Review: Case based article on skin lesions associated with injecting drug use both typical and atypical lesions mentioned. Includes criteria for substance dependence and discussion particularly related to amphetamin use. Comment: Helpful for all GPs to be aware of this. Not all presentations of injecting drug use are `typical'.
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Manage a case of alcohol abuse in pregnancy: Arrange and interpret appropriate maternal and fetal investigations Liaise with primary care, social services, alcohol dependency team and refer, where appropriate, for further assessment and treatment Counsel regarding maternal, fetal and neonatal risks Institute and modify supportive and drug therapy Plan pregnancy, delivery and postnatal care. Manage a case of substance abuse in pregnancy: Arrange and interpret appropriate maternal and fetal investigations Liaise with primary care, social services, alcohol dependency team and refer, where appropriate, for further assessment and treatment Counsel regarding maternal, fetal and neonatal risks Institute and modify supportive and drug therapy Plan pregnancy, delivery and postnatal care.
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1. Pau H and Wahl M: Myambutol-Schadigung des Auges. Ber Dtsch Ophthalmol Ges 72: 176, 1972. Trusciewicz D: Farnsworth 100-Hue test in diagnosis of ethambutol-induced damage to optic nerve. Ophthalmologica 171: 425, 1975. Zrenner E and Kriiger CJ: Ethambutol mainly affects the function of red green opponent neurons. Doc Ophthalmol Proc Ser 27: 13, 1981. Carr RE and Henkind P: Ocular manifestations of ethambutol. Toxic amblyopia after administration of an experimental antituberculous drug. Arch Ophthalmol 67: 566, 1962.
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Received March 16, 2004, revision accepted June 25, 2004. For reprint contact: Hiroyuki Mochizuki, M.D., Department of Pediatrics and Developmental Medicine, Gunma University Graduate School of Medicine, Showa-Machi 33915, Maebashi 3718511, JAPAN and
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Sigal and Hassett published an article about Lyme disease in the EHP Supplements Sigal and Hassett 2002 ; , suggesting that chronic Lyme disease is "psychogenic." I do not think that Sigal and Hassett, nonpsychiatrists, are qualified to speak about psychiatric matters. I, however, actually have had the disease, which they characterize as "medically unexplained, " for over 25 years and have 15 years of experience as a patient advocate and educator. I beg to differ. Many reports in the peer-reviewed medical literature substantiate the notion of persistent infection. Borrelia burgdorferi, the causative organism, has been cultured after "adequate" antibiotic therapy from the brain, eye, heart, spleen, spinal fluid, skin, lymph nodes, joints, and synovial fluid Cimmino et al. 1989; Cimperman et al. 1996; Haupl et al. 1993; Liegner et al. 1992; Oksi et al. 1996; Patmas 1994; Peter et al. 1993; Pfister et al. 1991; Preac Mursic et al. 1993; Reimers et al. 1993; Schmidli et al. 1988 ; . Table 1 provides information on some of the articles supporting persistent infection. A more complete listing of Lyme disease abstracts may be obtained from the Lyme Disease Network 2002 ; . I and the many other Lyme patients I know are neither "confused" nor "insecure." We did not seek a "societally and morally acceptable explanation" Sigal and Hassett 2002 ; for our illness; we sought a scientific and medical explanation. We have and
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Note: Clinical development for new drugs is divided into three phases: Phase I: Testing for safety using a small group of healthy subjects. Phase II: Testing for safety and efficacy using a small group of patients. Phase III: Double-blind tests to compare efficacy against similar, existing drugs and other drugs using a large group of patients and
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He diagnosis of irritable bowel syndrome IBS ; is based on symptom criteria and exclusion of organic disease. Manning and colleagues in 1978 reported a set of criteria to differentiate between IBS and structural diseases of the gut. 1 In an effort to develop criteria for all functional gastrointestinal disorders, the Rome I criteria were developed in 1991 by international consensus. 2 However, these criteria were relatively complex and difficult to use and were later revised. 3 The latter Rome II ; criteria are simpler, require presence of symptoms over one year, have more specific requirements for abdominal pain and place less emphasis on stool form. 4 The Rome criteria have been applied primarily in clinical research but not as commonly in clinical practice. 5 The Rome I criteria have shown good agreement with the Manning criteria. 6, 7 However.
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Hypoxic pulmonary vasoconstriction HPV ; is essential for matching lung perfusion with ventilation, thus optimizing pulmonary gas exchange. Preceding studies provided evidence for a role of both nitric oxide NO ; and superoxide H2O2 formation in this vasoregulatory mechanism. Both agents might be operative via stimulation of guanylate cyclase with formation of the vasodilatory cyclic guanosine monophosphate cGMP ; , the loss of which under conditions of hypoxia contributes to HPV. This view is challenged by the recent suggestion of increased rather than decreased superoxide H2O2 formation in hypoxia. We addressed the role of NO-dependent versus NO-independent guanylate cyclase activity in hypoxic and pharmacologically evoked vasoconstriction in perfused rabbit lungs. Two inhibitors of soluble guanylate cyclase, LY83583 2 to 16 and methylene blue 20 to 60 increased baseline pulmonary artery pressure under normoxic conditions and markedly amplified the vasoconstrictor response to both hypoxia and the stable thromboxane analogue U46619. Under conditions of preblocked lung NO synthesis NG-monomethyl-L-arginine ; , however, additional guanylate cyclase inhibition further enhanced the vasoconstrictor response to U46619 but did not influence the strength of HPV. The selective phosphodiesterase V inhibitor Zaprinast 1 to 10 used for prolongation of the cGMP half-life, reduced the hypoxia-induced pressor response to a larger extent than the pressor response to U46619. This difference was lost under conditions of preblocked NO synthesis. Equilibration of the lung perfusate with molecular NO suppressed the HPV more potently than the U46619-induced vasoconstrictor response. We conclude that NO-dependent guanylate cyclase activity has an important role in attenuating the vasoconstrictor response to alveolar hypoxia in rabbit lungs. In contrast, no evidence was obtained for a role of NOindependent cGMP formation in HPV. In this feature, HPV differs from that elicited by the thromboxane analogue U46619, for example, aspirin.
