New developments in the treatment of cutaneous leishmaniasis

Leishmaniasis, including the cutaneous form, poses an important public health threat around the world, while no vaccine is currently available against any form of leishmaniasis. The drugs used in the first line treatment of cutaneous leishmaniasis (CL) are commonly pentavalent antimonials despite their toxicities, long-term treatment duration and increasing resistance rates. Other alternatives are amphotericin B, pentamidine, miltefosine and paromomycine. Movement of the population, especially in endemic regions, increases the spread of the parasite and affectes the distribution of causative species, which requires re-evaluation the treatment regimen. Extensive researches are carried out on the treatment of leishmaniasis. The immunotherapeutic and targeted therapeutic approaches, formulations of carrier-loaded active drugs, local thermotherapeutic applications, the combination of antileishmanial drugs/compounds, the use of new synthetic and natural products are promising therapeutic options in the future. Herein, the author reviews the potential treatment modalities of CL with a brief overview of current treatments in the light of ongoing studies around the world.

Quiste óseo aneurismático en el húmero distal. Reporte de un caso y tratamiento actual / Aneurysmal bone cyst in distal humerus. Case report and current treatment

El quiste óseo aneurismático es una lesión ósea benigna que se presenta a edad temprana; su comportamiento suele ser agresivo por lo cual, la resección quirúrgica y la prevención de su recidiva son los pilares fundamentales de el tratamiento. Presentamos el caso de una paciente de 6 años de edad residente en Gualaceo, Ecuador, con masa de crecimiento progresivo y deformante en el codo izquierdo. Por las características de los exámenes de imagen y el cuadro sintomático se dignostica quiste óseo aneurismático que fue tratado con cirugía de resección intralesional y terapia adyuvante (fresado de alta velocidad, coagulación térmica y crioterapia). Se confirmó el diagnostico mediante el estudio histopatológico posquirúrgico

The aneurysmal bone cyst is a benign osseous lesion of presentation at an early age whose behavior is usually aggressive, so its surgical resection and the prevention of its recurrence is the fundamental pillar for the treatment. We present the case of a girl of 6 years of age living in Gualaceo, Ecuador, with a mass of progressive and deforming growth in the left elbow. By characteristics in the imaging tests and clinical picture it was considered as an aneurysmal bone cyst which was treated with intralesional resection surgery and adjuvant therapy (high speed burr, thermal coagulation and cryotherapy). The diagnosis was confirmed with postoperative histopathological study

Tratamento da hepatite crônica pelo vírus C: Novas perspectivas / Treatment of chronic hepatitis C virus: new perspectives

A infecção pelo vírus da hepatite C (HCV) é importante causa de hepatite crônica, cirrose e carcinoma hepatocelular, sendo razão para a indicação de transplante hepático no mundo industrializado (Sherlock, 1995). Várias estratégias de tratamento da hepatite C foram empregadas ao longo dos últimos anos. O interferon peguilado em monoterapia ou combinado à ribavirina tornou-se tratamento padrão. Em 2011, foram introduzidos os inibidores de protease. Em dezembro de 2013, uma nova geração de drogas tem conferido resultados auspiciosos à terapia.

The hepatitis C virus infection (HCV) is an important cause of chronic hepatitis, cirrhosis and hepatocellular carcinoma, which leads indication for liver transplantation in the industrialized world (Sherlock, 1995). Many treatment strategies for hepatitis C were used for the latest years. Pegylated interferon monotherapy or combined to the ribavirin became a standard treatment. In 2011, protease inhibitors were introduced. In December 2013, a new generation drugs have been presented auspicious results to the therapy.

Actualización en fibromialgia / Update on fibromyalgia

El síndrome de fibromialgia (FM) es una enfermedad crónica que causa dolor, rigidez y sensibilidad en músculos, tendones y articulaciones. También se caracteriza por alteraciones del sueño, cansancio, fatiga, ansiedad, depresión y alteraciones en las funciones intestinales. La etiología de la fibromialgia sigue siendo desconocida, pero los recientes avances y descubrimientos han ayudado a desentrañar algunos de los misterios de esta enfermedad. La investigación pone de relieve algunas de las anormalidades bioquímicas, metabólicas e inmunológicas asociadas con la fibromialgia. Guías basadas en la evidencia sugieren que la fibromialgia sea manejada con terapias multidisciplinarias tales como la medicación, terapia cognitivo-conductual, educación y ejercicio...

Fibromyalgia syndrome (FMS) is a chronic condition causing pain, stiffness, and tenderness of the muscles, tendons, and joints. It is also characterized by restless sleep, tiredness, fatigue, anxiety, depression, and disturbances in bowel functions. The etiology of fibromyalgia remains unknown, but recent advances and discoveries have helped to unravel some of the mysteries of this disease. Research highlights some of the biochemical, metabolic, and immune regulatory abnormalities associated with fibromyalgia. Evidence-based guidelines suggest that fibromyalgia is typically managed with multidisciplinary therapies involving medication, cognitive behavioral therapy, education, and exercise...

