The serotonin transporter promoter repeat length polymorphism, seasonal affective disorder and seasonality

BACKGROUND

Conflicting results have been reported in previous association studies of the serotonin transporter promoter repeat length polymorphism (5-HTTLPR), seasonal affective disorder (SAD) and seasonality (seasonal variations in mood and behaviour). The aim of this study was to test for association in new case-control and population-based materials, and to perform a combined analysis of all published studies of 5-HTTLPR and SAD.

METHOD

One hundred and forty-seven new SAD cases and 115 controls were genotyped for 5-HTTLPR and in total 464 patients and 414 controls were included in the pooled analysis. In addition, 226 individuals selected for unusually high or low seasonality scores from a population based material and 46 patients with non-seasonal depression were analysed. Different genetic models were tested and seasonality was analysed both as a qualitative (high v. low) and as a quantitative trait in the different sample sets.

RESULTS

No association between 5-HTTLPR and SAD was found in the new case-control material, in the combined analysis of all samples, or when only including 316 patients with controls (N = 298) selected for low seasonality. A difference was detected between the population based high and low seasonality groups, when assuming a recessive effect of the short allele (20% and 10% short allele homozygotes, respectively, OR (95% CI): 2.24 (1.03-4.91)). Quantitative analysis of seasonality revealed no association with 5-HTTLPR in any sample set.

CONCLUSIONS

These results do not suggest a major role of the short variant of 5-HTTLPR in susceptibility to SAD, but provide modest evidence for an effect on seasonality.

Facilitation of source discrimination in the novelty effect

It has been demonstrated experimentally that recognition of novel items is more accurate than recognition of previously familiarized items. Tulving and Kroll (1995) proposed that this effect is due to novelty detectors in the brain giving processing priority to novel information. Recently, Dobbins et al. (1998) suggested that the effect is due to source discrimination problems. In the present two experiments attempts were made to facilitate source discrimination by having different orienting tasks and materials in the familiarization and in the critical presentations. Degree of familiarization was manipulated by varying number of presentations one, two or three times. The results in Experiment 1 showed that the novelty effect increased linearly as a function of presentations in the familiarization phase. In the second experiment the difference between familiar and novel items was even more pronounced. Enactment at encoding was added as a manipulation during familiarization. The results of Experiment 2 showed that the novelty effect did increase linearly for items with nonenacted encoding (in which the familiarization and the critical phase were more similar) but not for enacted encoding. All subjects reported experiencing source discrimination difficulties in both experiments despite the measures taken to diminish them. It seems safe to conclude that source discrimination difficulties are a part of the novelty effect.

Season of birth variations in the temperament and character inventory of personality in a general population

BACKGROUND

Since several studies show season of birth variations in morbidity, suicidal behavior and CSF (cerebrospinal fluid) monoamine metabolites, we investigated season of birth variations in personality in the population.

METHODS

We analyzed by multiple logistic regressions the Temperament and Character Inventory (TCI) for 2,130 individuals taking part in the Betula prospective random cohort study of Umeå, Sweden.

RESULTS

The personality dimensions were correlated significantly with age and gender. We stratified the data according to age, gender and the season of TCI measurement. By the median split in each stratum, a high-value group and a low-value group were obtained for each of the personality dimensions. Those born during February to April were significantly more likely than those born during October to January to have high NS (novelty seeking) among women, particularly the subscale NS2 (impulsiveness vs. reflection), and to have high PS (persistence) among men. Temperament profiles also showed season of birth variations.

CONCLUSIONS

We discuss the associations in the literature between personality and the monoamines serotonin and dopamine, and suggest that our results are compatible with a hypothesis of season of birth variation in the monoamine turnover. The personality traits are likely to be influenced by several genetic and environmental factors, one of them being the season of birth.

Reactivation of motor brain areas during explicit memory for actions

Recent functional brain imaging studies have shown that sensory-specific brain regions that are activated during perception/encoding of sensory-specific information are reactivated during memory retrieval of the same information. Here we used PET to examine whether verbal retrieval of action phrases is associated with reactivation of motor brain regions if the actions were overtly or covertly performed during encoding. Compared to a verbal condition, encoding by means of overt as well as covert activity was associated with differential activity in regions in contralateral somatosensory and motor cortex. Several of these regions were reactivated during retrieval. Common to both the overt and covert conditions was reactivation of regions in left ventral motor cortex and left inferior parietal cortex. A direct comparison of the overt and covert activity conditions showed that activation and reactivation of left dorsal parietal cortex and right cerebellum was specific to the overt condition. These results support the reactivation hypothesis by showing that verbal-explicit memory of actions involves areas that are engaged during overt and covert motor activity.

Quality of life rapidly improves with budesonide therapy for active Crohn's disease. Canadian Inflammatory Bowel Disease Study Group

Our aims were to assess the impact on health-related quality of life (HRQOL) of a controlled ileal release (CIR) formulation of budesonide in active Crohn's disease (CD) and further define the role of HRQOL, using the Inflammatory Bowel Disease Questionnaire (IBDQ), in assessing outcome in CD. A randomized trial was conducted in 258 patients with active ileal or ileocecal CD. Budesonide CIR 1.5 mg, 4.5 mg, 7.5 mg, or placebo was given b.i.d. for 8 weeks. IBDQ score changes were compared among groups. Correlations for IBDQ and Crohn's Disease Activity Index (CDAI) scores were calculated. Mean IBDQ scores improved significantly over placebo by 2 weeks in budesonide 15 mg (155+/-38; p = 0.006) and 9 mg groups (157+/-33; p = 0.0002). Bowel, systemic, social, and emotional subscores were also significantly better (p < 0.002) at 2 and 8 weeks in the 9 mg group. Improved HRQOL scores correlated well with decreased CDAI (-0.8 < r < -0.4). Average per item change in IBDQ at remission was 1.17 to 1.48. Prior surgery (p < 0.005) or current smoker (p < 0.05) status predicted poorer initial HRQOL but not response. Budesonide CIR 9 or 15 mg/day rapidly and significantly improved HRQOL in active CD.

Activity in motor areas while remembering action events

Episodic memory for simple commands is better following enacted than verbal encoding. This has been proposed to be due to the possibility to base retrieval on motor information. Here we used PET to test the hypothesis that motor brain areas show increased retrieval-related activity following enacted compared to verbal encoding. Brain activity was also monitored during retrieval after imaginary enactment during encoding. It was found that activity in the right motor cortex was maximal following encoding enactment, intermediate following imaginary encoding enactment, and lowest following verbal encoding. These findings provide support that one basis for the facilitating effect on memory performance of overt, and to a lesser degree covert, encoding enactment is the possibility to base retrieval on motor information.

