This case report describes a transvestic fetishist, a heterosexual male who derives sexual pleasure from cross-dressing. Like in other paraphilias, the onset of the paraphilic behavior can be traced to adolescence. A 15-year old boy was brought by his parents with a history of collecting female undergarments and wearing them for the past 6 months. He had recurrent thoughts about the undergarments and an urge to pick them up whenever he saw them, either in his own house or their neighbors. He had been wearing them secretly until he was caught by his mother wearing five panties beneath his dress. On further enquiry, he admitted pursuing these activities solely for pleasure, but denied any other sexual activity following cross-dressing. These recurrent thoughts about undergarments had a compulsive character. He tried to suppress these thoughts and was partly successful, until he saw undergarments in their neighborhood. He would pick them up and wear them or throw them in fear of discovery. He was caught once stealing them and was beaten by people, but he still continued these activities. He was diagnosed as having transvestic fetishism and was prescribed escitalopram, 10 mg day. He showed significant improvement after four weeks, with a decrease in recurrent thoughts and urges to pick up clothes. Most of the cases of transvestic fetishism do not turn up for treatment and are discovered accidentally, as is in this case. There are no well established drugs for treatment of transvestic fetishism, and only case reports of successful treatment with buspirone Fedoroff, 1988; Fedoroff, 1991 ; , fluoxetine Jorgensen, 1990 ; , sertraline and lithium Rubenstein and Engel, 1996 ; are published. Fluoxetine has been used in treatment of other paraphilias Emmanuel et al., 1991; Perilstein et al., 1991; Kafka and Prentky, 1992 ; . Stein et al. 1992 ; hypothesized that obsessions and compulsions are at the compulsive end and paraphilias are at the impulsive end of a neurobiological spectrum and discussed the use of serotonergic medications in the treatment of sexual obsessions and paraphilias. Abdo et al. 2001 ; have reported two cases in which transvestism was OCD-related and suggested that in those whose cross-dressing was more egodystonic responded better to treatment. In the case described above, the boy had strong urge to collect and wear the undergarments, which had a compulsive quality. There may be a subset of cases of transvestic fetishism, which lie in the OCD-transvestism continuum, who may have dysregulation of serotonergic neurons, and these group of patients may respond preferentially to SSRIs. Subsequent episode of impaction and was transferred to a medical facility. Upon return to the State Hospital, the patient was on lactulose Chronulac ; , polyethylene glycol, docusate sodium and milk of magnesia prn. The clozapine was discontinued and olanzapine Zyprexa ; was started. Upon discharge the patient was only receiving olanzapine, divalproex ER and docusate sodium. In the next report, a 41 year-old female was admitted for the treatment of schizoaffective disorder, bipolar type. The patient had been on the same HIV regimen for over two years. This included fosamprenavir Lexiva ; , tenofovir emtricitabine Truvada ; and lamivudine Epivir ; . Since 2005, the patient has been on lithium, pantoprazole, omega 3-fatty acids and docusate calcium at steady doses. Paroxetine Paxil ; was started on 3 23 06, clozapine was started on 8 15 06, clonidine Catapres ; was started 8 31 06 and lactulose was started on 9 12 06. The clozapine was titrated to 150 mg day as previous higher doses of clozapine lead to severe constipation and stomach aches requiring the use of laxatives and enemas on several occasions. These symptoms progressed to include difficulty swallowing, vomiting once ; and increased AST and ALT on 10 6 The HIV agents were discontinued on 10 13 and clozapine was reduced to 100 mg day and subsequently discontinued. The liver function tests improved after the discontinuation of the HIV medications and clozapine. An 18 year-old female was admitted for the treatment of schizoaffective disorder. The patient was prescribed oxcarbazepine Trileptal ; , pantoprazole Protonix ; , escitalopram Lexapro ; and olanzapine Zyprexa ; during admission in late August. The olanzapine was increased to 30 mg day on 9 5 06. Lithium was started on 9 25 and was increased to 1200 mg day on 10 2 06. Clozapine was initiated at 12.5 mg day on 10 9 06. The next day, the dose was increased to 25 mg day and at the same time the olanzapine dose was decreased to 20 mg day. Early the next morning 12: 52 a.m. ; the patient had a grand mal seizure lasting approximately 3.5 minutes followed by an 8 minute postictal state. Clozapine was discontinued and the oxcarbazepine dose was increased. No additional seizures occurred between the time of this incident and the time of submitting the report about 1 month ; . A 37 year-old male was admitted for the treatment of schizoaffective disorder, bipolar type. On admission, it was noted that the patient had been noncompliant with his outpatient medication for approximately 4 days. On admission, the patient was started on the previously prescribed dose of clozapine Clozaril ; 150 mg at bedtime. In addition, risperidone Risperdal ; M-tabs 2 mg at