The other major area of recent emphasis in adrenergic drug research has been development of selective 3-agonists to induce lipolysis in white adipose tissue. This area has been extensively reviewed 4, 7, 8, ; . Because obesity and diabetes are reaching epidemic proportions in the United States, an effective weight reduction has enormous therapeutic and market potential 99 ; . As consequence, there is a veritable avalanche of potential new drugs being published. To date several compounds that looked promising in receptor assays and animal studies have entered clinical trials and failed. The reader should consult the listed reviews for extensive descriptions of the progress in this field through 2000. Some of the most promising recent candidates have been an extensive series of 3 -methylsulfonamido-4 -hydroxyphenylethanolamines prepared by competing groups. Compounds 107 ; BMS-194449 ; and 108 ; BMS-196085 ; have both gone into clinical trial but are reported to have failed 100, 101 and tamsulosin.
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Hillary Clinton Claims Pro-Life Advocates Increase Abortions Hillary Clinton, the pro-abortion New York senator and likely 2008 presidential candidate, has sent out a fundraising letter claiming prolife lawmakers and advocates are to blame for abortions. Frustrated that Americans are increasingly pro-life and opposed to abortions in most situations, abortion advocates like Clinton are trying to turn the tables in their favor. Clinton makes the allegation that because prolife lawmakers are opposing bills to mandate contraception coverage in insurance plans or allowing sales of the morning after pill, which can cause abortions, over the counter, they must not want to reduce abortions. Her recent fundraising letter says, "It's time to find out if Congress is serious about reducing unwanted pregnancies and abortions." LifeNews 5 18 06 ; Giving Birth Better than Abortion Pregnant teens who carry their babies to term do better psychologically than those who choose abortions, according to a study by Bowling Green State University. That finding flies in the face of contentions by pro-abortion advocates that teenagers are better off if they choose abortion. One fourth of U.S. abortions each year are done on teenagers. When Sydna Masse had an abortion in 1981, she thought it would be for the best. "The prospect of abortion. seemed like the perfect solution, " she said, "because that would allow me to go with my life." To cope, she began smoking marijuana, a behavior common among teens who have had abortions. Dr. Priscilla Coleman, the lead researcher on the Bowling Green study, found that they're six times more likely to use drugs. The study also found girls who aborted their babies were four times more likely to have sleep disturbances and five times more likely to seek counseling. Family News in Focus 8 21 06 ; Abortion Linked to Premature Birth A new report from a committee of the National Academies of Science NAS ; finds that a firsttrimester abortion, the most common abortion procedure, is linked to an increased risk of premature birth. The report comes from the Institute of Medicine IOM ; , an NAS organization. In the report is a list of "immutable medical risk factors associated with preterm birth" and "prior first-trimester abortion" is listed third among other risk factors that increase the risk of having a subsequent premature birth. Premature birth can lead to a host of problems, including cerebral palsy for the child and breast cancer for the mother. The IOM reported that premature births before 37 weeks gestation represent 12.5 percent of all U.S. births, a 30% increase since 1981. Abortion became legally accessible in 1973 and the number of abortions peaked in the early 1980s as it became more ingrained in society. The IOM said premature births cost U.S. society $26.2 billion in 2005. A 2003 article in the Journal of American Physicians and Surgeons finds at least sixty significant studies published since 1963 report an abortion-premature birth link. Teenagers who have an abortion also have a higher premature birth risk than adults because of the higher risk of infection and weakened cervix. LifeNews 7 27 06 ; Dead Baby Found In Abortion Clinic, Clinic Closed Editor's Note: This is the actual title that ran with the following CNN story. Hialeah FL ; Police Homicide Detectives are investigating the gruesome discovery of a dead baby's body inside an abortion clinic. Witnesses tell police that a young woman arrived at the clinic last Thursday at roughly 22 weeks pregnant for an abortion procedure. Police say the woman arrived the next day after the procedure complaining of severe pain. The woman was taken into a recovery room and according to witnesses, gave birth in the clinic. ''Employees cut the umbilical cord, put the baby in a bag and walked away with it, " Hialeah Lt. Ralph Gracia said. An anonymous caller, who police believe to be a clinic worker, alerted officials that the baby was born alive and possibly killed. When officials arrived, however, there was no body to be found. When police were called to the scene a second time, they found the body of a dead baby in a biohazard bag. Detectives believe the abortion clinic tampered with the evidence. The clinic's doors have been closed while the investigation continues. Officials are awaiting the autopsy to determine the exact cause of death. No word yet if charges will be filed. CBS4 News 7 29 06.
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31-41 11 ; publisher: springer previous article next article view table of contents key: - free content - new content - subscribed content - free trial content abstract: up to 60% of children with attention-deficit hyperactivity disorder adhd ; suffer from comorbid affective or behavioral impairments, the most common condition being oppositional defiant disorder odd ; , which occurs in 40-60% of children with adhd.
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