scholarly journals Failure of radiotherapy in acromegaly

2001 ◽  
pp. 717-726 ◽  
Author(s):  
R Cozzi ◽  
M Barausse ◽  
D Asnaghi ◽  
D Dallabonzana ◽  
S Lodrini ◽  
...  
Keyword(s):  
Side Effects ◽  
Tumor Size ◽  
Primary Treatment ◽  
Large Tumor ◽  
Antisecretory Drug ◽  
Igf I ◽  
Surgical Failure ◽  
Antisecretory Treatment ◽  
Lost To Follow Up

BACKGROUND: Recent data has raised skepticism regarding the long-term effectiveness of radiotherapy (RxT) in acromegaly and its role as an ancillary tool to neurosurgery (Tx). PATIENTS: We evaluated 72 acromegalic patients previously submitted to RxT. Data were discarded in 23 patients, who were lost to follow-up, operated on after RxT or irradiated with techniques different from external conventional fractionated RxT. Among the remaining 49 (five with mixed GH-prolactin adenoma), 34 were irradiated after surgical failure and 15 as primary treatment. A second cycle of RxT was administered in two. RESULTS: (i) GH/IGF-I. After a median follow-up of 14 years (range 3-41), normal age-matched IGF-I levels were reached in eight patients (16%) after 10 years, and GH levels <2.5 microg/l in six (12%) after 9 years. The rate of persistently pathological hormonal levels was still 90% at 25 years. All patients with GH/IGF-I normalization had undergone irradiation without any antisecretory drug. Neither basal GH nor tumor size affected the outcome of RxT. In three patients (6%) a relapse/worsening occurred. (ii) Tumor size. Tumor shrank after 8.5 years in 24 patients (49%), in nine of whom during GH-suppressive treatment. Tumor shrinkage was not predictive of hormonal normalization. (iii) Side-effects. Hypopituitarism was diagnosed in four patients (selective in three and global in one) and GH deficiency in one. Three patients had neurological side-effects and meningioma was shown in two patients. CONCLUSION: RxT is unable to cure acromegaly, because it seldom achieves hormonal normalization even after a very prolonged follow-up. Concomitant antisecretory treatment seems to counteract its effects. RxT can still play a role in those patients with large tumor remnants, because of its capacity to shrink tumor size.

Adrenocortical carcinoma in children: a study of 40 cases.

1990 ◽  
Vol 8 (1) ◽  
pp. 67-74 ◽  
Author(s):  
R C Ribeiro ◽  
R S Sandrini Neto ◽  
M J Schell ◽  
L Lacerda ◽  
G A Sambaio ◽  
...  
Keyword(s):  
Complete Remission ◽  
Adrenocortical Carcinoma ◽  
Tumor Size ◽  
Abdominal Mass ◽  
Univariate Analysis ◽  
Tumor Resection ◽  
The United States ◽  
Primary Treatment ◽  
Lost To Follow Up

Adrenocortical carcinoma (ACC), a very rare tumor in children in the United States, is apparently more common among Brazilian children. We reviewed the medical records of 40 children whose disease was diagnosed between 1966 and 1987. There were 12 boys and 28 girls; their median age was 3.9 years (range, 1 day to 15.7 years). Virilization was the most common clinical sign (37 of 40); other signs included abdominal mass, deepened voice, plethora, hypertension, seizures (seven patients) and, rarely, weight loss (two patients). The median time between first signs or symptoms and diagnosis was 1.4 years (range, 3 days to 5 years). Four of 33 tumors were classified as benign according to the Weiss, van Slooten, or Hough systems (tumor tissue was unavailable for seven patients). Tumors were completely resected in 26 of 38 patients; of those, 17 are in continuous complete remission, five relapsed, and four have been lost to follow-up. One patient, who had local recurrence, has been in a third complete remission for 18+ months after tumor resection and chemotherapy (cisplatin and etoposide). Of the remaining 14 patients, 11 died of progressive disease, the diagnosis was confirmed at autopsy in two, and one has been lost to follow-up. Univariate analysis disclosed that age greater than or equal to 3.5 years at diagnosis, interval of greater than or equal to 6 months between first symptoms and diagnosis, tumor weight greater than 100 g, tumor size greater than 200 cm3, and high levels of urinary 17-ketosteroids (17-KS) and 17-hydroxycorticosteroids (17-OH) were associated with an unfavorable outcome. Multivariate analysis disclosed that only a tumor size greater than 200 cm3 independently identifies those patients with an unfavorable prognosis. Among the variables known before surgery, age, and the interval between first symptoms and diagnosis were important predictors of outcome. Our data suggest that some children with ACC and certain clinical characteristics are at high risk of primary treatment failure and, therefore, are good candidates for investigational adjuvant therapy.

