To describe the Sacral Hitch, vesical pexys to sacral promontory, an alternative technique to the Psoas Hitch when this is impossible to perform. We report intraoperative complications, and long-term functional results.
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The antiarrhythmic effects of amitriptyline (1), its secondary amine metabolite nortriptyline (2), as well as cyclobenzaprine (3) and cyproheptadine (4), tertiary amine analogues of 1, were studied in conscious dogs 24 h after myocardial infarction. Since the sedative side effect of 4 presents a potential problem for its clinical use, a quarternary derivative of 4, cyproheptadine methiodide (5), was prepared and its effects also studied in this model. Complete conversion to a normal sinus rhythm occurred in all animals studied after cumulative doses of 1700 micrograms/kg (6.17 mumol/kg) of 3, 1300 micrograms/kg (4.69 mumol/kg) of 1, 300 micrograms/kg (1.04 mumol/kg) of 4, and 25 micrograms/kg (0.058 mumol/kg) of 5. While 2 significantly decreased ventricular ectopic activity, it did not convert any of the animals studied to a sinus rhythm at doses up to 3000 micrograms/kg. Thus, the order of potency for conversion to a normal sinus rhythm appears to be 5 > 4 > 1 > 3 > 2. These data suggest that 5 is very potent in converting ventricular arrhythmias associated wtih myocardial infarction.
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A case of a 62-year-old woman presenting with a 20-year history of vulvodynia previously unresponsive to medical treatment is described. The epidemiology, phenomenology and medical management of vulvodynia is reviewed. The case presentation illustrates the role of pregabalin in successful medical management of this chronic pain disorder, as well as the management of common psychiatric morbidities associated with this condition.
The case notes of 22 patients who reported facial pain after sinonasal surgery or trauma out of a cohort of 973 patients seen in a rhinology clinic were reviewed retrospectively. This group included 10 patients who had undergone endoscopic sinus surgery and four who had suffered facial fractures. None of the patients reported any facial pain before surgery or trauma. In only one case was there any evidence, clinically, endoscopically, or radiologically, of any paranasal sinus disease and when this resolved with nasal medical treatment the pain remained. The treatment of these patients' facial pain centred on the use of neurological medical treatment. One third of the patients responded to low-dose amitriptyline, a further third showed some response to other pharmacological agents including carbamazepine, and the remaining third showed no response. These cases illustrate the characteristics and management of facial pain after sinonasal surgery and highlight the importance of medical neurological treatment in the absence of any objective evidence of sinus disease.
Aromatic anticonvulsant agents such as carbamazepine and phenytoin can induce anticonvulsant hypersensitivity syndrome (AHS) at a frequency of 1 in 10,000 to 1 in 1,000 treated patients. The hypersensitivity syndrome is a potentially life-threatening adverse drug reaction with multiorgan involvement, and incidental reexposure must be strictly avoided. Patients and treating physicians must be informed and educated about the causal drug and its potential immunologic or toxicologic cross-reactivity with other compounds. It has been well established that for future antiepileptic drug therapy, carboxamides (carbamazepine and oxcarbazepine), phenytoin, and barbiturates (phenobarbital and primidone) have to be avoided owing to their high degree of cross-reactivity. Other anticonvulsant agents, such as valproic acid, benzodiazepines, and gabapentin, may be prescribed.
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Six tricyclic antidepressants were tested for their ability to antagonize histamine actions at histamine H1 receptors in a bioassay for these receptors (histamine-induced contractions of guinea pig ileum). All compounds were competitive antagonists with equilibrium dissociation constants in the range of 5.6 x 10(-11) M to 1.5 x 10(-7) M. Doxepin hydrochloride and amitriptyline hydrochloride were the most potent compounds of the series and may be the most potent antihistamines known. Antagonism at histamine H1 receptors by these compounds may explain their sedative effects.
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Both antidepressant drugs and repeated electroconvulsive shock (ECS) produce adaptive changes in cerebral neurotransmitter systems. As in the clinical practice ECS is used almost always after therapeutical failure of pharmacotherapy, we investigated presently how chronic administration of an antidepressant amitriptyline affects the action of subsequent multiple ECS in rats. Amitriptyline differed from ECS and from other classical antidepressant in producing no beta-downregulation and potentiating the inhibitory effect of protein kinase C activator, 12-O-tetradecanoylphorbol 13-acetate (TPA), on responses of alpha 1-adrenoceptor system to noradrenaline. The action of ECS on alpha 1-adrenoceptor system remained essentially unaffected by previous amitriptyline administration. Its downregulatory effect on responses of beta-adrenoceptor system to noradrenaline, and particularly to isoproterenol, were attenuated by previous drug treatment. The present results suggest that previous chronic administration of antidepressant drugs may alter the effect of subsequent ECS.
