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Biomedical subjects

P Hollander

Publications and source records attributed to P Hollander.

At least 19 recordsLinked to original sources
PubMed2004

Acute effects of inspiratory pressure support during exercise in patients with COPD.

The aim of the present study was to evaluate the acute effects of inspiratory pressure support (IPS) of 5 cmH2O (IPS5) and 10 cmH2O (IPS10) on exercise endurance. Forty-five patients with COPD (mean forced expiratory volume in one second (FEV1) = 39 +/- 14% pred) performed three constant-load endurance tests on a cycle ergometer at 75% of maximal workload. One test was without IPS, one test with IPSs, and one with IPS10. No statistically significant difference was found in exercise endurance between tests without IPS and IPS5 (4.2 +/- 2.6 versus 4.4 +/- 2.9 min). In contrast, IPS10 resulted in a statistically significant increase in endurance compared with exercise without IPS (6.3 +/- 6.7 versus 4.2 +/- 2.6 min), as well as compared with exercise with IPS5 (6.3 +/- 6.7 versus 4.4 +/- 2.9 min). A wide scatter in individual responses to IPS was found, ranging from a deterioration of 1.6 min (-36%) to an improvement of 16.3 min (+445%). In only 15 patients, the increase in endurance exceeded the upper limit of the 95%, confidence interval. Stepwise multiple regression analysis showed that maximal inspiratory pressure was the most important determinant of the increase in exercise endurance due to the application of IPS10. It was concluded that in contrast to inspiratory pressure support of 5 cmH2O, the application of inspiratory pressure support of 10 cmH2O during exercise resulted in a statistically significant improvement in exercise endurance in patients with COPD compared with exercise without inspiratory pressure support. However, on an individual basis, large differences in responses were found. Inspiratory muscle weakness was revealed as a determinant of improvement in exercise endurance due to the application of inspiratory pressure support of 10 cmH2O, explaining only 24% of the variance in outcome.

Adult↗
PubMed2003

Addition of pramlintide to insulin therapy lowers HbA1c in conjunction with weight loss in patients with type 2 diabetes approaching glycaemic targets.

AIM: Two long-term, randomized, double-blind, placebo-controlled clinical trials in insulin-using patients with type 2 diabetes, spanning a wide range of baseline glycaemic control, have shown that the addition of pramlintide, an analogue of the beta-cell hormone amylin, to pre-existing insulin regimens results in reductions in HbA1c that are accompanied by weight loss. METHODS: To assess whether this profile of pramlintide is observed in patients approaching, but not yet reaching, glycaemic targets, we conducted a pooled post hoc analysis of the two trials, including all patients with an entry HbA1c between 7.0 and 8.5%. Within this subset of patients, 80 were treated with placebo + insulin [baseline HbA1c 8.0 +/- 0.3%, weight 87.3 +/- 19.3 kg (mean +/- s.d.)] and 86 with pramlintide (120 micro g bid) + insulin [HbA1c 8.0 +/- 0.4%, weight 92.5 +/- 20.4 kg (mean +/- s.d.)]. Endpoints included changes from baseline to Week 26 in HbA1c, body weight, and the event rate of severe hypoglycaemia. RESULTS: Adjunctive therapy with pramlintide resulted in significant reductions in both HbA1c and body weight from baseline to Week 26 (-0.43% and -2.0 kg differences from placebo, respectively, both p < 0.001). These changes were achieved without a concomitant increase in the overall rate of severe hypoglycaemic events (0.13 pramlintide vs. 0.19 placebo, events/patient year of exposure). CONCLUSIONS: The data from this post hoc analysis indicate that the addition of pramlintide to insulin therapy may help patients with type 2 diabetes who are approaching, but not yet reaching, glycaemic targets to achieve further reductions in HbA1c without concomitant weight gain and increased risk of severe hypoglycaemia.

Aged↗
PubMed1997

Acarbose in the treatment of type I diabetes.

