Efficacy and tolerability of lumiracoxib in the treatment of primary dysmenorrhoea.

Two randomised, multicentre, double-blind, placebo- and active-controlled, 3-way crossover studies were performed to evaluate the efficacy and tolerability of the novel COX-2 selective inhibitor lumiracoxib in the treatment of primary dysmenorrhoea. Subjects with moderate-to-severe dysmenorrhoea received lumiracoxib 400 mg once daily (od), rofecoxib 50 mg od and placebo (Study 1; n = 84) or lumiracoxib 400 mg od, naproxen 500 mg twice daily and placebo (Study 2; n = 99). For the primary variable, summed pain intensity difference from 0 to 8 h on day 1 (SPID-8), all active treatments were superior to placebo in each study (p < 0.001); lumiracoxib was comparable to rofecoxib and naproxen. For PID (categorical scale), all active treatments were significantly better than placebo from 2 to 12 h; lumiracoxib was generally comparable to rofecoxib and naproxen. All treatments were well tolerated. Lumiracoxib 400 mg is effective and well tolerated in the treatment of primary dysmenorrhoea, with efficacy comparable to rofecoxib and naproxen.

Peptide nucleic acids specifically cause antigene effects in vivo by systemic injection.

Peptide nucleic acids (PNAs) are uncharged DNA analogs that hybridize to complementary sequences with high affinity and stability. We previously showed that PNAs, after intraperitoneal injection into rats, are effective antisense compounds in vivo. The present study was designed to test whether PNAs also have antigene effects in vivo. The renin-angiotensin system is critical in the control of blood pressure. We designed and synthesized sense (antigene) PNAs to angiotensinogen, which is the precursor protein that leads to angiotensin I and II. Spontaneously hypertensive rats received intraperitoneal injections of either 20 mg/kg sense-angiotensinogen-PNA, mismatch-angiotensinogen PNA, or saline. Only the sense-angiotensinogen PNA treatment resulted in a significant decrease in plasma angiotensin I, systolic blood pressure, and liver and brain angiotensinogen mRNA levels. Thus, these results demonstrate on the molecular, protein, and physiological levels that antigene PNAs are effective in vivo upon systemic administration.

Altering behavioral responses and dopamine transporter protein with antisense peptide nucleic acids.

The dopamine transporter (DAT) plays a role in locomotion and is an obligatory target for amphetamines. We designed and synthesized an antisense peptide nucleic acid (PNA) to rat DAT to examine the effect of this antisense molecule on locomotion and on responsiveness to amphetamines. Rats were injected intraperitoneally daily for 9 days with either saline, an antisense DAT PNA, a scrambled DAT PNA, or a mismatch DAT PNA. On days 7 and 9 after initial motility measurements were taken, the animals were challenged with 10 mg/kg of amphetamine and scored for motility. On day 7, there was no significant difference between the baseline levels of activity of any of the groups or their responses to amphetamine. On day 9, the antisense PNA-treated rats showed a statistically significant increase in their resting motility (P < 0.01). When these rats were challenged with amphetamine, motility of the saline-, scrambled PNA-, and mismatch PNA-treated animals showed increases of 31-, 36-, and 20-fold, respectively, while the antisense PNA-treated animals showed increases of only 3.4-fold (P < 0.01). ELISA results revealed a 32% decrease in striatal DAT in antisense PNA-treated rats compared with the saline, scrambled PNA, and mismatch PNA controls (P < 0.001). These results extend our previous findings that brain proteins can be knocked down in a specific manner by antisense molecules administered extracranially. Additionally, these results suggest some novel approaches for the treatment of diseases dependent upon the function of the dopamine transporter.

Paramedic success rate for blind nasotracheal intubation is improved with the use of an endotracheal tube with directional tip control.

STUDY OBJECTIVES: Blind nasotracheal intubation (BNTI) is used to secure the airway in patients who are spontaneously breathing. The success rate for BNTI is often lower than for orotracheal intubation. We conducted this study to determine whether the use of an endotracheal tube (ETT) capable of directional tip control can improve the BNTI success rate. METHODS: This prospective, experimental study was conducted by a state emergency medical services agency during 1997, 1998, and 1999. Consecutive patients undergoing attempted BNTI or orotracheal intubation were included. Five paramedic units were trained to use an ETT with triggeractivated distal tip directional control for BNTIs (intervention group). Ten units used conventional ETTs for BNTIs and served as concurrent controls (control group). Subjects in the 2 groups were enrolled concurrently with nonrandomized allocation based on the agency providing service. An intubation attempt was defined by tube passage, and success was defined as confirmed endotracheal placement. RESULTS: A total of 219 BNTIs were studied (141 in the control group and 78 in the intervention group). BNTI was successful in 82 (58%) of 141 cases using conventional ETTs, and in 56 (72%) of 78 cases using directional tip control (P =.04). The overall success rate was 63%. CONCLUSION: Use of ETTs with distal directional control is associated with a higher success rate for BNTI than conventional ETTs. Use of ETTs with directional tip control significantly improves the success rates for BNTIs.

