We studied the efficacy and safety of oral tetrahydroaminoacridine (THA) combined with lecithin in 52 patients with Alzheimer's disease. The maximal tolerated dose of THA (up to 100 mg per day) was determined during an eight-week titration period, after which the tolerated dose of THA or placebo was given during two sequential randomized periods of treatment lasting eight weeks each. Highly purified lecithin (4.7 g per day) was administered during all phases of the study. Efficacy was expressed in terms of scores on the Mini-Mental State (MMS) test, the modified MMS test, the Hierarchic Dementia Scale, the Rapid Disability Rating Scale-II, and the behavioral scale of Reisberg et al. Safety was assessed by careful clinical monitoring as well as serial measurements of liver aminotransferases. Forty-six patients completed the titration period, and 39 completed the double-blind period, during which only the MMS score showed a small but significant increase (P less than 0.05) after four weeks of treatment with THA. Autonomic side effects of THA were common but mild. Reversible elevations of serum aspartate and alanine aminotransferase levels to three or more times the upper limit of normal occurred in 17 percent of patients; most of the patients affected were women. A liver biopsy performed in one patient showed resolving focal liver-cell necrosis. These studies fail to demonstrate a significant clinical benefit of THA given orally in a maximal dose of 100 mg per day over a period of eight weeks in combination with lecithin.

Sixteen healthy male dogs were used at random in this protocol. The dogs were anaesthetized with isoflurane in oxygen. Eight of the dogs received 0.25 mg/kg of butorphanol (group B) and the others an equal volume of isotonic saline (group S) administered by a catheter inserted in the lumbosacral epidural space. Butorphanol concentrations in plasma and cerebrospinal fluid (CSF) were measured using high-performance liquid chromatography with electrochemical detection. Maximum concentration of butorphanol and time to obtain this concentration were 42.28 ng/mL at 13.88 min in blood, and 18.03 ng/mL at 30 min in CSF. Volume of distribution, clearance, mean distribution and elimination half-lives were respectively 4.39 L/kg, 2.02 L/h.kg, 16.5 min and 189.1 min. Mean isoflurane minimal alveolar concentration values for group B obtained following hind- or forelimb stimulation decreased by 31% after epidural butorphanol. Cutaneous analgesia (to pin-prick test) persisted for 3 h after the end of isoflurane anaesthesia in group B and was in correlation with the plasmatic analgesic dose of butorphanol (9 ng/mL). These results suggested that analgesia was predominantly obtained by action of butorphanol on the supraspinal structures following its vascular systemic absorption.

No abstract

Since the discovery of a significant depletion of acetylcholine in discrete areas of the brain of patients affected by Alzheimer's disease, attempts at symptomatic therapy have concentrated on acetylcholine supplementation, an approach that is based upon the efficacy of dopaminergic supplementation therapy for Parkinson's disease. Choline, then lecithin, used orally, failed to improve symptoms but the hypothesis that long-term choline supplementation might stabilize the course of Alzheimer's disease remains to be tested. Nerve growth factor may also offer that possibility. Bethanechol administered intracerebroventricularly did not help when a fixed dose was used but individual titration of more selective muscarinic agonists may prove more effective. In this article we report that tetrahydroaminoacridine (THA), given together with highly concentrated lecithin, appears to bring improvement in cognition and in functional autonomy using the Mini Mental State and the Rapid Disability Rating Scale-2 respectively, without change in behavior as reflected by the Behave-AD. Double-blind cross-over studies are in progress to establish its efficacy. Improvement in study design and means of assessment of cognition, functional autonomy and behavior have been made possible by these drug trials. RESUME: Rapport d'etape sur 1'etude multicentrique Canadienne avec tetrahydroaminoacridine et lecithine pour la maladie d'Alzheimer. Depuis la d6couverte d'une perte substantcielle d'acetylcholine dans certaines regions du cerveau de patients souffrant de maladie d'Alzheimer, les essais pour traitment symptomatique ont vis6 a supplier l'ac6tylcholine, une approche fondee sur le succes de la supplementation en dopamine pour la maladie de Parkinson. La choline, puis la lecithine orale n'ont pas ameliore de symptomes mais l'hypothese qu'un supplement a long-terme de choline pourrait stabiliser devolution de la maladie d'Alzheimer reste a verifier. Le facteur de croissance neuronale pourrait 6galement agir en ce sens. Le bethanechol administre par voie intraventriculaire n'a pas aide lorsqu'administre' a une dose fixe mais une titration individuelle utilisant des agonistes muscariniques plus selectifs pourrait s'aveYer plus efficace. Dans cette publication nous rapportons que la tetrahydroaminoacridine avec lecithine hautement concentree semble ameliorer l'intellect et l'autonomie fonctionnelle tel que reflate par le Mini Mental State et la Rapid Disability Rating Scale-2 respectivement. Des etudes en double-insu avec chasse-croise sont en cours pour confirmer son efficacite. Des ameliorations dans le design des etudes et les mesures de fonctions intellectuelles, dautonomie fonctionnelle, de comportement et d'humeur ont ete rendues possibles par ces essais cliniques.

