Few Weeks Of Treatment Research Articles

The results of an 8 h thrice weekly haemodialysis schedule.

volume by a slow ultrafiltration, down to dry weight. acetate=35, K=1.5, Ca=1.75, Mg=0.75. A bicarbonate In most patients, tight control of blood pressure (BP) buVer is now used in 30% of the patients. The dialysate flow is achieved without the need for antihypertensive med- is 500 ml/min, the blood flow 220 ml/min. The blood access ication [2]. The incident population case mix shows used for dialysis in 75% of the patients is an arteriovenous an important trend toward older, weaker patients, with fistula. In the last few years, 15% of the patients have been high co-morbidity. The mortality and the morbidity using a central venous catheter and 10% a Thomas femoral on our long HD are better than usually reported. A shunt. major factor responsible for the good long-term sur- The patients are requested to eat a varied diet unrestricted in proteins with a large calorie intake. They are asked not vival seems to be the tight control of blood pressure. to add salt to their food. However, the use of cheese, a staple The purpose of this report is to describe the long part of the French diet, is not restricted (except during the HD method and to analyse its results in term of first few weeks of treatment). mortality and morbidity, with special attention to the The most usually prescribed medications include calcium, control of BP. vitamin D and aluminium hydroxide, if needed for phosphate Table 1. Demographic data of 876 patients included in the study Subjects and methods

Mood symptoms during corticosteroid therapy: a review.

Corticosteroids such as prednisone are commonly prescribed for a variety of illnesses mediated by the immune system. This paper reviews the available literature on mood symptoms during corticosteroid treatment. Few studies have used well-recognized measures of symptoms or clearly defined diagnostic criteria to characterize such mood changes. The limited data available suggest that symptoms of hypomania, mania, depression, and psychosis are common during therapy. Symptoms appear to be dose dependent and generally begin during the first few weeks of treatment. Risk factors for the development of mood instability or psychosis are not known. The similarities of the psychiatric symptoms resulting from corticosteroid treatment to the symptoms of bipolar disorder are discussed.

A quantitative HCV-PCR test for routine diagnostics

The aim of this study was to develop a reliable and simple method for hepatitis C virus (HCV)-PCR using standard, automated laboratory equipment. HCV-RNA was extracted from serum and amplified in a single PCR with an internal standard. The PCR product was detected using fluoroimmunoassay. Quantification was based on external and internal standards. Linearity was observed over a wide range (10-107 geq). Mean inter and intra serial coefficients of variation were 35% and 23%, respectively. The limit of quantification was 1000 geq/ml based on intra and inter serial variations, while levels of 110 geq/ml were always detectable. Lower concentrations were intermittently positive. The ability to separate HCV-signals in healthy and infected persons was good, based on the distribution of HCV-signals from 353 random blood donors and 191 patient samples. To illustrate the applicability of the test, HCV-RNA quantification was performed in 11 patients during treatment with interferon alpha-2b. Ten of 11 patients showed a decline in HCV-RNA within the first few weeks of treatment. After four weeks most patients were still HCV-RNA positive but below the limit of quantification. The present method for quantification of HCV-RNA was shown to have sensitivity at the level of nested PCR techniques. Until now HCV-PCR has been complicated, time-consuming and costly, and therefore not suitable for routine diagnostics. The PCR method described here is easy to perform, fast and cost-effective.

STRESS, ANXIETY AND DEPRESSION

The acute response to stress is embodied in the ‘fight or flight reaction’, inducing a state of anxiety. When stress is long-continued, depression may develop insidiously under the cloak of continuing anxiety symptoms. Depression inhibits the ability to cope with stress and so a ‘vicious circle’ becomes established, depression aggravating stress and vice versa. Of 100 patients attending the Maudsley Stress Clinic, 49 were suffering from major depression (DSM-III-R). Treatment with antidepressant drugs was highly effective in breaking the vicious circle and improvement in depression was accompanied by a reduction in severity of the various stress factors measured. Choice of drug is important, and when sleep disturbance is prominent, then it is better to use a sedative antidepressant. Alternatively, a short-acting hypnotic may be useful, particularly during the first few weeks of treatment. It is better to use both antidepressant and hypnotic drugs that restore a normal pattern of sleep, particularly in relation to deep sleep.© 1997 John Wiley & Sons, Ltd.

