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The efficacy of hydroxyzine was investigated in 110 patients suffering from generalized anxiety, in a double-blind placebo controlled multicentre study. Oral hydroxyzine 50mg/day for four weeks significantly improved standard measurements of anxiety compared with placebo control. These improvements were seen from the end of the first week of treatment and were maintained throughout the study; there was no rebound effect after cessation of therapy. The most commonly reported adverse effect in both active and placebo treatment groups was a transient sleepiness. We conclude that hydroxyzine is an effective and well-tolerated treatment for generalized anxiety. [ABSTRACT FROM AUTHOR]

Aims: To assess the antihistaminic activity of levocetirizine and fexofenadine 2 h and 24 h after drug administration using facial thermography and to compare the results with those using well-established parameters of antihistaminic activity in the nose and skin., Methods: This was a randomized, double-blind, three-treatment, three-period, single-dose, cross-over study in healthy males taking levocetirizine 5 mg, fexofenadine 120 mg or placebo. The primary endpoint was nasal skin temperature after nasal histamine challenge recorded for 20 min at 2 and 24 h after drug intake. The secondary endpoints were nasal symptoms and a histamine skin prick test., Results: Thirty subjects were randomized. At 2 h after drug intake the inhibition of the nasal temperature increase from baseline was not significantly different between levocetirizine and fexofenadine. At 24 h it was significantly more pronounced after levocetirizine than fexofenadine (difference: least-squares mean: -0.13 degrees C; P < or = 0.024, 95% CI -0.24, -0.02). Both drugs significantly reduced (P < or = 0.001) the mean temperature increase from baseline compared with placebo at 2 and 24 h (least-squares mean increase and (95% CI): levocetirizine, -0.28 degrees C (-0.42, -0.14) and -0.32 degrees C (-0.43, -0.21); fexofenadine -0.35 degrees C (-0.49, -0.21) and -0.19 degrees C (-0.30, -0.08), respectively). Results of nasal symptom score and wheal and flare were consistent with the thermography results., Conclusions: Facial thermography is an objective, non-invasive and sensitive method to study antihistaminic activity at the nose level. Levocetirizine and fexofenadine demonstrate the same activity at 2 h after drug intake, but levocetirizine has a more sustained activity at 24 h.

Introduction: The aim of this study was to compare the decongestant properties and tolerability of oral cetirizine and pseudoephedrine in a prolonged release form with those of nasal (aqueous spray) budesonide., Methods: Thirty-six individuals experiencing allergic rhinitis to house dustmites (HDM) participated in a study according to a randomized, crossover, two-period, two-treatment design with at least a 2-week washout period between treatments. In each period of 4 consecutive days, medications were taken twice daily. On day 1, immediately after the first intake of medication, individuals were exposed to HDM extract in the Vienna Challenge Chamber (VCC) for 5 hours. The primary efficacy parameter was nasal congestion, assessed by active anterior rhinomanometry and rating of nasal cavity photos., Results: Rhinomanometry and nasal cavity photos both indicated that cetirizine/pseudoephedrine efficacy was statistically superior to budesonide in the management of nasal congestion during VCC sessions. The efficacy of cetirizine/pseudoephedrine was similar to that of budesonide from the end of day 1 up to day 4 when individuals were exposed to their natural environment post exposure to the aeroallergens. This study confirms the efficacy of cetirizine/pseudoephedrine and budesonide in the management of nasal congestion associated with allergic rhinitis. Both medications were well-tolerated. Cetirizine/pseudoephedrine was more effective than budesonide during HDM exposure, whereas budesonide became as effective as cetirizine/pseudoephedrine several hours post exposure to the allergens.

