Nitric oxide (NO) is an inhibitory neurotransmitter released by non-adrenergic and non-cholinergic neurons that innervate the smooth muscles of the gastrointestinal tract. We examined whether NO, derived from a sustained-release preparation of isosorbide dinitrate, influenced gastric emptying and gastroduodenal motility after a meal. Eleven healthy volunteers participated in a double-blind, placebo-controlled, cross-over study. Each subject ingested 40 mg isosorbide dinitrate orally as a sustained-release formulation or oral placebo, in random order. Gastric emptying and gastroduodenal motility were measured using scintigraphic and manometric techniques. Isosorbide dinitrate did not change the area under the curve of gastric retention versus time, and did not influence the frequency of antral contractions as assessed at 15-min intervals or the integrated duodenal motility index, as recorded over consecutive 15-min periods. A 40 mg single dose of sustained-released isosorbide dinitrate does not seem to alter gastric emptying or gastroduodenal motility after a meal.
Background: Telestroke can improve ischemic stroke patient outcomes by improving access to physicians specialized in stroke care and increasing the rate of thrombolysis. The aim of this study to assess the effect of the newly implemented Telestroke service on ischemic stroke patient outcomes in New Brunswick, Canada, a province with a high rural population. Methods: By means of a retrospective chart review, data for 366 adult acute ischemic stroke patients (Telestroke = 15.3%; non-Telestroke = 84.7%) were collected from emergency departmentsspanning five sites in the province. Outcomes included home discharge rates, complications (i.e., hemorrhage,angioedema), mortality, rate of thrombolysis and time to treatment. Results: No significant differences emerged for home discharge rates, complications, mortality or door-to-needle time. Telestroke patients had a significantly greater rate of thrombolysis treatment (51.8% vs 6.1%) and significantly less door-to-CT time (M= 27.63 min vs M= 100.78 min) compared to the non-Telestroke group. Conclusions: Overall, both groups had similar outcomes with some trends toward improvements for patients utilizing Telestroke.
The effect of long-term treatment with alprenolol on left ventricular function was investigated in a controlled double-blind study of 15 patients with ischaemic heart disease (alprenolol 6, placebo 9), by measurement of systolic time intervals (STI). Significant prolongation of QS2I was observed in patients treated with alprenolol (p less than 0.05), while changes in PEPI, LVETI and PEP/LVET were all insignificant. The heart rate x systolic blood pressure product (RPP) was significantly reduced in the alprenolol group (p less than 0.05). The data suggest that long-term treatment with alprenolol did not impair left ventricular function as evaluated by STI, and that myocardial oxygen demand, assessed by RPP, was reduced during the treatment.
The PARAGON Investigators* Background-Unstable angina and non-Q-wave myocardial infarction involve coronary arterial plaque rupture, platelet activation, and thrombus formation. This study tested the benefit of different doses of lamifiban (a platelet IIb/IIIa antagonist) alone and in combination with heparin in patients with these conditions to select the most promising lamifiban regimen for subsequent evaluation. Methods and Results-At 273 hospitals in 20 countries, 2282 patients were randomly assigned to lamifiban (2ϫ2 factorial design: low-dose [1 g/min] with and without heparin versus high-dose [5 g/min] with and without heparin) or to standard therapy (placebo and heparin). All patients received aspirin. The composite primary end point of death or nonfatal myocardial infarction at 30 days occurred in 11.7% of those receiving standard therapy, 10.6% receiving low-dose lamifiban, and 12.0% receiving high-dose lamifiban (Pϭ0.668). By 6 months, this composite was lowest for those assigned to low-dose lamifiban (Pϭ0.027) and intermediate for those assigned to high-dose lamifiban (Pϭ0.450) compared with control (13.7%, 16.4%, and 17.9%, respectively). Compared with control, the combination of high-dose lamifiban and heparin resulted in more intermediate or major bleeding (12.1% versus 5.5%; Pϭ0.002) and a similar rate of ischemic events. Conversely, low-dose lamifiban and heparin yielded similar bleeding rates as in the control group but fewer ischemic events at 6 months (12.6% versus 17.9%; Pϭ0.025). Conclusions-In unstable angina and non-Q-wave infarction, platelet IIb/IIIa antagonism with lamifiban reduces adverse ischemic events at 6 months beyond that of aspirin and heparin therapy. The role of conjunctive heparin remains uncertain but appears more favorable with low-dose IIb/IIIa antagonism. Larger-scale study is needed to more reliably estimate these effects. (Circulation. 1998;97:2386-2395.)
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