Volume 1, Number 5: November 1998
Advantage of post-operative oral
administration of UFT (tegafur and uracil) for completely
resected p-stage I-IIIa non-small cell lung cancer.Cochrane Injuries Group Albumin
Reviewers Pathophysiology and treatment of
painful diabetic neuropathy of the lower extremity.New Strategies in the Medical
Management of AsthmaSource: Eur J
Cardiothorac Surg 1998 Sep;14(3):256-62; discussion 263-4
OBJECTIVE: Although adjuvant therapy after
surgery for non-small cell lung cancer (NSCLC) has been reported
to be ineffective, it has been recently reported in prospective
randomised studies conducted by two different groups in Japan
that oral administration of a 5-fluorouracil (5-FU) derivative
drug, UFT (a combination drug of tegafur and uracil) can improve
the post-operative survival [The Study Group of Adjuvant
Chemotherapy for Lung Cancer (Chubu, Japan). A randomized trial
of postoperative adjuvant chemotherapy in non-small cell lung
cancer (the second cooperative study). Eu J Surg Oncol
1995;21:69-77; Wada, H., Hitomi, S., Teramatsu, T, West Japan
Study Group for Lung Cancer Surgery. Adjuvant chemotherapy after
complete resection in non-small-cell lung cancer. J Clin Oncol
1996;14:1048-1054]. To examine the
efficacy of UFT as post-operative adjuvant therapy, a
retrospective study was performed.
METHODS: A total of 655 consecutive patients who underwent complete tumor resection for pathologic stage I-IIIa, NSCLC at the Department of Thoracic Surgery, Chest Disease Research Institute, Kyoto University between 1976 and 1992 were retrospectively reviewed. As post-operative adjuvant therapy, UFT was administrated to 98 patients (UFT group), and was not administered to the other 557 patients (Control group).
RESULTS: The 5-year survival rate of the UFT group was 76.5%, which was significantly better than that of the Control group (5-year survival rate: 58.6%, P = 0.005). Stratified with pathologic stage, the efficacy of UFT was seen in the p-stage I disease (5-year survival rate: 88.6% for the UFT group, 72.0% for the Control group, P = 0.013) and in the p-stage IIIa, pN2 disease (5-year survival rate: 54.3% for the UFT group, 37.5% for the Control group, P = 0.037). Multivariate analysis of the prognostic factors also revealed the efficacy of UFT (P = 0.004, 95% confidence interval of relative risk: 0.325-0.840). Post-operative intravenous chemotherapy or radiation therapy did not prove to be significant factors affecting the prognosis.
CONCLUSIONS: Efficacy of oral administration of UFT as post-operative adjuvant therapy for completely resected NSCLC was proposed. To confirm the efficacy, a prospective randomized study for a more homogenous patient group is needed.
Cochrane Injuries Group
Albumin Reviewers
Source: BMJ 1998;317:235-240 ( 25 July )
Objective: To quantify effect on
mortality of administering human albumin or plasma protein
fraction during management of critically ill patients.
Design: Systematic review of randomised controlled trials
comparing administration of albumin or plasma protein fraction
with no administration or with administration of
crystalloid solution in critically ill patients with
hypovolaemia, burns, or hypoalbuminaemia.
Subjects: 30 randomised controlled trials including
1419 randomised patients.
Main outcome measure: Mortality from all causes at end of
follow up for each trial.
Results: For each patient category the risk of death in
the albumin treated group was higher than in the comparison group.
For hypovolaemia the relative risk of death after albumin administration
was 1.46 (95% confidence interval 0.97 to 2.22), for
burns the relative risk was 2.40 (1.11 to 5.19), and
for hypoalbuminaemia it was 1.69 (1.07 to
2.67). Pooled relative risk of death with albumin
administration was 1.68 (1.26 to 2.23). Pooled
difference in the risk of death with albumin was 6%
(95% confidence interval 3% to 9%) with a fixed
effects model. These data suggest that for every
17 critically ill patients treated with albumin there is
one additional death.
