Un caso atípico de neoplasia de pulmón / An atypical case of lung neoplasia

Introducción: El cáncer de pulmón se considera el tumor maligno que más muertes produce en el mundo, por encima de otros cánceres y en el 90 por ciento de los casos se diagnostica en estadios avanzados. Objetivos: Describir una forma atípica de presentación de una neoplasia de pulmón. Caso clínico: Paciente masculino de 68 años, fumador de más de 37 años, con antecedentes de insuficiencia cardíaca para lo cual llevó tratamiento con nitrosorbide (10 mg) 1 tableta cada 8 horas y aspirina (125 mg) 1 tableta al día. Refirió dolor en miembro inferior izquierdo, intenso que no se aliviaba durante todo el día y se exacerbaba con los movimientos y esfuerzos físicos. Además, presentó aumento de volumen en la región anterior media del tórax, de aproximadamente 15 cm de longitud, dura, dolorosa, de bordes regulares, superficie lisa. No tuvo tos, disnea, fiebre u otra sintomatología. Conclusiones: El paciente tuvo una forma diferente de presentación de la neoplasia de pulmón. No presentó manifestaciones respiratorias que orientaran hacia la identificación de una causa pulmonar. Es necesaria la identificación del patrón cancerígeno, así como su estadiaje para prescribir el tratamiento y conducta adecuada (AU)

Introduction: Lung cancer is considered the malignant tumor that produces more deaths in the world over other cancers and in 90 percent of cases they are diagnosed in advanced stages. Objectives: To describe an atypical form of presentation of lung neoplasia. Clinical case: A 68-year-old male patient, a smoker over 37 years of age, with a history of heart failure for which he was treated with nitrosorbide (10 mg) 1 tablet every 8 hours and aspirin (125 mg) 1 tablet per day. He reported pain in the lower left limb, which was not relieved throughout the day and was exacerbated by physical movements and efforts. In addition, there was an increase in volume in the middle anterior region of the chest, approximately 15 cm long, hard, painful, with regular edges, smooth surface. He had no cough, dyspnea, fever or other symptoms. Conclusions: The patient had a different form of lung neoplasia presentation. He did not present respiratory manifestations that oriented towards the identification of a pulmonary cause. The identification of the carcinogenic pattern is necessary, as well as its staging to prescribe the appropriate treatment and management(AU)

Formulation and evaluation of transdermal drug-delivery system of isosorbide dinitrate / Formulação e avaliação de sistema transdérmico droga-entrega de dinitrato de isossorbida

The purpose of this study was to develop a reservoir-type transdermal delivery system for isosorbide dinitrate (ISDN). The developed patch consisted of five layers from bottom to top, namely, a temporary liner, an adhesive layer, a rate-controlling membrane, a reservoir and a backing. The effects of chemical penetration enhancers, reservoir materials and rate-controlling membranes on the release behaviour of ISDN from the transdermal patch were studied, and the in vitro release of ISDN from the developed patch was studied and compared with the commercially available ISDN patch. The results showed that there was no significant difference in permeation rates between the developed reservoir-type patch and the commercially available ISDN patch (p> 0.05). Moreover, the cumulative release ratio of the commercially available ISDN patch in 48 h was up to 89.8%, whereas the developed patch was only 34.9%, which meant the sustained release time of the developed patch was much longer than the commercially available ISDN patch, and would promote the satisfaction of the patient...

O objetivo do presente estudo foi desenvolver um sistema de liberação transdérmico do tipo reservatório para o dinitrato de isossorbida (ISDN, abrevitura em Inglês). A formulação transdérmica desenvolvida constou de cinco camadas de baixo para cima, ou seja, um revestimento temporário, uma camada adesiva, uma membrana controladora da taxa de liberação, um reservatório e um reforço. Estudaram-se os efeitos dos potenciadores de penetração química, materiais do reservatório e membranas de controle da taxa de liberação no comportamento da formulação transdérmica de dinitrato de isossorbida. A liberação in vitro da formulação transdérmica de dinitrato de isossorbida desenvolvida foi estudada em comparação com a formulação de dinitrato de isossorbida disponível comercialmente. Os resultados mostraram que não existem diferenças significativa nas taxas de permeação entre o tipo de reservatório desenvolvido e o de dinitrato de isossorbida desenvolvido comercialmente (p>0,05). Ademais, a taxa de liberação cumulativa da formulação de dinitrato de isossorbida disponível comercialmente em 48 horas foi de até 89,8% e a da formulação desenvolvida, de apenas de 34,9%, o que provou que a liberação sustentada da formulação desenvolvida foi muito maior do que a de dinitrato de isossorbida desenvolvida comercialmente, o que promoveria a satisfação do paciente...

