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At least 469 records · Page 26Linked to original sources
PubMed1982

Amiodarone pulmonary toxicity.

Pulmonary toxicity may occur in association with amiodarone hydrochloride therapy. The clinical features of the pulmonary involvement are mild dyspnea, leukocytosis, hypoxemia, elevation in the erythrocyte sedimentation rate, and restrictive changes on pulmonary function testing. Diffuse interstitial and patchy peripheral alveolar infiltrates, which may frequently involve the upper lobes, characterize the radiologic findings. Accumulation of foamy macrophages in alveolar spaces, hyperplasia of type II pneumocytes, and widening of alveolar septae are noted histologically. Ultrastructural examination shows granular and lamellar membranous structures within distended lysosomes. With cessation of amiodarone therapy and treatment with corticosteroids, clinical symptoms and radiographic abnormalities resolve. The time interval for resolution of radiographic changes appears to be greater than 2 months. The precise role of corticosteroid therapy remains unknown in light of pathologic findings suggesting a metabolic rather than immunologic basis for the toxicity.

Adult↗
PubMed2004

Trial of targeting therapy against malignant glioma using monoclonal antibody.

Although the conventional treatment of malignant gliomas including surgery, radiotherapy and systemic chemotherapy has advanced, their current prognosis remains poor. The reactivity of monoclonal antibodies (mAbs) with human tumor cells may allow precise localization and appropriate therapy. We have developed several mAbs against malignant gliomas, and have reported the results of the experimental studies aimed at their clinical application as targeting therapy. The initial results of employing murine mAb 425 which binds to specifically to the epidermal growth factor (EGF) receptor in glioma therapy have been excellent, but less satisfactory, positively due to the immunogenicity of the murine mAbs, and limitations of the efficacy of the unmodified antibodies. Therefore, we also investigated the accumulation and the tumor suppression effect of human mAb CLNIgG and CLNIgG-drug (DXR: doxorubicin) conjugates to the tumor. The human mAb CLNIgG, derived from human uterine cancer lymph node cells, was found to bind strongly to human malignant glioma cells.

Animals↗
PubMed2002

[Endoscopic and surgical treatment of chronic pancreatitis].

Therapeutic management of patients with chronic pancreatitis is a multidisciplinary approach. Although interventional endoscopy and external lithotripsy have an important role to play, surgery keeps a prominent position in the therapeutic armentarium. The progress in radiology and endoscopy, the possibility of a preliminary therapeutic approach by a nonsurgical therapy have led to precise guidelines in the management. Surgery is indicated not only for rescue when endoscopic treatment is unsuccessful, but also as a one step procedure when failure of nonsurgical therapy can be anticipated right away. A key point is that nonsurgical and surgical therapeutic modalities are now complementary instead of being competitive.

Anastomosis, Surgical↗
PubMedDate not supplied

Infarct size reduction: a review of the clinical trials.

The most important finding to emerge from this review of experimental and clinical studies is that the earlier therapy is begun after the onset of symptoms of acute MI, the greater the potential for reduction of infarct size and possibly mortality. It is difficult to define a precise time after which therapy would not have an effect, since the clinical trials for each drug group vary significantly in respect to time of therapy initiation. In experimental studies, major salvage of ischemic myocardium occurs when the drug is given within two hours of coronary artery occlusion. If drug therapy is begun four to six hours postocclusion, then only minor or no reductions in infarct size will occur. The ability of any drug or intervention to reduce infarct size in humans would be optimized if therapy were begun less than four hours of onset of symptoms. With the realization of the wavefront phenomenon and the potential salvage of myocardium at risk with reperfusion, the introduction of reperfusion in the clinical setting with thrombolytic agents or other procedures becomes highly desirable. Clot-selective thrombolytic agents, such as tissue plasminogen activator, diminish the adverse effects and high costs of intracoronary thrombolytic therapy or PTCA. Consequently, it is probable that the initial procedure of choice would be the use of clot-selective thrombolytic therapy. Thrombolytic therapy only lyses thrombi and does not affect the underlying causes of the coronary artery occlusion. Therefore, therapy to reduce the chances of reinfarction and death must also be initiated. Percutaneous transluminal coronary angioplasty, in selected patients, should reduce the reocclusion rate. Beta-adrenoceptor blocking agents appear to be an excellent therapy for reducing mortality when administered chronically; these agents reduce myocardial oxygen consumption and reverse the imbalance between oxygen supply and oxygen demand caused by activation of the sympathetic nervous system and actions of catecholamines. Since thrombus formation has occurred at least once in patients who survive an MI, it is probable that the conditions for thrombus formation still exist. Therefore, institution of antiplatelet aggregating drugs, such as aspirin, would seem to be an appropriate prophylactic regimen. Beta blockers and possibly nitroglycerin have desirable effects when thrombolysis is unavailable. The efficacy of calcium-channel blocking agents on reduction of infarct size appears to be limited, although in the setting of stable and unstable angina postinfarction, these agents can play an important role.(ABSTRACT TRUNCATED AT 400 WORDS)

