Valuable Treatment For Patients Research Articles

Circulation Editors’ Picks

<i>Circulation</i> Editors’ Picks

Abstracts from the TOXINS 2012

Abstracts from the TOXINS 2012

Successful Treatment of Severe Bruxism with OnabotulinumtoxinA in Patients with Post Anoxic Brain Injury (P01.237)

Objective: Intramuscularly administered OnabotulinumtoxinA is an effective treatment for a variety of movement disorders. Severe bruxism, which can generate discomfort, pain, tongue laceration and tooth fragmentation, is a frequent complication of anoxic brain injury. Severe bruxism is usually amenable to medical treatment. We report successful symptomatic treatment of severe bruxism with OnabotulinumtoxinA in four patients with anoxic brain injury. Background Four patients with severe bruxism secondary to post anoxic brain injury were seen on the inpatient and/or outpatient service at Henry Ford Health System between November 2003 and August 2011 and treated with OnabotulinumtoxinA. Design/Methods: All four patients were females, three were African American and one Caucasian. Ages ranged from twenty three to sixty three years old. All four patients received OnabotulinumtoxinA injection to the bilateral masseter and/or temoporalis muscles (total of 50-100units were injected during each visit). Two of the four patients received multiple injections separated by two weeks to 3 months due to severity of the symptoms. Results: All four patients responded positively to the injections. No side effects were reported in any of the studied patients. Conclusions: OnabotulinumtoxinA injections are an efficacious and valuable treatment for patients with severe bruxism post anoxic brain injury. Disclosure: Dr. Murshed has nothing to disclose. Dr. Dakka has nothing to disclose. Dr. Angus has nothing to disclose.

Ceratectomia lamelar anterior profunda usando a técnica "big-bubble" em pacientes com ceratocone

To evaluate patients with keratoconus 12 months after deep anterior lamellar keratectomy using the big-bubble technique. A retrospective study of 79 consecutive eyes of 71 patients with moderate to severe keratoconus with visual impairment after optical correction and intolerant to contact lens fitting. All transplants were performed by the same experienced surgeon, from January 2007 to February 2009 using the technique of deep anterior lamellar keratectomy by big-bubble. Data analyzed were gender, age, corneal pachymetry, endothelial cell density, dynamic astigmatism and best correct visual acuity after keratectomy. Mean age was 30,4 (± 10.2) years, 39 (54,9%) were female and 32 (45,1%) male. The ultrasonic pachymetry average was 518.6 (± 29.5) μm. Seventy-two (91.1%) had a best dynamic corrected visual acuity better or equal to 20/50. Mean dynamic astigmatism was - 3.5 (± 1.5) spherical diopters. The mean endothelial cell density found according to age distribution had patients between 11-20 years with 3,053 (± 532) cel/mm(2); 21-30 years with 2,674 (± 25) cel/mm(2); 31-40 years with 2,737 (± 575) cel/mm(2); 41-50 years with 2,585 (± 476) cel/mm(2) and 51-60 years with 2,398 (± 667) cel/mm(2). Microperfurations had incidence of 8,8%. The deep anterior lamellar keratectomy using the big-bubble technique is a valuable treatment for patients with keratoconus, reaching a final best correct visual acuity similar to penetrating keratoplasty. The mean endothelial cell count is within the normal range for age after the procedure. No rejection or corneal edema were noted after all points' removal. The dynamic astigmatism in deep anterior lamellar keratectomy is similar to that found in reports of penetrating keratoplasties. Deep anterior lamellar keratectomy using the big-bubble technique must be studied as the first option for the treatment of keratoconus.

Mild to moderate hidradenitis suppurativa treated with local excision and primary closure

Hidradenitis suppurativa (HS) is a chronic skin disease with a great impact on quality of life. Treatment with antibiotics or anti-inflammatory drugs, such as prednisone or TNF-alpha-inhibitors usually achieves only temporary improvement. Surgical intervention is considered as the only curative treatment for recurrent lesions. To determine the efficacy and patient satisfaction of local excision followed by primary closure. Between 2005 and 2010, 92 local excisions with primary closure were performed in 57 patients with mild to moderate HS. All patients were treated on an outpatient basis, under local anaesthesia. Local excision was defined as complete excision of the affected tissue, beyond the borders of activity, leaving clear margins. The medical records were reviewed retrospectively in 2010. The final outcome of the procedure, cosmetic appearance and patient satisfaction was measured using a questionnaire. Successful treatment, without recurrence, was accomplished in 66% of the cases. The intervention was generally well tolerated: 84% of the patients stated that they would undergo the same surgical procedure again if necessary, and 89% would recommend the procedure to other patients. Local excision followed by primary closure is a valuable treatment for patients with mild to moderate HS (Hurly stage I & II), with low morbidity and a high patient satisfaction rate.