Analysis of traditional Chinese medicine syndrome, traditional Chinese medicine and western medicine in 84 697 patients with coronary heart disease based on big data / 中国中药杂志

In order to understand the clinical characteristics of patients with coronary heart disease (CHD) in real world and provide reference for clinical prevention and treatment, this study analyzed informations of patient with CHD in hospital information system. Data from 17 national hospitals were collected. Select patients with coronaryheart disease in diagnosis of the first place in 17 hospitals, general informations and traditional Chinese medicine (TCM) syndrome, complications, medicine were analyzed using frequency method and association rules. This study included 84 697 patients with CHD, the majority of men and in the elderly. The average age of patients was 71 years. The proportion of men to women was about 1. 45: 1. Hospital stay time ranged from 8 to 14 d. The most common total hospitalization cost distribution was 5 000-20 000 RMB. Young patients have a rising trend year by year. The death of patients increased with increasing age. Common complications were hypertension, diabetes, cerebral infarction and hyperlipidemia, 57.24 percent of the CHD patient complicated with hypertension, 21.94 percent patients complicated with diabetes. Among TCM syndrome types, Qi-Yin deficiency and qi deficiency blood stasis were the most common syndromes. Blood stasis was the highest syndrome elements, accounted for 79.97%, followed by Qi deficiency, phlegm, Yin deficiency, and so on. The most common western medicine was aspirin, followed with isosorbide dinitrate, clopidogrel. The most common used traditional Chinese medicine was danhong injection, followed by shuxuetong injection. Combined with removing blood stasis drugs has been more common at present clinical treatment, there were 43.46 percent of patients combined with anti-platelet western drug and injection of removing blood stasis.

Outcome study on parenterally administered shenfu in treatment of coronary heart disease / 中国中药杂志

<p><b>OBJECTIVE</b>To understand the clinical circumstances for the use of parenterally administered Shenfu in the treatment of coronary heart disease, in order to provide a reference guide for its clinical use.</p><p><b>METHOD</b>Information was extracted and summarized on the treatment of coronary heart disease patients, who received parenterally administered Shenfu, from 20 nationwide general hospitals HIS data. Descriptive statistical methods were used to analyze the usage and dosage. Correlation analysis was adopted to analyze information including drug combinations, and outcomes were compared with other combinations.</p><p><b>RESULT</b>Real world HIS data showed that the drug delivery method for parenterally administered Shenfu was intravenous infusion. Treatment courses were from 3 to7 days, at a dosage of 60 mL. The drug combination was mostly with chemical drugs. The most common combinations were Shenfu plus clopidogrel, aspirin and isosorbide dinitrate.</p><p><b>CONCLUSION</b>Parenterally administered Shenfu is a common drug used in the treatment of coronary heart disease. Most of the usage was in accordance with instructions. The chemical combination drugs were mainly clopidogrel, aspirin and isosorbide dinitrate.</p>

Analysis of salvianolate injection combined with usual drugs in treatment of coronary heart disease in real world / 中国中药杂志

<p><b>OBJECTIVE</b>Based on real world research the circumstances of the clinical use of usual drugs combined with salvianolate injection are surveyed.</p><p><b>METHOD</b>Descriptive statistics on the use of salvianolate injection in 18 general hospitals in China.</p><p><b>RESULT</b>In 1 605 patients with coronary heart disease (CHD), salvianolate injection was most frequently (51%) combined with clopidogrel and isosorbide dinitrate. In addition this combination showed a higher clinical effectiveness as compared with other drug combinations.</p><p><b>CONCLUSION</b>In the real world, salvianolate injection combined with usual treatment was found to be more effective than other treatment combinations. In addition practice conformed to the clinical treatment of coronary heart disease (CHD) guidelines for drug use. However, liver and kidney function, routine blood tests and the blood's coagulation function require ongoing monitoring.</p>

The effects and its mechanism of N-arginine chitosan as transdermal enhancer / 药学学报

The purpose of this study is to investigate the penetration effects and mechanism of N-arginine chitosan (ACS). This novel transdermal enhancer with a mimetic structure of cell-penetration peptides was synthesized by introducing hydrophilic arginine groups to the amino-group on chitosan's side chain. The structure of ACS was confirmed by FT-IR, 1H NMR and element analysis. In addition, attenuated total reflection Fourier transform infrared spectroscopy (ATR-FTIR) was used to study the protein conformation and the water content of stratum corneum, and the result suggested that ACS can change the orderly arrangement of the molecules in the stratum corneum, making the stack structure of keratin become loose. And ACS can increase the water content of the stratum corneurn. Inverted fluorescence microscope and flow cytometry were used to examine penetration effect of ACS on Hacat cell. The result confirmed that the uptake of ACS was enhanced with increased substitution degree of arginine by 4-8 folds compared to chitosan. In vitro penetration studies on three electrical types of drugs were carried out using three model drugs of negatively charged aspirin, positively charged terazosin and neutral drug isosorbide mononitrate by the method of Franz diffusion cells. The results showed that ACS has obviously penetration of the negatively charged drug aspirin, and certain penetration of neutral drug issorbide mononitrate, but inhibition of positively charged terazosin. In vivo imaging technology research results show that the ACS can significantly enhance the fluorescence intensity of morin, which is the auto-fluorescence anionic drug. These obtained results suggested that ACS, as a promising transdermal enhancer, can change the structure of the keratinocytes and analog penetrating peptides promote absorption, but have certain selectivity for the drug.

