Epithelioid Sarcoma: Need for a Multimodal Approach to Maximize the Chances of Curative Conservative Treatment

2013 ◽  
Vol 21 (1) ◽  
pp. 269-276 ◽  
Author(s):  
Antonin Levy ◽  
Cécile Le Péchoux ◽  
Philippe Terrier ◽  
Ryan Bouaita ◽  
Julien Domont ◽  
...  
2019 ◽  
Vol 6 (11) ◽  
pp. 3951
Author(s):  
Ketan Vagholkar

Background: Fissure in ano is one of the commonest disease affecting all age groups. The condition is quite painful leading to interference in activities of daily living. A wide variety of modalities ranging from medical to surgical approaches have been proposed. However no single modality can be called the gold standard of treatment. Hence the need to develop an optimum graded approach to manage the condition.Methods: Fifty consecutive cases of fissure in ano presenting in an acute state were studied prospectively to develop a therapeutic algorithm for rational treatment of the painful condition.Results: Conservative treatment was commenced in all cases. Eighteen required anal dilatation while out of these eighteen patients, ten required sphincterotomy despite anal dilatation. Four patients had recurrence of symptoms despite all surgical treatments.Conclusions: Conservative treatment still has a significant and positive outcome in fissure in ano. Anal dilatation and sphincterotomy are the next options of treatment. Therefore a graded multimodal approach is therapeutic in treating fissure in ano.


2020 ◽  
Vol 29 (4) ◽  
pp. 2109-2130
Author(s):  
Lauren Bislick

Purpose This study continued Phase I investigation of a modified Phonomotor Treatment (PMT) Program on motor planning in two individuals with apraxia of speech (AOS) and aphasia and, with support from prior work, refined Phase I methodology for treatment intensity and duration, a measure of communicative participation, and the use of effect size benchmarks specific to AOS. Method A single-case experimental design with multiple baselines across behaviors and participants was used to examine acquisition, generalization, and maintenance of treatment effects 8–10 weeks posttreatment. Treatment was distributed 3 days a week, and duration of treatment was specific to each participant (criterion based). Experimental stimuli consisted of target sounds or clusters embedded nonwords and real words, specific to each participants' deficit. Results Findings show improved repetition accuracy for targets in trained nonwords, generalization to targets in untrained nonwords and real words, and maintenance of treatment effects at 10 weeks posttreatment for one participant and more variable outcomes for the other participant. Conclusions Results indicate that a modified version of PMT can promote generalization and maintenance of treatment gains for trained speech targets via a multimodal approach emphasizing repeated exposure and practice. While these results are promising, the frequent co-occurrence of AOS and aphasia warrants a treatment that addresses both motor planning and linguistic deficits. Thus, the application of traditional PMT with participant-specific modifications for AOS embedded into the treatment program may be a more effective approach. Future work will continue to examine and maximize improvements in motor planning, while also treating anomia in aphasia.


VASA ◽  
2017 ◽  
Vol 46 (4) ◽  
pp. 304-309 ◽  
Author(s):  
Achim Neufang ◽  
Carolina Vargas-Gomez ◽  
Patrick Ewald ◽  
Nicolaos Vitolianos ◽  
Tolga Coskun ◽  
...  

Abstract. Background: Surgical revascularization for chronic critical limb ischaemia in patients with thromboangiitis obliterans (TAO) still remains controversial. Generally, besides cessation of smoking, conservative treatment supported by intravenous administration of vasoactive agents is regarded as the treatment of choice, in combination with local wound therapy or minor amputation. Patients and methods: In four male patients (42-47 years) surgical revascularization was chosen as therapy for established gangrene or non-healing ulceration after unsuccessful conservative treatment and cessation of smoking. Angiography was able to identify a suitable distal arterial segment for the bypass which was revascularized by means of an autologous vein graft. Grafts were followed with repetitive duplex ultrasound. Revision of the bypass graft was initiated if indicated by pathological duplex findings. Results: In all cases a bypass could be constructed with either the ipsilateral greater saphenous vein or arm veins. A distal origin configuration was possible in three cases with popliteo-pedal or cruro-pedal bypasses. In the fourth case the distal superficial femoral artery was used for inflow. Two early graft thromboses underwent successful revision. During follow-up, duplex ultrasound identified graft stenoses in three bypasses which were successfully treated with endovascular techniques. All grafts are patent with complete resolution of ischaemic symptoms after 46, 42, 32, and 29 months. The patients remained non-smokers and returned to a professional life. Conclusions: Surgical therapy with distal vein bypass for persistent ischaemic symptoms after definitive cessation of smoking seems feasible in selected cases with TAO and a suitable distal artery. Close follow-ups of the patients with duplex ultrasound are necessary to identify developing vein graft stenoses. Angioplasty seems to be an important part of the long-term therapeutic concept.


VASA ◽  
2009 ◽  
Vol 38 (3) ◽  
pp. 263-266 ◽  
Author(s):  
Yuan ◽  
Tager

Penetrating atherosclerotic ulcer of the aorta is uncommon, and usually develops in the descending thoracic aorta. Rarely this condition involves the branch vessels of the aorta. We report a case of ruptured aneurysm of the innominate artery resulting from penetrating atherosclerotic ulcer. Open surgery was the treatment of choice for the ruptured aneurysm, while conservative treatment was recommended for the associated penetrating atherosclerotic ulcers of the descending aorta.


VASA ◽  
2011 ◽  
Vol 40 (4) ◽  
pp. 271-279 ◽  
Author(s):  
Wagner

Lymphedema and lipedema are chronic progressive disorders for which no causal therapy exists so far. Many general practitioners will rarely see these disorders with the consequence that diagnosis is often delayed. The pathophysiological basis is edematization of the tissues. Lymphedema involves an impairment of lymph drainage with resultant fluid build-up. Lipedema arises from an orthostatic predisposition to edema in pathologically increased subcutaneous tissue. Treatment includes complex physical decongestion by manual lymph drainage and absolutely uncompromising compression therapy whether it is by bandage in the intensive phase to reduce edema or with a flat knit compression stocking to maintain volume.


2012 ◽  
Vol 73 (S 02) ◽  
Author(s):  
M. Sadadcharam ◽  
R. Wormald ◽  
M. Javadpour ◽  
D. Rawluk ◽  
R. McConn-Walsh

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