Showing papers on "Symptomatic relief published in 1985"

Hypertensive hypertrophic cardiomyopathy of the elderly.

Abstract: Using echocardiography, we identified 21 patients with a syndrome that included severe concentric cardiac hypertrophy, a small left ventricular cavity, and supernormal indexes of systolic function without concurrent medical illness or ischemic heart disease. Thirteen of the patients presented with dyspnea or chest pain. All patients studied had a history of hypertension and were compared with normotensive controls matched for age and sex. The patients were elderly (mean age, 73.3 years), predominantly female (16 patients), and mostly black (15 patients). Their cardiac function was characterized by excessive left ventricular emptying (ejection fraction on two-dimensional echocardiography [patients vs. controls], 79 +/- 4 vs. 59 +/- 5 per cent, P less than 0.001) and abnormal diastolic function as manifested by a prolonged early diastolic filling period (279 +/- 25 vs. 160 +/- 45 msec, P less than 0.001) and reduced peak diastolic dimension increase (11 +/- 4 vs. 16 +/- 5 cm per second, P less than 0.05). In spite of the clinical presentation of heart failure, all of 9 patients receiving either beta-receptor antagonists or calcium-channel blocking agents obtained symptomatic relief, whereas 6 of 12 patients receiving vasodilator medications had severe hypotensive reactions, including one death. We conclude that this unique subset of hypertensive patients has a clinical syndrome that warrants recognition and tailored management.

Is bile acid malabsorption underdiagnosed? An evaluation of accuracy of diagnosis by measurement of SeHCAT retention.

Abstract: The cause of intractable chronic diarrhoea was found to be malabsorption of bile acid in five out of 42 patients thought to have the irritable bowel syndrome, six out of 29 patients with persistent diarrhoea after surgery for peptic ulcer, 23 who had undergone small bowel resection, and two others. Specific treatment brought symptomatic relief. The diagnosis was established by measuring the proportion of SeHCAT, a synthetic bile salt, retained one week after oral administration of a tracer dose of less than 100 micrograms of the compound labelled with 40 kBq (1 microCi) of selenium-75. These results indicate that malabsorption of bile acid is a more common cause of chronic diarrhoea than is generally appreciated. Measurement of retention of SeHCAT is a simple, accurate, and acceptable means of establishing the diagnosis of this debilitating but treatable condition.

Scorpaenidae envenomation. A five-year poison center experience.

Abstract: This article describes 51 cases of Scorpaenidae envenomation, 45 of which were lionfish stings to aquarists or fish handlers. The primary manifestation of envenomation in all victims was intense local pain. Various other local and systemic symptoms were also noted. Immersion in hot water produced either complete (80%) or moderate (14%) symptomatic relief in 94% of the victims. This simple and effective treatment was generally unknown to emergency personnel treating these patients. (JAMA1985;253:807-810)

Metal fume fever—A review

Abstract: Metal fume fever (MFF) is an acute industrial disease caused by the inhalation of a variety of heavy metal oxides MFF occurs most commonly during welding operations, particularly those involving zinc oxide The illness is of short duration and produces symptoms of cough, fever, chills, malaise, and myalgias Its etiology is uncertain, and its diagnosis is difficult because symptoms resemble a number of pulmonary illnesses Supportive treatment, with bed rest, analgesics, and fever control is used for symptomatic relief Emergency medicine physicians must differentiate the clinical picture from other common respiratory illnesses The mainstay of therapy for MFF consists of recognizing the disease and preventing subsequent exposure to harmful metals

Reoperation for coronary artery disease.

Abstract: Repeat coronary artery bypass grafting (CABG) accounts for approximately 5% of all myocardial revascularization procedures in the United States annually; it is estimated that nearly 7000 reoperations will be performed in 1984. Angiographic indications for repeat CABG include primary bypass graft obstruction, progressive coronary arteriosclerosis, and combined graft failure and new coronary artery disease. Saphenous vein obstruction secondary to arteriosclerosis occurs in more than half the bypass grafts at 10 years after CABG. Successful aortocoronary reoperation is dependent on careful attention to special surgical technical considerations such as chest reentry, cardiopulmonary bypass management and myocardial preservation, primary graft handling and identification of the target coronary vessel, choice of available bypass conduits, completeness of revascularization, and hemostasis and blood conservation. Operative mortality for repeat CABG is approximately twice that for an initial aortocoronary bypass procedure. Overall operative morbidity is not significantly different for primary and subsequent myocardial revascularization. Five-year survival after repeat aortocoronary surgery is approximately 90% and compares favorably with survival rates after initial CABG. However, symptomatic relief of angina pectoris is not as effective after a repeat myocardial revascularization as it was after the first CABG; only half the patients are angina-free 5 years after reoperation. As with primary revascularization, long-term graft patency rates after coronary reoperation are superior for the internal artery as compared with the saphenous vein.