Adrenergic beta-Antagonists↗
PubMed1996

Quality assurance and radiotherapy.

As mentioned in several chapters of this report, administering the radioactive dosage requires a high level of precision. Demands on precision dosimetry have increased with modern curative radiotherapy. A few percent increase or decrease in the dose level may, in some cases, represent the difference between successful and unsuccessful therapy (Chapter 10). High precision is therefore required of basic dosimetry for different types and qualities of radiation, and in applied dosimetry for, eg, dose planning and in vivo dosimetry. External audits should be used to avoid systemic error. Comparative dose measurements are important, both to establish variations within a department and between departments. Simulators and/or therapeutic equipment should be checked regularly to assure that the direction of the radioactive beam and the field size complies with the plan. Margins that are too narrow can miss part of the target volume and increase the risk for relapse. If, on the other hand, the margins are too wide, the reaction to radiation in nearby organs at risk may be unacceptable. Accessible field control images should therefore be integrated in regular routines, at least when the margins between tumors and risk organs are small.

Humans↗
PubMed1995

A diagnostic-quality electronic portal imaging system.

Initial clinical experience is presented, on the use of a prototype portal imaging system which is designed to provide diagnostic-quality images on-line at the accelerator. The system comprises a compact diagnostic X-ray unit mounted on the accelerator head, with its source in the isocentric plane exactly 37 degrees around from the therapy source. The image detector is an image intensifier with digital image storage/processing facilities. Images were taken at the accelerator of treatment fields in seven patients (pelvic, head and neck, chest fields) and these images were comparable in anatomical contrast to simulator radiographs. Two techniques for marking the therapy field onto the portal images were successfully demonstrated. One was to mark relevant corners or edges of the therapy light field on the skin using small Pb markers which become clearly visible in the 'diagnostic' portal image. The other was to record a separate 'therapy' image and through the software, extract and superimpose the field edges on to the 'diagnostic' image. The system and method proved fundamentally sound on criteria of image quality, geometric precision of rotation between therapy and imaging conditions, and its potential for development as a practical clinical tool.

Female↗
PubMed2006

Current developments in radiotherapy for paediatric brain tumours.

This review summarises current developments in radiation oncology and how they impact on the management of children with brain tumours. Improved understanding of radiobiology has led to attempts to improve the therapeutic ratio with hyperfractionated radiotherapy. Recent advances in planning and delivery of radiotherapy, including three-dimensional conformal radiotherapy, intensity modulated radiotherapy, and proton therapy allow a more precise localisation of the maximum dose region with maximum sparing of normal brain. Increasingly interactions between drugs and radiotherapy are exploited, but it is important to evaluate toxicity of combined modality therapy. The introduction of models to predict the impact of radiotherapy dose-volume parameters on long-term neuropsychological function will hopefully lead to further benefit with respect to sparing of normal tissue morbidity.

Antineoplastic Agents↗
PubMed1998

What is the scientific meaning of empirically supported therapy?

It is important to define precisely what is and is not meant by "empirically supported treatments," rigorously based on what is actually known about the nature of experimental therapy research. The criteria for empirically supported treatments merely allow conclusions about whether treatments cause any change beyond the causative effect of such factors as placebo or the passage of time. Applied implications are limited, due to external validity and to the fact that applied decisions are influenced by cost-benefit analyses. Creating increasingly effective therapies through between-group designs is best done by controlled trials specifically aimed at basic questions about the nature of psychological problems and the nature of therapeutic change mechanisms. Naturalistic research is important for external validity but is valuable only if it uses scientifically valid methods to address basic knowledge questions.

