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"Standardized management"

Min-Jeong Kim, Eun Seok Kim, Seung-Gu Yeo
BACKGROUND: Standard management for locally advanced rectal cancer (LARC) involves preoperative chemoradiotherapy (CRT) and radical surgery. However, this level of treatment may be unnecessary for a subgroup of LARC patients. Previous reports have shown that approximately 20% of LARC patients experience a complete tumor response to preoperative CRT. Post-CRT nonoperative management of these patients may prevent morbidities associated with radical surgery. To our knowledge, this case report firstly presents the favorable long-term outcomes of a LARC patient who underwent definitive aim CRT...
October 2016: Medicine (Baltimore)
Anahita Dua, Steven Koprowski, Gilbert Upchurch, Cheong J Lee, Sapan S Desai
BACKGROUND: In 2014, we published a series of articles in the Journal of Vascular Surgery that detailed the decrease in volume of open aneurysm repair (OAR) completed for abdominal aortic aneurysm (AAA) by vascular surgery trainees. At that time, only data points from 2000 through 2011 were available, and reliable predictions could only be made through 2015. Lack of data on endovascular aneurysm repair (EVAR) using fenestrated (FEVAR) and branched (BrEVAR) endografts also affected our findings...
October 12, 2016: Journal of Vascular Surgery
Ichiro Kurokawa, Naoki Oiso, Akira Kawada
The standard management of acne vulgaris in Japan includes a combination of topical treatment with benzoyl peroxide (BPO) and BPO/clindamycin (CLDM), topical adapalene and systemic antimicrobials. However, the treatment of therapy-resistant complications such as postinflammatory hyperpigmentation (PIH), erosions with inflamed red papules and atrophic scars has not been established. We performed chemical peeling with glycolic acid and iontophoresis with ascorbyl 2-phosphate 6-palmitate and DL-α-tocopherol phosphate for the treatment of PIH, erosions with inflamed red papules and non-inflamed atrophic scars in 31 patients with acne vulgaris (mild to severe severity), and evaluated the efficacy and safety of these interventions...
October 15, 2016: Journal of Dermatology
Prabhu Nagnathappa Kasture, K H Nagabhushan, Arun Kumar
INTRODUCTION: Dengue is a rapidly expanding global health problem. Approximately 2.5 billion people live in dengue-risk regions with about 100 million new cases each year worldwide. The cumulative dengue diseases burden has attained an unprecedented proportion in recent times with sharp increase in the size of human population at risk. The management of dengue virus infection is essentially supportive and symptomatic and no specific treatment is available for increasing the fallen platelets, which have a significant role in causing the mortality of dengue patient...
June 2016: Journal of the Association of Physicians of India
Christine Graven, Kim Brock, Keith D Hill, Sue Cotton, Lynette Joubert
BACKGROUND AND PURPOSE: Depression is a common issue after stroke. A focus on assisting people to achieve their personal participation goals may reduce levels of depression. The aim of this study was to investigate the effectiveness of a person-centered, integrated approach on facilitating goal achievement in the first year poststroke on depressive symptoms. METHODS: This study was a randomized controlled trial that addressed ways to enhance participation in patient-valued activities and intermittently screen for adverse sequelae postdischarge from rehabilitation...
October 13, 2016: Stroke; a Journal of Cerebral Circulation
Ling Zhao, Wei Wang, Jiwen Zhong, YaYun Li, YanZi Cheng, Zhenjiao Su, Wei Zheng, Xiang-Dong Guan
PURPOSE: To evaluate the clinical effects of magnesium sulfate in the treatment of diffuse axonal injury (DAI). PATIENTS AND METHODS: This study was a randomized, double-blind, placebo-controlled trial conducted in the First Affiliated Hospital of Sun Yat-sen University, Guangzhou and Zhuhai People's Hospital, Zhuhai, two trauma center hospitals. A total of 128 patients suffered from DAI, with initial Glasgow coma scale (GCS) scores of 3-8. They were randomly divided into two groups: magnesium sulfate treatment (MST) group (n=64) and control group (n=64)...
