Nenad Bursac, PhD
https://medicine.duke.edu/faculty/nenad-bursac-phd
Kytril dosages: 2 mg, 1 mg
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Prevention of hepatorenal syndrome in sufferers with cirrhosis and ascites: a pilot randomized control trial between pentoxifylline and placebo. Effects of lumbar sympathetic block on kidney perform in cirrhotic sufferers with hepatorenal syndrome. Subclinical hepatic encephalopathy predicts the development of overt hepatic encephalopathy. The function of transjugular intrahepatic portosystemic shunt in the administration of portal hypertension. Review article: potential mechanisms of action of rifaximin in the management of hepatic encephalopathy and different problems of cirrhosis. Current analysis and management of post-transjugular intrahepatic portosystemic shunt refractory hepatic encephalopathy. A current evaluation of the diagnostic and remedy methods of hepatic encephalopathy. The impact of normalization of plasma amino acids on hepatic encephalopathy in man. Zinc supplementation and amino acid-nitrogen metabolism in patients with advanced cirrhosis. Long-term results of partial splenic artery embolization as supplemental therapy for portal-systemic encephalopathy. Hepatic hydrothorax: scientific options, administration, and outcomes in 77 sufferers and review of the literature. Natural historical past of repaired umbilical hernias in patients with and without ascites. Incarceration of umbilical hernia following transjugular intrahepatic portosystemic shunt for the therapy of ascites. Complicated hernia presentation in patients with superior cirrhosis and refractory ascites: management and end result.
Side results embody bradycardia, hypotension, atrial fibrillation, pulmonary edema, pleural effusion, bronchospasm, hypokalemia, leukocytosis, adrenal insufficiency, and N/V. Dexmedetomidine crosses the human placenta, which also binds a large fraction, delaying switch. Administration with anesthetics, sedatives, hypnotics, and opioids is likely to result in enhanced effects. This impact has been confirmed with sevoflurane, isoflurane, propofol, alfentanil, and midazolam, although no pharmacokinetic interactions have been demonstrated. Pregnancy Category: C Lactation Category: U � Dexmedetomidine should be used throughout pregnancy and lactation only if the benefit justifies the potential perinatal danger. Fetal Considerations D Breastfeeding Safety Drug Interactions References Summary Dexmethylphenidate International Brand Names None identified. Rodent research have shown a decrease in maternal gestational weight while taking methylphenidate. Side results embody seizures, dependency, arrhythmia, angina, thrombocytopenia, leukopenia, nervousness, insomnia, abdominal pain, headache, dizziness, palpitations, blurred imaginative and prescient, anorexia, weight loss, dyskinesia, and rash. Rodent research are reassuring, revealing no evidence of teratogenicity, although delayed ossification is seen at the highest dose stage. Dexmethylphenidate appears to enter human breast milk, however at ranges that are clinically irrelevant with an estimated relative toddler dose of <0. Methylphenidate reduces serum prolactin, but the impact of methylphenidate on milk production is unknown. Serious antagonistic events have been reported when used with clonidine, though no causality has been established. Pregnancy Category: C Lactation Category: S (probably) � Dexmethylphenidate ought to be used during pregnancy and lactation only if the profit justifies the potential perinatal danger. D Breastfeeding Safety Drug Interactions References Summary Dextroamphetamine International Brand Names Drug Class Indications Mechanism Dosage With Qualifiers - (Amphaetex; Das; Dexampex; Dexedrina; Dexedrine; Dextrostat; Ferndex; Oxydess; Spancap No.
