• Title/Summary/Keyword: Sequential therapy

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Sequential treatment with transurethral resection and hormonal therapy for bladder endometriosis of vesicoureteric junction

  • Abdulelah AlAdimi;Nabil AlOdaini;Atef M. M. Darwish
    • Journal of Medicine and Life Science
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    • v.19 no.3
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    • pp.116-120
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    • 2022
  • Objective: To estimate the efficacy of sequential treatment of bladder endometriosis (BE) of the vesicoureteric junction using transurethral resection (TUR) and hormonal therapy. Design: Case report. Setting: Private multispecialty hospital. Patient: A multiparous woman presented with perimenstrual lower urinary tract symptoms, cyclic chronic pelvic pain, and left loin pain. Intervention[s]: Ultrasonography revealed marked left renal dilatation. Computed tomography confirmed the presence of a bladder mass. A diagnostic cystoscopy revealed compression of the left vesicoureteral junction. Complete TUR BE with release of chocolate material during resection, followed by ureteric double J stent insertion for 3 months, was performed. Histopathology confirmed the diagnosis of BE, followed by adjuvant hormonal therapy (dienogest) for 3 months. Follow-up for about 2 years revealed complete relief of the symptoms without any recurrence. Main Outcome Measure[s]. Success and recurrence rates of sequential TUR and hormonal therapy of BE of the vesicoureteric junction. Result[s]. TUR BE followed by adjuvant hormonal therapy was very effective in eradicating BE of the vesicoureteric junction in a safe manner without recurrence on follow-up for 2 years. Conclusion[s]. BE of the vesicoureteric junction can be properly treated by sequential TUR and hormonal therapy without recurrence over a 2-year follow-up.

Effect of Sequential Intermittent Pneumatic Compression for Lymphedema (임파부종 환자의 간헐적 공기압박 치료의 효과)

  • Kim, Seng-Jung;Rhee, Hyeon-Sook;Kim, Soon-Hee
    • Journal of Korean Physical Therapy Science
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    • v.5 no.2
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    • pp.595-602
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    • 1998
  • The purpose of this study was to investigate the effect of sequential intermittent pneumatic compression in patients with lymphedema who were hospitalized for three days at Samsung Medical Center. Thirty-three subjects with lymphedema was selected by physician referral. A selection of the patients was made according to the following criteria : 1) no known metastases, 2) no infection after the a difference of at least 10% in the volumes of edematous limb. All patients were treated with the Lympha-Press(Model 103-A). Circumferential limb mesurements was done before and after a 3-day treatment period. As a result of sequential intermittent pneumatic compression therapy. All extremity showed a decrease in circumferential measurements with the maximal reduction occurring at the wrist(55.75 %) for the upper extremities and at the lower 1/3 of calf (40.61%) for the lower extremities. Upper extremity arm was reduced by 42.1% and lower extremity leg by 33.61%. In contrast with this, the proximal levels of arm patients and leg showed comparatively poor reduction than distal levels. Almost 44.44% of arm patients and 5.26% of leg patients experienced significant reduction(> 50%) after compression therapy. These data clearly indicates that Sequential Intermittent Pneumatic Compression Therapy was effective treatment for reducing of extremity volume in patients with lymphedema. but this was variable degree and dependent on the amount of pre-existing lymphedema. Other factors such as duration of edema, etiology, previous history of radiology, age did not appear to influence the extend of improvement. Further sutdies will be necessary to determine long term benefit of this therapy.

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Efficacy of Hormone Replacement Therapy on Lipid Profile and Bone Mineral Density in Postmenopausal Women: Continuous vs. Sequential Treatment (페경기 여성에서 호르몬 대체요법의 지질대사 및 골밀도에 대한 효과: 지속적 요법과 순차적 요법의 비교)

