摘要:

SummaryA new hypocholesterolaemic drug, probucol, was effective in reducing mean serum cholesterol level in 52 patients by 17% after 3 months of treatment, and in 44 patients by 23% after one year of therapy. The level of baseline serum triglyceride did not significantly affect the cholesterol-lowering response. There was no significant difference in serum triglyceride response between patients on placebo and those on probucol. Except for one patient who exhibited a hypersensitivity reaction, the drug was well tolerated.

ISSN:0300-7995    

DOI:10.1185/03007997309111689

出版商:Taylor&Francis    

年代:1973

数据来源: Taylor

摘要:

SummaryRadioiodine (131I) therapy for thyrotoxicosis has the advantages of simplicity, effectiveness and safety in patients over 40 years of age and especially in the frail and elderly when there is often associated cardiac disease.131I should not be used in children except in unusual circumstances such as drug sensitivity and refusal to have an operation. There is, however, only a relative contra-indication to its use in adults less than 40 years of age and it is the best treatment for a post-operative recurrence irrespective of the age of the patient. The physician must be sure the patient is not in early pregnancy and she should avoid this state for several months.131I therapy does not cause leukaemia, thyroid cancer nor other damage, but all patients made euthyroid are at risk to the development of hypothyroidism, although its onset may be delayed for up to 15 years; once a patient is made firmly euthyroid with131I therapy a true recurrence of thyrotoxicosis is exceptionally rare.Since131I therapy seems to destroy the whole thyroid (or damage all the cells) leading to hypothyroidism and because125I, an alternative nuclide, may not do this it is being tried in special trials. The results are very promising although it is too early to advise the routine use of125I.This final section ends with an account of the management of severe thyrotoxicosis (including crisis), thyrocardiac disease including the use ofβ-adrenergic blocking drugs. A short note on the management of thyrotoxicosis in pregnancy and in children and of eye-signs is added.In this three-part review, those aspects of causation relevant to the course and treatment of thyrotoxicosis are presented. The large majority in the United Kingdom have Graves' disease. LATS is linked in some way to Graves' disease, but its unique stimulating effect on thyroid function is puzzling as autoantibodies are usually destructive. LATS may be an antichalone which reacts with thyroid chalone, probably a 4S compound in thyroid cell sap, and so neutralises the chalone's normal inhibitory control of mitosis. This speculative hypothesis is worth further study. LATS activity correlates in a general way with control of the thyrotoxic process but as yet it has not been shown to be of value in selecting therapy or predicting its results.Antibody studies also suggest that in Graves' disease there is an inherited abnormality of immune homeostasis, which probably explains the familial nature of the condition. Patients with high titres of thyroid autoantibodies are more prone to hypothyroidism after surgery, but not after antithyroid drugs or131I therapy and this is puzzling too.The indications for, efficacy, advantages and disadvantages, and complications of antithyroid drug therapy, thyroidectomy and131I therapy are discussed in detail.There is a renewed interest in antithyroid drugs, the best of which seems to be carbimazole. The majority of young patients with Graves' disease are best treated in the first instance with carbimazole and the T3 thyroid suppression test is of some value in following the disease process and predicting remissions after antithyroid drug therapy.The results and complications of surgery are scrutinised. There is more awareness of postoperative hypothyroidism, which is more common than at one time appreciated; its frequency varies and evidence that it is cumulative is conflicting. Its incidence reflects the extent of the resection and the care taken with follow-up. Autoimmunity is a contributory factor. The frequency of permanent damage to the recurrent laryngeal nerve and of persistent severe parathyroid insufficiency is fortunately low. Changes in the voice without impairment of cord movement and biochemical parathyroid insufficiency are, however, more frequent. There is a correlation between hypoparathyroidism and recurrent laryngeal nerve damage which is related to the extent of gland mobilisation at operation. Second thyroidectomies are contra-indicated because of the risk of damage to adjacent structures and of the poor functional results achieved.The present position of131I therapy is presented. In particular, its single but significant shortcoming, namely a cumulative incidence of hypothyroidism is noted. The reasons for this are mentioned. Modifications to current practice are discussed, including a regime of reduced131I dosage supplemented by an antithyroid drug, and the use of a different isotope of iodine, namely125I.125I has different energy characteristics from131I and these are likely to restrict its irradiation effects on the thyroid cell chiefly to the area where hormone is synthesised. As a result, cell function should be impaired and the thyrotoxic process controlled while the cell nucleus should be spared and the likelihood of future hypothyroidism diminished.Brief consideration is given to current standard practice in the management of severe thyrotoxicosis, including thyroid crisis and thyrocardiacs, thyrotoxicosis in pregnancy and in children, and the ophthalmopathy of Graves' disease.

ISSN:0300-7995    

DOI:10.1185/03007997309111690

出版商:Taylor&Francis    

年代:1973

数据来源: Taylor

摘要:

SummaryAlclofenac, a new anti-inflammatory agent, has been assessed comparatively with phenylbutazone in a double-blind cross-over study including 92 patients with rheumatoid arthritis, using alclofenac at a dose of 2 g. and phenylbutazone 600 mg. daily in divided doses. Both objective measurements and subjective criteria revealed that the patients improved equally on both drugs but that alclofenac was statistically superior to phenylbutazone in improving morning stiffness.Adverse clinical reactions occurred in 18 patients on phenylbutazone and on 9 patients with alclofenac. It was necessary to discontinue phenylbutazone treatment in 5 patients and to discontinue alclofenac in 2 patients. No serious side-effects occurred with alclofenac.A double-blind crossover trial has been conducted to compare the therapeutic efficacy of a new antirheumatic drug, alclofenac, with that of phenylbutazone in rheumatoid arthritis. One hundred and four patients were randomly allocated to 4 treatment groups: alclofenac followed by phenylbutazone, phenylbutazone by alclofenac, phenylbutazone by phenylbutazone, or alclofenac by alclofenac. Each drug period lasted 14 days and the daily oral dose levels of alclofenac and phenylbutazone were 2 g. and 600 mg. respectively, as tablets to be taken one 4 times each day.Most subjective and objective clinical parameters improved equally with the two drugs after 14 and 28-days' treatment, but alclofenac was significantly superior to phenylbutazone in improving morning stiffness. The introduction of alclofenac is a valuable contribution to the treatment of rheumatoid arthritis; because of its excellent tolerance, it should be tested long term in this condition, particularly when adverse effects prohibit the use of other drugs.

