SEARCH · PubMed Health

Results for “First-line”

Explore indexed PubMed citations for clinical trials, systematic reviews and public health research. Read source abstracts and follow each citation to its original PubMed record.

Quote a phrase for an exact phrase match. Source license links do not imply unrestricted reuse.

At least 487 records · Page 27Linked to original sources

PubMed1991

[Bactericide activity of cefadroxil comparated with amoxicillin-clavulanic acid, cefaclor and josamycin].

Betalactamase-producing organisms are responsible for an increasing number of ENT and lower respiratory tract infections. Or cephalosporins and the combination of amoxicillin with the beta-lactamase inhibitor clavulanic acid are alternatives to ampicillin therapy. The killing activity of cefadroxil on the organisms most often responsible for ENT and respiratory infections was evaluated in vitro using a viable bacteria count method, comparatively with cefaclor, josamycin, and amoxicillin-clavulanic acid. Killing activity was found to be time-dependent for all the antimicrobial agents studied. Cefadroxil exhibited the same bactericidal effect on Streptococcus pyogenes and S. pneumoniae than the other agents. Haemophilus influenzae and an increasing number of Pneumococcus strains were resistant to josamycin which is therefore not appropriate for first-line therapy. As compared with amoxicillin and amoxicillin-clavulanic acid, cefadroxil was less active on H. influenzae and more active on Staphylococcus aureus. Production of beta-lactamase failed to influence the killing activity of cefadroxil. These bacteriologic data, together with results of pharmacologic studies (long half-life and good penetration within tissues) can explain the clinical successes obtained with cefadroxil in ENT and lower respiratory tract infections.

Amoxicillin↗

PubMed1991

The role of atopy in asthma.

Allergy plays an important role in chronic asthma. Aeroallergens, both indoor and outdoor, provide a constant source of bronchial inflammation that increases bronchial hyperreactivity. This increased reactivity lowers the threshold of response to nonspecific triggers of asthma flares such as viral infections, pollutants, and cold air. Asthma is a chronic inflammatory disease in much the same way that the rheumatic diseases are. In that respect, therapy should be directed at reducing inflammation, as it is in the rheumatic diseases. Along these lines, newer approaches to asthma therapy should emphasize steroids as first-line treatment. In this way, therapy is targeted against the underlying inflammation that causes the bronchial obstruction, rather than treating with bronchodilators such as theophylline and B agonists. The effect of such continuous antiinflammatory therapy is decreased airway hyperresponsiveness, which has obvious clinical benefit.

Age Factors↗

PubMed1991

Beneficial effects on serum lipids in noninsulin dependent diabetics by acarbose treatment.

Acarbose (Bay g 5421, Glucobay; CAS 56180-94-0) inhibits alpha-glucosidases of the small intestine and thus delays glucose release from complex carbohydrates. It is therefore efficient as a first-line drug in the treatment of noninsulin-dependent diabetics (NIDDM) insufficiently treated with diet alone. Information is scarce whether under acarbose treatment the lipid metabolism can also be improved. Therefore the changes of triglycerides, cholesterol and HDL-cholesterol were analyzed in a randomized double-blind placebo-controlled trial. In brief, 94 NIDDM aged 43 to 70, after a pretreatment period of at least 3 months, were treated with 100 mg acarbose t.i.d. or placebo for 24 weeks. The patients were recruited after a 4-week screening phase with reinforcement of diet. The most impressive results of acarbose treatment were lowering of blood glucose and insulin, especially in the postprandial state, and of HbA1 (glycosylated hemoglobin). Results on lipids: The initial serum cholesterol levels showed a broad spectrum. Low concentrations remained unchanged under acarbose, while high concentrations (the upper tercile) decreased from 273 to 251 mg/dl. This effect was statistically significant compared to placebo. HDL-cholesterol levels increased continuously under acarbose and placebo as well thus indicating some study effect. Similarly, fasting triglycerides leveled down under acarbose and placebo. However, drastic differences appeared in postprandial triglycerides which were checked 1 and 5 h after a test meal given at entry and at finish of the study. The lowering by acarbose compared to placebo was highly significant for the 1 h postprandial concentrations. It is concluded that acarbose treatment can reduce elevated cholesterol concentrations and postprandial triglyceride concentrations.(ABSTRACT TRUNCATED AT 250 WORDS)

Acarbose↗

PubMed1991

[Study of vinorelbine (V) combined with hexamethylmelamine (H) (combination V-H) in adenocarcinoma of the ovary: results a phase I-IIA trial, NHO-88, of ARTAC "ovarian" group].

