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At least 433 records · Page 24Linked to original sources

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↗

PubMed1991

[Treatment of relapses and failures in disseminated Hodgkin's disease].

Treatment of disseminated Hodgkin's disease still fails in about 50 percent of the cases. The prognosis is poorer in case of early relapse or when the disease is refractory to first-line therapy from the start. Second- or third-line chemotherapy regimens have given rather disappointing results with a complete remission rate usually around 30 percent and a small number of cures. The indications for radiotherapy in localized lymph node relapses remain to be precisely determined. Based on the theoretical dose-effect concept, high-dose chemotherapy followed by autologous bone marrow transplantation increases the number of prolonged complete remissions in patients who respond to salvage chemotherapy. A wider use of haematopoietic growth factors should reduce the toxicity of this treatment.

Antineoplastic Combined Chemotherapy Protocols↗

PubMed1991

Antihypertensive monotherapy with nitrendipine in general practice.

Efficacy and tolerability of antihypertensive monotherapy with the calcium antagonist nitrendipine were investigated in a 6-month open trial in 495 patients with mild to moderate essential hypertension from 101 practicing internists and general practitioners. Previous antihypertensive therapy (57.4%) was stopped for 1 week and therapy then started with nitrendipine, 20 mg once daily. Sixty-one patients discontinued therapy prematurely because of unwanted effects, mostly characteristic with dihydropyridines (headaches, flushing, and ankle edema), and 23 patients because of insufficient efficacy. In 75% of the remaining 411 patients, the goal blood pressure was achieved by nitrendipine monotherapy (10 mg in 17.6%, 20 mg in 73.3%, and 20 mg b.i.d. in 8%) and diastolic blood pressure was between 90 and 95 mm Hg in another 6%. The reduction in blood pressure did not result in changes of heart rate or weight. Nitrendipine was effective in patients of all age groups but patients older than 60 years of age showed a significantly greater fall in systolic pressure than middle-aged or young patients. At the end of the study, 15 patients still reported side effects. Nitrendipine appears to be well suited for first-line therapy of mild to moderate essential hypertension.

Adult↗

PubMed1991

Angiotensin-converting enzyme inhibitors in the treatment of hypertension.

This article examines the evidence justifying the use of angiotensin-converting enzyme (ACE) inhibitors as first-line antihypertensive drugs. ACE inhibitors are as effective as traditional antihypertensive agents and, in addition, exert their blood-pressure-lowering effect with near optimal hemodynamic alterations. These drugs have a good tolerance and safety profile although they induce cough in an appreciable number of patients. They can be safely associated with other antihypertensive agents to provide therapeutic benefit in a large proportion of the hypertensive population. ACE inhibitors are contraindicated only in bilateral renal artery stenosis or stenosis of a single kidney. Although to date no prospective study has examined the ability of ACE inhibitors to reduce cardiovascular morbidity and mortality in hypertension, several features of these drugs suggest that this may be the case as several effects of ACE inhibitors in hypertension are potentially nephroprotective and cardioprotective.

Angiotensin-Converting Enzyme Inhibitors↗

PubMed1991

Safety profile of lacidipine: a review of clinical data.

The clinical safety of the new dihydropyridine calcium antagonist lacidipine was assessed in 14 clinical trials, including 1,372 patients treated with lacidipine and 687 treated with an alternative antihypertensive agent. The type and incidence of adverse events seen with lacidipine were characteristic of this class of drug, being mainly those associated with the pharmacologic effect of vasodilation, but with a lower incidence of edema than seen with nifedipine. There were no unexpected adverse effects. Hence, lacidipine is likely to be well accepted in general clinical use. Furthermore, as it has the advantages of a long duration of action and once-daily dosage, the benefit/risk ratio indicates that lacidipine is a suitable agent for the first-line treatment of hypertension across a wide range of patients.

Adult↗

PubMed1992

Treatment of otitis media.

Amoxicillin is the first-line drug for otitis media. Effective second-line drugs for resistant beta-lactamase-producing bacterial strains include trimethoprim-sulfamethoxazole, erythromycin-sulfisoxazole, cefaclor, cefuroxime axetil and cefixime. In choosing an antibiotic, the physician should consider proven efficacy, cost, side effect profile, compliance issues, spectrum of coverage and the age of the child. Children with recurrent infections may benefit from antibiotic prophylaxis. About 10 percent of children with episodes of acute otitis media develop a chronic middle ear effusion that persists beyond three months. Referral for insertion of tympanostomy tubes is most appropriate for patients with documented language delay and/or significant medical complications.

Algorithms↗

PubMed1992

The role of corticosteroids in the management of childhood asthma. The Thoracic Society of Australia and New Zealand.

