Treatment Options for Gastrointestinal Carcinoid Tumors

Science.gov (United States)

... factors affect prognosis (chance of recovery) and treatment options. The prognosis (chance of recovery ) and treatment options ... body. Has not gotten better with treatment. Treatment Option Overview Key Points There are different types of ...

Treatment Options by Stage (Pancreatic Cancer)

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... factors affect prognosis (chance of recovery) and treatment options. The prognosis (chance of recovery ) and treatment options ... or in other parts of the body. Treatment Option Overview Key Points There are different types of ...

Treatment Options by Stage (Esophageal Cancer)

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... factors affect prognosis (chance of recovery) and treatment options. The prognosis (chance of recovery ) and treatment options ... or in other parts of the body. Treatment Option Overview Key Points There are different types of ...

Treatment Options by Stage (Vulvar Cancer)

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... factors affect prognosis (chance of recovery) and treatment options. The prognosis (chance of recovery ) and treatment options ... or in other parts of the body. Treatment Option Overview Key Points There are different types of ...

Treatment Options by Stage (Penile Cancer)

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... factors affect prognosis (chance of recovery) and treatment options. The prognosis (chance of recovery ) and treatment options ... or in other parts of the body. Treatment Option Overview Key Points There are different types of ...

Treatment Options for Non-Hodgkin Lymphoma

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... factors affect prognosis (chance of recovery) and treatment options. The prognosis (chance of recovery ) and treatment options ... lymphoma may come back as indolent lymphoma. Treatment Option Overview Key Points There are different types of ...

Treatment Options by Stage (Prostate Cancer)

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... factors affect prognosis (chance of recovery) and treatment options. The prognosis (chance of recovery ) and treatment options ... or in other parts of the body. Treatment Option Overview Key Points There are different types of ...

Treatment Options by Stage (Adrenocortical Carcinoma)

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... affect the prognosis (chance of recovery) and treatment options. The prognosis (chance of recovery ) and treatment options ... or in other parts of the body. Treatment Option Overview Key Points There are different types of ...

Treatment Options for Childhood Hodgkin Lymphoma

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... factors affect prognosis (chance of recovery) and treatment options. The prognosis (chance of recovery ) and treatment options ... the lungs , liver , bones, or bone marrow . Treatment Option Overview Key Points There are different types of ...

Treatment Options for Adult Hodgkin Lymphoma

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... factors affect prognosis (chance of recovery) and treatment options. The prognosis (chance of recovery ) and treatment options ... or in other parts of the body. Treatment Option Overview Key Points There are different types of ...

Treatment Option Overview (Small Intestine Cancer)

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... factors affect prognosis (chance of recovery) and treatment options. The prognosis (chance of recovery ) and treatment options ... or in other parts of the body. Treatment Option Overview Key Points There are different types of ...

Treatment Option Overview (Adult Hodgkin Lymphoma)

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... factors affect prognosis (chance of recovery) and treatment options. The prognosis (chance of recovery ) and treatment options ... or in other parts of the body. Treatment Option Overview Key Points There are different types of ...

Treatment Option Overview (Merkel Cell Carcinoma)

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... factors affect prognosis (chance of recovery) and treatment options. The prognosis (chance of recovery ) and treatment options ... common for Merkel cell carcinoma to recur. Treatment Option Overview Key Points There are different types of ...

Treatment Option Overview (Childhood Hodgkin Lymphoma)

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... factors affect prognosis (chance of recovery) and treatment options. The prognosis (chance of recovery ) and treatment options ... the lungs , liver , bones, or bone marrow . Treatment Option Overview Key Points There are different types of ...

Treatment Options for AIDS-Related Lymphoma

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... factors affect prognosis (chance of recovery) and treatment options. The prognosis (chance of recovery ) and treatment options ... nervous system is not primary CNS lymphoma. Treatment Option Overview Key Points There are different types of ...

Treatment Options for Renal Cell Cancer

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... factors affect prognosis (chance of recovery) and treatment options. The prognosis (chance of recovery ) and treatment options ... or in other parts of the body. Treatment Option Overview Key Points There are different types of ...

Treatment Options by Stage (Gastric Cancer)

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... factors affect prognosis (chance of recovery) and treatment options. The prognosis (chance of recovery ) and treatment options ... such as the liver or lymph nodes . Treatment Option Overview Key Points There are different types of ...

Treatment Options by Stage (Thyroid Cancer)

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... factors affect prognosis (chance of recovery) and treatment options. The prognosis (chance of recovery ) and treatment options ... or in other parts of the body. Treatment Option Overview Key Points There are different types of ...

Treatment Options for Chronic Myelogenous Leukemia

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... factors affect prognosis (chance of recovery) and treatment options. The prognosis (chance of recovery ) and treatment options ... of blast cells increases after a remission . Treatment Option Overview Key Points There are different types of ...

Treatment Options for Actinic Keratosis

Science.gov (United States)

... factors affect prognosis (chance of recovery) and treatment options. The prognosis (chance of recovery ) depends mostly on ... helped by lip balm or petroleum jelly . Treatment Option Overview Key Points There are different types of ...

Treatment Option Overview (Vaginal Cancer)

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... factors affect prognosis (chance of recovery) and treatment options. The prognosis (chance of recovery ) depends on the ... or in other parts of the body. Treatment Option Overview Key Points There are different types of ...

Treatment Option Overview (Anal Cancer)

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... affect the prognosis (chance of recovery) and treatment options. The prognosis (chance of recovery ) depends on the ... or in other parts of the body. Treatment Option Overview Key Points There are different types of ...

Treatment Options by Stage (Chronic Lymphocytic Leukemia)

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... examination under a microscope. Certain factors affect treatment options and prognosis (chance of recovery). Treatment options depend ... that does not get better with treatment. Treatment Option Overview Key Points There are different types of ...

Traditional preventive treatment options

DEFF Research Database (Denmark)

Longbottom, C; Ekstrand, K; Zero, D

2009-01-01

Preventive treatment options can be divided into primary, secondary and tertiary prevention techniques, which can involve patient- or professionally applied methods. These include: oral hygiene (instruction), pit and fissure sealants ('temporary' or 'permanent'), fluoride applications (patient...... options....

Treatment Options for Adult Soft Tissue Sarcoma

Science.gov (United States)

... reacts to the light. Certain factors affect treatment options and prognosis (chance of recovery). The treatment options ... or in other parts of the body. Treatment Option Overview Key Points There are different types of ...

Treatment Options by Stage (Merkel Cell Carcinoma)

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... factors affect prognosis (chance of recovery) and treatment options. The prognosis (chance of recovery ) and treatment options ... common for Merkel cell carcinoma to recur. Treatment Option Overview Key Points There are different types of ...

Treatment Options for Hodgkin Lymphoma during Pregnancy

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... factors affect prognosis (chance of recovery) and treatment options. The prognosis (chance of recovery ) and treatment options ... or in other parts of the body. Treatment Option Overview Key Points There are different types of ...

Treatment Option Overview (Adult Soft Tissue Sarcoma)

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... reacts to the light. Certain factors affect treatment options and prognosis (chance of recovery). The treatment options ... or in other parts of the body. Treatment Option Overview Key Points There are different types of ...

Treatment Option Overview (Adult Non-Hodgkin Lymphoma)

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... factors affect prognosis (chance of recovery) and treatment options. The prognosis (chance of recovery ) and treatment options ... lymphoma may come back as indolent lymphoma. Treatment Option Overview Key Points There are different types of ...

Treatment Option Overview (Small Cell Lung Cancer)

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... factors affect prognosis (chance of recovery) and treatment options. The prognosis (chance of recovery ) and treatment options ... or in other parts of the body. Treatment Option Overview Key Points There are different types of ...

Treatment Option Overview (Adult Acute Lymphoblastic Leukemia)

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... factors affect prognosis (chance of recovery) and treatment options. The prognosis (chance of recovery ) and treatment options ... marrow , or other parts of the body. Treatment Option Overview Key Points There are different types of ...

Treatment Options for Adult Acute Lymphoblastic Leukemia

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... factors affect prognosis (chance of recovery) and treatment options. The prognosis (chance of recovery ) and treatment options ... marrow , or other parts of the body. Treatment Option Overview Key Points There are different types of ...

Treatment Options for Adult Acute Myeloid Leukemia

Science.gov (United States)

... factors affect prognosis (chance of recovery) and treatment options. The prognosis (chance of recovery ) and treatment options ... back in the blood or bone marrow . Treatment Option Overview Key Points There are different types of ...

Enclomiphene Citrate for the Treatment of Secondary Male Hypogonadism

Science.gov (United States)

Rodriguez, Katherine M.; Pastuszak, Alexander W.; Lipshultz, Larry I.

2016-01-01

Introduction Hypogonadism is a growing concern in an aging male population. Historically treated using exogenous testosterone, concerns about possible adverse effects of testosterone have led physicians to seek alternative treatment approaches. Areas Covered Enclomiphene citrate is the trans isomer of clomiphene citrate, a non-steroidal estrogen receptor antagonist that is FDA-approved for the treatment of ovarian dysfunction in women. Clomiphene citrate has also been used off-label for many years to treat secondary male hypogonadism, particularly in the setting of male infertility. Here we review the literature examining the efficacy and safety of enclomiphene citrate in the setting of androgen deficiency. Expert Opinion Initial results support the conclusion that enclomiphene citrate increases serum testosterone levels by raising luteinizing hormone (LH) and follicle stimulating hormone (FSH) levels, without negatively impacting semen parameters. The ability to treat testosterone deficiency in men while maintaining fertility supports a role for enclomiphene citrate in the treatment of men in whom testosterone therapy is not a suitable option. PMID:27337642

Novel preventive treatment options

DEFF Research Database (Denmark)

Longbottom, C; Ekstrand, K; Zero, D

2009-01-01

A number of novel preventive treatment options which, as with traditional methods, can be differentiated into 3 categories of prevention (primary, secondary and tertiary), have been and are being currently investigated. Those reviewed are either commercially available or appear relatively close...... of these techniques show considerable promise and dentists should be aware of these developments and follow their progress, the evidence for each of these novel preventive treatment options is currently insufficient to make widespread recommendations. Changes in dental practice should be explored to see how oral...

Role of male partner involvement in ART retention and adherence in Malawi's Option B+ program.

Science.gov (United States)

Wesevich, Austin; Mtande, Tiwonge; Saidi, Friday; Cromwell, Elizabeth; Tweya, Hannock; Hosseinipour, Mina C; Hoffman, Irving; Miller, William C; Rosenberg, Nora E

2017-11-01

Malawi's Option B+ program provides all HIV-infected pregnant women free lifelong antiretroviral therapy (ART), but challenges remain regarding retention and ART adherence, potentially due to male partner barriers. We explored relationships between male partner involvement and Option B+ retention and adherence. In 2014, a randomized controlled trial in Malawi compared male recruitment strategies for couple HIV testing and counseling (cHTC) at an antenatal clinic. This secondary analysis was conducted among the entire cohort (N = 200) of women, irrespective of randomization status. We assessed whether cHTC attendance, early disclosure of HIV-positive status, and partner ART reminders were associated with retention and adherence at one month after starting treatment. Retention was defined as attending HIV clinic follow-up within one day of running out of pills. Adherence was defined as taking ≥95% of ARTs by pill count. We used binomial regression to calculate adjusted risk ratios (aRR) and 95% confidence intervals (CI). Median female age was 26 years. Most women (79%) were retained; of these, 68% were adherent. Receiving cHTC was associated with improved retention (aRR 1.33, 95% CI 1.12, 1.59). Receiving male partner ART reminders was weakly associated with retention (aRR 1.16, 95% CI 0.96, 1.39). Disclosure within one day was not associated with retention (aRR 1.08, 95% CI: 0.91, 1.28). Among those who were retained, these three behaviors were not associated with improved 95% adherence. CHTC could play an important role in improving Option B+ retention. Increasing cHTC participation and enhancing adherence-related messages within cHTC are important.

Treatment Options by Stage (Vaginal Cancer)

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... factors affect prognosis (chance of recovery) and treatment options. The prognosis (chance of recovery ) depends on the ... or in other parts of the body. Treatment Option Overview Key Points There are different types of ...

Treatment Options for Chronic Myeloproliferative Neoplasms

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... factors affect prognosis (chance of recovery) and treatment options for primary myelofibrosis. Prognosis (chance of recovery ) depends ... factors affect prognosis (chance of recovery) and treatment options for essential thrombocythemia. Prognosis (chance of recovery ) and ...

Treatment Options for Nonmelanoma Skin Cancer

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... factors affect prognosis (chance of recovery) and treatment options. The prognosis (chance of recovery ) depends mostly on ... helped by lip balm or petroleum jelly . Treatment Option Overview Key Points There are different types of ...

Treatment Option Overview (Chronic Myeloproliferative Neoplasms)

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... factors affect prognosis (chance of recovery) and treatment options for primary myelofibrosis. Prognosis (chance of recovery ) depends ... factors affect prognosis (chance of recovery) and treatment options for essential thrombocythemia. Prognosis (chance of recovery ) and ...

Disease spectrum and treatment patterns in a local male infertility clinic.

Science.gov (United States)

Ho, K L; Tsu, James H L; Tam, P C; Yiu, M K

2015-02-01

To review disease spectrum and treatment patterns in a local male infertility clinic. Case series. Male infertility clinic in a teaching hospital in Hong Kong. Patients who were seen as new cases in a local male infertility clinic between January 2008 and December 2012. Infertility assessment and counselling on treatment options. Disease spectrum and treatment patterns. A total of 387 new patients were assessed in the male infertility clinic. The mean age of the patients and their female partners was 37.2 and 32.1 years, respectively. The median duration of infertility was 3 years. Among the patients, 36.2% had azoospermia, 8.0% had congenital absence of vas deferens, and 48.3% of patients had other abnormalities in semen parameters. The commonest causes of male infertility were unknown (idiopathic), clinically significant varicoceles, congenital absence of vas deferens, mumps after puberty, and erectile or ejaculatory dysfunction. Overall, 66.1% of patients chose assisted reproductive treatment and 12.4% of patients preferred surgical correction of reversible male infertility conditions. Altogether 36.7% of patients required either surgical sperm retrieval or correction of male infertility conditions. The present study provided important local data on the disease spectrum and treatment patterns in a male infertility clinic. The incidences of azoospermia and congenital absence of vas deferens were much higher than those reported in the contemporary literature. A significant proportion of patients required either surgical sperm retrieval or correction of reversible male infertility conditions.

Treatment Option Overview (Kaposi Sarcoma)

Science.gov (United States)

... Treatment Childhood Vascular Tumors Treatment Research Kaposi Sarcoma Treatment (PDQ®)–Patient Version General Information About Kaposi Sarcoma ... Certain factors affect prognosis (chance of recovery) and treatment options. The prognosis (chance of recovery ) and treatment ...

Treatment Options by Stage (Small Cell Lung Cancer)

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... factors affect prognosis (chance of recovery) and treatment options. The prognosis (chance of recovery ) and treatment options ... or in other parts of the body. Treatment Option Overview Key Points There are different types of ...

Treatment Option Overview (Childhood Acute Lymphoblastic Leukemia)

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... factors affect prognosis (chance of recovery) and treatment options. The prognosis (chance of recovery ) depends on: How ... cancer that does not respond to treatment. Treatment Option Overview Key Points There are different types of ...

Treatment Option Overview (Ewing Sarcoma)

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... Ewing Sarcoma Treatment Osteosarcoma Treatment Research Ewing Sarcoma Treatment (PDQ®)–Patient Version General Information About Ewing Sarcoma ... started or in another part of the body. Treatment Option Overview Key Points There are different types ...

Treatment Option Overview (Ovarian Germ Cell Tumors)

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... Germ Cell Tumors Treatment (PDQ®)–Patient Version Treatment Option Overview Go to Health Professional Version Key Points ... and restore) the body’s blood cells. New treatment options Combination chemotherapy (the use of more than one ...

Treatment options for Primary CNS Lymphoma.

Science.gov (United States)

Laghari, Altaf Ali; Ahmed, Syed Ijlal; Jabbar, Adnan; Shamim, Muhammad Shahzad

2018-03-01

Primary CNS lymphoma (PCNSL) is a rare and aggressive brain tumour that is uniformly fatal. The rarity of the disease and the poor response to treatment makes it difficult to reach a consensus with regards to treatment options. In this review, the authors have discussed different treatment modalities used in the management of PCNSL including chemotherapy, surgery and radiation, as well as the results of recent clinical trials on treatment options for PCNSL.

Male baldness.

Science.gov (United States)

Clarke, Philip

2016-04-01

Male baldness is very common. Its effect on individuals is extremely variable, and in some people it will have a significant adverse effect on their quality of life. The objectives of this article are to help general practitioners (GPs) be aware of potential health problems related to male baldness, to have an approach to assessing hair loss and to be aware of treatment options. Male baldness is, most often, a normal occurrence, but it may have significant effects on a man's health. It may also be a pointer to other potential health issues. The GP is in the ideal position to conduct an initial evaluation, consider other health issues and advise on treatment options.

Nail Psoriasis: A Review of Treatment Options.

Science.gov (United States)

Pasch, Marcel C

2016-04-01

Nail involvement affects 80-90 % of patients with plaque psoriasis, and is even more prevalent in patients with psoriatic arthritis. This review is the result of a systemic approach to the literature and covers topical, intralesional, conventional systemic, and biologic systemic treatments, as well as non-pharmacological treatment options for nail psoriasis. The available evidence suggests that all anti-tumor necrosis factor-α, anti-interleukin (IL)-17, and anti-IL-12/23 antibodies which are available for plaque psoriasis and psoriatic arthritis are highly effective treatments for nail psoriasis. Conventional systemic treatments, including methotrexate, cyclosporine, acitretin, and apremilast, as well as intralesional corticosteroids, can also be effective treatments for nail psoriasis. Topical treatments, including corticosteroids, calcipotriol, tacrolimus, and tazarotene, have also been shown to have a position in the treatment of nail psoriasis, particularly in mild cases. Finally, non-pharmacological treatment options, including phototherapy, photodynamic therapy, laser therapy, and several radiotherapeutic options, are also reviewed but cannot be advised as first-line treatment options. Another conclusion of this review is that the lack of a reliable core set of outcomes measures for trials in nail psoriasis hinders the interpretation of results, and is urgently needed.

Treatment Option Overview (Mycosis Fungoides and the Sezary Syndrome)

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... factors affect prognosis (chance of recovery) and treatment options. The prognosis (chance of recovery ) and treatment options ... or in other parts of the body. Treatment Option Overview Key Points There are different types of ...

Patellofemoral pain syndrome in female athletes: A review of diagnoses, etiology and treatment options.

Science.gov (United States)

Vora, Molly; Curry, Emily; Chipman, Amanda; Matzkin, Elizabeth; Li, Xinning

2017-12-14

Patellofemoral pain syndrome (PFPS) is one of the most common causes of knee pain and is present in females disproportionately more relative to males. PFPS causes tend to be multifactorial in nature and are described in this review. From a review of the current literature, it is clear that there needs to be further research on PFPS in order to better understand the complex etiology of this disorder in both males and females. It is known that females with patellofemoral pain syndrome demonstrate a decrease in abduction, external rotation and extension strength of the affected side compared with healthy patients. Conservative management, including optimizing muscle balance between the vastus medialis and lateralis around the patella along with formal therapy should be the first line of treatment in patients presenting with PFPS. Surgery should be reserved for patients in which all conservative management options have failed. This review aims to guide physicians in accurate clinicaldecision making regarding conservative and surgical treatment options when specifically faced with PFPS in a female athlete. Furthermore, we will discuss the anatomic variants, incidence and prevalence, etiology, diagnosis and treatment of PFPS.

Patellofemoral pain syndrome in female athletes: A review of diagnoses, etiology and treatment options

Science.gov (United States)

Vora, Molly; Curry, Emily; Chipman, Amanda; Matzkin, Elizabeth; Li, Xinning

2018-01-01

Patellofemoral pain syndrome (PFPS) is one of the most common causes of knee pain and is present in females disproportionately more relative to males. PFPS causes tend to be multifactorial in nature and are described in this review. From a review of the current literature, it is clear that there needs to be further research on PFPS in order to better understand the complex etiology of this disorder in both males and females. It is known that females with patellofemoral pain syndrome demonstrate a decrease in abduction, external rotation and extension strength of the affected side compared with healthy patients. Conservative management, including optimizing muscle balance between the vastus medialis and lateralis around the patella along with formal therapy should be the first line of treatment in patients presenting with PFPS. Surgery should be reserved for patients in which all conservative management options have failed. This review aims to guide physicians in accurate clinicaldecision making regarding conservative and surgical treatment options when specifically faced with PFPS in a female athlete. Furthermore, we will discuss the anatomic variants, incidence and prevalence, etiology, diagnosis and treatment of PFPS. PMID:29564075

Treatment Options By Stage (Ovarian Germ Cell Tumors)

Science.gov (United States)

... Germ Cell Tumors Treatment (PDQ®)–Patient Version Treatment Option Overview Go to Health Professional Version Key Points ... and restore) the body’s blood cells. New treatment options Combination chemotherapy (the use of more than one ...

Conservative Nonhormonal Options for the Treatment of Male Infertility: Antibiotics, Anti-Inflammatory Drugs, and Antioxidants

OpenAIRE

Calogero, Aldo E.; Condorelli, Rosita A.; Russo, Giorgio Ivan; La Vignera, Sandro

2017-01-01

The nonhormonal medical treatment can be divided into empirical, when the cause has not been identified, and nonempirical, if the pathogenic mechanism causing male infertility can be solved or ameliorated. The empirical nonhormonal medical treatment has been proposed for patients with idiopathic or noncurable oligoasthenoteratozoospermia and for normozoospermic infertile patients. Anti-inflammatory, fibrinolytic, and antioxidant compounds, oligo elements, and vitamin supplementation may be pr...

Treatment Option Overview (Childhood Acute Myeloid Leukemia/Other Myeloid Malignancies)

Science.gov (United States)

... factors affect prognosis (chance of recovery) and treatment options. The prognosis (chance of recovery ) and treatment options ... the cancer does not respond to treatment. Treatment Option Overview Key Points There are different types of ...

Conservative Nonhormonal Options for the Treatment of Male Infertility: Antibiotics, Anti-Inflammatory Drugs, and Antioxidants.

Science.gov (United States)

Calogero, Aldo E; Condorelli, Rosita A; Russo, Giorgio Ivan; La Vignera, Sandro

2017-01-01

The nonhormonal medical treatment can be divided into empirical, when the cause has not been identified, and nonempirical, if the pathogenic mechanism causing male infertility can be solved or ameliorated. The empirical nonhormonal medical treatment has been proposed for patients with idiopathic or noncurable oligoasthenoteratozoospermia and for normozoospermic infertile patients. Anti-inflammatory, fibrinolytic, and antioxidant compounds, oligo elements, and vitamin supplementation may be prescribed. Infection, inflammation, and/or increased oxidative stress often require a specific treatment with antibiotics, anti-inflammatory drugs, and/or antioxidants. Combined therapies can contribute to improve sperm quality.

Guidelines for the diagnosis and treatment of testosterone deficiency (hypogonadism in male patients with diabetes mellitus (Draft

Directory of Open Access Journals (Sweden)

Galina Afanas'evna Melnichenko

2017-06-01

Full Text Available Hypogonadism in male patients is defined as a decrease in the serum testosterone level; it is associated with specific symptoms and/or signs (see the detailed description below. It is a common complication in diabetes mellitus. The guidelines do not review all disorders leading to the development of hypogonadism but focus on options for the treatment of hypogonadism, which is generally observed in male patients with diabetes. In the literature, data on the prevalence of hypogonadism in patients with diabetes are available. In the section on diagnostics, the medical history of patients with hypogonadism and diabetes, including the necessary methods for physical and laboratory inspection. Risk factors for and the clinical consequences of hypogonadism are separately considered. In the section on treatment options, variations in treatment using various androgenic therapeutic agents based on patients’ requirements, conservation of their reproductive function, and their risk factors are provided. Special attention is given to indications of, contraindications of and risk factors for androgenic therapy in male patients with diabetes, particularly those in their advanced age. The principles of the clinical monitoring are developed. The favourable effects of androgenic therapy for hypogonadism in male patients with diabetes are shown.

Management options of varicoceles

Directory of Open Access Journals (Sweden)

Peter Chan

2011-01-01

Full Text Available Varicocele is one of the most common causes of male infertility. Treatment options for varicoceles includes open varicocelectomy performed at various anatomical levels. Laparoscopic varicocelectomy has been established to be a safe and effective treatment for varicoceles. Robotic surgery has been introduced recently as an alternative surgical option for varicocelectomy. Microsurgical varicocelectomy has gained increasing popularity among experts in male reproductive medicine as the treatment of choice for varicocele because of its superior surgical outcomes. There is a growing volume of literature in the recent years on minimal invasive varicocele treatment with percutaneous retrograde and anterograde venous embolization/sclerotherapy. In this review, we will discuss the advantages and limitations associated with each treatment modality for varicoceles. Employment of these advanced techniques of varicocelectomy can provide a safe and effective approach aiming to eliminate varicocele, preserve testicular function and, in a substantial number of men, increase semen quality and the likelihood of pregnancy.

Treatment Option Overview (Wilms Tumor and Other Childhood Kidney Tumors)

Science.gov (United States)

... factors affect prognosis (chance of recovery) and treatment options. The prognosis (chance of recovery ) and treatment options ... come back) after it has been treated. Treatment Option Overview Key Points There are different types of ...

Treatment Option Overview (Plasma Cell Neoplasms Including Multiple Myeloma)

Science.gov (United States)

... factors affect prognosis (chance of recovery) and treatment options. The prognosis (chance of recovery ) depends on the ... going up even though treatment is given. Treatment Option Overview Key Points There are different types of ...

Fibromyalgia Pathogenesis and Treatment Options Update.

Science.gov (United States)

Chinn, Steven; Caldwell, William; Gritsenko, Karina

2016-04-01

This review article presents and summarizes up-to-date literature on the clinical manifestations, diagnosis, pathophysiological mechanisms, and treatment options for fibromyalgia patients. First, the most recent diagnostic criteria for fibromyalgia, as put forth by the American College of Rheumatology will be summarized. Clinical features, including chronic widespread pain, hyperalgesia, mood disorders, anxiety, and disturbed sleep patterns will be explored in-depth. The pathogenesis and pathophysiology of fibromyalgia involves alterations in multiple ascending and descending central nervous system pathways, as well as peripheral pathways, leading to heightened pain sensitivity. Risk factors have been studied extensively, and the most recent research focuses on various genetic influences and the contributions of stress and poor sleep. Lastly, the discussion in this article focuses on treatment options for fibromyalgia; some have been mainstay options for many years. Pharmacological agents include tricyclic antidepressants, anti-epileptic drugs, selective serotonin reuptake inhibitors, norepinephrine/serotonin reuptake inhibitors, as well as some investigational agents. The evidence behind non-pharmacologic treatments, including massage therapy, exercise, and acupuncture, are discussed.

Male Infertility

Science.gov (United States)

... to have a baby? If treatment doesn’t work, what are our other options? Resources National Institute of Child Health and Human Development, What Causes Male Infertility? Last Updated: May 30, 2017 This ...

Current options for the treatment of pathological scarring.

Science.gov (United States)

Poetschke, Julian; Gauglitz, Gerd G

2016-05-01

Scarring is the consequence of surgery, trauma or different skin diseases. Apart from fresh, immature scars,that transform into mature scars over the course of would healing and that do not require further treatment,linear hypertrophic scars, widespread hypertrophic scars, keloids and atrophic scars exist. Symptoms like pruritusand pain, stigmatization as well as functional and aesthetic impairments that are very disturbing for the affected patients can bethe basis for the desire for treatment. Today, a multitude of options for the treatment and prevention of scars exists. Topical agents based on silicone or onion extract, intralesional injections of cristalline glucocorticoids (oftentimes in combinationwith cryotherapy) or 5-Fluorouracil as well as ablative and nonablative laser treatment are used. Current guidelines summarize the multitude of available treatment options and the currently available datafor the treating physicians, allowing them to make clear therapy recommendations for every single scar type. Relieving patients of their discomfort and doing their aesthetic demands justice is thus possible. Apart from scar prevention becoming more and more important, the increased use of modernlaser treatment options constitutes a key point in clinical scar treatment. At the same time the attention is turned to evaluating current therapeutic options with the help of contemporary study designs so as to graduallyimprove the level of evidence in scar treatment. © 2016 Deutsche Dermatologische Gesellschaft (DDG). Published by John Wiley & Sons Ltd.

Microwave treatment of BPH: still an option?

NARCIS (Netherlands)

de la Rosette, J. J.

1994-01-01

Surgery, the gold standard in the treatment of benign prostatic hyperplasia (BPH), is presently performed in the majority of patients who receive treatment. An increasing number of alternative options recently became available for treatment of BPH and especially minimal invasive treatment

Alternative Cancer Treatments: 10 Options to Consider

Science.gov (United States)

Alternative cancer treatments: 10 options to consider Alternative cancer treatments can't cure your cancer, but they may provide some ... that may help them, including complementary and alternative cancer treatments. If cancer makes you feel as if you ...

Review of Saccharomyces boulardii as a treatment option in IBD

DEFF Research Database (Denmark)

Sivananthan, Kavitha; Petersen, Andreas Munk

2018-01-01

CONTEXT: Review of the yeast Saccharomyces boulardii as a treatment option for the inflammatory bowel diseases (IBD) ulcerative colitis and Crohn's disease. OBJECTIVE: IBD is caused by an inappropriate immune response to gut microbiota. Treatment options could therefore be prebiotics, probiotics......, antibiotics and/or fecal transplant. In this review, we have looked at the evidence for the yeast S. boulardii as a treatment option. MATERIAL AND METHODS: Searches in PubMed and the Cochrane Library with the MeSH words 'Saccharomyces boulardii AND IBD', 'Saccharomyces boulardii AND Inflammatory Bowel Disease....... Saccharomyces boulardii is, however, a plausible treatment option in the future, but more placebo-controlled clinical studies on both patients with ulcerative colitis and Crohn's disease are needed....

Achalasia: Treatment Options Revisited

Directory of Open Access Journals (Sweden)

Willemijntje A Hoogerwerf

2000-01-01

Full Text Available The aim of all current forms of treatment of achalasia is to enable the patient to eat without disabling symptoms such as dysphagia, regurgitation, coughing or choking. Historically, this has been accomplished by mechanical disruption of the lower esophageal sphincter fibres, either by means of pneumatic dilation (PD or by open surgical myotomy. The addition of laparoscopic myotomy and botulinum toxin (BTX injection to the therapeutic armamentarium has triggered a recent series of reviews to determine the optimal therapeutic approach. Both PD and BTX have excellent short term (less than three months efficacy in the majority of patients. New data have been published that suggest that PD and BTX (with repeat injections can potentially obtain long term efficacy. PD is still considered the first-line treatment by most physicians; its main disadvantage is risk of perforation. BTX injection is evolving as an excellent, safe option for patients who are considered high risk for more invasive procedures. Laparoscopic myotomy with combined antireflux surgery is an increasingly attractive option in younger patients with achalasia, but long term follow-up studies are required to establish its efficacy and the potential for reflux-related sequelae.

Treatment options for hepatocellular carcinoma.

Science.gov (United States)

Sandhu, Dalbir S; Tharayil, Vivek S; Lai, Jin-Ping; Roberts, Lewis R

2008-02-01

Hepatocellular carcinoma (HCC) is frequently diagnosed at advanced stages and has a high mortality rate. With improved survival of patients with cirrhotic liver disease and increased prevalence of chronic hepatitis C viral infections, a rise in the number of HCC cases is being reported worldwide. Early diagnosis and treatment can significantly improve the prognosis of patients with HCC. Although surgical resection is an important potentially curative therapy for liver tumors, in appropriately selected patients, liver transplantation has been shown to achieve excellent survival rates for a solid tumor. Locally ablative and locoregional therapies in the form of percutaneous ethanol injection, radiofrequency ablation, transcatheter arterial chemoembolization and transcatheter arterial radioembolization (TheraSphere) are viable options in patients with unresectable HCC. Unfortunately, the role of systemic therapy has been very limited in the treatment of these patients. Novel treatment options based on an improved understanding of the molecular pathogenesis of HCC are being explored. These targeted molecular therapies are aimed at growth factors and their receptors, intracellular signal transduction and cell cycle control. A substantial improvement in outcomes of intermediate and advanced stage HCC is expected with the advent of these targeted therapies, used in combination with surgical or locoregional therapies. Recent positive results from a large Phase III study of the receptor tyrosine kinase inhibitor, sorafenib, hold great promise in the treatment of HCC.

Patient knowledge on stroke risk factors, symptoms and treatment options.

Science.gov (United States)

Faiz, Kashif Waqar; Sundseth, Antje; Thommessen, Bente; Rønning, Ole Morten

2018-01-01

Public campaigns focus primarily on stroke symptom and risk factor knowledge, but patients who correctly recognize stroke symptoms do not necessarily know the reason for urgent hospitalization. The aim of this study was to explore knowledge on stroke risk factors, symptoms and treatment options among acute stroke and transient ischemic attack patients. This prospective study included patients admitted to the stroke unit at the Department of Neurology, Akershus University Hospital, Norway. Patients with previous cerebrovascular disease, patients receiving thrombolytic treatment and patients who were not able to answer the questions in the questionnaire were excluded. Patients were asked two closed-ended questions: "Do you believe that stroke is a serious disorder?" and "Do you believe that time is of importance for stroke treatment?". In addition, patients were asked three open-ended questions where they were asked to list as many stroke risk factors, stroke symptoms and stroke treatment options as they could. A total of 173 patients were included, of whom 158 (91.3%) confirmed that they regarded stroke as a serious disorder and 148 patients (85.5%) considered time being of importance. In all, 102 patients (59.0%) could not name any treatment option. Forty-one patients (23.7%) named one or more adequate treatment options, and they were younger ( p options, which may contribute to reduce prehospital delay and onset-to-treatment-time.

Treatment Option Overview (AIDS Related-Lymphoma)

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... and treatment options. AIDS-related lymphoma is a disease in which malignant (cancer) cells form in the ... cord. The sample may also be checked for Epstein-Barr virus . This procedure is also called an LP ...

Novel treatment options in depression and psychosis

Directory of Open Access Journals (Sweden)

Ceskova E

2018-03-01

Full Text Available Eva Ceskova, Petr Silhan Department of Psychiatry, University Hospital Ostrava, Ostrava, Czech Republic Abstract: In spite of tremendous development in central nervous system research, current treatment is suboptimal, especially in severe mental disorders. In medicine, there are two main methods of improving the health care provided: seeking new treatment procedures and perfecting (optimizing the existing ones. Optimization of treatment includes not only practical tools such as therapeutic drug monitoring but also implementation of general trends in the clinical practice. New pharmacological options include new more sophisticated forms of monoaminergic drugs, old drugs rediscovered on the base of a better understanding of pathophysiology of mental illnesses, and drugs aimed at new treatment targets. In depression, treatment resistance to antidepressive pharmacotherapy represents one of the most important clinical challenges. Switching to monotherapy with new multimodal/multifunctional antidepressants and augmentation with new atypical antipsychotics (aripiprazole and brexpiprazole may be promising options. Further, current evidence supports utility and safety of adjunctive treatment of nutraceuticals. Novel approaches being studied include ketamine and opioids. Recent advances in technology and emerging knowledge about dysfunctional brain circuits and neuroplasticity have led to the development of different new neuromodulation techniques usually used as add-on therapy. Antipsychotics are still the cornerstone of the current treatment of schizophrenia. Two new partial dopamine agonists, brexpiprazole and cariprazine, are now available in addition to aripiprazole. Although the mechanisms of action are similar, the two agents differ in terms of their pharmacodynamic profiles. Further, two new formulations of long-acting injections of second-generation antipsychotics (aripiprazole lauroxil and 3-month paliperidone palmitate were introduced into

Prostatitis and male infertility.

Science.gov (United States)

Alshahrani, Saad; McGill, John; Agarwal, Ashok

2013-11-01

The prostate gland plays an important role in male reproduction. Inflammation of the prostate gland (prostatitis) is a common health problem affecting many young and middle aged men. Prostatitis is considered a correctable cause of male infertility, but the pathophysiology and appropriate treatment options of prostatitis in male infertility remain unclear. This literature review will focus on current data regarding prostatitis and its impact on male infertility. Copyright © 2013 Elsevier Ireland Ltd. All rights reserved.

Cyanobacterial Treatment Options: Permanganate and ...

Science.gov (United States)

This presentation will begin with a brief overview of drinking water treatment options for cyanobacteria and their toxins. The treatment discussion will focus on the impacts of permanganate addition to suspensions of toxin-producing Microcystis aeruginosa, followed by powdered activated carbon (PAC) addition. Results will be presented that show changes in toxin concentrations, chlorophyll-a concentrations and cell membrane integrity. The EPA Small Systems Webinar Presentations allow the dissemination of the latest Agency guidance and research to a large geographically dispersed audience while minimizing taxpayer expense

Treatment options for carcinoma in situ testis

DEFF Research Database (Denmark)

Mortensen, M S; Gundgaard, M.G.; Daugaard, G

2011-01-01

countries only offer this to high-risk patients. The treatment options range from orchidectomy and chemotherapy to radiotherapy and in rare cases surveillance. Results of the different treatment strategies are presented in this review. The optimal radiation dose is still not clarified. Most patients have...

[Necessary and unnecessary treatment options for hemorrhoids].

Science.gov (United States)

Zindel, Joel; Inglin, Roman; Brügger, Lukas

2014-12-01

Up to one third of the general population suffers from symptoms caused by hemorrhoids. Conservative treatment comes first unless the patient presents with an acute hemorrhoidal prolapse or a thrombosis. A fiber enriched diet is the primary treatment option, recommended in the perioperative period as well as a long-term prophylaxis. A timely limited application of topical ointments or suppositories and/or flavonoids are further treatment options. When symptoms persist interventional procedures for grade I-II hemorrhoids, and surgery for grade III-IV hemorrhoids should be considered. Rubber band ligation is the interventional treatment of choice. A comparable efficacy using sclerosing or infrared therapy has not yet been demonstrated. We therefore do not recommend these treatment options for the cure of hemorrhoids. Self-treatment by anal insertion of bougies is of lowrisk and may be successful, particularly in the setting of an elevated sphincter pressure. Anal dilation, sphincterotomy, cryosurgery, bipolar diathermy, galvanic electrotherapy, and heat therapy should be regarded as obsolete given the poor or missing data reported for these methods. For a long time, the classic excisional hemorrhoidectomy was considered to be the gold standard as far as surgical procedures are concerned. Primary closure (Ferguson) seems to be superior compared to the "open" version (Milligan Morgan) with respect to postoperative pain and wound healing. The more recently proposed stapled hemorrhoidopexy (Longo) is particularly advisable for circular hemorrhoids. Compared to excisional hemorrhoidectomy the Longo-operation is associated with reduced postoperative pain, shorter operation time and hospital stay as well as a faster recovery, with the disadvantage though of a higher recurrence rate. Data from Hemorrhoidal Artery Ligation (HAL)-, if appropriate in combination with a Recto-Anal Repair (HAL/RAR)-, demonstrates a similar trend towards a better tolerance of the procedure at the

Treatment options in otitis media with effusion.

Science.gov (United States)

Upadhya, Ila; Datar, J

2014-01-01

Secretary Otitis media with effusion (OME) is the accumulation of mucus in the middle ear and sometimes in the mastoid air cell system. The main etiological factor is alteration in mucociliary system of middle ear secondary to ET malfunction which may be primary or secondary. OME is the cause of concern due to its occurance in paediatric age group, highest at 2 years of age, presenting as impairment of hearing leading to delayed speech and language development, poor academic performance and behavioral problems. In spite of this there are no confirmed guidelines of treatment to overcome. Many treatment options are available medical as well as surgical. Prospective study conducted to evaluate various treatment options revealed that auto inflation of ET is the main stay of treatment. If the ET malfunction is due to any reasons like adenoids, deviated nasal septum, hypertrophied turbinates or any other cause surgical intervention of the same gives 100% results. Medical management gives good results but recurrence is equally common.

[Treatment options for patellar tendinopathy].

Science.gov (United States)

Duthon, V B; Borloz, S; Ziltener, J-L

2012-07-25

Patellar tendinopathy is also called jumper's knee because of its high incidence in athletes with jumping or cutting activities as soccer, basketball, volleyball. Many different treatment methods have been described. However, no consensus exists regarding the optimal treatment for this condition. According to the literature, eccentric exercise-based physical therapy should be proposed first because of its strong scientific evidence. Shockwave therapy and injections may be useful but their real efficacy still has to be proven by randomized controlled study. For patients recalcitrant to more conservative options, operative management may be indicated.

Psychological aspects of male fertility treatment.

Science.gov (United States)

Mikkelsen, Alice Toft; Madsen, Svend Aage; Humaidan, Peter

2013-09-01

To explore and to identify the possible need for psychological communicative support in men undergoing fertility treatment. Male infertility affects many aspects of a man's life and may cause a life crisis. Although infertility treatment is now commonplace in men, they often feel remote and disconnected from the treatment process. A descriptive survey. A questionnaire with structured and open-ended questions was completed by 210 Danish men undergoing fertility treatment. The questionnaire covered three issues: individual perception of male infertility, gender equality issues, and communication with health professionals in the clinic. Data were collected during 2008. Of the participants, 28% believed that their reduced sperm quality affected their perception of masculinity. 46% stated that equal involvement between partners was a very important element of the treatment; however, 63% said that the health professionals communicated primarily with their female partner. Finally, 62% found that there was a need for a deeper dialogue with the nurses concerning male infertility and 72% lacked information about the psychological consequences of male infertility. In general, participants wanted a more open and balanced dialogue about infertility treatment and the role of the male partner during this process. Infertile men want health professionals to view them on equal terms with their partner. When treating the infertile man, there is a further need to develop more inclusive communication skills. © 2012 Blackwell Publishing Ltd.

An update on adjunctive treatment options for bipolar disorder.

Science.gov (United States)

Dean, Olivia M; Gliddon, Emma; Van Rheenen, Tamsyn E; Giorlando, Francesco; Davidson, Sandra K; Kaur, Manreena; Ngo, Trung T; Williams, Lana J

2018-03-01

Bipolar disorder is a complex illness often requiring combinations of therapies to successfully treat symptoms. In recent years, there have been significant advancements in a number of therapies for bipolar disorder. It is therefore timely to provide an overview of current adjunctive therapeutic options to help treating clinicians to inform their patients and work towards optimal outcomes. Publications were identified from PubMed searches on bipolar disorder and pharmacotherapy, nutraceuticals, hormone therapy, psychoeducation, interpersonal and social rhythm therapy, cognitive remediation, mindfulness, e-Health and brain stimulation techniques. Relevant articles in these areas were selected for further review. This paper provides a narrative review of adjunctive treatment options and is not a systematic review of the literature. A number of pharmacotherapeutic, psychological and neuromodulation treatment options are available. These have varying efficacy but all have shown benefit to people with bipolar disorder. Due to the complex nature of treating the disorder, combination treatments are often required. Adjunctive treatments to traditional pharmacological and psychological therapies are proving useful in closing the gap between initial symptom remission and full functional recovery. Given that response to monotherapy is often inadequate, combination regimens for bipolar disorder are typical. Correspondingly, psychiatric research is working towards a better understanding of the disorder's underlying biology. Therefore, treatment options are changing and adjunctive therapies are being increasingly recognized as providing significant tools to improve patient outcomes. Towards this end, this paper provides an overview of novel treatments that may improve clinical outcomes for people with bipolar disorder. © 2018 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

Emerging treatment options for meibomian gland dysfunction

Directory of Open Access Journals (Sweden)

Qiao J

2013-09-01

Full Text Available Jing Qiao, Xiaoming YanDepartment of Ophthalmology, Peking University First Hospital, Key Laboratory of Vision Loss and Restoration, Ministry of Education, Beijing, People's Republic of ChinaAbstract: Meibomian gland dysfunction (MGD is one of the most common diseases observed in clinics; it influences a great number of people, and is the leading cause of evaporative dry eye. Given the increased recognition of the importance of MGD, a great amount of attention has been paid to therapies targeting this condition. The traditional treatments of MGD consist of warm compresses and lid hygiene for removing an obstructed meibum, as well as antibiotics and anti-inflammatory agents to improve the quality of the meibum. However, each of these treatments has a different shortcoming and the treatment of MGD remains challenging. Despite the numerous possible treatment options for MGD, it is still difficult to obtain complete relief of signs and symptoms. This review focuses on current emerging treatment options for MGD including intraductal meibomian gland probing, emulsion eye drops containing lipids, the LipiFlow® thermal pulsation system, N-acetyl-cysteine, azithromycin, oral supplementation with omega-3 essential fatty acids, and cyclosporine A.Keywords: meibomian gland dysfunction, dry eye, emerging treatment

Cyanobacterial Treatment Options: Permanganate and Powdered Activated Carbon

Science.gov (United States)

This presentation will begin with a brief overview of drinking water treatment options for cyanobacteria and their toxins. The treatment discussion will focus on the impacts of permanganate addition to suspensions of toxin-producing Microcystis aeruginosa, followed by powdered ac...

The option value of innovative treatments in the context of chronic myeloid leukemia.

Science.gov (United States)

Sanchez, Yuri; Penrod, John R; Qiu, Xiaoli Lily; Romley, John; Thornton Snider, Julia; Philipson, Tomas

2012-11-01

To quantify in the context of chronic myeloid leukemia (CML) the additional value patients receive when innovative treatments enable them to survive until the advent of even more effective future treatments (ie, the "option value"). Observational study using data from the Surveillance, Epidemiology and End Results (SEER) cancer registry comprising all US patients with CML diagnosed between 2000 and 2008 (N = 9,760). We quantified the option value of recent breakthroughs in CML treatment by first conducting retrospective survival analyses on SEER data to assess the effectiveness of TKI treatments, and then forecasting survival from CML and other causes to measure expected future medical progress. We then developed an analytical framework to calculate option value of innovative CML therapies, and used an economic model to value these gains. We calculated the option value created both by future innovations in CML treatment and by medical progress in reducing background mortality. For a recently diagnosed CML patient, the option value of innovative therapies from future medical innovation amounts to 0.76 life-years. This option value is worth $63,000, equivalent to 9% of the average survival gains from existing treatments. Future innovations in CML treatment jointly account for 96% of this benefit. The option value of innovative treatments has significance in the context of CML and, more broadly, in disease areas with rapid innovation. Incorporating option value into traditional valuations of medical innovations is both a feasible and a necessary practice in health technology assessment.

Tooth wear : a systematic review of treatment options

NARCIS (Netherlands)

Muts, Erik-Jan; van Pelt, Hans; Edelhoff, Daniel; Krejci, Ivo; Cune, Marco

2014-01-01

STATEMENT OF PROBLEM: Treatment of tooth wear is increasing. Because no evidence-based guidelines are available, the clinician may have difficulties deciding which treatment option to choose to resolve complex situations. PURPOSE: The purpose of this systematic review was to identify similarities

Stereotactic Neurosurgical Treatment Options for Childhood Craniopharyngioma

Directory of Open Access Journals (Sweden)

Michael eTrippel

2012-05-01

Full Text Available Craniopharyngioma are the most common non glial tumors in childhood. The results of different studies indicate that radical excision surgery is not an appropriate treatment strategy for childhood craniopharyngioma with hypothalamic involvement. Stereotactic neurosurgery provides save, minimal invasive and cost efficient options in the treatment of childhood craniopharyngioma. In this review a summary of the contribution of the stereotactic neurosurgery in the interdisciplinary treatment regime of childhood craniopharyngioma will be given and discussed in detail.

The pharmacotherapy of male hypogonadism besides androgens.

Science.gov (United States)

Corona, Giovanni; Rastrelli, Giulia; Ratrelli, Giulia; Maggi, Mario

2015-02-01

Adulthood male hypogonadism (HG) is the most common form of HG. Although testosterone (T) replacement therapy (TRT) is the most common way of treating HG, other options are available depending on patient's needs and expectations. We analyze alternative options to TRT as a medical intervention in treating HG. Gonadotropin (Gn) therapy is the treatment of choice in men with secondary HG (sHG), who require fertility. Gonadotropin-releasing hormone therapy represents an alternative to Gn for inducing spermatogenesis in patients with sHG, however, its use is limited by the poor patient compliance and high cost. In obese HG men, lifestyle modifications and, in particular, weight loss should be the first step. Recent data suggest that antiestrogens represent a successful treatment for sHG. Other potential therapeutic options include the stimulation of hypothalamic activity (i.e., kisspeptin and neurokinin-B agonists). Conversely, the possibility of increasing Leydig cell steroid production, independently from Gn stimulation, seems unreliable. Understanding the nature of male HG and patient's needs are mandatory before choosing among treatment options. For primary HG only TRT is advisable, whereas for the secondary form several alternative possibilities can be offered.

Cabergoline in the Treatment of Male Orgasmic Disorder—A Retrospective Pilot Analysis

Science.gov (United States)

Hollander, Adam B.; Pastuszak, Alexander W.; Hsieh, Tung-Chin; Johnson, William G.; Scovell, Jason M.; Mai, Christina K.; Lipshultz, Larry I.

2016-01-01

Introduction Male orgasmic disorder is common, with few treatment options. Cabergoline is a dopamine agonist that acts centrally to normalize serum prolactin that could improve orgasmic dysfunction. Aims To determine whether cabergoline increases the potential for orgasm in men with orgasmic disorder. Methods A retrospective chart review of men treated in a single andrology clinic for delayed orgasm or anorgasmia in a pilot study using cabergoline 0.5 mg twice weekly was performed. Duration of treatment and response were noted. Medical records were examined for other factors including history of prostatectomy and concomitant androgen supplementation. Main Outcome Measures Subjective improvement in orgasmic function resulting from cabergoline treatment. Results Of 131 men treated with cabergoline for orgasmic disorder, 87 (66.4%) reported subjective improvement in orgasm and 44 (33.6%) reported no change in orgasm. Duration of therapy (P = .03) and concomitant testosterone therapy (P = .02) were associated with a significant positive response to cabergoline treatment. No differences were found between injectable and non-injectable testosterone formulations (P = .90), and neither age (P = .90) nor prior prostatectomy (P = .41) influenced the outcome of cabergoline treatment. Serum testosterone levels before (P = .26) and after (P = .81) treatment were not significantly different in responders vs non-responders. Conclusion Cabergoline is a potentially effective and easy-to-administer treatment for male orgasmic disorder, the efficacy of which appears to be independent of patient age or orgasmic disorder etiology. Prospective randomized trials are needed to determine the true role of cabergoline in the treatment of this disorder. PMID:26944776

Lack of tolerable treatment options for patients with schizophrenia

Directory of Open Access Journals (Sweden)

Citrome L

2015-12-01

Full Text Available Leslie Citrome,1 Anna Eramo,2 Clement Francois,2 Ruth Duffy,3 Susan N Legacy,3 Steve J Offord,3 Holly B Krasa,3 Stephen S Johnston,4 Alice Guiraud-Diawara,5 Siddhesh A Kamat,3 Patricia Rohman3 1Department of Psychiatry and Behavioral Sciences, New York Medical College, Valhalla, NY, 2Lundbeck, Deerfield, IL, 3Otsuka America Pharmaceuticals, Princeton, NJ, 4Truven Health Analytics, Bethesda, MD, USA; 5Lundbeck SAS, Issy-les-Moulineaux, France Purpose: Atypical antipsychotics (AAs, an effective treatment for schizophrenia, have a range of pharmacologic properties leading to differences in tolerability as well as heterogeneity in treatment response. Individual patient characteristics must be considered when making treatment choices, especially from an adverse event (AE or tolerability perspective. Despite the availability of numerous AAs, after appraising patient characteristics at the time of treatment selection, physicians may quickly run out of tolerable treatment options. Patients and methods: AE risk factors, defined as having either a prior history of an AE or a risk factor for that AE, were determined for Medicaid-insured and Commercially insured patients using database analysis. Patients receiving AA treatment between January 1, 2010 and December 31, 2012 defined the index date of first observed AA prescription during this period. Nine AAs were evaluated for association with AE risk factors as informed by drug prescribing information from the different manufacturers and published meta-analyses. The proportion of patients with pre-index AE risk factors prescribed an AA associated with that risk factor was then determined. Results: A high proportion of patients (>80% were prescribed an AA associated with extrapyramidal symptoms or akathisia despite experiencing extrapyramidal symptoms or akathisia prior to AA treatment initiation. Similar trends were observed among patients with diabetes (>60% and obesity (>40%. From the nine treatment

Treatment options for patellofemoral instability in sports traumatology

Directory of Open Access Journals (Sweden)

Philippe M. Tscholl

2013-09-01

Full Text Available Patellofemoral instability not only involves lateral patellar dislocation, patellar mal-tracking or subluxation but can also cause a limiting disability for sports activities. Its underlying causes are known as morphological anomalies of the patellofemoral joint or the mechanical axis, femorotibial malrotation, variants of the knee extensor apparatus, and ligamentous insufficiencies often accompanied by poor proprioception. Athletes with such predisposing factors are either suffering from unspecific anterior knee pain or from slightly traumatic or recurrent lateral patellar dislocation Treatment options of patellar instability are vast, and need to be tailored individually depending on the athlete’s history, age, complaints and physical demands. Different conservative and surgical treatment options are reviewed and discussed, especially limited expectations after surgery.

