Investigation of neuromuscular blocking agents at Richter Ltd

Investigation of new neuromuscular blocking agents was started 30 years ago in Richter Ltd. This paper presents the results obtained by Richter's scientists. 2 compounds out of 100 bisquaternary ammonio steroid having androstane skeleton were selected for further pharmacological study. One of these agents, pipecuronium bromide (Arduan) elicited long-lasting block of neuromuscular transmission without cardiovascular side effects in both animal experiments and clinical studies. Arduan is a powerful competitive antagonist of acetylcholine, since it can bind pre- and postsynaptic (N1) receptors of the transmitters. It has no remarkable cumulative effect. Neostigmine rapidly and completely antagonized the neuromuscular blockade caused by pipecuronium. Arduan was introduced into clinical practice. The second compound, RGH-4201 (Duador) evoked a neuromuscular block of short duration. It showed slight atropin-like cardio-vagolytic effect in animal experiments. In the clinical studies, however, the cardiovascular side effects were found to be too strong. Therefore, it was not introduced in clinical practice.     

Action-state orientation and the self-regulation of eating behavior

The present study examined the association between eating behavior and individual differences in volitional functioning as assessed by the Action Control Scale [Kuhl, J. (1994a). Action versus state orientation: psychometric properties of the Action-Control Scale (ACS-90). Volition and personality: action versus state orientation (pp. 47-56). Seattle: Hogrefe Huber]. Two hundred and nineteen undergraduate women completed measures of personality, affect, and eating behavior, which included the Action Control Scale (ACS) and the Three-Factor Eating Questionnaire [J. Psychosom. Res. 29 (1985) 71]. Hierarchical regression analyses that controlled for the influence of negative affect showed that scores on the Hesitation subscale of the ACS were positively associated with overeating and negatively associated with dietary restraint. These findings illustrate the importance of action-state orientation in the self-regulation of eating behavior and suggest the potential utility of targeting volitional skills in interventions to modify dysfunctional patterns of eating.     

Inhibition of gastric emptying and small intestinal transit by ethanol is mediated by capsaicin-sensitive afferent nerves

The neural mechanisms involved in mediation of the inhibitory effects of ethanol on the gastric emptying and the small intestinal transit were studied in adult male rats. The gastrointestinal transit was determined by measuring the amount of phenol red recovered from the stomach and small intestine after intragastric administration. Spinal and/or vagal peptidergic afferent nerves were subjected to selective denervation by chemodenervation techniques using capsaicin, a potent and specific sensory neurotoxin.Intragastric administration of a 2.5 g/kg body weight dose of ethanol resulted in inhibition of the gastric emptying and the small intestinal transit. Prior systemic treatment with capsaicin, which defunctionalizes both spinal and vagal capsaicin-sensitive afferent nerves, abolished the inhibitory effect of ethanol on the gastrointestinal transit. Similarly, selective chemodenervation of the vagal afferents by perineural capsaicin treatment completely blocked the effect of ethanol. These observations furnish evidence indicative of the involvement of capsaicin-sensitive neural pathways, and in particular vagal afferent nerves, in the mediation of the inhibitory effect of large doses of ethanol on the gastrointestinal motility.     

Effectiveness of standardized direct suggestions in dental hypnosis

The frequency of occurrence of amnesia, analgesia and time distortion during hypnotic dental treatments (n = 60) was investigated on high dental anxiety patients. Hypnosis with and without standardised direct suggestions related to amnesia, analgesia and time distortion were compared. Treatment of alert patients without direct suggestions (n = 10) were also used for comparison. Amnesia and time distortion was higher (p < or = 0.05) with the use of suggestions under hypnotic conditions, but analgesia was not significantly different. Alert appearance of the events were in all cases less (p < or = 0.01) than under hypnotic conditions.     

Surgical aspects of histologically unproven space-occupying lesions of the pancreas head

A suspected, but unproved malignant tumor in the head of the pancreas is a fairly common problem for surgeon. Even intraoperatively, differentiation between chronic pancreatitis and carcinoma is difficult. We try to give guidelines about what can be done with a pancreas head mass intraoperatively without previous cytology or histology. When do we have to achieve definite diagnosis at all costs, and how can we achieve it? Results of 40 intraoperative aspiration cytologies, performed for suspected pancreatic cancer were analysed. All of them were controlled by histology in the resected specimen. Intraoperative biopsy was false negative in 12.5% and the diagnosis was uncertain in 35%. These data show that a benign result by itself never excludes the presence of malignancy. If pathology will alter our decision about resection, all efforts should be made to confirm the diagnosis. On the other hand, in a case of a mass lesion with obstructive symptoms, cytology does not alter the need for surgical decompression, and some kind of resection is a reasonable option, even in case of chronic pancreatitis. Nihilistic approach in the case of pancreatic head mass with suspected but unproved malignancy is not justified. Pancreatoduodenectomy should be performed for all tumors even without histologic confirmation if an experienced team can perform it with low postoperative morbidity and mortality.     

