RESUMEN
OBJECTIVES: Colonic manometry is a test used in the evaluation of children with defecation disorders unresponsive to conventional treatment. The most commonly reported protocol in pediatrics consists of a study that lasts approximately 4 hours. Given the wide physiological variations in colonic motility throughout the day, longer observation may detect clinically relevant information. The aim of the present study was to compare prolonged colonic manometry studies in children referred for colonic manometry with the more traditional short water-perfused technology. METHODS: Colonic manometry studies of 19 children (8 boys, mean age 9.4 ± 0.9, range 3.9-16.3) with severe defecation disorders were analyzed. First, a "standard test" was performed with at least 1-hour fasting, 1-hour postprandial, and 1-hour postbisacodyl provocation recording. Afterwards, recordings continued until the next day. RESULTS: In 2 of the 19 children, prolonged recording gave us extra information. In 1 patient with functional nonretentive fecal incontinence who demonstrated no abnormalities in the short recording, 2 long clusters of high-amplitude contractions were noted in the prolonged study, possibly contributing to the fecal incontinence. In another patient evaluated after failing use of antegrade enemas through a cecostomy, short recordings showed colonic activity only in the most proximal part of the colon, whereas the prolonged study showed normal motility over a larger portion of the colon. CONCLUSIONS: Prolonged colonic measurement provides more information regarding colonic motor function and allows detection of motor events missed by the standard shorter manometry study.
Asunto(s)
Colon/fisiopatología , Estreñimiento/fisiopatología , Defecación , Incontinencia Fecal/fisiopatología , Manometría , Adolescente , Niño , Preescolar , Ayuno , Femenino , Motilidad Gastrointestinal , Humanos , Masculino , Periodo Posprandial , Sueño , Factores de TiempoRESUMEN
BACKGROUND: Solid-state (SS) manometry catheters with portable data loggers offer many potential advantages over traditional water-perfused (WP) systems, such as prolonged recordings in a more physiologic ambulatory setting and the lack of risk for water overload. The use of SS catheters has not been evaluated in comparison with perfused catheters in children. This study aims to compare data provided by SS and WP catheters in children undergoing colonic manometry studies. METHODS: A SS catheter and a WP catheter were taped together such that their corresponding sensors were at the same location. Simultaneous recordings were obtained using the SS and WP catheters (both 8 channels, 10 cm apart) in 15 children with severe defecation disorders referred for colonic manometry. Signals were recorded for a minimum of 1 h during fasting, 1 h after ingestion of a meal, and 1 h after the administration of bisacodyl. Solid-state signals from the data logger were analyzed against the perfused signals. All high-amplitude propagated contractions (HAPCs), the most recognizable and interpreted colonic motor event, were evaluated for spatial and temporal features including their durations, amplitudes, and propagation velocities. KEY RESULTS: A total of 107 HAPCs were detected with SS and 91 with WP catheters. All WP-HAPC were also observed with SS. Linear regression analysis showed that SS catheters tended to give higher readings in the presence of amplitudes <102 mmHg and lower reading with amplitudes >102 mmHg. An opposite trend was found for the duration of contractions. No significant difference was found for HAPC velocity. CONCLUSIONS & INFERENCES: SS catheters are more sensitive in recording HAPCs in children with defecation disorders compared with the more traditional WP assembly. There is a difference in measurements of amplitude between the two systems. Solid-state catheters offer potential advantages over WP catheters in children, being portable, safer to use, and may provide data over a more prolonged period.
