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Clin Neuropharmacol ; 37(4): 96-9, 2014.
Artigo em Inglês | MEDLINE | ID: mdl-24992088


BACKGROUND: According to recent investigations, the eradication of Helicobacter pylori (H. pylori) may influence levodopa (LD) pharmacokinetics (PK) and improve the motor function of infected patients with Parkinson disease (PD). The aim of this study was to compare PK of LD and its metabolite 3-O-methyldopa (3-OMD), between H. pylori-positive (HP+) and -negative (HP-) patients with PD and motor fluctuations. MATERIALS AND METHODS: Patients with the clinical diagnosis of PD, under stable LD therapy, reporting daily motor fluctuations and who had no history of previous eradication treatment were screened for the H. pylori infection with an antigen stool test. Two groups of patients-bacteria-infected and noninfected-matched demographically and clinically, were selected for the examination of PK values. Blood samples were collected after morning oral LD dose. Noncompartmental PK parameters were computed from the LD and 3-OMD plasma concentration-time data. RESULTS: Interindividual variability was seen in LD absorption curve in both groups. There were no clinically significant differences in PK parameters of LD and 3-OMD. Changes of small magnitude but with possible clinical impact were found according to tmax and Cmax that tended to be lower in HP- patients and AUC0-t that was larger in the HP+ group. The Cmax value of 3-OMD was almost identical in both groups. The HP- group had smaller AUC0-∞t of 3-OMD. CONCLUSIONS: The H. pylori infection in PD patients with motor fluctuations, despite not significantly influencing PK parameters of LD and 3-OMD, may still have important clinical implications.

Antiparkinsonianos/farmacocinética , Infecções por Helicobacter/complicações , Helicobacter pylori/patogenicidade , Levodopa/farmacocinética , Atividade Motora/efeitos dos fármacos , Doença de Parkinson , Adulto , Idoso , Antiparkinsonianos/uso terapêutico , Benserazida/uso terapêutico , Di-Hidroxifenilalanina/análogos & derivados , Di-Hidroxifenilalanina/sangue , Jejum , Feminino , Infecções por Helicobacter/sangue , Humanos , Levodopa/uso terapêutico , Masculino , Pessoa de Meia-Idade , Doença de Parkinson/sangue , Doença de Parkinson/complicações , Doença de Parkinson/tratamento farmacológico , Índice de Gravidade de Doença , Tirosina/análogos & derivados
World J Gastrointest Pharmacol Ther ; 2(6): 50-1, 2011 Dec 06.
Artigo em Inglês | MEDLINE | ID: mdl-22180850


Symptomatic gastro-esophageal reflux disease (GERD) is a very common disease. The consequence of GERD is not only erosive esophagitis, but also esophageal stricture, Barrett's esophagus and extra-esophageal damage (including the lungs, throat, sinuses, middle ear and teeth). GERD and Barrett's esophagus are also identified as major risk factors for esophageal carcinoma. Therapy with melatonin prevents esophageal injury from acid-pepsin and acid-pepsin-bile exposure in animals, then further studies are required in humans to establish whether a melatonin supplement is able to protect the patients with GERD from erosions, Barrett's and neoplasia.

World J Gastrointest Pharmacol Ther ; 2(2): 9-16, 2011 Apr 06.
Artigo em Inglês | MEDLINE | ID: mdl-21577312


Chronic anal fissure (CAF) is a painful tear or crack which occurs in the anoderm. The optimal algorithm of therapy for CAF is still debated. Lateral internal sphincterotomy (LIS) is a surgical treatment, considered as the 'gold standard' therapy for CAF. It relieves CAF symptoms with a high rate of healing. Chemical sphincterotomy (CS) with nitrates, calcium blockers or botulinum toxin (BTX) is safe, with the rapid relief of pain, mild side-effects and no risk of surgery or anesthesia, but is a statistically less effective therapy for CAF than LIS. This article considers if aggressive treatment should only be offered to patients who fail pharmacological sphincterotomy. Aspects of anal fissure etiology, epidemiology and pathophysiology are considered with their meaning for further management of CAF. A molecular model of chemical interdependence significant for the chemistry of CAF healing is examined. Its application may influence the development of optimal therapy for CAF. BTX is currently considered the most effective type of CS and discussion in this article scrutinizes this method specifically. Although the effectiveness of BTX vs. LIS has been discussed, the essential focus of the article concerns identifying the best therapy application for anal fissure. Elements are presented which may help us to predict CAF healing. They provide rationale for the expansion of the CAF therapy algorithm. Ethical and economic factors are also considered in brief. As long as the patient is willing to accept the potential risk of fecal incontinence, we have grounds for the 'gold standard' (LIS) as the first-line treatment for CAF. The author concludes that, when the diagnosis of the anal fissure is established, CS should be considered for both ethical and economic reasons. He is convinced that a greater understanding and recognition of benign anal disorders by the GP and a proactive involvement at the point of initial diagnosis would facilitate the consideration of CS at an earlier, more practical stage with improved outcomes for the patient.