OBJECTIVE: This 36-week multicenter double-blind placebo-controlled study was designed to assess the safety and efficacy of acarbose, administered in conjunction with diet and insulin therapy, for the treatment of patients with type I diabetes. RESEARCH DESIGN AND METHODS: Acarbose was administered using a forced titration protocol in dosages ranging from 50 to 300 mg t.i.d. RESULTS: Treatment with acarbose was associated with a mean reduction in postprandial glucose levels (60 min after the administration of a test meal) of 59 mg/dl and a mean reduction in HbA1c levels of 0.48%. There was no difference in the incidence of hypoglycemia between treatment groups. Gastrointestinal events, including flatulence, diarrhea, and abdominal pain, were reported more frequently in acarbose-treated patients than in placebo-treated patients. CONCLUSIONS: Acarbose was found to be a safe and effective agent, when used in combination with diet and insulin therapy, for the treatment of type I diabetes.

Acarbose↗
PubMed1994

Intensified insulin regimens. Should they be used in all patients with type I diabetes?

The results of the Diabetes Control and Complications Trial demand a more aggressive approach to glucose control for patients with insulin-dependent diabetes mellitus. Intensified insulin regimens offer the potential for implementing this mandate. Goals of treatment should be jointly set by the patient and the professional healthcare team. The emphasis then should be on achieving those goals, using the simplest possible intensification regimen.

Animals↗
PubMed1992

Safety profile of acarbose, an alpha-glucosidase inhibitor.

Acarbose, an alpha-glucosidase inhibitor, delays absorption of carbohydrate in the gut, thereby lowering postprandial glucose levels. Safety data on this drug have been gathered in a series of studies on animals and in extensive clinical trials in humans. Although an initial long term feeding study in rats showed an excess of renal tumours at very high dosages of acarbose (up to 300 mg/kg bodyweight daily), further evaluation with similar studies in rats, hamsters, and dogs indicated that the problem was related to carbohydrate malabsorption. With adequate glucose intake and in gavage studies, no difference in tumour incidence between placebo- and acarbose-treated groups was seen. From 1976 to 1989, safety data on acarbose were obtained in approximately 8800 patients in 2 separate groups of clinical trials, the Bayer International Clinical Data Pool and the American phase III trials. Almost all adverse experiences, as reported by 56 to 76% of patients on acarbose vs 32 to 37% of patients on placebo, were related to the digestive system and included diarrhoea, flatulence, bloating and nausea. Most symptoms were of mild to moderate intensity and tended to improve with time. In the American trials a small but significant increase in liver transaminases was seen, 3.8% in acarbose-treated patients vs 0.9% in controls together with a 1% increase in anaemia in the acarbose group. Overall, acarbose was well tolerated and the adverse experience profile was clinically acceptable.

Acarbose↗
PubMed1991

Premixed insulins. How do they compare with other insulin preparations?

With the availability of premixed insulins, physicians and diabetic patients have a wider choice of therapeutic options. The premixed preparation now available in the United States consists of 70% NPH insulin and 30% regular insulin. The major advantages of premixed insulins are convenience and improved accuracy. They are suitable for patients who are too impaired to mix their own insulin dose and for those whose mixed-dose ratio is similar to that of the 70/30 preparation.

Diabetes Mellitus↗
PubMed1989

Type II diabetes. More than 'just a touch' of diabetes.

Type II diabetes is a challenge, not only because it is complex to treat but also because many physicians and patients do not appreciate the seriousness of the disease and thus do not undertake therapy aggressively. Only with the recognition that treatment and follow-up monitoring of type II diabetes require the same careful approach as type I diabetes can physicians be assured that these patients are getting the best care.

Blood Glucose↗
PubMed1988

Gestational diabetes. Ensuring optimal outcome for mother and child.

Traditional management recommendations for gestational diabetes are being questioned and are changing. Key components of revised plans of management are that all pregnant women should be screened for gestational diabetes, that stringent goals for blood glucose level are important for better outcome, that self-monitoring of blood glucose levels is essential, and that close attention should be paid to monitoring weight gain during pregnancy. Moreover, maintenance of ideal weight and yearly assessments for diabetes are important follow-up measures for the woman with gestational diabetes.

Blood Glucose↗
PubMed1988

Implementation of the group sequential methodology in a randomized trial in metastatic colorectal carcinoma.

