bluuebunny/crossref_metadata_2025 huggingface dataset:
Evaluation of a New Venoactive Micronized Flavonoid Fraction (S 5682) in Symptomatic Disturbances of the Venolymphatic Circulation of the Lower Limb: A Double-Blind, Placebo-Controlled Study
Authors: Gilly R. , Pillion G. , Frileux C.
Published: January 2017

Objective:

To determine the effect of a new venoactive flavonoid fraction (S 5682) in the treatment of symptomatic disturbances of the venolymphatic system.

Design:

Double-blind, randomized, placebo-controlled, Parallel group trial conducted in two centres.

Setting:

Department of Internal Medicine, La Palmosa Hospital, Menton, France, and Department of Vascular Surgery, Kremlin-Bicêtre University Hospital, Le Kremlin-Bicêtre, France.

Patients:

One hundred and sixty patients with symptomatic disturbances of the venolymphatic system, including chronic venous insufficiency, were included in the study.

Interventions:

Treatment lasted 8 weeks and consisted of the daily administration of two tablets of either S 5682 ( n = 80) or placebo ( n = 80).

Main outcome measures:

The primary end-point was the evolution of eight symptoms of disturbance of the venolymphatic system over the 2-month observation Period. The secondary end-point was the change of circumference of each affected leg over the same observation period.

Results:

When compared with placebo, S 5682 led to a significant improvement in four symptoms (functional discomfort, sensation of heaviness, nocturnal cramps, sensation of swelling) at week 4 and in two additional symptoms (pain and sensation of heat or burning) at week 8. Similarly, S 5682 was associated with a significant decrease in calf muscle and supramalleolar circumferences at week 4 ( p < 0.001) and week 8 ( p < 0.001) reflecting a reduction of oedema. The decrease of the supramalleolar circumference correlated well with the improvement of the swelling sensation ( r < 0.56; p < 0.001). The clinical and biological acceptability of S 5682 was good.

Conclusions:

These results indicate that S 5682 shows early and prolonged efficacy in the treatment of symptomatic disturbances of the venolymphatic system, including chronic venous insufficiency, without significant side-effects.
Is Arterial Disease a Risk Factor for Chronic Leg Ulceration?
Authors: Fowkes F. G. R. , Callam M. J.
Published: January 2017

Objective:

To compare extent of arterial disease in chronic leg ulcer patients and controls without leg ulcer.

Design:

Case control study.

Setting:

Lothian and Forth Valley Leg Ulcer Study (patients) and Edinburgh Artery Study (controls).

Patients:

331 leg ulcer patients aged 55–74 years identified in a population survey and 331 age- and sex-matched population controls.

Interventions:

Questionnaires which included cardiovascular history. Measurement of ankle and brachial systolic pressures.

Main outcome measures:

History of intermittent claudication, previous heart attack, hypertension, diabetes mellitus. Lower ankle brachial pressure index (ABPI) of either leg.

Results:

Frequencies of intermittent claudication, previous heart attack, hypertension and diabetes mellitus were very similar between the study groups. Mean (SE) ABPI was 1.1 (0.01) in patients and 1.0 (0.01) in controls ( p < 0.001), although the difference was due partly to variation in measurement techniques.

Conclusions:

Arterial disease was not found more frequently in patients than in controls, suggesting that arterial disease is not a risk factor for chronic leg ulceration, but clarification is required from other studies.
Ultrasound for Cutaneous Wound Healing
Authors: Ernst E.
Published: January 2017

Objective:

To review the published data on ultrasound as a means to enhance wound healing.

Study selection:

A combined computerized (Medline 1980–94) and manual search of the world literature was performed.

Data extraction:

All controlled trials on cutaneous wound healing were admitted. Three experimental and five clinical studies were retrieved.

Data synthesis:

The experimental studies imply that cutaneous wounds treated with ultrasound heal quicker than untreated wounds. Clinical trials suggest that ultrasound speeds the healing of leg ulcers and possibly also of pressure sores

Conclusion:

Ultrasound is a promising adjunct to the complementary treatment of wounds, which would need more detailed, definitive study.
Two-Dimensional Laser Doppler Perfusion Imaging and Microcirculatory Function in Patients with Venous Skin Damage
Authors: Cheatle T. R. , Quashie C. , Villemur B. , Carpentier P.
Published: January 2017

Objective:

To assess the use of two-dimensional laser Doppler perfusion imaging in the quantification of venous skin damage.

Design:

Comparison of disease group with control group.

Setting:

Department of Medicine, Hôpital du Nord, Grenoble, France.

Subjects:

Six patients (nine limbs) with lipodermatosclerosis (LDS) due to duplex-proven venous insufficiency and six controls subjects (11 limbs).

Interventions:

Perfusion images were collected at rest, after venous hypertension and after skin heating.

Main outcome measures:

Mean skin perfusion (mV).

Results:

An increased basal flux at rest was found in lipsclerotic skin (1.6 V) compared with controls (0.94, V, 95% CI = 0.16–1.48). An impairment of hyperaemic responsiveness to heat was also shown (factor of increase = 1.87 (LDS) compared with 3.28 (controls); 95% CI = 0.85–2.44).
A Rare Case of an Aneurysm of the External Iliac and the Common Femoral Vein
Authors: Labropoulos N. , Volteas S. K. , Kutoubi A. Al , Nicolaides A. N. , Mansfield A. O.
Published: January 2017

Objective:

To report a case of an external iliac – common femoral vein aneurysm and review the literature on the subject.