Asunto(s)
Catéteres , Enfermedades Intestinales/diagnóstico , Manometría/instrumentación , Complejo Mioeléctrico Migratorio/fisiología , Adolescente , Niño , Preescolar , Femenino , Humanos , Enfermedades Intestinales/fisiopatología , MasculinoRESUMEN
OBJECTIVE: There are no objective ambulatory studies on the temporal relationship between reflux and cough in children. Commercial pHmetry loggers have slow capture rates (0.25 Hz) that limit objective quantification of reflux and cough. The authors aimed to evaluate if there is a temporal association between cough and acid pH in ambulatory children with chronic cough. DESIGN, SETTING AND PATIENTS: The authors studied children (aged <14 years) with chronic cough, suspected of acid reflux and considered for pHmetry using a specifically built ambulatory pHmetry-cough logger that enabled the simultaneous ambulatory recording of cough and pH with a fast (10 Hz) capture rate. MAIN OUTCOME MEASURES: Coughs within (before and after) 10, 30, 60 and 120 s of a reflux episode (pH<4 for >0.5 s). RESULTS: Analysis of 5628 coughs in 20 children. Most coughs (83.9%) were independent of a reflux event. Cough-reflux (median 19, IQR 3-45) and reflux-cough (24.5, 13-51) sequences were equally likely to occur within 120 s. Within the 10 and 30 s time frame, reflux-cough (10 s=median 2.5, IQR 0-7.25; 30 s=6.5, 1.25-22.25) sequences were significantly less frequent than reflux-no cough (10 s=27, IQR 15-65; 30 s=24.5, 14.5-55.5) sequences, (p=0.0001 and p=0.001, respectively). No differences were found for 60 and 120 s time frame. Cough-reflux sequence (median 1.0, IQR 0-8) within 10 s was significantly less (p=0.0001) than no cough-reflux sequences (median 29.5, 15-67), within 30 s (p=0.006) and 60 s (p=0.048) but not within 120 s (p=0.47). CONCLUSIONS: In children with chronic cough and suspected of having gastro-oesophageal reflux disease, the temporal relationship between acid reflux and cough is unlikely causal.
Asunto(s)
Tos/complicaciones , Monitorización del pH Esofágico/instrumentación , Reflujo Gastroesofágico/complicaciones , Adolescente , Niño , Preescolar , Enfermedad Crónica , Diseño de Equipo , Femenino , Reflujo Gastroesofágico/diagnóstico , Humanos , Concentración de Iones de Hidrógeno , Lactante , Masculino , Factores de TiempoRESUMEN
Interobserver variability affects investigations involving assessment of complex visual data, such as histopathology, radiology and motility. This study assessed interobserver variation for interpretation of antroduodenal manometry (ADM), as this has not been previously investigated. Thirty-five ADM recordings from children aged 0.3-18 years were independently evaluated by five experienced paediatric gastroenterologists who were blinded to cases' clinical histories. Intra-class correlation (ICC) was analysed for detection and measurement of phase three of the migrating motor complex (MMC) and Cohen's kappa statistic was calculated between observer pairs for detection of specific motility features and final diagnosis. Observers were unanimous on the differentiation of normal and abnormal motility in 63% of cases. There was excellent interobserver agreement for the number of phase three of the MMC in fasting (ICC = 0.82, P < 0.0001) and for measurements of phase three of the MMC (ICC = 0.9999, P < 0.0001). Detection of other normal and abnormal motility patterns varied more. Objective findings such as the presence of phase three of the MMC correlated more closely than findings that involved the integration of several variables, such as final diagnosis. However, these data overall indicate that agreement between expert observers for the distinction of normal and abnormal antroduodenal motility compares favourably with other standard medical assessments.
