Swiss medical weekly
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Swiss medical weekly · Mar 1995
Case Reports[Recombinant activated Factor VII (Novoseven Novo Nordisk) for hemostasis in acquired Factor VIII-inhibitor hemophilia].
One life threatening mediastinal hemorrhage and two limb threatening hemorrhages, one in the retroperitoneal and thigh muscles and the other in the back of the hand requiring surgical evacuation, were treated with recombinant activated factor VII concentrate (rFVIIa; Novoseven Novó Nordisk) in a patient with a postpartum acquired inhibitor against factor VIII. High dose activated prothrombin complex concentrate (Feiba sTIM4 Immuno), repeatedly administered, had proven to be ineffective; porcine factor VIII concentrate (Hyate C Porton) had become ineffective due to a rise in inhibitor titers against human and porcine factor VIII as well. 90 micrograms rFVIIa per kg body weight was administered as an i.v. bolus injection every 2-3.5 hours. The treatment periods were 22.5 days in the mediastinal and 11 days in each of the two other hemorrhages. ⋯ No inhibitors against patient's factor VII, induced by rFVIIa, were detected. Due to its extrinsic factor VIII bypass effect, rFVIIa led to excellent hemostasis even with inhibitor titers of 376 Bethesda units against human and 44 against porcine factor VIII. Nevertheless, immunosuppressive treatment with cyclophosphamide and prednisone was performed, with prompt decrease of the inhibitor titer.(ABSTRACT TRUNCATED AT 250 WORDS)
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Swiss medical weekly · Jan 1995
Review[Vigabatrin and lamotrigin: experiences with 2 new anticonvulsants in the Swiss epilepsy clinic].
Vigabatrin and lamotrigine are two new antiepileptic drugs which have recently become available. Vigabatrin is a specific and irreversible inhibitor of the enzyme gamma-amino-butyric-acid (GABA) transferase. Its administration leads to a long lasting increase in GABA, the most important inhibitory neurotransmitter. ⋯ Lamotrigine is also effective in the treatment of partial seizures, for which it is approved. However, uncontrolled studies and our own experience have shown that it is even more effective in generalized seizures. As add-on therapy in absences and tonic or tonic-clonic seizures, a significant reduction in seizure frequency--in individual cases seizure freedom--can be achieved.(ABSTRACT TRUNCATED AT 250 WORDS)
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Spinal cord damage is one of the main dose limiting processes in radiation therapy. Radiation myelopathy was first observed in 1941, but it was only in the early 1980s that more clear information on tolerance was available. Animal experimentation in particular has thrown light on pathogenesis and factors playing a role in this pathology. ⋯ Vascular damage may or may not be present. A dual pathogenesis is postulated. Oligodendrocytes and endothelial cells are the most likely target cells.(ABSTRACT TRUNCATED AT 250 WORDS)
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Basilar artery thrombosis is a potentially treatable neurologic disease whose initial symptoms are sometimes difficult to recognize. The basilar artery is hyperdense on computed tomography in cases with basilar artery thrombosis. ⋯ While it is not always possible to detect basilar artery thrombosis simply by evaluation of the tomodensitometric values before or after contrast, the differential values obtained by subtracting them (after contrast/before), or by an attenuation ratio corresponding to the differential value divided by the value before contrast, are more helpful. Indeed, the differential values and attenuation ratios in the normal population have a mean value of 51.1 and 1.37 compared with 14.47 and 0.33 in patients with basilar artery thrombosis.
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Anemia of cancer patients is multifactorial but often resembles anemia of chronic inflammatory disorders. We investigated the possibility of measurably increased parameters of inflammation in the serum of cancer patients and examined the correlation of hemoglobin levels, serum iron, and markers of inflammatory response in 201 cancer patients. ⋯ No significant correlations were seen between hemoglobin levels and neopterin or s-IL-2R. The correlation between hemoglobin levels in cancer patients and elevated markers of inflammatory responses, such as CRP, suggest that cytokines involved in the inflammatory responses may be at least partially responsible, directly or indirectly, for anemia in cancer patients.