Showing papers in "Clinica Terapeutica in 1995"

Evaluation of the action of glucomannan on metabolic parameters and on the sensation of satiation in overweight and obese patients

Abstract: The authors studied the behavior of body weight, blood glucose, total serum cholesterol, and hunger and satiety sensation in 30 patients treated for 60 days with a 1.200 kcal (5040 kj) diet plus either placebo or glucomannane. All the variables considered show that the low-calorie diet plus glucomannane is more effective than the low-calorie diet alone.

[Synergic effect of albendazole plus metronidazole association in the treatment of metronidazole-resistant giardiasis].

Abstract: Twenty patients with intestinal giardiasis, already resistant to 3-5 previous courses of oral metronidazole, were randomly distributed into 2 different groups: 10 subjects were given oral albendazole (440 mg/two times per day for 7 days) and 10 were submitted to the association of albendazole (400 mg/two times per day for 7 days) plus metronidazole (250 mg/three times per day for 7 days). All patients were evaluated both for clinical and parasitological status, immediately before and after therapy and, then, 4 weeks later. Only 3 patients of those treated with albendazole alone, showed a clinical and parasitological remission at the end of therapy, and one of them relapsed 4 weeks later. All patients who underwent albendazolemetronidazole association responded to the therapy and all except one were defined as "cured" 4 weeks later. Our study demonstrates that albendazole alone is not an effective therapeutic alternative for "metronidazole-resistant" giardiasis. The association of metronidazole plus albendazole seems synergic and deserves further studies.

[Tumors of the temporal bone and the cerebellopontine angle. Diagnosis, characterization and assessment of extension by using imaging technics].

Abstract: We discuss in this paper the reliability of neuroimaging techniques in the diagnosis of neoplastic masses of the posterior-lateral skull base. We also discuss the role of TC and MRI in the evaluation of the extension pattern of these masses.

Interferons in the therapy of solid tumors

Abstract: Belonging to the vast family of cytokines, interferons (IFN) have recently been widely investigated concerning their possible clinical applications, both in virology and oncology. In this field results have been quite mixed but definitely encouraging. The best achievements have been obtained in hematology, and particularly in the treatment of hairy cell leukemia and chronic myelogenous leukemia, but new perspectives have also opened in the therapy of solid tumors, especially in the local treatment of superficial bladder cancer and ovarian cancer, AIDS-related Kaposi's sarcoma and malignant melanoma. IFN have in certain cases showed an efficacy comparable to that of classic treatments but with lower toxicity, and in some tumors they have even improved the results obtained so far, especially in combined therapy. We have here gathered the most recent results concerning the use of IFN in the therapy of solid tumors in order to highlight the new therapeutic opportunities available to clinical oncology.

Evaluation of the efficacy of oral sumatriptan in the management of migraine attacks. Clinical results

Abstract: This italian multicentre, double blind, parallel groups study compared the efficacy, safety and tolerability of oral sumatriptan, given as new film-coated tablet, with placebo in the acute treatment of migraine. 88 Patients received placebo and 162 patients received sumatriptan 100 mg (plus an optional dose 2 h later if the headache persisted plus a further optional dose for recurrence within 24 h). Sumatriptan was significantly more effective than placebo at releiving headache at 2 h (51% versus 31%, P = 0.003) and 4 h (71% versus 35%, P < 0.001). Fewer sumatriptan-treated patients required a second dose compared with placebo-treated patients (49% versus 74%, P < 0.001). Sumatriptan was more effective than placebo at relieving nausea, vomiting and photophobia/phonophobia. Few patients were evaluable for treatment of headache recurrence, and statistical analysis was not possible. More sumatriptan-treated patients than placebo-treated patients reported adverse events (29% versus 16%) but the difference was not statistically significant. More of these events were mild to moderate in severity, of short duration and resolved without treatment. Sumatriptan had no clinically significant effect on blood pressure, heart rate, electrocardiogram or laboratory test results. It is concluded that oral sumatriptan 100 mg, given as a film-coated, tablet, provides an effective and well-tolerated acute treatment for migraine.

