Divalproex Sodium Therapy in Elderly with Dementia-Related Agitation

OBJECTIVE:

To review available literature regarding the use of divalproex sodium in the treatment of agitation in elderly patients with dementia.

DATA SOURCES:

Clinical trials and review articles were identified by MEDLINE search (1966 — March 2002).

DATA SYNTHESIS:

The literature provides information regarding the potential benefits and tolerability of divalproex sodium in the treatment of dementia-related agitation. This article analyzes 7 studies to better understand the role of divalproex sodium in the treatment of dementia.

CONCLUSIONS:

Divalproex sodium may offer a slight benefit to elderly patients suffering from dementia-related agitation. Until better-controlled trials demonstrate statistical significance and comparisons with established treatments are performed, practitioners should use divalproex sodium cautiously.

Effects of 5-fluorouracil on flexor tendon repair

This study was performed to assess the effects of a single 5-minute exposure of 5-fluorouracil (5-FU) applied topically at the time of flexor tendon repair in an attempt to reduce postoperative adhesions. The flexor digitorum profundus tendon to the long and fourth toe of Leghorn chickens was lacerated and primarily repaired using a 2-strand technique. The repair site was then exposed to a single 5-minute application of 5-FU in concentrations of 5, 25, or 50 mg/mL. Legs were casted for 3 weeks. After death the tendon was examined for the work of flexion using a tensile testing machine and examined with light microscopy, scanning electron microscopy, and transmission electron microscopy for morphologic and histologic differences in adhesion formation. Forty-seven chickens were examined. Average work of flexion values were 0.12 J for normal tendon, 0.31 J for operative controls, 0.34 J for the 5 mg/mL group, 0.15 J for the 25 mg/mL group, and 0.19 J for the 50 mg/mL group. The work of flexion was significantly reduced in the 25 and 50 mg/mL groups compared with the operative controls (p =.008 and p =.03, respectively). Histologic sections as graded by a blinded pathologist revealed decreased adhesion formation in all the 5-FU-treated animals (p <.008). Histologic examination showed that the highest concentration of 5-FU was not as effective at reducing adhesions as the 25 mg/mL dose. This appeared to be due to increasing inflammatory changes seen around and within the tendons of the 50 mg/mL group. Overall, a single intraoperative application of 5-FU at concentrations of 25 mg/mL appears to be an effective mechanism for reducing postoperative flexor tendon adhesions.

Crystallization and preliminary X-ray diffraction studies of homoserine dehydrogenase from Saccharomyces cerevisiae

Recombinant homoserine dehydrogenase from Saccharomyces cerevisiae has been crystallized in three different forms. Crystals of the apo-enzyme belong to the tetragonal space group P4 and have unit-cell-dimensions a = b = 130 and c = 240 A. The resolution limit for these crystals is 3.9 A. Crystals of homoserine dehydrogenase grown in the presence of the co-factor NAD+ have the tetragonal space group P41212 or its enantiomorph P43212. The unit-cell dimensions for these crystals are a = b = 80.4 and c = 250.2 A, and the observed resolution limit is 2.2 A. Protein crystals grown in the presence of the product L-homoserine and the inert NAD+ analogue 3-aminopyridine adenine dinucleotide belong to the monoclinic space group P21 with unit-cell parameters a = 58.8, b = 104.2, c = 120.7 A, beta = 91.9 degrees. This last crystal form has a diffraction limit of 2.7 A resolution.