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PubMed1996

Non-pharmacological management of hypertension: results from interviews with 100 general practitioners.

OBJECTIVE: To describe the type and level of non-pharmacological management offered by general practitioners for essential hypertension. DESIGN: An open-ended interviewer-administered survey using a standard case of a 60-year-old man with essential hypertension. Seventy interviews were conducted face-to-face and 30 by telephone. SETTING: Auckland general practices. SUBJECTS: A random sample of 100 Auckland general practitioners. MAIN OUTCOME MEASURES: Aspects of the medical histories of patients, physical examination, laboratory testing and treatment relevant to non-pharmacological management. RESULTS: There was an 84% response rate. Most general practitioners reported offering non-pharmacological management at the first consultation before prescribing medication. However, few offered detailed programmes. Dietary therapy, restriction of alcohol consumption and exercise were suggested by most general practitioners. Restriction of sodium intake and behavioural therapy were less popular non-pharmacological interventions. The median number of visits of patients to a general practitioner before drugs were prescribed was five, which is in keeping with guidelines. The median number of days from the first visit to prescription of drug therapy was 42 (range 2-341). The clinical advice given by the majority of participants was consistent with current guidelines on the treatment of hypertension but the range of advice given was wide. CONCLUSIONS: The results suggest that general practitioners are aware of non-pharmacological interventions for the management of hypertension. They report making routine use of non-pharmacological therapies for blood pressure reduction and other health benefits early in the clinical process before considering pharmacological therapy. These non-pharmacological therapies are not delivered with well-defined and detailed programmes.

Alcohol Drinking↗
PubMed2001

Pharmacokinetic-pharmacodynamic modelling of human insulin: validity of pharmacological availability as a substitute for extent of bioavailability.

A method for assessing the extent of bioavailability (EBA) of human insulin from pharmacological data was determined. The time course governing increases in the plasma concentration of immuno-reactive insulin (IRI), as well as its pharmacological effects (glucodynamics), was determined after the intravascular administration of varying doses of human insulin. Pharmacokinetic (PK), pharmacodynamic (PD), and link models were constructed to elucidate the quantitative relationship between plasma IRI levels and pharmacological effects. After extravascular administration of the test formulation, only the time course governing the observed pharmacological effects was determined. The pharmacological data was translated into theoretical plasma concentration data, using the PK-PD model. Following this, the area under the theoretical plasma concentration-time curve (AUC) of the test formulation was calculated. The EBA was then estimated against a reference (intravascular) formulation, using a conventional equation. Since the pharmacological effects of insulin were observed to be highly dosing-rate-dependent, the PD model used in this study was modified to apply over a wide range of infusion rates. The results of the PK-PD analysis indicate that the doses administered can be accurately predicted from pharmacological data. To validate this method, the EBAs of controlled release formulations (the Osmotic Mini Pumps) of insulin, subcutaneously administered to the rat, were estimated. The EBA values obtained (92-96%) fell within a reasonable range. The area under the effect-time curves (AUE) obtained following subcutaneous applications of the Osmotic Mini Pump were calculated in a model-independent manner, in addition to pharmacological availabilities (PA), which were estimated against the reference (intravascular) formulations. The estimated PA values varied from 312% to 78%, in accordance with the intravascular input rates of the reference formulations. This indicates that PA should not be used as a substitute for EBA, unless data involving similar intravascular dosing rates to that of the reference formulations is available.

Animals↗
PubMed2003

A comparison of the neuroprotective efficacy of pharmacological pretreatment and antidotal treatment in soman-poisoned rats.

