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Management Options (management + option)
Kinds of Management Options Selected AbstractsNausea and Vomiting Side Effects with Opioid Analgesics during Treatment of Chronic Pain: Mechanisms, Implications, and Management OptionsPAIN MEDICINE, Issue 4 2009Frank Porreca PhD ABSTRACT Objectives., Gastrointestinal (GI) side effects such as nausea and vomiting are common following opioid analgesia and represent a significant cause of patient discomfort and treatment dissatisfaction. This review examines the mechanisms that produce these side effects, their impact on treatment outcomes in chronic pain patients, and counteractive strategies. Results., A number of mechanisms by which opioids produce nausea and vomiting have been identified. These involve both central and peripheral sites including the vomiting center, chemoreceptor trigger zones, cerebral cortex, and the vestibular apparatus of the brain, as well as the GI tract itself. Nausea and vomiting have a negative impact on treatment efficacy and successful patient management because they limit the effective analgesic dosage that can be achieved and are frequently reported as the reason for discontinuation of opioid pain medication or missed doses. While various strategies such as antiemetic agents or opioid switching can be employed to control these side effects, neither option is ideal because they are not always effective and incur additional costs and inconvenience. Opioid-sparing analgesic agents may provide a further alternative to avoid nausea and vomiting due to their reduced reliance on mu-opioid signalling pathways to induce analgesia. Conclusions., Nausea and vomiting side effects limit the analgesic efficiency of current opioid therapies. There is a clear need for the development of improved opioid-based analgesics that mitigate these intolerable effects. [source] Management Options to Treat Gastrointestinal Bleeding in Patients Supported on Rotary Left Ventricular Assist Devices: A Single-Center ExperienceARTIFICIAL ORGANS, Issue 9 2010Helen M. Hayes Abstract Gastrointestinal (GI) bleeding in ventricular assist devices (VADs) has been reported with rotary devices. The pathophysiological mechanisms and treatments are in evolution. We performed a retrospective review of GI bleeding episodes for all VADs implanted at our institution. Five male patients experienced GI bleeding,age 63.6 ± 3.64 years. VAD type VentrAssist n = 1, Jarvik 2000 n = 2, and HeartWare n = 2. All patients were anticoagulated as per protocol with antiplatelet agents (aspirin and/or clopidogrel bisulfate [Plavix] and warfarin (therapeutic international normalized ratio 2.0,3.5). There was no prior history of gastric bleeding in this group. Ten episodes of bleeding requiring blood transfusion occurred in five patients. Some patients had multiple episodes (1 × 5, 1 × 2, 3 × 1). The events occurred at varying times post-VAD implantation (days 14, 21, 26, 107, 152, 189, 476, 582, 669, and 839). Octreotide (a long-acting somatostatin analogue that reduces splanchnic arterial and portal blood flow) was administered subcutaneously or intravenously. Three patients received infusions of adrenaline at 1 µg/min to enhance pulsatility. Anticoagulation was interrupted during bleeding episodes but successfully introduced post bleeding event. GI bleeding is a significant complication of VAD therapy. In this article, we discuss diagnosis and management options. [source] Management options for river conservation planning: condition and conservation re-visitedFRESHWATER BIOLOGY, Issue 5 2007SIMON LINKE Summary 1. Systematic conservation planning is a process widely used in terrestrial and marine environments. A principal goal is to establish a network of protected areas representing the full variety of species or ecosystems. We suggest considering three key attributes of a catchment when planning for aquatic conservation: irreplaceability, condition and vulnerability. 2. Based on observed and modelled distributions of 367 invertebrates in the Australian state of Victoria, conservation value was measured by calculating an irreplaceability coefficient for 1854 subcatchments. Irreplaceability indicates the likelihood of any subcatchment being needed to achieve conservation targets. We estimated it with a bootstrapped heuristic reserve design algorithm, which included upstream,downstream connectivity rules. The selection metric within the algorithm was total summed rarity, corrected for protected area. 3. Condition was estimated using a stressor gradient approach in which two classes of geographical information system Layers were summarised using principal components analysis. The first class was disturbance measures such as nutrient and sediment budgets, salinisation and weed cover. The second class was land use layers, including classes of forestry, agricultural and urban use. The main gradient, explaining 56% of the variation, could be characterised as agricultural disturbance. Seventy-five per cent of the study area was classified as disturbed. 4. Our definition of vulnerability was the likelihood of a catchment being exposed to a land use that degrades its condition. This was estimated by comparing land capability and current land use. If land was capable of supporting a land use that would have a more degrading effect on a river than its current tenure, it was classified vulnerable (66% of the study area). 79% of catchments contained more then 50% vulnerable land. 5. When integrating the three measures, two major groups of catchments requiring urgent conservation measures were identified. Seven per cent of catchments were highly irreplaceable, highly vulnerable but in degraded condition. These catchments were flagged for restoration. While most highly irreplaceable catchments in good condition were already protected, 2.5% of catchments in this category are on vulnerable land. These are priority areas for assigning river reserves. [source] Implications of climate change for grassland in Europe: impacts, adaptations and mitigation options: a reviewGRASS & FORAGE SCIENCE, Issue 2 2007A. Hopkins Summary Climate change associated with greenhouse gas (GHG) emissions may have important implications for Europe's grasslands. Projected scenarios indicate that increased temperatures and CO2 concentrations have the potential to increase herbage growth and to favour legumes more than grasses, but changes in seasonal precipitation would reduce these benefits particularly in areas with low summer rainfall. Further implications for grasslands may arise from increased frequency of droughts, storms and other extreme events. Potential farm-scale adaptive responses to climate change are identified. Grassland agriculture also contributes