[Management of alcohol use disorders in ambulatory care: Which follow-up and for how long?]. / Stratégie de prise en charge de l'alcoolodépendance en ambulatoire : quel suivi et quelle durée de traitement ?

BACKGROUND: Alcohol consumption with its addictive potential may lead to physical and psychological dependence as well as systemic toxicity all of which have serious detrimental health outcomes in terms of morbimortality. Despite the harmful potential of alcohol use disorders, the disease is often not properly managed, especially in ambulatory care. Psychiatric and general practitioners in ambulatory care are first in line to detect and manage patients with excessive alcohol consumption. However, this is still often regarded as an acute medical condition and its management is generally considered only over the short-term. On the contrary, alcohol dependence has been defined as a primary chronic disease of the brain reward, motivation, memory and related circuitry, involving the signalling pathway of neurotransmitters such as dopamine, opioid peptides, and gamma-aminobutyric acid. Thus, it should be regarded in terms of long-term management as are other chronic diseases. OBJECTIVE: To propose a standard pathway for the management of alcohol dependence in ambulatory care in terms of duration of treatment and follow-up. METHODS: Given the lack of official recommendations from health authorities which may help ambulatory care physicians in long-term management of patients with alcohol dependence, we performed a review and analysis of the most recent literature regarding the long-term management of other chronic diseases (diabetes, bipolar disorders, and depression) drawing a parallel with alcohol dependence. RESULTS: Alcohol dependence shares many characteristics with other chronic diseases, including a prolonged duration, intermittent acute and chronic exacerbations, and need for prolonged and often-lifelong care. In all cases, this requires sustained psychosocial changes from the patient. Patient motivation is also a major issue and should always be taken into consideration by psychiatric and general practitioners in ambulatory care. In chronic diseases, such as diabetes, bipolar disorders, or depression, psychosocial and motivational interventions have been effective to improve the patient's emotional functioning and to prevent or delay relapses. Such interventions help patients to accept their disease and to promote long-term therapeutic plans based on treatment adherence, behavioural changes, self-management and self-efficacy. The management of alcohol-dependence in ambulatory care should be addressed similarly. Therapeutic monitoring may be initiated to manage alcohol use disorders, including alcohol dependence, especially when the patient is unwilling or unready for alcohol withdrawal (i.e. using the strategy of reduction of alcohol consumption, which is considered a possible intermediate step toward abstinence). CONCLUSION: Alcohol dependence needs long-term medical supervision, and the therapeutic success depends on the initiation of sustained monitoring at the time of diagnosis (initiating phase with several consultations over 2-4 weeks) with psychosocial and motivational interventions in order to address all the patient uncertainties, to involve him/her in a proactive disease management plan, and to insure adherence to treatment, behavioural changes and new lifestyle. A close monitoring (once a month during the first 6 months) during a consolidation phase is necessary. Finally, a regular monitoring should be maintained overtime after 6-12 months in order to insure that the patient maintains a minimal consumption during the first year, to consolidate the patient's motivation, to abstain in at risk situations, and to maintain a controlled consumption or abstinence.

[Evolution in styles of romantic and interpersonal attachment in depressed adult women during hospitalization]. / Évolution des styles d'attachement romantique et interpersonnel au cours de l'hospitalisation chez des femmes adultes déprimées.

