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At least 757 records · Page 42Linked to original sources
PubMed1997

Acute myeloid leukemia following psoralen with ultraviolet A therapy: a fluorescence in situ hybridization study.

A woman with mycosis fungoides treated by psoralen with ultraviolet A (PUVA) and electron beam therapy developed acute myeloid leukemia (AML) three years later. Karyotypic analysis of the leukemia cells revealed monosomy 7. Fluorescence in situ hybridization showed that the monosomy 7 clone had accounted for about a third of the marrow cells after PUVA treatment, but replaced the entire marrow at leukemic transformation. These findings were consistent with a secondary AML evolving from an underlying myelodysplasia, supporting that PUVA therapy might have a mutagenic effect on hematopoietic cells. This might be related to its effect on circulating hematopoietic stem cells.

Chromosomes, Human, Pair 7↗
PubMed1996

Microwave coagulation therapy for hepatocellular carcinoma.

BACKGROUND & AIMS: Surgical resection is not always feasible in patients with hepatocellular carcinoma. Microwave coagulation therapy has been used as an alternative to resection, and its efficacy has been evaluated. METHODS: Nineteen patients with unresectable hepatocellular carcinoma underwent microwave coagulation therapy through laparotomy (n = 12), laparoscopy (n = 5), or thoracotomy (n = 2) because of advanced liver cirrhosis and/or intrahepatic metastases. One nodule was treated in 13 patients, tumor size ranged from 5 to 90 mm. Patient outcomes were studied. RESULTS: Microwave coagulation therapy created a reproducible regional necrosis. Fourteen patients underwent potentially curative treatment; the remaining 5 patients underwent palliative treatment (n = 4) or incomplete tumor coagulation (n = 1). Of the 31 nodules treated, 28 underwent complete tumor ablation. Only 2 patients undergoing laparoscopic microwave coagulation therapy developed local recurrence. The coagulated area subsequently shrank. Patients showed rapid recovery without hepatic dysfunction. Thirteen patients, including 2 long-term survivors, are alive either without tumor (n = 10; 14-64 months) or with tumor (n = 3; 17-22 months). Six patients died of hepatocellular carcinoma (n = 4) or liver insufficiency (n = 2). CONCLUSIONS: This preliminary study suggests the efficacy of microwave coagulation therapy, including safety and potential curability, in patients with hepatocellular carcinoma with advanced liver cirrhosis and multifocal or central tumors.

Adult↗
PubMed2006

The ethics of functional genomics: same, same, but different?

Respect for human life--a notion of worth uniting all members of the human race--constitutes a sense of anthropocentrism that has long been the justification for the enrollment of animals in experimentation executed to develop therapies to alleviate human suffering. Currently, however, advances in functional genomics are causing a qualitative transformation of the rationale for medical research performed on animals. The notion of human distinctness is being fundamentally challenged when gene sequences similar to those found in humans are identified in different species. In this Opinion article, we would like to highlight an inherent tension brought about by the current developments in functional genomics: a tension between the scientific and the ethical status of gene sequences. Is it reasonable to argue that they are the same for all practical purposes but different in ethical status?

Animal Rights↗
PubMed2005

Auditive stimulation therapy as an intervention in subacute and chronic tinnitus: a prospective observational study.

Tinnitus is a noise, a ringing, or a roaring sound in the affected ear and is becoming an increasingly serious problem for health care systems. Integrative treatment concepts are currently regarded as promising therapeutic approaches for managing tinnitus. The aim of this study was to present the results of auditive stimulation therapy, a program of music therapy developed specifically for tinnitus treatment. We collected data on outpatient treatment results from 155 tinnitus patients and evaluated them in a prospective observational study with three defined times of measurement (start, end, and 6 months after the end of treatment). Apart from anamnestic data and subjective evaluation of treatment, the major outcome parameter was the score of the tinnitus questionnaire. To evaluate effectiveness of the therapy, we calculated effect sizes (according to Cohen). Fifty-one percent of the patients were male, and the mean patient age was 49 years. Of the 155 patients, 137 (88%) were capable of gainful employment, which means that they fell in the age range between 18 and 65 years. The duration of tinnitus was more than 6 months for 80% of patients, and 43% had been suffering from tinnitus for more than 3 years. In general, all subscales of the tinnitus questionnaire showed highly significant changes (t-test, p < .01) between the measurement points "start of therapy" and "end of therapy," whereas no significant difference was found between the measurement points "end of therapy" and "follow-up". At follow-up, the values of the subscales were stabilized at a level recorded at the end of the therapy; we did not observe a reduction to the level prior to treatment. The values for the effect sizes mostly ranged between medium (> 0.5) and high (> 0.8). Closer investigations indicated that a combination of music therapy and psychological training rendered the best effect sizes. This study demonstrated that music therapy is an effective integrated treatment approach and offers a way to make progress in tinnitus treatment.

