Side Effect Research Papers - Academia.edu (original) (raw)

Purpose A eutectic mixture of local anesthetics (EMLA) is commonly used to provide topical anesthesia for intravenous (iv) cannulation. One of its side effects is vasoconstriction, which may render cannulation more difficult. A gel... more

Purpose A eutectic mixture of local anesthetics (EMLA) is commonly used to provide topical anesthesia for intravenous (iv) cannulation. One of its side effects is vasoconstriction, which may render cannulation more difficult. A gel formulation of amethocaine (Ametop™) is now commercially available. The aim of this study was to compare EMLA and Ametop™ with regard to the degree of topical anesthesia afforded, the incidence of vasoconstriction and the ease of iv cannulation. Methods Thirty two ASA 1 adult volunteers had a # 16 gauge iv cannula inserted on two separate occasions using EMLA and Ametop™ applied in a double blind fashion for topical anesthesia. Parameters that were recorded after each cannulation included visual analogue pain scores (VAPS), the presence of vasoconstriction and the ease of cannulation, graded as: 1 = easy, 2 = moderately difficult, 3 = difficult and 4 = failed. Results The mean VAPS ± SD after cannulation with Ametop™ M was 12 ± 9.9 and with EMLA was 25.3 ± 16.6 (P = 0.002). Vasoconstriction occurred after EMLA application on 17 occasions and twice after Ametop™ (P = 0.001). The grade of difficulty of cannulation was 1.44 ± 0.88 following EMLA and 1.06 ± 0.25 with Ametop™ (P = 0.023). Conclusions Intravenous cannulation was less painful following application of Ametop™ than EMLA. In addition, Ametop™ caused less vasoconstriction and facilitated easier cannulation. Its use as a topical anesthetic agent is recommended, especially when iv access may be problematic. Objectif Un mélange eutectique d’anesthésiques locaux (MEAL) est souvent utilisé pour l’anesthésie topique lors d’une canulation intraveineuse (iv). La vasoconstriction, qui est l’un des effets secondaires du MEAL, peut compliquer la mise en place d’une canule. Une présentation en gel d’améthocaïne (Ametop™) est maintenant offerte dans le commerce. Le but de la présente étude était de comparer le MEAL et l’Ametop™ en regard du degré d’anesthésie topique fourni, de l’incidence de la vasoconstriction et de la facilité de la canulation iv. Méthode: On a inséré, en deux occasions séparées chez 32 volontaires adultes d’état physique ASA 1, une canuleiv de calibre 16 en utilisant en double aveugle le MEAL et Ametop™ pour réaliser l’anesthésie topique. Après chaque canulation, on a enregistré les paramètres suivants: les scores de douleur à l’échelle visuelle analogue (EVA), la présence de vasoconstriction et la facilité de canulation notée 1 = facile, 2 = modérément difficile, 3 = difficile et 4 = impossible. Résultats Les scores moyens à l’EVA ± l’écart type ont été de 12 ± 9,9 à la suite de la canulation avec Ametop™ M et de 25,3 ± 16,6 après le MEAL (P = 0,002). La vasoconstriction est survenue en 17 occasions après l’application du MEAL et deux fois plus souvent après Ametop™ (P = 0,001). Le degré de difficulté de canulation a été de 1,44 ± 0,88 après le MEAL et de 1,06 ± 0,25 après Ametop™ (P = 0,023). Conclusion La canulation intraveineuse est moins douloureuse après l’application d’Ametop™ que celle du MEAL. De plus, l’Ametop™ a provoqué moins de vasoconstriction et a facilité l’introduction d’une canule. Son usage comme anesthésique topique est recommandé, surtout lorsqu’une action rapide est nécessaire ou que l’accèsiv peut être problématique.

Puberty suppression by means of gonadotropin releasing hormone (GnRH) analogs is considered a diagnostic aid in gender dysphoric adolescents. However, there are also concerns about potential risks, such as poor outcome or post-surgical... more

Puberty suppression by means of gonadotropin releasing hormone (GnRH) analogs is considered a diagnostic aid in gender dysphoric adolescents. However, there are also concerns about potential risks, such as poor outcome or post-surgical regret, adverse effects on metabolic and endocrine status, impaired increment of bone mass, and interference with brain development. This case report is on a 22-year follow-up of a female-to-male transsexual, treated with GnRH analogs at 13 years of age and considered eligible for androgen treatment at age 17, and who had gender reassignment surgery at 20 and 22 years of age. At follow-up, he indicated no regrets about his treatment. He was functioning well psychologically, intellectually, and socially; however, he experienced some feelings of sadness about choices he had made in a long-lasting intimate relationship. There were no clinical signs of a negative impact on brain development. He was physically in good health, and metabolic and endocrine parameters were within reference ranges. Bone mineral density was within the normal range for both sexes. His final height was short as compared to Dutch males; however, his body proportions were within normal range. This first report on long-term effects of puberty suppression suggests that negative side effects are limited and that it can be a useful additional tool in the diagnosis and treatment of gender dysphoric adolescents.

‘Broadcasting the archive’ is an independent project conceived and curated by us in collaboration with Van Abbemuseum, Middlesbrough Institute of Modern Art (mima) and the Asociación de Arte Útil. The idea arose from the urgency to... more

‘Broadcasting the archive’ is an independent project conceived and curated by us in collaboration with Van Abbemuseum, Middlesbrough Institute of Modern Art (mima) and the Asociación de Arte Útil. The idea arose from the urgency to spread the Arte Útil archive created as a principal source of reference and the core of ‘The Museum of Arte Útil’1 beyond the institution, which hosts the material. Being the initial archive researchers, we started thinking about how to make visible the poten- tiality that the archive – intended as a tool – has. The project is the first attempt to emancipate usership around the Arte Útil archive through a year touring activity programmes such as workshops, discussions and tours hosted by different organiza- tions in various locations in Europe and United States. This interview will reflect on how ‘Broadcasting the archive’ could be considered as a new methodology to under- stand the porosity of Arte Útil – intended as a movement – outside and inside the institutional framework, with a particular reference to the programme we developed at Museo d’Art Contemporani de Barcelona (MACBA), in collaboration with the Avalancha collective, Núria Güell, Rubén Santiago and Valentina Maini. We invited them to revisit the conversations we had during the weekend for this journal.

