Myopathies of the lower extremities

The myopathies that can manifest themselves within the lower extremity are reported here and can serve as a guideline for clinicians in the early diagnosis of these disabling conditions. The classification of these disease entities based on signs and symptoms is significant if correlated with the age of the patient at the time of onset, the evolution and course, and the type of familial inheritance. This article can also aid the practitioner in assessing and planning the course of treatment for a particular patient.     

Pharmacological analysis of the interaction between Bay K 8644 and 5-HT in rabbit aorta

Bay K 8644 potentiated and augmented 5-hydroxytryptamine (5-HT)-induced contractions in the rabbit, isolated aorta preparation, as manifested in leftward shift and increase in the asymptote of 5-HT E/[A] (effect vs concentration) curves. The operational model of agonism (Black & Leff, 1983) was used to analyse this interaction and the concomitant effects of irreversible receptor alkylation by phenoxybenzamine. The competitive effects of spiperone in the presence and absence of Bay K 8644 were also examined. From these analyses it is concluded that Bay K 8644 elicits its potentiating effects by increasing the efficacy of 5-HT at the 5-HT2 receptor with no alteration in affinity. This is consistent with the known effect of Bay K 8644 of causing an increase in the functional concentration of plasmalemmal calcium channels coupled to the 5-HT2 receptors in this preparation. The positively co-operative shape of the 5-HT E/[A] curves obtained in the aorta and the quantitative nature of their potentiation by Bay K 8644 indicated that the coupling of 5-HT2 receptor occupancy to intracellular calcium concentration is linear and that the co-operativity resides in the subsequent relation between intracellular calcium and pharmacological effect. Bay K 8644 may serve as a probe for differentiating between the types of calcium channels that transduce 5-HT receptor-mediated effects in different systems. Such information would be useful in the classification of agonist interactions with 5-HT receptors.     

Managing self-injection difficulties in patients with relapsing-remitting multiple sclerosis.

Difficulties with self-injection, including inabillity to self-inject, are common for individuals taking home-administered injectable medications. In relapsing-remitting multiple sclerosis (MS), all of the currently available disease-modifying medications are injectables marketed for self-injection. Problems with self-injection pose a barrier to treatment adherence for many patients. Clinicians at the University of California, San Francisco (UCSF) Multiple Sclerosis Center have developed a number of strategies to help patients who experience anxiety associated with self-injection. These strategies have been empirically tested and found to be effective and easily implemented by mental health professionals and nurses. This article offers case examples and discussion of the principles of the techniques developed at UCSF to remediate patients' difficulties with self-injection. Nurses are most often the healthcare providers responsible for training MS patients in self-injection and monitoring their compliance. Nurses who are familiar with these tools have the opportunity to have a significant positive impact on patient comfort, confidence, and, ultimately, successful long-term adherence to disease-modifying medications.     

Primary lymphoma of prostate: transrectal ultrasonic appearance

In the case presented, primary lymphoma of the prostate was diagnosed by ultrasonically guided transrectal biopsy. Primary lymphoma of the prostate should be included in the differential diagnosis of a hypoechoic lesion found on ultrasonic evaluation of the prostate in a young adult.     

Drugs and the bone marrow

Some drugs have a predictable suppressive effect upon the bone marrow and are used in the treatment of malignant disease. Others are unpredictable and may cause unanticipated side effects to bone marrow during the treatment of non-malignant pathologies. In this article, bone marrow maturation is discussed and both the defined and potential effects of drugs upon the bone marrow are considered.     

Immunosuppressive agents in current use

The use of immunosuppressants has increased as clinical applications for such therapy have become more widespread. Immunosuppressive therapy is now particularly relevant in the field of organ transplantation, a practice that has only developed over the last 20 years. Drugs used as immunosuppressants are discussed in relation to disease category, where they are of value, mode of action, and potential side effects. Future prospects concerning the development and use of immunosuppressants are considered.