We report a method for simultaneous measurement of five commonly used tricyclic antidepressant drugs (doxepin, desipramine, nortriptyline, imipramine, and amitriptyline) in serum by paired-ion high-performance liquid chromatography, with use of a reversed-phase column and ultraviolet detection at 254 nm. The drugs are extracted from 2 ml of serum at pH 14 into hexane/isoamyl alcohol (99/1 by vol) and re-extracted into 200 microliter of 0.1 mol/liter HCI. An aliquot of the aqueous acid phase is chromatographed with use of a methanol/acetonitrile/water (41/15/44) solvent system, containing 5 mmol of pentanesulfonic acid per liter of phosphate buffer (0.1 mol/liter, pH 6.5), at a flow rate of 1,5 ml/min. Analytical recoveries of the drugs from serum increase with increasing concentration, from 62% at 25 microgram/liter to 93% at 300 microgram/liter. Linear response is observed for drug concentrations up to 1500 microgram/liter and the detection limit is 2-3 microgram/liter. Within-run precision ranges from 1.4 to 2.9% and day-to-day precision from 1.7 to 7%, depending on the specific drug. The entire procedure can be completed within 45 min and is well adapted to the routine clinical laboratory. Of 48 common basic and several neutral drugs tested for possible interferences, only three benzodiazepines, three phenothiazines, and three antihistamines interfere with the assay of doxepin, desipramine, and nortriptyline, respectively.
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We described the findings of a study into the post-mortem redistribution (PMR) of 76 drugs found in 129 drug-related cases between 2006 and 2009. Seventy six drugs (psychotropic drugs (n=14), antidepressants (n=9), sedatives (n=6) and so on) were simultaneously quantified in cardiac and peripheral blood by gas chromatography-mass spectrometry (GC/MS) or liquid chromatography-tandem mass spectrometry (LC/MS/MS). The absence, possibility or presence of PMR of drugs was determined according to the ratios of cardiac to femoral blood concentrations (C/P ratios). Proxyphylline (C/P ratio: 0.85) showed no PMR; carbamazepine was not subject to PMR; a potential for PMR of lorazepam and mirtrazapine cannot be excluded; chlordiazepoxide is subject to PMR; acetaminophen and alprazolam exhibit minimal PMR; amitriptyline and benztropine exhibit PMR. Codeine (C/P ratio: 4.9), zolpidem (C/P ratio: 3.74), chlorpromazine (C/P ratio: 2.97), fluoxetine (C/P ratio: 2.83) and propranolol (C/P ratio: 2.72) had the largest C/P ratios. Postmortem drug concentrations showed variations depending on sampling sites and characteristics of the drugs. It is continuously necessary to analyze commonly used or abused drugs in simultaneously collected cardiac and peripheral blood to establish significant reference values for PMR. These findings can be used to reach a conclusion about the cause and manner of death.
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Epidemiological and clinical studies have demonstrated comorbidity between migraine and affective disorders. However, it is unclear whether chronic migraine can lead to affective disorders in other animals.
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Fourteen case reports were identified in which intravenous lipid emulsion was used to treat toxicities due to local anesthetics and other medications (amitriptyline, diltiazem, bupropion, dosulepin, lamotrigine, quetiapine, and verapamil). Thirteen cases demonstrated a beneficial response in reversing systemic toxicity; 1 of these patients developed hypertriglyceridemia and pancreatitis. The dosage regimens used in this series were dissimilar.
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In this double-blinded, 3-way crossover trial, 17 healthy males received acute doses of 10 mg paroxetine, 25 mg amitriptyline, and placebo. The subjects were administered three driving tasks--road tracking, car following, and harsh braking--performed using a driving simulator and three cognitive tasks--Wisconsin Card Sorting Test, Continuous Performance Test, and N-back test at baseline and at 1 h and 4 h post-dosing. The Stanford Sleepiness Scale scores were also assessed.
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A systematic review of the most relevant clinical trials of migraine headache and its epidemiology, pathophysiology, comorbidity, and prophylactic treatment (medical and nonmedical) was carried out using "Medline" and "PsychINFO" from 1973 to 2009. Approximately 110 trials met our inclusion criteria and were included in the current review.
