A RANDOMISED,DOUBLE-BLIND,PARALLEL-GROUP COMPARISON OF VENLAFAXINE AND DOTHIEPIN IN GERIATRIC PATIENTS WITH MAJOR DEPRESSION

This randomised, double-blind study conducted at nine sites in the UK and the Netherlands compared the safety and antidepressant efficacy of venlafaxine and dothiepin. Ninety-two geriatric patients (aged 64-87 years) with major depression were randomly assigned to receive either venlafaxine or dothiepin for up to 43 days. The dose of venlafaxine or dothiepin was titrated up to a maximum of 150 mg per day for the first 15 days, and thereafter could range from 50 to 150 mg per day. Adjusted mean scores on the MADRS and the HAM-D decreased significantly (p 0.05) from baseline to the end of the study in both groups. A response to therapy was observed in 60% of patients in the venlafaxine group and 53% of patients in the dothiepin group on the MADRS, and in 60% of patients in both groups on the HAM-D. Suicidal ideation scores on the MADRS were significantly (p=0.042) lower in the venlafaxine group at week 6. Treatment-emergent study events were the primary reason for withdrawal in only 7% of venlafaxine-treated patients and 8% of dothiepin-treated patients. The results confirm the efficacy and tolerability of venlafaxine for treating major depression in the elderly.     

A DOUBLE-BUND,RANDOMISED COMPARISON OF FLUVOXAMINE WITH DOTHIEPIN IN THE TREATMENT OF DEPRESSION IN ELDERLY PATIENTS

SUMMARY The efficacy and tolerability of the selective 5-HT reuptake inhibitor fluvoxamine were compared with the tricyclic dothiepin in 52 elderly (age > 64 years) hospital patients in a multi-centre double-blind randomised trial. Patients met DSM-III criteria for ‘major depressive episode’ and scored > 29 on the Montgomery Asberg Depression Rating Scale (MADRS) after a one-week placebo baseline. Active treatment was for six weeks. The dosage of both drugs was 50 mg nocte for three days, 100 mg nocte for the remainder of the first week, thereafter increasing to a maximum of 200 mg/day according to response/tolerance. MADRS scores improved by 63.5% with fluvoxamine and 60.0% with dothiepin; there were no significant differences between treatments at any assessment. Nausea, dizziness, headache, somnolence and constipation in both groups, plus dry mouth and asthenia in the dothiepin group were more frequent than single reports. Two patients in each group discontinued treatment owing to unwanted effects. There were no clinically significant changes in haematological, biochemical or cardiovascular parameters.     

A STUDY OF AUTONOMIC CARDIOVASCULAR REFLEXES IN ELDERLY PATIENTS WITH PNEUMONIA

People recovering from pneumonia are often weak for no apparent reason. Clinical features such as postural hypotension, arrhythmia and syndrome of inappropriate ADH have, in other circumstances, been attributed to impaired autonomic function. The aim of this study was to see whether elderly patients with pneumonia had impaired autonomic cardiovascular reflexes and, if so, how long this persisted. We compared healthy elderly controls, elderly controls with trauma (fractured femoral neck) and elderly patients with pneumonia. Thirty-eight subjects were studied in a series of cardiovascular autonomic function tests. Results suggest that elderly people have a high prevalence of impaired cardiovascular autonomic reflexes in the immediate post-pneumonic phase, and that this improves significantly after six weeks, with a further improvement by six months. Elderly patients recovering from pneumonia are predisposed to the adverse effects of drugs and other factors which can further impair autonomic cardiovascular reflexes.     

ABNORMALITIES OF THYROID HORMONAL FUNCTION TESTS IN HOSPITALISED ELDERLY PATIENTS: A PROSPECTIVE STUDY

We measured thyroidal hormonal function tests in unselected sick and hospitalised elderly patients with a new immunoassay technique. Our results show a significant percentage of subjects with thyroid hormonal dysfunction.     

