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Natural Progression (natural + progression)
Selected AbstractsFull Scope of Effect of Facial Lipoatrophy: A Framework of Disease UnderstandingDERMATOLOGIC SURGERY, Issue 8 2006BENJAMIN ASCHER MD BACKGROUND Facial lipoatrophy has been observed to occur in a variety of patient populations, with inherited or acquired disease, or even in aging patients as a natural progression of tissue change over time. There is currently no framework from which physicians of all medical specialties can communally discuss the manifestations, diagnoses, and management of facial lipoatrophy. OBJECTIVE The aim of this assembly was to derive a definition of facial lipoatrophy capable of being applied to all patient populations and develop an accompanying grading system. RESULTS The final consensus of the Facial Lipoatrophy Panel encompasses both aging and disease states: "Loss of facial fat due to aging, trauma or disease, manifested by flattening or indentation of normally convex contours." The proposed grading scale includes five gradations (Grades 1,5; 5 being the most severe), and the face is assessed according to three criteria: contour, bony prominence, and visibility of musculature. CONCLUSION Categorizing the presentation of facial lipoatrophy is subjective and qualitative, and will need to be validated with objective measures. Furthermore, during the assembly, several topics were exposed that warrant further research, including the physiology of volume loss, age and lipoatrophy, and human immunodeficiency virus and lipoatrophy. [source] MRI of early- and late-stage arterial remodeling in a low-level cholesterol-fed rabbit model of atherosclerosisJOURNAL OF MAGNETIC RESONANCE IMAGING, Issue 4 2007John A. Ronald MS Abstract Purpose To monitor early- and late-stage arterial remodeling following low-level cholesterol (CH) feeding in rabbits using a standardized MRI protocol. Materials and Methods New Zealand White rabbits were fed a CH diet (0.25% w/w) (n = 15) or normal chow (n = 6) and imaged either at 0, 2, 6, 8, and 11 months ("early-stage") or 12, 14, 16, 18, and 20 months ("late-stage"). T2-weighted fast-spin-echo images (,200 ,m in-plane resolution) of aortic lesions were collected using either a 1.5 or 3.0T MR scanner interfaced with a customized surface RF coil. Luminal (LA), outer vessel wall boundary (OVBA), and vessel wall areas (VWA) were assessed. Results Among CH-fed animals in the early-stage group, increased VWA associated with decreased OVBA and a more pronounced decrease in LA was first detectable at 8 months. These changes became more evident between 8 and 11 months. In the late-stage group, lesions continued to grow in response to CH-feeding, as VWA significantly increased at regular 2-month intervals. Beyond 16 months, signal intensity differences (reflecting increased lesion complexity) within the vessel wall were noted. Conclusion This often-overlooked rabbit model combined with customized MR technology holds tremendous promise for studying the natural progression, regression, and remodeling of atherosclerotic lesions. J. Magn. Reson. Imaging 2007;26:1010,1019. © 2007 Wiley-Liss, Inc. [source] In-vitro and in-vivo assays for angiogenesis-modulating drug discovery and developmentJOURNAL OF PHARMACY AND PHARMACOLOGY: AN INTERNATI ONAL JOURNAL OF PHARMACEUTICAL SCIENCE, Issue 2 2006Michelle W. Phung In the past 35 years, significant findings have been made in relation to angiogenesis, and how this usually normal physiological function is converted into an abnormal state in cancer. To search for agents that can inhibit angiogenesis, and thereby prevent a tumour from proliferation and spread that is ultimately fatal to the patient, various in-vitro assays have been developed. In addition, older assays have been refined usually into high throughput screening formats, mainly by the biopharmaceutical industry in their attempts to develop novel therapeutic molecules and maintain a pipeline of lead candidates. The central aim is to extract more accurate data that would facilitate the birth of innovative mechanisms to defeat aberrant angiogenesis in-vivo. At the same time, better in-vivo models have been established, with the goal to mimic as close as possible the natural progression of various types of neoplasms in response to a good angiogenic response. More clinically relevant models are needed as anti-angiogenesis drug discovery and drug development companies fast track their lead molecules from preclinical investigations to phase I clinical trials. [source] Clinical