Weight gain induced by antipsychotics is the second most frequently given reason for noncompliance with pharmacologic therapy; excessive sedative effects rank first, with extrapyramidal side effects ranking third. Frequently, weight gain... more

Weight gain induced by antipsychotics is the second most frequently given reason for noncompliance with pharmacologic therapy; excessive sedative effects rank first, with extrapyramidal side effects ranking third. Frequently, weight gain leads to inconsistent pharmacologic treatment; this exposes patients to the risk of recurrent symptoms. In fact, one of the key contributors to good clinical outcomes in schizophrenic patients is compliance with pharmacologic treatment. The goals of this study were to evaluate weight gain in a group of patients treated with olanzapine, diet modifications, and moderate physical activity and to compare the findings with those from a second group of patients who were given only olanzapine treatment. For 8 wk, investigators followed 2 groups of patients suffering from schizophrenia and hypomania in bipolar disorder, according to the nosographic criteria of The Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV). The first group (A) of 18 patients (9 female, 9 male) affected by manic episodes in bipolar disorder received olanzapine (10-20 mg/d), jogged lightly for 30 min 3 times a week, and complied with a diet that consisted of 500 kcal/d less than usual. The second group (B) of 10 patients (4 female, 6 male) with schizophrenia received only olanzapine (10-20 mg/d). All patients from both groups were weighed at the beginning 123 Advances in Therapy ®

Objective: Agomelatine is a relatively new antidepressant, with affinities to MT1 and MT2 (responsible for the circadian rhythm) as well as to 5-HT2C receptors. Since antidepressants have demonstrated some benefit in the treatment of ADH... more

Objective: Agomelatine is a relatively new antidepressant, with affinities to MT1 and MT2 (responsible for the circadian rhythm) as well as to 5-HT2C receptors. Since antidepressants have demonstrated some benefit in the treatment of ADH and because of the fact, that ADHD is often associated with sleep disorders, we assumed, that it might be a therapeutic alternative also for ADHD. Method: We proved this assumption in ten ADHD patients in a placebo controlled manner. Results: Agomelatine’s effect was superior to that of placebo, but seems to be less than that of Methylphenidate or placebo. Conclusion: If ADHD therapy with Methylphenidate or Atomoxetine is not indicated e.g. because of adverse side effects and if an ADHD patient suffers from additional sleep disorders, Agomelatine might be a helpful therapeutic alternative.

The reluctance of physicians to use estrogens in women with hormone responsive disorders is a tragic result of the 2002 WHI study. Although their hostility to estrogen therapy antedated these studies, the flawed data is now used as... more

The reluctance of physicians to use estrogens in women with hormone responsive disorders is a tragic result of the 2002 WHI study. Although their hostility to estrogen therapy antedated these studies, the flawed data is now used as justification for the denial of estrogens for treatment of low bone density and various types of hormone responsive depression in women. Estrogens

The aim of this study was to explore the nursing role in education and follow-up of patients who were taking oral chemotherapy (CT) and to identify the worldwide gap in patient education about oral CT. Materials and methods Multinational... more

The aim of this study was to explore the nursing role in education and follow-up of patients who were taking oral chemotherapy (CT) and to identify the worldwide gap in patient education about oral CT. Materials and methods Multinational Association of Supportive Care in Cancer members were invited to participate in a survey on oral CT. Nurse coordinators collected data via a 16-item questionnaire. Respondents totaled 1115 oncology nurses from 15 countries. Results Findings showed that about half of subjects work in outpatient/ambulatory clinics and had given at least two or more oral CT drugs. Although 52% had some type of guidelines/protocols, 47% reported not having received any

Previous experiments have demonstrated that auditory (AS) and/or somatosensory (SS) stimulation can increase the duration of REM sleep periods in rats, cats and humans. The objectives of this study were to determine whether repeated AS... more

Previous experiments have demonstrated that auditory (AS) and/or somatosensory (SS) stimulation can increase the duration of REM sleep periods in rats, cats and humans. The objectives of this study were to determine whether repeated AS stimulation causes habituation to the stimulus and whether any additive effects could be obtained with the simultaneous application of AS and SS. Three experimental procedures were used in this study. In experiment 1, animals were recorded for 4 consecutive days with AS, followed by a post-stimulus session. In experiment 2, they were recorded for 24 hours with AS applied at each REM period, followed by a subsequent 24-hours-post-stimulus recording. In experiment 3, animals underwent AS, SS stimulation, or simultaneous application of both in a random fashion at each REM period. The results of all experiments confirm previous findings showing that auditory or somatosensory stimuli significantly increase REM sleep period duration. In addition, AS--applie...