Nonsurgical Treatment Options for Basal Cell Carcinoma

International Nuclear Information System (INIS)

Lien, M. H.; Sondak, V. K.; Sondak, V. K.

2011-01-01

Basal cell carcinoma (BCC) remains the most common form of non melanoma skin cancer (NMSC) in Caucasians, with perhaps as many as 2 million new cases expected to occur in the United States in 2010. Many treatment options, including surgical interventions and nonsurgical alternatives, have been utilized to treat BCC. In this paper, two non-surgical options, imiquimod therapy and photodynamic therapy (PDT), will be discussed. Both modalities have demonstrated acceptable disease control rates, cosmetically superior outcomes, and short-term cost-effectiveness. Further studies evaluating long-term cure rates and long-term cost effectiveness of imiquimod therapy and PDT are needed.

Clomiphene citrate and testosterone gel replacement therapy for male hypogonadism: efficacy and treatment cost.

Science.gov (United States)

Taylor, Frederick; Levine, Laurence

2010-01-01

The efficacy of oral clomiphene citrate (CC) in the treatment of male hypogonadism and male infertility (MI) with low serum testosterone and normal gonadotropin levels has been reported. The aim of this article is to evaluate CC and testosterone gel replacement therapy (TGRT) with regard to biochemical and clinical efficacy and cost. The main outcome measures were change in serum testosterone with CC and TGRT therapy, and change in the androgen deficiency in aging male (ADAM) questionnaire scores with CC therapy. Men receiving CC or TGRT with either Androgel 1% or Testim 1% for hypogonadism (defined as testosterone treatment initiation and semi-annually thereafter. Retrospective data collection was performed via chart review. Subjective follow up of patients receiving CC was performed via telephone interview using the ADAM questionnaire. A hundred and four men (65 CC and 39 TGRT) were identified who began CC (50 mg every other day) or TGRT (5 g). Average age (years) was 42(CC) vs. 57 (TGRT). Average follow up was 23 months (CC, range 8-40 months) vs. 46 months (TGRT, range 6-149 months). Average posttreatment testosterone was 573 ng/dL in the CC group and 553 ng/dL in the TGRT group (P value treatment option for men with hypogonadism, demonstrating biochemical and clinical efficacy with few side effects and lower cost as compared with TGRT.

Perceptions of substance use, treatment options and training needs among Iranian primary care physicians

Directory of Open Access Journals (Sweden)

Dolan Kate A

2005-06-01

Full Text Available Abstract In order to be optimally effective, continuing training programmes for health-care professionals need to be tailored so that they target specific knowledge deficits, both in terms of topic content and appropriate intervention strategies. A first step in designing tailored treatment programmes is to identify the characteristics of the relevant health-care professional group, their current levels of content and treatment knowledge, the estimated prevalence of drug and alcohol problems among their patients and their preferred options for receiving continuing education and training. This study reports the results of a survey of 53 primary care physicians working in Iran. The majority were male, had a mean age of 44 years and saw approximately 94 patients per week. In terms of their patients' drug use, primary care physicians thought most patients with a substance use problem were male, women were most likely to use tobacco (52%, opium (32% and marijuana/hashish and young people were most likely to use tobacco, alcohol, marijuana and heroin. Counselling and nicotine patches were the treatments most commonly provided. Although the majority (55% reported referring patients to other services, more than a third did not. Most primary care physicians reported being interested in attending further training on substance abuse issues. The implications of these data for ongoing education and training of primary care physicians in Iran are discussed.

Review of Saccharomyces boulardii as a treatment option in IBD.

Science.gov (United States)

Sivananthan, Kavitha; Petersen, Andreas Munk

2018-05-17

Review of the yeast Saccharomyces boulardii as a treatment option for the inflammatory bowel diseases (IBD) ulcerative colitis and Crohn's disease. IBD is caused by an inappropriate immune response to gut microbiota. Treatment options could therefore be prebiotics, probiotics, antibiotics and/or fecal transplant. In this review, we have looked at the evidence for the yeast S. boulardii as a treatment option. Searches in PubMed and the Cochrane Library with the MeSH words 'Saccharomyces boulardii AND IBD', 'Saccharomyces boulardii AND Inflammatory Bowel Disease', 'Saccharomyces boulardii AND ulcerative colitis' and 'Saccharomyces boulardii AND Crohn's disease' gave total a total of 80 articles. After exclusions because of irrelevance, articles in other languages and some articles that were not available, 16 articles were included in this review. Three of the clinical trials showed a positive effect of S. boulardii in IBD patients (two Crohn's disease, one ulcerative colitis), while there was one trial that didn't prove any effect (Crohn's disease). Included Animal trials and cell assays describes different anti-inflammatory mechanisms of S. boulardii supporting a possible effect when treating IBD patients. The number of studies of S. boulardii as treatment for IBD is limited. Furthermore, the existing trials have small populations and short duration. We do not have enough evidence to prove the effect of S. boulardii in IBD. Saccharomyces boulardii is, however, a plausible treatment option in the future, but more placebo-controlled clinical studies on both patients with ulcerative colitis and Crohn's disease are needed.

Acute intermittent porphyria: Diagnostic dilemma and treatment options

Directory of Open Access Journals (Sweden)

Mohan Deep Kaur

2015-01-01

Full Text Available Acute intermittent porphyria (AIP presents with diverse group of symptoms making its early diagnosis difficult. Delaying diagnosis and treatment of AIP can be fatal or can cause long term or permanent neurological damage. We present here a case report of AIP where the diagnosis was missed. The diversity of symptoms and details concerning the treatment options for AIP are discussed.

Acute intermittent porphyria: Diagnostic dilemma and treatment options

Science.gov (United States)

Kaur, Mohan Deep; Hazarika, Nita; Saraswat, Namita; Sood, Rajesh

2015-01-01

Acute intermittent porphyria (AIP) presents with diverse group of symptoms making its early diagnosis difficult. Delaying diagnosis and treatment of AIP can be fatal or can cause long term or permanent neurological damage. We present here a case report of AIP where the diagnosis was missed. The diversity of symptoms and details concerning the treatment options for AIP are discussed. PMID:26330726

A comparative review of the options for treatment of erectile dysfunction: which treatment for which patient?

Science.gov (United States)

Hatzimouratidis, Konstantinos; Hatzichristou, Dimitrios G

2005-01-01

The field of erectile dysfunction (ED) has been revolutionised over the last two decades. Several treatment options are available today, most of which are associated with high efficacy rates and favourable safety profiles. A MEDLINE search was undertaken in order to evaluate all currently available data on treatment modalities for ED. Phosphodiesterase type 5 (PDE5) inhibitors (sildenafil, tadalafil, vardenafil) are currently the first-choice of most physicians and patients for the treatment of ED. PDE5 inhibitors have differences in their pharmacological profiles, the most obvious being the long duration of action of tadalafil, but there are no data supporting superiority for any one of them in terms of efficacy or safety. Sublingual apomorphine has limited efficacy compared with the PDE5 inhibitors, and its use is limited to patients with mild ED. Treatment failures with oral drugs may be due to medication, clinician and patient issues. The physician needs to address all of these issues in order to identify true treatment failures. Patients who are truly unresponsive to oral drugs may be offered other treatment options.Intracavernous injections of alprostadil alone, or in combination with other vasoactive agents (papaverine and phentolamine), remain an excellent treatment option, with proven efficacy and safety over time. Topical pharmacotherapy is appealing in nature, but currently available formulations have limited efficacy. Vacuum constriction devices may be offered mainly to elderly patients with occasional intercourse attempts, as younger patients show limited preference because of the unnatural erection that is associated with this treatment modality. Penile prostheses are generally the last treatment option offered, because of invasiveness, cost and non-reversibility; however, they are associated with high satisfaction rates in properly selected patients. All treatment options are associated with particular strengths and weaknesses. A patient

Effects of acute corticosterone treatment on partner preferences in male and female zebra finches (Taeniopygia guttata).

Science.gov (United States)

LaPlante, Kimberly A; Huremovic, Enida; Tomaszycki, Michelle L

2014-04-01

Stress alters physiology and behavior across species. Most research on the effects of stress on behavior uses chronic stressors, and most are correlational. The effects of acute stressors on physiology and behavior have been mixed. Here, we use zebra finches, a highly gregarious species that forms long-term pair bonds, to test the effects of an acute corticosterone (CORT) on opposite-sex partner preferences over a same-sex individual or a group (the latter is a highly appealing option). We had two competing hypotheses. First, we predicted that acute CORT would alter preferences for the opposite sex bird in both conditions in both sexes. However, since there is a sex difference in the effects of CORT on partner preferences in voles, these effects may be more pronounced in males than in females. To test our hypotheses, we administered 2 doses of CORT (10μg and 20μg) or vehicle (control) using a repeated measures design. In the male vs. female test, there was a significant Sex by Treatment interaction, such that in males, 10μg CORT increased preferences for a female over the male compared to when these same males were treated with saline at baseline. There were no effects of treatment in females. In the opposite-sex vs. group condition, there was an overall effect of Treatment, such that the 10μg dose increased preference for the opposite-sex individual over both saline treatments, regardless of sex. These findings further our understanding of the effects of an acute stressor on sexual partner preferences. Copyright © 2014 Elsevier Inc. All rights reserved.

Renal Artery Embolization - A First Line Treatment Option For End-Stage Hydronephrosis

International Nuclear Information System (INIS)

Mitra, Kakali; Prabhudesai, Vikramaditya; James, R. Lester; Jones, Robert W. A.; French, Michael E.; Cowling, Mark; West, David J.

2004-01-01

Conventionally poorly functioning hydronephrotic kidneys have been removed if they are symptomatic. In our unit, patients are offered renal artery embolization as an alternative treatment option. Patients and Methods: Fifteen patients (11 male, 4 female) with a mean age of 32.9 yr (20-51 yrs) have undergone renal artery embolization for symptomatic hydronephrosis with poor function. Mean follow-up was 64.13 weeks (range 14-200). All patients had loin pain and hydronephrosis. Twelve patients had primary pelvi-ureteric junction obstruction (PUJO). Two patients had poorly functioning hydronephrotic kidneys secondary to chronic calculous obstruction. One patient had chronic pain in an obstructed but reasonably functioning kidney following a previous pyeloplasty for PUJO which demanded intervention. Mean split function on renography was 11% (range 0-46%). Selective renal artery embolization was carried out under antibiotic cover using a 7 Fr balloon occlusion catheter and absolute alcohol, steel coils, and polyvinyl alcohol particles.Results: Nine patients developed post-embolization syndrome of self-limiting pain and pyrexia with no evidence of sepsis. One patient required readmission with this condition. One patient developed a hematoma at the puncture site. Mean hospital stay was 2.3 days. Fourteen patients are happy with the result and are completely pain free. One patient has minor discomfort but is delighted with the result. Nine patients have had follow-up ultrasound confirming resolution of the hydronephrosis. Conclusion: Renal artery embolization is an effective, safe, well-tolerated minimally invasive treatment option in end-stage hydronephrosis and we routinely offer it as an alternative to nephrectomy

Treatment Options for Narcolepsy.

Science.gov (United States)

Barateau, Lucie; Lopez, Régis; Dauvilliers, Yves

2016-05-01

Narcolepsy type 1 and narcolepsy type 2 are central disorders of hypersomnolence. Narcolepsy type 1 is characterized by excessive daytime sleepiness and cataplexy and is associated with hypocretin-1 deficiency. On the other hand, in narcolepsy type 2, cerebrospinal fluid hypocretin-1 levels are normal and cataplexy absent. Despite major advances in our understanding of narcolepsy mechanisms, its current management is only symptomatic. Treatment options may vary from a single drug that targets several symptoms, or multiple medications that each treats a specific symptom. In recent years, narcolepsy treatment has changed with the widespread use of modafinil/armodafinil for daytime sleepiness, antidepressants (selective serotonin and dual serotonin and noradrenalin reuptake inhibitors) for cataplexy, and sodium oxybate for both symptoms. Other psychostimulants can also be used, such as methylphenidate, pitolisant and rarely amphetamines, as third-line therapy. Importantly, clinically relevant subjective and objective measures of daytime sleepiness are required to monitor the treatment efficacy and to provide guidance on whether the treatment goals are met. Associated symptoms and comorbid conditions, such as hypnagogic/hypnopompic hallucinations, sleep paralysis, disturbed nighttime sleep, unpleasant dreams, REM- and non REM-related parasomnias, depressive symptoms, overweight/obesity, and obstructive sleep apnea, should also be taken into account and managed, if required. In the near future, the efficacy of new wake-promoting drugs, anticataplectic agents, hypocretin replacement therapy and immunotherapy at the early stages of the disease should also be evaluated.

Management of male breast cancer

Directory of Open Access Journals (Sweden)

Nikolay V. Dimitro v

2011-12-01

Full Text Available The management of male breast cancer is still under discussion due to lack of information from prospective, randomized clinical trials and low incidence of this disease. Current management is based largely on extrapolation from data related to treatment of female breast cancer. Over the last two decades, several review articles have discussed mainly retrospective and anecdotal data related to hormonal and chemotherapy treatment modalities. In this review, we present the most recent information and future considerations related to the management of male breast cancer. In addition to the conventional treatment options we will discuss the possible role of targeted therapy. Establishing a national or global registry for male breast cancer will provide more precise information about the natural history of the disease and will facilitate the design and execution of prospective, randomized multicenter clinical trials.

Keratosis lichenoides chronica: Case-based review of treatment options.

Science.gov (United States)

Pistoni, Federica; Peroni, Anna; Colato, Chiara; Schena, Donatella; Girolomoni, Giampiero

2016-08-01

Keratosis lichenoides chronica (KLC) is a rare dermatological condition characterized by keratotic papules arranged in a parallel linear or reticular pattern and facial lesions resembling seborrheic dermatitis or rosacea. The clinical, histological and therapeutic information on 71 patients with KLC retrieved through a PubMed search plus one our new case were analyzed. KLC affects patients of all ages, with a modest male predominance. Pediatric cases represent about one quarter of patients. Diagnosis is usually delayed and histologically confirmed. All patients have thick, rough and scaly papules and plaques arranged in a linear or reticular pattern, on limbs (>80%) and trunk (about 60%). Face involvement is described in two-thirds of patients. Lesions are usually asymptomatic or mildly pruritic. Other manifestations, such as palmoplantar keratoderma, mucosal involvement, ocular manifestations, nail dystrophy, are reported in 20-30% of patients. Children present more frequently alopecia. No controlled trials are available. Results from small case series or single case reports show that the best treatment options are phototherapy and systemic retinoids, alone or in combination, with nearly half of patients reaching complete remission. Systemic corticosteroids as well as antibiotics and antimalarials are not effective.

Desmoid tumors: clinical features and treatment options: a case ...

African Journals Online (AJOL)

Desmoid tumors: clinical features and treatment options: a case report and a review of literature. Amel Achour Jenayah, Hajer Bettaieb, Sarra Saoudi, Anissa Gharsa, Ezzeddine Sfar, Fethia Boudaya, Dalenda Chelli ...

Engineered Option Treatment of Remediated Nitrate Salts: Surrogate Batch-Blending Testing

Energy Technology Data Exchange (ETDEWEB)

Anast, Kurt Roy [Los Alamos National Lab. (LANL), Los Alamos, NM (United States)

2016-03-11

This report provides results from batch-blending test work for remediated nitrate salt (RNS) treatment. Batch blending was identified as a preferred option for blending RNS and unremediated nitrate salt (UNS) material with zeolite to effectively safe the salt/Swheat material identified as ignitable (U.S. Environmental Protection Agency code D001). Blending with zeolite was the preferred remediation option identified in the Options Assessment Report and was originally proposed as the best option for remediation by Clark and Funk in their report, Chemical Reactivity and Recommended Remediation Strategy for Los Alamos Remediated Nitrate Salt (RNS) Wastes, and also found to be a preferred option in the Engineering Options Assessment Report: Nitrate Salt Waste Stream Processing. This test work evaluated equipment and recipe alternatives to achieve effective blending of surrogate waste with zeolite.

Current status in the treatment options for esophageal achalasia.

Science.gov (United States)

Chuah, Seng-Kee; Chiu, Chien-Hua; Tai, Wei-Chen; Lee, Jyong-Hong; Lu, Hung-I; Changchien, Chi-Sin; Tseng, Ping-Huei; Wu, Keng-Liang

2013-09-07

Recent advances in the treatment of achalasia include the use of high-resolution manometry to predict the outcome of patients and the introduction of peroral endoscopic myotomy (POEM). The first multicenter randomized, controlled, 2-year follow-up study conducted by the European Achalasia Trial group indicated that laparoscopic Heller myotomy (LHM) was not superior to pneumatic dilations (PD). Publications on the long-term success of laparoscopic surgery continue to emerge. In addition, laparoscopic single-site surgery is applicable to advanced laparoscopic operations such as LHM and anterior fundoplication. The optimal treatment option is an ongoing matter of debate. In this review, we provide an update of the current progress in the treatment of esophageal achalasia. Unless new conclusive data prove otherwise, LHM is considered the most durable treatment for achalasia at the expense of increased reflux-associated complications. However, PD is the first choice for non-surgical treatment and is more cost-effective. Repeated PD according to an "on-demand" strategy based on symptom recurrence can achieve long-term remission. Decision making should be based on clinical evidence that identifies a subcategory of patients who would benefit from specific treatment options. POEM has shown promise but its long-term efficacy and safety need to be assessed further.

Angina pectoris: current therapy and future treatment options.

Science.gov (United States)

Parikh, Raj; Kadowitz, Philip J

2014-02-01

Angina pectoris is the consequence of an inequality between the demand and supply of blood to the heart. Angina manifests itself as chest pain or discomfort and is a common complaint of patients in the hospital and in the clinic. There are, in fact, roughly half a million new cases of angina per year. Chest pain, while having many etiologies, is generally considered to be most lethal when related to a cardiac cause. In this review, the authors outline the current medical and surgical therapies that are used in the management of angina. Highlights of the various clinical trials that have assisted in the investigation of these therapies are summarized also. Then, the authors provide a focused review of the novel therapy options for angina that are currently being explored. From new medical treatments to revised surgical techniques to the discovery of stem cell therapy, many innovative options are being investigated for the treatment of angina.

Current treatment options for vulvovaginal candidiasis caused by azole-resistant Candida species.

Science.gov (United States)

Sobel, J D; Sobel, R

2018-06-22

Clinicians are increasingly challenged by patients with refractory vulvovaginal candidiasis (VVC) caused by azole-resistant Candida species. Fluconazole resistant C.albicans is a growing and perplexing problem following years of indiscriminate drug prescription and unnecessary drug exposure and for which there are few therapeutic alternatives. Regrettably, although the azole class of drugs has expanded, new classes of antifungal drugs have not been forthcoming, limiting effective treatment options in patients with azole resistant Candida vaginitis. Areas covered: This review covers published data on epidemiology, pathophysiology and treatment options for women with azole-resistant refractory VVC. Expert opinion: Fluconazole resistant C.albicans adds to the challenge of azole resistant non-albicans Candida spp. Both issues follow years of indiscriminate drug prescription and unnecessary fluconazole exposure. Although an understanding of azole resistance in yeast has been established, this knowledge has not translated into useful therapeutic advantage. Treatment options for such women with refractory symptoms are extremely limited. New therapeutic options and strategies are urgently needed to meet this challenge of azole drug resistance.

Current treatment options for meningioma.

Science.gov (United States)

Apra, Caroline; Peyre, Matthieu; Kalamarides, Michel

2018-03-01

With an annual incidence of 5/100,000, meningioma is the most frequent primary tumor of the central nervous system. Risk factors are radiotherapy and hormone intake. Most meningiomas are grade I benign tumors, but up to 15% are atypical and 2% anaplastic according to the WHO 2016 histological criteria. Areas covered: This review details the current standard therapy based on international guidelines and recent literature, and describes new approaches developed to treat refractory cases. First-line treatments are observation and surgery, but adjuvant radiotherapy/radiosurgery is discussed for atypical and indicated for anaplastic meningiomas. The most problematic cases include skull base meningiomas that enclose vasculo-nervous structures and surgery- and radiation-refractory tumors that present with significant morbidity and mortality. The treatment of recurrent tumors is based on radiotherapy and repeated surgery. Systematic therapies are not effective in general but several clinical trials are ongoing. Expert commentary: Molecular characterization of the tumors, based on genetic mutations such as NF2, SMO, TERT, TRAF7, and on the methylation profile are developing, completing the histological classification and giving new insights into prognosis and treatment options.

Comparative efficacy and safety of treatment options for MDR and XDR Acinetobacter baumannii infections: a systematic review and network meta-analysis.

Science.gov (United States)

Kengkla, Kirati; Kongpakwattana, Khachen; Saokaew, Surasak; Apisarnthanarak, Anucha; Chaiyakunapruk, Nathorn

2018-01-01

To comprehensively compare and rank the efficacy and safety of available treatment options for patients with MDR and XDR Acinetobacter baumannii (AB) infection. We searched PubMed, Embase and the Cochrane register of trials systematically for studies that examined treatment options for patients with MDR- and XDR-AB infections until April 2016. Network meta-analysis (NMA) was performed to estimate the risk ratio (RR) and 95% CI from both direct and indirect evidence. Primary outcomes were clinical cure and microbiological cure. Secondary outcomes were all-cause mortality and nephrotoxic and non-nephrotoxic adverse events. A total of 29 studies with 2529 patients (median age 60 years; 65% male; median APACHE II score 19.0) were included. Although there were no statistically significant differences between treatment options, triple therapy with colistin, sulbactam and tigecycline had the highest clinical cure rate. Colistin in combination with sulbactam was associated with a significantly higher microbiological cure rate compared with colistin in combination with tigecycline (RR 1.23; 95% CI 1.03-1.47) and colistin monotherapy (RR 1.21; 95% CI 1.06-1.38). No significant differences in all-cause mortality were noted between treatment options. Tigecycline-based therapy also appeared less effective for achieving a microbiological cure and is not appropriate for treating bloodstream MDR- and XDR-AB infections. Combination therapy of colistin with sulbactam demonstrates superiority in terms of microbiological cure with a safety profile similar to that of colistin monotherapy. Thus, our findings support the use of this combination as a treatment for MDR- and XDR-AB infections. © The Author 2017. Published by Oxford University Press on behalf of the British Society for Antimicrobial Chemotherapy. All rights reserved. For Permissions, please email: journals.permissions@oup.com.

Neonatal hepatic haemangioendothelioma: treatment options and dilemmas

International Nuclear Information System (INIS)

Meijs, Bram B. van der; Merks, Johannes H.M.; Haan, Timo R. de; Tabbers, Merit M.; Rijn, Rick R. van

2009-01-01

We describe a case of rapidly progressive neonatal diffuse hepatic haemangioendotheliomas. The clinical picture was characterized by respiratory insufficiency due to gross abdominal enlargement, coagulopathy, and the development of cardiovascular insufficiency during the course of disease. Pharmacological, radiotherapeutic and endovascular treatment options all proved ineffective. We describe our own experience and the steps taken to treat this child. Unfortunately, the child died as a consequence of the disease. As cases like this are rare and are associated with severe morbidity and high mortality, more knowledge needs to be gained on infantile hepatic haemangioendotheliomas and their optimal treatment. The use of a web-based data registry could be beneficial. (orig.)

Male Breast Cancer Treatment (PDQ®)—Health Professional Version

Science.gov (United States)

Male breast cancer treatment may include surgery with or without radiation therapy, chemotherapy, endocrine therapy, and/or HER2-directed therapy. Get detailed information about the diagnosis and treatment of newly diagnosed and recurrent male breast cancer in this summary for clinicians.

Hyaluronic acid and other conservative treatment options for osteoarthritis of the ankle

NARCIS (Netherlands)

Witteveen, Angelique G. H.; Hofstad, Cheriel J.; Kerkhoffs, Gino M. M. J.

2015-01-01

Background The cause of ankle osteoarthritis (OA) is usually trauma. Patients are relatively young, since ankle trauma occurs at a relatively young age. Several conservative treatment options are available, evidence of the benefits and harms of these options are lacking. Objectives To assess the

Progressive Supranuclear Palsy and Corticobasal Degeneration: Pathophysiology and Treatment Options

OpenAIRE

Lamb, Ruth; Rohrer, Jonathan D.; Lees, Andrew J.; Morris, Huw R.

2016-01-01

Opinion statement There are currently no disease-modifying treatments for progressive supranuclear palsy (PSP) or corticobasal degeneration (CBD), and no approved pharmacological or therapeutic treatments that are effective in controlling their symptoms. The use of most pharmacological treatment options are based on experience in other disorders or from non-randomized historical controls, case series, or expert opinion. Levodopa may provide some improvement in symptoms of Parkinsonism (specif...

Progressive Supranuclear Palsy and Corticobasal Degeneration: Pathophysiology and Treatment Options

OpenAIRE

Lamb, R.; Rohrer, J. D.; Lees, A. J.; Morris, H. R.

2016-01-01

There are currently no disease-modifying treatments for progressive supranuclear palsy (PSP) or corticobasal degeneration (CBD), and no approved pharmacological or therapeutic treatments that are effective in controlling their symptoms. The use of most pharmacological treatment options are based on experience in other disorders or from non-randomized historical controls, case series, or expert opinion. Levodopa may provide some improvement in symptoms of Parkinsonism (specifically bradykinesi...

24-h Efficacy of Glaucoma Treatment Options.

Science.gov (United States)

Konstas, Anastasios G P; Quaranta, Luciano; Bozkurt, Banu; Katsanos, Andreas; Garcia-Feijoo, Julian; Rossetti, Luca; Shaarawy, Tarek; Pfeiffer, Norbert; Miglior, Stefano

2016-04-01

Current management of glaucoma entails the medical, laser, or surgical reduction of intraocular pressure (IOP) to a predetermined level of target IOP, which is commensurate with either stability or delayed progression of visual loss. In the published literature, the hypothesis is often made that IOP control implies a single IOP measurement over time. Although the follow-up of glaucoma patients with single IOP measurements is quick and convenient, such measurements often do not adequately reflect the untreated IOP characteristics, or indeed the quality of treated IOP control during the 24-h cycle. Since glaucoma is a 24-h disease and the damaging effect of elevated IOP is continuous, it is logical that we should aim to understand the efficacy of all treatment options throughout the 24-h period. This article first reviews the concept and value of diurnal and 24-h IOP monitoring. It then critically evaluates selected available evidence on the 24-h efficacy of medical, laser and surgical therapy options. During the past decade several controlled trials have significantly enhanced our understanding on the 24-h efficacy of all glaucoma therapy options. Nevertheless, more long-term evidence is needed to better evaluate the 24-h efficacy of glaucoma therapy and the precise impact of IOP characteristics on glaucomatous progression and visual prognosis.

Emerging therapeutic options for sporadic inclusion body myositis

Directory of Open Access Journals (Sweden)

Alfano LN

2015-09-01

Full Text Available Lindsay N Alfano, Linda P Lowes Nationwide Children’s Hospital, Center for Gene Therapy, Columbus, OH, USA Abstract: Sporadic inclusion body myositis is the most common inflammatory muscle disorder preferentially affecting males over the age of 40 years. Progressive muscle weakness of the finger flexors and quadriceps muscles results in loss of independence with activities of daily living and eventual wheelchair dependence. Initial signs of disease are often overlooked and can lead to mis- or delayed diagnosis. The underlying cause of disease is unknown, and disease progression appears refractory to available treatment options. This review discusses the clinical presentation of inclusion body myositis and the current efforts in diagnosis, and focuses on the current state of research for both nonpharmacological and pharmacological treatment options for this patient group. Keywords: myositis, inclusion body myositis, inflammatory myopathy, treatment, function, outcomes

Current options for the treatment of facial angiofibromas.

Science.gov (United States)

Salido-Vallejo, R; Garnacho-Saucedo, G; Moreno-Giménez, J C

2014-01-01

Facial angiofibromas are hamartomatous growths that are closely associated with tuberous sclerosis complex and, in fact, they constitute one of the main diagnostic criteria for that disease. These lesions composed of blood vessels and fibrous tissue appear on the face at an early age. Since they have important physical and psychological repercussions for patients, several treatment options have been used to remove them or improve their appearance. However, the lack of treatment guidelines prevents us from developing a common protocol for patients with this condition. The present article aims to review the treatments for facial angiofibromas used to date and to propose a new evidence-based treatment protocol. Copyright © 2012 Elsevier España, S.L. and AEDV. All rights reserved.

Alternative pharmacological treatment options for agitation in Alzheimer’s disease

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Francesco Panza

2015-11-01

Full Text Available In patients with dementia and Alzheimer’s disease (AD, treatment of neuropsychiatric symptoms (NPS is a major concern in the management of these devastating diseases. Among NPS in AD, agitation and aggression are common with earlier institutionalization, increased morbidity and mortality, and greater caregiver burden. Pharmacological treatments for AD-related agitation, specifically off-label use of atypical antipsychotics, showed only modest improvements, with increased side-effect burden and risk of mortality. Non-pharmacological treatment approaches have become the preferred firstline option. However, when such treatments fail, pharmacological options are often used. Therefore, there is an urgent need to identify effective and safe pharmacological treatments for agitation/aggression in AD and dementia. Unfortunately, progresses have been slow, with a small number of methodologically heterogeneous randomized controlled trials (RCTs, with disappointing results. However, evidence coming from recently completed RCTs on novel or repositioned drugs (mibampator, dextromethorphan/ quinidine, cannabinoids, and citalopram showed some promise in treating agitation in AD, but still with safety concerns. Further evidence will come from ongoing Phase II and III trials on promising novel drugs for treating these distressing symptoms in patients with AD and dementia.

Acceptability of lifelong treatment among HIV-positive pregnant and breastfeeding women (Option B+ in selected health facilities in Zimbabwe: a qualitative study

Directory of Open Access Journals (Sweden)

Addmore Chadambuka

2017-07-01

Full Text Available Abstract Background Zimbabwe’s Ministry of Health and Child Care (MOHCC adopted 2013 World Health Organization (WHO prevention of mother-to-child HIV transmission (PMTCT guidelines recommending initiation of HIV-positive pregnant and breastfeeding women (PPBW on lifelong antiretroviral treatment (ART irrespective of clinical stage (Option B+. Option B+ was officially launched in Zimbabwe in November 2013; however the acceptability of life-long ART and its potential uptake among women was not known. Methods A qualitative study was conducted at selected sites in Harare (urban and Zvimba (rural to explore Option B+ acceptability; barriers, and facilitators to ART adherence and service uptake. In-depth interviews (IDIs, focus group discussions (FGDs and key informant interviews (KIIs were conducted with PPBW, healthcare providers, and community members. All interviews were audio-recorded, transcribed, and translated; data were coded and analyzed in MaxQDA v10. Results Forty-three IDIs, 22 FGDs, and five KIIs were conducted. The majority of women accepted lifelong ART. There was however, a fear of commitment to taking lifelong medication because they were afraid of defaulting, especially after cessation of breastfeeding. There was confusion around dosage; and fear of side effects, not having enough food to take drugs, and the lack of opportunities to ask questions in counseling. Participants reported the need for strengthening community sensitization for Option B+. Facilitators included receiving a simplified pill regimen; ability to continue breastfeeding beyond 6 months like HIV-negative women; and partner, community and health worker support. Barriers included distance of health facility, non-disclosure of HIV status, poor male partner support and knowing someone who had negative experience on ART. Conclusions This study found that Option B+ is generally accepted among PPBW as a means to strengthen their health and protect their babies

Acceptability of lifelong treatment among HIV-positive pregnant and breastfeeding women (Option B+) in selected health facilities in Zimbabwe: a qualitative study.

Science.gov (United States)

Chadambuka, Addmore; Katirayi, Leila; Muchedzi, Auxilia; Tumbare, Esther; Musarandega, Reuben; Mahomva, Agnes I; Woelk, Godfrey

2017-07-25

Zimbabwe's Ministry of Health and Child Care (MOHCC) adopted 2013 World Health Organization (WHO) prevention of mother-to-child HIV transmission (PMTCT) guidelines recommending initiation of HIV-positive pregnant and breastfeeding women (PPBW) on lifelong antiretroviral treatment (ART) irrespective of clinical stage (Option B+). Option B+ was officially launched in Zimbabwe in November 2013; however the acceptability of life-long ART and its potential uptake among women was not known. A qualitative study was conducted at selected sites in Harare (urban) and Zvimba (rural) to explore Option B+ acceptability; barriers, and facilitators to ART adherence and service uptake. In-depth interviews (IDIs), focus group discussions (FGDs) and key informant interviews (KIIs) were conducted with PPBW, healthcare providers, and community members. All interviews were audio-recorded, transcribed, and translated; data were coded and analyzed in MaxQDA v10. Forty-three IDIs, 22 FGDs, and five KIIs were conducted. The majority of women accepted lifelong ART. There was however, a fear of commitment to taking lifelong medication because they were afraid of defaulting, especially after cessation of breastfeeding. There was confusion around dosage; and fear of side effects, not having enough food to take drugs, and the lack of opportunities to ask questions in counseling. Participants reported the need for strengthening community sensitization for Option B+. Facilitators included receiving a simplified pill regimen; ability to continue breastfeeding beyond 6 months like HIV-negative women; and partner, community and health worker support. Barriers included distance of health facility, non-disclosure of HIV status, poor male partner support and knowing someone who had negative experience on ART. This study found that Option B+ is generally accepted among PPBW as a means to strengthen their health and protect their babies. Consistent with previous literature, this study demonstrated the

Current Treatment Options for Auricular Hematomas.

Science.gov (United States)

MacPhail, Catriona

2016-07-01

Ear disease, such as otitis externa, resulting in aggressive head shaking or ear scratching, is the most common cause of the development of aural hematomas in dogs and cats. An underlying immunologic cause has also been proposed to explain cartilage and blood vessel fragility. Numerous options exist for management of aural hematomas, from medical management alone with corticosteroids, to simple hematoma centesis, to surgical intervention. Because this condition is usually secondary to another disease process, regardless of mode of treatment, likelihood of recurrence is low if the underlying condition is managed properly. Copyright © 2016 Elsevier Inc. All rights reserved.

Assessment of Options for the Treatment of Nitrate Salt Wastes at Los Alamos National Laboratory

International Nuclear Information System (INIS)

Robinson, Bruce Alan; Funk, David John; Stevens, Patrice Ann

2016-01-01

This paper summarizes the methodology used to evaluate options for treatment of the remediated nitrate salt waste containers at Los Alamos National Laboratory. The method selected must enable treatment of the waste drums, which consist of a mixture of complex nitrate salts (oxidizer) improperly mixed with sWheat Scoop®1, an organic kitty litter and absorbent (fuel), in a manner that renders the waste safe, meets the specifications of waste acceptance criteria, and is suitable for transport and final disposal in the Waste Isolation Pilot Plant located in Carlsbad, New Mexico. A Core Remediation Team was responsible for comprehensively reviewing the options, ensuring a robust, defensible treatment recommendation. The evaluation process consisted of two steps. First, a prescreening process was conducted to cull the list on the basis for a decision of feasibility of certain potential options with respect to the criteria. Then, the remaining potential options were evaluated and ranked against each of the criteria in a consistent methodology. Numerical scores were established by consensus of the review team. Finally, recommendations were developed based on current information and understanding of the scientific, technical, and regulatory situation. A discussion of the preferred options and documentation of the process used to reach the recommended treatment options are presented.

Assessment of Options for the Treatment of Nitrate Salt Wastes at Los Alamos National Laboratory

Energy Technology Data Exchange (ETDEWEB)

Robinson, Bruce Alan [Los Alamos National Lab. (LANL), Los Alamos, NM (United States); Funk, David John [Los Alamos National Lab. (LANL), Los Alamos, NM (United States); Stevens, Patrice Ann [Los Alamos National Lab. (LANL), Los Alamos, NM (United States)

2016-03-17

This paper summarizes the methodology used to evaluate options for treatment of the remediated nitrate salt waste containers at Los Alamos National Laboratory. The method selected must enable treatment of the waste drums, which consist of a mixture of complex nitrate salts (oxidizer) improperly mixed with sWheat Scoop®1, an organic kitty litter and absorbent (fuel), in a manner that renders the waste safe, meets the specifications of waste acceptance criteria, and is suitable for transport and final disposal in the Waste Isolation Pilot Plant located in Carlsbad, New Mexico. A Core Remediation Team was responsible for comprehensively reviewing the options, ensuring a robust, defensible treatment recommendation. The evaluation process consisted of two steps. First, a prescreening process was conducted to cull the list on the basis for a decision of feasibility of certain potential options with respect to the criteria. Then, the remaining potential options were evaluated and ranked against each of the criteria in a consistent methodology. Numerical scores were established by consensus of the review team. Finally, recommendations were developed based on current information and understanding of the scientific, technical, and regulatory situation. A discussion of the preferred options and documentation of the process used to reach the recommended treatment options are presented.

For Some Breast Cancers, New Drug May Be Treatment Option

Science.gov (United States)

Results from an international clinical trial suggest that women with metastatic, HER2-positive breast cancer that is no longer responding to the targeted therapy trastuzumab (Herceptin) may soon have a new treatment option.

Municipal solid waste options : integrating organics management and residual disposal treatment : executive summary

Energy Technology Data Exchange (ETDEWEB)

Cant, M. (comp.) [Totten Sims Hubicki Associates Ltd., Calgary, AB (Canada); Van der Werf, P. [2cg Inc., Edmonton, AB (Canada); Kelleher, M. [Kelleher Environmental, Toronto, ON (Canada); Merriman, D. [MacViro Consultants, Markham, ON (Canada); Fitcher, K. [Gartner Lee Ltd., Toronto, ON (Canada); MacDonald, N. [CH2M Hill Engineering Ltd., Calgary, AB (Canada)

2006-04-15

The Municipal Solid Waste (MSW) Options Report explored different MSW management options for 3 community sizes: 20,000, 80,000 and 200,0000 people. It was released at a time when many communities were developing waste management plans to cost-effectively reduce environmental impacts and conserve landfill capacity. The purpose of this report was to provide a greater understanding on the environmental, social, economic, energy recovery/utilization and greenhouse gas (GHG) considerations of MSW management. The report also demonstrated the interrelationships between the management of organics and residuals. It was based on information from existing waste diversion and organics management options and emerging residual treatment technology options. The following organics management and residual treatment disposal options were evaluated: composting; anaerobic digestion; sanitary landfills; bioreactor landfills; and thermal treatment. Composting was examined with reference to both source separated organics (SSO) and mixed waste composting. SSO refers to the separation of materials suitable for composting solid waste from households, while mixed waste composting refers to the manual or mechanical removal of recyclable material from the waste, including compost. The composting process was reviewed along with available technologies such as non-reactor windrow; aerated static pile; reactor enclosed channel; and, container tunnel. An evaluation of SSO and mixed waste composting was then presented in terms of environmental, social, financial and GHG impacts. refs., tabs., figs.

Current options for the treatment of optic neuritis

Directory of Open Access Journals (Sweden)

Pula JH

2012-07-01

Full Text Available John H Pula,1 Christopher J MacDonald21Division of Neuro-ophthalmology, University of Illinois College of Medicine at Peoria, Peoria; 2University of Illinois College of Medicine at Urbana-Champaign, Champaign, IL, USAAbstract: Optic neuritis can be defined as typical (associated with multiple sclerosis, improving independent of steroid treatment, or atypical (not associated with multiple sclerosis, steroid-dependent improvement. Causes of atypical optic neuritis include connective tissue diseases (eg, lupus, vasculitis, sarcoidosis, or neuromyelitis optica. In this manuscript, updated treatment options for both typical and atypical optic neuritis are reviewed. Conventional treatments, such as corticosteroids, therapeutic plasma exchange, and intravenous immunoglobulin therapy are all discussed with commentary regarding evidence-based outcomes. Less commonly used treatments and novel purported therapies for optic neuritis are also reviewed. Special scenarios in the treatment of optic neuritis – pediatric optic neuritis, acute demyelinating encephalomyelitis, and optic neuritis occurring during pregnancy – are specifically examined.Keywords: optic neuritis, optic neuropathy, treatment, neuroophthalmology

Current and emerging treatment options for nasopharyngeal carcinoma

Directory of Open Access Journals (Sweden)

Spratt DE

2012-10-01

Full Text Available Daniel E Spratt, Nancy LeeDepartment of Radiation Oncology, Memorial Sloan-Kettering Cancer Center, New York, NY, USAAbstract: In this article, we focus on the current and emerging treatments in nasopharyngeal cancer (NPC. A detailed evolution of the current standard of care, and new techniques and treatment options will be reviewed. Intergroup 0099 established the role for chemoradiotherapy (chemo-RT in the treatment of nasopharyngeal carcinoma. Multiple randomized Phase III trials have shown the benefit of chemo-RT; however, none of these studies utilized modern radiotherapy (RT techniques of intensity-modulated radiation therapy (IMRT. IMRT has the ability to deliver high doses of radiation to the target structures while sparing adjacent bystander healthy tissues, and has now become the preferred RT treatment modality. Chemotherapy also has had a shifting paradigm of induction and/or adjuvant chemotherapy combined with RT alone, to the investigation with concurrent chemo-RT. New treatment options including targeted monoclonal antibodies and small molecule tyrosine kinase inhibitors are being studied in NPC. These new biologic therapies have promising in vitro activity for NPC, and emerging clinical studies are beginning to define their role. RT continues to expand its capabilities, and since IMRT and particle therapy, specifically intensity-modulated proton therapy (IMPT, has reports of impressive dosimetric efficacy in-silica. Adaptive RT is attempting to reduce toxicity while maintaining treatment efficacy, and the clinical results are still in their youth. Lastly, Epstein–Barr virus (EBV DNA has recently been studied for prediction of tumor response and its use as a biomarker is increasingly promising to aid in early detection as well as supplementing the current staging system. RT with or without chemotherapy remains the standard of care for nasopharyngeal carcinoma. Advances in RT technique, timing of chemotherapy, biologically

Treatment Options for Primary Nocturnal Enuresis by Parents in a ...

African Journals Online (AJOL)

femi oloka

common treatment option was waking up child at intervals during the night to void by 103 (45.2 ... patient/family education, simple behavioral ... nocturnal enuresis were employing in managing ..... Dental and Medical Sciences 2014;13:41 – 4.

Current and emerging treatment options for myopic choroidal neovascularization

Directory of Open Access Journals (Sweden)

El Matri L

2015-04-01

Full Text Available Leila El Matri, Ahmed Chebil, Fedra Kort Department B of Ophthalmology, Hedi Rais Institute of Ophthalmology, Faculty of Medicine of Tunis, University of El Manar, Tunis, Tunisia Abstract: Choroidal neovascularization (CNV is the main cause of visual impairment in highly myopic patients younger than 50 years of age. There are different treatments for myopic CNV (mCNV, with 5- to 10-year outcomes currently. Chorioretinal atrophy is still the most important determinant factor for visual outcome. The purpose of this study is to provide an overview of the current treatments for mCNV, including laser, surgical management, verteporfin photodynamic therapy, and mainly anti-vascular endothelial growth factor therapy. Emerging treatment options are also discussed. Keywords: myopia, choroidal neovascularization, current treatment, emerging treatment

Current and future treatment options in osteoporosis.

LENUS (Irish Health Repository)

Brewer, Linda

2012-02-01

PURPOSE: The incidence of osteoporosis-related fractures will increase substantially over the coming decades as the population ages globally. This has important economic and public health implications, contributing substantially to morbidity and excess mortality in this population. METHODS: When prescribing for older patients the effectiveness profile of drugs needs to be balanced against their tolerability in individual patients. RESULTS: Currently we have good anti-fracture data to support the use of many available anti-resorptive and anabolic drugs including bisphosphonates, strontium ranelate and recombinant human parathyroid hormone. We also have evidence to demonstrate the importance of calcium and vitamin D repletion in these patients. However, in recent years our understanding of normal bone physiology and the mechanisms underlying the development of osteoporosis has significantly advanced and this has led to the development of new therapies. Novel agents, particularly denosumab, but also inhibitors of cathepsin K and anabolic agents that act on Wnt signalling, will increase the therapeutic options for clinicians in the coming years. CONCLUSION: This review discusses the evidence supporting the use of currently available treatment options for osteoporosis and potential future advances in drug therapy. Particular consideration should be given when prescribing for certain older patients who have issues with compliance or tolerance and also in those with co-morbidities or levels of frailty that may restrict the choice of therapy. Understanding the evidence for the benefit and possible harm of osteoporosis treatments is critical to appropriate management of this patient population.

Options Assessment Report: Treatment of Nitrate Salt Waste at Los Alamos National Laboratory

Energy Technology Data Exchange (ETDEWEB)

Robinson, Bruce Alan [Los Alamos National Lab. (LANL), Los Alamos, NM (United States); Stevens, Patrice Ann [Los Alamos National Lab. (LANL), Los Alamos, NM (United States)

2015-12-17

This report documents the methodology used to select a method of treatment for the remediated nitrate salt (RNS) and unremediated nitrate salt (UNS) waste containers at Los Alamos National Laboratory (LANL). The method selected should treat the containerized waste in a manner that renders the waste safe and suitable for transport and final disposal in the Waste Isolation Pilot Plant (WIPP) repository, under specifications listed in the WIPP Waste Acceptance Criteria (DOE/CBFO, 2013). LANL recognizes that the results must be thoroughly vetted with the New Mexico Environment Department (NMED) and that a modification to the LANL Hazardous Waste Facility Permit is a necessary step before implementation of this or any treatment option. Likewise, facility readiness and safety basis approvals must be received from the Department of Energy (DOE). This report presents LANL’s preferred option, and the documentation of the process for reaching the recommended treatment option for RNS and UNS waste, and is presented for consideration by NMED and DOE.

Options assessment report: Treatment of nitrate salt waste at Los Alamos National Laboratory

Energy Technology Data Exchange (ETDEWEB)

Robinson, Bruce Alan [Los Alamos National Lab. (LANL), Los Alamos, NM (United States); Stevens, Patrice Ann [Los Alamos National Lab. (LANL), Los Alamos, NM (United States)

2015-09-16

This report documents the methodology used to select a method of treatment for the remediated nitrate salt (RNS) and unremediated nitrate salt (UNS) waste containers at Los Alamos National Laboratory (LANL). The method selected should treat the containerized waste in a manner that renders the waste safe and suitable for transport and final disposal in the Waste Isolation Pilot Plant (WIPP) repository, under specifications listed in the WIPP Waste Acceptance Criteria (DOE/CBFO, 2013). LANL recognized that the results must be thoroughly vetted with the New Mexico Environment Department (NMED) and the a modification to the LANL Hazardous Waste Facility Permit is a necessary step before implementation of this or any treatment option. Likewise, facility readiness and safety basis approvals must be received from the Department of Energy (DOE). This report presents LANL's preferred option, and the documentation of the process for reaching the recommended treatment option for RNS and UNS waste, and is presented for consideration by NMED and DOE.

Gastroparesis: a review of current and emerging treatment options

Directory of Open Access Journals (Sweden)

Enweluzo C

2013-09-01

Full Text Available Chijioke Enweluzo, Fahad AzizHospital Medicine, Department of Internal Medicine, Wake Forest School of Medicine, Winston Salem, NC, USAAbstract: Gastroparesis is a motility disorder of the stomach causing delay in food emptying from the stomach without any evidence of mechanical obstruction. The majority of cases are idiopathic. Patients need to be diagnosed properly by formal testing, and the evaluation of the severity of the gastroparesis may assist in guiding therapy. Initially, dietary modifications are encouraged, which include frequent and small semisolid-based meals. Promotility medications, like erythromycin, and antiemetics, like prochlorperazine, are offered for symptom relief. In patients who are refractory to pharmacologic treatment, more invasive options, such as intrapyloric botulinum toxin injections, placement of a jejunostomy tube, or implantation of a gastric stimulator, can be considered. Hemin therapy and gastric electric stimulation are emerging treatment options that are still at different stages of research. Regenerative medicine and stem cell-based therapies also hold promise for gastroparesis in the near future.Keywords: Gastroparesis, gastric emptying, gastric electrical stimulation, hemin

Male contraception.

Science.gov (United States)

Amory, John K

2016-11-01

Although female contraceptives are very effective at preventing unintended pregnancy, some women can not use them because of health conditions or side-effects, leaving some couples without effective contraceptive options. In addition, many men wish to take active responsibility for family planning. Thus, there is a great need for male contraceptives to prevent unintended pregnancies, of which 80-90 million occur annually. At present, effective male contraceptive options are condoms and vasectomy, which are not ideal for all men. Therefore, efforts are under way to develop novel male contraceptives. This paper briefly reviews the advantages and disadvantages of condoms and vasectomies and then discusses the research directed toward development of novel methods of male contraception. Copyright © 2016 American Society for Reproductive Medicine. Published by Elsevier Inc. All rights reserved.

Treatment of Male Sexual Offenders in a Correctional Facility.

Science.gov (United States)

Whitford, Robert W.

1987-01-01

Provides some background and treatment perspectives for counselors and psychologists who treat or contemplate treatment of adult male sexual offenders in prison settings. Discusses identification, assessment, amenability to treatment, assessment instruments, and treatment of sexual offenders. (ABL)

SURGICAL TREATMENT OF HEMORRHOIDS: A CRITICAL APPRAISAL OF THE CURRENT OPTIONS

Science.gov (United States)

CERATO, Marlise Mello; CERATO, Nilo Luiz; PASSOS, Patrícia; TREIGUE, Alberto; DAMIN, Daniel C.

2014-01-01

Introduction Surgical treatment of hemorrhoids is still a dilemma. New techniques have been developed leading to a lower rate of postoperative pain; however, they are associated with a greater likelihood of recurrence. Aim To review current indications as well as the results and complications of the main techniques currently used in the surgical treatment of hemorrhoidal disease. Methods A systematic search of the published data on the options for treatment of hemorrhoids up to December 2012 was conducted using Medline/PubMed, Cochrane, and UpToDate. Results Currently available surgical treatment options include procedure for prolapse and hemorrhoids (PPH), transanal hemorrhoidal dearterialization (THD), and conventional hemorrhoidectomy techniques. Excisional techniques showed similar results regarding pain, time to return to normal activities, and complication rates. PPH and THD were associated with less postoperative pain and lower complication rates; however, both had higher postoperative recurrence rates. Conclusion Conventional surgical techniques yield better long-term results. Despite good results in the immediate postoperative period, PPH and THD have not shown consistent long-term favorable results. PMID:24676303

Current options for palliative treatment in patients with pancreatic cancer.

Science.gov (United States)

Ridwelski, K; Meyer, F

2001-01-01

Palliative treatment is often the only remaining option in the management of pancreatic carcinoma, but its efficacy is poor due to low tumor sensitivity and inadequate treatment protocols. There are several options of palliative treatment with antitumor or supportive intention. Classical end points of palliative treatment are survival, tumor response, and quality of life. A decade ago, palliative chemotherapy consisted mainly of 5-fluorouracil as the standard agent in combination with either other agents and/or radiotherapy. Only the new antineoplastic drug gemcitabine, which was introduced simultaneously with the definition of novel end points of chemotherapy such as clinical benefit, allowed to achieve some progress. However, while gemcitabine monotherapy appeared to be superior to 5-fluorouracil and improved important parameters of quality of life, it could not provide a significant improvement of survival. A novel concept, therefore, is to improve this beneficial cytostatic response in pancreatic carcinoma using a gemcitabine-based protocol by combining it with antineoplastic drugs such as taxanes or platin analogs. This strategy may have the potential to improve the outcome in palliative chemotherapy of pancreatic carcinoma patients with advanced tumor growth or metastases. Best supportive care in pancreatic cancer consists of the treatment of symptoms, such as pain, jaundice, duodenal obstruction, weight loss, exocrine pancreatic insufficiency, and tumor-associated depression. Copyright 2001 S. Karger AG, Basel

Managing AVN following internal fixation: treatment options and clinical results.

Science.gov (United States)

Hoskinson, Simon; Morison, Zachary; Shahrokhi, Shahram; Schemitsch, Emil H

2015-03-01

Avascular necrosis (AVN) after internal fixation of intracapsular hip fractures is a progressive multifactorial disease that ultimately results in local ischemia with ensuing osteocyte necrosis and structural compromise. This disease can cause significant clinical morbidity and affects patients of any age, including young and active patients. Effective treatment of this condition among young adults is challenging due to their high functional demands. The aim of managing AVN is to relieve pain, preserve range of movement and improve function. Treatment methods vary depending on the stage of the disease and can be broadly categorised into two options, hip preserving surgery and hip arthroplasty. Although, hip preserving techniques are attractive in the young adult, they may alter the morphology of the proximal femur and make subsequent arthroplasty more challenging. Conversely, arthroplasty in the young adult may require repeat revision procedures throughout the patient's life. Current evidence suggests that modifications of prevailing treatments, in addition to new technologies, have led to the development of management strategies that may be able to alter the course of femoral head osteonecrosis. This review aims to summarise the options available for treatment of AVN in the young adult and review the clinical results. Copyright © 2014 Elsevier Ltd. All rights reserved.

