Comparison of the apoptotic effects of topically applied papaverine, diltiazem, and nitroprusside to internal thoracic artery

Abstract Objective: To detect and to compare the apoptotic effects of intraoperatively topically applied diltiazem, papaverine, and nitroprusside. Methods: Internal thoracic artery segments of ten patients were obtained during coronary bypass grafting surgery. Each internal thoracic artery segment was divided into four pieces and immersed into four different solutions containing separately saline (Group S), diltiazem (Group D), papaverine (Group P), and nitroprusside (Group N). Each segment was examined with both hematoxylin-eosin and the terminal deoxynucleotidyl transferase-mediated dUTP-biotin nick end labeling (TUNEL) method in order to determine and quantify apoptosis. Results: Apoptotic cells were counted in 50 microscopic areas of each segment. No significant difference was observed among the four groups according to hematoxylin-eosin staining. However, the TUNEL method revealed a significant increase in mean apoptotic cells in the diltiazem group when compared with the other three groups (Group S=4.25±1.4; Group D=13.31±2.8; Group N=9.48±2.09; Group P=10.75±2.37). The differences between groups were significant (P=0.0001). No difference was observed between the samples of the diabetic and non-diabetic patients in any of the study groups. Conclusion: The benefit of topically applied vasodilator drugs must outweigh the potential adverse effects. In terms of apoptosis, diltiazem was found to have the most deleterious effects on internal thoracic artery graft segments. Of the analyzed medical agents, nitroprusside was found to have the least apoptotic activity, followed by papaverine. Diabetes did not have significant effect on the occurrence of apoptosis in left internal thoracic artery grafts.

Effect of papaverine on left internal mammary artery flow: topical spraying versus perivascular injection method

Abstract Objective: To analyze two techniques of papaverine application, topical spray on the harvested left internal mammary artery (LIMA) and perivascular injection, to find out their ability to improve LIMA flow. Methods: Forty patients were randomized into two groups. In Group 1, papaverine was sprayed on the harvested pedunculated LIMA. In Group 2, papaverine was delivered into the perivascular plane. Drug dosage was the same for both groups. LIMA flow was measured 20 minutes after applying papaverine. Blood flow was recorded for 20 seconds and flow per minute was calculated. The systemic mean pressures were maintained at 70 mmHg during blood collection. The data collected was statistically evaluated and interpreted. Results: The LIMA blood flow before papaverine application in the Group 1 was 51.9±13.40 ml/min and in Group 2 it was 55.1±15.70 ml/min. Statistically, LIMA flows were identical in both groups before papaverine application. The LIMA blood flow, post papaverine application, in Group 1 was 87.20±13.46 ml/min and in Group 2 it was 104.7±20.19 ml/min. The Group 2 flows were statistically higher than Group 1 flows. Conclusion: Papaverine delivery to LIMA by the perivascular injection method provided statistically significant higher flows when compared to the topical spray method. Hence, the perivascular delivery of papaverine is more efficient than the spray method in improving LIMA blood flow.

Effect of local papaverine on arteriovenous fistula maturation in patients with end-stage renal disease / Efeito da papaverina local na maturação de fístulas arteriovenosas em pacientes com doença renal terminal

Abstract Background: Arteriovenous fistula (AVF) maturation is one of the main concerns in patients with end-stage renal disease (ESRD) and finding a strategy for increasing success rate and accelerating fistula maturation is valuable. The aim of this study was to evaluate the effects of papaverine injection on AVF maturation and success rate. Method: This study was a randomized clinical trial that involved 110 patients with ESRD that were referred for AVF construction. Patients were allocated in papaverine group and control group with block randomization according to age and sex. In the case group, papaverine (0.1 or 0.2 cc) was injected locally within the subadventitia of artery and vein after proximal and distal control during AVF construction and in the control group, AVF construction was done routinely without papaverine injection. Results: Maturation time in case and control groups was 37.94 ± 11.49 and 44.23 ± 9.57 days, respectively (p=0.004). Hematoma was not seen in the case group but occurred in one patient in the control group. One patient of the case group developed venous hypertension. Four functional fistulas, 1 (1.8%) in the case group and 3 (5.5%) in the control group, failed to mature (p=0.618). Maturation rate did not differ between the two groups statistically (p=0.101). Conclusion: Local papaverine injection increased vessel diameter and blood flow, increasing shearing stress in both arterial and venous segment of recently created AVF. In this way, papaverine probably can decrease AVF maturation time without an increase in complications.

