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At least 145 records · Page 8Linked to original sources
PubMed1993

Triiodothyronine therapy in open-heart surgery: from hope to disappointment.

A controversy persists as to whether cardiopulmonary bypass (CPB) decreases plasma levels of triiodothyronine (T3), thereby justifying peri-operative administration of T3 to improve haemodynamic recovery. To examine the effects of T3 therapy on post-CPB haemodynamics and to determine whether the potential inotropic effects of T3 are mediated by an increase in beta-adrenergic responsiveness, a prospective, randomized, double-blind, placebo-controlled study was performed in 20 patients undergoing cardiac surgery with CPB. T3 or placebo solution (10 patients in each group) was given intravenously at the time of aortic unclamping and 4, 8, 12 and 20 h thereafter. End points included (1) thyroid hormone levels measured by radioimmunoassay (2) standard haemodynamic parameters (3) the density of lymphocyte beta-adrenoceptors measured by a radioligand (125I-iodocyanopindolol) binding technique. Post-CPB values (cross clamp removal) of T3 (pg.ml-1) were not significantly decreased compared with pre-CPB values: 3.3 +/- 0.2 vs 3.1 +/- 0.2 in controls and 3.3 +/- 0.4 vs 3.7 +/- 0.6 in T3-treated patients, respectively. The haemodynamic parameters were no different between the two groups at any postoperative time point. Likewise, density and affinity of lymphocyte beta-adrenoceptors were not significantly different from pre-operative values in either group. Thus, there seems to be no sound justification for a routine use of T3 in patients undergoing open-heart procedures.

Adult↗
PubMed2004

Secondary prevention of coronary heart disease is disappointing among patients of working age.

BACKGROUND: The risk factors underlying coronary heart disease (CHD) are well known. OBJECTIVE: The purpose of this study was to evaluate risk factors related to secondary prevention of working-age CHD patients. METHODS: CHD patients with (n = 139) and without (n = 203) myocardial infarction were selected from a postal questionnaire study (n = 21 101) of randomly selected Finns aged 20-54 years (HeSSup study). Four age- and sex-matched controls were chosen for every patient. RESULTS: CHD patients still smoke, are obese and suffer hangovers more frequently than the control population. CONCLUSION: The health care system has not succeeded in the secondary prevention of CHD.

Adult↗
PubMed1988

Surgical oncology research. A disappointing status report.

The purpose of this paper is to evaluate certain aspects of the present status of surgical oncology research. We have attempted to define the magnitude of the problem, characterize features unique to the surgical community, and formulate potential solutions. Demographic data concerning grant applications submitted to and funded by the National Cancer Institute (NCI) over the time period from 1980 to 1985 were analyzed. Departments of surgery submitted and were awarded substantially fewer grants over the study period than departments of medicine. Additionally, the number of applications submitted from departments of medicine increased during this time period while those from departments of surgery declined. This record is particularly worrisome because it occurred during a period of time of unprecedented scientific and educational opportunities and support mechanisms provided by the NCI. Further conclusions and potential solutions are discussed in this paper.

Evaluation Studies as Topic↗
PubMed1996

Combining 5-fluorouracil with interferon-alpha in the treatment of advanced colorectal cancer: optimism followed by disappointment.

Pre-clinical data have demonstrated synergy between 5-fluorouracil (5-FU) and interferon (IFN)-alpha in colon cancer cell lines. In 1989 the first small single-institution phase II study with this combination in advanced colorectal cancer showed a response of 81% with substantial toxicity, whereas IFN-alpha alone was virtually inactive. Ten published phase II studies including 175 evaluable patients have demonstrated a response rate of 2.3%. 5-FU alone has been used extensively and is moderately active with response rates of 10-11% in 1148 patients evaluated by the Advanced Colorectal Cancer Meta-analysis Project in 1992 and 1994. Eleven subsequent phase II studies with 5-FU + IFN-alpha published over the period of 1990-1994 on 548 patients showed a response rate of 28% with 2% toxic deaths. Recently, nine phase III clinical trials including 1727 randomized patients have compared 5-FU + IFN-alpha to some standard therapies, most often treatment regimens based on 5-FU + leucovorin. Except for one study involving 105 patients, the rest of the phase III studies have demonstrated either no difference (six studies) or significantly worse results (two studies showing substantial toxicity with IFN-alpha + 5-FU). Several studies are ongoing, but results are not likely to change. In conclusion, after a period of high hopes, the combination of 5-FU + IFN-alpha does not seem to fulfill the original expectations. It is costly, it is toxic and it is not effective. New treatment strategies must be developed if progress is to be obtained.

Antimetabolites, Antineoplastic↗
PubMed1999

Disappointing results with Tc-99m tetrofosmin for detecting medullary thyroid carcinoma metastases comparison with Tc-99m VDMSA and TI-201.

