Showing papers on "Symptomatic relief published in 1981"

Response of Cluster Headache Attacks to Oxygen Inhalation

Abstract: SYNOPSIS Fifty-two randomly selected patients diagnosed as having either active episodic or chronic cluster headaches were evaluated for symptomatic response to oxygen inhalation. At the onset of attacks, 100% oxygen was administered through a facial mask at a rate of 7 liters per minute, for 15 minutes. Each patient self-treated ten attacks, and timed the rated reduction of pain. A successful treatment result required complete or almost complete reduction of pain in seven of ten attacks, within 15 minutes.In a second (crossover) trial involving an additional 50 patients, sublingual ergotamine tartrate (ErgomarO) was compared to oxygen inhalation for symptomatic relief of cluster attacks. Each patient treated ten attacks with either preparation in accordance with the crossover design. Oxygen was administered as described above. Sublingual ergotamine was used every five minutes, to a maximum of three tablets, if necessary.In the first trial 3952 (75%) of patients obtained significant relief from cluster pain. The greatest benefit (92.9%) was found among episodic patients under 50 years of age. The least benefit (57%), was found among chronic patients over 49 years of age. In the second trial, results among oxygen users were better (82%) than those of ergotamine users (70%), but not significantly. Rapidity of relief was similar in both groups.The results of both series indicate that oxygen inhalation is an efficacious symptomatic treatment for cluster attacks. It is superior to ergotamine since there are neither complications nor contraindications to its use. Ergotamine, however, has the advantage of convenience.

Intracardiac Electrophysiologic Techniques in Recurrent Syncope of Unknown Cause

Abstract: Twenty-five patients with recurrent episodes of syncope, unexplained despite thorough medical and neurologic evaluation, underwent intracardiac electrophysiologic study with programmed stimulation. Electrophysiologic study yielded a presumptive diagnosis in 17 patients: nine with rapid ventricular tachycardia by programmed stimulation, three with intra-His conduction delays, one with symptomatic atrial flutter, one with sick sinus syndrome, and three with persistent hypervagotonia manifested as atropine-reversible prolongation of atrioventricular nodal refractoriness. Therapy based on these findings provided complete symptomatic relief in 14 and improvement in one of these 17 patients during a mean follow-up of 18 +/- 10 months. Therapy based on electrophysiologic testing was ineffective in two of the 17 patients. Syncope persisted in four of the eight patients in whom electrophysiologic study did not define a probable arrhythmic mechanism. These observations indicate that full electrophysiologic evaluation with programmed stimulation is useful in the diagnosis and therapy of recurrent unexplained syncope.

Clinical Pharmacokinetics of Indomethacin

Abstract: Indomethacin (l-(p-chlorobenzoyl)-5-methoxy-2-methylindole-3-acetic acid) is an anti-inflammatory antipyretic drug commonly used for symptomatic relief of pain and stiffness in rheumatic diseases.

Reduced efficacy of coronary bypass surgery in women.

Abstract: To estimate long-term efficacy of coronary bypass surgery, we examined our experience with 3155 patients observed over a 78-month period. Preoperative clinical profile, operative risk, and long-term symptomatic status and survival were compared in 2663 men and 492 women. To minimize influence of unequal baseline characteristics, surgical results were also compared in 412 pairs of men and women matched by computer for age, preoperative angina classification and number of diseased vessels. Operative mortality was not significantly different in matched patients. Women had smaller distal coronary arteries, more diabetes and hypertension, a higher rate of incomplete revascularization, and reduced graft patency compared with men. Cumulative survival for men and women was 92% at 42 months. At late follow-up, significantly more men were asymptomatic (70% vs 52%, p less than 0.001) and men achieved higher activity levels. We conclude that men have more symptomatic relief after coronary bypass surgery than women. A better-quality revascularization in men may be part of the reason for this outcome.