  • Lee, Chang Yun;Lee, Sukhyang
    • Korean Journal of Clinical Pharmacy
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    • v.10 no.3
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    • pp.101-106
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    • 2000
  • Menopausal women experience urogenitory and vasomotor symptoms with increased risk of osteoporosis and cardiovascular diseases, which can be reduced by hormone replacement therapy. However unopposed estrogen therapy has been associated with an increased risk of endometrial hypeiplasia or cancer. The objectives of this study were to compare effects of continuous vs. sequential hormone replacement therapy (HRT) on lipid profile, bone mineral density and menopausal symptoms of postmenopausal women and to assess how they perceive the menopause and HRT culturally. In this retrospective study, women in menopause longer than 6 months, normal in the mam-mogram and Papanicolaou smear, cholesterol level lower than 190 mg/dL or triglyceride level lower 4han 500 mg/dL were treated with Srogen (conjugated equine estrogen 0.625 mg tablet) and Provera (medroxyprogesterone acetate 2.5 mg tablet) for continuous treatment(CT) or Cycloprogynova (Estradiol valerate 2 mg and Norgestrel 0.5 mg complex tablet) for sequential treatment(ST). They were evaluated for lipid profile, bone mineral density, menopausal symptoms, side effects and their perception of menopause and HRT. As results, total sixty-seven patients out of ninety-four enrollees were included in final analysis (33 in continuous therapy, 34 in sequential therapy). There were significant decrease in total cholesterol ($15.04\pm3.17$, p=0.0001), LDL ($19.72\pm3.27$, p=0.0001), and increase in HDL ($5.89\pm1.63$, p=0.0001). Bone minora) density increased significantly with HRT ($0.02\pm0.11$, p=0.0001). But, there were no significant differences in change of lipid profile between continuous and sequential therapy: Total cholesterol, $13.12\pm4.7\;vs.\;16.91\pm4.3;\;LDL\;20.53\pm4.1\;vs.\;18.93\pm5.12:HDL\;7.15\pm2.3\;vs.\;4.67\pm2.2,\;p>0.05$. Incidences of flush reduced from $75\%\;(CT)\;to\;3.13\%\;and\;71.88\%\;(ST)\;to\;9.35\%$. The change of endometrium and breast were found 3 (CT) and 5 (ST) women, respectively. Most of women recognized that HRT is necessary $(70\%)$ for postmenopausal period but did not understand well the cardiovascular protective effect. In conclusion, hormone replacement therapy was effective in improving lipid profile, bone mineral density and menopausal symptoms in both continuous and sequential treatments with similar efficacy.

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Effect of IL-1 Polymorphisms, CYP2C19 Genotype and Antibiotic Resistance on Helicobacter pylori Eradication Comparing Between 10-day Sequential Therapy and 14-day Standard Triple Therapy with Four-Times-Daily-Dosing of Amoxicillin in Thailand: a Prospective Randomized Study

  • Phiphatpatthamaamphan, Kittichet;Vilaichone, Ratha-korn;Siramolpiwat, Sith;Tangaroonsanti, Anupong;Chonprasertsuk, Soonthorn;Bhanthumkomol, Patommatat;Pornthisarn, Bubpha;Mahachai, Varocha
    • Asian Pacific Journal of Cancer Prevention
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    • v.17 no.4
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    • pp.1903-1907
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    • 2016
  • Background: Studies of effects of IL-1 polymorphisms, CYP2C19 genotype together with antibiotic resistance for H. pylori eradication are rare worldwide. The present study was designed to evaluate efficacy of 10-day sequential therapy (SQT) and 14-day standard triple therapy (STT) with four- times-daily dosing of amoxicillin for H. pylori eradication related to these important host and bacterial factors in Thailand. Materials and Methods: This prospective randomized study was performed during March 2015 to January 2016. H. pylori infected gastritis patients were randomized to receive 10-day sequential therapy and 14-day standard triple therapy. CYP2C19 genotyping, IL1 polymorphism (IL-1B and IL-1RN genotypes) and antibiotic susceptibility tests were performed in all patients. 13C-UBT was conducted to confirm H. pylori eradication at least 4 weeks after treatment. Results: A total of 100 patients (33 males and 67 females, mean age=51.1 years) were enrolled. Eradication rate by PP analysis was 97.9% (47/48) with the 10-day SQT regimen and 87.8% (43/49) with 14-day STT regimen (97.9% vs 87.8%; p-value=0.053). Antibiotic susceptibility testing demonstrated 45% resistance to metronidazole, 14.8% to clarithromycin, and 24.1% to levofloxacin. CYP2C19 genotyping revealed 44.9% RM, 49% IM and 6.1% PM. IL-1B and IL-1RN genotypes were demonstrated as 21.4% for CC, 48.1% for TC, 36.8% for TT, 72.7% for 1/1, and 21.2% for 1/2 genotypes, respectively. The 10-day SQT regimen provided 100% eradication in patients with clarithromycin or dual clarithromycin and levofloxacin H. pylori resistant strains. Moreover, the 10-day SQT regimen resulted in a 100% eradication rate in all patients with CYP2C19 genotype RM and almost type of IL-1B (TC and TT) and IL1-RN genotypes ( 1/2 and other). Conclusions: Treatment with 10-day sequential therapy is highly effective for H. pylori eradication regardless of the effects of clarithromycin resistance, dual clarithromycin and levofloxacin resistance, CYP2C19 genotype, IL-1B and IL1-RN genetic polymorphisms and can be used as effective first line therapy in Thailand.

