Showing papers on "Symptomatic relief published in 1988"
TL;DR: The surgical goals described were attained and use of the sacrospinous ligament fixation procedure as a therapeutic procedure only is defended.
305 citations
TL;DR: Predominantly sensory neuropathy in HIV infection appears to be a distal axonal degeneration primarily involving sensory neurons, and the mechanism is unknown, but the neuropathy is associated with the late manifestations of HIV infection.
Abstract: The most common type of peripheral neuropathy associated with human immunodeficiency virus (HIV) infection, predominantly sensory neuropathy, affects 10–30% of patients with acquired immunodeficiency syndrome (AIDS). From 40 individuals with peripheral neuropathy and HIV infection, we have identified 26 patients with this syndrome. All had constitutional symptoms when neuropathic symptoms developed; 20 had AIDS and six had AIDS-related complex. The most common complaint was pain on the soles. Paresthesias were frequent and usually involved the entire foot. Signs of peripheral neuropathy were present in all; the most frequent finding was absent or reduced ankle reflexes. Electrophysiologic studies revealed abnormal sensory and motor conduction, studies suggesting a dying-back axonopathy. Over time, the neuropathy progressed in all except one patient with ARC, who had spontaneous subjective improvement. Tricyclic antidepressants provided partial symptomatic relief. In three patients, the neuropathy did not change during azidothymidine treatment. Predominantly sensory neuropathy in HIV infection appears to be a distal axonal degeneration primarily involving sensory neurons. The mechanism is unknown, but the neuropathy is associated with the late manifestations of HIV infection.
283 citations
TL;DR: Long-term follow-up of argon laser photocoagulation in the management of central serous retinopathy revealed no evidence that treatment significantly influenced the visual outcome as measured by the Snellen chart and by the Farnsworth-Munsell 100-hue test.
Abstract: In a prospective randomised trial of argon laser photocoagulation in the management of central serous retinopathy, long-term follow-up (6.4 to 12.1 years) revealed no evidence that treatment significantly influenced the visual outcome as measured by the Snellen chart and by the Farnsworth-Munsell 100-hue test. Treatment did not reduce either the recurrence rate or the prevalence of chronic disease. Complications of treatment were uncommon. The justification for argon laser photocoagulation appears to be limited to the hastening of symptomatic relief by earlier resolution of serous detachment.
221 citations
TL;DR: This observed superiority of omeprazole 40 mg in the morning over ranitidine 150 mg twice daily in the short term treatment of reflux oesophagitis was obtained without major clinical or biochemical side effects, but further research is needed into longer term use of omEPrazole and the effects of the acid inhibition it induces.
Abstract: One hundred and sixty two patients with endoscopically proved reflux oesophagitis stratified for severity, 66 with grade 1 disease (erythema and friability) and 96 with grade 2 or 3 disease (including erosions or ulcerations), were allocated at random to double blind treatment with omeprazole 40 mg in the morning or ranitidine 150 mg twice daily for up to 12 weeks. A patient could be evaluated sooner if symptomatic relief and endoscopically normal mucosa (grade 0) were noted after four to eight weeks' treatment. Patients treated with omeprazole responded significantly more rapidly than those treated with ranitidine (p less than 0.0001), cumulative healing rates at four, eight, and 12 weeks being 90%, 100%, and 100% respectively for those with grade 1 disease and 70%, 85%, and 91% respectively for those with grade 2 or 3 disease in the omeprazole group. Corresponding rates in the ranitidine group were 55%, 79%, and 88% (grade 1) and 26%, 44%, and 54% (grade 2 or 3). Relief of the major symptoms of heartburn, regurgitation, and dysphagia and improvements in the histological appearance of the mucosa occurred earlier and were again more pronounced during treatment with omeprazole than with ranitidine. This observed superiority of omeprazole 40 mg in the morning over ranitidine 150 mg twice daily in the short term treatment of reflux oesophagitis was obtained without major clinical or biochemical side effects, but further research is needed into longer term use of omeprazole and the effects of the acid inhibition it induces.
199 citations
TL;DR: Between January 1983 and October 1985, 65 patients with malignant airway compromise have had 93 flexible bronchoscopic placements of a nylon afterloading catheter for low dose rate iridium-192 temporary intraluminal brachytherapy.
98 citations
TL;DR: Pleuroperitoneal shunting is an alternative therapy for pleural effusions that requires a limited hospitalization only, is associated with minimal and short-term discomfort, achieves excellent results in properly selected patients, and is the only viable therapy when lung expansion cannot be achieved.
