Pharmacokinetics--a relevant factor for the choice of a drug?

Pharmacokinetics may be utilized as a tool in the drug development process, either with respect to therapeutics or in allowing a drug's disposition characteristics to be defined. If two drugs of the same class have a similar dose-efficacy profile, then the favourable/unfavourable balance of the pharmacokinetic characteristics of the drugs may determine the drug of choice. Pantoprazole, a proton pump inhibitor, appears to meet the above criteria and has been found to exhibit reliable, predictable pharmacokinetic characteristics as opposed to other members of the class. The pharmacokinetics of pantoprazole over a range of intravenous and oral doses are described in healthy volunteers and are compared with values obtained for omeprazole. Studies in patients with severe cirrhosis, renal failure, and in the elderly are also described as well as potential interactions due to food and five other drugs.     

Quinupristin-dalfopristin-resistant Enterococcus faecium on chicken and in human stool specimens

BACKGROUND: The combination of the streptogramins quinupristin and dalfopristin was approved in the United States in late 1999 for the treatment of vancomycin-resistant Enterococcus faecium infections. Since 1974, another streptogramin, virginiamycin, has been used at subtherapeutic concentrations to promote the growth of farm animals, including chickens. METHODS: To determine the frequency of quinupristin-dalfopristin-resistant E. faecium, we used selective medium to culture samples from chickens purchased in supermarkets in Georgia, Maryland, Minnesota, and Oregon and stool samples from outpatients. RESULTS: Between July 1998 and June 1999, samples from 407 chickens from 26 stores in four states were cultured, as were 334 stool samples from outpatients. Quinupristin-dalfopristin-resistant E. faecium was isolated from 237 chicken carcasses and 3 stool specimens. The resistant isolates from stool had low-level resistance (minimal inhibitory concentration [MIC], 4 microg per milliliter; resistance was defined as a MIC of at least 4 microg per milliliter). The resistant isolates from chickens in general had higher levels of resistance (MICs ranging from 4 to 32 microg per milliliter; MIC required to inhibit 50 percent of isolates, 8 microg per milliliter). CONCLUSIONS: Quinupristin-dalfopristin-resistant E. faecium contaminates a large proportion of chickens sold in U.S. supermarkets. However, the low prevalence and low level of resistance of these strains in human stool specimens suggest that the use of virginiamycin in animals has not yet had a substantial influence. Foodborne dissemination of resistance may increase, however, as the clinical use of quinupristin-dalfopristin increases.     

Bandnaht und/oder Kapsulodese bei skapholunärer Instabilität

We have reviewed 37 patients with scapholunate instability, operated in Paris between 1979 and 1995 7 months after the injury. There were 12 partial and 18 complete ligament ruptures, but also 4 distensions. The repair was a secondary suture in 16 cases (7 direct, 1 transosseous, 1 combined, 5 anchor, 2 transosseous with anchor). A capsulodesis was performed 7 times as an isolated and 8 times as a combined procedure. 6 previous cases have been treated by ligamentoplasty. We present the results after a mean postoperative follow-up of 27 months, with good results on pain and grip, maintaining a satisfactory range of motion.     

The Management of a Pulmonary Artery Aneurysm

A 51-year-old woman with a giant pulmonary artery aneurysm was referred to our department for surgical opinion. Imaging study confirmed a large aneurysmal dilatation of the left pulmonary artery starting in the pulmonary trunk. There was no underlying pathology except for a pulmonary commissurotomy 20 years previously for a significant valvular pulmonary stenosis. The role of surgery in this entity is not well defined. We report the management of one case.     

FDG uptake at the bronchial stump after curative lobectomy for non-small cell lung cancer

Purpose

Focal areas of FDG uptake may occur at the bronchial stump following curative lobectomy for non-small-cell lung carcinoma (NSCLC), even in the absence of suspicious CT changes. The purpose of our study was to investigate the significance of such PET/CT findings.

Methods

FDG-PET/CT scans performed in 54 patients after lobectomy for NSCLC were reviewed. The presence of focal areas of FDG uptake at the bronchial stump, associated CT abnormalities, SUVmax, and normalized SUV (SUVnorm = SUVmax/mean liver SUV) were recorded. Final diagnosis was based on biopsy or imaging follow-up.

Results

Focal areas of FDG uptake at the bronchial stump were detected in 30 patients (56 %). Mean SUVmax was 4.0?±?1.9 (range; 2.2–12.1) and mean SUVnorm was 1.8?±?0.8 (range; 0.9–4.5). Biopsy showed recurrence in two patients. In these patients, SUVnorm was respectively 4.4 and 4.5 (with SUVmax of 8.8 and 12.1), whereas SUVnorm was lower than 4.0 in those without recurrence, with mean SUVnorm of 1.6?±?0.5 (range; 0.9–3.4) and mean SUVmax of 3.6?±?0.9 (range; 2.2–5.8). The CT component of the PET/CT revealed ill-defined peribronchial soft tissue opacity only in both patients with recurrence.

Conclusion

FDG uptake at the bronchial stump is a frequent finding after pulmonary lobectomy. Moderate levels of FDG uptake (i.e., SUVnorm?<?4.0) without corresponding abnormal CT findings might be a dual criterion for diagnosing benign post-surgical changes.

     

The three-way stopcock may be a weak component of total intravenous anaesthesia

Background: An intravenous line is needed to administer anaesthesia, particularly when total intravenous anaesthesia (TIVA) is performed. A disadvantage of TIVA is that the intravenous concentration of anaesthetics cannot be easily measured compared with volatile anaesthetics. If a three-way stopcock is accidentally unscrewed, TIVA drugs cannot reach the patient's veins, thus resulting in inadequate anaesthesia levels, possibly resulting in awareness. We therefore measured the required torque to open five different brands of three-way stopcocks in an attempt to make an intravenous-line including all elements safer.
Methods: The torque required to open one, two or three three-way stopcocks being connected in a perpendicular manner was measured with a biaxial servo hydraulic material testing machine.
Results: The force required to open three-way stopcocks connected with an intravenous catheter ranged in five different stopcock models from 5.03±0.75 to 2.21±0.51 N respectively; with two three-way stopcocks from 2.68±0.42 to 1.31±0.59 N, respectively, and with three three-way stopcocks from 1.29±0.27 to 0.82±0.05 N, respectively.
Conclusion: Turning a three-way stopcock to become loose with possibly leaking drugs requires minimal amounts of force and decreases significantly if not connected in-line.     

Zur Lehre von dem Cheyne-Stokes'schen Phänomen

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