Lessons from pathological analysis of recurrent early esophageal squamous cell neoplasia after complete endoscopic radiofrequency ablation

Endoscopy ◽  
2018 ◽  
Vol 50 (08) ◽  
pp. 743-750 ◽  
Author(s):  
Wen-Lun Wang ◽  
I-Wei Chang ◽  
Chien-Chuan Chen ◽  
Chi-Yang Chang ◽  
Cheng-Hao Tseng ◽  
...  
Keyword(s):  
Radiofrequency Ablation ◽  
Local Recurrence ◽  
Endoscopic Resection ◽  
Squamous Cell ◽  
Complete Response ◽  
Primary Treatment ◽  
Long Term Follow Up ◽  
Endoscopic Radiofrequency Ablation ◽  
Lost To Follow Up

Abstract Background Endoscopic radiofrequency ablation (RFA) is a treatment option for early esophageal squamous cell neoplasia (ESCN); however, long-term follow-up studies are lacking. The risks of local recurrence and “buried cancer” are also uncertain. Methods Patients with flat-type ESCN who were treated with balloon-type ± focal-type RFA were consecutively enrolled. Follow-up endoscopy was performed at 1, 3, and 6 months, and then every 6 months thereafter. Endoscopic resection was performed for persistent and recurrent ESCN, and the histopathology of resected specimens was assessed. Results A total of 35 patients were treated with RFA, of whom 30 (86 %) achieved a complete response, three were lost to follow-up, and five (14 %) developed post-RFA stenosis. Two patients had persistent ESCN and received further endoscopic resection, in which the resected specimens all revealed superficial submucosal invasive cancer. Six of the 30 patients with successful RFA (20 %) developed a total of seven episodes of local recurrence (mean size 1.4 cm) during the follow-up period (mean 40.1 months), all of which were successfully resected endoscopically without adverse events. Histological analysis of the resected specimens revealed that six (86 %) had esophageal glandular ductal involvement, all of which extended deeper than the muscularis mucosae layer. Immunohistochemistry staining for P53 and Ki67 suggested a clonal relationship between the ductal involvement and epithelial cells. None of the tumors extended out of the ductal structure; no cases of cancer buried beneath the normal neosquamous epithelium were found. Conclusions Because ductal involvement is not uncommon and may be related to recurrence, the use of RFA should be conservative and may not be the preferred primary treatment for early ESCN.

scholarly journals A prospective study to evaluate the acceptance, efficacy, side effects and expulsion rates of post-placental intrauterine device

2017 ◽  
Vol 6 (11) ◽  
pp. 4821
Author(s):  
Richa S. Sankhe ◽  
Meenal T. Kamble
Keyword(s):  
Side Effects ◽  
Intrauterine Device ◽  
Excessive Bleeding ◽  
Factors Associated ◽  
Insertion Techniques ◽  
Insertion Efficacy ◽  
Post Placental ◽  
A Prospective Study ◽  
Lost To Follow Up

