RESUMEN
The pharmacotherapy of inflammatory bowel disease (IBD) is still not fully effective and safe. Attempts to search for new IBD drugs remain an incessant research aim. One of the novel approaches is targeting the developmental pathway molecules and effector cytokines of Th17/Treg axis. This study aimed to elucidate the impact of new pyrrolo[3,4-d]pyridazinone derivatives, compounds 7b, 10b, or 13b, on the course of experimental colitis in rats and to assess whether these new compounds may influence Th17/Treg axis. Rats were pretreated with studied compounds intragastrically before intrarectal administration of 2,4,6-trinitrobenzenesulfonic acid used for colitis induction. Body weight loss, disease activity index, colon index, and colon tissue damage were analyzed to evaluate the severity of colitis. The colonic levels of RORγt, STAT3, CCR6, Foxp3, IL-6, IL-10, IL-17, TNF-α, IL-23, and PGE2 were assessed. Pretreatment with compounds 7b and 13b alleviated the severity of colitis and concomitantly counteracted the increased levels of RORγt, STAT3, CCR6, IL-6, IL-17, IL-23, TNF-α, and PGE2. The beneficial effect of compounds 7b and 13b may be due to the decrease in the levels of Th17-specific transcription factors and cytokines. The studied compounds might therefore constitute a promising therapeutic strategy in Th17/Treg imbalance-driven inflammatory conditions such as IBD.
Asunto(s)
Colitis , Enfermedades Inflamatorias del Intestino , Animales , Colitis/inducido químicamente , Colitis/tratamiento farmacológico , Colitis/metabolismo , Citocinas/metabolismo , Modelos Animales de Enfermedad , Enfermedades Inflamatorias del Intestino/tratamiento farmacológico , Interleucina-17/metabolismo , Interleucina-23/metabolismo , Interleucina-6/metabolismo , Miembro 3 del Grupo F de la Subfamilia 1 de Receptores Nucleares/metabolismo , Oxadiazoles , Prostaglandinas E/efectos adversos , Ratas , Factor de Transcripción STAT3/metabolismo , Linfocitos T Reguladores/metabolismo , Células Th17/metabolismo , Ácido Trinitrobencenosulfónico/efectos adversos , Factor de Necrosis Tumoral alfa/metabolismoRESUMEN
Glucocorticoid (GC)-induced avascular osteonecrosis of femoral head (AOFH) is a devastating complication, and no cures are currently available for it. Previous studies have demonstrated that implantation of bone marrow mesenchymal stem cells (BMMSCs) may prevent the progression of pre-collapse AOFH. Based on previous observations, we hypothesized that GCs induce AOFH via the COX-2 (cyclooxygenase-2)-PGE-2 (prostaglandin E2)-HIF-1α (hypoxia-inducible factor-1α) axis, and that modification of BMMSCs may improve the efficacy of their implantation. BMMSCs isolated from wild-type (WT) mice were treated with dexamethasone (Dex) and the results showed that Dex repressed the expression of COX-2. Femoral head samples harvested from both WT and COX-2 knock-out (COX-2-/-) mice were subjected to micro-computed tomography and histological examinations. Compared with their WT littermates, COX-2-/- mice had larger trabecular separations, diminished microvasculature, and reduced HIF-1α expression in their femoral heads. In vitro angiogenesis assays with tube formation and fetal metatarsal sprouting demonstrated that Dex repressed angiogenesis and PGE-2 antagonized its effects. An AOFH model was successfully established in C57BL/6J mice. In vitro experiment showed that BMMSCs infected with Lentivirus encoding HIF-1α (Lenti-HIF-1α) resulted in a robust increase in the production of HIF-1α protein. Implantation of BMMSCs overexpressing HIF-1α into femoral heads of AOFH mice significantly reduced osteonecrotic areas and enhanced bone repair, thus largely preserving the structural integrity of femoral heads. Our studies provide strong rationales for early intervention with core decompression and implantation of modified BMMSCs for GC-induced AOFH, which may spare patients from expensive and difficult surgical procedures.
