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[Effect of obzidan on coronary blood flow in patients with the hyperkinetic type of hemodynamics in the acute period of myocardial infarct].

Changes in the rate of coronary venous flow through the affected area under the effect of intravenous jet injections of propranolol, 0.1 mg per 1 kg body weight, were assessed in 18 patients of the hyperkinetic central hemodynamic type during acute myocardial infarction. In the first group of patients, whose mean flow rate through the affected wall was 106.2 +/- 5.7 ml/min, the latter parameter decreased in proportion to the drop in double product. In the second group of patients, whose coronary venous flow rate was reduced (51.4 +/- 6.9 ml/min), propranolol-induced drop in the flow rate was less marked, as compared to the drop in double product. It was correlated with dramatically depressed pumping function of the heart.

Adult↗

[Clinical effectiveness of ethacizine in various methods of intravenous administration].

Intravenous jet injections of 50 mg ethacizine (10 mg/min) are effective in 100% of cases of ventricular extrasystoles, and paroxysms of supraventricular and ventricular tachycardia, and in 59.5% of cases of atrial fibrillation paroxysms. A relationship has been demonstrated between the magnitude of therapeutic effect and the duration of atrial fibrillation as well as the type of underlying disease. The use of the drug is not justified in paroxysmal auricular flutter. Ethacizine is effective in 82.4% of patients with acute myocardial infarction, and in 65% of patients with other diseases. A similar effect was obtained with intravenous drip injections at the rate of 1.7 mg/min, while the incidence of side effects was reduced essentially. Therefore, drip injections of ethacizine are preferable for the treatment of heart rhythm disorders, such as extrasystoles, particularly in patients with acute myocardial infarction.

Adult↗

[4-component chemotherapy and radiation therapy of breast cancer].

The treatment schedule for disseminated breast carcinoma has been developed. It includes the use of adriamycin (30 mg/m2, days 1, 8, 15), methotrexate (30 mg/m2, day 1), 5-FU (600 mg/m2, day 8), and cyclophosphamide (400 mg/m2, day 15 i. v. by jet injection). A complete response was obtained in 50 to 56% of the patients, with remissions lasting for an appreciable period of time. The use of chemotherapy according to the described schedule combined with radiation of the bones of the pelvis and lumbar part of the spine brought about complete or partial reparation of the osteolytic, osteoblastic and mixed metastatic foci in 76.2% of the patients.

Antineoplastic Combined Chemotherapy Protocols↗

Anesthesia for foreign bodies in the tracheo-bronchial tree in children.

The authors present the anesthetic and ventilation techniques, used in 106 children, who were suspected of foreign body aspiration in the respiratory tract. In 62 children a foreign body was found. The youngest child was 8 months old and the oldest 13 years, with an age distribution peak in the 1 to 2 years age group. A predominance for the male sex (60%) was present. Foreign bodies of organic nature were found most frequently (80%), 39 of them consisting of peanuts. The bronchi were involved more often than the trachea and the foreign body was located more frequently at the right bronchus (38 pt). The children were ventilated initially with an intermittent oxygen jet injection technique, using a home made apparatus, but since 1978 with HFPPV, using the AGA Bronchovent. Induction of anesthesia was done with halothane and maintenance with etomidate infusion (10-20 micrograms/kg/min.) or thiopental increments (2 to 3 mg/kg). The technique so far used, proved to be satisfactory, specially since HFPPV is used. Few complications occurred. One child died during the bronchoscopic procedure and in an other child a tracheostomy had to be performed for extraction of the foreign body.

Adolescent↗

Delivery of anesthesia services throughout the world.

The application of the principles of basic sciences in anesthesiology not only has succeeded in allaying man's pain on Earth, but also within this decade has provided him with a controlled safe environment for successive journeys into outer space and to the moon and soon to planets beyond. These same principles have made possible his exploration of the ocean floors in artifical atmospheres and pressures and his escape, without breathing devices, from depths of 300 feet. The science of anesthesia has contributed immeasurably to the active treatment of paralytic poliomyelitis and to resuscitation. Furthermore, it has introduced needless jet injection for drug and vaccine therapy in epidemics and with increasing rapidity to diabetcs. This accumulating body of knowledge within the past 13 decades has contributed to the development of modern surgery, obstetrics, and dentistry, and provided techniques for the control of pain from metastatic cancer, from trauma, from arthritis, and during postoperative convalescence. The anesthesiologist shares with the surgeon and clinical pathologist the responsibility for the safe use of fluid and blood replacement therapy; and with the internist, psychiatrist, and general practitioner the proper sequential medication of analgesics, anesthetics, ataractics, cortisone, antihypertensive and antihistaminic agents, and prompt reversal of many undesirable depressions during emergence. A new concept is the reversal of many narcotic states with cyclic AMP. Major advances in anesthesia have been developed on every continent. The fact that there are at least 30 anesthetic techniques and 62 agents in worldwide use reemphasizes our present lack of an ideal single anesthetic agent and technique. Iti is encouraging to note that the science of anesthesiology has made more progress during the past three decades than in all of the previous century. The great preponderance of that progress has been largely confined to Canada, the United States, the British Commonwealth, Western Europe, and a few of the metropolitan areas in South America. Happily, the significant progress in the last decade has added monitors and other safeguards, understanding, tecyniques, agents, and pioneer investigators, in increasing proportions for a world that will double its population in the present half-century. Surely, there is no more important field toward the direction of world scientific effort for human betterment than in this broad area of universal agreement.

