scholarly journals Treatment of Aspergillosis

2018 ◽  
Vol 4 (3) ◽  
pp. 98 ◽  
Author(s):  
Jeffrey Jenks ◽  
Martin Hoenigl
Keyword(s):  
Neutropenic Patient ◽  
Treatment Options ◽  
Primary Treatment ◽  
Antifungal Prophylaxis ◽  
Successful Outcome ◽  
High Morbidity ◽  
Oral Itraconazole ◽  
Chronic Pulmonary Aspergillosis ◽  
Patient Groups

Infections caused by Aspergillus spp. remain associated with high morbidity and mortality. While mold-active antifungal prophylaxis has led to a decrease of occurrence of invasive aspergillosis (IA) in those patients most at risk for infection, breakthrough IA does occur and remains difficult to diagnose due to low sensitivities of mycological tests for IA. IA is also increasingly observed in other non-neutropenic patient groups, where clinical presentation is atypical and diagnosis remains challenging. Early and targeted systemic antifungal treatment remains the most important predictive factor for a successful outcome in immunocompromised individuals. Recent guidelines recommend voriconazole and/or isavuconazole for the primary treatment of IA, with liposomal amphotericin B being the first alternative, and posaconazole, as well as echinocandins, primarily recommended for salvage treatment. Few studies have evaluated treatment options for chronic pulmonary aspergillosis (CPA), where long-term oral itraconazole or voriconazole remain the treatment of choice.

scholarly journals Immune Parameters for Diagnosis and Treatment Monitoring in Invasive Mold Infection

2019 ◽  
Vol 5 (4) ◽  
pp. 116 ◽  
Author(s):  
Jeffrey Jenks ◽  
Stephen Rawlings ◽  
Carol Garcia-Vidal ◽  
Philipp Koehler ◽  
Toine Mercier ◽  
...  
Keyword(s):  
Treatment Monitoring ◽  
Antifungal Prophylaxis ◽  
Antifungal Treatment ◽  
Diagnosis And Treatment ◽  
Response To Treatment ◽  
Successful Outcome ◽  
High Morbidity ◽  
Immune Parameters ◽  
Immunologic Markers ◽  
Invasive Mold Infections

Infections caused by invasive molds, including Aspergillus spp., can be difficult to diagnose and remain associated with high morbidity and mortality. Thus, early diagnosis and targeted systemic antifungal treatment remains the most important predictive factor for a successful outcome in immunocompromised individuals with invasive mold infections. Diagnosis remains difficult due to low sensitivities of diagnostic tests including culture and other mycological tests for mold pathogens, particularly in patients on mold-active antifungal prophylaxis. As a result, antifungal treatment is rarely targeted and reliable markers for treatment monitoring and outcome prediction are missing. Thus, there is a need for improved markers to diagnose invasive mold infections, monitor response to treatment, and assist in determining when antifungal therapy should be escalated, switched, or can be stopped. This review focuses on the role of immunologic markers and specifically cytokines in diagnosis and treatment monitoring of invasive mold infections.

scholarly journals P.017 Efficacy of stereotactic intracavitary instillation of 90yttrium colloid for treatment of cystic sellar/parasellar tumors

2017 ◽  
Vol 44 (S2) ◽  
pp. S18-S18
Author(s):  
DB Clarke ◽  
AL Hebb ◽  
R Hill ◽  
SA Imran ◽  
A Mishra ◽  
...  
Keyword(s):  
Early Experience ◽  
Primary Treatment ◽  
Visual Field Defects ◽  
High Morbidity ◽  
Efficacy And Safety ◽  
Cystic Tumors ◽  
Pre Treatment ◽  
Health Canada ◽  
Neurosurgical Techniques

