Re-evaluation of randomized controlled trials of lithium monotherapy.
Explore the source record for details and available documents.
Antimanic Agents↗
SEARCH · PubMed Health
Results for “Lithium Compounds”
Explore indexed PubMed citations for clinical trials, systematic reviews and public health research. Read source abstracts and follow each citation to its original PubMed record.
Quote a phrase for an exact phrase match. Source license links do not imply unrestricted reuse.
Allopurinol as an adjunct to lithium and haloperidol for treatment of patients with acute mania: a double-blind, randomized, placebo-controlled trial.
OBJECTIVE: Allopurinol, a hypouricemic agent, has been shown to present therapeutic effects in mania associated with hyperuricemia. This study assessed the efficacy and safety of risperidone as an adjunctive agent to lithium and haloperidol for the treatment of acute mania in hospitalized bipolar patients. METHODS: Eighty-two patients aged between 18 and 49 were eligible to participate, as they met the DSM-IV criteria for a current manic episode, on the basis of a clinical interview by two academician psychiatrists. In addition, a score of at least 20 points on the Young Mania Rating Scale was required representing at least a moderate-to-severe mania. Forty-one patients were randomly allocated to lithium (1-1.2 mEq/L) + haloperidol (10 mg/day) + allopurinol (300 mg/day) (group A) or lithium (1-1.2 mEq/L) + haloperidol (10 mg/day) + placebo (group B) for an 8-week, double-blind, placebo-controlled study. Patients were assessed by a third-year resident of psychiatry at baseline and at 7, 14, 28, 42, and 56 days after the medication started. The mean decrease in the Young Mania Rating Scale score from baseline was used as the main outcome measure of response of mania to treatment. The extrapyramidal symptoms were assessed using the Extrapyramidal Symptoms Rating Scale (ESRS). Side effects were systematically recorded throughout the study and were assessed using a checklist. RESULTS: Young Mania Rating Scale scores improved with allopurinol. The difference between the two protocols was significant as indicated by the effect of the group, the between-subjects factor (F = 5.22, df = 1, p = 0.008). The mean ESRS scores for the placebo group were higher than the allopurinol group. However, the differences were not significant over the trial. The difference between the two groups in the frequency of side effects was not significant except for agitation that was more often in the placebo group. CONCLUSIONS: The efficacy of allopurinol to obtain a greater improvement in patients with mania seems to support the purinergic dysfunction in mania.
Acute Disease↗
Increased erythrocyte aldose reductase activity in type 1 diabetic patients.
Elevated erythrocyte sorbitol levels have been demonstrated in diabetic patients. In order to explain the enhanced sorbitol formation, it has been suggested that aldose reductase might be activated by hyperglycaemia. Although aldose reductase activity has been reported to be increased in some tissues of diabetic patients, the effects of varying concentrations of glucose on the enzyme activity in vivo are unknown. To determine whether or not erythrocyte aldose reductase activity is increased in diabetic patients and is affected by glucose levels, we collected blood samples from 10 Type 1 diabetic patients while fasting and 2 h after a standard meal. We measured the activity of erythrocyte aldose reductase after partial purification by column chromatography. The results showed that erythrocyte aldose reductase activity was significantly increased in diabetic patients as compared with non-diabetic subjects (7.3 +/- 0.7 (+/- SE) vs 5.2 +/- 0.3 u l-erythrocytes-1, p less than 0.05). No correlation, however, was observed between fasting plasma glucose levels and the enzyme activity, and acute elevation of the blood glucose level did not affect the enzyme activity.
Aldehyde Reductase↗
The role of continuous renal replacement therapy in the treatment of poisoning.
Extracorporeal elimination of drugs and toxins is a critical component in the management of poisonings, though specific techniques and indications remain a matter of debate. Conventional hemodialysis is frequently the treatment of choice because of its widespread availability and proven effectiveness for certain drugs and toxins. With the increased availability of continuous renal replacement therapy (CRRT) modalities, there is yet another therapeutic option, but one that has yet to find a definitive role in this field. The continuous nature of these therapies is attractive for the management of acute renal failure, but the relatively slower clearance rates as compared to conventional hemodialysis is a distinct drawback in patients with acute xenobiotic-induced toxicity. There are abundant case reports as well as a few small case series in the medical literature documenting the use of CRRT, but specific techniques and the clinical outcomes vary considerably. Therefore one cannot draw definitive conclusions regarding benefit. Some patients, particularly those who are hemodynamically unstable and are not candidates for conventional hemodialysis, may warrant a trial of CRRT. However, at the present time, routine use for the treatment of poisoning is not supported. Controlled trials to better clarify its role would be beneficial, though such studies would be extremely difficult to conduct in this field. We believe that the intelligent application of extracorporeal modalities requires a thorough knowledge of drug pharmacokinetics, of the techniques utilized, and a skeptical analysis of the available literature.
