The use of nasal calcitonin spray in the treatment of hypercalcaemia of malignancy.
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Administration, Intranasal↗
Biomedical subjects
J Davenport
Publications and source records attributed to J Davenport.
Comparison of ondansetron with dexamethasone and domperidone in the prophylaxis of non-cisplatin chemotherapy induced emesis refractory to dexamethasone.
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Adult↗
Addison's disease.
Addison's disease is an uncommon endocrine condition manifested by a variety of nonspecific symptoms, such as malaise, anorexia and nausea. Symptoms usually do not occur until most of the adrenal gland has been destroyed. Autoimmune disease has surpassed tuberculosis as the primary cause of Addison's disease. Nevertheless, tuberculosis still accounts for a significant proportion of cases. The rapid adrenocorticotropic hormone (ACTH) stimulation test is useful for identifying adrenal insufficiency. Maintenance therapy consists of hydrocortisone and fludrocortisone.
Addison Disease↗
Preliminary study of the treatment of advanced breast cancer in postmenopausal women with the aromatase inhibitor CGS 16949A.
Thirty-one postmenopausal women with advanced breast cancer have been treated with the nonsteroidal competitive aromatase inhibitor CGS 16949A at p.o. doses of 0.3, 1, and 2 mg twice a day. All patients were assessed for response. Five patients, all treated with 1 mg twice daily, had objective evidence of response (two complete responses and three partial responses); disease stabilized in 17 patients. Minor side effects were reported by ten patients. Two further patients treated with 2 mg twice a day experienced persistent nausea which improved after dose reduction, and one patient, treated with 0.3 mg twice daily, developed a vasculitic rash requiring discontinuation of CGS 16949A. Estradiol levels measured in 24 patients were significantly suppressed 2 wk after starting CGS 16949A treatment at all doses used. Treatment with 2 mg twice a day lowered estradiol levels to a mean of 29% of pretreatment values which was significantly lower than the corresponding figure of 57% for patients treated with 0.3 mg twice daily. Aldosterone levels were significantly lowered below pretreatment values by the 1- and 2-mg twice daily doses. No clinically apparent cases of adrenocortical insufficiency occurred, although small changes in serum electrolyte levels were noted. The results indicate that CGS 16949A is an effective aromatase inhibitor, requiring further evaluation in the treatment of advanced breast cancer. The optimal dose is likely to be 1 mg twice a day.
Aldosterone↗
Treatment of advanced breast cancer in postmenopausal women with 4-hydroxyandrostenedione.
4-Hydroxyandrostenedione (4-OHA), a new specific aromatase inhibitor, was used to treat 57 postmenopausal women with advanced breast cancer at a dose of 250 mg by i.m. injection every 2 weeks; 55 women were assessable for response. In all, 18 patients (33%) had objective evidence of a response to treatment, with a median duration of 12 months; the disease stabilised in 8 (14%) patients. Serum oestradiol levels, which were measured weekly in nine of the patients, were found to be suppressed to a mean of between 36% and 51% of pretreatment levels during the first 6 weeks of treatment. Three patients were withdrawn from treatment because of toxicity (pain at injection site, sterile abscess and rash). One patient had an isolated episode of anaphylaxis after 6 months of treatment. In comparison with our previous reports of 4-OHA treatment, a dose of 250 mg given i.m. fortnightly appears to be the optimal dose regimen. The efficacy of the drug seems to be similar to that of tamoxifen and aminoglutethimide.
Adult↗
Phase I/II study of the anti-oestrogen zindoxifene (D16726) in the treatment of advanced breast cancer. A Cancer Research Campaign Phase I/II Clinical Trials Committee study.