Abstract: Pleural effusions are resistant to standard therapy, which causes discomfort and can require prolonged hospitalization. As an alternative, pleuroperitoneal shunting for pleural effusions of various etiologies was evaluated. We implanted 36 shunts in 29 patients. Two patients had bilateral shunts and five had shunt revisions. The effusion was related to a malignancy in 22 patients, postoperative chylothorax in two patients, and other causes in five patients. Therapeutic thoracentesis had been attempted in 28 patients, and eight had had chest tube placement previously with attempted sclerosis. Seven patients had a trapped lung syndrome. There was no operative mortality. All patients were deemed ready for discharge from the hospital if they had recovered from the operation within 48 hours. Five patients had poor results, either because of a moribund status or their refusal or inability to pump the shunt. Of the remaining 24 patients, four had good results with temporary improvement, and excellent results were achieved in 20 patients (83.3%), who experienced symptomatic relief and stabilization or regression of pleural effusion until the time of their death. Patients with chylothorax experienced complete resolution. The 14 patients with malignant effusions had a median survival of 4 months, and there were no instances of peritoneal tumor seeding. In conclusion, pleuroperitoneal shunting is an alternative therapy for pleural effusions that requires a limited hospitalization only, is associated with minimal and short-term discomfort, achieves excellent results in properly selected patients, and is the only viable therapy when lung expansion cannot be achieved.
67 citations
TL;DR: It is concluded that pulmonary hypertension is common in isolated aortic stenosis and is related to an elevated left ventricular end-diastolic pressure, frequently with preserved systolic function.
66 citations
TL;DR: It was concluded that factors other than those involving the site of vascular access must have important etiological roles in the development of the carpal tunnel syndrome.
Abstract: In forty-six (9 per cent) of 485 patients who were receiving long-term renal hemodialysis, a carpal tunnel syndrome developed in at least one hand. A total of sixty-four surgical procedures were performed for this problem in forty-one patients. All of the forty-one patients reported symptomatic relief, although three had recurrent symptoms. There was no correlation between the time of onset of the carpal tunnel syndrome and such factors as the patient's age, sex, or race; the cause of renal failure; the site of vascular access for hemodialysis; or a history of parathyroidectomy. There was a correlation, however, between the development of the carpal tunnel syndrome, the side of the longest functional vascular access, and the presence of arterial calcifications. In all eleven patients in whom a radial steal syndrome developed, an ipsilateral carpal-tunnel syndrome also developed. It was concluded that factors other than those involving the site of vascular access must have important etiological roles.
64 citations
TL;DR: It is indicated that rapid intestinal nutrient transit and associated malabsorption is a factor in the development of diarrhoea postvagotomy and that symptomatic relief can be achieved in most patients by more rational use of existing drugs.
Abstract: Patients with chronic severe diarrhoea after truncal vagotomy and pyloroplasty are often difficult to treat using conventional antidiarrhoeal drugs and remain severely disabled. We examined the effect of two drugs, codeine phosphate and loperamide, on upper intestinal transit and carbohydrate absorption, measured non-invasively by serial exhaled breath hydrogen monitoring, in patients with postvagotomy diarrhoea who had previously failed to gain relief from drug therapy. Orocaecal transit was consistently faster in these patients than a group of controls and was associated with malabsorption of glucose. Codeine phosphate 60 mg significantly delayed transit in patients and controls and was associated with a reduction in glucose malabsorption and improvement in symptoms. Loperamide also delayed transit and improved symptoms, but the doses required for this effect (12-24 mg) were higher than usually considered necessary in secretory diarrhoea. These studies indicate that rapid intestinal nutrient transit and associated malabsorption is a factor in the development of diarrhoea postvagotomy and that symptomatic relief can be achieved in most patients by more rational use of existing drugs.
63 citations
TL;DR: The authors have performed rectal excision and formation of an ileal reservoir with ileoanal anastomosis in two patients in whom constipation followed colectomy, and in one patient there was objective improvement in transit studies, sensory testing, and proctography.
Abstract: The standard surgical therapy for severe idiopathic constipation remains total colectomy with ileorectal anastomosis, but approximately 10 percent of patients develop recurrent severe constipation. The authors have performed rectal excision and formation of an ileal reservoir with ileoanal anastomosis in two patients in whom constipation followed colectomy. Both patients experienced symptomatic relief, and in one patient there was objective improvement in transit studies, sensory testing, and proctography. In both patients a permanent ileostomy was avoided.
58 citations
TL;DR: Bilateral hip involvement, osteoporosis, and high turnover skeletal remodelling at the cement-bone interface potentially contributed to a failure rate that was higher in this group than that reported for primary hip arthroplasty for other diagnoses.
