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Pulmonary Amyloidosis with Pulmonary Arteriovenous FistulaAmyloid deposition has been reported to make vessels fragile, and some cases of hemorrhage caused by amyloidosis have been reported. We report herein a case of pulmonary amyloidosis suspected of causing a pulmonary AV fistula. read only
Case Report
A 77-year-old man was admitted for close examination of abnormal shadows on his chest roentgenogram, which was taken during a routine check-up. His medical history revealed a gastric ulcer and cerebral hemorrhage. His family history was unremarkable. At the age of 62, his chest roentgenogram showed two tumorous shadows in the left upper lobe, and an open biopsy disclosed “benign lung tumors” of unknown origin. Since then he had received no treatment or follow-up examination. On admission, he was asymptomatic and his physical examination disclosed bruit on the right chest wall audible only on inspiration. No telangiectasia was seen on his skin or in his oral cavity. Laboratory data revealed increased ESR, CRP and CEA. Blood gas analysis showed mild hypoxia (PaOs of 62 mm Hg, PaC02 of 33 mm Hg) while the results of a lung (unction test were unremarkable. Sputum examination did not suggest malignancy or tuberculosis. Chest roentgenogram revealed bilateral multiple nodular calcified shadows (Fig 1). …Read the rest of this article

Although this procedure inescapably compounds differences based upon monitoring of symptoms (ie, drug usage is reduced until symptoms appear). Results of the present study show that 42 percent of the patients receiving slow-release oral ketotifen were able to reduce (or, in some cases, stop) the amount of additional antiasthmatic drug therapy, compared to 27 percent of patients receiving a placebo. This outcome accords with experience in previous trials with ketotifen, and the drug-sparing effect of ketotifen is comparable to that of cromolyn sodium in a study of similar design. read …Read the rest of this article

Ketotifen in the Prophylaxis of Extrinsic Bronchial Asthma: DiscussionKetotifen (Zaditen or Zasten) is a benzocylohepta-thiophene derivation that is orally active; it is metabolized in humans to the glucuronide and desmethyl derivatives, both of which are excreted in the urine. Clinical studies have shown ketotifen to be effective in the treatment of asthma when compared with placebo, theophylline, and cromoglycate, and to have steroid-sparing effects. Ketotifen inhibits eosinophil activation and accumulation* and diminishes development of airway hyperreactivity. It is widely held that asthmatic airways become hyperreactive as a consequence of inflammatory events in which eosinophils predominate; hence, these properties of ketotifen may be expected to confer efficacy in the treatment and prevention of asthma and allergic reactions. Ketotifen has also been shown to preempt the hyposensitivity that often follows regular use of P-adrenergic agonists. buy mircette online …Read the rest of this article

Efficacy
The intensity of asthmatic attacks during the day and night, as well as the total number of days with asthmatic attacks, decreased during treatment in both groups. At the end of treatment, there was a statistically significant difference between the two groups in favor of slow-release oral ketotifen. A Mann-Whitney rank-sum test with significance of p<0.01 was calculated on the frequency and intensity of asthmatic attacks during the day and night between weeks 6 and 12, as well as on the mean value of the results during weeks 8 to 12 (Fig 1). Clinical symptoms and signs (eg, cough, expectoration, nasal obstruction and discharge, runny eyes, cutaneous signs, and wheezing) also improved progressively. At the end of the trial treatment, analysis showed a statistically significant difference between the two groups for all symptoms except conjunctivitis and atopic eczema (Fig 2). There was a slight improvement in PEFR (Fig 3) and FEVt for both groups, but this was not statistically significant. …Read the rest of this article

Ketotifen in the Prophylaxis of Extrinsic Bronchial Asthma: ResultsStatistical Analysis
According to the type and distribution of the data, either parametric tests (Students f-test) or nonparametric analyses (Wil-coxon-Mann-Whitney U-test) were utilized. In x* tests, “n-1” replaced “n” in the formula used for continuity correction of 2 x 2 tables. The level of significance was defined with alpha=0.05 (two-sided tests), but if the difference was close to the significance level, x2 values were calculated also by the C-test of Woolf. canadian health&care mall …Read the rest of this article

Design of Study
The study was a double-blind, randomized, controlled multicenter study (22 centers in nine European countries) comparing a slow-release oral formulation of ketotifen with placebo for a period of 12 weeks in patients with mild extrinsic bronchial asthma. The dosing regimen for the slow-release oral tablet of ketotifen was based on the known efficacy of twice daily administration of 1 mg of ketotifen. A treatment duration of 12 weeks was selected based on previous controlled studies proving the efficacy of prophylactic treatments in bronchial asthma. The patients (in the case of children, their parents or guardians) volunteered for the trial after an explanation of the protocol, which was approved by the hospitals’ ethics committees. Oral consent was obtained from each participant. …Read the rest of this article

Ketotifen in the Prophylaxis of Extrinsic Bronchial AsthmaA Multicenter Controlled Double-Blind Study with a Modified-Release Formulation
Ketotifen (Zaditen or Zasten) is widely used as a prophylactic drug in the treatment of extrinsic bronchial asthma, with the exception of the United States. In controlled studies, efficacy has been detected in the majority (50 to 70 percent) of patients. The only prominent side effect is sedation occurring in up to 20 percent of adult patients. A patients acceptance and compliance with treatment with a drug such as ketotifen is dependent on psychologic, environmental and social factors, as well as on characteristics of the drug regimen. Drug-related characteristics comprise efficacy of the drug, adverse effects, frequent-dose regimens, and the physical feature of the drug itself. A slow-release oral formulation of ketotifen (Zaditen SRO) has been developed to improve patients’ overall acceptance and compliance by reducing the frequency of drug administration from twice to once per day. Additionally, it is anticipated that the incidence and severity of sedation may be reduced by eliminating fluctuations (peaks in blood levels) and by administering the drug before bedtime.
The present trial was designed to investigate the efficacy and tolerability of orally administered slow-release tablets containing 2 mg of ketotifen compared with placebo, in the treatment of mild extrinsic bronchial asthma. …Read the rest of this article