[Average steady-state plasma levels with slow release quinidine preparations]. / Concentrations plasmatiques moyennes à l'état d'équilibre avec des préparations de quinidine à libération progressive.

Arabogalactane sulphate of quinidine (AGSQ) is a slow release preparation of quinidine. The aim of this study was to compare the plasma levels of quinidine obtained by different preparations of AGSQ (AGSQ I, II and III) and to determine which was best suited to therapeutics. The "in vitro" study showed different amounts of quinidine liberated in 6 hours, 34% with AGSQ I, 58% with AGSQ II and 100% with AGSQ III. The plasma quinidine levels were studied after administration of a dose corresponding to 330 mg quinidine base, morning and evening for 7 consecutive days to 27 hospitalised patients; 7 received AGSQ I, 11 received AGSQ II 5, received AGSQ III and 4 quinidine sulphate. The delay in reaching a steady state was 24 hours for the quinidine sulphate 36 hours for AGSQ I, 48 hours for AGSQ II and 60 hours for AGSQ III. The average plasma level on the 7th day (Cee) was 2.74 +/- 0.71 microgram/ml, 2.62 +/- 0.74 microgram/ml and 3.29 +/- 0.72 microgram/ml respectively. The plasma quinidine levels were maintained between toxic and therapeutic levels (3,5 and 1,7 microgram/ml) only with AGSQ II by suppressing the peak observed 1 hour administration of quinidine sulphate. An excellent correlation (r = 0,984) was observed between the plasma quinidine 6 hours after ingestion and the Cee. A blood test during the steady state, 6 hours after ingestion of the drug, is useful in adjusting the dosage. These results suggest that AGSQ II is the preparation best suited for therapeutic usage although it does not give the best relative bioavailability of the drug.

[Laxative effect and tolerance of lactulose administrated in one or two intakes in the treatment of chronic idiopathic constipation. Groupe d'Investigateurs O'Ile-de-France (GIIF)]. / Effet laxatif et tolérance du lactulose administré en une ou deux prises dans le traitement de la constipation chronique idiopathique, Groupe d'Investigateurs d'Ile-de-France (GIIF).

OBJECTIVES: The aim of this study was to compare the tolerance and effects of lactulose taken at a daily dose of 20 mg in one or two intakes, in the treatment of idiopathic chronic constipation. METHODS: A total of 121 outpatients (30 men, 91 women, mean age 55) was included in a prospective double blind crossover multicentric study. Patients took lactulose according to two different ways of administration and for two successive 3-week periods. Each period consisted in 2 weeks of adaptation and one week of evaluation. At the end of each period, a global visual satisfactory scale was evaluated as a global index. Patients collected every day the frequency and the aspects of the stools, the quality of exoneration and the existence of digestive symptoms. RESULTS: Number of stools per week (7.29 +/- 3.20 vs 7.08 +/- 3.03), consistency, quality of exoneration, were equivalent whatever the number of intakes and the period of treatment. With one or two intakes, the satisfactory index was the same but significantly better at the end of the second period. With one or two intakes, frequency and intensity of side effects were low and identical. They mostly occurred during the first period. CONCLUSION: Effects and tolerance with one single intake of lactulose (20 g) in the evening and with two intakes, were found to be equivalent. Effect on exoneration persists during the six weeks of administration and then tolerance improves.

[Reproducibility of intradermal tests after anaphylaxis caused by muscle relaxants]. / Reproductibilité des tests cutanés intradermiques après anaphylaxie aux myorelaxants.

Intradermal tests with 5 muscle relaxants were performed on two occasions in 56 patients who had experienced an adverse event during general anaesthesia: anaphylactoid reaction with at least one positive test 19.5 +/- 13.5 months previously in 50 cases; adverse reaction unrelated to muscle relaxants and with negative tests 21 +/- 6.4 months previously in 6 cases. Sixteen healthy subjects who had never been tested served as controls; their tests were all negative. The reproducibility of 244 assessable tests in the 56 patients reached 88.1%. Twenty-three (9.4%) of the tests previously positive had become negative and six (2.5%) of the tests previously negative had become positive. Tests performed with pancuronium or vecuronium had more often become negative (47% and 40% respectively) than those performed with the other 3 muscle relaxants tested (P less than 0.001). These results suggest that skin tests should be repeated prior to general anaesthesia in all patients who previously developed an anaphylactoid reaction to muscle relaxants.

Prick tests in the diagnosis of anaphylaxis to general anaesthetics.

Pre-charged prick tests and intradermal skin tests (two dilutions) were tested simultaneously in 79 patients using seven drugs (suxamethonium, gallamine, alcuronium, pancuronium, vecuronium, fentanyl and thiopentone) commonly administered during general anaesthesia. Fifty-seven of the patients had suffered anaphylaxis to anaesthetics: 50 had been tested previously (19.5 +/- 13.5 months) by intradermal tests (group 1) and seven were tested for the first time (group 2). Six patients had suffered a side effect during anaesthesia which was unrelated to anaesthetic agents (group 3) and 16 were control subjects (group 4). Prick and intradermal skin tests were simultaneously positive in 98 instances out of 553 (17.7%) and negative in 440 out of 553 (79.6%)--a correlation of 538 out of 553 (97.3%; P less than 0.001). In groups 1, 2 and 3 the correlation was 426 out of 441 (96.6%; P less than 0.001). In group 1, a correlation was observed between the diameters of the weals (r = 0.5; P less than 0.001) obtained by prick and intradermal skin tests, and between the diameters of the flares (r = 0.5; P less than 0.001).