Intrapartum Care of a Woman With Aortic Aneurysms

Advances in technology and complex care have enabled women with various health problems to become and remain pregnant. Consequently, health-care practitioners are seeing an increasing number of pregnant women who have aortic aneurysms. This case study describes the culturally sensitive intrapartum care of a Middle Eastern woman with ascending and descending aortic aneurysms.     

Screening, Detection and Management of Depression in Elderly Primary Care Attenders. II: II: Detection and Fitness for Treatment: a Case Record Study

Case note data were obtained for 186 elderly primary care attenderswho also completed the 15 item Geriatric Depression Scale (GDS15).The presence or absence in the case notes of a current or pastdiagnosis of depression, of current treatment of depression,and of a number of clinical features of depression were noted.Case notes were also rated for the presence or absence of contraindicationsto the use of tricyclic antidepressants (TCAs) and to serotonin-specificreuptake inhibitors (SSRIs). Whereas 65 (35%) patients wererated as ‘cases’ of depression on the GDS15, only28 (15%) had a current case note diagnosis of depression and37 (20%) had one or more current symptoms of depression recordedin the case notes. Patients rated by their GP as having oneor more current symptoms of depression scored higher on theGDS15 (P < 0.05) and were more likely to be categorized asa GDS case (P = 0.05). There was no significant relationshipbetween GDS caseness and a current case note diagnosis of depression.Seventy-three patients (39%) had a past history of depressionand 53 (28.5%) patients had previously been treated with antidepressants.The former was significantly associated with GDS caseness (P< 0.05). Twenty-four patients (13%) were currently on antidepressants,19 of them receiving adequate doses (equivalent to at least75 mg of amitriptyline). Current antidepressant treatment wasnot associated with GDS ‘caseness’. A significantlyhigher proportion of patients (both in the sample as a wholeand in the subgroup of GDS15 depression ‘cases’)had a medical condition or were taking a drug that mitigatedagainst the use of TCAs than was the case for SSRIs.     

A 13-Week Toxicologic and Pathologic Evaluation of Prolonged Cytochromes P450 Inhibition by 1-Aminobenzotriazole in Male Rats

The pharmacologic, toxicologic, and microscopic effects of 100mg/kg/day of 1-Aminobenzotriazole (ABT), a suicide substrateinhibitor of cytochromes P450, were assessed in male Sprague-Dawleyrats over a 13-week period. Hepatic cytochromes P450 levelsand resorufin dealkylase activity were decreased to less than30% of control values beginning at Day 2 and from Day 8 to Day92. These decreases were not accompanied by overt clinical toxicity,e.g., changes in body weight, food consumption, or clinicalappearance, during the study. Hemoglobin, hematocrit, and erythrocytecounts were slightly decreased at 8, 29, and 92 days and wereaccompanied by increased spleen weights and extramedullary hematopoiesis.Additionally, mean corpuscular hemoglobin concentration, meancorpuscular volume, red cell distribution width, and mean corpuscularhemoglobin were slightly increased at 92 days. Increases inliver weights at 8, 29, and 92 days were accompanied by centrilobularhypertrophy and intracytoplasmic vacuolization consistant withlipid accumulation. Thyroid stimulating hormone (TSH) was slightlyelevated and triiodothyronine and thyroxine were slightly decreasedat 29 days. TSH was also slightly elevated at 8 and 92 days,and thyroid gland weights were increased at 8, 29, and 92 dayswith microscopic evidence of hyperplasia and hypertrophy ofthyroid gland follicular cells. Increased adrenal weights andhypertrophy of the zona fascicularis of the adrenal gland wereobserved at 8, 29, and 92 days. Kidney weights were also increasedat these assessments. Changes in the thyroid gland, the thyroidhormone profile, and the liver may reflect increased synthesisof microsomal enzymes, an effect that is sometimes difficultto demonstrate directly with suicide substrate inhibitors ofcytochromes P450. In general, the effects of daily ABT administrationto male rats at a dose that significantly reduces oxidativemetabolism over a 13-week period were considered to be well-toleratedunder controlled laboratory conditions.     

Role of Acid and Salivary Epidermal Growth Factor in Gastric Mucosal Adaptation to Naproxen in Man

Background: Non-steroidal anti-inflammatory drugs (NSAIDs) frequently damage the gastrointestinal tract, but with continued administration this usually resolves by a process of adaptation. There is evidence that the acute injury can be reduced by acid suppression, and animal models have shown that salivary epidermal growth factor (EGF) is an important factor in gastric mucosal adaptation. We therefore wanted to assess the effect of acid suppression and salivary EGF output during naproxen-induced acute gastric injury and subsequent adaptation. Methods: Healthy subjects were given a 14-day course of naproxen with different regimens of ranitidine and placebo. Before and on three occasions during treatment subjects provided a salivary sample for EGF and underwent gastroscopy to assess gastric damage. Results: Similar gastric damage occurred after 24 h in all groups and resolved in most subjects. Base-line salivary EGF output was similar in all groups but increased in the placebo/ranitidine group on day 3 and in the ranitidine group on day 9. Conclusions: Acid suppression with ranitidine did not prevent acute gastric injury. Adaptation may be associated with an increase in salivary EGF output.