Home About us Contact
|
Home About us Contact | ||
|
|
||
Various Therapies (various + therapy)
Selected Abstracts006 Efficacy of photochemotherapy and UVA-1 therapy in patients with morphea or lichen sclerosusPHOTODERMATOLOGY, PHOTOIMMUNOLOGY & PHOTOMEDICINE, Issue 2 2002K. Ghoreschi Morphea and lichen sclerosus are inflammatory skin diseases of unknown aetiology. Morphea can be subdivided into plaque morphea, linear morphea and disabling or generalized morphea. In most patients morphea leads to superficial or deep sclerosis of the skin. The characteristic features of lichen sclerosus which often affects the genital area are edema of upper dermis, inflammatory infiltration and hyalinisation to the dermis at advanced stages. Patients with morphea or lichen sclerosus suffer especially from scar formation and morphea may lead to severe disfigurement, contractures and reduction of quality of life. Skin sclerosis seems to be the result of vascular damage, T cell activation and altered connective tissue production. Various therapies have been reported for lichen sclerosus and morphea. Whereas the topical use of ultrapotent corticosteroids is well established for genital lichen sclerosus, immunosuppressive agents are normally not successful in resolving extragenital skin sclerosis. In a retrospective study we confirmed the efficacy of phototherapy in more than 50 patients with morphea. Fourty treatments with 30 J/cm2 UVA-1 or PUVA-bath photochemotherapy resulted in a significant improvement, reduced skin thickness, as determined by high frequency ultrasound and reconstitution of functional mobility of the skin and even the underlying fasciae. In lichen sclerosus phototherapy was successful only in some patients. Thus for lichen sclerosus the use of topical corticosteroids is the first choice therapy, while phototherapy using either PUVA-bath or medium dose UVA-1 are the most effective treatments for morphea. [source] Comparison of efficacy criteria across onychomycosis trials: need for standardizationINTERNATIONAL JOURNAL OF DERMATOLOGY, Issue 4 2003Aditya K. Gupta MD, FRCP(C) Background The last 10 years have seen a substantial increase in the number of studies reporting the efficacy of the various antifungal agents used to treat onychomycosis. Aim To examine the definitions of efficacy parameters reported in clinical studies on the treatment of onychomycosis and discuss the importance of standardized reporting. Methods We searched MEDLINE (1966,2001) for studies in which oral treatments, griseofulvin, ketoconazole, terbinafine (continuous and pulse), itraconazole (continuous and pulse), and fluconazole, were used to treat dermatophyte onychomycosis. Results Mycologic cure was predominantly defined as negative microscopy and culture. Unlike mycologic cure, clinical parameters (e.g. clinical response, clinical cure) were variably defined. Subjective terms, such as "cure" or "markedly improved," were used; although these terms appear to be explicit, what is considered to be "cured" or "markedly improved" by one evaluator may not be by another. Also, infected nails were clinically evaluated to determine the response to treatment. Studies measured the distance between the proximal nail fold and a notch in the nail plate, at the junction between the diseased and normal-appearing nail, or in some cases estimated the diseased nail plate involvement. Conclusions This review of the literature on systemic agents used to treat onychomycosis shows that standard and explicit definitions are required for the accurate comparison of the effectiveness of the various therapies. [source] Review article: primary prophylaxis for portal hypertensive bleeding in cirrhosisALIMENTARY PHARMACOLOGY & THERAPEUTICS, Issue 7 2000Vlachogiannakos Variceal bleeding is a consequence of portal hypertension, which in turn is the major complication of hepatic cirrhosis. Given the high rate of mortality of the first bleeding episode, primary prophylaxis to prevent bleeding from varices and portal hypertensive gastropathy is the current optimal therapeutic approach. The difficulty in identification of patients with varices who will bleed, before they do so, can justify a strategy of treating all patients with varices prophylactically. We evaluated the various therapies that have been assessed in randomized controlled trials for prevention of first bleeding, using meta-analysis where applicable. The current first choice treatment is non-selective ,-blockers; it is cheap, easy to administer, and is effective in preventing the first variceal haemorrhage and bleeding from gastric mucosa. Combination drug therapy of ,-blockers and nitrates looks promising, but needs further evaluation in randomized controlled trials. The conflicting results of the randomized studies of endoscopic banding ligation and the small number of patients and clinical events, as well as the cost, do not warrant any change in current practice. However, endoscopic banding ligation may be a reasonable alternative for patients who cannot tolerate, or have contraindications to ,-blockers or no haemodynamic response to the drug therapy, but this must be proved in randomized trials. [source] Low-dose broad-band UVA in morphea using a new method for evaluationPHOTODERMATOLOGY, PHOTOIMMUNOLOGY & PHOTOMEDICINE, Issue 2 2000M. El-Mofty Until recently, various therapies for localized scleroderma have been used with limited success. Recently, phototherapy, with or without psoralen, was proposed as a successful treatment modality. The aim of this study was to evaluate