Cardiogenic Shock From Global Myocardial Ischemia Induced by Simultaneous Multivessel Coronary Spasm

Coronary artery spasm is an uncommon, but well recognized, etiology for acute myocardial infarction. However, cardiogenic shock with myocardial infarction resulting from simultaneous multiple coronary artery spasm has been rarely reported, and not in Korea. Recently, we experienced such a case in a 50-year-old Korean man without previous diagnosis of variant angina. The patient, hospitalized for blood sugar control, developed severe chest pain accompanying ST-segment elevation in multiple leads. The patient immediately received cardiac catheterization because of cardiogenic shock. Coronary angiogram revealed the severe and simultaneous spasm of three major epicardial arteries, which was promptly relieved by an intracoronary administration of isosorbide dinitrate. This case highlights the need to rule out the potential mechanism of coronary spasm even in the most severe episodes of acute coronary syndrome.

Efeito do dinitrato de isossorbida sobre a hiperalgesia corneana induzida por lipopolissacarídeo / Isosorbide dinitrate effect on corneal hyperalgesia induced by lipopolysaccharide

OBJETIVO: Avaliar o efeito do dinitrato de isossorbida (DNI) sobre a hiperalgesia corneana e a infiltração de neutrófilos em um modelo experimental de ceratite superficial induzida pelo lipopolissacarídeo (LPS). MÉTODOS: A hiperalgesia foi estudada através da indução de uma ceratite inflamatória em ratos (n = 60), pela exposição da córnea ao LPS (LPS +). Após a exposição, os olhos foram tratados durante quatro dias, com as soluções tópicas: DNI (200 mg, 65 mg e 20 mg), prednisolona 1 por cento (PRED) ou Veículo. Olhos controles foram expostos apenas à solução salina (LPS -). Para avaliar a dor ocular, contouse o número de piscadas em 40 segundos, após instilação de uma gota de capsaicina 0,01 mM. A análise histopatológica foi realizada para avaliação da infiltração neutrofílica. RESULTADOS: Foram observadas áreas esbranquiçadas no estroma corneano dos olhos com a ceratite induzida pelo LPS, entre os dias 3 e 15 dias. Esses olhos (LPS +) apresentaram um número significativamente maior de piscadas que os LPS - (P = 0,019) à estimulação química. O tratamento tópico com o DNI reduziu o número de piscadas observadas (P = 0,010). Da mesma forma, olhos expostos ao LPS e tratados com DNI demonstraram redução significativa na infiltração neutrofílica (P = 0,0031). CONCLUSÃO: Baixas doses de DNI reduziram a hiperalgesia corneana e a infiltração neutrofílica nesse modelo de ceratite. Dessa forma, doadores de óxido nítrico, como o DNI, poderão ser úteis no futuro ao tratamento clínico de diversas condições dolorosas da superfície ocular.

PURPOSE: To analyze effects of isosorbide dinitrate (DNI) on corneal hyperalgesia and neutrophil infiltration in an experimental model of superficial keratitis induced by lipopolysaccharide (LPS). METHODS: Hyperalgesia was studied through the induction of inflammatory keratitis in rats (n=60), by corneal exposure to LPS. Following exposure, the inflamed eye was treated for four days, with one of the following solutions: topical DNI (200 λg, 65 λg and 20 λg), prednisolone 1 percent (PRED), and vehicle. Saline-exposed eyes (LPS -) underwent the same protocol. To evaluate ocular pain, the number of blinks in 40 seconds was counted, after one drop of 0.01 λM capsaicin. Histopathological analysis was performed with evaluation of neutrophil infiltration. RESULTS: White clouding areas were observed in the corneal stroma of eyes with LPS-induced keratitis, between day 3 and day 15. Eyes exposed to LPS had a significantly higher number of blinks than LPS - (P=0.019). Topical treatment of LPS-induced keratitis eyes with DNI reduced capsaicin-induced blinks (P=0.010). Similarly, eyes exposed to LPS and treated with DNI also displayed reduced neutrophil infiltration (P=0.0031). CONCLUSION: Low doses of topical NO donors, like DNI, reduce corneal hyperalgesia and neutrophil infiltration in this keratitis model. NO donors may be useful in the clinical treatment of painful conditions associated with surgical procedures of the ocular surface.