INTRODUCTION/OBJECTIVE: Bowlby (1984) regarded attachment as a model of psychological vulnerability to depression. Since then, a large number of studies have considered vulnerability to depression in light of the idea of attachment style. Attachment styles correspond to two dimensions observed in relationships (anxiety and avoidance) evoking ideally the internal operating models of self and other respectively, as first described by Bowlby (1984). Two types of adult attachment styles are evaluated in our study: romantic attachment (Hazan and Shaver, 1987) and interpersonal attachment (Bartholomew and Horowitz, 1991). The existing literature indicates that depression is associated with the insecure attachment styles, in both romantic an interpersonal relationships. Nevertheless, a question remains concerning the nature of the link between attachment style and depression: are attachment styles stable and independent of the depression or are they modified as the depression evolves? The aim of the present study was to investigate the relationships between attachment and depression in adult women hospitalized for depression; following up the evolution in their romantic and interpersonal attachment styles from the beginning to the end of their hospitalization. METHODOLOGY: The study population consisted of 50 women hospitalized for an episode of major depression (Axis I, DSM IV). Individuals exhibiting bipolar disorders and other pathologies linked to depression were not included in the population. Sixty-eight percent of the depressed women in our population had previously experienced depressive episodes and 42% of them also exhibited a personality disorder (Axis II, DSM IV). The clinical group participated in two psychological investigations, one at the beginning (T1) and one at the end of the hospitalization (T2), including each time a clinical interview during which the depression as well as the romantic (ECR, 1998) and interpersonal (RQ, 1991) attachment styles were evaluated. STUDY RESULTS: Our findings showed that depression is positively correlated with the "avoidant" dimension of the romantic attachment style and negatively with the "secure" dimension of the interpersonal attachment style. Between the beginning and the end of hospitalization, only the "secure" and "fearful" dimensions of the interpersonal attachment styles were modified, whereas the styles of romantic attachment remained stable. In terms of the links between attachment styles and the evolution of depression during hospitalization (between T1 and T2), we noted that an increase in security of attachment was correlated with a decrease in the depressive symptomatology. Conversely, the other romantic and interpersonal attachment styles were not linked with the evolution of the depressive symptomatology. DISCUSSION/CONCLUSION: Our results confirm that romantic and interpersonal styles of attachment constitute factors of vulnerability to depression. But more importantly, these findings open up new perspectives in terms of the nature of the relationships between attachment styles and depression. They provide matter for discussion concerning the stability or the change in romantic and interpersonal attachment styles. Indeed, we have revealed the stable and independent nature of romantic attachment styles in relation to depressive symptomatology. On the contrary, security in the interpersonal attachment style was shown to be a factor of change, associated with the evolution of the depressive symptomatology in progress. In the quest to take combined account of romantic and interpersonal attachment styles and their links with the evolution of depression, the present study results in a new understanding of depression, viewed from the perspective of the model of attachment in adults.

[Stress and smoking in treatment-seeking smokers]. / Stress et tabagisme des consultants en tabacologie.

Fear of not controlling stress is the most frequently reported obstacle to smoking cessation. We report a retrospective study involving 70 smokers whose files were randomly selected from a smoking cessation clinic's recruitment. Stress management as a motive to smoke (SMMS) was systematically explored at the first visit, before quit date. SMMS mean score was 7.36 (+/- 2.4) on a 10 point scale. The score was higher in females than in males (p = 0,048). A multivariate logistic regression showed that SMMS was explained by two variables: physical dependence as measured with the FTND score (OR = 1.7, 95% CI = 1.18-2.46), and anxiety as measured with the HAD scale (OR = 1.27, 95% CI = 1.03-1.56). In conclusion, the high frequency and impact of perceived stress on smoking behavior call for a systematic clinical evaluation of perceived stress when engaging a treatment for smoking dependence. Our work has confirmed the importance for the smokers of perceived stress on their smoking behavior, particularly in females. Perceived stress showed a strong relationship with nicotine dependence and anxiety. Further investigation is warranted for a better understanding of the relationship between perceived stress and anxiety in smokers.

Synthesis, structure, and magnetic properties of the NaCoXO4F·2H2O phases where X = S and Se.

A novel hydrated fluoroselenate NaCoSeO(4)F·2H(2)O has been synthesized, and its structure determined. Like its sulfate homologue, NaCoSO(4)F·2H(2)O, the structure contains one-dimensional chains of corner-sharing MO(4)F(2) octahedra linked together through F atoms sitting in a trans configuration with respect to each other. The magnetic properties of the two phases have been investigated using powder neutron diffraction and susceptibility measurements which indicate antiferromagnetic ordering along the length of the chains and result in a G-type antiferromagnetic ground state. Both compounds exhibit a Néel temperature near 4 K, and undergo a field-induced magnetic phase transition in fields greater than 3 kOe.

