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Journal of Vascular Surgery Cases and... Dec 2023We present a case of medication-induced priapism that was refractory to conventional urologic methods and required treatment with a caverno-saphenous bypass. The patient...
We present a case of medication-induced priapism that was refractory to conventional urologic methods and required treatment with a caverno-saphenous bypass. The patient had been misusing an injectable erectile dysfunction medication consisting of alprostadil, papaverine, and phentolamine (Trimix), resulting in multiple episodes of priapism. His initial episodes of priapism were successfully treated with the traditional urologic algorithm, including phenylephrine, aspiration, and distal shunting. However, due to his continued medication misuse, these became ineffective, requiring proximal shunt surgery. Priapism requiring an extra-anatomic bypass is exceedingly rare. Following our proximal shunt surgery, he maintained partial sexual function, and his bypass remained patent.
PubMed: 38106342
DOI: 10.1016/j.jvscit.2023.101359 -
Asia Pacific Journal of Clinical... Jun 2024Feeding intolerance (FI) is a common problem in late preterm infants (34 weeks ≤ gestational age < 37 weeks). This study aimed to evaluate the efficacy and safety of... (Randomized Controlled Trial)
Randomized Controlled Trial
BACKGROUND AND OBJECTIVES
Feeding intolerance (FI) is a common problem in late preterm infants (34 weeks ≤ gestational age < 37 weeks). This study aimed to evaluate the efficacy and safety of phentolamine combined with B vitamins in treating FI in late preterm infants and to explore its effects on gastrointestinal symptoms, inflammation and complications.
METHODS AND STUDY DESIGN
We randomly assigned 118 late preterm infants with FI to a treatment group (n = 56) or a control group (n = 62). The treatment group received intravenous phentolamine and intramuscular B vitamins, whereas the control group received basic treatment only. We measured the time of disappearance of gastrointestinal symptoms, the time of basal at-tainment, the time of hospitalisation, the incidence of complications, the concentrations of inflammatory markers and the overall effective rate of treatment.
RESULTS
The treatment group had a shorter duration of gastrointestinal symptoms than did the control group (p < 0.01). The treatment group also had lower concentrations of inflammatory markers and a higher overall effective rate than did the control group (p < 0.05). There was no difference between the two groups in the time of hospitalisation, basal attainment, weight re-covery and the incidence of complications (p > 0.05).
CONCLUSIONS
Phentolamine and B vitamins can reduce gastrointestinal symptoms and inflammation in late preterm infants with FI but do not affect the occurrence of complications.
Topics: Humans; Infant, Premature; Infant, Newborn; Male; Female; Phentolamine; Vitamin B Complex; Food Intolerance; Gastrointestinal Diseases
PubMed: 38794979
DOI: 10.6133/apjcn.202406_33(2).0006 -
Farmacia Hospitalaria : Organo Oficial... May 2024To review and analyze the available literature on peripheral administration of noradrenaline (NA) with the aim of providing recommendations to ensure correct use and... (Review)
Review
PURPOSE
To review and analyze the available literature on peripheral administration of noradrenaline (NA) with the aim of providing recommendations to ensure correct use and patient safety.
METHODS
Systematic review on the databases PubMed, ISI Web of Science, SCOPUS and Science Direct, using the following search terms: ("Noradrenaline" [Mesh]) AND ("Norepinephrine" [Mesh]) AND ("Vasopressors" [Mesh]) AND ("Peripheral infusions" [Mesh]) OR ("Extravasations" [Mesh]). A total of 1,040 articles were identified. Animal studies and studies written in languages other than English were excluded. Finally, 83 articles were included.
RESULTS
NA can be administered peripherally. The risk of extravasation should be taken into account, with phentolamine being the first pharmacological line of treatment. It has also been related to the appearance of thrombophlebitis, cellulitis, tissue necrosis, limb ischemia and gangrene, although its incidence seems to be low. The use of peripheral NA in children seems to be carried out without obvious complications. The use of standard concentrations is suggested to reduce the risk of errors. It is recommended to use 0.9% saline as the default diluent for peripheral NA.
CONCLUSIONS
Peripheral infusions of NA could be a safe and beneficial option in early resuscitation provided that a number of guidelines are followed that reduce the likelihood of complications associated with this route.
