An integrated evaluation of the adaptation system and existing risk factors as a method for the objective assessment of the efficacy of sanatorium-health resort treatment

It has been shown that antihemolytic effect of trifluoroperazine is realized directly at the stage of hyperosmotic stress during cell transfer to 4.0 M NaCl and is not the result of preliminary cell treatment by this amphypathic compound. The value of protecting effect of trifluoroperazine is determined by preliminary RBS dehydration condition. Cell treatment by hemin, modifying cytoskeleton and membrane, significantly affects cell sensitivity to hyperosmotic stress both in the presence of trifluoroperazine and without the latter.     

Gingival hyperplasia during treatment with nifedipine

INTRODUCTION: Nifedipine is a relatively new and increasingly used medication for treatment of all kinds of angina pectoris and arterial hypertension. The principal action of nifedipine is to inhibit the influx of extracellular calcium ions across the membranes of cardiac and vascular smooth muscle cells, without changing serum calcium concentration (1). One of the side effects of this drug is gingival hyperplasia which was first described in 1984 by Lederman (2). He noted that gingival hyperplasia is mostly marked on the labial gingiva of the upper and lower anterior teeth and appeared 1 to 2 months after nifedipine therapy began at a dose of 90 mg per day, and never occurs in edentulous areas. This paper reports gingival hyperplasia in a patient treated with nifedipine. CASE REPORT: A 73-year-old man referred to the dental clinic for evaluation of gingival enlargement in the maxillar left quadrant which he had noticed about 3 months after starting the nifedipine therapy. Clinical examination showed gingival enlargement around the teeth 22, 23, 24 and 27, but with normal edentulous area (Fig. 1). The enlarged gingiva was red, smooth and shiny, with no pain on touch, and bled easily on probing. There were metal crowns with overhanging margins and pseudopockets--6 mm with dental plaque and calculus. Radiographs showed moderate alveolar bone resorption of horizontal type. The patient's maxillar left first premolar exhibited severe bone loss, resulting in a hopeless prognosis. This tooth was extracted under local anesthesia. The dental treatment included replacement of the ill-fitting metal crowns, scaling and root planning, and instructions on appropriate method for brushing teeth. 6 weeks later, the hyperplastic tissues were removed surgically. In a 1-year follow-up period, the patient was recalled at regular intervals for control, and no signs of recurrence of gingival hyperplasia have been observed in spite of continued nifedipine treatment. Biopsies taken from the gingivectomy specimens were handled with standard histological method. Histological examination showed a thick epithelium with parakeratosis and acanthosis, and irregular elongation of the rete peg. The underlying connective tissues contained dense fibers with inflammatory cell infiltrate mainly composed of plasma cells. DISCUSSION: The exact mechanism of action of nifedipine in causing gingival enlargement is unknown at present. There is also no answer to the question why gingival enlargement appears in some patients treated with nifedipine, but in others not. The clinical findings (3, 4, 5, 6, 7) and results of in vitro study (8) and this case report showed that hyperplastic change of gingiva started only in areas displaying signs of inflammation, but not in healthy and edentulous areas. These observations suggest that local factors and associated inflammation is essential for onset of the nifedipine-induced gingival hyperplasa. Moreover, it was suggested that duration of nifedipine therapy (more than 2 months) and drug dosage (90 mg per day) could be important (1,2,3). This case report also demonstrates that no signs of recurrence of hyperplasia were observed after elimination of the local inflammatory factors: extensive dental pluque control and surgical removal of the hyperplastic gingival tissue even though administration of nifedipine was continued. CONCLUSION: It was concluded that gingival enlargement occurs in patients with nifedipine therapy only in the areas where local inflammatory factors are present.     

The non-surgical treatment of thyroid cancer

The non-surgical treatment of thyroid cancer is outlined. The success of chemotherapy and of radiotherapy is dependent on the number of tumour cells present, and immediate postoperative treatment is therefore often valuable. The role of X-ray therapy, radio-iodine, hormones and chemotherapy is discussed for the different histological types.     

