RESUMO
We compared the effect of topical 0.5% tetracaine, 1:2,000 epinephrine, and 11.8% cocaine (TAC) with 1% lidocaine infiltration on bacterial proliferation in experimental lacerations. Forty-eight lacerations were made on the backs of Hampshire pigs, inoculated by injection with infectious doses of Staphylococcus aureus and randomly anesthetized with either topical TAC or lidocaine infiltration. Wounds were sutured, and quantitative cultures were obtained by excision after 48 hours. The mean log10 bacteria per gram of tissue for wounds anesthetized with TAC was 6.818 (95% confidence interval [CI], 6.07 to 7.54) compared with 6.820 (95% CI, 5.91 to 7.75) for those treated with lidocaine; this difference was not significant (P less than .05 by paired two-tailed t test). The probability of failing to detect an intergroup difference of 0.5 log10 bacteria per gram was less than .0001. TAC does not increase bacterial proliferation more than lidocaine infiltration in contaminated experimental porcine lacerations.
Assuntos
Anestésicos Locais/farmacologia , Bactérias/efeitos dos fármacos , Cocaína/farmacologia , Epinefrina/farmacologia , Lidocaína/farmacologia , Tetracaína/farmacologia , Administração Tópica , Anestésicos Locais/administração & dosagem , Anestésicos Locais/efeitos adversos , Animais , Bactérias/crescimento & desenvolvimento , Cocaína/administração & dosagem , Cocaína/efeitos adversos , Combinação de Medicamentos/administração & dosagem , Combinação de Medicamentos/efeitos adversos , Combinação de Medicamentos/farmacologia , Epinefrina/administração & dosagem , Epinefrina/efeitos adversos , Masculino , Staphylococcus aureus/efeitos dos fármacos , Suínos , Tetracaína/administração & dosagem , Tetracaína/efeitos adversos , Infecção dos Ferimentos/etiologia , Ferimentos Penetrantes/terapiaRESUMO
A few minutes after sucking a lozenge for a sore throat a 68-year-old man developed an anaphylactic shock. At a heart rate of 110/min there was no palpable blood pressure. A red confluent exanthem, predominantly of the trunk, was noted. After brief intensive-care treatment the patient was completely well again and diagnostic tests for allergy were performed. The prick test for the 14 individual ingredients of the throat lozenge produced massive reddening and urticaria on the test arm with carbowax, a polyethylene glycol which serves as a vehicle in the remedy and does not have to be listed. Later there were an urge to cough and urticaria all over the trunk. There was no systemic reaction. Neither specific IgE antibodies nor any complement-consuming reaction could be demonstrated. Thus the precipitating mechanism remains unexplained.
Assuntos
Anafilaxia/induzido quimicamente , Álcoois Benzílicos/efeitos adversos , Compostos de Benzil/efeitos adversos , Cetilpiridínio/efeitos adversos , Gramicidina/efeitos adversos , Compostos de Piridínio/efeitos adversos , para-Aminobenzoatos , Ácido 4-Aminobenzoico/efeitos adversos , Idoso , Anafilaxia/diagnóstico , Diagnóstico Diferencial , Combinação de Medicamentos/efeitos adversos , Humanos , Imunoglobulina E/análise , Masculino , Excipientes Farmacêuticos/efeitos adversos , Faringe , Testes Cutâneos , ComprimidosRESUMO
Parkinson's disease continues to be a tragic debilitator of close to half a million Americans. As more is learned about the disease, pharmacological treatment improves. Just recently, deprenyl became a part of our therapeutic armamentarium, and it appears that Sinemet CR will soon be following. It is hoped that these drugs will improve the quality and quantity of life for patients with PD until the disease can be cured.
