Efficacy Of Various Combinations Research Articles

Cost-effectiveness analysis of different strategies for treating duodenal ulcer. Helicobacter pylori eradication versus antisecretory treatment.

Helicobacter pylori has recently been recognised as a causative agent for duodenal ulcer, and the efficacy of various combinations of antibacterials and antisecretory agents in eradicating this pathogen has been assessed. The objective of this study was to determine the efficiency of 2 treatment strategies for patients with H. pylori-positive duodenal ulcer. Cost effectiveness was analysed for antisecretory therapy (omeprazole 20 mg/day for 4 weeks), and eradication therapy (triple therapy: omeprazole 40 mg/day plus clarithromycin 1 g/day plus amoxicillin 2 g/day for 1 week). In a Markov model, a hypothetical cohort of 5000 patients was followed for 10 years through 6 disease states. Cyclic eradication therapy (i.e. in the first duodenal ulcer episode and in relapses) was the most cost effective [21 Spanish pesetas (Pta) per day free of symptoms (DFS); Pta128 = $US1 (October 1995)] of the eradication options evaluated [antisecretory in the first episode, then eradication for relapses (Pta22.3/DFS), and eradication therapy first, then antisecretory therapy (Pta27.3/DFS)]. Antisecretory therapy alone was less cost-effective (Pta39/DFS) than each of the 3 eradication options. Eradication treatment in the first episode of duodenal ulcer and relapses has savings in direct costs per patient of up to 56% compared with antisecretory therapy alone. Sensitivity analyses showed the model to be very robust. It is, therefore, advisable to treat initial episodes of H. pylori-positive duodenal ulcer and relapses with triple therapy. The improved cost-effectiveness ratio was largely explained by the long term reduction in relapses obtained with the eradication strategies.

Effects of separation, dilution, washing and acidification on ammonia volatilization from surface-applied cattle slurry

SUMMARYTreatments which lowered the rate of ammonia volatilization from surface-applied cattle slurry were evaluated in three field experiments during 1989/90 at the Agricultural Research Institute of Northern Ireland. The relative effects of separation, dilution with water before application and washing with a water spray after application, on ammonia volatilization rates were compared over 4 days using ventilated enclosures. As the loss rate of ammonia during the first 4 days after application was highly correlated with the loss rate over the first 4 hours after application, the loss rate in the first 4 hours was used as a rapid method to assess the efficacy of various combinations of separation, dilution and acidification. Ammonia volatilization loss rates from treatment combinations were compared to the loss rate from whole slurry.A 50% decrease in ammonia volatilization was achieved by separation through a 0·4 mm mesh, separation through a 10·0 mm mesh plus dilution with 86% by volume of water, or separation through a 2·0 mm mesh plus washing with 53% by volume of water.A 75% decrease in ammonia volatilization was achieved by acidification to pH 6·5, or combinations of separation and dilution, namely separation through a 0·4 mm mesh plus 50% dilution or separation through a 5·0 mm mesh plus 100% dilution.A 90% decrease in ammonia volatilization was achieved by acidification to pH 6·0, dilution by 50% plus acidification to pH 6·5, or separation through a 0·4 mm mesh plus acidification to pH 6·5.The effects of separation and acidification on ammonia volatilization were cumulative. There was a highly significant inverse linear relationship between ammonia volatilization rate and volume of nitric acid used. Adding 10 M nitric acid at 1·4% by volume lowered volatilization by 75% of that from whole slurry and increased the nitrogen content of the slurry by 2 g N/l, making it a more balanced NPK fertilizer for cut swards. Because the variable value of cattle slurry is due to loss of nitrogen as ammonia and smothering of the sward with slurry solids, a combination of separation or dilution to lower sward contamination and acidification with nitric acid to lower volatilization may be the best practical option for improving cattle slurry as a fertilizer for cut grass.

