Index by author

July 01, 1993; Volume 60,Issue 4

  1. Bakst, Alan

    1. From bathtub ring to osteoporosis: a clinical review of the bisphosphonates
      Angelo A. Licata, MD, PhD
      Cleveland Clinic Journal of Medicine July 1993, 60 (4) 284-290;

      BACKGROUND Etidronate and pamidronate are bisphosphonates, a class of chemical compounds originally used to soften hard water and prevent soap scum. Etidronate was serendipitously found to abate calcification in a child with myositis ossificans progressiva.

      OBJECTIVE Review the basic pharmacology of these compounds, as well as clinical uses of the approved and nonapproved forms.

      DISCUSSION Etidronate is approved for the treatment of hypercalcemia, Paget’s disease of bone, and ectopic calcification, and has been used to treat hyperparathyroidism and nephrolithiasis with limited success. Recently it has been used to treat osteoporosis. Pamidronate is approved to treat hypercalcemia. These two drugs are the only bisphosphonates available in the United States.

      CONCLUSIONS Clinical trials with etidronate have aroused widespread interest in the application of bisphosphonates to treat osteoporosis. Many trials are underway to evaluate these new drugs. More information will be available within the next 5 years.

    2. The fifth report of the Joint National Committee on Detection, Evaluation, and Treatment of High Blood Pressure: insights and highlights from the chairman
      Alan Bakst, PharmD and Ray W. Gifford, MD
      Cleveland Clinic Journal of Medicine July 1993, 60 (4) 273-277;

      Highlights include the new classification schema and recommendations on the use of labetalol.

    3. Assessing hypertension management: the role of 24-hour blood pressure monitoring
      Beatriz Esayag-Tendler, MD and William B. White, MD
      Cleveland Clinic Journal of Medicine July 1993, 60 (4) 278-283;

      BACKGROUND The first fully automatic portable invasive blood pressure recorder was developed 30 years ago. Today, portable noninvasive ambulatory blood pressure devices are capable of measuring blood pressure intermittently for periods of 24 to 48 hours.

      OBJECTIVE To discuss the utility of automatic ambulatory blood pressure recording in assessing antihypertensive therapy.

      SUMMARY Ambulatory blood pressure monitoring is helpful in assessing the pharmacodynamics and the clinical efficacy of an-tihypertensive drugs. It is superior to office blood pressure measurement in predicting hypertensive end-organ disease. In clinical trials, ambulatory blood pressure monitoring permits a more varied population to enter a study, the number of subjects required is often reduced, and a placebo control group may be unnecessary.

      CONCLUSIONS The various methods of analyzing ambulatory blood pressure data should be used in a complementary fashion to evaluate antihypertensive drug therapy. We believe that this technique will soon become much more commonly used for hypertension management.

    4. The use of G-CSF and GM-CSF in bone marrow transplantation
      Brian J. Bolwell, MD
      Cleveland Clinic Journal of Medicine July 1993, 60 (4) 291-302;

      Using hematopoietic growth factors appears to have made bone marrow transplantation safer. Treatment-related morbidity and mortality have decreased, and patients are discharged from the hospital sooner.

  2. Barnett, Gene H.

    1. Stereotactically guided thrombolysis of deep cerebral hemorrhage: preliminary results
      David W. Miller, MD, Gene H. Barnett, MD, Donald W. Kormos, PhD and Charles P. Steiner, BS
      Cleveland Clinic Journal of Medicine July 1993, 60 (4) 321-324;

      BACKGROUND The neurologic outcome from conventional medical or surgical therapy of intracerebral hemorrhage (ICH) is poor; however, stereotactically guided instillation of thrombolytic agents to dissolve parenchymal clots due to hypertensive hemorrhage has recently produced results equal to or better than those obtained with conventional therapies.

      OBJECTIVE To determine whether stereotactic thrombolysis of deep ICH is safe and effective.

      METHODS We administered urokinase to clots in four patients with hypertensive ICH. After the hemorrhage was localized using angiography and computed tomography-assisted stereotactic technique, a ventricular catheter was used to administer urokinase to the clot.

      RESULTS Preliminary results showed dramatic reduction in clot volume within 48 hours of initiating treatment and modest clinical improvement in all four patients. No further hemorrhages were seen after treatment. Three patients ultimately died of non-neurologic causes.

      CONCLUSIONS With careful patient selection, stereotaxy-assisted thrombolytic therapy may be an advance in the treatment of certain cases of ICH.

  3. Bolwell, Brian J.

    1. The elevated peripheral white blood count
      Brian J. Bolwell, MD
      Cleveland Clinic Journal of Medicine July 1993, 60 (4) 267-268;
    2. The use of G-CSF and GM-CSF in bone marrow transplantation
      Brian J. Bolwell, MD
      Cleveland Clinic Journal of Medicine July 1993, 60 (4) 291-302;

      Using hematopoietic growth factors appears to have made bone marrow transplantation safer. Treatment-related morbidity and mortality have decreased, and patients are discharged from the hospital sooner.

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