Aim: To investigate the role of IL- 7 in HIV- infected children on highly a ctive antiretroviral therapy (HAART) and its association with laboratory paramet ers related to disease progression. Patients and methods: A ...Aim: To investigate the role of IL- 7 in HIV- infected children on highly a ctive antiretroviral therapy (HAART) and its association with laboratory paramet ers related to disease progression. Patients and methods: A cross- sectional study in 31 vertically HIV- infected children (median age 8.4 y) t reated with HAART, and a longitudinal study in four of those same children was c arried out. In both studies, viral load, CD4+ T- cell counts, thymic producti on of T cells by TCR rearrangement excision circles (TRECs), IL- 7 plasma level s and viral phenotype were determined. Results: IL- 7 levels were higher in HIV - infected children than in age- matched, uninfected controls. In addition, HI V children with CD4+ T cells between 200 and 500 T cells/mm3 had higher IL- 7 levels and lower TREC values than HIV- infected children with CD4+ T cells > 500 T cells/mm3. IL- 7 levels were higher in children with syncytium- inducin g (SI) phenotype than in those with nonsyncytium- inducing (NSI) variants. Duri ng the follow- up of four HIV children, the decrease in viral load after HAART was always associated with a recovery of CD4+ T cells and TRECs, which was fol lowed by a decrease in IL- 7 returning to the levels present prior to the drop in CD4+ Tcells. The four HIV- infected children had SI/X4 isolates in PBMC be fore HAART, and the viral phenotype switched to NSI/R5 after HAART. Conclusion: Our data suggest that IL- 7 plays a key role in the maintenance of T- cell hom eostasis in HIV- infected children on HAART, both through peripheral expansion and through a thymus- dependent mechanism.展开更多
Aims: To evaluate the effect of the implementation of an asthma clinical path way on asthma in children in general practice. Methods: A randomized, controlled trial involving 270 general practitioners. One group of ge...Aims: To evaluate the effect of the implementation of an asthma clinical path way on asthma in children in general practice. Methods: A randomized, controlled trial involving 270 general practitioners. One group of general practitioners i mplemented the asthma clinical pathway for children (intervention group)- and t he control group continued with their usual asthma medical care management. The main outcome measures were admissions to hospital for asthma and attendance at t he Children’s Emergency Department. Compliance with the guidelines was assesse d by examining asthma drug prescriptions. Results: Admissions to hospital for as thma dropped 40% in the intervention group, by 33% in the control group and by 22% in general practitioners not participating in the trial. The difference s between the intervention and control and between the intervention and non- pa rticipating general practitioners were not statistically significant. The decrea se in attendance at the Children’s Emergency Department decreased by 25% , 30 % and 19% , respectively, but this was not statistically signifi- cant. Ther e was a significant decrease in prescriptions for oral relievers, dry powder rel ievers in the under 6s, mast cell stabilizers and methylxanthines in both contro l and intervention groups. However, only for oral relievers was there a signific ant difference between the intervention group and control, with the decrease lar ger in the intervention group (p < 0.001). Conclusions: Admissions to hospital f or asthma decreased, as did attendance at the Children’s Emergency Department. Prescriptions for asthma medication changed in the direction anticipated with c ompliance with the asthma clinical pathway. However, we found no evidence within the study that implementation of the asthma clinical pathway by general practit ioners resulted in lower morbidity than those general practitioners who did not implement the pathway. Possible explanations are that these general practitioner s were already providing care according to the recommendations of the pathway, o r that there was contamination of the control group by the intervention, or that the guidelines, although based on currently accepted recommendations, are ineff ective.展开更多