Therapeutic maturation of endometrium in in vitro fertilization and embryo transfer

To provide an up-to-date review of studies that have examined the relative role of endometrial development in in vitro fertilization (IVF) and embryo transfer (ET) treatment in relation to the treatment outcome. The most important published studies and personal communications related to this topic have been identified through a computerized bibliographical search (MEDLINE). Studies that have evaluated the endometrial maturation in IVF and ET treatment with respect to different treatment protocols of ovarian stimulation. Clinical trials exploring the efficacy of various combinations of hormonal supplementation that aim to improve the endometrial environment and treatment outcome. Publications and personal communications reporting a variety of treatment protocols and drugs utilized for the creation of artificial endometrial cycles in IVF treatment employing donated eggs. Ovarian stimulation frequently adversely affects the process of endometrial maturation. Various kinds of hormonal supplementation, used in clomiphene citrate- and/or human menopausal gonadotropin (hMG)-stimulated cycles have not improved treatment outcome. Human chorionic gonadotropin or natural progesterone (P) supplementation administered after controlled ovarian stimulation with gonadotropin-releasing hormone and hMG effectively corrected the luteal phase defect and resulted in an improved conception rate. The endometrium of agonadal women is highly conducive to hormonal manipulation. All estrogen preparations used effectively promoted endometrial growth and proliferation. Natural P is superior to synthetic progestins for induction of receptive secretory endometrium. The development of adequately receptive endometrium is a major factor determining the outcome of IVF and ET treatment.

A Prospective, Randomized Controlled Study on the Treatment of Stage C and Stage D Prostatic Cancer with Estracyt in Combination with Other Chemotherapeutic Agents

The present study was designed to investigate the efficacy of various combinations of chemotherapeutic agents in the treatment of prostatic cancer in a group refractory to antiandrogenic therapy (Group 1) and in a previous untreated group (Group 2). Therapeutic combinations of Estracyt (E) + Peplomycin (P) + Doxorubicin (Do) and P + Do + 5 FU (F) in Group 1 and E + P, Honvan (Ds) + P and E in Group 2 were carried out. The main objectives of this study were estimations of the efficacy of E and P in relation to the refractory cases of Group 1 and the efficacy of the combination E + P, in Group 2. This is the first such prospective, randomized, controlled study to be carried out in Japan in relation to prostatic cancer. The results obtained in the present study indicated that chemotherapeutic regimens including E provide some enhanced efficacy, but that the efficacy with regard to refractory cases is poor (23.1-27.3%), as has been reported of studies conducted in the USA and Europe. With regard to previously untreated cases, the E + P regimen achieved a relatively higher response rate than the other treatments (72.7 vs 44.5 or 50.0%). In the comparison of survival times and survival curves, there were no statistically significant differences among the various treatment subgroups. A comparison of survival curves revealed the interesting finding that the PAP-related response showed a clear correlation to the survival curves of Group 2 patients.

Inhibition of spermatogenesis in men using various combinations of oral progestagens and percutaneous or oral androgens

Eight men (experiment 1) requesting male contraception received a daily oral dose of 20 mg medroxyprogesterone acetate (MPA) combined with 125 mg percutaneous dihydrotestosterone (DHT). Three months later the mean sperm count was only diminished slightly; the replacement of DHT for four men by percutaneous testosterone at the same concentration led to a dramatic fall in sperm count. For 6-18 months all men were treated with MPA plus percutaneous testosterone (250 mg daily). The latter dose restored physiological levels of plasma testosterone. Follicle-stimulating hormone levels were inhibited more severely than in the DHT-treated group, whereas LH levels were variable. Azoospermia was achieved and maintained in six cases; two men were oligozoospermic and in one case a moderate secondary rise in the sperm count was observed. Twelve volunteers (experiment 2) received a daily oral dose of either 5 or 10 mg norethisterone acetate plus percutaneous testosterone (250 mg daily). All of them achieved azoospermia within 2 months, but two subjects later exhibited a partial restoration in sperm count. Follicle-stimulating hormone and LH levels were inhibited more severely than in the first experiment. The sperm count and gonadotrophin levels returned to initial values within 6 months after cessation of the treatment in both experiments. No side-effects were noted concerning blood parameters, libido or body weight. However, several female partners had elevated levels of plasma testosterone. In experiment 3 (13 volunteers), percutaneous testosterone was replaced by oral testosterone undecanoate (160 mg daily). Only seven men were azoospermic and most of them had lowered levels of plasma testosterone. Thus, the combination of percutaneous testosterone and oral progestagens appears to be the most convenient for male hormonal contraception.

