Therapy For Prevention Of Recurrence Research Articles

Laser depilation as adjuvant therapy in prevention of recurrence of pilonidal sinus disease: initial experience of a district general hospital in the UK.

Pilonidal disease is a chronic condition involving the sacrococcygeal area. It can have a significant impact on quality of life, social activities and occupation. Surgery is the mainstay of treatment. However, laser depilation has been proposed as an adjunct to surgery and has shown improved results in some studies. We present our experience of laser depilation in the treatment of pilonidal disease in a district general hospital setting in the UK. A prospectively maintained database of all consecutive patients who received laser depilation after elective surgery for pilonidal disease was analysed. Patients were offered a minimum of two sessions of laser depilation. The primary outcome measure was disease recurrence. Evidence of new symptoms or signs of pilonidal disease after one year from the latest surgical intervention was defined as recurrent disease. Data are presented as medians with interquartile ranges. A total of 64 patients underwent laser depilation after elective surgery between 1 June 2013 and 1 June 2018; 57 were eligible for final analysis. Sixty-five per cent of patients received six or more sessions of laser treatment. There were no short- or long-term complications related to laser depilation. Patients who had more than two sessions of laser depilation showed an improved recurrence rate. Overall, recurrence rate in our series was 12% at a median follow-up of 172 weeks. Laser depilation is a safe and effective adjunct to surgery in minimising the recurrence of pilonidal disease. Patients with primary pilonidal disease and those who are undergoing minimally invasive surgery may also benefit from adjuvant laser depilation. Further high-quality control trials are required to assess its efficacy and safety.

Role of Anti Angiogenic Therapy in Prevention of Recurrence in Hormonal Positive Breast Cancer: A Secondary Prevention Strategy and Method of Therapy

Existing literature supports the role of signaling protein vascular endothelial growth factor (VEGF) in tumor growth and metastasis and furthers its involvement in recurrence. In both experimental and clinical studies, VEGF has been shown to be a significant factor involved for aberrant blood vessel growth, and in fact is the target of several classes of antineoplastic drugs [1] [2] [3] [4]. That said, the current standard of care for estrogen receptor positive breast cancer (although improved over the last decade), has not provided a “meaningful preventive shift” since the discovery of angiogenesis and its role in induction of recurrence. In this article, we discuss an anti angiogenic therapy implementing natural compounds to inhibit the production of VEGF. We applied our preclinical data to justify the predicted effect on VEGF. We used liquid biopsy to monitor patients response to therapy as a surrogate for recurrence. We hypothesize that by inhibition of angiogenesis through this protocol, we are able to positively impact tumor recurrence. It is our experience that patients in our sample even with high recurrence scores (based on Oncotype Dx testing) had a major reduction in recurrence when estrogen blockers were combined with this protocol. We also propose longitudinal studies to compare outcomes with combinational therapies with estrogen blockers in highly expected to recur disease.

The BRI-on-chip disposable test device opens up substantial savings potentials in urolithiasis treatment

Scientific objectives Urolithiasis is a widespread disease in the developed countries with rising prevalence rates which presently lie at least at 5%. Thus, 25 Mio. EU-citizens suffer from that symptom which burdens the healthcare systems by several tens of billions of Euros yearly. Stone formation is the result of an altered urinary composition, mostly caused by an underlying metabolic disease and disadvantageously interacting external risk factors. This makes the pathogenesis in each patient unique and thus diagnosis, causal treatment and therapeutic monitoring difficult, costly and time-consuming. Mostly, no specific long-term therapy for prevention of recurrence follows the purely symptom-based stone removal. The consequence is a diagnostic and therapeutic under-supply which inevitably results in a vicious circle of recurrent stone formation, although the recurrence rate can be lowered from 80% without metaphylaxis down to 20% under risk-adopted therapy. A paradigm shift from “stone-removal-only” towards a predictive, preventive and personalized treatment according to guideline recommendations is required. Routine urinalysis is restricted to only a few selected lithogenically important constituents whose concentrations partly can be combined to indices. However, to date no simple, cost-effective and precise method to determine the crystal formation risk of a native urine exists on the market. Technological approaches The scientifically established Bonn-Risk-Index (BRI) is based on a crystallization test induced within a sample of native urine. As urine composition reflects the influence of any of the patient’s metabolic processes – even of those analytically not directly accessible – BRI reflects a patient’s risk situation on a highly personalized level. BRI has proven its excellent appropriateness by showing diagnostic sensitivity and specificity clearly exceeding even those of the most evolved analysis-based risk indices. Whereas BRI can be cheaply and beneficially determined within a few minutes, standard urinalysis needs unacceptable amounts of time and costs. In 2008 the “Urolizer” mini-lab for fully-automated BRI measurement was developed; some devices are still in use. Experience shows that the requirements of medical laboratories, hospitals and medical offices differ in part. Whereas the former are very satisfied about the Urolizer, the latter two asked again for a simplified BRI test device.

