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Your purchase entitles you to access the website until the second edition of Clinical Gastroenterology and Hepatology is published or until this first edition is no longer offered for sale by Elsevier, whichever occurs first. If the next edition is published less than one year after your purchase, you will be entitled to online access for one year from your date of purchase. Elsevier reserves the right to offer a suitable replacement product such as a downloadable or CD-ROM-based electronic version ; should online access to Clinical Gastroenterology and Hepatology be discontinued. No part of this e-dition may be returned for refund or credit if box is opened or damaged.
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ADJUSTMENT OF ANESTHESIA DEPTH BY BISPECTRAL INDEX ELONGATED SEIZURE DURATION IN ELECTROCONVULSIVE THERAPY AUTHORS: F. Nishihara AFFILIATION: Gunma University, Maebashi, Japan. INTRODUCTION: In the clinical practice of electroconvulsive therapy ECT ; , extremely short seizure and abortive one are considered to be ineffective 1 ; . Since significant correlation between seizure duration and bispectral index BIS ; value immediately before electrical stimulus has been reported 2 ; , adjustment of anesthesia depth by BIS may be effective to obtain a desired seizure length. In the present study, we examined the hypothesis in the subjects who had short seizure length in an ECT trial. METHODS: ECT was prescribed to 15 patients suffering from endogenous depression. Atropine 0.01 mg kg ; im was given as premedication. The BIS electrode was attached to forehead of the patients as instructed by the manufacturer. Single lead electroencephalography EEG ; was recorded on the same monitor. General anesthesia was induced with propofol 1-2 mg kg ; . After loss of consciousness, succinylcholine chloride 1 mg kg ; was administered and ventilation was assisted using a face mask and 100% oxygen. The electroshock stimulus was delivered by a trained psychologist using ECT-stimulator. The efficacy of electrical stimulation was determined by tourniquet technique, electromyogram and electroencephalography. Consciousness was assessed by calling patient's name every 30 seconds after the start of spontaneous respiration. When a patient had a short seizure, in the next ECT trial, the patient received electrical stimulus after waiting an elevation in BIS value + 10-20 ; . Intensity of electrical stimulus and anesthesia condition were identical in the two trials. RESULTS: The patients ranged from 22 to 80 years of age. Intensity of stimulus was 3615%. No patient could recall ECT procedures, and no complaint was reported after ECT regardless the BIS score prior to electrical shock. All patients had longer seizures when stimulus was delivered after BIS elevation. Seizure duration measured by muscle movement was 3610 s when stimulus was delivered without waiting and 4915 s when delivered after waiting . There was significant difference in seizure duration between the two values p 0.01 ; . DISCUSSION: Although the view that seizure duration is a primary determinant of treatment efficacy is changing, extremely short seizure is still believed to be ineffective. In conclusion, seizure duration has a positive correlation with BIS value immediately before electrical shock. Anesthesists can adjust anesthesia depth by BIS value to obtain a longer seizure. REFERENCES: 1 ; Anesth Analg 91: 1531-6, 2000 ; Anesth Analg 93: 1249-52, 2002.