Shoulder impingement syndromes in athletes and their surgical management

Abstract: The painful arc syndrome may be produced by im pingement of the supraspinatus tendon, the biceps tendon, or the greater tuberosity of the humerus against the coracoacromial arch. Where conservative measures have failed, surgical intervention may pro vide considerable symptomatic relief by decompress ing the coracoacromial arch. In 20 cases surgically treated for biceps or supraspinatus impingements, 17 patients have returned to sporting activities without symptoms. The painful arc syndrome persists in three patients but they are symptomatically improved. Six patients with complete rotator cuff tears and subse quent impingement of the greater tuberosity of the humerus against the coracoacromial arch underwent widespread decompression. Five of the patients have returned to sporting activities much improved. Failure to recognize the associated acromioclavicular joint pathology is a frequent cause of failure of surgical treatment.

Spherocentric arthroplasty of the knee. Clinical experience with an average four-year follow-up.

Abstract: We studied eighty-two consecutive spherocentric total knee arthroplasties with an average follow-up of four years (range, two to six years). All patients had either severe preoperative instability or deformity, or both. The over-all functional improvement and symptomatic relief were excellent. Knees with preoperative instability did as well as those with preoperative deformity that were stable. The knees with preoperative valgus deformity were the most likely to have postoperative wound problems or transient nerve palsy, while those with preoperative varus deformity were much more likely to have loosening. Postoperative limb alignment of 7 to 9 degrees of valgus angulation protected against lucency and loosening. No new cases of lucency or loosening appeared after two and one-half years. The infection rate was 4 per cent and the rate of failure due to loosening was 5 per cent. The over-all reoperation rate was 9 per cent. Nine patients (with eleven arthroplasties) died during the follow-up period.

Particulate intraarterial embolization in pelvic arteriovenous malformations

Abstract: Pelvic arteriovenous malformation is a rare disease with a protracted course which is a major therapeutic problem as it is usually not cured by any means. Symptoms are incapacitating and at times life-threatening. Intraarterial embolization can provide symptomatic relief but recurrence of the lesion occurs in most cases. Intraarterial embolization can be repeated several times but becomes increasingly difficult as new collaterals develop while the major feeders remain occluded. Surgical excision is contraindicated except in well localized lesions. In these cases, preoperative embolization may decrease operative morbidity and facilitate a thorough extirpation.

Fenbufen: a review of its pharmacological properties and therapeutic use in rheumatic diseases and acute pain.

