Pharmacokinetic Considerations for Digoxin in Older People

Objective: This review aims to arm readers with a deep understanding of pharmacokinetics of digoxin. Data Sources: Pharmacology and pharmacokinetic references texts, and peer reviewed medical journal manuscripts indexed on Medline included based on currency, accuracy and appropriateness. Results: Physiologic changes and disease associated with aging have an impact on pharmacokinetics and pharmacodynamics of medications. Altered drug response and increased adverse reactions are common amongst the elderly. The narrow therapeutic index of digoxin and pharmacokinetic changes associated with aging increases the risk of toxicity. In the aging population, a number of factors combine to increase the risk, severity and likelihood of hospitalisation or death due to adverse drug effects: • changes to absorption, distribution, metabolism and excretion, • increased susceptibility to drug sensitivity, • co-existing pathology, • polypharmacy. Conclusion: A thorough und erstanding of digoxin pharmacokinetics in the older person is essential for improved therapeutic outcomes, improved compliance, reduced morbidity and improved quality of life.6 page(s

Scintigraphic evaluation of acute lower gastrointestinal hemorrhage : current status and future directions

This review examines the role and limitations of scintigraphic evaluation in acute lower gastrointestinal hemorrhage. A detailed discussion of methods for improving diagnostic outcomes is provided. Techniques and recommendations are offered for optimization of red blood cell scintigraphy for earlier detection and more accurate localization of acute lower gastrointestinal hemorrhage.8 page(s

Inflammation and cancer: tumor initiation, progression and metastasis, and Chinese botanical medicines

Both historically and contemporarily, cancer is seen as an inflammatory process. Evidence has emerged in the last two decades that at the molecular level most chronic diseases, including cancer, are caused by a dysregulated inflammatory response. The identification of transcription factors such as nuclear factor-kappa B and signal transducer and activator of transcription 3 and their gene products such as tumor necrosis factor, interleukin-1, interleukin-6, chemokines, cyclooxygenase-2, and vascular endothelial growth factor, adhesion molecules and others has provided the molecular basis for the role of inflammation in cancer. Tumor initiation, its progression and metastasis and the failure of immune suppression of tumors all can be attributed in part to chronic and systemic inflammation. Chinese herbs have a long history in both treatment of cancer and suppression of inflammation. This paper looks at recent research on cancer and inflammation and Chinese herbs and compounds, which can be used in the treatment of cancer.8 page(s

Integrative oncology in Australia

The use of alternative medicine (AM) in Australia dates back to its earliest times, with the indigenous medicine of the aboriginal peoples and the folk medicine of the early English settlers. AM has until recently existed quite separately from Western biomedicine (WB) and there has been little integration of the two systems. Now, referred to as complementary medicine (CM), there has been a movement over the last 20 years to include CM in WB mainstream practices. Varying degrees of success have been reported but for the discipline of oncology. Medical oncology (MO) in Australia is demanding CM provide high levels of evidence for any inclusion in cancer protocols. There are just now the beginnings of this integration, particularly as CM is now being taught in the public university system to a PhD level as well as the public demand for their medical doctors to communicate with their CM practitioners. MO specialists are now open to a dialogue with their CM counterparts.5 page(s

Thermal control of brown adipose tissue in ¹⁸F-FDG PET

The visualization of hypermetabolic brown adipose tissue (BAT) on ¹⁸F FDG PET lowers the efficacy of PET and has been linked with the environmental temperature of the patient before presentation. The objective of this paper is to investigate the effectiveness of thermal control on BAT and ¹⁸F-FDG PET. Methods: Three hundred patients undergoing ¹⁸F-FDG PET were defined by 1 of 2 groups. Group A consisted of 150 consecutive patients from August to October 2009 (spring). Group B consisted of 150 consecutive patients from December to February 2010 (summer). In addition to normal preparation, group B received instructions to dress warmly and was warmed during the uptake period of their scan. Images were assessed for the presence of BAT. Standardized uptake value data were collected and compared. Results: BAT was present in 9.3% of patients; 15.3% of patients that were not warmed (group A) demonstrated BAT, and this was reduced to 3.3% in the group that underwent warming (group B) (P 5 0.0005). BAT was more common in men (10.9%) than women (6.8%), and women responded better to warming. Younger patients were more likely to demonstrate BAT (P < 0.001). No significant relationship between BAT and height, weight, or body mass index was found. The most common site for BAT visualization was the cervical region (89%), followed by supraclavicular (75%), paravertebral (50%), suprarenal (21%) and paraaortic (7%) regions. Conclusion: Thermal control for the reduction of BAT can achieve reductions in the incidence of BAT by as much as 78%. The reduction of BAT on PET images can reduce falsepositive and false-negative results and minimize the need for rescanning.5 page(s

The Role of Ginkgo biloba extract in the integrative management of dementia

The incidence of dementia is steadily rising in developed countries and represents a significant burden to the health care system. Given the limitations with respect to cost effectiveness of conventional pharmaceutical treatment, herbal extracts may provide a sound strategy in preventing dementia, delaying its onset, slowing progression or managing the symptoms of dementias. Gingko biloba has been widely investigated for suitability as an alternative treatment in patients with Alzheimer's disease. While discrepancies exist in historical reviews due to design limitations, this review explores more recent trials and describes the potnetial role for Gingko biloba in the management of dementia.8 page(s

Technetium-99m-labeled RBC scintigraphy : unrealized potential, unharnessed power?

Letter to the Editor.3 page(s

Global contrast in nuclear medicine

2 page(s

Cancer stem cells and the impact of Chinese herbs, isolates and other complementary medical botanicals : a review

To elucidate the connection between the origin of certain cancers and stem cells, cancer stem cells, the stem cell niche and the tumor microenvironment, and to examine the ability of traditional Chinese herbal medicines and isolates in treating these types of cancers, the existing literature was examined and eight studies regarding Chinese herbal medicines and the prevention of cancer recurrence were critically analyzed and evaluated. Tumor stem cells may be the final target of traditional Chinese medicine. Soy flavones, ginsenoside Rg3, parthenolide, berbamine and curcumin are several examples of Chinese herbal medicines, which have been shown to be effective in the treatment of cancer, and seem to act by targeting cancer stem cells and associated pathways resulting in tumorigenesis. The treatment approaches combined with an overall treatment protocol for the tumor microenvironment and chronic systemic inflammation are likely to provide a more successful outcome than a single tactical approach. As shown in numerous studies in the literature, using complementary disciplines with orthodox treatments may enhance treatment outcomes.11 page(s