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At least 793 records · Page 44Linked to original sources
PubMed2005

Advances in nasopharyngeal carcinoma.

PURPOSE OF REVIEW: Intergroup 0099 established the role of concurrent chemotherapy with radiation therapy in the treatment of locally advanced nasopharyngeal carcinoma, but its reproducibility was unclear and chemotherapy compliance was poor. Multiple concurrent chemoradiation phase III trials were initiated in response to the Intergroup trial, and technologic advances in radiotherapy were explored to improve the therapeutic ratio. This review highlights recent advances in the management of nasopharyngeal carcinoma as a result of these endeavors. RECENT FINDINGS: Five randomized phase III trials confirmed the benefit of concurrent chemoradiation over radiation therapy alone, firmly establishing concurrent chemoradiation as the standard of care in locally advanced nasopharyngeal carcinoma. Each of these studies used conventional radiation therapy and noted an increase in toxicity over radiation therapy alone. Intensity-modulated radiation therapy is an advanced form of three-dimensional conformal radiotherapy which allows delivery of high doses of radiation to the tumor while sparing adjacent normal tissues, leading to improved local control and decreased radiation therapy-induced toxicities. Distant metastasis remains a significant problem despite intensity-modulated radiation therapy. Taxane-based induction chemotherapy seems promising in phase II studies. Targeted therapies remain a major area of interest and require further investigation. SUMMARY: Cisplatin-based concurrent chemoradiation followed by adjuvant chemotherapy is the standard of care for locally advanced nasopharyngeal carcinoma. Intensity-modulated radiation therapy has undergone a rapid evolution and is replacing conventional radiation therapy in many institutions. A multidisciplinary effort is under way to explore more effective systemic therapy to improve the distant metastasis free rates.

Antineoplastic Combined Chemotherapy Protocols↗
PubMed2005

Concurrent occurrence of allergic granulomatous angiitis and temporal arteritis: a case report and review of the literature.

Allergic granulomatous angiitis (AGA) is a disease entity that was first distinguished from classical polyarteritis nodosa by Churg and Strauss in 1951, and is characterized by the clinical features of allergic rhinitis or bronchial asthma, eosinophilia, and vasculitis. Allergic granulomatous angiitis has been described to mainly involve small vessels. We herein describe a case of Churg-Strauss syndrome which demonstrated the clinical and laboratory findings supporting a diagnosis of AGA and was also associated with the clinical and pathological findings for temporal arteritis, which was characterized by eosinophil infiltration and granuloma formation of the temporal artery (middle-sized vessel).

Journal Article↗
PubMed2006

Concurrent herpes simplex viral lymphadenitis and mantle cell lymphoma: a case report and review of the literature.

We report a case of localized herpes simplex virus lymphadenitis in a patient with mantle cell lymphoma (MCL). A 43-year-old woman with a 2-month history of lymphadenitis and peripheral lymphocytosis received a diagnosis of stage IV MCL based on histologic, flow cytometric, and immunohistochemical findings. One week after completion of chemotherapy, she presented with rapidly enlarging bilateral cervical lymph nodes, a retropharyngeal mass, and incipient respiratory compromise. Multiple biopsies of the cervical nodes and oropharynx that were submitted for morphologic, flow cytometric, and immunohistochemical studies revealed involvement by MCL with superimposed herpes simplex virus lymphadenitis. The recognition of herpes simplex virus infection with MCL is important for treatment as well as to rule out transformation of MCL to a higher-grade lesion.

Adult↗
PubMed2005

[Attempts to improve organ preservation in patients with squamous cell carcinoma of the head and neck].

When surgical resections are performed for patients with locally advanced head and neck cancer, a critical consideration is which organs and functions of patients are sacrificed. In attempts to improve the organ preservation rate in patients with advanced squamous cell carcinoma of the head and neck (SCCHN), chemotherapy has been used either before(neoadjuvant or induction), with (concurrent or concomitant), after (adjuvant) radiotherapy, or as alternating treatment with radiotherapy. A recent systematic review using meta-analysis has revealed that concurrent chemotherapy with radiotherapy shows a significant benefit for the survival rate of patients with SCCHN when compared with radiotherapy alone, and is superior to neoadjuvant chemotherapy. However, no standard concurrent chemoradiotherapy regimen has been defined,although concurrent chemotherapy together with regimens including cisplatin has been considered to be most effective for SCCHN. We combined radiotherapy concurrently with chemotherapy including cisplatin, 5-fluorouracil, methotrexate, and leucovorin in patients with advanced resectable SCC of the hypopharynx to minimize the necessity of radical surgery and preserve the functional larynx. In conclusion, previous reports and our data show that an organ preservation treatment approach using concurrent chemoradiotherapy is feasible.

