Nihon rinsho. Japanese journal of clinical medicine
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Angiotensin-converting enzyme (ACE) inhibitors are the first-line drugs for the treatment of congestive heart failure, but many patients could not receive those benefits because of intolerance. Recent randomized trials of angiotensin receptor blockers (ARB) in the treatment of patients with congestive heart failure elucidated clinical benefits of ARB as well as ACE inhibitors. ⋯ Val-HeFT showed additive benefits of valsartan on standard treatment with ACE inhibitors, diuretics and digitalis in patients with heart failure. CHARM would be elucidate the clinical usefulness of candesartan cilexetil in a broad spectrum of patients with symptomatic heart failure including patients whose LVEF greater than 40%.
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Japanese guideline for treatment and management of childhood asthma was published in April, 2000. This is the Japan original guideline. The general and practical asthma treatment in Japan is described. ⋯ There are many Japan original therapies such as the isoproterenol continuous inhalation therapy. Also, as for this guideline the education, vaccination and exercise of the patient are written in detail. We hope that this guideline is translated to English and be published.
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Several classes of medications are used in the treatment of bronchial asthma. Inhaled corticosteroids are the most potent and effective anti-inflammatory agents. ⋯ Combination treatment with fluticasone and salmeterol improves symptoms and lung function, reduces supplemental use of short-acting beta 2-adrenergic bronchodilator. The combination therapy provides better asthma control and may simplify the management of asthma.
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The polarized Th2 cells play an important role in the pathogenesis of atopic asthma as well as in the induction of airway inflammation. Th2 cytokines, such as IL-4, IL-5 and IL-13, are pivotal in regulating the allergic phenotype, the IgE response or the inflammatory cell-mediated function. Selective inhibition of Th2 cytokines by pharmacologic agents, including anti-cytokine blocking antibody, cytokine mutant and soluble cytokine receptor, will contribute to asthma therapy. Strategies based on blocking key signaling cytokines are also discussed.
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Trigeminal neuralgia is a disease affecting older individuals. The clinical hallmark of trigeminal neuralgia is a sudden, excruciating paroxysm of pain in the area of the trigeminal nerve. Drug therapy is considered the first line of treatment for trigeminal neuralgia. ⋯ Nerve block with neurolytic solutions and radiofrequency thermocoagulation is a simple, less invasive therapy. In order to avoid hypesthesia and dysesthesia, nerve block using a high concentration of local anesthetics is recommended. In recent years, stereotactic radiosurgery for trigeminal neuralgia has emerged as a new therapeutic modality.