Main Treatment Option For Patients Research Articles

Outcomes in Peritoneal Carcinomatosis from Appendiceal Goblet Cell Carcinoma Treated with Cytoreductive Surgery and Hyperthermic Intraperitoneal Chemotherapy (CRS/HIPEC).

Appendiceal goblet cell adenocarcinoma (GCA) is often misclassified and mistreated due to mixed histologic features. In general, cytoreductive surgery plus hyperthermic intraperitoneal chemotherapy (CRS/HIPEC) is standard of care for peritoneal carcinomatosis (PC) from mucinous appendiceal tumors; however, in PC from GCA, data are limited and the role of CRS/HIPEC is controversial. We report outcomes in PC from appendiceal GCA treated with CRS/HIPEC. A prospective institutional database of 391 CRS/HIPEC patients with appendiceal carcinomatosis from 1998 to 2018 was reviewed. Twenty-seven patients with GCA were identified. Perioperative variables were described. Survival was estimated using the Kaplan-Meier method. GCA occurred in 7% (27/391) of appendiceal CRS/HIPEC patients. Seven (26%) cases were aborted. Two patients underwent a second CRS/HIPEC for peritoneal recurrence. Median age at diagnosis was 53years (range 39-72years), and 12 (60%) were female. All underwent previous surgery. Seven (35%) had prior chemotherapy and received a median of 5 cycles (range 3-8). Median PCI was 6 (range 1-39). Complete cytoreduction was achieved in 95% (19/20). Grade III complications occurred in three (15%) patients, and no perioperative deaths occurred. Median follow-up was 97months. Overall survival at 1, 3 and 5years was 100%, 74% and 67%, respectively. Progression-free survival at 1, 3, and 5years was 94%, 67% and 59%, respectively. CRS/HIPEC should be considered as the main treatment option for patients with PC from appendiceal GCA. When performed at a CRS/HIPEC specialty center, 5-year OS of 67% can be achieved.

Perioperative Targeted Therapy Or Immunotherapy In Non-Small-Cell Lung Cancer.

Targeted therapy and immunotherapy have changed the treatment modes for advanced non-small cell lung cancer (NSCLC), moving from second-line to first-line treatment and significantly extending patients’ survival. Surgery and chemoradiotherapy remain the main treatment options for patients with locally advanced lung cancer, but recurrence and metastasis still occur in some patients. The survival rates of conventional perioperative chemotherapy among NSCLC patients have increased by only 5%. Therefore, more studies have begun to explore targeted and immune neoadjuvant/adjuvant therapies in early-stage and locally advanced NSCLC, and the relevant clinical research data have shown good efficacy and safety profiles. This article summarizes several clinical studies of critical importance.

Quality of life outcomes after low dose-rate brachytherapy for localized prostate cancer: Current status and future perspectives.

The present review summarizes data from studies reporting on health-related quality of life after brachytherapy and competing modalities. There are various therapeutic modalities for localized prostate cancer, including radical surgery, external beam radiotherapy and active surveillance. Advances in surgical and radiation treatment have entered clinical practice in the form of robot-assisted surgery or intensity-modulated radiotherapy. Brachytherapy remains the main treatment option for patients with localized prostate cancer, with 10-year survival data showing favorable outcomes. Because each treatment modality has achieved favorable survival outcomes, focus in determining appropriate treatment has shifted toward health-related quality of life, where each treatment has a different profile and/or adverse symptoms. The development of health-related quality of life assessment tools has allowed the creation of a pool of specific health-related quality of life data across many studies. The present article reviews the impact of brachytherapy and other modalities on quality of life, as well as future directions.

Accuracy of CAPRA-S Score for Predicting Long-Term Biochemical Progression After Radical Prostatectomy.

