Carbamazepine-risperidone interactions in patients with epilepsy

Because concomitant administration of psychoactive and antiepileptic drugs is increasing progressively in neurologic and psychiatric practice, the aim of the current study was to evaluate the pharmacokinetic interactions between risperidone (RISP) and carbamazepine (CBZ) plasma concentrations in a group of patients with epilepsy with behavioral disturbances. The authors assessed eight patients on CBZ monotherapy (CBZ extended-release capsules) at a mean dosage of 625 +/- 253 mg/day (range, 400-1,200 mg/day) for at least 1 year. RISP (1 mg in one daily dose) was added to CBZ therapy for the occurrence of behavior disturbances. CBZ blood levels were assessed before (T0), 24 hours after (T1), and 2 weeks after (T2) RISP administration. Steady-state plasma concentrations of CBZ increased from 6.67 +/- 0.41 microg/mL at baseline to 7.37 +/- 0.59 microg/mL (p < 0.01) at T1, to 7.95 +/- 0.47 microg/mL (p < 0.0001) at T2. The pharmacokinetic data suggest either a possible role of RISP in inhibiting the cytochrome P450 microsomal enzyme system (CYP)-3A4 pathway or a potential role of CYP2D6 in CBZ metabolism.     

Informed consent in complementary and alternative medicine: current status and future needs

"Informed consent" is an action. It is a process that fulfills the pretreatment ethical obligations of provider to patient. Through the process, the provider discloses meaningful and realistic facts about positive and negative expectations concerning the proposed intervention and addresses concerns that are pertinent to the patient. Disclosure is of facts that are known or realistically expected to be known by a qualified provider regardless of background or product genus. The disclosure obligation does not vary with the background of the provider or the label given to the therapy. MD, nurse, naturapath, chiropractor, and licensed and unlicensed practitioner have the responsibility to provide quality information about the therapeutic worth of the intervention based on reliable data. This obligation pertains whether the intervention is standard, experimental, investigational, natural, alternative, complementary, or unproven. Misrepresentation of material facts voids consent and triggers legal liability. Today, the oncology community meets the informed consent obligation through a stepwise process that produces standards of care and builds studies and data collection to produce reliable outcome information on patient benefit. These data enrich the ability of a patient to consider and provide informed consent to treatment. In contrast, although there are some ongoing studies of complementary and alternative (CAM) therapies, there does not appear to be a groundswell of support for these activities within the CAM community. The development of standards of care and reliable information about CAM therapies appears to be seriously lagging and a disservice to obligations toward informed participation and consent by the patients seeking CAM interventions.     

Practice MRI: Reducing the need for sedation and general anaesthesia in children undergoing MRI

The aim of this study was to evaluate the effectiveness of a practice magnetic resonance unit, in preparing children to undergo magnetic resonance procedures without general anaesthesia (GA) or sedation. The records of children who attended the practice MRI between February 2002 and April 2004 were retrospectively reviewed. Each record was assessed as to whether the child had passed or failed the practice MRI intervention. Those children who were considered to have passed and were proceeded to a clinical non‐GA MRI had the report of the clinical scan reviewed. If the scan had been reported as non‐diagnostic because of movement artefact it was classified as a failed scan, otherwise it was considered a pass. One hundred and thirty‐four children undertook a practice MRI (age range 4.1–16.1 years, median age 7.7 years, 47% boys) and 120/134 (90%) passed the practice session. In all, 117/120 (98%) subsequently had a clinical non‐GA MRI and 110/117 (94%) passed (median age 7.8 years, 47% boys). Preparation is a safe and effective method to reduce the need for sedation and GA in children undergoing a clinical MRI scan. It provides a positive medical experience for children, parents and staff, and results in cost savings for the hospital.     

Whole body protein metabolism in children with cancer

Whole body protein synthesis and catabolism were measured using the [ring-2H5]phenylalanine and [1-13C]leucine primed constant infusion technique in 32 paediatric patients with cancer at different stages of treatment. Rates of synthesis (S) and catabolism (C) derived from the [ring-2H5]phenylalanine and [1-13C]leucine models were 4.7 (SD 1.3) (S) and 6.0 (1.5) (C) g/d/kg, and 5.5 (0.8) (S) and 6.8 (1.2) (C) g/d/kg, respectively. These results show that these two tracer techniques give similar results in this study population. Comparison of these values with results previously reported for groups of control children using the [ring-2H5]phenylalanine model (S = 3.69 and 3.93; C = 4.09 and 4.28 g/d/kg) and the [1-13C]leucine model (S = 4.32; C = 4.85 g/d/kg) show that rates of synthesis and catabolism were higher in cancer patients than in controls. Thus whole body protein turnover is increased in children under treatment for cancer. Other indices of metabolism such as plasma amino acids and intermediary metabolites were also measured and showed that, although subjects were in isotopic steady state, there were significant metabolic changes during the course of the primed constant infusions used to measure protein turnover.     

Protein nutrition, faecal flora and iron metabolism: the role of milk-based formulae

This paper explores the role of milk-based formulae in achieving four aspects of nutritional health in infants and toddlers: in the suckling, to mimic the amino acid metabolism and the faecal flora of a breast-fed baby; in the weanling, to achieve adequate protein intakes in later infancy and beyond and to achieve satisfactory haemoglobin concentrations in the early toddler years. Milk-based formulae have two roles in infant nutrition: as so-called breast milk substitutes and as a safety net during the weaning period; the latter role may be the more important.     

PAROXYSMAL TACHYCARDIA IN INFANCY AND CHILDHOOD I. Paroxysmal Supraventricular Tachycardia

A 1 to 30 year follow-up study of 54 infants and children with paroxysmal supraventricular tachycardia is presented. In 28 cases the first attack occurred in infancy, and in 18 of these already in the first months of life. Nine patients had organic heart disease. The WPW syndrome was diagnosed in 30 cases. When first seen, most of the infants presented signs of incipient or manifest congestive heart failure, which was very unusual in the children, most of whom had only minor symptoms. Four children had experienced brief syncopes during attacks. Digitalis was effective against congestive heart failure and, when continued, may have prevented failure during subsequent attacks. Whether digitalis and other anti-arrhythmic agents facilitated conversion to sinus rhythm could not be established in this study. Vagal stimulation was only rarely effective. Preventive treatment with digitalis or other antiarrhythmic drugs seemed to have little if any effect on the frequency of recurrent attacks. Out of 23 infants who were followed for at least 5 years, 17 had been free from attacks during the last 3 years and 13 of these had had their last attack before the age of 6 months. Out of 23 children followed for 5 years or more, only 3 had been free from recurrences during the last 3 years. Patients with the WPW-syndrome had a somewhat higher incidence of recurrent attacks.