The lack of decisive progress in ovarian cancer chemotherapy in recent years led the ARTAC "Ovary" group to initiate a study based on the hypothesis of collateral sensitivities. In this phase I-II trial, NHO-88, the V-H combination (associating vinorelbine (VNB) and hexamethylmelamine (HMM) was studied in patients with advanced ovarian adenocarcinomas, most of which had become resistant to previous chemotherapy. The aim of the study was to find an active combination without complete cross resistance with first-line platinum salt based combinations, such as CAP, FAP or CACb-300. A pilot feasibility study was first carried out to determine the maximum tolerated weekly dose (MTWD) of VNB (20 mg/m2/week), HMM being administered per os on days 1-14 of every 28-day cycle at a standard dose of 250 mg/m2/day. An open phase II-A study was further carried out according to a 2-step sequential analysis method for phase II clinical trials. We observed: 1), a good tolerance of the V-H combination apart from frequent neutropenia; 2), a response rate of 35% (95% confidence interval: 23-47%); 3), a median response duration of 4 months (range: 1-7 months); 4), in some cases, the absence of a complete cross-resistance between the V-H regimen and the previously administered platinum-based combinations. These results, which are currently being validated (phase II-B ongoing), constitute the first step in the search for active systems of sequential or alternate chemotherapeutic regimens for the treatment of advanced carcinomas.

Adenocarcinoma↗

PubMed1991

From stepped care to tailored therapy.

In 1977 the National Heart, Lung and Blood Institute in the USA drew together a panel of experts as the first 'Joint National Committee' to provide guidelines on the detection, evaluation and management of hypertension. This was the birth of 'stepped care', which was internationally adopted, and consisted of: step 1--a diuretic; step 2--if step 1 is inadequate, add a beta-blocker; step 3--if step 2 is inadequate, add a vasodilator (e.g. hydralazine). With the evolution of a broader, multiple risk factor approach to the management of hypertension, and the development of newer agents, this simple system was modified during the 1980s. The relative importance of non-pharmacological intervention resulted in step 1 becoming drug-free, and alternative agents necessitated wider 'steps'. The interaction of hypertension with other coronary heart disease (CHD) risk factors, the disappointing effect of thiazides and beta-blockers on CHD events in intervention trials, and the increasingly large list of potential drug combinations meant that by 1989 several international consensus bodies no longer considered stepped care to be viable. Stepped care has been replaced by 'tailored therapy'. That is, based on an assessment of the patient's overall cardiovascular risk profile, the choice of first-line drug therapy has been broadened beyond diuretics and beta-blockers to include ACE inhibitors, calcium antagonists and selective alpha 1-blockers. Many hypertension experts are now of the opinion that, except in limited circumstances, diuretics and beta-blockers should only be used as second-line or third-line agents.

Antihypertensive Agents↗

PubMed1991

Oral lesions in the systemic mycoses.

Oral lesions have rarely been reported in systemic mycoses, though over the past few years they have been recorded particularly in immunocompromised individuals. The dramatic increase in numbers of immunocompromised persons, especially those infected with human immunodeficiency virus, has almost certainly been responsible for the increase in reports of oral disease caused by systemic mycoses, particularly aspergillosis, cryptococcosis, and histoplasmosis. However, reports of coccidioidomycosis, blastomycosis, and paracoccidioidomycosis have, as yet, increased little in this population. Dentists, when they observe chronic oral ulceration, chronic maxillary sinus infection, or bizarre mouth lesions (particularly in immunocompromised patients) should be aware of the possibility of a systemic mycosis. Amphotericin remains the standard therapy for most deep mycoses, while the newer azoles are the first-line agents for superficial mycoses, such as candidiasis, and are increasingly used in the deep mycoses.

Antifungal Agents↗

PubMedDate not supplied

Idarubicin in blastic crisis of chronic myelogenous leukemia.

