Chemotherapy of Brain Metastases from Lung Carcinoma: A Controlled Randomized Study

Neurosurgery ◽  
1991 ◽  
Vol 28 (2) ◽  
pp. 201-205 ◽  
Author(s):  
Yukitaka Ushio ◽  
Norio Arita ◽  
Toru Hayakawa ◽  
Heitaro Mogami ◽  
Hiroshi Hasegawa ◽  
...  
Keyword(s):  
Brain Metastasis ◽  
Brain Metastases ◽  
Lung Carcinoma ◽  
Tumor Regression ◽  
Randomized Study ◽  
Multidisciplinary Treatment ◽  
Group A ◽  
Radiotherapy Alone ◽  
The Difference ◽  
Group B

Abstract A controlled randomized study was carried out to evaluate the effects of chemotherapy in patients with brain metastases from lung carcinoma. One hundred patients were randomly divided into three groups at the time of diagnosis or after surgery for metastases. Group A received radiotherapy alone; Group B received radiotherapy and chloroethylnitrosoureas (methyl-CCNU, 100-120 mg/m2, or ACNU 80-100 mg/m2, every 6-8 weeks), and Group C received radiotherapy and a combination of chloroethylnitrosoureas and tegafur (300 mg/m2. daily). Of the 100 patients, 88 could be evaluated. The reduction rates of the tumors of the patients in whom tumor was not surgically removed or not totally removed were compared. Complete resolution of the tumor was noted in 29, 69, and 63% of the patients in Groups A, B, and C, respectively, Tumor regression of ⩾50% was seen in 36, 69. and 74% of the patients in Groups A, B, and C, respectively. The difference in the response rates of Groups A and C was statistically signficiant (P<0.05). Median survival after the start of treatment for brain metastasis was 27, 30.5, and 29 weeks in Groups A, B, and C, respectively. There was 1 long-term survivor (more than 5 years) in Group A, 3 in Group B, and 1 in Group C. The main cause of death was deterioration attributable to the primary lesion or systemic metastasis, and no statistical difference was noted in survival time among the groups. Our results indicate that combination chemotherapy with chloroethylnitrosoureas and tegafur has an additive effect on radiotherapy in reducing or eliminating brain metastases from lung carcinoma, and that brain metastasis is well controlled by multidisciplinary treatment including chemotherapy.

Efficacy and Safety of Oral Ivermectin and Topical Permethrin in the Treatment of Scabies

2020 ◽  
Vol 33 (1) ◽  
pp. 41-47
Author(s):  
Mohsena Akhter ◽  
Ishrat Bhuiyan ◽  
Zulfiqer Hossain Khan ◽  
Mahfuza Akhter ◽  
Gulam Kazem Ali Ahmad ◽  
...  
Keyword(s):  
Skin Diseases ◽  
Close Contact ◽  
Randomized Study ◽  
Sarcoptes Scabiei ◽  
Efficacy And Safety ◽  
Common Skin ◽  
Group A ◽  
The Mean ◽  
The Difference ◽  
Group B

Background: Scabies is one of the most common skin diseases in our country. It is caused by the mite Sarcoptes scabiei var hominis, which is an ecto-parasite infesting the epidermis. Scabies is highly contagious. Prevalence is high in congested or densely populated areas. Individuals with close contact with an affected person should be treated with scabicidal which is available in both oral and topical formulations. The only oral but highly effective scabicidal known to date is Ivermectin. Amongst topical preparations, Permethrin 5 % cream is the treatment of choice. Objective: To evaluate the efficacy & safety of oral Ivermectin compared to topical Permethrin in the treatment of scabies. Methodology: This prospective, non-randomized study was conducted at the out-patient department of Dermatology and Venereology of Shaheed Suhrawardy Medical College & Hospital over a period of 6 months, from August 2016 to January 2017. The study population consisted of one hundred patients having scabies, enrolled according to inclusion criteria. They were divided into two groups. group A was subjected to oral Ivermectin and the group B to Permethrin 5% cream. Patients were followed up on day 7 and 14 for assessment of efficacy and safety. Result: The mean scoring with SD in group A (Ivermectin) and group B (Permethrin) were 8.26 ± 2.22 and 7.59 ± 2.01 respectively at the time of observation. The difference between the mean score of the two group is not significant (p=0.117) the mean scoring with SD in group A and group B were 4.54 ± 2.05 and 1.64 ± 1.84 respectively at 7thdays. The difference between the mean score of the two group is significant (p<0.001). The mean scoring with SD in group A and group B were 2.68± 2.35 and .36± 1.10 respectively at 14th day difference between the mean score of the group is significant (p<0.001). Conclusion: Topical application of permethrin 5% cream is more effective and safer than oral Ivermectin in the treatment of scabies. TAJ 2020; 33(1): 41-47

