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At least 235 records · Page 13Linked to original sources
PubMed1997

[Significance of double crush in carpal tunnel syndrome].

From June 1992 to October 1995, 224 patients were operated on carpal tunnel syndrome. We treated 71 male and 153 female patients. During our investigations, we found that one third of the patients suffered from a double crush syndrome. 84% of the patients suffered from one or more predisposing accompanying diseases. In most of them (42%) we found rheumatic diseases, 19% diabetes mellitus, 8% hyperuricaemia, and 6% hypothyreosis. In 33%, we observed a very short history and a bilateral carpal tunnel syndrome. According to the preoperative tests, four different groups of patients regarding electrophysiological parameters and the graduation of thenar atrophy were differentiated. The fourth group was composed of patients with double crush syndrome, who continued to complain of considerable pain despite surgery, the operated hand remaining both weak and awkward in its movements. Inspired by the prospective study by Dellon (1992) and our results, we will perform a retrospective analysis of the longterm effect of carpal tunnel release in diabetic neuropathy.

Adult↗
PubMed1998

Flare during drug withdrawal as a method to support efficacy in rheumatoid arthritis: amiprilose hydrochloride as an example in a double blind, randomized study.

OBJECTIVE: To evaluate the use of a randomized, double blind, drug withdrawal design as a means to test the efficacy of longterm therapy with antirheumatic drugs. METHODS: We evaluated 286 patients with rheumatoid arthritis (RA) treated with amiprilose hydrochloride for 1-3 years, with response, with or without other antirheumatic therapy, in a double blind, 12 week withdrawal study that compared patients randomized to continue amiprilose therapy vs patients randomized to placebo. The primary efficacy variable was preventing a predefined degree of clinical reactivation, or flare; the statistical tests of success were a difference in the proportion of flares and in the mean time to flare. RESULTS: Thirty percent of patients taking amiprilose and 43% of placebo patients experienced flare (p = 0.026). Patients taking amiprilose had a longer flare-free interval compared to placebo patients (p = 0.027), with the time to reactivation or flare becoming statistically different 73 days after withdrawal. CONCLUSION: Placebo controlled withdrawal designs are useful as evidence to support the longterm effectiveness of therapy in a proportion of patients with RA.

Adolescent↗
PubMed1998

Longterm mortality outcome in patients with rheumatoid arthritis: early presenters continue to do well.

OBJECTIVE: Patients with rheumatoid arthritis (RA) have reduced life expectancy; however, there are few data on the changing pattern of causes of death with longterm followup, or on the longterm effect of early presentation. The objectives of this study were (1) to examine the effect of early presentation on subsequent mortality; (2) to compare the causes of death early and late in the followup period; and (3) to compare survival of the cohort with that of the general population (adjusted for age and sex) over a followup period of up to 27 years. METHODS: A cohort of 448 patients with RA (inpatients and outpatients), assembled 1968-74, were followed to December 31, 1990. Death certificates were obtained for all who had died and coded using the International Classification of Diseases. Kaplan-Meier survival curves were constructed. RESULTS: By the end of the study, 266 patients (59%) had died. The standardized mortality ratio (SMR) was 2.7 (95% CI 2.4-3.1). Patients who presented early continued to do well. Most excess deaths were due to cardiovascular disease. SMR due to infection, renal failure, and non-Hodgkin's lymphoma rose with disease duration. CONCLUSION: Patients with RA should be referred early, and those with chronic disease should be closely monitored for evidence of infection and renal impairment.

Adult↗
PubMed1998

Clinical cardiac magnetic resonance spectroscopy--present state and future directions.

