Successful Course Of Treatment Research Articles

Clinical effect and action mechanism of Weicao Capsule (威草胶囊) in treating gout

To study the therapeutic effect of Weicao Capsule (WCC) on gout. Two hundred gout patients were assigned to two groups. The treated group was treated with WCC and the control group was treated with Tongfengding Capsule. Both groups were given the respective treatments orally 3 times a day, 2 capsules each time with 2 weeks as one course and all patients received 2 successive courses of treatment. Changes of blood beta(2)-microglobulin (beta(2)-M), hemoglobin (Hb), 24 h urinary protein (24 h UP), pH value of urine and blood uric acid (BUA) as well as kidney function were observed. After treatment, level of beta(2)-M got lowered significantly, Hb and 24 h UP, blood urea nitrogen, serum creatinine and the clearance rate of creatinine, as well as blood lipids all improved obviously in the treated group (all P<0.01), while these parameters remained unchanged in the control group (P>0.05). The pH value of urine was improved in both groups showing an insignificant difference between them (P>0.05). BUA was decreased in both groups with a decrease to a larger extent in the treated group (P<0.01). The total effective rate was 87% in the treated group, which was superior to that in the control group (62%, P<0.05). WCC has a favorable therapeutic effect on gout and its mechanism of action for improving renal function and reducing urinary protein could be related with the lowering of blood beta(2)-M, BUA and lipids.

Group motivational enhancement therapy as an adjunct to inpatient treatment for eating disorders: a preliminary study

Difficulties in fostering eating disorder (ED) patients' motivations to overcome their illness are widely considered to be a major hurdle in the course of successful treatment. However, no previous study has assessed the use of interventions specifically designed to target poor motivation amongst patients with illnesses that are severe enough to warrant hospitalisation. A brief Motivational Enhancement Therapy (MET) group programme for inpatient ED sufferers was developed and evaluated. Forty two consecutive inpatients were sequentially allocated to treatment groups. Twenty three inpatients completed a four session MET group programme in addition to routine hospital care. A control group of 19 participants completed treatment as usual (TAU). Despite an absence of significant differences between the MET and the TAU groups on the overall formal outcome measures, there were nevertheless differences between the groups. Specifically, the MET groups appeared to foster longer term motivation and engagement, and to promote treatment continuation. The results tentatively suggest that MET could be valuable for the treatment of inpatient eating disorder patients and further research is warranted.

Upper extremity paraesthesia: Clinical assessment and reasoning

The art of clinical assessment involves an accurate determination of the cause(s) of a patient's symptoms. Given that a set of symptoms can be influenced by many contributing factors and features, assessment needs to differentially evaluate these. Accurate and appropriate treatment depends on differential assessment based on sound clinical reasoning. Many conditions derive from multiple causes demanding evaluation of as many etiological features as can be identified. The case review presented here involves a patient presenting with paraesthesia spreading into her right upper extremity. A complex history, involving her neck and contralateral upper extremity was assessed. The patient was found to have at least seven underlying, predisposing, and etiological, conditions capable of initiating, aggravating, or maintaining the presenting symptoms. Weighing the relative contributions of these often interacting features, and correlating this with the history, helped to identify a successful course of treatment.

A phase I study of a novel taxane, TL310, orally administered every week in patients (pts) with advanced solid tumors

2544 Background: TL310 is a novel, oral taxane with potent pre-clinical activity in taxane-resistant model systems. This is the first study to evaluate the safety, tolerability and pharmacokinetics (PK) of TL310 in pts with advanced refractory solid tumors. Methods: Pts with adequate hematologic, renal, and liver function received TL310 administered orally on days 1, 8 and 15 of a 28-day cycle. Pts were continuously assessed for safety and dose-limiting toxicity (DLT) was based on first cycle toxicity only. A rapid dose escalation schedule was used (1 pt per dose level until ≥ grade 2 toxicity then 3–6 patients per cohort). The maximum tolerated dose (MTD) was defined as the dose level below that at which ≥ 2 of 3–6 pts experienced DLT. PK sampling was performed on days 1, 2, 3–4, 8, 15, 16, 17–18, 22 of cycle one. Serial imaging with CT was performed every 8 weeks to assess response. Results: 18 patients [M=11, F=7], ECOG PS ≤ 2 were treated with doses of 5 (1 pt), 10 (1pt), 20 (1pt), 40(2pts), 80 (5pts), 120 (3pts) and 160 mg/m2 (5pts). 1 pt had grade 2 vomiting at 80mg/m2. This, and subsequent, dose levels were expanded to include 3 pts. 3 pts (2 at 80 and 1 at 160 mg/m2) vomited immediately after drug administration during cycle 1 and were replaced. 1/5 patients experienced a DLT at 160 mg/m2 with G5 neutropenic sepsis, G4 neutropenia and G4 thrombocytopenia. No other grade 3/4 toxicities attributed to study drug have occurred. Of 18 patients assessable for response, 1 had a partial response (gastric cancer) at 80 mg/m2 and 6 had stable disease for &gt; 2 cycles (esophageal 3, melanoma 1, ovary 1, cervix 1). The maximum concentration (Cmax) increased with dose up to 120 mg/m2, but appeared to plateau (86±6 ng/ml) in 4 of 5 patients at 160 mg/m2. TL310 has a half-life of up to 80 hours, but PK were very similar on successive courses of treatment. Conclusions: TL310 can be administered orally up to 160 mg/m2 on day 1, 8, 15 of a 28 day cycle and shows promising activity at doses below the MTD. The MTD has not yet been defined and dose escalation continues. No significant financial relationships to disclose.

