Clinical recurrence

Marcucci R, et al. Tissue factor and homocysteine levels in ischemic heart disease are associated with angiographically documented clinical recurrences after coronary angioplasty. Thromb Haemost 2000 83(6) 826-832. 

After successful initial therapy, CEA levels decline. During remission, CEA levels are stable. Rising CEA values may indicate recurrence of disease. The lead time from CEA elevation to clinical recurrence is about 5 months. A repeat laparotomy can be performed to confirm the relapse, which is detected in 90% of cases. In the monitoring of metastatic colon cancer, CEA is useful in following patients throughout therapy and the clinical course of the disease. 

Iimnunomodulators. Since immunosuppression is associated with enhanced viral replication, Sheiner et al., (240) have postulated that clinical recurrence of the disease may be associated with augmented immunosuppression consequent to anti-rejection therapy. 

Antibiotics can be used as either (1) adjunctive treatment along with other medications for active IBD (2) treatment for a specific complication of Crohn s disease or (3) prophylaxis for recurrence in postoperative Crohn s disease. Metronidazole, ciprofloxacin, and clarithromycin are the antibiotics used most frequently. They are more beneficial in Crohn s disease involving the colon than in disease restricted to the Ueum. Specific Crohn s disease-related complications that may benefit from antibiotic therapy include intra-abdominal abscess and inflammatory masses, perianal disease (including fistulas and perirectal abscesses), small bowel bacterial overgrowth secondary to partial small bowel obstruction, secondary infections with organisms such as Clostridium difficile, and postoperative complications. Metronidazole may be particularly effective for the treatment of perianal disease. Postoperatively, a 3-month course of metronidazole (20 mg/kg/day) can prolong the time to both endoscopic and clinical recurrence. 

In addition to volume reduction, the detection of new fibroids should be a priority since it is very common with other uterus-sparing therapies [20]. The remaining question is the duration between UFE and clinical recurrence due to new fibroids and whether this interval is different from that seen after myomectomy. 

Early recurrence of symptoms can occur when uterine artery embolization is performed on patients with adenomyosis (please see Chap. 10.4). Uterine artery embolization for adenomyosis is reported to be effective to control the bleeding initially [22,23] however, this clinical success is short-term. There is a high rate of clinical recurrence after embolization of the uterine artery for adenomyosis. In a recent study by Pelage et al, 44% of the patients required an additional treatment, including hysterectomies in 28% of the cases [24]. 

The Cooperative Aneurysm Study reported that women have a 2.2 times higher recurrence rate of hemorrhage than men. Recurrent hemorrhage was also more frequently associated with a poorer neurologic grade at presentation and increased systolic blood pressure (Torner et al. 1981). Clinically, recurrent hemorrhage may present with new neuro-... 

Fohc acid is safe, even at levels of daily oral supplementation up to 5—10 mg (97). Gastrointestinal upset and an altered sleep pattern have been reported at 15 mg/day (98). A high intake of foHc acid can mask the clinical signs of pernicious anemia which results from vitamin deficiency and recurrence of epilepsy in epileptics treated with dmgs with antifolate activity (99). The acute toxicity (LD q) is approximately 500 and 600 mg per kg body weight for rats and mice, respectively (100). 

There is now good evidence that the clinical manifestations of asthma symptoms - impairment of lung function, sleep disturbances, limitations of daily activity, and the use of rescue medications - can be controlled with appropriate treatment. When asthma is controlled, there should be no more than occasional recurrence of symptoms and severe exacerbations should be rare. 

Most recently, a phase-I-study defined a dose of 13-ris-retinoic acid that was tolerable in patients after myeloablative therapy, and a phase-III-trial showed that postconsolidation therapy with 13-cis-retinoic acid improved EFS for patients with high-risk neuroblastoma [7]. Preclinical studies in neuroblastoma indicate that ATRA or 13-cw-RA can antagonize cytotoxic chemotherapy and radiation, such that use of 13-cis-RA in neuroblastoma is limited to maintenance after completion of cytotoxic chemotherapy and radiation. It is likely that recurrent disease seen during or after 13-cis-RA therapy in neuroblastoma is due to tumor cell resistance to retinoid-mediated differentiation induction. Studies in neuroblastoma cell lines resistant to 13-cw-RA and ATRA have shown that they can be sensitive, and in some cases collaterally hypersensitive, to the cytotoxic retinoid fenretinide. Here, fenretinide induces tumor cell cytotoxicity rather than differentiation, acts independently from RA receptors, and in initial phase-I-trials has been well tolerated. Clinical trials of fenretinide, alone and in combination with ceramide modulators, are in development. 

The mood stabilizers were so called because they prevent recurrences of mood swings in people with bipolar disorder. The evidence for this is best with lithium, but is based on smdies carried out more than 20 years ago. However, recent naturalistic surveys tend to find that lithium is far less useful in general clinical practice than in research settings. Many patients discontinue lithium... 

Clinical trials and meta-analyses have demonstrated that early carotid endarterectomy (CEA) is the preferred treatment for most patients with severe symptomatic internal carotid artery (ICA) stenosis and selected patients with moderate disease.However, CEA is often delayed in chnical practice, or may not be appropriate in some patients due to an unfavorable risk-benefit profile. In these settings, it is reasonable to consider acute antithrombotic treatment to prevent early recurrent stroke. 

Lacunar stroke is characterized by occlusion of a small penetrating artery creating a small deep infarct. Lacunar strokes have the lowest early recurrence risk and best survival rates, but may still cause significant functional morbidity. Although subgroup analyses are available from secondary prevention trials in lacunar stroke, few clinical trial data are available regarding nonthrombolytic antithrombotic therapy for lacunar stroke in the acute setting. 

Since functional outcome and risk of recurrent stroke are, in part, predictable based on the pathophysiologic subtype of stroke, the ability to accurately classify patients based on emergency clinical and imaging data would provide valuable predictive information. Unfortunately, misclassifications of stroke subtypes based on clinical data and a noncontrast CT scan are common. The final subtyping of stroke is made with all available clinical data, but is heavily influenced by neuroimaging studies that identify the location, size, and vascular distribution of the infarct, or that establish that the arteries supplying the region of stroke are stenotic or occluded. 

Epilepsy is a clinical disorder characterized by spontaneous, recurrent seizures arising from excessive electrical activity in certain parts of the brain [51]. Currently available drugs, such as phenytoin, carbamazepine, valproic acid, lamotrigine, and topiramate (for molecular structures see Fig. 6), provide symptomatic seizure suppression in only 60-70% of those receiving treatment [52-54]. These drugs are also associated with unwanted side... 

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