Clinical trial comparing a new NSAID with 2 different dosages and diclofenac in patients with arthralgia in acute phase

Abstract: In this study 30 athletes suffering from acute post-traumatic arthralgia were divided into 3 groups: 10 were treated with Amtolmetineguacil at the following dosages, 600 mg by os twice daily the first two days followed by 600 mg once daily for 19 days (Group A1); 10 patients treated with Amtolmetineguacil 600 mg twice daily for 21 days (Group A2); 10 patients treated with diclofenac 50 mg twice daily by os for 21 days (Group V). The dosage used in Group A1 was as efficacious as that used in Group A2. Furthermore Amtolmetineguacil was better tolerated than diclofenac.

Evaluation of the effectiveness and tolerability of MED 15 vs. piroxicam in patients with acute epicondylitis

Abstract: In this trial we studied 30 patients with acute epicondylitis: 15 were treated with Med 15, a new non-steroidal anti-inflammatory drug, and 15 with piroxicam. Med 15 was administered orally for 15 days: the first 2 days 2 tablets daily (1.200 mg) and the following 13 days 1 tablet daily (600 mg). Piroxicam was administered 2 tablets the first 2 days and 1 tablet daily the following 13 days. It was demonstrated that the new compound is significantly more active and better tolerated than the reference drug.

Beta-interferon, retinoids and tamoxifen as maintenance therapy in metastatic breast cancer. A pilot study.

Abstract: Background Chemotherapy (CT), fundamental for the treatment of metastatic breast cancer (MBC), rarely cures, due to the presence of minimal residual disease (MRD). Based on the synergistic antiproliferative effect of interferon, retinoids and tamoxifen on breast cancer cell lines, we designed a pilot study to test if a combination of beta-interferon (beta-IFN), retinoids and tamoxifen could improve the progression free survival and overall survival in patients (PTS) treated with CT for MBC. Methods Thirty-six patients, with stage IV carcinoma of the breast, were treated with a combination of Cyclophosfamide, 5-fluorouracil, 4-epidoxorubicin, vincristine and prednisone every 3 weeks for six courses (FECPV), followed by two courses of methotrexate, mitomycin-c and mitoxantrone (MMM). Treatment was continued, in response, with low dose beta-interferon, retynil palmitate and tamoxifen until disease relapse. Results Among 36 evaluable PTS, 23 achieved a clinical response (64%) (95% c. i. 48 x 80%), 7 had disease stability (19%), and 6 (17%) progressed. Leukopenia occurred in 15 patients, thrombocytopenia in six, and anemia in 11. 16 patients had nausea/vomiting; stomatitis was observed in nine patients and diarrhea in three. Toxicity of maintenance therapy was mild and mainly hepatic. Median response duration was 31 months (range 5-75+). Median overall survival was 32 months (9-83+). Conclusions Our study shows that this regimen is feasible and shows activity in MBC with an acceptable toxicity.

A case of pulmonary aspergillosis effectively treated with itraconazole. Possible interaction of the antimycotic agent with hydroquinidine

Abstract: This study describes a case of pulmonary aspergilloma in a neutropenic patient affected with myelodysplastic syndrome. It reports the therapeutic efficacy of itraconazole, emphasizing in particular the possible interaction with quinidine, with QT prolongation--at ECG--disappeared after quinidine withdrawal.

[Therapy of arrhythmia induced by myocardial ischemia. Association of L-carnitine, propafenone and mexiletine].

Abstract: To assess the anti-arrythmic effect of L-carnitina, propafenone and mexiletine, we tested the drugs in 50 patients with effort angina and ventricular ectopic beats (VEB). The patients were randomized in 5 groups: Group A: was treated with oral L-carnitine at the dose of 2 g x 3 for two weeks. Group B: oral propafenone at the dose of 300 mg x 3 for two weeks. Group C: as group B+L-carnitine+g x 3 at the second weeks. Group D: oral mexiletine at the dose of 200 mg x 3 for two weeks. Group E: as group D+L-carnitine 2 gr x 3 at the second week. After 7 and 14 days of treatment, in all patients an Holter examination was performed. Our results show that L-carnitine exerts a significant reduction of the VEB and its administration potentiates the anti-arrythmic effect of propafenone and mexiletine.