Multidisciplinary team approach for the management of patients with locally advanced non-small cell lung cancer: searching the evidence to guide the decision

  • Oh, In-Jae;Ahn, Sung-Ja
    • Radiation Oncology Journal
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    • v.35 no.1
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    • pp.16-24
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    • 2017
  • Locally advanced non-small cell lung cancer (LA-NSCLC) is composed of heterogeneous subgroups that require a multidisciplinary team approach in order to ensure optimal therapy for each patient. Since 2010, the National Comprehensive Cancer Network has recommended chemoradiation therapy (CRT) for bulky mediastinal disease and surgical combination for those patients with single-station N2 involvement who respond to neoadjuvant therapy. According to lung cancer tumor boards, thoracic surgeons make a decision on the resectability of the tumor, if it is determined to be unresectable, concurrent CRT (CCRT) is considered the next choice. However, the survival benefit of CCRT over sequential CRT or radiotherapy alone carries the risk of additional toxicity. Considering severe adverse events that may lead to death, fit patients who are able to tolerate CCRT must be identified by multidisciplinary tumor board. Decelerated approaches, such as sequential CRT or high-dose radiation alone may be a valuable alternative for patients who are not eligible for CCRT. As a new treatment strategy, investigators are interested in the application of the innovative radiation techniques, trimodality therapy combining surgery after high-dose definitive CCRT, and the combination of radiation with targeted or immunotherapy agents. The updated results and on-going studies are thoroughly reviewed in this article.

Comparison of Motor Skill Acquisition according to Types of Sensory-Stimuli Cue in Serial Reaction Time Task

  • Kwon, Yong Hyun;Lee, Myoung Hee
    • The Journal of Korean Physical Therapy
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    • v.26 no.3
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    • pp.191-195
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    • 2014
  • Purpose: The purpose of this study is to investigate whether types of sensory-stimuli cues in terms of visual, auditory, and visuoauditory cues can be affected to motor sequential learning in healthy adults, using serial reaction time task. Methods: Twenty four healthy subjects participated in this study, who were randomly allocated into three groups, in terms of visual-stimuli (VS) group, auditory-stimuli (AS) group, and visuoauditory-stimuli (VAS) group. In SRT task, eight Arabic numbers were adopted as presentational stimulus, which were composed of three different types of presentational modules, in terms of visual, auditory, and visuoauditory stimuli. On an experiment, all subjects performed total 3 sessions relevant to each stimulus module with a pause of 10 minutes for training and pre-/post-tests. At the pre- and post-tests, reaction time and accuracy were calculated. Results: In reaction time, significant differences were founded in terms of between-subjects, within-subjects, and interaction effect for group ${\times}$ repeated factor. In accuracy, no significant differences were observed in between-group and interaction effect for groups ${\times}$ repeated factor. However, a significant main effect of within-subjects was observed. In addition, a significant difference was showed in comparison of differences of changes between the pre- and post-test only in the reaction time among three groups. Conclusion: This study suggest that short-term sequential motor training on one day induced behavioral modification, such as speed and accuracy of motor response. In addition, we found that motor training using visual-stimuli cue showed better effect of motor skill acquisition, compared to auditory and visuoauditory-stimuli cues.

