Aminophylline for prevention of bradyarrhythmias induced by rheolytic thrombectomy

In patients with acute ST-elevation myocardial infarction or in those with thrombus-containing lesions, percutaneous coronary intervention (PCI) represents a clinical challenge to the interventionist, because coronary thrombus is a predictor of adverse outcomes. Thrombectomy, or the removal of thrombusfrom the infarct-related vessel prior to PCI, might improve clinical outcomes. The AngioJet Rheolytic Thrombectomy System (Possis Medical, Inc., Minneapolis, Minnesota) is commonly used to treat lesions containing thrombus burden. A complication of rheolytic thrombectomy is transient cardiac rhythm disturbances, specifically bradyarrhythmia requiring temporary pacing. Aminophylline, a methylxanthine and a competitive inhibitor of the adenosine receptor, may prevent rheolytic thrombectomy-associated bradyarrhythmias. This report describes the use of aminophylline alone to prevent rheolytic thrombectomy-induced bradyarrhythmias in a single tertiary care center.

Intracoronary aminophylline for management of bradyarrhythmias during thrombectomy with the AngioJet catheter

Thrombectomy with the AngioJet rheolytic thrombectomy catheter frequently causes bradyarrhythmias. This necessitates temporary pacemaker insertion and limits the device's use. Novel approaches for treatment of bradyarrhythmias are being tested. This article focuses on the evidence supporting the role of adenosine in bradyarrhythmias during thrombectomy and presents; data from a porcine model and the first human experience supporting the use of aminophylline, a competitive inhibitor of the adenosine receptor, via an intracoronary route, for prevention of bradyarrhythmias during thrombectomy.

[Study on the value of the formula of rapid synchronous stepwise increase in dosage of epinephrine combined with aminophylline (7 mg/kg) in cardiopulmonary resuscitation]

OBJECTIVE

To investigate the effect of application and clinical value of use of epinephrine in graduate increased dosage according to the equation G=(K+2n-1)mg/3 minutes (K=1,2,n=1,2...5,G< or =0.2 mg/kg) combined with aminophylline in cardiopulmonary resuscitation (CPR).

METHODS

Three hundred and seventy-six patients with sudden cardiac arrest(CA) were randomly divided into 3 groups. Epinephrine and aminophylline were given through cubital vein with following methods: (1)CONTROL: (n=130). 1 mg of adrenaline was given as the first treatment. Repeat the same every 3 minutes if there was no effect. (2) In one hundred and thirty cases, the first dose of epinephrine was K=1 mg (n=122), K=2 mg (n=124). In K=1 mg group,epinephrine 1 mg and aminophylline 7 mg/kg were given as the first dose. If it was not effective, increasing dosage of epinephrine in order of 2, 3...17 mg and aminopyrine 7 mg/kg was given intravenously successively every 3 minutes (K=1, 2, n=1, 2...5). In group 2 (group equation 2), epinephrine 2 mg and aminophylline 7 mg/kg were given rapidly intravenously. If not effective, the drugs were repeated according to the equation intravenously every 3 minutes. When the dose of epinephrine exceeded 0.2 mg/kg, it should be stopped. Electrocardiogram, mean arterial pressure (MAP), the heart rate (HR), and the time of recovery of spontaneous circulation (+ROSC) were monitored, and they were evaluated for the effectiveness of resuscitation.