The Cancer of the Prostate Risk Assessment Postsurgical (CAPRA-S) score is a tool to stratify patients into groups according to their risk for biochemical recurrence after radical prostatectomy. The aim of this study was to assess the accuracy of the CAPRA-S score for predicting biochemical progression at 5 and 10 years in our cohort of patients after radical prostatectomy. Between June 2004 and December 2015, radical prostatectomy was performed as the main treatment option for patients with localized prostate cancer. Patients who had received adjuvant or neoadjuvant treatment were excluded from this study. Biochemical progression after radical prostatectomy was considered in patients by prostate-specific antigen (PSA) > 0.1 ng/mL after surgery (biochemical persistence) and by at least 2 determinations of PSA > 0.2 ng/mL in those patients with initial undetectable postoperative PSA any time during their follow-up (biochemical failure). Cox proportional hazard model and Kaplan-Meier analysis were used for the statistical analysis. Of 531 patients who underwent radical prostatectomy, 479 met the inclusion criteria. Mean follow-up was 85 months (min-max, 13-153 months). The rate of biochemical progression-free survival at 10 years was 84.2%, 55.1%, and 32.8%, respectively, for high-, intermediate-, and low-risk patients according to the CAPRA-S score. The concordance index for CAPRA-S predicting biochemical progression at 5 years was 0.71 and at 10 years was 0.70. The CAPRA-S score is a useful and easy-to-use tool in patients after radical prostatectomy to classify their risk for biochemical progression, thus helping decide if adjuvant treatment should be required.

Treatment of higher risk myelodysplastic syndromes

The two main treatment options for patients with higher risk of myelodysplastic syndromes (MDS) are allogeneic hematopoietic stem cell transplantation and azacitidine therapy. Of these, only allogeneic hematopoietic stem cell transplantation is curative, and azacitidine treatment is selected for patients not suitable for transplantation. Compared to conventional treatment with supportive treatment alone or with low dose cytarabine, azacitidine treatment improves survival in MDS patients, even in patients over the age of 75. Because azacitidine treatment takes 4-6 cycles until an initial response, several response-predicting scoring systems have been developed. Novel therapeutic agents and combination therapies of azacitidine with a variety of drugs are currently under study.

Effect of delayed radical cystectomy for invasive bladder tumors on lymph node positivity, cancer-specific survival and total survival.

Radical cystectomy (RC) is the main treatment option for patients with muscle-invasive bladder cancer (MIBC) and non-muscle-invasive bladder cancer (NMIBC), which carry the highest risk of progression. In this study, we investigated the effect of time from transurethral resection of the bladder (TUR-B) to cystectomy on lymph node positivity, cancer-specific survival and overall survival in patients with MIBC. The records were reviewed of 530 consecutive patients who had RC and pelvic lymphadenectomy procedures with curative intent performed by selected surgeons between May 2005 and April 2016. Our analysis included only patients with transitional cell carcinoma of the bladder; we excluded 23 patients with other types of tumor histology. Patients who underwent delayed RC were compared with patients who were treated with early RC; both groups were similar in terms of age, gender, T stage, tumor grade, tumor differentiation, lymph node status and metastasis status. However, when both groups were compared for disease-free survival and overall survival, patients of the early-RC group had a greater advantage. The optimal time between the last TUR-B and RC is still controversial. A reasonable time for preoperative preparation can be allowed, but long delays, especially those exceeding 3 months, can lead to unfavorable outcomes in cancer control.

Trichostatin A inhibits proliferation of triple negative breast cancer cells by inducing cell cycle arrest and apoptosis.

Triple negative breast cancer (TNBC) is the most aggressive subtype of breast cancer with poor outcome. Because of lacking therapeutic targets, chemotherapy is the main treatment option for patients with TNBC. Overexpression of HDACs correlates with tumorigenesis, highlighting the potential of HDACs as therapeutic targets for TNBC. Here we demonstrate that trichostatin A (TSA, a HDAC inhibitor) selectively inhibits the proliferation of TNBC cell lines HCC1806 and HCC38 rather than a normal breast cell line MCF10A. The inhibition of TNBC by TSA is via its roles in inducing cell cycle arrest and apoptosis. TSA treatment leads to decreased expression of CYCLIN D1, CDK4, CDK6 and BCL-XL, but increased P21 expression. Moreover, combination of TSA with doxorubicin has synergistic effects on inhibiting proliferation of HCC1806 and HCC38 cells. Our studies identified a promising epigenetic-based therapeutic strategy that may be implemented in the therapy of fatal human breast cancer.