How to keep the dialysis patients normotensive? What is the secret of Tassin?

ultrafitration. Altogether the BP will increase after a few days. The In Tassin we obtain a normal BP without medication patient will then need a higher ultrafiltration rate and within the fi rst few weeks of treatment in 95% of the eventually antihypertensive drugs which, in turn, patients and they remain then normotensives through- increase the hazard of hypotensive episodes. We call out all their maintenance HD time. We strongly believe this ‘the vicious circle of shorter dialysis’. Each patient that this is due to the control of sodium and water has his own refilling capacity and therefore his own overload. Our goal is to reach the ‘dry weight’, and our need for a personalized dialysis session duration results confirm that more than 90% of cases of hyperten- according to the interdialytic weight gain. Surprisingly, sion on dialysis are due to overhydration. Furthermore the mean interdialytic weight gain in our population even in our group (with less than 3% of hypertensive is less than 2 kg. The patients do not feel thirsty, the patients) higher BP correlates with higher cardiovascular relatively low average concentration of urea and mortality and lower survival. When we split this popula- 138 mmol of Na concentration in the dialysate may tion into two cohorts according to median predialysis explain this absence of thirst. mean arterial pressure (MAP), 343 pts higher and 342 pts lower than the median (97 mmHG) the cohort The secret of Tassin? We have two secrets with lower MAP has a significantly better survival, and the number of CV death is twofold lower (13 vs 28 The first is ‘Father Time’. Opposite to what was deaths for 1000 patients/year). universally reported in the 70s when dialysis time was The method to achieve this normal BP is a quest for long, with shorter schedules, in spite of new antihyper‘dry weight’. Dry weight is that body weight at the tensive medications, 50‐80% of the patients are end of dialysis at which the patient can remain normo- hypertensive. We had the opportunity to switch to long tensive without antihypertensive medication despite dialysis 110 patients treated for 6 months or more by fluid accumulation until the next dialysis. Dry weight short HD. Half of them received BP pills and the mean keeps changing with lean and fat body mass and must of their predialytic mean MAP was 116 mmHg. After be evaluated at each session. We collect and summarize 3 months all but one were o antihypertensive treaton a chart pre- and post-dialysis weight and BP data ment and the mean MAP was 99 mmHg. in order to prescribe the ultrafiltration during the The second secret is the ‘doctor dose’. It takes a lot session. Our computer chart features on screen the last of time to explain to the patients and to the nurses the 10 sessions. After each session the doctor in charge benefit of longer dialysis, to control the chart after must validate the results and mention if the weight each session, to change the weight step by step. But must be changed. We do not wait for obvious signs of this is mandatory to reach the goal of normotension. overhydration (oedema, hypertension, etc.) but focus The results of HD depend upon quality of delivered on small signs such as headache or slight increase of treatment. The dose of dialysis must be correct, Kt/V, PCR, URR, TAC, can control this dose. Unfortunately

SSRIs AND HYPONATRAEMIA

SUMMARYIncreasing age, certain medications such as diuretics, disease processes such as malignant neoplasm and schizophrenia, and a history of hyponatraemia or polydipsia may predispose patients to the development of hyponatraemia. In addition, certain psychotropic medications, including TCAs, MAOIs, carbamazepine, trazodone and neuroleptics, may predispose to hyponatraemia, yet a causative role for most has not been firmly established and the effect is most likely to be more idiosyncratic. The SSRIs have been associated with hyponatraemia in a small number of case reports. The mean age and sex of patients in reported cases is over 70 years and predominantly female, and patients were often receiving concomitant diuretic therapy. The frequency of hyponatraemia in elderly female patients receiving fluoxetine has been estimated to be as high as eight per 1000. The risk of developing hyponatraemia appears to be highest during the first few weeks of treatment. Because of the potential seriousness of hyponatraemia, if an elderly patient receiving an SSRI develops unexplained symptoms during the first few weeks of therapy, it is necessary to measure the serum sodium level.

