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Emergency Department Management of Common End-of-Life and Palliative Care Symptoms: Three Cases

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… The patient was then given atropine 0.5 mg IV after suctioning failed to control his secretions, with only mild improvement. However, he continued to have dyspnea. The patient's oxygen saturation was 97% on room air. … These patients can benefit from suctioning or pharmaceutical interventions, such as atropine, L-hyoscyamine sulfate, or scopolamine [ 17 ]. However, if dyspnea continues after the correction of treatable causes, palliative treatments should be enforced. …

A case of catatonia resembling frontotemporal dementia and resolved with electroconvulsive therapy.

We describe a case of catatonia in a 51-year-old man in whom the catatonic symptoms could not be distinguished from symptoms of frontotemporal dementia (FTD) until they were resolved with electroconvulsive therapy (ECT). When it is difficult to distinguish between catatonia and FTD in patients with frontal dysfunction associated with frontal lobe atrophy, we believe that sequential administration of benzodiazepines and ECT is important for therapeutic diagnosis because the risk of missing a diagnosis of catatonia outweighs the risks associated with administration of benzodiazepines and/or ECT.

[Anesthesia in magnetic resonance tomography].

Sixty patients were anesthesized for MRI. Intravenous and/or intramuscular anesthesia with ketamine, diazepam, pipolphen (promethazine) was supplemented by aminazine (chlorpromazine) or tisercin for adult patients. Spontaneous respiration was maintained, which helped avoid problems with endotracheal intubation and assisted ventilation. The method is safe, economic, and its side effects are negligible. Main features of MRI and specific anesthesiological problems associated with this method are discussed.

Prospective study comparing hyoscyamine, doxazosin, and combination therapy for the treatment of urgency and frequency in women.

Anticholinergics are commonly used for the treatment of frequency, urgency, and urge incontinence in women. Alpha-blockers have been shown to have a modulating effect on bladder smooth muscle but are not commonly used clinically for this indication. To evaluate the clinical effectiveness of each treatment as well as the combination therapy, we performed an open prospective study comparing these agents. Between September 1994 and October 1995, 34 women aged 28-91 (mean age, 62) received either 0.375 mg of sustained-release hyoscyamine twice a day or 2 mg doxazosin QHS prior to being crossed ove

Tolterodine--a new bladder-selective antimuscarinic agent.

Tolterodine is a new muscarinic receptor antagonist intended for the treatment of urinary urge incontinence and other symptoms related to an overactive bladder. The aim of the present study was to compare the antimuscarinic properties of tolterodine with those of oxybutynin, in vitro and in vivo. Tolterodine effectively inhibited carbachol-induced contractions of isolated strips of urinary bladder from guinea pigs (K(B) 3.0 nM; pA2 8.6; Schild slope 0.97) and humans (K(B) 4.0 nM; pA2 8.4; Schild slope 1.04) in a concentration-dependent, competitive manner. The affinity of tolterodine was simil

Pluripotent mouse embryonic stem cells are able to differentiate into cardiomyocytes expressing chronotropic responses to adrenergic and cholinergic agents and Ca2+ channel blockers.

A defined cultivation system was developed for the differentiation of pluripotent embryonic stem cells of the mouse into spontaneously beating cardiomyocytes, allowing investigations of chronotropic responses, as well as electrophysiological studies of different cardioactive drugs in vitro. The beta-adrenoceptor agonists (-)isoprenaline and clenbuterol, the mediators of cAMP metabolism, forskolin and isobutylmethylxanthine (IBMX), the alpha 1-adrenoceptor agonist (-)phenylephrine, and the heart glycoside digitoxin induced a positive, the muscarinic cholinoceptor agonist carbachol and L-type Ca

Ca2+ channel blockers stimulate ileal and colonic water absorption.

The effects of calcium channel blockers on water transport in the rat ileum and distal colon were studied in vivo using the single-pass perfusion technique. Parenteral but not intraluminal verapamil, and parenteral nifedipine increased ileal water absorption, with effects lasting at least 60 min. In contrast, i.p. verapamil had no effect on rat distal colonic water absorption, whereas intraluminal verapamil significantly stimulated colonic water absorption. Similarly, perfusing the rat descending colon with low-Ca2+ Ringer's-HCO3 stimulated colonic water absorption. Verapamil was not antisecre

Muscarinic cholinergic binding in rat brain.

Binding sites with high affinity and specificity for [(3)H]quinuclidinyl benzilate (QNB) are present in homogenates of rat brain. The characteristics of the binding sites resemble those of muscarinic cholinergic receptors. Specific binding is saturable with respect to [(3)H]QNB and tissue concentration and is time-, temperature-, and pH-dependent. The bimolecular rate of association (2.0 x 10(8) M(-1) min(-1)) and dissociation (1.2 x 10(-2) min(-1)) at 35 degrees indicate a dissociation constant of 60 pM and a density of 65 pmol/g of brain. Muscarinic antagonists and agonists displace specific

Urinary Bladder Dysfunction in Transgenic Sickle Cell Disease Mice.

BACKGROUND: Urological complications associated with sickle cell disease (SCD), include nocturia, enuresis, urinary infections and urinary incontinence. However, scientific evidence to ascertain the underlying cause of the lower urinary tract symptoms in SCD is lacking. OBJECTIVE: Thus, the aim of this study was to evaluate urinary function, in vivo and ex vivo, in the Berkeley SCD murine model (SS). METHODS: Urine output was measured in metabolic cage for both wild type and SS mice (25-30 g). Bladder strips and urethra rings were dissected free and mounted in organ baths. In isolated detrus