Showing papers on "Symptomatic relief published in 1978"

Medical adrenalectomy with aminoglutethimide: clinical studies in postmenopausal patients with metastatic breast carcinoma.

Abstract: The use of adrenalectomy and hypophysectomy in the management of postmenopausal patients with metastatic breast carcinoma is reserved for highly selected patients. As an alternate approach, a pharmacologic method of inhibiting adrenal cortical secretion was developed which consisted of the daily administration of 1000 mg of aminoglutethimide to block steroidogensis and either dexamethasone (2.0-3.0 mg/day) or hydrocortisone (40-60 mg/day) as replacement glucocorticoid. This regimen markedly suppressed plasma levels of DHA-S, androstenedione, estrone, and estradiol, and urinary levels of aldosterone. Of 50 patients treated, 19 (38%) demonstrated either a complete (8/19) or a partial (11/19) objective disease remission which lasted for 18.05 +/- 3.1 months (mean +/- SEM). In 10 (20%) patients, there was stabilization of disease (7.8 +/- 1.2 months), accompanied by symptomatic relief of bone pain in six (12%). There was disease progression in 20 (40%) patients. The acute side effects of aminoglutethimide therapy were significant and consisted of transient lethargy (41.5%) and a cutaneous rash (35.8%). Chronic toxicity was negligible. The medical adrenalectomy regimen of aminoglutethimide plus glucocorticoid offers a suitable alternative to surgical adrenalectomy or hypophysectomy in the management of postmenopausal patients with metastatic breast carcinoma.

Failed lumbar disc surgery requiring second operation. A long-term follow-up study

Abstract: Forty-five patients who had lumbar disc surgery 10 or more years previously, and had required a second operative procedure, have been evaluated. Failures occurred up to 16 years after the first operation, and were most commonly due to pseudoarthrosis in the patients who underwent spinal fusion initially, and to recurrent disc lesions at the same level as previous surgery in the patients who did not have fusion. The clinical and functional results in the second group of patients who required a second procedure were comparable to those of patients who required only a single procedure. In contrast, patients who had undergone spinal fusion who required a second procedure had significantly worse clinical and functional results, both in comparison to the patients who did not undergo fusion as well as to patients who had had fusion as a single procedure. The only predictable, demonstrable source of failure was acquired spondylolysis. Frequently, repair of pseudoarthrosis did not lead to symptomatic relief. These data suggest that spinal fusion, when it fails, has a significantly worse prognosis than simple disc excision in the management of lumbar disc disease.

Baclofen for spasticity in multiple sclerosis. Double-blind crossover and three-year study.

Abstract: Baclofen is a safe and effective means for treating spasticity associated with multiple sclerosis. We found no toxic effects on hepatologic, hematopoietic, or renal function, acutely or for over 3 years of follow-up. A statistically significant reduction was noted in frequency of spasms, and clonus, and there was improved range of joint movement, which enabled patients to maintain functional status for prolonged periods. For the more disabled patients, treatment with baclofen gave symptomatic relief of painful spasms and made immobility more tolerable. Optimum effect was achieved when baclofen was administered in the early stages of disease, before major disabilities became permanent.

The clinical value of digoxin in patients with heart failure and sinus rhythm.

Abstract: Six patients in sinus rhythm with congestive heart failure due to either myocardial infarction or cardiomyopathy, were given oral frusemide to eliminate oedema. Symptomatic relief occurred as body weight was reduced, and after a ‘dry’ basal weight had been achieved, progressive-load exercise testing was done to examine any benefit that derived from adding oral digoxin to the diuretic. Three pairs of sub-maximal exercise tests were done at intervals over three months, and the responses of each patient when using digoxin and diuretics were compared with those when using diuretics alone. One patient did not complete this study, because more frequent premature beats and increased angina followed the withdrawal of digoxin. For the five patients who completed three pairs of tests, there was no significant change in symptoms, in workload achieved, or in heart rate, respiratory rate, ventilation and respiratory quotient, whether digoxin was added or removed. It is concluded that in these patients where salt and water retention was controlled with diuretics, digoxin did not improve the capacity for exercise, and it is suggested that for such patients with myocardial disease in sinus rhythm, treatment should begin with diuretics.

