Pressurized IntraPeritoneal Aerosol Chemotherapy (PIPAC) in patients with peritoneal metastasized colorectal, appendiceal and small bowel cancer

2019 ◽  
Vol 106 (1) ◽  
pp. 70-78
Author(s):  
Ines Gockel ◽  
Boris Jansen-Winkeln ◽  
Linda Haase ◽  
Stefan Niebisch ◽  
Yusef Moulla ◽  
...  
Keyword(s):  
Small Bowel ◽  
Treatment Option ◽  
Palliative Therapy ◽  
Median Number ◽  
Intestinal Cancer ◽  
Effective Treatment Option ◽  
Palliative Intent ◽  
Peritoneal Carcinomatosis Index ◽  
Data Registry ◽  
Standard Laparoscopy

Background: Patients with intestinal cancer (colorectal, appendiceal, and small bowel) with peritoneal metastases (PM) have a poor prognosis. We assessed whether pressurized intraperitoneal aerosol chemotherapy (PIPAC) together with systemic chemotherapy is an effective treatment option for these entities in palliative intent. Methods: Between November 2015 and February 2018, prospective data registry was performed (NCT03100708). Thirteen patients with intestinal cancer (median age 61 years [range 49–77]) underwent 26 PIPAC procedures with a median number of 2 interventions per patient (range 1–6). A chemoaerosol consisting of cisplatin/doxorubicin was administered during standard laparoscopy. Results: The median peritoneal carcinomatosis index according to Sugarbaker before the first PIPAC was 14 (range 2–27), and the median ascites volume was 10 mL (range 0–6300 mL). Six patients who received 2 or more PIPAC procedures had decreased and stable ascites volumes, while only 1 patient displayed increased ascites. The median overall survival was 303 days (range 30–490) after the first PIPAC procedure. Conclusions: PIPAC offers a novel treatment option for patients with PM. Our data show that PIPAC is safe and well-tolerated. Ascites production can be controlled by PIPAC in patients with intestinal cancer. Further studies are required to document the significance of PIPAC within palliative therapy concepts. Trial registration: NCT03100708

Effective Remedy for Encapsulating Peritoneal Sclerosis with Ureteroileal Fistula

2017 ◽  
Vol 37 (6) ◽  
pp. 648-649
Author(s):  
Masataka Banshodani ◽  
Hideki Kawanishi ◽  
Sadanori Shintaku ◽  
Masahiro Yamashita ◽  
Misaki Moriishi ◽  
...  
Keyword(s):  
Peritoneal Dialysis ◽  
Small Bowel ◽  
Effective Treatment ◽  
Treatment Option ◽  
Surgical Intervention ◽  
Oral Intake ◽  
Intestinal Bypass ◽  
Effective Treatment Option ◽  
Effective Remedy ◽  
The Right

Encapsulating peritoneal sclerosis (EPS), treated with surgical enterolysis as a final option, may become refractory to surgical intervention due to intraperitoneal complications. We report the case of a 59-year-old man presenting with EPS who underwent enterolysis at the age of 50, following 15 years of peritoneal dialysis (PD) and peritonitis. During the patient's first surgery, complete surgical enterolysis could not be performed due to severe intestinal adhesions with a deteriorated/calcified small bowel. Six months after the surgery, the obstructive bowel symptoms occurred several times a year. Nine years later, the patient suffered cystitis-like symptoms and fecal discharge from the urinary meatus. The patient was subsequently diagnosed with EPS recurrence with ureteroileal fistula between the right ureter and ileum. During the second surgical intervention, we conducted a divided jejunostomy, as surgical enterolysis and fistulectomy were unachievable due to severe ileal adhesion with calcified capsule and inflammation. Thereafter, symptoms reduced dramatically and oral intake became possible. Three years following surgery, the patient's condition is improved, with no evidence of EPS recurrence or cystitis-like symptoms. Although EPS with ureteroileal fistula is extremely rare, we propose that jejunostomy may be an effective treatment option for patients with EPS refractory to surgical enterolysis or intestinal bypass due to intraperitoneal complications.

scholarly journals AB0533 COMBINATION OF METHOTREXATE AND LEFLUNOMIDE IS SAFE AND HAS GOOD DRUG RETENTION AMONG PATIENTS WITH PSORIATIC ARTHRITIS

2021 ◽  
Vol 80 (Suppl 1) ◽  
pp. 1298.1-1298
Author(s):  
M. Haroon ◽  
S. Batool ◽  
S. Asif ◽  
F. Hashmi ◽  
S. Ullah
Keyword(s):  
Psoriatic Arthritis ◽  
Combination Therapy ◽  
Treatment Option ◽  
Retention Time ◽  
Median Number ◽  
First Line ◽  
Effective Treatment Option ◽  
Drug Retention ◽  
Synthetic Dmards

