bluuebunny/crossref_metadata_2025_split huggingface dataset:
Intraperitoneal Thrombolytic Therapy for Peritoneal Dialysis–Associated Peritonitis
Authors: Worland Melinda A , Radabaugh Rhonda S , Mueller Bruce A 
Published: March 2004

OBJECTIVE: To review the literature pertaining to the use of adjunctive thrombolytic therapy for the treatment of peritoneal dialysis–associated peritonitis (PDAP). DATA SOURCES: A MEDLINE search was conducted (January 1966– December 1997) to find articles using the terms peritonitis, peritoneal dialysis, and each thrombolytic drug. References from these articles were then reviewed to identify further sources. DATA EXTRACTION: Representative case reports and clinical trials are summarized in this report. Information regarding thrombolytic dosing, administration techniques, and reported efficacy rates are included from both case reports and clinical trials. DISCUSSION: Thrombolytic agents administered intraperitoneally appear to facilitate antibiotic penetration into the biofilm formed by certain bacteria. Numerous case reports of intraperitoneal thrombolytic adjunctive therapy for recurrent or persistent PDAP have indicated that these agents may have a role in the treatment of selected patients. Urokinase and streptokinase are the only thrombolytics that have been studied. They appear to have similar efficacy, but the adverse drug event rate with streptokinase is unacceptably high. The efficacy of therapy with urokinase is probably inferior to removal of the peritoneal dialysis catheter, but, if successful, allows for the continuation of peritoneal dialysis therapy. CONCLUSIONS: In conjunction with appropriate antibiotic therapy, intraperitoneal instillation of urokinase should be reserved for patients who develop two or more episodes of recurrent or persistent PDAP in the absence of poor compliance and in whom dialysis catheter removal should be avoided (i.e., they cannot tolerate hemodialysis).
Pharmacoeconomic Analysis of Using Sinemet CR over Standard Sinemet in Parkinsonian Patients with Motor Fluctuations
Authors: Hempel Alan G , Wagner Mary L , Maaty Mohamed A , Sage Jacob I 
Published: March 2004

OBJECTIVE: To compare the costs of pharmacotherapy in patients with Parkinson's disease before and after converting from standard Sinemet to extended-release Sinemet CR. DESIGN: Investigators retrospectively reviewed records of patients converting from Sinemet to Sinemet CR for efficacy and total drug costs. Cost-effectiveness was evaluated retrospectively from data collected in prospective Sinemet CR efficacy trials. SETTING: Parkinson's disease clinic at a tertiary care university teaching hospital. PATIENTS: 100 patients with motor fluctuations who had undergone an initial 6-month course of Sinemet therapy, followed by a 6-month course of Sinemet CR. MAIN OUTCOME MEASURES: Total cost was measured as the cost of Sinemet formulations plus the costs of other antiparkinson medications. Differences in pre- and postconversion costs were compared by using the paired, two-tailed Student's t-test. A substudy of 39 patients on the cost-effectiveness of conversion measured the ratio of daily medication costs to the daily hours “on” without chorea. RESULTS: While total daily medication costs after conversion increased by 21%, patients experienced either a comparable or an improved degree of disease control with Sinemet CR. Patients who were also taking selegiline were able to decrease selegiline expense by 20%. The costs of other adjunctive medications did not differ significantly after conversion. The cost-effectiveness analysis revealed an increase in postconversion on time by 2.2 hours (p = 0.0001), accompanied by a $2.85 decrease in total cost per hour on without chorea (p = 0.11). CONCLUSIONS: Although Sinemet CR is more costly, it may be more cost-effective in patients with motor fluctuations. Some patients may be able to reduce adjunctive medications.
Low-Molecular-Weight Heparins in the Treatment of Deep-Vein Thrombosis
Authors: Martineau Pierre , Tawil Nadine 
Published: March 2004

