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PubMedDate not supplied

[Blunt liver trauma: therapeutic options].

Therapeutic options for management of blunt hepatic trauma include both non-operative and operative management, until liver transplantation. The presence of associated intraabdominal lesions increases mobility and mortality. A total of 58 patients with blunt hepatic injury, observed at the 2nd Surgical Unit of the "Santa Chiara Hospital" of Trento over a four-year period (1999-2003), were analyzed. Thirty-eight patients (65.5%) were treated conservatively with a 94.7% success rate. Twenty (34.5%) patients were surgically treated. Suture hepatorraphy was the most common procedure performed. The overall morbidity in surgical patients was 25%, with 20% of liver related complications. Four patients (20%) died with a liver related mortality of 10%. Advantages of non-operative management included a reduced need for transfusion (1.1 vs. 4.3 U), with 81.5% of patients not requiring transfusion, a reduced stay in the ICU and a reduced rate of morbidity and mortality (2.6% vs. 20%). Hemodynamic instability and the presence of an associated lesion in blunt hepatic trauma patients require emergency laparotomy. The widespread application of non-operative management has reduced the rate of morbidity and mortality related to unnecessary surgical approaches.

Adolescent↗
PubMed1995

[Therapeutic options in locally advanced breast cancers].

The authors are showing their experience on 394 locally advanced breast cancer in the last 10 years. In this trial were included the tumours larger than 5 cm, multiple tumours, tumours invading the skin or the thoracic wall with invaded or fixed axillary or supraclavicular nodes and acute carcinomatous mastitis. The optional therapeutic schedule was modified upon the stage. It consisted in pre- or postoperative radiotherapy, polychemotherapy or polychemo- or radiotherapy alone, associated with nonspecific immunotherapy and hormonotherapy. In patients with complex treatment the survival rate was 45.4% at 5 years and 12.3% at 10 years. The authors highlight the importance of the surgical treatment which offer a big potential in the context of the complex treatment.

Adult↗
PubMed2007

Therapeutic options for Bowen's disease.

Multiple therapeutic options are available for treatment of Bowen's disease. The choice of therapy depends on clinical circumstance and medical practitioner experience. Newer therapies have more extensive support from the literature, but more established therapies may be preferred because of accessibility, cost and efficacy. An overview of the current therapeutic options for Bowen's disease is presented.

Aminoquinolines↗
PubMed1999

[Thrombolytic therapy in acute cerebral infarction--a time study when organizing a new therapeutic option].

Cerebral thrombolysis is a therapeutic option for patients with acute cerebral infarction, but its use can be limited by delayed hospital admission. The aim of this study was to examine this delay, to improve admission routines and thus increase the number of potential candidates for treatment. In the first part of the study, time from first symptoms until hospital admission (time from first symptoms to contact with the primary health care system, and from contact to admission) was registered for 100 patients with acute stroke. Time spent to cerebral CT scan, and within the hospital was also registered. Measures to shorten admission time were then instituted, including information to the public and to primary health care professionals. An identical study was then performed on another 124 patients. Referral procedures were significantly improved, whereas time taken for patients to contact the primary health care system remained unchanged. Direct contact by emergency telephone secured the fastest admissions. The number of patients admitted within two hours after stroke onset increased from 17% to 26%. Four patients (3%) were treated with thrombolysis. Our study indicates that improved admission routines reduce admission delay. More public information is necessary to change patient behaviour.

Acute Disease↗
PubMed2004

[Therapeutic options for patients with localized prostatic carcinoma: our experience with 454 patients].

