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PubMed2004

A comparison of retreatment decisions among general dental practitioners and endodontists.

This study compared the difference in decision making regarding retreatment of endodontically treated teeth by general dental practitioners and endodontists. Thirty radiographs of endodontically treated teeth taken from undergraduate records with their respective case descriptions were submitted to fifteen endodontists and fifteen general dental practitioners. Seven treatment alternatives were given as choices; reasons for retreatment, if chosen, were also requested and presented as choices. The results showed statistically different decisions among these two groups regarding retreatment cases. More endodontists opted for retreatment of cases, while higher percentages of general dentists decided to observe, not treat or extract. To prevent misdiagnosis and eventually mistreatment, endodontic decision making should be taught. Currently, there are no specific guidelines for management of failed root canal retreatment. It is suggested that guidelines generated by evidence-based dentistry may produce less variation in clinical decision making.

Adolescent↗
PubMed2005

Retreatment of lung adenocarcinoma patients with gefitinib who had experienced favorable results from their initial treatment with this selective epidermal growth factor receptor inhibitor: a report of three cases.

Gefitinib is a selective inhibitor of epidermal growth factor receptor (EGFR) tyrosine kinases, and shows favorable antitumor activity against chemorefractory non-small cell lung cancer (NSCLC). The majority of responders (patients who are sensitive to gefitinib), however, relapse within 1.5 years, indicating an acquired resistance to gefitinib. Here we report three chemotherapy refractory NSCLC patients who were retreated with gefitinib. All three cases were nonsmokers and showed an adenocarcinoma histology. While they had experienced successful control from their initial treatment with gefitinib for more than 12 months, gefitinib therapy was terminated because two cases (cases 1 and 3) relapsed during the therapy and case 2 suffered alveolar hemorrhage. After more than 7 months from the time of discontinuation of the initial gefitinib treatment, they were retreated with gefitinib, as further tumor progression was observed. Of the three cases, cases 1 and 2 were well controlled by retreatment with gefitinib monotherapy for more than 7 months, suggesting sensitivity to retreatment. Case 3 also showed a regression in size of several tumors, while some other lesions progressively enlarged and developed a malignant pleural effusion after 4 months. These observations suggest the possibility that retreatment with gefitinib might be useful when 1) initial treatment shows a favorable clinical response, and 2) there has been a period of time following the termination of the initial gefitinib treatment.

Adenocarcinoma↗
PubMed2005

[Retreatment of patients with chronic hepatitis C].

Impressive gains have been made in the treatment of chronic hepatitis C virus (HCV) infection during the past decade. As the treatment for chronic hepatic C has improved, the question has arisen as to whether patients who failed previous HCV treatment regimens should be retreated. Several recent studies involving retreatment have established that a small but significant increase in sustained virologic response (SVR) resulted when nonresponders to prior interferon monotherapy were retreated with interferon and ribavirin. Given the superior results observed with pegylated interferon and ribavirin in the treatment of naive population, it is now appropriate to consider whether retreating previous relapsers and nonreponders, particularly nonresponders to conventional interferon and ribavirin, will be effective. Such treatment would be most advantageous for patients with advanced fibrosis or cirrhosis who are at the highest risk of developing complications of advanced liver disease, including hepatocellular carcinoma. Namely, there is no doubt that interferon-based regimens may reduce hepatic inflammation in the abscence of SVR. For this reason, patients with advanced liver disease receive histologic benefit from therapy in addition to the potential benefit of viral eradication, because progression of fibrosis to cirrhosis is a function of hepatic inflammation. A number of investigator-initiated clinical trials have been started to study response in prior nonresponders and relapsers retreated with pegylated interferon and ribavirin. From the data obtained from these trials, so far is clear that combined therapy can clear HCV-RNA in a significant number of prior nonresponders (25% to 40%) while on treatment, yet the rate of SVR appears to be by far lower (20%). Better results have been reported with relapsers to prior combination therapy. Moreover, preliminary results from the HALT-C trial have shown that maintenance therapy with pegylated interferon and ribavirin can significantly delay fibrosis progression and reduce the risk of hepatic decompensation and hepatocellular carcinoma and the need of liver transplantation. According to these results, many authors have proposed a course of combination therapy with pegylated interferon and ribavirin for relapsers and nonresponders with advanced fibrosis and cirrhosis.