The Effectiveness of Radiation Therapy in the Treatment of Bone Metastases from Breast Cancer

Abstract: The authors studied 75 patients with 158 areas of bone metastases from breast cancer treated by radiation therapy. The treatment regimen used was usually 2000 to 2500 rads delivered over a period of 2 weeks. Both subjective and objective responses were evaluated. This dose schedule proved to be highly effective In symptomatic relief and In healing osteolytic lesions; various levels of pain relief for about one year were observed In 96% (151/158 treatment areas), and radiographic evidence of recalclfication was observed in 78% (73/94 treatment areas examined by serial radiography). After cases from previous studies were incorporated, the subjective response rate of the overall group was 91 % (191/212) for a mean duration of 12 months, and the objective response rate was 75% (151/202) for a mean duration of 9 months.

Return to work after coronary artery surgery for angina.

Abstract: The working habits of 115 consecutive patients who underwent coronary artery vein bypass grafting for angina were assessed. Only 25 patients worked up to the operation. Seven patients were housewives and seven retired. Sixty-eight patients had had to give up work because of their angina pectoris, and most of these had been off work for between six months and two years. After the operation 75 patients returned to full-time work, 59 within two to six months. These 75 patients included 23 of the 25 at work preoperatively and 47 of the 68 unable to work preoperatively. Most patients returned to their original occupation. We conclude that coronary artery surgery, as well as bringing symptomatic relief, increases the patient's ability to return to and maintain gainful employment.

Glomus jugulare and vagale.

Abstract: The therapeutic results in 72 patients with glomus jugulare and nine with glomus vagale have indicated a surgical cure rate of 80% in the former and 100% in the latter. Radiotherapy demonstrated a 65% tumor response rate and a 25% cure rate histologically and clinically. Embolization with Gelfoam beads in seven patients resulted in diminished tumor size and arterial circulation from the external carotid system. However, in all cases the tumor persisted. Embolization diminished intraoperative bleeding. Nevertheless, the use of embolization as a palliative modality demonstrated significant symptomatic relief in aged, debilitated patients and in all patients with large inoperable glomus jugulare tumors.

Watery diarrhea syndrome. Two unusual cases and further evidence that VIP is a humoral mediator.

Abstract: Two unusual cases of the watery diarrhea syndrome are presented. In one patient an adrenal medullary tumor, a pheochromocytoma that produced vasoactive intestinal polypeptide (VIP) was excised with total relief of symptoms. The second patient a 65-year-old man with abrupt onset of massive watery diarrhea that led to acidosis and coma was symptomatically controlled for one year on 10 mg/day of prednisone. Elevated levels of VIP returned to normal after prednisone therapy was started. A benign islet cell tumor not localized by angiography was removed by distal pancreatic resection. Tissue levels of VIP were markedly elevated. VIP is a humoral mediator of the water diarrhea syndrome. Both benign and malignant pancreatic and extrapancreatic tumors may cause the watery diarrhea syndrome. Steroids may cause symptomatic relief of the diarrhea by lowering peptide levels to normal. The term watery diarrhea syndrome may be more accurate than the pancreatic cholera syndrome.

Intramural coronary artery as a cause of unstable angina pectoris.

Abstract: A patient with an anomalous intramyocardial course of the LAD coronary artery, causing angina pectoris, is described. The patient had symptomatic relief after an aortocoronary artery bypass operation. Intramural coronary arteries may be clinically significant. In cases where medical management does not provide relief, surgical correction of the anomaly may give symptomatic improvement and improved exercise tolerance.

Left ventricular aneurysmectomy in patients with single vs multivessel coronary artery disease.

Abstract: To identify clinical syndromes benefiting from post-myocardial infarction (MI) left ventricular (LV) aneurysmectomy, 145 consecutively operated patients were followed a mean of 23 +/- 2 months postoperatively. Of the 145 patients, 49% had single-vessel (SV) coronary artery disease (CAD) (> or = 70% stenosis), 49% had multivessel (MV) CAD, and 2% (3 patients) had an unknown extent of CAD. Patients with SV-CAD and MV-CAD had similar distributions of age, sex, aneurysm location, LV end-diastolic pressure, LV ejection fraction, and scar size. In the SV-CAD group, the major operative indication was incapacitating heart failure (CHF), whereas in the MV-CAD group, the major operative indication was angina, often in combination with CHF. Coronary bypass grafting was done in 17/71 (24%) of SV-CAD and 64/71 (90%) of MV-CAD. Acute (30-day) postoperative survival was 89% (129/145) overall, and long-term survival 73%. Throughout the follow-up period, survival was similar in SV-CAD and MV-CAD. At follow-up, 89% of all survivors had CHF symptoms of functional Class II severity or less, and 97% of survivors had angina of Class II severity or less. Improvement in angina was most striking in the multivessel group whose angina had been more severe preoperatively. Thus, in patients undergoing LV aneurysmectomy and concomitant coronary revascularization: 1) SV-CAD is common; 2) SV-CAD has predominantly CHF preoperatively and usually relief of CHF postoperatively; 3) MV-CAD has both angina and CHF preoperatively, with symptomatic relief of both postoperatively; and 4) preoperative CAD extent does not influence survival.