OBJECTIVE: To compare the characteristics and clinical efficacy of low-molecular-weight heparins (LMWHs) and unfractionated heparin (UFH) in the treatment of deep-vein thrombosis (DVT). Adverse effects, dosing, and cost issues are also discussed. DATA SOURCES: A MEDLINE search (January 1984–October 1997) was used to identify pertinent French and English literature, including clinical trials and reviews on LMWHs and their use in DVT. STUDY SELECTION: Trials comparing dalteparin, enoxaparin, tinzaparin, and nadroparin with UFH were selected. As studies were numerous, only randomized trials including more than 50 patients were reviewed. Moreover, all patients studied had a first episode of symptomatic DVT confirmed by objective tests (i.e., venography, duplex ultrasonography, impedance plethysmography). Clinical efficacy and safety of LMWHs were assessed in these trials. DATA EXTRACTION: Results pertaining to venographic assessment, recurrent thromboembolism, total mortality, and bleeding complications were extracted from the selected studies. DATA SYNTHESIS: Compared with UFH, LMWHs have a longer plasma half-life, better subcutaneous bioavailability, more predictable anticoagulant response, and require less intense laboratory monitoring. Most trials demonstrate comparable effects on thrombus extension and incidence of recurrent thromboembolism. Compared with UFH, LMWHs do not alter total mortality. Although animal trials predict a lower hemorrhagic potential for LMWHs, the incidence of bleeding complications is generally similar to that observed with UFH. Outpatient management of DVT with LMWHs has shown comparable safety and efficacy with inpatient UFH use but a shorter hospital stay. CONCLUSIONS: Because LMWHs are as safe and as effective as UFH, and because of their more convenient method of administration, they can be considered valuable alternatives for the treatment of DVT. Savings generated by less intensive laboratory monitoring and the possibility of early hospital discharge and outpatient therapy may outweigh the higher acquisition cost of LMWHs.
Pressure Ulcer Management in the Geriatric Patient
Authors: Orlando Patricia L 
Published: March 2004

OBJECTIVE: To increase the understanding of pharmacists and other health-system clinicians regarding pharmaceutical applications of pressure ulcer prevention and treatment in geriatric patients. DATA SOURCES: An extensive MEDLINE retrieval was conducted which encompassed the years 1967–1998; the search terms used included pressure sore, pressure ulcer, decubitus ulcer, and geriatrics. DATA SUMMARY: Pressure ulcers affect populations with limited mobility, reduced cognition, and less-independent activities of daily living, such as the elderly. Identification of the high-risk patient is required for successful prevention outcomes. For existing lesions, a variety of treatment modalities exist, not all of which have demonstrated therapeutic benefit. Given these options, clinicians are faced with treatment selection challenges that should be based on the clinical setting, available scientific evidence, and individualized patient care needs. CONCLUSIONS: Prevention of pressure ulcerations is imperative to reduce patient morbidity, mortality, and overall healthcare costs. Given the number of treatment options available, pharmacists can assist in the treatment selection process. Education of the patient and family regarding pressure ulcer prevention and treatment requires early and ongoing involvement by the interdisciplinary team.
Dapsone-Induced Methemoglobinemia
Authors: Ward Kristina E , McCarthy Michelle W 
Published: March 2004

OBJECTIVE: To report a case of methemoglobinemia in a patient receiving dapsone for prophylaxis of Pneumocystis carinii pneumonia (PCP). CASE SUMMARY: A 69-year-old white woman was hospitalized to rule out sepsis. Two years prior to this admission, the patient received an orthotopic liver transplant after which she required hemodialysis three times weekly. Because of intolerance to trimethoprim/ sulfamethoxazole and aerosolized pentamidine, she was prescribed dapsone therapy on hospital day 13, that was continued for 11 days. On hospital day 45 the patient received a cadaveric kidney transplant, and dialysis treatments were scheduled only as needed. One week after the transplant, dapsone therapy was resumed. Nine days into this course of dapsone, the patient developed dyspnea and oxygen desaturation of unknown etiology. The patient was evaluated for and diagnosed with methemoglobinemia. She received two doses of intravenous methylene blue and one dose of oral activated charcoal due to fluctuating methemoglobin concentrations. DISCUSSION: The elimination of dapsone is not completely understood. Several case reports of dapsone-induced methemoglobinemia are present in the literature. Most have occurred in patients who have accidentally or deliberately overdosed. Cases of methemoglobinemia in patients receiving therapeutic doses of dapsone are discussed. CONCLUSIONS: The growing numbers of immunosuppressed patients due to transplantation or HIV may result in increased dapsone use for the prevention of PCP. Clinicians should be aware of the adverse effects associated with dapsone therapy, and patients with dyspnea and hypoxemia of unclear etiology should be evaluated for methemoglobinemia.
Vitamin E in the Treatment of Tardive Dyskinesia
Authors: Boomershine Kellie H , Shelton Penny S , Boomershine Jason E 
Published: March 2004

