SEARCH · PubMed Health

Results for “Precision therapy”

Explore indexed PubMed citations for clinical trials, systematic reviews and public health research. Read source abstracts and follow each citation to its original PubMed record.

Quote a phrase for an exact phrase match. Source license links do not imply unrestricted reuse.

At least 415 records · Page 23Linked to original sources

PubMed2005

Tethered cord syndrome.

AIM: Tethered cord syndrome (TCS) is a stretch-induced disorder of the spinal cord. Tethering is due to an inelastic structure anchoring the caudal end of the spinal cord as a short and thick filum terminale. Spinal dysraphism is occasionally associated,but the etiological relationship between these disorders remain unclear. Other anomalies may be concurrently found as hydromielia and Arnold-Chiari malformation. METHODS: The authors analysed neuroradiological findings in 5 children and 9 patients of 20-24 years of age; there were four male and ten female. The criteria for inclusion were neurological disturbances (disorders!) localizable to the level of the conus and evidence for spinal dysraphism. The purpose of this study was to make the precise diagnosis and make also precise planning for therapy, conservative or surgical treatment. RESULTS: The age of diagnosis of TCS varies from under 1 year to 14 years and is very rarely as late as adulthood. TCS can present late and insidiously with progressive gait disturbances, atrophy of various muscle groups or the entire limb, loss of reflexes,loss of sensation in the sacral dermatomes, sphincter disturbances, gait abnormality and pain in the gluteal, perianal and other pelvic areas. The diagnosis involves standard X-RAY examination, CT and CT-Mielography but MRI is now a diagnostic method of choice. Surgical untethering of the cord is recommended. The associated pain responds best to surgical treatment; ambulation and bladder function may improve as well. CONCLUSIONS: However sphincter dysfunction often remains a permanent problem. Given the potential for rapid deterioration with incomplete neurological recovery, even prophilactic surgery seems advisable. The patient need to be followed up, if not operated upon.

Adult↗

PubMed1990

[New methods and new technics in pedodontics: "conscious sedation"!].

The reasons why is it sometimes necessary to resort in paediatric dentistry to the use of conscious sedation with N2O/O2 are explained together with clinical indications and applications. The excellent results obtained with this technique lead to greater cooperation of the child, to a positive emotional contact with dental treatment and the possibility of performing the necessary therapies with greater precision.

Ambulatory Surgical Procedures↗

PubMed1990

[The physiopathology of supranuclear structures in oculomotor disorders].

Several structures, located at different levels in the Central Nervous System (CNS), collaborate to the control and realization of ocular movements (O.M.) Therefore, alterations of oculomotricity, of varying degree and of different kinds, may be found in a lot of diseases of the CNS. The study of O.M., expecially when carried out by means of specific techniques such as electro-oculography, may represent an useful tool in the diagnosis (both from a topographic and an etiological standpoint) and in the follow-up of patients, possibly also allowing a precise evaluation of therapy effectiveness. In this review the Authors briefly examine the role of the supranuclear structures mostly involved in the control and in the execution of oculomotricity and the characteristics of the different types of O.M. (rapid and slow, vergence movements). Successively, they analyze the semeiological features of supra-nuclear disturbances of O.M., describing alterations of saccadic movements (slowing, dysmetria) and of smooth pursuit, fixation instability (square waves, flutter, opsoclonus, nystagmus,...) and other alterations of O.M. (ocular bobbing, see-saw nystagmus, skew deviation,...). Successively, disturbances of O.M. are analyzed in relation to their topodiagnostic significance, describing oculomotor involvements due to focal lesions of different areas of CNS (frontal cortex, parieto-occipital cortex, basal ganglia, cerebellum, brainstem) and particular syndromes (Foville syndromes, locked-in syndrome, Parinaud syndrome, anterior internuclear ophthalmoplegia, "one and a half" syndrome, Balint syndrome,...). Finally, particular attention is drawn to the oculomotor disturbances observed in degenerative cerebellar and multisystemic diseases, and several abnormal "oculomotor patterns", which seem to be specifically related to particular diseases, are described. In particular, the oculomotor patterns of Steele-Richardson-Olszewsky disease (slowing and hypometria of horizontal saccades, loss of upward saccades with preservation of reflex movements) and of Friedreich ataxia (fixation instability mostly due to the occurrence of square waves, saccadic dysmetria, impairment of smooth pursuit) are stressed.