features and natural history of acquired cold urticaria in a tertiary referral hospital: a 10-year prospective studyJOURNAL OF THE EUROPEAN ACADEMY OF DERMATOLOGY & VENEREOLOGY, Issue 12 2008A Katsarou-Katsari Abstract Background, Acquired cold urticaria (ACU) represents a heterogeneous group of disorders that share a common clinical feature: the development of urticaria or angioedema after cold exposure. We present epidemiological and clinical data of subjects with ACU, natural progression and we examine possible parameters that could correlate with disease severity. Methods, During a 10-year period in all subjects with ACU, detailed record of personal history, laboratory testing, cold stimulation testing (CST), atopy assessment and disease severity took place. In a re-evaluation visit at the end of the surveillance period, ACU progression was assessed from patients in a subjective way. Results, Four thousand one hundred fifty-seven individuals with chronic urticaria were referred, and 352 (198 males, 154 females, 8.47% of patients with chronic urticaria) presented definite symptoms of physical urticarias, while 95 individuals (49 males, 46 females, 27% of patients with physical urticarias) were detected with ACU. Sixty-two participants were included in study analysis. Thirty-two patients (51.6%) were female; the mean age was 41.5 ± 15.6 years, while the mean age at disease onset was 32.5 ± 15.6 years; half were , 30 years old at disease onset. The mean duration of surveillance was 9.0 ± 6.9 years. During this time interval, 18 patients (29.0%) showed the same or even worse symptomatology, 26 patients reported some improvement (41.9%), while in 18 patients, symptoms resolved completely (29.0%); the mean time to resolution was 5.6 ± 3.5 years. Disease severity was the only variable statistically significantly related to disease progression (P = 0.004). Conclusions, Cold urticaria is a chronic persistent disorder with occasional severe clinical manifestations. [source] Clinical course of hepatitis B virus infection during pregnancyALIMENTARY PHARMACOLOGY & THERAPEUTICS, Issue 7 2009G. NGUYEN Summary Background, For women with hepatitis B virus (HBV) infection, little is known about the natural progression of the disease during pregnancy or its impact on pregnancy outcomes. Objectives, To investigate the natural progression of HBV infection during pregnancy or its impact on pregnancy outcomes. Methods, In this retrospective cohort study, we reviewed medical records of all patients who were pregnant and presented with HBsAg-positivity between 2000 and 2008 at a community gastroenterology practice and a university hepatology clinic. Maternal characteristics were analysed according to maternal and perinatal outcomes. Results, A total of 29 cases with at least 2 measurements of either HBV DNA or alanine aminotransferase (ALT) levels were included. Older age was the only predictor of a trend towards higher risk of an adverse clinical outcome [OR = 1.21 (0.97,1.51), P = 0.089], defined as either a negative foetal outcome (premature delivery, spontaneous abortion), or a negative maternal outcomes (gestational diabetes mellitus, pre-eclampsia, hepatic flare, liver failure). This trend for age remained even after adjusting for baseline ALT. Baseline serum HBV DNA, ALT, hepatitis B e antigen status, gravida and parity were not significant predictors for adverse clinical outcomes. Four patients developed liver failure. Conclusions, Maternal and neonatal outcomes are highly variable in this clinic-based patient cohort. Severe complications due to HBV infection can occur during pregnancy in previously asymptomatic patients. It is unclear how generalizable the results observed in this cohort would be to the general population; therefore, further studies are needed to identify reliable predictors for significant adverse outcomes and until more data are available, pregnant patients with HBV infection should be monitored with periodic serum HBV DNA and ALT levels. [source] Long-term efficacy of a fractional resurfacing device,,§LASERS IN SURGERY AND MEDICINE, Issue 2 2010Arisa E. Ortiz MD Abstract Background and Objective Recently, there has been much debate regarding the long-term efficacy of fractional resurfacing devices. While pulsed CO2 laser resurfacing is considered a highly effective treatment, fractionated resurfacing is a newer modality and its long-term efficacy has yet to be assessed. We report the long-term outcomes of subjects previously treated with fractional CO2 resurfacing for photodamaged skin and acne