Combined therapies procedures

Cyclosporine has been approved for use in allogeneic kidney, liver, and heart transplant patients and is under study for use in pancreas, bone marrow, single lung, and heart-lung transplant procedures. It is recommended that corticosteroids, such as prednisone, be used concomitantly, although at half or less of their usual dose. Such combined therapy leads to fewer side effects, a decreased incidence of infectious complications, efficacy of lower doses of cyclosporine, and a better history of patient survival. 

Since the late seventies, the clinical application of cisplatin has increased enormously16-18), mainly as a result of improved administration procedures and its use in combination therapy, i.e. the simultaneous application of a variety of synergistic antitumor drugs. Nowadays, usually a dosage per patient of about 100 mg of cisplatin per m2 body surface area, dissolved in saline, is given intravenously every month by standard administration protocols. 

Thus, the development and validation of enhanced throughput methods with simple extraction procedure followed by LC-MS/MS are of high interest for the simultaneous analysis of every major anticancer-targeted agent [130,131], which in the future may possibly be used also in combination therapy [132],... 

Combination therapy The use of local-interventional procedures is restricted to a maximum tumour size of 5 cm in diameter. Therefore, a combination of two local techniques is seen as promising. The joint application of PEI and TAB has proved its efficacy for some time. (177) Similarly, there have been reports about the successful use of TACE following laser thermal ablation. (136) Further encouraging options include a combination of TACE and RFTA, TACE with microwave coagulation (149) or TACE with cryotherapy. Using TACE, the size of the HCC can be reduced in some cases, making it possible to carry out subsequent ablation with better results. 

A recent study has shown that the PERT assay can be used to monitor the effect of antiretroviral treatment of HIV-1 infected patients. In this study, HIV RNA by the Roche HIV Monitor assay (Roche Diagnostic Systems, Inc., Branchburg, NJ) became undetectable in 33 of 125 samples (26.4%) from 23 patients treated with an antiretroviral combination therapy. Particle-associated RT correlated well with the values of viral RNA, but remained above the detection limit of the PERT assay, even in samples that were negative by both PCR for viral RNA and a p24 antigen detection procedure shown to be as sensitive as PCR (14). Moreover, the susceptibility to RT inhibitors of virus populations taken from biological fluids ex vivo can be directly assessed in vitro, without a need to first amplify the virus in cell culture. Thus, the RT activity... 

Similarly, in the Strategies for Patency Enhancement in the Emergency Department (SPEED) trial, patients with STEMI were randomized to receive full-dose reteplase, abciximab, or combination therapy with reduced-dose reteplase + abciximab followed by immediate diagnostic catheterization. The primary endpoint, the rate of TIMI grade 3 flow at 60-90 minutes, was improved with the combination reteplase (5 U -H 5 U) -I- abciximab + standard dose UFH when compared with standard dose reteplase (IOU-hIOU)-h standard dose UFH (61.1% vs. 46.9% p = 0.05) (14). Although the subsequent performance of PCI was neither randomized nor mandated, patients who were treated with combination therapy had improved pre-PCI infarct artery flow, improved procedural success, and trends toward decreases in death, reinfarction, and urgent revascularization compared with those patients who received hill-dose reteplase or abciximab alone before primary PCI. 

Either UFH or LMWH should be administered to patients with NSTE ACS. Therapy should be continued for up to 48 hours or until the end of the angiography or PCI procedure. In patients initiating warfarin therapy, UFH or LMWHs should be continued until the International Normalized Ratio (INR) with warfarin is in the therapeutic range for 2 consecutive days. The addition of UFH to aspirin reduces the rate of death or MI in patients with NSTE ACS.47 Enoxaparin was mentioned as preferred over UFH in the 2002 ACC/AHA clinical practice guidelines, as two large clinical trials found a reduction in the combined endpoint of death, MI, or need for PCI in patients... 

This work finally resulted in a new protocol for treating psoriasis, a chronic skin disease that can be seriously debilitating. The patient receives successive oral doses of methoxsalen followed by ultraviolet irradiation of the affected areas of skin. The procedure effectively controls psoriasis, and with improvements incorporated over the past twenty years it has become a standard therapy. Related procedures bring relief from several other skin diseases. In addition, the combination of psoralens and light has a key role in a promising treatment now under development for a white blood cell cancer. 

Many diseases, such as hereditary metabolic defects and tumors, can still not be adequately treated. About 10 years ago, projects were therefore initiated that aimed to treat diseases of this type by transferring genes into the affected cells (gene therapy). The illustration combines conceivable and already implemented approaches to gene therapy for metabolic defects (left) and tumors (right). None of these procedures has yet become established in clinical practice. 

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