Is controlled drinking an acceptable goal in the treatment of alcohol dependence? A survey of French alcohol specialists.

AIM: Assessing acceptance of controlled drinking (CD) among French alcohol specialists. METHODS: On-line survey of 547 French alcohol specialists. We searched factors associated with acceptance of CD, and factors that affected the specialists' selection of treatment goal. Criteria for success used by specialists in clinical practice were compared with criteria expected to be used in clinical trials. RESULTS: CD was accepted as a treatment goal by 48.6% of alcohol specialists (n = 105, n = 216), and 61.9% practiced CD for their own patients (n = 130, n = 210). Factors in selecting outcome goals were: patient's choice, perceived self-efficacy, relapse history and severity of dependence. Age, profession and basis of specialists' opinion on CD were associated with acceptance of CD. CONCLUSION: Half of French alcohol specialists accept CD as a goal. Acceptance was associated with specialists' personal and professional characteristics. The criteria for success specialists use in their clinical practice differ from those they expect to be used in clinical trials.

[Cocaine induced psychotic disorders: a review]. / Les troubles psychotiques induits par la cocaïne: une revue synthétique.

Cocaine remains the second most used illicit drug in Europe, after cannabis, though levels of use vary between countries. This psychostimulant has become a noticeable part of the European drug scene. Cocaine dependence, a chronic, relapsing and multifactorial disorder, is a significant worldwide public health problem with somatic, legal, social, cognitive and psychological complications. The relationship between clinical psychotic symptoms and use of specific substances other than cannabis has received minimal attention in the literature. Psychotic symptoms and experience of paranoia and suspiciousness are reported during the use and the withdrawal of cocaine. Furthermore, although psychotic symptoms were found to be common among substance users, the risk for development of chronic psychotic disorder was found. In the light of recent epidemiological data stating that there is an increased cocaine use, that there is an increased number of patients entering drug treatment for primary cocaine use in Europe for several years and that cocaine users are an heterogeneous group, we made a review on the specific topic of cocaine-induced psychotic disorders. This review is based on Medline, EMBASE, PsycINFO and Google Scholar searches of English and French-language articles published between 1969 and February, 2010.

[Work: a potential addiction]. / Le travail: une addiction potentielle?

Although the term workaholism is widely used, there is very little consensus about its meaning. Since the seventies, workaholism has been described as a work addiction such as drug or alcohol addiction. Similarities with other addictions include craving, withdrawal, tolerance, progressive involvement, and denial. Although considerable attention has been devoted to the concept of workaholism in recent years, little empirical research has been undertaken to further the understanding of this phenomenon. The existence of different types of workaholism has been described. Questionnaires were developed to assess this concept. This heterogeneous disease has negative health, personal, family relationships and professional consequences. Many therapeutic interventions are possible for this unknown addictive trouble. The objective of this paper is to gain a better understanding and knowledge regarding the phenomenon of workaholism. Data obtained for this review are based on a Medline, EMBASE, PsycINFO, Google Scholar search of English- and French-language articles published between 1968 and 2009.

[Intrauterine device and pelvic inflammatory disease: Myth or reality?] / Dispositif intra-utérin et infections génitales hautes : mythe ou réalité ?

INTRODUCTION: Intrauterine device (IUD) is a reliable contraceptive method that is long term reversible, and well tolerated. Numerous studies prove its efficiency and report rare complications that are attributed to it. However, its use is limited due to fear that it can cause a pelvic inflammatory disease (PID). This is based on historical data on infections related to the "Dalkon Shield", which was removed from the market in 1974. METHOD: The analyzed articles were extracted from PUBMED database between 2000 and 2016. In total, 22 studies were retained. A meta-analysis was not possible due to the methodological diversity among the selected articles contributing to this narrative review of the literature. RESULTS: After analysis, the following factors influence the risk of PID linked to IUDs: an advanced age and sexually transmitted infections. CONCLUSION: The risk of PID linked to IUDs is lower than 1%. This is explained by new models of IUD, better screening tests, more frequent follow-up of the patients and the improvement of care PID patients. In the light of our results, the threat of pelvic inflammatory disease should not hinder the use of IUDs.

