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PubMed1994

Is baseline agitation a relative contraindication for a selective serotonin reuptake inhibitor: a comparative trial of fluoxetine versus imipramine.

A common presentation for major depression includes psychomotor agitation. However, this subtype has been the infrequent subject of controlled investigation during depression trials. Yet, the subcategorization of agitated depression has historically been associated with the belief that older, sedating compounds have a superior risk:benefit profile. In the 8-week, double-blind, randomized, parallel trial, 124 subjects with Research Diagnostic Criteria-compatible agitated depression were randomized to either imipramine (IMI) or fluoxetine (FLU). Both compounds proved to be similarly effective as measured by change in HAM-D17, HAM-D17 response, and HAM-D17 remission rates. Similar comparability was seen in secondary measures of agitation, anxiety, suicidality, and global impressions. However, of note, a statistically significant difference in early discontinuations because of intolerable adverse events emerged. Whereas 43.5% of IMI subjects discontinued early, only 9.7% of FLU subjects (p < 0.001) did. Significantly more central nervous system events characterized the IMI than the FLU subgroup (IMI, 24.2%, vs. FLU, 6.5%; p = 0.006). In conclusion, among subjects with major depression, subtype agitated, the risk:benefit profile favored FLU over IMI. This was driven by the superior tolerance of FLU. No evidence emerged in support of the clinical hypothesis that a "sedating" agent is the treatment of choice for this group. The results are important when striving to maximize compliance with pharmacotherapy in order to minimize recidivism and associated psychological and economic morbidity.

Adolescent↗
PubMed1994

Is overhydration in CAPD patients a contraindication to renal transplantation?

Over a 14 year period, 56 of 415 CAPD patients (34 male, 22 female), aged 42.7 +/- 11 years, underwent renal transplantation (TR). A cadaver kidney was used in 53 patients (kidney-pancreas in 2), and a human leucocyte antibody (HLA) identical related donor organ was used in 3. Underlying renal diseases were chronic glomerulonephritis in 30 patients, diabetic nephropathy in 10, interstitial nephropathy in 5, vascular in 4, polycystic kidney in 3, and undetermined in 4. Mean duration of CAPD prior to TR was 13 months (2-56 months). A three-week peritonitis episode-free interval was requested prior to TR. At year 1, actuarial patient and graft survival (96% and 86%, respectively), plasma creatinine, and number of rejection episodes were not different from those recorded in patients treated with hemodialysis (HD) prior to TR. At TR, pulmonary artery pressure (PAP) was elevated (average 21.1 +/- 7.4 mm Hg), > or = 25 mm Hg and > or = 30 mm Hg in 36% and 14.6% of CAPD patients, respectively. Post-TR, HD was performed in 4 patients; no peritoneal infection occurred. Postoperative sonography disclosed ascitis in 12.7% of CAPD patients. The PD catheter was removed two months post-TR. Hemodynamic findings at TR suggest a frequently underestimated overhydration in CAPD patients, which should be detected and treated in order to reduce acute cardiovascular complications at TR.

Adult↗
PubMed1994

[Indications and contraindications for therapy with implantable cardioverters/defibrillators].

Despite all advances in the diagnostic and therapy of cardiovascular diseases the mortality from malignant ventricular tachyarrhythmias is still a major health problem. In addition to established therapeutic strategies in the prevention of sudden cardiac death such as antiarrhythmic drug treatment, catheter ablation or antiarrhythmic surgery the implantable cardioverter/defibrillator was introduced to clinical practice in 1980. The number of 50,000 overall implants reflects the current clinical status of the therapy with implantable cardioverters/defibrillators. Significant technical improvements in the defibrillator therapy may contribute to an increase in therapy acceptance. These advances include the introduction of nonthoracotomy lead systems, enhanced defibrillation efficacy, full programmable devices providing tiered electrical therapy, improved diagnostic Holter functions and enhanced arrhythmia detection algorithms. The major present goals of defibrillator therapy are, detection and termination of malignant ventricular tachyarrhythmias, reduction of sudden cardiac death, reduction in patient's mortality and improvement in quality of life. The efficacy and safety of defibrillator therapy to prevent sudden arrhythmic death has been proven in several large clinical investigations. The annual sudden cardiac death mortality is < 2% even in high-risk patient populations. Compared to sudden cardiac death rate there is a much higher rate of overall cardiac mortality because a defibrillator is not able to prevent nonarrhythmic cardiovascular deaths. There is a clinical impression that cardiovascular mortality is lower in patients treated with an implantable cardioverter/defibrillator compared to patients treated with other therapies. However there are no results from controlled studies providing scientific evidence that defribillator therapy can reduce overall cardiovascular mortality.(ABSTRACT TRUNCATED AT 250 WORDS)

Contraindications↗
PubMed1994

Indications and contraindications for upper gastrointestinal endoscopy.