to GHG emissions, particularly methane and nitrous oxide, and management of grassland affects net carbon balances and carbon sequestration. Management options are identified for mitigating grassland's contribution to GHG emissions which need to be developed in a holistic way that also considers other pressures. [source] Metastatic squamous cell carcinoma of the neck from an unknown primary: Management options and patterns of relapse,HEAD & NECK: JOURNAL FOR THE SCIENCES & SPECIALTIES OF THE HEAD AND NECK, Issue 3 2002Shahrokh Iganej MD Abstract Purpose Management of squamous cell carcinoma of undetermined primary tumors in the head and neck region is controversial. Here we report the Southern California Kaiser Permanente experience with these patients. Methods and Materials From January 1969 through December 1994, 106 patients were eligible for this retrospective analysis. Distribution of nodal staging was as follows: 14 N1, 27 N2A, 39 N2B, 2 N2C, and 24 N3. Initial treatment included excisional biopsy alone in 12, radical neck dissection alone in 29, radiotherapy alone in 24, excisional biopsy followed by radiotherapy in 15, and radical neck dissection plus postoperative radiation in 26 patients. Results Except for two patients, all patients have had a minimum follow-up of 5 years. Overall, 57 patients (54%) have had recurrences. Only two patients (3%) who had received radiotherapy as part of their initial treatment had an appearance of a potential primary site inside the irradiated field vs 13 patients (32%) who had not received radiotherapy (p = .006). Combined modality therapy resulted in fewer neck relapses, particularly in patients with advanced neck disease. Including salvage, surgery alone as the initial treatment resulted in 81% ultimate tumor control above the clavicle for patients with N1 and N2a disease without extracapsular extension. The 5-year survival for the entire population was 53%. Radiotherapy alone resulted in poor survival in patients with advanced/unresectable neck disease. No significant difference in survival based on the initial treatment was found. The statistically significant adverse factors in determining survival included advanced nodal stage and the presence of extracapsular extension. Conclusions Radiotherapy is very effective in reducing the rate of appearance of a potential primary site. However, in the absence of advanced neck disease (N1 and N2A without extracapsular extension), radiotherapy can be reserved for salvage. Radiotherapy alone results in poor outcomes in patients with advanced/unresectable neck disease, and incorporation of concurrent chemotherapy and cytoprotective agents should be investigated. © 2002 Wiley Periodicals, Inc. Head Neck 24: 236,246, 2002; DOI 10.1002/hed.10017 [source] Examining the Utility of In-Clinic "Rescue" Therapy for Acute MigraineHEADACHE, Issue 6 2008Veronica Morey RN Background., Management options currently are limited for patients with acute migraine whose symptoms prove refractory to self-administered therapy. Objective., To evaluate the clinical utility and cost-effectiveness of a management program offering in-clinic "rescue" treatment for patients with acute migraine. Methods., Two hundred consecutive migraine patients presenting to a university-based headache clinic were randomized to receive either optimal self-administered medical therapy for acute migraine ("standard therapy") or similar therapy plus the option of in-clinic parenteral drug administration should self-administered therapy prove ineffective ("rescue therapy"). Patients randomized to the latter group were restricted to a maximum of 2 "rescue visits" per month, and all patients were followed for one year. Patients "rescued" in clinic were contacted by telephone 24 hours following treatment to evaluate their treatment response. The primary analysis involved a comparison of the number of emergency department (ED) visits for headache recorded within each group over the one-year period of study. For all ED visits in the rescue group and for a randomly selected and equal number of ED visits within the standard group, the direct costs associated with those visits were assessed, and the direct costs of all in-clinic rescue visits also were recorded and analyzed. Results., The 2 groups studied were similar in terms of age, gender ratio, migraine subtype, migraine-related disability status at baseline and type/extent of medical insurance coverage. Over the one-year study period, the rescue group recorded 423 in-clinic rescue visits and reported 27 ED visits for headache treatment. The standard therapy group reported 73 ED visits (27 vs 73 visits; P < .01). The total direct costs associated with ED visits were $45,330 for the rescue group (mean $1690 per ED visit) and (by extrapolation from the sample selected) $147,971 for the standard therapy group (mean $2027 per ED visit). The total direct cost of the 423 "rescue visits" was $33,647 (mean $80 per visit). In 79% of the 423 rescue encounters, the patients involved reported no residual functional disability 24 hours following treatment. Of those in the rescue group who sought in-clinic rescue, 89% reported themselves "very satisfied" with such management. Conclusion., Providing the alternative of in-clinic "rescue" for acute migraine refractory to self-administered therapy offers an attractive alternative for patients and appears to substantially lower use of an ED for headache treatment and the cost associated with that use. [source] Successful salvage of RAEB/AML relapsing early post allograft with FLAG-Ida conditioned mini-allograft: a report of two casesINTERNATIONAL JOURNAL OF LABORATORY HEMATOLOGY, Issue 2 2001C.H. Hui Management options are often limited for patients with AML or high grade myelodysplasia (MDS) relapsing within a year of allogeneic transplantation. We report, in two such patients, the use of re-induction with FLAG-Ida chemotherapy, followed by the infusion of GCSF-mobilized blood stem cells from the same HLA-matched donor. Both patients achieved durable complete remissions with good quality of life and longer disease-free survival than after the first myeloablative allografts. This mini-allograft approach offers a practical, well-tolerated salvage and a potentially curative treatment for relapsed AML/high grade MDS patients failing a first conventional myeloablative allogeneic transplants. [source] Stage I seminoma: What should a practicing uro-oncologist do in 2009?INTERNATIONAL JOURNAL OF UROLOGY, Issue 6 2009Julia Skliarenko Abstract Testicular tumors are uncommon, but they continue to represent an important group of malignancies in young men. It is the most common solid malignancy in males between the ages of 20 and 35, and primary germ cell tumors are the most