Histomonas meleagridis in turkeys: dissemination kinetics in host tissues after cloacal infection.

Histomonas meleagridis is a flagellated protozoa causing histomoniasis, a disease of gallinaceous fowl. This disease is characterized by necrotic typhlitis, hepatitis, and high mortality, especially in turkeys. In an attempt to detect the progression of H. meleagridis in the turkey, birds were infected via the cloaca. Between d 0 and 19, a group of 4 turkeys was killed and autopsied every 3 d. Cecal and hepatic lesion scores were used to measure severity of infection. For each turkey, 15 tissue samples were taken. Another group of 3 infected turkeys were placed separately, and samples of cecal and intestinal stool were collected every 3 d. Samples were analyzed by PCR. For samples of cecal droppings, cecum, cecal content, rectum, proventriculus, and bursa of Fabricius, the number of birds detected as positive by PCR followed the evolution of the lesion scores. Within the liver, the parasite DNA was detected only in some severe lesions. The parasite DNA was also detected in duodenum, jejuno-ileum, spleen, heart, lungs, and brain samples. The parasite DNA was not detected in the blood, kidneys, pancreas, or muscle of the thigh. Results of the PCR were in agreement with the evolution of the clinical signs and of the cecal and liver lesions.

[Styles of attachment and social support perceived in depressed women]. / Styles d'attachement et soutien social perçu chez des femmes déprimées.

RESULTS: This study, inspired by the attachment model and research in the field of social support, attempts to reveal the link between styles of attachment, social support and depressive vulnerability. AIM OF THE STUDY: It investigates current styles of attach-ment and the quality of social support perceived by 35 hospitalized, depressed subjects compared to 35 control subjects who exhibited no pathology. After giving their consent, each subject took part in an in-depth psychological investigation consisting of a recorded clinical interview and various clinical scales. METHOD: The study presents only the responses to the Perception of Relations questionnaire which distinguishes between four styles of attachment (secure, detached, preoccupied and disorganized) and the Social Support Questionnaire (SSQ6) which contains two dimensions: social availability and social satisfaction. The results were subjected to statistical analyses: a comparative analysis between the two groups and a correlational analysis between the dimensions of social support and the dimensions of style of attachment. On the one hand, the study reveals that the social network is perceived to be less available by depressed subjects, together with the absence of a current intimate relationship with other people, the absence of people to confide in, and a relationship between this absence and the large number of losses experienced by depressed subjects, in particular the loss of figures of attachment (father and mother). On the other hand, depressed subjects tend to exhibit a preoccupied, disorganized style of attachment which is characterized by negative models of the self. DISCUSSION: The discussion addresses the way these styles of attachment should be understood: do they represent the consequence of the depressive pathology or an older relational style?

[Short- and long-term consequences of prenatal exposure to cannabis]. / Conséquences à court et long terme d'une exposition prénatale au cannabis.

OBJECTIVE: Cannabis is one of the most commonly used drugs by pregnant women. The objective of this review of literature was to examine the association between cannabis use during pregnancy and effects upon growth, cognitive development (memory, attention, executive functions...) and behavior of newborns, children and teenagers. MATERIAL AND METHODS: We searched for articles indexed in the medline database from 1970 to 2005. The following terms were used in the literature search: cannabis/marijuana, pregnancy, fetal development, newborn, prenatal exposure, neurobehavioral deficits, cognitive deficits, executive functions, cannabinoids, reproduction. Most of the articles were published in English. RESULTS: Cannabis use during pregnancy is related to diverse neurobehavioral and cognitive outcomes, including symptoms of inattention, impulsivity, deficits in learning and memory, and a deficiency in aspects of executive functions. It seems difficult to identify complications, such as lower birth weight, only attributable to cannabis as opposed to the multiple perinatal complications associated with tobacco smoking. CONCLUSION: In addition to alcohol and cigarettes, information should be given to women about the potentially harmful effects on fetal development, newborns, children and teenagers of smoking cannabis. Therefore, it seems necessary to develop prevention programs on this subject.