CASCADE: a European collaborative study on vascular determinants of brain lesions. Study design and objectives

Dementia is a highly prevalent disease that may have a cardiovascular component. White matter lesions and brain atrophy (brain abnormalities) are prevalent in dementia cases and might form part of the anatomical basis for the disease. We designed a multi-centre study, CASCADE (Cardiovascular Determinants of Dementia), to examine long-term (10-20 years) and short-term (5 years) cardiovascular risk factors for, and the cognitive consequence of, brain abnormalities. White matter lesions and atrophy are measured with magnetic resonance imaging. Cognitive function is measured with nine tests of memory and executive function. The studies included in CASCADE were ongoing and geographically spread throughout Europe to capture the cardiovascular risk gradient. In each study, a random sample of at least 100 subjects aged 65-75 years was selected who participated in the previous research examinations conducted by the respective centres. The objectives and design of the CASCADE project are described.

Treatment of joint pain in Crohn's patients with budesonide controlled ileal release

1. Joint pain is a frequent manifestation of Crohn's disease. Budesonide controlled ileal release (CIR) is a predominantly topically acting glucocorticosteroid, which is effective in treating active ileal or ileocaecal Crohn's disease. 2. Therefore, it was of interest to study the effect of this predominantly topically acting therapy on the treatment of an extraintestinal symptom of Crohn's disease by analysing data collected from budesonide CIR (Entocort; Astra Draco AB, Lund, Sweden) trials. 3. Three large studies of budesonide CIR treatment in active Crohn's disease provided a reliable source of clinical data. Of the 611 patients treated in the prospective double-blind controlled trials, 291 had joint pain (arthritis/arthralgia) at entry, which was recorded as part of the Crohn's Disease Activity Index. Statistical analysis was based on all patients treated, provided that the patient had joint pain at the start of treatment. 4. Daily oral budesonide CIR (9mg) resulted in clinical remission of joint pain in 74% (95% confidence intervals (CI) 67-82%) of patients. This outcome was nearly twice as good as placebo (41%; 95% CI 34-57%) and as good as the outcome effected by daily oral prednisolone (40mg; 72%; 95% CI 60-84%). The favourable response to budesonide CIR (9 mg) did not correlate with glucocorticosteroid-associated side effects or with adrenal suppression, which were half those in the prednisolone (40 mg/day) group. 5. The favourable outcome may relate to restitution of normal intestinal immune function.

Subjective gastrointestinal tolerability of acetylsalicylic acid and paracetamol after single dose treatment

A prospective, randomised, double-blind, parallel group, two center, single-dose study was conducted to evaluate and compare the incidence of upper gastrointestinal complaints of acetylsalicylic acid and paracetamol. 600 healthy volunteers received acetylsalicylic acid (2 effervescent tablets of 400 mg), paracetamol (2 effervescent tablets of 500 mg) or placebo (2 effervescent tablets) in three treatment groups. Subjects filled in a questionnaire at 0.5, 1, 2, 3 and 4 h after dosing to evaluate eight upper gastrointestinal symptoms, which were stomach pain, burning sensation, nausea, heartburn, gas, burping, indigestion and upset stomach. The primary study objective was to show equivalence between acetylsalicylic acid and paracetamol.

RESULTS

The absolute number of subjects reporting gastrointestinal intolerance were 50 of 200 in the placebo group, 46 of 200 in the paracetamol group and 56 of 201 in the acetylsalicylic acid group. The statistical test showed equivalence between both active substances.

CONCLUSION

The rate of gastrointestinal intolerance following a single dose of two effervescent tablets of acetylsalicylic acid is equivalent to that of paracetamol and not different from gastrointestinal intolerance of placebo.

Oral budesonide for prevention of postsurgical recurrence in Crohn's disease. The IOIBD Budesonide Study Group

BACKGROUND & AIMS

Prevention of postoperative recurrence after resection for Crohn's disease (CD) would be of great clinical benefit. The efficacy of oral budesonide for prevention of endoscopic recurrence was evaluated in patients undergoing resection for ileal or ileocecal CD.

METHODS

Sixty-three patients received budesonide and 66 received placebo in a double-blind, randomized trial with parallel groups. Ileocolonoscopy, including biopsy, was performed after 3 and 12 months. Indications for surgery were fibrostenosis (78 patients), disease activity (41), and other reasons (10).

RESULTS

The frequency of endoscopic recurrence did not differ between the groups at 3 and 12 months. In patients with disease activity as indication for surgery, the endoscopic recurrence rate at the anastomosis was lower in the budesonide group at 3 months, although not significantly (21% vs. 47%; P = 0.11), and at 12 months (32% vs. 65%; P = 0.047). There was no such difference with respect to fibrostenosis as indication for surgery. No differences in adverse event patterns were found between the two groups.

CONCLUSIONS

Oral budesonide, 6 mg daily, offered no benefit in prevention of endoscopic recurrence after surgery for ileal/ileocecal fibrostenotic CD but decreased the recurrence rate in patients who had undergone surgery for disease activity.

Quality decision making in dialysis

A patient approaching the final stage of his renal disease is faced with many difficult questions. Should he opt for a transplant or start on dialysis? In the case of dialysis, can he manage his treatment at home or will he need to be cared for in a clinic? Should be choose peritoneal dialysis or haemodialysis? Is the freedom of being independent from a machine, given by CAPD, as valuable as the freedom of having days without treatment, given by HD? The issues are complex and do not have a given answer. To make the proper decisions about his treatment the patient needs extensive information and support from the caregivers. Likewise, the caregivers need to know the patient well in order to give appropriate advice. In this exchange of information, the renal nurse has a very important role. Some patients may need to be dialysed in a hospital but most can get an equally good or even better dialysis treatment in a less stressful environment. A high degree of self-care is preferred by people who value independence and freedom of movement. Self-care also improves the self-confidence and increases the chances of maintaining employment and a rich social life. Self-care could mean both PD and HD, sometimes with the assistance of a spouse or a nurse. But a certain degree of self-care can also be maintained in limited-care centres and satellites, where the presence of nursing staff gives the feeling of security. For everybody involved, not least the purchasers of health care, it is desirable to keep the patients out of the costly hospital environment for as long as possible.