Acoustic Stimulation↗
PubMed2006

Initial data supporting the design of the Candesartan in Heart failure--assessment of reduction in mortality and morbidity (CHARM) programme.

BACKGROUND: The therapies developed to treat heart failure over the years have resulted in a significant improvement in clinical outcome. The 1-year mortality following hospital discharge remains unacceptably high, however. Furthermore, a significant number of patients are unable to tolerate angiotensin-converting enzyme (ACE) inhibitors. Clearly, scope remains for the improvement of neurohormonal blockade in patients with heart failure, and there is a particular need for alternative therapies in patients who are unable to tolerate ACE inhibitors. The use of angiotensin II receptor blockers may provide a means of fulfilling these needs. OBJECTIVES: This paper reviews the studies examining the angiotensin II receptor blocker candesartan in comparison with placebo, in comparison with ACE inhibitors, and in combination with ACE inhibitors. CONCLUSIONS: Overall the review found candesartan was effective and safe in various clinical settings. These initial data were used to design the Candesartan in Heart failure--Assessment of Reduction in Mortality and morbidity (CHARM) programme. The mechanistic studies performed prior to the CHARM programme supported the rationale to design a large trial examining the effects of candesartan on clinical events.

Angiotensin II Type 1 Receptor Blockers↗
PubMed2006

Pharmacological prevention and treatment of acute pancreatitis: where are we now?

Acute pancreatitis is a disease of increasing prevalence, unchanged mortality over many decades, and limited treatment strategies. Progress has been made in developing therapies that reduce the rate of endoscopic retrograde cholangiopancreatography (ERCP)-associated pancreatitis and in preventing infected pancreatic necrosis with intravenous carbapenems. Attempts at reducing pancreatic enzyme output or inhibiting the activity of digestive enzyme proteases have not yielded encouraging results - nor have anti-inflammatory strategies for the treatment of acute pancreatitis been found to be effective so far. Future therapeutic options that are presently being developed or under investigation attempt to restore pancreatic secretory function, interfere with inflammatory pathways in a more effective manner, or inhibit digestive enzyme proteases more selectively.

Analgesics↗
PubMed2003

Detection of clinically significant, occult prostate cancer metastases in lymph nodes using a splice variant-specific rt-PCR assay for human glandular kallikrein.

PURPOSE: To compare the detection of human glandular kallikrein 2 (hK2) mRNA expression in archival lymph nodes with disease progression, the development of prostate cancer metastases, and mortality in patients undergoing radical prostatectomy for locally advanced nonmetastatic prostate cancer. PATIENTS AND METHODS: We evaluated total RNA extracted from fixed, paraffin-embedded, histopathologically normal pelvic lymph nodes, removed at radical prostatectomy, from 199 pT3N0 prostate cancer patients (150 extraprostatic extension only; 49 seminal vesicle involvement) for hK2-expressing cells using a novel reverse transcriptase polymerase chain reaction (RT-PCR)/hK2 assay. Cumulative incidence functions and Cox proportional hazards analyses were performed. RESULTS: Forty patients (20%) had positive results, 80 patients (40%) had negative results, and 79 patients (40%) had equivocal results. RT-PCR/hK2 status was not associated with any pathologic characteristics (P >.05). In postoperative multivariable models, the RT-PCR/hK2 result was associated with prostate cancer progression (P =.001), development of distant metastases (P =.001), and prostate cancer-specific survival (P =.005). In patients experiencing biochemical progression (n = 33), RT-PCR/hK2 status was a predictor of failure to respond to salvage radiotherapy (P =.002). CONCLUSION: RT-PCR/hK2 can detect biologically and clinically significant occult prostate cancer metastases in histopathologically normal lymph nodes. In patients with locally advanced prostate cancer, RT-PCR/hK2 is strongly associated with prostate cancer progression, failure following salvage radiation therapy, development of clinically evident metastases, and prostate cancer-specific mortality after surgery.