Urologic cancer in China

Cancer remains to be the second most common cause of death, and its incidence and mortality rates are increasing in China. According to the 2015 National Central Cancer Registry (NCCR) of China, the incidence of bladder cancer and prostate cancer ranked sixth and seventh, respectively, in male cancers. The majority of prostate cancer patients were diagnosed at an advanced stage. Early diagnosis of prostate cancer is the key to improve prostate cancer survival in China. Radical prostatectomy or radical radiotherapy is the main treatment for localized prostate cancer, and a comprehensive therapy based on androgen deprivation therapy is the treatment for advanced disease. The most common histologic types of bladder cancer in China were urothelial carcinoma, followed by adenocarcinoma and squamous carcinoma. The majority of patients were diagnosed using white-light cystoscopy with biopsy. Fluorescence and narrow-band imaging cystoscopy had additional detection rates and are becoming more popular. Following Chinese guidelines, most non-muscle invasive bladder cancer patients were treated with diagnostic transurethral resection and more than half of the muscle invasive bladder cancer patients were treated with radical cystectomy. Due to the increased detection rate of kidney tumors by ultrasound in physical examination, the number of incidentally diagnosed renal cell carcinoma has increased. Localized kidney cancers are more and more often treated by nephron-sparing surgery. Radical nephrectomy is still the main treatment option for patients with locally advanced renal cell carcinoma. Both laparoscopic and robotic-assisted laparoscopic surgeries have been used in big medical centers. Both testicular cancer and penile cancer have lower incidence levels than that in Europe. As we have an enormous population base, the absolute patient number is big. The diagnosis and treatment follows the Chinese guidelines. In China, both medical professionals and public should concern more on the early diagnosis, as there is not enough cancer prevention information available. Urologists should also take a more active role in educating the population.

Randomized phase II trial of docetaxel plus prednisolone with or without androgen deprivation treatment in castration-resistant prostate cancer.

217 Background: Androgen deprivation therapy (ADT) has been the main treatment option for patients with locally advanced or metastatic prostate carcinoma. However, the impact of continued ADT on clinical outcomes in castration-resistant prostate cancer (CRPC) patients treated with cytotoxic chemotherapy is controversial. We conducted a randomized phase II study to assess the impact of continued ADT in patients with CRPC receiving docetaxel plus prednisolone chemotherapy. Methods: Patients with CRPC were randomly assigned (in a 1:1 ratio) to receive docetaxel (75mg/m2 every 3 weeks) plus prednisolone (5mg twice daily on days 1-21) with ADT (leuprolide 11.25 mg long-acting depo every 12 weeks, ADT group) and docetaxel plus prednisolone without ADT (No-ADT group). For patients in the No-ADT group, ADT was resumed at the end of chemotherapy. The primary endpoint was time to PSA progression. Secondary objectives included PSA response rates, progression-free survival (PFS), and overall survival (OS). Suspension of leuprolide support prevented the attainment of our original goal of enrolling 80 men. Results: Between April 2011 and July 2014, 45 patients were enrolled in this study; 23 patients were randomly assigned to the ADT group and 22 to the No-ADT group. The median age was 68 years (range = 49-81) and median baseline serum PSA was 60.3 ng/mL (interquartile range = 14.7-157.3). Time to PSA progression was 6.5 months in ADT group and 4.3 months in No-ADT group, respectively (P = 0.673). PSA response rates were 55.2% and 44.8% in the ADT group and the No-ADT group, respectively (P = 0.463). The median PFS and OS were 5.3 months and 19.4 months for ADT patients and 4.3 months and 20.8 months for No-ADT patients, respectively (P = 0.608, P = 0.635). The testosterone level rose to more than the castrate level in 5 (22.7%) patients of the No-ADT group. Conclusions: Clinical outcomes were not significantly different when patients with CRPC received concurrent ADT, or were not so treated, when receiving docetaxel plus prednisolone chemotherapy. Clinical trial information: NCT01487902 Clinical trial information: NCT01487902.