The focus of interventional radiology has since shifted to therapeutic interventions to cut back and mitigate the sequelae of portal hypertension. Etiologies of portal vein thrombosis embrace iatrogenic causes (prior portal vein catheterization), hypercoagulable states, trauma, tumors, postinflammatory circumstances (pancreatitis), and postsurgical states. Patients with cirrhosis and portal vein thrombosis are often asymptomatic, with the condition recognized by the way on imaging. Occlusion of the portal vein or its branches in noncirrhotic livers may cause localized alterations in hemodynamics; this incidence accounts for less than 10% of all instances of portal hypertension. Recanalization of the occluded portal vein by angioplasty and stenting by way of a transjugular or a percutaneous transhepatic method may be carried out to alleviate signs. Surgical shunting or devascularization is usually avoided within the cirrhotic affected person to keep transplant options sooner or later. The subsequent step is to probe with a stiff guidewire and try to direct the wire toward the anticipated place of the principle portal vein. In all cases, stent graft positioning ought to be intrahepatic, with the possibility for future transplant stored into consideration. This causes symptoms of massive ascites, hepatosplenomegaly, belly ache, variceal bleeding, and jaundice from hepatic congestion, which, when left untreated, progresses to hepatic necrosis and fibrosis. The goal of treatment in these patients is to restore physiological move to relieve hepatic congestion and forestall development to irreversible liver damage. Endovascular options are also available and highly effective if the obstruction happens over a brief phase. Digital subtraction angiography picture depicting occlusion of the hepatic veins with "spider internet" look of venous collaterals (*). Longer segments of venous occlusion are harder to reopen and are related to high reocclusion rates. As at all times, evaluation of cross-sectional imaging is important to determine the anatomy and orientation of the portal vein in relation to the hepatic vein stump. Some radiologists choose a left internal jugular vein access approach, as this approach might provide favorable working angles. The presence of a tumor within the liver is taken into account a contraindication to the creation of a portacaval shunt using the normal strategy.
Although nobody knows when this practice started, archeological proof suggests a quantity of thousand years in the past. The coca leaf had necessary spiritual significance to the Inca people however was used for medicinal and work-related purposes as well. When the Spanish conquistadores encountered the Incas during the sixteenth century, they were at first disturbed by the spiritual use of coca, which was, of course, inconsistent with Catholicism (see Drugs and Culture Box 6. After conquering the Incas, the Spanish permitted and actually inspired using coca as a outcome of they believed it helped the Incas to work more durable and longer. The Spanish ultimately got here to management Inca access to the coca leaf through the use of it as a form of payment and levying taxes to be paid in coca leaves. The Spanish thought of chewing coca a vice and neither used coca themselves nor encouraged different Europeans to use it (Kennedy, 1985; Streatfeild, 2001). The Incas of the Andes regions of Bolivia, Ecuador, and Peru developed the follow of chewing the coca leaf greater than 3,000 years ago. One fantasy had it that coca had been an attractive woman who was executed for adultery. From her remains, the divine coca plant grew, to be consumed only by royalty in her memory (Petersen, 1977). Spanish conquistadores recounted tales of early coca use as in this quote from the journal of Pedro Cieza de Leon: In all elements of the Indies via which I have travelled, I really have noticed that the Indians take nice delight in having herbs or roots of their mouths. They go about with small coca leaves of their mouths, to which they apply a mix, which they carry in a calabash, made from a certain earth-like lime. Throughout Peru the Indians carry this coca in their mouths, and from the morning until they lie all the method down to sleep they never take it out. Because of its social significance, nevertheless, the Spanish finally took over coca production and distribution and used coca as a device to control the conquered inhabitants. Then European naturalists started to discover Peru and experiment with coca, and soon strange and often conflicting tales started to circulate about coca. Some, such because the German naturalist Edward Poeppig, seen coca as deadly: "The apply of chewing the leaf is attendant with essentially the most pernicious consequences, producing an intoxication like that of opium. As indulgence is repeated the urge for food for it will increase and the power of resistance diminishes until at last death relieves the depressing sufferer" (Kennedy, 1985, p. Others, such as the Italian biologist Paolo Mantegazza who chewed coca while in Peru, were more positive: "I sneered at poor mortals condemned to stay in this valley while I, carried on the wings of two coca leaves, went flying by way of the spaces of 77,438 worlds, every extra splendid than the one before" (Mortimer, 1901, p.
