Failure Of Conventional Treatment Research Articles

Efficiency and Safety of Intracoronary Epinephrine Administration in Patients With ST-Elevation Myocardial Infarction With Refractory Coronary No-Reflow

Studies assessing the treatment of refractory no-reflow in ST-elevation myocardial infarction (STEMI) patients are limited to clinical cases and pilot studies. This study aimed to evaluate the efficacy and safety of intracoronary epinephrine administration in such patients. Ninety consecutive patients with refractory coronary no-reflow during percutaneous coronary intervention (PCI) were prospectively included after initial failure of conventional treatment. They were randomized into 2 groups: 45 patients in group 1 received epinephrine, and 45 patients in group 2 (control) received conventional treatments alone. Following intracoronary drug administration, the epinephrine group demonstrated significantly higher rates of coronary flow restoration in the infarct-related artery to the level of thrombolysis in myocardial infarction (TIMI) grade 3 (56% versus 29% (p=0.01)) and resolution of ST-segment elevation >50% post PCI (78% versus 36% (p<0.001)). Additionally, the epinephrine group showed a lower indexed microvascular obstruction (MVO) volume compared to the control group (0.9 (0.3; 3.1)% versus 1.9 (0.6; 7.9)% (p=0.048)). A significant improvement in ejection fraction (EF) was observed in the epinephrine group (p=0.025). Intracoronary epinephrine administration during PCI in STEMI patients with refractory no-reflow is more effective compared to conventional treatments. This approach improves coronary flow in the infarct-related artery, facilitates a faster resolution of ST segment elevation, enhances EF, and reduces MVO volume. Intracoronary epinephrine administration demonstrates a comparable safety profile to conventional treatment strategies in terms of life-threatening arrhythmias occurrence. The study suggests that intracoronary epinephrine administration during PCI could be an effective treatment strategy for STEMI patients with refractory no-reflow.

The role of immunotherapy in the treatment of lip squamous cell carcinoma: A series of six cases and a review of the current literature

BackgroundSquamous cell carcinoma (SCC) of the lip is a distinct subtype of oral cavity SCC, accounting for about 10–20 % of all oral cavity cancers. According to National Comprehensive Cancer Network (NCCN) guidelines, treatment consists of surgical resection with adjuvant radiotherapy or chemoradiotherapy as indicated. The role of immunotherapy as a treatment modality remains unclear. MethodsWe identified six patients with SCC of the lip who had locally advanced or recurrent disease and treated with PD-1 inhibitors, either as monotherapy or as part of a chemo-immuno regimen. Three patients were diagnosed with locoregional recurrences after conventional treatment failure, one of whom concurrently diagnosed with distant metastases. Two cases involved treatment with immunotherapy as an alternative to surgery or radiotherapy. Clinical and radiological responses were assessed, and side effects were recorded. ResultsAll patients exhibited complete clinical response, five showed complete radiological responses per PET-CT. One patient was yet to be assessed radiologically. Another had a PET-avid supraclavicular node negative for malignancy. The median follow-up time since treatment initiation was 11.49 months (IQR 7.77 - 29.03). Adverse effects included severe myositis (n = 1), arthralgia (n = 1), psoriasis (n = 1), esophagitis (n = 1), mild hepatitis (n = 1) and pruritus (n = 2). Management included corticosteroids (topical or systemic) and/or 2nd generation antihistamines and treatment cessation as indicated. ConclusionImmunotherapy shows promise for lip SCC after conventional treatment failure or as an alternative to surgery or radiotherapy in unsuitable candidates, suggesting a tumor biology resembling cutaneous rather than oral cavity SCC. Patients should be closely monitored for potential side effects.

Aberrantly Glycosylated GLUT1 as a Poor Prognosis Marker in Aggressive Bladder Cancer.

