The Experts below are selected from a list of 436224 Experts worldwide ranked by ideXlab platform
Martin Bornhauser - One of the best experts on this subject based on the ideXlab platform.
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allogeneic stem cell transplantation for the Treatment of refractory scleromyxedema
Translational Research, 2015Co-Authors: Nona Shayegi, Nael Alakel, Jan Moritz Middeke, J Schetelig, Luisa Mantovaniloffler, Martin BornhauserAbstract:Scleromyxedema is a rare disorder of connective tissue with unknown etiology. Its manifestation includes a generalized mucin deposition, which is frequently associated with paraproteinemia. The course of scleromyxedema is progressive and often lethal. As a result of its poorly understood pathogenesis, there is no causative Treatment Option. The efficacy of cytoreductive agents and autologous stem cell transplantation has been reported, but so far allografting as a Treatment Option has not yet been documented. Herein, we report on a patient with severe neurologic involvement and refractory course attaining durable remission after receiving an allogeneic hematopoietic cell transplant from an human leukocyte antigen-matched sibling. This case not only illustrates a potential new Treatment Option for selected patients, but also provides insights into the pathogenesis of this rare disease.
Eugen Trinka - One of the best experts on this subject based on the ideXlab platform.
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lacosamide as a new Treatment Option in status epilepticus
Epilepsia, 2013Co-Authors: Julia Hofler, Eugen TrinkaAbstract:Status epilepticus is among the most common neurologicemergencies, with a mortality rate of up to 20%. The mostimportant therapeutic goal is fast, effective, and well-tolerated cessation of status epilepticus. Intravenous phe-nytoin/fosphenytoin, phenobarbital, or valproate is thecurrent standard Treatment after failure of benzodiaze-pines. Lacosamide as a new antiepileptic drug has beenavailable as an intravenous solution since 2009. To date,PubMed lists 19 studies (10 single case reports and 9 caseseries), reporting a total of 136 episodes of refractorystatus epilepticus (50% nonconvulsive status epilepticus,31% focal status epilepticus, and 19% convulsive statusepilepticus) treated with lacosamide. The most often usedbolus dosewas 200 –400 mgover 3 –5 min.The overall suc-cess rate was 56% (76/136). Adverse events (AEs) werereported in 25% (34/136) of patients: mild sedation in 25cases, 1 patient with possible angioedema, 2 with allergicskinreaction,4 with hypotension, and1 withpruritus. Onepatient developed a third-degree atrioventricular (AV)block and paroxysmal asystole. Overall, the rate of AEswas low. Current evidence on the use of intravenous laco-samideinacuteseizuresandstatusepilepticusisrestrictedtoretrospectivecasereportsandcaseseries(classIV).Fur-therprospectivestudiestoinformcliniciansarenecessary.KEY WORDS: Lacosamide, Acute seizures, Seizureemergency,Treatmentalgorithm,Antiepilepticdrug.
C Cooper - One of the best experts on this subject based on the ideXlab platform.
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shared decision making is doing nothing a Treatment Option
Orthopaedic Proceedings, 2018Co-Authors: L E Jones, Lisa Roberts, Paul Little, Rose Wiles, Mark Mullee, J A Cleland, C CooperAbstract:Purpose of the Study and BackgroundWith a strong political agenda for change towards patient-centred healthcare, the notion of shared decision-making is reported to substantially improve patient experience, adherence to Treatment and health outcomes. In clinical practice however, observational studies have shown shared decision-making is rarely implemented and patient preferences are seldom met.The aim of this study was to measure the extent of shared decision-making in clinical encounters involving physiotherapists and patients with low back pain.Methods and ResultsEighty outpatient encounters (from 12 clinicians) were observed, audio-recorded, transcribed verbatim and analysed using the Option instrument. This measures 12 decision-making items, rated on a scale 0–4, which are summated and scaled to give a percentage: The higher the score, the greater the shared decision-making competency.The mean Option score was 24.0% (range 10.4%–43.8%). Providing patients with a list of Treatment Options was the only...
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shared decision making is doing nothing a Treatment Option
Journal of Bone and Joint Surgery-british Volume, 2014Co-Authors: L E Jones, Lisa Roberts, Paul Little, Rose Wiles, Mark Mullee, J A Cleland, C CooperAbstract:Purpose of the Study and Background With a strong political agenda for change towards patient-centred healthcare, the notion of shared decision-making is reported to substantially improve patient experience, adherence to Treatment and health outcomes. In clinical practice however, observational studies have shown shared decision-making is rarely implemented and patient preferences are seldom met. The aim of this study was to measure the extent of shared decision-making in clinical encounters involving physiotherapists and patients with low back pain. Methods and Results Eighty outpatient encounters (from 12 clinicians) were observed, audio-recorded, transcribed verbatim and analysed using the Option instrument. This measures 12 decision-making items, rated on a scale 0–4, which are summated and scaled to give a percentage: The higher the score, the greater the shared decision-making competency. The mean Option score was 24.0% (range 10.4%–43.8%). Providing patients with a list of Treatment Options was the only behaviour exhibited by every clinician, however in 73.8%, this was not demonstrated beyond a perfunctory level. Failure to offer the choice of doing nothing, or deferring the decision precluded clinicians from attaining a higher Option score. Conclusion Despite the political agenda, a paternalistic view of care was evident and shared decision-making was under-developed in this cohort of patients with back pain. Providing a comprehensive outline of the available Treatment Options forms part of the duty-of-care and, whilst clinicians may have altruistic motives and a strong desire to treat, depending on patient preference and clinical indicators, doing nothing could be a legitimate Option.
