Clinical evaluation, dose-finding and acceptability of AERODIOL, the pulsed estrogen therapy for treatment of climacteric symptoms

S21400 (AERODIOL) is a new intranasal formulation of 17beta-estradiol. It provides a pulsed estrogen therapy that ensures sufficient estrogenisation of tissues to treat estrogen deficiency symptoms, particularly those of the menopause. This multicentric study was designed to determine dose-range, efficacy and acceptability of S21400. One hundred and thirty four women were allocated a daily dose of 100-900 microg for 12 weeks. The doses of 100, 600 and 900 microg were given in two daily administrations, the doses of 200, 300 and 450 microg were given in one and two daily administrations. Oral progestogen was added the last 10-14 days of each cycle of estrogen therapy in all non-hysterectomized women. S21400 showed a dose-effect relationship and provided adequate estrogenisation in more than 80% of patients receiving a dose ranging from 200 to 600 microg daily. Hormonal impregnation was judged sufficient in 23% of women receiving the lowest dose (100 microg). It was often considered excessive for daily doses of 900 microg (36%). After 12 weeks of treatment, efficacy was similar whether the total daily dose was given in one or two administrations. Treatment was well tolerated and accepted, with only minor nasal events (prickling, sneezing). It was perceived by 92% of patients as good or excellent and 81% chose to continue the nasal treatment when it was offered to them. An initial dose of 300 microg per day provides an optimal efficacy/tolerability ratio. In summary, the pulsed estrogen therapy with AERODIOL in one daily administration offers a safe, well accepted and highly effective treatment to alleviate climacteric symptoms. It can be adapted easily to ensure optimal clinical efficacy.

Subjective and autonomic responses to emotion induction in psychopaths

It has been theorized that psychopaths have a fundamental deficit with respect to emotions (Cleckley, 1941). This study compares psychopaths with control subjects (Hare, 1991) in terms of their physiological and subjective responses to video clips depicting different emotions: joy, fear, anger, sadness, and disgust. Physiological measures assessed cardiovascular, respiratory, electrodermal, electromyographic responding, as well as skin temperature. Subjective measures assessed bodily sensations and subjective emotional appraisal. The principal physiological difference was a lower blood pressure among psychopaths before and during emotional stimulation. Thus, while psychopaths's autonomic base-line may be generally hyporeactive, they do not seem to have any emotion-specific physiological deficit. Globally, the results suggested no specific psychophysiological deficits among psychopaths in a context using daily emotions. Subjective measures also revealed that, compared to control subjects, psychopaths reported less intense bodily sensations during emotional stimulation. There was no difference between the two groups in terms of emotional appraisal.

[Evaluation of antibiotic use: a prospective study in a university hospital center]

The inappropriate use of antibiotics has been documented by several studies. Most of these studies have been performed in the USA and there is very little data from Europe and Switzerland. A three-month prospective study was carried out at the University Medical Center of Lausanne in the departments of internal medicine, general surgery and traumatology. During this period, 2112 patients were hospitalized among whom 878 received one or more courses of antibiotic therapy: the treatment was given prophylactically in 35% of the cases and therapeutically in the other 65%. A total of 1165 antibiotic prescriptions were evaluated. The administration of the antibiotic was considered to be indicated in 96% of the cases. However, 24% of the prescriptions contained at least one error. 50% of the errors were observed in prophylactic treatments and most were related to the length of administration and the spectrum of the agents. The errors in therapeutic prescription were found mainly in indications for urinary and respiratory tract infections, and were related to the spectrum of the antibiotic and the length of treatment. It was calculated that the inappropriate use of antibiotics accounted for approximately 7% of the total costs of all antibiotics used. We estimated that half of this excess in costs could probably be saved by the introduction of simple corrective measures mainly directed at limiting the duration of administration.

Computed tomographic follow-up study of forty-eight cases of nonoperatively treated lumbar intervertebral disc herniation

The authors prospectively followed the natural evolution of lumbar disc herniation in 48 patients treated by conservative measures. The initial computed tomographic scan was obtained during the acute phase of the disc herniation and the second was performed 1-48 months after healing. The initial computed tomographic scan allowed classification of the herniations according to size: 13 were considered small, 20 medium and 15 large. Comparison with follow-up computed tomographic scans showed that 9 of the herniations decreased by at least 25%, 8 decreased between 50 and 75% and 31 decreased between 75 and 100%. In the later group, a few had disappeared even though the second computed tomographic scan was performed as early as the month immediately after successful treatment. The largest herniations were those which had the greatest tendency to decrease in size. It is postulated that this could be secondary to the herniation breaking through the outer fibers of the anulus and entering the epidural space.

[X-ray computed tomographic study of the outcome of lumbar disk hernia after conservative medical treatment (34 cases)]

The subject of this prospective study was to appreciate the natural history of 34 herniated lumbar nucleus pulposus after recovery excluding surgical or intra-discal therapy. First CT scan was performed when radicular pain was worst, second CT between 1 and 32 months after recovery (6 to 40 months after the first CT). After the first 18 months, 18 herniations decreased more than 50% (group I) and 7 less than 25% (group II). Most herniations of group II were large or middle sized and two narrowing of discs were observed between the two CT. Group II was made of small sized herniations and 4 discs out of 7 narrowed. Beyond 18 months, herniations decreased more than 75% excepted one being calcified. Decrease of herniations and of intra-discal pressure were observed in the study. Both could allow recovery.

Simple method for rapid diagnosis of catheter-associated infection by direct acridine orange staining of catheter tips

Direct acridine orange (AO) staining was used to detect bacteria adherent to intravascular catheters (IVC). Samples from 710 IVC tips were first cultured on blood agar plates by a semiquantitative technique and then independently colored with AO and screened dry at a magnification of x100 for 3 min. In the absence of fluorescence, they were considered negative. When fluorescence was present, they were further examined for the presence of microorganisms at x1,000 with immersion oil. Of 710 IVC tips, 37 (5.2%) were positive upon culture (greater than or equal to 15 colonies) and 673 were negative (640 were sterile and 33 [4.6%] had 1 to 14 colonies). The AO sensitivity was 84%, and the AO specificity was 99%. When restricted to the 212 long IVC, AO sensitivity rose to 94%. AO staining was positive in all cases of catheter-associated bacteremia. The negative predictive value of the preliminary screening at x100 was 99.5%. The direct examination of IVC tips stained by AO appears to be a simple and rapid method for diagnosing IVC-associated infections. In addition, AO staining is easier to perform than Gram staining.