This study was designed to explore the relationships of early diabetic microangiopathy to alterations of cardiac sympathetic tone and myocardial blood flow(MBF)regulation in subjects with stable type 1 diabetes. In di...This study was designed to explore the relationships of early diabetic microangiopathy to alterations of cardiac sympathetic tone and myocardial blood flow(MBF)regulation in subjects with stable type 1 diabetes. In diabetes, augmented cardiac sympathetic tone and abnormal MBF regulation may predispose to myocardial injury and enhanced cardiac risk. Subject groups comprised healthy controls(C)(n=10), healthy diabetic subjects(DC)(n=12), and diabetic subjects with very early diabetic microangiopathy(DMA+)(n=16). [ 11C]meta-hydroxyephedrine([11C]HED)and positron emission tomography(PET)were used to explore left ventricular(LV)sympathetic integrity and [13N]ammonia-PET to assess MBF regulation in response to cold pressor testing(CPT)and adenosine infusion. Deficits of LV [ 11C]HED retention were extensive and global in the DMA+subjects(36±31%vs. 1±1%in DC subjects; p< 0.01)despite preserved autonomic reflex tests. On CPT, plasma norepinephrine excursions were two-fold greater than in C and DC subjects(p< 0.05), and basal LV blood flow decreased(-12%, p< 0.05)in DMA+but not in C or DC subjects(+45%and +51%, respectively). On adenosine infusion, compared with C subjects, MBF reserve decreased by-45%(p< 0.05)in DMA+subjects. Diastolic dysfunctionwas detected by two-dimensional echocardiography in 5 of 8 and 0 of 8 consecutively tested DMA+and DC subjects, respectively. Augmented cardiac sympathetic tone and responsiveness and impaired myocardial perfusion may contribute to myocardial injury in diabetes.展开更多
An increased lung to heart ratio(LHR) on thallium-201(Tl- 201) stress myocardial perfusion imaging(MPI) is a predictor of adverse cardiac events and identifies people with extensive coronary artery disease(CAD). The i...An increased lung to heart ratio(LHR) on thallium-201(Tl- 201) stress myocardial perfusion imaging(MPI) is a predictor of adverse cardiac events and identifies people with extensive coronary artery disease(CAD). The implications of increased LHR in patients undergoing stress technetium- 99m(tc- 99m) sestamibi are developing. Our aim is to evaluate the relationship between increased LHR and extent of CAD in patients undergoing tc- 99m sestamibi MPI. Methods: We reviewed the records and images of 530 consecutive subjects who underwent exercise or adenosine tc- 99 m sestamibi MPI. One hundred thirty-two had transient or partially reversible myocardial perfusion defects and 79(exercise=34, adenosine=45, male=43, female=36, mean age=61 years) of these underwent coronary angiography(study population). The average LHR of these 79 subjects was compared to 79 patients(control population) with normal scans(exercise=50, adenosine=29, male=34, female=45, mean age=60 years). Results: The mean LHR(± SE) in subjects with normal scans was 0.30± 0.01. The mean LHR for those with abnormal scans and single vessel CAD who underwent exercise was 0.32± 0.01 and pharmacological stress was 0.31± 0.01. There was no statistically significant difference between the LHR of those with a normal scan and those with single vessel disease and an abnormal scan. However, there was a statistically significant association between the elevated LHR and multi-vessel CAD. The mean LHR for subjects with multi-vessel CAD with exercise was 0.39± 0.01(p=0.000) and for adenosine was 0.39± 0.02(p=0.000). Conclusion: An elevated LHR in patients undergoing exercise or pharmacological tc- 99m MPI correlates with multi-vessel CAD.展开更多
To investigate the efficacy and tolerability of orlistat in obese adolescents, a prospective, open-label, randomised, controlled pilot trial was performed. A total of 22 adolescents with exogeneous obesity were starte...To investigate the efficacy and tolerability of orlistat in obese adolescents, a prospective, open-label, randomised, controlled pilot trial was performed. A total of 22 adolescents with exogeneous obesity were started on orlistat (120 mg tid) and a daily multivitamin preparation in addition to conventional treatment which included nutritional and lifestyle modification programmes. The control group consisted of 20 obese adolescents who had similar duration of follow-up under conventional treatment alone. Of the 22 patients, 7 dropped out within the 1st month of the trial due to side-effects attributable to orlistat. The remaining 15 patients on orlistat were followed for 5-15months (average duration of treatment 11. 7 ± 3. 7 months). The control group was similar in age, sex, and duration of follow-up (10. 2 ± 3. 