3. Making illnesses better

2018 ◽  
pp. 53-67
Author(s):  
James Yeates
Keyword(s):  
Side Effects ◽  
X Rays ◽  
Veterinary Science ◽  
Multiple Treatments

An obvious part of veterinary science is about making animals better when they are ill, injured, or disabled. ‘Making illnesses better’ explains the processes involved in identifying what is wrong with an animal: initial observations and discussions with the owner and further tests, such as X-rays, ultrasound, and biological and chemical investigations. Veterinary treatments tend to belong to four broad methods: drugs, surgery, advice to change how patients are cared for, and euthanasia to prevent suffering where other treatments are not sufficiently likely to be beneficial. Multiple treatments are often combined in the care for each patient. However, treatments can often come with risks of unintended side-effects.

Anatomoradiological Landmarks for Accuracy of Radiofrequency Thermorhizotomy in the Treatment of Trigeminal Neuralgia

2008 ◽  
Vol 63 (suppl_1) ◽  
pp. ONS129-ONS138 ◽  
Author(s):  
Mehmet Tatli ◽  
Marc Sindou
Keyword(s):  
Side Effects ◽  
Trigeminal Neuralgia ◽  
Trigeminal Nerve ◽  
Study Groups ◽  
X Rays ◽  
Preoperative Pain ◽  
Paired Samples ◽  
Percutaneous Procedures ◽  
Trigeminal Root ◽  
Mean Differences

Abstract Objective: The correct positioning of the electrode is of prime importance for effectiveness and selectivity of percutaneous trigeminal radiofrequency thermorhizotomy (RF-TR) for the treatment of trigeminal neuralgia (TN). The aim of our study was to establish some anatomoradiological landmarks for the purpose of accurate placement of the electrode tip in RF-TR. Methods: Of 1000 patients who underwent RF-TR, 100 were retrospective and randomly selected and divided into study groups according to postoperative hypoesthesia in the trigeminal nerve divisions. The patients’ petroclival angle, petroelectrodal angle, electrode tip, and the petroelectrodal angle/petroclival angle ratio were calculated on lateral cranial x-rays. These measurements were then correlated with the topography of hypoesthesia obtained by the RF-TR to define the anatomoradiological x-ray landmarks corresponding to the divisions of the trigeminal root. The postoperative hypoesthesia groups were correlated with their respective preoperative pain topography to check the accuracy of the thermolesion. In addition, the intraoperatively evoked paresthesia responses and the side effects were evaluated. The results were analyzed using a paired-samples Student's ttest, the χ2 test, and one-way analysis of variance, followed by Bonferroni and Tamhane post hoc tests. Results: All study groups were comparable with respect to age, sex, side effects, electrode tip location, side of TN, and values of petroclival angle. The lowest values of petroelectrodal angle/orbitomeatal electrodal angle and petroelectrodal angle/ petroclival angle were detected in patients with V3 TN, whereas the greatest values were in patients who had TN in all branches of the trigeminal nerve. The greatest height of the electrode was in patients who had TN in all branches, whereas the least height was in patients with V3TN. When the results were compared with each other, the mean differences were found to be statistically significant between V3 TN patients and the other groups with different Pvalues. There was no statistical difference between the postoperative hypoesthesia data and the preoperative pain topography, which demonstrated evidence of the accuracy of the thermolesion in our series. Conclusion: Our data suggest that the determination of the presented landmarks allows customization to individual patient anatomy and may help the surgeon achieve a more selective effect with a variety of percutaneous procedures for each branch of the trigeminal root.

scholarly journals P153 IBD patients’ treatment preferences are heterogeneous, but largely affected by the avoidance of abdominal pain and side effects (P-POWER IBD study)

2021 ◽  
Vol 15 (Supplement_1) ◽  
pp. S232-S233
Author(s):  
E Louis ◽  
C A Siegel ◽  
B James ◽  
S Heidenreich ◽  
N Krucien ◽  
...  
Keyword(s):  
Abdominal Pain ◽  
Side Effects ◽  
Multinomial Logit Model ◽  
Preference Heterogeneity ◽  
Treatment Preferences ◽  
Cross Sectional Survey ◽  
Attribute Importance ◽  
Cross Sectional ◽  
Serious Infections ◽  
Multiple Treatments

