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At least 37 records · Page 2Linked to original sources
PubMed2000

Therapeutic hypothermia for head injury.

BACKGROUND: Mild to moderate induced hypothermia has been used in the treatment of head injury for over 50 years, although few randomised controlled trials have been performed. Recent encouraging results from small, single-centre trials and consistent findings of a cerebral protection effect of cooling in laboratory models of global ischaemia has led to a renewed interest in the area. OBJECTIVES: To determine whether the use of mild therapeutic hypothermia in the treatment of moderate and severe head injury improves short-term control of intracranial pressure (ICP) and long-term functional outcome. SEARCH STRATEGY: Electronic searches of the Injuries Group trial registry and EMBASE for any relevant randomised trials, supplemented by hand searching of conference proceedings and reference lists of relevant articles. SELECTION CRITERIA: All randomised controlled trials of mild hypothermia versus control (open or normothermia) in the treatment of patients with any closed head injury requiring hospitalisation. Mild hypothermia was defined as local or systemic cooling to a target temperature of at most 34-35 degrees Celsius for a period of at least 12 hours. Outcome was all-cause mortality and death or severe disability at the end of the scheduled follow-up period. All trials were assessed by two reviewers, and included or excluded on a consensus basis. DATA COLLECTION AND ANALYSIS: Eleven potential trials of therapeutic hypothermia for head injury were found, of which two are ongoing and one is awaiting assessment. The eight remaining trials were included in the systematic review. Data on death, GOS score at final follow-up, complications and ICP were sought and extracted, either from published material or by contact with the investigators. Mantel-Haenzel odds ratios and 95% confidence intervals were calculated for death and death and severe disability for each trial on an intention-to-treat basis. No quantitative synthesis of data on either complications or ICP was attempted. Trials of immediate and deferred hypothermia were analysed separately. MAIN RESULTS: Active immediate hypothermic treatment was associated with a 33% non-significant (p=0.16) reduction in the odds of death at the end of treatment or final follow-up, (OR 0.67, 95% confidence interval 0.38 to 1.17), and a 61% reduction (p=0.004) in the odds of being dead or severely disabled, (OR 0.39, 95% confidence interval 0.20 to 0.74). Similar effect sizes were found for delayed hypothermia. These results are, however, based on a few small trials each of less than 100 patients. A multi-centre trials of hypothermia versus control in 392 patients will be reporting results in 1999, providing substantially more evidence than is currently available. REVIEWER'S CONCLUSIONS: Although this review would suggest a strong positive effect of therapeutic hypothermia, the results are based on several small trials carried out in single, specialist centres. The results of a large multi-centre trial are expected in 1999 and will more than treble the available evidence. Until these results have been released, it would be inappropriate to make any short-term recommendations for clinical practice or research.

Craniocerebral Trauma↗
PubMed2002

Manufacture and composition of fresh frozen plasma and virus-inactivated therapeutic plasma preparations: correlation between composition and therapeutic efficacy.

The clinical efficacy of the therapeutic plasma used in the treatment of congenital and acquired severe coagulopathy depends on the potency of clotting factor and inhibitor activities. The composition of plasma strongly depends on the conditions under which it is produced. A low citrate anticoagulant-to-blood ratio, short intervals between donation and plasma separation and rapid freezing markedly improve the preservation of unstable coagulation factors. The influence of different leukocyte reduction filters on plasma quality still requires clarification. Recent trials on long-term storage conditions suggest that keeping plasma at -30 degrees C or colder over a period of 24-36 months prevents substantial decrease in clotting factor activities including factor VIII (FVIII). Three types of therapeutic plasma are currently available. Quarantine-stored fresh frozen plasma (FFP) contains physiological activities of therapeutically relevant plasma proteins, but carries a risk of transmitting blood-borne viruses that cannot be detected by human immunodeficiency virus (HIV) and hepatitis B and C screening. In contrast, solvent/detergent-treated plasma (SDP) and methylene blue/light-treated plasma (MBP) is virtually free of HIV and hepatitis C virus (HCV) subtypes. Virus inactivation procedures can have the consequence of reducing several clotting factors and inhibitors in SDP and MBP to varying degrees. However, pooling of plasma units before solvent/detergent (SD) treatment results in well-standardized protein levels of SDP. At least five prospective trials and four observational studies covering different clinical settings suggest that SDP and FFP do not substantially differ in their clinical efficacy or in their tolerance. By way of contrast, there is a lack of data about the clinical efficacy and tolerance of MBP compared to FFP.

