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PubMed1990

[Late results following meniscectomy].

In a retrospective study a total of 227 women and men between 24 and 79 years of age who had undergone meniscectomy at the State Orthopedic Clinic of Munich between 1958 and 1975 were reexamined clinically and radiologically in order to determinate late effects of surgery. Of 149 patients with an uncomplicated subtotal meniscectomy 35% showed an unsatisfactory subjective result while 62% were continuously free of symptoms regarding their operated knee. Including constitutional factors degenerative changes in the knee occurred in 50%, 34% of the total of 149 showing severe radiologic changes of grade 2 and 3. The roentgenographic changes in the knee correlated frequently with the subjective result. The frequency of degenerative arthritis in the follow-up investigation was significantly higher for patients with preoperative osteoarthritis than in those without. Some other factors seemed to have no bearing on the longterm effect of meniscectomy. The procedure of subtotal meniscectomy proved to be an important factor for degenerative arthritis. Arthroscopic and meniscus healing techniques require further examination of longterm results.

Adult↗
PubMed1992

Treatment of high altitude diseases without drugs.

Treatments other than descent and supplemental oxygen are discussed in this short review. Exercise gives rise to physiologic responses which may enhance acute mountain sickness (AMS), high altitude cerebral edema (HACE) and high altitude pulmonary edema (HAPE). Therefore, physical rest can be considered the principle treatment for moderate AMS and it should always accompany any treatment of severe high altitude illnesses as long as descent is not possible. Therapy with a portable fabric hyperbaric chamber has a beneficial short-term effect in subjects with AMS, HACE and HAPE. However, treatment modalities using this device which result in long-term beneficial effects need yet to be established. New technical solutions practicable under field conditions at extreme altitude are required for the removal of CO2 from the bag. Expiratory positive airway pressure (EPAP) improves arterial oxygen saturation by 10-20% in subjects with HAPE in trials of 10 min duration. Clinical studies examining longterm effects are necessary, before EPAP can be recommended as initial emergency treatment of HAPE.

Acute Disease↗
PubMed2002

Effects of limited work hours on surgical training.

BACKGROUND: Legal mandates to reduce resident work hours have prompted changes in the structure of surgical training programs. Such changes have included modification of on-call schedules and the adoption of "night float" resident coverage. Little is known about the effects of these changes on surgical resident education and perceptions of quality of patient care. STUDY DESIGN: The surgical housestaff and faculty at a single institution completed a 21-point Likert survey. Subjects were asked to compare parameters of resident education, patient care, and resident quality of life before and after institution of a strict 80-hour work week resident training schedule. The number of hours worked per week before and after these changes were reported. American Board of Surgery In-Training Examination (ABSITE) scores were compared for the 2 years before and after implementation of this schedule. Total number of surgical cases performed by graduating chief residents were recorded and compared for the 3 years before and after the schedule changes. RESULTS: Resident work hours reduced significantly after schedule changes were implemented. A majority of surgical residents reported an improvement in quality of life, but residents and faculty perceived changes to have a negative impact on continuity of patient care. Mean ABSITE composite percentile scores significantly improved after the reduction of working hours. ABSITE scores for junior residents improved significantly; no significant differences were noted in scores for senior residents. CONCLUSIONS: Reduction in resident work hours has salutary effects on perception of quality of life and basic education for surgical residents. These benefits may come at the expense of patient care, particularly continuity of care. This study did not directly assess patient outcomes but the perceptions of caregivers suggest that patient care may be compromised. Further research is needed to assess the longterm effects of changes on both residents and patients.

Attitude of Health Personnel↗
PubMed2002

The generation of oxygen radicals after drinking of oxygenated water.