Anticonvulsants↗
Lithium-induced confusional states: nonconvulsive status epilepticus or triphasic encephalopathy?
Lithium therapy can cause a confusional state by direct toxicity, precipitation of nonconvulsive status epilepticus, or by interplay with other neuroleptic medications to produce neuroleptic malignant syndrome or serotonin syndrome. These conditions resemble each other clinically, but EEG may help differentiate among them. We reviewed the EEG patterns with triphasic waves or rhythmic delta activity in lithium toxic patients and discuss clinical and EEG differentiation among syndromes. Lithium toxicity poses significant diagnostic challenges from EEG and clinical perspectives.
Adult↗
Lithium/carbon monofluoride (Li/CFx): a new pacemaker battery.
The reduction in pacemaker size coupled with the addition of more current demanding functions has motivated the development of batteries that can supply higher current densities at useful voltages than the lithium/iodine batteries in use today while retaining the volumetric energy density of that system. The lithium/CFx system offers an attractive alternative for advanced pacemaker systems. The battery can deliver currents in the milliampere range without significant voltage drop. The system is compatible with titanium casing, allowing a 50% reduction in weight over the same size lithium/iodine battery. Cells have been designed and tested in these laboratories and have been shown to be suitable for advanced pacemaker applications.
Biocompatible Materials↗
Genetic transformation of germinated conidia of the thermophilic fungus Humicola grisea var. thermoidea to hygromycin B resistance.
Germinated conidia of the thermophilic fungus Humicola grisea var. thermoidea were transformed to hygromycin B resistance using the plasmid pAN7.1. Transformation was achieved using lithium acetate treatment or electroporation. The efficiency of transformation was up to 32 and 25 transformants per microgram of plasmid DNA with the two methods, respectively. Transformants obtained by the lithium acetate method were more stable and showed a high copy number of the hph gene integrated into their genome. The other transformants, from the electroporation procedure, were stable, but unable to grow in the presence of high levels of hygromycin, and detection of the hph gene was only possible by polymerase chain reaction analysis.
Dose-Response Relationship, Drug↗
Renal, thyroid and parathyroid function during lithium treatment: laboratory tests in 207 people treated for 1-30 years.
A total of 207 patients (diagnoses revised according to DSM-III-R) attended our outpatient clinic and were treated with lithium for 1-30 years. They were subjected to conventional renal, thyroid and parathyroid function tests. With increasing treatment duration, the renal tests showed only moderate deviations from expected reference values. No patient developed renal insufficiency. Oversubstitution (thyrotropin < or = 0.1 mU/l) was suspected in 25% of the patients on thyroxine. Cross-sectionally unrecognized hypothyroidism was found in 6% of the patients. Elevated ionized serum calcium was found in 25% and elevated serum intact parathyroid hormone in 23% of the patients.
Adult↗
Interaction of metals in nickel-sensitive patients.
Nickel (Ni) dermatitis is thought to involve the formation of complexes between Ni ions and suitable proteins. 4 groups of 30 subjects who gave positive patch test responses to NiSO4 2.9% aq. were each retested to 1 of 4 different solutions containing equimolar (0.1 M) amounts of NiSO4 plus MgSO4, NiSO4 plus CuSO4, NiSO4 plus ZnSO4, and NiSO4 plus Li2SO4, respectively. The results, evaluated at 2 days by visual scoring only, demonstrated that the 4 metals exerted a different influence on the nickel reactions, perhaps interfering with one or more factors affecting the formation of Ni+ + complexes.
Copper↗
Melatonin-induced relaxation of rat aorta: interaction with adrenergic agonists.