RESULTS

(1)+ROSC rate (91.13%, 88.52%), the 24-hour survival rate (85.48%, 67.21%), the survival rate (49.19%, 31.15%), and the Glasgow coma scores [(13.12+/-1.27)scores, (12.28+/-1.32) scores] were all significantly elevated in groups in which patients received the modified regime compared with the control group [26.92%, 25.39%, 12.31% and (9.08+/-1.13) scores, all P<0.01]. The average time for +ROSC in the equation 2 and 1 groups was (8.93+/-3.27) minutes and (8.25+/-5.25) minutes, respectively, and they were significantly shorter than those of the control group [(39.25+/-9.75) minutes, both P<0.01]. (2) The average dose of the epinephrine was much reduced in achieving +ROSC in two groups with modified regimes as compared with control group [(11.75+/-3.25) mg and (13.85+/-5.15) mg, respectively vs. (24.65+/-4.35) mg, both P<0.05], and the number of using application epinephrine via intravenous from the CPR initial stage to +ROSC in the equation 2 and 1 groups was much significantly decreased compared with the control group [(3.45+/-0.55) times and (3.85+/-0.75) times vs. (18.25+/-0.75) times, both P<0.01].

CONCLUSION

The newly formed regime has better effects in increasing significantly the success rate of cardiac-resuscitation, the survival rate, and it also shortens the time for successful recovery of spontaneous circulation. It can improve the recovery of brain and nervous system function.

Aminophylline in bradyasystolic cardiac arrest

A short cut review was carried out to establish whether aminophylline improved return of spontaneous circulation rates and eventual outcome in bradyasystolic cardiac arrest. A total of 1154 papers were found using the reported searches, of which four presented the best evidence to answer the clinical question. The author, date and country of publication, patient group studied, study type, relevant outcomes, results and study weaknesses of these four papers are summarised in table 4. It is concluded that aminophylline offers no benefit in this situation.

Interleukin-6 attenuates hyperthermia-induced seizures in developing rats

Previous studies indicated that several cytokines influenced the seizure propensity in convulsive disorders and were the cause of encephalopathies in childhood. We studied the role of one inflammatory cytokine, interleukin-6 (IL-6), in hyperthermia-induced seizures in developing rats. Twenty-four male Lewis rats (23-28 days old) were divided into three groups (n=8/IL-6 (500 ng), IL-6 (50 ng), and saline control groups). We applied human recombinant IL-6 intra-nasally to developing rats 1h before seizures induced by moist heated air (50 degrees C). The seizure latency was defined as the time from hyperthermia onset until the appearance of continuous seizure discharges on electroencephalography (EEG), and the seizure duration as the duration of continuous spike and wave discharges on EEG. Five of the eight rats in the IL-6 (500 ng) group, two in the IL-6 (50 ng) group, and one in the control group exhibited no seizure discharges during the 360 s heating period. In these cases, the seizure latency time was regarded as 360 s and the seizure duration time as 0 s. The median seizure latency for the IL-6 (500 ng) group, 360 s (range: 256-360), was significantly longer than that for the control one, 249 (121-360) (P<0.05). The seizure duration for the IL-6 (500 ng) group, 0 s (0-20), was significantly shorter than that for the control one, 33 (0-76) (P<0.025). Also, the adenosine receptor antagonist, aminophylline, prevented these effects of IL-6 on hyperthermia-induced seizures. These results indicate that IL-6 plays an anti-convulsive role through the adenosine system in hyperthermia-induced seizures, which might be relevant as to human febrile seizures.

Reliability of salivary theophylline in monitoring the treatment for apnoea of prematurity

OBJECTIVE

To evaluate the reliability of salivary levels of theophylline in monitoring therapy of apnoea of prematurity.

STUDY DESIGN

Aminophylline was administered intravenously in 13 infants with apnoea, in a loading dose of 5 mg/kg and maintenance dose of 3 mg/kg, every 8 h. The patients were divided into two groups according to their postconceptional age (PCA): group A, of infants with small PCA (32.8+/-2.0 weeks; n=6 cases), and group B, infants with higher PCA (37.1+/-0.8 weeks; n=7 cases).

RESULTS

A total of 57 paired samples of serum and saliva were obtained in all 13 infants. The mean serum level of theophylline was 7.8+/-5.8 microg/ml and the ratio between serum and salivary concentration of theophylline was 1.53+/-0.28. A strong correlation between the serum and salivary concentration of theophylline (r=0.973) was found. Infants with small PCA had significant higher serum concentration of theophylline than those with higher PCA (10.6 vs 5.3 microg/ml; P=0.0002). The difference between the mean ratios of serum/salivary theophylline levels in the two groups was low (1.44 vs 1.62; P=0.0155).

