Completion Of Treatment In Patients Research Articles

Concurrent chemoradiation versus radiotherapy alone for the treatment of locally advanced cervical cancer in a low-resource setting

Our goal was to determine the clinical treatment response following radiation administered with or without chemotherapy for locally advanced cervical cancers in Honduras. This is a retrospective study of patients treated with either concurrent chemoradiation (CCRT) or external beam radiation therapy (EBRT) alone at a hospital in Tegucigalpa, Honduras. 70Gy of EBRT to the pelvis was given in all cases. Brachytherapy was not available. Chemotherapy was given when available. Extrafascial hysterectomy was performed 6weeks after completion of treatment in patients with a complete clinical response (cCR). Records for 165 women with locally advanced cervical cancer were reviewed; 25 (15.2%) stage IB2, 15 (9.1%) stage IIA, 90 (54.5%) stage IIB, and 35 (21.2%) stage IIIB. Ninety (54.5%) patients received EBRT alone; 75 (45.5%) received CCRT. Twenty-three (33.3%) of CCRT patients received weekly cisplatin, the remainder receiving other agents. Seventy (77.8%) of the 90 patients who received EBRT had a cCR; 25 out of 75 (33.3%) patients in the CCRT group achieved a cCR. The CCRT group treated with weekly cisplatin achieved an 80% cCR; while the CCRT group given alternative agents had only a 31% cCR. Patients unable to receive platinum-based CCRT had the worst outcome, and their responses were inferior to patients who received EBRT. The challenges of treating women with locally advanced cervical cancer in a low-resource setting are multifactorial and include treatment delays, the lack of brachytherapy and the unpredictable availability of chemotherapy.

Orthognathic surgery: surgical failures and complications

Orthognathic surgery procedures mark the endpoint of lengthy orthodontic-surgical preparations and herald the completion of treatment for patients and their families. The main types of procedure are full maxillary Le Fort I osteotomies, mandibular osteotomies and chin surgery. To ensure a successful outcome, all require a favorable environment and extreme technical skill. But, like all surgical operations, they are also subject to peri- and post-operative complications resulting from treatment hazards or errors. Whatever the cause, surgical complications can entail failures in the management of the malformation. By seeking to understand and analyzing these complications, we can already help to prevent and reduce the contingent risks of failure.

Carotid blowout in patients with head and neck cancer: Associated factors and treatment outcomes

The purpose of this study was to investigate factors associated with carotid blowout in the cervical portion of patients with head and neck cancer in a large cohort. We reviewed patients with head and neck cancer and identified those with carotid blowout. Variables of patients with and without carotid blowout were compared and associated factors were investigated by logistic regression model. A total of 2590 patients were included in the final analysis and 102 patients (3.9%) developed carotid blowout in the cervical region. Body mass index (BMI) <22.5 kg/M(2) , primary site in the hypopharynx or oropharynx, open wound in the neck requiring wet dressing, radical neck dissection, and total radiation dose to the neck ≥70 Gy were independent factors associated with carotid blowout. After completion of treatment in patients with head and neck cancer, carotid blowout was an uncommon complication with catastrophic results. Recognition of associated factors helps physicians to identify those at risk.

Omalizumab, an anti-immunoglobulin E antibody: state of the art.

A large number of trials show that the anti-immunoglobulin (Ig) E antibody omalizumab is very effective in patients with severe allergic asthma. This is acknowledged in consensus documents. The drug also has a good safety profile and a pharmacoeconomic advantage due to a reduction in the number of hospitalizations for asthma attacks. In recent years, some studies have shown that omalizumab is effective also in nonallergic asthma. Effects on the complex signaling mechanisms leading to activation of effector cells and to mediator release may account for this outcome. Indeed, omalizumab has been reported to be effective in a number of IgE-mediated and non-IgE-mediated disorders. Concerning the former, clinical efficacy has been observed in rhinitis, allergic bronchopulmonary aspergillosis, latex allergy, atopic dermatitis, allergic urticaria, and anaphylaxis. In addition, omalizumab has been demonstrated to be able to prevent systemic reactions to allergen immunotherapy, thus enabling completion of treatment in patients who otherwise would have to stop it. Concerning non-IgE-mediated disorders, omalizumab has been reported to be effective in nasal polyposis, autoimmune urticaria, chronic idiopathic urticaria, physical urticaria, idiopathic angioedema, and mastocytosis. Current indications for treatment with omalizumab are confined to severe allergic asthma. Consequently, any other prescription can only be off-label. However, it is reasonable to expect that the use of omalizumab will be approved for particularly important indications, such as anaphylaxis, in the near future.