Empiricism↗
PubMed2026

Defining and managing high-risk acute myeloid leukemia (AML) in 2026.

Acute myeloid leukemia (AML) remains a highly heterogeneous malignancy in which outcomes are particularly poor for patients classified as having high-risk disease. Traditionally, high-risk AML has been defined by adverse baseline genetic features, including complex cytogenetics, TP53 alterations, and mutations associated with secondary or therapy-related disease. However, this static, genetics-centered definition is increasingly insufficient in the modern therapeutic era. Emerging evidence supports a more dynamic and context-dependent model in which risk is shaped not only by molecular architecture but also by treatment intensity, patient fitness, measurable residual disease (MRD), and evolving resistance mechanisms. Advances in genomic profiling have refined risk stratification frameworks, including ELN 2022 for intensively treated patients and the ELN 2024 classification for those receiving less-intensive therapies. In parallel, MRD has emerged as a powerful biomarker that reclassifies patients during treatment, identifying those with persistent, therapy-resistant disease despite morphologic remission. Biologically, high-risk AML is driven by the interplay of clonal evolution, epigenetic plasticity, leukemic stem cell persistence, and protective microenvironmental and immune interactions, all of which contribute to relapse. Therapeutically, the landscape has expanded to include targeted agents, venetoclax-based combinations, and transplantation strategies, yet outcomes remain limited in key high-risk subsets, particularly TP53-mutated disease and post-venetoclax relapse. Accordingly, current strategies emphasize rational combination therapies, MRD-guided treatment adaptation, and approaches targeting both leukemic cells and their supportive niches. In 2026, high-risk AML is best understood as a dynamic, treatment-context-dependent state. Improving outcomes will require integration of precision diagnostics, biologically informed therapy, and adaptive strategies designed to anticipate and overcome resistance.

Humans↗
PubMedDate not supplied

Site and disease selection for hyperthermia clinical trials.

Significant progress has been made in the past 20 years in understanding the biological basis of hyperthermia-induced cytotoxicity, thermoenhancement of radiation therapy and chemotherapy, and in the development of clinically applicable microwave, radiofrequency, ultrasound and thermometry equipment. Numerous uncontrolled trials have suggested strongly that hyperthermia in conjunction with radiation therapy or chemotherapy may contribute to improved local control rates for recurrent or metastatic cancer without excessive morbidity. Carefully designed and well-controlled site and disease-specific prospective randomized trials with standardized hyperthermia and radiation therapy techniques, adequate thermometry, precise end points for tumour control and normal tissue toxicity are now essential to establish the role of hyperthermia in cancer management. Criteria for tumour site selection will be explored for trials employing radiation therapy and local-regional hyperthermia. Examples of sites selected will be presented which represent areas that can, with current technology, usually be adequately heated, and in which significant patient benefit may result from improved local-regional control.

Clinical Trials as Topic↗
PubMed2001

[Treatment strategy in functional temporomandibular joint changes].

In the management of functional disturbances of the stomatognathic system symptomatic and causal therapeutic methods can be distinguished. Symptomatic therapy encompasses medication, physical methods (heat, cold, radiation, TENS) in combination with physiotherapy and emergency splint. After one or two weeks of symptomatic therapy the patient should be free of pain allowing precise diagnostic procedures followed by causal therapy managing muscular problems, joint pathology and occlusal disturbances. Splint therapy is used to establish a therapeutic joint position according to articulator mounting. After splint therapy prosthodontic and/or orthodontic treatment is needed to restore occlusion. Interdisciplinary management in the therapy of functional disturbances of the stomatognathic system is of utmost importance due to the relationship between chewing muscles, neck muscles and body posture. In addition to splint therapy, physiotherapy, logopedic therapy, myofunctional therapy, psychologic and psychiatric intervention is performed.

Combined Modality Therapy↗
PubMed1982

Management of the dental patient receiving corticosteroid medications.

