Conservative Drug Therapy Research Articles

Benignes Prostatasyndrom: Medikamentös, operativ oder minimal invasiv – Welche Therapie ist sinnvoll?

Die therapeutischen Möglichkeiten des benignen Prostatasyndroms richten sich nach dem Ausmaß der Obstruktion und Intensität der irritativen Symptomatik. Bei Patienten mit leichtgradiger Symptomatik oder geringfügiger Obstruktion ist eine Therapie in vielen Fällen nicht erforderlich. Bei geringfügiger Symptomatik können Beschwerden häufig durch die Gabe von Phytotherapeutika gelindert werden. Bei stärker ausgeprägter Symptomatik ist eine medikamentös–konservative Therapie mit Alpha–Blockern (Alpha–1–Adrenozeptoren–Antagonisten) oder 5–Alpha–Reduktasehemmern anzustreben. Bleiben trotz medikamentöser Therapie Miktionsbeschwerden oder eine hochgradige Obstruktion bestehen, sollte ein operativer Eingriff erwogen werden. Bei den operativen Verfahren stehen derzeit verschiedene Möglichkeiten zur Verfügung, wobei die transurethrale Prostata–Resektion (TURP) bei Patienten mit einem Prostatavolumen bis 80 cm3 nach wie vor als Goldstandard gilt. Daneben haben sich vor allem minimalinvasive Laserverfahren als schonende Alternative etabliert. Insbesondere mit der der KTP (Kalium–Titanyl–Phosphat)–Laservaporisation („Greenlight–Laser”) und neuerdings auch mit der Diodenlaser–Vaporisation kann ein starker Gewebeabtrag bei gleichzeitig ausgezeichneter Hitzekoagulation der Gefäße erzielt werden. Die äußerst schonende TURis–Plasma–Vaporisation erzielt ebenfalls hohe Ablationsraten und damit gute Therapieerfolge. Hiervon profitieren vor allem Patienten, die durch die Einnahme antikoagulativer Medikamente einem erhöhten Operationsrisiko ausgesetzt sind.

The use of botulinum toxin type A (BoNT/A) as an adjunctive treatment modality for phonic tics on a series of 30 patients affected with tourette's syndrome (TS)

Introduction: Tics are the most important feature of Tourette's Syndrome (TS), and, together with a very variable comorbidity, can determine a significant social impairment. Although tic expression can be very variable, drug therapy has shown to be beneficial in a significant amount of patients. Botulinum toxin type A (BoNT/A) is nowadays used to treat a large variety of abnormal muscle tone disorders and cholinergic gland dysfunction, among which an ameliorating effect over TS has been documented. Material and methods: We assessed the effect of BoNT/A on phonic tics in patients affected with TS, refractory to conservative drug therapy with the currently accepted medications. A detailed informed consent was given to the patients prior to the procedure. A total number of 70 patients (29 children aged 10–16 and 41 adults aged 19–55) were included in this prospective, non-randomized study protocol, receiving 2.5 IU BoNT/A (Botox, Allergan) in both vocal cords, under EMG guidance. All the patients were assessed post-procedurally after 15 days and then 4 times over a 12-months period. At each endpoint, the following data were collected: global impression of change (CGI scale), tics phenomenology, number of injections performed, interval between injections, time and duration of response, presence and duration of side effects (mainly hypophonia), presence of premonitory sensations of the tics, and interference of the tics with the normal social functioning of the patient. Results: Phonic tics improved at the CGI scale in 66 patients (94%), 30 (41%) being completely tic-free, while a certain degree of improvement of the overall clinical picture of TS was present in all the patients. Average time before improvement was 4.2 days (SD 2), while average duration of improvement was 82 days (SD 14). Quality of life in terms of social integration improved for all the patients and a subjective diminution of premonitory sensations was also reported by the patients. Hypophonia was documented in 59 (84%) patients and its duration ranged 15–48 days. No major side effect was documented. Conclusions: An extremely disabling feature of TS as phonic tics in which resistance to conventional conservative drug therapy has been documented can to our experience be addressed with BoNT/A. Botulinum toxin injection should be used more extensively in the treatment of TS in that it specifically addresses the involved apparatus, thus avoiding systemic side effects. Reduction of premonitory sensations also indicates that modifications in sensory triggers can be of great interest in order to obtain a better knowledge of the pathophysiological mechanism of phonic tics.

Emergency management of ureteral stones: Recent advances

Most ureteral stones can be observed with reasonable expectation of uneventful stone passage. When an active ureteral stone treatment is warranted, the best procedure to choose is dependent on several factors, besides stone size and location, including operators’ experience, patients’ preference, available equipment and related costs. Placement of double-J stent or nephrostomy tube represents the classical procedures performed in a renal colic due to acute ureteral obstruction when the conservative drug therapy does not resolve the symptoms. These maneuvers are usually followed by ureteroscopy or extracorporeal shockwave lithotripsy, which currently represent the mainstay of treatment for ureteral stones. In this review paper a literature search was performed to identify reports dealing with emergency management of renal colic due to ureteral stones. The main aspects related to this debated issue are analyzed and the advantages and disadvantages of each treatment option are carefully discussed.

