The problems of radon therapy: its benefits and risks]

Local administration of drugs by means of aerosol device is widely used in the treatment of asthma. Nevertheless, the effectiveness of this method depends on an adequate inhalation technique (IT), which available evidence has shown to be rather problematic. The aim of this study was to assess IT in out-patients with bronchial asthma who frequently use aerosol therapy with Pressurized Metered dose inhalers (MDI), pressurized inhalers with spacer (MDI-S) and the Astra-Draco Turbuhaler system (TH). A sample of 150 adults with asthma were evaluated. These patients had been followed up for than two years and they often used one of the devices mentioned above. The IT has broken down into several steps for each procedure. Percentages of patients with one error in the IT were 50%, 44% and 42% for MDI, MDI-S and TH procedures, respectively. 18%, 20% and 14% of patients committed three errors in the IT, respectively. Differences detected were not significant. Seven patients committed errors in every step of the IT. In conclusion, the level of errors found in our study is high, similar to that cited in the existing literature. It is also roughly equivalent for the three devices tested. We believe that the proper teaching monitoring of IT skills is highly important in the treatment of bronchial asthma.     

Amiloride inhalation therapy in mucoviscidosis

The defective regulation of the secretory chloride channel and the accelerated rate of sodium absorption in the airway epithelia of patients with cystic fibrosis (CF) contribute to the dehydration of airway secretions which is responsible for secondary damage in the respiratory tract. The sodium-blocker amiloride inhibits sodium absorption depending on the dosage of the drug. This effect is documented by means of measuring transepithelial potential difference which is decreased following to inhalative amiloride administration in CF patients. Clinical long term efficiency has been shown to be probable, but has to be confirmed. Investigation in this field is difficult, because there are some other important factors which influence viscosity of mucus. The use of amiloride can best be evaluated, if it is given immediately after birth. However, the answer to some important questions has to be found before.     

Alcohol inhalation in asthma therapy

As part of the search for anticomplementary active components from natural products, the anticomplementary properties of methanolic extracts from the flower buds of Magnoliafargesii have been investigated. Bioassay-guided chromatographic separation of the active constituents led to the isolation of compound 1, whose structure was identified by spectroscopic methods to be kaempferol 3-O-beta-D-(6"-O-coumaroyl)glucopyranoside (tiliroside). Tiliroside showed very potent anti-complement activity (IC50=5.4 x 10(-5) M) on the classical pathway of the complement system, even higher than rosmarinic acid, which is a well-known inhibitor against the complement system. On the other hand, the hydrolysates of tiliroside, kaempferol, astragalin and p-coumaric acid showed very weak activity on this system.     

Different modalities of spa therapy for skin diseases at the Dead Sea area

BACKGROUND: Balneology and spa therapy, although not accepted as well-established treatment modalities in dermatology, are used throughout the world. The therapeutic properties for skin and rheumatic diseases of the Dead Sea area may be attributed to unique climatic characteristics and unique natural resources. The mechanisms by which a broad spectrum of diseases are alleviated by spa therapy may involve mechanical, thermal, and chemical effects. OBJECTIVE: To review and discuss various spa therapy modalities, used at the Dead Sea area for a wide spectrum of skin diseases. CONCLUSIONS: Existing evidence indicates the therapeutic potential of Dead Sea spa therapy modalities for psoriasis and psoriatic arthritis. A beneficial effect is hinted at for other skin diseases, but the absence of relevant methodological and clinical information precludes the drawing of any scientific conclusions. It is essential to establish therapeutic guidelines to determine the optimal treatment modality for each disease, and the optimal protocol of each treatment component, adjusted individually for each patient, with respect to remission and long-term adverse effects.     

Nitric oxide inhalation therapy for newborn infants

Binding of NO to heavy metal-containing proteins probably accounts for many of its physiologic actions. NO inhalation is a promising new treatment for various disorders of neonates. The therapy is most likely to benefit premature neonates who are hypoxemic despite breathing pure oxygen and those who suffer from impaired carbon dioxide elimination. Newborn infants who have congenital heart disease may benefit from inhaled NO therapy if their disease involves some form of pulmonary venous hypertension or if they have recently undergone surgery involving cardiopulmonary bypass grafting. The use of NO in infants with PPHN might obviate the need for ECMO or other invasive treatment methods. Neonates with CDH seem likely to benefit marginally from NO therapy. Minimizing the toxicities of NO inhalation therapy requires that the physicians understand the nuances of infant care. The therapeutic value of increasing carbon dioxide elimination with NO inhalation warrants further investigation.     

The comparison of early fluid therapy in extensive flame burns between inhalation and noninhalation injuries

Dopamine hydrochloride bearing positively charged small liposomes was prepared by sonicating the multilamellar vesicles. These vesicles were characterized for their physical attributes (shape, size, charge, drug entrapment efficiency, and drug leakage). The drug release kinetics from the liposomes were also studied and found to be Fickian-type diffusion. In vivo performance of the drug-entrapped liposomes was assessed by periodic measurement of drug- (chlorpromazine) induced catatonia in Sprague-Dowley rats. These results were compared with the plain dopamine HCl and levodopa preparations as well with the marketed formulation of levodopa containing carbidopa (Syndopa). These studies revealed that the dopamine can be effectively delivered to the brain by incorporating it into liposomes, and its degradation in circulation can also be protected. The results of liposomal formulation were found to be superior compared to plain levodopa as well as Syndopa.     