Patients who have undergone therapy with glucocorticoids present unique problems for the dentist. Persons currently receiving steroid therapy have altered responses to infection and wound healing. More important, many patients who are taking or have taken glucocorticoids have a high risk of developing acute adrenal insufficiency when placed in a stressful situation. When treating patients with a history of glucocorticoid therapy, one must obtain precise information from the medical history to determine the relative risk of pituitary-adrenal suppression. If the patient is at risk, the dentist must determine the need for the following prophylactic measures: (1) systemic antibiotic therapy, (2) anxiety control, and (3) increased administration of glucocorticoids (steroid prep). If a patient experiences adrenal crisis, the dentist must be capable of interpreting the signs and administering appropriate therapy.

Adrenal Cortex↗
PubMed2004

Quantitative real-time PCR with automated sample preparation for diagnosis and monitoring of cytomegalovirus infection in bone marrow transplant patients.

BACKGROUND: In bone marrow and stem cell transplant patients, the widespread use of preemptive cytomegalovirus (CMV) antiviral therapy necessitates faster, more precise, and more sensitive quantitative laboratory methods for serial viral load monitoring. METHODS: We developed a novel CMV viral load assay using real-time PCR of plasma DNA prepared by an automated robotic workstation. Fluorescent hybridization probes directed at the glycoprotein B (gB) gene (or EcoRI D region) of CMV were used to detect and quantify PCR products. The beta-globin gene was amplified in parallel to control for the efficiency of the extraction and PCR steps. RESULTS: The assay was linear (R = 0.999) from a lower detection limit of 125 copies/mL to 5 x 10(9) copies/mL with a PCR efficiency of 1.975 (gB) or 2.02 (EcoRI D). The viral loads determined by PCRs directed at these two different viral targets were no different (n = 53; R = 0.928). The interassay CV was 3.5%, and the intraassay CV was 1-4%. Compared with a commercially available quantitative competitive PCR assay (Roche MONITOR; R = 0.59), the mean CMV viral load by real-time PCR was 3.1 times higher (mean ratio; P = 0.002). The diagnostic sensitivity and specificity of the real-time assay were 96% and 100%, respectively (n = 147), compared with 74% and 98% for a qualitative PCR assay (Roche AMPLICOR). On a subset of samples, the diagnostic sensitivity of viral culture was no greater than 50% (n = 44). Of 1115 clinical referral samples from 252 patients, 10% of the samples and 18% of the patients had low-level CMV viremia (median, 500 copies/mL). In this predominantly (85%) bone marrow transplant testing cohort, serial CMV viral load results were the predominant clinical trigger for the initiation, monitoring, and cessation of preemptive antiviral therapy. CONCLUSIONS: The combination of automated DNA preparation and semiautomated real-time fluorescent PCR detection allows for a sensitive, precise, and accurate high-throughput assay of CMV viral load that can be used as the laboratory trigger for preemptive antiviral therapy.

Antiviral Agents↗
PubMedDate not supplied

Secondary leukemia in a child with neuroblastoma while on oral etoposide: what is the cause?

To date little has been reported about the risk of therapy-related leukaemia (t-AML) in children receiving oral etoposide therapy. The authors present a case of t-AML that developed in a child with metastatic neuroblastoma 18 months after he received oral etoposide, given for palliation purpose. The leukemic blasts were examined by morphological, immunohistochemical, cytogenetic, and molecular genetic analyses. Although the t-AML developed following oral etoposide therapy, the child had previously received high-dose, multiagent chemotherapy, and rearrangement of the MLL gene was not demonstrated. The use of modern multiagent therapy often makes it difficult to appropriately apportion blame for causation of specific side effects. Moreover, the etiology of t-AML and mechanism of leukemogenesis are likely to be multifactorial and complex. Further studies on the precise association with different therapies are thus needed. Oral etoposide remains an effective palliative agent and its usage should not be excluded without most careful consideration of the risks.

Administration, Oral↗
PubMed1995

[Isolated lung transplantation].

Over the last 10 years, single and bilateral lung transplantation has developed from an experimental technique to a valid therapy for patients with end-stage pulmonary or pulmonary-vascular disease. The main reasons for this progress are better defined selection criteria, improved operative technique and organ preservation, optimized peri- and postoperative management and more precise immunosuppressive and antiinfective therapy. Since 1983 more than 3000 lung transplantations have been performed worldwide with a 1- and 3-year survival rate of 70-90% and 60-70% respectively. In Switzerland 41 lung transplantations have been performed since 1992 with a 1-year survival rate of more than 80%. Indications, technique, treatment and results are discussed.

Adult↗