Background: This study was conducted to know the factors associated with acceptability of immediate post placental IUCD insertion in women and to know the level of safety, efficacy and expulsion of post placental insertion of IUCD.Methods: This study was conducted in Obstetrics and Gynecology Department of Kasturba General Hospital, Mumbai over a period of 1 year. Women admitted and delivered at KGH were informed and counselled regarding intrauterine devices regarding its insertion, efficacy and side effects. Cu T 380A was inserted within 15 minutes of delivery of placenta and membranes in women who gave consent and had no contraindications for IUD insertion. All these women were followed for 6 months in the post insertion period.Results: Total number of women counselled was 400 over the period of six months from August 2015 to January 2016. Out of these only 250 women gave consent for PPIUCD insertion. 50 were lost to follow up.  200 women were followed, out of which 15 women had expulsion, 15 women had excessive bleeding, 20 women complained of pelvic pain, bleeding and abdominal pain together was found in 25 women. 160 out of 200 continued with the method   while the rest discontinued.Conclusions: Based on present study it may be concluded that post placental intrauterine device is an effective method of contraception. Proper counselling and insertion techniques would further improve the acceptability and reduce the expulsion rates.

Treatment of mucosa-associated lymphoid tissue lymphoma of the stomach with radiation alone.

1998 ◽  
Vol 16 (5) ◽  
pp. 1916-1921 ◽  
Author(s):  
N R Schechter ◽  
C S Portlock ◽  
J Yahalom
Keyword(s):  
Side Effects ◽  
Antibiotic Therapy ◽  
Lymphoid Tissue ◽  
Low Dose ◽  
Complete Response ◽  
Primary Treatment ◽  
Low Grade ◽  
Low Dose Radiotherapy ◽  
H Pylori

PURPOSE Mucosa-associated lymphoid tissue (MALT) lymphoma of the stomach (MLS) has recently been defined as a distinct clinicopathologic entity, often associated with Helicobacter pylori infection. Many regard antibiotic therapy as the primary treatment of MLS, but in the absence of H pylori infection, or when salvage of antibiotic failures is required, gastrectomy and/or chemotherapy have frequently been used. This study evaluates the efficacy of low-dose radiotherapy alone as an alternative to surgery. PATIENTS AND METHODS Seventeen patients with stage I to II(2) low-grade MLS without evidence of H pylori infection or with persistent lymphoma after antibiotic therapy of associated H pylori infection were included in this series. Median age was 69 years (range, 39 to 84). Median total radiation dose was 30 Gy (range, 28.5 to 43.5 Gy) delivered in 1.5-Gy fractions within 4 weeks to the stomach and adjacent lymph nodes. Following treatment, all patients underwent endoscopic evaluation and biopsy at a median of 4 months, at 6-month intervals to 2 years, and annually thereafter. RESULTS All obtained a biopsy-confirmed complete response. At a median follow-up time of 27 months (range, 11 to 68) from completion of radiotherapy, event-free survival was 100%. Treatment was well tolerated, with no significant acute side effects. All remained asymptomatic at last follow-up. CONCLUSION These results suggest that effective treatment of MLS with low-dose radiation therapy alone is feasible and safe, and allows stomach preservation. Longer follow-up evaluation is required to determine the long-term efficacy of this treatment approach and its side effects. Further studies should clarify the indications for radiotherapy in H pylori-negative or antibiotic-resistant cases of MLS.

Combination of Prednisolone and Azathioprine for Steroid-Responsive Meningitis-Arteritis Treatment in Dogs

2020 ◽  
Vol 57 (1) ◽  
pp. 1-7
Author(s):  
Lucile Giraud ◽  
Maud Girod ◽  
Laurent Cauzinille
Keyword(s):  
Side Effects ◽  
Relapse Rate ◽  
Primary Treatment ◽  
Immunosuppressive Drug ◽  
Duration Of Treatment ◽  
Glucocorticoid Treatment ◽  
Immune Mediated

