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PubMed2004

The retreat of multiculturalism in the liberal state: theory and policy.

This article discusses a recent retreat of multiculturalism in the liberal state. This retreat has occurred both at the level of theory and policy. With the help of some recent liberal critiques of multiculturalism, the first part maps out some shortcomings of the notion of minority integration through cultural recognition, particularly with respect to immigrants. The second part discusses a retreat from multiculturalism policies in three states that had been prominently committed to them: Australia, the Netherlands, and Britain. This practical retreat of multiculturalism is due to a variety of factors, their importance differing across cases: the chronic lack of public support for multiculturalism policies; inherent deficits and failures of multiculturalism policies, especially in socio-economic respect; and a new assertiveness of the liberal state to impose liberal principles.

Acculturation↗

PubMed2006

Long-term follow-up of previous hepatitis C virus positive nonresponders to interferon monotherapy successfully retreated with combination therapy: are they really cured?

OBJECTIVES: To evaluate whether in chronic hepatitis C-positive patients who failed to respond to interferon (IFN) monotherapy a sustained response obtained with retreatment using the combination therapy of IFN + ribavirin can be safely considered to reflect eradication of the infection. METHODS: Prospective follow-up of a cohort of 97 patients who responded to retreatment with different regimens of IFN + ribavirin after failing to respond to a first IFN monotherapy course. The patients were followed throughout 7 yr of follow-up with determinations of HCV viremia every 6 months. RESULTS: At the end of the follow-up, 11 patients (11.3%) showed a viremic reappearance. HCV late relapse rates were 0%, 13%, 20%, and 12% in patients retreated, respectively, with 3 MU IFN + ribavirin for 12 months (Group 1), 5 MU IFN + ribavirin for 12 months (Group 2), 3 MU IFN + ribavirin for 6 months (Group 3), and 5 MU IFN + ribavirin for 6 months (Group 4) (Group 2 vs Group 3, p= 0.005). The virologic relapses occurred within 2 yr from therapy withdrawal. Among patients with genotype 1 and 4, the long-term response was significantly higher in Group 2 than in Group 3 (15%vs 3%, p= 0.03). In patients with genotype 2 and 3, the long-term virological response was not affected by the different regimens. CONCLUSIONS: Nonresponders to IFN monotherapy who achieve a sustained virologic response after retreatment with IFN + ribavirin stand a discrete risk of HCV reactivation within 2 yr after therapy.

Adult↗

PubMed1999

Effect of retreatment with interferon alone or interferon plus ribavirin on hepatitis C virus quasispecies diversification in nonresponder patients with chronic hepatitis C.

Alpha interferon (IFN-alpha) treatment is effective on a long-term basis in only 15 to 25% of patients with chronic hepatitis C. The results of recent trials indicate that response rates can be significantly increased when IFN-alpha is given in combination with ribavirin. However, a large number of patients do not respond even to combination therapy. Nonresponsiveness to IFN is characterized by evolution of the hepatitis C virus (HCV) quasispecies. Little is known about the changes occurring within the HCV genomes when nonresponder patients are retreated with IFN or with IFN plus ribavirin. In the present study we have examined the genetic divergence of HCV quasispecies during unsuccessful retreatment with IFN or IFN plus ribavirin. Fifteen nonresponder patients with HCV-1 (4 patients with HCV-1a and 11 patients with HCV-1b) infection were studied while being retreated for 2 months (phase 1) with IFN-alpha (6 MU given three times a week), followed by IFN plus ribavirin or IFN alone for an additional 6 months (phase 2). HCV quasispecies diversification in the E2 hypervariable region-1 (HVR1) and in the putative NS5A IFN sensitivity determining region (ISDR) were analyzed for phase 1 and phase 2 by using the heteroduplex tracking assay and clonal frequency analysis techniques. A major finding of this study was the relatively rapid evolution of the HCV quasispecies observed in both treatment groups during the early phase 1 compared to the late phase 2 of treatment. The rate of quasispecies diversification in HVR1 was significantly higher during phase 1 versus phase 2 both in patients who received IFN plus ribavirin (P = 0.017) and in patients who received IFN alone (P = 0. 05). A trend toward higher rates of quasispecies evolution in the ISDR was also observed during phase 1 in both groups, although the results did not reach statistical significance. However, the NS5A quasispecies appeared to be rather homogeneous and stable in most nonresponder patients, suggesting the presence of a single well-fit major variant, resistant to antiviral treatment, in agreement with published data which have identified an IFN sensitivity determinant region within the NS5A. During the entire 8 months of retreatment, there was no difference in the rate of fixation of mutation between patients who received combination therapy and patients who were treated with IFN alone, suggesting that ribavirin had no major effects on the evolution of the HCV quasispecies after the initial 2 months of IFN therapy.

