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PubMed2006

[Analysis of drug resistance to antituberculosis drugs of the first time retreated pulmonary tuberculosis patients in Shanghai].

OBJECTIVE: To investigate antituberculosis drug resistance among the first time retreated pulmonary tuberculosis patients in Shanghai, and therefore to provide evidence for establishing retreatment regimen. METHODS: Analysis was conducted retrospectively on drug susceptibility tests to isoniazid, rifampin, streptomycin, ethambutol and para-aminosalicylates of the first time retreated pulmonary tuberculosis patients with a positive sputum culture in Shanghai Center for Disease Control from January 2002 to December 2004. RESULTS: The total drug resistance rate was 39.6%. The drug resistance rate in male and female patients was 38.5% and 44.4% respectively, the difference being not significant. The drug resistance rate in the young age group, the middle age group and the old age group were 50.0%, 41.6% and 34.6% respectively, the difference being not significant. The total drug resistance rates in the treatment failure group with standard initial chemotherapy and in the relapse group with standard regimen were both higher than in the relapse group with non-standard regimen (70.0%, 47.5%, 28.2%). So do the drug resistance rates of more than two drugs (70.0%, 18.3%, 6.4%). The multi-drug resistance rate of the failures with standard regimen was 70.0%, much higher than the relapses with standard regimen and the relapses with non-standard regimen. In relapses with non-standard initial therapy, the drug resistance rate of patients who received medications > or = 12 months was 55.0%, significantly higher than those treated for 1 - 5 months (13.0%). The drug resistance rate of patients who were treated with one to two drugs was lower than those treated with > or = 3 drugs, but no significant difference was observed (24.4% and 30.8%). CONCLUSION: Drug resistance rate varies in different types of the first time retreated pulmonary tuberculosis patients due to the history of drug use, which indicates that the current standard retreatment regimen is probably ineffective for some patients.

Adult↗
PubMed1988

Radioimmunotherapy of patients with cutaneous T-cell lymphoma using an iodine-131-labeled monoclonal antibody: analysis of retreatment following plasmapheresis.

Radioimmunotherapy retreatment of patients receiving radiolabeled murine monoclonal antibodies is difficult because of human antimurine antibody (HAMA) formation. Retreatment therapy was initiated in three patients at the time of disease progression using a radioiodinated monoclonal antibody (T101). The clinical protocol consisted of a two day plasma exchange (4-6 L) to reduce HAMA titers. Immunoimaging was performed with 5 mCi 131I-T101 (10 mg). Gamma scintillation images were obtained 18 hr postinfusion, and radiation dosimetry estimates were performed. At 24 hr postinfusion, each patient received a 100-mCi 131I-T101 (10 mg) therapy dose. Results obtained after plasmapheresis showed a significant reduction, ranging from 28%-61%, in HAMA titers. Blood clearances were markedly different between initial therapy and retreatment therapy for patient with high HAMA titers, reflecting immune complex formation. Two patients responded to retreatment therapy with responses lasting 1 to 2 mo. Minimal acute and no chronic toxicities were observed during the retreatment protocol.

Antibodies, Monoclonal↗
PubMed1987

Resident-preceptor retreat for re-evaluating a pharmacy residency program.

The organization of a resident-preceptor retreat as one component of a process to re-evaluate a pharmacy residency program is described. Changes in the ASHP standards for residency training and recommendations from a recent reaccreditation survey as well as recent changes in the health-care environment prompted a re-evaluation of the existing 24-month residency and degree program at The Ohio State University Hospitals. Three task forces were created to evaluate issues in seven areas of residency training. Members of the task forces, which consisted of current residents and staff members with preceptorial responsibilities, discussed the issues assigned to them during a retreat at a state park. Recommendations made at the retreat were assigned to individual task force members for implementation. Within nine months of the retreat, 15 of 17 recommendations had been implemented. A retreat involving both residents and preceptors can be an effective forum for discussing and critically evaluating a pharmacy residency program.