common histological type. In the United States in 2008, approximately 4800 cases of seminoma, approximately 4100 of which were stage I disease were projected after the completion of staging investigations. Remarkable progress has been made in the treatment of testicular seminoma over the past 25 years. Management options of stage I seminoma include radiotherapy, surveillance, or adjuvant chemotherapy. Standard management until recent years has been adjuvant retroperitoneal radiotherapy. Although providing excellent long term results, this approach has been associated with increased risk of gonadal toxicity, development of secondary malignancies and an increased risk of cardiovascular disease. The use of surveillance in management of patients with stage I seminoma is therefore becoming more frequent as it minimizes the burden of treatment and maintains the cure rate at virtually 100%. Adjuvant chemotherapy using Carboplatin has been investigated as an alternative management approach. However, the long term outcomes of patients managed with Carboplatin are not yet clear and this strategy should only be used in a study setting. It has been suggested that more patients with stage I seminoma will die of their treatment than of their cancer; therefore, the thrust of modern management should be to maintain 100% cure while minimizing the burden of treatment. [source] Methane and nitrous oxide fluxes from a farmed Swedish HistosolEUROPEAN JOURNAL OF SOIL SCIENCE, Issue 3 2009Ĺ. Kasimir Klemedtsson Summary Fluxes of the greenhouse gases methane (CH4) and nitrous oxide (N2O) from histosolic soils (which account for approximately 10% of Swedish agricultural soils) supporting grassley and barley production in Sweden were measured over 3 years using static chambers. Emissions varied both over area and time. Methane was both produced and oxidized in the soil: fluxes were small, with an average emission of 0.12 g CH4 m,2 year,1 at the grassley site and net uptake of ,0.01 g CH4 m,2 year,1 at the barley field. Methane emission was related to soil water, with more emission when wet. Nitrous oxide emissions varied, with peaks of emission after soil cultivation, ploughing and harrowing. On average, the grassley and barley field had emissions of 0.20 and 1.51 g N2O m,2 year,1, respectively. We found no correlation between N2O and soil factors, but the greatest N2O emission was associated with the driest areas, with < 60% average water-filled pore space. We suggest that the best management option to mitigate emissions is to keep the soil moderately wet with permanent grass production, which restricts N2O emissions whilst minimizing those of CH4. [source] Modelling hydrological management for the restoration of acidified floating fensHYDROLOGICAL PROCESSES, Issue 20 2005Stefan C. Dekker Abstract Wetlands show a large decline in biodiversity. To protect and restore this biodiversity, many restoration projects are carried out. Hydrology in wetlands controls the chemical and biological processes and may be the most important factor regulating wetland function and development. Hydrological models may be used to simulate these processes and to evaluate management scenarios for restoration. HYDRUS2D, a combined saturated,unsaturated groundwater flow and transport model, is presented. This simulates near-surface hydrological processes in an acidified floating fen, with the aim to evaluate the effect of hydrological restoration in terms of conditions for biodiversity. In the acidified floating fen in the nature reserve Ilperveld (The Netherlands), a trench system was dug for the purpose of creating a runoff channel for acid rainwater in wet periods and to enable circum-neutral surface water to enter the fen in dry periods. The model is calibrated against measured conductivity values for a 5 year period. From the model simulations, it was found that lateral flow in the floating raft is limited. Furthermore, the model shows that the best management option is a combination of trenches and inundation, which gave the best soil water quality in the root zone. It is concluded that hydrological models can be used for the calculation of management scenarios in restoration projects. The combined saturated,unsaturated model concept used in this paper is able to incorporate the governing hydrological processes in the wetland root zones. Copyright © 2005 John Wiley & Sons, Ltd. [source] Sediment quality assessment and dredged material management in Spain: Part II, analysis of action levels for dredged material management and application to the bay of Cádiz,INTEGRATED ENVIRONMENTAL ASSESSMENT AND MANAGEMENT, Issue 4 2007Manuel Alvarez-Guerra Abstract When sediments are removed from aquatic bottoms, they turn into dredged material that must be managed, taking into account its environmental impact. In Part II of this 2-part paper addressing sediment quality assessment and dredged material management in Spain, legislation and criteria used to regulate dredged material disposal at sea in different European countries are reviewed, as are action levels (ALs) derived by different countries used to evaluate management of dredged sediments from Cádiz Bay located on the South Atlantic coast of Spain. Comparison of ALs established for dredged material disposal by different countries reveals orders of magnitude differences in the values established for the same chemical. In Part I of this 2-part paper, review of different sediment quality guideline (SQG) methods used to support sediment quality assessments indicated a great heterogeneity of SQGs, both with regard to the numeric values for a particular chemical and the number of substances for which SQGs have been derived. The analysis highlighted the absence of SQGs for priority substances identified in current European Union water policy. Here, in Part II, the ALs are applied to dredged sediments from Cádiz Bay (South Atlantic coast of Spain), evidencing that the heterogeneity of ALs implemented in the reviewed countries could determine different management strategies. The application of other measurements such as bioassays might offer information useful in identifying a cost-effective management option in a decision-making framework, especially for dredged material with intermediate chemical concentrations. [source] Consequences of shrub expansion in mesic grassland: Resource alterations and graminoid responsesJOURNAL OF VEGETATION SCIENCE, Issue 4 2003Michelle S. Lett Anon. (1986) Abstract. In the mesic grasslands of the central United States, the shrub Cornus drummondii has undergone widespread expansion in the absence of recurrent fire. We quantified alterations in light, water and N caused by C. drummondii expansion in tall-grass prairie and assessed the hypothesis that these alterations