Positional therapy for the reduction of obstructive sleep apnea

Positional obstructive sleep apnea (OSA) is defined as a 50% reduction in the apnea-hypopnea index (AHI) during non-supine sleep position. Positional OSA is more common in patients with mild to moderate OSA than in patients with severe OSA. The aim of this study was to assess the efficacy of positional therapy using a recently developed vest device for positional OSA. Fourteen participants with mild to moderate positional OSA were included. To evaluate the efficacy of the vest, changes in OSA observed between baseline and experimental polysomnography were assessed. The adverse event rate and subject satisfaction were also estimated. The AHI was lower in the experimental examination, with a value of 9.3 ± 8.3, than in the control examination, with a value of 22.8 ± 9.3 (P < 0.001). The AHI improved by approximately 57% when using the vest. Participant satisfaction with the vest was rated as “acceptable” and no adverse effects were reported. Positional therapy using the vest device appears to be a valuable treatment for patients with mild to moderate positional OSA.

Palliative Radiotherapy for Non-small Cell Lung Cancer: a Comparison of 2D vs 3D Planning

Introduction: Palliative radiotherapy (RT) is a valuable treatment for patients with advanced lung cancer. Short courses of RT are effective for most patients [1]. 3D conformal planning is used to reduce toxicity to normal structures and to improve dose distribution across the target volume.

Experience of Living Donor Liver Transplantation in Iran: A Single-Center Report

Living donor liver transplantation (LDLT) has been accepted as a valuable treatment for patients with end-stage liver disease seeking to overcome the shortage of organs and the waiting list mortality. The aim of this study was to report our experience with LDLT. We retrospectively analyzed 50 LDLTs performed in our organ transplant center from January 1997 to March 2008. We reviewed the demographic data, family history, operative and hospital stay durations as well as postoperation complications among donors and recipients. We also performed a retrospective analysis of recipient chemical and biochemical data. Among 50 patients (30 males and 20 females) of overall mean age of 7.21 +/- 5.35 who underwent LDLT (10 right lobe, 38 left lobe, and 2 left lateral segments), 47 received a liver graft from their parent, two from a brother, and one from an uncle. The most common indications for LDLT were end-stage liver disease due to Wilson's disease (16%), cryptogenic cirrhosis (16%), tyrosinemia (14%), biliary atresia (12%), autoimmune hepatitis (12%), and progressive familial intrahepatic cholestasis (12%). The mean follow-up was 16.91 +/- 23.74 months. There were 13 (26%) recipient mortalities including vascular complications; three to sepsis after bowel perforation, two from liver dysfunction, two from chronic rejection due to noncompliance, and one from diffuse aspergillosis. The morbidity rate was 50%, including 19 reexplorations during the hospital course and five biliary complications. This study demonstrated that LDLT can decrease the number of patients awaiting liver transplantation especially in the pediatric group. However, because of relatively high mortality and morbidity, we must improve our treatment outcomes.

Vinorelbine-based salvage therapy in HER2-positive metastatic breast cancer patients progressing during trastuzumab-containing regimens: a retrospective study

BackgroundThe vinka-alkaloyd vinorelbine is a potentially valuable treatment in patients with HER2-positive, trastuzumab-resistant advanced breast cancer. We sought to document the clinical activity of vinorelbine-based salvage treatments in this clinical setting.MethodsWe analyzed a cohort of 424 consecutive women receiving trastuzumab-based therapy for HER2-positive advanced breast cancer. Of these, 299 were identified as progressing during the initial trastuzumab-based treatment, and 77 received vinorelbine-based therapy as first salvage treatment. Central review of pathological specimens revealed that 70 patients had HER2-amplification detected by FISH. For these patients we determined overall response rate (ORR = complete-CR + partial-PR) and clinical benefit (CB = CR+PR+ Stable disease lasting at least 6 months), time to progression (TTP) and overall survival (OS) from the initiation of vinorelbine-based salvage therapy.ResultsIn 60 patients who were evaluable for tumor response, ORR and CB rates were 28% (95% C.I. 18%-41%) and 50% (95% C.I. 38%-62%), respectively. Median follow-up from the initiation of salvage therapy was 15 months (range 1–63 months). Median TTP and OS were 7.1 months (95% C.I. 6.6–7.7 months) and 21 months (95% C.I. 14.3–27.7 months), respectively. No differences in clinical outcomes were observed according to whether vinorelbine was administered as a single agent or in combination with other cytostatics, or whether trastuzumab was stopped or continued beyond disease progression.Conclusionour findings suggests that vinorelbine-based combinations are active and should be further evaluated in studies conducted in trastuzumab-resistant patients, including those evaluating newer HER2-targeting agents.