OBJECTIVE: To formulate recommendations for the role of corticosteroid therapy in the management of childhood asthma. DATA SOURCES: The recommendations are based on a review of the available literature and a variety of review articles on the efficacy and safety of corticosteroid therapy supplemented by personal experience in managing children with asthma. DATA SYNTHESIS: 1. Preventive therapy. Sodium cromoglycate should be considered first-line treatment. Inhaled corticosteroids are indicated in children who fail to achieve control on this therapy or those with severe disease. An initial dosage of 400-600 micrograms/day is recommended with subsequent variation in dosage related to clinical response. Large volume spacers can be used to improve aerosol delivery and minimise side effects. Indications for specialist assessment include: use of inhaled corticosteroids in children under 3 years of age; the requirement for high dose therapy (greater than 600 micrograms/day); or the need for regular oral corticosteroids. 2. Acute severe asthma. Systemic corticosteroid therapy is a valuable adjunct in the treatment of acute severe asthma and can be used safely in the short term. The efficacy of high dose inhaled corticosteroids in the management of acute severe asthma requires further evaluation. The need for systemic corticosteroid therapy signals the need for reassessment of that child's usual maintenance therapy. CONCLUSION: These recommendations are presented as a guide to the use of corticosteroid therapy in childhood asthma. In the individual child, the benefits of therapy need to be weighted against the possible risks, with the aim of maintaining good asthma control with the minimum dose of corticosteroid.

Asthma↗

PubMed1992

Mechanism of interferon action in hairy cell leukemia: a model of effective cancer biotherapy.

Hairy cell leukemia (HCL) is one of the few malignancies for which alpha-interferon (IFN alpha) is considered effective first-line therapy. However, the mechanisms of action of this agent in vivo have been the subject of much debate; in particular, the issue of whether clinical improvement in IFN-alpha-treated HCL patients is dependent upon enhancement of host defenses or upon direct actions of IFN alpha upon the hairy cell remains unresolved. In this review, we examine the evidence supporting both lines of argument and synthesize this information within the framework of clinical studies of IFN alpha in HCL, the purpose being to determine which proposed mechanisms of IFN alpha action are indeed effective in vivo. From our analysis, it appears that the beneficial effects of IFN alpha upon immune function are important in decreasing the frequency of infectious complications of HCL but that these effects are probably not responsible for hairy cell elimination and cannot therefore account for major responses to IFN alpha therapy. We conclude that the primary mechanism of action of IFN alpha in HCL involves the induction of hairy cell differentiation towards a stage less responsive to growth factor stimulation, the primary consequence being proliferative inhibition. These effects may mimic events that occur during normal lymphocyte development, suggesting that the benefits of biotherapeutic agents might best be harnessed via studies of the effects of multiple and sequential biological response modifiers upon the growth and differentiation patterns of normal and malignant cells. Hairy cell leukemia could thus serve as an excellent model in which to investigate combined cancer biotherapy; the implications of our present understanding of IFN alpha in HCL to the biotherapy of cancer are discussed.

Cell Differentiation↗

PubMed1992

The effect of aspirin on niacin-induced cutaneous reactions.

BACKGROUND: Niacin (nicotinic acid) is one of the first-line agents recommended for the treatment of hyperlipidemia. Bothersome cutaneous reactions (flushing, feeling of warmth, itching, and tingling), however, often limit patient acceptability and tolerability. The National Cholesterol Education Program recommends giving aspirin or another nonsteroidal anti-inflammatory drug before administering niacin. Lack of scientific data supporting this recommendation, however, led to this randomized, double-blind, placebo-controlled trial to evaluate the efficacy of 80 mg of aspirin and 325 mg of aspirin in reducing these cutaneous reactions. METHODS: Thirty-one healthy subjects were randomized into one of four groups. Each group completed four different treatment regimens (placebo-placebo; 80 mg of aspirin-500 mg of niacin; 325 mg of aspirin-500 mg of niacin; and placebo-500 mg of niacin). Subjects received one of each of the four treatment regimens on separate visits that were at least 24 hours apart. Intensity and tolerability of cutaneous reactions were evaluated by an intensity rating scale and a visual analog scale. RESULTS: Results indicate that 325 mg of aspirin is significantly better than 80 mg of aspirin in decreasing intolerability to niacin. Aspirin reduced the incidence of warmth and flushing associated with niacin, but not the itching and tingling. CONCLUSIONS: It appears from this pilot study that preceding niacin with 325 mg of aspirin will decrease the warmth and flushing associated with niacin.

Adult↗

PubMed1992

Listeria monocytogenes meningitis at King Edward VIII Hospital, Durban. A 10-year experience, 1981-1990.

Nine cases, 3 adults and 6 children, with Listeria monocytogenes meningitis were seen over a 10-year period at King Edward VIII Hospital, Durban. These cases accounted for 0.8% (3/374) and 0.6% (6/1,210) of all culture-positive cases of acute bacterial meningitis in adults and children, respectively, and represented 2.9% (4/136) of all culture-positive cases in the neonatal age group and 5.7% (3/53) of culture-positive cases in adults 50 years and older. The patients had positive blood and cerebrospinal fluid (CSF) cultures. All isolates were sensitive to ampicillin, chloramphenicol, sulphamethoxazole-trimethoprim combination and gentamicin. One isolate in an 11-month-old child was resistant to penicillin and 2 isolates in the adult patients displayed intermediate sensitivity to this antibiotic. The adults were over 50 years of age and presented with an abrupt onset of a pyrexial illness, meningitis and focal neurological signs; only 1 survived. Only 1 8-week-old infant of the paediatric cases survived. A polymorphonuclear leucocytosis, low serum glucose and elevated protein values were common findings in the CSF and the features in some patients mimicked tuberculous or viral meningitis. The fulminant course of the disease and the fact that penicillin and not ampicillin is the first-line antibiotic makes it essential to consider listeriosis as a possible diagnosis, particularly in the very ill patient.

Anti-Bacterial Agents↗

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↗