BACKGROUND: Blastic crisis (BC) is the terminal event in the natural history of most chronic myelogenous leukemia (CML) patients. Depletion of the normal stem cell compartment, as well as the proliferative advantage and frequent pharmacoresistance of the blastic clone, contribute to the poor prognosis of CML patients in this phase. Recent clinical trials have shown that idarubicin (IDR) in combination with cytosine arabinoside (ARA-C) is more active than daunorubicin at comparable doses in acute myelogenous leukemia (AML). Furthermore, IDR alone also exhibits antitumoral activity in the BC of CML. METHODS: Twelve Ph+ CML patients in BC (male 8, female 4; median age 45 yrs., range 19-55 yrs.) were treated with IDR 12 mg/m2/die for 3 consecutive days in sequential combination with Ara-C (1 hour i.v. infusion) 120 mg/m2/12 hrs. for 7 consecutive days. BC exhibited a myeloid phenotype in 9 and a lymphoid phenotype in 3 cases. Median duration of the previous chronic phase had been 36 months (range 6-180). RESULTS: Clearing of peripheral and bone marrow blasts was achieved in all but one patient. Three other patients were classified as resistant because of blastic regrowth, and 3 died of infection during postchemotherapeutic aplasia. Two patients achieved complete remission (CR) and 3 partial remission (PR). The median duration of response was 11 months (range 6-32). CONCLUSIONS: In BC of CML the IDR/Ara-C combination led to an encouraging rate of either partial or complete responses. The relatively long duration of unmaintained response was even more interesting, with the duration of PR approaching that of CR. These data suggest that IDR should be considered as one of the first-line drugs in the treatment of BC of CML.

Adult↗

PubMed1991

[Obstruction of pulmonary arteries. Contribution of the scanner and MRI. Apropos of 10 cases].

We present a retrospective study of ten patients presenting non specific clinical manifestations in whom the diagnosis of pulmonary embolism was documented by CT scan and/or MRI. Results of CT scan and/or MRI were compared to DSA bi-selective pulmonary angiography findings. In a large number of cases, CT scan and MRI allowed the detection of the obstruction within the right and left pulmonary arteries (RPA and LPA). Although these techniques did not permit the diagnosis of peripheral clots, pulmonary infarcts were usually depicted by these two procedures. CT scan and/or MRI could be performed as first-line investigations in case of atypical clinical symptoms because of their high relevance for proximal pulmonary artery obstruction, although these two non-invasive procedures cannot indicate the aetiology of the obstruction etiology.

Evaluation Studies as Topic↗

PubMedDate not supplied

Treatment of neuroblastoma with [131I]metaiodobenzylguanidine: long-term results in 25 patients.

From 1984 to 1990 we have treated altogether 25 children with [131I]metaiodobenzylguanidine (131I-MIBG) for a refractory, relapsed or metastasized neuroblastoma. Three children had stage III and 22 children had stage IV of the disease; at diagnosis their ages were between 4 months and 10 years. Children with stage III disease had at diagnosis a median age of 3.0 years and at treatment 3.8 years. After first-line chemotherapy 2 children had achieved a complete remission (CR), while in 1 child the tumor did not respond (NR) to the initial treatment. At the time of 131I-MIBG treatment 2 children had relapsed and in the other one no further response was achievable. The children were treated by a 13.5 +/- 12.9 mCi/kg BW per course with a mean total dose of 280.7 +/- 243.9 mCi. One child achieved CR by 131I-MIBG alone, while in 2 cases no measurable success was observed. All 3 children were treated additionally by surgery, chemotherapy and bone marrow transplantation (BMT). Two children have died but one is alive and in CR. The 22 children with stage IV disease were treated in two different study groups. In group A, 14 children were studied for side-effects and response to 131I-MIBG. All children were pretreated with standard chemotherapy. Five were treated in relapse, 5 in progression and 3 at a refractory state of the disease; only 1 child was in complete remission when being treated with 131I-MIBG. Group A patients were treated with a mean of 2.4 courses, with 10.3 mCi/kg BW for each course.(ABSTRACT TRUNCATED AT 250 WORDS)

3-Iodobenzylguanidine↗

PubMedDate not supplied

[Rilmenidine, a new antihypertensive agent in the first line treatment of essential arterial hypertension. Multicenter double-blind study versus atenolol].

