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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↗

PubMed1990

[The value of cytoreductive second-look surgery in advanced epithelial ovarian carcinoma].

40 patients with advanced epithelial ovarian carcinoma were investigated to evaluate the influence of further cytoreduction during second-look surgery on survival after termination of first-line polychemotherapy containing cisplatinum. Radical tumorectomy with no macroscopic residual tumor mass was achieved in 27.5% of cases; in 52.5% the residual tumour mass was less than 2 cm and in 20% it was more than 2 cm in diameter after cytoreductive second-look surgery. Median survival time after second-look within these three groups of patients was 15.2 months, 16.9 months and 15.3 months, respectively (Mantel test, p = 0.74). In contrast to the situation at the diagnostic operation, further cytoreduction during second-look surgery has no positive influence on survival. We therefore abandoned this operation in clinically tumour-positive patients.

Antineoplastic Combined Chemotherapy Protocols↗

PubMed1990

A comparative trial of flunarizine and propranolol in the prevention of migraine.

The calcium-entry blocker flunarizine (Sibelium; Janssen) was compared with the beta-adrenoreceptor-blocking agent propranolol in the prophylaxis of migraine. Fifty-eight patients were entered into a double-blind 4-month treatment trial. Patients in whom beta-blockers were contraindicated were excluded from the trial. At the end of the trial 28 patients had received 10 mg flunarizine at night during the study, 29 patients had received 60 mg propranolol 3 times a day and 1 patient was withdrawn. Both groups responded well; and there was a 4-fold drop in frequency of attacks. There was no significant difference between the two groups in terms of patient profile, onset of response to therapy, final response to therapy, incidence of dropout from the trial or incidence of side-effects. Side-effects for flunarizine were weight gain (9 patients) and tiredness (6), and for propranolol sleep disturbances including nightmares (6), tiredness (8), mental changes (e.g. irritability) (3) and weight gain (4). Both flunarizine and propranolol are useful drugs for migraine prophylaxis and can be used effectively as first-line drugs. The low incidence of generally mild side-effects with flunarizine may make it preferable to many of the agents at present in use for migraine prophylaxis.

Adolescent↗

PubMed1987

Evaluation of a new antihypertensive agent ketanserin versus methyldopa in the treatment of essential hypertension in older patients: an international multicenter trial.

The serotonergic antagonist ketanserin (K) was compared to methyldopa (M) in a four-center international study in 119 hypertensive patients over 50 years of age. After a 4-week placebo run-in period, patients randomly received K (20-40 mg b.i.d.) or M (250-500 mg b.i.d.) for 3 months. The drugs were given in monotherapy for at least 1 month, then a diuretic could be added if blood pressure remained abnormally high. For the patients on monotherapy, active drug was replaced by placebo at the end of the 3-month period until the patients were hypertensive again. K and M had a similar effect on systolic blood pressure, but diastolic blood pressure was reduced significantly more by K than by M. Significantly more patients had their blood pressure normalized in the K group (75%) than in the M group (49%). The twice daily dosage schedule caused trough blood pressure control with both drugs. No rebound hypertension occurred at discontinuation of treatment. Monotherapy with K caused a decrease in heart rate (-5 beats/min) while M produced no change. Body weight decreased with K (-0.5 kg) and increased with M (+ 0.4 kg). No important hematological or biochemical changes were seen with either drug. Slightly fewer patients reported adverse reactions during K monotherapy (40%) than with M (45%). In the latter group mainly central side effects were observed. The data confirm K to be an effective first-line antihypertensive agent with a favorable side-effect profile.

Blood Pressure↗

PubMed1987

Is first salvage chemotherapy the last-line chemotherapy in children with Hodgkin's disease? A tentative answer based on long observation of two patients.

In 82 children affected with Hodgkin's disease, in whom a complete remission was obtained, the first relapses occurred in 13 patients, their outcome was a follows: one child died of relapse and in 12 others second complete remissions were achieved. They were durable in 10 children (median, 65.5 months). Two remaining children had further relapses, their treatment consisted of four successive salvage chemotherapies. Both patients are now in their fifth complete remission. The third-line chemotherapy was already introduced 78+ months and 39+ months ago respectively. We believe that it is not possible to determine exactly the end-stage of Hodgkin's disease in those children and adolescents who have failed the first-line salvage chemotherapy.

Adolescent↗

PubMed1987

Carvedilol for systemic hypertension.