Espasmo coronariano no pós-operatório de cirurgia de revacularização do miocárdio sem circulação extracorpórea: Diagnóstico e manejo / Coronary-artery spasm after coronary artery bypass graft surgery without extracorporeal circulation: Diagnostic and management

O espasmo de artérias coronárias no perioperatório de cirurgia de revascularização do miocárdio é uma complicação grave, com elevada mortalidade. Paciente de 51 anos submetido à cirurgia de revascularização do miocárdio sem circulação extracorpórea. Apresentou no 1ºdia de pós-operatório (PO) alteração enzimática e supradesnivelamento do segmento ST, evoluindo, em seguida, em fibrilação ventricular, com reanimação cardiopulmonar com sucesso. Cateterismo cardíaco demonstrou espasmo importante de todas as artérias coronárias e da anastomose entre artéria torácica interna esquerda com artéria interventricular anterior. Utilizados vasodilatadores intracoronarianos e intra-enxerto, com restabelecimento de seus calibres usuais, imediata melhora clínica e estabilidade hemodinâmica. Com evolução satisfatória, o paciente recebeu alta hospitalar no 13º PO.

Coronary artery spasm in perioperative of coronary artery bypass graft surgery is a serious complication, with high rate mortality. Patient 51 years-old submitted to coronary artery bypass graft surgery without Extracorporeal Circulation. The patient evolved in 1st post operative (PO) day with enzymatic alteration and ST-elevation, developing soon afterwards in ventricular fibrillation, defibrillation with success. Cardiac catheterization showed important spasm of all coronary arteries and anastomosis between the left internal thoracic artery and the left anterior interventricular artery. Intracoronary Vasodilators and intra-graft, with re-establishment of their usual and immediate calibers to improve clinic and Hemodynamic stability was used. Satisfactory evolution, discharged at 13rd PO day.

Características e resultados do teste de inclinação na população sintomática: [revisão] / Characteristcs and results of tilt table testing in symptomatic population: [review] / Características y resultados de la prueba de inclinación en la población sintomática: [revisión]

Síncope é um sintoma de prevalência significativa na população geral e possui prognóstico variável de acordo com sua etiologia. O teste de inclinação ou Tilt-teste é um exame útil na investigação dos pacientes com Síncope, Hipotensão Postural e Disautonomia e trata-se de um exame já rotineiro em nosso meio. Objetivo: Analisar o índice de positividade do exame, além dos seus tipos de respostas mais comuns, e a necessidade do uso da sensibilização com dinitrato de isossorbida no auxílio do diagnóstico. Material e métodos: Entre o período de março de 2005 a junho de 2009, foram avaliados 348 pacientes submetidos ao Tilt-teste, dentre os quais, 244(70,1%) pacientes eram do sexo feminino com idade média de 36 anos. Resultados: O Tilt-teste foi negativo em 163(46,8%) pacientes. Nos exames positivos, o tipo mais comum de resposta foi a vasodepressora em 113(32,47%) pacientes, seguido pela resposta mista em 56(16,1%) pacientes e cardioninibiotória em 14(4%) pacientes. Dois pacientes apresentaram quadros de Disautonomia e Síndrome da Taquicardia Postural Ortostática (POTS). O tempo médio para positivação dos exames foi de 28 minutos após início da ortostase, sendo que, em 166(89,72%) pacientes, foi necessário uso de sensibilização com dinitrato de isossorbida por via sublingual. Conclusão: Na população estudada, observamos que o Tilt-teste foi positivo em 53,2% dos casos. Dentre esses pacientes, a forma mais comum de resposta da síncope neurocardiogênica foi a vasodepressora em 113 pacientes, sendo que o uso da sensibilização foi necessário em quase 90% dos pacientes na positivação dos exames.

Syncope is a symptom of significant prevalence in the general population and has changeable prognostic in accordance with its etiology. The inclination test or Tilt table test is a useful examination in the investigation of patients with syncope, postural hypotension and disautonomy and it is a routine examination already in our way. Objective: To analyze the positive rate of the exam, in addition to its most common types of response and the need of sensitization with isosorbide dinitrate to aid the diagnosis. Material and methods: 348 patients submitted to Tilt table test were evaluated between March of 2005 and June of 2009, 244 (70.1%) females at the mean age of 36 years. Results: The Tilt table test was negative in 163 (46.8%) patients. In the positive exams the most common type of response was the vasodepressor in 113 (32.47%) patients, followed by the mixed response in 56 (16.1%) patients and cardioinhibitory in 14 (4%) patients. Two patients had history of disautonomy and Postural Ortostatic Tachycardia Syndrome (POTS). The average time for positivation of the examinations was of 28 minutes after the beginning of the ortostasis, in 166 (89.72%) patients the use of sensitization with isosorbide dinitrate via sublingual was necessary. Conclusion: In the studied population weobserve that the Tilt table test was positive in 53,2% of the cases. Among these patients the most common response of neurocardiogenic syncope was the vasodepressor in 113 patients and the use of the sensitization was necessary in almost 90% of the patients in the positivation of the examinations.