The aim of this study was to compare the decongestant properties and tolerability of the sympathomimetic xylometazoline hydrochloride 0.1% (CAS 1218-35-5, XMZ) and an oral formulation of cetirizine hydrochloride 5 mg and pseudoephedrine hydrochloride 120 mg (CAS 83881-51-0 and 90-82-4, CTZ/PSE; Cirrus). Thirty-six asymptomatic patients suffering from perennial allergic rhinitis from house dust mite were randomized to this open two-period crossover study. Patients received the study medications for four days each. In each period, treatments were taken twice a day. On day 1 in each period, immediately after the first dose of medication, patients were challenged with Dermatophagoides pteronyssinus extract 1 in the Vienna Challenge Chamber for 5 h. Primary efficacy parameters were nasal congestion evaluated by digital analysis of nasal cavity photographs and nasal airflow. Furthermore amounts of nasal secretions, nasal and ocular symptoms were recorded. In addition, 5 independent Ear-Nose-Throat specialists also assessed nasal cavity photographs. Statistical analyses were conducted at the 5% level of significance. Digital analysis of the nasal cavity photographs as well as nasal airflow measurements did not differentiate XMZ from CTZ/PSE. Ratings of the photographs of the nasal cavity emphasized the rapid onset of XMZ. No clinically relevant adverse events were recorded. This rapid onset of action but short-lived effect of topical xylometazoline 0.1% should be balanced against the consistent and prolonged effect of systemic cetirizine/pseudoephedrine combination in the treatment of perennial allergic rhinitis as no significant differences between these 2 medications were noted regarding their decongestant properties. With the exception of nasal obstruction, all subjective symptoms as well as the global condition were significantly better under CTZ/PSE. Amounts of nasal secretions during these sessions were significantly lower with CTZ/PSE.

Objective: The aim of this study was to examine whether delirium has specific clinical subtypes., Method: One hundred and eighty-three elderly subjects meeting DSM-IIIR criteria for delirium were evaluated using a 19-item symptom check-list assessing different dimensions of delirium symptomatology. Exploratory factor analysis was conducted in order to examine which symptoms clustered., Results: Factor analysis confirmed the existence of two different clusters of symptoms: first, symptoms of hyperalert/hyperactive features (agitation, hyper-reactivity, aggressiveness, hallucinations, delusions); and second, symptoms of hypoalert/hypoactive features (decreased reactivity, motor and speech retardation, facial inexpressiveness)., Conclusion: This preliminary study seems to support the evidence of hypoactive and hyperactive subtypes of delirium, even though their aetiology and prognostic values need to be further examined., (Copyright 2000 John Wiley & Sons, Ltd.)

The SF-36 Health Status Questionnaire is a generic quality of life questionnaire based on 36 questions selected to represent nine health concepts. Perennial allergic rhinitis is a disease which causes variable restrictions on the physical, psychological and social aspects of patients' lives. According to the SF-36 questionnaire assessment, quality of life is impaired in these patients. Cetirizine, a potent, reliable histamine H1-receptor antagonist, has already been found to induce significant improvement in the quality of life of patients with chronic rhinitis, as assessed by the same SF-36 questionnaire after 1 and 6 weeks of treatment. This paper further investigates the extent to which cetirizine continues to improve quality of life after a long-term treatment (6 weeks) compared to a shorter treatment (1 week). The analyses show that, despite the significant improvement found after 1 week of treatment with cetirizine compared to placebo, a further 5-week course of therapy not only maintains this improvement but continues to enhance quality of life significantly above and beyond this.

Forty-five patients with residual or recurrent nasal polyposis after ethmoidectomy were treated with either cetirizine at twice the daily recommended (20 mg) dose or placebo for three months. The number and size of polyps remained unchanged during the study period. Cetirizine was found to reduce nasal sneezing and rhinorrhoea effectively. The drug also had a beneficial effect on nasal obstruction in the latter part of the study. The side effects of 20 mg (double the recommended daily adult dose) of cetirizine were few and comparable to placebo.

Using explicit criteria contained in the DSM III R, we collected in a prospective cohort study clinical features, outcome and risk factors from two cohorts of delirium in hospitalized elderly patients: 138 hospitalized in geriatric department and 45 patients admitted to an acute and comprehensive care hospital. The clinical features were assessed using a quantitative scale (developed by Derouesné). Delirium was unrecognized or misdiagnosed by physicians in 34% of the cases. The onset was known only two thirds of cases. The incidence of hyperactive type, prolonged hospital stay, poor outcomes (persistent delirium leading up to dementia) were highest in subjects admitted in comprehensive hospital. The etiology of delirium is complex and multifactorial. An underlying cause was identified in 80% of patients. The length or the worsening of delirium was significantly higher in patients with psychiatric or dementia comorbidity (OR: 0.2; IC 95%: 0.1-0.5). The prognosis was better in patients without psychoactive medications (OR: 0.2; IC 95%: 0.1-0.4) or with metabolic abnormalities or acute diseases and disorders (OR: 3.3; IC 95%: 1.5-7.6). The predisposing factors to the development of dementia were prior use of psychoactive medications and signs of prior cognitive impairment. This article suggests delirium in elderly patients is associated with several outcomes. The prognosis should be improved at admission by specific scale and an evaluation of predisposing and precipitating factors.

