[ Opposing effects of propranolol and diltiazem on the angina threshold during an exercise test in patients with syndrome X ] . Patients with angina pectoris , exercise induced myocardial ischemia , normal coronary arteries and no evidence of epicardial spasm , i.e . patients with syndrome x , have been suggested to haven inadequate increase in coronary blood flow during tachycardia , possibly due to a functional disorder of small coronary vessels . To evaluate the best medical management of this syndrome we studied 13 patients who showed the above set of findings . Patients were given propranolol ( 160 mg daily ) , diltiazem ( 360 mg daily ) and placebo for 2 weeks , using a randomized single blind protocol . Upright bicycle ergometer testing was performed at the end of each period of treatment . Compared to placebo , diltiazem significantly ( p less than 0.001 ) prolonged exercise duration ( x +/- SD : 365 +/- 86 vs 303 +/- 89 sec ) and time to onset of angina ( 358 +/- 88 vs 276 +/- 90 sec ) . Angina appeared in 7 patients with diltiazem vs 13 patients with placebo and occurred at a higher rate pressure product ( 26.3 +/- 3.5 vs 24.1 +/- 2.8 X 10 ( -3 ) ; p less than 0.02 ) . Conversely , following propranolol exercise duration and time to onset of angina were unchanged and angina appeared in all patients at a lower rate pressure product ( 18.3 +/- 2.9 vs 24.4 +/- 3.6 X 10 ( -3 ) ; p less than 0.001 ) . The most likely explanations for these findings are : propranolol counteracts beta 2-adrenergic receptors , thus further reducing coronary reserve . This may lower the anginal threshold ; Diltiazem reduces smooth muscle tone in small coronary vessels . This may result in increased coronary reserve and exercise duration .

propranolol

diltiazem

diltiazem

placebo

Upright bicycle ergometer testing

diltiazem

placebo

propranolol

Diltiazem

angina threshold

coronary blood flow during tachycardia

exercise duration

time to onset of angina

Angina

pressure product

angina

pressure product

coronary reserve .

anginal threshold ;

smooth muscle tone

patients with syndrome X ]

patients with syndrome x

13 patients


Abstinence or controlled drinking in clinical practice : indications at initial assessment . Previous research has suggested two leading hypotheses concerning which excessive drinkers can re-establish control : one based upon level of dependence , the other upon the client 's personal persuasion . Using initial assessment data from 46 clients of a clinical psychology alcohol problems service ( 30 men , 16 women ) , an attempt was made to operationalize the concepts of dependence and personal persuasion using a variety of indicators of each . Although SADQ scores and Rand definite alcoholism were in general agreement , there were a number of borderline instances and cases of disagreement , and neither was in good agreement with estimates of problem duration , nor with reports of recent or earlier attainment of abstinence or control . Indicators of personal persuasion were more consistent . Those with dependence indicators for abstinence tended to prefer abstinence as a goal , but there were many departures from this pattern particularly for women . It is concluded that in clinical practice it will be very difficult to make a clear cut recommendation about treatment goal at initial assessment except in a few cases .

Abstinence

controlled drinking

abstinence

control

SADQ scores

Rand definite alcoholism

personal persuasion

indicators for abstinence

Abstinence or controlled drinking

excessive drinkers

men

women


High general anger : correlates and treatment .

correlates

treatment .

anger :

High general anger


Domperidone , metoclopramide , and placebo . All give symptomatic improvement in gastroesophageal reflux . A double-blind crossover study was conducted of two gastric prokinetic drugs in 23 patients with gastroesophageal reflux . Patients were divided into two groups on the basis of a dual-isotope mixed-meal study of their gastric emptying ( GE ) . Group I had normal GE and group II delayed GE . Nine gastrointestinal symptoms were assessed for frequency and severity before treatment . The trial had three 1-month treatment periods using metoclopramide 10 mg q.i.d. , domperidone 20 mg q.i.d. , or placebo on a random basis . Symptoms were reassessed at the end of each month . Taken as a whole , the group showed a significant symptomatic response in all three treatment periods ( p less than 0.0001 ) , but patients with delayed or normal GE did not differ significantly in their symptomatic response . Eleven patients complained of side effects with metoclopramide and three stopped therapy before the 1-month course was completed . Two patients described side effects with domperidone , including one woman with galactorrhea after 36 h of treatment . Three patients on placebo also complained of important side effects . We conclude that a significant placebo effect is present in the treatment of gastroesophageal reflux . No significant difference was demonstrated in symptomatic improvement between placebo , domperidone , and metoclopramide in this study .

gastric prokinetic drugs

domperidone

placebo

metoclopramide

symptomatic response

side effects

galactorrhea

important side effects

symptomatic improvement

23 patients

gastroesophageal reflux


Zinc supplementation in alcoholic cirrhosis . A double-blind clinical trial . A double-blind clinical trial with zinc sulfate , 0.2 g three times daily , and a placebo was performed in 30 patients with biopsy-proven alcoholic liver cirrhosis . The disease was in a stable phase , and none of the patients showed evidence of a decompensated liver function . Parameters of liver function , taste acuity , dark adaptation and of zinc and vitamin A metabolism were followed for six weeks . In the zinc-treated group of 16 patients , serum zinc rose from a normal mean value of 13.3 to 17.4 mumol/l , whereas the mean serum vitamin A level remained practically unaltered within the normal range , 1.89 at the entry and 1.83 mumol/l at the end of the study . Plasma prothrombin and serum alkaline phosphatase levels of the zinc group increased and serum bilirubin and serum carotene decreased significantly . The dark adaptation did not change , but the taste function was significantly improved during zinc treatment . The results indicate that zinc supplementation causes alleviation of certain abnormalities of cirrhotics , which deserves further attention .

Zinc supplementation

zinc sulfate

placebo

zinc

vitamin A metabolism

zinc supplementation

serum zinc

mean serum vitamin A level

serum bilirubin and serum carotene

dark adaptation

taste function

alcoholic cirrhosis

30 patients


Acipimox in the treatment of patients with hyperlipidaemia : a double blind trial . Fifty-two patients with Fredrickson Type IIb or Type IV hyperlipidaemia , in whom diet had not achieved satisfactory lipid levels , completed a double blind randomised study of acipimox versus placebo . The patients were given acipimox , 250 mg three times daily or placebo for a three month period , and plasma lipids and glucose were monitored . The patients receiving acipimox showed a fall in the mean concentration of plasma triglyceride compared to placebo ( 0.74 mmol/l ) and this was most marked in patients whose initial plasma triglyceride levels were greater than 3 mmol/l ( 1.0 mmol/l , confidence limits 0.18 , 1.82 ) . Acipimox was well tolerated , and could be a useful addition to the drugs available for the treatment of patients with hypertriglyceridaemia .

Acipimox

acipimox

placebo .

acipimox

placebo

plasma lipids and glucose

plasma triglyceride

plasma triglyceride levels

tolerated

hyperlipidaemia

Fifty-two

hypertriglyceridaemia


Clofibrate and diabetes control in patients treated with oral hypoglycaemic agents . 1 . Twenty-two maturity-onset type diabetics treated with oral hypoglycaemic agents entered a single-blind crossover study using placebo ( periods A and C , 2 months each ) and clofibrate ( 2 g/day ; period B ; 2 months ) . 2 . In thirteen patients , under reasonably good control , clofibrate did not reduce fasting or post-prandial blood glucose , nor 24 h glycosuria ; no improvement was noted in the M-value , an index of diabetes control . 3 . In contrast , in nine patients , with poor diabetes control , clofibrate reduced 24 h glycosuria and significantly improved the M-value . 4 . In all patients , clofibrate therapy was associated with a significant 19-23 % reduction in plasma fibrinogen . 5 . It is suggested that addition of clofibrate may be useful in maturity-onset diabetics not adequately controlled by diet combined with oral hypoglycaemic agents .

Clofibrate

oral hypoglycaemic agents

oral hypoglycaemic agents

placebo

clofibrate

clofibrate

clofibrate

clofibrate therapy

clofibrate

oral hypoglycaemic agents

diabetes control

fasting or post-prandial blood glucose

24 h glycosuria

M-value

index of

diabetes control

diabetes control

24 h glycosuria

M-value

plasma fibrinogen

Twenty-two

thirteen


Intravenous regional anaesthesia below the knee . A cross-over study with prilocaine in volunteers . The quality of anaesthesia provided by three dosages of prilocaine , 40 ml 0.5 % , 20 ml 1 % , or 40 ml 1 % , administered in random order , for intravenous regional anaesthesia of the lower extremity below the knee was compared in six volunteers . Limited sensory blockade was achieved in the groups with 40 ml 0.5 % and 20 ml 1 % during the 30-minute test period . One subject was not fully anaesthetised with any of the dosages used . Recovery was rapid ( mean 12-13 minutes ) in these two groups . In two subjects given 40 ml of 1 % , complete recovery took 90 minutes . At 30 minutes , the degree of flexion remaining in the great toe ( control 100 % ) was 4 % in the groups who received 40 ml of 0.5 % and 1 % , but 34 % in those who received 20 ml of 1 % respectively . Full motor recovery was achieved in 8-9 minutes . Five of six volunteers who received the 400-mg dose experienced subjective signs of central nervous system side effects when the cuff was released . In this group , the mean plasma level of prilocaine at 2 minutes was 1.22 micrograms/ml , maximum 2.12 micrograms/ml . In a radiological examination , no leak of contrast medium under the tourniquet cuff ( 300 mmHg ) was detected . The development of anaesthesia was fastest following the largest dose , but the large number of central side effects makes that dosage less suitable for clinical work .

