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PubMed1990

Treatment of herniated lumbar disc by percutaneous nucleotomy with aspiration. Preliminary results in 70 cases.

Seventy patients suffering from lumbar pain with sciatica, radiculalgia or lumbodynia were reviewed at least 3 months after automated percutaneous nucleotomy (Nucleotome). There were 26 women and 44 men, aged from 19 to 72 years. Results were highly satisfactory in 39 patients (56.5%). Among these, 10 had lumbar pain of discal origin, 15 had pure radiculalgia and 14 had lumbar pain and radiculalgia. Incomplete improvement requiring medical treatment was obtained in 11 patients (15.5%). The procedure was unsuccessful in 20 patients (28.5%) with persistence or worsening of the initial symptoms; 5 of them subsequently underwent chemonucleolysis with 4 good medium-term results and 1 failure. These preliminary results show that percutaneous nucleotomy seems to be effective in lumbar pain of discal origin, with a 66.5% success rate. In patients with pure radiculalgia or lumbar pain cum radiculalgia the results are less impressive, with a success rate of about 50%. However, this well-tolerated technique may be used as first-line treatment of herniated discs when the discs are small, subligamentous and non migrated.

Adult↗

PubMed1990

[Clinical effectiveness of delayed-action theophylline preparations].

Clinical efficiency of course treatment has been assessed for 5 long-acting drugs of theophylline series: retaphylline (Finland), theo-dur (Sweden), durophylline (Yugoslavia), theopek and theobilong (USSR). The drugs were tested in 139 patients with chronic++ bronchial obstruction. It was established that first-line therapy with theophylline should be started with low doses (400 mg/day) and last for 3 days to define individual sensitivity to theophylline drugs followed by increasing doses. On day 7 serum theophylline levels were to be measured for control and dose correction. In cross administration and adequate doses the drugs activity was similar. For patients suffering from nocturnal asthma attacks it was an atypical doze regimen implying administration of two-thirds of the day, dose in the evening that produced the highest effect. The incidence and severity of CNS, cardiovascular and gastrointestinal side effects varied with the dose blood concentration and individual sensitivity to theophylline.

Adult↗

PubMed1990

Amyloid tumour resected by laser therapy.

We report a patient presenting with dyspnoea, cough and fever with a middle lobe atelectasis. Amyloid deposits in the bronchial wall caused almost complete obstruction of the middle lobe bronchus. The patient was treated with neodymium yttrium aluminium garnet (NdYAG) laser photoresection resulting in complete clearance of the middle lobe bronchus. Laser therapy has to be considered as first-line therapy for patients with endobronchial amyloidosis.

Adult↗

PubMed1990

[Treatment of invasive epithelioma of the uterine cervix: the experience at the Institut Gustave-Roussy].

The therapeutic protocole used at the Gustave Roussy Institute for invasive epithelioma of the uterine cervix rests, for limited forms (T1B-T2 proximal), on combined radiology and surgery. This include the recently introduced supraradical lymphadenectomy extended to the lumboarotic lymph nodes, first-line surgery in young women to preserve the ovarian function and postoperative chemotherapy for extra-pelvic N+ forms. In extensive forms (distal T2 and T3), the treatment of choice still is radiotherapy with external irradiation associated with curietherapy. T3 forms with urinary tract involvement now benefit from interventional radiology techniques. The basic treatment of T4 forms involving the bladder and/or rectum remains radiotherapy, but wide surgical resection (exenteration) is still indicated in some cases. The treatment of particular forms (post-hysterectomy cervix, uterine prolapse, pregnancy) relies on techniques that are suitable for each individual situation.

Cancer Care Facilities↗

PubMed1990

Definition of refractoriness against conventional chemotherapy in acute myeloid leukemia: a proposal based on the results of retreatment by thioguanine, cytosine arabinoside, and daunorubicin (TAD 9) in 150 patients with relapse after standardized first line therapy.