OBJECTIVES: To evaluate the influence of different therapeutic options on progression-free survival (PFS), overall survival (OS) and specific survival (SS) in a cohort of 454 patients with localized prostatic carcinoma, taking into account different prognostic factors, and to compare our results to those reported in the world literature. MATERIAL AND METHODS: Between 1983 and 2000 we have diagnosed 706 new cases of prostatic carcinoma and 454 were clinically localized tumors. The different therapeutic options employed in our series of patients have been: follow-up (FU) (103 patients); radical prostatectomy (RP) (108 patients); radiotherapy without hormonal blockade (RT) (148 patients); and hormonal blockade (HB) (95 patients). We have determined the PFS, the OS and the SS for each group of patients and compared them in patients with different prognostic factors at the time of diagnosis, including age, PSA levels, Gleason's grading and TNM staging. We have also analysed the influence of the tumor progression on the OS. The mean follow-up time has been 5.6 years (range: 0.1-19.2; median: 5.2). RESULTS: For PFS: the disease progressed in 145 patients (32%) and the PFS at 5 and 10 years has been 77% and 67% for FU; 61% and 50% for RP; 63% and 25% for RT; and 73% and 67% for HB, respectively. The differences between RT and RP were not statistically significant. For the subgroup of patients with PSA levels <10 and Gleason <8 the differences between FU, RP and RT did not reach statistical significance. For OS: 126 patients of our series died (28%) and the OS at 5 and 10 years has been 80% and 61% for FU; 90% and 76% for RP; 85% and 67% for RT; and 64% and 32% for HB, respectively. We have found no significant differences between FU, RP and RT. For SS: 31 patients of our series died of disease (6.8%). The SS at 5 and 10 years has been 100% and 94% for FU; 98% and 98% for RP; 97% and 88% for RT; and 83% and 77% for HB, respectively. We have found no significant differences in the OS between patients with disease progression and without disease progression treated with FU, RP and RT. CONCLUSIONS: Determination of PSA levels has allowed diagnosis of prostatic carcinomas in early stages of disease; however, our results and those reported in the literature cannot define which is the best therapeutic option in these patients. We should offer the patients individualized information both in the phase of early diagnosis and of therapeutic decisions.

Adenocarcinoma↗
PubMed2005

Sodium alginate as a novel therapeutic option in experimental colitis.

The potential therapeutic effect of low-viscosity sodium alginate (LVA) was studied in a rat model of acute colitis induced by intracolonic administration of acetic acid. This experimental model produced a significant ulcerative colitis. Induction of colitis also significantly enhanced the serum and colonic mucosal cytokine (IL-6 and TNF-alpha) and eicosanoid (LTB4 and PGE2) levels, which paralleled with the severity of colitis. LVA solution was administered orally as drinking water at concentration of 0.5% (W/V) for 1 week. The tolerability and inhibitory effect of LVA on matrix metalloproteinase-2 (MMP-2) were tested using WEHI-164 cell line and zymography method. The results showed that LVA therapy is able to significantly reduce colonic damage score, histological lesion, serum and colonic mucosal IL-6, TNF-alpha, LTB4 and PGE2 levels in treated group compared with nontreated controls. Moreover, in vitro examinations revealed that treatment with LVA could diminish MMP-2 activity. It is concluded that LVA is able to suppress acetic acid-induced colitis in rats. Some of the action of LVA may be associated with its inhibitory effects on cytokine and eicosanoid production and MMP-2 activity. Our data suggest that LVA could potentially be a novel therapeutic option for inflammatory bowel disease.

Alginates↗
PubMed2004

Acute bowel obstruction - the main complication of colorectal cancer. Therapeutical options.

AIM: to choose the proper therapeutical approach in obstructing colorectal cancer. MATERIAL AND METHOD: 77 (29.2%) obstructing colorectal cancers, 88.15% aged between 61 and 80 years, selected from 260 patients admitted in the last 10 years were analyzed. We noticed associated cardiovascular (42 cases=55.2%) and/or respiratory (18 cases=23.6%) disease in 89,55% of cases. The distribution of the obstructing lesions throughout the colon and rectum was: 39 cases on the left colon, 18 cases on the right colon, and 20 cases on the rectum, with the following pTNM staging: stage II 10%, stage III 67% and stage IV 23%. The infiltrative character of the primary tumor (61 cases) and the extension to the adjacent structures (24 cases) were the main causes of the acute bowel obstruction. The diagnosis was established on the clinical aspects and plain X-ray findings. The delay between the onset of the acute obstruction and the admission was 3 days on average, and we noticed severe biological disorders pertaining to the acute bowel obstruction in more than 75% of cases. 76 patients (99.6%) were operated on. We performed primary resection in 8 cases and staged-procedures (cecostomy or ileotransversostomy followed by resection and anastomosis after 3 weeks on average) in 33 cases. In 35 cases we performed one of the so called "exigency procedures" (colostomy, internal diversion or Hartman colectomy). RESULTS: 55 (72.36%) patients had a fair evolution. We registered 21 deaths, with a general mortality rate of 27.6%, and a mortality rate of 25% for primary resection, 9.09% for staged surgery and 47.05% for the so called exigency procedures. CONCLUSIONS: Acute bowel obstruction is the most common complication of the colorectal cancer, charged by multiple major risk factors. An adequate colon decompression and the treatment of the biological disorders are the main therapeutical objectives. Surgery of the obstructing colorectal cancer is always a palliative one. Staged surgery is the safest therapeutical option for colorectal cancers with acute bowel obstruction.

