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At least 271 records · Page 15Linked to original sources
PubMed2006

Etanercept responsive acrodermatitis continua of Hallopeau: is a pattern developing?

Acrodermatitis continua of Hallopeau (ACH) is a rare disease. Little is known about its etiology or relative effectiveness of the various therapeutic approaches. However, in the literature a pattern seems to be developing on successfully treated patients using biologic therapies. Here, we further emphasize the potential breakthrough presented by the novel immune based therapies. This report consists of a case of etanercept responsive ACH along with a brief review of the literature.

Acrodermatitis↗
PubMed2000

Intrauterine polyps--a cause of unscheduled bleeding in women using the levonorgestrel intrauterine system: case report.

The levonorgestrel intrauterine releasing system is a contraceptive that has been shown to reduce menstrual blood loss dramatically. Breakthrough bleeding, however, is a relatively common occurrence as with all methods of progestogen-only contraception and this limits its acceptability for women. Amenorrhoea can be achieved in the majority of women within 12 months of insertion. Any new pattern of bleeding after amenorrhoea or a persistence of heavy bleeding may be due to co-existing intrauterine pathology such as endometrial polyps. The use of out-patient techniques such as hysteroscopy and saline infusion sonography are indicated in these instances to exclude other intrauterine pathology.

Adult↗
PubMed1998

Methysergide.

Methysergide is a semisynthetic ergot alkaloid ergometrine derivative, introduced in pharmacotherapy for migraine prophylaxis as a specific serotonin (5HT) receptor antagonist. Methysergide is not just a 5HT2 antagonist, it is also a 5HT1 agonist. Open and controlled studies attest to methysergide's efficacy. It may be more effective in resistant cases with a high attack frequency and may act synergistically with ergotamine and dihydroergotamine (DHE) for breakthrough attacks. Contraindications include pregnancy, peripheral vascular disorders, severe arteriosclerosis, coronary artery disease, severe hypertension, thrombophlebitis or cellulitis of the legs, peptic ulcer disease, fibrotic disorders, lung diseases, collagen disease, liver or renal function impairment, valvular heart disease, debilitation, or serious infection. Methysergide can induce retroperitoneal fibrosis and pleural and heart valve fibrosis with an estimated incidence of 1 in 5,000 treated patients. Therefore, it should be reserved for severe cases in which other migraine preventive drugs are not effective.

Humans↗
PubMed2000

Protein adsorption on novel acrylamido-based polymeric ion exchangers. II. Adsorption rates and column behavior.

Uptake kinetics and breakthrough behavior were determined for bovine serum albumin (BSA) and alpha-chymotrypsinogen (alphaCHY) in new polymeric ion-exchange media based on acrylamido monomers. Two anion exchangers and a cation exchanger were investigated. As shown in Part I of this work, the two anion exchangers have different morphologies. The first one, BRX-Q, comprises a low-density gel with a matrix of denser polymeric aggregates. While this material has a very low size-exclusion limit for neutral probes, it exhibits an extremely high binding capacity for BSA. The second anion exchanger, BRX-QP, comprises large open pores but has a very low binding capacity. The cation exchanger, BRX-S, also comprises large open pores but exhibits an intermediate capacity; likely as a result of the presence of smaller pores. Dynamic protein uptake experiments showed that the highest mass transfer rates are obtained with BRX-Q. The apparent diffusivity is also highest for this material and increases substantially as the protein concentration is reduced. For these particles, the external film resistance is dominant at very low protein concentrations. Much lower rates and apparent diffusivities are obtained for BRX-QP. Finally intermediate rates and apparent diffusivities are found with BRX-S. The concentration dependence of the apparent pore diffusivity is much less pronounced in this case. The apparently paradoxical result that mass transfer rates are highest for the material with the smallest neutral-probe size-exclusion limit can be explained in terms of a general conceptual model where parallel pore and adsorbed-phase diffusion paths exist in these particles. In the first case, adsorbed phase diffusion in gel pores is dominant, while in the second transport is dominated by diffusion in a macroporous network. In the third case, both contributions are important. The conceptual model provides an accurate prediction of the breakthrough behavior of columns packed with these media using independently determined rate parameters. Dynamic binding capacities of 80-140 mg/ml were observed for BSA on BRX-Q in ca. 1.5 cm columns operated at 300-900 cm/h in agreement with theoretical predictions.