Response to salvage therapy at first and second relapse was analyzed in 150 patients with acute myeloid leukemia (AML) to improve the characterization of relapsed AML and to deduce from this analysis a proposal for the definition of refractoriness against conventional therapy. Salvage treatment consisted of a repetition of the TAD 9 regimen which was already applied as induction protocol at initial diagnosis. All patients were recruited from the multicenter 1982 trial of the German AML Cooperative Group and had thus received a standardized first line treatment. Response at first relapse was significantly related to the duration of the first remission. From 38 patients relapsing within 6 months after successful induction therapy, only 11 (28%) achieved a second complete remission as compared to 58 of 98 (59%) cases with later occurring relapses (p less than 0.01). This difference was due to a significantly higher incidence of persistent leukemia in the former group and not biased by differences in early death rates. No other variable was found predictive for the response to salvage treatment including age, WBC, serum LDH, morphologic subtype, presence or absence of DNA aneuploidy as detected by flow cytometry or maintenance chemotherapy. A low remission rate of 28% was also obtained in the 14 patients at second relapse. These data indicate that patients with a duration of their first remission of more than 6 months cannot be considered as being refractory against standard chemotherapy while patients with early relapses and second recurrences have a response rate of less than 30% due to refractory disease. Hence, the following criteria are proposed for the definition of refractoriness against standard chemotherapy in advanced AML: (a) nonresponse to first-line induction therapy, (b) early relapse within 6 to 12 months of first remission, (c) relapse after 6 to 12 months of first remission and failure on a reinduction attempt with established regimens, (d) second and subsequent relapses. These criteria may provide a useful rationale for the selection of the most appropriate treatment at relapse. They may also serve as eligibility criteria for clinical phase I/II studies and will facilitate interstudy comparisons.

Adult↗

PubMed1990

[Can tumors of the breast larger than 3 centimeters be treated conservatively?].

Unlike small breast cancers, which are now treated conservatively by primary tumorectomy, the most important lesions (T2 and T3) as usually treated tumorectomy, the most important lesions (T2 and T3) as usually treated by mastectomy. However, in patients with these large lesions attempts may be made at conserving the breast with reliable oncological safety and good cosmetic results. Depending on clinical presentation, one or the other of two therapeutic approaches may be considered. The most common treatment is preoperative radiotherapy of 45 Gy which, in more than 50 p. 100 of the cases results in a tumoral regression that is sufficient for secondary tumorectomy to be performed. In some patients, the first-line treatment consists of wide tumoral excision as part of a reductive mammaplasty, followed by radiation.

Breast Neoplasms↗

PubMed1990

Epidemiology of hypertension among Chinese in Taiwan.

A series of population surveys in Taiwan have found that hypertension was present in 14.1% in 1976 and in 14.8% in 1984 in those aged above 18, and in 33.4% in 1976 and in 31.4% in 1987 in the elderly. In 1976, 4.5% of hypertensives aged 18 and over had good blood pressure control and in 1982 this figure was still only 4.9%. The outcome among 3037 untreated hypertensives out of a general population of 17,000 in southern Taiwan showed that 49.9% of those hypertensives died in the 22-year follow-up period. The annual death rate from stroke was 5.9/1000/year in untreated hypertensives but only 0.8/1000/year in normotensives. Compliance rate for treatment of hypertension in Taiwan showed that 81.6% of patients had good compliance under a free-of-charge programme with 86.1% of them having their blood pressure under control. In a comparison of the efficacy of antihypertensive drugs as first-line, propranolol (40.8%) proved to be more efficacious than trichlormethiazide (33.2%) in Taiwanese hypertensives. The difference however was not statistically significant.

Adult↗

PubMed1990

[Surgical treatment of portal hypertension].

The surgical treatment, by means of shunts or disconnections, of ruptured oesophageal varices in portal hypertension is always indicated but not always on the forefront. However, it remains the first-line treatment in segmental portal hypertension and in Budd-Chiari syndrome. It is on a par with the non-surgical treatments in case of prehepatic block but ranks second in case of pre- and intrasinusoid blocks. In all the hepatic diseases with threatening hepatocellular deficiency, liver transplantation is the most spectacular of current and future achievements.

Ascitic Fluid↗

PubMed1990

Survey of physician practices in managing patients with chronic ventricular arrhythmias.

To better understand how physicians manage patients with chronic ventricular arrhythmias, questionnaires were mailed in July, 1989, to 680 internists, family physicians and cardiologists in West Virginia. Responses were returned by 35 per cent; those from 33 physicians who seldom prescribed drugs to treat arrhythmias were excluded from analysis. Quinidine and procainamide were the preferred first-line antiarrhythmics for 53.3 per cent and 24.3 per cent of physicians, respectively. Control of symptoms was listed as the usual indication for therapy by 32.2 per cent, and improvement in prognosis by 20.1 per cent. Physicians perceived a high prognostic benefit to antiarrhythmic treatment in patients with sustained ventricular tachycardia or history of cardiac arrest, and a generally low prognostic benefit in those with mitral valve prolapse. Opinion was divided on the prognostic benefit in other patient groups including those with frequent ventricular premature beats following myocardial infarction. These results help quantify current physician practices in managing patients with chronic ventricular arrhythmias.

