PubMed Health⌕ Search

Biomedical subjects

R Shupak

Publications and source records attributed to R Shupak.

7 recordsLinked to original sources
PubMed1997

Cardiovascular effects of different infusion rates of sufentanil in patients undergoing coronary surgery.

OBJECTIVE: Pharmacokinetics and haemodynamic effects of a total dose of 15 micrograms.kg-1 sufentanil, an opioid anaesthetic agent, were studied in patients undergoing aortocoronary bypass surgery at three infusion rates of 30 (group I), 5 (group II), and 2 (group III) micrograms.kg-1.min-1, respectively. RESULTS: Plasma concentrations of sufentanil could be optimally characterized by a linear biexponential pharmacokinetic model. Non-compartmental analyses indicated that there was no significant difference in the values of clearance (11.6, 13.3, 14.3 ml.min-1.kg-1), steady-state volume of distribution (0.220, 0.255 and 0.331 l.kg-1) and mean residence time (18.8, 13.3 and 14.3 min) among the groups. The observed mean Cmax values of 421 (group I), 125 (group II), and 53 (group III) ng.ml-1 and observed mean AUC values from 0 to 3 min were all consistent with the dosing regimens. There were large inter-individual variations in haemo-dynamic response. Compared to plasma data, a delay in haemodynamic effects was found. Times to reach peak haemodynamic effect ranged from 4.3 to 4.9 min for group I, from 4.6 to 6.1 min for group II, and from 9.9 to 11.3 for group III. Except heart rate, peak haemodynamic effects in these study patients generally ranged from 20.9% to 35.2%. Significant reductions in the area under the effect-time profiles of mean arterial blood pressure and systemic vascular resistance were observed in group II and group III, but not in group I. Significant reductions in the area under the effect-time profiles of left ventricular stroke work index were observed in group III only. No effect on heart rate was found in any group. CONCLUSION: Our findings suggested that a slower infusion rate of sufentanil at a dose of 15 micrograms.kg-1 tends to give a greater reduction in mean arterial blood pressure, systemic vascular resistance, and left ventricular stroke work index than does a faster infusion rate.

Analgesics, Opioid↗
PubMed1997

Rheumatic symptoms following adjuvant therapy for breast cancer.

Twenty-three women with a diagnosis of breast cancer who subsequently developed new nonmetastatic rheumatic symptoms, and/or had a history of rheumatic symptoms prior to their diagnosis of breast cancer, were identified from the oncology and rheumatology practices of a 400-bed tertiary-care teaching hospital. For each patient a structured telephone interview and detailed chart review were conducted. Of eight women with no previous rheumatic history (Group I), four developed polyarthritis (1 seropositive), three fibromyalgia, and one spondylosis after the diagnosis of breast cancer, which in four cases occurred during or shortly after cyclophosphamide-based combination chemotherapy, in two cases during tamoxifen therapy, and in one case after radiotherapy only. Of 15 women who had previous rheumatic symptoms (Group II), 12 developed worse and/or new symptoms, five after chemotherapy and seven on tamoxifen. In both groups the symptoms had a significant negative impact on functional status, and in some cases resolution was only partial even after many years of followup. Prospective studies are needed to determine the incidence, risk factors, and optimal management of nondestructive polyarthropathy or fibromyalgia in women who receive systemic adjuvant therapy for breast cancer.

Adult↗
PubMed1995

Aortic dissection in giant-cell arteritis.

Twenty-three cases of aortic dissection in patients with giant-cell arteritis are reviewed and an additional case is reported. Forty-six percent presented catastrophically with aortic dissection and no prior history of giant cell arteritis. Eighty percent died within 2 weeks of the event; four patients had successful surgical grafts. There was diffuse involvement of the aorta with giant cells in 89%, but dissecting tears occurred primarily in the proximal aorta in 85% of cases. The majority of cases with a preceding history of giant cell arteritis were on low doses of steroid or on no treatment at the time of dissection, and the median erythrocyte sedimentation rate of these patients was 62 mm/h (range 21-98). Evidence of some form of hypertension, whether acute or chronic, mild or severe, was found in 77% of patients. Inadequate treatment of giant-cell arteritis and underlying hypertension (treated or untreated) are potential factors leading to aortic dissection in these patients.

Aged↗
PubMed1988

Intraarticular methylprednisolone therapy in hemophilic arthropathy.

This small pilot study examined the use of intraarticular methylprednisolone in hemophilic synovitis. Nineteen joints in ten adult hemophiliacs were studied. There was subjective improvement at 24 hr following injection in 79% of joints injected, and the improvement persisted up to 8 wk in 58%. The number of hemarthroses decreased following intraarticular steroids (mean of 7.7 bleeds in the 8 wk prior to injection versus a mean of 1.9 bleeds in the 8 wk following injection). Similarly the amount of clotting factor used for the injected target joint decreased from a mean of 7,616 units to 2,315 units postinjection (p less than .001). Improvement correlated with presence of synovitis but not with radiologic stage of the joint. Aspirated synovial fluids were analyzed and showed characteristics consistent with low-grade inflammation. These preliminary observations suggest that intraarticular corticosteroid injection may be a useful therapeutic tool in the medical management of hemophilic arthropathy.

Adult↗
PubMed1983

Avascular necrosis of bone with rheumatoid vasculitis.

A 76-year-old woman with classical rheumatoid arthritis presented with a left groin mass associated with radiologic erosion of the adjacent bony public ramus. The hip joint was not involved. Computerized tomography showed an encapsulated cyst of the pubic ramus that was surgically excised and measured about 6 x 8 cm. Histologic examination of the cystic mass and adjacent bone showed marked avascular necrosis, surrounded by an acute necrotizing vasculitis with fibrinoid necrosis. We postulate that, in this case, rheumatoid vasculitis caused an avascular necrosis of the pubic ramus.

Aged↗
PubMedDate not supplied

Neuroarthropathy (Charcot joints) in familial amyloid polyneuropathy.

Two patients with familial amyloid polyneuropathy (FAP) of Andrade type developed neuroarthropathy (Charcot joints). In 1 patient both knees were affected and in the other patient both ankles. This complication added markedly to the already severe disability and limitation of movement caused by the underlying illness. To the best of our knowledge this is the first description of Charcot joints in FAP. Neuroarthropathy in FAP is probably more common than previously suspected and should be sought in any case of FAP with joint disease.

Adult↗