Evidence-based optimal treatment strategy of patients with angina pectoris

2008 ◽  
Vol 149 (7) ◽  
pp. 293-298
Author(s):  
András Jánosi
Keyword(s):  
Angina Pectoris ◽  
Treatment Strategy ◽  
Optimal Treatment ◽  
Evidence Based ◽  
Optimal Treatment Strategy

A szerző összefoglalja a stabil angina pectoris optimális kezelésével kapcsolatos evidenciákat. Az invazív kezelési stratégia (katéterterápia) térnyerése a stabil angina pectoris esetében is megfigyelhető. Számos országban – így hazánkban is – a percutan intervenciók száma meghaladja a műtéti beavatkozások gyakoriságát. A percutan intervenció, illetve a revascularisatiós műtét helyének meghatározása az angina pectoris kezelésében igen fontos és sokszor vitatott klinikai probléma. A szerző áttekinti a lehetséges három kezelési mód (gyógyszeres kezelés, percutan intervenció, revascularisatiós műtét) eredményességét vizsgáló randomizált tanulmányokat, illetve az ezekből levonható következtetéseket. A rendelkezésre álló adatok azt igazolják, hogy – a diagnózis objektív módszerrel is alátámasztott felállítása után első lépésben – a rizikófaktorok korrekciója, az életmódrendezés és az optimális gyógyszeres kezelés a választandó kezelési stratégia. Optimális gyógyszeres kezelésnek tekintjük a statin-, aszpirin-, ACE-gátló-terápiát és a tünetek befolyásolására irányuló antianginás kezelést, amelyben a béta-blokkoló alkalmazásának elsőrendű jelentősége van. A percutan intervenció első terápiás eszközként történő alkalmazása nem indokolt, mivel nincs adat arra, hogy javítaná az életkilátásokat, illetőleg a beavatkozással megelőzhető lenne a szívinfarktus. Amennyiben a panaszok gyógyszeres kezeléssel nem vagy nem eléggé befolyásolhatók, indokolt a revascularisatio (percutan intervenció vagy műtét) elvégzése, mivel e beavatkozásokkal a gyógyszeres kezelésnél jobban javítható a funkcionális stádium. A revascularisatiós műtét bizonyos esetekben (pl. főtörzsszűkület, háromérbetegség és csökkent balkamra-funkció) a panaszok kedvező befolyásolásán túlmenően a betegek életkilátásait is javítja. A rendelkezésre álló kezelési lehetőségek optimális megválasztása nemcsak a betegek számára fontos, hanem komoly gazdasági jelentősége is van.

The optimal treatment strategy for chronic hepatitis C

2005 ◽  
Vol 65 (2) ◽  
pp. 238-242
Author(s):  
S. de Rave ◽  
J.M. Vrolijk ◽  
S.W. Schalm
Keyword(s):  
Chronic Hepatitis ◽  
Hepatitis C ◽  
Chronic Hepatitis C ◽  
Treatment Strategy ◽  
Optimal Treatment ◽  
Optimal Treatment Strategy

scholarly journals Optimal treatment strategy in extremely elderly patients with hepatocellular carcinoma

2009 ◽  
Vol 9 (S1) ◽  
Author(s):  
A Ruzzenente ◽  
S Pachera ◽  
C Iacono ◽  
A Valdegamberi ◽  
P Nicoli ◽  
...  
Keyword(s):  
Hepatocellular Carcinoma ◽  
Elderly Patients ◽  
Treatment Strategy ◽  
Optimal Treatment ◽  
Optimal Treatment Strategy

PET/CT DERIVED ISCHEMIC BURDEN OF 10% PREDICTS OPTIMAL TREATMENT STRATEGY FOR SYMPTOMATIC CAD

2019 ◽  
Vol 73 (9) ◽  
pp. 3
Author(s):  
Kent G. Meredith ◽  
Stacey Knight ◽  
Raymond McCubrey ◽  
Steve Mason ◽  
David Min ◽  
...  
Keyword(s):  
Treatment Strategy ◽  
Optimal Treatment ◽  
Pet Ct ◽  
Optimal Treatment Strategy

scholarly journals RTHP-27. RARE INTRACRANIAL PRIMARY YOLK SAC TUMORS IN ADOLESCENT PATIENTS: A REPORT OF 10 CASES DEPARTMENT OF ONCOLOGY

2019 ◽  
Vol 21 (Supplement_6) ◽  
pp. vi215-vi215
Author(s):  
Weiping Hong ◽  
Yanying Yang ◽  
Linbo Cai
Keyword(s):  
Survival Time ◽  
Normal Level ◽  
Treatment Strategy ◽  
Tumor Recurrence ◽  
Severe Pneumonia ◽  
Yolk Sac ◽  
Optimal Treatment ◽  
Yolk Sac Tumors ◽  
Optimal Treatment Strategy