We report a phase I/II study of the indole derivative, zindoxifene, an anti-oestrogen with intrinsic oestrogenic activity. We have treated 28 women with advanced breast cancer of whom 26 had received prior endocrine therapy. Oral zindoxifene doses ranged from 10 to 100 mg daily; doses were escalated in some patients. Twenty-five patients were assessed for response; the remaining three patients completed less than 3 weeks of treatment. There were no objective responses; disease stabilised in seven patients for up to 5 months and progressed in the remaining 18. Five patients (including three treated with tamoxifen) responded to subsequent endocrine therapy. Nausea, which was dose-limiting, affected half of the patients treated with 80 mg daily. Metabolites of zindoxifene were detectable in serum at all doses used, and sex hormone binding globulin (SHBG) levels showed a strong tendency to rise at the higher doses, indicating that zindoxifene is absorbed and has biological activity. We conclude that zindoxifene in the doses used in this study has only marginal therapeutic activity in the treatment of advanced breast cancer.
Aged↗
Scaphoid fracture: evaluation with flexion-extension tomography.
Assessment of healing of a scaphoid fracture, which may be associated with delayed fusion and nonunion, is a challenging task for the radiologist. Thirty cases of clinically suspected nonunion scaphoid waist fractures with inconclusive plain radiographs were prospectively studied by means of stationary tomography and lateral flexion-extension tomography. The angle between the two scaphoid fragments as seen in extension was measured and compared with the angle as seen in flexion. A difference of 10 degrees or greater between flexion and extension was considered significant. This was noted in 14 of 15 cases of nonunion. Fifteen cases without angle differences were accurately diagnosed as stable. One false-negative case was noted, which on review was attributed to a limited extension view. Flexion-extension tomography is a highly valuable diagnostic modality in evaluating the stability and healing of scaphoid fracture and is superior to conventional (stationary) tomography.
Adolescent↗
Prosthetic valve endocarditis 1976-1987. Antibiotics, anticoagulation, and stroke.
We retrospectively reviewed the clinical characteristics and outcomes of 61 patients with 62 episodes of prosthetic valve endocarditis, paying particular attention to neurologic complications (stroke). Atypical features of the group included a benign outcome of early postoperative infection (18% mortality) and a high stroke morbidity and mortality rate with Staphylococcus epidermidis infections. Eleven patients (18%) suffered an embolic stroke, most less than or equal to 3 days after diagnosis and before the initiation of antimicrobial therapy; the rate of embolic stroke recurrence was low (9%). The risk of embolic stroke was lower with bioprosthetic than with mechanical valves. No protective effect of anticoagulation therapy with warfarin was observed. Six patients (8%) suffered brain hemorrhage due to septic arteritis, brain infarction, or undetermined causes; no specific risk of hemorrhagic stroke was evident with anticoagulation therapy. Antibiotic treatment appears to be more important than anticoagulation to prevent neurologic complications in patients with prosthetic valve endocarditis.
Anti-Bacterial Agents↗
Postpericardiotomy syndrome.
The increase in major cardiac operations performed in the United States has been accompanied by an increase in the incidence of postpericardiotomy syndrome. Family physicians must be able to recognize the clinical picture, since patients may present several weeks postoperatively. Symptoms include malaise, pleuritic pain, dyspnea, myalgias, arthralgias and anorexia. Signs include fever, rales, friction rubs, effusions and leukocytosis. Anti-inflammatory drugs are effective.
Heart Diseases↗
Pleural mesothelioma.
The incidence of pleural mesothelioma will probably increase into the next century. A complete occupational history should include an inquiry about asbestos exposure, especially in patients with chest pain or dyspnea. The latency period between exposure and mesothelioma is as long as 50 years. In some patients, early diagnosis leads to a chance of cure. In most cases, however, there is no cure. Accurate diagnosis and a frank discussion of prognosis will allow patients to prepare for death.
Aged↗
Late prosthetic joint infections: a problem for family physicians.
Infection occurs in 1 to 4 percent of the 185,000 prosthetic joint implantations performed each year. Over half of these infections occur more than 12 weeks after surgery, when the patient has been returned to the care of the family physician. Late prosthetic joint infections are usually hematogenously acquired from other sites. Physical signs and symptoms are nonspecific, and diagnostic imaging, primarily bone and indium scanning, is required to differentiate an infected prosthesis from a loose, noninfected component. Treatment involves antibiotics, debridement and removal of the prosthetic component. Prosthetic joint infections may be prevented by early recognition and treatment of distant infections, early recognition of potential prosthetic joint infections and the use of prophylactic antibiotics in selected patients.