Blood Coagulation Factors↗
PubMed1999

Therapeutic sclerokeratoplasty versus therapeutic penetrating keratoplasty in refractory corneal ulcers.

PURPOSE: To assess the efficacy of newer surgical technique of sclerokeratoplasty in cases of refractory corneal ulcers of the cornea and to compare it with therapeutic penetrating keratoplasty. METHODS: A randomized, prospective clinical trial in 20 eyes with refractory corneal ulcers was undertaken. Ten eyes each underwent sclerokeratoplasty (group I) or therapeutic penetrating keratoplasty (group II). Infections were considered cured if there was no evidence of corneal infiltration for 1 month following keratoplasty. Postoperative complications, visual acuity (VA), keratometry and graft status were evaluated with both the procedures after a minimum follow up of 1 year. RESULTS: Postoperative complications included epithelial defects, shallow anterior chamber, uveitis and secondary glaucoma, which were present following both procedures, with no significant difference in the frequency of complications between the two techniques (P < 005), Graft clarity and VA with both procedures were comparable. Significantly reduced astigmatism of < 1 D was seen in six eyes in group II in comparison with group I, where astigmatism of > 1.5 D was present in six eyes. Two eyes in group II developed re-infection, of which one was re-operated on, and the other developed endophthalmitis. CONCLUSIONS: Sclerokeratoplasty is a useful alternative to therapeutic penetrating keratoplasty in cases of refractory corneal ulcers with optimum clinical and useful visual outcome.

Adult↗
PubMed2003

Experimental therapeutics in Huntington's disease: are models useful for therapeutic trials?

PURPOSE OF REVIEW: Research conducted over the past 10 years has uncovered molecular mechanisms that are likely to be important in the early stages of Huntington's disease pathogenesis. This review summarizes the resources and strategies that are in place in order to exploit these new findings and use them to develop novel Huntington's disease therapeutics. The role that disease models will play in this process is discussed. RECENT FINDINGS: A wide variety of models of Huntington's disease have been developed including yeast, Caenorhabditis elegans, Drosophila melanogaster and mouse. These can be developed as screening assays for the identification of chemical compounds that show beneficial effects against a specific phenotype and for the cross validation of potential therapeutics. The first compounds arising through this drug development pipeline have been reported. Similarly, the preclinical screening of compounds in mouse models is being developed in a coordinated manner. SUMMARY: Our understanding of the molecular basis of Huntington's disease is increasing at an exponential rate. Over the next few years an increasing number of potential therapeutic compounds will have been identified. It will only be possible to take a small number of these through to phase III clinical trials. The challenge will be to use the in-vivo models of Huntington's disease to best predict which of these compounds should be pursued in the clinic, to avoid depleting the patient population willing to enter into trials, and demoralizing them by conducting repeated unsuccessful trials.

Acetamides↗
PubMed1981

New concepts in therapeutic photomedicine: photochemistry, optical targeting and the therapeutic window.

Advances in optics technology, synthetic photochemistry, and the science of photobiology make it possible to think beyond phototherapy and photochemotherapy which is dependent on direct photochemical alteration of metabolites or direct phototoxic insult to cells. This report discusses another gender of photomedicine therapy which includes in vivo photoactivation of medicines, photon-dependent drug delivery, and manipulation of host and exposure source to maximize therapeutic index. These therapeutic manipulations are made possible because the skin is highly overperfused and because non-ionizing electromagnetic radiation that enters skin and blood has adequate photon energy to cause electronic excitation. Radiation of 320-800 nm is not very directly phototoxic, is absorbed by a variety of relatively nontoxic photolabile molecules and has an internal dosimetric depth profile. This radiation can therefore be used to activate, deactivate, bind, release or biotransform medications in vivo in skin or other organs. The photochemist, synthetic chemist and photobiologist can collaborate to significantly increase therapeutic possibilities.