1. To study the influence of pharmacological pretreatment (PANPAL or pyridostigmine combined with biperiden) and antidotal treatment (the oxime HI-6 plus atropine) on soman-induced neurotoxicity, male albino rats were poisoned with a lethal dose of soman (54 (g/kg i.m.; 100% of LD50 value) and observed at 24 hours and 7 days following soman challenge. The neurotoxicity of soman was evaluated using a Functional observational battery and an automatic measurement of motor activity. 2. Pharmacological pretreatment as well as antidotal treatment were able to eliminate some of soman-induced neurotoxic effects observed at 24 hours following soman poisoning. The combination of pharmacological pretreatment (PANPAL or pyridostigmine combined with biperiden) and antidotal treatment was found to be more effective in the elimination of soman-induced neurotoxicity in rats at 24 hours following soman challenge in comparison with the administration of pharmacological pretreatment or antidotal treatment alone. To compare both pharmacological pretreatments, the combination of pyridostigmine with biperiden seems to be more efficacious to eliminate soman-induced signs of neurotoxicity than PANPAL. 3. At 7 days following soman poisoning, the combination of pharmacological pretreatment involving pyridostigmine and biperiden with antidotal treatment was only able to completely eliminate soman-induced neurotoxic signs. 4. Thus, our findings confirm that the combination of pharmacological pretreatment and antidotal treatment is able not only to protect the experimental animals from the lethal effects of soman but also to eliminate most soman-induced signs of neurotoxicity in poisoned rats. The pharmacological pretreatment containing pyridostigmine and biperiden appears to be more efficacious to eliminate soman-induced neurotoxic sings than PANPAL.

Animals↗
PubMed2002

Problem- vs. lecture-based pharmacology teaching in a German medical school.

We have compared the effectiveness of problem-based learning (PBL) and classical lecture-based learning (LBL) in conveying medical facts in a general pharmacology class of third year medical students ( n=107). Three groups with a total of 31 students were randomly assigned to PBL. The PBL groups (9-12 students each) received ten 2-h sessions in which a clinical case was discussed and ten 2-h sessions in which areas of pharmacology not covered by the case discussions were presented in an LBL format (one group with all 31 students). The other students were assigned to groups of 14-15 students and received 20 2-h sessions in an LBL format. At the end of the semester all students received a questionnaire and participated in the same 30-question multiple-choice exam. The mean number of false answers was 7.6+/-4.0 and 9.7+/-4.7 in the PBL and LBL groups, respectively ( P<0.05 in a two-tailed t-test), and the percentage of failing students (>10 false answers) was 27% and 38%, respectively. Both groups were asked to rate their pharmacology class on a scale of 1 (lowest) to 10 (highest). In this questionnaire, PBL students by average rated generated interest in pharmacology, conveyed knowledge in pharmacology and understanding of medical questions approximately 1 point higher than LBL students. In an additional questionnaire given to the PBL students only, they reported to have prepared themselves 0.9+/-1.1 h for their lecture sessions but 3.0+/-1.4 h for their case discussions. The above findings were largely confirmed in the next semester when students were allowed to decide whether to participate in PBL or LBL classes. Moreover, PBL students did not score worse than LBL students in nation-wide pharmacology exams (523+/-76 vs. 500+/-91 points, P=0.09). We conclude that a switch from LBL to PBL teaching of pharmacology does not occur at the expense of factual knowledge transmission.

Education, Medical, Undergraduate↗
PubMed2002

The educational preparation of undergraduate nursing students in pharmacology: clinical nurses' perceptions and experiences of graduate nurses' medication knowledge.

This paper explores clinical nurses' perceptions and experiences of graduate nurses' pharmacology knowledge. Six focus group interviews were conducted with clinical nurses of various appointment levels at two metropolitan public and two regional public hospitals in Victoria, Australia. Four major themes emerged from the study. First, participants indicated that graduate nurses had an overall lack of depth of pharmacology knowledge. While clinical nurses indicated that graduate nurses had enormous deficits in their pharmacology education, these deficits were not confined to graduate nurses--all nurses experienced difficulties in understanding and demonstrating pharmacological concepts in the clinical practice setting. Second, there was an unstructured approach to addressing the continuing education needs of graduate nurses. Third, theoretical and clinical principles of pharmacology knowledge were perceived to be important for practice. Fourth, improvements for nursing education involved the need for undergraduate students to take greater responsibility in monitoring and administering medications and the need for more structured learning experiences. The ultimate goal of consolidating pharmacology knowledge for graduate nurses is to optimise medication use, thereby improving the health outcomes of patients. Current teaching and learning opportunities appear to be inadequate in their efforts to enhance and improve graduate nurses' pharmacology knowledge. These inadequacies need to be addressed if the ultimate goal is to become a reality.