Acrylamides↗
PubMed1992

Visual impairment of open angle glaucomas at first presentation and after a five to ten year follow-up.

Of all patients attended to in a clinic during 1986, 441 had open angle glaucoma diagnosed during 1974-1986 on the basis of either a verified visual field defect, a glaucomatous disc, or a repeated intraocular pressure value of at least 35 mm Hg. At first presentation of recent cases 1984-1986 (N = 128) 65 per cent were more than 70 years old. Capsular glaucomas were twice as common as simple glaucomas (low tension cases included). 62 per cent of capsular but only 26 per cent of simple glaucomas had an initial pressure of 35 mm Hg or more (p < 0.001). One third of both capsular and simple glaucomas had an advanced visual field defect with breakthrough to the periphery in the worse eye already at first presentation. This was more common if the initial pressure was 35 mm Hg or more (p < 0.05). Almost half remained unilateral cases, and the rate of severely impaired visual function in the better eye did not exceed 15 per cent. While generally 30-50 per cent of glaucomatous field defects had progressed in five years, the progression in early detected cases was only three per cent (p < 0.05). Visual field defects with breakthrough to the periphery already at first presentation progressed more often than circumscribed scotomas (p < 0.02).

Aged↗
PubMed1963

Recent developments in ocular therapeutics.

Triethylene thiophosphoramide, an alkylating agent of value as a palliative in cases of neoplastic disease and reticulosis, has been effective in preventing vascularization of the cornea when used locally. Since recurrent pterygium, a persistent clinical problem, particularly in the Western states, is preceded by corneal vascularization and fibroplastic proliferation, it is possible that this drug when used topically may be useful in obviating to some extent the use of radiation, which must be used with great caution to avoid the production of cataract. In the treatment of gram-negative bacterial infection, especially Pseudomonas aeruginosa, the drug colistin has been known to be effective in some cases which were not helped by other antibiotics, including polymixin B. In the field of virus infections, a major breakthrough may have come about by the discovery that 5-iodo-2-deoxyuridine (IDU) attacks the herpes cirrus in the cornea as a metabolic antagonist. Animal experiments and some clinical studies have confirmed its effectiveness as compared with other therapeutic measures in selected cases. In the treatment of ocular problems resulting from systemic disease fibrinolysin (plasmin) has apparently caused dissolution of the clot and restoration of circulation in some cases of retinal artery occlusion. Severe diabetic retinopathy in younger diabetic patients has been shown to regress in certain cases treated by hypophysectomy or radiation of the pituitary gland employing the cyclotron. This gland is also associated intimately with the exophthalmos of thyroid origin, and its action may be aggravated by the use of ACTH or steroids.

Animals↗
PubMed1998

Relationship between circulating estradiol levels, body mass index, and breakthrough bleeding in postmenopausal women receiving hormone replacement therapy.

OBJECTIVE: The purpose of this prospective study was to investigate the association of breakthrough bleeding with circulating estradiol levels and obesity in postmenopausal women receiving hormone replacement therapy. DESIGN: Fifty postmenopausal women receiving 0.625 mg conjugated estrogen with 2.5 mg medroxyprogesterone acetate were included in the study. Patients are recalled at 1st, 5th and 9th weeks for the measurements of the serum estradiol levels. RESULTS: Twenty women (40%) had a bleeding episode within 9 weeks of therapy. Of the 25 women who had a body mass index (BMI) of > 25, 13 (52%) had bleeding. Of the 25 women who had a BMI of < 25, 7 (28%) had bleeding. There was a trend toward a relation between BMI and breakthrough bleeding, although the relation did not achieve significance (p = 0.14). Serum estradiol levels of both bleeders and nonbleeders remained similar throughout the study. Endometrial histology revealed proliferative endometrium in two cases and secretory endometrium in one case at baseline; two cases of proliferative endometrium were found during bleeding. The remaining samples revealed atrophy. CONCLUSIONS: No relation was found between serum estradiol levels and breakthrough bleeding. Nevertheless, increased BMI may have an impact on breakthrough bleeding in postmenopausal women receiving hormone replacement therapy.