Assuntos
Antiparkinsonianos/uso terapêutico , Carbidopa/uso terapêutico , Levodopa/uso terapêutico , Doença de Parkinson/tratamento farmacológico , Fenetilaminas/uso terapêutico , Selegilina/uso terapêutico , Idoso , Carbidopa/administração & dosagem , Carbidopa/efeitos adversos , Combinação de Medicamentos/administração & dosagem , Combinação de Medicamentos/efeitos adversos , Combinação de Medicamentos/uso terapêutico , Feminino , Humanos , Levodopa/administração & dosagem , Levodopa/efeitos adversos , Levodopa/farmacologia , Masculino , Pessoa de Meia-Idade , Doença de Parkinson/psicologia , Qualidade de Vida , Selegilina/administração & dosagem , Selegilina/efeitos adversosAssuntos
Anti-Inflamatórios não Esteroides/administração & dosagem , Dor/tratamento farmacológico , Tolmetino/análogos & derivados , Trometamina/administração & dosagem , Anti-Inflamatórios não Esteroides/efeitos adversos , Anti-Inflamatórios não Esteroides/farmacocinética , Ensaios Clínicos como Assunto , Combinação de Medicamentos/administração & dosagem , Combinação de Medicamentos/efeitos adversos , Combinação de Medicamentos/farmacocinética , Humanos , Injeções Intramusculares , Cetorolaco de Trometamina , Tolmetino/administração & dosagem , Tolmetino/efeitos adversos , Tolmetino/farmacocinética , Trometamina/efeitos adversos , Trometamina/farmacocinéticaAssuntos
Anticorpos/análise , Ciproterona/análogos & derivados , Veia Ilíaca , Trombose/induzido quimicamente , Adulto , Antagonistas de Androgênios/imunologia , Ciproterona/efeitos adversos , Ciproterona/imunologia , Acetato de Ciproterona , Combinação de Medicamentos/efeitos adversos , Etinilestradiol/efeitos adversos , Feminino , HumanosRESUMO
The quest for a brighter, more attractive smile has fueled rapid growth in the marketplace for tooth whiteners. With names like BriteSmile, Denta-Lite, Ultra Lite and Whiter Teeth, these products are grabbing the attention of looks-conscious consumers. More than a dozen whiteners have flooded the market recently, most of them available by dentist prescription, a few being sold directly to consumers over the counter. There's no doubt these products work as whiteners, at least on mild to moderate stains. The looming questions is this: are they safe? This article explores that safety question and seeks to provide practicing dentists with some perspective on the issue. We don't pretend to have the definitive answer. As always, it's up to you, doctor, to decide what's best for your patients. It's up to us to provide information that helps you make those crucial decisions. That's our goal.
Assuntos
Dentifrícios/uso terapêutico , Clareamento Dental/métodos , Descoloração de Dente/terapia , Peróxido de Carbamida , Dentifrícios/efeitos adversos , Combinação de Medicamentos/efeitos adversos , Combinação de Medicamentos/uso terapêutico , Humanos , Peróxidos/efeitos adversos , Peróxidos/uso terapêutico , Segurança , Ureia/efeitos adversos , Ureia/análogos & derivados , Ureia/uso terapêuticoRESUMO
Effects of ionic (Hypaque-76) and nonionic (Isovue-370 and Omnipaque-350) contrast media on oxyhemoglobin dissociation of normal human red blood cells were evaluated. In series 1, 4-mL venous blood samples were obtained from 15 normal human volunteers. One blood sample served as control, and 1 mL of either of the three contrast media was added in vitro to the other 4-mL blood samples. P50 values were estimated from the linear portion of the oxyhemoglobin dissociation curve obtained by tonometry. Determinations of P50 were performed at either pH 7.4 or 7.2. At pH 7.4, P50 in the absence of contrast media was 26.3 +/- 0.4 mm Hg (mean +/- SEM). The contrast media caused comparable decreases in P50 from this value (Hypaque-76, 20.0 +/- 0.5 mm Hg; Omnipaque-350, 21.6 +/- 0.4 mm Hg; Isovue-370, 20.7 +/- 0.4 mm Hg). Reducing pH to 7.2 in the absence of contrast media increased P50 to 33.3 +/- 1.0 mm Hg, evidence of the Bohr effect. The presence of contrast media either completely abolished (Hypaque-76 and Omnipaque-350) or markedly attenuated (Isovue-370) this effect. In series 2 (five patients), blood samples were withdrawn from the external iliac artery during injection of Isovue-370 (60-78 mL) into the proximal abdominal aorta to evaluate peripheral vascular disease. Measurement of P50 of these samples yielded findings consistent with those of series 1. The present findings demonstrate that both ionic and nonionic contrast media increase the affinity of hemoglobin for oxygen and, therefore, that they may inhibit oxygen delivery to body tissues.
