Pharmacokinetics and perioperative efficacy of intravenous ketorolac in dogs.

Ketorolac (KET) is a nonsteroidal anti-inflammatory drug approved for the use in humans that possesses a potent analgesic activity, comparable to morphine, and could represent a useful tool to control acute pain also in animals. The clinical efficacy and pharmacokinetic profile of intravenous (IV) ketorolac tromethamine (0.5 mg/kg) were studied in 15 dogs undergoing gonadectomy. Intra-operative cardiorespiratory variables were monitored, and post-operative pain was assessed using a subjective pain score (0-24) in all dogs, whereas the pharmacokinetic profile of the drug was determined in 10 animals. During surgery, mean minimal alveolar concentration of isoflurane was 1.69 ± 0.11%, and normocapnia and spontaneous ventilation were maintained in all animals. During pain assessment, no significant differences between males and females were found, and in no case rescue analgesia was necessary. No adverse effects were reported. Serum samples were purified by solid-phase extraction and analysed by HPLC with UV-Vis detection. A large variability was observed in serum concentrations. The kinetics of ketorolac was described by a noncompartmental analysis. The elimination half-life (t½λz ) and ClB were 10.95 ± 7.06 h and 92.66 ± 84.49 mL/h/kg, respectively, and Vdss and Vz were 1030.09 ± 620.50 mL/kg and 1512.25 ± 799.13 mL/kg, respectively. AUC(0→last) and MRT(0→last) were 6.08 ± 3.28 h × µg/mL and 5.59 ± 2.12 h, respectively. The results indicate that ketorolac possess good post-operative analgesic effects until about 6 h after administration in dogs undergoing moderately painful surgery.

Photodynamic therapy of spontaneous animal tumors using the active component of hematoporphyrin derivative (DHE) as photosensitizing drug: clinical results.

Photodynamic therapy was performed on 25 primary spontaneous tumors in dogs and cats. The animals were injected with 2.5 mg/kg body wt. of tumor localizing fraction of hematoporphyrin derivative and treated 48 h later with laser light at 631 nm. In 5 cases the treatment was performed on the tumor bed after surgical excision of the tumor mass. An evaluation of clinical results is presented and discussed. Complete remission was obtained in 19 cases and partial remission in 6 cases.

Hematoporphyrin derivative photochemotherapy of spontaneous animal tumors: clinical results with optimized drug dose.

Hematoporphyrin derivative (HpD) photochemotherapy was performed on 13 primary spontaneous tumors in dog and cat. The animals received an optimized drug dose of 5 mg/kg body wt i.v. 48 h before the first treatment with laser light at 631 nm. An evaluation of the clinical results is presented and discussed. Complete disappearance of the primary tumors was obtained in all cases with one or more light irradiations. Five cases presented recurrences that were cured with a further treatment. In 4 cases treated after surgical exeresis of the primary tumors, this therapy resulted in complete cure.

Meta-analysis of estrogen therapy in the management of urogenital atrophy in postmenopausal women: second report of the Hormones and Urogenital Therapy Committee.

OBJECTIVE: To evaluate the efficacy of estrogen therapy in the treatment of postmenopausal women with symptoms and signs associated with urogenital atrophy, by meta-analysis of available data. METHODS: We searched the literature (Excerpta Medica, Biosis, MEDLINE, and hand search) for studies published between January 1969 and April 1995. Criteria for inclusion were English-language articles, peer-reviewed original publications, and urogenital atrophy assessed by at least one of the following outcomes: patient symptoms, physician report, pH, or cytologic change. Data had to allow comparison between treated and control groups in controlled trials or an estimated change from baseline in uncontrolled series. Meta-analytic methods were applied separately to controlled clinical trials and uncontrolled studies. RESULTS: Of the 77 relevant articles reviewed, nine contained ten randomized controlled trials. Meta-analysis of these using the Stouffer method revealed a statistically significant benefit of estrogen therapy for all outcomes studied. In 54 uncontrolled case series, the patient symptoms were treated by 24 different treatment modalities. All routes of administration appeared to be effective and maximum benefit was obtained between 1 and 3 months after the start of treatment. As expected, the least systemic absorption of estrogen was seen with estriol (administered orally or vaginally), then vaginal estradiol as measured by pretherapy and posttherapy serum estradiol and estrone. CONCLUSION: Estrogen is efficacious in the treatment of urogenital atrophy and low-dose vaginal estradiol preparations are as effective as systemic estrogen therapy in the treatment of urogenital atrophy in postmenopausal women.