are consistent with models of resource enrichment by woody plants. Responses in graminoid species, particularly the dominant C4 grass Andropogon gerardii, were concurrently evaluated. We also removed established shrub islands to quantify their legacy effect on resource availability and assess the capability of this grassland to recover in sites formerly dominated by woody plants. The primary effect of shrub expansion on resource availability was an 87% reduction in light available to the herbaceous understorey. This reduced C uptake and N use efficiency in A. gerardii and lowered graminoid cover and ANPP at the grass-shrub ecotone relative to undisturbed grassland. Shrub removal created a pulse in light and N availability, eliciting high C gain in A. gerardii in the first year after removal. By year two, light and N availability within shrub removal areas returned to levels typical of grassland, as had graminoid cover and ANPP were similar to those in open grassland. Recovery within central areas of shrub removal sites lagged behind that at the former grass-shrub ecotone. These results indicate that the apparent alternative stable state of C. drummondii dominance in tall-grass prairie is biotically maintained and driven by reductions in light, rather than resource enrichment. Within areas of shrub removal, the legacy effect of C. drummondii dominance is manifest primarily through the loss of rhizomes of the dominant grasses, rather than any long-term changes in resource availability. C. drummondii removal facilitates grassland recovery, but the effort required to initiate this transition is a significant cost of woody plant expansion in mesic grasslands. Prevention of woody plant expansion in remnant tall-grass prairies is, therefore, a preferred management option. [source] Clinical trial: a randomized trial comparing fluoroscopy guided percutaneous technique vs. endoscopic ultrasound guided technique of coeliac plexus block for treatment of pain in chronic pancreatitisALIMENTARY PHARMACOLOGY & THERAPEUTICS, Issue 9 2009D. SANTOSH Summary Background, Coeliac plexus block (CPB) is a management option for pain control in chronic pancreatitis. CPB is conventionally performed by percutaneous technique with fluoroscopic guidance (PCFG). Endoscopic ultrasound (EUS) is increasingly used for CPB as it offers a better visualization of the plexus. There are limited data comparing the two modalities. Aim, To compare the pain relief in chronic pancreatitis among patients undergoing CPB either by PCFG technique or by EUS guided technique. Methods, Chronic pancreatitis patients with abdominal pain requiring daily analgesics for more than 4 weeks were included. Fifty six consecutive patients (41 males, 15 females) participated in the study. EUSG-CPB was performed in 27 and PCFG-CPB in 29 patients. In both the groups, 10 mL of Bupivacaine (0.25%) and 3 mL of Triamcinolone (40 mg) were given on both sides of the coeliac artery through separate punctures. Results, Pre and post procedure pain scores were obtained using a 0-10 visual analogue scale. Improvement in pain scores was seen in 70% of subjects undergoing EUS-CPB and 30% in Percutaneous- block group (P = 0.044). Conclusions, EUS-guided coeliac block appears to be better than PCFG-CPB for controlling abdominal pain in patients with chronic pancreatitis. [source] Spatial variability of total soil carbon and nitrogen stocks for some reclaimed minesoils of southeastern Ohio,LAND DEGRADATION AND DEVELOPMENT, Issue 3 2008G. Nyamadzawo Abstract Reclamation of drastically disturbed minesoils and subsequent planting of trees and/or grasses can result in a rapid build-up of carbon (C) in the soil. However, the amount of C sequestered in reclaimed minesoils may vary with the amount of time since reclamation. In this study, we assessed total carbon (TC) and total nitrogen (TN) concentrations for reclaimed minesoils located in northeastern Ohio and characterized by distinct reclamation age chronosequences. Reclaimed minesoils studied were R78G, reclaimed in 1978 and immediately seeded to grass; R82GT, reclaimed in 1982 and immediately seeded to grass and trees were planted 5 years later; and R87G, reclaimed in 1987 and immediately seeded to grass. An unmined site, UMG, was also included as a reference. Our objectives were to evaluate the variability with respect to mean and the spatial variability of pH, bulk density (,b), TC and TN concentrations, and stocks in each reclaimed minesoil. Thirty soil samples were collected at each of the 0,15, 15,30, and 30,50,cm depth. The coefficient of variation (CV) for ,b was least, <15 per cent at each site and depth. For TN concentration and stock, CV was moderate, 15,35 per cent, in each field except the UMG where it was high, >35 per cent at 0,15, and 15,30,cm depths. For TC concentration and stocks, CV was high, >35 per cent, across all minesoils and generally increased with depth. The C/N ratio followed the same tend as TC and TN stocks and ranged from 40 per cent to 123 per cent across minesoils. Geostatistical analysis also showed an increase in sample variance with increasing amount of time since reclamation for most soil properties under investigation. Sample variance for TC concentration and stocks also increased with depth in reclaimed minesoils. However, no definite relationship emerged between amount of time since reclamation and the spatial dependence of TC and TN concentrations and stocks. Overall this study showed that reclamation of drastically disturbed minesoils increased the soil C concentration and stocks and reclamation by initially seeding to grasses followed by planting trees was the best management option for speedy accretion of soil C and soil quality enhancement. Copyright © 2007 John Wiley & Sons, Ltd. [source] Ileovesicostomy for adults with neurogenic bladders: Complications and potential risk factors for adverse outcomes,,NEUROUROLOGY AND URODYNAMICS, Issue 3 2008Hung-Jui Tan Abstract Aims Risk factors for complications following ileovesicostomy have not been well defined. This study's purpose was to examine outcomes following ileovesicostomy in adults and identify possible risk factors that may contribute to post-operative complications. Methods Retrospective database review identified ileovesicostomy procedures from August 1999 to September 2003. Demographic, pre-operative, and post-operative data were extracted. Statistical analysis determined whether risk factors influenced outcomes of urethral continence, re-operation, and post-operative complications. Factors included age, tobacco use, diabetes, neurogenic bladder etiology, body mass index, pre-operative indwelling catheterization, or simultaneous procedures including pubovaginal sling/urethral closure. Results 50 adults