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At least 793 records · Page 44Linked to original sources

PubMed2006

High dose of intravenously given glucocorticosteroids decrease IL-8 production by monocytes in multiple sclerosis patients treated during relapse.

The aim of our study was to determine whether high doses of intravenous methylprednisolone have significant impact on immune parameters during the multiple sclerosis (MS) exacerbations. Peripheral blood of 32 MS patients was evaluated, using two-color flow cytometry before glucocorticosteroids and after 7 days from starting therapy. Significant increase of B cells, decrease of NK cells and monocytes producing IL-8 were observed after treatment. IL-8 is one of the cytokines responsible for blood-brain-barrier disruption and migration of immune cells to the central nervous system; in this aspect, explaining glucocorticosteroid effects during MS exacerbations.

Adult↗

PubMed2004

Raloxifene therapy does not affect uterine blood flow in postmenopausal women: a transvaginal Doppler study.

OBJECTIVE: To monitor the effects of raloxifene therapy on the uterus of postmenopausal women by transvaginal ultrasonography and color flow Doppler. METHODS: Twenty-five healthy postmenopausal women were enrolled in this prospective longitudinal study performed at Department of Gynecology and Obstetrics, Faculty of Medicine of Ribeirão Preto. The patients were treated with raloxifene hydrochloride (60 mg per day) for 6 months. All were submitted to transvaginal ultrasound examination with color flow Doppler (ATL-HDI 3000 equipment) before the beginning and after 1, 3 and 6 months of treatment. Resistance index (RI) and pulsatility index (PI) of the uterine arteries were determined by the Doppler method, being considered as indicators of uterine perfusion. The following variables were analyzed: endometrial thickness, uterine volume, RI, and PI. Data were analyzed statistically by repeated-measures analysis of variance. RESULTS: Before treatment, endometrial thickness was 3.38 +/- 0.73 mm, and similar values were observed after 1, 3 and 6 months of treatment (3.04 +/- 0.82; 3.3 +/- 0.83; and 3.37 +/- 0.79, respectively) (P > 0.05). No significant differences in uterine volume were observed between the pre- and post-treatment periods. Uterine artery perfusion as indicated by RI and PI measured by Doppler also showed no significant variation, with a high impedance flow being maintained throughout treatment. CONCLUSIONS: In the group studied here, raloxifene treatment at the dose of 60 mg per day for 6 months did not induce significant changes in endometrial thickness, uterine volume or uterine artery perfusion, confirming that short-term raloxifene treatment does not affect the uterus of postmenopausal women.

Aged↗

PubMed1998

Timing for removal of tympanic ventilation tube in children.

The medical records of 220 ears of 137 pediatric patients (85 male and 52 female) in which three kinds of ventilation tubes were inserted for treating otitis media with effusion (OME) were reviewed. The tubes selected were the Shepard grommet (75 ears), Goode-T (39 ears), and Paparella type II tube (106 ears). The criteria for tube placement were as follows: (1) continuous conductive hearing loss with over 25 dB air-bone gap, (2) resistance to conservative therapy for over 6 months, and (3) retracted and glue-colored tympanic membrane with type B tympanogram. The tubes that remained in place for over 18-24 months were removed intentionally in combination with a freshening of the perforation edge and tape-patch technique using Steri-Strip tape (3M) for preventing permanent eardrum perforation, because the incidence of persistent perforation became higher after long-term intubation. Shepard grommets tended to be extruded earlier, while Paparella type II tubes tended to stay longer. The OME recurrence rate decreased 12 months or more after tubal insertion. There was a tendency for the recurrence rate to decrease the longer the tube stayed in the eardrum. The number of recurrences decreased when the patient's age at the tube removal or extrusion was 7-8 years old. Adenoidectomy did not influence the recurrence rate of OME. Although the Goode-T and Paparella tube II tubes showed high perforation rates, the perforation rate after extrusion or removal of the tube was decreased by the use of the tape patch technique in combination with a freshening of the perforation edge. From these findings, it was concluded that the appropriate intubation period for the treatment of OME in children is over 12 months with the use of a long-term tube, and that if the patient's age at the time of tube insertion was below 6 years, it might be better that the removal of the tube is postponed until the patient is 8 years of age.

Adenoidectomy↗

PubMed1997

Intracranial meningeomas: time- and dose-dependent effects of irradiation on tumor microcirculation monitored by dynamic MR imaging.

