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EFFICACY OF IRON IN PATIENTS WITH RESTLESS LEGS SYNDROME AND A LOW-NORMAL FERRITIN: A RANDOMIZED, DOUBLE-BLIND, PLACEBO CONTROLLED STUDY. JAMES Y WANG, MD ASSOCIATE VINCENT MYSLIWIEC, MD; COLLIN FISCHER, MD; PATRICIA DEHAAN, MD; DAVID OWSHALIMPUR MD; ANGELA MYSLIWIEC, MD. MADIGAN ARMY MEDICAL CENTER, TACOMA, WA Wang JY, 1 Mysliwiec V, 1 Mysliwiec A1 1 ; Medicine, Madigan Army Medical Center, Tacoma, WA, USA, 2 ; Medicine, Madigan Army Medical Center, Tacoma, WA, USA Introduction : The prevalence of RLS is increased in conditions associated with iron deficiency such as pregnancy and end stage renal disease. Prior studies have shown a relationship between serum ferritin and RLS symptom severity, and improvements have been described treating RLS patients with ferritins in the "low-normal" range 15-75mcg l ; . To this date there has not been a placebo-controlled study of oral iron replacement in symptomatic RLS patients with low-normal ferritin levels using a validated RLS symptom scale. The purpose of this study was to determine if these patients truly benefit from iron replacement. Methods : This was a prospective, randomized, placebo-controlled, double blinded study. Patients attending routine outpatient visits to the internal medicine, pulmonology, hematology oncology, neurology, and family practice clinics were asked to complete a survey and give consent to be contacted if they met study eligibility. Patients meeting diagnostic criteria for RLS and with a score of at least 11 using the validated scale developed by the IRLSSG International Restless Legs Syndrome Study Group ; were contacted and a CBC, iron panel, and ferritin were drawn. Subjects with a ferritin of 15-75mcg l and no recent iron replacement were then randomized to iron ferrous sulfate 325mg PO BID ; or placebo. Patients were followed at 6 and 12 weeks with a repeat RLS severity survey, CBC, ferritin, and iron panel. Results : Interim evaluation was performed on 373 completed and reviewed RLS surveys. 42% met diagnostic criteria for RLS. The mean RLS severity score in these patients was 20.2 + - 9.0. Of the 38 subjects who consented to participate in the study, 17 met all inclusion criteria and were enrolled. 8 patients have completed the study to date 4 placebo, 4 on iron supplementation ; . Mean baseline RLS scores for iron and placebo groups were 27.3 + - 6.2 and 22 + - 4.2, and mean baseline ferritin was 45.4 + - 18.3 and 44.2 + - 21.9 ng ml ; , respectively p NS for all ; . Mean change in ferritin after 12 weeks was 43.5 + - 17 and 3.6 + - 17.7 ng ml ; for iron and placebo groups p .02 ; . No significant change in RLS score was observed between groups although subjects on iron replacement were more likely to report improvement in the general quality of their lives. Conclusion : Preliminary data analysis suggests that treating RLS patients with low-normal ferritin with PO iron may improve RLS symptoms and overall quality of life. This study is ongoing. Support optional.
