ISSN:0277-0008    

DOI:10.1002/j.1875-9114.1993.tb02721.x

出版商:Blackwell Publishing Ltd    

年代:1993

数据来源: WILEY

ISSN:0277-0008    

DOI:10.1002/j.1875-9114.1993.tb02722.x

出版商:Blackwell Publishing Ltd    

年代:1993

数据来源: WILEY

摘要:

Oligonucleotide pharmacotherapy, although in a very preliminary stage, promises to provide new, highly specific tools for the treatment of human diseases, such as viral illnesses and cancer. The agents have several proposed mechanisms of action, including inhibition of translation, splicing, and transcription. In addition, the bioefficacy of oligonucleotides may be enhanced by phosphorothioates, methylphosphonates, and α‐oligonucleotides. The agents are delivered by the ex vivo or topical route, and new methods of administration are under study. It is predicted that within the decade these agents will be used routinely to treat several serious illness

ISSN:0277-0008    

DOI:10.1002/j.1875-9114.1993.tb02723.x

出版商:Blackwell Publishing Ltd    

年代:1993

数据来源: WILEY

摘要:

The management of sexually transmitted diseases (STDs) has reached a new level in the era of antibiotic resistance and human immunodeficiency virus infection. To date, no single antimicrobial is capable of eradicating the commonly encountered STD pathogens includingNeisseria gonorrhoeae, Chlamydia trachomatis, andTreponema pallidum.Among the marketed fluoroquinolones, ciprofloxacin, ofloxacin, lomefloxacin, and enoxacin all provide excellent in vitro activity (MIC90<0.06 μg/ml) and excellent in vivo efficacy againstN. gonorrhoeae, including multiply resistant isolates (penicillinase‐producingN. gonorrhoeaeand chromosomally mediated resistantN. gonorrhoeae). Ofloxacin is the only fluoroquinolone approved by the Food and Drug Administration for chlamydial infection. All of the quinolones lack reliable in vitro activity againstUreaplasma urealyticum, a cause of nongonococcal urethritis. Although limited data suggest the usefulness of ciprofloxacin and ofloxacin in the treatment of pelvic inflammatory disease, these drugs cannot currently be recommended for single‐agent therapy.Haemophilus ducreyiinfections, however, can be managed effectively with the fluoroquinolones. Although their role continues to evolve, this class of drugs cannot be used equally to treat all STDs, and notably, no quinolone to date inhibitsT. pall

ISSN:0277-0008    

DOI:10.1002/j.1875-9114.1993.tb02724.x

出版商:Blackwell Publishing Ltd    

年代:1993

数据来源: WILEY

摘要:

Use of addicting drugs among women during pregnancy exposes newborns to potentially serious disorders. A group of symptoms referred to as neonatal withdrawal syndrome (NWS) may occur in infants born to mothers addicted to certain drugs because, at birth, the infants suddenly are cut off from the drug supply. Classes of drugs that cause NWS are those that produce addiction in adults, including the opioids (heroin, methadone, morphine), barbiturates, alcohol, and benzodiazepines. Many of the manifestations of NWS occur regardless of the class of drug, including irritability, hyperactivity, abnormal sleep pattern, high‐pitched cry, tremor, vomiting, diarrhea, weight loss, and failure to gain weight. The fact that these symptoms are nonspecific makes it difficult to identify NWS unless it is specifically looked for. The onset, duration, and severity of the disorder differ based on such factors as the addictive drug used, time and amount of mother's last dose, and rate of elimination of the drug from the newborn. Pharmacologic intervention may be required to control severe symptoms and signs. The most common drugs used to modify withdrawal are phenobarbital, paregoric, chlorpromazine, and diazepam. Treatment is complicated by conflicting information on the effectiveness of various agent

ISSN:0277-0008    

DOI:10.1002/j.1875-9114.1993.tb02725.x

出版商:Blackwell Publishing Ltd    

年代:1993

数据来源: WILEY

摘要:

We performed a population‐based study of over 100,000 users of diclofenac, naproxen, or piroxicam to identify cases of important blood, skin, central nervous system, kidney, pancreas, or pulmonary disorders caused by these drugs. In three cases a causal relation seemed likely; one of hemolytic anemia attributed to diclofenac, one of neutropenia attributed to naproxen, and one of pancreatitis attributed to piroxicam. In 13 additional cases a causal connection seemed unlikely but could not be fully ruled out. We conclude that such illnesses are uncommonly caused by the three agents studie

ISSN:0277-0008    

DOI:10.1002/j.1875-9114.1993.tb02726.x

出版商:Blackwell Publishing Ltd    

年代:1993

数据来源: WILEY

摘要:

Study Objective. To determine the acute hemodynamic response of single‐dose coadministration of ibopamine plus nifedipine or diltiazem in patients with New York Heart Association functional class (NYHA FC) II—III congestive heart failure.Design. A single‐blind, placebo‐controlled, two‐paired, crossover study.Setting. Cardiology clinics at two large teaching hospitals.Patients. Eight patients with NYHA FC II—III congestive heart failure who met the inclusion criteria were selected randomly.Interventions. All patients underwent right heart catheterization. Day 1 consisted of concomitant calcium channel blocker plus placebo, with cardiac and peripheral hemodynamic recordings from 30 minutes–24 hours. The design was equivalent on day 2, with single‐dose administration of ibopamine plus calcium channel blocker.Measurements and Main Results. Single‐dose nifedipine‐diltiazem augmented cardiac output and stroke volume secondary to decreasing systemic vascular resistance. The nifedipine‐ibopamine and diltiazem‐ibopamine subgroups demonstrated relatively equal hemodynamics, augmenting cardiac index (nifedipine 43%, p<0.05; diltiazem 40%, p<0.05 vs baseline) while decreasing systemic vascular resistance (nifedipine 41%, p<0.05; diltiazem 28%, p NS vs baseline) 30 minutes after the dose. In contrast to single‐dose diltiazem, the diltiazem‐ibopamine subgroup exhibited an increased left ventricular filling pressure (122%, p<0.05 vs baseline) and mean pulmonary artery pressure (43%, p<0.05 vs baseline) at 30 minutes after the dose. One patient experienced a transient episode of chest pain associated with increased heart rate and blood pressure with diltiazem‐ibopamine.Conclusion. Diltiazem and ibopamine should be coadministered with caution in patients with coronary artery disease and

