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At least 343 records · Page 19Linked to original sources
PubMed2005

Ibritumomab: new drug. Interesting concept, disappointing in practice.

(1) First-line standard chemotherapy for follicular non-Hodgkin's lymphoma is based on alkylating agents. For patients who relapse, rituximab, a monoclonal antibody targeting CD20 receptors on tumour cells, induces remissions lasting at least 9 months in about 50% of cases. However, the infusions are often poorly tolerated and reactions can be severe. (2) Ibritumomab is a monoclonal antibody similar to rituximab. It is not in itself cytotoxic. Yttrium-90-radiolabeled ibritumomab has been licensed in the EU since 2004 for local tumour radiotherapy, administered shortly after rituximab therapy. It is approved as a third-line treatment for follicular lymphoma, after rituximab failure. (3) The only available comparative trial, lasting 4 years, involved 143 patients who were treated either with rituximab followed by radiolabeled ibritumomab, or with rituximab alone. The sequential treatment yielded more tumour responses but the time to lymphoma progression and clinical outcomes did not differ between the two treatment groups. (4) In a non comparative trial about half the patients in whom rituximab had failed responded to rituximab + radiolabeled ibritumomab, but lymphoma progression occurred after a median of only 7 months. (5) Patients who receive sequential therapy with rituximab + ibritumomab are exposed to the adverse effects of rituximab plus supplementary gastrointestinal, respiratory, haematological and infectious risks, mainly due to persistent myelosuppression. (6) The radiation hazard for the patient (irradiation of healthy organs) and for the environment appears to be limited, because of the short reach of beta particle emission (5 mm) and the short half-life of yttrium 90 (2.7 days). (7) Yttrium 90 radiolabeling requires special equipment and specialised personnel working in an approved centre, which can restrict access to treatment. (8) Radiolabeled ibritumomab appears to have a negative risk-benefit balance, and should only be used in clinical trials.

Antibodies, Monoclonal↗
PubMed2006

[50 years GTH -- expectations, progress, disappointments. A personal perspective].

The Deutsche Arbeitsgemeinschaft für Blutgerinnungsforschung (DAB) (German Working Party on Blood Coagulation) was founded in 1956 by a few German specialists in haemostasis. In 1982, the DAB was replaced by the Society on Thrombosis and Haemostasis (GTH), which was multinational, with emphasis on German speaking countries. Since I started in this field there was steady progress in the diagnosis and treatment of haemorrhagic and thrombotic disorders. Milestones were the production of effective and safe factor VIII and IX concentrates for haemophilia treatment, the diagnosis of venous thromboembolic disorders by non-invasive methods, the definition of thrombophilic states by laboratory methods and the diagnosis and treatment of immune coagulopathies. In other fields, progress was less impressive. During the last decades attempts have been made to optimize and standardize diagnosis and treatment in the thrombosis and haemostasis field (evidence based medicine). Despite guidelines and consensus statements the clinical problems in individual patients are still frequent and considerable. Therefore, physicians with a special expertise in the field of thrombosis and haemostasis are needed.

Blood Coagulation Disorders↗
PubMedDate not supplied

National rural health mission--hope or disappointment?

The recently declared National Rural Health Mission has aroused significant interest, being both welcomed and closely scrutinized, since there is a long overdue and outstanding need to strengthen weak and dysfunctional public health systems in rural India. In this setting, Jan Swasthya Abhiyan (JSA) has been involved in analysing various aspects of the Mission. The concern has been that it should develop in a manner that actually strengthens public health systems in an integrated manner, and that it should empower communities to be involved in the planning and utilization of these systems in a Rights-based framework. In this article, one will draw upon and reflect on a few of the major concerns about NRHM that have emerged during the insightful discussions in JSA.

Community Health Centers↗
PubMed2006

[Neurokinin 1 receptor antagonists--between hope and disappointment].

Substance P (SP)/Neurokinin 1 (NK1) receptor pathways have been repeatedly implicated in the pathophysiology of central, pulmonary, and gastric disorders. A large body of evidence that has been generated from animal experiments indicates that treatment with selective NK1 receptor antagonists might be effective in the treatment of certain forms of disorders, analgesia, depression, migraine, asthma, or gastrointestinal disorders. Accordingly, numerous NK1 receptor antagonists have either been synthesized and are under clinical development, or have already been tested in clinical trials. However, the initial encouraging clinical results were followed by repeated demonstration of a lack of effectiveness. Up to now, only one NK1 receptor antagonist, aprepitant, is available for therapeutical use. Aprepitant is a selective high-affinity human SP/NK1 receptor antagonist approved by the FDA in 2003. Aprepitant is indicated for prophylaxis of acute- and delayed-phase nausea and emesis caused by chemotherapy regimens. It is used in combination with a 5-hydroxytryptamine (5-HT3) antagonist and a corticosteroid. It is the first antiemetic agent that acts by binding the NK1 receptor. Research continues and novel molecules may show better pharmacokinetic and pharmacodynamic properties and, therefore, may achieve therapeutic success.

Analgesics↗
PubMed1991

Transplantation of purified autologous fat: a 3-year follow-up is disappointing.

The idea of autologous fat microtransplants has recently resurfaced because of interest by the press. Past experiments have shown that small amounts of fat may be transplanted with an expected survival rate between 10 and 50 percent without ectodermis. A great fund of knowledge exists showing that skin grafts will survive quite dependably if their thickness is up to about 0.0020 inch. For the first week or so, they live by diffusion and inosculation, and then neovascularization enables them to continue viability. I have developed a technique whereby fat is harvested through a blunt cannula with minimal vacuum to prevent explosion of the cellular fat globules. Fibrin and cellular debris are removed, and the fat globules are separated from the free fat, blood, and other constituents of the aspirate. Individual, free-floating 1- to 3-mm adipose fragments are then suspended in nutrient solution and injected through an 18-gauge needle. Multiple radial pathways, with each fat segment being separated from the other by host tissue, maximizes the host-prosthesis interface and the possibility for exchange of nutrients. I have attempted this procedure in more than 100 patients with widely varying results. In acne pits of the face, no significant improvement could be noted 6 weeks after injection. For the first few weeks, a near-perfect result was obtained, but none of these transplants in scarred areas of this kind have been of benefit. Injection of 10 to 50 cc in other areas has resulted in some cells (perhaps 10 percent) surviving over 2 years.(ABSTRACT TRUNCATED AT 250 WORDS)

Adipose Tissue↗