Resumo Introdução: A maturação da fístula arteriovenosa (FAV) é uma das principais preocupações em pacientes com doença renal terminal (DRT). Assim, é importante identificar estratégias para aumentar as taxas de sucesso e acelerar a maturação da fístula. O objetivo do presente estudo foi avaliar os efeitos da infiltração de papaverina sobre a maturação da FAV e suas taxas de sucesso. Método: O presente ensaio clínico randomizado incluiu 110 pacientes com DRT encaminhados para colocação de FAV. Os pacientes foram randomizados em bloco em função de idade e sexo e alocados nos grupos caso ou controle. Os indivíduos no grupo caso receberam infiltração local de papaverina (0,1 ou 0,2 ml) no plano da sub-adventícia da artéria e veia após o controle proximal e distal durante a construção da FAV. No grupo controle, a construção da FAV foi realizada rotineiramente sem infiltração de papaverina. Resultados: Os tempos de maturação dos grupos caso e controle foram 37,94 ± 11,49 e 44,23 ± 9,57 dias, respectivamente (p = 0,004). Foi observado hematoma em apenas um paciente do grupo controle. Um paciente do grupo caso desenvolveu hipertensão venosa. Quatro fístulas funcionais, uma (1,8%) no grupo caso e três (5,5%) no grupo controle, não amadureceram (p = 0,618). A taxa de maturação não diferiu estatisticamente entre os dois grupos (p = 0,101). Conclusão: A infiltração local de papaverina aumentou o diâmetro do vaso e o fluxo sanguíneo, elevando a tensão de cisalhamento nos segmentos arterial e venoso da FAV recentemente criada. Desta forma, a papaverina provavelmente consegue reduzir o tempo de maturação da FAV sem aumentar as complicações.

The Inhibitory Mechanism on Acetylcholine-Induced Contraction of Bladder Smooth Muscle in the Streptozotocin-Induced Diabetic Rat

Most diabetic patients experience diabetic mellitus (DM) urinary bladder dysfunction. A number of studies evaluate bladder smooth muscle contraction in DM. In this study, we evaluated the change of bladder smooth muscle contraction between normal rats and DM rats. Furthermore, we used pharmacological inhibitors to determine the differences in the signaling pathways between normal and DM rats. Rats in the DM group received an intraperitoneal injection of 65 mg/kg streptozotocin and measured blood glucose level after 14 days to confirm DM. Bladder smooth muscle contraction was induced using acetylcholine (ACh, 10⁻⁴ M). The materials such as, atropine (a muscarinic receptor antagonist), U73122 (a phospholipase C inhibitor), DPCPX (an adenosine A1 receptor antagonist), udenafil (a PDE5 inhibitor), prazosin (an α₁-receptor antagonist), papaverine (a smooth muscle relaxant), verapamil (a calcium channel blocker), and chelerythrine (a protein kinase C inhibitor) were pre-treated in bladder smooth muscle. We found that the DM rats had lower bladder smooth muscle contractility than normal rats. When prazosin, udenafil, verapamil, and U73122 were pre-treated, there were significant differences between normal and DM rats. Taken together, it was concluded that the change of intracellular Ca²⁺ release mediated by PLC/IP3 and PDE5 activity were responsible for decreased bladder smooth muscle contractility in DM rats.

