[Emergency care in acute left heart failure. Decreasing preload, oxygen inhalation].
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BACKGROUND: This section is under preparation and will be included in the next issue. OBJECTIVES: To determine whether, in preterm newborn infants who have hypoxic respiratory failure, treatment with inhaled nitric oxide improves oxygenation and reduces the rates of death, or adverse neurodevelopmental outcome. SEARCH STRATEGY: Electronic and hand searching of pediatric/neonatal literature and personal data files. SELECTION CRITERIA: Randomized and quasi randomized studies in preterm infants with hypoxic respiratory failure. Administration of inhaled nitric oxide. Clinically relevant outcomes, including death, oxygenation, intraventricular haemorrhage. DATA COLLECTION AND ANALYSIS: One randomized controlled trial of nitric oxide therapy was found in preterm infants with a high risk of developing bronchopulmonary dysplasia (Subhedar 1997). MAIN RESULTS: No significant effect of inhaled nitric oxide on any outcome variable was found. In particular there was no effect on the primary outcome variable of death or bronchopulmonary dysplasia. REVIEWER'S CONCLUSIONS: There is currently no published information to support the use of inhaled nitric oxide in preterm infants. Preterm infants should not be treated with inhaled nitric oxide except in the context of prospective, randomized controlled trials.
UNLABELLED: Down-regulation of the endogenous nitric oxide (NO) pathway may explain rebound pulmonary hypertension after discontinuation of inhaled NO. We determined whether the prolonged administration of inhaled NO increases pulmonary vasoconstriction, which may occur from decreased endogenous NO. Rats were placed in normoxic (N; 21% O2) or hypoxic (H; 10% O2) chambers with or without inhaled NO (20 ppm) for 1 or 3 wk. Immediately after or 24 h after discontinuation of NO, vasoconstrictive responses were determined in isolated lungs to acute hypoxia (HPV; 0% O2 for 6 min), angiotensin II (0.05 microg), and the thromboxane analog U-46619 in the presence and absence of the nitric oxide synthase inhibitor N(G)-nitro-L-arginine methyl ester (L-NAME; 100 microM). Inhaled NO did not alter HPV or angiotensin II vasoconstriction in the N group immediately after or 24 h after discontinuation of NO. In the H group, inhaled NO decreased HPV but had no effect on the angiotensin II vasoconstriction compared with H alone. Inhaled NO did not alter the response to L-NAME. Inhaled NO did not alter, whereas L-NAME significantly decreased, the dose of U-46619 required to increase the pulmonary pressure by 10 mm Hg. In conclusion, prolonged inhaled NO decreased or did not alter HPV and did not alter vasoconstriction secondary to angiotensin II, U-46619, or L-NAME in N and H rats. These results suggest that prolonged inhaled NO does not increase pulmonary vasoconstriction, as would be expected from down-regulation of endogenous NO. IMPLICATIONS: High pulmonary pressure has been observed clinically after discontinuation of inhaled NO. This rat study suggests that 1-3 wk of inhaled NO does not increase pulmonary vasoconstriction, as would be expected from decreasing the endogenous vasodilator NO.
Tertiary amyl methyl ether (TAME) is a gasoline fuel additive used to reduce emissions. Understanding the metabolism and distribution of TAME is needed to assess potential human health issues. The effect of dose level, duration of exposure and route of administration on the metabolism and distribution of TAME were investigated in male and female F344 rats and CD-1 mice following inhalation or gavage administration. By 48 h after exposure, >96% of the administered radioactivity was expired in air (16-71%) or eliminated in urine and feces (28-72%). Following inhalation exposure, mice had a two- to threefold greater relative uptake of [14C]TAME compared with rats. Metabolites were excreted in urine of rats and mice that are formed by glucuronide conjugation of tertiary amyl alcohol (TAA), oxidation of TAA to 2,3-dihydroxy-2-methylbutane and glucuronide conjugation of 2,3-dihydroxy-2-methylbutane. A saturation in the uptake and metabolism of TAME with increased exposure concentration was indicated by a decreased relative uptake of total [14C]TAME equivalents and an increase in the percentage expired as volatiles. A saturation of P-450 oxidation of TAA was indicated by a disproportional decrease of 2,3-dihydroxy-2-methylbutane and its glucuronide conjugate with increased exposure concentration.
1. The pharmacokinetics and disposition of picumeterol, a novel beta 2 receptor agonist agent, have been studied in the rat and dog following administration by inhalation, intravenous and oral routes at various dose levels. 2. Picumeterol was found to be transferred across the lung of the rat and dog following inhalation dosage. After i.v. dosage picumeterol was eliminated from plasma with a half-life of about 1 h in the rat and about 2 h in the dog. Plasma clearance in the rat was about twice liver blood flow and the plasma levels of picumeterol were low after oral administration. 3. Following instillation of 14C-picumeterol to the trachea of isolated respiring rat lung preparations radioactivity was transferred from the airways to perfusion media as unchanged drug within 2 min. After 2 h perfusion, no metabolites were detected in the recirculation perfusate or lung. 4. Picumeterol was extensively metabolized in vivo in the rat (about 95%) and dog (about 90%) and in vitro in microsomal preparations of rat, dog and human liver. O-dealkylation and beta-oxidation are important as routes of metabolism. 5. Radioactivity was largely excreted in the urine of the rat and dog (> 50% of dose), as metabolites, following i.v. administration. There was some excretion of radioactivity in dog bile. Extensive first-pass metabolism was found after oral administration in the rat.
BACKGROUND: A series of isolated studies has focused on the influence of smoking on bone around titanium implants. This study proposes to investigate the impact of two conditions, i.e., nicotine administration and cigarette smoke inhalation, on the healing around implants. METHODS: Forty-five Wistar rats were used. After anesthesia, the tibiae surface was exposed and a screw-shaped titanium implant was placed bilaterally. The animals were randomly assigned to one of the following groups: Group 1: control, n = 19; Group 2: intermittent cigarette smoke inhalation, n = 15; and Group 3: subcutaneous administration of nicotine (3 mg/kg) twice daily, n = 11. After 60 days, the animals were sacrificed. The degree of bone-to-implant contact (BIC) and the bone area (BA) within the limits of the threads of the implant were measured in the cortical (zone A) and cancellous bone (zone B) areas. RESULTS: In zone A, cigarette smoke presented a significant negative influence on BIC and BA (Kruskal-Wallis test, P < 0.05). In contrast, the administration of nicotine did not influence either parameter (P > 0.05). In zone B, cigarette smoke inhalation also resulted in a decreased percentage of BIC compared to the control group (P < 0.05). In addition, the BA was significantly decreased in groups 2 and 3 when compared to controls (P > 0.05). CONCLUSION: The negative impact of smoking on implant outcomes may be related to more than one molecule present in the cigarette smoke and nicotine seems to partially contribute, especially in the cancellous bone.
The paper summarizes the results of clinical studies of 98 children with mucoviscidosis whose age was 7 to 18 years. There is research evidence for possibility and expediency of using new classes of mucolytic agents in the therapy of mucoviscidosis in children. Analysis of the rheological properties of sputum showed the advantage of inhalation route of mucolytics over their oral administration. There is evidence for the advantage of mucosolvan over carbocysteine and unithiol via all routes of administration, the optimal methods of administration and differentiated indications have been developed.
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