Budesonide enema for the treatment of active, distal ulcerative colitis and proctitis: a dose-ranging study. U.S. Budesonide enema study group

BACKGROUND & AIMS

Budesonide is a highly potent topical glucocorticosteroid that is characterized by low systemic availability as a result of high first-pass hepatic metabolism. The aim of this study was to evaluate the efficacy and safety of three doses of an enema preparation of budesonide in patients with active distal ulcerative colitis/proctitis.

METHODS

In a double-blind multicenter trial, 233 patients were randomized to receive either a placebo enema or budesonide enema at a dose of 0.5 mg/100 mL, 2.0 mg/100 mL, or 8.0 mg/100 mL. The primary efficacy variables were an improvement of sigmoidoscopic inflammation grade, total histopathology score, and remission rates. Effects on cortisol concentrations were also assessed.

RESULTS

After 6 weeks of treatment, there was significant improvement in sigmoidoscopy and histopathology scores in the budesonide 2.0-mg and 8.0-mg dose groups compared with placebo. Remission was achieved in 19% of patients in the 2.0-mg budesonide group (P </= 0.050) and 27% of patients in the 8.0-mg budesonide group (P </= 0.001) compared with 4% in the placebo group. More than 90% of all budesonide patients had a normal adrenocorticotropin (ACTH)-stimulated cortisol response at the last visit. The budesonide enemas were well tolerated.

CONCLUSIONS

Budesonide enema is both effective and safe for the treatment of active distal ulcerative colitis/proctitis. A dose of 2. 0 mg/100 mL budesonide is the lowest effective dose.

The role of integration in recognition failure and action memory

In three experiments, we studied memory for action events with respect to exceptions from the Tulving-Wiseman function demonstrated in experiments on recognition failure of recallable words. In Experiment 1, we examined exceptions of poor integration in a regular recognition failure condition (i.e., recognition of targets without contextual cues, followed by recall of targets in the presence of contextual cues). In Experiment 2, we examined exceptions of cue overlap in which subjects also had access to the information of contextual cues at recognition test. In Experiment 3, we attempted to equate the levels of recognition across the action and verbal encoding. In addition, the cue overlap and no-cue overlap conditions were studied in a within-subjects design. Results from the three experiments indicated that encoding enactment (episodic integration) and conceptual integration (semantic integration) are related to each other. As a consequence of this relationship, there is a larger independence between recognition and recall of well-integrated items with encoding enactment. On the other hand, for the poorly integrated items without encoding enactment, there is a larger dependence between recognition and recall. Even in the cue overlap condition, where there is a case of large dependence between recognition and recall, the same pattern of data was observed. The results are discussed in terms of an episodic integration view of encoding enactment.

Swedish normative data on personality using the Temperament and Character Inventory

The Temperament and Character Inventory (TCI) is a self-report personality questionnaire based on Cloninger's psychobiological model of personality, which accounts for both normal and abnormal variation in the two major components of personality, temperament and character. Normative data for the Swedish TCI based on a representative Swedish sample of 1,300 adults are presented, and the psychometric properties of the questionnaire are discussed. The structure of the Swedish version replicates the American version well for the means, distribution of scores, and relationships within the between scales and subscales. Further, the Swedish inventory had a reliable factor structure and test-retest performance. The results of this study confirm the theory of temperament and character as a seven-factor model of personality.

Gender differences in episodic memory

The relationship between gender and memory has been largely neglected by research, despite occasional studies reporting gender differences in episodic memory performance. The present study examined potential gender differences in episodic memory, semantic memory, primary memory, and priming. Five hundred thirty women and 470 men, randomly sampled from the city of Umeå, Sweden, 35-80 years of age, participated in the study. There were no differences between men and women with regard to age or education, or on a measure of global intellectual functioning. As has been demonstrated previously, men out performed women on a visuospatial task and women outperformed men on tests of verbal fluency. In addition, the results demonstrated that women consistently performed at a higher level than did men on the episodic memory tasks, although there were no differences between men and women on the tasks assessing semantic memory, primary memory, or priming. The women's higher level of performance on the episodic memory tasks could not be fully explained by their higher verbal ability.

Physician and staff assessments of drug interventions and outcomes in Swedish nursing homes

OBJECTIVE

To describe the type and frequency of drug-related problems discussed in regular team meetings conducted in 15 Swedish nursing homes and report physician and staff assessments of these interventions and residents' outcomes.

DATA SOURCES AND METHODS

The data were collected within the context of a controlled trial with the primary aim of exploring the effects of regular team interventions on drug prescribing practices in Swedish nursing homes. In 15 experimental nursing homes, the residents' drug therapy was discussed regularly by a team consisting of a pharmacist, a physician, nurses, undernurses (similar to licensed practical nurses), and nurse's aides. The pharmacist documented problems, made changes, and observed outcomes. Following the intervention period, a questionnaire was sent to the medical staff that contained items regarding perceived outcomes, the intervention's impact on knowledge of drug therapy in the elderly, and attitudes toward the pharmacist's role.

RESULTS

Unclear indication and problematic choice of drugs were the most common drug-related problems discussed. In 19% of the situations, therapy changes were reported to have had a beneficial effect on the residents' clinical status; in 47% of the situations, staff reported no observable outcome from changes, suggesting that the changes had been appropriate. Finally, medical staff claimed in the follow-up survey that their knowledge about drug therapy had increased; they expressed an overall positive attitude toward this interactive collaboration.

CONCLUSIONS

Regular intervention conducted by a multidisciplinary team incorporating a pharmacist can effectively improve prescribing practices, increase staff knowledge about appropriate drug therapy in the elderly, and result in improved quality of care for nursing home residents.

The impact of regular multidisciplinary team interventions on psychotropic prescribing in Swedish nursing homes

OBJECTIVE

To evaluate the impact of regular multidisciplinary team interventions on the quantity and quality of psychotropic drug prescribing in Swedish nursing homes.

DESIGN

A randomized controlled trial.

SETTING

A sample of 33 nursing homes: 15 experimental homes and 18 control homes representing 5% of all Swedish nursing homes.

PARTICIPANTS

The sample consisted of 1854 long-term care residents with an average age of 83 years. Seventy percent of the residents were women, and 42% had a documented diagnosis of dementia. An additional 5% had a psychotic disorder, and 7% had a diagnosis of depression.

INTERVENTION

Experimental homes participated in an outreach program that was designed to influence drug use through improved teamwork among physicians, pharmacists, nurses, and nurses' assistants. Multidisciplinary team meetings were held on a regular basis throughout the 12-month study period.

