Long-term efficacy and safety of very-low-dose amiodarone treatment for the maintenance of sinus rhythm in patients with chronic atrial fibrillation after successful direct-current cardioversion

Background Long-term maintenance of sinus rhythm after successful conversion of chronic atrial fibrillation （CAF）, often ameliorates patients＇ symptoms, reduces the risk of ischemic stroke and improves cardiovascular hemodynamics. This prospective study aims to evaluate the long-term efficacy and safety of very low-dose amiodarone （100 mg daily） for the maintenance of sinus rhythm after successful direct-current （DC） cardioversion in patients with CAF and rheumatic heart disease （RHD） post intervention. Methods This study was a randomized prospective trial. One day after successful DC cardioversion （remained normal sinus rhythm） in patients with CAF and RHD post intervention for more than six months and adequate anticoagulation, all were randomly administered either amiodarone 200 mg daily in group A or amiodarone 100 mg dally in group B. Results A total of 76 patients （40 men and 36 women） were examined from February 1998 to December 1999. The mean age of the patients was （664- 10） years, and the mean follow-up was （674-8） months （range 61 to 84 months）. Actuarial rates of the maintenance of sinus rhythm were similar in the two groups after 5 years of follow-up. Four patients （11%） in group A but none in group B experienced significant adverse effects that necessitated withdrawal of amiodarone. No death occurred during the study period. Conclusion A very low dose of amiodarone results in adequate long-term efficacy and is safe for maintaining sinus rhythm in patients with CAF and RHD post intervention after successful DC cardioversion.     

Urodynamic analysis and treatment of male Parkinson’s disease patients with voiding dysfunction

Background Parkinson＇s disease （PD） is an extrapyramidal neurological disorder.Urinary symptoms are frequently present in patients affected by PD.Symptoms such as urgency,frequency,nocturia,and urge incontinence significantly impact the patient＇s quality of life.We attempted to investigate the urodynamic changes and treatment of male PD patients with voiding dysfunction by means of a review.Methods Comprehensive urodynamic examinations were performed in 141 male patients with PD associated with voiding dysfunction.Appropriate treatments were given to subgroups that were divided based on test results,and the changes in urodynamic parameters as well as the treatment efficacy were observed.Results Detrusor hyperreflexia without bladder outlet obstruction （BOO） was observed in 35 patients,who exhibited significant improvements in the international prostate symptom score （IPSS）,maximum flow rate （Qmax）,bladder volume at the first desire to void,post-void residual （PVR）,and bladder compliance.Detrusor hyperreflexia associated with BOO was observed in 59 patients.The patients exhibited significant improvements in IPSS,Qmax,PVR,and bladder compliance.Detrusor dysfunction without BOO was observed in 19 patients,for whom the IPSS and the bladder volume at the first desire to void were improved after treatment.Detrusor dysfunction with BOO was found in 28 patients,with no significant improvement in the urodynamic parameters after the treatment.Conclusions Urodynamic examination is recommended for male Parkinson＇s disease patients with voiding dysfunction.Early and effective treatment can improve the bladder function and quality of life of these patients.     

Evaluation of the efficacy and safety of tiotropium bromide (5 ug) inhaled via Respimat in Chinese patients with chronic obstructive pulmonary disease