Use of spa therapy to improve the quality of life of chronic low back pain patients

OBJECTIVES: This study assessed the effectiveness of adding spa therapy to usual drug treatment in chronic low back pain patients. METHODS: A total of 224 patients were assigned randomly to either a treatment (n=128) or a control (n=96) group. Subjects in both groups received usual drug therapy. Those in the treatment group also underwent spa therapy in Vittel, France, for 6 days a week for 3 consecutive weeks. Effectiveness was assessed using a quality-of-life scale (the Duke Health Profile), clinical measures, and the Roland and Morris disability questionnaire. Groups were compared using an analysis of variance with repeated measures. RESULTS: At both 3 weeks and 3 months, patients in the treatment group exhibited significant improvement in measures of: physical and mental dimensions of quality of life, anxiety, depression, pain duration, pain intensity, and functional disability. CONCLUSION: This study suggests that spa therapy is an effective treatment for chronic low back pain patients.     

Drug inhalation therapy. Therapy for patients with respiratory disorders

We detected a high number of patients suffering from respiratory ailments which require successive hospital stays due to acute setbacks in their chronic respiratory ailments. The majority of these patients receive outpatient clinic treatment based on use of an inhaler. Given the direct relationship between the correct use of an inhaler and its effectiveness, we designed our project with the goal to discover the adroitness these patients have with an inhaler. The results of our study showed that 67% of the patients tested did not correctly use their inhaler, there by annulling or diminished the effectiveness of its use.     

Interference therapy and radon baths in the combined treatment of patients with reflex cervicobrachial syndromes

Renal function was examined in 66 proteinura-free patients at the age of 40-67 years having diabetes mellitus (DM) type II for 4-10 years and HbA1c 7% maximum. Non-insulin-dependent DM was found to affect both glomerular and tubulointerstitial renal systems. This was indicated by reduced glomerular filtration, microalbuminuria, hyperenzymuria, high blood and urine levels of beta-2-microglobulin. Administration of glurenorm instead of maninil led to enhancement of glomerular filtration, lowerering of albuminuria, uroenyzmes, beta-2-microglobulin in the blood and urine. Glurenorm is a proper drug in DM type II as it has both sugar-reducing and nephroprotective effects.     

Treatment of lung metastases from malignant melanoma with IL-2 inhalation therapy

Seven patients with pulmonary metastases of malignant melanoma were treated with inhalation therapy with 36 million IU interleukin-2 for six months. Inhalation therapy was combined with four bolus infusions of DTIC at a dose of 850 mg/m2 once every four weeks. Response rates were 71.4% with 2 patients achieving a complete remission (CR), 2 partial remissions (PR), 1 stable disease (SD), and 2 progressing disease (PD). Therapy was well tolerated with low toxicity. Six of the patients developed cough; one patient was slightly feverish. We conclude that inhalation therapy of lung metastases is a promising addition to the therapeutic arsenal against malignant melanoma.     

NO inhalation therapy for post-operative pulmonary hypertensive crisis of the case of truncus arteriosus

OBJECTIVE: To test stability of insulin lispro in two insulin infusion systems over 48 h. RESEARCH DESIGN AND METHODS: We used reverse-phase and size-exclusion high-performance liquid chromatography (HPLC) to determine the purity, potency, and degree of polymerization of U100 insulin lispro (Humalog) after 24- and 48-h pump cycles conducted at 37 degrees C in five Disetronic H-TRON V100 and five MiniMed 504 pumps. Pumps were set to deliver a basal rate of 0.5 U/h and 6-U boluses at t = 0, 4, 8, 24, 24.5, 28.5, 32.5, and 48 h during each cycle. The effluent was collected into 1-ml vials, pooled at 24 or 48 h, and stored at 4 degrees C until assay. After each 48-h run period of insulin delivery, assays for potency, polymer, and purity were performed on the pooled samples from each individual cycle. m-cresol content and the pooled reservoir content were assayed in the 48-h pooled samples. RESULTS: Insulin lispro retained full HPLC potency (delta < or = 4%) at 48 h, with no degradation of insulin lispro to des-amidoinsulin forms (24 or 48 h). No increase in pumped insulin polymer concentration was observed following 24 h of pump flow. Nonsignificant increases of < or =0.09% (Disetronic) and < or =0.15% (MiniMed) from initial concentrations of 0.18% (polymer divided by total insulin) were detected in three of five pump cycles at 48 h when compared with 37 degrees C paired controls. Nonsignificant decreases (<5 and 10%, Disetronic and MiniMed, respectively) of m-cresol content occurred in both systems following 48 h storage in each device, but sterility was not compromised by this decrease (initial m-cresol concentration, 3.15 mg/ml). Pump performance was without mechanical or electrical fault throughout the study Basal and bolus insulin delivery was evaluated three times daily and remained as expected. Occlusion of catheters by insulin precipitation did not occur, and no change in pH was observed following delivery. CONCLUSIONS: We conclude that insulin lispro is suitable for prolonged infusion in these two medical devices when syringes and catheters are replaced at 48-h intervals.     

Desflurane: a new inhalation anesthetic]

Desflurane is a new fluoride-only halogenated inhalational anesthetic. It differs from other halogenated anesthetics, in having a lower solubility in all tissues and greater molecular stability in all media. These traits mean, on the one band, that desflurane affords rapid achievement of depth of anesthesia, recovery and management during surgery, and on the other, that its potential toxicity is low and that it is safe for use in low flow circuits. The pharmacodynamic effects of desflurane are similar to those of isoflurane in the blood stream, airways and brain. Sympathetic hyperactivity with increased heart rate and arterial pressure may be triggered when concentration is increased quickly, but this effect is partially abolished when fentanyl is administered. Induction of anesthesia with desflurane causes irritation of the airways, particularly in children, and its use in pediatric surgery is therefore inadvisable. Desflurane potentiates the action of neuromuscular relaxants, much like isoflurane. Desflurane represents a step forward in the search for the ideal anesthetic.