Improvement In Clinical Findings Research Articles

Review of endotoxin-adsorbing direct hemoperfusion therapy using a column containing polymyxin B immobilized fiber

Literature from 1999 on the endotoxin adsorption therapy, PMX, is reviewed. There has been no double-blinded controlled trial. Several papers reported controlled trials. The authors of these studies effectively treated septic patients with peritonitis after operation. Efficacies with PMX were demonstrated much more clearly in the patients with gram-negative sepsis or endotoxemia. The survival rate (14 days or 28 days after PMX) was compared between patients who received conventional treatment, those who received continuous hemofiltration (CHF), and those with disease of similar severity. The factors used to estimate the efficacy of PMX, aside from survival, were improvement in clinical findings and severity of symptoms as well as cardiovascular and mediator changes. Reduction of cytokines and other mediators during 2-hour PMX was also confirmed. Its mechanism of action is the blockade of endotoxin signal transduction due to endotoxin removal. It was reported that the mechanism of elevating blood pressure during PMX was adsorption of endogenous cannabinoid.

Effect of Four Computer Keyboards in Computer Users with Upper Extremity Musculoskeletal Disorders

Eighty computer users with musculoskeletal disorders participated in a six-month, randomized, placebo-controlled trial evaluating the effects of four computer keyboards on clinical findings, pain severity, functional hand status, and comfort. The alternative geometry keyboards tested were: the Apple Adjustable Keyboard™ [kb1], Comfort Keyboard System™ [kb2], Microsoft Natural Keyboard™ [kb3] and placebo. Compared to placebo, kb3 and to a lesser extent kb1 groups demonstrated an improving trend in pain severity and hand function following six months of keyboard use. However, there was no corresponding consistent improvement in clinical findings in the alternative geometry keyboard groups compared to the placebo group. Overall, there was a significant correlation between improvement of pain severity and greater satisfaction with the keyboards. These results provide evidence that keyboard users may experience a reduction in hand pain after several months of use of some alternative geometry keyboards.

Effect of four computer keyboards in computer users with upper extremity musculoskeletal disorders

Eighty computer users with musculoskeletal disorders participated in a 6-month, randomized, placebo-controlled trial evaluating the effects of four computer keyboards on clinical findings, pain severity, functional hand status, and comfort. The alternative geometry keyboards tested were: the Apple Adjustable Keyboard [kb1], Comfort Keyboard System [kb2], Microsoft Natural Keyboard [kb3], and placebo. Compared to placebo, kb3 and to a lesser extent kb1 groups demonstrated an improving trend in pain severity and hand function following 6 months of keyboard use. However, there was no corresponding consistent improvement in clinical findings in the alternative geometry keyboard groups compared to the placebo group. Overall, there was a significant correlation between improvement of pain severity and greater satisfaction with the keyboards. These results provide evidence that keyboard users may experience a reduction in hand pain after several months of use of some alternative geometry keyboards.

高齢者のＭＲＳＡ感染症に対するＶａｎｃｏｍｙｃｉｎ Ｈｙｄｒｏｃｈｌｏｒｉｄｅの使用法

Objectives: A dose of vancomycin should be reduced for treatment of methicillinresistant Staphylococcus aureus (MRSA) infections in elderly patients with decreased renal function to avoid nephrotoxicity and ototoxicity. By adjusting doses and dosing intervals with therapeutic drug monitoring (TDM), we studied the most appropriate use of vancomycin in 6 elderly patients with MRSA infections.Method: The dosage-regimen was as follows: Vancomycin was abministered intravenously over 60 min at a dose of 0.5 g, b.i.d. in all patients. The same dosage-regimen was maintained when the trough vancomycin concentration was less than 10 μg/ml on the 3rd day with TDM. If the trough concentration was≥10μg/ml, 0.5 g of vancomycin was given once daily. Three days after a change of dosing interval, the dose of vancomycin was reduced to 0.25 g if the trough concentration was≥10μg/ml with TDM, otherwise the second dosage-regimen was maintained. The primary endpoint was disappearance of MRSA and the second was improvement of clinical findings (CRP, body temperature, white cell count).Results: MRSA disappeared in all patients. Adjustment of the dosage-regimen was made in 4 out of 6 patients through the treatment. The global improvement rating was 83.3% in this study. Adverse events included the mild increase of serum GOT, GPT and ALP in only one patient. The values of these enzymes returned to normal range after cessation of the antibiotic without additional medical treatment.Conclusion: We recommend a dosage-regimen of vancomycin of 0.5 g, b.i.d. at the start of treatment of MRSA infections in elderly patients. TDM should be performed after steady-state vancomycin concentration is reached (usually 3 days after the start of treatment) in order to assure efficacy and safety of the antibiotic. Patients with decreased renal function (CLCR≤40 ml/min) should be treated with a much lower dose or a longer interval from the start of treatment, and TDM is strongly recommended for those patients.

