Nail shedding (Beau's lines) after severe gold dermatitis.
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Aged↗
Biomedical subjects
E H Wiltink
Publications and source records attributed to E H Wiltink.
Medication control in hospitals: a practical approach to the problem of drug-drug interactions.
An important task of pharmacists is medication control by screening the medication of an individual patient. Many computerized drug interaction screening programs are available, but they all have their drawbacks. Screening without a computerized program is possible, but very time-consuming. In contrast to daily living at home, the patient in a hospital setting is carefully monitored and relevant biochemical parameters are regularly checked. Many potential drug interactions are countered immediately by changing (dosage of) medication. The aim of our study was to determine the number of drug-drug interactions and (pseudo)double medications on the internal, pulmonary and cardiological ward in order to discuss them with the physicians. During this discussion the clinical relevance of interactions was determined. We conclude that the number of clinically relevant interactions and (pseudo)double medication is limited, but that the role of the pharmacist is an important one, especially with regard to medication, that is not regularly used on a ward. Potential drug interactions should be predicted and dealt with by close teamwork of physician and pharmacist at the moment medication is prescribed.
Aged↗
Beclomethasone dipropionate (3 mg) versus 5-aminosalicylic acid (2 g) versus the combination of both (3 mg/2 g) as retention enemas in active ulcerative proctitis.
Sixty patients with active distal ulcerative colitis participated in a multicentre randomized double-blind trial to compare the effect of a beclomethasone dipropionate (BDP) enema (3 mg/100 ml) with 5-aminosalicylic acid (5-ASA) enemas (2 g/ 100 ml) and enemas with a combination of BDP/5-ASA (3 mg/2 g/100 ml). The patients were treated for 4 weeks and the efficacy of the drugs was evaluated by sigmoidoscopy, histology and subjective symptoms after that time. The overall results after 28 days of treatment were: clinical improvement 100% (BDP/5-ASA) vs. 70% (BDP) and 76% (5-ASA); endoscopic improvement 100% (BDP/5-ASA) vs. 75% (BDP) and 71% (5-ASA); histological improvement 95% (BDP/5-ASA) vs. 50% (BDP) and 48% (5-ASA). After 4 weeks of treatment seven of 19 patients (37%) receiving BDP/5-ASA had healed endoscopically, compared with six of 20 receiving BDP (30%) and two of 21 receiving 5-ASA (10%). Two patients on 5-ASA and three on BDP had a marked deterioration during treatment. The combination of BDP and 5-ASA was significantly superior to single-agent therapy in terms of both improved sigmoidoscopic and improved histological score. No differences in improvement between the 5-ASA vs. BDP-treated patients were noticed. No side effects were seen. The results of the study show that topical treatment of active distal ulcerative colitis with either 5-ASA or BDP is equally efficacious. So far, no data on topical combination therapy have been described. However, combination therapy with BDP/5-ASA seems superior to single-agent therapy and causes no adverse reactions.
Adult↗
Antiviral drugs: present status and future prospects.
1. There is a limited number of antiviral drugs available for therapy. Many investigations and new analytical techniques have unraveled the development and progression of a viral infection. Nowadays there is a good understanding of the multiplication cycle of viruses, including the human immunodeficiency virus. 2. In this article the currently available antiviral drugs are presented arranged by their mode of action that can be understood by the multiplication cycle of the virus. 3. Clinical use and side-effects are discussed as well as place in current therapy. Some attention is paid on promising investigational antivirals.
Antiviral Agents↗
Future prospects in antiviral therapy.
Two important stumbling blocks to the development of effective and nontoxic antiviral drugs are the intracellular localization of the virus and the fact that a virus uses host cell functions to multiply. Therefore, new antiviral drugs must act on a virus-specific function. Most currently available useful antiviral drugs are the result of compound screening of large numbers of possible agents. Advances in our understanding of the molecular biology and biochemistry of the viral multiplication cycle and new laboratory techniques for determining the molecular sites of action have now made it possible to develop and screen new antiviral drugs in a more purposeful manner. Another possible option in antiviral therapy is combination therapy using drugs that enhance the therapeutic effect or diminish side-effects. The most promising new antiviral drugs are discussed according to the different steps they affect in the viral multiplication process. Combination therapy is also reviewed.
Antiviral Agents↗
Antiviral drugs.