Aged↗
Common questions about withdrawal of life support.
The case of William Drabick in California reflects mainstream legal trends and answers several common questions about life support. The Drabick court concluded that court intervention is usually not necessary before life support is withdrawn; that formal legal documents are not necessary; that the prior wishes of a patient must be considered in any decision; that when there have been no prior wishes, a surrogate must act in the patient's best interest, and that a court-appointed conservator is not always necessary.
Brain Death↗
Characteristics of a proteinase from ovarian fluid of the lumpsucker (Cyclopterus lumpus L.).
1. A proteinase has been isolated from the ovarian fluid of the lumpsucker (Cyclopterus lumpus). 2. The enzyme was purified essentially to homogeneity by a one step purification procedure using anion-exchange chromatography. 3. The mol. wt of the denatured enzyme is approximately 20,000 as judged by SDS-polyacrylamide gel electrophoresis. 4. The enzyme is inhibited by serine-proteinase inhibitors and acts in the manner of a trypsin-type proteinase both with respect to specific peptide substrates and enzyme inhibitors. 5. The lumpsucker proteinase exhibits low general proteolytic activity but acts effectively on the specific chromogenic peptide substrates.
Animals↗
Cardiovascular effects of antidepressants. Avoiding cardiotoxicity in the elderly.
Elderly patients are at high risk for both depression and cardiovascular disease. Withholding antidepressant therapy from an elderly patient who has a stable cardiac condition is usually unjustified. Knowledge of the cardiac side effects of commonly used antidepressants enables the primary care physician to prescribe these agents safely for depressed elderly patients.
Aged↗
Secondary prevention in elderly survivors of heart attacks.
More than 200,000 elderly patients survive myocardial infarctions each year. Thus, the achievement of even minimal decreases in reinfarction and mortality rates will benefit large numbers of patients. Secondary prevention strategies include smoking cessation; the control of hyperlipidemia, obesity and diabetes; the management of hypertension and stress; exercise; the use of drugs such as beta blockers and aspirin, and increased attention to general health.
Adrenergic beta-Antagonists↗
Spontaneous bacterial peritonitis.
Characteristics that make spontaneous bacterial peritonitis clinically noteworthy are its increasing prevalence, its tendency to present with few reliable clinical signs and its high mortality rate. Spontaneous bacterial peritonitis almost always occurs in the presence of ascites, and analysis of ascitic fluid is essential for diagnosis.
Aged↗
Peak intratracheal pressure during controlled ventilation in infants and children. A computer study of the Servo 900C ventilator.
The mathematical relationship between peak ventilator breathing system pressure displayed on the digital meter of the Siemens SV900C ventilator, and peak intratracheal pressure measured at the distal end of the tracheal tube, was defined and incorporated into a computer program. The mean difference between peak airway pressure calculated by the computer and directly measured peak intratracheal pressure was 0.02 kPa (SD 0.10) in 18 infants and children. The mean difference between ventilator breathing system pressure and intratracheal pressure in the same group was 0.82 kPa (SD 0.91). Bench tests established that the decrease in peak pressure displayed by the ventilator (from 1.36 to 0.38 kPa) while inspiratory time was increased from 20 to 80% of the respiratory period, concealed an increase (from 0.2 to 0.38 kPa) in intratracheal pressure which occurs during this process; and that the large increase in pressure displayed by the ventilator (from 0.3 to 6 kPa) while respiratory frequency was increased from 20 to 120 breaths/minute, concealed a small increase in peak intratracheal pressure (0.2-0.3 kPa) which occurs during this process. These changes were accurately predicted by the computer program. The increase in intratracheal pressure associated with prolonged inspiratory times explains the high incidence of barotrauma which has recently been associated with this procedure in infants.
Child↗