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PubMed2006

[A specific therapy for chronic depression. McCullough's Cognitive Behavioral Analysis System of Psychotherapy].

Chronic depression is a common disorder which causes significant impairment and enormous treatment costs. Traditional pharmacological and psychological treatment approaches have shown only modest success. The Cognitive Behavioral Analysis System of Psychotherapy (CBASP) by James McCullough is the only therapy developed specifically for chronic depression. It integrates behavioral, cognitive, and interpersonal strategies. The approach is supported empirically and shown to be effective. This article presents the state of the art regarding research in psychotherapeutic treatment for chronic depression. In addition, the development of the approach and therapeutic strategies and techniques of CBASP are described.

Antidepressive Agents↗
PubMed1997

Tamoxifen for flutamide/finasteride-induced gynecomastia.

OBJECTIVES: Current therapies for advanced prostate carcinoma lead to a marked decrease in serum testosterone levels, which renders patients impotent. In preliminary studies, combination therapy with flutamide and finasteride has been used as an alternative therapy for the treatment of prostate carcinoma because potency can be preserved. Both of these agents can cause gynecomastia and breast/nipple tenderness. METHODS: Six men being treated for advanced prostate carcinoma with flutamide/finasteride combination therapy developed painful gynecomastia, which was treated with tamoxifen 10 to 30 mg/day for 1 month. Clinical follow-up included breast measurements and determination of prostate-specific antigen (PSA), testosterone, and estradiol levels. RESULTS: While on this combination therapy for prostate carcinoma, 4 of 6 patients experienced a decrease in PSA level to less than 0.5 ng/mL. All patients remained potent. Serum testosterone increased in each patient who had a baseline level drawn. Estradiol levels were noted to be elevated in 4 of 6 patients at the time of evaluation for gynecomastia. After treatment with tamoxifen, circulating estradiol levels increased in 3 patients from 1.3 to 2.2 times the baseline level. Five patients experienced complete resolution of breast and nipple pain on tamoxifen 10 mg/day within the first month. The other patient had to be treated with 30 mg/day for 1 additional month, which subsequently resulted in pain resolution. CONCLUSIONS: These preliminary results suggest that low-dose tamoxifen is useful in treating painful gynecomastia for those patients on flutamide/finasteride combination therapy for advanced prostate carcinoma.

Aged↗
PubMed1993

Treatment strategies for Helicobacter pylori infection.

Helicobacter pylori can be eradicated easily in most patients with a 14-day triple-therapy regimen. In patients in whom this treatment fails or who cannot take a full course, other antimicrobial combinations must be considered. This article discusses the various alternatives and explains why various agents should or should not be used. It also includes many new therapies developed in 1992 that allow the physician to treat virtually all H. pylori infections.

Anti-Bacterial Agents↗
PubMed1995

Liposome-mediated in vivo E1A gene transfer suppressed dissemination of ovarian cancer cells that overexpress HER-2/neu.

The HER-2/neu proto-oncogene is frequently amplified or overexpressed in many different types of human cancers, a phenomenon that has been shown to correlate with shorter survival time and lower survival rate in ovarian cancer patients. We previously reported that increased HER-2/neu expression led to more severe malignancy and increased metastatic potential in animal models and that the adenovirus 5 E1A gene repressed HER-2/neu gene expression at transcriptional level and was able to suppress tumor growth when stably transfected into human ovarian cancer SKOV-3 cells which overexpress HER-2/neu. To investigate whether the E1A gene may be used as a therapeutic agent for HER-2/neu-overexpressing human cancers in living hosts, we first developed tumor-bearing mice by injecting SKOV-3 cells that overexpress HER-2/neu intraperitonealy into female nu/nu mice. Five days later, we used cationic liposomes to directly deliver the E1A gene into adenocarcinomas that developed in the peritoneal cavity and on the mesentery of the mice that received the SKOV-3 cell injection. We found that liposome-mediated E1A gene transfer significantly inhibited growth and dissemination of ovarian cancer cells that overexpress HER-2/neu in the treated mice; about 70% of these mice survived at least 365 days, whereas all the control mice that did not receive the gene therapy developed severe tumor symptoms and died within 160 days. The results suggest that liposome-mediated E1A gene transfer may serve as an effective therapy for human ovarian cancers that overexpress HER-2/neu by directly targeting the HER-2/neu oncogene.

Adenovirus E1A Proteins↗
PubMed1975

Sjogren's syndrome and drug reaction to practalol.

A case is reported of a patient who developed exfoliative dermatitis while being treated with practalol for angina pectoris. The patient also had trigeminal neuropathy, renal impairment and keratoconjunctivitis sicca. The antinuclear factor was diffusely positive but other antibodies were negative. At post mortem the patient was found to have acute pancreatitis, and peritonitis. It is postulated that the patient has antecedent Sjogren's syndrome and on introduction of practalol therapy developed a drug reaction with a generalised exfoliative dermatitis and exacerbation of keratoconjunctivitis sicca leading to bilateral corneal ulceration. The association of similar conditions in patients receiving practalol therapy is reviewed.

