scholarly journals Detecting Progression of Treated Choroidal Melanomas: Is Ultrasonography Necessary?

Cancers ◽  
2021 ◽  
Vol 13 (22) ◽  
pp. 5832
Author(s):  
Guy S. Negretti ◽  
Umiya Harley ◽  
Amit K. Arora ◽  
Gordon Hay ◽  
Mandeep S. Sagoo ◽  
...  
Keyword(s):  
Treatment Failure ◽  
Tumour Progression ◽  
Local Treatment ◽  
Choroidal Melanoma ◽  
Fundus Photography ◽  
Wide Field ◽  
Increased Risk ◽  
Choroidal Melanomas ◽  
Colour Photography ◽  
The Media

Prompt detection and treatment of local treatment failure after radiotherapy for choroidal melanoma optimises any opportunities for conserving vision and the eye, possibly reducing an increased risk of metastatic disease. Long-term surveillance is therefore required but is hampered by the perceived need to perform ultrasonography, which may not be available at a patient’s local hospital. The aim of this study was to determine whether local treatment failure can reliably be detected with colour fundus photography alone, and, if so, in which patients. Patients were included in the study if diagnosed with local treatment failure between April 2016 and February 2021 after eye-conserving therapy for choroidal melanoma. Wide-field colour and fundal autofluorescence (FAF) images, optical coherence tomography (OCT), and ultrasonography (US) were analysed by two of the authors (GN and UH). The cohort included 87 patients with local treatment failure. In 75 patients with clear media, tumour progression was detected by colour photography alone in 74 (98.7%) patients. Sensitivity was not increased by the addition of either OCT or AF. One patient with clear media developed extraocular extension detected with US without visible change in the intraocular part of the tumour. In the other 12 patients, US was required because of opaque media and a consequently poor fundal view. Local treatment failure after radiotherapy for choroidal melanoma is detected in 98.7% of cases with colour photography when the media are clear. Ultrasonography is useful when photography is prevented by opaque media or tumours having locations in the far periphery.

scholarly journals Сombined Treatment of Juxtaand Parapapillary Choroidal Melanoma

2020 ◽  
Vol 17 (2) ◽  
pp. 195-201
Author(s):  
V. V. Neroev ◽  
S. V. Saakyan ◽  
А. G. Amiryan ◽  
V. V. Valskiy ◽  
А. Iu. Tsygankov
Keyword(s):  
Optic Disc ◽  
Combined Treatment ◽  
Local Treatment ◽  
Flow Analysis ◽  
Choroidal Melanoma ◽  
Laser Coagulation ◽  
Basal Diameter ◽  
Tumor Focus ◽  
Choroidal Melanomas

Purpose. Estimation the local efficacy of the combined treatment — brachytherapy (BT) with laser coagulation (LC) in choroidal melanomas of juxta and parapapillary localization in the long-term follow-up. Patients and Methods. In 2009–2013, 50 patients with choroidal melanoma of juxta and parapapillary localization were examined and treated, 32 women and 18 men aged from 32 to 76 years old (average — 53.8 ± 9.6 years). The averaged tumor height was 3.8 ± 1.3 mm, basal diameter — 11.2 ± 2.4 mm. The combined organ-preserving treatment included a LC from the optic disc with subsequent BT was performed. The indications for this method were choroidal melanomas of juxta and parapapillary localization (the distance between the optic disc and the central border of the tumor was no more than 1.5 pd), with the absence of subretinal exudate and retinal detachment in this zone. The follow-up period after the combined treatment ranged from 18 to 102 months (Me = 60 months). Results. Complete tumor resorption was achieved in the majority — 38 (76.0 %) of cases, partial — in 11 (22.0 %) patients, stabilization of the process — only in one (2.0 %) patient, continued growth was not observed in any patient. The initial size of melanoma in patients with complete and partial tumor resorption showed similar averaged values, amounting to 3.8 ± 1.3 mm and 3.6 ± 1.1 mm (p > 0.05), respectively, basal diameter — 11.1 ± 2.4 mm and 11.4 ± 2.4 mm (p > 0.05), respectively. According to the duplex scanning, an increase in the distribution density of bloodflow in the projection of the tumor focus was noted compared with the initial data. In the spectral Doppler flow analysis study, an increase in the linear characteristics of the blood flow in the tumor’s own vessels after LC was recorded. Complications included optic neuropathy (88 %), hemorrhage (36 %) and secondary glaucoma (6 %). Conclusions. The combined treatment allowed to achieve high therapeutic results — 76.0 % of the total resorption of choroidal melanomas, which have unfavorable localization for BT. Given the main focus of local treatment of the choroidal melanoma on its destruction, this technique can be used to increase the effectiveness of the BT of choroidal melanomas of juxta and parapapillary localization.

