Unsedated transnasal percutaneous endoscopic gastrostomy placement in selected patients.

BACKGROUND AND STUDY AIMS: The placement of a percutaneous endoscopic gastrostomy (PEG) is the procedure of choice for the long-term management of dysphagic patients with neurological disease or with trauma or tumors of the head and neck. It is not always possible to perform conventional upper gastrointestinal endoscopy in such patients due to stenosis and/or occlusion of the mouth or pharynx and/or partial or complete trismus. The aim of this study was to show whether transnasal esophagogastroduodenoscopy (EGD) offers a feasible and effective alternative method for PEG placement in these selected patients. PATIENTS AND METHODS: PEG placement was required for 155 patients at our institution during a 27-month period. In 12 patients oral access of an endoscope into the esophagus was not possible. Unsedated transnasal EGD (T-EGD) was then performed using an ultrathin video gastroscope, which had a distal-end diameter of 5.9 mm. A 16-Fr polyurethane PEG tube with a conical, flexible, soft distal end and a collapsible bumper was used in all cases. The Gauderer-Ponsky pull technique was used for PEG placement. RESULTS: T-EGD and perendoscopic transnasal placement of a PEG tube was successfully performed in all 12 patients. No patient required sedation during the procedure. No immediate or late-onset procedure-related complications occurred in any of the 12 patients. CONCLUSIONS: In some dysphagic patients in whom the oral route is not accessible with a standard endoscope, a transnasal endoscopic approach allows the placement of a PEG tube. In these selected patients this technique has been shown to be safe and effective and does not require the use of sedation.

Avaliaçäo da absorçäo do ferro proteinsuccinilato em diferentes condiçöes bioquímicas gástricas e duodenais / Evaluation of the absorption of iron-protein-succinylate in different gastric and duodenal biochemical conditions

O ferro proteinsuccinilato é um novo preparado de ferro adequado à administraçäo oral. Esta molécula näo libera íons de ferro no pH gástrico (o que melhora a tolerabilidade do produto), mas somente a nível duodenal. A absorçäo do ferro do ferro proteinsuccinilato foi relatada por outros autores que notaram um aumento dos níveis séricos de ferro após a administraçäo oral do composto. Com o mesmo método estudamos a absorçä do ferro do ferro proteinsuccinilato antes e após um período de tratamento de seis semanas com ranitidina, um antagonista dos receptores H2 da histamina (300mgh/dia), em indivíduos com úlcera duodenal. O tratamento con ranitidina näo modificou a absorçäo do ferro do ferro proteinsuccinilato

Tratamento da deficiência de ferro em doadores de sangue: estudo comparativo entre sulfato ferroso e ferro proteinsuccinilato / Treatment of iron deficiency conditions in blood donors: controlled study of irn sulphate versus iron protein succinylate

ferro proteinsuccinilato é um novo preparado de ferro para administraçåo oral. Em estudo comparativo com o sulfato ferroso, em 40 doadores de sangue com baixos níveis de ferro de depósito, o tratamento por 30 dias com o ferro proteinsuccinilato resultou em maior absorçåo do ferro em comparaçåo com a droga de referência. A concentraçåo sérica de feroo aumentou significantemente em comparaçåo com os valores basais somente nos pacientes que receberam o ferro proteinsuccinilato. A quantidade de ferro de depósito, avaliada pelos níveis séricos de ferritina, aumentaram significativamente em ambos os grupos de tratamento

Pharmacodynamic effects of subinhibitory concentrations of imipenem on Pseudomonas aeruginosa in an in vitro dynamic model.

The postantibiotic effect (PAE), sub-MIC effect (SME), and postantibiotic sub-MIC effect (PASME) of imipenem on Pseudomonas aeruginosa were investigated with an in vitro dynamic model reproducing in vivo elimination kinetics of the antibiotic. The PASMEs were constantly longer than the corresponding SMEs, but differences between them were not statistically significant. Both PASMEs and SMEs were initially bactericidal and were significantly longer than PAEs. The mean values of both PASMEs and SMEs were over 12 h. SMEs appear to be more relevant for the bacterial growth kinetics than PAEs.

Bactericidal activity of two different dosage regimens of imipenem in an in-vitro dynamic model.

The antimicrobial activity of imipenem was tested in an in-vitro model mimicking human serum pharmacokinetics after either 1000 mg im once daily or 500 mg im twice daily. Six recent clinical isolates of Staphylococcus aureus, Pseudomonas aeruginosa, Escherichia coli, Proteus mirabilis, Klebsiella pneumoniae and Salmonella group B were used as test strains. Our results suggest that a single daily dose of imipenem 1000 mg im exerts an antibacterial action comparable to that obtained with two divided doses of 500 mg.

