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1.
Chem Pharm Bull (Tokyo) ; 72(1): 36-40, 2024 Jan 01.
Article in English | MEDLINE | ID: mdl-37899177

ABSTRACT

The spectrum of 31P-NMR is fundamentally simpler than that of 1H-NMR; consequently identifying the target signal(s) for quantitation is simpler using quantitative 31P-NMR (31P-qNMR) than using quantitative 1H-NMR (1H-qNMR), which has been already established as an absolute determination method. We have previously reported a 31P-qNMR method for the absolute determination of cyclophosphamide hydrate and sofosbuvir as water-soluble and water-insoluble organophosphorus compounds, respectively. This study introduces the purity determination of brigatinib (BR), an organophosphorus compound with limited water solubility, using 31P-qNMR at multiple laboratories. Phosphonoacetic acid (PAA) and 1,4-BTMSB-d4 were selected as the reference standards (RSs) for 31P-qNMR and 1H-qNMR, respectively. The qNMR solvents were chosen based on the solubilities of BR and the RSs for qNMR. CD3OH was selected as the solvent for 31P-qNMR measurements to prevent the influence of deuterium exchange caused by the presence of exchangeable intramolecular protons of BR and PAA on the quantitative values, while CD3OD was the solvent of choice for the 1H-qNMR measurements to prevent the influence of water signals and the exchangeable intramolecular protons of BR and PAA. The mean purity of BR determined by 31P-qNMR was 97.94 ± 0.69%, which was in agreement with that determined by 1H-qNMR (97.26 ± 0.71%), thus indicating the feasibility of purity determination of BR by 31P-qNMR. Therefore, the findings of this study may provide an effective method that is simpler than conventional 1H-qNMR for the determination of organophosphorus compounds.


Subject(s)
Organophosphorus Compounds , Protons , Reference Standards , Water , Solvents
2.
Chem Pharm Bull (Tokyo) ; 70(12): 892-900, 2022 Dec 01.
Article in English | MEDLINE | ID: mdl-36223954

ABSTRACT

Quantitative 1H-NMR (1H-qNMR) is useful for determining the absolute purity of organic molecules; however, it is sometimes difficult to identify the target signal(s) for quantitation because of their overlap and complexity. Therefore, we focused on the 31P nucleus because of the simplicity of its signals and previously reported 31P-qNMR in D2O. Here we report 31P-qNMR of an organophosphorus compound, sofosbuvir (SOF), which is soluble in organic solvents. Phosphonoacetic acid (PAA) and 1,4-bis(trimethylsilyl)benzene-d4 (1,4-BTMSB-d4) were used as reference standards for 31P-qNMR and 1H-qNMR, respectively, in methanol-d4. The purity of SOF determined by 31P-qNMR was 100.63 ± 0.95%, whereas that determined by 1H-qNMR was 99.07 ± 0.50%. The average half bandwidths of the 31P signal of PAA and SOF were 3.38 ± 2.39 and 2.22 ± 0.19 Hz, respectively, suggesting that the T2 relaxation time of the PAA signal was shorter than that of SOF and varied among test laboratories. This difference most likely arose from the instability in the chemical shift due to the deuterium exchange of the acidic protons of PAA, which decreased the integrated intensity of the PAA signal. Next, an aprotic solvent, dimethyl sulfoxide-d6 (DMSO-d6), was used as the dissolving solvent with PAA and sodium 4,4-dimethyl-4-silapentanesulfonate-d6 (DSS-d6) as reference standards for 31P-qNMR and 1H-qNMR, respectively. SOF purities determined by 31P-qNMR and 1H-qNMR were 99.10 ± 0.30 and 99.44 ± 0.29%, respectively. SOF purities determined by 31P-qNMR agreed with the established 1H-qNMR values, suggesting that an aprotic solvent is preferable for 31P-qNMR because it is unnecessary to consider the effect of deuterium exchange.