Current Treatment of Tibial Pilon Fractures / 대한족부족관절학회지

Pilon fractures involving distal tibia remain one of the most difficult therapeutic challenges that confront the orthopedic surgeons because of associated soft tissue injury is common. To introduce and describe the diagnosis, current treatment, results and complications of the pilon fractures. In initial assessment, the correct evaluation of the fracture type through radiographic checkup and examination of the soft tissue envelope is needed to decide appropriate treatment planning of pilon fractures. Even though Ruedi and Allgower reported 74% good and excellent results with primary open reduction and internal fixation, recently the second staged treatment of pilon fractures is preferred to orthopedic traumatologist because of the soft tissue problem is common after primary open reduction and internal fixation. The components of the first stage are focused primarily on stabilization of the soft tissue envelope. If fibula is fractured, fibular open reduction and internal fixation is integral part of initial management for reducing the majority of tibial deformities. Ankle-spanning temporary external fixator is used to restore limb alignment and displaced intraarticular fragments through ligamentotaxis and distraction. And the second stage, definitive open reduction and internal fixation of the tibial component, is undertaken when the soft tissue injury has resolved and no infection sign is seen on pin site of external fixator. The goals of definitive internal fixation should include absolute stability and interfragmentary compression of reduced articular segments, stable fixation of the articular segment to the tibial diaphysis, and restoration of coronal, transverse, and sagittal plane alignments. The location, rigidity, and kinds of the implants are based on each individual fractures. The conventional plate fixation has more advantages in anatomical reduction of intraarticular fractures than locking compression plate. But it has more complications as infection, delayed union and nonunion. The locking compression plate fixation provides greater stability and lesser wound problem than conventional implants. But the locking compression plate remains poorly defined for intraarticular fractures of the distal tibia. Active, active assisted, passive range of motion of the ankle is recommended when postoperative rehabilitation is started. Splinting with the foot in neutral is continued until suture is removed at the 2~3 weeks and weight bearing is delayed for approximately 12 weeks. The recognition of the soft tissue injury has evolved as a critical component of the management of pilon fractures. At this point, the second staged treatment of pilon fractures is good treatment option because of it is designed to promote recovery of the soft tissue envelope in first stage operation and get a good result in definitive reduction and stabilization of the articular surface and axial alignment in second stage operation.

The present situation of dysfunctional uterine bleeding treated with Anchong Decoction / 国际中医中药杂志

The paper reviewed clinical reports on the treatment of hypermenorrhea, menostaxis, and uterine bleeding with Ancong Decoction and modified Ancong Decoction. Although there were few reports concerned with clinical usage, Ancong Decoction has sound therapeutic effects, with more than 90% effective rate.

Current Trend of Early Glottic and Tongue Cancer Management in Korea / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: The management of early glottic, tongue and tongue base cancer remains controversial and the trends in the treatment rationale can be influenced by the clinician and/or the patient factors. This study assesses the current treatment trend in the management of glottic, tongue and tongue base cancer among the Korean Society of Head and Neck Surgeons membership. We want this data to give more information in regards to better selection of treatment against specific individual factors. MATERIALS AND METHODS: A survey instrument in the form of a questionnaire was designed by authors. The questionnaire was distributed to 91 members with 46 responses. After the data from these surveys were computerized, the analysis was performed using SAS software. RESULTS: The two most frequently used treatment regimens of T2N0 glottic cancers were conservation laryngeal surgery (45.7%) and radiation therapy alone (19.6%). T2N0 tongue cancer was usually treated with surgery (56.5%) and surgery with radiation therapy (26.1%). The treatment patterns for tongue base cancer were varied as follows: surgery, 23.9%; radiation therapy only, 21.7%; combined therapy, 30.4%; and patient choice, 23.9%. In situations where an unclear resection margin is found, participants usually underwent adjuvant postoperative radiotherapy. A trend toward lower application rates was noted from positive margin (82.6%) to close margin (67.4%) and the difference was statistically significant (p<0.020). Important factors to determine which patient should be entered into a combined therapy program after neck dissection were the N-staging system and the histological extracapsular spread of lymph node metastases. Examination of treatment rationale demonstrated that the most preferred form of treatment was based on the perception of superior oncologic outcomes (87.0%). Treatment recommendations were usually decided by the operator (52.3%) and the tumor board (25.0%). CONCLUSIONS: Treatment modalities were not significantly influenced by varied individual factors of participants. But a standard therapy has never been well defined. These varied factors in the management of early glottic, tongue and tongue base cancer and treatment rationale reflect that there are multiple influencing factors.