Mediastinal parathyroid adenoma detected by 99mTc-methoxyisobutylisonitrile: report of a case

In a randomized controlled clinical trial, 14 patients requiring resection of tumors were divided in two groups: one group was anesthetized with nitrous oxide [67% N2O-33% O2 (vol/vol)] and the other with propofol. Two other groups of subjects were studied: a group of patients that was undergoing orthopedic procedures and was anesthetized with nitrous oxide [67% N2O-33% O2 (vol/vol)] and a control group (fasted for 10 hrs and no anesthesia). In patients requiring resection of tumors, the blood L-methionine concentration was significantly lower and the blood amino acid pattern was significantly affected after the administration of nitrous oxide (120-310 mins) compared with values after the induction of anesthesia and before surgery. The administration of propofol (120-240 mins) did not produce any of these changes. No patients required blood transfusion during surgery, and the patients had not previously been treated with cancer chemotherapeutic agents. The administration of nitrous oxide (60-150 mins) to patients undergoing orthopedic procedures did not affect blood L-methionine. It is concluded that the administration of nitrous oxide to cancer-bearing patients, but not to those undergoing orthopedic surgery, produced major changes in amino acid metabolism; therefore, consideration should be given to the avoidance of exposure of cancer patients to nitrous oxide.     

Carotenoids synthesized by a culture of a mutant actinomycete strain

Twenty-five children with the diagnosis of acute glomerulonephritis were treated with oral or intravenous doses of furosemide. The intravenous administration of 1 mg/kg or greater resulted in an increase in urine volume in all patients. Oral doses of less than 2 mg/kg were not as effective, but there was wide variation in diuretic response to the drug. In 13 patients, plasma concentrations of furosemide were measured. The plasma half-life varied from 2.3 to 4.4 hours after intravenous administration of the drug. The plasma concentration of furosemide did not correlate with diuretic response.     

Administration of rhG-CSF increases complete remission rates after CHOP and ProMACE/CytaBOM for non-Hodgkin's lymphoma: a pilot study. Hokkaido Study Group of Malignant Lymphoma and rhG-CSF

To evaluate the clinical effects of the administration of recombinant human granulocyte-stimulating factor (rhG-CSF) post chemotherapy for patients with advanced-staged intermediate-grade or high-grade non-Hodgkin's malignant lymphoma (NHL), we conducted this multicenter study and compared the responses between both the regimens, CHOP as a first-generation chemotherapy and ProMACE/CytaBOM as a third-generation chemotherapy, when combined with the rhG-CSF administration. In this multicenter study, where forty patients were registered, patients in both the CHOP and ProMACE/CytaBOM groups were treated with the original regimen designs without the necessity of reducing drug dosages when combined with the administration of rhG-CSF. The administration of rhG-CSF post both of the cytotoxic therapies brought about much higher rates of complete remission in both the groups (CHOP, 75 percent; ProMACE/CytaBOM, 75 percent), as compared with those of the previous study without the rhG-CSF administration. Regarding response rates according to the International prognostic factor index, the CHOP group showed a lower rate of complete remission in patients with risk factors, compared with ProMACE/CytaBOM group. This result suggested that the administration of rhG-CSF may offer one important approach for improving the first-line therapy for aggressive NHL with high risk factors.     

Continuous infusion of loop diuretics in the critically ill: a review of the literature