Vasodilatory efficacy and impact of papaverine on endothelium in radial artery predilatation for cabg surgery: in search for optimal concentration

Abstract Objective: The aim of this study was to compare the efficacy of two different papaverine concentrations (0.5 mg/ml and 2 mg/ml) for vasospasm prevention and their impact on endothelium integrity. Methods: We have studied distal segments of radial arteries obtained by no-touch technique from coronary artery bypass graft (CABG) patients (n=10). The vasodilatory effect of papaverine (concentrations of 0.5 mg/ml and 2 mg/ml) was assessed in vitro, in isometric tension studies using ex vivo myography (organ bath technique) and arterial rings precontracted with potassium chloride (KCl) and phenylephrine. The impact of papaverine on endothelial integrity was studied by measurement of the percentage of vessel's circumference revealing CD34 endothelial marker. Results: 2 mg/ml papaverine concentration showed stronger vasodilatatory effect than 0.5 mg/ml, but it caused significantly higher endothelial damage. Response to KCl was 7.35±3.33 mN for vessels protected with papaverine 0.5 mg/ml and 2.66±1.96 mN when papaverine in concentration of 2 mg/ml was used. The histological examination revealed a significant difference in the presence of undamaged endothelium between vessels incubated in papaverine 0.5 mg/ml (72.86±9.3%) and 2 mg/ml (50.23±13.42%), P=0.002. Conclusion: Papaverine 2 mg/ml caused the higher endothelial damage. Concentration of 0.5 mg/ml caused better preservation of the endothelial lining.

The protective effect of Papaverine and Alprostadil in rat testes after ischemia and reperfusion injury

ABSTRACT Objective: To investigate the effect of papaverine and alprostadil on testicular torsion-detorsion injury in rats. Materials and Methods: A total of 40 male Wistar-Albino rats were used in this study. Four hours of right testicular torsion was applied to each group, excluding sham oper- ated group. The torsion-detorsion (T/D), T/D + papaverine and T/D + alprostadil groups received saline, papaverine and alprostadil at the same time as surgical detorsion, respectively. At 14 days after the surgical detorsion, ischaemic changes and the degree of damage were evaluated with Cosentino scoring and the Johnson tubular biopsy score (JTBS). Results: JTBS was determined as 8.8±2.7 in the Sham group, 5.08±1.9 in the T/D+papaverine group, 5.29±2.3 in the T/D +alprostadil group and 2.86±1.9 in the TD group. The JTBS was determined to be statistically significantly high in both the T/D + papaverine group and the T/D + alprostadil group compared to the T/D group (p=0.01, p=0.009). In the T/D + papaverine group, 3 (43%) testes were classified as Cosentino 2, 3 (43%) as Cosentino 3 and 1 (14%) as Cosentino 4. In the T/D +alprostadil group, 5 (50 %) testes were classified as Cosentino 2, 3 (30 %) as Cosentino 3 and 2 (20%) as Cosentino 4. Conclusion: The present study indicated that spermatic cord administration of alprostadil and papaverine showed a protective effect against ischemia/reperfusion injury after right-side testes torsion and histological changes were decreased after testicular ischemia reperfusion injury.

Avoiding liver injury with papaverine and ascorbic acid due to infrarenal cross-clamping: an experimental study

Abstract Objective: Ischemia-reperfusion injury after acute ischemia treatment is a serious condition with high mortality and morbidity. Ischemia-reperfusion injury may result in organ failure particularly in kidney, lung, liver, and heart. In our study, we investigated the effects of papaverine and vitamin C on ischemia-reperfusion injury developed in the rat liver after occlusion-reperfusion of rat aorta. Methods: 32 Sprague-Dawley female rats were randomized into four groups (n=8). Ischemia was induced with infrarenal aortic cross-clamping for 60 minutes; then the clamp was removed and reperfusion was allowed for 120 minutes. While the control group and the ischemia-reperfusion group did not receive any supplementary agent, two other groups received vitamin C and papaverine hydrochloride (papaverine HCL). Liver tissues were evaluated under the light microscope. Histopathological examination was assessed by Suzuki's criteria and results were compared between groups. Results: In ischemia-reperfusion group, severe congestion, severe cytoplasmic vacuolization, and parenchymal necrosis over 60% (score 4) were observed. In vitamin C group, mild congestion, mild cytoplasmic vacuolization and parenchymal necrosis below 30% (score 2) were found. In papaverine group, moderate congestion, moderate cytoplasmic vacuolization and parenchymal necrosis below 60% (score 3) were observed. Conclusion: An ischemia of 60 minutes induced on lower extremities causes damaging effects on hepatic tissue. Vitamin C and papaverine are helpful in reducing liver injury after acute ischemia reperfusion and may partially avoid related negative conditions.