status-post ileovesicostomy were identified. At last follow-up, 36 patients (72%) were continent per urethra. The incidence of complications decreased significantly from 3.38 per patient to 1.16 post-operatively (P,<,0.0001). Twenty-seven averaged 1.52 inflammatory or infectious post-operative complications per patient, 19 averaged 1.47 stomal complications, and 11 averaged 2.09 ileovesicostomy mechanical obstructions. Overall, 27 required 2.85 re-operations or additional procedures following ileovesicostomy. Sub-group analysis identified BMI (P,=,0.0569) as a possible risk factor. Differences in outcomes based on age, tobacco use, diabetes, neurogenic bladder etiology, pre-operative indwelling catheterization, or urethral closure were not significant. Conclusions Ileovesicostomy is a valuable management option for adults with neurogenic bladder unable to perform intermittent catheterization. The incidence of urinary tract comorbid events significantly decreased following ileovesicostomy though the onset of other complications should be considered. The morbidity associated with ileovesicostomy requires careful patient selection, close long-term follow-up, and potential subsequent interventions to address post-operative complications. Neurourol. Urodynam. 27:238,243, 2008. © 2007 Wiley-Liss, Inc. [source] Towards an integrated environmental assessment for wetland and catchment managementTHE GEOGRAPHICAL JOURNAL, Issue 2 2003R Kerry Turner This paper develops a decision support system for evaluation of wetland ecosystem management strategy and examines its, so far partial, application in a case study of an important complex coastal wetland known as the Norfolk and Suffolk Broads, in the east of England, UK. Most managed ecosystems are complex and often poorly understood hierarchically organized systems. Capturing the range of relevant impacts on natural and human systems under different management options will be a formidable challenge. Biodiversity has a hierarchical structure which ranges from the ecosystem and landscape level, through the community level and down to the population and genetic level. There is a need to develop methodologies for the practicable detection of ecosystem change, as well as the evaluation of different ecological functions. What is also required is a set of indicators (environmental, social and economic) which facilitate the detection of change in ecosystems suffering stress and shock and highlight possible drivers of the change process. A hierarchical classification of ecological indicators of sustainability would need to take into account existing interactions between different organization levels, from species to ecosystems. Effects of environmental stress are expressed in different ways at different levels of biological organization and effects at one level can be expected to impact other levels, often in unpredictable ways. The management strategy, evaluation methodologies and indicators adopted should also assess on sustainability grounds whether any given management option is supporting, or reducing, the diversity of functions which are providing stakeholders with the welfare benefits they require. [source] Salvage Conservation Laryngeal Surgery after Irradiation Failure for Early Laryngeal CancerTHE LARYNGOSCOPE, Issue 3 2006Mehdi Motamed FRCS Abstract Objectives: One third of recurrences after radiotherapy for early laryngeal cancer remain localized. Salvage conservation laryngeal surgery, with total laryngectomy held as reserve, is a surgical management option that is arguably underused. The aim of this review is to report the oncologic and functional results of salvage conservation laryngeal surgery, using the external or the endolaryngeal laser approach. Study Design: Review article. Methods: A computerized literature search of the Medline database from 1985 to 2005 was performed using the following search strategy: laryngeal neoplasm/AND salvage therapy/. Studies with a sample size less than 10 and an average follow-up of less than 24 months were excluded from analysis. The oncologic outcome, functional outcome, length of hospitalization, and the frequency of complications were recorded. Results: The average reported local control rate for recurrent early glottic cancer after radiotherapy salvaged by using the external or the endolaryngeal laser approach is 77% and 65%, respectively. The average reported overall local control rate, including cases that subsequently required total laryngectomy, is 90% and 83%, respectively. The endolaryngeal approach when compared with the extralaryngeal approach does have the advantage of reduced complications, lesser requirement for tracheostomy and nasogastric feeding, and shortened hospitalization time. Conclusions: Conservation laryngeal surgery is a safe and effective treatment for recurrent localized disease after radiotherapy for early stage glottic cancer. Local control may be achieved without the sacrifice of laryngeal function, and total laryngectomy may be held in reserve as the ultimate option for salvage without compromising ultimate survival significantly. [source] Randomized controlled trial of laparoscopic anterior versus posterior fundoplication for gastro-oesophageal reflux diseaseANZ JOURNAL OF SURGERY, Issue 7-8 2010Mansoor Khan Abstract Background:, The aim of the study was to compare the effect of laparoscopic anterior and posterior fundoplication on gastro-oesophageal reflux disease by means of a prospective randomized controlled trial. Methods:, One hundred and three patients were randomised to undergo either anterior (53) or posterior (50) fundoplication. Initial enrolment and subsequent clinical appointments were undertaken 1, 3, 6 and 12 months after the procedure using a standardized questionnaire. Ambulatory pH monitoring and manometry were undertaken both preoperatively and at approximately 3 months post-procedure. Results:, The mean operating time was similar in both groups (48 versus 52 min). Two operations in each group were converted to open surgery. Post-operative dysphagia in the first month was higher in the posterior fundoplication group compared with the anterior group (at 1 month, P= 0.002; and at 3 months, P= 0.014). The number of individuals suffering from post-operative heartburn was greater in the anterior fundoplication group (at 1 month, P= 0.008; at 3 months, P < 0.001; and at 6 months, P= 0.002). Eight individuals required reoperation in the anterior group and two individuals in the posterior group (P= 0.057). Conclusion:, Anterior and posterior fundoplication each have their advantages and disadvantages. There is an increased risk of early post-operative dysphagia after posterior fundoplication. Anterior fundoplication carries a greater risk of persistent or recurrent