Abstract Background Multiple treatments are approved for inflammatory bowel disease (IBD), each offering unique attribute profiles. Therapeutic targets historically included clinical and endoscopic outcomes, but updated guidelines1 also include absence of disability and restoration of quality of life (QoL). Optimising QoL requires understanding patient priorities and considering their preferences in treatment selection. This patient preference study (P-POWER IBD) quantified the tradeoffs patients would make between treatment attributes. Methods Adults with self-confirmed Crohn’s disease (CD) or ulcerative colitis (UC) who were receiving IBD treatment took part in an online cross-sectional survey. In a discrete choice experiment (DCE), patients were asked to choose between hypothetical treatments described by six attributes: administration, risk of mild or moderate side effects, risk of serious infections, and impact on abdominal pain, bowel urgency and fatigue. Attributes were selected based on foundational qualitative research and literature review.2 Qualitative and quantitative pilots were used to pre-test the DCE. Relative Attribute Importance (RAI) scores and maximum acceptable risk (MAR) of mild-to-moderate side effects were estimated from a mixed multinomial logit model. Results A total of 400 patients (CD: 54%; UC: 46%; female: 38%; mean age: 41 years [range: 18–78]) were recruited. All attributes significantly affected treatment preferences with preference heterogeneity observed (Figure 1). While all attributes were important, their relative importance differed (Figure 2). Avoiding abdominal pain was most important (RAI 33%) followed by the risk of mild or moderate side effects (RAI 27%), risk of serious infections (RAI 16%), treatment administration (RAI 10%), fatigue (RAI 9%), and bowel urgency (RAI 6%). CD patients placed greater importance on abdominal pain (p<0.05) than UC patients and UC patients greater importance on bowel urgency than CD patients (p<0.05). MAR indicated the increased risks of side effects patients would accept to improve other attributes (Figure 3). Notably, to reduce abdominal pain from severe to moderate, patients would accept an additional 19% risk of mild or moderate side effects and 31% if the pain was reduced to mild. Conclusion Patients with IBD had strong preferences that varied greatly and were willing and able to make tradeoffs between various important treatment attributes, in particular abdominal pain. Individual preferences should be considered in clinical practice as they may impact long-term targets and QoL. References

Radiotherapy and Its Impact on the Nervous System of Cancer Survivors

2020 ◽  
Vol 19 (5) ◽  
pp. 374-385
Author(s):  
Gautam Kumar ◽  
Priyadarshini Dutta ◽  
Vipan K. Parihar ◽  
Mallikarjuna R. Chamallamudi ◽  
Nitesh Kumar
Keyword(s):  
Side Effects ◽  
Neurological Complications ◽  
X Rays ◽  
Memory Processing ◽  
Different Types ◽  
Minimal Damage ◽  
Radioactive Seeds ◽  
Underlying Mechanisms ◽  
Late Side ◽  
Cessation Of Treatment

Radiotherapy is routinely used for the treatment of nearly all brain tumors, but it may lead to progressive and debilitating impairments of cognitive function. The growing evidence supports the fact that radiation exposure to CNS disrupts diverse cognitive functions including learning, memory, processing speed, attention and executive functions. The present review highlights the types of radiotherapy and the possible mechanisms of cognitive deficits and neurotoxicity following radiotherapy. The review summarizes the articles from Scopus, PubMed, and Web of science search engines. Radiation therapy uses high-powered x-rays, particles, or radioactive seeds to kill cancer cells, with minimal damage to healthy cells. While radiotherapy has yielded relative success in the treatment of cancer, patients are often plagued with unwanted and even debilitating side effects from the treatment, which can lead to dose reduction or even cessation of treatment. Little is known about the underlying mechanisms responsible for the development of these behavioral toxicities; however, neuroinflammation is widely considered as one of the major mechanisms responsible for radiotherapy-induced toxicities. The present study reviews the different types of radiotherapy available for the treatment of various types of cancers and their associated neurological complications. It also summarizes the doses of radiations used in the variety of radiotherapy, and their early and delayed side effects. Special emphasis is given to the effects of various types of radiations or late side effects on cognitive impairments.

