Control of postpartum hemorrhage in women with placenta accreta spectrum using prophylactic balloon occlusion combined with Pituitrin intra-arterial infusion.

OBJECTIVES: The aim of this study is to evaluate the efficacy of prophylactic internal iliac artery balloon occlusion combined with Pituitrin intra-arterial infusion in the control of postpartum hemorrhage in women with placenta accreta spectrum (PAS). METHODS: This is a prospective and non-randomized controlled study. The participants were assigned into three groups: without balloon catheterization (non-BC) group, balloon catheterization (BC) group, and Pituitrin combined with balloon catheterization (PBC) group. The primary outcomes were estimated blood loss (EBL) and the units of transfused packed red blood cells (PRBC). The secondary outcome was the incidence of hysterectomy. RESULTS: A total of 100 participants were recruited between August 2013 and November 2018 and assigned into the respective groups as follows: 27 in the non-BC group, 22 in the BC group, and 51 in the PBC group. No statistical differences were found in demographic characteristics among the three groups. There was a trend of lower EBL, PRBC, and hysterectomy rate in the BC group than those in the non-BC group, while all values showed no significant differences (all p > 0.05). Patients in the PBC group had significantly lower EBL, PRBC, and hysterectomy rate compared with those in the non-BC group (all p < 0.05). Linear regression analysis revealed that the PBC (vs. others) was negatively correlated with EBL and the non-BC (vs. others) independently predicted more EBL. CONCLUSIONS: Balloon occlusion combined with Pituitrin infusion is an effective treatment method which significantly reduced EBL, PRBC, and hysterectomy rate in patients with PAS. KEY POINTS: • Internal iliac artery balloon occlusion combined with Pituitrin intra-arterial infusion can significantly decrease EBL, PRBC, and hysterectomy rate during cesarean section in patients with PAS. • Cesarean section without balloon occlusion and placenta accreta depth are two independent risk factors for EBL in patients with PAS.

A network meta-analysis of updated haemostatic strategies for hysterectomy.

OBJECTIVE: To determine the best haemostatic strategy for hysterectomy through a network meta-analysis. METHODS: We conducted a systematic literature search of the PubMed, Embase, and Cochrane Library databases and extracted data from randomized controlled trials comparing haemostatic strategies for hysterectomy. Direct comparisons and network meta-analyses were conducted in RevMan and ADDIS. Consistency models were established to identify the differences among different haemostatic strategies, and cumulative probability was used to rank the included strategies. Inconsistencies were also tested using node-splitting models. RESULTS: Twenty studies from 16 articles (2 articles contained 3 studies each) comprising 1392 patients were included. Direct meta-analysis showed that the LigaSure (SMD = -1.42 [-2.39, -0.44], P = 0.004), bipolar vessel sealing systems (BVSS) (SMD = -0.35 [-0.66, -0.03], P = 0.03), and pituitrin (SMD = -2.13 [-4.14, -0.13], P = 0.04) applications were effective haemostatic strategies. Based on the network meta-analysis and related subgroup analysis of different surgical procedures, the results showed that the application of pituitrin seemed to be the best haemostatic method for hysterectomy (Rank P = 0.64), especially for vaginal hysterectomy (Rank P = 0.72). The application of LigaSure was the best strategy for abdominal hysterectomy (Rank P = 0.54) but was not effective for laparoscopic hysterectomy (direct comparison with BVSS, MD = -31.39 [-146.61, 83.83], P = 0.59). The node-splitting models test revealed that no significant inconsistencies existed in this research. CONCLUSIONS: Pituitrin application seemed to be the most effective haemostatic strategy for hysterectomy and was especially suitable for vaginal hysterectomy. The best method for reducing blood loss in abdominal hysterectomy was the application of LigaSure.

Extrapontine myelinolysis associated with pituitrin: case report and literature review.