Asunto(s)
Necrosis de la Cabeza Femoral , Células Madre Mesenquimatosas , Animales , Células de la Médula Ósea/metabolismo , Ciclooxigenasa 2/genética , Ciclooxigenasa 2/metabolismo , Cabeza Femoral/metabolismo , Cabeza Femoral/patología , Necrosis de la Cabeza Femoral/inducido químicamente , Necrosis de la Cabeza Femoral/patología , Necrosis de la Cabeza Femoral/terapia , Glucocorticoides , Humanos , Subunidad alfa del Factor 1 Inducible por Hipoxia/genética , Subunidad alfa del Factor 1 Inducible por Hipoxia/metabolismo , Células Madre Mesenquimatosas/metabolismo , Ratones , Ratones Endogámicos C57BL , Prostaglandinas E/efectos adversos , Prostaglandinas E/metabolismo , Microtomografía por Rayos XRESUMEN
Toll-like receptors (TLRs) are pattern recognition receptors that play a critical role in innate immune diseases. TLR3, which is localized in the endosomal compartments of hematopoietic immune cells, is able to recognize double-stranded RNA (dsRNA) derived from viruses and bacteria and thereby induce innate immune responses. Inflammatory periodontal bone resorption is caused by bacterial infections, which initially is regulated by innate immunity; however, the roles of TLR3 signaling in bone resorption are still not known. We examined the roles of TLR3 signaling in bone resorption using poly(I:C), a synthetic dsRNA analog. In cocultures of mouse bone marrow cells and stromal osteoblasts, poly(I:C) clearly induced osteoclast differentiation. In osteoblasts, poly(I:C) increased PGE2 production and upregulated the mRNA expression of PGE2-related genes, Ptgs2 and Ptges, as well as that of a gene related to osteoclast differentiation, Tnfsf11. In addition, we found that indomethacin (a COX-2 inhibitor) or an antagonist of the PGE2 receptor EP4 attenuated the poly(I:C)-induced PGE2 production and subsequent Tnfsf11 expression. Poly(I:C) also prolonged the survival of the mature osteoclasts associated with the increased mRNA expression of osteoclast marker genes, Nfatc1 and Ctsk. In ex vivo organ cultures of periodontal alveolar bone, poly(I:C) induced bone-resorbing activity in a dose-dependent manner, which was attenuated by the simultaneous administration of either indomethacin or an EP4 antagonist. These data suggest that TLR3 signaling in osteoblasts controls PGE2 production and induces the subsequent differentiation and survival of mature osteoclasts. Endogenous TLR3 in stromal osteoblasts and osteoclasts synergistically induces inflammatory alveolar bone resorption in periodontitis.
Asunto(s)
Resorción Ósea , Dinoprostona , Osteoblastos , Receptor Toll-Like 3 , Animales , Resorción Ósea/genética , Resorción Ósea/metabolismo , Células Cultivadas , Dinoprostona/biosíntesis , Dinoprostona/genética , Dinoprostona/metabolismo , Endosomas/metabolismo , Indometacina/farmacología , Ratones , Osteoblastos/metabolismo , Osteoclastos/metabolismo , Prostaglandinas E/efectos adversos , Prostaglandinas E/metabolismo , Ligando RANK/metabolismo , ARN Mensajero/metabolismo , Receptor Toll-Like 3/genética , Receptor Toll-Like 3/metabolismoRESUMEN
OBJECTIVE: The authors observed priapism as a side effect occuring during the intracavernous treatment of erectile dysfunction. Earlier priapism had been treated with an intracavernous injection of sympatomimetics; unfortunately several complications and contraindications were found. PATIENTS AND METHODS: Methylene blue was applied in the treatment of five patients. First a corpus cavernosum punction was performed and some blood was aspirated from the penis. Finally 100 mg of Methylthionin Chlorati was injected into the corpus cavernosum. RESULTS: A sufficient detumescence was observed in all of these cases. There were no complications. The method was applied effectively in two cases after an unsuccessful punction. CONCLUSION: The autors recommend intravenous methylene blue for the treatment of priapism. According to their experience this method is free of complications and as effective as a sympathomimetics treatment. As they think, it can be recommended in any manifestations of priapism because its force of action appears to be both chemically and biologically clear.
