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At least 775 records · Page 43Linked to original sources
PubMed1999

Comparison of ramosetron and granisetron for preventing postoperative nausea and vomiting after gynecologic surgery.

UNLABELLED: In a prospective, randomized, double-blinded study, we evaluated the efficacy of granisetron and ramosetron for preventing postoperative nausea and vomiting (PONV) in major gynecologic surgery. One hundred twenty patients, ASA physical status I or II, aged 23-65 yr, received i.v. granisetron 2.5 mg or ramosetron 0.3 mg (n = 60 each) at the end of surgery. A standard general anesthetic technique and postoperative analgesia were used. The incidence of a complete response, defined as no PONV and no need for another rescue medication, 0-3 h after anesthesia was 87% with granisetron and 90% with ramosetron; the corresponding incidence 3-24 h after anesthesia was 85% and 90%; the corresponding incidence 24-48 h after anesthesia was 70% and 92% (P < 0.05). No clinically serious adverse events due to the drugs were observed in any of the groups. In conclusion, prophylactic therapy with ramosetron is more effective than granisetron for the longterm prevention of PONV after major gynecologic surgery. IMPLICATIONS: We compared the efficacy of granisetron and ramosetron for preventing postoperative nausea and vomiting in major gynecologic surgery. Prophylactic therapy with ramosetron was more effective than granisetron for preventing postoperative nausea and vomiting 24-48 h after anesthesia.

Adult↗
PubMed1987

Longterm followup of treatment with D-penicillamine for rheumatoid arthritis: effectivity and toxicity in relation to HLA antigens.

To assess therapeutic effect and toxicity of D-penicillamine in relation to HLA antigens, 111 consecutive patients with rheumatoid arthritis (RA) were followed for a period of 7-9 years. Side effects occurred in 60% and were the main reason for withdrawal in 52%. HLA typing was performed in 86; overall frequencies were comparable with those found in other studies in patients with RA. Drug induced proteinuria (5 patients) was associated with HLA-B8/DR3 (60 vs 9%), and thrombocytopenia (23 patients) with HLA-DR4 (94 vs 67%). Therapeutic effect was good in 26 (23%), and moderate in 30 (27%). No single variable, including HLA antigens, was predictive of effectiveness. It is concluded that although some of the side effects were associated with HLA antigens, HLA typing is not useful in predicting the outcome of treatment with D-penicillamine.

Adult↗
PubMed1986

Verapamil in angina pectoris.

New knowledge of the pathophysiology of coronary disease has helped determine the therapy for angina pectoris. Calcium antagonists have the advantage of being direct coronary vasodilators as well as decreasing overall demand by systemic vasodilatation. Verapamil has the same anti-anginal effect during exercise as beta-adrenoceptor blockers but has the advantage of increasing rather than decreasing the cardiac output and so fatigue both at rest and exercise commonly seen with beta-adrenoceptor blockers is not found with verapamil. The longterm incidence of side-effects with verapamil are few and it can be used as a single anti-anginal therapy in a three times daily dosage. Left ventricular function where normal and near-normal is not depressed. Tolerance to therapy has not been recorded. The anti-anginal effects have been shown to remain effective over at least a 5 year period. Verapamil should be considered as initial therapy for patients with stable angina pectoris.

Adrenergic beta-Antagonists↗
PubMed1995

The effect of osteoarthritis on disability and health care use in Canada.

Osteoarthritis (OA) is an important cause of longterm health problems and the most frequently reported reason for longterm disability in the population. The overall prevalence of reported arthritis (mainly OA) was 18% of the Ontario household population (age > or = 16 years), with 2.5% of the population reporting longterm disability. An appreciable proportion used health care resources and continued to do so over the long duration of the condition. Longterm disability was accompanied by a substantial effect on daily life, including troubles with mobility, dependence, and difficulty with everyday living activities, social isolation, curtailment of leisure and employment activities, and low income.

Activities of Daily Living↗
PubMed1989

[Afterload reduction by long-term nitrate therapy].

