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 170,190 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

This study determined the importance of side effects and outcomes (i.e. the control of disease, convenient dosing and cost) in physicians' differentiation of drug products used to treat hypertension, allergic rhinitis, and gastroesophageal reflux. In addition, the study examined whether the importance of particular characteristics attributed to a drug varied with the practice setting. The multiattribute attitude model was used as a framework to examine physicians' perceptions of the importance and the probability of occurrence of specified side effects, results and their prescription intentions. Two groups of physicians were interviewed to identify determinant side effects and results. A questionnaire was used to obtain data by post from a random sample of 2,400 physicians in four types of practices: solo practice, group practice, institution and government (n = 527, 22% response). The findings indicate that the perceived likelihood of occurrence of side effects and results differed with the drug products but did not differ with the type of practice. Practice setting, however, was found to have a significant effect on intention to prescribe. Physicians in each setting differed in their intentions to prescribe certain studied drugs. Finally, physicians in the four settings were found to be similar in their ranking of the importance of particular characteristics of the drug. The control of disease was the most important result in all three scenarios, followed by individual side effects.
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PMID:The importance of side effects and outcomes in differentiating between prescription drug products. 128 24

This article reviews the current data available on the most frequently used drugs in bronchopulmonary dysplasia. Oxygen, diuretics, bronchodilators, steroids, ribavirin, and antioxidants, as well as medication available for pulmonary hypertension, systemic hypertension, and gastroesophageal reflux are discussed, with emphasis on known advantages, side effects, and current dosage.
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PMID:Pharmacotherapy in bronchopulmonary dysplasia. 332 29

A patient had syncope induced by swallowing. Electrocardiographic monitoring during eating and esophageal balloon inflation demonstrated a second-degree atrioventricular block (Mobitz type II) with dizziness. Radiologic and manometric examinations of the esophagus showed diffuse esophageal spasm associated with hypertension of the upper esophageal sphincter (UES), gastroesophageal reflux, and a sliding hiatal hernia. Cineradiographic observations were made during ingestion of a meal mixed with barium; at the time of cardiac dysrhythmia, the proximal part of the esophagus containing the bolus assumed a balloonlike shape, while the distal part and the UES contracted. On the basis of these observations and review of all published cases, we propose the pathways of this esophagocardiac reflex and discuss up-to-date treatment.
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PMID:Atrioventricular block induced by swallowing in a patient with diffuse esophageal spasm. 713 82

Esophageal investigation was performed successfully in 52 patients who were initially suspected of suffering from angina pectoris, but the pain was subsequently shown to be not of cardiac origin by radionuclide myocardiac perfusion and (or) coronary angiography in 74% of cases, and by EKG and poor response to anti-angina therapy in 26% of the cases. In 82.7% of the patients the diagnosis was gastroesophageal reflux disease (GERD), in 3.8% Nutcracker esophagus, and in 5.8% lower esophageal sphinctor hypertension. In the remaining 7.7% the diagnosis was unknown. In 43 patients with GERD, gastroesophageal reflux (GER) investigation showed GER symptoms in 61.5%, reflux esophagitis was confirmed with endoscopy in 45.3%. Abnormal esophageal manometry was found in 53.8%, positive provocative test in 42.9%, excessive radionuclide GER in 50%, and increased duration of hyperacidity in 57.1%. However, a combined study of the procedures mentioned above showed that the diagnosis was consistent with GERD in 82.3% of the patients. Chest pain was completely relieved in 34% of the cases and significantly relieved in 50%. No response was ilicited in 16% of the cases after 1-2 weeks of anti-reflux therapy. It is found that chest pain induced by GERD is very common, esophageal endoscopy and motor studies are helpful in the diagnosis of GERD and other esophageal motor diseases, and anti-reflux therapy is a reliable measure when a patient complains of unknown chest pain and GER symptoms.
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PMID:[Diagnosis and treatment of angina-like chest pain in 52 cases]. 826 55

Physiology of pain is a manifold and very complex phenomenon that is far from being understood. It cannot be explained without reference to psychosocial conditions. Pain has the function of a warning system, but the system is far from perfect, because a number of chronic diseases (e.g., arterial hypertension or malignant neoplasms) begin slowly and nearly painless. The role of pain in internal medicine will be exemplified by thoracic and abdominal pain. With regard to diagnoses both types of pain represent ambiguous symptoms. Their anatomic and physiologic substrates often cannot be ascertained completely by anamnestic means (according to localization, quality, trigger factors, time structure, and concomitant symptoms of pain). Visceral pain is regularly characterized by the phenomenon of the so-called "transferred pain": that means that the perception of pain is not restricted to the place of its origin but is also found in distant regions of the body, primarily in well defined dermatomes ("Head's areas"). This makes the differential diagnosis of internal diseases very difficult because of the parallel connection of nociceptive afferences from the skin and deeper-seated strata on identical spinal segments. Statements according to the pharmacotherapeutic aspects of pain primarily focus on the causal therapy of the prethoracic pain. In this regard differential-therapeutic aspects of angina pectoris, pericarditis, pleurisy, gastro-esophageal reflux, and vertebragenic, myogenic, and neurogenic disturbances are well to the fore.
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PMID:[Pain--from the physiological and internal medicine viewpoint]. 852 23

Morbid obesity is related to a severe decrease in life expectancy. No medical or dietary treatment offers an alternative to control hypertension, apnea syndrome, orthopedic diseases, ..., caused by overweight. With respect to a serious preoperative evaluation and a severe selection (psychologic, dietetic, ...) Silastic Ring Vertical Gastroplasty is considered in our experience (more than 300 cases) and in the literature as the gold standard for surgical treatment of obesity. The long term follow-up (24-66 months) of 100 consecutive operated patients shows a positive response on hypertension (96%), apnea syndrome (92%), diabetes (85%), gastroesophageal reflux (76%), orthopedic diseases (74%) and cardiorespiratory insufficiency (74%). Considering our experience in the medical and surgical management of patients operated in our department or referred from other centers for complications after different procedures, we actually propose SRVG as the treatment of choice for morbid obesity.
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PMID:[The treatment of morbid obesity with gastroplasty]. 892 52