Dilemma in clinical practice: methods of tumor detection in patients with deep vein thrombosis

Thrombosis being developed on the basis of acquired thrombophilia is a frequent and recognized complication of malignant diseases. Thrombosis may be presenting the first (and the only) symptom of cancers, therefore some kind of diagnostic procedure seems to be necessary for detecting malignancies. The occurrence of deep venous thrombosis with solid tumors had been studied, and the literature had been reviewed. The authors have discussed: 1. The epidemiology, 2. The prevalence and incidence of cancer with different types of thrombosis, 3. The most frequent malignancies, 4. The occult and undiagnosed tumors, 5. The cases at an early stage of cancer. Finally the authors tried to define a suitable diagnostic strategy. The point of this standard is that a detailed screening in patients at a high risk of cancer is reasonable even if there are no symptoms suggesting malignancy.     

Social background of small-for-gestational-age infants

INTRODUCTION: The Small for Gestational Age birth rate is still unchanged during the last decades opposite to the premature birth frequency. This fact needs further examinations. AIM AND METHODS: The association of socio-economic status and the development of intrauterine growth retardation was analysed in a two year prospective study. The study group consisted of 34 patients having small-for-gestational-age newborns. The control group consisted of those 68 women having normal term birth. RESULTS: Significant differences were found in the Body Mass Index, smoking habits during pregnancy, education, and poverty status. The difference in age was expressed, but not significant. There were no significant differences among alcohol and coffein consumption, family status, household crowding and employment. CONCLUSION: Beside the effective medical prenatal care the importance of education and social support is emphasised.     

Assessment of the aversion coefficient in nuclear safety in Hungary

The key elements of the optimization practice as applied to radiation protection are the monetary value of the averted person-sievert and the aversion coefficient. Determination of the monetary value of the unit averted person-sievert (as alpha(base)-parameter) in Hungary was presented in a previous paper. The estimation of this parameter was carried out by the willingness-to-pay (WTP) method associated with averted occupational exposure (at the NPP Paks/Hungary). The aversion coefficient predicts the importance of dose reduction based on the magnitude of the dose. The assessment of the aversion coefficient occurred also by means of the WTP method in the spring of 2000. Its value has been estimated on the basis of individual preferences concerning the distribution of individual exposure in nuclear safety. The results achieved by the WTP among the radiation specialists from the NPP Paks, Hungary, assessed a value for the aversion coefficient of 1.86 over the whole range of individual exposure levels. This value is a bit greater than the value obtained in France (1.7) and the higher coefficient expresses a higher priority to reduce the highest individual exposures.     

Sphincter of Oddi dysfunction--prolonged medical therapy or early endoscopic sphincter ablation

INTRODUCTION: Sphincter of Oddi dysfunction is a real challenge from both diagnostic and therapeutic point of view. PATIENTS AND METHODS: In the last two years the authors have performed ERCP and EST in 29 patients with positive evocative test results, who had important enzyme elevations and/or did not respond to prolonged medical treatment. RESULTS: Endoscopic findings were positive in 25/29 patients (86.2%): 8 adenoma of p. Vateri, 17 papillitis were identified, and in 4 cases the papilla was intact. Histopathology obtained in 12 patients supported the diagnosis. In 6 patients, who underwent a postpapillotomy evocative test, after an average of 10 months follow up the results have been converted from positive to negative response in all but two cases. The two patients continued to have abdominal symptoms with persistent positive provocation tests because of restenosis, were treated with repapillotomy. CONCLUSIONS: The Debray and Nardi tests are useful screening tests for hypertonic biliary or pancreatic dyskinesia. Structural endoscopic and histological findings are frequent already in the functional cases. Early sphincter ablation should be considered in failure of medical therapy for preventing the transformation of this functional disorder into an organic, potentially precancerous state.