Tolerance to arterial and venous effects is a common problem in longterm-therapy with nitrates when dosing schemes with multiple, regulary timed intervals throughout the day are applied. A balanced effect on preload and afterload is essential for a successful therapy of congestive heart failure. Interval therapy, the once daily medication of a nitrate, has a proven tolerancefree effect on preload. This study addresses the problem of afterload reduction under longterm interval therapy with nitrates. Nine patients with coronary heart disease NYHA II-III with congestion under exercise where included in the study. After a washout period they where treated with once-daily 120 mg ISDN s.r. Measuring mean arterial pressure and cardiac output, we compared the effect of the first dose (acute) with the effect after 5 weeks 1 x 1 120 mg ISDN s.r. (chronic). After acute therapy the mean arterial pressure under exercise was reduced by 14% from 121 +/- 12 mmHg to 104 +/- 11 mmHg. The average reduction of blood pressure under exercise was unchanged during chronic therapy (105 +/- 8 mmHg). Peripheral resistance was reduced by 21% from 914 +/- 266 to 722 +/- 190 dynsec/cm5 after the first dose. The afterload reduction was maintained during chronic therapy (727 +/- 176 dynsec/cm5).

Blood Pressure↗
PubMed1997

Autologous stem cell transplantation for autoimmune diseases: issues in protocol development.

For patients with autoimmune disease resistant to conventional therapy, aggressive strategies employing high dose chemoradiotherapy and autologous stem cell transplant appear to be warranted. Support for this approach comes from animal studies employing marrow transplantation, which have shown promising results. Likewise, longterm control of autoimmune disease has been demonstrated in some survivors of allogeneic transplants for malignancy who incidentally had preexisting autoimmune disease. Initial strategies for autografting will use intensive transplant regimens incorporating cyclophosphamide with or without total body irradiation. Peripheral blood stem cell grafts purified by CD34 selection will be depleted of lymphocytes, and lead to rapid hematologic reconstitution after treatment. Close monitoring for disease responses, adverse effects of intensive immunosuppression, and longterm sequelae of high dose therapies will be required. Initial studies are best performed as close collaborations between rheumatologists and transplant specialists in appropriate research centers.

Animals↗
PubMed1992

Reduction of left ventricular hypertrophy after longterm antihypertensive treatment with doxazosin.

The aim of this study was to evaluate the effect of antihypertensive treatment with doxazosin on left ventricular anatomy and function. Therefore, after 4 weeks of washout with placebo (phase 1), doxazosin (dosage range from 1 to 16 mg, plus hydrochlorothiazide when necessary) was given to 11 essential hypertensive patients (6 M, 5 F, age range 34-63 years) for 8 weeks (phase 2) in order to achieve diastolic blood pressure values less than 90 mmHg; this dosage was then maintained for a further 20 weeks up to the end of the study (phase 3). Blood pressure was significantly reduced (Anova P less than 0.05), while heart rate did not change. A significant reduction of left ventricular mass index (from 128.5 +/- 26 to 114 +/- 23 g/m2, at the end of phase 1 and 3 respectively, P less than .001)) was observed. Before and during treatment left ventricular systolic function, both at rest and during stress (handgrip and cold pressor tests), evaluated by fractional shortening as related to end-systolic stress, in every case within 95% confidence limits, was calculated in normal subjects. Diastolic function, as evaluated by the ratio between peak early and atrial velocities of transmitral flow examined by pulsed doppler was significantly improved. Plasma catecholamine concentrations, plasma renin activity and plasma aldosterone did not change. A significant reduction of plasma cholesterol concentration was observed. These results confirm that doxazosin is a well tolerated and effective antihypertensive drug, with a favourable effect on blood lipids and they indicate that its longterm administration can induce a significant reduction of left ventricular mass.

Adrenergic alpha-Antagonists↗
PubMed1990

[Chronic heart failure: effect and evaluation of therapy with positive inotropic substances].