Janus kinase (JAK) inhibitors, a novel class of targeted synthetic disease-modifying antirheumatic drugs (DMARDs), have shown their safety and efficacy in rheumatoid arthritis (RA) and are being intensively tested in other autoimmune and... more

Janus kinase (JAK) inhibitors, a novel class of targeted synthetic disease-modifying antirheumatic drugs (DMARDs), have shown their safety and efficacy in rheumatoid arthritis (RA) and are being intensively tested in other autoimmune and inflammatory disorders. Targeting several cytokines with a single small compound leads to blocking the physiological response of hundreds of genes, thereby providing the background to stabilize the immune response. Unfortunately, blocking many cytokines with a single drug may also bring some negative consequences. In this review, we focused on the activity of JAK inhibitors in the cardiovascular system of patients with RA. Special emphasis was put on the modification of heart performance, progression of atherosclerosis, lipid profile disturbance, and risk of thromboembolic complications. We also discussed potential pathophysiological mechanisms that may be responsible for such JAK inhibitor-associated side effects.

It has been suggested that constraining a natural language (NL) reduces the degree of ambiguity of requirement specifications written in that language. There is also a tendency to assume that an inescapable side effect of constraining a... more

It has been suggested that constraining a natural language (NL) reduces the degree of ambiguity of requirement specifications written in that language. There is also a tendency to assume that an inescapable side effect of constraining a natural language is a subsequent reduction in its expressiveness. The primary objective of this paper is to describe a technique that we have developed for empirically measuring the expressiveness of a constrained natural language (CNL) when used to specify the requirements in a particular application domain. Our simple yet practical and repeatable technique elucidates the individual contribution that each lexical entity of the CNL can make on the overall expressiveness of the CNL This technique is particularly useful for designing new CNLs, as well as situations where tailoring or streamlining existing CNLs for particular application domains is needed.

Our study aimed to identify perceptions Latina women have about four different contraceptive methods and to investigate whether religiosity and acculturation play a role in their contraceptive choice. An observational cross-sectional... more

Our study aimed to identify perceptions Latina women have about four different contraceptive methods and to investigate whether religiosity and acculturation play a role in their contraceptive choice. An observational cross-sectional study was performed at Bellevue Hospital. A questionnaire was given to women in the gynecology outpatient clinics asking about: oral contraceptive pills (OCP’s), injectable contraception (DMPA), the Intrauterine device (IUD) and the Ortho-Evra Patch (Patch). In the 102 complete surveys, self identified Latina women were not convinced of the safety of OCPs and DMPA (less than 50% perceived them to be safe) and largely uncertain about the Patch and IUD. Latinas also demonstrated more negative beliefs about the side effects of OCPs and DMPA. In particular, they were concerned about weight gain, method reversibility, and bleeding. There was no substantial correlation between religiosity and contraceptive beliefs. Low level acculturated women were more likely to believe that the IUD and OCPs were harmful, as opposed to their more acculturated counterparts who demonstrated more negative beliefs about the Patch. Overall, Latina women in this study tended to overrate the risks associated with contraceptive use, particularly OCPs and DMPA. The markedly low method confidence suggested by high rates of “unsure” answers is a possible explanation for why Latinas are less adherent with birth control than their white counterparts.

A 24-h pretreatment of mice with diphtheria and tetanus toxoids and whole-cell pertussis vaccines depressed liver cytochrome P-450 and therefore prolonged hexobarbital-induced sleeping time in mice. The depression of liver drug metabolism... more

A 24-h pretreatment of mice with diphtheria and tetanus toxoids and whole-cell pertussis vaccines depressed liver cytochrome P-450 and therefore prolonged hexobarbital-induced sleeping time in mice. The depression of liver drug metabolism by a cellular vaccine containing a mutated pertussis toxin was less marked than that induced by the wild-type vaccines, indicating that the mutated vaccine might have lower toxicity in this regard. The wild-type vaccines decreased microsomal P-450 levels by 50%, while the mutated whole-cell vaccine had a less marked effect (a decrease of 30%), paralleling the results obtained in sleeping time experiments. Furthermore, an acellular mutated vaccine did not affect liver drug metabolism, indicating a role of the whole bacterial cell in this side effect. All the cellular vaccines studied induced high serum interleukin-6 levels; on the other hand, the acellular mutated vaccine induced very low interleukin-6 levels, indicating that the whole bacterial cel...

Background: Several prognostic models have been developed to stage hepatocellular carcinoma (HCC) but there is no general consensus on which is the most reliable. We compared three prognostic indices (Okuda, CLIP, and BCLC scoring... more

Background: Several prognostic models have been developed to stage hepatocellular carcinoma (HCC) but there is no general consensus on which is the most reliable. We compared three prognostic indices (Okuda, CLIP, and BCLC scoring systems) in a large series of cirrhotic patients with HCC undergoing nonsurgical treatment in terms of their ability to classify patients into different risk groups Methods: We retrospectively studied 268 Italian patients with HCC. A total of 146 patients were treated with ablation, 132 with percutaneous ethanol injection, and 14 with radiofrequency ablation; 103 underwent transcatheter arterial chemoembolisation and 19 had supportive care alone. Factors determining survival were analysed by univariate and multivariate analysis using the Kaplan-Meier method and Cox proportional hazard regression models. Okuda, CLIP, and BCLC scores evaluated before treatment were applied. Results: Median survival was 25.7 months. In a multivariate analysis, portal vein thrombosis, a fetoprotein, total bilirubin, and tumour size were significant predictors of survival. Okuda, CLIP, and BCLC scores were all able to predict survival (p,0.001). They identified two, four, and six risk groups, respectively, with a median survival ranging from 27 to 19 months for Okuda, 30 to 5 months for CLIP, and 43 to 7 months for BCLC. Conclusions: Both CLIP and BCLC scores were more effective than the Okuda score in stratifying patients into different risk groups with early-intermediate HCC. However, the BCLC scoring system gave a better prediction of prognosis in patients with disease diagnosis at a very early stage.

