Some possible gynaecological indications for peripheral antidopamine therapy.

The effect of the dopamine receptor blocking domperidone (Motilium) has been examined in 73 gynaecological patients in a wide indication field. The treatment was successful in controlling dyspeptic symptoms of different origins, nausea-vomiting of different etiologies, climacteric flushes, and in the prevention of migraines in 67.1% of the cases. Partial response was obtained in 19.2%, and no response in 13.7% of the cases. According to the opinion of the authors the gastrokinetic and antiemetic effect of domperidone is of high value, the use of the drug may be attempted as a monotherapy or an adjuvant therapy for the prevention of migraine and the treatment of climacteric flushes.     

New indications for the use of therapeutic hypothermia

Randomised, controlled trials of therapeutic hypothermia have demonstrated improved outcomes after out-of-hospital cardiac arrest, where the initial cardiac rhythm was ventricular fibrillation. This therapy is now endorsed by the International Liaison Committee on Resuscitation. The role of therapeutic hypothermia in patients with anoxic neurological injury due to stroke, spinal cord injury or asphyxial cardiac arrest is uncertain. However, given the strong theoretical benefit and the minimal adverse side-effects, it is reasonable for clinicians to consider the use of therapeutic hypothermia in such cases.     

Non-steroidal anti-inflammatory drugs: indications for use

Non-steroidal anti-inflammatory drugs (NSAIDs) are among the most widely used of all therapeutic agents. Although they are effective analgesics they do have significant adverse side-effects. Before treatment is started the prescriber should always weigh efficacy against possible side-effects. NSAIDs vary in their selectivity for inhibiting the two types of cyclo-oxygenase. An NSAID should therefore be chosen on the basis of the incidence of associated side-effects.     

Vaginal support pessaries: indications for use and fitting strategies

Flexible silicone vaginal support pessaries offer a low-risk, effective option for treatment of symptoms of pelvic organ prolapse. This first article in a three-part series summarizes clinical recommendations and current evidence related to pessary indications, choice, and fitting.     

Clinical use of the artificial heart, indications and results

Clinical experience with the artificial heart now comprises 520 cases. 390 patients had to be supported mechanically when they could not be weaned off cardiopulmonary bypass. 177 (45%) subsequently had their assist devices removed and 100 (25.4%) were discharged. Good functional results were achieved, since 30 of 36 long-term survivors are in NYHA class I or II. 140 underwent two-stage cardiac transplantation. Of 63 patients implanted with a ventricular assist device (VAD) 71% were transplanted and 51% survived. A total artificial heart (TAH) was used in 77 cases, 81% were transplanted and 47% survived. Five patients received TAH implantations as a permanent replacement of the failing heart. Though the clinical courses were complicated by strokes and infections and the patients were tethered to bulky drive units, it was proven that the TAH may sustain human life for up to 622 days, much longer than so far achieved in animal experiments. Improvements of the atrial connectors and valve holding components and of the biocompatibility of the blood contacting surfaces should overcome the complication of thromboembolism. Fully implantable devices which are currently being developed will avoid the problem of drive-line infections and provide fuller mobility to the patient.