The Role of Postoperative Radiotherapy after Resection of Single Brain Metastases

Neurosurgery ◽  
1989 ◽  
Vol 24 (6) ◽  
pp. 798-805 ◽  
Author(s):  
Lisa M. DeAngelis ◽  
Lynda R. Mandell ◽  
H. Tzvi Thaler ◽  
David W. Kimmel ◽  
Joseph H. Galicich ◽  
...  
Keyword(s):  
Brain Metastasis ◽  
Brain Metastases ◽  
Postoperative Radiotherapy ◽  
Systemic Disease ◽  
Whole Brain Radiotherapy ◽  
Complete Resection ◽  
Term Survival ◽  
Single Brain Metastasis ◽  
Group A ◽  
Group B

ABSTRACT To assess the value of whole brain radiotherapy (WBRT) after complete resection of a single brain metastasis we reviewed the records of 98 patients who had elective craniotomy between 1978 and 1985. Seventy-nine patients received postoperative WBRT (Group A) and 19 patients no radiotherapy (RT) (Group B). Neurological relapse was designated as local (i.e., at the site of the original metastasis) or distant (i.e., elsewhere in the brain). Postoperative WBRT significantly prolonged the time to any neurological relapse (P = 0.034) with a 1-year recurrence rate of 22% in Group A and 46% in Group B patients; however, it did not specifically control either local or distant cerebral recurrence. Recurrence of metastatic brain disease was not affected by location of the original lesion; however, meningeal relapse occurred in 38% of cerebellar lesions, but only in 4.7% of supratentorial metastases (P = 0.003). The total radiation dose or fractionation scheme of RT did not affect survival nor time to neurological relapse. The median survival was 20.6 and 14.4 months for Groups A and B, respectively (not statistically different). Forty-eight percent of Group A and 47% of Group B patients survived for 1 year or longer; however, 11% of patients who had received RT and survived 1 year developed severe radiation-induced dementia. All patients with radiation-related cerebral damage received hypo-fractionated RT with high daily fractions as commonly designed for rapid palliation of macroscopic brain metastases. Thus, postoperative WBRT may be an important adjunct to complete resection of a single brain metastasis, particularly in patients with limited or no systemic disease who have the potential for long-term survival or even cure, but it carries a substantial risk of late neurological toxicity when hypofractionated RT schedules are used. For these good-risk patients, postoperative WBRT should be administered by standard fractionation schemes of 180 to 200 cGy/day to a total of 4000 to 4500 cGy, or hyperfractionation, which provides even lower doses/fraction to minimize potential neurotoxicity while delivering a maximally efficacious total dose, should be considered.

Comparing 60 versus 120 shocks per minute for shock-wave lithotripsy of solitary renal calculi: A controlled randomized study

2020 ◽  
pp. 205141582094592
Author(s):  
Tamer A Ali ◽  
Mohamed A Abdelaal ◽  
Moamen M Amin ◽  
Mohamed K Saif-Elnasr
Keyword(s):  
Shock Wave ◽  
Shock Wave Lithotripsy ◽  
Randomized Study ◽  
Renal Stones ◽  
Renal Calculi ◽  
Successful Outcome ◽  
Significant Difference ◽  
Group A ◽  
The Difference ◽  
Group B

