Expert review of neurotherapeutics
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The prevalence of obesity is increasing worldwide. For severely obese patients, bariatric surgery is the only effective option for sustained weight loss and associated health improvement. ⋯ Most drug-dosing guidelines are based on results from relatively small studies in moderately obese patients. Future systematic pharmacological research is needed for improved and more rational peri-operative care of morbidly obese patients.
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Expert Rev Neurother · May 2006
ReviewState of the art chemotherapeutic management of pediatric brain tumors.
CNS tumors are the most common solid tumor of childhood. This article will review current treatments for pediatric brain tumors; low-grade gliomas, high-grade gliomas, medulloblastomas and ependymomas. It will also highlight the treatments that are used for brain tumors in very young children and in children with recurrent brain tumors. ⋯ Future treatment paradigms will need to consider examining the use of multiple biological modifiers. Similarly, these agents will need to be examined in combination with cytotoxic chemotherapy. Finally, the future direction of pediatric neuro-oncology and the focus of the field as it battles pediatric brain tumors is discussed.
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Expert Rev Neurother · May 2006
ReviewPrevention, diagnosis and treatment of delirium: staff educational approaches.
Delirium is a common disorder especially among older people admitted to medical and surgical units. Research has demonstrated that many cases are underdiagnosed, misdiagnosed or not properly managed. Some of the difficulties encountered in the diagnosis, treatment and prevention may, in part, stem from a historical low emphasis on delirium in medical and nursing education. ⋯ In this review, diagnosis, treatment and prevention of delirium are considered in relation to the difficulties encountered in each of these areas. The role of increasing doctors' and nurses' awareness in the understanding of delirium through educational programs is also reviewed. The outcome of many cases of delirium is not changed by current treatment; however, there is increasing evidence that strategies employing appropriate multicomponent and/or educational staff intervention programs may decrease the prevalence of delirium.
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Complex regional pain syndrome (CRPS) most often follows injury to peripheral nerves or their endings in soft tissue. A combination of prostanoids, kinins and cytokines cause peripheral nociceptive sensitization. ⋯ In time, these neurons undergo central sensitization that lead to a major physiological change of the autonomic, pain and motor systems. The role of the immune system and the sickness response is becoming clearer as microglia are activated following injury and can induce central sensitization while astrocytes may maintain the process.
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Glioblastoma multiforme represents the most common primary malignant tumor of the adult CNS. Unfortunately, the median survival after surgical intervention alone is less than 6 months and the addition of radiotherapy can extend this time to only 9 months. ⋯ One such modality, gene therapy, has shown promise in the spectrum of agents utilized against brain tumors. This review highlights the principles of gene therapy and discusses the results of recent clinical trials in which gene therapy has been employed against malignant brain tumors.