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At least 91 records · Page 5Linked to original sources
PubMed1998

Prevention of preeclampsia: a big disappointment.

Preeclampsia is a multisystem disorder of unknown etiology. During the past 2 decades, numerous clinical reports and randomized trials described the use of various methods to prevent or reduce the incidence and severity of preeclampsia. These methods were used in an attempt to correct certain abnormalities such as biochemical imbalance, a pathophysiologic mechanism, or a dietary deficiency. There are at least 15 randomized trials evaluating the use of various antihypertensive drugs including diuretics for the prevention of preeclampsia. Results of these trials reveal no such benefit. There are few randomized trials evaluating magnesium (n = 2), zinc (n = 2), or fish oil supplementation (n = 3) to prevent preeclampsia. The majority of these trials had limited sample size; however, results reveal minimal-to-no benefit. There are 7 placebo-controlled trials evaluating calcium supplementation during pregnancy. Findings of these trials reveal that calcium supplementation does not reduce the incidence of preeclampsia in healthy nulliparous women. The majority of randomized trials for the prevention of preeclampsia have used low-dose aspirin. Results of early single-center trials demonstrated an average reduction of preeclampsia of 70% with low-dose aspirin. However, results of recent large multicenter trials (n = 7) that included >27,000 women revealed minimal-to-no benefit. Until the pathogenesis of preeclampsia is well defined, prevention of this syndrome with any modality remains unlikely.

Antihypertensive Agents↗
PubMed1996

Phase II study of alternating doses of vinorelbine in combination with cisplatin for non-small cell lung cancer (NSCLC): a disappointing experience.

UNLABELLED: In both Phase III trials of vinorelbine-cisplatin (VP) versus single-agent vinorelbine, the received vinorelbine dose intensities were 18.8 and 21.1 mg/m2 per week in the VP arms. Vinorelbine was administered at the weekly dose of 30 mg/m2. A new structure of the vinorelbine-cisplatin regimen delivering alternating doses of vinorelbine (35 mg/m2 on weeks 1, 3, 5 and 17.5 mg/m2 on weeks 2 and 4) was reported to increase the vinorelbine dose intensity in patients with non-small cell lung cancer (NSCLC). To further analyze the ability of such an alternating vinorelbine schedule to enhance vinorelbine delivery, a Phase II study of VP was conducted in NSCLC patients using the previously published alternating doses of vinorelbine for 6 cycles. Cisplatin was administered on weeks 1, 5 and every 6 weeks thereafter, at a dose of 75 mg/m2 in the first 14 patients and at a dose of 100 mg/m2 in the 18 remaining patients. The intended vinorelbine dose intensity was 26.25 mg/m2 per week. The median delivered dose intensities of vinorelbine calculated during the first 8-week period were: all patients, 17.9 mg/m2 per week; patients treated with cisplatin 75 mg/m2, 18.1 mg/m2 per week; patients receiving cisplatin 100 mg/m2, 17.9 mg/m2 per week; naive patients 18.2 mg/m2 per week and previously treated patients. 13.2 mg/m2 per week. Reductions and delays in the vinorelbine treatment mostly occurred on weeks 3 and 7, which are times of high-dose treatments (35 mg/m2) according to the protocol. The partial response rate was 34% (95% C.I. = 26-42%). Median survival was 21 weeks. The main toxicities were febrile neutropenia (nine patients, including two septic deaths) and constipation Grades 3 and 4 (five patients). CONCLUSION: The use of alternating doses of vinorelbine within the VP regimen did not lead to higher vinorelbine delivered dose intensities than those reported with a standard weekly 30 mg/m2 administration.

Adult↗
PubMed2004

Disappointing results with a new commercially available thoracic endograft.

INTRODUCTION: New devices for endovascular treatment of thoracic aortic diseases were recently approved for clinical use by European authorities, obtaining the Conformité Européenne (CE) mark. In all patients who underwent endovascular treatment of a thoracic aortic disease in 2002, we used a new CE-marked device, the Endofit stent graft. The device is constituted of nitinol stents and polytetrafluoroethylene fabric, and has a simple design and delivery system. METHODS: During 2002, 11 patients (mean age, 75 years; range, 66-85 years) underwent treatment of atherosclerotic aneurysm (n = 9), chronic type B dissection (n = 1), and intramural hematoma (n = 1). Disease involved the descending thoracic aorta in 7 patients and the distal aortic arch in 4 patients. RESULTS: In all cases the Endofit stent grafts were successfully deployed in the intended position. No postoperative paraplegia or paraparesis was recorded. There were two in-hospital deaths: 1 patient died in the operating room (postmortem examination showed a kinked graft); and the other patient died in the intensive care unit on postoperative day 30, after an intraoperative stroke. One surgical conversion was performed 2 weeks after the procedure, because of total collapse of the graft due to rupture of three stents. Other graft-related complications included type I endoleak (n = 2), type II endoleak (n = 1), and incomplete opening of the device (n = 1). CONCLUSION: Endovascular treatment of thoracic disease with the Endofit graft in this small heterogeneous group of patients resulted in several complications, which may arise from both the delivery system and the graft itself. At present, other commercially available endografts may be safer for endovascular treatment of thoracic aortic diseases.

Aged↗
PubMed2005

[Antiviral vaccination and respiratory mucosal immunity: still disappointing results from a seductive idea].

Mucosal surfaces of the respiratory tract represent a major portal of entry for most human viruses and a critical component of the mammalian immunologic repertoire. The major antibody isotype in external secretions is secretory immunoglobin A (S-IgA). The major effector cells in mucosal surfaces, however, are not IgA B cells, but T lymphocytes, which may account for up to 80% of the mucosal lymphoid cell population. Mucosal immunoprophylaxis is theoretically an important approach to control infections acquired through these portals. Passive antibodies can protect against mucosal viral infections, as shown for respiratory syncytial virus, but very high quantities of passive antibodies are needed to restrict virus replication on mucosal surface. Factors likely to induce mucosal antibody and cell-mediated immune responses include oral or respiratory routes of immunization and active (effectively replicating) vaccine agents. Very few antiviral vaccines have been developed to protect the mucosal surface of the respiratory tract, and only an attenuated influenza virus vaccine uses the nasal route. Other vaccines, approved for parenteral use, have been administered experimentally by the nasal route; these include active (replicating) and inactive (nonreplicating) vaccines. By this route they induce only a moderate local mucosal response. Neither the development of mucosal immunity nor the administration of vaccines via the mucosal route is essential for control or prevention of most respiratory viral infections and diseases acquired through the respiratory tract. Nonetheless, the example of the live attenuated intranasal influenza vaccine, which induces both systemic and local immune response, is promising for the future of mucosal immunization against respiratory viral infections.

Humans↗