Grey water characteristics and treatment options for rural areas in Jordan.

Science.gov (United States)

Halalsheh, M; Dalahmeh, S; Sayed, M; Suleiman, W; Shareef, M; Mansour, M; Safi, M

2008-09-01

Low water consumption in rural areas in Jordan had resulted in the production of concentrated grey water. Average COD, BOD and TSS values were 2568mg/l, 1056mg/l and 845mg/l, respectively. The average grey water generation was measured to be 14L/c.d. Three different treatment options were selected based on certain criterions, and discussed in this article. The examined treatment systems are septic tank followed by intermittent sand filter; septic tank followed by wetlands; and UASB-hybrid reactor. Advantages and disadvantages of each system are presented. It was concluded that UASB-hybrid reactor would be the most suitable treatment option in terms of compactness and simplicity in operation. The volume of UASB-hybrid reactor was calculated to be 0.268m(3) with a surface area of 0.138m(2) for each house having 10 inhabitants on average. Produced effluent is expected to meet Jordanian standards set for reclaimed water reuse in irrigating fruit trees.

Evaluation and treatment of male hypogonadism in primary care.

Science.gov (United States)

Pickett, Kim Anne

2016-08-18

Male hypogonadism is increasing in prevalence, particularly in the older male population. Signs and symptoms associated with hypogonadism are often nonspecific and may be difficult to categorize. This article discusses parameters for screening patients at risk, reviews how to establish the diagnosis of primary or secondary male hypogonadism, and offers important considerations for treatment of patients with hypogonadism.

Accounting treatment of currency options

Directory of Open Access Journals (Sweden)

Prošić Danica

2016-01-01

Full Text Available Currency options are often used to mitigate currency risk resulting from corporate activities. Their implementation can be complex, and there could be problems if the essential elements and principles are not fully understood. Although they are not the simplest financial products, currency options are interesting and useful to those who are trying to make a step forward in the area of currency risk management. This paper aims to present the general principles and specifics of accounting records and valuation of currency options used for hedging against risk. It is a complex process which, in addition to numerous conditions, also involves the implementation of accounting rules that deviate from the generally accepted accounting principles.

Current Treatment Options in Challenging Oral Diseases: Burning Mouth Syndrome

OpenAIRE

Bilgen Erdoğan; Murat Yılmaz

2012-01-01

Burning mouth syndrome is a chronic condition characterized by burning pain without any signs of an oral mucosal pathology, that usually affects postmenopausal women. Burning sensation is often accompanied by dysgeusia and xerostomia. The pathogenesis of the disease is unknown and an effective treatment option for most of the patients has not been defined yet. The aim of this review is to present current pharmacological and physicological treatments of burning mouth syndrome.

Current Treatment Options in Challenging Oral Diseases: Burning Mouth Syndrome

Directory of Open Access Journals (Sweden)

Bilgen Erdoğan

2012-12-01

Full Text Available Burning mouth syndrome is a chronic condition characterized by burning pain without any signs of an oral mucosal pathology, that usually affects postmenopausal women. Burning sensation is often accompanied by dysgeusia and xerostomia. The pathogenesis of the disease is unknown and an effective treatment option for most of the patients has not been defined yet. The aim of this review is to present current pharmacological and physicological treatments of burning mouth syndrome.

Twenty-five milligrams of clomiphene citrate presents positive effect on treatment of male testosterone deficiency - a prospective study

Directory of Open Access Journals (Sweden)

Carlos Teodósio Da Ros

2012-08-01

Full Text Available INTRODUCTION: Male testosterone deficiency is associated with bad sexual function and quality of life (QoL. The aim of this study was to determine whether a daily dose of 25 mg clomiphene citrate (CC is effective in stimulating the endogenous testosterone production pathway and to address the applicability of this medication as a therapeutic option for symptomatic hypogonadism. MATERIALS AND METHODS: This was a prospective study. Men with low sexual desire and testosterone levels (T below 400 ng/dL were selected to receive CC. Blood samples were obtained to determine baseline measurements of serum T, estradiol, LH, lipid profile and fasting plasma glucose. Each patient was treated with a daily dose of 25 mg CC for at least 3 months. Patients were asked if they experienced any side effects related to the use of CC and if they experienced any improvement in their sexual profile. Paired samples T-test was utilized to analyze responses to therapy. RESULTS: Our cohort consisted of 125 men with hypogonadism and low libido. Mean age was 62 years (± 11.1 years. Serum T levels ranged from 309 ng/dL (baseline, mean value to 642 ng/dL (3 months after CC initiation, mean value (p < 0.001. Serum cholesterol levels ranged from 197 to 186 mg/dL (p = 0.003. There were no statistically significant differences when comparing pre and post-treatment HDL-Cholesterol, triglycerides, fasting plasma glucose and prolactin. All men reported improvements in the post-treatment QoL scores. No serious adverse events were recorded. CONCLUSIONS: The CC was effective in stimulating the endogenous production of testosterone. A lower level of total cholesterol was verified after three months of treatment. This medication should be considered as a therapeutic option for some patients with symptomatic male testosterone deficiency.

Treatment of Male Infertility: A Brief Overview

Directory of Open Access Journals (Sweden)

Slobodan Vlajković

2012-01-01

Full Text Available Development of germ cells is a process starting in fetus and completed only in puberty. Spermatogonial stem cells maintain spermatogenesis throughout the reproductive life of mammals. They are undifferentiated cells defined by their ability to both self-renew and differentiate into mature spermatozoa. This self-renewal and differentiation in turn is tightly regulated by a combination of intrinsic gene expression as well as the extrinsic gene signals from the local tissue microenvironment. The human testis is prone to damage, either for therapeutic reasons or because of toxic agents from the environment. For preservation of fertility, patients who will undergo radiotherapy and/or chemotherapy have an attractive possibility to keep in store and afterwards make a transfer of spermatogonial stem cells. Germ cell transplantation is not yet ready for the human fertility clinic, but it may be reasonable for young cancer patients, with no other options to preserve their fertility. Whereas this technique has become an important research tool in rodents, a clinical application must still be regarded as experimental, and many aspects of the procedure need to be optimized prior to a clinical application in men. In future, a range of options for the preservation of male fertility will get a new significance.

Emerging medication for the treatment of male hypogonadism.

Science.gov (United States)

Aydogdu, Aydogan; Swerdloff, Ronald S

2016-09-01

Male hypogonadism is characterized by inadequate production of Testosterone (T) (hypoandrogenism) and deficiencies in spermatogenesis. The main treatment of male hypogonadism is T replacement therapy (TRT), but for some of the patients, alternative drugs may be more suitable. The available literature of T and alternative treatments for male hypogonadism are discussed. Transdermal application of T gels are the most commonly used route of T administration. Some oral T formulations are either associated with hepatic toxicity (i.e. methyltestosterone) or short half-lives that require multiple doses per day (i.e. oral testosterone undecanoate). Short acting, injectable T formulations are also available. If the patient prefers not to use daily drugs or short acting injectable formulations, depot formulations such as injectable testosterone undecanoate (TU) may be a good alternative. If the patient has hypogonadotropic hypogonadism and desires fertility or if he is adolescent, instead of TRT, gonadotropins can be started to stimulate testicular growth and spermatogenesis. In obese patients or for the patients having high risks for TRT, off label aromatase inhibitors (AI) and clomiphene citrate (CC), may be considered to stimulate LH, FSH and T levels. In patients with high prostate disease risk, selective androgen receptor modulators may be an alternative treatment but these latter treatments have not had high level evidence.

Endometriosis-associated infertility: aspects of pathophysiological mechanisms and treatment options.

Science.gov (United States)

Tanbo, Tom; Fedorcsak, Peter

2017-06-01

Endometriosis is a common condition in women of reproductive age. In addition to pain, endometriosis may also reduce fertility. The causes of infertility in women with endometriosis may range from anatomical distortions due to adhesions and fibrosis to endocrine abnormalities and immunological disturbances. In some cases, the various pathophysiological disturbances seem to interact through mechanisms so far not fully understood. Whether surgery should be offered as a treatment option in endometriosis-associated infertility has become controversial, partly due to its modest or undocumented effect. Medical or hormonal treatment alone has little or no effect and should only be used in conjunction with assisted reproductive technology (ART). Of the various methods of ART, intrauterine insemination, due to its simplicity, can be recommended in women with minimal or mild peritoneal endometriosis, even though insemination may yield a lower success rate than in women without endometriosis. In vitro fertilization (IVF) is an effective treatment option in less-advanced disease stages, and the success rates are similar to the results in other causes of infertility. However, women with more advanced stages of endometriosis have lower success rates with IVF. © 2016 Nordic Federation of Societies of Obstetrics and Gynecology.

Treatment options for permanent teeth with deep caries

OpenAIRE

Marending, Monika; Attin, Thomas; Zehnder, Matthias

2016-01-01

The goal of this narrative review was to summarize and compare treatment options for permanent teeth carious lesions that are radiographically close to the pulp chamber. Thanks to adhesive restorative materials, minimally invasive approaches are possible. In this context, the old question arises as to whether caries must be excavated completely, i.e., down to hard dentin, or whether it could be advantageous to leave some soft dentin, or even merely seal the whole lesion. To answer this questi...

Effluent treatment options for nuclear thermal propulsion system ground tests

International Nuclear Information System (INIS)

Shipers, L.R.; Brockmann, J.E.

1992-01-01

A variety of approaches for handling effluent from nuclear thermal propulsion system ground tests in an environmentally acceptable manner are discussed. The functional requirements of effluent treatment are defined and concept options are presented within the framework of these requirements. System concepts differ primarily in the choice of fission-product retention and waste handling concepts. The concept options considered range from closed cycle (venting the exhaust to a closed volume or recirculating the hydrogen in a closed loop) to open cycle (real time processing and venting of the effluent). This paper reviews the strengths and weaknesses of different methods to handle effluent from nuclear thermal propulsion system ground tests

The Male Aesthetic Patient: Facial Anatomy, Concepts of Attractiveness, and Treatment Patterns.

Science.gov (United States)

Keaney, Terrence C; Anolik, Robert; Braz, André; Eidelman, Michael; Eviatar, Joseph A; Green, Jeremy B; Jones, Derek H; Narurkar, Vic A; Rossi, Anthony M; Gallagher, Conor J

2018-01-01

BACKGROUND: The number of nonsurgical aesthetic procedures performed in men is growing rapidly. However, there are limited data on treatment principles and goals for the male aesthetic patient. OBJECTIVE: To review the objective data available on male aging and aesthetics and to synthesize with expert opinion on treatment considerations specific to male patients. METHODS: Expert advisors met to discuss anatomical differences in male versus female facial anatomy related to aging, facial treatment preferences in aesthetically oriented men, and current dosing data for facial injectable treatments in male versus female patients. RESULTS: Symmetry, averageness, sexual dimorphism, and youthfulness are generally accepted as factors that contribute to the perception of attractiveness. There are differences between men and women in facial anatomy, concepts of attractiveness in the context of masculinity and femininity, and treatment objectives. A communication gap exists for men, as evidenced by the lack of information available online or by word of mouth about injectable treatments. CONCLUSIONS: Approaches to aesthetic consultation and treatment should differ between men and women based on the fundamental dissimilarities between the sexes. Educating men about available aesthetic treatments and about the safety and side effects associated with each treatment, as well as addressing concerns about their treatment results looking natural, are key considerations. J Drugs Dermatol. 2018;17(1):19-28..

Bronchiolitis obliterans after allo-SCT: clinical criteria and treatment options

DEFF Research Database (Denmark)

Uhlving, H H; Buchvald, F; Heilmann, C J

2012-01-01

Bronchiolitis obliterans (BO) following allogeneic haematopoietic SCT (HSCT) is a serious complication affecting 1.7-26% of the patients, with a reported mortality rate of 21-100%. It is considered a manifestation of chronic graft-versus-host disease, but our knowledge of aetiology and pathogenes...... treatment options for BO and presents the treatment results with HDPM in a paediatric national HSCT-cohort.Bone Marrow Transplantation advance online publication, 29 August 2011; doi:10.1038/bmt.2011.161....

[Female sexual dysfunction: Drug treatment options].

Science.gov (United States)

Alcántara Montero, A; Sánchez Carnerero, C I

2016-01-01

Many women will likely experience a sexual problem in their lifetime. Female sexual dysfunction is a broad term used to describe 3 categories of disorders of a multifactorial nature. Effective, but limited pharmacotherapeutic options exist to address female sexual dysfunction. The FDA recently approved the first agent for treatment of hypoactive sexual desire disorder in pre-menopausal women. Off-label use of hormonal therapies, particularly oestrogen and testosterone, are the most widely employed for female sexual dysfunction, particularly in post-menopausal women. Other drugs currently under investigation include phosphodiesterase inhibitors and agents that modulate dopamine or melanocortin receptors. Copyright © 2016 Sociedad Española de Médicos de Atención Primaria (SEMERGEN). Publicado por Elsevier España, S.L.U. All rights reserved.

Treatment of Leukocytospermia in Male Infertility: A Systematic Review

Directory of Open Access Journals (Sweden)

Jae Hung Jung

2016-12-01

Full Text Available Male factors account for 20% to 50% of infertility cases, and infection in the genitourinary tract may play a contributing role in up to 15% of male infertility. Leukocytospermia is a well-known indicator of infection or inflammation in the male sex glands and the urogenital tract. Although great deal of effort has been expended to elucidate definite management strategies in infertile men with leukocytospermia, the gold standard of treatment remains unclear. Until recently, broad spectrum antibiotics and antioxidants have been used in the treatment of leukocytospermia for male infertility to eliminate infection and reduce reactive oxygen free radicals produced inside cellular mitochondria as a result of inflammation. The present review reveals that antibiotics might improve sperm parameters, the rate of resolution of leukocytospermia, the bacteriologic cure rate, and even the pregnancy rate, although some reports conflict. Antioxidants might also have clinical benefits for sperm function as shown by in vitro studies. However, the data are insufficient to conclude whether antibiotics and antioxidants for the treatment of infertile men with leukocytospermia are effective or not. Better designed investigations into leukocytospermia are needed.

Treatment Option Overview (Male Breast Cancer)

Science.gov (United States)

... Common Cancer Types Recurrent Cancer Common Cancer Types Bladder Cancer Breast Cancer Colorectal Cancer Kidney (Renal Cell) Cancer ... back). Tests include the following: Estrogen and progesterone receptor test : A test to measure the amount of ...

Treatment Options for Male Breast Cancer

Science.gov (United States)

... Common Cancer Types Recurrent Cancer Common Cancer Types Bladder Cancer Breast Cancer Colorectal Cancer Kidney (Renal Cell) Cancer ... back). Tests include the following: Estrogen and progesterone receptor test : A test to measure the amount of ...

Assessment of options for the treatment of Sizewell PWR liquid effluent

International Nuclear Information System (INIS)

Hornby, J.; Allam, J.; Knibbs, R.H.

1992-01-01

This report describes the origins of PWR liquid waste streams, their composition and rates of arising. Data has been collected from operational PWRs and estimates obtained for Sizewell B PWR liquid waste streams. Current liquid waste treatment practices are reviewed and assessments made of established and novel treatment techniques which could be applicable to Sizewell B. A short list of treatment options is given and recommendations are made relating to established treatment technologies suitable for Sizewell B and also to development work on more novel treatments which could lead to a reduction in waste disposal volumes. (author)

Adynamic Graciloplasty With a Pedicled Gracilis Muscle Flap Wrapped Around Bulbar Urethra for Treatment of Male Acquired Urinary Incontinence.

Science.gov (United States)

Guo, Hailin; Sa, Yinglong; Xu, Yuemin; Wang, Lin; Fei, Xiaofang

2016-05-01

To evaluate the efficacy of adynamic gracilis urethral myoplasty with a pedicled gracilis muscle flap wrapped around bulbar urethra for treatment of male acquired urinary incontinence. Twenty-four patients with acquired urinary incontinence (8 after radical prostatectomy, 7 after transurethral resection of the prostate, and 9 after posterior urethroplasty) were included in our study. Eighteen of these patients (75.0%) had mild to moderate urinary incontinence, and 6 (25.0%) had severe urinary incontinence. All patients received adynamic gracilis urethral myoplasty with a pedicled gracilis muscle flap wrapped around bulbar urethra and had a close follow-up. The mean postoperative maximum urethral pressure after the gracilis muscle wrapped around bulbar urethra was significantly higher than that of the preoperative measurements (P urethra can raise the urethral pressure. Adynamic graciloplasty with a pedicled gracilis muscle flap wrapped around bulbar urethra is a safe and effective surgical option in the treatment of male patients with mild to moderate incontinence, but is not suitable for severe incontinence. Copyright © 2016 Elsevier Inc. All rights reserved.

Ragweed-induced allergic rhinoconjunctivitis: current and emerging treatment options

Directory of Open Access Journals (Sweden)

Ihler F

2015-02-01

Full Text Available Friedrich Ihler, Martin CanisDepartment of Otorhinolaryngology, University Medical Center Göttingen, Göttingen, GermanyAbstract: Ragweed (Ambrosia spp. is an annually flowering plant whose pollen bears high allergenic potential. Ragweed-induced allergic rhinoconjunctivitis has long been seen as a major immunologic condition in Northern America with high exposure and sensitization rates in the general population. The invasive occurrence of ragweed (A. artemisiifolia poses an increasing challenge to public health in Europe and Asia as well. Possible explanations for its worldwide spread are climate change and urbanization, as well as pollen transport over long distances by globalized traffic and winds. Due to the increasing disease burden worldwide, and to the lack of a current and comprehensive overview, this study aims to review the current and emerging treatment options for ragweed-induced rhinoconjunctivitis. Sound clinical evidence is present for the symptomatic treatment of ragweed-induced allergic rhinoconjunctivitis with oral third-generation H1-antihistamines and leukotriene antagonists. The topical application of glucocorticoids has also been efficient in randomized controlled clinical trials. Combined approaches employing multiple agents are common. The mainstay of causal treatment to date, especially in Northern America, is subcutaneous immunotherapy with the focus on the major allergen, Amb a 1. Beyond this, growing evidence from several geographical regions documents the benefit of sublingual immunotherapy. Future treatment options promise more specific symptomatic treatment and fewer side effects during causal therapy. Novel antihistamines for symptomatic treatment are aimed at the histamine H3-receptor. New adjuvants with toll-like receptor 4 activity or the application of the monoclonal anti-immunoglobulin E antibody, omalizumab, are supposed to enhance conventional immunotherapy. An approach targeting toll-like receptor 9 by

Vaccines against drugs of abuse: a viable treatment option?

Science.gov (United States)

Kantak, Kathleen M

2003-01-01

Drug addiction is a chronically relapsing brain disorder. There is an urgent need for new treatment options for this disease because the relapse rate among drug abusers seeking treatment is quite high. During the past decade, many groups have explored the feasibility of using vaccines directed against drugs of abuse as a means of eliminating illicit drug use as well as drug overdose and neurotoxicity. Vaccines work by inducing drug-specific antibodies in the bloodstream that bind to the drug of abuse and prevent its entry into the brain. The majority of work in this area has been conducted with vaccines and antibodies directed against cocaine and nicotine. On the basis of preclinical work, vaccines for cocaine and nicotine are now in clinical trials because they can offer long-term protection with minimal treatment compliance. In addition, vaccines and antibodies for phencyclidine, methamphetamine and heroin abuse are currently under development. An underlying theme in this research is the need for high concentrations of circulating drug-specific antibodies to reduce drug-seeking and drug-taking behaviour when the drug is repeatedly available, especially in high doses. Although vaccines against drugs of abuse may become a viable treatment option, there are several drawbacks that need to be considered. These include: a lack of protection against a structurally dissimilar drug that produces the same effects as the drug of choice;a lack of an effect on drug craving that predisposes an addict to relapse; and tremendous individual variability in antibody formation. Forced or coerced vaccination is not likely to work from a scientific perspective, and also carries serious legal and ethical concerns. All things considered, vaccination against a drug of abuse is likely to work best with individuals who are highly motivated to quit using drugs altogether and as part of a comprehensive treatment programme. As such, the medical treatment of drug abuse will not be radically

New treatment options for fibromyalgia: critical appraisal of duloxetine

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Nurcan Üçeyler

2008-06-01

Full Text Available Nurcan Üçeyler1, Martin Offenbächer2, Frank Petzke3, Winfried Häuser4, Claudia Sommer11Department of Neurology, University of Würzburg, Germany; 2GRP – Generation Research Program, Human Science Center, University of Munich, Germany; 3Department of Anesthesiology, University of Cologne, Germany; 4Center of Pain Therapy, Klinikum Saarbrücken gGmbH, Winterberg 1, Saarbrücken, GermanyAbstract: Fibromyalgia syndrome (FMS is a chronic condition characterized by widespread pain, tender points, fatigue, and sleep disturbance. FMS leads to high disability levels, poor quality of life, and extensive use of medical care. Effective pharmacological treatment options are rare, and treatment effects are often of limited duration. Duloxetine is a new selective serotonin and norepinephrine reuptake inhibitor that is licensed for the treatment of pain in diabetic neuropathy. So far two randomized, placebo-controlled trials have investigated the short-term safety and efficacy of duloxetine 60 mg/day and 120 mg/day in patients suffering from FMS over a period of 12 weeks. Both dosages were superior to placebo in pain relief, and improvement in quality of life and depressive symptoms. The analgesic effect was largely independent of the antidepressant action of duloxetine. The higher dose of 120 mg/day further reduced the tender point count and elevated the tender point pain thresholds. Only mild to moderate adverse effects were reported. Duloxetine 60 mg/day and 120 mg/day has proven to be beneficial in the treatment of FMS symptoms. As true for other antidepressants further studies are needed to assess the long-term efficacy and safety of duloxetine as an additional pharmacological treatment option in FMS.Keywords: fibromyalgia syndrome, duloxetine, antidepressant, review, SNRI

Pelvic radiation disease: Updates on treatment options

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Frazzoni, Leonardo; La Marca, Marina; Guido, Alessandra; Morganti, Alessio Giuseppe; Bazzoli, Franco; Fuccio, Lorenzo

2015-01-01

Pelvic cancers are among the most frequently diagnosed neoplasms and radiotherapy represents one of the main treatment options. The irradiation field usually encompasses healthy intestinal tissue, especially of distal large bowel, thus inducing gastrointestinal (GI) radiation-induced toxicity. Indeed, up to half of radiation-treated patients say that their quality of life is affected by GI symptoms (e.g., rectal bleeding, diarrhoea). The constellation of GI symptoms - from transient to long-term, from mild to very severe - experienced by patients who underwent radiation treatment for a pelvic tumor have been comprised in the definition of pelvic radiation disease (PRD). A correct and evidence-based therapeutic approach of patients experiencing GI radiation-induced toxicity is mandatory. Therapeutic non-surgical strategies for PRD can be summarized in two broad categories, i.e., medical and endoscopic. Of note, most of the studies have investigated the management of radiation-induced rectal bleeding. Patients with clinically significant bleeding (i.e., causing chronic anemia) should firstly be considered for medical management (i.e., sucralfate enemas, metronidazole and hyperbaric oxygen); in case of failure, endoscopic treatment should be implemented. This latter should be considered the first choice in case of acute, transfusion requiring, bleeding. More well-performed, high quality studies should be performed, especially the role of medical treatments should be better investigated as well as the comparative studies between endoscopic and hyperbaric oxygen treatments. PMID:26677440

Evaluation of nasal and oropharyngeal flora in patients with acne vulgaris according to treatment options.

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Ozuguz, Pınar; Callioglu, Elif E; Tulaci, Kamil G; Kacar, Seval D; Balta, Ilknur; Asik, Gulsah; Karatas, Serap; Karaca, Semsettin

2014-11-01

The aim of this study was to evaluate changes in nasal and oropharyngeal flora in patients with acne during treatments with tetracycline and isotretinoin. Swab specimens were taken from the right and left nasal cavities and oropharynx of 55 patients with acne and 20 healthy volunteers who were admitted to the dermatology department (Etlik Educational and Research Hospital, Ankara, Turkey) before the administration of treatment and in the third month of treatment. Study participants were divided into four groups as follows: patients with acne on topical treatment only, systemic isotretinoin, and systemic tetracycline, and the control group. Of 55 patients with acne, 18 were male and 37 were female. The mean age of the patients and the control group was 22.21 ± 4.22 and 21.95 ± 7.64, respectively. Staphylococcus aureus was isolated from the nasal flora of five patients, normal flora was suppressed in the oropharyngeal cultures of seven patients, and normal flora grew in the cultures of the other 20 patients who were on tetracycline treatment. On the other hand, normal flora grew in the nasal and oropharyngeal cultures of all the patients who were on isotretinoin treatment. Treatment options and follow-up procedures for acne vulgaris may lead to the development of bacterial resistance and damage to flora. In particular, systemic tetracycline treatment leads to changes in flora of the nose and throat in patients with acne with an increased carriage of S. aureus. Therefore, careful attention should be paid to the duration of tetracycline treatment in order to not increase the risk of disturbance of microbial flora. © 2014 The International Society of Dermatology.

Novel treatment options for portal hypertension

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Laleman, Wim

2017-01-01

Abstract Portal hypertension is most frequently associated with cirrhosis and is a major driver for associated complications, such as variceal bleeding, ascites or hepatic encephalopathy. As such, clinically significant portal hypertension forms the prelude to decompensation and impacts significantly on the prognosis of patients with liver cirrhosis. At present, non-selective β-blockers, vasopressin analogues and somatostatin analogues are the mainstay of treatment but these strategies are far from satisfactory and only target splanchnic hyperemia. In contrast, safe and reliable strategies to reduce the increased intrahepatic resistance in cirrhotic patients still represent a pending issue. In recent years, several preclinical and clinical trials have focused on this latter component and other therapeutic avenues. In this review, we highlight novel data in this context and address potentially interesting therapeutic options for the future. PMID:28533907

Treatment Options for Severe Obesity in the Pediatric Population: Current Limitations and Future Opportunities.

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Ryder, Justin R; Fox, Claudia K; Kelly, Aaron S

2018-06-01

Severe obesity is the only obesity classification increasing in prevalence among children and adolescents. Treatment options that produce meaningful and sustained weight loss and comorbidity resolution are urgently needed. The purpose of this review is to provide a brief overview of the current treatment options for pediatric severe obesity and offer suggestions regarding future opportunities for accelerating the development and evaluation of innovative treatment strategies. At present, there are three treatment options for youth with severe obesity: lifestyle modification therapy, pharmacotherapy, and bariatric surgery. Lifestyle modification therapy can be useful for improving many chronic disease risk factors and comorbid conditions but often fails to achieve clinically meaningful and sustainable weight loss. Pharmacotherapy holds promise as an effective adjunctive treatment but remains in the primordial stages of development in the pediatric population. Bariatric surgery provides robust weight loss and risk factor/comorbidity improvements but is accompanied by higher risks and lower uptake compared to lifestyle modification therapy and pharmacotherapy. New areas worth pursuing include combination pharmacotherapy, device therapy, identification of predictors of response aimed at precision treatment, and interventions in the postbariatric surgical setting to improve long-term outcomes. Treating pediatric severe obesity effectively and safely is extremely challenging. Some progress has been made, but substantially more effort and innovation are needed in the future to combat this serious and ongoing medical and public health issue. © 2018 The Obesity Society.

Ustekinumab as an Alternative Treatment Option for Chronic Pityriasis Rubra Pilaris

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Mudit Chowdhary

2015-03-01

Full Text Available Pityriasis rubra pilaris (PRP is an exceptionally rare, chronic inflammatory dermatosis of unknown etiology. Patients classically present with small, follicular keratosis and salmon-colored plaques that begin at the head and neck and slowly progress to widespread erythroderma including the palms and soles. It is difficult to distinguish PRP from other inflammatory dermatoses; however, features that help aid in the diagnosis include ‘islands' of spared skin, orangish hue and typical findings on biopsy. There are no specific guidelines on therapy and treatment options include corticosteroids, vitamin D analogs, retinoids, methotrexate, cyclosporine, azathioprine and tumor necrosis factor alpha antagonists. Unfortunately options are limited for patients when these drugs do not work. We report a case of chronic PRP, refractory to conventional treatment, successfully treated with ustekinumab monotherapy. The patient was treated with 90 mg subcutaneous ustekinumab injections and began to show improvement within only 8 weeks. Long-term control of the disease has been attained without any significant side effects. We report this case to show that ustekinumab can be used as an alternative treatment method for patients with chronic, unremitting PRP. Treatment response is remarkably rapid and the infrequent dosing leads to patient compliance and a significantly improved quality of life.

Treatment options for polycystic ovary syndrome

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Ahmed Badawy

2011-02-01

Full Text Available Ahmed Badawy1 Abubaker Elnashar21Department of Obstetrics and Gynecology, Mansoura University, Mansoura, Egypt; 2Department of Obstetrics and Gynecology, Benha University, Benha, EgyptAbstract: Polycystic ovary syndrome (PCOS is the most common endocrine disorder in women. The clinical manifestation of PCOS varies from a mild menstrual disorder to severe disturbance of reproductive and metabolic functions. Management of women with PCOS depends on the symptoms. These could be ovulatory dysfunction-related infertility, menstrual disorders, or androgen-related symptoms. Weight loss improves the endocrine profile and increases the likelihood of ovulation and pregnancy. Normalization of menstrual cycles and ovulation could occur with modest weight loss as little as 5% of the initial weight. The treatment of obesity includes modifications in lifestyle (diet and exercise and medical and surgical treatment. In PCOS, anovulation relates to low follicle-stimulating hormone concentrations and the arrest of antral follicle growth in the final stages of maturation. This can be treated with medications such as clomiphene citrate, tamoxifen, aromatase inhibitors, metformin, glucocorticoids, or gonadotropins or surgically by laparoscopic ovarian drilling. In vitro fertilization will remain the last option to achieve pregnancy when others fail. Chronic anovulation over a long period of time is also associated with an increased risk of endometrial hyperplasia and carcinoma, which should be seriously investigated and treated. There are androgenic symptoms that will vary from patient to patient, such as hirsutism, acne, and/or alopecia. These are troublesome presentations to the patients and require adequate treatment. Alternative medicine has been emerging as one of the commonly practiced medicines for different health problems, including PCOS. This review underlines the contribution to the treatment of different symptoms.Keywords: treatment, polycystic ovary

The male reproductive system - An overview of common problems.

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Wijesinha, Sanjiva; Piterman, Leon; Kirby, Catherine N

2013-05-01

Many male reproductive system problems could be perceived as being embarrassing, which may be one of the reasons that they are often not identified in general practice. This article provides an overview of some common problems affecting the male reproductive system, and outlines current treatment options. Erectile dysfunction, premature ejaculation, loss of libido, testicular cancer and prostate disease may cause embarrassment to the patient and, occasionally, the general practitioner. We describe how patients affected by these conditions may present to general practice, and discuss the reasons why they may not present. We also discuss how GPs can overcome difficulties in identifying and dealing with their male patients suffering from male reproductive system issues.

Gonococcal Conjunctivitis Despite Successful Treatment of Male Urethritis Syndrome.

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Peters, Remco P H; Verweij, Stephan P; McIntyre, James A; Schaftenaar, Erik

2016-02-01

We report a case of progressive, cephalosporin-susceptible, Neisseria gonorrhoeae conjunctivitis despite successful treatment of male urethritis syndrome. We hypothesize that conjunctival infection progressed due to insufficient penetration of cefixime and azithromycin and point out that extragenital infection and male urethritis may not be cured simultaneously in settings where the syndromic approach is used.

Cortical activation during mental rotation in male-to-female and female-to-male transsexuals under hormonal treatment.

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Carrillo, Beatriz; Gómez-Gil, Esther; Rametti, Giuseppina; Junque, Carme; Gomez, Angel; Karadi, Kazmer; Segovia, Santiago; Guillamon, Antonio

2010-09-01

There is strong evidence of sex differences in mental rotation tasks. Transsexualism is an extreme gender identity disorder in which individuals seek cross-gender treatment to change their sex. The aim of our study was to investigate if male-to-female (MF) and female-to-male (FM) transsexuals receiving cross-sex hormonal treatment have different patterns of cortical activation during a three-dimensional (3D) mental rotation task. An fMRI study was performed using a 3-T scan in a sample of 18 MF and 19 FM under chronic cross-sex hormonal treatment. Twenty-three males and 19 females served as controls. The general pattern of cerebral activation seen while visualizing the rotated and non-rotated figures was similar for all four groups showing strong occipito-parieto-frontal brain activation. However, compared to control males, the activation of MF transsexuals during the task was lower in the superior parietal lobe. Compared to control females, MF transsexuals showed higher activation in orbital and right dorsolateral prefrontal regions and lower activation in the left prefrontal gyrus. FM transsexuals did not differ from either the MF transsexual or control groups. Regression analyses between cerebral activation and the number of months of hormonal treatment showed a significant negative correlation in parietal, occipital and temporal regions in the MF transsexuals. No significant correlations with time were seen in the FM transsexuals. In conclusion, although we did not find a specific pattern of cerebral activation in the FM transsexuals, we have identified a specific pattern of cerebral activation during a mental 3D rotation task in MF transsexuals under cross-sex hormonal treatment that differed from control males in the parietal region and from control females in the orbital prefrontal region. The hypoactivation in MF transsexuals in the parietal region could be due to the hormonal treatment or could reflect a priori cerebral differences between MF transsexual

[Intratympanic injection therapy for therapy refractory acute hearing loss: A safe option for secondary treatment].

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Mühlmeier, G; Maier, S; Maier, M; Maier, H

2015-10-01

High-dose corticosteroids are currently recommended for idiopathic sudden sensorineural hearing loss (ISSNHL) treatment. Intratympanic injections (ITI) are of growing importance, especially in cases of therapy resistance. The selection of patients for this procedure in SSNHL has not been adequately examined so far. A total of 77 patients with ISSNHL after ineffective systemic pretreatment underwent intratympanic administration of dexamethasone and hyaluronic acid. Improvement after treatment was determined by pure tone audiometry for both ears before and of the treated ear after ITI. In this study 34 female and 43 male patients with mean age of 57 years showed a pre-ITI hearing loss of 35 dB in the lower frequencies and 69 dB in the higher frequencies. The mean hearing gain was 10 dB and the response rate was 62%. Absolute hearing gain revealed significant improvements at 500 Hz, 1 kHz and 2 kHz. Under inclusion of contralateral thresholds there were hardly any differences up to 4 kHz. In a detailed analysis of responders moderate improvements could be observed even in higher frequencies. Overall, no relevant adverse events occurred. Treatment of ISSNHL resistant to systemic regimens by ITI of steroids provides an option that offers additional prospects of auditory improvement for affected patients. The presented results indicate that these modalities are also valid for patients with pancochlear ISSNHL.

Efficacy and safety of a low-level laser device in the treatment of male and female pattern hair loss: a multicenter, randomized, sham device-controlled, double-blind study.

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Jimenez, Joaquin J; Wikramanayake, Tongyu C; Bergfeld, Wilma; Hordinsky, Maria; Hickman, Janet G; Hamblin, Michael R; Schachner, Lawrence A

2014-04-01

Male and female pattern hair loss are common, chronic dermatologic disorders with limited therapeutic options. In recent years, a number of commercial devices using low-level laser therapy have been promoted, but there have been little peer-reviewed data on their efficacy. To determine whether treatment with a low-level laser device, the US FDA-cleared HairMax Lasercomb®, increases terminal hair density in both men and women with pattern hair loss. Randomized, sham device-controlled, double-blind clinical trials were conducted at multiple institutional and private practices. A total of 146 male and 188 female subjects with pattern hair loss were screened. A total of 128 male and 141 female subjects were randomized to receive either a lasercomb (one of three models) or a sham device in concealed sealed packets, and were treated on the whole scalp three times a week for 26 weeks. Terminal hair density of the target area was evaluated at baseline and at 16- and 26-week follow-ups, and analyzed to determine whether the hypothesis formulated prior to data collection, that lasercomb treatment would increase terminal hair density, was correct. The site investigators and the subjects remained blinded to the type of device they dispensed/received throughout the study. The evaluator of masked digital photographs was blinded to which trial arm the subject belonged. Seventy-eight, 63, 49, and 79 subjects were randomized in four trials of 9-beam lasercomb treatment in female subjects, 12-beam lasercomb treatment in female subjects, 7-beam lasercomb treatment in male subjects, and 9- and 12-beam lasercomb treatment in male subjects, compared with the sham device, respectively. Nineteen female and 25 male subjects were lost to follow-up. Among the remaining 122 female and 103 male subjects in the efficacy analysis, the mean terminal hair count at 26 weeks increased from baseline by 20.2, 20.6, 18.4, 20.9, and 25.7 per cm2 in 9-beam lasercomb-treated female subjects, 12-beam

Approved and Off-Label Uses of Obesity Medications, and Potential New Pharmacologic Treatment Options

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Fernando Cordido

2010-01-01

Full Text Available Available anti-obesity pharmacotherapy options remain very limited and development of more effective drugs has become a priority. The potential strategies to achieve weight loss are to reduce energy intake by stimulating anorexigenic signals or by blocking orexigenic signals, and to increase energy expenditure. This review will focus on approved obesity medications, as well as potential new pharmacologic treatment options.

The Effects of Accounting Treatment and Financial Crisis on the Stock Option Plans of Italian Companies

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Francesco Avallone

2014-03-01

Full Text Available Many studies state that favourable accounting treatment has been one of the main reasons behind employee stock options. In addition, stock options have recently been the target of growing criticism with a possible influence on incentive effectiveness and outrage costs. In such a perspective, the main purpose of the paper is to explore the impact of IFRS 2 and of the recent financial crisis on stock option compensation. Empirical evidence suggests that: (i IFRS 2 did not have a significant effect on stock option granting, (ii the issue of stock options is less likely to occur during the financial crisis.

Safety of treatment options for spondyloarthritis: a narrative review.

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D'Angelo, Salvatore; Carriero, Antonio; Gilio, Michele; Ursini, Francesco; Leccese, Pietro; Palazzi, Carlo

2018-05-01

Spondyloarthritis (SpA) are chronic inflammatory diseases with overlapping pathogenic mechanisms and clinical features. Treatment armamentarium against SpA includes non-steroidal anti-inflammatory drugs, glucocorticoids, conventional disease-modifying antirheumatic drugs (DMARDs, including sulfasalazine, methotrexate, leflunomide, cyclosporine), targeted synthetic DMARDs (apremilast) and biological DMARDs (TNF inhibitors, anti-IL 12/23 and anti-IL-17 agents). Areas covered: A narrative review of published literature on safety profile of available SpA treatment options was performed. Readers will be provided with a comprehensive overview on frequent and rare adverse events associated with each drug listed in current SpA treatment recommendations. Expert opinion: The overall safety profile of such molecules is good and serious adverse events are rare but need to be promptly recognized and treated. However, the monitoring of adverse events is a major challenge for clinicians because it is not adequately addressed by current treatment recommendations. A tailored treatment is crucial and rheumatologists must accurately select patients in order to identify those more susceptible to develop adverse events.

Treatment options for diabetic foot osteomyelitis.

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Senneville, Eric; Robineau, Olivier

2017-06-01

Diabetic foot osteomyelitis therapeutical options are based on antibiotic therapy and surgical resection of the infected bone(s). Surgical and medical approaches of patients suffering from a diabetic foot osteomyelitis do not oppose but are complementary and need to be discussed as a tailored manner. Areas covered: The aim of the present article is to discuss data issued from the most recent guidelines of the Infectious Diseases Society of America and the International Working Group on the Diabetic Foot on the management of the diabetic foot infection and from a search in the current literature using the terms diabetic foot osteomyelitis and treatment/therapy/therapeutical in both PubMed and Medline, restricted to the last five years. Expert opinion: Surgical removal of the entire infected bone(s) has been considered in the past as the standard treatment but medical approach of these patients has now proven efficacy in selected situations. The current emergence of bacteria, especially among Gram negative rods, resistant to almost all the available antibiotics gradually augments the complexity of the management of these patients and is likely to decrease the place of the medical approach and to worsen the outcome of these infections in the next future.

Facial Pores: Definition, Causes, and Treatment Options.

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Lee, Sang Ju; Seok, Joon; Jeong, Se Yeong; Park, Kui Young; Li, Kapsok; Seo, Seong Jun

2016-03-01

Enlarged skin pores refer to conditions that present with visible topographic changes of skin surfaces. Although not a medical concern, enlarged pores are a cosmetic concern for a large number of individuals. Moreover, clear definition and possible causes of enlarged pores have not been elucidated. To review the possible causes and treatment options for skin pores. This article is based on a review of the medical literature and the authors' clinical experience in investigating and treating skin pores. There are 3 major clinical causes of enlarged facial pores, namely high sebum excretion, decreased elasticity around pores, and increased hair follicle volume. In addition, chronic recurrent acne, sex hormones, and skin care regimen can affect pore size. Given the different possible causes for enlarged pores, therapeutic modalities must be individualized for each patient. Potential factors that contribute to enlarged skin pores include excessive sebum, decreased elasticity around pores, and increased hair follicle volume. Because various factors cause enlarged facial pores, it might be useful to identify the underlying causes to be able to select the appropriate treatment.

[Perinatal clomiphene citrate treatment changes sexual orientations of male mice].

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He, Feng-Qin; Zhang, Heng-Rui

2013-10-01

Perinatal period and adolescence are critical for brain development, which is the biological basis of an individual's sexual orientation and sexual behavior. In this study, animals were divided into two groups and their sexual orientations were observed: one group experienced drug treatments during the perinatal period, and the other group was castrated at puberty. The results showed that estradiol treatment had no effect on mature male offspring's sexual orientations, but 9 days and 14 days of clomiphene citrate treatment significantly increased the chance of homosexuality and effeminized behavior. In addition, the sexual orientation of mature normal male offspring, which were castrated when they were 21 days old,was not significant different from the control animals. These findings suggest that the inhibition of perinatal estrogen activities could suppress individual male-typical responses, enhance female-typical responses and induce homosexual orientations. Moreover, the masculinizing effects of estrogen were more obvious during perinatal period than adolescence.

Patients' Values Related to Treatment Options for Teeth with Apical Periodontitis.

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Azarpazhooh, Amir; Dao, Thuan; Ungar, Wendy J; Da Costa, Jose; Figueiredo, Rafael; Krahn, Murray; Friedman, Shimon

2016-03-01

This study aimed to explore patients' values when selecting treatment for a tooth with apical periodontitis (AP), namely retention via root canal treatment (RCT) and extraction without replacement or replacement with implant-supported crowns or fixed or removable partial prostheses. Through 2 surveys of patients (800 university patients and 200 community patients, response rate = 43%) and dentists (498 Ontario endodontists, periodontists, prosthodontists, oral and maxillofacial surgeons, response rate = 40% and 1983 Ontario general dentists, response rate = 15%), the importance of values that might be considered important to patients when selecting treatment options for a tooth with AP were recorded. Chi-square and Kendall's tau tests were used to respectively compare the importance rating frequency by each surveyed group and its correlation to their demographic variables (P ≤ .05). Patients considered communication and trust (94%), tooth retention (90%), esthetic outcome (84% regardless of location), cost (83%), longevity (83%), and preoperative pain (81%) as the most important decision values. Dentists overrated the importance of patients' previous experience with the treatment options (94% vs. 72%), dental insurance (90% vs. 70%), and intraoperative pain (79% vs. 60%) while underestimating the importance of maintenance cost (60% vs. 79%). Dentists should respect patients' views about esthetic outcome, longevity, and cost associated with treatment options for a tooth with AP. In particular, this survey highlights the value of communication and trust between patient and dentist and preservation of the natural tooth through RCT over implant-supported crown replacement when planning treatment for a tooth with AP. Copyright © 2016 American Association of Endodontists. Published by Elsevier Inc. All rights reserved.

Options for Healthcare Waste Management and Treatment in China

Institute of Scientific and Technical Information of China (English)

无

2006-01-01

Healthcare waste management and treatment is one of the national priority tasks of China's Tenth Five-Year Plan.Numerous installations disposing medical waste have already operated the project or under construction to the operation in 2006. This paper focuses on the assessment of existing and fu~re options to handle medical waste (MW). Internationally available and so far in China applied technologies and management practice are analysed, including the problems how to materials. Non-hazardous MW can be managed and treated in analogue to municipal solid waste (MSW). In most of the European countries decentralised hospital incinerators have been, because of high operation costs and pollution problems,widely banned and replaced by pre-treatment technologies at the source and centralised incineration plants for hazardous MW.Information for adapting and further developing MW management solutions and treatment technologies in China and applying the most appropriate MWM practice is provided.

Current treatment options for the management of patent ductus arteriosus

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Takeuchi K

2013-03-01

Full Text Available Koh Takeuchi,1 Atsushi Hirota,2 Sachito Minegishi,1 Jotaro Kobayashi,1 Keiji Tsuchiya3 1Division of Cardiovascular Surgery, 2Department of Neonatology, 3Department of Pediatrics, Japanese Red Cross Medical Center, Shibuya, Tokyo, Japan Abstract: Pharmacological and/or surgical closure of a hemodynamically significant patent ductus arteriosus (PDA in the very premature infant has been the standard of care over the past few decades. However, the rationale for closure of PDA has recently been challenged. In this article, three ways of approaching the closure of PDA including pharmacological treatment, catheter intervention, and surgical intervention, are reviewed in detail. In addition, the different treatment strategies applied in clinical care are evaluated with a focus on the discussion of the available evidence of PDA treatment in the literature. Keywords: patent ductus arteriosus, premature infant, treatment option

Treatment options for permanent teeth with deep caries.

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Marending, Monika; Attin, Thomas; Zehnder, Matthias

The goal of this narrative review was to summarize and compare treatment options for permanent teeth carious lesions that are radiographically close to the pulp chamber. Thanks to adhesive restorative materials, minimally invasive approaches are possible. In this context, the old question arises as to whether caries must be excavated completely, i.e., down to hard dentin, or whether it could be advantageous to leave some soft dentin, or even merely seal the whole lesion. To answer this question, the microbiological aspects of the lesion must be considered, along with the immunological response in the dental pulp, with the concurrent possible negative outcomes for the patient. Both aspects are considered in this review, and clinical studies comparing different treatment modalities are discussed. Situations in which calcium silicate cements could be advantageous over the gold standard calcium hydroxide preparations for covering the dentin/pulp wound are also discussed.

Pazopanib for metastatic pulmonary epithelioid hemangioendothelioma—a suitable treatment option: case report and review of anti-angiogenic treatment options

International Nuclear Information System (INIS)

Semenisty, Valeriya; Naroditsky, Inna; Keidar, Zohar; Bar-Sela, Gil

2015-01-01

Epithelioid hemangioendothelioma is a rare vascular tumor of borderline or low-grade malignancy. The lungs and liver are the two common primary organs affected. Metastatic disease was reported in more than 100 cases in the literature. However, no firm conclusions can be determined for recommended treatment options. The current case presents a patient with metastatic pulmonary epithelioid hemangioendothelioma to the cervical and mediastinal lymph nodes, lungs and liver that has been treated with pazopanib for more than two years with PET avid complete metabolic response in the mediastinum and lungs, and long-lasting stable disease. Target therapies that block VEGFR have a logical base in this rare malignancy. The current case is the first to report objective, long-lasting response to pazopanib

Excoriation (skin-picking disorder: a systematic review of treatment options

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Lochner C

2017-07-01

Full Text Available Christine Lochner,1 Annerine Roos,1 Dan J Stein2 1SU/UCT MRC Unit on Risk and Resilience in Mental Disorders, Department of Psychiatry, Stellenbosch University, South Africa; 2SU/UCT MRC Unit on Risk and Resilience in Mental Disorders, Department of Psychiatry and Mental Health, University of Cape Town, South Africa Abstract: Although pathological skin-picking has been documented in the medical literature since the 19th century, it has only recently been included as a distinct entity in psychiatric classification systems. In the Diagnostic and Statistical Manual of Mental Disorders, 5th Edition and the proposed International Classification of Diseases, Eleventh Revision, excoriation (skin-picking disorder (ED, also known as neurotic excoriation, psychogenic excoriation, or dermatillomania, is described as recurrent picking of skin, leading to skin lesions and significant distress or functional impairment. ED is listed as one of the obsessive–compulsive and related disorders, given its overlap with conditions such as trichotillomania (hair-pulling disorder. Arguably, its inclusion and delineation in the diagnostic nomenclature will lead to increased awareness of the condition, more research, and ultimately in treatment advances. This systematic review aims to provide readers with an up-to-date view of current treatment options for ED. A MEDLINE search of the ED treatment literature was conducted to collate relevant articles published between 1996 and 2017. The findings indicate that a number of randomized controlled trails on ED have now been published, and that current management options include behavioral therapy (habit reversal or acceptance-enhanced behavior therapy, and medication (selective serotonin reuptake inhibitors or N-acetyl cysteine. Keywords: excoriation, skin-picking, treatment, habit reversal therapy, behavioral therapy, pharmacotherapy, systematic review

The safety of treatment options available for gout.

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Schlesinger, Naomi

2017-04-01

Gout is the most common inflammatory arthritis in humans. Gout treatment includes rapid initiation of anti-inflammatory medications for acute attacks and chronically treating with urate lowering drugs as well as chronic anti-inflammatory prophylaxis. Areas covered: This review aims to provide an overview and discussion of the safety concerns of current treatment options available for gout. Expert opinion: Gout is a curable disease with appropriate treatment. The advent of new therapies provides encouraging opportunities to improve gout management. However, clinicians should be aware of some of the safety concerns of medications used to treat acute and chronic gout. When prescribing medications for gout one has to be mindful of the presence of comorbidities commonly affecting gout patients that may affect drug safety and efficacy, especially in the elderly and in patients treated with multiple drugs. The benefits of gout drugs, usually, outweigh their safety concerns. Studies are needed in gout patients with chronic kidney disease and/or cardiovascular disease, so that escalation of dosing /combination of anti-inflammatory drugs needed to suppress gouty inflammation as well as escalation of dosing/combination of urate lowering drugs needed to achieve target serum urate level will lead to better understanding of gout treatment safety issues.

A Multi-Criteria Decision Analysis of Waste Treatment Options for Food and Biodegradable Waste Management in Japan

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Micky A. Babalola

2015-10-01

Full Text Available Dealing with large-scale Food and Biodegradable Waste (FBW often results in many logistical problems and environmental impacts to be considered. These can become great hindrances when the integration of solid waste management is concerned. Extra care is needed to plan such waste disposal or treatment services and facilities, especially with respect to the ecological impact. Decision-making with regards to the sustainable use of these facilities also involves tradeoffs between a number of conflicting objectives, since increasing one benefit may decrease the others. In this study a Multi-Criteria Decision Analysis (MCDA is presented to evaluate different waste management options and their applicability in Japan. The analytical process aims at selecting the most suitable waste treatment option, using pairwise comparisons conducted within a decision hierarchy that was developed through the Analytical Hierarchy Process (AHP. The results of this study show that anaerobic digestion should be chosen as the best FBW treatment option with regards to resource recovery. The study also presents some conditions and recommendations that can enhance the suitability of other options like incineration and composting.