After 4 weeks on placebo, 90 hypertensive patients (37 men, 53 women, mean age 55 years) with systolic (SBP) and diastolic (DBP) blood pressures of 162/99 and 165/100 mmHg respectively received double-blind treatment with either rilmenidine 1 mg/day or atenolol 50 mg/day. This treatment was given alone for 8 weeks, with possible DBP greater than or equal to 90 mmHg, hydrochlorothiazide 25 mg/day was added between the 9th and 12th weeks of treatment. At week 13 all treatments were replaced by placebo. Both groups were similar at randomisation, and both treatments were similarly effective: after 8 weeks of monotherapy with rilmenidine or atenolol, the SBP/DBP had decreased by -18/-13 mmHg and by -21/-15 mmHg respectively, and the proportion of patients with normalised blood pressure (SBP/DBP less than or equal to 160/90 mmHg) was 66 percent and 65 percent. Effectiveness was maintained at 12 weeks, when less than 20 percent of the patients had taken hydrochlorothiazide. Both drugs were well tolerated clinically and electrocardiographically. There was a significantly greater decrease in heart rate on atenolol than on rilmenidine. Eleven patients (5 on rilmenidine, 6 on atenolol) dropped out of the trial, 2 and 3 patients in the respective groups on account of side-effects. Laboratory tests showed that the HDL-cholesterol level significantly decreased on atenolol and remained stable on rilmenidine (P less than 0.01), whereas the LDL-cholesterol level was stable on atenolol and decreased on rilmenidine (P less than 0.05). No rebound in blood pressure was observed on discontinuation of both treatments. This study shows that rilmenidine administered as first-line treatment is as effective as atenolol in lowering blood pressure, and it confirms that this drug is clinically and biochemically well tolerated.

Adult↗

PubMed1991

[Ovarian carcinomas. Intraperitoneal chemotherapy by needle].

Between January 1980 and February 1988, 61 women with ordinary ovarian carcinoma (OC) were treated with combined intraperitoneal and intravenous first-line therapy. For intraperitoneal infusions we did not use implanted systems which are often poorly tolerated and sometimes create non-negligible complications. We simply used a lumbar puncture needle left in situ for less than 2 hours. In second regard laparotomies, the 7 patients with stage I OC and the 3 patients with stage II OC were in histologically and cytologically proven complete remission, as were 34 of the 43 patients with stage III OC (79 percent) and 1 of the 8 patients with stage IV OC. After a mean follow-up of 56 months, the overall actuarial survival rate was 66 percent and the survival rate without recurrence was 54 percent. During the same period, 26 patients with recurrent OC were treated with second-line intraperitoneal chemotherapy. After a mean follow-up of 30 months, 10 were in apparently complete remission, and after a 27 to 61 months period 7 of these 10 patients had no recurrence. These results must be compared with those obtained with other salvage methods.

Abdominal Pain↗

PubMed1991

Anticholinergic bronchodilators in obstructive airway disease.

The appropriate use of anticholinergic bronchodilating agents in the management of patients with chronic obstructive pulmonary disease (COPD) or asthma is the subject of renewed academic interest. This article examines the physiology of airway function and the pharmacology of anticholinergic agents, and reviews the relevant clinical literature concerning the use of these agents for individuals with chronic obstructive pulmonary disease or asthma. It is suggested that anticholinergic bronchodilators are safe and effective as first-line therapy for COPD and should be considered as adjunctive therapy for asthma.

Asthma↗

PubMed1991

LH-RH analogue Zoladex in the treatment of pre- and perimenopausal women with metastatic breast cancer (results of the Italian Cooperative Study).

From May 1987 to May 1989 sixty one pre- and perimenopausal women with advanced or recurrent breast cancer entered in an open non comparative study. They were treated, as a first-line therapy, with goserelin (Zoladex ICI-118630) a long acting gonadotropin-releasing hormone (LH-RH)-analogue in a depot formulation. Fifty three patients were evaluable for response; median age at entry was 41 years (range 28-56). Serum concentrations of 17 beta estradiol, LH and FSH were significantly suppressed within the first four weeks of therapy and remained suppressed for the whole duration of treatment. Subjective responses were observed, such as pain reduction and/or performance status improvement in 58% of patients. Overall objective response (CR + PR) occurred in 16 (30.2%) patients in all major sites of disease with a median time to response of 12 weeks (range 8 to 48 weeks) and a lifetable median duration of response of 36 weeks (range 16 to 76 weeks). The lifetable median time to progression was 17 weeks (range 5 to 76 weeks). Goserelin depot was well tolerated with no withdrawal due to possible adverse reactions. The observed subjective and objective response rates are comparable to those induced by surgical oophorectomy. Goserelin provides a well tolerated medical alternative to ovarian ablation, without the morbidity associated to surgery. In conclusion the present paper suggests that this innovative chemical estrogen deprivation, in premenopausal breast cancer patients, might be favorably investigated as an adjuvant therapy in future clinical trials.