Abstract: Twenty-two patients had 36 total hip arthroplasties for painful osteonecrosis of the femoral head. At a mean of 86 months after operation, a complete follow-up evaluation, including physical examination, was obtained in 24 hips in 15 patients. An additional 12 hips in seven patients were followed by telephone interview and radiographic evaluation. Although most patients experienced improved hip function and symptomatic relief from pain as a result of the operation, 10 hips developed heterotopic bone, 5 hips dislocated after operation, 6 hips failed due to aseptic loosening, and 1 hip developed a deep infection, and one patient died due to pulmonary embolism. Neither sex, preoperative steroid dose, nor postoperative mean alternate-day steroid dose could be related to aseptic loosening. However, histologic examination of transilial bone biopsy specimens (7 patients, 13 hips) revealed steroid-induced osteoporosis, by the presence of hyperosteoidosis (increased unmineralized osteoid) and increased bone resorption. Bilateral hip involvement, osteoporosis, and high turnover skeletal remodelling at the cement-bone interface potentially contributed to a failure rate that was higher in this group than that reported for primary hip arthroplasty for other diagnoses. The existence of steroid-induced metabolic bone disease and preexisting renal osteodystrophy may pose a significant threat to the long-term survival of a total hip implant.
Journal Article•
TL;DR: Data obtained both in controlled clinical investigations and in a postmarketing surveillance program indicated that cyclobenzaprine treatment was associated with few serious adverse experiences and represents a cost-effective approach to the management of acute muscle spasm.
TL;DR: Femoropopliteal reconstruction for claudication may be carried out with acceptably low operative mortality and a subsequent amputation rate comparable with that anticipated from the natural history of the disease.
Abstract: • The current study was undertaken to examine the results of femoropopliteal bypass grafting with intermittent claudication as the indication. Of 1173 infrainguinal reconstructions carried out on our service during the past decade, 249 (21%) consecutive femoropopliteal grafts were performed for disabling claudication in 191 patients. The primary five-year cumulative patency rates were 78% for autogenous vein and 52% for polytetrafluoroethylene grafts. There were two (0.8%) 30-day operative deaths and a subsequent five-year amputation rate of 2.4% for both groups. Femoropopliteal reconstruction for claudication may therefore be carried out with acceptably low operative mortality and a subsequent amputation rate comparable with that anticipated from the natural history of the disease. While the five-year patency rate is significantly higher utilizing autogenous vein grafts, symptomatic relief may be expected with prosthetic grafts in approximately half the patients without incurring a higher risk of limb loss. ( Arch Surg 1988;123:1196-1198)
TL;DR: This article focuses on the pharmacological properties of ivermectin, with a brief consideration of its absorption, fate, excretion and side-effects, and a discussion of its micro filaricidal action.
TL;DR: It is suggested that pneumatic dilatation is safe, effective and particularly useful in the management of the elderly achalasic patient.
Abstract: Over an 11-year period 132 patients with achalasia underwent a total of 253 pneumatic bag dilatations of the cardia as the initial treatment. Adequate symptomatic relief was obtained in the majority, but 16 needed cardiomyotomy after pneumatic dilatation had failed to give lasting symptomatic relief. Older patients, aged 60 years or more, showed longer-lasting improvement with pneumatic dilatation than did younger ones and only 1 patient over 50 required cardiomyotomy. Benefit from pneumatic dilatation showed a closer relationship to age than to oesophageal diameter. Of 50 patients followed for more than 5 years, 48% required no further treatment, 40% needed at least one further dilatation to achieve symptomatic relief and 12% came to cardiomyotomy. This study suggests that pneumatic dilatation is safe, effective and particularly useful in the management of the elderly achalasic patient.
TL;DR: The initial results have been encouraging, and more prolonged study is required for a valid appraisal, although the alternative operation of stricturoplasty has recently become available.
Abstract: Standard surgical treatment for most cases of Crohn's disease of the small bowel or ileocecal region consists of resection, which, however, suffers 3 major disadvantages: (a) It often causes a fair amount of operative morbidity and mortality, especially when performed in the presence of septic complications. To reduce these immediate hazards, a strong case can certainly be made for an earlier resort to surgery before the onset of such complications; (b) It is followed by a high incidence of recurrence of the disease, amounting to about 50% by 10 years. Claims that the risk of recurrence can be reduced by using a more radical type of resection have not been substantiated. Fortunately, recurrences can usually be excised with no increased likelihood of further recurrence, and, by a combination of resection and reresection as required, many patients can be afforded prolonged periods of symptomatic relief; (c) Normal intestinal absorption is impaired, especially after major or repeated resections of the small bowel. The consequences are diarrhea and possible hematological and nutritional disturbances and a predisposition to the formation of biliary and urinary calculi. But, even a loss of up to 50% of the entire small intestine is often compatible with a reasonably good state of general health, particularly if most of the colon has been preserved. Fortunately, such extensive intestinal losses are rare, even after 2 or 3 resections.
