Current Trends In Treatment Research Articles

THE FACIAL NERVE: Current Trends in Diagnosis, Treatment, and Rehabilitation

Facial paralysis is a potentially devastating disorder with numerous implications. Multiple entities must be considered in its etiology, and recent advances in microbiology, radiographic imaging, electrodiagnostic testing, and microsurgery have provided great insight into the pathophysiology, diagnosis, treatment, and rehabilitation of the facial nerve. Recent DNA PCR testing has shed new insight into the potential cause for Bell's palsy. This article focuses on the evaluation, differential diagnosis, medical treatment, and rehabilitation of facial nerve pathology with primary emphasis on facial paralysis. Surgical management is also discussed, including reanimation of the paralyzed face.

Anterior cruciate ligament instability and reconstruction. Review of current trends in treatment.

Anterior cruciate ligament instability and reconstruction. Review of current trends in treatment.

Current trends in diagnosis and treatment of proximal interphalangeal joint injuries of the hand

Current trends in diagnosis and treatment of proximal interphalangeal joint injuries of the hand

The Role of the Nurse Case Manager in Substance Abuse Treatment

This article describes the evolution of the addiction nurse case manager's role in a substance abuse treatment program and the implementation of an outpatient treatment program based on current treatment trends. Three therapy phases of addiction treatment are described. Phase 1 therapy, is an assessment and educational phase teaching skills and imparting knowledge in coping skills training, 12-step study group, process group, a lecture group, and individual sessions. Phase 2 therapy, although less intensive, continues an educational component in a weekly aftercare group. Weekly meetings with a case manager provide an opportunity for reflection of recovery progress and relapse prevention. During phase 3 therapy the patients consolidate their progress and replace the void left by the drug's absence with relationships in the community. Retention rates and patient satisfaction reports in this program are favorable with reports in literature for outpatient addiction treatment.

Cervical pregnancy: past and future.

Cervical pregnancy (CP) is a rare life-threatening form of ectopic pregnancy occurring in 1 of 8628 deliveries. We reviewed 117 cases of CP in the English language literature from 1978 and added three cases from our department. Etiology of CP is still unknown, but there is evidence for its association with cervicouterine instrumentation. The possible role of embryo chromosomal abnormality in the CP etiology is considered. Sonography improved pretreatment diagnosis up to 81.8 percent. Obligatory sonographic criteria of CP include endocervical localization of the gestational sac and trophoblastic invasion. About 60 percent of cervical pregnancies are with a viable fetus. The majority of patients with a cervical pregnancy are women with low parity, thus, the current treatment trend is to preserve their reproductive function. The main problem of conservative treatment is life-threatening hemorrhage after pregnancy evacuation. The use of cervical canal tamponade with a Foley catheter balloon led to reliable hemostasis in 92.3 percent of cases in which this method was used. Early diagnosis of CP allowed for treatment by chemotherapy in 32 cases, with an 81.3 percent success rate. Serial beta-human chorionic gonadotropin levels and transvaginal ultrasound with color Doppler are used to monitor therapy. Another conservative treatment modality is local intrasac KCI injections. Hysterectomy is recommended mostly for second and third trimester cervical pregnancy, or for uncontrolled bleeding.

T1 breast carcinoma in women 70 years of age and older may not require axillary lymph node dissection

The current trend in breast cancer treatment is toward breast conservation and selective use of axillary lymph node dissection. Patient eligibility criteria for treatment without axillary dissection are evolving. We retrospectively reviewed the tumor registry over a 10-year period at Naval Medical Center San Diego and included all women aged 70 and older with T1 breast carcinoma (n = 78). Data included tumor size, surgical therapy, post-operative therapy, recurrence, and survival. The women were divided into groups by the approach taken toward the axilla. No patient was given adjuvant chemotherapy. There were no axillary cancer recurrences in our patients. No statistically significant difference existed, regardless of the approach to the axilla, in recurrence or survival between groups. Axillary dissection in this population did not influence postoperative treatment, decrease recurrence, or improve survival. Our study suggests breast cancer treatment in this population should not include axillary dissection.

Night soil treatment system equipped with ultrafiltration

The recent history of night soil (human waste) treatment technology in Japan is reviewed together with current trends in membrane filtration treatment. Operation of a high load denitrification human waste treatment facility using membrane filtration is described in detail. Membrane separation devices are shown to operate consistently and smoothly at the designed flux levels for more than 3 y. Good quality treated water can be obtained when special care is given to the biological reaction tank to prevent build-up of high molecular materials that degrade membrane performance.