Síncope es un síntoma de prevalencia significativa en la población general y tiene pronóstico variable de acuerdo con su etiología. La prueba de inclinación o Tilt-test es un examen útilen la investigación de los pacientes con Síncope, Hipotensión Postural y Disautonomia y ya se trata de un examen de rutina en nuestro medio. Objetivo: Analizar el índice de positividad del examen, además de sus tipos de respuestas más comunes, y la necesidad del uso de la sensibilización con dinitrato de isosorbida para ayudar el diagnóstico. Material y métodos: Entre el período de marzo de 2005 y junio de 2009, se evaluaron a 348 pacientes sometidos al Tilt-test, entre los cuales, 244 (70,1%) pacientes eran del sexo femenino con edad media de 36 años. Resultados: El Tilt-test fue negativo en 163 (46,8%) pacientes. En los exámenes positivos, el tipo más común de respuesta fue la vasodepresora en 113 (32,47%) pacientes, seguido de la respuesta mixta en 56 (16,1%) pacientes y cardioinhibitoria en 14 (4%) pacientes. Dos pacientes presentaron cuadros de Disautonomia y Síndrome de Taquicardia Postural Ortostática (POTS). El tiempo medio para positivación de losexámenes foi de 28 minutos tras el inicio de la ortostasis, siendo que, en 166 (89,72%) pacientes, fuenecesario el uso de sensibilización con dinitrato de isosorbida por vía sublingual. Conclusión: En la población estudiada, observamos que el Tilt-test fue positivo en el 53,2% de los casos. Entre dichos pacientes, la forma más común de respuesta del síncope neurocardiogénico fue la vasodepresora en 113 pacientes, siendo que el uso de la sensibilización fue necesario en casi el 90% de los pacientes en la positivación de los exámenes.

randomized clinical trial of pre-induction cervical ripening by isosorbide mononitrate at term prgnancy

Induction of labor is deemed successful when it initiates uterine contractions, progressively dilates and effaces the cervix, and leading to the normal vaginal birth of the baby with no maternal or fetal complications. Because the success of induction is related to cervical ripening, artificial cervical ripening before labor induction is used when the cervix is unfavorable to reduce the associated risk of cesarean delivery. To test the efficacy and safety of Isosorbide mononitrate for cervical ripening before the induction of labor at term, from. A randomized clinical trial was conducted in maternity hospital in Sulaimani, from the 1st of January 2008 to the 1st of July 2008. Forty six pregnant women with gestational age of [37- 42] weeks, singleton, viable, low risk pregnancy and cephalic presentation with Bishop score of less than 6 were selected for induction of labor for various causes. Forty eight hours before induction, 40 mg IMN [2 tablets of 20 mg] were inserted vaginally up to 3 doses 16 hours apart. It was found that the mean +/- SD Bishop score before IMN administration was [1.95 +/- 1.5], while after IMN was [6.65 +/- 3.06] P-value = 0.0001. Sixteen cases [35.6%] went to active labor. The mean +/- SD time of admission in labor room was [5.06 +/- 3.8] hours.43 cases [93.5%] needed oxytocin for their inductions and eighteen cases [39.1%] were delivered by C/S. There was no significant change in FHR before and after IMN and all women delivered active babies with normal Apgar score. The main side effect was headache which was experienced by 31cases [63.4%]. IMN is an effective and safe agent for cervical ripening which can be used as an outpatient basis

Influence of drug treatment on glucocorticoid receptor levels in patients with coronary heart disease / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>Glucocorticoid signaling exerts major roles in inflammation, metabolism and depression, which are three crucial factors accompanying or underlying coronary heart disease. Although accumulating evidence indicates the influence of glucocorticoids on the pathology and treatment of coronary heart disease, there is still a dearth of pharmaceutical mechanisms for this relationship. This study aimed to investigate the influence of drug treatment on glucocorticoid receptor levels in coronary heart disease.</p><p><b>METHODS</b>Eighty hospitalized patients (average age (59.0 +/- 7.5) years, 46 male and 34 female) with coronary heart disease were categorized into four groups with 20 members in each according to one of the four drugs they were treated with. The four drugs were: nitrated derivative isosorbide dinitrate, the beta-adrenergic receptor blocker metoprolol, the calcium antagonist nifedipine, and the HMG-CoA reductase inhibitor lovastatin. Glucocorticoid receptor protein levels of peripheral blood lymphocytes were tested using immunoblotting analysis before and after one month of treatment.</p><p><b>RESULTS</b>Immunoblotting analysis showed increased glucocorticoid receptor levels after treatment with metoprolol and nifedipine. There were no statistically significant changes of glucocorticoid receptor levels after treatment with isosorbide dinitrate or lovastatin, although there were trends of up-regulation of glucocorticoid receptor expression after both treatments.</p><p><b>CONCLUSIONS</b>Both the beta-blocker and the calcium blocker can increase glucocorticoid receptor levels after chronic administration. This effect suggests a mechanism for their anti-inflammatory and other therapeutic roles for coronary heart disease and comorbid disorders.</p>

