Effects of "body compression" on parameters related to ascites formation: therapeutic trial in cirrhotic patients.
J Gastroenterol. 1999 Feb;34(1):75-82. PMID: 10204614
M Uemura, M Matsumoto, T Tsujii, H Fukui, Y Miyamoto, H Kojima, E Kikuchi, K Fukui, M Fujimoto, A Mitoro, M Matsumura, A Takaya
Decreased effective circulating blood volume is an important factor in ascites formation in liver cirrhosis. We designed a "body compression" apparatus as a means to restore effective blood volume and investigated its effectiveness in reducing ascites formation in cirrhotics in terms of its effect on parameters of ascites formation noted below. The subjects, eight cirrhotics with ascites and eight cirrhotics without ascites were given spironolactone (50-75 mg/day) and furosemide (40-80 mg/day) while they received a diet containing 85 mEq of sodium per day. All four limbs and the lower abdomen were compressed with constant pressure [height (cm) divided by 13.6 mmHg] once, for 3h, using stroke rehabilitation splints, while patients lay supine. In cirrhotics both with and without ascites, urine volume, urinary sodium excretion, and creatinine clearance during the body compression were greater than values during control (non-compression) periods (urine volume, means 285 vs 169 ml/3h; P<0.001, urinary sodium excretion 15.8 vs 9.5 mEq/3h; p<0.001, creatinine clearance 74 vs 59 ml/min, P<0.001, respectively). The increased basal plasma renin activity, angiotensin II, aldosterone, and norepinephrine levels in all cirrhotics were significantly decreased by the body compression. In another group of six cirrhotics who received no diuretics or albumin, repeat body compression alleviated ascites in three with well preserved renal function, but was ineffective in three with markedly impaired renal function. These results suggest that the improvement in renal function brought about by the body compression is attributable to an increase in effective circulating blood volume. This maneuver may be a useful complementary therapy in patients with cirrhotic ascites with well preserved renal function.
Article Published Date : Feb 01, 1999
Relationships between pre-hospital characteristics and outcome in victims of foreign body airway obstruction during meals.
Resuscitation. 2015 Mar;88:63-7
Authors: Kinoshita K, Azuhata T, Kawano D, Kawahara Y
OBJECTIVE: The purpose of this study is to determine the outcome of foreign body airway obstruction according to the initial actions taken for choking victims during meals.
METHODS: Our subjects were patients who became unresponsive or unconscious because of foreign body airway obstruction (FBAO) during meals in the presence of bystander witnesses. We investigated the associations between outcome and the following factors: age, gender, type of foreign body, chest compressions after the patient became unresponsive or unconscious, episode of cardiac arrest, efforts by a bystander to remove the foreign body, eating-related activities of daily living, time elapsed from the 119 call to arrival of emergency medical technicians (EMTs), and time elapsed from the 119 call to hospital arrival (primary endpoint).
RESULTS: Of the 138 patients enrolled during the study period, 35 (25.4%) received chest compressions by bystanders after becoming unresponsive or unconscious and 69 (50.0%) suffered cardiac pulmonary arrest. Chest compressions by a bystander after the victim became unresponsive or unconscious (p<0.0001) and no CPA (p<0.0001) were significantly related to good outcome. Chest compressions by a bystander were both associated with good neurological outcome (odds ratio, 10.57; 95% CI, 2.472-65.059, p<0.0001). No CPA after FBAO was another independent predictor (odds ratio, 50.512; 95% CI, 13.45-284.41; p<0.0001), but efforts to remove the foreign body before the arrival of EMTs did not affect outcome.
CONCLUSION: Chest compressions by a bystander, a support received by only 25% of the patients, proved to be essential for improved outcome for choking victims who became unresponsive or unconscious. Education for lay-rescuer response to choking might further improve overall outcome.
PMID: 25555359 [PubMed - indexed for MEDLINE]
Alleviation of chronic pain following rat spinal cord compression injury with multimodal actions of huperzine A.
Proc Natl Acad Sci U S A. 2013 Feb 19;110(8):E746-55
Authors: Yu D, Thakor DK, Han I, Ropper AE, Haragopal H, Sidman RL, Zafonte R, Schachter SC, Teng YD
Diverse mechanisms including activation of NMDA receptors, microglial activation, reactive astrogliosis, loss of descending inhibition, and spasticity are responsible for ∼40% of cases of intractable neuropathic pain after spinal cord injury (SCI). Because conventional treatments blocking individual mechanisms elicit only short-term effectiveness, a multimodal approach with simultaneous actions against major pain-related pathways may have value for clinical management of chronic pain. We hypothesize that [-]-huperzine A (HUP-A), an alkaloid isolated from the club moss Huperzia serrata, that is a potent reversible inhibitor of acetylcholinesterase and NMDA receptors, could mitigate pain without invoking drug tolerance or dependence by stimulating cholinergic interneurons to impede pain signaling, inhibiting inflammation via microglial cholinergic activation, and blocking NMDA-mediated central hypersensitization. We tested our hypothesis by administering HUP-A i.p. or intrathecally to female Sprague-Dawley rats (200-235 g body weight) after moderate static compression (35 g for 5 min) of T10 spinal cord. Compared with controls, HUP-A treatment demonstrates significant analgesic effects in both regimens. SCI rats manifested no drug tolerance following repeated bolus i.p. or chronic intrathecal HUP-A dosing. The pain-ameliorating effect of HUP-A is cholinergic dependent. Relative to vehicle treatment, HUP-A administration also reduced neural inflammation, retained higher numbers of calcium-impermeable GluR2-containing AMPA receptors, and prevented Homer1a up-regulation in dorsal horn sensory neurons. Therefore, HUP-A may provide safe and effective management for chronic postneurotrauma pain by reestablishing homeostasis of sensory circuits.