Muscle-invasive bladder cancer (MIBC) remains a pressing health concern due to conventional treatment failure and significant molecular heterogeneity, hampering the development of novel targeted therapeutics. In our quest for novel targetable markers, recent glycoproteomics and bioinformatics data have pinpointed (glucose transporter 1) GLUT1 as a potential biomarker due to its increased expression in tumours compared to healthy tissues. This study explores this hypothesis in more detail, with emphasis on GLUT1 glycosylation patterns and cancer specificity. Immunohistochemistry analysis across a diverse set of human bladder tumours representing all disease stages revealed increasing GLUT1 expression with lesion severity, extending to metastasis, while remaining undetectable in healthy urothelium. In line with this, GLUT1 emerged as a marker of reduced overall survival. Revisiting nanoLC-EThcD-MS/MS data targeting immature O-glycosylation on muscle-invasive tumours identified GLUT1 as a carrier of short glycosylation associated with invasive disease. Precise glycosite mapping uncovered significant heterogeneity between patient samples, but also common glycopatterns that could provide the molecular basis for targeted solutions. Immature O-glycosylation conferred cancer specificity to GLUT1, laying the molecular groundwork for enhanced targeted therapeutics in bladder cancer. Future studies should focus on a comprehensive mapping of GLUT1 glycosites for highly specific cancer-targeted therapy development for bladder cancer.

Update for surgeons on novel induction treatments for acute severe inflammatory bowel disease associated colitis.

The landscape of biologic agents for the treatment of inflammatory bowel disease (IBD) associated colitis is rapidly evolving, requiring surgeons to be up-to-date as part of multi-disciplinary, evidence-based care. An update on novel therapies used to induce remission in IBD-associated colitis is presented. A systematic search through Ovid MEDLINE and CENTRAL using a combination of MeSH terms and Boolean operators was conducted. One thousand and twenty articles from which 38 articles were selected for inclusion in this review. Novel agents were trialled as 4th or 5th line treatment following conventional treatment failure. Rates of serious adverse effects were low. Janus kinase (JAK) inhibitors (upadacitinib and tofacitinib) were efficacious in inducing remission in ulcerative colitis, and IL-23p19 inhibitors (mirikizumab, guselkumab, and risankizumab) in Crohn's colitis. Evidence was limited for other drug classes. JAK-inhibitors and IL-23p19 inhibitors were found to be the most effective agents for inducting remission following failure of standard of care treatment. A significant proportion of patients did not respond, highlighting the inherent challenge in optimizing treatment for moderate to severe IBD-associated colitis. More robust study designs and comparator trials are required.

Nivolumab immunotherapy rechallenge for progressive laryngeal squamous cell carcinoma after failure of conventional treatment: A CARE case report

ObjectiveAnalysis of rechallenge with nivolumab as 5th-line therapy for locally and nodally failed laryngeal squamous cell carcinoma following conventional therapeutic modalities: radiotherapy, surgery and chemotherapy. ObservationA 70-year-old male, with local and nodal progression of laryngeal squamous cell carcinoma after treatment with chemoradiotherapy and surgery, was initially treated for recurrence with carboplatin, 5-fluorouracile (FU) and cetuximab, followed by second-line nivolumab, and then two lines of conventional chemotherapy with paclitaxel and cetuximab followed by carboplatin and cetuximab. He underwent rechallenge with nivolumab in 5th line, achieving 12months’ response, ongoing at the time of writing, and 42.5months’ survival since initiation of exclusive systemic management after failure of conventional treatment. ConclusionThis case report highlights the benefit of nivolumab rechallenge in 5th line following previous failure as stand-alone therapy in 2nd line for a patient with laryngeal squamous cell carcinoma locally and nodally uncontrolled after conventional treatment. Clinical trials evaluating the efficacy of this approach are necessary to assess its contribution, as it is currently not a standard therapeutic option.