7months, range 6-17 months) to the orlistat group. Compared to initial body weight, patients in the orlistat group lost-6. 27 ± 5. 4 kg, whereas those in the control group gained 4. 16 ± 6. 45 kg (P < 0. 001) during the study period. Patients in the orlistat group lost-7. 65% ± 6. 5% of their initial body weight, whereas, those of the control group gained 5. 7% ± 8. 3% (P < 0. 001). The body mass index decreased in the orlistat group by-4. 09 ± 2. 9 kg/m2 while it increased by + 0. 11 ± 2. 49 kg/m2 in the control group (P < 0. 001). Mild gastrointestinal complaints (frequent stools) were experienced by all patients in the orlistat group. Conclusion: Orlistat could be a useful adjunct in the treatment of severe obesity in adolescents; however, gastrointestinal side effects limit its usefulness in almost one in three adolescents.展开更多
Background: Major neurological handicaps and neuropsychological disturbances are more common in ex-preterm children than their counterparts born at term. Objective: To establish in a prospective study whether a charac...Background: Major neurological handicaps and neuropsychological disturbances are more common in ex-preterm children than their counterparts born at term. Objective: To establish in a prospective study whether a characteristic neuropsychological profile exists in ex-preterm children who do not exhibit neurodevelopmental deficits on routine clinical examination. Methods: Thirty intellectually normal children born preterm (30- 34 weeks gestation) without major neurological disabilities and a control group of term children matched for age, sex, and parental educational and occupational status were assessed at 3- 4 years of age to obtain a complete neuropsychological profile. Intellectual ability, language comprehension and expression, perceptual and visual motor function, working memory, and attention and behavioural problems were investigated. Results: Even in the absence of major neurological signs, children born preterm achieved lower mean scores than controls on the Stanford- Binet intelligence scale (110.8 v 121, p < 0.001 ), visual perception test (33.8 v 42.7, P< 0.001 ), visual motor integration test (42.6 v 47.4, P=0.049), memory for location test (8.4 v 9.5,P= 0.007), sustained attention test (41.6 v 51.5,P= 0.009), and the picture vocabulary test (33.3 v 44.7, P = 0.021). Conclusions: Neuropsychological abnormalities can be detected early in childhood in apparently normal ex-preterm children and are consistent with a growing body of evidence that prematurity may be associated with long term neuropsychological morbidity in childhood and adolescence.展开更多
Aims: To assess whether lung function in late childhood had improved in subjects born extremely prematurely in the early 1990s compared to the early 1980s, and whether neonatal factors in the respective periods had di...Aims: To assess whether lung function in late childhood had improved in subjects born extremely prematurely in the early 1990s compared to the early 1980s, and whether neonatal factors in the respective periods had different impact on long- term pulmonary outcome. Design: Population- based, controlled cohort study. Lung function was determined in 81 of 86 (94% ) eligible subjects born with gestational age ≤ 28 weeks or birthweight ≤ 1000 g in Western Norway in 1982- 85 (n = 46) and 1991- 92 (n = 35), and in 81 matched control subjects born at term. Results: The incidence of bronchopulmonary dysplasia was similar in the two periods. At follow- up, airway obstruction, hyper- responsiveness and pulmonary hyperinflation were similarly increased in both preterm cohorts compared to matched controls. Furthermore, current lung function was similarly related to neonatal respiratory disease in both birth- cohorts: FEV1 was reduced with respectively 18.6% and 18.7% of predicted in preterms dependent on supplemental oxygen at 36 weeks postmenstrual age. Lack of antenatal treatment with corticosteroids and prolonged neonatal oxygen treatment predicted similar significant airway obstruction in the two birth- cohorts Conclusion: Preterms born in different eras of neonatology had similar long- term decreases in lung function. Long periods of oxygen supplementation are still required to salvage immature infants, and airway obstruction may still be a common longterm outcome.展开更多
