An evolution of clinical practice: the impact of changes in clinical management of non-functioning pituitary adenomas on long-term pituitary function and risk of recurrence

2014 ◽  
Author(s):  
Michael O'Reilly ◽  
Harriet Pearce ◽  
Gabriella Bugg ◽  
Rosalind Mitchell ◽  
Andy Toogood ◽  
...  
Keyword(s):  
Clinical Practice ◽  
Clinical Management ◽  
Pituitary Adenomas ◽  
Pituitary Function ◽  
Risk Of Recurrence ◽  
The Impact ◽  
Non Functioning Pituitary Adenomas

scholarly journals The Defeat Depression Campaign

1997 ◽  
Vol 21 (3) ◽  
pp. 148-150 ◽  
Author(s):  
Ann Macaskill ◽  
Norman Macaskill ◽  
A. Nicol
Keyword(s):  
Clinical Practice ◽  
Royal College ◽  
Questionnaire Survey ◽  
Clinical Management ◽  
The Public ◽  
Health Practitioners ◽  
The Impact

The Royal College of Psychiatrists launched a five year campaign in 1992 to better inform health practitioners and the public about depression. A questionnaire survey of Sheffield general practitoners (GPs) to assess the impact of the Defeat Depression Campaign on their knowledge and clinical management of depression was carried out in May 1994, half way through the campaign. Overall, 75% of GPs who responded indicated that the Defeat Depression Campaign had had little or no impact on their clinical practice. It would appear that at its mid-point the Defeat Depression Campaign failed to achieve its main goals in relation to educating GPs about depression and its management.

scholarly journals Peritoneal Morphology after Long-Term Peritoneal Dialysis with Biocompatible Fluid: Recent Clinical Practice in Japan

2012 ◽  
Vol 32 (2) ◽  
pp. 159-167 ◽  
Author(s):  
Nobuhiro Ayuzawa ◽  
Yoshitaka Ishibashi ◽  
Yutaka Takazawa ◽  
Haruki Kume ◽  
Toshiro Fujita
Keyword(s):  
Peritoneal Dialysis ◽  
Clinical Practice ◽  
University Hospital ◽  
Dialysis Therapy ◽  
Compact Zone ◽  
Peritoneal Biopsy ◽  
The Mean ◽  
The Impact ◽  
Peritoneal Morphology

♦BackgroundMorphology changes of the peritoneal membrane after long-term peritoneal dialysis (PD) consist of denudation of peritoneal mesothelial cells, interstitial sclerosis, and hyalinizing vasculopathy. Those changes are considered to be the result of uremia and bioincompatible effects of conventional acidic lactate-buffered dialysate with glucose degradation products (GDPs). In the last decade, biocompatible dialysate with neutral pH and low GDPs has become widely used. Clinical practice has been modified in Japan, especially for anuric patients, and now includes the use of hybrid therapy. The impact on peritoneal morphology has not been well reported.♦ ObjectiveThe aim of the present study was to investigate the long-term effect on peritoneal morphology and function of biocompatible fluid use and current clinical practice in Japan, including hybrid dialysis therapy.♦MethodsWe evaluated peritoneal biopsy specimens from patients who had undergone PD for more than 3 years. We used the average peritoneal thickness (APT) of the submesothelial compact zone as a marker of interstitial sclerosis and the lumen/vessel diameter ratio (L/V ratio) at postcapillary venules as a marker of hyalinizing vasculopathy. Demography and other data for the patients, including dialysate-to-plasma (D/P) ratio of creatinine, were obtained at baseline and every 6 months by peritoneal equilibration test.♦ResultsBetween 2002 and 2009, 110 patients started PD therapy with biocompatible dialysate at Tokyo University Hospital. Among them, 11 patients (8 men, 3 women; age: 54.2 ± 11.8 years; 1 with diabetes mellitus) were enrolled into this morphology study. The mean duration of PD in this group was 61 ± 11.3 months, and the mean time to peritoneal biopsy was 58 ± 15.1 months. The median APT was 180 μm (96 – 1424 μm), and the median L/V ratio was 0.66 (0.46 – 0.74). No obvious correlations between APT, L/V ratio, and PD duration were detected. The D/P creatinine of the 11 patients was maintained at a favorably low value, comparable with that of the other 99 patients.♦ConclusionsPeritoneal dialysis therapy using biocompatible dialysate in conjunction with modification of clinical practice may minimize the progression of peritoneal interstitial sclerosis and hyalinizing vasculopathy, preserving favorable peritoneal function for more than 3 years.

scholarly journals New insights into treatment of venous thromboembolism

Hematology ◽  
2014 ◽  
Vol 2014 (1) ◽  
pp. 297-305 ◽  
Author(s):  
Stephan Moll
Keyword(s):  
Clinical Practice ◽  
Venous Thromboembolism ◽  
Clinical Management ◽  
Routine Clinical Practice ◽  
Acute Management ◽  
Clinical Context ◽  
High Profile ◽  
New Anticoagulants ◽  
Important Challenge