Subject(s)
Magnetic Resonance Imaging , Sofosbuvir , Deuterium , Magnetic Resonance Spectroscopy , Reference Standards , Solvents
3.
Sci Rep ; 12(1): 2993, 2022 02 22.
Article in English | MEDLINE | ID: mdl-35194070

ABSTRACT

The aim of this study was to evaluate influence of baseline imaging features on visual and anatomical outcomes in eyes with PCV treated with anti-VEGF monotherapy. In this prospective study we enrolled participants with treatment-naïve PCV who followed a treat-and-extend protocol using intravitreal aflibercept (IVA) monotherapy. Baseline clinical features evaluatedincluded best corrected visual acuity (BCVA), traditional features such as lesion size, fluid-related OCT parameters and novel parameters using automated software. This included quantitative and qualitative pigment epithelium detachment (PED) parameters [height, volume]; and choroidal parameters. [choroidal thickness (CT), choroidal volume (CV) and choroidal vascularity index (CVI). We evaluated the predictive value of each parameter on visual and anatomical outcome at month 12. We additionally evaluated initial treatment response after 3 monthly injections with respect to month 12 outcomes. Fifty-two eyes from 52 participants were included in the study. The BCVA increased from 61.1 ± 13.2 to 69.6 ± 13.2 early treatment diabetic retinopathy study (ETDRS) letters (p < 0.01) and CRT reduced from 455.7 ± 182.4 µm to 272.7 ± 86.2 (p < 0.01) from baseline to month 12. The proportion of eyes with PED decreased significant from 100% at baseline to 80% at month 12 (p < 0.01). Reduction in the mean maximum height of PED (from 381.3 ± 236.3 µm to 206.8 vs ± 146.4 µm) and PED volume (from 1322 ± 853 nl to 686 ± 593 nl) (p < 0.01) was also noted from baseline to month12. Baseline features associated with better month 12 BCVA included baseline BCVA (ß = - 0.98, 95%CI - 3.38 to - 1.61, p = 0.02) and baseline CRT (ß = - 0.98, 95%CI - 1.56 to - 0.40, p = 0.04) while the disease activity at month12 was significantly associated with lower baseline CRT (366.0 ± 129.5 vs 612.0 ± 188.0 , p < 0.001), lower baseline PED height (242.0 ± 150.0 vs 542.0 ± 298.0 µm, p < 0.01), lower baseline PED volume (0.6 ± 0.3 mm3 vs 2.2 ± 1.3 mm3 vs, p < 0.01), lower proportion with marked CVH (17.9% vs 46.2%, p = 0.02) and lower mean CVI (61.8 ± 1.4 vs 63.0 ± 1.4, p < 0.02). Additionally, a larger decrease in CRT (per 100 nm) and larger PED volume reduction (per 100 nl) at month 3 from baseline were associated with greater BCVA gain and inactive disease. PED-related volumetric parameters have an additional predictive value to traditional biomarkers of disease activity in eyes with PCV undergoing anti-VEGF monotherapy. With increasingly precise quantification, PEDs can be a crucial biomarker in addition to traditional parameters and may aid in retreatment decisions.


Subject(s)
Choroidal Neovascularization/diagnostic imaging , Macular Degeneration/diagnostic imaging , Tomography, Optical Coherence/methods , Aged , Biomarkers , Choroidal Neovascularization/drug therapy , Female , Humans , Intravitreal Injections , Macular Degeneration/drug therapy , Male , Middle Aged , Prospective Studies , Receptors, Vascular Endothelial Growth Factor/administration & dosage , Recombinant Fusion Proteins/administration & dosage , Retinal Detachment/pathology , Retinal Pigment Epithelium/pathology
4.
Chem Pharm Bull (Tokyo) ; 69(7): 630-638, 2021 Jul 01.
Article in English | MEDLINE | ID: mdl-33853973