Atrophy↗
PubMedDate not supplied

[Pregnancy after kidney transplantation. Case load of the Transplantation Center of Vicenza].

BACKGROUND: Pregnancy after kidney transplant has become possible thanks to recent surgical and pharmacological breakthroughs. MATERIALS AND METHODS: We performed a retrospective study including all pregnant women transplanted in our center after 1997. The following variables were analyzed. The type of nephropathy, patient age when dialysis began, patient age at trans-plantation, the time between dialysis and transplantation and the time between transplantation and childbirth. Immunosuppressive therapy, type of delivery, baby's weight and Apgar score were also considered. RESULTS: We followed four pregnancies in three patients who were, respectively, diagnosed with chronic pyelonephritis, post-partum cortical necrosis and immunoglobulin A (IgA) glomerulonephritis (GN). We observed complications in three cases and two pre-term births. In one case, the baby's weight at birth was lower when compared to the gestation age. We did not observe any significant disease in the baby's follow-up. CONCLUSIONS: We concluded that our data were in agreement with those in the literature confirming that pregnancy after kidney transplant, although possible, carries an elevated risk; and therefore, patients have to be referred to highly specialized centers.

Adult↗
PubMed1998

Efficacy of lamivudine re-treatment in a patient with hepatitis B virus (HBV) recurrence after liver transplantation and HBV-DNA breakthrough during the first treatment.

BACKGROUND: Transplantation for terminal hepatitis B virus (HBV) disease is aggravated by a high rate of reinfection and disease recurrence. Lamivudine, a new nucleoside analog, is a potent inhibitor of HBV synthesis, but its use may lead to the emergence of HBV-DNA polymerase mutants resistant to the drug. METHODS AND RESULTS: We describe the case of a patient who developed an HBV recurrence after liver transplantation and was treated with lamivudine. An HBV-DNA breakthrough occurred 7 months after the start of therapy, and the drug was stopped after 9 months. The molecular state of HBV-DNA was analyzed, and a mutation in the YMDD (tyrosine, methionine, aspartate, aspartate) locus of HBV-DNA polymerase was identified. Nine months after the suspension of lamivudine the patient experienced a new hepatic attack accompanied by high HBV-DNA levels. Lamivudine was given again. Serum HBV-DNA levels normalized after 45 days of re-treatment, but lamivudine-resistant mutants were again the prevalent viral population after 3 months. CONCLUSIONS: The case described suggests that retherapy with lamivudine after a first emergence of YMDD mutants is temporarily effective in recontrolling HBV synthesis but ultimately induces the accelerated reemergence of a prevalently mutant population of HBV. This emphasizes the need for combined antiviral therapy.

Antiviral Agents↗
PubMed1998

Failed postnatal immunoprophylaxis for hepatitis B: characteristics of maternal hepatitis B virus as risk factors.

A retrospective case-control study was conducted to determine why some infants born full-term without obstetric intervention to hepatitis B e antigen (HBeAg)-seropositive mothers become infected by hepatitis B virus (HBV) despite having received passive-active immunoprophylaxis. Cases and controls comprised 12 hepatitis B surface antigen (HBsAg)-seropositive infants and 22 HBsAg-seronegative infants, respectively. Infants infected by putative vaccine-escape mutants were excluded. Risk factors, after adjustment for the level of maternal viremia, were the following allelic base changes in maternal HBV:C158, A328, G365, and A479 (P = .017, .005, .003, and .005, respectively). High-level maternal viremia (i.e., > or = 10(8) genome equivalents/mL) was a significant factor only after adjustment for G365 (P = .027). HBV DNA sequences recovered from one of the cases, the case's mother, and three infected contacts all had the high-risk mutations. Specific allelic mutations in maternal HBV and level of maternal viremia are potential predictors of vertical breakthrough infection.

Case-Control Studies↗
PubMed2004

Biochemical reaction engineering for redox reactions.