Immune RNA Therapy as an Effective Adjuvant Immunotherapy After Surgery: An Animal Model

Transfer of tumor immunity as adjuvant cancer therapy has been a topic of intense interest. We have examined the efficacy of various combinations of surgery, xenogeneic immune RNA, xenogeneic normal RNA, tumor vaccine, and nonspecific splenocytes as adjuvant therapy for B16 melanoma in the C57BL/6J mouse system. B16 melanoma was transplanted by trocar into the right hind limb of 6-week-old mice. The tumors were readily palpable on the ninth day posttransplantation. The tumors were amputated at that time under mild anesthesia. Immune RNA was prepared by hot phenol extraction from immune sheep spleens. Various combinations of immune RNA, normal RNA, and tumor antigen, with or without normal mouse spleen cells, were administered every other day for a total of 10 injections. The survival and mode of death was followed up to 120 days. All mice without any treatment died within 30 days. Immunotherapy had no effect on the survival of mice that did not have surgical therapy. Individual group comparisons between mice that underwent surgery only and mice that had surgery plus immune RNA immunotherapy revealed a striking statistical improvement (P less than 0.01). Comparing all groups that received amputation plus various combinations of adjuvant immunotherapy showed no statistical difference in survival. However, immune RNA appears somewhat superior to normal RNA or antigen only. It appears that adjuvant immune RNA immunotherapy following surgical excision in the B16 melanoma model significantly improves survival and retards the spread of metastases.

Immune RNA therapy as an effective adjuvant immunotherapy after surgery: an animal model.

Transfer of tumor immunity as adjuvant cancer therapy has been a topic of intense interest. We have examined the efficacy of various combinations of surgery, xenogeneic immune RNA, xenogeneic normal RNA, tumor vaccine, and nonspecific splenocytes as adjuvant therapy for B16 melanoma in the C57BL/6J mouse system. B16 melanoma was transplanted by trocar into the right hind limb of 6-week-old mice. The tumors were readily palpable on the ninth day posttransplantation. The tumors were amputated at that time under mild anesthesia. Immune RNA was prepared by hot phenol extraction from immune sheep spleens. Various combinations of immune RNA, normal RNA, and tumor antigen, with or without normal mouse spleen cells, were administered every other day for a total of 10 injections. The survival and mode of death was followed up to 120 days. All mice without any treatment died within 30 days. Immunotherapy had no effect on the survival of mice that did not have surgical therapy. Individual group comparisons between mice that underwent surgery only and mice that had surgery plus immune RNA immunotherapy revealed a striking statistical improvement (P less than 0.01). Comparing all groups that received amputation plus various combinations of adjuvant immunotherapy showed no statistical difference in survival. However, immune RNA appears somewhat superior to normal RNA or antigen only. It appears that adjuvant immune RNA immunotherapy following surgical excision in the B16 melanoma model significantly improves survival and retards the spread of metastases.

Contribution of atenolol, bendrofluazide, and hydrallazine to management of severe hypertension.

The efficacy of various combinations of atenolol, bendrofluazide, and hydraliazine given twice daily was assessed in a double-blind trial on 39 patients with moderate to severe essential hypertension. Concurrent treatment with all three drugs proved most effective and produced a mean reduction in blood pressure of 43/31 mm Hg. In the dosage used, hydrallazine affected only the diastolic blood pressure, and when added to either bendrofluazide or bendrofluazide plus atenolol it produced a further mean reduction in pressure of 6 mm Hg. Once-daily treatment with atenolol and bendrofluazide was as effective in reducing blood pressure as the same combination given twice daily, and the hypotensive effect was still present at least 24 hours after the last dose of tablets. A combined tablet of atenolol and bendrofluazide taken once daily would be a simple regimen to follow and would provide almost as much hypotensive effect as a twice-daily regimen incorporating a modest dose of hydrallazine. The hypotensive effect of atenolol was equal to that of bendrofluazide on systolic pressure but significantly better than that of bendrofluazide on diastolic pressure. Atenolol reduced plasma renin and urate concentrations but increased plasma potassium levels. The biochemical effects of atenolol, therefore, may be an advantage over those of bendrofluazide when deciding on first-line treatment for essential hypertension.