OBJECTIVES: a) To present the pharmacodynamic concepts behind the administration of loop diuretics via continuous infusion; b) to review the clinical trials and reports in critically ill patients that have described this method of drug delivery; and c) to discuss the data. DATA SOURCES: Review of MEDLINE and International Pharmaceutical Abstracts from 1966 to the present. STUDY SELECTION: Study design was not a factor in selecting literature for this review. All studies, case reports, and case series describing infusion of a loop diuretic are included. DATA EXTRACTION: Cited literature was found in peer-reviewed clinical or basic science journals. DATA SYNTHESIS: There is a pharmacodynamic basis for the use of a controlled infusion of the loop diuretics in critically ill patients requiring extensive diuresis. Animal and human volunteer studies have demonstrated a clear improvement in efficiency of diuresis by controlled infusion Clinical studies in critically ill patients have demonstrated an improved diuretic response with a controlled infusion. Adverse effects appear to be minimal, and the amount of drug required for effect is less than the required amount for bolus administration. CONCLUSION: Administration of loop diuretics by continuous intravenous infusion may improve diuresis in critically ill patients who require prompt, controllable diuresis, or who demonstrate "diuretic tolerance" to conventional administration regimens. Despite few, well-designed studies using this method of administration in clinical practice, pharmacodynamic concepts support continuous infusion over bolus administration, including decreased dosage requirements, improved diuretic response and few adverse effects.     

Clinical tolerance of oral loading with elevated doses of amiodarone in a group of patients with heart failure

Amiodarone is a choice drug for the treatment of patients suffering from life-threatening hyperkinetic ventricular arrhythmias and depressed ventricular function. The drug is characterized by a remarkably long halflife and a delayed initial activity after oral administration of the usual loading levels. The aim of this study was to establish: -the clinical tolerance to elevated doses in patients with heart failure presenting complex, hyperkinetic ventricular arrhythmias; -the possibility to shorten hospitalization as a result of the oral loading; -whether this administration route would take less time to be efficacious. For this purpose, 30 patients with heart failure and complex, hyperkinetic ventricular arrhythmias were treated with 0.50 mg/kg body weight of amiodarone for three days and with 0.30 mg/kg on the 4th and 5th days, followed by a maintenance period of treatment with 200-400 mg daily. All patients underwent a 24-h Holter test before and after administration and an echocardiographic examination showing an average ejection fraction of approximately 30%. Amiodarone was clinically well tolerated; only 2 patients required discontinuation of therapy whereas, among the the remaining 28 patients, 2 cases of transient hypotension and 3 cases of gastroenteric disorders were observed. It was concluded that elevated doses of amiodarone were well tolerated, which allowed to reduce the loading period and, therefore, hospitalization.     

Efficacy of a decision-tree approach to the Luria-Nebraska Neuropsychological Battery.

Investigated whether the Luria-Nebraska Neurological Battery (LNNB) items could be arranged in a decision-tree fashion that would allow item administration based on the patient's performance. In Exp I, results from 40 standardly administered LNNB (full-LNNB) were compared with derived results based on the decision-tree administration procedure (decision-LNNB). Results show that the decision-LNNB was in 91% agreement with full-LNNB scale scores above the brain-impaired cutoff line. Using the 2-scale elevation rule of C. Golden et al (1980), the 2 administration procedures were in 100% agreement in selecting brain-impaired patients. In Exp II, the decision-LNNB was used alone with 26 brain-impaired patients and 4 normals. Results indicate an 87% hit rate. (3 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Lipoprotein Lp(a) excess and coronary heart disease

A pharmacokinetic study of all-trans retinoic acid (ATRA) was performed in 8 patients with various types of leukemia and MDS. After oral administration at a dose of 30 mg/m2, the mean peak plasma concentration was 430 ng/ml and was reached at 150 min. In one patient who failed to respond a very low plasma ATRA level was seen. Though the plasma ATRA exposure decreased significantly with daily drug administration, an intermittent schedule of ATRA administration would yield higher plasma drug concentrations. We treated 2 patients with refractory acute promyelocytic leukemia (APL) in a pilot study of ATRA followed by intensive chemotherapy (APL-ATRA protocol). Two patients successfully achieved complete remission with ATRA after failing under conventional chemotherapy. Based on the pharmacokinetic study of ATRA, an intermittent schedule of ATRA in addition to chemotherapy suggests an effective regimen for children with APL. Phase II trials to evaluate the role of intermittent schedules of ATRA are planned in Children's Cancer and Leukemia Study Group.     

