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Zolpidem is a non-benzodiazepine drug that has selectivity for the gamma-aminobutyric acid (GABA) receptors. We experienced paradoxical effect of zolpidem in a 48-year-old male patient with hypoxic-ischemic brain injury after cardiac arrest. The patient was in stupor and could not communicate. His Glasgow Coma Scale (GCS) was E2M4V2 and Rancho Los Amigos (RLA) was grade III to IV. Zolpidem was prescribed to induce sedation but paradoxically, he became alert (GCS 15, RLA VII) and was able to communicate. The arousal lasted for 2 hours repeatedly following each administration of the medication. While he was alert, electroencephalogram showed the reversal of slow wave into beta range fast activity and F-18 flumazenil positron emission tomography (PET) showed increased GABAergic receptor activity in both frontoparietotemporal cortices. Single photon emission computed tomography (SPECT) also showed increased cerebral perfusion and reversal of cerebellar diaschisis.
Citations
Objective: To investigate the changes of bone mineral density (BMD), biochemical bone markers, and lipid profiles after combination therapy of continuous hormonal replacement therapy (c-HRT) and alendronate in postmenopausal osteoporosis.
Method: We studied 89 women with postmenopausal osteoporosis (T-score＜2.5) who visited at Department of Rehabilitation Medicine, Kosin Medical Center from August 1999 to March 2001. Subjects were divided into two groups; Group I (n=40), treated with estrogen and alendronate (10 mg/day), and Group II (n=49), treated with estrogen alone. BMD at the lumbar spine and femur, osteocalcin, urine deoxypyridinoline and lipid profiles were measured at baseline and 1-year after treatment.
Results: 1) BMD at the lumbar spine increased significantly
in two groups, and BMD in Group I increased significantly more than that in Group II. But, change of BMD on femoral neck was not significantly different. 2) Biochemical bone markers (osteocalcin and urine deoxypyridinoline) decreased significantly in two groups. 3) Total cholesterol and LDL cholesterol decreased significantly in two groups, but HDL cholesterol and triglyceride showed no significant change in two groups. There was no significant differences between two groups in lipid profiles.
Conclusion: We concluded that combination therapy with c- HRT and alendronate in postmenopausal osteoporosis was more effective than c-HRT, which would not influence on positive effect of estrogen for lipid metabolism. (J Korean Acad Rehab Med 2002; 26: 208-214)
Objective: To determine whether estradiol (E2), lipid profile, biochemical markers, and bone mineral density (BMD) are related according to postmenopausal period.
Method: One hundred fifty four women were divided into four groups according to the time past menopause: group I (0∼5 years), group II (6∼10 years), group III (11∼15 years), group IV (more than 16 years). Group I, II, III were subdivided into osteoporosis group (t-score＜2.5) and non-osteoporosis group (t-score≥2.5). E2, lipid profile, osteocalcin, alkaline phosphatase, deoxypyridinoline, and BMD by DEXA were measured in all groups.
Results: There were significant inverse correlation between BMD and postmenopausal period (p＜0.05). Deoxypyridinoline and osteocalcin were correlated with postmenopausal period but there was no statistical significance. Deoxypyridinoline and osteocalcin were increased in osteoporosis group compared to non-osteoporosis group but there was no statistical significance. E2 had significant inverse correlations with postmenopausal period (p＜0.05). E2 had no correlation with factors such as biochemical markers and lipid profile in group I, II, III but had adverse correlation with deoxypyridinoline in group IV.
Conclusion: No specific biochemical markers regarding the duration of menopause were found. Regardless of the duration of menopause, checking both osteocalcin and deoxypyridinoline was statistically significant for the evaluation of postmenopausal osteoporosis.
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