OBJECTIVE: To review the efficacy of vitamin E in the treatment of tardive dyskinesia (TD). DATA SOURCES: Published articles and abstracts in English were identified from January 1986 to March 1999 by MEDLINE and International Pharmaceutical Abstracts searches using the terms vitamin E, α-tocopherol, and tardive dyskinesia. Additional articles were identified from the references of the retrieved articles and cross- referencing selected articles. DATA EXTRACTION: All clinical trials evaluating the use of vitamin E in human subjects with TD were reviewed. Selected articles also included those considered to be helpful in providing a basic introduction to TD pathophysiology and management. DATA SYNTHESIS: TD occurs in approximately 20% of patients treated with neuroleptics. The resulting dyskinesias can be irreversible and are often psychologically and physically debilitating. Recent research suggests that TD may be a result of neuronal damage inflicted by free radicals generated from increased neurotransmitter turnover and metabolism. Vitamin E as a naturally occurring free radical scavenger has been evaluated in the treatment of TD. Eighteen completed trials are available either in completed or abstract form. Twelve of these trials have produced positive results with vitamin E in the treatment of TD. Patients who have had TD for less than five years appear to respond better than patients with long-standing TD. CONCLUSIONS: Research suggests that vitamin E offers benefit in the management of a subgroup of patients with TD. Further investigation is needed to ascertain continued efficacy with long-term use as well as the role of vitamin E in TD prophylaxis.
Primary Induction with Mycophenolate Mofetil and Corticosteroids in a Liver Transplant Recipient with Hepatorenal Syndrome
Authors: Carr Roxane R , Yoshida Eric M , Chung Stephen W , Partovi Nilufar 
Published: March 2004

OBJECTIVE To report the use of mycophenolate mofetil for primary induction in a liver transplant recipient to avoid the nephrotoxicity of cyclosporine/tacrolimus. CASE SUMMARY: A 47-year-old white man in hepatic coma with anuric hepatorenal syndrome received a liver transplant, and was given mycophenolate mofetil and corticosteroids as primary induction immunosuppression with the addition of low-dose cyclosporine 13 days later. His renal function improved and he remains rejection-free after 13 months of follow-up. CONCLUSIONS This case suggests that mycophenolate mofetil may be used as a primary induction agent in liver transplant recipients with renal failure to avoid the additional nephrotoxicity of the standard immunosuppressants, cyclosporine and tacrolimus. Low-dose cyclosporine/tacrolimus may be introduced later as the renal function improves. OBJETIVO Se reporta el uso de micofenolato mofetíl como indución primaria en un recipiente con transplante hepático con el propósito de evitar la nefrotoxicidad debido a ciclosporina y tacrolimus. RESUMEN DEL CASO Un hombre de 47 años de edad en coma hepático y con síndrome hepáticorenal anúrico recibió un transplante de hígado y tratamiento con micofenolato mofetíl y corticosteroides como inducción inmunosupresiva primaria más la adición subsecuente de dosis bajas de ciclosporina después de 13 días. La función renal se mejoró y el paciente permaneció sin síntomas de rechazo después de 4 meses de observacions continuas. CONCLUSIONES La presentación de este caso sugiere que micofenolato mofétil puede ser usado como un agente inductivo primario en recipientes de transplantes hepáticos e insuficiencia renal con el fín de evitar la nefrotoxicidad adicional debido a los medicamentos inmunosupresivos estandar de ciclosporina y tacrolimus. Dosis bajas de ciclosporina y tacrolimus pueden ser añadidas en el futuro después de una mejoría en la función renal.
Pharmacologic Management of Alzheimer Disease Part III: Nonsteroidal Antiinflammatory Drugs — Emerging Protective Evidence?
Authors: Flynn Barbara L , Theesen Karen A 
Published: March 2004

OBJECTIVE: To provide information about research evaluating the role of nonsteroidal antiinflammatory drugs (NSAIDs) in the prevention, or delay in the onset of, Alzheimer disease (AD). DATA SOURCES: Studies, review articles, and editorials identified from MEDLINE searches (January 1990–December 1996) and bibliographies of identified articles. The addendum lists articles from 1996 to June 1999. STUDY SELECTION: Studies, review articles, and editorials addressing NSAIDs and AD pharmacotherapy research. DATA EXTRACTION: Pertinent information was selected and the data synthesized into a review format. DATA SYNTHESIS: AD is a complex disorder and there are numerous factors involved in the process. The pathology of AD is characterized by the development of amyloid plaques and neurofibrillary tangles. In addition, more than 40 immunoprotective proteins that are not unique to AD are found at autopsy that are normally absent, or present in very low concentrations, in normal brain. These findings suggest that AD may involve an inflammatory process. Preliminary results from studies investigating the incidence and onset of AD in patients with arthritis who have taken NSAIDs suggest that NSAIDs may have a protective effect. Studies evaluating the possible association between arthritis, NSAIDs, and AD are reviewed. CONCLUSIONS: Preliminary evidence suggests that NSAIDs may have a protective effect against the development of AD. Further prospective, double-blind, placebo-controlled studies are needed to determine the role of NSAIDs in AD. These dose-finding studies should focus on specific agents and identify the dosage and duration of therapy necessary for a protective or therapeutic effect. Additionally, not all elderly patients are candidates for NSAIDs. Determining the definitive mechanism of action of NSAIDs in AD may suggest alternative agents that have similar pharmacologic activity, but are associated with fewer adverse effects.
Beyond Benzodiazepines: Alternative Pharmacologic Agents for the Treatment of Insomnia
Authors: Wagner Judy , Wagner Mary L , Hening Wayne A 
Published: March 2004

