Plantes et dysfonction érectile

Résumé: La dysfonction érectile est un phénomène de santé relativement important dont les conséquences sont néfastes pour lhomme et son entourage. De nombreux traitements par des molécules de synthèse sont actuellement proposés pour pallier ces troubles, mais leur coût élevé, ainsi que les effets secondaires quils engendrent, redonnent un nouvel élan aux substances naturelles. Certaines préparations dorigine végétale nont pourtant aucun effet et ne sont pour la plupart que légendes. Dautres, peu nombreuses, ont une activité réelle prouvée sur le plan scientifique. Par ailleurs, de nombreuses plantes prometteuses dans le traitement des dysérections nont fait lobjet que de rares investigations et mériteraient une étude pharmacologique plus approfondie.     

Optimizing outcomes with antimicrobial therapy through pharmacodynamic profiling

In patients with infection, improving the probability of positive treatment outcomes depends on optimizing the interactions between the host, pathogen, and drug. In this setting, optimal regimens must be utilized which not only maximize effectiveness in a specific patient, but also minimize the development of microbial resistance. The probability of achieving a specifically targeted antimicrobial exposure can be assessed using Monte Carlo simulation, a technique which integrates an agents in vitro potency distribution (i.e., minimum inhibitory concentrations [MICs]) with the pharmacokinetic profile. The targeted pharmacodynamic parameters assessed by this technique include the ratio of peak concentration (C_max) to MIC (C_max:MIC); the ratio of the area under the plasma concentration-time curve (AUC) to MIC (AUC:MIC), and the time the drug concentration exceeds the MIC (T MIC). Some antimicrobials, e.g., the aminoglycosides, are most effective/bactericidal when they have a high C_max:MIC ratio; others, e.g., the fluoroquinolones, are more effective when the AUC:MIC ratio is high. In both of these scenarios, organism eradication is concentration-dependent, and the therapeutic goal is to maximize drug exposure. Like the fluoroquinolones, the efficacy of telithromycin, a newly developed ketolide, is most related to the AUC:MIC ratio. Outcome for other agents, such as the -lactams, is best predicted by the T MIC; in this case, organism eradication is time-dependent, and the therapeutic goal is to optimize the duration of antimicrobial exposure. This article discusses how the use of currently available antimicrobials can be optimized through an appreciation of pharmacodynamic profiling.     

Self-efficacy expectancies versus outcome expectancies as determinants of performance deficits and depressive affect

To compare the depression etiologies specified by self-efficacy theory versus the revised learned helplessness theory, 108 male and female undergraduates were assigned randomly to either high, low, or no self response expectancy manipulations and high, low, or no response outcome expectancy manipulations. Expectancies were modified by combinations of easy or difficult anagrams and graphs showing that most or few students solved the anagrams. Males exhibited performance deficits and depressed affect following manipulations only if self response expectancy had been set low and other response expectancy had been set high. Contrary to revised learned helplessness theory, no performance deficit or depressive affect occurred when both self response and response outcome expectancies were low. Females' performance and affect were not changed by combined low self response and high response outcome manipulations. Repeated subject ratings of self response and response outcome expectancies during manipulations suggest that females set their self response expectancies low before manipulations to avoid depression. Expectancy ratings also showed that self response expectancies correlated more strongly with performance than did response outcome expectancies.We thank Katherine Acosta, Michael Davis, Larry McFarland, and Janine Tronolone for their assistance as experimenters.     

Komplexitätstheorie und Manualmedizin

Zusammenfassung  Ausgehend von Fallbeobachtungen wird dargestellt, dass die teils sehr unterschiedlichen Effekte manueller Therapie (MT) am besten verständlich sind, wenn man 2 unterschiedliche Wirkungsweisen unterscheidet. Diese Differenzierung in robuste und subtile MT ermöglicht es, beide Behandlungstypen effizienter einzusetzen. Komplexitätstheoretische Konzepte und die Theorie des intelligenten Organismus werden zur Erklärung dieser Effekte erläutert und diskutiert.

