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Twenty-six-week oral toxicity of the new quinolone antibacterial agent levofloxacin in rats and cynomolgus monkeys.

The oral 26-week toxicity of (-)-(S)-9-fluoro-2,3-dihydro-3-methyl-10-(4- methyl-1-piperazinyl)-7-oxo-7H-pyrido [1,2,3-de][1,4]benzoxazine-6-carboxylic acid hemihydrate (levofloxacin, DR-3355, CAS 100986-85-4) was investigated in rats and monkeys. Rats receiving higher doses of DR-3355 exhibited an increased number of larger fecal pellets, salivation, lower neutrophil counts, enlargement of the cecum and prominent goblet cells in the cecal mucosa. Monkeys did not show any changes due to DR-3355 treatment. Therefore, a no-effect dose of DR-3355 under these conditions was determined as 20 mg/kg in the rat and 62.5 mg/kg in the cynomolgus monkey.

Animals↗

Reproductive toxicity of the new quinolone antibacterial agent levofloxacin in rats and rabbits.

The reproductive toxicity of (-)-(S)-9-fluoro-2,3-dihydro-3-methyl-10-(4- methyl-1-piperazinyl)-7-oxo-7H-pyrido [1,2,3-de][1,4]benzoxazine-6-carboxylic acid hemihydrate (levofloxacin, DR-3355, CAS 100986-85-4) was investigated in rats and rabbits. DR-3355 was administered orally prior to and in the early stage of pregnancy to male and female rats at doses of up to 360 mg/kg. No adverse effects on fertility or teratogenicity were noted at any dose. DR-3355 elicited no evidence of teratogenicity when administered during the fetal organogenesis period to pregnant rats at doses of up to 810 mg/kg, or to pregnant rabbits at doses of up to 50 mg/kg. However, female rats receiving 810 mg/kg showed salivation, soiled coats, soft stools and decreases in body weight and food intake. Rat fetuses in the 810 mg/kg group exhibited decreased body weight and retardation of ossification, and showed increases in mortality and skeletal variations. Decreases in maternal body weight and food intake were observed in rabbits in the 50 mg/kg group. No adverse effects were observed in perinatal and postnatal toxicity studies in rats using doses of up to 360 mg/kg.

Animals↗

[Case of primary Sjögren's syndrome with hypereosinophilia and elevation of serum IgE: measurements of serum IL-4, IL-5 and the IgG subclass].

A 62-year-old man admitted to our hospital because of dry eyes and thirst. On admission, his bilateral parotid and submandibular glands were swelling. Laboratory data revealed severe eosinophilia (3309/microl), elevated serum IgE (1821IU/dl) and hypergammaglobulinemia (IgG 6049 mg/dl). Interstitial pneumonia and renal dysfunction were present. He was diagnosed with Sjögren's syndrome (SjS) according to the European criteria. After the initiation of the therapy with 30 mg of prednisolone, all abnormal findings including salivation ameliorated promptly. In the absence of any other obvious causes of eosinophilia and elevation of serum IgE, these findings might be associated with SjS itself. Moreover, both serum IL-5 and IgG4 levels were elevated in this patient, suggesting that Th2 type cytokines were dominant. Elevation of serum IgE and IgG4, and hypereosinophilia were likely to be reactive. To our knowledge, there have been no reports of these cytokines and of IgG subclass in such patients. We propose the existence of Th2-type-cytokine-dominant subtype of SjS.

Eosinophilia↗

[Clinical feature of organophosphate poisoning patients requiring prolonged mechanical ventilation].

OBJECTIVE: To clarify the clinical characteristics in organophosphate poisoning patients who require prolonged mechanical ventilation (PMV). MATERIAL AND METHODS: We reviewed the medical records of 15 adults organophsophate poisoning patients who admitted to our intensive care unit between Junuary, 1995, and December, 2004. The patients were divided into two groups: a PMV group requiring mechanical ventilation for more than 1 week (n=7) and a non PMV group (n=8), and various factors relating to PMV were compared between the two groups. RESULTS: The mean value of mechanical ventilation days was 16 +/- 6 days for the PMV group, which was significantly greater than 1 +/- 1 days for the non PMV group (p < 0.01). There were no statistical differences in the physical findings such as Japan Coma Scale, vital signs, and salivation and/or diarrhea, and in the treatments such as gastric lavage, administration of activated charcoal, and intravenous administration of pralidoxim and/or atropine on admission between the groups. The intermediate syndrome developed in 5 patients of the PMV group during their hospital course, whereas in no patient of the non-PMV group (p < 0.05). Hospital length of stay was 35 +/- 7 days in the PMV group, comparing with 11 +/- 11 days in the non-PMV group (p < 0.01). All patients of both groups survived and all but one patient returned to pre-hospital activities of daily living. CONCLUSIONS: Organophosphate poisoning patients requiring PMV had a higher incidence of the intermediate syndrome, but had similar mortality and morbidity compared with patients without PMV.

