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At least 343 records · Page 19Linked to original sources

PubMed1992

Treatment of refractory colorectal carcinomas with fluorouracil, folinic acid, and interferon alfa-2a.

Interferon has been shown to augment the cytotoxic effects of fluorouracil (5-FU) against colon cancer in vitro and possibly in vivo. Therefore a pilot study was initiated to evaluate the effects of the combination 5-FU/FA/interferon alfa (IFN-alpha) in colorectal adenocarcinomas refractory to first-line therapy with 5-FU/FA. Eleven patients with rectum cancer and four patients with colon cancer were treated according to the following schedule: 9 million units IFN-alpha subcutaneous three times a week; 500 mg/m2 5-FU via an intravenous bolus 1 hour after the initiation of a 2-hour infusion of 500 mg/m2 of FA, once a week. Of 15 patients, one had a minor response, one had a disease stabilization, and three had a mixed response. No complete or partial remissions were seen. Looking at the sensitivity of lung metastases (three of three), the regressions can be explained through the additive effect of IFN-alpha to 5-FU/FA. Although minimal side effects (World Health Organization classification) were observed, most patients experienced a reduction of well-being.

Adult↗

PubMed1992

Interleukin-2 followed by fluorouracil and folinic acid in refractory colorectal cancer--results of a clinical phase II study.

In a clinical phase II study, 23 patients with progressive metastatic colorectal cancer and failure after first-line chemotherapy with fluorouracil (5-FU) and folinic acid (FA) were treated with a 5-day continuous infusion of recombinant interleukin-2 (IL-2), 3 x 10(6) cetus U/m2/d, followed after a rest period of 2 days by 5-FU, 600 mg/m2/d, and FA, 300 mg/m2/d over an additional 3 days. After two to four treatment cycles, eight of 22 evaluable patients (36%) revealed antitumor responses, with three partial remissions and five minor responses or stable disease. Side effects consisted most frequently of fever, nausea and vomiting, an elevation of liver enzymes, hypotension, and skin toxicity, and required a 50% reduction of IL-2 dose in 17 of 71 treatment courses (24%). In four of the 23 patients (18%), treatment had to be stopped completely. These data indicate a significant antitumor activity of IL-2 combined with 5-FU/FA therapy in chemotherapy-resistant colorectal cancer. Hence, in spite of a substantial treatment-related toxicity, further studies are warranted to substantiate these findings and to elucidate the underlying mechanisms of the IL-2-5-FU/FA combination therapy.

Adult↗

PubMed1992

[Loop-diuretics anno 1992. Mechanisms of effect and current therapeutic principles].

Loop-diuretics inhibit the Na+/K+/2Cl(-) -cotransport system in the thick ascending loop of Henle, and are the most potent of the diuretic agents. They also increase production of prostaglandins and, when given intravenously, reduce pulmonary capillary pressure. The clinical effects, and side effects, of loop diuretics are reviewed. In Norway, use of thiazide diuretics has declined, but use of loop-diuretics has remained unchanged. Loop-diuretics are still first-line drugs in cases of heart failure. The author discusses treatment of patients resistant to conventional doses of diuretics, and the causes of the resistance. Since furosemide and bumetanide may have very different effects and side effects, both are needed as treatment alternatives.

Bumetanide↗

PubMed1992

[The treatment of early asthma].

Asthma is an inflammatory disease of the bronchial mucosa associated with pulmonary function disorders of varying degrees of severity. The early detection of eosinophil-related mucosal inflammation constitutes both a diagnostic challenge and the key to treatment that may markedly improve outcome. Corticosteroids for inhalation are the first-line anti-inflammatory agents.

Administration, Inhalation↗

PubMed1992

[Right atrial thrombosis and severe pulmonary embolism].

Two cases of severe pulmonary embolism associated with right atrial thrombosis are reported. In the first case, fibrinolytic therapy was administered and was thought to be a causative factor in the death of the patient due to massive pulmonary embolism. In the second case, the patient was referred for surgery and two enormous thrombi were extracted. Unfortunately, the outcome was fatal. These two cases were confronted with the results of the literature. They strongly suggest that echocardiography should be a first-line investigation in severe pulmonary embolism. The detection of right atrial thrombosis modifies the clinical strategy and orientates treatment towards surgical referral when the patient's condition allows it.