Adult↗
PubMed1999

[Early gastric cancer. The therapeutic options].

The best therapeutic treatments for early gastric cancer are evaluated. Due to the difficulty of preoperative and intraoperative staging, it's reasonable to consider early gastric cancer as a composite disease; while some mucous localizations can benefit of minor therapeutic treatments, the submucous cancer must be treated as the parietal gastric cancer.

Clinical Trials as Topic↗
PubMed1999

Therapeutic options in locally defined or advanced prostate cancer.

OBJECTIVE: Critical discussion of the available therapeutic options in locally defined or advanced prostate cancer (PCa) in the absence of standards or guidelines. METHODS: Medline-based survey of the pertinent literature. The therapeutic options are presented stage-by-stage. RESULTS: Intracapsular PCa (T1a-T2bN0M0) is preferably managed by radical prostatectomy; 'insignificant' cancers may be treated expectantly. The outcome of irradiation is not as predictable as radical surgery. The following points regarding treatment of locally advanced PCa are still under debate: neoadjuvant treatment is probably not as efficient as believed; technical refinements of radical prostatectomy may be helpful; in some instances, the value of adjuvant treatment is undecided. The efficacy of irradiation in conjunction with androgen deprivation probably equals the efficacy of surgery. No consensus can be found in the presence of positive lymph nodes, although single institutions achieve remarkable results with surgery plus androgen deprivation. CONCLUSION: Prognostic factors beside the clinical stages and grades should be incorporated in the treatment decision, and quality-of-life measurement should gain more importance when the treatment outcome is assessed.

Combined Modality Therapy↗
PubMed1998

Therapeutic Options in Locally Defined or Advanced Prostate Cancer.

Objective: Critical discussion of the available therapeutic options in locally defined or advanced prostate cancer (PCa) in the absence of standards or guidelines. Methods: Medline-based survey of the pertinent literature. The therapeutic options are presented stage-by-stage. Results: Intracapsular PCa (T1a-T2bN0M0) is preferably managed by radical prostatectomy; 'insignificant' cancers may be treated expectantly. The outcome of irradiation is not as predictable as radical surgery. The following points regarding treatment of locally advanced PCa are still under debate: neoadjuvant treatment is probably not as efficient as believed; technical refinements of radical prostatectomy may be helpful; in some instances, the value of adjuvant treatment is undecided. The efficacy of irradiation in conjunction with androgen deprivation probably equals the efficacy of surgery. No consensus can be found in the presence of positive lymph nodes, although single institutions achieve remarkable results with surgery plus androgen deprivation. Conclusion: Prognostic factors beside the clinical stages and grades should be incorporated in the treatment decision, and quality-of-life measurement should gain more importance when the treatment outcome is assessed.

Journal Article↗
PubMed2002

Refractory angina pectoris: mechanism and therapeutic options.

As the survival of patients with primary coronary events continues to increase, the number of patients presenting with coronary artery disease unsuitable to further revascularization techniques and symptoms refractory to medical therapy also continues to rise. The aims of this review were to define the population of patients with refractory angina pectoris and to present the therapeutic options currently available for this condition. Refractory angina pectoris is defined, and traditional medical therapies are discussed. Then, current therapeutic options for patients with refractory angina are extensively reviewed. A multitude of therapeutic options exist for patients with refractory angina pectoris. Small, uncontrolled studies have shown a potential benefit for additional antiplatelet and antithrombotic therapy. In randomized trials, neurostimulation has been shown to be effective in reducing angina symptoms. Enhanced external counterpulsation is a viable treatment option for select patients with refractory angina. In many randomized trials, laser revascularization has been shown to diminish angina symptoms, although no placebo-controlled studies exist to date. Gene therapy is a promising area of research in this field. Percutaneous in situ coronary venous arterialization is in its infancy, but may be able to treat many patients if proved successful. No data support the role of chelation therapy in this population. Heart transplantation remains a final option for these patients. Further research of the techniques mentioned in this review is warranted. The importance of randomized, double-blinded, placebo-controlled trials cannot be overemphasized, as the placebo effect of these therapies is probably marked.