Splenectomy in myeloid metaplasia.

Abstract: A retrospective review of 19 patients with documented myeloid metaplasia undergoing, elective splenectomy during the past ten years at the Peter Bent Brigham Hospital is presented. The primary indications for splenectomy in 17 of these 19 were either hypersplenism or symptomatic splenomegaly. Eighteen of the 19 underwent both 59Fe-ferrokinetic studies and 51Cr-sequestration studies or, alternatively, 111In-marrow scintigraphy as a part of their routine preoperative evaluation. The death from sepsis of one patient six weeks post-operatively, whose marrow function was poor and whose level of splenic sequestration was minimal, confirms the efficacy of these studies in the preoperative prediction of hematologic response to splenectomy. Eighteen of the 19 patients benefited from the operation in terms of symptomatic relief and/or hematologic improvement, although surgery presumably did nothing to prolong survival in these patients. We conclude that splenectomy is indicated as a palliative maneuver for carefully selected patients with myeloid metaplasia without prohibitive operative risk, provided the criteria for selection of patients are adhered to and the surgeon and hematologist work together as a team.

How patients use domiciliary oxygen.

Abstract: Forty-five patients in Southampton who received domiciliary oxygen were visited at home to find out how they used and coped with their oxygen. Generally, the organisation and administration of supplies presented no problems, nearly all the apparatus complied with the drug tariff, and most patients coped well with the equipment. Only two patients were taking oxygen for prescribed periods; the others were taking it when necessary for symptomatic relief. No patient received oxygen for over five hours daily. Most patients thought that they were helped by oxygen, but only four said that it allowed them to increase their level of activity, and the overall benefit seemed slight. This was partly because oxygen was usually limited to one room, so patients used oxygen after rather than during exercise. The amount of oxygen consumed differed widely, ranging from three and a half cylinders a week in three patients to less than one cylinder in six months in 17 patients. The average yearly cost of oxygen per patient ranged from 500 pounds in patients consuming one cylinder or more per week, to 15 pounds in those consuming less than one cylinder in six months. The main cost of domiciliary oxygen is determined by the number of cylinder refills, so patients who use it infrequently are a relatively small drain on resources.

Single dose therapy of giardiasis with tinidazole and metronidazole

Abstract: In random order, a single dose of either tinidazole or metronidazole, calculated as 50mg/kg body weight, was given to 100 children with symptomatic giardiasis. Follow-up was done for 16 days and consisted of 4 clinical, parasitological and biochemical assessments at intervals of 4 days. The actual mean dose of the drugs received by the patients was 55.5 mg/kg of tinidazole and 52.0mg/kg of metronidazole. Success, i.e. parasitic clearance and symptomatic relief, was achieved in 80% of patients given tinidazole as opposed to 36% of patients given metronidazole (p less than 0.01). Moreover, control of diarrhoea and negative stool conversion for G. lamblia occurred earlier with tinidazole than with metronidazole (p less than 0.01). The incidence of gastrointestinal side-effects was 12% for tinidazole and 4% for metronidazole. Neither drug caused any abnormality of the blood count, blood urea, urine analysis or liver function tests.

Enhancement of the antidepressant response to L-tryptophan by a liver pyrrolase inhibitor: a rational treatment approach.

Abstract: In an open preliminary investigation, pre- and concomitant treatment with a liver pyrrolase inhibitor allopurinol to depressed male outpatients receiving L-tryptophan suggests a rational approach to treatment with this serotonin precursor. The combination is both safe and apparently effective; the rapidity of response in some patients underscores the clinical effects. Implications are that serotonin, or rather an excess in serotonin, is involved in the symptomatic relief of depressions in man.