Antiviral Agents↗
PubMed1996

Endodontic retreatment. 2: Methods.

The best method for retreating a tooth that has already undergone root treatment will depend on the root filling technique and material used; a combination of retreatment techniques may be required. The correct method, combined with the required equipment, skill and experience, are necessary to produce a high standard of retreatment and a successful result. In part 1 of this article, the indications and case selection for root canal retreatment were discussed; this article will now discuss the methods of retreatment available.

Dental Debonding↗
PubMed1999

Retreatment of chronic hepatitis B e antigen-positive patients with recombinant interferon alfa-2a. The European Concerted Action on Viral Hepatitis (EUROHEP).

Fifty-seven patients with chronic hepatitis B, hepatitis B virus (HBV) e antigen (HBeAg) and HBV DNA positivity, and aminotransferase elevation despite a previous course of any type of adequate interferon alfa (IFN-alpha) therapy were included in a multicenter prospective randomized controlled trial. The objective of the study was to compare a second course of IFN-alpha therapy (9 million units [MU] of IFN-alpha-2a, Roferon-A, thrice weekly for 6 months) versus no therapy in terms of loss of HBV DNA and HBeAg. At the end of the study, a sustained clearance of HBV DNA and HBeAg was observed in 9 of the 27 (33.3%) patients who had received retreatment with IFN-alpha compared with 3/30 (10%) patients who spontaneously cleared these markers in the untreated control group (chi2 = 4.66, P =.031; odds ratio: 4.5, 95%; confidence interval: 1.1-18.9). None of the responders lost HBsAg. Patients retreated with IFN-alpha were more likely to have biochemical remission in association with HBV clearance (5/27, 18.5%) compared with untreated patients (1/30, 3. 3%; Fisher's exact test P =.09 ). Histological improvement in the liver necroinflammatory activity was observed among sustained responders to IFN-alpha retreatment, consisting of regression of the portal and periportal inflammation and of the piecemeal necrosis; there was no change in the degree of liver fibrosis. Side effects were similar to those previously reported during IFN-alpha treatment; these were mild and reversible on IFN-alpha discontinuation. None of the baseline features were associated with response by Cox's regression analysis. In summary, viremic patients with chronic HBeAg-positive hepatitis may experience disease remission following retreatment with IFN-alpha. Thus, retreatment with IFN-alpha may be considered a therapeutic option.

Adolescent↗
PubMed1998

Taxol hypersensitivity: rapid retreatment is safe and cost effective.

OBJECTIVE: The aim of this study was to describe a rapid retreatment strategy that is safe and cost effective in ovarian cancer patients with Taxol hypersensitivity reactions. METHODS: A retrospective review of 91 women receiving Taxol-based chemotherapy at the University of Iowa Hospitals and Clinics between October 1991 and July 1996 was performed. All patients who developed hypersensitivity reactions to Taxol were identified and their treatment course and outcome were reviewed. RESULTS: Seven women (7.7%) developed hypersensitivity reactions. All received standard premedications consisting of corticosteroids and histamine blockers. Six of the seven were rechallenged with the original Taxol solution starting at a slower rate. In these cases the infusion was completed within 24 h and none of these patients had a reaction in subsequent courses. One patient was not retreated due to the severity of her reaction during a 3-h infusion. CONCLUSION: Retreatment with the original Taxol solution is safe and cost effective in most patients with hypersensitivity reactions. Retreatment with Taxol should be completed within 24 h. A schema for retreatment is presented.

Adrenal Cortex Hormones↗
PubMed1994

Interferon retreatment of nonresponders with HCV-RNA-positive chronic hepatitis C.

Interferon has been shown to be an effective treatment for some patients with chronic hepatitis C. In this study, the value of retreatment of nonresponders to interferon was investigated. Thirty-eight patients with hepatitis C virus (HCV)-RNA-positive chronic hepatitis C who had been treated with beta-interferon but still showed an alanine aminotransferase (ALT) level > 50 KU upon completion of therapy were retreated with alpha-interferon. Eight patients (21.1%) had normalization of ALT levels for at least 6 months after the completion of retreatment. The factors related to normalization of ALT levels after interferon retreatment were studied. Of 16 patients with transient HCV-RNA negativity 1 month after the initial interferon therapy, 7 (43.8%) had a complete response, with normalization of ALT levels and undetectable HCV-RNA, more than 6 months after interferon retreatment. On the other hand, of the 22 patients with HCV-RNA activity 1 month after the initial interferon therapy, only 1 (4.5%) had a complete response. Multivariate analysis, using a multiple logistic model, indicated that a complete response to readministration of interferon was most strongly correlated to transient negative conversion for HCV-RNA after the initial course of treatment.

