Medicamentous Therapy Research Articles

Impact of physical treatment and medicamentous therapy on muscle strength in subjects with lower bone density

Impact of physical treatment and medicamentous therapy on muscle strength in subjects with lower bone density

The clinical and oncological aspects of the treatment of laryngeal and laryngopharyngeal cancer

The objective of the present study was to estimate the justification of extended cervical lymphodissections and to evaluate the influence of adjuvant medicamental therapy in combination with the targeted treatment on the results of the management of oncological conditions. The 81 patients included in the study were allocated to the three groups. Group 1 was comprised of the patients (n=28) given neoadjuvant therapy and surgical treatment. Group 2 included the patients (n=27) undergoing the surgical treatment followed by remote gamma-therapy during the postoperative period. Group 3 consisted of the patients (n=26) receiving both the surgical treatment and targeted adjuvant medicamental therapy. The study has demonstrated that percent of wound complications after 2--3 courses of polychemotherapy in the patients of group 1 was higher by a factor of 5 in comparison with the patients of the two other groups. Wound healing by second intention was documented in 59% of the patients in group 1 and 10% of those in both groups 2 and 3. The five-year survival rate in the patients of group 3 was estimated at 38.5% (6.4 and 8.9% higher than in groups 1 and 2 respectively).

The possibilities for the treatment of exudative otitis media in the children presenting with chronic adenoiditis

The objective of the present study was to improve the effectiveness of medicamental therapy of exudative otitis media in the children with recurrent and chronic adenoiditis. It was shown that the use of fluifort (carbocysteine lysine salt) for the treatment of exudative otitis media in the children presenting with chronic adenoiditis is a more effective approach in comparison with the expectant management. It is concluded that the application of carbocysteine lysine salt in combination with the mometasone furoate nasal spray ensures the rapid elimination of the symptoms of adenoiditis and significantly accelerates the resolution of exudative otitis media compared with the monotherapeutic treatment.

The problems of antihypertensive balneotherapy

This review is devoted to the challenging problems of balneotherapeutics, such as the mechanisms of antihypertensive balneotherapy and its optimization. The experience of the authors with the practical application of chloride - sodium, iodine - bromide, and hydrogen sulfide mineral baths is analysed in comparison with the literature data. The role, dosage regimen, and duration of balneotherapeutic treatment as well as the effectiveness of its combination with medicamental therapy are considered. The authors hope that the discussion of these issues will be conducive to the solution of problems currently facing modern antihypertensive balneotherapy.

The influence of low-intensity intravenous laser irradiation of the blood on the endothelial function in the patients presenting with gastroesophageal reflux disease

The present study included 100 patients presenting with gastroesophageal reflux disease (GERD) including 68 (68%) women and 32 (32%) men. They were divided into 2 groups, with the study group comprised of 70 patients and the control one containing 30 patients. The objective of the study was to estimate the influence of low-intensity intravenous laser irradiation of the blood on the NO-producing function of vascular endothelium in the patients suffering GERD. The results of the study indicate that traditional medicamental therapy of the patients with GERD does not produce a significant improvement of plasma levels of stable nitric oxide metabolites whereas low-intensity intravenous laser irradiation of the blood results in well apparent normalization of this parameter regardless of its initial value, either high or low.

Orthopädische Rheumatologie

Rheumatic diseases with their progressive inflammatory systematic nature are important diseases any clinical practising orthopaedic doctor is frequently confronted with. In case of mono- or polyarticular joint swelling, stiffness or inflammatory arthralgia, rheumatoid arthritis has to be deliberated particularly in differential diagnostic considerations. When diagnosed early, a joint treatment by an internal specialist as well as the initiation of a basic medicamentous therapy are highly recommended. Therefore, corticosteroids and disease modifying anti-rheumatic drugs (DMARDs) such as methotrexate can be used, in case of failure a treatment with biologicals should follow. The operative therapy depends on the stadium of joint destruction. In early stadiums (LDE 0-3) and in case of therapy resistant inflammation a synovectomy should be performed as a preventive intervention. Given an already advanced destruction, alloarthroplasty or arthrodesis are indicated as reconstructive procedures.