MEASUREMENTS

Lists of each resident's prescriptions were collected 1 month before and 1 month after the 12-month intervention. Measures included the proportion of residents with any psychotropic drug, polymedicine, and therapeutic duplication and proportion of residents with nonrecommended and acceptable drugs in each psychotropic drug class, as defined by current Swedish guidelines.

RESULTS

Baseline results show extensive psychotropic drug prescribing, with the most commonly prescribed drugs being hypnotics (40%), anxiolytics (40%), and antipsychotics (38%). After 12 months of team meetings in the experimental homes, there was a significant decrease in the prescribing of psychotics (-19%), benzodiazepine hypnotics (-37%), and antidepressants (-59%). Orders for more acceptable antidepressants also increased in the experimental homes. In the control homes there was increased use of acceptable antidepressants, but there were no significant reductions in other drug classes.

CONCLUSIONS

There is excessive prescription of psychotropic drugs in Swedish nursing homes. Improved teamwork among caregivers can improve prescribing as defined by clinical guidelines.

Gender differences in episodic memory

The relationship between gender and memory has been largely neglected by research, despite occasional studies reporting gender differences in episodic memory performance. The present study examined potential gender differences in episodic memory, semantic memory, primary memory, and priming. Five hundred thirty women and 470 men, randomly sampled from the city of Umeå, Sweden, 35-80 years of age, participated in the study. There were no differences between men and women with regard to age or education, or on a measure of global intellectual functioning. As has been demonstrated previously, men out performed women on a visuospatial task and women outperformed men on tests of verbal fluency. In addition, the results demonstrated that women consistently performed at a higher level than did men on the episodic memory tasks, although there were no differences between men and women on the tasks assessing semantic memory, primary memory, or priming. The women's higher level of performance on the episodic memory tasks could not be fully explained by their higher verbal ability.

Oral budesonide is as effective as oral prednisolone in active Crohn's disease. The Global Budesonide Study Group

BACKGROUND

The use of corticosteroids in active Crohn's disease often becomes limited by side effects. Budesonide is a potent corticosteroid with low systemic bioavailability due to an extensive first pass liver metabolism.

AIMS

To compare the efficacy and safety of two dosage regimens of budesonide and prednisolone in patients with active Crohn's disease affecting the ileum and/or the ascending colon.

PATIENTS AND METHODS

One hundred and seventy eight patients were randomised to receive budesonide controlled ileal release (CIR) capsules 9 mg once daily or 4.5 mg twice daily, or prednisolone tablets 40 mg once daily. The treatment period was 12 weeks. The primary efficacy variable was clinical remission, defined as a Crohn's Disease Activity Index (CDAI) of 150 or less.

RESULTS

After eight weeks of treatment, remission occurred in 60% of patients receiving budesonide once daily or prednisolone and in 42% of those receiving budesonide twice daily (p = 0.062). The presence of glucocorticoid associated side effects was similar in all groups; however, moon face was more common in the prednisolone group (p = 0.0005). The highest frequency of impaired adrenal function, as measured by a short ACTH test, was found in the prednisolone group (p = 0.0023).

CONCLUSIONS

Budesonide CIR, administered at 9 mg once daily or 4.5 mg twice daily, is comparable to prednisolone in inducing remission in active Crohn's disease. The single dose administration is as promptly effective as prednisolone and represents a simpler and safer therapeutic approach, with a considerable reduction in side effects.

Effects of division of attention during encoding and retrieval on age differences in episodic memory

This study examined the effects of dual task requirements on age differences in free recall performance. One thousand adults ranging in age between 35 and 80 years performed a word recall task alone and concurrently with a card-sorting task (at encoding, retrieval, or both). Age differences in memory performance were substantial under single task conditions, but after correcting memory performance under dual task conditions for differences in single task performance, age did not predict performance. These results do not support the hypothesis that reduced attentional capacity in old age is underlying age differences in episodic memory.

Pharmacokinetics of cloxacillin in patients undergoing hip or knee replacement

OBJECTIVE

The pharmacokinetics of cloxacillin was investigated in 14 men and 24 women undergoing cemented hip (n = 19; age range 56-90) or knee replacement surgery (n = 19; age range 51-84) for osteoarthritis. Cloaxacillin 1 g was given intravenously as a bolus dose at the induction of anesthesia, and plasma samples and urine were collected for 6 h. Drug levels were determined using HPLC.

RESULTS

Preoperative serum creatinine levels were 84 mumol.l-1 in hip patients and 72 mumol.l-1 in knee patients. The calculated values for creatinine clearance were 63 and 85 ml.min-1.1.73 m-2, respectively. Total clearance of cloxacillin was 134 ml.min-1.1.73 m-2 in eighteen evaluated patients undergoing hip replacement, and 162 ml.min-1.1.73 m-2 in eighteen patients undergoing knee surgery. Renal clearance was 72 and 79 ml.min-1.1.73 m-2, respectively. Non-renal clearance was 57 ml.min-1.1.73 m-2 in hip patients and 77 ml.min-1.1.73 m-2 in knee patients. Renal clearance of cloxacillin correlated with the estimated creatinine clearance (r = 0.652). Although women received higher doses than men (median 2.02 vs 2.32 mmol.1.73 m-2), there were no sex differences in clearance corrected for body surface area.

CONCLUSION

Total clearance of cloxacillin was lower in patients undergoing hip replacement than in patients undergoing replacement of the knee, but there was no difference between men and women.

Adult age differences in source recall: a population-based study

Age differences in source recall were investigated in a population-based sample of healthy adults aged 35 to 80 years (N = 1000). Participants, who were screened on a variety of demographic, psychological, and biological variables, studied facts about well-known and unknown persons that were presented in four different ways, depicting four different sources of item information. An age-related deterioration of both item and source recall was observed, with source recall being more impaired than item recall. Source error analyses revealed an increase of source amnesia in subjects aged 75-80 years. Individual differences in background variables, age, gender, and word comprehension were related to source recall of well-known items, whereas age and years of formal education were related to source recall of unknown items. Source amnesia was accentuated in the two oldest cohorts and related to word comprehension. The age-related tendency to forget the source even when the fact is retained is suggested to be a specific feature of cognitive aging.