Lymphatic malformations: a 9-year experience at the vascular anomaly clinic

PurposeTo share our experience in the management of a specific type of vascular malformations (lymphatic) at a specialized multidisciplinary clinic for vascular anomalies.MethodsData of patients attending the vascular anomaly clinic during the period 2015 through 2023 were retrospectively analyzed. The study included cases diagnosed primarily as lymphatic malformations (LMs). We excluded cases associated with complex/syndromic vascular malformations. Available data included regional distribution of the LMs, age at presentation, sex, imaging studies, and different modes of treatment.ResultsThe study included 131 cases of LMs whose data were available for retrospective analysis. Generally, LMs had a benign course with good prognosis apart from two recorded mortalities (1.5%) during the 9-year period of the study. In this series, 93 cases were managed by injection sclerotherapy (Bleomycin). About 57 cases showed satisfactory response to injection sclerotherapy alone without the need to add other treatment modalities. Forty cases underwent surgical excision/debulking. Postoperative wound complications were recorded in 5 cases (12.5%). Sirolimus was offered for patients with LMs after the failure of conventional treatment (injection/surgery) to control associated significant complications.ConclusionLymphatic malformations represent a common presentation at the vascular anomaly clinic, which usually have a benign course. Complications are mainly cosmetic especially when involving the face, and sometimes superadded infections may occur. Airway compromise is a potential serious complication with submandibular lymphatic malformations in the neck.

Antibacterial Effect and Therapy of Chronic Skin Defects Using the Composite Bioscaffold Polycaprolactone/GelitaSpon/Povidone-Iodine in Domestic Dogs.

Chronic wounds and the failure of conventional treatment are relatively common in veterinary medicine. Recently, there has been a growing interest in alternative therapeutic approaches and the utilization of biodegradable materials. Their potential application in wound therapy may offer a novel and more suitable option compared to conventional treatment methods. Biodegradable materials can be classified into two main categories: natural, synthetic, and a combination of both, which have the potential to have synergistically enhanced properties. In this study, four domestic dogs with clinical symptoms of chronic wounds were enrolled. These wounds underwent treatment utilizing a novel biodegradable composite material composed of gelatin sponge combined with two electrospun layers of polycaprolactone (PCL) along with polyvinylpyrrolidone (PVP) fibers containing povidone-iodine complex (PVP-I). The initial phase of the study was dedicated to evaluating the antibacterial properties of iodine against Staphylococcus aureus and Escherichia coli. On average, wound healing in domestic dogs took 22 days from the initial treatment, and iodine concentrations demonstrated a significant antibacterial effect against Escherichia coli and Staphylococcus aureus. Based on the favorable outcomes observed in wound management, we believe that the utilization of a blend of natural and synthetic biodegradable materials holds promise as an effective wound therapy option.

Contemporary aminophylline use for status asthmaticus in pediatric ICUs: a questionnaire-based study

Background: Status asthmaticus is severe acute exacerbation asthma that results in respiratory failure due to the failure of conventional treatment. Aminophylline is one of the methylxanthines used to manage status asthmaticus in the pediatric intensive care unit (PICU). However, aminophylline&amp;apos;s role in managing severe asthma among children is still controversial, and PICUs still use it. There is no data on using aminophylline in Saudi Arabia. This study aimed at assessing the use and causes of using aminophylline in the PICU and the perception of pediatricians on using aminophylline in the PICU. Methods: A cross-sectional study was conducted on pediatric physicians working in PICUs employing pre-validated questionnaire. The Statistical Package for the Social Sciences program was used to analyze the retrieved data. Results: One hundred seventy-one pediatricians participated in the study; 85.4% reported IV aminophylline for acute asthma exacerbation, and 69% reported using it if the patient did not improve on other medications. About 68.4% and 83% considered IV aminophylline an effective and safe option, respectively. The side effects of IV aminophylline reported were arrhythmia at 75.3% and gastrointestinal tract side effects at 15.1%. Conclusion: Aminophylline was found highly used in PICUs in Saudi Arabia; this can be attributed to the perception of pediatricians, as it is a safe and effective treatment option.

Submucosal dissection of a large colonic angiodysplasia in case of failure of conventional treatment.

Digestive angiodysplasias are responsible for about 10 % of lower digestive bleeds and may also be revealed with an iron deficiency-related anemia [1]. They are common in elderly populations with a history of heart disease or anticoagulant medication. The currently recommended treatment is the use of argon plasma. However, this treatment can be associated with significant morbidity, especially for large angiodysplasias where post-procedural hemorrhage or secondary perforations are reported [2].