Intravenous regional anaesthesia

prilocaine

prilocaine

prilocaine

Recovery was rapid

complete recovery

Full motor recovery

mean plasma level

fastest

large number of central side effects

less suitable for clinical work

six


Evaluation of three dosage-prediction methods for initial in-hospital stabilization of warfarin therapy . Three dosage-prediction methods for initial in-hospital stabilization of warfarin therapy were evaluated . Adult inpatients who had received warfarin sodium 10 mg daily for less than three days were eligible for the study . After receiving their third warfarin dose , patients were randomly assigned to have their warfarin dosages adjusted using one of three dosage-prediction methods : by analog computer ( n = 31 ) , linear regression ( n = 22 ) , or empiric dosing by the physician ( n = 34 ) . A prothrombin time ( PT ) ratio ( patient PT divided by control PT ) between 1.3 and 2.5 was considered to be in the therapeutic range . For patients who achieved a stable PT ratio ( defined as a PT ratio between 1.3 and 2.5 that varied by less than 0.05 on two consecutive days or by less than 0.1 on three consecutive days without a dosage change ) before discharge , the number of days ( time to stabilization ) from administration of the first warfarin dose to achievement of the warfarin dosage that produced a stable PT ratio ( stabilization dosage ) was compared . A total of 54 patients met the study criteria for a stable PT ratio before hospital discharge ( analog computer , n = 20 ; linear regression , n = 15 ; empiric dosing , n = 19 ) . The mean times to stabilization were 6.8 days in the analog-computer group , 7.3 days in the linear-regression group , and 8.4 days in the empiric-dosing group ; these times were not significantly different . All 20 stabilized patients in the analog-computer group achieved a stable PT ratio by the fourth dosage prediction . ( ABSTRACT TRUNCATED AT 250 WORDS )

three dosage-prediction

Three dosage-prediction methods

warfarin therapy

warfarin sodium 10 mg daily

warfarin

warfarin

analog computer

linear regression

empiric dosing by the physician

prothrombin time ( PT ) ratio

stable PT ratio

stable PT ratio

stabilization dosage )

stable PT ratio

mean times to stabilization


Beta-adrenoceptor blockade and cardiovascular response to the cold pressor test . Seven healthy subjects immersed a hand in random order in either warm water or in cold water at 5 degrees C for 2 min , after taking orally a single dose of 120 mg of propranolol or a placebo in a double blind fashion . The cold stress resulted in a significant increase in blood pressure and the rate pressure product without a change in heart rate . Beta-adrenoceptor blockade did not affect the pressor response the cold . The changes induced by the cold stress in the cardiovascular variables in the placebo and propranolol experiments were not statistically different . The highest rate pressure product during the cold pressor test was about 109 units . This was well below the pain threshold value of about 200 found during exercise in patients with ischaemic heart disease . In the recovery phase , the cardiovascular variables reverted to pre-immersion values within 1 min inspite of continued low hand skin temperature .

propranolol

placebo

cardiovascular response

blood pressure

rate pressure product

heart rate .

pressor response the cold .

cardiovascular variables

rate pressure product

pain threshold

cardiovascular variables


Parietal cell density in duodenal ulcer patients after short-term treatment with cimetidine and antacids . In a prospective study , 20 patients with endoscopically proven duodenal ulcers were randomised to be treated with cimetidine 1 g daily or with antacids 350 mmol daily . The duration of treatment was 30 days , but this was extended to three months in 3 patients in the cimetidine group and 4 patients in the antacid group . A morphological study of biopsies taken via a gastroscope from the corpus mucosa showed no change in mucosal height , parietal cell density per unit volume or changes in cellular infiltration after 30 and 90 days treatment in the two groups . Neither H-2 receptor blockers nor antacids alter mucosal height or parietal cell density . Treatment was not found to induce gastritic changes in the mucosa .

cimetidine

antacids

cimetidine

antacids

cimetidine

antacid

H-2 receptor blockers

antacids

Parietal cell density

mucosal height

parietal cell density per unit volume

changes in cellular infiltration

mucosal height

parietal cell density

gastritic changes

duodenal ulcer

endoscopically proven duodenal ulcers


[ Results of a cooperative prospective study of treatment of primary digestive localizations of non-Hodgkin 's lymphoma ] . We report the results of chemotherapy treatment in 82 patients presenting with primary digestive lymphoma and included in a study conducted between October 1977 and October 1985 . There were 31 gastric lymphoma , 18 small intestinal lymphomas , and 19 with multiple involvement : 63 patients had had a surgical staging with total tumor resection in 15 cases . Nineteen patients with limited disease ( ID and IID ) were randomly assigned to either a 3-week chemotherapy regimen associated with whole abdominal radiotherapy or chemotherapy for 3 years . Twenty-seven stage IIID and thirty-six stage IV were treated with chemotherapy alone for 3 years . Low grade lymphomas ( 16 patients ) received a cyclophosphamide , vincristine , prednisone association . Intermediate ( 56 patients ) and high grade ( 10 patients ) lymphomas received cyclophosphamide , vincristine , adriamycin , prednisone . The overall complete remission obtained was 63 p. 100 ( 51 patients ) with 17 patients in relapse within 6 to 40 months . Overall survival was 46 p. 100 at 5 years . Survival was dependent on abdominal extension , histologic grade according to the new working formulation used for lymph-node lymphomas , initial localization ( gastric lymphomas have the best survival ) and achievement of complete remission . Chemotherapy is an effective treatment for primary digestive lymphomas . The role of surgery in the management of lymphomas has to be defined by further studies .

chemotherapy treatment

chemotherapy

whole abdominal radiotherapy

chemotherapy

chemotherapy

cyclophosphamide

vincristine

prednisone association

cyclophosphamide

vincristine

adriamycin

prednisone

Chemotherapy

overall complete remission

relapse

Overall survival

Survival

complete remission

treatment

non-Hodgkin 's lymphoma ]

primary digestive lymphoma

gastric lymphoma

small intestinal lymphomas

multiple involvement

Nineteen

limited disease ( ID and IID )

Twenty-seven

stage IIID

thirty-six

stage IV


The Eastern Cooperative Oncology Group experience with cyclophosphamide , adriamycin , and 5-fluorouracil ( CAF ) in patients with metastatic breast cancer . Data on 162 women ( 90 premenopausal and 72 postmenopausal ) with metastatic breast cancer randomized to receive cyclophosphamide , Adriamycin ( doxorubicin ) and 5-fluorouracil ( CAF ) on two Eastern Cooperative Oncology Group ( ECOG ) protocols were analyzed . Twenty-three percent had complete remission ; 39 % had partial remission ; 28 % had no change ; and 3 % had disease progression . Of those patients in whom receptors were known , response rates were 65 % for estrogen ( ER ) -receptor positive and 70 % for ER-negative patients . The median duration of response was 11.4 months . The median survival time from the start of CAF was 20.2 months . The response rate , time to treatment failure ( TTF ) , and median survival time were superior in the premenopausal women . These differences ceased , however , to be statistically significant in logistic models . Factors significantly associated with longer TTF and longer survival were as follows : one or two organs with metastases ( TTF , P less than 0.0001 ; survival , P less than 0.0001 ) ; dominant site other than soft tissue ( TTF , P less than 0.0001 ; survival , P = 0.05 ) ; and an initial good performance status ( TTF , P = 0.007 ; survival , P = 0.02 ) . Patients with ER-positive disease had a significantly longer median survival time ( P = 0.003 ) .

median duration

median survival time

response rate

time to treatment failure ( TTF )

median survival time

TTF

survival

longer median survival time

metastatic breast cancer

premenopausal

postmenopausal

metastatic breast cancer


Butorphanol and meperidine compared in patients with acute ureteral colic . Pain relief was evaluated in 81 patients with acute ureteral colic and the confirmed presence of a calculus . A randomized double-blind comparison of intramuscular 2 and 4 mg. butorphanol and 80 mg. meperidine was used . Pain intensity and pain relief were evaluated at half hour and hourly intervals for 4 hours . A 2 mg. dose of butorphanol was found to be analgesically equivalent to 80 mg. meperidine , while a 4 mg. dose of butorphanol was found to be more effective than 80 mg. meperidine and 2 mg. butorphanol . Each patient received up to 2 doses of analgesic medication when necessary . There was no significant difference in the incidence of side effects among treatments . One patient had visual hallucinations after a 2 mg. dose of butorphanol , possibly owing to its antagonistic activity to significant narcotic experience given previously at another hospital . There was no other evidence of toxicity with butorphanol . It was found to be a safe , effective and wall tolerated drug for the treatment of ureteral colic and is recommended in place of narcotics .

Butorphanol

meperidine

butorphanol

meperidine

butorphanol

meperidine

butorphanol

meperidine

butorphanol

butorphanol

butorphanol

Pain intensity

pain relief

incidence of side effects

visual hallucinations

toxicity

safe , effective and wall tolerated

acute ureteral colic

acute ureteral colic


Results of a prospective randomized study of hepatic artery infusion with 5-fluorouracil versus intravenous 5-fluorouracil in patients with hepatic metastases from colorectal cancer : A Central Oncology Group study . In a controlled , prospectively randomized trial , 74 patients with hepatic metastases from colorectal cancer were randomized to either intra-arterial hepatic artery infusion with 5-fluorouracil ( 5-FU ) or systemic chemotherapy with 5-FU . In 61 acceptable patients , there was no significant difference in terms of response rate , time to progression , duration of the response , and survival rate . Though the response rate for the intra-arterial infusion arm was slightly higher than for the systemic arm , the difference was not significant , and the intra-arterial infusion arm was associated with a greater incidence of nausea , vomiting , diarrhea , in addition to complications of femoral-arterial thrombosis , bleeding , and infection at the catheter site not seen in patients treated by systemic chemotherapy . Patients with an objective response to chemotherapy on either treatment arm survived twice as long as the nonresponders . Long-term survival in one patient , 77 months , can occasionally be achieved in patients with hepatic metastases .

intravenous 5-fluorouracil

systemic chemotherapy with 5-FU

systemic chemotherapy

response rate

time to progression

duration of the response

survival rate

response rate

nausea

vomiting

diarrhea

femoral-arterial thrombosis

bleeding

infection at the catheter site

survived

Long-term survival

hepatic metastases

colorectal cancer

hepatic metastases

colorectal cancer


Comparison of maintenance treatment regimens for first central nervous system relapse in children with acute lymphocytic leukemia . A Pediatric Oncology Group study . Eighty-seven children with central nervous system ( CNS ) leukemia were randomized to receive either induction intrathecal chemotherapy ( ITC ) and cranial irradiation ( CRT ) plus maintenance ITC , or induction ITC and craniospinal irradiation ( CSpRT ) with no maintenance ITC . ITC consisted of six weekly injections of methotrexate , hydrocortisone , and arabinosylcytosine . Also , intensification of systemic induction and maintenance chemotherapy was given . CRT + ITC was given as CRT , 2400 rad in 12 fractions followed by ITC maintenance bimonthly for 2 years . Craniospinal irradiation consisted of CRT + 1400 rad in ten fractions to the spine . Randomization was stratified according to whether CNS leukemia occurred at initial diagnosis of acute lymphocytic leukemia ( ALL ) ( Stratum I , 15 patients ) , during first bone marrow ( BM ) remission ( Stratum II , 49 patients ) , simultaneous with first BM relapse ( Stratum III , 12 patients ) , or during second BM remission ( Stratum IV , 11 patients ) . The median follow-up for patients who remain at risk is 15 + months . Eight children ( seven on CRT + ITC , one on CSpRT ) developed presumed therapy related encephalopathy . In Stratum II , 16 of 29 ( 55 % ) patients receiving CRT + ITC experienced adverse events : 3 deaths during continuous complete remission ( CCR ) and 13 relapses ( 2 CNS , 1 CNS + BM , 1 BM + testes , and 2 testes ) as compared with only 5 relapses in 20 ( 25 % ) patients on CSpRT ( 1 CNS , 1 CNS + BM , 1 BM , and 2 testes ) . The children on both regimens were comparable for sex , race , age at initial ALL diagnosis , time from ALL diagnosis to first episode of CNS leukemia , systemic therapy both before and after CNS relapse , and number of blasts in the spinal fluid at diagnosis of CNS leukemia . The conclusion is that children with isolated CNS leukemia can achieve prolonged survival with aggressive therapy , and that CSpRT is possibly less toxic and more likely than is CRT + ITC to prevent subsequent BM and testicular relapse ( P less than 0.02 ) , but not subsequent CNS relapse ( P = 0.7 ) . A possible systemic therapy effect of spinal irradiation is postulated to explain the superiority of CSpRT .

