RESUMEN
OBJECTIVES: Validation of cerebrospinal fluid (CSF) indexes as a measure for intrathecal C3 and C4 production. Examination of their role in differential diagnosis of immunological disorders of the central nervous system (CNS). MATERIAL AND METHODS: Correlative study in controls (low back pain without disk herniation) between the CSF/serum ratio (Q) for albumin, and Q C3 and Q C4. Comparative study of C3 and C4 indexes in patients with CNS dysfunction due to relapsing-remitting (RR) multiple sclerosis (MS), secondary progressive (SP) MS, systemic lupus erythematosus (SLE), and human immunodeficiency virus (HIV) infection. RESULTS: Strong and statistically highly significant correlations between Q albumin and Q C3 (r=0.89, P=0.0001), and Q C4 (r=0.68, P= 0.0001). In MS patients decreased mean values for serum (RR, SP) and CSF (RR) C3, and increased C3 index mean value (RR, SP). In CNS SLE increase of mean C3 and C4 index values. In CNS HIV increase of mean C3 and C4 index values, and CSF C3 and C4 concentrations. Most individual index values were within the reference range. CONCLUSION: CSF index is a valid tool to detect intrathecal C3 or C4 production. C3 or C4 index contributes little to the differential diagnosis of immunological CNS disorders. C3 might play a pathogenic role in various immunological CNS disorders.
Asunto(s)
Complejo SIDA Demencia/líquido cefalorraquídeo , Complemento C3/líquido cefalorraquídeo , Complemento C4/líquido cefalorraquídeo , Lupus Eritematoso Sistémico/líquido cefalorraquídeo , Esclerosis Múltiple Crónica Progresiva/líquido cefalorraquídeo , Esclerosis Múltiple Recurrente-Remitente/líquido cefalorraquídeo , Complejo SIDA Demencia/sangre , Complejo SIDA Demencia/diagnóstico , Albúminas/líquido cefalorraquídeo , Enfermedades Autoinmunes , Barrera Hematoencefálica , Estudios de Casos y Controles , Diagnóstico Diferencial , Femenino , Humanos , Inmunoglobulina G/análisis , Inmunoglobulina M/análisis , Lupus Eritematoso Sistémico/sangre , Lupus Eritematoso Sistémico/diagnóstico , Masculino , Esclerosis Múltiple Crónica Progresiva/sangre , Esclerosis Múltiple Crónica Progresiva/diagnóstico , Esclerosis Múltiple Recurrente-Remitente/sangre , Esclerosis Múltiple Recurrente-Remitente/diagnóstico , Valores de Referencia , Albúmina Sérica/análisis , Estadísticas no ParamétricasRESUMEN
The pharmacokinetics, efficacy and safety of metoprolol tartrate 25 mg fatty suppositories were studied in 5 healthy volunteers and in 8 patients suffering from instable angina pectoris. Metoprolol 25 mg capsules were used as a control oral dosage form. Metoprolol showed a considerable rectal bioavailability (AUC, C max) and was absorbed quickly from the rectum (T max). In both groups rectal bioavailability was comparable. However, oral bioavailability was much lower in the volunteer group than in the patient group. Furthermore, ratios of metoprolol/alpha-OH-metoprolol concentrations in plasma and urine gave an indication for a partial avoidance of the first pass effect after rectal administration. Further research is necessary to define an exact rectal dosage of metoprolol. In all patients, a substantial drop in heart rate, systolic and diastolic blood pressure was seen after administration of the first suppository. Metoprolol suppositories appear to be an effective, safe and suitable alternative for patients who are in need for beta blocking medication and who are unable to take oral medication for a certain amount of time.
Asunto(s)
Antagonistas Adrenérgicos beta/administración & dosificación , Antagonistas Adrenérgicos beta/farmacocinética , Angina Inestable/metabolismo , Metoprolol/administración & dosificación , Metoprolol/farmacocinética , Administración Oral , Administración Rectal , Antagonistas Adrenérgicos beta/efectos adversos , Adulto , Disponibilidad Biológica , Presión Sanguínea/efectos de los fármacos , Frecuencia Cardíaca/efectos de los fármacos , Humanos , Metoprolol/efectos adversos , Persona de Mediana Edad , Factores de TiempoRESUMEN
The purpose of the study was to evaluate the effect of antiischemic treatment on left ventricular function in selected patients with unstable angina pectoris that was due to severe proximal left anterior descending coronary artery narrowing and to identify subgroups liable to an adverse outcome (mean term 2.7 years). Effect of antiischemic treatment on systolic and diastolic left ventricular wall motion was studied in 35 patients who had unstable angina pectoris and an electrocardiogram that indicated severe proximal left anterior descending coronary artery narrowing. Treatment consisted of either a revascularization procedure (17 patients) or antianginal drug therapy (18 patients). All patients underwent a two-dimensional echocardiographic study within 48 hours (mean 20 hours) of entry into the study. This study semiquantitatively analyzed systolic performance of the ischemia-related segments by calculation of a total wall motion score. In 16 patients this investigation was combined with a continuous detailed recording of only the apical interventricular septal wall motion. This detailed study included measurements for regional function by providing a typification of the pattern of systolic and early diastolic excursion of the endocardial border of the apical interventricular septum. A repeat ultrasonic study was performed at least 1 month (median 2 months, 7 days) after admission. Results of the systolic wall motion analyses of all 35 patients showed, in both treatment groups, a significant improvement in systolic wall motion of the anterior and apical segments (mean total wall motion score at early study vs late study: revascularization, 6.9 vs 2.2 and medical therapy, 4.6 vs 1.0).(ABSTRACT TRUNCATED AT 250 WORDS)