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The trace element nutrient selenium Se ; has been implicated as a potent chemopreventive agent for some cancers. Two large human clinical trials are ongoing to establish its efficacy for prostate and lung cancer prevention. The mechanisms of action remain largely unknown. Since angiogenesis is obligatory for solid tumor growth and progression, we investigated the anti-angiogenic attributes of two pools of Se metabolites, namely methylselenol or related monomethyl Se vs. hydrogen selenide, to define potential target proteins and cellular processes crucial to tumor angiogenesis inhibition. Data obtained with cell culture models showed that monomethyl Se potently inhibited endothelial expression of matrix metalloproteinase-2 MMP-2 ; and cancer epithelial expression of vascular endothelial growth factor VEGF ; . In contrast, Se forms that enter the hydrogen selenide pool lacked any inhibitory effect. The methyl Se-specific inhibitory effects on these proteins were rapid and primary actions, independent of inhibitory effects on mitogenic signaling at the level of MAPK1 2 and of cell apoptosis. In addition, methyl Se exposure induced vascular endothelial G1 arrest at physiologically relevant concentration ranges and induced caspase-mediated apoptosis at pharmacological dosages. We examined the hypothesis that methyl Se inhibits G1 cycle progression by targeting specific protein kinase signaling pathway s ; . We developed a synchronized human umbilical vein endothelial cell HUVEC ; G1 progression model to evaluate the G1-stage specific action of methyl Se. During stimulation by the bovine pituitary extract endothelial cell growth supplement ECGS ; , methyl Se targeted a mechanism s ; in mid- to late-G1. The PI3K inhibitors, wortmannin and LY294002, showed the same stage-specific inhibitory action on G1 progression to S, while having no inhibitory effect on DNA synthesis once S phase had initiated. In contrast, the mitogen-activated protein kinase kinase MEK ; pathway appeared to be involved in signaling G0 G1 entry because the MEK inhibitor PD98059 moderately inhibited DNA synthesis when given before ECGS-stimulation, but did not have inhibitory effect after cell cycle had progressed for 6 h or beyond. Furthermore, MSeA exerted an additive inhibitory effect with wortmannin, but did not increase the inhibitory action of PD98059. Taken together, the results support a potent inhibitory activity of methyl Se on ECGSstimulated vascular cell mitogenesis and the target s ; of this inhibitory activity appeared to be related to PI3K pathway. Based on the low concentration of Se required for the methyl Se-specific inhibition of angiogenic cytokine VEGF expression in cancer cells and vascular endothelial expression of MMP-2 and antimitogenic action, we speculate that these activities may dampen angiogenic switching in early lesions in vivo to achieve cancer chemoprevention i.e., angioprevention ; . The efficacy for an organ to enrich monomethyl Se metabolites and the nature of the angiogenic switch mechanisms in that organ site may contribute to the organ-specific cancer preventive efficacy of Se.
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SUGGESTED FURTHER READINGS Breggin, Peter 1994. Toxic Psychiatry. London: Fontana. Ehrenberg, Alain. 2000. La fatigue d'etre soi: depression et societe. Paris: Odi1e Jacob. Fukuyama, Francis. 2002. Our Posthuman Future: Consequences of the Biotechnology Revolution. New York: Farrar, Straus & Giroux. Gelman, She1don. 1999. Medicating Schizophrenia: A History. New Brunswick, NJ: Rutgers University Press. Healy, David Healy. 1997. The Antidepressant Era. Cambridge, MA: Harvard University Press. Healy, David. 2002. The Creation of Psychopharmacology. Cambridge, MA: Harvard University Press. Rabinow, Paul. 1996. Making PCR: A Story of Biotechnology. Chicago: University of Chicago Press. Smith, Micky. 1991. A Social History of the Minor Tranquilizers. Binghamton, NY: Pharmaceutical Products Press. Stock, Gregory. 2002. Redesigning Humans: Our Inevitable Genetic Future. New York: Houghton Mifflin.
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1. Gallagher RM. Primary care and pain medicine. Med Clin N Am. 1999: ; 83 3 ; : 555-583 2. Semenchuk M, Adjuvant analgesic for management of neuropathic pain. Pharmacy Newswatch. Biezer JL ed. Park-Davis. 1999; 6 ; no 1.
The treatment protocol was approved by the interhospital Ethics Committee. Informed consent to study participation was obtained from each patient. Subjects were Japanese outpatients attending appointments at the Neurology and Neurosurgical Department, Ishikawa Hospital, Japan, suffering with intractable severe migraine, despite routine treatments; subjects were enrolled in the study consecutively, in order of appointment. Patients suffering migraine with aura manifested by scintillating scotoma were recruited; the required aura was defined as an initially small scintillating scotoma appearing at the center of the visual field and gradually enlarging over 3050 minutes, with the migraine ictus occurring at the middle to end of this period. Subjects in part one included the first 10 consecutive patients suffering from migraine following scintillating scotoma three men, seven women ; . The average age of these patients was 47.3 years range 2961 years ; at the first medical examination. The 13 consecutive patients suffering from migraine three men, 10 women ; in part two had an average age of 37.0 years range 1355 years ; at the first medical examination. Other than platelet hyper-aggregability, there were no other vascular risk factors in any of these patients. Patients in part two were evaluated using the MIDAS questionnaire2, 3 and urecholine.
