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Biomedical subjects

A Hollmen

Publications and source records attributed to A Hollmen.

11 recordsLinked to original sources
PubMed1999

Continuous and intermittent itraconazole dosing schedules for the treatment of onychomycosis: a pharmacokinetic comparison.

This multicentre, double-blind, randomized study compared the pharmacokinetics of itraconazole given at 200 mg once daily for 3 months and intermittently at 200 mg twice daily for 1 week per month followed by a 3-week drug-free period for 3 months in the treatment of onychomycosis. Patients were followed for 9 months after treatment. Itraconazole and hydroxy-itraconazole plasma concentrations and itraconazole nail tip concentrations were determined at regular intervals. With intermittent therapy (n = 64), increases of consistent magnitude were seen in the mean itraconazole and hydroxy-itraconazole plasma concentrations at the end of each 1-week treatment phase; values returned towards baseline during each subsequent 3-week drug-free period. The mean concentration of itraconazole in fingernail tips increased steadily from week 4, reached a maximum value at week 24 (213 ng/g), declined sharply between weeks 24 and 36 and returned to baseline by week 48; the mean concentration profile was similar for toenail tips (maximum value 305 ng/g at week 24) but decreased at a slower rate. With continuous therapy (n = 65), steady-state mean plasma concentrations of itraconazole and hydroxy-itraconazole were obtained within 4-5 weeks of the start of treatment and remained reasonably constant between weeks 4 and 12. The mean concentration of itraconazole in fingernail tips reached a maximum value at week 12 (524 ng/g) and returned towards baseline by week 48; in contrast, the maximum mean concentration of itraconazole in toenail tips was 698 ng/g at week 36 and did not return to baseline by week 48. No clear relationship was observed between response to treatment and concentration of itraconazole or hydroxy-itraconazole in plasma or itraconazole in nails, suggesting that concentrations exceeded therapeutic levels. In conclusion, intermittent therapy resulted in higher maximum itraconazole plasma concentrations but lower total drug exposure, and hence lower itraconazole nail concentrations, than continuous therapy. However, the intermittent schedule was not associated with a lower cure rate, which indicates that itraconazole nail concentrations remained within the therapeutic range.

Adolescent↗
PubMed1997

A double-blind, randomized study comparing itraconazole pulse therapy with continuous dosing for the treatment of toe-nail onychomycosis.

In this multicentre, double-blind, parallel group study, we evaluated the efficacy and safety of continuous treatment with itraconazole, 200 mg daily for 3 months, in comparison with itraconazole pulse therapy, 400 mg daily 1 week per month for 3 months, in the treatment of toe-nail onychomycosis. The study included 129 patients with distal subungual onychomycosis of the toe-nails, confirmed by microscopy and positive for dermatophyte culture; 65 received continuous treatment and 64 received pulse therapy. Patients were followed up for 9 months after treatment. After 12 months, there were 62 evaluable patients in the continuous group and 59 evaluable patients in the pulse group. The clinical response (i.e. the size of the affected area and the progress of the infection) and mycological cure (i.e. negative results on microscopy and culture) were the main outcome measures. A clinical response was defined as a cure or a marked improvement. Clinical response rates were 69%, in the continuous group, and 81% in the pulse group at month 12; the corresponding mycological cure rates were 66 and 69%. A better improvement in signs and symptoms was noted in the pulse group. Six patients were withdrawn from treatment because of adverse events, not all of which were thought to be drug-related. There were no clinically relevant laboratory abnormalities. We conclude that both regimens are effective, safe and well tolerated. The superiority of one treatment over the other was not established, but the results tended to favour pulse therapy. Equivalence testing confirmed that pulse therapy was at least equivalent to continuous treatment.

Adolescent↗
PubMed1992

Efficacy and safety of itraconazole in the long-term treatment of onychomycosis.

Sixty-one patients with a clinical diagnosis of onychomycosis in finger or toe nails were treated with itraconazole 100 mg/day or griseofulvin 500 mg/day for six to nine months. The infective causes were Trichophyton rubrum, Trichophyton mentagrophytes, or Trichophyton violaceum, and in two cases Candida albicans. A total of 27 finger and 390 toe nails were infected. Statistically significant intragroup reductions from baseline symptom severity values were seen at endpoint (month 6 or 9) for both treatment groups for all parameters: colour change, thickness, brittleness and unaffected area. No clinically or statistically significant differences between the treatment groups were seen at endpoint. However, the itraconazole group continued to improve during the follow-up, while the mean symptom severity ratings remained the same in the griseofulvin group. All itraconazole patients and 85% of griseofulvin patients were rated as cured or markedly improved at endpoint. Nineteen out of 26 evaluable itraconazole patients (73%) remained cured during the three month follow-up period, compared with 12 out of 17 griseofulvin patients (71%). The rather large number of drop-outs, especially among griseofulvin patients, makes it difficult to draw definitive conclusions of the symptom recurrence. Two itraconazole patients stopped medication due to an adverse event, compared to four patients in the griseofulvin group. The clinical laboratory data on itraconazole-treated patients did not show any statistically or clinically significant changes. In conclusion, itraconazole was at least as effective as griseofulvin in the treatment of onychomycosis. The itraconazole group continued to improve after the treatment was stopped. The results show that itraconazole 100 mg/day is safe and efficient in the long-term treatment of fungal nail infections.

Adolescent↗
PubMed1990

Plasma catecholamines, corticosterone, glucose and fatty acids concentrations and mean arterial pressure and body temperature in haemorrhagic hypovolaemia, hypothermia and a combination of these in the rabbit.