ABSTRACT

Recently, quantitative NMR (qNMR), especially 1H-qNMR, has been widely used to determine the absolute quantitative value of organic molecules. We previously reported an optimal and reproducible sample preparation method for 1H-qNMR. In the present study, we focused on a 31P-qNMR absolute determination method. An organophosphorus compound, cyclophosphamide hydrate (CP), listed in the Japanese Pharmacopeia 17th edition was selected as the target compound, and the 31P-qNMR and 1H-qNMR results were compared under three conditions with potassium dihydrogen phosphate (KH2PO4) or O-phosphorylethanolamine (PEA) as the reference standard for 31P-qNMR and sodium 4,4-dimethyl-4-silapentanesulfonate-d6 (DSS-d6) as the standard for 1H-qNMR. Condition 1: separate sample containing CP and KH2PO4 for 31P-qNMR or CP and DSS-d6 for 1H-qNMR. Condition 2: mixed sample containing CP, DSS-d6, and KH2PO4. Condition 3: mixed sample containing CP, DSS-d6, and PEA. As conditions 1 and 3 provided good results, validation studies at multiple laboratories were further conducted. The purities of CP determined under condition 1 by 1H-qNMR at 11 laboratories and 31P-qNMR at 10 laboratories were 99.76 ± 0.43 and 99.75 ± 0.53%, respectively, and those determined under condition 3 at five laboratories were 99.66 ± 0.08 and 99.61 ± 0.53%, respectively. These data suggested that the CP purities determined by 31P-qNMR are in good agreement with those determined by the established 1H-qNMR method. Since the 31P-qNMR signals are less complicated than the 1H-qNMR signals, 31P-qNMR would be useful for the absolute quantification of compounds that do not have a simple and separate 1H-qNMR signal, such as a singlet or doublet, although further investigation with other compounds is needed.


Subject(s)
Cyclophosphamide/analysis , Water/analysis , Magnetic Resonance Spectroscopy , Molecular Structure , Phosphorus
5.
Chem Pharm Bull (Tokyo) ; 69(1): 118-123, 2021 Jan 01.
Article in English | MEDLINE | ID: mdl-33087642

ABSTRACT

Quantitative NMR (qNMR) is applied to determine the absolute quantitative value of analytical standards for HPLC-based quantification. We have previously reported the optimal and reproducible sample preparation method for qNMR of hygroscopic reagents, such as saikosaponin a, which is used as an analytical standard in the assay of crude drug section of Japanese Pharmacopoeia (JP). In this study, we examined the absolute purity determination of a hygroscopic substance, indocyanine green (ICG), listed in the Japanese Pharmaceutical Codex 2002, using qNMR for standardization by focusing on the adaptation of ICG to JP. The purity of ICG, as an official non-Pharmacopoeial reference standard (non-PRS), had high variation (86.12 ± 2.70%) when preparing qNMR samples under non-controlled humidity (a conventional method). Additionally, residual ethanol (0.26 ± 0.11%) was observed in the non-PRS ICG. Next, the purity of non-PRS ICG was determined via qNMR when preparing samples under controlled humidity using a saturated sodium bromide solution. The purity was 84.19 ± 0.47% with a lower variation than that under non-controlled humidity. Moreover, ethanol signal almost disappeared. We estimated that residual ethanol in non-PRS ICG was replaced with water under controlled humidity. Subsequently, qNMR analysis was performed when preparing samples under controlled humidity in a constant temperature and humidity box. It showed excellent results with the lowest variation (82.26 ± 0.19%). As the use of a constant temperature and humidity box resulted in the lowest variability, it is recommended to use the control box if the reference ICG standard is needed for JP assays.


Subject(s)
Indocyanine Green/analysis , Magnetic Resonance Spectroscopy , Molecular Structure , Wettability
6.
Masui ; 63(2): 149-52, 2014 Feb.
Article in Japanese | MEDLINE | ID: mdl-24601106