Therapeutic Success of the Ketogenic Diet as a Treatment Option for Epilepsy: a Meta-analysis

Science.gov (United States)

Li, Hai-feng; Zou, Yan; Ding, Gangqiang

2013-01-01

Objective To systematically evaluate therapeutic success of the ketogenic diet (KD) as a treatment option for epilepsy. Methods Using MEDLINE and Google Scholar search, we searched for studies investigating the therapeutic success of ketogenic diet for epilepsy. We estimated therapeutic success rate for ketogenic diet as a treatment option for epilepsy and its 95% CIs using generic inverse variance method. Findings A total of 38 studies met the inclusion criteria. In retrospective studies, the weighted success rate of the patients who take the KD as a treatment option for epilepsy was 58.4% (95% confidence interval (95%CI)=48.7% – 69.9%) at 3 months (n=336); 42.8% (95%CI =36.3% – 50.3%) at 6 months (n=492), and 30.1% (95%CI =24.3% – 37.2%) at 12 months (n=387); in prospective studies, weighted success rate was 53.9% (95%CI 45.5% – 63.8%) at 3 months (n=474); 53.2% (95%CI =44.0% – 64.2%) at 6 months (n=321), and 55.0% (95%CI =45.9% – 65.9%) at 12 months (n=347). Conclusion This meta-analysis provides formal statistical support for the efficacy of the ketogenic diet in the treatment of epileptic patients. PMID:24910737

Emerging treatment options for acute bacterial skin and skin structure infections: focus on intravenous delafloxacin

Directory of Open Access Journals (Sweden)

Righi E

2018-04-01

Full Text Available Elda Righi, Alessia Carnelutti, Antonio Vena, Matteo Bassetti Infectious Diseases Division, Santa Maria della Misericordia University Hospital, Udine, Italy Abstract: The increase in hospitalization due to acute bacterial skin and skin structure infections (ABSSSI caused by resistant pathogens supports the need for new treatment options. Antimicrobial options for ABSSSI that provide broad-spectrum coverage, including gram-negative pathogens and multidrug-resistant gram-positive bacteria, such as methicillin-resistant Staphylococcus aureus (MRSA, are limited. Delafloxacin is a novel fluoroquinolone available as intravenous and oral formulations and is characterized by an increased efficacy in acidic environments and activity on bacterial biofilm. Delafloxacin displays enhanced in vitro activity against MRSA, and enterococci, while maintaining efficacy against gram-negative pathogens and anaerobes. Delafloxacin has been studied for the treatment of ABSSSI and respiratory infections. Phase III studies have demonstrated noninferiority of delafloxacin compared to vancomycin, linezolid, tigecycline, and the combination of vancomycin plus aztreonam in the treatment of ABSSSI. Due to its favorable pharmacokinetic characteristics, the wide spectrum of action, and the potential for sequential therapy, delafloxacin represents a promising option in the empirical and targeted treatment of ABSSSI, both in hospital- and in community-based care. Keywords: bacterial skin and skin structure infections, multidrug-resistant bacteria, methicillin-resistant Staphylococcus aureus, delafloxacin

Current Treatment Options for Bilateral Vocal Fold Paralysis: A State-of-the-Art Review

Science.gov (United States)

Li, Yike; Garrett, Gaelyn; Zealear, David

2017-01-01

Vocal fold paralysis (VFP) refers to neurological causes of reduced or absent movement of one or both vocal folds. Bilateral VFP (BVFP) is characterized by inspiratory dyspnea due to narrowing of the airway at the glottic level with both vocal folds assuming a paramedian position. The primary objective of intervention for BVFP is to relieve patients’ dyspnea. Common clinical options for management include tracheostomy, arytenoidectomy and cordotomy. Other options that have been used with varying success include reinnervation techniques and botulinum toxin (Botox) injections into the vocal fold adductors. More recently, research has focused on neuromodulation, laryngeal pacing, gene therapy, and stem cell therapy. These newer approaches have the potential advantage of avoiding damage to the voicing mechanism of the larynx with an added goal of restoring some physiologic movement of the affected vocal folds. However, clinical data are scarce for these new treatment options (i.e., reinnervation and pacing), so more investigative work is needed. These areas of research are expected to provide dramatic improvements in the treatment of BVFP. PMID:28669149

Remediation options and the significance of water treatment at former uranium production sites in Eastern Germany

International Nuclear Information System (INIS)

Gatzweiler, R.; Jakubick, A.T.; Kiessig, G.

2000-01-01

The WISMUT remediation project in the States of Saxony and Thuringia, Germany, comprises several mine and mill sites including large volumes of production residues. Due to the climate, the intensive land use and the regulatory conditions, the water path is most important in evaluating remediation options. Water treatment is an integral part of mine flooding, mine dump and tailings remediation, and treatment costs represent a major portion of the overall costs of the project. Uncertainties in the estimations of quantities of mine and seepage waters, variations in quality from site to site, and changing conditions in time demand a strategic approach to the selection and optimization of water treatment methods. The paper describes options considered and experience gained including efforts to limit long-term treatment costs by developing and applying passive treatment systems and negotiating acceptable discharge limits. (author)

Clinical characteristics of older male military veterans seeking treatment for erectile dysfunction.

Science.gov (United States)

Beaudreau, Sherry A; Rideaux, Tiffany; Zeiss, Robert A

2011-02-01

Male sexual dysfunction is a significant international public health issue affecting both middle-aged and older adults. To date, however, no studies have compared age differences in psychiatric issues, frequency of sexual activity and treatment recommendations between older and middle-aged male military Veterans seeking treatment for erectile dysfunction (ED) in the U.S.A. Data were collected between 1982 and 2003 at the Palo Alto Veterans Affairs Andrology Clinic. The 1,250 participants, aged 22 to 87 years (median = 63), completed a semi-structured interview. Using multiple linear regressions, we examined age differences in five domains: medical and endocrine risk factors; psychiatric and psychosocial risk factors; frequency of sexual behaviors; self-reported and objectively measured erectile function; and treatment recommendations. Compared with middle-aged adults, older adults were more likely to present for ED treatment with medical risk factors and were more often recommended a vacuum pump treatment. Middle-aged male Veterans were more likely to experience psychiatric risk factors for ED and were more sexually active than older Veterans. Despite greater objective erectile ability in middle-aged adults, there were no age differences in maximum self-reported erectile functioning. These results provide some evidence of age-related characteristics and treatment needs of male patients seeking treatment for sexual dysfunction. We encourage health care professionals working with adults across the lifespan to consider ways to individualize psychoeducation and brief psychotherapy for the treatment of ED to the specific needs of the patient, which may vary between middle-aged and older cohorts of patients.

Informing patients about emerging treatment options: creating "saviour siblings" for haemopoietic stem cell transplant.

Science.gov (United States)

Strong, Kimberly A

2009-05-04

In June 2008, the ABC screened a television documentary involving a couple who decided to have an additional child in the hope of obtaining umbilical cord blood to treat their daughter who had leukaemia. The couple conceived naturally, meaning that there was a one in four chance that their child would be suitably matched. They seemed to be unaware of technologies that, if successful, could provide a near certainty that the next child would be a matched "saviour sibling". This story raises questions about whether clinicians have an obligation to discuss emerging and morally contentious treatment options. Ignorance of technology, assumptions about availability, and medical assessment of burdens and benefits may affect attitudes towards treatment options, but they do not justify non-disclosure of information.

Solidification of radioactive liquid wastes, Treatment options for spent resins and concentrates - 16405

International Nuclear Information System (INIS)

Roth, Andreas

2009-01-01

Ion exchange is one of the most common and effective treatment methods for liquid radioactive waste. However, spent ion exchange resins are considered to be problematic waste that in many cases require special approaches and pre-conditioning during its immobilization to meet the acceptance criteria for disposal. Because of the function that they fulfill, spent ion exchange resins often contain high concentrations of radioactivity and pose special handling and treatment problems. Another very common method of liquid radioactive waste treatment and water cleaning is the evaporation or diaphragm filtration. Both treatment options offer a high volume reduction of the total volume of liquids treated but generate concentrates which contain high concentrations of radioactivity. Both mentioned waste streams, spent resins as well as concentrates, resulting from first step liquid radioactive waste treatment systems have to be conditioned in a suitable manner to achieve stable waste products for final disposal. Spent resin and concentrate treatment often appear as a specific task in decommissioning projects, because in the past those waste streams typically had been stored in tanks for the lifetime of the plant and needs to be retrieved, conditioned and packed prior to dismantling activities. Additionally a large amount of contaminated liquids will be generated by utilizing decontamination processes and needs to be processed further on. Such treatment options need to achieve waste products acceptable for final disposal, because due to the closure of the site no interim storage can be envisaged. The most common method of treatment of such waste streams is the solidification in a solid matrix with additional inactive material like cement, polymer etc. In the past good results have been achieved and the high concentration of radioactivity can be reduced by adding the inactive material. On the other hand, under the environment of limited space for interim storage and the absence

Process options for treatment of organic containing ILWs by wet oxidation

International Nuclear Information System (INIS)

Holman, D.J.

1989-01-01

The process chemistry, applications and experience with several wet oxidation options are reviewed along with criteria for the selection of viable systems and plant designs, covering a range of organic wastes, including solvents, cellulosic filters, chelant decontamination reagents and ion exchange resins. The use of hydrogen peroxide to treat water-cooled reactor residues containing mixed inorganic and organic filter materials with ion exchange resins is examined in further detail along with treatment of secondary arisings. The technical and financial justifications for treatment are examined along with the engineering requirements to retro-fit the required plant to an existing cement encapsulation facility. (author)

Advances in Male Contraception

Science.gov (United States)

Page, Stephanie T.; Amory, John K.; Bremner, William J.

2008-01-01

Despite significant advances in contraceptive options for women over the last 50 yr, world population continues to grow rapidly. Scientists and activists alike point to the devastating environmental impacts that population pressures have caused, including global warming from the developed world and hunger and disease in less developed areas. Moreover, almost half of all pregnancies are still unwanted or unplanned. Clearly, there is a need for expanded, reversible, contraceptive options. Multicultural surveys demonstrate the willingness of men to participate in contraception and their female partners to trust them to do so. Notwithstanding their paucity of options, male methods including vasectomy and condoms account for almost one third of contraceptive use in the United States and other countries. Recent international clinical research efforts have demonstrated high efficacy rates (90–95%) for hormonally based male contraceptives. Current barriers to expanded use include limited delivery methods and perceived regulatory obstacles, which stymie introduction to the marketplace. However, advances in oral and injectable androgen delivery are cause for optimism that these hurdles may be overcome. Nonhormonal methods, such as compounds that target sperm motility, are attractive in their theoretical promise of specificity for the reproductive tract. Gene and protein array technologies continue to identify potential targets for this approach. Such nonhormonal agents will likely reach clinical trials in the near future. Great strides have been made in understanding male reproductive physiology; the combined efforts of scientists, clinicians, industry and governmental funding agencies could make an effective, reversible, male contraceptive an option for family planning over the next decade. PMID:18436704

Treatment of central sensitization in patients with 'unexplained' chronic pain: what options do we have?

Science.gov (United States)

Nijs, Jo; Meeus, Mira; Van Oosterwijck, Jessica; Roussel, Nathalie; De Kooning, Margot; Ickmans, Kelly; Matic, Milica

2011-05-01

Central sensitization accounts for chronic 'unexplained' pain in a wide variety of disorders, including chronic whiplash-associated disorders, temporomandibular disorders, chronic low back pain, osteoarthritis, fibromyalgia, chronic fatigue syndrome and chronic tension-type headache among others. Given the increasing evidence supporting the clinical significance of central sensitization in those with unexplained chronic pain, the awareness is growing that central sensitization should be a treatment target in these patients. This article provides an overview of the treatment options available for desensitizing the CNS in patients with chronic pain due to central sensitization. It focuses on those strategies that specifically target pathophysiological mechanisms known to be involved in central sensitization. In addition, pharmacological options, rehabilitation and neurotechnology options are discussed. Acetaminophen, serotonin-reuptake inhibitor drugs, selective and balanced serototin and norepinephrine-reuptake inhibitor drugs, the serotonin precursor tryptophan, opioids, N-methyl-d-aspartate (NMDA)-receptor antagonists, calcium-channel alpha(2)delta (a2δ) ligands, transcranial magnetic stimulation, transcutaneous electric nerve stimulation (TENS), manual therapy and stress management each target central pain processing mechanisms in animals that - theoretically - desensitize the CNS in humans. To provide a comprehensive treatment for 'unexplained' chronic pain disorders characterized by central sensitization, it is advocated to combine the best evidence available with treatment modalities known to target central sensitization. © 2011 Informa UK, Ltd

Taxing Options: Do Ceos Respond To Favorable Tax Treatment Of Stock Options?

OpenAIRE

Martin Gritsch; Tricia Coxwell Snyder

2007-01-01

CEO stock option compensation increased tremendously during the 1990s. During this period, the spread between the marginal income and capital gains tax rates increased substantially, creating the potential for tax avoidance. Using ExecuComp data from 1992-2000, we estimate CEOs’ responsiveness to changes in these tax rates. Our findings show that an increase in the marginal income and a decrease in the capital gains tax rate create a significant increase in stock option compensation. Furtherm...

Anakinra as a diagnostic challenge and treatment option for systemic autoinflammatory disorders of undefined etiology.

Science.gov (United States)

Harrison, Stephanie R; McGonagle, Dennis; Nizam, Sharmin; Jarrett, Stephen; van der Hilst, Jeroen; McDermott, Michael F; Savic, Sinisa

2016-05-05

Some adult patients presenting with unexplained pyrexia, serositis, skin rashes, arthralgia, myalgia, and other symptoms commonly found in autoinflammatory disorders may not fit a specific diagnosis, either because their clinical phenotype is nondiagnostic or genetic tests are negative. We used the term undifferentiated systemic autoinflammatory disorder (uSAID) to describe such cases. Given that well-defined autoinflammatory diseases show responses to IL-1 blockade, we evaluated whether anakinra was useful for both diagnosing and treating uSAID patients. We performed a retrospective analysis of consecutive patients presenting with uSAID between 2012-2015 who were treated with the recombinant IL-1 receptor antagonist anakinra. uSAID was diagnosed after excluding malignancy, infection, and pathogenic mutations in known hereditary fever syndromes (HFS) genes and where clinical criteria for adult onset Still's disease (AOSD) were not met. A total of 11 patients presented with uSAID (5 males and 6 females), with a mean time to diagnosis of 3.5 years (1-8 years). Patients were unresponsive or only partially controlled on disease-modifying antirheumatic drug (DMARD)/steroid treatment. Anakinra controlled symptoms within 4-6 weeks of starting treatment in 9 of 11 cases. Two patients discontinued therapy - one due to incomplete response and another due to severe injection-site reactions. This retrospective case series demonstrates that the spectrum of poorly defined autoinflammatory disorders that show responsiveness to anakinra is considerable. Anakinra seems a viable treatment option for these patients, who are unresponsive to standard steroid/DMARD treatments. Moreover, given the mechanisms of action, response to anakinra implicates underlying IL-1 dysregulation in the disease pathogenesis of responding uSAIDs patients.

Treatment efficacy, treatment failures and selection of macrolide resistance in patients with high load of Mycoplasma genitalium during treatment of male urethritis with josamycin.

Science.gov (United States)

Guschin, Alexander; Ryzhikh, Pavel; Rumyantseva, Tatiana; Gomberg, Mikhail; Unemo, Magnus

2015-02-03

Azithromycin has been widely used for Mycoplasma genitalium treatment internationally. However, the eradication efficacy has substantially declined recent decade. In Russia, josamycin (another macrolide) is the recommended first-line treatment for M. genitalium infections, however, no data regarding treatment efficacy with josamycin and resistance in M. genitalium infections have been internationally published. We examined the M. genitalium prevalence in males attending an STI clinic in Moscow, Russia from December 2006 to January 2008, investigated treatment efficacy with josamycin in male urethritis, and monitored the M. genitalium DNA eradication dynamics and selection of macrolide resistance in M. genitalium during this treatment. Microscopy and real-time PCRs were used to diagnose urethritis and non-viral STIs, respectively, in males (n = 320). M. genitalium positive patients were treated with recommended josamycin regimen and treatment efficacy was monitored using quantitative real-time PCR. Macrolide resistance mutations were identified using sequencing of the 23S rRNA gene. Forty-seven (14.7%) males were positive for M. genitalium only and most (85.1%) of these had symptoms and signs of urethritis. Forty-six (97.9%) males agreed to participate in the treatment efficacy monitoring. All the pre-treatment M. genitalium specimens had wild-type 23S rRNA. The elimination of M. genitalium DNA was substantially faster in patients with lower pre-treatment M. genitalium load, and the total eradication rate was 43/46 (93.5%). Of the six patients with high pre-treatment M. genitalium load, three (50%) remained positive post-treatment and these positive specimens contained macrolide resistance mutations in the 23S rRNA gene, i.e., A2059G (n = 2) and A2062G (n = 1). M. genitalium was a frequent cause of male urethritis in Moscow, Russia. The pre-treatment M. genitalium load might be an effective predictor of eradication efficacy with macrolides (and possibly

New and current preventive treatment options in actinic keratosis.

Science.gov (United States)

Arenberger, P; Arenbergerova, M

2017-09-01

Actinic keratosis (AK) is a characteristic skin lesion on skin areas of subjects with mainly phototype I and phototype II, or with specific genetic factors and who are exposed to prolonged ultraviolet radiation. AK may be considered a precursor of in situ squamous cell carcinoma (SCC), a type of non-melanoma skin cancer (NMSC). However, it is still not possible to predict which AK lesions will develop into SCC. Early treatment of AK is therefore recommended. Despite the increasing number of patients with AK developing into SCC, to date, there is still no clear suggestion of therapeutic strategy for AK. Current treatment consists of a multitude of topical lesion-directed or field-directed therapies or a combination of both. Recently, orally administered nicotinamide has shown to significantly reduce rates of new NMSC and AK in high-risk patients. This study aims to provide an update on the most relevant information about AK and to provide an insight into current and new treatment options. © 2017 European Academy of Dermatology and Venereology.

Thyroid Cancer Treatment Choice: A pilot study of a tool to facilitate conversations with patients with papillary microcarcinomas considering treatment options.

Science.gov (United States)

Brito, Juan P; Moon, Jae Hoon; Zeuren, Rebecca; Kong, Sung Hye; Kim, Yeo Koon; Iñiguez-Ariza, Nicole M; Choi, June Young; Lee, Kyu Eun; Kim, Ji-Hoon; Hargraves, Ian; Bernet, Victor; Montori, Victor; Park, Young Joo; Tuttle, R Michael

2018-06-15

The 2015 American Thyroid Association guidelines recognize active surveillance as an alternative to immediate surgery in patients with papillary microcarcinomas (PMCs). As a way to incorporate active surveillance as one of the management options for patients with PMCs, we describe the development and initial testing of a tool to support conversations between clinicians and patients with PMCs considering treatment options. Thyroid Cancer Treatment Choice was developed using an iterative process based on the principles of interaction, design and participatory action research. To evaluate the impact of the tool on treatment choice, a prospective study was conducted in two thyroid cancer clinics in Seongnam-si and Seoul, South Korea: both clinics had the expertise to offer active surveillance as well as immediate surgery. One clinic was trained in the use of the conversation aid, while the other clinic continued to care for patients without access to the conversation aid. Between May 2016 and April 2017, 278 patients mostly women (n=220, 79%) were included in the study; 152 (53%) received care at the clinic using the conversation aid. Age, gender, and mean tumor size [6.6 mm (SD 1.6) and 6.5 mm (SD 1.9)] distributions were similar across clinics. Overall, 233 (84%) patients opted for active surveillance and 53 (16%) for thyroid surgery. Patients in the conversation aid group were more likely to choose active surveillance than the patients seen in the usual care clinic [relative risk (RR) = 1.16; 95% confidence interval (CI), 1.04 - 1.29]. Of all patients opting for active surveillance, more patients in the conversation aid group had thyroid cancer nodules > 5 mm than in the usual care group (81% vs. 67% P = 0.013). Thyroid Cancer Treatment Choice is an evidence-based tool that supports the presentation of treatment options for PMCs. Pilot testing suggests that this conversation tool increases acceptance of active surveillance, suggesting that this option is an

Ozone-augmented percutaneous discectomy: A novel treatment option for refractory discogenic sciatica

International Nuclear Information System (INIS)

Crockett, M.T.; Moynagh, M.; Long, N.; Kilcoyne, A.; Dicker, P.; Synnott, K.; Eustace, S.J.

2014-01-01

Aim: To assess the short and medium-term efficacy and safety of a novel, minimally invasive therapeutic option combining automated percutaneous lumbar discectomy, intradiscal ozone injection, and caudal epidural: ozone-augmented percutaneous discectomy (OPLD). Materials and methods: One hundred and forty-seven patients with a clinical and radiological diagnosis of discogenic sciatica who were refractory to initial therapy were included. Fifty patients underwent OPLD whilst 97 underwent a further caudal epidural. Outcomes were evaluated using McNab's score, improvement in visual analogue score (VAS) pain score, and requirement for further intervention. Follow-up occurred at 1 and 6 months, and comparison was made between groups. Results: OPLD achieved successful outcomes in almost three-quarters of patients in the short and medium term. OPLD achieved superior outcomes at 1 and 6 months compared to caudal epidural. There was a reduced requirement for further intervention in the OPLD group. No significant complications occurred in either group. Discussion: OPLD is a safe and effective treatment for patients with refractory discogenic sciatica in the short and medium term. OPLD has the potential to offer an alternative second-line minimally invasive treatment option that could reduce the requirement for surgery in this patient cohort. - Highlights: • Discogenic sciatica is a common condition which causes significant morbidity. • Ozone augmented percutaneous lumbar discectomy (OPLD) is a novel treatment. • Comparison was made to caudal epidural injection. • All outcomes were superior in the OPLD treatment group. • OPLD appears is an effective treatment for refractory discogenic sciatica

Erectile Dysfunction in the Older Adult Male.

Science.gov (United States)

Mola, Joanna R

2015-01-01

Erectile dysfunction (ED) in the older adult male is a significant problem affecting more than 75% of men over 70 years of age in the United States. Older men have an increased likelihood of developing ED due to chronic disease, comorbid conditions, and age-related changes. Research has demonstrated that while the prevalence and severity of ED increases with age, sexual desire often remains unchanged. This article discusses the clinical picture of ED, including relevant pathophysiology, clinical presentation, and evaluation and treatment options.

Lycopene and male infertility

Science.gov (United States)

Durairajanayagam, Damayanthi; Agarwal, Ashok; Ong, Chloe; Prashast, Pallavi

2014-01-01

Excessive amounts of reactive oxygen species (ROS) cause a state of oxidative stress, which result in sperm membrane lipid peroxidation, DNA damage and apoptosis, leading to decreased sperm viability and motility. Elevated levels of ROS are a major cause of idiopathic male factor infertility, which is an increasingly common problem today. Lycopene, the most potent singlet oxygen quencher of all carotenoids, is a possible treatment option for male infertility because of its antioxidant properties. By reacting with and neutralizing free radicals, lycopene could reduce the incidence of oxidative stress and thus, lessen the damage that would otherwise be inflicted on spermatozoa. It is postulated that lycopene may have other beneficial effects via nonoxidative mechanisms in the testis, such as gap junction communication, modulation of gene expression, regulation of the cell cycle and immunoenhancement. Various lycopene supplementation studies conducted on both humans and animals have shown promising results in alleviating male infertility—lipid peroxidation and DNA damage were decreased, while sperm count and viability, and general immunity were increased. Improvement of these parameters indicates a reduction in oxidative stress, and thus the spermatozoa is less vulnerable to oxidative damage, which increases the chances of a normal sperm fertilizing the egg. Human trials have reported improvement in sperm parameters and pregnancy rates with supplementation of 4–8 mg of lycopene daily for 3–12 months. However, further detailed and extensive research is still required to determine the dosage and the usefulness of lycopene as a treatment for male infertility. PMID:24675655

Insurance status effects on stage of diagnosis and surgical options used in the treatment of breast cancer.

Science.gov (United States)

Lukavsky, Robert; Sariego, Jack

2015-05-01

Insurance status has the potential to play a significant role in an individual's health care by affecting the time of diagnosis and the treatment options used. Our study reviewed insurance status as a determinant of the time of a breast cancer diagnosis as well as the surgical treatment options offered. The American College of Surgeons' National Cancer Database benchmark reports were used to examine first-course surgery stratified by the stage of breast cancer diagnosed between 2000 and 2010. The data were stratified according to insurance status with a focus on insured patients versus underinsured patients. The relations among insurance status, breast cancer stage at the time of presentation, and initial treatment offered were then evaluated. There was a statistically significant relation between breast cancer stage at the time of diagnosis and insurance status. There also was a relation between insurance status and the treatment offered. Adequately insured patients presented at an earlier stage than did underinsured patients. In addition, in patients who present with early-stage disease, insured patients had a higher rate of breast-conserving surgery than did underinsured patients, 62.4% and 55.5%, respectively. This trend continued in late-stage breast cancer, in which mastectomy was the predominant treatment option overall. Despite this, insured patients underwent breast-conserving therapy more frequently than did underinsured patients, 24.2% and 21.2%, respectively. The discrepancy of the stage of diagnosis between insured patients and underinsured patients can be attributed to a host of factors, among which are access to regular office visits and screening tests for breast cancer. In addition, the surgical treatment options used may depend on the cost of treatment and accessibility to and compliance with follow-up care.

The efficacy of ultrasound treatment as a reversible male contraceptive in the rhesus monkey.

Science.gov (United States)

VandeVoort, Catherine A; Tollner, Theodore L

2012-09-12

The use of therapeutic ultrasound as a contraceptive approach has involved nonhuman primates as well as rats and dogs. The current study was undertaken to determine whether this treatment could be a method for reversible contraception, using a model with testes size similar to adult humans. Two methods of ultrasound exposure were used, either the transducer probe at the bottom of a cup filled with saline (Cup) or direct application to the surface of the scrotum (Direct). Four adult rhesus (Macaca mulatta) males with normal semen parameters were treated with therapeutic ultrasound at 2.5 W/cm(2) for 30 min. Treatment was given 3 times, one every other day on a Monday-Wednesday-Friday schedule. For each male, semen quality was evaluated a minimum of three times over several months prior to ultrasound exposure and weekly for two months following ultrasound treatment. Semen samples from all males, regardless of exposure method, exhibited a decrease in the percentage of motile sperm following ultrasound treatment. There was an average reduction in motility of 40% the week following treatment. Similarly, curvilinear velocity and the percentage of sperm with a normally shaped flagellum were also reduced in all males following ultrasound treatment. A significant reduction in the total number of sperm in an ejaculate (total sperm count) was only observed in males that received ultrasound via the cup method. Following treatment via the cup method, males exhibited up to a 91.7% decrease in average total sperm count (n = 2). Sperm count did not approach pre-treatment levels until 8 weeks following ultrasound exposure. The sustained reduction in sperm count, percent motility, normal morphology, and sperm vigor with the cup exposure method provides proof of principle that testicular treatment with ultrasound can be an effective contraceptive approach in humans.

The efficacy of ultrasound treatment as a reversible male contraceptive in the rhesus monkey

Directory of Open Access Journals (Sweden)

VandeVoort Catherine A

2012-09-01

Full Text Available Abstract Background The use of therapeutic ultrasound as a contraceptive approach has involved nonhuman primates as well as rats and dogs. The current study was undertaken to determine whether this treatment could be a method for reversible contraception, using a model with testes size similar to adult humans. Methods Two methods of ultrasound exposure were used, either the transducer probe at the bottom of a cup filled with saline (Cup or direct application to the surface of the scrotum (Direct. Four adult rhesus (Macaca mulatta males with normal semen parameters were treated with therapeutic ultrasound at 2.5 W/cm(2 for 30 min. Treatment was given 3 times, one every other day on a Monday-Wednesday-Friday schedule. For each male, semen quality was evaluated a minimum of three times over several months prior to ultrasound exposure and weekly for two months following ultrasound treatment. Results Semen samples from all males, regardless of exposure method, exhibited a decrease in the percentage of motile sperm following ultrasound treatment. There was an average reduction in motility of 40% the week following treatment. Similarly, curvilinear velocity and the percentage of sperm with a normally shaped flagellum were also reduced in all males following ultrasound treatment. A significant reduction in the total number of sperm in an ejaculate (total sperm count was only observed in males that received ultrasound via the cup method. Following treatment via the cup method, males exhibited up to a 91.7% decrease in average total sperm count (n = 2. Sperm count did not approach pre-treatment levels until 8 weeks following ultrasound exposure. Conclusions The sustained reduction in sperm count, percent motility, normal morphology, and sperm vigor with the cup exposure method provides proof of principle that testicular treatment with ultrasound can be an effective contraceptive approach in humans.

Current and emerging treatment options for Peyronie's disease

Directory of Open Access Journals (Sweden)

Gokce A

2013-01-01

Full Text Available Ahmet Gokce, Julie C Wang, Mary K Powers, Wayne JG HellstromDepartment of Urology, Tulane University – School of Medicine, New Orleans, LA, USAAbstract: Peyronie's disease (PD is a condition of the penis, characterized by the presence of localized fibrotic plaque in the tunica albuginea. PD is not an uncommon disorder, with recent epidemiologic studies documenting a prevalence of 3–9% of adult men affected. The actual prevalence of PD may be even higher. It is often associated with penile pain, anatomical deformities in the erect penis, and difficulty with intromission. As the definitive pathophysiology of PD has not been completely elucidated, further basic research is required to make progress in the understanding of this enigmatic condition. Similarly, research on effective therapies is limited. Currently, nonsurgical treatments are used for those men who are in the acute stage of PD, whereas surgical options are reserved for men with established PD who cannot successfully penetrate. Intralesional treatments are growing in clinical popularity as a minimally invasive approach in the initial treatment of PD. A surgical approach should be considered when men with PD do not respond to conservative, medical, or minimally invasive therapies for approximately 1 year and cannot have satisfactory sexual intercourse. As scientific breakthroughs in the understanding of the mechanisms of this disease process evolve, novel treatments for the many men suffering with PD are anticipated.Keywords: oral therapy, intralesional treatment, topical therapy, extracorporeal shockwave therapy, traction devices, plication, incision and grafting, penile prosthesis.

Depression in Parkinson’s disease: Health risks, etiology, and treatment options

Directory of Open Access Journals (Sweden)

Pasquale G Frisina

2008-03-01

Full Text Available Pasquale G Frisina1,2, Joan C Borod3,4, Nancy S Foldi3,5, Harriet R Tenenbaum61Leir Parkinson’s Disease Program, The Jewish Home and Hospital Lifecare System, New York, NY, USA; 2Department of Geriatrics and Adult Development, Mount Sinai School of Medicine, New York, NY, USA; 3Department of Psychology, Queens College and The Graduate Center of the City University of New York (CUNY, Flushing, NY, USA; 4Department of Neurology, Mount Sinai School of Medicine, New York, NY, USA; 5Department of Medicine, Winthrop-University Hospital, State University of New York, Stony Brook School of Medicine; 6Department of Psychology, Kingston University, Kingston upon Thames, UKAbstract: Depression is found in about 30%–40% of all patients with Parkinson’s disease (PD, but only a small percentage (about 20% receive treatment. As a consequence, many PD patients suffer with reduced health-related quality of life. To address quality of life in depressed PD patients, we reviewed the literature on the health correlates of depression in PD (eg, cognitive function, etiology of depression in PD, and treatment options (ie, antidepressants, electroconvulsive therapy, and psychotherapy. The current review is unique in its focus on psychosocial aspects, as well as neuropathological factors, of depression in PD. Overall, we conclude that neurochemical (eg, serotonin and psychosocial factors (eg, coping style, self-esteem, and social support contribute to the affective disturbances found in this neuropsychiatric population. Therefore, we recommend that a multidisciplinary (eg, pharmacotherapeutic, psychoeducational, and/or psychotherapeutic approach to treatment be taken with depressed PD patients.Keywords: depression, Parkinson’s disease, health outcomes, treatment options

HEMISECTION: A TREATMENT OPTION FOR AN ENDODONTICALLY TREATED MOLAR WITH VERTICAL ROOT FRACTURE

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Anitha

2015-05-01

Full Text Available Vertical root fractures in endodontically treated teeth have long been reported and pose diagnostic difficulties. A h emisection/Root resection procedure which removes the fractured fragments completely, and retains a portion of the compromised tooth offers a predictable treatment option. The key to this rests in ideal case selection invol ving balancing all indications and contraindications. The success of the treatment depends on careful case selection based on a firm set of guidelines. This article presents a case with vertical root fracture in an endodontic treated molar. This article de scribes the case of a 60 - year - old man with a vertical root fracture on the mesial root and a healthy periodontium supporting the distal root making it ideal for retention as well as restoration and support of the final prosthesis. Also, the patient was mot ivated to try and save as much of the tooth as possible. Post - operatively no untoward complication was reported making it an alternative treatment option in patients with vertical root fracture in a molar, willing to retain the remaining tooth portion. Wit h all other factors balanced, it allows for retaining the remaining intact portion of the tooth structure.

An update on male hypogonadism therapy.

Science.gov (United States)

Surampudi, Prasanth; Swerdloff, Ronald S; Wang, Christina

2014-06-01

Men who have symptoms associated with persistently low serum total testosterone level should be assessed for testosterone replacement therapy. Acute and chronic illnesses are associated with low serum testosterone and these should be recognized and treated. Once the diagnosis of male hypogonadism is made, the benefits of testosterone treatment usually outweigh the risks. Without contraindications, the patient should be offered testosterone replacement therapy. The options of testosterone delivery systems (injections, transdermal patches/gels, buccal tablets, capsules and implants) have increased in the last decade. Testosterone improves symptoms and signs of hypogonadism such as sexual function and energy, increases bone density and lean mass and decreases visceral adiposity. In men who desire fertility and who have secondary hypogonadism, testosterone can be withdrawn and the patients can be placed on gonadotropins. New modified designer androgens and selective androgen receptor modulators have been in preclinical and clinical trials for some time. None of these have been assessed for the treatment of male hypogonadism. Despite the lack of prospective long-term data from randomized, controlled clinical trials of testosterone treatment on prostate health and cardiovascular disease risk, the available evidence suggests that testosterone therapy should be offered to symptomatic hypogonadal men.

Minimally Invasive Treatment of Male Lower Urinary Tract Symptoms

NARCIS (Netherlands)

de La Rosette, Jean J. M. C. H.; Gravas, Stavros; Fitzpatrick, John M.

2008-01-01

During the past decade, increasing numbers of minimally invasive treatments for managing male lower urinary tract symptoms caused by urinary tract obstruction have been positioned. On one hand, transurethral needle ablation and transurethral microwave thermotherapy bridge the gap between medical

Interventional Radiology of Male Varicocele: Current Status

International Nuclear Information System (INIS)

Iaccarino, Vittorio; Venetucci, Pietro

2012-01-01

Varicocele is a fairly common condition in male individuals. Although a minor disease, it may cause infertility and testicular pain. Consequently, it has high health and social impact. Here we review the current status of interventional radiology of male varicocele. We describe the radiological anatomy of gonadal veins and the clinical aspects of male varicocele, particularly the physical examination, which includes a new clinical and ultrasound Doppler maneuver. The surgical and radiological treatment options are also described with the focus on retrograde and antegrade sclerotherapy, together with our long experience with these procedures. Last, we compare the outcomes, recurrence and persistence rates, complications, procedure time and cost-effectiveness of each method. It clearly emerges from this analysis that there is a need for randomized multicentre trials designed to compare the various surgical and percutaneous techniques, all of which are aimed at occlusion of the anterior pampiniform plexus.

Interventional Radiology of Male Varicocele: Current Status

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Iaccarino, Vittorio, E-mail: vittorio.iaccarino@unina.it; Venetucci, Pietro [University of Naples ' Federico II' , Diagnostic Imaging Department-Cardiovascular and Interventional Radiology, School of Medicine (Italy)

2012-12-15

Varicocele is a fairly common condition in male individuals. Although a minor disease, it may cause infertility and testicular pain. Consequently, it has high health and social impact. Here we review the current status of interventional radiology of male varicocele. We describe the radiological anatomy of gonadal veins and the clinical aspects of male varicocele, particularly the physical examination, which includes a new clinical and ultrasound Doppler maneuver. The surgical and radiological treatment options are also described with the focus on retrograde and antegrade sclerotherapy, together with our long experience with these procedures. Last, we compare the outcomes, recurrence and persistence rates, complications, procedure time and cost-effectiveness of each method. It clearly emerges from this analysis that there is a need for randomized multicentre trials designed to compare the various surgical and percutaneous techniques, all of which are aimed at occlusion of the anterior pampiniform plexus.

Selective androgen receptor modulators for the treatment of late onset male hypogonadism.

Science.gov (United States)

Coss, Christopher C; Jones, Amanda; Hancock, Michael L; Steiner, Mitchell S; Dalton, James T

2014-01-01

Several testosterone preparations are used in the treatment of hypogonadism in the ageing male. These therapies differ in their convenience, flexibility, regional availability and expense but share their pharmacokinetic basis of approval and dearth of long-term safety data. The brevity and relatively reduced cost of pharmacokinetic based registration trials provides little commercial incentive to develop improved novel therapies for the treatment of late onset male hypogonadism. Selective androgen receptor modulators (SARMs) have been shown to provide anabolic benefit in the absence of androgenic effects on prostate, hair and skin. Current clinical development for SARMs is focused on acute muscle wasting conditions with defi ned clinical endpoints of physical function and lean body mass. Similar regulatory clarity concerning clinical deficits in men with hypogonadism is required before the beneficial pharmacology and desirable pharmacokinetics of SARMs can be employed in the treatment of late onset male hypogonadism.

Selective androgen receptor modulators for the treatment of late onset male hypogonadism

Directory of Open Access Journals (Sweden)

Christopher C Coss

2014-04-01

Full Text Available Several testosterone preparations are used in the treatment of hypogonadism in the ageing male. These therapies differ in their convenience, flexibility, regional availability and expense but share their pharmacokinetic basis of approval and dearth of long-term safety data. The brevity and relatively reduced cost of pharmacokinetic based registration trials provides little commercial incentive to develop improved novel therapies for the treatment of late onset male hypogonadism. Selective androgen receptor modulators (SARMs have been shown to provide anabolic benefit in the absence of androgenic effects on prostate, hair and skin. Current clinical development for SARMs is focused on acute muscle wasting conditions with defi ned clinical endpoints of physical function and lean body mass. Similar regulatory clarity concerning clinical deficits in men with hypogonadism is required before the beneficial pharmacology and desirable pharmacokinetics of SARMs can be employed in the treatment of late onset male hypogonadism.

Selective androgen receptor modulators for the treatment of late onset male hypogonadism

Science.gov (United States)

Coss, Christopher C; Jones, Amanda; Hancock, Michael L; Steiner, Mitchell S; Dalton, James T

2014-01-01

Several testosterone preparations are used in the treatment of hypogonadism in the ageing male. These therapies differ in their convenience, flexibility, regional availability and expense but share their pharmacokinetic basis of approval and dearth of long-term safety data. The brevity and relatively reduced cost of pharmacokinetic based registration trials provides little commercial incentive to develop improved novel therapies for the treatment of late onset male hypogonadism. Selective androgen receptor modulators (SARMs) have been shown to provide anabolic benefit in the absence of androgenic effects on prostate, hair and skin. Current clinical development for SARMs is focused on acute muscle wasting conditions with defined clinical endpoints of physical function and lean body mass. Similar regulatory clarity concerning clinical deficits in men with hypogonadism is required before the beneficial pharmacology and desirable pharmacokinetics of SARMs can be employed in the treatment of late onset male hypogonadism. PMID:24407183

Bevacizumab as a treatment option for radiation-induced cerebral necrosis

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Matuschek, Christiane; Boelke, Edwin; Budach, Wilfried [Univ. Hospital Duesseldorf (Germany). Dept. of Radiation Oncology; Nawatny, Jens [Univ. Hospital Duesseldorf (Germany). Dept. of Radiology; Hoffmann, Thomas K. [Duisburg-Essen Univ., Essen (Germany). Dept. of Otorhinolaryngology; Peiper, Matthias; Orth, Klaus [Hospital Essen-Sued, Essen (Germany). Dept. of Surgery; Gerber, Peter Arne [Univ. Hospital Duesseldorf (Germany). Dept. of Dermatology; Rusnak, Ethelyn [State Univ. of New York, Buffalo, NY (United States). Dept. of Anesthesiology; Lammering, Guido [Univ. Hospital Duesseldorf (Germany). Dept. of Radiation Oncology; MAASTRO Clinic, Maastricht (Netherlands). Radiation Oncology

2011-02-15

Radiation necrosis of normal CNS tissue represents one of the main risk factors of brain irradiation, occurring more frequently and earlier at higher total doses and higher doses per fraction. At present, it is believed that the necrosis results due to increasing capillary permeability caused by cytokine release leading to extracellular edema. This process is sustained by endothelial dysfunction, tissue hypoxia, and subsequent necrosis. Consequently, blocking the vascular endothelial growth factor (VEGF) at an early stage could be an option to reduce the development of radiation necrosis by decreasing the vascular permeability. This might help to reverse the pathological mechanisms, improve the symptoms and prevent further progression. A patient with radiation-induced necrosis was treated with an anti-VEGF antibody (bevacizumab), in whom neurologic signs and symptoms improved in accordance with a decrease in T1-weighted fluid-attenuated inversion recovery signals. Our case report together with the current literature suggests bevacizumab as a treatment option for patients with symptoms and radiological signs of cerebral necrosis induced by radiotherapy. (orig.)

Bevacizumab as a treatment option for radiation-induced cerebral necrosis

International Nuclear Information System (INIS)

Matuschek, Christiane; Boelke, Edwin; Budach, Wilfried; Nawatny, Jens; Hoffmann, Thomas K.; Peiper, Matthias; Orth, Klaus; Gerber, Peter Arne; Rusnak, Ethelyn; Lammering, Guido; MAASTRO Clinic, Maastricht

2011-01-01

Radiation necrosis of normal CNS tissue represents one of the main risk factors of brain irradiation, occurring more frequently and earlier at higher total doses and higher doses per fraction. At present, it is believed that the necrosis results due to increasing capillary permeability caused by cytokine release leading to extracellular edema. This process is sustained by endothelial dysfunction, tissue hypoxia, and subsequent necrosis. Consequently, blocking the vascular endothelial growth factor (VEGF) at an early stage could be an option to reduce the development of radiation necrosis by decreasing the vascular permeability. This might help to reverse the pathological mechanisms, improve the symptoms and prevent further progression. A patient with radiation-induced necrosis was treated with an anti-VEGF antibody (bevacizumab), in whom neurologic signs and symptoms improved in accordance with a decrease in T1-weighted fluid-attenuated inversion recovery signals. Our case report together with the current literature suggests bevacizumab as a treatment option for patients with symptoms and radiological signs of cerebral necrosis induced by radiotherapy. (orig.)

Generalized Aggressive Periodontitis and Its Treatment Options: Case Reports and Review of the Literature

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T. Roshna

2012-01-01

Full Text Available Generalized aggressive periodontitis results in rapid destruction of the periodontium and can lead to early tooth loss in the affected individuals if not diagnosed early and treated appropriately. The diagnostic features of the disease are characteristic, but the clinical presentation and patterns of destructions may vary between patients. Successful management of the disease is challenging especially if diagnosed at advanced stages of the disease, but not impossible with the current therapeutic choices for the disease. A vast array of treatment modalities is available which can be employed in the treatment of generalized aggressive periodontitis with varying success rates, but a definite guideline for the management is yet to be formulated. However, with the exponential rate of developments in periodontal research, regenerative therapy, tissue engineering, and genetic technologies, the future seems promising in regard to options at managing the disease. This paper attempts to describe the clinical and radiographic diagnostic features and the current treatment options along with a suggested protocol for comprehensive management of generalized aggressive periodontitis patients with case reports and a brief review.

[The Probabilistic Efficiency Frontier: A Value Assessment of Treatment Options in Hepatitis C].

Science.gov (United States)

Mühlbacher, Axel C; Sadler, Andrew

2017-06-19

Background The German Institute for Quality and Efficiency in Health Care (IQWiG) recommends the concept of the efficiency frontier to assess health care interventions. The efficiency frontier supports regulatory decisions on reimbursement prices for the appropriate allocation of health care resources. Until today this cost-benefit assessment framework has only been applied on the basis of individual patient-relevant endpoints. This contradicts the reality of a multi-dimensional patient benefit. Objective The objective of this study was to illustrate the operationalization of multi-dimensional benefit considering the uncertainty in clinical effects and preference data in order to calculate the efficiency of different treatment options for hepatitis C (HCV). This case study shows how methodological challenges could be overcome in order to use the efficiency frontier for economic analysis and health care decision-making. Method The operationalization of patient benefit was carried out on several patient-relevant endpoints. Preference data from a discrete choice experiment (DCE) study and clinical data based on clinical trials, which reflected the patient and the clinical perspective, respectively, were used for the aggregation of an overall benefit score. A probabilistic efficiency frontier was constructed in a Monte Carlo simulation with 10000 random draws. Patient-relevant endpoints were modeled with a beta distribution and preference data with a normal distribution. The assessment of overall benefit and costs provided information about the adequacy of the treatment prices. The parameter uncertainty was illustrated by the price-acceptability-curve and the net monetary benefit. Results Based on the clinical and preference data in Germany, the interferon-free treatment options proved to be efficient for the current price level. The interferon-free therapies of the latest generation achieved a positive net cost-benefit. Within the decision model, these therapies

Understanding patient and physician perceptions of male androgenetic alopecia treatments in Asia-Pacific and Latin America.

Science.gov (United States)

Lulic, Zrinka; Inui, Shigeki; Sim, Woo-Young; Kang, Hoon; Choi, Gwang Seong; Hong, Woosung; Hatanaka, Toshiki; Wilson, Timothy; Manyak, Michael

2017-08-01

This survey aimed to explore patient and physician attitudes towards male androgenetic alopecia (AGA), satisfaction with currently available male AGA treatments and investigate the factors affecting treatment choice. The survey was carried out in five countries (Japan, South Korea, Taiwan, Mexico and Brazil) between November and December 2015 using a standard market research methodology. Questionnaires were completed by patients with male AGA or hair loss/thinning and practicing physicians who were responsible for prescribing AGA treatment. In total, 835 patients and 338 physicians completed the questionnaire. Overall, 37.6% of patients reported satisfaction with the treatments they had used. The highest patient satisfaction was reported for 5-alpha-reductase inhibitors (53.9% of patients satisfied). In all countries, physicians were more likely than patients to think that male AGA has a major impact on patient confidence (89.3% vs 70.4%, respectively). There was agreement by physicians and patients that male AGA patients who are involved in their treatment decisions have better outcomes. Patients who were satisfied with AGA treatments were more likely to have the level of involvement they desired in treatment decisions (69.1% of satisfied patients) than dissatisfied patients (56.4% of dissatisfied patients). This survey provides valuable insights into the attitudes of patients and physicians in Asia and Latin America about male AGA and its treatments. The survey identified areas of disconnect between physicians and patients regarding the impact of male AGA, treatment consultations and the importance of treatment attributes. It also highlights the need for physicians to spend sufficient time with patients discussing AGA treatment approaches. © 2017 GlaxoSmithKline. The Journal of Dermatology published by John Wiley & Sons Australia, Ltd on behalf of Japanese Dermatological Association.

Stem cell therapeutic possibilities: future therapeutic options for male-factor and female-factor infertility?

Science.gov (United States)

Easley, Charles A; Simerly, Calvin R; Schatten, Gerald

2013-07-01

Recent advances in assisted reproduction treatment have enabled some couples with severe infertility issues to conceive, but the methods are not successful in all cases. Notwithstanding the significant financial burden of assisted reproduction treatment, the emotional scars from an inability to conceive a child enacts a greater toll on affected couples. While methods have circumvented some root causes for male and female infertility, often the underlying causes cannot be treated, thus true cures for restoring a patient's fertility are limited. Furthermore, the procedures are only available if the affected patients are able to produce gametes. Patients rendered sterile by medical interventions, exposure to toxicants or genetic causes are unable to utilize assisted reproduction to conceive a child - and often resort to donors, where permitted. Stem cells represent a future potential avenue for allowing these sterile patients to produce offspring. Advances in stem cell biology indicate that stem cell replacement therapies or in-vitro differentiation may be on the horizon to treat and could cure male and female infertility, although significant challenges need to be met before this technology can reach clinical practice. This article discusses these advances and describes the impact that these advances may have on treating infertility. Copyright © 2013 Reproductive Healthcare Ltd. Published by Elsevier Ltd. All rights reserved.

Emergency treatment of male blunt urethral trauma in China: Outcome of different methods in comparison with other countries

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Yumeng Zhang

2018-04-01

Full Text Available Treatment of male urethral trauma is always a challenging problem. In China, as the incidence of urethral trauma keeps rising, more and more studies relating to this are being published. To compare the outcome of different emergency treatments in China and other countries, we searched Chinese and English literature about this topic in the past 16 years. A total of 167 studies involving 5314 patients were included, with 144 in Chinese and 23 in English. All studies were retrospective in nature. Based on the analyses, surgical methods include open realignment, endoscopic realignment and primary repair, and we summarized and compared the success rate and complications (mainly erectile dysfunction and incontinence of each method. We found that realignment of posterior urethra has similar success rate in China and other countries, but the outcome of realignment of anterior urethra is variable. The reason remains unknown. While long abandoned in Western countries, primary repair of anterior urethra is still an option in China and has high success rate. Keywords: Urethral trauma, Urethrogram, Endoscopic realignment, Primary repair

Acupuncture as a therapeutic treatment option for threatened miscarriage

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Betts Debra

2012-03-01

Full Text Available Abstract Background Threatened miscarriage involves vaginal bleeding in a pregnancy that remains viable. This is a common early pregnancy complication with increased risk factors for early pregnancy loss, preterm premature rupture of membranes (PPROM, preterm delivery, low birth weight babies and maternal antepartum haemorrhage. Currently there are no recommended medical treatment options, rather women receive advice that centres on a 'wait and see' approach. For women with a history of unexplained recurrent miscarriage providing supportive care in a subsequent pregnancy improves live birthing outcomes, but the provision of supportive care to women experiencing threatened miscarriage has to date not been examined. Discussion While it is known that 50-70% of miscarriages occur due to chromosomal abnormalities, the potential for therapeutic intervention amongst the remaining percentage of women remains unknown. Complementary and alternative medicine (CAM therapies have the potential to provide supportive care for women presenting with threatened miscarriage. Within fertility research, acupuncture demonstrates beneficial hormonal responses with decreased miscarriage rates, raising the possibility acupuncture may promote specific beneficial effects in early pregnancy. With the lack of current medical options for women presenting with threatened miscarriage it is timely to examine the possible treatment benefits of providing CAM therapies such as acupuncture. Summary Despite vaginal bleeding being a common complication of early pregnancy there is often reluctance from practitioners to discuss with women and medical personal how and why CAM may be beneficial. In this debate article, the physiological processes of early pregnancy together with the concept of providing supportive care and acupuncture are examined. The aim is to raise awareness and promote discussion as to the beneficial role CAM may have for women presenting with threatened miscarriage.

Beyond the Condom: Frontiers in Male Contraception.

Science.gov (United States)

Roth, Mara Y; Amory, John K

2016-05-01

Nearly half of all pregnancies worldwide are unplanned, despite numerous contraceptive options available. No new contraceptive method has been developed for men since the invention of condom. Nevertheless, more than 25% of contraception worldwide relies on male methods. Therefore, novel effective methods of male contraception are of interest. Herein we review the physiologic basis for both male hormonal and nonhormonal methods of contraception. We review the history of male hormonal contraception development, current hormonal agents in development, as well as the potential risks and benefits of male hormonal contraception options for men. Nonhormonal methods reviewed will include both pharmacological and mechanical approaches in development, with specific focus on methods which inhibit the testicular retinoic acid synthesis and action. Multiple hormonal and nonhormonal methods of male contraception are in the drug development pathway, with the hope that a reversible, reliable, safe method of male contraception will be available to couples in the not too distant future. Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Diagnosis and treatment of male patients with lower urinary tract symptoms in Spain - The MERCURY Study. Do urologists follow the recommendations of the European guidelines?

Science.gov (United States)

Errando-Smet, C; Müller-Arteaga, C; Hernández, M; Roset, M

2018-02-07

To explore the management of lower urinary tract symptoms (LUTS) in men in Spain and assess the compliance with recommendations established in the European Association of Urology (EAU) guidelines. MERCURY was an epidemiological and cross-sectional study which involved 227 Urology Units across Spain assessing adult male patients with mixed LUTS and persisting storage symptoms. Sociodemographic, clinical and resource use data for the 6 months prior to study inclusion were collected. Additionally, through a theoretical clinical case, clinicians described their attitude toward the diagnostic and therapeutic management of males with mixed LUTS and persisting storage symptoms during the first and second visits. Answer options given to clinicians about LUTS management were aligned with those recommended by EAU guidelines. 610 patients included in the study were evaluated. 87.7% of them consumed some health resource mainly due to: urologist visits (79.7%), PSA determination (76.6%) and treatment with alpha-blockers (37.5%) and alpha-blockers plus antimuscarinics (37.2%). According to the theoretical clinical case, urologists preference toward diagnostic tools and pharmacological treatment in first visit were mainly PSA determination (97.7%), digital rectal examination (91.4%) and treatment with alphablockers as monotherapy (56.6%), whereas in the second visit uroflowmetry (48.9%), voiding diary (40.3%) and treatment with alpha-blockers plus antimuscarinics (70.6%) were mainly preferred. Urologists attitude toward management of male patients with mixed LUTS and persisting storage symptoms is aligned with that recommended in the EAU guidelines. Copyright © 2018 AEU. Publicado por Elsevier España, S.L.U. All rights reserved.

Spinal Cord Injury in the Geriatric Population: Risk Factors, Treatment Options, and Long-Term Management.

