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First Line Therapy (first + line_therapy)
Selected AbstractsRobot Assisted Laparoscopic Pyeloplasty: a review of the current statusTHE INTERNATIONAL JOURNAL OF MEDICAL ROBOTICS AND COMPUTER ASSISTED SURGERY, Issue 1 2007Ketul K. Shah Abstract Background Over the last decade minimally invasive endourologic and laparoscopic techniques have become the first line therapies for primary UPJ obstruction. Robotic assisted laparoscopic pyeloplasty for the correction of ureteropelvic junction has achieved outcomes comparable to those of open and laparoscopic techniques. We present a comprehensive review of the current literature of robotic assisted pyeloplasty. Methods We performed a systemic review of all the current literature examining demographic data, intra operative parameters and post-operative outcomes. Results In most published series in the literature, the operative time ranges from 122 to 300 minutes and the operative time ranges from 27 to 77 ml. Most series considers subjective improvement in the symptoms and improved drainage on post-operative diuretic renal scan as the measures of success. The reported success rates vary from 89 to 100%. Conclusion Robotic pyeloplasty is a feasible alternative to laparoscopic pyeloplasty. Short-term results indicate equivalent outcomes with the laparoscopic procedure. Long-term studies are still needed to compare robotic and open pyeloplasty outcomes, and to define the role of robotic pyeloplasty in a cost prohibitive health care system. Copyright © 2007 John Wiley & Sons, Ltd. [source] Tunga penetrans: a stowaway from around the worldJOURNAL OF THE EUROPEAN ACADEMY OF DERMATOLOGY & VENEREOLOGY, Issue 1 2007MM Sachse Abstract Tungiasis is a cutaneous ectoparasitic infestation by the female sand flea Tunga penetrans. It is predominantly a health problem in sub-Saharan Africa, the Caribbean, Latin America and South America. However, increasing numbers of returning travellers, immigrants, and adopted children are also affected in non-tropical countries. It is a cause of substantial morbidity, with prevalence rates as high as 76% in certain endemic areas. To date, the early extraction of the flea is still the first line therapy. [source] Lichen amyloidosus treated by hydrocolloid dressingsJOURNAL OF THE EUROPEAN ACADEMY OF DERMATOLOGY & VENEREOLOGY, Issue 6 2004D Hallel-Halevy ABSTRACT We hereby report a case of lichen amyloidosus in a 69-year-old man unresponsive to various treatments. The patient was treated by occlusion with hydrocolloid dressings. Considerable subjective and objective improvement was observed with respect to the pruritus and cosmetic appearance. We suggest this convenient and efficacious treatment as first line therapy. [source] Superior effect of intravenous anti-D compared with IV gammaglobulin in the treatment of HIV-thrombocytopenia: Results of a small, randomized prospective comparisonAMERICAN JOURNAL OF HEMATOLOGY, Issue 5 2007Andromachi Scaradavou Abstract This small, prospective, randomized study compared increases in platelet counts and duration of response after intravenous gammaglobulin (IVIG) and IV anti-D in patients with HIV-related thrombocytopenia (HIV-TP). Nine Rh+, nonsplenectomized HIV-positive patients with thrombocytopenia were treated sequentially, in random order, with IVIG and IV anti-D in a cross over design, receiving each therapy for 3 months. Peak platelet counts and duration of effect after each treatment were compared. In addition, viral load measurements and CD4 counts were followed serially, as well as thrombopoietin levels. IV anti-D resulted in a mean peak platelet count of 77 x 109/L compared to only 29 x 109/L after IVIG (P = 0.07). The mean duration of response was significantly longer in patients treated with anti-D (41 days) compared to IVIG (19 days, P = 0.01). No consistent changes were seen in the CD4 counts or viral load measurements as a result of either therapy. Thrombopoietin levels were normal in all patients despite often severe thrombocytopenia. Anti-D was more efficacious than IVIG for the treatment of HIV-TP, confirming and extending previous results. Anti-D should be the first line therapy in HIV-positive, Rh+ patients, when antiretroviral agents are not indicated, not effective, or there is an urgent need to increase the platelet count. Am. J. Hematol. 