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Reducing the Duration of Postoperative Ileus
Postoperative ileus is a common reason for prolonged hospitalization after major abdominal surgery. The matter is complicated by the use of opioids to treat postoperative pain, since these drugs delay the recovery of gastrointestinal function. ADL 8-2698 is an investigational opioid antagonist that seems not to reverse the analgesic effects of opiates. It was studied in patients who underwent a partial colectomy or a total abdominal hysterectomy. As compared with placebo, ADL 8-2698 shortened the times to the first passage of flatus, the first bowel movement, and hospital discharge.
These findings demonstrate a novel approach to helping patients recover more quickly after major abdominal surgery. Postoperative pain is blocked centrally, but the effects of opioids on the bowel are inhibited with a local antagonist.
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Effects of Inhaled Glucocorticoids on Bone Density in Premenopausal Women
Inhaled glucocorticoid therapy is now recommended for most patients with asthma. Although oral glucocorticoid therapy is known to cause bone loss, whether inhaled glucocorticoid therapy does so is controversial. In this prospective study, bone density was measured for three years in 109 premenopausal women who were treated with inhaled triamcinolone. Inhaled glucocorticoid therapy was associated with a dose-related decline in the bone density of the total hip and trochanter, but not the femoral neck or lumbar spine.
The results of this study indicate that high doses of inhaled glucocorticoids can cause loss of bone. The dose of inhaled glucocorticoids should be as low as possible, and among patients who receive high doses, steps should be taken to minimize bone loss.
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Pamidronate to Prevent Bone Loss During Androgen-Deprivation Therapy for Prostate Cancer
Men with prostate cancer treated with a gonadotropin-releasing hormone agonist have decreased bone mineral density, with an attendant increase in the risk of fracture. In this study, 41 men with advanced prostate cancer received either leuprolide alone or leuprolide plus pamidronate. The men receiving pamidronate had no significant change in bone mineral density, whereas the men receiving leuprolide alone lost a significant amount of bone.
Androgen-deprivation therapy for prostate cancer causes bone loss, but pamidronate, a second-generation bisphosphonate that inhibits osteoclast-mediated bone resorption, appears to prevent this problem.
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Deep-Brain Stimulation for Parkinson's Disease
The involuntary movements and decreased mobility of patients with Parkinson's disease are thought to reflect increased neuronal activity in the subthalamic nucleus and the pars interna of the globus pallidus. This double-blind, prospective study of patients with advanced Parkinson's disease examined the effect of bilateral stimulation of these deep-brain areas. Bilateral stimulation was associated with significant improvement in the amount of time during which these patients had good mobility without involuntary movements.
Although the implantation of electrodes into the brain can have serious consequences, including intracranial hemorrhage, it can help some patients with advanced Parkinson's disease. This approach seems to have fewer serious complications than procedures that create lesions in these deep-brain structures.
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Special Article: Computerized Reminders and Preventive Care for Inpatients
The effectiveness of computerized reminders in increasing the use of preventive care in the inpatient setting has been unclear. In this randomized, controlled trial involving patients admitted to a general medical service, computerized reminders significantly increased the ordering rates for pneumococcal vaccination, influenza vaccination, prophylactic heparin, and prophylactic aspirin at discharge for appropriate candidates.
Opportunities for preventive care are often overlooked in the rush to care for hospitalized patients. Clinical computer systems can play an important part in improving preventive care by reminding clinicians about patients who are likely to benefit from preventive interventions. An efficient computer system can also simplify the process of ordering these interventions.
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Mechanisms of Disease: Maturity-Onset Diabetes of the Young
Maturity-onset diabetes of the young is a usually mild form of diabetes caused by mutations in any of several genes, the products of which regulate insulin secretion. This review describes the clinical, mechanistic, and genetic abnormalities that occur in patients with various types of this disorder.
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