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Primary Failure (primary + failure)
Selected AbstractsThoracoscopic talc pleurodesis for malignant pleural effusionANZ JOURNAL OF SURGERY, Issue 1-2 2003David Love Background: Malignant pleural effusion (MPE) is a common and distressing condition at the end of life for many patients with disseminated cancer. The challenge for the surgeon lies in managing this problem in order to deliver the most effective palliation with the least impact on the limited time available to these patients. Methods: Herein is reported a retrospective review of outcomes for a consecutive series of 66 MPE (61 patients) treated over a 5-year period from 1995 to 2000. A standard operative technique involving a single-lung anaesthetic and two-port thoracoscopy was employed. Outcomes were determined by contacting the referring practitioner or the patients themselves. Principal outcome measures included time to recurrence of the effusion and survival. Results: Complete follow up was achieved for 60 MPE (55 patients; five of whom were treated for metachronous, bilateral disease). The three most common primary sites were breast, lung and mesothelial tissue. The planned procedure was not completed in two cases due to encasement of the underlying lung by tumour. Primary failure (immediate recurrence of the effusion) occurred in six cases. Delayed recurrence of the effusion occurred in a further 23 MPE resulting in complete control in 31 cases (52%) until death. Overall median survival was 220 days and the 30-day mortality was 0. Conclusions: Complete and permanent control of a malignant effusion is difficult to achieve. Management based on thoracoscopy and talc insufflation produces satisfactory results with an acceptable morbidity and no early mortality. The ability to inspect the pleural space, break down adhesions and completely drain pockets of fluid to achieve complete lung expansion probably contributes to this. [source] Successful treatment of disseminated aspergillosis with the combination of voriconazole, caspofungin, granulocyte transfusions, and surgery followed by allogeneic blood stem cell transplantation in a patient with primary failure of an autologous stem cell graftEUROPEAN JOURNAL OF HAEMATOLOGY, Issue 5 2005Robert Dinser Abstract:, The treatment of disseminated aspergillus infections in neutropenic patients remains a major challenge in spite of several new antifungal drugs. We report the case of a patient with multiple myeloma in prolonged neutropenia after primary failure of an autologous stem cell graft who developed invasive aspergillosis despite voriconazole monotherapy. He responded to a combination of voriconazole and caspofungin, supported by granulocyte transfusions and surgery. A subsequent allogeneic peripheral blood stem cell transplantation did not lead to recurring aspergillus infection. The patient is well and free of clinical disease with respect to the fungal infection and myeloma more than 18 months after the allogeneic transplantation. [source] The mechanisms of coronary restenosis: insights from experimental modelsINTERNATIONAL JOURNAL OF EXPERIMENTAL PATHOLOGY, Issue 2 2000Gordon A.A. Ferns Since its introduction into clinical practice, more than 20 years ago, percutaneous transluminal coronary angioplasty (PTCA) has proven to be an effective, minimally invasive alternative to coronary artery bypass grafting (CABG). During this time there have been great improvements in the design of balloon catheters, operative procedures and adjuvant drug therapy, and this has resulted in low rates of primary failure and short-term complications. However, the potential benefits of angioplasty are diminished by the high rate of recurrent disease. Up to 40% of patients undergoing angioplasty develop clinically significant restenosis within a year of the procedure. Although the deployment of endovascular stents at the time of angioplasty improves the short-term outcome, ,in-stent' stenosis remains an enduring problem. In order to gain an insight into the mechanisms of restenosis, several experimental models of angioplasty have been developed. These have been used together with the tools provided by recent advances in molecular biology and catheter design to investigate restenosis in detail. It is now possible to deliver highly specific molecular antagonists, such as antisense gene sequences, to the site of injury. The knowledge provided by these studies may ultimately lead to novel forms of intervention. The present review is a synopsis of our current understanding of the pathological mechanisms of restenosis. [source] Ondansetron is as effective as diphenhydramine for treatment of morphine-induced pruritus after cesarean deliveryACTA ANAESTHESIOLOGICA SCANDINAVICA, Issue 6 2010S. M. SIDDIK-SAYYID Background: Subarachnoid (SA) morphine, highly effective for the management of pain after a cesarean delivery, is associated with a significant incidence of pruritus