[Study of toxicity effect of different rate of Sargassum and Radix Glycyrrhizae on rats].

OBJECTIVE: Study the toxicity effect of different rate of Sargassum and Radix Glycyrrhizae on rats. METHOD: 32 Wistar rats [body weight (123 +/- 15.3) g] were random divided into 4 groups of 8: normal group (A) and compatibility medicine group (B, C, D). The normal group was oral administrated with the distilled water, B, C, D group were oral given the Sargassum and Radix Glycyrrhizae (1:1), Sargassum and Radix Glycyrrhizae (1:2), Sargassum and Radix Glycyrrhizae (1:3) for 35 days, the dose was 20 mg x g(-1) weight, in the meantime, general state of health was observed, then rats were slaughtered, and the body weight, internal organs coefficient, blood routine, serum biochemistry and liver drug enzyme were assaied. RESULT: The rats' general state of health, body weight, internal organs coefficient has not been affected, the hemoglobin, the red blood cell, the kidney function and liver function have been affected, and has some toxic effect on the rats' white blood cell and cardic muscle, the toxic effect on cardic muscle was increase along with the rate of Sargassum and Radix Glycyrrhizae; liver drug enzyme activity has been improved. CONCLUSION: The different rates of Sargassum and Radix Glycyrrhizae have some selective toxic effect on internal organs of rats.

Neuromuscular disorder in intensive care unit patients treated with pancuronium bromide. Occurrence in a cluster group of seven patients and two sporadic cases, with electrophysiologic and histologic examination.

During six consecutive months, seven patients admitted to our ICU (15 beds, general ICU, approximately 300 intubated patients per year) for acute respiratory failure requiring intubation and mechanical ventilation presented with a peculiar neuromuscular disorder. After the occurrence of this cluster group of patients, we detected two more similar but isolated cases in the following 18 months, ie, altogether 9 patients in 2 years of observation, or 1.55 percent of all intubated patients in our ICU. Sedation was achieved using midazolam, curarization was effected with the neuromuscular non-depolarizing agent pancuronium bromide (PB), and corticosteroids were administered to eight patients. Shortly after discontinuation of sedation and curarization, we observed a persistent tetraparetic syndrome and/or peroneal palsy with a concomitant increase of serum creatine kinase (CK). None of the patients was septic or had the multisystem organ failure. A strong association between CK increase and PB administration was found, whereas no patient suffered severe liver or kidney failure. The duration of the neurologic deficit ranged from 4 to 52 weeks, with only partial recovery for some patients; the duration of dysfunction was apparently related to the total dose of corticosteroids received. Two patients had difficulty being weaned from the respirator and required tracheostomy. Electrophysiologic studies showed signs of axonal neuropathy and myopathic changes, ie, motor units of brief duration, small amplitude, overly abundant for the voluntary effort being exerted. Muscle biopsies showed significant myopathic alterations, with foci of muscle necrosis in most patients and minimal lymphocytic inflammation in one patient. The neurologic complication described differs from the polyneuropathy in critically ill patients. Furthermore, PB or corticosteroids or both appear to be the causal agents. The duration of the neuromuscular dysfunction may be related to concomitant steroid therapy. The CK enzyme seems to be a marker of the disorder. This disorder is associated with myopathic alterations and axonal degeneration in some patients. Pancuronium bromide should be used with caution, particularly when associated with steroids therapy, and it may cause difficulty in weaning patients from the respirator.

Neuroleptic malignant syndrome in a patient with head injury.

Neuroleptic malignant syndrome is an idiosyncratic reaction associated with the use of neuroleptic drugs. We report a case of this rare syndrome in a head injury patient associated with some unusual features: rhabdomyolysis with a high level of creatine kinase, the development of acute renal failure, the early use of continuous venovenous haemofiltration in treatment and rigidity that was refractory to conventional treatment with dantrolene and bromocriptine. The diagnosis in patients with multiple injuries must be based on a high index of suspicion.

Prolonged neuromuscular blockade in two critically ill patients treated with atracurium.

Recent literature suggests that the risk of prolonged neuromuscular blockade associated with atracurium compared with other nondepolarizing neuromuscular blocking agents may be minimal. Two patients experienced prolonged weakness associated with the administration of atracurium. Both received atracurium 0.5-0.7 mg/kg/hour in combination with methylprednisolone 500-600 mg/day. Electromyographic results and creatine kinase levels were suggestive of muscular weakness in both patients. Despite high-dose corticosteroid therapy, the electromyographic evidence supporting prolonged weakness did not suggest typical corticosteroid myopathy. Although some clinicians advocate routine administration of atracurium in critically ill patients due to the relative lack of reports of prolonged weakness, this may be premature. Although there are fewer reports of atracurium-associated prolonged weakness compared with pancuronium and vecuronium, the patients we describe suggest that it may occur.

[Rhabdomyolysis in severe acute asthma]. / Rhabdomyolyse au cours d'un asthme aigu grave.