Adult↗
PubMed2002

The educational preparation of undergraduate nursing students in pharmacology: perceptions and experiences of lecturers and students.

This paper explores the perceptions and experiences of lecturers and undergraduate nursing students relating to teaching and learning issues in pharmacology. A total of 14 focus group interviews were conducted at 10 university settings, which involved seven academic staff and seven student interviews. The focus group interviewing method was used because it enabled all participants to have 'a say', facilitated the expression of diverse views, and allowed participants to express themselves without fear that their views would be openly criticised. Student participants comprised second and third year undergraduate nurses while lecturer participants involved course coordinators, subject coordinators, and bioscience and nursing lecturers. The 'framework' method was used for data analysis, which involved the following stages: familiarisation, identifying a thematic framework, indexing, charting, and finally, mapping and interpretation. Four major themes emerged from discussions with lecturers and students: teaching considerations, learning considerations, the relationship between pharmacology knowledge and clinical practice, and the features of an 'ideal' programme in pharmacology. The findings highlighted that potential conflicts existed among academic staff relating to the balance of pharmacology and nursing content in curricula, which often led to over-laden curricula. Potential conflicts also existed between lecturers and students about the value placed on a separate pharmacology subject as opposed to an integrated pharmacology programme. In summary, there is still much scope for educational initiatives to improve students' knowledge of pharmacology and medication management.

Adult↗
PubMed2001

Usage of the Internet pharmacology resources among European pharmacologists: a preliminary investigation.

The Internet is becoming an ever more important source of information in pharmacology and medicine. Little is known, however, about which Internet pharmacology resources are actually used by the pharmacologists - and to what extent - and how they estimate the Internet information quality and evaluation. This pilot study used an anonymous questionnaire, distributed among 250 mostly European (220/250) pharmacologists from 30 European countries attending The 2nd European Congress of Pharmacology, held in Budapest, Hungary, in 1999. According to study results, 93% of all participants use the Internet pharmacology resources: 56%, 35% and 9% of them on a daily, weekly and monthly basis, respectively. Among 56 pharmacological/medical free online databases offered, the general scientific databases were found to greatly prevail (Pub Med 60%, Evaluated MEDLINE 37%, Internet Grateful Med 29%, etc.), while drug monographs or toxicological databases were less used [e.g. ECDIN, RxList, National Toxicology Programme (NTP) < 10%]. Some 80% of the participants estimated the quality of the pharmacological information on the Internet as good or very good, while 20% thought the quality should be improved. Also, 35% of participants felt the need for improvement of the Internet pharmacological information evaluation, which should be the goal of pharmacology professional.

Europe↗
PubMed2002

Evaluating knowledge retention of third-year medical students taught with an innovative pharmacology program.

PURPOSE: To explore the degree of retention of pharmacologic knowledge of third-year medical students taught in a new pharmacology teaching program. METHOD: In 1997, the authors administered a retention test consisting of 100 multiple-choice questions, each with only one correct answer, to 457 third-year medical students at the National University of Mexico. Students were not told in advance about this diagnostic evaluation, which was given eight months after they completed the second-year pharmacology course. As a comparison, the authors also analyzed the results obtained by the same students in the three partial examinations taken during the second-year pharmacology course. The Kolmogorov-Smirnov procedure and Wilcoxon and chi-square tests were used to analyze data. RESULTS: The distribution of scores obtained in the partial exams well approximated a symmetrical bell-shaped curve, and the mean score was 59.9%. In contrast, in the retention test the distribution was negatively skewed, the mean score (69.8%) was significantly higher (p <.001), and the curve was clearly displaced to the right of that corresponding to the partial exams. The percentage of students obtaining at least a passing score (60%) was considerably higher for the retention test (82.5 versus 51.9). CONCLUSION: These findings, indicating that medical students taught in a new pharmacology program developed adequate basic pharmacologic knowledge, should encourage other medical schools to formally evaluate their teaching programs and continue efforts to improve pharmacologic education of medical students.