Innovative approach to laser acupuncture therapy of acute obstruction in asthmatic children

A prospective randomized study encompassed 100 patients with asthma in the stage of acute bronchial obstruction, 7 to 17 years of age, of both sexes and with the similar rate of attack severity. The patients were spirometrically monitored (FVC, FEV1, PEF and FEF 25-75%) by a pediatrician-pulmonologist for 12 days. Fifty patients were subjected to conservative drug therapy, whereas other 50 patients additionally underwent the Su Jok therapy according to the 6-Ki principles, applying laser ray at the acupuncture points in the hand. After 12 days of treatment the group, in which both therapy methods were applied, reached the range of referent values for all investigated parameters. In the same period of time the group undergoing only conservative drug therapy retained values below the reference ones for the given age for 3 (FEV1, PEFR and FEF 25-75%) out of 5 investigated parameters. The obtained results differed from the group subjected to the combined therapy with the high rate of statistical significance. On the basis of the obtained results the efficacy of the 6-Ki technique of Su Jok therapy was confirmed as the therapeutic method supplementary to the conservative drug therapy in the treatment of acute bronchial obstruction in asthmatic children, provided that therapy is carried out in stationary conditions and under constant spirometric surveillance of the patient.

Renovascular disease: effect of ACE gene deletion polymorphism and endovascular revascularization.

Renal artery stenosis (RAS) is associated with high cardiovascular mortality and significant clinical complications, including resistant hypertension and ischemic nephropathy. Despite availability of endovascular revascularization techniques, determining which patients should undergo revascularization and the timing of the procedure still are controversial. Several studies have reported a higher frequency of the DD genotype of the insertion/deletion (I/D) polymorphism of the angiotensin converting enzyme (ACE) gene in patients with RAS, and one study found higher mortality in patients with the DD genotype. Material and methods We retrospectively studied 100 patients with documented atherosclerotic RAS and evaluated long-term (median follow-up, 28 months) mortality, blood pressure control, and renal function in relation to the ACE genotype and two therapeutic strategies, that is, endovascular treatment with percutaneous renal transluminal angioplasty or stenting (ET group) versus conservative drug therapy (CT group). Comparison between therapeutic groups showed a higher cumulative probability of survival (86.7% vs 67.1%), better blood pressure control (57.4% vs 29%), and slower decline in renal function (17.9% vs 48.4%) in the ET group. The DD genotype was strongly represented in our study patients (DD, 50%; II, 15.5%; I/D, 34.5%), but bore no relation to mortality, blood pressure control, decline in renal function, or rate of recurrent stenosis. Conservative medical treatment of RAS, compared with endovascular treatment, is associated with higher mortality, poorer blood pressure control, and impaired renal function over the long term. Early endovascular treatment enables amelioration of this unfavorable evolution. The DD genotype does not predict clinical outcome of RAS.

Successful relief of hip joint pain by percutaneous radiofrequency nerve thermocoagulation in a patient with contraindications for hip arthroplasty.

and groin for years. She experienced gradually worsening pain in the inguinal, thigh, and hip area to the level that she could not walk, sit, take care of herself at home, and sleep well. She was only able to ambulate with a wheelchair. The pain was constant, severe, sharp, and deep in her thigh, groin, and hip. It radiated to the left anterior knee at times. Past conservative drug therapy had failed. Hip arthroplasty was contraindicated because of the presence of severe lymphedema and the high risk of infection. The hip x-ray indicated severe bilateral hip joint destruction. MRI of pelvis also indicated severe bilateral hip joint degeneration and destruction.

CO 2 laser surgery of oral premalignant lesions

Experiences gained in the CO 2 laser treatment of patients with oral dysplastic precancerous lesions are presented. Besides 7 lichens planus, 50 leukoplakias of all grades of dysplasia, and carcinoma in situ and one lentigo maligna were removed superficially with a defocused laser. Within the average follow-up period of 37 months, 22% local recurrences were observed. In comparison with conservative drug therapy, conventional surgical procedures, and cryosurgical therapy, the CO 2 laser treatment of multicentric premalignant diseases of the oral mucosa can be recommended as an alternative therapy.

Rectus Abdominis Nerve Entrapment Syndrome

To the Editor.— Recognition of pain secondary to abdominal wall pathologic conditions may prevent unnecessary laparotomies. Report of a Case.— In February 1978, a 33-year-old woman came to our Pain Control Center with a one-year history of lower left abdominal pain during the midpoint of her menstrual cycle. Over the course of a year, this patient consulted frequently with her gynecologist, who could not relieve her pain with conservative drug or hormonal therapy. After a normal laparotomy in October 1977, the patient was referred to us for evaluation before a planned hysterectomy. While attempting to differentiate between pain of visceral or somatic origin, we noted the pain and tenderness to palpation over the left abdomen was intensified as the abdominal muscles were contracted via leg lift in the supine position. This sign in a patient with chronic pain is strongly suggestive of a nerve entrapment syndrome involving the rectus abdominis

Prevention and therapy of intrauterine asphyxia

Conservative drug prevention and therapy of intrauterine asphyxia is of great practical importance.