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Adrian Gillissen

Publications and source records attributed to Adrian Gillissen.

27 records · Page 2Linked to original sources
PubMed2003

[Severe acute respiratory syndrome (SARS)].

Severe acute respiratory syndrome (SARS) is a viral disease, observed primarily in Southern China in November 2002, with variable flu-like symptoms and pneumonia, in approx. 5% leading to death from respiratory distress syndrome (RDS). The disease was spread over more than 30 states all over the globe by SARS-virus-infected travelers. WHO and CDC received first information about a new syndrome by the end of February 2003, after the first cases outside the Republic of China had been observed. A case in Hanoi, Vietnam, led to the first precise information about the new disease entity to WHO, by Dr. Carlo Urbani, a co-worker of WHO/Doctors without Borders, who had been called by local colleagues to assist in the management of a patient with an unknown severe disease by the end of February 2003. Dr. Urbani died from SARS, as did many other health care workers. In the meantime, more than 7,000 cases have been observed worldwide, predominantly in China and Hong Kong, but also in Taiwan, Canada, Singapore, and the USA, and many other countries, and more than 600 of these patients died from RDS. Since the beginning of March 2003, when WHO and CDC started their activities, in close collaboration with a group of international experts, including the Bernhard-Nocht-Institute in Hamburg and the Department of Virology in Frankfurt/Main, a previously impossible success in the disclosure of the disease was achieved. Within only 8 weeks of research it was possible to describe the infectious agent, a genetically modified coronavirus, including the genetic sequence, to establish specific diagnostic PCR methods and to find possible mechanisms for promising therapeutic approaches. In addition, intensifying classical quarantine and hospital hygiene measures, it was possible to limit SARS in many countries to sporadic cases, and to reduce the disease in countries such as Canada and Vietnam. This review article summarizes important information about many issues of SARS (May 15th, 2003).

Canada↗
PubMed2002

[State of the art of the inhalation therapy of asthma].

The current concept of asthma pathogenesis is that a characteristic chronic inflammatory process involving the airway wall causes the development of airflow limitation and increased responsiveness, thereby predisposing the airways to narrow in response to a variety of specific (allergic) or unspecific stimuli. Medications for asthma are used to reverse and prevent symptoms and airflow limitation and include controllers and relievers. The major advantage of delivering drugs directly into the airways via inhalation is that high concentrations can be delivered more effectively to the airways, and systemic side effects are avoided or minimized. Bronchodilators with or without anti-inflammatory substances are used as basic therapeutic approach in these patients. The stepwise approach to therapy recommends that the number/type and frequency of medications are increased with increasing asthma severity by adding systemic medications to existing inhalation therapy (step III-IV in asthma management guidelines). Combination therapy using a long acting beta 2-agonist and a glucocorticosteroid resulted in higher lung function improvement, and was superior in reduction of exacerbation rates compared with an inhaled glucocorticosteroid alone. Hence, the development of a fixed combination containing both substances in one device is a logic consequence, and thus, simplifying asthma therapy.

Administration, Inhalation↗
PubMed2002

[Do we need inhalative steroids in chronic COPD patients?].

The use of inhaled steroids in the management of chronic obstructive pulmonary disease (COPD) is controversially discussed. Neither the optimistic view of the 90s nor the current pessimistic view on these substances seems to be justified. It becomes apparent that a more differentiated approach, depending on the clinical situation and the cellular composition in the airways, is necessary. Patients with severe inflammation, poor lung function, and frequent exacerbations seem to benefit more from inhaled steroids. Patients in early stages of the disease with occasional symptoms only, and patients predominantly suffering from emphysema than from bronchitis seem to have no benefit from this treatment option. Special attention should be turned to mixed types with asthma-like symptoms. The combination of inhaled long-acting beta 2-mimetics and steroids seems to be of advantage; for a final judgment, however, the results of ongoing clinical trials have to be awaited.

Administration, Inhalation↗
PubMed2002

Early therapy with the neuraminidase inhibitor oseltamivir maximizes its efficacy in influenza treatment.

Influenza illness is an important cause of severe morbidity and mortality in the population. Oseltamivir, the first oral neuraminidase inhibitor, has proven efficacy. In children of 1 year and older (weight-dependent dosing: 30 mg, 45 mg, 60 mg or 75 mg BID for 5 days) and adults (75 mg BID for 5 days), oseltamivir reduces the duration and severity of acute influenza. Furthermore, it decreases the incidence of secondary complications such as otitis media, bronchitis, pneumonia and sinusitis. Oseltamivir has been shown to prevent influenza when given for long-term prophylaxis or for post-exposure prophylaxis. Because oseltamivir blocks the neuraminidase, an enzyme crucial to influenza virion liberation from the host cell, it is only effective during the replication phase. Clinical benefits are only seen, when oseltamivir is applied within 48 h after onset of symptoms, and clinical efficacy in acute influenza is highly dependent on the beginning of treatment. Treatment within 12 h after onset of symptoms reduces the duration of illness by an additional 74.6 h, and treatment within 24 hours an additional 53.9 h compared to the benefit seen with an intervention at 48 h. In conclusion, clinical efficacy of oseltamivir can be maximized by early start of treatment. Resistance of influenza virus against oseltamivir has rarely been observed and seems to be of no clinical relevance due to reduced transmissibility and pathogenicity of mutants. Oseltamivir is generally well tolerated. About 10% of the patients complain of transient upper gastrointestinal events, which resolved within 1-2 days, and which could be reduced when the medication was taken with a light snack.