ISSN:0277-0008    

DOI:10.1002/j.1875-9114.1993.tb02727.x

出版商:Blackwell Publishing Ltd    

年代:1993

数据来源: WILEY

摘要:

Study Objective. To compare the clinical safety and efficacy of ramipril, a new long‐acting nonsulfhydryl inhibitor of angiotensin‐converting enzyme (ACE), with enalapril.Design. A randomized, double‐blind trial.Setting. Multicenter trial involving 4 large teaching hospitals and 12 community medical centers.Patients. One hundred fifty‐nine patients with mild to moderate essential hypertension were enrolled. Two patients were excluded from the efficacy analysis because they failed to return for follow‐up.Interventions. Patients were randomized to receive ramipril 2.5, 5, or 10 mg, or enalapril 5, 10, or 20 mg once/day for 3 or 4 weeks.Measurements and Main Results. At baseline, supine diastolic blood pressures ranged from 98–116 mm Hg. Supine and standing systolic blood pressures were reduced by 11.8 and 10.2 mm Hg with ramipril 10 mg (p≤0.001) and 9.3 and 10.7 mm Hg with enalapril 20 mg (p≤0.001). At the end of the 4‐week trial, patients in all six dosage groups had clinically and statistically significant reductions in supine diastolic blood pressure compared with baseline values. The agents did not differ significantly with respect to their blood pressure‐lowering effects. Both lowered plasma ACE activity; after 4 weeks, changes from baseline were highly significant for all dosage groups (p≤0.001).Conclusion. Ramipril was as effective in reducing blood pressure and was as well tolerated as enalapril. A larger average decrease in plasma ACE activity was achieved with ramipril over all dosages (71%) compared with that for enalapril (48%), suggesting that ramipril has greater ACE inhibiti

ISSN:0277-0008    

DOI:10.1002/j.1875-9114.1993.tb02728.x

出版商:Blackwell Publishing Ltd    

年代:1993

数据来源: WILEY

摘要:

Study Objective. To evaluate two methods of gastrointestinal decontamination, low‐volume whole bowel irrigation (WBI) and activated charcoal, for their ability to prevent absorption of salicylate.Design. Randomized, two‐phase crossover study.Setting. A clinical research unit in a university‐based teaching hospital.Patients. Six healthy, volunteer men.Interventions. Subjects were assigned to receive 3000 ml WBI or syrup of ipecac 30 ml followed by activated charcoal 50 g in sorbitol, and were crossed over to the other treatment phase after 1 week. All treatments began 30 minutes after ingestion of 3.25 g aspirin. Urine was collected over 24 hours for analysis of total urinary excretion of salicylate. Serial blood samples were collected for salicylate determination and were subjected to pharmacokinetic analysis.Measurements and Main Results. Mean ± SD recovery of salicylate were WBI 48.6 ± 5.4% and ipecac‐charcoal 37.0 ± 2.6% from urine (p<0.01).Conclusion. Ipecac‐charcoal produced a significantly lower salicylate absorption (peak concentration, AUC) than WBI (p<0.01) and thus was superior to lo

ISSN:0277-0008    

DOI:10.1002/j.1875-9114.1993.tb02729.x

出版商:Blackwell Publishing Ltd    

年代:1993

数据来源: WILEY

摘要:

The administration of aerosolized metered‐dose inhalers (MDIs) to mechanically ventilated patients is labor intensive due to the large number of activations required and the currently recommended 30‐ to 60‐second “wait and shake” between each puff. No studies have been published that assess the relationship between this delay between puffs and drug delivery. To address this issue, we conducted an in vitro, randomized, single‐blind study using fenoterol MDI containing technetium‐99m pertechnetate. Four modes of MDI administration were tested in triplicate by random sequence. Eight activations of the MDI were performed for each mode according to the following procedures: rapid succession (5 sec apart); 30‐second intervals and shaking MDI between two rapid activations; 30‐second intervals and shaking between each activation; and 60‐second intervals and shaking between each activation. Two closed in vitro systems were designed to collect and measure the radiolabeled aerosol. In the first system, the MDI was activated into a plastic collection container; with the second system, the MDI was administered through an aerosol holding chamber with attached circuit filter positioned on the inspiratory line of the ventilator circuit. Sixty‐second intervals between each activation were not tested with the second system. Radioactivity was measured before and after each mode of testing. No difference was found between the various modes of administration other than a 14% decrease in the amount of radioactivity released with the 60‐second waiting period between puffs, compared with their rapid succession when using the plastic collection container system. Our results support the hypothesis that the delay after each activation of a M

ISSN:0277-0008    

DOI:10.1002/j.1875-9114.1993.tb02730.x

出版商:Blackwell Publishing Ltd    

年代:1993

数据来源: WILEY