induction intrathecal chemotherapy

( ITC )

cranial irradiation ( CRT )

plus

maintenance ITC

induction ITC

methotrexate

hydrocortisone

arabinosylcytosine

intensification of systemic induction

maintenance chemotherapy

CRT

ITC

CRT

ITC

CSpRT

adverse events :

relapses

relapses

CSpRT is possibly less toxic

subsequent BM and testicular relapse

CNS relapse

spinal irradiation

superiority of CSpRT .

central nervous system relapse

children

acute lymphocytic leukemia

Eighty-seven

central nervous system ( CNS ) leukemia


5 FU infusion with mitomycin-C vs. 5 FU infusion with methyl-CCNU in the treatment of advanced upper gastrointestinal cancer : a Southwest Oncology Group Study . A randomized trial was conducted by the Southwest Oncology Group ( SWOG ) in advanced carcinoma of the stomach and pancreas . Patients were assigned to receive monthly 5-fluorouracil 96-hour continuous infusions with either bolus mitomycin-C or oral methyl-CCNU . Mitomycin-C and methyl-CCNU were administered every eight weeks . The 5 FU-mitomycin combination produced a 14 % and 22 % response rate in disseminated stomach and pancreatic carcinoma , respectively . The combination of infusion 5 FU and methyl-CCNU achieved responses in 9 % and 5 % of stomach and pancreatic tumors , respectively . There was no significant difference in survival between limbs for either tumor . Median survival in gastric carcinoma on the 5 FU-mitomycin regimen was 25 weeks vs. 18 weeks on the 5 FU-METHYL-CCNU arm . In pancreatic carcinoma median survival on the mitomycin limb was 19 weeks as compared to 17 weeks on the methyl-CCNU program . Leukopenia was greater for the first course on the mitomycin limb . Regression analysis demonstrated that performance status was the most important pretreatment characteristic for predicting survival in both tumors . Neither 5 FU infusion combination appears to significantly alter the dismal prognosis of advanced upper gastrointestinal neoplasms .

bolus mitomycin-C or oral methyl-CCNU

Mitomycin-C and methyl-CCNU

5 FU-mitomycin combination

5 FU-mitomycin

5 FU-METHYL-CCNU

methyl-CCNU

mitomycin

5 FU infusion

response rate

responses

difference in survival

Median survival

pancreatic carcinoma median survival

Leukopenia

performance status

survival


Intraocular pressure changes with propofol ( 'Diprivan ' ) : comparison with thiopentone . The effects of propofol , a new non-barbiturate intravenous anaesthetic agent , on intraocular pressure ( IOP ) were assessed and compared with those of thiopentone . IOP was measured using an applanation tonometer for 5 min following administration of induction doses of propofol or thiopentone and inhalation of 66 % nitrous oxide in oxygen . Both agents produced a significant fall in IOP for the period of study , by a maximum of 53 % with propofol and 40 % with thiopentone . Apnoea occurred with similar frequency in the two groups . Use of propofol was associated with a significant fall in arterial pressure and pain on injection in 5 out of 20 patients .

propofol

thiopentone

propofol

thiopentone

propofol

thiopentone

nitrous oxide in oxygen

intraocular pressure

IOP

IOP

Apnoea

arterial pressure

pain on injection

20 patients


Randomized trial of combination chemotherapy in hormone-resistant metastatic prostate carcinoma . A prospective randomized study was conducted in 51 patients with stage D hormone-resistant prostatic carcinoma , comparing a combination of doxorubicin and lomustine ( DC ) with cyclophosphamide and 5-FU ( CF ) . Patients were assessed objectively ( employing National Prostate Cancer Project criteria ) and subjectively ( using a numerical scoring scheme ) . Each regimen was well tolerated with acceptable levels of myelosuppression . The objective partial response rate was 57 % for DC and 8 % for CF . Objective stabilization occurred , respectively , in 14 % and 44 % of the patients . Similarly , DC demonstrated a significantly superior subjective response rate ( partial plus complete ) of 82 % , compared to 48 % for CF . Patients with poor initial performance status or liver involvement had significantly lower response rates and reduced survival . Overall , there was no significant difference in survival between the two arms , reflecting the similarity between DC and CF in total objective response rate ( partial response plus stable disease ) . DC provided superior palliation and was well tolerated by an essentially geriatric population .

chemotherapy

doxorubicin

lomustine

cyclophosphamide and 5-FU ( CF )

CF

DC

CF

DC

tolerated

levels of myelosuppression

objective partial response rate

Objective stabilization

response rates

survival

survival

tolerated


A randomized , prospective trial of adjuvant chemotherapy in adults with soft tissue sarcomas of the head and neck , breast , and trunk . Since 1977 , 31 patients were entered in a randomized , prospective study testing the efficacy of adjuvant chemotherapy after aggressive local treatment of high-grade sarcomas of the head , neck , breast , and trunk ( excluding retroperitoneal sarcomas ) . All patients had complete resection of gross tumor and underwent postoperative radiotherapy ( 6000-6300 rads over 7-8 weeks ) . Seventeen patients received adjuvant chemotherapy consisting of doxorubicin ( less than or equal to 550 mg/m2 ) , cyclophosphamide ( less than or equal to 5500 mg/m2 ) , and methotrexate ( less than or equal to 1000 mg/kg ) . Three-year actuarial disease-free survival in the chemotherapy arm was 77 % , compared to 49 % in the no-chemotherapy arm ( P = 0.075 ) . Three-year overall actuarial survivals in the two treatment arms , however , were 68 % and 58 % , respectively ( P = 0.38 ) . Considering only patients with tumors of the trunk ( 22 patients ) , 3-year actuarial disease-free survival in the chemotherapy arm was 92 % , compared to 47 % in the no-chemotherapy arm ( P = 0.006 ) . Actuarial 3-year overall survival in the chemotherapy arm was 82 % , compared to 61 % in the no-chemotherapy arm ( P = 0.18 ) . An additional 26 patients were treated in an identical fashion , but were not part of the randomized trial because of contraindications to chemotherapy , refusal to enter the randomized trial , or because they were treated before 1977 in a trial in which all patients received chemotherapy . Considering the entire group of 57 patients , follow-up ranged from 10 to 86 months ( median , 35 months ) . Local control was achieved in 46 patients ( 81 % ) ; 3-year actuarial disease-free and overall survivals were 67 % and 77 % , respectively . A tendency toward improved disease-free survival was apparent among patients treated with chemotherapy ( P = 0.018 ) , but there was no statistically significant improvement in overall actuarial survival ( P = 0.46 ) . The subgroup of patients with sarcomas of the trunk ( 39 patients ) demonstrated the greatest benefit from chemotherapy , with regard to disease-free survival ( P less than or equal to 0.001 ) . The most significant toxicity associated with chemotherapy was doxorubicin-induced cardiomyopathy , which resulted in clinically apparent congestive heart failure in five patients . Thus , the use of chemotherapy when combined with aggressive local measures appears to improve disease-free survival , but additional patients and longer follow-up are necessary to determine if improved overall survival will result .

adjuvant chemotherapy

adjuvant chemotherapy

resection of gross tumor

postoperative radiotherapy

chemotherapy

no-chemotherapy

chemotherapy

chemotherapy

doxorubicin-induced

chemotherapy

actuarial disease-free survival

overall actuarial survivals

Local control

disease-free survival

overall actuarial survival

disease-free survival

toxicity

doxorubicin-induced cardiomyopathy

congestive heart failure

disease-free survival

overall survival

adults


The treatment of senile dementia associated with cerebrovascular insufficiency : a comparative study of buflomedil and dihydrogenated ergot alkaloids . Seventy-six patients took part in a randomized , comparative study of the efficacy of buflomedil hydrochloride and dihydrogenated ergot alkaloids in the treatment of senile dementia associated with cerebrovascular insufficiency . Efficacy was assessed by the patients ' performance in four psychometric tests . The results showed that a trend in favour of the buflomedil group in three of the tests became statistically significant in the fourth . Both drugs appeared to be safe , causing no marked adverse reactions . In conclusion , buflomedil is as effective or more effective than dihydrogenated ergot alkaloids in the treatment of senile dementia associated with cerebrovascular insufficiency and could prove a valuable addition to long-term therapy if further studies support the trend shown in this study .

buflomedil

dihydrogenated ergot alkaloids

buflomedil hydrochloride

dihydrogenated ergot alkaloids

senile dementia

senile dementia

Efficacy

psychometric tests

safe

adverse reactions

senile dementia

dihydrogenated


Neuroleptic-related dyskinesias in autistic children : a prospective study .

Neuroleptic-related dyskinesias

autistic


[ Randomized control study of high-dose metoclopramide in the prevention of CDDP-induced emesis ] . The effect of high-dose metoclopramide ( 2 mg/kg , 4 times every 2 hours ) on the emesis of patients treated with CDDP ( 80 mg/m2 ) was examined by randomized control trial . The above metoclopramide regimen significantly suppressed the frequency of vomiting on the day of CDDP administration . The duration of nausea and anorexia after CDDP treatment was also shortened by high-dose metoclopramide administration .

metoclopramide

high-dose metoclopramide ( 2 mg/kg

metoclopramide

metoclopramide

CDDP-induced emesis ]

emesis

suppressed the frequency of vomiting

nausea and anorexia


[ Clinical trials with pirprofen and naproxen in patients with gonarthrosis and coxarthrosis ] .

pirprofen

naproxen

gonarthrosis and coxarthrosis


Interference on metabolism induced by muzolimine and chlorthalidone in type II hypertensive diabetics . There is a very high prevalence of hypertension in diabetic subjects , which makes it necessary to use an antihypertensive drug with the least possible metabolic interference . For example , in the early phase of hypertension , diuretics usually worsen the metabolic equilibrium . According to recent reports , a new diuretic , muzolimine ( MZ ) , which acts on the loop of Henle , seems to present a minor effect on carbohydrate metabolic balance . In order to determine whether this assumption was correct or not , we carried out a clinical trial on 26 type II ( non-insulin-dependent ) diabetics , in fairly good metabolic control and with moderate hypertension ( orthostatic diastolic pressure from 100 to 115 mmHg ) , comparing the effect of MZ with those of chlorthalidone ( CL ) . According to a randomized , single-blind cross-over design , the patients were treated with MZ ( 20 mg/day ) or CL ( 50 mg/day ) for the duration of 4 weeks . After the treatment period with the first drug , there was a 2 week wash-out period on placebo ( PL ) before the second drug was given . During the study , a set of metabolic and non-metabolic parameters was monitored , as were the clinostatic and orthostatic blood pressure values . The results show that the antihypertensive effect of the two drugs was the same ( both caused a more than 10 % decrease in systolic and diastolic blood pressure ) . No significant changes in plasma electrolyte levels occurred . There was a significant ( p less than 0.05 ) increase in urinary aldosterone excretion after CL ( 20.7 +/- 11 micrograms/24 hours vs. 13.3 +/- 8.5 after PL , and 14.5 +/- 7.2 after MZ ) ( mean values +/- standard deviations ) . ( ABSTRACT TRUNCATED AT 250 WORDS )

muzolimine

chlorthalidone

antihypertensive drug

muzolimine ( MZ )