The utilization of midazolam as a pharmacologic adjunct to endotracheal intubation by paramedics.

OBJECTIVE: Pharmacologic agents have been used in the prehospital setting for facilitating endotracheal intubation (ETI). The purpose of this study was to determine the utility of intravenous midazolam for prehospital patients who require pharmacologic relaxation to facilitate ETI. METHODS: Data were reviewed retrospectively using paramedic charts from an eight-month period for a three-county state EMS system. RESULTS: There were 26,133 paramedic dispatches during the study period. Six hundred eighty-three ETIs were attempted, including 72 midazolam-facilitated intubations (MFIs). The most common indications for MFI were "clenched teeth," "gag," and "combativeness." Successful MFI was achieved in 45 of 72 cases (62.5%). Midazolam-facilitated intubation was less successful for trauma patients (41.2%) than for medical patients (69.1 %) (p = 0.04). Of the 58 failed conventional ETIs that occurred during the study period, 25 (43.1%) were identified as having one or more indications for the use of MFI. Although the use of intravenous midazolam was effective in facilitating ETI, a high MFI failure rate (37.5%) was noted. CONCLUSION: Although it is of limited efficacy, MFI is underutilized and should be considered by medical direction as a pharmacologic adjunct to ETI in selected field patients.

Unusual course of right atrial myxoma, masked by acute abdominal pain, and complicated by pulmonary embolus.

In a 17-year-old youth, exploratory laparotomy for acute abdominal pain was complicated by circulatory arrest related to pulmonary embolism. Echocardiography after resuscitation revealed a hitherto "silent" right atrial myxoma, fragmentation of which had blocked the right atrioventricular ostium, causing the pain. Operation was successful. As only a few similar cases have been reported, pulmonary embolism due to fragmentation of a right atrial myxoma may account for some unexplained sudden deaths beyond medical help.

[Myocardial revascularization for sudden cardiac death in patients after previous coronary angioplasty]. / Rewaskularyzacja serca w trybie naglym u chorych po przebytej koronaroplastyce.

UNLABELLED: PTCA was introduced into our hospital in June 1991. Since then till the end of 1996 emergency CABG operations were performed in fourteen patients. They were indicated because of acute myocardial ischaemia and hemodynamic deterioration that was the result of the dissection and occlusion of a coronary artery during angioplasty. There were 11 male and 3 female patients in this group aged 34 to 65 average 50 years. Twenty-three grafts were performed in total (18 saphenous, 5 using internal mammary artery), that is 1.6 graft per patient. A female patient died of myocardial infarction on the first postoperative day. All other patients survived and are under outpatient clinic's care. Over the analysed 6 years' period of time 1079 PTCAs were performed. The low rate of the unsuccessful procedures (1.3%) that required the emergency CABG is noteworthy. Since 1995, when the implantation of stents was introduced into our hospital, there were only 2 such procedures (0.4% of all PTCAs). CONCLUSIONS: The CABG operation performed shortly after a dissection and occlusion of the coronary artery underwent angioplasty usually prevents myocardial infarction and saves the patient's live. The introduction of implantation of the stents significantly diminished a number of patients who required an emergency CABG operation.

[Follow up results of radical correction of Fallot's syndrome]. / Wyniki odlegle korekcji calkowitej zespolu Fallota.

In the years 1981-1989 in the Department of Cardiosurgery, Institute of Cardiology, Medical Academy in Lódz, 39 patients with Fallot's syndrome were subjected to radical correction of the congenital heart disease. In 18 cases the correction was preceded by a palliative operation carried out on the average four years before the radical correction of the congenital heart disease. During the early postoperative period seven patients died which accounted for 17%. Out of 39 patients treated surgically, 32 were in I or II haemodynamic grade according to NYHA.

[Traumatic avulsion of penile skin in a child]. / Urazowe zerwanie skóry pracia u dziecka.

Avulsion of the penis due to trauma was observed in a boy aged 9 years. The penis was covered with a medium-thickness skin graft. After 5 weeks the boy was discharged home in a good general condition. Control examination after 6 months showed a very good cosmetic result.