Usefulness of transstenotic coronary pressure gradient measurements during diagnostic catheterization.

Abstract: A difficult problem in coronary arteriography is the assessment of the hemodynamic significance of stenoses that appear angiographically to be of only moderate severity (25 to 75% diameter narrowing). This is particularly important in patients who may be candidates for invasive therapy, such as percutaneous transluminal coronary angioplasty (PTCA) or coronary bypass surgery. To determine the significance of such lesions, we measured transstenotic coronary pressure gradients in 15 patients with angiographically moderate stenoses. For comparison, similar measurements were made in 17 patients with severe stenoses (more than 75% diameter narrowing) being considered for PTCA. The transstenotic pressure gradients were measured with a 2.0Fr polyvinyl chloride catheter cleared of microbubbles of air by flushing with carbon dioxide and degassed saline solution and attached to a low-volume displacement transducer for optimal frequency response. Mean transstenotic pressure gradients greater than 10 mm Hg at rest or more than 20 mm Hg under conditions of high coronary blood flow, as induced by Renografin 76, appeared to be associated with objective evidence of myocardial ischemia and symptomatic relief from PTCA. Smaller pressure gradients occurred in patients whose symptoms probably were not ischemic in nature. Transstenotic pressure gradient determination performed at the time of diagnostic catheterization may provide assistance in clinical decision-making in selected patients with angiographically moderate stenoses.

Presentation and management of parasellar and suprasellar metastatic mass lesions.

Abstract: Ten patients with parasellar metastatic lesions presented with insidious painful or painless ophthalmoplegia. Visual loss secondary to a chiasmal syndrome was identified in three of them. A mass lesion was demonstrated by CT scan with precise outlining of the location and size of the lesion. Symptomatic relief was achieved with local radiotherapy in those patients who had early diagnosis.

Neoplastic fever responds to the treatment of an adequate dose of naproxen.

Abstract: Twenty-one patients with neoplastic fever due to malignancy were treated with naproxen. A prompt and complete lysis of fever was obtained in 20 patients within 12 hours when an adequate dose of naproxen was given, and a sustained normal temperature was maintained in all responding patients while receiving naproxen except for one in whom a low grade fever recurred. Lysis of fever usually was followed by excessive sweating and subjective symptomatic improvement. However, when naproxen was discontinued in ten patients, febrile state to the pretreatment level recurred in seven patients within three days. This observation suggests naproxen has a definite and effective antipyretic activity against neoplastic fever although it may recur as the drug is discontinued. Naproxen may be a useful adjunctive agent in patients with neoplastic fever for a short-term symptomatic relief.

Comparison of ranitidine, domperidone maleate and ranitidine + domperidone maleate in the short-term treatment of reflux oesophagitis.

Abstract: In the treatment of reflux oesophagitis, either drugs preventing regurgitation of gastric juice in the lower oesophagus or pharmacological agents increasing the pH of the refluxing material are employed. In the present study 45 outpatients with reflux oesophagitis were randomly treated with either ranitidine (150 mg b.i.d.) or domperidone maleate (20 mg t.i.d.) or both drugs for six weeks. Before and after treatment the severity of dyspeptic symptoms and the grade of endoscopic and histological changes were assessed. The three therapeutic regimens were significantly and equally effective in inducing symptomatic relief and promoting endoscopic and histological disappearance or improvement of oesophagitis. The combined use of ranitidine and domperidone maleate failed to show any additional benefit compared with treatment with either drug alone.

Lumbar sympathectomy for lower extremity vasospasm.