Quantitative molecular monitoring of human immunodeficiency virus type 1 activity during therapy with specific antiretroviral compounds

Methods for the absolute quantitation of nucleic acids present in small amounts in biological samples (competitive PCR and competitive reverse transcription PCR) were applied to the direct monitoring of specific anti-human immunodeficiency virus type 1 (HIV-1) therapy. With these techniques, different parameters of HIV-1 activity (including genomic RNA copy numbers in plasma, proviral and late transcript copy numbers in peripheral blood lymphocytes, and mean transcriptional activity per each HIV-1 provirus) were monitored during therapy with azidothymidine or ddI. In most of these treated patients, a direct response to the antiretroviral compounds employed was detected during the first few weeks of treatment, as documented by a fast decrease of all molecular indexes of HIV-1 activity. However, residual viral replication (albeit at minimal levels) was documented during therapy in all subjects monitored in this study. In a minority of the patients under study (3 of 12), the drug-dependent viral inhibition was maintained throughout the observation time (213 to 791 days), but in 9 patients a rebound in viremia level was detected during therapy with competitive reverse transcription PCR. Sequencing analysis of a portion of the HIV-1 gene pol from cell-free virions showed that circulating viral variants bearing at least two mutations compatible with azidothymidine or ddI resistance were detectable in the patients who exhibited a rebound in cell-free HIV-1 genomic RNA copy numbers in plasma but not in one patient who maintained (for 455 days) lowered levels of viral load during ddI treatment.

Cost effectiveness of adjuvant bile salt treatment in extracorporeal shock wave lithotripsy for the treatment of gall bladder stones.

The relative cost effectiveness of adjuvant urso and chenodeoxycholic acid treatment in extracorporeal shockwave lithotripsy (ESWL) has been assessed as part of a pragmatic randomised controlled trial of ESWL as a treatment of gall bladder stones. Of the first patients with gall stone volume < 4 cm3 randomised to ESWL in the main trial, 24 were randomised to have ESWL alone and 26 to have adjuvant bile acid treatment, one of whom died before the end of the 12 month follow up period. At 12 months after treatment, differences in gall stone clearance between ESWL alone (3/24 (13%) clear, 5 (21%) referred for surgery) and ESWL and bile acids (6/25 (24%) clear, 2 (8%) referred for surgery) were not significant (p = 0.36, log rank test). Patients in both groups had substantial and significant health gains (according to biliary pain frequency and severity, Nottingham Health Profile scores, visual analogue scale symptom scores, and complications) but there were no significant differences between the groups. Improvements in both groups usually occurred within a few weeks of treatment and were unrelated to gall stone clearance. Costs were greater in the bile salt group (95% confidence intervals for estimated cost difference: 90 pounds to 630 pounds). If the purpose of treatment is symptom relief rather than gall stone clearance then adjuvant bile salt treatment seems to be unnecessary.

Fumigating mature spruce branches with SO2: effects on net photosynthesis and stomatal conductance

Branches on mature red spruce trees (Picearubens Sarg.) were fumigated with SO2 in late summer of 1990 and 1991. There were four SO2 treatment levels (0, 0.1, 0.2, and 0.4 ppm) and 12 fumigation chambers. Each treatment was replicated on three neighboring trees. Net photosynthesis and stomatal conductance of current-year foliage were determined with a Li-Cor photosynthesis system. Rates of foliar SO2 absorption were estimated using regression models, with leaf temperature, relative humidity, atmospheric CO2 concentrations, and photosynthetically active radiation as predictors. Fumigation effects became visible in terms of needle yellowing and browning after a few weeks of treatment. Effects on net photosynthesis and stomatal conductance were generally negative and in direct proportion with cumulative foliar SO2 absorption. It was found that, in shade-adapted foliage, visible symptoms were delayed, and stomatal conductance was slightly stimulated at low SO2 levels. In other foliage, leaf yellowing and browning occurred earlier, and stomatal conductance was depressed. Net photosynthesis was depressed at about the same rate regardless of branch position. Foliage subjected to high SO2 concentration treatments did not recover from SO2 damage 1 year after treatment: needles had fallen off the twigs, and needle and twig length of new foliage was reduced.

