Palonosetron versus granisetron in combination with aprepitant for the prevention of chemotherapy-induced nausea and vomiting in patients with gynecologic cancer / 부인종양

OBJECTIVE: There is no research regarding the appropriate antiemetic agents for female patients, especially those receiving moderately emetogenic chemotherapy (MEC). We evaluated the antiemetic efficacy of a combination of 5-HT3 receptor with/without aprepitant in patients with gynecological cancer treated with the TC (paclitaxel and carboplatin) regimen of MEC. METHODS: We enrolled 38 patients diagnosed with gynecologic cancer and scheduled to receive the TC regimen. The patients were randomly assigned to receive a 5-HT3 receptor antagonist, either palonosetron in the first cycle followed by granisetron in the second cycle or vice versa. In the third cycle, all patients received a combination of the 5-HT3 receptor and dexamethasone with/without aprepitant. RESULTS: When three drugs were administered, palonosetron consistently produced an equivalent complete response (CR) rate to granisetron in the acute phase (89.5% vs. 86.8%, p=0.87) and delayed phase (60.5% vs. 65.8%, p=0.79). With regard to the change in dietary intake, palonosetron exhibited similar efficacy to granisetron in the acute phase (92.1% vs. 89.4%, p=0.19) and delayed phase (65.7% vs. 68.4%, p=0.14). However, in the delayed phase, the addition of aprepitant therapy with a 5-HT3 receptor antagonist and dexamethasone produced a higher CR rate than a 5-HT3 receptor antagonist with dexamethasone (93.3% vs. 47.8%, p<0.001) and allowed the patients to maintain a higher level of dietary intake (93.3% vs. 56.5%, p<0.001). CONCLUSION: The addition of aprepitant therapy was more effective than the control therapy of a 5-HT3 receptor antagonist, and dexamethasone in gynecological cancer patients treated with the TC regimen.

The infusion rate of mivacurium or atracurium for cesarean section compared with gynecological procedures

Mivacurium is mainly metabolized by plasma cholinesterase, whereas atracurium is removed by Hofman elimination. The purpose of this study was to compare the infusion rate of atracurium and mivacurium in maintaining surgical relaxation, and to compare their recovery indices between parturients and non-pregnant women. Muscle relaxation was maintained by the continuous infusion of relaxants to retain the first response of train-of-four (TOF) at 5% of control. When mivacurium was used, Bolus-T5 (duration from the end of mivacurium bolus injection to 5% single twitch recovery) was measured. After discontinuing the infusion, the recovery index was measured. The infusion rate of mivacurium, not atracurium, was significantly lower in parturients and Bolus-T5 of parturients was significantly longer than that of non-pregnant women. There was no significant difference in the recovery indices of both relaxants. The authors concluded that the infusion rate of mivacurium in maintaining muscle relaxation in parturients should be reduced compared to the rate in non-pregnant women and measuring Bolus-T5 may be helpful in determining the infusion rate to maintain muscle relaxation.

Análisis de dos dosificaciones de mivacurio sobre las respuestas neuromusculares y cardiovasculares durante la anestesia en el paciente pediátrico ambulatorio / Neuromuscular and cardiovascular responses of two doses of mivacurium during ambulatory anestheria in pediatric patientes

