Systematic Treatment Program Research Articles

Ghost cell odontogenic carcinoma: A rare case report and review of literature.

Ghost cell odontogenic carcinoma is a rare malignant odontogenic carcinoma characterized by the presence of ghost cells. It has a nonspecific clinical and radiographic presentation and can be locally destructive and invasive, sometimes with distant metastases. However, no effective systemic therapy is currently recommended for such patients. The patient has been unable to undergo surgery or radiotherapy again. Therefore, he was referred to our department for a more aggressive, multimodal systematic treatment program. The histopathological examination was morphologically suggestive of ghost cell odontogenic carcinomas. We report a case of locally invasive primary inoperable odontogenic shadow cell carcinoma in a 31-year-old Chinese man who achieved treatment with Toripalimab and chemotherapy, followed by Toripalimab maintenance therapy after 6 cycles. He achieved partial remission after treatment. The quality of life significantly improved after treatment. There were no grade 3/4 treatment-related adverse events during treatment. This case presented that Toripalimab and chemotherapy may be a safe and effective systemic therapy for ghost cell odontogenic carcinoma.

아이슬란드의 마약류사범 갱생보호제도 연구

In Korea, the importance of the ideology of supporting and managing the concept of treatment rather than criminal punishment for drug offenders is recognized, and drug offenders are treated in the same way as treatment protection and treatment order systems. However, the incidence and recidivism rate of drug crimes are on the rise, which shows that probability there are problems with the treatment of drug offenders in Korea, so improvement is necessary. Therefore, in order to discuss improvement measures, the case of Iceland, an advanced country in drug offenders correctional welfare, was studied and compared with domestic cases. In the case of Iceland, policies are being implemented to provide rehabilitation protection services under the concept of the general welfare to released drug offenders and to recommend and encourage cooperation from community agencies. Based on the government’s interest and support for rehabilitation support, released prisoner, released prisoners who have an addiction and mental illness problems can be provided with systematic, professional, and continuous treatment and protection measures. However, in Korea, there were many problems in the released drug offender support system, including lack of budget, lack of professionals, absence of phased and systematic treatment programs, and absence of follow-up management. To solve the problem, this study suggested the need to provide general correctional welfare services to drug offenders, centering on the Korea Rehabilitation Agency(‘Gongdan’), the central organization for preventing recidivism in society. With the Korea Rehabilitation Agency at the center, it is expected to effectively curb social problems and criminal damage caused by drug abuse by promoting the rehabilitation service for released prisoners and released drug offenders, providing released criminal follow-up management, and establishing a linkage system with the community welfare service providers.

Comparison of the Effects of Task-Oriented Circuit Training and Treadmill Training on Walking Function and Quality of Life in Patients With Post-Stroke Hemiparesis: Randomized Controlled Pilot Trial

Background: Many studies regarding task-oriented training have recently demonstrated functional improvement in patients with post-stroke hemiparesis. The task-oriented approach is very diverse, and chronic stroke patients must have access to a sustained systematic treatment program to enhance their walking ability. Objectives: This study aimed to compare the effects of the task-oriented circuit training and treadmill training on walking function and quality of life in patients with chronic stroke. Methods: Fourteen patients with chronic stroke volunteered for this study. The subjects were randomly divided into a task-oriented circuit training group and a treadmill training group with 7 patients in each. Each training regimen was performed for 30 min a day and 3 days a week for 4 weeks. Assessment tools included the Timed Up-and-Go Test (TUGT), 10-m Walk Test, 6-min Walk Test (6MWT), and the Stroke Impact Scale (SIS). Results: The change in results of the TUGT, 6MWT, and SIS measured prior to and following the training regimens appeared to be significantly different between the two groups (p

Treatment response of bipolar and unipolar alcoholics to an inpatient dual diagnosis program

Background Depressed and bipolar alcoholics represent a significant affective subgroup that has a poorer prognosis than either diagnosis alone. To date few systematic treatment programs have been developed to treat dual diagnosis. Methods An inpatient treatment program was developed at St Patrick's Hospital Dublin to treat dual diagnosis clients with alcohol dependence and either unipolar or bipolar affective disorder. Clients ( N = 232) were assessed for depression, anxiety, elation, cravings, drink and drug intake on admission, discharge, 3 and 6 months post-discharge from the program. Results In the overall group there was a reduction in number of drinking days and units per drinking day over the study ( p < .01). There was a 71.8% complete abstinent rate at 3 months and 55.8% at 6 months in the depression group, non-significantly greater than for the bipolar group at 64.7% and 54.1% respectively. Gamma GT, MCV and craving scores were significantly reduced over time ( p < .01). Mania, depression and anxiety inventory scores fell over time in both groups ( p < .01). 15–21-year olds were more severely anxious, had higher illicit drug use, and were more likely to relapse to drug use than older clients. Bipolar 1 clients were significantly more likely than bipolar 2 clients to be on mood stabilisers at all follow-up stages ( p < .001). Limitations No control group was used. Conclusions There is evidence for efficacy of a specifically designed dual diagnosis inpatient treatment program as both depressed and bipolar alcoholics had significant reductions in all measurements of mood, craving, and alcohol/drug consumption by self report and biological markers, suggesting both diagnoses can be effectively treated together.

