British medical bulletin
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Over the past decade, the potential for delivering targeted therapy against malignant disease by the use of monoclonal antibodies (MoAbs) has begun to be realized. The development of human or chimeric antibodies and protein engineering to combine MoAbs with other biologically active molecules, such as radio-isotopes, toxins, chemotherapy and cytokines, has made available a new range of agents with clinical activity. ⋯ The trials of the next decade will address issues such as the optimal strategies and timing for clinical use, the role of radio- and immuno-conjugates and, finally, what other potential molecules, such as those influencing cell growth and death, may be targeted.
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Most procedures to treat refractive error are based on laser surgery, but other techniques are available. We review the relative advantages and the risk associated with the different surgical options. ⋯ Because refractive surgery is an area of rapidly developing technology, the relative benefits of the different surgical options remain uncertain. AREAS TO DEVELOP RESEARCH: Controlled trials are needed to provide better guidance as to the relative merits of the different surgical options. Better interventions are required to minimize the biological response after laser surface treatment to eliminate the need for mechanical cutting of a flap for laser in situ keratomileusis. An effective surgical treatment for presbyopia is awaited.
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Trachoma is the most common infectious cause of blindness worldwide. It afflicts some of the poorest regions of the globe, predominantly in Africa and Asia. The disease is initiated in early childhood by repeated infection of the ocular surface by Chlamydia trachomatis. ⋯ This involves surgery for trichiasis, antibiotics for infection, facial cleanliness (hygiene promotion) and environmental improvements to reduce transmission of the organism. Where this programme has been fully implemented, it has met with some success. However, there are significant gaps in the evidence base and optimal management remains uncertain.
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British medical bulletin · Jan 2006
ReviewIdiopathic intracranial hypertension and visual function.
Idiopathic intracranial hypertension is a relatively common condition (incidence up to 19/100 000/year in the high-risk group of obese women in reproductive age range) causing headaches with papilloedema. Detailed investigations are required to exclude other causes of raised intracranial pressure. The condition may be self-limiting or enter a chronic phase with significant morbidity because of headache and visual loss. ⋯ Management of hypertension is initially medical, utilizing a combination of managed weight reduction and diuretic therapy. Cerebrospinal fluid (CSF) diversion surgery may be required to stabilize vision. Options include neurosurgical shunting by lumbar-peritoneal of ventriculo-peritoneal routes or by optic nerve sheath fenestration or both. High category evidence from randomized trials to guide management decisions is lacking. This article sets out to guide current best practice.
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The haemolytic uraemic syndrome (HUS) is characterized by the triad of thrombocytopenia, microangiopathic haemolytic anaemia and acute renal failure. HUS may be classified as either diarrhoeal-associated or non-diarrhoeal/atypical (aHUS). aHUS has recently been shown to be a disease of complement dysregulation, with 50% of cases involving the complement regulatory genes, factor H (CFH), membrane cofactor protein (MCP; CD46), and factor I (IF). However, incomplete penetrance of mutations in each of these genes is reported. ⋯ The reported precipitating events predominantly cause endothelial injury. Discovery of these mutations has revealed important genotype-phenotype correlations. MCP-HUS has a better prognosis and a better outcome after transplantation than either CFH-HUS or IF-HUS.