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Between psychology and neurology, and b ; researchers' lack of understanding as to why people yawn. After review of the literature and personal observation, it is concluded that yawning is a complex arousal defense reflex located in the reticular brainstem with a peripheral and central arche, whose aim is to reverse brain hypoxia. Yawning occurs with loss of interest boredom ; and may or may not be associated with fatigue. By reversing drowsiness, yawning avoids a decreased concentration capacity resulting from borderline hypoxia. It is hoped that this article will stimulate further research on the phenomenon. Askenasy, J. J. and N. Askenasy 1996 ; . "Inhibition of muscle sympathetic nerve activity during yawning." Clin Auton Res 6 4 ; : 237-9. Yawning is a complex event that depends largely on the autonomic nervous system. Microneurographic techniques were used to study the mechanism involved in yawning. A series of spontaneous yawns displayed by a healthy 39-year-old male offered us the opportunity to study the muscle sympathetic nerve activity MSNA ; during this phenomenon. It was found that 2 s of yawning inhibited the MSNA recorded at the right peroneal nerve in the lateral knee area, while 3 s of slow expiration succeeding a yawn provoked an MSNA discharge. Blood pressure decreased with each slow expiration by 5-6 mmHg, and increased again with the renewed MSNA discharge. We conclude that yawning is associated with a sympathetic suppression that favours a parasympathetic dominance, as indicated by the MSNA and the decrease in blood pressure. The slow expiration following a yawn is associated with a sympathetic activation marked by an MSNA discharge and an increase in blood pressure. Atallah, M. M., A. Hoeft, et al. 1998 ; . "Does spinal anesthesia affect cerebral oxygenation during transurethral prostatectomy?" Reg Anesth Pain Med 23 2 ; : 119-25. BACKGROUND AND OBJECTIVES: Transurethral resection of the prostate TURP ; is associated with the unique complication of transurethral resection of prostate syndrome TURS ; , which is attributed to the absorption of irrigating fluid. This study was initiated to investigate the effects of spinal anesthesia and TURP on cerebral oxygen balance. METHODS: Thirty patients scheduled for TURP were included. Jugular bulb oxygen saturation SjbO2 ; was measured via retrograde cannulation of jugular venous bulb. Spinal anesthesia was initiated by 3 mL hyperbaric 0.5% bupivacaine injected at L3-L4 in the sitting position, producing a block to the T10 dermatome. Hemodynamic measurements and arterial and jugular bulb blood gasometry were performed before and after spinal anesthesia, throughout surgery, and during the postoperative period. RESULTS: A significant decrease of cerebral perfusion pressure after spinal anesthesia was accompanied by a significant decrease of SjbO2 below a preoperative value of 61% + - 1. Eight patients developed yawning, irritability, restlessness, and nausea toward the end of surgery, and these were considered to be early signs of TURS. These patients demonstrated SjbO2 below 55% and 50% in 63% and 42% of respective data set points. CONCLUSION: The neurologic symptoms in patients undergoing TURP during spinal anesthesia might not only be caused by absorption of irrigating fluid but also by impairment of cerebral oxygenation. Aumente Baena, J. 1953 ; . "[Clinical study of yawning.]." Rev Clin Esp 51 5 ; : 308-14. Aureli, F. and F. B. de Waal 1997 ; . "Inhibition of social behavior in chimpanzees under high-density conditions." J Primatol 41 3 ; : 213-28. This is the first study to investigate the short-term effects of high population density on captive chimpanzees Pan troglodytes ; . Subjects of the study were 45 chimpanzees living in five different groups at the Yerkes Regional Primate Research Center. The groups were observed under two conditions: 1 ; when they had access to both the indoor and outdoor sections of their enclosures; 2 ; during cold days when they were locked into the indoor runs, which reduced the available space by more than half. Under the high-density condition, allogrooming and submissive greetings decreased, but juvenile play increased. Remarkably, the rate of various forms of agonistic behavior, such as aggression, bluff charge, bluff display, and hooting, occurred less frequently under the high-density condition. This general decrease in adult social activity, including agonistic behavior, can be interpreted as an inhibition strategy to reduce opportunities for conflict when interindividual distances are reduced. This strategy is probably effective only in the short run, however. Behavioral indicators of anxiety, such as rough scratching and yawning, showed elevated rates, suggesting increased social tension under the high-density condition. Aurich, C., J. E. Aurich, et al. 1993 ; . "Naloxone affects gastrointestinal functions and behaviour in horses." Dtsch Tierarztl Wochenschr 100 8 ; : 314-5. Clinical effects of the opioid antagonist naloxone were investigated in healthy horses. Naloxone caused a transient increase in the frequency of defecations, a softening of the faeces and alterations in the intensity of abdominal borborygmi. Total serum protein concentrations decreased. Behavioural changes like frequent yawning and flehmen occurred, heart rate decreased and respiratory rate tended to increase but no clinical signs of distress or and bicalutamide.