Night soil treatment system equipped with ultrafiltration

The recent history of night soil (human waste) treatment technology in Japan is reviewed together with current trends in membrane filtration treatment. Operation of a high load denitrification human waste treatment facility using membrane filtration is described in detail. Membrane separation devices are shown to operate consistently and smoothly at the designed flux levels for more than 3 y. Good quality treated water can be obtained when special care is given to the biological reaction tank to prevent build-up of high molecular materials that degrade membrane performance.

Rheumatoid arthritis: current trends in diagnostics, conservative treatment, and surgical reconstruction

Rheumatoid arthritis: current trends in diagnostics, conservative treatment, and surgical reconstruction

Future immunotherapy: What lies ahead?

There is currently great interest in developing improved methods of immunotherapy and new techniques of immune system manipulation to ameliorate allergic diseases. This article reviews current research trends in the immunologic treatment of allergy, including the use of chemically modified allergens, nonparenteral allergen exposure, sustained-release allergen delivery, anti-immunoglobulin E antibodies, γ-globulin, immune complexes, cytokines, and T-cell – tolerogenic peptides. (OTOLARYNGOL HEAD NECK SURG 1995;113:603-5.)

Future immunotherapy: what lies ahead?

There is currently great interest in developing improved methods of immunotherapy and new techniques of immune system manipulation to ameliorate allergic diseases. This article reviews current research trends in the immunologic treatment of allergy, including the use of chemically modified allergens, nonparenteral allergen exposure, sustained-release allergen delivery, anti-immunoglobulin E antibodies, gamma-globulin, immune complexes, cytokines, and T-cell-tolerogenic peptides.

Sinonasal Undifferentiated Carcinoma: Current Trends in Treatment

Sinonasal undifferentiated carcinoma (SNUC) is a rare and highly aggressive neoplasm of the paranasal sinuses, which has recently been characterized as a distinct pathologic entity. The prognosis for patients with SNUC is poor. Early case reports describe patients with lesions that were clinically advanced at initial presentation and surgically unresectable. Survival was reported in months after treatment with chemotherapy and radiation. As more experience was gained with treatment of SNUC, it was found that aggressive, combined surgical therapy of lesions previously considered unresectable has shown increased survival. We report a case of a 38-year-old man with SNUC originating in the posterior ethmoid, extending into the anterior cranial fossa and orbit, who was treated with preoperative hyperfractionated radiation therapy, chemotherapy, and craniofacial resection.

Introduction to the special section: research on the nature and treatment of alcoholism--does one inform the other?

Although the 2 topics of the nature and treatment of alcoholism have both been investigated for years, they are just recently beginning to interface with and complement one another. This special section addresses the interface from both perspectives and covers content areas that touch on current issues, research and treatment trends, and controversies in the alcohol field. The first 2 articles focus on the nature of alcoholism with commentary on implications for treatment, and the second 4 articles shift to examine research on treatment of alcohol problems, with implications for understanding the nature of alcoholism. This introductory article describes the special section, summarizes the articles in the section and integrates the information to discuss areas of increasing interface between research on the nature and treatment of heterogeneous substance abuse problems.

Current trends in research and treatment of intracranial hypertension.

The effects of a severe head injury are immediate and have been the subject of research for decades. Heightened awareness of proposed metabolic changes and new treatments are guiding current management. The metabolic derangements that occur at the time of injury and continue through the acute phase are discussed as well as proposed treatments. In addition, advances in hemodynamic monitoring, respiratory management, and general aspects of nursing care are presented.

The use of nuclear morphometry to predict prognosis in pediatric urologic malignancies: a review.

Wilms tumor, the most common pediatric urologic malignancy, and genitourinary rhabdomyosarcoma, the most common soft tissue sarcoma of childhood, represent two of the most commonly diagnosed pediatric urologic malignancies. The introduction and use of multimodal therapy (surgery, radiation, and chemotherapy) by the National Wilms Tumor Study (NWTS) and the Intergroup Rhabdomyosarcoma Study (IRS) groups have greatly improved the survival among children with these malignancies. Present survival rates for Wilms tumor exceed 85% and for rhabdomyosarcoma survival rates are approaching 80% as well. For Wilms tumor, current treatment trends suggest less intense therapy for those children with favorable histology tumors who are considered at relatively low risk for tumor recurrence. Likewise, the significant morbidity associated with the present therapy regimens for rhabdomyosarcomas has prompted investigators to search for individualized management schemes for children with a high probability of responding. The need for accurate criteria to separate these high and low risk groups becomes imperative. In this review we present our work using nuclear morphometry, as a prognostic indicator, to retrospectively predict response to therapy for children with Wilms tumors and genitourinary rhabdomyosarcomas.