A prospective randomized trial using the group sequential statistical method with frequent planned interim analyses was initiated in patients with metastatic colorectal adenocarcinoma comparing methotrexate and 5 fluorouracil (MTX-FU) to methyl CCNU, vincristine, FU, and streptozotocin (MOF-Strep). As a requirement of the group sequential design, a p value of 0.0125 was necessary to stop the trial at the first analysis. The first analysis was done after 17 patients were entered in each study arm and revealed six partial responses to MOF-Strep (35%) and one partial response to MTX-FU (6%) (p = 0.017). As a result, patient accrual continued. Problems encountered with the implementation of the group sequential methodology and the importance of stratification for prognostic variables are discussed.

Adult↗
PubMed1988

Phase II trial of menogarol in the treatment of advanced adenocarcinoma of the pancreas.

Fifteen patients with advanced adenocarcinoma of the pancreas were treated with menogarol 150-225 mg/m2 i.v. every 3 weeks. All patients had bidimensionally measurable disease. This regimen and dosage schedule are well tolerated, with minimal toxicity that included myelosupression; median white blood cell (WBC) count nadir of 2,700 cells/mm3 (range 1,400-7,100 cells/mm3) and median platelet nadir of 162,000 cells/mm3 (range 53,000-390,000 cells/mm3). Anorexia occurred in one patient, nausea or vomiting in six, phlebitis in one, and alopecia in six patients. No patients responded. At this dosage and schedule, there is no role for menogarol in the treatment of advanced pancreatic adenocarcinoma.

Adenocarcinoma↗
PubMed1988

Atrial capture detection with endocardial electrodes.

A new method of evoked response detection, previously demonstrated in the ventricle, has been studied in the atrium at the time of routine pacemaker implant in 16 patients. The atrial evoked response was readily detectable in all patients due to excellent recovery from poststimulus polarization. In six patients, as experimental threshold-tracking pacemaker was used to automatically verify atrial capture and to generate strength-duration curves. It is concluded that this pacing technique is both simple and reliable, and that automatic atrial threshold tracking is feasible.

Atrial Function↗
PubMed1988

Managing diabetes in the home: a model approach.

The Diabetes Home Care Program has been an effective means of providing diabetes management and education to homebound, usually elderly, persons with diabetes. The program appears to be cost effective, the average cost per patient is less than one day of hospitalization. Reimbursement of the program has been good as patients have qualified for reimbursement under Medicare guidelines. Improved diabetes control has been demonstrated following the home care intervention. Since elderly persons with diabetes are frequently referred for home care, it would be appropriate for home care agencies to provide specialized care for persons with diabetes. The Diabetes Home Care Program can serve as a model of diabetes management and education for homebound persons with diabetes.

Diabetes Mellitus↗
PubMed1987

Gallium nitrate in prostatic cancer: evaluation of antitumor activity and effects on bone turnover.

Gallium nitrate, an agent known to inhibit bone resorption, was evaluated in patients with bidimensionally measurable hormone-refractory prostatic cancer. The starting dose was 200 mg/m2 iv by continuous infusion over 7 days. Two patients (10%; 95% confidence limits, 0%-22%) achieved short partial remissions of 1 and 6+ months, while seven of 23 (30%; 95% confidence limits, 14%-52%) showed a diminution of bone pain. Serial indices of bone turnover including serum calcium, phosphorus, and urinary hydroxyproline excretion showed a significant decrease at the completion of the infusion which returned to baseline prior to the next cycle. The data suggest the effect on bone was too short to produce consistent improvement. Reasons for the dissociation of pain relief and antitumor activity are discussed.

Adenocarcinoma↗
PubMed1986

Etoposide in prostatic cancer: experimental studies and phase II trial in patients with bidimensionally measurable disease.

Etoposide, a semisynthetic derivative of podophyllotoxin, was evaluated concurrently in vitro against a human derived hormone-resistant cell line, PC-3, and in vivo in bidimensionally measurable hormone-resistant human prostatic cancer. In vitro, a dose-response relationship was observed, with 74% inhibition at 10 micrograms/ml (1 h incubation) and greater than 99% inhibition at 90 micrograms/ml, both in the range of clinically achievable concentrations. In vivo, 1 PR (5%, 95% confidence limits 0-12%) of 18+ months was observed in 20 adequately treated patients. The results confirm the limited role of etoposide in hormone-refractory disease and the need for new model systems for evaluation of potential chemotherapeutic compounds in this disease.

Adenocarcinoma↗