Brain Diseases↗

PubMed1989

Pharmacokinetics and haemostatic status during consecutive infusions of recombinant tissue-type plasminogen activator in patients with acute myocardial infarction.

Pharmacokinetics and systemic effects of recombinant tissue-type plasminogen activator (rt-PA) were determined during coronary thrombolysis in 12 acute myocardial infarction patients using a consecutive intravenous infusion regimen. Ten mg rt-PA were infused in 2 minutes resulting in a peak plasma concentration (mean +/- SD) of 3310 +/- 950 ng/ml, followed by 50 mg in 1 h and 30 mg in 1.5 h yielding steady state plasma levels of 2210 +/- 470 ng/ml and 930 +/- 200 ng/ml, respectively. All patients received intravenous heparin. Total clearance of rt-PA was 380 +/- 74 ml/min, t1/2 alpha was 3.6 +/- 0.9 min and t1/2 beta was 16 +/- 5.4 min. After 90 min, in plasma samples containing anti-rt-PA-IgG to inhibit in vitro effects, fibrinogen was decreased to 54%, plasminogen to 52%, alpha 2-antiplasmin to 25%, alpha 2-macroglobulin to 90% and antithrombin III to 85% of initial values. Coagulation times were prolonged and fibrin D-dimer concentrations increased from 0.40 to 2.7 micrograms/ml. It is concluded that pharmacokinetics of rt-PA show low interpatient variability and that its short mean residence time in plasma allows precise control of therapy. Apart from its moderate effect on the haemostatic system, rt-PA appears to lyse a fibrin pool in addition to the coronary thrombus.

Aged↗

PubMed1989

High-dose etoposide and autologous bone marrow transplantation as intensification treatment in small cell lung cancer: a pilot study.

A pilot study was conducted in which 15 patients with small cell lung cancer (SCLC) with limited or extended disease were treated with high dose etoposide (600 mg/m2 daily for 3 consecutive days) followed by autologous bone marrow transplantation (ABMT). Twelve patients underwent a double graft. All had achieved complete or partial remission with conventional induction chemotherapy (adriamycin and etoposide, plus cisplatin in five cases). After ABMT six of the 15 patients did not receive radiotherapy to the chest; all but four patients received prophylactic brain irradiation. No toxic deaths were recorded during the period of aplasia. Eleven patients relapsed and died after ABMT. The median time to death was 18 months. One other patient died at 13 months of unknown cause. At the present time three patients are alive and free of disease at 54, 51 and 47 months respectively. This pilot study shows that high dose etoposide and ABMT is well tolerated as late intensification for responsive SCLC. Definite conclusions about its precise role in therapy cannot yet be drawn.

Adult↗

PubMed1985

Urodynamics of the female lower urinary tract.

The symptoms associated with voiding disorders and incontinence in female patients are notoriously misleading. Even experienced urodynamicists are unable to achieve a 50 per cent success rate for predictive diagnosis based on symptoms and physical examination in any group except pure stress incontinence. Urodynamic studies are an essential part of the investigative sequence required to make an accurate diagnosis. If this is not made, then treatment will be empirical and the success of therapy correspondingly disappointing. The advent of urodynamic investigations has allowed a more rational approach to treatment with documented improvement in the success of therapy. However, our precise understanding of the pathophysiology of incontinence and voiding disorders remains incomplete. Nevertheless, a systematic scheme of investigation using standardized record-keeping and urodynamic techniques allows an accurate diagnosis in most patients. It is essential that additional testing should be performed when the urodynamic investigations fail to explain the patient's complaints. It is hoped that advanced techniques and in particular the electrophysiologic approach may provide the explanation for phenomena as yet ill-understood, such as bladder instability. This article has outlined the importance of a thorough basic assessment of each female patient with a symptomatic inquiry guided by urodynamic insight and a careful physical examination. The basic techniques of flow studies, cystometry, both filling and voiding, and urethral profilometry were described, and the more complex and difficult electrophysiologic tests were outlined.