Asunto(s)
Inhibidores Enzimáticos/uso terapéutico , Disfunción Eréctil/tratamiento farmacológico , Azul de Metileno/uso terapéutico , Priapismo/inducido químicamente , Vasodilatadores/efectos adversos , Humanos , Inyecciones , Masculino , Papaverina/administración & dosificación , Papaverina/efectos adversos , Fentolamina/administración & dosificación , Fentolamina/efectos adversos , Prostaglandinas E/administración & dosificación , Prostaglandinas E/efectos adversos , Vasodilatadores/administración & dosificaciónRESUMEN
OBJECTIVES: To evaluate the direct in vitro cytotoxicity of vasoactive agents (papaverine, phentolamine, and prostaglandin E(1) [PGE(1)]) to human penile cavernosal smooth muscle cells. Intracavernous pharmacotherapy with vasoactive agents for male erectile dysfunction has been associated with long-term complications such as a reduction in penile smooth muscle content and fibrosis. METHODS: Human penile cavernosal tissue explants (1 to 2 mm(3) size) were obtained with proper institutional review board approval from patients undergoing penile prosthesis implantation. Primary culture was initiated in Dulbecco's modified Eagles medium containing 10% fetal bovine serum, and monolayer cavernosal cells were grown in 48-well tissue culture dishes. At 60% to 80% confluence, cells were labeled overnight with (51)Na(2)CrO(4) (1.5 microCi) and then incubated with therapeutic concentrations of papaverine (1.5 to 30 mg/mL), phentolamine (0.5 mg/mL), and PGE(1) (5 microg/mL) alone, as well as in combination, for 30 minutes at 37 degrees C. At the end of incubation, an aliquot of supernatant was collected in scintillation vials. The release of cell-free chromium in supernatants was determined in a liquid scintillation counter, and results were expressed as the percentage of cytotoxicity. RESULTS: Papaverine induced a significant dose-dependent increase in chromium release from the cavernosal cells. At therapeutic concentrations, papaverine (30 mg/mL) produced up to 60% cytotoxicity; PGE(1) (5 microg/mL) resulted in 40% toxicity. The combination of papaverine with either PGE(1) or phentolamine had a cumulative toxic effect, and maximal toxicity (70%) was observed with the triple combination. CONCLUSIONS: Papaverine-induced cytotoxicity to cavernosal smooth muscle cells may contribute to the fibrosis and loss of smooth muscle content associated with the intracavernous pharmacotherapy. Quantitative evaluation of in vitro cytotoxicity in human cavernosal smooth muscle cell culture may be important in the development of new intracavernosal vasoactive agents.