Aggressivity is a common problem in the management of elderly patients with dementia. Medications currently used to diminish aggressive behaviour in dementia can have problematic side effects. We present a case and systematic review of... more

Aggressivity is a common problem in the management of elderly patients with dementia. Medications currently used to diminish aggressive behaviour in dementia can have problematic side effects. We present a case and systematic review of the current knowledge about the use of cyproterone acetate to treat aggressivity (excluding hypersexuality related behaviours) in dementia. An 82-year-old man required psychiatric inpatient admission due to agitation and aggressivity and was diagnosed with Alzheimer's disease. After failed trials of atypical antipsychotics (quetiapine 100 mg/day and risperidone 1 mg/day), drugs for dementia (memantine 20 mg/day and rivastigmine 9 mg/day) and benzodiazepines (lorazepam 0.5-1 mg prn) he was started on cyproterone acetate titrated up to 50 mg twice daily. After two weeks he was calmer and did not express aggressivity. Two months later he was discharged to a community placement where he subsequently remained settled on cyproterone. We reviewed literature on the use of cyproterone in aggressivity (excluding hypersexuality) associated with dementia. We searched the main medical databases including articles in English, Spanish, French and Italian. Only one randomized double-blind trial was found, comparing cyproterone with haloperidol (n ¼ 27). Cyproterone was more effective controlling aggressivity and had lower incidence of side effects. In the one uncontrolled naturalistic observational study identified (n ¼ 19), cyproterone was associated with significant reductions in aggressivity without causing major side effects. Further literature was limited to theoretical discussions. Despite there being evidence to support our observations of a useful role for cyproterone in aggressivity in dementia, further studies are needed to establish the efficacy and safety of this therapeutic option.

To define a safe and effective dose of Dysport for treating hip adductor spasticity. Patients with definite or probable multiple sclerosis, and disabling spasticity affecting the hip adductor muscles of both legs, were randomised to one... more

To define a safe and effective dose of Dysport for treating hip adductor spasticity. Patients with definite or probable multiple sclerosis, and disabling spasticity affecting the hip adductor muscles of both legs, were randomised to one of four treatment groups. Dysport (500, 1000, or 1500 Units), or placebo was administered by intramuscular injection to these muscles. Patients were assessed at entry, and 2, 4 (primary analysis time-point), 8, and 12 weeks post-treatment. A total of 74 patients were recruited. Treatment groups were generally well matched at entry. The primary efficacy variables-passive hip abduction and distance between the knees-improved for all groups. The improvement in distance between the knees for the 1500 Unit group was significantly greater than placebo (p = 0.02). Spasm frequency was reduced in all groups, but muscle tone was reduced in the Dysport groups only. Pain was reduced in all groups, but improvements in hygiene scores were evident only in the 1000 ...

Therapy with bisphosphonates, including alendronate (ALN), is considered a safe and effective treatment for osteoporosis. However, recent studies have reported an unexpected increase in serious atrial fibrillation (AF) in patients treated... more

Therapy with bisphosphonates, including alendronate (ALN), is considered a safe and effective treatment for osteoporosis. However, recent studies have reported an unexpected increase in serious atrial fibrillation (AF) in patients treated with bisphosphonates. The mechanism that explains this side effect remains unknown. Since AF is associated with an altered sarcoendoplasmic reticulum calcium load, we studied how ALN affects cardiomyocyte calcium homeostasis and protein isoprenylation in vitro. Acute and long-term (48 h) treatment of atrial and ventricular cardiomyocytes with ALN (10 − 8 -10 − 6 M) was performed. Changes in calcium dynamics were determined by both fluorescence measurement of cytosolic free Ca 2+ concentration and western blot analysis of calcium-regulating proteins. Finally, effect of ALN on protein farnesylation was also identified. In both atrial and ventricular cardiomyocytes, ALN treatment delayed and diminished calcium responses to caffeine. Only in atrial cells, long-term exposure to ALN-induced transitory calcium oscillations and led to the development of oscillatory component in calcium responses to caffeine. Changes in calcium dynamics were accompanied by changes in expression of proteins controlling sarcoendoplasmic reticulum calcium. In contrast, ALN minimally affected protein isoprenylation in these cells. In summary, treatment of atrial cardiomyocytes with ALN-induced abnormalities in calcium dynamics consistent with induction of a self-stimulatory, pacemaker-like behavior, which may contribute to the development of cardiac side effects associated with these drugs.

The efficacy and toxicity of amifostine (300 mg/m 2 three times a week for three consecutive weeks for a maximum of six courses) was evaluated in 12 patients with primary myelodysplastic syndromes. Dose escalation up to 400 mg/m 2 was... more

The efficacy and toxicity of amifostine (300 mg/m 2 three times a week for three consecutive weeks for a maximum of six courses) was evaluated in 12 patients with primary myelodysplastic syndromes. Dose escalation up to 400 mg/m 2 was allowed to patients who failed to response. Hemoglobin concentration was increased ] 1.5 g/dl on two (18%) of the 11 anemic patients. These two patients obtained transfusion indepedence for 20 weeks. Reticulocyte counts and ANC increased ]50% of baseline in four (44%) of the nine patients with reticulocytopenia and in three (25%) of the 12 neutropenic patients. Platelet count increased in three (50%) of the six patients with thrombocytopenia. Progenitor growth of CFU-GMs and BFU-Es improved in 8/12 patients. No major side effects were observed. In conclusion amifostine is well tolerated and can promote the growth of primitive hematopoietic progenitors and ameliorate the cytopenias in MDS patients.