Reducing premature death and renal failure in Australian Aboriginals

To describe results of a systematic treatment program to modify renal and cardiovascular disease in an Aboriginal community whose rates of renal failure and cardiovascular deaths are among the highest in Australia. Longitudinal survey of people during treatment, and comparison of rates of natural death and renal failure with those in a historical control group. Tiwi Islands (population, about 1800), November 1995 to December 1998. All adults with blood pressure > or = 140/90, with diabetes and urinary albumin/creatinine ratio (ACR) > or = 3.4 g/mol (microalbuminuria threshold), or with progressive overt albuminuria (ACR > or = 34 g/mol) were eligible for treatment. The historical control group comprised 229 people who satisfied these criteria in the pretreatment period 1992-1995. Perindopril, combined with calcium-channel blockers and diuretics if needed to achieve blood pressure goals; attempts to improve control of blood glucose and lipid levels; health education. Blood pressure, ACR, serum creatinine level and glomerular filtration rate (GFR) over two years of treatment; rates of renal failure and natural death compared with control group (analysed on intention-to-treat basis). 258 people enrolled in the program, and 118 had complete data for two years of treatment. In these 118, blood pressures fell significantly, while ACR and GFR stabilised. Rates of the combined endpoints of renal failure and natural death per 100 person-years were 2.9 for the treatment group (95% CI, 1.7-4.6) and 4.8 for the control group (95% CI, 3.3-7.0). After adjustment for baseline ACR category, the relative risk of the treatment group versus the control group for these combined endpoints was 0.47 (95% CI, 0.25-0.86; P = 0.013). Treatment benefit was especially marked in people with overt albuminuria or hypertension and in non-diabetic people. The estimates of benefit were supported by a fall in community rates of death and renal failure. Aboriginal people can participate enthusiastically in chronic disease management, with rapid, dramatic improvement in clinical profiles and mortality. Similar programs should be introduced urgently into other Aboriginal communities nationwide.

Blood Pressure Reduction and the Risk of Myocardial Infarction-Reply

In Reply.— Compliance, or its absence, may, as Dr Rudd suggests, have affected patient experience. We have no data to suggest frequent wide blood pressure (BP) swings in the studied patients, nor did we find a relation between BP variability and outcome. Moreover, our systematic treatment program is designed to maximize adherence (measured by persistence in treatment), and BP control has been very high. 1 Parenthetically, we do not agree with the characterization of our studied group as being high risk: 10% had a prior cardiovascular disease, less than 5% had diabetes, one third were smokers, and 25% had an abnormality on an electrocardiogram, which we believe to represent the mixture found in the community. Staessen et al have correctly noted that the Cox analytical procedure does not test for curvilinear relationships. We did, however, treat BP fall as both a dichotomous and a continuous variable and found consistent results

Treatment-Induced Blood Pressure Reduction and the Risk of Myocardial Infarction

To examine the relationship between degree of treatment-induced blood pressure (BP) reduction and myocardial infarction, the experience of 1765 previously untreated, mild to moderate hypertensives (initial BP greater than or equal to 160 and/or greater than or equal to 95 mm Hg) in a systematic treatment program was reviewed. Over an average of 4.2 years, there were 39 morbid or fatal myocardial infarctions. Three types of fall in diastolic BP (final minus pretreatment) were defined: small (less than or equal to 6 mm Hg), moderate (7 to 17 mm Hg), and large (greater than or equal to 18 mm Hg). By Cox regression, an association was observed between myocardial infarctions and both a large and a small fall, relative to a moderate decline. Age and sex were independent risk factors. Body mass index, cholesterol level, electrocardiogram, race, prior cardiovascular disease, smoking status, initial and final revisit BP, total intreatment BP, and systolic BP were not. Since both a large and small reduction in diastolic BP were associated with a higher incidence of myocardial infarction (relative to a moderate fall), perhaps a moderate reduction in diastolic BP should be the goal of treatment for mild and moderate hypertensives.

Treatment of rheumatoid arthritis: a review including newer and experimental anti-inflammatory agents.

Treatment of rheumatoid arthritis is often frustrating for patient and physician alike because of its chronic nature and our lack of knowledge about precise cause. It can be confused by the vast array of anti-inflammatory drugs now available, with new agents being added all the time. We present here an outline for a systematic treatment program that must be tailored to each patient's needs. It emphasizes a broad approach on the part of the physician and indicates that drugs comprise only one part of treatment. We review the drugs currently used in the treatment of rheumatoid arthritis and include discussion of those newer antiinflammatory agents that should be available shortly. A rational scheme for the use of these drugs is proposed.