Adult↗

PubMed1985

Urodynamics of the lower urinary tract.

The symptoms associated with voiding disorders and incontinence in female patients are notoriously misleading. Even experienced urodynamicists are unable to achieve a 50% success rate for predictive diagnosis based on symptoms and physical examination in any group expect pure stress incontinence. Urodynamic studies are an essential part of the investigative sequence required to make an accurate diagnosis. If this is not made, treatment will be empirical and the success of therapy correspondingly disappointing. The advent of urodynamic investigations has allowed a more rational approach to treatment, with documented improvement in the success of therapy. However, our precise understanding of the pathophysiology of incontinence and voiding disorders remains incomplete. Nevertheless, a systematic scheme of investigation, using standardized record-keeping and urodynamic techniques, allows an accurate diagnosis in most patients. It is essential that additional testing should be performed when the urodynamic investigations fail to explain the patient's complaints. It is hoped that advanced techniques, and, in particular, the electrophysiological approach, may provide the explanation for phenomena as yet ill understood, such as bladder instability. The chapter outlines the importance of a thorough basic assessment of each female patient with a symptomatic enquiry guided by urodynamic insight and a careful physical examination. The basic techniques of flow studies, cystometry, both filling and voiding, and urethral profilometry are described. The more complex and difficult electrophysiological tests are outlined.

Electromyography↗

PubMed1982

[Fulminant infection in a splenectomized patient with Hodgkin disease. Fatal pneumococcal meningitis in a cured patient seven years after splenectomy].

Ten years ago, because of the increasing number of patients recovering from Hodgkin disease, some authors advocated systematic laparotomy with splenectomy for more accurate staging in order to adjust therapy with more precision. This attitude now seems questionable because of the occurence of several complications, particularly of life-threatening infections, which can be fatal even after recovery from Hodgkin disease. The case of a twenty-three-year-old male patient with Hodgkin disease stage III A, histological grade I, is reported. MOPP chemotherapy, splenectomy and cobalt radiotherapy were followed by complete recovery. Seven years later the patient died from fulminant pneumococcal meningitis. A review of previously published cases show that prolonged prophylaxis with oral penicillin is mandatory in splenectomized patients. Immunization with the pneumococcal polysaccharide vaccine should be attempted even though the long-term results are still unknown.

Adult↗

PubMed1983

The role of therapeutic drug monitoring in childhood.

Therapeutic drug monitoring (TDM) can greatly improve the precision of drug therapy, provided 1) the analytical technique is sensitive, selective, and reproducable enough, 2) the pharmacokinetics of the drug is reasonably well known, and 3) the quantitative relation between kinetics and clinical effect is not too complicated. The TDM service must be supervised and further developed by a responsible group of experts, for example, a section or department of clinical pharmacology that should also provide service to help the physicians to take full advantage of the system. The appearance of active drug metabolites (for some drugs) and the considerable fluctuations in blood levels (in some patients) may complicate the interpretation. A cost-benefit analysis should continuously be made of the system; small, peripheral units for TDM may be too expensive to run.

Age Factors↗

PubMed1980

[Prevalence of migraine in a working population group in the Aquitaine region. Methodology and results (author's transl)].

To our knowledge, no study of prevalence of migraine has ever been carried out in France. Since this is a well defined disease with precise diagnosis and therapy, it was possible for us to carry out a survey on a large population. We therefore had to build an automatic process if migraine diagnosis using simple computerized questionnaires. The results presented are these relative to a survey carried out on a working population group of about 3,000 persons. These were interviewed during the annual medical examination which workers in France have to undergo. The socio-economic consequences of migraine could thus be studied.

Adolescent↗

PubMed1995

Immunosuppressive therapy for vasculitis.

There are few controlled trials of immunosuppressive therapy for vasculitis, making the further study of long-term outcome of these diseases with contemporary modes of management necessary. Relapse is frequent in many forms of vasculitis. The consequences of immunosuppressive therapy, including opportunistic infection, have been emphasized. Novel forms of therapy have been described in small series and case reports, although the precise role of such therapies in the treatment of vasculitis in general is far from certain in the absence of collaborative, multicenter controlled studies. The relationship between vasculitis and hepatitis C virus has prompted the use of interferon therapy in the treatment of vasculitic complications resulting from this infection.