PubMed: 38724402
DOI: 10.1016/j.farma.2024.04.003 -
International Journal of Molecular... Jun 2023This study aimed to elucidate the vasodilatory effects and cytotoxicity of various vasodilators used as antispasmodic agents during microsurgical anastomosis. Rat smooth...
This study aimed to elucidate the vasodilatory effects and cytotoxicity of various vasodilators used as antispasmodic agents during microsurgical anastomosis. Rat smooth muscle cells (RSMCs) and human coronary artery endothelial cells (HCAECs) were used to investigate the physiological concentrations and cytotoxicity of various vasodilators (lidocaine, papaverine, nitroglycerin, phentolamine, and orciprenaline). Using a wire myograph system, we determined the vasodilatory effects of each drug in rat abdominal aortic sections at the concentration resulting in maximal vasodilation as well as at the surrounding concentrations 10 min after administration. Maximal vasodilation effect 10 min after administration was achieved at the following concentrations: lidocaine, 35 mM; papaverine, 0.18 mM; nitroglycerin, 0.022 mM; phentolamine, 0.11 mM; olprinone, 0.004 mM. The IC for lidocaine, papaverine, and nitroglycerin was measured in rat abdominal aortic sections, as well as in RSMCs after 30 min and in HCAECs after 10 min. Phentolamine and olprinone showed no cytotoxicity towards RSMCs or HCAECs. The concentrations of the various drugs required to achieve vasodilation were lower than the reported clinical concentrations. Lidocaine, papaverine, and nitroglycerin showed cytotoxicity, even at lower concentrations than those reported clinically. Phentolamine and olprinone show antispasmodic effects without cytotoxicity, making them useful candidates for local administration as antispasmodics.
Topics: Humans; Rats; Animals; Parasympatholytics; Papaverine; Nitroglycerin; Phentolamine; Endothelial Cells; Microsurgery; Muscle, Smooth, Vascular; Vasodilator Agents; Vasodilation; Myocytes, Smooth Muscle; Lidocaine
PubMed: 37446027
DOI: 10.3390/ijms241310850 -
Cardiovascular and Interventional... Dec 2023To describe a novel technique of transvenous radiofrequency catheter ablation of an aldosterone-producing adenoma (APA) of the left adrenal gland using the GOS System...
PURPOSE
To describe a novel technique of transvenous radiofrequency catheter ablation of an aldosterone-producing adenoma (APA) of the left adrenal gland using the GOS System (Japan Lifeline, Tokyo, Japan). Using the GOS system, a flexible radiofrequency tip catheter can be inserted into the adrenal central and tributary veins, the drainers for functional tumors.
MATERIALS AND METHODS
An APA at the left adrenal gland, which was diagnosed by segmental adrenal venous sampling following administration of 0.25 mg cosyntropin, was ablated using the GOS catheter inserted into adrenal tributary veins via a right femoral vein 7-Fr sheath. The effect of radiofrequency ablation on APA was assessed using the international consensus on surgical outcomes for unilateral primary aldosteronism (PA).
RESULTS
No device-related complications were observed. The patient was deeply sedated under blood pressure and heart rate control with continuous administration of β-blockers. Then, the tumor and surrounding adrenal gland were cauterized at 7000 J two times each in sequence. The output time was 7-11 min for each ablation and 80 min in total. For blood pressure and pulse rate control, esmolol hydrochloride and phentolamine mesylate were used. The contrast enhancement of APA disappeared on dynamic CT immediately after the procedure. PA was biochemically cured until 12 months after the procedure.
CONCLUSION
Using the radiofrequency device with the GOS catheter and system is a method for cauterizing adrenal tumors from blood vessels. This approach resulted in a marked reduction in aldosterone concentrations and a complete biochemical cure of PA over the observation period.
Topics: Humans; Aldosterone; Adrenal Glands; Adrenal Gland Neoplasms; Catheters; Catheter Ablation; Hyperaldosteronism
PubMed: 37973663
DOI: 10.1007/s00270-023-03584-x -
Journal of Medical Case Reports Mar 2024This report presents a case of cannabinoid-induced hyperemesis syndrome causing repeated violent retching in a patient with a large (8 cm) adrenal pheochromocytoma...