Design:

Case report.

Setting:

Academic Vascular Surgery and Radiology Units, St Mary's Hospital, London, UK.

Patients, Interventions and Results:

The aneurysm occurred in a 34-year-old woman and was diagnosed with venography, duplex scanning and magnetic resonance venography. It underwent acute thrombosis and, as the thrombus was well organized and extensive, thrombectomy was not possible. The patient was treated with standard heparin followed by oral anticoagulants for 5 months. Thirty months after the operation the right calf remains swollen but soft and non-tender and the patient is currently treated with grade II full-length compression stockings. Since there were no findings of vein compression or malignancy it seems that the formation of the aneurysm resulted from a congenital weakness of the venous wall.

Conclusions:

The most common presentation of these aneurysms is of a mass of the abdomen or the iliac fossa, while thromboembolism is not uncommon. The main causes are arteriovenous (AV) fistula formation and congenital weakness of the vein wall. For the first the preferred treatment is AV fistula ligation while for the rest ligation with or without vein reconstruction has been successfully used.
Neutrophil CD11b Expression in Patients with Venous Disease
Authors: Shields D. A. , Saharay M. , Timothy-Antoine C. , Porter J. B. , Scurr J. H. , Smith P. D. Coleridge
Published: January 2017

Objective:

To determine whether neutrophil CD11b, a marker of neutrophil adhesion, differs in patients with varying degrees of severity of venous disease, and to compare the values obtained with those of age-matched normal control subjects.

Design:

Prospective study, measuring white cell count and neutrophil CD11b expression in whole blood using a fluorescent-labelled monoclonal antibody in a flow cytometer.

Setting:

The Middlesex Hospital Vascular Laboratory, a referral centre for the investigation of venous disease.

Patients:

Ten patients with uncomplicated varicose veins, 10 patients with skin changes of lipodermatosclerosis (LDS), and 20 age-matched control subjects with no history or clinical finding of venous disease.

Results:

Higher levels of CD11b were found in patients with uncomplicated varicose veins compared with their controls (median 4.6 cf. 1.43 for normal controls, P = 0.005, Mann-Whitney U-test, difference between medians 2.7, 95% confidence interval 1 to 4.6), and lower levels in patients with LDS (median 1.22 cf. 1.53 for normal controls, p = 0.028, Mann-Whitney U-test, difference between medians 0.45, 95% confidence interval 0.02 to 1.3). There was no difference in the white cell or neutrophil count between the patient and control groups.

Conclusions:

This study demonstrates increased neutrophil surface CD11b expression in patients with uncomplicated varicose veins, but decreased levels in patients with LDS. This might be due to up-regulation of CD11b in some neutrophils with subsequent adhesion, so that only those with low expression remained in the peripheral circulation. Alternatively, this might represent either down-regulation or chronic exhaustion of neutrophil CD11b in these patients.
Objective Quantification of the Continuous-Wave Venous Doppler Examination
Authors: Harward T. R. S. , Kraemer K. , Bernstein E. F. , Fronek A.
Published: January 2017

Objective:

To develop a quantitative, objective method to diagnose deep venous thrombosis (DVT) with the continuous-wave (CW) Doppler system.

Design:

Case control study.

Setting:

Vascular Laboratory of the Surgical Services, Veteran's Affairs Medical Center, La Jolla, California, USA.

Patients, participants:

Thirty-five control subjects and the limbs of 50 patients with suspected DVT were examined.

Main outcome measures:

Phlebography, CW Doppler ultrasound. CW Doppler output was recorded from the popliteal, superficial femoral and common femoral veins. The response to standardized calf compression was analysed.

Results:

The most useful information included the Doppler velocity increase, decay time and deceleration. Because the determination of decay time does not require calibration of the Doppler system, it is the preferred parameter.

Conclusions:

A decay time longer than 1.05 s is a very good discriminant between normal control and DVT limbs.
Sclerotherapy for Telangiectasis of the Leg: Results of a 5-Year Follow-up
Authors: Lucchi M. , Bilancini S. , Tucci S.
Published: January 2017

Objective:

To evaluate the recurrence of telangiectases in patients who had previously been treated by sclerotherapy.

Design:

Retrospective single patient group study with 5-year follow-up.

Setting:

Centra Studi Malattie Vascolari ‘J. F. Merlen’, Frosinone, Italy.

Patients and methods:

The records of 52 patients who had been treated by sclerotherapy for leg telangiectases 5 years earlier were reviewed. Patients had been reviewed at yearly intervals. The reappearance of telangiectases at the initial treatment site and at new sites had been recorded at each review.

Results:

In 77% of patients studied (40/52) new telangiectases appeared. Of these, 67% (35/72) were in a different area and 56% (29/52) were in the same area (χ2 = N.S.). In 46% of cases (24/52) telangiectases occurred both in the area treated originally and in additional areas. In 48% of cases affected by a recurrence (19/40), the additional telangiectases were of minimal extent requiring little if any treatment.