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Marrow transplantation HDC ABMT ; .1, 2 Infectious etiologies have been identified in about 50% of cases and include cytomegalovirus CMV ; , herpes simplex virus, respiratory syncytical virus RSV ; , Pneumocystis carinii, adenovirus, Aspergillus, and Candida.1, 2 In the remaining cases in which no infectious agents could be identified, several distinct syndromes have been described. Idiopathic pneumonia syndrome IPS ; is the most severe form of posttransplant interstitial pneumonitis and is best characterized by severe hypoxemia, radiographic infiltrates, and is associated with high mortality.35 However, we have recently described in detail a milder form of posttransplant pneumonitis occurring in autologous bone marrow transplant BMT ; patients that we have termed delayed pulmonary toxicity syndrome DPTS ; .6 DPTS is characterized by its high incidence 69% ; , prompt response to steroids with resolution of pulmonary symptoms and improvement in diffusion of carbon monoxide Dlco ; , and very low mortality.6, 7 Radiographic abnormalities, when present, typically appear as scattered, predominantly peripheral ill-defined opacities.8 Possible mechanisms for the pathogenesis of either IPS or DPTS include the following: 1 ; pulmonary drug toxic reactions caused by carmustine BCNU ; and or cyclophosphamide; 3, 9 2 ; imbalance of lung cytokines that promote a proinflammatory state; 10, 11 3 ; occult latent viral infections eg, CMV, RSV, Epstein-Barr virus, or human herpes 6 virus 12, 13 or 4 ; an imbalance in pulmonary oxidants and antioxidants.14 Allogeneic transplant patients, in contrast to autologous, are also susceptible to graft-vshost disease processes and in addition, are maintained in an immunodeficiency state for an extended time. The coronaviruses are one of the more recently identified major family of viruses that have been associated with the development of the common cold. They are a family of positive-sense single-stranded RNA viruses with distinctive club-shape projections imparting a crown or coronashaped appearance. OC43 and 229E are two major serologic coronavirus strains identified to be important in human disease.1517 Only indirectly has coronavirus been linked to lower respiratory tract infections.18 20 In this report, we document the development of acute and sumycin.
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Lower Urinary Tract Symptoms LUTS ; and Sexual Dysfunction increase with age. While, essentially, quality of life issues, with both conditions, are associated with other morbidities and are interrelated. Overactive Bladder OAB ; is defined as a condition referring to the symptoms of urgency, frequency, nocturia, and urge incontinence. These symptoms can occur singly or in combination, and in the absence of local pathologic factors. In males, LUTS includes BPH prostate disease ; , and OAB symptoms are often present. LUTS is strongly associated with sexual dysfunction in both sexes and in all age groups. Studies have shown that the treatment of LUTS improves sexual function. While the correction of associated comorbidities must be considered, pharmacologic therapy remains the mainstay of LUTS and ED erectile dysfunction ; . Drugs Commonly Used: OAB Tolteridine Detrol ; , Oxybutinin Ditropan ; BPH Doxazosin Hyyrin ; , Terazosin Yhtrin ; , Tamsulosin Flomax ; , Alfuzosin Xatral ; ED Sildenafil Viagra ; , Tadalafil Cialis ; , Vardenafil Levitra ; Successful diagnosis and treatment of LUTS, OAB, BPH, and ED leads to improved quality and quantity of life and risedronate.
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At advanced stages, breast cancer is currently a disease for which palliation is the most practicable approach. The reasons for the refractionness of metastatic breast cancer to significantly life-prolonging treatment are multiple: 1 ; The evolution of the disease over several years has preceded this state during which time increasingly malignant clones of tumor cells can develop; 2 ; Heterogeneity of the disease, whose recognition and implications have yet to be well defined and understood prevents optimal individual-specific treatment; 3 ; Most importantly, an absence of adequately effective - "curative" therapies separates breast cancer from other malignancies for which remarkably effective drugs have been identified empirically. While our knowledge of breast cancer biology has grown exponentially in recent years, and our abilities to apply currently available techniques of drug dose density, bone marrow transplantation, and biological response modifiers have increased, practical life-prolonging therapies for populations are yet to be defined.