Genetic markers associated with high versus low performance on episodic memory tasks

Associations were studied between six serum protein polymorphisms (C3, BF, HP, ORM, TF, and GC) and high versus low scoring on episodic memory tasks in an attempt to identify QTL (quantitative trait loci) contributing to the heritability of this quantitative trait. Since a highly significant sex difference (p = .00002) was found with respect to the distribution of high and low scoring, with men showing a poorer performance, associations were studied separately for males and females. In females significant differences (p < .05) between the high and the low groups were found in four of six marker systems (C3, HP, TF, and CG), whereas in males a significant difference was found only in the HP system. Significant differences from population frequencies were also found more frequently in females than in males. The strongest marker associations were found with complement C3 and the acute-phase reactant HP, which suggests that immune response factors may be of importance in preserving episodic memory function. The overall results appear to indicate that episodic memory is a multifactorial and heritable quantitative trait where sex is an important determinant.

Age differences in episodic memory, semantic memory, and priming: relationships to demographic, intellectual, and biological factors

This study examined age differences in episodic memory, semantic memory, and priming using a random sample of 1,000 men and women from 10 age groups (35, 40, 45, . . . 80 years). The main purpose was to determine whether an age effect existed after differences on various demographic, intellectual, and biological factors had been controlled for. The simple correlations of age with episodic and semantic memory performance were found to be significant, whereas no relationship was found between age and levels of priming. After controlling for differences on the background factors, age predicted episodic but not semantic memory performance. It is proposed that the failure to account for the age effect on episodic memory is because it is caused by age-related neuronal changes.

Network analysis of positron emission tomography regional cerebral blood flow data: ensemble inhibition during episodic memory retrieval

Two important objectives in the neuroscience of memory are (1) identification of neural pathways involved in memory processes; and (2) characterization of the pattern of interactions between these pathways. Functional neuroimaging can contribute to both of these goals. Using image subtraction analysis of regional cerebral blood flow data measured with positron emission tomography, we identified brain regions that changed activity during episodic memory retrieval (visual work recognition). Relative to a baseline reading task, decreased activity was observed in bilateral prefrontal, bilateral anterior and posterior temporal, and posterior cingulate cortices. Brain regions showing increased activity were the right prefrontal (different from deactivated regions), left anterior cingulate, and left occipital cortices, and vermis of cerebellum. We then performed a network analysis with structural equation modeling to test the hypothesis that regional decreases came about through active inhibition by regions showing increased activity during retrieval. This analysis demonstrated that the influence of activated regions on deactivated regions was more negative during retrieval than during reading, confirming the inhibition hypothesis. Such confirmation could not have been made from the subtraction analysis alone because decreases can come about, at the very least, through reduction of functional influences as well as by active inhibition. The concepts of ensemble excitation and inhibition, as defined through network analysis, are introduced. We argue that is is critical to examine the combined pattern of excitatory and inhibitory influences to fully appreciate the neural basis of episodic memory.

Activation of medial temporal structures during episodic memory retrieval

Medial temporal lobe structures have been implicated in human episodic memory. Patients with medial temporal lesions show memory deficits, and functional neuroimaging studies have revealed activation in this region during episodic encoding and retrieval when data are averaged over a sample of subjects. The relevance of such observations for memory performance has remained unclear, however. Here we have used positron emission tomography (PET) to examine cerebral blood flow related to verbal episodic retrieval. We observed strong positive correlations between retrieval and blood flow in left medial temporal structures in individual normal human subjects. In addition, multivariate analysis showed that regions in the left medial temporal lobe were dominant components of a pattern of brain regions that distinguished a high-retrieval condition from conditions of lower retrieval. These results suggest that medial temporal activity is related to retrieval success rather than retrieval attempt, possibly by reflecting reactivation of stored patterns.

Memory dysfunction in mild aphasics

The effect of mild aphasia (n = 9), as a result of subarachnoid haemorrhage (SAH), was evaluated against one matched (sex, age, and education) control group suffering from SAH of unknown origin without aphasia, and against one matched healthy control group. According to aphasia testing (Reinvang & Engvik, 1980), criteria for a classical diagnosis were not met. Therefore, the patients were characterized as mild aphasics: They generally displayed intact audo-verbal comprehension and repetition abilities, and they demonstrated a fluent, spontaneous speech. However, they showed phonemic and semantic paraphasias, with self-corrections; a few patients displayed alexia and agraphia. Memory performance of these three groups was evaluated by a neuropsychological test battery, designed to tap various components of verbal memory function. From the results it was concluded that: (a) Short-term memory is impaired, as regards the phonological loop and the central executive in working memory, whereas maintenance rehearsal is unaffected, given that the demands on phonological coding is minimized, (b) long-term memory is also generally impaired, whereas long-term learning and forgetting by means of subject-performed tasks proceeds within a normal range. Impairments were hypothesized to reflect less efficient central executive functions of working memory, involving generation of less appropriate semantic codes and phonological representations, (c) mildly aphasic patients are not subjectively aware of their own memory deficits, and (d) aphasia classification by means of standard procedures do not sufficiently characterize the nature of a mildy aphasic patient's memory problems.

Oral budesonide as maintenance treatment for Crohn's disease: a placebo-controlled, dose-ranging study. Canadian Inflammatory Bowel Disease Study Group

BACKGROUND & AIMS

Budesonide is a corticosteroid with high topical anti-inflammatory activity and low systemic activity due to rapid hepatic metabolism. The efficacy and safety of an oral controlled-release preparation of budesonide for maintenance of remission was evaluated in patients with ileal or ileocecal Crohn's disease.

METHODS

In a double-blind, multicenter trial, 105 patients were randomly assigned to receive placebo or budesonide at doses of 3 or 6 mg daily for 1 year. The primary outcome measure was relapse defined by a Crohn's Disease Activity Index score of > 150 and a minimum increase of 60 points.

RESULTS

Patients receiving 6 mg of budesonide had a median time to relapse or discontinuation of therapy of 178 days compared with 124 days in those receiving 3 mg of budesonide and 39 days in those receiving placebo. However, at 1 year, the rate of relapse in the group receiving 6 mg of budesonide was similar to the rates in the 3-mg and placebo groups. Basal plasma cortisol levels and incidence of corticosteroid-associated effects were similar in the three groups.

CONCLUSIONS

Oral controlled-release budesonide (6 mg/day) was well tolerated and prolonged remission in Crohn's disease of the ileum and proximal colon, but this effect was not sustained at 1-year follow-up.