Conclusions:

Sclerotherapy of telangiectases treats the consequences of the disease and does not address the cause. Consequently, patients often suffer recurrence of their telangiectases. This may be regarded as an evolution of the disease, affecting new veins, rather than true recurrence. Maintenance treatment will often be required to sustain the results following the initial course of sclerotherapy.
A Double-Blind Clinical Trial of Hydroxyethylrutosides in the Treatment of the Symptoms and Signs of Chronic Venous Insufficiency
Authors: Cloarec M. , Clément R. , Griton P.
Published: January 2017

Objective:

To study the safety and efficacy of hydroxyethylrutosides (HR) in patients with chronic venous insufficiency (CVI) (Widmer grade II) and examine any correlation with objective measurements (plethysmography and Tc Po2).

Design:

Double-blind, randomized, placebo-controlled, multicentre trial.

Setting:

One outpatient university angiology clinic, one outpatient angiology clinic in a military hospital and one private angiological consultation, all in the Paris area.

Patients:

One hundred and nine patients with grade II Widmer CVI, confirmed by echo-Doppler and plethysmography. Elastic stockings were excluded. After five exclusions, 53 received HR and 51 placebo.

Interventions:

Patients randomized to one sachet of 1 g HR twice daily (or placebo) for 2 months, after a 1 month placebo run-in period. Examinations on entry to the trial (T–1), after 1 month run-in (T–0) and after 1 (T+1) and 2 months (T+2) treatment.

Main outcome measures:

These were measured at each of the four visits. Primary outcome: minimal ankle and maximal calf circumferences. Secondary outcomes: five individual leg symptoms and total symptom score, pitting oedema. Plethysmography (six calculated variables) and Tc Po2.

Results:

The reduction of both ankle and calf circumferences was significantly greater in the HR group ( p<0.0001), as was pitting oedema ( p<0.001), the five individual symptoms and the total symptom score ( p<0.001). Of the plethysmographic findings, there was a significant reduction in maximum venous outflow ( p<0.001 at T+1 and p<0.05 at T+2). Overall there was no significant change in Tc Po2.

Conclusions:

HR is an effective and well-tolerated treatment for leg oedema and symptoms of patients with CVI.
The Effect of Probe Position, Calf Muscle Function and Lipodermatosclerosis on Photoplethysmographic Venous Refilling Time
Authors: Rashid P. , Stacey M. C. , Hoskin S. E. , Pearce C. A.
Published: January 2017

Objective:

To assess the influence of probe position, lipodermatosclerosis and method of calf muscle emptying on the venous refilling time as measured by photoplethysmography in both normal limbs and limbs with chronic venous disease.

Design:

Prospective evaluation of age- and sex-matched control and study groups.

Setting:

University Department of Surgery, Vascular Research Laboratory, Fremantle Hospital, Western Australia.

Patients:

There were 38 controls and 31 patients with venous ulceration.

Interventions:

Venous refilling times were measured in six positions on the leg in all subjects: the foot, 5 cm below medial tibial condyle in the upper calf, and in the gaiter region on the medial, lateral, anterior and posterior positions at 7.5 cm above the medial malleolus. Measurements were undertaken on active exercise and after bimanual calf compression in the medial gaiter region. Measurements were also undertaken in areas of lipodermatosclerotic skin and in normal-appearing adjacent skin.

Results:

In normal legs, the lowest refilling times were in the anterior and lateral gaiter positions. Venous patients had a shorter refilling time in the dorsal foot, medial gaiter, posterior gaiter and medial below-knee positions, when compared with controls (Mann–Whitney U-test, p<0.01). The shortest refilling time in patients with venous disease was in the medial gaiter region. Refilling time was slightly prolonged over Hpodermatosclerotic skin compared with adjacent normal-looking skin. Refilling time measured after passive emptying of the calf muscle by external compression was significantly prolonged compared with calf emptying by active calf compression ( p<0.01). This change was similar for both groups.

Conclusions:

When using venous refilling time on photoplethysmography to distinguish venous from normal limbs, the best separation is in the medial gaiter position. If other probe sites or methods of calf emptying are to be employed, it is imperative that individual laboratory normal ranges be established for the particular method being employed.
The Effect of Graduated Compression Stockings on Lower Limb Venous Haemodynamics
Authors: Cooke E. A. , Benkö T. , O'Connell B. M. , McNally M. A. , Mollan R. A. B.
Published: January 2017

Objectives:

To compare the effect of four types of thigh-length graduated compression stockings (GCS) on lower limb venous blood flow using strain-gauge Plethysmography (SGP).

Design:

A randomized controlled study.

Setting:

Inpatient Orthopaedic Centre.

Patients:

200 preoperative patients admitted for elective lower limb orthopaedic surgery.

Interventions:

Patients were randomized to five groups to wear one of four types of GCS or no stocking (control). Resting venous flow parameters were measured prior to application of GCS and after 20 min bed rest with the stockings in situ.

Main outcome measures:

Effects on resting venous capacitance (Vc) and venous outflow (Vo).

Results:

In the control group 20 min bed rest had no effect on the parameters studied. Both Vc and Vo were significantly increased ( p<0.001) in all the groups wearing stockings. There was a significant variation in the changes in outflow produced by the different stocking types ( p<0.05).

Conclusions:

GCS have a beneficial effect on lower limb venous outflow, preventing venous stasis, an important factor in the development of deep venous thrombosis. This effect varies depending on which type of stocking is used.
Laser Doppler Flux in Normal and Varicose Long Saphenous Vein Wall
Authors: Taccoen A. , Lebard C. , Zuccarelli F.
Published: January 2017

Objective:

To assess the wall perfusion in normal and varicose veins.

Design:

Observational study.