Effects of Massed and Distributed Practice on P300 Latency in a Sequential Timing Task (시열과제 운동학습 시 집중연습과 분산연습이 P300 출현시기에 미치는 영향)

  • Kwon, Yong-Hyun;Lee, Myoung-Hee
    • The Journal of Korean Physical Therapy
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    • v.26 no.4
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    • pp.234-239
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    • 2014
  • Purpose: The purpose of this study is to use P300 latency to determine whether methods of motor learning in terms of massed and distributed practice can affect motor sequential learning in healthy adults. Methods: Twenty-four healthy subjects participated in this study. They were randomly allocated into three groups: a 10 minute, a 12 hour, and a 24 hour group. In the SRT task, eight numbers were adopted as auditory stimuli. During an experiment, participants were instructed to press the matching key as quickly and accurately as possible when one of the eight numbers was presented randomly. The subjects practiced for three sessions, each of which comprised five blocks of 40 serial reaction time tasks. While they practiced during these three sessions, P300 latency was measured. The data were analyzed using ANCOVA. Results: The P300 latency of Fz, Cz, and Pz decreased in all groups except for the Fz area of the 10 min group. Overall, the P300 latency of the 10 min group showed a smaller decrease compared with the 12 hr and 24 hr groups. Statistically, no significant differences in the Fz and Cz areas were observed among the three groups. The P300 latency in the Pz area of the 10 min group showed a significantly smaller decrease compared with the other groups. Conclusion: These findings suggest that short-term sequential motor training can alter brain functions such as the P300 latency. We also found that better acquisition of a motor skill was obtained with distributed practice of a task than with massed practice.

The Effect of Implicit Motor Sequence Learning Through Perceptual-Motor Task in Patients with Subacute Stroke (아급성기 뇌졸중 환자에서 지각-운동 과제를 통한 내잠 학습의 효과)

  • Lee, Mi-Young;Park, Rae-Joon;Nam, Ki-Seok
    • The Journal of Korean Physical Therapy
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    • v.20 no.3
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    • pp.1-7
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    • 2008
  • Purpose: Implicit motor learning is the capacity to acquire skill through physical practice without conscious awareness of what elements of performance improved. This study investigated whether subacute stroke patients can implicitly learn a perceptual-motor task. Methods: We recruited 12 patients with subacute stroke and 12 age-matched controls. All participants performed a perceptual-motor task that involved pressing a button corresponding with colored circles (blue, green, yellow, red) on a computer screen. The task consists of 7 blocks composed of 10 repetitions for a repeating 12-element sequence (total 120 responses). Results: Both groups demonstrated significant improvement in acquisition performance. Reaction times deceased in both groups at similar rate within the sequential block trials (2-5 blocks), and reaction times increased at a similar rate when the task paradigm was transferred from the sequential block trial to the random block trial (5-6-7 blocks). Conclusion: The results of this study suggest that patients with sub-actue stroke can implicitly learn a perceptual motor skill. Although explicit instructions should be used to focus the learner's attention rather than provide information about the task, the application of implicit motor learning strategies in the rehabilitation setting may be beneficial.

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Change of Fractional Anisotropy in the Left Inferior Frontal Area after Motor Learning (운동학습에 의한 왼쪽 하전두영역의 분할비등방성의 변화)

  • Park, Ji-Won;Nam, Ki-Seok
    • The Journal of Korean Physical Therapy
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    • v.22 no.5
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    • pp.109-115
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    • 2010
  • Purpose: This study was to delineate the structural change of neural pathway after sequential motor learning using diffusion tensor imaging (DTI). Methods: The participants were 16 healthy subjects, which were divided by training (n=8) and control (n=8) group. The task for the training was the Serial Reaction Time Task (SRTT) which was designed by Superlab program. When the 'asterisk' shows up in the 4 partition spaces on the monitor, the subject presses the correct response button as soon as possible. The training group participated in the training program of motor learning with SRTT composed of 24 digits pattern in one hour per daily through 10 days during 2 weeks. Results: In the behavioral results the training group showed significant changes in the increase of response number and the reduction of response time than those of the control group. There was significant difference in the left inferior frontal area in the fractional anisotropy (FA) map of the training group in DTI analysis. Conclusion: Motor sequential learning as like SRTT may be needed to the learning of language and visuospatial processing and may be induced for the experience-dependent structural plasticity during short period.