Aged↗
PubMed1998

Gastro-oesophageal reflux and Helicobacter pylori.

The nature of the relationship between Helicobacter pylori infection and reflux oesophagitis is still not completely understood. To review the available evidence from the literature concerning the relationship between Helicobacter pylori infection and reflux oesophagitis with or without Barrett's metaplasia, we performed a Medline search to discover all published reports available in this field since the first description of Helicobacter pylori (1984) to April 1998. A total of 37 papers were found addressing the issue. From the available data, it can be concluded that Hp infection has probably only a minor protective role against the development of reflux oesophagitis. The related mechanisms are, however, still to be clarified. The presence of Helicobacter pylori infection is also likely to increase the efficacy of PPI drugs and, conversely, the eradication of the bacterium decreases the drug effect. The bacterial production of ammonia is the most likely factor explaining this observation. Furthermore, it is now sufficiently clear that patients placed on long-term PPI therapy develop atrophic gastritis only if Helicobacter pylori infection is not eradicated. Finally, both the development of metaplastic changes and the progression to severe dysplasia and adenocarcinoma in Barrett's oesophagus patients are phenomena not related to the presence of Helicobacter pylori antral or oesophageal colonization.

Adenocarcinoma↗
PubMed1975

Meningitis developing during cephalothin therapy of septicaemia.

A 63-year-old woman developed pneumococcal meningitis during cephalothin treatment for pneumococcal septicaemia. The poor penetration of this antibiotic over the blood-brain barrier makes it unsuitable for the therapy of meningitis. If cephalothin is used in other serious infections, the patient should be closely observed for the development of meningitis.

Blood-Brain Barrier↗
PubMed1999

Post-mastectomy radiotherapy in pT3N0M0 breast cancer: is it needed?

BACKGROUND AND PURPOSE: It is not been established whether breast cancer patients who have a primary tumor 5 cm or larger but no axillary nodal or distant metastases at the time of the diagnosis (pT3N0M0) benefit from post-operative radiation therapy after mastectomy. MATERIAL AND METHODS: We identified 81 patients with T3N0M0 breast cancer out of the total of 4190 breast cancer patients treated in one university radiotherapy department from 1987 to 1994 from the department patient registry, and examined the clinical records and histopathological slides. RESULTS: Only 38 of the 81 patients had true pT3N0M0 breast cancer after the review (0.9% of the 4190 new breast cancer patients registered in the department from 1987 to 1994). Three (60%) of the five patients who were not treated with post-operative radiation therapy developed locoregional recurrence of breast cancer as compared with only three (9%) of the 33 patients who were given post-operative radiotherapy during a median follow-up of 58 months (P = 0.0003). Patients who were given post-operative radiotherapy had a better distant disease-free survival rate (P = 0.04) and overall survival rate (P = 0.03) than the ones who were not treated with radiation therapy after surgery. Of the 29 patients who had chest wall irradiation only, one had in-field recurrence at the surgical scar, one both at the scar and the unirradiated axilla, and only one (3%) solely in the axilla. CONCLUSIONS: Patients with true pT3N0M0 breast cancer are rare. The results suggest that women with pT3N0M0 breast cancer benefit from post-operative radiotherapy, but the value of irradiating the dissected ipsilateral axilla remains unsettled.

Adult↗
PubMed1997

Gastrointestinal carcinoid tumors: current management strategies.