Non-invasive ventilation for cancer patients with life-support techniques limitation

Goals of work The study was conducted to determine the usefulness and efficacy of non-invasive ventilation (NIV) in cancer patients with life-support techniques limitation admitted for an acute respiratory distress, in terms of intensive care unit (ICU) and hospital discharges.Patients and methods A total of 18 consecutive cancer patients (17 with solid tumours and one with haematological malignancy) with life-support techniques limitation in acute respiratory failure and who benefited from NIV were included. NIV was provided with a standard face mask by the BiPAP Vision ventilator (Respironics Inc.). Variables related to the demographic parameters, SAPS II score, cancer characteristics, intensive care data and hospital discharge were recorded.Main results Complications leading to NIV were hypoxemic respiratory failure in 11 patients and hypercapnic respiratory failure in seven. Total median duration of NIV was 29 h. NIV was applied during a median of 2.5 days with a median of 16 h per day. Total median ICU stay was 7 days (range 1–21). Fourteen and ten patients were discharged from ICU and from hospital, respectively.Conclusion NIV appears to be an effective ventilation support for cancer patients with life-support techniques limitation.     

A Computational Positron Emission Tomography Simulation Model for Imaging β-Amyloid in Mice

Purpose We aimed to develop a computational simulation model for -amyloid (A) positron emission tomography (PET) imaging.Procedures Model parameters were set to reproduce levels of A within the PDAPP mouse. Pharmacokinetic curves of virtual tracers were computed and a PET detector simulator was configured for a commercially available preclinical PET-imaging system.Results We modeled the effects of A therapy and tracer affinity on the ability to differentiate A levels by PET. Varying affinity had a significant effect on the ability to quantitate A. Further, PET tracers for A monomers were more sensitive to the therapeutic reduction in A levels than total brain amyloid. Following therapy, the decrease in total brain A corresponded to the slow rate of change in total amyloid load as expected.Conclusions We have developed a first proof-of-concept A-PET simulation model that will be a useful tool in the interpretation of preclinical A imaging data and tracer development.     

The roles of historical experience and construct accessibility in judgments about alcoholism

A preliminary survey study (1) screened potential subjects and (2) identified characteristics associated with alcoholic and social drinker labels. Subjects at three experience levels (parent alcoholic, friend alcoholic, and no experience) then participated in a perception experiment in which a construct (alcoholic/social drinker) was experimentally primed, followed by an interpersonal understanding experiment in which subjects rated the drinking habits either of hypothetical others or of the self in hypothetical situations. Results indicated that primes significantly interacted with level of prior experience (only subjects with no historical experience tended to make drinking judgments that were more in the direction of alcoholism following an alcoholic prime). Results are discussed in terms of the notion that increased historical exposure to a construct may lead to the development of clearer construct boundaries, thereby reducing the tendency toward indiscriminate construct use under conditions of heightened accessibility.The present research was supported in part by the National Institute on Alcohol Abuse and Alcoholism Research Grant No. AA-06319 to the first author. Parts of this study were presented at the annual meeting of the American Psychological Association, Anaheim, California, August 1983.     

Shock and the kidney: Pathophysiology and pharmacological support

This article reviews current knowledge as to the physiological mechanisms that control renal vascular resistence. The contribution of both extrinsic and intrinsic neuro-humoral regulation of both blood flow and glomerular filtration rate are described. The changes that occur both to the renal blood flow and glomerular filtration rate in the pathophysiological situation of pre-renal uraemia as well as acute tubular necrosis are described. Within this setting pharmacological manoeuvres that may improve both renal blood flow and glomerular filtration rate are discussed. In addition, the indications for and general principles of haemo- and peritoneal dialysis are described.     

A new method for the diagnosis of acute hemorrhagic-necrotizing pancreatitis using contrast-enhanced CT

Twenty-eight consecutive patients with a first attack of alcohol-induced pancreatitis were studied using contrast-enhanced CT. The findings on CT were then related to the course of the disease. The patients with acute hemorrhagic-necrotizing pancreatitis showed significantly lower enhancement values of the pancreatic parenchyma than those with milder forms of the disease.The next 20 patients with severe pancreatitis were scanned using a slightly modified procedure. The enhancement values were calculated and plotted on the graphs for the 2 former groups.Two categories of pancreatic enhancement were found: low enhancement and high enhancement. In all 10 patients with low-enhancement values surgery revealed hemorrhagic-necrotizing pancreatitis. In the 10 patients with highenhancement values conservative treatment was continued, and the clinical course was nonfulminant in all of them.     

Patient assessment of a combined medical and nursing preparation to cytotoxic chemotherapy

At Auckland hospital there is a combined medical and nursing preparation for patients receiving cytotoxic chemotherapy. The aim of the current study was to assess whether patients felt that this combined approach had prepared them adequately for chemotherapy. Patients were asked to complete three questionnaires anonymously at different times in their treatment programme: Immediately prior to chemotherapy, after three cycles of chemotherapy and 2 months after completion of chemotherapy. A high level of satisfaction with the programme was demonstrated: 68% of patients thought the orientation programme had prepared them very well, 32% adequately and none poorly for their chemotherapy. Separate interviews with medical and nursing staff were thought a good idea by 86% of patients and only 1 of 100 medical and 100 nursing interviews was assessed as not worthwhile. This study suggests that a combined medical and nursing preparation is a worthwhile practice in preparing patients for cytotoxic chemotherapy.     

