Group office visits in obesity.

A conference convened by the NIH in 1985 officially designated obesity a health hazard, stopping short of calling it a disease; yet its characteristic progressive, debilitating and refractory nature is impressively disease-like. Long-term weight loss occurs in only 5% of patients. Group office visits led by physicians have been used in a number of life-style conditions. In diabetes this format enhances blood sugar control and in obesity it improves five-year weight loss success to 20%. In patients with coronary artery disease risk factor a 21% decrease in angina, 55% improvement of exercise tolerance, and 21% decrease in cholesterol occurred in a pilot study. Group office physician-led visits offer encouraging results for the mitigation of life-style conditions.     

Preoperative pupil fatigue.

Pupils are frequently dilated on the day before cataract surgery and for retinal detachment surgery so the fundus can be examined. This may, however, interfere with pupil mydriasis on the day of surgery. This study looked at the effect of pupil dilation with tropicamide 1% and with cyclopentolate 1% on pupil mydriasis 24 hours later, using phenylephrine 10% and cyclopentolate 1%, in 40 cataract patients. The pupils dilated with cyclopentolate one day previously demonstrated a mean reduction in subsequent mydriasis of 0.73 mm compared with pupils that had been dilated with tropicamide (P less than .0001). The magnitude of this difference was not related to the patient age (P = .12) or to iris color (P = .21). If it is necessary to dilate pupils on the day before surgery, tropicamide 1% rather than cyclopentolate 1% should be used, as it is less likely to interfere with the pupil mydriasis produced with cyclopentolate 1% and phenylephrine 10% on the day of surgery.     

Pharmacokinetics and serum protein binding of 3-keto-desogestrel in women during three cycles of treatment with a low-dose combination oral contraceptive.

The serum concentrations of 3-keto-desogestrel have been measured in 43 women who took a low-dose oral contraceptive containing 30 micrograms ethinyl estradiol (CAS 57-63-6) together with 150 micrograms desogestrel (CAS 54024-22-5) for a period of 3 months. Basic pharmacokinetic parameters, like Cmax, tmax and AUC, as well as the serum protein binding of 3-keto-desogestrel were determined on days 1, 10 and 21 of the first and the third treatment cycle, respectively. During cycle one, Cmax, AUC(0-4h) and AUC(0-24h) values on day 1 were 1.9 +/- 0.7 ng/ml, 3.9 +/- 1.3 ng.ml-1.h and 12.4 +/- 5.7 ng.ml-1.h, respectively. These values increased to 4.7 +/- 2.0 ng/ml, 12.1 +/- 5.6 ng.ml-1.h and 47.3 +/- 26.0 ng.ml-1.h on day 21. Within cycle 3, a similar, although less steep increase was observed for these parameters and there was practically no difference in the values of corresponding parameters on day 21 of both cycles. Throughout treatment, there was a redistribution of 3-keto-desogestrel with respect to the binding proteins albumin and sex hormone binding globulin (SHBG). During cycle 1, the free fraction decreased from 1.8% on day 1 to 1.1% on day 21, and the SHBG-bound fraction increased at the same time from 40% to 62%, mainly at the expense of the albumin-bound fraction. During cycle 3, there were only minor changes as compared to cycle one. The observed changes in the serum protein binding were related to an increase in SHBG levels during the treatment period.     

Twice daily 4% Sodium Cromoglycate vs. 2% Sodium Cromoglycate used four times daily in seasonal (grass pollen) allergic conjunctivitis

It is well established that 2% Sodium Cromoglycate is an effective treatment for a number of allergic eye diseases. It has been shown to be non-toxic. It can be used longterm and in serious allergic problems it is a useful adjunctive therapy to steroids. The main problem with Sodium Cromoglycate is that the recommended dosage is a four times daily application and patient non-compliance is common. One of the main objectives of any therapy is to reduce the frequency of dosage and the current study has been designed to investigate the efficacy of a 4% solution of Sodium Cromoglycate, used twice daily, versus a 2% solution used four times daily in seasonal allergic conjunctivitis. A multicentre study, therefore, was carried out to assess the efficacy of both drugs and to assess any possibility of side effects. In addition, a unit dose was used, thus eliminating preservatives and it was used specifically in seasonal allergic conjunctivitis in the pollen season. This study showed that 4% Sodium Cromoglycate used twice daily was at least as affective as 2% Sodium Cromoglycate used four times daily.     