The natural history of herniated nucleus pulposus with radiculopathy.

The present study retrospectively investigated the morphologic changes that occurred during conservative treatment of patients with unilateral leg pain resulting from herniated nucleus pulposus without significant lumbar canal stenosis. The results were correlated with clinical outcomes and extruding forms to determine which type of herniated nucleus pulposus had the greatest capacity for spontaneous regression and how rapidly such regression might occur. The study population consisted of 77 patients with radiculopathy. All patients complained primarily of unilateral leg pain, and 94% had positive tension signs. Additionally, 32% exhibited muscle weakness corresponding to the symptomatic nerve root. All patients were studied more than twice using magnetic resonance imaging during conservative therapy at a mean interval of 150 days. Morphologic changes on magnetic resonance imaging fell into four categories, with herniated nucleus pulposus classified into three types using T1-weighted sagittal views. Each patient was reexamined on the same scanner; 53 patients were examined twice, and 24 patients were examined more than three times. Morphologic changes, with the exception of 13 false-negative cases, basically corresponded to clinical outcome. In half of the cases that showed some improvement at follow-up evaluation, improvement of clinical findings were seen before those observed on magnetic resonance imaging. Migrating herniated nucleus pulposus frequently presented an obvious decrease in size, and even disappearance in seven cases. The further the herniated nucleus pulposus migrated, the more decrease in size could be observed. The cases apparently corresponding to "protrusion" showed little or no change on follow-up magnetic resonance imaging. Regarding the mechanism of herniated nucleus pulposus disappearance, exposure to the vascular supply undoubtedly took a part, although many factors were suspected to have some influence. Morphologic changes on magnetic resonance imaging mainly corresponded to clinical outcomes but tended to lag behind improvement of leg pain. Disappearance of herniate nucleus pulposus was seen frequently in the cases of migrating disc herniation, and it was presumed that exposure to the vascular supply had a lot to do with this phenomenon.

Clinical trial on standardised celandine extract in patients with functional epigastric complaints: results of a placebo-controlled double-blind trial

The efficacy and tolerance of standardised celandine extract in the form of Gallopas 100 film-coated tablets were investigated in a placebo-controlled, double-blind trial on groups of 30 patients with functional epigastric complaints. Over the 6 week observation period, the only improvement in clinical findings was noted during treatment with the active drug. The distribution of the test findings showed a trend towards freedom from symptoms on Gallopas 100 for most of the symptoms. It was particularly noticeable that doctor and patients regarded the active medication as better tolerated than placebo. Inferential statistics validated the differences between Gallopas 100 and placebo in terms of efficacy and tolerance in respect of disorders of the gallbladder, biliary tract and pancreas.

メシル酸ガベキサートによる骨髄移植後間質性肺炎の治療

The incidence of interstitial pneumonia (IP) after bone marrow transplantation (BMT) were decreased by; the fractionation of total body irradiation, anti-cytomegalovirus antibody negative platelet transfusion and prophylactic administration of anti-cytomegalovirus immunoglobulin. However, the establishment of much better prophylactic procedures and treatments for IP after BMT is essential when considering the mortality rate. On the other hand, it has been reported that superoxide and some protease released by neutrophils may be related to the progression of interstitial pneumonia.Gabexate mesilate (FOY), a protease inhibitor, was used in two cases which were clinically diagnosed to be IP after BMT. Effects of FOY were remarkable with the improvement of clinical findings and recovery from IP. The inhibitory effect of FOY on superoxide production by neutrophils in vivo and in vitro was examined. FOY did not suppress the production of superoxide by the neutrophils in vitro, but did suppress in vivo. These results suggest that FOY improved the clinical findings of patients with IP after BMT by the indirect suppression of the production superoxide by the neutrophils.