Angina Pectoris↗
PubMed1997

Poor prognosis and limited therapeutic options in patients with Budd-Chiari syndrome and portal venous system thrombosis.

OBJECTIVES: Therapeutic options in Budd-Chiari syndrome (BCS) are highly dependent on the site and extent of hepatic vein thrombosis. The aim of this study was to evaluate the effect of additional portal venous system thrombosis on the clinical presentation, treatment and outcome in patients with BCS. PATIENTS: Clinical notes of 51 patients with BCS admitted to our centre were evaluated. We identified 13 patients (25%) with BCS and additional portal venous system thrombosis. Ten patients were female and three male with a mean age at presentation of 42 years (range 32-67). RESULTS: An underlying haematological aetiology was identified in 10 of the 13 patients. Only four patients (31%) were anticoagulated before referral to our centre. In addition to hepatic vein thrombosis seven patients had portal vein thrombosis (PVT), three had PVT, splenic vein (SV) and superior mesenteric vein (SMV) thrombosis and three had either SV, SMV or inferior vean cava (IVC) thrombosis. The presentation was acute in three patients, subacute in six and chronic in four with a high incidence of encephalopathy (6/13; 46%). Treatment included liver transplantation (four), mesoatrial shunt (one) and balloon dilatation of hepatic veins (two). Six patients were treated medically as all other options were considered too risky or technically impossible. Nine of 13 patients (70%) died either after surgery or before any treatment could be instituted (median survival 1 month), compared to 14/38 (37%) in patients with isolated hepatic vein thrombosis (median survival 6.3 years). CONCLUSION: We conclude that patients with BCS and portal venous system thrombosis constitute a unique group with limited therapeutic options and poor prognosis. The importance of early recognition and anticoagulation of patients with BCS is emphasized.

Adolescent↗
PubMed2004

[Multiple sclerosis: potential therapeutic options and update of ongoing studies].

The therapeutic options for the treatment of multiple sclerosis (MS) have experienced enormous progress over recent years. Despite these encouraging developments, available therapies are only partially effective, and the ultimate goal of curing MS is still far from being attained. The improved understanding of the cellular and molecular mechanisms of MS (immune) pathogenesis together with recent shifts in paradigms led to a variety of new therapeutic targets and approaches. In addition to modulation of the inflammatory process, therapeutic approaches focussing on active neuroprotection, remyelinization, and regeneration have become increasingly important. Based on current concepts of the MS pathogenesis, this article summarizes new therapeutic approaches. Substances and strategies currently tested in clinical trials are reviewed.

Adjuvants, Immunologic↗
PubMed2001

New therapeutic options for urge incontinence.

A critical evaluation of the literature published over the past year reveals several therapeutic options for urge incontinence. Basic science advances in understanding the pathophysiology of bladder instability are paramount in the development of new therapeutic options, chief of which is sacral neuromodulation. Epidemiologic studies from around the world impact the therapies and diagnosis. Therapies include hormone delivery systems, pharmaceutical, combined behavioral and drug, botulinum, surgery, magnetic stimulation, and sacral neuromodulation.

Aged↗
PubMed2005

[Therapeutically options for primary and secondary hepatic malignancies].

Therapeutically options for the treatment of patients with primary hepatic malignancies have grown in recent years. Apart from liver resection and organ transplantation, representing the only curative strategies for primary hepatic malignancies, a variety of palliative procedures have been introduced. Some of these result in extended patient survival. However, the combination of a malignant disease and an irreversible organ damage remains to be the main problem in the majority of patients with primary liver Cancer. Liver resection is the only curative therapy for patients with isolated hepatic colorectal metastases and can be performed with low morbidity and mortality if a correct indication and a standardized procedure is applied. In case of intrahepatic tumour recurrence re-resection is indicated as long as extrahepatic metastases can be excluded. In patients with primary unresectable metastases a downstaging-chemotherapy, two-stage hepatectomy or portal vene embolization might result in a secondary respectability. Locally ablative procedures are being evaluated at present, in the palliative Situation survival can be prolonged. In the future multimodal therapeutic approaches will dominate the treatment of primary and secondary hepatic malignancies.

