Initial therapy and when to transfer at non-pci centres

2020 ◽  
pp. 75-77
Author(s):  
Thomas Alexander
Keyword(s):  
Initial Therapy

Germ cell tumors in the basal ganglia: problems of early diagnosis and treatment

2008 ◽  
Vol 2 (2) ◽  
pp. 118-124 ◽  
Author(s):  
Yukihiko Sonoda ◽  
Toshihiro Kumabe ◽  
Shin-Ichiro Sugiyama ◽  
Masayuki Kanamori ◽  
Yoji Yamashita ◽  
...  
Keyword(s):  
Basal Ganglia ◽  
Early Diagnosis ◽  
Germ Cell ◽  
Precocious Puberty ◽  
Germ Cell Tumors ◽  
Young Patients ◽  
Early Recurrence ◽  
Initial Therapy ◽  
Motor Weakness ◽  
Delay In Diagnosis

Object Intracranial germ cell tumors (GCTs) originating in the basal ganglia are rare. The authors investigated factors related to the diagnosis of these lesions as well as outcome in order to help decrease the time to diagnosis and improve treatment efficacy. Methods The authors reviewed the clinical features of 142 cases of intracranial GCT in their institute. Fourteen cases of basal ganglia GCT were identified. The symptoms, neuroimaging findings, delay between symptom onset and diagnosis or treatment, initial and further treatment, and outcome were investigated. Results Major symptoms were motor weakness and precocious puberty. Gadolinium-enhanced T1-weighted MR images showed enhancement in 8 of 11 patients examined, but only slight hyperintensity without enhancement in 2 patients. Ipsilateral peduncle and hemispheric atrophy were found in 3 and 4 patients, respectively. Cases of basal ganglia GCT were characterized by a longer delay from the initial neuroimaging examination to diagnosis compared with GCT in other regions. Five patients had aggravated hemiparesis in the extremities due to the delay in diagnosis. Despite good response to the initial therapy, 5 patients experienced recurrence; 2 of these 5 had malignant GCTs, and 3 had been treated only with chemotherapy or radiochemotherapy with insufficient radiation dose and field. Finally, the 2 patients with malignant GCTs died of the disease, and 1 died of aspiration pneumonia due to dissemination around the brainstem. Conclusions Early diagnosis requires MR imaging with administration of contrast medium in young patients presenting with motor weakness and/or precocious puberty. Serial neuroimaging studies should be performed if any tiny lesion is detected in the basal ganglia. Since insufficient treatment resulted in early recurrence, radiation therapy with adequate dose and field is essential.

A Comparative clinical evaluation of Sirodhara with Sukhosnajala, Tila Tailam and Brahmi Tailam in the management of mild to moderate essential hypertension

2018 ◽  
Vol 3 (3) ◽  
Author(s):  
Bhargavi M ◽  
Shilpa PN ◽  
K. Chaithanya
Keyword(s):  
Essential Hypertension ◽  
Clinical Evaluation ◽  
Lifestyle Modification ◽  
Medical Science ◽  
Initial Therapy ◽  
Joint National Committee ◽  
Moderate Essential Hypertension ◽  
National Committee ◽  
Antihypertensive Medications ◽  
Causative Factors

In worldwide 25% of population is suffering with Hypertension. As it is an instrumental disease, asymptomatic in nature, it was named as Silent killer. The causative factors of Essential hypertension were Genetic predisposition and environmental factors but these factors are triggered by stress hence it comes under stress related psycho-somatic disorder. In Hypertensive patients, Decrease in 5mm of Hg in SBP and DBP results in decrease in cardiovascular risk, stroke which decreases mortality rate worldwide. The management aspect of modern medical science remains symptomatic with troublesome side effects. The Joint National Committee (JNC 8) guideline advise higher blood pressure goals, less use of several types of antihypertensive medications and suggests lifestyle modification and relaxation are the best initial therapy. In Ayurveda, Shirodhara is one of the panchakarma therapy meant for relaxation and stress reducing procedure mentioned in Dharakalpaas a preventive and curative treatment for many stress related disorders. So, Present study is planned as “A Comparative clinical evaluation of Shirodhara with Sukhos̩n̩ajala, Tila tailam and Brahmitailamin the management of mild to moderate essential hypertension”was selected. This paper is going to describe about conclusion drawn from the study i.e. effect of three types of dhara on Objective parameters SBP, DBP, PP, and MAP.