Guillain-Barre syndrome

Guillain-Barre syndrome is an acute inflammatory demyelinating polyradiculoneuropathy of autoimmune etiology, which is characterized by peripheral paralysis and protein-cell dissociation in the cerebrospinal fluid in most cases. The Guillain-Barre syndrome prevalence is 0.6-2.4 cases per 100 thousand population. In Moscow, about 200 people are taken ill with Guillain-Barre syndrome each year. Currently, four main clinical variants of Guillain-Barre syndrome are described: acute inflammatory demyelinating polyradiculoneuropathy, axonal form, acute motor axonal neuropathy, and Miller-Fisher syndrome. Disease development is preceded by contact with the viral or bacterial infections causative agent such as Campylobacter jejuni, Mycoplasma pneumonia, cytomegalovirus, Epstein-Barr virus and influenza virus. Guillain-Barre syndrome pathogenesis is «molecular mimicry» between infectious agents surfaces and the peripheral nerves structures. High titer of antibodies to the GM1, GD1a, GD1b and GQ1b gangliosides is found in patients blood serum. Diagnostic criteria for the Guillain-Barre syndrome diagnosis are the physical examination results, cerebrospinal fluid analysis and electroneuromyographic study. The North American motor deficit severity scale is used to assess the neurological status. This scale allows to evaluate the patient’s condition and movement abilities. Currently plasmapheresis and immunoglobulin G therapy are the main treatment options for patients with Guillain-Barre syndrome. The favorable prognosis in the form of disease clinical manifestations regression reaches 60-80%. Mortality in Guillain-Barre syndrome is 5% in average and may reach 20% in patients on mechanical ventilation. The most common death causes of patients with Guillain-Barre syndrome are respiratory failure, aspiration pneumonia, sepsis, and pulmonary embolism. Early treatment initiation can reduce serious complications risk, including respiratory failure, what ultimately leads to decrease in mortality and patients disablement.

Negative outcomes associated with medication in patients with chronic atrial fibrillation who present at the emergency department.

Medication is the main treatment option for patients with chronic atrial fibrillation. However, medication can have negative effects. We aimed to detect negative outcomes associated with medication that led to patients with chronic atrial fibrillation presenting themselves to hospital emergency departments. We assessed the severity of those outcomes and comment on whether they could have been avoided. This descriptive, cross-sectional study included all patients with chronic atrial fibrillation who attended the emergency department of our tertiary hospital. We used the Dader method to identify and evaluate the negative outcomes associated with medication through interviews with patients and scrutiny of the clinical charts. Of the 198 eligible patients who presented at the emergency department, 134 (67·7%) did so because of negative outcomes associated with medication (41% related to necessity, 32·1% to effectiveness and 26·9% to safety); 67·9% of those negative outcomes could have been avoided. In terms of severity, 6·7% were mild, 31·3% moderate, 51·5% severe and 10·4% fatal. The Anatomical Therapeutic Chemical Classification anatomical group most frequently associated with negative outcomes was the cardiovascular system, followed by blood/blood-forming organs. A high percentage of patients with chronic atrial fibrillation presenting at hospital emergency departments had negative outcomes associated with medication. Some led to deaths. More than half of these were severe, and most could have been avoided.

Cognitive function in Chinese prostate cancer patients on androgen-deprivation therapy: A cross-sectional study.

Androgen-deprivation therapy (ADT) is a main treatment option for patients with prostate cancer (PCa), but its effect on cognition remains unclear. The primary purpose of this cross-sectional case-control study was to evaluate the effects of ADT on cognition in Chinese PCa patients. Participants included PCa patients who had undergone ADT (ADT group, n = 33) and patients who did not undergo ADT (non-ADT group, n = 32), as well as age- and education-matched healthy controls (HC group, n = 35). All participants were examined using the neuropsychological battery aimed at assessing several cognitive domains including attention, memory and information processing performance. The ADT group obtained significantly worse scores than the non-ADT and HC groups in the following neuropsychological tests: Recognition (P < 0.01), WAIS Digit Span forward (P < 0.05), Trailmaking B (P < 0.01) and Stroop Interference test (P < 0.01). No significant difference was found between the non-ADT and HC groups (P > 0.05). Chinese PCa patients receiving ADT showed cognitive impairments in several domains including memory, attention and information processing performance.