There are only a limited number of effective, non-toxic antiviral drugs for clinical use, whereas there is a great need for such drugs. Especially for the treatment of patients infected with the human immuno-deficiency virus (HIV) anti-HIV drugs are required. At the same time viral infections secondary to AIDS cannot yet be treated effectively. An increasing problem is the development of virus strains resistant to the available drugs. At this moment a great effort is made in the research for new antiviral drugs. In this article the available antiviral drugs are reviewed. Their antiviral properties, mechanism of action, clinical use, pharmacokinetic properties and side-effects are discussed. Some attention is paid to the future directions in the search for new anti-HIV drugs.
Animals↗
Retrograde spread of mesalazine (5-aminosalicylic acid)-containing enema in patients with ulcerative colitis.
In order to investigate the retrograde spread in the colon and its relationship to the extent of the diseased area, the authors evaluated a 100ml enema of mesalazine (5-aminosalicylic acid, Pentasa') lg in a consecutive series of 30 patients with ulcerative colitis. The enema was labelled with 10 MBq 99mtechnetium-human serum albumin microcolloid. Sequential scintigraphic imaging was performed in all patients, and the results compared with the extension of the disease as found by colonoscopy. If the enema reached the entire affected area it was interpreted as 'topically adequate'. In 80% of the patients there was retrograde spread of the enema beyond the rectosigmoid, thus reaching the affected area in ulcerative colitis. No relationship was found between the extent of dispersion of the enema and the time of defecation prior to scintigraphy. The authors conclude that a 100ml 'Pentasa' enema may be adequate for treatment of ulcerative colitis extending up to the splenic flexure.
Adolescent↗
Dissolution profiles of mesalazine formulations in vitro.
In vitro dissolution profiles of three controlled-release mesalazine formulations were determined at pH 1.0, 6.0 and 7.5. A closed-column type dissolution apparatus was used. A reproducible gradual dissolution profile was seen for Pentasa at all pH values. Dissolution starts immediately and is complete after 20 h. Dissolution profiles at pH 1 and pH 7.5 are much alike and dissolution is faster than at pH 6. The behaviour of Asacol at different pH values corresponds with the expectations: no release at pH 6 and pH 1, fast release at pH 7.5. Dissolution starts after 1 h and is complete after 3 h. Mesalazine release from Salofalk tablets at pH 7.5 and pH 6.0 starts after 2 and 3 h, respectively, and is complete after 5 and 10 h. However, after a long lag-time (10 h) mesalazine is also released from Salofalk tablets at pH 1 and dissolution is complete after 23 h.
Aminosalicylic Acids↗
Failure of zidovudine prophylaxis after accidental exposure to HIV-1.
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HIV Infections↗
Absorption of oral mesalazine-containing preparations and the influence of famotidine on the absorption.
The mesalazine-containing preparations Asacol, Pentasa, and Salofalk (=Claversal) are frequently used in the treatment of inflammatory bowel disease. The release patterns of these formulations are time- and/or pH-dependent. The aim of this study was to investigate the patterns of absorption of these preparations and the influence of raised intragastric pH on absorption. Gastric pH was raised by simultaneous administration of famotidine. Absorption was determined by assaying with a high-performance liquid chromatography method the urinary excretion of acetylmesalazine, the major metabolite of mesalazine. A large intra- and inter-individual variability in absorption was found for all three formulations, both with and without concomitant famotidine administration. Asacol and Pentasa were significantly less absorbed than Salofalk. A significant lower absorption of mesalazine was seen when Asacol was combined with famotidine. Variations in gastric pH have negligible effect on the bioavailability of mesalazine in vivo.
Administration, Oral↗
Formulation and stability of a beclomethasone dipropionate enema.
A beclomethasone dipropionate (BDP) enema and a BDP/mesalazine combination enema (containing 2 mg BDP and 1 g mesalazine and 2 mg BDP, respectively per 40 ml) were formulated. BDP and mesalazine were suspended in a carbomer-water gel. No degradation of BDP was measured during the storage period of the BDP enema (4 weeks at 20 degrees C) and of the BDP/mesalazine enema (44 days at 4 degrees C, 20 degrees C and 37 degrees C, respectively). Progressive darkening of colour occurred for the BDP/mesalazine enema during storage at 20 degrees C and at 37 degrees C, probably induced by mesalazine degradation products. Only very slight colouring was observed at 4 degrees C. Hardly any precipitation of BDP and mesalazine was seen during the storage period and the enemas could easily be resuspended.
Beclomethasone↗
Topical corticosteroids in inflammatory bowel disease.
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Administration, Topical↗
Comparison of beclomethasone dipropionate (2 and 3 mg) and prednisolone sodium phosphate enemas (30 mg) in the treatment of ulcerative proctitis. An adrenocortical approach.
