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Protocol Consisting (protocol + consisting)
Selected AbstractsProtocol consisting of cisplatin, etoposide and irinotecan induced complete pathological remission of primary small cell carcinoma of the bladderINTERNATIONAL JOURNAL OF UROLOGY, Issue 9 2006TAKASHI KAWAHARA Abstract, A 73-year-old man with primary small-cell carcinoma of the bladder was treated by radical cystectomy with neoadjuvant chemotherapy. Pathological complete remission was achieved by combination chemotherapy composed of cisplatin, etoposide and irinotecan. The patient is free of disease 19 months after surgery. [source] Nonobese population in a developing country has a high prevalence of nonalcoholic fatty liver and significant liver disease,,HEPATOLOGY, Issue 5 2010Kausik Das There is a paucity of community-based epidemiological data on nonalcoholic fatty liver (NAFL) among nonaffluent populations in developing countries. Available studies are radiological and/or biochemical and lack histological assessment, limiting their strength. We conducted a prospective epidemiological study comprising a 1:3 subsample of all adult (>18 years) inhabitants of a rural administrative unit of West Bengal, India. Subjects positive for hepatitis B virus and/or hepatitis C virus infection and consuming any amount of alcohol were excluded. Diagnosis of NAFL was by dual radiological screening protocol consisting of ultrasonographic and computed tomographic examination of the liver. Transient elastographic examination and liver biopsy were performed in a subset to identify significant liver disease. The risk factors of having NAFL were analyzed. A total of 1,911 individuals were analyzed, 7% of whom were overweight and 11% of whom had abdominal obesity. The prevalence of NAFL, NAFL with elevated alanine aminotransferase, and cryptogenic cirrhosis was 8.7%, 2.3%, and 0.2%, respectively. Seventy-five percent of NAFL subjects had a body mass index (BMI) <25 kg/m2, and 54% were neither overweight nor had abdominal obesity. The subjects with the highest risk of having NAFL were those with a BMI >25 kg/m2 (odds ratio 4.3, 95% confidence interval 1.6-11.5). Abdominal obesity, dysglycemia (fasting plasma glucose >100 mg/dL or elevated homeostatic model assessment of insulin resistance), and higher income were the other risk factors. Even having a normal BMI (18.5-24.9 kg/m2) was associated with a 2-fold increased risk of NAFL versus those with a BMI <18.5 kg/m2. Conclusion: There is a significant prevalence of NAFL and potentially significant liver disease, including cryptogenic cirrhosis, in this predominantly nonobese, nonaffluent population in a developing country. NAFL will be a major determinant of future liver disease burden in countries of the developing world. (HEPATOLOGY 2010) [source] Single-Stage Adenosine Tilt Testing in Patients with Unexplained SyncopeJOURNAL OF CARDIOVASCULAR ELECTROPHYSIOLOGY, Issue 6 2004SUNEET MITTAL M.D. Introduction: We previously have shown that a 3-minute single-stage adenosine tilt test has a diagnostic yield comparable to a two-stage protocol consisting of a 30-minute drug-free tilt followed by a 15-minute isoproterenol tilt. In this study, we sought to further define the clinical utility of adenosine tilt testing in patients with unexplained syncope by prospectively evaluating test specificity and determining predictors of a positive test response. Methods and Results: The specificity of single-stage adenosine tilt testing was determined using 30 control subjects. To determine the diagnostic yield of this protocol, adenosine tilts were performed in 129 patients with unexplained syncope. The adenosine tilt test protocol had high specificity (100%) but a low overall diagnostic yield (18%). However, the yield was affected significantly by age. In patients ,40 years of age, the tilt test was positive in 15 (41%) of 37 patients, which was significantly greater than the yield in patients between the ages of 41 and 64 years (6/41 patients [15%], P = 0.012) and those ,65 years of age (2/41 patients [5%], P < 0.0001). Conclusion: These data support single-stage adenosine tilt testing in patients ,40 years of age because the diagnostic yield of the test is maximal in this group and the test can be completed in ,3 minutes. Conversely, the diagnostic yield of adenosine tilt testing in patients >40 years of age is low, suggesting that the clinical utility of this protocol is limited in these patients. (J Cardiovasc Electrophysiol, Vol. 15, pp. 1-4, June 2004) [source] Magnetic Resonance Imaging in Patients Diagnosed With Papilledema: A Comparison of 6 Different High-Resolution T1- and T2(*)-Weighted 3-Dimensional and 2-Dimensional SequencesJOURNAL OF NEUROIMAGING, Issue 2 2002Johannes Seitz MD ABSTRACT Purpose. To evaluate visualization and signal characteristics of macroscopic changes in patients with ophthalmologically stated papilledema and to find a suitable high-resolution magnetic resonance imaging (MRI) protocol. Method. Nine consecutive patients with 12 ophthalmologically stated papilledemas underwent MRI of the head and orbits, which consisted of the following high-resolution sequences: 3-dimensional (3D), T2*-weighted (T2*w) constructive interference in steady-state sequence (CISS); 3D, T1-weighted (T1w) magnetization prepared-rapid gradient echo sequence (MP-RAGE) (with and without intravenous contrast medium); transverse 3D and 2-dimensional (2D) (2mm), T2-weighted (T2w) turbo spin echo (TSE); transverse 2D (2mm), contrast-enhanced T1w TSE with fat-suppression technique; and transverse 2D (5mm), T2w TSE. A quantitative and qualitative evaluation of the papilla, optic nerve, optic nerve sheath, optic chiasm, and the brain was performed. The 6 high-resolution sequences were compared. Results. The elevation of the optic disc into the optic globe in ophthalmologically stated papilledema was best visualized in T2w, 3D CISS sequence. The pathological contrast enhancement was best seen in T1w contrast-enhanced 2D TSE sequence with fat-suppression technique. The mean width of the optic nerve sheath directly behind the globe was 7.54 mm (± 1.05 mm) in the pathological eyes, compared to 5.52 mm (± 1.11 mm) in the normal eyes. In all patients, the cerebral indices calculated showed no signs of increased intracranial pressure or other abnormalities changing the volume of the brain or ventricles. The contrast of the orbital fat versus the optic nerve sheath, the optic nerve sheath versus the surrounding cerebrospinal fluid (CSF), the surrounding CSF versus the optic nerve, the optic chiasm versus the CSF, and the optic papilla versus the optic globe were best visualized in the 3D, T2*w CISS sequence. An enhancement of the swollen optic nerve head was best seen in all 12 cases in the T1w contrast-enhanced 2D TSE sequence with fat-suppression technique. Conclusion. An MRI protocol consisting of a 5-mm transverse T2w TSE sequence; a T2*w, 3D CISS sequence; a T1w, 3D MP-RAGE sequence with and without contrast medium; and a transverse T1w, (2-mm) 2D TSE sequence with fat-suppression technique with intravenous contrast medium is suitable to visualize the macroscopic changes in papilledema. In addition, this combination is an excellent technique for the examination of the orbits and the brain. [source] Combination Chemotherapy in Feline Lymphoma: Treatment Outcome, Tolerability, and Duration in 23 CatsJOURNAL OF VETERINARY INTERNAL MEDICINE, Issue 2 2008D. Simon Background: Different chemotherapy regimes have been described for feline lymphoma with varying outcomes. Hypothesis: In cats with lymphoma, a long-term, multiagent chemotherapy protocol will be effective and carry acceptable toxicity. Animals: Twenty-three cats with histologically or cytologically confirmed diagnosis of lymphoma. Methods: Prospective, single-arm clinical trial in which cats were treated with a chemotherapy protocol consisting of a cyclic combination of l -asparaginase, vincristine, cyclophosphamide, doxorubicin, methotrexate, and prednisolone with a planned total treatment time of 122 weeks. Results: Complete remission (CR) rate was 74% (n = 17). Fourteen percent of cats attained partial remission (PR). Median duration of first CR was 264 days (range, 45,2,485 days). Six-month, 1-, and 2,5-year remission rates were 75, 50, and 34%, respectively. Duration