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At least 397 records · Page 22Linked to original sources

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↗

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↗

PubMed1979

[Current chemotherapy of pulmonary tuberculosis].

Tuberculosis has today lost much of its dread for mankind: in 1976, 1823 persons contracted tuberculosis and 182 died of pulmonary tuberculosis in Switzerland. In contrast, 1375 died of pneumonia, 1309 of non-specific airway disease and 2202 of bronchial cancer in the same year. The present data on morbidity and mortality in Switzerland resemble those of the other industrial European countries or the USA. The decrease in morbidity and mortality of pulmonary tuberculosis was caused-among other factors-by chemotherapy. Chemotherapy not only profoundly changed the infectivity of tuberculous patients and made ambulatory, domiciliary treatment possible, but cured pulmonary tuberculosis. The introduction of the bactericidal rifampicin led to the latest major landmark in the chemotherapy of tuberculosis in the past 20 years: namely, short-course chemotherapy. Together with the other first-line drugs (isoniazid, streptomycin, ethambutol), rifampicin shortened the duration of chemotherapy from 18--24 to 9--12 months. Short-course chemotherapy is today the therapy of choice for most patients with pulmonary tuberculosis.

BCG Vaccine↗

PubMed2026

[Tics and Tourette Syndrome].

Tics disorders and Tourette syndrome (TS) are neurodevelopmental conditions characterized by motor and/or vocal tics with onset in childhood. Their clinical presentation is heterogeneous and fluctuating over time, with exacerbations related to emotional, environmental, and medical factors. Diagnosis is clinical and based on medical history and neurological examination, following DSM-5-TR criteria, with ancillary testing rarely required. The prevalence of TS is estimated at 0.7%, while transient tic disorders affect up to 10% of children. The natural history is generally favorable, with symptom improvement during adolescence, although a subset of patients continues to experience tics into adulthood. Most individuals with TS present psychiatric comorbidities, particularly attention-deficit/hyperactivity disorder and obsessive-compulsive disorder, which significantly impact quality of life and should be prioritized in management decisions. Treatment is recommended only when tics cause functional impairment and follows a stepwise approach including psychoeducation, behavioral interventions, and individualized pharmacological therapy. Comprehensive behavioral intervention for tics is considered first-line treatment when available. Alpha-2 adrenergic agonists and dopamine antagonists are the most commonly used pharmacological options. Neuromodulation therapies are reserved for severe, refractory cases. These recommendations from the Ibero-American Academy of Pediatric Neurology summarize current evidence and provide a practical, updated framework for the diagnosis and management of tic disorders and Tourette syndrome in pediatric patients.

Humans↗

PubMed1978

Rheumatoid arthritis.

Management should help relieve symptoms, increase or maintain function, produce few side effects and keep the cost to a minimum. Aspirin remains the first-line drug; other nonsteroidal anti-inflammatory drugs may be useful when aspirin cannot be tolerated. Symptoms and signs of rheumatoid disease may be suppressed by corticosteroids, but only gold compounds, penicillamine and cytotoxic therapy have been shown to decrease disease activity and lessen permanent joint damage.

Adrenal Cortex Hormones↗

PubMed1976

Role of DTIC (NSC-45388) in the chemotherapy of sarcomas.

DTIC was one of the first of several new agents evaluated by the Southwest Oncology Group (SWOG) and the M.D. Anderson Hospital and Tumor Institute (MDAH) in the therapy of adult patients with metastatic sarcomas. It yielded an overall response rate of 17%. This is similar to that seen in a review of 138 patients who represent the total number reported in either published or unpublished data. The subsequent addition of DTIC to adriamycin in several studies carried out at the MDAH and in the SWOG has increased the complete and partial remission rate over that seen with adriamycin alone, and more importantly has increased remission duration and survival. DTIC is currently used in combination with adriamycin in the first-line therapy of patients with metastatic sarcomas and should be considered for patients who have relapsed on primary therapy not including DTIC.

Clinical Trials as Topic↗

PubMed1976

Present state of cardiovascular community control programme in the Czech Socialist Republic.

The high incidence, great import, and long duration of cardiovascular diseases are reflected in high demands placed on the health services. Experience shows that utilization of the results of research in general practice is lagging behind. The application of any improvement in the diagnosis, therapy, and prevention in health care waits several years for its accomplishment. In order to improve this situation, the Ministry of Health of the CSR constituted, in line with WHO recommendations, a Department for Cardiovascular Diseases Control. The Department has worked out a programme of prevention and control of the major cardiovascular diseases, in particular, ischaemic heart disease, systemic hypertension and its complications, rheumatic heart disease, congenital cardiac and vascular defects, and cor pulmonale. New diagnostic, therapeutic, and preventive procedures are first tried out in so-called model areas and are only after this introduced into the national health care of people suffering from or endangered by cardiovascular diseases. In parallel, organizational measures necessary for comprehensive care are implemented. The authors report on the experience gained so far with the realization of the programme of care of people suffering from IHD and acute myocardial infarction. They emphasize the importance of continual schooling of medical personnel and of health education of the entire population. They describe the implementation on a national scale of postgraduate cardiological courses intended especially for first-line doctors.

Cardiovascular Diseases↗

PubMed1976

Buccal administration of fenoterol aerosol in young children with asthma.

A new technique for the administration of a bronchodilator aerosol, fenoterol, in young children with asthma is described. Rapid and effective bronchodilatation can be obtained in many patients simply by directing the jet of the bronchodilator aerosol onto the buccal mucosa. This method will frequently obviate the need for painful or potentially dangerous injections of adrenaline or aminophylline as a first-line treatment in children with acute attacks of asthma.

Aerosols↗