Standard of Care - Recent changes [en]

Guanfacine

Scohen — Wed, 22 May 2013 01:49:35 GMT

Revision as of 01:49, 22 May 2013		Current revision
Line 1:		Line 1:
	An alpha2-adrenergic agonist .		An alpha2-adrenergic agonist .
		+
		+	Trade names Tenex, and Intuniv.
		+
		+	Administered orally and intravenously.
		+
		+	Has a bioavailability of 99.9%, and a half-life of 14.8-18.3 hours.
		+
		+	Really excreted and metabolized by the CYP3A system.
		+
		+	A sympatholytic agent, and is a selective α2A receptor agonist, which are concentrated in the prefrontal cortex and the locus coeruleus, with the potential to improve attention abilities via modulating post-synaptic α2A receptors.
		+
		+	Lowers both systolic and diastolic blood pressure by activating the central nervous system α2A norepinephrine autoreceptors, which results in reduced peripheral sympathetic outflow and thus a reduction in peripheral sympathetic tone.
		+
		+	Side effects are dose dependent.
		+
		+	It reduces hypertension with normalization of blood pressure of 54% treated over a year and 66% over two years.
		+
		+	1 mg Guanfacine tablets.
		+
		+	An extended-release formulation of guanfacine (Intuniv) has also been approved for the treatment of attention-deficit hyperactivity disorder (ADHD) in people ages 6–17.
		+
		+	Extended-release formulation of guanfacine strengthens prefrontal cortical regulation of attention and behavior.
		+
		+	When used in conjunction with stimulants, augment therapeutic actions, counters side effects, reduces rebound, and when taken at night induces sleep.
		+
		+	Improves regulation of behavior, attention, and emotion through actions at post-synaptic α2A adrenergic receptors on prefrontal cortical neurons.
		+
		+	Performance increases in spatial working memory, and may help with prefrontal cortical disorders, including traumatic brain injury to the frontal lobe, strokes affecting higher cognitive function,and emotional disorders.
		+
		+	Used for treatment of anxiety, such as generalized anxiety disorder and post-traumatic stress disorder symptoms.
		+
		+	It reduce sympathetic arousal, weaken the emotional responses of the amygdala, and strengthen prefrontal cortical regulation of emotion, action and thought.
		+
		+	All of these actions likely contribute to the relief of the hyperarousal, re-experiencing of memory, and impulsivity associated with PTSD.
		+
		+	Improves sleep interrupted by nightmares in PTSD patients.
		+
		+	Side effects: depression, dizziness, drowsiness, headache, constipation, gas pains, diarrhea, loss of appetite, fatigue, and nasal congestion may occur.
		+
		+	Less common side effects include: chest pain, dyspnea, skin rash, swelling, blurred vision, jaundice, mental/mood changes, tingling sensation, dry mouth, impotence, decreased sexual desire, vision changes, taste changes, tinnitus, and leg cramps.
		+
		+	Cardiovascular side effects include orthostatic hypotension, dizziness, palpitations, and tachycardia upon standing, and bradycardia.
		+
		+	Gradual discontinuation is recommended, as rebound hypertension is a possibility with sudden drug withdrawal.
		+
		+	CYP3A4/5 inhibitors elevate plasma concentrations
		+
		+	Has a bioavailability of nearly 100% and half-life of 17 hours.
		+
		+	Eliminated primarily by renal route.

	Can mimic effects of norepinephrine		Can mimic effects of norepinephrine

Working formulation

Scohen — Tue, 21 May 2013 23:19:55 GMT

Revision as of 23:19, 21 May 2013		Current revision
Line 282:		Line 282:


-	839.00 - 839.59 Dislocation of vertebra	+
-	ICD-9 codes not covered for indications listed in the CPB:	+
-	722.4 - 722.73 Degeneration of intervertebral disc	+
-	724.2 Lumbago	+
-	Other ICD-9 codes related to the CPB:	+
-	V45.4 Arthrodesis status [status post fusion]	+
-	Intervertebral body fusion devices (e.g., BAK Interbody Fusion System, Ray Threaded Fusion Cage, STALIF stand-alone anterior lumbar fusion cage, carbon fiber cage):	+
-	CPT codes covered if selection criteria are met:	+
-	+ 22851	+
-	Other CPT codes related to the CPB:	+
-	20936 - 20938	+
-	ICD-9 codes covered if selection criteria are met:	+
-	722.51 Degeneration of thoracic or thoracolumbar intervertebral disc [see criteria in CPB 743]	+
-	722.52 Degeneration of lumbar or lumbosacral intervertebral disc [see criteria in CPB 743]	+
-	756.11 Spondylolysis, lumbosacral region [see criteria in CPB 743]	+
-	756.12 Spondylolisthesis [see criteria in CPB 743]	+
-	Percutaneous polymethylmethacrylate vertebroplasty (PPV) or kyphoplasty:	+
-	CPT codes covered if selection criteria are met:	+
-	22520	+
-	22521	+
-	+ 22522	+
-	22523	+
-	22524	+
-	+ 22525	+
-	Other CPT codes related to the CPB:	+
-	72291	+
-	72292	+
-	HCPCS codes covered if selection criteria are met:	+
-	S2360 Percutaneous vertebroplasty, one vertebral body, unilateral or bilateral injection; cervical	+
-	S2361 each additional cervical vertebral body (list separately in addition to code for primary procedure)	+
-	ICD-9 codes covered if selection criteria are met:	+
-	170.2 Malignant neoplasm of vertebral column, excluding sacrum and coccyx [see criteria]	+
-	170.6 Malignant neoplasm of pelvic bones, sacrum, and coccyx [see criteria]	+
-	192.2 Malignant neoplasm of spinal cord [see criteria]	+
-	192.3 Malignant neoplasm of spinal meninges [see criteria]	+
-	198.3 Secondary malignant neoplasm of brain and spinal cord [see criteria]	+
-	198.4 Secondary malignant neoplasm of other parts of nervous system [see criteria]	+
-	198.5 Secondary malignant neoplasm of bone and bone marrow [see criteria]	+
-	200.00 - 208.92 Malignant neoplasm of lymphatic and hematopoietic tissue [see criteria]	+
-	228.09 Hemangioma of other sites [painful and/or aggressive + criteria]	+
-	277.89 Other specified diosrders of metabolism [painful vertebral eosinophilic granuloma + criterai]	+
-	721.7 Traumatic spondylopathy [see criteria]	+
-	733.00 - 733.09 Osteoporosis [see criteria]	+
-	733.13 Pathologic fracture of vertebrae [painful, debilitating osteoporotic collapse/compression fractures + criteria]	+
-	805.00 - 805.7 Fracture of vertebral column without mention of spinal cord injury [steroid-induced + criteria]	+
-	806.00 - 806.79 Fracture of vertebral column with spinal cord injury [steroid-induced + criteria]	+
-	ICD-9 codes not covered for indications listed in the CPB:	+
-	722.0 - 722.93 Intervertebral disc disorders	+
-	Other ICD-9 codes related to the CPB:	+
-	723.1 Cervicalgia	+
-	723.2 Cervicocranial syndrome	+
-	723.8 Other syndromes affecting cervical region	+
-	724.1 Pain in thoracic spine	+
-	724.2 Lumbago	+
-	724.3 Sciatica	+
-	724.5 Backache, unspecified	+
-	E932.0 Adverse effect of adrenal cortical steroids	+
-	V58.65 Long term (current) use of steroids	+
-	Endoscopic Spinal Surgery - no specific codes:	+
-	Other CPT codes related to the CPB:	+
-	62267	+
-	62287	+
-	77002	+
-	Experimental and Investigational Interventions for treatment of back pain:	+
-	Radiofrequency lesioning of dorsal root ganglia - no specific codes:	+
-	Radiofrequency lesioning of terminal (peripheral) nerve endings - no specific codes:	+
-	Epiduroscopy:	+
-	Other CPT codes related to the CPB:	+
-	62318	+
-	62319	+
-	72275	+
-	Epidural injections of lytic agents:	+
-	CPT codes not covered for indications listed in the CPB:	+
-	62280	+
-	62281	+
-	62282	+
-	Other CPT codes related to the CPB:	+
-	72275	+
-	HCPCS codes not covered for indications listed in the CPB:	+
-	J3470 Injection, hyaluronidase, up to 150 units	+
-	J3471 Injection, hyaluronidase, ovine, preservative free, per 1 USP unit (up to 999 USP units)	+
-	J3472 Injection, hyaluronidase, ovine, preservative free, per 1000 USP units	+
-	J3473 Injection, hyaluronidase, recombinant, 1 USP unit	+
-	ICD-9 codes not covered for indications listed in the CPB:	+
-	322.0 - 322.9 Meningitis of unspecified cause	+
-	720.0 - 724.9 Dorsopathies	+
-	729.2 Neuralgia, neuritis, and radiculitis, unspecified	+
-	905.1 Late effect of fracture of spine and trunk without mention of spinal cord lesion	+
-	907.3 Late effect of injury to nerve root(s), spinal plexus(es), and other nerves of trunk	+
-	959.19 Other injury of other sites of trunk	+
-	Yeung Endoscopic Spinal Surgery System, Y.E.S.S. - no specific codes:	+
-	Microsurgical anterior foraminotomy - no specific codes:	+
-	Other CPT codes related to the CPB:	+
-	63075 - 63078	+
-	Other HCPCS codes related to the CPB:	+
-	S2350 Discectomy, anterior, with decompression of spinal cord and/or nerve root(s), including osteophytectomy; lumbar, single interspace	+
-	S2351 Discectomy, anterior, with decompression of spinal cord and/or nerve root(s), including osteophytectomy; lumbar, each additional interspace (list separately in addition to code for primary procedure)	+
-	Sacroiliac fusion:	+
-	CPT codes not covered for indications listed in the CPB:	+
-	27280	+
-	Sacroplasty:	+
-	CPT codes not covered for indications listed in the CPB:	+
-	0200T	+
-	0201T	+
-	Racz procedure (epidural adhesiolysis with the Racz catheter):	+
-	CPT codes not covered for indications listed in the CPB:	+
-	62263	+
-	62264	+
-	Other CPT codes related to the CPB:	+
-	72275	+
-	Microdiskectomy:	+
-	Other CPT codes related to the CPB:	+
-	22220 - 22226	+
-	62267	+
-	62287	+
-	+ 69990	+
-	77002	+
-	Other HCPCS codes related to the CPB:	+
-	C2614 Probe, percutaneous, lumbar discectomy	+
-	S2350 Discectomy, anterior, with decompression of spinal cord and/or nerve root(s), including osteophytectomy; lumbar, single interspace	+
-	S2351 Discectomy, anterior, with decompression of spinal cord and/or nerve root(s), including osteophytectomy; lumbar, each additional interspace (list separately in addition to code for primary procedure)	+
-	Microendoscopic discectomy (M	+
-	62287	+
-	+ 69990	+
-	77002	+
-	Other HCPCS codes related to the CPB:	+
-	C2614 Probe, percutaneous, lumbar discectomy	+
-	S2350 Discectomy, anterior, with decompression of spinal cord and/or nerve root(s), including osteophytectomy; lumbar, single interspace	+
-	S2351 Discectomy, anterior, with decompression of spinal cord and/or nerve root(s), including osteophytectomy; lumbar, each additional interspace (list separately in addition to code for primary procedure)	+
-	Dynamic stabilization (e.g., Dynesys Spinal System and the Stabilimax NZ Dynamic Spine Stabilization System) - no specific codes:	+
-	Inter-spinous distraction (X Stop Device, Coflex interspinous stablilization spinal implant, Extensure bone allograft inter-spinous spacer, Eclipse inter-spinous distraction device, and the TOPS System):	+
-	CPT codes not covered for indications listed in the CPB:	+
-	0171T	+
-	+ 0172T	+
-	0202T	+
-	HCPCS codes not covered for indications listed in the CPB:	+
-	C1821 Interspinous process distraction device (implantable)	+
-	Endoscopic laser foraminoplasty - no specific codes:	+
-	Piriformis muscle resection - no specific codes:	+
-	CPT codes not covered for indications listed in the CPB:	+
-	27006	+
-	ICD-9 codes not covered for indications listed in the CPB:	+
-	355.0 Lesion of sciatic nerve	+
-	724.3 Sciatica	+
-	726.5 Enthesopathy of hip region	+
-	Xclose Tissue Repair System - no specific codes:	+
-	Radiofrequency denervation for sacroiliac joint pain:	+
-	CPT codes not covered for indications listed in the CPB:	+
-	27035	+
-	64635	+
-	+ 64636	+
-	ICD-9 codes not covered for indications listed in the CPB:	+
-	355.0 Lesion of sciatic nerve	+
-	724.3 Sciatica	+
-	724.4 Thoracic or lumbosacral neuritis or radiculitis, unspecified	+
-	726.5 Enthesopathy of hip region	+
-	Coccygeal ganglion (ganglion impar) blockade for pelvic	+
-	Extreme lateral interbody fusion (XLIF) - no specific codes:	+
-	Vesselplasty (e.g., Vessel-X) - no specific codes:	+
-	Epidural fat grafting :	+
-	Other CPT codes related to the CPB::	+
-	20926 Tissue grafts, other (e.g., paratenon, fat, dermis) [not covered during lumbar decompression laminectomy/discectomy]	+
-	Interlaminiar lumbar instrumented fusion (ILIF):	+
-	No specific codes	+
-	Aspen spinous process fixation system:	+
-	No specific codes	+
-	OptiMesh grafting system:	+
-	No specific codes	+
-	Radiofrequency/pulsed radiofrequency ablation of trigger points:	+
-	No specific codes	+

