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Standard Management (standard + management)
Selected AbstractsStage I seminoma: What should a practicing uro-oncologist do in 2009?INTERNATIONAL JOURNAL OF UROLOGY, Issue 6 2009Julia Skliarenko Abstract Testicular tumors are uncommon, but they continue to represent an important group of malignancies in young men. It is the most common solid malignancy in males between the ages of 20 and 35, and primary germ cell tumors are the most common histological type. In the United States in 2008, approximately 4800 cases of seminoma, approximately 4100 of which were stage I disease were projected after the completion of staging investigations. Remarkable progress has been made in the treatment of testicular seminoma over the past 25 years. Management options of stage I seminoma include radiotherapy, surveillance, or adjuvant chemotherapy. Standard management until recent years has been adjuvant retroperitoneal radiotherapy. Although providing excellent long term results, this approach has been associated with increased risk of gonadal toxicity, development of secondary malignancies and an increased risk of cardiovascular disease. The use of surveillance in management of patients with stage I seminoma is therefore becoming more frequent as it minimizes the burden of treatment and maintains the cure rate at virtually 100%. Adjuvant chemotherapy using Carboplatin has been investigated as an alternative management approach. However, the long term outcomes of patients managed with Carboplatin are not yet clear and this strategy should only be used in a study setting. It has been suggested that more patients with stage I seminoma will die of their treatment than of their cancer; therefore, the thrust of modern management should be to maintain 100% cure while minimizing the burden of treatment. [source] Malignant retroperitoneal tumor arising in a multicystic dysplastic kidney of a girl with Schinzel,Giedion syndromeINTERNATIONAL JOURNAL OF UROLOGY, Issue 12 2005FUMI MATSUMOTO Abstract, We report the first case of malignant retroperitoneal tumor arising in a multicystic dysplastic kidney of an 8-year-old girl with Schinzel-Giedion syndrome. Although conservative treatment has been regarded as the standard management for asymptomatic multicystic dysplastic kidney, prophylactic surgical removal should be considered for selected children with potential risk of malignancy. [source] Comparison of microvessel densities in rat prostate tissues treated with finasteride, bicalutamide and surgical castration: A preliminary studyINTERNATIONAL JOURNAL OF UROLOGY, Issue 2 2005CEVDET KAYA Abstract Background: A group of anti-androgens with different mechanisms of action and adverse effects have been investigated in patients with gross hematuria related to benign prostate hyperplasia; however, there is not yet any consensus about the standard management of these patients. The present study aims to identify if any one type of the hormonal intervention is superior in terms of the suppression of microvessel formation in the prostate. Materials and methods: A total of 28 mature, healthy male Sprague,Dawley rats (300 ± 50 g) were used in this study. The rats were randomly assigned to one of four groups (n = 7 per group). The effects of three different hormonal therapies on angiogenesis and microvascularity in rat ventral prostate were compared. Groups 1 and 2 were treated for 28 days with finasteride and bicalutamide, respectively, and rats from Group 3 underwent surgical castration. Following treatment, all rats included in the study underwent dissection of the ventral prostate and immunohistochemical analysis of microvessel density by factor VIII-related antigen. Results: The mean number of microvessels in the finasteride and bicalutamide groups was 24.5 (±8.44 SE) and 27 (±9.89 SE) respectively. In contrast, the castration and control groups had microvessel numbers of 12.9 (±5.35 SE) and 40.3 (±5.03 SE) respectively. Differences were statistically significant between all three treatment groups and the controls (P < 0.005); the number of microvessels in rat prostate tissues of the control group was significantly higher than the treatment groups. Mean microvessel densities in the bicalutamide and finasteride groups were significantly higher than microvessel densities in the castration group (P < 0.005). There was no statistically significant difference between mean microvessel number in rat prostate tissue treated with finasteride or bicalutamide (P > 0.05). Conclusions: Even though finasteride was not as effective as castration in reducing microvessel number, its effect was equal to that of bicalutamide in terms of suppressing the angiogenesis in prostatic tissue. Based on the findings of the present study, finasteride might offer a viable option in the management of macroscopic hematuria by inhibition of microvessel formation within the prostatic tissue. Further clinical studies are warranted. [source] Fitness testing of pediatric liver transplant recipientsLIVER TRANSPLANTATION, Issue 3 2001Viswanath B. Unnithan PhD Liver transplantation is accepted as the standard management for end-stage liver disease in children. Pediatric heart and heart-lung transplant recipients have shown significantly diminished exercise capacities compared with age-matched, able-bodied, control subjects. The primary aim of this study is to compare the fitness levels of a group of pediatric liver transplant (LT) recipients (LT group, 20 boys, 9 girls; age, 8.9 ± 4.8 years; 56 ± 35 months posttransplantation) with a group of able-bodied control subjects (22 boys, 12 girls; age, 8.4 ± 3.8 years). The secondary aim is to compare the performance of the LT group against the Fitnessgram criterion standards. We assessed muscular endurance by means of a partial curl-up, flexibility by means of the back-saver sit and reach, and cardiorespiratory