Aged↗
PubMed2001

Venous thromboembolism and hormone replacement therapy.

There is evidence that postmenopausal women who take hormone replacement therapy develop biochemical hypercoagulability, expressed by increased activity of coagulation enzymes. Such effects are observed whether estrogen is given alone or in combination with progestogens, orally or transdermally. Two recent randomized, double-blind clinical trials have shown that hormone replacement therapy leads to an increased risk of venous thromboembolism (VTE) in postmenopausal women. Generally, in women with no additional risk factors for VTE, the excess risk due to hormone replacement therapy is rather small. However, women with a history of VTE should not be prescribed hormone replacement therapy.

Journal Article↗
PubMed1994

Combined chemotherapy and radiation in locally advanced non-small cell lung cancer.

The majority of patients with locally advanced, unresectable, non-small cell lung cancer (NSCLC) treated with conventional radiation therapy develop distant metastases and succumb to the disease. Thus, NSCLC should be viewed as a systemic disease, and attempts to control micrometastatic disease with chemotherapy should have a greater impact on survival. This does not eliminate the role of radiation therapy, as locoregional control is equally important. Combined chemoradiotherapy has become the major area of clinical research to improve long-term outcomes in patients with locally advanced NSCLC. The optimal chemoradiotherapy sequence is yet to be determined. Several randomized studies have demonstrated that sequential chemotherapy followed by definitive thoracic irradiation is superior to the same radiation therapy alone. The overall impact has been on both survival and incidence of distant metastasis. A number of pilot studies (phase II) have tested concurrent chemoradiotherapy in patients with locally advanced NSCLC. At the University of Maryland Cancer Center, we are evaluating the efficacy of thoracic radiation (60 Gy) with concurrent weekly carboplatin, which has known activity in NSCLC and also has radiosensitizing effects. Preliminary results show that the combination is feasible and well tolerated; median survival rates compare favorably to those seen in the combined-modality arms of the randomized, sequential studies. Definitive conclusions based on the results of the reported studies are not possible, yet there seems to be a potential benefit to adding chemotherapy to radiation therapy. These trials need to be confirmed before they can be used to define a "standard of care" for patients with locally advanced, unresectable NSCLC.

Antineoplastic Combined Chemotherapy Protocols↗
PubMed2000

Periodontal management of the patient with diabetes mellitus.

Diabetes mellitus is a common medical disorder that will be encountered by every practicing dentist. Knowledge by the dentist of the general and oral signs and symptoms of undiagnosed or poorly controlled diabetes mellitus are essential, and patients displaying these signs or symptoms should receive medical referral. Patients suspected, or known to suffer from undiagnosed or uncontrolled diabetes mellitus should receive only emergency care until their health status has been properly evaluated. In the event the degree of control of a known diabetic is unknown or the patient is poorly controlled, antibiotic therapy should be administered in conjunction with any necessary surgical procedure or in the presence of oral infection. The practitioner must be prepared to manage diabetic emergencies should they occur in the dental office, and hypoglycemic incidents are most likely. The developing therapies now available for medical management of diabetes mellitus suggest that this condition will be more effectively controlled in the future, but medical consultation is important to proper periodontal patient management. New evidence suggests that advanced periodontal disease may interfere with diabetes mellitus control and the physician should be made aware of the patient's periodontal status. Under most circumstances, the well-controlled diabetes mellitus patient can receive safe and effective periodontal therapy with some modification of office protocol, and there is little reason to anticipate that the controlled diabetes mellitus patient cannot look forward to a lifetime of periodontal health if proper and timely periodontal therapy is rendered and the patient maintains effective oral hygiene measures accompanied by appropriate supportive periodontal recall therapy.

Dental Care for Chronically Ill↗
PubMed2004

Molecular adsorbents recirculating system dialysis for liver insufficiency and sepsis following right ventricular assist device after cardiac surgery.

We report a case of right heart failure (RHF) and sepsis with liver insufficiency in a 70-year-old patient after coronary artery bypass graft surgery. Three hours after surgery the patient suddenly developed therapy refractory cardiac arrest caused by RHF. He had to have emergency surgery, under which the graft to the right coronary artery was revised and a right ventricular assist device was implanted. Heart function recovered and the assist device was explanted on day 1 after surgery. Thoracic closure was performed on day 5 after surgery. The patient went into septic shock on day 11. Liver dysfunction developed postoperatively and worsened the course of sepsis. Therefore, MARS (molecular adsorbents recirculating system) dialysis was performed once on day 20 after surgery. Liver function improved after MARS therapy and the patient recovered from sepsis. On day 46 the patient was transferred from the ICU of another hospital to one of the peripheral wards, to be finally discharged on day 67.