Macular degeneration

Scohen — Tue, 21 May 2013 03:51:35 GMT

Revision as of 03:51, 21 May 2013		Current revision
Line 1:		Line 1:
	Leading cause of irreversible visual impairment and blindness in the U.S.		Leading cause of irreversible visual impairment and blindness in the U.S.
		+
		+	Age-related macular degeneration accounts for more than 50% of all blindness in United States.

	Among individuals 75 years and older more than 25% have signs of age related maculopathy and 6-8% have advanced stages of disease.		Among individuals 75 years and older more than 25% have signs of age related maculopathy and 6-8% have advanced stages of disease.
Line 10:		Line 12:

	Estimated 1.75 million people in the U.S. have advanced age-related macular degeneration, accounting for most cases of severe vision loss.		Estimated 1.75 million people in the U.S. have advanced age-related macular degeneration, accounting for most cases of severe vision loss.
		+
		+	Is expected that the number of persons with advanced AMD will double over the next 20 years.

	About 7.3 million people have early disease, which is usually associated with little or no vision loss, but increases the risk of developing advanced age related macular degeneration.		About 7.3 million people have early disease, which is usually associated with little or no vision loss, but increases the risk of developing advanced age related macular degeneration.
Line 20:		Line 24:

	Hallmarks include the presence of hard or soft drusen and nonspecific pigment alterations at the retinal pigment epithelium.		Hallmarks include the presence of hard or soft drusen and nonspecific pigment alterations at the retinal pigment epithelium.
		+
		+	Median age-related macular degeneration is defined as bilateral drusen.

	Hallmark of the disease is the presence of drusen.		Hallmark of the disease is the presence of drusen.
Line 62:		Line 68:

	Higher intake of vegetable, monounsaturated and polyunsaturated fats are associated with higher risk of macular degeneration.		Higher intake of vegetable, monounsaturated and polyunsaturated fats are associated with higher risk of macular degeneration.
		+
		+	Observational studies suggested higher dietary intake of lutein plus zeaxanthin and eicosapentaenoic acid are associated with these decreased risk of developing age-related macular degeneration.
		+
		+	Lutein and zeaxanthin are the major components of macular pigment.

	Direct association between homocysteine concentration in the blood and risk of disease.		Direct association between homocysteine concentration in the blood and risk of disease.
Line 68:		Line 78:

	The Age-Related Eye DiseaseStudy (AREDS) indicated that taking a high formulation of her antioxidants and zinc significantly reduces the risk of advanced disease and its associated vision loss for persons at intermediate disease stages.		The Age-Related Eye DiseaseStudy (AREDS) indicated that taking a high formulation of her antioxidants and zinc significantly reduces the risk of advanced disease and its associated vision loss for persons at intermediate disease stages.
		+
		+	In the above study there was reduced risk of developing advanced AMD by 25% at five years.

	Treatment for wet age related macular degeneration include laser surgery, photodynamic therapy, and injections into the eye of anti-angiogenic medications.		Treatment for wet age related macular degeneration include laser surgery, photodynamic therapy, and injections into the eye of anti-angiogenic medications.
		+
		+	Intraocular drugs that inhibit vascular endothelial growth factor are available for the treatment of neovascular age-related macular degeneration and there is presently no effective therapy for atrophic AMD.

	Bevacizumab (Avastin) and ranibizumab (Lucentis) have equivalent results on visual acuity when treated with intravitreal injections (CATT Research Group).		Bevacizumab (Avastin) and ranibizumab (Lucentis) have equivalent results on visual acuity when treated with intravitreal injections (CATT Research Group).

Glaucoma

Scohen — Tue, 21 May 2013 03:09:42 GMT

Revision as of 03:09, 21 May 2013		Current revision
Line 85:		Line 85:

	Glaucomatous changes in the optic nerve head usually can be detected over time.		Glaucomatous changes in the optic nerve head usually can be detected over time.
		+
		+	Glaucomatous optic nerve changes on direct ophthalmoscopy includes large cup-to disc ratio or hemorrhage at the optic disc.
		+
		+	The risk of inducing an angle closure glaucoma with pharmacological manipulation is 1 in 3800 to 1 in 20,000.
		+
		+	Using a slitlamp ophthalmoscopy or stereoscopic photographs one can better evaluate three dimensional architecture and more accurately assesses the cup-to-disk ratio.

	If the optic cup increases in size over a period of months or years, or if notching is observed around the nerve head rim, and/or if an asymmetry is observed between the optic cups of the two eyes, then glaucoma may be expected.		If the optic cup increases in size over a period of months or years, or if notching is observed around the nerve head rim, and/or if an asymmetry is observed between the optic cups of the two eyes, then glaucoma may be expected.

Strokes

Scohen — Tue, 21 May 2013 02:55:15 GMT

Revision as of 02:55, 21 May 2013		Current revision
Line 62:		Line 62:

	In other countries the rate of hemorrhagic strokes may be higher, up to 25-60% (Brainin M, Durai Pandian J).		In other countries the rate of hemorrhagic strokes may be higher, up to 25-60% (Brainin M, Durai Pandian J).
		+
		+	Causes and risk factors for ischemic stroke and young adults and adolescents include: large vessel atherosclerosis. 2-11%, small vessel disease 7-14%, cardiac embolism 20-47% and other causes 20-34% and multiple causes 2-3%.

	Headache, neck stiffness, vomiting and coma are more common in hemorrhagic strokes.		Headache, neck stiffness, vomiting and coma are more common in hemorrhagic strokes.

Gynecomastia

Scohen — Tue, 21 May 2013 02:50:09 GMT

Revision as of 02:50, 21 May 2013		Current revision
Line 22:		Line 22:

	Adults with gynecomastia need to have assessment for alcohol, drug or medication abuse, liver kidney or lung dysfunction and for hypogonadism or hyperthyroid disease.		Adults with gynecomastia need to have assessment for alcohol, drug or medication abuse, liver kidney or lung dysfunction and for hypogonadism or hyperthyroid disease.
		+
		+	Occurs in up to 80% of patients who receive nonsteroidal anti-androgens such as bicalutamide, flutamide, or nilutamide, usually within the first 6-9 months after treatment onset.

	Trial of an antiestrogen such as tamoxifen may be beneficial.		Trial of an antiestrogen such as tamoxifen may be beneficial.

Strokes

Scohen — Tue, 21 May 2013 02:45:19 GMT

Revision as of 02:45, 21 May 2013		Current revision
Line 26:		Line 26:

	Mainly affects elderly, but 10% occur in individuals younger than 50 years.		Mainly affects elderly, but 10% occur in individuals younger than 50 years.
		+
		+	Up to 14% of all strokes occur in children and young adults.
		+
		+	The incidence rates of strokes in young adults are 10-23 ischemic strokes for 100,000 young adults aged 18-50 years and 3-9 hemorrhagic strokes per 100,000 young adults.
		+
		+	Diagnosis in young individuals underrecognized and often misdiagnosed, particularly those less than 35 years of age and those with impaired posterior circulation.

	Prevalence higher among older persons, American Indians/Alaska natives, blacks and persons with lower levels of education.		Prevalence higher among older persons, American Indians/Alaska natives, blacks and persons with lower levels of education.

Supraventricular tachycardia

Scohen — Tue, 21 May 2013 02:36:32 GMT

Revision as of 02:36, 21 May 2013		Current revision
Line 42:		Line 42:

	Atrioventricular nodal reentrant tachycardia and atrioventricular reciprocating tachycardia are caused by abnormal electrical circuits.		Atrioventricular nodal reentrant tachycardia and atrioventricular reciprocating tachycardia are caused by abnormal electrical circuits.
		+
		+	Atrioventricular nodal reentry tachycardia most common among individual 20 years of age or older.
		+
		+	Atrioventricular reciprocating tachycardia occurs most frequently in the pediatric age group.

	Atrial tachycardia can be focal in nature or caused by small abnormal electrical circuits.		Atrial tachycardia can be focal in nature or caused by small abnormal electrical circuits.
		+
		+	Atrial tachycardia is the least common of three above supraventricular tachycardia.