of PR ranged between 23 and 63 days. Median survival in cats with CR was 296 days (range, 50,2,520 days). Six-month, 1-, 2-, and 3,5-year survival rates in cats with CR were 82, 47, 34, and 27%, respectively. Survival of cats achieving PR ranged between 38 and 120 days. Of the analyzed variables, only anatomical location had a significant influence on remission duration (P=.022). Actual median treatment time in cats with CR was 128 days (18 weeks). Hematologic and gastrointestinal toxicosis was infrequent and mostly low grade. Conclusions and Clinical Importance: In this population of cats with lymphoma, chemotherapy was effective. With infrequent and mostly low-grade toxicosis, tolerability of the protocol may be considered good. [source] Treatment of Dogs with Lymphoma Using a 12-Week, Maintenance-Free Combination Chemotherapy ProtocolJOURNAL OF VETERINARY INTERNAL MEDICINE, Issue 4 2006D. Simon Background: Treatment of lymphoma in dogs by long-term chemotherapy has favorable results. However, the efficacy of short-term, maintenance-free treatment protocols on remission and survival times in dogs has not been determined. Hypothesis: That treatment using a 12-week chemotherapy protocol would be associated with satisfactory treatment outcome in dogs with lymphoma. Animals: 77 dogs with histologically or cytologically confirmed diagnosis of lymphoma. Methods: Prospective clinical trial in which dogs were treated with a 12-week chemotherapy protocol consisting of L-asparaginase, vincristine, cyclophosphamide, doxorubicin, and prednisolone. Results: Complete remission rate was 76.3%. Multivariate logistic regression analysis revealed that clinical substage (P= .006) and immunophenotype (P= .003) had a significant influence on the likelihood of a dog achieving complete remission. Median duration of first complete remission was 243 days (range 19,1, 191 days). The 6-month, 1-year, and 2-year remission rates were 68%, 28%, and 16%, respectively. In the multivariate analysis of patient variables, immunophenotype (P= .022) revealed a significant influence on first remission duration. Toxicosis was mild with the exception of 1 treatment-associated death. Conclusions and Clinical Importance: In this group of dogs the 12-week maintenance-free chemotherapy protocol was well tolerated and had satisfactory results. [source] Multimodal approach to rapid discharge after endoscopic thoracic sympathectomyACTA ANAESTHESIOLOGICA SCANDINAVICA, Issue 2 2005M. G. C. Cruvinel Background:, After a large experience (more than 10 years) with bilateral endoscopic thoracic sympathectomy (ETS) surgery on an outpatient basis, we studied prospectively a multimodal approach to rapid discharge patients undergoing this procedure. Methods:, One hundred and seventeen consecutive patients, aged 13,60 years, ASA physical status I or II, undergoing outpatient ETS under general anaesthesia were enrolled in this study. All patients were managed using a predefined multimodal clinical care protocol consisting of a general balanced anaesthesia. Basic demographic information was collected from each patient. Duration of surgery and anaesthesia and times to PACU and home discharge were recorded as well as intraoperative and postoperative complications like nausea and vomiting. Results:, Surgery took 41.4 ± 22.1 min and anaesthesia lasted 63 ± 21.5 min. Time between induction of anaesthesia and beginning of surgery and end of surgery to extubation was 15.0 ± 2.0 and 7.2 ± 3.1 min, respectively. It took 4.9 ± 1.5 min from extubation to OR discharge. Time from PACU arrival to discharge was 12.8 ± 6.3 min. Time of hospital stay was 132 ± 18 min. No patient experienced vomiting and two had nausea, representing an incidence of 1.7%. The only anaesthetic cause for hospital admission was a severe allergic reaction. Conclusion:, Multimodal management to rapid discharge after ETS surgery did result in a short time to patient discharge. We confirm that endoscopic thoracic sympathectomy can be performed safely on an outpatient basis with brief postoperative hospital care and a low rate of complications. [source] Endotoxemia does not limit energy supply in exercising rat skeletal