EFFICACY AND SAFETY OF ORAL SILDENAFIL IN THE TREATMENT OF ERECTILE DYSFUNCTION: A DOUBLE-BLIND,PLACEBO-CONTROLLED STUDY OF 329 PATIENTS

SUMMARY The efficacy and safety of oral sildenafil citrate for the treatment of erectile dysfunction (ED) were assessed in a 12-week placebo-controlled study. Men with ED of organic, psychogenic, or mixed aetiology were randomised to placebo (n=166) or 50 mg sildenafil (n=163), with adjustment to 100 mg or 25 mg based on efficacy and tolerability. Efficacy assessments included a global efficacy question, event log data, and an optional partner questionnaire. At the end of the study, improved erections were reported by 74% of patients receiving sildenafil versus 16% for placebo (p<0.0001). In the final 4 weeks of treatment, 65% of all attempts at sexual intercourse were successful for all patients (responders and non-responders) receiving sildenafil versus 20% for placebo (p<0.001).The mean number of successful attempts per month was 5.9 for patients receiving sildenafil versus 1.5 for those receiving placebo (p<0.0001). The most common adverse events – headache, flushing, and dyspepsia – were generally mild to moderate in nature and rarely (<1%) a reason for discontinuation of treatment. Oral sildenafil is an effective, reliable and well-tolerated treatment for ED of organic, psychogenic or mixed aetiology.     

THE LONG-TERM SAFETY AND TOLERABILITY OF TRANSDERMAL GLYCERYL TRINITRATE,WHEN USED WITH A PATCH-FREE INTERVAL IN PATIENTS WITH STABLE ANGINA

SUMMARY The safety and tolerability of intermittent (16 hours on/8 hours off) nitrate patch therapy (0.2, 0.4 or 0.6 mg/hr: dose adjusted as required) was studied for a median duration of 356 days in 106 patients (mean age 60.9 ±8.6 years) with angina pectoris. Most patients (82%) were on existing beta-blocker and/or calcium antagonist therapy. Safety, tolerability and efficacy data were obtained by means of patient diary cards and regular clinic visits. Almost 90 treatment years revealed no significant or serious adverse events, and there were no changes in haematology or biochemistry associated with intermittent nitrate patch therapy. The most frequently reported side-effects were headache, skin reactions and dizziness (53%, 20% and 8% of patients respectively). Treatment resulted in a sustained reduction in the frequency and severity of angina attacks, reduced sublingual GTN consumption, an improvement in general wellbeing and a rise in the proportion of patients in whom angina was controlled.     

DOUBLE-BLIND STUDY COMPARING THE LONG-TERM EFFICACY OF THE COX-2 INHIBITOR NIMESULIDE AND NAPROXEN IN PATIENTS WITH OSTEOARTHRITIS

This double-blind one-year study compares the long-term efficacy and safety of nimesulide with naproxen in patients with osteoarthritis (OA) of the knee or hip. Patients were randomised to nimesulide 100 mg twice daily (n=183) or naproxen 250 mg morning, 500 mg evening (n=187). The primary efficacy variable was change in pain intensity (WOMAC A scale) at 6 months. Nimesulide tablets showed at least equivalent efficacy to naproxen tablets in reducing pain intensity at 6 and 12 months (nimesulide -22.5% at 6 and 12 months; naproxen -22.4% at 6 months, -19.9% at 12 months; non-inferiority proven). At 6 months the investigator assessed efficacy as ‘good’ or ‘excellent’ in 59.3% of nimesulide and 56.4% of naproxen-treated patients, with corresponding values for patient assessment of 57% and 52.7%. Both treatments were well tolerated, with fewer related gastrointestinal adverse events reported with nimesulide (77 cases, 47.5%) than with naproxen (96 cases, 54.5%). This study shows nimesulide to be as effective as naproxen in the long-term treatment of OA and to be associated with fewer gastrointestinal side-effects.     

