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At least 865 records · Page 48Linked to original sources
PubMed1999

Results from a historical survey of the survival of cancer patients given Di Bella multitherapy.

BACKGROUND: The Italian media have given wide coverage to a number of successes in treating cancer patients with an alternative therapy developed by Dr. Luigi Di Bella, a physician in Modena, Italy. In 1998, the Ministry of Health, under considerable pressure from the public, decided to promote studies to evaluate its efficacy. METHODS: Follow-up was conducted for cancer patients previously treated during the years 1971-1997 by Dr. Di Bella and registered in his archive. Identified cases were searched in cancer registries for diagnostic confirmation, date of diagnosis, and follow-up. Survival was compared with that in individually matched cancer cases derived from a pool of Italian cancer registries (the ITACARE data base). Kaplan-Meier survival curves were produced for all adult cancer patients as well as for children with leukemia and, in the matched analysis, for patients with cancer at the major anatomic sites and for all cancer patients combined. The homogeneity of survival curves between the two groups was tested by means of the log rank test. RESULTS: After several exclusions, 314 patients were entered into the study. Follow-up was completed for 79%. Only four patients received Di Bella Multitherapy (MDB) as their only anticancer therapy. Of these, only 1 is still alive 2 years after diagnosis. Five-year survival rates for children with leukemia and adult cancer patients were both 29.4%. Five-year survival was significantly lower in comparison with ITACARE cases for patients with childhood leukemia, breast carcinoma, and adult leukemia, and for all cancer patients combined. Twenty-seven MDB patients survived 10 years or longer after diagnosis. In only three cases was this long survival unexpected. CONCLUSIONS: The results for this series did not give any evidence that MDB improved the survival of the cancer patients. [See editorial on pages 1887-9 and commentaries on pages 1900-2 and 1903-11 this issue.]

Adolescent↗
PubMed1996

Surgical management of cervical cancer complicating pregnancy: a case-control study.

A retrospective, case-control analysis of 30 women with cervical cancer associated with pregnancy, surgically managed at the University of Iowa between 1960 and 1994, was performed. Controls were matched with cases based on age, histology, stage, treatment, and year of treatment. Patients were divided into two groups: Group I, radical hysterectomy (26 patients) and group II, simple hysterectomy (4 patients). Eleven patients underwent surgical treatment in the third trimester with a mean planned delay in therapy of 16 weeks. None of the patients with a planned delay in therapy developed recurrent disease. No neonatal morbidity was encountered in these patients. Among group I patients, there was longer anesthesia time (P < 0.03), but there were no differences in the mean operative time. There was more blood loss at the time of surgery among pregnant patients (1493 cc vs 1065 cc for group I, P = 0.005; 812 cc vs 362 cc for group II, P = 0.03); however, there was no difference in the frequency of blood transfusion. The percentage of patients receiving a transfusion decreased significantly after 1991 (33% versus 90%, P = 0.01 for pregnant patients and 33% versus 85%, P = 0.03 for nonpregnant patients). There were no differences in the time required for postoperative bladder drainage, mean hospital stay, febrile morbidity, incidence of wound infection, wound separation, pelvic abscess, thromboembolic disease, or urinary tract infection. One case patient and 3 control patients died of disease, but this difference was not statistically significant. Based upon our data, in selected cases of early-stage cervical cancer, surgical management of cervical cancer is safe during pregnancy. For early Stage I squamous cancers, planned delay in therapy is safe.

Adult↗
PubMed1999

Cytomegalovirus retinitis in advanced HIV-infected patients treated with protease inhibitors: incidence and outcome over 2 years.

We prospectively studied the incidence of cytomegalovirus (CMV) retinitis in 93 patients treated with highly active antiretroviral therapy (HAART) containing a protease inhibitor (PI), during a median follow-up period of 24 months. The median initial CD4+ count was 22 cells/microl (range, 1-311 cells/microl), and the median plasma HIV viral load was 5.1 log10 copies/ml (range, 2.4-6.4 log10 copies/ml). The fundus was examined monthly in patients with a history of CMV retinitis or an initial CD4+ count <50 cells/microl and every 3 months in the other patients. Of patients with previously controlled CMV retinitis, 1 of 7 relapsed. In addition, 6 of 59 patients with a CD4+ count <50 cells/microl and no history of CMV retinitis before starting PI therapy developed CMV retinitis. Of them, 3 had at least one relapse during follow-up. CD4+ counts were <40 cells/microl at the time of primary or recurrent CMV retinitis, except in two cases (147 cells/microl and 203 cells/microl). In conclusion, the incidence of CMV retinitis was 0.091 per patient-year among study subjects with advanced HIV infection who were receiving HAART (95% confidence interval [CI], 0.037-0.145). The time to progression of CMV retinitis (mean, 215 days; 95% CI, 113-317 days) was longer than reported before widespread use of PIs.