Surgical Treatment of Bilateral Bullous Exudative Retinal Detachment Following Systemic Corticosteroid Therapy: A Case Report from Aceh

Introduction: Exudative retinal detachment refers to elevation of the neural retina caused by subretinal fluid accumulation in the absence of a retinal break or significant preretinal traction. Management of exudative retinal detachment should include management of the underlying disease. When the fluid is not resolved, surgical intervention is planned after failure of conventional treatment. We demonstrated the successful surgical management of exudative bullous retinal detachment using the internal drainage technique. Case Presentation: A 45 years old man presented with complaint of blurred vision since 5 months before admission. Worsening occurred mainly after administration of high dose methylprednisolone infusion therapy. Visual acuity of the right eye was hand motion, and left eye was 1 meter finger counting. Fundus examination revealed exudative bullous retinal detachment in both eyes. Discussion: Surgery can be considered as a treatment of choice for exudative retinal detachment if medical management is unsuccessful. A complete examination to determine the cause of the disease is needed before carrying out surgery. External and internal drainage techniques have been reported to be successful in managing subretinal fluid in chronic exudative retinal detachment. We chose vitrectomy with internal drainage because large amount of dense subretinal fluid can make transscleral drainage very difficult. Conclusions: Surgical management (vitrectomy with internal drainage) can provide good results in chronic exudative retinal detachment, but should not be used as first-line therapy.

Living guideline on ulcerative colitis

The treatment spectrum for ulcerative colitis has greatly increased in recent years. Mesalazine is still the standard drug treatment for uncomplicated ulcerative colitis in various forms of administration. Glucocorticoids are highly effective in the acute treatment of ulcerative colitis but should only be used on a short-term basis due to the pronounced side effects. For forms with a complicated course of ulcerative colitis, immunosuppressive and immunomodulating substances, such as azothioprine as well as various biologicals, Janus kinase inhibitors (JAKi), sphingosine-1-phosphate receptor agonists (S1PR agonists) and calcineurin inhibitors are available after failure of conventional treatment. A proctocolectomy should be considered in cases of a treatment-refractive course or with detection of carcinomas and high-grade epithelial dysplasia.

Biologics in inflammatory bowel diseases

In addition to conventional anti-inflammatory treatment for chronic inflammatory bowel disease (IBD), there has been an evolution of new treatment options over the past 20 years. Already approved biologics provide multiple treatment alternatives but also make the treatment algorithms more complex. This development results in a substantial improvement in patient care. The ambitious treatment targets are associated with a higher quality of life and the reduction of long-term disability and morbidity. The aim of this article is to give an overview of how biologics can currently be implemented in IBD. In particular, the current clinical management is presented and an outlook on future treatment options with biologics for IBD is provided. A search was carried out in PubMed and ClinicalTrials.gov and the current German and European guidelines and expert recommendations were evaluated. Since the late 1990s there have been a continuously increasing number of treatment options for IBD. All substances have proven safety and efficacy in large randomized clinical studies and enable increasingly more individualized treatment for patients with IBD. Biologics are currently the standard treatment of choice for moderate to severe inflammatory activity as well as for steroid-refractory or steroid-dependent courses of disease after failure of conventional treatment. The diversity of IBD treatment offers increasing treatment options and thus improved patient care; however, as the number of new substances increases treatment becomes more complex. This article summarizes the current and future treatment options for IBD and their integration into current treatment algorithms.

Quiescent human glioblastoma cancer stem cells drive tumor initiation, expansion, and recurrence following chemotherapy.

We test the hypothesis that glioblastoma harbors quiescent cancer stem cells that evade anti-proliferative therapies. Functional characterization of spontaneous glioblastomas from genetically engineered mice reveals essential quiescent stem-like cells that can be directly isolated from tumors. A derived quiescent cancer-stem-cell-specific gene expression signature is enriched in pre-formed patient GBM xenograft single-cell clusters that lack proliferative gene expression. A refined human 118-gene signature is preserved in quiescent single-cell populations from primary and recurrent human glioblastomas. The F3 cell-surface receptor mRNA, expressed in the conserved signature, identifies quiescent tumor cells by antibody immunohistochemistry. F3-antibody-sorted glioblastoma cells exhibit stem cell gene expression, enhance self-renewal in culture, drive tumor initiation and serial transplantation, and reconstitute tumor heterogeneity. Upon chemotherapy, the spared cancer stem cell pool becomes activated and accelerates transition to proliferation. These results help explain conventional treatment failure and lay a conceptual framework for alternative therapies.

