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At least 379 records · Page 21Linked to original sources

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↗

PubMedDate not supplied

Treatment of paroxysmal supraventricular tachycardia with adenosine: implications for nursing.

Paroxysmal supraventricular tachycardia (PSVT) is a frequently occurring arrhythmia. Currently, verapamil and manual vagal stimulation are the first-line interventions for PSVT. Although verapamil is widely used for the treatment of PSVT, it can result in hypotension and ventricular fibrillation if given to a patient with ventricular tachycardia. Because the differential diagnosis of broad QRS complex tachycardia is difficult, the development of a safer drug for the treatment of both narrow- and broad-complex tachycardia is extremely important. Adenosine is a promising new drug for the treatment of PSVT. Its use is reviewed in three presentations.

Adenosine↗

PubMed1992

[Ultrasonography and ultrasound-guided biopsy in lymphomas].

The authors have reviewed the literature on imaging techniques for the diagnosis of lymphoma. Lymphography, axial computerized tomography (CT) and echotomography have been compared as to their sensitivity and specificity. Lymphography allows diagnosis of the disease even in lymph nodes of less than 0.5 cm diameter, but this technique cannot be applied to all lymphatic station. Echotomography and CT are equivalent as to the accuracy of diagnosis and are both helpful for guided needle biopsy. In view of its low cost, echotomography is considered by most workers the first-line approach to the evaluation of lymphoma patients. In spite of its advantages over other methods, echotomography must, nevertheless, be integrated by CT, lymphography, and nuclear magnetic resonance.

Biopsy↗

PubMed1992

[Radiological aspects of acoustic neurinoma].

For a long time CT constituted the technique of choice for the investigation and pretreatment staging of acoustic neuroma. It is sometimes inadequate especially for defining the extra-axial site of a tumour or for identifying small lesions. Today, any case of suspected acoustic neuroma should undergo first-line MR studies. MR identifies almost all extra-axial lesions, clearly visualises small lesions and provides a satisfactory pretreatment staging in the majority of cases, acoustic neuroma presents a signal intensity identical to or lower than that of the brainstem with a high intensity signal on T2-weighted SE sequences and post-gadolinium T1-weighted SE sequences, generally with a mixed intra- and extra-meatal location and eccentric in relation to the anterior border of the porus.

Humans↗

PubMed1992

[Rare tumors of the cerebellopontine angle].

Tumours of the cerebellopontine angle are essentially benign in adults, are generally treated surgically and require a preoperative assessment as precise as possible. MRI simplifies the diagnostic assessment; it is indicated as the first-line investigation and is usually sufficient whenever a tumour of the posterior cranial fossa is suspected. Acoustic neuromas represent 75% of all tumours of the cerebellopontine angle. Other tumours are rare and essentially consist of meningioma, detected in 10 to 14% of cases and cholesteatoma in 1 to 5% of cases. Cholesteatoma, with a pathognomonic appearance, must be distinguished from arachnoid cyst. Other tumours are exceptional. The authors define the diagnostic criteria based on their experience and present a recent review of the literature.

Cerebellar Neoplasms↗

PubMed1991

[Phase II study of lung cancer--evaluation of new drug in small cell lung cancer (SCLC) and phase II testing of analogues].

The purpose of this report is to review the problems in the evaluation of new drugs in SCLC and phase II testing of analogues in lung cancer. SCLC is one of the most chemotherapy-sensitive solid tumours and patients (pts) who relapse after their first-line treatment are likely to have resistant tumors, precluding the appropriate evaluation of new drugs, especially analogues. However, it is ethically difficult to evaluate new drugs in untreated pts with SCLC. Based on many issues, We recommended that new drugs should be evaluated in "good" pts with extensive-stage SCLC and that the trial design should include early stopping rules as well as a crossover to an active alternative regimen such as etoposide and cisplatin for non-responders. Also, I recommended that the endpoint for a positive phase II study with an analogue depends upon which of the following four ways the analogue's superiority is hope for; (1) superior efficacy in responsive tumors; (2) broader spectrum; (3) cross-over resistance to the parent structure; (4) diminished toxicity.

Antineoplastic Agents↗

PubMed1991

Salvage therapy in recurrent germ cell cancer.

Testicular cancer is an important malignancy, not only because it has high curative potential with surgical resection (in local disease) and chemotherapy (in metastatic disease), but also because it serves as a pre-eminent example of the successful linkage between preclinical and clinical research experience. Improvements in salvage therapy have resulted in important advances in first-line therapy in germ cell cancer. Testicular cancer remains one of the few solid tumors in which a curative approach may be taken in patients who are not cured with initial induction chemotherapy. Furthermore, it remains as a fertile testing ground for future drug development and other innovative treatment approaches.

Antineoplastic Combined Chemotherapy Protocols↗

PubMed1991

Salvage chemotherapy with CCNU and methotrexate for small cell lung cancer resistant to CAV/PE alternating chemotherapy.

CCNU and methotrexate were employed as salvage treatment in 34 small cell lung cancer patients resistant to CAV/PE alternating induction chemotherapy. In the 33 evaluable patients we observed an objective response rate of 21.2% and 3% complete response; median survival was 4 months with 2 patients alive 18 months from starting salvages chemotherapy. The treatment was well tolerated. CCNU and methotrexate has shown to be a moderately active and tolerable salvage treatment for small cell lung cancer after CAV/PE alternating first-line chemotherapy.

Adult↗

PubMed1991

Treatment of delirium in the critically ill patient.

The clinical use of neuroleptics, benzodiazepines, narcotic analgesics, barbiturates, and neuromuscular blockers to manage delirium and agitation in the intensive-care setting is reviewed. Delirium is the most commonly encountered mental disturbance in critically ill patients and may be precipitated by factors such as physical illness, medications, pain, and emotional stress. If agitation cannot be controlled through nonpharmacologic means, pharmacologic intervention may be necessary. Haloperidol is the neuroleptic of choice for rapid control of delirium and agitation in the critically ill patient. It has few adverse effects in most patients, even at high doses, although it can cause extrapyramidal symptoms. Among the benzodiazepines, lorazepam should be considered a first-line agent. It may be used alone or in combination with haloperidol (or another neuroleptic). Midazolam is suitable for administration by continuous i.v. infusion in the intensive-care setting because of its water solubility, short half-life, and short duration of action. The sedative effects of narcotics may be advantageous in patients with both agitation and pain. Barbiturates are not recommended for routine use in the treatment of delirium and agitation. The use of neuromuscular blocking agents such as pancuronium bromide and metocurine iodide may be necessary when other therapies have failed. Haloperidol and the benzodiazepines, alone or in combination, are the drugs of choice for treatment of acute agitation and delirium in critically ill patients.

Anti-Anxiety Agents↗

PubMed1991

Beta-blocker therapy: identification and management of side effects.

The purpose of this study was to develop and test a new beta-Blocker Visual Analog Scale designed to identify and quantify the impact that the side effects of beta-blocker therapy have on people's lives, and the self-management practices people use to mediate their influence. Instruments included the 20-item beta-Blocker Visual Analog Scale and the Profile of Mood States. Subjects had hypertension; 51 men were involved in a larger study involving antihypertensive medications and exercise, and 19 men and women were receiving beta-blocker therapy as first-line drug of choice. Estimates of internal consistency reliability, content validity, and concurrent and discriminant validity were moderately strong. The most problematic side effects were related to lack of sleep, vivid or active dreams, lack of energy and pep, diminished interest in sexual activity, and changes in vision. Among self-management practices used to mediate side effects were planning rest and activity periods, thinking carefully before reacting, and seeking out others for support.

Adaptation, Psychological↗