Adult↗

Carbofuran poisoning among farm workers.

Accidental or intentional ingestion of carbofuran can produce a life-threatening syndrome that requires prompt diagnosis and treatment. This paper investigates unintentional carbofuran poisoning in farm workers. Thirteen patients were admitted to the emergency department with carbofuran poisoning between January 2002 and August 2004 (2 female, 11 male). The patients had been poisoned while mixing the liquid form of carbofuran with seeds. Their hands were red on admission. Complaints most commonly reported by the patients on admission were nausea, vomiting, headache, weakness, dizziness and blurred vision. The most commonly observed signs were tachycardia, tachypnea, salivation, miosis, elevated blood pressure, and fasciculation. Three patients were agitated and one was lethargic on admission. We reviewed the patients' medical charts retrospectively, as well as the demographic data, intoxication route, clinical and laboratory presentations, and outcomes. We made the diagnosis according to a compatible exposure history and clinical findings. The most commonly observed laboratory finding was hyperglycemia, which was found in 6 patients. Serum pseudocholinesterase level was low in only one patient. All the patients were cured and discharged from the hospital in good physical condition. Rapid onset, mild illness and quick recovery are typical characteristics of acute occupational carbofuran poisoning. We conclude that public health efforts should educate farm workers about the dangers of pesticide application so that its threat can be diminished.

Adult↗

[Therapeutic possibilities of sympathoadrenergic reactions during general anesthesia using sublingual application of glycerol trinitrate].

Strong surgical stimulation (for e. g. sternotomy, mediastinal preparation and aortic dissection in heart surgery) leads to an adrenergic reaction with the so-called haemodynamic break-through phenomenon. The inhibition of this reaction by means of narcotics is always connected with a dangerous decrease of cardiac index. Therefore, the sublingual application of nitroglycerin (GTN: 7 micrograms/kg), well established in the therapy of angina pectoris, was used as a rapidly applicable alternative. Patients with coronary heart disease under neuroleptanaesthesia (n = 10) were investigated in comparison to volunteers (n = 5). Beside the registration of haemodynamic parameters by invasive monitoring, the determination of arterial plasma concentrations of GTN and its metabolites 1.2- and 1.3-glyceryl dinitrate (GDN) were performed using gas-chromatographic technique. Using the same doses the haemodynamic changes are more marked and of longer duration in the anaesthetised patients than in the awake volunteers. The cause seems to be the higher and longer detectable active concentrations of GTN and GDN (the average maximum GTN concentrations greater than 0.5 ng/ml still after 12 minutes in contrast to 7 minutes). After discussing various different pharmacokinetic possibilities this effect is probably related to the simple fact of an improved resorption of the drug in the anaesthetised patient (no salivation, no swallow movements). On the basis of this investigation the sublingual application of GTN is a very useful therapy for the blockade of sympathoadrenergic reactions under anaesthesia, but the commonly used doses of GTN has to be reduced by half (3-4 micrograms/kg).

Administration, Sublingual↗

Evaluation on the therapeutic effects of digital acupoint pressure for obstetric spastic cerebral palsy.

To probe the evaluation methods for effects of TCM treatment of cerebral palsy through clinical observation on the digital acupoint pressure in treating obstetric spastic cerebral palsy. From 1998-2003, 40 cases of spastic cerebral palsy were treated with digital acupoint pressure therapy. Ten indexes including intelligence, language, salivation, hand-grasping, thumb-adduction, turnover, sitting, standing, walking, and scissors-gait were divided into the 4 grades of normal, mild abnormal, moderate abnormal, and severe abnormal (dysfunction), respectively marked as 6, 4, 2, and 0 point, with 2 points increased for improving each grade of each item after the treatment. Meanwhile, the ranges were recorded and evaluated before and after the treatment on shoulder-abduction, elbow-extension, wrist-extension, forearm-backward-rotation, hip-abduction, straight-leg-lifting, knee-extension, and ankle-dorsiflexion. Those with the improvement of 10 degrees, 15 degrees, 20 degrees, 25 degrees, and 30 degrees in the range of movement of their contractured joints would obtain respectively 1, 2, 3, 4, and 5 points. There were significant differences before and after the treatment in the 18 items under observation except for intelligence, with obvious improvement shown after the treatment (P<0.01), the effective rate being 92.5%. The therapeutic criteria set in this research are well established in reflecting the functional improvements of the patient.

