• Title, Summary, Keyword: Refractory

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Rituximab Treatment for Idiopathic Hypertrophic Pachymeningitis

  • Jang, Yoonhyuk;Lee, Soon-Tae;Jung, Keun-Hwa;Chu, Kon;Lee, Sang Kun
    • Journal of clinical neurology
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    • v.13 no.2
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    • pp.155-161
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    • 2017
  • Background and Purpose Hypertrophic pachymeningitis (HP) is a rare disease caused by autoimmunity in the meninx that causes various neurologic symptoms, including headache, seizures, weakness, paresthesia, and cranial nerve palsies. Although the first-line therapy for HP is steroids, many HP cases are refractory to steroids or recur when the steroids are tapered. Here we report three HP cases that were successfully treated with rituximab (RTX). Methods From an institutional cohort recruited from April 2012 to July 2016, three HP cases that were identified to be steroid-refractory were treated with RTX (four weekly doses of $375mg/m^2$). Clinical improvement was assessed by the number of relapses of any neurologic symptom and the largest dural thickness in MRI. Results All three patients were recurrence-free of neurologic symptoms and exhibited prominent decreases in the dural thickness after RTX treatment. No adverse events were observed in the patients. Conclusions We suggest RTX as a second-line therapy for steroid-refractory HP. Further studies are warranted to confirm this observation in a larger population and to consider RTX as a first-line therapy.

Pembrolizumab for Refractory Metastatic Myxofibrosarcoma: A Case Report

  • Song, Haa-Na;Kang, Min Gyu;Park, Jeong Rang;Hwang, Jin-Yong;Kang, Jung Hun;Lee, Won Seop;Lee, Gyeong-Won
    • Cancer Research and Treatment
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    • v.50 no.4
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    • pp.1458-1461
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    • 2018
  • Myxofibrosarcoma is a rare tumor, refractory to cytotoxic chemotherapy and radiotherapy. Pembrolizumab is an innovative immunotherapy drug consisting of programmed death receptor ligand 1 antibody proven to be useful for numerous types of cancer cells. A patient had been diagnosed with metastatic myxofibrosarcoma, refractory to radiotherapy and conventional cytotoxic chemotherapy. The patient achieved a partial response during palliative chemotherapy with pembrolizumab for 14 cycles. To the best of our knowledge, this is the first case report demonstrating the efficacy of pembrolizumab for refractory myxofibrosarcoma.

Effects of Vagus Nerve Stimulation on Adults and Children with Refractory Epilepsy (소아와 성인의 난치성 간질 환자에서 미주신경 자극술의 효과)

  • Kim, Cheon-Sik;Ro, Yeong-Joo;Choi, Sang-Yong;Kim, Dae-Sik
    • Korean Journal of Clinical Laboratory Science
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    • v.38 no.2
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    • pp.141-146
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    • 2006
  • Vagal nerve stimulation (VNS) has been proposed as a possible way to improve the control of refractory epilepsy. We report the effects following VNS treatment in patients with refractory epilepsy. Seventeen patients with a mean age of 12.8 years, ranging from 5 to 29 years, underwent the implantation of vagal nerve stimulation (Cyberonics, Houston, TX). We reviewed the clinical findings before and after VNS in seizure frequency, number of antiepileptic drugs (AED), and quality of life (QOL). All of the patients had intractable seizures, eleven of the patients had additional medical complications, three had hippocampus atrophy, one had encephalomalacia, five had encephalitis, one had pachygyria, and one had schizencephaly. Thirteen patients had symptomatic partial epilepsies, three patients had Lennox-Gastaut syndrome and one had cryptogenic partial epilepsy. The mean follow up duration was 35 months. The mean reduction of seizure frequency compared with baseline before VNS was 26.1% after 3 months (p<0.005), 41.9% after 6 months (p<0.001), 46.9% after 1 year (p<0.001), and 53% at the latest follow-up (p<0.001). Twelve patients showed an improvement of QOL such as mood, language, alertness, expression, and motor function. The most common side effects were transient hoarseness or voice change or cough, which was detected in six patients (35%) and wound infection in one patient (5%). This study has shown a good anti-seizure effect of VNS, decrease in seizure frequency and improvements in QOL. We concluded that VNS is a beneficial therapy in refractory epilepsy with a non-resectable epileptic focus. Further studies should be focused on the prediction of unresponsiveness and the adjustment of VNS parameters for maximum efficacy in patients with various medical histories.