Cyclophosphamide↗

PubMed1993

Future directions in 3-dimensional radiation treatment planning.

In recent years, computed tomography data have been used to build three-dimensional (3D) patient models for radiation treatment planning. The strength of 3D treatment planning systems lies in their ability to substantially improve the precision of radiation therapy and provide some of the tools needed to improve dose conformation. This article describes the V2 virtual simulation system used at the University of North Carolina at Chapel Hill. The virtual simulator allows the patient model to be rotated to determine the best beam angles and calculates the positions of the table, gantry, and collimator necessary to achieve desired beam orientations. Considerable disagreement remains as to how to produce an optimal radiation treatment plan using 3D systems. The University of North Carolina's VISTAnet project provides real-time 3D radiation dose calculation and display, allowing the user to search for the optimal plan.

Humans↗

PubMed1994

Severe combined immunodeficiency, interleukin-2 (IL-2), and the IL-2 receptor: experiments of nature continue to point the way.

The recent discovery of molecular defects in three forms of X-linked immunodeficiency has quickly transformed the study of immunodeficiency into one of the most exciting in basic and clinical immunology. The identification of defects in the IL-2R gamma chain in the etiology of X-linked SCID has suggested a heretofore unanticipated functional role of the gamma chain in immunologic development. While new and novel cytokines and cytokine receptors continue to be identified, it has become clear that our knowledge of IL-2, one of the best understood cytokine/receptor systems, is far from complete. Clarifying the molecular interactions between IL-2 and its receptor complex will improve the sophistication with which these interactions are manipulated in the clinic for the treatment of autoimmune disorders and allograft rejection, treatment of lymphoid malignancies, and cytokine-based therapies for immunotherapeutic treatment of nonlymphoid cancers. Recent gene therapy approaches to the treatment of children with the ADA-deficient form of SCID offers yet another exciting path for investigation. The use of retrovirally infected cord blood hematopoietic progenitor cells in attempts to reconstitute the immune system of ADA-deficient SCID children with ADA-producing cells raises the possibility of similarly "correcting" the defect in X-linked SCID. Such approaches almost certainly loom on the near horizon for other diseases. However, in view of the complexity and potentially pleiomorphic nature of defects in the IL-2R gamma chain, both in terms of their identification and correction, gene therapy for treatment of X-linked SCID will require a thorough understanding of the molecular nature of the respective defects. Effective therapy will require precise knowledge of the defects, in terms of their influence on the ligand, receptor, and signaling apparatus, as well as their potential effects on cells of multiple lineages. However, these caveats aside, the potential for understanding and correcting a disease that robs infants at so early an age of the potential for a normal life will continue to make these exciting and extraordinarily rewarding pursuits.

Humans↗

PubMed1996

Autologous blood donation and epoetin alfa in cancer surgery.

Patients undergoing cancer surgery frequently require blood, and the transfusion of allogeneic blood in these patients has been controversially linked to an increased risk of tumor recurrence. This patient population may therefore benefit from preoperative autologous blood donation (ABD) with or without epoetin alfa therapy, although the precise impact of autologous blood transfusion has not been fully explored. In some trials, preoperative ABD reduced allogeneic blood exposure by 50% in patients undergoing surgery for cancer resection, while, in another study, perioperative treatment with epoetin alfa significantly increased hematocrit (Hct) levels preoperatively and led to a reduction in postoperative allogeneic blood exposure. A combination of epoetin alfa and preoperative ABD seems a reasonable approach to reducing allogeneic blood exposure in patients undergoing cancer surgery.

Anemia↗

PubMed1995

[Synchronous carcinomas of the colon and rectum].

The authors base their observations on 3 cases of synchronous carcinoma of the large intestine and 1 case of association of cancer on polyps and synchronous colorectal carcinoma. After a short review of the etiopathogenetic and diagnostic aspects, they focus attention in particular on the various types on surgical approach which synchronous carcinoma of the large intestine offer to surgeons. The authors underline that numerous forms of surgery exist which are often complex and difficult, especially if multiple neoplasia involve separate colic segments and above all if they affect the distal rectal section. In conclusion, they affirm that the association of cancer on polyps and synchronous colorectal carcinoma is not rare and should be treated using combined endoscopic and surgical therapy. To the precise colic exeresis should be followed by endoscopic resection in the case of a scissil, villous polyps with high non-differentiated neoplastic tissue laying close on the endoscopic plane of section.