scars. Study Design/Materials and Methods Ten subjects from our previous studies who received fractional resurfacing for the treatment of acne scarring and photodamage returned for long-term follow-up visits at 1 and 2 years, respectively. Investigators graded maintenance of improvement on a quartile scale based on clinical photography. Results Subjects maintained 74% of their overall improvement at their long-term visits compared to 3-month follow-up visits. While clinical improvement was maintained long-term, the results were not as remarkable as those seen at 3-month visits. The authors speculate that results seen at 3 months may be enhanced by persistent inflammatory changes, as evidenced by heat shock protein 47 activity and ongoing collagen remodeling seen in previous histologic studies. Relaxation of tightening is to be expected with any procedure along with the natural progression of aging. However, patient satisfaction was upheld long-term. Conclusion Fractional CO2 laser resurfacing does have long-term efficacy and persistence of improvement of acne scarring and photodamage compared to baseline. However, additional treatments may be necessary to enhance long-term results. Lasers Surg. Med. 42:168,170, 2010. © 2010 Wiley-Liss, Inc. [source] Neuroprotective therapy in Parkinson's disease and motor complications: A search for a pathogenesis-targeted, disease-modifying strategyMOVEMENT DISORDERS, Issue S11 2005C. Warren Olanow MD, FRCPC Abstract The introduction of levodopa in the late 1960s represented a landmark in the therapy of Parkinson's disease (PD). However, motor complications of chronic levodopa therapy have emerged as a major limitation of this otherwise effective therapy. Advancing medical and surgical treatment of these complications has been the main objective of clinical trials during the past few decades. In addition, basic research has focused on better understanding of the mechanisms of motor complications and how to prevent them. Slowing or delaying the progression of the disease delays the need for levodopa therapy; therefore, neuroprotective strategies may play an important role in preventing the onset and reducing the severity of levodopa-related adverse effects. In this introductory review, we present the rationale for current and experimental therapies designed to favorably modify the progression of PD. If implemented early in the course of the disease, such treatments, if found effective, may not only alter the natural progression of the disease but may also delay or minimize motor and nonmotor complications associated with levodopa. © 2005 Movement Disorder Society [source] The Age-related Eye Disease Study (AREDS)NUTRITION REVIEWS, Issue 9 2002Article first published online: 16 SEP 200 Some of the earliest and best known manifestations of malnutrition involve visual disorders, such as blindness that results from vitamin A deficiency. Interest is now being focused on the role of nutrition in the prevention and treatment of chronic age-related disorders. The Age-related Eye Disease Study (AREDS) was conducted in order to determine whether high-dose supplementation could influence the natural progression of eye disease in older Americans. AREDS found that prospective administration of purified vitamin C, vitamin E, ,-carotene, zinc, and copper had some benefits for age-related maculopathy, but had virtually no impact on the progression of cataracts. [source] Latest news and product developmentsPRESCRIBER, Issue 23-24 2007Article first published online: 8 JAN 200 Cervical cancer risk falls after COC use ends Combined oral contraceptives (COCs) are associated with a slight increase in the risk of cervical cancer but this diminishes with time after use ends, an international study has shown (Lancet 2007;370:1609,21). Analysis of data for 16 573 women with and 35 509 women without cervical cancer confirmed that using a COC for 10 years between the ages of 20 and 30 increases the incidence of invasive cervical cancer from 3.8 to 4.5 per 1000 by age 50. However, the excess risk disappears 10 years after cessation of use. , A new analysis of the US Nurses' Health Study suggests that protection against ovarian cancer does not persist beyond 20 years after cessation of COC use. This study also showed that tubal ligation is associated with reduced risk of ovarian cancer (Am J Epidemiol 2007; 166;894,901). Pharmaceutical services fund moves to PCTs The ,global sum' that provides central funding for NHS pharmaceutical services is being shifted to PCTs. The Government has included legislation for