Setting:

Departments of vascular surgery of private and public hospitals.

Patients:

Twenty-seven patients undergoing vein surgery (43 long saphenous veins) and eight controls operated on for femoral-popliteal bypass.

Methods:

Laser Doppler flowmetry assessing long saphenous vein wall perfusion 3 cm below the saphenofemoral junction.

Results:

Significantly reduced wall perfusion was shown in varicose long saphenous veins compared with normal veins: 16.3 (SD 10.3) versus 45.4 (SD 14.9); p<0.001.

Conclusion:

Our data suggest a primary or secondary role for lower perfusion within the vein wall in varicose veins.
Risk of and Prophylaxis for Venous Thromboembolism in Hospital Patients
Authors:   Second Thromboembolic Risk Factors (THRiFT II) Consensus Group
Published: January 2017

Objective:

To review the published clinical data on prophylaxis for thromboembolism in order to develop general guidelines to encourage the establishment of local protocols for management.

Data sources:

Published papers on thromboembolism over the period 1991–1997 were identified by Medline search and/or from the authors' personal literature collections and reviewed.

Study selection:

A total of 981 studies were identified. Only those papers reporting randomized studies with clearly defined diagnostic methods and clear end-points were included in this review.

Data extraction:

The available evidence for each specialty was summarized and reviewed by the authors responsible for each specialty, prior to presentation and discussion of their findings within the group. Where a consensus opinion was achieved in a speciality, general guidelines for thromboprophylaxis were summarized. Where a consensus could not be agreed, recommendations for further work were made.

Data synthesis:

There is evidence to support the preferred use of low-molecular-weight heparins (LMWHs) over unfractionated heparin (UFH) in orthopaedic surgery, major trauma and general surgery. However, the ideal duration of thromboprophylaxis has yet to be defined. The use of once daily subcutaneous administration of LMWH offers major practical advantages and may have significant cost saving implications. Further work is required to investigate the use of thromboprophylaxis in minimal access surgery, trauma, elective lower limb surgery, hip fracture and pregnancy; to compare the efficacy of LMWH and mechanical prophylaxis; and to investigate extended prophylaxis after discharge.

Conclusions:

There is overwhelming evidence that thromboembolic prophylaxis reduces the incidence of postoperative deep vein thrombosis and pulmonary embolism. Recommendations concerning the management of these patients when stratified into low, moderate and high risk are made with the suggestion that hospitals develop their own guidelines for the treatment of these patients.
The Effect of Compression on Venous Haemodynamics Assessed by Quantitative Photoplethysmography
Authors: Fronek A. , Goldman M. , Fronek K.
Published: January 2017

Background:

The purpose of this study was to examine quantitatively the effect of compression stockings on venous haemodynamics at the level of the ankle.

Methods:

To obtain quantifiable results, a computer-controlled photoplethysmographic system was used to measure the displacement of local blood volume induced by exercise (exercise displacement volume, EDV) and by tilting the subject (tilt displacement volume, TDV). The test was repeated after application of class I compression stockings 20–30 mmHg). The ratio EDV/TDV is considered to represent the efficiency of the veno-muscular pump. Three groups of subjects were studied: a control group ( n = 8), patients with telangiectases ( n = 10) and a group with large varices ( n = 11).

Results:

The application of external compression had a quantifiable and beneficial effect on venous haemodynamics and was most significantly documented by an increase in veno-muscular efficiency (EDV/TDV) from 28% to 44% in the varicose vein patients. Statistically significant increases of EDV/TDV could also be identified in the telangiectatic patients and normal subjects. EDV also showed an increase with compression stockings; however, statistical significance was only reached in the varicose vein group.

Conclusion:

External compression (class 1 compression stockings) significantly improved venous haemodynamic indices, especially in patients with varicose veins. Quantitative photoplethysmography used in this study permits a fast, non-invasive and quantifiable evaluation of venous haemodynamics of the lower extremities.
Design of Randomized Controlled Trials in the Treatment of Leg Ulcers: More Answers with Fewer Patients
Authors: Prescott R. J. , Nelson E. A. , Dale J. J. , Harper D. R. , Ruckley C. V.
Published: January 2017

Objective:

To illustrate the benefit of the factorial design in randomized controlled trials of leg ulcers.

Design:

A 2 × 2 × 2 factorial design.

Setting:

Hospital leg ulcer clinics in Edinburgh and Falkirk.

Patients:

Adults with at least one unhealed leg ulcer of determined origin, present for at least 2 months and greater than 1 cm in diameter.

Interventions:

Pentoxifylline (Trental) 400 mg, three times daily, versus placebo

Main outcome measure:

Complete healing of all ulcers within 24 weeks.

Results:

Of 525 patients screened, 200 pure venous ulcers were randomized (58.5% healed by 24 weeks), 45 complex venous ulcers were randomized (57.8% healed) and 41 arterial patients were randomized (excluding bandaging comparisons) (19.5% healed). There were no interactions between treatments.

Conclusion:

The factorial design was feasible to administer and allowed three therapeutic questions to be investigated using the same resources as would have been needed to answer a single question.
There is No Benefit from 6 Weeks' Postoperative Compression after Varicose Vein Surgery: A Prospective Randomised Trial
Authors: Raraty M. G. T. , Greaney M. G. , Blair S. D.
Published: January 2017

Background:

It is often recommended that patients should wear compression stockings for 6 weeks after varicose vein surgery. The aim of this trial was to ascertain whether this is necessary.

