration has approved PLLA for use in people with the human immunodeficiency virus (HIV), it is well-suited for patients seeking cosmetic treatment. OBJECTIVE To evaluate the efficacy and incidence of adverse events of HIV-negative patients treated with PLLA for volume restoration. MATERIALS AND METHODS This is a retrospective, single-center study of 130 HIV-negative patients treated with PLLA from 2003 to 2008. Patient satisfaction and incidence of adverse reactions were evaluated. RESULTS The most common reaction to PLLA treatment was the formation of nodules (8.5%). Almost all of the nodules were palpable; only one was visible. Treatment areas with the highest incidence of post-treatment nodules were the hands (12.5%) and cheeks (7.2%). Overall, patients were satisfied, with 55% having good to excellent correction; 75% of patients with five or more treatments rated their correction as good to excellent. Sixty-eight percent of all patients would repeat the procedure again. CONCLUSION PLLA is a safe, biodegradable volumizer used to reverse the signs of aging by gradually correcting volume loss. Patients should be aware of possible adverse reactions during the course of treatment. Nodule formation is low, with most patients having good to excellent correction. Drs. Butterwick and Goldman are consultants for Sanofi-Aventis. [source] Treatment of Inflammatory Facial Acne Vulgaris with Intense Pulsed Light and Short Contact of Topical 5-Aminolevulinic Acid: A Pilot StudyDERMATOLOGIC SURGERY, Issue 8 2006JINDA ROJANAMATIN MD BACKGROUND Photodynamic therapy (PDT) with topical 5-aminolevulinic acid (ALA) and red light (550,700 nm) has been introduced for effective treatment of facial acne. Untoward side effects are common, however. OBJECTIVE To evaluate the efficacy and safety of the short contact of topical ALA and intense pulsed light (IPL) in treatment of inflammatory facial acne. METHODS Fourteen patients with inflammatory facial acne were treated with IPL on the left side and combination of IPL and topical ALA on the right side at 3- to 4-week intervals for three sessions. Clinical photographs and lesion counts were obtained for evaluation. RESULTS All patients revealed a reduction in number of acne lesions on both sides. On the ALA-pretreated side, lesion counts decreased 87.7% at 12 weeks after the last treatment (p<.01). Meanwhile, lesion counts on the nonpretreated side decreased 66.8% (p<.01). In addition, a number of lesion counts on the ALA-pretreated side decreased. Mild edema and minimal crust developed on the combined-treatment side. CONCLUSION Short contact of topical ALA and IPL or IPL alone showed some beneficial effect in treatment of inflammatory facial acne; however, degree of improvement was better and remained longer with the combined regimen. Side effects were mild and reversible. [source] Nonablative Acne Scar Reduction after a Series of Treatments with a Short-Pulsed 1,064-nm Neodymium:YAG LaserDERMATOLOGIC SURGERY, Issue 8 2006GRAEME M. LIPPER MD BACKGROUND Effective treatment of facial acne scarring presents a major challenge. Nonablative lasers and radiofrequency devices work by thermally stimulating dermal collagen remodeling, thereby softening acne scars in a minimally invasive fashion. One such laser, a 1,064-nm short-pulsed Nd:YAG, uses rapidly scanned low-energy infrared pulses to heat the dermis selectively through the normal dermal microvasculature. OBJECTIVE In this pilot study, the safety and efficacy of a novel short-pulsed Nd:YAG laser were investigated for the treatment of moderate to severe facial acne scarring. MATERIALS AND METHODS Nine of 10 enrolled patients with moderate to severe facial acne scarring received eight sequential 1,064-nm Nd:YAG treatments (laser parameters 14 J/cm2, 0.3 milliseconds, 5-mm spot size, 7-Hz pulse rate, 2,000 pulses per side of face). Patients were graded for the presence and severity of three scar morphologies: superficial (rolling), medium-depth (boxcar), and deep (ice pick). Outcome measures included blinded evaluation of before and after photographs by three physician observers (scar severity score) and patient self-assessment. RESULTS Acne scarring improved in 100% of the nine patients completing the study. Scar severity scores improved by a mean of 29.36% (95% confidence interval, 16.93%,41.79%; p=.006); 89% of patients noted greater than 10% scar improvement. No treatment-related adverse events were seen. CONCLUSION Our findings support the use of a short-pulsed, low-fluence 1,064-nm Nd:YAG laser as a safe, effective treatment for facial acne scarring. Scar improvement was noted in all treated subjects with minimal discomfort and no downtime. This protocol appears to be most effective at reducing scar depth and softening scar contours. [source] Periungual Basal Cell Carcinoma: Case Report and Literature ReviewDERMATOLOGIC SURGERY, Issue 2 2006PAUL T. MARTINELLI MD BACKGROUND Basal cell carcinoma, the most common malignancy in humans, rarely occurs on the nail unit and may be frequently misdiagnosed clinically. OBJECTIVES To present a case of basal cell carcinoma of the nail unit successfully treated with the mohs technique and to review the literature regarding this unique presentation of this tumor. MATERIALS AND METHODS: Case report and review of the English literature of nail unit basal cell carcinoma. RESULTS In addition to the currently described patient, 17 other patients with nail unit basal cell carcinaoma have been reported. The tumor occurred approximately 3 times more often on the fingers then on the toes and had a slight predilection to occur in men. Ulceration, noted in more than one-half of patients, was the