Análisis retrospectivo de pacientes con traqueostomía nueva en 2010-2011 / Retrospective analysis of patients with a new tracheostomy in 2010-2011

Estudio descriptivo y retrospectivo realizado durante el período 2010-2011. Se incluyeron en el estudio los pacientes que se internaron en el CIM 62 del hospital Garrahan con traqueostomía realizada durante dicha internación. Se registraron 88 pacientes. La mayoría de ellos (85%) presentaban alguna Enfermedad de Base previa a la realización de la traqueostomía, siendo la enfermedad neurológica la más frecuente. El principal motivo de realización de traqueostomía fue el fracaso en la extubación/ARM prolongada. Los pacientes presentaron una estancia media de internación de 35 días posteriores a la realización de la traqueostomía. Actualmente se está desarrollando un Programa de Entrenamiento en el manejo de la traqueostomía con el objetivo de agilizar su egreso (AU)

A retrospective descriptive study was conducted over the period 2010-2011. Patients admitted to CIM 62 of hospital Garrahan who required a tracheostomy during their hospital stay were included in the study. Overall, 88 patients were included. The majority (85%) presented with some underlying disease, most frequently a neurological disorder, previous to the tracheostomy, The main reason for tracheostomy was extubation failure/prolonged MV. Mean hospital stay before tracheostomy was 35 days. Currently a training program for tracheostomy placement is being developed to streamline discharge (AU)

Simultaneous determination of propranolol or metoprolol in the presence of butyrophenones in human plasma by gas chromatography with mass spectrometry.

A method has been developed for the simultaneous gas chromatographic determination of propranolol or metoprolol and butyrophenones butyrophenones in human plasma in vitro. The drugs were extracted from plasma by solid-phase extraction. Calibration graphs were linear in the 50-300-ng/mL range. The recovery of the compounds was 80-90%. The sensitivity of the method was adequate for the determination of the drugs at toxic concentrations and at therapeutic levels. It is a simple, rapid, and reproducible method for the simultaneous determination of propranolol or metoprolol and some butyrophenones. The minimum detectable concentration was 50 ng/mL with a flame ionization detector and 10 ng/mL with a mass spectrometer detector.

Simultaneous determination of quinidine and butyrophenones in human plasma by GC-MS.

This report describes a sensitive GC and HRGC-MS procedure for the simultaneous determination of Quinidine and some bytyrophenone drugs in human plasma. The quantitative response is linear from 50-250 ng/ml using Pipamperone as international standard. It is suitable for clinical analysis at therapeutic levels.

HPLC analysis of doxorubicin, epirubicin and fluorescent metabolites in biological fluids.

A specific, sensitive and reliable HPLC method for the determination of doxorubicin (DX), epirubicin (epiDX) and their known fluorescent metabolites [doxorubicinol (DXol), epirubicinol (epiDXol) 7-deoxy-adriamycinone (metabolite C), adriamycinone (metabolite D), 7-deoxy-13-dihydro-adriamycinone (metabolite E), 13-dihydro-adriamycinone (metabolite F), 4'-O-beta-D-glucuronyl-4'-epiDX (metabolite G) and 4'-O-beta-D-glucuronly 13-dihydro-4'-epiDX (metabolite H)] in biological fluids (human plasma, bile and urine) has been developed and tested. Plasma samples were solid-phase-extracted (C18-bonded silica cartridges). Urine and bile samples were injected directly after the addition of the internal standard and dilution with 0.3 M phosphoric acid. Complete separation of unchanged drugs and metabolites was achieved with a mobile phase consisting of 75.6% 10 mM KH2PO4 and 24.4% CH3CN (the pH of the solution was adjusted to 4.3 with 0.03 M H3PO4) at a flow rate of 1.5 ml/min. For the analyses we used a cyanopropyl chromatographic column (25 cm x 4.6 mm i.d.; particle size 5 micron) and fluorescence detection with excitation wavelength set at 470 nm and emission at 580 nm. Sensitivity was better than 0.3 ng/ml for all substances analysed. The mean absolute recovery of unchanged drugs and metabolites was between 88.3% (metabolite E) and 98.92% (metabolite G). Intra- and interassay precisions (plasma samples) were better than 10.6% and 13.0%.

Epirubicin and doxorubicin comparative metabolism and pharmacokinetics. A cross-over study.

