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Speciality Spotlight
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Monica Escher, Jules Desmeules et al.
Hepatitis associated with Kava, a herbal remedy for anxiety.
BMJ, Jan.20, 2001, pg.139
Kava, the rhizome of the pepper plant Piper methysticum, has been widely used in the South Pacific as a narcotic drink. Lactones, the major constituents of Kava, are considered to be active ingredients and sold in Europe and USA as standardised extracts for anxiety and tension.
This is a case report of a 50-yr old man who presented with jaundice. He was taking 3-4 capsules of Kava extract daily for 2 months for anxiety (maximum recommended dose 3 capsules) corresponding to a dose of 210-280mg lactones. He took no other drugs and did not consume alcohol. Liver function tests were abnormal and he developed encephalopathy. He received a liver transplant 2 days later and recovered uneventfully. Histology of liver showed extensive and severe hepatocellular necrosis and extensive lobular and portal infiltration of lymphocytes and eosinophils. Assessment of causality according to the definitions of WHO is ‘probable’.
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A H Young , J N Calabrese , Department of Psychiatry, Royal Victoria Infirmary, Newcastle & Case Western Reserve University School of Medicine , USA.
Treatment of bipolar affective disorder – New drug treatments are emerging, but more clinical evidence is required.
BMJ, Vol.321, 25, November 2000, pg. 1302-1303.
Bipolar affective disorder is a common condition and ranks second only to unipolar depression as a cause of worldwide disability.
Despite its shortcomings lithium has long been the mainstay of treatment. Several new drugs have emerged over the past 10 years , but evidence of their effectiveness is lacking . Anticonvulsants carbamazepine and valproate are established alternative and adjunctive treatments to lithium . Their mechanism of action is not clear. Efficacy of carbamazepine in treating mania bipolar depression and in prophylaxis has been shown to have acute effecacy in bipolar depression and in prophylaxis has been shown in randomised controlled trials. Anticonvulsant lamotrigine has been shown to have acute efficacy in bipolar depression in 2 randomised controlled trials.
Antipsychotics have long been used in bipolar disorder . Typical antipsychotics are effective in acute mania but may exacerbate postmanic depression. Placebo controlled studies of olanzepine and risperidone have shown acute antimanic efficacy of both these atypical antipsychotics.
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Gastrointestinal Problems
Ko CY, Tong J, Lehman RE, et al [ Univ of California, Los Angeles; Univ of California, San Francisco]
Biofeedback is Effective Therapy for Fecal Incontinence and Constipation
Arch Surg 132: 829-834, 1997
Fecal incontinence results from neurogenic causes, sphincter injuries or failure of surgical repair. 25 such patients [21 women and 4 men, median age, 63 years] were taken for study. 17 patients of constipation [ 12 women and 5 men, median age, 50 years] had pelvic floor dysfunction or expulsion weakness.
Retraining the pelvic floor comprised contracting the anal sphincter for five seconds. Of the 25 patients with incontinence 23 improved. The two with pudendal nerve disease did not improve. Of the 17 with constipation 13 showed improvement. The 4 that did not improve exhibited colonic delay or were unable to follow the biofeedback instructions.
Biofeedback thus constitutes an important step in managing rectal dysfunction.
- Karlbom
U, Hallden M, Eeg-Olofsson KE, et al [ Univ Hosp,
Uppsala, Sweden]
Results of Biofeedback in Constipated Patients : A Prospective study
Dis Colon Rectum 40: 1149-1155, 1997
Paradoxical contraction of the levator any muscle can be a cause of constipation usually psychological and rarely due to neurologic disorders. Exercising this muscle helped 19 of the 28 participants. This treatment was carried out for 3 months.