BACKGROUND: Hyponatremia is the most common electrolyte abnormality encountered in hospitalized patients, resulting from a varied spectrum of conditions. Both the primary disturbance and its correction can result in life-threatening neurological consequences. Extrapontine myelinolysis is one such complication that is associated with the rapid correction of hyponatremia. Here we describe a patient who developed extrapontine myelinolysis unexpectedly after the correction of hyponatremia, which involved the drug pituitrin. CASE PRESENTATION: A 24-year-old Chinese woman was transferred to our neurology department with the symptoms of dysarthria and quadriparesis developing one day after the correction of hyponatremia (from 118 mmol/L to 140 mmol/L), which followed with a continuous intravenous drip of pituitrin used to control hemoptysis in the emergency room. During the course, she developed involuntary movement. Magnetic resonance imaging changes were consistent with extrapontine myelinolysis. CONCLUSION: This present case describes the mechanism of profound hyponatremia involving pituitrin, and the subsequent development of extrapontine myelinolysis. Physicians may approach effective clinical management of patients through awareness of the adverse effect of pituitrin on serum sodium levels, and avoid rapid correction of hyponatremia in clinical practice.

Pharmacokinetics of phosphocreatine and its active metabolite creatine in the mouse plasma and myocardium.

BACKGROUND: The pharmacokinetic (PK) studies of phosphocreatine (PCr) and its active metabolite creatine (Cr) are considerably lacking. This study is to comparatively investigate the PK profiles of PCr and Cr in mice plasma and myocardium as well as the ATP level. METHODS: After iv administration of equimolar PCr and preformed Cr to healthy and Pit-induced myocardial ischemic mice, plasma and myocardium samples were analyzed for exogenous PCr, Cr and related ATP concentrations using a specific ion-pair reversed-phase HPLC-UV assay. RESULTS: The plasma C-T data of iv PCr and Cr were well fitted to two-compartment model. Following iv PCr, Cr appeared in plasma as early as 1.0 min postdose with a longer t1/2 than PCr and had a fm of 72%. The mice dosed iv PCr preceded 5 min by ip Pit 30 U/kg showed longer t1/2ß PCr and t1/2 Cr in plasma and elevated Cmax, Cr and Cmax, ATP in myocardium compared with mice dosed iv PCr alone, and it was estimated that about 40% ATP produced by iv PCr was from Cr. CONCLUSION: The PCr in plasma is converted to Cr rapidly and mostly, and shows an elimination rate limited (ERL) metabolite disposition. Iv PCr caused a significantly elevated and long-lasing myocardial ATP and Cr levels. The Pit-induced myocardial ischemia brings slower elimination of PCr and Cr and higher peak concentrations of Cr and ATP in myocardium. The metabolite Cr at least partially mediates PCr-caused rise in myocardial ATP level and also possibly the cardio-protective effects of PCr.

Neurohypophyseal hormones protect against pentylenetetrazole-induced seizures in zebrafish: role of oxytocin-like and V1a-like receptor.

Oxytocin (OT) and arginine-vasopressin (AVP) are involved in the physiological response to different stressors like the occurrence of seizures which is regarded as a severe stress factor. Zebrafish (Danio rerio) is recently featured as a model of epilepsy but the role of neurohypophyseal hormones on this teleost is still unknown. We attempted to determine whether non-mammalian homologues like isotocin (IT) and vasotocin (AVT) affected pentylenetetrazole (PTZ)-induced seizures in adult zebrafish in comparison with OT/AVP. The mechanism was studied using the most selective OT and AVP receptor antagonists. Zebrafish were injected i.m. with increasing doses (0.1-40 ng/kg) of the neuropeptides 10 min before PTZ exposure. DesGly-NH2-d(CH2)5-[D-Tyr2,Thr4]OVT (desglyDTyrOVT) for OT receptor and SR49059 for V1a subtype receptor, were injected together with each agonist 20 min before PTZ exposure. All the peptides significantly decreased the number of seizures, increased the mean latency time to the first seizure and decreased lethality. This protective effect led to a dose-response curve following a U-shaped form. IT was approximately 40 times more active than OT while AVT was 20 times more potent than AVP in reducing the number of seizures. DesglyDTyrOVT was more effective in antagonizing OT/IT, while SR49059 mainly blocked AVP/AVT-induced protection against PTZ-induced seizures. The present findings provide direct evidence of an important involvement of IT/OT and AVP/AVT as anticonvulsant agents against PTZ-induced seizures with a receptor-mediated mechanism in zebrafish. These data reinforce zebrafish as an emerging experimental model to study and identify new antiepileptic drugs.