Successful Treatment of Plantar Warts with Very Diluted Bleomycin Using a Translesional Multipuncture Technique: Pilot Prospective Study

2012 ◽  
Vol 16 (4) ◽  
pp. 250-256 ◽  
Author(s):  
Khalid M. Alghamdi ◽  
Huma Khurram
Keyword(s):  
Side Effects ◽  
Injection Technique ◽  
Complete Clearance ◽  
Low Concentration ◽  
The Mean ◽  
High Concentrations ◽  
Multiple Treatments ◽  
Plantar Warts

Background: Plantar warts are common and often painful. Treatment of plantar warts is difficult and requires multiple treatments. Several clinical trials have proven the efficacy of bleomycin, but relatively high concentrations have been required and considerable side effects have been experienced. Objective: To evaluate the efficacy and safety of low-concentration (0.1 U/mL) bleomycin using a translesional injection technique for the treatment of plantar warts. Methods: The study included 23 patients with single or multiple plantar warts. Very low-concentration bleomycin was injected into a single wart or the largest plantar wart in the case of multiple lesions. Injections were performed at 4-week intervals until resolution of the warts or development of side effects. The translesional multipuncture technique was used. Results: Thirteen patients were male (56.5%), and the mean age was 27.7 years. The results revealed complete clearance of warts in 17 of 23 (74%) patients, partial response in 1 (4.3%) patient, and no response in 3 (13%) patients. Recurrence was observed in 2 patients at 3 months of follow-up. Among those two, one patient showed complete clearance after the second injection at 6 months of follow-up. All patients were followed for 6 months after the initial treatment. No significant long-term adverse effects were noted. Only three patients (13%) had localized moderate pain for 2 to 3 days after the injection. Conclusion: Translesional injection by very low-concentration (0.1 U/mL) bleomycin appears to be a simple, effective, and safe treatment modality for plantar warts.

Intraoperative Radiotherapy (Iort) for Breast Cancer Using the Intrabeam™ System

2005 ◽  
Vol 91 (4) ◽  
pp. 339-345 ◽  
Author(s):  
Uta Kraus-Tiefenbacher ◽  
Antonella Scheda ◽  
Volker Steil ◽  
Brigitte Hermann ◽  
Tanja Kehrer ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Side Effects ◽  
Local Recurrence ◽  
Cancer Patients ◽  
Tumor Resection ◽  
Intraoperative Radiotherapy ◽  
X Rays ◽  
Breast Cancer Patients ◽  
Tumor Bed ◽  
Acute Side Effects

Introduction Intraoperative radiotherapy (IORT) with low-energy X-rays (30–50 KV) is an innovative technique that can be used both for accelerated partial breast irradiation (APBI) and intraoperative boosting in patients affected by breast cancer. Immediately after tumor resection the tumor bed can be treated with low-distance X-rays by a single high dose. Whereas often a geographic miss in covering the boost target occurs with external beam boost radiotherapy (EBRT), the purpose of IORT is to cover the tumor bed safely. This report will focus on the feasibility and technical aspects of the Intrabeam™ device and will summarize our experience with side effects and local control. Materials and methods Between February 2002 and June 2003 57 breast cancer patients, all eligible for breast conserving surgery (BCS), were treated at the Mannheim Medical Center with IORT using the mobile X-ray system Intrabeam™. The patient population in this feasibility study was not homogeneous consisting of 49 patients with primary stage I or II breast cancer, seven with local recurrence after previous EBRT and one with a second primary in a previously irradiated breast. The selection criteria for referral for IORT included tumor size, tumor cavity size, margin status and absence of an extensive intraductal component. The previously irradiated patients with local recurrences and 16 others received IORT as single modality. In all other cases IORT was followed by EBRT with a total dose of 46 Gy in 2-Gy fractions. The intraoperatively delivered dose after tumor resection was 20 Gy prescribed to the applicator surface. EBRT was delivered with a standard two-tangential-field technique using linear accelerators with 6- or 18-MV photons. Patients were assessed every three months by their radiation oncologist or surgeon during the first year after treatment and every six months thereafter. Breast ultrasound for follow-up was done every six months and mammographies once yearly. Acute side effects were scored according to the CTC/EORTC score and late side effects according to the Lent-Soma classification. Results Twenty-four patients received IORT only; eight patients because they had received previous radiotherapy, 16 because of a very favorable risk profile or their own preference. Thirty-three patients with tumor sizes between 1 and 30 mm and no risk factors were treated by IORT as a boost followed by EBRT. The Intrabeam™ system was used for IORT. The Intrabeam source produces 30–50 KV X-rays and the prescribed dose is delivered in an isotropic dose distribution around spherical applicators. Treatment time ranged between 20 and 48 minutes. No severe acute side effects or complications were observed during the first postoperative days or after 12 months. One local recurrence occurred 10 months after surgery plus IORT followed by EBRT. In two patients distant metastases were diagnosed shortly after BCS. Discussion IORT with the Intrabeam system is a feasible method to deliver a single high radiation dose to breast cancer patients. As a preliminary boost it has the advantage of reducing the EBRT course by 1.5 weeks, and as APBI it might be a promising tool for patients with a low risk of recurrence. The treatment is well tolerated and does not cause greater damage than the expected late reaction in normal tissue.