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The Relationship between Epileptic Focus and Psychiatric Symptoms of the Refractory Epileptic Patients (난치성 간질환자의 간질초점 위치와 정신증상과의 관련성)

  • Han, Wou-Sang;Kim, Jong-Hoon;Lee, Sang-Kun;Cho, Doo-Young;Kwon, Jun-Soo;Ha, Kyoo-Seob
    • Korean Journal of Psychosomatic Medicine
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    • v.4 no.1
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    • pp.64-70
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    • 1996
  • The prevalence rate of psychiatric symptoms of the refractory epileptic patients was evaluated according to the location of the epileptic focus. The subjects were 91 patients admitted to Epilepsy Monitoring Unit of Seoul National University Hospital. The psychiatric symptoms were assessed by Korean version of Symptom Checklist-90-R(SCL-90-R). The locus of epileptic focus was assessed by clinical features, 2-hour interictal EEG, long-term video-EEG monitoring, brain MRI, interictal and ictal brain SPECT, and interictal brain PET The subjects were divided into three groups according to the epileptic focus, non-temporal(N=29), left temporal (N=26), and right temporal(N=32). There were no statistical differences in demographic and seizure-related variables among groups. The number of patients with $T-score {\geq} 65$ at any subscale of the SCL-90-R were compared by $X^2-test$ among groups. The mean T-scores of each subscale of the SCL-90-R were compared by oneway-ANOVA among groups. The prevalence rate of psychiatric symptoms of the refractory epileptic patients was 38.5%. There was no statistical difference in the prevalence rate of psychiatric symptoms among groups. However, the patients with non-temporal or right temporal epileptic foci showed statistically significant higher mean T-scores of interpersonal sensitivity, depression, hostility, and phobic subscales than the patients with left temporal epileptic foci. These results suggest that the epileptic focus plays an important role in the production of interictal psychiatric symptoms of the refractory epileptics.

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Study on the Corrosion Characteristics in the Slag Line of SEN Oxide Refractory (산화물계 SEN내화물의 슬래그 라인부 침식특성 연구)

  • Sung, Young Taek;Son, Jeong Hun;Lee, Sung Seok;Bae, Dong Sik
    • Korean Journal of Materials Research
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    • v.24 no.1
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    • pp.53-59
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    • 2014
  • The corrosion resistance of submerged entry nozzle (SEN) materials were investigated for high-class steel manufacturing. Composite samples were fabricated by mixing $ZrO_2$, $Al_2O_3$, MgO, mullite, spinel, and carbon. The raw materials were mixed with attrition milling, compacted in a uniaxial pressure of 200MPa and calcined at $1000^{\circ}C$ for 3 h in $N_2$ atmosphere. The bulk density and apparent porosity of the calcined samples were measured by the liquid displacement method in water using Archimedes's principle. The corrosion resistance of the samples were measured by cup test with mold powder at $1550^{\circ}C$ for 2 h. The microstructure and elemental analysis of samples were observed by scanning electron microscopy (SEM), energy dispersive spectrum (EDS), and X-ray diffraction pattern (XRD). The XRD result shows that the starting raw materials were crystalline phase. The microstructure of fabricated specimen was investigated before and after corrosion tests at $1000^{\circ}C$ and $1550^{\circ}C$ for 2h. $ZrO_2$-C composite showed good resistance in the slag corrosion test. Among the composite oxide materials, $ZrO_2-Al_2O_3$-C and $ZrO_2$-MgO-C showed better resistance than $ZrO_2$-C in the slag corrosion test. The diameter variation index of $ZrO_2$-C refractory was 16.1 at $1000^{\circ}C$ for 2 h. The diameter variation index of the $ZrO_2-Al_2O_3$-C refractory was larger than that of the $ZrO_2$-C refractory at $1550^{\circ}C$ for 2 h.