CONCLUSION

The strong correlation of theophylline in serum and in saliva recommends the salivary levels as a reliable method for monitoring the treatment of apnoea of prematurity.

Aminophylline treatment of refractory bronchospasm in mechanically ventilated neonates: case report

BACKGROUND

The aim was to determine the effectiveness of continuous aminophylline infusion on refractory bronchospasm in long-term mechanically ventilated neonates.

CASE REPORT

Presented are seven newborns with gestational ages from 24 to 38 weeks and mean age at treatment of 29.7 days. All were mechanically ventilated from birth because of respiratory distress syndrome. Bronchospasm was diagnosed by wheezing, worsening of gas exchange, lengthening of expiratory time, and the need to modify the peak inspiratory pressure (PIP) to maintain the tidal volume. All patients had received conventional bronchodilator treatment for more than 24 hours before aminophylline treatment, without significant response. After discontinuation of previous bronchodilator drugs, an intravenous 6 mg/kg aminophylline bolus was administered over 20 minutes, followed by continuous infusions of 0.7 mg/kg/h for 12 hours and 0.35 mg/kg/h during the next 12 hours. Altogether, the treatment was carried out for 24 hours. Pulse-oximetry saturation (SpO(2)), transcutaneous pO(2)/pCO(2) (TcPO(2)/PCO(2)), heart rate, blood pressure, mean airway pressure (MAP), and fraction of inspired oxygen (FiO(2)) were recorded before and after the treatment. The SpO(2) (p<0.005) and TcPO(2) (p<0.002) increased significantly, while significant reductions in TcPCO(2) (p<0.00008) and FiO(2) (p<0.03) were observed. No signs of toxicity or significant differences in heart rate or blood pressure were reported. Mean serum aminophylline concentration resulted in therapeutic levels at both 12 and 24 hours.

CONCLUSIONS

It is suggested that continuous infusion of aminophylline is well tolerated and may prove useful in improving the gas exchange in long-term mechanically ventilated neonates with refractory bronchospasm.

Anaphylactoid shock in a patient following 5% human serum albumin infusion during off-pump coronary artery bypass grafting

A 59-year-old diabetic male patient undergoing off-pump coronary artery bypass grafting developed anaphylactoid shock after 5% human serum albumin (HSA) infusion started. During the first anastomosis, blood loss was more than 600 ml, with slightly decreased blood pressure. Therefore, 5% HSA, 250 ml, was infused against hypovolemia. However, as his blood pressure was decreasing continuously during the second anastomosis, another 250 ml of 5% HSA was added. The blood pressure rapidly dropped to 50/30 mmHg after the second 5% HSA administration started. As i.v. phenylephrine and ephedrine were not effective, norepinephrine was infused. Then we found a high cardiac output (10 l x min(-1)) and peak airway pressure (32 cmH(2)O), with a decrease of oxygenation (P/F ratio, 82), and we suspected 5% HSA-caused anaphylactic shock. Therefore, aminophylline was infused to treat bronchoconstriction. These treatments were effective, and the operation was successfully completed. Postoperatively, we noticed that these reactions may have been anaphylaxis, because the patient had a higher serum tryptase level (16.2 ng x ml(-1)) than the reported nonanaphylaxis serum tryptase level (8.23 ng x ml(-1)). HSA is a relatively safe colloid for use as a volume expander, because it has been reported that the risk of anaphylactoid reactions with HSA was much less than that with gelatins and dextrans, and similar to that with starches. However, the present case suggests that severe allergic reactions should be kept in mind with the use of any colloids.