Liver stem cells: a two compartment system

STUDY OBJECTIVE: To develop management guidelines for the treatment of anaphylactoid reactions to intravenous N-acetylcysteine (NAC) and to assess the safety of restarting the infusion after a reaction. METHODS: In phased 1, we used a 6-year retrospective case series of hospitalized patients and a review of the literature to develop the management guidelines for anaphylactoid reactions to intravenous NAC. In phase 2, these guidelines were evaluated prospectively in our poison-control center. RESULTS: In phase 1, the charts of 11 patients with anaphylactoid reactions (9 cutaneous and 2 systemic) were reviewed. In most cases, no treatment or treatment with diphenhydramine alone or with salbutamol was sufficient to continue or restart NAC infusion safely. On the basis of our findings in those patients and on published experience, we concluded that anaphylactoid reactions to intravenous NAC are dose-related and the antihistamines are useful in controlling and in preventing recurrence of anaphylactoid symptoms. We developed the following guidelines: flushing requires no treatment, urticaria should be treated with diphenhydramine, and NAC infusion should be continued in both cases. Angioedema and respiratory symptoms each require the administration of diphenhydramine and symptomatic therapy. In these cases, NAC infusion should be stopped but, when necessary, can be started 1 hour after the administration of diphenhydramine in the absence of symptoms. In phase 2, 50 patients (31 cutaneous and 19 systemic reactions) were treated prospectively with the use of these guidelines. Recurrence of symptoms occurred in only one case involving a deviation from the guidelines. The NAC infusion was restarted immediately after the administration of diphenhydramine in a patient who sustained a systemic reaction. CONCLUSION: Non-life-threatening anaphylactoid reactions to intravenous NAC are treated easily and the infusion may be continued or restarted safely after the administration of diphenhydramine.     

Clinical case of the month. Galloping nephropathy in a patient with type 2 diabetes

Thirteen surgical patients affected by colorectal cancer have been evaluated to study the effectiveness of a short-term preoperative therapy with interleukin-2 (IL-2). Seven patients have been treated for three days before surgery with subcutaneous administration of IL-2 (9.000.000 U.I. b.i.d.). Six patients have been treated with placebo and have been considered as control group. All the patients have been operated upon 36-48 hours after the last administration of IL-2 or placebo. The assays of CD-3+, CD-4+, CD-8+ e CD-56+ lymphocytes, evaluated preoperatively and 7 days after the operation, have showed a postoperative increase of CD8+ and CD56+ and a decreased ratio of CD4+/CD8+. The results of this study, although not conclusive, suggest a positive antitumoral response in patients treated preoperatively with IL-2. Further studies could be performed to evaluate the survival after such a treatment.     

Indium-111 pentetreotide single-photon emission tomography in patients with TSH-secreting pituitary adenomas: correlation with the effect of a single administration of octreotide on serum TSH levels

Few data are available on the visualization of somatostatin receptors in vivo in patients with thyrotropin (TSH)-secreting adenoma. We studied five patients with TSH-secreting adenomas using single-photon emission tomography (SPET) after administration of indium-111 pentetreotide. The intensity of 111In-pentetreotide uptake by the tumours was correlated with the degree of TSH suppression after a single administration of 100 microg octreotide s. c. Five patients (three women and two men) aged 27-46 years were investigated. Except for one patient with acromegaly, all had pure TSH-secreting tumours. One patient was previously untreated, while two had received octreotide, one antithyroid drugs, and one radioiodine. In all patients SPET demonstrated increased uptake of 111In-pentetreotide by the pituitary adenoma. The target to non-target ratio (T/nT) of 111In-pentetreotide uptake was higher than 10 in three patients. Administration of 100 microg octreotide s. c. caused a significant reduction in TSH levels from 4.8+/-1.4 mU/l to a nadir of 3.1+/-1.1 mU/l after 6 h (P<0.001 by ANOVA). Suppression of TSH secretion ranged from 30% to 60% of the baseline value. The T/nT ratio showed a trend toward a direct relationship with the degree of TSH inhibition after acute octreotide administration (r=0.67; P=NS). Our study showed that 111In-pentetreotide scan visualized somatostatin receptors in all five of the patients with TSH-secreting pituitary adenomas, confirming the frequent presence of somatostatin receptors in these rare tumours, even though the correlation with the TSH inhibition after a single administration of octreotide did not reach significance.     