	Symptoms include: palpitations, dizziness, anxiety, chest pain, pounding sensation in the neck and chest and dyspnea.		Symptoms include: palpitations, dizziness, anxiety, chest pain, pounding sensation in the neck and chest and dyspnea.

BMI (Body mass index)

Scohen — Mon, 20 May 2013 21:41:41 GMT

Revision as of 21:41, 20 May 2013		Current revision
Line 10:		Line 10:

	For a given BMI the degree of body fat tends to be higher in women than men and in older than younger individuals.		For a given BMI the degree of body fat tends to be higher in women than men and in older than younger individuals.
		+
		+	There are multiple loci, approximately 32, associated with body mass index and susceptibility to obesity..

	BMI overestimates the degree of fat in athletes.		BMI overestimates the degree of fat in athletes.

Obesity

Scohen — Mon, 20 May 2013 21:40:43 GMT

Revision as of 21:40, 20 May 2013		Current revision
Line 14:		Line 14:

	American adults who are obese has increased 140% over the last decade.		American adults who are obese has increased 140% over the last decade.
		+
		+	There are multiple loci, approximately 32, associated with body mass index and susceptibility to obesity..

	Since 1999 the prevalence has stabilized at 35.5% in adult men, 35.8% among adults women, and 16.9% for children and adolescents.		Since 1999 the prevalence has stabilized at 35.5% in adult men, 35.8% among adults women, and 16.9% for children and adolescents.

Soft drinks

Scohen — Mon, 20 May 2013 21:34:00 GMT

Revision as of 21:34, 20 May 2013		Current revision
Line 4:		Line 4:

	Contain large amounts of fructose corn syrup which increases blood glucose.		Contain large amounts of fructose corn syrup which increases blood glucose.
		+
		+	Consumption of sugar-sweetened beverages are the leading source of sugar in diet for various racial and ethnic groups.

	Leading source of added sugar in American diet.		Leading source of added sugar in American diet.
		+
		+	Overweight and obese adolescents get more than 300 kcal per day from these products, which is an average of 15% of their total daily intake (Yang WC et al).

	Increased consumption of sweetened beverages with sugar associated with weight gain and increased risk of type 2 diabetes in women.		Increased consumption of sweetened beverages with sugar associated with weight gain and increased risk of type 2 diabetes in women.

Working formulation

Scohen — Mon, 20 May 2013 20:54:22 GMT

Revision as of 20:54, 20 May 2013		Current revision
Line 274:		Line 274:
	Pulsed radiofrequency is usedto treat myofascial and neuromatous pain.		Pulsed radiofrequency is usedto treat myofascial and neuromatous pain.

-	All cases in which PRF was used to treat myofascial (trigger point) and neuromatous pain.	+
-		+


Line 283:		Line 282:


-
-
-
-
-	CPT codes covered if selection criteria are met:
-	62292
-	Other CPT codes related to the CPB:
-	72125 - 72133
-	72141 - 72158
-	72240 - 72270
-	ICD-9 codes covered if selection criteria are met:
-	722.10 Displacement of lumbar intervertebral disc without myelopathy [see criteria]
-	722.73 Intervertebral disc disorder with myelopathy, lumbar region [see criteria]
-	724.3 Sciatica [due to herniated disc - see criteria]
-	ICD-9 codes not covered for indications listed in the CPB:
-	170.2 Malignant neoplasm of vertebral column, excluding sacrum and coccyx
-	170.6 Malignant neoplasm of pelvic bones, sacrum, and coccyx
-	192.2 Malignant neoplasm of spinal cord
-	192.3 Malignant neoplasm of spinal meninges
-	198.3 Secondary malignant neoplasm of brain and spinal cord
-	198.4 Secondary malignant neoplasm of other parts of nervous system
-	198.5 Secondary malignant neoplasm of bone and bone marrow
-	213.2 Benign neoplasm of vertebral column, excluding sacrum and coccyx
-	213.6 Benign neoplasm of pelvic bones, sacrum, and coccyx
-	225.3 Benign neoplasm of spinal cord
-	225.4 Benign neoplasm of spinal meninges
-	237.5 Neoplasm of uncertain behavior of brain and spinal cord
-	237.6 Neoplasm of uncertain behavior of meninges
-	239.7 Neoplasm of unspecified nature of endocrine glands and other parts of nervous system
-	320 - 359.9 Diseases of the nervous system
-	344.60 - 344.61 Cauda equina syndrome
-	630 - 677 Complications of pregnancy, childbirth, and the puerperium
-	722.0 Displacement of cervical intervertebral disc without myelopathy
-	722.11 Displacement of thoracic intervertebral disc without myelopathy
-	722.71 Intervertebral disc disorder with myelopathy, cervical region
-	722.72 Intervertebral disc disorder with myelopathy, thoracic region
-	722.80 - 722.83 Postlaminectomy syndrome
-	723.0 Spinal stenosis of cervical region
-	724.00 - 724.09 Spinal stenosis, other than cervical
-	724.1 Pain in thoracic spine
-	724.2 Lumbago
-	724.5 Backache, unspecified
-	724.6 Disorders of sacrum
-	724.8 Other symptoms referable to back
-	724.9 Other unspecified back disorders
-	738.4 Acquired spondylolisthesis
-	756.11 Spondylolysis, lumbosacral region
-	756.12 Spondylolisthesis
-	781.0 - 781.99 Symptoms involving nervous and musculoskeletal systems
-	V22.0 - V23.9 Supervision of pregnancy
-	Other ICD-9 codes related to the CPB:
-	728.87 Muscle weakness (generalized)
-	729.2 Neuralgia, neuritis, and radiculitis, unspecified
-	729.5 Pain in limb
-	782.0 Disturbance of skin sensation
-	Percutaneous lumbar discectomy or laser-assisted disc decompression (LADD):
-	CPT codes covered if selection criteria are met:
-	0274T
-	0275T
-	62287
-	Other CPT codes related to the CPB:
-	62267
-	63001 - 63091
-	63185 - 63190
-	72125 - 72133
-	72141 - 72158
-	72240 - 72270
-	77002
-	Other HCPCS codes related to the CPB:
-	C2614 Probe, percutaneous lumbar discectomy
-	ICD-9 codes covered if selection criteria are met:
-	722.10 Displacement of lumbar intervertebral disc without myelopathy [see criteria]
-	722.73 Intervertebral disc disorder with myelopathy, lumbar region [see criteria]
-	Radiofrequency facet denervation:
-	CPT codes covered if selection criteria are met:
-	64633
-	64634
-	64635
-	64636
-	Other CPT codes related to the CPB:
-	22548 - 22812
-	64479 - 64484
-	72125 - 72133
-	72141 - 72158
-	72240 - 72270
-	97001 - 97139
-	Other HCPCS codes related to the CPB:
-	L0112 - L0999 Orthotic devices-spinal
-	ICD-9 codes covered if selection criteria are met:
-	723.1 Cervicalgia [see criteria]
-	723.2 Cervicocranial syndrome [see criteria]
-	723.8 Other syndromes affecting cervical region [see criteria]
-	724.1 Pain in thoracic spine [see criteria]
-	724.2 Lumbago [see criteria]
-	724.3 Sciatica [see criteria]
-	724.5 Backache, unspecified [see criteria]
-	ICD-9 codes not covered for indications listed in the CPB:
-	722.0 - 722.93 Intervertebral disc disorders
-	724.6 Disorders of sacrum
-	Other ICD-9 codes related to the CPB:
-	V58.64 Long term (current) use of non-steroidal anti-inflammatories (NSAID)
-	Implantable infusion pumps:
-	CPT codes covered if selection criteria are met:
-	62350
-	62351
-	62355
-	62360
-	62361
-	62362
-	62365
-	62367
-	62368
-	62369
-	62370
-	95990
-	95991
-	HCPCS codes covered if selection criteria are met:
-	A4220 Refill kit for implantable infusion pump
-	A4300 Implantable access catheter, (e.g., venous, arterial, epidural subarachnoid, or peritoneal, etc.) external access
-	A4301 Implantable access total catheter, port/reservoir (e.g., venous, arterial, epidural, subarachnoid, peritoneal, etc.)
-	A4305 Disposable drug delivery system, flow rate of 50 ml or greater per hour
-	A4306 Disposable drug delivery system, flow rate of less than 50 ml per hour
-	C1772 Infusion pump, programmable (implantable)
-	C1891 Infusion pump, non-programmable, permanent (implantable)
-	C2626 Infusion pump, non-programmable, temporary (implantable)
-	E0782 Infusion pump, implantable, non-programmable (includes all components, e.g., pump, catheter, connectors, etc.)
-	E0783 Infusion pump system, implantable, programmable (includes all components, e.g., pump, catheter, connectors, etc.)
-	E0785 Implantable intraspinal (epidural/intrathecal) catheter used with implantable infusion pump, replacement
-	E0786 Implantable programmable infusion pump, replacement (excludes implantable intraspinal catheter)
-	Other ICD-9 codes related to the CPB:
-	170.2 Malignant neoplasm of vertebral column, excluding sacrum and coccyx
-	170.6 Malignant neoplasm of pelvic bones, sacrum, and coccyx
-	192.2 Malignant neoplasm of spinal cord
-	192.3 Malignant neoplasm of spinal meninges
-	198.3 Secondary malignant neoplasm of brain and spinal cord
-	198.4 Secondary malignant neoplasm of other parts of nervous system
-	198.5 Secondary malignant neoplasm of bone and bone marrow
-	213.2 Benign neoplasm of vertebral column, excluding sacrum and coccyx
-	213.6 Benign neoplasm of pelvic bones, sacrum, and coccyx
-	225.3 Benign neoplasm of spinal cord
-	225.4 Benign neoplasm of spinal meninges
-	720.0 - 724.9 Dorsopathies
-	742.51 - 742.59 Other specified anomalies of spinal cord
-	756.10 - 756.19 Anomalies of spine
-	Pedicle screws for spinal fixation:
-	CPT codes covered if selection criteria are met:
-	22840 - 22847
-	Other CPT codes related to the CPB:
-	22548 - 22812
-	63001 - 63091
-	ICD-9 codes covered if selection criteria are met:
-	722.80 - 722.83 Postlaminectomy syndrome
-	733.82 Nonunion of fracture [pseudoarthrosis]
-	737.0 - 737.9 Curvature of spine [requiring spinal instrumentation]
-	738.4 Acquired spondylolisthesis [grades I-IV]
-	754.2 Certain congenital musculoskeletal deformities of spine
-	756.11 Spondylolysis lumbosacral region [grades I-IV]
-	756.12 Spondylolisthesis [grades I-IV]
-	756.19 Other anomalies of spine
-	805.00 - 805.7 Fracture of vertebral column without mention of spinal cord injury
-	806.00 - 806.79 Fracture of vertebral column with spinal cord injury
	839.00 - 839.59 Dislocation of vertebra		839.00 - 839.59 Dislocation of vertebra
	ICD-9 codes not covered for indications listed in the CPB:		ICD-9 codes not covered for indications listed in the CPB:

Candida-Invasive candidiasis

Scohen — Mon, 20 May 2013 14:27:45 GMT

Revision as of 14:27, 20 May 2013		Current revision
Line 8:		Line 8:

	Risk factors divided into host related (immunocompromised) and healthcare related factors (surgery, antibiotics, intravascular catheters).		Risk factors divided into host related (immunocompromised) and healthcare related factors (surgery, antibiotics, intravascular catheters).
		+
		+	In patients with hematologic malignancies beneficial bacteria in the GI tract are often destroyed by antibiotics and these bacteria normally inhibit the growth of yeasts.