Key messages
|
Conclusions
Because this review was based on relatively small trials in which
there were only a small number of deaths the results must be
interpreted with caution. Nevertheless, we believe that a
reasonable conclusion from these results is that the
use of human albumin in the management of critically
ill patients should be reviewed. A strong argument
could be made that human albumin should not be used
outside the context of a properly concealed and otherwise rigorously
conducted randomised controlled trial with mortality as
the end point. Until such data become available, there is also
a case for a review of the licensed indications for albumin
use.
Pathophysiology and treatment of
painful diabetic neuropathy of the lower extremity.
Source: South Med J 1998
Oct;91(10):894-8
BACKGROUND: Symptomatic peripheral
neuropathy is the most common complication of diabetes mellitus,
affecting up to 62% of Americans with diabetes.
METHODS: We reviewed the literature using the National Library of Medicine's MEDLINE search service. In total, we reviewed 54 articles.
RESULTS: Hyperglycemia leads to increased activity in the polyol pathway in nerve cells; this ultimately results in abnormal nerve function. Numerous pharmacologic agents have been used to treat symptomatic peripheral neuropathy, but all of these drugs can be associated with adverse side effects. Recent work has indicated that subsensory electrical stimulation may be preferred to pharmacotherapy, since it is equally effective and has a more favorable safety profile.
CONCLUSION: Although the pathophysiology of diabetic neuropathy is well understood, treatment of the symptoms associated with this condition can be challenging. Additional research is needed to reveal a safe and effective treatment for this debilitating sequela of diabetes mellitus.
How Is Diabetic
Neuropathy Usually Treated?
Treatment aims to relieve discomfort and prevent further tissue
damage. The first step is to bring blood sugar under control by
diet and oral drugs or insulin injections, if needed, and by
careful monitoring of blood sugar levels. Although symptoms can
sometimes worsen at first as blood sugar is brought under
control, maintaining lower blood sugar levels helps reverse the
pain or loss of sensation that neuropathy can cause. Good control
of blood sugar may also help prevent or delay the onset of
further problems. Another important part of treatment involves
special care of the feet, which are prone to problems.
A number of medications and other approaches are used to relieve
the symptoms of diabetic neuropathy.
Relief of Pain
For relief of pain, burning, tingling, or numbness, the doctor
may suggest an analgesic such as aspirin or acetaminophen or
anti-inflammatory drugs containing ibuprofen. Nonsteroidal
anti-inflammatory drugs should be used with caution in people
with renal disease. Antidepressant medications such as
amitriptyline (sometimes used with fluphenazine) or nerve
medications such as carbamazepine or phenytoin sodium may be
helpful. Codeine is sometimes prescribed for short-term use to
relieve severe pain. In addition, a topical cream, capsaicin, is
now available to help relieve the pain of neuropathy.
The doctor may also prescribe a therapy known as transcutaneous
electronic nerve stimulations (TENS). In this treatment, small
amounts of electricity block pain signals as they pass through a
patient's skin. Other treatments include hypnosis, relaxation
training, biofeedback, and acupuncture. Some people find that
walking regularly or using elastic stockings helps relieve leg
pain. Warm (not hot) baths, massage, or an analgesic ointment
such as Ben Gay may also help.
Gastrointestinal
Problems
Indigestion, belching, nausea or vomiting are symptoms of
gastroparesis. For patients with mild symptoms of slow stomach
emptying, doctors suggest eating small, frequent meals and
avoiding fats. Eating less fiber may also relieve symptoms. For
patients with severe gastroparesis, the doctor may prescribe
metoclopramide, which speeds digestion and helps relieve nausea.
Other drugs that help regulate digestion or reduce stomach acid
secretion may also be used or erythromycine may be prescribed. In
each case, the potential benefits of these drugs need to be
weighed against their side effects.
To relieve diarrhea or other bowel problems, antibiotics or
clonidine HCl, a drug used to treat high blood pressure, are
sometimes prescribed. The antibiotic tetracycline may be
prescribed. A wheat-free diet may also bring relief since the
gluten in flour sometimes causes diarrhea.