Strategies for improving the outcomes of small-for-size grafts in adult-to-adult living-donor liver transplantation

Living-donor liver transplantation (LDLT) has been refined and accepted as a valuable treatment for patients with end-stage liver disease in order to overcome the shortage of organs and mortality on the waiting list. However, graft size problems, especially small-for-size (SFS) grafts, remain the greatest limiting factor for the expansion of LDLT, especially in adult-to-adult transplantation. Various attempts have been made to overcome the problems regarding SFS grafts, such as increasing the graft liver volume and/or controlling excessive portal inflow to a small graft, with considerable positive outcomes. Recent innovations in basic studies have also contributed to the treatment of SFS syndrome. Herein, we review the literature and assess our current knowledge of the pathogenesis and treatment strategies for the use of SFS grafts in adult-to-adult LDLT.

Neurturin gene therapy improves motor function and prevents death of striatal neurons in a 3-nitropropionic acid rat model of Huntington's disease

Huntington's disease (HD) is a devastating neurodegenerative disease characterized by the selective loss of neurons in the striatum and cerebral cortex. This study tested the hypothesis that an adenoassociated viral (AAV2) vector encoding for the trophic factor neurturin (NTN) could provide neuroprotection in the rat 3-nitropropionic acid (3NP) model of HD. Rats received AAV2-NTN (CERE-120), AAV2-eGFP or Vehicle, followed 4 weeks later by the mitochondrial toxin 3NP. 3NP induced motor impairments were observed on the rotarod test, the platform test, and a clinical rating scale in all groups. However, each of these deficits was attenuated by AAV2-NTN (CERE-120). Stereological counts revealed a significant protection of NeuN-ir striatal neurons from 3NP toxicity by AAV2-NTN. These data support the concept that AAV2-NTN might be a valuable treatment for patients with Huntington's disease.

Clinical Outcomes After Deep Anterior Lamellar Keratoplasty Using the Big-bubble Technique in Patients With Keratoconus

To report clinical outcomes of deep anterior lamellar keratoplasty (DALK) using the big-bubble technique in patients with keratoconus. Prospective noncomparative interventional study. Single hospital. Eighty-one unselected consecutive patients with moderate to advanced keratoconus intolerant to contact lenses and with poor spectacle-corrected visual acuity. DALK big-bubble technique. Intraoperative and postoperative complications, postoperative uncorrected visual acuity (UCVA), best spectacle-corrected visual acuity (BSCVA), manifest refraction, corneal topography, and endothelial cell density. Seventy-eight procedures (96%) were completed as DALK. Big-bubble was achieved in 50 cases (64%); 28 (36%) required manual intrastromal dissection. Intraoperative microperforations occurred in 11 cases (13%). Baseline mean uncorrected visual acuity was 20/500 and 20/60 two years after surgery. Average preoperative BSCVA, was 20/100 and 20/30 at the end of follow-up. Final BSCVA was better in patients in whom big-bubble with exposure of the Descemet membrane was achieved (P < .05). Average keratometry and SD (standard deviation) refraction changed from 62.1 +/- 6.7 diopters and -10.76 +/- 5 diopters to 47.51 +/- 4.73 diopters and -1.81 +/- 3.2 diopters, respectively after surgery. Mean preoperative endothelial cell density was 2202.29 +/- 392.35 cells/mm(2) and 2034 +/- 438.39 cells/mm(2) two years after surgery. Two patients developed stromal rejection. The DALK big-bubble technique is a valuable treatment in patients with keratoconus. Visual outcome is comparable to standard penetrating keratoplasty (PK) when formation of big-bubble with exposure of the Descemet membrane (DM) was achieved. Clinically important graft-host interface developed in some cases after manual intrastromal dissection. Stromal rejection is a rare complication.

2155: Primary Chemoradiation for Adenocarcinoma of the Rectum

Chemoradiation therapy (CRT) is primarily used as preoperative treatment for T3/4 rectal adenocarcinoma but is also a valuable treatment for patients with non-metastatic adenocarcinoma of the rectum who are medically unfit for, refuse radical surgery, or are unresectable. The purpose of this retrospective review was to assess toxicity and outcomes of patients with rectal adenocarcinoma treated with CRT alone at our centre.

The present role of percutaneous cervical cordotomy for the treatment of cancer pain

The results obtained by percutaneous cervical cordotomy (PCC) were analysed in 43 terminally ill cancer patients treated in our institution from 1998 to 2001. We wished to determine whether there is still a place for PCC in the actual clinical situation with its wide choice of pain therapies. All patients had severe unilateral pain due to cancer, resistant to opioids and co–analgesics. Following PCC, mean pain intensity was reduced from Numeric Rating Scale (NRS) 7.2 to 1.1. At the end of life, pain had increased to NRS 2.9. Initially following PCC a good result (NRS<3) was obtained in 95% of patients. At the end of life, a good result was still present in 69% of patients. Mean duration of survival after the intervention was 118 days (2–1460). In general, complications were mild and mostly subsided within 3–4 days. There was one case of partial paresis of the ipsilateral leg. PCC remains a valuable treatment in patients with treatment–resistant cancer pain and still deserves a place in the treatment of terminal cancer patients with severe unilateral neuropathic or incidence pain.