Dyspnoea, asthma, and bronchospasm in relation to treatment with angiotensin converting enzyme inhibitors

To evaluate the occurrence of asthma and dyspnoea precipitated or worsened by angiotensin converting enzyme inhibitors. Summary of reports of adverse respiratory reaction in relation to treatment with angiotensin converting enzyme inhibitors that were submitted to Swedish Adverse Drug Reactions Advisory Committee and to World Health Organisation's international drug information system until 1992. Sales of angiotensin converting enzyme inhibitors in Sweden were also summarised. Patients receiving angiotensin converting enzyme inhibitors who reported adverse respiratory reactions. Clinical characteristics of adverse reactions of asthma, bronchospasm, and dyspnoea. In Sweden 424 adverse respiratory reactions were reported, of which most (374) were coughing. However, 36 patients had adverse drug reactions diagnosed as asthma, bronchospasm, or dyspnoea. In 33 of these cases the indication for treatment with angiotensin converting enzyme inhibitors was hypertension, in only three heart failure. The respiratory symptoms occurred in about half of the patients within the first two weeks of treatment, and about one third needed hospitalisation or drug treatment. Dyspnoea symptoms occurred in conjunction with other symptoms from the airways or skin in 23 out of the 36 cases. In the WHO database there were 318 reports of asthma or bronchospasm, 516 reports of dyspnoea, and 7260 reports of cough in relation to 11 different angiotensin converting enzyme inhibitors. Symptoms of airway obstruction in relation to treatment with angiotensin converting enzyme inhibitors seem to be a rare but potentially serious reaction generally occurring within the first few weeks of treatment.

First generation aromatase inhibitors ? aminoglutethimide and testololactone

Aminoglutethimide and testololactone may be considered the first generation aromatase inhibitors for the endocrine treatment of breast carcinoma. Initially, both of these agents were designed and used clinically based on different concepts of their mechanisms of action. Only later were they both demonstrated to inhibit aromatase. Curiously, testololactone was earlier and more widely used than aminoglutethimide in treating advanced breast carcinoma. The discovery of the peripheral aromatase inhibition as the proper mechanism of action was delayed for both the agents but was relatively more timely for aminoglutethimide. Paradoxically, the clinical use of testololactone has become already obsolete since its true mechanism of action was discovered. Aminoglutethimide is still the most widely used aromatase inhibitor in treating advanced breast carcinoma. Due to the initial misinterpretation of its mechanism of action, aminoglutethimide was used for a long time at a relative high daily dose, always combined with hydrocortisone. Subsequent phase II and then randomized phase III studies demonstrated an equivalent efficacy using half (500 mg) of the previous conventional daily dose (1000 mg), with hydrocortisone. Very recently, a randomized clinical trial demonstrated that administering this lower dose without hydrocortisone did not significantly decrease the clinical efficacy. By decreasing the dose of aminoglutethimide, the incidence of side effects has been reduced. So, the last paradoxical aspect of the aminoglutethimide story is that this agent seemed initially very toxic but finally, with the new schedules, shows a very low toxicity profile, especially after the first few weeks of treatment.

Mechanism of Cyclosporine-Induced Hypertension

Cyclosporine is a common immunosuppressive agent used in solid organ and bone marrow transplants and the treatment of some immunological diseases. It has been established that treatment with cyclosporine can cause a patient to develop hypertension within a few weeks of treatment. This review will examine this effect and effective ways to treat it.

Serum iron and transferrin in acute neuroleptic induced akathisia.

Thirty acute psychiatric patients were examined prospectively at the beginning of neuroleptic treatment for acute psychotic symptoms and on average 16 days later. Two alternative hypotheses were examined: 1) neuroleptic treatment affects the levels of serum iron and transferrin; 2) acute akathisia developing during the initial few weeks of treatment is associated with low levels of serum iron and transferrin, either initially or at follow up or both. Serum iron levels did not change on repeat measurement, while there was a small, but significant decrease of serum transferrin. There was a significantly greater decrease in iron and transferrin levels in patients with akathisia on follow up compared with non-akathisics. In addition, akathisia ratings were highly correlated with serum transferrin levels on follow up.