Curriculum↗
PubMed1997

Pharmacological importance of stereochemical resolution of enantiomeric drugs.

Drug enantiomers have identical properties in an achiral environment, but should be considered as different chemical compounds. This is because they often differ considerably in potency, pharmacological activity and pharmacokinetic profile, since the modules with which they interact in biological systems are also optically active. Within biological systems, the metabolism of one isomer may be via a different pathway or occur at a different rate from that of the other isomer. Preferential binding of one isomer to plasma proteins may cause differences in circulating free drug and hence alter concentrations at active sites. Interactions of both isomers may differ at the active sites through which pharmacological action is mediated. Actions and levels of activity of the stereoisomers in vivo may also differ. All the pharmacological activity may reside in a single enantiomer, whereas several possibilities exist for the other enantiomer-- it may be inactive, have a qualitatively different effect, an antagonistic effect or produce greater toxicity. Two isomers may have nearly identical qualitative pharmacological activity, qualitatively similar pharmacological activity but quantitatively different potency, or qualitatively different pharmacological activity. To avoid adverse effects and optimise the therapeutic value of enantiomeric drugs, it is necessary that methods for the resolution of racemates be evolved and devolved to determine isomeric purity, establish the effectiveness of isomers of the drug, and detect the presence of an enantiomer with lower therapeutic activity and undesirable adverse effects. Even if a drug is given as a pure enantiomer, methods to discriminate between enantiomers are required because racemisation can occur both in vitro and in vivo. Methods developed for resolution of drug enantiomers should facilitate routine testing of single isomers and their metabolites, studies of pharmacological, toxicological and clinical effectiveness, routine analysis of racemates, pure enantiomers or intermediates in manufacturing processes, and investigation of the potential for inversion of an enantiopure drug substance during the early stages of drug development and therapeutic drug monitoring.

Drug Design↗
PubMed1999

Pharmacology--a unique discipline for unique questions?

This article discusses the nature and responsibilities of the biomedical subject known as pharmacology. It will attempt to show how pharmacology is a very special subject that is uniquely positioned to ask fundamental questions about drugs, such as how they produce their actions, and how they may be used more effectively in man. Furthermore, pharmacology is a most important subject to the pharmaceutical industry as it is pharmacology, combined with medicinal chemistry and toxicology, that is responsible for the introduction of the vast majority of new drugs. Thus, pharmacologists are to be found in universities, research institutes and industry. In universities, pharmacologists are concerned more with discovering new drug-like entities in the body and natural world and in understanding how current drugs work. In industry, pharmacologists seek new drugs. Over the last decade there have been many discoveries in molecular biology, the new biology. The enthusiasm and revolutionary spirit which greets such discoveries leads to an assumption by some that pharmacology in its present form has been rendered redundant. This article refutes such a conclusion and shows how pharmacology has unique attributes and approaches that are as important now as they always were. Indeed, it argues for improvements in the understanding of pharmacology and how it remains a unique and special subject that should be nurtured.

Forecasting↗
PubMed1998

[Military pharmacology education outside the imperial school of medicine].

In 1870, just after starting medical education in Turkish at the Imperial School of Medicine (Mekeb-i Tibbiye-i Sahani) favor in the pharmacology and surgery courses decreased; and even pharmacology graduates continued their education to be physicians. This change gave rise to the shortage of pharmacists and surgeons in the army, and consquently in 1873 the branch of surgery and in 1876 pharmacology were inaugurated at the Haydarpasa Military Hospital. Those who had studied at this Hospital for three years were given a diploma for pharmacy practice (ameliyat eczaciligi sehadetnamesi) and were appointed to the army and to military hospitals. The years of education was raised to four years in 1888, and it was reduced to three years again in 1891. According to Charles Bonkowski, the chemist of Sultan Abdulhamid II, the instruction of military pharmacology was independent from the School of Medicine; he suggested the foundation of a higher school of pharmacy in Istanbul on the standards of the Paris Higher School of Pharmacology (Ecole Superieur de Pharmacie de Paris) where he had studied and graduated in 1865. Unfortunately this advice was not realised; but a department of pharmacology was opened within the Military High School for Veterinarians (Baytar Rustiye-i Askeriyesi) in Eyup in order to educate the students properly. This institution, renamed as the Military High School for Veterinarians and Pharmacists (Baytar ve Eczact Mekteb-i Rustiye-i Askeriyesi), had sent its graduates to the Imperial School of Medicine for many years. Since this process had proved to be useful, the Pharmacology Branch at the Haydarpasa Military Hospital was closed in 1892. In 1895, another military school which was called Eczaci ve Timarci Sibyan Mektebi started instruction on the Naval Hospital. Graduates of this school were appointed to the naval offices for minor operations.

