Pharmacotherapy for fecal incontinence: a review.

Fecal incontinence is a common clinical problem that often is frustrating to the patient and treating physician. Nonsurgical management for fecal incontinence includes dietary manipulation, Kegel exercises, perianal skin care, and biofeedback therapy. Pharmacotherapies often are used to assist in management of fecal incontinence.

The rationale and design of the Glycemic Effects in Diabetes Mellitus Carvedilol-Metoprolol Comparison in Hypertensives (GEMINI) trial.

Beta-blockers utilized in the Type 2 diabetic patient result in an even greater decrease in cardiac events than in the nondiabetic patient. Unfortunately, first-and second-generation beta-blockers are associated with the worsening of insulin resistance, deterioration of glycemic control, peripheral vasoconstriction, potentially worsening peripheral vascular disease, and more frequent and severe hypoglycemia. The third-generation beta-blockers have unique properties, including alpha1-blockade, and have been shown to lower insulin resistance, improve glycemic control, and vasodilate resistance arterioles.

Force control and disease severity in Parkinson's disease.

Several measures of isometric contractions reflect motor impairments in subjects with Parkinson's disease (PD), including long relaxation times and greater power in the 5 to 15 Hz electromyographic (EMG) bandwidth during the holding phase of contractions compared to those measures in healthy subjects. We sought to determine whether the impairments observed in subjects with PD in the performance of isometric contractions reflect disease severity. Twenty-eight subjects with PD performed isometric contractions at a torque level equal to 50% of the torque generated during a maximum voluntary contraction while off medication.

Munchausen's syndrome in neurosurgery: report of two cases and review of the literature.

Objective And Importance: Munchausen's syndrome is a rare psychiatric condition, in which patients seek medical treatment for factitious or self-induced medical problems. Reports in the literature of postoperative Munchausen's syndrome are extremely rare. The major obstacle to improving management of the patients with Munchausen's syndrome is increasing physicians' awareness and recognition of the disease.

Dynamic loads are determinants of peak bone mass.

This study investigated the association between non-invasive measurements of bone mass and markers of dynamic and static hip joint loads in subjects expected to be at peak bone mass. The bone mineral density (BMD) and bone mineral content (BMC) of three proximal femoral sites (neck, greater trochanter, and total) were measured by dual energy X-ray absorptiometry, and the peak external joint moments at the hip during walking and jogging were calculated from gait analyses of 31 normal human subjects ranging in age from 30 to 49 years (18 females, 13 males). Various multiple regression analyses were performed to determine how much of the variance in BMD and BMC was explained by height, body mass, and the peak hip joint moments.

Street drug abuse leading to critical illness.

Critical care physicians are frequently confronted with intoxicated patients who have used street drugs. In the last decade there has been an upward trend in the use of these substances, particularly amongst adolescents and young adults in large urban areas. In excess quantities all street drugs can lead to critical illness.

Normative data for 144 compound remote associate problems.

We have developed and tested 144 compound remote associate problems. Across eight experiments, 289 participants were given four time limits (2 sec, 7 sec, 15 sec, or 30 sec) for solving each problem. This paper provides a brief overview of the problems and normative data regarding the percentage of participants solving, and mean time-to-solution for, each problem at each time limit.

Effects of COX inhibition on blood pressure and kidney function in ACE inhibitor-treated blacks and hispanics.

Cyclo-oxygenase (COX) inhibitors attenuate the antihypertensive effects of angiotensin-converting enzyme (ACE) inhibitors and reduce kidney function. The study tests the hypothesis that these two classes of drugs have similar effects on glomerular filtration rate (GFR) and 24-hour blood pressure. The primary endpoint was change in 24-hour systolic blood pressure.

Design optimization of intraoperative radiotherapy cones.

Purpose: Electron intraoperative cones (EIORCs) commonly used for intraoperative radiation therapy (IORT) often generate high-dose regions at superficial depths. This study was performed to optimize the use of rings in the EIORC design that reduces the high-dose region while minimizing the loss of the treatment volume at the prescribed depth.

Methods And Materials: Monte Carlo simulations were performed to study the dosimetry properties of various EIORC designs.

Angiotensin converting enzyme inhibitors or angiotensin receptor blockers in nephropathy from type 2 diabetes.

Type 2 diabetes is the most common cause of end-stage renal disease in the United States, and type 2 diabetes has been shown to be a myocardial infarction equivalent in regard to risk of death from a cardiovascular event. Proteinuria is a surrogate marker for renal disease progression, and although data favor both the angiotensin converting enzyme (ACE) inhibitors and angiotensin receptor blockers (ARBs) in reducing proteinuria, data for renal outcomes, such as time to dialysis, only exist for the ARBs, which clearly increase the duration to dialysis. Conversely, ACE inhibitors have overwhelming data that show substantial risk reduction from cardiovascular events and death in people with type 2 diabetes.

Preclinical evaluation of sodium cellulose sulfate (Ushercell) as a contraceptive antimicrobial agent.

The spread of sexually transmitted infections (STIs) and limited methods for control of pregnancies presents high risks to the reproductive health of women. Methods controlled by women and directed toward disease prevention and contraception are needed. We report on preclinical studies of the biological properties of sodium cellulose sulfate (Ushercell) currently being developed for use as a topical contraceptive antimicrobial agent.

