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Termination of second trimester pregnancy with intraamniotic administration of 16-phenoxy-omega-tetranor-PgE2-methylsulfonamide (SHB 286) alone and combined with oxytocin and calcium gluconate.

Midtrimester abortion was succesfully induced within 30 hours in 62 out of 90 patients by intraamniotic administration of 16-phenoxy-omega-17,18,19, 20-tetranor-prostaglandine-E2-methylsulfonamide. The Pg-analogue was tested in 5 groups of patients which received 1,2 or 3 mg. In group IV, 2 mg of the analogue was combined with oxytocin. In group V, 3 mg of the analogue was combined with 2.75 grams of calcium gluconate. The success rate was significantly influenced by the amount of the drug administered. Side effects were minimal. Multiparous women respond better to the therapy than nulliparous patients. The combination with oxytocin was more effective than the Pg-analogue alone and the combination of sulprostone with calcium gluconate was 87% succesful within 30 hours and 100% succesful within 36 hours.

Abortion, Induced

[Effects of calcium gluconate and calcium chloride on cardiocirculatory parameters in man (author's transl)].

In 44 patients with congenital or acquired heart disease, functional class II--IV NYHAC, the effects of calcium gluconate (10 ml 10%) and calcium chloride (10 ml 5.5%) on hemodynamics, inotropy and myocardial oxygen consumption were investigated during and immediately after cardiosurgical procedures. There was a significant increase in blood pressure, left ventricular pressure, total systemic resistance, cardiac index, stroke index, peak dp/dt and myocardial oxygen consumption as well as in arterial perfusion pressure during extracorporeal circulation due to i.v.-injection of either one of the drugs. The positive inotropic effects were more pronounced after application of calcium chloride. In emergency situations during anaesthesia or resuscitation, therefore, calcium chloride seems to be of more advantage than calcium gluconate.

Calcium Chloride

Biochemical dehydrogenations of saccharides. VII. 2-Deoxy-D-gluconic acid from 2-deoxy-D-glucose.

Fermentation of a medium containing 5% 2-deoxy-D-glucose and barium carbonate by a strain of Pseudomonas aeruginosa yielded barium 2-deoxy-D-gluconate. The yield was 77% theoretical. The strain in question makes it possible to prepare directly calcium, magnesium, manganese and ferrous salts of 2-deoxy-D-gluconic acid. A treatment of 5% solution of 2-deoxy-D-glucose with commercial glucose oxidase preparation caused also a complete dehydrogenation.

Barium

Saturation behavior of ascites tumor cell chloride exchange in the presence of gluconate.

Steady state Cl- flux across the Ehrlich mouse ascites cell membrane was studied when gluconate replaced Cl- in the external medium. Saturation behavior was observed; K 1/2 was 23.9 mM Cl- and V was 758 micromol.g-1 dry weight.h-1. The cells lost K+, Cl- and H2O, consistent with relative impermeability to gluconate, and the Cl- efflux rate coefficient was elevated. The results indicate that a major portion of Cl- exchange occurs as a membrane transport process and suggest that the process is sensitive to intracellular Cl- levels.

Animals

Respiratory insufficiency after intraperitoneal administration of Kanamycin: failure of calcium gluconate to reverse toxic effects.

A 47-year-old woman developed postanesthesia respiratory insufficiency five hours after an intramuscular injection of 0.5 gm of kanamycin and one hour and 40 minutes after peritoneal lavage with 1.0 gm of kanamycin. The respiratory insufficiency was not reversed by an intravenous infusion of 400 mg of calcium gluconate. This is the third reported instance of respiratory insufficiency after kanamycin lavage. Only one of the previously reported patients responded to intravenous infusion of calcium gluconate, despite the experimental evidence supporting its efficacy.

Anesthetics

Use of chlorhexidine gluconate and povidone iodine mouthwashes in the treatment of acute ulcerative gingivitis.

A trial was conducted to compare the effectiveness of povidone iodine and chlorhexidine gluconate with buffered peroxyborate in the treatment of acute ulcerative gingivitis. After 20 patients had entered the trial and 11 had required additional therapy with metronidazole to control their symptoms, the study was terminated. Those patients receiving peroxyborate all showed a satisfactory improvement in clinical signs and symptoms. One patient each receiving povidone iodine or chlorhexidine reported a symptomatic improvement, although gingival ulceration was still apparent at 1 week. The remaining patients all required metronidazole therapy to control their symptoms. Povidone iodine and chlorhexidine gluconate therefore cannot be recommended for the treatment of acute ulcerative gingivitis.

Acute Disease

Chemistry of 99mTc tracers. II. In vitro conversion of tagged HEDP and pyrophosphate (bone-seekers) into gluconate (renal agent). Effects of Ca and Fe (ii) on in vivo distribution.

Sodium gluconate transforms the bone-seekers 99mTc-HEDP and 99mTc-pyrophosphate into the renal agent 99mTc-gluconate. In these in vitro processes, pyrophosphate is displaced faster than HEDP, while the HEDP reaction is accelerated by calcium ions. The in vivo distributions of these bone and kidney agents are altered by the prior local injection of calcium or iron(II). These transformation and translocation phenomena are explained in terms of the mechanistic behavior of Tc(IV) complexes.