Adult↗

PubMedDate not supplied

[Urological complications in renal transplantation].

1,224 renal transplant patients were studied. 50 kidneys were obtained from living related donors. The mean age of the recipients was 34.6 years (16.8 to 67.6 years) Ureteric reimplantation was initially performed by uretero-ureteric anastomosis (19%), then into the bladder according to the Leadbetter-Politano technique (69%) and subsequently according to the Lich-Gregoire extra-vesical technique (10%). A cutaneous ileostomy or reimplantation into the renal pelvis was performed in the remaining 2% of cases. The risk of one or more urological complications was 11.2% (137/1,224) and 7.9% when only those patients requiring surgical intervention were taken into account. These complications were classified into 3 categories: strictures (60.6%), fistulae (35.8%) and stones (6.6%). The frequency of urological complications was lower with the Lich-Gregoire technique (4.1%) which we have currently adopted. The renal transplant was lost in 6.1% of cases directly related to a urological complication. The presence of urinary tract fistulae had an unfavourable influence on graft survival due to detransplantations. Whenever possible, our preferred approach consists of percutaneous and/or endourological techniques as first-line treatment followed by second-line surgical treatment in the event of failure of the percutaneous approach.

Adolescent↗

PubMedDate not supplied

[Cystic renal cancers. 14 case reports].

The authors present 14 cases of renal cancers with a cystic appearance raising pre and intraoperative diagnostic difficulties. Although ultrasonography has become the first-line investigation, computed tomography is now the most accurate diagnostic examination. The diagnosis of complicated benign cyst must be proposed very cautiously and the persistence of doubtful images justifies surgical exploration. In order to be reliable, frozen section histological examination must include all of the cystic tumour. Polar nephrectomy with frozen section examination is therefore the recommended intraoperative diagnostic procedure in a case of suspicious cyst. The curative treatment of these cancers is classical radical nephrectomy.

Adult↗

PubMedDate not supplied

Radiation therapy for primary non-Hodgkin's lymphoma of the head and neck.

From October 1977 through September 1986, a total of 77 patients (Stage I, 26; II, 35; and III-IV, 16) with primary non-Hodgkin's lymphoma (NHL) of the head and neck were treated with radiation therapy and chemotherapy (CVP or CHOP regimen) or radiation therapy alone. Actuarial 5-year survival rates by stage were 79% in Stage I, 35% in II, and 8% in III-IV. Significant prognostic factors were clinical stage (p = 0.0001), histological grade by the Working Formulation (p = 0.0089), and surface marker (T and B cell analysis) (p = 0.0001). In Stage II patients, the serum lactate dehydrogenase (LDH) level (p = 0.0286), the number of cervical lymph nodes involved (p less than 0.03), and maintenance chemotherapy after initial treatment (p = 0.0077) were significant prognostic factors. In conclusion, more intensive chemoradiotherapy is necessary as the first-line treatment in those with poor prognosis, especially those with T-cell type and high grade histology. In addition, maintenance chemotherapy after initial chemoradiotherapy is very important for Stage II NHL patients, especially those with a high LDH value or multiple cervical lymph node involvement.

Antineoplastic Combined Chemotherapy Protocols↗

PubMed1991

[ACE inhibitors in the treatment of hypertension in elderly patients].

Recent epidemiological studies clearly indicate that blood pressure rises with age and that hypertension remains a major risk factor for cardiovascular morbidity and mortality in the elderly. An accurate antihypertensive therapy reduces in these patients the incidence of stroke and heart failure. Because of their clinical efficiency and good therapeutic tolerance, the angiotensin-converting enzyme (ACE) inhibitors are first-line drugs for the treatment of elderly hypertensive patients. ACE inhibitions is expected to normalize blood pressure in approximately 40-60% of the patients. When needed, they can be combined with other drugs of different antihypertensive properties. In these cases, the most rational combination therapy consists of an ACE inhibitor with a diuretic or a calcium antagonist.

Aged↗

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↗