	Risk factors for sepsis include parenteral nutrition, acute renal insufficiency, chemotherapy administration, breakdown of anatomic barriers, transplantation, malignancies and colonization of Candida.		Risk factors for sepsis include parenteral nutrition, acute renal insufficiency, chemotherapy administration, breakdown of anatomic barriers, transplantation, malignancies and colonization of Candida.

Aspergillus

Scohen — Mon, 20 May 2013 14:25:49 GMT

Revision as of 14:25, 20 May 2013		Current revision
Line 3:		Line 3:
	Contracted through the respiratory tract.		Contracted through the respiratory tract.

-	Most common life threatening invasive mould infection worldwide.	+	Most common life threatening invasive mold infection worldwide.
		+
		+	The genus comprises several 100 species, but poses little threat to people with healthy immune systems

	Patients with hematologic diseases and transplant recipients make up the vast majority of invasive pulmonary aspergillosis cases.		Patients with hematologic diseases and transplant recipients make up the vast majority of invasive pulmonary aspergillosis cases.

Pelvic floor

Scohen — Mon, 20 May 2013 05:15:45 GMT

Revision as of 05:15, 20 May 2013		Current revision
Line 6:		Line 6:

	Up to 50% of parous women have vaginal wall laxity, with 10-20% being symptomatic.		Up to 50% of parous women have vaginal wall laxity, with 10-20% being symptomatic.
		+
		+	Pelvic floor disorders are common with nearly one in four women having at least one pelvic floor condition.

	Lifetime risk of undergoing surgery to correct a pelvic floor dysfunction is estimated at 11%.		Lifetime risk of undergoing surgery to correct a pelvic floor dysfunction is estimated at 11%.

Psoriasis

Scohen — Mon, 20 May 2013 05:00:37 GMT

Revision as of 05:00, 20 May 2013		Current revision
Line 4:		Line 4:

	Worldwide prevalence 0.1 to 3%.		Worldwide prevalence 0.1 to 3%.
		+
		+	More than 125 million patients suffer with psoriasis worldwide.

	US estimated prevalence estimated at 3%, with approximately 17% having moderate-severe plaque disease.		US estimated prevalence estimated at 3%, with approximately 17% having moderate-severe plaque disease.
Line 14:		Line 16:

	Caused by an immune response driven by Th1 cells, which secrete high levels of interferon-gammaanf by Th17 cells which secrete interleukin 17A, interleukin 17F, and interleukin 22.		Caused by an immune response driven by Th1 cells, which secrete high levels of interferon-gammaanf by Th17 cells which secrete interleukin 17A, interleukin 17F, and interleukin 22.
-

	Approximate 30% of patients will develop psoriatic arthritis (Gladdman DD).		Approximate 30% of patients will develop psoriatic arthritis (Gladdman DD).
Line 29:		Line 30:

	Interleukin-17 cytokine family has 6 cytokines, interleukins A-F and 5 receptors, interleukins 17RA to 17RE.		Interleukin-17 cytokine family has 6 cytokines, interleukins A-F and 5 receptors, interleukins 17RA to 17RE.
-

	Patients may develop co-morbidities such as metabolic syndrome, coronary artery disease, diabetes, and cerebral vascular disease along with psoriatic arthritis.		Patients may develop co-morbidities such as metabolic syndrome, coronary artery disease, diabetes, and cerebral vascular disease along with psoriatic arthritis.
		+
		+	Associated with adverse cardiovascular outcomes that is most pronounced among young patients with severe psoriasis.
		+
		+	TNF Inhibitors associated with a significant reduction in MI risk compared with topical agents and associated with a non-statistically significant lower MI incident rate compared with treatments with oral agents or phototherapy.

	Obesity a risk factor for the development of psoriasis, and is associated with increased the severity of psoriasis (Wilson FC).		Obesity a risk factor for the development of psoriasis, and is associated with increased the severity of psoriasis (Wilson FC).

Pelvic organ prolapse

Scohen — Mon, 20 May 2013 04:40:55 GMT

Revision as of 04:40, 20 May 2013		Current revision
Line 20:		Line 20:

	2% of women are symptomatic with pelvic organ prolapse.		2% of women are symptomatic with pelvic organ prolapse.
		+
		+	7-19% of women receive surgical repair.

	Women with pelvic floor prolapse have pelvic connective tissues with decreased collagen and higher collagen turnover rates than women without prolapse.		Women with pelvic floor prolapse have pelvic connective tissues with decreased collagen and higher collagen turnover rates than women without prolapse.
Line 44:		Line 46:

	Surgery intended to repair vaginal compartments into which pelvic organs prolapse anteriorly, posteriorly or apically.		Surgery intended to repair vaginal compartments into which pelvic organs prolapse anteriorly, posteriorly or apically.
		+
		+	Abdominal sacrocolpopexy involves attaching the vaginal apex to the sacral anterior llongitudinal ligament reinforced with a graft, that is usually synthetic mesh.

	Sacrocolpopexy is surgical approach for apical prolapse.		Sacrocolpopexy is surgical approach for apical prolapse.

	Sacrocolpopexy success ranges from 58-100% at 6 months after surgery.		Sacrocolpopexy success ranges from 58-100% at 6 months after surgery.
		+
		+	225,000 surgical cases per year of pelvic organ prolapse.

	Some women have concomitant stress incontinence while others do not associated a result of the obstructive effect of the prolapsed pelvic organs causing urethral kinking.		Some women have concomitant stress incontinence while others do not associated a result of the obstructive effect of the prolapsed pelvic organs causing urethral kinking.

Working formulation

Scohen — Mon, 20 May 2013 01:09:48 GMT

Revision as of 01:09, 20 May 2013		Current revision
Line 280:		Line 280:


-	The CoFlex-F Implant	+
-	The Coflex-F implant is a posterior, non-pedicle supplemental fixation device intended for use with an interbody cage as an adjunct to fusion at a single level in the lumbar spine (L1 to S1) that can be delivered through a minimally invasive approach. The implant is a type of posterior fixation instrumentation intended to rigidly hold vertebrae together while spinal fusion occurs. It is intended for attachment to the spinous processes for the purpose of achieving stabilization to promote fusion in patients suffering from DDD, with or without attendant grade I spondylolisthesis. On October 6, 2010, the Coflex-F implant was cleared by the FDA via the 501(k) process for the purpose of achieving stabilization to facilitate fusion in patients treated for DDD (defined as back pain of discogenic origin with degeneration of the disc confirmed by history and radiographic studies); with up to grade 1 spondylolisthesis. However, the Belgian Health Care Knowledge Center (2011) stated that that it is unclear what data for the Coflex-F was submitted for FDA clearance.	+
-	An UpToDate review on "Lumbar spinal stenosis: Treatment and prognosis" (Levin, 2012) states that "Intraspinous spacer implantation -- A potentially less invasive treatment option involves implanting a device between the spinous processes at one or two vertebral levels, relieving compression. This procedure is said to be appropriate for those patients with spinal stenosis without spondylolisthesis who have intermittent claudication symptoms that are exacerbated in extension and relieved in flexion .... It is unclear how this newer procedure compares with the standard surgical procedure, decompressive laminectomy, in terms of effectiveness, side effects, recovery time and long-term outcomes. This treatment does not appear to be helpful in patients who have spondylolisthesis".	+