The rehabilitative treatment of children with bronchial asthma

A corneal oblique incision running along the chord relative to the limbus has been developed, which enables to finish an operation without suturing the incision. A reliable union of the incision edges is attained after air injection to the anterior chamber, the incision being no more than 5 or 5.5 mm. The incision was used in 72 clinical operations for extraction of congenital, secondary, and traumatic cataracts. The shape of incision, absence of sutures and additional injury caused by removal of sutures helped reduce the postoperative astigmatism and brought about good functional results.     

The treatment of patients with benign prostatic hyperplasia using the selective alpha-blocker alfuzosin

40 patients with benign prostatic hyperplasia (BPH) were treated with the alpha-blocker alfuzosin which was administered per os twice a day in a dose 5 mg. The treatment brought about a decrease of the mean symptom score from 19.6 to 12.2, of quality of life from 5.2 to 2.1, of residual urine from 152 to 82 ml. Mean and maximal urinary flow rates rose by 35 and 45%, respectively. The level of prostate-specific antigen over the treatment course did not change. The findings of the trial evidence for high efficacy of alfuzosin in the treatment of urination disorders in BPH patients.     

Health resort treatment of eye diseases caused by ischemia]

The authors discuss the results of ophthalmodynamometric tests used for the assessment of cerebro-retinal vessels reactivity following carbon dioxide baths and "peat collars". An analysis of systemic and local blood pressure in the ophthalmic artery measured with Weigelin and Lobstein technique enables to assess changes in blood pressures following a/m balneologic procedures. It was found that blood pressure does not change parallelly due to the mechanism of cerebral autoregulation. Transient decrease in blood pressure in the ophthalmic artery is produced by the dilatation of the internal carotid artery indicating a potent vasodilating action of carbon dioxide.     

Influence of health resort treatment on insulin and C-peptide concentration in girls with insulin-dependent diabetes

The influence of treatment in health resorts on the behaviour of C-peptide and insulin concentrations was evaluated in serum and urine of diabetics. The group examined comprised 68 girls with insulin-dependent diabetes estimated by radioimmunological methods. The study was carried out during and after health resort treatment. C-peptide initial concentrations constituted the basis for the examined and comparative group division into the following sub-groups: A--C-peptide secretion within standard limits, B--C-peptide trace secretion, and C--patients whose C-peptide concentrations were not determined. After health resort treatment a statistically significant difference of C-peptide secretion was found in serum in the groups with the well preserved secretion and that with only traces of C-peptides. A statistically significant difference in insulin concentrations was also found. Summing up, after health resort treatment of insulin-dependent diabetics with preserved only insignificant secretion of endogenous C-peptide, the secretion of this hormone increased.     

Long-term somatic follow-up of prenatally treated children with congenital adrenal hyperplasia

Prenatal virilization of female fetuses is a serious symptom associated with severe congenital adrenal hyperplasia. In attempt to avoid sexual ambiguity, prenatal treatment of 21-hydroxylase deficiency was initiated in 1984, with the first Scandinavian case treated in 1985. Here we have studied the outcome of prenatal diagnosis and therapy of 44 at-risk pregnancies monitored during the years 1985-1995 in Scandinavia. Treated mothers and children were compared with matched controls. Compared to their elder affected sisters, all 5 girls with severe congenital adrenal hyperplasia who were treated until term showed little virilization. Only 1 required surgery for labial fusion. The majority of the 44 dexamethasone-treated fetuses demonstrated normal pre- and postnatal growth compared to matched controls. However, several adverse events such as failure to thrive and delayed psychomotor development, were reported among the treated infants. In addition, treated mothers reported more side-effects during pregnancy than did controls. A significant increase in weight gain was observed during early pregnancy when treatment was initiated, but this initial rapid weight gain declined during late pregnancy or when treatment was terminated. Thus, experience to date suggests that prenatal treatment of affected female fetuses is generally efficient in minimizing virilization of external genitalia. However, there is still a need to collect more data concerning possible rare unfavorable effects of this therapy on mother and child.     

The treatment of benign prostatic hyperplasia using the Mumie-Vitas preparation

Overall thirty-eight patients presenting with stage I-II benign prostate hyperplasia received treatment with a new local drug preparation Mumiyo-Vitas, 0.2 g on a once- or twice-daily basis over six months. Effects were studied of the drug on the urologic symptomatology and quality of life of patients presenting with ongoing micturitional disturbances, functional state of detrusor vesicae, prostate volume and urethral resistance. Efficiency of the treatment given was assessed by the International system, uroflowmetry, ultrasonic investigation. Mumiyo-Vitas appeared to be of therapeutic benefit in those patients with subjective and objective symptoms of the urinary bladder obstruction who had innocent prostate hyperplasia.     