Assuntos
Diatrizoato de Meglumina/efeitos adversos , Diatrizoato/efeitos adversos , Eritrócitos/efeitos dos fármacos , Iohexol/efeitos adversos , Iopamidol/efeitos adversos , Oxiemoglobinas/efeitos dos fármacos , Angiografia , Combinação de Medicamentos/efeitos adversos , Feminino , Hematócrito , Hemodiluição , Humanos , Concentração de Íons de Hidrogênio , Injeções Intra-Arteriais , MasculinoRESUMO
The effectiveness of prophylaxis of thromboembolism either by acetyl-salicylic-acid (ASA) 0.5 g + dihydroergotamin (DHE) 2.5 mg three times a day or by Heparin 5000 IU + 0.5 mg DHE (HDHE) three times a day was compared in 404 patients, elder than 55 years, with fractures close by the hip joint. Effectiveness was proved daily clinical controls, perfusion scintigraphy on the day after admission, the fourth postoperative day and the day before discharge and by autopsy of the died patients. Clinical manifest thrombosis were seen on the operated legs in the HDHE-group in 7.6% of the patients, in ASA-DHE-group in 15.6%, on the not operated leg under prophylaxis by HDHE in 3.8%, by ASA-DHE in 4.1% of the patients. Increased postoperative bleeding could be found under HDHE in 16.1% of the patients, under ASA-DHE in 9.3% of the patients, wound haematoma in 9.5% under HDHE and in 5.7% of the patients of the ASA-DHE-group. Superficial wound infections occurred under HDHE in 8.1%, under ASA-DHE in 5.7% of the patients, deep infections under HDHE in 0.5% and under ASA-DHE in 1.6% of the patients. Gastrointestinal bleeding under HDHE in 0.5% of the cases and under ASA-DHE in 3.1% of the cases. Prophylaxis had to be discharged in 7.6% of the patients of the HDHE-group and of 19.7% of the ASA-DHE-group. Pathologic perfusion scars should be found in 54.0% of the patients of the HDHE-group and in 54.9% of the ASA-DHE-group. Pulmonal perfusion became worse despite of prophylaxis by HDHE in 15.6% of the cases and despite prophylaxis with ASA-DHE in 17.6%. Pulmonal perfusion became better under HDHE in 11.9% and under ASA-DHE in 12.4% of the cases. The mortality was 9.7%. Fatal thromboembolism occurred under HDHE in three patients (1.4%) and under ASA-DHE in three patients too (1.6%), after subcapital fractures in 0.5%, after pertrochanteric fractures in 2.1% and after subtrochanteric fractures in 6.25% of the patients without any significant difference between the two groups of prophylaxis. Fatal gastrointestinal bleeding had to be remarked in 1.0% of the patients of the HDHE-group and in 2.1% of the ASA-DHE-group, fatal infections in 0.5% of the patients of the HDHE-group and in 1.6% of the ASA-DHE-group. Fatal cardinal infarction could be seen under HDHE in 1.9% of the patients, under ASA-DHE no fatal cardial infarction occurred.(ABSTRACT TRUNCATED AT 400 WORDS)
Assuntos
Aspirina/administração & dosagem , Parafusos Ósseos , Di-Hidroergotamina/administração & dosagem , Fixação Interna de Fraturas , Heparina de Baixo Peso Molecular , Heparina/administração & dosagem , Fraturas do Quadril/cirurgia , Prótese de Quadril , Complicações Pós-Operatórias/prevenção & controle , Tromboembolia/prevenção & controle , Idoso , Idoso de 80 Anos ou mais , Aspirina/efeitos adversos , Causas de Morte , Di-Hidroergotamina/efeitos adversos , Combinação de Medicamentos/administração & dosagem , Combinação de Medicamentos/efeitos adversos , Feminino , Hemorragia/induzido quimicamente , Heparina/efeitos adversos , Humanos , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/mortalidade , Estudos Prospectivos , Embolia Pulmonar/prevenção & controle , Ensaios Clínicos Controlados Aleatórios como AssuntoRESUMO
It is important to be aware of the potential ototoxicity of any drug, vehicle, or antiseptic that is used in the middle ear. Frequently used ear drops (Cortisporin otic suspension, Coly-Mycin S Otic, and VoSoL otic solution) were studied for their ototoxicity. Compound action potentials were measured before and at 1, 2, and 24 hours following drug application on the round window membranes of chinchillas. Each drug was applied for 10 minutes and then was removed by rinsing. The sound pressure in decibels sound pressure level that produced a compound action potential amplitude of 10 microV was defined as the threshold. The change in threshold was interpreted as hearing loss. On the basis of the short-term results at 24 hours following drug application, the ototoxicity of Coly-Mycin was calculated to be twice that of Cortisporin, and the ototoxicity of VoSoL four times that of Cortisporin.