Challenges in Treating Chlamydia trachomatis, Including Rectal Infections: Is It Time to Go Back to Doxycycline?

2021 ◽  
pp. 106002802110299
Author(s):  
S. Lena Kang-Birken
Keyword(s):  
Chlamydia Trachomatis ◽  
Treatment Failure ◽  
English Language ◽  
Treatment Guidelines ◽  
Case Reports ◽  
Controlled Trial ◽  
Absolute Difference ◽  
Cochrane Library ◽  
Increased Risk ◽  
Meta Analyses

Objective: To evaluate recent publications on efficacy of single-dose azithromycin and 7-day doxycycline when treating Chlamydia trachomatis. Data Sources: A literature search of MEDLINE, EMBASE, PubMed, and Cochrane library was conducted (1990 to June 13, 2021) using the terms: Chlamydia trachomatis, genital chlamydia, rectal chlamydia, extragenital chlamydia, azithromycin, doxycycline, and treatment guidelines. ClinicalTrials.gov was searched to identify ongoing trials. Study Selection and Data Extraction: English language studies, including controlled studies, retrospective analyses, systematic reviews, meta-analyses, and case reports, reporting microbiological or clinical outcomes in adolescents and adults were considered. Data Synthesis: Systemic reviews and meta-analyses of randomized trials reported azithromycin efficacy of 96% to 97% in genital chlamydia. However, reports of treatment failure have emerged, especially among symptomatic males, with an increased risk of microbiological failure after azithromycin than doxycycline (relative risk = 2.45; 95% CI = 1.36-4.41). Retrospective analyses and prospective observational cohort studies reported lower efficacy range following azithromycin than doxycycline (74%-87% vs 92%-100%, respectively) in rectal chlamydia. First randomized controlled trial comparing azithromycin and doxycycline reported significantly higher microbiological cure following doxycycline, with absolute difference of 26% (95% CI = 16%-36%; P < 0.001). The proposed 2021 Centers for Disease Control and Prevention treatment guidelines designate doxycycline as the preferred agent for treatment at any site. Relevance to Patient Care and Clinical Practice: A growing body of evidence for treatment failure following azithromycin, especially in rectal chlamydia supports updating current practice. Conclusions: Doxycycline continues to achieve high efficacy in genital and rectal chlamydia. Clinicians should consider efficacy with convenience of dosing regimen, medication compliance, and sexual behavior risks when treating chlamydia infections.

Paediatric empyema: worsening disease severity and challenges identifying patients at increased risk of repeat intervention

2020 ◽  
Vol 105 (9) ◽  
pp. 886-890 ◽  
Author(s):  
Stuart Haggie ◽  
Hasantha Gunasekera ◽  
Chetan Pandit ◽  
Hiran Selvadurai ◽  
Paul Robinson ◽  
...  
Keyword(s):  
Treatment Failure ◽  
Initial Treatment ◽  
Group A Streptococcus ◽  
Thoracoscopic Surgery ◽  
Tertiary Hospital ◽  
Fibrinolytic Therapy ◽  
Younger Age ◽  
Increased Risk ◽  
Group A ◽  
Single Intervention