177 Lu-PSMA-617 radioligand therapy of metastatic castration-resistant prostate cancer: Initial 254-patient results from a prospective registry (REALITY Study)

PurposePreliminary data from retrospective analyses and recent data from large randomized controlled trials suggest safety and efficacy of radioligand therapy (RLT) targeting prostate-specific membrane antigen (PSMA) in men with metastatic castration-resistant prostate cancer (mCRPC). Limited data on this modality have been published regarding large samples treated in everyday practice.MethodsWe analyzed prospectively collected registry data regarding lutetium-177 (177Lu)-PSMA-617 RLT of 254 consecutive men with mCRPC seen in everyday academic practice. Since 177Lu-PSMA-617 was experimental salvage treatment following failure of individually appropriate conventional therapies, patients were generally elderly and heavily pretreated (median age 70 years; prior taxanes 74.0%, 188/254), with late–end-stage disease (visceral metastasis in 32.7%, 83/254). Primary endpoints were response to RLT, defined by changes from baseline serum prostate-specific antigen (PSA) concentration, PSA progression-free survival (PSA-PFS), and overall survival (OS), estimated with Kaplan–Meier statistics, and caregiver-reported and patient-reported safety. Unless noted, median (minimum–maximum) values are given.ResultsPatients received 3 (1–13) 177Lu-PSMA-617 activities (6.5 [2.5–11.6] GBq/cycle) every 5.7 (3.0–11.0) weeks. Best response was ≥ 50% PSA reduction in 52.0% of patients (132/254). PSA-PFS was 5.5 (95% confidence interval [95%CI] 4.4–6.6) months and OS, 14.5 (95%CI 11.5–17.5) months. In multivariable Cox proportional-hazards modeling, response to the initial ≤ 2 RLT administrations was the strongest significant prognosticator related to OS (hazard ratio 3.7 [95%CI 2.5–5.5], p < 0.001). No RLT-related deaths or treatment discontinuations occurred; the most frequent RLT-related Grade 3/4 adverse events were anemia (18/254 patients, 7.1%), thrombocytopenia (11/254, 4.3%), and lymphopenia (7/254, 2.8%). RLT-related xerostomia, all grade 1/2, was noted in 53/254 (20.9%).ConclusionsIn a large, prospectively observed “real-world” cohort with late-stage/end-stage mCRPC and conventional treatment failure, 177Lu-PSMA-617 RLT was effective, safe, and well-tolerated. Early biochemical disease control by such therapy was associated with better OS. Prospective study earlier in the disease course may be warranted.

Endoscopic internal drainage of complex bilomas and biliary leaks by transmural or transpapillary/transfistulary access

Bilomas most frequently result from postoperative bile leaks. The endoscopic conventional treatment is sphincterotomy ± stent placement. In complex cases, such as altered anatomy or failure of conventional treatment, transpapillary/transfistulary (TP/TF) drainage or EUS-guided transmural drainage (EUS-TD) may obviate additional biliary surgery. This study reports our experience with treating biloma secondary to refractory biliary leak with TP/TF drainage or EUS-TD and evaluates the safety and outcomes associated with this approach. This observational study focused on consecutive patients managed for biliary leakage (diagnosis based on imaging and/or bile outflow from a surgical drain) at a tertiary care hospital (2007-2017). TP/TF drainage was performed by double-pigtail stent(s) placement to drain the biloma through the leak during ERCP. For EUS-TD, plastic stent(s) were placed under EUS control. Primary outcomes were a composite of clinical success (patient free of sepsis after percutaneous drain removal and, in patients with benign disease, removal of all endoscopically placed stents, without need for reintervention) and biloma regression (<3 cm) at last follow-up. Thirty patients (men, 57%; median age, 55 years) were included. Most biliary leaks resulted from cholecystectomy (27%) and hepatectomy (50%). Initial EUS-TD and TP/TF drainage were performed in 14 (47%) and 16 (53%) patients, respectively. At last follow-up (median, 33.2 months), clinical success and primary outcome were achieved in 70.4% of patients (EUS-TD, 75%; TP/TF, 67%). Additional surgery was necessary in 1 patient. Rate of serious adverse events was 23% (7/30), of which 13% (4/30) were procedure related. There were 4 deaths during the course of treatment, 2 of which were related to endoscopic interventions (hemorrhage and fibrillation). TP/TF drainage or EUS-TD is technically feasible with high clinical success and may avoid the need for additional surgery in complex cases or in patients with altered anatomy.