Direct myocardial revascularisation: experience with 9364 operations.

Abstract: Between July 1968 and December 1976, 9364 consecutive patients with coronary insufficiency underwent direct myocardial revascularisation using aortocoronary bypass (ACB). Among these patients 8017 had ACB alone, and the remaining 1347 had ACB in addition to correction of other cardiac and vascular lesions. In the series of patients having ACB alone the hospital (early) mortality was 3.9%, but for 2383 surgical patients in 1976 this figure was 2.2%. Operative mortality was higher for women (6.85%) than for men (3.5%), but late survival was about the same for both sexes. Among surviving patients 88% were improved or symptom-free after undergoing ACB. According to our data, at the end of eight years 80% of the patients will be survivors. These results, when compared with other series of patients treated medically, indicate the superiority of surgical treatment both in terms of symptomatic relief and also in increased life expectancy.

A Double-Blind, Crossover Controlled Evaluation of a Syrup for the Night-Time Relief of the Symptoms of the Common Cold, Containing Paracetamol, Dextromethorphan Hydrobromide, Doxylamine Succinate and Ephedrine Sulphate

Abstract: Seventy subjects suffering from the common cold were recruited at general practitioner surgeries and were treated with an evening doseof a syrup't containing 600 mg paracetamol, 15 mg dextromethorphan hydrobromide, 8 mg ephedrine sulphate, 7·5 mg doxylamine succinate per 30 ml or an identical-appearing and flavoured control syrup without the active ingredients, in a double-blind crossover design study, lasting two days. Subjects were randomly allotted to two equal groups. One group took active formulation the first evening followed by the controlformulation the second evening. The second group took the twoformulations in the reverse order. Evaluation of symptomatic relief on a 6-point rating scale against eight major cold symptoms was carried out by each subject at 10a.m.followingthe administration of active or control formulation the previous evening. Following combination of data for the two groups, results showed a significant degree of relief provided by the activeformulation compared to controlfor thefollowing symptoms, cough, nasal congestion, nasal discharge, sneezing, generally feeling unwell, headache, sore throat, disturbed sleep, the difference between the two preparations inreliefofcough being highly signifi­ cantly in favour ofthe "active" preparation. A dditionally, a highly significant number of the subjects expressed a preferencefor the global symptomatic relief provided by the active formulation as compared to control. These results have demonstrated that the "active" formulation provides effective therapy for night-time symptomatic reliefofthe eight major symptomsofthe common cold.

Treatment of congestive cardiomyopathy.

Abstract: Although the majority of patients with cardiomyopathy are in the category of primary or idiopathic cardiomyopathy, for which therapy is symptomatic and non-specific, there are a number of secondary forms of cardiomyopathy for which specific therapy is available, thus giving impetus to prompt and accurate diagnosis. Among inflammatory lesions, brucellosis, psittacosis and toxoplasmosis are examples. Treatable metabolic causes include thyrotoxicosis and thiamine deficiency, the latter as well as calorie-protein malnutrition are also preventable. There is presumptive evidence that the cardiomyopathy of haemochromatosis is benefited by repeated phlebotomies. Symptomatic relief of obstructive cardiomyopathy is achieved by beta-adrenergic blockade, although resection of obstructing myocardium still has a place. The therapeutic approach to the vast majority of cases of congestive cardiomyopathy is non-specific, comprising controlled activity, sodium restriction, digitalis and diuretics. Vasodilators and, occasionally, beta-adrenergic blockade may be beneficial. Pacemakers may be life-saving, whereas the place of anti-arrhythmics remains uncertain. Transplantation warrants further application. Valve replacement has little to offer. Primary prevention, comprising balanced nutrition, vaccines and genetic counselling, merits wider application. In individuals at risk or already afflicted, programmes of secondary prevention should include good nutrition, abstinence from alcohol and protection from drugs and toxins.

Treatment of the ischemic finger secondary to digital artery occlusion

Abstract: We present 7 cases of digital artery thrombosis with ischemic symptoms. Six were treated successfully by application of the Leriche principle of resection of a segment of the thrombosed artery. One was treated successfully by resection of a thrombosed segment and replacement with a small vein graft. The symptomatic relief has been conplete in 4 of the 6 patients who had resections, and in the patient who had the single vein graft. The other two patients (with resection only) have had improvement.

