Cabergoline compared to levodopa in the treatment of patients with severe restless legs syndrome: results from a multi-center, randomized, active controlled trial.

We report the first large-scale double-blind, randomly assigned study to compare two active dopaminergic therapies for Restless Legs Syndrome (RLS), the dopamine agonist cabergoline (CAB) and levodopa/benserazide (levodopa). Patients with idiopathic RLS were treated with fixed daily doses of 2 or 3 mg CAB or 200 or 300 mg levodopa for 30 weeks. Efficacy was assessed by changes in the IRLS (International RLS Severity Scale) and by time to discontinuation of treatment due to loss of efficacy or augmentation. 361 of 418 screened patients (age 58 +/- 12 years, 71% females) were randomly assigned and treated (CAB: n = 178; levodopa: n = 183) in 51 centers of four European countries. Baseline IRLS total score was 25.7 +/- 6.8. The baseline-adjusted mean change from baseline to week 6 in IRLS sum score was d = -16.1 in the CAB group and d = -9.5 in the levodopa group (d = -6.6, P < 0.0001). More patients in the levodopa group (24.0%) than in the CAB group (11.9%, P = 0.0029, log-rank test) discontinued because of loss of efficacy (14.2% vs. 7.9%, P = 0.0290) or augmentation (9.8% vs. 4.0%, P = 0.0412). Adverse events (AEs) occurred in 83.1% of the CAB group and in 77.6% of the levodopa group. In both groups, most frequent AEs were gastrointestinal symptoms (CAB: 55.6%, levodopa: 30.6%, P < 0.0001). This first large-scale active controlled study in RLS showed superior efficacy of cabergoline versus levodopa after a 30-week long-term therapy. Tolerability was found more favorable with levodopa than with cabergoline.     

Bizepssehnenruptur

Trauma und Berufskrankheit - Zusammenfassung Diese Arbeit beschäftigt sich mit der Häufigkeit, dem Entstehungsmechanismus und der Behandlung von Bizepssehnenrupturen. Veränderte...     

A Randomized Pilot Study of Behavioral Treatment to Increase Calorie Intake in Toddlers With Cystic Fibrosis

This pilot study examined a behavioral treatment to increase calorie intake in toddlers with cystic fibrosis. Eight toddlers were randomly assigned to behavioral plus nutrition (BEH) or nutrition intervention (NTR) conditions. Calorie intake and weight were measured at pre- and posttreatment. The BEH group showed a trend for changes in calorie intake pre- to posttreatment (p = .07; 40% increase). Results for the BEH and NTR groups did not differ significantly. Most participants achieved weight gains consistent with normal growth. Seventy-five percent had not shown this pattern during the year prior to intervention. These results support the feasibility and potential for behavioral interventions in this age group.     

Experimental and clinical possibilities of MR spectroscopy of the heart

MR-spectroscopy of the heart is a relatively new technique for the study of various aspects of cardiac metabolism. The majority of results has so far been obtained with the isolated perfused heart. Here, 31P-MR spectroscopy can be employed to measure high-energy phosphate metabolism and intracellular pH repeatedly and non-invasively. Using a technique called saturation transfer, velocities of enzymatic reactions, such as the creatine kinase reaction, can be measured. Intra- and extracellular Na+ and K+ concentrations can be registered with 23Na- and 39K-MR in conjunction with shift reagent. 13C-MR can be used to tackle carbohydrate metabolism. In-situ-R-spectroscopy allows determination of high-energy phosphates in intact large mammals. Clinical applications of MR-spectroscopy remain to be defined; preliminary results indicate high diagnostic and prognostic potential for patients with coronary artery disease and congestive heart failure.     

Psychosocial occupational therapy intervention with AIDS patients

The role of psychosocial occupational therapy with AIDS patients is explored. The clinical picture is defined, information regarding the transmission, incidence, diagnosis, and treatment is presented, and the impact of the illness on the developmental life cycle is described. The occupational behavior framework is used to guide evaluation and intervention and case examples are provided. Finally, fears and issues affecting therapists working with these patients are explored.     

Glucose-potassium-insulin in hypodynamic septic shock

Haemodynamic and metabolic effects of glucose-potassium-insulin (GKI) were studied in 14 patients with peritonitis. Study entry criteria were: hypodynamic septic shock (mean arterial pressure less than 50 mmHg and cardiac index less than 3.5 l/min) despite a highly positive fluid balance (greater than +2,000 ml during the last 12 h) and use of catecholamines (greater than 15 mcg/kg/min Dobutamine). GKI (glucose 70% 1 g/kg + potassium 10 mval + insulin 1.5 U/kg) was infused within 15 min via a central venous catheter. Before and 10 min after GKI haemodynamic and metabolic measurements were performed. GKI led to significant increases in systolic (+53%) and mean (+61%) arterial pressures, cardiac index (+50%), right (+60%) and left (+109%) ventricular stroke work indices, and oxygen consumption index (+18%). Heart rate remained unchanged, pulmonary shunt fraction increased slightly, systemic and pulmonary vascular resistances showed an insignificant decline. Serum glucose (p less than 0.01) and pCO2 (p less than 0.1) increased. The haemodynamic improvement lasted from 30 min or less (n = 3; 21%) to several hours. Nine patients (64%) survived more than 2 days, and two patients (14%) were eventually discharged from the hospital. We conclude, that in hypodynamic septic shock refractory to volume loading and catecholamine treatment GKI may be beneficial, although the mechanism of action remains unclear.     

Coronary-like revascularization for atherosclerotic renal artery stenosis

AIMS: The aim of this study was to document the early outcome of coronary-like revascularization for atherosclerotic renal artery stenosis (ARAS). METHODS AND RESULTS: A total of 181 consecutive patient, 102 men, mean age 66.1 (+/- 9.2) years and 79 females, mean age 68.4 (+/- 9.2) years and 198 lesions were treated between February 1999 and May 2004 for ARAS and retrospectively analyzed. At least one major cardiovascular risk factor was present in 179 (98.9%) patients. Pre-dilatation ARAS was 81.3+/-9.6%, 27 ARAS were 50-70% and no ARAS was <50%. 135 (68.2%) of the ARAS lesions were ostial and 63 (31.8%) were non-ostial. In 17 (9.4%) patients bilateral ARAS were present. Technical success defined as residual stenosis < or =30% was achieved in 178 (98.3%) of patients and 195 (98.5%) of lesions. In one patient (0.5%) the target ARAS could not be crossed, in two (1.1%) patients residual stenosis was >30%. No major adverse cardiac or cerebral effects were observed. In 3.9% of patients minor local complications of the access site occurred; 4 (2.2%) inguinal hematoma, 3 (1.7%) pseudoaneurysm were documented. Serum creatinine concentrations and systolic and diastolic blood pressure before and after the intervention were not statistically different. CONCLUSIONS: Coronary-like approach to ARAS revascularization is technically feasible and associated with a very low complication rate.