muscleMUSCLE AND NERVE, Issue 4 2008Benoit Giannesini PhD Abstract Although depletion in high-energy phosphorylated compounds and mitochondrial impairment have been reported in septic skeletal muscle at rest, their impact on energy metabolism has not been documented during exercise. In this study we aimed to investigate strictly gastrocnemius muscle function non-invasively, using magnetic resonance techniques in endotoxemic rats. Endotoxemia was induced by injecting animals intraperitoneally at t0 and t0 + 24 h with Klebsiella pneumoniae lipopolysaccharides (at 3 mg kg,1). Investigations were performed at t0 + 48 h during a transcutaneous electrical stimulation protocol consisting of 5.7 min of repeated isometric contractions at a frequency of 3.3 HZ. Endotoxin treatment produced a depletion in basal phosphocreatine content and a pronounced reduction in oxidative adenosine triphosphate (ATP) synthesis capacity, whereas the resting ATP concentration remained unchanged. During the stimulation period, endotoxemia caused a decrease in force-generating capacity that was fully accounted for by the loss of muscle mass. It further induced an acceleration of glycolytic ATP production and an increased accumulation of adenosine diphosphate (ADP, an important mitochondrial regulator) that allowed a near-normal rate of oxidative ATP synthesis. Finally, endotoxemia did not affect the total rate of ATP production or the ATP cost of contraction throughout the whole stimulation period. These data demonstrate that, in an acute septic phase, metabolic alterations in resting muscle do not impact energy supply in exercising muscle, likely as a result of adaptive mechanisms. Muscle Nerve, 2008 [source] Performance of a Rate Responsive Accelerometer-Based Pacemaker with Autocalibration During Standardized Exercise and RecoveryPACING AND CLINICAL ELECTROPHYSIOLOGY, Issue 6 2002STEPHANE GARRIGUE GARRIGUE, S., et al.: Performance of a Rate Responsive Accelerometer-Based Pacemaker with Autocal-ibration During Standardized Exercise and Recovery. The rate responsiveness of a single chamber, accelerometer-based pacemaker with an autocalibration function (Opus G VVIR pacemaker, ELA Medical) was studied with a daily life protocol developed to automatically optimize the programming of accelerometer-based sensors. This new sensor was compared with two other body activity sensors that were manually optimized patient by patient. Forty-three pacemaker recipients (mean age 71 ± 11 years), paced > 95% of the time, underwent a daily life protocol consisting of rapid walking for 6 minutes (W), climbing upstairs for 1.5 minutes (U), and downstairs for 1.5 minutes (D), alternated by recovery phases. The results were compared with performances measured in a control population of healthy subjects and in two paced patient populations (one equipped with a Dash Intermedics VVIR pacemaker and the other equipped with a Sensolog III Pacesetter/St. Jude VVIR pacemaker). Sex distribution and mean age between paced patients and control subjects were statistically comparable. The mean heart rate achieved by all paced patients at each time sample was compared with the normograms, assigning acceleration (slope) and rate (rate) scores for exercise and recovery phases. Scores ranged from -10 (hypochronotropic) to +10 (hyperchronotropic). Zero represents exact concordance with the responses of healthy individuals, and values between -2.5 and +2.5 were considered statistically similar to normal. During W, although the overall performances of the Dash, Sensolog, and Opus G did not statistically differ from healthy controls, the scores obtained by the Opus G were significantly closer to controls than those of the two other pacemakers (P = 0.02). For U, the three sensors were hypochronotropic (P = 0.03), though the Opus G was associated with a heart rate response closer to that of healthy controls (P = 0.04). D provided similar mean heart rate scores for the Opus G and the Dash compared with healthy controls, in contrast with the hyperchronotropic behavior of the Sensolog (P = 0.02). Opus G revealed a physiological modulation of the heart rate for W and D tests with a slightly hypochronotropic