摘要:

Bacterial infections, including those that cause infection in the healthy host as well as those that are more opportunistic, occur very commonly among persons infected with the human immunodeficiency virus (HIV). Bacterial infections are a direct result of the severe humoral and cellular immune defects found in these patients. Epidemiologic factors such as intravenous drug use and stage of HIV infection may also play important roles. Pulmonary, bloodstream, gastrointestinal, central nervous system, skin and soft tissue, and catheter‐related infections are common, as are endocarditis, prostatitis, and others. Frequently reported pathogens are common organisms such asStaphylococcus aureus, Haemophilus influenzae, Streptococcus pneumoniae, and enteric gram‐negative pathogens, as well as less typical ones such asListeria monocytogenesandNocardiasp. The frequency of infection is specific to organ system and pathogen, often being many times higher than in immunocompetent hosts. Prompt recognition and aggressive therapy are required to reduce morbidity and mortality due to these infecti

ISSN:0277-0008    

DOI:10.1002/j.1875-9114.1993.tb04303.x

出版商:Blackwell Publishing Ltd    

年代:1993

数据来源: WILEY

摘要:

During and immediately after myocardial infarction (MI), many interrelated and complex processes manifest the body's attempt to minimize damage and compensate for lost cardiac function. Although these compensatory responses may provide some short‐term restoration of function, their long‐term consequences actually may increase morbidity and mortality. Several agents have established roles in the treatment of these patients, whereas others, including the angiotensin‐converting enzyme (ACE) inhibitors, have yet to be investigated thoroughly. Results of two trials investigating the role of ACE inhibition after MI seem to provide sufficient data to warrant the use of these drugs in certain patient populations. These results are promising, but further investigation is necessary to answer key questions arising from these t

ISSN:0277-0008    

DOI:10.1002/j.1875-9114.1993.tb04304.x

出版商:Blackwell Publishing Ltd    

年代:1993

数据来源: WILEY

摘要:

Calcium channel blockers are extensively used for their beneficial effects on the cardiovascular system. Solid organ transplant recipients commonly have cardiovascular disease and are often treated with these agents. Research demonstrates that calcium antagonists may have beneficial effects in this population that are independent of their effects on the cardiovascular system. Indeed, both in vitro and in vivo studies suggested that they may possess immunosuppressive properties. Their actions at the cellular level in both the afferent and efferent arms of the immune system indicate that alone, as well as in combination with cyclosporine, these agents possess immunosuppressive properties that may potentially benefit the transplant population.

ISSN:0277-0008    

DOI:10.1002/j.1875-9114.1993.tb04305.x

出版商:Blackwell Publishing Ltd    

年代:1993

数据来源: WILEY

摘要:

Many patients with diabetic nephropathy undergoing continuous ambulatory peritoneal dialysis (CAPD) use their peritoneal access to administer insulin. Compared with the subcutaneous route, intraperitoneal (IP) insulin may display more consistent absorption, produce more physiologic insulin concentrations, and be more convenient to administer. However, there are no well‐controlled trials that have demonstrated a clinically significant difference in glycemic control between IP and subcutaneous administration. For patients who choose to begin IP insulin at the time CAPD is initiated, the starting dose is 2–3 times the previous subcutaneous dose. For patients previously stabilized on CAPD, the conversion factor may be less. Doses are divided equally between bags. Some authors recommend adding more insulin to bags with a higher concentration of dextrose. In addition, the dose should be decreased when added to a bag used for an overnight dwell. Exchanges performed during the day may be timed to start 30 minutes before a meal. Unless clinical trials demonstrate a difference in efficacy between subcutaneous and peritoneal insulin administration, the route will remain a matter of patient prefere

ISSN:0277-0008    

DOI:10.1002/j.1875-9114.1993.tb04306.x

出版商:Blackwell Publishing Ltd    

年代:1993

数据来源: WILEY

摘要:

We followed 37,233 outpatients for 45 days after receiving a prescription for ciprofloxacin to identify any newly diagnosed, important illnesses that might have been caused by the drug. For 29 users the role of ciprofloxacin in the etiology of the illness could not be confidently ruled out (7.79/10,000 persons; 95% CI 5.42‐11.18). In only seven was a causal relation to ciprofloxacin considered likely: three skin reactions and one case each of thrombocytopenia, “headache, nausea, and shakes,” hallucinations, and palpitations. No fatal illnesses occurred, and all patients recovered after discontinuing the drug. In addition, few cases of photosensitivity were associated with the agent. We conclude that important adverse reactions attributable to ciprofloxacin are unc

ISSN:0277-0008    

DOI:10.1002/j.1875-9114.1993.tb04307.x

出版商:Blackwell Publishing Ltd    

年代:1993

数据来源: WILEY

摘要:

