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Biomedical subjects

G Barbeau

Publications and source records attributed to G Barbeau.

12 recordsLinked to original sources

Laser recanalization in high risk patients.

Laser recanalization was attempted in 13 patients in whom the risk of surgical therapy was increased by severe angina, infection, absent venous conduit, or recent deep venous thrombosis, and in 4 patients at high risk for limb loss due to severe infrapopliteal arterial occlusive disease. Total occlusions of the superficial femoral, tibial, or peroneal arteries were treated. Recanalization was accomplished using Argon laser power and a Spectraprobe-PLR. Two patients also required common femoral artery endarterectomy to improve inflow. Laser recanalization was successful in 9 patients (53%), and 8 (47%) had relief symptoms. None of the 4 patients with tibial and peroneal artery occlusion had successful recanalization or limb salvage. Restenosis or reocclusion developed in 4 patients during the first year after successful recanalization, but only 1 had recurrent symptoms. Limb salvage was initially achieved in 5 of 8 recanalization failures by surgical reconstruction but 3 developed graft infections requiring graft removal in 2 and amputation in 1. Thus, laser recanalization can accomplish limb salvage in selected patients whose medical or surgical risks complicate arterial bypass surgery.

Adult

Pharmacokinetics of mexiletine in the elderly.

The effect of advancing age on the kinetics of the antiarrhythmic agent mexiletine was studied by comparing various kinetic parameters calculated after administration of a single oral dose of mexiletine hydrochloride to seven elderly and eight young healthy volunteers. The rate of absorption of the drug from the gastrointestinal tract was significantly slower in the elderly (1.37 +/- 0.51 hr-1) than in the young group (2.25 +/- 0.79 hr-1). The mean values for elimination half-life and oral clearance were 12.3 +/- 3.7 hr and 10.3 +/- 5.4 mL/min/kg respectively in the young group and 14.4 +/- 4.5 hr and 8.5 +/- 2.9 mL/min/kg respectively in the elderly group. Neither of these parameters was significantly different between the two groups. The amount of mexiletine eliminated in urine up to 48 hours postdose was identical in both groups and represented less than 5% of the administered dose. It is concluded that the age-related modifications in the kinetics of mexiletine are not clinically important during chronic administration of the drug.

Adult

Pharmacokinetics of a sustained-release product of indomethacin in the elderly.

The pharmacokinetics of indomethacin (Indo) was studied in 10 healthy elderly male volunteers (age 67-81 years) following the oral administration of a single 75-mg dose of a sustained release form of Indo. The total and free plasma and erythrocyte concentrations of Indo were determined by a specific high-pressure liquid chromatographic method. A maximum concentration (Cmax) of 4.28 +/- (SE) 0.43 micrograms/ml was reached after 1.85 +/- 0.22 h. The area under the plasma concentration versus time curve (AUC) was 22.83 +/- 2.70 micrograms ml-1 h and the plasma elimination half-life was 4.34 +/- 0.64 h. The maximum concentration of Indo in the red blood cells was 0.123 +/- 0.013 microgram/ml and was obtained at 1.95 +/- 0.14 h after drug administration. The erythrocyte concentrations of Indo represented 2.4% of the total plasma levels of Indo whereas only 1.3% of the drug was unbound to plasma proteins. The Cmax and AUC values determined in the elderly were approximately double the values reported in young adults for the same dose.

Administration, Oral

Pharmacokinetics of ceftazidime in elderly volunteers.

The pharmacokinetics of ceftazidime after a 1-g bolus dose were studied in six elderly volunteers and 12 young subjects. Serum and urine samples were collected in serial order for 24 h and assayed by high-pressure liquid chromatography. The ceftazidime renal clearance was reduced in elderly subjects, a symptom related to normal aging of the kidneys. The decrease in volume of distribution in the elderly group may be explained by a reduction in total body water and an increase in fat tissue. Dosage adjustment is probably not necessary for otherwise healthy elderly patients requiring ceftazidime.

