Background: Delayed elimination kinetics of steroidal neuromuscular blocking agents have been observed in patients with cirrhosis. Like other steroidal muscle relaxants, rapacuronium may, in part, be eliminated by the liver. To determine the influence of liver disease on its neuromuscular blocking effect, we studied the pharmacokinetics and pharmacodynamics of rapacuronium in patients with cirrhosis.
Methods: Sixteen patients undergoing elective surgery or endoscopy with general anesthesia, eight with cirrhosis and eight with normal liver function, were studied. Anesthesia was induced with fentanyl 2 [mu]g/kg and thiopental 5-7 mg/kg and maintained with 60% nitrous oxide and 0.6-0.8% isoflurane in oxygen and repeated doses of fentanyl 1 [mu]g/kg. Rapacuronium 1.5 mg/kg was administered intravenously before tracheal intubation. Thumb adduction force evoked by supramaximal ulnar nerve stimulation was recorded in 16 patients. Venous blood was sampled at frequent intervals for 8 h. Rapacuronium and its breakdown product Org 9488 were measured in plasma by high-pressure liquid chromatography. Values are reported as median (range).
Results: The central volume of distribution was increased to 131 (104-141) ml/kg in patients with cirrhosis (P < 0.01), compared with 75 (47-146) ml/kg in controls. The total apparent volume of distribution was also increased (P < 0.05) to 331 (284-488) ml/kg in patients with cirrhosis, compared with 221 (124-285) ml/kg in controls. The elimination half-life was 88 (77-102) min in controls and 90 (76-117) min in patients with cirrhosis. Plasma clearance was increased (P < 0.05) to 6.9 (6.1-8.9) ml [middle dot] min-1 [middle dot] kg-1 in patients with cirrhosis, compared with 5.3 (4.2-8.4) ml [middle dot] min-1 [middle dot] kg-1 in controls. Rapacuronium neuromuscular blocking effect was similar between the two groups. Onset time was 65 (40-110) s in controls and of 60 (52-240) s in patients with cirrhosis. Time to return to 90% of thumb adduction force control value was of 49 (28-80) min in controls and 47 (28-71) min in patients with cirrhosis. 相似文献
Background: Because the intensity of neuromuscular block at the diaphragm(DIA) is indirectly assessed, the electromyographic measurementsof the DIA (DIAEMG) from surface electrodes were related toinformation provided by visual estimation of neuromuscular transmissionat the adductor pollicis (AP) and the corrugator supercilii(CSC) during recovery from vecuronium block. Methods: Twelve adult patients were studied during balanced anaesthesia.After induction of anaesthesia and tracheal intubation withoutneuromuscular blocking agent, supramaximal stimulations wereapplied to phrenic, ulnar and facial nerves. During recoveryfrom vecuronium 0.1 mg kg–1 an independent observer blindedto DIAEMG counted visually detectable train-of-four (TOF) atCSC (TOFCSC) and post-tetanic AP (PTCAP) responses. Times torecovery of PTCAP = 1, 5, <10 and >10, and TOFCSC = 1–4responses were related to DIAEMG. Values are means (SD). Results: Reappearance of the first response to PTCAP occurred significantly(P < 0.05) earlier and for a lower recovery of DIAEMG thanthat of TOFCSC [24 (8) min vs 33 (9) min, and 10 (10)% vs 25(8)%, respectively]. With PTCAP 5 response, DIAEMG recoverywas 21 (11)%. Recovery of TOFCSC = 1 and 2 coincided with DIAEMGrecovery of 25 (8)% and 47 (9)%, respectively. Conclusions: PTCAP may better reflect early recovery of vecuronium-inducedDIA paralysis than TOFCSC. The findings suggested that PTCAP 5 warranted deep neuromuscular block of the DIA. 相似文献
Duplication of the urethra is a rare congenital anomaly, usually found in children and adolescents. The authors present a rare case of urethral duplication, presenting in a 58-yr-old man, with symptoms of bladder outlet obstruction. 相似文献
Danon disease is a rare lysosomal disorder. It is due to deficiency of lysosomal-associated protein-2. In human LAMP-2 gene is located at chromosome region Xq24. Danon disease is characterized by hypertrophic cardiomyopathy, skeletal myopathy, mental retardation and retinopathy. To date, the morphological characterization of Danon disease has been limited to endomyocardial and skeletal muscle biopsies. In the current study we demonstrated that electron microscopy of a more accessible tissue, skin biopsies, is a useful method in the diagnosis of Danon disease. 相似文献
OBJECTIVE: To study IL-6, IL-10, IL-12 levels and circulating immune complexes (CIC) containing IgG, IgM or IgA in sera of 14 TAO patients and 12 healthy blood donors. To evaluates the ability of TAO PBMC to produce IL-6, IL-10, IL-12, as well as to detect PBMC apoptosis after stimulation with different stimuli. METHODS: In vitro stimulation of PBMC with lypopolysaccharide (LPS), phytohemagglutinin (PHA), C3 binding glycoprotein from uscuta europea (C3bgp), pokeweed mitogen (PWM), and dexamethasone (DM) were performed. The quantities of the secreted cytokines in sera and in culture supernatants, as well as CIC were detected by ELISA. The apoptosis was assessed according to nuclear morphology, after acridine orange staining, by fluorescence microscopy. RESULTS: Significantly higher IL-6 levels in the patients', than in the controls' sera was found. An increased production of IL-6 and IL-12 in TAO PBMC supernatants was detected, regardless of the stimuli used. A hyporeactivity of TAO PBMC toward IL-10 production was found after C3bgp, LPS, PHA and PWM stimulation, compared to the controls' PBMC. The spontaneous and induced apoptosis was significantly higher in TAO compared to the control group. Increased CIC quantities were detected in 75% of the patients tested. According to the CIC isotype, the IgG CIC positives (75%) prevailed over IgA CIC positives (50 %). CONCLUSION: The altered production of IL-6, IL-12 and IL-10, the increased apoptosis as well as the elevated levels of CIC could be a reason for the persisting immune inflammation in TAO. 相似文献
