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At least 109 records · Page 6Linked to original sources
PubMed2006

Management of depression relapse: re-initiation of duloxetine treatment or dose increase.

Continuation of antidepressant therapy after patients have responded to medication has been shown to greatly reduce but not eliminate relapse. We evaluated response to reinstating or increasing drug doses in patients who relapsed during a long-term, randomized, double-blind, continuation phase study of duloxetine treatment for major depressive disorder (MDD). Patients with HAMD17 scores of >18 and CGI-Severity scores of >4 received duloxetine 60 mg QD for 12 weeks, responders then received 26 weeks of duloxetine 60 mg QD or placebo. The relapsing patients who started 12 weeks of rescue treatment received duloxetine 60 mg QD (if relapsing on placebo) or duloxetine 60 mg BID (if relapsing on duloxetine). In the continuation phase, 87 patients received duloxetine 60 mg QD (n=58) or 60 mg BID (n=29) as treatment for relapse. The percentage of patients who responded to treatment after relapse was 62% of those whose dose was increased from 60 mg QD to 60 mg BID, and 74% for those who switched from placebo to duloxetine 60 mg daily. By the end of the study, 32 patients taking duloxetine 60 mg QD were in remission (57%), compared with 11 patients taking duloxetine 60 mg BID (38%). There was significant improvement in HAMD17 and CGI-Severity scores for both groups at endpoint vs. start of treatment for relapse. Significant improvements were seen for all visual analog scale parameters in the 60 mg QD group, but only Interference with Daily Activities and Back Pain parameters showed significant improvement for patients receiving 60 mg BID. Significant within-group improvement from baseline was seen for both groups in Symptom Questionnaire-Somatic Subscale total and pain subscales. Treatment-emergent adverse events were mild/moderate in severity; no clinically significant changes were noted in laboratory results or vital signs. Reinstatement of duloxetine 60 mg QD was effective for patients who relapsed after discontinuing drug. Patients relapsing on duloxetine 60 mg QD benefited from an increase to 60 mg BID. These duloxetine doses were well tolerated and effective, and appear appropriate for MDD patients requiring treatment of relapse.

Adult↗
PubMed1999

Management of interferon relapsers.

Relapse in patients who have evidenced an initial response to a course of interferon monotherapy for chronic hepatitis C virus (HCV) infection has been a major frustration. At least 70% of responders will relapse after a 6-month course of treatment and more than 50% will relapse after a 12-month course of treatment, usually within the first 3 to 6 months after treatment discontinuation. At most, half of patients relapsing after an initial 6-month course will have a sustained response to a second, 12-month course of interferon monotherapy. A more promising second-line regimen is the combination of interferon plus ribavirin. A recent multicenter international trial has shown that this regimen results in a sustained virologic response rate of nearly 50%, fully 10-fold higher than the sustained response rate observed with a second 6-month course of interferon alone (49% vs 5%, respectively). In patients with non-1 genotype and viral levels no greater than 2 million copies/mL, the likelihood of sustained response to the second course of combination therapy was 100%. Biochemical and virologic responses (normalization of liver enzymes and disappearance of HCV RNA from the serum) were frequently accompanied by histologic improvement. HCV-RNA levels < or = 2 million copies/mL and non-1 viral genotype predicted treatment response, whereas age, gender, body weight, source of infection, type of interferon used for the first round of treatment, and elapsed time since first treatment had no effect. Based on these data, combination therapy with interferon and ribavirin is now considered the treatment of choice for relapsers. It is not clear whether 12 months of combination therapy might have produced even better rates of viral eradication in relapsed patients.

Antiviral Agents↗
PubMed1996

Hodgkin's disease: management of first relapse.