82: 2007. © 2006 Wiley-Liss, Inc. [source] Use of fibrates in diabetes: what does the FIELD trial tell us?PRACTICAL DIABETES INTERNATIONAL (INCORPORATING CARDIABETES), Issue 3 2006Consultant PhysicianArticle first published online: 24 MAY 200, Dr NI Jowett MD, FRCP Consultant in Cardiovascular Medicine Abstract FIELD was the largest cardiovascular prevention trial using fibrates in type 2 diabetes. Whilst the primary endpoint was not achieved, fenofibrate therapy associated with fewer non-fatal myocardial infarctions and revascularisation procedures. Progress of renal and retinal microvascular disease appeared to be slowed. Although many patients were also taking statin therapy, FIELD does not provide evidence on efficacy or long-term safety when co-prescribed with fibrates. Statin monotherapy remains first line therapy for diabetic dyslipidaemia. Copyright © 2006 John Wiley & Sons, Ltd. [source] Fetal supraventricular tachycardia: a role for amiodarone as second-line therapy?PRENATAL DIAGNOSIS, Issue 2 2003Jean-Marie Jouannic Abstract Objective The aim of this study was to evaluate the role of amiodarone for the prenatal treatment of hydropic fetuses with supraventricular tachycardia. Methods A group of 26 hydropic fetuses with supraventricular tachycardia was studied retrospectively. Results Twenty-five fetuses received transplacental treatment. The overall prenatal conversion rate was 60%. Nine fetuses were converted to sinus rhythm using either flecainide (n = 7) or amiodarone (n = 2) as first line therapy, whilst digoxin alone or in association with sotalol failed to restore sinus rhythm in all cases. After first-line therapy, supraventricular tachycardia persisted in 10 fetuses. Nine fetuses received amiodarone alone or in association with digoxin as second-line therapy, five of whom were converted to sinus rhythm. Among the 11 live neonates treated by amiodarone in utero, 2 (17%) presented an elevated thyroid stimulating hormone at day 3,4. These two infants received thyroid hormone substitution therapy and had a normal outcome. Conclusion When first-line therapy fails to restore sinus rhythm in hydropic fetuses with supraventricular tachycardia, amiodarone therapy should be considered as it allows a substantial number of fetuses to be converted prenatally. Copyright © 2003 John Wiley & Sons, Ltd. [source] 4 Audit of androgen deprivation therapy (ADT) register in Auckland regionBJU INTERNATIONAL, Issue 2006H. ZARGAR Aim:, To determine the indications for therapy and disease state of men with prostate cancer on Luteinizing Hormone Releasing Hormone (LHRH) analogue treatment entered in the Auckland regional ADT register. Method:, Patients were identified from ADT register and further information was obtained using hospital electronic databases (Concerto and CRIS) and general practitioner records. Results:, Two hundred and eleven patients were registered from Jan 2000 to June 2005 on ADT register. The median age at diagnosis was 73 (45,91). 151 patients (71%) were alive at the time of audit. 118 of patients (56%)had a bone scan, 60 of which confirmed bony metastases (28% of all patients). Based on PSA score at diagnosis (>20), Gleason score (8,9,10) and stage of clinical disease (T3 or higher), high-risk patients were identified. The most common indication for LHRH analogue therapy as first line therapy was advanced local/metastatic disease (39%). 81 (38%) of patient developed hormone refractory disease while on treatment. The patients in high-risk group were more likely to develop hormone refractory disease (Chi Square test P = 0.009). PSA Doubling Time (PSADT) of less than 10 months was associated with significance risk of developing local/bony complications (Chi Square test P = 0.002) and mortality (Chi Square test P = 0.034). Presence of metastatic disease was associated with increased mortality (Chi Square test P = 0.012). Conclusion:, Patients in high-risk group are more likely to develop hormone refractory disease. PSADT can be used as an indicator for identifying patients with increased risk of developing complications. Presence of metastatic disease at the time of diagnosis is associated with increased mortality. [source] Intraarticular Lidocaine versus Intravenous Procedural Sedation with Narcotics and Benzodiazepines for Reduction of the Dislocated Shoulder: A Systematic ReviewACADEMIC EMERGENCY MEDICINE, Issue 8 2008Robert Warne Fitch MD Abstract Background:, Anterior shoulder dislocations commonly present to the emergency department (ED). The time associated with procedural sedation for the reduction of anterior shoulder dislocations can be lengthy and may require use of additional personnel. Complications associated with intravenous (IV) medications for procedural sedation are well documented. Objectives:, The aim was to determine if intraarticular lidocaine (IAL) injection is as effective as IV procedural sedation with narcotics and benzodiazepines for reduction of anterior shoulder dislocations. Methods:, This was a systematic review of randomized controlled trials (RCTs). The authors performed a PubMed, EMBASE, and Cochrane database search using key words: "shoulder dislocation" and "reduction" and retrieved every RCT published that compared the use of IV sedation to IAL as medication for reduction. Each manuscript was reviewed and the results of each was compared regarding medications used, success