Analysis of 30 patients with persistent or recurrent squamous cell carcinoma of the cervix within one year after concurrent chemoradiotherapy.

ObjectiveTo investigate the recurrence sites, risk factors, and prognosis of patients with persistent or recurrent squamous cell carcinoma (SCC) of the cervix within one year after undergoing concurrent chemoradiotherapy (CCRT).MethodsClinical data of 30 patients with persistent or recurrent SCC of the cervix within one year after CCRT between July 2006 and July 2011 were analyzed retrospectively. These data were compared with those of 35 SCC cases with no signs of recurrence after complete remission. These 35 patients were treated during the same period (between 2006 and 2011) and selected randomly.ResultsAmong these 30 patients, 25 exhibited distant metastases of which 14 were observed within 6 months after CCRT. Univariate analysis showed higher incidence of pelvic or para-aortic lymphadenectasis and SCC-ag >10 ng/mL in the group with persistent or recurrent disease before treatment (P<0.01). Multivariate analysis by logistic regression revealed that the pre-therapeutic pelvic or para-aortic lymph node enlargement and SCC-ag >10 ng/mL were the independent risk factors. Palliative chemotherapy was the main treatment option for patients with persistent or recurrent disease. The 2-year survival rate was 21.7%, and the median survival time was 17 months.ConclusionPatients with persistent or recurrent SCC of the cervix after CCRT exhibited a high rate of distant metastasis with poor prognosis. The pre-therapeutic pelvic or para-aortic lymph node enlargement and SCC-ag >10 ng/mL were identified as the independent risk factors for persistent or recurrent SCC within 1 year after CCRT.

Chemotherapy (CT) for advanced biliary tract cancers (BTC): A retrospective analysis from UT Southwestern Medical Center (UTSW) and Parkland Hospital (PH).

e15200 Background: CT is the main treatment option for patients (pts) with advanced BTC. There is limited randomized data to guide treatment selection. Based on phase 3 data, gemcitabine (G)/cisplatin (C) is an acceptable 1st line CT, but 5-FU based regimens are also used. We reviewed data from our institution to elucidate treatment preferences and responses. Methods: This is a retrospective analysis of pts treated at UTSW and PH from Jan 2008 to Dec 2011. Patient lists were obtained from the tumor registry at each hospital from Jan 2008 to Dec 2011. Results: 60 pts had inoperable or metastatic disease. 26/60 pts did not receive CT due to poor functional status. 34/60 pts received 1st-line CT- 26 cholangiocarcinoma, 7 gall bladder cancer, 1 ampullary cancer. 10/34 pts were not evaluated for treatment response due to lack of follow-up. Of the remaining 24 pts, 12 received 2nd line CT. In combined analysis of 1st and 2nd line CT in pts with adequate clinic follow-up, G alone (n=10) or in combination (with C n=9, C+ Cetuximab (CX) n=1, Oxaliplatin n=5, Capecitabine (CAP) n=1, Docetaxel n=1) was the most frequently used CT. 2 pts received CAP with radiation. 6 pts received 5-FU based regimen (FOLFOX n=1, FOLFOX/CX n=1, FOLFIRI n=1, FOLFIRI/CX n=1, FOLFIRI/panitumumab n=2). In 1st line, best response (BR)—partial response (PR) 4 pts, stable disease (SD) 14 pts, progressive disease (PD) 6 pts. Response duration range (RDR) in 1st line was 2-22 months (m). In 2nd line, BR—PR 1 pt, SD 7 pts, PD 2 pts. RDR in 2nd line was 2-10 m. Of the 4 pts who received CT combined with an EGFR inhibitor (EGFRI), 2 had SD, 2 had PR; RDR 3-10 m. Disease control (DC) rate (PR+SD) from 1st line CT 53%, 2nd line CT 67%. All 4 pts who received EGFRI in combination with CT showed evidence of DC. Conclusions: CT is effective in BTC with benefit seen in the majority of treated pts. 43% of pts were unable to receive CT which underscores the poor outlook in this malignancy. Interestingly we noted that even in our small subgroup who received EGFRI based combination CT, there was clinical benefit even in 2nd line CT. There is some published data to support this finding. EGFRI based CT should be further studied in this population.