Method:

Following a standardised operation for primary varicose veins, patients were randomised to receive postoperative compression with either Panelast Acryl adhesive short-stretch bandages for 1 week or crepe bandages for 16 h followed by 6 weeks wearing of TED antiembolic stockings. Symptoms were quantified by questionnaire and clinical assessment at 1 and 6 weeks.

Results:

Postoperatively there was significantly more bleeding in the crepe/TED group and a larger area of bruising at the end of the first week (117.5 cm2 vs. 96 cm2, p<0.02; Mann–Whitney U-test). However, this did not correlate with any difference in discomfort or activity between the two groups. There was no statistical difference in the symptoms reported after the first week. Twenty-seven patients out of 52 randomised to TEDs discarded them before the end of the 6 weeks. Both groups returned to full activities and work after similar periods (Panelast 18.5 days vs. crepe 20.0 days).

Conclusion:

There was no benefit in wearing compression for more than 1 week. Wearing Panelast bandages for the first week did significantly reduce pain on the first postoperative day, bleeding and the extent of bruising.
Iatrogenic Leg Ulcer after Subfascial Endoscopic Perforator Surger (SEPS)
Authors: Huang A. , McWhinnie D. L.
Published: January 2017

Objective:

To report a case of iatrogenic leg ulcer after subfascial endoscopic perforator surgery (SEPS).

Design:

Case report.

Setting:

Department of Vascular Surgery, Milton Keynes Hospital, a district general hospital.

Patient, intervention and results:

A 57-year-old woman underwent SEPS for a venous ulcer secondary to an incompetent perforating vein. Post-operatively she developed a new ulcer directly over the site of the divided perforator. The ulcer healed completely with conservative bandaging treatment after 4 months.

Conclusion:

We describe a complication of SEPS not previously reported. The perforating artery might have been divided inadvertently instead of the perforating vein. It is important to positively identify the perforating vein during SEPS before its division, especially in the presence of mixed arteriovenous disease.
The Effect of Food on the Absorption of Pivampicillin and a Comparison with the Absorption of Ampicillin Potassium
Authors: Fernandez C A , Menezes J P , Ximenes J
Published: January 2017

The effect of food on the absorption of pivampicillin hydrochloride and ampicillin potassium was compared in a single-dose, 3-way, cross-over study in fifteen healthy adult subjects. The antibiotics were given in their recommended doses in capsule form: 350 mg of pivampicillin and 500 mg of ampicillin.

Ampicillin was administered in the fasting state while pivampicillin was administered both in the fasting state and during a standardized cooked breakfast.

The presence of food caused a substantial decrease and delay in the absorption of pivampicillin. Pivampicillin administered during a meal, as recommended to minimize gastro-intestinal irritation, resulted in lower serum levels than those attained with ampicillin given without food. The average peak serum levels of pivampicillin taken during meals was 3.34 mcg/ml compared to 4.47 mcg/ml with ampicillin given in the fasting state. The total antibiotic coverage indicated by time-absorption curves was also considerably lower with pivampicillin than with ampicillin under conditions simulating those recommended during clinical use by the respective manufacturers.
Steroid Contraceptives: Neuro-Psychiatric & Electroencephalographic Complications
Authors: Elwan Osamah , Madkour Obsis , Kamal Ibrahim , Abdallah Mohamed
Published: January 2017

Eighty women attending the Family Planning Clinic showed negative findings when submitted to a special gynaecological and neuro-psychiatric questionnaire, as well as clinical neuro-psychiatric and electroencephalographic examinations, to exclude present or past menstrual troubles, premenstrual tension symptoms and/or neuro-psychiatric illness.

They were divided into eight groups each of ten cases receiving one type of steroid contraceptive throughout the whole period of study.

Repeated submission to the previously used neuro-psychiatric questionnaire as well as clinical neuro-psychiatric examination was carried out every three months. EEG tracings were recorded at the end of the trial.

Neuro-psychiatric side-effects were noted in sixty-one cases (76.2%).

EEG changes were reported in forty-eight cases (60%).

It was concluded that both components of the steroid should be included in the pill preferably in minimum concentration. Selective use or relative increase of either components would be associated with more side-effects.
A Comparison of the Absorption of Two Formulations of Paracetamol
Authors: Hedges A , Kaye C M
Published: January 2017

The absorption of two formulations of paracetamol was compared in four normal human volunteers. A cross-over study was employed in which each was given the tablet or effervescent formulation with a seven day interval between medications. Plasma levels of paracetamol were measured up to four hours after administration using a gas-liquid chromatographic technique. The tablet formulation (Panadol) gave rise to peak plasma levels at times varying from less than thirty minutes to two hours, while the effervescent formulation (Para-seltzer) gave rise to higher plasma concentrations of paracetamol in three of the four volunteers and peak levels occurred at or before thirty minutes in all four volunteers, indicating a more rapid absorption of the effervescent formulation.
The Hypnotic Efficacy of Triazolam
Authors: Wang Richard I H , Stockdale Susan L
Published: January 2017