Abstract OBJECTIVE To retrospective analyze 10 patients with intracranial primary yolk sac tumors(YST) for exploring an optimal treatment strategy. METHODS Ten patients with YST were confirmed by pathological diagnosis (9 male and 1 female), with a median age of 13 years. Except for 1 case was lost to follow-up, 9 patients were treated with partial resection, followed by WBRT and local boosts, and then adjuvant chemotherapy. The time it took for serum AFP to decrease to the lowest level (including abnormal situation) or to return to the normal level was recorded. The brain tumor apoplexies before and after treatment were studied. Finally, OS and PFS of the patients were analyzed. RESULTS The patients were followed-up to 02-2019, with a mean follow-up time of 25.44 months. The analysis showed that the mOS and mPFS were 18 months and 7 months, respectively, and that 1y-OS and 2y-OS were 77.8% and 22.2%, while 1y-PFS and 2y-PFS were 22.2% and 11.1%. The time it took for serum AFP to decrease to the lowest level or to return to the normal level was 0–382 days, with a median time of 144 days (165.22±131.71 days). After being followed-up to 02-2019, 4 patients still survived; 4 patients died of tumor recurrence; 1 patient died of severe pneumonia. Although one of the 4 patients (tumor recurrence) was treated with 3 times of surgeries, died of tumor progression, with a survival time of 17 months. The other one patient had a 1y-PFS of 3 months, and he received surgery and chemotherapy for recurrent tumors, achieving a 2y-PFS up to 71+ months. CONCLUSION YST has a low incidence rate and is easy to recurrence, with a poor prognosis. Resection combined with chemoradiotherapy can prolong the survival time of patients, but the optimal treatment strategy remains unclear and needs further research.

scholarly journals Optimal treatment strategy for type A acute aortic dissection with intramural hematoma

2014 ◽  
Vol 147 (1) ◽  
pp. 307-311 ◽  
Author(s):  
Mitsumasa Hata ◽  
Hiroaki Hata ◽  
Akira Sezai ◽  
Isamu Yoshitake ◽  
Shinji Wakui ◽  
...  
Keyword(s):  
Aortic Dissection ◽  
Treatment Strategy ◽  
Acute Aortic Dissection ◽  
Intramural Hematoma ◽  
Type A ◽  
Optimal Treatment ◽  
Optimal Treatment Strategy

Optimal treatment strategy in patients with papillary thyroid cancer: A decision analysis

Surgery ◽  
2001 ◽  
Vol 130 (6) ◽  
pp. 921-930 ◽  
Author(s):  
Nestor F. Esnaola ◽  
Scott B. Cantor ◽  
Steven I. Sherman ◽  
Jeffrey E. Lee ◽  
Douglas B. Evans
Keyword(s):  
Thyroid Cancer ◽  
Decision Analysis ◽  
Papillary Thyroid Cancer ◽  
Treatment Strategy ◽  
Optimal Treatment ◽  
Papillary Thyroid ◽  
Optimal Treatment Strategy

Ossified pseudomeningocele after the removal of an intradural neurinoma in the lumbar spine. A case report and literature review

2018 ◽  
Vol 20 (3) ◽  
pp. 67-73
Author(s):  
G. Yu. Evzikov ◽  
M. G. Bashlachev ◽  
K. A. Belozerskih ◽  
Kh. N. Aakef
Keyword(s):  
Lumbar Spine ◽  
Treatment Strategy ◽  
Optimal Treatment ◽  
Complete Regression ◽  
Study Objective ◽  
Lumbar Drainage ◽  
Dural Sac ◽  
Biological Glue ◽  
External Lumbar Drainage ◽  
Optimal Treatment Strategy

The study objective is to describe a case of ossified pseudomeningocele after spinal surgery and to develop an optimal treatment strategy for this disorder.Materials and methods. We report a case of ossified pseudomeningocele developed after the removal of an intradural neurinoma in the lumbar spine in a female patient treated in the Clinic for Nervous Diseases, University Clinical Hospital No. 3 of the I.M. Sechenov First Moscow State Medical University in 2017. We also reviewed research literature describing this pathological condition.Results. Upon admission, the patient was diagnosed with paresis of the left foot occurring in ankle joint dorsiflexion (score 4), absence of the Achilles reflex on the left side, and hypoesthesia of two first toes of the left foot. Magnetic resonance imaging revealed a postoperative cyst of irregular shape located in soft tissues at the level of L vertebral body and compressing the dural sac. The patients underwent surgery that included separation of the pseudomeningocele cavity from the dural sac and placement of an external lumbar drainage. In the postoperative period, we observed a complete regression of neurological symptoms.Conclusion. Since ossified pseudomeningocele in the lumbar spine is extremely rare, an optimal treatment strategy has not been developed so far. We believe that maximum possible excision of the cyst wall and anastomotic sealing with a muscular or fat flap with biological glue followed by flap fixation from the extradural space is a simple and robust method of decompression and separation of the anastomosis. To eliminate the cavity in soft tissue of the paravertebral space, we recommend reconstruction of epidural fat with additional sealing using biological glue. To prevent anastomosis recurrence, we recommend placing an external lumbar drainage.

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