Abstract: Ten patients, 8 female and 2 male, with refractory episodic lower extremity vasospasm were encountered during a 15 year period in which over 600 patients with upper extremity vasospasm were studied. Seven patients had associated upper extremity vasospasm. No patient had evidence of autoimmune disease. Lower extremity reserpine Bier block produced symptomatic relief for 1 to 3 days in all patients in whom it was used. Oral medications were ineffectual. A diagnostic toe photoplethysmographic pattern was noted in these patients, consisting of a normally pulsatile tracing after warming and a flat, nonpulsatile or minimally pulsatile tracing after cooling. Each patient underwent lumbar sympathectomy. During follow-up, which averaged 4 years, each patient remained free of episodic vasospasm on the side of surgery. We conclude that lumbar sympathectomy is an effective and durable treatment for lower extremity vasospasm.

Method and apparatus of treatment of symptoms of the Irlen syndrom

Abstract: Specially tinted lenses will provide substantial benefits to patients with various forms of visual disturbance caused by a recently identified functional disorder called the Irlen Syndrome of scotopic sensitivity, who show over-stimulation of receptor cells in the wavelength band of 425 to 575 nm. Symptomatically, the Irlen Syndrome is characterized by reduced visual resolution, impaired depth perception, impaired peripheral vision, and ocular vertigo. With use of the lenses the patients report improved visual resolution, increased comfort from reduced symptoms of eye strain, increased depth perception and peripheral vision, and reduced symptoms of ocular vertigo. The treatment includes experientially fitting the patient with lenses of an optimal color and transmission density, namely a predetermined attenuation in the 425-575 nm band. It has been determined according to the invention that pink and peach singly or in combination with blue, green, gray, purple, goldenrod, and yellow tints, can be effectively combined to achieve symptomatic relief. The color and density which is optimal for each patient must be determined individually for each patient and optimized as evaluated by pre-testing and post-testing on the Irlen Differential Perception Scale. Tinting and optical density are further optimized in each patient for near vision, far vision, and night vision.

Extracranial-intracranial arterial bypass for middle cerebral artery stenosis and occlusion: Operative results in 65 cases

Abstract: Forty-seven patients with middle cerebral artery (MCA) stenosis and 18 patients with MCA occlusion underwent extracranial-intracranial arterial bypass procedures. Patients presented with a history of transient ischemic attacks (TIA's), reversible ischemic neurological deficits, TIA's after initial stroke, stroke-in-evolution, or completed stroke. Angiography revealed that the MCA stenosis ranged from 70% to over 95%. Two patients (4.3%) in the stenosis group had a perioperative stroke (within 30 days of operation). There was no perioperative mortality. In the occlusion group, no patient had a perioperative stroke, and one patient (5.5%) died from a non-neurological disease. The TIA's resolved completely in 90% of the patients with stenosis and in 91.6% of those with occlusion. No patient with MCA stenosis had a late ipsilateral stroke, although five had a contralateral or vertebrobasilar stroke. One patient with MCA occlusion had a late ipsilateral stroke. The bypass patency rate at late follow-up review was 100%. The results of intracranial-extracranial arterial bypass procedures appear to be similar for patients with either stenosis or occlusion of the MCA. Symptomatic relief of TIA's was excellent and, in two patients with progressive stroke-in-evolution, the deficit was stabilized. The incidence of postoperative ipsilateral stroke was low in patients with TIA's alone or with TIA's after an initial stroke, but among patients with completed stroke, improvement was confined to slight reduction in the neurological deficit.

Addition of nifedipine to maximal beta-blocker-nitrate therapy: Effects on exercise capacity and global left ventricular performance at rest and during exercise

Abstract: Nifedipine is a potent coronary vasodilator in the resting state and an effective afterload-reducing agent. This study was undertaken because of the concern that the addition of nifedipine to beta-blocker therapy could produce serious untoward hemodynamic consequences. Although this combination is usually well tolerated, occasional reports suggest that the combination of nifedipine and beta-blocking agents may increase the likelihood of congestive heart failure, severe hypotension or exacerbation of angina. Further, there is a need to know if the addition of nifedipine to therapy with maximally tolerated doses of long-acting nitrates and beta blockers would provide further symptomatic relief without excessive adverse effects. Finally, the effect of adjunctive nifedipine on global left ventricular performance at rest and during exercise was examined. Sixteen patients, all of whom had 3 or more episodes per week of angina pectoris despite therapy with long-acting nitrates and beta blockers, were selected. Radionuclide ventriculography was performed at rest and during exercise; global ejection fractions (EFs) were determined by manually tracing the left ventricular end-diastolic perimeter with an electronic cursor. In the first phase, beta blockers and nitrates were used; in the second phase nifedipine, 10 mg every 6 hours, was added and titrated to reduce systolic blood pressure at rest by at least 10 mm Hg or until intolerable adverse effects occurred. When nifedipine was added to therapy, the difference between global EF at rest and during exercise was reduced from - 0.15 to + 0.02 (p less than 0.00001); exercise duration was increased from 431 seconds to 532 (p less than 0.001), with only 8 patients limited by angina, compared with 16 during the initial therapy.(ABSTRACT TRUNCATED AT 250 WORDS)