Background:Among patients with psoriatic arthritis (PsA), there remains a considerable confusion regarding the effectiveness of conventional synthetic DMARDs (csDMARDs), especially methotrexate (MTX). The availability of biologic DMARDs and targeted synthetic DMARDs have revolutionised the management of psoriatic disease; however, it comes with a significant cost burden. We believe that combination of DMARDs, especially combining MTX and Leflunomide (LEF) provides a valuable low-cost treatment option for patients with PsA after failure of MTX monotherapy. Hence, in our practice, we are inclined to use combination of potent DMARDs after MTX failure, prior to considering biologic therapies. Little is known about the combination use of LEF and MTX in PsA, especially in the context of drug retention time and tolerability.Objectives:We aimed to review our PsA cohort data especially examining the drug retention of first-line csDMARD monotherapy and combination csDMARDs.Methods:In our centre, MTX is a preferred first line csDMARD, unless contraindicated, and patients are followed up with a protocol on 4-6 weekly basis unless complete remission is achieved. MTX if needed is escalated to the maximum tolerated dose (up to 25mg/week), and if PsA is still active then preferably LEF is added (usual starting dose for add-on therapy is 10mg a day and if needed escalated to 20mg a day, without any loading dose). Other csDMARDs, such as sulphasalazine are used, if needed. For this study, after written-informed consent, only those adult patients were included who had a follow up of at least 6 months with our rheumatology services, and were fulfilling CASPAR criteria. Moreover, only patients who were DMARD-naïve (no prior DMARD therapy for any cause, including psoriasis), and initiated DMARD as monotherapy after 1 April 2018 were included. If any patient had already been on any DMARDs prior to attending our rheumatology services was excluded.Results:A total of 81 PsA patients [mean age 45.6±6 years; 52% male; mean PsA disease duration=9±4 years; 35% with dactylitis, 42% with enthesitis, 17% with sacroiliitis, median current PASI=2.6, median number of swollen joints=8.0, median number of tender joints= 11.0] fulfilled the inclusion and exclusion criteria. As regards first-line csDMARD monotherapy, 88% (n=71) of patients were commenced on MTX. In total, 79% (n=56 out of 71) of patients who were started on MTX as their first-line csDMARD therapy failed this monotherapy during follow-up (51=ineffective, 5=intolerance). After a median follow-up of 22 months, MTX median drug retention among all MTX monotherapy users (n=71) was only 7 months (IQR 5-7); and among MTX failures (n=56), MTX monotherapy median drug retention was 6.0 months (IQR 4-8). Eighty percent (n=45 out of 56) of the MTX monotherapy failure cohort was started on combination therapy of MTX and LEF (combo MTX+LEF); among them, only 7 patients needed escalation of therapy to bDMARDs, and the rest are still using combo MTX+LEF. It was noted that to date median drug retention time of combo MTX+LEF has been 8 months (IQR 7-11), and 84% (n=38 out of 45) of these patients are still using this combo therapy. Significantly more patients managed to continue the combo MTX+LEF therapy compared to MTX monotherapy (84% vs. 21%, p<0.001)Conclusion:Among csDMARD naïve PsA patients, 79% of patients failed MTX monotherapy with median drug retention time of only 6 months. Combination of MTX and LEF was well tolerated and had good drug retention time, with 84% of patients having ongoing treatment to date. Our data provides initial evidence that MTX and LEF combination therapy could be an effective treatment option for PsADisclosure of Interests:Muhammad Haroon Speakers bureau: Roche, Novartis, Grant/research support from: Abbvie, Pfizer, Shabnam Batool: None declared., Sadia Asif: None declared., Farzana Hashmi: None declared., Saadat Ullah: None declared.