Study of efficacy and safety of a new local cream ("healer") in the treatment of chronic anal fissure: a prospective, randomized, single-blind, comparative study / Estudo da eficácia e segurança de novo creme cicatrizante para o tratamento da fissura anal crônica: estudo prospectivo, randomizado, simples-cego e comparativo

OBJECTIVES: To determine the efficacy and safety of "healer" cream as monotherapy in the treatment of acute and chronic anal fissure. STUDY DESIGN: A prospective, randomized, single blinded, comparative trial. METHODS: Sixty patients suffering from anal fissure were included in the study. Patients were randomly divided into three groups: group A: treated with "healer" local cream application 3 times daily; group B: treated with nitroglycerine 0.25 percent local cream 3 times daily; group C: treated with a lidocaine 2 percent cream applied locally 3 times daily. All the followings were followed up and compared between groups. (1) Visual pain analogue score after defecation; (2) severity of straining and discomfort during defecation; (3) frequency of ulcer healed at 30 days; (4) any side effects or complications. RESULTS: The pain scoring after defecation was significantly reduced in the three treatment groups. The group treated with "healer" isosorbide-di-nitrate showed the greatest reduction of the visual pain analogue score median from 9 before treatment to 3 & 1 after 10 and 20 days respectively, while the median visual pain analogue score in group B treated with nitroglycerine cream was 9 reduced to 4 & 2 after 10 and 20 days respectively, and the median visual pain analogue score in lidocaine group only dropped from 9 to 6 and 4, respectively. The reduction of both pain scoring and defecation scoring with "healer" was statistically significantly greater than the other two treatments by Kruskal-Wallis test, P<0.001. The number of patients experiencing complete relief and passing stools easily after 10 days was significantly higher in "healer" group, by Pearson Chi square = 22.94, P<0.001. After 30 days, the fissures were healed in 18 (90 percent) of 20 patients in the "healer" group and in 12 (60 percent) of 20 in the nitroglycerin group, while only 6 (30 percent) of patients treated with lidocaine cream had their fissures healed by ...

OBJETIVOS: Determinar a eficácia e segurança de "creme cicatrizante" (dinitrato de isosorbida 1 por cento; lidocaína 2 por cento; rutosídios 5 por cento em base de creme anti-séptico) como monoterapia no tratamento da fissura anal aguda ou crônica. METODOLOGIA: Estudo prospectivo, randomizado, simples-cego, comparativo. Foram incluídos 60 pacientes com fissura anal. Foram divididos randomicamente em três grupos: grupo A: tratados com "creme cicatrizante", grupo B: tratados com creme de nitroglicerina 0,25 por cento e grupo C: tratados com creme de lidocaína 2 por cento aplicado. Em todos foi feita aplicação local 3 vezes ao dia. Os seguintes parâmetros foram aferidos: 1) escore analógico visual de dor após defecação, 2) severidade de esforço e desconforto para evacuar, 3) frequência da cicatrização após 30 dias, 4) presença de efeitos colaterais ou complicações. RESULTADOS: O escore de dor após a defecação foi reduzido significativamente nos três grupos. O grupo tratado com creme cicatrizante mostrou grande redução do escore médio de 9 para 3 e 1 após 10 e 20 dias de tratamento, respectivamente, enquanto que a média do grupo B foi reduzida de 9 para 4 e 2 e do grupo C de 9 para 6 e 4 após 10 e 20 dias de tratamento, respectivamente. A redução tanto da dor como do desconforto evacuatório com o uso de "creme cicatrizante" foi significativo em comparação com os outros cremes pelo teste de Kruskal-Wallis, P<0,001. O número de pacientes que referiram alívio completo e passagem fácil da fezes após 10 dias de tratamento foi maior e significativo no grupo A pelo teste Pearson, P<0,001. Após 30 dias, as fissuras estavam cicatrizadas em 18 (90 por cento) pacientes do grupo A, em 12 (60 por cento) do grupo B e em apenas 6 (30 por cento) do grupo C. Qui ao quadrado = 15 (P = 0,001). CONCLUSÃO: O "creme cicatrizante" é um tratamento que promete ser promissor e seguro na fissura anal aguda ou crônica. A característica farmacocinética do creme leva ...

Synthesis and cardioprotective effect of a novel anti-ischemic/reperfused injury compound / 药学学报