Abstract: Synopsis: Fenbufen 1 is a phenylalkanoic acid derivative with analgesic and anti- inflammatory activity. The anti- inflammatory activity appears to reside in the metabolites. Published data indicate that fenbufen 600 to 1000mg daily is comparable in effectiveness to therapeutic doses (3 to 4g) of aspirin, indomethacin (75 to 100mg) or phenylbutazone (300 to 400mg) in rheumatoid arthritis, but generally causes fewer side effects. At a daily dosage of 600mg, fenbufen is comparable with aspirin 3.6g or indomethacin 75mg in osteoarthritis. Initial studies suggest that fenbufen 600 to 900mg daily is at least as effective as ibuprofen 1200 to 1800mg or fenoprofen 1800 to 2400mg daily. It has not been compared with naproxen or sulindac in adequate numbers of patients. Fenbufen is effective when given twice daily and there is some evidence that once daily dosage is adequate in known responders to the drug. As with other non- steroidal alkanoic acid drugs, gastrointestinal complaints are the most frequently reported side effects, but there have been no reports of peptic ulcer to dale. Pharmacology: In nonspecific animal models, oral fenbufen has been shown to possess anti-inflammatory activity as evidenced by inhibition of carrageenan-induced foot oedema, ultraviolet-induced erythema, adjuvant-induced arthritis and urate synovitis. One of the principal metabolites, 4-biphenylacetic acid, is active topically in suppressing ultraviolet-induced erythema and when injected into the site of urate-induced synovitis, whereas fenbufen itself is inactive under these circumstances. This, plus the fact that the metabolite, but not fenbufen, inhibits prostaglandin synthetase, strongly suggests that fenbufen must be metabolised to exert its anti-inflammatory effects. Fenbufen is about 7 times more potent (weight for weight) than aspirin in raising the pain threshold in rats with yeast-induced paw pain and is effective in lowering body temperature in rats with yeast-induced fever. Fenbufen has a lesser ulcer-producing potential than the biphenylacetic acid metabolite in rats and a higher therapeutic ratio with respect to gastrointestinal bleeding than indomethacin. Fenbufen appears to cause less faecal blood loss in humans than aspirin or indomethacin, but studies are limited. Pharmacokinetics: Fenbufen is readily absorbed after oral administration and is extensively metabolised to active metabolites. At 2 hours after ingestion unchanged fenbufen ac-1 ‘Bufemid’ (Brazil). ‘Cincopal’ (Spain, Venezuela).‘Napanol’ (Japan). ‘Lederfen’ (Germany. England), ‘Cincopal’ (other countries). All are trade names of American Cyanamid Company. counts for only 11 % of total drug-related compounds in plasma. The half-life of fenbufen and the 2 principal metabolites is about 10 hours, thus enabling twice daily administration. Absorption is delayed but not significantly decreased by food. Total drug-related compounds are present at about one-third the serum concentration in synovial fluid. Fenbufen, like otther widely used non-steroidal anti-inflammatory agents, is highly protein bound. The main route of excretion is via the kidneys with about 42% of a dose being recovered in the urine in the first 24 hours after ingestion. About 8 % is recovered in the faeces and expired air. However, serum concentrations of fenbufen and its principal active metabolites are reported not to be increased in renal impairment. Therapeutic Trials: Double-blind crossover trials in patients with rheumatoid arthritis have shown fenbufen 600 to 1000mg daily to provide symptomatic relief comparable to that of aspirin 3.6 to 4.8g daily, indomethacin 75 to 100mg daily and phenylbutazone 300 400mg daily. The trials have involved reasonably adequate numbers of patients and have allowed 6 weeks’ treatment with each drug, but in some instances have not allowed a drug free period between treatments. Adverse effects have generally occurred less frequently with fenbufen than with the standard drugs. In comparisons with other phenylalkanoic acid derivatives, fenbufen 600 to 900mg has been slightly more effective than fenoprofen 1800 2400mg daily, at least as effective as ibuprofen 1200 to 1800mg and comparable with naproxen 500mg daily. Further studies with full doses of naproxen and other non-steroidal anti-inflammatory drugs with a long half-life are required to determine their relative effica and patient acceptability. Trials in osteoarthritis have often used fixed dosages of fenbufen and the standard comparative drugs, but indicate that fenbufen 600mg daily is at least as effective as indomethacin 75mg or aspirin 3600mg daily in relieving pain and in some instances more effective than these drugs in alleviating hip or knee pain on active movement. Long term studies in small numbers of patients indicate that fenbufen maintains its effectiveness in most patients treated for periods of up to 24 months. Fenbufen has been used successfully to alleviate symptoms in fibrositis, tendinitis and periarthritis of the shoulder and of acute gout. Single-dose studies have shown that fenbufen 400 to 900mg is an effective analgesic in moderate to severe pain resulting from minor surgical procedures, trauma and fractures. Side Effects: Gastrointestinal effects such as abdominal discomfort, epigastralgia heartburn, nausea and vomiting have been the most frequently reported side effects, occurring in a total of about 12 % of patients. Dosage: The adult dosage is 600 to 1000mg daily usually given in 2 divided doses.

Pleuroscopy in clinical evaluation and staging of lung cancer.

Abstract: The use of pleuroscopy in patients with bronchogenic carcinoma has not been reported previously. We performed this procedure in 45 lung cancer patients in whom pleural involvement was suspected. Pleural fluid or mestastases were found in 37 patients, 5 of whom had also major atelectasis due to bronchial obstruction by tumor. Neoplasm penetrating vital structures (aorta, brachial plexus) was found in 3 patients, tumor confining to resectable structures in 3; no pleural abnormalities were disclosed in 2. Based on these findings, 43 tumors were assigned stage III. Only on two occasions pleuroscopy did not aid staging. In 20 patients with massive pleural effusion causing dyspnea we insufflated talc in order to produce pleurodesis. This was fully successful in 16 patients, while in 2 the pleural cavity became only partially obliterated, with symptomatic relief. In 2 patients pleurodesis could not be evaluated because of early death caused by progression of cancer. Pleuroscopy is a highly informative procedure, applicable when involvement of pleura by lung cancer is suspected. It is helpful in clinical staging of the tumor and in assessment of its resectability, particularly in elderly, poor-risk patients. It provides the best way for talc insufflation when pleurodesis is indicated. Pleuroscopy should have an established place in the clinical evaluation and staging of lung cancer.

