Pharmacokinetic and pharmacodynamic characteristics of trazodone in the elderly.

The pharmacokinetic and some pharmacodynamic characteristics of a single oral dose of 100 mg trazodone were compared in young and elderly volunteers. The maximum plasma concentration of trazodone was similar in both age groups. The time to maximum concentration was apparently prolonged in four subjects who swallowed the capsule with a minimal volume of fluid. This may have been due to the capsule being retained in the oesophagus. The terminal phase half-life of trazodone was significantly prolonged (P less than 0.05) and area under the plasma concentration-time curve was significantly larger (P less than 0.01) in the elderly. Apparent oral clearance was significantly reduced (P less than 0.01) in the elderly. Measurement of critical flicker fusion threshold and subjective assessment of alertness using a visual analogue scale, confirmed the sedative effect of trazodone in both age groups. The elderly subjects were less alert for a longer period following drug administration than the young. The differing pharmacokinetic and pharmacodynamic characteristics of trazodone in the young and elderly may be due to an age-related reduction in hepatic drug-metabolising activity, a difference in regional distribution or a change in CNS sensitivity to the drug.     

Role of non-attendance statistics in assessing the efficiency of geriatric day hospitals

Summary Statistical data are not routinely available on the number of patients who fail to attend geriatric day hospitals. The non-attendances at one of the three main geriatric day hospitals in South Glamorgan were analysed for the year July 1978 to June 1979. The number of non-attendances totalled 1274 (11 per cent of booked attendances). Non-attenders were more likely to be women and very elderly. A taxonomy of non-attendances was developed according to whether they have implications for resource use or patient care. ‘Broken appointments’ and ‘No shows’, where the day hospital staff were given inadequate or no notice of non-attendance, accounted for 907 wasted ambulance journeys. This involved the ambulances in travelling 1814 miles and wasting 302 man-hours. Community nurses, health visitors and social workers visited 130 ‘No shows’ unnecessarily. ‘Self discharges’ and ‘New refusals’ were more dependent than regular attenders matched for age and sex. They also gave lower scores for most items on a linear analogue self-assessment questionnaire designed to quantify their views of day care. Health care planning teams need to consider whether day hospitals really are an efficient method of delivering care to very elderly women. Nonattendance data have a role in monitoring the efficiency of day hospitals for the elderly and should supplement the information about total attendances and number of new patients presently included in routine DHSS statistics.     

Factors affecting estrogen receptor status in a multiracial Asian country: an analysis of 3557 cases

Estrogen receptor (ER) positive rates in breast cancer may be influenced by grade, stage, age and race. This study reviews the ER positive rates over a 15-year period at the University Malaya Medical Centre, Kuala Lumpur, Malaysia. Data on ER status of 3557 patients from 1994 to 2008 was analyzed. ER status was determined by immunohistochemistry with a cut-off point of 10%. ER positivity increased by about 2% for every 5-year cohort, from 54.5% in 1994-1998 to 58.4% in 2004-2008. Ethnicity and grade were significantly associated with ER positivity rates: Malay women were found to have a higher risk of ER negative tumors compared with Chinese women. Grade 1 cancers were nine times more likely to be ER positive compared with grade 3 cancers. In summary, the proportion of ER positive cancers increased with each time period, and ethnicity and grade were independent factors that influenced ER positive rates.     

Disease profile and treatment results of anal canal SCC: Experience from AIIMS, New Delhi

Introduction: Anal Canal squamous cell carcinoma (SCC) accounts for nearly 2% of all cancers of the alimentary tract. Over the past few years, the management of anal canal cancer has changed from primary surgery to primary chemo-radiotherapy (CRT). Methods: A total of 83 patients' (pts) records (62 males, 21 females) were retrospectively reviewed. Length of disease was <5 cm in 44 pts and confined to primary in 46 pts. Ten pts have anti-cancer therapy outside. We delivered radiotherapy (RT) alone to 16 pts, chemotherapy (CT) alone to 4 pts, CRT in 51 pts and pre-operative (pre-op) RT in 2 pts. RT dose was up to 30 Gray (Gy) =16; 30-50 Gy=12 and >50 Gy=41 pts. Results: RT compliance was optimal in 64/69, grade (Gr) ≤ 2 toxicity in 56/69 and Gr ≥ 2 in 13/69 pts. Thirteen pts (18.84%) were hospitalized during RT. No response (NR) was found in 4/83, <50% in 18/83, >50-<100% in 39/83 and complete response (CR) in 22/83 pts. Recurrence at primary site was seen in 7 and loco-regional in 2 pts. Salvage therapy was done in all 9 pts (surgery=8 and CT=1). Status at last follow up, alive without disease = 22/83 and with disease = 61/83 pts. Conclusion: This retrospective analysis revealed that the advanced disease was in 47%, the optimal anti-cancer therapy could be delivered to 63.9%. Despite heterogeneity of patient population and management, the overall disease-free survival (DFS) with sphincter-preservation was achieved in 26.5% pts. Key Words: Anal canal, squamous cell carcinoma, chemo-radiotherapy, sphincter preservation, disease free survival.     

水体中克雷伯菌属的分布及其在水源性急性肠道感染中的价值

俄罗斯不同气候地区不同功能水体中克雷伯菌属广泛分布。克雷伯菌属可见于遭受生物、化学污染的集中供水的地表水源,无防护的地下蓄水层,缺乏有效清洁、消毒系统的饮用水。研究表明,水体中的克雷伯菌属具有致病性和毒性,对现代药物和消毒剂(氯、紫外线)具有抗性,很容易穿透进入地下蓄水层。克雷伯菌属细菌有很强的致病性(粘附力、侵袭力、磷酸酯酶、卵磷脂酶、脱氧核糖核酸酶、溶血活性),含有致病性遗传标记cnf-1。克雷伯菌属(100 CFU/dm³)可引起急性肠道感染。在不检测总大肠菌群的情况下,检测水体尤其是饮用水中的克雷伯菌属,可以评估所用水的流行病学危险。     

重组腺病毒bcl-xs基因对人卵巢癌裸鼠移植瘤作用的研究

目的 观察重组腺病毒bcl-xs基因（adv-bcl-xs基因,简称bcl-xs基因）对人卵巢癌裸鼠移植瘤的生长抑制和荷瘤裸鼠生存率的影响。为卵巢癌的基因治疗提供实验基础。方法 采用以复制缺陷型腺病毒bcl-xs基础感染的人胚肾细胞,使bcl-xs基因对NUTU-19细胞的生长抑制作用并检测其病毒滴度后,将bxl-xs基因导入人卵巢癌裸鼠移植瘤中,观察bcl-xs基因对腹水的生长抑制作用,计算裸鼠的生存时间,并观察bcl-xs基因对裸鼠全身和局部的毒副作用。电镜观察bcl-xs基因的病毒颗粒,以免疫细胞化学染色测定bcl-xs基因表达情况。结果 bcl-xs基因可在人胚肾细胞内扩增,对NUTU-19细胞有抑制和杀伤作用。并在裸鼠体内呈过度表达,使裸鼠腹水形成的时间由5-10d延长至11-23d,裸鼠平均生存时间由24d延长至39d,bcl-xs基因对裸鼠全身和局部无明显毒副作用。结论 bcl-xs基因导入人卵巢癌裸鼠移植肿瘤,能延缓腹水形成,延长裸鼠的生存时间,为卵巢癌的基因治疗提供了一种新方法。