2016: Therapeutics and Clinical Risk Management
Mohamed El-Shazly, Mohamed Aziz, Hamdy Aboutaleb, Shady Salem, Eid El-Sherif, Mohamed Selim, Mohamed Sultan, Mohamed Omar, Tarek Abd Elbaky, Fouad Zanaty, Talal Alenezi, Abdelazeem Ghobashi, Adel Allam
BACKGROUND: Fournier's gangrene (FG) is an acute progressive necrotizing fasciitis of the genital area and perineum with possible extension to the abdominal wall. Surgical debridement is the gold standard management modality of established patients. Equivocal (early) FG represents a challenge in diagnosis. The objective of this study was to compare conservative management and early exploration in cases of equivocal (early) FG. METHODS: This was an observational study where data of all patients diagnosed as early FG in our departments over 4 years (2011-2015) were enrolled...
October 2016: Therapeutic Advances in Urology
Nina E Diana, Saraladevi Naicker
The prevalence of HIV-associated chronic kidney disease (CKD) varies geographically and depends on the definition of CKD used, ranging from 4.7% to 38% globally. The incidence, however, has decreased with the use of effective combined antiretroviral therapy (cART). A wide variety of histological patterns are seen in HIV-associated kidney diseases that include glomerular and tubulointerstitial pathology. In resource-rich settings, there has been a plateau in the incidence of end-stage renal disease secondary to HIV-associated nephropathy (HIVAN)...
2016: International Journal of Nephrology and Renovascular Disease
X F Wang, H Y Zhao, Y H Feng
No abstract text is available yet for this article.
August 20, 2016: Chinese Journal of Industrial Hygiene and Occupational Diseases
T Lurthu Reetha, J Johnson Rajeswar, T J Harikrishnan, K Sukumar, P Srinivasan, J John Kirubakaran
AIM: To study the effect of Newcastle disease (ND) oral pellet vaccine in egg production and egg quality in desi chicken. MATERIALS AND METHODS: The study was conducted at Veterinary University Training and Research Centre, Tiruchirapalli, Tamil Nadu. A total of 48-day-old desi chicks obtained from a private hatchery in Namakkal, Tamil Nadu, were maintained under cage system of rearing up to 52 weeks of age as per standard management practices. All the 48 chicks were divided into six groups having eight chicks in each group were subjected to different treatment regimes...
August 2016: Veterinary World
Clay Angel, Kristen Brooks, Julie Fourie
CONTEXT: Delirium is common among inpatients aged 65 years and older and is associated with multiple adverse consequences, including increased length of stay (LOS). However, delirium is frequently unrecognized and poorly understood. At one hospital, baseline management of delirium on medical-surgical units varied greatly, and psychiatric consultations focused exclusively on crisis management. OBJECTIVE: To implement a multidisciplinary program for rapid identification and proactive management of patients with delirium on medical-surgical units...
September 9, 2016: Permanente Journal
P Brinas, C Bréhin, S Breinig, P Galinier, I Claudet, P Micheau, O Abbo
Tracheal injuries are a rare but potentially lethal entity, most particularly in pediatrics. While standardized management allows quick therapeutic decisions in adults, based on the results of the initial bronchoscopy, the use of diagnostic exams remains unclear during childhood. We describe the case of a 6-year-old patient with a posterior tracheal wall injury due to a car accident, which was managed without tracheal endoscopy. Based on our experience and on a literature review, we suggest clarifying the management of tracheal injury in children, defining the place of computerized tomodensitometry and endoscopy in the decision process...
October 2016: Archives de Pédiatrie: Organe Officiel de la Sociéte Française de Pédiatrie
Ilana B Richman, Michael Fairley, Mads Emil Jørgensen, Alejandro Schuler, Douglas K Owens, Jeremy D Goldhaber-Fiebert
Importance: Among high-risk patients with hypertension, targeting a systolic blood pressure of 120 mm Hg reduces cardiovascular morbidity and mortality compared with a higher target. However, intensive blood pressure management incurs additional costs from treatment and from adverse events. Objective: To evaluate the incremental cost-effectiveness of intensive blood pressure management compared with standard management. Design, Setting, and Participants: This cost-effectiveness analysis conducted from September 2015 to August 2016 used a Markov cohort model to estimate cost-effectiveness of intensive blood pressure management among 68-year-old high-risk adults with hypertension but not diabetes...
September 14, 2016: JAMA Cardiology
Denis Migliorini, Sara Fertani, Pierre-Yves Dietrich
The standard management of a single brain metastasis is usually maximal resection when feasible followed by radiotherapy. In case of multiple lesions, several options have to be considered depending on the natural behavior of the primary tumor, the localization of brain lesions, their functional impact and related symptoms. In case of life-threatening brain metastasis, debulking surgery is often proposed first, with the risk of major bleeding and postponing the initiation of other treatments. This approach is now challenged by the rapid tumor shrinkage that could be observed with novel targeted therapies...