A case is reported of a 74-year-old man who developed rhabdomyolysis during treatment for status asthmaticus. This patient had a history of asthma. He was admitted after a cardiac arrest during a severe asthma attack. Continuous muscle relaxation (4 mg.h-1 of pancuronium for 10 days; total dose 960 mg) was required to carry out mechanical ventilation. Bronchodilators and high doses of steroids (300 mg.day-1 of methylprednisolone for 10 days) were also given. After the administration of muscle relaxant had been discontinued, the patient displayed a severe, predominantly proximal, quadriplegia as well as a raised blood creatinine kinase concentration. The urine was brown coloured over a 24 h period. Rhabdomyolysis was confirmed by muscle biopsy. The patient recovered over a period of one month. This case is discussed in the light of some other similar reports in the literature. It seems that the combination of muscle relaxant with high doses of steroids is to be incriminated.

[Preventive effect of cardiomyopeptidin on rat heart injured by ischemia-reperfusion].

OBJECTIVE: To investigate the preventive effect of cardiomyopeptidin of small molecular weight polypeptide on rat hearts injured by ischemia-reperfusion. METHODS: In a rat model injured by ischemia-reperfusion in the heart, observation was made on the influence of cardiomyopeptidin on the activities of creatine kinase (CK) and lactate dehydrogenase(LDH), as well as on the content of MDA in plasma after the preventive drug was used. RESULTS: Cardiomyopeptidin could obviously prevent the injury caused by ischemia-reperfusion, reduce the activities of CK and LDH and the content of MDA in a dose-dependent manner. CONCLUSION: Cardiomyopeptidin has a preventive effect on myocardium injured by ischemia-reperfusion and this may be related to its reducing the release of myocardial enzyme and anti-lipoperoxidation.

Prophylactic nitroglycerin infusions during coronary artery bypass surgery.

The effects of prophylactic infusion of 1 microgram X kg-1 X min-1 nitroglycerin (NTG) on the incidence of ischemia, hypertension, hypotension and perioperative myocardial infarction were studied in 81 patients during coronary artery bypass grafting (CABG). Forty-one patients (Group 1) received NTG and 40 patients (Group 2) received placebo. All patients received fentanyl for anesthesia and pancuronium. Mean arterial pressure (MAP), pulmonary capillary wedge pressure (PCWP), heart rate (HR), and cardiac output (CO) were measured before and after induction of anesthesia, after intubation, before and after chest incision, after sternotomy, after the pericardium was opened, and during normothermic cardiopulmonary bypass. Myocardial ischemia and infarction were diagnosed from the ECG, hypertension was defined as a 20% increase in MAP, and hypotension was defined as a 20% decrease in MAP compared with preinduction values. No significant differences between Groups 1 and 2 in HR, PCWP, or CO were seen. MAP was significantly lower in Group 1 than Group 2 (P less than 0.05) before chest incision, but increased to levels equal to Group 2 after sternotomy. Hypertension occurred in 32 Group 2 patients and 25 Group 1 patients (0.05 less than P less than 0.1). Group 1 patients had 0.95 +/- 0.14 episodes per patient of hypertension, while Group 2 patients had 2.10 +/- 0.31 episodes (P less than 0.05). Hypotension occurred in 20 Group 1 patients but only six Group 2 patients (P less than 0.05). There was no difference in the incidence of ischemia. In Group 1, nine patients (22%) had ECG changes of ischemia, while 12 patients in Group 2 (30%) had ischemia.(ABSTRACT TRUNCATED AT 250 WORDS)

Pretreatment with vecuronium as a prophylactic against post-suxamethonium muscle pain. Comparison with other non-depolarizing neuromuscular blocking drugs.

One hundred and ninety-eight patients undergoing minor surgery were assessed for evidence of post-suxamethonium muscle pain on the 1st and 2nd days following surgery. Patients were allocated to nine groups and were given one of four non-depolarizing neuromuscular blocking drugs (vecuronium, gallamine, tubocurarine or pancuronium) 1 or 2 min before the administration of suxamethonium. A control group received an inert medication. Forty-one per cent of patients receiving no pretreatment experienced muscle pain. This frequency was decreased to around 20% following pretreatment. In general, the frequency of pain was less in the groups receiving pretreatment at 1 min, but the difference was not significant. The groups receiving vecuronium before suxamethonium had the lowest overall frequency of pain over the 2 days (19%), although this was not significantly different from other pretreatments.

Myocardial injury during reoperation for coronary artery bypass surgery.

OBJECTIVES: To determine the incidence, triggers, and timing of myocardial injury during reoperation for coronary artery bypass surgery. DESIGN: Prospective observational. SETTING: One tertiary care university hospital. PARTICIPANTS: 15 patients undergoing reoperation. INTERVENTIONS: Multilead electrocardiographic monitoring approximately every 3 minutes during surgery. MEASUREMENTS AND MAIN RESULTS: The occurrence of a new ischemic ST elevation or depression on the electrocardiogram (ECG) was determined. A major deterioration in ventricular function after cardiopulmonary bypass (CPB) also was determined. Peak creatine kinase myocardial band (CK-MB) > or = 25 IU/L was considered to be the marker of myocardial injury. Seven patients demonstrated myocardial injury, all intraoperatively. Five of these patients had new ST elevation episodes before CPB. Three of the episodes were temporally associated with an abrupt increase in the heart rate. The other two episodes were temporally associated with surgical manipulation of the heart and the old grafts. The sixth patient had a significant deterioration of ventricular function during CPB. One of the patients who had ST elevation before CPB and the seventh patient developed ST elevation towards the end of protamine administration. CONCLUSIONS: In patients undergoing reoperation, the intraoperative incidence of myocardial injury, especially before CPB, was found to be substantially higher than that previously reported.