Adult↗

PubMed2005

Influence of coil thickness on packing, re-opening and retreatment of intracranial aneurysms: a comparative study between two types of coils.

OBJECTIVES: To compare packing, re-opening and retreatment of intracranial aneurysms treated with two types of coils with different wire thickness and different shapes. MATERIALS AND METHODS: Packing, defined as the ratio between volume of inserted coils and volume of aneurysm, was calculated for 235 aneurysms-120 treated with predominantly helical-shaped coils of 0.010-inch diameter wire (GDC 10) and 115 treated with predominantly complex shaped coils of 0.012-inch diameter wire (Cordis TruFill). Aneurysm packing, re-opening and retreatment during follow-up were compared for aneurysms treated with either type of coils. RESULTS: Mean packing was significantly higher (absolute value 6.8%, relative value 23.0%, p<0.0001) in aneurysms treated with Cordis TruFill coils compared with aneurysms coiled with GDC 10 coils. Six month follow-up angiography was available in 194 of 235 aneurysms. Re-opening occurred in 22 of 99 aneurysms (22.2%) treated with GDC 10 coils and in 15 of 95 aneurysms (15.8%) treated with Cordis TruFill coils. Retreatment was performed in 16 of 120 aneurysms (13.3%) treated with GDC 10 coils and in nine of 115 aneurysms (7.8%) treated with Cordis TruFill coils. CONCLUSION: Coiling of intracranial aneurysms using complex shaped Cordis TruFill coils with a wire diameter of 0.012 inch results in significantly better packing compared with helical GDC 10 coils of 0.010-inch diameter wire. The retreatment rate was lower for aneurysms treated with Cordis TruFill coils compared with aneurysms treated with GDC 10 coils.

Cerebral Angiography↗

PubMed1998

Retreatment of regression after photorefractive keratectomy for myopia.

PURPOSE: To study results of retreatment after regression in myopic patients who underwent photorefractive keratectomy (PRK). METHODS: Procedures were performed with the Nidek EC-5000 excimer laser. This was a retrospective study of 20 of 2127 patients, with follow-up of at least 6 months, who underwent repeated excimer laser ablation. RESULTS: No patient with low myopia had regression. We evaluated six eyes (group I) with moderate myopia; 13 eyes (group II) with high myopia; and ten eyes (group III) with extreme myopia. Average uncorrected visual acuity at 6 months after retreatment was 0.73 +/- 0.21 in group I, 0.64 +/- 0.35 in group II, and 0.61 +/- 0.38 in group III. At six months after retreatment, the average was -0.36 +/- 1.05 D in group I, -0.42 +/- 1.12 D in group II, and -1.40 +/- 1.62 D in group III. CONCLUSION: The amount and frequency of regression was higher in patients with high and extreme myopia; however, the preliminary results of retreatment of regression were satisfactory.

Adult↗

PubMed1990

An auxiliary retreat: why? Why not?

Although the first auxiliary educational retreat was held in 1982 and articles have been written about retreats periodically since then, many auxiliaries still have not sponsored one. In the following article, Marge Lattman, member of the AHA's Committee on Volunteers, past-president of the Association of Florida Hospital Auxiliaries, and active member of the Venice (FL) Hospital Auxiliary, explains why an auxiliary educational retreat is valuable and highlights some of her experiences as a retreat presenter.

Communication↗

PubMed2000

Partial flap during laser in-situ keratomileusis: pathogenesis and timing of retreatment.

PURPOSE: To report the timing of retreatment and clinical outcomes in patients with a partial corneal flap during laser in-situ keratomileusis (LASIK), and to describe the causes of this complication. METHODS: Retrospective review of case records of four patients (4 eyes) who had a partial corneal flap during LASIK. RESULTS: The mean age of the four patients was 23 +/- 4.7 years, and mean preoperative spherical equivalent (SE) refraction was -9.1 +/- 3.1 D (range, -5.5 to -13 D). A 160 microns corneal flap was attempted during the initial treatment. Retreatment with a 180 microns corneal flap was performed at a mean of 5.1 +/- 1.6 weeks (range, 4 to 7.5 weeks) after the initial procedure. There were no intraoperative complications during retreatment. Post-LASIK mean SE refraction was -1.0 +/- 1.1 D (range, +0.38 to -2.0 D), after a mean follow up of 19 +/- 15.7 weeks (range, 7 to 42 weeks). Best spectacle-corrected visual acuity decreased in one eye from 6/5 to 6/6 and was maintained in the others. CONCLUSION: LASIK retreatment can be performed as early as one month after a partial flap, if the refraction is stable and a thicker corneal flap is created.