Asunto(s)
Motilidad Gastrointestinal/fisiología , Manometría , Variaciones Dependientes del Observador , Estómago , Adolescente , Niño , Preescolar , Ingestión de Alimentos , Ayuno , Femenino , Humanos , Lactante , Masculino , Complejo Mioeléctrico Migratorio/fisiología , Estómago/anatomía & histología , Estómago/fisiologíaRESUMEN
BACKGROUND: Cough is a very common symptom presenting to medical practitioners. Gastroesophageal reflux disease (GORD) is said to be the causative factor in up to 41% of adults with chronic cough. However cough and GORD are common ailments and their co-existence by chance is high. Also cough can induce reflux episodes. Treatment for GORD includes conservative measures (diet manipulation), pharmaceutical therapy (motility or prokinetic agents, H(2) antagonist and proton pump inhibitors (PPI)) and fundoplication. OBJECTIVES: To evaluate the efficacy of GORD treatment on chronic cough in children and adults with GORD and prolonged cough that is not related to an underlying respiratory disease i.e. non-specific chronic cough. SEARCH STRATEGY: The Cochrane Register of Controlled Trials (CENTRAL), the Cochrane Airways Group Specialised Register Collaboration and Cochrane Airways Group, MEDLINE and EMBASE databases, review articles and reference lists of relevant articles were searched. The date of last search was 7th April 2006. SELECTION CRITERIA: All randomised controlled trials on GORD treatment for cough in children and adults without primary lung disease. DATA COLLECTION AND ANALYSIS: Results of searches were reviewed against pre-determined criteria for inclusion. Two independent reviewers selected, extracted and assessed data for inclusion. Authors were contacted for further information. Data was analysed as "intention to treat" as well as "treatment received". Paediatric and adults data were considered separately. Sensitivity analyses were performed. MAIN RESULTS: Thirteen studies (3 paediatric, 10 adults) were included. Data from six were available for analysis. None of the paediatric studies could be included in meta-analysis. In adults, analysis on use of H(2) antagonist, motility agents and conservative treatment for GORD were not possible (from lack of data) and there were no controlled studies on fundoplication as an intervention. Six adult studies comparing PPI (2-3 months) to placebo were analysed for various outcomes in the meta-analysis. Enrolment of subjects for two studies were primarily from medical clinics and another 4 studies were otolaryngology clinic patients or patients with laryngitis. Using "intention to treat", pooled data from 4 studies resulted in no significant difference between treatment and placebo in total resolution of cough, Odds Ratio 0.46 (95% CI 0.19 to 1.15). Pooled data revealed no overall significant improvement in cough outcomes (end of trial or change in cough scores). Significant differences were only found in sensitivity analyses. A significant improvement in change of cough scores was found in end of intervention (2-3 months) in those receiving PPI with a standardised mean difference of -0.41 (95%CI -0.75, -0.07) using GIV analysis on cross over trials. Two studies reported improvement in cough after 5 days to 2 weeks of treatment. AUTHORS' CONCLUSIONS: There is insufficient evidence to definitely conclude that GORD treatment with PPI is universally beneficial for cough associated with GORD in adults. The beneficial effect was only seen in sub-analysis and its effect was small. The optimal duration of such a trial of therapy to evaluate response could not be ascertained in the meta-analysis although two RCTs reported significant change by 2 weeks of therapy. Clinicians should be cognisant of a period (natural resolution with time) and placebo effect in studies that utilise cough as an outcome measure. Data in children are inconclusive. Future paediatric and adult studies are needed whereby studies should be double blind, randomised controlled, parallel design, using treatments for at least two months, with validated subjective and objective cough outcomes and include ascertainment of time to respond as well as assessment of acid and/or non acid reflux whilst on therapy.
Asunto(s)
Tos/terapia , Reflujo Gastroesofágico/terapia , Adulto , Niño , Enfermedad Crónica , Tos/complicaciones , Reflujo Gastroesofágico/complicaciones , Humanos , Ensayos Clínicos Controlados Aleatorios como AsuntoRESUMEN
OBJECTIVE: To evaluate the efficacy of treatment for gastro-oesophageal reflux disease (GORD) on chronic cough in children and adults without an underlying respiratory disease. DESIGN: Systematic review and meta-analysis. DATA SOURCES: Cochrane, Medline, and Embase databases, references from review articles. INCLUDED STUDIES: Randomised controlled trials on GORD treatment for cough in children and adults without primary lung disease. Two reviewers independently selected studies and extracted paediatric and adult data on primary (clinical failure) and secondary outcomes. RESULTS: 11 studies were included. Meta-analysis was limited to five studies in adults that compared proton pump inhibitors with placebo. All outcomes favoured proton pump inhibitors: the odds ratio for clinical failure (primary outcome) was 0.24 (95% confidence interval 0.04 to 1.27); number needed to treat (NNT) was 5 (harm 50 to infinity to benefit 2.5). For secondary outcomes, the standardised mean difference between proton pump inhibitors and placebo was -0.51 (-1.02 to 0.01) for mean cough score at the end of the trial and -0.29 (-0.62 to 0.04) for change in cough score at the end of the trial. Subgroup analysis with generic inverse variance analysis showed a significant mean change in cough (-0.41 SD units, -0.75 to -0.07). CONCLUSION: Use of a proton pump inhibitor to treat cough associated with GORD has some effect in some adults. The effect, however, is less universal than suggested in consensus guidelines on chronic cough and its magnitude of effect is uncertain.
