One hundred and fourteen patients with clinical or pathological stages IIIB and IV Hodgkin's disease have been treated with MVPP chemotherapy followed by radiotherapy to sites of previously bulky disease. The minimum follow-up is 2 years with a median of 5 years. The overall remission rate was 92 per cent with 74 per cent achieving CR. A discriminant analysis showed that the presence of bulky disease was the only independent factor that predicted a lower chance of CR (66 per cent vs 82 per cent, P = 0.045). The 5-year survival was 70 per cent overall and 85 per cent for CR patients. A Cox multivariate analysis demonstrated that stage III disease, age less than 36 years and female sex were all variables which independently predicted a more favourable prognosis in terms of overall survival. However, a similar analysis for survival of CR patients showed that age less than 36 years and the absence of bulky disease were the only two factors to independently predict a more favourable outcome. Of 14 patients who did not receive the chemotherapy according to protocol 5 have relapsed compared to 7 of 70 who did. A Cox analysis confirmed that this variable was the only one of significant prognostic import in predicting relapse-free survival. Using the Cox analyses we have been able to devise a scoring system which accurately predicts the outcome for these patients. This model may be useful in determining which patients have a worse prognosis following treatment with MVPP thus allowing more intensive therapy to be given to such patients while minimising treatment for those with favourable features.

Adolescent↗

PubMedDate not supplied

Bioavailability studies of acetaminophen and nitrofurantoin.

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Absorption↗

PubMedDate not supplied

Stenting and superior vena caval syndrome.

The use of intravascular stents in the management of Superior Vena Caval Obstruction is a relatively recent development. We describe our experience with six patients, aged between 64 and 85 years who developed SVC obstruction secondary to malignant disease and who had one or more intravascular stents inserted. Five of the patients had lung cancer and one metastatic breast carcinoma. Positive histology was available in three cases. A partial or complete clinical response was seen in all patients and two patients developed recurrent symptoms. Stenting appears to provide effective palliation of SVC obstruction symptoms.

Aged↗

PubMedDate not supplied

Perinatal substance abuse: a rural network.

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Female↗

PubMedDate not supplied

Selection bias in the management of unstable angina.

OBJECTIVES: To examine the criteria for selecting patients presenting with unstable angina for cardiac catheterisation and to assess the extent to which these criteria successfully incorporate high risk groups. METHODS AND RESULTS: This was a prospective cohort study of 517 patients admitted with unstable angina with 12 months follow-up; 139 patients (26.9%) had cardiac catheterisation 32 days or longer after presentation. The odds of early catheterisation were increased by regional ST segment depression on the presenting ECG (odds ratio (OR) 1.70, 95% confidence intervals (CI) 1.01-2.87) and ongoing ischaemic chest pain more than 12 hours after admission (OR 9.72, CI 6.10-15.49), and reduced by age over 65 years (OR 0.56, 95% CI 0.35-0.90) and heart failure (OR 0.26, CI 0.11-0.64). The 12-month rates of myocardial infarction (MI) or death were 8.6% and 17.7% (p = 0.01) in patients who were and were not referred for early cardiac catheterisation, respectively. Survival analysis showed that the odds of MI and death in the first 12 months were increased substantially by heart failure (OR 2.82, 95% CI 1.53-5.20) and age over 65 (OR 1.91, 95% CI 1.13-3.23). CONCLUSION: Selection for early cardiac catheterisation in this unstable angina population was largely ischaemia-driven, based on ongoing chest pain and ST segment depression. This policy was associated with a low event rate in the ischaemic group, but it failed to target elderly patients and those with heart failure who were at greatest risk of MI and death during the first year.

Aged↗

PubMedDate not supplied

[Antiasthmatic drug consumption as an indicator of the prevalence of respiratory pathology in a pediatric population].

The study of disease prevalence requires specific and sensitive indicators, which are hardly gathered at population level. The use of anti-asthma drugs, which are relatively specific for diseases characterised by bronchospasms, has been already experimented in the USA with algorithms describing patients affected by asthmatic disease by their use of drugs. We retrospectively analyse spatial variations of drug use as dispensed by the SSN (National Health Service) to Lombardy children less than 15 years old, between 1st January 1995 and 31st December 1997, estimating prevalence of use as a proxy of disease prevalence. Two algorithms already experimented and a new one have been employed to select children treated with antiasthmatic therapy (R03 of ATC classification) dispensed. Local communities' data were used for basic demography. Number of daily defined doses (DDD) dispensed has been used as indicator of drug quantity. Euro/year per person has been used as indicator of costs. Small area distribution analysis has been performed with a Geographic Information System at local Communities level. Frequency of patients (of a total of 1,252,958 children): with at least one dispensed drug in the three years was 26.6% (SD 10.5), DDD per person per month were 1.21 (SD 0.78), Euro/Year per person 6.84 (SD 3.61); with the association of a anti-inflammatory and a b2-agonist was 8.2% (SD 5.6), DDD per person per month were 3.01 (SD 3.07), Euro/Year per person 15.87 (SD 15.07); with at least 90 days of DDD in the three years was 2.6% (SD 1.3) DDD per person per month were 7.79 (SD 4.48), Euro/Year per person 37.66 (SD 21.83). It must be taken into account that, in the best of cases, these approximation refers to the prevalence of all diseases, characterised by bronchospasm, treated with the selected drugs. Estimated data of prevalence are comparable with those of other authors. Prevalence of drug use appears to have relevant geographical differences. Taking into consideration these comments, prevalence of drug use and consequently the estimated disease prevalence appears to be worryingly high, having as well wide geographical differences.

Adolescent↗

PubMedDate not supplied

Methodological issues in using drugs data in epidemiology.

Using drugs data in epidemiological studies is becoming fashionable with the large databases available today. We describe the philosophical basis and the main methodological issues. The process leading a patient affected by a disease to be treated with an appropriate drug appears to be complex, and influenced by external and internal many factors, described here. The disease-drug use relationship is disentangled describing its main characteristics. Drug use data means the information concerning the use of drugs, which encompasses any form of record, on paper or computerised, collected from patients, doctors prescribing the drug, pharmacists dispensing it, the drug company that produces it, or its distributor. The possible sources of drug use data are described, along with the possible strengths and weaknesses of each source. Various examples of uses of drug utilisation data as indicator in epidemiological researches are presented. Drug utilisation studies are a recent issue of public health research, merging knowledge of public health doctors, epidemiologists, pharmacologists and health economists. Automated databases demonstrate nowadays to be a valuable approach to drug utilisation investigation. In conclusion, the aim of any forward looking health care system should be to collect and freely circulate these detailed information, allowing not only useful health care planning but also indeep, population based, health research.

Drug Utilization↗

PubMedDate not supplied

The role of drug use data in public health research.

The growing importance of drug consumption automated databases in public health research is summarised in this research. Dispensed drugs data, and drug consumption data more in general, are a relatively new source of information for health research. This analysis takes into consideration the known uses of drug consumption data in various fields of health related research. Pharmacoepidemiology examples of adverse drug reaction studies are presented along with drug prescription surveillance and analysis of prescribing patterns, useful tools for health services evaluation as well as health economics, from the simple evaluation of health care burden for drug expenditure to the various studies of cost of drugs. Other fields of use are prevalence and incidence epidemiology studies, or causal inference studies using drugs data as health indicators. Drug utilisation automated databases, organised and maintained in large areas, with individual information, seem to improve the feasibility and usefulness of this kind of studies. It reduces the need for time, money and people to perform valid scientific investigations, in epidemiology as well as in other areas of health research.

Biomedical Research↗