in up to 80% of patients. No previous study has compared the effectiveness of ondansetron (5-HT3 antagonist) vs. diphenhydramine (H1 receptor blocker) for the treatment of this side effect. Methods: In this randomized, double-blind study, 113 patients with a pruritus score 3 or 4 (1=absent; 2=mild, no treatment required; 3=moderate pruritus, treatment required; and 4=severe pruritus) after SA morphine 0.2 mg were assigned to group ondansetron, which received 4 mg intravenously (i.v.) ondansetron, and group diphenhydramine, which received 25 mg i.v. diphenhydramine. Patients who continued to have pruritus ,3 30 min after the study drug were considered treatment failures and were treated with naloxone 0.04 mg i.v. repeatedly, as well as patients who relapsed. Pain scores, nausea, vomiting, and sedation were determined before and 30 min after the study drugs were administered. Patients were followed up for 24 h. Results: The success rate was comparable between the two groups [40/57 (70%) and 38/56 (70%), P=0.79, in group ondansetron and group diphenhydramine, respectively]. Among the successfully treated patients, the recurrence rates of moderate to severe pruritus were 11/40 (28%) in group ondansetron and 13/38 (35%) in group diphenhydramine, P=0.52. The side effect profile was similar between the two groups. Conclusion: Ondansetron is as effective as diphenhydramine in relieving pruritus caused by SA morphine in patients undergoing a cesarean delivery. However, up to 50% of patients required naloxone either for primary failure or for recurrence. [source] Mechanism and control of tooth eruption: overview and clinical implicationsORTHODONTICS & CRANIOFACIAL RESEARCH, Issue 2 2009WR Proffit Structured Abstract Authors,,, Proffit WR, Frazier-Bowers SA Objectives,,, To review pre- and post-emergent eruption, with particular emphasis on distinguishing isolated molar ankylosis from primary failure of eruption (PFE) and genetic considerations in eruption problems. Material and Methods,,, Radiographic review of eruption failure patients; animal and human experiments; high precision observations of movements of erupting teeth. Results,,, In pre-emergent tooth eruption, the controlling element is the rate of resorption of overlying structures. A path is cleared, and then the erupting tooth moves along it. This has clinical importance in recognizing the cause of eruption problems, particularly PFE, in which all teeth distal to the most mesial involved tooth do not erupt or respond to orthodontics. In our study of by far the largest sample of PFE cases yet reported, familial cases of PFE accounted for approximately ¼ of all cases examined. Candidate genes now are being evaluated. In post-emergent eruption, control seems to be light forces of long duration that oppose eruption, rather than heavy forces of short duration such as those during mastication. Studies of human premolars in their passage from gingival emergence to the occlusal plane show that in this phase eruption occurs only during a few hours in the early evening. The critical hours for eruption parallel the time that growth hormone levels are highest in a growing child. In this stage intermittent force does not affect the rate of eruption, but changes in periodontal blood flow do affect it. [source] Endovenous laser treatment for long saphenous vein incompetence,BRITISH JOURNAL OF SURGERY (NOW INCLUDES EUROPEAN JOURNAL OF SURGERY), Issue 7 2006M. A. Sharif Background: Endovenous laser treatment is a percutaneous technique used for the treatment of long saphenous vein (LSV) incompetence. This paper presents the results of an uncontrolled case series undertaken to assess the feasibility, safety and efficacy of this technique. Methods: Some 145 incompetent LSVs in 136 patients with saphenofemoral reflux were treated with endovenous laser. The data were evaluated prospectively. Assessment was carried out at 1 week, 3 and 12 months for LSV occlusion and symptomatic relief. Results: Primary procedural success was achieved in 124 (85·5 per cent) of 145 LSVs. Reasons for primary failure included failed cannulation, failure to pass the guidewire and patient discomfort. At 3 months' follow-up, 105 (89·7 per cent) of 117 veins were totally and nine (7·7 per cent) were partially occluded. At 12 months, 63 (76 per cent) of 83 veins were totally and 15 (18 per cent) were partially occluded. At this stage 73 (88 per cent) of 83 patients remained satisfied, but 26 (31 per cent) had residual or recurrent varicosities. Of these, only five required further treatment. Complications included saphenous nerve injury in one patient and superficial skin burns in a second. Conclusion: Endovenous laser treatment for LSV reflux is safe and can be carried out under local anaesthesia in an outpatient setting with good patient satisfaction and low complication rates. Copyright © 2006 British Journal of Surgery Society Ltd. Published by John Wiley & Sons, Ltd. [source] | ||||||||||