Multiple cutaneous metastases in laryngeal carcinoma: A rare occurrence

Metastasis to the skin in laryngeal squamous cell carcinoma is an extremely rare occurrence. We report a case of multiple cutaneous metastases in the follow-up of a 60-year-old male with squamous carcinoma of the vocal cords that were treated with surgery and radiotherapy. The patient presented with multiple painful skin nodules at 3 months following the completion of treatment. Clinically the skin nodules mimicked an inflammatory skin lesion. The diagnosis of metastatic skin lesions was made by cytological examination. Appearance of new painful skin lesions soon after the completion of treatment in patients treated for squamous carcinoma of the larynx should warrant a clinical suspicion of cutaneous metastases.

Delayed Complications after Anterior Craniofacial Resection of Malignant Skull Base Tumors

Objective To report complications occurring at least 6 months after completion of treatment for patients with anterior skull base malignancy undergoing anterior craniofacial resection (CFR). Design Retrospective review of medical records of all patients undergoing traditional CFR for treatment of anterior skull base malignancy from 2002 through 2011. Setting Massachusetts General Hospital/Massachusetts Eye and Ear Infirmary Cranial Base Center. Participants Thirty-one consecutive patients who had at least 18 months of follow-up for analysis were reviewed. All patients underwent traditional CFR. A total of 28 patients received postoperative proton beam radiation therapy. Eleven patients received adjuvant chemotherapy. Main Outcome Measures A delayed complication was any complication occurring at least 6 months after the completion of treatment. Results Seventeen patients had delayed complications. Orbital complications were the most common type (13 patients) followed by issues with wound healing (6 patients). The most common orbital complication was epiphora (7 patients). The most common wound complication was a nasocutaneous fistula (5 patients). Conclusions Patients with anterior skull malignancy can develop complications months to years after the completion of treatment. Therefore, it is important to continue to follow and report complications for several years when deciding on the optimal approach for treatment of these patients.

Serum VEGF and VEGF-C values before surgery and after postoperative treatment in gastric cancer

Angiogenesis and lymphangiogenesis are essential processes for the formation of blood and lymphatic vessels that allow tumour growth and spread. The binding of VEGF and VEGF-C factors with their receptors (VEGFR2, VEGFR3) in endothelial cells triggers signals that regulate these processes. We compared preoperative serum VEGF and VEGF-C levels with samples obtained after completion of surgery and adjuvant treatment in patients with gastric cancer. In addition, we determined the prognostic value and relationship to survival of serum VEGF and VEGF-C levels. We used a prospective cohort study of 59 gastric cancer patients who underwent surgery. Serum VEGF and VEGF-C were measured by enzyme-linked immunosorbent assay (ELISA) the day before surgery and 6months later, after completion of adjuvant treatment. Serum VEGF values decreased after treatment in patients with resectable tumours (mean±SD) (405.42±298.38 vs. 306.38±212.47pg/ml; p<0.01), poorly differentiated and undifferentiated tumours (G3, G4) (438±339.71 vs. 322.47±210.71pg/ml; p=0.01), locally advanced gastric tumours (T4 stage) (424.27±323.08 vs. 333.62±221.72pg/ml; p=0.03) and tumours with a greater number of involved regional lymph nodes (N3) (442.38±311.52 vs. 337.4±203.64pg/ml; p=0.04). Serum preoperative VEGF values over 761pg/ml were associated with shorter patient survival. The mean overall survival time for patients with serum VEGF levels higher than 761pg/ml was 7±2.99months (95% CI 1.14-12.86) while for patients with serum VEGF levels of less than 761pg/ml was 21.18±2.88 (95% CI 15.54-26.83) The mean disease-specific survival time for patients with serum VEGF levels higher than 761pg/ml was 6.25±2.53months (95% CI 1.29-11.21) while for patients with serum VEGF levels of less than 761pg/ml was 27.57±3.45 (95% CI 20.80-34.35). Multivariate analysis identified preoperative serum VEGF levels as an independent prognostic factor (HR=0.144; p=0.03). Serum VEGF levels decreased after the completion of treatment in patients with resected tumours, suggesting VEGF tracking may be useful in monitoring progression. Preoperative measurement of serum VEGF may help us identify patients with a poor prognosis.