Magnetresonanztomografie der Arteriitis temporalis Horton

Giant cell (temporal) arteritis is a diagnostic challenge. Blindness is a dreaded complication, especially if high-dose steroid treatment is delayed. With an optimized MR protocol, noninvasive diagnosis of giant cell arteritis is facilitated. Submillimeter in-plane resolution makes it possible to distinguish healthy segments from inflamed segments. The lumen and arterial wall can be depicted in high detail. Post-contrast high-resolution MRI visualizes the superficial cranial arteries bilaterally and simultaneously, allowing assessment of the cranial involvement pattern. In combination with MR angiography of the aortic arch and supra-aortic arteries, the extracranial involvement pattern can be demonstrated in a single comprehensive MR examination assessing the cranial, cervical and thoracic vasculature. Good diagnostic image quality can be achieved at 1.5 Tesla and at 3 Tesla. However, due to higher signal-to-noise ratios, image quality seems to be superior at 3 Tesla. Over the course of successful long-term treatment, MR signs of mural inflammation decrease significantly and eventually vanish entirely. In contrast to color-coded Duplex sonography, which is a comparatively cost-efficient imaging modality, acquisition of high-resolution MRI is almost independent of the investigator's expertise. Compared to positron emission tomography with 18F-fluoro-2-deoxy-D-glucose, which is a very sensitive whole-body screening tool for detecting extracranial involvement of large vessel vasculitis, MRI allows visualization and assessment of both the superficial cranial arteries in high detail and the extracranial large artery involvement in the same investigation.

How long do patients with erectile dysfunction continue to use sildenafil citrate? Dropout rate from treatment course as outcome in real life

To study the dropout rate for use of sildenafil after initial prescription and during successful treatment to clarify their risk factors. A total of 1036 patients with erectile dysfunction who were treated with sildenafil were analyzed. The dropout rate during successful treatment and its risk factors were assessed using the Kaplan-Meier method and Cox proportional hazards model, respectively. Thirty-one percent (n = 322) of the patients dropped out after the initial prescription. The cumulative dropout rate during successful treatment at 3 years after starting usage was 48%. A lower International Index of Erectile Function (IIEF-5) score before treatment was a significant risk factor for dropout during a successful treatment course (P < 0.029 by the Cox proportional hazards model). Approximately 30% and 50% of the patients dropped out of treatment after the first prescription and at 3-year follow-up, respectively. Adequate initial instruction and long-term follow-up are required even for patients with successful treatment.

The efficacy of multiple courses of alefacept in patients with moderate to severe chronic plaque psoriasis

Among patients with psoriasis who did not achieve Psoriasis Area and Severity Index 50 during the first course of alefacept therapy, 53% achieved Psoriasis Area and Severity Index 50 during the second course (odds ratio [95% confidence interval] vs placebo 2.30 [1.26-4.19]). Alefacept provided incremental efficacy over 5 successive 12-week treatment courses.

Cerebral Infarctions and Brain Abscess due to Lemierre Syndrome

Lemierre syndrome is characterized by anaerobic bacterial infection in the head and neck, causing thrombophlebitis of the jugular vein and septic metastasis to various distant organs, most often the lungs. Here we describe previously unreported clinical features of cerebral infarctions and brain abscess due to metastatic septic embolism of this uncommon but lethal syndrome, and the successful course of treatment with ampicillin, cefotaxime and metronidazole.

