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As part of a socio-anthropological study on the use of pharmaceutical drugs among polymedicated elderly patients in Switzerland, an anthropologist and a filmmaker are making a research film. The main issue raised is the question of the scientific status that can be attributed to research films. This process initiates a reflexive thought process around the various epistemological, technical and deontological challenges encountered. It also questions the contribution that the production of a research film can bring to the anthropological field. The introduction of audiovisual data adds density and textures that cannot appear in a text and gives the actors of the study an opportunity to develop a new storytelling process that highlights their expertise. This is of particular interest in the context of anthropological analysis, which is shaped, during fieldwork, by mobilizing the ethnographic intuition and imagination of the researcher and opens up an exchange between peers.

Prostate carcinoma is the most common cancer in men. Hormone-resistance is the natural history of this metastatic disease and requires the use of docetaxel as the standard chemotherapy. At present, there is no approved second-line treatment. Here, we report a combination of treatment with Adriamycin and ifosfamide in a series of 7 relatively young patients with an average age of 57 years at the time of diagnosis. Chemotherapy was administered over 3 days with the following schedule: 20 mg/m(2) Adriamycin per day and 1-1.5 mg/m(2) ifosfamide per day, in association with Uromitexan. Treatment was repeated every 3 weeks. Three biological responses, one CT scan response, one bone scan response and two CT scan stabilizations, were obtained. Mean survival following this combination was 6.6 months, and over 26 months after first-line chemotherapy. Tolerance was good with the use of granulocyte-colony stimulating factors. Our observations clearly show that the use of this type of salvage therapy for relatively young patients in good physical condition should be further assessed in a clinical trial, particularly when different lines of chemotherapy are required.

To determine the pharmacokinetic, subjective effects of a single 20 mg dose of nefopam administered either intravenously or orally in healthy volunteers, twenty-four healthy Caucasian men received 20 mg nefopam orally+placebo intravenous infusion and placebo orally+intravenous infusion of 20 mg nefopam with one week interval, in a double-blind, double-dummy cross-over study. Nefopam and desmethyl-nefopam plasma concentrations were measured by HPLC with UV detection up to 48 hr after drug administration. Self-rating questionnaires (Mood and vigilance Visual Analogue Scales, Addiction Research Centre Inventory) and drug safety were investigated. The F value (bioavailability) of the parent drug was 0.36+/-0.13. The AUCoral/AUCiv ratio of nefopam+desmethyl-nefopam was 0.62+/-0.23. The half-life of nefopam was similar whether administered orally (5.1+/-1.3 hr) or intravenously (5.1+/-0.6 hr). The half-life of desmethyl-nefopam was two to three times longer than that of the parent molecule (orally: 10.6+/-3.0 versus 5.1+/-1.3 hr, P<10(-4) and intravenously: 15.0+/-2.4 versus 5.1+/-0.6 hr, P<10(-4)). As assessed by the Addiction Research Centre Inventory, no evidence of abuse liability in healthy, drug-naive volunteers was observed. On visual analogue scales, volunteers rated themselves as more drowsy, less alert, less energetic and less anxious after oral compared to intravenous administration. The AUC0-->24 hr of anxiety and energy parameters were not different after oral and intravenous administration: 90+/-142 versus 35+/-84 (P=0.27) and 66+/-74 versus 46+/-54 mm x hr (P=0.36), respectively. The AUC0-->24 hr of drowsiness and alertness parameters were significantly greater after oral than after intravenous administration: 68+/-65 versus 27+/-30 (P=0.005) and 54+/-63 versus 28+/-48 mm x hr (P=0.03), respectively. A clockwise hysteresis loop was observed for drowsiness in 16 out of 24 volunteers after oral administration. The results suggest that in healthy volunteers desmethyl-nefopam may contribute to the pharmacodynamic effects of single dose nefopam solution administered orally. This study shows a rather low bioavailability of nefopam given in intravenous solution when administered orally. Nevertheless, when the main metabolite desmethyl-nefopam is taken into account, the ratio of the areas under the curves is almost doubled.