Cystic thyroid lesions in children

BACKGROUND/PURPOSE: Cystic lesions of the thyroid encompass a wide and heterogeneous group of disease states in children, ranging from benign purely cystic entities to malignant tumors. The purpose of this study was to study both the presentation and management of cystic thyroid lesions in the pediatric population. METHODS: A retrospective review of all thyroid masses presenting between 1978 and 1996 and found to be purely or partially cystic on ultrasound examination was conducted, looking at presentation, family history, laboratory values, ultrasound scan and radionuclide imaging, and pathological and cytological evaluation. RESULTS: Twenty-four patients (19 girls, 5 boys) aged 6 to 18 years received the diagnosis of cystic lesions of the thyroid. Of these, 23 presented with painless neck masses, 21 were clinically euthyroid, only one had a single abnormal thyroid function test, only two had mildly positive antithyroid antibody test results, and nearly 30% had a positive family history of thyroid disease. Ultrasonography showed pure cysts in five patients and mixed solid cystic lesions in 19 patients. On scintiscan, six lesions were hot, 13 were cold, three showed normal uptake, and two were mixed. Treatment included either observation, aspiration, cyst sclerosis, surgery, or combinations thereof. Pathological and cytological results included follicular adenoma (n = 9), cystic degeneration (n = 6), multinodular goiter (n = 4), carcinoma (n = 2), branchial cleft cyst (n = 1), and undetermined (n = 2). CONCLUSIONS: Thyroid cysts are often thought to represent benign degenerative disease. Our study, which is the first in the literature to specifically address thyroid cysts in children, shows that ultrasound scan is useful in evaluating thyroid masses, whereas laboratory and radionuclide are of less value, and that single lesions of mixed echogeneity are likely to represent neoplasms, a significant percentage of which are malignant.     

Primary and secondary carcinomata with focal nodular hyperplasia in a multinodular thyroid: case report

A patient is described whose multinodular thyroid gland was found to have a primary papillary adenocarcinoma, a metastatic renal-cell carcinoma, and focal nodular hyperplasia. To our knowledge, this is the first case report of such an unusual combination. In a patient with known malignancy elsewhere, the possibility that a recent thyroid mass may be a metastasis should be considered.     

Surgical treatment of well-differentiated thyroid carcinoma with laryngotracheal invasion

We reviewed 141 cases of well-differentiated thyroid carcinoma with laryngotracheal invasion surgically treated from 1957 through 1984. Of the 141 cases, 68 had the tumor adhesive to the larynx or/and trachea, 66, the tumor invading the cartilage of airway, and 7, the tumor invading into the lumen of airway. 82 cases (33 with microscopically residual tumor, and 26 with grossly residual tumor) underwent total resection. Postoperative radiotherapy was added to the last two groups. The 10-year survival rate was 84.45%, but in Group I, II and III it was 93.94%, 90.68%, and 53.91% respectively. Radiotherapy which was added postoperatively was a positive prognostic factor in improving the survival.     

The efficacy of treating patients with allergic diseases at a health resort with a gastroenterologic profile

45 allergic patients were treated in gastrointestinal sanatorium. Balneological and speleo modalities were employed. The clinical symptoms and humoral immunity indicated high efficacy of such treatment. The complex is recommended for introduction in gastrointestinal sanatoria.     

Pulmonary metastases in children and adolescents with well-differentiated thyroid cancer