scholarly journals Topical Application of Phlorotannins from Brown Seaweed Mitigates Radiation Dermatitis in a Mouse Model

Marine Drugs ◽  
2020 ◽  
Vol 18 (8) ◽  
pp. 377
Author(s):  
Kyungmi Yang ◽  
Shin-Yeong Kim ◽  
Ji-Hye Park ◽  
Won-Gyun Ahn ◽  
Sang Hoon Jung ◽  
...  
Keyword(s):  
Side Effects ◽  
Mouse Model ◽  
Brown Seaweed ◽  
Vehicle Control ◽  
Radiation Dermatitis ◽  
Heme Oxygenase 1 ◽  
Related Factor ◽  
Nuclear Factor ◽  
X Rays ◽  
Radiation Induced

Radiation dermatitis (RD) is one of the most common side effects of radiotherapy; its symptoms progress from erythema to dry and moist desquamation, leading to the deterioration of the patients’ quality of life. Active metabolites in brown seaweed, including phlorotannins (PTNs), show anti-inflammatory activities; however, their medical use is limited. Here, we investigated the effects of PTNs in a mouse model of RD in vivo. X-rays (36 Gy) were delivered in three fractions to the hind legs of BALB/c mice. Macroscopic RD scoring revealed that PTNs significantly mitigated RD compared with the vehicle control. Histopathological analyses of skin tissues revealed that PTNs decreased epidermal and dermal thickness compared with the vehicle control. Western blotting indicated that PTNs augmented nuclear factor erythroid 2-related factor 2 (NRF2)/heme oxygenase-1 (HO-1) pathway activation but attenuated radiation-induced NF-κB (nuclear factor kappa-light-chain-enhancer of activated B cells) and inflammasome activation, suggesting the mitigation of acute inflammation in irradiated mouse skin. PTNs also facilitated fast recovery, as indicated by increased aquaporin 3 expression and decreased γH2AX (histone family member X) expression. Our results indicate that topical PTN application may alleviate RD symptoms by suppressing oxidative stress and inflammatory signaling and by promoting the healing process. Therefore, PTNs may show great potential as cosmeceuticals for patients with cancer suffering from radiation-induced inflammatory side effects such as RD.

scholarly journals Comparative Efficacy of Prolactin inhibitors and PGF2 analogue in Bitches Affected with Cystic Endometrial Hyperplasia-Pyometra Complex

2018 ◽  
Vol 14 (1) ◽  
Author(s):  
Q. Mandhwani ◽  
A. Bhardwaz ◽  
R. Aich ◽  
M. Shivhare ◽  
S. Kumar ◽  
...  
Keyword(s):  
Side Effects ◽  
Biochemical Parameters ◽  
Endometrial Hyperplasia ◽  
Povidone Iodine ◽  
Treatment Approach ◽  
Animal Husbandry ◽  
Veterinary Science ◽  
Comparative Efficacy ◽  
Luminal Diameter ◽  
Blood Samples