Adult↗
PubMed1990

[Combination radiotherapy and chemotherapy in bronchial cancer: benefits and limitations].

A minority of lung cancers is potentially curable by surgery. Radiotherapy, chemotherapy or a combination of both play an important role in this type of cancer. There are three major ways of combining radiotherapy and chemotherapy: sequential combination, concurrent combination and alternating combination. This review of the literature focuses on combined modalities in inoperable, non-metastatic, non-small cell carcinoma of the lung. Widest experience has been accumulated with sequential combinations. None of the randomized trials demonstrated that this type of association is better than radiation alone. Concurrent combination schedules are more recent: phase II studies have shown a high response rate (50-80%) but modest median survival (9-12 months). Rapidly alternating programs are also recent. They are based on mathematical models and experimental studies showing a high degree of activity with this type of association. Clinical phase II studies are still limited; they demonstrate a high response rate (50-80%) but the impact on survival cannot be assessed at this time. Intermediate analysis of a collaborative study (Groupe d'Oncologie Thoracique Alpine) with 50 patients is encouraging: we obtained a high response rate with 80% overall response (32% complete and 48% partial responses) and median survival of 16 months. We will continue to investigate this type of combined modality.

Antineoplastic Combined Chemotherapy Protocols↗
PubMed1989

Monitoring and evaluating psychotropic drug use for persons with mental retardation: a follow-up report.

Psychotropic drug use in a large Massachusetts public facility for mentally retarded adults was reduced and maintained at approximately 20% over an 8-year period during which a monitoring and evaluating procedure (including interdisciplinary team review, identification of target behaviors, and concurrent alternative forms of treatment) was in effect. Average daily dosages for antipsychotics were lower than usually reported in institutional settings. Follow-up of 225 individuals receiving psychotropics showed that of 130 withdrawn, 69% remained off drugs, demonstrating sustained effectiveness of the review process.

Adult↗
PubMed1995

Parkinsonism in motor neuron disease: case report and literature review.

This report describes a patient who had clinical features of both motor neuron disease and Parkinson's disease. Neuropathological examination and immunocytochemical studies showed that he had motor neuron disease of the progressive muscular atrophy type, and Lewy body Parkinson's disease, with intracytoplasmic inclusion bodies characteristic of both conditions. This is the first detailed description of these two diseases occurring concurrently in the same patient. A review of all previously reported cases of combined motor neuron disease and parkinsonism has led to the following conclusions: (1) that these two neuropathologically defined diseases occur together very infrequently, but (2) that parkinsonism and substantia nigra degeneration are not uncommon as part of the multi-system disease process underlying motor neuron disease.

Aged↗
PubMed2002

ECT use delayed in the presence of comorbid mental retardation: a review of clinical and ethical issues.

The objective is to develop a clinically and ethically supportive literature for the use of electroconvulsive therapy (ECT) in patients with mental retardation who are concurrently experiencing a significant psychiatric illness. A review of both the clinical and ethical literature using traditional, manual library methods and the Medline and Psychlit databases was undertaken. In addition, a record of all patients who had undergone ECT at our facility between 1995 and 2000 was examined for patients with comorbid mental retardation. We found that the use of ECT for people who have both a psychiatric illness and comorbid mental retardation was significantly delayed. However, a rapid response to index, continuation, and maintenance ECT was also noted. Further, this response occurred with routine ECT administered irrespective of age, gender, diagnosis, stimulus parameters, electrode placement, or number of treatments. In addition, the successful use of right-sided unilateral ECT at six times the initial seizure threshold was reported in a patient who had previously responded to bilateral ECT. A cogent ethical justification was developed with the use of the rule of double effect. We concluded that for patients who have mental retardation and who subsequently develop a psychiatric illness, ECT is delayed and left as a treatment of last choice. Although the literature is sparse and uncontrolled, a cogent clinical and ethical justification may help negotiate these and other delays.

Comorbidity↗
PubMed1981

Bullous pemphigoid: the frequency of mucosal involvement and concurrent malignancy related to indirect immunofluorescence findings.