ABSTRACT

BACKGROUND: Although shoulder-tip pain during cesarean section has been reported, little is known about this entity. We investigated the incidence of shoulder-tip pain in patients undergoing cesarean delivery under combined spinal-epidural anesthesia (CSEA). Next, we studied whether head-up position during surgery reduced the incidence of shoulder-tip pain due to prevention of the spread of blood and amniotic fluid from the subphrenic space. METHODS: Women with ASA physical status I or II undergoing elective or emergency cesarean delivery under CSEA at our hospital were enrolled in this study. In all women, it was investigated whether shoulder-tip pain occurred or not during and after cesarean delivery. In some of the parturient women in this study, 2 to 5 degree head-up position was employed during the operation (head-up group). We compared the frequency of shoulder-tip pain in the head-up group with that in women who were maintained in a horizontal position (horizontal group). RESULTS: One hundred and twelve of the 242 women recruited to this study experienced shoulder-tip pain. The pain was usually mild to moderate and was relieved in a few days, but 14 patients experienced severe pain as "can not breathe". One hundred and twenty-six of the 160 women lying on an operating table in a head-up position were classified as a head-up group. Shoulder-tip pain was less frequent in the head-up group than horizontal group (50/126 vs. 62/164, P < 0.05). CONCLUSIONS: This study showed that women undergoing cesarean section under CSEA experience shoulder-tip pain with great frequency. Head-up position during surgery decreases shoulder-tip pain during and after cesarean delivery. The results suggest that one of the causes of this pain is the presence of blood or amniotic fluid in the subdiaphragmatic region.


Subject(s)
Anesthesia, Epidural , Anesthesia, Obstetrical , Anesthesia, Spinal , Cesarean Section , Intraoperative Complications/etiology , Intraoperative Complications/prevention & control , Patient Positioning , Postoperative Complications/etiology , Postoperative Complications/prevention & control , Posture/physiology , Shoulder Pain/etiology , Shoulder Pain/prevention & control , Adult , Amniotic Fluid , Female , Humans , Pregnancy , Regional Blood Flow
7.
J Anesth ; 28(5): 696-701, 2014 Oct.
Article in English | MEDLINE | ID: mdl-24531938

ABSTRACT

BACKGROUND: Although femoral nerve block provides good analgesia after total knee arthroplasty (TKA), residual posterior knee pain may decrease patient satisfaction. We compared the efficacy of periarticular infiltration analgesia (PIA) and sciatic nerve block (SNB) for posterior knee pain. METHODS: Forty-nine patients scheduled for TKA were prospectively randomized into the PIA group (n = 25) or SNB group (n = 24) and received general anesthesia with ultrasound-guided femoral nerve block (FNB). In the PIA group, 60 ml 0.5% ropivacaine and 0.3 mg epinephrine were injected intraoperatively into the periarticular soft tissue before inserting the components. In the SNB group, patients received ultrasound-guided SNB with 20 ml 0.375% ropivacaine and periarticular infiltration with 20 ml normal saline and 0.3 mg epinephrine. We evaluated postoperative pain scores, posterior knee pain, frequency of rescue analgesics for 36 h, and performance time of PIA and SNB. RESULTS: Visual analogue pain scores at 12-24 h were significantly lower in the PIA group than in the SNB group (p < 0.05). The majority of patients had no posterior knee pain. There were no significant differences between the groups in frequency and time of first administration of rescue analgesics and in side effects. Time for performance of periarticular infiltration was significantly shorter than that for SNB (p < 0.05). The dose of intraoperative remifentanil was significantly lower in the SNB group than in the PIA group (p < 0.001). CONCLUSIONS: The combination of FNB and PIA provides sufficient analgesia after TKA. The rapid and convenient periarticular infiltration technique could be a good alternative to SNB.


Subject(s)
Analgesia/methods , Arthroplasty, Replacement, Knee/methods , Nerve Block/methods , Pain, Postoperative/drug therapy , Aged , Amides/administration & dosage , Epinephrine/administration & dosage , Female , Humans , Male , Middle Aged , Pain Management , Pain Measurement , Patient Satisfaction , Prospective Studies , Ropivacaine , Sciatic Nerve
8.
J Atheroscler Thromb ; 21(6): 574-81, 2014.
Article in English | MEDLINE | ID: mdl-24492523