Altitude↗

[Comparative clinical study of trimecaine and lidocaine as anti-arrhythmia agents in myocardial infarct].

The article discusses the comparative antiarrhythmic effectiveness of trimecaine and lidocaine in patients with acute myocardial infarction in the first 24 hours of the disease. The 45 patients included in the study were separated into 3 groups: the 1st (control) group consisted of 15 patients with acute myocardial infarction who were not given antiarrhythmic or arrhythmogenic agents; the 2nd group was formed of 15 patients who from the time of admission were given trimecaine by intravenous drip at a rate of 2 mg/min for purposes of prevention after preliminary jet-injection of 80 mg of the drug; the 3rd group consisted of 15 patients given lidocaine by the same schedule. An antiarrhythmic effect was noted in 60% of group 2 patients and in 87% of group 3 patients. No antiarrhythmic effect was produced in 40% of patients treated with trimecaine and in 13% of those given lidocaine.

Acetanilides↗

[Build up of a given concentration of tobramycin and sisomycin in the blood of young children by the intravenous infusion of the antibiotics according to a calculated regimen].

Three regimens for intravenous infusion of tobramycin and sisomicin in doses of 1.33 and 1 mg/kg, respectively were analysed theoretically with the use of the constants of a two-compartmental model characterizing the tobramycin pharmacokinetics in adults. The regimen implied administration of the antibiotics by means of a 12-hour infusion. The second regimen consisted of a jet injection of the initial dose simultaneously with the beginning of the maintenance infusion. The third regimen consisted of a rapid initial infusion followed by a slow maintenance infusion. It was shown that maintenance of the drug concentration at the required levels, i.e. 2-8 microgram/ml for tobramycin and 2-61 microgram/ml for sisomicin was most safely provided by the regimen of the subsequent infusions. This regimen was tried clinically in the treatment of 17 children aged 2 months to 2.5 years with severe forms of acute pneumonia. The rate of the 25-minute initial infusion of tobramycin was 22.2 microgram/kg . min and that of the subsequent 2.7-hour maintenance infusion was 4.85 microgram/kg . min, the total dose being 1.33 mg/kg. The rate of the 20-minute initial infusion of sisomicin was 21.7 microgram/kg . min and that of the subsequent 2.4-hour maintenance infusion was 3.88 microgram/kg . min, the total dose being 1 mg/kg. It was shown that the levels of both the antibiotics in the blood serum of the patients were within the required ranges.

Anti-Bacterial Agents↗

[Pharmacokinetic characteristics of trimecaine compared to lidocaine in myocardial infarct patients].

The authors studied pharmacokinetics of trimecain and lidocain in 10 and 15 patients with myocardial infarction, respectively, after a single intravenous jet injection in the dose of 80 mg. The groups were comparable as to age, mass and surface of the body. In all patients the dependence of trimecain and lidocain concentrations on time was biexponential. Average individual values of distribution volumes in stationary condition and in the stage of elimination, clearance and half-life differed but insignificantly for trimecain and lidocain. The results obtained justify the conclusion that trimecain and lidocain are identical from the pharmacokinetic point of view.

Acetanilides↗

[Combined (associated) immunization against typhoid, typhus and plague].

The article substantiates epidemiological expediency of complex (associated) immunization of servicemen and population against typhoid, typhus and plague in polyetiological zones of these infections, and also in cases of simultaneous proliferation of these diseases. For simultaneous preventive vaccination against these infections a complex immunization scheme was experimentally substantiated and clinically approved. It is based on national commercial vaccines and ensures a simultaneous administration of 2-3 vaccine preparations by hypodermic syringe or jet injection. Typhoid and typhus vaccines are injected under one shoulder-blade, and plague vaccine is injected under another shoulder-blade. This complex vaccine is harmless, moderately reactogenic, develops expressing immunity which have the same protective features as monovaccines alone. This scheme is recommended for use in anti-epidemic practice.

Adolescent↗

Intravenous cannulation: a different approach.