Simple screening for urinary incontinence in the elderly: comparison of simple and multichannel cystometry.

Urinary incontinence is a major cause of suffering and disability especially in the elderly. Accurate diagnosis is important to optimize treatment and multichannel cystometry is regarded as the gold standard. Simple cystometry is a technique of bedside cystometry using a single lumen catheter and filling syringe. Simple cystometry was compared with multichannel cystometry in 83 patients (mean age 73.5 years) and was found to have a specificity of 75 percent and a sensitivity of 88 percent for the diagnosis of detrusor instability. Simple cystometry is a quick, easy, and useful test which can be readily performed in the elderly by a doctor or trained nurse. Residual urine measurement, testing for stress incontinence, and estimation of flow rate can be performed at the same time. It can enable the most appropriate treatment to be initiated by improving the diagnostic accuracy of the clinical assessment when more complex resources and expertise is not available. In a proportion of patients further referral and investigation may be necessary.

Parkinson's disease in the elderly: psychiatric manifestations.

Drug-induced psychiatric symptoms are usually reversible within days. However, if the patient also has cognitive impairment of a more permanent nature, improvement may not be seen for weeks or even months. During the year preceding the diagnosis of Parkinson's disease, the incidence of depression, hyperirritability, and instability of emotions is significant. After the onset of Parkinson's disease, depression is very common.

Urinary incontinence in the elderly.

Incontinence is a distressing, complex health problem which disproportionately affects older people. It is commonly endured silently, with many sufferers and carers not receiving appropriate support. In addition, incontinence is generally poorly managed both by families and health-care professionals, and is a major contributing factor in the institutionalization of the elderly. This paper argues that incontinence experienced in later life is often multifactorial in nature, thus health care professionals need to be cognizant of the many causes of incontinence, as well as the impact of lifestyle factors and 'normal' ageing processes. Incontinence in the community-based elderly can be cured or significantly improved in over 60% of cases with conservative management. Unfortunately community and professional attitudes and ignorance remain major barriers to continence.

Pharmacokinetics, intraoperative effect and postoperative analgesia of tramadol in cats.

Tramadol is a synthetic codeine analogue used as an analgesic in human and veterinary medicine, but not approved for use in cats. Tramadol (2 mg/kg) was administered intravenously (IV) as preoperative analgesic in 12 cats (6 males) undergoing surgical gonadectomy. The pharmacokinetic profile of the drug and its O-desmethyl metabolite were determined in 8 animals (4 males), while intraoperative effects and postoperative analgesia, estimated by subjective pain score (0-24), were evaluated in all. Mean intraoperative isoflurane consumption was reduced, but hypoventilation was not observed. Sex-related differences were not observed, particularly in terms of postoperative analgesia: rescue analgesic was never administered. Concentrations of the active O-desmethyl metabolite were persistently high in all the animals. Considering the results obtained in this study, tramadol, at the dose of 2 mg/kg IV, did not produce any evident intraoperative cardiorespiratory side effects and with additional investigation may prove to be an appropriate intraoperative analgesic in cats undergoing gonadectomy.

Promoting continence as a health issue.

Urinary incontinence is a common condition affecting hundreds of millions of people worldwide but for which up to 70% of sufferers seek no help. Continence promotion activities must target not only the incontinence sufferers and their families but also the general community, health professionals, the industry that manufactures continence products and drugs, and the Government which is responsible for funding directly or indirectly various programmes. Continence promotion programmes must therefore be sufficiently flexible to target these groups about what incontinence is, what can be done about it, and where to get help, and most importantly to de-stigmatise this condition. Continence promotion is taking place internationally through the efforts of the International Continence Society and locally through various national non-profit-making organisations. Activities include public awareness and professional education programmes; continence prevention strategies; and establishing mechanisms for improved communication. 'CONTInet', a dedicated Internet facility, is evolving as a major tool to achieve many of these goals.

Telelink: the use of telephone conferences for multidisciplinary team meetings.