The resulting higher levels of free drug within the mother and fetus could enhance the danger of toxicity in both. Long-term follow-up studies reveal regular fertility in ladies beforehand treated with cisplatin. Side effects embrace nephrotoxicity, ototoxicity, neuropathy, optic neuritis, papilledema, seizures, anemia, hypokalemia, hypoglycemia, blurred vision, paresthesia, ataxia, elevated hepatic enzymes, rash, urticaria, muscle weak spot, and loss of taste. Cisplatin crosses Considerations the human placenta, though the serum degree is about half of that within the mother. Damage to the fetal renal and hepatic mitochondria on account of transplacental drug publicity seems mild. Limited research reveals cisplatin is present in human breast milk at concentrations with a relative toddler dose of <0. Pregnancy Category: D Lactation Category: S � Patients should be suggested to keep away from being pregnant throughout therapy. Summary Citalopram Drug Class Indications Mechanism Dosage With Qualifiers - (Celexa) International Brand Names Log on to ExpertConsult. Pregnancy increases the metabolism of citalopram, necessitating an increasing dose to maintain impact. Side results embody nephrotoxicity, ototoxicity, neuropathy, optic neuritis, seizures, anemia, hypokalemia, and hypoglycemia. Citalopram crosses Considerations the human placenta, achieving an F:M ratio approximating 0. Although the medical reviews are generally reassuring, neonatal withdrawal syndrome has been reported after third-trimester publicity. However, sertraline and paroxetine have a greater neonatal safety profile and are the medicine of choice throughout breastfeeding.
Use with valproic acid was associated with a big increase of the ratio of umbilical cord/maternal level of carbamazepine10,11-epoxide and carbamazepine-10,11-epoxide/carbamazepine ratio in each maternal serum and umbilical cord. Further, the co-administration of enzyme-inducing antiepileptics and valproic acid increases the obvious oral clearance of carbamazepine. Some epidemiologic research suggest carbamazepine is a teratogen causing facial dysmorphism, spina bifida, distal phalange hypoplasia, and developmental delay. The mixture of carbamazepine with other antiepileptic drugs has a synergistic effect on the prevalence of birth defects. Rodent research reveal an elevated prevalence of talipes, cleft palate, and anophthalmos. Mixing it with either chlorpromazine resolution or liquid thioridazine causes a precipitate. Drugs which were proven, or would be expected, to enhance carbamazepine ranges embody acetazolamide, cimetidine, clarithromycin, dalfopristin, danazol, delavirdine, diltiazem, erythromycin, fluoxetine, grapefruit juice, isoniazid, ketoconazole, loratadine, itraconazole, macrolides, niacinamide, nicotinamide, propoxyphene, terfenadine, troleandomycin, valproate, and verapamil. Drugs which have been shown, or could be anticipated, to lower carbamazepine levels embody cisplatin, doxorubicin, felbamate, phenobarbital, phenytoin, primidone, rifampin, theophylline, and troleandomycin. Altered thyroid function has been reported when combined with different anticonvulsant medicines. Breakthrough bleeding has been reported in women receiving oral and subdermal implant contraceptives, and their reliability could also be adversely affected. Pregnancy Category: C Lactation Category: S (likely) � Carbamazepine should be used during pregnancy and lactation only if the benefit justifies the potential perinatal threat; different anticonvulsants are preferable. References Summary 102 Carbenicillin International Brand Names Drug Class Indications Mechanism Dosage With Qualifiers - (Geocillin) Log on to ExpertConsult. Side results include seizures, anaphylaxis, Stevens-Johnson syndrome, hemolytic anemia, neutropenia, nausea, urticaria, diarrhea, rash, and fever. Carbenicillin blood levels may be elevated and prolonged by administration with probenecid. Pregnancy Category: B Lactation Category: S � Penicillin-class drugs are usually thought of secure throughout being pregnant. Breastfeeding Safety Drug Interactions References Summary Carbidopa None recognized.
Embolization of parasitized extrahepatic arteries to reestablish intrahepatic arterial supply to tumors earlier than yttrium-90 radioembolization. Nontarget delivery of embolic brokers can lead to serious gastrointestinal problems, together with erosion, ulceration, and perforation. Meticulous catheter strategies and in-depth information of vascular anatomy are required for secure and effective endovascular procedures. Important extrahepatic vessels arising from the hepatic arteries include the right gastric artery, pancreaticoduodenal arteries, cystic artery, falciform artery, and inferior phrenic artery. Prophylactic extrahepatic embolization, selective catheter place, antireflux infusion system, and flow redistribution are a variety of the methods used to reduce nontarget radioembolization. The management of variant arterial anatomy throughout hepatic arterial infusion pump placement. Anatomic and technical ability factor of gastroduodenal complication in post-transarterial embolization for hepatocellular carcinoma: a retrospective examine of 280 instances. Selective inner radiation therapy for nonresectable hepatocellular carcinoma with intra-arterial infusion of 90yttrium microspheres. Hepatic yttrium-90 (90Y) radioembolization is an evolving palliative therapy option offering new promise to sufferers with typically limited remedy decisions. As with different transarterial therapies, radioembolization relies on the twin blood provide of the liver. More particularly, malignant tumors are primarily supplied by the hepatic artery, whereas the background nontumorous liver is primarily supplied by the portal vein. Therefore, radioembolization delivers high-dose internal radiation to the tumor whereas sparing much of the nontumorous liver. This article will evaluate affected person choice, technique, and outcomes of hepatic radioembolization for primary and select secondary tumor sorts.