Asunto(s)
Tos/tratamiento farmacológico , Reflujo Gastroesofágico/tratamiento farmacológico , Inhibidores de la Bomba de Protones , Adulto , Niño , Enfermedad Crónica , Tos/etiología , Femenino , Reflujo Gastroesofágico/complicaciones , Humanos , Masculino , Ensayos Clínicos Controlados Aleatorios como AsuntoRESUMEN
BACKGROUND: Cough is a very common symptom presenting to medical practitioners. Gastroesophageal reflux disease (GORD) is said to be the causative factor in up to 41% of adults with chronic cough. However cough and GORD are common ailments and their co-existence by chance is high. Also cough can induce reflux episodes. Treatment for GORD includes conservative measures (diet manipulation), pharmaceutical therapy (motility or prokinetic agents, H(2) antagonist and proton pump inhibitors (PPI)) and fundoplication. OBJECTIVES: To evaluate the efficacy of GORD treatment on chronic cough in children and adults with GORD and prolonged cough that is not related to an underlying respiratory disease i.e. non-specific chronic cough. SEARCH STRATEGY: The Cochrane Register of Controlled Trials (CENTRAL), the Cochrane Airways Group Specialised Register Collaboration and Cochrane Airways Group, MEDLINE and EMBASE databases, review articles and reference lists of relevant articles were searched. The date of last search was 4th April 2004. SELECTION CRITERIA: All randomised controlled trials on GORD treatment for cough in children and adults without primary lung disease. DATA COLLECTION AND ANALYSIS: Results of searches were reviewed against pre-determined criteria for inclusion. Two independent reviewers selected, extracted and assessed data for inclusion. Authors were contacted for further information. Data was analysed as "intention to treat" as well as "treatment received". Paediatric and adults data were considered separately. Sensitivity analyses were performed. MAIN RESULTS: 11 studies (3 paediatric, 8 adults; 383 participants) were included. None of the paediatric studies could be included in meta-analysis. In adults, analysis on use of H(2) antagonist, motility agents and conservative treatment for GORD were not possible (from lack of data) and there were no controlled studies on fundoplication as an intervention. Five adult studies comparing PPI (2-3 months) to placebo were analysed for various outcomes in the meta-analysis. Enrollment of subjects for two studies were primarily from medical clinics and another three studies were otolaryngeal clinic patients. Using "intention to treat", pooled data from three studies resulted in no significant difference between treatment and placebo in total resolution of cough. Pooled data revealed no significant improvement in cough outcomes (end of trial or change in cough scores). Significant differences were only found in sensitivity analysis. A significant improvement in change of cough scores was found in end of intervention (2-3 months) in those receiving PPI with a standardised mean difference of -0.41 (95%CI -0.75, -0.07) using GIV analysis on cross over trials. Two studies reported improvement in cough after 5 days to 2 weeks of treatment. Significant heterogeneity was found between studies using omeprazole and other PPIs. AUTHORS' CONCLUSIONS: There is insufficient evidence to definitely conclude that GORD treatment with PPI is beneficial for cough associated with GORD in adults. The beneficial effect was only seen in sub-analysis and its effect was small. The optimal duration of such a trial of therapy to evaluate response could not be ascertained in the meta-analysis although two RCTs reported significant change by two weeks of therapy. Clinicians should be cognisant of a period (natural resolution with time) and placebo effect in studies that utilise cough as an outcome measure. Data in children are inconclusive. Future paediatric and adult studies are needed whereby studies should be double blind, randomised controlled, parallel design, using treatments for at least two months, with validated subjective and objective cough outcomes and include ascertainment of time to respond as well as assessment of acid and/or non acid reflux whilst on therapy.