Colchicine is safe and effective for secondary prevention of recurrent pericarditis

The CORP (COlchicine for Recurrent Pericarditis) trial [7]is a prospective, randomized, double-blind, placebo controlled, multicenter trial to evaluate the efficacy and safety of colchicine (1.0–2.0 mg on the first day, followed by a maintenance dose of 0.5–1.0 mg/day for 6 months) in association with conventional anti-inflammatory therapy for the secondary prevention of recurrence in patients with a first relapse of pericarditis. Patients were excluded if they were having their first episode of acute pericarditis, or their second or subsequent recurrence, or had pericarditis with tuberculous, purulent, or neoplastic causes. The primary study end point was the recurrence rate at 18 months. Secondary end points were symptom persistence after 72 h, remission rate at 1 week, number of recurrences, time to first recurrence, disease-related hospitalizations,cardiac tamponade, and constrictive pericarditis rates.120 patients (60 in the colchicine and 60 in the placebo group) were included in the analysis. The recurrence rate is 24 % in the colchicine group and 55 % in the placebo group (absolute risk reduction 0.31 [95 % CI 0.13–0.46];relative risk reduction 0.56 [0.27–0.73]; number needed to treat 3 [2–7]). Colchicine improves the persistence of symptoms at 72 h (absolute risk reduction 0.30 [95 % IC,0.13–0.45]; relative risk reduction 0.56 [0.27–0.74]). It also reduces the mean number of recurrences, increases the remission rate at 1 week and prolongs the time to subsequent recurrence. Colchicine and placebo groups have similar rates of side effects (7 %) and drug withdrawal (8 vs. 5 %, P = 0.89);no severe side effects occurred in any of the groups. Gastrointestinal intolerance was the main side effect during the study.

MP-04.01 Maintenance Bacillus Calmette-Guérin Intravesical Instillation Therapy Is Effective for Prevention of Recurrence in Japanese Non Muscle Invasive Bladder Cancer Cases

Bacillus Calmette-Guérin (BCG) is the gold standard therapy for prevention of recurrence after transurethral resection (TUR-Bt) of non muscle invasive bladder cancer (NMIBC). However, in some cases the outcome is not optimal with the standard protocol and therefore interest has focused on additional maintenance therapy. The present study was conducted to assess its utility in Japanese cases.

Meta-analysis: the efficacy of anti-viral therapy in prevention of recurrence after curative treatment of chronic hepatitis B-related hepatocellular carcinoma

The role of anti-viral therapy in prevention of hepatocellular carcinoma (HCC) recurrence is to be defined. To investigate the role of anti-viral therapy in prevention of tumour recurrence after curative treatment of hepatitis B virus (HBV)-related HCC. A systematic electronic search on keywords including HCC and different anti-viral therapies was performed through eight electronic databases, including Medline, EMBASE and Cochrane Databases. The primary outcome was HCC recurrence after curative treatment of HBV-related HCC. The secondary outcomes were mortality related to HCC, mortality related to liver failure and the overall mortality. Nine cohort studies were included with a total number of 551 patients: 204 patients with anti-viral treatment group and 347 patients without anti-viral treatment (control group). There was significant difference in the incidence of HCC recurrence in favour of the anti-viral treatment group (55% vs. 58%; odds risk (OR)=0.59, 95% CI 0.35-0.97, P=0.04). The risk of HCC was reduced by 41% in the anti-viral treatment group. There were also significant differences in favour of anti-viral treatment group in terms of liver-related mortality (0% vs. 8%; OR=0.13, 95% CI 0.02-0.69, P=0.02) and overall mortality (38% vs. 42%; OR=0.27, 95% CI 0.14-0.50, P<0.001). Anti-viral therapy has potential beneficial effects after the curative treatment of HBV-related hepatocellular carcinoma in terms of tumour recurrence, liver-related mortality and overall survival. Anti-viral therapy should be considered after curative treatment of hepatocellular carcinoma.