A review of 124 cases of bullous pemphigoid was made and the clinical findings correlated with the results of indirect immunofluorescence. A circulating IgG basement membrane zone (BMZ) antibody was detected in the serum of eighty-nine (72%) of the patients. Antibody titres in these patients did not correlate with the extent of the disease or with the presence of mucous membrane lesions. Indeed, oral lesions were more common in the thirty-five sero-negative patients with 17% of such patients being affected compared to only 10% of those with positive indirect immunofluorescence findings. This difference, however, was not statistically significant. Concurrent malignant disease (i.e. malignancy occurring within 6 months of pemphigoid being diagnosed) occurred in eight of the seronegative group (23%) and in only four of the eighty-nine seropositive cases (4%); this difference was significant. The association of bullous pemphigoid and malignant disease still remains controversial, but those who believe that the relationship is coincidental must now explain why concurrent malignant disease is more common in patients who have bullous pemphigoid and negative indirect immunofluorescence findings.

Adult↗
PubMedDate not supplied

[Personality disorders and substance abuse disorders. Psychosocial strategies].

The article begin with a review of the high prevalence of concurrent mental illness and substance abuse disorders among general and clinical populations, highlighting the need for development of appropriate services to treat these persons. Several studies have revealed a significant adverse impact of comorbid personality disorders on treatment tenure and outcome in substance abuse populations and vice versa. We review findings on the longitudinal course of dual disorders in traditional treatment systems, which provide separate mental health and substance abuse programs, and describe new programs that integrate both types of treatment at the clinical level. This is followed by a description of main difficulties to do with outcome and treatment retention. Finally, we review the effectiveness of several specific treatments programs within psychiatric care for patients who have a dual diagnosis of a severe personality disorder and a substance abuse disorder. Such programs include, brief integrated programs based on the disease-and-recovery model or on the cognitive-behavioral model, comprehensive integrated assertive programs and intensive partial hospitalization programs. We conclude, that although several program features appear to be associated with effectiveness, there is no clear evidence supporting an advantage of any type of program when co-occurring substance abuse with severe personality disorder. Implementation of new specialized services for dual disorders should be within the context of simple, well designed controlled studies.

Diagnosis, Dual (Psychiatry)↗
PubMed1982

The effect of concurrent feedback in reducing inappropriate hospital utilization.

This study conducted in four general hospitals, evaluates the effectiveness of feedback from utilization review coordinators in reducing the number of inappropriate hospital days. Experimental control was exerted over the type of feedback provided in the utilization review process to produce four treatment groups (including a control group) that vary according to 1) the channel used to inform an attending physician of a probable inappropriately located patient and 2) the amount of discretion permitted the nurse coordinator in deciding whether, when and to whom this information is provided. The results of the study indicate that physician and hospital performance in utilization review, measured both by inappropriate patient days and length of stay, are affected by the feedback strategy employed. For patients inappropriately located for a portion of their hospital stay, provision of concurrent feedback resulted in reduction of approximately two thirds of an inappropriate day and two and one half total days, compared with patients for whom no feedback was provided or for whom physician advisor involvement was required. In addition, the effect of reasons causing patients to be inappropriately located (barriers) was assessed. Barriers outside the realm of influence of the hospital or the physician were found to impede the effectiveness of the utilization review systems.

California↗
PubMed1995

Malacoplakia of the epididymis. Report of a case and review of the literature.

A 65-year-old diabetic man presented with a painful swelling of his right epididymis. Urine culture was sterile. Semicastration was performed and histology revealed malacoplakia of the epididymis without involvement of the testis. Histologic workup demonstrated typical von Hansemann cells and Michaelis-Gutmann bodies stained by von Kossa's stain. This is the 19th case of epididymal malacoplakia and the 9th case of epididymal malacoplakia without concurrent involvement of the testis. Literature review shows that the present case is typical with respect to the clinical presentation and with regard to the age of presentation. The fact that this patient was suffering from diabetes mellitus lends some support to the assumption that a compromised immune status could be etiologic in malacoplakia.

Aged↗
PubMed2003

Breast cancer and pregnancy: a diagnostic and management dilemma.

BACKGROUND: The purpose of the present paper was to review the current knowledge of pregnancy concurrent with a diagnosis of breast cancer, and how best to manage this group of women and those breast cancer survivors who may subsequently conceive. RESULTS: Pregnancy-associated breast cancer or gestational breast cancer is defined as breast cancer diagnosed during pregnancy or in the 12 months post-partum. A review of the current literature on breast cancer-related pregnancy suggests an incidence of between 0.7 and 3.9%. The prognosis is thought not to be significantly different from non-pregnancy-associated breast cancer, except in cases where a delay in diagnosis is associated with more advanced disease. The treatment is similar to non-pregnant cases, with the exception of radiotherapy, which is contraindicated throughout pregnancy; and chemotherapy, which is contraindicated during the first trimester. Few breast cancer survivors go on to conceive, but those who do have no worse breast cancer or pregnancy outcomes. CONCLUSION: Most of the research in this field has come from small, specialized institutions and may not reflect what occurs in the wider community. Further population-based research in this area is needed, and is currently being undertaken in Western Australia.

