From the First Department of Internal Medicine, School of Medicine, Kanazawa University, Kanazawa, Ishikawa, Japan. Address correspondence to Yukihiro Nagai, MD, First Department of Internal Medicine, School of Medicine, Kanazawa University, 13-1 Takara-machi, Kanazawa, Ishikawa, Japan 920-8641. E-mail: ynagai med.kanazawa-u.ac.jp.
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COURSE OBJECTIVES: Upon completion of this course, the participant will be able to: 1. Describe the prevalence and barriers to treatment of behavior problems in the older population. 2. Recognize the importance of nonpharmacologic as well as pharmacologic management in depression, dementia and delirium. 3. Differentiate medications based on efficacy and safety profile. 4. Select and manage medications for optimal treatment of these conditions in the elderly. COURSE OUTLINE: Introduction & Demographics Depression Differentials Home and Family Nursing Facility considerations Non-pharmacologic approaches Medications Dosing & Titrations SSRI TCA Dementia Disorders & Co-Morbidities Non-pharmacologic approaches Medications - Dosing & Titrations Atypical Neuroleptics Delirium APA Criteria & risk factors Management principles Summary & Conclusions, because topical flutamide.
3. Klotz LH, Newman T. Does maximal androgen blockade MAB ; improve survival? A critical appraisal of the evidence. Can J Urol. 1996; 3: 246-250. Debruyne FM, De Gery A, Hucher M, et al. Maximum androgen blockade with nilutamide combined with orchidectomy in advanced prostate cancer: an updated meta-analysis of 7 randomised, placebo controlled trials 1191 patients ; . Eur Urol. 1996; 30 suppl 2 ; : 264. Abstract 990. 5. Bennett CL, Tosteson TD, Schmitt B, et al. Maximum androgen-blockade with medical or surgical castration in advanced prostate cancer: a meta-analysis of nine published randomized controlled trials and 4128 patients using flutamide. Prostate Cancer Prostat Dis. 1999; 2: 4-8.
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I was still not out of the woods. My PSA continued to rise and by December 1992 it was 10.3 and my PAP was 1.44. The PAP or prostate acid phosphatase blood test is another useful "marker" for monitoring the progression of PCa. About this time I read of pioneering work being done at Allegheny General Hospital in Pittsburgh, PA. The research using dogs demonstrated that cryoablation of the prostate was effective in destroying cancer cells. I went to Pittsburgh in March 1993 for an evaluation for this new procedure. My pre-op PSA was 18.2 when the cryosurgical ablation procedure was performed in June 1993. The procedure is similar to brachytherapy, but instead of seeds, the surgeon implants into the prostate five probes the temperatures of which are brought down to a sub-freezing level. The location of the probes is monitored with ultrasound to ensure that the ice balls do not freeze vital tissue. A warming catheter is inserted in the urethra and the entire prostate and seminal vesicles are frozen twice during the one hour procedure. I tolerated it well. Three months later I had a 12-point TRUSP biopsy. Two of the 12 cores came back positive and my PSA had reached 20.7. Now I had two strikes against me - first the failed brachytherapy and now the failed cryoablation. The last remaining treatment modality for me was hormone therapy HT ; , also known as androgen ablation. It is chemical castration. Its purpose is to shut down the entire production of testosterone since PCa cells need testosterone in order to grow. Back at Walter Reed in October 1993, I began HT with a Lupron shot an LHRH agonist ; every 28 days and two flutamide tabs an antiandrogen ; every eight hours. The LHRH blocks 95% of the testosterone which comes from the testicles and the antiandrogen blocks the other 5% coming from the adrenal glands. Finally some good news! My PSA went from 20.7 to 0.1 and my PAP went from 2.2 to 0.7 within 60 days. I.
