Efficacy of intravenous gammaglobulin therapy in chronic refractory polymyositis and dermatomyositis: an open study with 20 adult patients
Article Abstract:
Polymyositis and dermatomyositis are connective tissue diseases characterized by inflammation and deterioration of the muscles, inflammation of the skin, and accumulation of tissue fluid. The cause of these conditions is not known, but may be related to immune or viral factors. Polymyositis can be treated with corticosteroids, drugs that suppress the immune system, radiation therapy, or plasmapheresis (a blood preparation procedure). However, these various approaches to treating polymyositis are not consistently effective, and may cause side effects. Polyvalent human intravenous immunoglobulin (IVIG) is an immune protein preparation that has been effective against certain immune disorders. The effectiveness of IVIG was assessed in 14 patients with polymyositis, and in six patients with dermatomyositis. These patients did not respond to other drugs commonly used to treat these conditions. IVIG was the drug of choice for one patient, who tested positive for infection with picornavirus. Treatment with IVIG was combined with prednisone in 15 patients, with methotrexate in six patients, and with plasmapheresis in one patient. The immune protein contained in the IVIG preparation was immunoglobulin G. Doses of one gram per kilogram (g/kg) were given two days a month to 13 patients, and 0.4 g/kg were given five days a month to seven patients. IVIG therapy caused clinical improvement in 15 patients and biochemical improvement in 18 patients. It improved muscle strength and reduced levels of creatine kinase, which are usually increased during muscle injury. IVIG caused only mild side effects in four patients and reduced the steroid dose needed by the patients. These findings suggest that IVIG is effective in treating polymyositis and dermatomyositis, and may be an alternative to treatment with steroids or immunosuppressive agents. (Consumer Summary produced by Reliance Medical Information, Inc.)
Publication Name: American Journal of Medicine
Subject: Health care industry
ISSN: 0002-9343
Year: 1991
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Antibiotic therapy for pseudomonas aeruginosa bacteremia; outcome correlations in a prospective study of 200 patients
Article Abstract:
The bacteria pseudomonas aeruginosa produces an infection that is frequently fatal, particularly among patients with leukemia and lymphoma. The selection of antibiotics to be administered is frequently based on results of testing performed on a specimen of infected material taken from the patient's body (in vitro testing). There has been little correlation between the results of in vitro antibiotic susceptibility testing (the selection of drugs to the bacteria responds) and clinical outcome. To determine whether the in vitro responsiveness of the organism to the various antibiotics tested, or the synergistic effect of multiple antibiotics, has a significant correlation with clinical outcomes, 200 patients with pseudomonas infection were evaluated. The antipseudomonal antibiotic agent, or combination of agents, selected for in vitro testing was the same that was used to treat the patient. No significant correlation was found between the results of in vitro testing and the actual clinical results in terms of which antibiotic or combination of antibiotics was effective. (An antibiotic which was effective in eradicating pseudomonas in a patient specimen in the laboratory may have been less effective when actually administered to the patient.) However, patients whose primary infection site was the urinary tract had a higher survival rate than patients whose lungs were the point of entry for the pseudomonas. Patients receiving therapy with only one antibiotic had a mortality rate of 47 percent, as opposed to a 27 percent mortality rate for those receiving combination therapy. As a result, the authors urge that pseudomonas infections be treated with combination antibiotic therapy.
Publication Name: American Journal of Medicine
Subject: Health care industry
ISSN: 0002-9343
Year: 1989
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Trends in systolic blood pressure, 24-hour sodium excretion, and stroke mortality in the elderly in Belgium
Article Abstract:
Clinicians practicing in the 1950s and 1960s frequently encountered systolic blood pressure (SBP) so high that it could not be measured with the manometer. Advanced eye and brain damage were not uncommon then, but are rarely encountered now, and severe systolic hypertension has almost disappeared. The purpose of this study was to determine whether blood pressure had actually decreased in Belgium since 1967. Stroke mortality has also been decreasing in Belgium. However, deaths from stroke are still rising in Hungary, perhaps because Hungarians eat more saturated fat than Belgians do, although both nationalities eat almost the same amount of total fat. A series of six studies analyzed a total of 3,328 patients at least 60 years old. If the decrease in SBP was related both to the treatment of hypertension and to less dietary salt after a national campaign to reduce salt consumption, the decrease would be greater in Belgium than in neighboring countries. Belgium had the largest decrease of all European countries in deaths from stroke, and ranked fifth of the 29 countries measured worldwide, even though treatments were similar in all. It is likely that systolic blood pressure was lower in 1986 than in 1967, among both treated and untreated people. The national campaign to reduce sodium intake was part of the reason. Also, because so many more of the elderly are being treated, high blood pressure has declined overall. Future studies should consider salt intake in large samples, and should also consider the amount and kinds of fats in the diet. (Consumer Summary produced by Reliance Medical Information, Inc.)
Publication Name: American Journal of Medicine
Subject: Health care industry
ISSN: 0002-9343
Year: 1991
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