Asunto(s)
Antihipertensivos/efectos adversos , Músculo Liso/efectos de los fármacos , Papaverina/efectos adversos , Fentolamina/efectos adversos , Prostaglandinas E/efectos adversos , Vasodilatadores/efectos adversos , Células Cultivadas , Radioisótopos de Cromo/farmacocinética , Humanos , Masculino , Músculo Liso/citología , Músculo Liso/metabolismo , Pene/citología , Pene/efectos de los fármacos , Pene/metabolismoAsunto(s)
Tejido Adiposo Pardo/patología , Mucosa Gástrica/patología , Obstrucción de la Salida Gástrica/etiología , Prostaglandinas E/efectos adversos , Tejido Adiposo Pardo/efectos de los fármacos , Cardiotónicos/uso terapéutico , Dopamina/uso terapéutico , Resultado Fatal , Femenino , Mucosa Gástrica/diagnóstico por imagen , Mucosa Gástrica/efectos de los fármacos , Obstrucción de la Salida Gástrica/diagnóstico por imagen , Humanos , Hiperplasia/inducido químicamente , Hiperplasia/complicaciones , Hiperplasia/diagnóstico por imagen , Síndrome del Corazón Izquierdo Hipoplásico/diagnóstico por imagen , Síndrome del Corazón Izquierdo Hipoplásico/tratamiento farmacológico , Síndrome del Corazón Izquierdo Hipoplásico/cirugía , Recién Nacido , Necrosis , Oxitócicos/efectos adversos , Embarazo , UltrasonografíaRESUMEN
OBJECTIVE: To evaluate the incidence of pharmacologically induced priapism in the diagnostic and therapeutic management of erectile dysfunction. PATIENTS AND METHODS: Over a period of 7 years, 685 men were investigated for erectile failure. They underwent a simple test with vaso-active drugs, and the nonresponders were further investigated. Eventually, 83 men began autoinjections and 45 still continue. RESULTS: Eight (1.2%) cases of priapism presented during the simple test with vaso-active drugs in these patients, while none occurred during self-injection treatment. Three were prolonged erections induced by prostaglandin E1 (PGE1) and 5 by papaverine (Pap). Six were treated safely with intracavernosal injection of etilephrine without blood aspiration. CONCLUSION: Priapism is always a potential phenomenon where no individual, no particular drug and no specific dose are completely safe. It may be caused even with 5 microg of PGE1 or 7.5 mg of Pap. Auto-injection therapy however is a safe kind of treatment in well-experienced patients. Careful regulation of the doses and practice in the use of vaso-active drugs may reduce the priapism rate.
Asunto(s)
Disfunción Eréctil/diagnóstico , Disfunción Eréctil/tratamiento farmacológico , Papaverina/efectos adversos , Priapismo/inducido químicamente , Priapismo/epidemiología , Prostaglandinas E/efectos adversos , Adulto , Anciano , Anciano de 80 o más Años , Estudios de Cohortes , Relación Dosis-Respuesta a Droga , Humanos , Incidencia , Masculino , Persona de Mediana Edad , Papaverina/uso terapéutico , Pronóstico , Prostaglandinas E/uso terapéutico , Medición de Riesgo , Factores de RiesgoRESUMEN
A premature baby had severe hypertension associated with idiopathic arterial calcification of infancy. Despite the fact that there was laboratory evidence of renin-mediated hypertension, the disease was refractory to specific renin antagonist and failed to respond to conventional medical treatment. Prostaglandin E1 (PGE1) infusion (dosage range 0.017-0.068 microgram/kg/min) promptly controlled hypertension on two occasions. The drug was given for a total of 65 days and then stopped after the appearance of severe thrombocytopenia; other side effects included sporadic hyperthermia and irritability. Blood pressure was then stabilized satisfactory by a multiple-antihypertensive regimen. In the light of these findings, we believe that PGE1 infusion is a possible therapeutic alternative for babies with idiopathic arterial calcification complicated by severe hypertension refractory to conventional treatment.
Asunto(s)
Calcinosis/complicaciones , Hipertensión/tratamiento farmacológico , Prostaglandinas E/uso terapéutico , Ecocardiografía , Femenino , Humanos , Hipertensión/etiología , Recién Nacido , Recien Nacido Prematuro , Prostaglandinas E/efectos adversosRESUMEN
OBJECTIVE: To compare intramuscular (IM) prostaglandin 15 methyl-F2 alpha (15M-PGF2 alpha) with prostaglandin E2 (PGE2) vaginal suppositories for second-trimester abortion in terms of efficacy and side effects. METHODS: Fifty-one women were randomized to receive either 15M-PGF2 alpha IM injections or PGE2 intravaginal suppositories for second-trimester abortion. Efficacy and side effects of the two agents were analyzed by two-tailed t tests, chi 2 analysis with Fisher exact test, and survival analysis. RESULTS: The mean times to rupture of membranes, delivery of fetus, and delivery of placenta were significantly less for women receiving PGE2 vaginal suppositories. The cumulative abortion rate after 24 hours for the PGE2 group was 96%, compared with 69% for the 15M-PGF2 alpha group. Although there were few differences in side effects, the 15M-PGF2 alpha group had significantly fewer headaches, fevers, and chills. CONCLUSION: Intravaginal PGE2 is superior to IM 15M-PGF2 alpha for second-trimester abortion.