慢性関節リウマチに対する滑膜切除術の術後成績に関するX線的研究

The early postoperative results following Mori's knee joint synovectomy usually gives satisfactory improvemtnt clinically on the operated knee joint.However, in so far as early postoperative improve ment following synovectomy is concerned, radiological evidence to support this clinical improvement has not yet been fully confirmed even in literature.The author collected 10 knee joints in which improvement in clinical findings was obtained and pre- and postoperative radiographs were available for comparison.In these 10 joints radiological findings were as follows. Postoperatively widening of joint line was seen in 10 joints. Postoperative improvement in joint line contour was seen in 4 joints. Therefore, improvement in joint line contour including widening was seen in 4 joints.In this surgical series, most of the joints postoperatively showed the sa me radiological findings as they showed preoperatively.It is very likely, howe ver, that the above radiological findings demonstrate an inhibition of the progression in the disease process in the operated knee joint following surgery and that this demonstrates the success of synovectomy for these patients.As our second study, radiological and clinical data we re studied on a series of patients with bilateral knee joint involvement. The operated knee joint was compared with the contralateral non surgical side. The number of the cases were 17 and the period of follow-up was a mean value of 12.3 years. An investigation was done radiologically using Steinbrocker's or Larsen's method and also clinically using our method of evaluating pain, swelling, ROM, and function in the knee.The following main conclusions were attained.: Preoperatively all the 17 knees were found worse than the opposite non surgical side clinically and radiologically 8 pairs of joints were similar and 9 joints were worse than the contralateral non surgical side. Postoperatively, however, as for the operated 17 knee joints 5 pairs of joints were found to be similar,6 joints were better and only 6 joints were worse than the contralateral non surgical knee.From these findings the author concludes that the presence of a “prophylactic effect” following Mori's knee joint synovectomy has been confirmed.

Biochemical studies of pyridoxal and pyridoxal phosphate status and therapeutic trial of pyridoxine in patients with carpal tunnel syndrome.

A number of recent studies report response of patients with carpal tunnel syndrome to pyridoxine treatment. Neurological and biochemical studies were therefore performed on six patients both before and after treatment with pyridoxine for at least 9 weeks. Free pyridoxal, pyridoxal phosphate, and total pyridoxal were assayed in plasma and neutrophils. The pyridoxal status was also estimated by assaying red cell aspartate aminotransferase. No evidence was obtained to suggest that these patients were deficient in either pyridoxal or pyridoxal phosphate. Although four of the patients claimed some partial symptomatic relief, there was no consistent improvement in clinical findings or neurophysiological measurements following pyridoxine treatment.

Sputum penetration of fusidic acid in patients with cystic fibrosis.

We report the sputum penetration and efficacy of fusidic acid in 16 children with cystic fibrosis (CF) who were hospitalized because of acute respiratory tract infection due to Staphylococcus aureus. Penetration into sputum and response to therapy were evaluated after intravenous and oral drug administration. Oral fusidic acid therapy (approximately 1,000 mg/m2/day) achieved highly satisfactory serum (10–50 μg/ml) and sputum (0.6–4.0 μg/ml) concentrations which were several fold greater than the MIC of the infecting S. aureus strains. The average percentage penetration into sputum during the steady state phase of the concentration-time curve was between 5 and 10%. The efficacy of treatment is reflected by improvement in clinical findings and laboratory data. Eradication of S. aureus from the sputum was documented in 14 of the 16 patients, although 6 months later this was shown to be transient in half of them (7 of 14 patients). No staphylococci resistant to fusidic acid were found. Nine of the 14 children with documented staphylococcal eradication from the sputum had received gentamicin in addition to fusidic acid therapy which could have added antistaphylococcal efficacy. Further investigations are needed to formulate the definitive role of fusidic acid in the antistaphylococcal therapy of patients with CF.

The treatment of intermittent claudication with beta-pyridyl carbinol over two years

Forty-six patients with clinically significant peripheral atherosclerosis were randomly allocated into two groups; one receiving tablets of betapyridyl carbinol, up to 1800 mg daily, the other receiving a placebo. Patients were assessed clinically and their performance on a treadmill measured over intervals for two years. Plasma lipids were also measured. There was a slightly significant improvement in clinical findings after two years in those receiving drug treatment but no difference in symptoms. Treadmill performance appeared to improve equally in both placebo and drug treated groups. The plasma cholesterol fell significantly in the treated group compared the controls but the plasma triglycerides were not altered. Drop-outs from the trial did not differ significantly between the two groups. Two cases of hepatocellular dysfunction were attributable to betapyridyl carbinol.