A phase II study of concurrent chemoradiotherapy with weekly docetaxel and cisplatin in advanced oesophageal cancer

Concurrent chemoradiotherapy (CRT) is a main treatment option for patients with advanced oesophageal cancer. However, improvement of survival outcomes and toxicities according to the selected treatment is still needed. This phase II trial was conducted to assess the efficacy and safety of concurrent CRT with weekly docetaxel and cisplatin in advanced oesophageal cancer. Patients with unresectable oesophageal cancer due to advanced stage or patients medically unfit for surgery were enrolled. Patients received 20mg/m(2) docetaxel and 25mg/m(2) cisplatin in weeks 1, 2, 3, 5, 6, and 7 with concurrent 54-Gy radiotherapy at 200cGy/day. Thirty-six patients with oesophageal squamous cell carcinoma were enrolled from December 2007 to December 2009. Among them, the toxicity and response rate of 35 were evaluated. Thirty-five patients completed radiotherapy as planned, and 33 completed chemotherapy as planned. Grade 3 or 4 toxicity during CRT included leucopenia (5.7%), febrile neutropenia (2.9%), oesophagitis (22.9%), and tracheo-oesophageal fistula (5.7%). After CRT, 8 patients (22.9%) had a complete response, 22 (62.9%) had a partial response, 4 (11.4%) had stable disease, and 1 (2.9%) had progressive disease. Improvement of dysphagia was observed in 85.3%. At a median follow-up of 26.7months, the median time to progression was 13.5months, and median overall survival was 26.9months. The 3-year progression-free survival rate was 16.7%, and survival rate was 27.8%. Concurrent CRT with weekly docetaxel and cisplatin was well tolerated and is a convenient combination with promising efficacy. This result indicated favourable activity in terms of both tumour and symptom control.

Liver transplantation for hepatocellular carcinoma: the Hong Kong experience

Orthotopic liver transplantation (OLT) is the best treatment option for selected patients with hepatocellular carcinoma (HCC) with the background of cirrhosis since this treatment modality can cure both diseases at once. Over the years, the applicability of OLT for HCC has evolved. In Asia, including Hong Kong, a shortage of deceased donor liver grafts is a universal problem having to be faced in all transplant centers. Living-donor liver transplant (LDLT) has therefore been developed to counteract organ shortage and the high prevalence of HCC. The application of LDLT for HCC is a complex process involving donor voluntarism, selection criteria for the recipient and justification with respect to long-term survival in comparison to the result of deceased donor liver transplant. This article reviews the authors' experience with OLT for HCC patients in Hong Kong, with emphasis on the applicability and outcome of LDLT for HCC. Donor voluntarism has a significant impact on the application of LDLT. "Fast-track" LDLT in the setting of recurrence following curative treatment carries a high risk of recurrence even though the tumor stage fulfills the standard criteria. Although the survival outcome may be worse following LDLT than DDLT for HCC, LDLT is still the main treatment option for patients with transplantable HCC in Hong Kong, and a reasonable survival outcome can be achieved in selected patients with extended indications. It is particularly true that LDLT provides the only hope for patients with advanced HCC under the constricting problem of organ shortage.