Modulation of radiotherapy photon beam intensity using magnetic field.

The purpose of this study was to explore the potential advantages of using strong magnetic fields to increase tumor dose and to decrease normal tissue dose in radiation therapy. Strong magnetic fields are capable of altering the trajectories of charged particles. A magnetic field applied perpendicularly to the X-ray beam forces the secondary electrons and positrons to spiral and produces a dose peak.

Splenectomy ablates endotoxin-induced IFNgamma response in rats.

The mechanism of liver injury in endotoxemia is unclear. Previous studies have shown that splenectomy protects the liver from endotoxin-induced injury. The purpose of this study was to determine the relationship of TNFalpha and IFNgamma release and endotoxin-induced liver injury in splenectomized and nonsplenectomized rats.

Restless legs syndrome: treatment with dopaminergic agents.

Restless legs syndrome (RLS) is a common neurologic disorder that affects 5 to 10% of the population and increases in prevalence with aging. The clinical hallmarks of RLS include dysesthesias or paresthesias in the legs and sometimes the arms, occurring primarily at rest, which are usually worse in the evening and are alleviated by movement. RLS can be a disabling disorder, causing sleep disturbance at night and excessive sleepiness during the day.

Choices and goals in the treatment of the diabetic hypertensive patient.

The number of people living in the United States who have diabetes and high blood pressure is over 11 million and rising. Together, these two diseases are devastating to the whole body if not aggressively controlled. The tight recommendations put forth by the Joint National Committee VI for better control of blood pressure and control of proteinuria have helped diminish further organ failure in patients with hypertension and diabetes.

Evaluation of poly(styrene-4-sulfonate) as a preventive agent for conception and sexually transmitted diseases.

A commercial preparation of a sodium polystyrene sulfonate (designated as N-PSS; its molecular weight is 500000 daltons) was tested as an inhibitor of sperm function and as a preventive agent for conception and the transmission of sexually transmitted diseases. The polymer is an irreversible inhibitor of hyaluronidase and acrosin; its IC50 values are 5.7 microg/mL and 0.

Flow cytometric detection of HLA-specific antibodies as a predictor of heart allograft rejection.

Background: Historically, panel reactive antibody (PRA) analysis to detect HLA antibodies has been performed using cell-based complement-dependent cytotoxicity (CDC) techniques. Recently, a flow cytometric procedure (FlowPRA) was introduced as an alternative approach to detect HLA antibodies. The flow methodology, using a solid phase matrix to which soluble HLA class I or class II antigens are attached is significantly more sensitive than CDC assays.

[Mechanism of primary hypertension].

We review various theories of the pathogenetic mechanisms of steroid-induced and essential hypertension. We investigated the possibility that a pathogenetic mechanism leading to glucocorticoid (GC)-induced hypertension or to mineralocorticoid (MC)-induced hypertension, or both, may be of critical importance in primary hypertension. We studied plasma levels of corticosterone (BK) and aldosterone (Aldo), and their concentrations in arterial and renal tissues of spontaneously hypertensive rats (SHR), a model of primary hypertension, and in the antecedent strain WKY rats as a normotensive control.

Hemodynamic homeostasis during acute hypoxia in septic and nonseptic piglets: differential role of prostaglandins and nitric oxide.

We studied the hemodynamic responses of 29 anesthetized and mechanically ventilated piglets to acute hypoxia [reduction of Pao2 from 130 to 38 mm Hg induced by inhalation of 7% fraction of inspired oxygen (Fio2) for 7.5 min] before and during group B beta-hemolytic streptococci (GBS) sepsis. During hypoxia, nonseptic piglets maintained stable systemic blood pressure [105+/-9 (SD) to 97+/-14 mm Hg] and cardiac output (CO) (667+/-72 to 685+/-113 mL/min).

Stroke in African Americans.

There is an excess burden of cerebrovascular disease in African Americans. This article will define possible reasons for excess stroke risk, review racial differences in stroke subtype and stroke prevention programs in the African American Community, and delineate sequelae of stroke. The authors provide insights about stroke prevention in African Americans and highlight challenges to reduce the burden of cerebrovascular disease in this high-risk group.

Plasma lipids and stroke.

High plasma levels of lipids are an important modifiable risk factor for coronary heart disease, but are not established as a risk factor for stroke. Pathophysiologic evidence that links lipids to major systemic artery disease, and the results of clinical trials of coronary heart disease prevention in relation to lipid-lowering suggest that lipids may play an important role in the causation of stroke. We discuss the controversy concerning plasma lipids as a risk factor for stroke.

Changes in adverse events reported by patients during 6 months of fluoxetine therapy.

Background: Although a period of 6 to 12 months of antidepressant therapy is recommended for most patients with depression, systematic examinations of the course of adverse events over time, the resolution of early-onset events, and the possible emergence of later-onset events are limited. We examined the safety of fluoxetine, 20 mg/day, in a large, prospective, long-term treatment trial, and we report a comparison of early- and late-onset adverse events and the course of adverse events over 26 weeks of treatment.

Method: Adverse events were recorded at each visit in a uniform format by open-ended questioning, regardless of perceived causality.