ISSN:0277-0008    

DOI:10.1002/j.1875-9114.1992.tb04459.x

出版商:Blackwell Publishing Ltd    

年代:1992

数据来源: WILEY

摘要:

Teniposide is a widely used anticancer drug that is extensively bound to plasma proteins (>95%). We evaluated the drug's plasma protein binding in nine patients with acute lymphocytic leukemia who were in their first complete remission, and in a second group of nine patients at the time of relapse and subsequently after achieving another complete remission. Plasma protein binding was assessed by equilibrium dialysis, with direct high‐performance liquid chromatographic measurement of total and free teniposide. The mean unbound fraction was 0.44% (0.21–0.88%) in the plasma of patients in first remission. It was significantly higher in patients at the time of relapse (mean = 0.86%; range 0.68–1.08%) and after achieving another complete remission (mean = 1.25%; range 0.51–2.11%). Serum albumin values were significantly lower at the time of relapse (mean = 4.6 vs 4.0 mg/dl; p<0.014), and decreased further during intensive postremission therapy containingl‐asparaginase (mean = 3.2; p<0.05). For all 18 patients, a significant negative correlation (r2=0.667; p<0.001) was found between serum albumin and unbound teniposide, with low albumin being associated with higher unbound fraction. Such patients have higher systemic exposure tounbound(presumably active) teniposide at any given total plasma concentration of

ISSN:0277-0008    

DOI:10.1002/j.1875-9114.1992.tb04460.x

出版商:Blackwell Publishing Ltd    

年代:1992

数据来源: WILEY

摘要:

The neuromuscular and cardiovascular effects of intubating doses of pipecuronium 80 μg/kg, pancuronium 100 μg/kg, atracurium 500 μg/kg, and vecuronium 100 μg/kg were compared in 62 patients under isoflurane (end‐tidal concentration = 0.5–1%) anesthesia. Pipecuronium, pancuronium, and vecuronium had no significant effect on systolic or diastolic blood pressure. In one patient the administration of atracurium resulted in significant hypotension. Heart rate was significantly increased only after the administration of pancuronium. The neuromuscular‐blocking effect of pipecuronium and pancuronium appears to be twice as long as that of vecuronium and atracurium. Administration of neostigmine resulted in significantly faster recovery of muscle function in patients receiving vecuronium or atracurium. Although pipecuronium's neuromuscular‐blocking effect is similar to that of pancuronium, its lack of cardiovascular effects more closely resembles that of

ISSN:0277-0008    

DOI:10.1002/j.1875-9114.1992.tb04461.x

出版商:Blackwell Publishing Ltd    

年代:1992

数据来源: WILEY

摘要:

A prospective surveillance program was initiated to determine the relative role of antibiotics containingN‐methylthiotetrazole (NMTT) versus patient risk factors in producing antibiotic‐associated bleeding. Five hundred forty‐six critically ill patients with serum albumin 30 g/L or below were evaluated for evidence of a bleeding event as documented by clinical observation, hemoglobin changes, and transfusions. Bleeding events occurred in 16% of patients receiving an aminoglycoside combination, 10% receiving antibiotics with the NMTT side chain, and 14.5% receiving antibiotics not containing NMTT (p>0.05). The bleeding rate was highest in febrile patients with cancer (14.5%) and lowest in those with a suspected or documented abdominal infection (10%) (p=0.04), but within each patient group there was no difference among the antibiotics. We conclude that the use of NMTT‐containing antibiotics is not an independent risk factor for bleeding, but the role of severity of illness may be underappr

ISSN:0277-0008    

DOI:10.1002/j.1875-9114.1992.tb04462.x

出版商:Blackwell Publishing Ltd    

年代:1992

数据来源: WILEY

摘要:

Combination therapy with insulin and sulfonylureas for treatment of noninsulin‐dependent diabetes mellitus has been evaluated frequently. However, many of the trials either lacked proper control or were of inadequate duration, and none compared combination therapy to intensive insulin therapy using several daily injections. Such a combination decreases, but does not return to normal, glycosylated hemoglobin and fasting glucose concentrations in comparison to therapy with one or two daily injections of insulin in some subjects. Alternatively, adding a sulfonylurea to insulin therapy may allow a reduction in the insulin dosage without compromising glycemic control. When considering the use of the two agents, the possible advantage of a simplified insulin regimen must be weighed against the disadvantages of an increased potential for adverse effects and increased cos

ISSN:0277-0008    

DOI:10.1002/j.1875-9114.1992.tb04463.x

出版商:Blackwell Publishing Ltd    

年代:1992

数据来源: WILEY

摘要:

