Traumatic bilateral anterior dislocation of the shoulders. A case report in a geriatric patient.
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Biomedical subjects
Publications and source records attributed to F Lokiec.
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907 patients were operated on for fracture of the proximal femur in 1986-1987 and were then followed for an average of 7 months. There was a relatively high rate of complications in those over the age of 71, in whom mortality reached 15.5%, while the overall mortality was 6.8%. There was also a high rate of complications in those operated 3 or more days after the fracture had occurred. In those up to the age of 60, the ratio of males to females was almost 1 to 1, but in those over 80 the ratio was 1 to 4. The mortality of males was higher (9.2%) than that of females (5.5%). In trochanteric fractures treated by various methods of rigid fixation there were no problems of union or delayed union. Early mobilization and early discharge from hospital reduced mortality and complications.
We report a case of reversible myoclonic encephalopathy which appeared after intravenous acyclovir treatment in a patient in CAPD for which pharmacological dosages have been made in serum, peritoneal dialysate and cerebrospinal fluid (CSF). Encephalopathy appeared after two intravenous doses of 7.33 mg/kg (doses higher than recommended), administered on admission and 16 hours later. Pharmacological dosages indicated that acyclovir peritoneal clearance was negligible, and that acyclovir persisted a long time in plasma and CSF. Neurological symptoms persisted although serum concentrations returned to normal value. The diagnostic value of pharmacological dosages in serum and CSF is discussed. In addition, neurological symptoms disappeared following two consecutive hemodialysis procedures. Hence we suggest that hemodialysis could be used for drug removal in case of acyclovir overdose in CAPD patients.
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During experimental treatment of human immunodeficiency virus (HIV-1) infection using high doses of acyclovir (ACV) (600 mg IV every 8 h), cyclosporin, and several courses of plasmapheresis (PE) (60 ml/kg), ACV pharmacokinetics in three patients have been measured. The results with or without PE were not significantly different: half-time of elimination 3 vs. 2.3 h, volume of distribution 1.8 vs. 1.14 liter/kg, and total clearance 404 vs. 314 ml/min. The clearance and the fraction of elimination due to PE were 5.27 ml/min and 2.5%, respectively. These findings suggest that supplemental doses of ACV are not needed when plasmapheresis is performed.
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Ceftriaxone penetrates into the aqueous humour in man. The interaction of indomethacin on the disposition of ceftriaxone appeared to be time-dependent. Indomethacin delayed ceftriaxone penetration into, but enhanced its persistence in, the aqueous humour, permitting a period of antibioprophylaxis covering the required time for surgical treatment.
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Fotemustine (S 10036) is a new nitrosourea compound whose antitumoral activity has been demonstrated, particularly in disseminated malignant melanoma. Pharmacokinetic parameters of this drug were investigated during phase II clinical trials and compared according to tumor type. Twenty-six patients entered the study and received an induction treatment (weekly 100 mg/sq.m of fotemustine in 250 ml of 5% glucose in water over a one-hour IV infusion for 3 consecutive weeks) followed by a 4-week rest period. A maintenance therapy (100 mg/sq.m every three weeks) was proposed in stabilized or responsive patients. Plasmatic assay of fotemustine was carried out by HPLC. Seventy-one cycles were analyzed. A short half-life and a large intra and inter-individual variability of all kinetic parameters (especially plasmatic clearance) was found independent of tumour type. The study of patient's clinical behaviour was shown to be related to the clearance value obtained during the first treatment cycle which seems to predict the clinical response in the case of malignant melanoma. This finding needs to be confirmed in a larger number of patients and in other tumor localizations.
A new method, nonparametric maximum likelihood (NPML), for statistical analysis of population kinetic data is proposed. NPML provides a discrete estimate of the whole probability density function of the pharmacokinetic parameters. This permits a straightforward derivation of usual population characteristics. To illustrate the application of the NPML method, a population analysis of cyclosporine RIA measured plasma levels in 188 bone marrow transplant patients after intravenous infusion, is presented. The capability of NPML to extract population information from sparse individual data is also outlined.
On the 4th day of acyclovir treatment for Herpes simplex pneumonia, a 28 month-old girl who had received allogenic marrow transplant for stage IV neuroblastoma presented with severe neurologic disorders including coma and choreic movements. These symptoms disappeared 9 days after acyclovir was stopped. The disturbance in acyclovir kinetics because of acute renal failure and/or a cerebral cortex atrophy might explain the poor neurologic tolerance of acyclovir. This reversible neurologic involvement on a prone patient should be known as a differential diagnosis of Herpes simplex encephalitis.
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