The purpose of this study was the characterization of the time- and dose-dependent effects of irradiation on tumor microcirculation by means of dynamic MR imaging and correlation of the estimated data with tumor response in patients with meningeomas. Dynamic MR imaging studies were performed in 20 patients with intracranial meningeomas prior to (n = 20) and at 6 (n = 17), 18 (n = 17), and 50 wk (n = 14) after the end of radiotherapy. In seven of these patients, dynamic measurements were also performed during fractionated radiotherapy after approximate 20 Gy and 54 Gy. During and after short-time infusion of gadopentetate dimeglumine, the kinetics of lesion response was resolved using a strongly T1-weighted saturation recovery TurboFLASH (SRTF) sequence. The signal-time courses of the suspected lesions were analyzed using a pharmacokinetic two-compartment model. The calculated parameters amplitude A (reflecting gadopentetate dimeglumine accumulation in the extracellular space) and exchange rate constant k21 (depending on vascular permeability and blood flow) were displayed as color-coded images and analyzed as a function of time of therapy and radiation dose. All meningeomas showed a high exchange rate constant k21 (median, 5.7 min-1; range, 1.9-23.0 min-1) and a high amplitude A (median, 1.5 arbitrary units; range, 1.1-2.7) prior to X-ray treatment. During radiotherapy we found a dose related significant (p < .01) increase of k21 accompanied by an increase of the amplitude A as compared to the pretreatment values. Analysis of tumor volume 6, 18, and 50 wk after X-ray treatment revealed two different groups. In the responder group (n = 13) the median of the tumor volume decreased from 10.0 to 7.5 cm3. For this group, we found a significant drop (p < .01) of the median of the amplitude A and a decrease of the exchange rate constant k21. In the nonresponder group (n = 4) the median of the tumor volume increased after radiation from 3.5 to 4.5 cm3. The pharmacokinetic analysis revealed a decrease of the amplitude A-and an increase of the exchange rate constant k21. The response of meningeomas to radiotherapy is influenced by the effect of X-rays on tumor microcirculation. This effect on tumor microcirculation can be derived by analysis of pharmacokinetic maps obtained from dynamic MR images. Furthermore, these pharmacokinetic maps can possibly be used to differentiate groups of patients who respond or do not respond to radiotherapy and, thus, could benefit from another treatment modality.

Contrast Media↗

PubMed1982

Five-year follow-up of a man with subcutaneous mycetomas caused by Microsporum audouinii.

A black man with subcutaneous mycetomas caused by Microsporum audouinii was treated by a combination of griseofulvin, 18.5 g of amphotericin B, excisional surgery, and later, ketoconazole, resulting in a satisfactory arrest or cure of the clinical illness. Complications of therapy included residual impaired renal function and a change in hair color from black to a rust brown color. The continued use of the term mycetoma to describe such lesions is justified.

Adult↗

PubMed1978

Symmetrical lividity of the palms and soles.

Symmetrical lividity (SL) was the term coined by Pernet in 1925 for symmetrical, bluish-red plaques on the soles of the feet, accompanied by hyperhidrosis and not corresponding to areas of pressure or patterns of innervation. We report two patients with a persistent eruption of the palms analogous to that described by Pernet on the feet. Unlike most reported cases of SL, our patients did not respond to topical drying treatments, but one patient partially responded to tretinoin. There appear to be two forms of SL: transient, which responds to drying; and persistent which does not respond to drying. The hyperhidrosis studied in one of our two patients was significantly greater within the plaques of SL than the normal palm. While we could suppress the hyperhidrosis with topical therapy, this failed to clear his hyperkeratosis or eliminate the livid color.

Adult↗

PubMed2003

[Conservative treatment of erectile dysfunction].

The development of diagnostical and therapeutical methods of erectile dysfunction opened new possibilities for patients. In our time, andrologists are capable of treating most patients. The ones who cannot be helped are unable to lead sexual life due to physical reasons. The application of hormone examinations, color Doppler and Rigiscan exams help at establishing diagnoses. In the therapy, modern peroral pharmacotherapy is dominant, mainly phosphodiesterase inhibitors and central peroral pharmacon are applied. The means of getting the vasoactive drugs into the body have been extended (subcutan, transdermal, and drugs absorbable through mucosa). Psychotherapy is indispensable at some patients. The surgical solution (mainly prosthesis implantation) can be regarded critically, yet their presence among therapies is necessary. According to authors' opinion, the qualitative development of vasoactive drugs (efficacy extension and side-effect reduction) that can be simply and conveniently applied in the future.

Administration, Oral↗

PubMed1990

[Esophageal varices: is bleeding predictable?].

