Tidsskrift for den Norske lægeforening : tidsskrift for praktisk medicin, ny række
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Cannabis has been used throughout human history. Delta (9)-tetrahydrocannabinol (THC) is the primary psychoactive component of cannabis. THC metabolises to 11-OH-THC and further to THC-acid, which is an inactive metabolite. We present an overview of the pharmacokinetics and pharmacodynamics of cannabinoids. ⋯ It has been demonstrated that mammalian tissues express cannabinoid receptors (CB1, CB2 and most probably CB3) and endogenous ligands for these. Knowledge of these receptors has lead to the development of components that stimulate (CB-agonists) or block their function (CB-antagonists). This opens up for the study of any potential therapeutic effects of cannabinoids. Research on a possible therapeutic potential of cannabinoids should however not overshadow the well-documented negative effects of cannabis; i.e. impaired cognitive functions, intoxication and an increased risk for development of psychosis and psychotic symptoms.
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Tidsskr. Nor. Laegeforen. · Mar 2007
Review[Rehabilitation of patients with chronic obstructive lung disease].
Pulmonary rehabilitation is well established and is increasingly prescribed as part of the treatment for chronic obstructive pulmonary disease (COPD). ⋯ The essential elements of rehabilitation include a multidisciplinary approach; focus on the individual patient; and emphasis on emotional, social, and physical health aspects. The selected patients have COPD symptoms; are fully aware of their physical limitations and motivated to take an active part in the treatment. Pulmonary rehabilitation is also beneficial for patients with other chronic lung diseases A systematic programme includes a detailed clinical examination of the patient, teaching, training in mucus mobilization and breathing techniques, exercise training and psychosocial support. Evidence-based effects of rehabilitation include symptom relief, increased exercise performance, improved quality of life and reduced use of health services. Pulmonary rehabilitation is also necessary before and after lung transplants and in connection with volume reducing surgery for emphysema.
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Tidsskr. Nor. Laegeforen. · Jan 2007
Review[Therapeutic hypothermia--pharmacology and pathophysiology].
Therapeutic hypothermia is used primarily to limit the ischemic damage following cardiac arrest. The main goal for the treatment is the brain. Therapeutic hypothermia is resource demanding and is therefore done in intensive care units with strong competence in treatment and monitoring of critically ill patients. This review focuses mainly on physiological and pharmacological aspects of therapeutic hypothermia. ⋯ Biochemical changes during hypothermia lead to increased tolerance to ischemic episodes and can reduce post-ischemic reperfusion injury to the central nervous system. Knowledge of pharmacological changes during hypothermia is limited, and hypothermic patients are often given doses of drugs recommended for normothermic patients. Reduced enzyme activity during hypothermia, reduced perfusion of liver and kidney and reduced bile-production also contribute to slower elimination of drugs. For some drugs the distribution volume is altered. Consequently, the dosing of several drugs should be reduced during hypothermia. Knowledge about the influence of hypothermia on receptors is sparse. Little is also known about the effects of reheating, but one has to assume that the process will be reversed and that the dosing therefore has to be increased upon reheating. The need for additional studies of the pharmacology of therapeutic hypothermia is obvious.
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Even though the BCG vaccine is one of the most used vaccines in the world, tuberculosis is still a major problem worldwide. Research aimed at developing new vaccines against tuberculosis has become more goal-directed during the last 10-15 years, and there are now several vaccine candidates in clinical study phases I and II, that should be in phase III in 2010. It will then still take several years before we know whether a new vaccine will reduce the occurrence of tuberculosis. ⋯ Estimations show that an effective vaccine against latent tuberculosis will give a rapid and considerable reduction in tuberculosis. The current vaccine candidates are however developed to protect against primary tuberculosis and not against reactivated latent tuberculosis. It is important to ensure an optimal experimental basis for new tuberculosis vaccines and to compare them so the best can be selected.
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Haemolysis, elevated liver enzymes, and low platelet (HELLP) syndrome is a severe form of preeclampsia. It is often manifested clinically by elevated blood pressure, proteinuria and abdominal pain. Women diagnosed with the HELLP-syndrome normally show evidence of recovery within the first 48 hours after delivery. There is however a small group of patients in which no arrest or reversal of the HELLP process can be seen after 72 hours post partum. These patients have a high incidence of maternal morbidity and mortality. Several studies have shown benefits to HELLP patients after administration of corticosteroids. ⋯ None of the studies show statistically significant differences in maternal morbidity or mortality by administering corticosteroids to patients with HELLP syndrome. Treatment can give a faster increase in the platelet count for patients with platelets < 50 (10(9)/L), but larger trials are needed to support the use of corticosteroids for treatment of HELLP-syndrome.