TL;DR: Inequality of leg lengths is associated with low back pain, greater trochanteric bursitis, and degenerative hip disease and the pelvic obliquity that results from a discrepancy of leg length may contribute to degenerative changes in the lumbar spine.
TL;DR: The failure of penicillin to provide much additional benefit makes its routine early prescription specifically for symptomatic relief questionable.
TL;DR: Sustained improvement in symptoms and arterial blood gas tensions has been maintained, independence and the capacity for gainful employment have been regained in those of an appropriate age, and the incidence of subsequent hospital admissions has been low.
Abstract: Prolonged ventilatory support has been used to treat 51 patients with respiratory failure secondary to skeletal (22) or neuromuscular (29) disease. Symptomatic relief was achieved in five patients with rapidly progressive neurological disease who died within 27 months. The remaining 46 patients, aged 11-69 years at presentation, have been followed for more than two and a half years. All but 10 were treated with negative pressure ventilation from the outset, intermittent positive pressure ventilation being used initially in the others and continued at home in three. Nocturnal negative pressure ventilation has been used at home by 39 patients. A permanent tracheostomy has been maintained in 14, to facilitate positive pressure ventilation in three and to circumvent upper airway obstruction during sleep in 11. Sustained improvement in symptoms and arterial blood gas tensions has been maintained, independence and the capacity for gainful employment have been regained in those of an appropriate age, and the incidence of subsequent hospital admissions has been low. Neither the mode of presentation nor the aetiology of the restrictive ventilatory defect influenced outcome in patients with stable or only slowly progressive primary disease.
TL;DR: A case involving an early adolescent boy suffering from overanxious disorder is reported, in which buspirone provided substantial symptomatic relief and facilitated adjustment to school.
Abstract: The pharmacologic treatment of anxiety disorders in children and adolescents has depended largely on the use of antidepressants, particularly imipramine. Benzodiazepines, although well established in the treatment of adult anxiety, have not been shown to be efficacious in children. Buspirone, a novel anxiolytic, has a variety of potential advantages for use in children. A case involving an early adolescent boy suffering from overanxious disorder is reported, in which buspirone provided substantial symptomatic relief and facilitated adjustment to school.
TL;DR: This review analyzes each of the new nonsedating antihistamines developed in the 1980s and evaluates its clinical efficacy, safety, and convenience in the treatment of chronic urticaria.
Abstract: Antihistamines are the drugs of choice in the symptomatic relief of chronic urticaria; however, the usefulness of classic antihistamines has been limited by side effects, especially daytime sedation. In the 1980s a new class of antihistamines has been developed that maintains effectiveness and produces less sedation. This review analyzes each of the new nonsedating antihistamines and evaluates its clinical efficacy, safety, and convenience in the treatment of chronic urticaria.
TL;DR: A single sclerotherapy treatment with tetracycline at a dose of 20 mg/kg was as effective as two scler therapy treatments and provided symptomatic relief in 46 of the 50 patients with malignant pleural effusion.
TL;DR: Survival at five years after operation equals that of the general ESRD population, but is lower than that of nonuremic patients after cardiac surgery, largely influenced by the high prevalence of noncardiac morbid conditions in the E SRD group.
Abstract: To assess risk and intermediate results, 36 consecutive patients with end-stage renal disease (ESRD) who underwent 36 cardiac operations at The Cleveland Clinic Foundation from 1980 to 1986 were studied. Such surgery can be done with acceptable risk and yields satisfactory symptomatic relief. Survival at five years after operation equals that of the general ESRD population, but is lower than that of nonuremic patients after cardiac surgery. This is largely influenced by the high prevalence of noncardiac morbid conditions in the ESRD group.
TL;DR: On clinical suspicion of a foregut carcinoid tumor, or in patients with carcinoid tumors without anatomical localization, PG provocation should not be used until the excretion of MeImAA has been determined.