-	CPT Codes / ICD-9 Codes / HCPCS Codes	+
-	Facet joint injections:	+
-	CPT codes covered if selection criteria are met:	+
-	64479	+
-	+ 64480	+
-	64483	+
-	+ 64484	+
-	64490	+
-	64491	+
-	64492	+
-	64493	+
-	6449	+
-	ICD-9 codes covered if selection criteria are met:	+
-	723.1 Cervicalgia [covered for the diagnosis of facet pain with chronic back or neck pain lasting more than 3 months despite appropriate conservative treatment - not for therapy]	+
-	723.2 Cervicocranial syndrome [covered for the diagnosis of facet pain with chronic back or neck pain lasting more than 3 months despite appropriate conservative treatment - not for therapy]	+
-	723.8 Other syndromes affecting cervical region [covered for the diagnosis of facet pain with chronic back or neck pain lasting more than 3 months despite appropriate conservative treatment - not for therapy]	+
-	724.1 Pain in thoracic spine [covered for the diagnosis of facet pain with chronic back or neck pain lasting more than 3 months despite appropriate conservative treatment - not for therapy]	+
-	724.2 Lumbago [covered for the diagnosis of facet pain with chronic back or neck pain lasting more than 3 months despite appropriate conservative treatment - not for therapy]	+
-	724.3 Sciatica [covered for the diagnosis of facet pain with chronic back or neck pain lasting more than 3 months despite appropriate conservative treatment - not for therapy]	+
-	724.5 Backache, unspecified [covered for the diagnosis of facet pain with chronic back or neck pain lasting more than 3 months despite appropriate conservative treatment - not for therapy]	+
-	Trigger point Injections:	+
-	CPT codes covered if selection criteria are met:	+
-	20552	+
-	20553	+
-	Other CPT codes related to the CPB:	+
-	76942	+
-	77002	+
-	77021	+
-	97001 - 97139	+
-	Other HCPCS codes related to the CPB:	+
-	E0200 - E0239 Heat/cold application	+
-	S9117 Back school, per visit	+
-	ICD-9 codes covered if selection criteria are met:	+
-	723.1 Cervicalgia [see criteria]	+
-	723.2 Cervicocranial syndrome [see criteria]	+
-	723.8 Other syndromes affecting cervical region [see criteria]	+
-	724.1 Pain in thoracic spine [see criteria]	+
-	724.2 Lumbago [see criteria]	+
-	724.3 Sciatica [see criteria]	+
-	724.5 Backache, unspecified [see criteria]	+
-	729.1 Myalgia and myositis, unspecified [see criteria]	+
-	Other ICD-9 codes related to the CPB:	+
-	V58.64 Long term (current) use of non-steroidal anti-inflammatories (NSAID)	+
-	Sacroiliac joint injections:	+
-	CPT codes covered if selection criteria are met:	+
-	27096	+
-	Other CPT codes related to the CPB:	+
-	77003	+
-	HCPCS codes covered if selection criteria are met:	+
-	G0260 Injection procedure for sacroiliac joint; provision of anesthetic, steroid and/or other therapeutic agent, with or without arthrography	+
-	Other HCPCS codes related to the CPB:	+
-	G0259 Injection procedure for sacroiliac joint; arthrography	+
-	ICD-9 codes covered if selection criteria are met:	+
-	724.1 Pain in thoracic spine [more than 3 months duration and part of a comprehensive pain management program, including physical therapy, patient education, psychosocial support, and oral medication where appropriate]	+
-	724.2 Lumbago [more than 3 months duration and part of a comprehensive pain management program, including physical therapy, patient education, psychosocial support, and oral medication where appropriate]	+
-	724.3 Sciatica [more than 3 months duration and part of a comprehensive pain management program, including physical therapy, patient education, psychosocial support, and oral medication where appropriate]	+
-	Epidural injections of corticosteroid preparations:	+
-	CPT codes covered if selection criteria are met:	+
-	62310	+
-	62311	+
-	62318	+
-	62319	+
-	Other CPT codes related to the CPB:	+
-	72275	+
-	97001 - 97139	+
-	Other HCPCS codes related to the CPB:	+
-	J1020 Injection, methylprednisone acetate, 20 mg	+
-	J1030 Injection, methylprednisone acetate, 40 mg	+
-	J1040 Injection, methylprednisone acetate, 80 mg	+
-	ICD-9 codes covered if selection criteria are met:	+
-	723.1 Cervicalgia [see criteria]	+
-	723.2 Cervicocranial syndrome [see criteria]	+
-	723.8 Other syndromes affecting cervical region [see criteria]	+
-	724.1 Pain in thoracic spine [see criteria]	+
-	724.2 Lumbago [see criteria]	+
-	724.3 Sciatica [see criteria]	+
-	724.5 Backache, unspecified [see criteria]	+
-	ICD-9 codes not covered for indications listed in the CPB:	+
-	170.2 Malignant neoplasm of vertebral column, excluding sacrum and coccyx	+
-	170.6 Malignant neoplasm of pelvic bones, sacrum, and coccyx	+
-	192.2 Malignant neoplasm of spinal cord	+
-	192.3 Malignant neoplasm of spinal meninges	+
-	198.3 Secondary malignant neoplasm of brain and spinal cord	+
-	198.4 Secondary malignant neoplasm of other parts of nervous system	+
-	198.5 Secondary malignant neoplasm of bone and bone marrow	+
-	213.2 Benign neoplasm of vertebral column, excluding sacrum and coccyx	+
-	213.6 Benign neoplasm of pelvic bones, sacrum, and coccyx	+
-	225.3 Benign neoplasm of spinal cord	+
-	225.4 Benign neoplasm of spinal meninges	+
-	237.5 Neoplasm of uncertain behavior of brain and spinal cord	+
-	237.6 Neoplasm of uncertain behavior of meninges	+
-	239.7 Neoplasm of unspecified nature of endocrine glands and other parts of nervous system	+
-	Chymopapain chemonucleolysis:	+
	CPT codes covered if selection criteria are met:		CPT codes covered if selection criteria are met:
	62292		62292

Glaucoma

Scohen — Mon, 20 May 2013 00:50:45 GMT

Revision as of 00:50, 20 May 2013		Current revision
Line 4:		Line 4:

	Characterized by irreversible loss of retinal ganglion cells, with progressive thinning of the retinal nerve fiber layer.		Characterized by irreversible loss of retinal ganglion cells, with progressive thinning of the retinal nerve fiber layer.
		+
		+	Characteristic appearance of the optic nerve cupping is due to the loss of retinal nerve fiber layer tissue.
		+
		+	Associated with an increased cup-to-disc ratio.
		+
		+	Optic disc cupping determined by ophthalmologic exam, disc photographs or through interpretation of special diagnostic tests measuring retinal nerve fiber layer thickness.

	The leading cause of irreversible blindness worldwide and is second only to cataracts as the most common cause of blindness overall.		The leading cause of irreversible blindness worldwide and is second only to cataracts as the most common cause of blindness overall.
Line 12:		Line 18:

	A disease of the optic nerve.		A disease of the optic nerve.
		+
		+	Risk factors are: high myopia, family history, black race, and advanced age.

	Affects more than 60 million patients worldwide, and an estimated 10% of those with glaucoma are blind.		Affects more than 60 million patients worldwide, and an estimated 10% of those with glaucoma are blind.
Line 88:		Line 96:
	Smaller optic fibers, which primarily detect light, are damaged later and is best detected by conventional perimetry.		Smaller optic fibers, which primarily detect light, are damaged later and is best detected by conventional perimetry.

-	Therefore discrimination peripheral perimetry seems to be more sensitive than a standard perimeter in detecting early glaucomatous visual field losses	+	Therefore discrimination peripheral perimetry seems to be more sensitive than a standard perimeter in detecting early glaucomatous visual field losses.
		+
		+	As many as 40% of axons can be lost before standard visual tests indicate the presence of an abnormal result.
		+
		+	Testing for optic nerve cupping is determined by ophthalmologic examination, reviewing stereo photographs, or the interpretation of specialized tests that measures the retinal nerve fiber layer thickness.

		+	Early glaucoma usually affects peripheral vision and is asymptomatic, ,as central vision is relatively spared until later stages of the process.
		+	,
	Usually, the elevated pressure in open angle glaucoma can be controlled using glaucoma medications, which either decrease the production of aqueous fluid or else increase its outflow from the eye.		Usually, the elevated pressure in open angle glaucoma can be controlled using glaucoma medications, which either decrease the production of aqueous fluid or else increase its outflow from the eye.

Anticholinergic drugs

Scohen — Sun, 19 May 2013 14:00:35 GMT

Revision as of 14:00, 19 May 2013		Current revision
Line 25:		Line 25:
	Scopolamine anticholinergic and antimuscularinic drug: patches (contain 1.5 mg) q 72 hours achieve maximum blood levels in 12 hours, subcutaneous, intravenous or intramuscular dose 0.3-0.6 mg q 4-8 h.		Scopolamine anticholinergic and antimuscularinic drug: patches (contain 1.5 mg) q 72 hours achieve maximum blood levels in 12 hours, subcutaneous, intravenous or intramuscular dose 0.3-0.6 mg q 4-8 h.

-	Scopolamine may precipitate dementia, and acute glucoma.	+	Scopolamine may precipitate dementia, and acute glaucoma.
-		+	.
	Excess scopolamine can be treated with phsostigmine intravenously.		Excess scopolamine can be treated with phsostigmine intravenously.

Glaucoma

Scohen — Sun, 19 May 2013 00:14:48 GMT

Revision as of 00:14, 19 May 2013		Current revision
Line 2:		Line 2:

	Progressive optic nerve disease often associated with elevated intraocular pressure and characterized by optic disc cupping and visual field loss.		Progressive optic nerve disease often associated with elevated intraocular pressure and characterized by optic disc cupping and visual field loss.
		+
		+	Characterized by irreversible loss of retinal ganglion cells, with progressive thinning of the retinal nerve fiber layer.
		+
		+	The leading cause of irreversible blindness worldwide and is second only to cataracts as the most common cause of blindness overall.
		+
		+	Second most common cause of blindness in the U.S. affecting 3% of persons older than 55 years.
		+
		+	Leading cause of blindness in African-Americans.
		+
		+	A disease of the optic nerve.
		+
		+	Affects more than 60 million patients worldwide, and an estimated 10% of those with glaucoma are blind.

	Some patients have normal intraocular pressure, normal tension glaucoma.		Some patients have normal intraocular pressure, normal tension glaucoma.
Line 16:		Line 28:

	Open angle glaucoma increases with age.		Open angle glaucoma increases with age.
		+
		+	As many as 50% of patients with undiagnosed glaucoma have severe disease on presentation.
		+
		+	Primary open angle glaucoma is the predominant form.
		+
		+	Primary open angle glaucoma affects approximately 2.2 million individuals in the US.
		+
		+	Primary open angle glaucoma represents the largest pool of preventable blindness in North America.
		+
		+	It is estimated that 50% of patients with glaucoma have undiagnosed disease.

	Open angle glaucoma, a chronic and painless condition, also can be caused when the posterior portion of the iris, surrounding the pupil, adheres to the anterior surface of the lens and prevents intraocular fluid from passing through the pupil into the anterior chamber.		Open angle glaucoma, a chronic and painless condition, also can be caused when the posterior portion of the iris, surrounding the pupil, adheres to the anterior surface of the lens and prevents intraocular fluid from passing through the pupil into the anterior chamber.
		+
		+	In primary open angle glaucoma the iridocorneal angle appears anatomically open and is morphologically normal on clinical examination.
		+
		+	A significant proportion of patients with primary open angle glaucoma have normal intraocular pressures of 21 mmHg or less.
		+
		+	In primary open angle glaucoma elevated intra-ocular pressures are caused by outflow resistance through the trabecular meshwork portion of the Iridocorneal angle.
		+
		+	Primary 'coma without elevated intraocular pressure is known as normal tension glaucoma and is characterized by a glaucomatous optic disc and visual field changes but the intraocular pressure is never greater than 21 mmHg.
		+
		+	Lowering intraocular pressure, even in patients with normal tension glaucoma, slows the disease process.

	If the angle between and iris and the cornea is too narrow, or is even closed, then the fluid backs up because it cannot flow out of the eye properly and causes an increased intraocular pressure in what is known as closed angle glaucoma.		If the angle between and iris and the cornea is too narrow, or is even closed, then the fluid backs up because it cannot flow out of the eye properly and causes an increased intraocular pressure in what is known as closed angle glaucoma.
Line 69:		Line 101:

	Currently no cure and lowering the intraocular pressure is the primary treatment.		Currently no cure and lowering the intraocular pressure is the primary treatment.
		+
		+	Progression of primary open angle glaucoma can be slowed with treatment.

	Vision loss is asymptomatic and irreversible.		Vision loss is asymptomatic and irreversible.
-
-	Is a leading cause of blindness and vision impairment.
-
-	Affects approximately 2.5 million people in the the U.S.
-
-	Second most common cause of blindness in the U.S. affecting 3% of persons older than 55 years.
-
-	Leading cause of blindness in African-Americans.
-
-	A disease of the optic nerve.

	Characterized by progressive damage of optic that usually begins with a subtle loss of peripheral vision that can progress, if untreated, to loss of central vision and blindness.		Characterized by progressive damage of optic that usually begins with a subtle loss of peripheral vision that can progress, if untreated, to loss of central vision and blindness.
Line 115:		Line 139:

	Optic nerve damage generally precedes visual field loss.		Optic nerve damage generally precedes visual field loss.
		+
		+	Therapy is based on reduction of intraocular pressure with topical medications, laser surgical procedure and intraocular surgery.

