Second Course Of Therapy Research Articles

RELATIONSHIP OF BACTERIURIA IN PREGNANCY TO ACUTE PYELONEPHRITIS, PREMATURITY, AND FETAL MORTALITY

8907 patients had their urine screened for significant bacteriuria at their first visit to the antenatal clinic. The incidence of bacteriuria was 4.4%. Short-term chemotherapy (eight days) reduced the incidence of acute pyelonephritis in 285 patients with bacteriuria during pregnancy to 2.8%. Patients whose infection failed to respond to primary treatment were more likely to develop acute pyelonephritis. Despite adequate courses of chemotherapy, birth-weights of infants of bacteriuric patients were significantly lower than in control patients without bacteriuria. Persistent infection increased the risk, and the smallest infants were born to women whose infection failed to respond to multiple courses of antibiotic therapy. The rate of fetal loss was also higher in patients whose infections were refractory to treatment. Short-term chemotherapy was as effective as long-term therapy in the treatment of bacteriuria of pregnancy (75% were cured by one course, and a further 16% by a second course of therapy). A major advantage of using short courses of chemotherapy is that it facilitates recognition of the group of women in whom the incidence of acute pyelonephritis, small infants, and fetal loss will be greater than in other women.

Long-term follow-up observations in cervical cancer

During the period 1935–1954 a total of 394 patients with primary cervical cancer were examined with a view toward treatment. Ten of that number were diagnosed as having carcinoma in situ. Treatment was omitted for specific reasons in 10 of the patients with invasive cancer.A 5 to 20 year follow-up is reported for the remaining 375 patients treated primarily by irradiation. That consecutive series of cases can be divided into two groups of approximate equal number at the end of year 1949. The effectiveness of treatment is tested by comparing relative 5 year results for the more recently treated patients with those applying to the earlier group. Advance in survival is not demonstrated despite the fact that the percentage distribution of early lesions increased during the years in question.The difference in results is investigated by tabulating data in accumulative survival rates. At 5 years' observation those values do not differ from relative results because all of the patients are observed for that number of years. The accumulative rates present a more valid assessment, however, by showing the rate of accumulated deaths from cancer as well as from other causes. The lesser survival rate patients treated in the 1950–1954 period is explained by a greater loss due to causes other than cancer and by a disproportionate incidence of cases with an unfavorable prognosis. The less favorable material is recognized by more rapidly accumulated cancer deaths during the first year of observation. Those patients are found among the Stage II cases treated in 1952 and in 1953.At more than 5 years' observation the accumulative survival rate falls below the corresponding relative value. The number of patients changes by decrease in the number not yet followed for specified periods. The accumulative survival rate falls below relative values by the weight of difference in early results upon all subsequent time intervals.Deaths from cancer accumulate rapidly for the first 2 years following treatment. A realistic majority is reached by the fifth year, but there is, in this series, a gradual accumulation through the eleventh year. A satisfactory statement of results can be made, therefore, on the basis of 5 year values. A patient clinically well but lost to follow-up after that period has low probability of dying from cancer. The risk appears almost eliminated after the tenth year. In the observations here reported the accumulative loss to follow-up does not reach significant proportions until after the ninth year. The deaths due to intercurrent conditions also accumulate slowly, but continue to expand for the total period of observation. A significant number of these are due to the development of second primary cancers. Three occurred in the rectum and one in the endometrium. Consideration is given the possibility that the previous irradiation may be an etiological factor.Experience with programs of secondary irradiation has been unfavorable in the treatment of patients with persistent or reappearing cancer. In more than 50 such attempts only 2 patients have survived an additional 5 years after the second course of therapy. Pelvic exenteration is more effective, but in 5 of the 9 attempts at operation the disease was found too advanced. The spread of cancer is believed assessable in 123 of the 132 deaths from cancer in Stages I, II, and III. Half of that number were in patients with distant metastases with or without local disease in the pelvis. The most common sites of involvement are lung and bone. The incidence of distant spread is greatest in Stage I, which shows a rate of 66 per cent.The effectiveness of treatment is assessed in relation to complications. Two examples are reported of very late injury attributed to radiation. Among major complications the incidence of fistula is believed to have identity with significant changes in radium treatment. The rate falls from 11 per cent in the earliest years of the report to only 2 per cent in the 1950–1954 period. This improvement is taken as evidence of advance in treatment, despite the lack of increased survival rates for the most recent years.A statement of relative survival has weakness if used alone to compare results. The fall in survival rate for the 1950–1954 period is satisfactorily explained in accumulative tables, but it is possible that treatment is also a factor. During those years experience was accumulated in the use of specific applicators for radium treatment. There is more than speculative reason to suspect overexposure. Whatever the cause of failure there is evidence of recovery from those defects at the end of the 1950–1954 period. Additional exploration by dosimetry studies is intended as a supplement to this report.