Complexes of grass pollen allergens and specific antibodies reduce allergic symptoms and inhibit the seasonal increase of IgE antibody

Complexes made from antigen and specific antibodies have been used to suppress specific antibody production. This property is of potential therapeutic interest in immediate hypersensitivity states which are characterized by hyperproduction of IgE antibodies. We report here on the use of antigen-antibody complexes in patients with hypersensitivity to grass pollen. Specific anti-allergen antibodies were prepared by immunoadsorption from the serum of hypersensitive individuals and mixed with grass pollen allergens to form complexes in antibody excess. These complexes were used in a strictly autologous manner for inoculating patients prior to and during a pollen season. The study comprised two randomly defined groups of 15 patients who were inoculated intradermally either with a preparation of allergen-antibody complexes or with the carrier buffer, according to a double-blind protocol. Diary cards were used to follow nasal and ocular symptoms, bronchial asthma and medication intake. Specific IgE antibodies were assayed during the trial and 1 year afterwards. Inoculation of allergen-autologous antibody complexes was well tolerated. It significantly reduced ocular symptoms (Mann-Whitney U-test, P less than 0.05), bronchial asthma during the first part of the season (Mann-Whitney U-test, P less than 0.001) and drug intake (Mann-Whitney U-test, P less than 0.001). This treatment prevented the seasonal increase in specific IgE antibodies, whose production continued to decrease after the pollen season. These effects were obtained within a few weeks of treatment, using a cumulative amount of allergen 100-fold lower than the amount which would have been used for a conventional hyposensitization.(ABSTRACT TRUNCATED AT 250 WORDS)

Acute liver failure induced by carbamazepine.

Two children developed acute liver failure while taking carbamazepine. Clinical and laboratory findings suggested an immunoallergic reaction, but only one child improved on steroids. Determination of liver function during the first few weeks of treatment and early detection of signs of idiosyncrasy may prevent this rare but severe complication.

In Vitro Radiosensitivity of Human Diploid Fibroblasts Derived from Women with Unusually Sensitive Clinical Responses to Definitive Radiation Therapy for Breast Cancer

Between January 1985 and December 1986, 811 patients were treated for carcinoma of the breast at the Joint Center for Radiation Therapy by an identical protocol. Of these 811 patients, five patients (0.6%) were identified as having an unusually sensitive clinical response to routine external beam irradiation. This unusual clinical response was characterized by severe skin erythema and edema during the first few weeks of treatment, requiring treatment breaks. Skin fibroblast cell strains were established from these five women as well as from six women with a normal clinical response to breast irradiation (chosen at random from the population of 811 patients). Radiation survival parameters were determined by a colony formation assay from complete survival curves in coded and blinded samples. Cells from the sensitive patients were significantly more sensitive to the cytotoxic effects of radiation in vitro as determined by the parameters D0, D, D10, and n, than were the strains derived from patients with a normal response. We conclude that an unusually severe response to standard fractionated radiotherapy may be associated with greater intrinsic radiation sensitivity of the individual's somatic cells.

INFLUENCE DE L’ENRICHISSEMENT CARBONÉ ET DE SON MODE DE DISTRIBUTION SUR L’ÉVOLUTION DES ÉCHANGES GAZEUX DE LA TOMATE DE SERRE

Net photosynthesis, stomatal conductance, internal CO2 concentration and transpiration were measured on the fifth well-developed and excised leaf of tomato seedlings (Lycopersicon esculentum Mill. ’Vedettos’) 48–83 d old. These measurements were taken in order to monitor the evolution of the gas exchanges of seedlings exposed to concentrations of 330 or 1000 ppm, continuously, to 1000 ppm from 06: 00 h to 10: 00 h or to 1000 and 330 ppm alternately every 2 h. CO2 enrichment substantially increased the net photosynthesis rate of the seedlings, particularly at the beginning of the experiment. The long-term effects of CO2 enrichment subsided after a few weeks of treatment. Intermittent CO2 enrichment is partially helpful in remedying the loss of effectiveness of the CO2 after a long period of enrichment. High CO2 concentrations reduced the opening of the stomata. Our work shows that maintaining a high internal CO2 content in the leaves would indirectly reduce the stomatal conductance of the seedlings. However, our results show that the long-term loss of photosynthetic efficiency in the enriched seedlings cannot be attributed solely to an increase in the resistance of the stomata, since the internal CO2 concentration of the leaves remains very high regardless of which method of CO2 enrichment is used. Continuous CO2 enrichment improved the water uptake efficiency of the seedlings.Key words: Carbon dioxide, intermittent enrichment, gas exchanges, tomato, greenhouse, Lycopersicon esculentum Mill.