Primary bone grafting is the recommended treatment for orbital floor fractures with bone defects, but this technique has a greater operative morbidity than the simpler use of the Teflon prosthesis. This study evaluates the use of the Teflon prosthesis. In 9 years, 110 patients with 115 orbital floor fractures were treated with Teflon prostheses. Of those, 90 patients had only orbital floor or orbito-zygomatic fractures and 20 had panfacial fractures. The mean operative time was 87 mins. Seventy-seven patients had good results. Complications included diplopia, ectropion, enophthalmia and palpable prosthesis. Seven prostheses required removal between three and 11 months postoperatively. No prosthesis became infected. Orbital floor reconstruction with a Teflon prosthesis is a relatively simple and short procedure associated with a low morbidity, giving good results except in cases of severe floor defects.

The purpose of the present study was to describe the outcomes associated with reduction mammaplasty in terms of physical parameters and health-related quality of life. A prospective cohort study was designed and included women undergoing bilateral breast reduction surgery at the Royal Victoria Hospital, Montreal, Quebec, who consented to participate. Women were evaluated preoperatively for symptoms, physical parameters, quality of life (Short Form [SF]-36 and Multidimensional Body Self Relations Questionnaire [MBSRQ]) and general demographic characteristics that were identified as potential confounders. Postoperatively, women were re-evaluated at six months for symptoms, physical parameters and quality of life. A total of 74 women were entered in the study. Their average age was 32.3 years, and the mean mass of resected volume per breast was 630 g. There was a statistically significant improvement in symptoms six months after surgery (P<0.05). There was also a statistically significant improvement in the physical component summary scale of the SF-36 and several additional subscales: bodily pain, physical functioning, role-physical, and vitality. The MBSRQ subscale of appearance evaluation was significantly increased (2.69 compared with 3.12, P=0.000), whereas the appearance orientation subscale was unchanged. The amount of tissue removed did not appear to correlate with the change in physical symptoms or health-related quality of life resulting from the surgery. This study showed significant improvement in physical and psychological aspects of health-related quality of life in women undergoing reduction mammaplasty.

The purpose of the present study was to describe the outcomes associated with reduction mammaplasty in terms of physical parameters and health-related quality of life. A prospective cohort study was designed and included women undergoing bilateral breast reduction surgery at the Royal Victoria Hospital, Montreal, Quebec, who consented to participate. Women were evaluated preoperatively for symptoms, physical parameters, quality of life (Short Form [SF]-36 and Multidimensional Body Self Relations Questionnaire [MBSRQ]) and general demographic characteristics that were identified as potential confounders. Postoperatively, women were re-evaluated at six months for symptoms, physical parameters and quality of life. A total of 74 women were entered in the study. Their average age was 32.3 years, and the mean mass of resected volume per breast was 630 g. There was a statistically significant improvement in symptoms six months after surgery (P<0.05). There was also a statistically significant improvement in the physical component summary scale of the SF-36 and several additional subscales: bodily pain, physical functioning, role-physical, and vitality. The MBSRQ subscale of appearance evaluation was significantly increased (2.69 compared with 3.12, P=0.000), whereas the appearance orientation subscale was unchanged. The amount of tissue removed did not appear to correlate with the change in physical symptoms or health-related quality of life resulting from the surgery. This study showed significant improvement in physical and psychological aspects of health-related quality of life in women undergoing reduction mammaplasty.

A prospective randomized study was designed to address the safety of performing reduction mammaplasty without drains. In the same cohort, the postoperative pain requirements, length of stay and complications were recorded in an effort to document the efficacy of performing this surgery in an outpatient setting. All women presenting for reduction mammaplasty at the Royal Victoria Hospital during a one-year period were asked to participate in the study. A total of 75 patients enrolled, and complete data were available at the 28-day follow-up for all women. The overall hematoma rate was 0% with drains and 2.7% without drains. The observed infection rate was 8% with drains and 5% without drains. There is no statistically significant or clinically meaningful difference in complication rates between breasts treated with drains and those treated without drains. In addition, 90% of women can be managed with oral analgesics within 23 h of surgery. Combined, this information suggests a potential cost savings of 57% based on prestudy observations. Careful analysis of the process of care will continue to enable the care of patients to be more efficient without compromising quality or safety.