ABSTRACT Treatment with high corticosteroid dosages for steroid-responsive meningitis-arteritis (SRMA) is correlated with severe adverse effects and worse quality of life. In order to improve immunosuppression and decrease dosage and duration of glucocorticoid treatment, a second immunosuppressive drug is commonly used in most of the immune-mediated diseases. The objective of this retrospective study was to evaluate the efficacy, tolerability, and occurrence of relapse for the combination of prednisolone and azathioprine. All dogs received azathioprine 2 mg/kg q 24 hr for 1 mo and then 2 mg/kg every other day for 2 mo; prednisolone was started at an immunosuppressive dosage and tapered off gradually during a mean of 3 mo. Twenty-six dogs met inclusion criteria. Twenty-one dogs (81%) were in clinical remission with no relapse observed within the 2 yr follow-up period. Treatment was well tolerated in all dogs and side effects were most of the time mild and self-limiting. The relapse rate (19%) was lower than most published rates. A prednisolone and azathioprine combination appeared to be effective for primary treatment of dogs with SRMA and allows a quicker tapering in prednisolone dosage, a decrease in long-term side effects of steroids, a shorter duration of treatment, and a low relapse rate.

Primary Treatment with Pulsed Melphalan, Dexamethasone, Thalidomide (MDT) for Symptomatic Patients with Multiple Myeloma ≥ 75 Years of Age.

Blood ◽  
2004 ◽  
Vol 104 (11) ◽  
pp. 1482-1482 ◽  
Author(s):  
Meletios A. Dimopoulos ◽  
Panagiotis Repoussis ◽  
Evangelos Terpos ◽  
Maria Christina Kyrtsonis ◽  
Athanasios Zomas ◽  
...  
Keyword(s):  
Multiple Myeloma ◽  
Peripheral Neuropathy ◽  
Side Effects ◽  
Elderly Patients ◽  
Objective Response ◽  
Elevated Serum ◽  
Primary Treatment ◽  
Moderate Degree ◽  
The Impact

Abstract Introduction: Thalidomide is usually administered orally continuously once daily and has shown remarkable activity in about 30% of patients with heavily pretreated multiple myeloma (MM). Moreover, there is considerable interest in the administration of thalidomide-containing combinations as primary treatment of MM. With such regimens at least 60% of patient achieve an objective response. Thalidomide can cause a variety of side effects whose incidence and severity may be related to the maximum dose and duration of thalidomide treatment. Furthermore, this drug may be poorly tolerated by older patients. We designed a phase II study for the primary treatment of elderly patients (≥ 75 years of age) with MM which was based on intermittent oral administration of melphalan, thalidomide and dexamethasone. Patients and Methods: This ongoing multicenter study was initiated in February 2003 and includes patients with symptomatic myeloma ≥75 years of age regardless of performance status, renal function, and comorbidities. Treatment consists of melphalan (M) 8mg/m2 days 1–4, dexamethasone (D) 12mg/m2 p.o. after breakfast on days 1–4 and 14–18 and thalidomide (T) 300 mg p.o. at bedtime on days 1–4 and 14–18. This regimen is repeated every 5 weeks for 3 courses. Patients without evidence of progressive disease are scheduled to receive 9 additional courses of MDT (but without DT on days 14–18) every 5 weeks. Results: As of July 2004, 43 patients have been enrolled. Their median age is 78 years (range: 75 to 85 years). Features of advanced myeloma are frequent and include International Staging System (ISS) 3 in 58%, hemoglobin <8.5g/dl in 13%, calcium >11.5 in 15%, creatinine > 2 mg/dl in 28% and elevated serum LDH in 11%. On an intent-to-treat basis, 72% of patients achieved at least a partial response (EBMT criteria) including 10% of patients who achieved a complete response with negative immunofixation. Median time to 50% reduction of monoclonal protein was 2 months (range 0.5 to 5.5). Grade 3 or 4 granylocytopenia and thrombocytopenia occurred in 15% and 10% of patients respectively. Twelve episodes of infections were noted one of which was fatal. Several patients developed thalidomide-related side effects, usually of mild or moderate degree, such as constipation (30%), somnolence (35%), tremor (25%), xerostomia (15%), headache (10%). Deep venous thromosis (DVT) and peripheral neuropathy occurred in 10% of patients each. With a mean follow-up of 15 months, 88% of patients remain alive. Conclusions: This is one of few prospective studies designed for myeloma patients with advanced age (≥75 years) ie patients who are frequently excluded from trials. The pulsed MDT regimen appears to be a well tolerated and active primary treatment for elderly patients with multiple myeloma. The incidence of DVT and of peripheral neuropathy appears lower than that seen when thalidomide is administered continuously. Patient accrual and follow-up is ongoing in order to assess the impact of this regimen on response duration and survival.