Antineoplastic Agents↗
PubMed1994

Possible interactions with terfenadine or astemizole.

Concurrent use of terfenadine or astemizole with erythromycin or ketoconazole can prolong the QT interval and produce potentially fatal ventricular arrhythmias. We examine the frequency and patterns of concurrent prescribing and suggest methods to reduce the incidence of serious drug interactions. By retrospectively reviewing Oregon Medicaid prescription claims data over 22 months, we determined the frequency of concurrent prescribing of terfenadine or astemizole with macrolide antibiotics or ketoconazole. From 1991 to 1992, terfenadine use increased by 29%, with a seasonal peak in June of each year. Terfenadine was one of the most prescribed medications from March through July 1992. During the 22 months reviewed, there were 122 episodes of concurrent use of terfenadine or astemizole with macrolide antibiotics or ketoconazole. Most of these episodes (94%) involved terfenadine. The frequency of concurrent use increased more than threefold from 1991 to 1992. Although patients received prescriptions from different physicians in 48% of these episodes, they used different pharmacies only 3% of the time. We demonstrate that terfenadine use is extensive and increasing, thus increasing the possibility of serious interactions, and many physicians may remain unaware of this potential. Effective prospective screening by pharmacists could dramatically reduce the incidence of concurrent prescribing. Physicians must be aware of the potential for these drug interactions, avoid prescribing these medications concurrently, and consider these interactions in the evaluation of syncope and cardiac arrhythmias.

Adolescent↗
PubMedDate not supplied

The development of a partial hospitalization program for mentally ill chemically abusing (MICA) patients.

The article begins with a review of the high prevalence of concurrent mental illness and chemical abuse (MICA) disorders among clinical populations, highlighting the need for development of appropriate services to treat these persons. This is followed by a description of a partial hospitalization program developed at the University of Rochester Medical Center-Strong Memorial Hospital, established to treat MICA patients. The program description includes information pertaining to the mission of the program, treatment setting, staffing, schedule, and diagnostic and sociodemographic data on 50 consecutive patients admitted to the program. It includes a review of the major goals of the program and the manner in which each of these goals is addressed. This is followed by a discussion of several arguments for the inclusion of patients with personality disorders in MICA treatment when there is concurrent substance abuse. It concludes with a case vignette of a patient treated in the MICA program.

Adaptation, Psychological↗
PubMed2003

Altered fractionation and combined radio-chemotherapy approaches: pioneering new opportunities in head and neck oncology.

Squamous cell carcinoma of the head and neck (HNSCC) are increasingly treated by multimodality approaches combining surgery, radiotherapy and chemotherapy. Randomised controlled trials have demonstrated major improvements in loco-regional tumour control from altered fractionation radiotherapy, accelerated fractionation and hyperfractionation, as compared with conventional fractionation. This experience is summarised, and the limit as to how far these modifications can be taken is discussed. It is emphasised that radiation fractionation will need to be optimised separately in multimodality strategies. Combined chemotherapy and radiotherapy has also been shown in phase III trials to produce an improved survival and an improved disease control. Chemotherapy may be given as neoadjuvant, concurrent or adjuvant treatment and the biological rationales for each of these, and the data supporting them, are reviewed. Although, large meta-analyses have shown concurrent chemoradiation to be the most effective, there is still a strong rationale for trying to develop neoadjuvant and adjuvant schedules. New, more active drugs may be important in this context. As therapy is becoming more intense, a careful recording and reporting of treatment-related morbidity is a crucial element in estimating the therapeutic gain from competing therapeutic management strategies. Development of non-cytostatic drugs and individualization of therapy using molecular prognostic markers are exciting areas of research with a great potential for improving therapy in the next decade and these are briefly discussed. Finally, a number of avenues for further research are identified.

Antineoplastic Agents↗
PubMed2001

Exercise interventions during cancer treatment: biopsychosocial outcomes.

More than 1.2 million Americans are diagnosed with cancer each year, and many receive intensive medical treatments. Currently, exercise is not considered a standard quality-of -life intervention for cancer patients. In this article, 11 studies are reviewed that have examined exercise interventions concurrent with cancer treatment. The key conclusion is that exercise improves a wide range of biopsychosocial outcomes in cancer patients, but much more reserch is needed.

Exercise Therapy↗