Alanine Transaminase↗
PubMed2002

Retreat site selection and social organization in captive electric fish, Apteronotus leptorhynchus.

Gymnotiform fish use their electric organ discharge for electrolocation and communication. They are active nocturnally and seek retreat sites during the day. We examined retreat site selection in Apteronotus leptorhynchus by assessing their preference for retreat tubes that differed in opacity and dimension. Isolated fish preferred opaque to clear tubes, long and narrow diameter tubes to short, wide diameter tubes, and open-ended to closed tubes. We also assessed how groups of fish distributed themselves in tubes according to sex and electric organ discharge frequency under four conditions: (1) unlimited tube availability, (2) limited tube availability, (3) variation in tube opacity, and (4) variation in tube dimension. When tube availability was unlimited, fish generally preferred to occupy tubes alone. However, females, but not males, often cohabited tubes with consexuals. When tube availability was limited, females were more often than males found outside of tubes. When tubes varied by opacity and dimension, fish clustered most commonly in preferred tube types (opaque and long tubes). Males with the highest electric organ discharge frequencies usually occupied the most preferred tube type. Thus, fish have clear preferences in selecting retreat sites and groups of fish reveal their dominance relationships when presented with variation in retreat sites.

Animal Communication↗
PubMed1997

Preterm lung function after retreatment with antenatal betamethasone in preterm lambs.

OBJECTIVE: We hypothesized that two doses of betamethasone administered 1 week apart would further enhance postnatal pulmonary function in preterm lambs (compared with a single dose). STUDY DESIGN: Fetal sheep (121 days' gestation) randomly received saline solution or betamethasone (0.5 mg/kg) as a single injection. Six days later fetal sheep were retreated with either saline solution or corticosteroid, and postnatal lung function was evaluated 1 day later. RESULTS: Betamethasone improved compliance and ventilation efficiency index nearly 50%, and total lung volume increased twofold. No effects of treatment-to-delivery interval (1 vs 7 days) or corticosteroid retreatment on pulmonary function were apparent. Although surfactant pool sizes increased as a function of duration of exposure, no additional effect of corticosteroid retreatment was noted. Antenatal betamethasone increased messenger ribonucleic acid levels for the surfactant proteins A and C, and retreatment augmented surfactant protein B messenger ribonucleic acid levels but suppressed surfactant protein A and C messenger ribonucleic acid. CONCLUSION: Improved postnatal lung function resulting from antenatal betamethasone was not augmented by retreatment.

Animals↗
PubMed1993

Treatment philosophy and retreatment rates following piezoelectric lithotripsy.

Second generation lithotriptors offer the advantage of anesthesia-free fragmentation of renal and ureteral calculi but they frequently require multiple treatments to attain a stone-free status. However, excessive single lithotripsy sessions or multiple treatments may be associated with significant damage to the kidney. For some clinicians a common treatment philosophy involves evaluation of serial plain abdominal films every 24 hours after lithotripsy and immediate retreatment of all patients with incomplete fragmentation. To avoid unnecessary retreatments and, thus, minimize potential renal damage, we prospectively evaluated 100 patients undergoing lithotripsy on a Wolf Piezolith 2300 device. Patients were routinely treated with 4,000 shocks at 1,100 bar. Serial plain abdominal films were obtained at 1 day and 2 weeks after lithotripsy. The need for retreatment was determined by the plain abdominal film results. Additional therapy was considered necessary if there was no stone fragmentation or if residual fragments measured greater than 4 mm. Of the patients whose plain abdominal film at 24 hours indicated the need for a repeat treatment 43% were stone-free on the 2-week film. Thus, these patients were spared an unnecessary treatment by allowing adequate time for the stone fragments to pass spontaneously. Our data suggest that repeat treatments on second generation lithotriptors should not be performed within 24 hours. Rather, the patient should be reevaluated at least 1 to 2 weeks later to avoid unnecessary retreatment with the attendant potential for renal injury. In addition, when comparing the retreatment rates of various lithotriptors, one should also consider the treatment philosophy used at the particular institution and the timing of the radiographic studies used to determine the stone-free status.