In a double-blind cross-over study, triazolam, a substituted benzodiazepine, was compared to flurazepam and to placebo for their hypnotic activities and side-effects. Twenty adult male patients with histories of insomnia requiring nightly hypnotic medication received placebo, 0.5 mg triazolam, 1.0 mg triazolam, 15 mg flurazepam, or 30 mg flurazepam on five consecutive nights, according to a randomized schedule. As a hypnotic medication, triazolam was found to be thirty to sixty times as potent as flurazepam, on a weight basis. In the therapeutic dosages given, triazolam demonstrated significant activity in prolonging the duration and increasing the depth of sleep, and in reducing the number of times of waking. Patient satisfaction with triazolam was good. The side-effects reported by some subjects were mild and did not interfere with the course of administration. A slightly higher incidence of side-effects was reported following 0.5 mg of triazolam than after 1.0 mg of the drug.
Glipizide: Results of a Multicentre Clinical Trial
Authors: Lahon H F J , Mann R D
Published: January 2017

This programme has included 177 patients and shown that glipizide is an effective high-potency oral sulphonylurea, which provides an overall satisfactory control rate of 73.7% and a 45% satisfactory control rate in diabetics who have been failures on previous treatment. These comparative studies have shown the efficacy of glipizide to be at least equal to that of glibenclamide.

It has been shown that the average daily dose of glipizide is about 12.3 mg/ day with a range of from 1.25 mg/day to the maximum dose of 30 mg/day.

The toleration and safety of glipizide is excellent; furthermore, no effect on the liver or renal function was detected and neither ophthalmological roentgenological nor electrocardiographical abnormalities were observed.
Interaction and Fate of Massive Doses of Epinephrine and Norepinephrine
Authors: Terry E N , Redisch W , Rouen L R , Clauss R H
Published: January 2017

Massive doses of Epinephrine (E), Norepinephrine (NE) or a mixture of both were administered intravenously to intact anaesthetized dogs. Serial determinations of plasma catecholamine levels were performed, as were vessel wall assays. Injection of either, or both, brought about highly significant rises in plasma levels of both attributed to the metabolic fate of NE and the NE releasing effect of E. NE and E vessel wall contents rose significantly over baseline values, without however any quantitative correlation to changes in plasma catecholamines.
A Clinical Trial of ICI 58,834 – A Potential Anti-Depressant
Authors: Peet Malcolm
Published: January 2017

Twenty-four in-patients with depressive illness were treated with either ICI 58,834 or imipramine for twenty-one days in a single-blind controlled trial. No statistically significant difference in response was found between the two groups, as assessed by the Hamilton Rating Scale and the Beck Depression Inventory. Blood levels of ICI 58,834 at one hour were not correlated with clinical response. Nausea and vomiting occurred in three patients taking ICI 58,834. It is concluded that further investigation of the apparent antidepressant activity of this new drug is indicated.
Rapid Re-Synthesis of Catecholamines in the Dog's Adrenal Medulla during Insulin-Induced Hypoglycaemia
Authors: Zileli M S , Gedik O
Published: January 2017

The effect of insulin-induced hypoglycaemia was investigated on adrenal medullary secretion and synthesis of catecholamines in the adrenal glands of dogs. Hypoglycaemia induced increased secretion and very rapid and abundant synthesis of catecholamine in the adrenal.
The Prescribing of Hypnotics in General Practice
Authors: MacPhail I , Ogilvie A , Purvis C R
Published: January 2017

A trial was undertaken to convert patients who were habitual users of barbiturates or Mandrax to flurazepam. This was accomplished in 45 of the 57 patients (78·9°) within a period of 2 to 5 weeks. Three typical case histories are given. The flurazepam was well tolerated and apart from the metallic taste reported by four patients, no other side-effects were reported.
Rapid Resynthesis of Catecholamines in the Dog Adrenal Medulla during Haemorrhage
Authors: Zileli M ş , Gedik O
Published: January 2017

The effect of acute bleeding on catecholamine synthesis in the dog adrenal medulla has been investigated. This study showed that haemorrhage was associated with an increase in the synthesis of catecholamine. The increase in the synthesis was found to be about 66 % when compared with the catecholamine content of the left adrenal, the control gland.
Induction of Labour Using Oral Prostaglandin E2 Tablets
Authors: Elder M G , Stone M
Published: January 2017

Labour was induced in 91 patients by means of low amniotomy and an escalating dose of oral prostaglandin E2 tablets* up to a maximum dose of 1.5 mg hourly. This regime led to vaginal delivery in 91.2% of patients. The induction delivery interval was 11.2 ± 4.9 and 7.5 ± 4.5 hours for primiparous and multiparous patients respectively. The incidence of gastrointestinal side-effects was 15.4%, with 6 patients being unable to tolerate the regime. It is suggested that a higher hourly dose is necessary for primiparous patients with a low Bishop score.
Radio-Isotopic Evaluation with 99mTc of Diftalone's Activity on Articular Inflammation: Comparison with Acetylsalicylic Acid and Indomethacin
Authors: Grimaldi M G , Luvarà A
Published: January 2017

The99m Tc uptake by the proximal interphalangeal joints (2 nd, 3 rd, 4 th, 5 th fingers of both hands) was measured by external directional counting in 24 patients ( three groups of eight patients each) affected by rheumatoid arthritis, before and after five days of treatment with acetylsalicylic acid (3 gm/day), indomethacin (200 mg/day), and diftalone (1000 mg the first day and 750 mg/day subsequently).

