Ideal Treatment Goal Research Articles

Microsurgery and/or Radiosurgery for Central Skull Base Tumors: An Update for Functional Restoration

Tumor control with functional restoration is an ideal goal of treatment of patients with central skull base tumors. Experiences are reported of 466 patients who were treated with microsurgery or radiosurgery (via gamma-knife [GK] or Cyberknife [CK]), with the goal of achieving functional restoration.

Intravenous immunoglobulin selectively decreases circulating autoantibodies in pemphigus

Autoantibody-mediated diseases such as pemphigus are caused by a single or very limited number of pathogenic autoantibodies. A major problem with all current therapies for these diseases is that they target all antibodies rather than selectively targeting only pathogenic antibodies. The following study was conducted to confirm observations made in a limited number of patients that suggest intravenous immunoglobulin (IVIg) may be able to selectively lower serum levels of only abnormal autoantibodies. The study was conducted in 12 patients who received IVIg for the treatment of recalcitrant pemphigus. Serum levels of antibodies to desmoglein 1 (Dsg 1) and desmoglein 3 (Dsg 3) were measured by enzyme-linked immunosorbent assay immediately before IVIg treatment and following a median of 2 cycles (range, 1-3) of treatment. As control, serum levels of several normal antibodies (against herpes simplex virus types 1 and 2, mumps, and varicella) were measured concurrently. Within a median of 2 weeks following the last cycle of IVIg serum, anti-Dsg 3 declined in all patients who tested positive at baseline and in 8 of 10 (80%) patients testing positive for anti-Dsg 1. On average, anti-Dsg 3 decreased by 45% and anti-Dsg 1 by 32%. By contrast, serum levels of the 4 normal antibodies increased in almost all patients, by an average of 408% (P < .001). Correlation of clinical response to treatment with IVIg was not performed. The sample size was limited. These results indicate that IVIg can selectively and markedly decrease serum levels of abnormal antibodies in pemphigus without decreasing the levels of normal antibodies. Thus IVIg appears able to achieve the ideal goal of treatment in autoantibody-mediated diseases--selectively removing from the circulation only those antibodies that cause the disease.

Osteochondritis dissecans involving the trochlea of the humerus treated with transplantation of tissue-engineered cartilage: A case report

Osteochondritis dissecans (OCD) of the elbow is typically located in the capitellum of the humerus in young teenagers. There are only a few reports of OCD in the trochlea of the humerus.9,17,28 The ideal goal of treatment for OCD lesions is to resurface the osteochondral defect with hyaline cartilage and to prevent the occurrence of osteoarthritis. Recently, to achieve this surgical goal, autologous chondrocyte implantations (ACIs) or tissue-engineered cartilage transplantations (TCTs) have been performed for OCD lesions of the knee and the ankle.

Les craniopharyngiomes

Craniopharyngiomas are rare benign epithelial tumors, arising from the pituitary stalk or gland and developing in the sellar and suprasellar region, affecting both adults and children. Incidence is 0.5 to 2 new cases per million inhabitants. Clinical features essentially include visual disturbances, endocrine deficiencies, and neurological signs. Initial signs are often visual loss and increased intracranial pressure in children, growth and pubertal delay in teenagers, visual disturbances or cognitive impairment in adults. Diagnosis is made on MRI and CT scan, demonstrating a sellar or suprasellar tumor, heterogeneous, with frequent calcifications. Craniopharyngiomas can be classified depending on their locations from the sella, the diaphragma sellae, and upon their origins from the pituitary stalk or the infundibulum. They can also be classified depending on the location from the optic chiasm and the third ventricle. This classification allows surgical series comparison, which is of importance since developments and extensions of the tumor can explain surgical difficulties. The management of this lesion is still controversial. Because it is an extra-cerebral benign lesion, the ideal goal of treatment should be complete tumor removal with improvement of altered visual functions, minimal deterioration of endocrine function, and no neuropsychological impairment. But the situation of the tumor, its relationship with third ventricle, hypothalamus, optic tract, vascular structures make its removal often difficult. However, great progresses have been realized in surgical treatment, resulting in a dramatic improvement of the prognosis of craniopharyngiomas. Nowadays, one can expect total removal in 60 to 70% of patients, subtotal removal in 20 to 30%, and partial removal in 10%. When total removal is impossible, radiotherapy may reduce the risk of a poor evolution. Recurrences are a problem in 15% of patients with total removal, 35% in subtotal removal, 70% in partial removal. If radiotherapy has not been performed as first treatment, it is efficient in 80% of recurrences. Long term follow up is necessary in these patients, due to medical management of endocrine, visual and psychological problems, and risk of late recurrence. With close involvement in this management, most of patients may enjoy a good outcome, 80% being able to return to normal active life.

Perawatan Maloklusi Kelas III Skeletal dengan Kombinasi Ortodontik-Bedah Orthognatik

Non-growing patient with excessive mandible and underdeveloped of the maxilla who classified as a class III skeletal malocclusion often found in the orthodontic daily practice. If they come earlier when potential growth is still left, sometimes growth modification can be applied to prevent further facial deformity (by using extra-oral device, for instance). In non-growing class III malocclusions, treatment alternative may consist of compromised-treatment without concerning an ideal treatment goal. However, with the development of knowledge and skills and with the potential improvement of interspecialistic team-work, nowadays, ideal facial aesthetics become possible. The combined orthodontic-orthognathic surgical treatment alternative to correct skeletal facial deformity may be a better alternative. This treatment changes the hostile environment, so that a more stable treatment result with better facial appearance can be achieved. This poster presents a case report of severe class III skeletal malocclusion whose treted with combined orthodontic-orthognathic surgery. The facial and dental improvements as well as the cephalometric changes are presented. The procedure of treatment and the interspecialistic team-work will also be briefly described.

Paget's disease of bone. An update on management.

The essential requirement for effective treatment of Paget's disease of bone is that the characteristic abnormality of bone remodelling is predictably corrected without the occurrence of significant side effects. Although the ideal agent is not currently available, appropriate use of the calcitonins or diphosphonates goes a long way to achieving this goal. Calcitonin (50 to 100 MRC units subcutaneously daily or 3 times weekly) will generally reduce bone turnover by approximately 50% within 6 months. However, very active disease will not be controlled and bone turnover will generally increase once treatment is withdrawn. Calcitonin is without significant side effects, although some patients will develop antibody-mediated resistance to the exogenous calcitonin species. An advantage of calcitonin is that there is radiographic evidence of a return to normal bone remodeling during treatment. Although a number of diphosphonates (now more correctly termed bisphosphonates) are available for experimental use, only the first generation compound, disodium etidronate (EHDP) is commercially available. It too will reduce bone turnover by about 50% within 6 months when given in a dose of 5 mg/kg daily. Unlike calcitonin, it results in a more sustained control of bone turnover while having the additional advantage that it can be given by mouth. Although larger doses are more effective in controlling very active disease, there is a real risk of causing defective bone mineralisation which may result in the development of atraumatic long bone fractures or diffuse bone pains. Combinations of calcitonin and disodium etidronate in conventional dosage seem to result in an additive suppressant effect on bone turnover and may be indicated for more active disease. Advances in treatment are progressing rapidly and it seems likely that in the next few years the introduction of new agents for the control of Paget's disease will more nearly approach the ideal goal of treatment.