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The use of naloxone in small doses in complex therapy of postabstinent heroin syndrome: enkephalinase mechanisms.

The use of naloxone hydrochloride (0.2-0.4 mg) in complex therapy of adolescent heroin addicts significantly prolonged the half-life of serum leu-enkephalin, slightly elevated the thresholds of thermal nociceptive reactions, and improved some clinical indices (considerably reduced drug addiction, eliminated affective disorders, etc.), which are important for deactualization of drug addiction and promoting remission.

Adolescent↗

The fear of reducing medication, and where have all the patients gone?

In spite of the enormous effort made by the Boston group, the findings were few. The high rate of dropouts and refusals to be assessed raise serious questions. One significant point that should be raised is that there was no difference in the use of medication between the treatments, and there should have been to foster underlying change with expressive psychotherapy. Also, treatment was not attempted without medication. Did patients drop out to avoid medication? Would a more flexible technique such as multiple crisis intervention have reduced dropout? Did selecting subjects with normal Wechsler Adult Intelligence Scale scores eliminate severe thought disorders, making differential improvement impossible? Was eliminating the sickest third of patients a mistake?

Antipsychotic Agents↗

Improving the diffraction quality of MTCP-1 crystals by post-crystallization soaking.

Significant improvement in the resolution and quality of the X-ray diffraction of crystals of MTCP-1 protein was observed on post-crystallization soaking. The MTCP-1 crystals grown from 1.5 M ammonium sulfate diffracted to only 3.0 A resolution with some disorder in the diffraction. After post-crystallization soaking in a solution containing 2.0 M ammonium sulfate, the disorder was eliminated and diffraction extended to better than 2.0 A resolution. Both native and selenomethionine-enriched crystals demonstrated better diffraction after soaking for several months. This simple technique may be useful to improve the diffraction quality of protein crystals generally.

Ammonium Sulfate↗

High clearance of (S)-warfarin in a warfarin-resistant subject.

A 30 year old black male required a 60 mg daily dose of warfarin to elicit a therapeutic anticoagulant response (normal warfarin dose 2.5-10 mg day-1; maximum 15 mg day-1). Hereditary warfarin resistance was suspected after compliance, diet, concurrent medication and any gastrointestinal disorder were eliminated as contributory causes. The disposition of vitamin K and vitamin K epoxide was examined in the propositus, his two sisters and 13 control black male subjects. Each subject was given an i.v. bolus dose (5 mg) of vitamin K prior to and after 2 weeks of warfarin therapy (5 mg day-1). The oral clearances of (S)- and (R)-warfarin were also measured in each subject during the last day of warfarin therapy. The mean (+/- s.d.) systemic clearance of vitamin K was similar in all subjects before (114 +/- 35 ml min-1) and after (112 +/- 40 ml min-1) warfarin therapy. The mean (+/- s.d.) AUC value for vitamin K epoxide was increased by warfarin treatment (6.5 +/- 5.4 micrograms ml-1 min before and 139 +/- 78 micrograms ml-1 min after) in all subjects. In the propositus, the oral clearance of (S)-warfarin (14.5 ml min-1) and the clearance ratio for (S)/(R)warfarin (2.6) differed by more than 7 standard deviations from the control group (4.3 +/- 1.1 ml min-1 and 1.2 +/- 0.2, respectively). In one sister of the propositus, the stereoselective disposition of warfarin was comparable with that of her brother ((S)-warfarin clearance = 16.2 ml min-1; and (S)/(R)-warfarin clearance ratio = 2.7).

Adult↗

Current status of iodine deficiency in Mongolia in 1998-1999.

In 1992, the Mongolian government conducted a nationwide palpation study of the thyroid glands, and the study showed an overall goiter rate of 30%. As a result of this, the Mongolian Government launched its Iodine Deficiency Disorders (IDD) Elimination Programme in 1996 and its primary strategy was salt iodization. In 1998 and 1999, we carried out programme monitoring studies in 11 provinces. The results showed: among schoolchildren, a goiter rate was 22.8% (n = 6,535), median values of urinary iodine excretion ranged from 11 micrograms/l to 256 micrograms/l (n = 1,930), and usage rates of iodized salt (> 20 PPM iodine content) in their households ranged from 3% to 82%. We concluded that severe iodine deficiency in 1992 was improved from moderate to mild severity a few years later by salt iodization. However, stronger official commitments and community participation are needed to improve the programme so that iodized salt will be made more widely available.

Child↗

Therapy with nCPAP: incomplete elimination of Sleep Related Breathing Disorder.

