Conventional and contemporary management approaches for the treatment of vestibular schwannomas: Microsurgery versus radiosurgery, a literature review

2004 ◽  
Vol 4 (1) ◽  
pp. 39-45
Author(s):  
K. Hickey
Keyword(s):  
Treatment Options ◽  
Cranial Nerves ◽  
Vestibular Schwannomas ◽  
Treatment Modalities ◽  
The Past ◽  
Close Proximity ◽  
Technical Advances ◽  
Management Approaches ◽  
Contemporary Management

The management of intracerebral tumours has always provided us with a challenge when deciding upon the best treatment approach. However, when such tumours are benign and located in close proximity to critical structures, tumour management becomes all the more challenging.The treatment of vestibular schwannomas has always posed such problems because of their anatomical proximity to critical structures such as the brainstem and several cranial nerves. Through a comprehensive literature appraisal, this article evaluates the problems associated with conventional treatment options and discusses how technical advances over the past decades have affected disease management and therefore impacted on the range and type of treatment modalities employed. In addition, it highlights the role of alternative contemporary approaches in the management of vestibular schwannomas.

Chemo- and Optogenetic Strategies for the Elucidation of Pain Pathways

2019 ◽  
pp. 816-832 ◽  
Author(s):  
Sascha R. A. Alles ◽  
Anne-Marie Malfait ◽  
Richard J. Miller
Keyword(s):  
Chronic Pain ◽  
Pain Response ◽  
Conscious Perception ◽  
Novel Therapies ◽  
The Past ◽  
Nociceptive Pathways ◽  
Pain Pathways ◽  
Technical Advances ◽  
The Brain

Pain is not a simple phenomenon and, beyond its conscious perception, involves circuitry that allows the brain to provide an affective context for nociception, which can influence mood and memory. In the past decade, neurobiological techniques have been developed that allow investigators to elucidate the importance of particular groups of neurons in different aspects of the pain response, something that may have important translational implications for the development of novel therapies. Chemo- and optogenetics represent two of the most important technical advances of recent times for gaining understanding of physiological circuitry underlying complex behaviors. The use of these techniques for teasing out the role of neurons and glia in nociceptive pathways is a rapidly growing area of research. The major findings of studies focused on understanding circuitry involved in different aspects of nociception and pain are highlighted in this article. In addition, attention is drawn to the possibility of modification of chemo- and optogenetic techniques for use as potential therapies for treatment of chronic pain disorders in human patients.

scholarly journals The Emerging Therapeutic Landscape of Advanced Melanoma

2018 ◽  
Vol 24 (5) ◽  
pp. 549-558 ◽  
Author(s):  
Vanessa Henriques ◽  
Teresa Martins ◽  
Wolfgang Link ◽  
Bibiana I. Ferreira
Keyword(s):  
Skin Cancer ◽  
Metastatic Melanoma ◽  
Treatment Options ◽  
Acquired Resistance ◽  
Treatment Modalities ◽  
Specific Therapy ◽  
Novel Treatments ◽  
The Past ◽  
Therapeutic Landscape ◽  
Paradigm Shifting

Melanoma is the deadliest form of skin cancer being responsible for 80% of skin cancer deaths. Furthermore, the incidence of metastatic melanoma has increased over the past three decades with a mortality rate that continues to rise faster than most of all other cancers. The last few years have witnessed an unparalleled change in treatment options for patients with metastatic melanoma by the development of new therapeutic strategies like targeted therapies and immunotherapies that highly improved the patient’s prognosis. Despite the paradigm- shifting success of these novel treatments, their effectiveness is still limited by intrinsic or acquired resistance. The objective of this review is to provide an overview of the new available treatment modalities, criteria to select patients who might benefit from a specific therapy, mechanisms of innate and acquired resistance to these treatments and to discuss strategies to overcome drug resistance.