BACKGROUND
This report presents a case of cannabinoid-induced hyperemesis syndrome causing repeated violent retching in a patient with a large (8 cm) adrenal pheochromocytoma resulting in hypertensive urgency.
CASE PRESENTATION
A 69-year-old white male patient with a previously diagnosed pheochromocytoma presented to the emergency department with nausea and vomiting and was found to have hypertensive urgency. Computed tomography scan did not show any acute abdominal pathology and history was inconsistent with a gastrointestinal etiology. Patient had a history of daily cannabinoid use for many years and repeated self-limited hyperemesis episodes, and thus a diagnosis of cannabinoid-induced hyperemesis syndrome was made. It was concluded that the likely explanation for the hypertensive urgency was from physical compression of his adrenal tumor during the episodes of retching resulting in a catecholamine surge. The patient was given antiemetics and admitted to the intensive care unit for blood pressure management. Blood pressure was initially controlled with phentolamine and a clevidipine infusion, then transitioned to oral doxazosin and phenoxybenzamine. Hyperemesis and abdominal pain resolved after 24 hours, and his blood pressure returned to baseline. The patient was discharged with the recommendation to stop all cannabis use. On follow-up, his blood pressure remained well controlled, and he subsequently underwent adrenalectomy for tumor removal.
CONCLUSION
Hyperemesis can cause hypertensive events in patients with pheochromocytoma by increasing abdominal pressure, leading to catecholamine release.
Topics: Aged; Humans; Male; Adrenal Gland Neoplasms; Cannabinoid Hyperemesis Syndrome; Cannabinoids; Catecholamines; Hypertensive Crisis; Pheochromocytoma; Vomiting
PubMed: 38500192
DOI: 10.1186/s13256-024-04497-0 -
SAGE Open Medical Case Reports 2023We report the anesthetic management of a case of paraganglioma, which was challenging because of intraoperative circulatory changes and difficult ventilatory management....
We report the anesthetic management of a case of paraganglioma, which was challenging because of intraoperative circulatory changes and difficult ventilatory management. A 52-year-old man with a history of chronic obstructive pulmonary disease was scheduled for paraganglioma resection under general anesthesia combined with epidural anesthesia. Since a marked increase in blood pressure was observed immediately after administration of rocuronium, antihypertensive agents were administered as necessary. The ventilatory settings were initially adjusted to deliver a tidal volume of 7 mL/kg, and the drive pressure was maintained at 13 cm HO or less. However, despite increasing the minute volume, PETCO increased to 60 mmHg and PaCO to 76 mmHg before tumor removal. Blood pressure decreased immediately after tumor removal, and PETCO and PaCO gradually returned to normal. We speculated that the increases in PETCO and PaCO might have been due to both an increase in endogenous catecholamine secretion as well as chronic obstructive pulmonary disease. It is important to preoperatively evaluate the functionality of the tumor and to anticipate perioperative cardiorespiratory instability in the management of paragangliomas.
PubMed: 37434894
DOI: 10.1177/2050313X231183881 -
Journal of Dental Anesthesia and Pain... Aug 2023Local anesthesia has been reliably used to control pain during dental procedures and is important in pediatric dentistry. However, children occasionally complain of...
BACKGROUND
Local anesthesia has been reliably used to control pain during dental procedures and is important in pediatric dentistry. However, children occasionally complain of prolonged numbness after dental treatment, leading to several problems. Studies conducted to reverse the effect of local anesthesia using phentolamine mesylate and photobiomodulation therapy (PBM) are encouraging but limited. PBM is a type of light therapy that utilizes visible and near-infrared non-ionizing electromagnetic spectral light sources. Hence, this study used this modality to compare the reversal of local anesthesia at two different wavelengths. This study compared the effect of PBM at 660 and 810 nm wavelengths on the reversal of soft tissue local anesthesia using a diode LASER in pediatric dentistry.
