A prospective randomized study of Chop versus Chop plus alpha-2B interferon in patients with intermediate and high grade non-Hodgkin's lymphoma: the International Oncology Study Group NHL1 Study .

The addition of a brief alpha interferon regimen to each CHOP induction cycle, plus one year of alpha interferon thrice weekly maintenance therapy, has no early effect on response rates or survival in patients with Intermediate or High grade cell NHL. BACKGROUND: The CHOP (Cyclophosphamide, Adriamycin. Vincristine, Prednisone) regimen is the most widely used first-line therapy for patients with Intermediate or High Grade (IG/HG) non-Hodgkin's lymphoma (NHL). Alpha 2b interferon (INF) enhances response rates and improves survival in low-grade NHL. The International Oncology Study Group (IOSG) conducted a prospective randomized study comparing CHOP alone or combined with INF in patients with IG/HG-NHL. The primary study aim was to compare the objective response rates in these patient cohorts. PATIENTS AND METHODS: Patients with a confirmed diagnosis of measurable NHL of International Working Formulation (IWF) groups D to H histology were randomized to receive CHOP alone or CHOP with 5Mu INF s.c. for 5 days on days 22 to 26 of each 28 day cycle with INF 5 million units (Mu) given three times per week subcutaneously for 52 weeks in those patients who responded to CHOP plus INF. RESULTS: The overall response rates were equivalent in both groups: CHOP alone (214 patients) 81% (complete 55%, partial 26%); CHOP plus INF (221 patients) 80% (complete 54%, partial 26%). At 36 months, the actuarial survival rate was equivalent in both groups. CONCLUSIONS: There is no apparent early advantage in terms of response or survival conferred by adding the study INF regimen to CHOP therapy for patients with IG/HG-NHL.     

B-type natriuretic peptide in the assessment of acute lung injury and cardiogenic pulmonary edema

OBJECTIVE: The role of plasma B-type natriuretic peptide (BNP) in critically ill patients with acute pulmonary edema is controversial. We postulated that a low BNP level would exclude cardiac dysfunction as the principal cause of pulmonary edema and therefore help in the diagnosis of acute lung injury. DESIGN: A retrospective derivation cohort was followed by a prospective validation cohort of consecutive patients with acute pulmonary edema admitted to three intensive care units. BNP was measured within 24 hrs from onset. Critical care experts blinded to BNP results integrated clinical data with the course of disease and response to therapy and served as the reference standard. SETTING: Three intensive care units at the tertiary center. PATIENTS: Consecutive critically ill patients with acute pulmonary edema. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: In a derivation cohort of 84 patients, a BNP threshold of 相似文献   

Perioperative management of patients who have pulmonary disease

The identification of risk factors and optimization of respiratory status are crucial to the successful management of patients who have pulmonary disease and are undergoing a surgical procedure. This article explores the approach to pulmonary patients, from the preoperative assessment to the intraoperative and postoperative periods. The management of specific pulmonary disorders in the perioperative period is discussed.     

Valvular vegetations? Cardiac amyloidosis is a possibility

Cardiovascular system is a frequent target for the deposition of amyloid, specially in the primary type. Patients with this condition can present with myocardial dysfunction due to heavy interstitial myocardial deposits. We report a case of primary cardiovascular amyloidosis in a male with sudden cardiac death. The distribution of amyloid was remarkable for exclusive deposition in the pulmonary and systemic arterial adventitia and more strikingly over all valves, specially the mitral valve. These were large enough to simulate vegetations.     

The effects of systemic alpha-1 adrenergic antagonists on pupil diameter in rats

PURPOSE: To investigate the effects of alpha-1 adrenergic blockers on pupil diameter (PD) in rats. METHODS: Four groups, with 10 rats each, were designed to receive terazosin, tamsulosin, doxazosin, and no medication. Dilated pupil diameter (PD) measurements were performed 24 hr before, 24 hr after, and 30 days after the initiation of medication, and after 30 days of washout. The intergroup and intragroup differences in PD were evaluated using one-way ANOVA and Wilcoxon signed rank test, respectively. RESULTS: In day 1, PD decreased in both eyes significantly only in tamsulosin and doxazosin groups, but these effects became insignificant at 30 days of treatment (p > 0.05). The control group showed no significant difference in PD (p > 0.05). PD values returned to baseline after the washout period in all groups. CONCLUSIONS: A significant reduction in PD occurred in two of the three groups with alpha-1 adrenergic blockers (tamsulosin and doxazosin), but this effect was not sustained at 30 days. Further functional and structural studies of the iris are needed to determine the clinical significance of these findings.     

Randomized, double-blind comparison of acute beta1-blockade with 50 mg metoprolol tartrate vs 25 mg carvedilol in normal subjects

Differential efficacy of immediate-release metoprolol tartrate and carvedilol in the treatment of congestive heart failure remains a subject of ongoing debate. The degree of beta1-blockade can be assessed by percentage reduction of exercise heart rate. Twelve healthy subjects underwent symptom-limited cardiopulmonary exercise testing repeated weekly and 2 hours after randomized, double-blind administration of 50 mg metoprolol tartrate vs 25 mg carvedilol. Baseline heart rate, heart rate at 40% and 70% peak O2 consumption, and maximal exercise were significantly blunted more by metoprolol tartrate than by carvedilol (P<.05 for all). Peak O2 consumption was significantly reduced by metoprolol tartrate (P<.03) but not by carvedilol (P=.054). The change in O2 consumption was significantly correlated with the degree of beta1-blockade (r =0.45; P<.05). In healthy subjects, a higher degree of beta1-blockade is achieved with 50 mg metoprolol tartrate compared with 25 mg carvedilol.     

Effect of guided participation on feeding competencies of mothers and their premature infants

The effect of guided participation (GP) on premature infant and maternal feeding competencies was examined, controlling for infant, maternal, and family conditions. Competencies were examined longitudinally and within age (1, 4, 8, and 12 months post-term age) for 42 mother-infant pairs randomly assigned to either GP or Standard Care (SC) groups. The hypothesized GP effect on competencies across infant age received support for infants (at 1 and 8 months) and for mothers (at 4 months). The hypothesized contribution of conditions was most strongly supported by the negative relationship between family poverty status and the two maternal competency variables. The hypothesized GP moderator effect on the relationship between depressive symptoms and maternal competency variables was supported for regulation of negative affect and behavior at 8 months. Despite study limitations in power and sensitivity to detect effects, findings indicate that further study of the GP intervention is merited.     

Knowledge of personal and sexual development amongst young people in Pakistan

Pakistan has one of the largest cohorts of young people in its history, yet research on their circumstances and needs is still relatively new. In this study, twenty four focus group discussions were conducted to explore young peoples' experiences of gaining knowledge of personal and sexual development. Young women typically gained information from a limited number of sources within the home, while young men accessed a wide variety of information sources outside the home. Gaining information was frequently event-based, whereby specific events (i.e. puberty, marriage) trigger information provision to young people, however often too late to be educative. Overall, young people were critical of the quality of information they received, which often led to confusion and stress in understanding sexual development. Findings highlight a gap in formal systems of information provision. Although young people highlighted the merits of school-based information delivery, low school attendance and high drop-out rates amongst girls mean that alternative mechanisms of reaching young Pakistani women need to be identified.