Self blood pressure measurement (SBPM) is not fully applied because of the cost of devices and the lack of efficient dedicated medical networks. The aim of the REVEIL study was to allow patients to freely rent SBPM devices by their pharmacist after initial medical prescription. Practitioners taught SBPM methods to the patients with a booklet and the pharmacist explained them how to use the device. This preliminary report focuses on the 428 first patients included from September 1999 to June 2000 by their general practitioner (n = 59) or cardiologist (n = 12) in the centre of the city of Reims (France), when he thought there was an indication for a SBPM period. The patient received a medical prescription and took a validated device (Omron 705CP) by one of the 44 pharmacists who accepted to participate. After 7 days the patient consulted his practitioner with the filled booklet. The prescription was for 7 days with 3 measurements each morning (before intake of antihypertensive drugs) and each evening (12 hours later). Patients reported the results on the booklet and enclosed the report printed by the device. From the 428 included patients, 362 (85%) gave analyzable data, the difference being explained by refusals (n = 39) and by the lag between inclusion and completion. Mean age was 55.2 (range 20 to 90). Education levels were: no graduation (n = 71), primary school (n = 172), college (n = 59), university (n = 86) [no answer in n = 40]. Seventy nine percent (n = 286) performed at least 12 measurements on three consecutive days. There is no significant difference between morning and evening completions. According to themselves, 294 patients fully succeeded in SBPM. Eighteen failed (6 reported a failure of the device, 2 had not understood the procedure, 5 had forgotten, 5 reported another cause), 50 did not answer. These results establish the fair applicability of SBPM under the realistic conditions of the REVEIL study (free rent of devices after medical prescription) as 85% of patients gave contributive information with a good quality in 79% of them.

The REVEIL study is a pilot studies to determine the feasibility of self blood pressure measurement (SBPM). Feasibility was assessed by the quality of measurements and the patient opinion. This preliminary report focused on the patient opinion. Patients were included in the study by their general practitioner or cardiologist when he thought there was an indication for SBPM. Patients were excluded if their physical or mental autonomy was not sufficient to perform SBPM or if they were arrhythmic. The lending of the device was free (against a guarantee of 800 F) and it was available in one of the 44 drugstores that participated to the study. The physician performed patient education about SBPM and the druggist explained the handling of the device. SBPM was performed over a 7-day period: every day two series of 3 consecutive measurements were requested in the morning before taking the antihypertensive treatment, and in the evening between dinner and bedtime. The device was the validated OMRON 705 CP. 428 patients were included in the study. Among them, 385 (90%) accepted to participate to the study and 43 refused (10%). Almost half of the refusals were due to patients that did not want to take care of them and 16% were justified by a technical problem. Preliminary data included 362 patients aged 55.2 years, 79 of them older than 70 years. 80 patients (22%) experienced difficulties to perform SBPM, 28 of them (7.3%) to perform measurements and 13 (3.4%) to understand how worked the device. At the end of the study, 82 patients (23%) had better understanding of their hypertension, 90 patients (25%) felt themselves more motivated to take their medication and 111 patients (31%) found that their physician took better charge of them. 286 patients (79%) evaluated the overall satisfaction at SBPM. Among them, 276 patients (97%) were very satisfied (57%) or satisfied (40%) with SBPM when only 3% of patients were not. In summary, SBPM was easily performed in the conditions of the REVEIL study, and the majority of patients was satisfied with this experience.