ABSTRACT

AIMS: The association between a low ankle brachial index(ABI) and mortality and vascular morbidity in Japanese individuals with diabetes and the independence of this association from other risk factors have not yet been examined in the primary care setting among a large number of patients. METHODS: An observational prospective cohort study was performed among 3,004 Japanese individuals(2,598 patients with diabetes) to examine all-cause death and cardiovascular disease(CVD) in relation to low ABI(<0.9) values and other risk factors. RESULTS: Low ABI values were found in 127 subjects(4.2%) and was associated with smoking, diabetes, hypertension, pulse pressure, glycosylated hemoglobin A1C, lipid profiles, glomerular filtration rate, uric acid and prevalent CVD at baseline. Over 13,242 person-years, 93 deaths and 117 cases of CVD occurred. In a multivariate Cox regression analysis, the hazard ratio for low-normal ABI values was 3.97(95% CI, 2.29 to 6.88) for all-cause death and 2.86(95% CI, 1.83-4.49) for fatal and non-fatal CVD and all-cause death. Similar hazard ratios were found when the subjects were confined to those with diabetes. All risk analyses indicated that age, a low ABI, diabetes, a history of CVD and smoking remained significantly and independently predictive of CVD and all-cause death. CONCLUSIONS: A low ABI exhibits significant cross-sectional associations with conventional risk factors and further more with the glomerular filtration rate, uric acid level and presence of prevalent CVD at baseline, and a low ABI independently predicts subsequent death and cardiovascular events. These findings support the concept that a low ABI is an integrated marker of an excess risk of death and cardiovascular events, independent of conventional risk factors.


Subject(s)
Ankle Brachial Index , Cardiovascular Diseases/complications , Cardiovascular Diseases/mortality , Diabetes Complications/mortality , Diabetes Mellitus/mortality , Aged , Blood Glucose/analysis , Blood Pressure , Female , Humans , Japan , Lipids/blood , Male , Middle Aged , Proportional Hazards Models , Prospective Studies , Risk Factors , Smoking , Time Factors , Treatment Outcome , Uric Acid/blood
9.
Diabetes Care ; 36(10): 3227-33, 2013 Oct.
Article in English | MEDLINE | ID: mdl-23780946

ABSTRACT

OBJECTIVE: Studies on the rate of remission of macroalbuminuria in patients with type 2 diabetes mellitus (T2DM) and the effects of reduction in albuminuria on renal prognosis in a primary care setting are absolutely lacking. RESEARCH DESIGN AND METHODS: A total of 211 T2DM patients with albuminuria≥300 mg/g were enrolled in a prospective observational study (mean of 4.5 years). The incidence of patients with remission of macroalbuminuria at every 1-year study time point after starting intensified diabetes treatment and the factors associated with remission were evaluated. The association of reduction in albuminuria with renal events (doubling of serum creatinine and end-stage renal disease) was also investigated. RESULTS: During the 5-year study period, remission to microalbuminuria occurred in 116 patients and the 5-year cumulative incidence was 58.3%. Notably, most cases (82.8%) obtained remission at the 1-year study time point. The remission rate increased with achieving therapeutic targets for blood pressure and blood glucose. Remission and reduction in albuminuria of ≥50% were associated with preservation of renal function. In particular, patients who obtained both remission and 50% reduction at the 1-year study time point exhibited a significantly reduced risk for renal events as compared with those with no remission and no reduction (adjusted hazard ratio 0.30 [95% CI 0.12-0.76]). CONCLUSIONS: Remission of macroalbuminuria occurs frequently and is associated with the preservation of renal function in T2DM patients. The initial adequate diabetes treatment aimed at reducing albuminuria may lead to improved renal prognosis in the primary care setting.


Subject(s)
Albuminuria/physiopathology , Diabetes Mellitus, Type 2/physiopathology , Kidney/physiopathology , Proteinuria/physiopathology , Aged , Female , Humans , Male , Middle Aged , Prospective Studies
10.
J Anesth ; 26(6): 900-4, 2012 Dec.
Article in English | MEDLINE | ID: mdl-22718015

ABSTRACT

Anesthesiologists occasionally encounter bradycardia during abdominal surgery and recognize the phenomenon as a vagal reflex. The presence of bradycardia implies efferent vagal dominance in the autonomic nervous system during this vagal reflex. In this study, we investigated the effect of abdominal surgical manipulation on autonomic nervous activity, using heart rate variability analysis. Abdominal surgical manipulation decreased the heart rate and enhanced not only the high-frequency power (0.15-0.4 Hz) but also the low-frequency power (0.04-0.15 Hz) calculated from the power spectral density of heart rate variability. Our results suggest that both vagal tone and sympathetic tone could be activated during the vagal reflex caused by abdominal surgical manipulation.