Redox reactions are still a challenge for biochemical engineers. A personal view for the development of this field is given. Cofactor regeneration was an obstacle for quite some time. The first technical breakthrough was achieved with the system formate/formate dehydrogenase for the regeneration of NADH2. In cases where the same enzyme could be used for chiral reduction as well as for cofactor regeneration, isopropanol as a hydrogen source proved to be beneficial. The coproduct (acetone) can be removed by pervaporation. Whole-cell reductions (often yeast reductions) can also be used. By proper biochemical reaction engineering, it is possible to apply these systems in a continuous way. By cloning a formate dehydrogenase and an oxidoreductase "designer bug" can be obtained where formate is used instead of glucose as the hydrogen source. Complex sequences of redox reactions can be established by pathway engineering with a focus on gene overexpression or with a focus on establishing non-natural pathways. The success of pathway engineering can be controlled by measuring cytosolic metabolite concentrations. The optimal exploitation of such systems calls for the integrated cooperation of classical and molecular biochemical engineering.

Enzymes↗
PubMed1989

Comparison of continuous and sequential oestrogen-progestogen treatment in women with climacteric symptoms.

Continuous (Kliogest) and sequential (Trisequens) oestrogen-progestogen treatment were compared in a randomized, parallel, group study in women suffering from climacteric symptoms. The subjects were treated with Trisequens for 4 mth prior to randomized assignment to 1 of 2 treatment groups, and with either Trisequens or Kliogest for 12 mth thereafter. Forty-one (41) patients were initially recruited for the study. Of these, 34 completed the study, each treatment group hence comprised 17 women. The results suggest that continuous treatment is as effective as sequential treatment in alleviating climacteric symptoms. Luteinizing hormone (LH) and follicle-stimulating hormone (FSH) levels were significantly reduced after changeover from sequential to continuous treatment (LH: P less than 0.001; FSH: P less than 0.01). Breast cancer was detected in 2 women, 1 being from each treatment group. Weight, blood pressure and cholesterol concentrations were not significantly altered in either of the groups. There were no cases of endometrial hyperplasia. In the continuous-treatment group a temporary increase in breakthrough bleeding occurred at the beginning of the treatment period. It was concluded that continuous treatment seems to constitute an efficacious regimen for climacteric symptoms, which does not induce monthly bleeding.

Climacteric↗
PubMed1994

Clinical experience with intravenous granisetron.

This review discusses the development and use of 5-hydroxytryptamine3 (5-HT3) antagonists, especially granisetron, for the treatment of chemotherapy-induced emesis. Following recent evidence suggesting that high-dose chemotherapy is more effective in increasing tumor response rate and median survival time, more effective antiemetic control is essential. Granisetron, a new 5-HT3, is approximately 400 times more potent than metoclopramide and, unlike metoclopramide, does not produce extrapyramidal side effects. Granisetron has been shown to be effective as a single prophylactic dose, over 5 days and in patients receiving repeated cycles of chemotherapy. Patients with nausea and vomiting within the first 24 h after chemotherapy are more likely to experience delayed symptoms; however, episodes of breakthrough nausea and vomiting can be controlled by intervention with one, and in some cases more, doses of granisetron. The development of granisetron represents an important advance in the control of chemotherapy induced emesis.

Animals↗
PubMed2005

[Beyond the genome to the proteome].

The sequence of the human genome has been decoded and a post-genome era is now beginning. This is the start of the protein/peptide era. Working in the fundamental research division of a pharmaceutical company and being engaged in studies on the research and development of new drugs based upon genomic information, it was clear to me that genomic information was useful, significant and indispensable in driving forward to new drug discovery. However, it is also true that we need more than that. I have faced multiple barriers in pursuing genomic information alone. There are numerous dead-end stories in genome-based new drug discovery and in many cases, those hurdles are very hard to get over. What approach can be a breakthrough of this bottleneck? I believe that one answer is research into proteins. The proteome describes all the proteins within an organism. The proteome analysis research field promises a bright future for the discovery of new drugs, diagnosis and therapeutics. I believe the mass spectrometer(MS) will be a key instrument in this research. The contribution of mass spectrometry was recently recognized in the Nobel Prize for Chemistry 2002, for 'the discovery of Soft Laser Desorption/Ionization' awarded to Mr. Koichi Tanaka. There is no doubt that the MS will play an essential role in accelerating proteome analysis. However, the present proteome analysis technology has not yet reached a sufficient scientific level. Further improvements of both hardware and software are necessary. For the hardware, improvements in sensitivity, accuracy and high-throughput, in addition to equipment for ultra-micro analysis applied to the analysis of the proteome should be addressed. Regarding software, we need to develop new chemistries for proteome analyses and propose original, user-friendly proteome analysis methods. In this review, starting with a briefing on genome-based drug discovery, I will discuss a new concept for proteome analysis based on mass spectrometry and new methodologies. This 'next generation' platform may provide a solution for the development of an integrated system that will contribute to our understanding of clinical information/bioinformatics, therapeutics, diagnosis and even drug discovery.