Correct assessment of the overall treatment effectiveness requires knowledge about therapy compliance and efficacy. This study aimed to determine overall long-term apnoea alleviation after continuous positive airway pressure (CPAP) in a complete sleep laboratory cohort. Out of 209 consecutive CPAP candidates (mean age 57+/-12 yrs, body mass index (BMI) 30.0+/-5.1 kg x m2, respiratory disturbance index (RDI) 32.9+/-29 h), follow-up treatment was performed in 149 of them at 9, 18 and 30 months after CPAP prescription. Compliance with CPAP (machine run time/days CPAP available) was adjusted for the individual subjective sleep-time. Apnoea alleviation was defined as adjusted compliance multiplied by the CPAP effect (RDI with CPAP applied), remaining RDI was calculated. The baseline RDI, age or BMI in 75 patients, who did not tolerate nasal continuous positive airway pressure (nCPAP), did not differ from those accepting CPAP (acceptors, n=74). In acceptors at 9 months follow-up RDI with CPAP applied was 1.4+/-2.6 (CPAP effect, n=66), mean CPAP use was 3.6+/-2.5 x 24 h(-1) (n=68), mean apnoea alleviation was 52.4+/-32.0% (range 1-100%, n=47), the average remaining whole-night RDI was 17.8+/-26. At 9, 18 and 30 months (n=47), the mean daily CPAP use increased from 3.6+/-2.5 h to 4.1+/-2.5 h and 4.4+/-2.4 h (p<0.01). Effectiveness of continuous positive airway pressure is potentially high but acceptance was low. When accounting for sleep-time, its actual effect and use, only 50% adjusted continuous positive airway pressure effectiveness was observed.

Adult↗

Dysfunctional elimination syndrome: is it related to urinary tract infection or vesicoureteral reflux diagnosed early in life?

OBJECTIVE: It has been suggested that urinary tract infections (UTIs) early in life predispose to dysfunctional elimination syndrome (DES). This study evaluated the relationship between early UTI, vesicoureteral reflux (VUR), and DES by comparing two cohorts of school-aged children. METHODS: The UTI cohort (n = 123) included children previously enrolled in a prospective treatment trial conducted between 1992 and 1997. All were diagnosed with a febrile UTI before 2 years of age. The comparison cohort (n = 125) included children who were evaluated for fever in the emergency department between 1992 and 1997, whose urine culture was negative. Dysfunctional elimination symptoms were compared in the two cohorts by having families complete a revised version of the Dysfunctional Voiding Scoring System. RESULTS: Completed questionnaires were received from 248 children. There were no significant differences in selected demographic or clinical characteristics between the two cohorts. DES was present in 22% and 21% of children with and without a history of early UTI, respectively. Among children with UTIs, 18% of those with VUR and 25% of those without VUR had DES. CONCLUSIONS: Dysfunctional elimination is common in a general pediatric population. Neither UTI nor VUR diagnosed before 2 years of age was associated with DES in school-aged children.

Child↗

Diabetic neuropathy in the elderly.

Neuropathy is the most common symptomatic chronic complication in diabetic patients and accounts for substantial morbidity in the diabetic population. It is predominently a disease of the older diabetic population, and shows a progressive course with limb amputation as the final end-point of the disease. Pathologically the disorder is characterised by progressive degeneration as well as impaired regenerative ability of peripheral nerve fibers, resulting in a progressive loss and dying-back of the longest nerve fibres innervating the distal limbs. These changes are associated with progressive impairment of nerve function leading to impaired sensitivity in the limbs, which sometimes is associated with troublesome pain. Qualitatively similar but much milder functional and structural changes occur during normal aging processes, which potentially could make elderly diabetic patients more susceptible to an additional hyperglycaemic insult. The mechanisms underlying the development of diabetic neuropathy involve hyperglycaemia-induced metabolic abnormalities of peripheral nerve fibres and the supporting nutritive vascular supply. One of the major abnormalities involves activation of the polyol pathway with subsequent impairments in nerve function and vascular supply. Since hyperglycaemia appears to be the major culprit in the development of diabetic neuropathy, good glycaemic control is paramount in the long term treatment of diabetic patients to attenuate the development and/or progression of the disorder. Furthermore, elimination of risk factors such as obesity, smoking and excessive alcohol (ethanol) consumption, as well as patient education, are all important factors in the care of diabetic patients. In symptomatic neuropathic patients, including those with painful neuropathy, symptomatic and palliative measures are often effective. Stepwise addition of antidepressants to simple analgesics has proven to be effective in patients with troublesome pain. During recent years a class of drugs have been developed that inhibits the activation of the polyol pathway in diabetic nerves. These so-called aldose reductase inhibitors hold promise for a targeted treatment regimen in the near future. The aldose reductase inhibitors are already available in several European countries and in Japan.