Working formulation

Scohen — Sat, 18 May 2013 21:26:58 GMT

Revision as of 21:26, 18 May 2013		Current revision
Line 271:		Line 271:

	Minimally invasive transforaminal lumbar interbody fusion is perfojrmed through small incisions opening an operative corridor through the muscles using endoscopes to with less trauma to soft tissues.		Minimally invasive transforaminal lumbar interbody fusion is perfojrmed through small incisions opening an operative corridor through the muscles using endoscopes to with less trauma to soft tissues.
		+
		+	Pulsed radiofrequency is usedto treat myofascial and neuromatous pain.
		+
		+	All cases in which PRF was used to treat myofascial (trigger point) and neuromatous pain.
		+




-	Tamimi et al (2009) noted that clinical reports using pulsed radiofrequency (PRF) have shown promise in the treatment of a variety of focal, neuropathic conditions. To date, scant data exist on the use of PRF to treat myofascial and neuromatous pain. All cases in which PRF was used to treat myofascial (trigger point) and neuromatous pain within the authors' practice were evaluated retrospectively for technique, efficacy, and complications. Trigger points were defined as localized, extremely tender areas in skeletal muscle that contained palpable, taut bands of muscle. A total of 9 patients were treated over an 18-month period. All patients had longstanding myofascial or neuromatous pain that was refractory to previous medical management, physical therapy, and trigger point injections. Eight out of 9 patients experienced 75 to 100 % reduction in their pain following PRF treatment at initial evaluation 4 weeks following treatment. Six out of 9 (67 %) patients experienced 6 months to greater than 1 year of pain relief. One patient experienced no better relief in terms of degree of pain reduction or duration of benefit when compared with previous trigger point injections. No complications were noted. The authors concluded that this review suggested that PRF could be a minimally invasive, less neurodestructive treatment modality for these painful conditions and that further systematic evaluation of this treatment approach is warranted.
-	Lee et al (2011) noted that recently, clinical reports using PRF have shown favorable effects in the treatment of a variety of focal pain areas, even in non-nervous tissues; however, the mechanism of effect underlying this treatment to non-nervous tissue remains unclear. These researchers reported the case of a 67-year old male who presented with pain reliving point in the posterior neck. The patient had pain in the posterior neck for 3 years. The pain subsided with pressure applied to a point in the posterior neck. There were no specific abnormal findings on laboratory testing and radiological examinations. After PRF treatment to the pain-relieving point, he had pain relief that lasted more than 5 months.
	The CoFlex-F Implant		The CoFlex-F Implant
	The Coflex-F implant is a posterior, non-pedicle supplemental fixation device intended for use with an interbody cage as an adjunct to fusion at a single level in the lumbar spine (L1 to S1) that can be delivered through a minimally invasive approach. The implant is a type of posterior fixation instrumentation intended to rigidly hold vertebrae together while spinal fusion occurs. It is intended for attachment to the spinous processes for the purpose of achieving stabilization to promote fusion in patients suffering from DDD, with or without attendant grade I spondylolisthesis. On October 6, 2010, the Coflex-F implant was cleared by the FDA via the 501(k) process for the purpose of achieving stabilization to facilitate fusion in patients treated for DDD (defined as back pain of discogenic origin with degeneration of the disc confirmed by history and radiographic studies); with up to grade 1 spondylolisthesis. However, the Belgian Health Care Knowledge Center (2011) stated that that it is unclear what data for the Coflex-F was submitted for FDA clearance.		The Coflex-F implant is a posterior, non-pedicle supplemental fixation device intended for use with an interbody cage as an adjunct to fusion at a single level in the lumbar spine (L1 to S1) that can be delivered through a minimally invasive approach. The implant is a type of posterior fixation instrumentation intended to rigidly hold vertebrae together while spinal fusion occurs. It is intended for attachment to the spinous processes for the purpose of achieving stabilization to promote fusion in patients suffering from DDD, with or without attendant grade I spondylolisthesis. On October 6, 2010, the Coflex-F implant was cleared by the FDA via the 501(k) process for the purpose of achieving stabilization to facilitate fusion in patients treated for DDD (defined as back pain of discogenic origin with degeneration of the disc confirmed by history and radiographic studies); with up to grade 1 spondylolisthesis. However, the Belgian Health Care Knowledge Center (2011) stated that that it is unclear what data for the Coflex-F was submitted for FDA clearance.

Vanishing bile duct syndrome

Scohen — Sat, 18 May 2013 20:47:42 GMT

Revision as of 20:47, 18 May 2013		Current revision
Line 48:		Line 48:


		+	No evidence corticosteroids are beneficial and may worsen the metabolic effects of end stage liver disease and cholestasis.

-	Corticosteroids are often used in treatment of severe cholestasis and VBDS, but there is no evidence that they are beneficial and they can worsen the secondary metabolic effects of end stage liver disease and cholestasis. Ursodiol is almost universally used in the treatment of VBDS, and while prospective controlled trials have not been conducted to demonstrate their benefit, anecdotal reports have suggested that they are beneficial in ameliorating the injury. Importantly, VBDS can slowly resolve on its own and a major focus of management should be avoidance of further injury. Careful attention to nutrition and vitamin and mineral replacement (vitamin D, E, K and calcium) are important in managing patients with this rare but challenging condition. Experimental approaches to treating VBDS include immunosuppression with calcineurin inhibitors or monoclonal antibodies. Despite all interventions, however, a proportion of patients with VBDS due to medications eventually develop cirrhosis and end stage liver disease requiring liver transplantation.	+	Ursodiol is almost always used and there is anecdotal reports of benefit.
		+
		+
		+	The process can slowly resolve and a major focus of management should be avoidance of further injury.
		+
		+	There should be attention to nutrition and vitamin and mineral replacement.
		+
		+	A number of patients with VBDS due to medications eventually develop cirrhosis, end stage liver disease and will require liver transplantation.

Working formulation

Scohen — Sat, 18 May 2013 02:18:26 GMT

Revision as of 02:18, 18 May 2013		Current revision
Line 275:		Line 275:


-	Inamasu et al (2008) reported a patient with a flexion-distraction injury of the L1 vertebra treated with a combination of short-segment posterior fixation and Optimesh (Spineology Inc., St. Paul, MN), a flexible balloon-shaped mesh that is deployed into the fractured vertebra together with allograft. The patient, a 47-year-old man, was admitted after sustaining a motor vehicle accident. Imaging studies showed an L1 compression fracture. The patient had no neurological deficits and was treated conservatively. However, intense back pain persisted and significant kyphosis was noted when he mobilized. Review of the imaging studies strongly suggested disruption of the posterior spinal ligaments. Surgical intervention was performed to address both restoration of the posterior tension band and anterior column height simultaneously. The combined procedure consisted of short-segment posterior fixation from T12 to L2, and placement of OptiMesh filled with allograft into the L1 vertebral body. The anterior column height was restored and spinal alignment was corrected by the procedure, and the patient's back pain subsided soon after the procedure. The role of minimally invasive procedures for reconstruction of the vertebral column height, including the OptiMesh system, in patients with thoracolumbar compression fracture seems promising. However, the long-term effectiveness of these new techniques is unknown. It also remains to be seen how the delivery of allograft into the fractured vertebra via OptiMesh affects remodeling, and whether the restored vertebral height is maintained.
-	Radiofrequency/Pulsed Radiofrequency Ablation of Trigger Point Pain
	Tamimi et al (2009) noted that clinical reports using pulsed radiofrequency (PRF) have shown promise in the treatment of a variety of focal, neuropathic conditions. To date, scant data exist on the use of PRF to treat myofascial and neuromatous pain. All cases in which PRF was used to treat myofascial (trigger point) and neuromatous pain within the authors' practice were evaluated retrospectively for technique, efficacy, and complications. Trigger points were defined as localized, extremely tender areas in skeletal muscle that contained palpable, taut bands of muscle. A total of 9 patients were treated over an 18-month period. All patients had longstanding myofascial or neuromatous pain that was refractory to previous medical management, physical therapy, and trigger point injections. Eight out of 9 patients experienced 75 to 100 % reduction in their pain following PRF treatment at initial evaluation 4 weeks following treatment. Six out of 9 (67 %) patients experienced 6 months to greater than 1 year of pain relief. One patient experienced no better relief in terms of degree of pain reduction or duration of benefit when compared with previous trigger point injections. No complications were noted. The authors concluded that this review suggested that PRF could be a minimally invasive, less neurodestructive treatment modality for these painful conditions and that further systematic evaluation of this treatment approach is warranted.		Tamimi et al (2009) noted that clinical reports using pulsed radiofrequency (PRF) have shown promise in the treatment of a variety of focal, neuropathic conditions. To date, scant data exist on the use of PRF to treat myofascial and neuromatous pain. All cases in which PRF was used to treat myofascial (trigger point) and neuromatous pain within the authors' practice were evaluated retrospectively for technique, efficacy, and complications. Trigger points were defined as localized, extremely tender areas in skeletal muscle that contained palpable, taut bands of muscle. A total of 9 patients were treated over an 18-month period. All patients had longstanding myofascial or neuromatous pain that was refractory to previous medical management, physical therapy, and trigger point injections. Eight out of 9 patients experienced 75 to 100 % reduction in their pain following PRF treatment at initial evaluation 4 weeks following treatment. Six out of 9 (67 %) patients experienced 6 months to greater than 1 year of pain relief. One patient experienced no better relief in terms of degree of pain reduction or duration of benefit when compared with previous trigger point injections. No complications were noted. The authors concluded that this review suggested that PRF could be a minimally invasive, less neurodestructive treatment modality for these painful conditions and that further systematic evaluation of this treatment approach is warranted.
	Lee et al (2011) noted that recently, clinical reports using PRF have shown favorable effects in the treatment of a variety of focal pain areas, even in non-nervous tissues; however, the mechanism of effect underlying this treatment to non-nervous tissue remains unclear. These researchers reported the case of a 67-year old male who presented with pain reliving point in the posterior neck. The patient had pain in the posterior neck for 3 years. The pain subsided with pressure applied to a point in the posterior neck. There were no specific abnormal findings on laboratory testing and radiological examinations. After PRF treatment to the pain-relieving point, he had pain relief that lasted more than 5 months.		Lee et al (2011) noted that recently, clinical reports using PRF have shown favorable effects in the treatment of a variety of focal pain areas, even in non-nervous tissues; however, the mechanism of effect underlying this treatment to non-nervous tissue remains unclear. These researchers reported the case of a 67-year old male who presented with pain reliving point in the posterior neck. The patient had pain in the posterior neck for 3 years. The pain subsided with pressure applied to a point in the posterior neck. There were no specific abnormal findings on laboratory testing and radiological examinations. After PRF treatment to the pain-relieving point, he had pain relief that lasted more than 5 months.
Line 294:		Line 292:
	64492		64492
	64493		64493
-	64494	+	6449
-	64495	+
-	0213T	+
-	+ 0214T	+
-	+ 0215T	+
-	0216T	+
-	+ 0217T	+
-	+ 0128T	+
-	Other CPT codes related to the CPB:	+
-	72275	+
-	76942	+
-	77002	+
-	77021	+
	ICD-9 codes covered if selection criteria are met:		ICD-9 codes covered if selection criteria are met:
	723.1 Cervicalgia [covered for the diagnosis of facet pain with chronic back or neck pain lasting more than 3 months despite appropriate conservative treatment - not for therapy]		723.1 Cervicalgia [covered for the diagnosis of facet pain with chronic back or neck pain lasting more than 3 months despite appropriate conservative treatment - not for therapy]

Laminectomy

Scohen — Fri, 17 May 2013 03:57:57 GMT

Revision as of 03:57, 17 May 2013		Current revision
Line 1:		Line 1:
	A surgical procedure that removes a portion of the vertebral bone, the lamina.		A surgical procedure that removes a portion of the vertebral bone, the lamina.
		+
		+	[[Image:Image.jpg]]

	Procedure requires small skin incisions.		Procedure requires small skin incisions.