[Lamotrigine: first experience in Italy].

Abstract: LTG, lamotrigine is a new antiepileptic agent chemically unrelated to any established drugs in use. The safety and the efficacy of LTG (564.5 +/- 74.4) mg/day was evaluated as add-on therapy (plus CBZ) in a placebo controlled study of 34 patients with refractory partial complex and/or partial secondary generalized seizures. The incidence of adverse effects of the drug is low and the unwanted effects are reversible. The long half-life and lack of effect on other AEDs will render LTG an easily dosable addiction to a patient's existing regimen. Reduction in the total number seizures was recorded in 61.4% of patients. We conclude that LTG is an effective AED for treatment of therapy-resistant partial seizure.

C0Q10 in the prevention and treatment of primary osteoporosis. Preliminary data

Abstract: Preliminary data are reported of an as yet uncompleted clinical study aimed at evaluating the therapeutic efficacy of C0Q10 for primary osteoporosis. In spite of the small number of subjects treated (only 5) the results obtained are evidence of the efficacy of this agent which had never before been used in the therapy of osteoporosis. The possible mechanisms of action C0Q10 are discussed in the light of an original interpretation of the etiopathogenesis of this very complex bone disease. Details of the study will be reported once the trial has been completed.

RS3PE syndrome. A new rheumatic inflammatory syndrome in advanced age

Abstract: RS3PE syndrome (Remitting Seronegative Symmetrical Synovitis with Pitting Edema) is a new form of arthritis in the elderly, characterized by symmetrical polysynovitis of acute onset associated with distal pitting edema. Tests for serum IgM rheumatoid factor are typically negative. RS3PE syndrome affects Caucasians aged over 60, predominantly males. It has a benign course and remits completely without residua.

Prolonged treatment with ursodeoxycholic acid for primary biliary cirrhosis.

Abstract: Eighteen patients affected with biopsy-proved primary biliary cirrhosis (PBC) (histological stage III and IV) received ursodeoxicholic acid (UDCA) 600 mg for 1 year. Signs and symptoms and biochemical tests (glutamic and oxalcetic transaminase, glutamic and pyruvic transaminase, bilirubine, gamma-glutamyl transpeptidase, alkaline phosphatase, leucine aminopeptidase, bile acids, plasma proteins electrophoresis, immunoglubulins A, G and M) and antimitochondrial antibodies were evaluated before the treatment and every four months during the treatment. The results were compared with those obtained in 8 untreated patients affected PBC. The control group of patients were comparable (as far as age, histological stage, biochemical tests are concerned) to the group who received UDCA. Bilirubine, ALP, gamma-GT and LAP decreased during the treatment with UDCA and remained lower than baseline values until the end of the observation (12 months), while no changes occurred in the untreated patients. Both in the treated and untreated group plasma protein electrophoresis, serum immunoglubulins A, G and M remained unchanged, as well as anti-mitochondrial antibody. A moderate reduction of transaminases and bile acids was observed in the group of patients receiving UDCA but it did not reach statistical significance. In 16 out of the 18 treated patients pruritus disappeared and resulted diminished in the remaining 2 patients. No significant amelioration of pruritus was observed in the patients who did not receive UDCA. In conclusion, our data show that prolonged treatment with UDCA drastically reduces pruritus and improves cholestasis biochemical tests in patients affected with symptomatic PBC.(ABSTRACT TRUNCATED AT 250 WORDS)

Diagnostic accuracy of computerized tomography. Preoperative staging of gastric cancer