Aminophylline for the treatment of symptomatic bradycardia and asystole secondary to cervical spine injury

INTRODUCTION

Bradycardia is a common complication of cervical spine damage in the weeks following injury, occurring in up to 100% of patients in some studies. Cardiac arrest and asystole have been reported in as many as 15% of these patients and cardiac events are the main cause of death within the first year. We describe the case of a 25-year-old African-American male involved in a motor vehicle collision who suffered C6-C7 subluxation.

METHODS

Following cervical discectomy and spinal fusion the patient began to develop progressive bradycardia culminating on hospital day 20 with two asystolic events requiring atropine administration. In an attempt to prevent further events and generate hemodynamic stability, aminophylline therapy was initiated.

RESULTS

Following day two of therapy, the patient's bradycardia resolved, and no further asystolic events occurred.

CONCLUSION

There is limited evidence for the use of methylxanthines in the treatment of bradycardia associated with spinal cord injury. In patients with recurrent asystolic events or symptomatic bradycardia the use of these agents should be considered.

Anti-hypoxia and anti-oxidation effects of aminophylline on human with acute high-altitude exposure

OBJECTIVE

To investigate the anti-hypoxia and anti-oxidation effects of aminophylline on human with acute high-altitude exposure.

METHODS

Totally 100 young male army members newly recruited from Sichuan province (400 meters above sea level) were enrolled. They were randomly divided into two groups: 50 in aminophylline group (A group) and 50 in control group (C group). A group and C group orally took aminophylline and placebo respectively for 10 days, 7 days before entering Lhasa (3 658 meters above sea level) by air and 3 days after it. Several parameters were measured at three time points: before drug taken, 7 days after drug taken, and 3 days after ascending high altitude. These parameters included serum levels of nitric oxide (NO), superoxide dismutase (SOD), catalase (CAT), hydrogen dioxide (H2O2), lactic acid (LA), as well as arterial oxygen saturation (SO2), arterial oxygen partial pressure (PaO2), and arterial carbon dioxide partial pressure (PaCO2). Statistical analysis was conducted to compare the difference between two groups with Stata 7.0 software system.

RESULTS

There were no statistical differences between groups in hypoxia and oxidation indicators before and after drug taken in plain area. Three days after ascending high altitude, the serum levels of SOD, CAT, H2O2, LA, PaCO2 increased in both groups, yet to a much larger degree in C group than A group (P < 0.01); and NO, SO2, PaO2 decreased more markedly in C group (P < 0.05 for NO, P < 0.0001 for SO2 and PaO2).

CONCLUSION

Aminophylline has significant anti-hypoxia and anti-oxidation effects at high altitude.

A rare complication of chlorine gas inhalation: pneumomediastinum

Chlorine gas is a potent pulmonary irritant that causes acute damage in both the upper and lower respiratory tract.

Doxapram and aminophylline on bispectral index under sevoflurane anaesthesia

BACKGROUND AND OBJECTIVE

To evaluate and compare the effect of two clinically available central nervous system stimulants, namely doxapram and aminophylline on arousal from sevoflurane anaesthesia and bispectral index.

METHODS

This randomized, double-blind, placebo-controlled, prospective study was conducted in 90 adult females, ASA I-II, scheduled for elective lower abdominal surgeries at Taipei Medical University Hospital. At 5 min before the completion of surgery, under sevoflurane anaesthesia, patients were divided into three groups to receive doxapram 1 mg kg(-1), aminophylline 2 mg kg(-1) or saline placebo intravenous. Standard vital signs, end-tidal CO(2), end-expiratory sevoflurane concentration, bispectral index and neuromuscular blockade were measured plus clinical parameters of recovery from general anaesthesia.

RESULTS

Compared with the control group, patients receiving doxapram or aminophylline showed a similarly faster recovery from sevoflurane anaesthesia correlated with increase in bispectral index.

CONCLUSION

Intravenous administration of doxapram 1 mg kg(-1) or aminophylline 2 mg kg(-1) hastened the early recovery from sevoflurane anaesthesia. The arousal effect of aminophylline and doxapram appears to be similar.

