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Several Treatment Options (several + treatment_option)
Selected AbstractsExercise-induced wheeze: Fraction of exhaled nitric oxide-directed managementRESPIROLOGY, Issue 4 2010Douglas C. COWAN ABSTRACT Background and objective: Exercise-induced wheeze (EIW) is common. Several treatment options exist. Patients with low fraction of exhaled nitric oxide (FENO) are unlikely to be steroid-responsive and might benefit from non-steroidal therapies. We assessed: the efficacy of cromoglycate, formoterol and montelukast in patients with EIW and low FENO (<35 ppb) in a randomized cross-over trial, and the efficacy of inhaled corticosteroid in a high FENO (>35 ppb) group. Methods: Patients had EIW and airway hyperresponsiveness (AHR) to mannitol and/or exercise. Those with low FENO (n = 19) received cromoglycate (20 mg inh. bd + before challenge tests), formoterol (12 µg inh. bd + before challenge tests) and montelukast (10 mg p.o. od), each for 2 weeks. Those with high FENO (n = 20) took inhaled fluticasone (500 µg) daily for 4 weeks. Primary end-points were: 50% reduction in maximum FEV1 %fall (clinical protection) and decrease in AHR to mannitol. Results: In patients with low FENO, cromoglycate, formoterol and montelukast significantly decreased AHR to mannitol in 63%, 61% and 47% of patients, respectively. In this group, the magnitude of exercise-induced bronchoconstriction (EIB) was significantly reduced with montelukast and formoterol; between-treatment differences were not significant. Of 6/19 with low FENO and EIB, protection occurred in 67% (cromoglycate), 83% (formoterol) and 50% (montelukast), respectively. In the high FENO group, AHR to mannitol and EIB decreased significantly with fluticasone (P < 0.001, P = 0.005, respectively), and protection occurred in 7/8 (88%) with EIB. Conclusions: In patients with EIW and low FENO, the number of ,responders' to cromoglycate, formoterol and montelukast was similar. In a high FENO population the response to inhaled corticosteroid was highly significant and comparable to previous studies. [source] Intralesional bleomycin injections in the treatment of benign lymphoepithelial cysts of the parotid gland in HIV-positive patients: Case reports,THE LARYNGOSCOPE, Issue 2 2010Glen M. Monama MBChB, MMed (ORL) Abstract Benign lymphoepithelial cysts (BLCs) of the parotid gland are associated with human immunodeficiency virus. These cysts may grow large and uncomfortable, causing significant cosmetic embarrassment for the patient. Several treatment options have been described with varying successes. We report successful treatment of three adults with bleomycin. All three patients presented with bilateral parotid enlargements. They received a total dose of between 180 U and 270 U of bleomycin over a period of 6 to 10 weeks. They all responded completely without morbidity or recurrence. Bleomycin is effective in the treatment of BLCs of the parotid glands in HIV-positive patients. Laryngoscope, 2010 [source] Opioid-induced pruritus: an updateCLINICAL & EXPERIMENTAL DERMATOLOGY, Issue 1 2010A. Reich Summary Pruritus is an unpleasant sensation leading to scratching. It can be a feature of numerous skin or systemic diseases, and may also be a side-effect of various drugs. Opioids are one of the best-known medicines evoking pruritus. The pathogenesis of opioid-induced pruritus is still not fully known, but two different mechanisms have been proposed: peripheral and central. Several treatment options have been tested for opioid-induced pruritus, but none has been completely satisfactory. Opioid antagonists seem to be the most potent antipruritic drugs, but they also decrease analgesia, which limits their usage. Many other treatments have been tried, but to date, the data are conflicting or only limited studies have been performed to confirm their efficacy. Further studies are still needed to better elucidate the mechanism of opioid-induced pruritus and to develop more effective treatment options. [source] Review article: diagnosis and treatment of non-alcoholic fatty liver diseaseALIMENTARY PHARMACOLOGY & THERAPEUTICS, Issue 5 2008M. K. OH Summary Background, Non-alcoholic fatty liver disease (NAFLD) is an increasingly prevalent condition affecting adults and children, leading to significant morbidity. It is often associated with the metabolic syndrome, although multiple pathogenetic mechanisms have been suggested. In the coming decades, it promises to be the leading cause of liver disease in industrial countries. Aim, To provide a comprehensive, updated review of diagnosis and management of NAFLD and to appraise the evolution of new modalities in these areas. Methods, An Ovid MEDLINE search was performed to identify pertinent original research and review articles. Selected references in these articles were also evaluated. Results, The diagnosis of hepatic steatosis and steatohepatitis or non-alcoholic steatohepatitis (NASH) is not yet possible without liver biopsy. This is impractical given the large numbers affected by the condition. Current therapy has focused on improving insulin resistance and mediators of inflammation, factors probably associated with disease progression. Conclusions, There are no proven non-invasive diagnostic modalities to distinguish NAFLD and NASH, but new biomarker panels are approximating the liver biopsy in accuracy. Therapeutic targets of drug development are in early stages, but a multifaceted approach will probably yield several treatment options in the years to come. [source] Metastatic Renal Cell Carcinoma to the Head and Neck,THE LARYNGOSCOPE, Issue 9 2002Keith M. Pritchyk MD Abstract Objectives The objectives of the study were to present four cases of renal cell carcinoma (RCC) metastatic to the head and neck, to recognize the appearance on radiographic studies, to understand the importance of preoperative embolization, and to review the results of treatment. Study Design Retrospective review of patients diagnosed with metastatic RCC to the head and neck. Methods The records of four patients diagnosed with metastatic RCC at a tertiary medical center over a 5-year period from 1996 to 2001 were reviewed and analyzed for demographic and outcomes data. Results Metastatic RCC to the head and neck was seen in the following locations: nasal cavity, lower lip, hard palate, tongue, and maxillary sinus. Presenting signs were loose upper molars, dysphagia, nasal obstruction, lower lip lesion, recurrent epistaxis, and foul nasal drainage. Histological studies confirmed metastasis of RCC in all four patients. Treatment consisted of preoperative radiation therapy, embolization, and local excision with adjunct chemotherapy. Conclusions Metastatic RCC to the head and neck is rare but can have serious consequences if not recognized before biopsy. We present several treatment options with local excision as the primary mode of treatment. [source] A Generalized Estimator of the Attributable Benefit of an Optimal Treatment RegimeBIOMETRICS, Issue 2 2010Jason Brinkley Summary For many diseases where there are several treatment options often there is no consensus on the best treatment to give individual patients. In such cases, it may be necessary to define a strategy for treatment assignment; that is, an algorithm that dictates the treatment an individual should receive based on their measured characteristics. Such a strategy or algorithm is also referred to as a treatment regime. The optimal treatment regime is the strategy that would provide the most public health benefit by minimizing as many poor outcomes as possible. Using a measure that is a generalization of attributable risk (AR) and notions of potential outcomes, we derive an estimator for the proportion of events that could have been prevented had the optimal treatment regime been implemented. Traditional AR studies look at the added risk that can be attributed to exposure of some contaminant; here we will instead study the benefit that can be attributed to using the optimal treatment strategy. We will show how regression models can be used to estimate the optimal treatment strategy and the attributable benefit of that strategy. We also derive the large sample properties of this estimator. As a motivating example, we will apply our methods to an observational study of 3856 patients treated at the Duke University Medical Center with prior coronary artery bypass graft surgery and further heart-related problems requiring a catheterization. The patients may be treated with either medical therapy alone or a combination of medical therapy and percutaneous coronary intervention without a general consensus on which is the best treatment for individual patients. [source] | ||||||||||