Annals of clinical research
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Randomized Controlled Trial Comparative Study Clinical Trial
A comparative study of loperamide and diphenoxylate in the treatment of chronic diarrhoea caused by intestinal resection.
A double-blind cross-over study of the antidiarrhoeal effects of loperamide and diphenoxylate in 29 patients with chronic diarrhoea due to intestinal resection is presented. Most of these subjects had had surgery for Crohn's disease which was in a stable and nonactive phase during the study. Loperamide and diphenoxylate were presented as identical capsules. ⋯ The number of capsules required to control diarrhoea was significantly smaller in the loperamide group than in the diphenoxylate group. Loperamide was also statistically superior to diphenoxylate at reducing the number of stools and improving the faecal consistency. Nineteen of the 29 patients considered loperamide to be the most effective antidiarrhoeal drug, five preferred diphenoxylate and five did not notice any difference.
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Comparative Study Clinical Trial Controlled Clinical Trial
The antagonistic effect of pentazocine on fentanyl induced respiratory depression compared with nalorphine and naloxone.
The effect of pentazocine, a strong analgesic with a weak opiate antagonistic activity, on fentanyl-induced respiratory depression was studied after anaesthesia in patients undergoing gynaecological laparotomy. Pentazocine (1 mg/kg) was given intravenously at the end of operation. ⋯ The results show that pentazocine has a clear antagonistic effect on fentanyl-induced respiratory depression but the effect of 1 mg/kg is weaker and shorter than that produced by 5 mg of nalorphine or 0.4 mg of naloxone. Postoperative analgesia in patients who received pentazocine was not longer than that in patients who received no opiate antagonists at the end of the operation.
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This is a review article of the debated massive use of balance electrolyte solutions in the replacement of blood loss. We cannot directly apply the results and conclusions of American reviews on this subject as there are significant differences between USA and Finland in the use and availability of alternative fluids. Electrolyte solutions pass freely across the capillary membrane and are distributed in the extracellular compartment and as such poorly restore and maintain blood volume. ⋯ In blood loss replacement electrolyte solutions without dextrose are preferred. The minimal amounts of potassium in balanced electrolyte solutions is of no practical value. Even though crystalloid solutions can be tolerated in massive amounts, marked blood loss is replaced more physiologically and effectively using natural or artificial colloids in iso-oncotic concentrations together with red cell concentrates and fresh blood.
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Oxygen transport and tissue oxygenation were investigated in twelve patients undergoing coronary bypass surgery under normovolemic moderate and extreme hemodilution. Moderate hemodilution, that was carried out after induction of anesthesia, decreased the mean hematocrit from 0.43 to 0.33. Concurrently, the cardiac index and the left ventricular filling pressure increased slightly whereas the systemic oxygen transport declined by 20%. ⋯ In general, total body oxygen consumption changed parallelly with the tissue oxygen tension. Lactate concentration in the mixed venous blood increased in the beginning of the extracorporeal circulation and remained rather stationary thereafter. All patients recovered normally without any perioperative myocardial infarctions.
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With some amplifications, Starling's concept of the serum colloid osmotic or oncotic pressure as the determinant of fluid partition between the intravascular and the interstitial compartment has been confirmed by modern physiological research. The relationship between serum oncotic pressure and interstitial edema is non-linear, i.e. edema becomes progressively greater per mm decrease of the oncotic pressure. The intravascular volume effect of crystalloids is inseparable from interstitial edema, because it depends on an expansion of the interstitium which increases the hydrostatic pressure in that compartment sufficiently to compensate for a lowered capillary oncotic pressure. ⋯ In the lung, fluid exchange and distribution between the intravascular and the interstitial compartment is influenced by additional factors, and opinions on the use of colloids versus crystalloids continue to differ, particularly with respect to those circumstances where capillary permeability is presumably or demonstrably abnormal. However, the weight of the evidence still favours the concept that in patients with a much greater than respiratory distress syndromes much greater than, the serum oncotic pressure should at any rate not be permitted to drop below a certain critical level. A condensed review of these complex and as yet incompletely clarified problems is presented.