Plasma concentrations of mianserin after single dose and at steady-state in depressed elderly patients

Plasma mianserin and desmethylmianserin concentrations were measured in 17 clinically depressed elderly patients after a single 30 mg dose of mianserin. The patients then received mianserin 30 mg daily for up to 6 weeks and the plasma concentrations were measured at weekly intervals. The relationship between concentrations of mianserin and desmethylmianserin at steady-state and at 16 and 24 hours after the single test dose was not good enough to be used for prediction of dosage requirements. Reasons for this finding are discussed.     

甲氨蝶呤、来氟米特联合小剂量泼尼松治疗老年类风湿关节炎的疗效观察

目的评价甲氨蝶呤（MTX）、来氟米特（LEF）联合小剂量泼尼松治疗老年类风湿关节炎的有效性和安全性。方法回顾性分析应用MTX、LEF联合小剂量泼尼松治疗的29例老年类风湿关节炎患者的临床资料。结果临床缓解9例,明显进步7例,进步4例,总有效率为69.0%。不良反应为口腔溃疡、胃肠道反应、全血细胞减少、肝损害和血糖升高。结论 MTX、LEF联合小剂量泼尼松治疗老年类风湿关节炎有效、安全。     

Benzodiazepine drugs in general medical patients.

Data from a hospital-based drug surveillance programme were used to determine how often benzodiazepine drugs were used in general medical wards. Benzodiazepines were the drugs most commonly used as hypnotics and were given to 32% of these patients. Concomitant use of more than one benzodiazepine drug or of benzodiazepines with other psychoactive drugs was common and often irrational. A series of double-blind patient-preference studies comparing various benzodiazepines and a benzodiazepine with an antihistamine showed that for short-term hypnotic effect there were no differences between three common benzodiazepines but elderly patients preferred benzodiazepines to the antihistamine, which produced more undesired effects. These results suggest that currently diazepam is the hypnotic of choice for medical ward inpatients.     

Pharmacokinetics of lofepramine and amitriptyline in elderly healthy subjects

Pharmacokinetics of 3 doses (70 mg, 105 mg and 140 mg) of lofepramine were compared with amitriptyline (50 mg) in 6 healthy drug free elderly subjects aged between 65 and 72 years. Pharmacokinetics of lofepramine in the elderly appear to be similar to young adults as published before. Peak plasma lofepramine and amitriptyline concentrations were achieved at about 1 h and 3 h of dosing respectively. Elimination half-life of lofepramine was 2.5 h and that of amitriptyline was 31 h. A 24-fold inter-individual variation in peak plasma lofepramine concentrations was observed, but amitriptyline levels in plasma showed less variation. Pharmacokinetic parameters of amitriptyline were comparable to other published studies involving elderly people. Compared to placebo and lofepramine, amitriptyline produced drowsiness and dry mouth, reduced salivary volume and increased movement reaction time. These effects correlated with the plasma amitriptyline levels.     

小剂量沙利度胺治疗老年性瘙痒症的临床观察

目的研究口服小剂量沙利度胺治疗老年性瘙痒症的疗效。方法将75例老年性瘙痒症患者随机分为2组。治疗组口服沙利度胺75 mg,每晚1次;对照组口服盐酸左西替利嗪片5 mg,每晚1次。分别于治疗前、治疗4周时进行瘙痒评分,治疗后观察两组疗效及安全性。结果治疗组和对照组治疗前瘙痒评分分别为8.36±2.89、8.24±2.32,差异无统计学意义(P>0.05),治疗后治疗组瘙痒评分低于照组(3.71±1.92vs.5.45±2.11),差异有统计学意义(t=3.74,P<0.01),治疗组总有效率为86.8%,对照组为43.2%,治疗组明显优于对照组(χ2=15.73,P<0.01)。结论应用小剂量沙利度胺治疗老年性瘙痒症的疗效良好,值得进一步研究及推广应用。     

Once daily flupenthixol in the treatment of elderly depressed patients: A multi-centre trial in general practice

Summary

Ninety-five elderly depressed patients were entered into an open trial of 0.5 to 1.0?mg flupenthixol dihydrochloride, as a single daily dose in the morning. Eighty-seven patients were treated and assessed for 14 days, 6 patients failed to attend follow-up appointments and 2 patients were withdrawn from the trial because of acute physical illness. After 14-days' treatment, a decrease in the severity of the illness was recorded on the Clinical Global Impression Scale in 77% of the patients, and statistically significant improvements were noted in the 5 individually rated symptoms of lowered mood, fatigue, tendency to weep, feelings of inadequacy and irritability. The number and severity of adverse effects recorded on a checklist decreased during the treatment period. The results suggest that flupenthixol is an effective antidepressant and is well tolerated by the elderly as a single daily dose.     

