RESUMEN
PURPOSE: To assess the efficacy and tolerability of high-dose (2000microg) intravitreous ganciclovir in the maintenance therapy of CMV retinitis in AIDS patients. MATERIAL: and methods: Prospective open study in a single center. The maintenance therapy of CMV retinitis consisted of a single high-dose (2000microg) intravitreous injection per week. The evaluation criteria were clinical examinations, and photographs when necessary. RESULTS: Over a 44-week period, twenty-four eyes (15 patients) have been included. The relapse rate evaluated by the survival curves method was 5% at 44 weeks. No ocular toxicity was reported after a follow-up of 24 weeks. CONCLUSION: High-dose intravitreous ganciclovir induces a prolonged remission of CMV retinitis and is well tolerated. Therefore, we recommend the use of the 2000microg dosage per intravitreous injection instead of the classical dosage of 400microg.
Asunto(s)
Infecciones Oportunistas Relacionadas con el SIDA/tratamiento farmacológico , Antivirales/administración & dosificación , Retinitis por Citomegalovirus/tratamiento farmacológico , Ganciclovir/administración & dosificación , Adulto , Antivirales/efectos adversos , Relación Dosis-Respuesta a Droga , Femenino , Ganciclovir/efectos adversos , Humanos , Inyecciones , Masculino , Persona de Mediana Edad , Estudios Prospectivos , Recurrencia , Resultado del Tratamiento , Cuerpo Vítreo/efectos de los fármacosRESUMEN
PURPOSE: To assess the tolerability and efficacy of intravitreal injections of foscarnet in cytomegalovirus (CMV) retinitis in acquired immunodeficiency syndrome (AIDS). METHODS: Patients with CMV retinitis resistant and/or intolerant to intravenous foscarnet and ganciclovir and resistant to intravitreal ganciclovir were included. The induction therapy consisted of intravitreal injections of 2,400 micrograms of foscarnet twice a week. The assessment was performed by clinical examination and photographies of the fundus. RESULTS: Three patients (four eyes) have been included. Three eyes were administered seven and one eye eight intravitreal injections. The tolerability was good, but the efficacy was mere: the retinal lesions became less edematous, but they still extended. CONCLUSION: In these four eyes with CMV retinitis resistant to intravitreal ganciclovir, intravitreal injections of foscarnet were well tolerated but did not stop the progression of the retinitis.
Asunto(s)
Infecciones Oportunistas Relacionadas con el SIDA/tratamiento farmacológico , Antivirales/administración & dosificación , Retinitis por Citomegalovirus/tratamiento farmacológico , Foscarnet/administración & dosificación , Inyecciones/métodos , Cuerpo Vítreo , Infecciones Oportunistas Relacionadas con el SIDA/patología , Retinitis por Citomegalovirus/patología , Progresión de la Enfermedad , Esquema de Medicación , Monitoreo de Drogas , Femenino , Humanos , Masculino , Resultado del TratamientoRESUMEN
As already reported, PGE1 induces a valid erection, when administered intracavernously, without causing prolonged erection or general side effects. We have tested PGE1 (< 20 micrograms) in 180 patients suffering from organic erectile impotence, a complete erection was observed in 130 (72.2%), while incomplete erection was noted in 37 (20.5%). In both groups (92.7%) erection was sufficient for sexual intercourse. Among the best results, 41 patients had previously received high doses intracavernous injection of papaverine, without any benefit, and 15 patients have cavernosal venous leakage documented by cavernosometry and cavernosography before prostaglandin E1 test. Tumescence without rigidity was noted in 13 (7.2%). Of these 167 patients, 95 entered an autoinjection protocol for treatment of erectile dysfunction, using special device. In our series neither systemic reaction nor prolonged erection occurred. No fibrosis of cavernous tissue or scar formation was observed after up to 125 injections. However, 19 patients (10.5%) reported burning sensations during the entire period of erection and one patient (0.5%) had an haematoma at the site of the injection. PGE1 is effective in inducing artificial penile erection and it has a role in the diagnosis and treatment of erectile dysfunction, it is considered to be a more suitable agent than other vasoactive drugs.
Asunto(s)
Alprostadil/uso terapéutico , Disfunción Eréctil/tratamiento farmacológico , Adulto , Anciano , Anciano de 80 o más Años , Alprostadil/farmacología , Disfunción Eréctil/diagnóstico , Disfunción Eréctil/epidemiología , Disfunción Eréctil/etiología , Disfunción Eréctil/fisiopatología , Estudios de Seguimiento , Humanos , Inyecciones/métodos , Masculino , Persona de Mediana Edad , Erección Peniana/efectos de los fármacos , Pene , Factores de Riesgo , AutoadministraciónRESUMEN
The effects of propofol induction (2.5 mg kg-1) and of two continuous infusion rates of propofol (100 and 200 micrograms kg-1 min-1) on baroreflex control of heart rate and on plasma noradrenaline concentration were investigated in 11 unpremedicated patients. Baroreflex function was assessed using a pressor test (phenylephrine) and a depressor test (sodium nitroprusside). In addition, samples for subsequent determination of plasma noradrenaline levels and blood propofol levels were collected before each test. Baroreflex sensitivity and plasma noradrenaline concentrations were not significantly changed at any time of the study. By contrast, a significant and sustained resetting of baroreflex set point was observed, allowing unchanged heart rate at lower arterial pressure. It is concluded that the effects of propofol on baroreflex function and noradrenaline concentration are moderate.