bedtime, lithium 1200 mg at bedtime and pantoprazole Protonix ; 40 mg daily was prescribed. The next day, it was noted that the patient had a tonic-clonic seizure and projectile vomiting. The patient was transferred to a medical facility for four days. The clozapine was discontinued without subsequent seizure event. The patient had no prior history of seizures. A 55 year-old male was admitted to the State Hospital for the treatment of his first psychotic break. Prior to admission, the patient was taking a product called RelacoreTM for several months and he was on no prescription medication at the time of admission. He had no known drug allergies and no known medical conditions. Few weeks before admission, he began experiencing insomnia, delusions, paranoia and decreased appetite. On admission, he had pressured speech, felt paranoid that people are talking in code and untrusting of the admitting physician. The RelacoreTM was discontinued and ziprasidone Geodon ; was initiated. A 45 year-old male was admitted for the treatment of schizoaffective disorder, bipolar type. He was continued on the medication from his previous hospital stay. These include ziprasidone Geodon ; 240 mg day, olanzapine Zyprexa ; 30 mg day, lithium controlled release 1350 mg day, ritonavir Norvir ; 200 mg day, saquinavir Invirase ; 2000 mg day, stavudine Zerit ; 80 mg day, and lamivudine Epivir ; 300 mg day. Olanzapine and lorazepam Ativan ; prn were added later. An EKG completed about a week after admission showed a QTc interval of 490 ms with a left atrial abnormality. Previous EKGs obtained 28 months and 19 months before this one, showed QTc intervals of 408 ms and 428 ms, respectively. A 52 year- old male was admitted for the treatment of schizoaffective disorder, bipolar type. On admission, the patient was treated with quetiapine Seroquel ; 900 mg day, pantoprazole Protonix ; 40 mg day ; and divalproex Depakote ; ER 1000 mg day. Three days after admission, the divalproex ER was increased to 2000 mg day. Ten days after admission, clonazepam Klonopin ; 1.5 mg day was added. Fourteen days after admission, oxcarbazepine Trileptal ; 600 mg day was added. Around this time, the patient began complaining of sedation and deteriorating eye sight. In addition, the patient was poorly oriented to time. The symptoms progressed and the patient became obtunded and was unresponsive. The patient was transferred to a medical facility where he was.
E-mail: john.marley medicine.adelaide .au. KIMBERLY A. GALT, PHARM.D., FASHP, is Associate Professor of Pharmacy Practice and Family Medicine, University of Nebraska Medical Center College of Pharmacy, Omaha. MARYANN Z. SKRABAL, PHARM.D., is Assistant Professor Pharmacy Practice, Creighton University School of Pharmacy and Allied Health Professions, Omaha. IVAN G. ABDOUCH, M.D., is Assistant Professor of Family Medicine, University of Nebraska Medical Center College of Medicine, Bellevue, Nebraska. CARROLL THOMAS, R.N., is Clinic Nurse Manager, University of Nebraska Medical Center, Omaha. KIMBERLEE D. THOMPSON, PHARM.D., is Pharmacist Supervisor, Summit Plaza Pharmacy and Courtesy Instructor, University of Nebraska Medical Center College of Pharmacy, Bellevue. JAMES E. DUBE, PHARM.D., FASHp' is Manager, Pharmacy Services, University of Nebraska Medical Center Department, because escitalopram pharmacokinetics.
J.A. Cabrera 1 , D. Sanchez Quintana 2 , S. Yen Ho 3 , J.M. Rubio 4 , F. Sanmillan 4 , J. Pindado 4 , C.G. Santos-Gallego 5 , J. Farre 4 . 1 Fundacion Jimenez Diaz, Cardiology, Madrid, Spain; 2 Extremadura University, Human Anatomy, Badajoz, Spain; 3 Imperial College, Paediatric Cardiac Morphology, London, United Kingdom; 4 Fundacion Jimenez Diaz, Cardiology, Madrid, Spain; 5 Fundacin Jimnez Daz, Cardiology, Madrid, Spain Introduction: Phrenic nerve stimulation is a well-recognised complication during transvenous and epicardial left ventricular lead implantation for cardiac resynchronization therapy CRT ; in patients with advanced heart failure. Methods: nine human cadavers 6 male, 3 female; mean age 709 years old ; without obvious signs of thoracic pathology or prior surgery were carefully dissected. We examined the anatomic relationship between the left phrenic nerve LFN ; with the coronary sinus and its tributaries, the great cardiac vein GCV ; and left obtuse marginal vein LOMV ; or lateral vein. Results: the LFN, branch of the cervical plexus, runs along the left brachiocephalic vein. It continues closely applied over the aortic arch, pulmonary trunk and left atrial appendage and descends in front of the root of the left lung embedded in between the fibrous pericardium and the mediastinal pleura to the diaphragm. In 67% of the hearts, the nerve was separated from the fibrous pericardium by variable amount of adipose tissue.In 7 specimens 79% ; , the LFN passed over the obtuse cadiac margin close along the course of the left obtuse marginal vein. When the LFN course was related to the anterior aspect of the left ventricle 2 specimens, 21% ; the nerve passed adjacent to the great cardiac vein anterior interventricular vein ; . In 43% of cases, we found the LFN at a distance 3 mm from the lateral vein LOMV ; . Table shows the mean maximal and minimal distances in millimeters between the LFN and the great cardiac vein or left obtuse marginal vein.
