Ping wei san, a Chinese medicine for gastrointestinal disorders.

OBJECTIVE: To describe the dilemma that American pharmacists face when their patient uses a traditional Chinese herbal formula. Ping wei san (PWS), an agent used to treat gastrointestinal disorders, is used to illustrate the problems encountered and to identify resources on Chinese herbal medicines available to pharmacists. DATA SYNTHESIS: In the US, Chinese herbal medicine is making its way into mainstream Western medicine. Patients may discover PWS in their search for a substitute for cisapride, which was partially withdrawn from the US market in July 2000. The pharmacist may be called on to assist in the management of patients who wish to use PWS for treatment of common gastrointestinal disorders like gastritis, esophageal reflux, gastric or duodenal ulcers, and acute or chronic enteritis. As with most other Chinese herbal formulas, English-language literature about PWS is limited and is often difficult to interpret. Pharmacists who are unfamiliar with the basic principles and terminology used in traditional Chinese medical practices will need to identify sources of information about this complementary alternative practice to be able to provide pharmaceutical care for patients taking a Chinese herbal formula like PWS. CONCLUSIONS: To develop a pharmaceutical care plan for patients using a Chinese herbal medicine therapy such as PWS, the pharmacist will need to become familiar with traditional Chinese medical practices and terminology describing indications, therapeutic effects, and risks. Fortunately, resources are available to pharmacists who need assistance in interpreting information on Chinese herbal therapies so that they can appropriately manage patients using them.

Barriers to compliance with OBRA'90 regulations in community pharmacies.

OBJECTIVE: To identify which barriers have been most significant to community pharmacists in their ability to comply with the Omnibus Budget Reconciliation Act of 1990 (OBRA'90) regulations during its first year of implementation. METHODS: Mailing of a two-page survey in April 1994. SETTING: Four hundred randomly selected community pharmacies in the Commonwealth of Massachusetts. PARTICIPANTS: Of 400 pharmacies surveyed, 156 surveys were completed and returned for analysis. RESULTS: Barriers that were considered most significant to pharmacies surveyed in their ability to implement OBRA'90 regulations were excessive workload, lack of financial compensation, and patients' attitudes. Of least significance were inadequate knowledge about drugs, inadequate references, and store layout. Almost half the responding pharmacists indicated that OBRA'90 regulations had not affected or changed their practice, one-quarter of the pharmacists believed their practice was less rewarding after OBRA'90, and about one-fifth believed it was more rewarding. CONCLUSIONS: Community pharmacists in Massachusetts are making an attempt to comply with OBRA'90, but there are specific barriers that are affecting their ability to do so. The OBRA'90 regulations appear to have had little impact on the practice of most community pharmacies. Community pharmacy management needs to examine (1) expanded roles of supportive personnel to give pharmacists more time to spend counseling patients, (2) reimbursement mechanisms for cognitive service, and (3) approaches to educating patients about these changes in the pharmacy profession.

Psychedelic and entactogenic drugs in the treatment of depression.

CNS deficiency of 5-hydroxytryptamine (serotonin) has been implicated as a biochemical basis in some forms of depression. Existing drug modalities for treating depression include some with serotonergic effects. Studies suggest that psychedelic drugs are also serotonergic. This may indicate a role for psychedelics in the treatment of depression. Such treatment has already been attempted using psychedelic drugs in both the indoleamine and phenylalkylamine categories. Encouraging results seem to recommend further research, with special emphasis on drugs in the phenylisopropylamine subgroup of phenylalkylamines that are only peripherally psychedelic. Certain of these, called entactogens or empathogens, cause substantially less distortion of normative consciousness than classic psychedelics, such as LSD or mescaline. They could therefore be more easily assimilated into existing psychotherapy approaches, where their function would be to enhance the normal psychotherapeutic process rather than serving a maintenance role as chemotherapeutic agents. Their usefulness in such an application would be mainly at the start of psychotherapy in order to (1) reduce the client's "fear response" that often inhibits ability to deal with repressed traumatic material; (2) facilitate the client's interpersonal communications with the therapist, spouse or significant others; and (3) accelerate formation of a therapeutic alliance between client and therapist.

Thoracoscopic resection of a pericardial cyst.

The development of new instruments that can be applied endoscopically opens up new possibilities for minimally invasive thoracic surgery. The surgical technique is exemplified by a thoracoscopic resection of a pericardial cyst. The benefits for the patient are impressive: minimization of surgical trauma and postoperative pain, a short convalescence, and an optimal cosmetic outcome.

Lymphokine production by T cells generated during infection with Trichinella spiralis.

Lymphokine production by mesenteric lymph node cells (MLNC) taken from mice during infection with the intestinal nematode parasite Trichinella spiralis was investigated. Upon stimulation in vitro with a protective crude antigen preparation of the infective L1 larvae, MLNC proliferated in a specific manner, and were observed to release the T-cell lymphokines IL-2, IL-3 and interferon. IL-2 and IL-3 release by MLNC was greatest when taken during the early intestinal phases of infection. Interferon was also released by cells taken from infected mice, with highest levels observed shortly after expulsion of the parasite from the gut. MLNC taken during the early intestinal phases of infection were also able to respond and proliferate to an exogenous source of IL-2, suggesting clonal expansion of T cells within the node. Lymphokine release from T. spiralis specific T-cell lines was also examined.

Antigen-specific T-cell lines transfer protective immunity against Trichinella spiralis in vivo.

T-cell lines specific for infective muscle larvae antigens of the intestinal nematode Trichinella spiralis have been generated in vitro. These antigen-specific T-cell lines express the L3T4+ Ly2- phenotype and secrete the lymphokines IL-2, IL-3 and gamma-IFN. They are stable in culture for up to 15 weeks and are protective when adoptively transferred into naive recipients. As few as 2 x 10(5) T. spiralis-specific tract. In addition, intestinal mastocytosis and peripheral blood eosinophilia were accelerated after adoptive transfer of T. spiralis-specific T-cell lines.

Taking birth trauma seriously.

Virtually all mainstream schools of psychology, including biological psychology, reject the idea that people sustain psychological trauma at birth. Their objections are basically those raised by Freud more than 50 years ago: (1) lack of solid evidence that difficult births are related to mental disturbances and (2) a general conviction that the neonatal brain is not sufficiently developed to experience birth psychologically. But recent empirical evidence gathered by Stanislav Grof in over 3500 psychotherapy sessions using psychedelic drugs as a facilitator seems to show that a link does exist between birth trauma memory "matrices" in the unconscious and various mental conditions. And separate research on psychedelic drug effects, subcortical learning mechanisms and the nature of emotional response suggest that birth trauma memories might be explained in a way that circumvents without refuting Freud's basic objections. The following briefly reviews these developments, concluding that birth trauma theories--especially Grof's--deserve more serious consideration by mainstream psychologists and medical researchers.

L3T4-positive T lymphoblasts are responsible for transfer of immunity to Trichinella spiralis in mice.

The characteristics of lymphocyte subpopulations involved in mediating immunity to the intestinal nematode Trichinella spiralis in vivo have been examined using adoptive transfer in conjunction with accurate cell-sorting and cell-depletion techniques. Positive selection of cell subsets, using FACS sorting and velocity sedimentation at unit gravity, confirm that rapidly dividing T blasts are the major population that mediates expulsion of the worm from the gut. Furthermore, cell-depletion studies demonstrated that the T-cell subset involved is of the L3T4 + ve Lyt 2-ve phenotype. This phenotype suggests class II MHC restriction in recognition of T. spiralis antigens by T cells in vivo. The roles that such T cells play in immunity to T. spiralis are discussed in terms of lymphokine release.