MZ

chlorthalidone ( CL )

MZ

CL

placebo

metabolic equilibrium

metabolic and non-metabolic parameters

antihypertensive effect

systolic and diastolic blood pressure

plasma electrolyte levels

urinary aldosterone excretion

type II hypertensive diabetics .

hypertension in diabetic subjects


Immunotherapy using BCG during remission induction and as the sole form of maintenance in acute myeloid leukaemia . Thirty-two adults with acute myeloid leukaemia ( AML ) were randomized to receive , from the time of diagnosis , either chemotherapy alone ( C group ) or chemotherapy plus Bacille Calmette-Guérin vaccine ( BCG ) ( C+I group ) . After remission induction and consolidation , chemotherapy was stopped in both groups but BCG was continued in the C+I group . The overall survival of the C+I group was significantly increased ( P less than 0.05 ) . There was no significant increase in the duration of first remission in the C+I group ( 0.05 less than P less than 0.1 ) nor in the time from first relapse to death ( 0.05 less than P less than 0.1 ) . There was no significant difference in the incidence of first or second remissions , and the time taken to enter remission did not differ significantly between the two groups . Comparison with the results of other trials suggests that the use of maintenance chemotherapy in addition to immunotherapy produces longer remissions . Five patients in the C group developed leukaemic central-nervous-system ( CSN ) involvement , in comparison with none in the C+I group . CNS relapse did not produce a significant decrease in remission length ( P greater than 0.1 ) but reduction in survival after CNS relapse was highly significant ( P = 0.001 ) . These results suggest that administration of BCG from an early stage in the treatment of AML may protect the CNS against leukaemic infiltration and therefore serve as a simple , innocuous form of CNS prophylaxis .

Immunotherapy

BCG

chemotherapy alone

survival

duration of first remission

first relapse to death

incidence of first or second remissions

time taken to enter remission

remissions

remission length

survival

leukaemic infiltration

prophylaxis

acute myeloid leukaemia .

Thirty-two

adults


Prophylactic lidocaine in the early phase of suspected myocardial infarction . Four hundred two patients with suspected myocardial infarction seen within 6 hours of the onset of symptoms entered a double-blind randomized trial of lidocaine vs placebo . During the 1 hour after administration of the drug the incidence of ventricular fibrillation or sustained ventricular tachycardia among the 204 patients with acute myocardial infarction was low , 1.5 % . Lidocaine , given in a 300 mg dose intramuscularly followed by 100 mg intravenously , did not prevent sustained ventricular tachycardia , although there was a significant reduction in the number of patients with warning arrhythmias between 15 and 45 minutes after the administration of lidocaine ( p less than 0.05 ) . The average plasma lidocaine level 10 minutes after administration for patients without a myocardial infarction was significantly higher than that for patients with an acute infarction . The mean plasma lidocaine level of patients on beta-blocking agents was no different from that in patients not on beta blocking agents . During the 1-hour study period , the incidence of central nervous system side effects was significantly greater in the lidocaine group , hypotension occurred in 11 patients , nine of whom had received lidocaine , and four patients died from asystole , three of whom had had lidocaine . We can not advocate the administration of lidocaine prophylactically in the early hours of suspected myocardial infarction .

Prophylactic lidocaine

lidocaine

placebo

Lidocaine

lidocaine

lidocaine

lidocaine

lidocaine

lidocaine

incidence of ventricular fibrillation

sustained ventricular tachycardia

sustained ventricular tachycardia

average plasma lidocaine level

minutes after

mean plasma lidocaine level

hypotension

died

Four hundred two

myocardial infarction


A randomized comparative trial of combined versus alternating therapy with cytostatic drugs and high-dose medroxyprogesteron acetate in advanced breast cancer . A prospective multicenter trial was conducted in 155 consecutive patients with Stage IV breast cancer randomly allocated to receive either ( 1 ) vincristin ( V ) 1.2 mg/m2 ( maximum dose , 2 mg ) , Adriamycin ( A ) ( doxorubicin ) 40 mg/m2 , and cyclophosphamide ( C ) 500 mg/m2 , all intravenously on day 1 , every 4 weeks , in combination with medroxyprogesteron acetate ( MPA ) 600 mg orally on days 1 through 14 , 500 mg intramuscularly on days 1 through 28 , and twice weekly afterwards ( combined chemoendocrine approach ) or ( 2 ) the same combination chemotherapy ( VAC ) for three cycles alternating with MPA in the above-mentioned dosage during 8 weeks ( alternating chemoendocrine approach ) . Results show an overall response rate of 73 % with 26 % complete responses in the combined treatment arm , whereas in the alternating arm , an overall response rate of 76 % with 20 % complete responses was observed . In patients with more than one metastatic site , response rate was higher in the combination treatment , and only in this arm were complete responses observed in these patients . Although the median duration of response was long in both treatment arms ( combination , 19 months versus alternating , 21 months ) , the median overall survival in both groups was not definitely prolonged ( 22 versus 24 months , respectively ) . However , results in subsets of patients suggest that the alternating chemoendocrine approach may be better for estrogen receptor ( ER ) -negative patients , for patients younger than 51 years of age , and for patients with a disease-free interval of 1 year or less . Patients with these parameters probably belong to the same population . It is concluded that combination of chemotherapy and high-dose MPA may be indicated in ER-positive patients when a clinical response is urgently needed . In ER-negative patients , the alternating use of both treatment modalities deserves further investigation .

vincristin ( V )

Adriamycin ( A ) ( doxorubicin )

cyclophosphamide ( C )

medroxyprogesteron acetate ( MPA )

overall response rate

overall response rate

response rate

median duration of response was long

overall survival

advanced breast cancer


Chemotherapy with cyclophosphamide , doxorubicin , vincristine , and prednisone alone or with levamisole or with levamisole plus BCG for malignant lymphoma : a Southwest Oncology Group Study . Between 1977 and 1983 the Southwest Oncology Group ( SWOG ) evaluated chemotherapy alone ( cyclophosphamide , doxorubicin , vincristine , prednisone ; CHOP ) or chemoimmunotherapy ( CHOP-levamisole or CHOP-levamisole-BCG ) in a randomized prospective clinical trial involving 715 eligible patients with all types of malignant lymphoma ( ML ) . Of 281 evaluable patients with favorable histologic types of ML , 171 ( 61 % ) achieved complete remission ( CR ) and there was no difference in CR rate , CR duration , or survival according to the type of initial treatment . Of 388 evaluable patients with unfavorable histologic types of ML , 194 ( 50 % ) achieved CR . Levamisole appeared to adversely affect CR rates in nodular mixed and nodular large-cell lymphoma and CR duration in patients with unfavorable histology ML . Chemoimmunotherapy with levamisole or levamisole-BCG offers no advantage in terms of CR rates , CR duration , or survival compared to CHOP chemotherapy alone , and levamisole may have had an adverse impact on outcome in certain subtypes of ML .

Levamisole

CHOP chemotherapy

levamisole

complete remission ( CR )

CR rate , CR duration , or survival

CR

CR rates

CR duration

CR rates

CR duration ,

or

survival

malignant lymphoma

ML


Hodgkin 's disease in childhood and adolescence : results of chemotherapy-radiotherapy in clinical stages IA-IIB . From April 1972 to May 1980 , 72 children and adolescents ( aged 5 to 19 years old , median 16 ) with Hodgkin 's disease , clinical stages IA-IIB ( IA , 18 ; II2A , two areas involved on the same side of the diaphragm , 23 ; II3+A , three areas or more , 16 ; IIB , 15 ) were prospectively treated in two successive clinical trials ( H 72 and H 77 ) . Clinical stages IA and II2A received three courses of mechlorethamine , Oncovin , procarbazine , and prednisone ( MOPP ) and supradiaphragmatic radiotherapy ( 40 Gy ) , and no laparotomy was performed . Clinical stages II3+A and IIB received either six cycles of MOPP ( H 72 ) , three cycles of MOPP , or three cycles of CCNU , vinblastine , procarbazine , and prednisone ( CVPP ) ( H 77 ) and subsequently had a laparotomy followed by supradiaphragmatic radiotherapy and a lumboaortic field if results of laparotomy were positive . Patients without evidence of mediastinal involvement did not have mediastinal radiotherapy . At the completion of therapy , the disease in 70 of 72 patients was in complete remission ( one failure , one death during treatment ) . Eight patients relapsed ( in situ , 1 ; marginal , 1 ; nonirradiated subdiaphragmatic area , 6 ) after three to 57 months of complete remission ( median 20 months ) ; one patient died after relapse . There were three deaths after complete remission of the disease ( infection , two ; acute nonlymphocytic leukemia [ ANLL ] , one ) . As of June 1984 the median follow-up was 82 months ( range , 49 to 145 months ) , the actuarial probabilities for survival and freedom from relapse for all patients being 91.6 % and 87.6 % , respectively . There was no statistical difference according to clinical stage , age ( greater than 15 or less than 15 years ) , sex , or number of cycles of chemotherapy ( six or three ) . Bone growth defects related to radiotherapy were reduced particularly in the 29 patients who did not receive mediastinal radiotherapy . None of these patients had a mediastinal relapse . Azoospermia was the rule for the male patients studied , but young girls and young women retained reproductive integrity .

no laparotomy

MOPP

CCNU , vinblastine , procarbazine

prednisone

laparotomy

supradiaphragmatic radiotherapy

failure

death

relapsed

deaths

nonlymphocytic leukemia

number of cycles of chemotherapy

mediastinal relapse

Azoospermia

Hodgkin 's disease

childhood

adolescence

children

adolescents

Hodgkin 's disease

mediastinal involvement


Double-blind trial comparing the effectiveness of the homeopathic preparation Galphimia potentiation D6 , Galphimia dilution 10 ( -6 ) and placebo on pollinosis . The preparation of homeopathic drugs is based on potentiation . In this potentiation the primary substance is specially mixed with a carrier ( typically 90 % ethanol ) in the ratio 1:10 . Usually this potentiation is done repeatedly and the final drug is labeled , e.g. , " D6 " which means a 6 times decimal potentiation . In a controlled randomized strictly double-blind trial with 164 patients the effectiveness of homeopathically prepared Galphimia D6 , a conventional Galphimia dilution 10 ( -6 ) and a placebo was investigated for the therapy of pollinosis . The average duration of treatment was about 5 weeks . Although no statistical significance was achieved , it is remarkable that there was a clear trend for the superiority of Galphimia D6 while the Galphimia dilution 10 ( -6 ) was about equally effective compared with placebo . The study itself demonstrates that it is possible to do strictly controlled trials for homeopathic drugs and with medical practitioners .

Galphimia dilution 10 ( -6 )

placebo

homeopathic drugs

ethanol

Galphimia D6

Galphimia dilution

placebo

Galphimia D6

placebo

homeopathic drugs

average duration of treatment

superiority

pollinosis .

pollinosis .


New drug trials in attention deficit disorder .

