Use of transdermal amitriptyline gel in a patient with chronic pain and depression

A man with severe inflammatory bowel disease suffered from chronic abdominal pain and depression. A transdermal amitriptyline gel preparation was compounded since he was unable to take drugs orally Serum concentrations of amitriptyline and its active metabolite nortriptyline were measured over 24 hours. Symptoms of depression were monitored before starting transdermal therapy and at the end of 6 weeks. Pain symptoms and amitriptyline adverse drug events were monitored daily Steady-state serum concentrations of drug and metabolite were within the therapeutic range over 24 hours. The patient reported that his mood was improved but his abdominal pain remained unchanged. Transdermal amitriptyline gel was well tolerated and is an alternative delivery system in patients unable to take drugs orally.     

Geomagnetic disturbances are associated with reduced nocturnal excretion of a melatonin metabolite in humans.

The effects of geomagnetic disturbances on urinary excretion of the melatonin metabolite, 6-hydroxymelatonin sulfate (6-OHMS), were studied in conjunction with 60 Hz magnetic field (MF) and ambient light exposure in 132 electric utility workers. Geomagnetic activity was assessed using a local (equivalent amplitude or A(K), Boulder, CO) and global (average antipodal or aa) index. Personal exposures to 60 Hz MFs and light were obtained using data-logging meters. The relationship between geomagnetic activity and 6-OHMS was assessed with adjustment for age, light exposure, and month of participation. Mean overnight 6-OHMS excretion was lower on days when the 36-h A(K) or aa values exceeded 30 nT. A greater reduction in 6-OHMS excretion was observed when increased geomagnetic activity was combined with elevated 60 Hz MF or reduced ambient light exposures.     

Transesophageal guided left atrial positioning of a percutaneous ventricular assist device

Cardiogenic shock in the setting of myocardial infarction continuesto represent a high proportion of immediate mortality in thispatient population, despite ongoing advances in thrombolytics,PCI, and medical management of AMI. We present a case of peri-MIcardiogenic shock necessitating deployment of a percutaneousventricular assist device (pVAD). TEE guidance played a crucialrole in optimal positioning of the venous cannula in the leftatrium.     

Acute sternal opening after cardiac surgery in children: effect on plasma atrial natriuretic peptide.

Plasma atrial natriuretic peptide (ANP) was measured immediately before and 15 minutes after re-opening of the sternotomy and delayed sternal closure were performed to alleviate possible myocardial compression in 3 children. As acute re-opening of the sternotomy is a rare occurrence our sample size was necessarily small. ANP increased following the procedure in all 3 patients, and this was significant (p less than 0.02) when compared to plasma levels obtained from 9 children who underwent sternotomy prior to elective cardiac surgery. Following acute re-opening of the sternotomy there was an increase in median urine output and a decrease in median central venous pressure. Our results illustrate that it is atrial wall stress rather than intra-atrial pressure that determines release of ANP, and in addition suggest ANP may be a factor in the rapid clinical improvement following delayed sternal closure for atypical tamponade in children.     

Proximal tooth surface quality and periodontal probing depth

The proximal tooth surface integrity of 826 patients was correlated with periodontal probing depths. Results show relatively increased probing depths adjacent to restored proximal tooth surfaces, with the greatest probing depths adjacent to overhanging restorations and restorations with recurrent caries. The data confirm the significant tendency of the periodontal condition to deteriorate as a function of decreasing surface quality. Probing depth appeared to increase with the patient's age. Surface condition, however, showed a significant relationship with probing depths in all age groups.     

The kallikrein-kininogen-kinin system in chronic inflammation

We examined bradykinin's effects on macrophages and fibroblasts, two cell types important in the pathogenesis of chronic inflammation. Bradykinin stimulated release of proteins of 18 kDa from macrophages. These proteins caused increased thymocyte proliferation (interleukin 1, IL-1) and completely inhibited lipoprotein lipase (tumor necrosis factor, TNF). When fibroblasts were incubated with bradykinin, PGE2 synthesis was stimulated. Pretreatment with IL-1 or TNF dramatically amplified bradykinin-stimulated PGE2 synthesis. Thus, bradykinin is involved in a positive feedback loop in which bradykinin activates macrophages to release potent inflammatory cytokines; these in turn amplify responsiveness of bradykinin target tissues.