Cefamandole prophylaxis for cardiovascular surgery: a dosage comparison

For more than a decade, studies have indicated that antibiotic dosing immediately before and for a short time after surgery is effective in reducing the incidence of infectious complications of open-heart operations. At our institution we have used cefamandole, because of its broad spectrum of activity against bacteria common to the skin and respiratory system and its low toxicity. However, in response to more recent studies that threw doubt on the ability of the recommended dosing regimen (1.0 g given intravenously every six hours for three days) to maintain adequate intraoperative levels of cefamandole in heart tissue, we undertook an evaluation of a dosage of 2.0 g given intravenously every 6 hours for two days. This was a randomized study of 211 successive, evaluable, open-heart surgery patients who had no concurrent infections or cephalosporin allergy. Postoperatively, there were eight surgery-related infections (3.9%) and eight nosocomial infections in the 2.0-g dose group, compared with seven surgery-related infections (3.5%) and seven nosocomial infections in the 1.0-g dose group. These differences were not statistically significant. Tissue levels and cardiopulmonary bypass pump time were not risk factors for infection. We conclude that the 2.0-g doses over two days are no more effective than the 1.0-g doses over three days. However, when administration fees are considered, in a cost comparison, the 2.0-g dosing regimen is more economical than the 1.0-g regimen.     

Medication and dosage considerations in the prophylaxis and treatment of high-altitude illness

With increasing numbers of people traveling to high altitude for work or pleasure, there is a reasonable chance that many of these travelers have preexisting medical conditions or are receiving various medications at the time of their sojourn. As with all travelers to high altitude, they are at risk for altitude illnesses such as acute mountain sickness, high-altitude cerebral edema, and high-altitude pulmonary edema. While there are clear recommendations for pharmacologic measures to prevent or treat these illnesses, these recommendations are oriented toward healthy individuals and do not take into account the presence of preexisting medical conditions. In this review, we consider how the choice and dose of the medications used in the management of altitude illness-acetazolamide, dexamethasone, nifedipine, tadalafil, sildenafil, and salmeterol-are affected by a patient's underlying medical conditions. We discuss the indications and current dosing recommendations for individuals without underlying disease, and then consider how drug selection or dosing regimens will be affected by the presence of renal insufficiency, hepatic insufficiency, other important medical conditions, and the potential for serious drug interactions. We include comments about interactions with antimalarial medications and antibiotics used in the treatment of traveler's diarrhea, as well as the safety of use during pregnancy. By giving these issues adequate consideration, clinicians can increase the chances that properly evaluated patients with underlying medical conditions will enjoy a safe trip to high altitude.     

骨质疏松发生的细胞学基础及其防治

骨质疏松症以全身骨量减少及骨组织结构改变为主要病理特征 ,分为原发性和继发性 ,虽两者病因迥异 ,但基本病理改变相同 ;老年性骨折是其造成的主要危害之一。造成骨质疏松骨折的因素 ,与骨量丢失有关 ,但与骨的结构完整性及力学特征关系更为密切。骨组织中 ,正常的成骨细胞、骨细胞和破骨细胞功能 ,是赋予生理骨量和骨结构的基础。骨改建与骨塑建周期中 ,由破骨细胞引起的“骨吸收”与由成骨细胞引起的“骨形成”间的“耦联” ,是维持骨结构完整性及合适骨强度的关键环节。进一步了解骨质疏松成骨细胞和破骨细胞的变化及其规律 ,调节并改善…     

Twenty-four hour prophylaxis with increased dosage of octreotide reduces the incidence of post-ERCP pancreatitis