ObjectiveEmpyema is the most common complication of pneumonia. Primary interventions include chest drainage and fibrinolytic therapy (CDF) or video-assisted thoracoscopic surgery (VATS). We describe disease trends, clinical outcomes and factors associated with reintervention.Design/setting/patientsRetrospective cohort of paediatric empyema cases requiring drainage or surgical intervention, 2011–2018, admitted to a large Australian tertiary children’s hospital.ResultsDuring the study, the incidence of empyema increased from 1.7/1000 to 7.1/1000 admissions (p<0.001). We describe 192 cases (174 CDF and 18 VATS), median age 3.0 years (IQR 1–5), mean fever duration prior to intervention 6.2 days (SD ±3.3 days) and 50 (26%) cases admitted to PICU. PICU admission increased during the study from 18% to 34% (p<0.001). Bacteraemia occurred in 23/192 (12%) cases. A pathogen was detected in 131/192 (68%); Streptococcus pneumoniae 75/192 (39%), S. aureus 25/192 (13%) and group A streptococcus 13/192 (7%). Reintervention occurred in 49/174 (28%) and 1/18 (6%) following primary CDF and VATS. Comparing repeat intervention with single intervention cases, a continued fever postintervention increased the likelihood for a repeat intervention (OR 1.3 per day febrile; 95% CI 1.2 to 1.4, p<0.0001). Younger age, prolonged fever preintervention and previous antibiotic treatment were not associated with initial treatment failure (all p>0.05).ConclusionWe report increasing incidence and severity of empyema in a large tertiary hospital. One in four patients required a repeat intervention after CDF. Neither clinical variables at presentation nor early investigations were able to predict initial treatment failure.

scholarly journals Intravitreal Anti-Vascular Endothelial Growth Factor Agents for the Treatment of Diabetic Retinopathy: A Review of the Literature

Pharmaceutics ◽  
2021 ◽  
Vol 13 (8) ◽  
pp. 1137
Author(s):  
Irini Chatziralli ◽  
Anat Loewenstein
Keyword(s):  
Diabetic Retinopathy ◽  
Vitreous Hemorrhage ◽  
Fundus Photography ◽  
Panretinal Photocoagulation ◽  
Wide Field ◽  
Vascular Endothelial ◽  
Keywords Diabetic Retinopathy ◽  
Anti Vegf ◽  
The Impact

Background: Diabetic retinopathy (DR) is the leading cause of blindness in the working-age population. The purpose of this review is to gather the existing literature regarding the use of the approved anti-vascular endothelial growth (anti-VEGF) agents in the treatment of DR. Methods: A comprehensive literature review in PubMed engine search was performed for articles written in English language up to 1 July 2021, using the keywords “diabetic retinopathy”, “ranibizumab”, “aflibercept”, and “anti-VEGF”. Emphasis was given on pivotal trials and recent robust studies. Results: Intravitreal anti-VEGF agents have been found to significantly improve visual acuity and reduce retinal thickness in patients with diabetic macular edema (DME) in a long-term follow-up ranging from 1 to 5 years and are considered the standard-of-care in such patients. Regarding DR, intravitreal anti-VEGF agents provided ≥2-step improvement in DR severity on color fundus photography in about 30–35% of patients with NPDR at baseline, in the majority of clinical trials originally designed to evaluate the efficacy of intravitreal anti-VEGF agents in patients with DME. Protocol S and CLARITY study have firstly reported that intravitreal anti-VEGF agents are non-inferior to panretinal photocoagulation (PRP) in patients with proliferative DR (PDR). However, the use of new imaging modalities, such as optical coherence tomography-angiography and wide-field fluorescein angiography, reveals conflicting results about the impact of anti-VEGF agents on the regression of retinal non-perfusion in patients with DR. Furthermore, one should consider the high “loss to follow-up” rate and its devastating consequences especially in patients with PDR, when deciding to treat the latter with intravitreal anti-VEGF agents alone compared to PRP. In patients with PDR, combination of treatment of intravitreal anti-VEGF agents and PRP has been also supported. Moreover, in the specific case of vitreous hemorrhage or tractional retinal detachment as complications of PDR, intravitreal anti-VEGF agents have been found to be beneficial as an adjunct to pars plana vitrectomy (PPV), most commonly given 3–7 days before PPV, offering reduction in the recurrence of vitreous hemorrhage. Conclusions: There is no general consensus regarding the use of intravitreal anti-VEGF agents in patients with DR. Although anti-VEGF agents are the gold standard in the treatment of DME and seem to improve DR severity, challenges in their use exist and should be taken into account in the decision of treatment, based on an individualized approach.