UNLABELLED: It has been speculated whether ingestion of oxygenated water can lead to an enhanced generation of oxygen radicals. The purpose of three prospective randomized blinded clinical studies was therefore to measure if, when and at which oxygen content in the water,drinking of oxygenated water induces the generation of radicals. Moreover in the fourth prospective,randomized, blinded study possible longterm effects of drinking oxygenated water were examined. METHODS: Altogether 66 volunteers were drinking 300 ml oxygenated or tap water within 15 minutes. Before drinking, altogether 15 ml of blood from the antecubital vein was collected for determination of ascorbyl radicals with ESR, routine laboratory data (hemoglobin, erythrocytes, hematocrit, leukocytes, thrombocytes, uric acid) and the vitamins A,C,E by HPLC. After drinking the ascorbyl radical measurements were repeated from blood of the antecubital vein. In the longterm study ( fourth study) the volunteers had to undergo the same procedure, as described above, at day 1 and day 21. In the meantime they were drinking per day three times 300 ml either oxygenated water or tap water. RESULTS: All subjects exhibited normal vitamin levels in all three studies. Concommitantly in the fourth study there was no statistically relevant alteration of vitamin concentrations during the observation period of three weeks in the verum and placebo-group. 30 minutes after drinking oxygenated water the concentration of ascorbyl radicals increased significantly by median 42 % from median 48 to 65 nmol/l. This increase of ascorbyl radicals after 30 minutes was reproducible in all studies. The levels of ascorbyl radicals remained elevated for 60 minutes after drinking and returned to normal after 120 minutes. This increase was independent of the oxygen concentration in the water, beginning at 30 mg oxygen/l. Water containing 15 mg oxygen/l did not lead to an enhanced radical formation. Longterm consumption of oxygenated water attenuated the ascorbyl radical increase normally observed, thus the initial increase of ascorbyl radicals at day 1 could not be observed after day 21, if the subjects were drinking oxygenated water regularly during the observation period. CONCLUSION: Drinking of oxygenated water possibly leads to a time-limited, yet very moderate, systemic generation of radicals. Regular consumption of oxygenated water over a longer period of time seems to attenuate this effect. The mechanisms leading to this effect and adaptation are unknown.

Adult↗
PubMed1992

From aspirin to biologics: therapeutic implications for rheumatoid arthritis.

As effective antiinflammatory agents have been added to our armamentarium, 2 major treatment strategies for the treatment of rheumatoid arthritis have developed. The traditional pyramid strategy is based on initial, conservative measures, followed by more aggressive therapy as the disease progresses. The step-down bridge approach is an alternative, more aggressive strategy that favors earlier use of more potent agents. The longterm effects of disease modifying antirheumatic drugs (DMARD) and combination second line therapy on disease progression remain unclear. Advances in the development of more specific DMARD and in human recombinant proteins offer promising future therapies.

Adrenal Cortex Hormones↗
PubMed1993

[Clinical evaluation of risperidone].

The author presents some comments of an open study on clinical evaluation of risperidone. Except for the diminuation of the manifest psychotic symptoms sedative and extrapyramidal side-effects appeared, which decreased during further medication, as well as the tachycardia. The exclusion of the restless patient at the very beginning of the study was the negative result of the wash-out interval. As a maintenance therapy 1-2 mg daily dose of respiridone was enough. Further follow-up is useful after one year medication to study the longterm effect of the therapy. The main purpose of the paper is to state ten practical problems which should be taken into consideration.

Antipsychotic Agents↗
PubMed1997

Human factors field evaluation of automotive headway maintenance/collision warning devices.

Three on-road studies were conducted to determine how headway maintenance and collision warning displays influence driver behavior. Visual perspective, visual perspective with a pointer, visual perspective combined with an auditory warning, discrete visual warning, and discrete auditory warning were assessed during both coupled headway and deceleration events. Results indicate that when drivers are provided with salient visual information regarding safe headways, they utilize the information and increase their headway when appropriate. Auditory warnings were less effective than visual warnings for increasing headways but may be helpful for improving reaction time during events that require deceleration. Drivers were somewhat insensitive to false alarm rates, at least during short-term use. Finally, and most important, driver headway maintenance increased by as much as 0.5 s when the appropriate visual display was used. However, a study to investigate the longterm effects of such displays on behavior is strongly recommended prior to mass marketing of headway maintenance/collision warning devices.

Accidents, Traffic↗
PubMed1989

Relevance of cellular to clinical electrophysiology in interpreting antiarrhythmic drug action.