BACKGROUND: Carcinoid or neuroendocrine tumors of the gastrointestinal tract, although characteristically indolent, are also quite heterogeneous both with respect to histologic and endocrine features and with respect to clinical presentation and behavior. PURPOSE: This study was undertaken to review and summarize the current literature on classification controversies, site-specific carcinoid presentation and behavior, and diagnostic and management strategies for primary and advanced carcinoid tumors and the carcinoid syndrome. RESULTS: For carcinoid tumors, oncologic results depend on the location of the primary tumor, extent of locoregional and metastatic disease, functioning status of the tumor, and the feasibility of complete surgical extirpation. Whereas favorable survival rates are typically observed for appendiceal and rectal primaries, less favorable rates are often observed for colonic and ileal tumors. A search for additional tumors is generally advised because multiple carcinoids and second neoplasms are not uncommon. Because of the indolent nature of the tumor and because these therapies have been shown to improve quality and quantity of life, otherwise fit patients with advanced carcinoid disease should be treated with aggressive medical and surgical therapies. Development of a malignant carcinoid syndrome indicates the presence of a functionally active carcinoid tumor and portends a poor prognosis. CONCLUSION: Gastrointestinal carcinoids, although malignant, behave differently from other carcinomas. Results are highly variable and must be individualized according to the site of the primary tumor, extent of spread, and general condition of the patient. A prolongation of quality life can often be accomplished through aggressive medical and surgical therapies.

Biomarkers↗
PubMed1996

Surgical management of rhabdomyosarcoma in children.

This review of the past year's literature summarizes the most relevant advances in the surgical treatment of rhabdomyosarcomas. Improved responses to multimodality therapy and advances in surgical techniques have allowed for more aggressive surgical resection in some patients and less extensive resections in others. The Intergroup Rhabdomyosarcoma Study committee continues to examine prognostic factors in attempts to provide risk-adapted therapy. Development and evaluation of specific recommendations for surgical treatment by site of tumor continue to be a focus of the Intergroup Rhabdomyosarcoma Study. The overall trend is toward less radical surgical intervention with organ preservation.

Chemotherapy, Adjuvant↗
PubMed2005

Recurrent and self-healing cutaneous monoclonal plasmablastic infiltrates in a patient with AIDS and Kaposi sarcoma.

Infection with human immunodeficiency virus (HIV) increases the risk of developing non-Hodgkin lymphoma. Plasmablastic lymphoma (PBL) is a rare variant of diffuse large cell lymphoma that often involves the oral cavity of HIV+ patients. It is characterized by immunoblastic morphology and plasma cell phenotype. Cutaneous involvement in PBL appears to be rare. We report a 44-year-old man with AIDS and Kaposi sarcoma (KS) previously treated with doxorubicin who, following treatment with highly active antiretroviral therapy, developed an erythematous infiltrated nodule on the right arm. Histology showed subcutaneous fat necrosis and clusters of atypical large plasma cells (plasmablastic cells). Immunohistochemistry revealed lambda light chain restriction. Epstein-Barr virus (EBV) mRNA was detected by in situ hybridization within the plasmablastic cells. Polymerase chain reaction amplification with specific primers for human herpesvirus 8 (HHV-8) performed on the skin biopsy specimen detected a specific band. A complete screening (bone marrow biopsy, computed tomographic scan, radiological survey) disclosed no abnormalities. The lesion resolved spontaneously after 3 months. Two years later an infiltrated plaque developed on the abdominal wall. The clinical and histopathological features of this new lesion were similar to those observed 2 years previously. No evidence of extracutaneous involvement was detected. The lesion again resolved spontaneously after 25 days. PBL may be seen in patients with transplants or receiving chemotherapy, but is usually observed in patients with advanced AIDS. The observation of recurrent self-healing EBV- and HHV-8-associated cutaneous monoclonal plasmablastic infiltrates, in a patient with AIDS and KS, expands the clinical spectrum of AIDS-associated plasmablastic lymphoproliferative disorders.

Acquired Immunodeficiency Syndrome↗
PubMed1977

Cultural adaptability as an attribute of therapies: the case of Morita psychotherapy.

Morita psychotherapy, a form of therapy developed in Japan some sixty years ago, has survived extensive changes in Japanese society, and is now enjoying popularity in the United States. This gives us an opportunity to look closely at the concept of 'cultural fit' between an important therapeutic technique and its social milieu, and to speculate about recent changes in American culture that may account for the growing popularity of Moritism. In contrast to Western style 'talking therapies' like psychoanalysis, Morita psychotherapy is relatively group-centered, ritualistic, and behavioristic. On would expect to find these features in a Japanese therapy, but their acceptance in America suggests that previously popular Western techniques may not be optimum for handling certain problems of the post-industrial American. McLuhan, Peacock, Douglas, and others have suggested some emerging traits of Western character that might shed some light on this question.