Asunto(s)
Tos/terapia , Reflujo Gastroesofágico/terapia , Adulto , Niño , Enfermedad Crónica , Tos/complicaciones , Reflujo Gastroesofágico/complicaciones , Humanos , Ensayos Clínicos Controlados Aleatorios como AsuntoRESUMEN
A 6 year old boy presenting with a five month history of fever, lethargy, and anorexia, was found to have hepatitis B associated membranous glomerulonephropathy and nephrotic syndrome. After two months treatment with oral lamivudine, his proteinuria cleared and serum albumin and aminotransferases normalised, associated with disappearance of hepatitis B e antigen (HBeAg) and appearance of anti-HBeAg antibodies. After 12 months, without side effects, lamivudine was discontinued. He remains well 11 months off treatment.
Asunto(s)
Hepatitis B/complicaciones , Lamivudine/administración & dosificación , Síndrome Nefrótico/virología , Inhibidores de la Transcriptasa Inversa/administración & dosificación , Administración Oral , Antígenos Virales/análisis , Niño , Glomerulonefritis Membranosa/tratamiento farmacológico , Glomerulonefritis Membranosa/patología , Glomerulonefritis Membranosa/virología , Hepatitis B/tratamiento farmacológico , Humanos , Masculino , Microscopía Electrónica , Síndrome Nefrótico/tratamiento farmacológico , Síndrome Nefrótico/patologíaRESUMEN
BACKGROUND: Data from recent studies indicate that the presence of depression is an independent risk factor for cardiovascular and cerebrovascular events. The mechanism by which depression increases the morbidity and mortality risks in patients with comorbid vascular disease is currently the object of considerable research interest. Platelets may be involved in this pathological process. Although many investigators have extensively evaluated platelet biochemistry in depressed patients, there currently exists very little information regarding how the biochemical alterations might relate to an increased risk of cardiovascular events. In this study, we examined the responsivity of platelet cytosolic calcium concentrations ([Ca++]i) to serotonin stimulation in populations of hypertensive patients with or without comorbid depressive symptoms. METHODS: We utilized Fura-2 loaded platelets to compare changes in intracellular calcium levels (delta [Ca++]i) following serotonin stimulation among 48 patients with hypertension and varying degrees of depressive symptomatology. RESULTS: We found that those patients with higher scores on standardized depression rating scales showed significantly greater [Ca++]i (82.82 +/- 15.88 mmol/L) increase compared with [Ca++]i (60.10 +/- 22.65 mmol/L) patients with lower depression scores. CONCLUSIONS: The results of this study support the hypothesis that the enhanced platelet reactivity seen in patients with depressive symptoms may mediate the deleterious effects of depression on cardiovascular disease.
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Plaquetas/efectos de los fármacos , Plaquetas/metabolismo , Calcio/metabolismo , Trastorno Depresivo Mayor/sangre , Hipertensión/sangre , Anciano , Antihipertensivos/uso terapéutico , Trastorno Depresivo Mayor/diagnóstico , Humanos , Hipertensión/diagnóstico , Hipertensión/tratamiento farmacológico , Membranas Intracelulares/metabolismo , Masculino , Receptores Citoplasmáticos y Nucleares/efectos de los fármacos , Factores de Riesgo , Índice de Severidad de la Enfermedad , Factores de TiempoRESUMEN
OBJECTIVE: To compare the efficacy of salbutamol delivered by jet nebuliser (JN) with salbutamol via a pressurised metered dose inhaler (PMDI) and a large volume spacer (Volumatic) for management of acute asthma. STUDY POPULATION: A total of 160 children aged from 4 to 12 years presenting to an Emergency Department with acute asthma. METHODS: The study was of multicentre (n=5) randomised, double blind, parallel design. Children weighing less than 25 kg received salbutamol 2.5 mg via the JN or 600 microg (six puffs) from the PMDI. Children over 25 kg received salbutamol 5 mg via the JN or 1200 microg (12 puffs) via the PMDI. Clinical score (range 0-12) and PEF (over 7 years) were recorded at baseline and 15, 30, 45 and 60 mins post administration. RESULTS: The improvement from baseline at 30 min in the clinical score was 1.87 for JN and 1.43 for PMDI (P=0.09) and at 60 min was 2.15 for JN and 1.12 for PMDI (P=0.0001). The improvement in PEF at 30 min was 51 L min(-1) for JN and 27 L min(-1) for PMDI (P=0.0007) and at 60 min was 57 L min(-1) for JN and 31.5 L min(-1) for PMDI (P=0.001). CONCLUSION: Administration of salbutamol via a PMDI and a large volume spacer device provides effective relief in the management of acute asthma in children, but to a lesser extent than a jet nebuliser. This difference may represent a dose response effect.