The usefulness of cellular electrophysiologic techniques in elucidating the fundamental actions of antiarrhythmic drugs is contrasted with their apparent lack of relevance to the selection of drugs for the treatment of particular arrhythmias. Clinical electrophysiologists employ different techniques, but their results may be explained in terms of cellular drug actions. The varying clinical effects of class IA, IB and IC agents are due to differences in the speed of their attachment to, and detachment from, sodium channels. The role of sympathetic activity in arrhythmogenesis is complex, but again readily explicable in terms of the electrophysiologic cellular actions of stimulation of the individual types of adrenoceptors (alpha 1, alpha 2, beta 1 and beta 2) and the distribution of these receptors, and of the longterm effects of sympathetic deprivation, either by antisympathetic drugs (class II) or by sympathetic denervation. Delayed repolarization (e.g., by class III drugs or prolonged beta blockade) is antiarrhythmic because it is homogeneous, despite the incidental prolongation of QT. If, however, QT is prolonged by heterogeneity of conduction or repolarization, or by partial sympathetic denervation (long QT syndrome or post myocardial infarction), this indicates increased risk of arrhythmia. Finally, the efficacy of calcium antagonists (class IV) in supraventricular arrhythmias is attributable to the cellular electrophysiologic characteristics of sinoatrial and atrioventricular nodal and transitional elements.

Anti-Arrhythmia Agents↗
PubMed1978

[Drug therapy of osteoarthrosis of the hip (author's transl)].

Experience in therapy with sulindac and S-adenosyl-L-methionine (SAMe) is reported. Sulindac is an indene derivative which is particularly indicated in degenerative skeletal diseases and is essentially free from the well-known side-effects of traditional analgesics. The results of therapy were good in 75%. SAMe is the most important methyl group donor and is consequently responsible for the methylation (inactivation) of histamine, upon which its antiphlogistic action is based. SAMe is also particularly involved in the transfer of sulfate groups in the body. Sulfur compounds are esentially involved in the synthesis of cartilage. The short-term trials with SAMe were altogether more favorable than the longterm trials, yet there was a longterm effect in about half the cases.

Drug Evaluation↗
PubMed1989

Vibratory stimulation as a treatment alternative in patients with tinnitus.

We evaluated the effect of vibratory stimulation on 10 patients with tinnitus and controlled it in a double-blind crossover trial against the sound stimulus delivered by the same apparatus. Five patients reported decreased intensity of tinnitus during treatment when vibratory stimulation was used, as opposed to 1 patient who reported decreased intensity of tinnitus when only the sound stimulus was used. There were no significant differences between the groups in the reduction of the unpleasantness associated with tinnitus. No longterm effects of treatment were seen.

Adult↗
PubMed1987

[Discontinuous drug release as an alternative to interval therapy in the treatment of coronary heart disease with nitroglycerin patches].

In ten patients with angiographically-documented coronary artery disease, according to a double-blind, placebo-controlled protocol, the antiischemic and antianginal actions of a new transdermal nitroglycerin patch system with discontinuous drug release (7.5 mg/24 hours, two-thirds of which is released within the first twelve hours) were assessed on three consecutive days to determine whether effective longterm treatment is possible (Figure 1). At 2.5 hours after initial application, as compared with placebo, the active drug led to a reduction in exercise-induced ST-segment depression of 55.9% (p less than 0.001; Figure 2), the exercise capacity to onset of 1 mm ST-segment depression increased 129% (p less than 0.05; Figure 3), angina pectoris during exercise was incurred in only 20% of the patients (Figure 4). At twelve hours, the corresponding effects were attenuated at -44%, +114% and +60%. 24 hours after patch application, an appreciable effect could no longer be detected. After renewed patch application on the second day, as compared with the initial application, the actions on ST-segment depression and exercise capacity were diminished about 20%. Similarly, there was an increase in the number of patients who developed angina during exercise. At twelve hours, there was more marked attenuation of the effects on all three parameters than that which had already been observed on the first day. At 24 hours, there were no significant effects. At 2.5 hours after renewed patch application on the third day, the effects on ST-segment depression, exercise capacity and incurrence of angina pectoris were essentially similar those seen after the second application.(ABSTRACT TRUNCATED AT 250 WORDS)

Administration, Cutaneous↗
PubMed1989

Effect of peritoneo-venous shunt on portal pressure.