Adult

Pharmacokinetics of sulfisoxazole in young and elderly subjects.

The pharmacokinetics of sulfisoxazole was studied in 6 elderly (age 63-75 years) and 7 young (age 22-37 years) healthy nonsmoking volunteers following the oral administration of 2 g of Gantrisin. The plasma levels of sulfisoxazole obtained in the postabsorption phase were higher in the elderly subjects. There was no significant variation between the two groups of volunteers in the absorption rate constant, Cmax, bioavailability, the fraction of the dose of sulfisoxazole excreted unchanged, the area under the plasma curve of the N4-acetyl conjugate formed, and in the apparent volume of distribution of the drug. The tmax value and plasma half-life of sulfisoxazole were significantly longer, and the total body and renal clearances of the drug decreased in the elderly subjects. Diminished renal function as estimated by the creatinine clearance and urinary flow may explain the slower elimination of sulfisoxazole in the elderly subjects. Therefore, advancing age should be considered as a factor in the adjustment of sulfisoxazole dosage.

Adult

Pharmacokinetics of nalidixic acid in old and young volunteers.

Plasma levels of active naphthyridine were measured in healthy old (mean age 77.3 years) and young (mean age 25.4 years) subjects following oral administration of 1 Gm nalidixic acid. The plasma levels of active naphthyridine, i.e., nalidixic acid and its metabolite 7-hydroxynalidixic acid, were generally higher in the old group, particularly in the elimination phase. Significant variations in the pharmacokinetic parameters were obtained between the two groups of volunteers. The plasma half-life of active naphthyridine averaged 11.5 hours in old subjects and 2.7 hours in the younger group. Diminished renal function in the geriatric group may explain the slower elimination of the drug in the old subjects. The mean values of the other parameters calculated were: apparent volume of distribution, 0.55 (old) and 0.47 (young) liter/kg body weight; area under the curve, 327.7 (old) and 156.3 (young) micrograms/ml x hr; total body clearance 2.9 (old) and 8.3 (young) liters/hr; absorption rate constant, 0.29 (old) and 0.52 (young) hr. -1

Adult

Nalidixic acid-induced photodermatitis after minimal sun exposure.

More than 30 cases of bullous photodermatitis have already been associated with the administration of nalidixic acid. This reaction is reported in a 57-year-old woman whose sun exposure was minimal. Nalidixic acid-induced photoreactions generally occur in females; they affect mainly the dorsal surfaces of the hands, feet, and legs, and usually do not involve the face. Blistering is always reported, and erythema is common. Dosage regimen and duration of treatment have little influence on the onset and severity of the reaction, which is probably of allergic nature. Its duration may be long, from three to six weeks, reexposure to the sun may trigger the reappearance of blistering for several months, even in the absence of a drug rechallenge.

Female

Pharmacokinetics of ciprofloxacin in elderly subjects.

The pharmacokinetics of single-dose oral ciprofloxacin 500 mg was ascertained in 12 elderly and 12 young subjects. Mean age of the elderly volunteers was 75.4 years and the mean measured creatinine clearance in this group was 40.7 ml/min. Serum and saliva were collected in serial order for 24 hours (elderly) and 10 hours (young), and assayed for ciprofloxacin by high-performance liquid chromatography. The geriatric subjects had higher serum levels throughout the sampling period, with a peak level of 3.24 +/- 0.79 versus 2.26 +/- 0.75 micrograms/ml for the younger group (p less than 0.005; one-way analysis of variance). A twofold increase in the ciprofloxacin half-life may be partly explained by a decrease in the glomerular filtration rate, as shown by slower ciprofloxacin renal clearance (152.4 +/- 54.2 vs 395.6 +/- 139.0 for elderly and young subjects respectively; p less than 0.001). We concluded that in elderly patients, ciprofloxacin should be administered at an interval not less than every 12 hours to prevent accumulation and eventually toxicity.

Adult