Adaptation, Psychological↗
PubMed1996

The interaction of the alliance and therapy microprocess: a sequential analysis.

The interaction of the working alliance with the therapy microprocess was explored in a sequential analytic study of brief therapy (N = 32). The alliance was largely formed within the first session and was most associated with a mutual emotional engagement process. Thereafter, log-linear modeling revealed marked alliance-related and primarily phase-specific effects on the therapy microprocesses. The alliance was associated with differing patterns of therapy activities, topics, emotions, and verbal content. High-alliance midtherapy displayed more of an alternating pattern of therapist-patient emotional engagement, although therapists also appeared to take greater charge in midtherapy. High-alliance patients were generally more emotionally engaged and responded with less dejection to therapists. The alliance-dependent differences in verbal content appeared to be secondary, with the most obvious negative effects of low-alliance levels appearing in midtherapy. Apparently, the high- and low-alliance therapies developed somewhat differently, a factor that may need to be considered in constructing theories of therapeutic change.

Adult↗
PubMed1984

Review of recent experience in the treatment of carcinoma of the anal canal.

A retrospective study was conducted for evaluation for the therapeutic efficacy of the various modalities for treatment of carcinoma of the anal canal. Thirty-seven patients were reviewed. Patients commonly presented in their sixth decade of life and a four-fold predominance of women was noted. Tumor histopathology was of little relevance in determining prognosis. Surgery alone was performed on 15 patients, consisting of either abdominoperineal resection or wide excision. Multidisciplinary therapy as described by Nigro et al., 10-12 which included preoperative chemotherapy and radiation followed by surgery within a period of 4-6 weeks, was used to treat 13 patients. Radiation alone or in combination with surgery was used to treat six patients. One patient refused further treatment following radiation and chemotherapy, and the remaining two patients refused treatment from the onset. There was no difference in survival in Stages O and I patients when treated by surgery alone or with the Nigro protocol. However, Stages II and III patients had a more favorable outcome when treated by the Nigro protocol than by any other regimen. Thirteen of 21 patients treated by surgery and/or radiation therapy developed recurrence, resulting in seven deaths. Three out of 13 patients treated by the Nigro protocol developed recurrence, all of whom are alive and well following salvage treatment. Despite its infrequent use, a favorable trend is noted as a result of utilizing the multimodality protocol, particularly in patients with invasive disease.

Aged↗
PubMed2007

Targeted interventions for difficult-to-treat asthma.

Chronic persistent asthma has a significant burden in terms of healthcare-related expenses, decreased productivity and reduced quality of life for patients. Currently available guideline-directed therapy can control the majority of patients, but roughly one-third of patients will require additional care. This article reviews the barriers that hinder the ability of practitioners and patients to gain and maintain control of asthma, including inaccurate assessment measures, variability in patient response, and poor adherence. Strategies aimed at controlling difficult-to-treat disease, such as the use of biomarkers to assess control, are discussed. Newer and developing therapies that cater to specific types of asthmatic patients and may lead to improved outcomes in those patients for whom standard care is insufficient are also looked at.

Anti-Asthmatic Agents↗
PubMed1979

Hepatic toxicity of adjuvant chemotherapy for carcinoma of the breast.

Four patients developed abnormal liver function tests and focal defects on liver scan while receiving cyclophosphamide, methotrexate and 5-fluorouracil as adjuvant chemotherapy following mastectomy for breast cancer. Liver biopsies showed severe focal inflammation. The biopsy findings and the subsequent clinical course of the patients strongly suggest that these abnormalities were due to hepatic toxicity of the chemotherapy and not metastic breast cancer. A review of serial liver function tests performed on 24 patients in that chemotherapy program revealed that four out of eight patients with elevated alkaline phosphatase prior to therapy developed early metastatic cancer. Elevated alkaline phosphatase occurring during chemotherapy on the other hand was quite common but more likely due to hepatic toxicity of the drugs. The development of abnormal liver function tests even in association with focal defects on liver scan is not sufficient to diagnose metastatic breast cancer in patients receiving adjuvant chemotherapy.

Adult↗