Treatment Of Young Adult Patients Research Articles

Three Decade Single-Institution Experience of Safety and Efficacy of Radiotherapy and Adjuvant Chemotherapy for Young Adult Patients with Medulloblastoma

The rarity of medulloblastoma in the adult population limits information on optimal treatment and clinical outcomes. Adjuvant chemoradiation has been correlated to improved overall survival (OS) in a recent National Cancer Database (NCDB) analysis. We performed a retrospective safety and efficacy analysis of radiation (RT) +/- adjuvant chemotherapy (aCTH) in young adult patients with medulloblastoma to better understand outcomes, prognostic factors, and possibly optimal treatment strategies. We conducted an IRB-approved retrospective chart review on young adult (age ≥18 - 39 years old) patients with medulloblastoma treated at our institution (1992-2018) with a minimum follow-up of 6 months from completion of therapy. We gathered data on patient and disease characteristics, treatment, and clinical outcomes, including OS, progression-free survival (PFS), local control (LC), and freedom from distant metastasis (FDM). We employed Cox regression model for univariable and multivariable analyses and Kaplan-Meier (KM) test methods for survival analyses, using JMP version 15.0 software. Thirty-one patients were treated with postoperative RT including craniospinal irradiation (median dose: 2340 cGy/13 fractions) followed by tumor bed/posterior fossa (median total dose: 5580 cGy/31 fractions) either alone (n = 9; 29%) or with adjuvant chemotherapy (aCTH: n = 22; 71%); mostly as per COG A9961 Regimen A: oral lomustine, intravenous cisplatin, and intravenous vincristine (n = 12). 54.6% (n = 12) were known to complete the full aCTH course. Common RT acute toxicities included G1-2 nausea and/or vomiting (N/V; n = 8) and G1-2 fatigue (n = 6). Common aCTH acute toxicities included G1-2 N/V (n = 7) and peripheral neuropathy: G1-2 (n = 6) and G3 (n = 3). Late adverse events were primarily G1-2 peripheral neuropathy and gait imbalance (22.6%), G1-2 hormonal disturbances (19.4%) and G1-2 neurocognitive impairment (16.1%). Male patients had worse OS, PFS, FDM, and LC. Age at diagnosis, tumor location (lateral vs. central), and completion of aCTH course were shown on uni- and multi-variable analysis to be significantly associated with OS; p<0.05. KM survival analysis revealed superior 10-year PFS and OS in patients who completed aCTH compared to those who received RT alone or did not complete aCTH: 72.9% vs 59.3% vs 42%, p = 0.461, and 74.1% vs 63.5% vs 40%, p = 0.033, respectively. A similar trend was noted for LC and FDM. Our series provides a report of acute and late side effects of treatment of young adult patients with medulloblastoma. Significant OS and PFS advantage are seen of aCTH completion in this patient population. Since optimal treatment of these patients is still an unmet need, prospective studies for this rare disease entity are needed.

\u201cBreaking down the wall\u201d patients` and families` experience of multifamily therapy for young adult women with severe eating disorders