Functional brain maps of retrieval mode and recovery of episodic information

Positron emission tomography (PET) was used to identify brain regions associated with two component processes of episodic retrieval; those related to thinking back in subjective time (retrieval mode) and those related to actual recovery of stored information (ecphory). Healthy young subjects recognized words that had been encoded with respect to meaning or the speaker's voice. Regardless of how the information had been encoded, recognition was associated with increased activation in regions in right prefrontal cortex, left anterior cingulate, and cerebellum. These activations reflect retrieval mode. Recognition following meaning encoding was specifically associated with increased activation in left temporal cortex, and recognition following voice encoding involved regions in right orbital frontal and parahippocampal cortex. These activations reflect ecphory of differentially encoded information.

Dissociative effects of elaboration on memory of enacted and non-enacted events: a case of a negative effect

One experiment compared the effect of elaboration on enacted and non-enacted events. The commands were either presented in a basic form (e.g., "wave your hands") or in an enriched form. The commands were enriched by adding statements to the commands of how to perform the actions (e.g., "wave your hands as a conductor"). Free- and cued-recall data showed elaboration to have a dissociative effect on enacted and non-enacted events. Memory for the non-enacted events benefited from enrichment, whereas simple enacted events were remembered to a higher extent than complex enacted events. Lack of benefit from elaboration on memory of enacted events is suggested to be due to enactment leading to a sufficient degree of item-specific processing, and a negative effect of elaboration is suggested to occur when the way of manipulating item complexity decreases the familiarity of the actions. Familiarity ratings of the items by two independent groups of subjects supported this interpretation.

The role of enactment in implicit and explicit memory

Enactment during the encoding of simple imperatives has been found to improve substantially performance on conceptually driven explicit-memory tests. In two experiments the effect of this manipulation on a conceptually driven implicit test (category association) was studied. A conceptually driven explicit test (free recall) was also included. In Experiment one three different study conditions (enactment with real objects, reading, and generation) were considered. In Experiment two there were two study conditions (enactment with imaginary objects and reading). Compared to reading, generation was found to improve the performance on both free recall and category association, whereas enactment affected free recall only. In a final experiment subjects imagined that they performed the tasks, and this manipulation was found to improve the memory performance on both tests. Taken together, this pattern of results is interpreted as suggesting that free recall and category association have a process in common that is sensitive to semantic processing at study (promoted by generation and imagery, but not by enactment), and that free recall involves a retrieval process in addition that is facilitated by a rich encoding environment (provided by enactment).

Recognition failure of categorised words: further evidence of exceptions

When subjects study a list of B items paired with A items and are tested for recognition of the B items alone, and then for recall of the B items given the A items as cues, B items that can be recalled frequently go unrecognised. The extent of this recognition failure is predictable from a function discovered by Tulving and Wiseman (1975), which relates the probability of recognising the recallable items to the probability of recognising all items. Two kinds of exceptions to this function have been discovered: encoding exceptions and retrieval exceptions. Very few observations of retrieval exceptions exist. Four experiments described in this article provide further evidence that such exceptions occur when the B items are categorised and the A items are the names of the categories. According to a contextual account of the function and exceptions to it, these retrieval exceptions occur because the information provided by the A-item cues can be largely retrieved from the B items in the recognition test; hence, as cues, the A items do not provide much different contextual information to that provided by the B items. By this account, the function is an empirical law; exceptions fall outside the range of this law and define its boundary conditions.

The effect of retrieval enactment on recall of subject-performed tasks and verbal tasks

The effect of retrieval enactment on memory for nouns (objects) or verbal phrases describing simple actions (e.g., "lift the box") was addressed in two experiments. In Experiment 1, the type of object involved in the actions was manipulated, with three different types of object being used (body parts, laboratory-related objects, and external objects). In Experiment 2, the integration between the verb-noun pairs was manipulated (well-integrated vs. poorly integrated). Results from both experiments showed that whereas encoding enactment (motor encoding and verbal test) substantially improved the memory performance compared with a verbal condition (verbal encoding and verbal test), retrieval enactment (verbal encoding and motor test) had no major impact on the number of recalled nouns or phrases. Moreover, there was no additional effect of dual enactment (motor encoding and motor test). The overall pattern of the results suggests that there is a fundamental difference between motor processing at encoding and motor processing at retrieval, and the lack of encoding specificity advantage for the motor modality contradicts the view that encoding enactment of verbal commands results in storage of motor representations.

Subarachnoid blood on CT and memory dysfunctions in aneurysmal subarachnoid hemorrhage

Ninety patients with a previous subarachnoid haemorrhage (SAH) were given a set of memory tests comprising immediate free recall of words (indexing long-term memory, LTM, and short-term memory, STM), final free recall of words (indexing LTM), final cued recall of words (indexing LTM), and a digit span test (indexing working memory, WM). Patients with a large amount of blood on CT, carried out within 72 h of the bleed, showed LTM as well as STM dysfunction, whereas patients with a small amount of subarachnoid blood evidenced only STM dysfunction. Patients with the ruptured aneurysm located on the anterior cerebral artery, however, constituted an exception with dysfunction of both LTM and STM together with intact WM, independent of the amount of subarachnoid blood. Also, patients with internal carotid artery or middle cerebral artery aneurysms and large volume SAH displayed LTM dysfunction, but differed concerning STM, the former showing intact STM and the latter showing STM dysfunction. Thus, it appears, that the combined information from factors such as the amount of subarachnoid blood and the location of the ruptured aneurysm is of vital importance for explaining the different patterns of memory dysfunctions after SAH.

Oral budesonide for active Crohn's disease. Canadian Inflammatory Bowel Disease Study Group

BACKGROUND

Corticosteroids are the most efficacious drugs for inducing remission in active Crohn's disease, but their benefits are frequently offset by serious side effects. Budesonide is a corticosteroid with high topical antiinflammatory activity but low systemic activity because of extensive hepatic metabolism. We investigated the efficacy and safety of an oral controlled-ileal-release preparation of budesonide in patients with active Crohn's disease involving the ileum or ileum and proximal colon.

METHODS

In a double-blind, multicenter trial, 258 patients were randomly assigned to receive placebo or one of three doses of budesonide--3, 9, or 15 mg daily. The primary outcome measure was clinical remission, as defined by a score of 150 or less on the Crohn's disease activity index.

