Analgesic Mechanism of Electroacupuncture in an Arthritic Pain Model of Rats: A Neurotransmitter Study

PURPOSE: We investigated what kinds of neurotransmitters are related with electroacupuncture (EA) analgesia in an arthritic pain model of rats. MATERIALS AND METHODS: One hundred rats were assigned to six groups: control, EA, opioid, adrenergic, serotonin and dopamine group. A standardized model of inflammatory arthritis was produced by injecting 2% carrageenan into the knee joint cavity. EA was applied to an acupoint for 30 min in all groups except fo the control group. In the opioid, adrenergic, serotonin and dopamine groups, each receptor antagonist was injected intraperitoneally to their respective group before initiating EA. RESULTS: In the opioid receptor antagonist group, adrenergic receptor antagonist group, serotonin receptor antagonist group, dopamine receptor antagonist group and the control group weight-bearing force decreased significantly from 30 min to 180 min after EA in comparison with the EA group. CONCLUSION: The analgesic effects of EA are related to opioid, adrenergic, serotonin and dopamine receptors in an arthritic pain model of rats.

Guidelines for the Treatment of Irritable Bowel Syndrome / 대한소화기학회지

Traditional symptom-based therapies of irritable bowel syndrome (IBS) are directed at the relief of individual IBS symptoms, but they are often of limited efficacy in addressing the entire symptom complex. Combinations of drugs to target bothersome symptoms are suggested as the first-line pharmacologic treatment. Increasing knowledge of the pathophysiology and molecular mechanisms of IBS has resulted in the development of several new therapeutic approaches. Thirteen consensus statements for the treatment of IBS were developed using the modified Delphi approach. Exclusion diets have modest efficacy in improving symptoms in some IBS patients. Symptom-based therapies with dietary fiber, bulking agents, laxatives, antispasmodics and laxatives are effective in the improvement of some individual symptoms, e.g. dietary fiber and bulking agents for constipation, laxatives for constipation, antispasmodics for abdominal pain and discomfort, antidiarrheals for diarrhea. 5HT3 receptor antagonists and 5HT4 receptor agonists are effective in the relief of global IBS symptoms and individual symptoms such as abdominal pain and abnormal bowel habits. A short term course of nonabsorbable antibiotics may improve global IBS symptoms, particularly in patients with diarrhea- predominant IBS. Some probiotics appear to have the potential benefit in improving global IBS symptoms. Selective C-2 chloride channel activator is more effective than placebo at relieving global IBS symptoms in patients with constipation-predominant IBS. Both tricyclic antidepressants and selective serotonin reuptake inhibitors are equally effective in relieving global IBS symptoms, and have some benefits in treating abdominal pain. Certain types of psychologic therapy may be effective in improving global symptoms in some IBS patients. Further studies are strongly needed to develop better treatment strategies for Korean patients with IBS.

Comparison of Azasetron and Ondansetron for Preventing Postoperative Nausea and Vomiting in Patients Undergoing Gynecological Laparoscopic Surgery

PURPOSE: We compared the prophylactic effects of intravenously administered azasetron (10 mg) and ondansetron (8 mg) on postoperative nausea and vomiting (PONV) in patients undergoing gynecological laparoscopic surgery under general anesthesia. MATERIALS AND METHODS: We studied 98 ASA physical status I or II 20-65 years old, female patients, in this prospective, randomized, double blind study. Patients were randomly divided into two groups and received ondansetron 8 mg (group O) or azasetron 10 mg (group A) 5 min before the end of surgery. The incidence of PONV, Visual Analogue Scale (VAS) for pain, need for rescue antiemetic and analgesics, and adverse effects were checked at 1, 6, 12, 24, and 48 h postoperatively. RESULTS: The overall incidence of PONV was 65% in group O and 49% in group A. The incidence of PONV was significantly higher in group O than in group A at 12-24 h postoperatively (nausea; 24% vs. 45%, p = 0.035, vomiting; 2% vs. 18%, p = 0.008), but there were no significant differences at 0-1, 1-6, 6-12 or 24-48 h. CONCLUSION: In conclusion, azasetron (10 mg) produced same incidence of PONV as ondansetron (8 mg) in patients undergoing general anesthesia for gynecological laparoscopic surgery. Azasetron was more effective, in the intermediate post-operative period, between 12 and 24 h.

