Common Indication For Treatment Research Articles

Radioiodine treatment for malignant thyroid disease

Radioiodine treatment for thyroid disease has been given for half a decade in Sweden. The most common indication for treatment is hyperthyroidism, when iodine uptake is high. The situation in which radioiodine treatment is used in thyroid cancer is less favourable and measures therefore have to be taken to optimize the treatment. Treatment should be performed early in the course of the disease to achieve the highest possible differentiation. Before treatment the iodine and goitrogen intake should be kept low. Stimulation of the thyrocytes by thyroid-stimulating hormone (TSH) should be high. It is conventionally achieved by thyroid hormone withdrawal rendering the patient hypothyroid, or by the recently available recombinant human TSH (rhTSH) which can be recommended for ablation of the thyroid remnant after thyroidectomy and for treatment of metastases in fragile patients unable to undergo hypothyroidism. Finally, stunning – the negative effect of a prior test dose from radioactive iodine – should be avoided.

Warfarin maintenance dosages in the very elderly

The effect of age on maintenance dosages among elderly patients with a stable International Normalized Ratio (INR) was studied. The records of all patients monitored by an anticoagulation clinic between October 2000 and July 2002 were randomly selected for review. Data collection continued until at least 50 patients were enrolled in each of the following age groups: <75, 75-79, 80-84, and >/=85 years. To be included in the analysis, patients had to have been >50 years of age, had to have had a targeted INR of 2-3, and had to have had two consecutive INR values within the targeted range not more than 60 days apart. A total of 532 patient charts were reviewed, and 253 met the criteria for inclusion in the study. The mean +/- S.D. age of the patients was 80.6 +/- 7.8 years (range, 55-98 years). Atrial fibrillation or flutter was the most common indication for treatment. The mean daily warfarin dose was significantly lower with increasing age; the mean +/- S.D. daily dose for patients younger than 75 years was 4.9 +/- 2.6 mg/day, while that for patients 85 years or older was 3.5 +/- 2.6 mg/day. The warfarin dosage for maintenance therapy in elderly patients, especially those older than 75 years, appeared to be inversely related to age.

Surgical management of benign solid and cystic liver lesions

The aim is to evaluate the indications for and results of surgery in patients with benign solid and cystic liver lesions. Resection is the best method of management of symptomatic benign solid liver lesions. For cystic lesions fenestration or resection have been the most-used treatments. Recently, laparoscopy has changed the way we treat these lesions. We reviewed the clinical files of all patients with benign solid and cystic liver lesions operated-upon between May 1995 and May 2003. There were 64 patients included in the present analysis (57 female; 7 male); median age was 48 years (range 21–74 years); 32 (50%) with benign solid liver lesions of which 22 were cavernous haemangiomas; 23 (35.9%) with non-parasitic liver disease (NPLD) and 9 (14%) had polycystic liver disease (PLD). There were 54 patients (84.3%) who had symptoms. Thirty-nine patients had liver resections performed (16 major and 23 minor), 15 patients were treated by open fenestration and 10 were treated by laparoscopic fenestration. There were 10 patients (15.6%) who presented complications; operative mortality was zero. The presence of symptoms is the most common indication for treatment. Laparoscopic fenestration has become the first-line treatment tor symptomatic NPLD and selected patients with benign solid liver lesions and PLD. However, in our centre, a considerable proportion of patients is still operated-upon via the open approach. A careful selection of cases is necessary to ensure good outcomes.

Endobronchial electrocautery and argon plasma coagulation: a practical approach.

The present review covers the technical and practical aspects of endobronchial electrocautery, including argon plasma coagulation, which have great potential for widespread use by pulmonologists around the world. The various electrocautery modes, power settings and electrode probes are described in detail, and the authors' clinical and technical approach is demonstrated with a narrative description and brief case presentations. Malignant airway obstruction, hemoptysis, web-like stenosis, stent related granulation tissue and early lung carcinomas are the most common indications for treatment. Advantages of electrocautery, such as low cost, rapid effect, safety and ease of use, are contrasted to other endobronchial therapeutic modalities. Published experience with electrocautery is reviewed.

Clinical characteristics of dural arteriovenous fistula

Intracranial dural arteriovenous fistula (DAVF) is an uncommon neurosurgical condition; in particular, it has been infrequently reported in Korea. To understand the general clinical characteristics of DAVFs, the authors reviewed 53 cases and analyzed factors affecting DAVF hemorrhage of and treatment outcome. Since 1980 we have encountered 480 pial and 53 DAVFs, a ratio of 9.1 to 1. The age of these patients ranged from 1 month to 71 years, the most common being in the 6th decade, and females exceeded males by 1.65 to 1. All lesions except three were single, and symptoms were related to location and the venous drainage pattern. The most common location was the cavernous sinus, accounting for about 64% of cases, with the result that the most common clinical symptoms of DAVFs were ocular, namely proptosis and chemosis. The next was tinnitus also found in transverse-sigmoid sinus DAVFs. Intracranial hemorrhage was seen in eight cases,(15%) the primary cause of hemorrhage was retrograde intracranial venous drainage (P=0.017), and one hemorrhage was observed in cases with no intracranial venous drainage. Intracranial hemorrhage was more frequently in transverse-sigmoid than cavernous sinus DAVFs (P=0.049), and this proved to be so even where there was intracranial venous drainage. However, two of 34 patients with cavernous DAVFs became blind in one eye, demonstrating that in such patients, the clinical course could be aggressive. Thirteen patients were treated conservatively. The conservative treatment group was comprised of 13 patients, two of three patients with transverse-sigmoid sinus DAVF expired, and 7 of 10 with cavernous sinus DAVF experienced a clinical improvement or cure. Surgical excision was performed in only two patients. A total of 39 patients underwent embolization; clinical cure was achieved in 13, improvement of symptoms in 12, an unchanged or aggravated result occurred in 9, one died, and four were lost to follow up. During intervention, there was one hemorrhagic complication, owing to obstruction of the venous outflow with embolic materials.In this study, the most common location of DAVFs was the cavernous sinus. The cortical venous drainage remains the primary determinant of intracranial hemorrhage. Common indications for treatment include hemorrhage and neurological deficit. Endovascular treatment is preferred in the majority of cases except tentorial DAVF. The goal of embolization in cavernous DAVF is the alleviation of symptoms, not angiographic cure. But transverse-sigmoid sinus DAVF with venous restriction and leptomeningeal drainage should be treated aggressively.

