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Biomedical subjects

P Amadio

Publications and source records attributed to P Amadio.

33 records · Page 2Linked to original sources
PubMed1985

The effect of tolmetin on the chronic pain and decreased functional capacity associated with degenerative joint disease.

Degenerative joint disease (DJD) is a common disorder characterized by chronic pain and limitation of activity, for which treatment with a nonsteroidal anti-inflammatory drug (NSAID) is often useful. The anti-inflammatory activity of the NSAID tolmetin sodium has been well described, being comparable in efficacy to indomethacin and effective for the relief of the acute and chronic symptoms that accompany DJD. To examine specifically the effect of tolmetin in controlling the pain and functional limitation in DJD of the spine, tolmetin was tested against placebo in a double-blind, two-segment, crossover study. Twenty-six patients (mean age, 62.5 years; range, 42-79 years) received three weeks of tolmetin 1,200 mg/d and three weeks of placebo. The results showed that tolmetin provided significantly greater relief of symptoms than placebo in virtually all measurements of joint pain and stiffness: tenderness, pain at rest, pain on motion, intensity of joint pain (P less than 0.001), and duration of morning stiffness (P = 0.002). Statistically significant improvement was noted in two of the three measures of cervical range of motion (P less than or equal to 0.01) and in all assessments of daily living activities (P = 0.001 in four parameters; P = 0.02 in a fifth parameter). Global evaluations of response to treatment by both patients and investigator also demonstrated significant effects (P less than or equal to 0.002). Significantly more placebo patients (13 of 26) than tolmetin patients (two of 26) found the medication ineffective and discontinued treatment prematurely (P = 0.01). No serious or limiting adverse reactions were seen during placebo or tolmetin therapy. The most frequently reported side effects on both therapies were gastrointestinal.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1985

Frequency of Chlamydia trachomatis as the cause of pharyngitis.

We evaluated the incidence of Chlamydia trachomatis as the etiologic agent of uncomplicated pharyngitis by the cell culture procedure recommended by the Centers for Disease Control, Atlanta, Ga., and by the MicroTrak direct immunofluorescent stain (Syva Co., Palo Alto, Calif.) for elementary bodies on throat swabs collected from 126 symptomatic patients. Of the 126 cultures, 8% were positive for group A beta-hemolytic streptococci. Of 126 chlamydia cultures, none was positive. The MicroTrak test gave one borderline positive result. In contrast to a previously published report that C. trachomatis is the most frequent nonviral cause of adult pharyngitis (A. L. Komaroff, M. D. Aronson, T. M. Pass, C. T. Ervin, and W. T. Branch, Jr., Science 222:927-929, 1983), our data indicated an infection rate of less than 1%.

Adolescent↗
PubMed1984

Peripherally acting analgesics.

The therapeutic effect of aspirin and the other nonsteroidal anti-inflammatory drugs derives from the peripheral inhibition of prostaglandin synthetase. Aspirin produces irreversible inhibition, whereas the inhibition triggered by the other nonsteroidal anti-inflammatory drugs is reversible. Despite proved analgesic efficacy, use of aspirin and the nonsteroidal anti-inflammatory drugs may be accompanied by a wide range of side effects of a potentially serious nature. For relief of pain, there appears to be no clear-cut superiority of one nonsteroidal anti-inflammatory drug over another, and patients who fail to respond to one class of nonsteroidal anti-inflammatory drugs may respond to a representative of another class. As with aspirin, it is difficult to demonstrate the superiority of higher doses of these agents over the lower doses. The side-effect profile of non-narcotic analgesics favors acetaminophen, presumably because its inhibition of prostaglandin synthetase occurs centrally. Acetaminophen does not appear to have the same potential for toxicity that is seen with aspirin and other nonsteroidal anti-inflammatory drugs. At dosages up to 4 g per day, acetaminophen compares favorably in analgesic potency to aspirin and other nonsteroidal anti-inflammatory drugs, and it should be considered the treatment of choice for mild-to-moderate pain. Safe conditions for the analgesic use of nonsteroidal anti-inflammatory drugs in children and pregnancy have not been established. Because it is virtually free of side effects, acetaminophen may be the mild analgesic of choice for the pregnant patient. It has been used safely for years in children. Only a limited number of analgesic studies have been conducted in children. The results of analgesic studies carried out in adults are generally recognized as applicable to pain relief in children.

Acetaminophen↗
PubMed1978

Interpositional arthroplasty for rheumatoid carpometacarpal joint disease.

Over the past 3 years the Swanson great toe prosthesis was used in an interpositional arthroplasty at the carpometacarpal joint in 21 thumbs of 19 patients with rheumatoid arthritis and three thumbs of two patients with lumpus arthritis. In selected patients with advanced disease, this prosthesis has the advantage of allowing for correction of deformity while preserving carpal stock which may be important if a surgical procedure is required at the wrist. Stable capsular closure does not require reinforcement by adjacent tendon. Twenty-two thumbs of 19 patients were improved, although in three the prosthesis was malpositioned. Two patients required reoperation and removal of the prosthesis: one for infection, and one for failure to correct deformity. Overall functional results often were affected by the status of disease in other joints, but in general were acceptable.

Adult↗
PubMedDate not supplied

Measuring disability of the upper extremity: a rationale supporting the use of a regional outcome measure.