A significant decrease in the articular uptake was found only in the group of patients treated with diftalone. The differences relative to diftalone were also statistically significant when the results were analyzed comparatively.
Alprenolol in Hypertension: An Open Assessment in General Practice
Authors: Madill F L , Nyberg G
Published: January 2017

In an open study of alprenolol for hypertension in 100 patients and involving 29 practitioners, the drug was found to he capable of controlling blood pressure to a level of 120 mm Hg mean blood pressure in 79 patients, either alone or in combination with other drugs, at an average dose of 359 mg daily. The average systolic blood pressure fell from 186 to 157 mm Hg, and the average diastolic pressure fell from 112 to 95 mm Hg over 8-12 weeks.

Three patients had to withdraw from treatment due to side-effects. Thirteen patients had side-effects of tolerable nature, and 16 patients with side-effects of similar severity on previous treatment suffered less or not at all when switched to alprenolol.

These results are very similar to other studies of the same type using other beta-blockers, but the side-effect frequency seems to be lower with alprenolol. This is corroborated by comparative official side-effect reporting over seven years for different beta-blockers.
The Treatment of Depression in Geriatrics with Anafranil*
Authors: Botter P A , Sunier A
Published: January 2017

The influence of Anafranil® on the symptomatology of depression has been evaluated in an open trial in 30 patients suffering from various types of depression. All the patients were hospitalized in the geriatric department of a psychiatric centre for the whole duration of the trial.

Within one week a marked decrease in the depressive symptoms was observed. This improvement reached its maximum after 3 weeks and remained at this level during the 4 th week of treatment.

At a daily dose of 30 to 50 mg of Anafranil ( mean: 40 mg) the results were good in 19 and moderate in 8 patients, whereas in 3 patients there was no change in their depressive state.

Anafranil was well tolerated; no abnormalities were observed in the laboratory investigations.
The Effect of Piracetam (Nootropil, UCB-6215) upon the Late Symptoms of Patients with Head Injuries
Authors: Aantaa E , Meurman O H
Published: January 2017

Sixty patients whose head injuries had occurred 2-6 months previously were examined in a double-blind trial to demonstrate the effect of piracetam ( UCB-6215) upon late symptoms. A significantly better result of treatment of vertigo was established in the piracetam group compared to the placebo group. The disappearance of symptoms of vertigo could also be objectively established by diminished spontaneous and positional nystagmus as well as diminished pendel deviations with eyes closed. No significant change during the period of treatment could be established with respect to the caloric test.
A Controlled Comparative Trial of a New Antidepressant, Ciclazindol
Authors: Levine Sidney
Published: January 2017

The author describes a controlled, double-blind, comparative trial of a new tetracyclic compound, ciclazindol (WY 23409), against amitriptyline in the treatment of thirty-five patients admitted to hospital with depressive illness. Each patient was randomly allocated to three weeks treatment with either 50 mg b.d. ciclazindol or 50 mg b.d. amitriptyline. In the event of a poor response the dose level was raised to 75 mg b.d.

Separation of cases of endogenous depression and severity of depression were assessed by the Levine-Pilowsky Depression Questionnaire, a self-rating technique. Severity of depression was also assessed using the Hamilton Rating Scale. No significant difference was noted between the drugs in either the degree or the rate of response nor when the endogenous cases alone were studied.

The interesting observation was made that only one-third of ciclazindol patients gained weight compared to almost three-quarters of the amitriptyline group and the mean weight gain of the latter was over double that of the ciclazindol group.

The author concludes that ciclazindol offers promise and merits further study using higher dosage levels once its full safety trials have been completed.
Angina Pectoris: Effective Therapy Once Daily
Authors: Prager Gerold
Published: January 2017

Twenty-nine anginal patients were randomly allocated to nadolol once daily, or propranolol four times daily and titrated to optimum dosage over 14 weeks under double-blind conditions: all patients then continued on nadolol once daily. Efficacy was assessed by numbers of anginal attacks and nitroglycerin (GTN) usage, and exercise EKG on the bicycle ergometer. Results showed the two drugs to have similar effects regarding anginal attacks and GTN consumption, but nadolol produced better performance in exercise time. In the extended treatment period on nadolol, the improvements over baseline readings were maintained. No serious side-effects or laboratory abnormalities were encountered.
Successful Use of a Moderate Analgesic (Fortagesic) in the Symptomatic Treatment of Osteoarthritis
Authors: Rooney G I
Published: January 2017

In a between-patient single blind controlled trial, two groups of patients with osteoarthritis were treated for two weeks with either Fortagesic or naproxen tablets.

Onset of analgesia was significantly more rapid with Fortagesic than with naproxen. Other assessments favoured Fortagesic but the differences were not statistically significant. It is concluded that Fortagesic can be successfully used to fill the gap between mild analgesics and the anti-inflammatory agents in the symptomatic treatment of osteoarthritis.
Oxamethacin: A Pilot Field Survey
Authors: Polderman J
Published: January 2017

Two hundred sixty-four general practice patients were treated with oxamethacin (100 mg b.i.d.) and 261 with indomethacin (50 mg b.i.d.) for a maximum period of two weeks. Both drugs showed equally good analgesic and anti-inflammatory effects. Thirty-six patients (14%) treated with oxamethacin and sixty patients (23%) treated with indomethacin reported side-effects. Among them, seventeen patients on oxamethacin (6%) and forty-three patients on indomethacin (16.5%) reported gastro-intestinal disorders. Side-effects necessitated interruption of treatment in fourteen patients (5%) on oxamethacin and in thirty-three patients (13%) on indomethacin.
Piroxicam in the Treatment of Osteoarthrosis: A Multicentre Study in General Practice Involving 1218 Patients
Authors: Dessain P , Estabrooks T F , Gordon A J
Published: January 2017

A non-comparative multicentre trial was conducted by 156 general practitioners with 1218 patients in eight European countries to assess the efficacy and toleration of once daily doses of piroxicam in the treatment of osteoarthrosis (degenerative joint disease). Drug was taken for an average of 2.5 months with more than 75% on piroxicam for 7 weeks or more. The maintenance dose in 81% of all patients was the same as the recommended starting dose of 20 mg, taken once daily after breakfast. Although more than 40% of patients received concurrent analgesic/anti-inflammatory drug(s) at the beginning of the trial, only 10% to 15% took such therapy by the end of their treatment period.