Antioxidant therapy in the elderly with tinnitus / Efeito da terapia com antioxidantes sobre o zumbido em idosos

ABSTRACT INTRODUCTION: Several approaches have been tried for the treatment of tinnitus, from cognitive-behavioral therapies and sound enrichment to medication. In this context, antioxidants, widely used in numerous areas of medicine, appear to represent a promising approach for the control of this symptom, which often is poorly controlled. OBJECTIVE: To evaluate the effects of antioxidant therapy for tinnitus in a group of elderly patients. METHODS: Prospective, randomized, double-blinded, placebo-controlled clinical trial. The sample consisted of 58 subjects aged 60 years or older, with a complaint of tinnitus associated with sensorineural hearing loss. These individuals completed the Tinnitus Handicap Inventory (THI) questionnaire before and after six months of therapy. The treatment regimens were: Ginkgo biloba dry extract (120 mg/day), a-lipoic acid (60 mg/day) + vitamin C (600 mg/day), papaverine hydrochloride (100 mg/day) + vitamin E (400 mg/day), and placebo. RESULTS: There was no statistically significant difference between THI by degree (p = 0.441) and by score (p = 0.848) before and after treatment. CONCLUSION: There was no benefit from the use of antioxidant agents for tinnitus in this sample.

Resumo Introdução: Uma série de abordagens terapêuticas tem sido empregada no tratamento do zumbido, desde terapias cognitivo-comportamentais e de enriquecimento sonoro até terapias medicamentosas. Nesse contexto, os agentes antioxidantes, amplamente utilizados em diversas áreas da medicina, parecem representar uma perspectiva promissora para o controle desse sintoma, que muitas vezes tem um controle clínico insatisfatório. Objetivo: Avaliar os efeitos da terapia com agentes antioxidantes sobre o zumbido em um grupo de pacientes idosos. Método: Ensaio clínico prospectivo, randomizado, duplo-cego e controlado por placebo. A amostra composta de 58 indivíduos com 60 anos ou mais, com queixa clínica de zumbido associado à perda auditiva, do tipo neurossensorial, em graus variados. Esses indivíduos foram submetidos ao questionário THI (Tinnitus Handicap Inventory) antes e após 6 meses de uso da medicação. Os esquemas terapêuticos foram os seguintes: extrato seco de Ginkgo biloba(120 mg/dia), ácido a-lipóico (60 mg/dia) + vitamina C (600 mg/dia), cloridrato de papaverina(100 mg/dia) + vitamina E (400 mg/dia) e placebo. Resultados: O THI após o tratamento foi estatisticamente igual ao THI antes do tratamento, tanto em graus (p = 0,441) quanto em escores (p = 0,848). Conclusão: Não se verificou benefício estatisticamente significativo com o uso de agentes antioxidantes para o zumbido dos indivíduos avaliados.