Abstract: Two cases of gastric carcinoid tumors with the foregut carcinoid syndrome are presented. Due to elevated urinary levels of 5-hydroxyindoleacetic acid (5-HIAA), primary tumors of midgut origin were suspected. Provocation with pentagastrin (PG) elicited atypical flushing and severe bronchoconstriction, most probably caused by the release of histamine. Excessive excretion of the main histamine metabolite, tele-methylimidazole acetic acid (MeImAA), in urine of both patients was demonstrated. Both patients had good symptomatic relief with prednisolone and blockade of histamine receptors. One of the patients had excessive secretion of serotonin (5-HT) as well as of histamine. Peripheral blockade of 5-HT2receptors was therefore added to the medical treatment. This patient had a subjective and biochemical response to cytotoxic treatment with streptozotocin and later responded well to a somatostatin analogue. On clinical suspicion of a foregut carcinoid tumor, or in patients with carcinoid tumors without anatomical localization, PG provocation should not be used until the excretion of MeImAA has been determined.
TL;DR: There is uterine hypercontractility in endometriosis, which seems to be of minor importance in causing symptoms, whereas the frequency of fundal contractions during the luteal phase was decreased.
Abstract: SummaryTo study uterine contractions in proved endometriosis and the effects of operative and danazol treatment, intrauterine pressures at the isthmus and fundus level were recorded 27 times in 17 women with endometriosis and 20 times in 10 healthy women. In endometriosis a pattern of hypercontractility in the form of increased resting pressure was observed both during the luteal phase of the cycle and during menstruation, whereas the frequency of fundal contractions during the luteal phase was decreased. This pattern of uterine contractions was not affected by operative or danazol (600 mg/day) treatment, although these treatments provided symptomatic relief. These data suggest there is uterine hypercontractility in endometriosis, which seems to be of minor importance in causing symptoms.
Journal Article•
TL;DR: It is suggested not only that hereditary hemorrhagic telangiectasia is transmitted as a dominant trait, but that there is also a hereditary transmission of hepatic involvement in this disease.
Abstract: The cases of two brothers with intrahepatic arterio-venous shunt causing hyperdynamic circulation in hereditary hemorrhagic telangiectasia are presented. There was a strong family history of fatal liver involvement in all members of the previous generation. The first patient had embolization of the right hepatic artery with symptomatic relief, but developed cirrhosis with portal hypertension seven years later. The second patient developed cirrhosis with portal hypertension, and died following rupture of esophageal varices, within a year. It is suggested not only that hereditary hemorrhagic telangiectasia is transmitted as a dominant trait, but that there is also a hereditary transmission of hepatic involvement in this disease.
TL;DR: A 53-year-old man with metastatic ileal carcinoid ultimately failed to respond to conventional measures of surgery and was finally treated with a new long acting somatostatin analogue, SMS 201–995 for 7 months, which gave symptomatic relief and induced a reduction in metastatic tumor mass.
Abstract: A 53-year-old man with metastatic ileal carcinoid ultimately failed to respond to conventional measures of surgery and was finally treated with a new long acting somatostatin analogue, SMS 201–995 for 7 months. SMS 201–995 not only gave symptomatic relief but also induced a reduction in metastatic tumor mass.
TL;DR: Though the blood flow of theinternal mammary artery and the size of the coronary arteries were smaller in patients with small body structure, excellent patency of the internal mammary arteries graft and satisfactory symptomatic relief can be expected.
TL;DR: Angioplasty was performed with an initial success rate of 88%, and compared favorably with bypass surgery in terms of in-hospital mortality, freedom from angina, and subsequent employment at 18 months follow-up.
Abstract: To evaluate current strategies for the management of unstable angina, 104 consecutive patients admitted to the coronary care unit with unstable angina during a 6-month period were followed prospectively. Although 58 patients had symptomatic relief with the initiation of intensive medical therapy, 46 (44%) continued to have episodes of angina despite maximal tolerated triple-drug antianginal therapy as well as aspirin or heparin, or both. In-hospital mortality for the 104 patients was 4%. The incidence of myocardial infarction was 8%, and differed (p
TL;DR: A number of studies dealing with vertigo of central etiology were positive and the level of proof for flunarizine is still as good as for other substances or better, whether the effects are due to calcium entry blocking properties.
Abstract: Few calcium entry blockers have been studied in the treatment of vertigo. Flunarizine and cinnarizine are the most extensively studied substances. They have been shown to be valuable drugs in the therapeutic approach to vertigo. A few pilot studies have been performed with nimodipine but controlled data are lacking. Flunarizine has a direct long-lasting vestibulodepressant effect in both animals and humans. In patients with labyrinthine vertigo, it produced a marked symptomatic relief of symptoms significantly exceeding the effects of placebo or nicergoline. A number of studies dealing with vertigo of central etiology were also positive. Patient selection in such trials, however, is doomed to be less precise so that cautiousness must be exerted in interpreting such studies. The level of proof for flunarizine is still as good as for other substances or better. It is discussed whether the effects are due to calcium entry blocking properties.