the change in the recent Health and Social Care Bill. The fund pays the fees and allowances for pharmacy contractors and appliance contractors. The Government says this is a ,natural progression and in keeping with moves to devolve NHS funds to the frontline' that will enable PCTs to manage pharmacy services better by ,encouraging best prescribing practice'. Fewer fluoroquinolones in the community Restricting prescribing of fluoroquinolone antibacterials does not increase hospital admissions for infection among older people, say Canadian researchers (Am J Med 2007;120:893,900). Their analysis of an Ontario medical database shows that, in a community where fluoroquinolones were the most widely prescribed antibacterials, a one-third reduction in prescribing was not followed by an increase in hospital admissions for infectious episodes in the over,65s. On the contrary, there was a 32 per cent reduction in admissions for gastrointestinal conditions. FDA reports increased TB risk with infliximab The US Food and Drug Administration has published an analysis of cases of TB associated with infliximab (Remicade) detected via its spontaneous adverse event reporting scheme (Ann Intern Med 2007;147: 699,702). In 2001 the FDA placed a warning about the risk of TB on product labelling for infliximab and advised testing for TB before initiating treatment. This analysis of 130 cases of TB since reported in patients treated with infliximab found that 45 per cent had developed extra-pulmonary disease; risk factors included use of immunosuppressants (including methotrexate), a history of TB and time spent in an endemic area. Of 67 cases in which treatment was initiated after the warning was issued, 34 with a negative tuberculin skin test developed TB after receiving infliximab. MHRA announces anticounterfeit strategy The UK is a transit point, distribution hub and end-user of counterfeit medicines, says the MHRA in its first anti-counterfeiting strategy (www.mhra.gov.uk). Counterfeits have been detected in the legitimate supply chain with increasing frequency since 2004, resulting in nine batch recalls and a further five incidents detected at wholesale level. The MHRA's proposed approach includes: communication to raise awareness of the risk and facilitate reporting, collaboration with the WHO, the industry and law enforcement agencies, and targeted surveillance, prosecution and regulation. Evidence lacking for choosing DMARD There is insufficient evidence to choose one DMARD or biological agent over another in patients with RA, US investigators say (www.annals.org/cgi/content/abstract/0000605,20080115000192v1). Their systematic review of meta-analyses and intervention and observational trials found no evidence of differences among DMARDs or anti-TNF agents. Mono-therapy with an anti-TNF agent was associated with superior radiographic but not clinical outcomes; methotrexate plus an anti-TNF agent was superior in clinical and functional terms to either drug given alone. Be alert to psychiatric ADRs with rimonabant Clinicians should remain alert for the development of anxiety, depression and an increased risk of suicide with rimonabant (Acomplia), say Danish investigators (Lancet 2007;370:1706,13). Their meta-analysis of four randomised trials involving a total of 4105 patients showed that rimonabant was associated with an increased risk of serious adverse events (odds ratio 1.4; number needed to harm, NNH, 59), including a 2.5,fold increased risk of depression (NNH 49) and a threefold increased risk of anxiety (NNH 166). Following a warning from the FDA of an increased risk of suicide with rimonabant, the authors say their findings indicate a need for ,increased alertness by physicians to these potentially severe psychiatric adverse reactions'. New strategy for NHS medicines information The UK Medicines Information Service (www.ukmi.nhs.uk) has published its new management strategy setting out how it will respond to recent developments in the NHS. Developments include greater access to information for patients, support for nontraditional prescribers and new commissioning arrangements. New antiretroviral Maraviroc (Celsentri) is the first CCR5 antagonist to be introduced for the treatment of HIV infection. CCR5 is one of two co-receptors to which the HIV virus must attach to achieve cell entry. Maraviroc is licensed for use by treatment-experienced patients in whom only CCR5-tropic HIV-1 is detectable. The recommended dose ranges from 150 to 600mg twice daily depending on interactions with concurrent medication. Dimeticone superior