Colorectal Neoplasms↗
PubMed2001

Therapeutic options for acute myelogenous leukemia.

BACKGROUND: General therapeutic options for patients with acute myelogenous leukemia (AML) are reviewed and specific new therapies are described. METHODS: Data in this review came from the published literature and the M. D. Anderson Cancer Center's acute leukemia database. RESULTS: Outcome following standard therapy of AML is so variable that is best to speak of a range of outcomes determined by various prognostic factors. Therapy can (and usually does) fail because of treatment-induced mortality or (more usually) resistance to therapy. Performance status and age are the principal predictors of early death, whereas cytogenetics, a history of abnormal blood counts, and MDR1 expression are predictors of resistance. Using this information, physicians can categorize patients into those in whom 1) standard therapy is indicated, 2) either standard or investigational therapy is appropriate, and 3) investigational therapy is indicated. The majority of even newly diagnosed patients belong to Group 3. The availability of allogeneic or autologous transplantation does not alter this conclusion. Investigational therapies have been developed that are directed against the CD33 surface antigen, the multidrug-resistant MDR1 protein, and other targets. Because of the number of new therapies clinical research in AML should emphasize pilot trials rather than traditionally large Phase III studies. CONCLUSIONS: Most patients with newly diagnosed AML should be offered investigational regimens.

Antibiotics, Antineoplastic↗
PubMedDate not supplied

Outpatient left ventricular assist device support: a safe and economical therapeutic option for heart failure.

The left ventricular assist device (LVAD), once considered for acute cardiac failure only when no other therapeutic option was available, is now used routinely at selected centers to allow the sickest patients to become self-sufficient and go home. This represents a dramatic change in the physician's perception of the LVAD in the early 1990s. The creation of these mechanical assist outpatient programs are possible for the following reasons: 1) confidence in the devices allow patients, their families, and health care providers to be more comfortable with outpatient therapy; 2) the devices are simplified and durable, allowing extended duration of support and more options for patients; and 3) a change in the perception of the LVAD from a last-resort therapeutic option to that of a safe and reliable bridge to recovery and transplant. With these general concepts in mind, programs have been created with specific safety nets, patient education goals, and discharge criteria. By using this construct, we have developed a successful outpatient LVAD program in which 70% of our vented electric LVAD patients were discharged with a 0% mortality and minimal morbidity. From our experience and studies, we believe that not only is an outpatient LVAD program safe and economical, but it is also socially, physically, and psychologically beneficial to the patient. In the current economic environment of cost containment, outpatient LVAD therapy is a necessary part of an LVAD program that should be sought by most cardiac mechanical assist programs.

Ambulatory Care↗
PubMed2006

Does allergen-specific immunotherapy represent a therapeutic option for patients with atopic dermatitis?

House dust mite (HDM) allergens are perennial indoor allergens, which may play a role as allergic trigger factors in atopic dermatitis (AD). Facilitated by their high enzymatic activity, HDM allergens are capable of penetrating the impaired epidermal skin barrier in patients with AD, gaining access to immune cells. In this way, HDM allergens induce both allergic reactions of the immediate type and allergic reactions of the delayed type, which contribute to impairment of AD. Because allergen reduction achieved by encasing strategies does not always lead to significant improvement of clinical symptoms, specific immunotherapy (SIT) might represent an attractive therapeutic option for long-time treatment of this subgroup of patients with AD. However, systematic studies on the effectiveness of SIT in patients with AD are rare. Furthermore, data on the immunologic changes induced by SIT in patients with AD are not well studied. In this review, we provide an overview of the pathogenic impact of HDM allergens as an example for aeroallergens on the course of AD. In addition, we discuss prophylactic and therapeutic options for the treatment of HDM allergy in patients with AD, including a summary of the current data available on SIT as a potential therapeutic option for patients with AD.

Adolescent↗