AIDS-Related Opportunistic Infections↗
PubMed1991

Autotransplants in acute leukaemia.

The data we review indicate that in adults with ALL in first remission intensive chemotherapy and radiation given before a transplant is more effective in eradicating leukaemia than current chemotherapy. This is not so in adults with AML in first remission where more intensive therapy does not reduce the likelihood of relapse. Furthermore, leukaemia relapse because of re-infused leukaemia cells is an important issue in autotransplants for ALL. Whether re-infusing leukaemia cells would be important in AML were more effective pretransplant therapy developed is unknown. Presently, there appears to be little sense to test in vitro approaches to remove leukaemia cells in autotransplants for AML because efficacy cannot be evaluated. (A randomized trial is an exception but would not be expected to show a difference.) Another conclusion is that attempts to induce GVHD in autotransplant recipients, such as by using cyclosporine post-transplant (Jones et al, 1989), are more likely to succeed in AML than ALL since the impact of GVHD is substantially greater (Horowitz et al, 1990). However, the GVHD-related antileukaemia effect in AML is associated with chronic GVHD whereas cyclosporine treatment of autotransplant recipients results in acute GVHD. Also, attempts to separate clinical and antileukaemia effects of GVHD were unsuccessful (Sullivan et al, 1989). Another caution is that in AML we detected an immune antileukaemia effect distinct from GVHD (termed GVL) only after HLA-identical sibling transplants. Since GVL was absent in twins it is unlikely to operate after autotransplants. In summary, there is sense in studying autotransplants in adults with acute leukaemia in first remission. However, there are currently no convincing data that autotransplants are superior to current therapy. More intensive treatment seems effective in ALL; the focus should be on increasing the antileukaemia efficacy of pretransplant therapy and on attempts to remove leukaemia cells from the graft. In AML, there is no evidence that more intensive therapy is more effective. This problem needs resolution before evaluating attempts to remove leukaemia cells from the graft. The best place to test new pretransplant regimens is in twins and recipients of HLA-identical sibling transplants without GVHD. The data and ideas we review and discuss should be useful in planning clinical trials.

Bone Marrow Transplantation↗
PubMed1991

Vincristine therapy for severe platelet alloimmunization.

A 19-month-old girl with idiopathic severe aplastic anemia refractory to multi-agent immunosuppressive therapy developed severe platelet alloimmunization following several months of platelet transfusions. She became refractory to human leukocyte antigen (HLA)-matched platelet transfusions and experienced frequent episodes of bleeding. She was treated with intravenous vincristine administered weekly for three doses and showed marked improvement in both clinical and laboratory response to platelet transfusions. When vincristine was held for 3 weeks, she again became refractory to HLA-matched platelet transfusion. Reinstitution of vincristine resulted in cessation of clinical bleeding and improved response to platelet transfusion. The mechanism of response likely involves selective delivery of cytotoxic drug to macrophages. To our knowledge this is the first reported case of alloimmune thrombocytopenia responsive to vincristine.

Anemia, Aplastic↗
PubMed1981

Captopril, an orally active converting enzyme inhibitor, in the treatment of primary hypertension. A controlled long-term study with reference to initial plasma renin activity.