Analgesic activity of flupirtine maleate: a controlled double-blind study with diclofenac sodium in orthopaedics.

A controlled, parallel group study of the analgesic efficacy of flupirtine maleate, was compared against diclofenac sodium in 40 orthopaedic patients with post-operative pain. Clinically, both drugs were of equal analgesic efficacy. A mathematical model has been developed, however, to evaluate the speed, intensity and duration of the analgesic effect and provides data which significantly favour flupirtine maleate in the treatment of these patients.

Drug monitoring study of a product containing ferritin.

A drug monitoring study was carried out co-operatively by industry, a university department of clinical pharmacology and a randomly selected sample of general practitioners throughout Italy to collect case history and clinical data on over 10,000 patients with anaemia treated for 2 to 4 months with a preparation containing ferritin plus vitamin B12 co-enzyme and folinic acid. Analysis of the data generated, whilst confirming the effectiveness and tolerability of the study medication, highlighted the usefulness of the research methodology for describing the pattern of use of a drug widely prescribed in general medicine.

Treatment of iron deficiency conditions in blood donors: controlled study of iron sulphate versus iron protein succinylate.

Iron protein succinylate is a new iron preparation for oral administration. In a controlled study versus iron sulphate in 40 blood donors with low levels of stored iron, treatment for 30 days with iron protein succinylate resulted in greater iron absorption compared to the reference drug. Serum iron concentration significantly increased compared with baseline values only in patients given iron protein succinylate. The amount of stored iron, evaluated by serum ferritin levels, significantly increased in both treatment groups.

Effectiveness of pinaverium bromide in the treatment of primitive biliary dyskinesia: 99mTc-P-IDA scintigraphic evaluation.

The 99mTc-P-IDA (technetium-p-iminodiacetic acid) hepatocholangiocholecystoscintigraphy is a diagnostic technique which allows information on the liver biligenetic and excretory capabilities to be obtained. It is, moreover, a test that mirrors closely the anatomic and functional conditions of the cholecyst and choledochus. In this study the authors wanted to verify whether pinaverium bromide, a drug with a documented musculotropic-spasmolytic activity, was able to induce changes in some abnormal instrumental parameters observed in 24 subjects with primitive biliary dyskinesia. The results revealed that the ti values, characteristically longer in those subjects, were significantly reduced in the group of patients treated with pinaverium bromide. On the contrary, in the group of patients treated with placebo, there was no change with respect to this parameter.

Flupirtine: the first Italian experience.

This paper reports the results of five single-dose short-term, controlled clinical trials conducted in Italy with the structurally new analgesic flupirtine. A total of 200 patients were enrolled in the trials. One hundred and two patients received flupirtine, 61 were treated with reference drugs (suprofen and paracetamol) and 37 were on placebo. Analgesic efficacy was evaluated in post-episiotomy pain (2 studies and 70 patients), post-traumatic pain (2 studies and 100 patients) and in 30 post-operative patients. Flupirtine was given as a single dose of 100 mg (one capsule) or as a single day's treatment (100 mg t.i.d.). For suprofen and paracetamol, oral doses of 200 mg and 500 mg respectively were used. A semi-quantitative four- or five-point scale or a linear analogue scale was used to determine the degree of pain. In post-episiotomy pain, the time required to achieve a reduction of 50% of the initial pain was also used. In post-operative pain, flupirtine induced a 69% reduction in the pain score 6 hours after administration, compared with 26% in the placebo group. In post-episiotomy pain and pain due to sport injury, flupirtine showed greater efficacy as judged by the number of patients reporting good and acceptable pain relief, and a faster onset of pain relief than suprofen (episiotomy) or paracetamol plus massage (sport injury). The adverse reaction, nausea, was complained of once only during treatment with flupirtine.

Effects of pinaverium bromide in the premedication of endoscopic retrograde cholangio-pancreatography and on motor activity of the sphincter of Oddi.

A double-blind study was carried out in 18 patients with biliary and pancreatic disease to assess the use of pinaverium bromide in premedication for endoscopic retrograde cholangio-pancreatography and its effects on motor activity of the sphincter of Oddi. Patients were divided at random into three groups. One group received 100 mg pinaverium bromide twice daily for 3 days before and then 100 mg 1 hour before the examination, the second group received placebo, and the third had no medication. All patients received 10 to 20 mg diazepam intravenously 10 minutes before endoscopy. Assessments were made of the transit time of various endoscopic phases and patients' tolerance of the procedure. The effects of treatment on the sphincter of Oddi were estimated by means of endoscopic manometry. The results showed that pinaverium bromide allowed transit time reduction in endoscopic procedure, a greater tolerance on the part of the patient and marked reduction in the amplitude and duration of the phasic activity of the sphincter.