Placental transport occurs, however research counsel low transfer especially when the umbilical venous stress is elevated. Amiodarone has been used in isolated instances to deal with a fetal arrhythmia, usually atrial flutter unresponsive to other brokers. Among sixty four pregnancies uncovered to amiodarone, 17% of neonates had hypothyroidism (10 detected at start, 1 in utero), 18% of whom had a goiter. Neurodevelopmental evaluation of the hypothyroid infants, when carried out, revealed in some instances of gentle abnormalities usually just like the nonverbal studying disability syndrome. These options were additionally reported in some amiodaroneexposed euthyroid infants, suggesting a direct neurotoxic impact of amiodarone during fetal life. Amiodarone is excreted in breast milk at concentrations excessive sufficient to have a pharmacologic impact. Amiodarone might have an effect on the metabolism of quite a few medication, and the potential for medical influence is real. Affected medicine embody cyclosporine, simvastatin, digoxin, quinidine, procainamide, phenytoin, flecainide, -blockers, calcium channel antagonists, and warfarin. Chronic (>2 w) oral amiodarone impairs the metabolism of phenytoin, dextromethorphan, and methotrexate. A Breastfeeding Safety Drug Interactions References Summary Amitriptyline International Brand Names Drug Class Indications Mechanism - (Amicen; Amilent; Amyzol; Elavil; Larozyl; Pinsanu; Vanatrip) Log on to ExpertConsult. Epidemiologic research indicates an increased risk of preeclampsia in women taking tricyclic agents. Poor metabolizers have larger than expected plasma concentrations when given usual doses. These medication embrace quinidine, cimetidine, many other antidepressants, phenothiazines, and the kind 1C antiarrhythmics corresponding to propafenone and flecainide. Pregnancy Category: C Lactation Category: S (likely) � Amitriptyline must be used throughout pregnancy only if the profit justifies the potential perinatal risk.
Dan, 52 years: Although these extreme penalties were designed to curb the very real crack problem within the United States, the legal guidelines resulted in inequities that have been increasingly seen as problematic. Cocaine is metabolized quickly, with most of its effects dissipating 20 to eighty minutes after administration (Newton et al. I run about a $100, $150-a-day habit, so I even have to cop twice that a lot to hold my fence joyful. With progression of the illness, vasodilatation is accentuated, and cardiac output continues to increase.
Snorre, 36 years: Very small proportions of caffeine are also excreted in feces, saliva, semen, and breast milk. Cross-tolerance Tolerance to a drug or drugs by no means taken that results from protracted tolerance to one other drug or drugs (Chapter 5). One extensively publicized episode concerned Rudy Eugene, a Miami man who attacked and was chewing the face of his victim when he was shot and killed by police in May 2012. The distribution of consumption model has three central propositions (Rush & Gliksman, 1986; Schmidt & Popham, 1978).
Treslott, 25 years: Hepatopulmonary shunting and extrahepatic flow are evaluated on the preliminary 90Y shunt mapping research previous to remedy. Systematic review of ablation methods for the remedy of malignant or aggressive benign lesions in youngsters. When seen by a psychiatrist in the outpatient clinic, Connie is pale and skinny, wearing worn-out jeans and dark blue sweater. You learned in Chapter 1 that the overall prevalence of drug use masks important differences amongst subgroups of the population.
Miguel, 46 years: A mixture of behavioral and pharmacological remedies appears to work finest for these people. The anxiolytic effects of benzodiazepines are more selective than these of other depressants as a result of they relieve anxiety at doses that produce minimal sedation and motor impairment. For pack-a-day smokers, estimates common a hundred and fifty nicotine reinforcements a day, which equals about fifty five,000 a year. Though psychological dependence is common, no cases of physical dependence on nicotine have been identified.
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