Abstract: "Imaging techniques" have assumed greater clinical value in the further assessment of an endoscopically or radiologically verified neoplastic lesion of the stomach through the ability to evaluate its extent of invasion, metastatic involvement of lymphnodes and/or distant organs. US, CT, and more recently NMR are non-invasive modalities that provide an accurate preoperative assessment of potential surgery decision making. Common current practice of preoperative CT in gastric cancer and relevant results documented in letterature, have inclined many clinicians in its use in staging this disease. The aim of the study is to evaluate and assign the efficacy of CT imaging in the preoperative staging of gastric cancer by comparing the results obtained with this imaging technique with the postoperative histopatologic findings of 25 patients with adenocarcinoma of the stomach. CT demonstrates the primitive lesion as a gastric wall differentiate T1 (parietal invasion extending to the lamina propria and submucosa) and T2 (invasion of the muscolaris propria and the submucosa). The performance values of CT in detecting tumor extension to the sierosa were as follows: sensitivity of 78%, specificity of 63%; and overall accuracy of 72%. The sensitivity and specificity of CT in demonstrating adjacent organ involvement were approximately 75% and 85% respectively, and overall accuracy of 84%. In the detection of metastatic involvement of lymphnodes CT demonstrated to be 70% sensitive, 62% specific with an efficacy of 68%. In terms of M-stage, CT imaging identified liver metastases in 3 patients (2 located in the VII segment and 1 in the IV) and 1 metastasis to the adrenal gland. All were confirmed by specimen histopathologic findings.

[Tolrestat in the therapy of diabetic peripheral neuropathy: is this drug really useful?].

Abstract: The authors have studied the effect of the treatment with an aldose reductase inhibitor, tolrestat, on the peripheral diabetic neuropathy during a placebo controlled randomised trial. 74 diabetics affected by peripheral neuropathy were divided in two groups of 39 (group A) and 35 (group B) patients comparable as to age, sex, duration of diabetes and severity of the neurological symptoms. The group A was treated with tolrestat orally 200 my once daily for six months, the group B was treated with placebo. After six months an improvement of analysed symptoms (pain and paraesthesias) and objective assessments (NCV-DB) was observed in patients treated with tolrestat (group A) significantly higher than in patients treated with placebo (group B). A light improvement was found also during a control effected after three months of treatment with tolrestat. The improvement after six months of therapy was mild but significant; therefore the authors conclude that the tolrestat is an useful drug in the treatment of the peripheral diabetic neuropathy in addition to attainment of a better glycemia's control.

Update on the use of interferons in clinical practice

Abstract: Discovered by Isaac and Lindemann as a substance able to induce a biological interference among viruses and host cells, interferon appeared to include three main antigenic classes: alpha, beta and gamma. There is a large variety of actions exhibited by different types of interferon and among them it is possible to distinguish an antiviral, antineoplastic, immunomodulatory or hormonal activity. Many years ago, the antiviral action seemed to be relative to some cellular membrane disorders, but later other mechanisms were stressed. Among them, it is worth describing the transcription and transduction of antiviral proteins like the oligoadenilsinthetase and proteinphosphokinase, able to cause the viral RNA breackage. The antineoplastic action is exerted by direct and indirect mechanisms. Direct mechanisms include an antiproliferative activity and the induction to cellular differentiation whereas the indirect ones involve the enhancement on tumor cell surfaces of some tumor associated antigens included in the I class of MHC system. The immunomodulatory action is exerted by the stimulation of macrophages, T cells and Killer cells cytotoxic activity. The list of viral diseases sensitive to interferon treatment includes condiloma acuminata, herpes zoster, chronic B and C hepatitis and Kaposi sarcoma AIDS-related. High proportions of overall response rate were observed among interferon treated patients with condiloma acuminata (80-100%). The use of interferon in the treatment of herpes zoster achieved good results regarding a shorter duration of the time spent to induce the chest pains and cutaneous symptoms disappearance when compared with that relative to other antiviral drugs. Results obtained in the treatment of chronic B and C hepatitis regard the disappearance of viral replication serological markers and the improvement of histological and enzymatic pattern. The effectiveness of interferon in the therapy of Kaposi sarcoma is demonstrated by the reduction of cutaneous symptoms and recurrent infectious diseases incidence. The use of interferon in treatment of solid tumors seems to play secondary role and, at any rate, to be adjuvant to chemotherapy. The administration of beta interferon as therapy of breast cancer seems to increase the estrogens and progesterone concentration in the neoplastic tissue and so it aims to improve the sensitivity to the tamoxifen treatment. The addition of interferon alpha both to 5-FU and cis-platinum seems to improve the proportion of overall response rate respectively in the treatment of colon cancer and head and neck cancer.(ABSTRACT TRUNCATED AT 400 WORDS)

[Effect of sumatriptan on facial temperature variations, blood pressure and electrocardiogram in healthy subjects and patients with migraine without aura].