Science.gov (United States)

Ikpeze, Tochukwu C; Mesfin, Addisu

2017-06-01

Spinal cord injuries (SCIs) are sustained by more than 12 500 patients per year in the United States and more globally. The SCIs disproportionately affect the elderly, especially men. Approximately 60% of these injuries are sustained traumatically through falls, but nontraumatic causes including infections, tumors, and medication-related epidural bleeding have also been documented. Preexisting conditions such as ankylosing spondylitis and diffuse idiopathic skeletal hyperostosis can render the spine stiff and are risk factors as well as cervical spondylosis and ensuing cervical stenosis. Treatment options vary depending on the severity, location, and complexity of the injury. Surgical management has been growing in popularity over the years and remains an option as it helps reduce spinal cord compression and alleviate pain. Elevating mean arterial pressures to prevent spinal cord ischemia and avoiding the second hit of SCI have become more common as opposed to high dose steroids. Ongoing clinical trials with pharmacological agents such as minocycline and riluzole have shown early, promising results in their ability to reduce cellular damage and facilitate recovery. Though SCI can be life changing, the available treatment options have aimed to reduce pain and minimize complications and maintain quality of life alongside rehabilitative services.

Mixed waste management options

International Nuclear Information System (INIS)

Owens, C.B.; Kirner, N.P.

1992-01-01

Currently, limited storage and treatment capacity exists for commercial mixed waste streams. No commercial mixed waste disposal is available, and it has been estimated that if and when commercial mixed waste disposal becomes available, the costs will be high. If high disposal fees are imposed, generators may be willing to apply extraordinary treatment or regulatory approaches to properly dispose of their mixed waste. This paper explores the feasibility of several waste management scenarios and management options. Existing data on commercially generated mixed waste streams are used to identify the realm of mixed waste known to be generated. Each waste stream is evaluated from both a regulatory and technical perspective in order to convert the waste into a strictly low-level radioactive or a hazardous waste. Alternative regulatory approaches evaluated in this paper include a delisting petition) no migration petition) and a treatability variance. For each waste stream, potentially available treatment options are identified that could lead to these variances. Waste minimization methodology and storage for decay are also considered. Economic feasibility of each option is discussed broadly. Another option for mixed waste management that is being explored is the feasibility of Department of Energy (DOE) accepting commercial mixed waste for treatment, storage, and disposal. A study has been completed that analyzes DOE treatment capacity in comparison with commercial mixed waste streams. (author)

Nonsurgical and surgical treatment of periodontitis: how many options for one disease?

Science.gov (United States)

Graziani, Filippo; Karapetsa, Dimitra; Alonso, Bettina; Herrera, David

2017-10-01

Treatment of periodontitis aims at preventing further disease progression with the intentions to reduce the risk of tooth loss, minimize symptoms and perception of the disease, possibly restore lost periodontal tissue and provide information on maintaining a healthy periodontium. Therapeutic intervention includes introduction of techniques to change behavior, such as: individually tailored oral-hygiene instructions; a smoking-cessation program; dietary adjustment; subgingival instrumentation to remove plaque and calculus; local and systemic pharmacotherapy; and various types of surgery. No single treatment option has shown superiority, and virtually all types of mechanical periodontal treatment benefit from adjunctive antimicrobial chemotherapy. Periodontal treatment, because of the chronic nature of periodontitis, is a lifelong commitment to intricate oral-hygiene techniques, which, when properly implemented, will minimize the risk of disease initiation and progression. © 2017 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

Antenatal Hydronephrosis: Differential Diagnosis, Evaluation, and Treatment Options

Science.gov (United States)

Herndon, C.D. Anthony

2006-01-01

The diagnosis, evaluation and management of antenatal hydronephrosis has undergone a two stage paradigm shift since the advent of prenatal ultrasonography in the early 1980s. Initially the identification of a large number of asymptomatic infants appeared to afford the surgeon the opportunity for preemptive intervention. However, it has now become apparent that antenatal hydronephrosis (AH) is far more difficult to interpret thanoriginally perceived. The initial enthusiasm for surgery has now been replaced by a much more conservative approach to ureteropelvic junction(UPJ) obstruction, multi-cystic dysplastic kidney(MCDK), vesicoureteral reflux and the non-refluxing megaureter. This review will highlight the postnatal evaluation of AH and include an overview of the Society for Fetal Urology grading system for hydronephrosis. The differential diagnosis and treatment options for UPJ obstruction, vesicoureteral reflux, MCDK, duplication anomalies, megaureter, and posterior urethral valves will be discussed. PMID:17619702

Outpatient Treatment of Primary Anorexia Nervosa in Adult Males.

Science.gov (United States)

Ziesat, Harold A., Jr.; Ferguson, James M.

1984-01-01

Describes three cases of adult-onset primary anorexia nervosa in males. For each case, the history and diagnostic patterns are considered, followed by a discussion of the course of outpatient treatment. The therapy was multimodal and included elements of behavioral contingency management, cognitive therapy, and dynamic psychotherapy. (JAC)

Transepidermal drug delivery: a new treatment option for areata alopecia?

Science.gov (United States)

Issa, Maria Claudia Almeida; Pires, Marianna; Silveira, Priscilla; Xavier de Brito, Esther; Sasajima, Cristiane

2015-02-01

Transepidermal drug delivery (TED) is a new potential method in dermatology. Permeability alterations induced by ablative fractional resurfacing have been described with the aim to increasing the delivery of different substances into the skin. To evaluate clinical response and side effects of TED in areata alopecia (AA) treatment using ablative fractional methods associated with acoustic pressure ultrasound (US) to deliver triamcinolone solution into the skin. Five cases of AA underwent treatment which comprised of 3 steps: 1) Ablative fractioned RF or CO2 laser 2) topical application of triamcinolone 3) acoustic pressure wave US. The number of sessions varied according to the clinical response, ranging from one to six sessions. All patients had complete recovery of the area treated. Two of them treated with ablative fractional RF + triamcinolone + US had complete response after three and six sessions. The other two treated with ablative fractional CO2 + triamcinolone + US had complete response after one session. Fractioned ablative resurfacing associated with acoustic pressure wave US is a new option to areata alopecia treatment with good clinical result and low incidence of side effects.

Profiles of Juvenile Male Incest Perpetrators: Preliminary Treatment Implications.

Science.gov (United States)

Nanjundappa, G.; And Others

1987-01-01

Evaluated the effects on participants' self-image of sexual offenses they had committed. Subjects (N=6) were male adolescents convicted of child molestation in a residential treatment and care facility. Results suggested subjects (who were themselves victims of family violence) perceived an above average self-image and handled their problems by…

Process and technological options for odorous emissions control in wastewater treatment plants

International Nuclear Information System (INIS)

Cernuschi, S.; Torretta, V.

1996-01-01

The emissions of odorous substances together with noise and issues related to proper architectural design within the existing territorial context, have certainly to be considered one of the most significant environmental effects determined by wastewater treatment plants particularly in the most frequent case of their localization in dense urban areas. Following a brief introduction on the chemical properties of odorous compounds and the corresponding methods for representing their concentration levels in air, present work reports on the main qualitative and quantitative characteristics of odorous emissions originating from single unit operations of typical wastewater treatment plants and on the technological and process options available for their control

Mine Drainage Generation and Control Options.

Science.gov (United States)

Wei, Xinchao; Rodak, Carolyn M; Zhang, Shicheng; Han, Yuexin; Wolfe, F Andrew

2016-10-01

This review provides a snapshot of papers published in 2015 relevant to the topic of mine drainage generation and control options. The review is broken into 3 sections: Generation, Prediction and Prevention, and Treatment Options. The first section, mine drainage generation, focuses on the characterization of mine drainage and the environmental impacts. As such, it is broken into three subsections focused on microbiological characterization, physiochemical characterization, and environmental impacts. The second section of the review is divided into two subsections focused on either the prediction or prevention of acid mine drainage. The final section focuses on treatment options for mine drainage and waste sludge. The third section contains subsections on passive treatment, biological treatment, physiochemical treatment, and a new subsection on beneficial uses for mine drainage and treatment wastes.

[Evidence-based therapy for cartilage lesions in the knee - regenerative treatment options].

Science.gov (United States)

Proffen, B; von Keudell, A; Vavken, P

2012-06-01

The treatment of cartilage defects has seen a shift from replacement to regeneration in the last few years. The rationale behind this development is the improvement in the quality-of-care for the growing segment of young patients who are prone to arthroplasty complications because of their specific characteristics - young age, high level of activity, high demand for functionality. These days, two of the most popular regenerative treatments are microfracture and autologous chondrocyte implantation (ACI). Although these new options show promising results, no final algorithm for the treatment of cartilage lesions has been established as yet. The objective of this review is to describe and compare these two treatment options and to present an evidence-based treatment algorithm for focal cartilage defects. Microfracture is a cost-effective, arthroscopic one-stage procedure, in which by drilling of the subchondral plate, mesenchymal stem cells from the bone marrow migrate into the defect and rebuild the cartilage. ACI is a two-stage procedure in which first chondrocytes are harvested, expanded in cell culture and in a second open procedure reimplanted into the cartilage defect. Microfracture is usually used for focal cartilage defects osteophyte, and for the ACI patient, periosteal hypertrophy and the need for two procedures in ACI. Only a few studies provide detailed and evidence-based information on a comparative assessment. These studies, however, are showing widely similar clinical outcomes but better histological results for ACI, which are likely to translate into better long-term outcomes. Although evidence-based studies comparing microfracture and ACI have not found significant differences in the clinical outcome, the literature does show that choosing the treatment based on the size and characteristics of the osteochondral lesion might be beneficial. The American Association of Orthopedic Surgeons suggest that contained lesions < 4 cm2 should be treated by

Cryoablation in fibro-adipose vascular anomaly (FAVA): a minimally invasive treatment option

International Nuclear Information System (INIS)

Shaikh, Raja; Alomari, Ahmad I.; Kerr, Cindy L.; Miller, Patricia; Spencer, Samantha A.

2016-01-01

Fibro-adipose vascular anomaly (FAVA) is a complex vascular malformation that typically presents with persistent pain, discomfort, contracture and other disabling symptoms. There are no minimally invasive treatment options to effectively control these symptoms. Image-guided percutaneous cryoablation, which has been used to control pain in people with cancer, could be used for similar indications in FAVA. To assess the role of image-guided percutaneous cryoablation for control of symptoms in FAVA lesions. We conducted a retrospective cohort study of 20 children and young adults with FAVA who underwent percutaneous cryoablation at 26 sites, from September 2013 to August 2015. The outcome was based on the brief pain inventory scoring (BPI), concurrent symptoms, clinical response and patient satisfaction. After cryoablation there was significant improvement in pain, which dropped by 3 points (pain now) to 3.7 points (pain in the last 24 h). Most patients indicated that pain interfered less in their everyday social life. Concurrent symptoms like swelling, physical limitations and skin hyperesthesia also improved. Clinical response was greatest at 2-5 months follow-up after cryoablation, with acceptable patient satisfaction thereafter. Technical response was 100%. There were no major complications. Image-guided percutaneous cryoablation is a safe and effective option for treatment of symptomatic FAVA lesions. (orig.)

Ozone-augmented percutaneous discectomy: a novel treatment option for refractory discogenic sciatica.

Science.gov (United States)

Crockett, M T; Moynagh, M; Long, N; Kilcoyne, A; Dicker, P; Synnott, K; Eustace, S J

2014-12-01

To assess the short and medium-term efficacy and safety of a novel, minimally invasive therapeutic option combining automated percutaneous lumbar discectomy, intradiscal ozone injection, and caudal epidural: ozone-augmented percutaneous discectomy (OPLD). One hundred and forty-seven patients with a clinical and radiological diagnosis of discogenic sciatica who were refractory to initial therapy were included. Fifty patients underwent OPLD whilst 97 underwent a further caudal epidural. Outcomes were evaluated using McNab's score, improvement in visual analogue score (VAS) pain score, and requirement for further intervention. Follow-up occurred at 1 and 6 months, and comparison was made between groups. OPLD achieved successful outcomes in almost three-quarters of patients in the short and medium term. OPLD achieved superior outcomes at 1 and 6 months compared to caudal epidural. There was a reduced requirement for further intervention in the OPLD group. No significant complications occurred in either group. OPLD is a safe and effective treatment for patients with refractory discogenic sciatica in the short and medium term. OPLD has the potential to offer an alternative second-line minimally invasive treatment option that could reduce the requirement for surgery in this patient cohort. Copyright © 2014 The Royal College of Radiologists. Published by Elsevier Ltd. All rights reserved.

Economic assessment of preeclampsia : Screening, diagnosis, treatment options, and long term outcomes - A systematic review

NARCIS (Netherlands)

Zakiyah, Neily; Van Asselt, Antoinette D.; Baker, Philip N.; Postma, Maarten J.

OBJECTIVES: Provide a comprehensive overview of the existing evidence on the health economics of screening, diagnosis, and treatment options in preeclampsia. METHODS: A systematic literature search was undertaken using three electronic databases (MEDLINE, Embase, Cochrane) to identify all English

Cachexia and pancreatic cancer: Are there treatment options?

Science.gov (United States)

Mueller, Tara C; Burmeister, Marc A; Bachmann, Jeannine; Martignoni, Marc E

2014-01-01

Cachexia is frequently described in patients with pancreatic ductal adenocarcinoma (PDAC) and is associated with reduced survival and quality of life. Unfortunately, the therapeutic options of this multi-factorial and complex syndrome are limited. This is due to the fact that, despite extensive preclinical and clinical research, the underlying pathological mechanisms leading to PDAC-associated cachexia are still not fully understood. Furthermore, there is still a lack of consensus on the definition of cachexia, which complicates the standardization of diagnosis and treatment as well as the analysis of the current literature. In order to provide an efficient therapy for cachexia, an early and reliable diagnosis and consistent monitoring is required, which can be challenging especially in obese patients. Although many substances have been tested in clinical and preclinical settings, so far none of them have been proven to have a long-term effect in ameliorating cancer-associated cachexia. However, recent studies have demonstrated that multidimensional therapeutic modalities are able to alleviate pancreatic cancer-associated cachexia and ultimately improve patients’ outcome. In this current review, we propose a stepwise and pragmatic approach to facilitate and standardize the treatment of cachexia in pancreatic cancer patients. This strategy consists of nutritional, dietary, pharmacological, physical and psychological methods. PMID:25071331

The genetics of age-related macular degeneration (AMD)--Novel targets for designing treatment options?

Science.gov (United States)

Grassmann, Felix; Fauser, Sascha; Weber, Bernhard H F

2015-09-01

Age-related macular degeneration (AMD) is a progressive disease of the central retina and the main cause of legal blindness in industrialized countries. Risk to develop the disease is conferred by both individual as well as genetic factors with the latter being increasingly deciphered over the last decade. Therapeutically, striking advances have been made for the treatment of the neovascular form of late stage AMD while for the late stage atrophic form of the disease, which accounts for almost half of the visually impaired, there is currently no effective therapy on the market. This review highlights our current knowledge on the genetic architecture of early and late stage AMD and explores its potential for the discovery of novel, target-guided treatment options. We reflect on current clinical and experimental therapies for all forms of AMD and specifically note a persisting lack of efficacy for treatment in atrophic AMD. We further explore the current insight in AMD-associated genes and pathways and critically question whether this knowledge is suited to design novel treatment options. Specifically, we point out that known genetic factors associated with AMD govern the risk to develop disease and thus may not play a role in its severity or progression. Treatments based on such knowledge appear appropriate rather for prevention than treatment of manifest disease. As a consequence, future research in AMD needs to be greatly focused on approaches relevant to the patients and their medical needs. Copyright © 2015 Elsevier B.V. All rights reserved.

Economic assessment of preeclampsia : Screening, diagnosis, treatment options, and long term outcomes, a systematic review

NARCIS (Netherlands)

Zakiyah, N.; Van Asselt, A.; Baker, P.; Postma, M.J.

2014-01-01

Objectives: To provide a comprehensive overview of the existing evidence on the health economics of screening, diagnosis, and treatment options in preeclampsia. Methods: A systematic literature search was undertaken using three electronic databases (MEDLINE, Embase, Cochrane) to identify all English

Sexual function in male patients with obstructive sleep apnoea after 1 year of CPAP treatment

DEFF Research Database (Denmark)

Petersen, Marian Christin; Kristensen, Ellids; Berg, Søren

2012-01-01

OBJECTIVE: Our objective was to investigate what impact 1 year of effective nocturnal continuous positive airway pressure (CPAP) treatment had on general and functional aspects of sexuality in male patients with a confirmed diagnosis of obstructive sleep apnoea (OSA). METHODS: Before and after 1...... year of CPAP treatment, a total of 207 CPAP-compliant male patients (age 26-77) received a survey with questions drawn from two self-administered questionnaires on sexuality - Life Satisfaction 11 (LiSat-11) and brief sexual function inventory (BSFI). For assessment of daytime sleepiness, we used...... of CPAP treatment. ESS score decreased significantly after 1 year of CPAP treatment. CONCLUSION: One year of CPAP treatment improves all aspects of sexual function in male patients with OSA. Our data indirectly suggest that organic factors are the most likely explanation to these improvements....

24 CFR 35.120 - Options.

Science.gov (United States)

2010-04-01

... 24 Housing and Urban Development 1 2010-04-01 2010-04-01 false Options. 35.120 Section 35.120... and Definitions for All Programs. § 35.120 Options. (a) Standard treatments. Where interim controls are required by this part, the designated party has the option to presume that lead-based paint or...

Health facility challenges to the provision of Option B+ in western Kenya: a qualitative study.

Science.gov (United States)

Helova, Anna; Akama, Eliud; Bukusi, Elizabeth A; Musoke, Pamela; Nalwa, Wafula Z; Odeny, Thomas A; Onono, Maricianah; Spangler, Sydney A; Turan, Janet M; Wanga, Iris; Abuogi, Lisa L

2017-03-01

Current WHO guidelines recommend lifelong antiretroviral therapy (ART) for all HIV-positive individuals, including pregnant and breastfeeding women (Option B+) in settings with generalized HIV epidemics. While Option B+ is scaled-up in Kenya, insufficient adherence and retention to care could undermine the expected positive impact of Option B+. To explore challenges to the provision of Option B+ at the health facility level, we conducted forty individual gender-matched in-depth interviews with HIV-positive pregnant/postpartum women and their male partners, and four focus groups with thirty health care providers at four health facilities in western Kenya between September-November 2014. Transcripts were coded with the Dedoose software using a coding framework based on the literature, topics from interview guides, and emerging themes from transcripts. Excerpts from broad codes were then fine-coded using an inductive approach. Three major themes emerged: 1) Option B+ specific challenges (same-day initiation into treatment, health care providers unconvinced of the benefits of Option B+, insufficient training); 2) facility resource constraints (staff and drug shortages, long queues, space limitations); and 3) lack of client-friendly services (scolding of patients, inconvenient operating hours, lack of integration of services, administrative requirements). This study highlights important challenges at the health facility level related to Option B+ rollout in western Kenya. Addressing these specific challenges may increase linkage, retention and adherence to life-long ART treatment for pregnant HIV-positive women in Kenya, contribute towards elimination of mother-to-child HIV transmission, and improve maternal and child outcomes.

Surgical options for treatment of traumatic subdural hematomas in children younger than 2 years of age.

Science.gov (United States)

Melo, José Roberto Tude; Di Rocco, Federico; Bourgeois, Marie; Puget, Stephanie; Blauwblomme, Thomas; Sainte-Rose, Christian; Meyer, Philippe G; Zerah, Michel

2014-04-01

Subdural hematoma (SDH) is the most common finding on cranial CT in pediatric victims of abusive head trauma (AHT). The hematomas are commonly bilateral and sometimes associated with interhemispheric hyperdensity and/or convexity hemorrhages. There is no consensus regarding the best surgical treatment in such cases nor are there standardized surgical protocols. The authors report their experience and discuss the routine surgical options in the management of traumatic SDH at a Level 1 Pediatric Trauma Center. In this paper, the authors describe a cross-sectional study with consecutive revision of data described in the medical records of Hôpital Universitaire Necker-Enfants Malades between January 2008 and January 2013. During this period, all children younger than 2 years of age who were admitted with a traumatic SDH identified on CT scans were included in this study. One hundred eighty-four children who had SDH and were younger than 2 years of age were included. Their median age was 5.8 months (range 5 days-23 months), and 70% of the children were male. On admission CT scans, the SDH was bilateral in 52% of cases and homogeneously hypodense in 77%. Neurosurgical treatment was undertaken in 111 children (60%) with an admission Glasgow Coma Scale score of 12 or less, bulging fontanels, or other signs suggestive of intracranial hypertension. The first surgical option was craniotomy in 1.8% (2) of these 111 cases, decompressive craniectomy in 1.8% (2), transcutaneous subdural puncture in 15% (17), external subdural drainage in 16% (18), subdural-subgaleal shunt placement in 17% (19), and subdural-peritoneal shunt placement in 48% (53). In 82% of the children initially treated with transcutaneous subdural puncture and in 50% of those treated with external subdural drainage, increase or persistence of the SDH, CSF or skin infection, or shunt system malfunction was observed and further surgical intervention was required. There was a 26% rate of complications in patients

Cocaine Addiction Treatments to improve Control and reduce Harm (CATCH): new pharmacological treatment options for crack-cocaine dependence in the Netherlands

NARCIS (Netherlands)

Nuijten, Mascha; Blanken, Peter; van den Brink, Wim; Hendriks, Vincent

2011-01-01

Cocaine, particularly in its base form ('crack'), has become one of the drugs of most concern in the Netherlands, being associated with a wide range of medical, psychiatric and social problems for the individual, and with significant public order consequences for society. Available treatment options

[Novel current and future therapy options for treatment of dry eye disease].

Science.gov (United States)

Messmer, E M

2018-02-01

Dry eye disease was redefined by the dry eye workshop (DEWS II) in May 2017. According to the new definition "dry eye is a multifactorial disease of the ocular surface characterized by a loss of homeostasis of the tear film and accompanied by ocular symptoms". The current definition encompasses etiological factors, such as instability and hyperosmolarity of the tear film, ocular surface inflammation and damage as well as a new aspect compared to the former definition, neurosensory abnormalities. Recent and future therapeutic options for dry eye focus on treatment of the aforementioned pathogenetic events. New tear substitutes, medications and devices to stimulate tear production, innovative anti-inflammatory treatment, medications to influence corneal innervation and new methods for treatment of Meibomian gland dysfunction are already available or will be available in the near future.

Treatment of Hyperthyroidism in Down Syndrome: Case Report and Review of Literature.

Science.gov (United States)

Ali, Fawzi E.; Al-Busairi, Waleed A.; Al-Mulla, Fatema A.

1999-01-01

A case of an institutionalized adult male with Down syndrome and hyperthyroidism is reported. After treatment with radioactive iodine, he was found to be markedly hypothyroid when he was reviewed 11 weeks later. Three treatment options for hyperthyroidism in Down syndrome are reviewed: surgery, medical treatments, and radiotherapy. (Author/CR)

What Treatment Options Are Available for Male Infertility?

Science.gov (United States)

... Research Information Find a Study Resources and Publications Klinefelter Syndrome (KS) Condition Information NICHD Research Information Find a ... infertility? Related A-Z Topics Infertility and Fertility Klinefelter Syndrome (KS) Sexually Transmitted Diseases (STDs) NICHD News Spotlights ...

[Prevalence of psychiatric disorders, psychopathology, and the need for treatment in female and male prisoners].

Science.gov (United States)

von Schönfeld, C-E; Schneider, F; Schröder, T; Widmann, B; Botthof, U; Driessen, M

2006-07-01

While the international literature documents a high prevalence of psychiatric disorders in prisoners, German studies in this field are rare. The base of knowledge is even worse with regard to female prisoners. The purpose of this study was to investigate DSM-IV axis I and II psychiatric disorders and current psychopathology and to estimate treatment needs in prisoners. On the 1st of May 2002, all female prisoners in Brackwede I Prison in Bielefeld, Germany, were included; and a sample of incarcerated men was matched according to age, nationality, and length of stay. Sixty-three women and 76 men participated. Criminal history and current living conditions were investigated using a questionnaire and prison documents. Psychopathology and psychiatric disorders were investigated using structured clinical interviews. In 88.2% of the sample, at least one current axis I (83.5%) and/or axis II personality disorder (53.2%) was found. Comorbidity rates were high, with 3.5+/-2.7 diagnoses per case. Mean SCL scores revealed a substantial psychopathologic burden. In female prisoners, opiate-related and polysubstance use disorders and affective and post-traumatic stress disorders were more frequent than in the male subsample, which in turn showed higher rates of alcohol-related disorders. Specific treatment needs were indicated in 83.4% of the sample. These results indicate that the proportion of mentally ill persons in prisons is substantially higher than in specialized hospitals for mentally ill criminals. More treatment options are urgently needed than has been realized up to now.

End-stage renal disease treatment options education: What matters most to patients and families.

Science.gov (United States)

St Clair Russell, Jennifer; Boulware, L Ebony

2018-03-01

Treatment modality education can offer many important benefits to patients and their families. Evidence suggests such education can increase use of home dialysis, reduce catheter use, decrease 90-day mortality, and increase transplantation. While these benefits are encouraging, not all patients are offered options education and when they are, it may not be presented in a way that is immediately applicable to them and their lives. Furthermore, little is known regarding specific characteristics (e.g. format such as group or individual or in-person or online, duration, teaching methods, location, content) of educational programs that are most successful. No single approach has emerged as a best practice. In the absence of such evidence, adult learning principles, such as involving patients and families in the development programs and materials, can serve as a guide for educational development. Adult learning principles can enhance options education, evolving them from information delivery to a person-centered, values-based endeavor that helps match treatment to values and lifestyle. © 2018 Wiley Periodicals, Inc.

Is there a place for nutritional supplements in the treatment of idiopathic male infertility?

Directory of Open Access Journals (Sweden)

Davide Arcaniolo

2014-09-01

Full Text Available Objective: Infertility affects 15% of couples in fertile age. Male factor is a cause of infertility in almost half of cases, mainly due to oligoasthenoteratozoospermia (OAT. The purpose of this study is to review the effects of nutritional supplements as medical treatment for idiopathic male infertility. Material and methods: A Pub Med and Medline review of the published studies utilizing nutritional supplements for the treatment of male infertility has been performed. Results: Clinical trials on Vitamin E, Vitamin A, Vitamin C. Arginine, Carnitine, N-Acetyl-Carnitine, Glutathione, Coenzyme Q10, Selenium and Zinc were reviewed. Although there is a wide variability in selected population, dose regimen and final outcomes, nutritional supplements both alone and in combination seems to be able to improve semen parameters (sperm count, sperm motility and morphology and pregnancy rate in infertile men. Conclusions: There are rising evidences from published randomized trials and systematic review suggesting that nutritional supplementation may improve semen parameters and the likelihood of pregnancy in men affected by OAT. This improvement, however, is not consistent and there is a wide variation in the treatment regimens used. Well designed and adequately powered RCTs are needed to better clarify the role of nutritional supplements as treatment for male infertility.

Treatment Options

Science.gov (United States)

... one that is tailored to your symptoms. article Protecting your eyesight when taking Plaquenil Some lupus treatments have the potential for eye health side-effects. Know the warning signs. article ​ ...

Cost-effectiveness analysis of Option B+ for HIV prevention and treatment of mothers and children in Malawi.

Science.gov (United States)

Fasawe, Olufunke; Avila, Carlos; Shaffer, Nathan; Schouten, Erik; Chimbwandira, Frank; Hoos, David; Nakakeeto, Olive; De Lay, Paul

2013-01-01

The Ministry of Health in Malawi is implementing a pragmatic and innovative approach for the management of all HIV-infected pregnant women, termed Option B+, which consists of providing life-long antiretroviral treatment, regardless of their CD4 count or clinical stage. Our objective was to determine if Option B+ represents a cost-effective option. A decision model simulates the disease progression of a cohort of HIV-infected pregnant women receiving prophylaxis and antiretroviral therapy, and estimates the number of paediatric infections averted and maternal life years gained over a ten-year time horizon. We assess the cost-effectiveness from the Ministry of Health perspective while taking into account the practical realities of implementing ART services in Malawi. If implemented as recommended by the World Health Organization, options A, B and B+ are equivalent in preventing new infant infections, yielding cost effectiveness ratios between US$ 37 and US$ 69 per disability adjusted life year averted in children. However, when the three options are compared to the current practice, the provision of antiretroviral therapy to all mothers (Option B+) not only prevents infant infections, but also improves the ten-year survival in mothers more than four-fold. This translates into saving more than 250,000 maternal life years, as compared to mothers receiving only Option A or B, with savings of 153,000 and 172,000 life years respectively. Option B+ also yields favourable incremental cost effectiveness ratios (ICER) of US$ 455 per life year gained over the current practice. In Malawi, Option B+ represents a favorable policy option from a cost-effectiveness perspective to prevent future infant infections, save mothers' lives and reduce orphanhood. Although Option B+ would require more financial resources initially, it would save societal resources in the long-term and represents a strategic option to simplify and integrate HIV services into maternal, newborn and child

An estimation of US horse-owner/caregiver willingness-to-pay for daily use and infectious upper respiratory disease treatment options.

Science.gov (United States)

Kibler, M L; Pendell, D L; Costanigro, M; Traub-Dargatz, J

2018-07-01

Equine injury and disease cause two types of costs for those financially responsible for treating and caring for the infected horse(s); direct costs of treating the horse and indirect cost of lost use of the horse for a period of time to the user of the horse (daily horse use). Indirect costs are more difficult to estimate but pose significant financial implications for equine-owners/caregivers. Additionally, there exists a gap in existing research regarding the valuation of infectious treatment options in horses. To estimate the value a US horse-owner/caregiver places on daily horse use and describe respondents' willingness-to-pay for various attributes of equine treatment options. Online questionnaire survey. An online questionnaire was provided to equine-owners and caretakers, and owner demographic, horse care and horse use information from respondents were requested. Additionally, respondents were presented with hypothetical disease treatment options with the following attributes: daily dosage, number of days of rest required, route of administration and out-of-pocket cost to the owner/caretaker through a choice experiment. Data were analysed using a rank-ordered logit analysis and willingness-to-pay estimates for daily use and treatment options were calculated. Results suggest that the average horse-owner with an uninsured and insured horse is willing to pay $12.07 (95% confidence interval: -$15.01, -$9.69) and $17.95 (95% confidence interval: -$25.30, -$11.20) per day to reduce lost use days required (due to need for rest) respectively. Respondents showed preferences for oral administration over treatments requiring i.m. injections. As this study employed an online survey it was subjected to self-selection bias and a sample size calculation was not performed. Veterinarians and pharmaceutical companies may use these results when promoting various treatment options to horse-owners/caregivers and in product development. Additionally, promotion efforts may be

Cabergoline in the Treatment of Male Orgasmic Disorder—A Retrospective Pilot Analysis

Directory of Open Access Journals (Sweden)

Adam B. Hollander, MD

2016-03-01

Conclusion: Cabergoline is a potentially effective and easy-to-administer treatment for male orgasmic disorder, the efficacy of which appears to be independent of patient age or orgasmic disorder etiology. Prospective randomized trials are needed to determine the true role of cabergoline in the treatment of this disorder.

Primary spontaneous coronary dissectİon in a young male and the role of intravascular ultrasonography for diagnosis and treatment

Directory of Open Access Journals (Sweden)

Sadık Volkan Emren

2015-09-01

Full Text Available Primary spontaneous coronary artery dissection (SCAD is a rare cause of acute coronary syndrome and is observed especially during gestation or the postpartum period of young healthy female patients. SCAD is much more rarely seen in young male patients. A 32 year-old male was admitted to our clinic with a typical anginal complaint that had begun after a verbal discussion in a family environment. The patient was hospitalized with a diagnosis of acute myocardial infarction without ST elevation. During coronary angiography, a lesion seen as a dissection in the proximal region of the left anterior descending artery (LAD, 30% stenosis in the circumflex artery and plaque in the right coronary artery were observed. In the LAD osteal region, a dissection flap and intimal rupture was observed at the 12:00–2:00 o'clock position using intravascular ultrasonography (IVUS. Our case was very young and had no atherosclerotic risk factors except for a history of smoking. It was suggested that intense emotional stress was the triggering factor for coronary dissection. The gold standard imaging method for spontaneous coronary dissection is coronary angiography. Recently, imaging methods like IVUS have made important contributions to the diagnosis of dissections that cannot be detected by coronary angiography. Treatment must be individual since there is no standard protocol. Medical therapy, percutaneous coronary intervention and coronary artery bypass surgery are the main treatment options.

Split high-dose oral levothyroxine treatment as a successful therapy option in myxedema coma.

Science.gov (United States)

Charoensri, Suranut; Sriphrapradang, Chutintorn; Nimitphong, Hataikarn

2017-10-01

High-dose intravenous thyroxine (T4) is the preferable treatment for myxedema coma. We describe the clinical course of a 69-year-old man who presented with myxedema coma and received oral levothyroxine (LT4) therapy (1 mg) in a split dose. This suggests split high-dose oral LT4 as a therapeutic option in myxedema coma.

Male hypogonadism: Symptoms and treatment

Directory of Open Access Journals (Sweden)

Peeyush Kumar

2010-01-01

Full Text Available Male hypogonadism is a condition in which the body does not produce enough of the testosterone hormone; the hormone that plays a key role in masculine growth and development during puberty. There is a clear need to increase the awareness of hypogonadism throughout the medical profession, especially in primary care physicians who are usually the first port of call for the patient. Hypogonadism can significantly reduce the quality of life and has resulted in the loss of livelihood and separation of couples, leading to divorce. It is also important for doctors to recognize that testosterone is not just a sex hormone. There is an important research being published to demonstrate that testosterone may have key actions on metabolism, on the vasculature, and on brain function, in addition to its well-known effects on bone and body composition. This article has been used as an introduction for the need to develop sensitive and reliable assays for sex hormones and for symptoms and treatment of hypogonadism.

Atypical antipsychotics as a possible treatment option for irritable bowel syndrome.

Science.gov (United States)

Pae, Chi-Un; Lee, Soo-Jung; Han, Changsu; Patkar, Ashwin A; Masand, Prakash S

2013-05-01

Irritable bowel syndrome (IBS) is a prevalent functional gastrointestinal disorder (FGID) that is characterised by chronic abdominal pain, discomfort, bloating, and alteration of bowel habits. Although the pathophysiology of IBS is not fully understood, it is believed that psychiatric comorbidities are highly common in such patients. A variety of psychotropic medications are widely used in the treatment of IBS, particularly older antidepressants such as tricyclic antidepressants (TCAs). With the advent of newer antidepressant classes with better safety and tolerability compared with TCAs, such as serotonin reuptake inhibitors (SSRIs) and serotonin-norepinephrine reuptake inhibitors (SNRIs), clinicians now have more advanced treatment options for treating IBS. Additionally, some atypical antipsychotics (AAs) have recently received approval for treatment of major depressive disorder (MDD). Some AAs may have potentials based on their pharmacodynamic profile and proven benefit for mood symptoms, pain, anxiety and sleep disturbances. This article describes the potential rationale, clinical data and practical aspects involved in the use of AAs for patients with IBS. Atypical antipsychotics (AAs) may have a role in the treatment of irritable bowel syndrome (IBS) based on the currently available findings, although there is no clear evidence, and a number of clinical issues to be addressed in the use of AAs for the treatment of IBS.

Tadalafil once daily: Narrative review of a treatment option for female sexual dysfunctions (FSD in midlife and older women

Directory of Open Access Journals (Sweden)

Chiara Borghi

2017-03-01

Full Text Available Female Sexual Disorders (FSD include a complex, multidimensional, individual experience that can change as an individual age, suggesting that these problems are caused by multiple factors including psychosocial factors, personal relationships, pathologic changes caused by diseases, and pharmacologic influences. Menopause is an important time for middle aged women and postmenopausal physiological changes could have a significant role in the development of FSD. Few is still known about their correct definition and treatment. Their incidence, prevalence and risk factors are difficult to define because of a high level of overlap in the experience of problems with desire, arousal, and orgasm. Little evidences are known about the best therapeutic approach, and both non-pharmacological and pharmacological treatment options have been described. Among these, phosphodiesterase type 5 inhibitors could be an effective option for many subtypes of female sexual disorders, with an improvement in different aspects of sexual function, such as desire, arousal, orgasm and sexual satisfaction. In this paper authors reviewed what is already known about the use of these vasoactive agents, particularly tadalafil, as a treatment option for female sexual disturbances.

Maturity onset diabetes of the young: Diagnosis and treatment options

Directory of Open Access Journals (Sweden)

Serghei Covanțev

2016-12-01

Full Text Available Diabetes is a complicated disease, so multiple factors are involved in its development. Nevertheless some of the patients with type 1 and 2 diabetes mellitus have a monogenic form of this disease which has different treatment options and usually fewer complications. It is estimated that about 5% of patients with type 2 diabetes melitus (T2DM and about 10% of type 1 diabetes melitus (T1DM are misdiagnosed and have maturity onset diabetes of the young (MODY. We present a review study of the management of most frequent monogenic forms of diabetes such as MODY 1, 2 and 3 and the possibilities of their diagnosis including in resource limited situations.

Laryngeal manifestations of relapsing polychondritis and a novel treatment option.

Science.gov (United States)

Childs, Lesley F; Rickert, Scott; Wengerman, Oscar C; Lebovics, Robert; Blitzer, Andrew

2012-09-01

Laryngotracheal involvement in relapsing polychondritis (RP) is rare. However, it is one of the most common causes of death in this patient population. We present three patients who primarily presented with laryngeal manifestations of RP and a novel treatment option for bamboo nodules. Retrospective chart review and comprehensive review of the literature. Two patients first presented to an otolaryngologist because of hoarseness and chronic cough that eventually progressed to dyspnea upon exertion. Laryngeal examination revealed subglottic stenoses. Upon rheumatologic workup both were diagnosed with RP. After treatment with steroids and immunosuppressive drugs, one of the patient's laryngeal symptoms improved, whereas the other required dilation procedures. Neither patient had classic auricular or nasal symptoms upon initial presentation. The third patient was being treated for spasmodic dysphonia and was noted to have bamboo nodules with accompanying dysphonia. Rheumatologic workup revealed RP and systemic treatment ensued. Unfortunately, her symptoms of hoarseness persisted despite systemic treatment. A pulsed-potassium-titanyl-phosphate (KTP) laser was applied to the bilateral bamboo nodules, which eventually caused resolution of her vocal fold lesions and dysphonia. We present three patients with RP, all of whom sought health care by an otolaryngologist primarily. Awareness of this disease entity and the possibility for early laryngeal involvement is crucial for proper care of those with this life-threatening disease. Copyright © 2012 The Voice Foundation. Published by Mosby, Inc. All rights reserved.

Adjustable perineal male sling using tissue expander as an effective treatment of post-prostatectomy urinary incontinence

Directory of Open Access Journals (Sweden)

Melih Balci

2015-04-01

Full Text Available Purpose To report our intermediate experience in treating patients with severe incontinence using an adjustable perineal male sling with a tissue expander. Materials and Methods An adjustable male sling procedure was performed on 21 patients with severe incontinence. The underlying etiology of urinary incontinence was radical prostatectomy in 13 patients, open prostatectomy in 5 patients and transurethral prostate resection in 3 patients. The difference between the classical and the adjustable sling is that in the latter there is a 25 mL tissue expander between the two layers of polypropylene mesh with an injection port. Adjustment of the sling was performed with saline via an inflation port, in case of recurrence or persistence of incontinence. Results The mean age of the patients was 66.2±7.3 (50-79 years and mean pad usage was 6.4±0.6 per day. The mean follow-up time was 40.1±23.2 (6-74 months. The balloon was postoperatively inflated on average with 11.6±5.7 (5-25 mL. After the mean 40.1 months of follow-up, 16 of the 21 patients (76.2% were dry (11 patients, 0 pads; 5 patients using safety pads, 3 patients (14% had mild and 2 (9.8% had moderate degree post-prostatectomy urinary incontinence (PPI. The average maximum urine flow rate of the patients was 15.6±4.7 (10-31 mL/s. No residual urine was found. In 2 patients, all parts of the device were removed due to infection and discomfort, and in 3 patients only the inflation component was removed due to local scrotal infection. Conclusions Our results show that using an adjustable perineal male sling with a tissue expander seems to be an efficient, and safe surgical treatment option in patients with PPI.

Rapidly changing treatment options adding burden to the management of typhoid fever

Directory of Open Access Journals (Sweden)

Jaspal Kaur

2015-01-01

Full Text Available Typhoid fever continues to be a global public health problem. It is caused by the facultative intracellular organisms Salmonella enteric serotype Typhi and Salmonella paratyphi. Antimicrobial therapy is the mainstay for treatment of typhoid fever. Chloramphenicol, ampicillin, and cotrimoxazole had been in use for decades for treating enteric fever. But the emergence and rapid spread of drug resistance has resulted in rapid shift of treatment options from chloramphenicol to fluoroquinolones to third generation cephalosporins to azithromycin with tigecycline and carbapenems in line, thus adding burden to the health-care sector in developing countries. Rational and judicious antibiotic prescribing practices by health professionals are necessary to prevent further development of drug resistance and help in re-emergence of sensitive strains.

Treatment options for renal cell carcinoma in renal allografts: a case series from a single institution.

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Swords, Darden C; Al-Geizawi, Samer M; Farney, Alan C; Rogers, Jeffrey; Burkart, John M; Assimos, Dean G; Stratta, Robert J

2013-01-01

Renal cell carcinoma (RCC) is more common in renal transplant and dialysis patients than the general population. However, RCC in transplanted kidneys is rare, and treatment has previously consisted of nephrectomy with a return to dialysis. There has been recent interest in nephron-sparing procedures as a treatment option for RCC in allograft kidneys in an effort to retain allograft function. Four patients with RCC in allograft kidneys were treated with nephrectomy, partial nephrectomy, or radiofrequency ablation. All of the patients are without evidence of recurrence of RCC after treatment. We found nephron-sparing procedures to be reasonable initial options in managing incidental RCCs diagnosed in functioning allografts to maintain an improved quality of life and avoid immediate dialysis compared with radical nephrectomy of a functioning allograft. However, in non-functioning renal allografts, radical nephrectomy may allow for a higher chance of cure without the loss of transplant function. Consequently, radical nephrectomy should be utilized whenever the allograft is non-functioning and the patient's surgical risk is not prohibitive. © 2013 John Wiley & Sons A/S.

Diagnosis and Surgical Management of Male Pelvic, Inguinal, and Testicular Pain.

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Belanger, Gabriel V; VerLee, Graham T

2016-06-01

Pain occurs in the male genitourinary organs as for any organ system in response to traumatic, infectious, or irritative stimuli. A knowledge and understanding of chronic genitourinary pain can be of great utility to practicing nonurologists. This article provides insight into the medical and surgical management of subacute and chronic pelvic, inguinal, and scrotal pain. The pathophysiology, diagnosis, and medical and surgical treatment options of each are discussed. Copyright © 2016 Elsevier Inc. All rights reserved.

Concurrent Male Gynecomastia and Testicular Hydrocele after Imatinib Mesylate Treatment of a Gastrointestinal Stromal Tumor

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Kim, Hawk; Chang, Heung-Moon; Ryu, Min-Hee; Kim, Tae-Won; Sohn, Hee-Jung; Kim, So-Eun; Kang, Hye-Jin; Park, Sarah; Lee, Jung-Shin

2005-01-01

We report a gastrointestinal stromal tumor (GIST) patient with male gynecomastia and testicular hydrocele after treatment with imatinib mesylate. A 42 yr-old male patient presented for management of hepatic masses. Two years earlier, he had undergone a small bowel resection to remove an intraabdominal mass later shown to be a GIST, followed by adjuvant radiation therapy. At presentation, CT scan revealed multiple hepatic masses, which were compatible with metastatic GIST, and he was prescribed imatinib 400 mg/day. During treatment, he experienced painful enlargement of the left breast and scrotal swelling. Three months after cessation of imatinib treatment, the tumors recurred, and, upon recommencing imatinib, he experienced painful enlargement of the right breast and scrotal swelling. He was diagnosed with male gynecomastia caused by decreased testosterone and non-communicative testicular hydrocele. He was given androgen support and a hydrocelectomy, which improved his gynecomastia. The mechanism by which imatinib induces gynecomastia and hydrocele is thought to be associated with an inhibition of c-KIT and platelet-derive growth factor. This is the first report, to our knowledge, describing concurrent male gynecomastia and testicular hydrocele after imatinib treatment of a patient with GIST. PMID:15953881

Current and potential treatment options for hyperphosphatemia.

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Carfagna, Fabio; Del Vecchio, Lucia; Pontoriero, Giuseppe; Locatelli, Francesco

2018-05-21

Hyperphosphatemia is common in late stages of chronic kidney disease and is often associated with elevated parathormone levels, abnormal bone mineralization, extra-osseous calcification, and increased risk of cardiovascular events and death. Several classes of oral phosphate binders are available to help control plasma phosphorus levels. Although effective at lowering serum phosphorus, they all have safety, tolerability, and compliance issues that need to be considered when selecting which one to use. Areas covered: This paper reviews the most established treatment options for hyperphosphatemia, in patients with chronic kidney disease, focusing on the new inhibitors of active phosphate absorption. Expert opinion: The prevention and the treatment of hyperphosphatemia is today far to be satisfactory. Nonetheless, an extending range of phosphate binders are now available. Aluminum has potentially serious toxic risks. Calcium-based binders are very effective but can lead to hypercalcemia and/or positive calcium balance and progression of cardiovascular calcification. No long-term data are available for the new calcium acetate/magnesium combination product. Lanthanum is an effective phosphate binder, and long-term effects of tissue deposition seem clinically irrelevant. Sevelamer, appear to have profiles that would lead to pleiotropic effects and reduced progression of vascular calcification, and the main adverse events seen with these agents are gastrointestinal. Iron has a powerful capability of binding phosphate, thus numerous preparations are available, both with and without significant systemic absorption of the iron component. The inhibitors of active intestinal phosphate transport, with their very selective mechanism of action and low pill burden seem the most interesting approach; however, do not seem at present to be effective alone, in reducing serum phosphorus levels.

Male and female alcohol consumption and live birth after assisted reproductive technology treatment

DEFF Research Database (Denmark)

Vittrup, Ida; Petersen, Gitte Lindved; Kamper-Jørgensen, Mads

2017-01-01

The objective was to assess the potential association between female and male alcohol consumption and probability of achieving a live birth after assisted reproductive treatment. From a nationwide Danish register-based cohort information on alcohol consumption at assisted reproductive treatment i...

Surgical options for lumbosacral fusion: biomechanical stability, advantage, disadvantage and affecting factors in selecting options.

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Yoshihara, Hiroyuki

2014-07-01

Numerous surgical procedures and instrumentation techniques for lumbosacral fusion (LSF) have been developed. This is probably because of its high mechanical demand and unique anatomy. Surgical options include anterior column support (ACS) and posterior stabilization procedures. Biomechanical studies have been performed to verify the stability of those options. The options have their own advantage but also disadvantage aspects. This review article reports the surgical options for lumbosacral fusion, their biomechanical stability, advantages/disadvantages, and affecting factors in option selection. Review of literature. LSF has lots of options both for ACS and posterior stabilization procedures. Combination of posterior stabilization procedures is an option. Furthermore, combinations of ACS and posterior stabilization procedures are other options. It is difficult to make a recommendation or treatment algorithm of LSF from the current literature. However, it is important to know all aspects of the options and decision-making of surgical options for LSF needs to be tailored for each patient, considering factors such as biomechanical stress and osteoporosis.

Split high‐dose oral levothyroxine treatment as a successful therapy option in myxedema coma

OpenAIRE

Charoensri, Suranut; Sriphrapradang, Chutintorn; Nimitphong, Hataikarn

2017-01-01

Key Clinical Message High‐dose intravenous thyroxine (T4) is the preferable treatment for myxedema coma. We describe the clinical course of a 69‐year‐old man who presented with myxedema coma and received oral levothyroxine (LT4) therapy (1 mg) in a split dose. This suggests split high‐dose oral LT4 as a therapeutic option in myxedema coma.

Treatment of male androgenetic alopecia with topical products containing Serenoa repens extract.

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Wessagowit, Vesarat; Tangjaturonrusamee, Chinmanat; Kootiratrakarn, Tanawatt; Bunnag, Thareena; Pimonrat, Tanatya; Muangdang, Nattaporn; Pichai, Pitchayasak

2016-08-01

Male androgenetic alopecia (AGA) is a common hair problem. Serenoa repens extract has been shown to inhibit both types of 5-α reductase and, when taken orally, has been shown to increase hair growth in AGA patients. The aim of this study was to assess the efficacy of topical products containing S. repens extract for the treatment of male AGA. This was a pilot, prospective, open, within-subject comparison limited to 24 weeks using no placebo controls. In all, 50 male volunteers aged between 20 and 50 years received topical S. repens products for 24 weeks. The primary end-point was a hair count in an area of 2.54 cm(2) at week 24. Secondary end-points included hair restoration, investigators' photographic assessment, patients' evaluation and discovering adverse events. The average hair count and terminal hair count increased at weeks 12 and 24 compared to baseline. Some of these positive results levelled off at week 24, presumably because the concentrated topical product containing S. repens extract was stopped after 4 weeks. The patients were satisfied with the products and the side-effects were limited. The topical application of S. repens extract could be an alternative treatment in male pattern baldness in male patients who do not want or cannot tolerate the side-effects of standard medications, but the use of a concentrated S. repens product beyond 4 weeks may be necessary for sustained efficacy. © 2015 The Australasian College of Dermatologists.

Male Hypogonadism and Osteoporosis: The Effects, Clinical Consequences, and Treatment of Testosterone Deficiency in Bone Health

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Houdek, Devon

2017-01-01

It is well recognized that bone loss accelerates in hypogonadal states, with female menopause being the classic example of sex hormones affecting the regulation of bone metabolism. Underrepresented is our knowledge of the clinical and metabolic consequences of overt male hypogonadism, as well as the more subtle age-related decline in testosterone on bone quality. While menopause and estrogen deficiency are well-known risk factors for osteoporosis in women, the effects of age-related testosterone decline in men on bone health are less well known. Much of our knowledge comes from observational studies and retrospective analysis on small groups of men with variable causes of primary or secondary hypogonadism and mild to overt testosterone deficiencies. This review aims to present the current knowledge of the consequences of adult male hypogonadism on bone metabolism. The direct and indirect effects of testosterone on bone cells will be explored as well as the important differences in male osteoporosis and assessment as compared to that in females. The clinical consequence of both primary and secondary hypogonadism, as well as testosterone decline in older males, on bone density and fracture risk in men will be summarized. Finally, the therapeutic options and their efficacy in male osteoporosis and hypogonadism will be discussed. PMID:28408926

Male Hypogonadism and Osteoporosis: The Effects, Clinical Consequences, and Treatment of Testosterone Deficiency in Bone Health

Directory of Open Access Journals (Sweden)

Gary Golds

2017-01-01

Full Text Available It is well recognized that bone loss accelerates in hypogonadal states, with female menopause being the classic example of sex hormones affecting the regulation of bone metabolism. Underrepresented is our knowledge of the clinical and metabolic consequences of overt male hypogonadism, as well as the more subtle age-related decline in testosterone on bone quality. While menopause and estrogen deficiency are well-known risk factors for osteoporosis in women, the effects of age-related testosterone decline in men on bone health are less well known. Much of our knowledge comes from observational studies and retrospective analysis on small groups of men with variable causes of primary or secondary hypogonadism and mild to overt testosterone deficiencies. This review aims to present the current knowledge of the consequences of adult male hypogonadism on bone metabolism. The direct and indirect effects of testosterone on bone cells will be explored as well as the important differences in male osteoporosis and assessment as compared to that in females. The clinical consequence of both primary and secondary hypogonadism, as well as testosterone decline in older males, on bone density and fracture risk in men will be summarized. Finally, the therapeutic options and their efficacy in male osteoporosis and hypogonadism will be discussed.

An overview of seasonal affective disorder and its treatment options.

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Howland, Robert H

2009-12-01

Seasonal affective disorder (SAD) is defined as a history of major depressive episodes that recur regularly at a particular time of year. Depending on the diagnostic instruments and criteria available, the reported prevalence (1%-10%) varies. Neurotransmitter abnormalities have been implicated in the pathophysiology, but they do not necessarily explain the seasonal pattern or the known chronobiological abnormalities in SAD compared with nonseasonal depression. Circadian rhythm abnormalies have been hypothesized to account for these aspects of SAD, and they provide a rationale for the therapeutic use of light therapy. Family history, twin, and molecular genetics studies suggest that hereditary factors are also involved. Light therapy and antidepressant medication are effective treatment options, with limited evidence for the efficacy of psychotherapy. Some studies demonstrate that narrow-band short wavelength "blue" light, naturalistic dawn simulation, and high-density negative air ionization are effective. Patients should be informed of the benefits of diet and exercise. Light therapy should be clinically monitored in the same manner, as it is done for other antidepressant treatments.

Contemporary surgical devices for male stress urinary incontinence: a review of technological advances in current continence surgery.