RESULTS

After eight weeks of treatment, remission occurred in 51 percent of the patients in the group receiving 9 mg of budesonide (95 percent confidence interval, 39 to 63 percent), 43 percent of those receiving 15 mg (95 percent confidence interval, 31 to 55 percent), and 33 percent of those receiving 3 mg (95 percent confidence interval, 21 to 44 percent), as compared with 20 percent of those receiving placebo (P < 0.001, P = 0.009, and P = 0.13, respectively). Improvements in the quality of life, as measured by the patients' responses to the inflammatory bowel disease questionnaire, paralleled these remission rates. Location of disease, prior surgical resection, and previous use of corticosteroids did not affect the outcome. A total of 119 patients (46 percent) were withdrawn from the study before the trial ended, 96 because of insufficient therapeutic effects, 13 because of adverse reactions, and 10 because of noncompliance. Budesonide caused a dose-related reduction in basal and corticotropin-stimulated plasma cortisol concentrations but was not associated with clinically important corticosteroid-related symptoms or other toxic effects.

CONCLUSIONS

In an eight-week trial, an oral controlled-release preparation of budesonide at an optimal daily dose of 9 mg was well tolerated and effective against active Crohn's disease of the ileum and proximal colon.

Recognition failure and integration

If a recognition test is followed by a cued recall test then the probability of recognition given recall generally follows the Tulving-Wiseman function. Despite this regularity two types of exceptions have been discovered. Both poor integration and cue overlap causes an observed value of recognition given recall that is higher than predicted. The present study explores the first type of exception by proposing and testing an analytical tool, which emanates from confidence ratings given to recall responses, for relating poor integration directly to variations in the degree of deviation from the function. It is demonstrated that very poor integration produces a deviation above the function, whereas a very good integration produces a deviation below the function. The effect of integration (and cue overlap) is explained by means of a conceptualization cue dependency. Support is also given to the notion that an enhanced variability of goodness of encoding contributes to an enhanced dependence between recall and recognition.

Angiotensin I is converted to angiotensin II by a serine protease in human detrusor smooth muscle

The aim of the present study was to investigate whether a pathway for conversion of angiotensin I (ANG I) to angiotensin II (ANG II) other than that via angiotensin-converting enzyme (ACE) is present in the smooth muscle of the human detrusor. Isolated detrusor strips from 11 patients were contracted by ANG I (1 microM) in the absence or presence of enalaprilat (10 microM), soybean trypsin inhibitor (STI, 200 micrograms/ml), or both. The metabolic activity in detrusor membranes from four patients was studied separately using Hip-Gly-Gly or ANG I as a substrate, with or without various protease inhibitors. The contractile response to ANG I (1 microM) was depressed by enalaprilat from 66 +/- 22 (mean +/- SD) to 39 +/- 13% of the K+ (124 mM)-induced response (P < 0.01, n = 11), and the combination of enalaprilat and STI resulted in a further reduction in contractile amplitude to 25 +/- 14% (P < 0.01 vs. K+, and P < 0.05 vs. enalaprilat alone) and a significantly slower developing contraction with a time to peak of 3.7 +/- 1.7 vs. 1.1 +/- 0.3 min for ANG I alone (P < 0.01). In detrusor membranes, a low ACE activity, inhibitable by captopril, was demonstrated by the formation of hippuric acid (0.70 nmol.min-1.mg protein-1) from the synthetic ACE substrate, Hip-Gly-Gly. However, the conversion of ANG I (166 nmol.min-1.mg protein-1) to ANG II was not affected by ACE inhibition, while serine protease inhibitors, e.g., STI and chymostatin, completely prevented ANG II formation.(ABSTRACT TRUNCATED AT 250 WORDS)

Attentional demands and recall of verbal and color information in action events

Two experiments addressed the influence of secondary task performance at encoding on recall of different features of subject-performed tasks (SPTs) involving objects (e.g., turn the wallet). In Experiment 1, memory for verbs and colors of objects was assessed, with object names serving as cues. In Experiment 2, object and color memory were assessed, with verbs serving as cues. Results from both experiments indicated a greater deterioration of memory performance under divided attention for verbal features than for colors. In addition, intention to remember did not affect performance for any feature in either experiment. The overall pattern of outcome is discussed relative to the view that encoding of verbal features of SPTs is more attention-demanding than encoding of physical task features, such as color.

Mathematical constraints and the Tulving-Wiseman law: a rejoinder

Hintzman (1991; 1992) has claimed that the reason data points approximate the recognition failure function discovered by Tulving and Wiseman (1975) is that they are mathematically constrained to do so, and the reason that a few data points do not approximate the function, but are exceptions to it, is that these data points are less subject to mathematical constraints. He has additionally argued that such exceptions are more likely with low levels of recall and strong underlying sources of positive covariance. We provide empirical evidence relevant to this mathematical model using 301 observations from a database of all relevant experimental conditions published between 1973 and 1992 (Nilsson & Gardiner, 1993). We conclude that mathematical constraints have only a minor influence on the function, not the causal role assigned to them in Hintzman's (1992) model. By our account, both the function and exceptions to it reflect a single psychological principle, the functional effectiveness of contextual cues.

Identifying exceptions in a database of recognition failure studies from 1973 to 1992

This paper presents a database of all published studies based on the recognition failure paradigm, which involves the study of pairs of items followed by a recognition test of the second item of each pair and a recall test of the same target item with the first item of each pair provided as a context cue. The paper also identifies, on the basis of a quantitative analysis, exceptions to the recognition failure function encompassing most data in the database. The database includes reference information about each study and a short description of materials and the manipulations made in each of the 302 experimental conditions reported. The database also includes information about the total number of observations for each condition, the overall hit rate in free or forced choice recognition, the overall probability of recall, the observed probability of recognition given recall, the predicted probability of recognition given recall, the difference between observed and predicted values, and the critical ratio between these difference scores and their overall standard deviation.

Visual half-field testing of memory functions in patients considered for surgical treatment of intractable complex partial epilepsy

The present research employed the visual half-field (VHF) technique to assess memory functions in normal subjects and in patients with unilateral temporal lobe epilepsy prior to surgery. Two studies were conducted. In Study 1, concrete and abstract words were presented to the left (LVF) or the right visual half field (RVF), and measures were made of response latencies, naming, free recall, and recognition. In Study 2, pictures depicting random shapes with low verbal association values were presented, and measures were made of latencies for identification and recognition of the shapes. Overall, the results showed a RVF advantage for words, but no lateralization for shapes. A selective hemisphere memory deficit was obtained for abstract words in patients with left temporal lobe lesions. Otherwise, no obvious lesion-related differences were found in the preoperative analyses. It is concluded that VHF testing of verbal information, but not abstract visuo-spatial information, is discriminative in assessing hemispheric functions in normal subjects and patients with temporal-lobe epileptic lesions.