Abstract Several advances have occurred over the last 2 years in the clinical management of venous thromboembolism (VTE), as evidenced by several high-profile publications in top-tier medical journals. The translation of the knowledge gained into routine clinical practice is an important challenge so that VTE is managed optimally and established and new anticoagulants are used effectively and safely. This chapter reviews issues of VTE treatment from acute management to treatment of long-term complications, addressing new data gained in the last 2 years and putting them into a clinical context, with the goal of improved everyday VTE management.

scholarly journals Deep inspiration breath hold versus free breathing technique in mediastinal radiotherapy for lymphoma

BJR|Open ◽  
2021 ◽  
Vol 3 (1) ◽  
pp. 20200067
Author(s):  
Orla Anne Houlihan ◽  
Guhan Rangaswamy ◽  
Mary Dunne ◽  
Christine Rohan ◽  
Louise O'Neill ◽  
...  
Keyword(s):  
Spinal Cord ◽  
At Risk ◽  
Clinical Practice ◽  
Organs At Risk ◽  
Free Breathing ◽  
Breath Hold ◽  
Deep Inspiration ◽  
Deep Inspiration Breath Hold ◽  
The Impact

Objective: Radiotherapy plays an important role in the management of lymphoma and many patients with lymphoma are cured with treatment. Risk of secondary malignancy and long-term cardiac and pulmonary toxicity from mediastinal radiotherapy exists. Delivery of radiotherapy using a deep inspiration breath-hold (DIBH) technique increases lung volume and has the potential to reduce dose to heart and lungs. We undertook a prospective study to assess the dosimetric differences in DIBH and free breathing (FB) plans in patients requiring mediastinal radiotherapy in clinical practice. Methods: We performed both FB and DIBH planning scans on 35 consecutive patients with mediastinal lymphoma needing radiotherapy. Contours and plans were generated for both data sets and dosimetric data were compared. All patients were planned using volumetric modulated arc therapy (VMAT). Data were compared for FB and DIBH plans with each patient acting as their own control using the related-samples Wilcoxon signed rank test. Results: DIBH significantly reduced lung doses (mean 10.6 vs 11.4Gy, p < 0.0005; V20 16.8 vs 18.3%, p = 0.001) and spinal cord maximum dose (20.6 vs 22.8Gy, p = 0.001). DIBH increased breast V4 (38.5% vs 31.8%, p = 0.006) and mean right breast dose (4.2 vs 3.6Gy, p = 0.010). There was no significant difference in heart doses when the entire study cohort was considered, however, mean heart dose tended to be lower with DIBH for upper mediastinal (UM) tumours (4.3 vs 4.9Gy, p = 0.05). Conclusion: Our study describes the potential benefit of DIBH in a population reflective of clinical practice. DIBH can decrease radiation dose to lungs, heart and spinal cord, however, may increase dose to breasts. DIBH is not always superior to FB, and the clinical significance of differences in dose to organs at risk in addition to the time required to treat patients with DIBH must be considered when deciding the most appropriate radiotherapy technique for each patient. Advances in knowledge: To our knowledge, this is the largest study comparing DIBH and FB planning for patients with lymphoma receiving mediastinal radiotherapy in clinical practice. It demonstrates the impact of an increasingly common radiotherapy technique on dose to organs at risk and the subsequent potential for long-term radiotherapy side-effects.

scholarly journals Comparing progression of non-functioning pituitary adenomas in hypopituitarism patients with and without long-term GH replacement therapy

2009 ◽  
Vol 161 (5) ◽  
pp. 663-669 ◽  
Author(s):  
D S Olsson ◽  
M Buchfelder ◽  
S Schlaffer ◽  
B-Å Bengtsson ◽  
K-E Jakobsson ◽  
...  
Keyword(s):  
Survival Rate ◽  
Replacement Therapy ◽  
Pituitary Adenomas ◽  
Tumour Progression ◽  
Progression Free Survival ◽  
Control Population ◽  
Free Survival ◽  
Gh Replacement ◽  
Non Functioning Pituitary Adenomas

ObjectiveAn important safety issue with GH replacement therapy (GHRT) in hypopituitary patients with a history of a pituitary adenoma is the risk for tumour recurrence or enlargement.DesignCase–control study.Subjects and methodsWe studied tumour progression rate in 121 patients with hypopituitarism on the basis of non-functioning pituitary adenomas (NFPA) receiving long-term GHRT. A group of 114 NFPA patients not receiving GHRT who were matched in terms of duration of follow-up, gender, age, age at diagnosis and radiotherapy status were used as a control population. The average duration of GHRT was 10±4 years (range 2–17).ResultsIn patients with a known residual adenoma, 63% had no detectable enlargement of tumour during the study. In patients who had no visible residual tumour prior to GHRT, 90% did not suffer from recurrence. In total, the 10-year tumour progression-free survival rate in patients with NFPA receiving GHRT was 74%. In the control population not receiving GHRT, the 10-year progression-free survival rate was 70%. Radiotherapy as part of the initial tumour treatment reduced the rate of tumour progression in both GHRT and non-GHRT patients to a similar extent.ConclusionsThe rate of tumour progression was similar in this large group of GHRT patients and the control population not receiving GHRT. Our results provide further support that long-term use of GH replacement in hypopituitarism may be considered safe in patients with residual pituitary adenomas.