In most patients with newly diagnosed Hodgkin's disease, initial therapy is curative. However, a small portion of patients treated with radiotherapy alone for limited favorable disease, and a larger percentage of patients treated with combination chemotherapy, with or without radiotherapy, for advanced-stage or unfavorable disease relapse after initial remission. Patients relapsing after radiotherapy alone should do as well with salvage combination chemotherapy as patients with advanced disease who have never received radiation. In patients who relapse after combination chemotherapy, retreatment with the same regimen or employment of a non-cross-resistant regimen offers high response rates among those with favorable characteristics. However, long-term disease-free survival is achieved in a minority of these patients, and in even fewer of those with early relapse or other unfavorable characteristics. High-dose therapy with autografting shows the greatest promise in the treatment of patients at relapse.

Antineoplastic Combined Chemotherapy Protocols↗
PubMed1997

Factors influencing the relapse of patients with inflammatory bowel disease.

The management of relapse of inflammatory bowel disease (IBD) remains a clinical challenge and a relatively neglected area of current research. Many factors contribute to relapse, and the proper identification of the cause of each case may influence optimal management. Often, relapse is related to the failure of maintenance therapy. Mesalamine sensitivity is difficult to recognize and should be considered when increased doses are associated with the worsening of symptoms. An increase in eosinophil activity could explain seasonal relapses of IBD as a result of exposure to allergens, but other eosinophil activation pathways also will influence the course of IBD. Infection, either enteric or systemic, may trigger a relapse by activating the gastrointestinal mucosal immune system. Nonsteroidal anti-inflammatory drug use is a well-recognized cause of exacerbation of disease. Smoking status is emerging as a complex factor in IBD, and a change in smoking status may influence the course of IBD.

Acute Disease↗
PubMed1988

Factors associated with maintenance and relapse following self-management training.

In this study, we examined factors associated with relapse and maintenance following a self-management training course. Thirty-five community professionals participated in a 3-week (30-hr) graduate-level extension course in self-management, which included a self-modification project. Results at a 10-week follow-up showed that end-of-class self-efficacy and outcome expectancy correctly classified over 80% of those who maintained gains in their projects versus those who relapsed. The professionals in the relapsed group also reported significantly more difficulty with anticipated high-risk situations than did those in the maintenance group.

Adult↗
PubMed2005

Anesthetic management of the parturient with relapsing polychondritis.

PURPOSE: To present the anesthetic management of a parturient with relapsing polychondritis (RP) and to discuss the anesthetic implications of RP. CLINICAL FEATURES: A 28-yr-old primiparous woman with known RP, spondyloarthropathy and fibromyalgia presented for urgent Cesarean delivery for breech presentation and prodromal labour. Her pregnancy had been complicated by a hospital admission for an exacerbation of her RP as manifested by hoarseness, increased pain and tenderness of her left ear and nasal bridge cartilages, sinusitis with bloody nasal discharge and increased pain and tenderness of the anterior tracheal rings. Epidural anesthesia was administered for the Cesarean delivery. Her intraoperative and postoperative course was uneventful. Close cooperation among obstetricians, anesthesiologists and rheumatologists resulted in a successful outcome. CONCLUSION: Relapsing polychondritis is a syndrome with important anesthetic implications. Multidisciplinary cooperation is essential in managing these high risk parturients.

Adult↗
PubMed2006

Late relapses of germ cell malignancies: incidence, management, and prognosis.

Late relapses of malignant germ cell tumors (MGCTs) are rare and occur, by definition, 2 years or later after successful treatment. They represent a major challenge of today's treatment of MGCTs. Because of the rarity and heterogeneity of late relapses, many aspects of their main characteristics remain obscure. We present relevant literature on relapsing MGCTs to highlight the following issues: incidence, impact of initial treatment on the subsequent risk of late relapse, treatment, and survival. In a pooled analysis, the incidence is 1.4% and 3.2% in seminoma and nonseminoma patients, respectively. The predominant site of relapse is the retroperitoneal space in both histologic types. The initial treatment appears to be important for the risk and localization of late relapses. The treatment of late relapses should be based on a representative presalvage biopsy and includes radical surgery and salvage chemotherapy in most cases. Five-year cancer-specific survival is above 50% in the recent large series and reaches 100% in case of single-site teratoma. Diagnosis and treatment of late-relapsing MGCT patients is challenging and should be performed in experienced centers only. Referral of late-relapsing patients to high-volume institutions ensures the best chances of cure and enables increasing understanding of tumor biology and the clinical course of these patients.