Cost of Initial Therapy in the Electrophysiological Study Versus ECG Monitoring Trial (ESVEM)

Circulation ◽  
1995 ◽  
Vol 91 (4) ◽  
pp. 1070-1076 ◽  
Author(s):  
Nowamagbe A. Omoigui ◽  
Frank I. Marcus ◽  
Jay W. Mason ◽  
Elizabeth A. Hahn ◽  
Vernon L. Hartz ◽  
...  
Keyword(s):  
Electrophysiological Study ◽  
Initial Therapy ◽  
Ecg Monitoring

Optimizing Outcomes in Multiple Sclerosis – A Consensus Initiative

2009 ◽  
Vol 15 (2_suppl) ◽  
pp. 5-35 ◽  
Author(s):  
P Coyle ◽  
B Arnason ◽  
B Hurwitz ◽  
F Lublin
Keyword(s):  
Disease Progression ◽  
Online Survey ◽  
Initial Therapy ◽  
Clinically Isolated Syndrome ◽  
Optimal Management ◽  
Disease Course ◽  
Response Relationship ◽  
Dose Response Relationship ◽  
Key Issues ◽  
Delay Progression

Background Initiation of immunomodulators in patients experiencing a clinically isolated syndrome (CIS) may delay progression to clinically definite MS. However, lack of consensus remains on many issues affecting optimal management of MS. Method A panel of 21 MS experts met during 9 meetings to explore key issues in MS and CIS. Meetings addressed 3 phases: 1. CIS definition and diagnosis; 2. initial therapy; and 3. monitoring disease progression and treatment efficacy. Newsletters covering each phase were sent to 5000 U.S.-based neurologists who were invited to participate in an online survey on key issues. Results Most panel members agreed that early treatment may minimize neurodegeneration and most would recommend it for patients; that a dose-response relationship exists for beta-interferon therapy; that more aggressive therapy was most effective early in the disease course; and, that MRI has a role in monitoring disease progression. In face of suboptimal response, most would switch patients to a different therapy; while combination therapy would be reserved for those failing monotherapy regimes. Most online survey respondents agreed with these positions. Conclusions There was uniform consensus from this panel of MS experts that early initiation of immunomodulator therapy was beneficial for CIS patients.

scholarly journals Canadian Melanoma Conference Recommendations on High-Risk Melanoma Surveillance: A Report from the 14th Annual Canadian Melanoma Conference; Banff, Alberta; 20–22 February 2020

2021 ◽  
Vol 28 (3) ◽  
pp. 2040-2051
Author(s):  
Christina W. Lee ◽  
J. Gregory McKinnon ◽  
Noelle Davis
Keyword(s):  
High Risk ◽  
Brain Magnetic Resonance Imaging ◽  
Initial Therapy ◽  
Expert Opinions ◽  
High Risk Melanoma ◽  
Novel Approach ◽  
Positron Emission ◽  
Risk Melanoma ◽  
National Expert ◽  
Melanoma Surveillance