of reduction, complications, pain perceived, ease of reduction, and time spent in the ED. Results:, Six Level 1 RCTs were identified. No studies showed a statistically significant difference in success rate between IAL versus IV sedation. The complication rate was significantly higher in the IV sedation groups (p < 0.001), and the total time spent in the ED was longer for the IV sedation group. Conclusions:, The use of IAL for reduction of anterior shoulder dislocations should be strongly considered as a first line therapy because it is effective and safe and may potentially reduce time spent in the ED. [source] Due to low infection rates no routine anti-infective prophylaxis is required in younger patients with chronic lymphocytic leukaemia during fludarabine-based first line therapyBRITISH JOURNAL OF HAEMATOLOGY, Issue 1 2007Barbara F. Eichhorst Summary The impact of the combination therapy fludarabine plus cyclophosphamide (FC) in comparison with fludarabine alone regarding the incidence and severity of infections among previously untreated patients with chronic lymphocytic leukaemia (CLL) was evaluated within a multicentre phase III study. A total of 375 patients, up to 65 years old, were randomised between fludarabine or FC for first line therapy. No routine anti-infective prophylaxis was provided. A total of 196 infectious episodes, including 33 severe infections, were documented. In the fludarabine arm, 32·9% of the patients developed an infectious complication compared with 39·9% in the FC arm (P = 0·2). No difference was observed in the rate of severe infections (Common Toxicity Crtieria grades III and IV) between both treatment arms. Dose reductions were performed more frequently in FC-treated patients. Granulocyte colony-stimulating factor (G-CSF) was administered due to leucopenia in 5% of all patients. A multivariate regression model identified only elevated thymidine kinase, but not the treatment arm, as a statistically independent risk factor for infections. In summary, FC was not associated with a higher rate of infections compared with fludarabine alone. No routine antibiotic or virostatic prophylaxis, or pre-emptive treatment with G-CSF, is necessary in first line therapy with fludarabine-based regimens in younger patients with CLL, if adequate dose reduction is performed. The combination therapy FC is not associated with a higher rate of infections compared with fludarabine alone. No routine antibiotic or virostatic prophylaxis as well as pre-emptive treatment with G-CSF is necessary in first line therapy with fludarabine-based regimen in younger patients with CLL, if adequate dose reductions due to cytopenia or previous infections are performed. [source] Progress in the appraisal and management of inflammatory CNVsACTA OPHTHALMOLOGICA, Issue 2009P NERI Purpose To review the current Literature and to describe the experience of a tertiary referral centre on the progress in the appraisal and the management of inflammatory choroidal neovascularization (CNV). Methods The current literature is reviewed and the experience of a tertiary referral centre is reported. Results CNV is a potentially severe sequela of posterior uveitis. The role of chronic inflammation has been described in experimental uveitis. For such reasons, even when biomicroscopy and fluorangiography (FA) cannot detect abnormalities, Indocyanine Green Angiography (ICGA) can show choridal anomalies. ICGA greatly improved the appraisal of the choroidal involvement, by providing reliable data for the diagnosis and for the management of inflammatory CNV. The new spectral domain optical coherence tomography (OCT) equipments can provide further informations that can be useful for a correct clinical assessment. The out-come of subfoveal CNV is poor if untreated: several procedures have been considered, even though there is lack of guidelines. Steroids, both local and systemic, are the first line therapy for non-infectious choroidal inflammation, although their long-term use can lead to unpleasant sequala, such as glaucoma and cataract. Immunesuppressive agents, lasers photocoagulation, photodynamic treatment, surgical removal and anti-Vascular Endothelial Growth Fact (VEGF) are other options. Conclusion CNV secondary to uveitis is a severe sequela leading to significant visual impairment. ICGA is mandatory in order to obtain relevant informations about the choroidal status. Several therapeutic options have been considered, but no guidelines are available at the moment. [source] Toll-like receptor ligands as adjuvants in allergen-specific immunotherapyCLINICAL & EXPERIMENTAL ALLERGY, Issue 12 2005P. Johansen Summary Background Allergen-specific immunotherapy (SIT) leads to long-term amelioration of T-helper type 2 (Th2)-mediated allergic symptoms and is therefore recommended as a first line therapy for allergies. The major disadvantage of