Animals

The effect of partial dentures and chlorhexidine gluconate gel on plaque accumulation in the absence of oral hygiene.

A study was made of the effect of wearing partial dentures upon plaque accumulation in a group of 24 partial denture wearers, when oral hygiene procedures were withdrawn. The modifying effect of a 1% chlorhexidine gluconate gel on this plaque accumulation was measured. Plaque accumulation was measured at the end of four different denture-wearing regimens each 3 days in length. The wearing of a partial denture either day only or day and night, significantly increased plaque accumulation over not wearing a denture. There was no significant difference between plaque accumulation with day wear and day and night wear. The increase in plaque accumulation with day and night wear resulted from an equal and significant increase in both buccal and lingual plaque accumulation. Chlorhexidine gluconate in the form of a gel significantly reduced plaque accumulation during daytime wear. These results tend to confirm that plaque control is a major factor in determining the long-term effects of partial dentures upon the periodontal structures and emphasize the importance of oral hygiene in partial denture wearers.

Adult

Oral use of chlorhexidine gluconate toothpaste in epileptic children.

The purpose of this clinical study was to evaluate the effect of a 3-min daily toothbrushing with 1% chlorhexidine gluconate toothpaste on dental plaque, gingivitis and gingival hyperplasia in 30 mentally retarded epileptic children treated with phenytoin. A double-blind cross-over technique was used. Brushing once daily for 2 months with 1% chlorhexidine gluconate toothpaste resulted in significantly lower Pl I and G I values. Gingival hyperplasia was not significantly reduced by the use of the chlorhexidine toothpaste.

Administration, Oral

Effectiveness of chlorhexidine gluconate-impregnated dressings in preventing central line-associated bloodstream infection in a paediatric intensive care unit: A randomised controlled trial.

OBJECTIVES: To compare the effectiveness and dermatological safety of chlorhexidine gluconate (CHG)-impregnated dressings versus conventional transparent dressings in preventing central line-associated bloodstream infection (CLABSI) in paediatric patients admitted to a PICU. METHODS: A single-blind, randomised controlled trial with a 1:1 allocation ratio was conducted in a tertiary PICU. A total of 250 paediatric patients with a central venous catheter were included (125 per group). Patient characteristics, catheter-related variables, catheter dwell time and skin alterations were recorded. The primary outcome was CLABSI, defined according to CDC/NHSN criteria. Bivariate analyses and multivariable logistic regression were performed, including clinically relevant covariates related to catheter exposure, dressing type, and vaccination status. The trial was registered at ClinicalTrials.gov (NCT07175116). RESULTS: CLABSI incidence was significantly lower in the CHG group compared with the conventional dressing group (2.4% vs. 18.4%; p&#xa0;<&#xa0;0.001). In multivariable analysis, CHG-impregnated dressings were independently associated with reduced CLABSI risk (OR = 0.15; 95% CI: 0.04-0.58). Longer catheter dwell time (OR = 1.13 per day; 95% CI: 1.04-1.22) and absence of complete vaccination (OR = 8.68; 95% CI: 2.48-30.47) were also associated with increased infection risk. Incomplete vaccination showed a similar trend without reaching statistical significance (OR = 6.48; 95% CI: 0.95-44.20). Skin alterations were more frequent in the CHG group (16.8% vs. 11.2%), predominantly in younger infants. CONCLUSIONS: CHG-impregnated dressings were associated with a significant reduction in CLABSI incidence in critically ill paediatric patients, although their use was linked to a modest increase in mild skin reactions. IMPLICATIONS FOR CLINICAL PRACTICE: CHG-impregnated dressings may be considered as part of a multifaceted infection prevention strategy, alongside appropriate catheter management, minimisation of catheter manipulation and proactive skin monitoring, with cautious and individualised use in infants.

Humans

Studies on an iron-poly(sorbitol-gluconic acid) complex for parenteral treatment of iron deficiency anaemia.

A preparation containing an iron-poly(sorbitol-gluconic acid) complex for parenteral treatment of iron deficiency anaemia is described. The physical and chemical properties of the iron complex have been studied by using electrophoresis and gel permeation chromatography. A rapid absorption from the injection site after intramuscular administration to rabbits takes place, 70% of the iron being absorbed after 24-48 hours. Thereafter, the absorption rate is slower, and 32 days after the injection 94% has been absorbed from the injection site. In rabbits the maximum level of iron in serum is reached after 12-24 hours; in dogs after 1-3 hours. Disappearance from the serum takes place slowly. The complex is exclusively absorbed via the lymphatic route. Nine to ten per cent of the given dose is excreted by the kidney within 72 hours in rats and 24 hours in rabbits after intramuscular administration. On administration of the preparation to rats, made anaemic by phlebotomy, a rapid increase of haemoglobin values is observed as well as a very high utilization of the retained amount of the given dose.

Absorption

Pharmacological studies on an iron-poly-(sorbitol-gluconic acid) complex for parenteral treatment of iron deficiency anaemia.