Intragastric alkali infusion: a simple, accurate provocative test for diagnosis of symptomatic alkaline reflux gastritis.

Abstract: Alkaline reflex gastritis is a disabling clinical syndrome, occurring most often after gastric surgery. It is characterized by abdominal pain and bilious vomiting, and, presumably, is due to gastric irritation by regurgitated duodenal contents. The only known effective treatment is by surgical diversion to prevent the duodenal reflux. Unfortunately, the clinical diagnosis is difficult to prove, and the results of surgery are too often disappointing because of inaccurate patient selection. This is a report of a new test for distinguishing patients with symptomatic bile reflux gastritis. The test consists of blind sequential infusion into the stomach, via nasogastric tube, of 20 ml of 0.1 N HCl, normal saline, 0.1 N NaOH, and the patient's own gastric contents. Each solution is given twice. A positive test is defined as reproduction of the patient's usual pain by NaOH, and/or gastric contents, but not by acid or saline. Fifteen of 21 patients with clinical symptoms and endoscopic findings suggesting bile gastritis had a positive alkali infusion test, while only one of 18 normal controls and none of 17 controls with other causes of abdominal pain had a positive test (p less than 0.001). Of the 21 patients with clinical-endoscopic bile gastritis, 15 have had surgical treatment by Roux-en-Y gastrojejunostomy. Nine of ten patients with positive test had excellent symptomatic relief after surgery. Zero of five patients with a negative test were relieved of pain after the operation. Tis simple test appears to be a sensitive, specific, and accurate means for selecting patients for surgical treatment of alkaline reflux gastritis.

Suppression of the hypothalamic-pituitary-adrenal axis after a single intramuscular injection of methylprednisolone acetate.

Abstract: Fourteen patients with hay fever were treated with one intramuscular injection of methylprednisolone acetate, which gave satisfactory symptomatic relief for three weeks. Their hypothalamic-pituitary-adrenal function was moderately but significantly suppressed for three weeks but became normal again after four weeks.

Idiopathic Pulmonary Fibrosis

Abstract: BETSY Harris, MD, Assistant Resident in Medicine, the Jewish Hospital of St Louis: A 49-year-old woman was admitted to the hospital with a five-day history of short-ness of breath. Two weeks before admission, a cough that produced "some whitish material" developed and an oral temperature of 37°C was recorded. At that time, the lungs were clear to auscultation and percussion. Tetracycline hydrochloride therapy (250 mg four times a day) resulted in moderate symptomatic relief within two days. Subsequently, the patient noted the progressive development of shortness of breath when she was at rest (which was exacerbated by exertion), diaphoresis, and a productive cough. She had smoked one pack of cigarettes per day for 20 years. She denied exposure to potentially toxic sprays or to persons with respiratory diseases. She had no allergies. Clinically, she appeared to be a well-nourished, afebrile woman in moderate respiratory distress. Physical examination results were essentially

The treatment of 'cimetidine resistant peptic ulcers by ranitidine hydrochloride: A new histamine H2-receptor antagonist

Abstract: SummaryTwelve patients with endoscopically confirmed peptic ulcers which had failed to heal despite standard cimetidine therapy were treated with 300 mg ranitidine hydrochloride daily for 4 to 8 weeks. Nine patients had complete symptomatic relief although the ulcer was found to have healed endoscopically in only six. Two patients derived no benefit from treatment and in 1 patient symptoms continued despite ulcer healing. Ranitidine would appear, therefore, to be of benefit in some ‘cimetidine resistant’ patients.

Pruritic urticarial papules and plaques of pregnancy.