Aged↗
PubMed1999

Therapy related acute myeloid leukemia after exposure to 5-fluorouracil: a case report.

Therapy related acute myeloid leukemia occurs after exposure to various cytotoxic agents. Among typical chemotherapeutic agents are the alkylating agents and topoisomerase II inhibitors. This type of leukemia has been reported after the use of antimetabolites. We report here a patient who developed therapy related acute myeloid leukemia secondary to the use of 5-fluorouracil.

Acute Disease↗
PubMed2001

Progressive hearing loss in hearing impaired children: immediate results of antiphlogistic--rheologic infusion therapy.

OBJECTIVE: The question whether progressive sensorineural hearing loss during childhood is the fateful course of a main illness has been discussed controversially over 60 years. No medicamentous therapy with satisfactory results has been described in the literature. The goal of this study was to determine whether an infusion therapy, developed for the treatment of sudden hearing loss in the elderly, can induce recovery after progression in sensorineural hearing loss during childhood. METHODS: Out of 20 children suffering from acute progression in sensorineural hearing loss, seven children were treated with an infusion therapy containing prednisolone, pentoxifylline and a plasma expander (group I), and 13 children were not treated (group II). All children were advised not to use hearing aids for 6 weeks. RESULTS: In group I, we observed partial to complete restoration of hearing threshold towards the original hearing threshold given by previous routine controls in 6/7 children. In group II, only three children recovered, with the state of ten children's' hearing loss remaining unchanged. The long-term follow-up, however, showed no distinct difference in either group. CONCLUSION: Infusion therapy can be helpful when treating acutely progressing sensorineural hearing loss during childhood. The benefit for communicative competence has to be discussed. Further studies should be conducted.

Case-Control Studies↗
PubMed1988

Irritant contact facial dermatitis due to nebulizer therapy.

A case is reported of a patient with long-standing, severe airflow obstruction requiring long-term nebulizer therapy developing a facial dermatitis in the area bounded by the nebulizer mask. The facial dermatitis seems to be the result of the combined irritancy of the nebulizer solutions and moisture, and prophylactic measures are suggested for patients requiring long-term nebulizer therapy.

Atropine Derivatives↗
PubMedDate not supplied

[Cell therapy and other neuroregenerative strategies in Parkinson's disease (II)].

OBJECTIVE: To review, from a mainly clinical standpoint, the different strategies applied to regenerate or restore the nigrostriatal dopaminergic system in Parkinson's disease (PD). A previous first part focused on the results of adrenal medulla and human fetal mesencephalic transplants, and this second part addresses transplants of other cell types, administration of trophic factors, and gene therapy. DEVELOPMENT: As an alternative to human fetal mesencephalic neurons, other donor cells types (porcine mesencephalic neurons, retinal pigment epithelial cells) with similar 'dopaminergic' action mechanism have been tried, although with heterogeneous results. Transplantation of carotid body cell aggregates may be a promising therapy because of its neurotrophic action mechanism. The perspectives of cell therapies based on genetically modified cells and precursor cells of different origin are also reviewed. Among other neuroregenerative approaches, the clinical outcomes of direct administration of neurotrophic factors and the perspectives for in vivo gene therapy are also addressed. CONCLUSIONS: The objective of neuroregenerative therapy for PD should include trophic restoration of damaged neuronal systems, since improvement in striatal dopaminergic function is not sufficient. After the recent failure of the direct (intraventricular or intraputaminal) administration of glial cell line-derived neurotrophic factor (GDNF), attention of researchers has focused on indirect methods, including transplantation of GDNF-producing cells (carotid body cell aggregates or different genetically modified cells), and in vivo gene therapy.

Brain Tissue Transplantation↗
PubMed2004

[New therapeutic strategies in HIV infection-immune reconstitution and virus suppression].

BACKGROUND: In the last years, highly active antiretroviral therapy has decreased AIDS-associated mortality of patients dramatically. Due to this prolonged lifetime, the emergence of resistance against antiretroviral therapy has increased. Additionally, cross-resistance within the classes of nucleoside reverse transcriptase inhibitors (NRTI), non-nucleoside reverse transcriptase inhibitors (NNRTI), and protease inhibitors (PI) complicates HIV therapy. Development of new classes of therapeutic agents can help avoiding cross-resistance. Fuzeon, the first agent in the new class of fusion inhibitors, should be combined with as many effective antiretroviral agents as possible. CASE REPORT: The course of a 106-week therapy in a patient infected with a multiresistant virus is described. CONCLUSION: Fusion inhibitor Fuzeon represents a new option for patients having multiple resistance against HAART.

Acquired Immunodeficiency Syndrome↗
PubMed2003

Treatment of Acanthamoeba keratitis.