The cause of variceal bleed after a peritoneo-venous shunt is not known. Portal haemodynamic consequences of a peritoneo-venous shunt are poorly understood. The most critical period after a peritoneo-venous shunt is the early postoperative period when rapid mobilisation of peritoneal fluid occurs. Serial changes in the portal pressure during the early postoperative period have not been recorded. In the present study preoperative wedge hepatic vein (WHV), right atrial (RA) and pulmonary capillary wedged (PCW) pressures, cardiac index (CI), and plasma volume (PV) were measured in five alcoholic cirrhotic patients with tense ascites for up to 20 hours postoperatively. The longterm effect was assessed by repeating the intrahepatic and/or wedged hepatic vein pressures in three of the surviving patients after 10 to 20 months. A significant increase in the circulatory dynamics and portal pressure was seen within two hours after shunt placement. Wedged hepatic vein pressure increased from 27.6 (8.2) mmHg to 37.2 (9.2) mmHg (p less than 0.01), RA pressure increased from 6.8 (1.5) mmHg to 14.0 (4.3) mmHg (p less than 0.05), PCW increased from 7.2 (3.5) mmHg to 19.3 (5.7) mmHg (p less than 0.01), CI increased from 3.4 (0.27) lit/m2/min to 4.3 (0.85) lit/m2/min (p less than 0.05). This was accompanied by a 34% increase in the plasma volume from 1838.5 (142.1) to 2471.4 (210) ml/m2. These derangements were maintained up to 20 hours postoperatively. After 10 to 20 months, repeat measurements revealed a return to preoperative measurements. It is concluded that there is an acute increase portal pressure after a peritoneo-venous shunt attributed to increased circulation plasma volume, resulting from rapid mobilisation of ascitic fluid after the shunt. A sudden increase in portal pressure might be an important provoking factor for variceal bleeding after peritoneo-venus shunt.

Blood Pressure↗
PubMed1995

[Arguments against routine mumps vaccination].

Routine immunization against mumps was included in the MMR-elimination-programme of Switzerland despite the lack of any public health necessity. Seven years later, the theoretical presumptions of the mumps immunization campaign are challenged by practical experiences: An unnecessary vaccination proves to be of insufficient efficacy, yet associated with an unexpected high complication rate and bears thus the risk of discrediting also other immunizations in the general public. What could be considered a particular immunization failure reveals important inconsistencies of the entire MMR-mass-immunization-campaign. The project remains epidemiologically highly vulnerable and thus hazardous. Because of its constraining effects on the general population, compatibility with basic civil rights can be questioned. The reasons why some 20% of the Swiss population refuse mumps vaccination are little investigated so far. Nevertheless, research can provide important clues for further investigations in this field. As the maturation of the immune system follows learning principles, the question arises whether childhood diseases are not essential for the normal development of immunocompetence. In cancer therapy new attention is drawn to hyperthermia and thus to the healing potential of fever. And finally, there are concerns about the longterm effects of manipulations of the natural balance between man and microorganisms.

Adolescent↗
PubMed1998

[Medication-related attitudes of chronic schizophrenic patients. A follow-up study after psycho-educational intervention].

OBJECTIVE: To evaluate the effect of a psychoeducational training, compliance, medication management, and illness-related attitudes were assessed among schizophrenic outpatients. METHODS: Study patients who attended at least 70% of 10 psychoeducational sessions (n = 74) and the 57 patients of the control group were reexamined 2 years after the end of intervention. RESULTS: Attenders had better compliance, were more confident in medication codetermination and more satisfied with their knowledge about medication. Confidence in medication and physician increased whereas in the control both decreased. CONCLUSIONS: Although there were no statistically significant differences the results show impressive longterm effects of psychoeducational training.

Adult↗
PubMed1994

[Non-arteritic anterior ischemic optic neuropathy: long-term results after hemodilution therapy].