The purpose of this study to compare breast milk pharmacokinetics between miso prostol 200 μg and methylergometrine 250 μg after single oral dosing in women who require postpartum uterotonic therapy. Open prospectiv...The purpose of this study to compare breast milk pharmacokinetics between miso prostol 200 μg and methylergometrine 250 μg after single oral dosing in women who require postpartum uterotonic therapy. Open prospective randomized phase I s tudy measuring misoprostol and methylergometrine on postpartum days 3 to 6 in mi lk 0.5, 1, 2, 3, 4, and 5 hours postdose, and in maternal serum at 0.5 and 1 hou rs (misoprostol) and 1 and 2 hours (methylergometrine) in 10 lactating women per group. Milk misoprostol levels rose and declined rapidly, which gave a milk eli mination half-life of less than one half that of methylergometrine (mean ±SE,1 .1 ±0.3 hours [median, 0.6 hours] vs 2.33 ±.0.3 hours [median, 1.9 hours]; P = . 003)-. Milk/plasma ratios for misoprostol were one third of those for methyle rgometrine at 1 hour (P <. 0001) and 2 hours (P <. 0015). Misoprostol warrants f urther investigation as an alternative to postpartum methylergometrine because i t enters and leaves breast milk at twice the rate, with one third of the milk/pl asma ratio, which significantly lowers infant exposure and facilitates a timed d osing regimen.展开更多
Objective: To compare the efficacy and side effects of sublingual misoprostol and intravenous methylergometrine for active management of third stage of labor. Method: One hundred twenty low risk pregnant women at term...Objective: To compare the efficacy and side effects of sublingual misoprostol and intravenous methylergometrine for active management of third stage of labor. Method: One hundred twenty low risk pregnant women at term with spontaneous onset of labor were included in the study. The women were randomized to receive either two tablets of misoprostol (200 μ g/tablet) sublingually or 1 ml of methylergometrine (200 μ g) intravenous injection, after the delivery of the anterior shoulder of the baby. The main outcome measures were: need for additional oxytocic drugs, blood loss ≥ 500 ml, change in hemoglobin levels and side effects. Results: Postpartum hemorrhage as defined by hemorrhage ≥ 500 ml occurred in 3.1% of the women in the sublingual misoprostol group but none of the women in the methylergometrine group (P > 0.05). There was a need for additional oxytocic drugs in 5.0% and 8.3% after methylergometrine and misoprostol, respectively (P > 0.05). The change in hemoglobin levels at 24 h postpartum were 0.8 and 0.7 mg% in methylergometrine and misoprostol group, respectively(P > 0.05). In the misoprostol group, 6.6% women developed fever ≥ 38° C and 21.6% had shivering while in methylergometrine group none experienced these side effects. However, the incidence of other side effects like nausea, vomiting, headache and giddiness were similar in both groups. Conclusion: Sublingual misoprostol appears to be as effective as intravenous methylergometrine in the prevention of postpartum hemorrhage. However, larger randomized studies are needed to advocate its routine use.展开更多
文摘Aim: To investigate the role of IL- 7 in HIV- infected children on highly a ctive antiretroviral therapy (HAART) and its association with laboratory paramet ers related to disease progression. Patients and methods: A cross- sectional study in 31 vertically HIV- infected children (median age 8.4 y) t reated with HAART, and a longitudinal study in four of those same children was c arried out. In both studies, viral load, CD4+ T- cell counts, thymic producti on of T cells by TCR rearrangement excision circles (TRECs), IL- 7 plasma level s and viral phenotype were determined. Results: IL- 7 levels were higher in HIV - infected children than in age- matched, uninfected controls. In addition, HI V children with CD4+ T cells between 200 and 500 T cells/mm3 had higher IL- 7 levels and lower TREC values than HIV- infected children with CD4+ T cells > 500 T cells/mm3. IL- 7 levels were higher in children with syncytium- inducin g (SI) phenotype than in those with nonsyncytium- inducing (NSI) variants. Duri ng the follow- up of four HIV children, the decrease in viral load after HAART was always associated with a recovery of CD4+ T cells and TRECs, which was fol lowed by a decrease in IL- 7 returning to the levels present prior to the drop in CD4+ Tcells. The four HIV- infected children had SI/X4 isolates in PBMC be fore HAART, and the viral phenotype switched to NSI/R5 after HAART. Conclusion: Our data suggest that IL- 7 plays a key role in the maintenance of T- cell hom eostasis in HIV- infected children on HAART, both through peripheral expansion and through a thymus- dependent mechanism.