If Migraine Prophylaxis Does Not Work, Think About Compliance

Cephalalgia ◽  
1994 ◽  
Vol 14 (6) ◽  
pp. 463-464 ◽  
Author(s):  
TJ Steiner ◽  
T Catarci ◽  
R Hering ◽  
T Whirmarsh ◽  
EGM Couturier
Keyword(s):  
Side Effects ◽  
Real Time ◽  
Pressure Change ◽  
Migraine Prophylaxis ◽  
Event Recorder ◽  
Ihs Criteria ◽  
Lost To Follow Up

Data are presented on nine patients with migraine by IHS criteria, recruited from those presenting to the clinic for treatment and needing prophylaxis. Pizotifen 0.5 mg tds was prescribed for 8 weeks and dispensed in special containers with an electronic event recorder concealed in the lid. This responded to the pressure change with each opening of the container and recorded it in real time. The information was later downloaded to a PC for analysis. At trial end, two patients had been lost to follow-up, one had not started the treatment at all, two had dropped out because of alleged side effects (drowsiness), and four patients had completed the study. For these, the quantity of tablets used as a percentage of that prescribed (i.e., compliance assessed on the basis of returned-tablet count) ranged from 62.6% to 91.9%; the percentage of days in which three doses had been taken ranged from only 15.8% to 79%; the percentage of doses taken on schedule (8 h ± 25% after the previous dose) ranged from 21.1% to 47.3%. It is possible that all evaluations of efficacy and tolerance of migraine prophylactics reported so far have been unsoundly based.

scholarly journals Completed Audit Cycle on Lithium Monitoring on Older Adults in Northumbria Healthcare NHS Trust, UK

2009 ◽  
Vol 24 (S1) ◽  
pp. 1-1
Author(s):  
A. Ghosh Nodiyal ◽  
G. Ramsay ◽  
S. Wilson
Keyword(s):  
Side Effects ◽  
General Hospital ◽  
Similar Distribution ◽  
National Formulary ◽  
Information Leaflets ◽  
Audit Data ◽  
Audit Cycle ◽  
One Year ◽  
Lost To Follow Up

Aims:The aim of this study was to audit the practise of Lithium monitoring on all patients over the age of 65 years, over a one-year period in North Tyneside General Hospital, against the recommended standards, and re-auditing the following year.Methods:During the audit; data was collected from the medical notes of all patients prescribed Lithium, over 65 years in North Tyneside General Hospital. This was from January 2004 - January 2005. The standards used were the recommendations of The British National Formulary. The monitoring of urea, electrolytes, TSH and Lithium were recorded. The presence of an ECG, documentation of side effects, information leaflets’ distribution and patients lost to follow up were noted. Following the audit, recommendations were made and prescribing Consultants were informed. A re-audit was conducted on all patients on Lithium the next year from January 2006 - June 2006, using the same designed tool.Results:22 patient's notes were audited and 29 notes re-audited. 41% were males and 59% females in the audit, with similar distribution in the re-audit. 54% were between 65-75 years and 45% over the age of 75years in the audit. 41% and 59% respectively in the re-audit. Blood monitoring followed the standards in 86% in the audit and 95% in the re-audit. 32% had documentation of side effects in the audit, increasing to 72% in the re-audit. While 23% patients were lost to follow up in the audit, all were followed up in the re-audit.Conclusions:The re-audit encouragingly showed significant improvement in practise.