019 AGING WITH A SPINAL CORD INJURY: FACTORS ASSOCIATED WITH THE NEED FOR MORE HELP Nathania R. Liem, MD, Division of Physical Medicine and Rehabilitation, University of Ottawa; Mary Ann McColl, PhD, School of Rehabilitation Therapy, Queen's University; Will King, PhD, Department of Community Health and Epidemiology, Queen's University; Karen M. Smith, MD, Division of Physical Medicine & Rehabilitation, Queen's University Objectives: The objectives of this study were to determine 1 ; the prevalence of a decline in function as expressed by the need for more help NMH ; , 2 ; the prevalence of medical problems, and 3 ; the association between medical, injury and socio-demographic factors and the NMH, among people aging with spinal cord injury SCI ; . Methods: The study was a cross-sectional secondary analysis of a dataset n 352 ; obtained by surveying individuals with SCI in Canada, the U.S. and England. Participants had acquired an SCI at least 20 years previously. To determine the NMH outcome, participants were asked whether or not they needed more help with activities of daily living ADL ; over the past three years. Medical, injury and socio-demographic data were also obtained from the dataset. Multivariate logistic regression was used to determine the relationship between the NMH and the medical, injury and socio-demographic variables. Results: 32% needed more help to perform ADLs within the past three years. Those needing more help were significantly older 59.3 10.7 vs. 56.3 10.1 years, p 0.05 ; and had lived longer with SCI 35.3 8.1 vs. 32.5 8.1 years, p 0.05 ; . Level and completeness of SCI were not related to the NMH p 0.05 ; . The most prevalent medical problems were constipation 48% ; , bowel accidents 42% ; and pressure sores 39% ; . On multivariate analysis, constipation OR 1.97, 95% C.I. 1.19-3.26 ; , pressure sores OR 1.76, 95% C.I. 1.07-2.87 ; , female gender OR 1.96, 95% C.I. 1.04-3.70 ; and decades post injury OR 1.42, 95% C.I. 1.00-2.01 ; were significantly associated with an increased likelihood of needing more help over a three year time period. Conclusions: This study may be used to identify those individuals most at risk for a decline in function. Aggressive prevention and management of neurogenic bowel and pressure sores has the potential to maintain the independence of people 20 years post-SCI and
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ABSTRACT: Patients diagnosed as having benign prostatic hyperplasia BPH ; had determination of prostate volume PV ; , prostate-specific antigen PSA ; , and serum testosterone before consideration for entry into a double-blind, randomized trial of flutamide 750 mg day for 6 months ; . The mean PSA level for these patients N 43 ; was 7.6 ng ml range: 1.0 to 45.7 ; , and the mean PV was 76.8 cm3 range: 24 to 198 ; . Linear regression analysis demonstrated a strong correlation between the two r 0.876, P 0.05 ; . Every 10 cm3 of prostate volume accounted for 1.02 ng ml of PSA in the serum. Twenty-two patients 11 treated with flutamide, 11 with a placebo ; agreed to enter the and
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United States of America -- The manufacturer of flutamide capsules, Eulexin, has issued a letter warning of liver toxicity in patients taking flutamide and monitoring requirements to avoid hepatic injury. Post-marketing reports for liver failure included a description of elevated serum transaminase levels, jaundice, hepatic encephalopathy and death related to acute hepatic failure. Approximately half of the reported cases occurred in the 3 months following initiation of treatment. Serum transaminase levels should be measured prior to initiating treatment with flutamide which is not recommended in patients whose alanine transaminase ALT ; values exceed twice the upper limit of normal. Serum transaminases levels should then be measured every month for the first four months of treatment and periodically thereafter. Liver function tests should be obtained at the first sign or symptom of liver dysfunction. In the event of jaundice or raised ALT, flutamide should be discontinued immediately with close follow-up of liver function tests until resolution. Flutxmide is not indicated for use in women and
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SNB neuronal nuclei cross-sectional area. The size of the nuclei of SNB neurons was smaller following prenatal FL p 0.001 ; and larger after postnatal TP p O.OOl ; , but there was no significant interaction of the pre- and postnatal treatments Table I ; . There were no significant effects of cross-fostering. Perineal muscle weight. Prenatal flutamide decreased perineal muscle complex weight p O.OOl ; , and postnatal TP increased muscle weight p 0.001; Table II ; . TP had a significantly greater masculinizing effect on animals that had received prenatal flutamide rather than prenatal PG p 0.001 ; . While cross-fostering did not have a significant main effect on muscle weight, there was a significant interaction of fostering and prenatal treatment p 0.05 ; . Specifically, cross-fostering resulted in increased muscle weight of animals receiving prenatal PG p 0.05 ; but did not alter the muscle weight of animals treated with flutamide prenatally p 0.05; Table II ; . Number of LA muscle fibers. The estimated number of LA muscle fibers was decreased by prenatal FL p 0.001 ; and increased by postnatal TP p 0.001; Fig. 4 ; . Once again, postnatal TP had a significantly more masculinizing effect on animals treated with prenatal FL p 0.01 ; . There were no significant effects of cross-fostering on the number of LA fibers.
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From the above, it is clear that as the prevalence of single drug resistance rises, the risk of failure also increases but it is not a direct correlation. This is understandable because chemotherapy of tuberculosis consists of multiple drugs. Also, the risk of rifampicin resistance is low if there is no history, for example, flutamice drug.
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Leave home for a short time or go on holiday, do your asthma symptoms improve? MOULD AND POLLEN SPORES Pollens and moulds are well-known seasonal allergens. You may be allergic to: tree pollen in the spring; grass pollen in the early summer; ragweed in mid-August until the first frost; Fungal spores moulds from spring until beyond the frost; levels are highest in the fall and fungi may also grow indoors i.e., in humidifiers and air conditioners. Here are tips for reducing your exposure to these allergens. 1. Keep windows and doors closed so allergens can't enter your home. In hot weather, an air conditioner effectively filters these out. 2. On sunny days in the morning or afternoon, when pollen and mould-spore counts are at their highest, try to avoid being outside. Counts are lowest just after it rains and in the evening and night. 3. Cutting the grass, camping, going into barns, sweeping up leaves and working with compost heaps will expose you to high levels of pollen and mould spores and thus should be avoided. 4. If you go on holiday, go out of season or to areas with low counts. For instance, western North America has low counts of ragweed pollen. 5. Add an anti-mould solution to your humidifier available in drug and appliance stores ; and be sure to clean it regularly.
