Papaverine hydrochloride in the treatment of atopic dermatitis: a double-blind, placebo-controlled crossover clinical trial to reassess safety and efficacy.

In a double-blind crossover study, oral papaverine hydrochloride in doses of 150-300 mg t.i.d. was compared to placebo as an adjunctive treatment of atopic dermatitis. Twenty patients completed both 2-week phases of the crossover during which time the physician's weekly evaluation included an estimate of percentage skin involvement with disease, global evaluation and the grading of the erythema, scale and lichenification of a representative plaque. The patients' evaluation included their assessment of the degree of pruritus, and an estimate of the percentage of the day pruritus was present as well as a global evaluation of disease. Papaverine demonstrated no statistically significant advantage over placebo for any of the parameters measured and was noted to cause transient asymptomatic liver function test abnormalities in 3 of the study patients.     

Environment-specific tolerance to nicotine

Research has shown that tolerance to the behavioral effects of numerous drugs is mediated by learning. The present study was designed to test whether animals develop tolerance to the antinociceptive effects of nicotine, and whether these effects are also learned. Rats were given dally injections of nicotine in the same environment. After each injection, the latency of tail withdrawal from a hot water bath was measured. This was continued until they were tolerant to the drug: i.e., their response latencies did not differ from animals repeatedly given saline. The role of learning in nicotine tolerance was assessed by changing the environment in which they received nicotine on the day after tolerance was achieved. When the drug environment was changed, the animals recovered the full dose effect of nicotine on tail-flick latencies. These results show that tolerance develops to nicotine's antinociceptive effects, and that this tolerance also may be influenced by learning.     

Pediatric Heart Transplant Candidates With Failed Donor Heart Allocation After Eurotransplant Urgency Listing Profit From Pretransplant Mechanical Circulatory Support Bridging

Abstract:  Due to the Eurotransplant organ allocation policy, urgency listing for heart transplantation (HTx) remains in force until ventricular assist device (VAD) implantation in Germany. We studied the prognosis of HTx candidates after failed donor heart allocation in urgent status. We studied all adult and pediatric (<18 years) HTx candidates who underwent primary HTx after Eurotransplant urgency listing between January 2001 and December 2006 (Group A-uHTx [A-"u"rgent status "HTx"], n  = 99; Group P-uHTx [P-"u"rgent status "HTx"], n  = 24) and those to whom donor heart was not urgently allocated before VAD implantation or death in the same period (Group A-fHA [A-"f"ailed "H"eart "A"llocation], n  = 21, Group P-fHA [P-"f"ailed "H"eart "A"llocation], n  = 10). Mortality rate after urgency listing or primary VAD implantation was studied in each group. In adult patients, 1-year mortality rate after urgency listing in Group A-fHA was 56.8% and significantly higher than in Group A-uHTx (30.6%, P  < 0.001, log-rank test). After failed urgent heart allocation, 15 out of 21 patients in Group A-fHA had VAD implantation and two patients (9.5%) underwent HTx after VAD implantation. In pediatric patients, 1-year mortality rate in Group P-fHA was 40.0% and significantly higher than in Group P-uHTx (8.5%, P  < 0.05). In Group P-fHA, all 10 patients underwent VAD implantation after failed urgent heart allocation and six patients (60.0%, P  < 0.01 vs. Group A-fHA, Fisher's exact test) underwent HTx after VAD implantation. After failed urgent donor heart allocation, pediatric HTx candidates seem to profit more from mechanical circulatory support than adults.     

Consequences of childhood sexual abuse experiences on dental care

OBJECTIVE: Around 20% of female patients seeking dental care may have experienced childhood sexual abuse (CSA). Several similarities between abuse situations and dental treatment lead to dental fear. Since dental fear hampers oral health, the long-term effects of CSA on dental care and the specific factors that lead to increased stress during dental treatment have been investigated in women exposed to CSA. METHODS: A self-administered questionnaire, which was developed to investigate the objectives of the study, was distributed to 111 women recruited from support centers for women with CSA experiences. CSA was explored with a modified version of the questionnaire developed by Wyatt. Data from 85 women with CSA experiences were used for comparison to the data of 170 matching control women recruited, who were mothers of children attending kindergarten. RESULTS: Compared to controls, women exposed to CSA exhibited several long-term effects on dental care in terms of major psychological strain during dental treatment (36.5%/18.8%; P<.005), a lower number of prophylactic controls (72.9%/89.4%; P<.005), and preference for a female dentist to a male dentist (29.4%/8.2%; P<.0001). Women with CSA experiences considered four of five defined stressors associated with dental treatment as more intense. Of these women, 28% suffered from memories of their original abuse situations during dental treatment, and 29.4% believed that the dentist should have known about their history of abuse. CONCLUSION: CSA experiences may increase psychological strain during dental treatment. To improve dental care for women exposed to CSA, dentists should adjust their treatment plans to the specific needs of these patients.     

Retrospective motion gating in small animal CT of mice and rats

OBJECTIVES: Implementation and evaluation of retrospective respiratory and cardiac gating of mice and rats using a flat-panel volume-CT prototype (fpVCT). MATERIALS AND METHODS: Respiratory and cardiac gating was implemented by equipping a fpVCT with a small animal monitoring unit. ECG and breathing excursions were recorded and 2 binary gating signals derived. Mice and rats were scanned continuously over 80 seconds after administration of blood-pool contrast media. Projections were chosen to reconstruct volumes that fall within defined phases of the cardiac/respiratory cycle. RESULTS: Multireader analysis indicated that in gated still images motion artifacts were strongly reduced and diaphragm, tracheobronchial tract, heart, and vessels sharply delineated. From 4D series, functional data such as respiratory tidal volume and cardiac ejection fraction were calculated and matched well with values known from literature. DISCUSSION: Implementation of retrospective gating in fpVCT improves image quality and opens new perspectives for functional cardiac and lung imaging in small animals.     

Intravenous clonidine infusion in infants after cardiovascular surgery

BACKGROUND: The aim of this study was to investigate the hemodynamic profile and heart rhythm in infants who were given intravenous clonidine infusion after prolonged analgesia/sedation following cardiac surgery. METHODS: This is a single center retrospective review. A total of 542 cardiovascular surgical procedures in infants aged 0-24 months with congenital heart disease were performed between 01/2003 and 12/2005 at the Deutsches Herzzentrum in Berlin. The majority received no long-term analgesia/sedation, but 50 (9%) of these infants received clonidine (dosed at 0.18-3.6 microg.kg(-1).h(-1)) for sedation and to reduce withdrawal symptoms such as CNS hyperactivation, hypertension, tachycardia, and fever. The hospital records of these infants were studied. RESULTS: Fifty infants (median age 5.0 months, median body weight 5.3 kg, 32 males/18 females) received prolonged analgesia/sedation to ensure hemodynamic stability. Clonidine infusion started on day 5 (median) after surgery. During clonidine treatment we found an age-related normalized profile of hemodynamic parameters with a reduction of heart rate and mean arterial pressure from the upper norm to the mean within 24 h (P < 0.001). In no case did clonidine cause low blood pressure resulting in additional therapy to reach the target blood pressure. There were no adverse effects on cardiac rhythm, especially no onset of atrioventricular block. Midazolam, fentanyl, and other opioids could be ended on day 4 of clonidine treatment. CONCLUSIONS: Although off-label, it is feasible to use clonidine infusions in infants in the PICU setting after cardiac surgery without hemodynamic problems arising.