[A clinical study of pituitrin versus norepinephrine in the treatment of patients with septic shock].

OBJECTIVE: To investigate whether pituitrin can lower 28-day mortality as compared with treatment with norepinephrine (NE) in patients with septic shock. METHODS: Randomized, controlled, open-label trial was conducted. One hundred and thirty-nine septic shock patients with dopamine requirements exceeding 5 µg×kg(-1)×min(-1) were divided at random into two groups as the study group and control group. All patients enrolled were treated by the same treatment principle and measures. In patients of study group injection of pituitrin 0.017-0.042 U/min (1.0- 2.5 U/h) was given, and if hemodynamics was still unstable, catecholamines was added to obtain the target blood pressure; while in the control group catecholamines was given to maintain stability of hemodynamics. RESULTS: Among 139 patients enrolled in the study, 66 composed of the clinical study group and 73 in the control group. The main principle of the treatment in the two groups was similar. There was no significant difference in overall 28-day mortality rate between study group and control group (40.9% vs. 46.6%, P > 0.05). In patients whose acute physiology and chronic health evaluation II ( APACHE II ) score was less than 25, the mortality of study group was significantly lower than that of control group [10.3% (3/29) vs. 35.7% (10/28), P < 0.05]. The length of stay in intensive care unit [ICU, days: 5(3,8) vs. 5(3,8)], and duration of mechanical ventilation [days: 4.0 (2.8, 6.0) vs. 4.0 (2.0, 5.0)] were similar in two groups (both P > 0.05). The dosage of NE (µg/min: 7.99 ± 5.02 vs. 10.12 ± 5.12) and heart rate (beat/min: 93.27 ± 7.84 vs. 108.45 ± 12.31) were significantly lower in study group compared with that of control group (both P < 0.05). Serum creatinine and lactate levels in the two groups were similar at baseline, and creatinine [µmol/L: 87.5 (62.8, 157.0) vs. 76.0 (52.5, 117.0)] and lactate level (mmol/L: 3.72 ± 2.47 vs. 3.53 ± 1.86) were still similar in two groups 24 hours later (all P > 0.05). The rate of use of glucocorticoid (43.9% vs. 31.5%) and heparin in small dosage (42.4% vs. 41.1%) had no significant difference between two groups (both P > 0.05). CONCLUSIONS: Combined use of pituitrin in patients with septic shock can reduce the dosage of catecholamines, and decrease the heart rate. Although it can not lower the overall mortality of septic shock, among patients with less severity whose APACHE II score lower than 25, low-dose pituitrin in conjunction with catecholamine vasopressors can reduce 28-day mortality .

[Treatment of septic shock in children with low dose pituitrin: report of 24 cases].

OBJECTIVE: To explore the clinical effect of low dose pituitrin in children with septic shock. METHODS: A total of 48 pediatric cases with septic shock, in whom 6 hours, conventional treatment could not reverse shock from January 2008 to December 2010, were selected for this study. The patients were divided into two groups randomly (completely random design) (control group 24, remedial group 24). The conventional treatment included antibiotics/fluid resuscitation/correcting acid-base imbalance, glucocorticoid, organ (heart/lung) support, dopamine 1 - 15 µg/(kg·min) and norepinephrine 0.5 - 2 µg/(kg·min) pumped in continuously in the control group. In initial 6 hours the same treatment was given to the remedial group, while low dose pituitrin (0.01 - 0.03 U/min) was pumped additionally during the rest of time. The therapeutic effect on correcting shock was evaluated in both groups. RESULTS: The total effective rate was 76.2% in the remedial group and 40.0% in the control group; the mortality was 33.3% and 60% respectively. The difference between both groups was significant (P = 0.025). CONCLUSION: Low dose pituitrin could improve the clinical effect significantly in children with septic shock in whom 6 hours conventional treatment failed to correct shock, shorten the total periods of treatment, and decrease mortality.

[Optimization of PNS/TGCO components effect on experimental Qi stagnation and blood stasis type of coronary heart disease with increase-decrease baseline geometric proportion design method].