We compared the effect of glycerol-induced hyperhydration (GIH) to that of water-induced hyperhydration (WIH) on cardiovascular and thermoregulatory functions and endurance performance (EP) during prolonged cycling in a temperate climate... more

We compared the effect of glycerol-induced hyperhydration (GIH) to that of water-induced hyperhydration (WIH) on cardiovascular and thermoregulatory functions and endurance performance (EP) during prolonged cycling in a temperate climate in subjects consuming fluid during exercise. At weekly intervals, 6 trained male subjects ingested, in a randomized, double-blind, counterbalanced fashion, either a glycerol (1.2 g glycerol/kg bodyweight (BW) with 26 mL/kg BW of water - aspartame-flavored fluid) or placebo solution (water - aspartame-flavored fluid only) over a 2 h period. Subjects then performed 2 h of cycling at 66% of the maximal oxygen consumption (VO2 max) and 25 °C while drinking 500 mL/h of sports drink, which was followed by a step-incremented cycling test to exhaustion. Levels of hyperhydration did not differ significantly between treatments before exercise. During exercise, GIH significantly reduced urine production by 246 mL. GIH did not increase sweat rate nor did it dec...

The Supreme Court's decision in Kansas v. Hendricks suggests that few constitutional limitations will be imposed. This article discusses the four elements imposed by the Court in Hendricks, and then discusses the likely implications... more

The Supreme Court's decision in Kansas v. Hendricks suggests that few constitutional limitations will be imposed. This article discusses the four elements imposed by the Court in Hendricks, and then discusses the likely implications of the decision, using civil commitment laws currently on the books and actual post-Hendricks decisions. The article concludes that the imbalance between commitments and discharges will cause commitment populations to grow over the foreseeable future. Eventually the huge costs of commitment schemes will force serious assessment of whether the facial logic of these programs hides seriously distorted resource allocation and anti-therapeutic side-effects.

The selective serotonin reuptake inhibitors (SSRIs) are now being employed in the treatment of the full spectrum of anxiety disorders. In comparative trials, the SSRIs are proving to be equal or superior in efficacy to traditional... more

The selective serotonin reuptake inhibitors (SSRIs) are now being employed in the treatment of the full spectrum of anxiety disorders. In comparative trials, the SSRIs are proving to be equal or superior in efficacy to traditional antianxiety medications. Due to their favorable side effect profile, safety, and tolerability, they are rapidly replacing older agents in the treatment of anxiety. Neuroanatomical pathways that may be important in the antianxiety effect of the SSRIs are outline and discussed, followed by a review of the clinical evidence supporting the efficacy of this class of medications in the treatment of anxiety disorders.

There are well defined therapeutic protocols for childhood nephrotic syndrome. Appropriate therapy helps in minimizing side effects besides decreasing referrals to tertiary care centres. We have analysed the appropriateness of therapy of... more

There are well defined therapeutic protocols for childhood nephrotic syndrome. Appropriate therapy helps in minimizing side effects besides decreasing referrals to tertiary care centres. We have analysed the appropriateness of therapy of primary care physicians in 111 children with nephrotic syndrome referred to our Institute from January 1989 to December 1991. Prednisone was administered in adequate doses in 51 (52.6%), and for adequate duration in 41 children (42.2%). Adjunctive cyclophosphamide therapy was administered in the recommended doses and duration in 33% of the cases. On evaluation of the therapy it was observed that inappropriate treatment had been administered by 39.4% of the pediatricians, 59% of internists and 80% of general practitioners. This study highlights the lacunae in the current state of knowledge amongst the primary physicians and highlights the need for creating greater awareness regarding the therapy of children with nephrotic syndrome.

Post-herpetic neuralgia (PHN) is a common and often intractable neuropathic pain syndrome predominantly affecting the elderly. Topical local aneslthetics have shown promise in both uncontrolled and controlled studies. Thirty-five subjects... more

Post-herpetic neuralgia (PHN) is a common and often intractable neuropathic pain syndrome predominantly affecting the elderly. Topical local aneslthetics have shown promise in both uncontrolled and controlled studies. Thirty-five subjects with established PHN affecting the torso or extremities completed a four-session, random order, double-blind, vehicle-controlled study of the analgesic effects of topically applied 5% lidocaine in the form of a non-woven polyethylene adhesive patch. All subjects had allodynia on examination. Up to 3 patches, covering a maximum of 420 cm 2, were applied to cover the area of greatest pain as fully as possible. Lidocaine containing patches were applied in two of the four 12-h-long sessions, in one session vehicle patches were applied, and one session was a no-treatment observation session. Lidocaine containing patches significantly reduced pain intensity at all time points 30 rain to 12 h compared to no-treatment observation, and at all time points 4-12 h compared to vehicle patches. Lidocaine patches were superior to both no-treatment observation and vehicle patches in averaged category pain relief scores. The highest blood lidocaine level measured was 0.1 /xg/ml, indicating minimal systemic absorption of lidocaine. Patch application was without systemic side effects and well tolerated when applied on aUodynic skin for 12 h. This study demonstrates that topical 5% lidocaine in patch form is easy to use and relieves post-herpetic neuralgia.

Cisplatin is for a long time in clinical use as efficient antitumor drug. The success in cisplatin-based chemotherapy, however, strongly depends on how careful the drug's dosages are monitored in order to reduce severe side-effects and... more

Cisplatin is for a long time in clinical use as efficient antitumor drug. The success in cisplatin-based chemotherapy, however, strongly depends on how careful the drug's dosages are monitored in order to reduce severe side-effects and overcome cellular resistance. The use of micellar electrokinetic chromatography with direct UV detection is described for the determination of intact cisplatin in human serum. The main product of drug's hydrolytic metabolism, cis-diammineaquachloroplatinum(II), was quantified using capillary zone electrophoresis in combination with indirect UV detection and on-line transient isotachophoresis preconcentration. The detection limits of platinum species studied were about 2-3 mol l −1 that allows the proposed methods to be applied for quantification of the administered levels of cisplatin as well as drug's active metabolite. Changes in the speciation of cisplatin occurring after intravenous administration can also be monitored using these simple and convenient CE techniques.