THU0557 Low-Frequency Pulsed Electromagnetic Field Therapy for Non-Specific Neck Pain

BackgroundThere are several types and causes of neck pain. Non-specific neck pain is the most common type. In most of the cases an underlying pathology cannot be definitively determined. It...

Inzidentalom und subklinische Funktionsstörungen der Nebenniere

Autonomous secretion of adrenal hormones can follow a subclinical course or even be masked by other frequent diseases. Patients with incidentally discovered adrenal masses (incidentaloma) represent another diagnostic challenge. Their frequency has increased through the growing number of medical imaging procedures. Although the proportion of malignant or hormonally active lesions is low, patients with adrenal incidentalomas (> 1cm) should undergo an endocrine work-up in order to detect subclinical courses of Cushing's syndrome, pheochromocytoma or primary aldosteronism. Enhanced CT is of help in the assessment of the dignity of discovered lesions. In order to evaluate the hormonal activity, it is recommended to perform low dose dexamethason suppression test and to determine the plasma metanephrines and the aldosterone to renin ratio (in hypertensive patients). The therapy of suclinical Cushing's syndrome (operative vs. medicamentous therapy) remains a single-case decision in the absence of randomised prospective studies. All tumors with criterias for malignancy (> 4cm) and subclinical pheochromocytoma and aldosterone producing adenomas should undergo surgery. In the case of non operated tumors annual bichemical follow-up controls should be performed over a duration of 5 years. In the case of a significant gain of tumor size during follow-up, adrenalectomy should be considered.

The application of the physical factors for the rehabilitation of the children presenting with bronchial asthma

The use of anti-asthmatic preparations alone can not be considered sufficient for the rehabilitation of the children suffering from bronchial asthma. Traditional medicamental therapy does not allow mortality from asthma to be appreciably reduced. At the same time, it is known to produce serious adverse effects. The physical factors proved to be fairly well compatible with the basal treatment; specifically, their application makes it possible to decrease the amount of pharmaceutical products and the duration of therapy.

Palliativmedizin und medikamentöse Therapie in der Sterbephase

The idea of modern palliative care goes back to the times of Dame Cicely Mary Strode Saunders in 1967, a British nurse and physician. Modern palliative care is a multimodal therapeutic and supportive concept for the patient, when curative care has failed or seems to be not reasonable. In this article we review the basics of current palliative care and focus in particular on specific medicamentous therapy during the final episode of life.

Reduction of inflammation in patients of different age groups with secondary peritonitis by using immunomodulation therapy as a part of a combination treatment regimen

This paper describes the experience of including anti-thymocytic globulin (ATG) into the combination treatment regimen for the patients within different age groups from 29 to 83 years with diffuse secondary peritonitis. The study was based on the observations of 60 patients, of whom 29 (48%) received Antilympholin, an ATG, in their postoperative period, while the rest, 31, from the control group were not given any immunomodulating therapy under the combination treatment regimen. The obtained data is reliable evidence for the efficacy of applying ATG for normalizing the indicators of innate immunity and reducing the inflammatory process. The developed immunostimulating effect in the patients receiving ATG was already observed on the fourth day from the start of the therapy. The preparation proved to be efficacious equally in the subjects of younger and middle age, on the one hand, and in the elderly and most senior patients, on the other hand. A positive ATG effect on the course of the inflammatory process is confirmed by decreased blood levels of C-reactive protein and γ-globulin and by the normalization of α1-protein fractions. The administration of ATG offers a possibility of speeding up a reverse bias in the inflammatory process, which improves the quality of treatment and reduces the length of medicamentous therapy and rehabilitation.

