Anticholinergic therapy together with behavioral treatment are the mainstays of treatment for the overactive bladder. Successful
therapy and patient compliance depend very much on side effects. In the past, little attention has been paid to anticholinergic
side effects in the central nervous system (CNS), which can be critical, especially for elderly patients. Incidence and intensity
of CNS effects depend on the pharmacokinetic and pharmacodynamic properties that are decisive whether anticholinergics pass
the blood-brain barrier as a result of passive and active transport mechanisms. To measure potential CNS side effects of anticholinergic
drugs, rapid eye movement sleep analysis, quantitative-topographic electroencephalogram studies, and psychometric tests were
performed. Structural changes in brain morphology (resulting from anticholinergics) also were analyzed in a postmortem study.
However, the data of these studies do not always correlate with clinical experience. The results of clinical studies in elderly
patients are also controversial mainly due to the different design of the studies. Spontaneous reporting may not be appropriate,
but targeted tests for memory and cognitive function should be applied. Moreover, the treatment period must be adequate. Therefore,
further clinical studies in patients with overactive bladder are mandatory, with adequate study design and adequate duration
of anticholinergic therapy. 相似文献
Trenkwalder P, Plaschke M, Aulehner R, Lydtin H.Felodipine or Hydrochlorothiazide/Triamterene for Treatment of' Hypertension in the Elderly: Effects on Blood Pressure, Hypertensive Heart Disease, Metabolic and Hormonal Parameters.
The aim of the study was to compare the antihypertensive efficacy of either felodipine or the diuretic combination hydrochlorothiazide/triamterene in a group (n = 65) of elderly (≥70 years) hypertensives (office blood pressure ≥ 60/95 mmHg) with special regard to ambulatory blood pressure monitoring, hypertensive heart disease and metabolic parameters. This was a randomized, double-blind study with a treatment period of 6 months. Reduction of office and 24-hr ambulatory blood pressure was comparable with both treatment regimens; after 6 months, 18 of 29 patients in the felodipine group (62%) and 20 of 27 patients in the diuretic group (74%; p = 0.4) were controlled. While episodes of ischemic type ST-segment depression were significantly reduced in the felodipine group (from 49 to 9 episodes), there was no significant change in the diuretic group (from 24 to 21 episodes). Both regimens decreased left ventricular wall thickness, but the decline in left ventricular muscle mass index was significant only for felodipine. Felodipine did not induce any change in metabolic or hormonal parameters; the diuretic combination significantly increased serum creatinine, uric acid, plasma renin activity, and plasma prorenin. Thus, the antihypertensive efficacy of felodipine and the diuretic combination was comparable in elderly hypertensives; only felodipine, however, improved parameters of hypertensive heart diesease and showed a neutral metabolic and hormonal profile. 相似文献
Marked neovascularization is a hallmark of many neoplasms in the nervous system. Recent reports indicate that the endothelial
mitogen vascular endothelial growth factor (VEGF) may play a critical role in the regulation of vascular endothelial proliferation
in malignant gliomas. Using novel monoclonal antibodies to the VEGF polypeptide we have determined the expression and cellular
distribution of VEGF protein in a representative series of 171 human central nervous system (CNS) tumors by immunohistochemistry
and immunoblotting. In agreement with previous in situ hybridization data, 19 out of 20 glioblastomas (95%) showed immunoreactivity
for VEGF, whereas both the percentage of immunoreactive tumors and the extent of immunoreactivity for VEGF were significantly
lower in astrocytomas. Of the pilocytic astrocytomas (WHO grade I) 44% were immunoreactive for VEGF, but we observed several
cases with pronounced vascular proliferates in the absence of VEGF. In ependymomas, meningiomas, hemangioblastomas, and primitive
neuroectodermal tumors, there was no correlation between VEGF expression, vascular endothelial proliferation and the grade
of malignancy. Oligodendrogliomas and the oligodendroglial component of mixed gliomas lacked immunoreactive VEGF, indicating
that endothelial growth factors other than VEGF may regulate tumor angiogenesis in these neoplasms. Western blot analysis
showed a predominant VEGF protein species of 23 kDa and confirmed the immunohistochemical data in all cases. Our findings
demonstrate that VEGF is expressed in a wide spectrum of brain tumors in which it may induce neovascularization. However,
other angiogenic factors also appear to contribute to the vascularization of CNS neoplasms.