OBJECTIVE: Many existing upper extremity outcome measures have been designed for a specific anatomic site (e.g., shoulder) or a specific disease entity (e.g., carpal tunnel syndrome). The purpose of this paper is to examine whether questionnaire items taken from very specific measures are considered relevant only to that specific region or are applicable to the whole extremity. METHODS: Fifteen practicing clinicians categorized a sample of 132 items from existing questionnaires according to whether the items reflected disability specific to an anatomic site or were relevant to the whole extremity. RESULTS: Seventy-two percent of the items were categorized as relevant to the extremity as a whole, while only 21% of the items were categorized as specific to an anatomic site. CONCLUSION: Items in existing specific upper extremity questionnaires are also relevant to other regions and conditions. This finding is in agreement with kinesiologic and biomechanical theories that the upper extremity acts as a single functional unit. Questionnaires designed for the whole extremity could provide a more practical and still valid measure of upper extremity disability.

Activities of Daily Living↗
PubMedDate not supplied

Oxaliplatin and raltitrexed in the treatment of inoperable malignant pleural mesothelioma: results of a pilot study.

AIMS AND BACKGROUND: The treatment of inoperable malignant pleural mesothelioma is a challenge for the oncologist. Available chemotherapy regimens achieve poor results, therefore new agents or combinations are needed. In a phase I study, the combination of oxaliplatin and raltitrexed was shown to be active against malignant pleural mesothelioma. We herein report the results of a pilot study about the treatment of this disease. METHODS: From April 1999 to June 2000, we enrolled 11 chemotherapy-naïve patients with inoperable malignant pleural mesothelioma suitable to receive the following combination chemotherapy: raltitrexed, 3 mg/m2 iv, and oxaliplatin, 130 mg/m2, as a 2-hr infusion every 3 weeks. RESULTS: Four partial responses, 1 regression of disease (objective response rate, 45%; 95% CI, 15.6-74.4%), 4 stable diseases and 2 progressions of disease were observed. An improvement in disease-related symptoms was recorded in all responders and in 2 patients with stable disease. Toxicity was mild, with no toxic-related death and only 1 episode of grade 4 neurotoxicity. CONCLUSIONS: We consider the combination promising and worthy of further studies.

Adult↗
PubMedDate not supplied

Angiosuppression and chemotherapy: strategies aimed at their integration in cancer patients.

A number of antiangiogenic agents have been developed as pharmaceuticals and are currently being tested in clinical studies. Potential strategies to enhance the activity of angiogenesis inhibitors could be to combine them, or better still, to administer them either sequentially or concurrently with cytotoxic drugs. Chemotherapy would be a more appropriate initial choice for patients with advanced disease since cytostatic agents can induce a fast regression of the tumor and cancer-related symptoms. Antiangiogenic treatment could be used after chemotherapy in patients who achieve disease remission to prolong the time to progression, the symptom-free interval and the overall survival. Antiangiogenic treatment is likely to attain an important role in the adjuvant setting. In fact, it could be used for prolonged periods after radical surgery to maintain dormancy of residual tumor cells. In spite of these promising preclinical data, several points need to be clarified before the initiation of clinical trials. In fact, certain misconceptions may interfere with their optimum design and result analysis.

Angiogenesis Inhibitors↗
PubMedDate not supplied

[Prevention and treatment of mucositis from cytotoxic chemotherapy].

The administration of several chemotherapeutic regimens could be conditioned by the onset of mucositis. The characteristic lesions of the mucositis affect whole buccal mucosa. That derives from rapid turnover of the oropharyngeal epithelial surfaces. The mucosa can suffer from direct damage of antiblastic drugs or be susceptible of microbic infections. Moreover, other factors correlated to the patients as age, nutritional status, tumor type, oral hygiene and neutrophil count. Up to date, there is not a standard therapy for the cure or mucositis prevention. Some formalities can be employed in order to reduce chemo-induced damage: 1) altering the distribution and the excretion of drugs on the mucosa; 2) stimulating the basal cells of the mucosa; 3) trying to modify the infectious or inflammatory risks. The effective oral care, dietary changes and the use of protective topical and the careful use of topical and systemic anesthetic drugs are the cornerstones of mucositis care.

Anti-Infective Agents↗
PubMedDate not supplied

Office-based evaluation of renal function in elderly patients receiving nonsteroidal anti-inflammatory drugs.

Elderly patients with multiple diseases who are receiving diuretics are at risk for renal dysfunction from nonsteroidal anti-inflammatory drugs (NSAIDs). Fifty-two elderly patients (mean age = 72 years, range = 63-87 years) with degenerative joint disease and multiple concomitant illnesses were randomly selected to receive ibuprofen suspension (400 mg) or aspirin (650 mg) 4 times a day. Serum creatinine (Cr), blood urea nitrogen (BUN), weight, and blood pressure were measured at baseline and at weekly intervals for 6 weeks. There were no significant changes from baseline in any tests reflective of renal function, no significant differences between ibuprofen and aspirin, and no influence of concomitant diuretic therapy. Ibuprofen and aspirin administered in the doses examined for 6 weeks appear to have little effect on renal function as measured by serum Cr and BUN in a sample of elderly patients for whom these drugs are commonly employed. Concomitant diuretic therapy does not appear to increase the risk. While these drugs are contraindicated in patients with severe hemodynamic insult, they should not be withheld from elderly patients who require this therapy for analgesic/anti-inflammatory effects because of concern for renal impairment. Further prospective research should be undertaken to clarify levels of patient risk and to define appropriate monitoring in such patients.

Aged↗