The Use of “As Many As Can” Versus “Feel Like Continuing” Stop Rules During Worrying

Two studies are reported that investigated the processes involved in stopping worry. Study 1 found that the use of as many as can stop rules was significantly related to measures of trait worry and beliefs about the positive and negative consequences of worrying, and Study 2 demonstrated that the reported use of as many as can stop rules significantly predicted perseveration on behavioral measures of catastrophic worrying. Reported use of feel like continuing stop rules was unrelated to any measures of worry in both studies. These results indicate that the use of as many as can stop rules is a highly significant predictor of worry frequency and perseveration, and that beliefs about the positive and negative consequences of worry also independently predict the use of as many as can stop rules. These findings are consistent with (1) the view that the stop rules used by worriers are closely associated with, or directly derived from, the more stable, global beliefs that worriers hold about the utility of the worry process, and (2) predictions from the mood-as-input model of catastrophic worrying (H. M. Startup & G. C. L. Davey, 2001).     

Mnemonic distortion following behavior observation: Interactions of negative versus positive behavior valence,diagnostic label,and relative behavior frequency

To study how diagnostic labels, positive or negative behavior valence, and high versus low behavior frequencies affect distortion of memory for behavior, 72 undergraduates used an observation system to record occurrences of 10 negative and 10 positive behaviors shown on one of two videotapes of a child. Pilot testing had verified that one tape showed many negative but few positive behaviors, and that the other tape showed few negative but many positive behaviors. Just before viewing the tape, subjects were told either that the child was behaviorally disturbed or normal, or had been given no label. Exaggeration of observed frequencies at a 1-week recall was shown by significant and separate interactions of behavior valence and frequency, and of behavior valence and label. Specifically, negative behavior frequencies were exaggerated significantly at recall when the behaviorally disturbed or no label was present for both high and low frequencies of the negative behaviors. However, recalled frequencies of negative behaviors were exaggerated for the normal label only when they were low in frequency relative to positive behaviors. Positive behavior frequencies were exaggerated significantly in memory only if the normal label was used and then only if the positive behaviors had occurred at low frequencies relative to negative behaviors. No significant underestimation of previously observed behavior frequencies was found for either positive or negative behaviors. Implications of these findings for cognitive theories of memory and behavior, and for minimization of mnemonic stigma, are noted.We thank Laurie Kaslove for composing the videotapes used in this study, and Chris Beebe, Gail Morganstein, and Eric Pedersen for serving as experimenters.     

Immediate effects on depression of cognitive therapy interventions

The immediate effects on depression of exploring versus modifying depressive thoughts were compared in chronic moderately to severely depressed patients receiving cognitive behavioral therapy (CBT). Using a withinsubject design, it was found that periods of cognitive CBT consistently produced more change in belief in identified depressive thoughts than did similar periods devoted to exploring and obtaining more information relevant to the thoughts. The greater change in belief resulting from cognitive CBT was consistently accompanied by greater reduction in self-rated depressed mood than was obtained in the Thought Exploration condition. Differences in the effects of the two conditions on a measure of speech rate were not consistent. The results support a central prediction of the cognitive model of depression and suggest the specific therapeutic effectiveness of cognitive CBT techniques.This research was supported by the Medical Research Council of the United Kingdom. We are grateful to Peter Amies and Gillian Butler, who rated the recordings of the treatment interventions.     

Angiographic manifestations of regional enteritis

Regional enteritis may be a protean disease, easily diagnosed when the common clinical presentation is noted. Occasionally, however, atypical features lead to the clinical suspicion of neoplastic disease. Four patients underwent angiographic evaluation in this clinical setting, all demonstrating similar changes in the mesenteric arteries. A serrated, corkscrew pattern was present and corresponded well to the perivascular fibrosis noted histologically. Recognition of this angiographic pattern may be important in differentiating neoplastic from inflammatory disease processes.     