The treatment of Acanthamoeba keratitis has now been possible since the first successful therapy developed in the mid 1980s with a combination of propamidine 0.1% (Brolene) and neomycin 1%. However, only half the patients responded to this regimen as the cysts were often resistant to neomycin and relatively insensitive to propamidine. This led to research for better therapy, culminating in the mid 1990s with research in Glasgow demonstrating much increased effectiveness with use of the biguanide chlorhexidine 0.02% and in London and Bristol for similar effectiveness with the polymeric polyhexamethylene biguanide (PHMB) 0.02%. Both biguanides were combined with propamidine for enhanced effectiveness but were also shown to be effective as monotherapy. While this therapy inactivates the trophozoites and cysts in Acanthamoeba keratitis in the majority of patients (approximately 90%), there have been notable failures particularly when presentation is late with deep stromal infection. Additional highly acanthamoebicidal drugs are needed that can penetrate the stroma for synergistic action. This role may be taken up by certain antineoplastic drugs, such as alkylphosphocholine-1 (Miltefosine), that also have antiprotozoal activity.

Acanthamoeba Keratitis↗
PubMed2006

A chaperone-mediated approach to enzyme enhancement as a therapeutic option for the lysosomal storage disorders.

Enzyme activity can be deficient in the lysosome because certain newly synthesised mutation-bearing proteins are unstable and prone to misfolding. These structurally defective proteins are detected by the quality control system in the endoplasmic reticulum and subsequently diverted to cellular pathways of degradation. Recent studies have shown that low molecular weight ligands that are competitive inhibitors for some of these lysosomal enzymes can, in subinhibitory concentrations, act as 'chaperones' and rescue the mutant proteins, leading to the reconstitution of their hydrolytic activity within the lysosome. The potential of these agents as a therapeutic option will be dependent on their safety and tolerability profile, and the absence of toxic metabolic byproducts resulting from their use; there should be no or minimal nonspecific interference with other physiological or adaptive cellular activities. Compared with enzyme replacement therapy, the plausible advantages of using small molecule chaperones derive from the ease of oral administration, lack of immunogenicity and the possibility of delivery across the blood-brain barrier; and thus the potential to treat neurodegenerative clinical variants. The major challenges in developing therapies for rare diseases, such as the lysosomal storage disorders (LSDs), include recruitment of a sufficient number of suitable study patients and establishment of the optimal (dose/frequency) regimen to achieve a meaningful outcome. Multiple therapeutic approaches for the LSDs will provide patients with a range of options, which may be adequate as singular strategies or when given in combination. This review examines the characteristics of select agents that represent current candidates for a chaperone-mediated approach to the treatment of a subgroup of the LSDs, specifically the glycosphingolipidoses. Clinical trial experience with the use of these drugs will clarify their position in the management algorithm, which currently has enzyme replacement therapy as its linchpin. A major therapeutic goal would be improved physical and functional wellbeing, leading to increased meaningful survival.

Animals↗
PubMed2006

[Neurotrophin and erectile dysfunction in diabetes].

Neurotrophins play significant roles in the development, differentiation and regeneration of many neurons. The abnormal changes of neurotrophins are one of the nosogenesis of diabetic peripheral neuropathy. Erectile dysfunction (ED) in diabetes is multifactorial and one of the most important causes is the injury of pelvic splanchnic nerves. Neurotrophins therapy shows exact effects on ED with pelvic splanchnic nerves injured. Recent researches indicates that the same treatment has the similar therapeutic effects on the ED animals with diabetes. Neurotrophins therapy develops a new way for us to cure the ED with diabetes.

Animals↗
PubMed2003

Toward therapy for DYT1 dystonia: allele-specific silencing of mutant TorsinA.

A three-nucleotide (GAG) deletion in the TOR1A gene is the most common cause of inherited dystonia, DYT1. Because the mutant protein, TorsinA (TA), is thought to act in a dominant manner to cause disease, inhibiting expression from the mutant gene represents a potentially powerful therapeutic strategy. In an effort to develop therapy for this disease, we tested whether small interfering RNA (siRNA) could selectively silence expression of mutant TA. Exploiting the three-base pair difference between wild-type and mutant alleles, we designed siRNAs to silence expression of mutant, wild-type, or both forms of TA. In transfected cells, siRNA successfully suppressed wild-type or mutant TA in an allele-specific manner: for example, mutant-specific siRNA reduced the levels of mutant TA to less than 1% of controls with minimal effect on wild-type TA expression. In cells expressing both alleles, thus simulating the heterozygous state, siRNA-mediated suppression remained robust and allele specific. Our siRNA studies demonstrate allele-specific targeting of a dominant neurogenetic disease gene and suggest the broad therapeutic potential of siRNA for DYT1 dystonia and other dominantly inherited neurological diseases.

Alleles↗