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Methotrexate and surgery

David E Rosow, Jamal Ahmed
Importance: Adult laryngotracheal stenosis (LTS) is typically managed surgically, but some patients fail treatment because of rapid restenosis or granulation tissue formation. The need for frequent surgery or tracheostomy reduces the quality of life in these patients and poses a significant challenge for the treating physician. New adjuvant treatments are required to reduce the surgical burden of this condition. Objective: To examine whether patients with rapidly recurrent nonvasculitic LTS who fail surgical management of their stenosis (ie, requiring dilation more frequently than every 6 months) experience longer intervals between surgical procedures when receiving adjuvant treatment with low-dose methotrexate...
October 20, 2016: JAMA Otolaryngology—Head & Neck Surgery
M C Winter, J A Tidy, A Hills, J Ireson, S Gillett, K Singh, B W Hancock, R E Coleman
OBJECTIVE: To evaluate the outcome of patients treated with second-line chemotherapy for methotrexate-resistant low-risk GTN at the Sheffield Centre, UK between 2001 and 2015, including the novel use of single-agent carboplatin as a strategy to reduce exposure to combination chemotherapy. METHODS: 392 low-risk GTN patients were treated with first-line methotrexate. The selection of chemotherapy regimen following methotrexate-resistance depended on the volume of residual disease as indicated by the serum hCG value at the time, with patients switching to either single-agent dactinomycin at an hCG level<150IU/L from 2001-2010 and <300IU/L since 2010, or to combination treatment with etoposide/dactinomycin (EA) above these thresholds...
October 15, 2016: Gynecologic Oncology
Soumyarwit Manna, James J Augsburger, Zelia M Correa, Marwan F Al-Rjoub, Marepalli B Rao, Rupak K Banerjee
PURPOSE: The purpose of this study is to noninvasively evaluate the safety and toxicity of a chitosan (CS) and polylactic acid (PLA)-based sustained-release methotrexate (MTX) intravitreal microimplant in normal rabbit eyes using electroretinography (ERG). METHODS: PLA-coated CS-based microimplants containing 400 μg of MTX and placebo microimplants (without drug) were surgically implanted in the vitreous of the right and the left eyes, respectively, in each of the 8 New Zealand rabbits using minimally invasive technique...
October 18, 2016: Journal of Ocular Pharmacology and Therapeutics
D Jurkovic, M Memtsa, E Sawyer, Ana Donaldson, A Jamil, K Schramm, Y Sana, M Otify, L Farahani, N Nunes, G Ambler, J A Ross
OBJECTIVE: Methotrexate is routinely used worldwide for medical treatment of clinically stable women with tubal ectopic pregnancies. This is despite the lack of robust evidence to show its superior effectiveness over expectant management. The aim of our multicentre randomised trial study was to compare the success rates of methotrexate with placebo for the conservative treatment of tubal ectopic pregnancies. METHODS: The study was multicentre; it took place in three UK early pregnancy units between January 2006 and June 2014...
October 12, 2016: Ultrasound in Obstetrics & Gynecology
Semih Z Uludag, Mehmet S Kutuk, Mehmet Ak, Mahmut T Ozgun, Mehmet Dolanbay, Ercan M Aygen, Yılmaz Sahin
OBJECTIVE: The aim of this study was to compare the use of systemic and local methotrexate in the treatment of cesarean scar pregnancy. STUDY DESIGN: In this retrospective cohort study, we collected the data of 44 patients with cesarean scar pregnancy. The patients were grouped according to treatment modality: Group 1, local methotrexate injection (n=17) and Group 2, systemic methotrexate (n=27). The groups were compared with respect to side effects, recovery time, reproductive outcome, and treatment cost...
September 21, 2016: European Journal of Obstetrics, Gynecology, and Reproductive Biology
Fatemeh Davari-Tanha, Mohadese Ghazi, Mona Mohseni, Farahnaz Ahmadi
Objective: To evaluate the plasma creatine phosphokinase (CPK) level after injection of methotrexate (MTX) as a predictor of treatment success in ectopic pregnancy (EP). Materials and methods: One hundred women treated with single dose of methotrexate for ectopic pregnancy were evaluated in a prospective study, for CPK and ß-subunit of human chorionic gonadotropin (ß-hCG) levels. They received intramuscular MTX at a dose of 50 mg/m2. The day of injection was considered as day 1 (D1). CPK level on the day of Methotrexate injection was compared between success group who were treated by a single MTX injection, and the unsuccessful groupwho were treated by two or three MTX injections or by surgery...
June 2016: Journal of Family & Reproductive Health
Ying Feng, Suwen Chen, Changdong Li, Xiaofeng Zhang, Hua Duan, Suren Sooranna, Mark R Johnson, Jian Li
In the present study, we evaluated the diagnosis and management modalities of caesarean scar pregnancy (CSP). Thirty patients diagnosed with CSP were retrospectively studied between February, 2010 and February, 2012. Twenty-five patients were offered prophylactic uterine artery embolization (UAE) and methotrexate (MTX) prior to uterine suction curettage. Five cases were referred from other hospitals where the initial management with uterine suction curettage had resulted in uncontrollable massive haemorrhage, 4 of the cases had UAE and one proceeded immediately to hysterectomy...