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Chung, Eric

2017-07-01

Male stress urinary incontinence (SUI) remains a debilitating condition that adversely impacts all domains of quality of life and is associated with significant social stigma and health economic burden. The incidence of post-prostatectomy urinary incontinence (PPI) depends on the definition of urinary incontinence and the length of patient follow up. In patients with persistent PPI following failure of conservative measures, surgical treatment is recommended although there is no published guideline on when surgery should be performed, and what the best surgical option is. Male slings (MS) can be divided into adjustable or non-adjustable types, and offers an attractive option for patients who wish to avoid mechanical handling during urinary voiding. Published intermediate data supports good safety and efficacy rate in men with mild to moderate degree of SUI. The AMS 800 artificial urinary sphincter (AUS) remains the standard of treatment for complete continence and has the longest efficacy and safety records. Other AUS-like devices are designed to address current AMS 800 limitations but themselves are fraught with their own issues.

Gender identity disorder: general overview and surgical treatment for vaginoplasty in male-to-female transsexuals.

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Selvaggi, Gennaro; Ceulemans, Peter; De Cuypere, Griet; VanLanduyt, Koen; Blondeel, Phillip; Hamdi, Moustapha; Bowman, Cameron; Monstrey, Stan

2005-11-01

After studying this article, the participant should be able to discuss: 1. The terminology related to male-to-female gender dysphoria. 2. The different theories regarding cause, epidemiology, and treatment of gender dysphoria. 3. The surgical goals of sex reassignment surgery in male-to-female transsexualism. 4. The surgical techniques available for sex reassignment surgery in male-to-female transsexualism. Gender identity disorder (previously "transsexualism") is the term used for individuals who show a strong and persistent cross-gender identification and a persistent discomfort with their anatomical sex, as manifested by a preoccupation with getting rid of one's sex characteristics, or the belief of being born in the wrong sex. Since 1978, the Harry Benjamin International Gender Dysphoria Association (in honor of Dr. Harry Benjamin, one of the first physicians who made many clinicians aware of the potential benefits of sex reassignment surgery) has played a major role in the research and treatment of gender identity disorder, publishing the Standards of Care for Gender Dysphoric Persons. The authors performed an overview of the terminology related to male-to-female gender identity disorder; the different theories regarding cause, epidemiology, and treatment; the goals expected; and the surgical technique available for sex reassignment surgery in male-to-female transsexualism. Surgical techniques available for sex reassignment surgery in male-to-female transsexualism, with advantages and disadvantages offered by each technique, are reviewed. Other feminizing nongenital operative interventions are also examined. This review describes recent etiopathogenetic theories and actual guidelines on the treatment of the gender identity disorder in male-to-female transsexuals; the penile-scrotal skin flap technique is considered the state of the art for vaginoplasty in male-to-female transsexuals, whereas other techniques (rectosigmoid flap, local flaps, and isolated skin

A review of treatment options for Graves' disease: why total thyroidectomy is a viable option in selected patients.

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Mohan, Vinuta; Lind, Robert

2016-01-01

Graves' disease is the most common cause of hyperthyroidism. If left untreated, patients may have multiple systemic complications such as cardiac, reproductive, and skeletal disease. Thionamides, such as methimazole and propylthiouracil, and I(131) iodine ablation are the most commonly prescribed treatment for Graves' disease. Total thyroidectomy is often overlooked for treatment and is usually only offered if the other options have failed. In our case, we discuss a patient who was admitted to our medical center with symptomatic hyperthyroidism secondary to long-standing Graves' disease. She had a history of non-compliance with medications and medical clinic follow-up. The risks and benefits of total thyroidectomy were explained and she consented to surgery. A few months after the procedure, she was biochemically and clinically euthyroid on levothyroxine. She had no further emergency room visits or admissions for uncontrolled thyroid disease. Here we review the advantages and disadvantages of the more typically prescribed treatments, thionamides and I(131)iodine ablation. We also review the importance of shared decision making and the benefits of total thyroidectomy for the management of Graves' disease. Given the improvement in surgical techniques over the past decade and a significant reduction of complications, we suggest total thyroidectomy be recommended more often for patients with Graves' disease.

Management of patients with hormone receptor–positive breast cancer with visceral disease: challenges and treatment options

International Nuclear Information System (INIS)

Harb, Wael A

2015-01-01

Endocrine therapy is an important treatment option for women with hormone receptor–positive (HR+) advanced breast cancer (ABC), yet many tumors are either intrinsically resistant or develop resistance to these therapies. Treatment of patients with ABC presenting with visceral metastases, which is associated with a poor prognosis, is also problematic. There is an unmet need for effective treatments for this patient population. Although chemotherapy is commonly perceived to be more effective than endocrine therapy in managing visceral metastases, patients who are not in visceral crisis might benefit from endocrine therapy, avoiding chemotherapy-associated toxicities that might affect quality of life. To improve outcomes, several targeted therapies are being investigated in combination with endocrine therapy for patients with endocrine-resistant, HR+ ABC. Although available data have considered patients with HR+ ABC as a whole, there are promising data from a prespecified analysis of a Phase III study of everolimus (Afinitor ® ), a mammalian target of rapamycin (mTOR) inhibitor, in combination with exemestane (Aromasin ® ) in patients with visceral disease progressing after nonsteroidal aromatase inhibitor therapy. In this review, challenges and treatment options for management of HR+ ABC with visceral disease, including consideration of therapeutic approaches undergoing clinical investigation, will be assessed

Clozapine Can Be the Good Option in Resistant Mania

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S. M. Yasir Arafat

2016-01-01

Full Text Available Bipolar mood disorder is a mental disorder with a lifetime prevalence rate of about 1% in the general population and there are still a proportion of individuals who suffer from bipolar mood disorders that are resistant to standard treatment. Reporting clozapine responsive mania that was not responding to two previous consecutive atypical antipsychotics and one typical antipsychotic was aimed at. A 17-year-old male manic patient was admitted into the psychiatry inpatient department and was nonresponsive to Risperidone 12 mg daily for 4 weeks, Olanzapine 30 mg daily for 3 weeks, and Haloperidol 30 mg daily for 3 weeks, along with valproate preparation 1500 mg daily. He was started on clozapine as he was nonresponsive to Lithium in previous episodes and did not consent to starting Electroconvulsive Therapy (ECT. He responded adequately to 100 mg clozapine and 1500 mg valproate preparation and remission happened within 2 weeks of starting clozapine. Clozapine can be a good option for resistant mania and further RCT based evidences will strengthen the options in treating resistant mania.

Inpatient treatment of male pathological gamblers in Germany.

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Schwarz, J; Lindner, A

1992-03-01

Pathological gambling is viewed as a disease of unknown cause which requires treatment. Demographic and psychological traits of fifty-eight male patients are described. A control group of fifty-four patients with other addictions was used to determine the validity of a diagnostic test which aims to differentiate between harmless gambling behavior and addiction to gambling. This test is described along with the stages of pathological gambling and the process of treatment for the disorder. Most of the gamblers are young, often previously convicted of theft, highly indebted, in danger of committing suicide, and susceptible to other addictive substances, especially alcohol. Harmless, critical and chronic stages are described. Regarding in-patient treatment, it has proved to be useful to integrate individual members into groups of alcoholics as they are a therapeutic benefit to these groups. The pragmatic and symptom-oriented therapy proved to be good for gamblers as well. A follow-up with forty-nine patients for one year and twenty-five for two years found 71% abstinent after one year and 62% abstinent after two years of treatment. These results are similar to those obtained with alcoholics.

Management of stage IV rectal cancer: Palliative options

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Ronnekleiv-Kelly, Sean M; Kennedy, Gregory D

2011-01-01

Approximately 30% of patients with rectal cancer present with metastatic disease. Many of these patients have symptoms of bleeding or obstruction. Several treatment options are available to deal with the various complications that may afflict these patients. Endorectal stenting, laser ablation, and operative resection are a few of the options available to the patient with a malignant large bowel obstruction. A thorough understanding of treatment options will ensure the patient is offered the most effective therapy with the least amount of associated morbidity. In this review, we describe various options for palliation of symptoms in patients with metastatic rectal cancer. Additionally, we briefly discuss treatment for asymptomatic patients with metastatic disease. PMID:21412493

Testicular tissue cryopreservation in prepubertal male children: an analysis of parental decision-making.

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Ginsberg, Jill P; Li, Yimei; Carlson, Claire A; Gracia, Clarisa R; Hobbie, Wendy L; Miller, Victoria A; Mulhall, John; Shnorhavorian, Margarett; Brinster, Ralph L; Kolon, Thomas F

2014-09-01

Infertility is an unfortunate treatment-related consequence for some pediatric malignancies as well as some non-malignant conditions treated with stem cell transplant. Unlike pubertal males, prepubertal males cannot produce semen for cryopreservation. This manuscript reports on the acceptability and safety of a multi-institutional protocol for offering testicular tissue cryopreservation to families of prepubertal male children at highest risk for infertility. Data on decision influences, decision-making control, and emotional state when considering this option are described. Prepubertal males facing gonadotoxic therapy were offered testicular cryopreservation. Post-biopsy, patients were followed for acute side effects. In addition, parents and patients were asked to complete questionnaires, whether or not they chose to cryopreserve tissue. Seventy-four prepubertal male children were approached. Fifty-seven families (77%) consented to the testicular biopsy; 48 of 57 underwent the procedure. There was one post-operative side effect. Parents who agreed to testicular cryopreservation and those that did not felt in control of this decision. Parents who consented to the biopsy and refusers were not deterred by the experimental nature of the protocol. An important decision-making influence was the risk of the biopsy. Biopsy and cryopreservation of testicular tissue from prepubertal male children was performed successfully and safely at three institutions. Parents faced with this option at diagnosis can make an informed decision and weigh carefully the risks and benefits. Although asked to make a decision soon after they were given a difficult diagnosis, parents uniformly felt in control of this decision. © 2014 Wiley Periodicals, Inc.

Pre-eclampsia Diagnosis and Treatment Options: A Review of Published Economic Assessments.

Science.gov (United States)

Zakiyah, Neily; Postma, Maarten J; Baker, Philip N; van Asselt, Antoinette D I

2015-10-01

Pre-eclampsia is a pregnancy complication affecting both mother and fetus. Although there is no proven effective method to prevent pre-eclampsia, early identification of women at risk of pre-eclampsia could enhance appropriate application of antenatal care, management and treatment. Very little is known about the cost effectiveness of these and other tests for pre-eclampsia, mainly because there is no clear treatment path. The aim of this study was to provide a comprehensive overview of the existing evidence on the health economics of screening, diagnosis and treatment options in pre-eclampsia. We searched three electronic databases (PubMed, EMBASE and the Cochrane Library) for studies on screening, diagnosis, treatment or prevention of pre-eclampsia, published between 1994 and 2014. Only full papers written in English containing complete economic assessments in pre-eclampsia were included. From an initial total of 138 references, six papers fulfilled the inclusion criteria. Three studies were on the cost effectiveness of treatment of pre-eclampsia, two of which evaluated magnesium sulphate for prevention of seizures and the third evaluated the cost effectiveness of induction of labour versus expectant monitoring. The other three studies were aimed at screening and diagnosis, in combination with subsequent preventive measures. The two studies on magnesium sulphate were equivocal on the cost effectiveness in non-severe cases, and the other study suggested that induction of labour in term pre-eclampsia was more cost effective than expectant monitoring. The screening studies were quite diverse in their objectives as well as in their conclusions. One study concluded that screening is probably not worthwhile, while two other studies stated that in certain scenarios it may be cost effective to screen all pregnant women and prophylactically treat those who are found to be at high risk of developing pre-eclampsia. This study is the first to provide a comprehensive overview

Male Hormonal Contraception: Looking Back and Moving Forward

OpenAIRE

Roth, Mara Y.; Page, Stephanie T.; Bremner, William J.

2015-01-01

Despite numerous contraceptive options available to women, approximately half of all pregnancies in the United States and worldwide are unplanned. Women and men support the development of reversible male contraception strategies, but none have been brought to market. Herein we review the physiologic basis for male hormonal contraception, the history of male hormonal contraception development, currents agents in development, as well as the potential risks and benefits of male hormonal contrace...

Comparative study of the efficacy of different treatment options in patients with chronic blepharitis.

Science.gov (United States)

Arrúa, M; Samudio, M; Fariña, N; Cibils, D; Laspina, F; Sanabria, R; Carpinelli, L; Mino de Kaspar, H

2015-03-01

To compare the efficacy of 3 treatment options in patients with chronic blepharitis. An experimental, randomized, controlled study was conducted on 45 patients (female 67%; Mean age: 40.5 years) diagnosed with chronic blepharitis, in order to compare the effectiveness of three treatment options. Group 1: eyelid hygiene with neutral shampoo three times/day; group 2: neutral shampoo eyelid hygiene plus topical metronidazole gel 0.75% twice/day; group 3: neutral eyelid hygiene with shampoo plus neomycin 3.5% and polymyxin 10% antibiotic ointment with 0.5% dexamethasone 3 times/day. The symptoms and signs were assessed by assigning scores from 0: no symptoms and/or signs; 1: mild symptoms and/or signs, 2: moderate symptoms and/or signs; and 3: severe symptoms and/or signs. A significant improvement was observed in the signs and symptoms in all 3 treatment groups. While groups 1 and 2 had more improvement in all variables studied (P<.05), Group 3 showed no clinical improvement for itching (P=.16), dry eye (P=.29), eyelashes falling (P=.16), and erythema at the eyelid margin (P=.29). Shampoo eyelid hygiene neutral and neutral shampoo combined with the use of metronidazole gel reported better hygiene results than neutral shampoo lid with antibiotic ointment and neomycin and polymyxin dexamethasone. Copyright © 2013 Sociedad Española de Oftalmología. Published by Elsevier España, S.L.U. All rights reserved.

Solidification of radioactive liquid wastes. A comparison of treatment options for spent resins and concentrates

International Nuclear Information System (INIS)

Roth, A.; Willmann, F.; Ebata, M.; Wendt, S.

2008-01-01

Ion exchange is one of the most common and effective treatment methods for liquid radioactive waste. However, spent ion exchange resins are considered to be problematic waste that in many cases require special approaches and pre-conditioning during its immobilization to meet the acceptance criteria for disposal. Because of the function that they fulfill, spent ion exchange resins often contain high concentrations of radioactivity and pose special handling and treatment problems. Another very common method of liquid radioactive waste treatment and water cleaning is the evaporation or diaphragm filtration. Both treatment options offer a high volume reduction of the total volume of liquids treated but generate concentrates which contain high concentrations of radioactivity. Both mentioned waste streams, spent resins as well as concentrates, resulting from first step liquid radioactive waste treatment systems have to be conditioned in a suitable manner to achieve stable waste products for final disposal. The most common method of treatment of such waste streams is the solidification in a solid matrix with additional inactive material like cement, polymer etc. In the past good results have been achieved and the high concentration of radioactivity can be reduced by adding the inactive material. On the other hand, under the environment of limited space for interim storage and the absence of a final repository site, the built-up of additional volume has to be considered as very critical. Moreover, corrosive effects on cemented drums during long-term interim storage at the surface have raised doubts about the long-term stability of such waste products. In order to avoid such disadvantages solidification methods have been improved in order to get a well-defined product with a better load factor of wastes in the matrix. In a complete different approach, other technologies solidify the liquid radioactive wastes without adding of any inactive material by means of drying

Emerging treatment options for refractory angina pectoris: ranolazine, shock wave treatment, and cell-based therapies.

Science.gov (United States)

Gennari, Marco; Gambini, Elisa; Bassetti, Beatrice; Capogrossi, Maurizio; Pompilio, Giulio

2014-01-01

A challenge of modern cardiovascular medicine is to find new, effective treatments for patients with refractory angina pectoris, a clinical condition characterized by severe angina despite optimal medical therapy. These patients are not candidates for surgical or percutaneous revascularization. Herein we review the most up-to-date information regarding the modern approach to the patient with refractory angina pectoris, from conventional medical management to new medications and shock wave therapy, focusing on the use of endothelial precursor cells (EPCs) in the treatment of this condition. Clinical limitations of the efficiency of conventional approaches justify the search for new therapeutic options. Regenerative medicine is considered the next step in the evolution of organ replacement therapy. It is driven largely by the same health needs as transplantation and replacement therapies, but it aims further than traditional approaches, such as cell-based therapy. Increasing knowledge of the role of circulating cells derived from bone marrow (EPCs) on cardiovascular homeostasis in physiologic and pathologic conditions has prompted the clinical use of these cells to relieve ischemia. The current state of therapeutic angiogenesis still leaves many questions unanswered. It is of paramount importance that the treatment is delivered safely. Direct intramyocardial and intracoronary administration has demonstrated acceptable safety profiles in early trials, and may represent a major advance over surgical thoracotomy. The combined efforts of bench and clinical researchers will ultimately answer the question of whether cell therapy is a suitable strategy for treatment of patients with refractory angina.

Options for Steam Generator Decommissioning

International Nuclear Information System (INIS)

Krause, Gregor; Amcoff, Bjoern; Robinson, Joe

2016-01-01

Selecting the best option for decommissioning steam generators is a key consideration in preparing for decommissioning PWR nuclear power plants. Steam Generators represent a discrete waste stream of large, complex items that can lend themselves to a variety of options for handling, treatment, recycling and disposal. Studsvik has significant experience in processing full size Steam Generators at its metal recycling facility in Sweden, and this paper will introduce the Studsvik steam generator treatment concept and the results achieved to date across a number of projects. The paper will outline the important parameters needed at an early stage to assess options and to help consider the balance between off-site and on-site treatment solutions, and the role of prior decontamination techniques. The paper also outlines the use of feasibility studies and demonstration projects that have been used to help customers prepare for decommissioning. The paper discusses physical, radiological and operational history data, Pro and Contra factors for on- and off-site treatment, the role of chemical decontamination prior to treatment, planning for off-site shipments as well as Studsvik experience This paper has an original focus upon the coming challenges of steam generator decommissioning and potential external treatment capacity constraints in the medium term. It also focuses on the potential during operations or initial shut-down to develop robust plans for steam generator management. (authors)

Use of the adjustable trans-obturator male sling system for the treatment of male incontinence. An initial experience

Directory of Open Access Journals (Sweden)

M.S. El Badry

2016-06-01

Conclusions: Our early experience demonstrated that the ATOMS system may be a safe and effective procedure for the treatment of male urinary incontinence. It has the advantage of being feasible any time after an operation when necessary. However, long-term follow-up on a large number of cases is required to ensure its long-term efficacy and safety.

Biofeedback as complementary treatment in patients with epilepsy – an underestimated therapeutic option? Review, results, discussion

Directory of Open Access Journals (Sweden)

Uhlmann Carmen

2016-12-01

Full Text Available Background. Biofeedback methods represent side effect free complementary options in the treatment of epilepsy. In this paper we review the current status of these methods in terms of clinical study results and their evaluation by systematic review papers. Possible mechanisms of action in biofeedback methods are discussed.

Effective treatment options for musculoskeletal pain in primary care: A systematic overview of current evidence

Science.gov (United States)

Hill, Jonathan C.; Foster, Nadine E.; Protheroe, Joanne

2017-01-01

Background & aims Musculoskeletal pain, the most common cause of disability globally, is most frequently managed in primary care. People with musculoskeletal pain in different body regions share similar characteristics, prognosis, and may respond to similar treatments. This overview aims to summarise current best evidence on currently available treatment options for the five most common musculoskeletal pain presentations (back, neck, shoulder, knee and multi-site pain) in primary care. Methods A systematic search was conducted. Initial searches identified clinical guidelines, clinical pathways and systematic reviews. Additional searches found recently published trials and those addressing gaps in the evidence base. Data on study populations, interventions, and outcomes of intervention on pain and function were extracted. Quality of systematic reviews was assessed using AMSTAR, and strength of evidence rated using a modified GRADE approach. Results Moderate to strong evidence suggests that exercise therapy and psychosocial interventions are effective for relieving pain and improving function for musculoskeletal pain. NSAIDs and opioids reduce pain in the short-term, but the effect size is modest and the potential for adverse effects need careful consideration. Corticosteroid injections were found to be beneficial for short-term pain relief among patients with knee and shoulder pain. However, current evidence remains equivocal on optimal dose, intensity and frequency, or mode of application for most treatment options. Conclusion This review presents a comprehensive summary and critical assessment of current evidence for the treatment of pain presentations in primary care. The evidence synthesis of interventions for common musculoskeletal pain presentations shows moderate-strong evidence for exercise therapy and psychosocial interventions, with short-term benefits only from pharmacological treatments. Future research into optimal dose and application of the most

Low-grade MALT lymphoma of the stomach: a review of treatment options

International Nuclear Information System (INIS)

Schechter, Naomi R.; Yahalom, Joachim

2000-01-01

Purpose: Low-grade mucosa-associated lymphoid tissue (MALT) lymphoma of the stomach (MLS) is often associated with the presence of Helicobacter pylori (H. pylori) bacteria. Eradication of the infection with antibiotic therapy may result in regression of the lymphoma. But when antibiotic treatment fails to reverse the malignant process or if H. pylori is absent, other treatment options should be considered. Because MLS is often confined to the stomach and regional lymph nodes, it is potentially curable with local therapy. Endoscopy and improved imaging, with endoscopic ultrasound (EUS) and computerized tomography (CT), have reduced the prior dependence on surgery for diagnosis and staging of gastric lymphomas. Methods and Results: This review details the advances in the diagnosis, classification, and imaging of MLS. We also describe the experience that supports the use of radiation therapy as the preferred treatment of MLS in patients who have not responded to antibiotic therapy or have not had evidence for H. pylori infection. Conclusions: Radiation therapy for MLS is not only effective and safe, but offers the significant advantage of low morbidity and gastric function preservation

Approaches to the identification of new nonhormonal targets for male contraception.

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Kopf, Gregory S

2008-10-01

Fertility control is a global health issue with major personal and societal impact. Although, currently, there are several different options for contraception, the technologies behind these are antiquated, and the options for male-based contraception (i.e., withdrawal, condom and vasectomy) are inadequate. The genomic, proteomic and bioinformatic revolutions have provided new tools and new targets for contraceptive development, and the results of such approaches have identified gene products that play critical roles in male reproduction, thus expanding the array of potential targets for novel and innovative male-based contraceptives. This article will review the types of targets being considered in the development of nonhormonal male contraceptives and the technologies used to identify and validate these targets.

Treatment Outcome in Male Gambling Disorder Patients Associated with Alcohol Use

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Jiménez-Murcia, Susana; Del Pino-Gutiérrez, Amparo; Fernández-Aranda, Fernando; Granero, Roser; Hakänsson, Anders; Tárrega, Salomé; Valdepérez, Ana; Aymamí, Neus; Gómez-Peña, Mónica; Moragas, Laura; Baño, Marta; Sauvaget, Anne; Romeu, Maria; Steward, Trevor; Menchón, José M.

2016-01-01

Aims: The primary objective of this study was to analyze the association between alcohol consumption and short-term response to treatment (post intervention) in male patients with gambling disorder enrolled in a group cognitive behavioral therapy (CBT) program. Methods: The sample consisted of 111 male individuals with a diagnosis of Gambling Disorder, with a mean age of 45 years (SD = 12.2). All participants were evaluated by a comprehensive assessment battery and assigned to CBT groups of 10–14 patients attending 16 weekly outpatient sessions lasting 90 min each. Results: The highest mean pre- and post-therapy differences were recorded for the alcohol risk/dependence group on the obsessive/compulsive and anxiety dimensions of the SCL-90-R. As regards the presence of relapses and dropouts over the course of the CBT sessions, the results show a significant association with moderate effect size: patients with risk consumption or alcohol dependence were more likely to present poor treatment outcomes. Conclusions: Alcohol abuse was frequent in GD, especially in patients with low family income and high accumulated debts. High levels of somatization and high overall psychopathology (measured by the SCL-90-R) were associated with increased risk of alcohol abuse. Alcohol abuse was also associated with poor response to treatment. PMID:27065113

Treatment of gynecomastia in patients with prostate cancer and androgen deprivation.

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Bautista-Vidal, C; Barnoiu, O; García-Galisteo, E; Gómez-Lechuga, P; Baena-González, V

2014-01-01

Gynecomastia, defined as benign proliferation of glandular breast tissue has a prevalence of 32% to 72% in the male. In the urology setting, it is associated to patients with prostate cancer and hormone treatment with a prevalence of 15% in the case of complete hormone blockage and 75% in monotherapy. The different options of treatment in prostate cancer have changed in recent decades. Thus, we have focused on this subject to evaluate the different therapy options of hormone manipulation induced gynecomastia in prostate cancer patients. To synthesize the available evidence on the different therapeutic options in prostate cancer patients who develop gynecomastia due to the use of nonsteroidal antiandrogens and to generate a diagnostic algorithm and treatment. Using the PICO type structured search strategy (Patient or problem, Intervention, Comparison, Outcome or result) in the data bases of PubMed-Medline and Cochrane, identification was made of the relevant studies related to the treatment of gynecomastia in Prostate Cancer patients treated with nonsteroidal antiandrogens. We have found 3 possible therapeutic options for the treatment of gynecomastia and mastodynia in patients with hormone deprivation therapy for prostate cancer. The 10Gy radiotherapy would be an option for the treatment of gynecomastia, although not all the patients need prophylactic treatment since only 50% report moderate-severe discomfort. Another option is the use of drugs such as tamoxifen 20mg/day that lead to a significant decrease in the mammary effects. Gynecomastia and mastodynia, given their high incidence, make the physical examination a fundamental tool for all patients before initiating treatment with antiandrogens. The use of tamoxifen 20mg/day is the best treatment and prevention option against gynecomastia and mastodynia, while in the case of long-course established gynecomastia, surgery is the gold standard. Copyright © 2012 AEU. Published by Elsevier Espana. All rights reserved.

Single-tooth replacement: factors affecting different prosthetic treatment modalities

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Al-Quran Firas A

2011-12-01

Full Text Available Abstract Background The choice between several treatment options for replacing a single missing tooth is influenced by clinical, dentist- and patient-immanent factors. This study aimed to determine the patient factors that would affect the treatment decision to replace a single missing tooth and to assess the satisfaction with several options. Method 200 volunteers involved (121 females and 79 males divided into four groups, Group A: consisted of patients with conventional fixed partial dentures or patients with resin bonded fixed partial dentures. Group B: consisted of patients who received removable partial dentures while Group C: consisted of patients who received a single implant supported crown, and a control group D: consisted of patients who received no treatment. Data were collected using a questionnaire. Results The highest percentage of males within groups (58% was within the removable prostheses category. The majority of the subjects in the study reported that the main reason for replacing a missing tooth was for esthetic and function. Most important factor affecting the choice between treatment modalities was damaging the neighboring teeth. Pain, post operative sensitivity and dental phobia were important factors in choosing the prosthesis type and affected the control group patients not to have any treatment. The highest satisfaction percentage among groups studied was recorded for dental implants then FPD groups, while the least percentage were in both the control and RPD groups, for all aspects of function, esthetic and speech efficiency. Conclusions The final choice between FPD, RPD and implant depended on several factors which affected the decision making; among these is cost and patients' awareness of the different treatment options.

Use of Exogenous Testosterone for the Treatment of Male Factor Infertility: A Survey of Nigerian Doctors.

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Omisanjo, Olufunmilade Akinfolarin; Ikuerowo, Stephen Odunayo; Abdulsalam, Moruf Adekunle; Ajenifuja, Sheriff Olabode; Shittu, Khadijah Adebisi

2017-01-01

Though exogenous testosterone is known for its contraceptive effects in men, it is sometimes prescribed by medical practitioners for the treatment of male factor infertility in the mistaken belief that exogenous testosterone improves sperm count. The aim of this study was to evaluate the scope of testosterone use in the treatment of male factor infertility by medical practitioners in Lagos, Nigeria. A survey using a structured questionnaire was carried out amongst doctors attending a regular Continuing Medical Education (CME) programme in Lagos, Nigeria. There were 225 respondents. Most of the respondents (69.8%, n = 157) indicated that exogenous testosterone increases sperm count. Only 22 respondents (9.8%) indicated (correctly) that exogenous testosterone decreases sperm count. Seventy-seven respondents (34.2%) had prescribed some form of exogenous testosterone in the treatment of male factor infertility. The vast majority of respondents who had prescribed testosterone (81.8%, n = 63) thought exogenous testosterone increases sperm count. There was no statistically significant difference in the pattern of prescription across the respondents' specialty ( p = 0.859) or practice type ( p = 0.747). The misuse of exogenous testosterone for the treatment of male infertility was common amongst the respondents, with most of them wrongly believing that exogenous testosterone increases sperm count.

The Socio-economics and Alternative Livelihood Options of Fishers ...

African Journals Online (AJOL)

The Socio-economics and Alternative Livelihood Options of Fishers of Lake Victoria, ... PROMOTING ACCESS TO AFRICAN RESEARCH ... Most fishers were males aged 29-38yrs while women were involved in processing and marketing.

The psychological impact of infertility and fertility treatment on the male partner.

Science.gov (United States)

Dooley, Maeve; Dineen, Tim; Sarma, Kiran; Nolan, Aonghus

2014-09-01

This paper reports the findings of two studies that examined factors predicting infertility distress in male partners within couples with an infertility diagnosis and where the couple was receiving fertility treatment. A cross-sectional design was implemented using a questionnaire battery (The questionnaire battery comprised an inventory of four different standardised questionnaires compiled together into one booklet) compiled from earlier theory-building qualitative research conducted by the authors. Infertility related distress was examined in relation to a number of psychosocial variables including relationship dynamics, self-esteem, current mental health and attitudes towards idealised masculinity. The questionnaire battery was completed by 167 men undergoing or consulting for fertility treatment. Participants were recruited through Irish fertility clinics (Study 1, n = 111) and through an online survey (Study 2, n = 55). Regression analyses identified four variables that predicted variance in infertility distress in both studies: 'Attitude towards idealised masculinity', 'Mental health', 'Relationship satisfaction' and 'Self-esteem'. This finding was found to be robust having controlled for age, time since diagnosis, number of attempts at treatment and diagnostic category (male factor, female factor or mixed factor infertility). ConclusiON: Recommendations for fertility clinics and mental health professionals should be made in relation to managing infertility distress and supporting couples during fertility treatment.

Tank Space Options Report

International Nuclear Information System (INIS)

BOYLES, V.C.

2001-01-01

A risk-based priority for the retrieval of Hanford Site waste from the 149 single-shell tanks (SSTs) has been adopted as a result of changes to the Hanford Federal Facility Agreement and Consent Order (HFFACO) (Ecology et al. 1997) negotiated in 2000. Retrieval of the first three tanks in the retrieval sequence fills available capacity in the double-shell tanks (DSTs) by 2007. As a result, the HFFACO change established a milestone (M-45-12-TO1) requiring the determination of options that could increase waste storage capacity for single-shell tank waste retrieval. The information will be considered in future negotiations. This document fulfills the milestone requirement. This study presents options that were reviewed for the purpose of increasing waste storage capacity. Eight options are identified that have the potential for increasing capacity from 5 to 10 million gallons, thus allowing uninterrupted single-shell tank retrieval until the planned Waste Treatment Plant begins processing substantial volumes of waste from the double-shell tanks in 2009. The cost of implementing these options is estimated to range from less than $1 per gallon to more than $14 per gallon. Construction of new double-shell tanks is estimated to cost about $63 per gallon. Providing 5 to 10 million gallons of available double-shell tank space could enable early retrieval of 5 to 9 high-risk single-shell tanks beyond those identified for retrieval by 2007. These tanks are A-101, AX-101, AX-103, BY-102, C-107, S-105, S-106, S-108, and S-109 (Garfield et al. 2000). This represents a potential to retrieve approximately 14 million total curies, including 3,200 curies of long-lived mobile radionuclides. The results of the study reflect qualitative analyses conducted to identify promising options. The estimated costs are rough-order-of magnitude and, therefore, subject to change. Implementing some of the options would represent a departure from the current baseline and may adversely impact the

Sacral electrical neuromodulation as an alternative treatment option for lower urinary tract dysfunction.

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Grünewald, Volker; Höfner, Klaus; Thon, Walter F.; Kuczyk, Markus A.; Jonas, Udo

1999-01-01

Temporary electrical stimulation using anal or vaginal electrodes and an external pulse generator has been a treatment modality for urinary urge incontinence for nearly three decades. In 1981 Tanagho and Schmidt introduced chronic electrical stimulation of the sacral spinal nerves using a permanently implanted sacral foramen electrode and a battery powered pulse generator for treatment of different kinds of lower urinary tract dysfunction, refractory to conservative treatment. At our department chronic unilateral electrical stimulation of the S3 sacral spinal nerve has been used for treatment of vesi-courethral dysfunction in 43 patients with a mean postoperative follow up of 43,6 months. Lasting symptomatic improvement by more than 50 % could be achieved in 13 of 18 patients with motor urge incontinence (72,2 %) and in 18 of the 21 patients with urinary retention (85,7 %). Implants offer a sustained therapeutic effect to treatment responders, which is not achieved by temporary neuromodulation. Chronic neuromodulation should be predominantly considered in patients with urinary retention. Furthermore in patients with motor urge incontinence, refusing temporary techniques or in those requiring too much effort to achieve a sustained clinical effect. Despite high initial costs chronic sacral neuromodulation is an economically reasonable treatment option in the long run, when comparing it to the more invasive remaining therapeutic alternatives.

Nonsurgical Treatments of Patellar Tendinopathy: Multiple Injections of Platelet-Rich Plasma Are a Suitable Option: A Systematic Review and Meta-analysis.

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Andriolo, Luca; Altamura, Sante Alessandro; Reale, Davide; Candrian, Christian; Zaffagnini, Stefano; Filardo, Giuseppe

2018-03-01

Patellar tendinopathy is a condition characterized by anterior knee activity-related pain. It has a high incidence among athletes engaged in jumping sports and may become a chronic condition. Nonoperative management is the first choice in these patients, and several nonsurgical treatment options have been proposed. Nonetheless, clear indications on the most effective approach to address patellar tendinopathy are still lacking. To analyze the evidence on nonoperative options to treat chronic patellar tendinopathy through a systematic review of the literature and to perform a meta-analysis to identify the most effective nonsurgical option. Systematic review and meta-analysis. The search was conducted with the PubMed and Cochrane databases on January 4, 2017. All clinical English-language reports of any level of evidence on nonsurgical treatment of patellar tendinopathy were included. The quality of each article was assessed by use of the Coleman score. A meta-analysis was performed on all articles reporting the Victorian Institute of Sport Assessment scale for patellar tendinopathy to evaluate the results of the most described treatments. A total of 70 studies involving 2530 patients were included in the qualitative data synthesis. The Coleman score showed an overall poor study quality. The most described treatment groups that could be included in the meta-analysis were reported in 22 studies on eccentric exercise, extracorporeal shockwave therapy (ESWT), and platelet-rich plasma (PRP). Single and multiple PRP injections were evaluated separately. Eccentric exercise therapies obtained the best results ( P patellar tendinopathy with important limitations in terms of study quality. The available evidence showed an overall positive outcome, but some differences have been highlighted. Eccentric exercises may seem the strategy of choice in the short-term, but multiple PRP injections may offer more satisfactory results at long-term follow-up and can be therefore considered

Technological Options to Ameliorate Waste Treatment of Intensive Pig Production in China：An Analysis Based on Bio-Economic Model

Institute of Scientific and Technical Information of China (English)

LU Wen-cong; MA Yong-xi; Holger Bergmann

2014-01-01

Ameliorating waste treatment by technological improvements affects the economic and the ecological-environment beneifts of intensive pig production. The objective of the research was to develop and test a method to determine the technical optimization to ameliorate waste treatment methods and gain insight into the relationship between technological options and the economic and ecological effects. We developed an integrated bio-economic model which incorporates the farming production and waste disposal systems to simulate the impact of technological improvements in pig manure treatment on economic and environmental benefits for the case of a pilot farm in Beijing, China. Based on different waste treatment technology options, three scenarios are applied for the simulation analysis of the model. The simulation results reveal that the economic-environmental beneifts of the livestock farm could be improved by reducing the cropland manure application and increasing the composting production with the current technologies. Nevertheless, the technical efifciency, the waste treatment capacity and the economic beneifts could be further improved by the introduction of new technologies. It implies that technological and economic support policies should be implemented comprehensively on waste disposal and resource utilization to promote sustainable development in intensive livestock production in China.

Evidence-Based Treatment Options in Recurrent and/or Metastatic Squamous Cell Carcinoma of the Head and Neck

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Athanassios Argiris

2017-05-01

Full Text Available The major development of the past decade in the first-line treatment of recurrent and/or metastatic squamous cell carcinoma of the head and neck (R/M SCCHN was the introduction of cetuximab in combination with platinum plus 5-fluorouracil chemotherapy (CT, followed by maintenance cetuximab (the “EXTREME” regimen. This regimen is supported by a phase 3 randomized trial and subsequent observational studies, and it confers well-documented survival benefits, with median survival ranging between approximately 10 and 14 months, overall response rates between 36 and 44%, and disease control rates of over 80%. Furthermore, as indicated by patient-reported outcome measures, the addition of cetuximab to platinum-based CT leads to a significant reduction in pain and problems with social eating and speech. Conversely, until very recently, there has been a lack of evidence-based second-line treatment options, and the therapies that have been available have shown low response rates and poor survival outcomes. Presently, a promising new treatment option in R/M SCCHN has emerged: immune checkpoint inhibitors (ICIs, which have demonstrated favorable results in second-line clinical trials. Nivolumab and pembrolizumab are the first two ICIs that were approved by the US Food and Drug Administration. We note that the trials that showed benefit with ICIs included not only patients who previously received ≥1 platinum-based regimens for R/M SCCHN but also patients who experienced recurrence within 6 months after combined modality therapy with a platinum agent for locally advanced disease. In this review, we outline the available clinical and observational evidence for the EXTREME regimen and the initial results from clinical trials for ICIs in patients with R/M SCCHN. We propose that these treatment options can be integrated into a new continuum of care paradigm, with first-line EXTREME regimen followed by second-line ICIs. A number of ongoing clinical trials

Racial Differences in the Perception of Contraception Option Attributes.

Science.gov (United States)

McDermott, Robert J.; Gold, Robert S.

1987-01-01

More than 600 never-married college students completed a questionnaire regarding their attitudes toward 10 contraceptive options. Results were analyzed separately for Blacks and Whites, and then for males and females. Findings are discussed. (MT)

Efficacy and safety of 5% minoxidil topical foam in male pattern hair loss treatment and patient satisfaction.

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Hasanzadeh, Hournaz; Nasrollahi, Saman Ahmad; Halavati, Nader; Saberi, Maryam; Firooz, Alireza

2016-09-01

Male pattern hair loss is widespread around the world. Its prevalence indicates the importance of finding the best treatment modalities. This study evaluates the efficacy and safety of minoxidil 5% topical foam in male pattern hair loss treatment and patient satisfaction. This study was a before-and-after trial on 17 male patients with male pattern hair loss. Subjects were instructed to apply one capful (1 ml) of minoxidil 5% topical foam on the scalp daily for 6 months. Efficacy was assessed through hair counts, subject assessment, and global photographic review. Seventeen male volunteers were recruited, and three volunteers were withdrawn; 14 participated in the trial for 16 weeks, and 12 continued up to 24 weeks. The average hair count with a camera at week 16 (181.87 ± 52.42) and week 24 (194.58 ± 62.82) and with an eye count at week 16 (62.57 ± 15.28) and week 24 (69.91 ± 15.61) increased significantly compared to the baseline after intervention. This study confirmed that minoxidil 5% topical foam is a safe and effective treatment for MPHL. The effect of it is evident after 24 weeks of use.

Tumescent power liposuction in the treatment of the enlarged male breast.

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Boni, Roland

2006-01-01

Tumescent power liposuction is widely used on various parts of the body for minimal-access lipectomy. The undesired fat deposits are injected with tumescence fluid containing saline, epinephrine, bicarbonate and lidocaine; the latter is used as the only source of pain control. The fat is then removed using vibrating microcannulas. To evaluate the value of tumescent power liposuction in the treatment of the enlarged male breast. 38 male patients aged 23-64 years (mean age 39.8 +/- 9.7 years) with enlarged breasts were enrolled in the study. In 32 patients, breasts were enlarged due to fat tissue, and the ductal glands were not palpable (pseudogynecomastia). In 6 patients, the ductal glands were enlarged (gynecomastia). All patients were treated with tumescent liposuction over a 2-year period using a single entry site from the axillary fossa. Both fat as well as ductal and stromal tissue were removed by microcannulas. None of the patients had early postoperative complications of infection, hematoma or seroma. There were no treatment-induced asymmetries, contour deformities or irregularities. No open excision or skin reduction procedures were required. Tumescent liposuction using a single entry site in the axillary fossa is a minimally invasive technique to treat enlarged male breasts. Both fat (pseudogynecomastia in adipose patients) as well as ductal and stromal tissue (in gynecomastia) can be removed with tumescent liposuction, resulting in a high level of patient satisfaction. Copyright 2006 S. Karger AG, Basel.

Methadone treatment, bruxism, and temporomandibular disorders among male prisoners.

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Enguelberg-Gabbay, Judith V; Schapir, Lior; Israeli, Yair; Hermesh, Haggai; Weizman, Abraham; Winocur, Ephraim

2016-06-01

There is little information on bruxism related to illicit drug use. Prolonged drug use may damage the stomatognathic system via oral motor overactivity. The aim of the present study was to compare the rates of bruxism and temporomandibular disorders (TMDs) between prisoners with and without drug-use disorders, to evaluate the association between methadone treatment and bruxism and to assess the possible relationship between bruxism and pain. The sample included 152 male prisoners, 69 of whom were drug users maintained on methadone. All prisoners were examined by an experienced dentist and completed a questionnaire on their oral habits, with the aim of detecting signs or symptoms of TMD and/or bruxism. Additional data were collected from medical files. The prevalence of sleep bruxism and awake bruxism, but not of TMDs, was significantly higher among drug-user than non-drug user prisoners (52.2% vs. 34.9% for sleep bruxism, 59.7% vs. 30.1% for awake bruxism, and 46.3% vs. 25.6% for TMDs, respectively). Participants with awake bruxism were statistically more sensitive to muscle palpation compared with participants with sleep bruxism [rating scores (mean ± SD): 0.32 ± 0.21 vs. 0.19 ± 0.28, respectively]. An association was found between sleep bruxism and awake bruxism. It seems that there is a direct or an indirect association between methadone maintenance treatment and sleep bruxism or awake bruxism in male prisoners. © 2016 Eur J Oral Sci.

Immunotoxin – a new treatment option in patients with relapsed and refractory Hodgkin lymphoma

Science.gov (United States)

Novakovic, Barbara Jezersek

2015-01-01

Background Even though Hodgkin lymphoma is a highly curable disease, some of the patients have either a refractory disease or experience a relapse following a successful primary therapy. Durable responses and remissions in patients with relapsed or refractory disease may be achieved in approximately one-half with salvage chemotherapy followed by high dose chemotherapy (HDT) and autologous hematopoietic cell rescue (SCT). On the other hand, patients who relapse after HDT and autologous SCT or those who have failed at least two prior multi-agent chemotherapy regimens and are not candidates for HDT have limited treatment options. Conclusions A new treatment option in this population is an immunotoxin Brentuximab vedotin composed of a CD30 directed antibody linked to the antitubulin agent monomethyl auristatin E. It has demonstrated a substantial effectiveness and an acceptable toxicity. In the pivotal study, the overall response rate was 75% with 34% of complete remissions. The median durations of response were 20.5 and 6.7 months for those with complete remission and all responding patients, respectively. The median overall survival was 40.5 months (3-years overall survival 54%) and the median progression-free survival 9.3 months. The most common non-hematologic toxicities were peripheral sensory neuropathy, nausea, and fatigue while the most common severe side effects were neutropenia, thrombocytopenia, anemia, and peripheral sensory neuropathy. PMID:26834516

Treatment of infertility in men with spinal cord injury

DEFF Research Database (Denmark)

Brackett, N.L.; Lynne, C.M.; El Dib, Hussein Ibrahim El Desouki Hussein

2010-01-01

Most men with spinal cord injury (SCI) are infertile. Erectile dysfunction, ejaculatory dysfunction and semen abnormalities contribute to the problem. Treatments for erectile dysfunction include phosphodiesterase type 5 inhibitors, intracavernous injections of alprostadil, penile prostheses...... of intrauterine insemination increases as the total motile sperm count inseminated increases. In vitro fertilization and intracytoplasmic sperm injection are options in cases of extremely low total motile sperm count. Reproductive outcomes for SCI male factor infertility are similar to outcomes for general male...... factor infertility...

Finasteride treatment and male breast cancer

DEFF Research Database (Denmark)

Meijer, Mathias; Thygesen, Lau Caspar; Green, Anders

2018-01-01

A potential link has been suggested between dispensed finasteride and increased risk of male breast cancer (MBC). Due to the rare occurrence of MBC, it remains to be established if such a relationship exists. The purpose of this study was to combine nationwide registers in four countries to assess...... the potential association between dispensed finasteride and MBC. A cohort of all males with dispensed finasteride in Denmark, Finland, Norway, and Sweden (1,365,088 person years) was followed up for up to 15 years for breast cancer, and compared to a cohort of males unexposed to finasteride. Individual...

Anastomotic leakage after esophageal resection: new treatment options by endoluminal vacuum therapy.

Science.gov (United States)

Weidenhagen, Rolf; Hartl, Wolfgang H; Gruetzner, Klaus U; Eichhorn, Martin E; Spelsberg, Fritz; Jauch, Karl W

2010-11-01

Anastomotic leakage after esophagectomy is an important determinant of early and late morbidity and mortality. Control of the septic focus is essential when treating patients with anastomotic leakages. Surgical and endoscopic treatment options are limited. Between 2005 and 2009, we treated 6 patients who experienced an intrathoracic anastomotic leakage after esophageal resection. After all established therapeutic measures had failed, we explored the feasibility of an endoscopically assisted mediastinal vacuum therapy. We were able to heal intrathoracic esophageal leakages in all 6 patients without any local complications and without the need for reoperation. One patient died because of a progressive pneumonia. Endoscopic vacuum-assisted closure of anastomotic leakages may help to overcome the limitations that are associated with intermittent endoscopic treatment and conventional drainage therapy. Our preliminary results suggest that this new concept may be suitable for those patients. Copyright © 2010 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.

Direct visual internal urethrotomy: Is it a durable treatment option?

Science.gov (United States)

Pal, Dilip Kumar; Kumar, Sanjay; Ghosh, Bastab

2017-01-01

To evaluate the long-term success rate of direct vision internal urethrotomy as a treatment for anterior urethral strictures. We retrospectively analyzed the results for patients who underwent internal urethrotomy from January 2009 to January 2014 for anterior urethral strictures. Patients were followed till January 2016. Patients with complicated urethral strictures with a history of previous urethroplasty, hypospadias repair, or previous radiation were excluded from the study, as anticipated low success rate of direct visual internal urethrotomy (DVIU) in these patients. The Kaplan-Meier method was used to analyze stricture-free probability after the first, second, and third urethrotomy. A total of 186 patients were included in this study. Stricture-free rates after first, second, and third urethrotomy were 29.66%, 22.64%, and 13.33%, respectively. Although DVIU may be a management option for anterior urethral stricture disease, it seems that long-term results are disappointing.

Treatment options for subjective tinnitus: Self reports from a sample of general practitioners and ENT physicians within Europe and the USA

Directory of Open Access Journals (Sweden)

Hall Deborah A

2011-11-01

Full Text Available Abstract Background Tinnitus affects about 10-15% of the general population and risks for developing tinnitus are rising through increased exposure to leisure noise through listening to personal music players at high volume. The disorder has a considerable heterogeneity and so no single mechanism is likely to explain the presence of tinnitus in all those affected. As such there is no standardized management pathway nor singly effective treatment for the condition. Choice of clinical intervention is a multi-factorial decision based on many factors, including assessment of patient needs and the healthcare context. The present research surveyed clinicians working in six Westernized countries with the aims: a to establish the range of referral pathways, b to evaluate the typical treatment options for categories of subjective tinnitus defined as acute or chronic, and c to seek clinical opinion about levels of satisfaction with current standards of practice. Methods A structured online questionnaire was conducted with 712 physicians who reported seeing at least one tinnitus patients in the previous three months. They were 370 general practitioners (GPs and 365 ear-nose-throat specialists (ENTs from the US, Germany, UK, France, Italy and Spain. Results Our international comparison of health systems for tinnitus revealed that although the characteristics of tinnitus appeared broadly similar across countries, the patient's experience of clinical services differed widely. GPs and ENTs were always involved in referral and management to some degree, but multi-disciplinary teams engaged either neurology (Germany, Italy and Spain or audiology (UK and US professionals. For acute subjective tinnitus, pharmacological prescriptions were common, while audiological and psychological approaches were more typical for chronic subjective tinnitus; with several specific treatment options being highly country specific. All therapy options were associated with low levels

Management of patients with resistant hypertension: current treatment options

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Kumar N

2013-10-01

Full Text Available Nilay Kumar,1 David A Calhoun,2 Tanja Dudenbostel21Department of Medicine, 2Division of Cardiovascular Disease, Hypertension and Vascular Biology Program, University of Alabama at Birmingham, Birmingham, AL, USAAbstract: Resistant hypertension (RHTN is an increasingly common clinical problem that is often heterogeneous in etiology, risk factors, and comorbidities. It is defined as uncontrolled blood pressure on optimal doses of three antihypertensive agents, ideally one being a diuretic. The definition also includes controlled hypertension with use of four or more antihypertensive agents. Recent observational studies have advanced the characterization of patients with RHTN. Patients with RHTN have higher rates of cardiovascular events and mortality compared with patients with more easily controlled hypertension. Secondary causes of hypertension, including obstructive sleep apnea, primary aldosteronism, renovascular disease, are common in patients with RHTN and often coexist in the same patient. In addition, RHTN is often complicated by metabolic abnormalities. Patients with RHTN require a thorough evaluation to confirm the diagnosis and optimize treatment, which typically includes a combination of lifestyle adjustments, and pharmacologic and interventional treatment. Combination therapy including a diuretic, a long-acting calcium channel blocker, an angiotensin-converting enzyme inhibitor, a beta blocker, and a mineralocorticoid receptor antagonist where warranted is the classic regimen for patients with treatment-resistant hypertension. Mineralocorticoid receptor antagonists like spironolactone or eplerenone have been shown to be efficacious in patients with RHTN, heart failure, chronic kidney disease, and primary aldosteronism. Novel interventional therapies, including baroreflex activation and renal denervation, have shown that both of these methods may be used to lower blood pressure safely, thereby providing exciting and promising new

Frequency and antibiotic susceptibility patterns of urinary pathogens in male outpatients in Argentina.

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Villar, Hugo E; Jugo, Mónica B; Macan, Alejandro; Visser, Matias; Hidalgo, Mariana; Maccallini, Gustavo Cesar

2014-06-11

Knowledge of the etiology and antimicrobial susceptibility patterns of uropathogens is important for determining the best treatment option. This study aimed to determine the distribution and antibiotic susceptibility patterns of bacterial strains isolated from adult male outpatients. Between November 2012 and April 2013, 3,105 community urine samples were analyzed from adult male patients who attended the Laboratorio Hidalgo, Buenos Aires, Argentina. Antimicrobial susceptibility testing was performed by the Kirby-Bauer disc diffusion method. Isolates resistant to third generation cephalosporin were tested for extended-spectrum beta-lactamase (ESBL) production using the double-disk synergy test. Of the 3,105 urine samples analyzed, 791 (25.5%) had significant bacteriuria. The frequency of positive urine cultures increased significantly with patient age. Escherichia coli was isolated most frequently (47.3%), followed by Enterococcus faecalis (13.6%), and Klebsiella pneumoniae (11.9%). Gram-negative organisms represented 78.8% of urinary pathogens. The highest activities against Gram-negative bacteria were found with imipenem (99.0%), amikacin (98.1%), ertapenem (94.2%), fosfomycin (90.7%), and piperacillin-tazobactam (90.1%). The frequencies of ESBLs among E. coli, K. pneumoniae, and P. mirabilis were 15.2 %, 22.3%, and 8%, respectively. Fosfomycin, piperacillin-tazobactam, and nitrofurantoin were most effective against Gram-positive organisms. Fosfomycin may be an excellent option for cystitis treatment in patients without risk factors, whereas piperacillin-tazobactam is preferred for the treatment of parenchymatous UTIs, complicated UTIs, and UTIs associated with risk factors. To ensure the optimal selection of antibiotics, physicians should have access to up-to-date information about the local prevalence of antimicrobial resistance.

Male hormonal contraception: looking back and moving forward.

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Roth, M Y; Page, S T; Bremner, W J

2016-01-01

Despite numerous contraceptive options available to women, approximately half of all pregnancies in the United States and worldwide are unplanned. Women and men support the development of reversible male contraception strategies, but none have been brought to market. Herein we review the physiologic basis for male hormonal contraception, the history of male hormonal contraception development, currents agents in development as well as the potential risks and benefits of male hormonal contraception for men. © 2015 American Society of Andrology and European Academy of Andrology.