scholarly journals Optical Coherence Tomography: An Adjunctive Tool for Differentiating between Choroidal Melanoma and Metastasis

2016 ◽  
Vol 2016 ◽  
pp. 1-7 ◽  
Author(s):  
Vicktoria Vishnevskia-Dai ◽  
Dinah Zur ◽  
Shiran Yaacobi ◽  
Iris Moroz ◽  
Hadas Newman ◽  
...  
Keyword(s):  
Optical Coherence Tomography ◽  
Retinal Thickness ◽  
Pigment Epithelium ◽  
Retinal Pigment ◽  
Choroidal Melanoma ◽  
Case Series ◽  
Subretinal Fluid ◽  
Optical Coherence ◽  
Choroidal Melanomas ◽  
Anterior Choroidal

Purpose.To investigate the value of optical coherence tomography (OCT) for differentiation between choroidal melanoma and metastasis based on characteristics of the anterior choroidal surface and the chorioretinal interface.Methods.This retrospective observational case series included 29 patients with untreated choroidal melanomas and 21 patients with untreated choroidal metastases. Regularity and lobularity characteristics of the anterior choroidal surface were evaluated in a masked manner. Retinal and retinal pigment epithelium (RPE) findings were documented as well.Results.OCT demonstrated a regular and smooth anterior choroidal surface in 89.7% of the eyes with melanoma and in 47.6% of the eyes with metastasis (p=0.002; sensitivity = 89.7%; specificity = 52.4%). The anterior choroidal contour was lobulated in 81.0% of the eyes with metastasis versus 17.2% of the eyes with melanoma (p<0.001; sensitivity = 82.8%; specificity = 81.0%). RPE thickness and neuroretinal characteristics (e.g., retinal thickness, the presence of cysts, and the presence of subretinal fluid) were similar in both choroidal tumors.Conclusion. OCT may serve as a noninvasive adjunctive tool for the differential diagnosis of choroidal tumors. Choroidal melanomas usually demonstrate regular surfaces on OCT, while choroidal metastases usually have an irregular and lobulated surface.

Approach to the patient in the diagnosis of Choroidal Malignant Melanoma. Question and Answer

2019 ◽  
pp. 317-320
Keyword(s):  
Risk Factor ◽  
Malignant Melanoma ◽  
Diagnostic Method ◽  
Choroidal Melanoma ◽  
Intraocular Tumors ◽  
Indirect Ophthalmoscopy ◽  
Choroidal Malignant Melanoma ◽  
Choroidal Melanomas ◽  
Venous Phase ◽  
Treatment Changes

The most valuable diagnostic method in intraocular tumors is indirect ophthalmoscopy. USG is very important in determining the thickness of the lesion and documenting post-treatment changes. However, in today's conditions, we have important auxiliary examination opportunities. OCT is especially important in detecting macular edema and fluid. In choroidal melanomas, thickening and edema of the macula may be observed before treatment due to increased VEGF levels in the eye. OCT is important in detecting such changes. Since FAF shows the amount of lipofuscin in the lesion, it reveals the activity of the lesion. Hyperotofluorescence of> 50% of the lesion surface, in other words, the diffuse pattern is a risk factor for growth and metastasis. On fluorescein angiography, choroidal melanoma shows focal hyperfluorescence starting from the late venous phase and gradually increasing.

Predictive Value of First Posttreatment Imaging Using Standardized Reporting in Head and Neck Cancer

2019 ◽  
Vol 161 (6) ◽  
pp. 978-985 ◽  
Author(s):  
Derek Hsu ◽  
Falgun H. Chokshi ◽  
Patricia A. Hudgins ◽  
Suprateek Kundu ◽  
Jonathan J. Beitler ◽  
...  
Keyword(s):  
Treatment Failure ◽  
Head And Neck ◽  
Proportional Hazards ◽  
Proportional Hazards Model ◽  
Strong Association ◽  
Treatment Completion ◽  
Tertiary Hospital ◽  
Cox Proportional Hazards ◽  
Cox Proportional Hazards Model ◽  
Increased Risk

