摘要:

Captopril, a competitive antagonist of angiotensin converting enzyme, has been marketed in the United States for the treatment of resistant hypertension. Despite extensive study, its exact mechanism of action remains unclear; decreased renin‐angiotensin‐aldosterone and sympathoadrenal system activity as well as increased bradykinin and prostaglandin E and F activity have been postulated. The drug decreases peripheral vascular resistance. Controlled trials in resistant hypertension of various etiologies and chronic congestive heart failure have demonstrated sustained effectiveness and therapeutic benefits. Side effects include skin rash, loss of taste, proteinuria, and leukopenia; higher doses and concomitant renal dysfunction appear to be predisposing factors. The benefit‐to‐risk ratio for captopril clearly justifies its use in resistant cases of hypertension and congestive heart failure, but further experience is needed to evaluate its use in milder forms of these d

ISSN:0277-0008    

DOI:10.1002/j.1875-9114.1982.tb03167.x

出版商:Blackwell Publishing Ltd    

年代:1982

数据来源: WILEY

摘要:

Calcium polycarbophil is the calcium salt of polyacrylic acid crosslinked with divinyl glycol. It is chemically and physiologically inert. In dilute alkali it possesses marked hydrophilic capacity (60 to 100 times its weight), which is the basis for its therapeutic use. In daily dosages of 4 to 5 g in adults, it appears to be quite safe, is non‐toxic, does not interfere with digestion or absorption, and does not cause gastrointestinal irritation. It appears to be effective in the treatment of both constipation and diarrhea due to functional or organic causes. Several days of continuous use are necessary before effectiveness becomes apparent. Clinical studies, of which there are relatively few, range from uncontrolled, unblinded evaluations of an almost anecdotal nature to well controlled, double‐blind, crossover studies. Additional carefully controlled studies on dietary influences, exercise, and patient compliance would be helpful. Adverse effects, which are minimal, include epigastric fullness or heaviness, abdominal distention and bloating, and flatulence. As with all bulk‐forming agents, calcium polycarbophil should not be used by persons who have stenotic lesions of the gastrointestinal

ISSN:0277-0008    

DOI:10.1002/j.1875-9114.1982.tb03168.x

出版商:Blackwell Publishing Ltd    

年代:1982

数据来源: WILEY

摘要:

Motion sickness is a common clinical malady. Until recently, the use of scopolamine, the drug of choice for the treatment of motion‐induced nausea and vomiting, has been sometimes associated with a variety of unacceptable side effects. These side effects could result from the unpredictable blood levels attained with oral dosage (pulse delivery). A new system of drug delivery, the transdermal therapeutic system (TTS) — Transderm®‐V — has been developed. The TTS delivers scopolamine across the skin at a constant rate. This permits a drug with a very short half life to be administered over prolonged periods, thereby maintaining blood concentrations at the defined therapeutic level. This precludes the necessity for frequent dosing and increases patient acceptability and compliance while minimizing the untoward effects associated with conventional dosage forms of

ISSN:0277-0008    

DOI:10.1002/j.1875-9114.1982.tb03169.x

出版商:Blackwell Publishing Ltd    

年代:1982

数据来源: WILEY

摘要:

Certain enteric ailments are particularly common among homosexual men. They are primarily infectious diseases and include not only such common veneral diseases as gonorrhea and syphilis but also infections not usually regarded as being sexually transmitted. Among the latter are shigellosis, salmonellosis, giardiasis, and amebiasis.Patients' symptoms are non‐specific and seldom helpful in diagnosing particular diseases. The practitioner must be prepared to identify a number of infections with similar presentations that may occur singly or together in gay men.Gonorrhea is probably the most common bacterial infection in gay men. Carriage rates as high as 50% have been reported, and extra‐genital carriage is common; this necessitates culturing the urethra, rectum, and pharynx. Procaine penicillin G is the treatment of choice for most patients; spectinomycin is probably the drug of choice in penicillin‐sensitive patients. In contrast to other venereal diseases, syphilis may have a characteristic protoscopic presentation. Benzathine penicillin G is the treatment of choice for most patients. Lymphogranuloma venereum causes penile lesions and inguinal lymphadenitis in heterosexual men, whereas homosexual men are more prone to proctitis. The disease may mimic Crohn's disease. Recommended treatment includes tetracycline or sulfamethoxazole‐trimethoprim. Shigellosis usually presents as an acute diarrheal illness. Patients generally require only supportive treatment with fluids.Herpes simplexviral infection is difficult to diagnose and has several different presentations, including lumbosacral radiculomyelopathy. Symptomatic treatment with sitz baths, anesthetic ointment, and analgesics is recommended. Venereal warts are believed to be caused by the same virus that causes verrucous warts; they are usually found in the anal canal or around the anal orifice. They are commonly treated with 25% podophyllin solution.Parasitic infections include giardiasis, amebiasis, and pinworm infections. Metronidazole may be used in the treatment of symptomatic giardiasis and amebiasis, but it is not approved for the former indication; quinacrine is approved for giardiasis. Pinworm infestation may be treated with pyrantel pamoate or mebendazole.Cure of enteric diseases in homosexual men must be doc