Assuntos
Ácido Acético , Perda Auditiva Neurossensorial/induzido quimicamente , Otite Média/tratamento farmacológico , Acetatos/administração & dosagem , Acetatos/efeitos adversos , Potenciais de Ação , Administração Tópica , Animais , Benzetônio/administração & dosagem , Benzetônio/efeitos adversos , Chinchila , Colistina/administração & dosagem , Colistina/efeitos adversos , Modelos Animais de Doenças , Combinação de Medicamentos/administração & dosagem , Combinação de Medicamentos/efeitos adversos , Perda Auditiva Neurossensorial/tratamento farmacológico , Perda Auditiva Neurossensorial/fisiopatologia , Hidrocortisona/administração & dosagem , Hidrocortisona/efeitos adversos , Neomicina/administração & dosagem , Neomicina/efeitos adversos , Polimixina B/administração & dosagem , Polimixina B/efeitos adversos , Propilenoglicóis/administração & dosagem , Propilenoglicóis/efeitos adversosRESUMO
The consequences of using surgical bone wax are not well studied. We evaluated the infection-promoting potential of sterile bone wax in a rat model of chronic Staphylococcus aureus osteomyelitis. The addition of bone wax greatly reduced the quantitative bacterial inoculum (log colony-forming units) required to establish chronic osteomyelitis in 50% and 100% of challenged animals. The 50% infection rate was reduced from log 6.9 to 2.6 and the 100% infection rate from 8.2 to 4.4, respectively (p less than 0.015, t test for parallelism). Separate experiments were done 10 to 30 minutes after inoculation with only log 6.4 staphylococci. Tibiae of animals that received bone wax yielded more organisms than those that did not (log 2.76 +/- 0.68 versus 1.72 +/- 0.94, p less than 0.01). At 24 hours quantitative colony counts were not significantly different whether animals received wax or not (log 5.02 +/- 0.42 versus 4.43 +/- 0.65, p greater than 0.09). These studies suggest that the routine surgical use of bone wax should be reassessed.
Assuntos
Hemostáticos/efeitos adversos , Osteomielite/microbiologia , Palmitatos/efeitos adversos , Ácidos Palmíticos/efeitos adversos , Infecções Estafilocócicas/microbiologia , Ceras/efeitos adversos , Animais , Contagem de Colônia Microbiana , Combinação de Medicamentos/efeitos adversos , Combinação de Medicamentos/farmacologia , Hemostáticos/farmacologia , Osteomielite/etiologia , Palmitatos/farmacologia , Ratos , Ratos Endogâmicos , Infecções Estafilocócicas/etiologia , Staphylococcus aureus/efeitos dos fármacos , Staphylococcus aureus/crescimento & desenvolvimento , Infecção da Ferida Cirúrgica/microbiologia , Tíbia/cirurgia , Ceras/farmacologiaRESUMO
Ribbon gauze impregnated with bismuth iodoform paraffin paste is a dressing used in both oral and ENT surgery. A case is presented in which it was implicated in increased postoperative morbidity highly suggestive of a toxic state.