In congestive heart failure (CHF), even today, pharmacotherapy renders primarily only symptomatic improvement. The success of the treatment is basically dependent on the degree of functional myocardial impairment, that is, the condition of the inadequately treatable underlying disease. Treatment should be differentially oriented to the nature of the LV dysfunction as systolic or diastolic whereby the latter may account for 20 to 40% of those with CHF. In the case of diastolic LV dysfunction, because of the impaired compliance, vasodilators are not beneficial since small changes in volume may cause marked changes in filling pressures and vice versa. Additionally, inotropic substances are unfavorable since they further increase filling pressure and impedance, that is, diastolic LV function may become more compromised. For systolic LV dysfunction both vasodilators and positive inotropic substances can be employed. Some unsettled issues remaining include the appropriate time to begin treatment, the most suitable form of combined treatment and the best dosing regimens. Digitalis, as dobutamine, increases measured contractility; those seen to profit from digitalis include symptomatic patients with LV dilatation and impaired pump function as well as patients with supraventricular tachyarrhythmias. Prior to use of positive inotropic drugs in CHF, consideration should be given to whether favorable acute effects can be maintained during longterm treatment, adverse reactions such as arrhythmogenicity are acceptable, and the actions on myocardial oxygen balance. New nonglycoside positive inotropic agents which can also be administered orally, acutely improve hemodynamics; these include catecholamine derivatives, phosphodiesterase inhibitors (PDH). Both substance groups increase contractility but arrhythmogenicity as well, in general via increased concentrations of intracellular cyclic AMP. Reservations regarding the use of positive inotropic drugs for CHF have been supported by the results of studies showing that beta 1 agonists such as prenalterol and beta 2 agonists such as salbutamol or pirbuterol, due to down-regulation of beta-receptor density, are not capable of maintaining improved contractility during chronic treatment; intermittent dobutamine treatment resulted in higher mortality; beta-blockers without intrinsic sympathomimetic activity reduced mortality in patients with CHF after myocardial infarction while on use of beta-receptor blockers with intrinsic sympathomimetic activity, this favorable effect was not observed; during chronic PDH treatment, there was an unfavorable one-year mortality rate (50 to 100%); a controlled study with amrinone did not show a higher mortality than placebo. For most PDH, it is not known with certainty at which therapeutically effective dose the positive inotropic effect can best be realized and whether the acute hemodynamic effects are not predominantly attributable to the vasodilatory properties.(ABSTRACT TRUNCATED AT 400 WORDS)

Cardiomyopathy, Dilated↗
PubMed2002

[Sterile peritonitis after administration of icodextrin].

INTRODUCTION: Icodextrin is an 7.5% isoosmotic solution of the glucose polymer maltodextrin, recently frequently used in continuous ambulatory peritoneal dialysis (CAPD). It improves ultrafiltration and decreases glucose absorption. Among side effects of icodextrin, skin reactions and sterile peritonitis have been described. The authors present two cases of sterile peritonitis after icodextrin. CLINICAL PRESENTATION: In these two patients, the adverse events included peritoneal reaction to icodextrin solution. The reaction did not occur immediately after the initial administration of icodextrin, but after 70 (case 1) and 412 days (case 2) of regular use. This reaction to icodextrin solution resembled chemical peritonitis, however, the clinical picture was not absolutely typical of bacterial peritonitis either. Both patients had cloudy dialysate, elevated WBC in dialysate, no microorganisms were isolated, and no signs of allergic reaction could be detected. The clinical course was characterized by rapid remission upon isodextrin withdrawal. One patient received empiric antibiotic therapy, the other did not. Upon switching from icodextrin to glucose-based dialysate, the two patients were not challenged to icodextrin, and were doing well, without any symptoms of peritonitis. DISCUSSION AND CONCLUSION: The icodextrin solution contains an isoosmolar glucose polymer which allows longterm stable ultrafiltration. Among side effects, cutaneous reactions have been described (exfoliative, in the form of vesicles, psoriatic plaque or generalized exanthema in the form of pustules), which may occur in as many as 15% of patients. These symptoms and signs disappear upon discontinuation of icodextrin. Icodextrin side effects also include mild abdominal pain, allergic and hypersensitivity reactions, and recently sterile peritonitis. The patients described developed a clinical picture suggestive of chemical peritonitis. From the effluent no microorganisms were isolated, and the clinical picture was not absolutely typical of bacterial peritonitis either. Discontinuation of icodextrin was followed by immediate clearing of the effluents and normalization of WBC count.

Adult↗
PubMed2003

Effects of hospital volume on life expectancy after selected cancer operations in older adults: a decision analysis.