Leichte kognitive Beeinträchtigung bei Patienten mit einem Morbus Wilson unter Langzeittherapie

Wilson's disease is a rare autosomal recessive disorder of hepatic copper transport leading to a biliary excretion inhibition of copper. Overloading of the metal mainly in the liver and basal ganglia leads not only to hepatic but also to extrapyramidal motor as well as psychiatric clinical symptoms. Cognitive dysfunction is often reported and patients suffer from additional depressive symptoms. In this study, a cognitive impairment profile with SIDAM (SISCO) including mini-mental state, digit span and the trail making test was performed in 32 patients with Wilson's disease (24 patients with the neurological form, 8 patients with the non-neurological form) undergoing long-term medicamentous therapy. The extent of neurological impairment was assessed in a neurology score. The Beck depression inventory (BDI) was used for the detection of depressive symptoms. Results of cognitive testing and BDI score were correlated with the results of the clinical investigation. Median results of MMSE, SIDAM, part of digit span and trail-making test are significantly worse in patients with the neurological form of Wilson's disease. There is no significant difference in median results of BDI, although the number of patients with a score suggesting a mild depressive disorder is higher in the group with the neurological form. The median result of SIDAM was 52 (45-55) in the neurological form and 54 (53-55) points in the non-neurological form. There is no statistical significance in the correlation to the severity of the neurological score. Depressive symptoms and cognitive impairment in Wilson's disease are frequently reported by patients who are on long-term treatment. In particular, the ability to concentrate and undertake executive functions are affected in the neurological form of Wilson's disease while functions of memory are less impaired. Since movement disorders often have improved with therapy, additional observation of cognitive function and depressive disorders seems to be useful. However, mild cognitive impairment occurs independently of the severity of the neurological symptoms.

The effect of low frequency pulsing electromagnetic field in treatment of patients with knee joint osteoarthritis

Pulsing electromagnetic field represents effective rocedure in treating of diverse diseases and p pathologic conditions, especially in rheumatology, orthopaedics and traumatology. The goal of this research is the objective evaluation of the treapeutic effect of low frequency pulsing electromagnetic field (LFEMF), in comparison with the effect of the other physical procedure: interfererence currents (IFC) and the medicamentous therapy, in treating of patients with knee joint osteoarthritis. This study was made as experimental, randomized, controlled clinical trial, opened type. The examination included 60 patients (40 females and 20 males) with osteoarthritis of the knee joint. All patients were divided in three groups. The first group of 20 persons, composed of patients treated with medicamentous therapy (Diklofenak of 100 mg, 2 tablets per day). The second group consisted of 20 patients treated by LFPEMF and the third group consisted of 20 patients treated by IFC. All procedures were implemented during 10 days All of patients had also the same duration therapeutic exercise. As observing parameter was used: Lattinen test for the evaluation of the pain sensitivity, before and after therapy. For the statistical analysis of the aquired data, was used Student's t-test. After therapy the pain was considerably reduced in each group, but this effect was the most significant in the II group of the examinees, treated by LFPEMF (p< 0.001), than the effects in other groups of patients: I group (p< 0.05) and III group (p< 0.01). According to the results of this study it can be concluded that LFPEMF is very effective therapeutic procedure in treatment of patients with knee joint osteoarthritis.

P-09 - Psychiatric comorbidity of heroin dependence and personality disorders and treatment within work-occupational therapy

Addiction is a process which is followed by use and abuse of psychoactive substances. It is characterised by behevioral patterns which gradually become dominant in motivational hierarchy of individual. Therefore, heroine addicts, almost as a rule, manifest personality disorder. The purpose of this study is to show that antisocial personality disorder is often in comorbidity with heroine addiction, as well as to show positive therapeutic effects of the work-occupational therapy. Personality disorders are diagnosed by applaying Psychiatric interwiew and TCI-9 (Temperament and Character Inventory). Within work-occupational therapy, Scale of Interest and Aggression Evaluation Questionnaire are used in order to include patient in different kinds of sport and recreational activities and to evaluate the level of aggression in first four weeks. Seventy patients who were hospitalised at the addiction department during 2009 and 2010 were tested. Heroin addiction and antisocial personality disorders are by high percentage in comorbidity 50%, narcissistic personality disorder 14%, borderline personality disorder 11%, paranoid personality disorder 3%, schizoid personality disorder 1%, and 14% without personality disorder. Level of aggressivness and tension was decreasing from week to week, proportional to the activity at the working-occupational therapy. The results gained from the study confirm a belief that heroine addiction is in high degree in comorbidity with antisocial personality disorder. This study shows that longer and greater activity at the work-occupational therapy leads to the reduction of aggressiveness and almost complete exclusion of medicament therapy.