Assuntos
Bismuto/efeitos adversos , Hipersensibilidade a Drogas , Hidrocarbonetos Iodados/efeitos adversos , Curativos Oclusivos/efeitos adversos , Distúrbios do Início e da Manutenção do Sono/induzido quimicamente , Tremor/induzido quimicamente , Idoso , Combinação de Medicamentos/efeitos adversos , Humanos , Cistos Maxilomandibulares/cirurgia , MasculinoRESUMO
A large-scale, open, nonrandomized, multicenter, 90-day study of the safety and efficacy of a thiazide diuretic and aldosterone antagonist combination (Aldactazine, 25 mg spironolactone and 15 mg altizide, 1/day) as monotherapy was performed in 946 patients with mild to moderate hypertension (diastolic blood pressure [BP] between 90 and 120 mm Hg). Adverse effects were assessed, and body weight, heart rate, serum potassium, creatinine and uric acid measurements were monitored. On day 45 of the study, BP was normalized (diastolic BP less than or equal to 90 mm Hg) in 72% of the patients. The dose was increased to 2 tablets per day in the patients whose BP did not reach normal levels. By the end of the study, BP was controlled in 83% of the patients. No significant changes were noted in body weight, heart rate or laboratory values; however, treatment had to be discontinued in 6 patients because of hypokalemia (n = 4) or elevated serum creatinine levels (n = 2). Serum uric acid levels were increased in 5.5% of patients. The rate of adverse effects, as reported by the patients, was low (5%). Thus, this study demonstrates that diuretics, especially the combination of a thiazide diuretic and aldosterone antagonist, remain a safe, effective and economical therapy for patients with mild to moderate hypertension.
Assuntos
Benzotiadiazinas , Hipertensão/tratamento farmacológico , Inibidores de Simportadores de Cloreto de Sódio/uso terapêutico , Espironolactona/uso terapêutico , Sulfonamidas/uso terapêutico , Adolescente , Adulto , Idoso , Pressão Sanguínea/efeitos dos fármacos , Diuréticos , Combinação de Medicamentos/administração & dosagem , Combinação de Medicamentos/efeitos adversos , Combinação de Medicamentos/uso terapêutico , Feminino , Humanos , Hipertensão/fisiopatologia , Masculino , Pessoa de Meia-Idade , Estudos Multicêntricos como Assunto , Inibidores de Simportadores de Cloreto de Sódio/administração & dosagem , Inibidores de Simportadores de Cloreto de Sódio/efeitos adversos , Espironolactona/administração & dosagem , Espironolactona/efeitos adversos , Sulfonamidas/administração & dosagem , Sulfonamidas/efeitos adversosRESUMO
The safety and efficacy of a thiazide/potassium-sparing diuretic and an angiotensin-converting enzyme inhibitor used concomitantly was evaluated in a large, multicenter study. Aldactazine was administered alone for 2 months, after which time captopril was added in those whose blood pressure had not normalized (332 patients). At the end of the 6-month study, control of blood pressure was achieved in 88% of the patients with one or the other regimen. No clinically significant changes were recorded for a number of biologic parameters. Specifically, there was 1 case of hyperkalemia (6 mmol/liter), a very low incidence of hypotension (1.6%), and a low rate of adverse effects. Therefore, such a combination could provide important therapeutic benefits in hypertensive patients.