Humans↗
PubMed1996

A therapeutic approach to erythrodermic psoriasis: report of a case and a discussion of therapeutic options.

In this case report a patient with therapeutically recalcitrant erythrodermic psoriasis is presented. After various attempts with several major therapies in this patient, the first substantial improvement was achieved using the combination of cyclosporine and calcipotriol, followed by the combination of UVB and calcipotriol. The therapeutic options for severe psoriasis are discussed, and since combined approaches seem to be an attractive alternative for severe psoriasis, mechanisms of synergy of combined therapeutic approaches are hypothesised.

Aged↗
PubMed2000

Enhancing therapeutic impact and therapeutic alliance through electronic mail homework assignments.

Homework assignments can enhance therapeutic impact and increase therapy effectiveness by encouraging patients to focus on therapy-related issues between sessions. Computer technology provides a new avenue for reporting, monitoring, and feedback of patient homework assignments through electronic mail (e-mail). In two case examples, e-mail was used as an extension of therapy to enhance patient involvement in treatment. In both cases, patient reports suggest that therapeutic alliance and therapeutic impact improved with the use of e-mail homework reporting. The costs and benefits of the use of e-mail as an adjunct to therapy are discussed.

Adult↗
PubMed2001

[Therapeutic aspects of HIV/AIDS infected patients and evaluation of therapeutic protocols].

The first HIV-infected patients were treated in 1986, however, at that time medicines inhibiting HIV replication were not available. Solely the complications of AIDS and opportunistic infections could be treated. The HIV replication inhibition capacity of antiretroviral nucleoside and ribavirin were tested in Hungary in 1987, an early date even in international practice. The first nucleoside reverse transcriptase inhibitor (NRTI), azidothymidine, presently called zidovudine (ZDV), was introduced in 1989. By giving patients the appropriate dosage of this, the progression of the disease could be delayed by approximately 6 months to one year. In 1991, the application of two new NRTI was commenced, namely zalcitabine (DDC) and didanosine (DDI). These medicines were applied partly in case of ZDV intolerance and as a part of the sequential monotherapy. In 1994 and 1995 two new NRTI's were introduce, namely stavudine (d4T) and lamivudine (3 TC). At that same time, to obtain a more effective replication inhibition method, a double NRTI combination became part of the therapeutic protocol. The year 1996 resulted in significant changes. At the beginning of the year, two compounds belonging to two new therapeutic procedures. These are saquinavir (SQV) and delavirdine (DLV) belonging to the groups of protease inhibitors and non-nucleoside reverse transcriptase, respectively. The so-called virus cocktails and the effective active antiretroviral therapy (HAART) were applied and, later, to monitor the efficiency of the treatment, the opportunity was provided to measure the copy number of HIV-RNS. The treatment of the HIV disease entails a number of unanswered questions. The maximum result that can be achieved by using today's therapeutic methods is to prolong that particular phase of the HIV disease, which secures the patient a fairly good quality of life. The new combination of the antiretroviral compounds produced by the pharmaceutical industry provides better changes to prolong said period by years, sometimes decades. However, the real solutions to the problem are only theoretically known treatment procedures (gene therapy, cytokins) today.

Acquired Immunodeficiency Syndrome↗
PubMedDate not supplied

[Therapeutic systems and drug delivery. 3. Transdermal therapeutic systems].

Following a short review of penetration of drugs through the skin (a bilayer membrane which consists of the stratum corneum and the viable epidermis), transdermal therapeutic systems (TTS) are described. These systems are special pharmaceutical preparations capable of delivery of some drugs (e.g. very potent drugs, with narrow therapeutic index, short biological half-life) via skin under well controlled conditions. After their application drug passes directly into the systemic circulation avoiding the effect of first-pass hepatic metabolism. At the same time, their advantages and disadvantages are presented. Finally, currently existing TTS in the market containing e.g. scopolamine (motion sickness), nitroglycerin (angina pectoris), estradiol (postmenopause), clonidine (hypertension) and systems in the development are briefly reported. These transdermal therapeutic systems are considered as a new approach to improve the usage of drugs in terms of better dosage control, increased safety and easier application.