OBJECTIVE: To review the epidemiology, etiology, and classification of insomnia and provide an overview of the pharmacologic therapy of insomnia. Novel nonbenzodiazepine hypnotics including zolpidem, zopiclone, and zaleplon, as well as nonprescription products such as valerian and melatonin, are reviewed in detail. DATA SOURCES: A MEDLINE search was performed to identify relevant clinical studies, case reports, abstracts, and review articles published between April 1992 and December 1997. Key search terms included insomnia, benzodiazepines, zolpidem, zopiclone, zaleplon, Cl 284,846, melatonin, and valerian. Additional references were obtained from the lists of review articles and textbooks. DATA EXTRACTION AND SYNTHESIS: Data concerning the safety and efficacy of the hypnotic agents were extracted from all available clinical trials and abstracts. Background information regarding insomnia, benzodiazepines, and other hypnotics was extracted from the most current literature, including review articles and textbooks. CONCLUSIONS: New developments in benzodiazepine receptor pharmacology have introduced novel nonbenzodiazepine hypnotics that provide comparable efficacy to benzodiazepines. Although they may possess theoretical advantages over benzodiazepines based on their unique pharmacologic profiles, they offer few, if any, significant advantages in terms of adverse effects. Over-the-counter agents such as valerian and melatonin may be useful in alleviating mild, short-term insomnia, but further clinical trials are required to fully evaluate their safety and efficacy.
Lack of Pharmacokinetic Interaction between Mexiletine and Omeprazole
Authors: Kusumoto Masaaki , Ueno Kazuyuki , Tanaka Kazuhiko , Takeda Kazuya , Mashimo Kohji , Kameda Takaya , Fujimura Yasuo , Shibakawa Masahiko 
Published: March 2004

OBJECTIVE: To investigate the effect of omeprazole on the pharmacokinetics of mexiletine. METHODS: Nine healthy male Japanese volunteers participated in a crossover study. On day 1, the subjects received mexiletine 200 mg. On days 2–7, they received omeprazole 40 mg, and on day 8 they received mexiletine 200 mg and omeprazole 40 mg concomitantly. Serum concentrations of mexiletine were determined just before drug administration and at 1, 2, 3, 4, 6, 8, 12, and 24 hours on day 1 and day 8. RESULTS: No differences in mexiletine concentrations were observed between the two phases of the study. The mean AUCs after administration of mexiletine alone and in combination with omeprazole 40 mg/d were 6.26 and 6.20 ng·h/L, respectively. CONCLUSIONS: These findings suggest that omeprazole does not affect mexiletine metabolism. OBJETIVO: Investigar el efecto de omeprazole en la farmacocinética de mexiletine. MÉTODOS: Nueve hombres japoneses saludables participaron en forma voluntaria en un estudio cruzado. En el primer día, los voluntarios recibieron mexiletine 200 mg solamente. Desde el segundo al séptimo día, los sujetos recibieron omeprazole, y en el octavo día recibieron mexiletine y omeprazole 40 mg concomitantemente. Los concentracions séricas de mexiletine fueron tomadas justo antes de la administración del medicamento en la 1, 2, 3, 4, 6, 8, 12, y 24 hora después de la administración del medicamento en el día 1 y en el día 8. RESULTADOS: En las concentraciones de mexiletine no fueron observadas diferencias entre los dos fases del estudio. El área promedio bajo la curva de concentración versus tiempo despues de la administración de mexiletine solo y en combinación con omeprazole 40 mg/día fueron 6.26 y 6.20 ng·h/L, respectivamente. CONCLUSIONES: Los hallazgos sugieren que omeprazole no afecta el metabolismo de mexiletine. OBJECTIF: Évaluer l'influence de l'oméprazole sur la pharmacocinétique de la mexilétine. MÉTHODES: Neuf volontaires sains ont participé à cette étude. Tous les individus étaient d'origine Japonaise et de sexe masculin. Dans un premier temps, les individus ont reçu une dose unique de 200 mg de mexilétine. Puis ils ont reçu 40 mg d'oméprazole pendant 6 jours. La huitième journée de l'étude, on leur a administré 40 mg d'oméprazole accompagné de 200 mg de mexilétine. Des prélèvements sanguins ont été effectués immédiatement avant l'administration de mexilétine et après 1, 2, 3, 4, 6, 8, 12, et 24 heures. Les concentrations de mexilétine étaient mesurées par chromatographie liquide haute performance. RÉSULTATS: Aucune différence n'a été noté entre les concentrations de mexilétine au jour 1 et celles au jour 8. Les surfaces sous la courbe moyennes étaient de 6.26 et 6.20 ng · h/L, respectivement. CONCLUSIONS: Les résultats suggérent que l'oméprazole n'affecte pas le métabolisme de la mexilétine.
Comparison of Tacrolimus Absorption in Transplant Patients Receiving Continuous versus Interrupted Enteral Nutritional Feeding
Authors: Murray Michelle , Grogan Tracy A , Lever Jacqueline , Warty Vijay S , Fung John , Venkataramanan Raman 
Published: March 2004