Kallikrein gene therapy: a new strategy for hypertensive diseases

The effects of tolcapone, a catechol-O-methyltransferase inhibitor, on the bioavailability and efficacy of levodopa were evaluated in 12 patients with Parkinson's disease (PD), 8 of whom showed signs of daily motor fluctuations (wearing-off phenomenon). Motor disabilities were assessed in 12 patients at 7 time points before and after the chronic administration of tolcapone using the Unified Parkinson's Disease Rating Scale (UPDRS). The UPDRS score was improved at all points of determination. Eight patients with wearing-off phenomenon on levodopa showed symptomatic improvement on the combination. The area under the curve (AUC) for levodopa increased by 34% (p = 0.0059) after the administration of tolcapone. The elimination half-life (T1/2) of levodopa was significantly prolonged by 81% (p = 0.0001) after the treatment. The AUC of 3-O-methyldopa, a metabolite of levodopa, was decreased by 79% (p = 0.0001) and the Cmax (maximum concentration) was also decreased by 80%d after the administration (p = 0.0001) of tolcapone. The combination of tolcapone and levodopa was well tolerated. Our findings suggest that tolcapone improves the pharmacokinetics of levodopa in plasma and motor symptoms of fluctuating PD patients. It is suggested that tolcapone may be useful drug adjunct to levodopa in treating patients with PD with wearing-off phenomena.     

Pharmacist as a provider of oncology ambulatory care services

The services provided by a pharmacist to ambulatory oncology patients is described. The pharmacist takes drug histories, monitors drug therapy, gives patient discharge consultations and acts in cooperation with local physicians and the medical staff in providing chemotherapy to cancer patients for home administration. The pharmacist also provides inservice education and acts as a consultant to the medical, nursing and pharmacy staffs.     

Effect of beraprost sodium, a stable prostaglandin I2 analogue, on platelet aggregation in diabetes mellitus

Test results concerning platelet behavior in vitro, particularly aggregation, are frequently abnormal in diabetic patients. The concept has therefore arisen that platelet hyper-reactivity is one factor contributing to diabetic microangiopathy. We report here the antiplatelet effect of beraprost sodium, a chemically stable prostaglandin I2 analogue made in Japan, in 6 diabetic patients. Platelet aggregation induced by adenosine 5'-diphosphate (10 microM) after administration of beraprost sodium (40 micrograms every 8 h for 14 days) was significantly decreased as compared with levels before beraprost sodium administration. These results indicate the possibility that the occurrence of vascular complications in diabetes mellitus can be suppressed by long-term administration of beraprost sodium.     