BackgroundThis paper addresses patients` and families` experience of multifamily therapy (MFT) for young adults (18–22) with an eating disorder (ED). EDs are serious illnesses leading to lowered quality of life for the patient and their family. The Regional Centre for Eating Disorders (RESSP) at Nordland Hospital in Bodø, Norway has developed an adjunct psychotherapeutic approach for the treatment of young adult patients with severe EDs. The patient’s family members take part in the multifamily therapy (MFT) group programme.MethodsThe aim of the study was to explore patients` and families` experience of MFT for young adult women with severe EDs. A Grounded Theory (GT) approach was used. Data were collected by field observations in two MFT groups, qualitative group interviews and qualitative individual interviews with patients and their family members. Data were analysed using the constant comparative method. The data analysis consisted of open and selective coding and memo writing.ResultsTwo main categories were identified: ‘Connectedness and recognition’ and ‘Opening up and sharing`. MFT was described as a space for recognition within which it was possible to speak of things happening in the family with others with similar difficulties. It felt good and freeing, but also painful, to meet others with similar experiences. The participants had in common a considerable loneliness because it is difficult for outsiders to grasp what it is like in a home dominated by an ED. The meeting with other families created an underlying safety. The participants received help to distinguish between realistic and unrealistic concerns and learned about openness and communication in relation to their daughter. Some women with EDs said that MFT was most important for the parents but also had been good for them as things had become better at home.ConclusionThe participants reported that their family had become better at talking to each other after having been in MFT. As a result, they were able to speak more openly about difficult things and share feelings. This gave rise to increased understanding. The study shows that MFT was found to be valuable and important. Never before had these families had such an opportunity, something so directly tailored to them. MFT for adults can be developed further and used in other groups, such as those concerning other chronic illnesses.

Predictors of outcome among young adult patients with anorexia nervosa in a randomised controlled trial.

The prognosis in cases of anorexia nervosa (AN) is unsatisfactory, and it is therefore important to examine pretreatment predictors of outcome. Female AN patients (N=74) included in a randomised controlled trial receiving individual cognitive behavioural therapy (CBT) or family-based treatment (FBT) were included. Predictors of the outcome were explored using pretreatment eating disorder psychopathology. In the CBT group, lower levels of emotional dysregulation and greater deficits in identifying and coping with inner states were predictors of weight increase, explaining 37.7% of the variance. In the FBT group, lower interoceptive deficits predicted an increase in weight (explaining 17.7% of the variance), whereas bulimic behaviour (32.4%) and problems with emotional regulation (23.3%) were predictors of increased diagnostic symptoms. Bulimic symptoms and the ability to identify and cope with emotional states appear to be important aspects that should be addressed in the treatment of young adult patients with AN.

Effect of cannulated screws with deep circumflex iliac artery-bone grafting in the treatment of femoral neck fracture in young adults

ObjectivesSurgical treatment of femoral neck fracture in young adults is clinically challenging due to the high incidence of avascular necrosis of femoral head and fracture nonunion. The objective of this study is to evaluate the effectiveness of cannulated screws with deep circumflex iliac artery bone grafting (DCIABG) by comparing to the routinely used method in the treatment of femoral neck fracture in young adults. MethodsFrom March 2006 to December 2012, a total of 185 patients with femoral neck fracture were admitted to the hospital for internal fixation surgery, 103 patients (61 males and 42 females, mean age of 39.1 years) were treated with three cannulated screws with DCIABG (group A), and 82 patients (49 males and 33 females, mean age of 35.5 years) were treated with three cannulated screws without DCIABG (group B). ResultsAll patients were followed up for at least 24 months after the surgery. The patients in group A had a significantly higher Harris Hip Score (p < 0.001), shorter fracture healing time (p < 0.001), lower occurrence rate of avascular necrosis of femoral head (p = 0.008) and fracture nonunion (p = 0.012) compared to the patients in group B. However, the operation time and intraoperative blood loss were significantly lower in patients in group B than those in group A (p < 0.001). ConclusionsCannulated screws with DCIABG significantly reduced femoral head osteonecrosis and fracture nonunion. Therefore, it is a feasible and effective method in the treatment of young adult patients with femoral neck fracture.

Unusual Respiratory Manifestations in Two Young Adults with Duchenne Muscular Dystrophy

Adult respirologists are often involved in the evaluation and treatment of young adult patients with Duchenne muscular dystrophy. In this context, the most frequent respiratory complication is nocturnal and daytime hypoventilation related to respiratory muscle weakness. The present article describes cases of Duchenne muscular dystrophy involving two brothers, 17 and 19 years of age, respectively, who presented with less frequently reported respiratory complications of their disease: obstructive sleep apnea and Cheyne-Stokes respiration with central apnea, which were believed to be partially or completely related to congestive cardiomyopathy.