There are various circumstances where the traditional face to face setting for multidisciplinary meetings is not practical or possible. This includes departments which have a responsibility covering a large geographic region. This paper describes an inexpensive, cost-effective and novel way of conducting multidisciplinary meetings using the telephone conference facility. Team members based in the community are 'linked' by telephone to other members of the hospital-based Aged and Extended Care Department. These conferences led to a significant increase in the referral rate of community-based patients for fuller multidisciplinary geriatric assessment. It also provided a forum for education, exchange of ideas and development of new policy. Other uses for telelinking are highlighted, particularly its successful applications for linking together isolated and handicapped elderly people in the community.

Improving management of urinary incontinence in geriatric centres and nursing homes. Victorian Geriatricians Peer Review Group.

OBJECTIVE: To study prevalence and management of urinary incontinence in institutes and to recommend improved strategies of managing this problem. METHOD: A one-day census of ten geriatric assessment and rehabilitation services and nursing homes was undertaken to estimate the extent and management of urinary incontinence in Victoria. The definition of incontinence was extended to include patients with 'dependent continence', i.e. being dry of urine only as a result of being reminded or physically assisted. RESULTS: A total of 1659 patients, comprising 333 short-stay and 1326 nursing home type patients, was surveyed. The mean age was 77 and 81 years respectively. Only 43% and 23% of these patients respectively were independently continent, whilst 26% and 11% respectively of all patients were dependent continent. Incontinence occurred once or more per day in 85% of these patients and had usually been present for at least one month. There was a high association between incontinence and physical and mental infirmity. Dependent continent patients were as physically handicapped as their wet counterparts. A diverse range of management strategies, including various toileting programmes, was employed to deal with the incontinence. It is concluded that urinary incontinence is more common than reported in previous studies, largely as a result of the additional group of patients with dependent continence, a condition that often can be achieved. Proposed management protocols are outlined which aim to define different population subgroups that might respond more effectively to the various interventions available. The need for follow-up appraisal of these interventions is emphasized.

A prospective study of the incidence of urinary incontinence in an acute care teaching hospital and its implications on future service development.

OBJECTIVE: To assess the incidence of urinary incontinence and indwelling catheter use. METHOD: A prospective study of 627 consecutive admissions to an acute care teaching hospital over a 4-week period. RESULTS: At least one episode of urinary incontinence was experienced by 145 patients (23.4 per cent of all admissions) with 28 per cent of these having urinary incontinence lasting more than 10 days. Patients with urinary incontinence had a significantly greater age, mean length of stay and overall mortality compared with the total hospital inpatient population. During this survey, 7 per cent of all inpatients suffered from at least one episode of faecal incontinence, with the mean duration of faecal incontinence being 5.4 days. The major discriminating findings were from the data of patients with urinary incontinence for longer than 10 days. These patients had a longer length of stay (47 days compared with 17 days for patients with urinary incontinence 10 days) and poorer outcome (28 per cent went to nursing homes and 50% returned home compared with 7 per cent and 81 per cent respectively for pts with incontinence less than 10 days). Patients on medical wards and those with confusion or poor mobility fared disproportionately worse. After 10 days of incontinence, only 59 per cent of these patients had a rectal examination; and 90 per cent a urine specimen for culture. The interpretation and implication of these findings will be discussed particularly as it related to future planning for continence services and the development of clinical nurses with knowledge of urinary incontinence.

The ContiNet of the International Continence Society.

This is an account of the International Continence Society's ContiNet--the web server linking up continence organisations worldwide with provision to upload or download vast data stores of information on continence via e-mail, FTP, mailing lists, and special tools to seek information using "search engines." Special communication devices using internet voice/phone mail and real-time "text" or "voice" chats permit conversation globally over normal phone lines linked to the Net at local telephone rates. Special features of ContiNet include announcements of upcoming conventions, information for professionals and laypeople, and the capability to conduct research via the net and conduct consultations and discussions via newsgroups. In-built devices requiring special IDs and passwords permit privacy and security for users. Simple instructions are provided on how to get your PC up and running and get connected to fellow members of ICS, link up with national continence societies, or simply surf for professional enrichment and leisure. With the advent of advanced multimedia capabilities, the current poor quality videoconferencing on the Net will be replaced by excellent videophones by 1998.

Dynamic shape of the female urethra during micturition. Clinical methods.

Densitometry of the x-ray image provides a suitable technique for clinical quantification of the urethral shape during all stages of voiding. The technique of cystourethrographic densitometry is applied to determine the cross-sectional shape of the human female urethra during various phases of voiding. Errors that may occur because the x-rays are not perpendicularly incident to the urethral plane are considered and a method for their minimization is indicated.