Rituximab In Combination with High-Dose Dexamethasone: An Effective Treatment Option for Patients with Relapsed/Refractory Chronic Lymphocytic Leukemia

Blood ◽  
2010 ◽  
Vol 116 (21) ◽  
pp. 4629-4629
Author(s):  
Michael Doubek ◽  
Martin Simkovic ◽  
Anna Panovska ◽  
Monika Hrudkova ◽  
David Belada ◽  
...  
Keyword(s):  
Effective Treatment ◽  
Treatment Option ◽  
Progression Free Survival ◽  
Median Number ◽  
Infectious Complications ◽  
Lymphocytic Leukemia ◽  
High Dose ◽  
Significant Activity ◽  
Effective Treatment Option ◽  
High Dose Dexamethasone

Abstract Abstract 4629 Background: Patients with refractory CLL have poor outcome despite currently used salvage treatment. Regimens based on high-dose corticosteroids seem to offer a promising treatment option in this scenario. High-dose methylprenisolone combined with rituximab (R-HDMP) demonstrated significant activity in relapsed/refractory CLL but serious infectious complications occurred in a substantial proportion of patients. Pilot data have shown that combination of dexamethasone and rituximab (R-Dex) may provide comparable results with less toxicity. Aims and Methods: We performed a retrospective analysis of the efficacy and safety of R-Dex in patients (pts) with CLL treated at two tertiary centers between April 2006 and February 2010. Patients received two versions of R-Dex regimen: the dose of rituximab was either 500 mg/m2 on day 1, 8, 15, 22 (375 mg/m2 in 1st cycle), repeated every 4 weeks (n=25) or 500 mg/m2 on day 1 (375 mg/m2 in 1st cycle) repeated every 3 weeks (n=16). The dose of dexamethasone was identical in both regimens: 320 mg per cycle (40 mg on day 1–4 and 10–13 or 15–18). Results: R-Dex was administered to 41 patients (19 males) with median age of 68 years (range, 44–81) indicated for treatment according to NCI-WG criteria. Autoimmune hemolytic anemia or thrombocytopenia was the only indication for the treatment in 7 patients. Rai stage III/IV was present in 37/41 pts. IgVH genes were unmutated in 24/29 pts with available results. Cytogenetic aberrations detected by FISH (n=33) revealed del 17p in 7 patients; del 11q in 11 patients; del 13q in 15 patients and trisomy 12 in 5 patients. Median number of previous therapies was 2 (0-8); 29/41 pts were previously treated with fludarabine-based regimens. The effect of R-Dex in evaluable patients without hemolysis (n=32) was: overall response rate (ORR), n= 21 (62%), complete remission (CR), n=6 (18%), partial remission (PR), n=15 (44%), stable disease (SD), n=4 (12%) and progressive disease (PD), n=5 (15%). All patients treated with R-Dex for autoimmune cytopenia achieved complete resolution of hemolysis. Grade III or IV toxicity included infections in 13 patients (32%), steroid diabetes in 6 patients (15%) and rituximab infusion-related side effects in 3 patients (7%). At the time of analysis (February 2010), median progression free survival (PFS) was 9 months; median overall survival has not been reached. There was no difference in ORR, PFS or OS between the two versions of R-Dex regimen. Conclusions: This pilot study shows that R-Dex is a feasible and effective treatment for relapsed/refractory CLL. In particular, R-Dex appears to be highly effective in CLL with autoimmune cytopenias. However, infectious toxicity remains a serious issue. In addition, long-term disease control can be expected in minority of patients only. Interestingly, higher dose of rituximab per cycle did not result in improved efficacy. Supported by research project MZO 00179906 from Ministry of Health, Czech Republic, by research grant MSM 0021620808 and by the Czech Leukemia Study Group for Life. Disclosures: Smolej: Roche: Honoraria; Bayer-Schering: Honoraria; Genzyme: Honoraria.

Vision Therapy’s Role in Basic Intermittent Exotropia: A Case Report

2020 ◽  
pp. 64-73
Keyword(s):  
Treatment Option ◽  
Intermittent Exotropia ◽  
Effective Treatment Option ◽  
Control Scale ◽  
Case Presentation ◽  
Therapy Program ◽  
Convergence Insufficiency ◽  
Hispanic Male ◽  
Vision Therapy ◽  
Accommodative Function

Introduction: Vision therapy has been shown to be a successful treatment option for basic intermittent exotropia as long as a complete workup is performed to assess prognosis and appropriate management. Case Presentation: A 9 year old hispanic male presented to the clinic for a comprehensive exam and was subsequently diagnosed with a basic type intermittent exotropia with a V-pattern deviation. After thorough evaluation of binocular skills and accommodative function with a binocular vision evaluation, he was referred for a vision therapy program to improve fusional ranges, accommodative function, and symptoms. This program consisted of 20 sessions and significantly improved his binocular skills. Discussion: Basic intermittent exotropia can be treated in various ways. Vision Therapy is a worthwhile option. Surgical correction and overminus treatment have also been effective treatments. Assessment should include the intermittent exotropia control scale and the convergence insufficiency symptom survey. Vision therapy treatments focus on diplopia awareness, antisuppression, and fusional vergence ranges. Conclusion: Though more research is necessary, vision therapy has been proven to be a very effective treatment option in basic intermittent exotropia.