Pol Merkur Lekarski ; 18(105): 298-302, 2005 Mar.
Artigo em Polonês | MEDLINE | ID: mdl-15997637


UNLABELLED: Botulinum toxin type A is one of the most potent biological toxins, recently used clinically (Botox, Dysport) for wide range of indications. THE AIM OF THE STUDY was to assess the frequency and severity of side effects during BTX-A therapy for different indications and underlying possible mechanisms. MATERIAL AND METHODS: Material consisted of 327 patients (F202, M125) who underwent 1043 sessions of BTX-A injections for: cervical dystonia--CD (n=58), blepharospasm--BLP (n=31), hemifacial spasm--HFS (n=39), spasticity due to cerebral palsy--CP (n=96), chronic anal fissure--CAF (n=96), esophageal achalasia--AE (n=7). RESULTS: In CD the following side effects were observed: dysphagia (27% of patients and 7% of sessions), weakness of neck muscles (6.7% and 1.3%), pain during swallowing (5.1% and 1%), flu-like syndrome (3.4%, 0.7%). Dysphagia appeared 8.2 days after injection and lasted 14.9 days on average. In BLP authors noticed: unilateral ptosis (22%, 6.3%), bilateral ptosis (3%, 1.9%), haematoma (3%, 0.6%) and in HFS: excessive weakness resulting in asymmetry of face--mild (28.2% and 20%) and moderate (46% and 26.7%). In spasticity due to CP authors noticed: excessive weakness of lower limbs which lasted 13.8 days on average (6.2% and 1.9%), pain (5.2% and 1.6%), flu-like syndrome (4.1% and 1.3%). In CAF: mild incontinence of the flatus and faeces (9% and 5% of sessions), haematoma (5%), flu-like syndrome (3%), inflammation of external anal varices (2%), epididymitis (1%). In AE: chest pain in 6 (at the day of injection and lasted 2-4 days) and reflux in 2 patients (4-8 weeks after injection, lasted 2-3 weeks) were observed. CONCLUSION: Therapy with BTX-A is a very safe procedure, especially when compared with high rate of effectiveness of injections. The side effects are transient, mostly local and completely reversible.

Blefaroptose/induzido quimicamente , Toxinas Botulínicas Tipo A/efeitos adversos , Transtornos de Deglutição/induzido quimicamente , Debilidade Muscular/induzido quimicamente , Músculos/efeitos dos fármacos , Fármacos Neuromusculares/efeitos adversos , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Toxinas Botulínicas Tipo A/administração & dosagem , Criança , Pré-Escolar , Distúrbios Distônicos/tratamento farmacológico , Acalasia Esofágica/tratamento farmacológico , Feminino , Fissura Anal/tratamento farmacológico , Espasmo Hemifacial/tratamento farmacológico , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Espasticidade Muscular/tratamento farmacológico , Fármacos Neuromusculares/administração & dosagem
Eur J Gastroenterol Hepatol ; 14(8): 853-6, 2002 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-12172405


BACKGROUND: Botulinum toxin A (BT-A) is a powerful biological toxin. Nevertheless, it has proved to be a remarkable therapeutic agent for the treatment of benign anal disorders. Higher doses of BT-A could change the outcome of treatment. It is not known whether doses of BT-A higher than 20 units of Botox (or corresponding doses of Dysport) are as safe for patients as lower doses of BT-A. METHODS: The side effects of BT-A injections in the treatment of chronic anal fissure (105 patients) and functional outlet obstruction (34 patients) were analysed prospectively. The patients received at least 25 units of Botox or 150 units of Dysport. RESULTS: The patients with chronic anal fissure complained of incontinence of flatus (one severe case and eight mild cases), incontinence of faeces (five mild cases), anal haematoma (five cases), flu-like syndrome (three cases), an acute inflammation of external anal varices (two cases), epididymitis (one case) and haemorrhoid prolapse (one case). Patients with anismus suffered from intertrigo (one case); the pain after injection lasted for 2-4 days (four cases). No life-threatening side effects after 181 injections of BT-A were observed. Most of the side effects were only transient symptoms. No significant interdependence between injection methods (injection into one or two sites) and the risk of side effects was found. CONCLUSION: Treatment with BT-A is safe. Despite the application of higher doses of BT-A in the treatment of benign anal disorders so far, no severe side effects were observed.

Doenças do Ânus/tratamento farmacológico , Doenças do Ânus/patologia , Toxinas Botulínicas/administração & dosagem , Toxinas Botulínicas/efeitos adversos , Adulto , Idoso , Idoso de 80 Anos ou mais , Estudos de Coortes , Relação Dose-Resposta a Droga , Feminino , Fissura Anal/tratamento farmacológico , Fissura Anal/patologia , Seguimentos , Humanos , Injeções Intralesionais , Obstrução Intestinal/tratamento farmacológico , Obstrução Intestinal/patologia , Masculino , Manometria , Pessoa de Meia-Idade , Estudos Prospectivos , Medição de Risco , Sensibilidade e Especificidade , Resultado do Tratamento