Acupressure↗

Impact of gutkha chewing & smoking on microbial environment of oral cavity: a case study on slum dwellers of selected areas in Visakhapatnam.

Oral diseases are still a neglected epidemic. During the recent years, in India, both in urban and rual, consumption of tobacco in the form of direct chewing of gutkha is alarmingly increasing especially in the young adults as which is major reason for subsistence of oral cancer. In the present investigation an attempt was made to find out the relationship between gutkha chewing including smoking and oral micro flora in some slum dwellers of Visakhapatnam. The subjects were randomly selected and their health data was collected by distributing questionnaire to control and effected subjects. The oral saliva samples were collected from both gutkha chewers, smokers and from control groups by using saline swabs and inoculated on suitable nutrient media. The results revealed that decrease in salivation and mucous formation in gutkha chewers, which further resulted in reduction in number of oral micro flora. Aspergillus species appeared only in gutkha chewers and smokers. Gutkha chewing and smoking thus, may lead to an increase in the oral pathogens by reducing the normal symbiotic microbial flora.

Adolescent↗

[Xerostomia in palliative care].

Xerostomia is the subjective feeling of mouth dryness, caused or not by function lowering of salivary glands, with decrease of saliva quality or quantity. It's a frequent symptom in palliative care patients and its prevalence is referred to be 60% to 88% in advanced and progressive oncological disease patients. Xerostomia has physical, social and psychological consequences. Saliva plays an important role in maintaining the best physiological conditions of mouth. Besides humidifying the oral cavity tissues, its lubricating properties help swallowing, talking and prevents other damages caused by mechanical and noxious microbiological agents. Xerostomia is caused by three basic mechanisms: factors that compromise the salivary centre, factors related to the autonomic stimulation or factors related to salivary glands themselves. The diagnosis is mainly clinical. Mouth condition must be thoroughly evaluated. If justified, a quantitative evaluation of saliva secretion, in rest and under stimulation, might be done. The treatment must be oriented by aetiology and directed towards the disease effects in patient comfort and quality of life. During treatment, the use of xerogenic drugs should be controlled, hydration should be promoted and other symptom control measures improved. The symptomatic treatment has three pathways: the increasing of saliva production by mechanical, gustatory or pharmacological stimulation; the using of saliva substitutes and the improving of active mouth care. Mechanical stimulation is obtained by chewing gum and gustatory stimulation may be reached by sucking Vitamin C tablets. Pilocarpine is the available drug to improve salivation. A soft diet must be advised, hard and dry food, tobacco and alcoholic beverages should be avoided. It's important that health workers teach patients with xerostomia the best way to get relief and the measures to prevent its complications that could, even more, compromise their quality of life.

Humans↗

Influence of erythrocyte function-enhancing drugs on the bronchoprotective actions of chemokine receptor blockers in mice.

BACKGROUND: CC chemokine receptors are likely to have important roles in the regulation of leukocytes and mast cells. Chemokine receptors are crucial in orchestrating innate and acquired immune responses as well as in allergic inflammation. A disturbance in erythrocyte function can lead to bronchial hyperreactivity and asthma. MATERIAL/METHODS: This study was conducted on Swiss albino mice weighing between 25 to 35 g. The animals were divided into eight groups (n=8). Groups of mice (n=8) were pretreated with the chemokine receptor blockers A122058 (600 microg/kg i.p.) or cyclophosphamide (20 mg/kg i.p.). Other groups received A122058 or cyclophosphamide in combination with either erythropoietin and quercetin. The effects of these drugs on bronchoconstriction and salivation induced by carbachol were evaluated. RESULTS: The results of this study suggest that blockade of chemokine receptors significantly potentiated erythropoietin- and quercetin-induced inhibition of carbachol-induced bronchoconstriction (P<0.05) compared with the control group. However, pentoxifylline did not produce significant bronchoprotection against carbachol-induced bronchoconstriction (P>0.05). CONCLUSIONS: The results of this study suggest that blockade of chemokine receptors and enhancement of the erythrocyte function together potentiate the bronchoprotective effects of these drugs. This combination could be a novel strategy in combating bronchial hyper-responsiveness.