The study was carried out at the Veterinary Clinical Complex, College of Veterinary Science and Animal Husbandry, Mhow and in private clinics across Indore on 30 bitches suffering from Cystic Endometrial Hyperplasia-Pyometra Complex (CEH-PC). The animals were randomly subdivided into five groups each of six bitches and treated with bromocriptine (1 g/kg POx5 days) and cabergoline (5 g/kg POx5 days) alone and in combination with cloprostenol (5 g/kg s/c on day 0, 2 and 6) (Gr II to V) together with enrofloxacin (10-20 mg/kg PO, SID×5 days) + combination of metronidazole and povidone-iodine IU (5-10 ml×3 days), the later served as routine control Gr I.The treatment response of animals was evaluated through clinical, ultrasonographical, haematological and biochemical parameters. Blood samples were collected from cephalic or saphenous vein just before treatment (day 0) and after treatment on day 6 and day 14. Treatment approach -III (cabergoline 5 g/kg POx5 days) was found to be the most effective without side effects with significant decrease in uterine luminal diameter after treatment. The results showed significant improvement in haemato-biochemical attributes in dogs affected with CEH-P complex following treatment IV and V, i.e. with use of bromocriptine and cabergoline in combination with cloprostenol as compared to other groups.

Side effects and scandals

2021 ◽  
pp. 80-107
Author(s):  
Harold Thimbleby
Keyword(s):  
Side Effects ◽  
X Rays ◽  
Medical Interventions ◽  
Digital Healthcare

We accept that medical interventions like drugs and X rays have side-effects. It makes a lot of sense to think of digital healthcare as having side-effects too, and therefore it should be evaluated and regulated as carefully.

scholarly journals Evaluation of Combination of Microneedling with Tacrolimus in the Treatment of Stable Vitiligo

2021 ◽  
Vol 79 (3) ◽  
pp. 227-231
Author(s):  
Saurabh Sharma ◽  
Parwaaz Matharoo ◽  
Roopam Bassi
Keyword(s):  
Side Effects ◽  
Adverse Effects ◽  
Head And Neck ◽  
Drug Absorption ◽  
Psychological Effects ◽  
Safety And Efficacy ◽  
Single Method ◽  
Total Body ◽  
Multiple Treatments

Introduction: Vitiligo is an amelanotic disorder that can manifest as localized patches to near total body depigmentation. It is considered a cosmetic disease but it is accompanied by extensive psychological effects. Multiple treatments have been tried until now but no single method has achieved the desired response. Tacrolimus is frequently used for vitiligo treatment with few adverse effects. Microneedling is a newer modality of therapeutic wounding that augments drug absorption. Combination of microneedling and tacrolimus have been tried to improve the repigmentation response in vitiligo. Our objective was to assess the safety and efficacy of this combined modality. Methods: Forty patients were subjected to combination of tacrolimus 0.1% ointment and microneedling at 2 week intervals for maximum 10 sessions with a follow-up period of 6 months. Assessment was based on grading of repigmentation and clinical improvement according to vitiligo noticeability scale. Results: Excellent repigmentation was observed in 30% cases. Improvement was significantly higher in lesions present on the head and neck. Mucosal vitiligo also showed good to excellent response. No severe side effects were reported. No complications or recurrences were observed during the follow-up period. Conclusion: Combination of microneedling and tacrolimus was found to be safe and efficacious in the treatment of stable vitiligo.

White-Light Coronal Structures: Streamers and CMEs

1994 ◽  
Vol 144 ◽  
pp. 82
Author(s):  
E. Hildner
Keyword(s):  
Emission Line ◽  
Electron Density ◽  
White Light ◽  
Coronal Mass Ejections ◽  
X Rays ◽  
Solar Cycles ◽  
Temperature Function ◽  
X Ray ◽  
Eclipse Observations ◽  
Coronal Structures

AbstractOver the last twenty years, orbiting coronagraphs have vastly increased the amount of observational material for the whitelight corona. Spanning almost two solar cycles, and augmented by ground-based K-coronameter, emission-line, and eclipse observations, these data allow us to assess,inter alia: the typical and atypical behavior of the corona; how the corona evolves on time scales from minutes to a decade; and (in some respects) the relation between photospheric, coronal, and interplanetary features. This talk will review recent results on these three topics. A remark or two will attempt to relate the whitelight corona between 1.5 and 6 R⊙to the corona seen at lower altitudes in soft X-rays (e.g., with Yohkoh). The whitelight emission depends only on integrated electron density independent of temperature, whereas the soft X-ray emission depends upon the integral of electron density squared times a temperature function. The properties of coronal mass ejections (CMEs) will be reviewed briefly and their relationships to other solar and interplanetary phenomena will be noted.

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