参附注射液对老年血管性痴呆的治疗效果

目的探讨参附注射液对老年血管性痴呆病人认知功能的影响及应用的安全性。方法将93例老年血管性痴呆病人随机分为治疗组（47例）和对照组（46例）。对照组用生理盐水注射液250 mL加胞二磷胆碱注射液0.75 mL静脉注射,每日1次。治疗组在对照组用药的基础上联用生理盐水注射液250 mL加参附注射液40 mL静脉注射,每日1次。两组均以3周为1疗程。治疗前后采用简易智能状态量表（MMSE）和日常生活能力量表（ADL）评价临床疗效。结果治疗组1例失访,对照组3例失访。治疗后治疗组MMSE和ADL评分显著优于对照组（t=2.66、7.79,P〈0.01）。结论参附注射液治疗老年血管性痴呆安全性好,能改善病人的认知功能,提高生活质量。     

都可喜对老年慢性阻塞性肺疾病患者动脉血气的影响

目的观察长期服用都可喜对老年慢性阻塞性肺病稳定期患者血气指标的影响。方法采用自身对照法。选取老年慢性阻塞性肺病患者36例,口服都可喜治疗,每次1片,2次/d,疗程24周,用药前后分别进行血气指标测定。结果患者服用都可喜4周、24周后PaO2上升(P<0.01),PaCO2下降(P<0.01)。结论都可喜能够改善慢性阻塞性肺病稳定期患者的血气指标。     

曲唑酮治疗持续性疼痛性躯体形式障碍的双盲对照研究

目的:观察曲唑酮与止痛剂对持续性疼痛性躯体形式障碍的疗效与副反应。方法:140例患者随机分为2组进行双盲对照(每组70例),分别以曲唑酮或去痛剂布洛芬治疗4周。其疗效和副反应分别用汉密顿抑郁量表(HAMD)和临床疗效评定标准和副反应量表(TESS)评定。结果:曲唑酮的有效率大于布洛芬,分别是92.85％和62.85%(P<0.01);副反应发生率也大于布洛芬(P<0.01),但均较轻。结论:曲唑酮对持续性疼痛性躯体形式障碍疗效肯定,副反应轻。     

THE EFFECT OF COUNSELLING BY A PHARMACIST ON DRUG COMPLIANCE IN ELDERLY PATIENTS

The effect of counselling by a pharmacist on medication errors was assessed in fifty-three patients aged 65 years and over attending a day hospital. Despite random allocation to either the counselled or the uncounselled (‘control’) group, patients in the counselled group were making fewer errors than those in the control group even before they received instruction from the pharmacist. There was no evidence that those in the counselled group made fewer errors or complied better with their treatment as a result of counselling.     

肝癌、肝炎患者血液流变性研究

本研究对７７例肝癌和肝炎患者进行了血液流变学、纤维蛋白原和 血脂分析。结果表明，各类肝病患者均有不同程度的全血粘度增高（低切比，Ｐ＜０． ０１）和血浆粘度（η_（ｐ）增高的倾向（Ｐ＜０．０５）。值得注意的是，肝硬化和肝癌患者的 血沉、Ｋ值（Ｐ＜０．０１）和纤维蛋白原都有大幅度的增加（Ｐ＜０．０５）。甘油三脂的 增加仅见于肝炎和肝硬化（Ｐ＜０．０１），而肝癌与健康人相比则无差异（Ｐ＞０．０５）。 在肝癌和肝硬化中各项指标的异常相当掐近．     

COLORECTAL ADENOMA IN PATIENTS WITH A HISTORY OF BREAST CANCER: A PROSPECTIVE STUDY IN TAIWAN

The increased incidence of colorectal cancer in women with a history of breast cancer is well established. However, the relationship between the prevalence of adenomatous polyps and breast cancer is still controversial. We conducted a prospective study of the incidence of colorectal polyps in patients with a history of breast cancer in Taiwan. Eighty-nine patients (86 women and 3 men) received colonoscopy to test for precancerous lesions. Mean age was 49.4 ± 10.4 years. Twelve polyps (9 adenomatous, 2 hyperplastic, 1 inflammatory) (13.5%) and one cancer (1.1%) were found. The mean age of patients with and without colorectal neoplasia was 56.3 ± 9.4 and 48.2 ± 10.2 years respectively. (p<0.005); 10 out of 13 patients (77%) with colorectal neoplasia were over 50 (p<0.1). Compared with a study of Chinese people in Hong Kong, our population had a lower incidence of colorectal adenomatous polyps, but breast cancer patients have a greater risk of developing colorectal cancer than the general population in Taiwan.