September 2016: Experimental and Therapeutic Medicine
Damien Guindolet, Pascal Dureau, Céline Terrada, Catherine Edelson, Amandine Barjol, Georges Caputo, Phuc LeHoang, Bahram Bodaghi
PURPOSE: To evaluate the evolution of chronic uveitis in children undergoing cataract surgery with primary intraocular lens (IOL) implantation. METHODS: Twelve children with chronic uveitis underwent cataract surgery with primary posterior chamber intraocular lens (IOL) implantation. RESULTS: Fourteen eyes were implanted with a foldable hydrophobic acrylic IOL. The mean follow-up was 35.39 months (8.72-69.57). The mean BCDVA before surgery and at the end of follow-up was 1...
September 6, 2016: Ocular Immunology and Inflammation
Henri Marret, Arnaud Fauconnier, Gil Dubernard, Hélène Misme, Laurence Lagarce, Magali Lesavre, Hervé Fernandez, Camille Mimoun, Claire Tourette, Sandra Curinier, Benoit Rabishong, Aubert Agostini
Our objective is to describe off-label use of methotrexate in ectopic pregnancy treatment using evidence based medicine. The patient group includes all women with a pregnancy outside the usual endometrium, or of unknown location. Method used was a Medline search on ectopic pregnancy managed using methotrexate treatment; evidence synthesis was done based on this current literature analysis. Level of evidence (LE) were given according to the centre for evidence base medicine rules. Grade was proposed for guidelines but no recommendation was possible as misoprostol is off label use for all the indications studied...
October 2016: European Journal of Obstetrics, Gynecology, and Reproductive Biology
Sofia Avnet, Silvia Lemma, Margherita Cortini, Paola Pellegrini, Francesca Perut, Nicoletta Zini, Katsuyuki Kusuzaki, Tokuhiro Chano, Giulia Grisendi, Massimo Dominici, Angelo De Milito, Nicola Baldini
Current therapy of osteosarcoma (OS), the most common primary bone malignancy, is based on a combination of surgery and chemotherapy. Multidrug resistance mediated by P-glycoprotein (P-gp) overexpression has been previously associated with treatment failure and progression of OS, although other mechanisms may also play a role. We considered the typical acidic extracellular pH (pHe) of sarcomas, and found that doxorubicin (DXR) cytotoxicity is reduced in P-gp negative OS cells cultured at pHe 6.5 compared to standard 7...
August 22, 2016: Oncotarget
Claudia M Hattinger, Paola Biason, Erika Iacoboni, Sara Gagno, Marilù Fanelli, Elisa Tavanti, Serena Vella, Stefano Ferrari, Andrea Roli, Rossana Roncato, Luciana Giodini, Katia Scotlandi, Piero Picci, Giuseppe Toffoli, Massimo Serra
This study aimed to identify associations between germline polymorphisms and risk of high-grade osteosarcoma (HGOS) development, event-free survival (EFS) and toxicity in HGOS patients treated with neo-adjuvant chemotherapy and surgery.Germline polymorphisms of 31 genes known to be relevant for transport or metabolism of all four drugs used in HGOS chemotherapy (methotrexate, doxorubicin, cisplatin and ifosfamide) were genotyped in 196 patients with HGOS and in 470 healthy age and gender-matched controls. Of these 196 HGOS patients, a homogeneously treated group of 126 patients was considered for survival analyses (survival cohort)...
August 22, 2016: Oncotarget
Andy Schmitt, Patrice Crochet, Aubert Agostini
STUDY OBJECTIVE: To describe a technique of robotic-assisted laparoscopy of residual caesarean scar pregnancy (CSP) and uterine defect repair. DESIGN: Video case report. Step-by-step explanation of the procedure (Canadian Task Force classification III) SETTING: Cesarean scar pregnancy (CSP) may be treated by different approaches including surgery and methotrexate. Successful methotrexate treatments avoid an emergency surgical treatment. In these cases a residual CSP often remains and should be removed in women who desire to conceive...
August 17, 2016: Journal of Minimally Invasive Gynecology
Leonti Grin, Ahmed Namazov, Michael Volodarsky, Eyal Anteby, Ofer Lavie, Ofer Gemer
STUDY OBJECTIVE: To show the possibility of conservative laparoscopic management in a case of invasive mole perforating the uterus DESIGN: Video with explanations. SETTING: An invasive mole could potentially become a life threatening complication of gestational trophoblastic disease (1). This is a Case of a 24 y/o presented with abdominal pain and vaginal bleeding. Sonography demonstrated large amount of fluid and a 3x3cm heterogeneous lesion next to the posterior uterine wall...