Aminophylline in bradyasystolic cardiac arrest: a randomised placebo-controlled trial

BACKGROUND

Endogenous adenosine might cause or perpetuate bradyasystole. Our aim was to determine whether aminophylline, an adenosine antagonist, increases the rate of return of spontaneous circulation (ROSC) after out-of-hospital cardiac arrest.

METHODS

In a double-blind trial, we randomly assigned 971 patients older than 16 years with asystole or pulseless electrical activity at fewer than 60 beats per minute, and who were unresponsive to initial treatment with epinephrine and atropine, to receive intravenous aminophylline (250 mg, and an additional 250 mg if necessary) (n=486) or placebo (n=485). The patients were enrolled between January, 2001 and September, 2003, from 1886 people who had had cardiac arrests. Standard resuscitation measures were used for at least 10 mins after the study drug was administered. Analysis was by intention-to-treat. This trial is registered with the ClinicalTrials.gov registry with the number NCT00312273.

FINDINGS

Baseline characteristics and survival predictors were similar in both groups. The median time from the arrival of the advanced life-support paramedic team to study drug administration was 13 min. The proportion of patients who had an ROSC was 24.5% in the aminophylline group and 23.7% in the placebo group (difference 0.8%; 95% CI -4.6% to 6.2%; p=0.778). The proportion of patients with non-sinus tachyarrhythmias after study drug administration was 34.6% in the aminophylline group and 26.2% in the placebo group (p=0.004). Survival to hospital admission and survival to hospital discharge were not significantly different between the groups. A multivariate logistic regression analysis showed no evidence of a significant subgroup or interactive effect from aminophylline.

INTERPRETATION

Although aminophylline increases non-sinus tachyarrhythmias, we noted no evidence that it significantly increases the proportion of patients who achieve ROSC after bradyasystolic cardiac arrest.

A survey of consultant practice: intravenous salbutamol or aminophylline for acute severe childhood asthma and awareness of potential hypokalaemia

British Thoracic Society guidelines recommend intravenous salbutamol or aminophylline for acute severe asthma in children. In the survey reported here, 133 consultant paediatricians completed a questionnaire aimed at evaluating their choice of intravenous bronchodilator for acute severe asthma and their awareness of subsequent hypokalaemia. Of the non-Paediatric Intensive Care Unit (PICU) consultants who responded, 82%, including respiratory paediatricians, reported using aminophylline; in contrast, PICU consultants were significantly more likely to use salbutamol (p=<0.001). There was a lack of awareness that hypokalaemia occurs with aminophylline: 50% of the consultants suggested that hypokalaemia was rare or did not occur. Consultants using intravenous aminophylline were significantly less likely to recheck serum potassium levels than those using intravenous salbutamol (p=0.03). Based on the completed questionnaires, salbutamol infusions are rarely used outside the PICU, and the awareness of potential hypokalaemia following intravenous bronchodilator treatment is variable. It would appear, therefore, that standardised clinical practice is required in order to recognise and treat potential hypokalaemia.

[Severe bradycardia in an asymptomatic young subject: is there an indication to permanent cardiac pacing?]

Bradycardic effects of severe weight loss are well known like those observed in anorexia nervosa resulting from an increase in vagal tone associated with a low calorie-protein diet. We here report the case of a 19-year-old patient with asymptomatic severe bradycardia, which developed after voluntary weight loss of more than 30 kg during a few months. In absence of symptoms, ventricular arrhythmia or structural heart disease, and owing to normal ventricular function, no permanent pacemaker implantation was undertaken. After a follow-up of more than 15 years, clinical conditions are stable, the patient is asymptomatic and bradycardic, and no changes in weight are reported.

Oral xanthines as maintenance treatment for asthma in children

BACKGROUND

Xanthines have been used in the treatment of asthma as a bronchodilator, though they may also have anti-inflammatory effects. The current role of xanthines in the long-term treatment of childhood asthma needs to be reassessed.