Elbasvir/Grazoprevir Experience- A New Glance at HCV Treatment: Case Report

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Mustafa Kemal ÇELEN

2017-04-01

Full Text Available Hepatitis C is a viral disease having a worldwide importance and posing a risk for liver complications. With the new treatment options, it is easy to manage with higher rates of success. Among them, one of the most recent one is elbasvir/grazoprevir option. This study presents the results of two treatment-naive patients treated with elbasvir/grazoprevir. The first case was a male non-cirrhotic patient and the second one was a female who suffered from compensated hepatic cirrhosis. Both patients received elbasvir/grazoprevir 50/100 mg in a single tablet for 12 weeks. Persistent viral response was achieved in both patients and no side effect was observed during the treatment. Elbasvir/grazoprevir combination, one of the recent treatments, was considered effective and tolerable.

Clinical trials as treatment option: bioethics and health care disparities in substance dependency.

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Timmermans, Stefan; McKay, Tara

2009-12-01

Bioethicists have warned against the dangers of mixing research with treatment. They are concerned that research priorities may take precedence over individual patient needs and that research subjects tend to misunderstand the purpose of research or overestimate the direct medical benefits of participating in studies. Yet, other work has questioned whether clinical research can always be separated from therapeutic benefit for participants. Using in-depth interviews with participants in two phase III randomized U.S. clinical trials for methamphetamine dependency, we examine the treatment options available to participants, their experiences with participating in the trials, and potential problems of trial participation. We find that while participants have experience with four alternative treatment modalities - quitting alone, support groups, in-patient treatment facilities, and consulting primary care physicians - the randomized clinical trials compare favorably to alternatives because they provide access to evidence-based behavioral treatments, specialized medical professionals, non-judgmental staff, and the possibility of receiving an experimental drug. We conclude that while randomized clinical trials are imperfect substitutes for clinical care, they constitute a fragile and sporadic therapeutic niche in a country with fundamental problems in access to health care, a mixed punitive-therapeutic drug addiction policy, and a profit-driven pharmaceutical development and approval process.

[Systematic review on conservative treatment options in non-muscle-invasive bladder cancer patients refractory to Bacillus Calmette-Guérin instillation therapy].

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Martini, Thomas; Wezel, Felix; Löbig, Niklas; Mitterberger, Michael J; Colleselli, Daniela

2017-08-01

Background Adjuvant Bacillus Calmette-Guérin (BCG) intravesical instillation is the recommended standard treatment in patients with high-risk non-muscle-invasive bladder cancer (NMIBC). However, a significant proportion of patients fail treatment, and radical cystectomy (RC) is the subsequent gold standard. On the other hand, there is an unmet need for conservative alternatives for patients who are unfit or unwilling to undergo surgery. This study aimed to identify conservative treatment options in NMIBC patients after BCG failure. Material and Methods We performed a systematic search in the databases Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE and EMBASE, including all randomised controlled trials (RCTs), quasi-RCTs and single-arm studies, in which patients with NMIBC were treated with second-line intravesical or systemic therapy after BCG failure. A minimum of eight patients were included in each treatment arm. Full papers were restricted to English language. Literature research and data analysis were assessed independently by two reviewers. Data on treatment response, recurrence, time to recurrence, progression and rate of cystectomy were collected and analysed. Results  This systematic review included 42 publications with a total of 3521 patients (2371 BCG failures). Valrubicin, taxanes, gemcitabine, combination chemotherapy, thermochemotherapy, photodynamic therapy, combination of BCG and interferon and immunotherapies or targeted therapies were identified as conservative treatment options. For taxanes, gemcitabine and thermochemotherapy there is the highest evidence for a clinical meaningful response with minor toxicities. Conclusions Despite some promising response rates for taxanes, gemcitabine or thermochemotherapy, an evidence-based recommendation for treatment options superior to RC in patients failing BCG therapy cannot be made. The definition of BCG failure is still inconsistent and heterogeneous outcomes in patients with BCG

Cost-effectiveness of available treatment options for patients suffering from severe COPD in the UK: a fully incremental analysis

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Hertel N

2012-03-01

Full Text Available Nadine Hertel1, Robert W Kotchie1, Yevgeniy Samyshkin1, Matthew Radford1, Samantha Humphreys2, Kevin Jameson21IMS Consulting Group, London, UK; 2MSD Ltd, Hoddesdon, UKPurpose: Frequent exacerbations which are both costly and potentially life-threatening are a major concern to patients with chronic obstructive pulmonary disease (COPD, despite the availability of several treatment options. This study aimed to assess the lifetime costs and outcomes associated with alternative treatment regimens for patients with severe COPD in the UK setting.Patients and methods: A Markov cohort model was developed to predict lifetime costs, outcomes, and cost-effectiveness of various combinations of a long-acting muscarinic antagonist (LAMA, a long-acting beta agonist (LABA, an inhaled corticosteroid (ICS, and roflumilast in a fully incremental analysis. Patients willing and able to take ICS, and those refusing or intolerant to ICS were analyzed separately. Efficacy was expressed as relative rate ratios of COPD exacerbation associated with alternative treatment regimens, taken from a mixed treatment comparison. The analysis was conducted from the UK National Health Service (NHS perspective. Parameter uncertainty was explored using one-way and probabilistic sensitivity analysis.Results: Based on the results of the fully incremental analysis a cost-effectiveness frontier was determined, indicating those treatment regimens which represent the most cost-effective use of NHS resources. For ICS-tolerant patients the cost-effectiveness frontier suggested LAMA as initial treatment. Where patients continue to exacerbate and additional therapy is required, LAMA + LABA/ICS can be a cost-effective option, followed by LAMA + LABA/ICS + roflumilast (incremental cost-effectiveness ratio [ICER] versus LAMA + LABA/ICS: £16,566 per quality-adjusted life-year [QALY] gained. The ICER in ICS-intolerant patients, comparing LAMA + LABA + roflumilast versus LAMA + LABA, was £13

Treatment preferences and outcome in male hypogonadotropic hypogonadism: an Indian perspective.

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Sanyal, D; Chatterjee, S

2016-06-01

This retrospective study assessed treatment preferences and outcome with testosterone or HCG / HCG-FSH combination in Indian male idiopathic hypogonadotropic hypogonadism (IHH) subjects (n = 31) above 18 years of age. 38.7% of IHH study subjects had no fertility plans and chose 3 monthly intramuscular testosterone undecanoate. 73.7% of subjects with fertility plans chose human chorionic gonadotropin (HCG) alone due to cost considerations. Spermatogenesis occurred in 21.4% on HCG alone and 60% of subjects on HCG with follicle-stimulating hormone (FSH) combination. Treatment failure is higher than published Western rates. FSH and HCG combination regimen is costly but superior to HCG alone. However, treatment failure still persists, suggesting unknown testicular defect in IHH. © 2015 Blackwell Verlag GmbH.

Bayesian comparative effectiveness study of four consensus treatment plans for initial management of systemic juvenile idiopathic arthritis: FiRst-Line Options for Systemic juvenile idiopathic arthritis Treatment (FROST).

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Nigrovic, Peter A; Beukelman, Timothy; Tomlinson, George; Feldman, Brian M; Schanberg, Laura E; Kimura, Yukiko

2018-03-01

Systemic juvenile idiopathic arthritis is a rare febrile arthritis of childhood characterized by a potentially severe course, including prolonged glucocorticoid exposure, growth failure, destructive arthritis, and life-threatening macrophage activation syndrome. Early cytokine-blocking biologic therapy may improve long-term outcomes, although some systemic juvenile idiopathic arthritis patients respond well to non-biologic treatment, leaving optimal management undefined. Consequently, treatment of new-onset systemic juvenile idiopathic arthritis by expert clinicians varies widely. To describe a pragmatic, observational comparative effectiveness study that takes advantage of diversity in the management of a rare disease: FiRst-Line Options for Systemic juvenile idiopathic arthritis Treatment (FROST), comparing non-biologic and biologic consensus treatment plans for new-onset systemic juvenile idiopathic arthritis within the 60-center Childhood Arthritis and Rheumatology Research Alliance Registry (CARRA). FiRst-Line Options for Systemic juvenile idiopathic arthritis Treatment (FROST) is a multicenter, prospective, non-randomized study that compares four Childhood Arthritis and Rheumatology Research Alliance (CARRA) consensus treatment plans for new-onset systemic juvenile idiopathic arthritis: (1) glucocorticoids alone, (2) methotrexate, (3) interleukin-1 blockade, and (4) interleukin-6 blockade. Patients consenting to participation in the Childhood Arthritis and Rheumatology Research Alliance (CARRA) Registry are started on one of four Consensus Treatment Plans at the discretion of the treating physician. The outcome of primary interest is clinically inactive disease off glucocorticoids at 9 months, comparing non-biologic (Consensus Treatment Plans 1 + 2) versus biologic (Consensus Treatment Plans 3 + 4) strategies. Bayesian analytic methods will be employed to evaluate response rates, using propensity scoring to balance treatment groups for potential

Basic science and surgical treatment options for articular cartilage injuries of the knee.

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Tetteh, Elizabeth S; Bajaj, Sarvottam; Ghodadra, Neil S

2012-03-01

The complex structure of articular cartilage allows for diverse knee function throughout range of motion and weight bearing. However, disruption to the structural integrity of the articular surface can cause significant morbidity. Due to an inherently poor regenerative capacity, articular cartilage defects present a treatment challenge for physicians and therapists. For many patients, a trial of nonsurgical treatment options is paramount prior to surgical intervention. In instances of failed conservative treatment, patients can undergo an array of palliative, restorative, or reparative surgical procedures to treat these lesions. Palliative methods include debridement and lavage, while restorative techniques include marrow stimulation. For larger lesions involving subchondral bone, reparative procedures such as osteochondral grafting or autologous chondrocyte implantation are considered. Clinical success not only depends on the surgical techniques but also requires strict adherence to rehabilitation guidelines. The purpose of this article is to review the basic science of articular cartilage and to provide an overview of the procedures currently performed at our institution for patients presenting with symptomatic cartilage lesions.

Comparison of three surgical treatment options for unicameral bone cysts in humerus.

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Mavčič, Blaž; Saraph, Vinay; Gilg, Magdalena M; Bergovec, Marko; Brecelj, Janez; Leithner, Andreas

2018-04-23

Treatment of unicameral bone cysts (UBC) in the humerus with drainage screws is scarcely reported in the literature. The aim of this retrospective study was to compare drainage screws and alternative treatment methods with respect to the number of required surgical procedures to achieve sufficient UBC healing, postoperative fractures/recurrences/complications, and radiological outcome. Medical archives of two tertiary orthopedic referral centers were screened for all patients who were treated surgically for humeral UBC in the period 1991-2015 with a histologically/cytologically confirmed diagnosis. Sex, age, all surgical procedures, fractures, complications, recurrences, and the final radiological outcome were compared between patients treated with drainage screws, elastic intramedullary nails, or curettage with optional grafting. The study included 106 operated patients with a mean age of 10.3 years, with a mean follow-up of 5.7 years. The average number of UBC-related surgical procedures in sex-matched and age-matched treatment groups was 2.7 with drainage screws, 2.8 with intramedullary nails, and 3.5 with curettage/grafting (P=0.54). Intramedullary nails (odds ratio 0.20) and older age (odds ratio for each year 0.83) predicted a lower risk of postoperative UBC recurrence. Patients with drainage screws had the highest UBC recurrence rates and the lowest rates of changed initial treatment method. There was no difference between the treatment groups in the postoperative fracture rate, complications, or the final radiological outcome. UBC treatment in the humerus therefore requires approximately three surgical procedures, irrespective of the treatment modality chosen. Adding an elastic intramedullary nail to a humeral UBC cyst may reduce recurrence risk and prevent further fractures. Level III - therapeutic retrospective comparative study.

Balloon pulmonary angioplasty: a treatment option for inoperable patients with chronic thromboembolic pulmonary hypertension

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Aiko eOgawa

2015-02-01

Full Text Available In chronic thromboembolic pulmonary hypertension, stenoses or obstructions of the pulmonary arteries due to organized thrombi can cause an elevation in pulmonary artery resistance, which in turn can result in pulmonary hypertension. Chronic thromboembolic pulmonary hypertension can be cured surgically by pulmonary endarterectomy; however, patients deemed unsuitable for pulmonary endarterectomy due to lesion, advanced age, or comorbidities have a poor prognosis and limited treatment options. Recently, advances have been made in balloon pulmonary angioplasty for these patients, and this review highlights this recent progress.

Ovarian failure due to cancer treatment and fertility preservation options

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Soheila Aminimoghaddam

2016-04-01

Full Text Available Primary ovarian insufficiency (POI, commonly referred to premature ovarian failure, is defined as ovarian failure before the age of 40 years. It is the loss of ovarian function caused by a process directly affecting ovaries. Cancer therapy which includes surgery, radiotherapy, and chemotherapy influence ovarian function, leading to premature menopause and loss of fertility. POI is idiopathic in most cases (74-90%. The known causes, in addition to anticancer treatment, are other processes like chromosomal abnormalities, autoimmunity, and natural aging can result in secondary ovarian failure, which is detected by an increase in serum gonadotropin levels (FSH and LH. There are evident risks of POI in women treated for cancer. Those who receive anticancer treatments have an increased risk of developing POI. There by, anticancer drugs and radiation therapy are considered as the most common toxins of ovaries. Although cancer incidence rates in women less than 50 years old continue to increase during recent years, mortality rates are dramatically decreasing due to modern advances in treatment. Increasing numbers of survivors are now confronted with the long-term consequences of exposure to these treatments. The pool of primordial follicles in the ovary is fixed and any injury to the ovary can potentially reduce this ovarian reserve, effectively advancing the patient’s reproductive age, thus narrowing the window of reproductive opportunity. Ovarian failure occurs in a significant percentage of childhood cancer survivors and many of them will seek care for reproductive dysfunction. Nevertheless, Embryo cryopreservation, oocyte cryopreservation, ovary tissue cryopreservation, ovarian suppression and oophoro-pexy are some options to preserve fertility in these groups. As a result, having foreknowledge of potential treatment related ovarian failure will allow the physician to give a better counsel to patients and their family regarding the importance and

Clinical roundtable monograph: Emerging treatment options for TKI-resistant chronic myelogenous leukemia.

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Cortes, Jorge; Radich, Jerald; Mauro, Michael J

2012-10-01

The development of tyrosine kinase inhibitors (TKIs) that inhibit signaling of the constitutive BCR-ABL protein revolutionized the treatment of chronic myelogenous leukemia (CML). These agents have dramatically changed the treatment landscape for CML, shifting the use of allogeneic stem cell transplantation to selected patients in the salvage setting. Four BCR-ABL TKIs are now commercially available for the treatment of CML: the first-generation TKI imatinib, and the second-generation TKIs dasatinib, nilotinib, and bosutinib. Continuous treatment with these agents induces durable responses in a high proportion of patients with chronic-phase CML. Research is focused on identifying which patients can discontinue therapy without a recurrence of disease. For the group of patients with resistance to TKIs, multiple alternative therapies are being evaluated. The third-generation TKI ponatinib is a BCR-ABL inhibitor that has demonstrated significant activity, including in patients with the TKI resistance mutation T315I. The homoharringtonine derivative omacetaxine mepesuccinate, which inhibits protein synthesis, has also demonstrated clinical activity in CML, including in patients with TKI resistance due to T315I and in patients who have TKI resistance despite no evidence of ABL mutations. It is essential that clinicians implement these new agents with care and change therapies only when appropriate in order to preserve as many options as possible for future use if needed.

Treatment of hypogonadotropic male hypogonadism: Case-based scenarios

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Crosnoe-Shipley, Lindsey E; Elkelany, Osama O; Rahnema, Cyrus D; Kim, Edward D

2015-01-01

The aim of this study is to review four case-based scenarios regarding the treatment of symptomatic hypogonadism in men. The article is designed as a review of published literature. We conducted a PubMed literature search for the time period of 1989-2014, concentrating on 26 studies investigating the efficacy of various therapeutic options on semen analysis, pregnancy outcomes, time to recovery of spermatogenesis, as well as serum and intratesticular testosterone levels. Our results demonstrated that exogenous testosterone suppresses intratesticular testosterone production, which is an absolute prerequisite for normal spermatogenesis. Cessation of exogenous testosterone should be recommended for men desiring to maintain their fertility. Therapies that protect the testis involve human chorionic gonadotropin (hCG) therapy or selective estrogen receptor modulators (SERMs), but may also include low dose hCG with exogenous testosterone. Off-label use of SERMs, such as clomiphene citrate, are effective for maintaining testosterone production long-term and offer the convenience of representing a safe, oral therapy. At present, routine use of aromatase inhibitors is not recommended based on a lack of long-term data. We concluded that exogenous testosterone supplementation decreases sperm production. It was determined that clomiphene citrate is a safe and effective therapy for men who desire to maintain fertility. Although less frequently used in the general population, hCG therapy with or without testosterone supplementation represents an alternative treatment. PMID:25949938

Efficacy of paxil in the treatment of depressions in elderly males

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N A Tyuvina

2012-01-01

Full Text Available Objective: to study the efficacy of paxil in the treatment of depression of varying severity in elderly male. Patients and methods. Thirty-five males aged 50—78 years with depressive symptoms of varying severity in the framework of a depressive episode [n = 14 (40%], recurrent depressive disorder [n = 12 (34.3%], and bipolar affective disorder [n = 9 (25.7%] were examined. The efficacy of paxil 20—40 mg/day was clinically evaluated using psychometric scales (CGI, HDRS, and UKU on days 7, 14, 28, and 42. Results. Paxil was found to be highly effective in treating depressions in elderly males. The mean HDRS scores decreased from 24.7±0.3 to 4.9±1.1. By day 42, the reduction in depressive symptoms was 80.2%. 74.3% of the patients achieved recovery and a borderline state according to the CGI-S scale. There was cessation of asthenic symptoms and adynamia at week 1 of therapy, hypothymia at week 2, and anxiety caused by the consecutive manifestations of stimulating, antidepressant, and anxiolytic effects.

TISU: Extracorporeal shockwave lithotripsy, as first treatment option, compared with direct progression to ureteroscopic treatment, for ureteric stones: study protocol for a randomised controlled trial.

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McClinton, Samuel; Cameron, Sarah; Starr, Kathryn; Thomas, Ruth; MacLennan, Graeme; McDonald, Alison; Lam, Thomas; N'Dow, James; Kilonzo, Mary; Pickard, Robert; Anson, Ken; Keeley, Frank; Burgess, Neil; Clark, Charles Terry; MacLennan, Sara; Norrie, John

2018-05-22

Urinary stone disease is very common with an estimated prevalence among the general population of 2-3%. Ureteric stones are associated with severe pain as they pass through the urinary tract and have significant impact on patients' quality of life due to the detrimental effect on their ability to work and need for hospitalisation. Most ureteric stones can be expected to pass spontaneously with supportive care. However, between one-fifth and one-third of cases require an intervention. The two standard active intervention options are extracorporeal shockwave lithotripsy (ESWL) and ureteroscopic stone retrieval. ESWL and ureteroscopy are effective in terms of stone clearance; however, they differ in terms of invasiveness, anaesthetic requirement, treatment setting, complications, patient-reported outcomes (e.g. pain after intervention, time off work) and cost. There is uncertainty around which is the most clinically effective in terms of stone clearance and the true cost to the NHS and to society (in terms of impact on patient-reported health and economic burden). The aim of this trial is to determine whether, in adults with ureteric stones, judged to require active intervention, ESWL is not inferior and is more cost-effective compared to ureteroscopic treatment as the initial management option. The TISU study is a pragmatic multicentre non-inferiority randomised controlled trial of ESWL as the first treatment option compared with direct progression to ureteroscopic treatment for ureteric stones. Patients aged over 16 years with a ureteric stone confirmed by non-contrast computed tomography of the kidney, ureter and bladder (CTKUB) will be randomised to either ESWL or ureteroscopy. The primary clinical outcome is resolution of the stone episode (no further intervention required to facilitate stone clearance) up to six months from randomisation. The primary economic outcome is the incremental cost per quality-adjusted life years (QALYs) gained at six months from

Management options for food production systems affected by a nuclear accident. Task 7: biological treatment of contaminated milk

International Nuclear Information System (INIS)

Nisbet, A.F.; Marchant, J.K.; Woodman, R.F.M.; Wilkins, B.T.; Mercer, J.A.

2003-01-01

In the event of a nuclear accident affecting the UK, regulation of contamination in the foodchain would involve both the Food Standards Agency (FSA) and the Environment Agency (EA). Restrictions would be based on intervention levels imposed by the Council of the European Communities (often referred to as Council Food Intervention Levels, CFILs). FSA would be responsible for preventing commercial foodstuffs with concentrations of radionuclides above the CFILs from entering the foodchain, while EA would regulate the storage and disposal of the waste food. Milk is particularly important in this respect because it is produced continually in large quantities in many parts of the UK. An evaluation of various options for the management of waste foodstuffs has been carried out by NRPB, with support from FSA and its predecessor, the Ministry of Agriculture, Fisheries and Food, and EA. This report describes an evaluation of the practicability of one of those options, namely the biological treatment of contaminated milk. Whole milk has a high content of organic matter and in consequence a high biochemical oxygen demand (BOD) and chemical oxygen demand (COD). If not disposed of properly, releases of whole milk into the environment can have a substantial detrimental effect because of the high BOD. Biological treatments are therefore potentially an attractive management option because the fermentation by bacteria reduces the BOD in the resultant liquid effluent. The objectives of this study were as follows: a. To compile information about the options available for the biological treatment of milk; b. To establish the legal position; c. To assess practicability in terms of technical feasibility, capacity, cost, environmental and radiological impacts and acceptability; d. To assess the radiation doses that might be received by process operators, contractors, farmers and the general public from the biological treatment of contaminated milk. The radionuclides of interest were 131II

RANKL-Targeted Therapies: The Next Frontier in the Treatment of Male Osteoporosis

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Alicia K. Morgans

2011-01-01

Full Text Available Male osteoporosis is an increasingly recognized problem in aging men. A common cause of male osteoporosis is hypogonadism. Thousands of men with prostate cancer are treated with androgen deprivation therapy, a treatment that dramatically reduces serum testosterone and causes severe hypogonadism. Men treated with androgen deprivation therapy experience a decline in bone mineral density and have an increased rate of fracture. This paper describes prostate cancer survivors as a model of hypogonadal osteoporosis and discusses the use of RANKL-targeted therapies in osteoporosis. Denosumab, the only RANKL-targeted therapy currently available, increases bone mineral density and decreases fracture rate in men with prostate cancer. Denosumab is also associated with delayed time to first skeletal-related event and an increase in bone metastasis-free survival in these men. It is reasonable to investigate the use of RANKL-targeted therapy in male osteoporosis in the general population.

Treatment options for active removal of renal stones

NARCIS (Netherlands)

Warmerdam, G.J.J.; Laet, De K.; Wijn, R.P.W.F.; Wijn, P.F.F.

2012-01-01

This study provides an update on the technological aspects of the methods for active removal of renal stones. Currently, extracorporeal shock wave lithotripsy (ESWL), ureteroscopy (URS) and percutaneous nephrolithotomy (PCNL) are the available options. Findings are based upon recent literature from

Changing Profiles of Diagnostic and Treatment Options in Subclavian Artery Aneurysms

NARCIS (Netherlands)

Vierhout, B. P.; Zeebregts, C. J.; van den Dungen, J. J. A. M.; Reijnen, M. M. P. J.

Background: Subclavian artery aneurysms (SAAs) are rare and may cause life- and limb-threatening complications. Therapeutic options greatly differ as do access alternatives. The aim of the study was to assess its clinical presentation, diagnostics and therapeutic options as reported in the

Demasculinization of male fish by wastewater treatment plant effluent

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Vajda, A.M.; Barber, L.B.; Gray, J.L.; Lopez, E.M.; Bolden, A.M.; Schoenfuss, H.L.; Norris, D.O.

2011-01-01

Adult male fathead minnows (Pimephales promelas) were exposed to effluent from the City of Boulder, Colorado wastewater treatment plant (WWTP) under controlled conditions in the field to determine if the effluent induced reproductive disruption in fish. Gonadal intersex and other evidence of reproductive disruption were previously identified in white suckers (Catostomus commersoni) in Boulder Creek downstream from this WWTP effluent outfall. Fish were exposed within a mobile flow-through exposure laboratory in July 2005 and August 2006 to WWTP effluent (EFF), Boulder Creek water (REF), or mixtures of EFF and REF for up to 28 days. Primary (sperm abundance) and secondary (nuptial tubercles and dorsal fat pads) sex characteristics were demasculinized within 14 days of exposure to 50% and 100% EFF. Vitellogenin was maximally elevated in both 50% and 100% EFF treatments within 7 days and significantly elevated by 25% EFF within 14 days. The steroidal estrogens 17??-estradiol, estrone, estriol, and 17??-ethynylestradiol, as well as estrogenic alkylphenols and bisphenol A were identified within the EFF treatments and not in the REF treatment. These results support the hypothesis that the reproductive disruption observed in this watershed is due to endocrine-active chemicals in the WWTP effluent. ?? 2011 Elsevier B.V.

IBS Treatment Options

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... 01 July 2017 Print A short bout of abdominal pain and diarrhea or constipation now and then is not unusual. But long-term or recurring symptoms are not normal. They may signal irritable bowel syndrome (IBS) – and are generally treatable. IBS Treatments Depend ...

Interspinous Process Decompression: Expanding Treatment Options for Lumbar Spinal Stenosis

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Pierce D. Nunley

2016-01-01

Full Text Available Interspinous process decompression is a minimally invasive implantation procedure employing a stand-alone interspinous spacer that functions as an extension blocker to prevent compression of neural elements without direct surgical removal of tissue adjacent to the nerves. The Superion® spacer is the only FDA approved stand-alone device available in the US. It is also the only spacer approved by the CMS to be implanted in an ambulatory surgery center. We computed the within-group effect sizes from the Superion IDE trial and compared them to results extrapolated from two randomized trials of decompressive laminectomy. For the ODI, effect sizes were all very large (>1.0 for Superion and laminectomy at 2, 3, and 4 years. For ZCQ, the 2-year Superion symptom severity (1.26 and physical function (1.29 domains were very large; laminectomy effect sizes were very large (1.07 for symptom severity and large for physical function (0.80. Current projections indicate a marked increase in the number of patients with spinal stenosis. Consequently, there remains a keen interest in minimally invasive treatment options that delay or obviate the need for invasive surgical procedures, such as decompressive laminectomy or fusion. Stand-alone interspinous spacers may fill a currently unmet treatment gap in the continuum of care and help to reduce the burden of this chronic degenerative condition on the health care system.

Transition Hand-Off from Inpatient to Outpatient Treatment of Acute Pyelonephritis in an Elderly Male.

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Orlando, Patricia L; Shane-McWhorter, Laura

2017-04-01

Pyelonephritis is the progression of a urinary tract infection (UTI) to the kidney. In younger patients the infection may not be as severe and may even be treated with oral antibiotics. However, in elderly males pyelonephritis can be more complex and may require hospitalization and treatment with intravenous antibiotics. In the United States UTIs are responsible for frequent visits to emergency departments by elderly individuals. Current literature suggests that pyelonephritis in elderly males is a serious infection that may result in significant morbidity and mortality. Pharmacists are in a unique position to oversee the transition of antibiotic treatment from the inpatient to outpatienT SETTING.

Eurycoma longifolia: Medicinal Plant in the Prevention and Treatment of Male Osteoporosis due to Androgen Deficiency

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Nadia Mohd Effendy

2012-01-01

Full Text Available Osteoporosis in elderly men is now becoming an alarming health issue due to its relation with a higher mortality rate compared to osteoporosis in women. Androgen deficiency (hypogonadism is one of the major factors of male osteoporosis and it can be treated with testosterone replacement therapy (TRT. However, one medicinal plant, Eurycoma longifolia Jack (EL, can be used as an alternative treatment to prevent and treat male osteoporosis without causing the side effects associated with TRT. EL exerts proandrogenic effects that enhance testosterone level, as well as stimulate osteoblast proliferation and osteoclast apoptosis. This will maintain bone remodelling activity and reduce bone loss. Phytochemical components of EL may also prevent osteoporosis via its antioxidative property. Hence, EL has the potential as a complementary treatment for male osteoporosis.

Alopecia areata: Treatment options

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E. Kasumagić-Halilović

2006-02-01

Full Text Available Alopecia areata (AA is a common cause of reversible hair loss afflictingapproximately1-2%ofthegeneralpopulation. It commonly present as round patches of hair loss which can be the firstmanifestationofamoreseverealopecia totalis or universalis. The cause of AA is unknown although most evidence supports the hypothesis that AA is an immunologically mediated disease. Treatment of AA may be divided into four different categories of widely accepted therapeutic modalities: immune inhibitors (steroid or psoralen and UVA light- PUVA, topicalsensitizers (squaric acid dibutylester and diphenylcyclopropenone, non-specificirritants(anthralinandthevasodilatator minoxidil. Improved future treatments may be immunosuppressive or immunomodulatory or they may otherwise protect hair follicles from the injurious effects of inflammation.Theaimofthisarticleistoreviewavailable data on current and potential agents for the treatment of AA.

Biobank participant support of newborn screening for disorders with variable treatment and intervention options.

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Bunnell, Megan E; Tarini, Beth A; Petros, Michael; Goldenberg, Aaron J; Arjunan, Aishwarya; Wicklund, Catherine

2016-10-01

We aimed to better understand biobank participant opinions of the benefits of newborn screening (NBS) for certain disorder types and how terminology used in NBS discourse might impact stakeholder opinion. We conducted a between-subjects randomized survey of 5840 members of the Northwestern University Biobank. The survey contained 12 scenarios, each describing a disorder and its treatment. For each scenario, we varied the terminology used to describe treatment options. One survey version used the term intervention and the other treatment. The outcome measured for each scenario was perceived benefit (for the infant) and importance of testing (for participants). Comparisons were made between participants and between scenarios. Ratings of benefit and importance were not influenced by the use of the term intervention versus treatment within scenarios. Nuances existed in ratings of benefit to the infant and importance to participants amongst scenarios. Participants were most likely to perceive benefit and importance in screening for a disorder if treatment/intervention offered a high chance of improved outcomes. While participants perceived benefit to the infant and importance to themselves in screening for most disorders, nuances in inter-scenario ratings suggest participants weighed availability and type of treatment/intervention in consideration of the benefits of NBS.

Professionals' and laypersons' appreciation of various options for Class III surgical correction.

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Fabré, M; Mossaz, C; Christou, P; Kiliaridis, S

2010-08-01

The objectives of this study were to evaluate the assessments of maxillofacial surgeons, orthodontists, and laypersons on the predicted aesthetic outcome of various surgical options in Class III correction and the associations between certain initial cephalometric values and the judges' preferred option. Pre-surgical lateral headfilms and coloured profile photographs of 18 skeletal Class III Caucasian adult patients (10 males and 8 females) with a mean age of 24.5 years were used. The headfilms were hand traced and digitized. Conventional cephalometric analysis was performed. Computerized predictions of three surgical options, mandibular setback, Le Fort I advancement, and bimaxillary surgery, were made. For each case, the pre-surgical profile photograph with the three predictions was presented on a printed page. The questionnaire was sent to 51 maxillofacial surgeons (response rate 45.1 per cent), 78 orthodontists (response rate 71.8 per cent), and 61 laypersons (response rate 100 per cent) to aesthetically evaluate the pre-surgical photographs and the surgical predictions by placing a mark along a 10-graded visual analogue scale (VAS) using a standard profile for calibration. Confidence interval was calculated for each patient. An independent samples t-test was used to detect initial cephalometric values associated with the judges' preferred option and analysis of variance/Tukey's honestly significant differences to evaluate differences between judges. Intra-observer reliability was assessed with a paired t-test. All treatment predictions led to improved scoring of facial aesthetics with the exception of the setback option for three patients. For 14 patients, general agreement for the preferred option existed between the three groups of judges. Laypersons tended to give lower improvement scores than professionals. Overjet, nasofacial, and nasomental angles were important in decision making between the mandibular setback and Le Fort I options (the more negative

Life cycle assessment of wastewater treatment options for small and decentralized communities.

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Machado, A P; Urbano, L; Brito, A G; Janknecht, P; Salas, J J; Nogueira, R

2007-01-01

Sustainability has strong implications on the practice of engineering. Life cycle assessment (LCA) is an appropriate methodology for assessing the sustainability of a wastewater treatment plant design. The present study used a LCA approach for comparing alternative wastewater treatment processes for small and decentralised rural communities. The assessment was focused on two energy-saving systems (constructed wetland and slow rate infiltration) and a conventional one (activated sludge process). The low environmental impact of the energy-saving wastewater treatment plants was demonstrated, the most relevant being the global warming indicator. Options for reduction of life cycle impacts were assessed including materials used in construction and operational lifetime of the systems. A 10% extension of operation lifetime of constructed wetland and slow rate infiltration systems led to a 1% decrease in CO2 emissions, in both systems. The decrease in the abiotic depletion was 5 and 7%, respectively. Also, replacing steel with HDPE in the activated sludge tank resulted in a 1% reduction in CO2 emission and 1% in the abiotic depletion indicator. In the case of the Imhoff tank a 1% reduction in CO2 emissions and 5% in the abiotic depletion indicator were observed when concrete was replaced by HDPE.

Treatment Options in Kleptomania

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Lut Tamam

2009-06-01

Full Text Available Kleptomania is a rare disorder with inability or great difficulty in resisting impulses of stealing. People with this disorder are compelled to steal things, generally things of little or no value. This disorder usually begins during puberty and usually last until late adulthood; in some cases lasts throughout the person's life. People with this disorder are likely to have a comorbid conditions like mood disorders. Individuals with the disorder are usually referred for treatment due to the comorbid psychiatric complaints rather than kleptomanic behaviour per se. On the other hand literature lacks of studies about the treatment of kleptomania. A wide variety of therapeutic strategies have been proposed for its treatment, among them psychoanalytic oriented psychotherapy, behavioral therapy and pharmacotherapy. Some medications that are used for people diagnosed with kleptomania are selective serotonin reuptake inhibitors, mood stabilizers and opioid antagonists. There is evidence from numerous case studies that a variety of cognitive behavioral therapy techniques are effective in the treatment of kleptomania and it is favored over other approaches such as psychodynamic and psychoanalytic therapies. Studies to date suggest that cognitive behavioral therapy when used in combination with medication, is more effective than medication alone.

PTSD and comorbid AUD: a review of pharmacological and alternative treatment options

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Ralevski E

2014-03-01

Full Text Available Elizabeth Ralevski, Lening A Olivera-Figueroa, Ismene Petrakis Yale University School of Medicine, Department of Psychiatry, VA Connecticut Healthcare System, West Haven, CT, USA Background: Although posttraumatic stress disorder (PTSD and alcohol use disorders (AUD frequently co-occur there are no specific treatments for individuals diagnosed with these comorbid conditions. The main objectives of this paper are to review the literature on pharmacological options for PTSD and comorbid AUD, and to summarize promising behavioral and alternative interventions for those with these dual diagnoses. Methods: We conducted a comprehensive search on PsycINFO and MEDLINE/PubMed databases using Medical Subject Headings terms in various combinations to identify articles that used pharmacotherapy for individuals with dual diagnoses of PTSD and AUD. Similar strategies were used to identify articles on behavioral and alternative treatments for AUD and PTSD. We identified and reviewed six studies that tested pharmacological treatments for patients with PTSD and comorbid AUD. Results: The literature on treatment with US Food and Drug Administration approved medications for patients with dual diagnosis of PTSD and AUD is very limited and inconclusive. Promising evidence indicates that topiramate and prazosin may be effective in reducing PTSD and AUD symptoms in individuals with comorbidity. Seeking safety has had mixed efficacy in clinical trials. The efficacy of other behavioral and alternative treatments (mindfulness-based, yoga, and acupuncture is more difficult to evaluate since the evidence comes from small, single studies without comparison groups. Conclusion: There is a clear need for more systematic and rigorous study of pharmacological, behavioral, and alternative treatments for patients with dual diagnoses of PTSD and AUD. Keywords: dual diagnosis, PTSD, AUD, pharmacotherapy

The effectiveness of Korean medicine treatment in male patients with infertility: a study protocol for a prospective observational pilot study.

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Kim, Kwan-Ii; Jo, Junyoung

2018-01-01

Male factor subfertility has increasingly been considered the cause of infertility in couples. Many men with male infertility have sperm problems such as oligozoospermia, asthenozoospermia, or teratozoospermia. Because abnormal semen parameters are idiopathic to some extent, no standard therapy has been established to date. Herbal medicine has been reported to have beneficial properties in the treatment of subfertility, especially in improving semen quality both in vivo and in human studies. Therefore, we intend to investigate the effectiveness and safety of treatment using Korean medicine (KM) for infertile male patients with poor semen quality.This will be a single-center, prospective, case-only observational pilot study. About 20 male patients with infertility who visit Conmaul Hospital of Korean Medicine will be recruited. We will follow the standard treatment protocol, which has shown good results in the treatment of male infertility. The protocol is composed mainly of a 10-week herbal decoction treatment; acupuncture and/or pharmacopuncture are added when needed. Semen samples, quality of life, and the scrotal temperatures of infertile men will be observed before and after the 10-week treatment with KM.The study has received ethical approval from the Public Institutional Review Board (approval number: P01-201708-21-008). The findings will be disseminated to appropriate audiences via peer-reviewed publication and conference presentations. Korean Clinical Trial Registry (CRIS), Republic of Korea: KCT0002611.

Male fertility preservation before gonadotoxic therapies.

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Wyns, C

2010-01-01

Recent advances in cancer therapy have resulted in an increased number of long-term cancer survivors. Unfortunately, aggressive chemotherapy, radiotherapy and preparative regimens for bone marrow transplantation can severely affect male germ cells, including spermatogonial stem cells (SSCs), and lead to permanent loss of fertility. Different options for fertility preservation are dependent on the pubertal state of the patient. Relevant studies were identified by an extensive Medline search of English and French language articles. Sperm cryopreservation prior to gonadotoxic treatment is a well established method after puberty. In case of ejaculation failure by masturbation, assisted ejaculation methods or testicular tissue sampling should be considered. Although no effective gonadoprotective drug is yet available for in vivo spermatogonial stem cell (SSC) protection in humans, current evidence supports the feasibility of immature testicular tissue (ITT) cryopreservation. The different cryopreservation protocols and available fertility restoration options from frozen tissue, i.e. cell suspension transplantation, tissue grafting and in vitro maturation, are presented. RESULTS obtained in humans are discussed in the light of lessons learned from animal studies. Advances in reproductive technology have made fertility preservation a real possibility in young patients whose gonadal function is threatened by gonadotoxic therapies. The putative indications for such techniques, as well as their limitations according to disease, are outlined.

Economic Analysis of the Impact of Overseas and Domestic Treatment and Screening Options for Intestinal Helminth Infection among US-Bound Refugees from Asia.

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Brian Maskery

2016-08-01

Full Text Available Many U.S.-bound refugees travel from countries where intestinal parasites (hookworm, Trichuris trichuria, Ascaris lumbricoides, and Strongyloides stercoralis are endemic. These infections are rare in the United States and may be underdiagnosed or misdiagnosed, leading to potentially serious consequences. This evaluation examined the costs and benefits of combinations of overseas presumptive treatment of parasitic diseases vs. domestic screening/treating vs. no program.An economic decision tree model terminating in Markov processes was developed to estimate the cost and health impacts of four interventions on an annual cohort of 27,700 U.S.-bound Asian refugees: 1 "No Program," 2 U.S. "Domestic Screening and Treatment," 3 "Overseas Albendazole and Ivermectin" presumptive treatment, and 4 "Overseas Albendazole and Domestic Screening for Strongyloides". Markov transition state models were used to estimate long-term effects of parasitic infections. Health outcome measures (four parasites included outpatient cases, hospitalizations, deaths, life years, and quality-adjusted life years (QALYs.The "No Program" option is the least expensive ($165,923 per cohort and least effective option (145 outpatient cases, 4.0 hospitalizations, and 0.67 deaths discounted over a 60-year period for a one-year cohort. The "Overseas Albendazole and Ivermectin" option ($418,824 is less expensive than "Domestic Screening and Treatment" ($3,832,572 or "Overseas Albendazole and Domestic Screening for Strongyloides" ($2,182,483. According to the model outcomes, the most effective treatment option is "Overseas Albendazole and Ivermectin," which reduces outpatient cases, deaths and hospitalization by around 80% at an estimated net cost of $458,718 per death averted, or $2,219/$24,036 per QALY/life year gained relative to "No Program".Overseas presumptive treatment for U.S.-bound refugees is a cost-effective intervention that is less expensive and at least as effective as

Economic Analysis of the Impact of Overseas and Domestic Treatment and Screening Options for Intestinal Helminth Infection among US-Bound Refugees from Asia.

Science.gov (United States)

Maskery, Brian; Coleman, Margaret S; Weinberg, Michelle; Zhou, Weigong; Rotz, Lisa; Klosovsky, Alexander; Cantey, Paul T; Fox, LeAnne M; Cetron, Martin S; Stauffer, William M

2016-08-01

Many U.S.-bound refugees travel from countries where intestinal parasites (hookworm, Trichuris trichuria, Ascaris lumbricoides, and Strongyloides stercoralis) are endemic. These infections are rare in the United States and may be underdiagnosed or misdiagnosed, leading to potentially serious consequences. This evaluation examined the costs and benefits of combinations of overseas presumptive treatment of parasitic diseases vs. domestic screening/treating vs. no program. An economic decision tree model terminating in Markov processes was developed to estimate the cost and health impacts of four interventions on an annual cohort of 27,700 U.S.-bound Asian refugees: 1) "No Program," 2) U.S. "Domestic Screening and Treatment," 3) "Overseas Albendazole and Ivermectin" presumptive treatment, and 4) "Overseas Albendazole and Domestic Screening for Strongyloides". Markov transition state models were used to estimate long-term effects of parasitic infections. Health outcome measures (four parasites) included outpatient cases, hospitalizations, deaths, life years, and quality-adjusted life years (QALYs). The "No Program" option is the least expensive ($165,923 per cohort) and least effective option (145 outpatient cases, 4.0 hospitalizations, and 0.67 deaths discounted over a 60-year period for a one-year cohort). The "Overseas Albendazole and Ivermectin" option ($418,824) is less expensive than "Domestic Screening and Treatment" ($3,832,572) or "Overseas Albendazole and Domestic Screening for Strongyloides" ($2,182,483). According to the model outcomes, the most effective treatment option is "Overseas Albendazole and Ivermectin," which reduces outpatient cases, deaths and hospitalization by around 80% at an estimated net cost of $458,718 per death averted, or $2,219/$24,036 per QALY/life year gained relative to "No Program". Overseas presumptive treatment for U.S.-bound refugees is a cost-effective intervention that is less expensive and at least as effective as domestic

Characteristics of gram-negative urinary tract infections caused by extended spectrum beta lactamases: pivmecillinam as a treatment option within South Dublin, Ireland

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Fardod O’Kelly

2016-11-01

Full Text Available Abstract Background The prevalence of urinary tract infections (UTIs caused by extended-spectrum β-lactamase (ESBL-producing Enterobacteriaceae is increasing and the therapeutic options are limited, especially in primary care. Recent indications have suggested pivmecillinam to be a suitable option. This pilot study aimed to assess the viability of pivmecillinam as a therapeutic option in a Dublin cohort of mixed community and healthcare origin. Methods A prospective measurement of mean and fractional inhibitory concentrations of antibiotic use in 95 patients diagnosed with UTI caused by ESBL-producing Enterobacteriaceae was carried out. 36 % patients were from general practice, 40 % were admitted to hospital within south Dublin, and 25 % samples arose from nursing homes. EUCAST breakpoints were used to determine if an isolate was sensitive or resistant to antibiotic agents. Results Sixty-nine percent of patients (N = 66 with urinary ESBL isolates were female. The mean age of females was 66 years compared with a mean age of 74 years for males. Thirty-six percent of isolates originated from primary care, hospital inpatients (26 %, and nursing homes (24 %. The vast majority of ESBL isolates were E. coli (80 %. The E tests for mecillinam and co-amoxiclav had concentration ranges from 0.16 mg/L up to 256 mg/L. The mean inhibitory concentration (MIC of mecillinam ranged from 0.25 to 256 mg/L, while co-amoxiclav MICs ranged from 6 to 256 mg/L. The percentage of isolates resistant to mecillinam and co-amoxiclav was found to be 5.26 and 94.74 % respectively. Conclusions This is the first study exploring the use of pivmecillinam in an Irish cohort and has demonstrated that its use in conjunction with or without co-amoxiclav is an appropriate and useful treatment for urinary tract infections caused by ESBL-producing organisms.

Expensing options solves nothing.

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Sahlman, William A

2002-12-01

The use of stock options for executive compensation has become a lightning rod for public anger, and it's easy to see why. Many top executives grew hugely rich on the back of the gains they made on their options, profits they've been able to keep even as the value they were supposed to create disappeared. The supposed scam works like this: Current accounting regulations let companies ignore the cost of option grants on their income statements, so they can award valuable option packages without affecting reported earnings. Not charging the cost of the grants supposedly leads to overstated earnings, which purportedly translate into unrealistically high share prices, permitting top executives to realize big gains when they exercise their options. If an accounting anomaly is the problem, then the solution seems obvious: Write off executive share options against the current year's revenues. The trouble is, Sahlman writes, expensing option grants won't give us a more accurate view of earnings, won't add any information not already included in the financial statements, and won't even lead to equal treatment of different forms of executive pay. Far worse, expensing evades the real issue, which is whether compensation (options and other-wise) does what it's supposed to do--namely, help a company recruit, retain, and provide the right people with appropriate performance incentives. Any performance-based compensation system has the potential to encourage cheating. Only ethical management, sensible governance, adequate internal control systems, and comprehensive disclosure will save the investor from disaster. If, Sahlman warns, we pass laws that require the expensing of options, thinking that's fixed the fundamental flaws in corporate America's accounting, we will have missed a golden opportunity to focus on the much more extensive defects in the present system.

The influence of antibiotic treatment of bitches in oestrus on their attractiveness to males during mating.

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Dziecioł, M; Nizański, W; Stańczyk, E; Kozdrowski, R; Najder-Kozdrowska, L; Twardoń, J

2013-01-01

The aim of this study was to evaluate the influence of the antibiotic treatment, including the mode of drugs administration, on bitches' attractiveness to the stud dogs during mating. Moreover, we tried to estimate the possibility of aversive effect of the drug vehicle on the male behavior. In experiment I, four bitches in oestrus without antibiotic treatment (group A), four bitches treated with intravaginal antibiotic (group B) and four bitches treated with intramuscular antibiotic (group C) were presented to four stud dogs. In experiment II, bitches in oestrus (n = 5) were presented to the males (n = 2) before and after the application to the females' vulva the antibiotic carrier--Miglyol 840 (Sasol, Germany). In both experiments the presence of the typical sexual behavior of the males (sniffing, licking the vulva and anal region, mating attempts) was evaluated. In experiment III the reaction of the males to the samples containing oestrual discharge from the bitches untreated and treated with antibiotics was evaluated. In the last part of study the aversion reaction to the samples containing antibiotic and the antibiotic carrier was evaluated. The results of experiments showed that females treated with the antibiotics were less attractive to males than untreated females, regardless of the method of administration. We did not observe adverse effect of the antibiotic carrier but samples from the bitches treated with antibiotics were significantly less attractive to the males. We concluded that the reason for reduced attractiveness of the bitches in oestrus after antibiotic treatment was the changes in semiochemical signal emitted by treated females as a consequence of elimination of the vaginal bacterial flora, which seems to be involved in creation of the typical, recognizable by the stud dogs, oestrual signal but also by the possible covering effect of used drugs.

The outcome of ART in males with impaired spermatogenesis

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V S Mangoli

2008-01-01

Full Text Available Aims: This study was conducted to evaluate the outcomes of assisted reproductive technology (ART procedures, viz., intrauterine insemination (IUI, in vitro fertilization (IVF and intracytoplasmic sperm injection (ICSI in males with impaired spermatogenesis. Settings and Design: The subjects of the study were infertile couples who were undergoing ART treatment due to male factor indications. The project was designed to correlate the outcome of the ART treatment and its efficacy in different study groups. Methods: Males were grouped as: 1. oligozoospermia (n = 153, 2. asthenoteratozoospermia (n = 158, 3. obstructive azoospermia (n = 110 and 4. nonobstructive azoospermia (n = 58. Patients from groups 1 and 2 were considered for IUI, IVF and ICSI. Those from group 3 were considered for IVF and ICSI and the 4th group underwent only ICSI treatment. Results: Oligozoospermia showed lower pregnancy rates with IUI than with both IVF and ICSI. An average minimum native and postharvest count was obtained to get an acceptable IUI outcome. Asthenoteratozoospermia had the lowest pregnancy rate with IUI as compared to IVF, whereas ICSI showed significantly higher pregnancy rates in this group. Obstructive azoospermia showed significant improvement with ICSI over IVF. In nonobstructive azoospermia, ICSI resulted in a 27.58% pregnancy rate. Conclusion: The IUI outcome was impressive though less effective whereas there was no difference between the IVF and ICSI outcomes in oligozoospermia. In asthenoteratozoospermia, ICSI showed a significant advantage over IUI and IVF, with IUI resulting in poor outcome in this group. In obstructive azoospermia, ICSI had a distinct advantage over IVF whereas in nonobstructive azoospermia, ICSI, the only option, was found to be effective and helpful in achieving an acceptable pregnancy rate.

Comfort as a determiner of treatment position in radiotherapy of the male pelvis

International Nuclear Information System (INIS)

Cox, J.; Davison, A.

2005-01-01

Purpose: A comfortable treatment position in radiotherapy may promote patient stability and contribute to the best possible patient experience. Patients receiving radical radiotherapy for prostate cancer lie supine or prone, but little evaluation has been made of the comfort of these positions. The purpose of this research was to evaluate the comfort of the prone and supine positions and to assess any influence of feelings of anxiety. Methods: Self-reported comfort and anxiety levels were measured using visual analogue scales in the first and last weeks of treatment for patients receiving radical prostatic radiotherapy. The subjects were from two hospitals, 23 routinely treated lying prone and 21 routinely treated lying supine. Six subjects from each group were interviewed in the first week of treatment. Results: Comfort levels were high and no significant difference was found between treatment positions or between the first and last weeks of treatment. Anxiety levels were low with no significant variation according to position or week of treatment. Little correlation was seen between reported anxiety and comfort levels. Interview data supported the quantitative findings. Supine subjects indicated the need for lateral elbow support to improve feelings of stability. Conclusions: For radiotherapy of male patients without pain or other complicating factors, selection between the prone and supine positions may be made without considering comfort. Supine patients should be provided with lateral elbow support. Further research is indicated into the comfort of these positions for females and the phenomenon of low reported anxiety in male cancer patients

Hand infections: anatomy, types and spread of infection, imaging findings, and treatment options.

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Patel, Dakshesh B; Emmanuel, Neelmini B; Stevanovic, Milan V; Matcuk, George R; Gottsegen, Christopher J; Forrester, Deborah M; White, Eric A

2014-01-01

Infections of the hand are common, particularly in immunocompromised patients, and can lead to significant morbidity, including amputation, if not treated properly. Hand infection can spread far and wide from the original site of inoculation through interconnections between the synovium-lined and nonsynovial potential spaces. Because surgery is the mainstay of treatment, knowledge of the pertinent anatomy is imperative for accurately describing the presence, location, and extent of infection. The authors review the pertinent anatomy of the spaces of the hand and describe different types of infection-including cellulitis, necrotizing fasciitis, paronychia, felon, pyogenic flexor tenosynovitis, deep space infections, septic arthritis, and osteomyelitis-and common causative organisms of these infections. They also describe various modes of spread; the common radiologic appearances of hand infections, with emphasis on findings at magnetic resonance imaging and ultrasonography; and the role of radiology in the management of these infections, along with a brief overview of treatment options. ©RSNA, 2014.

Physics options in the plasma code VOA

International Nuclear Information System (INIS)

Eltgroth, P.G.

1976-06-01

A two dimensional relativistic plasma physics code has been modified to accomodate general electromagnetic boundary conditions and various approximations of basic physics. The code can treat internal conductors and insulators, imposed electromagnetic fields, the effects of external circuitry and non-equilibrium starting conditions. Particle dynamics options include a full microscopic treatment, fully relaxed electrons, a low frequency electron approximation and a combination of approximations for specified zones. Electromagnetic options include the full wave treatment, an electrostatic approximation and two varieties of magnetohydrodynamic approximations in specified zones

Conservative care as a treatment option for patients aged 75 years and older with CKD stage V: a National survey in the Netherlands.

