Protamine combined with small doses of epinephrine prevents serious reactions in cardiac patients.
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Biomedical subjects
Publications and source records attributed to M Mikhail.
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1. The effects of two non-steroidal anti-inflammatory drugs, ibuprofen (20 mg day-1 kg-1) and diclofenac sodium (2.5 mg day-1 kg-1), on the severity of gentamicin-induced nephrotoxicity were evaluated in rats. 2. Administration of gentamicin (100 mg day-1 kg-1) for 5 days resulted in a significant increase in renal cortical total phospholipids accompanied by a significant decrease in cortical Na+, K(+)-ATPase activity. These changes were associated with a significant decrease in body weight and increases in kidney weight, serum creatinine and urea nitrogen. 3. In rats treated simultaneously with both gentamicin and either ibuprofen or diclofenac sodium for 5 days, all the measured parameters of renal dysfunction were similar in magnitude to those observed in rats treated with gentamicin alone. 4. In contrast, rats treated with either ibuprofen or diclofenac sodium for 27 days and injected concurrently with gentamicin during the last 5 days of the treatment period had significantly higher kidney weight, lower renal cortical Na+, K(+)-ATPase activity and higher cortical phospholipid content, serum creatinine and urea nitrogen than did rats treated with gentamicin alone. A 27-day treatment with ibuprofen or diclofenac sodium alone resulted in no change in renal function. 5. These results demonstrate that gentamicin nephrotoxicity was potentiated after the long (27 days) but not after the short (5 days) period of treatment with ibuprofen and diclofenac sodium. Thus, prolonged administration of non-steroidal anti-inflammatory drugs should be considered as a risk factor that may increase the nephrotoxic potential of gentamicin.
We describe a 37-year-old patient with placenta previa, placenta accreta and a history of four previous cesarean sections who experienced massive hemorrhage after mid-trimester abortion by dilation and evacuation.
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The role of nutritional factors in biochemical interactions that are part of an oncogenic process or inhibit free radical proliferation have attracted considerable interest in relation to molecular mechanism(s) and the natural history of human cancer. Epidemiologic and experimental studies have drawn attention to the association between dietary micronutrient deficiencies and the incidence of neoplastic and malignant lesions. In the last two decades, the role(s) of retinoids, carotenoids, tocopherols and water-soluble antioxidant vitamins, and allegations of anti-tumor properties in the daily dietary consumption of fresh fruits and green leafy vegetables, have captured the attention of an increasingly sensitive diet- and health care-conscious public, the biochemical community, and industrial food producers. Moreover, recent epidemiologic and compelling advances in molecular biology have linked the presence of restricted human papillomavirus (HPV) subtypes to cervical carcinoma and precursor lesions. In the present report, we identify and review measurable effects of dietary deficiencies of selected antioxidant micronutrients (i.e., beta-carotene and vitamins A, C, and E) and their association with known cervix cancer risk factors in the pathogenesis and potential prevention of cervix dysplasias, presumed to be the precursor lesions of cervix cancer.
The authors present two cases of lymphangioma of the cervicofacial region, treated with a new investigational drug in North America, OK-432 (picibanil), a sclerosing agent intralesionally injected. Both patients had been treated surgically and had recurrence of the tumor. Intralesional injection of OK-432 without aspiration was employed for the first patient, and after aspiration in the second patient. A change in consistency of the tumor, manifested by softening, was followed by marked shrinkage. No complication either locally or systemically has occurred during the follow-up period (10 to 16 months). In both cases, satisfactory results were obtained, resulting in definite reduction in size and improvement in cosmetic appearance. The authors recommend OK-432 intralesional injection for surgically challenging lymphangioma. Their results support those of a recent Japanese study using OK-432 as sclerosing therapy for unresectable lymphangioma.
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Although the adverse effects of sickle cell disease on pregnancy outcome are well recognized, the contribution of placental pathology to these events remains controversial. Placentas from single, term deliveries of 21 women with sickle cell (SS) disease and 63 low-risk control women with hemoglobin AA, matched for maternal age, gestational age, and parity, were examined and findings correlated with neonatal outcome. Gross and microscopic examinations of these placentas were performed by a pathologist unaware of the pregnancy outcome. All placentas were weighed, and the relative placental weight was calculated and examined for the presence of infarction, villous sclerosis, and intervillous fibrin deposits. The mean birth weight of infants of the SS women was significantly lower than that of the low-risk controls (2830 +/- 310 g versus 3415 +/- 250 g, P < .05). The mean placental weight was also lower in the SS group compared with controls (445 +/- 78 g versus 568 +/- 86 g). The mean relative placental weight for the SS women was 12.9 +/- 4% and for the controls, 15.2 +/- 3.4%. Moderate-to-severe villous sclerosis, infarction, and intervillous fibrin deposits were present in 7 of 21 SS placentas but absent in placentas of low-risk controls. These 7 pregnancies with SS disease and abnormal placental findings had small-for-gestational-age infants, and their relative placental weight was less than 10%. We conclude that in SS disease, relative placental weight less than 10% and placental lesions of moderate-to-severe villous sclerosis, intervillous fibrin deposits, and infarction are associated with small-for-gestational-age infants.