scholarly journals Targeting mucosal healing in Crohn’s disease: what the clinician needs to know

2019 ◽  
Vol 12 ◽  
pp. 175628481985686 ◽  
Author(s):  
Entcho Klenske ◽  
Christian Bojarski ◽  
Maximilian Waldner ◽  
Timo Rath ◽  
Markus F. Neurath ◽  
...  
Keyword(s):  
Crohn’S Disease ◽  
Clinical Practice ◽  
Crohn's Disease ◽  
Clinical Management ◽  
Imaging Techniques ◽  
Treatment Options ◽  
Mucosal Healing ◽  
Ongoing Debate ◽  
Definition Of

In recent years, mucosal healing has emerged as a key therapeutic goal in the clinical management of patients with Crohn’s disease, as it has been associated with improved long-term clinical outcomes. With the vast improvements in endoscopic imaging techniques and the increase in available treatment options, which reportedly are able to induce mucosal healing, the practising physician is left to wonder: how is endoscopic mucosal healing exactly defined in Crohn’s disease, and how can it effectively be achieved and monitored in daily clinical practice? Within this review, we will give an overview of the ongoing debate about the definition of mucosal healing and the modalities to monitor inflammation, and finally present available therapies with the capacity to induce mucosal healing.

Effects of long-term treatment with the gonadotropin-releasing hormone analog nafarelin in patients with non-functioning pituitary adenomas

1994 ◽  
Vol 130 (4) ◽  
pp. 339-345 ◽  
Author(s):  
Paolo Colombo ◽  
Bruno Ambrosi ◽  
Katia Saccomanno ◽  
Monique Bassetti ◽  
Donatella Cortelazzi ◽  
...  
Keyword(s):  
Pituitary Adenomas ◽  
Term Treatment ◽  
Gonadotropin Releasing Hormone ◽  
Gnrh Analog ◽  
Hormonal Responses ◽  
Releasing Hormone ◽  
Hormone Analog ◽  
Long Term Treatment ◽  
Non Functioning Pituitary Adenomas

Colombo P, Ambrosi B, Saccomanno K, Bassetti M, Cortelazzi D, Faglia G. Effects of long-term treatment with the gonadotropin-releasing hormone analog nafarelin in patients with non-functioning pituitary adenomas. Eur J Endocrinol 1994;130:339–45. ISSN 0804–4643 The supposed origin of non-functioning pituitary adenomas (NFPA) from gonadotrophs prompted us to investigate the effects of the gonadotropin-releasing hormone (GnRH) analog nafarelin on hormonal and tumoral parameters in eight patients with NFPA, previously unsuccessfully operated and all hypogonadal. Nafarelin was administered intranasally for 1 year to all patients. Four patients received a dose of 1200 μg/day; the remaining four received 800 μg/day for 3 months, which was subsequently increased to 1200 μg/day. Basal gonadotropin and α-subunit (αSU) levels were low–normal. In four patients (nos. 1,2,3,5) nafarelin significantly lowered luteinizing hormone (LH) levels, and also folliclestimulating hormone (FSH) in three of them (nos. 1,2,3). Persistent FSH stimulation occurred in three patients (nos. 6,7,8), with a transient slight LH increase only in patient no. 8. In one patient (no. 7), αSU levels were persistently stimulated. Hormonal responses to an acute GnRH test during nafarelin administration were generally blunted when compared to the pretreatment responses. Immunofluorescence results, obtained before treatment in five adenomas (nos. 2,3,4,6,7), had been as follows: positive for FSH-β in all; negative for LH-β in all, except a few positive cells in case no. 4; positive for αSU in three (nos. 2,3,7). No changes of visual field and tumor size occurred in any patient during treatment. However, one patient who showed a persistent increase in FSH levels exhibited left palpebral ptosis after 12 months of therapy and underwent a second transsphenoidal surgery. In conclusion: NFPA behave heterogeneously in terms of hormonal responses to GnRH analog therapy; long-term nafarelin treatment was unsuccessful in reducing the size of NFPA; and stimulation rather than inhibition of gonadotropin levels may suggest discontinuance of GnRH analog therapy in NFPA. Paolo Colombo, Istituto di Scienze Endocrine, Ospedale Maggiore IRCCS-Pad, Granelli, via F. Sforza 35, 20122 Milano, Italy

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