This case report deals with the antipsychotic treatment in multiple sclerosis (MS). Psychiatric symptoms are a frequent event in patients with MS. However, there are only few systematic studies of antipsychotic treatment in MS patients.... more

This case report deals with the antipsychotic treatment in multiple sclerosis (MS). Psychiatric symptoms are a frequent event in patients with MS. However, there are only few systematic studies of antipsychotic treatment in MS patients. Most of the studies are related to clozapine due to the lack of neurological, particularly extrapyramidal side effects (EPS). Therefore, experiences with other atypical drugs are requested. This paper discusses the pros and cons of different atypical drugs using the example of one patient, who showed adverse effects after treatment with quetiapine and olanzapine. Risperidone was not administered with respect to possible EPS. However, ziprasidone was tolerated well and appeared to be effective.

patients with advanced primary squamous cell carcinoma (SCC) of cervix (FIG0 Stages RIB, IVA or extensive nodal involvement) and 8 with recurrent disease were treated using a pilot regimen of combination chemotherapy (CT): Mitomycin C... more

patients with advanced primary squamous cell carcinoma (SCC) of cervix (FIG0 Stages RIB, IVA or extensive nodal involvement) and 8 with recurrent disease were treated using a pilot regimen of combination chemotherapy (CT): Mitomycin C (MIT), 5 Fluorouracil (5 FU), and radiation therapy (RT). CT and RT doses on this Phase I-II Study were escalated to the current regimen. A split course of RT was used, either pelvic RT alone (4560 Gy in 28 fractions) or the same pelvic RT plus para-aortic RT (3600 Gy in 24 fractions). CT was given: MIT 6 mg/M* IV push day 1, and 5 FU 1.0 g/M* (maximum daily 1.5 g) by continuous IV infusion days 1 through 4 of each half-course of RT. This was followed by one application of intrauterine "'Cs when possible. Three of the 8 patients with recurrence in the pelvis or para-aortic nodes had a complete response (CR) to CT-RT and are alive without disease at 19, 19 and 22 months after treatment, respectively. Twenty of the 27 (74%) primary patients had a CR. With a median duration of follow-up of 6 months 4/20 have relapsed, 1 in RT field, 2 at distant sites, and 1 in both. Pelvic disease remains controlled in 19/27 (70%) including one patient salvaged with surgery. The acute toxicity of this regimen was tolerable: 2/35 developed transient leukopenia with one febrile episode, 9/35 developed transient thrombocytopenia without bleeding. Symp tomatic sigmoid strictures developed in two patients, one requiring surgical intervention.

An understanding of the relationship between the type of analgesic prescription and the prevalence and severity of side effects is crucial in making appropriate treatment decisions. The purposes of this study were: to determine if there... more

An understanding of the relationship between the type of analgesic prescription and the prevalence and severity of side effects is crucial in making appropriate treatment decisions. The purposes of this study were: to determine if there were differences in the prevalence of side effects among four different types of analgesic prescriptions (i.e., no opioid, only an as needed (PRN) opioid, only an around-the-clock (ATC) opioid, or an ATC + PRN opioid); to determine if there were differences in the severity of side effects among the four prescriptions groups; and to determine the relationships between the total dose of opioid analgesic medication prescribed and taken and the severity of side effects. As part of a larger study, 174 cancer patients with bone metastasis reported their analgesic use and the prevalence and severity of eleven side effects. Significant differences (P < 0.05) were found in prevalence rates for seven of the side effects among the four prescription groups. The highest prevalence rates were found in the only ATC and ATC + PRN groups. Significant differences were found in the severity scores for five of the side effects, with the highest severity scores reported by patients in the only ATC and ATC + PRN groups. Significant positive correlations were found between the severity of six of the side effects and the total dose of opioid prescribed and taken. Risk factors for analgesic-induced side effects are ATC and ATC + PRN prescription types and higher doses of opioid analgesics.

A multiinslitutiiinal Phase I study using i.v. melphalan was conducted in dogs with spontaneously occurring neoplasia. Melphalan was admin istered at 1.5, 10, 11.25, 12.5, and 20 mg/m2 of body surface area. Disproportionately greater... more

A multiinslitutiiinal Phase I study using i.v. melphalan was conducted in dogs with spontaneously occurring neoplasia. Melphalan was admin istered at 1.5, 10, 11.25, 12.5, and 20 mg/m2 of body surface area. Disproportionately greater toxicity was observed in small dogs. Seven of the eight dogs (88%) weighing less than 14 kg experienced severe myelosuppression (neutropenia, < 151M I/mm1; and/or thrombocytopenia,

Background and purpose: Some types of radiation therapy have been associated with an increased risk of cardiac mortality and morbidity in patients with early-stage breast cancer. A relationship has been observed between cardiac radiation... more

Background and purpose: Some types of radiation therapy have been associated with an increased risk of cardiac mortality and morbidity in patients with early-stage breast cancer. A relationship has been observed between cardiac radiation dose-volume and the level of excess risk of cardiac mortality. However, relatively few data are available on the morbidity from myocardial infarction associated with adjuvant radiotherapy.

In a placebo-controlled, double-blind study we evaluated the safety and kinetics of a new narcotic antagonist, nalmefene, after 2, 6, 12, and 24 mg intravenous doses to healthy men. At each dose level four subjects received active drug... more

In a placebo-controlled, double-blind study we evaluated the safety and kinetics of a new narcotic antagonist, nalmefene, after 2, 6, 12, and 24 mg intravenous doses to healthy men. At each dose level four subjects received active drug and two received placebo. The drug was well ...