Objective: This study aimed to compare the difference in outcome of shock-wave lithotripsy (SWL) using a slow rate of 60 shocks per minute versus a rapid rate of 120 shocks per minute generated by an electromagnetic lithotripter for renal calculi. Methods: From May 2017 to June 2019, 156 patients ( Mage=38.7 years) with single radio-opaque renal stones smaller than 20 mm were included and randomly divided into two groups: group A, 78 patients who received 60 shocks per minute; and group B, 78 patients who received 120 shocks per minute. Patients were radiologically reviewed at 3 months for an outcome. Results: There was no statistically significant difference between mean stone area treated ( p=0.222) or additional analgesic use in the form of patient-controlled analgesia (PCA; alfentanil; p=0.82). A successful outcome was defined by fragments smaller than 4 mm or stone-free status. In group A, 60% of patients had a successful outcome compared with 61.4% in group B ( p=0.869) following a single treatment. Post-treatment complications were similar in both groups at 12% for group A and 10.7% for group B ( p=0.797). Conclusions: There was no statistically significant difference between the delivery of 60 and 120 shocks per minute during SWL for the treatment of solitary renal stones with a mean stone area of 62 mm2 regarding the outcome, complications or PCA use when using a Dornier Compact Delta II lithotripter.

scholarly journals Parsplana vitrectomy alone versus parsplana vitrectomy combined with phacoemulsification for the treatment of rhegmatogenous retinal detachment: a randomized study

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Paolo Mora ◽  
Stefania Favilla ◽  
Giacomo Calzetti ◽  
Giulia Berselli ◽  
Lucia Benatti ◽  
...  
Keyword(s):  
Retinal Detachment ◽  
Rhegmatogenous Retinal Detachment ◽  
Randomized Study ◽  
Retinal Breaks ◽  
Retinal Tears ◽  
Retinal Reattachment ◽  
Group A ◽  
The Difference ◽  
Group B

Abstract Background To compare parsplana vitrectomy (PPV) with and without phacoemulsification to treat rhegmatogenous retinal detachment (RRD). Methods Subjects aged 48–65 years with RRD in a phakic eye due to superior retinal tears with an overall extension of retinal breaks < 90° underwent to PPV alone (group A); or PPV plus phacoemulsification (phacovitrectomy, PCV, group B). Post-operative follow-up visits occurred at 1 week, 1 month (m1), 3 months (m3), and 6 months (m6) after surgery. The main outcome was the rate of retinal reattachment. Secondary outcomes included best-corrected visual acuity (BCVA), intraocular pressure (IOP), central macular thickness (CMT), and cataract progression (in the lens-sparing [PPV-alone] group). Results In this initial phase of the study a total of 59 patients (mean age: 55 years, 59 eyes) were enrolled: 29 eyes in group A and 30 eyes in group B. Both groups had similar gas tamponade. During the follow-up there were three cases of RRD recurrence in group A and one in group B. The relative risk of recurrence in group A was 3.22 times higher but the difference was not significant (p = 0.3). The two groups were also similar in terms of BCVA and IOP variation. At m3, CMT was significantly higher in group B (p = 0.014). In group A, cataract progression was significant at m6 (p = 0.003). Conclusions In a cohort of RRD patients selected according to their preoperative clinical characteristics, PPV was comparable to PCV in terms of the rate of retinal reattachment after 6 months. Trial registration ISRCTN15940019. Date registered: 15/01/2021 (retrospectively registered).

scholarly journals PS1 - 140 The Effect of Timing of Stereotactic Radiosurgery Treatment of Melanoma Brain Metastases Treated with Ipilimumab

2016 ◽  
Vol 43 (S4) ◽  
pp. S6-S7 ◽  
Author(s):  
O. Cohen-Inbar
Keyword(s):  
Brain Metastasis ◽  
Brain Metastases ◽  
Stereotactic Radiosurgery ◽  
Stage Iv ◽  
Perilesional Edema ◽  
Therapeutic Benefits ◽  
Clinical Responses ◽  
Group A ◽  
Pre Treatment ◽  
Group B