Background: Traditional neurosurgical techniques and/or stereotactic radiotherapy, although effective for solid tumors, can be associated with high morbidity and be relatively ineffective for long-term control of cystic sellar/parasellar tumors. The rationale of our study was to examine the efficacy and safety of stereotactic intracavitary instillation of 90yttrium colloid for the primary treatment of cystic tumors. Methods: As part of a Health Canada approved clinical trial, we have enrolled nine patients (6 females, 3 males; mean age 64, range 43 to 83 years) for treatment of symptomatic and/or enlarging cysts. Ten cystic sellar/parasellar lesions underwent right frontal stereotactic insertion of 90yttrium colloid to deliver a radiation dose of 200 Gy to the cyst wall. Results: Compared with pre-treatment cyst volumes (mean 4.6 cc; range 0.8-16.1 cc), the cysts decreased in size at 3 months (2.6 cc; 0.2-10 cc) with further shrinkage (n=5) at 9 months (1 cc; 0.1-2.7 cc). Of 9 patients with pre-operation visual field defects, 6 showed improvement. The single complication was a delayed (1 month) incomplete CNIII palsy. Conclusions: Our early experience indicates that 90yttrium colloid delivered to a cystic craniopharyngioma provides an efficacious alternative to open surgery for primary treatment of these cystic lesions.

scholarly journals The Pain System in Oesophageal Disorders: Mechanisms, Clinical Characteristics, and Treatment

2011 ◽  
Vol 2011 ◽  
pp. 1-14 ◽  
Author(s):  
Christian Lottrup ◽  
Søren Schou Olesen ◽  
Asbjørn Mohr Drewes
Keyword(s):  
Severe Disease ◽  
Treatment Options ◽  
Primary Treatment ◽  
Lifestyle Changes ◽  
Sensory Receptors ◽  
Pain Mechanisms ◽  
Afferent Nerves ◽  
The Central Nervous System ◽  
The Brain

Pain is common in gastroenterology. This review aims at giving an overview of pain mechanisms, clinical features, and treatment options in oesophageal disorders. The oesophagus has sensory receptors specific for different stimuli. Painful stimuli are encoded by nociceptors and communicated via afferent nerves to the central nervous system. The pain stimulus is further processed and modulated in specific pain centres in the brain, which may undergo plastic alterations. Hence, tissue inflammation and long-term exposure to pain can cause sensitisation and hypersensitivity. Oesophageal sensitivity can be evaluated ,for example, with the oesophageal multimodal probe. Treatment should target the cause of the patient's symptoms. In gastro-oesophageal reflux diseases, proton pump inhibitors are the primary treatment option, surgery being reserved for patients with severe disease resistant to drug therapy. Functional oesophageal disorders are treated with analgesics, antidepressants, and psychological therapy. Lifestyle changes are another option with less documentation.

Inconsistency in the Management of Patients with Hepatocellular Carcinoma: The Need for a Strict Protocol

2011 ◽  
Vol 77 (2) ◽  
pp. 207-214 ◽  
Author(s):  
John Theodoropoulos ◽  
Ari Brooks
Keyword(s):  
Hepatocellular Carcinoma ◽  
Recent Progress ◽  
Treatment Options ◽  
Long Term Outcomes ◽  
Therapeutic Modalities ◽  
Unified Protocol ◽  
Dismal Prognosis ◽  
Patient Groups ◽  
Strict Protocol

As more therapies become available for the treatment of hepatocellular carcinoma (HCC), the management of patients with HCC is more complex, and the indications for the various therapeutic modalities are less clear. Although all of the treatment options have shown a certain efficacy in well-selected patient groups, their everyday use, especially in nonspecialized centers, is not always appropriate. We report our experience with 81 individuals who were diagnosed and treated in our institution between 2001 and 2007. Only patients who received transplants had good long-term outcomes, and we noted significant inconsistencies in the management of patients with similar stages of disease and degrees of cirrhosis. Despite recent progress, HCC still carries an overall dismal prognosis, making the optimization of the therapeutic plan mandatory to improve outcomes. We believe that a unified protocol, as well as the early involvement of the hepatology and transplant teams, can help physicians optimize the care of these patients.

Skull base osteitis following fungal sinusitis

1998 ◽  
Vol 112 (1) ◽  
pp. 92-97 ◽  
Author(s):  
Andrew C. Swift ◽  
David W. Denning
Keyword(s):  
Skull Base ◽  
Antifungal Agents ◽  
Treatment Options ◽  
Surgical Excision ◽  
Invasive Disease ◽  
Fungal Sinusitis ◽  
Non Invasive ◽  
Oral Itraconazole ◽  
Cranial Neuropathies

AbstractAspergillus sp. sinusitis is not uncommon in immunocompromised patients but is unusual in patients who are not immunocompromised. The disease may occur as a saprophytic condition, as an allergic sinusitis or as a potentially lethal invasive disease. The differentiation between non-invasive and invasive Aspergillus sp. sinusitis is crucial and this distinction is fully discussed. The treatment options are also considered. Invasive disease requires aggressive treatment with long-term antifungal agents in sufficient doses combined with wide surgical excision.We present a patient who presented with invasive Aspergillus fumigatus sinusitis and subsequently developed cranial neuropathies and skull base osteitis. She was initially treated with oral itraconazole (400 mg daily) for 18 months but due to lack of response this was changed to a new experimental oral azole (voriconazole) which was continued for a further 14 months. She has since remained well for the last five years.