Captopril (SQ 14 225), an orally active inhibitor of angiotensin converting enzyme, was evaluated in the treatment of primary (essential) hypertension in a placebo-controlled long-term study. In 24 patients allocated to captopril treatment, mean supine BP fell from 174 +/- 18/110 +/- 7 to 151 +/- 22/96 +/- 12 mmHg. Ten patients achieved a supine diastolic BP of less than or equally 90 mmHg with a mean BP fall of 28/22 mmHg after 4 weeks' captopril dose titration (75-450 mg daily). In 14 patients, BP fell 19/9 mmHg. When hydrochlorothiazide (50-100 mg daily) was subsequently added, a total supine BP reduction of 51/20 mmHg was noted. In the placebo control group (n = 16), BP changed +1/-2 mmHg from 171/110 mmHg while addition of hydrochlorothiazide caused a mean supine BP fall of 19/10 mmHg. During long-term follow-up (mean 11.8 months), no resistance to therapy developed. A weak correlation, (p less than 0.05) was seen between pretreatment plasma renin activity and initial captopril-induced BP reduction. However, in patients with clearly defined low renin hypertension, the hypotensive effect of captopril was much less than in patients with higher renin values. Captopril induced a significant decrease in urinary aldosterone excretion, which was partially reversed by addition of hydrochlorothiazide. Observed side-effects were proteinuria (1 case), rash (2 cases) and taste disturbances (3 cases). During long-term follow-up, seven patients have dropped out, four due to side-effects and three because of non-compliance.

Adult↗
PubMed2001

[The therapy of non-traumatic vegetative state syndrome in children].

Twenty nine non-traumatic appalic syndrome (AS) cases of various etiology were observed in children aged from 3 to 14 years. The clinical picture study was carried out, along with brain structure visualization in vivo (CT and MRT), EEG and cerebral blood flow detection with transcranial ultrasonic dopplerography. All the cases were studied in dynamics in relation to influence of complex course therapy developed by the authors, including vasoactive drugs, nootropics, craniopuncture, acupuncture and electrostimulation of craniopuncture zones. Five patients (17.2%) had a distinct positive dynamics with complete consciousness rehabilitation on the background of moderate neurological deficit regress. In general, CT-data and changes of EEG and cerebral blood flow in AS were not found to have any prognostic value and to be etiologically specific. But changes of EEG and cerebral blood flow in response to the treatment appear to be positive prognostic sign. The prognosis for AS due to meningoencephalitis is worse than one for AS due to hypoxic-ischemic encephalopathy. The non-traumatic AS duration for more than 2 months corresponds to unfavorable outcome.

Adolescent↗
PubMed1980

Colonization of nasal ulcers as a source of Candida parapsilosis fungemia.

Candida parapsilosis fungemia secondary to nasal colonization following application of nasal prongs for oxygen therapy developed in a 61-year-old man with known chronic lymphocytic leukemia and pulmonary infiltrates. Amphotericin B controlled the candidal infection, but the patient died of complications related to Aspergillus pneumonitis, intra-abdominal mucormycosis, and leukemia. The source of candidal infection was probably a combination of nasal ulceration resulting from oxygen administration by nasal prongs and alteration of the normal mucosal flora by multiple broad-spectrum antibiotics. Oxygen administration by mask to patients at risk of opportunistic infections may help obviate this potential complication, with its attendant danger of spread to the brain and cavernous sinuses. We discuss the rarity of triple infection with these three organisms.

Anti-Bacterial Agents↗
PubMed2002

Drug resistance at low viraemia in HIV-1-infected patients with antiretroviral combination therapy.

OBJECTIVE: To study the appearance of drug-induced mutations at low viraemia in treated HIV-1-infected patients. DESIGN AND METHODS: Fourteen patients, who received their first (n = 5), second (n = 7) or third (n = 2) line antiretroviral combination therapy, developed a persistent low-grade viraemia after an initial decrease of the viral load (VL) to less than 500 copies/ml. The amount of HIV-1 RNA (n = 71) and reverse transcriptase (RT)/protease sequences (n = 56) were determined in longitudinally obtained plasma samples during a mean period of 16.6 months. RESULTS: In the vast majority (93%) of patients, new primary resistance mutations were found in the RT and/or protease genes at virological failure at a median VL of 500 and 200 copies/ml, respectively. Drug-experienced patients developed mutations at a lower VL than naive patients. In one previously protease inhibitor-naive patient, primary RT and protease mutations were detected, although the VL was less than 50 copies/ml. A serial accumulation of drug resistance mutations was seen despite the VL increase being mostly modest, reaching a median of 1450 copies/ml at the end of the study, and the CD4 T cell counts continued to increase. One patient still had a VL of 300 copies/ml after 28 months, despite the presence of the multidrug-resistance Q151M mutation. CONCLUSION: Low viraemia after virological treatment failure can select for virus with several new drug resistance mutations, despite a concomitant increase in CD4 T cell counts. This serial accumulation of mutations is likely to exhaust future drug options

Anti-HIV Agents↗
PubMed1977

Family therapy after the divorce: developing a strategy.