Upper endoscopy is currently one of the most frequently performed procedures. The most common indications for diagnostic EGD include dyspepsia unresponsive to medical therapy or associated with systemic signs, dysphagia or odynophagia, persistent gastroesophageal reflux symptoms, occult gastrointestinal bleeding, and surveillance for malignancy. These guidelines, however, are largely based on consensus opinion, and few controlled trials have evaluated the effect of endoscopy on patient outcome, medical expenditures, and management. It appears that the benefits of therapeutic upper endoscopy for such conditions as acute gastrointestinal bleeding, foreign-body removal, and stricture dilatation are more well defined. Future studies should be directed at the most cost-effective and beneficial management strategies for many of these common conditions.

Contraindications↗
PubMed1994

Buried penis as a contraindication for circumcision.

Neonatal circumcision is a frequently performed procedure with rare complications. Buried penis is an infrequent congenital penile deformity. If unrecognized, circumcision of these infants may have serious consequences. Buried penis refers to a penile shaft that is buried below the surface of the prepubic skin because of an abnormally prominent suprapubic fat pad and dense fascial bands retracting and tethering the penis. Description of the entity and operative repair are discussed. Avoidance of neonatal circumcision in patients with buried penis is imperative to prevent worsening of the condition.

Circumcision, Male↗
PubMed1994

[Rehabilitation in coronary heart disease. Value, indications and contraindications of exercise therapy].

In the rehabilitation of patients with coronary heart disease, physical therapy, in particular kinesitherapy plays a central role. The effects of regular endurance training are multifarious, ranging from improvements in functional capacity to a reduction in risk factors and to psychosocial aspects. At the beginning of the rehabilitation program in particular, safety and close supervision are of primary importance, and training on the bicycle ergometer is a first choice method. Depending upon the extent of the coronary heart disease, for example disordered functioning of the left ventricle or postoperative status following revascularisation surgery, modification and adaptation of the treatment regimen may be required. The risk of a cardiovascular incident occurring is low, and extensive studies performed in recent years have shown a reduction in cardiovascular mortality through the use of long-term rehabilitation programs.

Contraindications↗
PubMedDate not supplied

[Substitutive hormone therapy in postmenopausal osteoporosis. Are there any contraindications?].

Estrogen deficiency is the main cause of postmenopausal osteoporosis. Replacement estrogen therapy protects the bone by reducing bone resorption and activating osteoblasts, as well as by promoting absorption of calcium and production of calcitonin. These preventive effects are especially marked in cancellous bone, provided estrogen therapy is initiated as soon as menstruation stops. Effects are dose-dependent and efficacy of the treatment is noticeable mainly during the period of administration. The rare contra-indications to estrogen therapy include hormone-dependent cancers, cholestatic jaundice, and large uterine myomas (for which surgical treatment is recommended). Metabolic disorders, arterial hypertension, and thyroid function disorders are less common with the new natural estrogens (estradiol) given orally or percutaneously to avoid hepatic passage of the drug. As for treatment induced cancers, sequential administration of a progestagen protects the endometrium and the relative risk seems negligible for breast cancer. Although concomitant use of a progestagen is mandatory, either natural progesterone or norpregnanes should be given to avoid adverse metabolic effects. Emphasis has recently been put on the role of concomitant progestagen therapy which may promote the formation of bone, probably by competing for glucocorticoid receptors in bone. There is still a need for prospective epidemiological studies, although evaluation methods and the long follow-ups needed raise significant problems.

Bone Resorption↗
PubMedDate not supplied

Indications and contraindications for heart transplantation in infancy.

Heart transplantation uniquely offers infants with irreversible myopathies and complex congenital heart disease (CCHD) the potential for survival. Heart transplantation in the first year of life has an actuarial 1-year survival rate of 85%. Controlling for the variables that lead to perioperative death can improve 1-year survival rates to 95%. Mortality is also accrued before transplantation, with 15% to 20% of infants dying before a donor organ is available. Because of this cumulative mortality, an algorithm was developed to maximize pre- and posttransplantation survival and thus increase the likelihood that the limited donor supply would have the greatest impact. The risk factors considered in the algorithm include: (1) hemodynamic stability, (2) central venous access/prostaglandin requirements, (3) need for ventilator support, (4) pulmonary blood flow dependent on a critically restricted atrial septal defect, (5) risk for pulmonary hypertension, (6) anomalous pulmonary venous return, and (7) history of sepsis. Overall, patient survival would be maximized by only using transplantation for patients with CCHD who have moderate or less risk of pre- or posttransplantation death (< 20%). Donor organ utilization could be maximized by reserving transplantation for patients without options (myopathies) and for patients with CCHD who have a low predicted risk of death (< 10%). Because the risks of death at transplantation or in the first year after transplantation are low and relatively fixed, changes in risks of palliative surgery or donor availability can be easily used to adjust the decision algorithm.

Contraindications↗