reflux. Overall, a posterior fundoplication produces a better management option for controlling gastro-oesophageal reflux disease when compared with an anterior fundoplication technique which utilizes unilateral fixation of the gastric fundus. [source] Milt characteristics of diploid and triploid Atlantic cod (Gadus morhua L.)AQUACULTURE RESEARCH, Issue 10 2009Stefano Peruzzi Abstract The work compares the characteristics of milt produced by diploid and triploid Atlantic cod in terms of sperm motility, density, DNA content, seminal-fluid composition and the ability of sperm to fertilize the eggs. The mean track velocity (VCL) was higher in the sperm of diploid than in the triploid males at 20 s post-activation (p.a.; 124.04 ± 6.91 vs. 113.32 ± 6.32 ,m s,1), but not at 40 s p.a. No differences between ploidies were observed for the remaining sperm-motility descriptors as for spermatozoa density, spermatocrit or seminal fluid's variables like pH, osmolarity, Cl,, Na+, Ca2+ and K+ concentration. Triploid males produced aneuploid sperm cells (average 1.46n, range 1.2,1.6n) and the larvae generated from artificial crossings with diploid females showed abnormal morphology and did not survive to exogenous feeding. Plasma concentration of 11-ketotestosterone in sexually mature diploid and triploid males was similar (5.35 ± 1.54 vs. 4.82 ± 1.15 ng mL,1) and no differences were found in the ability of males of both ploidies to induce spawning when held in tanks with diploid females. The paper provides evidence of gametic sterility of triploid males and examines the use of triploid fish as a management option to address the issues of genetic containment of farmed cod alongside measures for securing present fish-farming technologies. [source] Clinical recommendations for the use of lapatinib ditosylate plus capecitabine for patients with advanced or metastatic HER2-positive breast cancerASIA-PACIFIC JOURNAL OF CLINICAL ONCOLOGY, Issue 1 2009Raymond D SNYDER Abstract Primary and acquired resistance to trastuzumab pose a therapeutic challenge when treating patients with HER2 (erbB-2)-positive locally advanced or metastatic breast cancer (MBC). The recent introduction of lapatinib (Tykerb/Tyverb, GlaxoSmithKline, Brentford, UK) provides a new management option for such patients. A prospective, randomized phase III clinical trial has confirmed that lapatinib in combination with capecitabine extends time to progressive disease in HER2-positive MBC, compared with capecitabine alone in patients with disease progression despite prior anthracycline, taxane and trastuzumab therapy. Preliminary data also indicate that lapatinib may exert a beneficial effect on brain metastases, a common sanctuary site for HER2-positive breast cancer following trastuzumab treatment. The tolerability of lapatinib is commensurate with that of other erbB family tyrosine kinase inhibitors and no significant new adverse events have emerged following its introduction into clinical practice. In particular, no additive cardiotoxicity has been observed when lapatinib is prescribed after trastuzumab therapy. Based on the published literature and supplemented by clinical experience, this article provides practical management recommendations for the use of lapatinib plus capecitabine in patients with MBC. Issues addressed include patient selection, baseline evaluation and monitoring for clinical benefit. The minimization and management of adverse events is also discussed in detail, particularly the dermatological and gastrointestinal effects, which are the most clinically significant side-effects of lapatinib therapy. Further recommendations cover the minimization of drug interactions, anticipated dosing alterations and the optimal employment of oral anticancer regimens. [source] Sulfasalazine and dermatitis herpetiformisAUSTRALASIAN JOURNAL OF DERMATOLOGY, Issue 2 2005Elizabeth Willsteed SUMMARY Dermatitis herpetiformis that is unable to be controlled using dapsone and a gluten-free diet presents a therapeutic challenge. Three cases that responded well to sulfasalazine are presented. Two cases, who were unable to tolerate dapsone, had a rapid response to sulfasalazine, without apparent side-effects. The third case with dapsone-responsive blistering dermatoses, presumed to be dermatitis herpetiformis on the basis of serology, showed an excellent clinical response to sulfasalazine, but after 6 weeks of therapy had to cease it because of side-effects. Sulfasalazine is metabolized variably to sulfapyridine, a sulphonamide known to be an effective therapy for dermatitis herpetiformis but no longer available. Sulfasalazine should be considered as a management option for dermatitis herpetiformis. [source] An interinstitutional and interspecialty comparison of treatment outcome data for patients with prostate carcinoma based on predefined prognostic categories and minimum follow-up,CANCER, Issue 10 2002Frank A. Vicini M.D. Abstract BACKGROUND The optimal management of patients with clinically localized prostate carcinoma remains undefined due in part to the absence of well-designed, prospective, randomized trials. The current study was conducted to compare and contrast outcomes with different forms of therapy for patients with prostate carcinoma who were treated at several institutions using predefined prognostic categories. METHODS A retrospective study of 6877 men with prostate carcinoma who were treated between 1989 and 1998 at 7 different institutions with 6 different types of therapy was conducted. Five-year actuarial rates of prostate specific antigen (PSA) failure were calculated based on predefined prognostic categories, which included combinations of pretreatment PSA level, tumor stage, and Gleason score. In addition, outcome was calculated using consistent biochemical failure definitions and a minimum, median length of follow-up. RESULTS Substantial differences in outcome were observed for the same type of treatment and at the same institution, depending on the number of prognostic variables used to define treatment groups. However, estimates of 5-year PSA outcomes after all forms of therapy for low-risk and intermediate-risk patient groups were remarkably similar (regardless of the type of treatment) when all three pretreatment variables were used to define prognostic categories. For patients in high-risk groups, the 5-year PSA outcomes were suboptimal, regardless of the treatment technique used. CONCLUSIONS The current data suggest that interinstitutional and interspecialty comparisons of treatment outcome for patients with prostate carcinoma are possible but that results must be based on all major prognostic variables to be meaningful. Analyzed in this fashion, 5-year PSA results were similar for patients in low-risk and