Study Objective. To determine the disposition of cefepime in patients with cystic fibrosis compared with healthy controls.Design. Open‐label, single‐dose study.Setting. Laboratoire de Pharmacocinétique Clinique, Université Laval, Québec, Canada.Patients and Subjects. Twelve patients with the confirmed diagnosis of cystic fibrosis (CF) and 12 healthy volunteers. One subject with CF withdrew for personal reasons; the data of another patient were excluded from the evaluation of renal values due to incomplete urine collection.Interventions. A single 2000‐mg dose of cefepime was administered as a 30‐minute intravenous infusion. Healthy subjects did not use any other drugs throughout the study. Those with CF refrained from taking prophylactic antibiotics prior to and during the study, but continued to use pancreatic enzymes, multivitamins, and β‐agonist and/or steroid inhalers. One patient continued insulin treatment.Measurements and Main Results. Cefepime's maximum concentration was approximately 150 μg/ml at the end of the infusion, half‐life 2‐2.5 hours, and urinary recovery 80% in both groups. No statistically significant difference was seen in any of the pharmacokinetic values between the groups, except for the mean residence time (2.03 ± 0.26 vs 2.39 ± 0.37 hrs; p<0.02). Total clearance was 19% higher in patients with CF than in healthy volunteers (119.7 ± 20.1 vs 103.5 ± 19.8 ml/min), perhaps due to higher renal (95.1 ± 12.4 vs 85.1 ± 12.0 ml/min) and/or nonrenal (25.4 ± 13.1 vs 18.4 ± 12.0 ml/min) clearances in subjects with CF.Conclusions. The disposition of cefepime is not significantly affected by CF, and dosage adjustment appears not to be n

ISSN:0277-0008    

DOI:10.1002/j.1875-9114.1993.tb04308.x

出版商:Blackwell Publishing Ltd    

年代:1993

数据来源: WILEY

摘要:

Study Objective. To determine the pharmacokinetic disposition of morphine and its two major glucuronidated metabolites, morphine‐6‐glucuronide (M6G) and morphine‐3‐glucuronide (M3G), in serum and their penetration into cerebrospinal fluid (CSF).Design. A single‐dose, open‐label pharmacokinetic study.Setting. The Memphis Neurosciences Center at Methodist Hospital.Patients. Twenty patients undergoing a diagnostic lumbar myelogram.Interventions. All patients received morphine sulfate 10 mg intramuscularly approximately 1.5 hours before the procedure.Measurements and Main Results. Three blood samples were drawn after the dose and a CSF sample was drawn immediately after lumbar puncture. The mean ± standard deviation for the half‐life of morphine was 2.8 ± 1.4 hours. The apparent half‐lives of M6G and M3G were 5.7 ± 3.1 and 6.3 ± 2.2 hours, respectively, and were inversely related to the estimated creatinine clearance (r=‐0.61, p<0.007 and r=‐0.69, p<0.002, respectively). The mean concentrations of morphine, M6G, and M3G in the CSF (collection time 1.5 ± 0.32 hrs, n=19) were 3.1 ± 3.7, 12.5 ±17.6, and 19.6 ±16.1 nmol/L, respectively.Conclusions. Elderly patients and patients with renal dysfunction receiving morphine may experience prolonged analgesic and adverse effects secondary to a decre

ISSN:0277-0008    

DOI:10.1002/j.1875-9114.1993.tb04309.x

出版商:Blackwell Publishing Ltd    

年代:1993

数据来源: WILEY

摘要:

Study Objective. To determine the safety of three different dosage regimens of intravenous adenosine.Design. Open‐label, observational safety evaluation.Setting. University hospital‐based department of nuclear medicine.Patients. Cohort of 854 patients referred for myocardial perfusion imaging to evaluate their coronary artery disease and who were judged unable to perform physical exerciseInterventions. Subjects underwent myocardial perfusion imaging in conjunction with one of three intravenous dosage regimens: 1 = fixed dosage 140 μg/kg/minute for 6 minutes; 2 = dosage titration to a maximum of 140 μg/kg/minute; and 3 = dosage titration to a maximum of 200 μg/kg/minute. In regimens 2 and 3, maximum tolerated dosages were continued for a minimum of 3 minutes prior to radioisotope injection.Measurements and Main Results. Adenosine‐induced hemodynamic, electrocardiographic, and biochemical changes were measured. Adverse effects of the different adenosine dosages were compared. Noncardiac side effects such as flushing, dyspnea, neck tightness, and lightheadedness occurred at a significantly higher rate during regimens 2 and 3 than regimen 1. Chest pain and first‐ and second‐degree atrioventricular block were also more frequent during regimens 2 and 3. However, the frequency of other side effects such as complete heart block, hypotension, and ST segment depression did not differ among the regimens. High‐dose adenosine was associated with a significant increase in serum uric acid, a significant decrease in blood glucose, and a significant increase in serum triglyceride levels. Mean changes in hemodynamics and electrocardiographic intervals' were also not different among the groups except for a greater increase in PR interval in regimens 2 and 3 than regimen 1. Discontinuation of adenosine was infrequent (<1%) and did not differ among the regimens.Conclusions. Adenosine‐assisted myocardial perfusion imaging procedures are relatively safe for evaluating coronary artery disease. Despite 82% of patients reporting at least one side effect, only 10 (<1%) had to discontinue adenosine. No patient suffered any residual sequelae from the adverse effects. The fixed‐dose regimen is associated with fewer subjective side effects and is better tolerated than titration regimens. Appropriate safety precautions should nonetheless be taken during a