August 17, 2016: Journal of Minimally Invasive Gynecology
Elif Sari, Bülent Bakar, Bahram Sarkarati, Önder Bozdoğan, Tarık Çavuşoğlu
BACKGROUND/AIM: The survival of autologous fat graft tissue is dependent on various factors such as vascularization and inflammation. The aim of the present study was to evaluate the possible beneficial effects of low-dose methotrexate (LD-MTX) on fat graft volume and survival. MATERIALS AND METHODS: A total of 13 male Wistar albino rats were divided into two groups, a control group and an LD-MTX group. An autologous fat graft obtained from the inguinal region of each rat was transferred to its back...
2016: Turkish Journal of Medical Sciences
Young M Choi, Maya Debbaneh, Jeffrey M Weinberg, Paul S Yamauchi, Abby S Van Voorhees, April W Armstrong, Michael Siegel, Jashin J Wu
Treatment with systemic immunomodulatory agents is indicated for patients with moderate to severe plaque psoriasis and psoriatic arthritis. In these patients, surgery may confer an increased risk of infectious or surgical complications. We conducted a literature review to examine studies addressing the use of methotrexate, cyclosporine, and targeted immunomodulatory agents (tumor necrosis factor-alfa inhibitors, interleukin [IL]-12/23 inhibitors, IL-17 inhibitors) in patients undergoing surgery. We examined 46 total studies; the majority were retrospective studies in patients with rheumatoid arthritis and inflammatory bowel disease...
October 2016: Journal of the American Academy of Dermatology
R M Anghel, L N Gales, O G Trifanescu
RATIONALE: Urinary bladder cancer is the fourth most common cancer in men and the eighth in women, being an important public health issue. OBJECTIVE: to assess the outcome of patients with urinary bladder cancer treated in an oncologic center. METHODS: Medical files of 155 patients (132M/ 23F) with urinary bladder cancer treated between 2006 and 2012 were retrospectively analyzed. The median age at diagnosis was 65 years (range: 19-85 years)...
April 2016: Journal of Medicine and Life
Richard A Prayson
Sarcoidosis is a well-recognized systemic granulomatous process which involves the central nervous system in 5-15% of patients. One of the more frequent sites of central nervous system involvement is the pituitary and hypothalamic region. Involvement of the sellar region by sarcoidosis is overall an infrequent occurrence, comprising less than 1% of all intrasellar lesions. Patients typically present with an infiltrative lesion on imaging studies and clinically with symptoms related to diabetes insipidus or hyperprolactinemia...
July 21, 2016: Journal of Clinical Neuroscience: Official Journal of the Neurosurgical Society of Australasia
Ajay Gupta, Amit Kumar, Andaleeb Abrari, Rana Patir, Sandeep Vaishya
BACKGROUND: Medulloblastoma is the most common malignant brain tumor in children. Infants are in the high-risk category. Complete surgical resection is the single most important determinant of prognosis and survival in nonmetastatic disease. Infants with large primaries after incomplete resection/biopsy and poor general condition have bad prognosis. They are considered poor candidates for intensive chemotherapy involving high dose methotrexate/autologous stem cell transplantation as they are often unable to tolerate these aggressive regimens...
September 2016: World Neurosurgery
D Miguel, J Lukacs, T Illing, P Elsner
Necrobiotic xanthogranuloma (NXG) is an uncommon non-Langerhans cell histiocytosis involving skin and extracutaneous tissues. The lesions are usually asymptomatic and commonly appear in the periorbital area. Paraproteinemia is closely associated with NXG and its pathogenesis remains unclear. NXG prognosis is poor with several treatments showing variable results. Treatment of monoclonal gammopathy with alkylating agents does not necessarily influence the activity of the skin disease and vice versa. The aim of this systematic review is to summarize all reported treatments of necrobiotic xanthogranuloma of the skin, with or without underlying malignant condition and based on articles from the PubMed database using the query 'necrobiotic xanthogranuloma treatment', both in English and German, about 'human' subjects and published between 1980 and 2014, documenting adequate treatment for NXG...
July 19, 2016: Journal of the European Academy of Dermatology and Venereology: JEADV
Marius Rademaker, Monisha Gupta, Megan Andrews, Katherine Armour, Chris Baker, Peter Foley, Kurt Gebauer, Jacob George, Diana Rubel, John Sullivan
The Australasian Psoriasis Collaboration reviewed methotrexate (MTX) in the management of psoriasis in the Australian and New Zealand setting. The following comments are based on expert opinion and a literature review. Low-dose MTX (< 0.4 mg/kg per week) has a slow onset of action and has moderate to good efficacy, together with an acceptable safety profile. The mechanism of action is anti-inflammatory, rather than immunosuppressive. For pretreatment, consider testing full blood count (FBC), liver and renal function, non-fasting lipids, hepatitis serology, HbA1c and glucose...
July 12, 2016: Australasian Journal of Dermatology
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