intermediate-risk groups, regardless of the form of therapy. Findings from prospective, randomized trials using survival (cause specific and overall) as the end point for judging treatment efficacy and longer follow-up will be needed to validate these findings and to identify the most appropriate management option for patients with all stages of disease. Cancer 2002;95:2126,35. © 2002 American Cancer Society. DOI 10.1002/cncr.10919 [source] 4267: Diagnosis and management of iris melanomas: a clinical follow-up study of 12 yearsACTA OPHTHALMOLOGICA, Issue 2010L RAZZAQ Purpose Diagnosis of iris melanoma is challenging as no clear cut differentiating points exists for differentiation between iris naevi and melanoma. On the basis of our and others experience of iris tumors, an "iris melanoma module" was developed at LUMC in 1997 which included important clinical and UBM features of iris melanoma to diagnose and differentiate between iris naevi and -melanoma. This study is to identify important clinical and UBM variables predictive of diagnosing iris melanoma. Methods Between January 1997 and December 2007, total 117 patients were seen with suspected iris melanocytic tumors and the iris melanoma module is filled in all these patients. On the basis of the module score for each patient, decision was made whether to treat or observe the patient. We analyzed all these patients on the basis of follow-up and current status that whether the management strategy of these patients' iris tumors on the basis of module was right. Results 37 Patients were treated with plaque radiation (32%), 15 patients had excision or enucleation (13%), whereas in 65 patients lesions were observed with periodic follow-up (55%). The follow-up period is 2-12 years. Of the 65 lesions observed for growth only 6(9%) showed growth. Most of the lesions which were excised proved to be the iris melanoma. All the variables of iris melanoma module were also analysed using the univariate and multivariate analysis. Conclusion Clinical and UBM features of the iris tumors included in iris melanoma module appear to enable clinicians to differentiate reasonably well between probable malignant melanoma, for which prompt treatment is appropriate, and benign naevi, for which observation with periodic follow-up is the good management option. [source] Procedural Pain Management Patterns in Academic Pediatric Emergency DepartmentsACADEMIC EMERGENCY MEDICINE, Issue 5 2007Rishi Bhargava MD ObjectivesTo describe the current state of the art for pain and sedation management for five common pediatric emergency department (ED) procedure scenarios. MethodsFellowship directors of U.S. EDs with a pediatric emergency medicine fellowship training program were surveyed by mail and asked to choose the one most commonly used pain or sedation management option for five clinical scenarios: facial laceration repair, cranial computed tomography in a toddler, closed fracture reduction, neonatal lumbar puncture, and intravenous catheter insertion. Results were analyzed by using descriptive statistics, and the differences between high and low volume departments were compared by using a chi-square test. ResultsThirty-eight of 51 fellowship programs responded (75%). The majority of respondents were fellowship directors (76%). Topical anesthetics were most commonly reported as used for a simple facial laceration (84%), whereas ketamine sedation was most popular for fracture reduction (86%). Pain management for the other scenarios was more variable. More than half of the respondents (53%) would not sedate at all for cranial computed tomography, and only 38% reported use of pharmacologic pain management for intravenous catheter insertion. The majority (74%) reported use of anesthetic (topical or injected local) for neonatal lumbar puncture. High volume departments were more likely to use pain management for intravenous catheter insertions. ConclusionsPain and sedation management methods for pediatric procedures continue to evolve. Despite gains, there is still room for improvement, particularly regarding intravenous catheter insertions. [source] A methodology for inferring the causes of observed impairments in aquatic ecosystems,ENVIRONMENTAL TOXICOLOGY & CHEMISTRY, Issue 6 2002Glenn W. Suter II Abstract Biological surveys have become a common technique for determining whether aquatic communities have been injured. However, their results are not useful for identifying management options until the causes of apparent injuries have been identified. Techniques for determining causation have been largely informal and ad hoc. This paper presents a logical system for causal inference. It begins by analyzing the available information to generate causal evidence; available information may include spatial or temporal associations of potential cause and effect, field or laboratory experimental results, and diagnostic evidence from the affected organisms. It then uses a series of three alternative methods to infer the cause: Elimination of causes, diagnostic protocols, and analysis of the strength of evidence. If the cause cannot be identified with sufficient confidence, the reality of the effects is examined, and if the effects are determined to be real, more information is obtained to reiterate the process. [source] The artisanal fishery fleet of the lower AmazonFISHERIES MANAGEMENT & ECOLOGY, Issue 3 2008V. J. ISAAC Abstract, The present study analyses temporal trends in the characteristics of the artisanal fleet landing at ports in the city of Santarém (lower Amazon) from 1993 to 2003. A total of 2714 boats visited the city, accounting for more than 76 000 landings. Of these, 1952 were fishing boats; the others were buyer boats, specialised in the purchase of fish in rural areas for resale in Santarém. The activity involves more than 13 000 fishermen. Fishing boats are made of wood, are on average 11 m long and powered by a 20 hp outboard motor. Boats operate with an average of six to seven fishermen, spending 6 days per trip and catching between 300 and 800 kg of fish. Most variability in yield can be explained by the ice consumed (70%), the number of fishermen trip,1 (19%), fuel consumed (4%) and days spent fishing (3%). The yield changed according to the size, origin and type of boat. Fishing boats coming from more distant locations, in the state of Amazonas, performed better than those from Santarém. Total yield declined slightly during the study period. Mean age of fishing boats and fishing power is increasing. Consumption of ice and fuel by trip, number of fishermen trip,1 and mean days fishing showed positive trends. Financial subsidies from governmental agencies are criticised. Fleet performance and management options are discussed. [source] Use of response functions