ISSN:0277-0008    

DOI:10.1002/j.1875-9114.1982.tb03170.x

出版商:Blackwell Publishing Ltd    

年代:1982

数据来源: WILEY

摘要:

One‐hundred thirty‐two outpatients with pain following oral surgery were randomly assigned, on a double‐blind basis, to a single oral dose of diflunisal 500 or 1000 mg, propoxyphene napsylate 100 mg, a combination of propoxyphene napsylate 100 mg with acetaminophen 650 mg, or placebo. Using a self‐rating record, subjects rated their pain and its relief hourly for 12 hours after medication. Measures of total and peak analgesia were derived from the patient's subjective reports. Diflunisal 500 and 1000 mg were significantly superior to placebo and propoxyphene alone for every measure of total and peak analgesia, and the effect of diflunisal persisted for 12 hours. Diflunisal 1000 mg was significantly superior to the propoxyphene‐acetaminophen combination for all measures of analgesia. Although the propoxyphene‐acetaminophen combination was significantly superior to placebo for most measures of analgesia, propoxyphene alone was significantly superior for only two measures. Adverse effects attributed to all drugs were mild and

ISSN:0277-0008    

DOI:10.1002/j.1875-9114.1982.tb03171.x

出版商:Blackwell Publishing Ltd    

年代:1982

数据来源: WILEY

摘要:

Patient‐controlled analgesia is a relatively new method of administering intravenous narcotics for postoperative pain relief. The technique involves the self‐administration of a given analgesic in a bolus dose with the aid of a timed infusion and sequencing device. Ten morbidly obese patients undergoing elective gastric bypass surgery were treated in a prospective, unblinded, pilot project to evaluate the efficacy of patient‐controlled analgesia. Analgesic therapy was satisfactory in all patients. The mean total dose of morphine sulfate administered during the first 36 hours postoperatively was 66 mg, an average of 1.7 mg/hr. There was a tenfold variation (17.5–175 mg) in the 36 hr total dose. The total dose was not related to body surface area, age, sex, dose per injection, or anesthetic agent. The large variation in individual narcotic analgesic requirements could be a major factor in the suboptimal management of postoperative pain with conventional dosing. Patient‐controlled analgesia may circumvent these

ISSN:0277-0008    

DOI:10.1002/j.1875-9114.1982.tb03172.x

出版商:Blackwell Publishing Ltd    

年代:1982

数据来源: WILEY

摘要:

Adverse reactions to drugs often include an immunologic response. An understanding of immunologic mechanisms is useful in understanding the clinical manifestations of drug allergy. Predisposing factors to the development of allergic reactions to drugs include host factors as well as drug factors. Immune response relates to what we know about the components of the immune system as well as their differentiation and maturation processes. Immunologic reactions are often classified as Type I, Type II, Type III or Type IV, and these reaction types often correlate with clinical manifestations. For each reaction type the mechanism, drugs implicated, clinical manifestations, and treatment can be described.

ISSN:0277-0008    

DOI:10.1002/j.1875-9114.1982.tb03173.x

出版商:Blackwell Publishing Ltd    

年代:1982

数据来源: WILEY

ISSN:0277-0008    

DOI:10.1002/j.1875-9114.1982.tb03175.x

出版商:Blackwell Publishing Ltd    

年代:1982

数据来源: WILEY