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Prescription of medications for treatment of concussion.
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Regarding the use of intravenous lidocaine in fibromyalgia, there are no well-controlled studies. This study aimed to evaluate the effect of intravenous lidocaine on pain intensity, clinical manifestations and plasma levels of interleukin (IL)-1, IL-6, and IL-8 in fibromyalgia patients.
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Tianeptine is an antidepressant agent with a novel neurochemical profile. It increases serotonin (5-hydroxytryptamine; 5-HT) uptake in the brain (in contrast with most antidepressant agents) and reduces stress-induced atrophy of neuronal dendrites. Like the selective serotonin reuptake inhibitors (SSRIs) and in contrast with most tricyclic antidepressant agents, tianeptine does not appear to be associated with adverse cognitive, psychomotor, sleep, cardiovascular or bodyweight effects and has a low propensity for abuse. Tianeptine has a comparatively favourable pharmacokinetic profile. It is not subject to first-pass hepatic metabolism, has high bioavailability and limited distribution, and is rapidly eliminated. While this offers advantages for tianeptine over the tricyclic antidepressant agents in terms of dose titration, treatment changes and potential drug interactions, its rapid elimination makes adherence to dosage schedules more important. Tianeptine differs from most antidepressants in that it is not primarily metabolised by the hepatic cytochrome P450 system, indicating less likelihood of drug-drug interactions; this is of particular interest for elderly patients. Tianeptine, in dosages of 25 to 50 mg/day, has been investigated in patients with major depression, depressed bipolar disorder, dysthymia or adjustment disorder. It has equivalent antidepressant efficacy to several classical antidepressant agents (amitriptyline, clomipramine, imipramine, mianserin) and the SSRIs fluoxetine (in most patients), paroxetine and sertraline. Comparison with maprotiline indicated superior efficacy for tianeptine but dothiepin appeared superior in another study. Extended treatment with tianeptine decreases the incidence of relapse/recurrence of depression. Tianeptine appears to be as effective as fluoxetine, sertraline, amitriptyline, clomipramine and mianserin and more effective than maprotiline in improving associated anxiety in patients with depressive disorders. Depression and anxiety symptoms in alcohol dependant patients also respond well to tianeptine. The adverse effects associated with tianeptine are similar in many respects to those of the SSRIs and minimal in comparison with the tricyclic antidepressants. The most common adverse effects are nausea, constipation, abdominal pain, headache, dizziness and changes in dreaming. Anticholinergic effects occur less often with tianeptine than with tricyclic agents. Hepatoxicity is rare. The dosage should be decreased in elderly patients and those with severe renal failure, but adjustment is not necessary in patients with alcoholism or hepatic impairment, or those undergoing haemodialysis.
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The data from a series of studies in different patient samples are consistent in showing that resistance to dexamethasone suppression is selectively associated with primary major depressive disorder. In addition, nonsuppressors appear to have more depressive episodes, show greater improvement during hospitalization, tend to be older than suppressors, and may have a specific disturbance in cognitive function. Preliminary data suggest that nonsuppressors and suppressors respond preferentially to different antidepressants. These data raise the possibility that pituitary-adrenal disinhibition, as assessed by the dexamethasone suppression test, is associated with a depressive subtype having a distinctive pathophysiology, clinical course, and treatment response.
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Frequent or regular intake of antimigraine drugs, including analgesics, constitutes a common cause of chronic daily headache. Discontinuation of symptomatic medication can produce an increase in head pain accompanied by withdrawal symptoms. We report the favourable outcome of treating a group of outpatients with the combination of amitriptyline, dexamethasone and sumatriptan. Dexamethasone (4 mg/day) was given intramuscularly for 2 weeks, amitriptyline orally at night (50 mg/day) for at least 6 months, and sumatriptan subcutaneously to treat acute headache attacks. Eighteen out of 20 patients abstained from drug abuse. Eleven of these 18 patients showed a marked reduction in headache frequency (at least 75% in relation to the basal value), and were considered "very good responders". The other seven patients experienced at least 50% reduction in headache frequency compared to baseline. This preliminary report suggests that drug-induced headache can be treated effectively in outpatients using dexamethasone, amitriptyline and sumatriptan in combination with significant benefit in everyday life conditions.