most common presentation of nail unit basal cell carcinoma. Mohs micrographic surgery. Often with second intention healing, was successfully employed in 39% of patients. CONCLUSIONS Basal cell carcinaom infrequently involves the nail unit and often presents as ulceration. Adequate biopsy of the lesion is essential in making a timely diagnosis. Mohs micrographic surgery with second intension healing is an effective treatment that may offer excellent cosmetic and functional results. [source] Double-Blind, Randomized, Placebo-Controlled, Dose-Response Study of the Safety and Efficacy of Botulinum Toxin Type A in Subjects with Crow's FeetDERMATOLOGIC SURGERY, Issue 3 2005Nicholas J. Lowe MD Background Published evidence suggests that botulinum toxin type A (BTX-A) is an effective treatment for crow's feet. However, few dose-ranging studies have been performed. Objectives To assess the safety and efficacy of a single treatment with one of four doses of BTX-A (Botox/Vistabel, Allergan Inc) compared with placebo for the improvement of crow's feet. Methods Subjects received a single bilateral treatment of 18, 12, 6, or 3 U of BTX-A or placebo injected into the lateral aspect of the orbicularis oculi muscle (parallel-group, double,blind design). Investigators and subjects rated crow's feet severity at maximum smile on day 7 and at 30-day intervals from days 30 to 180. Results As observed by both investigators and subjects, all doses of BTX-A resulted in improvements in crow's feet severity when compared with placebo. A dose-dependent treatment effect for efficacy was observed, with higher doses having an increased magnitude and duration of effect. However, a clear differentiation between the 18 U and 12 U doses was not apparent. Few adverse events were reported, with no statistically significant differences between BTX-A and placebo in the incidence of subjects experiencing adverse events. Conclusion BTX-A is safe and effective in decreasing the severity of crow's feet, with 12 U per side suggested as the most appropriate dose. THIS STUDY WAS FUNDED BY ALLERGAN, WHICH WAS ALSO INVOLVED IN THE DESIGN AND CONDUCT OF THE STUDY; COLLECTION, MANAGEMENT, ANALYSIS, AND INTERPRETATION OF THE DATA; AND PREPARATION, REVIEW, AND APPROVAL OF THE MANUSCRIPT. DRS. LOWE AND FRACZEK ARE PAID CONSULTANTS FOR ALLERGAN, DRS. KUMAR AND EADIE ARE EMPLOYEES OF ALLERGAN, AND DRS. LOWE AND KUMAR HOLD STOCK OPTIONS. [source] Angiokeratoma Circumscriptum Naeviforme: Successful Treatment with Carbon-Dioxide Laser VaporizationDERMATOLOGIC SURGERY, Issue 2 2005Jesús del Pozo MD Background Angiokeratoma circumscriptum naeviforme (ACN) is an unusual type of localized angiokeratoma that occurs more frequently in females and is usually located on the buttocks or thighs, showing a unilateral distribution. ACN usually causes large lesions, which may require laser ablation because they often are too extensive to perform surgical excision. Carbon-dioxide laser is a known alternative for treating angiokeratomas. Objective Report of two cases of ACN treated with carbon-dioxide laser vaporization. Patients and methods A 28-year-old woman with a hyperkeratotic, violaceus plaque on her left buttock and a 24-year-old woman with a similar lesion on her right buttock were treated with a carbon-dioxide laser. Two laser passes were performed on each lesion within a single session. Results A successful cosmetic aspect of treated areas was obtained, with minimal pigmentary or textural changes. After a 2-year follow-up in the first patient and a 6-month follow-up in the second patient, no recurrence of the lesions was observed. Conclusions Our results, obtaining relevant cosmetic improvement after a few sessions of treatment, with low morbidity and minimal secondary effects, suggest that continuous-wave carbon-dioxide laser vaporization is a safe and effective treatment for ACN. JESÚS DEL POZO, MD, AND EDUARDO FONSECA, MD, HAVE INDICATED NO SIGNIFICANT INTEREST WITH COMMERCIAL SUPPORTERS. [source] Intense Pulsed Light for the Treatment of Refractory Melasma in Asian PersonsDERMATOLOGIC SURGERY, Issue 9 2004Chia-Chen Wang MD Background. Patients with dermal or mixed-type melasmas are often refractory to various treatments. Intense pulsed light has been used to treat melanocytic lesions with promising results. Objective. The purpose of this study was to clarify the effectiveness of intense pulsed light for refractory melasma in Asian persons. Methods. Seventeen patients were treated with intense pulsed light, during four sessions at 4-week intervals. The patients were also given 4% hydroquinone cream and broad-spectrum sunscreens to prevent and treat postinflammatory hyperpigmentation. Sixteen patients in the control group were treated with hydroquinone cream and sunscreens. The treatment efficacy was evaluated using reflectance spectrophotometer and patient satisfaction questionnaire. Results. Patients in the intense pulsed light group achieved an average of 39.8% improvement in relative melanin index, compared to 11.6% improvement in the control group (p<0.05) at Week 16. Six (35%) patients in the intense pulsed light group had more than 50% improvement, compared to two (14%) patients in the control group. Two patients in the intense pulsed light group, however, experienced transient postinflammatory hyperpigmentation, and partial repigmentation was noted 24 weeks after the last treatment session. Conclusion. Intense pulsed light is a safe and effective treatment for refractory melasma in Asian persons, with minimal side effects. Further treatment sessions are required for maintenance therapy. [source] | ||||||||||||||||||||||||||||||||||||||||||||||