scholarly journals COVID-19 convalescent plasma clears SARS-CoV-2 refractory to remdesivir in an infant with congenital heart disease

2020 ◽  
Vol 4 (18) ◽  
pp. 4278-4281 ◽  
Author(s):  
Zahidee Rodriguez ◽  
Andi L. Shane ◽  
Hans Verkerke ◽  
Christopher Lough ◽  
Matthew G. Zimmerman ◽  
...  
Keyword(s):  
Congenital Heart Disease ◽  
Heart Disease ◽  
Effective Treatment ◽  
Treatment Option ◽  
Congenital Heart ◽  
Effective Treatment Option ◽  
Immune Systems ◽  
Key Points ◽  
Donor Variability

Key Points COVID-19 convalescent plasma (CP) may be a safe and effective treatment option in SARS-CoV-2 infection refractory to remdesivir. Infants may benefit from CP despite developing immune systems and donor variability emphasizes the need for characterization prior to use.

scholarly journals Sialendoscopy With Intraductal Steroid Irrigation in Patients With Sialadenitis Without Sialoliths

2019 ◽  
Vol 98 (5) ◽  
pp. 291-294 ◽  
Author(s):  
Saudamini J. Lele ◽  
Mickie Hamiter ◽  
Torrey Louise Fourrier ◽  
Cherie-Ann Nathan
Keyword(s):  
Treatment Option ◽  
Case Series ◽  
Complete Response ◽  
Definitive Treatment ◽  
Invasive Technique ◽  
Effective Treatment Option ◽  
Patient Reported ◽  
History Of ◽  
The Mean

Sialendoscopy has emerged as a safe, effective and minimally invasive technique for management of obstructive and inflammatory salivary gland disease. The aim of our study was to analyze outcomes of sialendoscopy and steroid irrigation in patients with sialadenitis without sialoliths. We performed a retrospective analysis of patients who underwent interventional sialendoscopy with steroid irrigation from 2013 to 2016, for the treatment of sialadenitis without sialolithiasis. Twenty-two patients underwent interventional sialendoscopy with ductal dilation and steroid irrigation for the treatment of sialadenitis without any evidence of sialolithiasis. Conservative measures had failed in all. Eleven patients had symptoms arising from the parotid gland, 4 patients had symptoms arising from the submandibular gland, while 6 patients had symptoms in both parotid and submandibular glands. One patient complained of only xerostomia without glandular symptoms. The mean age of the study group which included 1 male and 21 females was 44.6 years (range: 3-86 years). Four patients had autoimmune disease, while 7 patients had a history of radioactive iodine therapy. No identifiable cause for sialadenitis was found in the remaining 11 patients. The mean follow-up period was 378.9 days (range: 16-1143 days). All patients underwent sialendoscopy with ductal dilation and steroid irrigation. Twelve patients showed a complete response and 9 patients had a partial response, while 1 patient reported no response. Only 3 patients required repeat sialendoscopy. The combination of sialendoscopy with ductal dilation and steroid irrigation is a safe and effective treatment option for patients with sialadenitis without sialoliths refractory to conservative measures. Prospective studies with a larger case series are needed to establish its role as a definitive treatment option.

scholarly journals Gentamicin susceptibility among a sample of multi-drug resistantNeisseria gonorrhoeaeisolates in India

2016 ◽  
pp. AAC.01907-16 ◽  
Author(s):  
Manju Bala ◽  
Vikram Singh ◽  
Aradhana Bhargava ◽  
Monika Kakran ◽  
Naveen Chandra Joshi ◽  
...  
Keyword(s):  
Effective Treatment ◽  
Treatment Outcomes ◽  
Treatment Option ◽  
Antimicrobial Susceptibility ◽  
Susceptibility Testing ◽  
Dual Therapy ◽  
Clinical Treatment ◽  
Antimicrobial Susceptibility Testing ◽  
Effective Treatment Option

Antimicrobial susceptibility testing of 258N. gonorrhoeaeisolates by Etest determined that 60.1% were MDR while 5% strains had decreased susceptibility to currently recommended extended-spectrum cephalosporins (ESCs). Among these, 84.5% MDR and 76.9% strains having decreased susceptibility to ESCs were susceptible to gentamicin. No MDR isolate was resistant to gentamicin. Thesein vitroresults suggest that gentamicin might be an effective treatment option for the MDR strains and in dual therapy for gonorrhea. However, further research regarding the clinical treatment outcomes is essential.

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