This article presents a different method of venous cannulation. It has been used successfully to teach dental residents working on pediatric and developmentally disabled patients. The technique includes using a syringe of 1% lidocaine hydrochloride attached to a 25-ga needle to produce a skin wheal by "jet injection." This is accomplished by placing the bevel of the needle downward and forcing the syringe in a downward and backward direction, with pressure being continuously exerted on the plunger. A 20-ga, 1 1/4-inch catheter is then attached to the syringe containing the remaining lidocaine hydrochloride. The catheter is bent, with its bevel up, approximately three-fourths of the way from the tip to form a gradually sloping bend of approximately 40 degrees to 45 degrees. The catheter is then inserted into the skin wheal and advanced into the vein. The advantages of this technique are that it (1) can eliminate the pain associated with a subcutaneous infiltration of a local anesthetic solution, (2) provides a method of venous cannulation that is easier to master by the novice, and (3) gives a visual check on successful catheterization of the vein.

Anesthesia, Dental↗

Twice-daily mixed regular and NPH insulin injections with new jet injector versus conventional syringes: pharmacokinetics of insulin absorption.

The purpose of the present study was to evaluate the feasibility of using a jet injector in a split and mixed regular and NPH insulin regimen and to compare serum glucose and free-insulin profiles obtained with the injector and the conventional syringe and needle. Twelve insulin-dependent diabetic patients were hospitalized for 5 days. After a stabilization day, six patients received their insulin injection with the injector for 2 days and with the syringe and needle for the following 2 days; the regimen was reversed for the other six patients. Diet, exercise, and insulin dosage remained constant. The serum glucose levels with the injector were consistently lower than those obtained with the syringe at all times of the day except at 5:00 a.m. and 7:30 a.m., when mean values were similar for both treatments. Free-insulin levels were higher with the injector from 10:30 a.m. to 4:30 p.m. These findings suggest that insulin absorption is faster and possibly greater with the injector than with the syringe. When switching from a syringe to an injector insulin program, insulin dose adjustment may be necessary.

Adult↗

[Cost of tetanus toxoid injection using a jet-injector (Imule) in collective immunization in Senegal: comparison with injection using a syringe and resterilizable needle].

Needle-less jet injectors were developed by the US army after World War II. Their principal use, however, has been in the administration of lyophilized vaccines from multidose vials to at-risk populations in developing countries. In 1983, a hepatitis B epidemic occurred among customers of a beauty clinic in California (USA) following the use of jet-injectors, demonstrating a clear risk of cross-contamination associated with this technique. As a result, the WHO and Unicef stopped recommending jet-injectors for collective immunizations in developing countries. To eliminate the risk of contamination, Pasteur Mérieux Sérums et Vaccins (now Aventis Pasteur) developed, in 1990, jet-injectors for use with single-use vaccine cartridges. These injectors were tested for tetanus toxoid, DTP, influenza, hepatitis A and typhoid Vi vaccination. The immunogenic reaction was as strong and the injection as well tolerated as for injections using a standard needle and syringe. The additional cost of the Imule technique was evaluated in a district-wide (127,000 inhabitants) tetanus toxoid immunization program at Velingara, Senegal in 1993. The total cost was estimated to be 1.51 FF (76 F CSA, 0.32 US dollars) for one dose of tetanus vaccine given by needle and syringe and 2.41 FF (121 F CSA, 0.56 US dollars) for one dose given by Imule. Thus, the additional cost of injection by ImuleTM was 0.90 FF (45 F CSA, 0.21 US dollars). The cost of cross infection in sub-Saharan Africa has been estimated to be 2.37 FF (118 F CSA, 0.55 US dollars) per injection if injection practices are not supervised. Therefore, the Imule technique may be considered to be cost-effective. However, the technique is still not completely reliable, as shown by the total breakdown of four jet injectors during this vaccination session. Lyophilized vaccines have also not been tested in the field. Vaccinators prefer Imule, training is easy and immunization can be carried out on a day-to-day basis with no vaccine wastage. Imule is not yet in mass production, which would reduce costs. In the face of the ever-increasing risk of cross-contamination during vaccination sessions in sub-Saharan Africa, the Imule technique deserves considerable attention.

Cost-Benefit Analysis↗

Comparison of plasma insulin profiles after subcutaneous administration of insulin by jet spray and conventional needle injection in patients with insulin-dependent diabetes mellitus.

The characteristics of plasma free insulin profiles after conventional subcutaneous injection of regular insulin (10 units) and after jet injection of this amount of insulin were compared in eight subjects with insulin-dependent diabetes mellitus. Although administration of insulin with the jet injector resulted in peak plasma free insulin concentrations (45 +/- 4 microU/ml) similar to those achieved after conventional injection (47 +/- 5 microU/ml), it produced more rapid increases in plasma free insulin concentrations (time to peak concentration, 76 +/- 11 minutes versus 152 +/- 16 minutes; P less than 0.01) and less prolonged hyperinsulinemia. Variability in the peak insulin concentrations and the time to peak concentration was comparable for both methods of administration of insulin. Thus, insulin administered by jet injector may improve control of postprandial hyperglycemia and diminish the risk for late hypoglycemia in some patients with insulin-requiring diabetes mellitus treated with conventional injections of insulin.

Diabetes Mellitus, Type 1↗