Electricity↗
PubMed1994

Endodontic retreatment of thermafil or lateral condensation obturations in post space prepared teeth.

The purpose of this study was to quantify the amount of remaining gutta-percha/sealer after retreatment of post space prepared teeth obturated with a lateral condensation technique or with Thermafil with plastic and metallic carrier. The time required for retreatment was also recorded. Forty-five extracted mandibular premolars were prepared using a step-back flared technique and obturated. The post space was prepared and a 5-mm obturation was left in the canal. Retreatment of all groups was done using a solvent technique. The teeth were split longitudinally and photographed. The total area of the canal and the area of gutta-percha/sealer were traced on white paper. Both areas were quantified using a computerized image analysis system and the ratio of remaining obturation material to root canal periphery was derived and statistically analyzed. Statistical analysis (analysis of variance, p = 0.01) showed no differences among the techniques when the average percentage of remaining gutta-percha/sealer was compared. Results revealed that the Thermafil metallic retreatment group consumed significantly more time than the others (analysis of variance, Scheffe p = 0.01). The metallic carriers were not easily removed from the canals, six metal carriers could not be retrieved during the retreatment routine.

Analysis of Variance↗
PubMed1994

Endodontic retreatment of Thermafil versus laterally condensed gutta-percha.

The Thermafil device is becoming a popular obturating material. Because endodontic failures inevitably occur with all techniques, questions of retreatment of Thermafil-obturated teeth will also arise. The purpose of this study was to compare retreatment of Thermafil and laterally condensed gutta-percha. Thirty-five mandibular incisors were prepared with a stepback flare technique and divided into two groups. One group (n = 20) was obturated using Thermafil, the other group (n = 15) was obturated with laterally condensed gutta-percha. The teeth were stored in a humidor for 3 months to allow sealer to set. Retreatment of both groups was accomplished using a combination of heat and chloroform solvent. The time for retreatment was recorded. The teeth were split longitudinally and the amount of gutta-percha remaining in the root canal was measured and analyzed statistically. The results showed that in the coronal one-third of the canal, use of the Thermafil device resulted in significantly more remaining gutta-percha than use of laterally condensed gutta-percha. However, in the apical and middle one-third of the canal the difference in remaining gutta-percha between Thermafil and laterally condensed gutta-percha was not significant. The metal carrier was easily removed and the mean time for retreatment was 6.3 min for Thermafil compared with 5.7 min in the lateral condensation group.

Analysis of Variance↗
PubMed1999

Photorefractive keratectomy retreatments: comparison of two methods of excimer laser epithelium removal.

BACKGROUND: Regression and undertreatment after initial photorefractive keratectomy (PRK) in higher myopes is not unusual. Patients frequently desire 20/20 uncorrected vision, which necessitates retreatments or enhancements. However, the safest and most efficacious way to treat these patients has not yet been established. This study evaluates two techniques of PRK enhancements, comparing two different methods of laser epithelial removal. DESIGN: Retrospective, nonrandomized, comparative trial. PARTICIPANTS: A total of 224 eyes. METHODS: Eyes were identified that had 6-month follow-up after a PRK enhancement from February 1995 through February 1997. Two methods of treatment were identified. The same VISX 20/20B laser in the same clinic was used for all retreatments. Group I patients had a total removal of the epithelium in a mode phototherapeutic keratectomy (PTK) prior to the refractive ablation. Group II patients had a total laser epithelial removal in two steps prior to the refractive ablation. The first step was a PRK and then a PTK. MAIN OUTCOME MEASURE: The disappearance of epithelial fluorescence was the end point for the PTK ablation in groups I and II. RESULTS: There were 131 eyes in group I and 93 eyes in group II. The mean spherical equivalent (SE) prior to the original PRK in group I was -7.5 diopters (D) +/- 3 D and in group II was -7.75 D +/- 2.34 D. The mean SE prior to the PRK retreatment in group I was -2.22 D +/- 1.29 D and in group II was -1.89 D +/- 0.83 D. The mean postoperative 6-month SE after the PRK enhancement in group I was -0.05 D +/- 0.80 D and in group II was 0.01 D +/- 1.08 D. A greater proportion of group I eyes (7.8%) had arcuate haze and a hyperopic shift from the 1- to 6-month postoperative visit (P = 0.03). CONCLUSIONS: A two-step laser epithelial removal compared with a one-step PTK epithelial laser removal in PRK retreatments provides a more even and confluent epithelial removal, less risk of arcuate haze development, and less risk of a hyperopic shift from 1 to 6 months after the retreatment.