Animals↗

Botulinum toxin type-A (Botox-A) injections for treatment of sialorrhoea in adults: a New Zealand study.

AIM: We report our initial experience using Botox-A injection to the salivary glands to control sialorrhoea. METHODS: Eight adult patients with significant sialorrhoea were referred from an inpatient rehabilitation unit, GP referral, and internal medicine department. All subjects underwent bilateral submandibular gland injections and, in addition, one patient (the first) also had intraparotid injections. Injections were performed with ultrasound guidance at Dunedin Hospital, New Zealand. Six patients received a total of 30 Units and two patients received 60 Units in the submandibular glands without any complications. Outcome was assessed using a drooling scale and VAS self report of sialorrhoea. RESULTS: Of the eight patients treated, six reported a marked reduction in salivation following treatment, and one patient improved partially. One patient did not find the Botox injection helpful in controlling sialorrhoea and was offered escalation of the Botox dose with a subsequent partial response. No serious adverse events occurred, and no procedure-related complications were noted. CONCLUSIONS: Our initial experience suggests that injection of Botox-A injected at a relatively low dose to the submandibular glands can be used to achieve desired results for the treatment of sialorrhoea. This is an easily performed procedure with low morbidity and can be recommended as a first-line intervention in the treatment of adult sialorrhoea.

Adult↗

Free jejunal autograft reconstruction after total pharyngolaryngeal resection.

A free jejunal autograft reconstruction after debulking high stage larynx and hypopharynx tumors has become a popular method in our 10-year experience. We retrospectively studied the efficacy and outcome. Nine patients (M/F, 8/1) underwent a total of 10 free jejunal autograft reconstructions. The median age was 58.6 years (range, 48-78 years). The median hospital stay was 32 days (range, 13-67 days) and the graft failure rate was 10% (1/10), 9/10 successfully retransplanted. Postoperative mortality rate was 0%; one patient was lost during follow-up, one patient died of lung cancer, three died of local recurrence, and four patients have no evidence of disease at this moment (mean follow-up of 16.5 months; range, 9-41 months). Salivation fistulas were present postoperatively in four patients: one closed spontaneously and three closed after surgery. In our hands, the free jejunal graft is the preferred method for single-stage reconstruction of circumferential defects of the gullet.

Aged↗

[Reversion of atracurium and vecuronium residual nondepolarising neuromuscular blockade with low doses of neostigmine].

OBJECTIVES: To assess the effectiveness of low doses of neostigmine in the reversion of residual non-polarising neuromuscular blockade (RNMB). MATERIAL AND METHODS: The work involved one hundred and nineteen adult patients, ASA I-III, anaesthetised with fentanyl, thiopental, O2-N2O-isoflurane and atracurium (n=62) or vecuronium (n=57). RNMB was monitored with continuous electromyography of adductor pollicis with TOF stimulation. When TOF-Ratio (TR) < 75%, neostigmine 0.035, 0.03, 0.025 or 0.02 mg/kg (and atropine 0.0175, 0.015, 0.0125 or 0.01 mg/kg) were administrated based on the degree of NMB (0-1, 2, 3 or 4) to TOF stimulation respectively, registering the time to achieve TR > 75% and secondary effects. RESULTS: Both groups were homogeneous. Twenty-five point eight percent (25.8%) (group A) and 21.1% (group V) presented TR>75% at the end of surgery, while 11.3% and 19.2% showed TR < 75% with 0-1 responses, 6.5% and 11.5% 2 responses, 4.8% and 7.6% 3 responses, and 51.6% and 50% 4 responses to TOF stimulation in groups A or V respectively. All patients who received neostigmine presented TR > 75% in 10.5+/-7 (group A) and 10.3+/-6.4 min. (group V). A predominance of secondary effects in the atracurium group was observed (p=0.027), basically due to excessive salivation, nausea and vomiting. There were no cases of RNMB. CONCLUSIONS: The reversion of the residual neuromuscular blockade of atracurium or vecuronium with low doses of neostigmine and atropine adjusted to the degree of RNMB is effective even in deep blockades, reducing the risk of secondary effects.