A systematic review on clinical management of antipsychotic-induced sexual dysfunction in schizophrenia

INTRODUCTION: Sexual dysfunction frequently occurs in patients with schizophrenia under antipsychotic therapy, and the presence of sexual side effects may affect compliance. The aim of this study was to review and describe clinical findings relating to the appropriate management of such dysfunctions. MATERIAL AND METHODS: The research was carried out through Medline (from 1966 to March 2005), PsycInfo (from 1974 to March 2005), and Cochrane Library (from 1965 to March 2005) and included any kind of study, from case reports to randomized trials. RESULTS: The most common sexual dysfunctions found in the literature were libido decrease, difficulties in achieving and maintaining erection, ejaculatory dysfunction, orgasmic dysfunction, and menstrual irregularities. Thirteen papers were found: eight of them were open-label studies, four were descriptions of cases, and only one was a randomized clinical trial. All of them were short-term and had small sample sizes. The agents used were: bromocriptine, cabergoline, cyproheptadine, amantadine, shakuyaku-kanzo-to, sildenafil and selegiline. DISCUSSION: There was no evidence that those agents had proper efficacy in treating the antipsychotic-induced sexual dysfunction. An algorithm for managing sexual dysfunction induced by antipsychotics is suggested as a support for clinical decisions. Since the outcome from schizophrenia treatment is strongly related to compliance with the antipsychotics, prevention of sexual dysfunction is better than its treatment, since there is a scarcity of data available regarding the efficacy of intervention to deal with these problems.

INTRODUÇÃO: Disfunção sexual freqüentemente ocorre em pacientes com esquizofrenia em terapia com antipsicóticos e a presença de efeitos adversos sexuais pode afetar a adesão ao tratamento. O objetivo do estudo é rever e descrever achados clínicos relacionados ao manejo apropriado de tais disfunções. MATERIAIS E MÉTODOS: A pesquisa foi feita pelo Medline (de 1966 a março de 2005), PsycInfo (de 1974 a março de 2005) e Biblioteca Cochrane (de 1965 a março de 2005) e incluiu qualquer tipo de desenho de estudo de relato de caso a estudos clínicos randomizados. RESULTADOS: As disfunções sexuais mais comuns encontradas na literatura foram diminuição da libido, dificuldades em alcançar e manter ereção, disfunção ejaculatória, orgásmica e irregularidades menstruais. Treze artigos foram encontrados: oito deles eram estudos abertos, quatro descrições de casos e somente um estudo clínico randomizado. Todos eram de curta duração e com tamanho de amostra pequeno. Os agentes usados foram: bromocriptina, cabergolina, ciproheptadina, amantadina, shakuyaku-kanzo-to, sildenafil e selegilina. DISCUSSÃO: Não há evidências de eficácia apropriada destes agentes no tratamento da disfunção sexual induzida por antipsicóticos. Um algoritmo foi sugerido para manejo da disfunção sexual induzida por antipsicóticos, suportando decisões clínicas. Como o desfecho da esquizofrenia é fortemente relacionado a adesão ao tratamento com antipsicóticos, a prevenção da disfunção sexual é melhor que seu tratamento, visto que muito poucos dados estão disponíveis sobre a eficácia de intervenções destes problemas.

Ondansetron amelioration of scopolamine induced cognitive deficits in three-panel runway apparatus in rats.

Effect of ondansetron (5-HT3-receptor antagonist) was studied on the working memory deficits induced by scopolamine, a muscarinic receptor antagonist in rats using a three-panel runway apparatus. Varying doses of scopolamine (0.1-0.56mg/kg, ip) were administered alone or in combination with ondansetron (0.01-1.0 mg/kg, ip) and memory errors and latency period of the session were recorded on a three-panel runway apparatus. Treatment with scopolamine (0.56 mg/kg) produced working memory deficits in rats. Treatment with ondansetron (1.0 mg/kg) significantly reduced the scopolamine-induced working memory deficits.