Melanoma represents the third most common cause of CNS metastases. Immunotherapy has evolved as a treatment option for patients with stage-IV melanoma. Stereotactic radiosurgery (SRS) also elicits an immune response within the brain and may interact with immunotherapy. We report a cohort of patients treated for brain metastasis with immunotherapy and evaluate the effect of SRS timing on the intracranial response. Methods: All consecutively treated melanoma patients receiving Ipilimumab and SRS for their brain metastasis were included in the retrospective analysis. 46 patients harboring 232 brain metastases were reviewed. The median clinical follow-up was 7.9 months (3-42.6). Median age was 63 years (24.3-83.6). 32 patients received SRS before or during ipilimumab cycles (Group-A) whereas 14 patients received SRS after the ipilimumab treatment (Group-B). Radiographic and clinical responses were assessed at approximately 3 months intervals after SRS. Results: The two cohorts were comparable in pertinent pre-treatment aspects with the exception of SRS timing relative to ipilimumab. Local recurrence free duration (LRFD) was significantly longer in Group-A patients (19.6 months, range 1.1-34.7 months) as compared to group-B patients (3 months, range 0.4-20.4 months), respectively (p=0.002). Post-SRS perilesional edema was more significant in Group-A. Conclusions: The effect of SRS and ipilimumab in attaining LRFD seems greater when SRS is performed before or during ipilimumab treatments. The timing of immunotherapy and SRS may effect LRFD and post-radiosurgical edema. The interactions between immunotherapy and SRS warrant further investigation so as to optimize the therapeutic benefits and mitigate the risks associated with multimodality, targeted therapy.

scholarly journals Comparison between stapler hemorrhoidectomy and open hemorrhoidectomy in the management of grade III and IV hemorrhoids: a prospective randomized study

2018 ◽  
Vol 5 (6) ◽  
pp. 2069
Author(s):  
Shailendra Pal Singh ◽  
Somendra Pal Singh ◽  
Vipin Gupta ◽  
Kutubuddin Quadri ◽  
Mohit Gupta
Keyword(s):  
Pain Score ◽  
Randomized Study ◽  
Lithotomy Position ◽  
Open Hemorrhoidectomy ◽  
Early Results ◽  
Group A ◽  
The Difference ◽  
Group B ◽  
Grade Iii

Background: Haemorrhoids are one of the most common anorectal disorders. Haemorrhoids or piles are dilated veins of the anal canal and are more common in obesity, constipation and pregnancy. Classically they occur in the 3, 7 and 11 o'clock position with the patient in lithotomy position. Symptoms of haemorrhoids are per rectal bleeding and prolapse. Bleeding is bright red in colour and which is painless. The aim of the study was to compare the early results in 60 patients randomly allocated to undergo either stapled or open hemorrhoidectomy.Methods: Out of 60 patients, 30 (50.0%) patients underwent hemorrhoidectomy by Open Milligan-Morgan’s method were classified as Group A while rest 30 (50.0%) patients underwent hemorroidectomy by Stapler method after anal stretching, these patients were classified as Group B.Results: Pain score of majority of patients of Group A was ≥7 (76.7%), only 6.7% had pain score <3 and rest 16.7% had pain score 3 to 6. On comparing the difference of pain in passage of first stool among patients of Group A and Group B statistically was found to be highly significant. Pain in follow up at 3, 7 and 15th day was also significantly higher in group A in comparison to group B.Conclusions: Of the 60 patients in the current study, 32 are still in the follow up with the maximum follow up period of 11 months. There was no case of recurrence of haemorrhoids in this study. The factor of cost was not evaluated in the study since the hospital stay as well as stapling instrument was totally free in U.P, UMS, Saifai.

scholarly journals Comparison of two insertion techniques for I-Gel placement in paediatric patients: standard vs rotational methods

