摘要:

Study Objectives. To examine the feasibility of administering and the psychometric properties of a general health status questionnaire in adults with epilepsy, and to assess the health status of these patients.Design. Prospective, cross‐sectional, observational study.Setting. Neurology clinic of a tertiary care medical center.Patients. One hundred forty‐eight ambulatory adults with epilepsy.Interventions. Patients completed the SF‐36, a general health status questionnaire. Respondent burden and data quality as well as psychometric characteristics were evaluated. Patients' SF‐36 scale scores, adjusted for comorbidities, were compared with those of 641 people without chronic conditions with the same sociodemographic characteristics.Measurements and Main Results. Administering the SF‐36 to adult outpatients with epilepsy is feasible and results are psychometrically sound. Compared with those who were not ill, patients had significantly (p<0.001) lower (0 = worst, 100 = best) scores in six of the eight SF‐36 domains: general health perceptions (57.7 vs 82.1), mental health (61.3 vs 79.6), vitality (53.5 vs 67.8), role limitations owing to physical (69.6 vs 95.0) and emotional problems (67.2 vs 88.4), and social functioning (75.2 vs 89.9).Conclusions. Lower SF‐36 scores may reflect patients' assessments of the balance among epilepsy, seizures, and antiepileptic drug therapy‐related effects. Incorporating health status information into therapeutic decision making may help to attain the ultimate goal of improving p

ISSN:0277-0008    

DOI:10.1002/j.1875-9114.1996.tb02911.x

出版商:Blackwell Publishing Ltd    

年代:1996

数据来源: WILEY

摘要:

We attempted to determine the mechanism(s) of poloxamer (P)‐407‐induced hyperlipidemia in rats by administering a lipid‐lowering drug with a known mechanism of action. Five weight‐matched animals were assigned to each of four treatment groups. Two groups received P‐407 300 mg/ml and two received saline 1 ml. One of the P‐407 and one of the saline groups were administered nicotinic acid 100 mg/kg by intraperitoneal injection at 6–96 hours after blood sampling. Blood samples were collected at 7 points from time zero to 120 hours and analyzed for triglyceride and cholesterol concentrations. The detergent produces hypertriglyceridemia (HTG) increasing from 53.4 ± 7.0 mg/dl (time zero) to 4026.9 ± 42.1 mg/dl by 24 hours. The HTG response was significantly attenuated by nicotinic acid (at t = 24 hrs). This, however, was followed by an average triglyceride concentration increase of 2.8‐fold from 72 to 120 hours. The detergent produces a dramatic hypercholesterolemia (HCHO), increasing cholesterol from 47.5 ± 1.8 mg/dl to 468.5 ± 27.9 mg/dl by 48 hours. The HCHO was significantly affected by nicotinic acid administration during the accumulation phase. Nicotinic acid reduced cholesterol concentration from 364.4 ± 16.1 mg/dl to 276.8 ± 16.4 mg/dl at 24 hours (p<0.05). It is a potent antilipolytic agent, limiting the free fatty acids available for the synthesis of triglyceride and cholesterol. These data suggest that P‐407 may act by stimulating the release of free fatty acids from the adipocyte for at least 2

ISSN:0277-0008    

DOI:10.1002/j.1875-9114.1996.tb02912.x

出版商:Blackwell Publishing Ltd    

年代:1996

数据来源: WILEY

摘要:

Cisplatin in combination with other cytotoxic agents is the backbone for a potential cure of testicular germ cell neoplasms and is a critical factor in the substantial activity observed in the treatment of small cell lung cancer, bladder cancer, and ovarian germ cell tumors. Resistance to cisplatin at the onset of treatment or at relapse limits its curative potential, however. Laboratory studies using both cells selected for cisplatin resistance by exposure to sublethal concentrations and biopsy specimens from patients' tumors provide insights for the potential mechanisms of resistance. The mechanisms identified in vitro include a complex and wide array of related and unrelated pathways such as alterations in cellular drug transport, enhanced DNA repair dependent and independent of signal transduction pathways, and enhanced intracellular detoxification such as glutathione and metallothionein systems. Studies of these mechanisms have identified a number of agents with known potential for administration to humans and that reverse cisplatin resistance in vitro; for example, reversal of cellular accumulation defects by dipyridamole; inhibition of DNA repair by hydroxyurea, pentoxifylline, and novobiocin; inhibition of the glutathione system by ethacrynic acid and buthionine sulfoximine; and inhibition of signal transduction pathways by cyclosporine, tamoxifen, and calcium channel‐blocking agents. Current phase I clinical trials are focusing on the most effective doses and schedules to administer these agents in combination with cisplatin. Initial uncontrolled trials in limited numbers of patients suggest that the addition of modulators of cisplatin has the potential to reverse resistance in patients previously failing therapy. Another promising avenue for circumventing cisplatin resistance is the development of noncross‐resistant platinum anal