Antagonistas 5-HT3: uma nova classe de ansioliticos? o exemplo do ondansetron / 5-HT3 antagonists: a new class of anxiolytic drugs? the example of ondansetron

Os benzodiazepinicos (BDZ) representam a opcao mais empregada no tratamento do transtorno da ansiedade generalizada (TAG). Embora possam ser considerados drogas relativamente seguras, os efeitos adversos dos BDZ tem motivado a procura por novos tratamentos farmacologicos para a TAG. Os antagonistas dos receptores da serotonina do tipo 3 (5-HT3) parecem ser uma alternativa segura e eficaz. A presente revisao (nao-sistematica) aborda os...

Ondansetron como fármaco alternativo no tratamento do prurido induzido pela morfina quando utilizada via peridural ou subaracnoídea / Ondansetron as alternative drug in treatment of pruritus induced by morphine when used by way epidural or subarachnoid

O prurido é um efeito colateral, dentre vários outros, gerado pelo uso da morfina administrada por qualquer via. Tal efeito, o prurido, pode assumir, muitas vezes, grandes proporcoes e com isso inviabilizar o emprego da morfina. No presente estudo, procurou-se obseervar os resultados obtidos, para o tratamento do prurido, com o uso de ondansetron, fármaco antagonista dos receptores 5-HT3, que já tem mostrado propriedades antipruriginosas excelentes conforme dados da literatura. Foi realizado um estudo prospectivo e duplo-cego em 80 pacientes com prurido após emprego de morfina administrada via peridural ou subaracnoídea. Nessa pesquisa, observaram-se se valores foram iguais ou superiores a 4 em uma escala variável de 0 a 10. Um grupo (n=40) recebeu 96ml de soluçäo fisiológica mais 8mg de ondansetron (4ml), e outro (n=40) grupo recebeu somente 100ml de soluçäo fisiológica. Considerou-se sucesso o tratamento quando se verificou uma diminuiçäo de 4 ou mais pontos nesta escala após a administraçäo da soluçäo e num período de 1h, medindo-se o resultado de 10 em 10 minutos. Os resultados mostraram sucesso no tratamento com ondansetron em 75 por cento dos casos de peridural e 75 por cento dos casos de bloqueio subaracnoídeo. No grupo tratado com placebo (soro fisiológico, o prurido cessou em 33 por cento dos casos de peridural e em 27,27 por cento dos casos de bloqueio subaracnoídeo. Ocorreu prevalência de sexo nos casos estudados: através de via peridural, o tratamento foi mais efetivo em mulheres, e por via subaracnoídea, os homens apresentaram melhora mais significativa. Quanto à idade, näo houve diferença no tratamento. Estes resultados só diferem dos encontrados na literatura no que se refere ao sexo. Quatro casos com ondansetron e 3 casos com o placebo (soro fisiológico) que apresentou sucesso no tratamento tiveram reincidência do prurido dentro das 12h subseqüentes, o que apresentou um percentual de 13 por cento para o grupo do ondansetron e 25 por cento para o grupo controle. Esses dados equiparam-se com aqueles vistos na literatura. Os resultados säo animadores e mostram outro fármaco com boas perspectivas para o tratamento desse efeito colateral sem comprometer a analgesia produzida pela morfina, como acontece quando säo empregados antagonistas puros dos narcóticos como a naloxona.