The influence of melatonin on alpha- and beta-adrenergic responses of vascular smooth muscle ex vivo were examined in these experiments. Melatonin caused a dose-dependent relaxation of precontracted (30 mM KCl) vascular smooth muscle. This response was not affected by the removal of vascular endothelium. Melatonin (10 nM) reduced the efficacy, but not potency, of the contractile responses to methoxamine and clonidine. Melatonin had no effect on the vascular beta-adrenergic response to isoproterenol. Pretreatment of vascular rings with lithium sulfate (0.1 mM) completely blocked the relaxation in response to melatonin, suggesting that the inositol phosphate pathway may be involved in this relaxation. Furthermore, pretreatment of vascular rings with phorbol 12-myristate-13-acetate, an activator of protein kinase C, antagonized the relaxation response to melatonin. Pharmacologic doses of melatonin (0.1 mM) slightly impaired the vascular smooth muscle response to calcium. These data indicate that melatonin per se is capable of relaxing vascular smooth muscle and that low doses of melatonin impair alpha-1 and alpha-2 adrenergic responses without changes in the beta adrenergic response of vascular smooth muscle.
Adrenergic alpha-Agonists↗
In vitro wear simulation measurements of composite versus resin-modified glass ionomer luting cements for all-ceramic restorations.
BACKGROUND: Although composite cements are generally indicated for cementation of all-ceramic restorations, some manufacturers of dental cements propose that resin-modified glass ionomers (RMGIs) may be used for cementation of high-strength ceramic restorations. PURPOSE: This study was undertaken to compare the in vitro abrasion and attrition wear of two dual-cure cements (in dual-cure and self-cure modes) and two RMGI cements when placed between ceramic and enamel to simulate the margin of a restoration. METHODS: Rectangular fragments of pressed ceramic (Empress 2) were cemented between the halves of bovine incisors sectioned mesiodistally, using one of the following materials: RelyX ARC, Variolink II, RelyX Luting, or ProTec CEM. The two resin cements were tested in dual-cure and self-cure modes. A three-body wear test was performed in the new Oregon Health Sciences University (OHSU) oral wear simulator (100,000 cycles; abrasion load: 20 N; attrition load: 90 N). Degree of conversion of resin cements was determined by Fourier transform infrared spectroscopy. Results were analyzed by analysis of variance and Tukey's test (p = .05). Epoxy replicas of wear specimens were observed in the scanning electron microscope. RESULTS: No significant differences in abrasion wear (RelyX ARC dual-cure: 11 +/- 4.4 microm; RelyX ARC self-cure: 17 +/- 7.0 microm; Variolink dual-cure: 14 +/- 8.6 microm; Variolink self-cure: 23 +/- 10.7 microm) or attrition wear (RelyX ARC dual-cure: 18 +/- 6.4 microm; RelyX ARC self-cure: 31 +/- 4.5 microm; Variolink dual-cure: 32 +/- 6.8 microm; Variolink self-cure: 39 +/- 15.9 microm) were found between activation modes of the resin cements. ProTec CEM (32 +/- 8.7 microm) showed abrasion similar to that of Variolink II and RelyX ARC self-cure. Resin-modified glass ionomers showed more attrition wear than the resin cements (ProTec CEM: 62 +/- 13.0 microm; RelyX Luting: 69 +/- 7.1 microm). RelyX ARC showed a similar degree of conversion for both activation modes (dual-cure: 70 +/- 4.3%; self-cure: 68 +/- 1.2%), but Variolink II had a higher degree of conversion in dual-cure mode (67 +/- 0.5% vs 60 +/- 1.0%). Cement wear was accompanied by marginal breakdown and increased surface roughness of enamel and ceramic. CONCLUSIONS: The activation mode of resin cements did not influence their wear resistance. The RMGIs underwent higher attrition wear than the resin cements. CLINICAL SIGNIFICANCE: Increased submargination associated with marginal breakdown and increased roughness of the surrounding structures may be expected when ceramic inlays are cemented with resin-modified glass ionomers.
Analysis of Variance↗
Electron fluence correction factors for various materials in clinical electron beams.
