Distribution, elimination, and action of d-tubocurarine in neonates, infants, children, and adults

The relation of plasma concentration of d-tubocurarine (dTc) to neuromuscular blockade, and the distribution and urinary excretion of dTc was determined in neonates (n = 4), infants (n = 6), children (n = 8), and adults (n = 8). The plasma concentration-time course curves to 24 hr are best described for all groups by three-compartment models. Both neonates and infants exhibit decreased plasma clearance (CLP), 1.1 +/- 0.08 and 1.0 +/- 0.06 ml X kg-1 X min-1, and in addition a prolonged t1/2 terminal phase, 311 +/- 44 and 306 +/- 35 (mean +/- SEM, min). The neonates' 24-hr urinary excretion, 27 +/- 2 (mean +/- SEM, % total dose) is significantly less than the adult value, 45 +/- 4% total dose. There was no significant difference seen in the log plasma concentration-evoked compound electromyogram (ECEMG) response between 20-80% paralysis for adults, children, infants, and five of the seven neonates studied. Two of the neonates had a significant shift of their log concentration-response curve to the right. There was also no significant difference between any of the groups in the time for 50% return of ECEMG stimulus height or the time required for recovery of the ECEMG from 25 to 75% of control value. for recovery of the ECEMG from 25 to 75% of control value.     

Orthopaedics, ethics, and industry. Appropriateness of gifts, grants, and awards

At the Academic Orthopaedic Society meeting in San Francisco on November 8 and 9, 1996, the membership addressed the issue of ethics and industry in an academic setting. Using a Delphi panel technique, they arrived at a definition of conflict of interest, and 41 separate points of acceptable and unacceptable behavior related to gifts, research awards, and funding of various activities. The Academic Orthopaedic Society Delphi Committee also mailed 191 questionnaires (157 department chairpersons and 34 program directors) to 157 training programs. The respective department chairpersons and program directors were asked to copy and distribute the questionnaires to staff (faculty) and house officers (residents and fellows) to complete anonymously and return them for collation. Ninety-one programs (58%) responded. Three hundred and fifty-two questionnaires were returned (237 from staff, 115 from house officers), each of which expressed agreement or lack of agreement with the Delphi panel report using a Likert scale technique. With only modest (and usually predictable) disagreement on certain items, the final statements by the Delphi panel were supported strongly by the survive results. The Academic Orthopaedic Society believes that the major points arrived at by the panelists should serve as the basis for ethical guidelines in the relation between academic orthopaedic institutions and industry.     

Methotrexate, Azathioprine, Cyclosporine, and Risk of Fracture

We studied the fracture risk associated with use of methotrexate, azathioprine, and cyclosporine. The study was designed as a case-control study. All patients with a fracture (n = 124,655) in the year 2000 in Denmark served as cases. Information on fractures and confounders was retrieved from the National Hospital Discharge Register and a number of other national registers. For each case, three age- and gender-matched controls were randomly drawn from the general population (n = 373,962). Exposure was use of the drugs and a number of covariates including other immunosuppressive drugs, corticosteroids, any cancer, Crohn’s disease, ulcerative colitis, rheumatoid arthritis, psoriasis, liver and kidney disease, prior fracture, and alcoholism. Azathioprine was associated with an increase in overall fracture risk, but besides this, none of the drugs was significantly associated with overall fracture risk or risk of hip, spine, or forearm fracture. Liver [odds ratio (OR) = 1.55, 95% confidence interval (CI) 1.42–1.69] and kidney (OR = 1.26, 95% CI 1.16–1.37) diseases were significantly associated with increased risk of fractures. Azathioprine was associated with an increase in overall fracture risk but not in the risk of spine, hip, or forearm fractures. Methotrexate and cyclosporine were not associated with fracture risk. It thus seems that the underlying disease for which the treatment is administered may be responsible for much of the increase in fracture risk rather than the drugs used to treat the disorder in question.     

Transcapillary exchange and retention of fluoride,strontium, EDTA,sucrose, and antipyrine in bone

Summary The extractions of⁸⁵Sr²⁺,¹⁸F⁻, sucrose-¹⁴C, EDTA-⁵¹Cr, and antipyrine-¹⁴C in bone were determined by the multiple indicator-dilution method. Fluoride and strontium extractions were 18 to 70% during a single transcapillary passage, and those of EDTA and sucrose were from 11 to 59%, whereas extraction of antipyrine was 87%. Injections of⁸⁵Sr²⁺ and¹⁸F⁻ made when perfusion was done alternately with blood and plasma resulted in similar fractional extractions. When flow and extraction were measured simultaneously, extraction was related inversely to flow.     