Quiescent Human Glioblastoma Stem Cells Mediate Tumor Initiation, Expansion, and Recurrence Following Chemotherapy

We test the hypothesis that human glioblastoma harbors quiescent cancer stem cells that evade anti-proliferative therapies. Functional characterization of spontaneous glioblastomas from genetically engineered mice reveals essential quiescent stem-like cells that can be directly isolated from tumors. A derived novel quiescent cancer stem cell specific gene expression signature is enriched in pre-formed patient xenograft single cell clusters that lack proliferative gene expression. A refined human 118-gene signature is preserved in quiescent single cell populations from primary and recurrent human glioblastomas. The signature conserved F3 cell surface receptor identifies quiescent tumor cells by antibody immunohistochemistry. F3 antibody sorted quiescent glioblastoma cells exhibit stem cell gene expression, enhanced self-renewal in culture, mediate tumor initiation, serial transplantation, and reconstitute tumor heterogeneity. Upon chemotherapy, the spared cancer stem cell pool becomes activated and accelerates transition to proliferation. These results help explain conventional treatment failure and lay a conceptual framework for alternative therapies.

Determinants of treatment-seeking behavior during self-reported febrile illness episodes using the socio-ecological model in Kilombero District, Tanzania

BackgroundFebrile diseases in Sub-Saharan Africa cause acute and chronic illness. Co-infections are common and these diseases have a complex etiology that includes zoonoses. For the implementation of appropriate treatment and control strategies, determinants of lay treatment-seeking behavior by the affected communities need to be understood. The objective of this study was to explore, using the socio-ecological model, the determinants of treatment-seeking actions among self-identified febrile illness cases in the Kilombero District of Tanzania.MethodsThirty-nine in-depth interviews were conducted with 28 men and 11 women in three villages in Kilombero district. These villages were purposively selected due to malaria endemicity in the area, animal husbandry practices, and proximity to livestock-wildlife interaction, all risk factors for contracting febrile zoonotic infections. Thematic analysis was conducted on the interviews to identify the key determinants of treatment-seeking actions.ResultsStudy participants attributed febrile illnesses to malaria, typhoid and urinary tract infections. Treatment-seeking behavior was an iterative process, influenced by individual, socio-cultural, ecological and policy factors. Age, expendable income, previous history with a febrile illness, perceptions on disease severity, seasonal livelihood activities and access to timely healthcare were some of the determinants. Self-treatment with pharmaceutical drugs and herbs was usually the initial course of action. Formal healthcare was sought only when self-treatment failed and traditional healers were consulted after the perceived failure of conventional treatment. Delays in seeking appropriate health care and the consultation of medically unqualified individuals was very common.ConclusionThe results imply that treatment-seeking behavior is shaped by multiple factors across all levels of the socio-ecological model. Public policy efforts need to focus on facilitating prompt health care seeking through community education on the complicated etiology of febrile illnesses. Improved access to timely treatment and better differential diagnostics by health professionals are essential to ensure correct and appropriate treatment and to reduce reliance of patients on unqualified persons.