文摘Aims: To evaluate the effect of the implementation of an asthma clinical path way on asthma in children in general practice. Methods: A randomized, controlled trial involving 270 general practitioners. One group of general practitioners i mplemented the asthma clinical pathway for children (intervention group)- and t he control group continued with their usual asthma medical care management. The main outcome measures were admissions to hospital for asthma and attendance at t he Children’s Emergency Department. Compliance with the guidelines was assesse d by examining asthma drug prescriptions. Results: Admissions to hospital for as thma dropped 40% in the intervention group, by 33% in the control group and by 22% in general practitioners not participating in the trial. The difference s between the intervention and control and between the intervention and non- pa rticipating general practitioners were not statistically significant. The decrea se in attendance at the Children’s Emergency Department decreased by 25% , 30 % and 19% , respectively, but this was not statistically signifi- cant. Ther e was a significant decrease in prescriptions for oral relievers, dry powder rel ievers in the under 6s, mast cell stabilizers and methylxanthines in both contro l and intervention groups. However, only for oral relievers was there a signific ant difference between the intervention group and control, with the decrease lar ger in the intervention group (p < 0.001). Conclusions: Admissions to hospital f or asthma decreased, as did attendance at the Children’s Emergency Department. Prescriptions for asthma medication changed in the direction anticipated with c ompliance with the asthma clinical pathway. However, we found no evidence within the study that implementation of the asthma clinical pathway by general practit ioners resulted in lower morbidity than those general practitioners who did not implement the pathway. Possible explanations are that these general practitioner s were already providing care according to the recommendations of the pathway, o r that there was contamination of the control group by the intervention, or that the guidelines, although based on currently accepted recommendations, are ineff ective.
文摘This study was designed to explore the relationships of early diabetic microangiopathy to alterations of cardiac sympathetic tone and myocardial blood flow(MBF)regulation in subjects with stable type 1 diabetes. In diabetes, augmented cardiac sympathetic tone and abnormal MBF regulation may predispose to myocardial injury and enhanced cardiac risk. Subject groups comprised healthy controls(C)(n=10), healthy diabetic subjects(DC)(n=12), and diabetic subjects with very early diabetic microangiopathy(DMA+)(n=16). [ 11C]meta-hydroxyephedrine([11C]HED)and positron emission tomography(PET)were used to explore left ventricular(LV)sympathetic integrity and [13N]ammonia-PET to assess MBF regulation in response to cold pressor testing(CPT)and adenosine infusion. Deficits of LV [ 11C]HED retention were extensive and global in the DMA+subjects(36±31%vs. 1±1%in DC subjects; p< 0.01)despite preserved autonomic reflex tests. On CPT, plasma norepinephrine excursions were two-fold greater than in C and DC subjects(p< 0.05), and basal LV blood flow decreased(-12%, p< 0.05)in DMA+but not in C or DC subjects(+45%and +51%, respectively). On adenosine infusion, compared with C subjects, MBF reserve decreased by-45%(p< 0.05)in DMA+subjects. Diastolic dysfunctionwas detected by two-dimensional echocardiography in 5 of 8 and 0 of 8 consecutively tested DMA+and DC subjects, respectively. Augmented cardiac sympathetic tone and responsiveness and impaired myocardial perfusion may contribute to myocardial injury in diabetes.