Adult↗

PubMedDate not supplied

Fetal biophysical profile scoring.

Assessment of real-time ultrasound fetal biophysical variables has a limited role in the management of selected high-risk pregnancies. Composite biophysical scores remain inadequately studied and are of unproven value as a first-line test.

Female↗

PubMed1992

[Chemotherapy of urologic metastases].

Antiblastic chemotherapy of the urological tumors proves to be effective in germ-cell testicular tumor, in bladder cancer and in penis cancer, while a real effective anti-cancer therapy for prostatic and renal cell cancer has not found yet. There is not a significant difference between BVP and BEP regimens as first-line treatments of the good risk germ-cell testicular tumors. On the contrary BEP showed a lower toxicity and an higher efficacy in the treatment of the poor risk patients. Considering salvage therapies, PEI regimen proves to be as the most effective, also in the management of patients pretreated with BEP; high dose chemotherapy with autologous bone marrow transplant is currently examined as third-line therapy. In the treatment of bladder cancer the most effective drugs are Methotrexate, Adriamycin, Vinblastine and Cyclophosphamide, that, when combined, are sensitively more efficacious. The different chemotherapies achieved elevated percentage of Complete and Partial Responses (CR+PR): however these results are maintained in only 10% of the cases. So far the aim of the last studies is to improve the results both with a modification of posology and of the schedule of administration, and with the employ of growth-factors to reduce toxicity. An appreciable improvement in the treatment of locally advanced penis cancer has been achieved employing VBM regimen as adjuvant therapy, especially for patients with extrinsic lymph-nodal metastases, who underwent bilateral inguinal and iliac lymphadenectomy.(ABSTRACT TRUNCATED AT 250 WORDS)

Aged↗

PubMed1992

Antiepileptic drug disposition during pregnancy.

A significant proportion of women with epilepsy have an increase in their seizure frequency during pregnancy. Multiple factors may be involved in this phenomenon, but changes in antiepileptic drug (AED) concentration appear to be the most significant. AED concentration declines as pregnancy progresses, due primarily to dynamic changes in plasma protein binding. Total concentrations of all first-line AEDs (carbamazepine, phenytoin, phenobarbital, and valproic acid) fall significantly during pregnancy, compared to baseline. Free or unbound drug concentrations, however, fall significantly only for phenobarbital. Valproate free concentrations actually increase by 25% by delivery. Women taking carbamazepine, phenytoin, or valproate may be relatively protected by adequate free concentrations of these compounds. When managing pregnant women with epilepsy, measurement of free AED concentrations and appropriate dose adjustment to maintain therapeutic ranges will permit more effective clinical management than using total concentration values.

Adult↗

PubMed1992

[Diagnosis of acute pharyngitis].

The diagnosis of acute pharyngitis relies on a good analysis of its signs and symptoms, one of the objectives of this thorough clinical study being to differentiate between pharyngitis as a symptom and as a disease. Establishing correlations between the clinical diagnosis of acute pharyngitis and a tentative microbiological diagnosis facilitates the first-line treatment.

Acute Disease↗

PubMed1992

[Mitoxantrone and conventional-dose cytosine arabinoside for relapsed and refractory acute leukemia].

Fourteen patients with relapsed or refractory acute leukemia received combination chemotherapy of mitoxantrone 6 mg/m2/day intravenously for three to six days and cytosine arabinoside 60 mg/m2/day intravenously over 24 hours continuously for five to ten days. Complete remission was attained in six patients (42.9%) and partial response in two patients (14.3%). Six patients (42.9%) had resistant disease, and four patients (28.6%) died during the myelosuppressive phase. Of the patients achieving complete remission, four relapsed and other two continued complete remission up to 27.3 months. Median remission duration was approximately 10.6 months. No significant difference was found with regard to the efficacy of our regimen between AML and ALL. Hematological toxicity was no more severe than the prior cumulative chemotherapy. Major non-hematologic side effects were nausea and vomiting (71.4%), stomatitis (64.3%) and liver dysfunction (57.1%), which were moderate and manageable, while no cardiotoxicity was observed in any patient. In conclusion, the combination chemotherapy of mitoxantrone and conventional dose cytosine arabinoside is an effective salvage therapy in relapsed or refractory acute leukemia, and our regimen has possible utility as first-line chemotherapy in de novo acute leukemia also.