Real-time monitoring of Pseudomonas aeruginosa biofilm growth dynamics and persister cells’ eradication

ABSTRACT Biofilm formation and the appearance of persister cells with low metabolic rates are key factors affecting conventional treatment failure and antibiotic resistance. Using impedance-based measurements, crystal violet staining and traditional culture we have studied the biofilm growth dynamics of 13 Pseudomonas aeruginosa strains under the effect of seven conventional antibiotics. Real-time growth quantifications revealed that the exposure of established P. aeruginosa biofilms to certain concentrations of ciprofloxacin, ceftazidime and tobramycin induced the emergence of persister cells, that showed different morphology and pigmentation, as well increased antibiotic resistance. Whole-genome sequencing of wildtype and persister cells identified several SNPs, a genomic inversion and a genomic duplication in one of the strains. However, these mutations were not uniquely associated with persisters, suggesting that the persistent phenotype may be related to metabolic and transcriptional changes. Given that mannitol has been proposed to activate bacterial metabolism, the synergistic combination of mannitol and ciprofloxacin was evaluated on clinical 48 h P. aeruginosa biofilms. When administered at doses ≥320 mg/L, mannitol was capable of preventing persister cell formation by efficiently activating dormant bacteria and making them susceptible to the antibiotic. These results were confirmed using viable colony counting. As the tested ciprofloxacin-mannitol combination appeared to fully eradicate mature biofilms, we conclude that impedance-based biofilm diagnostics, which permits antibiotic susceptibility testing and the identification of persister cells, is of great potential for the clinical practice and could aid in establishing treatment breakpoints for emerging biofilm-related infections.

Pleural empyema in children - benefits of primary thoracoscopic treatment.

IntroductionPleural empyema is the condition of the pleural cavity when initially sterile pleural effusion has become infected. In the majority of cases, it is of parapneumonic origin. Parapneumonic effusions and pleural empyemata usually continuously progress in severity. The American Thoracic Society divides them into three stages: exudative, fibrinopurulent and organizing. The therapy depends on the stage.AimTo assess whether thoracoscopy should be considered better than conservative treatment and to assess the feasibility of the thoracoscopic approach to the 3rd phase of pleural empyema.Material and methodsThe clinical course of 115 patients treated from 1996 to 2017 was analyzed. 45 patients operated on thoracoscopically after the failure of conventional treatment were compared with 70 patients treated by primary thoracoscopic drainage and decortication.ResultsThe results of the study demonstrated that patients treated primarily by thoracoscopy had a shortened length of hospital stay (16.6 vs. 19.3 days), reduced drainage time (7.9 vs. 9.8 days), and shorter time of general therapy (31.8 vs. 38.0 days). They required fibrinolysis less frequently (12.8 vs. 26.7% of patients) and had reduced risk of reoperation (10 vs. 15.6% of cases). Operation time in the 3rd stage was only 15 min longer. The difference in length of hospital stay was only 0.8 days in favor of less severe cases.ConclusionsThe thoracoscopic approach is safely feasible in the 3rd stage of pleural empyema and should be considered as the preferred approach. Furthermore, the post-operative stay and general course of the disease are milder whenever surgery would not be delayed by prolonged conservative treatment attempts.

Aromatherapy and Quitting Smoking

Today, the treatment approaches recommended for smoking cessation are pharmacological and behavioral therapy. Both approaches are reported to be effective alone; however, when used together, the success rate increases. Modern medicine methods, however, often have a negative image due to cost, complexity and limitations in human life. For this reason, complementary and alternative therapies are widely used in the community for the treatment of many diseases in every age group. When people are asked why they prefer complementary and alternative therapies, the most important reason seems to be to improve quality of life by providing symptom control. Other reasons include economic problems, the lack of health insurance, the improvement of quality of life, the influence of the media and the environment, a strong belief that it will help, disappointment of conventional treatment failure, the noninvasiveness of most complementary and alternative therapies, fear of medical treatments, dissatisfaction with the current health system, medicines. Avoiding side effects can be called as a desire to have more control over health decisions. Contrary to many pharmacological and behavioral treatments that investigate the effectiveness of smoking cessation, only a few studies have included complementary and alternative treatments. Complementary treatment methods such as aromatherapy are thought to be regularly included in smoking cessation programs and their use should be ensured/expanded.