Diagnosis, Differential↗
PubMed1998

"Breakthrough" during interferon therapy for chronic hepatitis C. Overview on the diagnosis, possible aetiology and recommendations for management.

A relapse of serum aminotransferase levels after complete normalisation during alpha interferon therapy for chronic hepatitis C is diagnosed as Breakthrough. Its prevalence ranges between 14% and 21% of the responders, with no significant differences between the alpha interferons. Hepatitis C virus genotype and interferon dose do not seem to represent predisposing factors. The development of neutralising antibodies to interferon is associated with Breakthrough in about half of the patients; other aetiologic factors such as down-regulation of interferon receptors or development of virus resistance to interferon may be implicated in the remaining cases. The therapeutic switch from recombinant to lymphoblastoid alpha interferon has been demonstrated to be a successful strategy to overcome Breakthrough and to restore a complete response.

Antibody Formation↗
PubMed2006

Anaesthetic management of a patient with relapsing polychondritis undergoing laparoscopic surgery.

We describe the anaesthetic management of a patient with relapsing polychondritis who underwent laparoscopic cholecystectomy. We failed to secure a patent airway with a ProSeal laryngeal mask airway, probably because of the deformity of the larynx. The glottis was small and it was only possible to pass a 5.5 mm cuffed endotracheal tube into the trachea. Positive pressure ventilation with 5 cm H2O positive end-expiratory pressure and surgery were safely performed. In relapsing polychondritis, recurrent inflammation and destruction of laryngeal and tracheobronchial cartilage causes airway obstruction, and various sizes of tracheal tubes and other airway manipulation devices should be prepared.

Adult↗
PubMed1999

Management of airway manifestations of relapsing polychondritis: case reports and review of literature.

STUDY OBJECTIVE: To report the first series of patients with severe airway manifestations of relapsing polychondritis (RP) that were managed successfully with self-expandable metallic stents, and to review the literature. DESIGN: Retrospective review of medical records, and current clinical follow-up. SETTING: Tertiary care referral hospital. PATIENTS: All patients with airway manifestations of RP that were managed with self-expandable metallic stents at our institution. RESULTS: All five patients (four women and one man; age, 40 to 69 years old) had severe airway manifestations, and three of them required mechanical ventilation. Spirometry with flow-volume curves showed severe combined obstructive and restrictive ventilatory defects. Bronchoscopy revealed dynamic collapse of the proximal airways. Diagnosis was made 8 months to 13 years after the first symptom of the disease. Pharmacotherapy included prednisone, methotrexate, cyclosporine, and dapsone. A total of 17 self-expandable metallic stents of varying sizes were placed using flexible bronchoscope from 4 to 19 years after the first symptom. The overall outcome was favorable in four patients. Three patients have survived without ventilatory support 16 to 18 months following the first stent placement, and the fourth patient survived for 20 months without ventilatory support before she died. The fifth patient, who was receiving mechanical ventilation, died in 1 week probably due to persistent dynamic collapse of the airways distal to the stents. CONCLUSION: Self-expandable metallic tracheobronchial stents should be considered in the management of airway manifestations of RP, especially in patients who require mechanical ventilation.

Aged↗
PubMed1984

Tremor as a feature of chronic relapsing and dysgammaglobulinemic polyneuropathies. Incidence and management.

Seven patients with chronic relapsing polyneuropathy and four patients with dysgammaglobulinemic polyneuropathy had tremor during the course of their illness. The tremor was coarse, irregular, and unrelated to proprioception loss, muscle weakness, or fatigue; it appeared to represent disease activity or an early sign of a new relapse. None of these patients had clinical signs of CNS disease or family history of essential tremor. The tremor in all seven patients with relapsing neuropathy and in one of the three treated patients with dysgammaglobulinemia responded to immunosuppressive drugs that controlled the underlying immune mechanism(s) of the disease. In two patients with dysgammaglobulinemic polyneuropathy, the tremor improved with propranolol hydrochloride.

Adolescent↗