Novos avanços no controle da náusea pós-quimioterapia antineoplásica / New advances in controlling nausea and vomiting related to anticancer chemotherapy

A náusea é um dos efeitos colaterais mais temidos pelos pacientes que se submetem à quimioterapia (QT) antineoplásica. O controle inadequado desta complicaçäo confere significativa morbidade aos pacientes tratados com QT. Com o advento dos antagonistas dos receptores 5-HT, a incidência de náusea e vômito relacionados à quimioterapia (NVQT) diminuiu significativamente. Isso permitiu a administraçäo de regimes altamente emetizantes em nível ambulatorial para a maioria dos pacientes com câncer, melhorando sua qualidade de vida. O uso dessas drogas, entretanto, aumentou sobremaneira os custos do tratamento. Nesta revisäo, abordaremos sumariamente os mecanismos fisiopatológicos da emese, para entäo podermos compreender como atuam as drogas antieméticas atualmente utilizadas na prática oncológica. Discutiremos também os novos rumos da pesquisa clínica nesta área, incluindo estratégias para minimizar o custo desse tratamento

Efficacy and tolerability of risperidone in chronic schizophrenic Thai patients.

Risperidone is a novel serotonin-dopamine antagonist antipsychotic in a class of benzisoxazole derivative which has been shown to be effective in reducing psychotic symptoms in schizophrenia. The study was designed as perspective, 8-week, multicenter, open label study in schizophrenic patients from 6 psychiatric hospitals. One hundred and twenty cases were recruited and 105 patients completed the study. The average total PANSS score at the baseline was 90.6 (range 60-133). Patients were evaluated with quantitative rating scales for the efficacy (PANSS score) and extrapyramidal rating scale at week 4 and 8 after starting risperidone treatment. The titrated dose of risperidone was given to the patients with the final dose of 6 mg risperidone throughout the study period. At week 4, the average PANSS score was significantly reduced to 73.4 (p < 0.05). The average PANSS score at week 8 was further declined to 61.9 which was significantly different (P < 0.05) from the baseline. Seventy-eight cases (74.3%) were classified as responders (those patients showing more than 20 per cent decrease in PANSS score). Extrapyramidal side effect was occurred in some patients, but usually mild and tolerable. However twenty-four patients (22.9%) required medications for this side effect. Other adverse reactions were insomnia found 15 cases (14.3%), elevated hepatic enzyme 5 cases (4.8%) and weight gained 2 cases (1.9%). Our data suggested that risperidone is effective and well-tolerated in chronic schizophrenic Thai patients.

Randomized single-blind trial of topical ketanserin for healing acceleration of diabetic foot ulcers

The objective of this study was to determine the efficacy of topically applied ketanserin for healing acceleration of diabetic foot ulcers. From august 1993 to september 1994, 140 NIDDM patients entered a randomized single-blind trial of topical ketanserin (Sufrexal, Janssen Pharmaceuticals; n=69) vs. normal saline (labeled here as placebo; n=71). All patients were subjected to surgical debridement of necrotic tissue and lavage with normal saline. Wound were <100 cm² in area. Persons with NIDDM and foot ulcers Wagner 2 and 3 with a median of 8 (interquartile range 4 -26) weeks duration were included. Ulcer area was measured at 0, 4, 8 and 12 weeks. The groups were similar in age, sex, years of diabetes duration, obesity, ulcer Wagner type, number of previous amputations and surgical debridements during this hospital stay. Average percent reduction in ulcer area at 12 weeks was 87 percent for ketanserin vs. 63 percent for placebo (p<0.001). The regression equations for the leastsquares fit to the area (y) against time (x) data points were y = 43.46-3.181x(r=0.995) for ketanserin and y= 39.46-2.016x(r=-0.999) for placebo (p<0.01). The 95 percent confidence limits for slopes were -3.181 ñ 0.98 and -2.016ñ0.15. Thus, average daily reduction in ulcer area was 4.5 mm²/day for ketanserin vs. 2.88 mm²/day for placebo. In clnclusion, topical ketanserin significantly accelerated wound healing in diaetic neurothrophic foot ulcers when applied as part of a comprehensive healing program

Açöes farmacológicas dos antidepressivos / Pharmacological actions of antidepressant drugs