Family therapy with the whole family after a divorce has taken place provides a unique opportunity for intervention. Though the spouses have legally terminated their relationship, their parenting function remains. However, this reality is often clouded by the emotional conflicts generated by the divorce. Family therapy can be useful in facilitating life in the post-divorce period. A four-part model for intervention is described. The first task is to redefine the family as existentially including all members. Next, generational boundaries are firmed in order to reduce the parentification process, often intensified by the parent's physical absence. Third, the family needs to have a replay of the history of the marriage to correct developmental distortions and offer a changce to mourn the loss of the intact family. Finally, the therapists attempt to facilitate an emotional divorce. A case study is presented to elucidate the manner in which these steps unfold in treatment.

Child Development↗
PubMed2003

Isolated limb perfusion with tumor necrosis factor-alpha and melphalan for patients with unresectable soft tissue sarcoma of the extremities.

BACKGROUND: Since 1992, isolated limb perfusion (ILP) with tumor necrosis factor-alpha (TNFalpha) and melphalan has been used for the treatment of patients with unresectable soft tissue sarcomas of the extremities. The authors retrospectively studied the results of limb salvage surgery using TNFalpha-ILP at their institution. METHODS: From 1992 to 2001, 49 patients (mean age, 51 years; range, 14-85 years) underwent ILP for unresectable soft tissue sarcomas of the extremities. All patients received melphalan and TNFalpha (four patients also received interferon-gamma). The median follow-up was 26 months (range, from 2 days to 103 months). RESULTS: In 1 patient (2%) who died 2 days after undergoing ILP, response and acute limb toxicity could not be assessed. One patient (2%) attained a clinical complete response (2%), 23 patients (47%) attained a clinical partial response, 17 patients (35%) demonstrated no change, and 7 patients (14%) had tumor progression. Thirty-one patients (63%) underwent tumor resection. Histologic material also was available from eight amputations and three punctures/biopsies. Pathologic response was complete in 4 patients (8%), partial in 14 patients (29%), and no change was observed in 24 patients (49%). Final response, based on both clinical and pathologic assessment in which pathology was decisive, was complete in 4 patients (8%) and partial in 27 patients (55%), resulting in a final overall response rate of 63%. Local control with preservation of the limb was attained in 28 patients (57%). Four of 32 patients (13%) who had been rendered tumor free by ILP with or without undergoing resection and radiation therapy, developed a local recurrence. The 5-year disease specific survival rate was 48% for the 49 patients. Acute limb toxicity after ILP was a mild Grade 1-2 reaction in 35 patients (71%) patients, a Grade 3 reaction in 12 patients (25%), and a Grade 4 reaction in 1 patient (2%). Three major ILP-related complications were encountered, including arterial thrombosis in two patients and a fulminant Clostridial infection leading to death in one patient. There were no severe cardiovascular reactions after ILP. CONCLUSIONS: In patients with unresectable soft tissue sarcomas of the limbs who underwent ILP with TNFalpha and melphalan followed by resection of the tumor remnant when possible, a 63% overall tumor response rate and a 57% local control rate with limb preservation was achieved.

Adolescent↗
PubMed2003

[The Temporal Smile. Speech therapy for facial palsy patients after temporal lengthening myoplasty].

We present our approach to speech therapy developed for patients with definitive peripheral facial palsy treated by temporal lengthening myoplasty. The main goal is to rehabilitate smiling function, a major component in social communication codes, by transferring labial and jugal functions to the transferred temporal muscle. Several phases are involved. The first phase, termed the Mandibular Smile involves mobilization of the mandible (original function of the temporal) by contraction of the transferred temporal and inducing an elevation of the commissura labiorum. The second phase, the Voluntary Temporal Smile is obtained by contraction of the temporal independently of mandibular movement which remains under voluntary control. The smile produces should become as symmetrical as possible. Finally, the last phase is designed to achieve a spontaneous smile independent of mandibular movement Spontaneous Temporal Smile. Temporal contraction should produce both a "real" expressive smile and good quality articulate speech, saliva evacuation, prehension, and labial junction. Acquisition of the Temporal Smile involves cerebral plasticity implying rehabilitation processes both on the peripheral and central levels.