October 2016: CNS Oncology
Matthew C Kinney, David Nagle, Tracey Bastrom, Michael S Linn, Alexandra K Schwartz, Andrew T Pennock
BACKGROUND: Displaced tibial shaft fractures are common in adolescent patients, yet there is no standardized management strategy. We compared surgical fixation and closed reduction and casting (CRC) of these fractures to assess treatment outcomes and determine predictors of failure. METHODS: We retrospectively reviewed all patients aged 12 to 18 who presented with a displaced tibial shaft fracture that required reduction over an 8-year period. Exclusion criteria included open fractures and lack of follow-up to radiographic union or to 6 months from the index procedure...
October 2016: Journal of Pediatric Orthopedics
Robert D Keeley, David S Brody, Matthew Engel, Brian L Burke, Kimberly Nordstrom, Ernesto Moralez, L Miriam Dickinson, Caroline Emsermann
Objective: To examine the effects of Motivational Interviewing (MI) conducted by primary care providers on rates of improvement over time for depressive symptoms and remission among low-income patients with newly diagnosed Major Depressive Disorder. Method: Ten care teams were randomized to MI with standard management of depression (MI-SMD; 4 teams, 10 providers, 88 patients) or SMD alone (6 teams, 16 providers, 80 patients). Patients were assessed at 6, 12 and 36 weeks with the Patient Health Questionnaire-9 (PHQ-9)...
September 5, 2016: Journal of Consulting and Clinical Psychology
María Martín-Cameán, Elsa Delgado-Sánchez, Antonio Piñera, Maria Dolores Diestro, Javier De Santiago, Ignacio Zapardiel
Nowadays, the standard management of advanced epithelial ovarian cancer is correct surgical staging and optimal tumour cytoreduction followed by platinum and taxane-based chemotherapy. Standard surgical staging consists of peritoneal washings, total hysterectomy, and bilateral salpingo-oophorectomy, inspection of all abdominal organs and the peritoneal surface, biopsies of suspicious areas or randomised biopsies if they are not present, omentectomy and para-aortic lymphadenectomy. After this complete surgical staging, the International Federation of Gynaecology and Obstetrics (FIGO) staging system for ovarian cancer is applied to determine the management and prognosis of the patient...
2016: Ecancermedicalscience
Pouya Iranmanesh, Olivier Tobler, Sandra De Sousa, Jean-Louis Frossard, Philippe Morel, Christian Toso
BACKGROUND AND AIMS: Initial cholecystectomy for patients at intermediate-risk of common bile duct (CBD) stone (including increased liver function tests but bilirubin <4 mg/dL and no cholangitis) showed decreased length of stay (LOS) and fewer common bile duct investigations without increased morbidity compared with sequential CBD endoscopic assessment and subsequent cholecystectomy in a randomized controlled trial. The objectives were to prospectively validate these results in daily clinical practice and discuss current guidelines...
August 24, 2016: Gastrointestinal Endoscopy
Boris Michael Holzapfel, Ferdinand Wagner, Laure Christine Martine, Stephan Reppenhagen, Maximilian Rudert, Michael Schuetz, Jim Denham, Jan-Thorsten Schantz, Dietmar Werner Hutmacher
Currently used surgical techniques to reconstruct tissue defects after resection of musculoskeletal tumours are associated with high complication rates. This drives a strong demand for innovative therapeutic concepts that are able to improve the clinical outcomes of patients suffering from bone and soft tissue tumours. Tissue engineering and regenerative medicine (TE&RM) provides a technology platform based on biochemical, molecular, cellular and biomaterials modules to selectively direct tissue healing processes for improved defect regeneration...
September 2016: Cancer Metastasis Reviews
Francesco Smeraglia, Angelo Del Buono, Nicola Maffulli
INTRODUCTION: Fractures of the distal radius account for 15% of all fractures. The use of arthroscopy is increasingly popular in the last years, with the goal to achieve a better anatomical reduction of the articular fragments. SOURCES OF DATA: We searched the literature on Medline (PubMed), Web of Science and Scopus databases using the combined keywords 'wrist', 'distal radial fracture', 'distal radius fracture' and 'arthroscopy'. Twenty-eight studies were identified...
September 2016: British Medical Bulletin
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