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Per year through 2004. 5 If that comes to pass, Americans will spend an estimated $218 to $254 billion on prescription drugs in 2005 and drug spending will represent as much as 14 percent of all health care spending, up from around 10 percent in 2000. The primary driver of this trend is the increase in the number of prescriptions being written, and the shift to newer, more expensive drugs.6 Numerous observers FIGURE 1 have raised concerns about whether mass Promotional Cumulative expenditure in Share of DTC Share of DTC media ads are inapproTherapeutic Category Rank Brand Name Spending 1999 $million ; Spending priately inducing demand for some new prescription 9% 1 Oral Antihistamine Claritin 136.8 9% 5% Antiulcerant Prilosec 79.4 14% medicines. They worry that 5% 3 Anti-obesity Xenical 76.2 18% people are beginning to 4% Male pattern baldness Propecia 71.1 23% ask their doctors for newer 4% 5 Oral antihistamine Zyrtec 57.1 26% 3% Cholesterol reducer Lipitor 55.5 30% and costlier medicines 3% 7 Smoking cessation Zyban 53.9 33% when less expensive drugs 3% 8 Respiratory steroids inhaled ; Flonase 53.5 37% may work just as well in 3% 9 Sexual function disorder Viagra 53.0 40% 3% Respiratory steroids inhaled ; Nasonex 52.3 43% many cases. There is also 3% 11 Oral contraceptives Ortho tri-cyclen 50.1 46% mounting concern that a ; 3% 12 Anti-obesity Metidia 43.5 49% mass media ads transform 3% 13 Oral diabetes Glucophage 43.1 52% 3% Oral anitihistamine Allegra 42.8 55% medicines into just another 3% 15 Antiviral Valtrex 40.9 57% consumer product and 2% 16 Bladder control Detrol 39.6 60% b ; put pressure on drug 2% 17 Cholesterol reducer Zocor 35.0 62% 2% Menopause Prempro 34.7 64% makers to build "brand" 2% 19 Anti-migraine Zomig 34.4 66% name products that may 2% 20 Respiratory steroids inhaled ; Flovent 31.7 68% have misplaced consumer 2% 21 Antidepressant Paxil 31.5 70% 2% Antiarthritic Celebrex 27.6 72% allegiance. 2% 23 Asthma control Singulair 25.4 74% Proponents of DTC 2% 24 Anti-alzheimer Aricept 25.2 75% advertising argue that the 2% 25 Asthma control Accolate 25.0 77% 1% Breast cancer Nolvadex 23.7 78% ads have added enor1% 27 Allergic conjunctivitis Patanol 23.0 80% mously to the information 1% 28 Smoking cessation Nicotrol inhaler 19.7 81% consumers are getting 1% 29 Antivirals Relenza 19.3 82% 1% Lyme disease vaccine Lymerix 18.3 83% about prevalent health 1% 31 Anti-migraine Imitrex 18.0 84% conditions and diseases. 1% 32 Menopause CombiPatch 17.8 85% They say the ads make 1% 33 Antiarthritic Vioxx 17.1 87% 1% Fungicide Ditropan XL 15.8 88% people aware of potential 1% 35 Antiviral Denavir 15.5 89% treatment options and fa1% 36 Anti-anemia Procrit 15.2 89% cilitate dialogue between 1% 37 Wrinkle control Renova 13.4 90% 1% Antifungal Diflucan 12.1 91% doctors and patients about 1% 39 Antiarthritic Enbrel 10.4 92% diseases and conditions 1% 40 Benign prostate disease Flomax 10.1 92% that are widely under1% 41 Respiratory steroids inhaled ; Nasacort AQ 9.6 93% 1% Antiarthritic Synvisc 9.0 94% treated in the U.S. such 1% 43 Acne treatment Differin 8.7 94% as early heart disease, 1% 44 Fungicide Lamisil 8.1 95% diabetes, depression and 1% 45 Oral diabetes Rezulin 7.7 95% 1% Menopause Premarin 7.6 95% high blood pressure ; . 1% 47 Menopause Cenestin 6.9 95% A cause-and-effect 1% 48 Diabetes non-oral ; Humulin 6.9 95% relationship between DTC 1% 49 Pregnancy prevention Depo-Provera 6.2 95% 1% Oral diabetes Avandia 5.9 95% ads and the rise in drug 3% Rest of Market 50.3 5% prescriptions and pharmaceutical spending has not Total 1, 590.2 100% been firmly established. SOURCE: American Institutes for Research analysis of Competitive Media Reporting data as presented in June, 2000 Med Ad News But many observers infer billion in 1997. It rose to $93.4 billion in 1998, an 18.4 percent increase. It jumped again to $111.1 billion in 1999, a 19 percent increase over 1998. Expenditures per person rose from an average $330 in 1998 to $387 in 1999, up 17 percent.4 Recent studies project that prescription drug spending will increase on the order of 12 to18 percent.