Application value of Toshiba 320-row dynamic volumetric CT angiography in the diagnosis of venous erectile dysfunction / 中华男科学杂志

<p><b>Objective</b>To investigate the application value of Toshiba 320-row dynamic volumetric CT angiography in the diagnosis of venous erectile dysfunction (VED).</p><p><b>METHODS</b>We enrolled in this study 33 patients diagnosed with ED by audiovisual sexual stimulation screening in the outpatient department. Penile erection was induced in the patients by injection of 2 mg phentolamine plus 30 mg papaverine into the corpus cavernosum, followed by that of contrast agent of iobitridol through the vein and corpus cavernosum successively. Then 320-row dynamic volumetric CT angiography was performed and the images of the corpus cavernosum in the arterial and venous phases were collected and processed.</p><p><b>RESULTS</b>Different degrees of abnormal venous drainage were observed in 29 of the patients, including 7 cases (24.1%) of back deep venous leakage, 6 cases (20.7%) of foot venous leakage, 3 cases (10.3%) of dorsal superficial venous leakage, 1 case (3.5%) of intervertebral venous leakage, 2 cases (6.9%) of cavernous venous leakage, and 10 cases (34.5%) of mixed venous leakage. Ten of the patients underwent surgery, dorsal deep penile vein ligation in 2 cases, dorsal deep vein embedding plus foot vein ligation in 4, and foot vein ligation in the other 4. Eight of the patients were followed up for 3－12 months post-operatively, during which 2 achieved obvious erectile improvement, while the other 6 gained normal penile erection.</p><p><b>CONCLUSIONS</b>Toshiba 320-row dynamic volumetric CT angiography is a reliable method for the diagnosis of VED, which displays the precise location of venous leakage for clinical treatment, with the advantages of clearer images, lower doses of contrast agent and radiation, and faster examination than X-ray penile angiography.</p>

Anterograde Intra-Arterial Urokinase Injection for Salvaging Fibular Free Flap

We present a case of a 57-year-old male patient who presented with squamous cell carcinoma on his mouth floor with cervical and mandibular metastases. Wide glossectomy with intergonial mandibular ostectomy, and sequential reconstruction using fibular osteomyocutaneous free flap were planned. When the anastomosis between the peroneal artery of the fibular free flap and the right lingual artery was performed, no venous flow was observed at the vena comitans. Then re-anastomosis followed by topical application of papaverine and lidocaine was attempted. However, the blood supply was not recovered. Warm saline irrigation over 30 minutes was also useless. Microvascular thromboses of donor vessels were clinically suspected, so a solution of 100,000 units of urokinase was infused once through a 26-gauge angiocatheter inserted into the recipient artery just at the arterial anastomotic site, until the solution gushed out through the flap vena comitans. Immediately after the application of urokinase, arterial flow and venous return were restored. There were no complications during the follow-up period of 11 months. We believe that vibrating injuries from the reciprocating saw during osteotomies and flap insetting might be the cause of microvascular thromboses. The use of urokinase may provide a viable option for the treatment of suspicious intraoperative arterial thrombosis.

Nafamostat Mesilate: Can It Be Used as a Conduit Preserving Agent in Coronary Artery Bypass Surgery?

BACKGROUND: Graft vessel preservation solution in coronary artery bypass surgery is used to maintain the graft conduit in optimal condition during the perioperative period. Nafamostat mesilate (NM) has anticoagulation and anti-inflammatory properties. Therefore, we investigated NM as a conduit preservative agent and compared it to papaverine. METHODS: Sprague-Dawley (SD) rat thoracic aortas were examined for their contraction-relaxation ability using phenylephrine (PE) and acetylcholine (ACh) following preincubation with papaverine and NM in standard classical organ baths. Human umbilical vein endothelial cells (HUVECs) were cultured to check for the endothelial cell viability. Histopathological examination and terminal deoxynucleotidyl transferase dUTP nick end labeling assay were performed on the thoracic aortas of SD rats. RESULTS: The anti-contraction effects of papaverine were superior to those of NM at PE (p90% in various concentrations of both NM and papaverine. A histopathological study showed a protective effect against necrosis and apoptosis (p<0.05) in the NM group. CONCLUSION: NM exhibited good vascular relaxation and a reasonable anti-vasocontraction effect with a better cell protecting effect than papaverine; therefore, we concluded that NM is a good potential conduit preserving agent.