Adult↗

In vivo evidence for tachykininergic transmission using a new NK-2 receptor-selective antagonist, MEN 10,376.

We have studied the effects of two newly developed tachykinin antagonists, MEN 10,207 and MEN 10,376, which are highly selective for NK-2 tachykinin receptors on tachykinin-induced contraction in the rat urinary bladder and guinea pig airways in vivo. MEN 10,207 exhibited antagonism only at doses which produced agonist effects. By contrast, MEN 10,376 was devoid of significant agonist activity at i.v. doses (1-3 mumol/kg) which selectively antagonized the effects of an NK-2 agonist [beta-Ala8]-neurokinin A(4-10) (bladder contraction in rats, bronchoconstriction in guinea pigs) without affecting the response to an NK-1 agonist [Sar9]-substance P sulfone (hypotension, salivation and bladder contraction in rats, bronchoconstriction in guinea pigs). At these NK-2-selective blocking doses, MEN 10,376: 1) did not affect urodynamic parameters at cystometry in normal rats but reduced amplitude of micturition contractions following induction of chemical (intravesical xylene) cystitis and 2) reduced by a maximum of 50% the noncholinergic bronchoconstrictor response to vagal nerve stimulation. These findings provide the first evidence for involvement of NK-2 receptors in physiological responses in the urinary and respiratory tracts.

Animals↗

[Symptomatic treatments in amyotrophic lateral sclerosis].

ALS is a progressive, fatal, degenerative motor neuron disease of unknown cause. Although advances in understanding pathophysiology of ALS have stimulated the development of new therapies, most of them remain few efficient or ineffective and the main management of ALS patient, to improve quality of life by alleviating symptoms, is symptomatic treatment. This article discusses the approaches now in use to manage some of the most common symptoms of ALS including the following: spasticity, cramps, pain, laryngospasm, pseudobulbar syndrome, salivation and drooling, sleep disorders and fatigue, constipation and trophic troubles.

Amyotrophic Lateral Sclerosis↗

Neurotoxicology of pyrethrin and the pyrethroid insecticides.

Natural pyrethrin and synthetic pyrethroid insecticides have been considered among the safest classes of insecticides available. Pyrethrins and pyrethroids are classified on the basis of their chemical structures and their toxicologic, neurophysiologic and pharmacologic effects. Cellular effects of pyrethrin and pyrethroid insecticides have been postulated to involve interactions with sodium channels, receptor-ionophore complexes, neurotransmitters, and ATPases. Toxicity is a function of chemical structure, metabolism, route of exposure, and the presence or absence of synergists. Pyrethroid insecticides are neurotoxic, and the development and severity of clinical signs is proportional to the nervous tissue pyrethroid concentration. Type I pyrethroid poisoning in mice and rats produces a syndrome characterized by tremors, prostration and altered startle reflexes. Type II pyrethroid poisoning in mice and rats causes ataxia, convulsions, hyperactivity, choreoathetosis and profuse salivation. A presumptive diagnosis of pyrethrin/pyrethroid poisoning is based upon history of exposure, development of appropriate clinical signs, and chemical analysis for insecticide residues. Treatment of pyrethrin and pyrethroid toxicosis involves basic life support, seizure control when needed, and the prevention of further insecticide absorption.

Animals↗

[Paroxysmal sympathetic storm after diffuse axonal head injury].

The term paroxysmal sympathetic storms is used to define episodic alterations in body temperature, blood pressure, heart and respiratory rate, size of pupil, and level of consciousness coinciding with hyperhidrosis, excessive salivation and extensor posturing. All the cases were presented after severe diffuse axonal head injury. We present two young patients with diffuse axonal head injury that develop in their evolution hypertension, tachycardia and fever without evidence during the episodes of epileptiform activity and without any infectious cause with excellent answer to the treatment with beta-blockers and morphine. We consider that the correct diagnosis of this entity minimizes the application of unnecessary studies allowing an appropriate treatment.

Adult↗

Suspected cycad (Cycas revoluta) intoxication in dogs.

Three dogs which ingested part of the stem of a Japanese cycad (Cycas revoluta) vomited repeatedly within hours after ingestion, showed marked depression, severely congested mucous membranes, increased thirst and profuse salivation. Subsequent hematological and blood chemical investigation revealed elevated serum concentrations of alanine transaminase, an initial mild lymphocytopenia, thrombocytopenia and a leucocytosis. The dogs recovered uneventfully.

Animals↗