PMID: 23386718 [PubMed - indexed for MEDLINE]
Comparison between the effect of strongly and weakly cationic exchange resins on matrix physical properties and the controlled release of diphenhydramine hydrochloride from matrices.
AAPS PharmSciTech. 2010 Sep;11(3):1104-14
Authors: Akkaramongkolporn P, Wongsermsin K, Opanasopit P, Ngawhirunpat T
This study focused on investigating and comparing between the effect of the strongly cationic exchange resin, Dowex 88 (Dow88), and the weakly cationic exchange resin, Amberlite IRP64 (Am64), on the physical properties of matrices and their drug release profiles. The matrices were prepared by direct compression of Methocel K4M (HPMC) or Ethocel 7FP (EC) polymeric matrix formers and contained diphenhydramine hydrochloride as a model drug. The addition of Dow88 to the matrices decreased matrix hardness and increased thickness, diameter, and friability. In contrast, the addition of Am64 increased matrix hardness and maintained the original thickness, diameter, and friability. In deionized water, both resins lowered drug release from HPMC-based matrices by virtue of the gelation property of matrix former and the drug exchange property of embedded resin, in other words in situ resinate formation. Dow88 strongly dissociated and lowered the drug release to a greater extent than Am64, which was weakly dissociated. However, Am64 could retard drug release under simulated gastrointestinal conditions. EC-based matrices containing either resin displayed a propensity for disintegration caused by swelling and wicking (water adsorption) actions by the resin. The results of this study provided useful information on the utilization of ion exchange resins as release modifiers in matrix systems.
PMID: 20617405 [PubMed - indexed for MEDLINE]
Arterial closure devices. A review.
J Cardiovasc Surg (Torino). 2007 Oct;48(5):607-24
Authors: Madigan JB, Ratnam LA, Belli AM
The use of arterial closure devices in achieving haemostasis following arterial puncture has become increasingly popular. This review aims to provide an overview of the currently available closure devices, with an up-to-date summary of the supporting literature. The various devices have their advantages and disadvantages as well as differing mechanisms of actions. Technical aspects of deployment affect the learning curve and ease of use of individual devices. Some complications that arise are device specific where others are related to arterial punctures in general. When choosing a device, all these factors should be taken into account as well as differing clinical requirements and priorities. Most studies of arterial closure devices that are currently in use conclude that the safety profile of closure devices is comparable to manual compression. The literature does not show superiority of any particular device. Caution is advised in extrapolating evidence based on differing patient groups, as many of the study populations are heterogeneous. As physicians become more familiar with the use of closure devices, off-label applications of some devices have emerged, some of which need further evaluation. The ideal closure device should reduce complication rates compared to manual compression, be easy to use with a short learning curve, and have a high rate of deployment success. It should also be usable across a wide range of sheath sizes, not leave any permanent foreign body behind, reduce time to haemostasis and ambulation, allow immediate repuncture, improve patient comfort and be cost effective. In spite of the wide range of devices currently available there remains room for improvement.
PMID: 17989631 [PubMed - indexed for MEDLINE]
Evaluating bone mass and bone quality in patients with breast cancer.
Clin Breast Cancer. 2005 Feb;5 Suppl(2):S41-5
Authors: Paterson AH
Bone remodeling is a process by which bone renews itself focally in distinct areas on cancellous (ie, trabecular) bone and/or in the Haversian systems of cortical (or compact) bone. Normal bone turnover involves the ordered metabolism of bone-resorbing cells (osteoclasts) and bone-forming cells (osteoblasts). Estrogen exerts a multitude of actions on bone tissues and is integral to bone health, and estrogen deprivation leads to accelerated bone loss. Bone strength reflects the integration of bone density and bone quality. Methods to assess bone strength fall into 3 categories: radiologic (ie, bone mineral density [BMD]), biochemical (ie, markers of bone turnover), and histologic (ie, bone biopsies for histomorphometry). The beneficial effect of aromatase inhibitors (AIs) and inactivators on breast cancer depends on reducing levels of circulating estrogens in the peripheral blood. There appears to be variability in the effects of AIs on bone in experimental animals, and this variability may not be the same in humans. In general, bone loss is an expected side effect of the AIs. For postmenopausal women receiving adjuvant anastrozole or other AIs, a BMD measurement using dual-energy x-ray absorptiometry is recommended, to be repeated every 1-2 years. Regular physical exercise is advised together with added calcium 1500 mg and vitamin D 800 U daily. If the T-score reaches a level of >2.5, or if it is between -1.5 and -2.5 in the presence of a fragility fracture or vertebral compression fracture, or if height loss > 2 cm occurs or BMD decreases > 3% in 1 year at the lumbar spine or > 5% at the femoral neck, bisphosphonate therapy should be considered.
PMID: 15807923 [PubMed - indexed for MEDLINE]