Implementation of a novel statistical design to evaluate successive treatment courses for metastatic transitional cell carcinoma. A Phase II trial at the M. D. Anderson Cancer Center

4543 Background: Patients undergoing chemotherapy often receive several successive courses of treatment whereby physicians use an adaptive strategy to decide whether to repeat the same regimen or switch to an alternate regimen. Although this medical practice is quite common, current clinical trial design does not account for such within-patient treatment decision strategies. Methods: We adopted a novel trial design best described as a ‘play-the-winner-and-drop-the-loser’ algorithm (Statist Med 19:1011, 2000) using 4 different chemotherapy regimens for a total of 12 two-stage strategies. This methodology can be used to select one best treatment, or a best pair of treatments as a two-stage strategy. Patients with metastatic urothelial carcinoma were treated with a 6-week course of therapy and then re-randomized to alternate therapy if they did not have at least a 40% reduction in their tumor. After the second 6-week course, a successful regimen or combination was defined as one which provided a >= 90% sustained reduction in tumor volume with no evidence of progression after initial response. Results: Since 2000, 65 patients (of a planned 120) received either ifosfamide-based chemotherapy (ifosfamide, taxol, platinum (ITP) or ifosfamide, adriamycin, gemcitabine (IAG)), and/or a gemcitabine-cisplatin regimen (gemcitabine, cisplatin (GC) or cisplatin, gemcitabine, ifosfamide (CGI)). The median survival for all patients was 16.3 months. After initial therapy, there were 12 CRs (IAG-4, ITP-3, GC-2, CGI-3). Of the 32 patients receiving second-line therapy, there were 7 CRs (IAG-2, ITP-1, GC-3, CGI-1). A total of 147.5 6-week courses were given (IAG-30, ITP-36, GC-42.5, CGI-39). A combination incorporating IAG had the best chance of success as defined by response (6 CRs of 30 courses given). Conclusions: Although results are still early, assigning successive chemotherapy courses using this strategy may have an improved survival as compared with historical data. This trial design provides a novel method for assessing and comparing treatment regimens in a multi-course setting. Author Disclosure Employment or Leadership Consultant or Advisory Stock Ownership Honoraria Research Funding Expert Testimony Other Remuneration Amgen; AstraZeneca; Novaritis; Novartis Oncology Amgen Lilly; Roche; Pfizer; Novartis

Implementation of a novel statistical design to evaluate successive treatment courses for metastatic transitional cell carcinoma. A Phase II trial at the M. D. Anderson Cancer Center

4543 Background: Patients undergoing chemotherapy often receive several successive courses of treatment whereby physicians use an adaptive strategy to decide whether to repeat the same regimen or switch to an alternate regimen. Although this medical practice is quite common, current clinical trial design does not account for such within-patient treatment decision strategies. Methods: We adopted a novel trial design best described as a ‘play-the-winner-and-drop-the-loser’ algorithm (Statist Med 19:1011, 2000) using 4 different chemotherapy regimens for a total of 12 two-stage strategies. This methodology can be used to select one best treatment, or a best pair of treatments as a two-stage strategy. Patients with metastatic urothelial carcinoma were treated with a 6-week course of therapy and then re-randomized to alternate therapy if they did not have at least a 40% reduction in their tumor. After the second 6-week course, a successful regimen or combination was defined as one which provided a >= 90% susta...

Tiapride for monosymptomatic hypochondriacal psychosis (dysmorphic delusion subtype) in presenile patients

AbstractMonosymptomatic hypochondriacal psychosis (dysmorphic delusion subtype) can be seen in people of all ages. It is well known as being difficult to treat, especially in presenile and older patients. In younger patients, it is commonly treated with neuroleptics like pimozide but in presenile and older patients this form of treatment is limited because of the aversive side‐effects of neuroleptics, such as extrapyramidal syndrome. The present study describes a successful course of treatment with tiapride in a presenile patient with monosymptomatic hypochondoriacal psychosis (dysmorphic delusion subtype) without any adverse side‐effects when compared to other treatments and monodelusional disorders in elderly people. It is concluded that tiapride should be considered the treatment of choice for monodelusional disorders in presenile people.