Dimeticone 4 per cent lotion (Hedrin) is superior to malathion 0.5 per cent in the eradication of head lice, a UK study in 58 children and 15 adults has shown (PLoS ONE 2007;2: e1127. doi:10.1371/journal.pone. 0001127). Two applications of dimeticone lotion one week apart cleared active infestation in 70 per cent of participants compared with 33 per cent in those who used a single application of malathion. Copyright © 2007 Wiley Interface Ltd. [source] Exercise participation after diagnosis of breast cancer: trends and effects on mood and quality of lifePSYCHO-ONCOLOGY, Issue 5 2002Bernardine M. Pinto Individuals treated for cancer often experience higher levels of emotional distress than the general population. Previous research has shown that exercise can have an ameliorating effect on these problems. This 12-month prospective longitudinal study investigated mood, quality of life, cancer-related symptoms, and exercise behavior of 69 women who had completed treatment for Stage 0,2 breast cancer. We studied the natural progression of exercise participation after cancer treatment. Effects on mood, quality of life, and cancer-related symptoms were assessed after controlling for demographic variables, disease variables, social support, and baseline values to test the hypothesis that women who exercised were more likely to report better mood, higher quality of life, and fewer cancer-related symptoms. Results indicated that women did not increase their exercise participation over time and that overall mean minutes of exercise participation were below recommended levels. Baseline demographic predictors of exercise participation included younger age, having a spouse or partner, increased time since diagnosis, higher social support, and higher depression. Exercise participation was associated with improved physical functioning, but not overall mood or cancer-related symptoms. We discuss implications of these findings towards the well-being of breast cancer survivors. Copyright © 2002 John Wiley & Sons, Ltd. [source] The Erasmus Atelectasis Classification: Proposal of a New Classification for Atelectasis of the Middle Ear in ChildrenTHE LARYNGOSCOPE, Issue 7 2007Johannes Borgstein MD Abstract Objectives: Atelectasis presents a challenging, often progressive, problem in children. Because of the lack of a clinically practical classification, we introduce a new classification, which in our opinion is more useful in the pediatric age group. This alternative classification enables a more clinically relevant correlation between stage of disease and clinical sequelae and technical difficulty at surgery. Study Design: Observational study of patients seen and operated at the Sophia Children's Hospital in Rotterdam, The Netherlands between 1989 and 2005. Methods: Based on clinical appearance, each ear was placed into one of the five groups of the proposed classification and into one of the four stages of Sadé's classification. Preoperative air and bone conduction thresholds and air-bone gaps (ABG) were calculated using the four-tone pure-tone (500, 1,000, 2,000, and 4,000 Hz) averages for bone and air conduction. Results: Of the 248 ears in the study group, 72 were in stage I, with an ABG of 18.2 ± 12.3 dB. Twenty-two were in stage II, with an ABG of 12.9 ± 9.5 dB. In stage III, there were 32 ears, with an ABG of 11.6 ± 10.0 dB. Thirty-one ears were in stage IV, with an ABG of 16.1 ± 11.5 dB. Eighty-five ears were in stage V, with an ABG of 26.1 ± 13.3 dB. When grouped according to Sadé's classification, 92 ears could not be classified. Conclusions: We found the currently proposed classification more useful in that it follows the natural progression of the disease and is more practical in determining operative procedures at each stage. [source] Need for hospice and palliative care services in patients with end-stage heart failure treated with intermittent infusion of inotropesCLINICAL CARDIOLOGY, Issue 1 2004Angel López-Candales M.D. FACC Abstract Background: Hospice and palliative care programs to relieve suffering and optimize management of terminally ill patients have grown rapidly in the United States. However, there are no data on the need for these services among patients with end-stage heart failure receiving intermittent infusion of intravenous inotropes. Hypothesis: The need for hospice and palliative care programs among patients in end-stage heart failure who receive intermittent infusion of inotropes is investigated. Methods: The study included all stable patients with refractory heart failure symptoms treated with