Asunto(s)
Albuterol/administración & dosificación , Asma/tratamiento farmacológico , Broncodilatadores/administración & dosificación , Nebulizadores y Vaporizadores , Enfermedad Aguda , Administración por Inhalación , Aerosoles , Niño , Preescolar , Método Doble Ciego , Femenino , Humanos , MasculinoRESUMEN
BACKGROUND: Serotonin produces an exaggerated rise in platelet cytosolic calcium (delta [Ca++]i) in patients with mood disorders. Studies on patients with bipolar disorder consistently demonstrate calcium abnormalities. By comparison, data on patients with major depression are more variable. METHODS: To determine causes of variability, we utilized Fura-2 loaded platelets to compare changes in platelet intracellular calcium levels (delta [Ca++]i) following serotonin stimulation in 24 patients with major depression and in 20 controls. We also sought relationships between the delta [Ca++]i responses and scores on clinical depression and anxiety scales. RESULTS: We found positive correlations between delta [Ca++]i responses and the clinical scales across all subjects. Furthermore, depressed patients with high anxiety had significantly increased delta [Ca++]i responses compared to depressed patients with low anxiety. In addition, patients receiving selective-serotonin reuptake inhibitors (SSRIs) demonstrated reduced delta [Ca++]i responses compared to patients not on SSRIs. CONCLUSIONS: Since elevations in [Ca++]i mediate platelet aggregation and secretion cascades, the enhanced responsivity observed in depressed, and in particular anxious, depressed patients may contribute to their increased risk for vascular disease.
Asunto(s)
Plaquetas/metabolismo , Calcio/sangre , Citosol/metabolismo , Trastorno Depresivo/sangre , Serotonina/farmacología , Adulto , Ansiedad/psicología , Plaquetas/efectos de los fármacos , Citosol/efectos de los fármacos , Trastorno Depresivo/tratamiento farmacológico , Trastorno Depresivo/psicología , Femenino , Colorantes Fluorescentes , Fura-2 , Humanos , Masculino , Escalas de Valoración PsiquiátricaRESUMEN
Obtaining education materials for both staff and patients can be expensive. Tracking staff certification requirements and available references for individual units can be time consuming and awkward. Using a regular home personal computer and inexpensive software applications, the staff nurse, educator, and manager can produce quality education products, maintain records, and graph representation of administrative trends.
Asunto(s)
Instrucción por Computador/métodos , Microcomputadores , Personal de Enfermería en Hospital/educación , Educación del Paciente como Asunto/métodos , Enfermería Pediátrica/educación , Niño , HumanosRESUMEN
OBJECTIVE: To assess differences in the binding of cocaine, cocaethylene, and benzoylecgonine among pigmented and senile white hairs of the graying human cocaine abuser. DESIGN: A sheath of graying hair in the region around the apex of the head was gathered between the thumb and index finger then cut and removed about 2 mm proximal to the scalp. The graying hair was divided into pigmented and senile white of equal weights and lengths and then analyzed by gas chromatography/mass spectrometry chemical ionization. Twenty-nine such pairs were analyzed. SUBJECTS: Male cocaine abusers, ages 33-55 years hospitalized for substance abuse. Informed consent was obtained and confidentiality assured. MAIN OUTCOME MEASURES: Concentrations of cocaine, cocaethylene and benzoylecgonine in ng were assessed for each of 29 paired hair samples by gas chromatography/mass spectrometry chemical ionization. RESULTS: There were statistically significant differences between pigmented and senile white sections of paired samples. Cocaine (ng/mg hair, mean +/- SD) was 31.5 +/- 30.2 for pigmented hair vs 14.9 +/- 19.8 for senile white portions; (p < 0.0001). Cocaethylene (ng/mg hair, mean +/- SD) 3.22 +/- 5.0 (pigmented) vs 0.52 +/- 0.88 (senile white); (p < 0.0016). Benzoylecgonine (ng/mg hair, mean +/- SD) 5.1 +/- 5.3 (pigmented) vs 3.9 +/- 4.8 (senile white); (p < 0.005). CONCLUSION: Melaninated pigmented hair seems to bind more cocaine, cocaethylene and benzoylecgonine than white hair in the same subject.