Neurological problems affecting the urinary tract can result in
infections or incontinence. The doctor may prescribe an
antibiotic to clear up an infection and suggest drinking more
fluids to prevent further infections. If incontinence is a
problem, patients may be advised to urinate at regular times
(every 3 hours, for example) since they may not be able to tell
when the bladder is full.
Dizziness, Weakness
Sitting or standing slowly may help
prevent light-headedness, dizziness, or fainting, which are
symptoms that may be associated with some forms of autonomic
neuropathy. Raising the head of the bed and wearing elastic
stockings may also help. Increased salt in the diet and treatment
with salt-retaining hormones such as fludrocortisone are other
possible approaches. In certain patients, drugs used to treat
hypertension can instead raise blood pressure, although
predicting which patients will have this paradoxical reaction is
difficult.Muscle weakness or loss of coordination caused by
diabetic neuropathy can often be helped by physical therapy.
Urinary and Sexual
Problems
Nerve and circulatory problems of diabetes can disrupt normal
male sexual function, resulting in impotence. After ruling out a
hormonal cause of impotence, the doctor can provide information
about methods available to treat impotence caused by neuropathy.
Short-term solutions involve using a mechanical vacuum device or
injecting a drug called a vasodilator into the penis before sex.
Both methods raise blood flow to the penis, making it easier to
have and maintain an erection. Surgical procedures, in which an
inflatable or semirigid device is implanted in the penis, offer a
more permanent solution. For some people, counseling may help
relieve the stress caused by neuropathy and thereby help restore
sexual function.
In women who feel their sexual life is not satisfactory, the role
of diabetic neuropathy is less clear. Illness, vaginal or urinary
tract infections, and anxiety about pregnancy complicated by
diabetes can interfere with a woman's ability to enjoy intimacy.
Infections can be reduced by good blood glucose control.
Counseling may also help a woman identify and cope with sexual
concerns.
New Strategies in the Medical
Management of Asthma
Source: American Family Physician
1998;July:89-108.
Asthma, a common chronic inflammatory
disease of the airways, may be classified as mild intermittent or
mild, moderate, or
severe persistent. Patients with persistent asthma require
medications that provide long-term control of their disease and
medications that provide quick relief of symptoms. Medications
for long-term control of asthma include inhaled corticosteroids,
cromolyn, nedocromil, leukotriene modifiers and long-acting
bronchodilators. Inhaled corticosteroids remain the most
effective anti-inflammatory medications in the treatment of
asthma. Quick-relief medications include short-acting beta2
agonists, anticholinergics and systemic corticosteroids. The
frequent use of quick-relief medications indicates poor asthma
control and the need for larger doses of medications that provide
long-term control of asthma. New guidelines from the National
Asthma Education and Prevention Program Expert Panel II recommend
an aggressive "step-care" approach. In this approach,
therapy is instituted at a step higher than the patient's current
level of asthma severity, with a gradual "step down" in
therapy once control is achieved. The significant new strategies
different from the past are the following.
The newly revised classifications for asthma are mild intermittent, mild persistent, moderate persistent and severe persistent.
If patients are using more than one canister of a quick-relief metered-dose inhaler per month, they are under poor control. Long-term control medications should be added or increased.
Asthma and its management still pose a
challenge. However, recent advances in our understanding of the
pathophysiology,
diagnosis and monitoring of asthma can help physicians optimize
treatment strategies. Contemporary treatment guidelines
emphasize an aggressive approach, with the prompt and liberal use
of anti-inflammatory medication to achieve long-term control of
this inflammatory disease. It is increasingly recognized that
successful asthma treatment requires a commitment from both
patient and physician. Patient education can empower persons with
asthma to begin guided self-management of their disease. Such
shared responsibility will help to ensure a favorable clinical
outcome and an enhanced quality of life.
Detailed information can be downloaded from http://www.aafp.org/afp/980700ap/gross.html.
| | | about us | | | activities | | | pharmaceutical information | | | products | | | web link to | | |
 |
||||||||||
| Thai Otsuka Pharmaceutical Co., Ltd. | ||||||||||