inotropes in our outpatient unit. A total of 73 patients (65 ± 12years; left ventricular ejection fraction 22 ± 9%; New York Heart Association class 3.6 ± 0.4) were seen during a 49-month period. Of these, 3 5 patients (48%) met hospice or palliative care evaluation criteria upon referral but were offered, and accepted, the alternative of parenteral inotropes. In all, 1,737 individual outpatient treatment sessions were given, with a mean of 24 ± 19 sessions per patient (range 5 to 118 sessions), representing a minimum of 9,948 h of inotrope therapy. Results: A total of 18 (25%) patients died, 6 (8%) patients were withdrawn from the program (3 by their primary physicians and 3 because of significant travel limitations); 4 (5%) patients required continuous intravenous home therapy; and 44 (61%) patients were discharged with significant improvement in their heart failure symptoms. Only 7 of the 18 patients who died had received hospice or palliative care intervention, mainly for the sake of comfort and to ease the transition among family members. The rest of the patients were comfortable and had accepted the natural evolution of their disease; they were not interested in or did not require hospice or palliative care intervention. Of the patients discharged from the outpatient cardiac infusion unit, the interval free of heart failure symptoms after the final infusion treatment ranged from 201 to 489 days, with no need for hospitalization or emergency room visits. Conclusion: Our results demonstrate that intermittent infusion of intravenous inotropes can be safely administered and can improve symptoms in a significant number of patients, probably by slowing the natural progression of heart failure. Although the full clinical impact of inotrope therapy in an outpatient setting has not been fully defined, other nonhemodynamic-related benefits should be sought and investigated. Our results suggest that intermittent infusion of intravenous inotropes is one of the prominent variables that requires particular attention. In our experience, the institution of intermittent infusions of intravenous inotropes can, in fact, modify end-stage heart failure symptoms that, in most patients, are currently perceived to lead to a terminal event. Thus, appropriate use of intermittent infusion of intravenous inotropes may not only improve functional class and symptoms in a significant number of patients identified as terminal by their poor response to conventional therapy, but it may also facilitate better utilization of hospice and palliative care resources among patients with end-stage heart failure. Furthermore, the need for hospice and palliative care in patients with heart failure should be revisited in view of adjuvant treatment options such as intermittent infusion of intravenous inotropes. [source] Acute colonic pseudo-obstruction following major orthopaedic surgeryCOLORECTAL DISEASE, Issue 5 2005M. G. A. Norwood Abstract Objective, Acute colonic pseudo-obstruction (ACPO) has been linked with multiple aetiologies including orthopaedic surgery. However, the actual incidence and natural progression are not well described in these patients. We aim to assess the incidence of ACPO in patients undergoing elective orthopaedic procedures, and to examine for potential exacerbating factors. Patients and methods, All patients from the orthopaedic directorate that had abdominal imaging in the five years from August 1998 to August 2003 were identified from radiology archives. A manual search of the patients' notes was conducted with data recorded on the patients' history, operative details and their postoperative course including their haematological and biochemical results. Details regarding their ACPO were documented with respect to the onset of symptoms, how the diagnosis was achieved, what treatment was instigated and how the condition progressed. A control group of age and sex matched patients was included for comparison. Results, Thirty-five patients with ACPO were identified. The operations included 21 hip replacements, 10 knee replacements and 4 spinal operations. The incidence of ACPO was 1.3%, 0.65% and 1.19%, respectively. In comparison to control patients, patients with ACPO had a lower postoperative serum sodium (P = 0.001), a higher serum urea (P = 0.021) and remained in hospital longer (P < 0.001). Conclusion, ACPO is uncommon in orthopaedic patients, however, its occurrence results in prolonged hospital stay. Attention to patients' postoperative fluid balance and biochemical status may reduce the incidence. [source] | ||||||||||