Introduction: There are a lack of established guidelines for the surveillance of high-risk cutaneous melanoma patients following initial therapy. We describe a novel approach to the development of a national expert recommendation statement on high-risk melanoma surveillance (HRS). Methods: A consensus-based, live, online voting process was undertaken at the 13th and 14th annual Canadian Melanoma Conferences (CMC) to collect expert opinions relating to “who, what, where, and when” HRS should be conducted. Initial opinions were gathered via audience participation software and used as the basis for a second iterative questionnaire distributed online to attendees from the 13th CMC and to identified melanoma specialists from across Canada. A third questionnaire was disseminated in a similar fashion to conduct a final vote on HRS that could be implemented. Results: The majority of respondents from the first two iterative surveys agreed on stages IIB to IV as high risk. Surveillance should be conducted by an appropriate specialist, irrespective of association to a cancer centre. Frequency and modality of surveillance favoured biannual visits and Positron Emission Tomography Computed Tomography (PET/CT) with brain magnetic resonance imaging (MRI) among the systemic imaging modalities available. No consensus was initially reached regarding the frequency of systemic imaging and ultrasound of nodal basins (US). The third iterative survey resolved major areas of disagreement. A 5-year surveillance schedule was voted on with 92% of conference members in agreement. Conclusion: This final recommendation was established following 92% overall agreement among the 2020 CMC attendees.

scholarly journals FRI0032 REGIONAL AND WIDESPREAD PATTERNS OF NON-ARTICULAR PAIN ARE COMMON AT RA DIAGNOSIS AND CONTRIBUTE TO POOR OUTCOMES AT 12 MONTHS: A PROSPECTIVE STUDY OF PAIN PATTERNS IN CANADIANS WITH RA

2020 ◽  
Vol 79 (Suppl 1) ◽  
pp. 589-590
Author(s):  
V. Bykerk ◽  
O. Schieir ◽  
M. F. Valois ◽  
L. Bessette ◽  
G. Boire ◽  
...  
Keyword(s):  
Initial Therapy ◽  
Multinomial Regression ◽  
Research Support ◽  
Clinical Nurse ◽  
Early Ra ◽  
Nurse Consultant ◽  
Patient Reported ◽  
Poor Outcomes ◽  
A Prospective Study ◽  
Articular Pain