Arrhythmias, Cardiac↗

PubMed1990

Antimicrobial susceptibility patterns of Haemophilus isolates from children in eleven developing nations. BOSTID Haemophilus Susceptibility Study Group.

The antimicrobial susceptibilities of 426 isolates of Haemophilus species, which were collected as part of a worldwide study of the etiology of acute respiratory disease in children in selected developing countries, were determined. Eleven antibiotics were tested using the recently described Haemophilus Test Medium. There was a low prevalence of antibiotic resistance; 6% of strains were resistant to ampicillin, and 1.6% were resistant to chloramphenicol. Strains resistant to both ampicillin and chloramphenicol were recovered only from Thailand. Susceptibility to penicillin G was also determined; the minimum inhibitory concentrations for penicillin and ampicillin were concordant within one 2-fold dilution in 97% of the isolates. Thus, Haemophilus isolates were as susceptible to penicillin G as they were to ampicillin, and penicillin resistance was infrequent overall. These data provide support for the current protocols for the management of acute respiratory infections in children in developing countries, in which penicillin G is a first-line agent.

Anti-Bacterial Agents↗

PubMed1990

[Empirical treatment of febrile episodes in granulocytopenic patients with a combination of piperacillin and ofloxacin. Preliminary study].

We evaluated the efficacy and toxicity of piperacillin-ofloxacin as an empiric treatment of fever in patients with neutropenia. 24 febrile episodes occurring in 21 patients (mean neutropenia: 204/mm3) were treated. The neutropenia was due to an hematologic malignancy in 6 cases and to chemotherapy in 15 cases. Fever was related to septicemia in 4 cases, urinary tract infection in 1 case, other infectious sites without microbiological documentation in 11 cases, and was of unknown origin in 8 cases. Empirical therapy was started within 24 hours of the occurrence of fever greater than 38.5 degrees C with the combination of intravenous piperacillin (12 g/day in 3 divided doses) and oral ofloxacin (400 mg/day in 2 doses). The overall response rate was 86% (19/22) of evaluable cases, with an immediate success rate (apyrexia within 48 hours) of 46%. Of the 3 failures, one was bacteriologically documented and was due to a multiply resistant strain of Staphylococcus haemolyticus (to which both piperacillin and ofloxacin were resistant). The therapy was clinically well tolerated in all except 3 patients, in whom intolerance to intravenous piperacillin was observed, leading to discontinuation of the drug in 2 cases. More extensive and comparative trials should better determine the place of this piperacillin-ofloxacin combination as first-line treatment of febrile episodes in patients with neutropenia.

Adult↗

PubMed1990

[A case of stage III ovarian carcinoma successfully treated with oral etoposide].

A 49-year-old woman with stage III ovarian cancer (undifferentiated adenocarcinoma), who refused combination chemotherapy for postoperative residual tumor, were successfully treated with daily oral etoposide in the outpatient clinic. The etoposide (50 mg/day) was first given orally and then a dose of etoposide was decreased to 25 mg/day because of alopecia and gastrointestinal toxicity. After seven months of treatment, the complete remission was confirmed by the second look laparotomy, and cytology of peritoneal surface revealed no signs of adenocarcinoma. This case suggests that daily oral etoposide therapy might be the alternative as a first-line and second-line chemotherapy of ovarian cancer in the outpatient clinic.

Adenocarcinoma↗

PubMed1990

Gastric polyps: the case for polypectomy and endoscopic surveillance.

Thirty-two patients with gastric polyps and a mean follow-up period of 18 months were analysed. The principal presentation was epigastric pain accompanied at times by haematemesis or melaena. As in other series, the hyperplastic polyps (21 cases) predominated, followed by the adenomatous type (six patients). Endoscopy was an effective first-line investigative method for 21 patients and for a further five who had initial false negative barium studies. Gastric polypectomy was performed for 60% of patients without any complications. There was discrepancy between the biopsy material and polypectomy specimen in five of seven patients who were recalled for snaring. Although no polyp in this series turned malignant, one diffuse polyposis patient developed linitis plastica after 4.5 years of follow-up. Hence, for reasons of recurrence, new polypoid growths and development of gastric cancer, long-term surveillance is indicated.

Adult↗

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↗