Objective Improvement In Patients Research Articles

Nisoldipine. A preliminary review of its pharmacodynamic and pharmacokinetic properties, and therapeutic efficacy in the treatment of angina pectoris, hypertension and related cardiovascular disorders.

Nisoldipine is an orally administered calcium entry blocking drug structurally related to nifedipine. In limited clinical trials it has been shown to be effective and relatively well tolerated in the treatment of patients with chronic stable angina pectoris and mild to moderate essential hypertension. As for all dihydropyridine-calcium antagonists, its major properties include potent peripheral and coronary vasodilation and improvement in myocardial oxygen supply relative to demand. These actions occur without depression of cardiac conduction or left ventricular function. Short term clinical trials have shown nisoldipine to produce both symptomatic and objective improvements in patients with chronic angina of effort and have suggested a benefit in vasospastic angina. A small number of comparative trials indicate that nisoldipine is equally as effective as nifedipine. In addition, in combination with beta-adrenoceptor blockade nisoldipine appears to offer additional benefit compared with beta-blockade alone and is well tolerated. In patients with mild to moderate essential hypertension nisoldipine monotherapy, in 1 or 2 daily doses, has maintained blood pressure control and has also been a useful addition to diuretics and beta-adrenoceptor blocking drugs in patients with poorly controlled disease. Side effects appear to be dose related, generally mild and transient, and are primarily those resulting from potent peripheral vasodilation - headache, flushing and pretibial or ankle oedema. Although studies to date are promising, there are no published long term studies (greater than 1 year) of nisoldipine in comparison with other calcium entry blockers and other drugs currently in clinical use for the treatment of angina pectoris or hypertension. Until such studies are completed the exact place of nisoldipine in the treatment of these diseases remains to be established.

Reduction in Depression Scores Are Appropriate to Objective Improvement in Patients with C.O.A.D. Treated with Oral Corticosteroids. No Evidence for ‘Steroid Euphoria’

Reduction in Depression Scores Are Appropriate to Objective Improvement in Patients with C.O.A.D. Treated with Oral Corticosteroids. No Evidence for ‘Steroid Euphoria’

Efficacy of prazosin in the management of chronic congestive heart failure: A 6-month randomized, double-blind, placebo-controlled study

The beneficial effects of acute prazosin therapy in patients with congestive heart failure (CHF) have been well documented; however, its chronic efficacy over several months has not previously been evaluated in a placebo-controlled manner. Therefore, an assessment was made by radionuclide ventriculography of the effect of prazosin, 20 mg/day, on left ventricular ejection fraction and end-systolic and end-diastolic volumes at rest and on peak upright bicycle exercise, as well as its effect on right ventricular ejection fraction at rest, exercise time and work load, and standard clinical variables in 23 patients with stable class III symptoms of CHF. The study consisted of a 6-month randomized, doubleblind, controlled evaluation of prazosin versus placebo in patients receiving a stable dose of digitalis and diuretics for at least 1 month. At entry, the prazosin and placebo groups did not differ in any respect. Prazosin caused no demonstrable effect on clinical variables such as status of symptoms, heart rate, mean arterial pressure, and cardiothoracic ratio when compared with placebo. Prazosin also caused no demonstrable effect compared with placebo on absolute or percent changes in radionuclide variables at rest or on peak exercise, or on exercise time or exercise work load. In addition, prazosin had no consistent effect compared with placebo on plasma renin activity or plasma catecholamine levels. However, there was a slight but significant increase in weight (p < 0.0001) and in plasma renin activity in the upright position (p < 0.002) with time, as well as a tendency for the diuretic dose to increase with time in both groups. Thus, long-term prazosin therapy generally produces no demonstrable subjective or objective improvement in patients with stable, chronic class III CHF receiving digitalis and diuretic therapy.

Use of arterial infusion of 5-fluorouracil either alone or in combination with supervoltage radiation as a treatment for carcinoma of the prostate and bladder

Arterial infusion of 5-fluorouracil either alone or in combination with supervoltage radiation achieves a definite objective improvement in patients with estrogen-resistant adenocarcinoma of the prostate. This improvement has been documented by a decrease in tumor size, improvement in intravenous pyelograms, and a change in cancer grade from undifferentiated to well differentiated. The quality of life in each case has been good, with 45 per cent of the patients treated in this category currently alive and well. The use of protracted arterial infusion of 5-fluorouracil in patients with stage C and D adenocarcinoma and transitional cell carcinoma of the bladder has had an even more satisfying outcome. Of those patients treated, 90 per cent are still alive and free of disease from six to sixty-six months. Eight of the patients have survived over two years with an excellent quality of life. A long-term outpatient infusion program is necessary to achieve these good results. It is also difficult and time-consuming. In addition to having well trained paramedical personnel constantly available, the patients must live within a reasonable radius of the treatment center so they can be treated almost immediately if problems develop. A fairly large number of patients must be treated in order to develop familiarity with the technics and to maintain a level of proficiency.

Results of Chemotherapy in Breast Cancer. Study Group for Therapy of Breast Cancer, Cancer Chemotherapy Committee, Italian Society of Cancerology

A summary of the results obtained by the Italian Breast Cancer Group in 122 patients with advanced breast cancer randomized over four different treatments: testosterone propionate, given i.m. 3 times a week at the dose of 100 mg per injection; cyclophosphamide, administered i.m. 25 times a month at the dose of 100 mg/day; testosterone + cyclophosphamide i.m. at the above doses; HMNT (4-hydroxy-17 methyl-19-nortestosterone) given i.m. 3 times a week at the dose of 100 mg/day. The criteria for patient selection and methods of evaluation were, with some modifications, these used by the American Breast Cancer Group. Objective improvements were observed in 26.9% of patients treated with testosterone propionate, in 15.6% of patients treated with cyclophosphamide, in 23.5% of those treated with testosterone + cyclophosphamide and in 20% of patients treated with HMNT. The most interesting result, worth of further evaluation, is that observed with the combined testosterone + cyclophosphamide therapy, which yielded the highest number of objective improvements in patients in menopause for less than one year.