Experimental Encapsulating Peritoneal Sclerosis Models: Pathogenesis and Treatment

2008 ◽  
Vol 28 (5_suppl) ◽  
pp. 21-28 ◽  
Author(s):  
Sun-Hee Park ◽  
Yong-Lim Kim ◽  
Bengt Lindholm
Keyword(s):  
Risk Factors ◽  
Peritoneal Dialysis ◽  
Animal Models ◽  
Genetic Factors ◽  
Treatment Options ◽  
Therapeutic Agents ◽  
Experimental Models ◽  
High Morbidity ◽  
Multiple Risk Factors

Encapsulating peritoneal sclerosis (EPS) is rare but, with its high morbidity and mortality, it represents one of the most serious complications of long-term peritoneal dialysis. The pathogenesis of EPS has not been elucidated yet; therefore, there has been a growing interest in establishing appropriate animal models for EPS that would explain the pathogenesis of EPS and verify the efficacy of therapeutic agents targeting pathways such as angiogenesis and/ or fibrosis. This brief review provides an update on previously published animal experimental models of EPS. Based on this review, we discuss some aspects of pathogenesis and treatment options in patients with EPS. Experimental models of EPS cannot exactly reproduce human EPS because the latter most likely has a diverse etiology, including the influences of uremia, dialysis, and genetic factors. There is a need for new animal models that would test interventions targeting multiple risk factors while also taking into account putative genetic diversities that most likely are involved in human EPS.

Electrocardiogram Recognition and Ablation of Atrial Tachycardia

2011 ◽  
Vol 3 (1) ◽  
pp. 80
Author(s):  
Alexander Feldman ◽  
Jonathan M Kalman ◽  
◽  
Keyword(s):  
Catheter Ablation ◽  
Atrial Tachycardia ◽  
Primary Treatment ◽  
P Wave ◽  
Wave Morphology ◽  
Focal Atrial Tachycardia ◽  
Mapping Techniques ◽  
Electrocardiogram Ecg ◽  
Surface Electrocardiogram

Focal atrial tachycardia (AT) is a relatively uncommon cause of supraventricular tachycardia, but when present is frequently difficult to treat medically. Atrial tachycardias tend to originate from anatomically determined atrial sites. The P-wave morphology on surface electrocardiogram (ECG) together with more sophisticated contemporary mapping techniques facilitates precise localisation and ablation of these ectopic foci. Catheter ablation of focal AT is associated with high long-term success and may be viewed as a primary treatment strategy in symptomatic patients.

Overview of Treatment Options for Critical Limb Ischaemia Patients

2011 ◽  
Vol 7 (1) ◽  
pp. 51 ◽  
Author(s):  
Frederic Baumann ◽  
Nicolas Diehm ◽  
◽  
Keyword(s):  
Treatment Options ◽  
Critical Limb Ischaemia ◽  
Treatment Modalities ◽  
High Morbidity ◽  
Limb Ischaemia ◽  
Arterial Revascularisation ◽  
Planning Treatment ◽  
Treatment Concepts ◽  
Peripheral Arterial ◽  
Renal Origin

Patients with critical limb ischaemia (CLI) constitute a subgroup of patients with particularly severe peripheral arterial occlusive disease (PAD). Treatment modalities for these patients that often exhibit multilevel lesions and severe vascular calcifications are complicated due to multiple comorbidities, i.e. of cardiac and vascular but also of renal origin. These need to be taken into consideration while planning treatment options. Although CLI is associated with considerably high morbidity and mortality rates, the clinical outcome of patients being subjected to revascularisation has improved substantially in recent years. This is mainly due to improved secondary prevention strategies as well as dedicated endovascular innovations for this most challenging patient cohort. The aim of this article is to provide a discussion of the contemporary treatment concepts for CLI patients with a focus on arterial revascularisation.

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