ISSN:0277-0008    

DOI:10.1002/j.1875-9114.1996.tb02913.x

出版商:Blackwell Publishing Ltd    

年代:1996

数据来源: WILEY

摘要:

Recombinant human DNase I, or dornase alfa, is the first new therapy developed specifically for cystic fibrosis in almost 30 years. It selectively digests extracellular DNA and reduces the viscosity of purulent sputum. In clinical trials dornase alfa modestly improved pulmonary function, slightly decreasing the number of respiratory exacerbations requiring parenteral antibiotics compared with placebo. Phase III studies suggest that patients receiving dornase alfa also spend slightly fewer days in the hospital than those treated with placebo. The aerosolized preparation is safe and generally well tolerated. Voice alteration and sore throat are the most commonly reported adverse effects. Further research is necessary to determine the optimum time to initiate therapy and to evaluate the agent's pharmacoeconomic impact on the treatment of cystic fibrosis. Aerosolized dornase alfa should always be given in conjunction with standard cystic fibrosis therapies including antibiotics, chest physiotherapy, and pancreatic enzyme supplementation.

ISSN:0277-0008    

DOI:10.1002/j.1875-9114.1996.tb02914.x

出版商:Blackwell Publishing Ltd    

年代:1996

数据来源: WILEY

摘要:

Alcohol withdrawal syndrome (AWS) may result in nausea, vomiting, diarrhea, weakness, sweating, tremors, tachycardia, hypertension, agitation, delirium, hallucinations, seizures, and death beginning 6 hours after alcohol cessation in alcoholics. Benzodiazepines are cross‐tolerant with ethanol and are considered first‐line therapy for treating AWS. Chlordiazepoxide and diazepam are first metabolized by hepatic oxidation, then glucuronidation. Lorazepam and oxazepam undergo only hepatic glucuronidation. Benzodiazepine oxidation is decreased in persons with liver disease and the elderly. Accumulation with resultant excessive sedation and respiratory depression may be significant when administering chlordiazepoxide or diazepam to patients with impaired oxidative metabolism. Lorazepam and oxazepam metabolism is minimally affected by age and liver disease. Chlordiazepoxide and diazepam are erratically absorbed by the intramuscular route. Lorazepam is predictably absorbed by the intramuscular route. Oxazepam is not available in parenteral form. Lorazepam appears to be the safest empiric choice among the various benzodiazepines for treating AWS in the elderly and in patients with liver disease, or those who require therapy by the intramuscular ro

ISSN:0277-0008    

DOI:10.1002/j.1875-9114.1996.tb02915.x

出版商:Blackwell Publishing Ltd    

年代:1996

数据来源: WILEY

摘要:

We evaluated the effect of Liqui‐E, a water‐soluble vitamin E preparation, on cyclosporin A (CyA) whole blood concentration in liver transplant recipients, and its impact on the cost of CyA. Patients were 26 liver transplant recipients (19 adults, 7 children) who were unable to achieve and maintain therapeutic CyA whole blood concentrations with the standard recommended oral daily dose in the early post‐transplant period. Liqui‐E 6.25 IU/kg orally was administered with CyA every 12 hours (median time of starting Liqui‐E day 14.5). With Liqui‐E, the daily oral CyA requirements (mean ± SD) were decreased in adults from 22.6 ± 8.9 to 16.2 ± 7.3 mg/kg/day (p<0.001) and in children from 78.6 ± 34.1 to 53.7 ± 35.0 mg/kg/day (pl0.02); intravenous administration of CyA was unnecessary. The CyA trough concentrations (mean ± SD) before and after Liqui‐E were 670 ± 186 and 1012 ± 216 ng/ml, respectively, in adults (pl0.001) and 732 ± 187 and 1052 ± 166 ng/ml, respectively, in children (pl0.01). When given with Liqui‐E, the daily cost of CyA decreased by 26% in both adults and children. No clinical or biochemical evidence of Liqui‐E toxicity was observed. Thus its administration in the early post‐transplantation period can enhance CyA absorption in adults and children who are unable to achieve adequate whole blood concentrations with the usual recommended oral dosages. In addition, a significant cost saving can be