Causes of primary refractoriness to the treatment of erectile dysfunction with phosphodiesterase type 5 inhibitors and means to overcome it

Aim: to elucidate causes of primary refractoriness to phosphodiesterase type 5 inhibitors. Materials and methods: 28 men aged from 38 to 59 (mean 46) years suffering from erectile dysfunction and primary refractoriness to the treatment with phosphodiesterase type 5 inhibitors were interviewed using the International Index of Erectile Function (IIEF-5) questionnaire. In addition, they were examined by ultrasound dopplerography of penile vessels, subjected to neurologic testing and measurement of blood testosterone, TSH, prolactin, and glucose levels. Results and discussion: The primary refractoriness to the treatment with phosphodiesterase type 5 inhibitors was attributable to hypothyroidism in 3.5% of the cases, to diabetic neuropathy in 3.5%, to complications of radical prostatectomy in 3.5%, to hyperprolactinemia in 7%, to atherosclerosis of cavernous arteries in 7%, to venogenic erectile dysfunction in 7%, to hypogonadism in 11%, to combination of hypogonadism, diabetic neuropathy and angiopathy in 57%. Hypothyroidism, hyperprolactinemia, hypogonadism, and type 2 diabetes mellitus (12.5% of the cases) were detected for the first time in the examined patients. Pathogenetic therapy resulted in the elimination of erectile dysfunction in the patients presenting with hypothyroidism, hyperprolactinemia, and isolated hypogonadism. Combined treatment of erectile dysfunction with Nebido and Levitra proved efficacious in 14 of the 16 patients with combined hypogonadism, diabetic neuropathy, and angiopathy. Conclusion: The main causes of primary refractoriness to phosphodiesterase type 5 inhibitors appear to be endocrinopathies and diabetic neuro/angiopathy. Combined examination of the patients in these conditions makes it possible to reveal dangerous disorders. Self-treatment with phosphodiesterase type 5 inhibitors is undesirable. Medicamental therapy (including combined application of testosterone preparations and phosphodiesterase type 5 inhibitors) permits to cope with erectile dysfunction in 75% of the patients.

The differences of clinical picture of macroprolactinomas and their response to medicamental therapy with dopamine agonists between men and women

The data about sex-specific differences of clinical signs and symptoms of macroprolactinomas and their response to medicamental therapy with dopamine agonists between men and women are reported. The present study included 306 patients (the men to women ratio 1.4:1) presenting with macroprolactinomas. Large and giant neoplasms were shown to predominate in men regardless of their age accompanied by clinical symptoms associated with the so-called «mass effect» of the tumour. The occurrence of macroprolactinomas of different size depended on the age of the patients. The majority of the young women had tumours of large and intermediate size and exhibited clinical features of hyperprolactinemic hypogonadism while those aged above 40 years had large and giant tumours accompanied by the symptoms of their «mass effect». The medicamental treatment with cabergolin was equally efficacious in both men and women.

Terson and #8217;s Syndrome Successfully Treated with Combined Therapy

To present a case of Terson's syndrome consequent to ruptured intracranial aneurism treated successfully with a combined therapeutic approach. Case report. A 37 year old man was urgently referred to the UCC Tuzla with sudden headache, vomiting and unconsciousness. CT scan showed ruptured aneurism of anterior communicant artery with signs of retinal thickening. Later ocular examination showed the massive bilateral vitreous haemorrhage. Patient was treated with medicamentous therapy for 7 months with no significant improvement. 7 months after aneurism rupture patient agreed to a surgical treatment. Right eye was treated surgically and left eye continued with conservative therapy. Visual acuity after vitrectomy improved in right eye to 1.0 and 0.5 in left eye. Terson's syndrome is relatively common complication of subarchnoid haemorrhage. Vitrectomy is safe and efficient approach to treat patients with Terson's syndrome.