behavior during U. The Opus G autocalibration function provided daily life performances closer to those of healthy controls than two other pacemakers equipped with a body activity sensor that were manually optimized. [source] Drought stress effects on photosystem I content and photosystem II thermotolerance analyzed using Chl a fluorescence kinetics in barley varieties differing in their drought tolerancePHYSIOLOGIA PLANTARUM, Issue 2 2009Abdallah Oukarroum Drought stress has multiple effects on the photosynthetic system. Here, we show that a decrease of the relative contribution of the I-P phase, ,VIP = ,VI = (FM,FI)/(FM, Fo), to the fluorescence transient OJIP is observed in 10 drought-stressed barley and 9 chickpea varieties. The extent of the I-P loss in the barley varieties depended on their drought tolerance. The relative loss of the I-P phase seems to be related to a loss of photosystem (PS) I reaction centers as determined by 820-nm transmission measurements. In the second part of this study, the interaction of drought and heat stress in two barley varieties (the drought tolerant variety A¨t Baha and the drought sensitive variety Lannaceur) was studied using a new approach. Heat stress was induced by exposing the plant leaves to temperatures of 25,45°C and the inactivation of the O2 -evolving complex (OEC) was followed measuring chlorophyll a (Chl a) fluorescence using a protocol consisting of two 5-ms pulses spaced 2.3 ms apart. In active reaction centers, the dark interval is long enough to allow the OEC to recover from the first pulse; whereas in heat-inactivated reaction centers it is not. In the latter category of reaction centers, no further fluorescence rise is induced by the second pulse. Lannaceur, under well-watered conditions, was more heat tolerant than Aït Baha. However, this difference was lost following drought stress. Drought stress considerably increased the thermostability of PS II of both varieties. [source] Severe necrotizing stomatitis and osteomyelitis after chemotherapy for acute leukaemiaAUSTRALIAN DENTAL JOURNAL, Issue 3 2009FA Santos Abstract Background:, Leukaemia is a malignant neoplasm characterized by clonal proliferation of white blood cells within the bone marrow. Despite an increase in the white blood cell count, the leukaemic leukocytes are non-functional. The oral complications arising in leukaemic patients can be attributed to the direct and indirect effects of immunosuppressive chemotherapy. Methods:, This case report describes severe maxillary and mandibular necrotizing stomatitis and osteomyelitis in a young female patient after chemotherapy for acute leukaemia. On physical examination, the patient presented malnourished with pale skin, cervical lymphadenitis, frequent fever and generalized pain. The intra-oral clinical examination found halitosis, multiple ulcers, necrotizing stomatitis and osteomyelitis located in the maxillary and mandibular regions. The necrotizing stomatitis and osteomyelitis were treated locally with atraumatic removal of the necrotized tissues. The patient received a daily preventive protocol consisting of oral hygiene care, including twice daily brushing, and mouthrinses with a solution of chlorhexidine. She was also treated with systemic metronidazole and amoxicillin for 21 days. Results:, During the course of management the patient's oral condition improved with some re-epithelialization being noted. However, severe alveolar bone destruction remained evident. Thirty-two months after presentation of the initial symptoms, the patient died due to complications related to leukaemia recurrence (haemorrhage, sepsis and respiratory distress syndrome). Conclusions:, Dental monitoring during cancer treatment is imperative in order to emphasize the importance of dental plaque control and the maintenance of a healthy periodontal condition throughout medical treatment. [source] Excellent clinical outcomes in primary kidney transplant recipients treated with steroid-free maintenance immunosuppressionCLINICAL TRANSPLANTATION, Issue 5 2006Amer Rajab Abstract:, Steroid-free maintenance immunosuppression is desirable to eliminate the side effects of chronic corticosteroid