Possibilities of gastroprotective therapy in NSA1Dinduced gastropathies with De-Nol

Objective. To assess efficacy of De-Nol in NSAID-induced gastropathies. Material and Methods. 45 pts with rheumatic diseases taking NSAID with gastric and/or duodenal ulcer up to 1 cm of size or multiple (>10) gastric erosions (MGE) confirmed with endoscopy were included. They were randomized to receive De-Nol 240 mg twice a day with amoxicillin 2 g/day and furosolidon 400 mg/day (subgroup la) or De-Nol 240 mg twice a day as monotherapy (subgroup lb). Group 2 patients were treated with ranitidin 150 mg twice a day. Demographic parameters, nosological structure, treatment of the main disease and gastrointestinal changes stmcture in these groups did not significantly differ. Elderly women with rheumatoid arthritis and gastric ulcer were prevalent. HP was revealed in 73,3% and 90% of pts. Dyspepsia and heartburn were present in 90% and 93,3% respectively. Therapy efficacy was assessed after 4 weeks. Preventive effect was assessed in 2 months after the successful treatment course. Preventive doses of the drugs were equivalent to ? of treatment doses. Results. 3 pts from group 1 and 1 pt from group 2 were lost to follow up. I pt from group I stopped De-Nol prematurely because of adverse event (diarrhea). Ulcer and erosion healing was achieved in 22 from 26 pts of group I (86.6%) and from 7 from 14 pts of group 2 (50%), p=0.036. After the course of therapy remained in in 4 pts of group 1 (15,4%) and 9 pts of group 2 (64,3%), p=0.003. 3 pts receiving De-Nol had adverse events (2 - diarrhea, 1 - wind). Antihelicobacter effect was assessed in 7 pts of subgroup la. Eradication was achieved only in 3. Antiulcer effect in subgroup la and lb did not differ (88,8% and 82,4% respectively, p=0,732. HP was present in 12 from 20 pts (60%) of subgroup lb. Antiulcer therapy was effective in 6 from 7 of HP-negative (85,7%) and in 8 from 10 of HP positive (80%) pts, p=0,S4l. Preventive effect was assessed in 15 pts of group I and 5 pts of group 2. Relapse frequency was 13,3% and 20% respectively. Conclusion. De-Nol is effective in NSAID-induced gastropathies and its effect does not depend on HP.

Thoracolumbar Kyphoscoliosis in Larsen's Syndrome

Severe thoracolumbar kyphosis in Larsen's syndrome is rare. A successful 10-year treatment course, including T2-L4 subfascial rod placement when the patient was 6 years 3 months of age, nine periodic lengthenings, and definitive surgery at age 14 years 4 months is presented. From preoperative to 2-year postoperative definitive surgery, the patient's T1 to S1 spine length increased from 19 to 36 cm. The patient's 83 degrees thoracolumbar kyphosis was transformed to 45 degrees kyphosis and 28 degrees lumbar lordosis, and scolioses of 95 degrees and 65 degrees were reduced to 64 degrees and 50 degrees.

Expression of Th1 and Th2 cytokine mRNAs in freshly isolated peripheral blood mononuclear cells of a patient with cutaneous paragonimiasis

Using semiquantitative reverse transcriptase polymerase chain reaction, we examined the levels of various cytokine mRNAs of freshly isolated peripheral blood mononuclear cells (PBMCs) from a cutaneous paragonimiasis patient in the course of successful treatment with praziquantel administration. The pre-treatment levels of Th2 cytokines such as interleukin (IL)-4, IL-5, IL-10 and IL-13 mRNAs in PBMCs of the patient were much higher than those of healthy controls. The levels of IL-4, IL-5 and IL-13 mRNAs slightly elevated on day 2 of the treatment and then declined to the control levels on day 25. The IL-10 mRNA level rapidly decreased after the chemotherapy. In contrast, the mRNA levels of interferon (IFN)- γ, a Th1 cytokine, remained in the control levels during the course. Peripheral eosinophil counts and levels of total IgE and eosinophil cationic protein in the sera correlated well with the levels of these Th2 cytokine mRNAs. These results suggested the major role of Th2 cytokines in clinical manifestation of human helminthic infection.

Does thymic extirpation, before 6 months of age, in children with congenital cardiac defects, affect the immunological development?