Intravenous injection of the iron-poly(sorbitol-gluconic acid) complex (IPSG) to cats anaesthetized with sodium pentobarbitone caused a transient decrease in mean arterial blood pressure and a temporary increase in central venous pressure, heart rate and femoral blood flow at large doses (cumulative doses up to 744 mg/kg). Tachyphylaxis developed upon repeated administration. A temporary reduction in the magnitude of the blood pressure responses to noradrenaline and isoprenaline was obtained after large doses of IPSG. The blood pressure effects of acetylcholine, histamine and bilateral carotid occlusion were not affected. No definite effects were seen on the electrocardiograms. The transient cardiovascular effects were interpreted as being due to the presence of small amounts of ferrous iron in the preparation. IPSG did not significantly affect blood coagulation or platelet aggregation as judged from results of in vitro and in vivo experiments. Immunogenicity studies in rabbits and antibody analyses of sera from patients treated with IPSG failed to demonstrate any effect of IPSG on the immune system.

Acetylcholine

Studies on the effect of parenteral iron, Ferastral, an iron-poly(sorbitol-gluconic acid) complex, on blood coagulation in man.

The possible influence of Ferastral, an iron-poly(sorbitol-gluconic acid) complex, on blood coagulation in man was investigated. Ferastral added to plasma produced no changes in blood coagulation until a final concentration of 2 000 microgram/ml (35.8 mmol/1) was used, when minimal changes in blood coagulation factors were observed. Five patients were given an intramuscular injection of 250 mg Ferastral. No changes in blood coagulation and thrombocyte function were observed up to 5 hours after the initial iron injection.

Adult

Oncological study in rats of Ferastral, an iron-poly-(sorbitol-gluconic acid) complex, after intramuscular administration.

Four groups of Sprague-Dawley rats were given Ferastral, an iron-poly(sorbitol-gluconic acid) complex (IPSG) or Imferon, an iron-dextran complex, intramuscularly twice a week for 17 weeks. The experiment lasted for 95 weeks. Each compound was given to two groups, one low dose group and one high dose group. Depending on the body mass, the dose levels varied between 2.5 and 10 mg (25-50 mg/kg body mass) and between 5 and 20 mg (50-100 mg/kg body mass) of iron per rat, respectively. The mean total dose of iron per rat was calculated to be 235 and 495 mg, respectively. Another group of animals served as a control. From about the 30th experimental week onwards tumours developed at the intramuscular injection sites in the groups given Ferastral and Imferon. The tumours appeared to be sarcomas. In almost all the treated animals that lived longer than 30 weeks after the start of the experiment, sarcomas were present at the intramuscular injection sites. The sarcomas appeared earlier in the high dose groups than in the low dose groups and slightly earlier in the rats given Ferastral than in those given Imferon. No other pathological changes, including neoplasms, were considered to be related to the treatment.

Animals

Distribution of 59Fe-labelled iron-poly(soribitol-gluconic acid) complex in normal and anaemic rats.

An iron carbohydrate complex, iron-poly(sorbitol-gluconic acid), Ferastral, was labelled with 59Fe, and its distribution in rats was studied. The animals were intramuscularly treated with a dose of 10 mg of iron/kg. Three groups of animals were used: group A: non-anaemic and group B: anaemic rats, both kept on iron-deficient diet, and group C: non-anaemic rats kept on iron-supplemented diet. Urinary and faecal excretion, distribution in the body and incorporation in blood of the 59Fe was followed up to 28 days. The total excretion after that time was 15%. There was a rapid initial phase followed by a slower continuous one. After 28 days group A had 25, group B 13 and group C 40% of the given dose remaining at the site of injection. The corresponding values in liver after 28 days were 7, 4 and 17% of the given dose, respectively. In blood a continuous increase was observed. At 28 days after administration 26, 43 and 17% of the given dose had been incorporated in the red blood corpuscles of the respective groups. These results show that the iron complex is absorbed from the site of injection and is utilized for haemoglobin synthesis. They also show that the disposition of the complex is influenced by the iron content of the diet.

Anemia, Hypochromic

The absorption and availability of iron from iron-poly(sorbitol-gluconic acid) complex in rats as measured by phlebotomy.

The local and systemic availability of the iron in an iron-poly(sorbitol-gluconic acid) complex (Ferastral) has been studied in rats. The animals were treated intramuscularly with the complex in a dose corresponding to 10 mg of iron per animal. The technique of repeated phlebotomy was used to induce and maintain constant levels of anaemia. The phlebotomies were started immediately after injection and at 14 and 28 days after dosing. At the end of the appropriate interval, the remaining amount of iron at the injection sites as well as the degree of utilization of the iron retained in the animals were estimated. It was shown that the amount of iron at the site of injection of these anaemic animals was less than 3% regardless of the time when the series of phlebotomies were started. It was also shown that the degree of utilization of the iron from the complex was 90% of the retained amount of iron when the phlebotomies immediately followed dosing, and 86% and 79% when initiated 14 days and 28 days respectively. The significance of the decrease in utilization is discussed.

Absorption