The pharmacokinetics and metabolism of doxorubicin (DX) and epirubicin (epiDX) were investigated in eight cancer patients who received 60 mg/m2 of both drugs independently by intravenous (i.v.) bolus at 3-week intervals according to a balanced cross-over design. Unchanged DX and epiDX plasma levels followed a triexponential decay. Half-lives (t/2) of the three decay phases were longer for DX (t/2 alpha: 4.8 vs. 3 min; t/2 beta 2.57 h vs. 1.09 h; t/2 gamma 48.4 vs. 31.2 h). According to a model-independent analysis, the different plasma disposition kinetics of the two compounds appears to be related to a higher plasma clearance (PlCl) and to a lower mean residence time (MRT) of epiDX (PlCl: 75.0 l/h, range: 35.6-133.4 l/h; MRT: 31.6 h, range: 7.0-41.5 h;) compared to DX (PlCl: 56.8 l/h, range: 24.4-119.5; MRT: 45.6 h, range: 26.0-83.1 h). No statistically significant differences could be detected for the volume of distribution at steady state (Vss) (epiDX, 31.8 l/kg; DX, 33.3 l/kg). Metabolites common to both compounds were detected in plasma: the 13-dihydro derivatives doxorubicinol (DXol) and epirubicinol (epiDXol), together with minor amounts of four aglycones (7-deoxy adriamycinone, adriamycinone, 7-deoxy 13-dihydro adriamycinone, and 13-dihydro adriamycinone). Following epiDX administration, two additional major metabolites were detected: the glucuronic acid conjugates of epiDX (4'-O-beta-D-glucuronyl-4'-epiDX) and epiDXol (4'-O-beta-D-glucuronyl 13-dihydro-4'-epiDX). This additional detoxication route appears to account for the more efficient and faster elimination of epiDX than of DX. In the urine collected in the 6 days after treatment, 12.2% of the DX and 11.9% of the epiDX dose was excreted as unchanged drug and fluorescent metabolites. A comparable renal clearance was calculated for DX (4.7 l/h, range 1.4-7.0 l/h) and epiDX (4.4 l/h, range 1.7-7.0 l/h). One patient with hepatic metastases and abnormal bilirubin serum level had percutaneous biliary drainage because of extrahepatic obstruction. The elimination of both drugs was significantly impaired in this patient; nevertheless, elimination of epiDX was still more efficient and faster than that of DX (PlCl: 35.6 vs. 24.4 l/h; MRT: 39.0 vs. 83.1 h; t/2 gamma: 47 vs. 74 h). This patient's biliary excretion accounted for 35.4% of the epiDX dose and 18.2% of the DX dose.

Biliary excretion and pharmacokinetics of 4'epidoxorubicin (epirubicin) in advanced cancer patients.

Plasma pharmacokinetics and biliary and urinary excretion of the new doxorubicin analogue, epirubicin, have been studied in three patients with extrahepatic obstruction and percutaneous biliary drainage. At variance with the reported observations concerning doxorubicin metabolism, conjugation of epirubicin and 13-dihydroepirubicin with glucuronic acid takes place, and corresponding amounts of 4'-o-beta-D-glucuronyl-4'-epidoxorubicin and 4'-o-beta-D-glucuronyl-13-dihydro-4'-epidoxorubicin can be found in the bile and urine. The total amount of unaltered drug and metabolites excreted in the bile in the first 4 days after treatment accounts for the 37%, 27%, and 40% of the administered dose; urinary excretion accounts for 19%, 16%, and 26%. Biliary clearance of epiDX (32.5, 8.1 and 21.6 l/h) is higher than renal clearance (15.2, 3.3 and 9.41 l/h). The relevance of the biliary disposition of epirubicin suggest prudent dose reduction in patients with impaired biliary drainage.

Thermistor use to monitor urine flow rates in dogs.

The small size of a new thermistor flowmeter facilitated implantation in ureters in anesthetized dogs. It consisted of a self-heating thermistor bead which was suspended centrally within an open catheter and dissipated heat as a function of fluid velocity. A continuous record of instantaneous flow rate was obtained, since the flowmeter catheter maintained a constant cross-sectional area around the thermistor bead. A continuous record of volume output was obtained simultaneously with an additional measurement technique. Spurt volumes of urine delivered in concert with ureter peristalsis were directly correlated to peak flow rates delineated by the flowmeter.

Anatomy and cannulation of the parotid duct in the dog.

The course of the dog's parotid duct is more complex than previously reported. The newly described features are that the duct has 2 right-angle curves in its terminal part and that it perforates the fascia and mucosa of the cheek between the orbicularis oris and buccinator muscles. The duct does not perforate the buccinator muscle. Based on these findings, a rapid and reliable technique for intubation of the duct was developed.

Leptospiral agglutinins in dogs in Sydney.

From June 1971 to June 1972, sera from 600 dogs in Sydney were tested for leptospiral agglutinins by a rapid slide agglutination method. The end-point titre was taken at 50 percent agglutination of the live organisms. Forty-one samples (6.8 percent) had a significant leptospiral titres (100 or greater) and 5 of these reacted to 2 serotypes. Thirty serums (5 percent) contained agglutinins against L. copenhageni, and 6 (1 percent) against L. pomona, while a few samples reacted against hardjo, tarassovi, australis, grippotyphosa or pyrogenes serotypes. No significant titres were found to L. canicola, L. hebdomadis, L. autumnalis or L. bataviae.