PURPOSE: This prospective study assessed the detectability of metastatic lesions by Tc-99m tetrofosmin in medullary thyroid carcinoma and to compare the results with Tc-99m penta dimercapto succinic acid (VDMSA) and TI-201. METHODS: A prospective study was performed on 24 patients (10 men, 14 women; ages 23 to 76 years) with medullary thyroid carcinoma after total thyroidectomy. Five cases were sporadic and 19 were familial. After the injection of 740 MBq (20 mCi) tetrofosmin, 740 MBq (20 mCi) VDMSA and 74 MBq (20 mCi) TI-201, whole-body scans and 5-minute static images of the head, neck, chest, abdomen and pelvis were obtained. All scintigraphic studies were compared with calcitonin levels, radiologic findings, histopathologic results, and clinical follow-up. RESULTS: Thirty-four metastatic sites were detected in 12 patients on the basis clinical, radiologic, and histopathologic findings. Patients were divided into three groups according to the calcitonin levels and scintigraphic findings. Group 1 consisted of patients with elevated calcitonin levels and positive scintigraphic findings. Among 34 metastatic sites, 30 could be detected with VDMSA. Only 21 and 20 metastatic sites could be visualized with TI-201 and tetrofosmin, respectively. All 30 lesions showed intense VDMSA uptake but only faint or no uptake with TI-201 and tetrofosmin. Patients in group 2 were accepted to have micrometastases. In this group, calcitonin was minimally elevated, and the results of all three scintigraphs were negative. Group 3 included patients with true-negative results. All patients had normal calcitonin levels and negative results of scintigraphic studies. CONCLUSIONS: Tetrofosmin has no role in the detection of medullary thyroid carcinoma metastases. These results show that VDMSA is clearly superior to TI-201 and tetrofosmin in the follow-up of patients with medullary thyroid carcinoma.

Adult↗
PubMed1998

Disappointing initial results with transurethral alprostadil for erectile dysfunction in a urology practice setting.

PURPOSE: We evaluate the response to intraurethral alprostadil administration using the Medicated Urethral System for Erection (MUSE) in unselect men with a history of erectile dysfunction. We determine the effects on blood pressure during in office monitoring and assess safety of this form of treatment. We compare the efficacy of MUSE in an office setting with the placebo controlled pivotal study. MATERIALS AND METHODS: A total of 115 men with erectile dysfunction underwent in office testing with MUSE following the algorithm recommended by the manufacturer and outlined in the original pivotal study. Patients were asked to rate the rigidity of erection from 1 to 5 with scores 4 and 5 for erections sufficient for intercourse, and level of discomfort from 1 (very uncomfortable) to 5 (very comfortable) at 15-minute intervals. Patients who did not achieve a sufficient erection were scheduled to return for in office testing using the next higher dose up to 1,000 microg. Patient supine and sitting blood pressures were recorded by a nurse before and every 15 minutes after administration. Telephone contact with patients 2 to 3 months after the last in office testing was made to determine whether they were using the system. RESULTS: Mean plus or minus standard deviation rigidity scores independent of dosage increased from 2.34+/-0.99 at 15 minutes to 2.49+/-0.96 at 30 minutes and decreased thereafter. Although the 1,000 microg. dosage resulted in highest mean score at all times, the differences between dosages were not significant. Rigidity score 4 or 5 was achieved in 13.2% (500 microg.) and 30% (1,000 microg.) of patients at 30 minutes. Mean level of discomfort was 3.6+/-1.2 at 15 minutes and improved thereafter. Comfort levels were not significantly different among dosages. Overall, at 15 minutes 16.8% of patients were uncomfortable (score 1 or 2) and 41.3% were somewhat uncomfortable (1, 2 or 3). For all dosages supine and sitting systolic and diastolic blood pressures decreased significantly from before treatment to 15 minutes and stayed lower during monitoring. Defined by strict criteria 41.2% of patients experienced orthostatic hypotension during in office testing. A total of 21 patients had adverse events, including pain, discomfort and burning in the penis (the most common), dizziness and chest pain. One patient had a syncopal episode and fell in the office. At last followup only 18.6% of the tested patients continued to use MUSE at home, while the remainder discontinued treatment due to pain, insufficient erections for intercourse and cost. CONCLUSIONS: We were unable to achieve similar results to the pivotal study following manufacturer instructions and the algorithm provided by that study. Independent of age and etiology no more than 30% of patients at any given time using any dose achieved erections sufficient for intercourse during in office testing. Because of this limited efficacy, discomfort, pain and burning associated with treatment, and cost, more than 80% of patients did not continue to use MUSE at home.

Adult↗
PubMed2000

Disappointing performance of literature-derived selective screening criteria for asymptomatic Chlamydia trachomatis infection in an inner-city population.

BACKGROUND: In an inner-city population with a low prevalence of Chlamydia trachomatis infection, selective screening may be indicated to increase the efficiency of screening. GOAL: To evaluate the performance of sets of selective screening criteria for asymptomatic Chlamydia trachomatis infection in an inner-city population. The criteria were derived from reports of studies carried out in various settings. STUDY DESIGN: A total of 5714 women age 15 to 40 years living in Amsterdam were invited for a screening based on home-obtained urine specimens. Criteria identified from the literature were applied to the screening population. A calculated area under the receiver-operator characteristic curve (AUC) of greater than 0.75 was considered a good measure of diagnostic accuracy. RESULTS: Of the four sets of criteria, selection based on the following determinants showed the highest diagnostic accuracy: younger than 25 years, being unmarried, number of partners during the previous 6 months, Surinam or Antillean origin (black), and vaginal douching (AUC, 0.67; 95% CI, 0.65-0.69). Selection based on age alone showed an AUC of 0.57 (95% CI, 0.55-0.69). CONCLUSION: The performance of selective screening criteria for asymptomatic C trachomatis infection in an inner-city population in Amsterdam was insufficient to recommend its implementation in practice.

Adolescent↗
PubMed2005

How we did it: neopharyngeal stricture management with the nitinol stent in the laryngectomized patient: our disappointing results.

Serial dilatation, the mainstay of benign 'neopharyngeal' stricture management, can have inconsistent results. Nitinol stents, as a metallic self-expanding coil, may have a role in such patients. Such stents were inserted in four patients but two had to be removed because of intractable pain. It is concluded that nitinol stents are unlikely to have a significant role in the management of neopharyngeal stricture management.

Aged↗