the effect of broad-band low-dose ultraviolet A (UVA) phototherapy in patients with localized scleroderma, using a new method for evaluation. Twelve patients complaining of morphea were exposed to UVA irradiation at a dose of 20 J/cm2 3 times per week for 20 sessions. Selected covered plaques served as internal controls. The efficacy of therapy was judged clinically by sequential inspection and palpation. In biopsy specimens from exposed and covered plaques stained with hematoxylin and eosin (H & E) and Masson trichrome stains, the concentration of collagen per dermal surface area was measured with the use of a computerized image analyzer. All patients reported remarkable softening of skin lesions, confirmed by sequential palpatory assessment. A significant reduction in the mean concentration of collagen per surface area was detected in the plaques exposed to UVA (the P value being 0.007, P<0.01), whereas in the covered plaques the difference was not statistically significant (the P value being 0.10, P>0.05). The conclusion is that low-dose broad-band UVA phototherapy is a very effective and safe treatment modality for localized scleroderma. [source] Efficacy of interferon-, in patients with refractory bullous pemphigoidTHE JOURNAL OF DERMATOLOGY, Issue 11 2007Takekuni NAKAMA ABSTRACT Bullous pemphigoid (BP) usually responds well to conventional therapies, although some severe cases show less response to various therapies or develop side-effects due to long-term drug administration using high doses. Most BP patients are elderly and are thus prone to systemic deterioration or unfavorable outcome. In the present study, we investigated the efficacy of interferon-, on severe BP patients resistant to conventional therapies. Interferon-, was administered to 10 severe BP patients at a dose of 2 million Japan reference units (JRU) once a day for 7 consecutive days by i.v. infusion in addition to oral corticosteroids. The degree of improvement in the clinical symptoms, serum interleukin (IL)-4, IL-5, and plasma RANTES concentrations, as well as the results of indirect immunofluorescence and BP180 enzyme-linked immunosorbent assay index values, were compared before and after the 7-day drug administration. Among the nine patients whose clinical symptoms were evaluated, an improvement was observed in all patients. Except for one patient, the serum IL-4 concentrations decreased and similar results were observed for the serum IL-5 concentration. All five patients in whom the plasma RANTES concentration was measured showed decreased levels. The indirect immunofluorescence titers decreased in only four patients. However, in seven patients in whom index values of BP180 enzyme-linked immunosorbent assay were evaluated, all patients showed significant decrease of the index values. These results suggest that, in severe BP patients refractory to conventional therapies, interferon-, in addition to oral corticosteroids is effective and thus should be considered for further clinical use. [source] Survival by radiation therapy oncology group recursive partitioning analysis class and treatment modality in patients with brain metastases from malignant melanomaCANCER, Issue 8 2002A retrospective study Abstract BACKGROUND In a population of patients with brain metastases from melanoma, the authors sought to determine whether various therapies provided any benefit at all, whether local therapy was better than whole brain radiotherapy (WBRT), and whether combined local therapy and WBRT provided any advantage over local therapy alone. They also analyzed survival according to a Radiation Therapy Oncology Group (RTOG) recursive partitioning analysis (RPA) to determine how well the RTOG RPA classes predicted survival in this patient population and whether treatments varied in effectiveness from category to category. METHODS A total of 74 patients with brain metastases from melanoma were treated at The Cleveland Clinic Foundation between 1984 and 1998. For this study, the authors reviewed patient charts and confirmed survival status. Survival was compared by treatment modality (surgical resection, WBRT, stereotactic radiosurgery, or WBRT combined with local therapy). Survival also was compared according to the RTOG RPA prognostic classes (Class 1, Class 2, or Class 3), which has not been validated previously in patients with malignant melanoma. RESULTS The median survival was 5.5 months for all patients. Survival varied significantly by RTOG prognostic class; The median survival was 10.5 months (range, 2.2,99.2 months) for patients in Class 1, 5.9 months (range, 0.2,43.9 months) for patients in Class 2, and 1.8 months (range, 0.1,6.9 months) for patients in Class 3 (P < 0.0001). Survival analysis showed that combined treatment offered significantly better survival (P < 0.0001; combined vs. other). The median survival was 8.8 months (range, 1.8,99.2 months) for the combined therapy group, 4.8 months (range, 1.2,27.8 months) for the local therapy alone group, 2.3 months (range, 0.2,9.6 months) for the WBRT alone group, and 1.1 months (0.1,3.0 months) for the group that received no therapy. CONCLUSIONS Adding WBRT to local therapy may improve survival in this group of patients: Combined therapy was superior to WBRT alone. The RPA classification scheme likely has prognostic value for patients with brain metastases from malignant melanoma. Prospective studies are required to overcome selection bias and confirm these results. Cancer 2002;94:2265,72. © 2002 American Cancer Society. DOI 10.1002/cncr.10426 [source] | ||||||||||