ABSTRACT
"Alcohol detox" is a common presentation to acute medical services and is usually managed via standardised guidelines and protocols. We present a case of chlordiazepoxide toxicity, requiring repeated bolus doses and subsequently 24 hours of an intravenous infusion of flumazenil in response to guideline directed management of an alcohol withdrawal state. The use of prolonged flumazenil infusions to treat benzodiazepine toxicity is infrequently described. Chlordiazepoxide is metabolised in the hepatic microsomal pathway and hepatic impairment can lead to accumulation of toxic metabolites, which may have been the explanation for toxicity in this case. In patients at risk of liver dysfunction we advise the use of benzodiazepines not requiring phase 1 oxidative metabolism, such as lorazepam or oxazepam.
ABSTRACT
We demonstrate a miniaturized single beam fiber optical trapping probe based on a high numerical aperture graded index (GRIN) micro-objective lens. This enables optical trapping at a distance of 200µm from the probe tip. The fiber trapping probe is characterized experimentally using power spectral density analysis and an original approach based on principal component analysis for accurate particle tracking. Its use for biomedical microscopy is demonstrated through optically mediated immunological synapse formation.
Subject(s)
Cholinesterase Inhibitors/therapeutic use , Dyskinesia, Drug-Induced/drug therapy , Indans/therapeutic use , Piperidines/therapeutic use , Adult , Aged , Antipsychotic Agents/adverse effects , Antipsychotic Agents/therapeutic use , Donepezil , Drug Administration Schedule , Dyskinesia, Drug-Induced/etiology , Humans , Male , Middle Aged , Psychotic Disorders/drug therapy , Schizophrenia/drug therapy , Treatment OutcomeABSTRACT
BACKGROUND: Tardive dyskinesia (TD) remains a significant clinical problem for which there is no uniformly effective treatment. Earlier trials with acetylcholine precursors may have been disappointing because of underlying damage to striatal cholinergic neurons in patients with TD. In contrast, new cholinesterase inhibitors, developed for the treatment of dementia, may improve TD by directly increasing cholinergic synaptic transmission. METHOD: We conducted an 8-week open-label trial of donepezil in the treatment of TD. Ten patients with schizophrenia or schizoaffective disorder who received stable doses of antipsychotics and met DSM-IV criteria for TD were treated with donepezil, 5 to 10 mg/day, for 6 weeks after a 2-week baseline period. Changes in total Abnormal Involuntary Movement Scale (AIMS) scores measured every 2 weeks were assessed for significance. Patients were also assessed using the Brief Psychiatric Rating Scale, the Mini-Mental State Examination, the Barnes Akathisia Scale, and the Simpson-Angus Scale. RESULTS: Total AIMS scores decreased significantly (p = .0009), with no changes in other measures. Nine patients showed a positive response. Improvement was greatest in orofacial and upper extremity movements. No significant interactions were noted between the total AIMS scores and age (p > .29), duration of TD (p > .38), or duration of antipsychotic treatment (p > .14). CONCLUSION: Donepezil appeared to be effective in suppressing TD in this pilot study. However, placebo-controlled, double-blind studies are necessary before donepezil can be recommended as a treatment for TD.
Subject(s)
Antipsychotic Agents/adverse effects , Dyskinesia, Drug-Induced/drug therapy , Indans/therapeutic use , Piperidines/therapeutic use , Psychotic Disorders/drug therapy , Schizophrenia/drug therapy , Adult , Aged , Antipsychotic Agents/therapeutic use , Donepezil , Dose-Response Relationship, Drug , Drug Administration Schedule , Dyskinesia, Drug-Induced/diagnosis , Female , Humans , Indans/adverse effects , Male , Mental Status Schedule , Middle Aged , Neurologic Examination/drug effects , Pilot Projects , Piperidines/adverse effects , Psychiatric Status Rating ScalesABSTRACT
Fifty-four patients underwent staging laparoscopic pelvic lymphadenectomy under general anesthesia for prostatic carcinoma (49), bladder carcinoma (3), penile carcinoma (1), and lymphoma (1). Conversion to an open procedure occurred only once in the series, but three patients received secondary open operations (5.5%). Complications recognized intraoperatively included bladder perforation (2) and mesenteric hematoma (1). One bladder perforation was repaired laparoscopically. The other was treated with catheter drainage. The mesenteric hematoma was explored surgically and found to be minor. Major postoperative complications included bleeding (4) requiring transfusion in two patients. One hematoma became infected requiring percutaneous drainage. One patient required intubation due to chronic obstructive pulmonary disease (COPD). Ureteral injury (1) was recognized late and required a psoas hitch and ureteroneocystostomy. Two patients developed small bowel obstructions due to herniation through a trocar site, requiring operative correction. Minor postoperative complications included ileus (4), diarrhea (2), bronchospasm (1), transient obturator nerve palsy (1), electrocardiogram changes (1), and fever (1). The overall major complication rate was 16.7%, and the overall minor complication rate was 18.4%. In this series, a substantial learning curve was seen with regard to complications, but the series compared favorably with open lymphadenectomy.