METHOD
Informed consent and assent were obtained, and the participants were then divided randomly into three groups of 20 children each: control group-without LASER irradiation, LASER irradiation at 660 nm, and LASER irradiation at 810 nm. Sixty children aged 4-8 years with deciduous mandibular molars indicated for pulp therapy were administered an inferior alveolar nerve block. After 45 min of injection, a duration that was similar to the approximate duration of treatment, they were exposed to 660- and 810-nm LASER irradiation according to their groups until reversal of local anesthesia was achieved. The control group did not undergo LASER irradiation. The reversal of the soft tissue local anesthetic effect was evaluated using palpation and pin prick tests every 15 min, and the LASER irradiation cycle continued until reversal of the soft tissue local anesthesia was achieved.
RESULTS
A significant reduction of 55.5 min (27.6%) in the mean soft tissue local anesthesia reversal time was observed after the application of 810 nm wavelength PBM and 69 min (34.7%) after 660 nm wavelength LASER irradiation.
CONCLUSION
PBM with a 660 nm wavelength was more effective in reducing the mean soft tissue local anesthesia reversal duration, and thus can be used as a reversal agent for soft tissue local anesthesia in pediatric dentistry.
PubMed: 37559668
DOI: 10.17245/jdapm.2023.23.4.229 -
BMC Anesthesiology Oct 2023Dexmedetomidine (DEX) is widely used in clinical sedation which has little effect on cardiopulmonary inhibition, however the mechanism remains to be elucidated. The...
BACKGROUND AND OBJECTIVES
Dexmedetomidine (DEX) is widely used in clinical sedation which has little effect on cardiopulmonary inhibition, however the mechanism remains to be elucidated. The basal forebrain (BF) is a key nucleus that controls sleep-wake cycle. The horizontal limbs of diagonal bundle (HDB) is one subregions of the BF. The purpose of this study was to examine whether the possible mechanism of DEX is through the α2 adrenergic receptor of BF (HDB).
METHODS
In this study, we investigated the effects of DEX on the BF (HDB) by using whole cell patch clamp recordings. The threshold stimulus intensity, the inter-spike-intervals (ISIs) and the frequency of action potential firing in the BF (HDB) neurons were recorded by application of DEX (2 µM) and co-application of a α adrenergic receptor antagonist phentolamine (PHEN) (10 µM).
RESULTS
DEX (2 µM) increased the threshold stimulus intensity, inhibited the frequency of action potential firing and enlarged the inter-spike-interval (ISI) in the BF (HDB) neurons. These effects were reversed by co-application of PHEN (10 µM).
CONCLUSION
Taken together, our findings revealed DEX decreased the discharge activity of BF (HDB) neuron via α adrenergic receptors.
Topics: Mice; Animals; Dexmedetomidine; Receptors, Adrenergic, alpha-2; Signal Transduction; Neurons; Adrenergic alpha-2 Receptor Agonists
PubMed: 37784079
DOI: 10.1186/s12871-023-02278-8 -
Experimental and Molecular Pathology May 2024pathological pain and Attention-deficit/hyperactivity disorder (ADHD) are two complex multifactorial syndromes. The comorbidity of ADHD and altered pain perception is...
pathological pain and Attention-deficit/hyperactivity disorder (ADHD) are two complex multifactorial syndromes. The comorbidity of ADHD and altered pain perception is well documented in children, adolescents, and adults. According to pathophysiological investigations, the dopaminergic system's dysfunction provides a common basis for ADHD and comorbid pain. Growing evidence suggests that oxidative stress may be crucial in both pathologies. Recent studies revealed that a small peptide encompassing the redox-active site of selenoprotein T (PSELT), protects dopaminergic neurons and fibers as well as lesioned nerves in animal models. The current study aims to examine the effects of PSELT treatment on ADHD-like symptoms and pain sensitivity, as well as the role of catecholaminergic systems in these effects. Our results demonstrated that intranasal administration of PSELT reduced the hyperactivity in the open field, decreased the impulsivity displayed by 6-OHDA-lesioned male mice in the 5-choice serial reaction time task test and improved attentional performance. In addition, PSELT treatment significantly increased the nociception threshold in both normal and inflammatory conditions. Furthermore, anti-hyperalgesic activity was antagonized with sulpiride pre-treatment, but not by phentolamine, or propranolol pre-treatments. The present study suggests that PSELT reduces the severity of ADHD symptoms in mice and possesses potent antinociceptive effects which could be related to the involvement of D2/D3 dopaminergic receptors.
PubMed: 38797131
DOI: 10.1016/j.yexmp.2024.104905