Fungal isolation and identification in 21 cases of guttural pouch mycosis in horses (1998-2002).

This aetiological study of guttural pouch mycosis (GPM) in the horse was based on the retrospective study of 21 horses brought into the National Veterinary School of Lyon (France) between 1998 and 2002. Biopsies were taken from the lesions caused by GPM during endoscopic examination. In 87% of the cases, direct examination gave positive results, whereas 43% of the cultures were found to be negative. The main fungi observed were Aspergillus fumigatus (in three cases), A. versicolor (in two cases, together with other fungi), and A. nidulans and A. niger (one case each). In six cases, the Aspergillus species could not be identified. In two cases, cleistothecia and/or Hulle cells were observed. In three cases, fungi other than Aspergillus were seen, mixed or not with Aspergillus. These results underline the importance of Aspergillus fumigatus in the development of GPM in horses.

Patients admitted to emergency services for drunkenness: moderate alcohol users or harmful drinkers?

OBJECTIVE: Most of the patients admitted to hospital emergency services are drunk. Some of them may need specific treatment after acute intoxication remits. At present, treatment for alcoholism is offered to less than 5% of these patients. The authors evaluated the biological markers carbohydrate-deficient transferrin (CDT) and gamma-glutamyltransferase (GGT) in patients admitted for acute alcohol intoxication (per DSM-IV criteria) supported by blood alcohol assay. These tests distinguished between otherwise moderate alcohol users who were acutely intoxicated and harmful drinkers or alcohol-dependent patients. METHOD: The authors conducted an exhaustive survey 24 hours a day during 2 nonconsecutive months. The study involved 166 patients (124 men and 42 women) who were admitted for acute alcohol intoxication as a principal or additional diagnosis. Their blood was analyzed for alcohol, GGT, and CDT levels. The CAGE questionnaire was administered, and social and demographic data were collected. RESULTS: About 80% of the population studied displayed elevated GGT or CDT levels (65.7% had CDT levels >60 mg/liter; 41.6% had GGT levels >65 IU/liter). Less than 10% of the patients with acute alcohol intoxication revealed results in the normal range for both markers and a negative finding on the CAGE questionnaire. CONCLUSIONS: Patients admitted to emergency services with high blood alcohol levels should not be assumed to be moderate drinkers. Any drunkenness should be interpreted as a sign of likely harmful alcohol consumption or alcohol dependency requiring clinical and biological tests, including GGT and CDT assays. Specific treatment for alcoholism should be systematically offered to these patients.

End-tidal CO2 analysis in sleep apnea syndrome. Conditions for use.

The diagnosis of sleep apnea syndrome (SAS) requires expensive and complex instrumentation. The purpose of the present study was to determine the value of end-tidal CO2 (EtCO2) in screening for sleep apneas. Thirty-nine patients referred to our sleep laboratory because of suspected SAS and ten normal subjects were studied. The EtCO2 was measured using an infrared spectrometer (POET) designed for simultaneous measurement of CO2 and pulse oximetry. In 29 subjects, expired gas was sampled with a nasobuccal mask (Respiron) with lateral orifices. In the other 20 subjects, sampling was done with nasobuccal prongs (Criticare) comprising a four-channel plastic tube to the mouth and the nostrils. Data from an 8-h night were transferred the following day to a microcomputer (Apple Macintosh) for processing. Apnea was defined as an absence of detection of CO2 for more than 10 s. Conventional polysomnography was performed (Respisomnographe). The number of apneas in 8 h and the apnea index (number of apneas in 1 h) were calculated after visual analysis on the screen of the polysomnograph and also with EtCO2 analysis. For recordings made with a nasobuccal mask, the regression curve between the apnea indices computed with EtCO2 and polysomnography was an order 2 polynomial curve (r = 0.76; p < 0.001), with an inflection point at 39 apneas per hour. For recordings with nasobuccal prongs, the correlation was very significant (r = 0.95; p < 0.0001), and the regression curve was linear. The EtCO2 with nasobuccal prongs appears to be a simple and reliable method for screening for SAS.