Mindfulness‐Based cognitive therapy for prevention of recurrence of suicidal behavior

Once suicidal thoughts have emerged as a feature of depression they are likely to be reactivated as part of a suicidal mode of mind whenever sad mood reappears. This article reviews the methods and the usefulness of mindfulness-based cognitive therapy (MBCT) as a treatment for the prevention of the reactivation of the suicidal mode. MBCT integrates mindfulness meditation practices and cognitive therapy techniques. It teaches participants to develop moment-by-moment awareness, approaching ongoing experience with an attitude of nonjudgment and acceptance. Participants are increasingly able to see their thoughts as mental events rather than facts (metacognitive awareness). A case example illustrates how mindfulness skills develop with MBCT and how they relate to the cognitive processes that fuel suicidal crises. An ongoing controlled trial will provide further evidence, but pilot work suggests that MBCT is a promising intervention for those who have experienced suicidal ideation in the past.

Chronic Longterm Electrophysiologic Study of Paroxysmal Ventricular Tachycardia

Nine patients with recurrent paroxysmal ventricular tachycardia underwent chronic electrophysiologic studies to delineate effective drug therapy for prevention of recurrence of this arrhythmia. The frequency of attacks of ventricular tachycardia necessitating hospitalization ranged from 2 to 12 (mean 5 +/- 4) attacks per year. Pacing induction of ventricular tachycardia was performed prior to and following intravenous or oral administration of procainamide (eight patients), disopyramide phosphate (nine patients), aprindine (five patients) and propranolol (four patients). Successful drug response (prevention of ventricular tachycardia induction or induction of nonsustained episodes of tachycardia) was noted in six of nine patients (66 percent). Lack of drug effect on the ability to sustain ventricular tachycardia was noted in three patients (34 percent). In addition, a deleterious drug response, manifested by potentiation of ventricular flutter or fibrillation, was observed in two of the three patients who failed to respond to drugs. Chronic drug therapy based on successful response in six patients resulted in cure of ventricular tachycardia in five of six patients (83 percent), one patient having one attack necessitating hospitalization. Of the three patients who demonstrated lack of drug effect during chronic electrophysiologic studies, one died suddenly and two had recurrent episodes of ventricular tachycardia while receiving a drug that did not prevent induction of ventricular tachycardia.

Long-term anticholinergic therapy for prevention of recurrences in duodenal ulcer

The effect of long-term Robinul therapy for prevention of recurrence and complication was investigated in 37 patients with chronic duodenal ulcer, utilizing a double-blind study. The results indicate a recurrence rate of 15% in the Robinul group of 20 patients versus 71% in the placebo group of 17 patients at the end of an 18-month follow-up study. Complications during treatment were observed in 5% of patients under Robinul therapy and in 59% of patients under placebo therapy. These differences are statistically significant. The combined results with the use of long-term anticholinergic therapy, the present study utilizing Robinul (double-blind study) and the previous study utilizing tricyclamol (single-blind study), showed that the incidence of recurrence was 11% in the anticholinergic group of 45 patients and 57% in the placebo group of 37 patients. The incidence of complications that developed under treatment was 7% in the anticholinergic group and 43% in the placebo group. The encouraging results in these studies might be attributed to the use of an “effective” anticholinergic drug and to the use of an optimal effective dose tailored to each patient. The results of these studies would indicate that the use of long-term anticholinergic therapy does alter the natural history of the duodenal ulcer disease in a significant number of cases. The rationale and the efficacy of anticholinergic therapy in peptic ulcer are discussed.