Administration, Cutaneous↗
PubMed1993

[Influential factors on the therapeutic response in the conditioning treatment of enuresis with an original therapeutic machine].

The conditioning treatment of enuresis with our original therapeutic machine, that is to awake the patient before enuresis may occur, has been performed since 1987. Influential factors on the therapeutic response were investigated. Twenty two patients with enuresis Type I were admitted and were treated for 5 nights with the therapeutic machine. Seven patients were cured (the cured group) and a certain effectiveness (decrease of the frequency of enuresis of more than 50%) was observed in 8 patients (the effective group). No effectiveness was obtained in 7 patients (the no change group). The average age of the cured group was higher than that of the no change group, and the difference was significant. No significant differences were found among the three groups in sex, the frequency of enuresis or the past experience of awakening before enuresis. Significant differences among the three groups were found in the average awakening score (how easily the patient awoke when a nurse called the patient after the machine alarmed) and the change of awakening score during treatment. The average awakening score of the cured group was the highest and that of the no change group was the lowest. The change of awakening score during treatment of the no change group was significantly lower than that of the cured group or that of the effective group. The desire to cure, scored 0-2 points at the time of discharge, was significantly stronger in the cured group than in the no change group. No significant differences were noticed among the three groups in the sleeping condition and the remembrance of awakening at the next morning.

Adolescent↗
PubMed1997

[Therapeutic trial, clinical research and therapeutic freedom--legal boundaries].

Clinical research can be therapeutic or purely scientific. The therapeutic trial is usually chosen to obtain treatment liberty. On the other hand, the physicians in controlled clinical trials have relatively little choice of treatments. In Germany, special statutes and the general law limit clinical trials. The sec. 41 AMG, 18 MPG allow therapeutical trials under special circumstances. There are requirements for clinically controlled trials, especially the provision to seek the approval of an ethic commission.

Clinical Trials as Topic↗
PubMedDate not supplied

The "new" drug-free therapeutic community. Challenging encounter of classic and open therapeutic communities.

In view of a rapidly changing society, reflected in many changes within the drug-free Therapeutic Communities (TCs), the question has been raised: "What can and cannot be changed in this modality?" This question was addressed at a European conference of experienced therapeutic community workers, who concluded that many changes have occurred and will continue to occur, but some basic concepts should be preserved. The changes inherent in postmodern society are examined here in an effort to foresee their impact on the evolution of the TC. Necessary changes and additions are discussed.

Congresses as Topic↗
PubMed1990

Relationship between involuntary admission and the therapeutic process in a closed ward functioning as a therapeutic community.

In a therapeutic community for acute psychiatric patients, the relationship between involuntary admission (13.6% of the episodes) and some patient and program characteristics was analyzed, using a total of 1586 treatment episodes in 838 patients between 1978-1987. Based on a logistic regression model, an elevated relative risk of involuntary admission was seen in the diagnostic groups of schizophreniform psychosis, unspecific psychosis, paranoid psychosis, and borderline psychosis. Also, the association with involuntary admission increased in the first or second treatment episode, or for patients that had a controversial or negative immediate outcome, for young patients under 21 years, and for patients who were passive in individual therapy. Still, the difference in outcome was minimal, and there were no differences in group or milieu therapy activity. The results suggest that involuntary admission is not necessarily a traumatic, negative experience in subsequent treatment episodes or in the patient career. The modified therapeutic community model presented contains peer and family support and ample opportunity to discuss and negotiate, which may alleviate the possible narcissistic pain of involuntary admission.

Adolescent↗
PubMed1981

Therapeutic paradox - the patient culture and the formal treatment programme in a therapeutic community.