Survival Outcomes of Recurrent Epithelial Ovarian Cancer: Experience from a Thailand Northern Tertiary Care Center

  • Jansaka, Natpat;Suprasert, Prapaporn
    • Asian Pacific Journal of Cancer Prevention
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    • v.15 no.24
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    • pp.10837-10840
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    • 2015
  • To assess survival outcomes in a retrospective study, recurrent epithelial ovarian cancer patients were divided into three groups according to the platinum free interval as follows: platinum refractory that included the patients with tumor progression during treatment; platinum resistant and platinum sensitive that included the patients with tumor progression less than or more than six months, respectively. Clinical data for tumor progression in epithelial ovarian cancer patients treated at Chiang Mai University Hospital between January, 2006 and December, 2010 were reviewed. Thirty-nine patients were in the platinum refractory group while 27 were in the platinum resistant group and 75 in the platinum sensitive group. The mean age, the parity, the administration of neoadjuvant chemotherapy and the serous type did not significantly different across groups while the mean total number of chemotherapy regimens, the early stage patients, the patients with complete surgery and the surviving patients were significant more frequent in the platinum sensitive group. Regarding subsequent treatment after tumor recurrence, 87.2% underwent chemotherapy. With the median follow up time at 29 months, the median overall survival rates were 20 months, 14 months and 42 months in platinum refractory, platinum resistant and platinum sensitive groups, respectively (p<0.001). In addition, when the platinum sensitive patients developed the next episode of tumor progression, the median progression free interval time was only three to four months. In conclusion, the outcomes for platinum refractory the and platinum resistant groups was poorer than the platinum sensitive group. However, subsequent progression in the platinum sensitive group was also associated with a poor outcome.

Resveratrol Prevents Hormone-refractory Prostate Cancer Cell Growth via Inhibition of STAT3 Activity (STAT3 활성 억제를 유도하는 resveratrol의 호르몬 불응성 전립선 암 예방 효과)

  • Cho, Seok-Cheol;Choi, Bu Young
    • Korean Journal of Food Science and Technology
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    • v.46 no.4
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    • pp.516-521
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    • 2014
  • The mechanisms underlying the refractory effects of flutamide, a first-line oral anti-androgen drug, have not been entirely elucidated. In the present study, we investigated the mechanism of flutamide-induced hormone-refractory prostate cancer cell growth and its modulation by resveratrol, a phytoalexin present in grapes. Resveratrol significantly attenuated interleukin 6 (IL-6)-induced signal transducer and activator of transcription 3 (STAT3) transcriptional activity and dihydrotestosterone (DHT) or IL-6-induced prostate-specific antigen (PSA) transcriptional activity. Furthermore, compared to treatment with DHT or IL-6 alone, combination treatment of cells significantly increased PSA transcriptional activity, and resveratrol markedly diminished DHT plus IL-6-induced STAT3 and PSA transcriptional activities. Thus, the inhibitory effects of resveratrol on IL-6-, DHT-, and flutamide-induced hormone-refractory prostate cancer cell growth are partly mediated by the suppression of STAT3 reporter gene activity, suggesting that resveratrol represents a promising therapy for prostate cancer.

Clinical outcome of patients with refractory Kawasaki disease based on treatment modalities

  • Kim, Hyun Jung;Lee, Hyo Eun;Yu, Jae Won;Kil, Hong Ryang
    • Clinical and Experimental Pediatrics
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    • v.59 no.8
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    • pp.328-334
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    • 2016
  • Purpose: Although a significant number of reports on new therapeutic options for refractory Kawasaki disease (KD) such as steroid, infliximab, or repeated intravenous immunoglobulin (IVIG) are available, their effectiveness in reducing the prevalence of coronary artery lesions (CAL) remains controversial. This study aimed to define the clinical characteristics of patients with refractory KD and to assess the effects of adjuvant therapy on patient outcomes. Methods: We performed a retrospective study of 38 refractory KD patients from January 2012 to March 2015. We divided these patients into 2 groups: group 1 received more than 3 IVIG administration+steroid therapy, (n=7, 18.4%), and group 2 patients were unresponsive to initial IVIG and required steroid therapy or second IVIG (n=31, 81.6%). We compared the clinical manifestations, laboratory results, and echocardiographic findings between the groups and examined the clinical utility of additional therapies in both groups. Results: A significant difference was found in the total duration of fever between the groups ($13.0{\pm}4.04days$ in group 1 vs. $8.87{\pm}2.30days$ in group 2; P=0.035). At the end of the follow-up, all cases in group 1 showed suppressed CAL. In group 2, coronary artery aneurysm occurred in 2 patients (6.4%). All the patients treated with intravenous corticosteroids without additional IVIG developed CALs including coronary artery aneurysms. Conclusion: No statistical difference was found in the development of CAL between the groups. Prospective, randomized, clinical studies are needed to elucidate the effects of adjunctive therapy in refractory KD patients.