BACKGROUND: Acute pancreatitis is a common complication of ERCP, occurring in up to 10% of cases. Chemoprevention of post-ERCP pancreatitis remains a debated issue. OBJECTIVE: This study evaluated whether increased dosage of octreotide, a potent inhibitor of pancreatic secretion, could reduce the incidence of post-ERCP pancreatitis. DESIGN: In a randomized, double-blind, placebo controlled trial, the effect of 500 microg octreotide, given 3 times daily subcutaneously starting 24 hours before the ERCP procedure, was compared with that of placebo in patients who underwent diagnostic and/or therapeutic ERCP. PATIENTS: A total of 202 patients were included in the trial. The 2 groups were similar in regards to age, sex, indications for treatment, underlying diseases, and types of therapeutic procedures. Patients were clinically evaluated, and serum amylase levels were determined before ERCP and at 6 to 8 hours thereafter. Standardized criteria were used to diagnose and to grade the severity of post-ERCP pancreatitis. RESULTS: The medication was discontinued because of an allergic reaction in 1 patient in the octreotide group. The incidence of post-ERCP pancreatitis was significantly lower in the octreotide group compared with the placebo group (2/10 [2%] vs 9/101 [8.9%], P = .03). All cases of acute pancreatitis were mild, except 2 (1 moderate and 1 severe) in the placebo group. CONCLUSIONS: The results of this trial support the use of 24-hour prophylaxis with high dose of octreotide in the prevention of post-ERCP pancreatitis.     

关注氟化物的剂量-效应问题

在氟的生物学效应与毒性作用研究中，各种实验结果的互相矛盾常常令人困惑。出现不同实验结果或意见分歧，除了应考虑实验动物的种属、饲养条件、处理因素、实验期限等方面情况外，氟化物的剂量至为重要[1]。本文拟从以下几方面来讨论有关氟的剂量一效应问题：     

乙胺丁醇眼部损害及其防治

196 1年首次报道乙胺丁醇 (ｅｔｈａｍｂｕｔｏｌ,ＥＭＢ)对结核病有治疗作用 ,次年国外就有ＥＭＢ眼毒性作用的报道[1] ,国内1978年后有类似报道 ,且呈逐年增多倾向[2 ] 。ＥＭＢ眼部损害主要在视神经、视网膜 ,导致视功能减退 ,甚者致盲。现就ＥＭＢ眼部损害的发病情况、发病机制、临床表现、预防、治疗作一综述。一、发病情况发生率 :口服ＥＭＢ 15ｍｇ·ｋｇ-1·ｄ-1为 0 .8% [3 ,4 ] ,2 5ｍｇ·ｋｇ-1·ｄ-1为 3% ,40～ 5 0ｍｇ·ｋｇ-1·ｄ-1则增至 15 %～ 30 % [5] 。说明剂量越大 ,眼损害率愈高。ＥＭＢ具有良好组织渗透性 ,适用于…     

Sulfur dioxide-induced bronchial constriction in asthmatics and its prophylaxis by salbutamol

Patients with bronchial asthma often develop acute attack in kitchen while burning honeycomb briquet which is widely used for cooking in southern China. Burning of a honeycomb briquet produces 0.6-4.3 ppm sulphur dioxide (SO2) in the kitchen air. To assess whether the above concentration of SO2 can induce bronchial constriction, we performed SO2 bronchial provocation test on 21 asthmatics (male 11, female 10, average age 28.8 +/- 2.0 years), 10 patients with allergic rhinitis (male 3, female 7.28 +/- 1.6 years) and 20 healthy non-smokers (male 13, female 7, 28.1 +/- 1.5 years). FEV1 showed no significant change in both healthy and rhinitis group even a maximal amount of SO2 (10 ppm) was given. The calculated PC20 FEV1 and PC35 SGaW in asthmatics were 3.7 +/- 0.22 ppm and 2.5 +/- 0.18 ppm respectively, which fell into the SO2 range yielded by a burning honeycomb briquet. Orally administered slow release salbutamol created protective effect in 5 out of 8 patients. Salbutamol inhalation, however, completely blocked SO2 induced bronchial constriction. We suggest that patient with bronchial asthma should receive salbutamol aerosol inhalation before cooking with burning honeycomb briquet.     

Drug prophylaxis of liver lesions induced by isoniazid and its metabolites

The results of the experiments with use of isoniazid and its metabolites showed that in the liver of rats isoniazid induced albuminous degeneration with stroma inflammation and hepatocyte necrosis, monoacetylhydrazine induced fatty hepatosis, acetylisoniazid induced fatty hepatosis with stroma inflammation and hepatocyte necrosis and isonicotinic acid induced granular degeneration. Piracetam proved to be efficient in fatty hepatosis. Riboxin and dibunol were efficient in hepatitis. The drugs used clinically as liver protectors, i.e. cobamamide, pyridoxal phosphate and methionine had no protective action in liver affections induced by isoniazid whereas catergen, lipamide, dipromonium and methindione even aggravated such affections.     