Education, Pharmacy↗
PubMedDate not supplied

Hazard and outcome of retreated choledochal cyst patients.

Thirty-nine patients initially treated for choledochal cyst (25: cyst-enterostomy for 15 type I and 10 type IV A, 13: cyst excision for 8 type I and 5 type IV A, 1: sphincterotomy for type III) have been completely followed up for a mean period of 17 years to examine the effect of surgical management on their lives. Eighteen of 25 cases with cyst-enterostomy (72%) needed retreatment due to the complications but one could not be retreated because of the presence of advanced bile duct carcinoma. Fourteen of 17 cases were retreated with cyst excision, of whom 12 showed an excellent outcome but other two were suffering from cholangitis and hepatolithiasis. The remaining 3 patients retreated with PTCS or cyst-enterostomy showed a poor outcome. Of 13 patients who had undergone cyst excision with hepatico-jejunostomy as the first choice, 12 showed a good outcome but one needed retreatment due to the anastomotic stenosis and hepatolithiasis. Thus, excision of cyst should be the surgical management for choledochal cyst. However, it should be noted that three of 27 patients treated initially or secondarily with cyst excision showed unsatisfactory results mainly due to the anastomotic stenosis. The results demonstrate that hepaticojejunostomy with a wide opening stoma is necessary to prevent postoperative morbidity.

Adolescent↗
PubMed1993

[Retreatment of pulmonary tuberculosis--duration of chemotherapy].

Although standard chemotherapy for initial treatment of pulmonary tuberculosis has been established, regimens for retreatment of tuberculosis have not yet been established. One hundred fifty nine retreatment pulmonary tuberculosis cases admitted to Fukujuji Hospital were retrospectively analyzed. Regardless of the age at the start of retreatment, majority of cases were treated previously between 1955 and 1960. Bacillary negative conversion rate, duration of chemotherapy, follow-up period and bacteriological relapse rate were compared according to resistance against isoniazid and/or rifampicin. Sixty four cases were sensitive to both INH and RFP. For this group the average duration of chemotherapy was 14.6 months, mean follow up period was 47.3 months and relapse rate was 3.1%. This rate was similar to that of initial treatment cases. Sixty one (94%), were treated with more than two sensitive drugs containing INH and RFP. The 22 INH-resistant and RFP-susceptible cases were treated for 18.6 months and followed up for 55.2 months. The relapse rate of this group was 13.6%. Thirteen cases were treated with more than 2 sensitive drugs containing RFP. Eleven cases were resistant to both INH and RFP. Five of them were surgically operated of which 3 cases were converted to negative and among the nonsurgical cases in this group only one remained sputum positive. All of these retreatment regimens did not contain pyrazinamide and ofloxacin. Although bacillary positive rate of INH and RFP susceptible cases was 13.0% at 6 months after treatment and 5.3% at 12 months after treatment, that of INH resistant and RFP susceptible cases were 25.0% and 12.5%, respectively. A certain rule of retreatment could be obtained from the result of this study.

Adolescent↗
PubMed2005

Nonsurgical retreatment of teeth with periapical lesions previously managed by either endodontic or surgical intervention.

OBJECTIVE: The purpose of this study was to evaluate the outcome of nonsurgical retreatment of teeth with periapical lesions, which had been previously managed by either endodontic or surgical intervention, and to identify factors that might influence the prognosis. STUDY DESIGN: Seventy-five endodontically and 11 surgically treated teeth with persisting periapical lesions ranging in size from 2 to 11 mm in diameter were included in this study. The teeth were nonsurgically retreated, using calcium hydroxide as intracanal medicament, and were followed for a period of 2 to 8 years. RESULTS: Clinical and radiographic assessment of retreatment showed that complete healing for all cases was 61.6% with an additional category of incomplete healing of 14%; 24.4% failed. The size of the periapical lesions and previous surgical treatment had marginally negative influences on the prognosis, but the differences were not statistically significant. CONCLUSION: The favourable results of this study demonstrated that nonsurgical root canal retreatment is an alternative to surgical intervention of postendodontic or postsurgical failure.