Venous plasma noradrenaline, adrenaline, dopamine, corticosterone, glucose and free fatty acid concentrations were measured in anaesthetized rabbits during hypovolaemia, hypothermia and a combination of these. The anaesthetic used was Hypnorm, which contains fentanyl and fluanisone. In the hypovolaemia group blood was shed via the venous cannula until the mean arterial pressure was 50 mmHg. The rabbits in the hypothermia group were cooled in iced water to a central temperature of 32 degrees C, and the rabbits in the combined hypovolaemia-hypothermia group were bled until hypovolaemic and then cooled in iced water to a central temperature of 32 degrees C. Rewarming was done in dry air at 43 degrees C. Bleeding and hypothermia activated the sympathicoadrenal system, causing a rise in the noradrenaline and adrenaline concentrations, as well as a rise in corticosterone. There were no significant differences in plasma noradrenaline and adrenaline values between the groups, whereas hypovolaemia alone also increased the dopamine concentration. In the hypothermia group the amount of corticosterone after cooling and rewarming was higher than in the combined group. Hypothermia and hypovolaemia increased the level of free fatty acids and blood glucose, which in the hypovolaemia group remained higher after volume replacement than in the other groups. Hypothermia in both groups increased the mean arterial pressure. In conclusion, the results suggest that hypothermia may prevent some harmful effects of hypovolaemia, e.g. by correcting mean arterial pressure, thus preventing the mortality seen in the hypovolaemia group.

Animals↗
PubMed1985

Trimethylpsoralen bath plus ultraviolet A combined with oral retinoid (etretinate) in the treatment of severe psoriasis.

Twenty five patients with severe and extensive psoriasis were treated with trimethylpsoralen (trioxsalen) bath plus ultraviolet A (bath PUVA) combined with oral retinoid, etretinate (Ro 10-9359). Etretinate was started (1 mg/kg/day) 2 weeks prior to starting the bath PUVA treatment daily. Psoriasis cleared with fifteen treatments in 96% of patients with a mean total UVA dose of 3.9 joules/cm2. The control group of nine patients received only bath PUVA without retinoid, and eight of them cleared with nineteen treatments and with a mean UVA dose of 7.2 joules/cm2. In addition, three psoriatic patients previously resistant to bath PUVA treatment were given etretinate (1 mg/kg/day), and they cleared in 4 to 8 weeks after starting etretinate with a UVA dose of 37-144 joules/cm2. In the maintenance therapy after the combination therapy of twenty-four patients, the results of treatment were good or excellent in fourteen of fifteen patients (93%) getting only bath PUVA one to two times a week and in four of nine patients (44%) getting etretinate (25-50 mg daily) in a mean follow-up time of 10 weeks. These results show the benefits of the combination of trimethylpsoralen bath PUVA with an oral retinoid, etretinate, in the treatment of severe and extensive psoriasis.

Administration, Oral↗
PubMed1981

Fabry's disease and cornea verticillata. A report of 3 cases.

Fabry's disease is a rare familial disorder of glycolipid metabolism which is caused by a deficiency of a lysosomal enzyme alpha-galactosidase. A Finnish family is described in which cornea verticillata was found in the father and 2 daughters. In all cases, there were symptoms suggesting Fabry's disease: febrile episodes the origin of which was not clear, limb pains and, in the case of the father, 20 years of proteinuria with elevated ESR, and hemiplegia and aphasia following a cerebral thrombosis at the age of 43. The diagnosis was confirmed by demonstration of an alpha-galactosidase deficit in the serum and urine of all patients. Deficiency of this enzyme leads to abnormally high urinary tri- and dihexosyl ceramide levels, and this was observed in the father and the elder daughter. At the age of 12, the daughter had loss of vision in her right eye as a result of occlusion of the central retinal artery. Electron microscopic (EM) examination of the father's dermal angioma suggested Fabry's disease. Computerized cranial tomography of the father revealed not only the cerebrovascular condition but also a disease affecting the white matter of the brain.

Adolescent↗
PubMed1977

Plasma renin activity, renal artery blood flow and cortical tissue oxygen tensionin haemorrhagic hypotension.

The changes occurring in plasma renin activity (PRA), tissue oxygen tension of the renal cortex and the change in renal total blood flow were studied during haemorrhagic hypotension in six dogs. The flow was measured with an electromagnetic flowmeter, the plasma renin activity was determined by radioimmunoassay and tissue oxygen tension with IBC oxygen electrodes. Haemorrhagic hypotension led to a significan increase in PRA. The fall in renal total blood flow and cortical tissue oxygen tension were significant after all three epizodes of bleeding (each of 10 ml/kg. Metabolic acidosis increased after every bleed. The correlation between PRA, renal blood flow and cortical tissue oxygen tension is evaluated in the discussion.

Acidosis, Renal Tubular↗
PubMedDate not supplied

Mucha-Habermann disease: a diagnostic possibility for prolonged fever associated with systemic and skin symptoms.

The severe form of Mucha-Habermann disease with systemic symptoms is a rarely diagnosed disease which should be considered for children with prolonged fever, impaired general condition, skin manifestations and elevated C-reactive protein concentration and/or erythrocyte sedimentation rate. Eleven cases have been described previously in children. We describe two acute episodes of this syndrome in a three-year-old child; the diagnosis was based on clinical, dermatological and histological findings. During both episodes, the fever lasted for more than one week, C-reactive protein concentration increased to more than 150 mg/l, and there was extensive lymph node enlargement. Skin eruption was initially maculopapulous, then vesiculous and finally pustulous. On skin biopsy, vasculitic changes were observed. We treated the second attack of our patient with high-dose gamma globulin; the first attack appeared to resolve itself spontaneously.

Arthritis, Juvenile↗