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41.
42.
Restless legs syndrome (RLS) is one of the commonest movement disorders affecting sleep and also daytime functioning. The prevalence may be 8%–10% of the white Caucasian population. The diagnosis is simple and is based on a well-validated clinical questionnaire, yet misdiagnosis is common and the condition remains underdiagnosed and consequently inappropriately treated, often causing great distress to the sufferers. In spite of robust evidence for effective treatment of RLS, patients may often be told to “put up with the symptoms” and suffer the consequence of years of poor sleep which may lead to major lifestyle changes. This review addresses the diagnostic issues, the differential diagnosis, and the evidence base for treatment of the common condition. 相似文献
43.
Kallol Ray Chaudhuri Pablo Martinez-Martin Anthony H V Schapira Fabrizio Stocchi Kapil Sethi Per Odin Richard G Brown William Koller Paolo Barone Graeme MacPhee Linda Kelly Martin Rabey Doug MacMahon Sue Thomas William Ondo David Rye Alison Forbes Susanne Tluk Vandana Dhawan Annette Bowron Adrian J Williams Charles W Olanow 《Movement disorders》2006,21(7):916-923
Nonmotor symptoms (NMS) of Parkinson's disease (PD) are not well recognized in clinical practice, either in primary or in secondary care, and are frequently missed during routine consultations. There is no single instrument (questionnaire or scale) that enables a comprehensive assessment of the range of NMS in PD both for the identification of problems and for the measurement of outcome. Against this background, a multidisciplinary group of experts, including patient group representatives, has developed an NMS screening questionnaire comprising 30 items. This instrument does not provide an overall score of disability and is not a graded or rating instrument. Instead, it is a screening tool designed to draw attention to the presence of NMS and initiate further investigation. In this article, we present the results from an international pilot study assessing feasibility, validity, and acceptability of a nonmotor questionnaire (NMSQuest). Data from 123 PD patients and 96 controls were analyzed. NMS were highly significantly more prevalent in PD compared to controls (PD NMS, median = 9.0, mean = 9.5 vs. control NMS, median = 5.5, mean = 4.0; Mann-Whitney, Kruskal-Wallis, and t test, P < 0.0001), with PD patients reporting at least 10 different NMS on average per patient. In PD, NMS were highly significantly more prevalent across all disease stages and the number of symptoms correlated significantly with advancing disease and duration of disease. Furthermore, frequently, problems such as diplopia, dribbling, apathy, blues, taste and smell problems were never previously disclosed to the health professionals. 相似文献
44.
The determination of the UK Government to modernise medical careers, the shortage of training jobs for local medical graduates, the establishment of the Postgraduate Medical Training and Education Board (PMETB) and European Union rules have combined to change the scheme of surgical training in the United Kingdom. In the opinion of the author, the Indian Otorhinolaryngological (ORL) trainee can no longer aspire to reasonable higher training in the UK. 相似文献
45.
Shane L. Carney Alastair H. B. Gillies Cheryl D. Ray 《Clinical and experimental pharmacology & physiology》1995,22(9):629-634
1. Despite human and animal studies, the direct effect of ethanol on renal water and electrolyte transport is poorly understood. The acute effect of increasing plasma concentrations of ethanol was evaluated in a water diuretic anaesthetized rat model which inhibits endogenous arginine vaso-pressin (AVP) release. 2. Ethanol at a plasma concentration of 1.69 ±0.28 mmol/L produced an immediate increase in urine flow (174 ± 11 μL/min pre-ethanol and 189 ± 13 and then 206 ± 12 μL/min during the ethanol infusion; P<0.001) as well as an increase in fractional sodium excretion (0.17 ± 0.04 to 0.28 ± 0.05 and 0.27 ± 0.05%; P<0.001). There was also a brief phosphaturia. These increases in electrolyte excretion had returned to control values by 20 min despite a further increase in the plasma ethanol concentration. 3. The urinary excretion of potassium, calcium and magnesium was not altered nor was glomerular filtration rate or renal plasma flow. 4. Ethanol at a mean concentration of 1.60 mmol/L did not alter the action of a maximal concentration of AVP (75 ng/kg) on water or electrolyte transport. However, the antidiuretic effect of a submaximal concentration of AVP (7.5 ng/kg) was augmented by ethanol at concentrations of 1.63 and 0.98 mmol/L. 5. These studies suggest that the ethanol induced diuresis commonly ascribed to inhibition of AVP secretion may also be due to other intrarenal effects of ethanol, possibly acting within the proximal tubule. These results also confirm recent in vitro findings that while ethanol does not inhibit the action of a maximal concentration of AVP, it does modulate the effects of lower AVP concentrations. 相似文献
46.
Ingunn Bj?rnsdóttir Thomas Ray Einarson Lárus Steintór Guemundsson Rannveig Alma Einarsdóttir 《Pharmacy World & Science》2007,29(6):577-583
Aim To determine the efficacy of diphenhydramine against cough due to respiratory infection or irritation in patients/subjects
without comorbidities.
Method Two reviewers independently identified English language studies, searching on: clinical trials, randomized, diphenhydramine
(OR dimenhydrinate), antitussive agents, cough (combine using AND). Sources were: Medline (1966–2005), Embase (1980–2005),
Cochrane and references from retrieved articles. Two other reviewers, blinded to study origin selected studies, inclusion
criteria being: diphenhydramine monotherapy against placebo, double-blinded, randomized, clinical trial, intention-to-treat,
dropout information. The blinded reviewers evaluated the selected studies on a quality scale.
Results Eleven articles were identified, 7 were rejected (4 not placebo controlled, 2 had no diphenhydramine, 1 not blinded), leaving
4 articles, that were included in the evaluation and scored 20, 21, 25 and 26 out of a maximum of 32. In these selected studies,
a total of 162 people were examined, 65 on diphenhydramine, 63 on placebo and 34 in a crossover setting. There was a total
of 13 dropouts. The crossover studies demonstrated significant effect; 27–56% reduction in 20 healthy volunteers and 21–26%
reduction in 13 patients (originally 14, one outlier left out), whereas the active versus placebo studies did not.
Conclusion In spite of the 60 years that the substance has been on the market, only few studies have properly evaluated the effect of
diphenhydramine against cough. Presumptions about efficacy of diphenhydramine against cough in humans are not univocally substantiated
in literature. 相似文献
47.
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49.
S. van Ruth† EBL van Dorst‡ MR Canninga-van Dijk§ MS de Bruin-Weller† 《Journal of the European Academy of Dermatology and Venereology》2007,21(5):678-680
Cutaneous metastasis of vaginal carcinoma is extremely rare. So far, the total number of reported skin metastasis of vaginal carcinoma is only one. We present another case with an unusual manifestation of vagina carcinoma metastasis: skin metastasis presenting as a leg ulcer on the lower leg. 相似文献
50.