Pharmacotherapy review: Emerging treatment modalities in transthyretin cardiac amyloidosis

2021 ◽  
Author(s):  
Emily Plumadore ◽  
Lindsay Lombardo ◽  
Katherine P Cabral
Keyword(s):  
Treatment Options ◽  
Disease State ◽  
Treatment Modalities ◽  
Limited Data ◽  
Limited Evidence ◽  
Agent Selection ◽  
Selection For ◽  
Tea Extract

Abstract Disclaimer In an effort to expedite the publication of articles , AJHP is posting manuscripts online as soon as possible after acceptance. Accepted manuscripts have been peer-reviewed and copyedited, but are posted online before technical formatting and author proofing. These manuscripts are not the final version of record and will be replaced with the final article (formatted per AJHP style and proofed by the authors) at a later time. Purpose This review aims to summarize the evidence and pharmacological characteristics of treatment options for transthyretin amyloid cardiomyopathy (ATTR-CM). Additionally, this review highlights the role of clinical pharmacists in helping to secure newly introduced therapies. Summary ATTR-CM, a disease characterized by misfolded protein that is deposited in the myocardium and disrupts cardiac functioning, has historically been underdiagnosed due to the need for invasive biopsy and an illusion of rarity. Once diagnosed, limited treatment modalities for ATTR-CM have led providers to rely on nonpharmacological remedies or off-label use of medications with limited evidence of benefit. However, recent noninvasive diagnostic advancements and heightened disease state awareness have revealed increased prevalence of ATTR-CM. This has led to the introduction of several first-in-class pharmaceuticals with actions targeted at inhibiting the various phases of amyloidosis: TTR stabilizers include diflunisal and first-in-class, Food and Drug Administration (FDA)-approved tafamidis; TTR silencers include patisiran and inotersen; fibril disrupters include doxycycline with tauroursodeoxycholic acid; and alternative agents include green tea extract and curcumin. Conclusion ATTR-CM treatments have emerged and, despite current limited data, are continuing to evolve. Tafamidis, the only agent approved by FDA for ATTR-CM, shows promise to improve survival and quality of life in patients with ATTR-CM. Pharmacists can play a key role in assisting with agent selection for this disease state, as well as providing knowledge about current and future clinical trials evaluating the safety and efficacy of the available treatment modalities.

scholarly journals Endovascular Intervention for Acute Ischemic Stroke in Light of Recent Trials

2014 ◽  
Vol 2014 ◽  
pp. 1-7 ◽  
Author(s):  
Kenan Alkhalili ◽  
Nohra Chalouhi ◽  
Stavropoula Tjoumakaris ◽  
David Hasan ◽  
Robert M. Starke ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Endovascular Treatment ◽  
Acute Ischemic Stroke ◽  
Treatment Strategies ◽  
Endovascular Intervention ◽  
Treatment Modalities ◽  
Efficacy And Safety ◽  
The Past ◽  
Endovascular Approach

Three recently published trials, MR RESCUE, IMS III, and SYNTHESIS Expansion, evaluating the efficacy and safety of endovascular treatment of acute ischemic stroke have generated concerns about the future of endovascular approach. However, the tremendous evolution that imaging and endovascular treatment modalities have undergone over the past several years has raised doubts about the validity of these trials. In this paper, we review the role of endovascular treatment strategies in acute ischemic stroke and discuss the limitations and shortcomings that prevent generalization of the findings of recent trials. We also provide our experience in endovascular treatment of acute ischemic stroke.

scholarly journals A Primer on AmpC β-Lactamases: Necessary Knowledge for an Increasingly Multidrug-resistant World

2019 ◽  
Vol 69 (8) ◽  
pp. 1446-1455 ◽  
Author(s):  
Pranita D Tamma ◽  
Yohei Doi ◽  
Robert A Bonomo ◽  
J Kristie Johnson ◽  
Patricia J Simner ◽  
...  
Keyword(s):  
Observational Studies ◽  
Treatment Options ◽  
Enterobacter Cloacae ◽  
Multidrug Resistant ◽  
Effective Management ◽  
Mechanisms Of Resistance ◽  
Management Approaches ◽  
Species Specific ◽  
Third Generation Cephalosporins

