Book Review - On acute oral dyskinesia. Behavioural effects of dopamine receptor agonists and antagonists in humans and primates

Henning Paikin giver i denne artikel en kort oversigt over forskellen mellem den biologisk-naturvidenskabelige og den humanvidenskabelige måde at anskue psykiske fæomener. På basis heraf beskriver han forskellen mellem at bruge psykofarmaka og benytte psykoterapeutiske metoder. Til slut diskuteres konsekvenserne af at benytte de fundamentalt forskellige behandlingsmetoder i kombination.     

Interaction between rifampin and levothyroxine.

Rifampin is a potent inducer of hepatic enzymes and is well documented to cause many clinically significant drug interactions. Studies in normal volunteers have shown its ability to decrease circulating levels of thyroid hormone, while having no effect on thyroid-stimulating hormone (TSH). Reports of rifampin's effects on patients on hormone replacement in the clinical setting are of interest since we believe only one such case has been described. We report the case of a man, stable on levothyroxine, who exhibited significantly elevated TSH levels during therapy with rifampin. Thyroid-stimulating hormone levels returned to baseline 9 days after discontinuance of rifampin.     

Time- and surgery-dependent effects of lipopolysaccharide on gut, cardiovascular and nitric oxide functions.

Lipopolysaccharide (LPS) is considered a major effector of hypotension in septic shock, partly through increasing nitric oxide (NO) formation. LPS-activation of leukocytes that express cytokines which induce NO synthase (iNOS) has also been considered an important contributor to shock. However, LPS, cytokines, and NO are not necessarily associated with hypotensive shock. We investigated whether the timing of LPS injection after initial surgery could influence responses to LPS. E. coli LPS (17 mg/kg 0111:B4 and 026:B6 serotypes) was injected 15 or 120 min after tracheal and femoral cannulation in the anesthetized rat. LPS caused hypotension for 2 h when injected 15 min (early injection) after initial surgery. LPS decreased blood pressure for only 15 min when injected 2 h (late injection) after initial surgery. Plasma NO was increased and leukocytes were decreased after both the early and late LPS injection. Blood pressure responded the same when a second surgery (ileal cannulation and luminal perfusion) followed the early or preceded the late LPS injection. Ileal NO secretion increased and effective mucosal blood flow decreased when LPS followed gut surgery, but these did not change when gut surgery followed LPS. Plasma NO was increased and leukocytes were decreased when LPS followed gut surgery, but these did not change when gut surgery followed LPS. Ileal water absorption was not affected by LPS. These observations suggest that a desensitization to the hypotensive effect of LPS develops with time after an initial trauma. An additional gut trauma does not change the blood pressure response, but does have effects on leukocyte sequestration and NO synthesis. NO synthesis alone could not explain the effects on blood pressure.     

The effect of lymphocytes from renal transplant patients on glomerular basement membrane sulfate uptake

We have studied the effect of peripheral blood mononuclear cells (PBMC) from renal transplant patients on³⁵sulfate uptake by rat glomerular basement membrane (GBM). Nine patients were included in the study; six were studied during an episode of acute allograft rejection and seven while not undergoing acute rejection. The sulfate uptake index, calculated as the ratio between uptake by GBM from rat glomeruli cocultured with PBMC and³⁵sulfate incorporation by GBM from glomeruli cultured alone, was significantly higher when glomeruli were co-cultured with PBMC from patients undergoing an acute rejection (3.26 ± 1.18, mean ± SEM) than it when glo meruli were cocultured with PBMC from nonrejecting transplant patients not showing proteinuria (0.81±0.11) (P = 0.0053). After reversing the acute allograft rejection with resolution of proteinuria, the sulfate uptake index returned to normal in four of five patients. The fifth patient had persistent nephrotic syndrome and his sulfate uptake index remained elevated. These findings are similar to those observed in idiopathic minimal lesion nephrotic syndrome patients in relapse. Because the GBM sulfated compounds may play a role in glomerular permeability to plasma proteins, by acting on these compounds PMBC may be a common mechanism for proteinuria.     

Does routine stress-thallium cardiac scanning reduce postoperative cardiac complications?