BACKGROUND: In addition to lower operative mortality, patients undergoing selected cancer operations at high volume centers have improved longterm survival. We sought to determine the overall effect of hospital volume on life expectancy after cancer surgery. STUDY DESIGN: We used a Markov decision analysis model to estimate life expectancy for patients undergoing resection for pancreatic, lung, or colon cancer. Model inputs included probabilities of operative mortality and longterm survival. For input data, we examined operative mortality (in-hospital or within 30 days) stratified by volume in over 400,000 patients undergoing resection for these three cancers using the national Medicare database (1994-1999). Risks of late mortality were abstracted from published studies (MEDLINE, 1966 to present) to model the effect of hospital volume on longterm survival. In analysis, we first calculated life expectancy for patients undergoing surgery at very low, low, medium, high, and very high volume hospitals. We then explored the effects of various regionalization strategies. RESULTS: Life expectancy increased steadily with hospital volume for all three cancers. Life expectancy after pancreatic cancer resection increased linearly with hospital volume: from 1.9 years at very low volume centers to 3.6 years at very high volume centers. For lung cancer, life expectancy ranged from 5.4 to 6.6 years. Increases in life expectancy for colon cancer were not as dramatic: from 6.8 at very low volume hospitals to 7.4 years at very high volume hospitals. Differences in life expectancy across volume strata were largely attributable to differences in longterm survival, not operative mortality. From a policy perspective, regionalizing surgery for colon cancer would produce the greatest overall life-expectancy gains, but it would require moving most patients. CONCLUSIONS: Patients aged 65 and older with pancreatic, lung, and colon cancer have substantially greater life expectancy after cancer resection at higher volume hospitals. Further work is needed to understand the mechanisms underlying differences in performance across hospitals in cancer care.

Aged↗
PubMed1975

Animal model acoustic neuroma.

As part of an effort to develop a longterm animal model simulating the effects of acoustic neuromas, a series of shortterm electrophysiological experiments were performed in the cat. The eighth nerve, as it exits the internal auditory meatus, was exposed and a silicone baloon catheter secured over the nerve. Pure tones and clicks were introduced ipsilaterally and primary evoked potentials were recorded from the contralateral auditory cortex. Alterations in the evoked potentials were examined as the baloons were inflated and deflated. Several reproducible phenomena were recorded: (1) contact between the silicone balloons and eight nerves resulted in substantial reductions in the evoked potential; (2) there was a further reduction in the evoked potential with inflation of the indwelling balloons; and (3) there was a prolongation of the latency period between auditory stimulation and the onset of the evoked potential with balloon inflation. All of these phenomena were reversed when either the contact was broken or balloons deflated.

Acoustic Stimulation↗
PubMed1997

[Local therapy with capsaicin or ASS in chronic pain].

OBJECTIVE: To provide a brief review of the current state of topical treatment with capsaicin or acetylsalicylic acid (ASA) for therapy of chronic pain syndromes. DATA SOURCES: A MEDLINE search was used to find the pertinent literature on "capsaicin" or "ASA" and "chronic pain"; further publications found in these articles were added. CONCLUSIONS: Capsaicin is a white crystalline parent compound of a group of vanillyl fatty acid amines. Because of its highly specific action in neurons it has become an important tool in neuroscience. Because of its effects, it is obvious to try for the therapy of circumscribed neuropathic pain. Capsaicin acts by depleting stores of substance P and other neurotransmitters, resulting in a blockade of a specific group of sensory afferents. The corresponding clinical findings are initial burning and a desensitization of specific C fiber nociceptors after repeated application. The pain relieving potency was observed in various clinical investigations and even in a few controlled, double-blind studies about neuropathic pain syndromes and (osteo)arthritis. In contrast to these findings, a recent study found no significant benefit of capsaicin, probably because this study was the first to use an active placebo. Therefore, and because clinical efficacy and advantages over other therapies have not been demonstrated up to now, capsaicin cannot be classified as standard therapy. It may be a therapeutic option as an alternative or as an adjuvant treatment. Pain reduction was also observed after topical application of ASA/ether mixture in the one and only controlled double-blind study on this issue. Therefore, topical ASA therapy for (post)herpetic neuralgia is mainly based on a few enthusiastic case reports rather than on well founded investigations. Furthermore, the discrimination of local from systemic effects, the toxicological profile of longterm topical treatment, and the mechanism of action has not been evaluated. In conclusion, topical ASA cannot be recommended for routine clinical use at present.

English Abstract↗
PubMed2005

Laparoscopic adjustable gastric banding: 1,014 consecutive cases.