This study tested the viability of auricular acupuncture in prisons for alleviating inmates' symptoms of psychological and physical discomfort and reducing their drug use. The experimental NADA-Acudetox protocol was compared with a... more

This study tested the viability of auricular acupuncture in prisons for alleviating inmates' symptoms of psychological and physical discomfort and reducing their drug use. The experimental NADA-Acudetox protocol was compared with a non-specific helix control protocol in a randomized trial. Over a period of 18 months, a 4-week, 14-session auricular acupuncture treatment program was offered in two prisons to 163 men and women with self-reported drug use. Among treatment completers, no differences by method were found in self-reported symptoms of discomfort. Drug use occurred in the NADA group but not in the helix group. In contrast, confidence in the NADA treatment increased over time while it decreased for the helix treatment. No significant negative side effects were observed for either method. Participants in both groups reported reduced symptoms of discomfort and improved nighttime sleep. Future research should compare auricular acupuncture to a non-invasive control in order to attempt to disentangle active effects from placebo.

Learning protocols are a self-guided way of writing that allows for elaboration and reflection on learning content. In an experimental study (N = 103), we supported protocol writing with prompts to elicit important strategies as... more

Learning protocols are a self-guided way of writing that allows for elaboration and reflection on learning content. In an experimental study (N = 103), we supported protocol writing with prompts to elicit important strategies as postulated by a cyclical model of selfregulated learning. Students received either (a) no prompts, (b) cognitive prompts, (c) metacognitive prompts, (d) mixed prompts without, or (e) including prompts for planning of remedial strategies. Prompting all essential sub-processes of self-regulated learning (group e) fostered students' comprehension best. Thus, with appropriate support, writing can serve as a beneficial medium helping students to self-regulate their understanding of subject matter.

Post-tonsillectomy swallowing pain is a common and distressing side effect after tonsillectomy and thus of great clinical interest. Up until now, there is no randomized controlled patient- and observer-blinded study evaluating the... more

Post-tonsillectomy swallowing pain is a common and distressing side effect after tonsillectomy and thus of great clinical interest. Up until now, there is no randomized controlled patient- and observer-blinded study evaluating the efficacy of acupuncture against swallowing pain after tonsillectomy. We therefore compared the potency of specific verum acupuncture points related to a Chinese medical diagnosis in reducing postoperative swallowing pain with non-specific control points on the body as well as a non-acupuncture group who received standard medication only. The standardized pain therapy after tonsillectomy was orally administered nonsteroidal anti-inflammatory drugs (NSAID) (diclofenac 3 × 50 mg oral). The patients (n = 123) treated with NSAID were asked about their acute pain after taking a sip of water between the first and fifth postoperative day. Participants’ pain was assessed using visual analog (VAS) [zero (0) for no pain up to ten (10) for the acute reported outset pain] before and 20 min, 1, 2 and 3 h after acupuncture treatment or standard pain medication, respectively. The functional assessment of diagnosis and treatment point-combination occurred by means of the “Heidelberg Model” of Traditional Chinese Medicine (TCM). Verum acupuncture lead to a significant additional pain relief. In comparison to the acupuncture, they also reported an average of 3 h duration of adequate pain-relief past taking the NSAID. This trial strongly supports a specific acupuncture scheme for the treatment of postoperative swallowing pain after tonsillectomy. It may particularly serve as an alternative pain treatment in case of NSAID intolerances.

The effects of the administration of 50 mg of guggulipid or placebo capsules twice daily for 24 weeks were compared as adjuncts to a fruit- and vegetable-enriched prudent diet in the management of 61 patients with hypercholesterolemia (31... more

The effects of the administration of 50 mg of guggulipid or placebo capsules twice daily for 24 weeks were compared as adjuncts to a fruit- and vegetable-enriched prudent diet in the management of 61 patients with hypercholesterolemia (31 in the guggulipid group and 30 in the placebo group) in a randomized, double-blind fashion. Guggulipid decreased the total cholesterol level by 11.7%, the low density lipoprotein cholesterol (LDL) by 12.5%, triglycerides by 12.0%, and the total cholesterol/high density lipoprotein (HDL) cholesterol ratio by 11.1% from the postdiet levels, whereas the levels were unchanged in the placebo group. The HDL cholesterol level showed no changes in the two groups. The lipid peroxides, indicating oxidative stress, declined 33.3% in the guggulipid group without any decrease in the placebo group. The compliance of patients was greater than 96%. The combined effect of diet and guggulipid at 36 weeks was as great as the reported lipid-lowering effect of modern drugs. After a washout period of another 12 weeks, changes in blood lipoproteins were reversed in the guggulipid group without such changes in the placebo group. Side effects of guggulipid were headache, mild nausea, eructation, and hiccup in a few patients.

Background: A very-low-energy diet (VLED) can result in sub- stantial,rapidweightlossandisincreasinglyprescribedbeforeobe- sitysurgerytominimizeriskanddifficultybyreducingliversizeand... more

Background: A very-low-energy diet (VLED) can result in sub- stantial,rapidweightlossandisincreasinglyprescribedbeforeobe- sitysurgerytominimizeriskanddifficultybyreducingliversizeand abdominaladiposity.Despiteitsgrowingpopularity,aVLEDinthis setting has received little attention. Objective:The aim of this study was to investigate the efficacy and acceptability of a preoperative VLED. Design: In a prospective observational study, 32 subjects (n 19 men and 13 women) with a mean (SD) age of 47.5 8.3 y and a body mass

The aim of the study was to evaluate the activity of decitabine, our preliminary experience with decitabine in patients with a hypomethylating agent, in the treatment of patients with accelerated and blastic phases of CML. chronic... more

