Diphenylhydantoin-induced block of the rat phrenic nerve-diaphragm preparation pretreated with p-hydroxymercuribenzoate

Pretreatment of the rat phrenic nerve-diaphragm preparation with the sulfhydryl-(SH) blocking agent p-hydroxymercuribenzoate (pOHMB) increased the blocking efficiency of the antiepileptic drug diphenylhydantoin (DPH) during indirect stimulation. Another SH-blocking agent, N-ethyl-maleimide (NEM) did not potentiate the block, but SH-group protection with dithiothreitol (DTT) abolished the effect of pOHMB. SH-binding was thus necessary but not sufficient for enhancement of DPH-block. High Ca2+-concentration potentiated the block. Well-maintained response of the isolated phrenic nerve, and of the diaphragm during direct stimulation, located the block at the neuromuscular junction. Microelectrode records in preparations which were curarized, cut or Mg2+ paralyzed to abolish action potential activity, disclosed an abrupt cessation of end-plate potentials (EPPs) by DPH, and pOHMB pretreatment reduced the time period to abrupt EPP fallout in the curarized preparation, suggesting depressed nerve terminal excitability as the cause of the block and its potentiation. Observation of miniature EPPs beyond the time of EPP cessation excluded a postsynaptic block. The pOHMB-treated preparation is suggested as a model for testing antiepileptic drugs.     

Coping,quality of life,and hope in adults with primary antibody deficiencies

Background  

Living with a chronic disease, such as primary antibody deficiency, will often have consequences for quality of life. Previous quality-of-life studies in primary antibody deficiency patients have been limited to different treatment methods. We wanted to study how adults with primary antibody deficiencies manage their conditions and to identify factors that are conducive to coping, good quality of life and hope.     

Functional oesophago-gastric junction imaging

Despite its role in disease there is still no definitive method to assess oesophago-gastric junction competence (OGJ). Traditionally the OGJ has been assessed using manometry with lower oesophageal sphincter pressure as the indicator. More recently this has been shown not to be a very reliable marker of sphincter function and competence against reflux. Disorders such as gastro-oesophageal reflux disease and to a lesser extend achalasia still effects a significant number of patients. This review looks at using a new technique known as impedance planimetry to profile the geometry and pressure in the OGJ during distension of a bag. The data gathered can be reconstructed into a dynamic representation of OGJ action. This has been shown to provide a useful representation of the OGJ and to show changes to the competence of the OGJ in terms of compliance and distensibility as a result of endoluminal therapy.     

Naltrexone implants -- duration, tolerability and clinical usefulness. A pilot study

Naltrexone blocks opioid effects effectively, but poor compliance limits the clinical usefulness in the treatment of opioid dependence. Long-acting implanted formulations might increase the clinical feasibility. Several implants have been produced, but few clinical reports have been published. This paper describes an open trial with an Australian implant. This implant is claimed to have duration of up to six months with double implants and acceptable levels of side effects. This was explored in the present pilot study with 13 opioid-dependent patients. By single implant of 1.8 g naltrexone the duration judged by naltrexone plasma levels above 1 ng/ml naltrexone was between 2 and 4 months. Double implants maintained such plasma levels for 5-6.5 months. Clinically, the implants appeared promising. Side effects were minimal. During the period with adequate plasma levels of naltrexone, use of opioids was absent and use of other psychoactive drugs reduced. At 1-year follow-up, the patients rated the implants highly positively.     

Imaging of the gastrointestinal tract-novel technologies

Imaging of the gastrointestinal tract is very useful for research and clinical studies of patients with symptoms arising from the gastrointestinal tract and in visualising anatomy and pathology. Traditional radiological techniques played a leading role in such studies for a long time. However, advances in non-invasive modalities including ultrasound （US）, computed tomography （CT）, positron emission tomography （PET）, magnetic resonance imaging （MRI）, etc, have in the last decades revolutionised the way in which the gastrointestinal tract is studied. The resolution of imaging data is constantly being improved and 3D acquisition, tools for filtering, enhancement, segmentation and tissue classification are continually being developed. Additional co-registration techniques allow multimodal data acquisition with improved classification of tissue pathology. Furthermore, new functional imaging techniques have become available. Altogether, the future of gastrointestinal imaging looks very promising which will be of great benefit in clinical and research studies of gastrointestinal diseases. The purpose of this review is to highlight the capabilities of the newest techniques to explore the detailed morphology, biomechanical properties, function and pathology of the gastrointestinal tract.     

New technologies in gastrointestinal research

This issue presents different new techniques aiming to increase our understanding of the gastrointestinal system and to improve treatment. The technologies cover selected methods to evoke and assess gut pain, new methods for imaging and physiological measurements, histochemistry, pharmacological modelling etc. There is no doubt that the methods will revolutionize the diagnostic approach in near future.     