Calcium Hydroxide↗
PubMed2000

The pattern of response to interferon alpha (alpha-IFN) predicts sustained response to a 6-month alpha-IFN and ribavirin retreatment for chronic hepatitis C. TVVH Study Group.

BACKGROUND/AIMS: In chronic hepatitis C, interferon-alpha (alpha-IFN) and ribavirin combination therapy improves sustained response compared to alpha-IFN monotherapy, both in naive patients and in previous alpha-IFN relapsers, but the efficacy of such therapy remains limited in non-responder cases. The aim of this study was to assess whether the pattern of response to alpha-IFN alone may predict sustained response to combination therapy during retreatment. METHODS: Fifty previous alpha-IFN relapsers and 50 previous alpha-IFN non-responders were retreated with a high alpha-IFN dose (6 MU/thrice weekly for 2 months; induction phase) and then randomised to continue with alpha-IFN alone (3 MU/thrice weekly) or to receive combination therapy (3 MU/thrice weekly of alpha-IFN and 1000-1200 mg/daily of ribavirin) for an additional 6 months according to the biochemical response to alpha-IFN shown after the induction phase. All patients were also evaluated for virological and histological response. RESULTS: Eleven of 25 (44%) relapsers treated with combination therapy and 4/25 (16%) treated with alpha-IFN alone achieved a sustained response. The corresponding figures among non-responders were 1/25 (4%) and 0/25, respectively. Among 26 patients with a complete ALT and HCV-RNA response after 2 months of alpha-IFN, sustained response was seen in 11/14 (79%) treated with combination therapy and in 4/12 (33%) treated with alpha-IFN alone (p=0.05). On the other hand, of 74 cases still HCV-RNA positive after 2 months of alpha-IFN alone, biochemical and virological end of therapy response was better with combination therapy (11/36; 30.5%) compared to alpha-IFN alone (4/38; 10.5%), but only one patient developed a sustained response (1/36; 3%). CONCLUSIONS: The retreatment with a 6-month combination therapy was associated with a high rate of sustained response only in patients showing a complete biochemical and virological response to alpha-IFN alone. Longer retreatment with combination therapy may be needed to achieve a sustained response in patients without a prompt virological response to alpha-IFN.

Adult↗
PubMed1996

Clinical management of nonhealing periradicular pathosis. Surgery versus endodontic retreatment.

OBJECTIVES: This prospective randomized study compared the outcome of retreatment and surgical intervention in root canal treated teeth with nonhealing periradicular pathosis. STUDY DESIGN: One such tooth from each of 38 patients was randomly allotted to retreatment or root-end resection and root-end filling. Treatment outcome after 1 year was evaluated and compared clinically and radiographically. RESULTS: The success rate for surgery was higher than for conventional retreatment, but the difference was not statistically significant. CONCLUSIONS: For management of nonhealing periradicular pathosis associated with root canal treated teeth, surgical intervention should be considered as an alternative to retreatment. In cases with a similar prognosis for both modes of treatment, the choice should be governed by consideration of intrinsic and extrinsic factors.

Adult↗
PubMed2002

Contemporary endodontic retreatments: an analysis based on clinical treatment findings.

A prospective in vivo investigation was conducted to determine radiographic and clinical factors associated with contemporary nonsurgical endodontic retreatments. Approximately 1,100 failing endodontically treated teeth were screened to determine an appropriate treatment plan. Using magnification, 337 consecutive retreatment cases were evaluated and treated. The vast majority of the retreated cases involved multiple factors. Eighty-five percent of the cases presented with periradicular radiolucencies. Sixty-five percent of the cases demonstrated poor radiographic obturation quality. Associated pain was noted 51% of the time. Forty-two percent of the teeth had untreated canal space. It was statistically significant (Chi-square, p < or = 0.05) that additional canal space was located and treated in 89% of the cases that had previous radiographic asymmetrical obturations. Evidence of coronal leakage was noted in 13% of the retreated teeth. Tooth number, obturation materials, overfills, and previous surgical retrofillings were also recorded. Recommendations were made that might improve the rate of clinical success.