OBJECTIVE: To determine the effect of enteral nutritional feeding on the absorption of tacrolimus administered through a nasoduodenal tube to organ transplant patients. METHODS: A nonrandomized, prospective study of tacrolimus absorption was performed in 10 liver or lung transplant patients who received Osmolite enteral nutrition through a nasoduodenal feeding tube. Multiple blood samples were collected just prior to and at 30 minutes, 1, 2, 3, 4, 6, 8, 10, and 12 hours after nasoduodenal administration of tacrolimus on 2 consecutive days, once when tacrolimus was administered along with the continuous enteral feeding and the other time when the enteral feeding was withheld 1 hour prior to and 8 hours after tacrolimus administration, to assess tacrolimus absorption. The whole blood tacrolimus concentrations were measured by the microparticulate enzyme immunoassay method. Pharmacokinetic parameters between the two time periods were compared by using a paired t-test at a significance level of a p value of 0.05 or less. RESULTS: The time to reach peak blood concentrations (p = 0.055), dose-normalized trough concentrations (p = 0.617), maximum blood concentrations (p = 0.197), and dose-normalized AUC (p = 0.755) were not significantly different between two study periods. CONCLUSIONS: This study demonstrated that simultaneous administration of Osmolite enteral feedings with tacrolimus did not interfere with tacrolimus absorption in transplant patients.
Respiratory Depression following Administration of Intrathecal Bupivacaine to an Opioid-Dependent Patient
Authors: Piquet Catherine Y , Mallaret Michel P , Lemoigne Aude H , Barjhoux Claude E , Danel Vincent C , Vincent Françoise H 
Published: March 2004

OBJECTIVE: To document two cases of respiratory depression in patients receiving morphine once the stimulating effect of pain on respiration was removed by bupivacaine. CASE SUMMARIES: Case 1: A 72-year-old 84-kg white man with cancer of the bladder and bone metastases had intense back and leg pain that was treated with intrathecal morphine for 6 months at an increasing dosage up to 10 mg twice daily. The intrathecal route was avoided for 4 days because of a suspected local infection at the site of the intrathecal catheter. During this 4-day period the patient received extended-release morphine and subcutaneous morphine daily. When the intrathecal route was used again, he received an identical dose of morphine plus bupivacaine and epinephrine. Ten minutes after the injection, fatal respiratory distress occurred. Case 2: A 92-year-old white woman was admitted for revascularization of arteritis on her left leg. To treat a painful sacrum and heel bedsores, she received extended-release oral morphine for 8 days. Induction of the intrathecal anesthesia was performed with bupivacaine. After 10 minutes, the patient became subcomatose, with miosis and apnea. Intravenous naloxone restored spontaneous respiration and normal consciousness. CONCLUSIONS: Pain is a physiologic antagonist of the respiratory depressant effects of opioid analgesics. By reducing pain stimulation, bupivacaine may make patients more susceptible to opioid respiratory depression. Such situations require titration of bupivacaine and other analgesics as well as increased monitoring of the patient.