Treatment of Paraphilia in Young Adults with Leuprolide Acetate: A Preliminary Case Report Series

Some juveniles who engage in sexual offenses may have a paraphilia, a psychiatric disorder characterized by a pervasive pattern of deviant and impairing sexual fantasies, thoughts, and/or behaviors. Though there is no known cure for these conditions, paraphilias can be effectively managed using a multimodal treatment approach. This may include the use of psychotherapeutic and pharmacological treatment interventions, including antiandrogen medications. One such agent, leuprolide acetate (leuprolide), a luteinizing hormone-releasing-hormone agonist, has been shown to be effective in reducing paraphilic symptoms in adult patients. To date, however, there is no published data on its use and effectiveness in adolescent and young adult paraphilic patients. This study consists of a case report series of six young adult patients treated with leuprolide. All subjects had been diagnosed with at least one paraphilia (i.e., Pedophilia, Sexual Sadism, Frotteurism, and Paraphilia Not Otherwise Specified). All subjects had been refractory to treatment in a residential program for adolescent sex offenders prior to initiation of leuprolide. All six subjects reported a reduction in sexually deviant symptoms following treatment with leuprolide. Clinicians rated four as much improved and two as moderately improved. The treatment was well tolerated in all six subjects. This preliminary case series supports the conclusion that leuprolide deserves further examination as a potentially safe and effective component in the treatment of young adult patients with paraphilia.

Photorefractive keratectomy for the treatment of purely refractive accommodative esotropia

Purpose To evaluate the results of photorefractive keratectomy (PRK) for the treatment of young adult patients with purely refractive accommodative esotropia. Setting Private practice and university hospital, Milan, Italy. Methods The medical records of consecutive patients who had PRK for hyperopia associated with purely refractive esotropia were reviewed retrospectively. Preoperative and postoperative visual acuity, alignment, and sensory data were recorded and analyzed. Surgical methods and complications were reviewed. Results Sixteen eyes of 8 patients were treated. The mean patient age at the time of treatment was 24.6 years (range 17 to 38 years). All patients were followed for 1 year. At the 1-year follow-up evaluation, the uncorrected visual acuity was 20/40 or better in all eyes. No patient lost a line of best spectacle-corrected visual acuity. The mean spherical equivalent was −3.7 diopters (D) preoperatively and −0.7 D postoperatively. All patients were within ±0.37 D of emmetropia at the 1-year evaluation. Preoperatively, the mean esotropic deviation was 10.75 prism diopters. Postoperatively, all patients were orthophoric without correction. Stereopsis was unaffected by PRK in all patients. There were no intraoperative or postoperative complications. Conclusion Photorefractive keratectomy was an effective treatment for esotropia associated with mild to moderate hyperopia in young adults with purely refractive accommodative esotropia. These findings should not be widely applied to children with accommodative esotropia.

THE PLACE OF APPENDICECTOMY IN THE TREATMENT OF YOUNG ADULT PATIENTS WITH POSSIBLE APPENDICITIS

As part of an extensive study of the treatment of patients admitted to hospital because of possible appendicitis, particular attention was given to 533 patients aged between twelve and twenty-nine years. Two basically different approaches to treatment were noted: the radical approach (operation in 4 of 5 cases) resulted in the removal of both more normal and more abnormal appendices than did the conservative approach (operation in 3 of 5 cases). The radical approach caused less morbidity than the conservative approach (16.6% of all patients as against 19.3%) and resulted in a lower incidence of recurrent symptoms (10.1% as against 17.7%). The avoidable mortality from the two approaches was closely similar. Appendicectomy seems to run in families although appendicitis does not. Both radical and conservative surgeons use operative treatment more frequently on patients with medical associations than on their other patients. It is concluded that the radical approach to the treatment of young adult patients admitted to hospital with possible appendicitis is preferable to the conservative approach.