Dental Leakage↗
PubMed2004

The outcome of endodontic retreatment: a 2-yr follow-up.

Retreatment is common in endodontics. The purpose of this article was to classify the different clinical situations encountered in retreatment cases and relate them to the outcome after an observation period of 24 months. A total of 425 patients (452 teeth) from 451 patients, consecutively admitted for root-canal retreatment, were monitored during a 24-month period. All teeth (254 molars, 107 premolars, and 91 single-root anterior teeth) were divided into two major categories: teeth with modified anatomy from previous endodontic treatment (root-canal-morphology altered) and teeth in which no significant anatomical changes were made by the former endodontic treatment (root-canal-morphology respected). Although the overall success was 69.03%, the success in the root-canal-morphology-respected group was 86.8% and in the root-canal-morphology-altered group 47% (Mann-Whitney U test p < 0.0001). The clinical success of an endodontic retreatment seems to depend on whether alterations in the natural course of the root canals were caused by previous root-canal treatment.

Adolescent↗
PubMed2005

In vitro evaluation of the ability of three apex locators to determine the working length during retreatment.

The purpose of this in vitro study was to evaluate the accuracy of three apex locators in determining the working length during the retreatment process. Twenty extracted single-rooted human teeth with mature apices were used in this study. The root canal length of each tooth was measured placing a #15 file until the tip was visible at the apical foramen. The direct visual measurement was reduced by 0.5 mm and recorded. The root canals were instrumented and filled to the direct visual measurement using lateral compaction technique. After 7 days the teeth were retreated using three apex locators: ProPex, NovApex, and Root ZX, for determining the retreatment working length. Afterward, comparison between the visual working length and the retreatment working length were made. ProPex, NovApex, and Root ZX were accurate within 0.5 mm 80, 85, and 95% of the time, and within 1 mm 95, 95, and 100%, respectively. No significant differences were detected between the three apex locators (p > 0.05).

Analysis of Variance↗
PubMedDate not supplied

Photodynamic therapy with verteporfin of choroidal neovascularization in angioid streaks: conventional versus early retreatment.

PURPOSE: To evaluate the effectiveness of conventional photodynamic therapy with verteporfin (PDT) in a series of patients with macular choroidal neovascularization (CNV) due to angioid streaks and to compare it to the effectiveness of early PDT retreatment. METHODS: This is a retrospective study of 24 eyes (22 consecutive patients) with subfoveal or juxtafoveal CNV secondary to angioid streaks treated with PDT from September 2000 through February 2003 and that completed at least the first year of follow-up. Until August 2001, retreatments were performed according to the conventional protocol for PDT every 3 months (Group 1, consisting of 11 eyes of 9 patients). After August 2001 (13 more eyes of 13 new patients), retreatments were performed earlier (every 8 weeks) when indicated (Group 2). The follow-up time ranged from 30 to 42 months and from 12 to 30 months in Groups 1 and 2. RESULTS: At the end of the follow-up, final best-corrected visual acuity decreased in 21 (87.5%), stabilized in 2 (8.3%), and improved in 1 (4.2%) of the total 24 eyes. In all, 19 of the 24 eyes (79.2%) had a final best-corrected visual acuity equal to or less than 20/400. There were not any statistically significant differences in final visual acuity between the two groups. CONCLUSIONS: In this large series of patients with macular CNV secondary to angioid streaks, the functional and the anatomic results of PDT were not satisfactory, even when retreatments were performed earlier than the conventional time of 3 months.

