Subject(s)
Antidepressive Agents, Second-Generation/adverse effects , Bipolar Disorder/drug therapy , Bruxism/chemically induced , Buspirone/administration & dosage , Cyclohexanols/adverse effects , Depressive Disorder, Major/drug therapy , Adult , Antidepressive Agents, Second-Generation/administration & dosage , Bruxism/drug therapy , Cyclohexanols/administration & dosage , Drug Therapy, Combination , Female , Humans , Venlafaxine HydrochlorideABSTRACT
BACKGROUND: One hypothesis to explain selective serotonin reuptake inhibitor (SSRI)-induced bruxism states that SSRIs increase extrapyramidal serotonin levels, thereby inhibiting dopaminergic pathways controlling movement. Previous reports have emphasized buspirone's postsynaptic dopaminergic effect as a partial antidote to the suppressed dopamine levels. CASE REPORTS: Four patients, recently started on treatment with the SSRI sertraline, presented with new-onset complaints attributable to SSRI-induced bruxism. All 4 responded to adjunctive buspirone, a serotonin-1A (5-HT1A) receptor agonist, with relief of bruxism and associated symptoms. DISCUSSION: We expand the hypothesis put forth in previous reports by proposing that buspirone is not only acting postsynaptically in the extrapyramidal system, but also presynaptically on serotonergic neurons that influence masticatory modulation in the mesocortical tract. Our 4 cases support the concept of buspirone acting as a full agonist at the presynaptic 5-HT1A somatodendritic receptors located on the cell bodies of raphe serotonergic neurons that project to the ventral tegmental area (VTA) of the midbrain. These serotonergic neurons modulate the firing of the mesocortical tract, which itself projects from the VTA to the prefrontal cortex and acts on masticatory muscle activity through inhibiting spontaneous movements such as bruxism. While the literature is confusing and contradictory on definitions of bruxism and etiologies of incompletely understood movement disorders, we believe SSRI-induced bruxism is best conceptualized as a form of akathisia.
Subject(s)
Bruxism/chemically induced , Bruxism/drug therapy , Buspirone/therapeutic use , Selective Serotonin Reuptake Inhibitors/adverse effects , Serotonin Receptor Agonists/therapeutic use , Sertraline/adverse effects , Adult , Akathisia, Drug-Induced/diagnosis , Bruxism/diagnosis , Buspirone/pharmacology , Diagnosis, Differential , Female , Humans , Male , Middle Aged , Receptors, Dopamine/drug effects , Receptors, Serotonin/drug effects , Serotonin Receptor Agonists/pharmacology , Selective Serotonin Reuptake Inhibitors/therapeutic use , Sertraline/therapeutic use , Treatment OutcomeABSTRACT
Esophageal dilatation by endoscopists is a commonly performed procedure. The introduction of tapered polyvinyl dilators by Savary has made the procedure even more popular. In the United States, esophageal dilatation with guide wires has been traditionally performed with fluoroscopy. By using a marked guide wire and by adhering to specific safety guidelines, the passage of the guide wire can be precise, even without fluoroscopy, and radiographic definition is not always required. This study describes the new guide wire and the technique.
Subject(s)
Dilatation/instrumentation , Esophageal Stenosis/therapy , Dilatation/adverse effects , Dilatation/methods , Equipment Design , Humans , Pilot ProjectsSubject(s)
Curriculum , Education, Nursing, Baccalaureate , Specialties, Nursing , Humans , Models, TheoreticalABSTRACT
The mercury contents in samples of flour, sugar, nonfat dry milk, potatoes, hamburger, chicken breast, shrimp, liver, eggs, and whole milk were determined by neutron activation analysis. The mercury was separated by anion exchange chromatography and precipitated as the sulfide. The mercury concentrations for all these foods were below 50 parts per billion.