Prestim in the Management of Mild to Moderate Essential Hypertension in General Practice

1983 ◽  
Vol 11 (3) ◽  
pp. 186-189 ◽  
Author(s):  
K Peacock ◽  
B Hodge
Keyword(s):  
Blood Pressure ◽  
Side Effects ◽  
Maximum Dose ◽  
Fixed Dose ◽  
Dose Titration ◽  
Timolol Maleate ◽  
Daily Dose ◽  
Dose Combination ◽  
Lost To Follow Up

Fifty-three hypertensive patients from one practice, of whom forty-two were new patients, were treated with Prestim — a fixed dose combination of 10 mg timolol maleate and 2·5 mg bendrofluazide. After a 2-week placebo run-in period, dose titration took place at weekly intervals up to a maximum of 4 tablets daily. Stabilized patients were followed-up at 3 months and approximately 1 year. At the 3-month follow-up, forty-nine patients were evaluated. Forty-two patients (85%) were well controlled (diastolic blood pressure below 95 mm Hg) on Prestim at a mean daily dose of 1·4 tablets. Four patients stopped therapy due to side-effects and in three patients the blood pressure was uncontrolled on the maximum dose of 4 tablets daily. After 1 year, thirty-four patients (75%) were still well controlled on a mean dose of 1·3 tablets daily. A further two patients were lost to follow-up and six other patients stopped therapy during the last nine months of the study. There were no unexpected side-effects and the general biochemical profile remained unaltered.

The Effectiveness of Nortriptyline and Tolerability of Side Effects in Neurogenic Cough Patients

2020 ◽  
pp. 000348942097023
Author(s):  
Sungjin A. Song ◽  
Kanittha Choksawad ◽  
Ramon A. Franco
Keyword(s):  
Side Effects ◽  
Case Series ◽  
Clinical History ◽  
Demographic Information ◽  
Retrospective Case ◽  
Exclusion Criteria ◽  
Level Of Evidence ◽  
Medication Dosage ◽  
Lost To Follow Up

Objective: To determine the effectiveness of nortriptyline and tolerability of side effects in the treatment of neurogenic cough. Secondary goal is to evaluate the association between laryngeal asymmetry and clinical response to nortriptyline. Study Design: Retrospective case series. Materials and Methods: Consecutive patients diagnosed with neurogenic cough at a quaternary care specialty hospital from 2001 to 2020 were identified. Subjects <18 years old, not treated with nortriptyline, did not have a nasolaryngoscopic examination and were lost to follow-up were excluded. Charts were reviewed for demographic information, clinical history, nasolaryngoscopic findings, medication dosage, side effects, and follow-up time. Results: Forty-two patients met inclusion and exclusion criteria, 7 males and 35 females with an average age of 56.5 (±13.1) years. There were 26/36 (72.2%) responders and 10/36 (27.8%) non-responders; 6 patients stopped nortriptyline due to side effects and were not included in the response comparison. Laryngeal asymmetry was present in 36/42 (85.7%) patients. No factors related to laryngeal asymmetry were significantly different between responders and non-responders. Medication tolerance was observed in 3/42 (7.1%) patients. Side effects were reported in 16/42 (38.1%) patients. The most common side effects were sedation 9/42 (21.4%) and xerostomia 3/42 (7.1%). Conclusion: Nortriptyline is effective for treating neurogenic cough with 72% of patients reporting improvement in cough. Evidence of laryngeal asymmetry was not associated with better treatment response. Although 38% experienced side effects, the majority of patients continued nortriptyline despite side effects. Level of Evidence: 4

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