Management of sexual disorders in spinal cord injured patients

Spinal cord injured [SCI] patients have sexual disorders including erectile dysfunction [ED], impotence, priapism, ejaculatory dysfunction and infertility. Treatments for erectile dysfunction include four steps. Step 1 involves smoking cessation, weight loss, and increasing physical activity. Step 2 is phosphodiesterase type 5 inhibitors [PDE5I] such as Sildenafil [Viagra], intracavernous injections of Papaverine or prostaglandins, and vacuum constriction devices. Step 3 is a penile prosthesis, and Step 4 is sacral neuromodulation [SNM]. Priapism can be resolved spontaneously if there is no ischemia found on blood gas measurement or by Phenylephrine. For anejaculatory dysfunction, massage, vibrator, electrical stimulation and direct surgical biopsy can be used to obtain sperm which can then be used for intra-uterine or in-vitro fertilization. Infertility treatment in male SCI patients involves a combination of the above treatments for erectile and anejaculatory dysfunctions. The basic approach to and management of sexual dysfunction in female SCI patients are similar as for men but do not require treatment for erectile or ejaculatory problems

[Peak systolic velocity of cavernosal artery of the penis before and after papaverine injection in erectile dysfunction]

Sexual dysfunction in males is characterized by the inability to achieve or maintain an erection sufficient for a satisfactory sexual activity. Erectile dysfunction is a common disorder in males and intracavernosal injection of papaverine followed by color Doppler ultrasonography of the penis is used to diagnose and treat vascular impotence. In this study, we examined the relationship between changes in peak systolic velocity [PSV] and erectile dysfunction with vascular cause after a cavernosal injection of papaverin. We performed this self-controlled clinical trial in Shahid Hasheminejad Hospital in Tehran, Iran during 2010 and 2011. The study population consisted of 90 patients with erectile dysfunction. The peak systolic velocity [PSV] of cavernosal arteries was evaluated before and after injection of 40-80 mg papaverine and it was compared in the patients with and without response to injection. The mean age of participants was 47.7 +/- 13.7 years. Response to papaverine injection was positive in 41[45.5%] patients. The mean PSV values were 14.68 +/- 5.65 and 53.74 +/- 18.8 cm/s before and after the injection, respectively [P<0.001]. A PSV cut-off point of 10 cm/s was determined for the condition before injection. The sensitivity and specificity of the value for diagnosis of arterial erectile dysfunction were calclulated as 50% and 100%, respectively. A PSV cut-off point of 10 cm/s in flaccid status before papaverine injection has a low sensitivity but high specificity for the diagnosis of arterial erectile dysfunction. Future studies with sufficient cases of arterial erectile dysfunction are necessary for final judgments and suggestion a new cut off point

Effects of papaverine and sodium nitroprusside solution as topical vasodilators for internal mammary artery

To compare the effects of topical sodium nitroprusside [SNP] and papaverine solutions to treat left internal mammary artery spasm. Randomized Control Trial [RCT]. AFIC / NIHD Rawalpindi from Jan 2009 to March 2009. Fifty consecutive patients undergoing elective coronary artery bypass graft surgery [CABG] were randomly assigned to two groups: group N [n=25, Sodium Nitroprusside solution], and group P [n=25, Papaverine]. In each patient, pedicled left internal mammary artery was harvested, five minutes after heparin administration, left internal mammary artery was divided distally; flow per minute was calculated after measuring the free flow for over 15 seconds; this is named [Flow 1.]Then, the pedicled left internal mammary artery was sprayed with the randomized solution, and covered with the test solution soaked sponge. The second flow measurement [Flow 2] was done before commencing cardiopulmonary bypass. A third flow measurement [Flow 3] was recorded just before left internal mammary artery to left anterior descending coronary artery anastomosis, while the patient was on cardio pulmonary bypass. Analysis of variance was applied to detect differences among groups; paired-sample t test was used for left internal mammary artery topical free flow in both groups. Mean left internal mammary artery free flows were as follows: group N, flowl=32.72 +/- 27.67 ml/min, versus group P flowl=23.44 +/- 15.16 ml/min [p<0.148], group N flow2=63.92 +/- 33.40 ml/min versus group P flow2=38.88 +/- 24.54 ml/min [p<0.004], and group N flow3=62.44 +/- 38.38 ml/min versus group P flow3=49.52 +/- 30.29 ml/min [p <.170]. Topical free flow difference amongst the two groups was statistically significant in the flow2 [p< 0.004]; whereas topical mean free flow difference was statistically significant when the groups were individually compared group N flowl:flow2, flow 1: flow 3and flow 2: flow 3 group N [p<.000, .000, .846] and group P [p<.001, .000, .001] respectively. Sodium nitroprusside [SNP] and papaverine solutions are able to treat vascular spasm and increase the flow of left internal mammary artery, when they are used topically. However sodium nitroprusside allows early and better relief of vascular spasm