低剂量布比卡因腰-硬联合麻醉在老年患者髋关节置换手术中的应用

目的观察低剂量腰-硬联合麻醉在老年患者髋关节置换手术中的应用效果及安全性。方法选取本院2012年4月～2013年4月ASAⅡ～Ⅲ级进行髋关节置换手术的60岁以上老年患者52例,行腰椎第2～3椎间隙穿刺注入布比卡因溶液,并置入硬膜外导管。记录麻醉前基础值,注药后5、10、15、30 min的BP,HR,SpO2,评价麻醉效果对血流动力学的影响。结果麻醉后患者的BP、HR、SpO2与麻醉前相比差异无统计学意义,术后无恶心、呕吐和头痛。结论低剂量腰-硬联合麻醉对血流动力学影响小,安全可靠,可安全用于老年患者髋关节置换手术。     

Adjunctive lithium carbonate in nortriptyline-resistant elderly depressed patients

Recent reports supporting the use of lithium carbonate as an adjunct to tricyclic antidepressants for the treatment of refractory depression have not utilized standardized tricyclic antidepressant therapy, nor have they addressed the efficacy of lithium augmentation in a geriatric population. A 3-week open trial was added to the medication regimen of 15 elderly depressed inpatients who had already failed 4 weeks of therapeutic levels of nortriptyline. Treatment response was determined by the 17-item Hamilton Rating Scale for Depression (HAM-D). Two of 15 partial responders before lithium augmentation became complete responders. Of the remaining 13 "nonresponders" before lithium augmentation, one had a complete response, 7 had a partial response and 5 remained nonresponders. Although there was a mean HAM-D change of 8.3 points after lithium augmentation (24.7 +/- 5.9 to 16.4 +/- 6.8, p less than .001), when considering the previously reported similar efficiency of extended nonaugmented nortriptyline, these data do not strongly support lithium augmentation in elderly subjects who fail to respond after 4 weeks of nortriptyline. Further study is needed to determine what role, if any, lithium augmentation should play in the treatment of geriatric depression.     

Use of antimicrobial drugs in medical wards.

Antimicrobial usage patterns in 17,750 consecutive medical in-patients, monitored between 1966 and 1972 are described. 36.4% of all patients were exposed to one or more antimicrobials and about half of them received more than one antimicrobial agent. Penicillins accounted for 49% of all exposures and use of ampicillin rose steadily over the years. Concomitant receipt of more than one antimicrobial was common (22% of all exposed patients). Of 171 possible two-drug combinations involving 19 drugs, 126 were actually encountered. Apart from combinations, 60% of antimicrobial recipients received more than one agent at different times.     

Stimulation of the pituitary-adrenal axis with a low dose [Arg8]-vasopressin in depressed patients and healthy subjects.

Graded doses arginine-vasopressin (AVP) were administered to depressed patients and control subjects to compare the sensitivity of the pituitary-adrenal system of these subjects for this compound. The plasma levels of cortisol, adrenocorticotropic hormone (ACTH) and ß-endorphin were measured before and after intravenous AVP injection. The hormonal output was taken as a measure of pituitary-adrenal function. In control subjects 3 doses AVP and placebo were used, whereas in patients two doses AVP, a low and high dose, and placebo were tested. All tests were carried out in the afternoon when the pituitary-adrenal system is stable and more susceptible for stimulation. Patients were subdivided into dexamethasone suppressors and nonsuppressors based on their DST status before testing to look for differences among these groups. Control subjects showed no response of the hormones to the lowest dose AVP and a moderate response to the higher doses. Interestingly, depressed patients as compared to controls responded more to the lowest dose AVP in particular with respect to ACTH. DST status did not influence the results. These findings suggest an enhanced sensitivity of the pituitary to low doses AVP in depressed patients. Thus, AVP might play a role in HPA dysfunction in depression.     