The diseases caused by cytomegalovirus (CMV) may threaten the life or sight of immunocompromised individuals such as patients undergoing transplantation and those with the acquired immunodeficiency syndrome. The management of CMV disease can be difficult. The antiviral agents ganciclovir and foscarnet are effective against CMV retinitis and gastrointestinal diseases, although dose‐limiting adverse effects and the need for long‐term maintenance therapy may hinder their use in many patients. When used to treat CMV pneumonitis in bone marrow transplant recipients, ganciclovir alone is not as effective as when it is combined with immune globulin. Since CMV disease can be fatal, several protocols have been developed for the transplant patient population, including administration of acyclovir, ganciclovir, screened blood products, and immune globul

ISSN:0277-0008    

DOI:10.1002/j.1875-9114.1992.tb04464.x

出版商:Blackwell Publishing Ltd    

年代:1992

数据来源: WILEY

摘要:

Patients with carotid artery occlusive disease (CAOD) may be at increased risk of iatrogenic cerebral hypoperfusion. Using the133xenon‐inhalation technique, we evaluated the effects of enalapril on regional cerebral blood flow (CBF) in 14 patients with chronic hypertension, 7 with CAOD and 7 without CAOD (no CAOD). Regional CBF and blood pressure were measured before and 60 minutes after a single dose of enalapril. Changes in mean arterial pressure after enalapril were not significantly different between the two groups: CAOD −4.67 ± 8.7 mm Hg, no CAOD −6.18 ± 8.2 mm Hg. Changes in mean CBF after enalapril were also not statistically different: CAOD −1.0 ± 3.9, no CAOD 1.0 ± 2.8. In the CAOD group only, however, changes in CBF were significantly related to increasing age (r= −0.9253, p>0.01), such that in patients 65 years or older CBF tended to decrease, whereas in younger patients it increased. Elderly patients with CAOD may be at increased risk of iatrogenic cerebral hypoperfusion, and it may be appropriate to evaluate prospectively the effects of antihypertensive medic

ISSN:0277-0008    

DOI:10.1002/j.1875-9114.1992.tb04465.x

出版商:Blackwell Publishing Ltd    

年代:1992

数据来源: WILEY

摘要:

Treating elderly debilitated patients with symptomatic bradyarrhythmia may be difficult. Traditional therapy includes use of limited resources (intensive care unit monitoring) and expensive interventions (permanent pacemaker insertion). When a pacemaker is not ideal or appropriate, yet intervention is desired to improve quality of life, theophylline may be a safe and effective alternative therapy. We expanded this use of theophylline in a series of 11 patients admitted 14 consecutive times with hemodynamically compromising bradyarrhythmias, including atropine‐resistant complete heart block with idioventricular rhythm. Three patients experienced deterioration of status and recurrence of bradycardia with the withdrawal or reduction of theophylline, and subsequent recovery of heart rate and conduction with its resumptio

ISSN:0277-0008    

DOI:10.1002/j.1875-9114.1992.tb04466.x

出版商:Blackwell Publishing Ltd    

年代:1992

数据来源: WILEY

摘要:

A 57‐year‐old woman believed that ibuprofen, prescribed for back pain, improved her idiopathic chronic cough that had been resistant to inhaled and oral corticosteroids. To confirm this observation, we performed an n‐of‐1 clinical trial with four treatment periods, each separated by a 4‐day washout. Ibuprofen 1800 mg/day for 6 days or placebo was randomly allocated in a double‐blind fashion with a block size of 4. The number of coughs during the first 30 minutes after awakening were counted daily throughout the study using a tape recorder. Sixty‐two coughs/hour occurred while taking ibuprofen, compared with 164 with placebo. We conclude that ibuprofen may be effective in idiopathic chronic cough, and suggest that prostaglandins may be pathogenic factors in

ISSN:0277-0008    

DOI:10.1002/j.1875-9114.1992.tb04467.x

出版商:Blackwell Publishing Ltd    

年代:1992

数据来源: WILEY

摘要:

Digoxin was administered to an 18‐day‐old infant who showed evidence of cardiac failure. When a Doppler echogram revealed a patent ductus, indomethacin was administered for medical management. Therapeutic digoxin doses then resulted in toxic serum concentrations of 8.2 ng/ml. Serum creatinine rose accordingly. Although this patient did not manifest signs of digoxin toxicity, practitioners should be alerted to the potential complications of these commonly used age

ISSN:0277-0008    

DOI:10.1002/j.1875-9114.1992.tb04468.x

出版商:Blackwell Publishing Ltd    

年代:1992

数据来源: WILEY