Objective The Neck Imaging Reporting and Data System (NI-RADS) is a standardized numerical reporting template for surveillance of head and neck squamous cell carcinoma (HNSCC). Our aim was to analyze the accuracy of NI-RADS on the first posttreatment fluorodeoxyglucose positron emission tomography/contrast-enhanced computed tomography (PET/CECT). Study Design Retrospective cohort study. Setting Academic tertiary hospital. Subject and Methods Patients with HNSCC with a 12-week posttreatment PET/CECT interpreted using the NI-RADS template and 9 months of clinical and radiologic follow-up starting from treatment completion between June 2014 and July 2016 were included. Treatment failure was defined as positive tumor confirmed by biopsy or Response Evaluation Criteria in Solid Tumors criteria. Cox proportional hazards models were performed. Results This study comprised 199 patients followed for a median of 15.5 months after treatment completion (25% quartile, 11.8 months; 75% quartile, 20.2 months). The rates of treatment failure increased with each incremental increase in NI-RADS category from 1 to 3 (4.3%, 9.1%, and 42.1%, respectively). A Cox proportional hazards model demonstrated a strong association between NI-RADS categories and treatment failure at both primary and neck sites (hazard ratio [HR], 2.60 and 5.22, respectively; P < .001). In the smaller treatment subgroup analysis, increasing NI-RADS category at the primary site in surgically treated patients and treatment failure did not achieve statistically significant association (HR, 0.88; P = .82). Conclusion Increasing NI-RADS category at the baseline posttreatment PET/CECT is strongly associated with increased risk of treatment failure in patients with HNSCC.

scholarly journals Residual or Recurrent Precancerous Lesions After Treatment of Cervical Lesions in Human Immunodeficiency Virus–infected Women: A Systematic Review and Meta-analysis of Treatment Failure

2019 ◽  
Vol 69 (9) ◽  
pp. 1555-1565 ◽  
Author(s):  
Pierre Debeaudrap ◽  
Joelle Sobngwi ◽  
Pierre-Marie Tebeu ◽  
Gary M Clifford
Keyword(s):  
Systematic Review ◽  
Cervical Cancer ◽  
Human Immunodeficiency Virus ◽  
Treatment Failure ◽  
Post Treatment ◽  
High Grade ◽  
Cervical Lesions ◽  
Pooled Prevalence ◽  
Increased Risk ◽  
Immunodeficiency Virus

Abstract Background Screening and treating premalignant cervical lesions (cervical intraepithelial neoplasia 2+ [CIN2+]) is an effective way to prevent cervical cancer, and recommendations exist for the monitoring of treatment success. Yet, there is no specific recommendation for human immunodeficiency virus (HIV)-infected women, who are at a known, increased risk of cervical cancer. Methods A systematic review was performed by searching MEDLINE, EMBASE, and Web of Science for studies published from January 1980 through May 2018. Eligible studies described the prevalence of histologically- and/or cytologically-defined lesions in HIV-infected women at least 6 months post-treatment. The primary endpoint was treatment failure, defined as the presence of residual and/or recurrent high-grade CIN2+/high-grade squamous intraepithelial lesions post-treatment. The pooled prevalence in HIV-infected women and the odds ratios (ORs) for HIV-infected compared to HIV-uninfected women were estimated using random-effects models. Results Among 40 eligible studies, the pooled prevalence of treatment failure in HIV-infected women was 21.4% (95% confidence interval [CI] 15.8–27.0). There was no significant difference in the treatment failure prevalence for cryotherapy (13.9%, 95% CI 6.1–21.6) versus loop electrosurgical excision procedure (13.8%, 95% CI 8.9–18.7; P = .9), but the treatment failure prevalence was significantly higher in women with positive (47.2%, 95% CI 22.0–74.0) than with negative (19.4%, 95% CI 11.8–30.2) excision margin (OR 3.4, 95% CI 1.5–7.7). Treatment failure was significantly increased in HIV-infected versus HIV-uninfected women, both overall (OR 2.7, 95% CI 2.0–3.5) and in all sub-group analyses. Conclusions There is strong evidence for an increased risk of treatment failure in HIV-infected women, in comparison to their HIV-negative counterparts. The only significant predictor of treatment failure in HIV-infected women was a positive margin status, but further data is needed on long-term outcomes after ablative treatment in HIV-infected women.

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