ISSN:0277-0008    

DOI:10.1002/j.1875-9114.1993.tb04310.x

出版商:Blackwell Publishing Ltd    

年代:1993

数据来源: WILEY

摘要:

Study Objective. To examine the comparative pharmacokinetics of long‐term methylprednisolone therapy in black and white renal transplant recipients.Design. Comprehensive pharmacokinetic evaluations of patients who participated in our glucocorticoid‐monitoring program.Setting. University‐based renal transplantation clinic.Patients. Six white renal transplant recipients with stable renal function, sex‐and (approximate) age‐matched with six preselected black patients.Interventions. The daily oral methylprednisolone dose for each patient was administered intravenously, and serial plasma samples were obtained over 24 hours.Measurements and Main Results. Methylprednisolone was analyzed by high‐performance liquid chromatography. The drug's pharmacokinetics in black and white patients, respectively, were as follows: mean clearance 234 ± 124 and 472 ± 180 ml/hr/kg (p<0.05); volume of distribution 0.3‐2.0 and 0.8‐2.0 L/kg; and elimination rate constant 0.13‐0.41 and 0.27‐0.42 hour−1(p<0.06). No statistical difference was noted in the last two parameters. The mean half‐life of 3.4 ± 1.4 hours in black patients compared with 2.1 ± 0.3 hours in white patients approached statistical significance (p<0.08).Conclusions. These preliminary observations suggest that the disposition of methylprednisolone differs between black and white renal transplant recipients. The current method of prescribing glucocorticoids employs a fixed‐dose regimen that does not take these possible interracial differences into consideration. Incorporating the differences may allow for more individualized dosing and more efficacious use of the age

ISSN:0277-0008    

DOI:10.1002/j.1875-9114.1993.tb04311.x

出版商:Blackwell Publishing Ltd    

年代:1993

数据来源: WILEY

摘要:

Study Objectives. To compare the efficacy of combination therapy with sustained‐release diltiazem and hydrochlorothiazide (DTZ SR‐HCTZ) with that of monotherapy with DTZ SR, HCTZ, or placebo in the treatment of essential hypertension; and to determine whether the addition of a diuretic to diltiazem at apparent optimum doses of each agent significantly enhances their antihypertensive effects.Design. Multicenter, randomized, double‐blind, placebo‐controlled, parallel‐group trial with a 6‐week treatment phase.Setting. Private and university‐based clinics.Patients and Participants. Subjects of either sex, ranging in age from 18–70 years, with a diagnosis of stable essential hypertension made from two consecutive weekly mean supine diastolic blood pressure (DBP) readings of 95 mm Hg or above to 110 mm Hg or less that varied 7 mm Hg or less after 4–6 weeks in the baseline phase. Of the patients enrolled, 298 met the inclusion criteria.Interventions. Combination therapy with DTZ SR‐HCTZ 120 mg‐12.5 mg, or monotherapy with DTZ SR 120 mg or HCTZ 12.5 mg, or placebo was administered twice daily.Measurements and Main Results. Combination therapy with DTZ SR‐HCTZ lowered both supine DBP and SBP significantly (p<0.005) more than either single agent. The combination also lowered DBP and SBP significantly more than either monotherapy. During a 12‐hour in‐clinic monitoring period spanning a dosing interval, both the combination and DTZ SR therapies maintained efficacy, whereas the antihypertensive effects of HCTZ dissipated after 8 hours. Treatment‐related adverse events for the combination and HCTZ were similar but slightly greater than those for DTZ SR and placebo.Conclusions. The addition of a diuretic to sustained‐release diltiazem produced an enhanced antihypertensive effect compared with monothera

ISSN:0277-0008    

DOI:10.1002/j.1875-9114.1993.tb04312.x

出版商:Blackwell Publishing Ltd    

年代:1993

数据来源: WILEY