Icio rss knowledge and perceptions of emergency contraceptive pills among a college-age population: a qualitative approach and esomeprazole.
1. Leon AC, Solomon DA, Mueller TI, et al. A 20-year longitudinal observational study of somatic antidepressant treatment effectiveness. J Psychiatry. 2003; 160: 727-733. Cohen LJ. Pharmacoeconomic issues in the treatment of depression. Formulary. 1995; 30 suppl 1 ; : S20-S25. 3. Burke WJ, Gergel I, Bose A. Fixed-dose trial of the single isomer SSRI escitalopram in depressed outpatients. J Clin Psychiatry. 2002; 63: 331-336. Wade AG, Michael Lemming O, Bang Hedegaard K. Escitalopram 10 mg day is effective and well tolerated in treating patients with depression in primary care. Int Clin Psychopharmacol. 2002; 17: 95-102. Reimherr FW, Chouinard G, Cohn CK, et al. Antidepressant efficacy of sertraline: a double-blind, placebo- and amitriptyline-controlled, multicenter comparison study in outpatients with major depression. J Clin Psychiatry. 1990; 51 Suppl B ; : 18-27.
ABSOLUTE CONTRAINDICATIONS: WOMEN WHO SHOULD NOT USE No known medical contraindications besides allergies to plastic and abnormalities in vaginal anatomy which interfere with satisfactory placement of the female condom. Women whose age, parity or health problems make pregnancy a high risk should use other more effective methods and estrace, for example, escitalopram pdf.
The tribunal therefore finds that dr anton francois hauptfleisch, medical practitioner of levin is guilty of professional misconduct in respect of his treatment of mrs a.
About that time of year again to stuff those pockets full of tissues and face the pollen-wielding outdoors. Experts predict that this year's allergy season could be particularly severe because several regions enjoyed unseasonably warm weather throughout the winter and early portion of spring. Each year, the Allergy and Asthma Foundation of America AAFA ; , in cooperation with research partner Pollen , identifies the top 100 cities in the United States that are the worst for seasonal allergies. This causes many to wonder how their city will fare, and alternatively, how they will prepare and arm themselves against the onset of itchy, watery eyes, runny noses and sneezing fits. According to the American Academy of Allergy, Asthma and Immunology, allergic diseases are the 6th leading cause of chronic disease in the United States and cost the healthcare system around billion annually. On the cusp of allergy season, FLAVORx Inc flavorx ; , the company dedicated to and estradiol.
Figure 1. Effect of escitalopram on duration of immobility in forced swim test in mice.
Drugs for Developing Countries Chairpersons: P.A. Winstanley, University of Liverpool, Liverpool, UK G. Edwards, University of Liverpool, Liverpool, UK The session began with a brief introduction from co-chair Peter Winstanley to set the scene with some demographic statistics that highlighted the importance of low cost drugs to countries in Africa, citing Malawi as an example as a country of low life expectancy and plagued by malaria, tuberculosis and HIV-AIDS, the three diseases whose management formed the basis of this symposium. Taking a lead from Professor Winstanley's initial remarks, Solomon Nwaka World Health Organisation, Geneva, Switzerland ; emphasised an urgent need for more effective and affordable drugs to control tropical diseases through a sustainable pipeline for new chemical entities. Dr Nwaka reminded the audience that we lacked mechanisms to translate our research strategies into promising leads for drugs that can treat the diseases of the developing world. Public private partnerships have emerged to help produce affordable and effective treatments for malaria for example, LapdapTM ; and the Medicines for Malaria Venture MMV ; aim to nurture novel chemotherapeutic agents from the laboratory to the clinic through a close collaboration between academia and industry. Other important collaborations between WHO and the pharmaceutical industry involving on site training of scientists from developing countries were highlighted by Dr Nwaka. However, the success of these strategies is dependent upon new leads becoming available and 14.
EDUCATION 1984-1988 1980-1984 MEDICAL TRAINING 1 95 3 Visiting Faculty, Divisions of Liver Transplantation and Hepatology, University of California, Los Angeles School of Medicine Gastroenterology Research Fellow, Department of Internal Medicine, Division of Gastroenterology, University of Texas Medical Branch, Galveston. Gastroenterology Fellowship, Department of Medicine, Division of Gastroenterology, University of Texas Medical Branch, Galveston, Texas Resident in Internal Medicine, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma Internship in Internal Medicine, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma M.D., University of Oklahoma College of Medicine, Oklahoma City, Oklahoma B.S. in Microbiology, University of Oklahoma, Norman, Oklahoma.
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