MR spectroscopy opens a window to the non-invasive evaluation of various aspects of cardiac metabolism. Experimentally, the method has extensively been used since 1970's. 31P-MR allows the registration of cardiac high-energy phosphate metabolism to non-invasively estimate the energetic state of the heart: ATP, phosphocreatine, inorganic phosphate, monophosphate esters and intracellular pH can all be quantitated. In conjunction with extracellular shift reagents such as [DyTTHA]3- or [TmDOTP]5-, 23Na- and 39K-MR allow the measurement of intra- and extra-cellular cation pools. 1H-MR spectroscopy allows the detection of a large number of metabolites such as, e.g. creatine, lactate, or carnitine. Human cardiac spectrocsopy has so far been confined to the 31P nucleus. Localization techniques (DRESS, ISIS, 3D-CSI etc.) are required to confine the acquired signal to the heart region. Relative quantification is straightforward (phosphocreatine/ATP ratio), absolute quantification (mM) is under development. Cardiac 31P-MR spectroscopy has research application in at least three clinical areas: (1) Coronary artery disease: A biochemical stress test for non-invasive ischemia detection (decrease of phosphocreatine with exercise) and viability assessment via quantification of ATP may become feasible. (2) Heart failure: The phosphocreatine/ATP ratio may provide an independent index for grading of heart failure, allow to monitor the longterm effects of different forms of drug therapy on cardiac energy metabolism in heart failure, and may also hold prognostic information on survival. (3) Valve disease: It is possible that the decrease of phosphocreatine/ATP can be used to guide the timing for the valve replacement. At the present time, no routine clinical applications can be defined for the use of human cardiac spectroscopy in patients with cardiac disease. However, the technique holds great potential for the future as a non-invasive approach to cardiac metabolism, and in coming years routine applications may become reality.

Adenosine Triphosphate↗
PubMed1998

The use of sulfasalazine in psoriatic arthritis: a clinic experience.

OBJECTIVE: To assess the tolerability of sulfasalazine in a clinic setting and determine its longterm effectiveness with respect to articular disease and prevention of radiographic progression in patients with psoriatic arthritis (PsA). METHODS: Patients who were given sulfasalazine during their attendance at the University of Toronto Psoriatic Arthritis Clinic were enrolled in the study. For patients that were able to tolerate sulfasalazine for at least 3 months a matched control was identified who did not receive sulfasalazine. The primary outcome measures were the tolerability of sulfasalazine, clinical response of the actively inflamed joints at 6 and 12 months, and the change in radiographic score at 24 months. RESULTS: Thirty-six patients received sulfasalazine. Fourteen of 16 patients discontinued sulfasalazine due to one or more side effects occurring within 3 months of treatment initiation. For the remaining 20 patients, a 50% reduction in actively inflamed joint count was noted in 7/20 patients at 6 months and 11/15 patients at 12 months, compared to 7/19 patients in the control group at 6 months and 10/20 patients at 12 months. The mean change in the radiographic score at 24 months between the 2 groups was not statistically significant. CONCLUSION: Sulfasalazine was not well tolerated in patients with PsA in our clinic. For those able to tolerate sulfasalazine, there was no evidence of a treatment effect with respect to articular involvement. In addition, sulfasalazine does not appear to halt radiographic progression in PsA.

Adolescent↗
PubMed1976

[Effect of long-term treatment with synthetic oestrogens on plasma lipids and arterial vessels in male rabbits (author's transl)].

The effects of long-term treatment with synthetic oestrogens (Retalon retard, Sanabo Ltd., Wien, 5 mg/kg i.m. at weekly intervals) were investigated in 12 male rabbits and compared with the data obtained in 9 saline-treated control animals. After 6 months of treatment the oestrogen group showed significantly higher plasma phospholipid (p less than 0.005) and cholesterol (p less than 0.01) concentrations than the control group. However, histological examination of various important arterial vessels (the aorta and the coronary, cerebral, limb and renal arteries) revealed no pathological changes indicative of premature atherosclerosis in either the oestrogen group or in the control group. It is concluded that long-term treatment with synthetic oestrogens does not result in a higher incidence of atherosclerosis in rabbits.

Animals↗
PubMed1996

Safety of nonsteroidal antiinflammatory drugs in pregnant patients with rheumatic disease.

OBJECTIVE: To determine whether active arthritis in pregnant patients can be safely treated with nonsteroidal antiinflammatory drugs (NSAID) without harm to the neonate or longterm adverse effects in the offspring. METHODS: Patients were recruited from a prospective study on pregnancy and rheumatic disease. A cohort of 88 pregnant patients with inflammatory rheumatic disease was divided into 2 groups, 45 who were treated 43 not treated with NSAID during pregnancy. Possible longterm effects of NSAID on physical and mental development of the offspring were evaluated by telephone interview. RESULTS: Groups did not differ with regard to demographic data. Fourty-nine pregnancies had been exposed to standard doses of NSAID for a mean duration of 15.3 weeks. A comparison of pregnancies exposed with those not exposed to NSAID revealed no differences in pregnancy outcome, duration of labor, complications at delivery, or neonatal health. No significant differences were found between the groups with respect to health and development of offspring at followup. CONCLUSION: This study of a limited number of pregnancies in rheumatic patients showed no teratogenicity or adverse effects of NSAID on the neonate, nor did it reveal harmful longterm effects caused by intrauterine exposure to these drugs.