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Lofepramine is a tricyclic antidepressant related to imipramine. Meta-analyses were carried out with respect to efficacy and tolerability by combining outcome and adverse reaction from over 20 controlled trials comparing lofepramine with other tricyclic antidepressants. Lofepramine was at least as effective as the comparators with fewer adverse effects. In particular, the risk/benefit ratio seemed superior to the comparators amitriptyline, imipramine, clomipramine, maprotiline and desipramine.
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We found 50 systematic reviews, RCTs, or observational studies that met our inclusion criteria. We performed a GRADE evaluation of the quality of evidence for interventions.
For the purpose of determining psychotropic properties of antiparkinsonian substances, the author has carried out a quantitative analytic study on EEG changes induced by six marketed antiparkinsonian drugs in young normal volunteers. The drugs were six antiparkinsonian agents, l-dopa (LDP) 100 mg, trihexyphenidyl (THP) 2 mg, 4 mg, biperiden (BPD) 1 mg, 2 mg, 5 mg, mazaticol (MZC) 4 mg, 8 mg, amantadine (AMD) 100 mg, bromocriptine (BMC) 1.25 mg, 2.5 mg, and amitriptyline (ATP) 25 mg, haloperidol (HPD) 3 mg, diazepam (DZP) 3 mg, inert placebo (PLB) as active and inactive controls. They were orally given to six healthy male volunteers respectively with two weeks interval and pre-drug, one, three, six hour post-drug EEGs were recorded and analyzed using our computer system with the periodgram technique. Placebo-controlled differences between pre- and post-drug EEGs were statistically treated with the principal component analysis. THP, BPD and MZC produced a marked decrease of alpha frequency associated with increases of slow and fast activities. In addition, MZC induced a slight delirious state with visual and auditory hallucinations at 8 mg in five of six subjects. EEG profiles of these drugs appeared very close to those of thymoleptics but the clinical observations suggest some psychodysleptic property of MZC at a higher dose. LDP provoked a decrease of lower alpha frequency and an increase of lower fast activity that may suggest central stimulant or mood elevating effects. BMC and AMD induced a decrease of slow activity associated with increases of higher alpha activity and lower fast activity in EEG and suggested their vigilance enhancing effects. Based on the current experience, it would be appropriate to use six EEG bands classification (delta, theta, lower alpha, higher alpha, lower beta, higher beta) instead of the fundamental four bands (delta, theta, alpha and beta) in pharmaco-EEG, as far as multivariate analysis of psychotropic drug profile is concerned. It must be noted that the higher part of alpha frequency present a completely different response from the lower part to the centrally effective drugs. Furthermore, psychiatrists should be as prudent as possible when prescribing antiparkinsonian drugs for prevention and treatment of drug induced extrapyramidalism.
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Ninety alcoholic patients with the secondary affective disorders (anxiety, depression) were divided into four groups. Patients in the first group received GABAB receptor ligands (baclofen), those in the second group, diazepam, those in the third group, amitriptyline and those in the fourth group, placebo. The results of clinical, psychological (tests of Spielberger, Zung and MMPI), and electrophysiological (superslow omega-potential) investigations showed that baclofen is an effective drug for affective disturbances in alcoholic patients, with efficacy superior to placebo and equal to diazepam and amitriptyline. At the same time baclofen does not have the side-effects and complications of the latter. Significant changes in platelet MAOB activity and the dopamine, serotonin and GABA concentrations in blood after treatment were not found in the four patient groups. The peripheral matabolism of GABA and monoamines do not seem to be related to the development of secondary affective disorders in alcoholic patients. This investigation encourages the search for drugs acting on the affective psychopathology of GABAB receptor ligands.
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Bupropion and fluvoxamine appear less effective in long-term treatment of MDD. These results should be confirmed by randomized placebo-controlled prospective studies with larger samples.
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Neuropathic pain is associated with significant co-morbidities, including depression, which impact considerably on the overall patient experience. Pain co-morbidity symptoms are rarely assessed in animal models of neuropathic pain. Neuropathic pain is characterized by hyperexcitability within nociceptive pathways and remains difficult to treat with standard analgesics.
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These findings suggest that antidepressants restore normal responding by permitting more effective adaptation to novel stimuli.
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Dose equivalence of antidepressants is critically important for clinical practice and for research. There are several methods to define and calculate dose equivalence but for antidepressants, only daily defined dose and consensus methods have been applied to date. The purpose of the present study is to examine dose equivalence of antidepressants by a less arbitrary and more systematic method.
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Randomized, controlled, double blind, triple crossover 8-week trial.