A picture of structures inside the body. Scans often used in diagnosing, staging, and monitoring disease include liver scans, bone scans, and computed tomography CT ; or computerized axial tomography CAT ; scans and magnetic resonance imaging MRI ; scans. In liver scanning and bone scanning, radioactive substances that are injected into the bloodstream collect in these organs. A scanner that detects the radiation is used to create pictures. In CT scanning, an x-ray machine linked to a computer is used to produce detailed pictures of organs inside the body. MRI scans use a large magnet connected to a computer to create pictures of areas inside the body. scrotum SKRO-tum ; In males, the external sac that contains the testicles. semen The fluid that is released through the penis during orgasm. Semen is made up of sperm from the testicles and fluid from the prostate and other sex glands. seminal vesicle SEM-in-al VES-ih-kul ; A gland that helps produce semen. seminal vesicle biopsy The removal of fluid or tissue with a needle from the seminal vesicles for examination under a microscope. The seminal vesicles are glands in the male reproductive tract that produce a part of semen. side effect A problem that occurs when treatment affects healthy tissues or organs. Some common side effects of cancer treatment are fatigue, pain, nausea, vomiting, decreased blood cell counts, hair loss, and mouth sores. stage The extent of a cancer in the body. Staging is usually based on the size of the tumor, whether lymph nodes contain cancer, and whether the cancer has spread from the original site to other parts of the body. stage I prostate cancer Cancer is found in the prostate only. It cannot be felt during a digital rectal exam and is not visible by imaging. It is usually found accidentally during surgery for other reasons, such as benign prostatic hyperplasia a condition in which an overgrowth of prostate tissue occurs ; . Also called stage A1 prostate cancer. stage II prostate cancer Cancer is more advanced than in stage I, but has not spread outside the prostate. Also called stage A2, stage B1, or stage B2 prostate cancer. stage III prostate cancer Cancer has spread beyond the outer layer of the prostate to nearby tissues and may be found in the seminal vesicles glands that help produce semen ; . Also called stage C prostate cancer. stage IV prostate cancer Cancer has metastasized spread ; to lymph nodes near or far from the prostate, or to other parts of the body, such as the bladder, rectum, bones, liver, or lungs. Metastatic prostate cancer often spreads to the bones. Also called stage D1 or stage D2 prostate cancer. staging STAY-jing ; Performing exams and tests to learn the extent of the cancer within the body, especially whether the disease has spread from the original site to other parts of the body. It is important to know the stage of the disease in order to plan the best treatment. standard therapy In medicine, treatment that experts agree is appropriate, accepted, and widely used. Health care providers are obligated to provide patients with standard therapy. Also called standard of care or best practice. stool The waste matter discharged in a bowel movement; feces. strontium-89 A radioactive compound that is absorbed by the bone. It is used to treat bone pain associated with prostate cancer.
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Health practitioners need to be aware of the health effects of reduced atmospheric pressure, transmeridian travel causing jetlag ; , and motion sickness and to consider passengers' fitness to travel by air. Guidelines for medical clearance, in-flight medical emergencies, and aircraft emergency medical equipment have been reviewed.28 The risk of transmission of respiratory diseases in association with air travel should also be considered. No case of active tuberculosis as a result of exposure during travel by air has yet been identified, but transmission of Mycobacterium tuberculosis may occur during flights of more than eight hours, as the risk of infection is related to the proximity and duration of exposure to the source patient.29 Considerable attention has been given to travel related deep vein thrombosis.30 31 The estimated risk of developing deep vein thrombosis after a long distance flight is between 0.1 and 0.4 per thousand of the general population.32 Methods of preventing deep vein thrombosis, including identification of travellers with predisposing risk factors, 32 are important. All passengers, regardless of their risk, should move around in their seats and in the aircraft cabin as much as possible during the journey. Drinks containing alcohol or caffeine should be avoided before and during the flight, and water or soft drinks should be taken to reduce the and mesterolone.