Abstract: Pruritic urticarial papules and plaques of pregnancy is a self-limiting disease generally seen in the first pregnancy during the third trimester. Lesions are frequently present centrally and are intensely pruritic. Mucous membranes are usually not involved. Histology shows a normal epidermis with mild perivascular lymphohistiocytic infiltrate. Blood vessels, cutaneous appendages, and subcutaneous tissue are normal. Immunofluorescence studies are negative. A review of the reported cases suggests that there is no increased incidence of fetal mortality or congenital malformations and that recurrences do not occur in most cases. Etiology is unknown. Treatment should be directed toward symptomatic relief only.

Low-dose topical atropine for rhinorrhea.

Abstract: One hundred years ago, atropine sulfate was commonly used to treat rhinorrhea. Atropine sulfate was applied topically at a dose of approximately 0.08 mg to each nostril in seven patients with rhinorrhea caused by allergic rhinitis and in 24 patients with rhinorrhea caused by viral rhinitis. All but one of the 31 patients had symptomatic relief. Twenty-four of the 31 patients showed a visible decrease in secretions, and three patients showed an obvious vasoconstriction of nasal blood vessels. None of the patients experienced any of the side effects of atropine. Since this was a one-dose pilot study, there are no data available on possible rebound or chemical rhinitis effects.

The treatment of 'cimetidine resistant' peptic ulcers by ranitidine hydrochloride: a

Abstract: Summary Twelve patients with endoscopically confirmed peptic ulcers which had failed to heal despite standard cimetidine therapy were treated with 300 mg ranitidine hydrochloride daily for 4 to 8 weeks. Nine patients had complete symptomatic relief although the ulcer was found to have healed endoscopically in only six. Two patients derived no benefit from treatment and in 1 patient symptoms continued despite ulcer healing. Ranitidine would appear; therefore, to be of benefit in some ‘cimetidine resistant ’patients. Ke-y words: Ranitidine - cimetidine - peptic ulceration

Urethrolysis in the management of females with recurrent frequency and dysuria.

Abstract: Summary— The symptomatic results of urethrolysis were assessed in 40 female patients with the urethral syndrome. A specific clinical group of patients was identified who obtained symptomatic relief following surgery and these were further analysed, using urodynamic studies, to assess how urethrolysis achieved this effect.

A comparison of a 3-day course of Mictral with a 7-day course of ampicillin in the treatment of urinary tract infection.

Abstract: This general practice study compared a 3-day course of a new preparation, Mictral, with a standard 7-day course of ampicillin in the treatment of uncomplicated urinary tract infection. Mictral achieved bacteriological cure in all infected patients by Day 4 while only 69% of infected patients in the ampicillin group were abacteriuric by Day 8. Symptomatic relief and the incidence of side-effects were similar for both groups. It is concluded that Mictral appears to be a useful addition to currently available therapy for urinary tract infection and merits further investigation.

Double-blind trial of cimetidine versus tri-potassium di-citrato bismuthate in chronic duodenal ulceration.

Abstract: Thirty-seven patients with chronic duodenal ulceration were entered into an endoscopically controlled trial of cimetidine (Tagamet) versus tri-potassium di-citrato bismuthate (De-Nol). At six weeks, 83% of patients taking cimetidine showed complete ulcer healing compared with 74% of patients taking tri-potassium di-citrato bismuthate. By ten weeks, the corresponding figures were 89% and 84% respectively. Symptomatic relief was similar in both treatment groups and, despite advice to the contrary, continued smoking and alcohol consumption did not appear to adversely affect healing. Both drugs appear to be equally effective in healing chronic duodenal ulcers.

Basal cell epithelioma with a hypopigmented halo.

Abstract: To the Editor.— We read with great interest in the MarchArchives(1980;116:352-353) the description by Johnson and Ceilley of a pigmented basal cell epithelioma surrounded by a zone of hypopigmentation. We have recently seen two similar cases. Report of Cases.—Case 1.— A 74-year-old woman was referred to us because of a pigmented lesion on her leg that had been present for a year. It crusted repeatedly and failed to heal. She had applied a clobetasol propionate ointment, which produced some symptomatic relief. Otherwise, she was in good health. She had lived in India for three years in her youth. On examination, there was an annular pigmented plaque, 18 × 10 mm, on the anterolateral aspect of the right leg. The edge was raised, rolled, and gray-brown, and there was a surrounding halo of hypopigmentation 1 to 2 cm wide. Histologic characteristics of the lesion after excision confirmed that it

Effect of prazosin on renal function in chronic congestive cardiac failure.

