Biomedical subjects
Publications and source records attributed to N Meyer.
Xenon arc photocoagulation of the fundus of pigmented rabbits resulted in no corneal endothelial cell damage when the experiment was designed to minimize corneal temperature rise by frequent topical instillations of ophthalmic irrigating solution.
Metoclopramide, a derivative of procainamide, was compared with thyrotropin releasing hormone (TRH), N3im-methyl-TRH and chlorpromazine as a prolactin (PRL) releaser in 11 euthyroid males. The peak response of serum PRL and the maximum increment of serum PRL (max deltaPRL) were greater (P less than 0.0005) after the administration of metoclopramide (deltaPRL 24.1 +/- 1.5 (SE) ng/ml) than after either TRH (14.9 +/- 1.5 ng/ml) or chlorpromazine (7.0 +/- 2.1 ng/ml). There were no significant differences between the peak and max deltaPRL responses to metoclopramide or N3im-methyl-TRH. Metoclopramide produced a small increase in serum thyrotropin and small reductions of serum growth hormone, luteinizing hormone and follicle-stimulating hormone. Metoclopramide may be useful for dynamic testing of PRL release. It offers the advantage of oral administration; a 10 mg dose produces a larger, more sustained increment in serum PRL than other agents used to evaluate prolactin reserve.
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Complex regional pain syndrome (CRPS) is an unusual complication after burns; however, it is important to recognize so that appropriate treatment can be administered. A 60-year-old man suffered an alkali burn to the right foot. Subsequently, the patient developed CRPS with severe pain and vasomotor changes. Multimodal treatment included the early use of ropivacaine and fentanyl via epidural catheter. Oral extended-release morphine, gabapentin, and amitriptyline also were administered. Once pain was controlled, early aggressive physical therapy was instituted, and attention was turned toward wound coverage. One year after discharge, the patient was ambulating well and has returned to work. His pain was managed with a single morning dose of gabapentin and a nonsteroidal anti-inflammatory agent. Current examination of the foot revealed mild forefoot swelling without residual erythema. Ambiguities exist in the mainstay of treatment for CRPS, but this multimodal method of controlling CRPS after burn injury allowed for control of the patient's pain, early mobilization, and eventual return to work.
BACKGROUND: Cellular expression of P-glycoprotein (P-gp) which mediates a well characterized mechanism of multidrug resistance (MDR) has been reported previously to be associated with an enhanced tumor dissemination. Since adhesion receptors of the beta 1 integrin family play a substantial role in tumor spread, we studied expression of VLA-1 to -6 in a total of four renal carcinoma cell (RCC) lines prior to and after induction of MDR via exposure to vinblastine. MATERIAL AND METHODS: Surface expression of P-gp and VLA-1 to -6 was determined immunocytochemically in untreated pre-established renal carcinoma cell lines (Caki-1, Caki-2, A498) and a cell line derived from a RCC patient who had received a vinblastine-containing therapy regimen prior to the resection of a local relapse of the tumor (EH). Resistant sublines were cultivated in the presence of 1 ng/ml and 10 ng/ml of vinblastine sulfate, respectively. RESULTS: In all cell lines examined, an increased number of P-gp expressing cells was observed upon exposure to vinblastine. Significant changes of beta 1 integrin expression were observed in three of four RCC cell lines. A de novo expression of VLA-1, VLA-2, and VLA-4 as detected by immunocytochemistry occurred in resistant Caki-1 cells. A498 cells showed an increasing number of VLA-2 positive cells in drug resistant sublines. In contrast, a decrease of VLA-2 and VLA-5 expression was found in EH cells, the only cell line exhibiting P-gp expression prior to vinblastine exposure. Caki-2 cells showed no significant changes of surface integrin expression upon treatment with vinblastine. CONCLUSIONS: Our results demonstrate that induction of drug resistance can be associated with substantial changes of the integrin phenotype in renal carcinoma cell lines. In our experiments, among all VLAs studied, VLA-2 was most frequently altered in expression by RCC cell lines. The significance of these observations for aberrant metastatic properties of multidrug resistant tumor cells will be the subject of further studies.