Subject(s)
Abdomen/surgery , Anesthesia, Epidural , Anesthesia, General , Heart Rate/physiology , Aged , Autonomic Nervous System/physiopathology , Blood Pressure/physiology , Female , Humans , Male , Middle Aged , Reflex/physiology , Surgical Procedures, Operative , Sympathetic Nervous System/physiopathology , Vagus Nerve/physiology
11.
Pharmacogenet Genomics ; 21(8): 495-505, 2011 Aug.
Article in English | MEDLINE | ID: mdl-21691256

ABSTRACT

OBJECTIVES: In this study, we evaluated (a) the contribution of SLCO1B3 and UGT1A polymorphisms to the pharmacokinetics of telmisartan in two forms, a microdose (MD) and a therapeutic dose (TD); (b) linkage disequilibrium (LD) between UGT1A1 and UGT1A3; and (c) linearity in the pharmacokinetics of telmisartan between the two forms. METHODS: Telmisartan was orally administered at MD condition (100 µg), and then at TD condition (80 mg) to 33 healthy volunteers whose genotypes were prescreened by DMET Plus. Plasma concentrations of telmisartan and its glucuronide were measured by LC-MS/MS, and population pharmacokinetic analysis was performed. RESULTS: No obvious effect of SLCO1B3 polymorphisms (334T>G, 699G>A, and rs11045585) on the pharmacokinetics of telmisartan was observed. The strong LD between UGT1A1*6 and UGT1A3*4a, and between UGT1A1*28 and UGT1A3*2a were observed. After both MD and TD administration, the mean area under the curve0-24 (±standard deviation) of telmisartan was significantly lower and higher in individuals with the UGT1A3*2a (TD, 1701±970 ng hr/ml; MD, 978±537 pg hr/ml) and *4a variants (TD, 5340±1168; MD, 3145±1093), respectively, compared with those in individuals with UGT1A3*1/*1 (TD, 2969±1456; MD, 1669±726). These results were quantitatively confirmed by population pharmacokinetic analysis. Nonlinearity of the dose-exposure relationship was observed between the MD and TD. CONCLUSION: The haplotypes of UGT1A3 significantly influenced pharmacokinetics of telmisartan and a strong LD between UGT1A1 genotype and UGT1A3 haplotype was observed. These findings are potentially of pharmacological and toxicological importance to the development and clinical use of drugs.


Subject(s)
Angiotensin II Type 1 Receptor Blockers/administration & dosage , Angiotensin II Type 1 Receptor Blockers/pharmacokinetics , Benzimidazoles/administration & dosage , Benzimidazoles/pharmacokinetics , Benzoates/administration & dosage , Benzoates/pharmacokinetics , Glucuronosyltransferase/genetics , Organic Anion Transporters, Sodium-Independent/genetics , Adult , Angiotensin II Type 1 Receptor Blockers/blood , Benzimidazoles/blood , Benzoates/blood , Dose-Response Relationship, Drug , Gene Frequency , Genotype , Haplotypes , Humans , Linkage Disequilibrium , Male , Pharmacogenetics , Polymorphism, Single Nucleotide , Solute Carrier Organic Anion Transporter Family Member 1B3 , Telmisartan
12.
Masui ; 58(10): 1232-5, 2009 Oct.
Article in Japanese | MEDLINE | ID: mdl-19860224