Acetamides↗
PubMed2002

Efficacy and safety of zanamivir in patients with influenza--impact of age, severity of infections and specific risk factors.

Influenza infections occur primarily in the winter season and may lead to serious morbidity and mortality, predominantly in patients with increased risk of complications; these include those with advanced age or with chronic clinical conditions. In this group, the rate of influenza-related hospitalization or death is considerably increased. New treatment options have been introduced for treatment of influenza infection, with the neuraminidase inhibitors zanamivir and oseltamivir being the most promising substances for treatment and prevention of influenza. Numerous double-blind, randomized, placebo-controlled trials in otherwise healthy individuals have demonstrated that zanamivir, when administered orally inhaled for 5 days, produced a statistically significant reduction (by 1.5 days) in the time to alleviation of influenza-related symptoms by compared to inhaled placebo (lactose). The time to alleviation was reduced by 2.5 days in high-risk patients and by 3.25 days in these patients with fever at enrollment. Likewise, the time to alleviation could be reduced by 2 days in patients with severe influenza-related symptoms aged under 50 years and by 7 days in the patient population aged over 50 years compared to placebo. In patients with asthma or chronic pulmonary disease, zanamivir demonstrated a comparable efficacy, reduced the rate of pulmonary complications and did not adversely affect pulmonary function. Zanamivir was well tolerated. In conclusion, zanamivir has proven to be efficacious in treating influenza infection: this was true especially in high-risk patient groups, e.g., patients with advanced age, underlying chronic medical conditions or presenting with severe influenza-related symptoms.

Administration, Oral↗
PubMed2002

[Prognosis, staging and therapy of malignant pleural mesothelioma].

PROGNOSIS: Prognosis of pleural mesothelioma remains dismal. Regardless of the modality employed median survival ranges between 6 and 12 months, only 20% of patients survive 1 year. In 1996 the International Mesothelioma Interest Group (IMIG) published a widely accepted staging system. So far there is no effective standard therapy. Even very aggressive therapies do not basically influence the course of the disease. THERAPEUTICAL STUDIES: Despite numerous single-agent and combination chemotherapy trials no standard regimen could be found. Few agents yield reproducible response rates above 20%. The majority of the trials are inconclusive according to statistical criteria, as subject numbers are insufficient to prove or deny effectiveness. It also remains obscure in which stage of the disease patients may benefit from chemotherapy because of a lack of analysis of response rates within different stages. Striking is the lack of sufficient studies analyzing patients' quality of life treated with often very toxic regimens. DRUG TREATMENT: Systemic administration of interferons alone or in combination with chemotherapeutic agents did not result in higher response rates or prolonged median survival. In very early stages of the disease patients may have limited benefit from intracavitary, local administration of gamma-interferon. MULTIMODALITY APPROACHES: Mere surgical procedures as extrapleural pneumonectomy or pleurectomy/decortication have been left in favor of multimodality approaches. Due to careful patient selection and improved operation techniques mortality could be reduced. Neither chemotherapy, radiotherapy nor photodynamic therapy can prevent local relapse which occurs in the majority of patients. RADIOTHERAPY: The effectiveness of primary radiation therapy remains controversial. Even very high doses of radiation cannot control tumor growth. It remains unclear whether radiation therapy may palliate tumor associated symptoms. Prophylactic radiation of puncture channels and thoracotomy scars is effective to prevent tumor growth caused by seeding of mesothelioma cells. PERSPECTIVES: Research of the biological behavior of mesothelioma resulted in first phase I gene therapy trials. The results of the few promising approaches tested in phase II and III trials with sufficient patient numbers have to be awaited until we have learned whether and in which stage of the disease patients may benefit from therapy.

Clinical Trials as Topic↗
PubMed2002

Local anaesthetic properties of ambroxol hydrochloride lozenges in view of sore throat. Clinical proof of concept.