Relative to solid water, electron fluence correction factors at the depth of dose maximum in bone, lung, aluminum, and copper for nominal electron beam energies of 9 MeV and 15 MeV of the Clinac 18 accelerator have been determined experimentally and by Monte Carlo calculation. Thermoluminescent dosimeters were used to measure depth doses in these materials. The measured relative dose at dmax in the various materials versus that of solid water, when irradiated with the same number of monitor units, has been used to calculate the ratio of electron fluence for the various materials to that of solid water. The beams of the Clinac 18 were fully characterized using the EGS4/BEAM system. EGSnrc with the relativistic spin option turned on was used to optimize the primary electron energy at the exit window, and to calculate depth doses in the five phantom materials using the optimized phase-space data. Normalizing all depth doses to the dose maximum in solid water stopping power ratio corrected, measured depth doses and calculated depth doses differ by less than +/- 1% at the depth of dose maximum and by less than 4% elsewhere. Monte Carlo calculated ratios of doses in each material to dose in LiF were used to convert the TLD measurements at the dose maximum into dose at the center of the TLD in the phantom material. Fluence perturbation correction factors for a LiF TLD at the depth of dose maximum deduced from these calculations amount to less than 1% for 0.15 mm thick TLDs in low Z materials and are between 1% and 3% for TLDs in Al and Cu phantoms. Electron fluence ratios of the studied materials relative to solid water vary between 0.83+/-0.01 and 1.55+/-0.02 for materials varying in density from 0.27 g/cm3 (lung) to 8.96 g/cm3 (Cu). The difference in electron fluence ratios derived from measurements and calculations ranges from -1.6% to +0.2% at 9 MeV and from -1.9% to +0.2% at 15 MeV and is not significant at the 1sigma level. Excluding the data for Cu, electron fluence correction factors for open electron beams are approximately proportional to the electron density of the phantom material and only weakly dependent on electron beam energy.
Electrons↗
Dosimetric characterization of a bi-directional micromultileaf collimator for stereotactic applications.
A 6 MV photon beam from Linac SL75-5 has been collimated with a new micromultileaf device that is able to shape the field in the two orthogonal directions with four banks of leaves. This is the first clinical installation of the collimator and in this paper the dosimetric characterization of the system is reported. The dosimetric parameters required by the treatment planning system used for the dose calculation in the patient are: tissue maximum ratios, output factors, transmission and leakage of the leaves, penumbra values. Ionization chambers, silicon diode, radiographic films, and LiF thermoluminescent dosimeters have been employed for measurements of absolute dose and beam dosimetric data. Measurements with different dosimeters supply results in reasonable agreement among them and consistent with data available in literature for other models of micromultileaf collimator; that permits the use of the measured parameters for clinical applications. The discrepancies between results obtained with the different detectors (around 2%) for the analyzed parameters can be considered an indication of the accuracy that can be reached by current stereotactic dosimetry.
Algorithms↗
The stability of liquid-filled matrix ionization chamber electronic portal imaging devices for dosimetry purposes.
This study was performed to determine the stability of liquid-filled matrix ionization chamber (LiFi-type) electronic portal imaging devices (EPID) for dosimetric purposes. The short- and long-term stability of the response was investigated, as well as the importance of factors influencing the response (e.g., temperature fluctuations, radiation damage, and the performance of the electronic hardware). It was shown that testing the performance of the electronic hardware as well as the short-term stability of the imagers may reveal the cause of a poor long-term stability of the imager response. In addition, the short-term stability was measured to verify the validity of the fitted dose-response curve immediately after beam startup. The long-term stability of these imagers could be considerably improved by correcting for room temperature fluctuations and gradual changes in response due to radiation damage. As a result, the reproducibility was better than 1% (1 SD) over a period of two years. The results of this study were used to formulate recommendations for a quality control program for portal dosimetry. The effect of such a program was assessed by comparing the results of portal dosimetry and in vivo dosimetry using diodes during the treatment of 31 prostate patients. The improvement of the results for portal dosimetry was consistent with the deviations observed with the reproducibility tests in that particular period. After a correction for the variation in response of the imager, the average difference between the measured and prescribed dose during the treatment of prostate patients was -0.7%+/-1.5% (1 SD), and -0.6%+/-1.1% (1 SD) for EPID and diode in vivo dosimetry, respectively. It can be concluded that a high stability of the response can be achieved for this type of EPID by applying a rigorous quality control program.
Electronics, Medical↗
Novel methods of measuring single scan dose profiles and cumulative dose in CT.