Adult↗

PubMed2006

[Retreatment with interferon of relapsed chronic hepatitis C patients].

OBJECTIVE: To evaluate the efficacy and investigate the influencing factors of the interferon (IFN) retreatment for patients with chronic hepatitis C relapsed after a previous IFN treatment. METHODS: A retrospective study was designed to analyze the retreatment with IFN of 60 relapsed chronic hepatitis C patients. All patients were from a randomized, opened and multi-center clinical trial about the efficacy and security of PEG-IFNalpha-2a compared to CIFNalpha-2a in the treatment of chronic hepatitis C in China. There were 35 patients treated with PEG-IFNalpha-2a and 25 with CIFNalpha-2a. The main parameter to evaluate the efficacy was sustained viral response (SVR) rate. The influence of viral concentration in serum, genotype and drug categories on the responses to IFN were analyzed. RESULTS: For all the patients, the end of treatment virus response (ETVR) and SVR rates were 55.00% and 35.00% respectively. ETVR rate of PEG-IFNalpha-2a was significantly higher than that of CIFNalpha-2a (74.29% and 28.00% respectively, P < 0.01). SVR rate of PEG-IFNalpha-2a was also markedly higher than that of CIFNalpha-2a (45.71% and 20.00% respectively, P < 0.05). However, there was no significant difference between the high and low viral load groups. Among the patients with genotype 1, ETVR and SVR rates of PEG-IFNalpha-2a (75.00%, 45.83%) were significantly higher than those of CIFNalpha-2a (22.22%, 11.11%), (P < 0.01, P < 0.05 respectively), but in patients with genotype non-1, there were no such differences between the two groups. CONCLUSION: Some relapsed patients were not responsive to the IFN retreatment. The efficacy of PEG-IFNalpha-2a was superior to CIFNalpha-2a. The conventional IFN was not suggested to be used in the relapsed cases with genotype 1. The viral load was not associated with the efficacy of IFN retreatment.

Adult↗

PubMed1990

Efficient and effective root canal retreatment without chloroform.

A root canal retreatment technique is described which eliminates the need for chloroform as a gutta percha solvent. This technique utilizes the gutta percha softening actions of both a self-heating instrument and the heat-potentiated solvent action of eucalyptol. In addition, sonics/ultrasonics and/or Gates-Glidden drills are suggested as useful adjuncts to canal debridement during re-preparation of the canal system. Given the controversy regarding the toxicity of chloroform, both for dental patients and dental personnel, practitioners may wish to consider using this retreatment technique to eliminate chloroform from endodontic retreatment procedures, while still achieving effective, efficient root canal retreatment.

Chloroform↗

PubMed1976

First-line chemotherapy in the retreatment of bacteriological relapses of pulmonary tuberculosis following a shortcourse regimen.

Totals of 404 Chinese and 778 East African patients with newly diagnosed drug-sensitive pulmonary tuberculosis were treated with short-course regiments of antituberculosis chemotherapy. The Chinese received 6-month and 9-month regimens of streptomycin plus isoniazid plus pyrazinamide, and the East Africans 6-month regiments of streptomycin plus isoniazid alone or with a third drug. 28 Chinese and 45 African patients who relapsed with drug-sensitive strains after their short-course regimen were retreated with standard first-line chemotherapy. The Chinese were given every single dose under full supervision, but the Africans the initial phase only. At 12 months from the start of their retreatment, all 28 Chinese and 40 (89%) of the 45 Africans had a favourable therapeutic response on their retreatment regimen. 2 of the 5 East African patients whose retreatment failed were known to have been irregular in taking their drugs.

Africa, Eastern↗

PubMed1994

[Clinical study of retreatment of chronic hepatitis C with interferon (IFN) for non-complete responders on initial treatment].

From August 1990 to May 1993, we treated 23 non-complete responders on initial treatment with interferon and studied the factor which affects the effectiveness in the attempt to verify the factors for the selection of patients who are to receive it. Complete response was achieved in 8 (34.8%) patients, while the other 15 patients did not achieve this degree of response. Three patients were of genotype II and 5 of genotype III in these 8 complete responders. All complete responders were patients with relapse who had had normalized serum ALT levels during the initial administration and undetectable HCV-RNA at the end of the period. No patient who failed to achieve normalization of the serum ALT level on initial treatment achieved a complete response on retreatment. HCV-RNA concentration before retreatment was significantly less than the one before initial treatment in 8 complete responders. Interferon retreatment of patients who do not achieve a complete response may be effective in relapsed cases with undetectable HCV-RNA at the end of initial treatment. Selection of patients to receive interferon retreatment requires careful review and consideration of genotype, HCV-RNA concentration, and the clinical response at initial treatment.