Simultaneous determination of 5 kinds of alkaloids in Kechuanning tablets by SPE-UPLC under different UV-vis wavelength / 药学学报

The paper is to establish a method for simultaneous determination of 5 kinds of alkaloids in ephedra and poppy which are in Kechuanning tablets. Solid-phase extraction (SPE) was adopted in pretreatment, and a UPLC method with 2 different wavelengths had been developed: 210 nm for the detection of morphine, codeine phosphate, ephedrine hydrochloride and pseudoephedrine hydrochloride, and 251 nm for papaverine hydrochloride. The column used was Acquity UPLC BEH C18 (100 mm x 2.1 mm ID, 1.7 microm) with linear gradient elution using acetonitrile and 0.1% phosphoric acid. The flow rate was 0.4 mL.min-1, and the column temperature was 30 degrees C. The linear response range was 0.375 0 - 12.50 microg.mL-1 for morphine, 0.064 32 - 2.144 microg.mL-1 for codeine phosphate, 0.030 06 - 1.002 microg.mL-1 for papaverine hydrochloride, 1.126 - 37.52 microg.mL-1 for ephedrine hydrochloride, 0.287 8 - 9.592 microg.mL-1 for pseudoephedrine hydrochloride (r = 0.999 7). The average recoveries of these compounds were 99.26%, 100.6%, 95.29%, 100.1% and 97.48%, respectively. This is a more reasonable and credible method of quality control for Kechuanning tablets.

Application of conventional and new biotechnological approaches for improving of morphinane alkaloids production

More than 12,000 alkaloids are known in plants, mostly used as medicine with a world market value of about 4 billion US$. Opium poppy, Papaver somniferum, is the most important economic source of morphinane alkaloids such as morphine, codeine, thebaine, narcotine and papaverine that are exploited by the pharmaceutical industry as analgesics, antitussives and anti-spasmodics. With regard to increasing demand for these compounds, the aim of this review is presenting an outlook of classical breeding programs that successfully applied for enhancing the alkaloid content of opium poppy. The latest biotechnological approaches also are discussed to give an outlook for future trends and possibilities

[ case report of radial artery spasm during anesthesia]

One of the most important drawbacks of radial artery is its tendency toward spasm and one of the rare etiologies of that is recurrent blood sampling of the artery. Other causes are injection of drugs in artery in spite of vein, or using radial artery in cardiopulmonary bypass. Papaverine is a useful drug in vasospasm, but it must be used with special caution to avoid it's complications such as arrhythmia. The patient was a 72 year old man with intestinal gangrene and peritonitis whom was operated in Al-Zahra hospital in 2008. During Laparatomy surgery, because of severe acidosis, blood sampling was done 3 times for blood gas analysis. After being taken to the recovery ward, no radial pulse was detectable in the patient's right hand and severe cyanosis in the same hand was seen. After inserting the arterial catheter in brachial artery, treatment with Papaverine, indications of recovery were seen. Despite the rarity of radial artery spasm during anesthesia, it is very dangerous situation, and anesthesiologist must try to prohibit and be able to manage this problem and have suitable drugs in the operation room

