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J Miles, SP Hanley, A Williams, JM Couriel, V Nathoo, J Roberts and L Hopkinson ABSTRACT Aim: To discern the availability of the Internet to patients attending clinics and surgeries in North Manchester General Hospital, UK. Method: A multidisciplinary group designed a questionnaire to be distributed to patients attending the authors' clinics between each October and November for five years. Results: The data from 1998 and 1999 are presented here. Three quarters of patients surveyed were unable to access the Internet and a significant number had no future plans to do so. Discussion: If access rates remain low over the next three to four years it is likely that the authors will continue to focus on providing patient information via the Internet at out-patient clinics. RESULTS Data for 202 patients surveyed in 1998 are shown in Table 1 whilst those for 165 patients surveyed in 1999 are shown in Table 2. There were no significant differences in either the ages or sex of the samples chosen during the two stages of the study mean age 1998: 37.2yr vs mean age 1999: 43.5yr; 58% F 1998 vs 52.3% F 1999 ; . Only one in four patients attending our clinics had access to the Internet, either at home or at work, and this figure has remained constant over the last two years. North Manchester is an area of high deprivation with one in three of our nearby houses occupied by a family member on income support. In 1998, 74% of people with the ability to access the Internet had done so for the purpose of obtaining medical information. A hospital website containing medical information would be found useful by 87% of responders. By contrast in the 1999 survey, only 19.5% of patients with access used the Internet for obtaining medical information. However, 86% still felt that a hospital website would be useful. There was a trend, in both years, for patients with future plans to access the Internet for medical information to be younger 1998: 25.6yr vs 44.2yr; 1999: 29.2yr vs 49.3yr, for example, clonazepam withdrawal symptoms. Disease Recurrence After recurrence, the patient was treated with cetuximab and irinotecan chemotherapy without significant reduction in the tumor. A radiofrequency ablation of the primary tumor was performed with limited success. The patient described his pain as 2-fold: a constant, gnawing sensation in his buttocks, back, and groin as well as a throbbing, burning, electric intermittent sensation down his left leg and foot. Multiple neuropathic medications nortriptyline, phenytoin sodium, baclofen, gabapentin, and clonazepam ; were administered without significant relief, although gabapentin seemed to reduce the burning, electric-like sensation. Various anti-inflammatory drugs, including oral steroids, were tried without longterm relief. Several opioid regimens were tried, including oral morphine, fentanyl patch, hydromorphone, and oxycodone. Oral oxycodone up to 2800 mg day in divided doses seemed to help take the edge off the pain. The burning electric-like sensation down his leg made it difficult to stand and to lie down on his back. He was able to sleep only a few hours during the night. He was quite frustrated with the way his pain interfered with daily life, and only wished to survive for 1 year in order to walk his daughter down the aisle at her wedding. The pain appeared opioid resistant, and thus the patient was considered for the placement of an intrathecal drug delivery system to palliate his pain.