Cavernous malformations presenting with seizures: Therapeutic options and outcome

Controversies exist regarding the appropriate initial management of patients with cavernous malformations associated with a seizure disorder. We retrospectively reviewed our experience with simple lesionectomy in the treatment of 82 patients with supratentorial cortical cavernous malformations who presented with seizures. Fifty-five patients had adequate follow up (at least 1 year; mean, 52 months) to assess outcome related to seizure control. Forty (73%) patients had single and 15 (27%) had multiple cavernous malformations. Eighteen (33%) patients underwent surgery within the first 2 months of their initial seizure. Thirty-seven (67%) patients had seizures for more than 6 months before their lesionectomy. All patients were treated with lesionectomy alone as their initial management. Outcomes were evaluated based on Engel's criteria. Seizure outcome was based on the number of seizures pre- and postoperatively, lesion location, and number of lesions. Of the 55 patients with adequate follow up, 69% were seizure free (grade 1) and 13% were almost seizure free (grade II). All 18 patients who were operated on within 2 months of their initial seizure have remained seizure free. Of the patients with chronic epilepsy before surgery, 57% are seizure free, and 17% are almost seizure free. Patients with multiple cavernous malformations and well-localized seizure activity on preoperative testing responded well to lesionectomy. Lesion location was not significant in predicting seizure outcome after surgery. Lesionectomy is a valuable treatment for patients with cavernous malformations associated with epilepsy and represents the best initial treatment option. Patients with chronic epilepsy who fail to become seizure free after lesionectomy may require further epilepsy monitoring and resection. Initial lesionectomy, however, will avoid unnecessary epilepsy surgery in most of these patients.

The value of knee arthroscopy in patients with severe radiological osteoarthritis.

This study was performed to assess the value of knee arthroscopy in patients with radiological signs of severe osteoarthritis. A total of 104 patients (50 men, 54 women, average age 60 years) with radiological knee osteoarthritis grade III/IV were followed up after knee arthroscopy between May 1989 and November 1996. The average follow-up time was 5.4 years after surgery. A significant ( p<0.01) increase in the Lysholm score was found, ranging from 40 points before arthroscopy to 69 points at the assessment. A total of 84 patients (81%) reported an increase in their activities of daily living, 44 patients (43%) were still without any complaints. The total outcome was rated very good or good by 67 patients (65%). Only 21 patients (20%) required further surgery before the assessment. Knee arthroscopy is a valuable treatment for patients with pain, swelling, and radiological signs of severe osteoarthritis. It improves the patients' activities of daily living and helps to postpone further surgery.

A stepwise approach to the treatment of early onset nephrotic syndrome

We have retrospectively reviewed our single-center experience of the treatment of early onset nephrotic syndrome (NS). From 1991 to 1998, ten children with NS were treated. Kidney biopsy showed focal sclerosis (n=1), diffuse mesangial sclerosis (n=7), and congenital NS of the Finnish type (n=2). Associated conditions included incomplete Drash syndrome (n=1), Galloway-Mowat syndrome (n=1), and severe mental and motor retardation of unknown origin (n=3). From 1991 to 1997, five children with NS were treated. Bilateral nephrectomy (NX) was performed in three, one patient with severe retardation died at 4 years and NX was not performed in one patient who showed satisfactory growth and development. Three of these children were dialyzed and two were successfully transplanted. One patient was transplanted without previous dialysis. From 1997 to 1998, five children were treated with a regimen that included captopril and indomethacin (CAPTO/INDO). CAPTO/ INDO was successful in increasing serum protein in all patients and producing growth and development in four patients. In two patients CAPTO/INDO was successful only after unilateral NX. Our experience indicates that CAPTO/INDO may be a valuable treatment in patients with early onset NS. An individualized stepwise approach including unilateral NX should be considered to achieve optimal results.

The effect of 13-cis-retinoic acid on wound healing in dogs.

13-cis-retinoic acid is currently accepted as a valuable treatment for patients with severe nodulocystic acne. Many of these individuals express interest in surgical scar-correcting procedures. To ascertain the effect of 13-cis-retinoic acid on wound healing, sequential biopsies were examined from partial and full-thickness wounds in dogs following a 2-month course of retinoids. No significant difference was histologically observed from the control animal.