Search

Several cellular and molecular alterations have been described in skeletal and respiratory muscles of patients with chronic obstructive pulmonary disease (COPD), but information on potential abnormalities of mitochondrial function is scarce. The aim of the present study was to investigate mitochondrial function in the vastus lateralis (VL) and external intercostalis (EI) of COPD patients. Biopsies from VL and EI were obtained during surgery for lung cancer in 13 patients with mild to moderate COPD (age 68+/-6 yrs, forced expiratory volume in one second (FEV(1)) 66+/-15% predicted) and 19 control subjects (age 67+/-9 yrs, FEV(1) 95+/-18% pred). State 3 and 4 mitochondrial oxygen consumption (V'(O(2),m)), ATP synthesis, citrate synthase, cytochrome oxidase (COX) and complex I-III activities, as well as reactive oxygen species (ROS) production, were determined. In COPD patients, in both muscles, COX activity (VL: COPD 3.0+/-0.8 versus control 2.0+/-0.8; EI: 3.7+/-1.6 versus 2.4+/-0.9 micromol min(-1) mg(-1)) and ROS production (VL: 1,643+/-290 versus 1,285+/-468; EI: 1,033+/-210 versus 848+/-288 arbitrary units) were increased, whereas state 3 V'(O(2),m) was reduced (VL: 2.9+/-0.3 versus 3.6+/-0.4; EI: 3.6+/-0.3 versus 4.1+/-0.4 mmol min(-1) kg(-1)). Skeletal muscle mitochondria of patients with chronic obstructive pulmonary disease show electron transport chain blockade and excessive production of reactive oxygen species. The concurrent involvement of both vastus lateralis and external intercostalis suggests a systemic (rather than a local) mechanism(s) already occurring in relatively early stages (Global Initiative for Chronic Obstructive Lung Disease stage II) of the disease.

To analyse the causes that prompted health care professionals to select naltrexone to treat alcoholism. One-year multicentric, prospective study conducted with 221 doctors specialized in alcoholism treatment and analysis of data derived from 1,396 patients attended. Naltrexone was not prescribed to 446 patients. The medical barriers to the prescription of naltrexone included the mode of understanding alcoholism by doctors (20 % of doctors), patients reluctance to take naltrexone (26.9 % of patients), the presence of a concomitant condition (27.6 %) and barriers associated with health care system (6 % of patients). The logistic regression model explained why doctors tended not to prescribe naltrexone when patients had a long course of their disease or had previously received acamprosate.

Controlled-release levodopa-carbidopa (CRLC) improves some aspects of Parkinson's disease (PD) in patients previously treated with standard levodopa formulations (SL). However, little is known about the effect of this strategy on the health-related quality of life (QoL).To assess the QoL and clinical changes due to the conversion of treatment from SL to CRLC in patients with mild to moderate PD.Through the Nottingham Health Profile (NHP), QoL was measured in 276 non-selected PD patients included in a multicenter, open study. Guidelines for switching to CRLC and optimization of treatment were given. Assessment of patients was carried out by means of the HoehnYahr, UPDRS, and SchwabEngland scales, and questionnaires for dyskinesias and sleep. Examination of the NHP-Spanish Version-scaling properties by fitting data to the Rasch model, disclosed that 3 NHP scales (Emotional reactions, Pain, and Physical mobility) and the NHP distress index (NHPD) were suitable for efficacy analysis.Comparison of scores at baseline and at the end of the study showed significant improvement (paired Student t-test, p0.0001) in all these four scales associated with the change to CRLC. Responsiveness to change of the NHP was high. In the present study, changes in QoL were not contingent to baseline factors such as age, gender, stage of disease or ADL capabilities.Conversion to CRLC significantly improves the QoL of patients with mild to moderate PD.

We present the results of an open, prospective, multicentric study including 450 patients with mild to moderate Parkinson's disease (PD) converted from standard Sinemet to Sinemet CR (controlled release; Dupont Pharma, Pavia, Italy). Patients with complex fluctuations and diphasic dyskinesias were excluded and the conversion was made after some recommendations, depending on the clinical problems and the daily dosage and administration schedule of standard (STD) Sinemet. The condition of more than 60% of the patients improved after the change and 80% of them preferred the CR formulation by the end of the study. We found a moderate, but significant, improvement in most of the efficacy parameters used, such as the Unified Parkinson's Disease Rating Scale (UPDRS), the Schawb and England scale, and dyskinesias and sleep questionnaires. Forty-five patients (10%) discontinued the study due to adverse effects (mainly gastrointestinal disturbances, functional deterioration, and dyskinesias). We conclude that Sinemet CR is a useful and safe therapeutic option in patients with mild and moderate PD. Selection of the patients is the most important outcome factor.

In 78 patients a total of 89 chest wall tumours were considered for surgery between 1960 and 1982. There were 63 neoplasms (12 benign, 51 malignant) and 26 pseudotumours (1 chest wall deformity, 6 inflammatory tumours and 19 hydatid cysts of the chest wall). Radical resection of some kind was possible for 67 tumours and 2 patients underwent palliative resection. Exploratory thoracotomy and biopsy were performed in 9 patients and thoracoscopy and biopsy in 10. One hydatid cyst was managed with mebendazole. There were 11 postoperative complications and three hospital deaths. Chest wall prostheses were used in 13 patients. There was no operative mortality. The mean survival time for the patients with malignant tumour was 12.3 months in pleural mesothelioma and in metastatic pleural tumours, 15.2 months in primary rib tumours and 6.4 months in metastatic rib tumours. There was one death in the benign tumour group and one in the pseudotumour group.