Histone-to-protamine exchange in haploid spermatids is known to play a central role for male fertility. The present study investigates, for the first time, the effects of vasectomy on the expression of protamines in the rabbit. During normal spermatogenesis, protamine-1 and protamine-2 mRNA were expressed from step 5 round spermatids to step 11 elongated spermatids. In unilaterally vasectomized animals, control testes revealed normal spermatogenesis with normal protamine expression, while vasectomized testes exhibited both normal spermatogenesis and spermatogenic arrest. Some testes with normal spermatogenesis revealed delayed expression of both protamine-1 and protamine-2. Furthermore, multinucleated round spermatids were a regular finding in these testes. In both treated and untreated animals, a higher percentage of spermatozoa from the cauda epididymis had highly condensed chromatin when compared with those from the testis. The percentage of spermatozoa with highly condensed chromatin from testes and epididymides from the vasectomized side of treated animals remained unchanged from controls. As the integrity of nuclear chromatin is important for oocyte fertilization, especially in intracytoplasmic sperm injection (ICSI), where most of the natural selection mechanisms are bypassed, our data add valuable information for the treatment of infertility by ICSI, showing that vasectomy may affect nuclear chromatin integrity of testicular spermatids but not epididymal spermatozoa. Microsurgical epididymal sperm aspiration (MESA), therefore, may be superior to testicular sperm extraction (TESE) in vasectomized patients. 相似文献
We report our clinical opinion for recombinant activated factor VII (NovoSeven, Novo Nordisk, Copenhagen, Denmark) administration in puerperae with massive haemorrhage caused by uterine hypotonia. Four women with severe bleeding in post-placental period received NovoSeven in bolus IV. The blood loss and laboratory changes in hematology and haemostasis parameters are monitored. The right time of application and the mean effective dose of the medication are discussed. The bleeding was ceased in all cases. Decrease in values of Hb, Er and PTT was noted. The mean administered dose of 72 micrograms/kg BW was effective. The laboratory values showed tendency for improvement on the 24 hour after administration and normal levels on discharge. The use of recombinant factor VIIA in puerperae with severe bleeding in the postplacental period is effective and safe enough and could be an alternative to the extreme surgical procedures. 相似文献
Virus pollution was studied in 734 water samples collected from the D?mbovi?a River (310), lakes inside the town of Bucharest (136) and swimming pools (288). The results showed that the works carried out these last years to regularize the D?mbovi?a led to a reduction of the virus pollution rate from 16.6-26.9% in 1984 to 4.16-5% in 1988. As for the lake and swimming pool waters, the pollution rate is directly proportional to the applied general hygiene measures. In summer, in drained lakes strictly controlled from the domestic and industrial sewage discharge point of view, the pollution rate was no higher than 6%, while in the lakes receiving sewage the frequency of isolations was between 12.5 and 18.75%. The same situation was found for swimming pools. A microepidemics of blepharoconjunctivitis was recorded in 1988 at a sport base: viruses were isolated from 20% of the water samples collected from its swimming pool, while virus pollution was about zero in the swimming pool water of some big hotels in Bucharest. 相似文献
Objective To evaluate viability of isolated peripheral blood mononuclear cells (PBMC) and production of cytokines in vitro after stimulation as prognostic factors for survival in sepsis patients.Design Prospective study of the biological response of PBMC in the onset of severe sepsis.Setting Research laboratory of molecular biology and immunology and university hospital ICU, Faculty of Medicine, Trakia University.Patients Twenty-three patients meeting the criteria for severe sepsis, and 14 control subjects.Interventions Isolated PBMC were stimulated in vitro with: C3-binding glycoprotein (C3bgp; 30 µg), lipopolysaccharide (30 µg), phytohemagglutinin (20 µg), pokeweed mitogen (30 µg), and dexamethasone (500 µg).Measurements and results We measured the levels of interleukins (IL) 6, 10, and 12 in culture supernatants. Stimulation with C3bgp and phytohemagglutinin led to significantly lower PBMC secretion of IL-6 in nonsurvivors than in survivors and healthy donors. Stimulation with C3bgp, lipopolysaccharide, and pokeweed mitogen considerably reduced IL-12 production in nonsurvivors. Stimulation with lipopolysaccharide and pokeweed mitogen caused immune cells in nonsurvivors to produce higher levels of IL-10 than in survivors. Survival of PBMC reduced viability for nonsurvivors PBMC, both spontaneously and as induced by lipopolysaccharide or pokeweed mitogen.Conclusions The viability of PBMC at the onset of sepsis and enhanced production of IL-12 and diminished production of IL-10 after stimulation with all stimuli used may be a favorable prognostic factor in sepsis. 相似文献