Intracranial Dural Arteriovenous Fistulas:: Endovascular Therapy

Dural arteriovenous malformations are probably acquired lesions, and therefore the term dural arteriovenous fistula (AVF) is more appropriate. Dural AVFs generally present with symptoms related to their venous drainage. Common indications for treatment include hemorrhage, progressive neurologic deficit, and intractable tinnitus. Endovascular therapy is preferred in the majority of cases, although certain locations warrant direct neurosurgical or combined techniques. Endovascular therapy of dural AVFs may be taxing for both patient and endovascular therapist. More than one treatment session employing both arterial and venous approaches may be required.

Paget's disease of bone: Orthopedic complications

Orthopedic complications of Paget's disease are among the most common indications for treatment of Paget's disease. These complications include severe bone pain, joint pain, skeletal deformity, pathological fracture, and rarely malignant degeneration. The use of effective pharmacological modalities has transformed the treatment of Paget's disease in the past four decades. Although few patients with Paget's disease ever require surgical therapy, successful surgical management of severe orthopedic complications has improved the quality of life for many sufferers. Selected modalities with promising results include total hip replacement for intractable pagetic arthritis of the hip, proximal tibial osteotomy for painful malalignment of the knees, total knee replacement for intractable arthritis of the knee, and internal fixation for pathological fracture. Common surgical complications of joint replacement include infection, hemorrhage, heterotopic ossification, and aseptic loosening. The medical, surgical, and rehabilitation modalities available in managing primary and secondary orthopedic complications of Paget's disease provide a wide array of options that must be carefully considered in each patient.

Intentions and outcomes in the radiotherapeutic management of epidemic Kaposi's sarcoma

The indications for and outcome of radiotherapy for 226 epidemic Kaposi's sarcomas are reported. The overall likelihood of obtaining complete regression of tumor masses was 68%, although residual purple pigmentation remained in 20%. Local recurrence developed in 9%. The indications for treatment were not equally represented. Palliation of pain or improvement of the patient's appearance were the most common indications for treatment. Kaposi's sarcoma lesions do not all behave in a like manner. Best fit log-linear models of associations among the variables were derived. They demonstrated that the combination of treatment intention, anatomic site, and Karnofsky score predicted the short-term and long-term tumor response. The intention of treatment was closely linked to the anatomic site of treatment and in concert directly influenced outcome. The host's Karnofsky score was an independent predictive factor, but had less impact on outcome than did site or intention. Our data demonstrate that case selection can markedly alter the observed response rate of epidemic Kaposi's sarcoma to radiotherapy. This finding should be considered in future analyses of trials that test the efficacy of treatment for this disease.

PSEUDOTUMOR CEREBRI AND MACULAR DISEASE

The most common indications for treatment of patients with pseudotumor cerebri are the presence of severe intractable headaches and evidence of optic neuropathy. The role of the ophthalmologist in following patients with pseudotumor cerebri has been to document optic nerve dysfunction in terms of visual field abnormalities or loss of visual acuity. Macular changes have been described in association with papilledema. A case of pseudotumor cerebri and associated macular disease is reviewed to call attention to the need for the ophthalmologist to differentiate between visual loss secondary to optic neuropathy from that of macular disease. The case illustrates how quickly macular disease can develop. The management of patients with pseudotumor cerebri is discussed.

Palliation of airway obstruction from tracheobronchial malignancy: use of the CO2 laser bronchoscope.

A CO2 laser rigid bronchoscope system has been used to palliate symptoms of a malignancy obstructing the tracheobronchial airway. Fifty-nine endoscopic laser operations (34 patients) were done between 1975 and 1981. Severe dyspnea and obstructive atelectasis were the most common indications for treatment. Contraindications for treatment included extrinsic tracheobronchial compression, widespread distant metastases, rapidly progressing tumors, and highly vascular neoplasms. There were nine primary tracheal malignancies, five metastases from distant sites, and 20 primary lung cancers with tracheobronchial obstructions. Most patients were previously treated with one or more standard modalities (radiation therapy, surgery, and chemotherapy). Removal of airway obstruction was occasionally indicated prior to radiation therapy to facilitate treatment. There were seven instances of complications in this group of patients and one mortality. Most patients (23 of 34) have died from their malignancy. The best palliation was achieved in proximal (tracheal and main stem bronchial), slower growing tumors.