Health-resort therapy and its importance for geriatric prophylaxis (author's transl)

The authors report on the influence of a single or repeated health-resort therapy in geriatric sanatoria on the subjective condition, the state of health, and the biochemical parameters.     

Cefoxitin: its role in treatment and prophylaxis of obstetric and gynecologic infections

Cefoxitin has become one of the most used parenteral antibiotics in the United States, perhaps because of a broad spectrum of activity, including activity against Bacteroides fragilis, which makes the drug suitable for prevention and treatment of intraabdominal and pelvic infections. This review focuses on the use of cefoxitin in obstetric and gynecologic infections, with comparisons to older and newer antibiotics. Numerous studies have shown that cefoxitin is clearly effective; in most of these studies, however, either the initial infection rates were low or the sample sizes were small--circumstances making it difficult to establish the superiority of any one agent. Thus, the necessity of using a drug with activity against B. fragilis for prevention and treatment of pelvic infections has not been proven. Several antibiotics without such activity have been equally effective. Cefoxitin may be of particular value when combined with surgical drainage of pelvic abscesses, infections in which control of B. fragilis may be especially important to outcome.     

Definitions for haemophilia prophylaxis and its outcomes: The Canadian Consensus Study

The creation of acceptable standard definitions for terms used in the care and assessment of haemophilia patients has become increasingly important, as a growing number of international clinical studies have been initiated. The Delphi approach has been used in health research to reach consensus in large groups and can be used to develop definitions by using several iterations of surveys eliciting opinions from specialists in the field. Three consecutive surveys were designed based on the Delphi approach and distributed to specialist physicians, nurses and physiotherapists in order to develop definitions for seven haemophilia terms: 'primary prophylaxis', 'secondary prophylaxis', 'target joint', 'joint bleed', 'significant soft-tissue bleed', 'superficial soft-tissue bleed' and 'mucosal bleed'. Suggestions were solicited, compiled into a subsequent survey and fed back to the group to rank-order the importance of each suggested component of the definition. Final definitions were created using the top-ranked suggestions and sent back to the experts for approval. Five of the seven terms were highly endorsed with greater than 90% agreement. Some differences in agreement were found when analysed by profession. Haemophilia terms were successfully defined using the Delphi approach. Further refinement from members of the international haemophilia community will ensure that comprehensive standard definitions can be used in multicentre studies in the future.     

日本血吸虫病肝纤维化的临床特点

目的通过检测有关细胞因子及病理学对肝组织标本从细胞、分子水平、组织超微结构等研究日本血吸虫病肝纤维化的发生、发展特点,并探讨合理的防治对策。方法晚期血吸虫病(晚血)包括切脾后、未达晚血标准的脾肿大者及晚血夹杂肝炎者分为A、B、C3组,除进行肝纤维化指标、生化检测和超声显像检测外,另对部分患者作淋巴细胞亚群、细胞膜CD35表达免疫学检测。部分患者作肝组织病理学的免疫组化检查。结果1212例中有94.06%的患者曾接受不同药物的病原治疗。血吸虫间接血凝试验、酶联免疫吸附试验1项或2项均为阳性者3组差异有显著性。肝纤维化4项指标测定中,层黏蛋白、透明质酸3组差异亦有显著性。超声显像肝实质分级3组差异亦有显著性。肝纤维化病理特征研究中,炎症与纤维化呈正相关。晚血肝纤维化时C-I、C-型胶原在肝汇管区、中央静脉、肝窦等部位含量均明显增加,肝窦本身出现扩张与狭窄两种病理改变。结论血吸虫病的病理不仅属窦前性改变,肝窦本身病变在肝纤维化的发生中起着重要作用。彻底杀虫治疗或切脾后,肝纤维化仍可继续发展,今后尚需加强随访与防治,减少晚血的发生与发展。     