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Cocaína/farmacocinética , Cabello/química , Narcóticos/farmacocinética , Pigmentos Biológicos/metabolismo , Adulto , Cocaína/análogos & derivados , Cocaína/análisis , Cocaína/metabolismo , Cromatografía de Gases y Espectrometría de Masas/métodos , Cabello/metabolismo , Humanos , Masculino , Persona de Mediana Edad , Narcóticos/análisis , Trastornos Relacionados con SustanciasRESUMEN
We have previously reported that binding to blood platelets of paroxetine, a selective serotonin (5-HT) reuptake inhibitor which binds to 5-HT uptake sites, is decreased in patients with posttraumatic stress disorder (PTSD). Specifically, we found a lower number of platelet 3H-paroxetine binding sites (Bmax) and a lower dissociation constant (Kd) for 3H-paroxetine binding in combat veterans with PTSD compared to normal control subjects. In the current study we assessed the relationship of platelet 3H-paroxetine binding to clinical features in 41 Vietnam combat veterans with SCID-diagnosed PTSD. The results indicated that Bmax of platelet 3H-paroxetine binding was negatively correlated with both state and trait anxiety, as well as with depressive and overall PTSD symptoms. However, there was no evidence that platelet 3H-paroxetine binding differed as a function of comorbid psychiatric diagnoses including major depression, other anxiety disorders, and substance abuse in these patients.
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Plaquetas/metabolismo , Trastornos de Combate/sangre , Serotonina/sangre , Adulto , Ansiedad/sangre , Ansiedad/etiología , Trastorno Depresivo/sangre , Trastorno Depresivo/etiología , Humanos , Masculino , Persona de Mediana Edad , Paroxetina/sangre , Paroxetina/farmacocinética , Serotonina/farmacocinética , TritioRESUMEN
Recent open clinical trials have found the selective serotonin reuptake inhibitor (SSRI) fluoxetine to be beneficial in the treatment of posttraumatic stress disorder (PTSD) symptoms. We have reported previously that the binding of a newer SSRI, paroxetine, to blood platelets is decreased in PTSD patients compared to normal control subjects. In the current study, pretreatment platelet paroxetine binding data were analyzed for ten Vietnam combat veterans who were treated clinically with fluoxetine for PTSD, diagnosed on the basis of the Structured Clinical Interview for DSM-III-R. Specific binding of 3H-paroxetine is reported in terms of the dissociation constant (Kd) and the maximum density of binding sites (Bmax). Based on our previous findings we hypothesized that decreased platelet 3H-paroxetine binding would be associated with positive therapeutic response to subsequent treatment with fluoxetine. Global clinical improvement ratings, conducted blind to the biochemical data, were used to separate patients into five maximal responders and five partial responders. The results indicated that maximal responders had lower pretreatment Kd values (p = .016) and a trend toward lower pretreatment Bmax values (p = .075) than the partial responders. These preliminary findings may warrant further study of platelet SSRI binding as a possible predictor of SSRI treatment response in PTSD patients.
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Plaquetas/metabolismo , Fluoxetina/uso terapéutico , Paroxetina/sangre , Trastornos por Estrés Postraumático/sangre , Trastornos por Estrés Postraumático/tratamiento farmacológico , Adulto , Interacciones Farmacológicas , Humanos , Cinética , Masculino , Persona de Mediana Edad , TritioRESUMEN
Only fragmentary information on the relationship between hair pigmentation (melanin) and the cocaine/benzoylecgonine content of hair samples is available. The in vitro incorporation of benzoylecgonine into the shafts of black, brown, and blond samples of human hair was accomplished. Post digestion analysis and wash samples demonstrate the relative incorporated ions of benzoylecgonine to be black > brown > blond. Melanin content seems to be important. Lightly pigmented blond hairs may be less appropriate samples for benzoylecgonine and cocaine analysis.