El mivacurio es un relajante muscular no despolarizante de corta acción sintetizado recientemente. Decidimos evaluar sus efectos neuromusculares y cardiovasculares por dosis respuesta en pacientes pediátricos. Método: Se estudiaron 60 pacientes entre 2 a 10 años de edad con estado físico I-II según ASA para cirugía electiva ambulatoria en procedimientos cortos (1 hora de duración) que requerían intubación endotraqueal: La anestesia fue bajo halothano-óxido nitroso y oxígeno. A treinta niños se le administró mivacurio a dosis de 150 µg/kg y treinta pacientes recibieron una dosis de 250 µg/kg ambos en bolo por vía endovenosa. La dosis se estimo a 2 x DE95. La respuesta neuromuscular se midió a través de la fuerza de contracción en forma indirecta del nervio cubital por estimulo de tren de cuatro a 2 HZ. La frecuencia cardiaca, presión arterial se evalúo cada minuto durante la inducción. Resultados: A dosis de 150 mg/kg de mivacurio el tiempo de latencia fue de 3.50 ñ 0.65 min; el tiempo de acción de 13.00 ñ 2.87 min y el tiempo de recuperación al 25 por ciento (T1) fue de 12.03 ñ 2.13 min. A la dosis de 250 µg/kg el periodo de latencia fue de 3.24 ñ 0.66 min, el periodo de acción de 14.08 ñ 2.76 min, y el tiempo de recuperación (T1) de 16.01 ñ 3.22 min. No hubo diferencias significativas en ambos grupos. Por otra parte, las variaciones cardiovasculares no fueron significativas, a pesar de que hubo discreta disminución en la presión arterial con elevación mínima en la frecuencia cardiaca a dosis de 250 µg/kg. en un niño se observo rash pasajero. NO se observaron diferencias significativas al comparar los efectos neuromusculares y cardiovasculares con dosis de mivacurio de 150-250 µg/kg en pacientes pediátricos en edades comprendidas de 2 a 10 años en anestesia general con halotano-oxígeno-óxido nitroso para cirugía ambulatoria

Effects of central epinephrine synthesis inhibition on stress-induced prolactin secretion in male rats

1. The present study was designed to examine the role of central epinephrine pathways in the control of stress-induced prolactin secretion in male adulto Wistar rats. 2. Intracerebroventricular adminsitration of two epinephrine synthesis inhibitors, SKF64139 (5 and 10 µg/rat) and LY 134046 (10 and 20 µg/rat), 6 h before the onset of immobilization stress blocked prolactin secretion in a dose-dependent manner. Prolactin values before stress were about 4.0 ng/ml and increased to almost 50 ng/ml in the control group. SKF 64139 injection in the higher dose (10 µg/rat) induced a complete blockade of the stress-induced prolactin release, whereas partial blockade was observed after the higher dose (20 µg/rat) of LY 134046. 3.Salbutamol pretreatment (10 µg/rat) completely restored stress-induced prolactin secretion in animals receiving a central injection of both epinephrine synthesis inhibitors under the same conditions as described above. 4. It is suggested that epinephrine pathways in the brain play an important role in the control of prolactin release occuring during immobilization stress

Avaliaçäo clínica do atracúrio / Clinical evaluation of atracurium

Um bloqueador neuromuscular da nova geraçäo foi estudado em 30 pacientes ASA I e II. Todos eles foram pré-medicados com diazepam, e a nenhum deles foi administrado bloqueador muscarínico. A anestesia foi induzida com fentanil (5 microng.kg-1) e tiopental sódico (5 mg.kg-1), e mantida com óxido nitroso/oxigênio/fentanil. A pressäo arterial foi monitorizada pelo método auscultatório, e a freqüência cardíaca foi determinada por eletrocardiograma. A funçäo neuromuscular foi monitorizada pela estimulaçäo do nervo ulnar nas freqüências de 1,5 e 40 Hz. Nenhuma alteraçäo estatisticamente significativa foi observada na pressäo arterial após a administraçäo de atracúrio na dose de 0,3 mg.kg-1. Observou-se, no entanto, uma diminuiçäo expressiva da freqüência cardíaca. O efeito máximo da droga foi obtido em 2,39 + ou - 0,76 min. A recuperaçäo de 100% da resposta a estímulo isolado, e de 95% a estímulos tetânicos ocorreu em 40,70 + ou - 12 e 58,47 + ou - 19,06 min, respectivamente

Liver collagen in Opisthorchis viverrini infected hamsters following praziquantel treatment.

The dose of praziquantel required to achieve a 100% worm reduction in O. viverrini infected hamsters was found to be 300 mg/kg body weight. The drug was administered orally for 1 day by dividing a total dose into 3 equal doses at 4 h interval. The effect of praziquantel treatment on liver collagen was followed by measuring liver collagen content in at various intervals after administration of the drug. A decrease in collagen content in the infected livers occurred within a few weeks following the treatment suggesting a recovery from liver fibrosis.