BACKGROUND: In patients with nonarteritic anterior ischemic optic neuropathy (AION) we investigated the long-term effect of hemodilution on functional results, recurrence rate in the affected and involvement of the second eye. PATIENTS AND METHODS: In a retrospective study we reviewed 24 patients ranging in age from 62 to 92 years (mean 77 years) with AION. The duration of follow-up was between 8-51 months (mean 24.8 months). All patients received iso- (Hct > 40%) or hypervolemic (Hct < or = 40%) hemodilution over 8-10 days with daily infusion of 10% hydroxyethyl-starch 200/0.5. The hematocrit decreased significant (p < 0.001) from 43.4 +/- 3.8% to 37.8 +/- 3.5% after this 10-day hemodilution treatment. RESULTS: After the longterm follow-up 29.1% of the patients had an improvement of the central vision by two or more lines, 16.7% had a deterioration, 54.2% remained unchanged. The resulting visual acuity was between 0.5-1.0 in 37.5%, between 0.4-0.1 in 41.7% and worse than 0.1 in 20.8%. Neither visual fields nor the VECP were significant changed by hemodilution. After the mean follow-up period of 24.8 months no recurrence occurred in the affected eye and the second eye as never involved. CONCLUSION: Hemodilution therapy has no significant longterm effect on visual acuity and visual fields, but it seems to have a beneficial influence on the recurrence rate in the affected and on the involvement of the second eye.

Aged↗
PubMed1985

Radiation effects on livestock: physiological effects, dose response.

Farm livestock show no measurable effects from being exposed to ionizing radiation unless the level is greatly in excess of the natural background radiation. Possible sources of ionizing radiation which might affect livestock or contribute to radioactivity in the food chain to humans are reactor accidents, fuel reprocessing plant accidents and thermonuclear explosions. Most data on ionizing radiation effects on livestock are from whole body gamma doses near the LD 50/60 level. However, grazing livestock would be subjected to added beta exposure from ingested and skin retained radioactive particles. Results of attempts to simulate exposure of the Hereford cattle at Alamogardo, NM show that cattle are more sensitive to ingested fallout radiation than other species. Poultry LD 50/60 for gamma exposure is about twice the level for mammals, and swine appear to have the most efficient repair system being able to withstand the most chronic gamma exposure. Productivity of most livestock surviving an LD 50/60 exposure is temporarily reduced and longterm effects are small. Livestock are good screeners against undesirables in our diet and with the exception of radiosotopes of iodine in milk, very little fission product radioactivity would be expected to be transferred through the food chain in livestock products for humans. Feeding of stored feed or moving livestock to uncontaminated pastures would be the best protective action to follow.

Animals↗
PubMed1992

Longterm drug therapy for rheumatoid arthritis in seven rheumatology private practices: I. Nonsteroidal antiinflammatory drugs.

The probability of continuation of a particular nonsteroidal antiinflammatory drug (NSAID) over 5 years was estimated for 1,775 courses taken by 532 patients with rheumatoid arthritis treated in 7 rheumatology private practices. Similar results were seen for 15 different NSAID--48% of courses were continued at 12 months, 36% at 24 months, and 20% at 60 months. Only acetylated salicylates, other than plain aspirin, were continued significantly longer than any of the other NSAID. The probability of continuation of plain aspirin was similar to other NSAID, including nonacetylated salicylates and nonsalicylate NSAID. The first NSAID taken by an individual patient was continued only marginally longer than the 4th NSAID taken by the same patient. While most NSAID courses were not continued for long periods, 20% were continued for longer than 5 years, suggesting effective longterm results in this minority of courses.

Anti-Inflammatory Agents, Non-Steroidal↗
PubMed1999

[Desire for children in tumor patients].

After a chemo- and/or radiotherapy not only acute side effects but also longterm side effects do occur. The following longterm side effects are observed: irregularities in the menstrual cycle, early onset of menopause and infertility. They are of special importance to children, teenagers and young adults having survived a malignancy. For young women experiencing a premature menopause a hormone replacement therapy is indicated. The degree of gonadal failure depends on the total dose of cytotoxics, radiation or the combination of both. Alkylating substances are responsible for gonadal failure whereas other cytotoxic agents lead to reversible gonadal dysfunction. An important risk factor for the development of ovarian failure is the woman's age at the time of treatment. A pregnancy in patients with a history of malignancy always is a high risk pregnancy and needs a close follow up. The offspring of cancer survivors do not show a higher rate of chromosomal abnormalities or neoplasms. Before starting a chemo- and/or radiotherapy the patient should be informed about acute and late effects. Men and adolescent boys should be given the opportunity for sperm cryopreservation. It is unclear whether a fertility reserve can be achieved by cryopreservation also in women.

Adolescent↗