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The present study attempts to investigate the impact of protein energy malnutrition (PEM) on chromosomes. Twenty infants suffering from marasmus and kwashiorkor were chosen from the in-patient paediatric hospital of Ain Shams University. They were matched by age and sex and socioeconomic status to ten healthy infants (controls). Whole blood lymphocytic cultures were set up for every infant and harvested after 48 h incubation. The frequency of chromosomal aberrations was found to be nearly nine times greater among infants with PEM compared to controls (6.7% versus 0.7% respectively); the difference was statistically highly significant, P less than 0.001. The recorded aberrations were mainly chromatid gaps and isogaps. In addition, chromatid breaks, dicentrics and acentric fragments were observed. Moreover, the younger the age of the infant the greater the frequency of chromosomal aberrations. The results direct our attention to the genetic risk effect of PEM.
The ability of a new continuous-wave Doppler esophageal probe to measure cardiac output noninvasively during surgery under general anesthesia was tested and compared with simultaneously measured thermodilution cardiac output. A Doppler computer, calibrated for the aortic diameter and the transcutaneously measured cardiac output from the suprasternal notch, computed the Doppler cardiac output from the descending aortic blood flow velocity signal. A total of 246 paired Doppler cardiac output and thermodilution cardiac output measurements were made in 14 patients during surgery. The average thermodilution cardiac output was 5.90 +/- 3.27 (standard deviation) liters/min (range 1.20 to 19.18); the average Doppler cardiac output was 6.21 +/- 4.0 liters/min (range 2.30 to 28.20). The difference between the cardiac output measured by the 2 techniques was 1.38 +/- 2.2 liters/min (range 0.04 to 16.8). Two to 5 cardiac output measurements were averaged and arranged into "time periods." The average standard deviations for thermodilution and Doppler cardiac outputs within each time period were 0.64 and 0.47 liters/min, respectively. There was a correlation between the 2 measurements over a range of cardiac output values (r = 0.76, Doppler cardiac output = 0.93 x thermodilution cardiac output +0.7, standard error of the estimate = 1.76). Reproducible measurements of Doppler cardiac output were obtained during intraobserver (mean difference 0.64 +/- 0.52 liter/min) and interobserver (mean difference 0.41 +/- 0.36 liter/min) studies (n = 8). Cardiac output measurement by the Doppler esophageal probe could be used for hemodynamic monitoring during surgery in selected patients with cardiopulmonary disease.
The dietary importance of beta-carotene as a factor in health maintenance has recently attracted considerable interest. Previously, total carotene content was estimated in a limited number of human tissues by means of spectrophotometric methods. In this study the levels of beta-carotene were measured by high-pressure liquid chromatography in tissue samples of uterine leiomyomas and adjacent normal myometrium obtained at hysterectomy from uteri of 18 patients. beta-Carotene concentration was significantly (p = 0.0013) lower in fibroid tissue than in normal myometrium. In addition, levels of beta-carotene were assayed in tissue samples of cancers of the cervix, endometrium, ovary, breast, colon, lung, liver, and rectum and were compared with levels of respective adjacent normal sites. The concentrations of beta-carotene were found to be lower in all cancer tissues. The decreased levels of beta-carotene suggest that beta-carotene deficiency may have a role in the cause and/or pathogenesis of leiomyomas and cancers of the organs that were investigated. The mechanism of action, however, remains unknown.
This is the first report of both reduced (RAA) and total (TAA) plasma ascorbic acid levels in women who smoke and are on oral contraception. 155 normal healthy subjects were investigated. A study questionnaire was completed including age, method of contraception, smoking status, and food intake at breakfast, prior to attending the clinic. Biochemical assays were promptly carried out without knowledge of subject's clinical or dietary status. One-way analysis of variance revealed that oral contraception per se, barrier or IUD methods have no effect on plasma ascorbic acid levels. The mean values (mg/dl +/- SD) for plasma RAA between smokers and nonsmokers were 0.512 +/- 0.241 and 0.601 +/- 0.263; and that for TAA were 0.565 +/- 0.232 and 0.682 +/- 0.231, respectively. Significant decreases in both plasma RAA (p less than 0.05) and TAA levels (p less than 0.001) were observed in smokers. Age was an interacting variable. No association of smoking or oral contraceptive use was seen with RAA or TAA levels among women less than 26 years, but decreases in both RAA and TAA levels were evident among smokers aged 26 years or older. The present study emphasizes the total exposure to smoking, e.g., pack years, is a significant confounding variable in the study of plasma ascorbic acid levels.
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In healthy adult goats, closure of the esophageal groove was induced by thirst, IV administered vasopressin, and intracarotid administration of hypertonic NaCl solutions. The efficiency of stimulation was tested directly by visual inspection of the course taken by orally administered solutions through a ruminal or abomasal fistula, palpation of the lips of the esophageal groove through a ruminal fistula, and indirectly by following the glucose dynamics in the blood after oral administration of glucose solution. Esophageal groove closure was observed during drinking after a 48-hour period of water deprivation. Intracarotid administration of 1.5 ml of a saturated solution or 10.5 ml of a 1.5% solution of NaCl also stimulated groove closure; however, groove closure stimulated by administration of vasopressin is the most satisfactory procedure for passing compounds of therapeutic importance directly from the cardiac orifice to the abomasum.