OBJECTIVE: Preliminary exploration of Panax notoginseng saponins (PNS) and total saponins from Cornus officinalis (TGCO) components treatment and characteristics of Qi stagnation and blood stasis type of coronary heart disease. METHODS: With increase-decrease baseline geometric proportion design method to Optimization of PNS/TGCO components, through observing different proportions effective components effect on mice with pituitrin-induced acute myocardial ischemia and the time of hypoxia tolerance. RESULTS: Prescriptions 1, 2, 3 and Xuesaitong groups had a certain degree of improvement the role of myocardial ischemia and prescriptions 4, 5, 6, compared with the control group with no significant changes; Prescriptions 3, 4, 5, 6 had a certain role in anti-anoxia in mice, prescriptions 1, 2 and Xuesaitong group, together with the control group with no significant changes. CONCLUSION: Prescription 3 has some effect on improving the role of myocardial ischemia and has a certain role in anti-anoxia. It's the best ratio of PNS/TGCO components for the treatment of Qi stagnation and blood stasis type of coronary heart disease.

[Effect of small doses of pituitrin on electrocardiography of ischemia in the experiment]. / Vliianie malykh doz pituitrina na ishemicheskie sdvigi élektrokardiogrammy v éksperimente.

A new type of reaction to the myocardial ischemia was established in chronic experiments in conscious dogs. It consists in some changes of local myocardial activity and, consequently, in constant or transient normalization of ECG. Pharmacological stabilization of this process augments myocardial resistance to ischemia 40-50 times and more. The role of small doses of pituitrin in this reaction was established.

[The sequelae of transient myocardial ischemia in chronic experiments]. / Izuchenie posledstvii vremennoi ishemii miokarda v khronicheskikh opytakh.

Reversible short-term and local myocardial ischemia in non-anaesthetized dogs involved a functional (if changing the activity of CPK) and morphologic aftereffect. At the same time it is possible to find some mechanisms of compensation (in chronic experiment).

[Lipid peroxidation in vasopressin-induced pulmonary edema and hyperbaric oxygenation therapy]. / Perekisnoe okislenie lipidov pri vazopressinovom oteke legkikh i giperoksibaroterapii.

Experiments in 150 albino rats have revealed that hyperbaric oxygenation (303.98 kPa) causes no decrease in pulmonary tissue hyperhydration and its blood filling induced by pituitrin administration. Hyperbaric oxygen therapy enhances pulmonary tissue peroxidation of lipids, without modifying them in blood. Application of lipid peroxidation inhibitors to prevention of pulmonary edema fails to affect pulmonary hydration and blood filling, which does not rule out the possibility of using them as protective agents against the toxic effects of oxygen in myocardial infarction which may be complicated by acute pulmonary edema.

[Effect of phentolamine in combination with pituitrin on the hepatic and systemic hemodynamics].

This experimental study was aimed at the effect of phentolamine used separately or in combination with pituitrin on hepatic and systemic hemodynamics in cirrhotic portal hypertensive dogs. The results showed that either of these drugs used separately could lead to reduction of portal venous pressure. Each of the drugs could also cause by-effect on systemic hemodynamics, or reduce hepatic blood flow. When phentolamine was used in combination with pituitrin no side effect was found in hepatic and systemic hemodynamics. It was suggested that phentolamine used in combination with pituitrin could efficiently decrease portal hypertension and counteract the side-effects. It would be useful in treatment of bleeding from esophageal variceal rupture in cirrhotic patients with portal hypertension.

[Effect of pituitrin or phentolamine alone or in combination on WHVP and systemic hemodynamics in patients with liver cirrhosis]. / Wirkung von Pituitrin und Phentolamin allein oder in Kombination auf WHVP und die systemische Hämodynamik bei Patienten mit Leberzirrhose.

We observed the effect of pituitrin and phentolamine alone or in combination on wedged hepatic venous pressure (WHVP) and systemic hemodynamics in 28 patients with cirrhosis. The results showed that either of these drugs used separately could lead to reduction in WHVP, each of them could also cause by-effects on systemic hemodynamics. When pituitrin in combination with phentolamine was administered, no change could be found in inferior vena cava pressure, mean arterial pressure, pulse rate and cardiac index. This suggested that pituitrin in combination with phentolamine could not only efficaciously decrease WHVP, but also counteract side effects on systemic hemodynamics of each other and improve hepatic microcirculation. Our study provided evidence for the usefulness of the combination of the two drugs in controlling bleeding from esophagus varices.