文摘An increased lung to heart ratio(LHR) on thallium-201(Tl- 201) stress myocardial perfusion imaging(MPI) is a predictor of adverse cardiac events and identifies people with extensive coronary artery disease(CAD). The implications of increased LHR in patients undergoing stress technetium- 99m(tc- 99m) sestamibi are developing. Our aim is to evaluate the relationship between increased LHR and extent of CAD in patients undergoing tc- 99m sestamibi MPI. Methods: We reviewed the records and images of 530 consecutive subjects who underwent exercise or adenosine tc- 99 m sestamibi MPI. One hundred thirty-two had transient or partially reversible myocardial perfusion defects and 79(exercise=34, adenosine=45, male=43, female=36, mean age=61 years) of these underwent coronary angiography(study population). The average LHR of these 79 subjects was compared to 79 patients(control population) with normal scans(exercise=50, adenosine=29, male=34, female=45, mean age=60 years). Results: The mean LHR(± SE) in subjects with normal scans was 0.30± 0.01. The mean LHR for those with abnormal scans and single vessel CAD who underwent exercise was 0.32± 0.01 and pharmacological stress was 0.31± 0.01. There was no statistically significant difference between the LHR of those with a normal scan and those with single vessel disease and an abnormal scan. However, there was a statistically significant association between the elevated LHR and multi-vessel CAD. The mean LHR for subjects with multi-vessel CAD with exercise was 0.39± 0.01(p=0.000) and for adenosine was 0.39± 0.02(p=0.000). Conclusion: An elevated LHR in patients undergoing exercise or pharmacological tc- 99m MPI correlates with multi-vessel CAD.
文摘To investigate the efficacy and tolerability of orlistat in obese adolescents, a prospective, open-label, randomised, controlled pilot trial was performed. A total of 22 adolescents with exogeneous obesity were started on orlistat (120 mg tid) and a daily multivitamin preparation in addition to conventional treatment which included nutritional and lifestyle modification programmes. The control group consisted of 20 obese adolescents who had similar duration of follow-up under conventional treatment alone. Of the 22 patients, 7 dropped out within the 1st month of the trial due to side-effects attributable to orlistat. The remaining 15 patients on orlistat were followed for 5-15months (average duration of treatment 11. 7 ± 3. 7 months). The control group was similar in age, sex, and duration of follow-up (10. 2 ± 3. 7months, range 6-17 months) to the orlistat group. Compared to initial body weight, patients in the orlistat group lost-6. 27 ± 5. 4 kg, whereas those in the control group gained 4. 16 ± 6. 45 kg (P < 0. 001) during the study period. Patients in the orlistat group lost-7. 65% ± 6. 5% of their initial body weight, whereas, those of the control group gained 5. 7% ± 8. 3% (P < 0. 001). The body mass index decreased in the orlistat group by-4. 09 ± 2. 9 kg/m2 while it increased by + 0. 11 ± 2. 49 kg/m2 in the control group (P < 0. 001). Mild gastrointestinal complaints (frequent stools) were experienced by all patients in the orlistat group. Conclusion: Orlistat could be a useful adjunct in the treatment of severe obesity in adolescents; however, gastrointestinal side effects limit its usefulness in almost one in three adolescents.
文摘Background: Major neurological handicaps and neuropsychological disturbances are more common in ex-preterm children than their counterparts born at term. Objective: To establish in a prospective study whether a characteristic neuropsychological profile exists in ex-preterm children who do not exhibit neurodevelopmental deficits on routine clinical examination. Methods: Thirty intellectually normal children born preterm (30- 34 weeks gestation) without major neurological disabilities and a control group of term children matched for age, sex, and parental educational and occupational status were assessed at 3- 4 years of age to obtain a complete neuropsychological profile. Intellectual ability, language comprehension and expression, perceptual and visual motor function, working memory, and attention and behavioural problems were investigated. Results: Even in the absence of major neurological signs, children born preterm achieved lower mean scores than controls on the Stanford- Binet intelligence scale (110.8 v 121, p < 0.001 ), visual perception test (33.8 v 42.7, P< 0.001 ), visual motor integration test (42.6 v 47.4, P=0.049), memory for location test (8.4 v 9.5,P= 0.007), sustained attention test (41.6 v 51.5,P= 0.009), and the picture vocabulary test (33.3 v 44.7, P = 0.021). Conclusions: Neuropsychological abnormalities can be detected early in childhood in apparently normal ex-preterm children and are consistent with a growing body of evidence that prematurity may be associated with long term neuropsychological morbidity in childhood and adolescence.