Stories from doctors of patients with pain. A qualitative research on the physicians’ perspective

Goal of work .The aim of this study was to explore the physicians internal representation of the doctor–patient relationship in the dramatic field of the patient with pain.Methods Using an open narrative format, 151 physicians were asked to Tell us about an episode during your professional experience in which you found yourself in difficulty whilst confronting a patient who was in pain. The narrations were examined in accordance with a clinical-interpretive method.Main results Three perspectives of observation were identified, namely: the biological perspective, the professional perspective, and the personal perspective. The biological perspective is about the biological model and the depersonalization of pain. In the professional perspective, the narrative concerns the patient as a person and the reattribution of the pain to the suffering person. The personal perspective is about the emotional-relational explosion within the meeting between the doctor as human being and the patient as human being. Most of the narrations did not strictly connect to one or another of the perspectives, but each story seemed a journey without peace back and forth among the perspectives.Conclusions The professional perspective seemed to be the only place in which physicians could stop, a space not extreme in which they seemed to express the need for education about the management of the professional relationship with the other person.     

Penetration of oral telithromycin into female genital tissues

To estimate the potential efficacy of telithromycin in the treatment of gynecological infections, a pharmacokinetic study was conducted in 13 Japanese subjects. Telithromycin was administered orally, at a dose of 600mg, to patients undergoing hysterectomy, 3.0 to 7.5h prior to the hysterectomy. At surgical operation, cubital venous blood, uterine arterial blood, vaginal cervix uteri (portio vaginalis), supravaginal uterine cervix, uterine endometrium, uterine myometrium, oviduct, and ovary specimens were collected separately. The blood and tissue concentrations of telithromycin were measured with a bioassay, using Micrococcus luteus ATCC 9361 as the test organism. The concentrations of telithromycin in these tissues and their proportions in relation to that in cubital venous blood (in parentheses) were as follows: cubital venous blood, 0.119 to 1.270mg/l; uterine arterial blood, 0.111 to 1.230mg/l; vaginal cervix uteri (portio vaginalis), 0.356 to 1.850mg/kg (1.324 to 5.640), supravaginal uterine cervix, 0.376 to 4.520mg/kg (1.108 to 16.807), uterine endometrium, 0.234 to 5.300mg/kg (0.975 to 12.185), uterine myometrium, 0.309 to 5.050mg/kg (1.288 to 19.832), oviduct, 0.375 to 5.550mg/kg (1.563 to 10.000); and ovary, 0.495 to 5.250mg/kg (1.835 to 6.851). From these results, it was concluded that the concentrations of telithromycin in female genital tissues are generally higher than those in blood. Taking the antimicrobial spectrum of telithromycin into consideration, it was suggested that telithromycin could potentially be a good candidate for the treatment of gynecological infections, including cases associated with sexually transmitted diseases.     

An expert system to teach troubleshooting of common problems associated with the automated anesthesia recordkeeper

Automated anesthesia recordkeepers have been used to monitor patients during surgery in up to 90% of cases at The Ohio State University. The record-keeping devices are complex and can be difficult to troubleshoot. The 1st-CLASS Fusion Program, an expert system shell-program, has been programmed to allow the resident or nurse anesthetist to solve the two most common types of problems associated with the recordkeeper: printer problems and patient monitor problems. Use of this program allows the resident or nurse anesthetist to troubleshoot the recordkeeper quickly and accurately and promotes in the user a sense of competence and control over the technology.     

Chronic daily headache: recent insights from functional imaging

Abstract New imaging technology allows us to study neurologic disorders that have had no previous structural basis. There have been recent reports on the involvement of nociceptive pathways in daily headache. A systematic review was performed using key words chronic daily headache and imaging. This paper reviews the literature on imaging studies performed on daily headache with emphasis on the new imaging technology.     

The activity of grepafloxacin in two murine models of <Emphasis Type="Italic">Mycobacterium avium</Emphasis> infection

The activity against Mycobacterium avium complex (MAC) of varying doses of grepafloxacin (GRE; 25mg/kg, 50mg/kg, 100mg/kg, and 200mg/kg) were compared to clarithromycin (CLA; 100mg/kg and 200mg/kg), ethambutol (EMB; 100mg/kg), and rifabutin (RBT; 10mg/kg) using an intranasal (IN) infection model compared to an intravenous (IV) infection model. Beige mice (C57BL6/J-Lyst bg J/+) were infected intranasally with about 10⁶ organisms and for the IV model about 10⁷ organisms. Treatment for both models was started 1 week postinfection and given by gavage 5 days/week for 4 weeks. At the initiation of therapy, an early control group was killed to determine the initial organism load. Three days following the completion of therapy, drug-treated groups of mice and the late control group were killed and the response to therapy measured. The most effective agents were CLA and RBT. GRE and EMB had modest activities in both the IN and the IV models. A matched comparison between IN and IV challenges for each of the agents used revealed greater suppression of MAC in the IN model compared to the IV model.