Adult↗
PubMedDate not supplied

[The retreatment with natural leukocyte interferon alfa-n3 of chronic hepatitis C patients: the intolerant and nonresponsive results to prior treatment with recombinant alfa interferon].

To evaluate leukocyte interferon alpha-n3 tolerability and efficacy in the retreatment of patients with chronic hepatitis C poorly tolerant to previous treatment with recombinant interferon alpha, 142 patients (73 "relapsers" and 69 "nonresponders") were retreated with leukocyte interferon alpha-n3 (6 MU thrice weekly for 6 months) and followed up for 12-42 months. Only patients with complete regression of any previous interferon-related adverse events were included. Three patients dropped out due to recurrence of a severe depressive syndrome. In 104/139 patients (75%) no significant life-style changes vs baseline were observed during retreatment, while 35 subjects experienced moderately negative interference with their living habits. The different influence on the patients' quality of life during leukocyte interferon alpha-n3 treatment in comparison with the previous treatment was significant. In 118 patients (85%) the interferon-related adverse events significantly decreased. After 12 months of follow-up, a sustained biochemical response was observed in 48 patients (35%), and a persistent biochemical and virological response was seen in 33 (23%). The good compliance with leukocyte interferon alpha-n3 administration shown by poorly tolerant patients, "relapsers/nonresponders" to recombinant interferon, permitted retreatment with full doses and thus increased the chance of obtaining a larger number of sustained responses.

Adult↗
PubMed2001

A case series: initial outcome of persons with multidrug-resistant tuberculosis after treatment with the WHO standard retreatment regimen in Ho Chi Minh City, Vietnam.

Few data address the outcomes of patients who have multidrug-resistant tuberculosis (MDR-TB), defined as resistance to at least isoniazid and rifampin, and who receive a standard World Health Organization (WHO) recommended retreatment regimen after relapse or failure with initial treatment. In this case series, we examined treatment outcomes of a convenience sample of 42 relapse or failure patients who had documented MDR-TB and who had received a standard WHO retreatment regimen (2SHRZE/1HRZE/5H3R3E3). One patient died of tuberculosis in the last month of treatment; the remaining 41 patients completed retreatment. Of the 42, 14 (33%) were sputum smear-negative on completion of therapy. The proportion of patients cured of MDR-TB with the WHO retreatment regimen was similar to historic outcomes when no chemotherapy for TB was given.

Adolescent↗
PubMed2001

[Outcome of endodontic retreatments at the Institute of Ondonto-Stomatology of Dakar (from 1986 to 1997].

The retrospective study on the endodontic retreatments done at the Odonto-Stomatology Institute of Dakar from 1986 to 1997 shows a small rate of 1.94% (unreached canalar root filling) for 4325 endodontic treatments. The endodontic retreatments concern almost women (54.76%), ageing between 20 to 30 years (45.24%); maxillary central incisors (21.43%) and first molars (21.43%). The clinical reason having conducted to a retreatment is prosthetic (46.4%) and symptomatic (38.10%); the immediate success rate of these retreatment stays favourable at 59.52%.

Adult↗
PubMed2002

[Excimer retreatment for undercorrection or regression after laser in situ keratomileusis].