Oncologic,Functional, and Cost Analysis of Open,Laparoscopic, and Robotic Radical Prostatectomy

ContextAlthough open radical retropubic prostatectomy (ORRP) remains the gold standard, the past years have seen a rise in both laparoscopic radical prostatectomy (LRP) and robot-assisted radical prostatectomy (RARP), and many patients seem to prefer the so-called minimally invasive procedures despite insufficient data demonstrating superiority over the established standard (ORRP).ObjectiveThis article seeks to review the most recent data on a variety of aspects of the different techniques for performing prostatectomies, such as cost, oncologic outcomes, continence, quality of life, and marketing and propaganda as well as the learning curve for each.Evidence acquisitionA search of the most recent literature was performed using PubMed, and data from lectures and presentations given at international conferences were used.Evidence synthesisThe review showed that, overall, LRP and RARP outcomes have not proved superior to ORRP outcomes or resulted in anticipated benefits to patients. In addition, current data seem to suggest that results of any of the procedures depend more on the surgeon's ability than on the approach, with rates of blood loss, positive surgical margins, incontinence, and erectile dysfunction varying widely from surgeon to surgeon with all three techniques. The aggressive marketing associated with RARP has also led to significantly higher rates of dissatisfaction and regret in patients.ConclusionsConsidering the evidence, ORRP remains the gold standard in radical prostatectomies. Moreover, although the differences among major outcomes are minor and associated with shorter lengths of stay, the costs associated with LRP and RARP are significantly higher than with ORRP. In the absence of solid scientific evidence, patient education, and counselling are crucial parts of the decision-making process, during which patients will opt for one treatment over another.     

The Invention and Development of Enflurane, Isoflurane, Sevoflurane, and Desflurane

Thirty-six halogenated Me Et ethers have been synthesized for evaluation as volatile anesthetics. Eleven of the ethers were too unstable to test, and, of the remaining 25, 13 had promising anesthetic properties in mice and are suitable for study in larger animals. Those ethers having one H with at least 2 halogens other than F or 2 or more H with at least one Br or Cl were the best anesthetics.     

Effects of genes, sex, age, and activity on BMC, bone size, and areal and volumetric BMD.

Quantitative genetic analyses of bone data for 710 inter-related individuals 8-85 yr of age found high heritability estimates for BMC, bone area, and areal and volumetric BMD that varied across bone sites. Activity levels, especially time in moderate plus vigorous activity, had notable effects on bone. In some cases, these effects were age and sex specific. INTRODUCTION: Genetic and environmental factors play a complex role in determining BMC, bone size, and BMD. This study assessed the heritability of bone measures; characterized the effects of age, sex, and physical activity on bone; and tested for age- and sex-specific bone effects of activity. MATERIALS AND METHODS: Measures of bone size and areal and volumetric density (aBMD and vBMD, respectively) were obtained by DXA and pQCT on 710 related individuals (466 women) 8-85 yr of age. Measures of activity included percent time in moderate + vigorous activity (%ModVig), stair flights climbed per day, and miles walked per day. Quantitative genetic analyses were conducted to model the effects of activity and covariates on bone outcomes. RESULTS: Accounting for effects of age, sex, and activity levels, genes explained 40-62% of the residual variation in BMC and BMD and 27-75% in bone size (all p<0.001). Decline in femoral neck (FN), hip, and spine aBMD with advancing age was greater among women than men (age-by-sex interaction; all p 相似文献   

Knowledge,Attitude, and Perception About Renal Transplantation of CKD Patients,Caregivers, and General Population

Introduction

In this study knowledge about kidney disease and the option of transplantation was assessed in chronic kidney disease (CKD) patients and their care givers.

Overview: Epidemiology,indications, goals,extent, and nature of work-up

Each year in the United States, it is estimated that there will be 42,000 new cases of rectal cancer and 8,500 deaths^.1,2 Some patients present with an incurable rectal cancer but more often death follows development of recurrent rectal cancer after failed curative-intent therapy. Knowledge of the natural history of rectal cancer and limitations of treatment options coupled with sound clinical judgment and compassion are essential prerequisites for the clinician providing palliative care.     

Epidemiology,Pathogenesis, and Pathophysiology of Urolithiasis

ContextUrolithiasis (UL) is one of the most common diseases, with worldwide increasing incidence and prevalence. The pathogenesis of calcium oxalate (CaOx) UL, which accounts for >80% of all urinary stones, is only incompletely understood.ObjectiveOur aim was to review trends in epidemiology and current concepts for the pathogenesis and pathophysiology of urinary stone disease.Evidence acquisitionWe reviewed data from the literature and our own series.Evidence synthesisUrinary stone formation is a result of different mechanisms. Completely different pathomechanisms lead to CaOx stone formation, with Randall plaques playing a key role in the pathogenesis.ConclusionsThe lithogenesis of key stones is multifactorial. Lifestyle and dietary choices are important contributing factors. The pathogenesis and pathophysiology of CaOx stones is still incompletely understood. Recent evidence suggests a primary interstitial apatite crystal formation that secondarily leads to CaOx stone formation.