ISSN:1075-2765    

出版商:OVID    

年代:1999

数据来源: OVID

摘要:

The objective of this study was to evaluate the hemodynamic and clinical effects of fosinopril in patients with heart failure. This was a prospective, multicenter, double-blind, randomized, parallel-group study. Patients 18 to 80 years of age who were receiving diuretics with a systolic blood pressure (SBP) > 90 mm Hg, New York Heart Association (NYHA) functional class II-IV, left ventricular ejection fraction < 40%, pulmonary capillary wedge pressure (PCWP) > 18 mm Hg, and a cardiac index (CI) < 2.6 L/min/m2were eligible. A total of 179 patients were randomized to a single, double-blind oral dose of placebo or fosinopril at 1, 20, or 40 mg, and hemodynamic monitoring was performed for 24 hours postdose; 155 patients with SBP > 90 mm Hg were re-randomized to 10 weeks of double-blind fosinopril at 1, 20, or 40 mg once daily. Hemodynamic monitoring was repeated at the last visit, beginning at 24 hours postdose (trough) and continuing for 12 hours thereafter. Significant decreases in preload (PCWP) and afterload (mean arterial blood pressure [MABP] and systemic vascular resistance [SVR]) were evident 3 to 4 hours after a single dose of fosinopril at 20 and 40 mg and continuing for up to 8 to 12 hours postdose for PCWP and SVR and for up to 24 hours postdose for MABP (P< .05vplacebo and baseline). Sustained decreases in PCWP, MABP, SVR, and heart rate and increases in CI and stroke volume index were observed after 10 weeks of treatment with fosinopril at 20 and 40 mg once daily (P< .05v1 mg group for PCWP and MABP at most time points andP< .05vbaseline for other parameters at most time points). Dose-related trends toward reduced supplemental diuretic use (P= .027) and reduced symptoms of dyspnea (P= .008) were observed with the 20-mg and 40-mg fosinopril dose groups. Once daily administration of fosinopril at 20 and 40 mg was safe and well tolerated, provided a sustained beneficial hemodynamic effect, improved left ventricular performance, and reduced symptoms of dyspnea, resulting in a reduced need for supplemental diuretic therapy.

ISSN:1075-2765    

出版商:OVID    

年代:1999

数据来源: OVID

摘要:

The efficacy and tolerability profile of nimesulide was assessed in a double-blind, piroxicam-controlled trial in 49 patients with osteoarthritis of the knee joint. Nimesulide was administered orally as 100 mg twice daily, and piroxicam was administered as 20 mg orally in the morning and placebo in the evening. These patients were stratified into two groups: clinical assessment and magnetic resonance imaging evaluation of the knee. All patients were followed for 8 weeks with clinical assessment every 2 weeks; of these, 11 patients were selected for magnetic resonance imaging evaluation, and they were treated for 24 weeks. The principal efficacy parameters were improvement in osteoarthritis severity index, joint tenderness, swelling, and functional capacity of the patients. The final judgment of efficacy was made by the physician. Nimesulide improved all primary and secondary efficacy parameters with an activity comparable to piroxicam. Significant reduction in joint swelling and tenderness was observed as early as 2 weeks in the two treatment groups; however, a greater number of patients were relieved in nimesulide group. At 8 and 24 weeks, the number of patients with no joint swelling were 66.7% versus 50% and 80% versus 66.7% in the nimesulide and piroxicam groups (P< .05). Functional capacity at 8 weeks improved in 72.2% of nimesulide and 44.4% of piroxicam recipients. Mild adverse effects, mainly gastrointestinal, considered possibly related to treatment were recorded in 4 patients treated with nimesulide and in 12 patients treated with piroxicam. No significant change in the articulating cartilage of the tibiofemoral joint was observed over a 24-week period with either treatment. Nimesulide was as efficacious as piroxicam in reducing the inflammatory indices, and both drugs were equally well tolerated.

ISSN:1075-2765    

出版商:OVID    

年代:1999

数据来源: OVID

摘要:

The in vitro adsorption of ciprofloxacin, a broad-spectrum antimicrobial with actions against a wide variety of microorganisms on activated charcoal (AC) and talc (TC), was investigated at various pH values that simulate the pH of most regions of the gastrointestinal tract. The results of the study indicate that AC and TC adsorbed ciprofloxacin effectively. Adsorption depended on the quantity of the adsorbents used, and for AC adsorption was complete within 2 hours and for TC it was complete within 1 hour with 0.5 g of either of the adsorbents. AC exhibited higher adsorptive capacity for ciprofloxacin than TC. Overall, AC and TC could be used as effective antidotes in poisoning resulting from ciprofloxacin.