Somitogenesis: segmenting a vertebrate

OBJECTIVE: To evaluate the effect of gliclazide administration to NIDDM patients on 1) monocyte adhesion to cultured endothelial cells, 2) plasma cytokine and lipid peroxide levels, and 3) monocyte cytokine production. RESEARCH DESIGN AND METHODS: Poorly controlled glyburide-treated diabetic patients (n = 8) and healthy control subjects (n = 8) were recruited. At the beginning of the study, glyburide was replaced by an equivalent hypoglycemic dose of gliclazide. Serum and monocytes were isolated from blood obtained from control and diabetic subjects before and after 3 months of treatment with gliclazide. RESULTS: Plasma lipid peroxide levels and monocyte adhesion to endothelial cells are enhanced in NIDDM patients, and gliclazide administration totally reverses these abnormalities. Before gliclazide treatment, serum levels of cytokines did not differ in the control and the diabetic groups, with the exception of an enhancement of tumor necrosis factor-alpha (TNF-alpha) and interleukin-6 (IL)-6 in NIDDM subjects. Basal and lipopolysaccharide (LPS)-stimulated monocyte production of interleukin-1 beta, IL-6, and IL-8 did not differ between the two groups. Furthermore, basal monocyte production of TNF-alpha was similar in the control and the diabetic groups, whereas a marked increase in the LPS-stimulated monocyte production of TNF-alpha was observed in the NIDDM group. Gliclazide treatment lowered LPS-stimulated TNF-alpha production by diabetic monocytes to levels similar to those observed in control subjects. CONCLUSIONS: Gliclazide administration to NIDDM patients inhibits the increased adhesiveness of diabetic monocytes to endothelial cells and reduces the production of TNF-alpha by these cells. These results suggest that treatment of NIDDM subjects with gliclazide may be beneficial in the prevention of atherosclerosis associated with NIDDM.     

Respiratory depression associated with patient-controlled analgesia: a review of eight cases

Patient-controlled iv delivery of opioids for postoperative pain management is a popular alternative to the traditional im route of administration. However, occasional patients receiving opioids in this manner develop severe respiratory depression. The purpose of this paper is to determine the incidence of, and factors contributing to, the development of this complication. To do this, the Office of Medical Quality Improvement retrospectively searched for reports of respiratory depression in a database compiled from the charts of approximately 1600 patients who had received PCA at the University of Alberta Hospitals in 1992. Eight cases of serious respiratory depression were detected. Factors associated with the occurrence of respiratory depression included the concurrent use of a background infusion, advanced age, concomitant administration of sedative/hypnotic medications, and pre-existing sleep apnoea syndrome. No cases were attributed to operator error or equipment malfunction. In conclusion, the risk of respiratory depression with patient-controlled opioid administration is similar to that observed when opioids are delivered by the traditional im or spinal routes. The safe and effective use of patient-controlled analgesia depends upon knowledgeable medical and nursing staff, clearly defined nursing policy and procedures, and frequent patient follow-up.     

Domiciliary oxygen therapy. Study of use in a rural area

OBJECTIVE: To assess use of long-term oxygen therapy (LTOT) in a rural community we conducted a transversal study. METHOD: Data was collected in patients' homes, and based on the total number of patients with LTOT, with reference to indication, follow-up and correct completion; two oximetries were carried out, breathing room air, and after breathing oxygen. Of the 70 patients with LTOT, 7 were considered not eligible, the prevalence was found to be: 179/100,000 inhabitants. Sixteen patients were excluded, 6 with exacerbation, and 10 who were unable to be contacted at their home address. The sample was composed of 45 patients. The most frequent diagnosis was COPD (34/45). Indication of LTOT was carried out in the hospital in 40 (89%) patients, and in the health centre in 5 (11%). RESULTS: In 22 (49%) the treatment could be considered acceptable, and only in 21 (46%), the indication of LTOT was correct. Oxygen was administered at least 15 hours/day in 42% of cases (19/45). Patients with periodical check-ups, maintained better pharmacological treatment, although there were no significant differences in the carrying out of LTOT. Using oximetry, it was shown that in 27 patients the SaO2 was lesser than or equal to 88%, and that in 23 cases (85%) administration of oxygen, corrected the saturation. Only in 11 (24%) the indication criteria and adequate administration of LTOT were carried out, as well as correction of the hypoxemia following administration of oxygen. CONCLUSIONS: The prevalence was found to be very high. The results show this form of treatment as being very badly controlled. In a rural community, the pulse oximetry is useful in the follow-up of TLOT.     