Abstract Understanding the nuances of AmpC β-lactamase–mediated resistance can be challenging, even for the infectious diseases specialist. AmpC resistance can be classified into 3 categories: (1) inducible chromosomal resistance that emerges in the setting of a β-lactam compound, (2) stable derepression due to mutations in ampC regulatory genes, or (3) the presence of plasmid-mediated ampC genes. This review will mainly focus on inducible AmpC resistance in Enterobacteriaceae. Although several observational studies have explored optimal treatment for AmpC producers, few provide reliable insights into effective management approaches. Heterogeneity within the data and inherent selection bias make inferences on effective β-lactam choices problematic. Most experts agree it is prudent to avoid expanded-spectrum (ie, third-generation) cephalosporins for the treatment of organisms posing the greatest risk of ampC induction, which has best been described in the context of Enterobacter cloacae infections. The role of other broad-spectrum β-lactams and the likelihood of ampC induction by other Enterobacteriaceae are less clear. We will review the mechanisms of resistance and triggers resulting in AmpC expression, the species-specific epidemiology of AmpC production, approaches to the detection of AmpC production, and treatment options for AmpC-producing infections.

Cabozantinib plus immunotherapy combinations in metastatic renal cell and urothelial carcinoma

2021 ◽  
pp. 00-00
Author(s):  
Luis Meza ◽  
Jasnoor Malhotra ◽  
Crystal Favorito ◽  
Sumanta K Pal
Keyword(s):  
Urothelial Carcinoma ◽  
Renal Cell ◽  
Progressive Disease ◽  
Treatment Options ◽  
Future Directions ◽  
The Past ◽  
Metastatic Urothelial Carcinoma ◽  
Novel Approaches

Treatment options for metastatic renal cell carcinoma (mRCC) and metastatic urothelial carcinoma (mUC) have increased dramatically over the past decade. However, even when novel approaches have proven to be effective as monotherapy, many patients still develop progressive disease, and different strategies are needed to increase clinical response and quality of life. Strategies combining targeted therapy (TT) and immunotherapy (IO) have emerged as a way to shorten the gap between responders and nonresponders to monotherapy and have reported promising results. In this review, we discuss the current role of cabozantinib in combination with IO agents in the treatment of metastatic RCC and UC and go over future directions in the field.

The Management of Corneal Neovascularisation – Update on New Clinical Data and Recommendations of Treatment

2016 ◽  
Vol 10 (02) ◽  
pp. 86 ◽  
Author(s):  
Natasha Spiteri ◽  
Vito Romano ◽  
Matthias Brunner ◽  
Bernhard Steger ◽  
Stephen B Kaye ◽  
...  
Keyword(s):  
Gene Therapy ◽  
Risk Factor ◽  
Clinical Data ◽  
Treatment Options ◽  
Experimental Treatment ◽  
Treatment Modalities ◽  
The Past ◽  
Recent Advances ◽  
The Future ◽  
Subsequent Failure

Vascularisation of the cornea may occur as a sight-threatening response to various insults to the cornea, such as infection, trauma and inflammation, and is a well-recognised risk factor for rejection and subsequent failure of corneal grafts. Various different treatment modalities have been used in the past, with varying levels of success. In this review, we discuss the pathogenesis of corneal neovascularisation, look at recent advances in the assessment of these patients and give an overview of currently available treatment options, both medical and surgical. We also discuss current experimental treatment for corneal neovascularisation, such as gene therapy, which may provide further treatment options in the future.