The aim of present study is to investigate the cardioprotective effect of a new compound acetyl ferulaic isosorbide (AFI), composed of ferulaic acid (FA) and isosorbide mononitrate (ISMN) by esterification in myocardial ischemia/reperfusion (MI/R). Male Sprague-Dawley rats, subjected to 30 minutes of myocardial ischemia and 3 hours of reperfusion, randomly received one of the following treatments separately: SHAM, I/R (MI/R + solvent), SF (MI/R+SF, 40 mg x kg(-1), ig), ISMN (MI/R + ISMN, 30 mg x kg(-1), ig), SF + ISMN (MI/R + SF + ISMN, 40 mg x kg(-1) + 30 mg x kg(-1), ig) and AFI (MI/R + AFI, 10 mg x kg(-1), ig). Left ventricle developed pressures (LVDP) and the maximal first derivative of developed pressure ( +/-dP / dtmax) were monitored throughout the experiments. Myocardial infarction size, serum creatine kinase (CK) activity, lactate dehydrogenase (LDH) activity, superoxide dismutase (SOD) activity, hydrogen peroxide (H2O2), malondialdehyde (MDA) and nitric oxide (NO) production were determined at the end of reperfusion. Compared with SF, ISMN or SF + ISMN treatment groups, AFI treatment decreased infarction size (n=8, P < 0.01), improved cardiac function as evidenced by increased LVDP and +/- dP/dtmax (n=8, P < 0.05), increased serum SOD activity, reduced serum CK and LDH activities, H2O2 and MDA production (n=8, P < 0.05). The new compound AFI showed a stronger cardioprotective effect against MI/R injury than SF, ISMN or their combined administration did.

Effect of prophylactic continuous infusion of isosorbide dinitrate on myocardial protection and hemodynamics in patients undergoing off-pump coronary bypass surgery

BACKGROUND: Multi-vessel off-pump coronary bypass surgery (OPCAB) imposes cumulative myocardial ischemia/reperfusion injury, which may be attenuated by continuous infusion of nitrate. However, nitrate infusion and consequent decrease in preload may be hazardous during heart displacement which causes restrictive filling of the ventricles. Therefore, we evaluated the effect of nitrate infusion on myocardial protection and hemodynamics in patients undergoing OPCAB, in a prospective, randomized and controlled trial. METHODS: Fifty patients with stable angina and left ventricular ejection fraction >40% undergoing elective, isolated, multivessel OPCAB were enrolled. Patients were randomized equally to either continuous infusion of isosorbide dinitrate 0.5microg/kg/min or same amount of normal saline during the surgery. Operative data including hemodynamic variables, intraoperative ST segment changes and postoperative cardiac enzyme release (creatine kinase-MB, troponin T) were compared. RESULTS: Patients characteristic and operative data including ST segment changes and use of vasopressors were similar between the groups except the total amount of infused crystalloid during the surgery which was significantly higher in the nitrate group. Postoperative variables including cardiac enzyme release were also similar between the groups. CONCLUSIONS: Prophylactic continuous infusion of nitrate during OPCAB exerted no additional benefit in terms of myocardial protection. It also, was not associated with accentuated decrease in cardiac output during heart displacement, and the decrease in preload seems to have been nullified by modest increase in fluid therapy.

Relevância diagnóstica da massagem do seio carotídeo durante teste de inclinação / Diagnostic relevance of the carotid sinus massage during a head up tilt table test (HUTT)

FUNDAMENTO: As síncopes por hipersensibilidade do seio carotídeo (HSC) podem ser pouco diagnosticadas por causa da baixa desconfiança diagnóstica ou do medo de complicações da própria massagem do seio carotídeo. OBJETIVO: Investigar o papel da hipersensibilidade do seio carotídeo (HSC) em desmaios não-convulsivos e quedas inexplicadas. MÉTODOS: Duzentos e cinqüenta e nove pacientes com idade média de 50±24 anos, encaminhados para investigação de desmaios não-convulsivos e quedas inexplicadas, foram submetidos ao Teste da Mesa Inclinada (TI) sem ("passivo") e com provocação farmacológica ("sensibilizado"). Exames clínicos e complementares não revelaram causa óbvia para as queixas. Cinqüenta e cinco voluntários com idade média de 57±21 anos sem história de epilepsia, desmaios e quedas serviram de controles. Todos os participantes foram submetidos ao TI precedido por estimulação digital dos seios carotídeos a zero e a 60º. RESULTADOS: A estimulação dos seios carotídeos foi positiva em 4 controles. O diagnóstico clínico de HSC foi endossado por resposta positiva à estimulação carotídea a 60º em 28 pacientes, em sua maioria homens idosos. A estimulação carotídea foi positiva a 0º em apenas três desses pacientes. Não houve diferença estatística no TI entre os pacientes com e sem HSC. CONCLUSÃO: A estimulação dos seios carotídeos a 60º deve ser incluída na avaliação rotineira de pacientes com desmaios não-convulsivos ou quedas inexplicadas, uma vez que os exames cardiovasculares de rotina, incluindo o TI, não foram úteis para estabelecer o diagnóstico nesses casos. Novos estudos em indivíduos normais são necessários para estabelecer o significado da resposta positiva à estimulação carotídea na ausência de história de desmaios ou quedas.