Received: 18 April 1996 / Revised, accepted: 20 August 1996 相似文献
Abstract: To be able to salvage heart failure patients, the need for an economical permanent ventricular assist device is increasing. To meet this increasing demand, a miniaturized centrifugal blood pump has been developed as a permanently implantable device. The Gyro permanently implantable model (PI-601) incorporates a sealless design with a blood stagnation free structure. The pump impeller is magnetically coupled to the driver magnet in a sealless manner. This pump is atraumatic and antithrombogenic and incorporates a double pivot bearing system. A miniaturized actuator was utilized in this system in collaboration with the University of Vienna. The priming volume of this pump is 20 ml. The overall size of the pump actuator package is 53 mm in height and 65 mm in diameter, 145 ml of displacement volume, and 305 g in weight. Testing to date has included in vitro hydraulic performance and hemolysis. This pump can provide 5 L/min against a 110 mm Hg total pressure head at 2,000 rpm and 8 Limin against 150 mm Hg at 2,500 rpm. The normalized index of hemo-lysis (NIH) value of this pump was 0.0028 g/100 L at 5 Limin against 100 mm Hg. A preliminary anatomical study revealed the possibility of the implantability of 2 such systems in biventricular bypass at a preperitoneal location. This system is feasible for use as a permanently implantable biventricular assist device. 相似文献
Background: During hemorrhagic hypotension, sympathetic vasoconstriction crucially contributes to gut mucosal damage. Sympathetic blockade by thoracic epidural anesthesia has been shown to increase mucosal microvascular perfusion and to improve survival after severe hemorrhage in laboratory animals. This study investigates the effects of thoracic epidural anesthesia on intestinal microvascular perfusion during hemorrhagic hypotension in rats.
Methods: In 32 anesthetized Sprague-Dawley rats either lidocaine 2% (thoracic epidural anesthesia) or normal saline (control) was infused via thoracic epidural catheters. Hemorrhagic hypotension (mean arterial pressure 30 mmHg for 60 min) was induced by withdrawal of blood, which was subsequently retransfused for resuscitation. Functional capillary density and erythrocyte velocity in the mucosa and muscularis were determined by intravital microscopy. Leukocyte-endothelium interaction was studied in postcapillary venules and sympathetic nerve fibers of the intestinal wall were identified by immunohistochemistry.
Results: During hypotension functional capillary density was significantly (P < 0.001) lower in the muscularis of the control group (median [25/75 percentile]: -46.5% [-59.6/-20.8%] change from baseline) as compared with animals that received thoracic epidural anesthesia (-6.1% [-13.4/1.1%]). There were no differences in erythrocyte velocity between groups throughout the experiment. Leukocyte rolling increased significantly (P < 0.001) after resuscitation in control (12 [6/15]vs. baseline 2.5 [1/8]) but not in thoracic epidural anesthesia (4 [2.3/7]vs. baseline: 5 [3/15.5]). Sympathetic nerve fibers were identified in the muscularis and submucosa but not in the mucosa. 相似文献
Background/aims: Quantitative measurement of skin roughness has proved to be a valuable tool in the efficacy-control of external applications, but it suffers from not yielding easily comparable results. The most important sources of inter-observer variability are high-pass filters used to separate roughness and waviness, and low-pass filters which result from the finite resolution of the instrument or from the finite sampling interval of digital measurement. In the present study, the effects of high-pass filters and sampling intervals on the roughness measured were investigated. Methods: Dynamically focusing optical profilometry was used to measure the surfaces of negative replicas of healthy human skin. High-pass cut-off wavelengths and sampling intervals were varied systematically. Results/conclusions: Virtually unbiased estimates for the roughness parameters K, Sk, Rq, and Ra can be obtained using sampling intervals of 40 or even 80 μm. Regarding these roughness parameters, it is far better to do more scans than to shorten the sampling interval. The roughness parameters Rz, Rp, Rt, Rpm, Rmax, Pt, on the other hand are very sensitive to the influence of the sampling interval; to achieve satisfying estimates, the sampling interval should be no longer than 2 to 5 urn; as an important parameter’of the measurement, it is worthy of remark and should always be indicated. The way the mean square roughness Rq depends on the cut-off wavelength is not well described by the Sayles-Thomas-relation Rq~λc0.5. If the power-spectrum |h*(v)|2 approximates sufficiently to a power law, |h*(v)|2~vδ, a better estimate is given by Rq~λcγ with γ=-(δ+1)/2. In many cases, γ=1 or Rq~λc will suffice. 相似文献