SIT is its low efficiency, requiring treatment over years. Objective In this study, we evaluated the potential of Toll-like receptor (TLR) ligands to facilitate Th1-type immune responses. Methods The immunogenicity and therapeutic potential of the major bee venom allergen phospholipase A2 (PLA2) combined with various TLR ligands were tested in mice and compared with immune responses induced by conventional aluminium-based preparations. Results Regarding total IgG against PLA2, TLR2/4-binding lipopolysaccharide and TLR3-binding polyriboinosinic polyribocytidylic (PolyI:C) were the superior adjuvants for prophylactic vaccination. However, TLR9-binding phosphorothioate-modified cytosine,guanosine-rich oligonucleotide (CpG), TLR-3-binding PolyI:C, and TLR2/6-binding peptidoglycan skewed the immune responses more towards IgG2a isotype and Th1 cytokines. Furthermore, in a therapeutic approach, CpG, PolyI:C and TLR7/8-binding 3M003 had immune modulating properties as they suppressed established IgE titres. Conclusion The potential of TLR ligands to adjuvate the immunogenicity of bee venom PLA2 and to skew the Th1,Th2 balance proved very heterogeneous. With respect to SIT, CpG, PolyI:C, and 3M003 were very promising. Hence, TLR ligands should be considered as adjuvants or immune modulators in SIT in human as to improve its efficiency regarding the Th1,Th2 balance of the immune response with a likely effect on therapy duration. [source] Cryofibrinogenaemia with a good response to stanozololCLINICAL & EXPERIMENTAL DERMATOLOGY, Issue 8 2000F. Revenga We report a 63-year-old patient with an IgA-kappa multiple myeloma in complete remission who developed necrotic lesions on both ears and papular, purpuric lesions on his legs and cheeks. Initial differential diagnosis included perniosis and skin necrosis secondary to interferon treatment but subsequent investigation revealed cryofibrinogenaemia as the underlying cause. Stanozolol therapy, 2 mg/12 h, achieved a complete clearance of the skin lesions. Cryofibrinogenaemia is a disease which can be under-diagnosed unless it is considered in the work-up of a patient with thrombotic skin lesions. Stanozolol is useful as first line therapy for this disorder. [source] Hoarse voice in adults: an evidence-based approach to the 12 minute consultationCLINICAL OTOLARYNGOLOGY, Issue 1 2009I. Syed Background:, The hoarse voice is a common presentation in the adult ENT clinic. It is estimated that otolaryngology/voice clinics receive over 50 000 patients with dysphonia each year. Good vocal function is estimated to be required for around 1/3 of the labour force to fulfil their job requirements. The assessment and management of the patient with a hoarse voice is potentially a complex and protracted process as the aetiology is often multi-factorial. This article provides a guide for the clinician in the general ENT clinic to make a concise, thorough assessment of the hoarse patient and engage in an evidence based approach to investigation and management. Method:, Literature search performed on 4 October 2008 using EMBASE, MEDLINE, Cochrane databases using subject headings hoarse voice or dysphonia in combination with diagnosis, management, investigation, treatment, intervention and surgery. Results:, General vocal hygiene is beneficial for non organic dysphonia but the evidence base for individual components is poor. There is a good evidence base for the use of voice therapy as first line treatment of organic dysphonia such as vocal fold nodules and polyps. There is little evidence for surgical intervention as first line therapy for most common benign vocal fold lesions. Surgery is, however, the treatment of choice for hoarseness due to papillomatosis. Both CO2 laser and microdissection are equally acceptable modalities for surgical resection of common benign vocal fold lesions. Laryngopharyngeal reflux is commonly cited as a cause of hoarseness but the evidence base for treatment with gastric acid suppression is poor. Despite the widespread use of proton pump inhibitors for treating laryngopharyngeal reflux, there is high quality evidence to suggest that they are no more effective than placebo. Conclusion:, A concise and thorough approach to assessment in the general ENT clinic will provide the diagnosis and facilitate the management of the hoarse voice in the majority of cases. Voice therapy is an important tool that should be utilised in the general ENT clinic and should not be restricted to the specialist voice clinic. If there is no improvement after initial measures, the larynx appears normal and/or the patient has failed initial speech & language therapy, referral to a specialist voice clinic may be helpful. More research is still required particularly with regard to laryngopharyngeal reflux which is often cited as an important cause of hoarseness but is still poorly understood. [source] |