New drug trials


Relief of pain by infusion of morphine after operation : does tolerance develop ? To see whether continuous intravenous infusion of opiates provides more effective postoperative relief of pain than conventional intramuscular injection these regimens were compared in a prospective double blind trial . Thirty patients undergoing elective cholecystectomy were allocated randomly to receive an infusion of morphine or an infusion of placebo ( control group ) for 24 hours . Both groups were allowed supplementary morphine boluses as requested . During the first 48 hours after operation the degree of pain was almost identical between the groups . Surprisingly , the group that was given the infusion of morphine received as much supplementary morphine as the control group during the first 24 hours and appreciably more during the 24 hours after the infusion had been withdrawn . Nausea and vomiting were more prevalent among the patients given the infusion of morphine . These results suggest that continuous infusion of morphine may be an inferior regimen to intermittent bolus administration in the relief of postoperative pain . This may be explained by the development of tolerance in patients who received the infusion of morphine .

morphine

morphine

placebo

morphine

morphine

morphine

morphine

morphine .

pain

tolerance

postoperative relief of pain

degree of pain

Nausea and vomiting

relief of postoperative pain

tolerance

Thirty

cholecystectomy


Controlled trial of induction of labor by vaginal suppositories containing prostaglandin E2 . A group of 84 women at 39-43 weeks of pregnancy were randomly allocated to a blind trial of induction of labor with vaginal suppositories containing inert material or either 0.2 mg or 0.4 mg of prostaglandin E2 . The suppositories were self-administered every two hours during waking hours on two successive days until labor started or 15 had been used . Side-effects were absent . Labor was established within 48 hr of insertion of the first suppository in 9.3 % of control patients , 65.4 % of those treated with 0.2 mg PGE2 and 85.7 % of those treated with 0.4 mg PGE2 . The mean Apgar scores in the three groups were the same . The mean total dose of PGE2 were 2.0 mg ( 0.2 mg group ) and 2.3 mg ( 0.4 mg group ) . It is concluded that vaginal PGE2 is an effective and acceptable method of inducing labor at term .

suppositories

prostaglandin E2

suppositories

inert material

prostaglandin E2

labor

labor

Labor was established

mean Apgar scores

mean total dose of PGE2

vaginal PGE2

method of inducing labor at term .

84 women at 39-43 weeks of pregnancy


Drug preference in normal volunteers : effects of age and time of day . These experiments assessed the influence of two variables , age of subjects and time of drug administration , on the reinforcing properties of amphetamine and of diazepam in normal volunteers . Three groups of subjects were tested : i ) a group of 40-55-year-old subjects ( AGE group ; N = 11 ) who were tested in the morning , ii ) a group of 21-35-year-old subjects ( CTL group ; N = 12 ) who were also tested in the morning , and iii ) a group of 21-35-year-olds who were tested in the late afternoon ( AFT group ; N = 13 ) . All subjects participated in three separate experiments comparing one drug ( 5 mg d , l-amphetamine , 5 mg diazepam or 10 mg diazepam ) to placebo . Each experiment consisted of nine sessions : On the first four sessions subjects sampled two color-coded capsules on alternate sessions and on the following five sessions they chose and ingested the capsule they preferred . Subjective effects of the drugs were monitored using the Profile of Mood States ( POMS ) and a shortened version of the Addiction Research Center Inventory ( ARCI ) . Subjects in all three groups chose 5 mg diazepam as often as placebo but preferred placebo to 10 mg diazepam . In contrast , they chose amphetamine either as often as or more often than placebo . The subjective effects of diazepam ( i.e . sedation ) were similar across all three groups , but after amphetamine the AGE group showed greater stimulant effects . In addition , the AFT group showed fewer positive mood effects after amphetamine than the CTL group . ( ABSTRACT TRUNCATED AT 250 WORDS )

amphetamine

diazepam

d , l-amphetamine

diazepam

diazepam

placebo

diazepam

diazepam

amphetamine

diazepam

Profile of Mood States ( POMS )

a group of 40-55-year-old subjects

N = 11

a group of 21-35-year-old subjects

a group of 21-35-year-olds


A comparative study of methyldopa and labetalol in the treatment of hypertension . 1 Twenty patients with essential hypertension completed a double-blind , dose-tritrated , cross-over comparison of methyldopa and labetalol . 2 Average lying BPs ( systolic/diastolic ) were reduced by 28/15 mmHg with methyldopa and by 23/15 mmHg with labetalol . 3 Average standing BPs ( systolic/diastolic ) were reduced by 29/14 mmHg with methyldopa and by 29/15 mmHg with labetalol . 4 Both lying and standing heart rates were reduced with labetalol . 5 It is concluded that the antihypertensive properties of labetalol and methyldopa are similar but that larger patient populations are needed to study the relative incidence of subjective adverse effects .

methyldopa

labetalol

methyldopa

labetalol

methyldopa

labetalol

methyldopa

labetalol

labetalol

labetalol

methyldopa

hypertension .

lying and standing heart rates

antihypertensive properties

hypertension

Twenty


[ The use of cephalosporins in hospital practice ] .

cephalosporins


Nutrient retention in preterm infants fed standard infant formulas . Our purpose was to compare nitrogen , mineral , and zinc balance in preterm infants fed standard infant formulas , Similac With Iron and Similac With Whey + Iron . Nitrogen and magnesium balances were similar during both feeds , and met estimated fetal requirements . Infants absorbed and retained ( milligrams per kilogram per day ) more calcium , phosphorus , and zinc when fed Similac With Iron . However , retention of calcium , phosphorus ( both formulas ) , and zinc ( Similac With Whey + Iron ) was inadequate to meet estimated fetal requirements . These findings are important in the rapidly growing preterm infant , who is already at risk for the development of rickets and zinc deficiency and may be fed either formula on discharge from the newborn nursery .

standard infant formulas

Similac With Iron

Nitrogen and magnesium balances

calcium , phosphorus , and zinc

preterm

preterm

preterm infant


Response to tubular airway resistance in normal subjects and postoperative patients . Critically ill patients must often breathe spontaneously through an endotracheal tube that acts as a fixed inspiratory and expiratory tubular airway resistor . Although this practice is common , its effect on the pattern of breathing is not known . The mean breathing patterns of seven normal , healthy male subjects and eight male patients who had undergone upper abdominal surgery 2-4 days previously were studied breathing through a mouthpiece fitted in random order with a 5 , 6 , 7 , 8 , or 15 mm diameter ( 17 mm long ) resistor . These diameters were selected because they simulate the pressure-flow relationships of adult endotracheal tubes . With the 15 mm aperture , the patients had a greater breathing frequency ( f ) than did the normal subjects ( 21 +/- 5 [ SD ] vs. 14 +/- 4 breaths/min , P less than 0.01 ) as well as a smaller mean tidal volume ( VT ) . In both groups , minute ventilation ( VE ) and f progressively decreased as resistance was increased by decreasing the aperture size from 15 to 16 mm . In the normal subjects but not the patients , VT also progressively decreased . When the diameter was decreased from 6 mm to 5 mm , there were increases in VT and decreases in f that were more marked in the normal subjects . In both groups , the changes in VE were accompanied by decreases in mean and peak inspiratory and expiratory flow rates . Throughout the study , oxygen consumption ( VO2 ) and carbon dioxide production ( VCO2 ) did not change . This , coupled with the decreases in VE resulted in decreases in the ventilatory equivalents to CO2 and O2 ( VE/VCO2 , VE/VO2 ) . ( ABSTRACT TRUNCATED AT 250 WORDS )

tubular airway resistance

endotracheal tube

breathing frequency ( f )

mean tidal volume ( VT ) .

minute ventilation ( VE )

f

VT

VT

f

changes in VE

normal

Critically ill

seven

normal , healthy

male

eight

male


An analysis of the mortality effect in a breast cancer screening study . In order to better understand the effect of breast cancer screening on mortality , we use the theory of competing risks to analyse deaths from the long-term follow-up of the HIP breast cancer screening trial . We conclude that some , but not all , of the breast cancer cases detected early as a result of screening realized a benefit in terms of elimination of the risk of breast cancer mortality . Breast cancer screening appears not to affect the rate of mortality from causes of death other than breast cancer . Methodologically , we demonstrate the importance of analysing mortality separately for the breast cancer cases as well as for the entire population in a trial .

breast cancer screening

HIP breast cancer screening trial

screening

Breast cancer screening

breast cancer mortality .

rate of mortality

breast cancer

breast cancer

HIP breast cancer

breast cancer

breast cancer

breast cancer


Zinc and copper balances in preterm infants . Preterm infants are at risk for copper and zinc depletion if sufficient quantities of these nutrients are not provided in a bioavailable form in postnatal life . The purpose of this study was to determine whether the use of a whey-predominant , 50 % medium chain triglyceride formula with relatively high concentrations of zinc and copper would promote the achievement of the in utero accretion rate for zinc and copper in the preterm infant . Two groups of five preterm infants were fed a diet containing 12.5 mg/L of zinc and either 0.9 mg/L or 2.1 mg/L of copper . Seventy-two-hour metabolic balance studies were performed at an average postconceptual age of 34 weeks and an average weight of 1,549 g. All infants were in positive zinc balance and nine of ten achieved the in utero accretion rate for zinc for a 34-week gestation fetus ( greater than or equal to 0.432 mg/d ) . Three infants receiving the high copper formula and two receiving the lower copper formula were in positive copper balance . Two infants from each group achieved the in utero accretion rate for copper for a 34-week gestation fetus ( 0.088 mg/d ) . A formula that provides 12.5 mg/L of zinc permits positive zinc balance and zinc retention similar to in utero rates . A formula that provides as much as 2.1 mg/L of copper , however , may not always permit positive copper balance .

Zinc and copper balances

copper

12.5 mg/L of zinc

0.9 mg/L or 2.1 mg/L of copper .