fitness by means of the progressive aerobic cardiovascular endurance run (PACER). The only significant (P < .05) difference between the 2 groups was the number of shuttles run in the PACER (control, 16.8 ± 9.8 v LT, 11.5 ± 8.4 shuttles). Other differences between the 2 groups were not significant. With regard to satisfying the Fitnessgram criterion standards, only 35% of the LT group achieved the standards for the partial curl-up, 88% of the LT group achieved the criterion standards for flexibility, and 0% achieved the standards for the PACER. These results indicate that the LT group has diminished exercise capacity. The origins of exercise limitations deserve further investigation. [source] Review Article: Probiotics for allergic diseases: Realities and mythsPEDIATRIC ALLERGY AND IMMUNOLOGY, Issue 6 2010Tsung-Chieh Yao Yao T-C, Chang C-J, Hsu Y-H, Huang J-L. Probiotics for allergic diseases: Realities and myths. Pediatr Allergy Immunol 2010: 21: 900,919. © 2009 John Wiley & Sons A/S The prevalence of allergic diseases such as asthma, allergic rhinitis, and atopic dermatitis has increased sharply over the past two to three decades in many countries, and allergies are now the most common chronic disease among children throughout the world. In the past few years, probiotics have been advocated for the management of allergic diseases in many parts of the world. Physicians have a responsibility to ensure the efficacy and safety of any products they prescribe or recommend. This article provides a comprehensive overview and a critical interpretation of currently available evidence regarding the role of probiotics in the prevention and treatment of allergic diseases in humans and also discusses several major myths and potential risks associated with the use of probiotics. In the current era of evidence-based medicine, there is still insufficient evidence to recommend probiotics for the prevention of allergic diseases or as part of standard management for any allergic conditions in children. [source] Hypophosphataemia causing profound cardiac failure after cardiac surgeryANAESTHESIA, Issue 12 2006R. M. Heames Summary We report the case of a patient who developed severe cardiac failure after cardiac surgery and required high-dose inotrope infusion. The patient was found to have significant hypophosphataemia and high insulin requirements immediately after surgery. On giving intravenous phosphate, there was a rapid decrease in inotrope requirement and improved glycaemic control. This occurrence raises questions about the cause of hypophosphataemia after cardiac surgery, the possible need for pre-operative plasma phosphate measurement and whether phosphate replacement should be part of the standard management of postoperative hypophosphataemia. [source] Rapid rise of serum prostate specific antigen levels after discontinuation of the herbal therapy PC-SPES in patients with advanced prostate carcinomaCANCER, Issue 3 2002Report of four cases Abstract BACKGROUND PC-SPES is an herbal supplement whose mechanisms of action are poorly understood, but may be estrogenic. The objective of the current report is to describe the effects of discontinuing PC-SPES treatment in four patients with androgen-independent prostate carcinoma. METHODS Patient charts were retrospectively reviewed. A MEDLINE search was performed to investigate whether these effects of PC-SPES had been previously reported. RESULTS Four men whose metastatic prostate carcinoma progressed despite androgen ablation and subsequent PC-SPES treatment are described. All four patients developed a rapid increase in serum prostate specific antigen (PSA) within one month of stopping PC-SPES, ranging from 345% to 880%. Two patients increased their PSA levels to 1300% and 1400% after 7 weeks. Compared to the rate of rise of PSA levels prior to and during PC-SPES therapy, the rise after stopping this treatment was much higher than expected. Clinical symptoms remained relatively stable despite the serologic changes. CONCLUSIONS Discontinuing PC-SPES therapy can be associated with a rapid rise in PSA. To the authors' knowledge, this effect has not been reported previously. This effect should be considered in the design of clinical trials as well as in the standard management of androgen-independent prostate carcinoma patients. Cancer 2002;94:686,9. © 2002 American Cancer Society. DOI 10.1002/cncr.10269 [source] Clinical characteristics and outcome of current standard management of central retinal artery occlusionCLINICAL & EXPERIMENTAL OPHTHALMOLOGY, Issue 5 2010Adam K Rudkin BMBS Abstract Background:, To investigate the visual outcomes in acute central retinal artery occlusion (CRAO) with current standard therapy at two university teaching hospitals. Methods:, Retrospective analysis of two cohorts of CRAO patients from John Hopkins Hospital (JHH; USA), and Flinders Medical Centre (FMC; Australia), treated with current standard therapy. The outcome measures were visual acuity, and subsequent ocular and systemic ischaemic events. Results:, The mean follow-up period was 11.2 ± 13.1 months in the JHH cohort and 35.4 ± 34.9 months in the FMC cohort. The frequency distribution of vascular risk factors and the incidence of subsequent ischaemic events were similar for the patients from both institutions. All patients from JHH were treated as inpatients, whereas 79% of patients from FMC were treated as outpatients. More patients in the JHH cohort underwent paracentesis, ocular massage or were treated with intraocular hypotensive agents (76%) than in the FMC cohort (26%); however, there was no significant difference in visual outcome between the two cohorts (P = 0.114). Conclusion:, Despite differences in management of CRAO between two institutions in different countries, visual outcomes were similar. This suggests a lack of efficacy of current standard treatment in acute CRAO. [source] | ||||||||||