Mycophenolate mofetil: fully utilizing its benefits for GvHD prophylaxis

Mycophenolate mofetil (MMF) has been widely used for the prophylaxis of graft-versus-host disease (GvHD) in hematopoietic stem cell transplantation (HSCT), based on clinical evidence established in organ transplantations. MMF is not a cytotoxic, but rather a cytostatic agent, and there have been several reports of significant advantages in engraftment as well as greatly reduced stomatitis compared to methotrexate (MTX). MMF has been preferred for MTX-free immunosuppression, especially in reduced intensity conditioning, but it is suitable for GvHD prophylaxis for any type of HSCT. Some clinicians doubt its effectiveness, due to the lack of advantage over MTX in acute GvHD prophylaxis, especially in myeloablative conditioning. Pharmacokinetics studies of mycophenolic acid (MPA), the active form of MMF, show large inter- and intra-patient variation, which make interpretations of its clinical usefulness difficult. Nevertheless, several studies, including ours, have demonstrated that relatively higher area under the curve (AUC) of the MPA group leads to significant suppression of acute GvHD in prophylactic use. We propose a model algorithm for optimal dose finding using therapeutic drug monitoring (TDM) for MPA. Preemptive strategies depending on plasma MPA levels could yield more effective approaches to GvHD prophylaxis, alternative to MTX.     

低剂量复方尼尔雌醇片和替勃龙对老年女性生命质量和糖脂代谢影响的比较

目的 观察低剂量复方尼尔雌醇片(尼尔雌醇0.5 mg/片,左炔诺酮0.15 mg/片)和替勃龙治疗对老年女性生命质量(QOL)和糖脂代谢的影响.方法 将145例患骨质疏松的老年女性随机分为3组:复方尼尔雌醇组(0.5片/次,1次/w,52例),替勃龙组(1.25 mg/次,隔日1次,53例),安慰剂组(40例),均干预治疗1年.用SF-36量表在基线、治疗0.5、1年时测量患者QOL;用全自动生化仪测定各组治疗前后空腹血糖(FBS)、血脂[甘油三酯(TG)、总胆固醇(TC)、低密度脂蛋白(LDL)、高密度脂蛋白(HDL)]及高敏C反应蛋白(hs-CRP)的值;用红外线扫描及B超监测乳腺,用B超测量子宫内膜厚度,观察对象以日记方式记录阴道出血、乳房胀痛等情况.结果 ①对同一指标不同时间点的差值进行比较,显示复方尼尔雌醇组和替勃龙组,△T0.5年-0、△T1年-0的总体健康、躯体疼痛、心理健康和精力较安慰剂组有显著性差异,二治疗组间以上指标无显著差异(P＞0.05).多变量方差分析结果显示:3个时间点患者QOL差异显著(F=5.78,P＜0.001);3个治疗方案间患者QOL差异有显著性(F=3.92,P＜0.05).②各组治疗前后FBS、TG、TC、LDL均无差异(P＞0.05);复方尼尔雌醇组、替勃龙组治疗后较治疗前HDL显著上升(P＜0.05);替勃龙组治疗后较治疗前CRP显著下降(P＜0.05).③治疗前后子宫内膜和乳腺体层厚度的变化在各组间无显著差异(P＞0.05).结论 低剂量复方尼尔雌醇或替勃龙替代治疗1年均能有效改善老年女性患者QOL,同时未损害糖脂代谢,也未发现子宫内膜和乳腺病变的增加.     

华法令在肺栓塞抗凝治疗中的剂量与使用方法

目的探讨华法令抗凝治疗肺血栓栓塞症（PTE）时尽快达到国际标准化比值（INR）在2—3之间时的剂量及方法。方法分析94例接受华法令口服抗凝治疗的PTE患者的临床资料；比较起始量3mg组与6mg组在华法令治疗第3、5、10天时INR达标情况；计算达标者每日人均华法令用量。结果94例患者中56例有明确达标剂量，占59．6％；所有达标者每日人均华法令用量为4．097mg；3mg组达标25例，6mg组达标22例；抗凝第3、5、10天时6mg组达标人数及百分比均明显高于3mg组（P〈0．05），两组达标时所用的华法令总量平均数皆为29mg左右；6mg组平均达标天数为第5—6天，3mg组为第8～9天（P〈0．05）；随年龄增大华法令需求量下降；94例PTE患者在华法令抗凝期间无一例发生出血，6mg组有1例出现再栓塞。结论使用6mg负荷量的给药方法可使PTE患者在第5～6天尽快达标同时又能避免早期再栓及出血；本组华法令平均个体维持量在4mg／d左右。