use. Complete steroid avoidance or rapid post-transplant steroid withdrawal has recently been used in renal transplant recipients with encouraging results. The present study evaluated the outcome of a steroid-free maintenance immunosuppressive protocol in kidney transplant recipients with at least one-yr follow up. Between April 2002 and October 2004, a total of 301 primary kidney transplant recipients received steroid-free maintenance immunosuppression. The regimen consisted of induction with thymogobulin and prednisone for the first five d. Patients were maintained on Sirolimus and Neoral. Neoral dose was adjusted to target C2 levels and the Sirolimus dose was adjusted to a target rapamycin trough level. All primary kidney transplants (n = 502) performed in the two yr (starting January 2000) prior to institution of the steroid-free regimen and thus maintained on a steroid-based immunosuppressive protocol were used for comparison. One-year patient and death censored graft survival were 93.1% and 98.1% for the steroid-free group vs. 95.2% and 95.2% for the comparator groups (p = ns). The incidence of biopsy-proven acute rejection was 4.9% in the steroid-free group vs. 9.4% in the comparator group (p < 0.01). Two (0.7%) of 301 patients in the steroid-free group lost their grafts because of acute rejection compared with nine (1.8%) patients in the comparator group (p < 0.05). At one-yr post-transplant the mean serum creatinine level was not different between the two groups. There were no significant differences in mean serum cholesterol and triglycerides levels as well as the percentage of patients on lipid lowering agents between the groups. White blood cell counts, daily doses of Neoral and weight gain were significantly lower in the steroid-free group vs. the comparator group. However, more patients in the steroid-free group required erythropoietin and iron therapy for anemia (p < 0.001). We conclude that excellent graft survival with a significantly lower incidence of acute rejection can be achieved using a steroid-free maintenance immunosuppressive protocol consisting of Neoral and Sirolimus. [source] A standardized protocol for the treatment of severe pneumonia in kidney transplant recipientsCLINICAL TRANSPLANTATION, Issue 6 2002Pierpaolo Sileri Abstract:, Although the incidence of pneumonia after kidney transplantation is the lowest among all solid organ transplants, it is associated with high mortality rate (40,50%). We evaluated the efficacy of a protocol consisting of bronco-alveolar-lavage (BAL) for early microbiological diagnosis, reduction of the immunosuppressive therapy, and prompt administration of standardized antibiotic regimen in renal transplant recipients with severe pneumonia. Between 6/1989 and 5/1999, 40 kidney transplant recipients developed 46 episodes of severe pneumonia (hypoxia and/or infiltrate on the chest X-ray). According to protocol, in all these cases, a BAL was immediately performed and empirical antibiotic therapy was initiated with erythromycin and trimethoprim-sulfamethoxazole i.v. Furthermore, the immunosuppressive therapy was drastically reduced. Analyses of BAL fluid included cell differential count, cytopathologic examination and cultures for bacteria, fungi and viruses. Within 48 h, the therapy was switched to proper i.v. antibiotics, if necessary, according to the results of sensitivity testing of BAL specimens. The mortality rate was 12.5% (5 of 40). Mechanical ventilation was required in 20 cases (34.5%) and four of the patients that required intubation died. BAL alone established a diagnosis in 67.4% (31 of 46) of the patients. Bacteria were responsible for 61% of the episodes, with fungi responsible for 29% and viruses for 10%. Seven cases of Pneumocystis carinii pneumonia were treated with the prolongation of the initial therapy. We conclude that a combination of early detection of the responsible pathogen by BAL, aggressive reduction of the immunosuppressive therapy and the immediate empirical administration of erythromycin and trimethoprim-sulfamethoxazole is an effective strategy to treat pneumonia kidney transplantation (KTX) recipients. [source] | |||||||||||||||||||