Colovaginal fistula secondary to diverticular disease

Colovaginal fistula is infrequently encountered in gynecologic practice, but, when it does occur, diverticular disease is the most common cause. This paper discusses current concepts in etiology, diagnosis, and treatment of patients with colovaginal fistula secondary to diverticular disease. Review of the literature reveals that a majority of patients have a history of hysterectomy and are primarily diagnosed by barium enema. The current trend in treatment is surgical correction with primary resection and anastomosis.

Swimming Pools – Brief Outline of Water Treatment and Management

A brief history of the development of swimming pool water treatment and management has been discussed, applicable to both large and small pools. An outline of typical bathing loads and current methods of water treatment has been presented with particular emphasis being given to disinfection. Chlorine has been the traditional sole disinfectant used since the 1920's but alternatives are continually being sought. Chief amongst the alternatives to date has been ozone, used in conjunction with chlorine. Ozone acts as a powerful oxidiser and disinfectant but has little residual effect. Chlorine is therefore used to provide a residual in the pool. Current British trends in pool design and treatment have been noted.

Current Trends in the Pharmacological Treatment of Alcohol‐related Problems

Abstract: Since alcohol‐related problems affect almost 20% of the adult population, effective therapies are needed. Newly developed pharmacological strategies have been tested experimentally in animals and humans and progress is apparent. For example, an imidazobenzodiazepine (Ro15–4513) has recently been found to antagonize ethanol intoxication in rats selectively. However, testing in humans may be prevented by toxicity and ethical concerns. Abrupt discontinuation of ethanol intake in dependent subjects results in a withdrawal syndrome (AWS). With the recently developed benzodiazepine loading dose technique, practically all patients can be effectively treated with oral diazepam. Recent studies in rats suggest that non‐sedative calcium channel blockers (e.g. nitrendipine, nifendipine) may also attenuate the AWS. New pharmacological strategies for decreasing alcohol consumption have also been developed. In three randomized, double‐blind, controlled studies, serotonin uptake inhibitors (zimelidine, citalopram and viqualine) have consistently attenuated alcohol consumption in early stage problem drinkers. Effects on ethanol intake are distinct from the antidepressant properties of these drugs and they are most likely explained by a facilitation of satiety signals. Recently, new pharmacological approaches for attenuating neurological and hepatic alcohol‐related problems have been described. Examples illustrate how the integration of basic and clinical pharmacological strategies may lead to improved pharmacotherapy for alcoholism within the foreseeable future.

Ectopic Pregnancy

The diagnosis of ectopic pregnancy has become precise and reliable. Consequently, the management of ectopic pregnancy has progressed to the point where the physician is often able to preserve fertility. Therefore, conservative surgery is indicated if the patient desires future fertility and conditions are appropriate. The combination of ultrasound, beta-hCG pregnancy testing, and laparoscopy has led to a rising incidence of diagnosed ectopic pregnancy prior to rupture. This has greatly facilitated the use of the conservative approach to the management of tubal pregnancy. Although ectopic pregnancy can be diagnosed early and managed conservatively, it is, and will remain a potentially life-threatening disease and must be approached as such. Table 3 summarizes our proposed surgical management of tubal pregnancy. Table 4 summarizes the results of conservative surgery for tubal pregnancy.

L-tryptophan as a hypnotic in special patients.

The authors briefly review prevalence and current treatment trends of sleep disorders in the elderly, underlining the need for the development of a more suitable hypnotic for this population. The use of L-tryptophan (LT) as a physiologic hypnotic in aged responders is considered and the hypnotic effect of 1- to 4-g bedtime doses on ten male inpatients and outpatients aged 30 to 72 years is evaluated. Results suggest a dramatic and sustained relief of insomnia for 3 weeks in 30 per cent of the patients and the absence of side effects in 90 per cent of those who took the agent. The authors conclude that despite its long therapeutic history, L-tryptophan has not been more successful because only a minority of humans appear to be responsive to its hypnotic actions. They point to the need to replicate their current preliminary observations in a larger controlled geriatric population and to delineate biochemical characteristics of LT responders in order to increase LT sensitivity in some patients and convert nonresponders to responders.