Radio-immunoassay of atrial natriuretic peptide (ANP) and characterization of ANP immunoreactivity in human plasma and atrial tissue

A sensitive radio-immunoassay (RIA) was developed to determine the occurrence of atrial natriuretic peptide (ANP) in plasma and atrial extracts from patients undergoing open heart surgery. The immunoreactive ANP (irANP) was characterized by high-pressure liquid chromatography coupled with RIA. The plasma irANP response to releasing stimuli during the operation was determined in simultaneously sampled venous and arterial blood, in order to evaluate any differences. The antiserum recognized the intact ring-structure of alpha-humanANP (alpha-hANP) and its propeptide gamma-hANP, as well as beta-hANP, an anti-parallel dimer of alpha-hANP. Less bioactive N-or C-terminal fragments of alpha-hANP, or an N-terminal fragment of the propeptide, gamma-hANP 1-67, did not cross-react with the antiserum. Sep Pak C18-extraction of plasma resulted in an 80% recovery of synthetic alpha-hANP. The assay had a sensitivity of 1.9 pmol l-1, well below the venous plasma concentrations of irANP found in healthy volunteers (7.4 +/- 1.3 pmol l-1, mean +/- SEM, n = 19), and the local standard was identical to an international standard of alpha-hANP. In atrial extracts three major peaks of irANP were identified as alpha-, beta- and gamma-hANP, with gamma-hANP as the most abundant form. In plasma alpha-hANP dominated, but in two cases high plasma levels of beta-hANP were seen, reflecting the high atrial content in these patients. In peripheral arterial blood, irANP was on an average 56% +/- 20% (p less than 0.01, n = 18) higher than in venous blood; this was associated with more distinct arterial irANP responses to releasing stimuli during the operation.

The generation effect in primed word-fragment completion reexamined

Two experiments were designed to test a claim made by Gardiner (1988) that there are generation effects in implicit memory as measured by word-fragment completion. Subjects either read words at study or generated the words from fragments. As in previous research, fragments were completed to a greater extent if they were identical at study and test than if they differed. In Experiment 1 it was found that subjects could recognize explicitly the exact form of fragments that had been used for self-generation and distinguish these from other forms of fragments. An analysis of the contingency relations between recognition of fragments and fragment completion showed a high degree of dependence between the two tests. In Experiment 2 it was found that the match of surface features between study and test was a necessary, but not sufficient, condition to produce enhancement of priming. The results are interpreted as supporting the claim that generation does involve a data-driven component in addition to semantic elaboration.

Cue utilization following different forms of encoding in mildly, moderately, and severely demented patients with Alzheimer's disease

The ability of patients with Alzheimer's disease (AD) to utilize semantic category cues in order to improve memory performance was examined. Categorizable lists of words or objects were presented under five different encoding conditions: (a) nouns, (b) objects, (c) objects with a semantic orienting question, (d) objects with self-generated motoric acts, and (e) objects with experimenter-instructed motoric acts. Subjects were asked to memorize the items for a free recall test, and were subsequently provided with the category names in a cued recall test. Mildly, moderately, and severely demented AD patients, and a group of normal older adults participated in the study. Results showed that normal older adults and mildly demented AD subjects were able to utilize cues to improve memory performance in all conditions. Moderately demented patients utilized cues in all conditions except in the verbal condition (condition [a]), whereas severely demented patients utilized cues only in the motoric condition (condition [e]). These results suggest that the ability to utilize category cues following a motoric encoding is preserved later in AD than the ability to utilize cues after a semantic encoding.

Randomised double-blind study of norfloxacin and cefadroxil in the treatment of acute pyelonephritis

In a coordinated, double-blind multi-centre trial, adults with symptoms of acute pyelonephritis were randomly assigned to receive a two-week course of oral treatment with either 400 mg norfloxacin twice daily or 1 g cefadroxil twice daily. Of 197 patients enrolled in the study, 140 could be evaluated for drug efficacy and 193 for drug safety. Norfloxacin gave a significantly higher bacteriological cure rate than cefadroxil, both at 3 to 10 days (98% versus 65%; p less than 0.0001; 95% confidence interval (CI) for difference in proportions 21-46%) and up to eight weeks (87% versus 48%; p less than 0.0001; 95% CI 25-54%) after cessation of treatment. The differences between the two regimens were most pronounced in men and in patients with complicating factors such as diabetes mellitus and urinary tract abnormalities. The clinical response during treatment did not differ between the two groups, but symptomatic recurrences at follow-up were more common in the cefadroxil group (28% versus 3%; p less than 0.0001; 95% CI 14-36%). Adverse events were more often reported by patients receiving cefadroxil (39% versus 22%; p = 0.011; 95% CI 4-30%) and consisted mainly of gastrointestinal disturbances and vulvo-vaginitis. In terms of bacteriological and clinical efficacy and safety, a two-week course of norfloxacin was superior to a two-week course of cefadroxil for oral treatment of community-acquired acute pyelonephritis.

Pharmacokinetics of diltiazem and its metabolites after repeated multiple-dose treatments in healthy volunteers

In a complete crossover study, balanced for sex and treatment order, we have investigated the pharmacokinetics of diltiazem in 10 healthy middle-aged volunteers. The treatments were 60 mg t.i.d. and 120 mg t.i.d. during 14 days' treatment, with the last dose pulsed with 1.85 MBq [14C]diltiazem. The absorption was rapid and did not differ between treatments. The disposition could be appropriately described using a two-compartment model with terminal half-lives of 6.57 +/- 1.41 h (mean +/- SD) after 60 mg t.i.d. and 5.44 +/- 0.66 h after 120 mg t.i.d. The half-life of the metabolite N-demethyldiltiazem (MA) was similar to that of diltiazem, whereas the half-lives of deacetyldiltiazem (M1) and N-demethyldeacetyldiltiazem (M2) were longer. The plasma concentrations and areas under the curve found after doubling of the dose were not significantly different from dose-adjusted directly proportional estimations. However, the mean concentration of MA in percent of diltiazem concentration was significantly higher at the lower-dose regimen 41 +/- 11% versus 36 +/- 8%, whereas the corresponding values for M1 were 11 +/- 3% versus 11 +/- 4% and for M2 12 +/- 4% versus 12 +/- 6%, respectively. The median cumulative excretions of radioactivity during 120 h were 90 and 93%, respectively. The drug was mainly excreted in urine (73 versus 73%, median), the remaining amounts were eliminated in feces.