Zinc and copper balances

positive zinc balance

in utero accretion rate for zinc

positive copper balance

preterm

infants

infants

preterm

infant

five


Haemodynamic profile of angiotensin II antagonism in essential hypertensive patients . 1 . The haemodynamic response to antagonistic ( 10 microgram min-1 kg-1 ) and agonistic ( 40 microgram min-1 kg-1 ) doses of saralasin was studied in young essential hypertensive patients . Blood pressure behaviour alone was thought to be inadequate to describe the response pattern . 2 . Pre-saralasin setting of the renin-angiotensin axis was varied with salt intake ( 15 and 290 mmol of Na+/day ) each for 10 days . This failed to influence blood pressure or plasma volume . 3 . Antagonist blockade after low salt lowered blood pressure in three patients with the highest plasma renin values . Cardiac output rose in two of these , but it dropped in all others . 4 . Decreases in cardiac output occurred with both doses of saralasin and even with suppression of the renin-angiotensin axis . This response is therefore unlikely to be due to removal of myocardial or venous angiotensin effects . 5 . The renin-angiotensin system played a part in maintenance of blood pressure only with severe salt restriction and in a small proportion of cases . 6 . No heart rate effect was seen with sarcalasin . 7 . Blood pressure and total peripheral resistance responses were dependent on pre- ( antagonist/agonist ) setting , but heart rate and cardiac output were not influenced by this factor .

angiotensin II antagonism

antagonistic

agonistic

saralasin

renin-angiotensin axis

Blood pressure behaviour

blood pressure or plasma volume .

blood pressure

Cardiac output

cardiac output

blood pressure

heart rate effect

heart rate

cardiac output


Effect of increasing doses of labetalol on blood pressure , plasma renin activity and aldosterone in hypertensive patients . 1 . Four different doses of labetalol ( 150 , 300 , 600 and 900 mg/day ) were given for 1 week to each of four groups of patients with essential hypertension ( six patients for each group ) . 2 . Labetalol decreased mean blood pressure and heart rate to the same extent on the first and the seventh days of treatment . Only standing blood pressure showed a dose-dependent inhibition both in the supine and upright position . 3 . Labetalol exerted a net inhibitory effect on plasma renin activity , which was related to basal renin values and was already maximal at the lowest doses . This effect was well maintained in the supine position . This effect was well maintained in the supine position , although during standing it tended to be less evident with increasing doses . 4 . Urinary aldosterone was decreased in a dose-dependent fashion and its changes were largely independent fashion and its changes were largely independent of plasma renin activity . 5 . Neither basal values nor changes of renin and aldosterone were related to the hypotensive effect of labetalol . 6 . During labetalol treatment urinary sodium excretion fell for 2-3 days and then returned to basal values . The retentive effect of labetalol on sodium was directly related to the decrease of blood pressure , and the successive sodium escape might be explained either by the observed increase of plasma volume ( indirectly measured by packed cell volume ) or by aldosterone inhibition .

labetalol

labetalol

Labetalol

Labetalol

labetalol

labetalol

blood pressure

plasma renin activity

aldosterone

blood pressure

heart rate

blood pressure

plasma renin activity

Urinary aldosterone

basal values nor changes of renin

aldosterone

urinary sodium excretion fell

blood pressure

successive sodium escape

hypertensive

essential hypertension

six


The effect of polyvinylpyrrolidone-iodine as an disinfectant in eye surgery . 105 patients admitted for cataract surgery were treated pre-operatively with polyvinylpyrrolidone-iodine ( PVP-I ) as a disinfectant , and consecutive bacterial cultures were obtained before initiating surgery and at the end of the operation . A control group ( n = 99 ) only had a standard disinfection procedure of the eye ( including instillation of Terramycin cum polymyxin B cream in the conjunctival sac the evening before surgery ) . The cultures obtained from the conjunctival sac of the control group principally showed growth of Staph . albus and Staph . aureus , and to a minor degree diphtheroids ( Corynebacterium species ) . Proteus mirabilis , Escherichia coli and micrococci . There was a significant quantitative diminished growth ( P less than 0.05 ) of bacteria in the group of patients treated with PVP-I compared to the control group . Concerning the growth of Staph . albus , this was reduced to almost one third and other bacteria were almost eliminated in the group receiving PVP-I . As we disclosed no toxic or allergic reaction post-operatively which could be related to the use of PVP-I as a disinfectant , this agent seems to constitute an effective pre-operative antimicrobial treatment , taking into consideration the broad antimicrobial spectrum of PVP-I shown by other authors .

polyvinylpyrrolidone-iodine

polyvinylpyrrolidone-iodine ( PVP-I )

standard disinfection procedure

Terramycin cum polymyxin B cream

PVP-I

PVP-I

PVP-I

PVP-I

disinfectant

standard disinfection

effective

cataract


[ Aortofemoral bifurcation bypass . Effect of the anesthesia procedure ( NLA , thoracic continuous catheter peridural anesthesia ) on circulation , respiration and metabolism . Homeostasis and oxygen transport ] . 50 patients were investigated during induction of anaesthesia and infrarenal aortic bypass surgery . 26 were operated on under neuroleptanaesthesia ( NA group ) and 24 under continuous epidural combined with a light general anaesthesia ( epidural group ) . Blood losses were replaced with 5 per cent human albumin , red cell concentrates , and fresh frozen plasma . Ringer lactate solution was used to replace the functional extracellular fluid volume . During induction and maintenance of anaesthesia body temperature fell ( NA group from 36.7 to 35.3 degrees C ; epidural group from 36.7 to 34.9 degrees C ) but no statistically significant difference could be found between the groups , in spite of better surface perfusion of the lower part of the body in the epidural group . The increase of plasma glucose concentration was lower in the epidural group as compared to the NA group . Stress mediated hypokalaemia was of the same degree in both groups , the median values of the plasma potassium concentrations being in the lower reference range ( 3.5-3.7 mmol X 1 ( -1 ] , although large amounts of red cell concentrates were given . During clamping of the aorta a moderate compensated acidosis developed in both groups . Declamping caused a more marked increase of paCO2 and a greater fall of pH in the NA group as compared to the epidural group . Induction of anaesthesia was followed by a fall in oxygen uptake ( NA group from 221 to 163 ml X min-1 ; epidural group from 230 to 189 ml X min-1 ) which appears to be delayed in the epidural group , with a short lasting statistically significant difference between the groups after eventration of the gut ( NA group : 162 ml X min-1 less than epidural group 184 ml X min-1 ) . Later on , oxygen uptake was equal in both groups , with no further changes due to clamping or declamping of the aorta . At the end of the operation , when nitrous oxide had been turned of , the oxygen uptake increased considerably in several patients , despite continuing artificial ventilation and intravenous hypnotics and analgesics having been given . Eventration and exterioration of the gut caused the most marked changes in haemodynamics and oxygen transport with significant differences between the groups . Immediately after eventration there was a sudden fall in paO2 in both groups ( NA group from 99 to 83 mm Hg ; epidural group from 96 to 84 mm Hg ) and an increase of the calculated intrapulmonary right-to-left-shunt ( NA group from 7 to 21 % ; epidural group from 10 to 19 % ) . ( ABSTRACT TRUNCATED AT 400 WORDS )

Aortofemoral bifurcation bypass

infrarenal aortic bypass surgery

neuroleptanaesthesia ( NA group )

Ringer lactate solution

surface perfusion

plasma glucose concentration

Stress mediated hypokalaemia

moderate compensated acidosis

marked increase of paCO2

greater fall of pH

fall in oxygen uptake

oxygen uptake

oxygen uptake

anaesthesia

infrarenal aortic bypass surgery

neuroleptanaesthesia

light general anaesthesia


Prevention of premature labor by 17 alpha-hydroxyprogesterone caproate . Eighty pregnant women at high risk of giving birth prematurely were divided randomly into two groups . Treatment with either 17 alpha-hydroxyprogesterone caproate , 250 mg by intramuscular injection once a week , or a placebo was given in a double-blind fashion . Imminent premature labor occurred in 29.0 % of the treated group and in 59.4 % of the control group ( p less than 0.025 ) . The rate of premature deliveries was also significantly lower in the treated group ( 16.1 % ) than in the control group ( 37.82 % ) ( p less than 0.05 ) . There were no cases of perinatal death or fetal malformations in either group . The mean birth weight of all infants of the treated group was significantly higher than in those of the control group ( 3111.9 +/- 905 gm versus 2680 +/- 813.4 gm , p less than 0.05 ) . The results support treatment with progesterone caproate for the prevention of premature labor .

17 alpha-hydroxyprogesterone caproate

17 alpha-hydroxyprogesterone caproate

placebo

control

progesterone caproate

rate of premature deliveries

perinatal death

fetal malformations

mean birth weight

Eighty

pregnant women

high risk of giving birth prematurely


Psychophysiological outcome of behavioral and pharmacological treatments of agoraphobia .

behavioral

pharmacological treatments

Psychophysiological

agoraphobia .


Therapist success and its determinants . This study examined the relatively unexplored contribution of the therapist 's performance in determining outcomes of treatment . Nine therapists were studied : three performed supportive-expressive psychotherapy ; three , cognitive-behavioral psychotherapy ; and three , drug counseling . Profound differences were discovered in the therapists ' success with the patients in their case loads . Four potential determinants of these differences were explored : patient factors ; therapist factors ; patient-therapist relationship factors ; and therapy factors . Results showed that patient characteristics within each case load ( after random assignments ) were similar and disclosed no differences that would have explained the differences in success ; therapist 's personal qualities were correlated with outcomes but not significantly ( mean r = .32 ) ; an early-in-treatment measure of the patient-therapist relationship , the Helping Alliance Questionnaire , yielded significant correlations with outcomes ( mean r = .65 ) ; among the therapy techniques , " purity " provided significant correlations with outcomes ( mean r = .44 ) , both across therapists and within each therapist 's case load . The three therapist-related factors were moderately associated with each other .

Therapist success

therapist 's performance

patient factors ; therapist factors

patient-therapist relationship factors

therapy factors

therapist 's personal qualities

purity


Prospectively randomized toxicity study of high-dose versus low-dose treatment strategies for lymphoblastoid interferon . It is unclear from preliminary laboratory studies whether a high- or a low-dose interferon treatment strategy is optimal . As part of an ongoing study of mechanisms of interferon action , we have evaluated toxicity in a two-arm protocol in which patients were randomly assigned to receive lymphoblastoid interferon by either a low-dose treatment strategy ( 2 X 10 ( 6 ) units/m2 daily X 28 days then daily X 5 days every other week by im injection ) or a high-dose treatment strategy ( 5 X 10 ( 6 ) units/m2 by continuous iv infusion over 24 hours , escalating by 5 X 10 ( 6 ) units/m2/day as tolerated over 10 days , repeated every 28 days ) . The main toxic effects in both arms were fever , fatigue , and anorexia . Marked interpatient differences within each dose arm were greater than differences between arms . Additional significant toxic effects included nausea and vomiting , hypotension , leukopenia , thrombocytopenia , and evidence of hepatic toxicity . Minor changes in serum electrolytes were noted . Coagulation studies were normal . The dose-limiting toxic effect for the high-dose arm was myelosuppression . Median maximum tolerated dose among high-dose strategy patients was 18 X 10 ( 6 ) units/m2 , but there was marked interpatient variation . We conclude that both dose schedules were relatively well-tolerated . Because of individual variation in tolerance , high-dose treatment should include a dose escalation strategy .

lymphoblastoid interferon .

high- or a low-dose interferon

interferon

lymphoblastoid interferon

toxicity

toxicity

main toxic effects

fever , fatigue , and anorexia .

changes in serum electrolytes

Coagulation studies

toxic effect

myelosuppression

maximum tolerated dose

relatively well-tolerated .

tolerance

lymphoblastoid interferon


Mass inoculation in a community : the effect of primary prevention of stress reactions . This study assessed the effectiveness of a brief , situation-specific , group-administered preparatory intervention in a nonclient school population undergoing mass inoculation against rubella . Fifty-one girls were randomly assigned to practice , no-practice , or control groups . Both the practice and the no-practice groups received information that described the inoculation procedure and how to cope with it by using cognitive-behavioral coping skills . The practice group was encouraged to perform coping techniques of this type , whereas the no-practice group was told only that the intervention would help them during the inoculation . Subjects in both practice and no-practice groups reported less anxiety and exhibited more cooperative behavior during inoculation than subjects in the control group , and those who were guided and prompted to actively practice derived greater benefit .

