[Prescription of cholinesterase inhibitors in Alzheimer's disease in France in 2000-2001: an assessment of compliance with national guidelines for diagnosis and follow-up]. / Prescription des anticholinestérasiques dans la maladie d'Alzheimer en France en 2000-2001: évaluation du respect des procédures diagnostiques et de suivi.

INTRODUCTION: Alzheimer's disease (AD) became a treatable disease about ten years ago when cholinesterase inhibitors (CI) became available. We conducted a national population-based study in France in order to describe patients taking CI in 2001, to compare the diagnostic procedures of AD and the drug prescriptions with the French National guidelines, and to analyze the follow-up procedures of the patients. METHODS: The study was carried out in nine regions of France between December 1st 2000 and February 28th 2001 and included 3510 patients with CI treatment prescribed by the physicians affiliated with the National Social Security Health Care Fund. RESULTS: We found that the diagnostic procedures and the prescriptions were in compliance with the national guidelines with more than 90 percent of patients referred to a specialist, brain imaging in 85 percent and a MMSE scored between 10 and 26 in more than 90 percent. However, patient follow-up was in compliance with the guidelines in only 50 percent of patients. CONCLUSION: Diagnostic procedures of AD and first prescription of CI seem to be adequate in France, but patient follow-up needs to be improved.

Effects of dietary inclusion of chromium propionate and calcium propionate on glucose disposal and gastrointestinal development in dairy calves.

In experiment 1, 21 male Holstein calves (43.9 kg) were fed only milk replacer at 1.4% of their body weight as dry matter for 6 wk. Dietary treatments included a commercial milk replacer (22% protein, 15% fat) containing (dry basis) either 6.4% Ca propionate or 6.4% dextrose (control) and either 0 or 0.5 mg/kg of supplemental Cr as Cr propionate. Neither Cr nor Ca propionate affected body weight gain; however, Ca propionate tended to increase the growth of the entire foregut measured after slaughter at 6 wk of age. A Minimal Model glucose tolerance test indicated that insulin sensitivity was not affected by treatment. However, calves fed Cr had higher glucose disappearance indexes than controls when propionate was not fed (0.013 vs. 0.019 units) but similar clearance when propionate was included (0.018 vs. 0.018 units, Cr x P interaction). The area under the glucose response curves after propionate-loading tests was much greater for calves fed the Cr versus control replacer when propionate was not present; however, when propionate was included, the response was less dramatic. In experiment 2, 25 Holstein calves were used to study performance and metabolic responses when milk replacer, and then postweaning starter, were supplemented with 0.5 mg/kg of Cr as Cr propionate. The metabolic responses of these calves were not affected by treatment. Overall, combined data suggested that supplemental Cr may improve glucose effectiveness; however, these responses seemed to be attenuated by supplemental propionate.

Intravenous or epidural clonidine for intra- and postoperative analgesia.

BACKGROUND: Intravenous and epidural clonidine both produce postoperative analgesia. Several experimental reports demonstrate a spinal site of action for the analgesic effects of this alpha 2-adrenoceptor agonist. Therefore, the authors evaluated the clinical analgesic benefits of using clonidine, both intra- and postoperatively, by the epidural or the intravenous route. METHODS: Using a randomized prospective double-blind study design, 40 patients, between 18 and 50 yr of age, undergoing intestinal surgery under general propofol/nitrous oxide anesthesia, were enrolled. Before anesthesia, an epidural catheter was inserted at the L1-L2 interspace. At induction, a clonidine infusion was started at the doses of 4 micrograms/kg in 10 ml during 20 min, followed by 2 micrograms.kg-1 x h-1 (5 ml/h) during 12 h, either by the epidural (group 1) or by the intravenous (group 2) route. Intraoperatively, increased blood pressure and heart rate not responding to additional propofol bolus (0.5 mg/kg) was treated with a bolus of alfentanil (7 micrograms/kg). Postoperatively, morphine boluses (1.5 mg) were given through a PCA device according to the patient's need. Intraoperative analgesia was assessed by the alfentanil requirements. Postoperative analgesia was assessed by recording the morphine requirements, the visual analogue scale (VAS) at rest and after mobilization, and the patients' analgesia scale at 0, 3, 6, 12, 18, 24, and 36 postoperative hours. Sedation analogue scale and side effects were also recorded. Heart rate and blood pressure were particularly detailed during the first 2 h of the clonidine infusion. Plasma clonidine concentrations were measured after 20 min and 6, 12, and 24 h. RESULTS: Epidural clonidine significantly reduced the intraoperative alfentanil requirements (0.93 +/- 1.2 in group 1 vs. 2.4 +/- 1.8 mg in group 2). The postoperative morphine requirements were also reduced during the first 6 h (8.3 +/- 5.8 in group 1 vs. 17.8 +/- 13.4 mg in group 2). The VAS were comparable in both groups, despite the better patients' analgesia score reported in the epidural group during the first 12 h. There was no difference in sedation score at any time interval considered. Epidural and intravenous clonidine reduced heart rate and blood pressure to the same extent. The plasma clonidine concentrations were less in the epidural group only after the loading doses. CONCLUSIONS: Epidural clonidine reduces the intra- and early postoperative analgesic requirements when compared with the same dose given by the intravenous route. The side effects were similar with the two routes of administration.