OBJECTIVES

To determine the efficacy of xanthines (e.g. theophylline) in the maintenance treatment of paediatric asthma.

SEARCH STRATEGY

A search of the Cochrane Airways Group Specialised Register was undertaken with predefined search terms. Searches are current to May 2005.

SELECTION CRITERIA

Randomised controlled trials,lasting at least four weeks comparing a xanthine with placebo, regular short-acting beta-agonist (SABA), inhaled corticosteroids (ICS), cromoglycate (SCG), ketotifen (KET) or leukotriene antagonist, in children with diagnosed with chronic asthma between 18 months and 18 years old.

DATA COLLECTION AND ANALYSIS

Two reviewers independently selected each study for inclusion in the review and extracted data. Primary outcome was percentage of symptom-free days.

MAIN RESULTS

Thirty-four studies (2734 participants) of adequate quality were included. Xanthine versus placebo (17 studies): The proportion of symptom free days was larger with xanthine compared with placebo (7.97% [95% CI 3.41, 12.53]). Rescue medication usage was lower with xanthine, with no significant difference in symptom scores or hospitalisations. FEV1 , and PEF were better with xanthine. Xanthine was associated with non - specific side-effects. Data from behavioural scores were inconclusive. Xanthine versus ICS (four studies) : Exacerbations were less frequent with ICS, but no significant difference on lung function was observed. Individual studies reported significant improvements in symptom measures in favour of steroids, and one study reported a difference in growth rate in favour of xanthine. No difference was observed for study withdrawal or tremor. Xanthine was associated with more frequent headache and nausea. Xanthine versus regular SABA (10 studies): No significant difference in symptoms, rescue medication usage and spirometry. Individual studies reported improvement in PEF with beta-agonist. Beta-agonist treatment led to fewer hospitalisations and headaches. Xanthine was associated with less tremor. Xanthine versus SCG (six studies ): No significant difference in symptoms, exacerbations and rescue medication. Sodium cromoglycate was associated with fewer gastro-intestinal side-effects than xanthine. Xanthine versus KET (one study): No statistical tests of significance between xanthine and ketotifen were reported. Xanthine + ICS versus placebo + same dose ICS (three studies) : Results were conflicting due to clinical/methodological differences, and could not be aggregated.

AUTHORS' CONCLUSIONS

Xanthines as first-line preventer alleviate symptoms and reduce requirement for rescue medication in children with mild to moderate asthma. When compared with ICS they were less effective in preventing exacerbations. Xanthines had similar efficacy as single preventative agent compared with regular SABA and SCG. Evidence on AEs (adverse effects) was equivocal: there was evidence for increased AEs overall, but no evidence that any specific AE (including effects on behaviour and attention) occurred more frequently than with placebo. There is insufficient evidence from available studies to make firm conclusions about the effectiveness of xanthines as add-on preventative treatment to ICS, and there are no published paediatric studies comparing xanthines with alternatives in this role. Our data suggest that xanthines are only suitable as first-line preventative asthma therapy in children when ICS are not available. They may have a role as add-on therapy in more severe asthma not controlled by ICS, but further studies are needed to examine this, and to define the risk-benefit ratio compared with other agents.

Serum thyroid hormones in preterm infants: associations with postnatal illnesses and drug usage

CONTEXT

Transient hypothyroxinemia is common in infants less than 30 wk gestation and is associated with neurodevelopmental deficits. Reductions in T4 and T3 levels with TSH unchanged are the key features of severe illness using surrogate indices of overall severity of illness, but these do not inform the impact of individual disease conditions or drug use.

OBJECTIVE

Our objective was to investigate the contribution of postnatal factors to the variations in serum levels of iodothyronines, thyroid-binding globulin, and TSH.

DESIGN

We recruited a cohort of infants (23-34 wk gestation; n = 780) between January 1998 and September 2001.

SETTING AND PATIENTS

The study involved 11 level III Scottish neonatal intensive care units and included cohorts of infants delivered at 23-34 wk gestation.