Background and Objectives: Hypertension is found in one-third of acromegalic patients. An heterogenous distribution of cardiac output has been recently demonstrated in acromegalic patients with an increased blood flow at the level of the upper limb, suggesting that acromegalic patients may have some degree of endothelial dysfunction. Elsewhere, studies involving hypopituitary GH-deficient adults have shown that GH and/or IGF-I may have direct effect on endothelial function., Subjects and Methods: We thus compared cutaneous vasoreactivity responses in 10 normotensive patients with active acromegaly (A) (six women and four men) aged 25-59 (mean, 43.2 years), whose basal GH and IGF-I levels ranged from 7.4 to 158 mU/l and from 401 to 1690 microg/l, respectively, and in 10 normal age- and sex-matched controls (NC) by means of Laser Doppler flowmetry at the levels of the palm and the dorsum of the right hand. Circulatory skin velocities were studied basally and after increasing skin temperature to 44 degrees C (in order to study direct nonspecific vasodilatation response which is independent of endothelial or autonomous nervous system and reflects normal vascular muscle function), after shear-stress (known to produce flow-dependent vasodilatation, mediated by nitric oxyde (NO) originating from endothelial cells) and after cold-stress applied on the opposite hand (known to produce vaso-constriction mediated by the sympathetic nervous system)., Results: The warm test induced a significant (P<0.001) and similar increase in both dorsal and palmar skin perfusion in A (mean +/- SD) (240+/-96 and 238+/-134%, respectively) and NC (232+/-137 and 233+/-73, respectively). Ischaemia release induced a significant increase in both dorsal and palmar skin blood flows in the two groups (P<0.001), but reactivities in acromegalic patients were about one half of those measured in controls (22.9+/-16.2% (A) vs. 46.9 25% (NC), 2P<0.02, at the level of the dorsum; and 45.0+/-43.6% (A) vs. 104.7+/-40.1 (NC), 2P<0.01, at the level of the palm). Cold pressor test resulted in significant decreases in both cutaneous flows (P<0.01) in the two groups, with a larger vasoconstriction (that did not reach statistical significance) in acromegalic patients as compared with controls (P< 0.10)., Conclusion: Vascular smooth cell ability to produce skin vasodilatation is normal but endothelium-dependent vasodilatation appears to be impaired while sympathetic-mediated vasoconstrictive response might be increased in acromegaly. This endothelial dysfunction may contribute to hypertension and represent a risk factor for cardiovascular complications in acromegaly.

Acetazolamide (ACTZ) vasodilating properties are used for the assessment of cerebral vasodilatory reserve not only in cerebral pathology investigation, but also in clinical pharmacology studies. However, the kinetics of these vasodilating properties are not clearly established; moreover, the cerebral selectivity of ACTZ-induced vasodilation has not been demonstrated. To address these issues, we performed an ACTZ test in 9 healthy volunteers and measured noninvasively the effects exerted by the drug simultaneously on common carotid artery blood flow (CCABF), middle cerebral artery mean blood flow (BF) velocity (MV) (transcranial Doppler technique), and facial cutaneous BF (CutBF). The time of the peak increase in MV was variable, occurring between 20 and 40 min after ACTZ, and brief. In addition, simultaneous increases (with variable mean peak times) occurred in flows in the CCA (+11% at 20 min) and in its intracranial (+25% at 30 min) and extracranial (+134% at 50 min) branches. The first finding suggests that the cerebral effects of ACTZ should be measured repeatedly to detect in each individual subject the time of MV peak increase; the transcranial Doppler is particularly suitable for such an approach. The second finding suggests that, especially in patients, extracranial actions of ACTZ must be taken into account for estimation of the cerebral vasodilatory reserve.

The effects of a single oral dose (20 mg) of lisinopril on systemic, carotid (pulsed Doppler), and cerebral (middle cerebral artery, transcranial Doppler) hemodynamics have been investigated over an 8-h period in eight healthy volunteers in a double-blind placebo-controlled crossover study. In addition, cerebral vasodilatory reserve was measured (acetazolamide test). Lisinopril did not affect systemic hemodynamics but it increased both common carotid artery blood flow (+26.2%, p < 0.01) and diameter (+4.5%, p < 0.05) after 8 h. Lisinopril did not affect middle cerebral artery mean blood flow velocity but increased cerebral resistance index (+8.1%, p < 0.05) at 4 h and cerebral vasodilatory reserve (+24.8%, p < 0.05). These data suggest that lisinopril produces a paradoxical vasoconstriction of the small cerebral arterioles. This vasoconstriction might be a compensatory mechanism to a dilation of large cerebral arteries, thus resulting in an unchanged cerebral blood flow.