-	The parts of the vertebra adjacent to the lamina are left intact.	+	The parts of the vertebra adjacent to the lamina are left intact.

Special:Log/upload

Scohen — Fri, 17 May 2013 03:56:01 GMT

uploaded "[[Image:Image.jpg]]"

Laminectomy

Scohen — Fri, 17 May 2013 03:51:59 GMT

New page

A surgical procedure that removes a portion of the vertebral bone, the lamina.

Procedure requires small skin incisions.

The parts of the vertebra adjacent to the lamina are left intact.

Working formulation

Scohen — Fri, 17 May 2013 02:32:14 GMT

Revision as of 02:32, 17 May 2013		Current revision
Line 273:		Line 273:


-	Khan Kinetic Treatment (KKT)	+
-	The Khan Kinetic Treatment, manufactured by Datrend Systems Inc (Richmond, British Columbia, Canada), is a medical device for the treatment of spine-related abnormalities causing pain. According to the manufacturer, the KKT uses high-frequency small-amplitude sinusoidal waves to vibrate the vertebrae and repeatedly activate associated neuromuscular structures, which evoke multiple mechanisms of pain relief. In a small, unblinded, randomized trial without placebo control, Desmoulin et al (2007) presented their initial findings on the use of KKT as a chronic neck pain treatment. They reported that, compared with a control group, the treatment group lowered both their self-recorded neck pain scores (p = 0.012) as well as pain medication dose (p = 0.048), although current functional assessment questionnaires (range of motion, overall activity, and recreation/work activities) did not detect changes (p = 0.233, 0.311, and 0.472, respectively). Limitations of this study included a lack of blinding and lack of placebo control. The authors concluded that although they await randomized, placebo-controlled trials and additional results from ongoing mechanistic studies, initial results show that KKT is potentially an effective treatment for chronic neck pain and may contribute to the reduction of pain relieving. Other published literature on KKT spine treatment consists of a study of the effect of KKT in an animal model (Desmoulin et al, 2010).	+
-	The OptiMesh Grafting System	+
-	OptiMesh is a conformable, porous, polymeric containment device that is inserted into the evacuated disc space and filled with a mixture of cortico-cancellous allograft with demineralized bone matrix, autograft, and bone marrow aspirate to aid traumatic fracture repair and interbody fusion. Evidence is limited to a single case study that utilized OptiMesh for a compression fracture. Long-term safety and effectiveness have not been established. OptiMesh received 510(k) approval in November, 2003 as a class II device. The device is intended to maintain bone graft material within a vertebral defect. This device is contraindicated for patients with instability and does not provide structural support. The safety and effectiveness of OptiMesh used for fusion of the interbody space has not been established. Further studies are needed to evaluate its safety and effectiveness.	+
	Inamasu et al (2008) reported a patient with a flexion-distraction injury of the L1 vertebra treated with a combination of short-segment posterior fixation and Optimesh (Spineology Inc., St. Paul, MN), a flexible balloon-shaped mesh that is deployed into the fractured vertebra together with allograft. The patient, a 47-year-old man, was admitted after sustaining a motor vehicle accident. Imaging studies showed an L1 compression fracture. The patient had no neurological deficits and was treated conservatively. However, intense back pain persisted and significant kyphosis was noted when he mobilized. Review of the imaging studies strongly suggested disruption of the posterior spinal ligaments. Surgical intervention was performed to address both restoration of the posterior tension band and anterior column height simultaneously. The combined procedure consisted of short-segment posterior fixation from T12 to L2, and placement of OptiMesh filled with allograft into the L1 vertebral body. The anterior column height was restored and spinal alignment was corrected by the procedure, and the patient's back pain subsided soon after the procedure. The role of minimally invasive procedures for reconstruction of the vertebral column height, including the OptiMesh system, in patients with thoracolumbar compression fracture seems promising. However, the long-term effectiveness of these new techniques is unknown. It also remains to be seen how the delivery of allograft into the fractured vertebra via OptiMesh affects remodeling, and whether the restored vertebral height is maintained.		Inamasu et al (2008) reported a patient with a flexion-distraction injury of the L1 vertebra treated with a combination of short-segment posterior fixation and Optimesh (Spineology Inc., St. Paul, MN), a flexible balloon-shaped mesh that is deployed into the fractured vertebra together with allograft. The patient, a 47-year-old man, was admitted after sustaining a motor vehicle accident. Imaging studies showed an L1 compression fracture. The patient had no neurological deficits and was treated conservatively. However, intense back pain persisted and significant kyphosis was noted when he mobilized. Review of the imaging studies strongly suggested disruption of the posterior spinal ligaments. Surgical intervention was performed to address both restoration of the posterior tension band and anterior column height simultaneously. The combined procedure consisted of short-segment posterior fixation from T12 to L2, and placement of OptiMesh filled with allograft into the L1 vertebral body. The anterior column height was restored and spinal alignment was corrected by the procedure, and the patient's back pain subsided soon after the procedure. The role of minimally invasive procedures for reconstruction of the vertebral column height, including the OptiMesh system, in patients with thoracolumbar compression fracture seems promising. However, the long-term effectiveness of these new techniques is unknown. It also remains to be seen how the delivery of allograft into the fractured vertebra via OptiMesh affects remodeling, and whether the restored vertebral height is maintained.
	Radiofrequency/Pulsed Radiofrequency Ablation of Trigger Point Pain		Radiofrequency/Pulsed Radiofrequency Ablation of Trigger Point Pain

Vanishing bile duct syndrome

Scohen — Fri, 17 May 2013 02:29:20 GMT

Revision as of 02:29, 17 May 2013		Current revision
Line 41:		Line 41:
	Management of itching includes use of antihistamines such as diphenhydramine and hydroxyzine, and the use of bile acid resins such as cholestyramine and colistipol to bind bile acids in the intestine.		Management of itching includes use of antihistamines such as diphenhydramine and hydroxyzine, and the use of bile acid resins such as cholestyramine and colistipol to bind bile acids in the intestine.

		+	Other less treatments for pruritus include rifampin and naltrexone which have been reported to be beneficial.

		+	Severe hyperlipidemia with painful xanthomata may require plasma exchange for management.

		+	Intractable pruritus can be an indication for liver transplantation.

-	Other less well established treatments for pruritus include rifampin and naltrexone which have been reported to be beneficial in small case series. Hyperlipidemia may require therapy as well and it responds minimally to HMG Coenzyme A inhibitors (statins) which are best avoided. Severe hyperlipidemia with painful xanthomata may plasma exchange for management. Indeed, severe intractable pruritus can be an indication for liver transplantation. Corticosteroids are often used in treatment of severe cholestasis and VBDS, but there is no evidence that they are beneficial and they can worsen the secondary metabolic effects of end stage liver disease and cholestasis. Ursodiol is almost universally used in the treatment of VBDS, and while prospective controlled trials have not been conducted to demonstrate their benefit, anecdotal reports have suggested that they are beneficial in ameliorating the injury. Importantly, VBDS can slowly resolve on its own and a major focus of management should be avoidance of further injury. Careful attention to nutrition and vitamin and mineral replacement (vitamin D, E, K and calcium) are important in managing patients with this rare but challenging condition. Experimental approaches to treating VBDS include immunosuppression with calcineurin inhibitors or monoclonal antibodies. Despite all interventions, however, a proportion of patients with VBDS due to medications eventually develop cirrhosis and end stage liver disease requiring liver transplantation.	+
		+
		+	Corticosteroids are often used in treatment of severe cholestasis and VBDS, but there is no evidence that they are beneficial and they can worsen the secondary metabolic effects of end stage liver disease and cholestasis. Ursodiol is almost universally used in the treatment of VBDS, and while prospective controlled trials have not been conducted to demonstrate their benefit, anecdotal reports have suggested that they are beneficial in ameliorating the injury. Importantly, VBDS can slowly resolve on its own and a major focus of management should be avoidance of further injury. Careful attention to nutrition and vitamin and mineral replacement (vitamin D, E, K and calcium) are important in managing patients with this rare but challenging condition. Experimental approaches to treating VBDS include immunosuppression with calcineurin inhibitors or monoclonal antibodies. Despite all interventions, however, a proportion of patients with VBDS due to medications eventually develop cirrhosis and end stage liver disease requiring liver transplantation.

Bosutinib

Scohen — Fri, 17 May 2013 02:23:42 GMT

Revision as of 02:23, 17 May 2013		Current revision
Line 4:		Line 4:

	Inhibits the Abl and Src signaling pathways, and is taken once a day at a dose of 500 mg by mouth.		Inhibits the Abl and Src signaling pathways, and is taken once a day at a dose of 500 mg by mouth.
		+
		+	Only two BCR/ABL 1 kinase mutations confirm resistance to bosutinib: the multiresistant T315 I mutations and V299l.
		+
		+	BELA trial phase 3 compared bosutinib to Imatinib with CCyR at 12 months, with identical response rates,70%,

	In the international, phase I/II study, all 546 adults enrolled were treated with bosutinib, for chronic, accelerated or blast phase CML, and had progressed after treatment with imatinib or with imatinib followed by dasatinib and/or nilotinib, or they could not tolerate previous treatments (FDA).		In the international, phase I/II study, all 546 adults enrolled were treated with bosutinib, for chronic, accelerated or blast phase CML, and had progressed after treatment with imatinib or with imatinib followed by dasatinib and/or nilotinib, or they could not tolerate previous treatments (FDA).
Line 18:		Line 22:

	Of the total 374 evaluable patients with chronic CML, 16 patients (4%) had confirmed disease transformation to advanced or blast phase while undergoing treatment with bosutinib.		Of the total 374 evaluable patients with chronic CML, 16 patients (4%) had confirmed disease transformation to advanced or blast phase while undergoing treatment with bosutinib.
		+
		+	Efficacy comparable with nilotinib and dasatinib In patients with Imatinib resistance.