Low molecular weight advanced glycation end products predict mortality in asymptomatic patients receiving chronic haemodialysis.

BACKGROUND: Advanced glycation end products (AGEs) have biological properties that may contribute to the premature cardiovascular mortality of haemodialysis patients. This study examines the hypothesis that low molecular weight forms of fluorescent AGEs (LMW fluorescence) predict mortality in haemodialysis patients. METHODS: The LMW fluorescence was measured in 85 patients treated with chronic haemodialysis and prospectively followed for 4 years. The primary outcome of all-cause mortality was assessed using Cox proportional hazards regression model. RESULTS: At the end of the follow-up period 37 (44%) patients died. The median LMW fluorescence level was 24.2 arbitrary units (range: 10.6-148.1 AU) and the receiver operator characteristic (ROC) curve cut-off for mortality was 37.0 AU. The LMW fluorescence predicted death both as a binary variable at the ROC cut-off, and as a continuous log-transformed variable when adjusted for age, albumin and C-reactive protein (CRP). Adjusted for age, albumin and CRP, the hazard ratio for mortality was 3.05 (1.41-6.60, P = 0.005) for LMW fluorescence as a binary variable and 2.71 per log unit (1.37-5.38, P = 0.004) as a continuous log-transformed variable. CONCLUSION: The low molecular weight forms of AGEs predict mortality in patients receiving chronic haemodialysis, and may be important in the mechanisms leading to atherosclerosis and inflammation in such patients.     

Multidisciplinary assessment of applicants for residential accommodation

Fifty of 62 applicants for residential accommodation underwent assessment at a geriatric day hospital. Twenty-five were suitable, 11 were suitable following rehabilitation and 14 were unsuitable for placement in residential accommodation. Around 35% of all applicants were not assessed. Seventy-nine per cent of assessed applicants, without dementia, either were unsure of how their application had been initiated or did not understand the implications of a move to residential accommodation. Twenty-two per cent of all applicants assessed were taking four or more drugs. To maximise the use of residential accommodation, all applicants should be assessed to reduce inappropriate referrals.     

Effect of clonidine on gastric emptying of liquids

We have investigated the effects of clonidine on gastric emptying of liquids in 30 patients. In a double-blind, randomized design, clonidine 150 micrograms, morphine 10 mg or saline in 1 ml was given i.m. One hour later, the patient drank a paracetamol solution (1.5 g in 50 ml water). Venous blood samples were obtained every 15 min for 90 min thereafter. Plasma paracetamol concentrations were measured using high- pressure liquid chromatography and the area under the concentration- time curve was calculated. The degree of sedation and complications were recorded. The area under the curve for 0-60 min was significantly smaller in the morphine group than in the saline group (P = 0.002; 95% confidence interval (CI) for difference -1237 to -502 micrograms min ml- 1), whereas it was greater in the clonidine group compared with the saline group, although this was not significant (95% CI for difference - 423 to 1264 micrograms min ml-1). Arterial pressure was significantly lower in the clonidine group compared with the saline group. Both clonidine and morphine appeared to cause mild sedation. We conclude that clonidine 150 micrograms i.m. does not delay gastric emptying of liquids in a similar manner to morphine.      

苯丙胺诱发小鼠激怒反应及其机制

苯丙胺15mg/kg ip能诱发小鼠激怒反应,使小鼠出现攻击和殴斗行为。强安定药、弱安定药和利血平有明显拮抗效果。镇静剂如巴比妥类、抗胆碱药及抗肾上腺素药均无拮抗作用。金刚胺、左旋多巴和阿扑吗啡均能增强苯丙胺的激怒效应。因苯丙胺激怒小鼠的方法简便易行,可作为筛选抗精神病药的动物模型。苯丙胺产生激怒作用的机制与增强多巴胺能神经的功能有关,推测可能是促进边缘系统多巴胺释放的结果。