Abstract: 40 patients were evaluated for skin temperature changes from baseline measurements and after 6 mg subcutaneous sumatriptan administration. During examination, skin temperature were recorded on a color picture at 10', 20', 30', 60', 90' and 120 minutes after sumatriptan administration. At the some time, heart rate (HR), systolic (SBP), diastolic (BDP) blood pressure and ECG-monitoring were automatically recorded. The patients were subgrouped as follow: 20 non migrainous control subjects (6 males and 14 females) aged 19 to 55 years (mean age 39.5 +/- 15.4); 20 headache free migrainous patients (6 males and 14 females) aged 25 to 46 years (mean age 37.8 +/- 8.4). Our data demonstrate a significant reduction in skin temperature (face) in all patients studied. 10 minutes after sumatriptan administration a significant increase (p > 0.001) both in SBP and BDP was observed. This findings suggest that sumatriptan show a vasoconstrictor effect as demonstrate by reduction in face temperature both in nonmigrainous and in migrainous patients. The unchange in HR and ECG and the transient increase in blood pressure, not associated with clinical symptoms, suggest that this drug may be used in migrainous patients.

Overdosing on diltiazem in heptic insufficiency

Abstract: In a patient with hepatic failure of middle grade diltiazem at standard therapeutic dosis for unstable angina caused collateral fuss on atrioventricular conduction. This event is not considered in medical literature or on the schedule of the product. Because of the pharmacokinetics features of diltiazem, a higher risk of side effects can be expected if a abnormality of hepatic function is present.

Reflexions on the Tietze syndrome. Clinical contribution

Abstract: The authors report 4 cases of Tietze's syndrome. In 3 of them the syndrome onset during a rheumatic disease (psoriatic arthritis, sternoclavicular hyperostosis). It is thus necessary to distinguish between the idiopathic of unknown ethiology and the secondary form due to, a well defined disease, in 3 cases observed.

Hyperlipidemia, hypertension and atherosclerosis in women. Reality and perspectives.

Abstract: The prevalence of ischemic cardiopathy is different from country to country, race to race, although there is a constant greater prevalence among males. After a certain age there is a modification of the ratio between males and females; but this ratio, before and after menopause, is varying in time and to a certain extent is due to the intervention of new risk factors or the greater influence of the traditional factors which are not age related. in this review are analyzed, with greater emphasis on the female sex, the major risk factors for the ischemic cardiopathy, their dependence on hormonal status before and after menopause, and the different life styles and behaviours that are probably influenced by ethnologic factors, in the so called advanced societies.

Evaluation of the treatment with thymopentin associated with radiotherapy in head and neck tumors

Abstract: The aims of the study has been the analysis of the optimal conditions for the use of thymopentin in reducing the incidence and severity of early and late complications following radiotherapy of patients with head and neck cancers submitted to radiotherapy by means of cobalt or linear accelerator. 168 patients of 10 Center have been examined. Analysis of the results demonstrated that the tymopentin reduce the incidence and severe reactions (p < 0.05) in statistically significant manner in cases of irradiation of the hypopharynx, oropharynx in oral cavity. The complications were more frequent during cobalt beam therapy (p < 0.01) and the beneficial effect of the immunomodulating treatment were greater for females than the males (p < 0.05).

The use of colchicine in the treatment of alcoholic liver fibrosis in the elderly. Report of 80 cases

Abstract: Having briefly analyzed the metabolism of ethanol in elderly subjects and the evidence of great resistance of the senile liver to alcohol-induced damage, the Author describes histological, clinical, biohumoral features of fibrosis and the necessary therapeutic measures. Eighty clinical cases of hepatic fibrosis are also illustrated, studied and observed during five years.