The authors, on a basis of experience acquisted since 1984 on two groups of patients, respectively 55 and 174 subjects with angina like chest-pain, individuated in the first group 45%, and 66.1% in the second group, the presence of GER-EMD with the execution of functional stationary manometric and 24 hour pH-metrical exams, without undergoing chemical, pharmacological, mechanical stimulation. They make note that 43 patients out of the second group, underwent, after a certain time, another cardiological study (negative for heart disease when recluted) due to graveness of the symptoms and 33 risulted holders of heart disease, 24 of whom also affected with EMD. The treatment with anti-H2 and procinethycs had succes in 39 patients out of 59, with GER; 10 patients underwent, with success, Nissen-Rossetti funduplication. Medical treatment with sublingual nifedipine was successful in 17 cases out of 56, with EMD; 19 underwent esophageal miotomy surgery commisurated on manometrical dates, with excellent results; 8 patients with hypertension of LES underwent pneumatic dilation with good results; 12 patients live, tolleratig angina like chest-pain. The final considerations are the following: it is not indispensable to look for contemperaly EMD and pain to afferm that pain is of esophageal origin; EMD must be clearly defined; the exclusion primarily of heart pathology must not exclude the possibility of the insorgence of heart desease, in the presence of EMD; the medical therapy, satisfactory in GER, is scarsely efficent in EMD, the decision for surgery must be taken on the gravity of pain associated with an esophageal pathology well defined with numerous diagnostic exams.
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PMID:[Clinical and therapeutic approaches in angina pectoris of esophageal origin]. 894 2

An understanding of changes in pulmonology disease patterns observed at a general hospital before and after implantation of a population-based model of health care not only provides useful insight into the diseases treated but also aids adjustment of health care service organization. The aim of this study was to compare data collected after 1992 (when the new system was established) with records kept by the same pulmonology group in earlier years (1974-1986). Data after 1992 described patients attended in Health District 11 by the newly organized pneumologists. For the two periods the most common pneumological diagnoses were chronic air flow obstruction and chronic hypersecretory bronchitis. The most common non pneumological diagnoses were systemic arterial hypertension, obesity, diabetes, liver disease and hiatus hernia/gastroesophageal reflux. The prospective study covered a larger population and was closer to primary care, including as it did patients at clinics unattached to hospitals. In the earlier hospital-based experience the most common diagnoses were acute respiratory infection, chronic air flow obstruction and asthma, apart from those patients referred in whom no respiratory disease was found. With the organizational integration of hospital and health district pulmonology service, contact between patients and specialists has increased. Record systems have been established for a well-defined population to permit better forecasting at less cost and facilitate contact with primary care givers and epidemiological studies.
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PMID:[Diseases diagnosed at a pneumology unit integrated with its health area. Comparison with historical controls]. 894 84

Cisapride, a cytochrome P450 3A4 (CYP3A4) substrate, is widely prescribed for the treatment of gastrointestinal motility disorders. Prolongation of QT interval, torsades de pointes, and sudden cardiac death have been reported after concomitant administration with erythromycin or azole antifungal agents, but not with other CYP3A4 inhibitors. A possible drug interaction occurred in a 45-year-old woman who was taking cisapride for gastroesophageal reflux disorder and diltiazem, an agent that has inhibitory effect on CYP3A4, for hypertension. The patient was in near syncope and had QT-interval prolongation. After discontinuing cisapride, the QT interval returned to normal and symptoms did not recur. We suggest that caution be taken when cisapride is prescribed with any potent inhibitor of CYP3A4, including diltiazem.
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PMID:Prolongation of the QT interval related to cisapride-diltiazem interaction. 954 59

Systemic sclerosis (SSc) is a heterogenous disease with a morbidity and mortality that varies widely. Nonetheless, the future clinical course of an individual patient can be estimated based on the severity of skin and internal organ involvement within the first several years of the disease. Patients with limited cutaneous SSc (ISSc) have skin thickening below the elbows or knees and may have face and neck involvement. Patients with this subtype of SSc have Raynaud's phenomenon, digital ulcers, and esophageal dysfunction. Significant morbidity and mortality arises in those patients with ISSc who develop interstitial lung disease or pulmonary artery hypertension. Patients with diffuse cutaneous SSc (dSSc) have skin thickening above the elbows and knees or on the trunk. These patients have a more abrupt onset of disease, often with constitutional symptoms and arthalgias. Severe heart, lung, gut, and renal involvement, if it occurs, tends to develop within the first 5 years of disease, especially within the first several years. Patients with significant internal organ involvement have a poorer prognosis than patients who do not. The goals of the initial history and physical and laboratory examinations are to classify the type of scleroderma as ISSc or dSSc, to estimate disease duration, and to define the extent and severity of organ involvement. Treatment of SSc is organ based. Treatment may reduce morbidity associated with Raynaud's phenomenon, digital ulcers, esophageal dysmotility, esophageal reflux, gut dysmotility, arthralgias, myositis, and pulmonary artery hypertension. Therapy may stabilize lung function in patients with interstitial lung disease with alveolitis and stabilize renal function in patients with renal crisis. The overall prognosis for patients with SSc appears to be improving. Patients with early dSSc should be considered for enrollment onto protocol testing of potential disease-modifying therapies.
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PMID:Clinical approach to scleroderma. 975 79


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