Efficacy of low-level laser therapy in the management of neck pain: a systematic review and meta-analysis of randomised placebo or active-treatment controlled trials

Neck pain is a common and costly condition for which pharmacological management has limited evidence of efficacy and side-effects. Low-level laser therapy (LLLT) is a relatively uncommon, non-invasive treatment for neck pain, in which non-thermal laser irradiation is applied to sites of pain. We did a systematic review and meta-analysis of randomised controlled trials to assess the efficacy of LLLT in neck pain. We searched computerised databases comparing efficacy of LLLT using any wavelength with placebo or with active control in acute or chronic neck pain. Effect size for the primary outcome, pain intensity, was defined as a pooled estimate of mean difference in change in mm on 100 mm visual analogue scale. We identified 16 randomised controlled trials including a total of 820 patients. In acute neck pain, results of two trials showed a relative risk (RR) of 1.69 (95% CI 1.22-2.33) for pain improvement of LLLT versus placebo. Five trials of chronic neck pain reporting categorical data showed an RR for pain improvement of 4.05 (2.74-5.98) of LLLT. Patients in 11 trials reporting changes in visual analogue scale had pain intensity reduced by 19.86 mm (10.04-29.68). Seven trials provided follow-up data for 1-22 weeks after completion of treatment, with short-term pain relief persisting in the medium term with a reduction of 22.07 mm (17.42-26.72). Side-effects from LLLT were mild and not different from those of placebo. We show that LLLT reduces pain immediately after treatment in acute neck pain and up to 22 weeks after completion of treatment in patients with chronic neck pain. None.

Isoniazid-Monoresistant Tuberculosis in the United States, 1993 to 2003

Seven percent of tuberculosis (TB) cases reported to the US National Tuberculosis Surveillance System in 2005 had Mycobacterium tuberculosis isolates with resistance to at least isoniazid. We undertook this study to describe demographic characteristics, risk factor information, and treatment outcomes for persons with isoniazid-monoresistant (resistant to isoniazid and susceptible to rifampin, pyrazinamide, and ethambutol hydrochloride) TB compared with persons with TB susceptible to all first-line anti-TB drugs. The numbers of isoniazid-monoresistant TB cases increased from 303 (4.1%) in 1993 to 351 (4.2%) in 2005. In our multivariate analysis of all TB cases reported from 1993 to 2003, the races/ethnicities of patients with isoniazid-monoresistant TB were significantly more likely to be US-born Asian/Pacific Islander (adjusted odds ratio [aOR], 1.9; 95% confidence interval [CI], 1.4-2.6), foreign-born Asian/Pacific Islander (1.8; 1.4-2.1), foreign-born black non-Hispanic (1.4; 1.1-1.7), or US-born Hispanic (1.3; 1.1-1.5). Isoniazid monoresistance was also associated with failure to complete therapy within 1 year (aOR, 1.7; 95% CI, 1.5-1.8), a history of TB (1.5; 1.3-1.7), and correctional facility residence (1.5; 1.2-1.7). Isoniazid-monoresistant TB did not decline from January 1, 1993, through December 31, 2005, despite national downward trends observed in overall TB cases and in multidrug-resistant TB cases. Physicians must ensure completion of treatment for patients taking isoniazid as part of their TB or latent TB infection therapy. In addition, physicians should maintain heightened vigilance for isoniazid resistance when evaluating certain at-risk populations for TB and latent TB infection.

Evaluación en salud pública: lecciones aprendidas de la gestión de la tuberculosis pulmonar

Pulmonary tuberculosis rates are increasing worldwide, including in Spain. One of the main challenges when treating this disease is achieving treatment completion, since studies have shown that approximately 30-35% of all patients do not take their medications as intended.The present article explores a continuum of evaluation strategies and performance measures for assessing the effectiveness of community-based programs designed to enhance treatment completion in patients with active pulmonary tuberculosis. Four traditional evaluation strategies (case studies, retrospective and case-control studies, forecasting/modeling, and cost effectiveness analysis) and 2 emerging and promising approaches (quality of life assessment and indicators of the continuum of care) are presented.Several of the evaluation strategies reviewed indicate that treatment programs using directly observed therapy (DOT) that are comprehensive, community-based and patient-centered achieve the highest treatment completion rates. Combinations of these strategies are recommended to create a body of evidence capturing the impact and nuances of community-based public health interventions in improving health outcomes, in this case for patients with pulmonary tuberculosis.