The Treatment of Hyperemesis Gravidarum with Chlorpromazine

Summary 1. The results of the treatment of 42 eases of hyperemesis gravidarum with ehlorpromazine are presented. 2. The severity of these cases is documented by the incidence of aceto-nuria, weight loss, history of hyperemesis with prior pregnancies, arid failure to respond to other drugs during the current pregnancy. 3. The dosage regimen is outlined, emphasizing the importance of beginning therapy in the hospital and individualizing the dose according to the patient’s response. 4. Thirty of our 42 patients were cured, 5 were improved, and 7 were initially unrelieved. Two of the latter 7 responded to a second course of therapy. 5. The toxicity of the drug is discussed in detail. All but 7 of the 42 patients exhibited some degree of toxic reaction, usually somnolence and weakness. Four of our own patients became jaundiced, an incidence of 10 per cent. Two other cases of jaundice were sent to us, and one other patient had a transient elevation of serum bilirubin.

Comparative effects of aspirin, ACTH and cortisone on the acute course of rheumatic fever in young adult males

A comparison was made of the effects of treatment with aspirin, cortisone and ACTH in 148 young adult males with acute rheumatic fever. Sixty-one of the patients received aspirin; forty-five received cortisone and forty-two received ACTH. Fever, joint pain and objective evidences of joint involvement were relieved most promptly with aspirin; ACTH was more effective in this respect than cortisone. Apart from the promptness of relief, there was little difference in the three drugs in their effects on the symptoms of acute rheumatic fever. The pattern of response of the erythrocyte sedimentation rate was different in each of the three therapy groups. Cortisone and ACTH treatment resulted in shortening the duration of abnormal auriculoventricular conduction; however, this might be a result of a specific action on conduction. Other indices of the effects of the drugs on carditis are presented but their final interpretation must await the results of a longterm follow-up. In each group, however, new murmurs appeared and persisted while the patients were receiving ostensibly full therapeutic dosages of the drugs. A clinical and/or laboratory relapse or “rebound” occurred in almost all of the patients in each group after cessation of therapy. This relapse subsided spontaneously in all except six aspirin-treated patients, one cortisone-treated patient and one ACTH-treated patient. A second course of therapy was administered to these patients. Toxicity and/or side-effects associated with use of the three drugs occurred in all the aspirin and ACTH-treated patients and in 75 per cent of the cortisone-treated patients. In only four patients, two each in the aspirin and ACTH-treated groups, were these severe enough to necessitate discontinuance of therapy. Acute psychoses developed in two ACTH-treated patients. Since an untreated control group of patients was not included in this study, it is not possible to determine what effect, if any, these three drugs had on the duration or residuals of acute rheumatic fever. It is clear, however, that the over-all effect of each of the drugs leaves much to be desired in the treatment of acute rheumatic fever and that adequate therapy for this disease is not presently available

TREATMENT OF TYPHOID IN CHILDREN WITH CHLORAMPHENICOL (CHLOROMYCETIN®)<subtitle>Report of Seven Cases</subtitle>

IN THE year 1948 Woodward 1 obtained excellent results in the treatment of 10 patients with endemic typhoid on the Malay Peninsula with chloramphenicol (chloromycetin®). Two patients relapsed, but a second course of therapy was effective. By 1949 this series had been extended to 44 cases, with continued excellent results. 2 Further reports on the treatment of endemic typhoid with chloramphenicol in India have been made by Shah. 3 Vakil 4 and Patel. 5 In the 53 cases reported by them, there were 7 relapses which responded to a second course of therapy and 3 deaths 5 occurring in the first 48 hours of treatment. Shah 3 felt that results were excellent only in those cases in which treatment was started before the tenth day of illness. Knight 6 treated 13 patients in Mexico, with good results. Murgatroyd 7 reported one case from Great Britain in which treatment for only