OBJECTIVE: Prophylactic cardiac revascularization in patients with ischemic myocardium could reduce postoperative cardiac complications after aortic reconstruction. However, the effectiveness of this approach has not been documented. SUMMARY BACKGROUND DATA: Stress-thallium scanning can identify patients with ischemic myocardium. Morbidity and mortality after aortic reconstruction appears to be largely caused by co-existent coronary artery disease, and patients who have had recent cardiac revascularization have few postoperative cardiac complications. METHODS: Preoperative stress-thallium scanning was evaluated prospectively in 146 patients undergoing aortic reconstruction. Patients with positive studies underwent coronary arteriography and cardiac revascularization, when appropriate. Postoperative cardiac complications and long-term survival in these patients were compared with results from 172 similar patients undergoing aortic reconstruction without stress-thallium scanning. Results also were analyzed to determine predictors of postoperative cardiac events. RESULTS: Forty-one per cent of patients undergoing stress-thallium testing underwent coronary arteriography, and 11.6% had cardiac revascularization. In contrast, 14.7% of patients treated without stress-thallium testing had coronary arteriography, and 4.1% had revascularization (p < 0.01). Despite this, cardiac mortality, serious cardiac complications, and long-term cardiac mortality were similar in both groups. Only advanced age and intraoperative complications (but not a positive stress-thallium test) predicted postoperative cardiac events. CONCLUSIONS: Preoperative stress-thallium testing confirmed a high incidence of significant coronary artery disease in patients undergoing aortic reconstruction, but prophylactic cardiac intervention does not reduce operative or long-term mortality. Thus, the risk and expense of routine stress-thallium testing and subsequent cardiac revascularization cannot be justified.     

Rifampin and rifabutin drug interactions: an update

Rifampin is a potent inducer of cytochrome P-450 oxidative enzymes. A few examples of well-documented clinically significant interactions include interactions with warfarin, oral contraceptives, cyclosporine, glucocorticoids, ketoconazole or itraconazole, theophylline, quinidine sulfate, digitoxin or digoxin, verapamil hydrochloride, human immunodeficiency virus-related protease inhibitors, zidovudine, delavirdine mesylate, nifedipine, and midazolam. Recent reports have demonstrated clinically relevant interactions with numerous other drugs, such as buspirone hydrochloride, zolpidem tartrate, simvastatin, propafenone hydrochloride, tacrolimus, ondansetron hydrochloride, and opiates. Rifabutin reduces serum concentrations of antiretroviral agents, but less so than rifampin. To avoid a reduced therapeutic response, therapeutic failure, or toxic reactions when rifampin is added to or discontinued from medication regimens, clinicians need to be cognizant of these interactions. Enhanced knowledge of known interactions will continue to develop, including research on the induction of specific cytochrome P-450 isoenzymes and on the importance of the P-glycoprotein transport system. New rifampin and rifabutin interactions will be discovered with further investigations.     

Are patients who refer themselves to physiotherapy different from those referred by GPs? Results of a national trial

Objectives

To establish if there are differences in the profile of patients who refer themselves to physiotherapy compared with patients referred by or at the suggestion of their general practitioner (GP) in a range of primary care settings.

Design of study

Quasi-experimental.

Setting

Twenty-nine general practices throughout Scotland.

Participants

Three thousand and ten patients (>16 years of age) and 100 physiotherapists.

Method

Self-referral was introduced in each site. The demographic and clinical data relating to all referrals collated over a full year were compared by referral group (self-referrals, GP-suggested referrals and GP referrals).

Results

There was no relationship between gender or age group and referral group, but other differences in the profile were found. The groups differed in terms of their presenting condition and its severity (P = 0.027). Greater proportions of patients who referred at the suggestion of their GP and patients who self-referred presented with low back and neck conditions (54% versus 43%, P < 0.001). Self-referrers reported having their symptoms for less than 14 days to a greater extent than the other groups (14% versus 9% and 10%, P = 0.011). Non-preferential treatment waiting time to physiotherapy also differed, with 44% of patients who self-referred being seen within 2 weeks of referral compared with 36% of patients who referred at the suggestion of their GP (P < 0.001). Self-referrers were absent from work in lower proportions (20% versus 28% and 28%, P = 0.048) and were absent for half the mean time (2.5 days versus 6 days). They also completed their treatment in greater proportions (76% versus 69% and 72%, P = 0.002). Although all groups experienced the same mean number of physiotherapy contacts (n = 4), patients who referred at the suggestion of their GP had a proportionally lower contact rate with 65% having four or less contacts compared with 55% of patients who self-referred and 51% of patients referred by their GP (P < 0.001). There was no difference in the outcome determined by physiotherapists or patients.

Conclusions

Patients who refer to physiotherapy at the suggestion of their GP and patients who self-refer appear to have a different profile from patients who are referred by their GP.     

永久起搏器在预防心房颤动中的作用

本文总结了用于预防和终止心房颤动的起搏器的类型。窦房结功能异常的病人,心室起搏与较高的心房颤动的发生率相关。有鉴于此,有心房颤动病史、因心动过缓而需要安装起搏器的病人,应该安装双腔或心房起搏生理性起搏器,而不应安装单腔的心室起搏器。