Education, Pharmacy↗
PubMed2006

Emil Starkenstein--one of the most important personalities of European continental pharmacology in the period between the two world wars.

Emil Starkenstein (1884-1942), professor of pharmacology at the German Medical Faculty of Charles University in Prague, was not only an experimental pharmacologist, but also the pioneer of clinical pharmacology. During the World War I (1914-1918) he took advantage of his knowledge of experimental pharmacology for the new approaches to the treatment of bacillary dysentery, cholera and of epidemic typhus fever. In 1918 he published the article "Clinical Pharmacology--Theory and Praxis at the Patient's Bedside", in which he defined the main task of clinical pharmacology as the implementation and verification of experimental pharmacology achievements in clinical therapy. During the period 1921-1933, his scientific interests involved namely analgesic combinations, seasickness therapy and pharmacology of iron. He published more than 240 scientific articles and three textbooks. Emil Starkenstein died on November 6, 1942 as a victim of Holocaust. Starkenstein s collection of more than 20,000 reprints of scientific studies, which has been deposited recently in the Archives of Charles University in Prague is very valuable.

Europe↗
PubMedDate not supplied

[Reviewing the initial plans for the teaching of pharmacology: quality vs. quantity of knowledge, hesitation is no longer possible].

Pharmacology is located at the intersection of several branches of medical education. This position and the exponential development of medical knowledge, constrains university professors of pharmacology to make teaching choices, since time-limited education is imposed in this subject. Thus, it is necessary to list specific educational objectives within a frame of well defined and clear hierarchized pharmacological concepts. General and practical pharmacology teaching is to be preferred since it provides the knowledge base for further acquisition of specialized pharmacology. The necessary data can be easily and rapidly taught by means of clinical observations and case reports in connection with basic pharmacological concepts and therapeutic strategy. The medical student has to acquire rational guidelines for proper drug monitoring. He also has to learn how to assess the efficacy of the prescribed treatment and how to supervise the compliance. When an adverse effect is observed, the future physician must be able to evaluate the benefit-risk ratio. Initiation into the analysis of published clinical trials is the best way to develop a critical sense. Concurrently, pharmacology teachers should make available technical and practical resources to facilitate access to updated scientific data.

Drug Prescriptions↗
PubMed2000

Pharmacological interventions for acute spinal cord injury.

BACKGROUND: Acute spinal cord injury is a devastating condition typically affecting young people with a preponderance of males. Pharmacological treatment in the early hours of the injury is aimed at reducing the extent of permanent paralysis during the rest of the patient's life. OBJECTIVES: To review randomized trials of pharmacological therapies for acute spinal cord injury. SEARCH STRATEGY: The review draws on the search strategy developed by the Cochrane Injuries Group. In addition, files of the National Acute Spinal Cord Injury Study have been reviewed. SELECTION CRITERIA: All published or unpublished randomized controlled trials of pharmacological treatment for acute spinal cord injury in any language. DATA COLLECTION AND ANALYSIS: Data have been abstracted from original trial reports. For the NASCIS, Japanese and French trials, additional data (e.g. SDs) have been obtained from the original authors. MAIN RESULTS: There are few trials in this area of medical care. Only one therapy has been extensively studied, methylprednisolone sodium succinate, which has been shown to improve neurologic outcome up to one year post injury if administered within 8 hours of injury and in a dose regimen of: bolus 30mg/kg administered over 15 minutes with a maintenance infusion of 5.4 mg/kg per hour infused for 23 hours. The initial North American trial was replicated in a Japanese trial but not in the one from France. Data has been obtained from the latter study to permit appropriate meta-analysis of all three trials. This analysis indicates significant recovery in motor function after methylprednisolone therapy. A more recent trial indicates that if methylprednisolone therapy is given for an additional 24 hours (for a total of 48 hours), additional improvement in motor neurologic function and functional status is observed. This is particularly observed if treatment cannot be started until between 3 to 8 hours after injury. The same methylprednisolone therapy has been found effective in whiplash injuries and a modified regimen found to improve recovery after surgery for lumbar disc disease. REVIEWER'S CONCLUSIONS: High dose methylprednisolone steroid therapy is the only pharmacological therapy shown to have efficacy in a Phase Three randomized trial when it can be administered within 8 hours of injury. High dose methylprednisolone has been accepted as standard therapy in many countries. A recent trial indicates additional benefit by extending the maintenance dose from 24 to 48 hours if start of treatment must be delayed to between 3 and 8 hours after injury. There is an urgent need for more randomized trials of pharmacological therapy for acute spinal cord injury.