Hemorrhage of oesophageal varices is still a life-threatening complication of portal hypertension. Parameters to identify patients being on risk to bleed are on demand for prophylactic therapy. Recent studies showed that bleeders present with larger varices, red color sign of the variceal wall and higher intravariceal hydrostatic pressure than patients without previous hemorrhage. Advanced liver disease (Child C) is an additional risk factor. The clinical value of the parameters appears to be decreased by a significant overlap of the findings obtained in bleeders and non-bleeders. However, patients with small varices, low variceal pressure (less than 12 mmHg) and fair condition are considered to be not on risk to bleed from varices. An additional clinical value of the parameters is provided by the potency to define patients more accurately for future clinical studies.

Esophageal and Gastric Varices↗

PubMed1996

[Recent progress in the diagnosis of gastroesophageal varices].

Recent advances in the diagnosis of gastroesophageal varices are reviewed in this paper. Endoscopy, angiography, ultrasound, and ultrasound Doppler are now employed in the diagnosis of varices. As for endoscopic diagnosis, new criteria for the evaluation of gastroesophageal varices have been applied. Angiography is now not only used to demonstrate the varices and collateral circulations in portal hypertension but also used in the embolization therapy for large gastric varices or intractable esophageal varices. Ultrasound and color Doppler are now widely used in the diagnosis of portal hypertension because of its noninvasiveness and conveniency. Furthermore, in its use in endoscopy, varical vessels and blood flow in the wall of the esophagus and the stomach can be directly demonstrated. Recent advances in these diagnostic modalities will made it possible to diagnose gastroesophageal varices and evaluate the pathophysiology in patients with portal hypertension more precisely.

Angiography↗

PubMed1995

Effects of long-term therapy with enalapril on severity of functional mitral regurgitation in dogs with moderate heart failure.

OBJECTIVES: This study examined the effects of early long-term monotherapy with enalapril on the severity of functional mitral regurgitation in dogs with moderate heart failure. BACKGROUND: Functional mitral regurgitation often develops in patients with heart failure and, depending on its severity, can have a marked adverse impact on the stroke output of the failing left ventricle and contribute to progressive deterioration of the heart failure state. METHODS: Left ventricular dysfunction (ejection fraction 30% to 40%) was produced in 14 dogs by multiple sequential intracoronary microembolizations. Dogs were randomized to 3 months of therapy with enalapril (10 mg twice daily, n = 7) or no therapy at all (control, n = 7). The severity of functional mitral regurgitation was quantified by Doppler color flow mapping in seven control and six enalapril-treated dogs. Mitral annular diameter was assessed by echocardiography and left ventricular volumes and shape by ventriculography. Measurements were made before initiation and after completion of therapy. RESULTS: In control dogs, the severity of mitral regurgitation increased during the follow-up period ([mean +/- SEM] 14 +/- 4 vs. 23 +/- 4%, p < 0.001) and was associated with increased left ventricular end-systolic and end-diastolic volumes. In contrast, the severity of regurgitation was not significantly changed in dogs treated with enalapril (18 +/- 3 vs. 16 +/- 6%, p < 0.59) and was associated with preservation of left ventricular volumes. CONCLUSIONS: In dogs with moderate heart failure, early long-term therapy with enalapril prevents progressive worsening of functional mitral regurgitation. This beneficial effect is most likely achieved by prevention of progressive left ventricular dilation.

Animals↗

PubMed1990

Acute reduction of atrial overload during vasodilator and diuretic therapy in advanced congestive heart failure.

Although acute afterload reduction is known to improve cardiac output in patients with congestive heart failure (CHF), the effect of therapy on the atrial overload directly causing congestive symptoms has not been systematically studied. Atrial volumes and mitral and tricuspid regurgitation, in addition to left ventricular ejection fraction and indexes of left ventricular contractility (mean acceleration, ejection time and peak systolic pressure/end-systolic volume index), were measured using 2-dimensional and Doppler echocardiography and color flow imaging in 30 patients with advanced CHF, before and after acute vasodilator and diuretic therapy tailored to hemodynamic goals. Therapy increased stroke volume by 64% (36 +/- 10 to 55 +/- 14 cc), decreased right atrial pressure by 45% (15 +/- 5 to 8 +/- 4 mm Hg), systemic vascular resistance by 36% (1,700 +/- 400 to 1,030 +/- 300 dynes s cm-5) and pulmonary capillary wedge pressure by 37% (31 +/- 6 to 19 +/- 6 mm Hg) (all p less than 0.001). Echocardiography showed simultaneous reductions in left and right atrial volumes: 24 +/- 19 and 18 +/- 12%, respectively (p less than 0.001). Mitral and tricuspid regurgitation measured by color flow fraction both decreased by a mean of 44% (p less than 0.001). While ejection fraction increased from 15 +/- 5 to 19 +/- 7% (p less than 0.001), there were no changes in relatively load-independent indexes of contractility. Therefore, acute therapy with vasodilators and diuretics in advanced CHF causes reductions in atrial volumes and atrioventricular valve regurgitation that are evident from serial noninvasive studies and may play a major role in the improvement of congestive symptoms.

