Theophylline revisited

For over 50 years, theophylline has been used regularly for the management of chronic asthma. However, because of its perceived narrow therapeutic index and the fact that it has been considered a weak bronchodilator, the use of theophylline therapy has diminished. Furthermore, with the introduction of newer pharmacologic agents and recommendations in widely accepted guidelines, both nationally and internationally, have further contributed to its decreased use. For years, theophylline has not only been considered a bronchodilator, but for many clinicians, an agent that could be used to enhance respiratory muscle function and mucociliary clearance and act at the level of the central nervous system to enhance ventilation. These properties were felt to be potentially useful for patients with severe exacerbated asthma. Recent studies have suggested that theophylline therapy can play a beneficial role in the management of both chronic stable asthma and exacerbated disease treated in the emergency department setting. Furthermore, a growing body of evidence suggests that theophylline has certain antiinflammatory and immunomodulating properties, even at plasma concentration levels below the accepted therapeutic range. If this is true, then theophylline may act best as a controller medication in the management of asthma. Because of its low cost and its ease of administration, theophylline therapy should be revisited and discussed as not only a reliever of bronchospasm, but a controller of chronic asthma.     

Sadism revisited

Sadism has been for a long time, among psychoanalytic and other writers, the subject of extensive theorizing and controversy. This paper takes a fresh look at the many dimensions (sexual, characterological, neurotic, psychotic, neurological) of this old aberrations.     

Benzodiazepines revisited

Glucagonoma is an endocrine tumor of almost exclusively pancreatic origin which is rarely associated with a clinical syndrome mainly characterized by migratory necrolytic erythema, hyperglycemia, weight loss, hypoaminoacidemia and anemia. Ten to 30% of the patients may present thromboembolic phenomenon, deep vein thrombosis and pulmonary embolism which often lead to the death of the patient. We report the case of a patient diagnosed with pancreatic glucagonoma the presentation of which consisted in episodes of repeated deep vein thrombosis without associated migratory necrolytic erythema.     

Recovery revisited

Recovery of mechanical properties during annealing of deformed metals has been modelled based on a microstructural representation comprising two elements, (i) the cell/subgrain structure (size δ) and (ii) the dislocation density (ρ) within the subgrains. These two microstructural elements are treated as independent internal state variables and the recovery of flow stress obtained by adding the time dependent contributions due to subgrain growth [σ ∝ 1/δ(t)] and dislocation network growth

. The growth of a dislocation network has been treated in terms of thermally activated glide, thermally activated cross-slip, climb and solute drag as rate-controlling mechanisms. Subgrain growth has been analysed in a manner analogous to normal grain growth, with climb of the boundary dislocations being the rate controlling mechanism. The model has successfully been applied in the interpretations of recovery observations in iron, aluminium and AlMg alloys. It follows from the theoretical treatment as well as from the analysis of experimental data that the characteristic logarithmic time dependence of low temperature recovery is the result of a reaction controlled either by thermally activated glide of jogged screw dislocations or by solute drag. It has been demonstrated that a mechanism based on thermally activated cross-slip does not apply in this context.     

Asylums revisited

The authors revisited Erving Goffman's Asylum (Saint Elizabeths Hospital) and found both the "institutionalization" and "secondary adjustment" phenomena he described 20 years ago. However, they question whether secondary adjustments necessarily follows institutionalization. They also express doubt that institutionalization should be condemned automatically and suggest that it may in fact be the approach of choice for some patients.     

Vesicorectostomy revisited

Between 1948 and 1959 vesicorectostomy, a permanent anastomosis between the bladder and rectum, was constructed in 7 male patients. Scattered reports of this procedure exist but none since 1959 and long-term followup has never been reported. we present long-term followup, including renal function, excretory urography and voiding cystorectography, and review the quality of life in the 7 patients. The most frequent complication was stenosis of the anastomosis. None of the patients in this series with normal preoperative upper tracts showed radiographic or chemical deterioration postoperatively. Since this procedure maintains urinary continence, does not disturb the normal physiology of the ureterovesical junction and minimizes urinary reabsorption its use should be considered in certain patients as an alternative method of urinary diversion.     

Peace revisited.

Replies to comments by Ralph H. Gundlach on an article, attributed to an E. J. McGuigan, "Crash Research Program for Peace" (see record 1959-08088-001). The present author, F. J. McGuigan, states that Gundlach either says or implies that in the article in question it is assumed that principles of individual behavior are applicable to groups, that such factors as "hurt pride, jealously [sic], or social pressure. Now it may well be that these are proper assertions to make about his position, or in fact they may not be proper. Similarly Gundlach's assertions in addition to those above may or may not be true. But whether or not these things are true is really irrelevant to the article in question for none of them are either asserted or denied, as even a cursory reading should show. The investigation was merely an attempt to obtain a sample of reactions from individuals who might influence international policy on the question of research on the problem of warfare. Clearly any restrictions on how to attack such a problem by stating limiting assumptions at this time would be premature. In any event, Gundlach's interest, in peace is to be praised. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Maelstrom revisited.

Comments on K. D. Brownell and J. Rodin's (see record 1995-03008-001) review of the debate (i.e., maelstrom) over the risks and benefits of weight loss dieting. Discussion includes the lack of evidence for the long term safety of clinical treatments for obesity, the effectiveness of weight loss maintenance programs, and the efficacy and safety of weight loss diets. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Objectivity revisited.

Contends that G. M. Alliger and P. J. Hanges's (see record 1985-02739-001) assertion that Paradigm I scientists acknowledge their personal inability to make completely value-free observations has no bearing on the present author's (see record 1983-20002-001) argument. Their attempt to characterize the objectivity of science fails to distinguish it from numerous other social enterprises, such as theology and baseball. G. Nettler (see record 1985-02742-001) misses the structure of the present author's argument and supposes that he subscribes to views that he has cited only to refute. The author's basic claim is misrepresented in both these critiques. It is not suggested that one should prefer subjectivity to objectivity but that the distinction between subjectivity and objectivity is incoherent. Contrary to Nettler's suggestion, the abandonment of the subject–object distinction does not commit one to the view that experience is chaotic. (4 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Neomycin toxicity revisited

Nephrotoxicity and ototoxicity represent the most hazardous side effects of the clincial use of neomycin sulfate. Despite therapeutic restriction of the latter compound to topical, irrigant, and bowel sterilization use, serious toxicity is still encountered. A 69-year-old patient was recently treated by us for acute renal failure and total deafness induced as a result of intermittent seven-day lavage of a surgical cavity with neomycin. Peritoneal dialysis reduced the serum concentration of the antibiotic and promoted complete recovery of renal function. The patient, however, remained deaf. This case serves as a reminder that neomycin can be absorbed systemically following its use as an irrigant solution. In such cases, it may produce an unsuspected form of "high output" renal failure and concomitant hearing loss. The renal failure is usually reveesible, but the hearing loss is frequently permanent.