Pre-emptive antiviral treatment efficiently prevents occurrence of cytomegalovirus (CMV) disease in allogeneic stem cell transplant recipients. However, successive treatment courses can be necessary. The current study was aimed at determining factors that could influence the response to antiviral treatment, in particular the donor CMV serostatus. A total of 147 consecutive CMV-seropositive recipients (R+) were included and prospectively monitored for 6 months after transplantation. Reactivation of CMV occurred in 111 patients, 61 of 78 with a CMV-positive donor (D+) and in 50 of 69 with a CMV-negative donor (D–) (p 0.45). Baseline viral loads and initial viral doubling times did not differ between D+/R+ and D–/R+. Fifteen D+/R+ and four D–/R+ had self-resolving CMV infections. A total of 92 patients received antiviral treatment and 81 (88%) had a significant decrease in CMV load under therapy. Repeated CMV episodes were observed in 67% of those and were significantly more frequent in D–/R+ than in D+/R+ (p <0001). Half-life of CMV under treatment was significantly longer in D–/R+ than in D+/R+. Treatment failure observed in eight recipients was associated with low leucocyte count at reactivation onset, and was significantly more frequent in D–/R+ (six patients) than in D+/R+ (two patients) (p <0.0001). CMV strains resistant to antivirals were found in two D–/R+. Donor CMV serostatus influenced neither CMV reactivation occurrence nor the kinetics of CMV DNA load in the early phase of CMV replication but had a significant impact on response to antiviral therapy. Virological drug-resistance remained rare.

Suspected bacterial meningoencephalitis in two adult horses

Bacterial infections (such as meningitis or meningoencephalitis) of the central nervous system are rare in horses. They are most prevalent in neonates as a result of septicaemia. A few cases...

Treatment of refractory juvenile chronic arthritis by monoclonal CD4 antibodies: a pilot study in two children.

OBJECTIVE--To study the effect of anti-CD4 treatment in patients suffering from refractory systemic onset juvenile chronic arthritis (JCA). METHODS--Two children were treated with the mouse CD4 antibody MAX.16H5. The effects on numbers of circulating CD4 T cells, clinical symptoms and C reactive protein (CRP) level were studied and the appearance of human antimouse immunoglobulin antibodies investigated. RESULTS--In patient one, disappearance of fever and malaise and a reduction of arthritic activity were observed together with a reduction in CRP. When disease activity returned eight weeks later, a second successful course of treatment was administered. It was possible to reduce the corticosteroid dosage permanently. In the other child, a first treatment cycle did not alter disease activity. A marked reduction in clinical and laboratory disease activity markers was observed after the second course. Only transient and mild side effects were observed. One patient exhibited a short lasting febrile reaction with chills, the other an urticarial rash. In both patients, human antibodies to mouse immunoglobulin became detectable. The decrease in the number of CD4 T cells in the peripheral blood was only short lasting and numbers returned to normal values within one to eight weeks, even after the second course of antibody treatment and under concomitant immunosuppressive treatment. No sustained clinical remissions could be achieved. CONCLUSIONS--These preliminary observations support the evidence of positive effects of CD4 antibody treatment in refractory systemic onset JCA. Long term efficacy, however, remains to be established.

Effects of Pirenzepine, Bromocriptine and Their Association on Basal and GHRH- and TRH-Induced GH Secretion in Acromegaly

In order to ascertain if pirenzepine (Pz), an antimuscarinic drug, could inhibit GH secretion in acromegaly, 8 patients were submitted to 3 successive treatment courses of 9 days each: Pz, bromocriptine (BRC) and Pz plus BRC. No change in basal levels of GH after Pz administration was seen, but its reduction (p less than 0.05) by BRC was observed. Pz plus BRC did not improve this response. None of these drugs abolished the paradoxical GH response to TRH. In 7 normal controls, Pz suppressed the GH responsiveness to GHRH (p less than 0.001), but not in acromegalic patients. BRC, instead, blunted this response. In conclusion, cholinergic control of GH secretion is altered in acromegaly. Pz, either when administered alone or associated with BRC, is not useful for the treatment of this disease.

Treatment of severe acne with isotretinoin in patients with inflammatory bowel disease

Four patients with inflammatory bowel disease and severe cystic acne were treated with isotretinoin. Two patients had a successful course of treatment without any gastrointestinal side-effects. One patient had two episodes of profuse rectal bleeding that were probably related to pre-existing haemorrhoids. The fourth patient had a flare-up of his Crohn's disease after starting isotretinoin.

Cross-cultural issues in the treatment of intractable anorexia nervosa

This paper presents a case of intractable anorexia nervosa in a child burdened beyond her capabilities by unresolved conflicts in a parent. The dynamics will be assessed in the context of open systems theory of family function to suggest that the mother's conflicts, fixated at the time she left her native country, and her attempts to adapt to a new one, combined with other family members' failure to understand or appreciate the mother's cultural roots, interrupted the patient's normal maturation/development. The paper also presents a successful course of treatment of the binational anorexic girl, using a comprehensive inpatient program, emphasizing intensive family therapy with an open systems theory framework.