Anti-Inflammatory Agents↗
PubMed2005

Primary study on the application of Serum Pharmacology in Chinese traditional medicine.

In the paper, two main methods, which are Serum Pharmacology and Traditional Pharmacology, were adopted to study Chinese traditional medicine, such as Ginkgo biloba extract (GBE), ginsenosides (GS) and compound GG (GBE+GS), pharmacology in vitro. The results showed that there were evident difference between the results of Serum Pharmacology and that of Traditional Pharmacology. There was no significant difference between the drug effect of crude GS on nitric oxide (NO) production in ECV304 and that of crude GBE, and the drug effect of GG was superior to that of GS and GBE, respectively. But, compared with GBE serum, the GS serum up-regulation of NO production in ECV304 increased significantly, and the GG serum up-regulation of the NO production in ECV304 was inferior to that of GS serum and GBE serum significantly. The results suggested that Serum Pharmacological study should be adopted in the pharmacological investigation on the Chinese traditional medicine and the drug screening of the Chinese traditional medicine.

Animals↗
PubMed1997

Pharmacological heterogeneity of NMDA receptors: characterization of NR1a/NR2D heteromers expressed in Xenopus oocytes.

The pharmacology of recombinant NR1a/NR2D NMDA receptors expressed in Xenopus oocytes was examined and compared to the pharmacology of NR1a/NR2A, NR1a/NR2B and NR1a/NR2C heteromers. The NR1/NR2D heteromer showed a pharmacological profile distinct from each of the other NR1/NR2 heteromers. This unique pharmacological profile was characterized by a relatively lower affinity for the agonist homoquinolinate and the antagonists 2-amino-5-phosphonopentanoate (D-AP5) and (R,E)-4-(3-phosphonoprop-2-enyl)piperazine-2-carboxylic acid (D-CPPene) but not for the antagonists (+/-)-4-(4-phenylbenzoyl) piperazine-2,3-dicarboxylic acid (PBPD) and alpha-amino-5-(phosphonomethyl)[1,1'-biphenyl]-3-propanoic acid (EAB515). NR2D-containing receptors displayed a pharmacological profile most similar to that observed for receptors containing the genetically related NR2C subunit. These findings parallel observations obtained for native NMDA receptors in the medial thalamus (presumed to contain NR2D subunits) and forebrain (presumed to contain NR2A and NR2B subunits). Thus, only compounds that discriminate between either NR2A- or NR2B-containing heteromers and NR2D-containing heteromers also discriminate between forebrain and medial thalamic NMDA receptors. While the pharmacology of the NR1a/NR2D receptor shows many parallels to the medial thalamic NMDA receptor, some differences were observed. Certain compounds which discriminate between medial thalamic and cerebellar (presumed to contain NR2C subunits) receptors (e.g., homoquinolinate, D-CPPene) did not show a similar selectivity for NR1a/NR2D receptors relative to NR1/NR2C receptors. Co-expression of NR1a, NR2B and NR2D subunits in Xenopus oocytes resulted in the formation of heteromeric complexes with unique pharmacological properties, suggesting the co-existence of these two distinct NR2 subunits in the same receptor complex.