2021 ◽  
Vol 8 (3) ◽  
pp. 373-376
Author(s):  
Rahul Yadav ◽  
Neeraj Kumar Tiwari ◽  
Milind Y Dharmamer ◽  
Sanil Mohan ◽  
Ajai Chandra ◽  
...  
Keyword(s):  
Success Rate ◽  
Randomized Study ◽  
Standard Technique ◽  
Paediatric Population ◽  
Insertion Time ◽  
Elective Surgical Procedures ◽  
Paediatric Patients ◽  
Group A ◽  
The Difference ◽  
Group B

: I-Gel has found increasing favour amongst anaesthesiologists for securing and maintaining a patent airway during routine as well as emergency surgeries in the paediatric population. The present prospective randomized study was conducted to compare the two techniques (standard and rotational methods) for I-Gel insertion in children; by assessing the first attempt success rate, insertion time and ease of insertion.: ASA I and II paediatric patients (1-6 years old) scheduled for brief elective surgical procedures lasting less than one hour were randomly allocated into two groups viz. Group A (n= 30) employing the standard technique, and Group B (n= 30) utilizing the rotational technique for I-Gel placement.: Group B subjects depicted a significantly higher first-attempt success rate vis a vis Group A subjects (P=0.040). The mean insertion time during the first attempt was longer in Group A (standard technique) as compared to Group B (rotational technique), but the difference was not statistically significant.: This study lends credence to the fact that the placement of I-Gel by employing the rotational method culminates in an increase in the first attempt success rate, suggestive of its potential superiority to the standard method

scholarly journals Parsplana Vitrectomy Alone Versus Parsplana Vitrectomy Combined With Phacoemulsification for The Treatment of Rhegmatogenous Retinal Detachment: A Randomized Study

2021 ◽  
Author(s):  
Paolo Mora ◽  
Stefania Favilla ◽  
Giacomo Calzetti ◽  
Giulia Berselli ◽  
Lucia Benatti ◽  
...  
Keyword(s):  
Retinal Detachment ◽  
Rhegmatogenous Retinal Detachment ◽  
Randomized Study ◽  
Retinal Breaks ◽  
Retinal Tears ◽  
Retinal Reattachment ◽  
Group A ◽  
The Difference ◽  
Group B

Abstract BACKGROUND: To compare parsplana vitrectomy (PPV) with and without phacoemulsification to treat rhegmatogenous retinal detachment (RRD).DESIGN: parallel, randomized trial.METHODS: subjects aged 48 - 65 years with RRD in a phakic eye due to superior retinal tears with an overall extension of retinal breaks < 90° underwent to PPV alone (group A); or PPV plus phacoemulsification (phacovitrectomy, PCV, group B). Post-operative follow-up visits occurred at 1 week, 1 month (m1), 3 months (m3), and 6 months (m6) after surgery. The main outcome was the rate of retinal reattachment. Secondary outcomes included best-corrected visual acuity (BCVA), intraocular pressure (IOP), central macular thickness (CMT), and cataract progression (in the lens-sparing [PPV-alone] group).RESULTS: in this initial phase of the study a total of 59 patients (mean age: 55 years, 59 eyes) were enrolled: 29 eyes in group A and 30 eyes in group B. Both groups had similar gas tamponade. During the follow-up there were three cases of RRD recurrence in group A and one in group B. The relative risk of recurrence in group A was 3.22 times higher but the difference was not significant (p = 0.3). The two groups were also similar in terms of BCVA and IOP variation. At m3, CMT was significantly higher in group B (p = 0.014). In group A, cataract progression was significant at m6 (p = 0.003).CONCLUSIONS: In a cohort of RRD patients selected according to their preoperative clinical characteristics, PPV was comparable to PCV in terms of the rate of retinal reattachment after 6 months.TRIAL REGISTRATION: ISRCTN15940019Date registered: 15/01/2021 (retrospectively registered)

scholarly journals A comparative study of the incidence of pain and infection in gall bladder extraction via umbilical and epigastric port