Two-Step Oxidation of Refractory Gold Concentrates with Different Microbial Communities

  • Wang, Guo-hua;Xie, Jian-ping;Li, Shou-peng;Guo, Yu-jie;Pan, Ying;Wu, Haiyan;Liu, Xin-xing
    • Journal of Microbiology and Biotechnology
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    • v.26 no.11
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    • pp.1871-1880
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    • 2016
  • Bio-oxidation is an effective technology for treatment of refractory gold concentrates. However, the unsatisfactory oxidation rate and long residence time, which cause a lower cyanide leaching rate and gold recovery, are key factors that restrict the application of traditional bio-oxidation technology. In this study, the oxidation rate of refractory gold concentrates and the adaption of microorganisms were analyzed to evaluate a newly developed two-step pretreatment process, which includes a high temperature chemical oxidation step and a subsequent bio-oxidation step. The oxidation rate and recovery rate of gold were improved significantly after the two-step process. The results showed that the highest oxidation rate of sulfide sulfur could reach to 99.01 % with an extreme thermophile microbial community when the pulp density was 5%. Accordingly, the recovery rate of gold was elevated to 92.51%. Meanwhile, the results revealed that moderate thermophiles performed better than acidophilic mesophiles and extreme thermophiles, whose oxidation rates declined drastically when the pulp density was increased to 10% and 15%. The oxidation rates of sulfide sulfur with moderate thermophiles were 93.94% and 65.73% when the pulp density was increased to 10% and 15%, respectively. All these results indicated that the two-step pretreatment increased the oxidation rate of refractory gold concentrates and is a potential technology to pretreat the refractory sample. Meanwhile, owing to the sensitivity of the microbial community under different pulp density levels, the optimization of microbial community in bio-oxidation is necessary in industry.

Capsule Endoscopy in Refractory Diarrhea-Predominant Irritable Bowel Syndrome and Functional Abdominal Pain

  • Valero, Manuel;Bravo-Velez, Gladys;Oleas, Roberto;Puga-Tejada, Miguel;Soria-Alcivar, Miguel;Escobar, Haydee Alvarado;Baquerizo-Burgos, Jorge;Pitanga-Lukashok, Hannah;Robles-Medranda, Carlos
    • Clinical Endoscopy
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    • v.51 no.6
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    • pp.570-575
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    • 2018
  • Background/Aims: Capsule endoscopy is a diagnostic method for evaluating the small bowel lumen and can detect undiagnosed lesions. The aim of this study was to evaluate the diagnostic yield and clinical impact of capsule endoscopy in patients with refractory diarrhea-predominant irritable bowel syndrome and functional abdominal pain. Methods: This study involved a retrospective analysis of prospectively collected data, maintained in a database. Patients with refractory diarrhea-predominant irritable bowel syndrome and functional abdominal pain within the period of March 2012 to March 2014 were included. Capsule endoscopy was used to detect small bowel pathologies in both groups. Results: Sixty-five patients (53.8% female) fulfilled the inclusion criteria and had a mean (${\pm}$standard deviation) age of $50.9{\pm}15.9$ years. Clinically significant lesions were detected via capsule endoscopy in 32.5% of the patients in the abdominal pain group and 54.5% of the patients in the diarrhea group. Overall, 48% of patients had small bowel pathologies detected during the capsule endoscopy study. Inflammatory lesions and villous atrophy were the most frequent lesions identified in 16.9% and 15.3% of patients in the abdominal pain and the diarrhea groups, respectively. Conclusions: Routine use of capsule endoscopy in patients with irritable bowel syndrome should not be recommended. However, in patients with refractory conditions, capsule endoscopy may identify abnormalities.