Most patients had moderate or severe involvement in one or more of knee, spine, hip, digit, or shoulder joints. From 75% to 80% of patients reported marked or moderate improvement in ability to move and use joints and their general overall feeling (‘quality of life’ measurement). Patients' self-assessment of joint pain and stiffness showed from 25% to 30% reduction after 2 weeks on drug and up to 60% reduction by the end of the treatment period. Onset of morning pain at baseline occurred within 1 to 2 hours after waking, but by final evaluation, the average time had risen to 6 hours in those patients still experiencing pain. Side-effects definitely attributed to piroxicam were reported by 13% of all patients; there were sixty discontinuations (5%) due to drug. The majority of side-effects were upper gastro-intestinal in origin, primarily epigastric distress, nausea, and indigestion. Most side-effects were mild or moderate and were experienced without incident within the first three weeks on drug.

In their global evaluation, investigators judged the efficacy of piroxicam as marked or moderate in 82% of patients while toleration was considered excellent or good in 92% of cases. In comparison to a patient's prior therapy, investigators considered piroxicam better in its overall effect in 72% of the cases. In summary, the data show that once-daily doses of piroxicam, mostly 20 mg, can provide very favourable efficacy and toleration in the treatment of osteoarthritis in general practice.
The Effect on Plasma Potassium of a Combined Preparation of Frusemide and Slow-Release Potassium Chloride (Diumide-K Continus® Tablets)
Authors: Lewis J G
Published: January 2017

An open trial was carried out on ten middle-aged and elderly patients in cardiac failure to assess the effect on plasma potassium levels of one or more tablets containing 40 mg frusemide and a controlled-release formulation containing 600 mg potassium chloride. Patients had previously been maintained on frusemide and potassium supplements given as separate tablets. No significant rise or fall was observed when treatment was changed to the combined tablet.
Comparison of Multiple-Dose Regimens of Netilmicin in Patients with Urinary Tract Infections
Authors: Cox Clair E
Published: January 2017

A clinical trial involving forty hospitalized patients with urinary tract infections was conducted to compare the effectiveness and tolerance of four dosage regimens of netilmicin: 1, 2, 3, and 4 mg/kg administered twice daily for 7 or 8 days. Each of the dosages was effective and the first three were equally well tolerated. At 4 mg/kg there was one case of renal dysfunction possibly related to netilmicin therapy. Serum concentrations of the drug measured 1 hour after injection were dose-related, as were those measured 1 hour before administration; no appreciable accumulation occurred with any of the regimens.
Neurobiochemical Aspects of Maprotiline (Ludiomil®) Action
Authors: Baumann P A , Maître L
Published: January 2017

In the first part of the paper a short review of the neurobiochemical effects of the antidepressant drug maprotiline is given. Its most obvious effect is the inhibition of noradrenaline uptake in peripheral and central neurones. The peculiarity of this action consists in its high degree of selectivity, as no inhibition of serotonin uptake could be demonstrated in vivo.

In the second part, the results of new experiments are described. These show that serotonin uptake is not diminished in rat mid-brain synaptosomes even after treatment with very high doses of maprotiline (600 mg/kg p.o.). In addition, the influence of the antidepressant on noradrenaline and serotonin uptake was studied in rat cerebral cortex, cerebellum, hypothalamus and pons-medulla. Dopamine and serotonin uptake were measured in the corpus striatum. Again, only the uptake of noradrenaline was found to be inhibited. There was not even a slight tendency towards inhibition of serotonin uptake. This high degree of selectivity distinguishes maprotiline from the tricyclic antidepressants and thus makes it an interesting ‘extreme-type’ uptake inhibitor.
A Three-Month Double-Blind Study of Clobazam versus Diazepam in Out-Patients Suffering from Neurotic Disturbances
Authors: Schjønsby H P , Gordon A E , Koeppen D
Published: January 2017

Efficacy and safety of the 1,5 benzodiazepine, clobazam, in comparison to the 1,4 benzodiazepine, diazepam, were controlled in sixty psychiatric out-patients over a period of three months.

In the course of this long treatment period data were obtained confirming findings of shorter-lasting studies.

Global assessment of the therapeutic efficacy and the total scores of the Hamilton Anxiety Scale revealed no significant difference between the compounds.

Both groups showed a significant (p < 0.01) improvement in the total scores of the Hamilton Anxiety Scale after two weeks of treatment.

Scores of the individual items indicated distinct spectra of action: Clobazam was more effective in diminishing anxious mood, whereas diazepam was better able to influence muscular symptoms of anxiety. The relevance of the findings for a more individualized therapy is pointed out.