Computed tomography dose index (CTDI) is a conventional indicator of the patient dose in CT studies. It is measured as the integration of the longitudinal single scan dose profile (SSDP) by using a 100-mm-long pencil ionization chamber and a single axial scan. However, the assumption that most of the SSDP is contained within the chamber length may not be valid even for thin slices. We have measured the SSDPs for several slice widths on two CT scanners using a PTW diamond detector placed in a 300 mm x 200 mm x 300 mm water-equivalent plastic phantom. One SSDP was also measured using lithium fluoride (LiF) TLDs and an IC-10 small volume ion chamber, verifying the general shape of the SSDP measured using the diamond detector. Standard cylindrical PMMA CT phantoms (140 mm length) were also used to qualitatively study the effects of phantom shape, length, and composition on the measured SSDP. The SSDPs measured with the diamond detector in the water-equivalent phantom were numerically integrated to calculate the relative accumulated dose D(L)(0)calc at the center of various scan lengths L. D(L)(0)calc reached an equilibrium value for L > 300 mm, suggesting the need for phantoms longer than standard CT dose phantoms. We have also measured the absolute accumulated dose using an IC-10 small volume ion chamber, D(L)(0)SV, at three points in the phantom cross section for several beamwidths and scan lengths. For one CT system, these measurements were made in both axial and helical scanning modes. The absolute CTDI100, measured with a 102 mm active length pencil chamber, were within 4% of D(L)(0)SV measured with the small volume ion chamber for L approximately 100 mm suggesting that nonpencil chambers can be successfully used for CT dosimetry. For nominal beam widths ranging from 3 to 20 mm and for L approximately 250 mm, D(L)(0)SV values at the center of the water-equivalent phantom's elliptic cross section were approximately 25%-30% higher than the measured CTDI100. For small beamwidths, the difference in D(L)(0)SV for L approximately 250 mm and L approximately 14 x beamwidth (CTDI14nT) reached up to 50%. Peripheral point doses at 70 mm depth along the major axis of the phantom for L approximately 250 mm were up to 22% higher than for L approximately 100 mm. The differences between CTDI100 and D(L)(0)SV for L approximately 250 mm were in good agreement with the predictions made from the numerical integration of the measured SSDPs. Due to the considerable dose measured beyond the length of standard CT phantoms, CT dosimetry for longer body scan series should be performed in longer phantoms. Measurements could be made as we have shown, using a small volume chamber translating through the beam using multiple scans.
Fluorides↗
Experimental determination of the dosimetric characteristics for the I-Plant model 3600 125I brachytherapy source.
The dosimetric characteristics for a new brachytherapy seed source (I-Plant model 3600) were measured using LiF thermoluminescent dosimeters and appropriate phantom materials in conformance with the methodology and guidance provided by the AAPM Task Group 43. The I-Plant model 3600 is the successor to the I-Plant model 3500. The major difference between these sources is that the model 3600 contains a leaded-glass core to provide radio-opacity (while the model 3500 contains a silver core), which does not produce spectral contamination upon neutron activation. The dose rate constant lambda for the model 3600 was determined to be 1.00 Gy h(-1) U(-1) (with a 6% overall relative standard deviation), compared to 1.01 cGy h(-1) U(-1) reported for the model 3500 in previous studies. The remaining dosimetric characteristics also are similar for both sources.
Anisotropy↗
UV-induced second readout of LiF thermoluminescent dosimeters in the therapeutic dose range.
A previously developed technique for reading out LiF thermoluminescent dosimeters (TLD) a second and subsequent time by means of ultraviolet (UV)-induced repopulation of dosimetry traps was studied to determine the feasibility of maintaining a second readout capability in a radiotherapy clinical setting. It was found that with grouping of the TLDs according to second readout sensitivity, the UV-induced readout attained a precision comparable to that of the initial readout. However, the UV-induced TL response retained a strong previous dose memory following a standard high-temperature anneal, and routine calibration before each reuse is recommended.
Fluorides↗
IAEA/WHO 60Co teletherapy dosimetry service using mailed LiF dosimeters. A survey of results obtained during 1975-1982.
During 1975-1982 the International Atomic Energy Agency (IAEA) in co-operation with the World Health Organization (WHO) carried out 603 absorbed dose determinations for 60Co gamma-ray beams for 278 radiotherapy institutes in 60 countries. The participants were asked to irradiate capsules containing LiF powder to 2 Gy in 5 cm of water. The percentage of the determinations in which the deviation between the institutes quoted dose and the IAEA measured dose was within +/- 5% was 62%. In 17% of the determinations, the deviation was more than +/- 10%. For around 70% of the institutes the deviation decreased when further measurements were carried out.
Cobalt Radioisotopes↗