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Only stud ies that com pared the effectiveness of psychotherapy w ith pharm acotherapy m et the inclusion criteria for this evid ence report. Psychotherapeutic interventions that have been d irectly com pared to pharm acotherapy in at least one RCT are presented in Table 10. Table 10. Interventions Compared by Studies That Address Key Question 3.
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PURPOSE: To determine the temporal histopathologic findings associated with selective arterial injection of a 1: ethiodized oil ethanol mixture EEM ; in normal rabbit kidney followed by administration of pure ethanol into the main renal artery. MATERIALS AND METHODS: In five rabbits, the EEM was injected sequentially into each segmental renal artery of the right kidney until capillary stasis occurred. Pure ethanol was then injected into the main renal artery to achieve complete arterial stasis. Before sacrifice, the left kidney in each animal was acutely ie, with a short follow-up period ; embolized by using the same technique. The 10 kidneys of the five rabbits were evaluated microscopically at 1 n and 3 hours n 1 ; and 1 n 1 ; , and 14 days n 1 ; after embolization. RESULTS: Injection of the EEM mean volume, 0.46 mL 0.14 [SD] ; followed by ethanol alone mean volume, 0.25 mL 0.09 ; led to complete stasis in all kidneys. There was no recanalization in the chronically ie, with a longer follow-up period ; embolized kidneys. Microscopically, uniform distribution of the EEM was evident in all slices at all time points. From 1 to 3 hours, sloughing of endothelium, formation of thrombi, and deposition of eosinophilic material along the renal, interlobar, and arcuate arteries were observed, without evidence of parenchymal damage. Within 24 hours, complete coagulative necrosis of the entire kidney occurred as a result of an occluding thrombus in the main renal artery. Analysis at subsequent time points revealed liquefaction of necrotic tissue and replacement with granulation tissue. CONCLUSION: In the rabbit, selective renal arterial injection of EEM followed by administration of ethanol produces vascular endothelial damage initiating thrombosis that results in renal infarction and ablation within 24 hours.
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The Clinical and Therapeutic Aspects of Aggression and Violence in Heroin Addicted Patients Assessment of the role of opioids in modulating aggressive behaviour is no easy matter, as most studies on the subject actually deal with animal models, where acts of aggression result in defensive behaviour a physiological form of response to threats from outer ; against preying. These studies have provided a variety of evidence, allowing the following conclusions to be drawn 120; 136; 335- Several areas of the brain that are related to the production and modulation of defensive behaviour are crowded with opioid receptors and enkephalin-binding axon terminals. These areas comprise: a ; the nucleus proprius of the terminal stria and the nucleus accumbens, as modulators of defence 15; 127; 128; b ; the periacqueductal grey substance, which produces enhances defence 18; 333; 338 . 2. The peripheral administration of naloxone heightens or elicits defensive behaviour and aggression. On the other hand, naltrexone failed to modulate defence in monkeys, while its administration to mice caused aggressive outbursts to dwindle in frequency. Most of the evidence indicates that the role of opioid modulation differs with the typology of aggression that is being considered 36; 101; 160; Naloxone-challenged cats showed greater proneness to defensive behaviours, in terms of a lowered threshold and a shortened latency of reaction. The effects measured depended on time and administered dosage. Interestingly, in the same model preying behaviours showed they had acquired a longer period of latency after naloxone administration 335. Violence of addicted patients: a consequence or a sign of adjunctive disease ? The data in the literature on the relationship between aggression and the opioid system mostly come from animal studies, due to the limitations placed on experimentation with humans. Despite this problem, the role played by opioids in regulating human aggression can be investigated through the natural model provided by opiate-addicted patients. On one hand, the exposure to opiates is responsible for acute neurochemical and behavioural alterations tolerance ; , which are expressed through withdrawal phenomena overlapping with those induced experimentally on animals. On the other hand, enduring exposure to some opiates produces stable behavioural conditioning, which is a crucial aspect of the clinical picture of addiction. Such behaviours are likely to be due to the impairment of normal opioid functioning. Investigations into the dynamics of opioid alteration in addicted patients, and into the links between aggression and other addictive features, may therefore lead to a better understanding of the ways opioids function in non-addicted humans. Opiate use does not produce a uniform degree of social impairment. In fact, different social typologies of heroin addicts have been described, as follows. The severest.
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Affinity toward d10 transition metal ions such as Ag + the other hand, a ligand for use as a suitable ion-carrier in a liquid membrane system should have rapid exchange kinetics and should be sufficiently lipophilic to avoid leaching into the aqueous donor and acceptor phases. Since MLC is a chelating reagent that is insoluble in water and can form a fairly stable complex with Ag + ion in nonaqueous media see previous section ; , we were interested in examining MLC as a potential ion-carrier for the selective and efficient transport of Ag + ion through a bulk type chloroform membrane. The liquid membrane operated here is schematically illustrated in Figure 4. After the complexation of carrier with Ag + on the left side of the membrane and therefore releasing H + to the donor phase, the neutral complex formed diffused down its concentration gradient. On the right side of the membrane the metal ion is released into the acceptor phase containing large amount of SCN via formation of a stable [Ag SCN ; 2] complex ion. At this stage the carrier diffuses back across the membrane. The net result is the transport of silver ions from the aqueous donor phase to the aqueous acceptor phase across the bulk of the organic phase the membrane ; . It should be noted that, the presence of lipophilic anions such as picrate and perchlorate in donor phase showed no improvement on the time and transport efficiency of silver ions. This result, once again, confirmed the formation of neutral complex between Ag + and MLC in the interface of two aqueousorganic phases.
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