Adult↗

PubMed1995

Interferon-alpha retreatment in chronic hepatitis C.

For chronic hepatitis C virus (HCV) infection, interferon-alpha (IFN-alpha) treatment has recently been established. However, the complete responding rate is not higher than 20-25%. The aim of our study was to assess IFN-alpha retreatment in chronic hepatitis C. In summary, during a second cycle of IFN-alpha, 60% of the patients responded to the retreatment. Indeed, a sustained complete response, together with long-lasting normal alanine aminotransferase values and negative serum HCV-RNA, was observed in about 40% of the retreated patients. Future prospective and controlled trials must define the optimal retreatment strategy, as well as the response-predicting factors including HCV genotypes and quantitative HCV-RNA levels.

Adult↗

PubMed1995

[Pelvic recurrence of cervical cancer: the prognostic relationship to the retreatment modalities].

OBJECTIVE: To investigate the prognostic factors in relation to retreatment modalities in patients with recurrent cervical carcinoma. METHODS: According to initial therapy, 194 patients with recurrence were grouped as: (1) surgery, 22 cases; (2) surgery and radiotherapy, 24 cases, and (3) radiotherapy alone, 148 cases. Factors such as clinical stage, sites of recurrence, time of diagnosis of recurrence after initial therapy and modalities of retreatment were analyzed. RESULTS: There were 19 cases alloted to stage I, 51 cases to stage II (IIa 23 and IIb 28) and 124 cases to stage III (IIIa 21 and IIIb 103); histopathologically confirmed squamous cell carcinoma in 181 cases and adenocarcinoma 13 cases. Central recurrences were found in 91 cases and lateral or pelvic recurrences in 103 cases. Time of diagnosis of recurrence within 2 years from initial treatments was shown in 118 patients and above 2 years in 76 patients. In 147 of the 194 patients retreated, those of the group 1 obtained a median survival rate of 24 months, which was significantly longer than that of group 2, and group 3. The sites of recurrence did not significantly affect the survival. CONCLUSION: Radiotherapy remains the treatment of choice for patients with pelvic recurrence after surgery. Previously irradiated patients retreated for recurrence by radiotherapy and (or) chemotherapy had lower response rates. The optimal therapy for these patients should be comprehensive managements including surgery, radiotherapy and chemotherapy.

Carcinoma, Squamous Cell↗

PubMed1996

Paclitaxel retreatment in patients with platinum and paclitaxel resistant ovarian cancer.

The optimal role of paclitaxel in the treatment of epithelial ovarian cancer has not been determined. Dose intense paclitaxel therapy is safe and often recommended as second-line treatment for platinum resistant ovarian cancer. Retreatment with a higher dose-intense schedule of paclitaxel is feasible and patients who had a prior dose of 135 mg/m2 or paclitaxel free interval of at least six months may respond. Sensitivity to initial doses and a prolonged paclitaxel-free interval are predictors of a successful reinduction. We report 10 patients who had paclitaxel as second-line treatment and were later retreated with paclitaxel. Three of these patients had a partial response (30%; 95% CI 6-66%). All but one patient had platinum resistant disease. Initial dose and the best response to initial paclitaxel were assessed in relation to reinduction response. Patients with at least a six-month paclitaxel-free interval and previously low dose paclitaxel (135 mg/m2), or a complete response with high dose paclitaxel (250 mg/m2) may respond to high dose paclitaxel retreatment. Prospective trials of paclitaxel retreatment are warranted.

Adult↗

PubMedDate not supplied

A retreat for families of children recently diagnosed with cancer.

PURPOSE: The authors describe a clinical intervention program designed for children recently diagnosed with cancer and their families. The rationale for a family weekend retreat, the planning process, and its implementation are outlined. DESCRIPTION OF PROGRAM: Staff members (nurses, social workers, child life specialists, and physicians) at the Children's Center for Cancer and Blood Disorders of the Richland Memorial Hospital in Columbia, South Carolina, conducted a comprehensive needs assessment of the families of children recently diagnosed with cancer. Subsequently, staff members planned and implemented the Family Weekend Retreat for these patients and their families. The program was designed to provide education to patients and parents, to reduce isolation within the family and among family systems, and to reduce individual and family stress. RESULTS: Using a 19-item evaluative questionnaire, the participating families indicated that the Family Weekend Retreat met their needs for education, recreation, and mutual support. The families expressed an interest in, and subsequently held, a retreat reunion. CLINICAL IMPLICATIONS: This program may be useful to other clinicians and/or cancer treatment facilities that wish to provide a network of support among families of recently diagnosed children who are struggling through the cancer experience.