Radical Prostatectomy

The first radical prostatectomy was performed in 1904. Since then, it has become one of the main treatment options for patients with prostate cancer, especially those with organ-confined disease. As it is the case in all types of malignancies, the treatment choice for the patient with prostate cancer depends on several considerations, the most important of which is the ability of the treatment modality to control disease. This review provides a brief comparison between radical prostatectomy and other main treatment options of prostate cancer, such as "watchful waiting" and radiation therapy, in terms of cancer control. In addition, an overview is provided of the oncological outcomes following various techniques and approaches of radical prostatectomy including open retropubic, perineal, laparoscopic, and robot-assisted surgery.

Diagnosis and treatment of Graves disease.

To review the etiology, diagnosis, and clinical presentation of Graves disease and provide an overview of the standard and adjunctive treatments. Specifically, antithyroid drugs, beta-blockers, inorganic iodide, lithium, and radioactive iodine are discussed, focusing on current controversies. Primary articles were identified through a MEDLINE search (1966-July 2000). Key word searches included beta-blockers, Graves disease, inorganic iodide, lithium, methimazole, and propylthiouracil. Additional articles from these sources and endocrinology textbooks were also identified. We agreed to include articles that would highlight the most relevant points, as well as current areas of controversy. Graves disease is the most common cause of hyperthyroidism. The 3 main treatment options for patients with Graves hyperthyroidism include antithyroid drugs, radioactive iodine, and surgery. Although the antithyroid drugs propylthiouracil (PTU) and methimazole (MMI) have similar efficacy, there are situations when 1 agent is preferred. MMI has a longer half-life than PTU, allowing once-daily dosing that can improve patient adherence to treatment. PTU has historically been the drug of choice for treating pregnant and breast-feeding women because of its limited transfer into the placenta and breast milk. Adjuvant therapies for Graves disease include beta-blockers, inorganic iodide, and lithium. beta-Blockers are used to decrease the symptoms of hyperthyroidism. Inorganic iodide is primarily used to prepare patients for thyroid surgery because of its ability to decrease the vascularity of the thyroid gland. Lithium, which acts in a manner similar to iodine, is not routinely used due to its transient effect and the risk of potentially serious adverse effects. In the US, radioiodine therapy has become the preferred treatment for adults with Graves disease. It is easy to administer, safe, effective, and more affordable than long-term treatment with antithyroid drugs. Hypothyroidism is an inevitable consequence of radioiodine therapy. Radioiodine is contraindicated in pregnant women because it can damage the fetal thyroid gland, resulting in fetal hypothyroidism. Bilateral subtotal thyroidectomy, which was once the only treatment available, is now performed only in special circumstances. In addition to the normal risks associated with surgery, laryngeal nerve damage, hypoparathyroidism, and hypothyroidism can occur following that procedure. Despite extensive experience with medical management, controversy prevails regarding choosing among the various drugs for treatment of Graves disease. None of the treatment options, including antithyroid drugs, radioiodine, and surgery, is ideal. Each has risks and benefits, and selection should be tailored to the individual patient.

The adequacy of pharmacotherapy in outpatients with obsessive???compulsive disorder

Pharmacotherapy and behavioural treatment are the main treatment options for patients with obsessive-compulsive disorder (OCD). Nevertheless, studies on the appropriateness of these treatments are scarce. We aimed to assess the adequacy of treatment in general, and pharmacotherapy in particular, in patients with OCD. Three hundred and thirteen outpatients with OCD were interviewed on admission at the University Medical Center (UMC) Utrecht, The Netherlands. Patients were evaluated for demographic and clinical characteristics. Current treatment was assessed on admission and treatment history was appraised retrospectively. On admission, only one-half of the patients took appropriate medication, of which 7.6% were prescribed maximal effective doses, 11.8% mean effective doses, 15% minimal effective doses and 19.4% ineffective doses. Approximately 35% of patients were prescribed no drugs and 16% inappropriate drugs. Although the majority of the patients had been treated on average three times prior to their current treatment, 24% had never received a serotonin reuptake inhibitor (SRI) or behaviour therapy. For approximately 50% of the total sample, the maximal effective dose of SRIs had never been taken during the course of treatment history. A large proportion of patients with OCD fail to receive adequate treatment. Many patients were prescribed SRIs at doses below those recommended for the guidelines.