Trends in Tuberculosis Reported From the Appalachian Region: United States, 1993‐2005

Appalachia has been characterized by its poverty, a factor associated with tuberculosis, yet little is known about the disease in this region. To determine whether Appalachian tuberculosis risk factors, trends, and rates differ from the rest of the United States. Analysis of tuberculosis cases reported to the Centers for Disease Control and Prevention's National Tuberculosis Surveillance System (NTSS) within the 50 states and the District of Columbia from 1993 through 2005. The 2005 rate of tuberculosis in rural Appalachia was 2.1/100,000, compared to 2.7/100,000 in urban Appalachia. Urban non-Appalachia had a 2005 tuberculosis rate of 5.4/100,000. Over the 13-year period, tuberculosis rates fell in Appalachia at an annual rate of 7.8%. In one age group (15- to 24-year-olds) the rates increased at an annual rate of 2.8%. Foreign-born Hispanics were the largest racial/ethnic group in this age group. When private providers gave exclusive care for tuberculosis disease, Appalachians were less likely to complete therapy in a timely manner when compared to non-Appalachians (OR 0.6, 95% CI 0.5-0.7). Tuberculosis rates and trends are similar in urban and rural Appalachia. It is crucial for public health officials in Appalachia to address the escalating TB rate among 15- to 24-year-olds by focusing prevention efforts on the growing numbers of foreign-born cases. Due to the increased risk of treatment failure among Appalachians who do not seek care from the health department, public health authorities must ensure completion of treatment for patients who seek private providers.

Laparoscopic treatment of early ovarian cancer

Recently some studies have reinforced the arguments supporting the laparoscopic management of early ovarian cancer. These studies and reports questioning the use of laparoscopy in patients with early ovarian cancer will be reviewed. Advances in laparoscopic techniques have enabled the surgeon to meet the staging criteria for early ovarian cancer as proposed by the International Federation of Gynecology and Obstetrics (FIGO) guidelines. Although some reports highlight the risk of ovarian cancer mismanagement, the safety and reliability of laparoscopic surgical staging has been demonstrated with encouraging results. However, the numbers of patients included in these studies are still insufficient to draw conclusions. Clinical evidence supports the use of laparoscopy in the treatment or completion of treatment in patients diagnosed with early ovarian cancer. If strict guidelines are respected, tumor rupture, dissemination and implant on the trocar insertion sites can be avoided and survival outcomes appear not to be jeopardized. Inadequate and hazardous laparoscopic management of early ovarian cancer is to be ascribed to the lack of guidelines and to surgeons without the competence to treat early ovarian cancer rather than to the surgical technique. The excellent outcomes could encourage studies with larger sample sizes to confirm the validity of laparoscopic treatment of patients with early ovarian cancer. Unfortunately, a clinical trial is unlikely to be undertaken due to the low incidence of this disease and the even lower number of events.

Intraperitoneal α-Interferon Alternating with Cisplatin in Residual Ovarian Carcinoma: A Phase II Gynecologic Oncology Group Study

Objective. The aim of this study was to study the combination of intraperitoneal α-interferon and cisplatin administered second-line in an alternating sequence in small volume residual epithelial ovarian cancer after second-look surgery and the activity of this combination based on prior response to first-line platinum compounds.Methods. Sixty-two patients with minimal residual (<0.5 cm) epithelial ovarian cancer at reassessment laparotomy were entered into a multicenter trial of intraperitoneal α-interferon alternating with cisplatin given for eight cycles unless disease progression or unacceptable toxicity occurred. The patients were considered favorable if they were platinum-sensitive and/or relapsed 6 months or longer after completing treatment. Another reassessment laparotomy was performed within 12 weeks of completion of treatment in patients who were in clinical remission.Results. Fifty-four patients were clinically evaluable and 18 were surgically reassessed, 5 of whom had a negative reassessment operation (20% complete response and 8% partial response). Of the 54 patients evaluable for toxicity, the most common adverse effects of more than grade 2 were gastrointestinal in 13 (47%), neutropenia in 9 (17%), and leukopenia in 6 (12%). Grade 4 toxicity was seen in 10 instances: 4 gastrointestinal, 2 neutropenia, 2 thrombocytopenia, 1 wound infection, and 1 allergic reaction.Conclusions. α-Interferon and cisplatin are active agents in favorable patients with minimal residual epithelial ovarian cancer at second-look. The combination of the two drugs administered in an alternating sequence appears to be associated with more side effects than when either drug is administered alone. The combination produced response rates similar to those seen when either drug is given alone.