ISSN:0277-0008    

DOI:10.1002/j.1875-9114.1996.tb02916.x

出版商:Blackwell Publishing Ltd    

年代:1996

数据来源: WILEY

摘要:

Desmopressin is a commonly used, well‐tolerated agent for the treatment of primary nocturnal enuresis and central diabetes insipidus. Intranasal desmopressin provides symptomatic relief with few serious complications. A 29‐year‐old woman with a long history of primary nocturnal enuresis began treatment with intranasal desmopressin. Although the enuresis ceased, she developed throbbing headaches, nausea, vomiting, paresthesia, lethargy, fatigue, and altered mental status over the next 7 days. When she came to the emergency room her sodium concentration was 127 mmol/L. The history of desmopressin use was not obtained at that time. She was treated with intravenous fluids and discharged. The symptoms returned and worsened over the next 4 days, and she returned to the emergency room stuporous. A repeat sodium was 124 mmol/L, and she was admitted. The history of desmopressin use was still not available. Medical evaluations included computerized tomography, lumbar puncture, complete blood counts, serum chemistries, and serologies. The next morning the woman was improved and informed clinicians of her desmopressin use. Without other causes for the hyponatremia, she was diagnosed with the syndrome of inappropriate antidiuretic hormone, presumably caused by desmopressin. Within 24 hours of fluid restriction and cessation of desmopressin, her symptoms and hyponatremia resolved. A review of the literature found 11 children and 2 adults in whom intranasal desmopressin was associated with hyponatremia, all of whom experienced seizures or altered mental status. Our patient illustrates the importance of early recognition and treatment of hyponatremia before the onset of seizures. When vague symptoms develop during desmopressin therapy, hyponatremia must be considered as part of the differential diagnosis. It may also be prudent to screen for electrolyte abnormalities in patients taking this agent to prevent serious iatrogenic complica

ISSN:0277-0008    

DOI:10.1002/j.1875-9114.1996.tb02917.x

出版商:Blackwell Publishing Ltd    

年代:1996

数据来源: WILEY

摘要:

A patient with a long‐standing history of chronic obstructive pulmonary disease suffered a thermal injury over 20% of his total body surface area. He required opiates for pain management and benzodiazepines for anxiety associated with dressing changes. The narcotics compromised his pulmonary function and level of consciousness, and interfered with several attempts to wean him from ventilator support. Intravenous ketorolac instead of narcotics before dressing changes alleviated the respiratory depression and returned his partial pressure of carbon dioxide‐mediated respiratory drive to normal. With these changes, including changes in respiratory rate to tidal volume, he was successfully weaned from ventilatory support. In addition, the patient's level of consciousness improved. These changes increased his participation in his daily physical therapy sessi

ISSN:0277-0008    

DOI:10.1002/j.1875-9114.1996.tb02918.x

出版商:Blackwell Publishing Ltd    

年代:1996

数据来源: WILEY

摘要:

Alopecia has been described in patients infected with the human immunodeficiency virus (HIV). Zidovudine reportedly influences hair growth in these patients, causing regrowth or thickening. A 33‐year‐old HIV‐infected man developed alopecia areata after beginning zidovudine therapy. The alopecia reversed after the drug was discont

ISSN:0277-0008    

DOI:10.1002/j.1875-9114.1996.tb02919.x

出版商:Blackwell Publishing Ltd    

年代:1996

数据来源: WILEY

摘要:

Current models of drug‐induced psychosis insufficiently describe the symptoms of schizophrenia. Phencyclidine‐induced psychosis is a model that more completely reflects the pathophysiology of the disease. By decreasing glutamatergic neurotransmission, phencyclidine decreases 7‐aminobutyric acid release from the nucleus accumbens, striatum, and hippocampus (manifested by MK‐801); may inhibit tonic release of dopamine from the nucleus accumbens and striatum, resulting in increased dopamine phasic reactivity; and decreases long‐term potentiation. Glutamatergic system dysfunction may be involved, but pharmacologic manipulation has not revealed a clear mechanism of this dy

ISSN:0277-0008    

DOI:10.1002/j.1875-9114.1996.tb02920.x

出版商:Blackwell Publishing Ltd    

年代:1996

数据来源: WILEY