BACKGROUND: Syncope due to carotid sinus hypersensitivity (CSH) may be underdiagnosed due to a low level of diagnostic suspicion and fear of complications caused by massage of the carotid sinus. OBJECTIVE: To investigate the relevance of carotid sinus massage in the diagnosis of non-convulsive faints and unexplained falls. METHODS: Two-hundred and fifty-nine patients with a mean age of 50±24 years referred for the investigation of non-convulsive faints or unexplained falls were evaluated with a head up tilt table test (HUTT) without ("passive") and with pharmacological stimulation. Clinical and laboratory work-up did not reveal an obvious cause for the complaints. Fifty-five volunteers with a mean age of 57±21 years with no history of seizures, faints or falls were used as controls. All participants underwent a HUTT preceded by digital stimulation of each carotid sinus both at zero and 60º. RESULTS: Carotid sinus massage was positive in 4 controls. The relevance of CSH in the evaluation of syncope was supported by a positive response to carotid sinus massage at 60º in 28 patients, most of whom were elderly men. Carotid sinus massage was positive at 0º in only three of such patients. The results of the HUTT did not show statistical difference between patients with and without CSH. CONCLUSION: Carotid sinus massage at 60º under controlled conditions should be included in the assessment of patients with non-convulsive faints or unexplained falls. Routine cardiovascular exams, including the HUTT, are not useful for the diagnosis in such cases. Further studies in normal individuals are needed to establish the significance of a positive response to carotid sinus massage in the absence of a history of fainting or falling.

Randomized double blind placebo controlled trial of outpatient cervical ripening with isosorbide mononitrate prior to induction of labor

Our aim was to examine the efficacy and safety of isosorbide mononitrate [IMN] for cervical ripening and labor induction. Two hundred and forty pregnant women of at least 41 week gestation with a bishop score <5 were selected for a double blind trial, to randomly receive either 60 mg of vaginal IMN or a vaginal placebo. Fifty-four percent treated with IMN went to active phase of labor compared to thirty-one percent in the placebo group [p<0.01]. Ninty-eight women in the study group had vaginal delivery compared to eighty-two women in the placebo group. Mean interval to active phase of labor had statistical differences between the two groups. Headache was the common side effect with moderate intensity in IMN group. Outpatient cervical ripening and labor induction with isosorbide mononitrate seems to be an effective, safe and well tolerated procedure. Although some of women experienced side effects, no serious clinical maternal or fetal adverse effects were diagnosed. The definitive clinical efficacy and safety need to be evaluated in larger series of patients

A Case of Multiple Intracranial Hemorrhage Associated with Enoxaparin Treatment for an Acute Myocardial Infarction after Resuscitation

We report a rare case of multiple intracerebral hemorrhage, subarachnoid hemorrhage, and intraventricular hemorrhage that developed after successful cardiopulmonary resuscitation (CPR). A 66-year-old man underwent CPR for about 10 minutes in his community hospital. At that time, his only sequela was ST depression in leads V3, and V4 with an ECG. There was no definite parenchymal lesion in the brain computed tomography (CT) scan taken in the community hospital, and the patient was transferred to Wonju christian hospital for post-resuscitation management. Upon arrival, echocardiographic findings showed akinesia of the anterior wall and anteroseptal wall together with decreased ejection fraction (34%). A cardiac enzyme assay showed a CK-MB concentration of 19.4 ng/ml and a troponin-I level of 1.66 ng/ml. He was mentally comatose and both pupils were isocoric and reflexive to light. We concluded that the cause of cardiac arrest was acute myocardial infarction (AMI), and the patient was treated with drugs including aspirin, clopidogrel, enoxaparin-sodium (1 mg/kg subcutaneous), and isosorbide dinitrate. At 10 hours after admission, a follow-up ECG showed ST elevation in lead I, aVL and all leads from V1 to V6. Right anisocoria was seen in neurologic examination at that time. A subsequent brain CT revealed multiple intracerebral hemorrhage, subarachnoid hemorrhage into all cisternal spaces, and intraventricular hemorrhage. Clotting evaluations yielded a prothrombin time (PT) of 14.6 sec., partial thromboplastin time (PTT) of 45.3 sec. and an INR of 1.32, and a hemoglobin count of 16.2 g/dL.

Studies on preparation of isosorbide-5-mononitrate pulsatile controlled-release pellets and various influence factors / 生物医学工程学杂志

We prepared the isosorbide-5-mononitrate pulsatile controlled-release pellets (PCRP) and studied the influencing factors in vitro. The isosorbide-5-mononitrate (5-ISMN) pellets prepared by extrusion-spheronization technology were coated with swelling material as the inner coating swelling layer, and with ethylcellulose aqueous dispersion as the outer coating controlled layer. The influences of the coating materials of the swelling layer, the coating levels of the swelling layer and controlled layer,and the pH values of the media on the release of 5-ISMN from PCRP were investigated. The drug release from the pellets was pulsatile. The ISMN-5-PCRP, with a lag time of 5 h and more than 80% released within the following 1.5 h,were prepared by using the low-substituted hydroxypropyl cellulose as the inner swelling layer with 15% (weight) in coating thickness, and the ethylcellulose aqueous dispersion as the outer controlling layer with 13% (weight) in coating thickness.