Specialisation and specialist education in prosthetic dentistry in Europe

This presentation reports on the results of a meeting of prosthodontists from selected European countries. The aim of the meeting was to analyse and promote specialisation and specialist education in Prosthetic Dentistry in Europe. Representatives for Europe were selected from the European Prosthodontic Association (EPA) board, the Education and Research Committee of International College of Prosthodontists (ICP), countries with a legally recognised speciality, countries without a recognised speciality but organised training programmes and countries with neither of these situations. Data about specialisation and specialist training in Prosthodontics in Europe was scrutinised and discussed. The programmes for countries with specialist training had relatively similar content, mostly of three years duration. There was strong agreement that a recognised speciality raises the level of care within the discipline for both specialists and non-specialists. In several of the countries where a speciality had been introduced it had been initiated by pressure from public health planning authorities. The conclusions are that from a professional viewpoint an advancement of the speciality over Europe would develop the discipline, improve oral health planning and quality of patient care. A working group for harmonisation was recommended.     

Implant retained or conventional dentures, which give more patients satisfaction?

DESIGN: This was a randomised controlled trial (RCT) set in a dental hospital. INTERVENTION: The implant group (IG) had two implants placed in the interforaminal region of the lower jaw followed (after healing) by a denture fixed to the implants by a ball attachment mechanism. In the conventional dentures group (CG), dentures were constructed using conventional replacement denture techniques. Patients in the IG had conventional upper dentures made in the same fashion. OUTCOME MEASURE: The performance of the dentures was evaluated using an oral health impact profile (OHIP) and a denture satisfaction scale before treatment and 3 months post-treatment. RESULTS: Analysis was conducted on an intention-to-treat basis. Substantial improvements in oral-health-related quality of life and denture satisfaction were reported by both groups. There were, however, no significant differences post-treatment between the groups. Patients randomised to the IG who declined implants had significantly lower pretreatment OHIP scores and there were significantly greater pre-/ post-treatment change-scores for individuals who had implants compared with the change-scores of people who declined. CONCLUSIONS: There were no significant post-treatment differences between the groups, but a treatment effect may be masked by the intention-to-treat analysis. The pre-/ post-treatment OHIP change-scores were significantly greater for people receiving implants than for those who refused.     

A comparative study of oxycodone and morphine in a multi-modal, tissue-differentiated experimental pain model

Visceral pain can be difficult to treat with classical mu-opioid agonists and it has been suggested to use opioids with distinct pharmacological profiles. In animal experiments, oxycodone has shown different effects compared to morphine, and clinical observations have shown that oxycodone may occasionally be superior to, e.g., morphine in the treatment of visceral pain. In the current study, we randomised 24 healthy subjects to treatment with either morphine (30 mg), oxycodone (15 mg) or placebo in a crossover study. The experimental pain model involved multi-modal (mechanical, thermal and electrical) pain tests in the skin, muscles and viscera. The pain tests were carried out at baseline and 30, 60 and 90 min after oral administration of the drugs. The model showed effect of the two opioids compared to placebo on all stimulus modalities in all three types of tissues (all P values <0.001). Both opioids attenuated the sensory response mainly to painful stimulations. Morphine and oxycodone were equipotent in pain modulation of the skin and muscles, but oxycodone had superior analgesic effect to both morphine and placebo on the mechanical (P<0.001) and thermal (P<0.001) stimulations of the oesophagus. In conclusion, the multi-modal and tissue-differentiated pain model could link findings from animal experiments to clinical findings. A different pharmacological profile of oxycodone compared to that of morphine was shown, and thus oxycodone may be a useful alternative to morphine in the treatment of visceral pain syndromes.     

Candidemia in Norway (1991 to 2003): results from a nationwide study

A long-term, nationwide prospective candidemia study has been ongoing in Norway since 1991. All medical microbiological laboratories in the country have participated. During the period 1991 to 2003 a total of 1,393 episodes of candidemia occurred in 1,348 patients. The incidence of candidemia episodes per 100,000 inhabitants increased from approximately 2 episodes in the early 1990s to 3 episodes in 2001 to 2003. The average annual incidences varied markedly between the age groups. The incidence was high in patients aged < 1 year and in patients aged > or = 70 years. In patients > or = 80 years of age, the incidence has increased during the last 3 years from an annual average of 6.5 to 15.6 cases/100,000 inhabitants in 2003. Four Candida species (C. albicans [70%], C. glabrata [13%], C. tropicalis [7%], and C. parapsilosis [6%]) accounted for 95.5% of the isolates. The species distribution has been constant during the 13-year study period. The distribution of the most important species varied with the age of the patient. In patients < 1 year of age, the majority of episodes were caused by C. albicans (91%). The occurrence of C. glabrata increased with age. In patients > or = 80 years of age, approximately 1/3 of all episodes were due to this species. All C. albicans strains were susceptible to fluconazole. The percentage of yeast isolates with decreased susceptibility to fluconazole (MICs > or = 16 microg/ml) was 10.7% during the first period of this study (1991 to 1996) and 11.7% during the second period (1997 to 2003).