BACKGROUND: The purpose of this study was to examine 1,014 consecutive laparoscopic adjustable gastric banding (LAGB) procedures with up to 48 months of followup, including evolution and changes in surgical technique, learning curve issues, weight loss outcomes, and complications. STUDY DESIGN: Between October 2000 and December 2004, 1,014 consecutive patients (81.8% women, mean age 42.3 years, mean body mass index 47.7 +/- 8.6 kg/m(2)) underwent LAGB operation at our center. Perigastric dissection was used in the first 44 patients; pars flaccida technique was used for the latter 970 patients. Fluoroscopy-guided adjustments were performed and patients received intensive followup. RESULTS: Excess weight loss at 12, 24, 36, and 48 months was 40.5 +/- 17%, 52.9 +/- 19.5%, 62 +/- 20.9%, and 64.3 +/- 19%, respectively, with data available in > 85% of patients who had reached each of the time intervals. Patients with lower preoperative body mass index had higher excess weight loss initially, but this difference was not apparent at 3 and 4 years' followup. At 36 and 48 months, respectively, 73.5% and 75% of patients had > 50% excess weight loss. Perigastric dissection led to 9 of 44 (20.5%) slippages, compared with 14 of 970 (1.4%) with pars flaccida technique. Other complications included 2 erosions (0.2%), 5 tubing breaks (0.5%), 7 access port problems (0.7%), and 14 acute stoma obstructions (1.4%). Eight (0.8%) bands were explanted. No deaths occurred. CONCLUSIONS: LAGB can achieve effective and safe weight loss. Change from perigastric to pars flaccida technique reduced slippage rate. Preoperative body mass index alone was not found to be a predictor of effective weight loss in the longterm.

Adolescent↗
PubMed2006

Sacral nerve stimulation for the overactive bladder.

Pharmacotherapy is the first-line treatment for overactive bladder, but many patients discontinue drug therapy because of intolerable side effects, expense, or lack of longterm adherence. Alternative treatments are needed for patients who are unable to tolerate pharmacotherapy or who do not derive the desired benefits. Sacral nerve stimulation therapy has evolved into one of the most widely accepted treatment modalities in the arena of neurourology. Sacral nerve stimulation activates or "resets" the somatic afferent inputs that play a pivotal role in the modulation of sensory processing for micturition reflex pathways in the spinal cord. This minimally invasive technology offers a safe, reliable, and durable treatment for lower urinary tract dysfunction.

Electric Stimulation Therapy↗
PubMed2003

Facing war, terrorism, and disaster: toward a child-oriented comprehensive emergency care system.

The combination of the overwhelming nature of disasters and the massive losses they engender gives rise to a complex clinical and social picture with longterm physical, psychological, and social effects on children, families, and communities. The authors suggest that to assess the damage properly, implement interventions on a large scale, keep tabs on rising needs, and restore societal function, mental health professionals must adopt an ecologic systems approach. This approach entails working within and together with related institutions (education, health, local government) and assisting other committed professionals within these institutions to mediate care. This is of utmost importance in the area of children's care because of their particular vulnerability and their special importance for families and society. For this reason, the authors suggest that emergency mental health systems be better designed and implemented while keeping children at the center of their focus. An essential component of the ecologic systems approach is improved education for mental health professionals, providing them the appropriate tools to cope with widespread disaster and the expertise to apply these tools. This approach, however, is not enough. A good outcome cannot be achieved without preparedness on the part of the other relevant institutions and the community as a whole. Greater awareness is needed among local and national authorities of the importance of metaadaptive systems and of local, national, and international networking. In the current global village that is threatened by pervasive terrorism, no community must face it alone. The challenge of a disaster to one community is a challenge to all. By working together we can lessen the devastating impact of these events, save countless lives, prevent untold suffering, and maintain hope for a better world for children.

Adolescent↗
PubMed2000

Use of higher dose extended interval aminoglycosides in a neonatal intensive care unit.

The objective of this study is to determine the safety and efficacy of an extended interval aminoglycoside dosing guideline implemented in our neonatal intensive care unit (NICU). A retrospective review of pharmacokinetic data on 44 patients led to the development of an extended interval aminoglycoside guideline utilizing a 5-mg/kg dose given at an interval based on postconceptional age and risk factors that may alter aminoglycoside clearance. After implementation of the new clinical guideline, a retrospective review of patient records was performed. Thirty-six of 43 peak levels were within the goal range. Trough levels were <1 microg/mL in 41 of 46 patients, with no trough >2 microg/mL. Thirty-three patients had clinical or culture proven sepsis and were successfully treated with the new regimen. No difference between pre- and post-treatment blood urea nitrogen (BUN) and serum creatinine values was observed. Hearing evaluations were performed in 32 patients with one failure. The patient who failed the hearing screen, passed a follow-up hearing test. Three deaths, none attributed to infection or the drug, occurred during the evaluation period. The dosing guidelines developed for our NICU patients are safe and effective, although evaluation of the longterm potential for ototoxicity should be performed.

Anti-Bacterial Agents↗