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Journal Article 2007; 28(Suppl 1): 27-33 PubMed PMID: 17262009 Citation  Keywords:  Antipsychotic Agents:therapeutic use, Humans, Patient Compliance, Psychiatry, Psychotic Disorders:drug therapy, Treatment Outcome,.   

: Compliance, usually referring to how well the patient takes the medication as prescribed, is an important issue in clinical practice. However, many patients, especially those with a psychiatric illness, stop taking their medications despite physician advice to continue. This cessation can lead to a deterioration in the condition, a relapse, or a recurrence of the illness. In the literature, many different factors contributing to poor compliance have been described, but the doctor's role and responsibilities are hardly mentioned. These factors will be discussed here with special emphasis on what a doctor should do and what a doctor should avoid....

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Journal Article 2007; 28(Suppl 1): 49-70 PubMed PMID: 17262007 Citation  Keywords:  Antipsychotic Agents:therapeutic use, Double-Blind Method, Humans, Placebos, Randomized Controlled Trials as Topic, Recurrence, Research Design, Schizophrenia:drug therapy, Treatment Outcome,.   

: Fourteen long-term (duration at least 26 months) double-blind, randomized studies comparing second-generation antipsychotics (SGAs) with placebo, conventional antipsychotics, or two or more SGAs, published after 2002 have been reviewed and are summarized in this chapter. Methodological problems and factors influencing results such as patient populations involved, outcome criteria, and dosages of evaluated drugs are discussed....

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Journal Article 2007; 28(Suppl 1): 117-133 PubMed PMID: 17262004 Citation  Keywords:  Antipsychotic Agents:adverse effects, Bipolar Disorder:drug therapy, Clinical Trials as Topic, Humans, Long-Term Care, Quality of Life, Schizophrenia:drug therapy, Treatment Outcome,.   

: Health-related quality of life (QoL) represents important measure of treatment outcome in mental disorders. Numerous studies indicate that QoL of people with schizophrenia and bipolar disorder is similar to that of patients with chronic physical conditions. It has been shown that schizophrenia patients can themselves reliably assess their QoL; in addition to the objective scales various self-reporting instruments are used. Patients with bipolar disorder have QoL consistently higher than patients with schizophrenia and similar to that found in people with unipolar depression. Quality of life can be negatively affected by drug-induced side-effects and subjective treatment response. The second-generation antipsychotics (SGA) have superior efficacy on QoL over classical antipsychotics in approximately half of the studies with schizophrenia; in the other half those groups are comparable. However, in none of the trials novel antipsychotics were inferior. All SGA (clozapine, olanzapine, risperidone, amisulpride, quetiapine, ziprasidone, or remoxipride) have been found to be beneficial for patients well-being. The most investigated drugs that convincingly improve QoL in schizophrenia are olanzapine and risperidone (including depot form). Results of several studies indicate that individual antipsychotics may differ in their effects on QoL, with suggested superiority of olanzapine. In bipolar disorder, SGA consistently showed their superiority over placebo in effects on QoL. The most studied SGA in bipolar disorder is olanzapine. More long-term controlled double-blind trials are needed to definitively uphold superiority and different effects of individual SGA on QoL of patients with schizophrenia and bipolar disorder....

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Journal Article 2006; 27(6): 818-821 PubMed PMID: 17187015 Citation  Keywords:  Adolescent, Adult, CA-125 Antigen:analysis, Dermoid Cyst:diagnosis, Female, Humans, Laparoscopy:methods, Middle Aged, Ovarian Neoplasms:diagnosis, Retrospective Studies, Treatment Outcome,.   

OBJECTIVE: Ovarian dermoid cysts are one of the most common germ cell tumors in women. The aim of the study was to analyze the use of laparoscopy in dermoid cysts treatment in women of reproductive age.

MATERIAL AND METHODS: The studied material consisted of 95 patients, aged 17-49, operated on because of dermoid cyst suspicion at the 1st Department of Obstetrics and Gynecology, Medical University of Warsaw, in the years 1996-2005. All the patients had pre-operative CA-125 antigen evaluation and transvaginal sonography with Doppler assessment of the ovarian pathology. All the women with tumors less than 8 cm in diameter were qualified for laparoscopic management.

RESULTS: The majority of patients were below 40 years of age (86 women; 90.5%). Out of 95 studied cases, 93 (97.9%) had the cyst removed during laparoscopy, mostly elective. Dermoid cyst enucleation was the most commonly applied procedure, while oophorectomy was the least frequent. The whole gonad was removed in 33 patients (34.7%), generally because of the total loss of functional ovarian tissue surrounding the cyst (28 women; 29.5%). All the extracted material was submitted for a histopathological examination--the diagnosis of mature ovarian cystic teratoma was confirmed in 100% of cases. The correspondence of pre-operative sonographic imaging and intraoperative macroscopic assessment was evaluated. In 85 (89.5%) operated patients an ovarian tumor was earlier described as a dermoid cyst.

CONCLUSIONS: Laparoscopic treatment of ovarian dermoid cysts is a safe method, offering many advantages in comparison to classical surgery. However, proper early qualification, based on medical history, gynecological and sonographic examination is of great importance....

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Clinical Trial 2006; 27(Suppl 1): 69-72 PubMed PMID: 16892009 Citation  Keywords:  Dental Implantation, Endosseous, Dental Implants:adverse effects, Humans, Hypersensitivity:prevention & control, Materials Testing, Treatment Outcome, Zirconium,.   

