RESUMO
The serine proteinase tissue-type plasminogen activator (t-PA) and the metalloproteinase gelatinase B (MMP-9) have recently been demonstrated in MS lesions. Both enzymes are interconnected in an enzyme cascade which contributes to destruction of the blood brain barrier and demyelination and both enzymes are inhibited by D-penicillamine. Metacycline was shown in in vitro experiments to inhibit gelatinase B. The combination of peroral D-penicillamine plus metacycline was evaluated in a double-blind placebo-controlled way in two groups of 10 patients suffering from secondary progressive multiple sclerosis. The major objectives of this pilot trial were to examine the safety of this combination and the possibility of blinding, while the effect on disease progression was considered as a secondary endpoint. Over a follow-up period of 1 year and in this selected patient group, there was no significant improvement in the Expanded Disability Status Scale score (EDSS) as compared with that of the placebo-control group. Toxicity was too high to consider additional trials with this combination of metalloproteinase inhibitors. Although peroral treatment is by most MS patients acknowledged as a major improvement in treatment compliance, one has to await the development of more selective and efficacious protease inhibitors than those used in the combination therapy described here.
Assuntos
Antibacterianos/toxicidade , Antirreumáticos/toxicidade , Metaciclina/toxicidade , Esclerose Múltipla/tratamento farmacológico , Penicilamina/toxicidade , Adulto , Método Duplo-Cego , Quimioterapia Combinada , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Projetos PilotoRESUMO
In this retrospective review of 29 patients with severe dysthyroid orbitopathy, the authors compare 3 invasive therapeutic modalities corticosteroids, radiotherapy and surgical orbital decompression) with special emphasis on the role of radiotherapy.
Assuntos
Doença de Graves/terapia , Corticosteroides/uso terapêutico , Adulto , Idoso , Diplopia/etiologia , Diplopia/cirurgia , Pálpebras/cirurgia , Feminino , Doença de Graves/complicações , Humanos , Masculino , Pessoa de Meia-Idade , Aceleradores de Partículas , Dosagem Radioterapêutica , Estudos RetrospectivosRESUMO
The history of 67 patients presenting with symptoms of macular pucker has been analysed retrospectively. Thirty-seven patients had a conservative follow-up. In 30 patients a pars plana vitrectomy with peeling of the premacular membrane has been performed. The natural course of the disease has been studied in the first group. For the second group surgical indications and results are discussed.