Adolescent↗

PubMed1996

[Possibilities of laparoscopic ultrasound diagnosis].

Both pre-operative transvaginal sonography and laparoscopical diagnosis leave gaps in the diagnosis of adnexal tumors. The combination of both methods seems to fill these gaps. For diagnosis with Laparoscopical Sonography a special scan head is needed: After removing the optical components there was a little linear-array installed into the original gastroscope with a diameter of only 9 mm which enables maximum flexibility during examinations. The linear-array consists of 128 crystals with a frequency of 7.5 MHz (penetration depth: 6 cm), enabling B-Image Sonography, Pulsed and Color Doppler as well as Angio-Color-Technique. Laparoscopical Sonography in addition to transvaginal and transabdominal sonography leads to progress in diagnosis and therapy. As the scan head can be placed directly in front of the area which is normally hardly detectable diagnosis is possible and plannings for the further operations as well as color-doppler controls during operations can be improved. In several cases this method allowed detection of metastases of the liver which were not visible by transabdominal ultrasound.

Equipment Design↗

PubMed1996

Transcranial duplex monitoring discloses hemorrhagic complication following rt-PA thrombolysis.

INTRODUCTION: Transcranial color-coded sonography (TCCS) allows imaging of basal cerebral arteries as well as brain parenchyma. It may therefore serve to monitor thrombolysis in acute stroke. CASE DESCRIPTION: rt-PA thrombolysis was performed in a patient, suffering from paradoxical embolism causing MCA occlusion. Hemorrhage immediately after completion of rt-PA infusion as well as delayed MCA recanalization could be monitored by TCCS. CONCLUSION: TCCS is useful to improve monitoring and safety of systemic thrombolytic treatment.

Adult↗

PubMed2002

PEI therapy for thyroid lesions.

PEI therapy has been applied clinically as a new treatment strategy for cystic lesions and autonomous functioning nodules of the thyroid. Some additional indications currently under consideration include cold benign tumors and inoperable advanced cancer of the thyroid, and postoperative recurrence of Graves' disease. At our institution, we have treated 2323 patients with thyroid disease by PEI therapy from 1999 to 2001. PEI is usually administered under ultrasound guidance in cases of cystic lesions, and under color-Doppler guidance in cases of solid lesions of the thyroid, with the goal of attenuating tumor blood flow. In consequence, of the total 2323 cases who received PEI therapy at our hospital, 1989 (85.6%) were classified as showing an effective response (ER) or partial response (PR). There were no major complications, such as recurrent laryngeal nerve palsy, uncontrollable pain, bleeding, or thyrotoxicosis. Our results also emphasize the importance of the use of color-Doppler guidance for control of the injection volume of ethanol to the minimum required for completely attenuating the tumor vascularity.

Administration, Cutaneous↗

PubMed1997

Effects of oophorectomy and hormone replacement therapy on ophthalmic artery blood flow velocity waveforms.

Our objective was to compare ophthalmic artery flow velocity waveforms in unilateral oophorectomized patients not on hormone replacement therapy with findings in bilateral oophorectomized patients on hormone replacement therapy. Ten patients who underwent hysterectomy and unilateral oophorectomy and 10 women treated by hysterectomy and bilateral oophorectomy were studied using color and pulsed Doppler ultrasonography 1 day before and on days 7 and 28 after surgery. Serum estradiol levels were measured serially. Bilateral oophorectomy patients were given hormone replacement therapy (conjugated estrogen, 0.625 mg/day, and medroxyprogesterone acetate, 2.5 mg/day) orally starting on day 8 after surgery. The pulsatility index values of the ophthalmic artery in unilateral oophorectomy patients were 1.93 +/- 0.41, 2.10 +/- 0.26, and 1.68 +/- 0.27 for 1 day before and on days 7 and 28 after surgery, respectively. The pulsatility index values of the ophthalmic artery in bilateral oophorectomy patients were 1.99 +/- 0.39, 2.17 +/- 0.47, and 1.75 +/- 0.32 for 1 day before and on days 7 and 28 after surgery, respectively. No significant differences were found between pulsatility index values in the unilateral and bilateral oophorectomy patients in each time period. The pulsatility index values on day 28 decreased significantly compared with the findings on day 7 in both groups (P < 0.05). The serum estradiol levels were significantly reduced from 1 day before to day 7 day after surgery and were significantly elevated by day 28 after surgery (P < 0.05) in both groups of patients. No significant differences were found between the serum estradiol levels in the unilateral and bilateral oophorectomy patients in each time period. Vascular tone in the ophthalmic artery seems to change according to serum estradiol levels, a finding that may help explain some of the beneficial effects of hormone replacement therapy for bilateral oophorectomized patients.

