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At least 415 records · Page 23Linked to original sources

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↗

PubMed1991

[Chemotherapy of penile carcinomas].

The value of chemotherapy in treatment of squamous epithelial carcinoma of the penis is still uncertain, and its clinical relevance is speculative. In locally delimited carcinoma (T1, T2), partial penectomy is still the first-line therapy, and the alternatives of bleomycin monotherapy or combination therapy with bleomycin and radiation should be applied only when patients rigorously reject surgery. The prospects of success are rather uncertain with these forms of treatment. Palliative chemotherapy for metastasized carcinoma has so far yielded data indicating that methotrexate administration is of therapeutic benefit, even if only for a short time. Elaborate multiple combinations must be considered critically, especially because of the appreciable burden on the patient, a rate of response that in the final analysis is still uncertain, and the small number of cases treated so far.

Antineoplastic Combined Chemotherapy Protocols↗

PubMed1991

Advances in the use of fine-needle aspiration cytology in the diagnosis of palpable lesions of the head and neck.

Our experience in performing fine-needle aspiration for the investigation of palpable lesions of the head and neck region is reviewed. Three hundred cases were performed over a period of approximately two years. In most circumstances, a diagnosis could be rendered simply on the basis of routine cytomorphologic interpretation. In some situations, it was necessary to employ ancillary techniques such as immunoperoxidase staining, electron microscopy, and flow cytometry to confirm the morphologic diagnosis. Several cases illustrating the clinical utility of the technique are presented in detail. Fine-needle aspiration is a relatively atraumatic, well-tolerated procedure which can be readily performed in the usual outpatient setting. This technique is an excellent first-line method for investigating the nature of palpable lesions in the head and neck region.

Adult↗

PubMed1990

Effect of bezafibrate on metabolic profiles in non-insulin-dependent diabetes mellitus.

Non-insulin-dependent diabetes mellitus (NIDDM) is characterized by hyperglycemia secondary to increased hepatic glucose output and impaired extrahepatic insulin sensitivity. Many NIDDM patients also have raised serum triglyceride and low-density lipoprotein (LDL) cholesterol levels, which may require drug therapy, as well as increased plasma nonesterified fatty acid concentrations. Some hypolipidemic agents such as bezafibrate lower fatty acid levels as well as LDL cholesterol and triglycerides. It has been suggested that raised fatty acid levels may be responsible in part for the increased hepatic glucose output and insulin insensitivity of NIDDM. Several groups have therefore sought to examine the effects of fibrates on glycemic control in NIDDM. In our own studies, we used bezafibrate (200 mg t.i.d.) in a double-blind, placebo-controlled design for 3 months. Fasting blood glucose, serum insulin, C-peptide, plasma nonesterified fatty acids, blood lactate and alanine, serum triglycerides, and LDL cholesterol were all lowered. HbA1 showed no significant change. Meal hormone and metabolite profiles were all improved although this reflected mainly the lower premeal values. The results of our and other studies are sufficiently encouraging to suggest that bezafibrate could provide alternative first-line drug therapy in hyperlipidemic NIDDM patients when diet alone has failed.

Bezafibrate↗

PubMedDate not supplied

MN (N = Novantrone) COP-B therapy on high and intermediate grade non-Hodgkin's lymphoma: an alternative to MA (A = adriamycin) COP-B?

BACKGROUND AND METHODS: From February, 1987 to August, 1988, fifty-one patients with high and intermediate grade non-Hodgkin's lymphoma (NHL) entered a chemotherapy program MNCOP-B (M = Methotrexate, N = Novantrone, C = Cytoxan, O = Oncovin, P = 6 methyl-prednisolone, B = Bleomycin). Forty patients received MNCOP-B as first-line therapy and 11 patients as salvage therapy after relapse-resistance to other schemes or radiotherapy. RESULTS: The overall remission rate was 51% with a similar distribution of remissions between the two groups under study. At a mean follow-up of 28 months, 20 patients (40%) remain in CR with a disease-free probability of 83% for patients treated with MNCOP-B as up-front therapy and 67% for patients treated with MNCOP-B as salvage therapy. The overall survival at 3 years is 45%; bulky, disease stages III-IV and symptoms are not correlated with poorer survival or a lower remission rate. Patients who received less than 70% of the scheduled doses paradoxically figure better than the others, showing an 87% remission rate, as compared to those who received 100% of the scheduled doses and obtained a 35% remission rate. Major toxicity consisted of mucositis, recorded in 15% and 9% of previously untreated and treated patients, respectively; severe neutropenia was recorded in 27% and 63%, respectively. Despite the number of recorded side effects, only one toxic death due to sepsis occurred. CONCLUSIONS: MNCOP-B is an effective regimen in intermediate and high grade NHL and easily manageable in the out-patient clinic. The incidence of mucositis is sensibly reduced as compared to the parental regimen MACOP-B reported in the literature; this result allows the use of MNCOP-B in older patients.

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↗

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↗