Adaptation, Psychological↗

PubMed2006

Pegylated interferon alfa-2b plus ribavirin in the retreatment of interferon-ribavirin nonresponder patients.

BACKGROUND & AIMS: Inadequate data are available about retreatment of nonresponders to interferon (IFN) and ribavirin. Thus, this study evaluated the efficacy and tolerability of a 48-week therapy with pegylated IFN-alpha-2b plus high-dose ribavirin in patients who have failed to respond to the combination. Treatment up to 48 weeks also in patients who have failed to clear hepatitis C virus (HCV) RNA by week 24 was also evaluated. METHODS: One hundred forty-one patients who previously did not respond to IFN and ribavirin, 86% with genotype 1 or 4 infection, 52% with high viral load (>800.000 IU/mL), 22% with cirrhosis, were retreated with pegylated IFN-alpha-2b 1.5 microg/kg per week and ribavirin 1000-1200 mg/day for 48 weeks and followed up for 24 weeks. RESULTS: By intent-to-treat analysis, 20% of patients achieved a sustained virologic response (SVR). SVR of genotype 1 patients was 19%. Independent predictors of SVR were low gamma-glutamyltransferase levels (OR, 22.9; 95% CI: 6.6-79.6) and low viral load (OR, 3.8; 95% CI: 1.1-12.6). Twelve (23%) out of 51 patients who were HCV RNA positive after 24 weeks of therapy achieved a late virologic response (after week 24) and 5 (10%) of them, all with genotype 1, achieved an SVR. Genotype was not associated with response (P = .2) or with early response (P = .3). CONCLUSIONS: Retreatment with pegylated IFN-alpha-2b and ribavirin of multi-experienced and "difficult to treat" nonresponder patients produced a very promising SVR. Accurate selection of patients, such as those with low viral load and low gamma-glutamyltransferase levels, and prolongation of therapy beyond 24 weeks also in HCV RNA-positive patients may further increase the rate of SVR.

Adult↗

PubMed2002

Acute onset of nephrotic syndrome during interferon-alpha retreatment for chronic active hepatitis C.

A 57-year-old woman was scheduled to receive recombinant interferon-alpha retreatment for chronic active hepatitis C. During the course of therapy, the patient showed rapid onset of oliguria, dizziness, edema, and a pre-shock state. She was subsequently admitted to hospital and was diagnosed as having nephrotic syndrome. After admission, albumin-dominant proteinuria persisted despite the discontinuation of interferon therapy. Light microscopy of a renal needle biopsy specimen showed interstitial lymphoid cell infiltration, but no marked changes of the glomeruli and no staining for immunoglobulin or complement. Electron microscopy showed diffuse effacement of the glomerular epithelial foot processes, leading to a diagnosis of minimal change nephrotic syndrome with interstitial nephritis. Proteinuria resolved after the initiation of oral prednisolone therapy (1 mg/kg per day). The number of patients with chronic hepatitis C requiring interferon retreatment is increasing rapidly. We herein report this rare case of acute onset of nephrotic syndrome during interferon-alpha retreatment.

Acute Disease↗

PubMed2006

Efficacy of retreatment techniques for a resin-based root canal obturation material.

Resilon/Epiphany obturation system is emerging as an alternative to gutta-percha (GP). The efficacy of retreatment techniques for Resilon removal has not been determined. The purpose of this study was to evaluate two commonly used retreatment techniques in the removal of Resilon. Sixty single-canal teeth were instrumented and obturated with either Resilon/Epiphany or GP/AH Plus. Each canal was randomly allocated to receive one of the two retreatment techniques-ProFile 0.06 rotary files combined with heat or chloroform. The time required to remove the obturation material was recorded and the cleanliness of canal walls was determined by stereomicroscope and electron microscopy. The results demonstrated that chloroform combined with rotary files was more efficient in material removal compared to heat (p < 0.05). Resilon was faster to remove than GP. Both techniques resulted in cleaner canal walls in the apical third of the teeth obturated with Resilon when compared to GP (p < 0.05).

Analysis of Variance↗