Bone Density And The Carpal Tunnel Syndrome

Abstract: Summary Bone density was studied in ten patients before and after release of an idiopathic carpal tunnel syndrome. A corticomedullary ratio was measured at the mid-point of the metacarpals and proximal phalanges of both hands. There was a significant increase in the mean bone density over the period of observation in the thumb and middle finger metacarpals and in the index, middle, and ring finger proximal phalanges of the operated hand. The was no significant increase in the density of either metacarpal or proximal phalanx on the non-operated side. Release of the carpal tunnel syndrome provides not only symptomatic relief but also leads to increased bone density.

Pathophysiology of capillary circulation: Raynaud's disease.

Abstract: Despite the frequency of Raynaud's disease in cold climates, the etiology of the condition remains uncertain. This report reviews the literature since Raynaud's original description and Lewis and Pickering's addition to the concept, and several recent observations which add to our understanding of the disease are discussed. We investigated the effect of posture and a vasodilator drug on the digital capillary circulation; digital blood flow increases as the body moves from a recumbent, through a sitting, ti an upright position. Bradilan, a vasodilator drug, increases the circulation in the recumbent and sitting positions, but has no effect in standing patients, despite symptomatic relief.

Controlled trial of a carbenoxolone/alginate antacid combination in reflux oesophagitis.

Abstract: A double-blind controlled trial was carried out in 37 patients with oesophagitis, confirmed endoscopically and histologically, to compare the efficacy of treatment with a carbenoxolone/alginate antaacid combination with that of the alginate antacid compound used alone. The total daily dosage of carbenoxolone was 100 mg. During the 8-week-period of the trial patients were seen every 2 weeks and endoscoped at 4 and 8 weeks. Response to treatment was assessed symptomatically and endoscopically using 6-point grading scales, and multiple oesophageal biopsies were taken at each endoscopy. The addition of carbenoxolone to the alginate antacid compound was shown to enhance symptomatic relief and to increase healing of oesophagitis and oesophageal ulceration significantly. No serious side-effects were reported in either group. Although there were a number of biochemical or clinical abnormalities recorded, none required any alteration in treatment.

Neurological features of polyarteritis nodosa.

Abstract: A series of 20 cases of polyarteritis nodosa (PAN) is presented. Clinical features of 2 cases are described in more detail to illustrate the most common neurological complications. PAN is an uncommon disease but one which usually presents with some form of neurological disturbance, often a mononeuritis multiplex or a symmetrical polyneuropathy. Diagnosis requires a high degree of clinical suspicion as serological tests are at best non-specific, and absolute biopsy proof often requires examination of multiple sites. Early diagnosis is important, as treatment with corticosteriods usually induces symptomatic relief and provides a better chance of long term survival. If an acute remission is obtained the patient not only should have a good quality of life but in a proportion of cases, where the remission is prolonged, steroid therapy may be ceased.

The screaming baby: treatment of a psychophysiological disorder of infancy.

Abstract: Principles of short-term treatment of infants with psychophysiological problems and their parents are illustrated by case reports of two infants with intractable screaming and disturbances of eating and sleeping. Depression and anger in the mothers and excessive sensitivity in the infants had led to mutually destructive interaction between them. Intervention included interruption of this cycle by symptomatic relief, establishment of a therapeutic alliance with parents, helping parents and infants to enjoy mutually satisfying unconflicted activities, and teaching parents to recognize and respond to their children's communications.

Management of recurrent aphthous stomatitis. A review.

Abstract: The management of recurrent aphthous ulceration is discussed. It appears that the treatment of choice in mild to moderately severe aphthous stomatitis is repeated application of topical tetracycline hydrochloride. Viscous lidocaine (2 percent) provides symptomatic relief and is therefore a useful adjunct to therapy. Cyclical estrogens appear to be helpful in recurrent premenstrual aphthosis. Immune-regulating agents such as levamisole hold promise for the future.

Emergencies in oncology. Current management.

Abstract: Malignant neoplasms may cause life-threatening complications requiring prompt diagnosis and emergency therapy. Whether or not the underlying neoplasm is potentially curable, the physician can often provide worthwhile prolongation of life and dramatic symptomatic relief. Among the serious complications of neoplasia are superior vena cava obstruction, airway obstruction, pericardial tamponade, spinal cord compression, brain metastasis, meningeal involvement by cancer, hyperuricemia, hypercalcemia and hyperkalemia.