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A particular methylated CD, the heptakis 2, 6-di-O-methyl-CD, called DIMEB ; is a crystalline product. It is extremely soluble in cold water but insoluble in hot water, therefore, its purification, and also the isolation, of its complexes is technically very simple. Up to now no better solubilizer has been found among the CDs. It is available in better than 95% isomeric purity for injectable drug formulation, but for widespread industrial application the cheaper randomly methylated CD called RAMEB ; is produced and marketed. The heptakis- sulfobutyl ; -CD is very soluble in water, non-crystallizable, and even at extremely high doses seems to be free from any toxic side-effects. It can be used as chiral separating agent in capillary zone electrophoresis, but the aim of the intensive research is to develop it as a parenteral drug carrier, for preparation of aqueous injectable solutions of poorly soluble drugs.
Appendix. Table 16. Linn~eus's Sexual .Method. 17. The Sexual System of Linnoeus, altered by Professor Thunberg, of Upsal and naprosyn.
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Calf serum. Primary cultures of normal acinar cells were prepared from rat pancreas according to collagenase digestion methods described by Lu and Logsdon 1992 ; . Normal acinar cells were plated overnight in collagen-coated dishes in Waymouth's medium containing 10% fetal calf serum. Cultures were maintained in a humidified atmosphere of 95% oxygen 5% CO 2 at 37C. In vitro calcium mobilization. Effects of gabapentin on calcium mobilization were evaluated by laser cytometry ACAS, Meridian Instruments, Okemos, MI ; in normal pancreatic acinar cells and in AR42J pancreatic tumor cells. Calcium flux was measured by using the acetoxymethyl ester form of the fluorescent calcium chelator Fluo-3 at excitation and emission wavelengths of 488 and 515 nm, respectively. Cells were plated into 24-well tissue culture dishes at a density of 2 10 cells well. Cells were pretreated with the fluorescent Ca 2 indicator at 5 mM for 30 min, rinsed once, and covered with phenol red-free DMEM and treated with CCK-8 and or gabapentin, as described in the figure legends. Cholecystokinin receptor competitive binding assays. To test the hypothesis that gabapentin's effects on intracellular calcium mobilization could be mediated by interactions at CCK receptors, ligand competition binding assays were conducted on normal rat pancreatic membranes as described above using 35 125I-BH-labeled CCK-8S in the presence of increasing concentrations of unlabeled CCK-8 or gabapentin ranging from 10 16 to 5M. Cell proliferation in vitro. Effects of gabapentin on proliferation of normal pancreatic acinar cells and AR42J rat pancreatic tumor cells was assessed by 3H-thymidine incorporation. Cells were plated at 60, 000 cm 2 in 12-well tissue culture dishes and incubated overnight. Medium was replaced with treatment solutions containing 1 Ci 3H-thymidine and increasing concentrations of gabapentin as indicated in the figure legends. Cells were incubated for 18 h, after which trichloroacetic acid-precipitable radioactivity was quantitated by scintillation spectroscopy. Statistical analyses. Treatment groups were compared using a one-way analysis of variance ANOVA ; with Student-Newman-Keuls post-hoc test, where appropriate. A p-value 0.05 was selected prior to the study, for determining statistical significance and soma.
| Buy meriidia over the counterBedchamber" in the traditional medical and erotic literature, generally takes a positive approach toward human sexuality. Emphasized are the various techniques whereby men and women can learn to satisfy one another in intensive, sensitive involvement and intimacy.8-11 In this perspective, strong libido depends on the state of one's total health. Emotional factors are important; notably, anger, fear, and anxiety for males, and worry, fear, and depression for females. Male sexual dysfunction and decline loss of libido largely pertain to KI Yang Deficiency. The female counterpart basically refers to KI Yin and Yang Deficiency. The key meridians for males that require tonification are the KI, LR, and TH; for females, the KI, SP, and PC. For both sexes, stimulation of the CV and GV extraordinary meridians is indicated to boost systemic Qi flow. It is useful to distinguish between these complex physiological and psychological sexual disorders and those ordinarily encountered in male and female urology and gynecology.12, 13 Females not only have various special problems surrounding menstruation, pregnancy, and menopause, but also more complex problems such as inhibited sexual response and dyspareunia "frigidity" ; . Special male problems include erectile dysfunction and premature ejaculation "impotence" ; . Regarding menopause in both sexes, libido does not necessarily decline with hormonal deficiency due to aging. TREATMENT Virtually all the author's patients are received as referrals from other physicians, and are considered to be difficult cases unresponsive to biomedical treatment mainly drug therapy ; . The complete biomedical data for each referred patient is then reviewed. A Four Diagnosis evaluation inquiry, observation, palpation, and auscultation olfactory ; is conducted. Assessment is made of a patient's Shen spirit ; and other techniques to select the optimal acupuncture points for stimulation. Basic electroacupuncture14 is utilized in about 90% of clinical treatments; most patients have chronic conditions and electroacupuncture is a more powerful tool for these conditions. Electroacupuncture generally produces a stronger stimulation than the standard insertion of acupuncture needles. Moreover, electroacupuncture allows the electrical stimulation to be precisely adjusted according to what is required for specific conditions. Electroacupuncture is beneficial not only for controlling pain, but also for harmonizing Qi. It may be applied by various devices such as the 4channel outlet model ITO IC 4107 ; that is commonly used in clinical.