The effect of escitalopram on sleep problems in depressed patients

The results from three 8-week escitalopram studies in major depressive disorder are presented with respect to efficacy and the effect on sleep quality, both in the full population and the subpopulation of patients with sleep problems at baseline.Analysis of pooled data from these randomized, double-blind, placebo-controlled, studies in which citalopram was the active reference, showed a significant improvement for escitalopram-treated patients (n = 52.0) in the Montgomery-Asberg depression rating scale (MADRS) item 4 ('reduced sleep') scores at weeks 6 and 8 compared with placebo (n=398; p < 0.01) and at weeks 4, 6 and 8 (n = 403; p < 0.05) compared with citalopram.Escitalopram-treated patients with sleep problems (MADRS item 4 score > or = 4; n = 254) at baseline showed a statistically significant improvement in mean MADRS item 4 scores at weeks 4, 6 and 8 compared with patients treated with placebo (n = 191; p < 0.05) or citalopram (n = 193; p < 0.01). These patients also showed a statistically significant (p < 0.05) and clinically relevant improvement in MADRS total score after escitalopram treatment compared with citalopram at weeks 1, 4, 6 and 8 (observed cases) and endpoint (-2.45; last observation carried forward [LOCF]). Statistical significance in favour of escitalopram versus placebo treatment was found at all visits, including endpoint (-4.2; LOCF).Thus, these post-hoc analyses suggest that escitalopram has a significant beneficial effect compared with placebo or citalopram in reducing sleep disturbance in patients suffering from major depressive disorder. The effect of escitalopram in improving 'reduced sleep' scores was clearly seen in patients with more severe sleep disturbance at baseline. A further prospective study is needed to establish this useful clinical effect in insomniac depressives.     

低剂量达菲林在控制性超促排卵中的应用

目的观察两种低剂量促性腺激素释放激素激动剂(GnRH-a,达菲林)在控制性超促排卵(COH)中对垂体降调节的效果.方法将67例接受体外受精及胚胎移植(IVF-ET)助孕患者随机分为两组.A组35例应用达菲林1.88mg(半量),B组32例应用达菲林剂量为1.25mg(1/3量),比较两组COH的疗效.结果1.两种低剂量达菲林均能抑制内源性LH峰;2.两组的获卵数、受精率、卵裂率及优质胚胎数无明显差异(P＞0.05),B组应用促性腺激素(Gn)总量及用药时间比A组少,卵巢过度刺激综合征(OHSS)发生率少,差异有显著性(P＜0.05).结论两种低剂量达菲林均达到垂体降调节效果,治疗费用低,副反应少.     

老年髋关节置换术患者全麻复合腰硬联合麻醉的效果

目的探讨老年髋关节置换术患者全麻复合腰硬联合麻醉的效果,探讨适合老年髋关节置换术的最佳麻醉方法。方法将100例老年新鲜股骨颈骨折需行髋关节置换术患者按照收治顺序编号,单号即复合组50例,采用全麻复合腰硬联合麻醉,双号即全麻组50例,采用全身静脉麻醉,比较两组麻醉效果、苏醒时间、疼痛程度、术中高血压和低血压以及术后躁动的发生率。结果复合组麻醉优良率为90.00%,全麻组为72.00%,复合优良率显著高于全麻组,差异有统计学意义(P0.05);复合组苏醒时间为(18.29±5.52)min,显著短于全麻组,差异有统计学意义(P0.05);复合组疼痛程度显著轻于全麻组,差异有统计学意义(Z=8.182,P0.05);复合组术中出现高血压3例,低血压2例,术后躁动11例,发生率均显著低于全麻组,差异有统计学意义(P0.05)。结论老年髋关节置换术患者采用全麻复合腰硬联合麻醉效果显著,并发症少,手术疼痛程度轻。     

低剂量纳洛酮对布托啡诺镇痛效应的影响

目的 观察低剂量纳洛酮(naloxone)对布托啡诺(butorphanoi)镇痛效应的影响.方法 受试小鼠80只随机分为2组,分别接受扭体法(40只,雌雄各半)和热板法(40只,雌性)试验,观察纳洛酮对布托啡诺镇痛小鼠热板法痛阈(HPPT)和扭体次数的影响.各组再按分层随机设计分为BS组(镇痛剂量布托啡诺与生理盐水合用)、 BN1组、BN2组和BN3组(布托啡诺分别与纳洛酮100、10、1 ng/kg合用).结果 热板法试验提示,与BS组比较,BN2组HPPT在用药后20、30min均增大(P<0.05);扭体法试验提示,与BS组比较,BN2组扭体次数减少(P<0.05).结论 低剂量纳洛酮可增强布托啡诺的镇痛效应,且以纳洛酮10 ng/kg效果最好.