Adult↗
PubMed1998

Results and prognostic factors in the retreatment of locally recurrent nasopharyngeal carcinoma.

PURPOSE: To review the results and evaluate the prognostic factors in the retreatment of locally recurrent nasopharyngeal carcinoma. METHODS AND MATERIALS: We reviewed the records of 74 patients with locally recurrent nasopharyngeal carcinoma treated at the University of California, San Francisco between 1957 and 1995. The histologic types included squamous cell carcinoma in 6 (8.1%), nonkeratinizing carcinoma in 48 (64.9%), and undifferentiated carcinoma in 20 (27%) cases. The site of recurrence was in the primary in 46 (62.2%), in the neck nodes in 20 (27%), and in both sites in 8 (10.8%) patients. The recurrent disease was Stage I in 10 (13.5%), Stage II in 16 (21.6%), Stage III in 20 (27%), and Stage IV in 28 (37.9%) patients. Thirty-seven (50%) patients developed recurrence within 2 years and 58 (78.4%) within 5 years after initial treatment. Radiotherapeutic techniques used in the retreatment of primary recurrence consisted of external beam radiotherapy (EBRT), intracavitary brachytherapy, heavy-charged particle beam, and gamma knife, alone or in combination. Reirradiation doses ranged from 18 to 108 Gy, with a median dose of 60 Gy. Treatment of recurrent neck nodes consisted of radical neck dissection (RND) +/- intraoperative radiotherapy (IORT), or EBRT +/- hyperthermia, or chemotherapy +/- hyperthermia. Chemotherapy was used in 22 (30%) patients. Median follow-up was 20 months (range: 2 to 308 months). RESULTS: The 3-, 5-, and 10-year actuarial overall survival following retreatment were 49, 37, 18%, respectively. Thirty-six patients (49%) were free of further local-regional recurrence after retreatment. The 3-, 5-, and 10-year local-regional progression-free rates were 52, 40, and 38%, respectively. On univariate analysis, histologic type (p < 0.0001), interval to recurrence (p = 0.034), and treatment modality for early-stage disease (p = 0.01) were significant prognostic factors for overall survival, with age being marginally significant (p = 0.053). For local-regional progression-free rate, only histology was significant (p = 0.035). On multivariate analysis, age (p = 0.026), histology (p = 0.015), and interval to recurrence (p = 0.030) were significant for overall survival, and only histology (p = 0.002) and presence of complications (p = 0.016) were significant for local-regional progression-free rate. Of the 64 reirradiated patients, late complications were documented in 29 (45%) patients. The late complications were permanent in 21 (33%) and severe in 15 (23%) patients. CONCLUSION: Retreatment using radiotherapy alone or in combination with other treatment modalities can achieve long-term local-regional control and survival in a substantial proportion of patients with locally recurrent nasopharyngeal carcinoma. Age, histology, and interval to recurrence were independent prognostic factors for overall survival, but only histology and presence of complications were significant for local-regional progression-free rate.

Adult↗
PubMedDate not supplied

Multiple excimer laser retreatments for scarring and myopic regression following photorefractive keratectomy.

Excimer laser retreatment for scarring with myopic regression following photorefractive keratectomy (PRK) has been reported. We present the 38 month course of a patient who had PRK followed by two retreatments. The patient experienced scarring with myopic regression after an initial PRK with a 5.00 mm ablation zone. These complications recurred 13 months after retreatment with a 5.00 mm ablation zone. Refractive effect, computer-assisted videokeratography measurements, and corneal clarity remained stable 12 months after a second retreatment with a 6.00 mm ablation zone, indicating that retreatment with a larger ablation zone diameter appeared to be an appropriate method for handling this complication.

Cicatrix↗
PubMed1997

Retreatment of patients with intracranial gliomas by external beam radiotherapy and cytotoxic chemotherapy.