Background:Persistent pain can occur in early RA patients, despite improvement in synovitis and may be due to coexisting non-articular pain (NAP). Though NAP is often attributed to fibromyalgia and widespread NAP, regional NAP syndromes may be more common and under-recognized.Objectives:To describe patterns of NAP, predictors of persistent NAP and impact on outcomes in the first year following early RA diagnosis.Methods:Data were from participants enrolled in the Canadian Early Arthritis Cohort (CATCH) between2017-2019who completed 0,6,12-month evaluations with patient-reported outcomes [PROs] and clinical data available. We used the McGill Body Pain Diagram (BPD) to classify patients as experiencing no NAP, regional (RP:1-2 regions) or widespread NAP (WP:3-5 regions). Multinomial regression was used to identify baseline predictors of persistent RP and WP at 12-months. Multi-adjusted GEE with linear and logit links were used to estimate time-varying associations of NAP patterns with outcomes updated at each time point.Results:Study included 421 participants: 66% were female, with a mean(sd) age 56 (14); 72% were seropositive and 90% were treated with MTX ± csDMARDs as initial therapy. NAP at baseline was common (55%), with majority (62%) reporting regional NAP. NAP prevalence was 33% at 12 months (Figure). Female sex and baseline depressive symptoms were independent predictors of widespread NAP at 12 months while poorer function and lack of early MTX treatment independently predicted regional NAP, at 12 mos. Regional and widespread NAP were associated with lower likelihood of remission in adjusted models that accounted for changes in NAP and remission over time (Table).Figure.Point prevalence of regional and widespread NAP at baseline, 6 and 12 months.Table .Results of Multi-Adjusted GEE Logistic Regression showing Regional and Widespread NAP is associated with a reduced likelihood of achieving Stringent Remission TargetsConclusion:NAP is commonly reported in early RA pts seen in real world settings. Regional NAP was more common than WSP at all time-points, but both NAP patterns were associated lower odds of achieving remission targets by 12 months. These data support considering the role of NAP when assessing RA treatment efficacy during clinical visits and warrant different treatment approaches to reduce symptoms in RA patients receiving target-based care.Disclosure of Interests:Vivian Bykerk: None declared, Orit Schieir: None declared, Marie-France Valois: None declared, Louis Bessette Grant/research support from: AbbVie, Amgen, Bristol-Myers Squibb, Celgene, Eli Lilly, Janssen, Merck, Novartis, Pfizer, Roche, Sanofi, UCB Pharma, Consultant of: AbbVie, Amgen, Bristol-Myers Squibb, Celgene, Eli Lilly, Janssen, Merck, Novartis, Pfizer, Roche, Sanofi, UCB Pharma, Speakers bureau: AbbVie, Amgen, Bristol-Myers Squibb, Celgene, Eli Lilly, Janssen, Merck, Novartis, Pfizer, Sanofi, Gilles Boire Grant/research support from: Merck Canada (Registry of biologices, Improvement of comorbidity surveillance)Amgen Canada (CATCH, clinical nurse)Abbvie (CATCH, clinical nurse)Pfizer (CATCH, Registry of biologics, Clinical nurse)Hoffman-LaRoche (CATCH)UCB Canada (CATCH, Clinical nurse)BMS (CATCH, Clinical nurse, Observational Study Protocol IM101664. SEROPOSITIVITY IN A LARGE CANADIAN OBSERVATIONAL COHORT)Janssen (CATCH)Celgene (Clinical nurse)Eli Lilly (Registry of biologics, Clinical nurse), Consultant of: Eli Lilly, Janssen, Novartis, Pfizer, Speakers bureau: Merck, BMS, Pfizer, Glen Hazlewood: None declared, Carol Hitchon Grant/research support from: UCB Canada; Pfizer Canada, Edward Keystone Grant/research support from: AbbVie, Amgen, Bristol-Myers Squibb, F. Hoffmann-La Roche Inc, Gilead, Janssen Inc, Lilly Pharmaceuticals, Pfizer Pharmaceuticals, Sanofi-Aventis, Consultant of: AbbVie, Amgen, AstraZeneca Pharma, Biotest, Bristol-Myers Squibb Company, Celltrion,Crescendo Bioscience, F. Hoffmann-La Roche Inc, Genentech Inc, Gilead, Janssen Inc, LillyPharmaceuticals, Merck, Pfizer Pharmaceuticals, Sandoz, UCB., Speakers bureau: Amgen, AbbVie, Bristol-Myers Squibb Canada, F. Hoffmann-La Roche Inc., Janssen Inc., Merck, Pfizer Pharmaceuticals, Sanofi Genzyme, UCB, Diane Tin: None declared, Carter Thorne Consultant of: Abbvie, Centocor, Janssen, Lilly, Medexus/Medac, Pfizer, Speakers bureau: Medexus/Medac, Janet Pope Grant/research support from: AbbVie, Bristol-Myers Squibb, Eli Lilly & Company, Merck, Roche, Seattle Genetics, UCB, Consultant of: AbbVie, Actelion, Amgen, Bayer, Boehringer Ingelheim, Bristol-Myers Squibb, Eicos Sciences, Eli Lilly & Company, Emerald, Gilead Sciences, Inc., Janssen, Merck, Novartis, Pfizer, Roche, Sandoz, Sanofi, UCB, Speakers bureau: UCB, Susan J. Bartlett Consultant of: Pfizer, UCB, Lilly, Novartis, Merck, Janssen, Abbvie, Speakers bureau: Pfizer, UCB, Lilly, Novartis, Merck, Janssen, Abbvie

Outcomes of surgical and/or medical treatment in patients with prolactinomas during long-term follow-up: a retrospective single-centre study

2020 ◽  
Vol 0 (0) ◽  
Author(s):  
Gamze Akkus ◽  
Barış Karagun ◽  
Hilal Nur Yaldız ◽  
Mehtap Evran ◽  
Murat Sert ◽  
...  
Keyword(s):  
Medical Treatment ◽  
Tumour Size ◽  
Optic Chiasm ◽  
Initial Therapy ◽  
Post Treatment ◽  
Surgical Removal ◽  
Average Dose ◽  
Single Centre Study ◽  
Pre Treatment