Adolescent↗
PubMed1997

Role of splenectomy in gastric cancer surgery: adverse effect of elective splenectomy on longterm survival.

BACKGROUND: Splenectomy, and in some cases pancreatico splenectomy, has been advocated by surgeons in an effort to improve clearance of metastatic nodes to splenic hilum (node 10) and splenic artery (node 11). Although splenectomy has known effects on increasing morbidity and even mortality after a variety of surgical maneuvers including gastrectomy, the longterm effect on survival is controversial. The purpose of this study is to review and analyze the effect of splenectomy on survival in patients having curative gastrectomy for stomach cancer. METHODS: We reviewed the role of splenectomy in patients having curative gastrectomy in a data base of stomach cancer patients that had been collected in 1987 as part of an American College of Surgeons Patterns of Care Study. This analysis had involved 18,344 patients, of whom 11,252 were first diagnosed in 1982 as part of a longterm study, and 7,092 were first diagnosed in 1987 as part of a shortterm study. From the two data collection periods information was available on 12,439 patients who received cancer directed abdominal surgery; 21.2% of these patients received a splenectomy. Among the 3,477 patients reported as having a curative gastrectomy (pathologically clear margins), 26.2% received a splenectomy. RESULTS: The operative mortality was 9.8% with splenectomy and 8.6% without splenectomy. In patients having a curative gastrectomy, the 5-year observed survival rate was 20.9% in patients having splenectomy versus 31% in patients who did not receive splenectomy (p < 0.0001). Examination of differences in survival by stage of diagnosis showed significantly reduced survival outcomes among patients with stage II and III, but not for those diagnosed with stage I or IV disease. The pattern of recurrence was moderately different with a larger proportion of patients having distant metastases among the group of patients who had undergone splenectomy compared with the patients who had not, 29% and 15.5%, respectively. Whether these differences are inherent in the splenectomy or in the associated cofactors was not determined in this study. CONCLUSIONS: The data suggest elective splenectomy should generally be avoided in patients with stage II and III gastric cancer. In patients with resectable proximal advanced (stage IV) cancer or who have extension to spleen and pancreas or macroscopic nodal metastases to splenic hilum, splenectomy might be necessary to facilitate complete removal of the tumor in an effort to achieve longterm tumor control. The importance of surgical judgment is emphasized as the major deciding factor in determining the need for splenectomy in the individual cancer patient.

Elective Surgical Procedures↗
PubMed1987

Hepatic adenoma within a spindle cell carcinoma in a woman with a long history of oral contraceptives.

The case of a young woman is presented who had a long history of oral contraceptive use and who was found to have a focal hepatic adenoma within a large spindle cell carcinoma of the liver. The pleomorphic tumor is positive for keratin and alpha 1-antitrypsin by immunohistochemistry, has intracellular lumina by electron microscopy, a moderately high thymidine labeling index, and is negative for estrogen and progesterone receptors. A review of the literature concerning liver tumors occurring in young patients indicates that there is an underlying disturbance of the hormonal milieu in all instances reported. The prognosis is widely variable and unpredictable.

Adult↗
PubMed1982

Effect of injectable norethisterone oenanthate (Norigest) on blood lipid levels.

Lipid concentrations were measured in 74 blood samples from 61 women who had been using the injectable contraceptive Norigest (norethisterone oenanthate) for between 2 to 4-1/2 years. There were no significant changes in the concentrations of total cholesterol, total triglycerides and low density and very low density lipoprotein cholesterol but high density lipoprotein cholesterol was significantly reduced. The reduction in serum HDL-C levels was not correlated with either the serum norethisterone concentrations or the length of use of Norigest nor was it affected by obesity or smoking.

Adult↗
PubMed1991

Long-term effects of depot-medroxyprogesterone acetate on lipoprotein metabolism.

