Central nervous system toxicity of H2-receptor antagonists has rarely been confirmed by the respective elevated cerebrospinal fluid drug concentrations. We observed two hemodialyzed neurosurgical patients in whom mental deterioration and convulsions developed after intravenous famotidine therapy (10 and 40 mg/day). Their cerebrospinal fluid drug concentrations were grossly elevated (i.e., 160 and 249 ng/ml) compared with those obtained from three other hemodialyzed neurosurgical patients who exhibited no central nervous system reactions (i.e., 47 to 85 ng/ml). In addition, the mean cerebrospinal fluid/plasma drug concentration ratio obtained from these five neurosurgical patients with renal failure (i.e., 0.46) and that from 10 other neurosurgical patients with normal renal function (i.e., 0.41) were about four times greater than that previously reported from non-neurosurgical patients with normal renal function (i.e., 0.12). Our observation suggests that patients with not only renal dysfunction but also following neurosurgical operations have an excessive accumulation of famotidine in the central nervous system and are more susceptible to the drug-induced adverse central nervous system reactions.
siveness when faced with multiple choices because of the dilemma posed by this choice. These persons need a developed theoretical grounding in order to justify their choice. An evaluation programme of the teaching of emergency practices has been developed in order to exploit the answers to a questionnaire offered to more than 7,000 first-aiders trained each year. This programme was designed for a Macintosh computer. It analyses four types of information: 1) personal details (profession, age) which remain confidential; 2) information concerning the training of the individual; 3) training course, quality, organization, teaching methods used, etc.; 4) answers to 10 questions concerning their knowledge of the CPR programme; the assessment of a victim, recovery position, mouth-to-mouth ventilation, chest compressions; and 5) steps to take when faced with: a) haemorrhage; b) heart attack; c) suffocation; d) electrocution; etc. The questions relating to the assessment of the level of knowledge can be modified without disrupting the comparative analysis from year to year. Thus, with the help of the programme, it is possible to devise a validation or non-validation of the choice of teaching practices.
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