Acute Disease↗

PubMed1992

[Autologous bone marrow transplantation for the treatment of malignant lymphoma in adults].

Seventeen adult patients with malignant lymphoma, including Hodgkin's disease(HD) during relapse after first-line chemotherapy (6 cases) or in advanced stage (2 cases) and non-Hodgkin's lymphoma (NHL) of high grades after staging (9 cases) were treated with high-dose chemoradiotherapy (Hd-VCCA+TLI) and autologous bone marrow transplantation(ABMT). 16 cases (94.1%) obtained complete remission (CR) after ABMT. The current long-term disease-free probability is 86% for HD group and 62% for NHL group. One case with marrow involvement proved by marrow harvesting is in prolonged unmaintained CR for more than 3 years after ABMT with marrow purging in vitro by hyperthermia (42 C x 60 min). 4 cases with advanced disease relapsed died within two years. 2 cases with advanced lymphoblastic lymphoma relapsed and died of acute lymphoblastic leukemia. These results confirmed the value of ABMT in the treatment of adult malignant lymphoma and suggest that it is necessary to purge the residual tumor cells in the bone marrow before ABMT in the patients with marrow involvement or lymphoblastic lymphoma.

Adult↗

PubMed1992

Multicenter randomized study comparing cyclosporine-A alone and antithymocyte globulin with prednisone for treatment of severe aplastic anemia.

We report the results of a randomized multicenter study comparing the efficacy of antithymocyte globulin (ATG) with that of cyclosporin A (CsA) as first-line therapy for severe aplastic anemia (SAA). Patients were randomized to receive ATG and prednisone (PDN) or CsA; hematologic response and toxicity were compared. At 3-month evaluation, patients who had no or minimal response received the alternative therapy to assess the value of a sequential immunosuppressive therapy for treatment of severe aplastic anemia. One hundred nineteen patients were randomized; 25 were excluded, of whom 3 were misdiagnosed and 22 did not follow the cross-over protocol. Ninety-four patients were analyzed; 46 received CsA, and 48 received ATG-PDN. The actuarial survival was 66.7%, with a median follow-up time of 19 months. There was no significant difference in survival between the groups with, at 3 months, an actuarial survival of 88% in the CsA group and 75% in the ATG group (NS); at 12 months, it was 70% in the CsA group and 64% in the ATG group (NS). The percentage of complete and partial response was 11.6% and 16%, respectively, at 3 months, and 31.6% and 30%, respectively, at 12 months (NS). The main prognostic factor was the absolute neutrophil count (ANC) at entry: Patients with ANC less than 0.2 x 10(9)/L had a significantly lower survival as compared with patients with more than 0.2 x 10(9)/L ANC (P = .0001). At 12 months, 62 evaluable patients were alive, with a complete or partial response in 36 patients. Patients who had responded to the first treatment had a better recovery of bone marrow failure than those who had sequential immunosuppression. The main complication was infection, which was more often observed and more often lethal during ATG and PDN therapy. In this study, initial treatment of SAA with either CsA or ATG-PDN followed by cross-over therapy for nonresponders produced comparable response and survival rates.

Adolescent↗

PubMed1992

Acute severe asthma: Part 2. Current therapy.

Acute severe asthma is an extremely common and serious public health problem in the United States. Current optimum therapy of acute severe asthma includes supplemental oxygenation, nebulized beta-adrenergic receptor agonist therapy, and prompt use of glucocorticosteroids. In view of its low therapeutic index and the availability of more effective, less toxic agents, theophylline is no longer considered a first-line treatment. Ipratropium bromide combined with beta-agonist may augment bronchodilator responsiveness.

Acute Disease↗

PubMed1992

[Drug therapy in supraventricular arrhythmia].

