Anticonvulsant combination therapy: rational concepts versus real effectiveness

Primary drug treatment of epilepsies is usually a monotherapy with an antiepileptic drug. This procedure causes less side effects as polytherapy and probably shows the same efficacy. Two third of patients with focal epilepsies are sufficiently treated with a single antiepileptic drug: 60% of patients with Grand mal and 22-30% of patients with complex focal seizures remain seizures free. An alternative monotherapy will suppress seizures in another 30% of patients. With polytherapy this is achieved in only 12% of the remaining patients, furthermore, side effects increase in polytherapy. Generalized epilepsies are usually treated with valproate monotherapy. Patients remain seizure free from absence in 60-90%, from myoclonic-impulsive seizures in 75-97% and from Grand mal in about 85%. Alternative monotherapy is less common because of the limited efficacy and possible side effects of drugs: ethosuximide does not control Grand mal and phenobarbitone may cause sedation. Thus, polytherapy is commonly initiated when monotherapy fails to control seizures (lamotrigine is often chosen as comedication). Rational polypharmacy is a term suggesting rational concepts in planning antiepileptic polytherapy leading to a superior anticonvulsant effect. However, this consideration is not based on or supported by clinical data. Yet, a combination of drugs which have no or little pharmacokinetic interactions seems to be a clinically relevant recommendation. Thus, newly developed drugs such as vigabatrin, lamotrigine or gabapentin are more frequently used as comedication with standard antiepileptic drugs.     

The therapy of peripheral obstructive arteriopathies: rational bases

The authors underline the relations among the anatomical lesion progression, the appearance of the clinical signs (claudicatio) of tissue ischaemia and the thromboembolic event in vascular districts like myocardium and brain, at high morbidity and mortality risk. They widely state the pathogenetic mechanism of the atherosclerotic arterial disease and the compensative mechanisms that may prevent the ischaemic effects of the vascular obstruction. It has been considered the importance of the hemorheologic changes and their influence on the development of the ischaemic syndrome. The therapeutic choice in relation to physiopathologic and hemorheologic events in the peripheral obstructive arterial disease is considered.     

Intestinal angiodysplasia: diagnosis and therapy

On the basis of two personal cases of angiodysplasia authors describe this rare pathology and its relative diagnostic difficulties. On the grounds of their experience and the international literature on this pathology, authors considered the angiography as the selected method for the diagnosis of intestinal angiodysplasia, and they consider surgical therapy as the best curative method for this pathology.     

Combination drug therapy in hypertension: a rational approach for the pharmacist

Knowledge of precise head kinematics during whiplash trauma is important for identifying possible injury mechanisms and their prevention. This study reports a comprehensive data set describing head kinematic response to horizontal accelerations simulating whiplash. Seven isolated fresh human cervical spine specimens (C0 to T1 or C7), each carrying a surrogate head designed to represent a 50th percentile human head, were mounted on the sled and subjected to incremental trauma by horizontal sled accelerations of 2.5, 4.5, 6.5, 8.5, and 10.5 g. Sled and head kinematics were measured with potentiometers and accelerometers. The incremental sled accelerations resulted in average (standard deviations) sled velocity changes (delta V) ranging from 5.8 (0.2) to 15.8 (0.2) km/h. Generally, all the peak head kinematic parameters increased with increasing sled acceleration, except for the peak head angular displacement, which decreased. In the initial phase of a whiplash trauma, the head translated posteriorly with respect to T1, without rotation. In the later phase, the head rotated backwards, but much less than its physiological limit. Maximum head rotation of 31.5 (23.9) degrees occurred in a 2.5 g trauma class, and this was less than the maximum physiological head extension of 55.1 (13.3) degrees. Head kinematics expressed in the T1 or shoulder coordinate system is better suited to study potential neck injury in whiplash.     

Religiously sensitive rational emotive behavior therapy: Theory, techniques, and brief excerpts from a case.

Rational emotive behavior therapy's (REBT's) methods for fostering change, such as disputation of irrational beliefs, are similar to the kinds of activities one may expect to encounter in many organized religions. REBT also bears a strong theoretical affinity with some religions because of its preferred therapeutic goal of helping clients examine and change their beliefs. Furthermore, the formal religious tenets and traditions to which many clients adhere will usually include doctrinal material that is highly congruent with REBT's theory of change. Such belief-oriented material may be enlisted during REBT to help religious clients evaluate and change their self-defeating, irrational beliefs. A case that integrates religious belief with REBT is presented. Finally, the authors conclude with a brief summary of preliminary outcome research regarding the efficacy of this approach. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

探讨呼吸机相关性肺炎临床诊治与分析

呼吸机相关性肺炎(VAP)是指原无肺部感染或原有肺部感染经呼吸机治疗后而发生的与呼吸机相关的感染,病原学常见为耐药菌与真菌等.在气管插管机械通气治疗后48 h或原有肺部感染用呼吸机48 h后发生新的感染,并经病原学证实.     

Mycetoma of the foot; a disease from the tropics

Two patients, a Surinamese man aged 50 and a Surinamese woman aged 56 exhibited a mycetoma of the foot, 30 and 28 years, respectively, after a local injury. Pathological examination revealed an aspecific chronic granulomatous inflammation. As causative agents a Fusarium species and a Cladosporium normodendrum, respectively, were cultured. The treatment consisted of curettage of fistulous ducts and administration of itraconazole.     

Religiously sensitive rational emotive behavior therapy: Elegant solutions and ethical risks.

Rational emotive behavior therapy (REBT) can be an elegant treatment modality for explicitly religious clients. This is true in spite of the traditional antireligious stance of Albert Ellis. In this article, the authors summarize the evolution of Ellis's views on religion and mental health, consider potential ethical dilemmas caused by utilizing REBT with religious clients, and recommend strategies for reducing violation of ethical and specialty guidelines in work with religious clients. The authors conclude by proposing a general model for religiously sensitive psychotherapy, which may serve to undergird theorizing and research on the application of REBT and other treatment approaches to religious clients. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Recurrent ovarian carcinoma: diagnosis and second-line therapy

Approximately 10% of patients with ovarian cancer will develop a recurrence. Successful treatment of recurring disease has been documented, and recent developments in chemotherapy are encouraging. In our study, CA125 Tumour Marker was a useful marker to monitor the course of such disease, and detected recurring ovarian cancer at a sub-clinical level, leading to earlier diagnosis. This may have implications for outcome.     

Acute pre-hepatic portal thrombosis: diagnosis and therapy

Portal vein thrombosis is a rare pathology. The etiopathogenetic causes that most frequently lead to this pathology are myeloproliferative syndromes. The authors present a case of acute pre-hepatic portal vein thrombosis and discuss its etiopathogenesis, diagnosis and therapy.     

Heart failure in utero: diagnosis and therapy

Over the past 15 years considerable advances in ultrasonography have made increasingly detailed evaluation of the human foetal heart feasible. Accordingly, the presence of cardiac failure can now be diagnosed in human foetuses during the last two thirds of pregnancy by foetal echocardiography. The underlying causes of foetal cardiac failure can be identified and prenatal treatment, if considered appropriate, can be monitored by ultrasonographic methods. Two-dimensional and M-mode echocardiography, as well as Doppler ultrasound, are equally important with respect to evaluation of foetal cardiac failure. Foetal echocardiography has contributed remarkably to broadening our understanding of the conditions and natural course of cardiac failure during prenatal life. In turn, this has led to an increasing readiness to consider new forms of prenatal treatment for foetal cardiac failure.