文摘Aims: To assess whether lung function in late childhood had improved in subjects born extremely prematurely in the early 1990s compared to the early 1980s, and whether neonatal factors in the respective periods had different impact on long- term pulmonary outcome. Design: Population- based, controlled cohort study. Lung function was determined in 81 of 86 (94% ) eligible subjects born with gestational age ≤ 28 weeks or birthweight ≤ 1000 g in Western Norway in 1982- 85 (n = 46) and 1991- 92 (n = 35), and in 81 matched control subjects born at term. Results: The incidence of bronchopulmonary dysplasia was similar in the two periods. At follow- up, airway obstruction, hyper- responsiveness and pulmonary hyperinflation were similarly increased in both preterm cohorts compared to matched controls. Furthermore, current lung function was similarly related to neonatal respiratory disease in both birth- cohorts: FEV1 was reduced with respectively 18.6% and 18.7% of predicted in preterms dependent on supplemental oxygen at 36 weeks postmenstrual age. Lack of antenatal treatment with corticosteroids and prolonged neonatal oxygen treatment predicted similar significant airway obstruction in the two birth- cohorts Conclusion: Preterms born in different eras of neonatology had similar long- term decreases in lung function. Long periods of oxygen supplementation are still required to salvage immature infants, and airway obstruction may still be a common longterm outcome.
文摘The purpose of this study to compare breast milk pharmacokinetics between miso prostol 200 μg and methylergometrine 250 μg after single oral dosing in women who require postpartum uterotonic therapy. Open prospective randomized phase I s tudy measuring misoprostol and methylergometrine on postpartum days 3 to 6 in mi lk 0.5, 1, 2, 3, 4, and 5 hours postdose, and in maternal serum at 0.5 and 1 hou rs (misoprostol) and 1 and 2 hours (methylergometrine) in 10 lactating women per group. Milk misoprostol levels rose and declined rapidly, which gave a milk eli mination half-life of less than one half that of methylergometrine (mean ±SE,1 .1 ±0.3 hours [median, 0.6 hours] vs 2.33 ±.0.3 hours [median, 1.9 hours]; P = . 003)-. Milk/plasma ratios for misoprostol were one third of those for methyle rgometrine at 1 hour (P <. 0001) and 2 hours (P <. 0015). Misoprostol warrants f urther investigation as an alternative to postpartum methylergometrine because i t enters and leaves breast milk at twice the rate, with one third of the milk/pl asma ratio, which significantly lowers infant exposure and facilitates a timed d osing regimen.
文摘Objective: To compare the efficacy and side effects of sublingual misoprostol and intravenous methylergometrine for active management of third stage of labor. Method: One hundred twenty low risk pregnant women at term with spontaneous onset of labor were included in the study. The women were randomized to receive either two tablets of misoprostol (200 μ g/tablet) sublingually or 1 ml of methylergometrine (200 μ g) intravenous injection, after the delivery of the anterior shoulder of the baby. The main outcome measures were: need for additional oxytocic drugs, blood loss ≥ 500 ml, change in hemoglobin levels and side effects. Results: Postpartum hemorrhage as defined by hemorrhage ≥ 500 ml occurred in 3.1% of the women in the sublingual misoprostol group but none of the women in the methylergometrine group (P > 0.05). There was a need for additional oxytocic drugs in 5.0% and 8.3% after methylergometrine and misoprostol, respectively (P > 0.05). The change in hemoglobin levels at 24 h postpartum were 0.8 and 0.7 mg% in methylergometrine and misoprostol group, respectively(P > 0.05). In the misoprostol group, 6.6% women developed fever ≥ 38° C and 21.6% had shivering while in methylergometrine group none experienced these side effects. However, the incidence of other side effects like nausea, vomiting, headache and giddiness were similar in both groups. Conclusion: Sublingual misoprostol appears to be as effective as intravenous methylergometrine in the prevention of postpartum hemorrhage. However, larger randomized studies are needed to advocate its routine use.