	Diarrhea, nausea, thrombocytopenia, vomiting, abdominal pain, rash, anemia, fever, and fatigue were among the most common adverse events		Diarrhea, nausea, thrombocytopenia, vomiting, abdominal pain, rash, anemia, fever, and fatigue were among the most common adverse events

Molecular profiling

Scohen — Fri, 17 May 2013 01:57:14 GMT

New page

Combines molecular medicine and bioinformatics to select the most appropriate therapy for patients with cancer.

Rather than identifying a cancer on the basis of morphological appearance of the cells and the environs, molecular characterization allows for classifications by determining the level of gene and protein expression within the malignancy and comparing that expression patterns. with the expression profiles of cancers with known outcomes.

Using algorithms the cancer is placed in outcome class derived from similar expression profiles to yield a survival probability.

Sofosbuvir

Scohen — Fri, 17 May 2013 01:42:26 GMT

Revision as of 01:42, 17 May 2013		Current revision
Line 2:		Line 2:

	Nucleotide analogues are phosphorylated within hosts hepatocytes to active nucleoside triphosphate, which competes with the natural nucleotides, terminating RNA replication in the nascent viral genome.		Nucleotide analogues are phosphorylated within hosts hepatocytes to active nucleoside triphosphate, which competes with the natural nucleotides, terminating RNA replication in the nascent viral genome.
		+
		+	Virologic breakthrough not observed with this drug.

	Active triphosphate nucleotide analogs target the active site of the HCV-specific NS5B polymerase, acting as a non-obligate chain terminator, an effect independent of the viral genotype.		Active triphosphate nucleotide analogs target the active site of the HCV-specific NS5B polymerase, acting as a non-obligate chain terminator, an effect independent of the viral genotype.
Line 12:		Line 14:

	In a randomized study of patients with hepatitis C receiving Sofosbuvir plus ribavirin a sustained virologic response was seen in all previously untreated patients with HCV genotype 2 or 3 infection and in the majority of previously untreated patients with HCV genotype 1 infection (Gane EJ et al).		In a randomized study of patients with hepatitis C receiving Sofosbuvir plus ribavirin a sustained virologic response was seen in all previously untreated patients with HCV genotype 2 or 3 infection and in the majority of previously untreated patients with HCV genotype 1 infection (Gane EJ et al).
		+
		+	Patients with genotype 4 or 6 have high rates of sustained virologic response with a 24 week regimen of sofosbuvir plus PEG interferon- ribavirin.
		+
		+	Sofosbuvir combined with Peginterferon-riboflavin in predominately 1 or 4 HCV infection hadbsustained virologic response of 90% at 12 weeks (Lawitz E et al).
		+
		+	In a non-inferiority trial patients with genotype two or three HCV infection randomly assigned to receive sofosbuvir-ribavirin for 12 weeks or peginterferon plus ribavirin for 24 weeks: They had nearly identical rates of response at 67% with less frequent adverse event in the sofosbuvir group (Lawitz E ey al).

Hepatitis C (HCV)

Scohen — Fri, 17 May 2013 01:26:58 GMT

Revision as of 01:26, 17 May 2013		Current revision
Line 2:		Line 2:

	2% of the U.S. population, or more than 4,100,000 people are infected.		2% of the U.S. population, or more than 4,100,000 people are infected.
		+
		+	As many as 350,000 die worldwide annually.

	80% of hepatitis C patients are viremic.		80% of hepatitis C patients are viremic.
Line 19:		Line 21:
	Patients released from the criminal justice system may account for up to 29-43% of the 2.7 million-3.9 million persons infected with hepatitis C in the US.		Patients released from the criminal justice system may account for up to 29-43% of the 2.7 million-3.9 million persons infected with hepatitis C in the US.

-	Most patients in the United States have now been infected with 10-30 years, making him at risk for hepatoma.	+	Most patients in the United States have now been infected with 10-30 years, making them at risk for hepatoma.
		+
		+	Genotype 1 represent more than 70% of all cases of chronic HCV infection in the US.

	Only 25-35% of individuals infected with HCV are aware of their condition.		Only 25-35% of individuals infected with HCV are aware of their condition.

Anaplastic lymphoma kinase

Scohen — Fri, 17 May 2013 00:41:04 GMT

Revision as of 00:41, 17 May 2013		Current revision
Line 1:		Line 1:
		+	Anaplastic lymphoma kinase is a receptor tyrosine kinase expressed in the CNS, small intestine, and testicle.
		+
	Anaplastic lymphoma kinase gene mutation was for translocations had been found in anaplastic large cell lymphoma, neuroblastoma, inflammatory		Anaplastic lymphoma kinase gene mutation was for translocations had been found in anaplastic large cell lymphoma, neuroblastoma, inflammatory
	myofibroblastic tumor and non-small cell lung cancers.		myofibroblastic tumor and non-small cell lung cancers.

Adenocarcinoma of the lung

Scohen — Fri, 17 May 2013 00:37:20 GMT

Revision as of 00:37, 17 May 2013		Current revision
Line 34:		Line 34:

	Over half of all cases can be to find by known genetic abnormalities or oncogenic drivers: most commonly activated mutations of KRAS and epidermal growth factor receptor, mutant BRAF and fusion oncogenes involving anaplastic lymphoma kinase (ALK).		Over half of all cases can be to find by known genetic abnormalities or oncogenic drivers: most commonly activated mutations of KRAS and epidermal growth factor receptor, mutant BRAF and fusion oncogenes involving anaplastic lymphoma kinase (ALK).
		+
		+	KRAS mutations seen about 15-25% of patients with adenocarcinomas of the lung, more commonly in smokers.

	Activation of oncogenic kinases such as epidermal growth factor receptor or anaplastic lymphoma kinase can lead to tumor dependent cells on activated kinase and sensitivity to the corresponding kinase inhibitor.		Activation of oncogenic kinases such as epidermal growth factor receptor or anaplastic lymphoma kinase can lead to tumor dependent cells on activated kinase and sensitivity to the corresponding kinase inhibitor.

Non-Small Cell Carcinoma of the Lung (NSCLC)

Scohen — Thu, 16 May 2013 20:32:21 GMT

Revision as of 20:32, 16 May 2013		Current revision
Line 35:		Line 35:

	Median survival for advanced disease was 2-4 months in 1970 and is presently greater than 12 months.		Median survival for advanced disease was 2-4 months in 1970 and is presently greater than 12 months.
		+
		+	Median overall survival for patients with advanced stage disease remains dismal, within one year survival rates at 40-50% at best, and two-year survival rates below 15-20%.
		+
		+	Only 3-5% of patients with advanced disease with 5 years.

	Modern chemotherapy doublets has increased median survival time to 8-11 months and with the use of biologic agents median survival times in some cases exceeds 12 months(Breathnach OS, Sandler A).		Modern chemotherapy doublets has increased median survival time to 8-11 months and with the use of biologic agents median survival times in some cases exceeds 12 months(Breathnach OS, Sandler A).
Line 302:		Line 306:

	63 patients with stage III/IV cancer having failed one or more chemotherapy regimens and tried on sunitinib 50 mg/day for 4 weeks followed by 2 weeks of rest resulted in a 9.5% response rate with a 42.9% stable disease rate.		63 patients with stage III/IV cancer having failed one or more chemotherapy regimens and tried on sunitinib 50 mg/day for 4 weeks followed by 2 weeks of rest resulted in a 9.5% response rate with a 42.9% stable disease rate.
		+
		+	Patients with activating mutations in the epidermal growth factor receptor
		+	(EGFR)domain or EML4-ALK translocation benefit from first-line treatment with erlotinib or crizotinib, respectively.

	ALK lung tumors can be inhibited by anaplastic lymphoma kinase inhibitor crizotinib, an oral small molecule inhibitor, with a response rate of 57% (Kwak EL et al).		ALK lung tumors can be inhibited by anaplastic lymphoma kinase inhibitor crizotinib, an oral small molecule inhibitor, with a response rate of 57% (Kwak EL et al).
Line 314:		Line 321:

	SRT to the long is associated with rib fractures and pneumonitis affecting up to 5% of patients.		SRT to the long is associated with rib fractures and pneumonitis affecting up to 5% of patients.
		+
		+	KRAS is the most common mutation in NSCLC.

	For a dose of at least 45 Gy in three fractions of stereotactic radiation, the average rate of adorable local control of non-small cell lung cancer exceeds 90%, and the average reported three-year overall survival exceeds 50%.		For a dose of at least 45 Gy in three fractions of stereotactic radiation, the average rate of adorable local control of non-small cell lung cancer exceeds 90%, and the average reported three-year overall survival exceeds 50%.

Adenocarcinoma of the lung

Scohen — Thu, 16 May 2013 20:28:13 GMT

Revision as of 20:28, 16 May 2013		Current revision
Line 37:		Line 37:
	Activation of oncogenic kinases such as epidermal growth factor receptor or anaplastic lymphoma kinase can lead to tumor dependent cells on activated kinase and sensitivity to the corresponding kinase inhibitor.		Activation of oncogenic kinases such as epidermal growth factor receptor or anaplastic lymphoma kinase can lead to tumor dependent cells on activated kinase and sensitivity to the corresponding kinase inhibitor.

-	Most patients with adenocarcinoma of the lung with EGFR mutations are non-smokers or light smokers, and more likely to be female and Asian.	+	Most patients with adenocarcinoma of the lung with EGFR mutations are non-smokers or light smokers, and more likely to be female and Asian.
		+
		+	Front-line pemetrexed and platinum superior to gemcitabine and platinum, with superior efficacy and improved side effects.
		+
		+	Patients with activating mutations in the epidermal growth factor receptor
		+	(EGFR)domain or EML4-ALK translocation benefit from first-line treatment with erlotinib or crizotinib, respectively.

Translational research

Scohen — Thu, 16 May 2013 14:18:24 GMT

Revision as of 14:18, 16 May 2013		Current revision
Line 1:		Line 1:
-	bench to bedside process of taking basic science to produce new drugs, devices and treatments by translating new science into new medical approaches.	+	Bench to bedside process of taking basic science to produce new drugs, devices and treatments by translating new science into new medical approaches.

	Includes attempts at bringing new treatments to everyday clinical medicine.		Includes attempts at bringing new treatments to everyday clinical medicine.

Laminotomy

Scohen — Thu, 16 May 2013 04:23:55 GMT

New page

An orthopedic/neurosurgical procedure that removes part of a lamina of the vertebral arch to decompress the corresponding spinal cord and/or spinal nerve root.

Commonly performed as the removal of a portion of both sides of the lamina, and retaining the rest to preserve vertebral stability.

Often accompanied by facetectomy.