Current orientation in medical management of ulcerative colitis

Abstract: Authors synthetically remind epidemiology, eziopathogenesis and clinic of ulcerative colitis; they after describe the drugs employed in therapy of disease, stressing the mechanism of action, efficacy, collateral effects. Authors remember the choice of cortisonic therapy in the acute and severe periods of disease and the specific activity of salazopyrine and its metabolite 5-aminosalycilic acid in the ulcerative colitis and refer about the use of drugs as immunodepressors, fatty acids omega 3, zileuton, short chain fatty acids. Practical patterns of therapy in the diverse stages and clinical forms of the disease are exposed.

Prevalence of patients with HIV infection in an emergency department

Abstract: The activity at an ED, primarily aiming at providing rational and qualified support to critically ill patients, is forced to manage very different nosographic entities, including infectious, often contagious, pathologies. In this context the diffusion of HIV infection poses a number of problems concerning both the kind of patients presenting to the ED and the professional risk of health-care workers. In the first four months of 1992 the incidence of patients with recognized or presumed HIV infection at the "Pronto Soccorso Medico" was of 1.78% of 2327 patients admitted. This study aims to contribute to the epidemiologic definition of the risk of HIV infection due to occupational exposure, stressing the peculiar conditions of urgency-emergency often characterizing the activity within the ED.

Deterministic chaos in biology

Abstract: Higher physiological organisms are characterised by a complex interaction of multiple control systems. This interaction permits man to adapt those unexpected demands given by experimental changes. The idea of complexity results basically from the non linearity of dynamic systems that are correlated to each other through feedback cycles. These systems fluctuate in an apparent chaos. The improvidence and the non uniformity of biological systems are basic qualities that define the state of health. It is anyhow possible to discriminate in them a certain repeatability of interaction that succeeded each other; this repeatability makes the system fit for a fractal interpretation.

Special aspects of carnitine in the neonatal period

Abstract: In view of the importance of L-Carnitine in neonatal metabolism, a study of 100 newborns aged between 33 and 40 weeks of gestation was carried out to determine the normal levels of total carnitine (CT), free carnitine (CL) and carnitine bound to acyl groups (AC), and to investigate any possible relationship between the above fractions and gestational age, type of nutrition and neonatal asphyxia. Suitable diets enriched with L-Carnitine, at a concentration of 1.04 mg/100 ml, included the administration of increasing amounts of milk formulas every 3rd hour, for a total of 7 times/day during the first week of life. Parenteral nutrition was given through an infusion pump during the early 48 hours of life; thereafter, the newborns were fed milk formulas enriched with L-Carnitine. It was observed that CT, CL and AC levels were significantly higher in newborns aged between 33 and 36 weeks of gestation than in older newborns. Nutrition with milk formulas enriched with L-Carnitine induced higher CT, CL and AC levels during the first week of life than on the first day of life. This increase is greater in newborns of more than 36 weeks of gestational age, with a significant difference from newborns of lower gestational age. Asphyxiated newborns showed a significantly higher CL concentration than non-asphyxiated newborns, while their AC values were lower than those found in control groups. In the post-natal period, the administration of milk formulas enriched with L-Carnitine is certainly beneficial for those metabolic processes in which L-Carnitine is involved.

[Obesity and arterial hypertension. Relation between insulin secretion, peripheral insulin resistance and pressure indices].

Abstract: The association between obesity and hypertension has been well documented. Both conditions are often linked to an insulin resistance state. In a group of homogeneously obese hypertensive subjects, the presence of a significant correlation between degree of insulin resistance and severity of hypertension was found. These results confirm that, independently of obesity and insulin secretion, equally present in all the subjects, high blood pressure is inversely correlated to hormone sensitivity.

[Treatment of chronic obliterative arteriopathy of the legs in the second Fontaine's stage. Personal experience with a buflomedil-pentoxifylline-defibrotide combination].

Abstract: The authors provide evidence for the efficacy of the buflomedil-pentoxifylline-defibrotide combination for treatment of lower limb chronic obstructive arterial disease, Fontain stage II. Improvement of walking autonomy obtained with these agents ranged from 50 to 100% in 29 of 36 patients (relative frequency = 0.80).