Asunto(s)
Aborto Inducido , Carboprost/administración & dosificación , Prostaglandinas E/administración & dosificación , Adulto , Carboprost/efectos adversos , Femenino , Humanos , Inyecciones Intramusculares , Embarazo , Segundo Trimestre del Embarazo , Prostaglandinas E/efectos adversos , Supositorios , Factores de Tiempo , Resultado del TratamientoRESUMEN
Prostaglandins are being commonly used to maintain the patency of the ductus arteriosus in infants with congenital ductal-dependent heart disease. A significant and unusual side effect of this drug treatment is the symmetrical development of periostitis of the long bones. A review of neonates with congenital heart disease requiring prostaglandin treatment at the Children's Hospital of Eastern Ontario revealed five infants who developed periostitis, the earliest onset being after 14 days of prostaglandin infusion. The drug dosage varied in these infants from 0.02 to 0.10 micrograms/kg/min. The periostitis was associated with limb pain and considerable swelling of the extremities in all children. The periostitis improved on cessation of the prostaglandin infusion, and by 6 weeks after the cessation of the drug, the periostitis had decreased significantly. Periostitis seemed more dependent on the duration of administration of the prostaglandin than on the dosage of prostaglandin administered. Awareness of this entity is essential not only for the treatment team caring for these infants but also for consultant pediatric orthopaedists to avoid excessive investigation for infection, metabolic disease, or vitamin deficiencies that resemble prostaglandin-induced periostitis.
Asunto(s)
Conducto Arterioso Permeable/tratamiento farmacológico , Periostitis/inducido químicamente , Prostaglandinas E/efectos adversos , Femenino , Humanos , Recién Nacido , Masculino , Periostitis/diagnóstico por imagen , Prostaglandinas E/uso terapéutico , Radiografía , Factores de TiempoRESUMEN
BACKGROUND: Prostaglandins are cytoprotective agents that have been shown to benefit patients with a variety of acute and chronic liver diseases. Few data exist on the frequency of adverse effects of prostaglandins in these patients. METHODS: We retrospectively studied 105 patients with liver disease who were treated with either intravenous (i.v.) or oral prostaglandin E (PGE). Forty-four patients with primary nonfunction after liver transplantation and 36 patients with fulminant hepatic failure received i.v. PGE1 for 4.5 +/- 2.6 and 12.6 +/- 10.9 days, respectively. Twenty-five patients with recurrent hepatitis B viral infection after liver transplantation received oral PGE1 for 105 +/- 94 days or PGE2 for 464 +/- 399 days. RESULTS: Twenty-six of 80 patients (33%) receiving i.v. PGE1 developed gastrointestinal and/or cardiovascular side effects and 8% developed arthritis. Twenty-three of 25 patients (92%) who received high-dose oral PGE1 or PGE2 incurred arthritis and/or gastrointestinal adverse effects. Twenty-five patients received prolonged PGE therapy (oral > 60 days; i.v. > 28 days). Of this group, 23 (92%) developed clubbing and cortical hyperostosis resembling hypertrophic osteoarthropathy. All adverse effects were dose related and resolved with reduction or cessation of therapy. CONCLUSION: PGE therapy resulted in a wide spectrum of multisystem adverse effects which were reversible with reduction or cessation of therapy. Although the administration of PGE was safe and generally well tolerated, close medical supervision is necessary to avoid serious side effects.