Comparison of primary medicament therapy effects and primary argon laser trabeculoplasty on regulation of intraocular pressure and stability of perimetry findings in open angle glaucoma

Argon Laser Trabeculoplasty (ALT) is a recognized method for reducing intraocular pressure (IOP) in patients with open angle glaucoma. The aim of this study was to compare the effects of primary medicament therapy and primary ALT on IOP regulation and stability of perimetry findings. A total of 50 eyes of 35 patients were treated with primary ALT while 50 eyes of 36 patients were treated with primary medicament therapy with 0.5% timolol with 20, 0.005% latanoprost 18 and with 2% dorzolamid 12 eyes. IOP was controled at 3 months, and the visual field at 6 months during a 30-month follow-up period. In the first 24 months of follow-up there was no statistically significant difference in percentage of eyes with successfully regulated IOP. At 27th and 30th month, in the group primarily treated with medicaments a statistically significant higher percentage of successfully regulated IOP was observed in 98%, and 96% of the eyes, respectively, while in the group primarily treated with ALT the decline in the percentage of successfully regulated IOP was observed in 78% and 76% of the eyes, (chi2-test, p = 0.002, p = 0.140). Both therapy groups showed stability of perimetry findings without statistically significant difference in the values of mean deviation (MD) index until the end of the monitoring period. The dynamics of change in MD index value showed a statistically significant greater decline in this parameter in subjects who had been primarily treated with medications during the last six months of follow-up, (two-factor analysis of variance with a repeated measurement, factor of time x type of therapy, p = 0.030). Primary ALT equally successfully regulates IOP and restores stability of perimetry findings in patients with open angle glaucoma like the primary medicament therapy.

Osteo - articular diseases as comorbidity in non - orthopaedic surgery

Osteo-articular diseases have significant presence among general population. Osteo-articular disorders can be caused by disease or by trauma. There are many osteo-articular diseases which have influence on general state of the organysm and on other present diseases in a various level. The influence appears by increasing risk of main disease complications, limited movement complicates postoperative treatment of main disease and medicament therapy of osteo-articular disease sometimes modifies perioperative therapy of main disease. Trauma as comorbidity needs urgent care and, in the same time, it is a huge complication for the injured condition. Osteoarticular trauma healing usually lasts several weeks, so it prolongs the healing of intercurrent surgical disease. Osteo-articular changes as comorbidity during the acute surgical disease healing need proper preoperative preparing, With the aim to minimise perioperative morbidity and mortality.

Vasospastic angina pectoris complicated by acute myocardial infarction and complete atrioventricular block

A prolonged coronary artery spasm with interruption of coronary blood flow can lead to myocardial necrosis and increase of cardiospecific enzymes and can be complicated with cardiac rhythm disturbances, syncopc, or even sudden cardiac death. A 55-year old male felt a severe retrosternal pain when exposing himself to cold weather. The pain lasted for 20 minutes and was followed by the loss of conscience. Electrocardiogram (ECG) showed a complete antrioventricular (AV) block with nodal rhythm and marked elevation of ST segment in inferior leads. Electrocardiogram was soon normalized, but serum activities of cardiospecific enzymes were increased. Coronarography showed normal findings for the left coronary artery and a narrowing at the middle part of the right coronary artery, which disappeared after intracoronary application of nitroglycerine. The following therapy was prescribed: Diltiazem, Amlodipin, Isosorbid mononitrate, Molisdomin, Atrovastatin, Aspirin and Nitroglycerine spray. After 7 months medicaments were abandoned and the patient experienced again reccurent chest pain episodes at rest. Transitory ST segment elevation was recorded in inferior leads of ECG, but without increase of cardiospecific enzymes serum activities. After restoration of the medicament therapy anginal episodes ceased. Coronary dilators in maximal doses can prevent attacks of vasospastic angina.