: Titanium dental implants have been used successfully in implantology for more than 40 years. Recent research, however, suggests that titanium might have more side effects than previously believed. Zirconia ceramics have been employed in orthopaedic surgery for approximately 30 years and were recently introduced into dentistry as a metal replacement for crown and bridge work as well as implant abutments. Zirconium dioxide has been shown in both in vitro and in vivo studies to have desirable osseointegrative properties. This clinical study shows that dental implants made from zirconia are a feasible alternative to titanium dental implants. In addition to excellent cosmetic results, zirconia implants allow a degree of osseointegration and soft tissue response that is superior to titanium dental implants....

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Clinical Trial 2005; 26(6): 709-712 PubMed PMID: 16380696 Citation  Keywords:  Adrenocorticotropic Hormone:blood, Adult, Dexamethasone:therapeutic use, Down-Regulation, Female, Humans, Hydrocortisone:blood, Middle Aged, Nelson Syndrome:blood, Somatostatin:therapeutic use, Treatment Outcome, Valproic Acid:therapeutic use,.   

OBJECTIVE: Pituitary tumours occurring in patients bilaterally adrenalectomized because of Cushing's disease (Nelson's syndrome) are frequently invasive and a complete their resection is not possible in most of them. Administration of the drugs decreasing ACTH secretion could be helpful in such unresectable tumours. We tried to evaluate the influence of somatostatin and valproic acid, compared to dexamethasone, in short-term studies, on plasma ACTH levels in Nelson's syndrome (NS).

MATERIAL AND METHODS: Basal ACTH levels were determined within 18 h after last dose of hydrocortisone and next, 1 and 2 hours following oral administration of 20 mg of hydrocortisone. Somatostatin was injected s.c. in two patients with NS while sodium valproate and dexamethasone were administered orally for three days in three patients with NS (two with an invasive pituitary tumour and one with a localized, intrasellar adenoma). The blood for ACTH and cortisol determination was drawn before the tests (two hours after 20 mg of hydrocortisone ingestion) as well as 1 and 2 hours following somatostatin injection and after 3 days of valproic acid or dexamethasone administration.

RESULTS: High plasma ACTH levels were found before the tests. Somatostatin lowered ACTH levels in both patients, more effectively in the patient with non-invasive pituitary adenoma. Valproic acid decreased moderately ACTH concentration in two patients, while following dexamethasone administration a fall in ACTH levels was observed in all three patients, the most evident in the patient with a non-invasive Nelson's adenoma.

CONCLUSION: Somatostatin seemed to be more effective in its inhibitory action on ACTH secretion than valproic acid, thus its administration in invasive cases of NS could be tried as a supplementary method to neurosurgery. The response to dexamethasone administration indicates that a feed-back regulation, although impaired, exists in these cases....

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Journal Article 2005; 26(Suppl 1): 67-73 PubMed PMID: 16361989 Citation  Keywords:  Antidepressive Agents, Second-Generation:therapeutic use, Antipsychotic Agents:therapeutic use, Bipolar Disorder:diagnosis, Cyclothymic Disorder:drug therapy, Humans, Treatment Outcome,.   

: Rapid cycling (RC) bipolar disorder is defined as four or more affective episodes within one year. RC bipolar disorder constitutes one of the most difficult forms of the illness to treat effectively. According to several studies, RC bipolar patients have more severe symptoms than non-rapid cycling bipolar patients. Most studies indicate that only 10% to 20% of patients with bipolar disorders experience rapid cycling, but this is of great concern to psychiatrists because of its association with treatment refractoriness. Second generation antipsychotics are increasingly being used in the treatment of bipolar disorder. A first step in the management of rapid-cycling bipolar disorder is the thorough assessment of possible medications or environmental factors that may destabilize the disorder and contribute to the recurrence of episodes, increasing cycle frequency, or both. All currently approved antidepressant drugs pose some risk of mood destabilization, but the risk is highest for tricyclic antidepressants. Discontinuation of antidepressants should be the first step in the management of RC patients....

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Journal Article 2005; 26(Suppl 1): 49-65 PubMed PMID: 16361988 Citation  Keywords:  Antidepressive Agents, Second-Generation:administration & dosage, Antipsychotic Agents:administration & dosage, Bipolar Disorder:drug therapy, Clinical Trials as Topic, Humans, Treatment Outcome,.   

: Conventional antipsychotic drugs, although efficacious in the treatment of mania, have not demonstrated a significant usefulness in the maintenance treatment of bipolar disorder. This has primarily been due to a tendency to induce depressive symptoms and depressive recurrences in this group of patients in the course of long-term administration. However, the picture has changed following the introduction of second-generation antipsychotics. These drugs have pro-depressant properties (if any) that are much weaker than conventional antipsychotics. Furthermore, their tolerability, especially in long-term treatment, is more favorable compared to classical antipsychotics. Clinical observations of the action profile of second-generation antipsychotic drugs in the treatment of schizophrenia have pointed to a possibility of these agents possessing mood-stabilizing properties. The first such suggestion was made by Zarate (1995) in connection with clozapine. The prevention of manic and depressive recurrences in bipolar disorder is a hallmark of the definition of mood-stabilizers....

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