Amides↗
PubMed2006

Fentanyl buccal tablets.

Fentanyl buccal tablets (FBT) are designed to manage the breakthrough pain associated with chronic pain with an enhanced rate and extent of fentanyl absorption through the buccal mucosa. The formulation incorporates an effervescent reaction to produce large shifts in pH that enhance absorption. Results from studies of safety and tolerability have shown FBT to be effective and well tolerated in opioid-tolerant chronic pain patients. Adverse events were similar to those seen with other opioids and included nausea and somnolence. Adverse events were common but mild or moderate in most cases and did not cause a high drop-out rate. In addition to the treatment of breakthrough pain, FBT could be clinically efficacious for the treatment of brief, anticipated painful events. The abuse liability of FBT is unknown and caution should be used in prescribing FBT to patients with histories of substance abuse.

Administration, Oral↗
PubMed1998

Experience with cardiac troponin T in difficult cases.

Recent years have seen the advent of new cardiac markers. These have been shown to be valuable in large controlled clinical trials. The breakthrough of the troponins world-wide for detection of myocardial lesions has meant that the Cardiac Troponin T parameter has been available in our hospital since August 1996. Analysis of the samples is carried out on the Elecsys, an automated immunology analyzer from Roche Diagnostics, Austria. The purpose of the present paper is to investigate whether study results on the diagnostic utility, sensitivity and specificity of troponin T can be confirmed in multimorbid patients in routine clinical practice, who are otherwise excluded from such trials. Troponin T was investigated in five cases including patients presenting with myocarditis and parallel damage of the skeletal muscles, as well as in haemodialysis patients. Cardiac troponin T has proved to be a very reliable parameter in all of these patients due to its high sensitivity and specificity, where other conventional diagnostic procedures were not helpful due to co-morbidity and confounding factors. New clinically relevant information can be obtained by both individual as well as serial measurements. Cardiac troponin T determination is a powerful new tool and should be considered seriously, regardless of other underlying diseases: it is, therefore, not only a diagnostic but also a management tool.

Aged↗
PubMed1999

[Refluxing megaureter in infancy--the significance of differentiation from primary high grade VUR].

BACKGROUND: Recent advance of perinatal ultrasound screening and/or physician's awareness of renal damage from recurrent pyelonephritis has brought about the increasing number of infants with primary vesicoureteral reflux (VUR) including refluxing megaureter which should be conceptually differentiated from simple high grade VUR. We evaluated the clinical outcome of infants diagnosed with refluxing megaureter. PATIENTS AND METHODS: We retrospectively reviewed the clinical records of 15 infants (17 ureters) diagnosed as refluxing megaureter (max caliber > or = 10 mm) at our institution from 1988 to 1997. We compared the clinical outcome of refluxing megaureter with that of high grade VUR. (Results) Patients were 13 boys and 2 girls. Megaureter was unilateral in 13 patients and bilateral in 2. Fourteen infants (93.3%) presented with febrile urinary tract infection (UTI). The diameter of megaureter was 10-21 mm (average: 13.6 +/- 4.0 mm) at excretory urogram. Nine of 15 infants (60.0%) had breakthrough urinary infection. Its incidence was significantly higher than that of high grade VUR (21.3%) (p = 0.02). In 13 cases surgical treatments were performed, however 2 cases (max caliber: 16 mm, 21 mm) by Politano-Leadbetter or Paquin procedure required re-ureteroneocystostomy by Psoas-hitch procedure because of persistent reflux and recurrent UTI. On the other hand no patient required re-ureteroneocystostomy in high grade VUR. CONCLUSION: It is important to differentiate refluxing megaureter from high grade VUR due to high incidence of breakthrough UTI. Ureteral remodeling and/or Psoas-hitch procedure are strongly recommended for adequate length of submucosal tunnel in refluxing megaureter.

Cystostomy↗