Lung size matching for double lung transplantation based on the submammary thoracic perimeter. Accuracy and functional results. The Joint Marseille-Montreal Lung Transplant Program.

The present study evaluates the accuracy of submammary thoracic perimeter for lung size matching between donor and recipient and analyzes the influence of donor lung size discrepancies on functional outcome after double lung transplantation. The population is composed of 18 double lung graft recipients, 16 of whom had cystic fibrosis. The lung size match was assessed by comparison of predicted total lung capacity of donor and recipient: five patients were matched in a 10% confidence interval; four received smaller lungs, and nine received larger ones. The functional outcome was assessed with the spirometric values measured at 3 and 6 months after transplantation. The final functional result was not influenced by the lung size (r = 0.142 for total lung capacity; r = 0.372 for vital capacity; r = 0.378 for forced expiratory volume in 1 second). For larger lungs the final result tended to the recipient's predicted, whereas for smaller lungs, spirometry tended to the donor's predicted (r = 0.906 for total lung capacity; r = 0.875 for vital capacity; r = 0.874 for forced expiratory volume in 1 second). The thoracotomy effect, that is, restrictive syndrome at 3 months that resolves at 6 months, was not correlated with the lung size (r = 0.07 for total lung capacity; r = 0.436 for vital capacity). It is concluded that respiratory functional result is not affected by larger lungs; despite the wide range of error, the submammary thoracic perimeter appeared to be a satisfactory selection parameter in this group of patients.

Efficacy of OKT3 therapy for acute rejection in isolated lung transplantation.

The purpose of this study was to evaluate the efficacy of muromonal-CD3 (Orthoclone OKT3) in the treatment of acute lung rejection. Criteria for its administration were (1) steroid-resistant acute rejection, (2) first-line therapy for grade III or higher acute rejection, and (3) second relapse after tapering off steroid treatment of acute rejection. During the period between May 1990 and May 1992, 41 patients had a total of 101 episodes of acute rejection. OKT3 (5 mg/kg for 7 to 10 days) was administered to 28 patients, of whom 19 responded (68%). Nine patients had either nonresponsive episodes or relapses immediately after completion of OKT3 therapy. Age, gender, cytomegalovirus status, underlying diseases, and type of procedure did not influence the outcome. Timing of OKT3 administration, however, was important; 16 (89%) of 18 patients responded to OKT3 therapy when administered during the first 6 months after transplantation, whereas 3 (30%) of 10 patients responded only beyond 6 months (p < 0.01). Infectious complications occurred after six treatments (21%), in which high-dose steroids were used concurrently (three Aspergillus, two Pseudomonas, and one cytomegalovirus pneumonia). Two patients also taking high-dose steroids had lymphoproliferative disorders. Three allergic reactions developed: one case of edema, one case of hypotension, and one case of arthralgia-myalgia syndrome. Serum antibody titers against OKT3 were persistently negative despite repeat (up to four times) therapy. We conclude that OKT3 is an effective and relatively safe therapy for steroid-resistant, high-grade, or relapsing acute lung rejection during the first 6 months. Antimicrobial prophylaxis must be considered when OKT3 is administered.

Six deaths linked to concomitant use of buprenorphine and benzodiazepines.