ABSTRACT

BACKGROUND: In the anesthetic management of laparoscopic surgery, hemodynamic changes appear on the skin incision and pneumoperitoneum. Remifentanil may suppress the cardiovascular changes on the pneumoperitoneum in the laparoscopic cholecystectomy (LC). METHOD: One hundred-seven patients scheduled for LC were assigned into two groups; remifentanil (R), and epidural (E) groups. In R group, remifentanil was administered at 0.2 microg x kg(-1) x min(-1) from the induction of anesthesia. In E group, an epidural catheter was placed between T10-12 and 0.2% ropivacaine was infused continuously at 6 ml x hr(-1) via epidural catheter. Anesthesia was maintained by propofol at 5 mg x kg(-1) x hr(-1) following the induction by propofol and vecuronium in both groups. Heart rate (HR), systolic blood pressure (SBP), diastolic blood pressure (DBP), mean arterial pressure (MAP) and bispectral index (BIS) were compared at the entrance of the operating room, skin incision, pneumoperitoneum and extubation of the endotracheal tube between two groups. RESULTS: At the pneumoperitoneum, statistical significance was found in HR, but there was no significant difference in blood pressure and BIS between the two groups. CONCLUSIONS: Compared with epidural anesthetic management, remifentanil suppresses significantly the elevation of heart rate, but not blood pressure at the pneumoperitoneum.


Subject(s)
Anesthesia, Intravenous , Anesthetics, Intravenous/administration & dosage , Cholecystectomy, Laparoscopic , Piperidines/administration & dosage , Aged , Anesthesia, Epidural , Female , Hemodynamics , Humans , Infusions, Intravenous , Male , Middle Aged , Pneumoperitoneum/physiopathology , Remifentanil
13.
Masui ; 56(2): 181-5, 2007 Feb.
Article in Japanese | MEDLINE | ID: mdl-17315736

ABSTRACT

We experienced a case of epidural hematoma caused by coagulopathy 3 days after surgery. A 72-year-old man, who had undergone a total gastrectomy, suffered from nausea and vomiting by ileus. He underwent repair of ileus under general anesthesia with thoracic epidural anesthesia. Three days after surgery, abnormal bleeding followed by disorder of prothrombin activity (PT) and activated partial thromboplastin time (aPTT) and paralysis due to thoracic epidural hematoma developed. It was suspected that these coagulopathies were the results of vitamin K deficiency. Vitamin K deficiency in this patient was considered to have been caused by cephem antibiotics containing N-methyl-thiotetrazole (NMTT) side chain and no oral intake of food for a few days preoperatively. The patient was treated with fresh frozen plasma and intravenous menatetrenon, which improved abnormal bleeding and disorder of PT and aPTT within 24hr. After a discussion with orthopedic consultants, we selected a conservative therapy rather than surgical removal of the hematoma. Thoracic epidural hematoma disappeared two months after surgery, but motor paralysis requiring rehabilitation remained. In conclusion, when patients have not eaten anything for a few days and antibiotics with an NMTT sidechain has been administered, care must be taken to prevent vitamin K deficiency and coagulopathy.


Subject(s)
Carbapenems/adverse effects , Hematoma, Epidural, Spinal/etiology , Postoperative Complications/etiology , Vitamin K Deficiency/chemically induced , Aged , Anesthesia, Epidural , Anesthesia, General , Carbapenems/chemistry , Gastrectomy , Hematoma, Epidural, Spinal/therapy , Humans , Ileus/surgery , Infusions, Intravenous , Male , Plasma , Postoperative Complications/therapy , Stomach Neoplasms/surgery , Tetrazoles/adverse effects , Vitamin K 2/administration & dosage , Vitamin K 2/analogs & derivatives , Vitamin K Deficiency/complications
14.
Can J Anaesth ; 52(2): 181-5, 2005 Feb.
Article in English | MEDLINE | ID: mdl-15684260