Aged↗

PubMed1998

Omentopexy for empyema due to lung fistula following lobectomy. A case report.

A case of sustained lung fistula after lung surgery is reported here. This case of a sustained pulmonary fistula was diagnosed by sustained air leak through the chest drain and a positive culture of the drainage fluid. The third re-operation was performed successfully by omentopexy via median sternotomy. Careful postoperative observation with chest radiography, bronchial fiberscopy, and determining whether infection is present in the drainage fluid are important for precise diagnosis and therapy for complications following pulmonary lobectomy.

Adenocarcinoma, Papillary↗

PubMed1998

Optical high-precision three-dimensional position measurement system suitable for head motion tracking in frameless stereotactic radiosurgery.

Head motion is a significant source of therapy-effect degradation in frameless stereotactic radiosurgery (SRS). In this study, a three-dimensional (3-D) optical head motion measurement system and a coordinate transformation algorithm were used to track patient head motion. With this system, head motion in frameless SRS was carefully investigated with a precision of < 0.1 mm. Head motions without any restraint (three cases) and with a Laitinen adapter (four cases) were measured with a data sampling rate of once per second for 30 min. Positions of IR light emission diode markers attached to the head were analyzed by two statistical methods. From these data, mathematically simulated head motions were obtained in each of the three coordinate directions for nonrestraint and Laitinen-adapter SRS. The results show that segmenting a frameless SRS procedure into a sequence of short intervals and repeating registration of the target position for each interval is a good strategy for better therapy precision. This optical 3-D position measurement system is suitable for high-precision head motion tracking in frameless SRS.

Adult↗

PubMed2026

Clinical impact of metagenomic next-generation sequencing for pathogen identification and guided therapy in pediatric intensive care unit patients with severe pulmonary infections.

UNLABELLED: To explore the diagnostic efficiency, clinical concordance, and precision treatment value of metagenomic next-generation sequencing (mNGS) for severe pulmonary infections in children in the pediatric intensive care unit (PICU), and to provide evidence for improving microbiological diagnosis and optimizing anti-infective strategies. A retrospective cohort study included 89 children with severe pneumonia in the PICU in 2024. All underwent routine microbiological testing and mNGS of bronchoalveolar lavage fluid (BALF). Detection rates, pathogen composition, co-infection identification, diagnostic concordance, and treatment impact were analyzed. Metagenomic next-generation sequencing demonstrated high diagnostic sensitivity in the PICU setting, achieving a positive detection rate of 90.0% (80/89) and identifying a diverse spectrum of 103 pathogens, including 50.5% viruses, 43.7% bacteria, 38.8% co-infections (vs 11.6%), and 86.3% diagnostic concordance (vs 55.8%, P < 0.01). Among 46 patients included in the therapeutic outcome analysis (22 in the mNGS-guided group), 21 patients in the mNGS-guided group improved. Multivariate logistic regression analysis, adjusting for confounding factors (age, underlying diseases, PaO2/FiO2 ratio, PRISM III score, and preoperative antibiotic use duration), confirmed that mNGS-guided therapy was an independent protective factor for achieving the primary outcome (OR = 5.23, 95% CI: 1.87-14.61, P = 0.002) and secondary outcomes (C-reactive protein reduction ≥50%: OR = 4.89, 95% CI: 1.72-13.93, P = 0.003; oxygenation improvement: OR = 5.67, 95% CI: 1.98-16.21, P = 0.001). Metagenomic next-generation sequencing demonstrated high diagnostic sensitivity in the PICU setting, guiding precision therapy, and improving prognosis. IMPORTANCE: It supports metagenomic next-generation sequencing (mNGS) as a supplementary tool for pediatric intensive care unit (PICU) refractory infections, guides anti-infective adjustments, and informs tiered diagnostic pathways for resource-limited settings to optimize cost-effectiveness.

Humans↗