International journal of clinical practice
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Int. J. Clin. Pract. · Jun 2003
ReviewLevosimendan: a new dual-action drug in the treatment of acute heart failure.
Levosimendan is a new agent for the treatment of acute heart failure. Levosimendan acts via complementary mechanisms; it enhances contractility by sensitising cardiac myofilaments to calcium and dilates blood vessels by opening ATP-dependent potassium channels. In contrast to traditional inotropes (beta-agonists or phosphodiesterase inhibitors), levosimendan does not raise myocyte calcium levels and is therefore less likely to elicit arrhythmias or to impair diastolic relaxation. ⋯ At 31 days post-treatment, mortality rates were halved in decompensated chronic heart failure patients who received levosimendan, compared with those on dobutamine--an advantage sustained at 180 days. Similar survival gains were observed among acute failure patients treated with levosimendan following myocardial infarction. With its substantial haemodynamic and survival benefits, levosimendan is well suited to be part of routine management for patients with acutely decompensated heart failure.
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Int. J. Clin. Pract. · Apr 2003
ReviewAnakinra: the first interleukin-1 inhibitor in the treatment of rheumatoid arthritis.
Rheumatoid arthritis is an immunologically mediated inflammation of joints of unknown aetiology and often leads to disability. This inflammatory process may also involve extra-articular connective tissue. New therapeutic approaches have been made by inhibition of proinflammatory cytokines. ⋯ More than 10,000 patients have been treated with anakinra with significant improvement of inflammation and pain; the rate of radiologically visible progressive joint damage was significantly reduced. Among the adverse events, injection site reactions were most frequent, followed by a mild increase in infections. No activation of tuberculosis, as in tumour necrosis factor-alpha antagonist administration, has so far been reported.
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Prostate cancer screening of asymptomatic men is not recommended by the National Screening Council at present and is not encouraged in the NHS. A number of randomised controlled trials are under way to establish the place of routine screening of asymptomatic men. We report the possible practice of prostate cancer screening with reference to the appropriate age range for screening, how to screen for prostate cancer and how often, and what constitutes an abnormal result that would merit referral to a urologist for a prostate biopsy.
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Int. J. Clin. Pract. · Dec 2002
ReviewFrom adrenaline to formoterol: advances in beta-agonist therapy in the treatment of asthma.
Long-acting beta2-agonists (formoterol and salmeterol) represent the latest advance in a series of improvements in beta-agonist asthma therapy since the introduction of isoprenaline. Traditional inhaled short-acting beta2-agonists (salbutamol and terbutaline) provide rapid as-needed symptom relief and short-term prophylactic protection against bronchoconstriction induced by exercise or other stimuli. ⋯ Formoterol is both rapid acting (as fast as salbutamol) and long acting (similar to salmeterol). Increasing clinical evidence suggests that inhaled formoterol is a convenient and well-tolerated treatment that is effective both for regular maintenance and as-needed relief of symptoms.
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Intermittent claudication, the most common symptomatology of peripheral arterial disease, is characterised by lower-extremity discomfort induced by exercise and relieved by rest. The most serious potential outcome of the condition is increased morbidity and mortality from cardiovascular disease, with which it is often associated, thus prompt diagnosis and management are crucial. Therapy consists of structured exercise and reduction of cardiovascular risk factors, followed by or together with pharmacological interventions with anticlaudicants (cilostazol or pentoxifylline) and specific antiplatelet agents (aspirin, clopidogrel). Revascularisation procedures are indicated in those with limb-threatening or lifestyle disabling disease.