Refractory angina

ESC CardioMed ◽  
2018 ◽  
pp. 1414-1419
Author(s):  
Alessia Azzano ◽  
Stefan Verheye
Keyword(s):  
Coronary Revascularization ◽  
Treatment Options ◽  
Interdisciplinary Approach ◽  
Refractory Angina ◽  
Chronic Total Occlusions ◽  
Risk Factor Modification ◽  
Shockwave Therapy ◽  
Percutaneous Coronary ◽  
Management Approaches ◽  
Contemporary Management

A growing number of patients who are no longer candidates for surgical or percutaneous coronary revascularization, continue to experience persistent and invalidating angina despite optimal medical therapy. Despite the advances in medical and invasive therapies for the treatment of ischaemic heart disease, the management of patients with refractory angina remains a clinical challenge. Since mortality in this patient population has decreased, the treatment of refractory angina should therefore be focused on improving quality of life. Myocardial ischaemia is traditionally treated with risk factor modification and antianginal medications, as well as percutaneous or surgical revascularization, increasing coronary blood flow, blood oxygen-carrying capacity, and decreasing oxygen consumption. Based on new therapeutic principles, such as metabolic modulation, oxygen sparing, and coronary flow redistribution, emerging treatment options have emerged. They include novel medical agents (ivabradine, nicorandil, ranolazine, or trimetazidine) and novel interventional techniques (percutaneous coronary intervention for chronic total occlusions, and the narrowing of the coronary sinus), therapeutic angiogenesis through gene or cell therapy, shockwave therapy, and neuromodulation. The contemporary management of refractory angina might be individualized, patient-centred, and arise from an interdisciplinary approach (including psychological and self-management approaches).

Management of congenital subglottic hemangioma: Trends and success over the past 17 years

2005 ◽  
Vol 132 (2) ◽  
pp. 226-231 ◽  
Author(s):  
Mohamed A. Bitar ◽  
Roger V. Moukarbel ◽  
George H. Zalzal
Keyword(s):  
Carbon Dioxide ◽  
Side Effects ◽  
Success Rate ◽  
Study Design ◽  
Complication Rate ◽  
Carbon Dioxide Laser ◽  
Treatment Options ◽  
Surgical Excision ◽  
Treatment Modalities ◽  
The Past

OBJECTIVE: To evaluate the success and complications of various treatment options of congenital subglottic hemangioma. STUDY DESIGN AND SETTINGS: Reported cases were grouped by treatment modalities and corresponding outcome evaluated. RESULTS: From 1986 through 2002, 372 patients were reported in 28 series. Carbon dioxide laser had 88.9% success rate yet 5.5 % significant subglottic stenosis. It shortened the tracheotomy duration by 13.7 months. Corticosteroids were not that beneficial (useful in only 24.5%) with 12.9% side effects. Intralesional corticosteroids were successful in 86.4% with 5.6% complication rate. Surgical excision (as young as 2.5 months), was useful in 98% with 10% complication rate, using cartilage grafts in 34%. Other modalities were less popular. CONCLUSION: Treatment should be individualized. Guidelines are suggested. Priority is given to secure the airways. The CO2 laser is useful when used cautiously. Steroids may be beneficial. Excision is for stubborn cases.

scholarly journals Myasthenia Gravis: A Review

2012 ◽  
Vol 2012 ◽  
pp. 1-10 ◽  
Author(s):  
Annapurni Jayam Trouth ◽  
Alok Dabi ◽  
Noha Solieman ◽  
Mohankumar Kurukumbi ◽  
Janaki Kalyanam
Keyword(s):  
Myasthenia Gravis ◽  
Treatment Modalities ◽  
Initial Symptom ◽  
Significant Progress ◽  
The Past ◽  
The Us ◽  
Circulating Antibodies ◽  
New Treatment ◽  
Made In

Acquired myasthenia gravis is a relatively uncommon disorder, with prevalence rates that have increased to about 20 per 100,000 in the US population. This autoimmune disease is characterized by muscle weakness that fluctuates, worsening with exertion, and improving with rest. In about two-thirds of the patients, the involvement of extrinsic ocular muscle presents as the initial symptom, usually progressing to involve other bulbar muscles and limb musculature, resulting in generalized myasthenia gravis. Although the cause of the disorder is unknown, the role of circulating antibodies directed against the nicotinic acetylcholine receptor in its pathogenesis is well established. As this disorder is highly treatable, prompt recognition is crucial. During the past decade, significant progress has been made in our understanding of the disease, leading to new treatment modalities and a significant reduction in morbidity and mortality.

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