Experimental study on the option of antispasmodic drugs for radial artery in elderly patients with coronary atherosclerotic heart disease / 中华外科杂志

<p><b>OBJECTIVE</b>To compare the relief effect of diltiazem, papaverine and nitroglycerin on radial artery spasm in elderly patients with coronary atherosclerotic heart disease.</p><p><b>METHODS</b>Sixty patients aged beyond 70 years underwent coronary artery bypass grafting (CABG) with autologous radial artery from July 2009 to March 2010. Redundant radial artery was collected and the relief function of different drugs was evaluated through "organ bath" technique in vitro. All the patients were randomly divided into 3 groups based on different antispasmodic drugs: diltiazem, papaverine and nitroglycerin. Thirty seconds free blood flow of radial artery and hemodynamic parameters (heart rate, mean arterial pressure and central venous pressure) were assessed before and after intra-radial administration of diltiazem, papaverine and nitroglycerin in vivo.</p><p><b>RESULTS</b>All three drugs could relieve radial artery spasm in different levels and the eventual relief rate was over 80%. Only nitroglycerin could relax radial artery completely, the relief capacity of nitroglycerin, diltiazem and papaverine decreased in order. There was no significant difference in the hemodynamic parameters before and after the injection. Blood flow of radial artery increased in nitroglycerin group [(42 ± 10) ml/30 s vs. (28 ± 7) ml/30 s, P < 0.05] while there was no significant difference in diltiazem [(23 ± 10) ml/30 s vs. (25 ± 8) ml/30 s, P > 0.05] and papaverine group [(25 ± 10) ml/30 s vs. (24 ± 9), P > 0.05].</p><p><b>CONCLUSIONS</b>Nitroglycerin could relieve vasospasm of radial artery effectively and increased blood flow. Nitroglycerin is the suitable antispasmodic drug for radial artery in the elderly patients with coronary atherosclerotic heart disease compare with diltiazem and papaverine.</p>

Comparison of efficacy of oral drotaverine plus mefenamic acid with paracervical block and with intravenous sedation for pain relief during hysteroscopy and endometrial biopsy.

Background : Office hysteroscopy with endometrial biopsy is usually the first investigation for abnormal uterine bleeding and other uterine diseases. Aims: To evaluate the effect of oral drotaverine with mefenamic acid on pain perception during hysteroscopy and endometrial biopsy and to compare it with that of paracervical block using 1% lignocaine and with that of intravenous sedation using diazepam with pentazocine. Settings and Design : Outpatient gynecological department and open randomized trial. Materials and Methods : One hundred twenty women undergoing hysteroscopy and endometrial biopsy were randomized into 3 groups. Group I received tablet containing drotaverine hydrochloride (80 mg) + mefenamic acid (250 mg), group II received lignocaine paracervically and group III received intravenous diazepam. The intensity of pain during the procedure, 30 and 60 minutes later on visual analog scale (VAS) was assessed. Statistical Analysis : Statistical analysis was performed using Kruskal-Wallis test, with the Bonferroni correction, the t test, and the χ2 test. Results: Groups were similar in age, parity, vaginal birth or relevant medical history. A statistically significant difference in pain scores was noted among the 3 groups during the procedure (group I, 4.13± 1.28; group II, 5.93± 1.26; group III, 5.58± 1.51), (P< 0.001); as well as 30 minutes later (group I, 1.78± 0.89; group II, 2.53± 0.81; group III, 2.23± 0.94), (P< 0.001) and 60 minutes later (group I, 1.2± 0.46; group II, 1.98± 0.83; group III, 1.68± 0.75), (P< 0.001). VAS at different time intervals among the groups was also statistically significant. No adverse effects were observed. Conclusions : Oral drotaverine with mefenamic acid is effective in women undergoing hysteroscopy and endometrial biopsy.