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Effect of some convulsants on the protective activity of loreclezole and its combinations with valproate or clonazepam in amygdala-kindled rats. K.K. BOROWICZ, S.J. CZUCZWAR. Pol. J. Pharmacol., 2003, 55, 727733. Loreclezole 5 mg kg ; exerted a significant protective action in amygdala-kindled rats, reducing both seizure and afterdischarge durations. The combinations of loreclezole 2.5 mg kg ; with valproate, clonazepam, or carbamazepine applied at their subprotective doses ; also exhibited antiseizure effect in this test. However, only two first combinations occurred to be of pharmacodynamic nature. Among several chemoconvulsants, bicuculline, N-methyl-D-aspartic acid and BAY k-8644 the opener of L-type calcium channels ; reversed the protective activity of loreclezole alone and its combination with valproate. On the other hand, bicuculline, aminophylline and BAY k-8644 inhibited the anticonvulsive action of loreclezole combined with clonazepam. The results support the hypothesis that the protective activity of loreclezole and its combinations with other antiepileptics may involve potentiation of GABAergic neurotransmission and blockade of L-type of calcium channels. Key words: loreclezole, valproate, clonazepam, chemoconvulants, amygdala-kindled seizures. Studies with paroxetine, clonazepam, sertraline and brofaromine show that continued treatment is associated with better maintenance of response and combivent. In a randomized trial, anesthesia-assisted heroin detoxification was less safe and not more effective than buprenorphine-assisted or clonidine-assisted detoxification.1 Methods: A total of 106 treatment-seeking heroin-dependent patients were randomized to participate in a trial comparing the opioid withdrawal severity of 3 interventions: Anesthesia-assisted rapid naltrexone detoxification, buprenorphine assisted rapid opioid detoxification with naltrexone and detoxification using clonidine followed by naltexone induction. All patients were admitted in the evening and hospitalized for 72 hours. Anesthesia assisted naltrexone induction was undertaken the next morning and maintained for 4 to 6 hours. Patients in the buprenorphine group received a single evening dose upon admission and naltrexone was started on day 2. The clonidine group received clonazepam, and naltrexone was not started until day 7. Patients in all groups received clonidine, clonazepam, and other adjuvant medications as needed. During hospitalization, withdrawal severity was measured 4 times daily using 3 different symptom severity scales. Following discharge, all patients received 12 weeks of twice-weekly relapse-prevention psychotherapy. They also met regularly with the study psychiatrist and were encouraged but not required to continue with naltrexone. Results: Anesthesia-assisted detoxification was associated with withdrawal symptoms comparable to the other 2 procedures. In the buprenorphine group, severity of withdrawal symptoms initially decreased and was followed by a substantial increase after naltrexone induction. Three patients in the anesthesia group experienced severe adverse events: pulmonary edema and aspiration pneumonia, onset of a bipolar mood state, and diabetic ketoacidosis. These patients had concealed prior histories of pneumonia bipolar disorder, and diabetic ketoacidosis. Five patients in each of the anesthesia and buprenorphine groups and 2 in the clonidine group completed 12 weeks of psychotherapy and had no more than 2 opiate-positive urine specimens during that time. Accompanying Editorial: None of these approaches is particularly effective.2 Detoxification-based approaches are limited by the lack of an effective strategy to keep patients free of drugs after detoxification. Opioid maintenance treatment has a long history of efficacy in keeping patients free of heroin. The recent approval of buprenorphine for this indication allows office-based administration of opioid maintenance therapy by appropriately trained physicians. There is some evidence that it can be very effective. As the populations, interventions and outcomes of the studies are disparate the studies still have to be considered separately. The extent to which the intermediate outcomes of treatment completion drug collections up to the end of treatment course ; and appointment attendance correlate with actual drug taking is unknown There are concerns about how quality assessment was accounted for in the trials included in the review. The authors note that none of the studies reported whether those assessing outcome were blinded to the intervention to which patients had been assigned. Additionally, allocation concealment did not take place in one trial Morisky 1990 ; and adequacy of concealment and the method used for generation of allocation sequence could not be determined in the remaining trials. Authors conclusions ""Reliable evidence is available to show some specific strategies improve adherence to tuberculosis treatment and these should be adopted in health systems depending on their appropriateness to practice circumstances and coumadin.