AbstractObjectivesProlactinoma is the most common cause of pituitary tumours. Current medical guidelines recommend dopamine agonists (cabergoline or bromocriptine) as the initial therapy for prolactinoma. However, surgical removal can also be considered in selected cases, such as patients with macroadenomas with local complications (bleeding or optic chiasm pressure) or those not responding to medical treatment.MethodsThe present retrospective study included patients with prolactinomas (n=43; female, 24; male, 19) who were primarily managed with medical (n=32) or surgical (n=11) treatment.ResultsMacroadenoma (n=29.67%) was commonly detected in both genders (female, 54%; male, 84%). Moreover, the mean pre-treatment prolactin levels were similar in both genders (female, 683.3 ± 1347 ng/mL; male, 685.4 ± 805 ng/mL; p=0.226). Surgically treated patients had a greater reduction in tumour size (27.7 ± 17.9 mm pre-treatment vs. 8.72 ± 14.2 mm post-treatment) than non-surgically treated ones (12.5 ± 7.5 mm pre-treatment vs. 4.1 ± 4.2 mm post-treatment; p=0.00). However, the decrease in prolactin levels was similar between the two patient groups (p=0.108). During the follow-up period (10.6 ± 7.0 years), the average cabergoline dose of the patients was 1.42 ± 1.47 mcg/week.ConclusionsAlthough a surgical approach was considered for selected cases of prolactinoma, the average dose used for medical treatment was highly inadequate for the patients in the present study.

scholarly journals RADT-23. IMPACT OF REIRRADIATION UTILIZING STEREOTACTIC RADIOSURGERY ON RECURRENT GLIOBLASTOMA

2020 ◽  
Vol 22 (Supplement_2) ◽  
pp. ii186-ii186
Author(s):  
O’Dell Patrick ◽  
H Nickols ◽  
R LaRocca ◽  
K Sinicrope ◽  
D Sun ◽  
...  
Keyword(s):  
Stereotactic Radiosurgery ◽  
Median Survival ◽  
High Performance ◽  
Performance Status ◽  
Treatment Options ◽  
Methylation Status ◽  
Initial Therapy ◽  
Recurrent Glioblastoma ◽  
Control Group ◽  
The Impact

Abstract BACKGROUND Patients who have recurrent glioblastoma have limited treatment options. We conducted a retrospective review of patients with recurrent glioblastoma treated with standard initial radiation and temozolomide with tumor treating fields to investigate whether reirradiation using radiosurgery would be associated with improved outcomes. METHODS We reviewed the records of 54 consecutively treated patients with recurrent glioblastoma with ECOG 0 or 1 at recurrence and conducted Kaplan-Meier analysis with Log-rank testing to determine significance between groups. RESULTS We identified 24 patients who were treated without radiation therapy (control) while 30 patients underwent re-irradiation using radiosurgery (ReSRS) with a median total dose of 25Gy in five fractions. All patients had completed standard initial therapy, and there was no difference in the time to recurrence between the two groups (10 months for control, 15 months for ReSRS, [P = 0.17, HR for progression 0.65 (95% CI 0.38-1.13)]. A larger proportion of patients in the control arm (54%) had subtotal or gross total resection of the recurrence compared with the ReSRS group (44%, P < 0.05). The majority of patients had recurrence confirmed with biopsy (18/22 in control group, 25/31 in the ReSRS group). MGMT methylation status did not differ between control vs ReSRS (29% vs. 27%). ReSRS was associated with improved median survival from the time of first recurrence of 11.6 months versus 3.8 months in the control arm [P< 0.0001, HR for death 0.33 (95% CI 0.18-0.6)]. CONCLUSIONS In a group of patients with high performance status diagnosed with recurrent glioblastoma, reirradiation with stereotactic radiosurgery was associated with nearly one year median survival after recurrence. Additional analyses are warranted to determine the impact of concurrent systemic therapies with irradiation and underlying tumor or patient factors to predict outcomes.

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