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Important Treatment (important + treatment)
Terms modified by Important Treatment Selected AbstractsMetformin use and diabetic pregnancy,has its time come?DIABETIC MEDICINE, Issue 3 2006G. Hawthorne Abstract The prevalence of Type 2 diabetes in women of childbearing age continues to grow as the incidence of Type 2 diabetes increases. Recent evidence shows that treatment of gestational diabetes ensures the best possible outcome for pregnancy complicated by gestational diabetes. Metformin is a logical treatment in these circumstances but there has always been concern about its safety for the fetus, particularly as it crosses the placenta and it may increase the risk of teratogenesis. Although evidence is accumulating that metformin is useful and has a role in polycystic ovary syndrome, a condition of insulin resistance, it is not yet accepted as treatment for Type 2 diabetes in pregnancy and gestational diabetes. Observational data supports the use of metformin in Type 2 diabetes in pregnancy and its role in gestational diabetes is currently under investigation. Metformin may become an important treatment for women with either gestational or Type 2 diabetes in pregnancy and indeed may have additional important benefits for women, including reducing insulin resistance, body weight and long-term risk of diabetes. There is a need for a randomized controlled trial in women with Type 2 diabetes in pregnancy with long-term follow-up of both mothers and children. Until then the best advice remains that optimized glycaemic control prior to conception and during pregnancy is the most important intervention for best possible pregnancy outcome. [source] Epilepsy with dual pathology: Surgical treatment of cortical dysplasia accompanied by hippocampal sclerosisEPILEPSIA, Issue 8 2010Dong W. Kim Summary Purpose:, The presence of two or more epileptogenic pathologies in patients with epilepsy is often observed, and the coexistence of focal cortical dysplasia (FCD) with hippocampal sclerosis (HS) is one of the most frequent clinical presentations. Although surgical resection has been an important treatment for patients with refractory epilepsy associated with FCD, there are few studies on the surgical treatment of FCD accompanied by HS, and treatment by resection of both neocortical dysplastic tissue and hippocampus is still controversial. Methods:, We retrospectively recruited epilepsy patients who had undergone surgical treatment for refractory epilepsy with the pathologic diagnosis of FCD and the radiologic evidence of HS. We evaluated the prognostic roles of clinical factors, various diagnostic modalities, surgical procedures, and the severity of pathology. Results:, A total of 40 patients were included, and only 35.0% of patients became seizure free. Complete resection of the epileptogenic area (p = 0.02), and the presence of dysmorphic neurons or balloon cells on histopathology (p = 0.01) were associated with favorable surgical outcomes. Patients who underwent hippocampal resection were more likely to have a favorable surgical outcome (p = 0.02). Conclusions:, We show that patients with complete resection of epileptogenic area, the presence of dysmorphic neurons or balloon cells on histopathology, or resection of hippocampus have a higher chance of a favorable surgical outcome. We believe that this observation is useful in planning of surgical procedures and predicting the prognoses of individual patients with FCD patients accompanied by HS. [source] Clinical experience with tumor necrosis factor blockers in Korean rheumatoid arthritis patientsINTERNATIONAL JOURNAL OF RHEUMATIC DISEASES, Issue 2 2006Jin-Wuk HUR Abstract Tumor necrosis factor (TNF) blockers have become an important treatment in rheumatoid arthritis (RA) with its proven effectiveness. But it is not universally effective in all patients and it comes with a relatively high economic burden. We should use them effectively. Advances in pharmacoeconomics and pharmacogenetics may be able to help us reach this goal. This article will review our clinical experience of biological agents to treat RA at Hanyang University in Korea, with emphasis on the current therapies targeting TNF and the rational use of theses agents in RA. [source] Peritoneal mesothelial cells and the extracellular matrixNEPHROLOGY, Issue 6 2001Susan Yung SUMMARY: Continuous ambulatory peritoneal dialysis (CAPD) is an important treatment for patients with end-stage renal failure. Long-term success is dependent on the functional and structural integrity of the peritoneal membrane. Conventional peritoneal dialysis fluids are non-physiological. They contain glucose at high concentrations to provide the osmotic drive for ultrafiltration, lactate to correct the metabolic acidosis of renal failure, and a low pH to prevent caramelization of glucose during heat sterilization. These components, in isolation or acting together, exert adverse influences on both the resident cellular and extracellular elements of the peritoneal membrane, as well as phagocytic cells which infiltrate the peritoneum during inflammation, culminating in detrimental structural and functional effects, compromising the viability of the peritoneum during dialysis. Peritoneal biopsy studies of patients on long-term CAPD have demonstrated an intercellular space between adjacent mesothelial cells which allows the penetration of peritoneal dialysis fluid into the underlying submesothelium. This, together with episodes of peritonitis, can initiate a chronic inflammatory reaction within the peritoneum characterized by increased synthesis of matrix proteins. Perturbation of the regulatory mechanisms which govern the balance of synthesis and degradation of extracellular matrix