A controlled study of the suppression of tinnitus by lidocaine infusion: (relationship of therapeutic effect with serum lidocaine levels).

Abstract: The relationship between serum lidocaine levels and tinnitus relief was assessed in 5 patients during intermittent intravenous infusions of the drug. Experiments were conducted under controlled conditions in that neither the attending physician nor the patient was aware of whether active drug or placebo was being infused at any particular time. A significant relationship between serum level and effect was observed in two patients. In the remaining patients this relationship was not readily apparent but there was still a trend for a better response to be seen at higher levels. A satisfactory response was generally seen at levels above 1 microgram/ml. The results are consistent with the hypothesis that the transient nature of the symptomatic relief caused by lidocaine is related to the fast clearance of the drug from the body.

Radiologic intervention in oriental cholangiohepatitis

Abstract: Interventional radiologic techniques can make a useful contribution to the management of patients with recurrent symptoms following surgical palliation of oriental cholangiohepatitis. Percutaneous removal of multiple, soft, pigmented biliary stones that form in this disease can be achieved by a combination of basket retrieval and crushing, as well as suction and irrigation techniques. Ducts that are obstructed by strictures can be drained by percutaneous catheters. Complete or partial symptomatic relief was obtained in six of eight patients, obviating additional surgical intervention.

Ibuprofen in the Treatment of UV-B-Induced Inflammation

Abstract: • Ibuprofen and placebo were compared in a randomized, double-blind, cross-over study of 19 psoriatic patients receiving UV-B phototherapy to evaluate the symptomatic relief of UV-B-induced inflammation. Signs and symptoms of UV-B-induced inflammation (erythema, pruritus, skin pain, general discomfort, and nocturnal restlessness) were assessed for each treatment. An evaluation of 104 treatments disclosed that, although ibuprofen significantly reduced technician-observed erythema, it was not significantly different from placebo for the five other end points studied. Separate evaluations of higher dose UV-B treatments showed a small, but statistically significant, reduction with ibuprofen for four of the six end points evaluated. The data suggest that ibuprofen is more effective than placebo for the relief of symptoms associated with UV-B-induced inflammation after high dose UV-B phototherapy for psoriasis, but the drug has limited usefulness in the treatment of sunburn reaction from these same doses. ( Arch Dermatol 1985;121:508-512)

Hemibody irradiation in lymphomas and related malignancies

Abstract: Between 1979 and 1984, 34 patients with advanced lymphoma or leukemia resistant to other treatments have been treated with single or sequential hemibody irradiation (11111). Good symptomatic relief was obtained in the majority of patients, with minimal acute toxicity. Disease regression occurred in the majority of patients and was maintained in those achieving a complete remission. Stage III disease and `good risk' histology predicted a good outcome. Marrow toxicity was marked only in those patients with marrow involvement. HBI is recommended as a worthwhile palliative treatment particularly in nodal nodular disease.

Thromboxane synthetase inhibition: potential therapy in migraine.

Abstract: SYNOPSIS Sixteen patients with migraine were treated prophylactically for 3 months with dazoxiben, a specific thromboxane synthetase inhibitor, in an open study, Frequency of all attacks was reduced by more than 50% in 7 patients, and of severe attacks in 8 of 10 patients who initially suffered severe attacks. Reductions in thromboxane B2 levels measured at intervals during treatment by radioimmunoassay may have reflected standards of compliance with the 6-hourly treatment regimen. However, a relationship emerged between thromboxane reduction and clinical response, with significantly greater reductions observed in patients who reported good symptomatic relief. This appears to support the hypothesis that platelet activation features in migraine causation.