2017 ◽  
Vol 4 (2) ◽  
pp. 747 ◽  
Author(s):  
Jugendra Pal Singh Shakya ◽  
Neelabh Agrawal ◽  
Arun Kumar ◽  
Akash Singh ◽  
Bhupesh Gogia ◽  
...  
Keyword(s):  
Laparoscopic Cholecystectomy ◽  
Gall Bladder ◽  
Randomized Study ◽  
Port Site ◽  
P Value ◽  
Medical College ◽  
Post Operative Pain ◽  
Group A ◽  
The Difference ◽  
Group B

Background: In laparoscopic cholecystectomy, gall bladder extraction via different ports has always been a matter of concern for the surgeons. This study is designed so as to determine the difference in the rate of pain and infection in gall bladder extraction via umbilical and epigastric port.Methods: A prospective randomized study was done from January 2015 to December 2015 at S. N. Medical College, Agra in which 200 patients of cholelithiasis were considered. The patients were randomly selected in the operation theatre for gall bladder extraction via epigastric port (designated as Group-A with n = 100 patients) and gall bladder extraction via umbilical port (designated as Group-B with n = 100 patients).Results: Post-operative pain at 24 hours, in terms of VAS was 3.67±1.42 in Group-A while 2.47±1.17 in Group-B with 10 being the worst pain. The p-value was calculated as .000048. The result is significant at p< .05. A total of eight patients out of two hundred patients suffered port site infections amongst which five were from Group-A (5%) and three were from Group-B (3%).Conclusions: This study thus indicates that in laparoscopic cholecystectomy, gall bladder retrieval through the umbilical port is a better alternative to gall bladder extraction via epigastric port in terms of post-operative pain and port site infection. Our study recommends gall bladder extraction via umbilical port rather than epigastric port. 

scholarly journals Efficacy & Safety of Oral Ivermectin and Topical Permethrin in the Treatment of Scabies

2020 ◽  
Vol 11 (2) ◽  
pp. 91-95
Author(s):  
Mohsena Akhter ◽  
Ishrat Bhuiyan ◽  
Md Shahadat Hossain ◽  
Zulfiqer Hossain Khan ◽  
Mahfuza Akhter ◽  
...  
Keyword(s):  
Skin Diseases ◽  
Close Contact ◽  
Randomized Study ◽  
Sarcoptes Scabiei ◽  
Medical College ◽  
Common Skin ◽  
Group A ◽  
The Mean ◽  
The Difference ◽  
Group B

Background: Scabies is one of the most common skin diseases in our country. It is caused by the mite Sarcoptes scabiei var hominis, which is an ecto-parasite infesting the epidermis. Scabies is highly contagious. Prevalence is high in congested or densely populated areas. Individuals with close contact with an affected person should be treated with scabicidal which is available in both oral and topical formulations. The only oral but highly effective scabicidal known to date is Ivermectin. Amongst topical preparations, Permethrin 5 % cream is the treatment of choice. Objective: To evaluate the efficacy & safety of oral Ivermectin compared to topical Permethrin in the treatment of scabies. Methodology: This prospective, non-randomized study was conducted at the out-patient department of Dermatology and Venereology of Shaheed Suhrawardy Medical College & Hospital over a period of 6 months, from August 2016 to January 2017. The study population consisted of one hundred patients having scabies, enrolled according to inclusion criteria. They were divided into two groups. Group A was subjected to oral Ivermectin and the Group B to Permethrin 5% cream. Patient were followed up on day 7, 14 and assessed for the efficacy and safety. Result: The mean scoring with SD in Group A and Group B were 8.26 ± 2.22 and 7.59 ± 2.01respectively at the time of observation. The difference between the mean score of the two group is not significant (p=0.117) The mean scoring with SD in group A and group B were 4.54 ± 2.05 and 1.64 ± 1.84 respectively at 7th days. The difference between the mean score of the two group is significant (p<0.001). The mean scoring with SD in group A and group B were 2.68± 2.35 and .36± 1.10 respectively at 14th day difference between the mean score of the group is significant (p<0.001). Conclusion: Topical application of Permethrin 5% cream is more effective and safer than oral Ivermectin in the treatment of scabies. J Shaheed Suhrawardy Med Coll, December 2019, Vol.11(2); 91-95

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