Search results for "Refractory"
showing 10 items of 253 documents
Central alterations of neuromuscular function and feedback from group III-IV muscle afferents following exhaustive high-intensity one-leg dynamic exe…
2015
The aims of this investigation were to describe the central alterations of neuromuscular function induced by exhaustive high-intensity one-leg dynamic exercise (OLDE, study 1) and to indirectly quantify feedback from group III-IV muscle afferents via muscle occlusion (MO, study 2) in healthy adult male humans. We hypothesized that these central alterations and their recovery are associated with changes in afferent feedback. Both studies consisted of two time-to-exhaustion tests at 85% peak power output. In study 1, voluntary activation level (VAL), M-wave, cervicomedullary motor evoked potential (CMEP), motor evoked potential (MEP), and MEP cortical silent period (CSP) of the knee extensor…
OnabotulinumtoxinA: how deep will it go?
2014
First-line treatment of overactive bladder syndrome (OAB) is based on conservative measures and oral medication such asmuscarinic receptor antagonists and, more recently, b3-adrenoceptor agonists.While this provides effective symptom relief for many patients, for others it has insufficient efficacy and/or intolerable side effects. The potent neurotoxin onabotulinumtoxinA (BoNT-A) has shown efficacy in placebo-controlled trials in patients with neurogenic voiding dysfunction or OAB [1], largely including patients exhibiting an insufficient treatment response to muscarinic antagonists. Although the role of a strong placebo component in the beneficial effects of oral treatment is well known, a…
Effects of Constant and Doublet Frequency Electrical Stimulation Patterns on Force Production of Knee Extensor Muscles
2016
International audience; This study compared knee extensors' neuromuscular fatigue in response to two 30-minute stimulation patterns: constant frequency train (CFT) and doublet frequency train (DFT). Fifteen men underwent two separate sessions corresponding to each pattern. Measurements included torque evoked by each contraction and maximal voluntary contractions (MVC) measured before and immediately after the stimulation sessions. In addition, activation level and torque evoked during doublets (Pd) and tetanic contractions at 80-Hz (P80) and 20-Hz (P20) were determined in six subjects. Results indicated greater mean torque during the DFT stimulation session as compared with CFT. But, no dif…
Refractory congestive heart failure: when the solution is outside the heart
2020
Abstract Refractory congestive heart failure is associated with an ominous prognosis in which the treatments strategies remain scarce and not well validated. In the last years, continuous ambulatory peritoneal dialysis (CAPD) has emerged as a therapeutic alternative in this subset of patients. So far, it has been associated with a significant improvement in functional capacity and quality of life, together with a striking reduction in the risk of readmissions. We present the case of an elderly patient with severe left ventricular dysfunction and severe mitral and tricuspid regurgitation who presents recurrent admissions for anasarca. After its inclusion in a CAPD programme, the patient expe…
Fluid therapy in non-septic, refractory acute decompensated heart failure patients – The cautious role of central venous pressure
2019
Purpose Fluid therapy in congestive acute decompensated heart failure (ADHF) patients might be inappropriate and worsening the prognosis. The aim of our study was to analyze the effect of fluid administration on mortality in non-septic, ADHF patients with reduced ejection fraction. Material and methods We analyzed 41 ADHF consecutive ‘cold-wet’ patients (mean age 69.3 ± 14.9 years, 27 men, LVEF 22.8 ± 11.1%, lactates 2.2 ± 1.6 mmol/L) without sepsis. At admission central venous pressure (CVP) was measured (17.6 ± 7.2 cm H2O), and ultrasound examination of inferior vena cava (IVC) was performed (IVC min. 18.6 ± 7.3 mm and IVC max. 24.6 ± 4.3 mm). Moreover, the groups were compared (survivors…
The glucocorticoid in acute decompensated heart failure: Dr Jekyll or Mr Hyde?
2012
Glucocorticoid administration is not recommended in patients with heart failure because of its related sodium and fluid retention. However, previous experimental and clinical studies have demonstrated that glucocorticoids can also induce a diuretic effect and improve renal function in patients with acute decompensated heart failure (ADHF) with refractory diuretic resistance. We report the case of a 65-year-old man with a known diagnosis of aortic stenosis, systolic ventricular dysfunction, and chronic obstructive pulmonary disease who was admitted for ADHF. After 3 days, during which resistance to conventional therapy was observed, intravenous methylprednisolone (60 mg/d) was added to ongoi…
Infliximab for pediatric ulcerative colitis: a retrospective Italian multicenter study.
2008
Abstract Background Infliximab (IFX), the chimeric anti TNFalpha antibody, an established treatment for Crohn's disease in adults and in children, is used less frequently in ulcerative colitis (UC). Aim of the study To report the clinical course of pediatric patients with active UC receiving IFX. Patients and methods Charts of 22 patients were reviewed (13 male, 9 female): 4 with a severe UC attack refractory to systemic corticosteroids (CS); 18 with a protracted course, of which 16 CS-dependent and 2 CS-resistant. The baseline therapeutic program consisted of 3 consecutive intravenous infusions (0, 2, 6 weeks) of IFX (5 mg/kg), followed by a retreatment schedule (infusion every 8 weeks); a…
Efficacy and safety of yttrium 90 ibritumomab tiuxetan in patients with relapsed or refractory diffuse large B-cell lymphoma not appropriate for auto…
2007
A prospective, multicenter, nonrandomized phase 2 trial was conducted to evaluate the efficacy and safety of a single dose of yttrium-90 (90Y) ibritumomab tiuxetan in elderly patients in first relapsed or primary refractory diffuse large B-cell lymphoma (DLBCL) ineligible for stem-cell transplantation. Patients had been previously treated with chemotherapy (group A, n = 76) or chemotherapy plus rituximab (group B, n = 28). Patients in group A were further divided into patients in whom induction therapy had failed (stratum AI, n = 33) and patients who had relapsed after achieving complete response (CR; stratum AII, n = 43). The overall response rate (ORR) was 52% and 53% in strata AI and AII…
Enhanced external counterpulsation for treatment of refractory angina pectoris
2006
OBJECTIVE: Enhanced external counterpulsation (EECP) is a noninvasive, well-tolerated treatment, effective for managing patients with refractory angina pectoris. The aim of this study was to evaluate the efficacy of EECP to relieve symptoms, to decrease myocardial ischaemia and to improve cardiac performance in patients with intractable angina, refractory to surgical and medical treatment. METHODS: Twenty-five patients (24 men and one woman, mean age 65 years) with persistent ischaemia notwithstanding optimal medical therapy or after interventional or surgical procedure, received EECP sessions for 35 h. Each patient underwent dobutamine stress echocardiography before and after treatment. We…
Improving Knowledge of Arterial Resistant Hypertension: What Is Relevant?
2013
Resistant hypertension, also known as refractory hypertension in the literature, is a relatively common disease that is associated with elevated cardiovascular and renal risk. Clinical trials suggest that its prevalence is around 35% in hypertensive patients with a baseline blood pressure (BP) > 160/100 mmHg. However, data obtained from registries or from the physician’s office suggest that its prevalence is around 12%. The recent National Health and Nutrition Examination Survey suggests a similar prevalence of 12.3% in diagnosed and treated hypertensive patients. An incidence study conducted at Kaiser Permanente Colorado and Kaiser Permanente Northern California followed up more than 200 0…