Background A pharmacokinetic study in an Asian population showed that tiotropium 5 μg via Respimat leads to the same plasma levels compared to 18 μg via HandiHaler.The objective of the trial was to compare the efficacy and safety of longterm treatment （1 year） with tiotropium bromide （5 μg） via Respimat（R） with placebo in patients with chronic obstructive pulmonary disease （COPD）.Methods A total of 3991 patients were randomized in this double-blind,placebo controlled,parallel group study,while in China 338 patients （309 males,29 females） received either tiotropium bromide （n=167） or placebo （n=171）.Tiotropium bromide solution or matching placebo was delivered via Respimat（R） at a dosage of 5 μg （2 x 2.5 μg/puff） once daily for 48 weeks.Co-primary endpoints were trough forced expiratory volume in one second （FEV1） and the time to first exacerbation.Results Statistically significant improvements in trough FEV1 and trough forced vital capacity （FVC） in the tiotropium group were achieved at weeks 4,24,and 48 compared with those in the placebo group.A statistically significant difference （P=0.0027） in favour of tiotropium was also observed for the time to first exacerbation.The total numbers of exacerbations during treatment were 90 and 128 in the tiotropium and placebo groups,respectively,with a rate ratio of 0.69 （P=0.0164）.The difference between the treatment groups in the adjusted mean changes from baseline of St.George Respiratory Questionnaire （SGRQ） total score was-3.9 （95% Cl：-7.5,-0.2） and was of statistical significance （P=0.0367）.The incidences of serious adverse events （SAEs） in the tiotropium and placebo groups were 16.2% and 17.0%,respectively.Seven deaths occurred whilst patients were on treatment,four in the tiotropium group and three in the placebo group,all of which were assessed as non-related study drugs by the investigators.Conclusions Tiotropium significantly improved lung function and quality of life,delayed the time to first exacerbation,reduced the number of exacerbations.Overall,tiotropium was well tolerated.     

Clinical course and cause of death in elderly patients with idiopathic Parkins on’s disease

Objective To improve the therapeutic and preventive measure for elderly patients (75 years and over) with idiopathic Parkinson’s disease (OEIPD). Methods Fifteen OEIPD patients were observed prospectively over a long period of time. Their diagnosis was confirmed by autopsy. Based on clinical and pathological data, the causes of death were analyzed.Results The mean clinical course in OEIPD patients was 6.2±3.6 years. The majority of the 15 patients were the akinetic type and the akinetic type with tremor (80.0%). In the late stages of disease (4.8±3.5 year), choking occurred in 12 OEIPD patients who received nasal feeding for an average of 4 months after the occurrence of choking. The most common complication in 12 patients was repeated pulmonary infections with an average rate of 2.9±1.9. The causes of death were bronchial pneumonia and shock induced by pulmonary infection (11 cases, accounted for 73.3%), acute myocardial infarction (2 cases), one case with cardiac rupture and one case with rupture of aortic aneurysm. Conclusions The clinical course was shorter in OEIPD patients. Levodopa therapy should be started early in OEIPD patients. Bronchial pneumonia and infectious shock constitute the major cause of death and choking was one of the main causes of aspiration pneumonia. Nasal feeding should be started as early as possible after the appearance of choking. Silent aspiration can be reduced by teaching the patient to protect the airway by ’supraglottic swallowing’.     

Discussion about the Prognoses of Wilson＇s Disease with Severe Cortex Structure Impairment--A Case Report of Wilson＇s Disease （WD） Treated by the Traditional Chinese Medicine and Western Medicine

Introduction： As we know, Wilson＇s disease（WD） patient with severe structure and function impairment will have a poor prognosis. We met an exceptional case and madea report, then discussed some viewpoints about prognosis of WD patients. Case report： A WD patient presenting with severe cortex structure and cerebral function impairment was followed up for 5 years, including his therapeutic regiment-the combined treatment of traditional Chinese medicine and western medicine, clinical manifestation, the 24-hr urine copper output and brain MRI. By effective copper-excluding therapy, his clinical manifestation went on worse I st year after diagnosis, and then was improved in the following years. The patient＇s symptoms almost complete recover 3 years afterward. During 5 years, the 24-hr urine copper excreted is tapered, but it was still higher than normal. The cerebral MR image of the patient was getting worse at 1^st year, then began to recover, and improved markedly 5 years after. Conclusion： For WD patients, treated with the traditional Chinese medicine and western medicine, even therapy start in serious conditions and in late adolescent, clinical manifestation may get striking improvement.