mass inoculation against rubella

practice , no-practice , or

control groups

stress reactions

anxiety

cooperative behavior


Differential inhibition of bronchoconstriction by the calcium channel blockers , verapamil and nifedipine . Recent studies have demonstrated that the calcium channel blocking agents can inhibit experimentally induced bronchoconstriction in asthmatics , but their protective action has been variable . To clarify the influence of stimulus intensity and choice of calcium blocker on these reported differences in outcome , we performed noncumulative thermal stimulus-response curves using isocapnic hyperventilation of cold air in 8 asthmatics . Subjects received pretreatment with orally administered nifedipine ( 20 mg ) , intravenously administered verapamil ( 10 mg bolus followed by a continuous infusion ) , or appropriate placebos in a randomized , double-blind fashion . Verapamil afforded no consistent protection against the thermal challenges , whereas nifedipine significantly blunted the bronchoconstrictor response to stimuli of low ( p less than 0.02 ) and middle ( p less than 0.03 ) intensity . At the highest thermal burden , the effect of nifedipine was inconsistent and not significantly different from that of placebo . These results indicate that the protection from bronchoconstriction afforded by the calcium channel blockers depends on the choice of agent and the intensity of the bronchoconstricting stimulus , and they raise the possibility that the contribution of transmembrane calcium ion influx to the pathogenesis of bronchoconstriction may vary according to stimulus intensity .

calcium channel blockers

verapamil

nifedipine

calcium channel blocking agents

nifedipine

verapamil

placebos

nifedipine

placebo

calcium channel blockers

effect of nifedipine

protection from bronchoconstriction

asthmatics

asthmatics


Comparative trial of carbenicillin and ampicillin therapy for purulent meningitis . A randomized therapeutic trial of carbenicillin ( CB ) or ampicillin ( AMP ) in purulent meningitis was performed in 86 pediatric and adult patients ( 41 Haemophilus influenzae , 22 Streptococcus pneumoniae , 13 Neisseria meningitidis , and 10 of unknown etiology ) . All isolates , incuding H. influenzae , were susceptible to CB and AMP . Median cerebrospinal fluid ( CSF ) antibiotic concentrations were 0.85 and 1.60 mug/ml for CB and AMP , respectively , during administration of daily doses of 400 mg/kg and 0.65 and 0.45 mug/ml , respectively , on daily doses of 200 mg/kg . Higher CSF concentrations , up to a median concentration of 4.5 mug/ml , were observed in patients with CSF protein concentrations > /=75 mg/100 ml . Clinical responses were equivalent on either antibiotic regimen . Among AMP patients ( 45 ) , 8 had significant residua and 3 died ; among CB patients ( 41 ) , 5 had residua and none died . However , 38 % of H. influenzae patients treated with CB had positive CSF cultures on day 1 follow-up lumbar punctures , compared with only 5.8 % of AMP patients with H. influenzae . The significance of a delay of CSF sterilization among CB-treated patients is unknown , since there was no correlation between persistence of hemophilus organisms and the frequency of adverse outcome . AMP and CB are equivalent for the treatment of bacterial meningitis due to susceptible organisms .

carbenicillin

ampicillin

AMP

CB

CB

AMP

CB

Higher CSF concentrations

Clinical responses

had significant residua

died ;

positive CSF cultures

delay of CSF sterilization

purulent meningitis

pediatric

adult

41 Haemophilus influenzae

22 Streptococcus pneumoniae

13 Neisseria meningitidis

influenzae

influenzae


A study of a Self-Care Rehabilitation Program in pediatric asthma . The Self-Care Rehabilitation in Pediatric Asthma ( SCRPA ) project was designed to ascertain the level to which children with asthma are able to acquire the asthma knowledge and skills presented in a self-management training program conducted by the American Lung Association of Utah and the effect of such training on the asthma experience . The preschool SCRPA Curriculum ( ages 2-5 ) consisted of six 1-hour classes scheduled twice a week for 3 weeks . The first and last classes were for one or both parents only , and the middle four sessions were for the child and parent ( s ) . The school-age SCRPA curriculum ( ages 6-14 ) consisted of eight 90-minute classes for both child and parent ( s ) scheduled twice a week for 4 weeks . Private physicians referred 21 preschool children and 38 school-age children into the program . The school-age children were randomly assigned to a study or control group , and the preschool children served as their own controls . A comparison of asthma episodes during the 3 months before and after training showed a statistically significant decrease in the number of episodes but no change in severity in the preschool , school study , and school control groups . The decrease in episodes for the control groups suggest that the family record keeping required of all subjects may have a beneficial effect , a phenomenon worth further investigation . Also , the school-age group , in pre- and posttesting , demonstrated that the SCRPA curriculum increased knowledge and skills in the study group , changes not found in the control group .

Self-Care Rehabilitation Program

Self-Care Rehabilitation

SCRPA

decrease in the number of episodes

severity

episodes

knowledge and skills

asthma

children

asthma

asthma

preschool

( ages 2-5 )

parents

child and parent ( s )

ages 6-14

child and parent ( s )

preschool children

38 school-age children

school-age children

preschool children


Chronic lateral humeral epicondylitis -- a double-blind controlled assessment of pulsed electromagnetic field therapy . Pulsed electromagnetic fields ( PEMF ) have been shown to be beneficial in the treatment of rotator cuff tendinitis . As lateral humeral epicondylitis ( tennis elbow ) is a similar chronic tendon lesion , 30 patients with both clinical and thermographic evidence of tennis elbow were randomly allocated to receive either active or inactive PEMF therapy . Treatment was continued for a minimum period of eight weeks . At this time there was no statistical difference between the two groups .

pulsed electromagnetic field therapy

Pulsed electromagnetic fields ( PEMF )

inactive

PEMF therapy

no statistical difference


Fluorouracil as an adjuvant to surgery in carcinoma of the colon .

Fluorouracil

surgery

carcinoma of the colon


Comparison of the potassium- retaining effects of amiloride and spironolactone in hypertensive patients with thiazide-induced hypokalaemia .

amiloride and spironolactone

potassium- retaining effects

hypertensive

thiazide-induced hypokalaemia


Bites by the saw-scaled or carpet viper ( Echis carinatus ) : trial of two specific antivenoms . Echis carinatus is the most important cause of morbidity and mortality from snake bite in Nigeria and in many other parts of the world . Forty-six patients with systemic poisoning by this snake were given echis antivenom made either by the South African Institute for Medical Research ( S.A.I.M.R . ) or by Behringwerke ( North and West African polyvalent antivenom ) . A simple test of blood coagulability was used to assess whether an adequate neutralizing dose of antivenom had been given . An average of 15.2 ml S.A.I.M.R . antivenom restored normal coagulability permanently in all 23 patients in one group , but in the other group receiving an average dose of 37.9 ml Behringwerke antivenom normal clotting resulted in only 18 out of 23 patients . Local tissue swelling was similar in both groups , but local necrosis occurred in three patients treated with Behringwerke antivenom and in none given S.A.I.M.R . antivenom .

S.A.I.M.R .

Behringwerke antivenom

Behringwerke antivenom

blood coagulability

normal coagulability

normal clotting

Local tissue swelling

local necrosis

Forty-six

systemic poisoning by this snake

patients in one group


Potassium , glucose , and insulin in treatment of myocardial infarction .

Potassium , glucose , and insulin

treatment

myocardial infarction .

myocardial infarction .


Beta-cytotrophic effects of glucose , glucagon , and tolbutamide in man .

glucose

glucagon

tolbutamide

Beta-cytotrophic effects


Effects of piracetam on regional cerebral blood flow and mental functions in patients with organic dementia . The effects of piracetam ( Nootropil , UCB6215 ) on mental functions and on regional cerebral blood flow ( rCBF ) were investigated in eight patients in the presenile age who displayed symptoms of moderate dementia . The double-blind crossover design included nine measurement occasions , each involving rCBF measurement by the 133-Xe inhalation method , ratings of symptoms of dementia , personality changes , and side effects , and a psychometric investigation . Three investigations were included in each of three treatment periods . The first investigation in a period was made without medication . Then either placebo or piracetam 4.8 g/day or 9.6 g/day was given during four weeks with measurements after 2 weekks and 4 weeks . There were intervals of 4 weeks without medication between the treatment periods . Piracetam had no significant effect on either mental functions or rCBF .

piracetam

piracetam

133-Xe inhalation method

placebo

piracetam

Piracetam

cerebral blood flow

mental functions

mental functions

regional cerebral blood flow ( rCBF )

rCBF measurement

mental functions

rCBF

patients with organic dementia .

eight

patients in the

presenile


PRL-8-53 : enhanced learning and subsequent retention in humans as a result of low oral doses of new psychotropic agent . The effect of 3- ( 2-benzylmethylaminoethyl ) benzoic acid methyl ester hydrochloride ( PRL-8-53 ) on learning and on retention of verbal information in human subjects was investigated . Using the serial anticipation method under double-blind conditions it was found that PRL-8-53 causes slight improvement of acquisition . Retinetion of verbal information was found improved to a statistically significant degree ( most P values better than 0.01 , some better than 0.001 ) . No significant changes were found for either visual reaction time or motor control after drug when compared with placebo values .

psychotropic

placebo

learning

retention

learning

retention of verbal information

visual reaction time or motor control


Protective effect of 1-adamantanamine hydrochloride on influenza A2 infections in the family environment : a controlled double-blind study .

1-adamantanamine hydrochloride

infections


A multicenter investigation of lorazepam in anxiety neurosis .

lorazepam

anxiety neurosis


[ Prognostic experiences in the long-term differential therapy of chronic aggressive hepatitides ] .

Prognostic experiences

chronic aggressive hepatitides


A double-blind crossover comparison of pindolol , metoprolol , atenolol and labetalol in mild to moderate hypertension . 1 This study was designed to compare in a double-blind randomized crossover trial , atenolol , labetalol , metoprolol and pindolol . Considerable differences in dose ( atenolol 138 +/- 13 mg daily ; labetalol 308 +/- 34 mg daily ; metoprolol 234 +/- 22 mg daily ; and pindolol 24 +/-2 mg daily were required to produce similar antihypertensive effects . 3 The overall incidence of side-effects was similar with atenolol , metoprolol and pindolol but was slightly less with labetalol . Sleep disturbances and abnormal dreaming patterns were most frequent with pindolol . 4 There was a significantly greater fall in pulse rate during atenolol and metoprolol treatment periods .

pindolol

metoprolol

atenolol

labetalol

atenolol

labetalol

metoprolol

pindolol

atenolol

labetalol

metoprolol

pindolol

atenolol

metoprolol

pindolol

labetalol

pindolol

atenolol

metoprolol

dose

antihypertensive effects

side-effects

Sleep disturbances

abnormal dreaming patterns


Dipyrone for treatment of post-operative pain .

Dipyrone

post-operative pain .

post-operative pain


A study of postoperative cytostatic medication in patients with operable carcinoma of the lung .

postoperative cytostatic medication

postoperative cytostatic medication

with operable carcinoma of the lung


Auditory signal detection in paranoid and nonparanoid schizophrenics .

Auditory signal detection

Auditory signal detection

paranoid and nonparanoid schizophrenics


Letter : Cephaloridine and gentamicin in prophylaxis of surgical wound infection .