Abstract: Prazosin was used as additional therapy in seven patients with severe chronic congestive cardiac failure. The effect on renal function in this situation was measured. Renal function improved in four of the seven patients, and this improvement was associated with improvement in their clinical condition; in two other patients, modest improvement in renal function was not associated with symptomatic relief which may have been the result of a gain in weight.

Clinical relevance of intrinsic sympathomimetic activity of beta blockers.

Abstract: beta-Blockers are effective in the symptomatic relief of angina pectoris by decreasing myocardial oxygen demand during effort and emotional stress. Agents with ISA such as pindolol produce effective beta-blockade during effort or emotional stress while conferring significant protection from myocardial depression and bradycardia at rest. In addition, agents with ISA have been shown to depress respiratory function to a lesser extent and to induce fewer peripheral vascular side effects than compounds devoid of this property. These potential effects of ISA may be counterbalanced by the consideration that ISA may be undesirable in angina occurring at rest or at low exercise levels. Additional well-controlled trials in patients with angina and resting bradycardia or impaired left ventricular function are needed to further document the clinical importance of ISA.

Out-patient treatment of haemorrhoids.

Abstract: The scope of out-patient treatment of haemorrhoids has been increased since the introduction by Barron in 19631 of rubber band ligation. This combined withconventional sclerotherapy can greatly reduce the number of hospital admissions for an extremely common condition. In May 1979 a ‘Rectal Clinic’ was established at the Royal Naval Hospital Haslar, primarily for the treatment of haemorrhoids but also to allow a rapid referral service in the hope of detecting large bowel cancer at an earlier stage. During a one year period over 100 patients have been referred for treatment of haemorrhoids, of whom 66 have completed their course of therapy. A retrospective survey of 60 in-patients with haemorrhoids admitted over a similar period in the previous year was made for comparison. Only six patients have required operation since the clinic commenced. Out-patient treatment has been found to give a better rate of symptomatic relief and resulted in a much shorter time away from work, without the considerable cost of hospitalisation. it is therefore recommended that such procedures should be more widely used in hospital practice.

The new nonsteroidal anti-inflammatory drugs

Abstract: Most physicians regard to newer short-acting anti-inflammatory drugs as a substitute for aspirin because they are less toxic. Although these drugs cannot induce remissions of rheumatoid arthritis, they do afford symptomatic relief and exert both a moderate algesic and anti-inflammatory effect in conditions like osteoarthritis, gout, pseudogout, and a variety of musculoskeletal syndromes. The many adverse reactions and toxic effects associated with these drugs are probably related to the inhibition of prostaglandin synthetase, which in turn reduces the biosynthesis of prostaglandins in widespread areas of the body. Thus limited in number, these compounds cannot play an effective role in the body's defense mechanisms. Researchers postulate that this failure accounts for the gastrointestinal and renal lesions--as well as other, as yet unexplained toxic manifestations--noted in patients taking these drugs. For safety's sake, the newer anti-inflammatory drugs should be used with large doses of aspirin, other agents that inhibit prostaglandin synthetase, or drugs that are potentially nephro-toxic.

Azatadine maleate (Zadine): evaluation in the management of allergic rhinitis.

Abstract: Azatadine maleate (Zadine), a new antihistamine, was evaluated for its efficacy in 20 patients with chronic allergic rhinitis. Eighty percent of patients had symptomatic relief with a twice daily dosage of 2 mg. Sedation was volunteered as a side effect by six of the patients and was admitted by two further patients after specific questioning. A choice reaction time test gave slowing of motor function in these sedated patients. Four of the previously sedated patients experienced good symptomatic control with minimal sedation when the azatadine dose was reduced to 1 mg twice daily; slowing of motor function was not observed at this, the normal recommended dose.