can lead to progressive fibrosis. Human peritoneal mesothelial cells (HPMC) have been shown to synthesize fibronectin, laminin, collagens, proteoglycans and hyaluronan in vitro, and thus play a role in the pathogenesis of peritoneal fibrosis. This review will give an overview of extracellular matrix (ECM) synthesis by HPMC, how changes in the synthesis are affected by CAPD and postulate how these changes can compromise the dialytic properties of the peritoneum. [source] Vitamin D production in psoriasis patients increases less with narrowband than with broadband ultraviolet B phototherapyPHOTODERMATOLOGY, PHOTOIMMUNOLOGY & PHOTOMEDICINE, Issue 3 2009Amra Osmancevic Background: Phototherapy of psoriasis is an effective treatment. In addition to standard broadband ultraviolet radiation B (UVB), (280,320 nm), narrowband phototherapy (NBUVB) (monochromatic UV between 311 and 312 nm) has become an important treatment for psoriasis. The same wavelength range of UVB (290,315 nm) induces synthesis of vitamin D. The aim was to compare the effect of broadband with NBUVB therapy on vitamin D synthesis in patients with psoriasis. Methods: Sixty-eight Caucasian patients (17 women and 51 men) mean age 54.1 ± 16.0 years, with active plaque psoriasis, were treated with broadband UVB (n=26) or NBUVB (n=42) two to three times/week for 8,12 weeks. The serum concentrations of 25-hydroxyvitamin D (25(OH)D3), 1,25-dihydroxyvitamin D (1,25(OH)2D3), intact parathyroid hormone (PTH), calcium and creatinine were measured before the first exposure and after the last dose of radiation. Results: In broadband UVB treated patients, 25(OH)D3 increased from 37.9 ± 16.9 to 69.4 ± 19.7 ng/ml (P<0.0001) and in patients treated with NBUVB from 34.8 ± 11.9 to 55.3 ± 17.6 ng/ml (P<0.0001) and P=0.008 between the treatment groups. PTH decreased on broadband UVB (P<0.05). The serum concentrations of 1,25(OH)2D3, calcium or creatinine remained unaltered. Conclusion: Serum 25(OH)D3 in psoriasis patients increased less with NBUVB than with broadband UVB phototherapy. Psoriasis improved on both regimens. [source] Advances in the understanding and future therapy of COPDCLINICAL & EXPERIMENTAL ALLERGY REVIEWS, Issue 4 2002L. Fabbri Summary Chronic obstructive pulmonary disease (COPD) is an enormous public health problem, which currently causes about 5% of all deaths worldwide. The main feature of COPD is a progressive loss of lung function as a result of structural changes in the airways and lung parenchyma. It is predominantly a disease of smokers, although only about 15% of smokers are thought to develop severe enough disease to be symptomatic. The reasons why some smokers are more susceptible to the disease than others are not clear, and are the subject of extensive research. Characteristically, inflammation is central to the pathophysiology of COPD, and it is clear that the inflammation of COPD differs from that seen in asthma. The most important treatment for COPD is smoking cessation, as other current treatments do not alter the course of the disease. Recent research into the cellular and molecular mechanisms underlying chronic obstructive pulmonary disease has provided potential new avenues for the development of rationally designed drugs, which may improve the outlook for patients with this debilitating condition. It is likely that different therapeutic approaches will be needed in different patients, because of the heterogeneity of the disease. [source] Update on skin repigmentation therapies in vitiligoPIGMENT CELL & MELANOMA RESEARCH, Issue 1 2009Rafael Falabella Summary Treatment for vitiligo is difficult and prolonged. Nevertheless, at present considerable knowledge accumulated during several decades on the pathogenic mechanisms, revealed important clues for designing new strategies to improve vitiligo depigmentation. With available medical therapies, high repigmentation percentages mostly on facial and neck lesions are achieved, although they are less effective on trunk and limbs and poor on the acral parts of the extremities. Narrow band UVB and psoralens and UVA are the two most important treatments for generalized vitiligo affecting more than 10,20% of the cutaneous surface, and topical corticosteroids, or calcineurin inhibitors are the most valuable treatments for localized vitiligo. Persistence of achieved regimentation is variable and an undefined percentage of patients may have variable recurrence. When vitiligo becomes refractory, surgical methods may improve depigmentation as effectively as with medical therapy; in segmental (unilateral) or long standing, non-segmental (bilateral) stable vitiligo, repigmentation with surgical methods is usually permanent. [source] THE SERMON ON MOUNT MORIAH: FAITH AND THE SECRET IN THE GIFT OF DEATHTHE HEYTHROP JOURNAL, Issue 1 2008ADAM KOTSKO This essay is an investigation of three attempts to think faith. I find my starting place in Jacques Derrida's The Gift of Death,1 one of the most important treatments of Christianity in Derrida's later thought, which was increasingly insistent in its engagement with religious questions up until his death in 2004. This reading of The Gift of Death will focus particularly on the question of secrecy and its relationship with faith, leading necessarily to an account of Derrida's reading of two of his primary references in this text: the second essay of Nietzsche's Genealogy of Morals2 and Kierkegaard's Fear and Trembling.3 Rather than simply rendering a judgment on Derrida's reading, I will endeavor to read these texts together, extending (or expanding upon) Derrida's reading while questioning some of the positive formulations he makes in his own name , all the while remaining attentive to the gambles involved in thinking faith. [source] | ||||||||||