Aged↗

Building a virtual reality temporal bone dissection simulator.

The temporal bone is one of seven bones that comprise the human skull, and has an intimate relationship with many vital structures. Anatomically, its three-dimensional relationships make it one of the most challenging areas for surgeons to understand and master. In addition, the temporal bone contains minute structures that are among the most sophisticated and delicate in the human body. These structures include the cochlea and vestibular organs, which are responsible for hearing and balance; the middle ear, including the ossicles, which conduct acoustic energy to the cochlea; and the facial nerve, which is responsible for controlling the muscles of facial expression, and contributes to the sensation of taste. Additionally, the temporal bone forms a major portion of the skull base, and has intimate relationships to vital structures including the carotid artery, jugular vein, cerebral cortex, brainstem, and cranial nerves. Surgical procedures performed on the temporal bone include: procedures to eradicate chronic and acute infections; procedures to remove malignant and benign tumors within the temporal bone, from the skull base, or from the posterior cranial fossa; procedures to restore the hearing mechanism; procedures to eliminate balance disorders; and procedures to correct congenital anomalies. For surgeons-in-training, and even surgeons-in-practice, mastery of the anatomy of the temporal bone and the many complex approaches necessary to treat patients takes years of focused endeavor. This is typically accomplished through the dissection of human cadaver temporal bones, which are scarce, and require a dedicated laboratory facility. Efforts are currently underway to develop a realistic simulator for temporal bone procedures. Users immersed in the simulator will interact with a three-dimensional temporal bone, derived from patient-specific data, using a haptic interface to simulate traditional surgical procedures. Feedback from experts in otologic surgery will be built into the system for additional instruction. This presentation will include an overview of the application being developed, a report of its current state of development, and plans for the future.

Computer Simulation↗

[Isolated testicular tuberculosis: report of a case].

In this study, a case has been reported involving a 66-year old male who was admitted for scrotal pain on the right side with possible testicular involvement, but with no associated urinary disorder. At physical examination, the right testicle was found to have increased in volume: this was further confirmed by ultrasonography, but the findings were insufficient to exclude the hypothesis of testicular cancer. An exploratory orchidectomy by upper inguinal route was therefore carried out, and histopathological examination showed the destruction of testicular tissue by several granulomas, and caseous necrosis with giant cells. Antibacterial chemotherapy was administered after an i.v. urography found no evidence of abnormality or urinary disorder, thereby eliminating an active site of genitourinary tuberculosis. This case shows the importance of considering testicular tuberculosis in the differential diagnosis of testicular enlargement in a region where this disease is endemic, despite the absence of systemic pulmonary and urinary signs of tuberculosis.

Aged↗

[Small intestinal occlusion by primary neoplastic stenosis. Concerning 10 patients (author's transl)].

The authors present 10 cases of primary cancer of the small intestine which had led to occlusive disorders. After eliminating occlusion due to strangulation and confirming the simple mechanical nature of the obstacle on confrontation of the clinical signs (Koenig's syndrome) and data from the plain X-rays of the unprepared abdomen, they carried out contrast radiography using barium, which enabled them in 6 cases to suspect the malignant nature of the stenosis.

Adult↗

[Choice of local anesthetic for epidural anesthesia in physiological labor].

In comparative analysis of epidural anesthesia by bupivacaine and ropivacaine the latter was shown to give smaller motor block and so can be applied at the end of both first and second stage of labor. Adequate anesthesia provides uneventful course of the second stage of labor, decreases its duration and eliminates the disorders of central hemodynamics and hormonal homeostasis. Currently naropin seems to be anesthetic of choice for epidural anesthesia of in labor by way of natural maternal passages.

Amides↗

Angioma serpiginosum.

Angioma serpiginosum is characterized by minute, coppery to bright-red, angiomatous puncta affecting mainly girls under age 16. The eruption predominates on the lower extremities. It is usually slowly progressive and chronic. The most important histological finding is the presence of dilated and tortuous capillaries in the dermal papillae and upper dermis. Although involution may occur, it is never complete. Treatment with a pulsed-dye laser improves or eliminates the disorder.

Adult↗

[Effect of inhalation of surface-active substances on the surfactant system of the lung].