Twenty-four hour profiles of intraarterial ambulatory blood pressure (BP) and heart rate were significantly reduced by administration of carvedilol, a new beta-blocker with vasodilating properties. Twelve patients were given carvedilol, 25 mg twice daily for 2 weeks; the dose was then increased to 50 mg twice daily if the target BP was not achieved. After 4 weeks of therapy, mean daytime reduction in BP was 25 +/- 3 mm Hg systolic and 19 +/- 3 mm Hg diastolic, and mean reduction in heart rate was 22 +/- 3 beats/min. BP at the peak of isometric exercise and during dynamic exercise was also significantly reduced. Radionuclide measurements showed that left ventricular ejection fraction was not affected by treatment, but there was a significant reduction in systolic and diastolic volumes. The drug was well tolerated. This clinical trial suggests that carvedilol will be a useful first-line drug for treatment of essential hypertension, and its vasodilating action may have a more favorable effect on left ventricular function than conventional beta-blocking drugs.

Adrenergic beta-Antagonists↗

PubMed1987

Long-term hypotensive treatment with nitrendipine in mild to moderate essential hypertension: preliminary results of a placebo-controlled study versus atenolol.

Nitrendipine is a dihydropyridine calcium antagonist suggested to be a new drug for first-line antihypertensive therapy, possibly active in once-daily administration. In the present study the acute and long-term hypotensive effects of nitrendipine have been evaluated in comparison with those of atenolol in a randomized, double-blind, clinical trial. Twenty-four patients have been studied, and the effects of treatment have been evaluated both at rest and during psychological and physiological stresses. Hemodynamic noninvasive parameters have also been obtained, at rest and during mental arithmetic tests, by a continuous-wave Doppler technique. Preliminary results about the first 13 consecutive patients are reported here. Nitrendipine induced a highly significant acute hypotensive effect (2 h after drug administration), whereas no effect was observed for atenolol except for heart rate. During chronic treatment (5 weeks), nitrendipine showed less hypotensive effect than atenolol when BP values 24 h after the last administration were analyzed, but significantly more effect when values obtained 2 h after drug administration were evaluated. These findings confirm that nitrendipine is effective in decreasing blood pressure, but the once-daily administration may not bring about the maximum effect in all patients. Interesting aspects of this drug, which make the clinical use of this compound safe, are represented by apparent lack in tolerance and rebound, and by the moderate increase in cardiac output associated with the treatment.

Adult↗

PubMed1989

European experience with ifosfamide in lymphomas.

In malignant lymphomas, ifosfamide-containing regimens were at first used mainly in second-line therapy and response-adapted protocols. Currently, in combination with other drugs, ifosfamide is being used in several phase-III trials. As salvage therapy in non-Hodgkin's lymphoma (NHL), IMV-Bleo (ifosfamide, methotrexate, etoposide, bleomycin) produced a complete remission (CR) rate of 41% and seemed to be particularly effective in patients with suboptimal response to first-line treatment. IBEP (ifosfamide, bleomycin, etoposide, procarbazine), in combination with procarbazine and bleomycin was an effective non-cross-resistant alternative in CHOP (cyclophosphamide, hydroxydauomycin/doxorubicin, vincristine, prednisone)-refractory NHL. In a trial of response-oriented therapy in high-grade malignant lymphoma patients, the investigators concluded that consolidation therapy was necessary even in patients with rapid response to CHOP. Patients with NHL resistant to or relapsing from conventional chemotherapy or with MOPP-ABVD (mechlorethamine, vincristine, procarbazine, prednisone, doxorubicin, bleomycin, vinblastine, decarbazine)-resistant Hodgkin's disease (HD) were treated with BMV-VIP [bleomycin, plus high-dose methylprednisolone plus ifosfamide, etoposide, plus methylprednisolone]. In high-grade malignant NHL, patients received three cycles of COP-BLAM (cyclophosphamide, vincristine, procarbazine, prednisone, bleomycin, doxorubicin). Those who achieved CR received two more cycles of COP-BLAM and IMV (ifosfamide, methotrexate, etoposide) as consolidation therapy. Patients in partial remission (PR) or with less of a response to COP-BLAM were switched to IMV. After reaching CR, patients received two additional cycles as consolidation therapy. After the second restaging, patients were randomized to observation v additional radiotherapy. Of 191 patients, 148 have passed first restaging with 51% in CR; 85 went through the second restaging with 61% in CR. Of 32 patients who only reached PR after the first restaging, 15 (47%) achieved CR with IMV. For primary treatment of HD, the German Hodgkin Study Group added a third non-cross-resistant regimen, IMEP (ifosfamide, methotrexate, etoposide, prednisone), to supplement COPP (cyclophosphamide, vincristine, procarbazine, prednisone) and ABV in the primary treatment of HD. In a pilot study, 87% of 63 evaluable patients reached CR. The current phase-III protocol is comparing COPP/ABVD with fast alternating cycles of COPP/ABV/IMEP.

Antineoplastic Combined Chemotherapy Protocols↗

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↗