Vários aspectos das drogas antidepressivas säo abordados no presente artigo. Assim, a toxicologia e/ou as características terapêuticas e principalmente o mecanismo de açäo säo apresentados para os antidepressivos tricíclicos, atípicos, aos inibidores da monoaminoxidase, lítio e outros fármacos utilizados no tratamento de distúrbios associados à depressäo

Manejo da emese no paciente oncológico / Emesis in oncologic patients

Os autores fazem uma revisäo da literatura sobre o manejo da emese no paciente oncológico, visando abordar de forma sucinta e clara este assunto, no intuito de facilitar seu manejo para os profissionais da área de saúde

Jaqueca y su tratamiento / Migraine and its treatment

La jaqueca es la cefalea vascular más frecuente y afecta especialmente el sexo femenino, pudiendo llegar a entorpecer las actividades habituales. En su cuadro clínico se reconocen una etapa prodrómica (vasoconstricción); una cefalálgica (vasodilatación) y una de declinación. En el tratamiento de las crisis jaquecosas el medicamento de elección es el tartrato de ergotamina, (oral, rectal o parenteral) cuya eficacia es tanto mayor mientras más precozmente se administra ya sea solo o asociado a cafeína y metamizol o paracetamol. En la prevención de las crisis, el medicamento más empleado es el propranolol. También se utilizan algunas drogas antiserotonina tales como el pizotifeno, la methisergida, la ciproheptadina y los bloqueadores de los canales del calcio

Avanços recentes no distúrbio obsessivo-compulsivo / ecent advances in obsessive compulsive disorder

Há um volume crescente de evidências provenientes da fenomenologia clìnica, incluindo disturbios associados, visualizaçäo do cérebro e estudos neurofarmacológicos, ligando a sìndrome psiquiátrica clássica do distúrbio obsessivo-compulsivo (DOC) a disfunçöes dos glânglios basais e ao sistema serotonìnico. Atualmente, o DOC é a sìndrome psiquiátrica com maior probabilidade de ser originária de uma disfunçäo neurológica especìfica, o que é corroborado por um modelo animal extremamente convincente. Acredita-se que a disfunçäo nos gânglios basais e na alça talâmica cortical frontal produziria os sintomas "positivos" de excesso de preocupaçäo com a higiene pessoal, detalhismo e ambivalência que säo caracterìsticos do DCO. Talvez os dados mais intrigantes sejam os resultados preliminares de ensaios clìnicos, nos quais vários outros comportamentos anormais assemelhados ao excesso de cuidados com a higiene, tanto em animais quanto em humanos, podem estar relacionados ao DOC. Uma perspectiva etológica é sugerida

El desarrollo de nuevas drogas antipsicoticas / Development of new antipsychotic drugs

Se da por sentado que en la esquizofrenia, los efectos terapéuticos de los neurolépticos se basan en el bloqueo de los receptores de dopamina situados en el cerebro. Sin embargo, también se admite que los neurolépticos "clásicos" presentan algunos incovenientes importantes: su relativa falta de efectos sobre los síntomas negativos y su capacidad de inducción de síntomas extrapoiramidales (SEP). Experiencias clínicas llevadas a cabo con pipamperona mostraron que un antagonista combinado de serotinina 5-HT2 y dopamina D2 presentaba ventajas en el tratamiento de la esquizofrenia. Esto se hizo patente a través de los efectos antiautísticos observados, de la regulación de los ritmos de sueño y de vigilia perturbados y de la baja tendencia a la inducción de SEP. Los estudios realizados con setoperona, compuesto de perfil farmacológico comparable, confirmaron estas observaciones. No se pudo explorar la exacta implicación del antagnista 5-HT2 en los tratamientos psicofarmacológicos de la esquizofrenia hasta no haberse realizado la síntesis del receptor antagonista selectivo y específico: la ritanserina. En efecto las pruebas de doble ciego efectuadas demostraron una majoría sensible de los síntomas negativos y extrapiramidales. Puesto que las ventajas de la monoterapia en el tratamiento de la esquizofrenia son innegables, lo lógico era pasar a la selección de un compuesto con un antagonismo central comparable al de...