UNLABELLED: Hepatitis C represents a major public health challenge due to its chronic evolution and major complications (eg liver tumor and cirrhosis). New treatment strategies (interferon pégylé +/- ribavirine) have recently improved the prognosis except in case of poor compliance. Psychiatric comorbidity, especially affective disorders, is commonly associated with hepatitis C and constitutes the main cause of poor compliance, therapeutic discontinuations and treatment contra-indication. At this moment of new therapeutic protocols and the possibility of curing HCV infections, it is of utmost importance to widen antiviral treatment in many indications, to upgrade compliance, and to limit therapeutic discontinuations. In this context, where anxious and depressive disorders are the main reasons for failure in curing, it is necessary to anticipate the appearance of these troubles within an earlier multidisciplinary taking in charge. The primary aim of our study is to emphasize the utility of a multi-disciplinary approach including psychiatric evaluation, preventive follow-up and preventive treatment. The secondary objective is to show that a previous story of depression or use of drugs should not be considered as an insuperable contra-indication provoding the implementation of a specific follow-up. Thirty nine interferon treated patients were included in a prospective study. Our data confirm the high rate (28%) of Major Depressive Disorders among the population of hepatitis C treated patients in a preventive follow-up. A previous story of alcoholism, of suicide attempt or break off treatment with Major Depressive disorders might be predictive of such a complication. According to the subjective feeling of these patients with previous break'off treatment associated, specific psychiatric follow-up may improve tolerance for the treatment. METHODS AND OBJECTIVES: 39 patients (17 men and 22 women) accepted, on (or after) the non-systematic proposal of their hepatologist, to consult the psychiatrist of the network, prior to any therapeutic decision. The first objectives of the consultations were to inform the patient (and, with his agreement, his -relatives), about the risk of depressive disorders while under treatment by interferon, as well as their potential consequences. Moreover, the psychiatrist answers their questions concerning this issue, and proposes him a long-term psychotherapeutic follow up (up to several months after the antiviral treatment end) including availability in emergency if necessary and preventive antidepressive treatment. In this framework, we assessed in a prospective way the frequency, the intensity and the time (or moments) when major depressive episode (MDE) (according to the DSM IV) appeared under interferon alpha, the predictive factors for these MDE, the interest and the quality of a preventive antidepressive treatment prescription and the psycho-social benefits of this taking in charge for the patient. RESULTS: Among these 39 patients -regularly followed during and after the antiviral therapy, 11 (28%) had a MDE while under treatment. These MDE, except for 2 (5%) of them which led to an hospitalization, were mild to moderate. They mainly appeared within the 2 first quarters of treatment without significant difference. Patients with antecedents of suicide attempt (80%), drug addiction (50%) or alcohol addiction (50%) are more likely to have a MDE under interferon alpha than other patients, but these risk factors are not a contra-indication for treatment because 95% of the patients ended their treatment and the 2 antiviral treatment discontinuations observed were secon-dary to (or following) an acute psychotic episode (hospitalization) and a maniac episode in a schizophrenic patient (outpatient care). The existence of antecedents of antiviral treatment discontinuations due to MDE (33%) does not seem to be a risk factor anymore when preventive care is provided. It is interesting to point out the existence of a certain male fragility, men are more psychologically sensitive to interferon alpha than women. About 90% of patients chose to take an antidepressant. The latter was mainly a treatment with sertraline (45% out of cases), with citalopram (40% out of cases), and for 15% of them antidepressive treatment previously prescribed and non modified because they were well-tolerated and efficient. 86% of the first prescriptions were not changed during the follow up. 75% of patients already treated by a previous antiviral treatment with interferon alpha estimated that an earlier psychiatric accompaniment was very beneficial for them, in terms of compliance and socio-professional insertion. CONCLUSION: A specialized psychiatric accompaniment within a coherent multidisciplinary network provides a major benefit to the patients in terms of compliance and safe care (even for population considered as having higher risks) although it is not possible to define accurately the influence of the preventive prescription of a antidepressant (which is not prejudicial anyway). a previous story of depressive disorder should not be considered as a contra-indication, but should imply a specific psychiatric follow-up especially when alcoholism, previous story of suicidal attempt and previous break'off treatment are reported.
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