Sammy Saab - One of the best experts on this subject based on the ideXlab platform.
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Retrograde Transvenous Obliteration (RTO): A New Treatment Option for Hepatic Encephalopathy
Digestive Diseases and Sciences, 2020Co-Authors: Sammy SaabAbstract:Hepatic Encephalopathy (HE) is a complication of liver disease, consisting of brain dysfunction often due to portosystemic shunting of blood flow in the liver. HE can range from minimal HE, presenting with normal neurological function, to overt HE, with neurological and neuropsychiatric abnormalities. Various clinical grading systems are used to differentiate HE to provide the appropriate Treatments. Traditional Treatment of HE aims to identify and resolve precipitating factors through targeting hyperammonemia and administering antibiotics or probiotics. While retrograde transvenous obliteration (RTO), including balloon-occluded retrograde transvenous obliteration, coil-assisted retrograde transvenous obliteration or plug-assisted retrograde tranvenous obliteration, is an established procedure to manage gastric varices, little is known about its potential to treat HE. RTO is a procedure to occlude a spontaneous portosystemic shunt, minimizing shunting of portal blood to systemic circulation. Though there is not a large study with HE patients who have undergone RTO; the results appear promising in reducing HE. Side effects, however, should be considered in the Treatment of HE such as the transient worsening of portal hypertension and the formation of additional shunts. While additional studies are needed to assess the long-term success, RTO appears to be an effective alternative method to alleviate clinical symptoms of HE when pharmacological therapies and other conservative medical managements have failed.
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coil assisted retrograde transvenous obliteration carto an alternative Treatment Option for refractory hepatic encephalopathy
The American Journal of Gastroenterology, 2018Co-Authors: Sammy Saab, Fady M Kaldas, Savannah Fletcher, Ronald W Busuttil, Francisco Durazo, Justin P Mcwilliams, Joseph Dinorcia, Siddharth A PadiaAbstract:Overt hepatic encephalopathy (OHE) is a serious complication of liver dysfunction, which is associated with severe morbidity/mortality and healthcare resource utilization. OHE can be medically refractory due to spontaneous portosystemic shunts (SPSSs) and therefore a new Treatment Option for these SPSSs is critical. This is a retrospective study of 43 patients with medically refractory OHE, who underwent CARTO (Coil-Assisted Retrograde Transvenous Obliteration) procedures between June 2012 and October 2016. The patient demographic characteristics, technical and clinical outcomes with an emphasis on HE improvement, and complications are reviewed and analyzed. The overall clinical success rate was 91% with a significant HE improvement. Eighty-one percent of patients had clinically significant improvement from OHE and 67% of patients had complete resolution of their HE symptoms during our follow-up period of 893 ± 585 days (range 36–1881 days, median 755.0 days). The median WH score improved from 3 (range 2–4) pre-CARTO to 1 (range 0–4) post-CARTO (p < 0.001). The median ammonia level significantly decreased from 134.5 pre-CARTO to 70.0 post-CARTO (p < 0.001) in 3 days. The overall mean survival was 1465.5 days (95% CI of 1243.0 and 1688.0 days). Only three patients had recurrent HE symptoms. There were 39.6% minor complication rate including new or worsened ascites and esophageal varices, and only 2.3% major complication rate requiring additional Treatment (one patient with bleeding esophageal varices requiring Treatment). No procedure-related death is noted. CARTO appears to be a safe and effective Treatment Option for refractory overt hepatic encephalopathy (OHE) due to spontaneous portosystemic shunts. CARTO could be an excellent addition to currently available Treatment Options for these patients.
Yong Sam Shin - One of the best experts on this subject based on the ideXlab platform.
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Stenting for vertebrobasilar dissection: a possible Treatment Option for nonhemorrhagic vertebrobasilar dissection
Neuroradiology, 2007Co-Authors: Yong Sam ShinAbstract:Introduction It has been reported that stent placement may improve compromised blood flow resulting from vertebrobasilar dissection. In this study the technical feasibility, safety, as well as short-term outcome of stent placement for the Treatment of nonhemorrhagic vertebrobasilar dissection was retrospectively investigated. Methods Ten patients (eight men, two women; age range 36 to 45 years) with nonhemorrhagic vertebrobasilar dissection were treated by stenting. Nine lesions were located at the vertebral artery (VA) (one bilateral case) and two at the basilar artery. Seven patients presented with ischemic symptoms and three with headache. Among the nine VA dissections, eight lesions involved the posterior inferior cerebellar artery (PICA). Angiographic findings included abrupt or irregular vessel narrowing with aneurysmal dilatation in nine lesions and irregular bulbous aneurysmal dilatation in two lesions. Results Placement of a stent-within-a-stent was performed in six lesions and single stent in five lesions. Initial Treatments were technically successful in all patients. Follow-up was performed using digital subtraction angiography (six patients) or CT angiography (two patients). Successful occlusion or decreased contrast filling of the aneurysm sac was noted in six patients (seven lesions), increased aneurysm sac filling in one patient, and parent artery occlusion in one patient. PICA flow was preserved in all those with follow-up (1 week to 17 months). Conclusion Stent placement is technically feasible and safe for the Treatment of vertebrobasilar artery dissection, especially for preserving PICA and/or major perforating arteries. However, a study with a larger population and longer follow-up is necessary for validation of the efficacy of this Treatment modality.