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26 Classic therapies are usually ineffective in the treatment of patients with very poor sperm density. The aim of this study was to determine the effect of acupuncture on these males. Semen samples of 20 patients with a history of azoospermia were examined by light microscope LM ; and scanning electron microscope SEM ; , with which a microsearch for spermatozoa was carried out. These examinations were performed before and 1 month after acupuncture treatment and revealed that the study group originally contained three severely oligoteratoasthenozoospermic OTA ; , two pseudoazoospermic and 15 azoospermic patients. The control group was comprised of 20 untreated males who underwent two semen examinations within a period of 2-4 months and had initial andrological profiles similar to those of the experimental group. No changes in any of the parameters examined were observed in the control group. There was a marked but not significant improvement in the sperm counts of severely OTA males following acupuncture treatment average 0.7 + - 1.1 x 10 6 ; spermatozoa per cjaculate before treatment vs. 4.3 + - 3.2 x 10 6 ; spermatozoa per ejaculate after treatment ; . A definite increase in sperm count was detected in the ejaculates of 10 67% ; of the 15 azoospermic patients. Seven of these males exhibited post-treatment spermatozoa that were detected even by LM. The sperm production of these seven males increased significantly, from 0 to an average of 1.5 + - 2.4 x 10 6 ; spermatozoa per ejaculate Z -2.8, P or 0.01 ; . Males with genital tract inflammation exhibited the most remarkable improvement in sperm density on average from 0.3 + - 0.6 x 10 6 ; spermatozoa per ejaculate to 3.3 + - 3.2 x 10 6 ; spermatozoa per ejaculate; Z -2.4, P or 0.02 ; . Two pregnancies were achieved by the IVF-ICSI procedure. It is concluded that acupuncture may be a useful, nontraumatic treatment for males with very poor sperm density, especially those with a history of genital tract inflammation. [22, 07 ecr-] 80- gera: 75561 di re ACUPUNCTURE IN INTRACTABLE EPILEPSY: LACK OF EFFECT ON HEALTH-RELATED QUALITY OF LIFE. STAVEM K ET AL. seizure. 2000, 9 6 ; , 422-6 eng ; . ref: 32 The objective of this study was to assess the effect on health-related quality of life of acupuncture and sham acupuncture as adjunctive treatment in intractable epilepsy. We performed a randomized controlled trail with two parallel treatment arms at The National Center for Epilepsy in Norway, a comprehensive epilepsy center. Thirty-four patients with long-standing drug resistant epilepsy completed the study. The intervention consisted of 20 acupuncture treatments bilateral needling of three acupoints plus one or two individually chosen points ; or sham acupuncture bilateral needling with smaller needles of three points outside the traditional meridians ; over 8 weeks. The main outcome measures were changes in mean health-related quality of life scores for the two groups after 8 weeks, using the 89-item Quality of Life in Epilepsy QOLIE-89 ; questionnaire. We found no difference between the acupuncture and sham acupuncture groups in score changes in any dimension of the QOLIE-89 questionnaire, despite testing a large number of dimensions. We also found no change in QOLIE-89 scores between baseline and 8 weeks in either groups. In conclusion, we could not demonstrate a significant effect of traditional acupuncture or sham acupuncture on the healthrelated quality of life of patients with intractable epilepsy. [14, 05 ecr-] 81- gera: 71722 di ra.
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