Asunto(s)
Hepatopatías/complicaciones , Prostaglandinas E/administración & dosificación , Prostaglandinas E/efectos adversos , Administración Oral , Adulto , Alprostadil/administración & dosificación , Alprostadil/efectos adversos , Dinoprostona/administración & dosificación , Dinoprostona/efectos adversos , Femenino , Encefalopatía Hepática/complicaciones , Hepatitis B/complicaciones , Humanos , Infusiones Intravenosas , Hepatopatías/fisiopatología , Masculino , Persona de Mediana Edad , Estudios RetrospectivosRESUMEN
One hundred and eighty patients, average age of 58 years (range 24-75) were evaluated for impotence and were advised to undergo pharmacologic self-injection therapy with either papaverine/Regitine (90%) or prostaglandin E1 (10%). Follow-up was available from 2 months to 3 years (average 11 months). The cause of impotence was determined by hormonal testing, Rigiscan and psychological testing. The etiology of impotence was organic (70%), psychogenic (20%), and mixed (10%). After the initial test injection 22% of patients did not enroll in the self-injection program or were lost to follow-up. The group with psychogenic impotence had the highest satisfaction/usage rate at 42%. Overall only 20% of patients were satisfied long-term and were actively using self-injection therapy. Of the 140 patients available for follow-up, 112 patients (80%) discontinued self-injection therapy. The reasons for discontinued usage were alternate treatment (prosthesis or vacuum device) 15%, return or improvement of erections 8%, partner dissatisfaction or loss of partner 10%, or complications of injection therapy 10%. Cost was not a factor for discontinued use. Loss of interest caused 57% of patients to stop using self-injection therapy. Although pharmacologic self-injection therapy is initially promising there is a high drop-out rate at long-term follow-up.
Asunto(s)
Disfunción Eréctil/tratamiento farmacológico , Papaverina/administración & dosificación , Pacientes Desistentes del Tratamiento/psicología , Prostaglandinas E/administración & dosificación , Adulto , Anciano , Disfunción Eréctil/psicología , Estudios de Seguimiento , Humanos , Inyecciones/psicología , Masculino , Persona de Mediana Edad , Papaverina/efectos adversos , Erección Peniana/efectos de los fármacos , Erección Peniana/psicología , Prostaglandinas E/efectos adversos , Autoadministración/psicologíaRESUMEN
Low dosage intravenous (< 0.01 micrograms.kg-1.min-1) and oral prostaglandin E have been reported to produce fewer complications than higher intravenous doses in the ductal manipulation of congenital heart disease. Over a 3-year period 34 patients were treated with low dosage intravenous or oral prostaglandin. Eighteen (53%) had complications associated with this treatment with 14 having more than one complication. Major complications occurred in nine neonates: necrotising enterocolitis (7), apnoea/bradycardia (5), convulsions (1), haemorrhage (1), and resulted in a change of management. This study therefore concludes that the high incidence of complications is similar with both low and high dosages of intravenous and oral prostaglandin. The use of prostaglandin in any form deserves caution.
Asunto(s)
Alprostadil/uso terapéutico , Dinoprostona/uso terapéutico , Cardiopatías Congénitas/tratamiento farmacológico , Administración Oral , Alprostadil/administración & dosificación , Alprostadil/efectos adversos , Dinoprostona/administración & dosificación , Dinoprostona/efectos adversos , Enterocolitis Seudomembranosa/inducido químicamente , Humanos , Recién Nacido , Infusiones Intravenosas , Prostaglandinas E/efectos adversos , Prostaglandinas E/uso terapéutico , Estudios Retrospectivos , Grado de Desobstrucción Vascular/efectos de los fármacosRESUMEN
Post-term pregnancy has been the indication for induction of delivery in 542 patients from a multicenter study with 1472 patients undergoing induction with prostaglandin E2 given as vaginal tablet (3 mg) or as intracervical gel (0.5 mg), according to cervical ripeness. The obstetric characteristics of these 542 patients were compared to the data of the Baden-Wuerttemberg obstetrical trial as controls. Although cervical ripeness parameters differed significantly from those of the controls, birth intervals were significantly shorter in the study group. Fetal outcome parameters (umbilical artery pH, Apgar values, frequency of admission to pediatric ward) turned out to be more favorable in the study group. Frequency of operative vaginal deliveries (12.7%) and of Cesarean sections (15.5%) was significantly higher in the study group as compared to the reference group (operative vaginal deliveries 8.1%, secondary Cesarean sections 7.3%). If we relate these frequencies to data from prospective, randomized studies comparing active management of post-term pregnancies, it can be demonstrated that active management in general is associated with lower frequencies of operative deliveries. Additionally, the data from our study with active management of post-term pregnancy revealed even lower frequencies for operative deliveries as seen from actively managed post-term deliveries in the literature reviewed. Hence, the induction protocol adapted to cervical ripeness reported in this study is an efficient and safe management for post-term pregnancy minimizing the rate of operative deliveries.