ISSN:1075-2765    

出版商:OVID    

年代:1999

数据来源: OVID

摘要:

The objective of this study was to assess the impact of an intervention to modify antitetanus prophylaxis of open wounds. This prospective, before-and-after study was conducted in an emergency department of a large metropolitan hospital. Consecutive patients with open wounds were managed according to the World Health Organization (WHO) guidelines before an intervention, then according to new guidelines afterwards. Locally developed guidelines were introduced and backed up by a teaching program, with emphasis on reducing unwarranted human tetanus immunoglobulins and costs. Serum tetanus antitoxins level was measured in postintervention patients mainly to verify the soundness of the intervention, eventually to complete patients' protection during follow-up, and to derive more reliable recommendations for the future. Main outcome measures included the number of treatments conforming to each set of guidelines, the rate of tetanus immunoglobulin prescriptions, and the cost of each strategy. Two groups of 389 and 459 patients were included. Treatment conforming to guidelines increased from 60% to 79%, under-treatment decreased from 31% to 19%, and overtreatment decreased from 9% to 2% (P< 0.001). Tetanus immunoglobulin prescriptions decreased from 23% to 1% (P< 0.001). On the basis of antitoxins level, 60% of 367 postintervention patients were correctly treated, 29% were overtreated, and 11% were undertreated. Nevertheless, with the WHO guidelines, only 49% would have been correctly treated, 39% would have been overtreated (29% with immunoglobulins), and 12% would have been undertreated (P< 0.001). Costs decreased from $32 to $24 per patient. New guidelines resulted in improved tetanus prophylaxis at reduced costs in an emergency department. Because they rely on immunization history, however, guidelines currently in use are misleading. More reliable recommendations, including a test for tetanus antibody status in some cases, are needed.

ISSN:1075-2765    

出版商:OVID    

年代:1999

数据来源: OVID

摘要:

The once-daily formulation of diltiazem hydrochloride (Cardizem CD) is marketed for the treatment of essential hypertension and stable angina pectoris. The steady-state pharmacokinetics of once-daily diltiazem and its metabolites, desacetyldiltiazem (DAD) andN-desmethyldiltiazem (MA), were examined in two groups of eight healthy subjects each. The first group (group A) received 240, 480, and 720 mg diltiazem once daily for 7 days in a single-blind, stair-step, dose-escalation design. The second group (group B) received 180, 360, and 720 mg diltiazem in a similar manner. At each dose level, serial blood samples were collected for up to 24 hours after the last (seventh) dose. Plasma samples were analyzed for diltiazem and the metabolites by high-performance liquid chromatography. The disposition of diltiazem, DAD, and MA was nonlinear over the 240− to 720-mg (group A) and 180− to 720-mg (group B) diltiazem dose ranges studied. In group A, mean diltiazem area under the plasma concentration-time curve (AUC) at the 240-mg dose level was 2410 h-ng/mL compared with 10,167 h-ng/mL at the 720-mg dose level. In group B, mean diltiazem AUC at the 180-mg dose level was 1092 h-ng/mL compared with 8398 h-ng/mL at the 720-mg dose level. The apparent oral clearance decreased 35% over a threefold dose range (group A) and 51% over a fourfold dose range (group B). Mean ratios of AUCDAD/AUCDILTwere similar at all dose levels. Mean AUCMA/AUCDILTratios, however, decreased with increasing diltiazem dose, suggesting that the nonlinear disposition of MA may be less pronounced than that of parent drug.

ISSN:1075-2765    

出版商:OVID    

年代:1999

数据来源: OVID

摘要:

The objective of this study was to compare the outcome of 7 versus 10 days of antibiotic therapy for inpatients with moderately severe community-acquired pneumonia (CAP). A prospective, randomized, double-blind study with a follow-up period of 42 days was conducted. Fifty-two veterans were treated with 2 days of cefuroxime at 750 mg intravenously every 8 hours followed by group 1, 8 days oral therapy, and group 2, 5 days oral therapy followed by 3 days of placebo. Oral therapy consisted of cefuroxime axetil at 500 mg every 12 hours. No difference was seen in cure rates: 20 of 22 (90.9%) patients in group 1 and 21 of 24 (875%) patients in group 2. There were no late recurrences. Potential US cost-savings is $27.2 million. Inpatients with moderately severe CAP can be treated with 2 days of intravenous antibiotics followed by 5 additional days of oral antibiotics. Longer treatment duration prolongs the cost of care, without increasing the cure rate or decreasing the pneumonia recurrence rate.

ISSN:1075-2765    

出版商:OVID    

年代:1999

数据来源: OVID

摘要:

Junctional ectopic tachycardia (JET) occurs most frequently after operative repair of congenital heart defects. The mechanism is thought to involve direct trauma to the atrioventricular node and His bundle resulting in an ectopic focus. Several therapeutic methods have been described in the pediatric literature with varying degrees of success and complication rates. Because heart rates may exceed 200 to 300 beats per minute, there may be inadequate time for ventricular filling. Ventricular filling can be further compromised because of the asynchrony between the atria and the ventricles. These factors can lead to significant compromise of cardiovascular function in the postoperative patient. We describe our experience with amiodarone in two patients who developed postoperative JET after repair of congenital heart defects. Dosing regimens and previous experience with amiodarone in patients with JET are reviewed.

ISSN:1075-2765    

出版商:OVID    

年代:1999

数据来源: OVID

摘要:

Basic studies as well as short-term clinical trials of the T-channel-selective calcium channel blocker, mibefradil, are reviewed. The compound reduced afterload and was effective for the symptomatic treatment of hypertension and stable angina pectoris. It did not display any relevant negative inotropic or positive chronotropic effect. Mibefradil has been withdrawn by the manufacturer because of drug interaction at the cytochrome P-450 3A4 enzyme. It is hoped that new T-channel-selective calcium channel blockers will be developed to explore further this promising but so far only preliminarily tested therapeutic possibility.

ISSN:1075-2765    

出版商:OVID    

年代:1999

数据来源: OVID