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Schering-Plough Corporation, FTC Docket No. 9297 Feb. 19, 2002 ; , available at : ftc.gov opa 2002 02 ahp . An administrative law judge has rendered an opinion, now on appeal, dismissing charges against Schering- Plough. : ftc.gov os caselist d9297 d ; In private litigation, the Gytrin and Cardizem CD courts have declared challenged agreements per se illegal. The agreements went beyond the scope of the patents at issue in the infringement litigation. See In re Terazosin Hydrochloride Antitrust Litigation, 164 F. Supp.2d 1340 S.D. Fla. 2000 In re Cardizem CD Antitrust Litigation, 105 F. Supp.2d 682 E.D. Mich. 2000 ; , appeal pending 6th Cir. ; . b ; Examples of other private litigation raising similar issues: A few of the other patent antitrust lawsuits in private litigation where there has been no parallel FTC case ; include: 1 ; In January of 1997, Bayer, Barr, and The Rugby Group signed an agreement involving Cipro, Bayer's brand name product, whereby Barr agreed not to sell its generic version of Cipro in the United States in exchange for payments of $24 million each to Barr and Rugby. The FTC has been investigating the arrangement, but has filed suit. Private litigants have filed several class action and individual lawsuits, many of which have been combined for multi-district litigation in the Eastern District of New York. On October 1, 2001, that court remanded eight indirect purchaser claims filed under California, Florida, Kansas, and Texas state antitrust and consumer protection laws to their respective state courts, rejecting defendants' arguments that federal question and diversity jurisdiction existed. 2 ; Over thirty private antitrust lawsuits have been filed against Zeneca Co., its successor AstraZeneca, PLC, and Barr Laboratories, Inc., "Barr" ; in connection with an allegedly anticompetitive patent settlement relating to the cancer drug tamoxifen. The complaints allege that after Barr successfully challenged Zeneca's patent for the drug in 1992, instead of marketing its generic drug, it signed a "confidential settlement agreement" with Zeneca that conceded the patent suit in exchange for $21 million and a license to sell a generic manufactured by Zeneca. 3 ; A federal court June 21 threw out two federal class action antitrust lawsuits brought by consumers and third-party payers alleging AstraZeneca illegally tried to keep generic versions of the heartburn drug Prilosec off the market Twin City Bakery Workers and Welfare Fund v. Astra Aktiebolag, S.D.N.Y., Nos. 01-CIV9730 JSR ; and 9105 JSR ; , dismissed with prejudice 6 21 02 and aripiprazole.
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The Kaiser Family Foundation, 2000, Sex Education in America: Series of National Surveys of Students, Parents, Teachers and Principals. A View From the Nation's Classrooms, California: Menlo Park. Report Summary available at kff . The survey of 503 likely voters was conducted in July 2002 by Peter D. Hart Research Associates for the Reproductive Health Technologies Project. backupyourbirthcontrol . Princeton Survey Research Associates November 19, 2000 ; , The Kaiser Lifetime vital signs index, survey no. 2, final topline, kff lifetime final topline . National Association of State Boards of Education, 1998, The role of education in teen pregnancy prevention, Policy Update, 6 11 ; . The Kaiser Family Foundation January 31, 2001 ; , Kaiser Daily Reproductive Health Report, International News, USA Today, Reports on availability of emergency contraception in British schools. The Kaiser Family Foundation, ibid. The Harlem Health Promotion Center and the Adolescent Initiative Project, Mailman School of Public Health, Columbia University, with the Academy for Educational Development, Providing Emergency Contraception to Adolescents. A Practical Guide for Clinicians, 2001, unpublished ; . Carol Roye, 2001, Routine provision of emergency contraception to teens and subsequent condom use: a preliminary study, letter to the editor, Journal of Adolescent Health, 28: 165-166.
York Central Hospital319 in suburban Toronto became the scene of a medical disaster and an emergency management fiasco during the early days of the SARS crisis. The medical disaster had its roots in the March 16, 2003, transfer of a patient from Scarborough Grace, Mr. H, whose story is told earlier in the report. Mr. H arrived at the York Central Hospital's intensive care unit, but no one knew he was infected with SARS. He infected 15 other patients and staff at York Central, an outbreak that led to closure of the hospital on March 28 and to an emergency management situation that resembled a poorly directed paramilitary operation.320 The SARS outbreak at York Central Hospital was discussed during a conference call on March 28, 12 days after the infectious transfer, the day the hospital became aware that it had SARS cases. The hour-long conference call between the high-level group managing the SARS emergency for the province, hospital officials and representatives of York Region Public Health resulted in a manager of the Emergency Operations Centre calling 911 at the end of the meeting and asking local police to "send units down to close York Central Hospital." Inexplicably, hospital staff were not told of the closing before the police were on the way, nor were police given any details other than a request not to let anyone in or out.
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