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In recognition of the growing need of African health care professionals for training in the latest treatment options for HIV AIDS, Pfizer and the Pfizer Foundation have helped to establish the new Infectious Diseases Institute IDI ; . Located at Makerere University Medical School in Kampala, Uganda, the IDI is a regional treatment and training institute intended to strengthen local capacity in HIV AIDS care. The Institute is the first substantial infrastructural component to be added to Makerere University's Medical School in 35 years. Pfizer has partnered with the Academic Alliance for AIDS Care and Prevention an association of African and North American infectious disease experts ; and several non-governmental organizations including the Academic Alliance Foundation, the Pangaea Global AIDS Foundation, the Infectious Diseases Society of.
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The first political killings were done by psychiatrists.[521] 70, 273 psychiatric patients were gassed.[522] Quoting from an American Journal of Medicine article, "Psychiatrists became concerned about whether there would be enough patients left to keep their specialty alive."[523] Nur ein guter Mensch kann ein guter Arzt sein Only a good person can be a good physician ; - Rudolph Ramm, the leading Nazi medical ethicist Eminent neuropathologist J. Hallervorden - described as "a small cheerful man, " "warm, friendly" - in his own words: I heard they were going to do that and so I went up to them: 'Look here now, boys, if you are going to kill all these people at least take the brains out so that the material can be utilized'. There was wonderful material among these brains, beautiful mental defectives. They asked me: 'How many can you examine?' and so I told them an unlimited number - the more the better. They came bringing them in like the delivery van from the furniture company. The Public Ambulance Society brought the brains in batches of 150-250 at a time. Where these brains came from and how they came to me was really none of my business.[524]!
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Codes 76811 and 76812 include all elements of codes 76805 and 76810 plus detailed anatomic evaluation of the fetal brain ventricles, face, heart outflow tracts and chest anatomy, abdominal organ specific anatomy, number length architecture of limbs and detailed evaluation of the umbilical cord and placenta and other fetal anatomy as clinically indicated. Patient record should document the results of the evaluation of each element described above or the reason for non-visualization. Code 76815 represents a focused "quick look" exam limited to the assessment of one or more of the elements listed in code 76815. Code 76816 describes an examination designed to reassess fetal size and interval growth or reevaluate one or more anatomic abnormalities of a fetus previously demonstrated on ultrasound, and should be coded once regardless of the number of fetus. Code 76817 describes a transvaginal obstetric ultrasound performed separately or in addition to one of the transabdominal examinations described above. For transvaginal examinations performed for non-obstetrical purposes, use code 76830. Reimbursement amounts for the Medicaid Obstetrical and Maternal Services Program MOMS ; are noted in parenthesis after the description of each code. For information on the MOMS Program, see Policy Section. 76801 Ultrasound, pregnant uterus, real time with image documentation, fetal and maternal evaluation, first trimester 14 weeks 0 days ; , transabdominal approach complete fetal and maternal evaluation single or first gestation MOMS $174.00 ; each additional gestation MOMS $136.00 ; List separately in addition to code for primary procedure ; Use 76802 in conjunction with code 76801 ; Ultrasound, pregnant uterus, real time with image documentation, fetal and maternal evaluation, after first trimester or 14 weeks 0 days ; , transabdominal approach complete fetal and maternal evaluation single or first gestation MOMS $174.00 ; each additional gestation MOMS $136.00 ; List separately in addition to code for primary procedure ; Ultrasound, pregnant uterus, real time with image documentation, fetal and maternal evaluation plus detailed fetal anatomic examination, transabdominal approach complete fetal and maternal evaluation single or first gestation MOMS $241.00 ; each additional gestation MOMS $120.00 ; List separately in addition to primary procedure ; Use 76812 in conjunction with 76811 ; Ultrasound, pregnant uterus, real time with image documentation, limited eg, fetal heart beat, placental location, fetal position and or qualitative amniotic fluid volume ; , one or more fetuses MOMS $116.00 ; Use 76815 only once per exam and not per element ; $55.00.
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