AIMS: Buprenorphine at high dosage became available in 1996 for substitution treatment in France. This drug is considered particularly safe and has become widely available in general medical practice. We investigated the possible implication of a buprenorphine-benzodiazepine association in six deaths of known abusers. DESIGN: Full investigation of cause of death was conducted for six drug abusers. SETTING: The deaths occurred in two regions of France (Auvergne and Lorraine). Assays were carried out by the Institut de Medecine Legale at Strasbourg, France, one of the few French laboratories equipped to assay buprenorphine. MEASUREMENT: First, the blood and urine underwent triple exhaustive screening. Secondly, buprenorphine and norbuprenorphine were analysed in all the autopsy samples by HPLC/MS. FINDINGS: Benzodiazepine-buprenorphine associations were found in every case; no other substances that could account for the death were found. The tissue concentrations were markedly higher than the blood levels. CONCLUSION: If the number of deaths linked to such drug misuse proves high, it may be necessary to review how buprenorphine is dispensed.

Tracheobronchial healing after lung and heart-lung transplantation. A critical review of 64 anastomoses. The Joint Marseille-Montréal Lung Transplant Program.

The authors report on an analysis concerning the healing of tracheobronchial anastomoses after lung and heart-lung transplantation. The present study includes 64 anastomoses selected from a total of 80. Sixteen were excluded because of early postoperative death; none of these deaths was related to an airway complication. Bronchial healing was assessed with bronchoscopic follow-up; the aspect of the suture line was classified according to the grades of Couraud. The initial reference was the examination at 2 weeks postoperatively, which was compared to subsequent follow-ups. At the initial assessment, 42 anastomoses were grade I, 4 were grade II, and 18 were grade III. The subsequent anatomic result was satisfactory for 52 sutures (81%). The complications observed in the remaining patients were malacia in 2, stenosis treated with a stenting device in 4 and dehiscence in 6. The duration of ischemia and postoperative mechanical respiratory support, as well as the proximal or distal location of the anastomosis appeared to be of significant prognostic value.

Unequal day-night terbutaline i.v. dosing in acute severe asthma: effect on nocturnal bronchial patency, heart rate, and arterial pressure.

Our study investigated the differential effects of continuous or unequal day-night terbutaline dosing on circadian bronchial patency, heart rate, and arterial pressure in severe acute asthma. Forty-five hospitalized asthmatic patients (19 women and 26 men, mean age 45.4 years, mean weight 63.5 kg) were included in this multicenter study. Three groups of patients (corresponding to three dosing schedules) were randomized; the three groups were comparable, since no statistically significant difference was detected in the age, weight, or peak expiratory flow values at the beginning of the study. In order to reach immediately the concentrations of terbutaline corresponding to the desired unequal day-night concentrations, a theoretical pharmacokinetic simulation was done to predict the outcome in terms of the plasma concentrations after the three dosing regimens; the results of this simulation allowed us to calculate the initial bolus dose to be given over 5 min to groups A, B, and C, i.e., 1.47, 2.94, and 4.41 micrograms/kg, respectively. This bolus was given to all patients at 0700 h, the beginning of the study.(ABSTRACT TRUNCATED AT 250 WORDS)

Efficacy of selamectin administered topically in the treatment of feline otoacariosis.

The efficacy of a novel avermectin, selamectin (Stronghold, Pfizer), was evaluated against naturally acquired aural infestations of Otodectes cynotis. Selamectin was administered topically in a single spot to the skin of each animal's back at the base of the neck in front of the scapulae at a minimum dosage of 6mgkg(-1). Thirty cats of a cattery of 120 animals with an endemic infestation were treated on days 0 and 30. Including untreated control cats was therefore not possible because of animal welfare consideration. Clinical examination and visualization of mites by otoscopic examination of the external ear canal and microscopic examination of aural debris/exudate were performed twice weekly from days 0 to 30. On day 0 (and day 28 if the ears canals were erythematous), a swab was taken from each canal and sent to bacteriology and mycology units for detection and identification of bacteria (Staphylococcus mainly) and yeast (Malassezia pachydermatis only). Selamectin was safe, parasites were killed before day 3 and eliminated before day 17. Selamectin was 100% effective against natural aural infestations, even if erythema (26-33% of cats) and scratch reflex (23-40% of cats) persisted for 2 weeks after the cats tested negative for mites.