An open, randomised, parallel group study of lactulose versus ispaghula in the treatment of chronic constipation in adults

The efficacy, tolerance and acceptability of lactulose (Duphalac) and ispaghula (Fybogel Orange) were assessed in the treatment of chronic constipation in adults. In an open, prospectively randomised, parallel group study, 124 patients with a history of constipation for more than three weeks were treated with either 15 ml bd of lactulose (increasing to 60 ml daily if necessary) or one sachet bd of ispaghula. Over the four-week treatment period both treatments were shown to be effective, and numbers of concurrent effects were similar between the two groups. Differences were demonstrated with regard to acceptability in favour of lactulose.     

Visual evoked potentials in optic nerve injury. Does it merit a mention?

Summary The value of Visual Evoked Potentials (VEP) in the management of indirect optic nerve injury was prospectively studied in 128 patients. In fifty patients who were either unconscious, uncooperative or had massive black eye, preventing the assessment of vision, a light Emitting Diode (LED) was used to record visual evoked potentials. The initial VEPs were normal in 17, abnormal in 49 and absent in 62. All 17 patients with normal VEP showed visual recovery. Amongst the 49 patients with abnormal VEP, 43 (88%) showed improvement. In 62 patients, initial VEPs showed no response but, in 12 subsequent VEP recordings wave formation was demonstrated. Thus in 50 patients repeated VEP recordings failed to demonstrate wave formation, and none of them improved. This study, thus brings out the high predictive value of both positive and negative VEPs, and specially the role of LED.     

Utility of coaxial technique for renal angioplasty in patients with a difficult-to-cross stenosis

The aim of this study was to evaluate the feasibility of coaxial approach in difficult-to-cross lesions in patients with failed percutaneous transluminal renal angioplasty by conventional over-the-wire exchange technique. Twelve stenoses in 10 patients (six women and four men; age range 19 ± 7 years) with uncontrolled hypertension were treated by this method. The stenosis was caused by nonspecific aortoarteritis in 8 patients and fibromuscular dysplasia in 2 patients. It was ostial in seven and post-ostial in five vessels. Conventional exchange technique was unsuccessful in all of them. All procedures were done by femoral route. Technical success was seen in 11 (92 %), without complication. The stenosis improved from 90 ± 2.1 % (range 80–100 %) to 6 ± 7 % (range 0–20 %), blood pressure decreased from 198 ± 12.3 mm Hg (range 180–220 mm Hg)/130 ± 6.7 mm Hg (range 120–140 mm Hg) to 119 ± 5.7 mm Hg (range 110–130 mm Hg)/83 ± 3.9 mm Hg (range 80–90 mm Hg), and number of drug treatments for hypertension fell from 3.6 ± 0.52 (range 3–4) to 1 ± 0.94 (range 0–3; p < 0.01). Percutaneous transluminal renal angioplasty resulted in “cure” in 3 patients and “improvement” in 7 patients. Follow-up period was 3–21 months (mean 6.4 months). No restenosis was detected. Coaxial approach is safe and effective in treating difficult-to-cross lesions in which renal angioplasty by conventional exchange technique is unsuccessful. Received: 7 May 1998; Revision received: 10 November 1998; Accepted: 25 November 1998     

Can radiation induce pituitary tumors? Giant prolactinoma after radiation exposure

Radiation is a well-known etiology for many CNS tumors, including meningiomas, sarcomas and gliomas. However, occurrence of pituitary adenoma after radiation exposure is rare. We report a 21-year-old man with a pituitary adenoma, who was treated with post-operative radiotherapy for pontine glioma at 6 years of age. The role of radiation exposure in the etiology of pituitary adenoma is discussed, along with a literature review of radiation-induced tumors.     

Efficacy and safety of oral tocainide in refractory ventricular arrhythmia: a preliminary report on an open label study

The preliminary data on efficacy and safety of oral tocainide in refractory ventricular dysrhythmia in 8 patients is described. Two patients died; one within 15 days and the other after 1750 days of continuous tocainide therapy. The cause of death in both patients was unclear. During initial administration and acute titration, oral tocainide was extremely effective in lidocaine-sensitive ventricular dysrhythmia and in patients with Q-T prolongation syndrome. Four out of 8 patients received tocainide in presence of left ventricular dysfunction and 2 out of 4 such patients died suddenly. Minor central nervous system side effects were seen in 2 patients and dermatologic adverse reaction was seen in one patient only.     

A RANDOMISED,DOUBLE-BLIND,PARALLEL-GROUP COMPARISON OF VENLAFAXINE AND DOTHIEPIN IN GERIATRIC PATIENTS WITH MAJOR DEPRESSION

This randomised, double-blind study conducted at nine sites in the UK and the Netherlands compared the safety and antidepressant efficacy of venlafaxine and dothiepin. Ninety-two geriatric patients (aged 64-87 years) with major depression were randomly assigned to receive either venlafaxine or dothiepin for up to 43 days. The dose of venlafaxine or dothiepin was titrated up to a maximum of 150 mg per day for the first 15 days, and thereafter could range from 50 to 150 mg per day. Adjusted mean scores on the MADRS and the HAM-D decreased significantly (p 0.05) from baseline to the end of the study in both groups. A response to therapy was observed in 60% of patients in the venlafaxine group and 53% of patients in the dothiepin group on the MADRS, and in 60% of patients in both groups on the HAM-D. Suicidal ideation scores on the MADRS were significantly (p=0.042) lower in the venlafaxine group at week 6. Treatment-emergent study events were the primary reason for withdrawal in only 7% of venlafaxine-treated patients and 8% of dothiepin-treated patients. The results confirm the efficacy and tolerability of venlafaxine for treating major depression in the elderly.     

Hypertension from targeted ablation of chromogranin A can be rescued by the human ortholog

The secretory prohormone chromogranin A (CHGA) is overexpressed in essential hypertension, a complex trait with genetic predisposition, while its catecholamine release-inhibitory fragment catestatin is diminished, and low catestatin predicts augmented adrenergic pressor responses. These findings from studies on humans suggest a mechanism whereby diminished catestatin might increase the risk for hypertension. We generated Chga and humanized mice through transgenic insertion of a human CHGA haplotype in order to probe CHGA and catestatin in vivo. Chga mice displayed extreme phenotypic changes, including: (a) decreased chromaffin granule size and number; (b) elevated BP; (c) loss of diurnal BP variation; (d) increased left ventricular mass and cavity dimensions; (e) decreased adrenal catecholamine, neuropeptide Y (Npy), and ATP contents; (f) increased catecholamine/ATP ratio in the chromaffin granule; and (g) increased plasma catecholamine and Npy levels. Rescue of elevated BP to normalcy was achieved by either exogenous catestatin replacement or humanization of Chga mice. Loss of the physiological "brake" catestatin in Chga mice coupled with dysregulation of transmitter storage and release may act in concert to alter autonomic control of the circulation in vivo, eventuating in hypertension.