ABSTRACT

PURPOSE: To assess the analgesic and side effects of the continuous epidural infusion of 0.2% ropivacaine combined with morphine compared to both drugs alone. METHODS: In this study, both observers and patients were blinded to patient group assignment. Sixty patients scheduled to undergo lower abdominal surgery were enrolled. Patients were randomized to one of three postoperative treatment groups: 1) combination group (a combination of 0.2% ropivacaine and 0.003% morphine); 2) morphine group (0.003% morphine); or 3) ropivacaine group (0.2% ropivacaine). Postoperatively, all solutions were administered epidurally at a rate of 6 mL.hr(-1) for 24 hr. Patients were given iv flurbiprofen as a supplemental analgesic on demand. RESULTS: The combination group showed lower visual analogue scale scores than those of patients receiving either drug alone, both at rest and on coughing. The combination group showed a slight motor block at two hours after the continuous epidural infusion, while the ropivacaine and morphine groups did not show any motor block. The incidence of itching was significantly increased in the morphine and combination groups, compared to the ropivacaine group. There was no significant difference between the numbers of patients with nausea in the three groups. No hypotension or respiratory complications were observed in the three groups. CONCLUSION: The combination of epidural 0.2% ropivacaine and 0.003% morphine has more effective analgesic effects than either of the drugs alone for postoperative pain relief after lower abdominal surgery.


Subject(s)
Abdomen/surgery , Amides/therapeutic use , Analgesia, Epidural , Analgesics, Opioid/therapeutic use , Anesthetics, Local/therapeutic use , Morphine/therapeutic use , Pain, Postoperative/drug therapy , Aged , Amides/adverse effects , Analgesics, Opioid/adverse effects , Anesthesia , Anesthetics, Local/adverse effects , Blood Pressure/drug effects , Blood Pressure/physiology , Cough/prevention & control , Digestive System Surgical Procedures , Double-Blind Method , Drug Therapy, Combination , Female , Humans , Hysterectomy , Male , Middle Aged , Morphine/adverse effects , Pain Measurement , Ropivacaine
15.
J Am Chem Soc ; 124(24): 6942-9, 2002 Jun 19.
Article in English | MEDLINE | ID: mdl-12059217

ABSTRACT

The static and dynamic fluorescence behavior of a series of hexaalkyl benzenehexacarboxylates (R(6)BHC; R = methyl (Me), tert-butyl (tBu), (-)-menthyl (Men), (-)-bornyl (Bor), (-)-1-methylheptyl (MHp), neopentyl (neoPn), and 2-adamantyl (Ad)) was studied by steady-state and time-resolved fluorescence spectroscopy. Dual fluorescence from both the partially relaxed metastable Franck-Condon-like (FC') and the fully relaxed (RX) state was observed for tBu(6)BHC, Men(6)BHC, Bor(6)BHC, MHp(6)BHC, neoPn(6)BHC, and Ad(6)BHC, whereas only single fluorescence from the RX state was observed for Me(6)BHC. Picosecond time-resolved fluorescence spectroscopic measurements clearly demonstrated that the initially formed Franck-Condon (FC) state sequentially converts to the FC' and then to RX state, with the relaxation hindered to such an extent that it shows variation with the steric bulk of the R groups. Thus, the fluorescence lifetimes (tau's) of FC' and RX are critically dependent on the bulkiness of the R groups, varying from 17 to 130 ps and from 0.6 to 1.1 ns, respectively. The relative intensity of FC' and RX fluorescence (I(RX)/I(FC)(')) was found to be dependent on the excitation wavelength, suggesting that the conformational relaxation from the FC' to RX state can compete with the vibrational relaxation of the FC' state. The temperature and pressure dependences were studied by steady-state fluorescence spectroscopy to give the activation energies of 1-3 kcal/mol for the FC'-to-RX relaxation of congested R(6)BHCs, as well as the activation volumes of 2.0, -0.62, and 7.4 mL/mol for tBu(6)BHC, Men(6)BHC, and Bor(6)BHC at room temperature. The fluorescence anisotropy (rho), as a measure of molecular motion, was also determined to be in the ranges of 0.03-0.3 for FC' and 0.003-0.01 for RX. The much larger rho's for the FC' fluorescence by a factor of 2-100 are attributed to the shorter tau's. The I(RX)/I(F' ratio was found to be insensitive to solvent polarity, but critically dependent on solvent viscosity, exhibiting an excellent linear relationship with the reciprocal viscosity. The potential use of these sterically congested R(6)BHCs as microenvironmental viscosity probes is proposed.

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