To assess the effects of depot-medroxyprogesterone acetate (DMPA) upon serum lipids and lipoproteins, a comparative study in chronic users and new acceptors was undertaken. Two groups of women of reproductive age were included in the study; group I (n = 8) was formed by new acceptors whereas, group II (n = 14) constituted DMPA users of more than five continuous years (7.0 + 2.1 years). Blood samples were taken on the day of injection and 15, 29, 57 and 92 days after the i.m. administration of 150 mg of DMPA for the measurement of total triglycerides (TG), cholesterol (CHOL) and phospholipids (PHL). In addition, the TG and CHOL content in the very low density (VLDL), low density (LDL) and high density (HDL) lipoprotein fractions obtained by ultracentrifugation were also determined. The results demonstrated a moderate increase in the serum total TG concentrations at the expense of the VLDL fraction in the group of chronic DMPA users. In both groups, the administration of DMPA induced a moderate, though not significant, decrease in total CHOL and HDL-chol, an effect that was noticed at the end of the treatment interval; the serum LDL-chol content remained unchanged. In addition, a decrease in the total serum phospholipids content was noticed after DMPA injection in both groups, which resembled the fluctuations observed in the luteal phase of normal ovulating women. The overall data indicate that acute and/or chronic DMPA administration at the dose currently employed for contraception does not induce major abnormalities in lipoproteins in serum.

Adult↗
PubMed1996

Clearing of psoriasis by a novel immunosuppressive macrolide.

Accumulating evidence suggests that psoriasis may be a genetically determined immunogenic, inflammatory disorder based on an ongoing autoreactive Th-1 response. Systemic immunosuppressive therapy is highly effective but fraught with longterm side effects. Our research therefore focuses on therapeutic strategies that induce local immunosuppression in the skin by topical, transepidermal delivery of immunosuppressive drugs. SDZ 281-240 is a newly developed macrolide of the ascomycin type. It is immunosuppressive by mechanism of action similar to that of FK506 but has no antiproliferative activity against keratinocytes in vitro. To evaluate whether SDZ 281-240 exhibits antipsoriatic activity when applied topically, we tested 15 patients with severe, recalcitrant psoriasis, using a microplaque assay in randomized, double-blind, placebo-controlled study, comparing the therapeutic efficacy of the macrolide with a potent halogenated corticosteroid and vehicle. All patients showed a significant improvement of psoriatic lesions treated with two concentrations of the macrolide and, as expected, with the corticosteroid but not with placebo. Both concentrations of the macrolide led to clearing of psoriasis after 10 days of treatment and biopsies confirmed a reversal of the histopathological and immunopathological phenotype of psoriasis to that of normal skin. Thus, an immunosuppressive agent that interferes with early T cell activation can be designed to penetrate into psoriatic lesions when applied topically and to be functionally active within the skin to suppress the ongoing psoriatic process.

Administration, Topical↗
PubMedDate not supplied

The effect of vasectomy on serum lipids.

The effects of vasectomy on serum lipids and free fatty acids were followed. The concentration of serum cholesterol was lower one year after vasectomy than one week after and immediately before vasectomy (p less than 0.01). The LDL-cholesterol concentration decreases by 16 per cent (p less than 0.01) within one year after vasectomy. The concentration of serum free fatty acids was significantly higher (p less than 0.001) before vasectomy than after it.

Adult↗
PubMed1986

Clinical experience with multiphasic oral contraceptives.

The short-term, mainly estrogen-induced side effects of oral contraceptives (OCs) have been minimized by a reduction in the estrogen component in formulations currently employed. Women may expect to continue OCs for several decades of their reproductive lives, commencing earlier and stopping later than did their mothers. Youth does not appear to offer protection from initiation of cardiovascular pathology. Data from the Bogalusa Heart Study show that risk factors for cardiovascular disease, such as elevated serum low-density-lipoprotein cholesterol, are associated with anatomic changes in the aorta and coronary arteries very early in life. Therefore, the focus now is on long-term OC effects, especially alterations in carbohydrate and lipid metabolism. Progestin components of some OCs may alter both carbohydrate and lipid metabolism significantly, in a dose- and potency-related manner. OC formulations, therefore, are moving toward a reduction in the dose as well as potency of the progestin used, with a special emphasis on lipid profile study. Multiphasic OCs, the most recent generation of formulations, achieve considerable reductions by starting each cycle at a low dose of progestin and altering the dose in stages. Two of the multiphasics incorporate norethindrone as the progestin. Here we examine the clinical experience with one of the norethindrone-containing agents, Ortho Novum 7/7/7, and compare its performance and metabolic side effects with those of the corresponding monophasic preparation.

Adult↗