in selecting lodgepole pine populations for future climatesGLOBAL CHANGE BIOLOGY, Issue 12 2006T. WANG Abstract Although growth response functions have previously been developed for lodgepole pine (Pinus contorta Dougl. ex Loud.) populations in British Columbia, new analyses were conducted: (1) to demonstrate the merit of a new local climate model in genecological analysis; (2) to highlight new methods for deriving response functions; and (3) to evaluate the impacts of management options for existing geographically defined seed planning units (SPUs) for reforestation. Results of this study suggest that new methods for anchoring population response functions, and a multivariate approach for incorporating climate variables into a single model, considerably improve the reliability of these functions. These functions identified a small number of populations in central areas of the species distribution with greater growth potential over a wide range of mean annual temperature (MAT). Average productivity of lodgepole pine is predicted to increase (up to 7%) if moderate warming (,2°C MAT) occurs in the next few decades as predicted, although productivity would substantially decline in some SPUs in southern BC. Severe global warming (>3°C MAT) would result in either a drastic decline in productivity or local populations being extirpated in southern SPUs. New deployment strategies using the best seed sources for future reforestation may not only be able to mitigate the negative impact of global warming, but may even be able to increase productivity in some areas. [source] Forage and biomass feedstock production from hybrid forage sorghum and sorghum,sudangrass hybridsGRASSLAND SCIENCE, Issue 4 2008Brad Venuto Abstract As the bioenergy industry expands, producers choosing to shift current forage crop production to dedicated biomass crops can benefit from growing lower risk multipurpose crops that maximize management options. Hybrid forage sorghums (HFS) and sorghum,sudangrass hybrids (SSG) are capable of impressive biomass yields and tolerance to environmental stress. Multiple vegetative harvests (ratoon harvests) of sorghum are possible and there are photoperiod-sensitive sorghums that remain vegetative. However, the response of newer HFS and SSG cultivars to harvest management practices designed for forage or cellulosic feedstock production has not been fully investigated in all environments. The objectives of this study were to: (i) determine biomass production and quality characteristics of a genetically diverse range of HFS, SSG and sudangrass cultivars and evaluate their interaction with harvest system; and (ii) provide data to aid selection of sorghum cultivars for both forage and biofuel uses. Mean yield across all entries and years for a single late season harvest was 27.1 Mg ha,1 of dry matter per year. Mean total yield for a first harvest plus a ratoon crop was 25.5 Mg ha,1 of dry matter per year. However, entries varied for yield and interacted with harvest system. Mean caloric value was 16.5 Gj Mg,1 and modest differences were observed among cultivars evaluated. The best performing entry (cv. Tentaka) yielded 40.3 Mg ha,1 of dry matter for a single late season harvest, demonstrating the biomass potential of existing sorghum cultivars, specifically those possessing photoperiod- and/or thermosensitive genotypes. [source] Modelling the benefits of American Mink Mustela vison management options for terns in west ScotlandIBIS, Issue 2008NORMAN RATCLIFFE American Mink Mustela vison is a semi-aquatic predator that has invaded the west coast of Scotland and many of its associated islands. We developed a GIS model of their potential range based on their dispersal abilities and habitat use, which revealed that most islands in west Scotland are accessible to Mink, and that these host a large proportion of the region's Common Sterna hirundo and Arctic Terns S. paradisaea. Mink are predators on tern eggs and chicks, and statistical modelling of long-term productivity data demonstrated that unprotected sites within their range have an average productivity of 0.33 chicks per pair, whereas that at sites where Mink were trapped was 253% higher. We assessed the benefits of current Mink control projects for terns in the Western Isles and the remainder of west Scotland using a population modelling approach. This showed that both projects delivered considerable benefits for Common Terns, because a large proportion of their numbers were within the area of the control programmes and in sites that would be accessible to Mink if no control were in operation. For Arctic Terns, the benefits were less clear, as a larger proportion of their numbers were outside the control areas, and many of these were in sites isolated from, or unsuitable for, Mink. We discuss the implications of these findings for future strategic planning of Mink management in west Scotland. [source] Importance of implementation and residual risk analyses in sediment remediationINTEGRATED ENVIRONMENTAL ASSESSMENT AND MANAGEMENT, Issue 1 2006Richard J Wenning Abstract Management strategies for addressing contaminated sediments can include a wide range of actions, ranging from no action, to the use of engineering controls, to the use of more aggressive, intrusive activities related to removing, containing, or treating sediments because of environmental or navigation considerations. Risk assessment provides a useful foundation for understanding the environmental benefits, residual hazards, and engineering limitations of different remedy alternatives and for identifying or ranking management options. This article, part of a series of panel discussion papers on sediment remediation presented at the Third International Conference on Remediation of Contaminated Sediments held 20,25 January 2005 in New Orleans, Louisiana, USA, reviews 2 types of risk that deserve careful consideration when evaluating remedy alternatives. The evaluation of remedy implementation risks addresses predominantly short-term engineering issues, such as worker and community health and safety, equipment failures, and accident rates. The evaluation of residual risks addresses predominantly longer-term biological and environmental issues, such as ecological recovery, bioaccumulation, and relative changes in exposure and effects to humans, aquatic biota, and wildlife. Understanding the important pathways for contaminant exposure, the human and wildlife populations potentially at risk, and the possible hazards associated with the implementation of different engineering options will contribute to informed decision making with regard to short- and long-term effectiveness, implementability, and potential environmental hazards. [source] | |||||||||||||||||||||||||||||||||||||