Adult↗

PubMed1989

Doppler color flow imaging of carotid body tumors.

Doppler color flow imaging is a new ultrasound method for the simultaneous spatial display of tissue and vessel morphology (B-mode echotomograms) and of color-coded blood flow velocity information (Doppler-mode analysis). This new method is particularly useful in the neck, not only for the assessment of brain arteries but also for the safe and valid identification of carotid paragangliomas compared with other neck tumors. Early clinical detection of carotid paragangliomas is difficult since these lesions often occur sporadically and the patients remain symptom-free until the tumor becomes noticeable. Doppler color flow imaging allows the diagnosis of even small paragangliomas, which may improve management because of existing complications of surgical therapy.

Adult↗

PubMed2004

Multifocal basal cell carcinoma developing in a facial port wine stain treated with argon and pulsed dye laser: a possible role for previous radiotherapy.

BACKGROUND: Basal cell carcinoma occurring in port wine stain is extremely rare but has been reported after radiotherapy for port wine stain. OBJECTIVE: The objective was to present 55-year-old man with a facial port wine stain who had multiple treatment sessions with both the argon laser and the pulsed dye laser and subsequently developed a recurrent multifocal basal cell carcinoma and highlight the treatment carried out and its effects on the outcome. METHODS: We describe the history of the patient's port wine stain treatment, the development of skin cancer within it, and the different modalities of therapy carried out. RESULTS: The patient developed basal cell carcinoma in his port wine stain. The possibility of a causal link between laser treatment and this skin cancer was considered but it was discovered that he had had radiotherapy treatment of his birthmark at age 9. The basal cell carcinoma was successfully treated. CONCLUSION: This case of a clinically indistinct multifocal basal cell carcinoma arising within facial port wine stain was most likely due to previous radiotherapy treatment as a child, rather than laser treatment. Careful treatment history should identify such patients who should be followed-up for development of skin cancer.

Argon↗

PubMed2000

A preliminary study of photodynamic therapy using verteporfin for choroidal neovascularization in pathologic myopia, ocular histoplasmosis syndrome, angioid streaks, and idiopathic causes.

OBJECTIVE: To evaluate short-term safety and the effects on visual acuity and fluorescein angiography of single or multiple sessions of photodynamic therapy with verteporfin for choroidal neovascularization (CNV) not related to age-related macular degeneration (AMD), including pathologic myopia, the ocular histoplasmosis syndrome, angioid streaks, and idiopathic causes. DESIGN: A nonrandomized, multicenter, open-label, dose-escalation phase 1 and 2 clinical trial. SETTING: Four ophthalmic centers in Europe and North America providing retinal care. PARTICIPANTS: Thirteen patients with subfoveal CNV due to pathologic myopia, the ocular histoplasmosis syndrome, angioid streaks, or idiopathic causes. METHODS: Standardized protocol refraction, visual acuity testing, ophthalmic examinations, color photographs, and fluorescein angiograms were used to evaluate the results of photodynamic therapy treatments with verteporfin. Follow-up ranged from 12 weeks for patients who were treated once to 43 weeks for patients who were treated up to 4 times. RESULTS: Verteporfin therapy was well tolerated in patients with CNV not related to AMD. No deterioration in visual acuity was observed; most patients gained at least 1 line of vision. Reduction in the size of leakage area from classic CNV was noted in all patients as early as 1 week after verteporfin therapy, with complete absence of leakage from classic CNV in almost half of the patients. Improvement in visual acuity after verteporfin therapy was greatest (+6, +8, and +9 lines) in 3 patients with relatively poor initial visual acuity (between 20/200 and 20/800). Up to 4 treatments were found to have short-term safety even with retreatment intervals as short as 4 weeks. CONCLUSIONS: Treatment of CNV not related to AMD with verteporfin therapy achieves short-term cessation of fluorescein leakage from CNV in a small number of patients without loss of vision. Further randomized clinical trials including a larger number of patients are under way to confirm whether verteporfin therapy is beneficial for subfoveal CNV not related to AMD.

Adult↗