Adolescent↗
PubMed2005

Absorbed fractions for alpha-particles in tissues of trabecular bone: considerations of marrow cellularity within the ICRP reference male.

UNLABELLED: Alpha-particles are of current interest in radionuclide therapy due to their short range and high rates of energy transfer to target tissues. Published values of alpha-particle absorbed fraction phi in the skeletal tissues, as needed for patient-specific dosimetry under the MIRD schema, do not generally account for its variation with particle energy or skeletal site. Furthermore, variations in alpha-particle absorbed fraction with marrow cellularity have yet to be fully considered. METHODS: In this study, a 3-dimensional (3D) chord-based radiation transport model (or 3D-CBIST) is presented, which combines (a) chord-based techniques for tracking alpha-particles across bone trabeculae, endosteum, and marrow cavities and (b) a spatial model of the marrow tissues that explicitly considers the presence of marrow adipocytes. Chord-length distributions are taken from a 44-y male subject (ICRP [International Commission on Radiological Protection] Reference Male) and are identical to those used currently for clinical dose estimates for beta-particle emitters. RESULTS: Values of phi(active marrow<--active marrow) given by the 3D-CBIST model are shown to be considerably lower than phi = 1.0 assumed under the ICRP Publication 30 and 2003 Eckerman bone models. For example, values of absorbed fraction for the self-dose to active bone marrow in the ribs, cervical vertebra, and parietal bone are 0.81, 0.80, and 0.55 for 6-MeV alpha-particles and are 0.74, 0.72, and 0.43 for 9-MeV alpha-particles, where each is evaluated at ICRP reference cellularities in the 3D-CBIST model (72%, 72%, and 42%, respectively, at age 25 y). CONCLUSION: Improvements in patient-specific dosimetry of skeletal tissues require explicit consideration of not only changes in target mass with variable patient marrow cellularity (i.e., active marrow) but also corresponding changes in values of the absorbed fraction. The data given in this study provide a more-firm basis for application of the MIRD schema to patient-specific dosimetry for newly developing therapies using alpha-particle emitters.

Adult↗
PubMed1999

Drug resistance mutations among HIV-1 strains from antiretroviral-naive patients in Martinique, French West Indies.

We report on the frequency of genetic mutations associated with drug resistance in antiretroviral treatment-naive patients from Martinique (French West Indies), where zidovudine (ZDV) has been available since 1987 and where combination therapy developed simultaneously with its use in continental France. Genotypic resistance was studied in plasma HIV RNA from samples collected between 1988 and 1998 from 70 antiretroviral-naive study subjects, half presenting with either primary infection or documented seroconversion. A line probe assay (LIPA) was used to detect substitutions on the reverse transcriptase (RT) codons 41, 69, 70, 74, 184, and 215. Direct sequencing was used to complete the data for RT codons which were uninterpretable by LIPA. Of these patients, 17 harbored mutated viruses with one or more mutations in the RT gene codons analyzed. ZDV resistance mutations T215Y/F, M41L, and K70R were found in 2, 5, and 12 individuals, respectively. Mutant strains L74V (didanosine [ddI] and dideoxycytidine [ddC]) were detected in 3 patients and M184V (lamivudine/ddI/ddC) in 4 patients. However, pure mutant results at one or more codons of interest were observed in only 5 (7%; 95% confidence interval [CI], 1%-13%) patients, all involving ZDV resistance. One carried both mutations T215Y and M41L known to confer a high degree of phenotypic resistance to ZDV. Among a subgroup of 28 patients with a timepoint of infection after 1995, 24 [86%; approximately 95% CI, 73%-99%) presented with a wild-type pattern. The significance of the high prevalence of mixed patterns observed in drug-naive patients remains unclear. However, the frequency of primary mutant genotypes associated with high levels of drug resistance is low in Martinique and in this study we did not observe any currently increased tendency in this frequency.

Anti-HIV Agents↗
PubMed1988

Influence of fluid replacement on extravascular lung water (EVLW) in patients with diabetic ketoacidosis.