Table 3. Estradiol and flutamie modulate cytokine and chemokine production after exposure of ileal segments to hypoxia plus acidosis and vepesid.
1. Advances in the treatment of HIV have produced dramatic reductions in morbidity and mortality. 2. HIV-infected patients live longer than previously and may need better psychological and social support. 3. The major challenge facing HIV health care providers is to ensure that everyone can benefit from the recent advances in HIV management, regardless of wealth, education and background. 4. GPs should have a central role in the care of HIV-infected patients and education of the general population regarding HIV and sexual health. 5. GPs can access many sources of information on HIV for themselves and their patients. Dr Richard Bellamy Department of Infectious Diseases.
Tial learning demonstrated that 70-day old male and female rat's water maze performance was significantly affected by prenatal hormones [3]. Steroid-sensitive sex differences were observed in water maze performance in favor of intact male rats compared to males prenatallytreated with flutamid4 and castrated at birth. Also, performance was enhanced in testosterone propionate TP ; and estradiol benzoate-treated EB ; female rats compared to intact female rats [3]. In summary, in learning and memory tasks requiring the use of spatial cues researchers have consistently found sex differences [16]. Males exhibit facilitated spatial learning and better spatial memory compared with females [714]. This sex difference is partially due to gonadal steroid differences in males and females [114]. The presence of testosterone, presumably via its intraneuronal conversion to estradiol [3, 1113], has been shown to enhance visual spatial ability [3, 1113]. However, data collected in intact animals and especially the examination of the effects of the prenatal hormones on visual spatial ability in these animals is scarce. Also, based upon the findings of our companion paper where dietary phytoestrogens significantly influenced visual spatial memory VSM ; . Therefore, in this study, we tested the hypothesis that manipulating the prenatal hormonal environment has long-term influences on VSM in adult male and female intact rats utilizing radial arm maze methods to examine varying aspects of memory ; . Additionally the influence of phytoestrogens plant compounds that are structurally and functionally similar to estradiol [1724] ; on VSM was assessed in these animals and famciclovir and flutamide.
Studies with the antiandrogen flutamide show that at doses significantly above that required to completely block prostate differentiation and cause genital feminization, wolffian ductal differentiation is significantly impaired.
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With reported Casodex effects on AR harboring mutation at position 741 22 however, it is unlikely that the stromal cells used in these experiments contain an AR with the same mutation because both flutamide and Casodex were able to block the DHT-induced IGF-I mRNA expression. Whether differences in androgen-responsive units in IGF-I and IGFBP-2 promoter sequences account for some of the differential effects of Casodex on these genes remains to be elucidated. DHEA and E2 did not significantly affect IGF axis gene and protein expression in stromal cells in this study, in contrast to their recently reported actions on human LNCaP prostate cancer cells 2 ; , wherein they increased cell proliferation, Prostate-specific antigen production, and modulation of the IGF axis, albeit with effects that were reduced and delayed compared with those elicited by DHT and T. The responses to DHEA and E2 in LNCaP cells may have been due in part to the known mutation in the LNCaP cell AR T877A ; , which allows for binding of DHEA and E2 and AR transactivation 8, 52 ; . Additionally, DHEA and E2 effects in LNCaP cells may have resulted from cellular metabolism of DHEA to more potent androgenic or estrogenic metabolites, with consequent binding to AR or estrogen receptor- 4, 19, 29 ; . Prostate stromal cells possess a wild-type AR that is not activated directly by DHEA or E2, but they do harbor the steroidogenic enzymes hydroxysteroid dehydrogenases 3 -HSD, 17 -HSD type 5, and 5 -reductase, which allow for metabolism of DHEA to T and DHT 3, 13 ; . Further studies are warranted to determine whether, and to what extent, DHEA is metabolized by prostate stromal cells. Of interest are the noted variations in degree of response among the different lots of primary stromal cells. DHT administration consistently modulated IGF-I, IGFBP-2, and IGFBP-3 gene and protein expression only in 6S and 9S stromal cell cultures, with no apparent effects in 5S cultures. All stromal cultures expressed similar levels of AR protein; therefore, the differences in responsivity of the IGF system to DHT observed in 6S and 9S vs. 5S stromal cultures do not appear to be explained by alterations in AR expression. Cytokeratin 18 expression was minimal to nonexistent in the stromal cell cultures we examined, suggesting that epithelial contamination.
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