Acetaminophen and ibuprofen in the management of fever and mild to moderate pain in children.

Acetaminophen has become the non-narcotic of choice for children because of concerns regarding the connection between acetylsalicylic acid exposure and Reye's syndrome. Ibuprofen, recently granted over-the-counter status for children over two years of age, offers another choice for treatment. The efficacy and safety of both drugs have been studied in numerous clinical trials. This paper reviews the published evidence about the efficacy and safety of acetaminophen and ibuprofen with regard to treating fever and mild to moderate pain in children.

Social science education as a component of medical training.

The broad view of health espoused by the World Health Organization is now generally accepted by medical educators. Implicit in the new paradigm is a recognition of multiple determinants of health and of shifting divisions of professional responsibilities among providers. As a consequence, the importance of social and behavioural science education as a foundation to medical training is increasingly appreciated. At the same time medical programmes are under pressure to contend with the explosion of knowledge in basic biomedical and life sciences and with technological innovation. Curricula are being submerged in facts, causing medical schools to look for innovative teaching models that feature more flexible approaches to the diverse body of knowledge supporting professional practice. Independent learning methods are being explored and revised teaching programs are being organized around coordinating themes, such as aging, human development and environmental health. Future programmes must be designed to encourage multiprofessional approaches while fostering awareness of the important interplay between health care (both curative and preventive) and social/behavioural science. Within the curriculum students should be offered options that include sociology, child growth and development, gerontology, medical anthropology, psychology, medical geography, health economics, political science and related subthemes. More important than the inclusion of any specific discipline is the creation of an environment in which future physicians may be exposed to critical thinking across a wide range of themes that characterize the social and cultural context for medical practice. Such enquiry is also likely to drive a closer relationship between medical schools and their parent universities within which the social science expertize resides.(ABSTRACT TRUNCATED AT 250 WORDS)

Twenty-four-hour intragastric measurements in twenty healthy subjects: effect of enisoprost, a novel and potent antisecretory and antipeptic synthetic E1 prostaglandin.

Gastric aspiration was performed continuously overnight and at hourly intervals during the daytime in 20 healthy male volunteers. Medications used included enisoprost 100, 200 or 400 micrograms, misoprostol 200 micrograms and placebo, given at bedtime. Each dose of enisoprost markedly inhibited nocturnal mean acid output, hydrogen ion activity, pH and peptic activity. The duration of these effects was up to 10 h. Misoprostol, given at bedtime, also decreased acid secretion, but the effect was significantly less than that observed with any of the doses of enisoprost. A dose-response effect for enisoprost was found for the mean nocturnal hydrogen ion activity and pH, as well as for maximum pH attained. Although enisoprost, given at bedtime, had a marked inhibitory effect on acid and pepsin secretion for the overnight interval, this did not result in rebound hyperacidity or a rise in serum total gastrin concentration. The results of this study suggest that enisoprost should be tested by clinical trial for the treatment of peptic ulcer disease.

Controlled delivery of an antitumor drug: localized action of liposome encapsulated cytosine arabinoside administered via the respiratory system.

Cytosine arabinoside in free or liposome encapsulated form was administered to the lungs of rats via intratracheal instillation. The free drug rapidly left the lung (T 1/2 = 40 min), while the encapsulated drug remained in the lung for a prolonged period (T 1/2 = 8 hr). Free cytosine arabinoside effectively inhibited DNA synthesis (measured by [14C]thymidine incorporation) in the intestine and bone marrow as well as in the lung. By contrast, liposome-encapsulated drug effectively inhibited DNA synthesis in the lung, but similar doses failed to inhibit DNA synthesis in other tissues. The metabolism of free and encapsulated drug were similar in that the same products resulted, namely the inactive catabolite uracil-beta-D-arabinofuranoside and the phosphorylated anabolites of cytoside arabinoside. These results suggest that the action of an antitumor drug can be confined to a single organ through the use of a liposomal drug delivery system.

Organ-selective action of an antitumor drug: pharmacologic studies of liposome-encapsulated beta-cytosine arabinoside administered via the respiratory system of the rat.

beta-Cytosine arabinoside (Ara-C) in free and liposome encapsulated form was administered to Wistar rats by intratracheal institution. Free [3H]Ara-C administered in this manner rapidly left the lung and entered the systemic circulation. Liposome-encapsulated [3H]Ara-C persisted in the lung for a long period, with little redistribution to other tissues. Liposomes administered via the trachea became widely distributed throughout the lung air spaces, as evidenced by the histochemical localization of liposomes containing horse-radish peroxidase. Free Ara-C (5 mg/kg) administered into the trachea effectively suppressed macromolecular incorporation of [14C]thymidine ([14C]dThd) in the bone marrow and gut as well as in the lung. Liposome-encapsulated Ara-C (5 mg/kg) effectively suppressed macromolecular incorporation of [14C]dThd in the lung but had little effect on this process in the gut and bone marrow. Our results suggest that liposome-encapsulated Ara-C may be able to produce a local pharmacologic effect within the lung without producing adverse side effects in other tissues. This observation may be relevant to the chemotherapy of pulmonary metastases.