Ultralow doses of vasopressin in the management of diabetes insipidus.

Management of postoperative diabetes insipidus (DI) frequently requires intermittent treatment with multiple subcutaneous injections of pituitrin or vasopressin, in doses averaging 20 IU/24 h. Use of a syringe pump for a continuous infusion of ultralow doses of pituitrin produced uniform, constant, and sustained reduction of urinary output, thus facilitating regular fluid replacement. Twelve patients with postoperative DI received iv pituitrin at a dose of 1.6 +/- 0.26 mIU/kg X h (1 to 2 IU/24 h). The antidiuretic effect began at the third hour of treatment, peaked by the sixth hour (diuresis of 37 ml/h, specific gravity of 1.018 +/- 0.002), and was sustained throughout infusion. Polyuria recurred 3 h after the infusion was discontinued; this rapid reversibility is highly advantageous when excessive fluid intake causes overhydration. Pressor effects were not observed during the treatment period.

A comparison of grooming behavior potencies of neurohypophyseal nonapeptides.

We have previously demonstrated that intracerebroventricular (ICV) administration of oxytocin (OXY) enhanced grooming behaviors in male and female rats at a 1 microgram dose. In the present study female rats were injected ICV with 1 microgram OXY or equimolar doses of other peptides. At this dose arginine-vasopressin (AVP), arginine-vasotocin (AVT) and lysine-vasopressin (LVP), as well as alpha-MSH, were as effective as OXY in increasing grooming behavior. At equimolar doses, ACTH1-10, tocinoic acid (the ring structure of OXY) and Pro-Leu-Gly-NH2 (the tail structure of OXY) had no significant effect on grooming behavior. The potency of AVP and AVT was determined across a 0.05-5 microgram dose range. Grooming scores increased in an apparent linear manner across a similar OXY dose range. Both AVP and AVT, however, manifested an inverted U grooming response curve. Maximum grooming scores resulted from a 0.1 microgram dose of AVT or a 0.5 microgram AVP dose. Analyses of the aspects of grooming separately found that nonapeptides OXY, AVP and AVT all elevated body grooming, washing, and scratching. Because AVT and AVP administration resulted in grooming scores significantly higher than OXY at lower doses, we concluded that the CNS is more sensitive to the effects of AVT and AVP on grooming behavior than OXY.

Mediastinal and retroperitoneal fibrosis with fibrotic pulmonary nodules: a case report.

We report a patient with a long history of pan-hypopituitarism treated with pituitary snuff who developed superior mediastinal fibrosis involving the visceral pericardium, retroperitoneal fibrosis, and a peculiar widespread nodular fibrosis of the lungs.

[Spontaneous rupture of the liver in pregnancy. Case study and review of the literature]. / La rupture "spontanée" du foie au cours de la grossesse. Etude d'un cas et revue de la littérature.

The authors report a case of "spontaneous" rupture of the liver in a woman of 35 years of age. This occurred immediately after post-partum eclampsia. It was not possible to obtain complete haemostasis using absorbable haemostatic compresses along the convexity of the liver. Complete cessation of bleeding only occurred after the operation when posterior pituitary abstracts had been transfused. The patient died 53 days after the initial procedure from a high gastro-intestinal haemorrhage. A study of the literature shows that this rare condition is most probably a complication of toxaemia of pregnancy but the physio-pathology of these liver lesions is ill-understood. The clinical picture is in two phases--the first corresponds to the formation of a sub-capsular haematoma and the second to the intra-peritoneal rupture of this haematoma. The prognosis for this condition is poor, the maternal mortality ranging from 56%-75%. The prognosis is linked to the speed with which the diagnosis is made and surgical intervention is carried out. This should be done before the capsule of the liver ruptures. Haemostasis is nearly always best obtained by using haemostatic compression with packs but haemostasis is not always adequate, particularly if there are several lesions in both lobes of the liver. This case history shows that using posterior pituitary abstracts in transfusion can be helpful.