Guidelines causing iatrogenic disease?
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Biomedical subjects
Publications and source records attributed to D J Dickson.
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Fifty-nine patients on long-term treatment with phenylbutazone or oxyphenbutazone for chronic rheumatic conditions were switched to treatment with naproxen and followed-up for 6 months in a compliance study. All patients were started on 500 mg naproxen twice daily but adjustment of the dosage was permitted. During the 6 months of the study only 3 patients returned to treatment with phenylbutazone. Of the remaining 56 patients, 45 were still taking naproxen after 6 months, 9 were changed to other non-steroidal, anti-inflammatory drugs and 2 were lost to follow-up. The study demonstrates that in routine general practice, phenylbutazone and oxyphenbutazone can be successfully replaced by less toxic drugs.
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Angiogenesis plays a key role in the growth of solid tumors. More recently, accumulating evidence has linked angiogenesis to the pathophysiology of leukemias. Different investigators have shown evidence of increased angiogenesis in the bone marrows of patients with acute and chronic leukemias. Elevated levels of angiogenic factors have also been reported in leukemic patients. A potential role for VEGF as an autocrine growth factor in AML has been suggested. Studies on the role of angiogenesis and VEGF as prognostic factors in leukemia require confirmation. The role of angiogenesis inhibitors in the treatment of leukemia is currently under investigation.
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