Long-term clinical effect of nilvadipine in patients with chronic heart failure: a double-blind placebo-controlled study

The long-term effect of calcium channel blockers on chronic heart failure is disappointing, probably because of reflex sympathetic activation through arterial vasodilation. However, nilvadipine may be beneficial for treatment of chronic heart failure since this drug has minimal effects on sympathetic activation. In this study, the effects of 12-week administration of nilvadipine or placebo on symptoms of heart failure and cardiac function were investigated in 23 patients with mild-to-moderate chronic heart failure in a double-blind trial. The patients were randomly assigned to either a nilvadipine group (16 mg daily) or a placebo group. Intergroup comparisons did not show significant differences in any parameters. Serious adverse effects were not observed during the study. Thus, this study failed to show any beneficial effect of nilvadipine in the long-term treatment of patients with chronic heart failure. We conclude that the long-term administration of nilvadipine (16 mg daily) is neither effective nor harmful in the treatment of patients with chronic heart failure.     

Symptomatic hypocalcemia in a patient with latent hypoparathyroidism and breast carcinoma with bone metastasis following administration of pamidronate

Pamidronate is an effective drug used not only in patients with tumor-associated hypercalcemia, but also in normocalcemic patients with metastatic bone disease to relieve pains. We describe a 39-year-old normocalcemic patient with subclinical hypoparathyroidism and bone metastasis due to breast carcinoma. Following parenteral administration of 60 mg pamidronate, the corrected serum level of calcium decreased from 2.12 mmol/l (=8.9 mg/dl) to 1.42 mmol/l (5.7 mg/dl), accompanied with carpal pedal spasm. The present case indicates that the hypocalcemia due to latent hypoparathyroidism was compensated by extensive osteolysis due to bone metastasis, and that overt hypocalcemia may develop after intravenous administration of pamidronate in such a patient.     

Pharyngeal lipoma with cartilaginous metaplasia (chondrolipoma): a case report and literature review

We report two cases of vasospastic angina associated with anaphylactic reaction caused by nonsteroidal anti-inflammatory drugs (NSAIDs). Both patients exhibited anaphylactic manifestations, such as general rash and urticaria, along with angina pectoris with electrocardiographic ST-segment elevations after suppository administration of diclofenac sodium or indomethacin, the most commonly used NSAIDs. Although these patients had normal coronary arteriograms, intracoronary administration of ergonovine or acetylcholine provoked diffuse coronary artery spasms accompanied by chest pain and ischemic ST-segment changes. It is therefore suggested that an allergic mechanism may be involved as a causative factor of the coronary artery spasm induced by NSAIDs.     

Implementation of a community pharmacy-based influenza vaccination program

OBJECTIVE: To increase accessibility of influenza vaccine in a rural community by establishing a community pharmacy-based influenza vaccination program. SETTING: An independent pharmacy in a rural eastern Iowa community of 5,000 people. PRACTICE DESCRIPTION: Protocols for identification and screening of patients, administration of vaccine, and treatment of emergencies were developed by the pharmacist and approved by the county health department medical director. Administration of vaccine began October 15, 1996, and was completed on December 6, 1996. PRACTICE INNOVATION: Patients were prospectively and retrospectively identified to receive the vaccination. Informed consent was obtained. Vaccine was administered by the pharmacist after screening for contraindications and counseling the patient. Weekly vaccination records were forwarded to the collaborating physician to update patient charts. MAIN OUTCOME MEASUREMENTS: To determine whether accessibility of influenza vaccine in the community was increased through pharmacist administration, the proportion of patients immunized in the pharmacy who were not vaccinated the previous year was determined. RESULTS: The pharmacist administered 343 doses of vaccine. Two-thirds of the immunized patients (67.9%) reported also being immunized the previous year. These patients were generally older (65 years of age +/- 13) than the previously nonimmunized patients (54 years of age +/- 16). However, 60.8% of the patients not immunized the previous year reported either they would not have gone elsewhere for the immunization (45.3%), or were unsure (25.5%). CONCLUSION: The data collected suggest that pharmacist administration of influenza vaccination in a rural community pharmacy increases access and, possibly, immunization rates. This may be especially true among high-risk younger adults who are often overlooked and would not normally have received the immunization.