MAIN OUTCOME

We assessed serum levels of iodothyronines, thyroid-binding globulin, and TSH at 7, 14, and 28 d adjusted for the potentially significant postnatal influences (n = 31).

RESULTS

Serum levels of TSH, free T4, T3, and T4 are variably but significantly associated with bacteremia, endotracheal bacterial cultures, persistent ductus arteriosus, necrotizing enterocolitis, cerebral ultrasonography changes, oxygen dependence at 28 d, and the use of aminophylline, caffeine, dexamethasone, diamorphine, and dopamine.

CONCLUSIONS

There are many more associations of postnatal factors with transient hypothyroxinemia than had previously been considered in preterm infants. Alternative strategies should be considered for correction of hypothyroxinemia rather than sole reliance on the direct therapy of hormone replacement. A more oblique preventative approach may be necessary through reduction in the incidence or severity of individual illness(es). Similarly, alternatives to those drugs that interfere with the hypothalamic-pituitary-thyroid axis should be evaluated (e.g. other inotropics instead of dopamine).

Effect of Oral Aminophylline on Pulmonary Function Improvement and Tolerability in Different Age Groups of COPD Patients

BACKGROUND

Aminophylline therapy in elderly patients with COPD is rarely studied. This study attempted to explore the symptoms, pulmonary function improvement, and adverse events related to aminophylline therapy in COPD patients of different age groups.

METHODS AND RESULTS

We designed a 10-week prospective study. Two groups of COPD patients were classified based on age (30 patients in group 1, 55 to 74 years old; 30 patients in group 2, 75 to 90 years old), with matched disease severity. After stopping all methylxanthines for 2 weeks in the washout period, therapy began with long-acting 225-mg aminophylline compounds bid po for 8 weeks. Pulmonary functions, respiratory symptoms, and laboratory examinations were checked at the initial visit and at every 4-week visit. After aminophylline therapy, the drug serum level showed no significant difference in either group (9.73 +/- 6.35 mg/dL [+/- SD] in group 1 and 7.82 +/- 6.68 mg/dL in group 2, p = 0.359). Improvements of FEV1 and FVC were noted in both groups; however, there was no significant difference. Peak expiratory flow rate (PEFR) was significantly improved in group 1 but not in group 2 (group 1, from 3.51 to 3.97 L/s, p < 0.05; group 2, from 2.78 to 3.08 L/s, p > 0.05). The degree of improvement in symptom scores was not different between the groups, except there was significantly less chest tightness in group 2 (from 0.79 +/- 0.74 to 0.40 +/- 0.50, p < 0.05). Electrolyte imbalance and arrhythmia did not appear in either group.

CONCLUSIONS

Our study demonstrated that the safety and drug concentration of aminophylline at a standard dose are not different in the sixth to ninth decades of COPD patients. Younger patients have more improvement in PEFR than older patients; however, older COPD patients have more symptoms relief in chest tightness after aminophylline therapy.

[Clarkson syndrome: a rare clinical condition characterized by generalized edema associated to monoclonal gammopathy]

Generalized edema is commonly due to cardiac failure, renal changes, hepatic and metabolic disturbances, or it can be idiopathic, i.e. primitive lymphedema. Here we describe a patient with several episodes of fluid extravasation characterized by hypotension, hemoconcentration and functional renal insufficiency. These findings, associated to a monoclonal gammopathy, lead to the diagnosis of systemic capillary leak syndrome or Clarkson Syndrome. This rare and perplexing disorder, characterized by a typical three-phase clinical feature, is due to an endothelium permeability alteration, rather responsible of these paroxysmal manifestations. Interleukin-2-pathway is considered as one of the underlying mechanisms. During acute phase the patient underwent therapy with plasma-expanders and glucocorticoids, although in quiescent phase we administered aminophylline, salbutamol and prednisone. After three months, the patient is asymptomatic.