Twenty-one patients with recurrent intracranial gliomas were retreated by external beam radiotherapy between 1987 and 1995. Twenty patients received cytotoxic chemotherapy involving CCNU as part of their retreatment. Only five of the 21 patients had received chemotherapy in combination with the initial external beam radiotherapy (RT) prior to recurrence. The different histological groups were analysed and the patients divided into two groups; group I (Grade I and II gliomas) and group II (Grade III, IV and glioblastoma). The overall median survival for all patients was 59 months, with a median survival of 22 months after recurrence. For group I and group II patients, the median survival was 26 months and 13 months after recurrence respectively. It was concluded that some highly selected patients with intracranial gliomas can be retreated safely by carefully planned external beam RT given to a relatively low dose in order to palliate neurological dysfunction and the symptoms of raised intracranial pressure, and to reduce steroid dependency. The results strongly suggest that recovery does occur after initial RT. Retreatment may possibly improve survival in a small proportion of patients. Further studies, including randomized trial designs, quality of life assessment, and neurological symptoms indices, would be required to determine the quantitative benefit of any such treatment policy. The objectives of this study were to determine whether patients received any benefit, such as symptom relief and the allowance of steroid withdrawal, after retreatment, and whether long term survival could be achieved.

Adult↗
PubMed2003

Randomized trial of prolonged interferon retreatment for chronic hepatitis C patients with HCV-genotype 1b and high virus load.

The aim of this study was to examine whether 78 week course of interferon (IFN) retreatment could improve the beneficial effect of IFN in chronic hepatitis C patients compared with 52 week course of IFN retreatment. Inclusion criteria were biopsy-proven chronic hepatitis, serum HCV-RNA level of more than 1 Meq/ml, HCV-genotype 1b, abnormal serum alanine aminotransferase (ALT), and transient negative conversion for HCV-RNA during the initial course of IFN therapy. Forty-one patients were randomly assigned to two groups, receiving total doses of: 1410 MU for 52 weeks (a 52 week-group: n=20), or 1995 MIU for 78 weeks (a 78 week-group: n=21). But three patients (one in the 52 week-group and two in the 78 week-group) were withdrawn from the study due to a transfer, refusal after randomization, and occurrence of malignant lymphoma before IFN retreatment, respectively. Therefore remainder 38 patients were studied about efficacy of IFN administration. A virological response (VR) to IFN therapy was defined as HCV-RNA negativity by the reverse transcription nested polymerase chain reaction both 3 and 6 months after the completion of IFN retreatment. A biochemical response (BR) was defined as normalization of ALT but positive HCV-RNA both 3 and 6 months after the cessation of IFN therapy. According to these criteria, VR was 36.8% (7/19) in the 52 week-group and 21.1% (4/19) in the 78 week-group. BR was 5.3%(1/19) in the 52 week-group and 21.1% (4/19) in the 78 week-group. There was no significant difference between the 52 week-group and the 78 week-group with respect to the effect of IFN. We conclude that 52 week course of IFN retreatment may be a sufficient strategy if patients, who have HCV-genotype 1b and high virus load, show negative HCV-RNA and normal ALT level during the first IFN therapy.

Journal Article↗
PubMed2003

Pilot study of prolonged interferon-alpha retreatment in chronic hepatitis C patients with genotype 1b.

OBJECTIVES: To investigate the efficacy of prolonged IFN retreatment for 3 years in chronic hepatitis C patients with high viral load and IFN treatment-resistant genotype 1b. PATIENTS AND METHODS: The study was conducted in 12 patients, not HCV RNA-negative after completion of the initial treatment. Retreatment consisted of administration of 6 million international units (MIU) of natural interferon-alpha, two or three times a week for 3 years. RESULTS: One patient was withdrawn for personal reasons. All other 11 patients completed treatment without any serious adverse reactions and were followed for 3 years. Of the patients, 4 (36%) showed a sustained virological response, 5 (45%) showed a biochemical response, and 2 (18%) relapsed after retreatment. All patients with a sustained response had a transient response to initial therapy. Patients showing a sustained response tested negative for HCV RNA within the first 6 months of retreatment. CONCLUSIONS: After prolonged IFN retreatment, a significant number of patients showed a sustained response for the first time and long-term improvement in ALT level.

Journal Article↗