Surface activity, biochemical composition and morphology of the rat lungs were studied in norm, under effect of acute hypoxia and after infusion of obsidan (1 mg/100g). The data permit suggesting that under the influence of obsidan and hypoxia a stability index of surfactants and quantity of phospholipids decreased, while the quantity of lysophosphatidylcholine and lysophosphatidylethanolamine increased. Morphology studies show that after hypoxia and obsidan infusion oedema and cell destruction developed in the lung. The inhalation of exogenous surfactant increased stability index and quantity of phospholipids, decreased the quantity of lysophospholipids but did not eliminate morphological disorders in the lung induced by hypoxia and obsidan infusion.

Administration, Inhalation↗

Six years' experience with systemic cyclosporin A prophylaxis in high-risk perforating keratoplasty patients. A retrospective study.

Starting with single cases in 1985, we have routinely applied systemic cyclosporin A since 1987 in high-risk keratoplasty patients for a period of up to 37 months postoperatively. In all, 69 eyes undergoing 74 perforating keratoplasties have thus far been treated. A considerable percentage of them initially suffered from chemical burns or from endogenous eczema associated with chronic atopic inflammation. All patients were followed closely and their courses were reevaluated retrospectively. Our current conclusions are that (1) immune reactions are efficiently inhibited with constantly effective blood levels of cyclosporin A, which has enormously increased the rate of keratoplasty successful in these patients; (2) if drug blood levels fall too low due to noncompliance of the patient or to metabolic disturbances, immune reactions may occur, especially during the early postoperative months; (3) serious chronic surface problems, which are especially associated with chemical burns, atopic inflammation, and other chronic kerato-conjunctival diseases, are partly ameliorated but not completely eliminated (surface disorders are presently ranked as the number one cause of transplant failure, whereas immune reactions can be effectively suppressed by cyclosporin A); and (4) close medical follow-up has revealed no serious systemic complication of cyclosporin A prophylaxis over periods of up to 37 months. The present study was not conducted in a prospective, double-blind, controlled fashion.

Adolescent↗

[A NSAID-associated alimentary tract disease in patients with rheumatism in Russia].

The aim of the study was to evaluate the prevalence and character of non-steroid antiinflammatory drug (NSAID)-associated pathology in patients with rheumatic diseases (RD) in the Russian population. The study included questioning of 2537 RD patients (81% women and 19% men, mean age 55.8 +/- 14.2 years) who were taking NSAID, in 6 regions of Russia, between the October of 2003 and April of 2004. The results were analyzed using chi2 criterion, Fisher exact test, and Student t-criterion. 7.6% of the questioned and 14.7% of their relatives had ulcerous background [corrected] history (ulcers diagnosted prior to the beginning of treatment with NSAID). Most patients (70.1%) were taking non-selective NSAID (NSNSAID), chiefly diclophenac (50.9%). The most often used non-selective cyclooxygenasa-2 (COG-2) inhibitor was nimesulid, taken by 23.5% of the patients. 20.2% of patients were not aware of the influence of NSAID on the gastric and intestinal mucosa. 33.7% of the patients underwent esophagogastroduodenoscopy (EGDS) while taking NSAID. In 8.8% of the examined gastric or duodenal ulcers were found while they were taking NSAID; 1.5% of the examined developed gastro-duodenal hemorrhage or ulcer perforation. 53.1% of the questioned had gastroduodenal complaints; in most cases it was heartburn (37.3%), "heaviness" in the epigastral area (37.4%), and meteorism (37.4%). 51.3% of the patients associated gastroesopagial reflux and dyspepsia symptoms with intake of NSAID. 26.9% of the questioned associated stool disturbances and meteorism with NSAID intake. 32% of the patients took medications to eliminate gastrointestinal disorder symptoms. Patients taking selective COG-2 inhibitors had complaints less frequently than those who were taking NSNSAID (p = 0). Most frequently complaints were associated with intake of glucocorticoids (p = 0), low doses of aspirin (p = 0), smoking (p = 0), and elderly age (p = 0.007). Appearance of complaints was not associated with the dose of NSAID (diclophenac) (p = 0.257). 8.8% of the patients with ulcerous background were not aware of the effects of NSAID on the alimentory tract; 34.1% of the patients din not undergo EGDS withing the period of treatment with NSAID. Only 40.3% of patients were taking selective COG-2 inhibitors; 54.7% of patients were taking gastroprotective preparations. Alimentary tract pathology is a prevalent complication of therapy with NSAID in the Russian population. The most frequent gastrointestinal symptoms are subjective; they affect life quality substantially. Their risk factors are: elderly age, ulcer background, and glucocorticoid intake. Russian doctors do not take sufficient measures to prevent serious NSAID intake complications.

Adolescent↗