RESUMO
Management of infected pacemakers always presents a problem. This report describes a method of managing infected pacemakers, using the infected unit as a temporary pacer. This method has worked well in four patients.
Assuntos
Marca-Passo Artificial/efeitos adversos , Infecções Relacionadas à Prótese/terapia , Infecções Estafilocócicas/terapia , Idoso , Antibacterianos/uso terapêutico , Humanos , Masculino , Pessoa de Meia-Idade , Recidiva , Reoperação , Infecções Estafilocócicas/etiologiaRESUMO
The literature supports the hypothesis that the association of a thromboxane (TX)A2 synthase inhibitor and a PGH2/TXA2 receptor antagonist has a superior antithrombotic effect when compared to both aspirin and single agent alone; a compound endowed with the dual mechanism of action might therefore be of therapeutic value for the management of thrombotic disorders. FCE 27262, an imidazol-1-yl-ethylideneaminooxypentanoic acid, displaces in vitro the binding of [3H]SQ 29,548 to washed human platelets (IC50 = 6.0 +/- 0.6 x 10(-8) M) and antagonizes human platelet aggregation induced by U 46619 in PRP with an IC50 (95% confidence limits) of 4.5(3.3-5.1) x 10(-7) M. It also selectively antagonizes the isolated vessel contraction induced by U 46619. In the rat aorta the Kb (95% confidence limits) was 1.6(0.6-4.3) x 10(-7) M. Additionally it inhibits in vitro TXB2 production in rat and human whole blood, the IC50 being, respectively, 5.9(3.3-9.6) x 10(-8) M and 3.8(2.9-5.0) x 10(-8) M. When administered orally to fed rats it also inhibits ex vivo TXB2 production in whole blood during clotting, the ID50 being 0.62(0.4-0.8) mg/kg. Both in vitro and ex vivo the effect of FCE 27262 on TXA2 synthase was selective, the production of PGE2, the product of a different isomerase from the common precursors, PG-endoperoxides, being concomitantly enhanced. In a canine model of electrically-induced coronary thrombosis, FCE 27262 (1 mg/kg i.v.) inhibits ex vivo TXB2 synthesis (> 95%), antagonizes U 46619-induced platelet aggregation and prolongs occlusion time (controls: 72 +/- 8 min, FCE 27262: 215 +/- 38 min; p < 0.01). In the same model both aspirin (5 mg/kg i.v.) and a pure PGH2/TXA2 receptor antagonist (L 670596), at a dose giving a similar degree of TXA2 synthase inhibition and receptor blockade, respectively, are significantly less effective. Thus, FCE 27262 combines thromboxane synthase inhibition and PGH2/TXA2 receptor antagonism in one molecule, resulting in enhanced antithrombotic activity. FCE 27262 thus may be an appropriate pharmacological tool to test the therapeutic potential of the dual mechanism of action.
Assuntos
Fibrinolíticos/farmacologia , Imidazóis/farmacologia , Ácidos Pentanoicos/farmacologia , Receptores de Prostaglandina/antagonistas & inibidores , Receptores de Tromboxanos/antagonistas & inibidores , Tromboxano-A Sintase/antagonistas & inibidores , Animais , Aorta/efeitos dos fármacos , Aspirina/farmacologia , Aspirina/uso terapêutico , Plaquetas/efeitos dos fármacos , Plaquetas/metabolismo , Carbazóis/farmacologia , Trombose Coronária/tratamento farmacológico , Modelos Animais de Doenças , Cães , Relação Dose-Resposta a Droga , Feminino , Fibrinolíticos/uso terapêutico , Cobaias , Humanos , Imidazóis/uso terapêutico , Masculino , Ácidos Pentanoicos/uso terapêutico , Agregação Plaquetária/efeitos dos fármacos , Piridinas/farmacologia , Coelhos , Ratos , Receptores de Tromboxano A2 e Prostaglandina H2RESUMO
The benefits of enteral nutrition for surgical patients have been well documented in the literature, and needle catheter jejunostomy is frequently used at initial surgical exploration. Occasionally, the need arises for prolonged use of the catheter, and problems occur with occlusion of the catheter. A simple technique is described for converting the needle-catheter jejunostomy into a standard-feeding jejunostomy.
Assuntos
Jejunostomia/métodos , Agulhas , Cateteres de Demora , Nutrição Enteral/métodos , HumanosRESUMO
FCE (+)22509, a chemically stable carboprostacyclin analogue, inhibited in vitro ADP-induced platelet aggregation in rat platelet-rich plasma (PRP) (IC50 = 7.7 ng/ml). Subcutaneous administration of the drug, inhibited both ADP-induced platelet aggregation in rat PRP (ED50 = 0.26 mg/kg) and mortality of mice induced by collagen plus adrenaline (ED50 = 0.35 mg/kg). The compound had no such preventive effects when given orally.
Assuntos
Epoprostenol/farmacologia , Agregação Plaquetária/efeitos dos fármacos , Difosfato de Adenosina/farmacologia , Animais , Colágeno/farmacologia , Epinefrina/farmacologia , Técnicas In Vitro , Dose Letal Mediana , Masculino , RatosRESUMO
Indobufen, administered by gavage, reduced mortality induced in mice and rabbits by intravenous injection of arachidonic acid (A.A.). The doses of compound required to protect 50% of the mice and rabbits from death (ED50) were 1.3 and 0.58 mg/kg respectively. Acetylsalicylic acid (ASA) was considerably less active than indobufen (ED50 = 22.4 and 8 mg/kg). Since the lethal effect of A.A. is mostly due to the formation of platelet aggregates (Silver et al., 1974; Kohler et al., 1976), it is concluded that indobufen is a very potent inhibitor of platelet aggregation in vivo.