ISSN:0300-7995    

DOI:10.1185/03007997309111691

出版商:Taylor&Francis    

年代:1973

数据来源: Taylor

摘要:

SummaryPentazocine does not cause the hypotension associated with the use of opiates in patients with myocardial infarction but some haemodynamic studies have suggested that the drug could be hazardous. An analysis is described of 457 consecutive patients admitted to a Coronary Care Unit, of whom 250 (55%) received pentazocine for relief of chest pain, while the remainder did not require analgesics and, therefore, acted as a control.Utilising a coronary prognostic index no significant difference in the mortality rate between the two groups was demonstrated, nor was the mortality dependent on the total dosage. Furthermore, no clinical disadvantage arose from the administration of pentazocine to patients with elevated systolic blood pressure on admission.

ISSN:0300-7995    

DOI:10.1185/03007997309111692

出版商:Taylor&Francis    

年代:1973

数据来源: Taylor

摘要:

SummaryA trial of 'Fortral' (pentazocine) suppositories was carried out in general practice in 48 patients with moderate or severe pain lasting from 1 to 7 days. The largest group were suffering from musculoskeletal disorders, especially pain in the lumbar region.Patients were assessed before and after treatment. Some patients also assessed the effect of each dose themselves but the usefulness of this method, at least in this study, is questioned.'Fortral' suppositories provided good analgesia with a low incidence of side-effects. There were no reports of local irritation. The suppositories were well accepted as a form of treatment.

ISSN:0300-7995    

DOI:10.1185/03007997309111693

出版商:Taylor&Francis    

年代:1973

数据来源: Taylor

摘要:

SummaryIn 50 adults with bacterial sinusitis, cyclacillin (1500 mg. per day for 7 days) proved significantly more effective than placebo in eliminating the signs and symptoms and in eradicating the causative microorganisms, (Staphylococcus aureus, Proteus mirabilis, and Staph, epidermidis were most frequently isolated in this series). Sixty percent of the cultures in the cyclacillin series were sterilized, compared with only 10% in the placebo series. Globally, 93% of the cyclacillin-treated patients and only 55 % of the placebo-treated patients were considered improved. Of the P. mirabilis strains encountered, 72% were eradicated by cyclacillin (only 40% by placebo) despite the relatively high cyclacillin M.I.C.s for this microorganism (50 to 100μg/ml.). Cyclacillin was much more effective in treating human sinusitis than would have been anticipated from the M.I.C.s alone.

ISSN:0300-7995    

DOI:10.1185/03007997309111694

出版商:Taylor&Francis    

年代:1973

数据来源: Taylor

摘要:

SummaryClindamycin palmitate hydrochloride is a water-soluble salt which in vivo undergoes hydrolysis into the active base. Following a single-dose administration of either 150 or 300mg. of the drug to elderly patients, serial blood sample estimations revealed that satisfactory therapeutic plasma levels were achieved and maintained in all patients with peak levels usually occurring at 2 hours and with a serum half-life of over 4 hours. The rate of urinary excretion was variable but, irrespective of dose, about 7% of the drug was recoverable from the urine in an active form during the following 24 hours. This study shows that clindamycin palmitate in suspension form provides an effective method of administering the antibiotic to elderly patients who may find difficulty in swallowing clindamycin in capsule form and suggests that 150 mg. every 8 hours comprises effective treatment.

ISSN:0300-7995    

DOI:10.1185/03007997309111695

出版商:Taylor&Francis    

年代:1973

数据来源: Taylor

摘要:

SummaryOne hundred and thirty-four healthy women of child-bearing age who were breastfeeding their young each completed more than 3 cycles on the oral contraceptive combination of 50 meg. ethinyloestradiol plus 250 meg. d-norgestrel. Very few untoward effects of medication were reported in the 1377 cycles of the study. Of 21 women selected at random, 18 reported no change in milk production and continued to lactate until the end of treatment. Lactation decreased in the remaining 3 women. Further intensive studies are indicated before any definite conclusion is reached on the effect of this combination on the quality of the breast milk and duration of lactation.

ISSN:0300-7995    

DOI:10.1185/03007997309111696

出版商:Taylor&Francis    

年代:1973

数据来源: Taylor

摘要:

SummaryPlasma concentrations of glucose, insulin, glucagon, Cortisol, gastrin, triglycerides and cholesterol were measured after intramuscular injections of tetracosactrin injection (‘Synacthen’) and tetracosactrin zinc (‘Synacthen' Depot) in 22 patients with rheumatoid arthritis, 3 patients with osteoarthritis and 1 patient with ankylosing spondylitis. Although marked elevation of serum gastrin concentrations were noted in patients while fasting, no effects on serum gastrin or of any of the other parameters studied were observed with tetracosactrin administration.

ISSN:0300-7995    

DOI:10.1185/03007997309111697

出版商:Taylor&Francis    

年代:1973

数据来源: Taylor