Impact of Triazole Therapeutic Drug Monitoring Availability and Timing.

Therapeutic drug monitoring (TDM) is an established strategy to optimize antifungal therapy with certain triazoles. While established relationships exist between concentration and safety or efficacy, the impact of TDM timing on outcomes is unknown. We report clinical outcomes, including antifungal exposure and mortality, in patients receiving institutional versus reference laboratory TDM. The availability of in-house triazole assays reduced the time to drug concentration result (12 versus 68 h; P < 0.001) and time to achieve therapeutic serum concentrations (10 versus 31 days; P < 0.001). Subtherapeutic concentrations were associated with higher patient mortality (32% versus 13.3%; P = 0.036).

Peroperative depth of anaesthesia may influence postoperative opioid requirements.

BACKGROUND: Studies on monitoring the depth of anaesthesia have shown that with the use of these monitors the peroperative consumption of anaesthetics can be reduced. Studies have also indicated that the peroperative depth of anaesthesia may affect the postoperative course. The purpose of this study was to evaluate a possible relation between the depths of anaesthesia and the postoperative pain score and consumption of morphine. METHODS: We used middle latency auditory evoked potentials (MLAEPs) for monitoring the depth of anaesthesia. The study was prospective, observer blinded and included 50 women scheduled for elective abdominal hysterectomy. Anaesthesia was induced using propofol and remifentanil. Before leaving the recovery room the patients were provided with a programmed patient-controlled pump (PCA), which was only activated on demand. Auditory evoked potentials were registered from just before induction of anaesthesia and during the whole procedure, but the anaesthetist did not have access to the monitor. RESULTS: Fifty patients were included and seven were excluded. The remaining 43 patients were divided into two groups: Group High (n=12) with an AAI>28 for >5% of the registration time and Group Low (n=31) with an AAI>28 for <5% of the registration time. Group High had significantly higher morphine requirements in the recovery and activated the PCA-pump more frequently during the first 24 postoperative hours. CONCLUSION: The results indicate that the peroperative depth of anaesthesia may have effects on the postoperative analgesic requirements.

Treatment of angioblastoma with recombinant interferon-alpha 2.

Interferon-alpha 2 has been used successfully to treat angiomatous lesions such as Kaposi sarcoma and life-threatening hemangiomas, possibly by its antiangiogenetic activity. We report the successful use of this agent in a child with an angioblastoma of the right leg.

Fracture of the acetabulum during insertion of an oversized hemispherical component.

A hemispherical metal-backed acetabular component that was oversized by two or four millimeters was introduced without cement into thirty fresh or embalmed cadaveric acetabula that were fifty, fifty-two, fifty-four, fifty-six, or fifty-eight millimeters in diameter. Manual tapping was used to insert the component into ten fresh and ten embalmed specimens, and a materials testing machine was used for the remaining five fresh and five embalmed specimens. The magnitude of force and the number of pulses necessary to seat the component were determined for the insertions performed with the materials testing machine; 2000 and 3000 newtons of force were required to insert the cups that were oversized by two and four millimeters, respectively. Visual and radiographic assessments were used to identify any resulting acetabular fractures. Over-all, eighteen (60 per cent) of the thirty acetabular specimens fractured. Of the eighteen fractures, only fifteen were detectable radiographically: ten on en face or lateral radiographs of the cup and five only on oblique radiographs of the cup. The remaining three fractures were apparent only after the removal of the acetabular component.(ABSTRACT TRUNCATED AT 250 WORDS)

Total fat and fatty acid composition of commercially available chocolate candies.

Forty different brands of chocolate candies were purchased in a supermarket. The wrappers were removed and coded, and the candy was re-wrapped in aluminum foil until analyzed. More than 60 percent of the samples had a polyunsaturated/saturated (P/S) ratio of less than 0.10. Although the candies examined had a higher carbohydrate than fat content, fat frequently contributed more calories in the candies containing more than 25 percent fat (15 of the 40 brands studied).

Electrocardiographic abnormalities in obese rats fed a commercially available liquid protein diet.

Male, obese and non-obese Osborne-Mendel rats were fed a commercially available liquid protein (LP) diet of poor nutritional quality in an amount proportional to that consumed by humans on this diet. Rats fed LP plus vitamins and minerals or a vitamin and mineral mixture only served as control groups. Electrocardiograms (ECG) were recorded weekly until the animals lost 45-50% of their original body weight. ECG's were normal in all groups at the start of the experiment. All rats consuming the LP diet only had arrhythmias. Intractable arrhythmias in the human have been of ventricular origin; in rats in this study various atrial disorders of an inconsistent nature were observed. Serum calcium was low in rats fed the LP diet, but normal in magnesium and potassium concentrations. Calcium, magnesium and potassium were in normal concentrations in cardiac and skeletal muscle, and in bone. Zinc and copper concentrations were low in hearts of rats fed the LP diet. The suggested role of calcium, magnesium and potassium in producing cardiac arrhythmias when subjects consume the liquid protein diet studied here as the sole source of calories is questioned.

Effect of dietary restrictions and source of rats on growth rate and efficiency of conversion of food into muscles, bones and organs.

Differences in weight of the body, six different skeletal muscles, epididymal fat pads, three different bones, spleen, heart, kidneys, testes and liver were observed in 21-day-old male Sprague-Dawley rats from two different suppliers. All rats were pair-fed a 10% casein diet ad libitum, 10%, 20%, 30% restricted for 4 or 8 weeks. Original body and tissue weight differences between the two strains of rats were maintained in all diets during the 4 and 8 week feeding periods. Trends in body and tissue weight changes due to dietary restriction were similar in both strains of rats. Diet restrictions for 4 or 8 weeks caused similar patterns of weight decrease in most tissues. Feed efficiency ratio (FER) was reduced significantly at the 20% and 30% restriction for 4 weeks only in the lighter strain of rats. FER was higher in the heavier strain than in the lighter strain of rats at all levels of diet restriction. Food conversion efficiency with reduced food intake was constant or decreased depending on the skeletal muscle studied; decreased significantly for epididymal fat pad, bone weight (one strain only), kidneys and liver (one strain only) with the 30% reduced diet for 4 weeks; and increased for bone length and testes weight. Therefore, significant deviations from ad libitum controls were found only at 30% diet restriction, and the wide differences in body and tissue weight of two strains of Sprague-Dawley rats did not affect the interpretation of results when fed the same restricted diets.