Tratamiento de la neurocisticercosis con praziquantel en Colombia / Treatment of neurocysticercosis with praziquantel in Colombia

Se estudiaron y trataron con praziquantel 39 casos de neurocisticercosis, de los cuales 3 tenian cisticercos subcutaneos. El diagnostico se hizo con tecnicas especializadas que incluyen la escanografia (TC) y la prueba de hemaglutinacion (HG). Se describen 4 sindromes principales: epilepsia (E) en 17 casos, hipertension intracraneana (HIC) en 8 casos, combinacion de los 2 sindromes en 8 y cefalea en 3 casos; en 2 casos se presentaron epilepsia, cefalea y vertigo. Se operaron 16 casos y en 11 se extirpo un cisticerco; en 4 se hicieron derivaciones para la hidrocefalia y en 1 la cirugia tuvo como objeto una calcificacion que no se encontro. Solamente se trataron 22 pacientes con prazinquantel. De 36 que tuvieron control posterior se observo la siguiente evolucion: en 8 con HIC, 7 curados (87%) y 1 mejorado; en 16 con epilepsia, 11 asintomaticos (69%), 4 mejorados y 1 sin cambios; en 8 con HIC y E, 5 asintomaticos (62.5%), 2 muertes y 1 mejorado; en 2 con cefalea, uno asintomatico y otro mejorado; en 2 con epilepsia, cefalea y vertigo, no hubo modificaciones en su cuadro clinico. La escanografia mostro mas de una fase de involucion del cisticerco en 17 casos. En 15 casos en que hay control de TC despues del tratamiento de las fases I-II-III, desaparecieron las imagenes en 9 (60%); en 4 (27%), basicamente permanecieron sin modificaciones; ..

Tratamiento con praziquantel en 6 casos de cisticercosis subcutanea y en un caso ocular / Treatment with prazinquantel in 6 cases of subcutaneous cysticercosis and an ocular case

Se presenta el resultado del tratamiento con praziquantel en 6 casos de cisticerosis subcutanea, 3 de los cuales tenian al mismo tiempo cisticerosis cerebral. En los pacientes sin compromiso del sistema nervioso central que presentaban unicamente de 1 a 3 quistes la dosis fue 30-45 mg/kg/dia asociados con prednisona en 2 de ellos; la curacion se obtuvo al cabo de 2 meses.Los casos con compromiso del cerebro presentaban de 4 a 11 quistes en la piel, uno de ellos recibio 30 mg/kg/dia por 6 dias en 2 veces con intervalo de 1 mes y los otros 50 mg/kg/dia por 10 dias consecutivos, asociados con prednisona. El paciente con 11 quistes curo completamente, 7 quistes desaparecieron en 15 dias y los 4 restantes en 4 meses. El paciente con 4 quistes aun presentaba uno al cabo de 10 meses, mientras que el paciente con 5 quistes curo de ellos en un mes y presento un quiste de nuevo a los 3 meses; a los 6 meses de control aun persistian 4 quistes antiguos y el nuevo. Un caso cisticerco unico en el humor vitreo no curo y al extraer quirurgicamente el quiste a los 7 meses del tratamiento, el parasito mostro caracteristicas de haber estado vivo

Studies on the chemotherapy of human opisthorchiasis: III. Minimum effective dose of praziquantel.

A clinical trial of praziquantel was carried out in patients with opisthorchiasis using low dosages with 30 and 60 days follow-up. In group III, 30 patients treated with praziquantel 25 mg per kg body weight bid, for one day yielded a cure rate of 88%. In group IV, 12 patients received 25 mg per kg body weight in a single dose and gave a cure rate of 44 %. In group V, 55 patients received 40 mg per kg body weight in a single dose and yielded a cure rate of 91%. Mild and transient side effects were present in 54%, these included abdominal pain, lassitude, headache, dizziness, nausea, diarrhoea, myalgia and tachycardia. Clinical improvement was observed in most of the patients after one month and 33% of them were clinically cured in two months. The recommended dose of praziquantel for the treatment and control of opisthorchiasis in the endemic area is a single dose of 40 mg per kg body weight after meals.