SPECT Imaging. E.G. DePuey, DS Berman, EV Garcia, Editors. Raven Press, Ltd., New York, 103-120, 1995. 69. Berman DS, Amanullah AM, Hayes S, Friedman JD, Hachamovitch R, Kang X, Lewin HC, Kiat H, Van Train KF, Dahr S, Germano G. Dual-Isotope Myocardial Perfusion SPECT with Rest Thallium-201 and Stress Technetium-99m Sestamibi. In: Zaret BL, Beller GA, ed. Nuclear Cardiology: State of the Art and Future Directions, 2nd edition. Philadelphia: Mosby Inc. 1999: 281-297. 70. Berman DS, Germano G. Clinical Applications of Nuclear Cardiology. In: Germano G, Berman DS, eds. Clinical Gated Cardiac SPECT. Futura Publishing Company. Armonk, NY. 1999: 1-71. 71. Berman DS, Germano G. An Approach to the Interpretation and Reporting of Gated Myocardial Perfusion SPECT. In: Germano G, Berman DS, ed. Clinical Gated Cardiac SPECT. Armonk, NY: Futura Publishing Company. 1999: 147-182. 72. Germano G, Berman DS. Acquisition and Processing for Gated Perfusion SPECT: Technical Aspects. In: Germano G, Berman DS, ed. Clinical Gated Cardiac SPECT. Armonk, NY: Futura Publishing Company, 1999: 93-113. 73. Germano G, Berman DS. Quantitative Gated Perfusion SPECT. In: Germano G, Berman DS, ed. Clinical Gated Cardiac SPECT. Armonk, NY: Futura Publishing Company, 1999: 115-146. 74. Germano G, Van Kriekinge, S, Berman DS. Quantitative Gated Blood Pool SPECT. In: Germano G, Berman DS, ed. Clinical Gated Cardiac SPECT. Armonk, NY: Futura Publishing Company, 1999: 339-347. 75. Van Train KF, Germano G, Berman DS. Computer Aspects of Perfusion Imaging. In: Henkin RE, ed. Nuclear Medicine, Vol. I. St. Louis, MO: Mosby Year Book Inc. 1999: 644-671. 76. Germano G, Berman DS. Basic Principles, Techniques, Camera Computer Systems, and Safety. In: Pohost GM, O'Rourke RA, Berman DS, Shah PM, editors. Imaging in Cardiovascular Disease. Lippincott Williams & Wilkins, Philadelphia, PA. 2000: 137-150. 77. Berman DS, Germano G. Myocardial Perfusion Single Photon Approaches. In: Pohost GM, O'Rourke RA, Berman DS, Shah PM, editors. Imaging in Cardiovascular Disease. Lippincott Williams & Wilkins, Philadelphia, PA. 2000: 159-194. 78. Germano G, Berman DS. Assessment of Ventricular Function: Gated Perfusion Methods. In: Pohost GM, O'Rourke RA, Berman DS, Shah PM, editors. Imaging in Cardiovascular Disease. Lippincott Williams & Wilkins, Philadelphia, PA. 2000: 277-294. 79. Germano G, Berman DS. Assessment of Ventricular Function: Gated Perfusion Methods. In: Pohost GM, O'Rourke RA, Berman DS, Shah PM, editors. Imaging in Cardiovascular Disease. Lippincott Williams & Wilkins, Philadelphia, PA. 2000: 277-294. Ciclonicate 33 ; , derpanicate 58 ; , estrapronicate 34 ; , glunicate 51 ; , hepronicate 22 ; , micinicate 44 ; , pantenicate 56 ; , sorbinicate 33 ; nitrile derivative: nimazone 21 ; other: nifungin 24 ; , nimidane 34 ; , nisbuterol 38 ; NO2 - derivatives: acenocoumarol 6 ; anticoag. ; , azathioprine 12 ; and tiamiprine 15 ; antimetabolites ; , bronopol 14 ; antiseptic ; , chloramphenicol 1 ; antibiotic ; , clonszepam 22 ; sed. ; , flurantel 25 ; anthelmintic ; , flutamide 33 ; nonsteroid anti-androgen and cozaar. 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Ms. Davidson is from Jefferson Medical College, Thomas Jefferson University, King of Prussia, Pennsylvania. Dr. Ringpfeil is from Jefferson Medical College, Thomas Jefferson University, Philadelphia, Pennsylvania. Dr. Lee is from the Ackerman Academy of Dermatopathology, New York, New York. Ms. Davidson is a medical student. Dr. Ringpfeil is an Assistant Professor in the Department of Dermatology and Cutaneous Biology. Dr. Lee is an Associate. Reprints: Jason B. Lee, MD, 145 E 32nd St, 10th Floor, New York, NY 10016.
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