Acclimation of Two Tomato Species to High Atmospheric CO2

Lycopersicon esculentum Mill. cv Vedettos and Lycopersicon chmielewskii Rick, LA 1028, were exposed to two CO(2) concentrations (330 or 900 microliters per liter) for 10 weeks. Tomato plants grown at 900 microliters per liter contained more starch and more sugars than the control. However, we found no significant accumulation of starch and sugars in the young leaves of L. esculentum exposed to high CO(2). Carbon exchange rates were significantly higher in CO(2)-enriched plants for the first few weeks of treatment but thereafter decreased as tomato plants acclimated to high atmospheric CO(2). This indicates that the long-term decline of photosynthetic efficiency of leaf 5 cannot be attributed to an accumulation of sugar and/or starch. The average concentration of starch in leaves 5 and 9 was always higher in L. esculentum than in L. chmielewskii (151.7% higher). A higher proportion of photosynthates was directed into starch for L. esculentum than for L. chmielewskii. However, these characteristics did not improve the long-term photosynthetic efficiency of L. chmielewskii grown at high CO(2) when compared with L. esculentum. The chloroplasts of tomato plants exposed to the higher CO(2) concentration exhibited a marked accumulation of starch. The results reported here suggest that starch and/or sugar accumulation under high CO(2) cannot entirely explain the loss of photosynthetic efficiency of high CO(2)-grown plants.

Guidelines for the use of pulse oximetry in the non-invasive estimation of oxygen saturation in oxygen-dependent newborn infants.

An Ohmeda Biox 3700 oximeter was evaluated during treatment of 12 patients with respiratory distress. The infants were of 27-33 weeks' gestation and between 2 days and 5 months postnatal age. Blood gases were taken from indwelling arterial catheters and were measured on an ABL 30 blood gas analyser. The study tested the accuracy of the oximeter in detecting hypoxia (PaO2 less than 55 mmHg) and hyperoxia (PaO2 greater than 80 mmHg). Results are based on 175 paired observations. Guidelines are suggested for the use of the pulse oximeter under three conditions. In a newborn infant with acute respiratory distress without direct arterial access, the limits should be set at 85% (lower) and 90% (upper). In an older infant with chronic respiratory distress, the upper limit of use should be 95%. In order to avoid oxygen tensions less than 55 mmHg which would increase the risk of pulmonary vasoconstriction, however, the lower limit should be 87%. Infants with indwelling arterial lines during their first few weeks of treatment should have oxygen tension measurements and simultaneous oxygen saturation readings plotted on a graph at the bedside. The graph should be updated every 48 h to take into account changed levels of 2,3-diphosphoglycerate, haemoglobin F, and carboxyhaemoglobin and the recommended limits should be changed accordingly.

Isoniazid therapy in Parkinson's disease.

The effect of isoniazid on levodopa-induced dyskinesias has been evaluated in 20 patients with Parkinson's disease, following a serendipitous observation that choreic dyskinesias induced by levodopa in one parkinsonian patient were markedly reduced during treatment with isoniazid for tuberculous infection. A mean average isoniazid dose of 290 mg was given without any change in current antiparkinsonian treatment. "Benefit of dose" choreic dyskinesias were markedly reduced in 18 patients within the first few weeks of treatment. This effect was accompanied by an intolerable worsening of parkinsonian signs. All patients returned to their basal situation after isoniazid interferes with the therapeutic action of levodopa and dopamine agonists. The precise mechanism by which this action occurred is not known, but several possible explanations are discussed.