Twenty-three patients with attacks of distal ulcerative colitis were treated randomly with either 2 or 3 mg of topically administered beclomethasone dipropionate (BDP) or 30 mg of prednisolone sodium phosphate (PP). The effect of the steroid enemas on adrenocortical function was assessed by ACTH tests, which were performed before and after treatment. Endoscopic, clinical and histological scores were comparable in the three treatment groups in this pilot trial. Fasting cortisol in the PP group decreased significantly from 0.47 +/- 0.12 mumol/l before to 0.22 +/- 0.14 mumol/l (P less than 0.05) after therapy; in the BDP group no significant changes were found. Urinary cortisol excretion in the PP group was not detectable after therapy; in the BDP group no changes were found. It is concluded that in the topical treatment of ulcerative colitis, BDP may be preferable to PP because it exerts a promising anti-inflammatory action without affecting adrenocortical function.
Adult↗
Retrograde spread of therapeutic enemas in patients with inflammatory bowel disease.
Little is known about the factors that determine the extent of dispersion of enema solutions in the colon. To unravel some of the determinants we evaluated a consecutive series of patients with left-sided colitis. 40 ml enema solutions, viscosity 0.062 Pa.s (62 cP) at 37 degrees C were labelled with 10 MBq 99m-technetium human serum albumin microcolloid. Scintigraphic imaging was performed in 35 patients until 2 hours after administration of the enema. In 8 of the 16 patients with limited retrograde spread the study was repeated after doubling the volume (80 ml). We conclude that the extent of dispersion of an enema 0.062 Pa.s solution is highly variable. The basic fluid component for therapeutic 40 ml enemas (viscosity 0.062 Pa.s) reaches the affected area in patients with left sided colitis only in 40% of the cases. Increasing the volume of the enema can be an effective way to increase the retrograde spread up to the affected area in patients with limited retrograde spread. Scintigraphic imaging is a simple and reliable method of checking whether an enema conforms to the requirements of medical treatment. Scintigraphic imaging lasting for 1 hour after administration of the enema appears to suffice.
Adolescent↗
Comparison of beclomethasone dipropionate and prednisolone 21-phosphate enemas in the treatment of ulcerative proctitis.
In a double-blind randomized clinical trial 18 patients with exacerbations of distal ulcerative colitis were treated for 4 weeks with enemas containing either prednisolone 21-phosphate 30 mg (PP) or beclomethasone dipropionate 1 mg (BDP) a surface-active corticosteroid. All 8 patients treated with PP showed clinical and endoscopic improvement in contrast with only 4 of 10 patients treated with BDP. Endocrinologic evaluation showed a significant decrease in morning plasma cortisol, in cortisol increase after synacthen, and in urinary free cortisol excretion after PP therapy, but no changes in these variables after BDP therapy. We conclude that PP enemas are more active in the treatment of ulcerative proctitis, but they cause a suppression of the adrenal cortex, in contrast to BDP.
Adult↗
Comparison of 5-aminosalicylic acid (3 g) and prednisolone phosphate sodium enemas (30 mg) in the treatment of distal ulcerative colitis. A prospective, randomized, double-blind trial.
Twenty-nine patients with attacks of distal ulcerative colitis were treated randomly with 3 g 5-aminosalicylic acid (5-ASA) or 30 mg of prednisolone phosphate sodium (PP) enemas (40 ml). Endoscopic, clinical, and histologic improvement were comparable in the two treatment groups. Our study showed that topical treatment with 5-ASA is as efficacious as PP in improving distal ulcerative colitis.
Adult↗
Determination of 9-(1,3-dihydroxy-2-propoxymethyl)guanine (DHPG) in biological fluids by reverse-phase high pressure liquid chromatography.
In this article a simple method for the determination of 9-(1,3-dihydroxy-2-propoxymethyl)guanine (DHPG) in biological fluids is presented, based on reversed-phase ion-pair HPLC with UV detection at 254 nm. No complicated extraction procedure is needed. The stationary phase consists of a reversed-phase C18 stainless steel column and the mobile phase of 0.005 M sodium acetate and 0.0025 M pentanesulfonic acid sodium salt (PIC-B5) as an ion-pair reagent in water (pH 6.5). DHPG is a new antiviral drug in research of the treatment of cytomegalovirus infections. As a pilot study serum and urine samples of a few patients were investigated to gain an impression of the therapeutic range of DHPG. The method is suitable for routine assay of DHPG.
Acyclovir↗