In order to examine the efficacy of cetirizine in cholinergic urticaria, we studied 24 patients in a double-blind crossover design during 3-week treatment periods, with either 10 or 20 mg/d cetirizine or placebo. The placebo period was always placed in between the two verum treatments to allow for a washout of the drug. Evaluation of the patients' daily symptom scores based on itching, erythema and whealing showed a highly significant improvement (p < 0.01). The percentage of days with mild or no symptoms was also increased significantly with the drug (p < 0.05). Except for whealing (p < 0.05), no significant differences between the two dosages of cetirizine could be determined. Since antihistamines have previously been shown to be frequently unsatisfactory in the treatment of cholinergic urticaria, the present data are encouraging regarding the control of symptoms in this condition.

Background and Aim: Perennial allergic rhinitis may impair social life. General scales of quality of life (QOL) are used to detect the importance of social life impairment, but the reliability and validity of QOL measures should be tested in patients with perennial allergic rhinitis. The extent to which QOL scores differ in patients with rhinitis and healthy subjects is unknown., Methods: A cross-sectional study was carried out in 111 patients with moderate to severe perennial allergic rhinitis and 116 healthy subjects to assess the validity of a general QOL scale, the SF-36 Health Status Questionnaire. This scale is based on 36 items selected to represent nine health concepts (dimensions). The internal reliability of each dimension of the questionnaire was examined. The differences in QOL scores between patients with rhinitis and healthy subjects were studied., Results: Most QOL scores were highly reliable. There was a significant impairment in eight of nine QOL dimensions in patients with perennial allergic rhinitis in comparison with healthy subjects., Conclusions: The SF-36 Health Status Questionnaire allows discrimination between patients with perennial allergic rhinitis and healthy subjects.

The mechanisms of adaptation allowing resting freshwater mussels Anodonta cygnea to maintain their oxygen consumption (MO2) constant when the O2 partial pressure in the inspired water (PIO2) varied were studied at 13 degrees C. Steady-state values of oxygen consumption and/or shell valve activity were determined at prefixed PIO2 for periods ranging from 2 to 15 days. Values of PO2, O2 concentration and acid-base status of arterial blood in the heart were determined after two days. MO2 was maintained constant over PIO2 ranging from 35 to less than 1 kPa. At 0.3 kPa it decreased by 50%. Valves remained open (and MO2 constant) most of the time even during a 4.5 day period at PIO2 approximately 1.5 kPa. Between 35 and 1 kPa, blood PO2 at the heart level can remain low and within a narrow range independent of PIO2. Blood PCO2 increased at high PIO2 and decreased at low PIO2. Data are compared to previous results in crayfish and in wels (sheat-fish). On the basis of data similarity it is proposed that these three animals exhibit the same basic strategy for maintaining resting MO2 when PIO2 varies. This common feature relies mainly on the ability to maintain PO2 in the arterial blood at a value which is low and independent of PIO2. Hence, in terms of O2, homeostasis of the milieu intérieur is accomplished.

The extracellular pH regulation was studied in the crayfish Astacus leptodactylus (a night animal) as a function of circadian rhythm. The venous acid-base balance (ABB) was determined in the morning (10 a.m.-12 a.m.) and in the evening (10 p.m.-12 p.m.) at PO2 ranging from 29 to 6 kPa and constant ABB in the water at 13 degrees C. In the morning the venous pH (pHv) was maintained constant by metabolic means independently of PO2 from 29 to 10 kPa. In the evening pHv again was constant and independent of PO2 but it was more alkaline by 0.1 unit corresponding to a shift along the in vitro buffer line. At that time, the ventilation required for providing a unit quantity of O2 (i.e. the ventilatory requirement) increased more than for simply providing O2. The related circadian changes of sensitivity of the ventilatory control system were assessed by comparing morning and evening ventilatory responses to 1-h periods of hypoxia and then hypercapnia. In the evening, the amplitude of the responses to both O2 and CO2 increased but the increase in CO2 sensitivity was proportionally more important. This is consistent with the increase of ventilatory requirement and the related decrease of hemolymph PCO2 during this period. It is concluded that in this animal there exists a circadian rhythm of extracellular pH that is achieved by controlling the CO2 partial pressure in the hemolymph. Results are discussed in terms of O2 transport processes and metabolic modulation through pH adjustments.