Fluid replacement is a major issue in the treatment of patients with diabetic ketoacidosis. During this therapy, development of pulmonary edema has been reported and attributed to an increase in pulmonary microvascular pressure and a decrease in colloid-osmotic pressure (COP). Because clinically apparent pulmonary edema is associated with an increase in extravascular lung water (EVLW) and impairment of pulmonary gas exchange, we studied the effect of fluid replacement on EVLW, COP, pulmonary hemodynamics and gas exchange parameters in 8 patients with diabetic ketoacidosis (blood glucose greater than 300 mg/dl, pH less than 7.1). EVLW was estimated by the thermal-dye technique. All variables were successively determined upon admission (A), after initial fluid replacement (IFR), when glucose had fallen below 180 mg/dl, after 8 h of intravenous glucose treatment (G), and after 24 h of total parenteral nutrition (TPN). Despite a total net fluid intake of 6.0 +/- 1.61, a significant decrease (p less than 0.001) in COP from 29.6 +/- 5.5 at A to 18.8 +/- 2.2 mmHg after TPE and a significant increase (p less than 0.001) in PCWP from 4 +/- 2 at A to 10 +/- 3 mmHg after TPE, EVLW remained almost unchanged. EVLW was 5.1 +/- 2.8 at A, 5.3 +/- 2.1 after IFR, 4.8 +/- 1.4 after G, and 5.3 +/- 1.7 ml/kg after TPN. However, PaO2 decreased from 137 +/- 17 at A to 87 +/- 10 mmHg after TPE (p less than 0.001), while Qs/Qt increased significantly (p less than 0.05). The alterations in gas exchange may be indicative of pulmonary dysfunction but as they were not associated with accumulation of EVLW, they may as well reflect the compensation of metabolic derangements in diabetic ketoacidosis.

Adult↗
PubMed1982

[The effect of Robert Koch's discovery and investigations on the development of the therapy of tuberculosis].

The discovery of the tuberculous bacillus and the methods of cultivation have been fundamental prerequisite for the development of the therapy of tuberculosis. Substances with antimycobacterial activity in vitro even in low concentrations have been found out already by Robert Koch, however not any effective ones in vivo. The cultural demonstration of tubercle bacilli is not only important for diagnosis but the essential criterion of efficacy of the drugs and for the success of treatment. Experiments with cultures of tuberculous mycobacteria represented the basis for detection of new antituberculous drugs, for the elucidation of the mechanism of their effect, for the inquiry of the type of antituberculous activity and the basic mechanism of the development of resistance. Out of these the principles for avoiding of that has been built up. Cultures are also used for the principal and individual determination of the concentration of antituberculous drugs in blood and organs. By the excellent efficacy of the causal antituberculous therapy it is possible to cure all kind of tuberculosis without any surgical interventions which are now needless. The results of in vitro-experiments on cultures represented also the starting point for the further development of antituberculous treatment. One-phasic or two-phasic intermittent treatment and short-course therapy have simplified treatment and marked it easier, which is supervised under ambulatory conditions, too. They lowered the costs for drugs and staff considerably. The causes of relapses, which have become now the main problem instead of resistance, could been investigated by means of tuberculous cultures. The possibilities of the realisation in practice of the obtained knowledge in the scale of a country are demonstrated on the example of the GDR and referred to the social and economical conditions, of which Robert Koch already had drawn the attention.

Antitubercular Agents↗
PubMed1975

Levodopa-induced myoclonus.

Twelve parkinsonian patients on long-term levodopa therapy developed intermittent, myoclonic body jerks. The movements consisted of single unilateral or bilateral abrupt jerks of the extremities and occurred most frequently during sleep. Although directly related to daily dosage of levodopa, the myoclonus was specifically blocked by the serotonin antagonist, methysergide. Levodopa-induced myoclonus may be related to intermittent increases of activity of serotonin in the brain and results from levodopa-induced dysregulation of serotonin activity.

5-Hydroxytryptophan↗
PubMed1975

Carcinoid myopathy. Serotonin-induced muscle weakness in man?

A myopathy, which improved with cyproheptadine hydrochloride therapy, developed in a patient with carcinoid syndrome of ten years' duration. Biopsy examination revealed advanced atrophy of type II muscle fibers, with type I fiber preponderance. Many of the small fibers had degenerated. Carcinoid myopathy may be due to excess circulating serotonin.

Adult↗