The aim of the study was to evaluate the activity of decitabine, our preliminary experience with decitabine in patients with a hypomethylating agent, in the treatment of patients with accelerated and blastic phases of CML. chronic myelogenous leukemia (CML) in transformation. Thirtyseven patients with CML in blastic (20 patients) or accelerated phases (17 patients) were treated. Their median age was 52

Docetaxel and sodium selenite are well known for their anticancer properties. While resistance to docetaxel remains an obstacle in prostate cancer chemotherapy, sodium selenite, has been exploited as a new therapeutic approach. Currently,... more

Docetaxel and sodium selenite are well known for their anticancer properties. While resistance to docetaxel remains an obstacle in prostate cancer chemotherapy, sodium selenite, has been exploited as a new therapeutic approach. Currently, development of therapies affecting a multitude of cell targets, have been proposed as a strategy to overcome drug resistance. This association may reduce systemic toxicity counteracting a wide range of side effects.

The objective of the treatment of intracranial hypertension is to decrease intracranial pressure (ICP) while maintaining cerebral blood flow (CBF). Despite numerous treatments, none of them associates total efficiency and security.... more

The objective of the treatment of intracranial hypertension is to decrease intracranial pressure (ICP) while maintaining cerebral blood flow (CBF). Despite numerous treatments, none of them associates total efficiency and security. Systemic secondary cerebral injuries, which are responsible for cerebral ischemia, lead us to administer non specific treatments in order to optimize CBF and cerebral oxygenation. Thus, the goals are:

Some treatments used for Parkinson's disease attenuate locomotor depression in rats treated with reserpine and a-methyl-p-tyrosine. In the present study memantine (2.5, 5.0mg/kg), amantadine (10, 20mg/kg) (both uncompetitive NMDA... more

Some treatments used for Parkinson's disease attenuate locomotor depression in rats treated with reserpine and a-methyl-p-tyrosine. In the present study memantine (2.5, 5.0mg/kg), amantadine (10, 20mg/kg) (both uncompetitive NMDA antagonists), and L-deprenyl (1.0, 5.0 mg/kg; MAO-B inhibitor) were tested for possible synergistic interactions with the dopamine agonists: bromocriptine (2.5, 5.0mg/kg) and L-DOPA (50, 100mg/kg, + benserazide, 100mg/kg). At higher doses, memantine (10mg/kg), amantadine (40mg/kg), bromocriptine (5 and 10mg/kg) and L-DOPA (100, 200mg/kg) but not Ldeprenyl (up to 10 mg/kg) produced a pronounced increase in locomotor activity when given alone. The combination of memantine, amantadine and L-deprenyl with bromocriptine did not result in synergism of action and, at best, an additive effect was seen. On the other hand the combination of these agents with L-DOPA produced a pronounced synergistic effect. Hence, the clinical observation that coadministration of L-DOPA with either memantine or amantadine results in enhancement of their action is also reflected in an animal model of Parkinson's disease. Such a combination therapy should allow the use of lower doses of both drugs which may reduce the occurrence of side effects and may also be predicted to have additional benefits related to the neuroprotective properties of memantine, amantadine, and L-deprenyl.

For a very long time, agricultural policy has been interested only in productive or economic aspects. Nevertheless, interventions aiming to support farmers’ income or to promote agricultural modernisation have resulted in several... more

For a very long time, agricultural policy has been interested only in productive or economic aspects. Nevertheless, interventions aiming to support farmers’ income or to promote agricultural modernisation have resulted in several ‘negative’ side-effects, such as increasing pollution, landscape depletion and deepening of regional disparities. Consequently, a need has emerged for confronting problems with a more comprehensive approach, taking into

many Study Objective: To assess the clinical use of ultrasonographic localization of the epidural space, and to evaluate the clinical efficacy of ultrasound diagnostics in obstetric anesthesia. Design: Randomized prospective study.... more

many Study Objective: To assess the clinical use of ultrasonographic localization of the epidural space, and to evaluate the clinical efficacy of ultrasound diagnostics in obstetric anesthesia. Design: Randomized prospective study. Setting: University Clinic of Obstetrics and Gynecology. Patients: 300 parturients, 85 of whom had conventional delivery and 65 who underwent cesarean section. Interventions: Patients underwent ultrasonography for the identification of the intervertebral structures. Puncture depth and angle were measured to improve the placement of the Tuohy needle. Measurements: In the ultrasound group, additional puncture data, optimized puncture point, expected puncture depth, and angle were used to optimize the puncture technique. To control for side effects, we compiled data on the number of puncture attempts and the number of necessary puncture levels, visual analog scale (VAS) scores, the rate of side effects, and the patient acceptance of the technique. Main Results: The two groups were similar regarding demographic data. Using ultrasound for structure detection, the rate of puncture attempts were significantly (p Ͻ 0.013) reduced from 2.18 Ϯ 1.07 to 1.35 Ϯ 0.61. The mean rate of necessary puncture levels was 1.30 Ϯ 0.55 and with ultrasound detection 1.136 Ϯ 0.36 (p Ͻ 0.029). Complete analgesia was achieved in 147 patients with ultrasound detection versus 138 patients in the Control group (p Ͻ 0,03). The maximum VAS pain score in the control group was 1.3 Ϯ 2.1 versus 0.8 Ϯ 1.5 in the Ultrasound group (p Ͻ 0.006). The rate of side effects were reduced significantly: 99 patients in the Control group had no side effects compared with 120 patients from the Ultrasound group who were free of side effects. Patient acceptance of the technique in the Ultrasound group was significantly higher than in the Control group. Conclusion: The clinical use of ultrasound for epidural catheter placement may improve regional anesthesia. The use of ultrasound resulted in superior quality in all measured endpoints.