Data collected by participant observation in a day hospital are used to examine the complex relationship between informal patient interaction and the formal group therapy programme of this therapeutic community. It was evident that staff might view apparently similar informal patient activities in quite different lights, as either complementary or as detrimental to the work of the formal groups. This apparent inconsistency in staff prescriptions was turned to a therapeutic purpose. Staff would point out to patients the "paradox" of the constant inconsistency of prescriptions for behaviour in daily life: parallels were drawn with the contingent and defeasible prescriptions to which patients were subject in most spheres of human activity. In learning to cope with incipiently contradictory prescriptions inside the day hospital it was felt that patients might learn to cope with incipiently contradictory prescriptions in their relationships outside the day hospital.

Day Care, Medical↗
PubMed2001

Heat shock proteins in health and disease: therapeutic targets or therapeutic agents?

For many years, heat shock or stress proteins have been regarded as intracellular molecules that have a range of housekeeping and cytoprotective functions, only being released into the extracellular environment in pathological situations such as necrotic cell death. However, evidence is now accumulating to indicate that, under certain circumstances, these proteins can be released from cells in the absence of cellular necrosis, and that extracellular heat shock proteins have a range of immunoregulatory activities. The capacity of heat shock proteins to induce pro-inflammatory responses, together with the phylogenetic similarity between prokaryotic and eukaryotic heat shock proteins, has led to the proposition that these proteins provide a link between infection and autoimmune disease. Indeed, both elevated levels of antibodies to heat shock proteins and an enhanced immune reactivity to heat shock proteins have been noted in a variety of pathogenic disease states. However, further evaluation of heat shock protein reactivity in autoimmune disease and after transplantation has shown that, rather than promoting disease, reactivity to self-heat shock proteins can downregulate the disease process. It might be that self-reactivity to heat shock proteins is a physiological response that regulates the development and progression of pro-inflammatory immunity to these ubiquitously expressed molecules. The evolving evidence that heat shock proteins are present in the extracellular environment, that reactivity to heat shock proteins does not necessarily reflect adverse, pro-inflammatory responses and that the promotion of reactivity to self-heat shock proteins can downregulate pathogenic processes all suggest a potential role for heat shock proteins as therapeutic agents, rather than as therapeutic targets.

Journal Article↗
PubMed2002

Combination of therapeutic apheresis and therapeutic ventricular assistance for end-stage heart failure patients.

Dilated cardiomyopathy is a cardiac disease of unknown origin which is characterized by the gradual development of cardiac failure associated with four-chamber dilatation of the heart. Heart transplantation has been considered as the last resort for this disease. However, some patients who received support with a ventricular assist device (VAD) as a bridge-to-transplantation and then recovered without transplantation have been reported. This new concept of treating heart failure is termed bridge-to-recovery. A VAD can inhibit the heart failure compensatory mechanisms by extreme ventricular unloading. Also, heart failure is a complex neurohormonal/autocrine-paracrine syndrome, and these mechanisms consecutively lead to inflammatory response by proinflammatory cytokines; interleukin-1 alpha (IL-1 alpha), interleukin-1 beta (IL-1 beta), interleukin-2 (IL-2), interleukin-6 (IL-6), and tumor necrosis factor-alpha (TNF-alpha). Furthermore, the existence of anti-beta1-adrenoceptor autoantibodies (A-beta1-AABs) in a patient with dilated cardiomyopathy has been reported. These proinflammatory cytokines and this antibody accelerate a ventricular remodeling and a contractile dysfunction over the long term. Apheresis can also inhibit the vicious cycle in heart failure by removing the factors that are produced by activated neurohormonal/autocrine-paracrine compensatory mechanisms. Therefore, we propose that the combined therapies, therapeutic VAD and therapeutic apheresis, will provide a prominent outcome for a patient who is suffering from end-stage heart failure.

Blood Component Removal↗
PubMed2003

Therapeutic plasma exchange: an underutilized therapeutic modality?

Since its clinical availability approximately 25 years ago, therapeutic plasma exchange (TPE) has become recognized as appropriate primary therapy for many diverse medical conditions. In some aspects TPE has been constrained in its use according to schedules of efficacy. Expansion of TPE to other indications is likely once attention is focused on its ability to enable patients to avoid potentially toxic pharmacologic interventions if employed as a chronic therapy, and especially when it is accepted that adjunctive use, not only a curative role, is a valuable use of this therapeutic modality.

Humans↗