Some Therapeutic Measures

Therapeutic measures which have been applied in both diseases, other than dietary prescriptions and symptomatic therapy, are few. The most important therapy is with estrogenic substances, the next that with thyroid hormone and related substances, and the third that with magnesium sulfate given parenterally. The role of hormones in cardiovascular disease has very recently been reviewed by Oliver and Boyd (1958). 

Dock (1956) has stressed that massive doses of estrogens cannot give immunity to coronary disease, as is readily seen in men with prostatic cancer treated with estrogens. Moreover, the side effects of doses effective on the blood pattern are marked if these doses are applied for a considerable time. 

Goldzieher (1949) and Kountz (1950) observed the augumented vascularization also in the nasal mucosa and submucosa in women (no data for men are given), and in the skin in men and women. Testosterone ointment applied to the skin seemed to have some effect also, but in a much lower percentage of cases than the estrogen preparation. Effects on the vascularization of the heart and the great vessels are not reported (and this will hardly be possible) but there is no special reason to suggest that such effects do not occur. 

Both in old men and in women in the menopause, the gonadotropin production is considerably increased. 

There is a relative predominance of estrogens in males with advancing age. For instance the androgen estrogen ratio is 13.9 between 17 and 29 years 7.0 between 50 and 59 6.4 between 60 and 69 and as low as 2.6 between 80 and 96 years of age (Kirk, 1951). Estrogenic substances are known to stimulate osteoblasts (Kenyon, 1942, with stilbestrol) and to prevent osteoporosis and the deposition of calcium in tissues other than 

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The success of infarct therapy critically depends on the length of time between the onset of the attack and the start of treatment Whereas some therapeutic measures are indicated only after the diagnosis is confirmed, others necessitate prior exclusion of contraindications or can be instituted only in specially equipped facilities. Without exception, however, prompt action is imperative. Thus, a staggered treatment schedule has proven useful. 

The purpose of using change-from-baseline analysis data sets is to measure what effect some therapeutic intervention had on some kind of diagnostic measure. A measure is taken before and after therapy, and a difference and sometimes a percentage difference are calculated for each post-baseline measure. These data sets are generally normalized... 

Thiazides should be used cautiously in the presence of severe renal and hepatic disease, since azotemia and coma may result. The most important toxic effect associated with this class of diuretics is hypokalemia, which may result in muscular and central nervous system symptoms, as well as cardiac sensitization (see Hypokalemia). Periodic examination of serum electrolytes for possible imbalances is strongly recommended. Appropriate dietary and therapeutic measures for controlling hypokalemia are described later in this chapter. The thiazides also possess some diabetogenic potential, and although pancreatitis during thiazide therapy has been reported in a few cases, the major mechanism contributing to the potential for glucose intolerance is not known. 

In the early Christian Middle Ages, however, a tradition arose that had a beneficial impact on the mentally ill, despite the fanaticism and incitement of later centuries the tradition of mercy. Prayers were said for the possessed and the Church initially saw itself as a haven for the insane and epileptics also. Only in the eleventh century were some madmen considered to be envoys of the devil, to be combated by all available means in the fourteenth century there was a change to isolating the insane from the healthy population in lunatic asylums and madhouses. Therapeutic measures for those isolated in this way were superfluous at that time, especially as those who knew about herbs and poisons were often themselves suspected of being witches (Duerr, 1979). 

Compared to other bioanalytical methods such as high-performance liquid chromatography (HPLC), the methods used to quantitate mAbs often display less precision and a higher between-day variability. In choosing a bioanalytical method it must also be considered that some assays measure the unbound fraction, the bound fraction, or both. When using FACS, only the fraction of the therapeutic antibody that is bound to its antigen on the cells is counted. In contrast, ELISA measures only the unbound fraction in serum that can react with the offered antigen. 

Treatment of fixed drug reactions involves removal of the offending agent. Other therapeutic measures include corticosteroids, antihistamines to relieve itching, and perhaps cool water compresses on the affected area. Photosensitivity reactions typically resolve with drug discontinuation. Some patients benefit from topical corticosteroids and oral antihistamines, but these are relatively ineffective. Systemic corticosteroids (e.g., oral prednisone 1 mg/kg/day tapered over 3 weeks) is more effective for these patients. 

Because the natural history of Graves ophthalmopathy is to imdergo spontaneous remission, evaluating the effectiveness of various forms of treatment is sometimes difficult. Also, one must know the phase in which the patient is identified because this, too, affects the treatment. With the knowledge that some eyes are lost solely due to failure to provide treatment, appropriate therapeutic measures may serve to reduce the risk to visual function and provide the patient with symptomatic relief... 

Psychometric test set (E. Kuntz, h.-D. Kuntz) This test set facilitates psychodiagnostic monitoring of potential liver-diseased patients, identification of SHE and control of therapeutic measures. In some cases, the very simple four basic tests can be evaluated in their overall assessment with even greater reliability by means of supplementary tests, which are likewise easy to implement. (19) (s. tab. 10.7)... 

In all patients, conservative therapy is initially founded on basic and diuretic therapy, which is successful in 60-80% of cases. In individual instances, the therapeutic measures of stage III are recommended. Apparent refractory forms of ascites call for paracentesis (stage IV), unless there are reasons against this. Some 80-90% of all patients with portal ascites can be successfully treated conservatively. Given the appropriate indication, reinfusion of ascitic fluid is also feasible. 

Spontaneous haemostasis Some 60-80% of all upper gastrointestinal haemorrhages cease spontaneously. Early diagnosis with simultaneous stabilization of the circulation facilitates such spontaneous haemostasis without further therapeutic measures being called for. In 10-15% of cases, the bleeding persists. 

The selection of an appropriate laboratory or biosafety level for a particular type of work hinges on a number of factors. Some of the more important of these factors are the potency and stability of the toxin being handled, the virulence and pathogenicity of the infectious agents being handled, and the availability of protective vaccines or therapeutic measures. 

A survey conducted 20 years ago and based on a total of 3921 cases showed 59% of laboratory-acquired infections had occurred in research laboratories (1). The majority of infections were of laboratory personnel but, in some cases, staff working outside the laboratory were also affected. Other events have emphasized the need for effective biosafety measures. These include two escapes of smallpox virus from laboratories that resulted in members of the public becoming fatally infected the emergence of new viral diseases with high case-fatality rates and the recognition that laboratory-based investigations would need to be made on viruses for which no prophylactic or therapeutic measures were available. Table 1 lists some viruses that have been identified as causal agents of laboratory-acquired infections (2-4). 

Hazard is the potential danger associated with a particular virus, and risk is the probability that the hazard will be expressed as an exposure with the possibility of infection. Containment refers to the control measures used to reduce the possibility of exposure. Some authorities categorize viruses according to hazard (4,5), whereas others have drawn up a classification based on risk, which includes such factors as pathogenicity, transmissibility, prophylaxis, and therapeutic measures (6). 

Pharmacotherapy, including the use of bronchodilatory drugs such as theophylline and P2 agonists and corticosteroids, can be attempted to determine whether the patient will respond. It is hard to determine a priori those patients who may respond to such therapeutic measures. There is some... 

Mahals We haven t yet tested this, but we intend to use non-invasive plethysmography for exactly this purpose this also has the great attraction of enabling us to do sequential measurements on the same animal. This is more relevant to the concept that these organisms or their products may have some therapeutic value. 

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