Science.gov (United States)

Susanto, Christopher; Kooman, J; Courtens, A M; Konings, C J A M

2018-01-01

Conservative care for patients aged 75 years and older with CKD stage 5 as a treatment option besides dialysis was proposed officially in the Netherlands in October 2016. This national survey showed the current implementation of this option in Netherlands nephrology departments. A web-based survey was sent to medical managers of 60 nephrology departments in the Netherlands in August 2016. Twenty-one medical managers (35%) completed the survey. The term "conservative care" is frequently used and well known. The estimated number of patients in whom the decision for maximal conservative care was made in 2015 was 310 of 2249 patients with CKD stage 5 age 75 years and older (range 5-50 patients per department). 164 patients became symptomatic and received no dialysis. There is no official registration for this treatment option and patient category. The practice patterns vary widely. Only one of 21 respondents reported a conservative care outpatient clinic. Formal training or education regarding conservative care is not available in most of departments. 95% of respondents discussed this treatment option with their patients. General practitioners are always being informed about their patient's decision. Their main role is providing or organizing palliative care support at the end of life and discussing advance care planning. Most respondents (86%) considered to include their patients in a prospective multicentre observational study, conservative care versus dialysis. Conservative care as a treatment option for patients with CKD stage 5 aged 75 years and older is well established. The practice patterns are varied in the Netherlands. Follow-up studies are needed to see whether the new multidisciplinary guideline facilitates harmonization of practice pattern. Funding is needed to optimize the implementation of conservative care.

Growth Hormone Receptor Antagonist Treatment Reduces Exercise Performance in Young Males

DEFF Research Database (Denmark)

Goto, K.; Doessing, S.; Nielsen, R.H.

2009-01-01

between the groups in terms of changes in serum free fatty acids, glycerol, (V) over dotO(2), or relative fat oxidation. Conclusion: GH might be an important determinant of exercise capacity during prolonged exercise, but GHR antagonist did not alter fat metabolism during exercise. (J Clin Endocrinol......Context: The effects of GH on exercise performance remain unclear. Objective: The aim of the study was to examine the effects of GH receptor (GHR) antagonist treatment on exercise performance. Design: Subjects were treated with the GHR antagonist pegvisomant or placebo for 16 d. After the treatment...... period, they exercised to determine exercise performance and hormonal and metabolic responses. Participants: Twenty healthy males participated in the study. Intervention: Subjects were treated with the GHR antagonist (n = 10; 10 mg/d) or placebo (n = 10). After the treatment period, they performed...

Exploring factors associated with ART adherence and retention in care under Option B+ strategy in Malawi: A qualitative study.

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Salem Gugsa

Full Text Available Although several studies have documented challenges related to inadequate adherence to antiretroviral therapy (ART and high loss to follow-up (LTFU among Option B+ women, there is limited understanding of why these challenges occur and how to address them. This qualitative study examines women's experiences with ART adherence and retention in care. Between July and October 2015, in-depth interviews were conducted with 39 pregnant and lactating women who initiated ART at Bwaila Hospital in Lilongwe, Malawi. Study participants included 14 in care and 25 out of care women, according to facility records. Data were analyzed using an inductive, open-coding approach to thematic analysis. Ten of the respondents (7 out of care, 3 in-care had stopped and re-started treatment before the interview date. One of the most important factors influencing adherence and retention was the strength of women's support systems. In contrast to women in-care, most out-of-care women lacked emotional and financial support from male partners, received minimal counseling from providers at initiation, lacked designated guardians to assist with medication refills or clinic appointments, and were highly mobile. Mobility led to difficulties in accessing treatment in new settings. The most common reasons women re-started treatment following interruptions were due to providers' counseling and encouragement and the mother's desire to be healthy. Improved counseling at initiation, active follow-up counseling, women's economic empowerment interventions, promotion of peer counseling schemes and meaningful engagement of male partners can help in addressing the identified barriers and promoting sustained retention of Option B+ women.

Endobronchial cryotherapy facilitates end-stage treatment options in patients with bronchial stenosis: A case series

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Gerard J Fitzmaurice

2014-01-01

Full Text Available In keeping with international trends, lung cancer incidence and mortality are increasing among the Irish population with many patients presenting with advanced disease that excludes the potential for curative management. Consequently palliative treatment options for this patient group are being increasingly explored with various degrees of success. Endobronchial stenosis represents a particularly challenging area of management among these patients and a number of techniques have been described without the identification of a single gold standard. We report our experience of the first time use of endobronchial cryotherapy in Ireland with reference to a case series, including an example of its use in the management of benign disease, in order to support patients with borderline lung function and enable definitive palliative treatment.

Endobronchial cryotherapy facilitates end-stage treatment options in patients with bronchial stenosis: A case series.

LENUS (Irish Health Repository)

Fitzmaurice, Gerard J

2014-04-01

In keeping with international trends, lung cancer incidence and mortality are increasing among the Irish population with many patients presenting with advanced disease that excludes the potential for curative management. Consequently palliative treatment options for this patient group are being increasingly explored with various degrees of success. Endobronchial stenosis represents a particularly challenging area of management among these patients and a number of techniques have been described without the identification of a single gold standard. We report our experience of the first time use of endobronchial cryotherapy in Ireland with reference to a case series, including an example of its use in the management of benign disease, in order to support patients with borderline lung function and enable definitive palliative treatment.

Public opinion on water reuse options

International Nuclear Information System (INIS)

Bruvold, W.H.

1988-01-01

Public policy on waste water reuse options must be informed by public opinion because it is the public who must pay the cost of developing the option and who will be served by the option in the future. For public policy on reuse, guidance for innovative reuse is not as simple as first believed. It seems that public opinion regarding actual community reuse options is affected by the linkage of several factors, including water conservation, health protection, treatment and distribution costs, and environmental enhancement. Probability sampling was used in 7 studies to select respondents who were queried regarding their opinions on various reclaimed water uses such as ranging from cooling tower water to full domestic use. These 7 are briefly reviewed

DIAGNOSTIC AND TREATMENT OPTIONS IN AUTISTIC SPECTRUM DIDORDERS – AN OVERVIEW

Directory of Open Access Journals (Sweden)

Sheffali GULATI

2014-03-01

Full Text Available Goal: To highlight the recent recommenddations and future trends in diagnosing and managing autistic spectrum disorder. Methodology: Comprehensive search was done in the electronic database, journals, reference lists and dissertation related to the field. Results and conclusion: Autistic spectrum disorder is characterized by onset before the age of 3 years, qualitative impairment in social and communication skills along with repetitive behavioural pattern and restricted interests. Multiple pathways involving genetic, structural and environmental factors have been implicated in the etiopathogenesis. Diagnosis is primarily clinical, based on caregiver interview and observing the patient. However, certain biochemical, radiological and electrophysiological investigations are indicated in relevant scenarios. The mainstay of therapy is behavioural intervention with pharmacotherapy indicated for certain behavioural issues. Complementary and alternate treatment, dietary and stem cell therapies are still investigational with some benefits.Various newer therapeutic options are currently being investigated, exploring the molecular and genetic basis of causation.

Male contraception: history and development.

Science.gov (United States)

Kogan, Paul; Wald, Moshe

2014-02-01

Although the twentieth century has seen great strides in the development of female contraception, not a single new agent has been introduced as an approved method for common use for male contraception. Condoms (considered uncomfortable by some) and vasectomy (a permanent invasive procedure) are the only options provided to men, leaving an undue burden on women to bear contraceptive responsibility. Significant developments have, however, been made with regard to hormonal and nonhormonal contraception, and minor, reversible, procedural contraception. This article reviews the currently available, soon to be available, and theoretically possible methods of male contraception. Copyright © 2014 Elsevier Inc. All rights reserved.

Immunotoxin – a new treatment option in patients with relapsed and refractory Hodgkin lymphoma

Directory of Open Access Journals (Sweden)

Novakovic Barbara Jezersek

2015-12-01

Full Text Available Background. Even though Hodgkin lymphoma is a highly curable disease, some of the patients have either a refractory disease or experience a relapse following a successful primary therapy. Durable responses and remissions in patients with relapsed or refractory disease may be achieved in approximately one-half with salvage chemotherapy followed by high dose chemotherapy (HDT and autologous hematopoietic cell rescue (SCT. On the other hand, patients who relapse after HDT and autologous SCT or those who have failed at least two prior multi-agent chemotherapy regimens and are not candidates for HDT have limited treatment options.

Testosterone for the aging male; current evidence and recommended practice

Directory of Open Access Journals (Sweden)

Roger D Stanworth

2008-03-01

Full Text Available Roger D Stanworth, T Hugh JonesCentre of Diabetes and Endocrinology, Barnsley Hospital NHS Foundation Trust, Barnsley, South Yorkshire, United Kingdom; Academic Unit of Diabetes, Endocrinology and Metabolism, University of Sheffield, Sheffield, South Yorkshire, United KingdomAbstract: An international consensus document was recently published and provides guidance on the diagnosis, treatment and monitoring of late-onset hypogonadism (LOH in men. The diagnosis of LOH requires biochemical and clinical components. Controversy in defining the clinical syndrome continues due to the high prevalence of hypogonadal symptoms in the aging male population and the non-specific nature of these symptoms. Further controversy surrounds setting a lower limit of normal testosterone, the limitations of the commonly available total testosterone result in assessing some patients and the unavailability of reliable measures of bioavailable or free testosterone for general clinical use. As with any clinical intervention testosterone treatment should be judged on a balance of risk versus benefit. The traditional benefits of testosterone on sexual function, mood, strength and quality of life remain the primary goals of treatment but possible beneficial effects on other parameters such as bone density, obesity, insulin resistance and angina are emerging and will be reviewed. Potential concerns regarding the effects of testosterone on prostate disease, aggression and polycythaemia will also be addressed. The options available for treatment have increased in recent years with the availability of a number of testosterone preparations which can reliably produce physiological serum concentrations.Keywords: review, testosterone, male, aging

Vitrification treatment options for disposal of greater-than-Class-C low-level waste in a deep geologic repository

International Nuclear Information System (INIS)

Fullmer, K.S.; Fish, L.W.; Fischer, D.K.

1994-11-01

The Department of Energy (DOE), in keeping with their responsibility under Public Law 99-240, the Low-Level Radioactive Waste Policy Amendments Act of 1985, is investigating several disposal options for greater-than-Class C low-level waste (GTCC LLW), including emplacement in a deep geologic repository. At the present time vitrification, namely borosilicate glass, is the standard waste form assumed for high-level waste accepted into the Civilian Radioactive Waste Management System. This report supports DOE's investigation of the deep geologic disposal option by comparing the vitrification treatments that are able to convert those GTCC LLWs that are inherently migratory into stable waste forms acceptable for disposal in a deep geologic repository. Eight vitrification treatments that utilize glass, glass ceramic, or basalt waste form matrices are identified. Six of these are discussed in detail, stating the advantages and limitations of each relative to their ability to immobilize GTCC LLW. The report concludes that the waste form most likely to provide the best composite of performance characteristics for GTCC process waste is Iron Enriched Basalt 4 (IEB4)

Sexually selected nest-building--Pomatoschistus minutus males build smaller nest-openings in the presence of sneaker males.

Science.gov (United States)

Svensson, O; Kvarnemo, C

2003-09-01

Both natural selection and sexual selection may act on nest-building. We tested experimentally how different regimes of egg-predation and male-male competition influence nest-building before mating, using the marine fish sand goby, Pomatoschistus minutus. Males with sneaker males present built the smallest nest-openings, smaller than males held alone or with Pomatoschistus microps males (which may predate eggs and compete over nest-sites but not compete over fertilizations). Males with visual access to other nest-building males tended also to build smaller openings than males held alone or with P. microps. Males with egg-predators present built nests with openings not differing significantly from any other treatment. Our results indicate that the small nest-openings found in the sneaker male treatment are sexually selected through protection against sneaking or by female choice. Across treatments, time span before a male started to build his nest also explained variation in nest-opening width; males starting late built larger nest-openings.

Thermal oxidation of nuclear graphite: A large scale waste treatment option

Science.gov (United States)

Jones, Abbie N.; Marsden, Barry J.

2017-01-01

This study has investigated the laboratory scale thermal oxidation of nuclear graphite, as a proof-of-concept for the treatment and decommissioning of reactor cores on a larger industrial scale. If showed to be effective, this technology could have promising international significance with a considerable impact on the nuclear waste management problem currently facing many countries worldwide. The use of thermal treatment of such graphite waste is seen as advantageous since it will decouple the need for an operational Geological Disposal Facility (GDF). Particulate samples of Magnox Reactor Pile Grade-A (PGA) graphite, were oxidised in both air and 60% O2, over the temperature range 400–1200°C. Oxidation rates were found to increase with temperature, with a particular rise between 700–800°C, suggesting a change in oxidation mechanism. A second increase in oxidation rate was observed between 1000–1200°C and was found to correspond to a large increase in the CO/CO2 ratio, as confirmed through gas analysis. Increasing the oxidant flow rate gave a linear increase in oxidation rate, up to a certain point, and maximum rates of 23.3 and 69.6 mg / min for air and 60% O2 respectively were achieved at a flow of 250 ml / min and temperature of 1000°C. These promising results show that large-scale thermal treatment could be a potential option for the decommissioning of graphite cores, although the design of the plant would need careful consideration in order to achieve optimum efficiency and throughput. PMID:28793326

Thermal oxidation of nuclear graphite: A large scale waste treatment option.

Directory of Open Access Journals (Sweden)

Alex Theodosiou

Full Text Available This study has investigated the laboratory scale thermal oxidation of nuclear graphite, as a proof-of-concept for the treatment and decommissioning of reactor cores on a larger industrial scale. If showed to be effective, this technology could have promising international significance with a considerable impact on the nuclear waste management problem currently facing many countries worldwide. The use of thermal treatment of such graphite waste is seen as advantageous since it will decouple the need for an operational Geological Disposal Facility (GDF. Particulate samples of Magnox Reactor Pile Grade-A (PGA graphite, were oxidised in both air and 60% O2, over the temperature range 400-1200°C. Oxidation rates were found to increase with temperature, with a particular rise between 700-800°C, suggesting a change in oxidation mechanism. A second increase in oxidation rate was observed between 1000-1200°C and was found to correspond to a large increase in the CO/CO2 ratio, as confirmed through gas analysis. Increasing the oxidant flow rate gave a linear increase in oxidation rate, up to a certain point, and maximum rates of 23.3 and 69.6 mg / min for air and 60% O2 respectively were achieved at a flow of 250 ml / min and temperature of 1000°C. These promising results show that large-scale thermal treatment could be a potential option for the decommissioning of graphite cores, although the design of the plant would need careful consideration in order to achieve optimum efficiency and throughput.

A PC-based software package for modeling DOE mixed-waste management options

International Nuclear Information System (INIS)

Abashian, M.S.; Carney, C.; Schum, K.

1995-02-01

The U.S. Department of Energy (DOE) Headquarters and associated contractors have developed an IBM PC-based software package that estimates costs, schedules, and public and occupational health risks for a range of mixed-waste management options. A key application of the software package is the comparison of various waste-treatment options documented in the draft Site Treatment Plans prepared in accordance with the requirements of the Federal Facility Compliance Act of 1992. This automated Systems Analysis Methodology consists of a user interface for configuring complexwide or site-specific waste-management options; calculational algorithms for cost, schedule and risk; and user-selected graphical or tabular output of results. The mixed-waste management activities modeled in the automated Systems Analysis Methodology include waste storage, characterization, handling, transportation, treatment, and disposal. Analyses of treatment options identified in the draft Site Treatment Plans suggest potential cost and schedule savings from consolidation of proposed treatment facilities. This paper presents an overview of the automated Systems Analysis Methodology

Changes of Serum Total and Free Testosterone Concentrations in Male Chronic Hemodialysis Patients with Secondary Hyperparathyroidism in Response to Cinacalcet Treatment

Directory of Open Access Journals (Sweden)

Piotr Kuczera

2016-01-01

Full Text Available Background/Aims: Calcium sensing receptor (CaSR is expressed, among others also in testis. Cinacalcet binds to the CaSR, increases sensitivity of CaSR to serum calcium and is used in the treatment of secondary hyperparathyroidism (sHPT in chronic hemodialysis patients (HDP. In most of male HDP, serum testosterone concentration is lower than in healthy males. The aim of this study was to assess the influence of six-month treatment with cinacalcet on the serum total and free testosterone concentration in male HDP with sHPT. Methods: 38 male, hemodialysed CKD patients with sHPT (PTH>300 pg/ml were enrolled into the study. In each patient serum PTH, total testosterone (TT and free testosterone (FT concentrations were assessed before the first dose of cinacalcet and then after 3 and 6 months of treatment. The results are presented as means with 95% confidence interval. Results: In 33 patients who completed the study cinacalcet treatment caused significant decrease of serum PTH from 1143 pg/ml (828 - 1458 pg/ml at the baseline, to 809 pg/ml (487 - 1132pg/ml after 3 month of treatment (p = 0.002, and to 607 pg/ml (281 - 934pg/ml; p Conclusion: Treatment with cinacalcet decreases serum total and free testosterone concentration in male hemodialysed patients with chronic kidney disease and secondary hyperparathyroidism.

AUTOLOGOUS STEM CELL TRANSPLANTATION FOR CHRONIC LYMPHOCYTIC LEUKEMIA STILL A VALID TREATMENT OPTION, OR IS THE GAME OVER ?

Directory of Open Access Journals (Sweden)

Fabienne McClanahan

2012-01-01

Full Text Available

Chemoimmunotherapy with fludarabine, cyclophosphamide, and rituximab (FCR has been established as the current standard of care for young and fit patients with chronic lymphocytic leukemia (CLL. In the early nineties of the last century, long before the advent of fludarabine or antibody-based strategies, there was realistic hope that myeloablative therapy followed by autologous stem cell transplantation (autoSCT might be an effective and potentially curative front-line treatment option for suitable patients with CLL. Since then, several prospective trials have disenthralled this hope: although autoSCT can prolong event and progression-free survival if used as part of early front-line treatment, it does not improve overall survival, while it is associated with an increased risk of late adverse events such as secondary malignancies. In addition, autoSCT lacks the potential to overcome the negative impact of biomarkers that confer resistance to chemotherapy or early relapse. The role of autoSCT has also been explored in the context of FCR, and it was demonstrated that its effect is inferior to the currently established optimal treatment regimen. In view of ongoing attempts to improve on FCR, promising clinical activity of new substances even in relapsed/ refractory CLL patients, exciting novel cell therapy approaches and advantages in the understanding of the disease and detection of Minimal Residual Disease (MRD, autoSCT has lost its place as a standard treatment option for CLL.

AUTOLOGOUS STEM CELL TRANSPLANTATION FOR CHRONIC LYMPHOCYTIC LEUKEMIA STILL A VALID TREATMENT OPTION, OR IS THE GAME OVER ?

Directory of Open Access Journals (Sweden)

Fabienne McClanahan

2012-11-01

Full Text Available Chemoimmunotherapy with fludarabine, cyclophosphamide, and rituximab (FCR has been established as the current standard of care for young and fit patients with chronic lymphocytic leukemia (CLL. In the early nineties of the last century, long before the advent of fludarabine or antibody-based strategies, there was realistic hope that myeloablative therapy followed by autologous stem cell transplantation (autoSCT might be an effective and potentially curative front-line treatment option for suitable patients with CLL. Since then, several prospective trials have disenthralled this hope: although autoSCT can prolong event and progression-free survival if used as part of early front-line treatment, it does not improve overall survival, while it is associated with an increased risk of late adverse events such as secondary malignancies. In addition, autoSCT lacks the potential to overcome the negative impact of biomarkers that confer resistance to chemotherapy or early relapse. The role of autoSCT has also been explored in the context of FCR, and it was demonstrated that its effect is inferior to the currently established optimal treatment regimen. In view of ongoing attempts to improve on FCR, promising clinical activity of new substances even in relapsed/ refractory CLL patients, exciting novel cell therapy approaches and advantages in the understanding of the disease and detection of Minimal Residual Disease (MRD, autoSCT has lost its place as a standard treatment option for CLL.

Removing a broken guidewire in the hip joint: treatment options and recommendations for preventing an avoidable surgical catastrophe. A case report

Directory of Open Access Journals (Sweden)

Abhijeet Ashok Salunke

Full Text Available ABSTRACT CONTEXT: Hardware breakage during hip surgery can pose challenging and difficult problems for orthopedic surgeons. Apart from technical difficulties relating to retrieval of the broken hardware, complications such as adjacent joint arthritis and damage to neurovascular structures and major viscera can occur. Complications occurring during the perioperative period must be informed to the patient and proper documentation is essential. The treatment options must be discussed with the patient and relatives and the implant company must be informed about this untoward incident. CASE REPORT: We report a case of complete removal of the implant and then removal of the broken guidewire using a combination of techniques, including a cannulated drill bit, pituitary forceps and Kerrison rongeur. CONCLUSIONS: We suggest some treatment options and recommendations for preventing an avoidable surgical catastrophe.

Type 3 Thyroplasty for a Patient with Female-to-Male Gender Identity Disorder.

Science.gov (United States)

Saito, Yu; Nakamura, Kazuhiro; Itani, Shigeto; Tsukahara, Kiyoaki

2018-01-01

In most cases, about the voice of the patient with female-to-male/gender identity disorder (FTM/GID), hormone therapy makes the voice low-pitched. In success cases, there is no need for phonosurgery. However, hormone therapy is not effective in some cases. We perform type 3 thyroplasty in these cases. Hormone therapy was started in 2008 but did not lower the speaking fundamental frequencies (SFFs). We therefore performed TP3 under local anesthesia. In our case, the SFF at the first visit was 146 Hz. The postoperative SFF was 110 Hz. TP3 was performed under local anesthesia in a patient with FTM/GID in whom hormone therapy proved ineffective. With successful conversion to a lower-pitched voice, the patient could begin to live daily life as a male. QOL improved significantly with TP3. If hormone therapy proves ineffective, TP3 may be selected as an optional treatment and appears to show few surgical complications and was, in this case, a very effective treatment.

Type 3 Thyroplasty for a Patient with Female-to-Male Gender Identity Disorder

Directory of Open Access Journals (Sweden)

Yu Saito

2018-01-01

Full Text Available Objective. In most cases, about the voice of the patient with female-to-male/gender identity disorder (FTM/GID, hormone therapy makes the voice low-pitched. In success cases, there is no need for phonosurgery. However, hormone therapy is not effective in some cases. We perform type 3 thyroplasty in these cases. Method. Hormone therapy was started in 2008 but did not lower the speaking fundamental frequencies (SFFs. We therefore performed TP3 under local anesthesia. Results. In our case, the SFF at the first visit was 146 Hz. The postoperative SFF was 110 Hz. Conclusions. TP3 was performed under local anesthesia in a patient with FTM/GID in whom hormone therapy proved ineffective. With successful conversion to a lower-pitched voice, the patient could begin to live daily life as a male. QOL improved significantly with TP3. If hormone therapy proves ineffective, TP3 may be selected as an optional treatment and appears to show few surgical complications and was, in this case, a very effective treatment.

Engineering Options Assessment Report. Nitrate Salt Waste Stream Processing

Energy Technology Data Exchange (ETDEWEB)

Anast, Kurt Roy [Los Alamos National Lab. (LANL), Los Alamos, NM (United States)

2015-11-13

This report examines and assesses the available systems and facilities considered for carrying out remediation activities on remediated nitrate salt (RNS) and unremediated nitrate salt (UNS) waste containers at Los Alamos National Laboratory (LANL). The assessment includes a review of the waste streams consisting of 60 RNS, 29 above-ground UNS, and 79 candidate below-ground UNS containers that may need remediation. The waste stream characteristics were examined along with the proposed treatment options identified in the Options Assessment Report . Two primary approaches were identified in the five candidate treatment options discussed in the Options Assessment Report: zeolite blending and cementation. Systems that could be used at LANL were examined for housing processing operations to remediate the RNS and UNS containers and for their viability to provide repackaging support for remaining LANL legacy waste.

Engineering Options Assessment Report: Nitrate Salt Waste Stream Processing

Energy Technology Data Exchange (ETDEWEB)

Anast, Kurt Roy [Los Alamos National Lab. (LANL), Los Alamos, NM (United States)

2015-11-18

This report examines and assesses the available systems and facilities considered for carrying out remediation activities on remediated nitrate salt (RNS) and unremediated nitrate salt (UNS) waste containers at Los Alamos National Laboratory (LANL). The assessment includes a review of the waste streams consisting of 60 RNS, 29 aboveground UNS, and 79 candidate belowground UNS containers that may need remediation. The waste stream characteristics were examined along with the proposed treatment options identified in the Options Assessment Report . Two primary approaches were identified in the five candidate treatment options discussed in the Options Assessment Report: zeolite blending and cementation. Systems that could be used at LANL were examined for housing processing operations to remediate the RNS and UNS containers and for their viability to provide repackaging support for remaining LANL legacy waste.

Understanding the Role of Serotonin in Female Hypoactive Sexual Desire Disorder and Treatment Options.

Science.gov (United States)

Croft, Harry A

2017-12-01

The neurobiology of sexual response is driven in part by dopamine and serotonin-the former modulating excitatory pathways and the latter regulating inhibitory pathways. Neurobiological underpinnings of hypoactive sexual desire disorder (HSDD) are seemingly related to overactive serotonin activity that results in underactive dopamine activity. As such, pharmacologic agents that decrease serotonin, increase dopamine, or some combination thereof, have therapeutic potential for HSDD. To review the role of serotonin in female sexual function and the effects of pharmacologic interventions that target the serotonin system in the treatment of HSDD. Searches of the Medline database for articles on serotonin and female sexual function. Relevant articles from the peer-reviewed literature were included. Female sexual response is regulated not only by the sex hormones but also by several neurotransmitters. It is postulated that dopamine, norepinephrine, oxytocin, and melanocortins serve as key neuromodulators for the excitatory pathways, whereas serotonin, opioids, and endocannabinoids serve as key neuromodulators for the inhibitory pathways. Serotonin appears to be a key inhibitory modulator of sexual desire, because it decreases the ability of excitatory systems to be activated by sexual cues. Centrally acting drugs that modulate the excitatory and inhibitory pathways involved in sexual desire (eg, bremelanotide, bupropion, buspirone, flibanserin) have been investigated as treatment options for HSDD. However, only flibanserin, a multifunctional serotonin agonist and antagonist (5-hydroxytryptamine [5-HT] 1A receptor agonist and 5-HT 2A receptor antagonist), is currently approved for the treatment of HSDD. The central serotonin system is 1 biochemical target for medications intended to treat HSDD. This narrative review integrates findings from preclinical studies and clinical trials to elucidate neurobiological underpinnings of HSDD but is limited to 1 neurotransmitter system

Lymphoepithelioma-like carcinoma of the urinary bladder: A case report and review of systemic treatment options

Directory of Open Access Journals (Sweden)

Nicholas M Pantelides

2012-01-01

Full Text Available Lymphoepithelioma-like carcinoma (LELC of the urinary bladder is a rare variant, which can occur in a pure form or in conjunction with transitional cell carcinoma. Owing to the scarcity of reported cases, the optimum treatment is yet to be defined, although the benefits of chemotherapy are increasingly recognised. We present a case of a 64-year-old man with pure LELC, treated with trans-urethral resection of the bladder tumor (TURBT and primary gemcitabine and platinum-based chemotherapy. He remained free of disease at six-month follow-up cystoscopy. The case adds to the growing evidence for the efficacy of chemotherapy, coupled with TUR, as part of a bladder-preserving treatment option for LELC.

Energy options

International Nuclear Information System (INIS)

Hampton, Michael

1999-01-01

This chapter focuses on energy options as a means of managing exposure to energy prices. An intuitive approach to energy options is presented, and traditional definitions of call and put options are given. The relationship between options and swaps, option value and option exercises, commodity options, and option pricing are described. An end-user's guide to energy option strategy is outlined, and straight options, collars, participating swaps and collars, bull and bear spreads, and swaption are examined. Panels explaining the defining of basis risk, and discussing option pricing and the Greeks, delta hedging, managing oil options using the Black-Scholes model, caps, floors and collars, and guidelines on hedging versus speculation with options are included in the paper

A rational approach for evaluation and screening of treatment and disposal options for the solar pond sludges at Rocky Flats

International Nuclear Information System (INIS)

Dickerson, K.S.

1995-01-01

This document consists of information about the treatment options for the sludge that is located in the evaporation ponds at the Rocky Flats Plant. The sludges are mixed low-level radioactive wastes whose composition and character were variable. Sludges similar to these are typically treated prior to ultimate disposal. Disposal of treated sludges includes both on-site and off-site options. The rational approach described in this paper is useful for technology evaluation and screening because it provides a format for developing objectives, listing alternatives, and weighing the alternatives against the objectives and against each other

A Fifth Option for Funding Long-Term Care in Canada - Shift the Resources from Medical Treatment and Universal Pension Entitlements.

Science.gov (United States)

Emery, J C Herbert

2016-01-01

Needs for non-medical residential care services, long-term care (LTC), will increase over the next 30 years as Canada's population ages. Adams and Vanin (2016) explore four options for raising the public and private monies required to meet LTC needs. In this commentary, I raise a fifth option for finding the resources to meet emerging LTC needs. An alternative approach is to divert resources from Canada's well-resourced, but inefficient, medical treatment system. The dividend of provinces pursuing long overdue reforms to medicare is the liberation of public funds to finance emerging priorities for Canadians like LTC.

A rational approach for evaluation and screening of treatment and disposal options for the solar pond sludges at Rocky Flats

Energy Technology Data Exchange (ETDEWEB)

Dickerson, K.S.

1995-12-31

This document consists of information about the treatment options for the sludge that is located in the evaporation ponds at the Rocky Flats Plant. The sludges are mixed low-level radioactive wastes whose composition and character were variable. Sludges similar to these are typically treated prior to ultimate disposal. Disposal of treated sludges includes both on-site and off-site options. The rational approach described in this paper is useful for technology evaluation and screening because it provides a format for developing objectives, listing alternatives, and weighing the alternatives against the objectives and against each other.

The current treatment options for epilepsy

International Nuclear Information System (INIS)

Sykora, P.; Svecova, L.

2014-01-01

Epilepsy is the most prevalent chronic brain disease manifesting with epileptic seizures. Epilepsy itself is not one nosological entity, it rather includes several diseases with various etiology, clinics, course and therapy. Antiepileptic therapy aims seizure freedom without affecting psychical and physical functions. The therapy is in first line pharmacological. The choice of antiepileptic drug depends not only on the seizure phenomenology, but also on the respective type of epilepsy syndrome. Most patients achieve seizure freedom or at least significant seizure frequency reduction. In 20-30% of the patients is the pharmacotherapy ineffective. In these cases of refractory epilepsy therapeutical options include epilepsy surgery, vagal stimulation or ketogenic diet. Despite recent advances in the diagnostics and therapy, epilepsy remains a serious medical and social issue. (author)

How does obesity affect fertility in men - and what are the treatment options?

Science.gov (United States)

Stokes, Victoria J; Anderson, Richard A; George, Jyothis T

2015-05-01

Adiposity is associated with reduced fertility in men. The aetiology is multifactorial, with obese men at greater risk of suffering from impaired spermatogenesis, reduced circulating testosterone levels, erectile dysfunction and poor libido. The diagnosis and treatment of reduced fertility observed in obese men therefore requires insight into the underlying pathology, which has hormonal, mechanical and psychosocial aspects. This article summarises the current epidemiological, experimental and clinical trial evidence from the perspective of a practicing clinician. The following conclusions and recommendations can be drawn: Obesity is associated with low serum testosterone concentrations, but treatment with exogenous testosterone is likely to adversely impact on fertility. It is important to discuss this with men prior to initiation of testosterone therapy. Obesity adversely affects sperm concentration and may affect sperm quality. However, whether or not weight loss will correct these factors remain to be established. Oestrogen receptor modulators (and aromatase inhibitors) are unlicensed in the treatment for male hypogonadism and/or infertility. These treatments should hence be considered experimental approach until ongoing clinical trials report their outcomes. © 2014 John Wiley & Sons Ltd.

Depression Screening and Education: Options to Reduce Barriers to Treatment (DESEO): protocol for an educational intervention study.

Science.gov (United States)

Sanchez, Katherine; Eghaneyan, Brittany H; Trivedi, Madhukar H

2016-07-29

Barriers to depression treatment among Hispanic populations include persistent stigma, inadequate doctor patient communication (DPC) and resultant sub-optimal use of anti-depressant medications. Stigma is primarily perpetuated due to inadequate disease literacy and cultural factors. Common concerns about depression treatments among Hispanics include fears about the addictive and harmful properties of antidepressants, worries about taking too many pills, and the stigma attached to taking psychotropic medications. The current manuscript presents the study protocol for the Depression Screening and Education: Options to Reduce Barriers to Treatment (DESEO) study funded by the Center for Medicare and Medicaid Services (CMS) Grants to Support the Hispanic Health Services Research Grant Program. DESEO will implement universal screening with a self-report depression screening tool (the 9-item Patient Health Questionnaire (PHQ-9)) that is presented through a customized web application and a Depression Education Intervention (DEI) designed to increase disease literacy, and dispel myths about depression and its treatment among Hispanic patients thus reducing stigma and increasing treatment engagement. This project will be conducted at one community health center whose patient population is majority Hispanic. The target enrollment for recruitment is 350 patients over the 24-month study period. A one-group, pretest-posttest design will be used to asses knowledge of depression and its treatment and related stigma before, immediately after, and one month post intervention. Primary care settings often are the gateway to identifying undiagnosed mental health disorders, particularly for people with comorbid physical health conditions. This study is unique in that it aims to examine the specific role of patient education as an intervention to increase engagement in depression treatment. By participating in the DEI, it is expected that patients will have time to understand treatment

Acupuncture treatment of a male patient suffering from long-term schizophrenia and sleep disorders

NARCIS (Netherlands)

Bosch, M.P.C.; Staudte, H.; Yeo, S.; Lee, S.H.; Lim, S.; Noort, M.W.M.L. van den

2017-01-01

Objective: To investigate the effectiveness of acupuncture in the treatment of chronic schizophrenia and co-morbid sleep disorders. Methods: A 42-year-old German male outpatient, suffering from long-term schizophrenia and sleep disorders, entered the study. Acupuncture was used as a

Antisperm antibodies as a factor of male infertility. Relevance, modern methods of diagnosis and treatment

Directory of Open Access Journals (Sweden)

O. A. Nikiforov

2017-08-01

Full Text Available According to WHO statistics 40 % of childless marriage is due to factors of male infertility. One of them is the presence of antisperm antibodies in the male organism, which may be in blood serum, on the surface of spermatozoids and seminal plasma. Aim. Оn the grounds of specialized literature analysis, to show the relevance of this problem in Reproductive Medicine, to descript Basic methods of Modern treatment and diagnosis of this pathology in the body of infertile males. The most common methods of antisperm antibodies identifying are: MAR-test sample Shuvarskiy–Sims–Hyuner, Kurtsrok–Miller test, the method of latex agglutination, solid-phase immunoenzymatic blood test. Indications for antisperm antibodies determining are: modified indices, deviations in post-coital test, a negative test of sperm and cervical mucus interaction in vitro, unexplained infertility in the married couples, failure or low indices during IVF (in vitro fertilization and of course, the exclusion of other causes of infertility. When antisperm antibodies are detected, the strategy of treatment may be destined to reduction of their titer for further pregnancy. Such types of therapy can be used: contraceptive (long-term use contraception barrier to reduce antisperm antibodies titer in women, plasmapheresis, artificial insemination with pretreated from antisperm antibodies husband's sperm, methods of assisted reproductive technologies. Conclusoins. The formation of antisperm antibodies leads to infertility of immunological genesis (in 20 % of couples with unexplained infertility. To confirm their presence in the male body it is necessary to perform the MAR-test, Shuvarsky test, other tests and, of course, the exclusion of other causes of infertility. Men of reproductive age with an immunological factor of infertility provides for a comprehensive treatment, including elimination of all possible causative and contributing factors of infertility (infection of the male

New surgical treatment options in patients with benign prostate hyperplasia (BPH)

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de Riese, Werner T. W.; Nelius, Thomas; Aronoff, David R.; Mittemeyer, Bernhard T.

2003-06-01

Benign prostatic hyperplasia (BPH) is a common disease in males older than 50 years of age. 75-80% of this population is considered to have some degree of BPH causing clinical symptoms and requiring urological treatment. Transurethral resection of the prostate (TUR-P) is currently the standard surgical treatment modality for BPH. In an attempt to minimize the need for hospitalization and the associated perioperative and postoperative morbidity, alternatives have been sought. Various types of Laser techniques such as interstitial Laser cogaulation and side-firing technology have been proposed. Numerous studies have shown that Laser procedures safely and effectively reduce the volume of the prostate. Intra- and postoperative bleeding are nearly unknown complications for Laser procedures, whereas this is the most relevant complication for the TUR-P. Due to significant tissue edema after Laser treatment, patients commonly show delayed time to void adequately, and therefore, catheter drainage is often necessary for 3 to 21 days. Retrograde ejaculation is reported to occur less (0 - 10%) compared to TUR-P (> 60%). Urinary tract infections are very common after interstitial laser coagulation. Although not many long-term clinical data are available, various studies have shown that BPH patients improve in symptom score, flow rate and post-void residual up to 3 years after Laser treatment. This paper presents a concise review of efficacy, advantages and disadvantages of the most frequently used Laser techniques as well as the long-term clinical data compared to TUR-P.

Treatment Option Overview (Unusual Cancers of Childhood)

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... cause both male and female children to develop masculine traits, such as body hair or a deep ... remove the tumor. Whether the child has developed masculine traits. These tumors can spread to the kidneys, ...

Berg River Textiles - Cleaner Production Option Report

DEFF Research Database (Denmark)

Wenzel, Henrik; Schneider, Zsig

schematics on the various wet treatment operations in the dyehouse, and water and energy balances were made to the extent data allowed. A number of options for saving water, energy and chemicals were identified. The potentials monetary savings and necessary investments were estimated, and a list of priority...... projects including milestone plans for their implementation was made. A saving potential of around 3 mill. R was identified with a pay-back period of around 0.2 years as average of the identified options. The company implemented a large number of the options right away....

Calcific tendinitis of the rotator cuff: management options.

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Suzuki, Kentaro; Potts, Aaron; Anakwenze, Oke; Singh, Anshu

2014-11-01

Calcific tendinitis of the rotator cuff tendons is a common cause of shoulder pain in adults and typically presents as activity-related shoulder pain. It is thought to be an active, cell-mediated process, although the exact pathophysiology remains unclear. Nonsurgical management continues to be the mainstay of treatment; most patients improve with modalities such as oral anti-inflammatory medication, physical therapy, and corticosteroid injections. Several options are available for patients who fail nonsurgical treatment, including extracorporeal shock wave therapy, ultrasound-guided needle lavage, and surgical débridement. These modalities alleviate pain by eliminating the calcific deposit, and several recent studies have demonstrated success with the use of these treatment options. Surgical management options include arthroscopic procedures to remove calcific deposits and subacromial decompression; however, the role of subacromial decompression and repair of rotator cuff defects created by removing these deposits remains controversial. Copyright 2014 by the American Academy of Orthopaedic Surgeons.

Cimetidine: A Safe Treatment Option for Cutaneous Warts in Pediatric Heart Transplant Recipients

Directory of Open Access Journals (Sweden)

Bibhuti B Das

2018-04-01

Full Text Available Background and Objectives: Immunosuppressed individuals are at particularly increased risk for human papilloma virus-related infections. The primary objective of our study is to determine if there are any adverse effects associated with high-dose cimetidine treatment. A secondary objective is to report our experience with cimetidine in the treatment of cutaneous warts in pediatric heart transplant recipients. Methods and Results: This was a retrospective observational study. A total of 8 pediatric heart transplant recipients diagnosed with multiple recalcitrant warts were the subject of the study. All patients were treated with cimetidine (30–40 mg/kg/day in two divided doses for 3 to 6 month durations. All patients had complete resolution of their lesions except 1 patient who had no clinical improvement. Of these 8 patients, one had recurrence of warts at one year follow-up, which resolved with restarting cimetidine therapy. One patient who had only 3 months of cimetidine therapy had immediate relapse after cimetidine was stopped. None of them had significant change in their tacrolimus trough, serum creatinine, and alanine transaminase levels. No adverse events were reported except one patient experienced mild gynecomastia. Conclusion: Cimetidine can be a safe and alternative treatment option for multiple warts in pediatric heart transplant recipients.

Excited delirium syndrome (ExDS): treatment options and considerations.

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Vilke, Gary M; Bozeman, William P; Dawes, Donald M; Demers, Gerard; Wilson, Michael P

2012-04-01

and initiate appropriate stabilizing treatment. ExDS patients will generally require transfer to an emergency department (ED) for further management, evaluation, and definitive care. In this paper, we present a typical ExDS case and then review existing literature for current treatment options. Copyright © 2011 Elsevier Ltd and Faculty of Forensic and Legal Medicine. All rights reserved.

Comparison of pregnancy rates in pre-treatment male infertility and low total motile sperm count at insemination.

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Xiao, Cheng Wei; Agbo, Chioma; Dahan, Michael H

2016-01-01

In intrauterine insemination (IUI), total motile sperm count (TMSC) is an important predictor of pregnancy. However, the clinical significance of a poor TMSC on the day of IUI in a patient with prior normal semen analysis (SA) is unclear. We performed this study to determine if these patients perform as poorly as those who had male factor infertility diagnosed prior to commencing treatment. 147 males with two abnormal SA based on the 2010 World Health Organization criteria underwent 356 IUI with controlled ovarian hyper-stimulation (COH). Their pregnancy rates were compared to 120 males who had abnormal TMSC at the time of 265 IUI with COH, in a retrospective university-based study. The two groups were comparable in female age (p = 0.11), duration of infertility (p = 0.17), previous pregnancies (p = 0.13), female basal serum FSH level (p = 0.54) and number of mature follicles on the day of ovulation trigger (p = 0.27). Despite better semen parameters on the day of IUI in the pre-treatment male factor infertility group (TMSC mean ± SD: 61 ± 30 million vs. 3.5 ± 2 million, p male factor infertility. More studies should be performed to confirm these findings.

Intracystic Papillary Carcinoma in the Male Breast: A Rare Endpoint of a Wide Spectrum

Directory of Open Access Journals (Sweden)

Ketan Vagholkar

2013-01-01

Full Text Available Introduction. Fibrocystic disease of the male breast is uncommon. The presence of a spectrum of changes ranging from fibrocystic disease to duct papilloma to papillary carcinoma in the same patient renders the case a rarity and therefore reportable. Case Report. A case of intracystic papillary carcinoma of the male breast is presented. Discussion. The pathological, clinical, diagnostic, and therapeutic options are discussed after reviewing the literature. Conclusion. Modified radical mastectomy with axillary clearance is the safest option for established cases.

Considering treatment of male genital schistosomiasis as a tool for future HIV prevention

DEFF Research Database (Denmark)

Stecher, Chalotte Willemann; Kallestrup, Per; Kjetland, Eyrun Floerecke

2015-01-01

OBJECTIVES: Male genital schistosomiasis (MGS) is a neglected manifestation of Schistosoma haematobium infection with ignored implications on reproductive health and a differential diagnosis to sexually transmitted infections in endemic regions. MGS may have associations with HIV transmission...... and acquisition, and treatment could be a neglected chance of HIV prevention. This review summarizes current knowledge on epidemiology, clinical manifestations, diagnosis and treatment of MGS as a hypothesized risk factor for HIV transmission. Future research areas of global interest are suggested. METHODS: Pub...... association between MGS and HIV are urgently needed. Furthermore, field diagnostic tools should be developed and future mass treatment programs should include adults to reduce morbidity and prevent HIV acquisition. SYSTEMATIC REVIEW REGISTRATION NUMBER: CRD42015016252....

Breaking the Mold: A Review of Mucormycosis and Current Pharmacological Treatment Options.

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Riley, Treavor T; Muzny, Christina A; Swiatlo, Edwin; Legendre, Davey P

2016-09-01

To review the current literature for the pathogenesis of mucormycosis, discuss diagnostic strategies, and evaluate the efficacy of polyenes, triazoles, and echinocandins as pharmacological treatment options. An electronic literature search was conducted in PubMed using the MESH terms Rhizopus, zygomycetes, zygomycosis, Mucorales and mucormycosis, with search terms amphotericin B, micafungin, anidulafungin, caspofungin, extended infusion amphotericin B, liposomal amphotericin B, combination therapy, triazole, posaconazole, isavuconazole, diagnosis, and clinical manifestations. Studies written in the English language from January 1960 to March 2016 were considered for this review article. All search results were reviewed, and the relevance of each article was determined by the authors independently. Mucormycosis is a rare invasive fungal infection with an exceedingly high mortality and few therapeutic options. It has a distinct predilection for invasion of endothelial cells in the vascular system, which is likely important in dissemination of disease from a primary focus of infection. Six distinct clinical syndromes can occur in susceptible hosts, including rhino-orbital-cerebral, pulmonary, gastrointestinal, cutaneous, widely disseminated, and miscellaneous infection. Diagnosis of mucormycosis is typically difficult to make based on imaging studies, sputum culture, bronchoalveolar lavage culture, or needle aspirate. Surgical debridement prior to dissemination of infection improves clinical outcomes. Surgery combined with early, high-dose systemic antifungal therapy yields greater than a 1.5-fold increase in survival rates. The Mucorales are inherently resistant to most widely used antifungal agents. Amphotericin B is appropriate for empirical therapy, whereas posaconazole and isavuconazole are best reserved for de-escalation, refractory cases, or patients intolerant to amphotericin B. © The Author(s) 2016.

[Outpatient treatment of selective mutism: long-standing selective mutism in a 17-year-old male].

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Herdener-Pinnekamp, Katharina; Gundelfinger, Ronnie; Steinhausen, Hans-Christoph

2010-01-01

The present case report describes the successful treatment of a 17 year old male adolescent suffering for 10 years from selective mutism. Following a summary review of recent publications on therapy approaches, the report describes the treatment concept in the present case, including detailed assessment of co-morbid disorders, motivation for change, behaviour therapy with supporting drug intervention, and intensive co-operation with parents and other caretakers.

Efficacy of non-surgical treatments for androgenetic alopecia: a systematic review and network meta-analysis.

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Gupta, Aditya K; Mays, Rachel R; Dotzert, Michelle S; Versteeg, Sarah G; Shear, Neil H; Piguet, Vincent

2018-05-24

Androgenetic alopecia, or male/female pattern baldness, is the most common type of progressive hair loss disorder. The aim of this paper is to review recent advances in non-surgical treatments for androgenetic alopecia and identify the most effective treatments. A network meta-analysis (NMA) was conducted of the available literature of the six most common non-surgical treatment options for treating androgenetic alopecia in both men and women; dutasteride 0.5mg, finasteride 1mg, low level laser therapy (LLLT), minoxidil 2%, minoxidil 5% and platelet rich plasma (PRP). Seventy-eight studies met the inclusion criteria and twenty-two studies had the data necessary for a network meta-analysis. Relative effects show LLLT as the superior treatment. Relative effects show PRP, finasteride 1 mg (male), finasteride 1 mg (female), minoxidil 5%, minoxidil 2% and dutasteride (male) are approximately equivalent in mean change hair count following treatment. Minoxidil 5% and minoxidil 2% reported the most drug-related adverse events (n=45 and n=23, respectively). The quality of evidence of minoxidil 2% vs. minoxidil 5% was high; minoxidil 5% vs. placebo was moderate; dutasteride (male) vs. placebo, finasteride (female) vs placebo, minoxidil 2% vs. placebo, minoxidil 5% vs. LLLT was low and finasteride (male) vs. placebo, LLLT vs. sham, PRP vs. placebo, finasteride vs. minoxidil 2% was very low. Results of this NMA indicate the emergence of novel, non-hormonal therapies as effective treatments for hair loss; however, the quality of evidence is generally low. High quality randomized controlled trials and head to head trials are required to support these findings and aid in the development of more standardized protocols, particularly for PRP. Regardless, this analysis may aid physicians in clinical decision making and highlight the variety of non-surgical hair restoration options for patients. This article is protected by copyright. All rights reserved. This article is protected by

Patterns of drug treatment entry by Latino male injection drug users from different national/geographical backgrounds.

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Reynoso-Vallejo, Humberto; Chassler, Deborah; Witas, Julie; Lundgren, Lena M

2008-02-01

This study examined patterns of treatment entry by Puerto Rican, Central American, Dominican, and other Latino male injection drug users (IDUs) in the state of Massachusetts over the time period 1996-2002. Specifically, it explored whether these populations had different patterns relative to three paths: entry into detoxification only, entry into residential treatment, or entry into methadone maintenance. Using a state-level MIS dataset on all substance abuse treatment entries to all licensed treatment programs, bi-variate and logistic regression methods were employed to examine patterns of drug treatment utilization among Latino men residing in Massachusetts. Three logistic regression models, which controlled for age, education, homelessness, employment, history of mental health treatment, health insurance, criminal justice involvement, having injected drugs in the past month, and number of treatment entries, indicated that Puerto Rican men were significantly less likely to only use detoxification services and residential treatment services, and significantly more likely to enter methadone maintenance compared to Latino men from Central American, Dominican, or other Latino backgrounds. For example, Central American men were 2.4 times more likely to enter only detoxification programs and 54% less likely to enter methadone maintenance programs than Puerto Rican male IDUs. For program planning, include the need to (a) develop varied drug treatment services to meet the needs of non-homogenous Latino groups within the population, (b) tailor outreach efforts to effectively reach all Latino groups, and (c) increase awareness among practitioners of differential patterns of treatment utilization.

Progressive Supranuclear Palsy and Corticobasal Degeneration: Pathophysiology and Treatment Options.

Science.gov (United States)

Lamb, Ruth; Rohrer, Jonathan D; Lees, Andrew J; Morris, Huw R

2016-09-01

There are currently no disease-modifying treatments for progressive supranuclear palsy (PSP) or corticobasal degeneration (CBD), and no approved pharmacological or therapeutic treatments that are effective in controlling their symptoms. The use of most pharmacological treatment options are based on experience in other disorders or from non-randomized historical controls, case series, or expert opinion. Levodopa may provide some improvement in symptoms of Parkinsonism (specifically bradykinesia and rigidity) in PSP and CBD; however, evidence is conflicting and where present, benefits are often negligible and short lived. In fact, "poor" response to levodopa forms part of the NINDS-SPSP criteria for the diagnosis of PSP and consensus criteria for the diagnosis of CBD (Lang Mov Disord. 20 Suppl 1:S83-91, 2005; Litvan et al. Neurology. 48:119-25, 1997; Armstrong et al. Neurology. 80(5):496-503, 2013). There is some evidence that intrasalivery gland botulinum toxin is useful in managing problematic sialorrhea and that intramuscular botulinum toxin and baclofen are helpful in reducing dystonia, including blepharospasm. Benzodiazepines may also be useful in managing dystonia. Myoclonus may be managed using levetiracetam and benzodiazepines. Pharmacological agents licensed for Alzheimer's disease (such as acetylcholinesterase inhibitors and N-Methyl-D-aspartate receptor antagonists) have been used off-label in PSP, CBD, and other tauopathies with the aim of improving cognition; however, there is limited evidence that they are effective and risk of adverse effects may outweigh benefits. The use of atypical antipsychotics for behavioural symptoms is not recommended in the elderly or those with demetia associated conditions and most antipsychotics will worsen Parkinsonism. Antidepressants may be useful for behavioral symptoms and depression but are often poorly tolerated due to adverse effects. In the absence of an effective drug treatment to target the underlying cause of

48 CFR 552.217-71 - Notice Regarding Option(s).

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2010-10-01

... 48 Federal Acquisition Regulations System 4 2010-10-01 2010-10-01 false Notice Regarding Option(s... Notice Regarding Option(s). As prescribed in 517.208(b), insert the following provision: Notice Regarding Option(s) (NOV 1992) The General Services Administration (GSA) has included an option to [Insert...

Fractional photothermolysis laser treatment of male pattern hair loss.

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Kim, Won-Serk; Lee, Hye In; Lee, Jin Woong; Lim, Yun Young; Lee, Seung Jae; Kim, Beom Joon; Kim, Myeung Nam; Song, Kye Yong; Park, Won Serk

2011-01-01

Various trials have been conducted on the management of male pattern hair loss (MPHL). A variety of laser and light sources have been used for the treatment of MPHL. To understand the effects of a 1,550-nm fractional erbium-glass laser on the hair cycle in an alopecia mouse model and to study the clinical effects of the same laser used as treatment for MPHL. Irradiation was applied to the shaved skin of C3H/HeN mice using various energy and density settings and varied irradiation intervals. In a clinical pilot study involving human subjects, 20 participants were treated over five sessions at 2-week intervals. A fractional photothermolysis laser was used at the energy of 5 mJ and a total density of 300 spots/cm(2). In the animal study, the hair stimulation effects were dependent upon the energy level, density, and irradiation interval. The anagen conversion of hair and the increase in Wnt 5a, β-catenin signals were observed. In the human pilot study, incremental improvements in hair density and growth rate were observed. This pilot study showed that a 1,550-nm fractional erbium-glass laser might induce hair growth, but more intensive studies are required to clarify the clinical applications of this treatment. © 2010 by the American Society for Dermatologic Surgery, Inc.

Male Fertility Issues

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Fertility issues are common in boys and men getting cancer treatment. Fertility preservation options include sperm banking, testicular shielding, testicular sperm extraction (TESE), and testicular tissue freezing. Support and clinical trials are listed.