Congenital pulmonary atresia with ventricular septal defect: angiographic and surgical correlates

Of 181 patients with severe congenital pulmonary atresia and ventricular septal defect or "type IV truncus" (an obsolete term), all but 11% had true central pulmonary arteries. These arteries were demonstrable by large serial biplane angiograms using multiple selective injections into collateral vessels, frequent photographic subtraction, and occasional pulmonary vein-wedge angiograms. These techniques are extremely important for accurate diagnosis and in planning corrective or palliative surgery, which was done in 77% of patients with pulmonary arteries.     

Prolonged radionuclide transit in “nutcracker esophagus”

Symptomatic patients with abnormal esophageal manometry characterized by esophageal peristaltic waves of increased amplitude (the nutcracker esophagus, NE) have been recognized with increasing frequency. Whether or not this represents a true functional abnormality is unresolved at this time. We have utilized radionuclide transit (RT), a true esophageal function test, to evaluate patients with NE. Eighteen consecutive symptomatic patients with the NE and ten clinically and manometrically normal subjects constituted this study group. RT in normals were 6.8±0.2 sec ( ±Se) and 27.6±3.8 in patients with NE. RT was abnormal in 17/18 patients with NE. Chaotic bolus transit was seen in 11/18 patients with NE but not in normals. The defect was localized to the distal esophagus since transit through the proximal esophagus was not significantly different between the two groups. This defect in RT may be related to spontaneous simultaneous contractions seen in 50% of these patients. Further work will be necessary to determine if NE is a true functional abnormality or a marker for other motility abnormalities such as diffuse esophageal spasm.This study is supported by Navy Clinical Investigation Protocol No. 0-06-1398.The opinions and assertions contained herein are the private views of the authors and are not to be construed as official or as reflecting the views of the Department of the Navy or the Department of Defense.     

Emergency department medication and drug interaction evaluation

The emergency department evaluation had two primary objectives: 1) to determine the accuracy of the oral medication history given at arrival at the emergency department and 2) to determine how often the emergency department physician may prescribe medications which when taken with current medications, may cause a potential drug interaction. Data were collected from 228 emergency department visits of clinic patients 65 years old and older. The average number of medications reported by the patients' medication history was 3.0 +/- 2.3 (range 0-13). The number of medications the patient "forgot" was 1.3 +/- 1.8 (range 0-9). A complete medication history was given by 50.4% of patients. There was an upward trend that correlated with an increased chance for an incomplete medication history as the total number of current medications increased. The rate of a potentially significant drug interaction between a newly prescribed medication in the emergency department and current medications was 3.4% for patients receiving a new medication.     

Effects of dizocilpine (MK 801) on noradrenaline, serotonin and dopamine release and uptake

In the present study, we examined the actions of the NMDA antagonist dizocilpine (MK801) on electrically evoked release and uptake of noradrenaline (NA) in the locus coeruleus (LC), serotonin (5-HT) in the dorsal raphe nucleus (DRN) and dopamine (DA) in the nucleus accumbens (NAc), measured by fast cyclic voltammetry (FCV) in rat brain slices. Dizocilpine (10 microM) significantly increased NA (to 248 +/- 15%) and 5-HT release (to 184 +/- 29%) and slowed monoamine uptake in the LC (t1/2 = 853 +/- 129%) and the DRN (t1/2 = 387 +/- 70%), respectively. However, dizocilpine had no effect on DA release or uptake in NAc. Actions on monoamines are thus likely and should be considered in the interpretation of data regarding dizocilpine.     

Complex Issues Affecting Student Pharmacist Debt

It is time for colleges and schools of pharmacy to examine and confront the rising costs of pharmacy education and the increasing student loan debt borne by graduates. These phenomena likely result from a variety of complex factors. The academy should begin addressing these issues before pharmacy education becomes cost-prohibitive for future generations. This paper discusses some of the more salient drivers of cost and student debt load and offers suggestions that may help alleviate some of the financial pressures.