2-Amino-5-phosphonovalerate↗
PubMed1997

Pharmacological classification of central post-stroke pain: comparison with the results of chronic motor cortex stimulation therapy.

In an attempt to clarify the neurochemical background of central post-stroke pain and to undertake a pharmacological analysis, the basic pharmacological characteristics of this intractable pain syndrome were investigated by the morphine, thiamylal and ketamine tests. In addition, the correlation between the pharmacological characteristics and the effects of chronic motor cortex stimulation therapy was examined. The study employed 39 central post-stroke pain patients who had intractable hemibody pain associated with dysesthesias, and radiologically demonstrated lesions in the thalamic area (thalamic pain, n = 25) or suprathalamic area (suprathalamic pain, n = 14). The pharmacological evaluations showed that definite pain reduction occurred in eight of the 39 cases (20.5%) by the morphine test, in 22 of the 39 cases (56.4%) by the thiamylal test, and in 11 of 23 cases (47.8%) by the ketamine test. Based on these pharmacological assessments, there was no obvious difference between thalamic and suprathalamic pain. A comparison of the long-term follow-up results of chronic motor cortex stimulation therapy revealed that thiamylal and ketamine-sensitive and morphine-resistant cases displayed long-lasting pain reduction with chronic motor cortex stimulation therapy, whereas the remaining cases did not show good results. We conclude that pharmacological classification of central post-stroke pain by the morphine, thiamylal and ketamine tests could be useful for predicting the effects of chronic motor cortex stimulation therapy. It has recently been suggested that excitatory amino acids may be involved in the development of central post-stroke pain. However, the fact that only 23 of the present 39 cases (59.0%) of thalamic and suprathalamic pain were sensitive to the thiamylal or ketamine test reflects the complex pharmacological background and the difficulties associated with treating central post-stroke pain.

Adult↗
PubMed1999

Prognostic indices in heart transplant candidates after the first hospitalization triggered by the need for intravenous pharmacologic circulatory support.

BACKGROUND: Patients with heart failure refractory to optimal oral pharmacologic therapy have a dismal short term prognosis. Heart transplantation is the only therapy shown to improve survival in these patients. Unfortunately, due to the critical shortage of donor organs, approximately 30% of listed patients with end-stage heart failure die before a suitable donor heart becomes available. The principal aim of this study was to determine whether intravenous pharmacologic circulatory support favorably influences the clinical course of heart transplant candidates or whether mechanical circulatory support should be instituted in this high risk patient population. METHODS: Data from 154 consecutive hospitalizations in 125 patients 49+/-12 years were retrospectively reviewed. The product limit method was used to estimate survival. Multiple logistic regression analysis was used to identify the clinical and hemodynamic variables that independently predict outcome after each admission in which heart transplantation did not occur. RESULTS: One year survival for the study population was 65%. This survival is significantly lower than the 91% 1 year survival in similarly ill patients undergoing heart transplantation. The Cox proportional hazard method identified serum bilirubin, blood urea nitrogen (BUN), serum sodium levels and right atrial pressure as independent prognostic indices. Serum bilirubin, BUN levels and duration of intravenous pharmacologic circulatory support were associated with a poor outcome. A composite index including serum bilirubin and BUN levels predicted outcome with a sensitivity and specificity of 79% and 77%, respectively. The addition of pharmacologic support duration increased the model's sensitivity to 95%, but did not significantly alter specificity that was 74%. Of the 125 patients hospitalized due to the need to initiate intravenous pharmacologic support for the first time (index hospitalization), 69 (55%) were discharged after optimization of medical therapy. Of 21 patients who did not undergo transplantation during the follow-up period, 18 (86%) died within 2 years of the index hospitalization. The duration of intravenous pharmacologic support beyond which prognosis dramatically worsens without heart transplantation is 21 days. CONCLUSION: Heart transplant candidates who require intravenous pharmacologic circulatory support for more than 21 days and do not receive a suitable donor heart within this period of time have a high mortality. Alternative therapies, such as implantation of a mechanical circulatory assist device should be considered in this high risk population.

Adolescent↗