Cephaloridine

gentamicin

prophylaxis

surgical wound infection .

prophylaxis

surgical wound infection


Coagulation factor concentrate in the treatment of the haemorrhagic diathesis of fulminant hepatic failure . To assess the value of clotting factor concentrate infusions in fulminant hepatic failure , a controlled trial was performed in which nine patients were randomly allocated to treatment with either concentrate alone or concentrate plus heparin . The five patients receiving concentrate alone all died , with major bleeding as the direct cause of death in three , whereas in the four receiving heparin as well there was only one instance of bleeding and one patient survived . Clinical evidence of intravascular coagulation appeared in two patients treated with concentrate alone and the laboratory evidence of this progressed during the period of infusions in all patients in both treatment groups , although to a lesser extent in those receiving heparin . Additional evidence for intravascular coagulation came from the changes observed in factor VIII levels which , although initially high in all patients , fell subsequently , particularly in those given concentrate alone . There was some improvement in the prothrombin ratio in both groups of patients but not complete correction , and serial assays of clotting factors showed that although factor II rose to high levels during treatment , factors IX and X showed little response . Thus , the use of concentrate of factor IX in this trial , as well as potentiating intravascular coagulation , was inadequate as replacement for the clotting factor deficiencies .

Coagulation factor concentrate

clotting factor concentrate infusions

concentrate

heparin

concentrate alone

heparin

concentrate

haemorrhagic diathesis

fulminant hepatic failure .

hepatic failure

died

major bleeding

bleeding

survived .

intravascular coagulation

factor VIII levels

prothrombin ratio

factor II

factors IX and X

factor IX

intravascular coagulation

fulminant hepatic failure


[ Carticaine in the therapie of pain ( author 's transl ) ] .

Carticaine

pain

pain


On the possibility of incorporating patients from non-randomising centres into a randomised clinical trial .

patients


Comparative trial of cephacetrile versus cephaloridine in the treatment of secondary respiratory infections in childhood pertussis .

cephacetrile

cephaloridine

secondary respiratory infections

secondary respiratory infections

childhood

pertussis


[ Pivampicillin treatment of uro-genital infections in gynaecological patients . A clinical evaluation ] .

[ Pivampicillin

uro-genital infections

uro-genital infections

gynaecological


[ Psychoexperimental studies on the effect of a valepotriate combination as well as the combined effects of valtratum and alcohol ] .

valepotriate combination

valtratum and alcohol ]


[ Piribedil in arterial diseases ] .

[ Piribedil

arterial diseases ]

arterial diseases


The effect of phenytoin on the absorption of synthetic folic acid polyglutamate . The absorption of synthetic pteroyltriglutamate has been measured in nine normal students with and without the anticonvulsant drug phenytoin . It has been shown that phenytoin has no effect on the absorption of this folate polyglutamate . The reasons are discussed for the disparity between this result and those reported in the literature when folate polyglutamates derived from yeast were used .

phenytoin

phenytoin

phenytoin

folate polyglutamate


Joint study of extracranial arterial occlusion . VI . Racial differences in hospitalized patients with ischemic stroke .


Truncal vagotomy and drainage for duodenal ulcer .

Truncal vagotomy and drainage

Truncal vagotomy and drainage

duodenal ulcer .

duodenal ulcer


Mebendazole in enterobiasis : a placebo -- controlled trial in a paediatric community .

Mebendazole

placebo -- controlled

enterobiasis

enterobiasis :

paediatric


The gastric emptying and small intestinal transit after highly selective vagotomy without drainage and selective vagotomy with pyloroplasty .

gastric emptying

and

small intestinal transit

vagotomy

selective vagotomy with pyloroplasty


[ Folic acid deficiency in pregnant women in Switzerland ] .

Folic acid deficiency

women


A controlled study of early discharge after uncomplicated myocardial infarction . Out of 383 myocardial infarction ( MI ) patients aged below 70 years , 252 ( 66 % ) were judged after the third day in hospital to have had uncomplicated infarctions . These patients were allocated at random to two groups , one of which was given treatment for 8 days and the other for 15 days . No significant differences in mortality , morbidity or incapacity for work could be detected during the three-month period of follow-up . The findings thus support previous conclusions that early discharge from hospital after uncomplicated MI is not associated with greater risk for the patient than later discharge .

early discharge

early discharge

mortality

morbidity

incapacity for work

myocardial infarction

myocardial infarction ( MI )

uncomplicated infarctions .


A randomized controlled trial of ergotamine tartrate .

ergotamine tartrate

ergotamine tartrate


Persistent phenothiazine dyskinesia treated with tetrabenazine . Six patients with persistent phenothiazine dyskinesia were treated in a double-blind controlled trial with tetrabenazine 100 mg in divided dosage . In three patients the abnormal movements were abolished and in two others there was some improvement , but this was no greater than that achieved with the diazepam control . Tetrabenazine may be useful in the treatment of some patients with persistent phenothiazine dyskinesia .

tetrabenazine

tetrabenazine 100 mg in divided dosage

diazepam

Tetrabenazine

Persistent phenothiazine dyskinesia

Six

persistent phenothiazine dyskinesia


Miotics in cataract surgery .

Miotics

Miotics in cataract surgery .


New methods applied to the analysis and treatment of ovarian cancer .

New methods

ovarian cancer .


Sequential radiotherapy and chemotherapy in the treatment of Hodgkin 's disease . A progress report .

progress report .

Hodgkin 's disease .


Evaluation of rapid radiation treatment schedules utilizing two treatment sessions per day . The authors studied normal human skin reactions to two different rapid radiotherapy schedules of 2 sessions per day and evaluated their effectiveness in relief of pain and local tumor control . Patients were randomized to three treatment groups : SCHEDULE A ( control ) : conventional one treatment per day regimen totalling 3,760 rads in 22-23 days ; SCHEDULE B : 2 sessions per day totalling 3,440 rads in 10-11 days ; and SCHEDULE C : 2 sessions per day totalling 3,568 rads in 10-11 days . The pattern and magnitude of skin reactions in the three schedules are nearly identical but tumor regression and pain relief were achieved faster in the rapid fractionation schedules .

rapid radiation treatment

rapid radiotherapy schedules

rads

2 sessions per day

rads

skin reactions

tumor regression

pain relief

rapid radiation treatment


Anaerobic infection in cancer patients : comparative evaluation of clindamycin and cefoxitin . Clindamycin and cefoxitin with or without gentamicin were administered to cancer patients having localized infections presumably caused by anaerobic pathogens . The rates of favorable response were 89 % in patients receiving clindamycine alone and 78 % in patients receiving cefoxitin alone . When the total experience is considered ( clindamycin or cefoxitin with and without gentamicin ) , 20 of 24 patients ( 83 % ) responded to clindamycin and 18 of 22 ( 82 % ) responded to cefoxitin . Both therapies were well tolerated . Clindamycin was found to be more effective than cefoxitin in eradicating the offending anaerobic pathogens from the site of infection . Aerobic pathogens were frequently isolated along with anaerobes from the infectious sites in this series ; their susceptibility or resistance to clindamycin or cefoxitin did not influence the therapeutic response .

clindamycin

clindamycine alone

cefoxitin alone .

( clindamycin

cefoxitin with and without gentamicin )

clindamycin

cefoxitin .

Clindamycin

clindamycin

cefoxitin

favorable response

responded

responded

tolerated

effective

Anaerobic infection in cancer patients

20 of 24

18 of 22


Psychiatric treatment of eczema : a controlled trial . Seventy-two patients with eczema were randomly allotted to one of two treatment groups : A , those receiving dermatological treatment only , and B , those receiving the same dermatological treatment plus psychiatric treatment , limited where possible to four months . Cases were followed up at six-monthly dermatological assessments , 57 ( 79 % ) for 18 months . The findings suggest that in the presence of overt emotional disturbance , of new psychological or psychophysiological symptoms preceding the rash by up to a year , and of high motivation for it , brief psychiatric treatment improves the outcome in eczema ( the proportion clear at 18 months was about doubled ) , whereas in their absence such treatment may worsen it , especially in the short term .

Psychiatric treatment

dermatological treatment only

psychiatric treatment

presence of overt emotional disturbance

high motivation

eczema

eczema

Seventy-two

eczema


A tube spacer to improve inhalation of drugs from pressurised aerosols .

tube spacer

tube spacer


Incidence of candida in hospital in-patients and the effects of antibiotic therapy .

antibiotic therapy

Incidence of candida


Long-term heparin treatment in ischaemic heart disease . Effects on clinical condition and plasma lipids .

heparin treatment


A comparison of the effects of ( - ) -hyoscine and amylobarbitone sodium on measurements of post-rotational turning sensation and nystagmus .

( - ) -hyoscine

amylobarbitone sodium

nystagmus .


The need for chemotherapy after prolonged complete remission in acute leukemia of childhood .

chemotherapy

acute leukemia

childhood


Para-anaesthetic headache in female patients .

Para-anaesthetic headache

headache

female


Comparison of some pharmacokinetic parameters of ( + ) -cyanidanol-3 obtained with specific and non-specific analytical methods .

( + ) -cyanidanol-3

pharmacokinetic parameters

( + ) -cyanidanol-3


Propranolol vs acetazolamide . A long-term double-masked study of the effect on intraocular pressure and blood pressure .

Propranolol

acetazolamide


Effects of progressive relaxation on autonomic processes .

progressive relaxation

autonomic processes

autonomic processes .


Generalizability and durability of treatment effects in an intervention program for coronary-prone ( Type A ) managers . To test the reliability and durability of positive treatment effects obtained in a type A intervention project for healthy managers , the analysis was extended to data available from a third treatment group ( a special behavior therapy group for participants eliminated from the main sample because of manifestations of clinical CHD ) and to measures obtained 6 months following the end of treatment . Immediately after treatment all three groups showed a similar pattern of improvement , although the two behavior therapy groups did show a greater decrease in serum cholesterol levels . Six months after treatment the sample as a whole showed good maintenance of treatment effects , but the differences between groups had become somewhat sharper , with the special behavior therapy group faring best , the regular behavior therapy group intermediate , and the psychotherapy group worst . The logical consistency of these findings increases our confidence in the initial treatment results , as well as permitting cautious optimism concerning the possibility of developing effective intervention programs for coronary-type ( type A ) behavior .

intervention program

type A intervention project

a special behavior therapy group

behavior therapy

regular behavior therapy

psychotherapy

Generalizability

durability

reliability

serum cholesterol levels

good maintenance of treatment effects

coronary-prone ( Type A ) managers .


The effects of premedication with pentazocine and pethidine on respiration during general anaesthesia .

pentazocine and pethidine

respiration

general anaesthesia


Response latencies to auditory stimuli in autistic children engaged in self-stimulatory behavior .

auditory stimuli

Response latencies to auditory stimuli

children

self-stimulatory behavior


Triamcinolone acetonide in the treatment of bursitis and other foot disorders .

Triamcinolone acetonide

bursitis and other foot disorders .


One-trial learning with control of item-difficulty .

One-trial learning

item-difficulty

One-trial learning


Alcoholism , avoidance learning and emotional responsiveness .

avoidance learning

avoidance learning

emotional responsiveness .