Prevalence of bacteria and fungi in athlete's foot of varying severity and response to topical antibacterial and antifungal therapies.

Abstract: Ninety-six patients with clinical evidence of interdigital lesions classified as mild, moderate and severe athlete's foot were investigated for bacterial and fungal populations in the interspaces. Gram-negative bacteria, which were not found in the toe spaces of 50 normal controls, were grown in increasing numbers and with increasing frequency as the symptoms progressed from mild to severe. Gram-positive bacteria were also isolated regularly and in increasing numbers commensurate with the severity of the disease. Similarly the isolation rates of dermatophytes and Candida species were higher in patients with moderate and severe disease compared to those with mild disease. Clinical and culture responses to topical applications with framycetin, tolnaftate, miconazole and clotrimazole were also studied. In some patients the prevalence of pathogenic fungi increased as bacterial numbers decreased. The pure antibacterial framycetin brought symptomatic relief, as did the purely anti-dermatophyte substance tolnaftate, but best results were seen with two azole compounds having mixed antibacterial and antifungal properties.

Surgical Treatment of Coronary Artery Disease

Abstract: The concept of surgical myocardial revascularization was initially explored by Beck [1], who observed large collateral vessels between the pericardium and the epicardium in persons who had had pericarditis in association with coronary obstructive disease. Beck reasoned that production of a pericardial inflammatory reaction might produce anastomoses between the pericardial vessels and the coronary arteries, which would provide an extraneous source of arterial blood to supply the ischemic myocardium. A variety of techniques for producing epicardial scarring and inflammation were introduced, and although some persons appeared to have symptomatic relief, it was never adequately demonstrated that the improvement of myocardial blood supply was significant in terms of relief of angina, improvement in longevity, or other criteria. The earliest attempts at direct relief of coronary arterial obstruction involved endarterectomy [2].

Pulmonary hypertension in systemic lupus erythematosus.

Abstract: The occurrence of pulmonary hypertension in systemic lupus erythematosus (SLE) has been rarely reported To date only 18 well documented cases of SLE with pulmonary hypertension have been published We review the literature on pulmonary hypertension in SLE, and add the case of a young woman with a recent onset of both SLE and pulmonary hypertension Hemodynamic studies were carried out before and during treatment with nifedipine and hydralazine alone and in combination Despite improvement in pulmonary vascular resistance, pulmonary pressures were unaffected by the drugs, although our patient had symptomatic relief

Transcutaneous electrical nerve stimulation. Practical aspects and applications.

Abstract: Transcutaneous electrical nerve stimulation (TENS) is a commonly used method of treating patients with pain, both acute and chronic. Although several hypotheses have been proposed, the mechanism by which TENS alters pain perception is still unknown. Symptomatic relief of pain adjunctive to a comprehensive program of pain management is the only justified indication for TENS use.

Pirenzepine in erosive duodenitis. A controlled clinical trial versus ranitidine.

Abstract: Fifty-five outpatients with chronic duodenal erosions and no previous ulcer history were treated, in a double-blind fashion, with either pirenzepine (50 mg twice daily) or ranitidine (150 mg twice daily) for 6 weeks. The drugs were equally effective in inducing symptomatic relief. At endoscopic control, 70.4% of subjects in the pirenzepine group and 39.3% of ranitidine-treated patients showed complete healing (p < 0.05). The results suggest that acid secretion is not an important factor in the pathogenesis of erosive duodenitis and that other mechanisms (such as impaired mucosal blood flow) must be considered.

Polyvalent non-specific immuno-stimulating vaccine and method

Abstract: A non-specific therapeutic polyvalent vaccine for subcutaneous injection containing a minimum combination of a PPD (tuberculin vaccine), a rabies vaccine, and snake venom vaccine and preferably including at least a DTP vaccine in addition and optimally a mumps antigen vaccine and Dermatophytin vaccine in controlled levels, all such constituent vaccines being commercially available. The vaccine provides a broad-based stimulation or potentiation of the immuno-defense system of the patient and is useful for the symptomatic relief and/or mitigation of diseases of viral origin, such as Herpes Zoster, labialis and genitalis, various neuralgias, mumps, measles, viral hepatitis, psoriasis and severe acne, or of autoimmune origin, such as multiple sclerosis and arthritis.