In view of their potentially dangerous proarrhythmic effects, antiarrhythmic drugs should only be prescribed for patients with poorly tolerated symptomatic supraventricular arrhythmias. The choice of a suitable preparation depends not only on the type of arrhythmia, but also on the underlying heart disease and left-ventricular function. Digoxin, verapamil, sotalol and quinidine remain first-line drugs, while in view of recent trials the type-1c antiarrhythmics (flecainide) should only be given in cases resistant to other agents. Amiodarone is also an important and efficacious "reserve" antiarrhythmic, which has to be utilized at low doses to avoid its well-known side effects.

Amiodarone↗

PubMed1992

[Sonography in therapy-oriented diagnosis and after-care of primary bone and soft tissue tumors].

Based on the results of 150 patients with primary tumors or the suspicion of malignant lesions of the locomotor system the perspectives and limits of the sonographic diagnosis under the therapeutic aspects of interdisciplinary oncologic cooperation is demonstrated. As the ideal adjunct to conventional roentgenograms, ultrasound is the first-line imaging procedure in the fields of primary diagnosis, follow-up, post-therapeutic care as well as tumor exclusion for methodic, patient-related and economic/logistic reasons. Its consequent application will markedly reduce the number of more invasive and expensive methods.

Adult↗

PubMed1992

Autologous hemopoietic reconstitution after fetal liver infusion in patients with bone marrow failure: consequence or coincidence?

In the past 4 years we have treated four patients with a total of 19 fetal liver infusions (FLI). Two cases of refractory anemia with excess blasts in transformation (RAEB-t) were conditioned with cyclophosphamide and total body irradiation (1400 cGy) and were treated with FLI. In spite of such intensive conditioning, one patient recovered autologous hemopoiesis 3 weeks later, remaining in remission 4 years after this procedure. The second patient died with aplastic marrow on day 154, and the third suffered from severe aplastic anemia refractory to several types of conventional treatment. After FLI and without previous conditioning therapy a partial fetal engraftment was documented. This was transient and followed by autologous hemopoietic recovery and cure of the disease. The fourth patient had bone marrow failure in the setting of a severe pneumonia following autologous bone marrow transplantation. Ten days after FLI the hematological parameters dramatically improved and the pneumonia resolved. Autologous reconstitution of hemopoiesis was demonstrated. These experiences suggest that FLI might stimulate autologous hemopoiesis. This therapeutic approach may be useful to treat bone marrow failure when there is no response to first-line therapy. In hematologic malignancies with an indication for stem cell transplantation, other sources such as allogeneic or autologous bone marrow seem preferable to fetal liver cells.

Adolescent↗

PubMed1977

Drug prescribing in rheumatoid arthritis in Otago.

The drug therapy prescribed for a group of 50 patients with rheumatoid arthritis in Otago prior to specialist referral was examined. Thirty-two patients were receiving some first-line anti-inflammatory drugs and six were receiving no therapy at the time of their first hospital clinic visit. Salicylates had been prescribed first in only 16 of the 50 patients while this drug had been withdrawn because of side effects in about one-third of the patients who had been treated with it prior to specialist referral. Seven patients had received phenylbutazone and six corticosteroids as the first treatment for their rheumatoid arthritis. About one-third of the patients were receiving more than one anti-inflammatory drug at the time of their initial clinic visit.

Adult↗

PubMed1979

Bretylium tosylate: a review.

The chemistry, pharmacology, pharmacokinetics, clinical uses, adverse effects, drug interactions and dosage of bretylium tosylate, a recently approved antiarrhythmic agent, are reviewed. Bretylium tosylate is used to treat life-threatening ventricular arrhythmias, principally ventricular fibrillation and ventricular tachycardia, that have not responded to treatment with first-line antiarrhythmic agents. The drug has a direct positive inotropic effect on the myocardium and blocking effect on postganglionic sympathetic nerve transmission. The drug is poorly absorbed orally, requiring either i.m. or i.v. administration. Drug excretion occurs primarily through the kidney, necessitating dosage modification in renal disease. Hypotension is the most commonly observed adverse reaction to bretylium tosylate. Rapid i.v. administration may cause severe nausea and vomiting, and i.m. injection at the same site may cause atrophy and necrosis of muscle tissue. Quinidine and procainamide may potentiate the hypotensive effects of bretylium. Bretylium will aggravate digitalis-induced arrhythmias. Bretylium's use in resistant ventricular tachyarrhythmias requires close clinical monitoring.

Arrhythmias, Cardiac↗