OBJECTIVE: To evaluate the results of excimer retreatment for undercorrection or regression after laser in situ keratomileusis (LASIK). METHODS: Eight-eight eyes received retreatment for undercorrection or regression after first LASIK (FLASIK) in 2 149 eyes in our photorefractive keratotectomy (PRK)/LASIK center from March, 1996 to July, 1999. They were divided into 2 groups according to their degrees of pre-FLASIK myopia spherical equivalents. Group I was </= 10.00 diopters (D) (41 eyes); group II was > 10.00 D (47 eyes). We analyzed the factors of FLASIK which led to the re-LASIK (RLASIK), and observed the mean spherical equivalents (MSE), the ratio within +/- 1.00 D of emmetropia, the uncorrected visual acuity (UCVA), the best corrected visual acuity (BCVA) and the complication after RLASIK for at least 1 year follow-up study. RESULTS: The retreatment ratio was 4.1% among the 2 149 eyes. In group II, the ratio was 2.3 times that of the group I. In the comparison with other eyes, the eyes received RLAISK had no difference in sex, laterality and age (P > 0.05). Over 50.0% had pre-FLASIK diopters >/= 10.00 D, and 73.9% had astigmatism correction in FLASIK. After RLASIK, no undercorrection or regression occurred in group I, but there was undercorrection in group II. The ratio within +/- 1.00 D of emmetropia after 1 year was 68.3% in group I and 51.1% in group II. The UCVA above 0.5 was over 90.0% in all eyes. Eight eyes (9.0%) lost two or more lines of BCVA. The serious complication after RLASIK was keratoconus of 3 eyes in group II. CONCLUSIONS: The risk factors which lead to retreatment after FLASIK are high myopia with astigmatism before FLKSIK and the reaction to the operation. In this study, RLKSIK is safe, effective, predictable and accurate for </= -10.00 D correction in FLASIK. But, to prevent the occurrence of serious complication such as keratoconus, it is better not to perform RLASIK for > -10.00 D in FLASIK.

Adult↗
PubMed2006

Representative drug susceptibility patterns for guiding design of retreatment regimens for MDR-TB.

BACKGROUND: There is no gold standard on how national tuberculosis programs should design retreatment regimens. Often drug susceptibility testing (DST) is not available for all patients, and representative DST patterns in patient populations are used to guide therapy. OBJECTIVES: To examine DST patterns in different patient populations based on previous treatment and to estimate the number of effective anti-tuberculosis agents in several retreatment regimens. METHODS: We reviewed DST results from patients treated with individualized regimens in Peru between January 1998 and July 2004. We stratified patients into four groups based on previous treatment exposure from Group 1 who had failed only one regimen to Group 4 who had failed three regimens. We compared resistance frequencies across the four groups. In Groups 1 and 3, the number of likely effective agents under six possible retreatment regimen scenarios was estimated. RESULTS: Resistance to second-line drugs was significantly higher in groups with more previous courses of treatment. A few retreatment regimens could be identified that would allow at least 80% of patients to receive at least four likely effective drugs. CONCLUSION: Because it is associated with resistance frequencies, previous treatment exposure can serve to guide the design of non-individualized MDR-TB regimens.

Adult↗
PubMed2006

Results of cohort analysis by category of tuberculosis retreatment cases in Morocco from 1996 to 2003.

OBJECTIVE: To analyse treatment outcomes by subcategory of tuberculosis (TB) retreatment cases. METHODS: All TB patients treated with the Category II regimen from 1996 to 2003 in Morocco were enrolled in this retrospective study. For each cohort, the retreatment outcome data were analysed as a whole and by the following sub-categories: 1) cases who relapsed after one course of anti-tuberculosis treatment; 2) cases who failed the Category I regimen; and 3) cases who interrupted one course of anti-tuberculosis treatment. RESULTS: The study population included 14 635 retreatment patients, among whom 81.7% were TB relapse cases, 5.2% had failed the Category I regimen and 13.1% were defaulters. The average treatment success rates were respectively 74.8% (range 71.8-76.6), 58.0% (range 52.4-74.0) and 51.4% (range 46.4-55.6) among relapse, failure and default cases. Failure and default rates were significantly higher (P < 0.001) among patients who failed Category I treatment and among those who defaulted, respectively. CONCLUSIONS: TB cases who fail the Category I regimen should systematically receive drug susceptibility testing, while defaulters should be given support to improve treatment adherence. Stratified cohort analysis by subcategory of retreatment has been shown to be useful for evaluating the performance of TB control programmes.

Antitubercular Agents↗