Single- and multiple-dose pharmacokinetics of ceftazidime in infected patients with varying degrees of renal function

To determine the single- and multiple-dose ceftazidime kinetics, we administered ceftazidime, 2 gm intravenous bolus every 12 hours, to 14 infected Chinese patients with various degrees of renal function. Blood samples were drawn in serial after the first and 7th dose and serum ceftazidime concentrations were measured by high pressure liquid chromatography. Ceftazidime concentration-time data were fitted to a two-compartment model with a nonlinear regression program. Ceftazidime kinetics was unaltered by repeated dosing. Both total body clearance and elimination rate constant of ceftazidime decrease significantly in proportion to the creatinine clearance estimated by Bjornsson's method. Renal insufficiency did not modify the steady-state volume of distribution (Vdss) of ceftazidime which, however, appeared to be larger than those reported previously. This larger Vdss may be explained by acute infection process, confinement to bed, and increased extracellular fluid volume as a result of hypoalbuminemia. Our study indicates the estimated creatinine clearance as a useful guide to ceftazidime dosage adjustment and also emphasizes the clinical relevance of conducting kinetic studies of antibiotics in infected patients.     

Distribution of radiolabeled 1-(4-amino-2-methyl-5-pyrimidinyl)methyl-3-(2-chloroethyl)-3-nitros ourea hydrochloride in rat brain tumor: intraarterial versus intravenous administration

To assess the rationale of intraarterial (i.a.) 1-(4-amino-2-methyl-5-pyrimidinyl)methyl-3-(2-chloroethyl)-3-nitrosourea chemotherapy, distribution of 14C-labeled 1-(4-amino-2-methyl-5-pyrimidinyl)methyl-3-(2-chloroethyl)- 3-nitrosourea in rat glioma was studied after i.a. or i.v. infusion. Immediately after infusion, the tumor located in the hemisphere of intracarotid infusion received 4.6-fold higher radioactivity than the tumor located contralaterally to intracarotid infusion and 2.8-fold higher radioactivity than i.v. infusion. The difference was kept up to 30 min after i.a. infusion. Autoradiographic observation indicated rather uniform distribution of the tracer in the central portion of i.a. infusion. However, in the periphery of i.a. infusion, distribution of the tracer was nonhomogenous. The results indicate that i.a. 1-(4-amino-2-methyl-5-pyrimidinyl)methyl-3-(2-chloroethyl)-3-nitrosourea chemotherapy is useful when the tumor has high blood flow and is located in the center of an infused area.     

Serum lidocaine levels during arthroscopy using continuous irrigation with lidocaine

Forty patients with symptoms of internal derangement of the knee were examined arthroscopically under local anesthesia using a continuous irrigation solution of 0.2% lidocaine. Serum levels were measured during and following the procedure to determine peak levels obtained and to assure that toxic levels were not exceeded. The procedure was well tolerated by all patients and found to be adequate by the surgeon. No procedure was terminated because of discomfort. Lidocaine levels ranged from undetectable to 2.5 micrograms/ml with an average of 0.6 microgram/ml. No complications of lidocaine toxicity were noted by the anesthesiologist or the operating surgeon. This technique provides a safe and efficient method of meeting the demands for diagnostic and therapeutic arthroscopy in ambulatory patients.     

Stenotrophomonas maltophilia bacteremia in adults: four years' experience in a medical center in northern Taiwan.

Stenotrophomonas maltophilia has become an important nosocomial pathogen in immunocompromised patients in Taiwan. Patients with underlying diseases such as diabetes, uremia, and solid malignancy are extremely vulnerable to this organism. S. maltophilia bacteremia has a mortality rate of up to 62% if appropriate antibiotics are not instituted early. Knowledge of the risk factors for infection as well as local susceptibility patterns is helpful in determining which patients should receive empirical antibiotics active against S. maltophilia. This study assessed the characteristics of 50 episodes of S. maltophilia bacteremia in 48 patients admitted between March 3, 1999 and May 21, 2003. The new fluoroquinolone levofloxacin showed promising in vitro activity against S. maltophilia in view of the increasing resistance of isolates to trimethoprim-sulfamethoxazole. For patients at risk for S. maltophilia infection, such as those receiving mechanical ventilation in the ICU or those with multiple vascular access devices, the need for antimicrobial agents to which S. maltophilia is normally sensitive should be considered in selecting empiric therapy.     

Transvaginal sonography in the morphological and functional assessment of segmental dilation of the distal ureter.

Primary megaureter presents a spectrum of findings ranging from mild, clinically unimportant, stable ureterectasis to severe, progressive obstructive hydroureteronephrosis. We report a patient with a double uterus and ipsilateral renal dystrophy. A previous imaging study had revealed a double uterus and obstructed left hemivagina, into which a single vaginal ectopic ureter inserted. On follow-up intravenous urography 8 years later, the left kidney was non-functioning, and there was segmental dilation of the distal right ureter. Transvaginal sonography with real-time scanning and Doppler were useful in exploring the morphological and functional status of this dilated distal ureter.     

烤瓷贴面修复20例临床观察

目的评价烤瓷贴面的修复效果。方法选择20例患者制作烤瓷贴面92个。复诊时对烤瓷贴面的边缘适合性,边缘着色及颜色进行评价;同时采用牙龈出血指数和菌斑指数评价治疗前后的牙周状况。观察时间为12～18个月。结果5颗牙烤瓷贴面失败,成功率为95.7%;烤瓷贴面治疗前后牙龈出血指数无显著性差异(P>0.05),治疗后菌斑指数降低(P<0.01)。结论烤瓷贴面具有较好的治疗效果。     

益气活血汤对老年肺心病心衰患者血液流变学的影响

目的探讨益气活血汤对老年肺心病心衰患者血液流变性的影响。方法将48例肺心病心衰患者随机分为两组,均采用常规西医治疗,治疗组加用益气活血汤;观察两组治疗前后血液流变学指标变化情况。结果治疗组治疗前后比较,各项血液流变学指标改变差异有显著性,对照组治疗前后比较无统计学意义;治疗组各项指标与对照组比较差异有显著性。结论益气活血汤对肺心病心衰有改善血液流变性的作用。     

High level of tumor necrosis factor alpha activity of plasma and serum from acute phase hemorrhagic fever with renal syndrome]

The level of TNF-alpha activity of plasma and serum from HFRS acute phase patients was investigated. The level of TNF (tumor necrosis factor) activity of plasma and serum from acute phase patients was higher than that of plasma and serum from convalescent phase patients or from normal group. The higher TNF activity of plasma or serum from acute phase patients was due to TNF-alpha, because the TNF activity was almost completely inhibited by polyclonal mouse serum against rHuTNF-alpha. Also, the increase in TNF-alpha positive ratio of PBMC from acute phase HFRS patients was found as compared to convalescent phase patients or to normal group. All these results strongly suggest that high level of TNF-alpha activity of plasma and serum may be involved in the development of clinic symptoms and pathological lesions during the course of HFRS disease.