Asunto(s)
Trabajo de Parto Inducido , Embarazo Prolongado , Prostaglandinas E/administración & dosificación , Administración Intravaginal , Peso al Nacer , Cuello del Útero/efectos de los fármacos , Cesárea , Extracción Obstétrica , Femenino , Geles , Edad Gestacional , Humanos , Recién Nacido , Oxitocina/administración & dosificación , Embarazo , Prostaglandinas E/efectos adversos , ComprimidosRESUMEN
The authors studied the possibilities of vaginal labour management by induction after previous caesarean section. They compared the effectiveness of oxytocin and prostaglandins in uterus action. A total of 48 patients after previous caesarean section were induced, 26 by oxytocin and 22 by prostaglandins. The success of the induction was 30.7% with oxytocin and 95.4% with prostaglandins. Compared were also both the incidence of complications during labour and the effect of the uterotonic used on the fetus. It follows from the results that local application of prostaglandins is more advantageous than overall application and carries practically no risk for the patient in labour.
Asunto(s)
Dinoprost/administración & dosificación , Trabajo de Parto Inducido/métodos , Oxitocina/administración & dosificación , Prostaglandinas E/administración & dosificación , Esfuerzo de Parto , Administración Intravaginal , Cesárea , Dinoprost/efectos adversos , Femenino , Humanos , Recién Nacido , Infusiones Intravenosas , Oxitocina/efectos adversos , Embarazo , Prostaglandinas E/efectos adversos , Reoperación , Contracción Uterina/efectos de los fármacosRESUMEN
Prostaglandin E2 is a powerful oxytoxic agent that reliably initiates labor, even in the presence of an unripened cervix. The very low incidence of obstetric and neonatal side effects contributes to its universal use. Only nine cases of uterine rupture during the third trimester of pregnancy after application of various prostaglandin E2 preparations have been reported in English. Although uterine rupture after prostaglandin administration is a very rare complication, no prostaglandin compound seems to be exempt from it.
Asunto(s)
Trabajo de Parto Inducido/efectos adversos , Prostaglandinas E/efectos adversos , Rotura Uterina/inducido químicamente , Adulto , Cesárea/estadística & datos numéricos , Quimioterapia Combinada , Femenino , Edad Gestacional , Humanos , Histerectomía/estadística & datos numéricos , Incidencia , Trabajo de Parto Inducido/métodos , Mortalidad Materna , Oxitocina/administración & dosificación , Paridad , Embarazo , Resultado del Embarazo , Tercer Trimestre del Embarazo , Prostaglandinas E/administración & dosificación , Rotura Uterina/epidemiología , Rotura Uterina/cirugíaRESUMEN
Right ventricular failure associated with pulmonary hypertension is a potential complication in selected cardiac surgical patients following cardiopulmonary bypass. Treatment modalities are generally focused on reduction of right ventricular afterload. PGE1 infusion is one method of providing afterload reduction by its vasodilating action on the pulmonary vasculature. Nursing management of the patient receiving PGE1 requires a thorough knowledge of the hemodynamic alterations occurring in right ventricular failure and pulmonary hypertension, as well as the effect of PGE1 on these hemodynamic parameters. The nurse must understand the rationale for concomitant administration of a vasoconstrictor with the PGE1 as well as possible methods of administering these agents. Lastly, recognition and management of possible adverse effects associated with PGE1 infusion are essential components of nursing care.