UNLABELLED: Acute oro-pharyngeal catarrh is characterised by mild to severe sore throat, such as pain on swallowing, feeling of scratchiness, burning and urge to cough. The present study was conducted to explore whether the test compound is going to show clinical relevance and is a suitable medication for the relief of these symptoms. OBJECTIVE: Description and comparison of the efficacy and tolerability of lozenges containing 20 mg ambroxol hydrochloride (trans-4-[(2-amino-3,5-dibrombenzyl)amino]cyclohexano hydrochloride, CAS 18683-91-5) in relieving acute sore throat, in comparison to placebo. DESIGN: Multi-centre, prospective, placebo-controlled, randomised, double-blind trial involving two days of treatment with up to 6 lozenges containing 20 mg ambroxol hydrochloride per day. SUBJECTS: Two-hundred-eighteen (218) patients were enrolled (97 males, 121 females, average age: 39.4 +/- 15 years, range: 17-81 years); 215 were treated: 107 with 20 mg ambroxol and 108 with placebo; 26 discontinued prematurely (13 in each treatment group). 208 patients constituted the intent-to-treat (ITT) dataset (105 and 103 for treatment with ambroxol and placebo, respectively); 196 patients constituted the perprotocol (PP) dataset (97 and 99, respectively); all treated patients were part of the dataset for safety analysis. TREATMENTS: Double-blind treatment with up to 6 lozenges per day containing 20 mg ambroxol hydrochloride or placebo (a lozenge with a distinct minty flavour). MAIN OUTCOME MEASURES: The time-weighted average pain relief over the first 3 h after the first lozenge as a ratio of the baseline pain intensity of sore throat (SPIDnorm) and the patients' evaluation of efficacy and tolerability at the end of each day of treatment. RESULTS: Both treatments led to a reduction of pain intensity; the mean (+/- SD) SPIDnorm after the 1st lozenge were 0.39 +/- 0.27 and 0.28 +/- 0.25 for 20 mg ambroxol hydrochloride and placebo, respectively; the treatment effect of ambroxol was statistically significantly superior compared to placebo (p: 0.0029; 95% confidence interval estimate of the mean treatment difference for ambroxol minus placebo: 0.04 to 0.18). At the end of each subsequent ambulatory treatment day with up to 6 lozenges per day, a statistically significantly higher proportion of patients scored a higher level of efficacy for the active treatments with ambroxol hydrochloride compared to placebo. The investigational treatments were equally well tolerated. CONCLUSIONS: Sucking lozenges containing 20 mg ambroxol hydrochloride has a beneficial pain relieving effect in patients with acute sore throat, superior to that which otherwise can be achieved by sucking a placebo lozenge. This finding confirms that the preclinical local anaesthetic properties of ambroxol hydrochloride may have beneficial clinical implications.

Administration, Oral↗
PubMed1999

Obstructive Sleep Apnea and Hypopnea Efficacy and Safety of a Long-Acting beta2-Agonist.

The effect of inhaled long-acting beta2-agonists in obstructive sleep apnea syndrome (OSAS) is unknown, although from the pharmacological point of view both therapeutic and adverse effects need to be considered. The purpose of this study was to obtain data on the efficacy and safety of salmeterol in patients with OSAS. In a randomized, double-blind, placebo-controlled, cross-over study, effects of salmeterol on respiration during sleep and sleep quality were investigated in 20 patients with OSAS. Of these, 4 patients were female, 16 male; the average age was 53.0 +/- 7.8 years, with average body mass index 28.0 +/- 3.0 kg small middle dot m(-2) and average apnea hypopnea index 35.6 +/- 17.8 h(-1). Patients with asthma, chronic obstructive pulmonary disease (COPD), and left heart failure were excluded. Placebo or verum (50 &mgr;g salmeterol) was administered at 7 pm by meter dose inhaler and spacer device. All patients underwent full polysomnography during baseline, placebo, and verum night. Statistical analysis was performed by StudentOs t-test (p > 0.05). Between the placebo and verum there were no differences in total sleep time, sleep stages, apnea index (AI), apnea hypopnea index (AHI), and nadir oxygen saturation. There was, however, 1) a significant deterioration of mean oxygen saturation (SaO2m; placebo 93.1 +/- 2.0 vs. verum 92.5 +/- 2.2%; p = 0.01), 2) of percent of time spent with an oxygen saturation (SaO2) </= 90% (placebo 13.1 +/- 14.5 vs. verum 19.5 +/- 20.8%; p = 0.02), and 3) a significant increase in heart rate (placebo 63.1 +/- 9.2 vs. verum 65.6 +/- 9.3 h(-1); p = 0.01). In patients with OSAS, salmeterol had no adverse effect on quality of sleep, AI or AHI. The slight increase in heart rate and the deterioration of oxygen saturation probably have no clinical relevance; the latter condition might be due to ventilation-perfusion-mismatch. This study excluded any influence of salmeterol on obstructive sleep apnea and hypopnea; on the other hand, salmeterol turned out to be safe in terms of OSAS. This might be of special importance in patients suffering from both OSAS and obstructive airway disease.

Journal Article↗