Assuntos
Benzotiadiazinas , Captopril/administração & dosagem , Hipertensão/tratamento farmacológico , Inibidores de Simportadores de Cloreto de Sódio/administração & dosagem , Espironolactona/administração & dosagem , Sulfonamidas/administração & dosagem , Adolescente , Adulto , Idoso , Pressão Sanguínea/efeitos dos fármacos , Captopril/efeitos adversos , Captopril/uso terapêutico , Diuréticos , Combinação de Medicamentos/administração & dosagem , Combinação de Medicamentos/efeitos adversos , Combinação de Medicamentos/uso terapêutico , Quimioterapia Combinada , Feminino , Humanos , Hipertensão/fisiopatologia , Masculino , Pessoa de Meia-Idade , Estudos Multicêntricos como Assunto , Inibidores de Simportadores de Cloreto de Sódio/efeitos adversos , Inibidores de Simportadores de Cloreto de Sódio/uso terapêutico , Espironolactona/efeitos adversos , Espironolactona/uso terapêutico , Sulfonamidas/efeitos adversos , Sulfonamidas/uso terapêuticoRESUMO
A multicenter study was performed in 919 hypertensive patients, 780 of whom could be evaluated. Patients in group I (n = 482) were treated with Aldactazine alone (altizide + spironolactone, 2 tablets per day). The other 298 patients (group II) were treated with 1 or 2 tablets per day of Aldactazine plus a conventional antihypertensive agent, e.g., a beta blocker, alpha-methyldopa or clonidine. After 45 days of treatment with Aldactazine alone, mean systolic and diastolic blood pressure (BP) decreased by 15 and 14%, respectively, vs baseline values. The addition of the other antihypertensive agent decreased BP further; however, the best results were obtained with the combination of Aldactazine and clonidine. With this combination, systolic and diastolic BP decreased by 16.6 and 18%, respectively, vs baseline. In terms of adverse effects, a few cases of gastrointestinal disturbances and orthostatic hypotension were reported.
Assuntos
Benzotiadiazinas , Hipertensão/tratamento farmacológico , Inibidores de Simportadores de Cloreto de Sódio/uso terapêutico , Espironolactona/uso terapêutico , Sulfonamidas/uso terapêutico , Antagonistas Adrenérgicos beta/administração & dosagem , Antagonistas Adrenérgicos beta/uso terapêutico , Adulto , Idoso , Idoso de 80 Anos ou mais , Clonidina/administração & dosagem , Clonidina/uso terapêutico , Diuréticos , Combinação de Medicamentos/administração & dosagem , Combinação de Medicamentos/efeitos adversos , Combinação de Medicamentos/uso terapêutico , Quimioterapia Combinada , Feminino , Humanos , Hipertensão/fisiopatologia , Masculino , Metildopa/administração & dosagem , Metildopa/uso terapêutico , Pessoa de Meia-Idade , Estudos Multicêntricos como Assunto , Inibidores de Simportadores de Cloreto de Sódio/administração & dosagem , Inibidores de Simportadores de Cloreto de Sódio/efeitos adversos , Espironolactona/administração & dosagem , Espironolactona/efeitos adversos , Sulfonamidas/administração & dosagem , Sulfonamidas/efeitos adversosRESUMO
Sucralfate is an effective agent in reducing the incidence of upper GI tract (UGIT) stress bleeding and nosocomial pneumonia in critically ill patients. Many of these patients are not intubated and are at increased risk for aspiration of large volumes of UGIT contents containing sucralfate. The effects of aspirated sucralfate are unknown. To investigate this, large-volume aspiration (2 ml/kg) was simulated in freshly tracheostomized rats (n = 6, all experimental groups) using normal saline, particulate antacid, and sucralfate adjusted to pH 3.6 and 5.0. Four hours after aspiration, the rats were killed and their lungs were formalin-fixed. Significant increases in lung inflammation were seen by light microscopy in all experimental groups at pH 3.6. Antacid aspirated at pH 5.0 induced significant increases in airway as well as parenchymal inflammation. At pH 3.6, the antacid aspiration led to significant increases in lung edema and hemorrhage. Sucralfate aspiration produced significant increases in pulmonary hemorrhage at pH 5.0. Our microscopic findings are consistent with the acute pulmonary histopathologic changes known to occur after large-volume aspiration of particulate materials, including antacids. Additionally, we show that large-volume aspiration of sucralfate produced significant acute pneumonitis, including pulmonary hemorrhage. In view of the proven usefulness of sucralfate, further investigations are indicated to evaluate these experimental findings before extrapolating to critically ill patients.