In this study, 27 patients less than 18 yr old with pulmonary metastases from well-differentiated thyroid carcinoma were evaluated to determine their response to (131)I therapy. METHODS: Of 121 children and adolescents treated with (131)I between 1963 and 1996, 27 patients had pulmonary metastases associated with nodal disease. Treatment response from (131)I was measured by three parameters: chest radiograph, scintigraphic images and serum thyroglobulin levels. Total activity of (131)I administered ranged from 4.6 GBq (125 mCi) to 38.7 GBq (1.05 Ci). Four patients were given one treatment, 8 were given two treatments, 4 were given three treatments and 11 were given more than three treatments. Radiation doses to the lungs were estimated in 14 patients using the MIRD methodology. The minimum duration of follow-up was 6 mo. RESULTS: At the time of initial presentation, diagnostic (131)I studies revealed bilateral radioiodine uptake in the lungs in 19 (70.4%) patients, whereas 12 (44.4%) patients had abnormal chest radiographs. One patient was lost to follow-up and was excluded from the study. Of the 26 patients studied, complete ablation of pulmonary metastases was observed in 8 (30.8%), partial ablation in 17 (65.4%) and there was no response to treatment in 1 (3.8%). Dosimetric parameters such as radioiodine uptake as a percentage of therapeutic activity, effective half-life and radiation dose delivered to the lungs were evaluated with each therapy. There was a progressive decline in each of these parameters with successive therapies. No correlation was observed between the radiation dose delivered and the response of pulmonary metastases to therapy. The number of therapies and amount of radioiodine administered had no influence on the ablation response. Of the 26 patients, 13 had a follow-up duration of less than 5 yr, 7 had 5-10 yr and 6 had more than 10 yr. One patient developed new metastases after 7 yr of diagnosis and treatment. One patient died of the disease after 4 yr. All surviving patients were asymptomatic and leading normal lives. CONCLUSION: Complete response of pulmonary metastases after (131)I therapy is difficult to achieve. A partial response with reduction of metastatic disease is possible and, in general, the patients had a good quality of life with no further disease progression and a low mortality rate.     

The treatment of benign prostatic hyperplasia with alpha blockers in men over the age of 80 years

OBJECTIVE: To determine the safety and efficacy of alpha blockade with doxazosin and terazosin in men over the age of 80 years with symptomatic benign prostatic hyperplasia (BPH). PATIENTS AND METHODS: Thirty-six men (mean age 83.6 years, SD 5.6, range 80-96) received either doxazosin 4 mg (11 men) or 8 mg (10 men), or terazosin 5 mg (five men) or 10 mg (10 men), once daily at night. Twenty-eight men (78%) were on other anti-hypertensive medication; the type and dosage were not changed during the study. Efficacy and safety were assessed using measurements of peak urinary flow rate, symptom scores and the incidence of adverse events. RESULTS: Of the 36 men, 33 (92%) remained on study medication at 6 months; the remaining three (8%) discontinued because of asthenia. After 3 months of treatment, the peak urinary flow rate increased significantly (P < 0.008) for both doxazosin (+3.7 mL/s) and terazosin (+3.2 mL/s). The American Urological Association symptom score improved significantly (P < 0.01) with both alpha blocker after 3 months of treatment and efficacy was maintained at 6 months. There were small, non-significant decreases in blood pressure in patients receiving doxazosin or terazosin, but no differences between patients who were normotensive at baseline and those whose blood pressure was controlled by other anti-hypertensive drugs. CONCLUSION: These results suggest that alpha blockade with either doxazosin or terazosin is well tolerated and effective in older men with symptomatic BPH. Furthermore, patients on concomitant anti-hypertensive medication need no alteration of their therapeutic regimen before the initiation of alpha blockade for BPH.     

Feline fibro-epithelial hyperplasia in 3 castrated tomcats following treatment with progestagens

This article describes three castrated tomcats that were treated with progestins. All three developed symptoms of fibroepithelial hyperplasia of the mammary gland, probably as a consequence of this treatment. This disease is commonly found in intact young female cats, pregnant cats, and progestin treated cats. Therapeutical consequences are dealt with and the importance of (histo)pathological investigation to 'Good Veterinary Practice' is pointed out.     

Transurethral endoscopic electrovaporization in the treatment of patients with benign prostatic hyperplasia

The adenoid tissue is an immunecompetent lymphoid organ, which has the capacity of reacting against numerous antigens. We have studied the influence that the elimination of the said tissue would have on the total IgE serum levels in 33 patients of an average age of 5 and criteria of adenoidectomy and in whom these levels were measured before and after surgery. We have not noticed any statistically significant differences in the IgE values after adenoidectomy with respect to those prior to surgery, which were normal. Adenoidectomy, like other authors have observed after tonsillectomy, does not alter the IgE serum values.