Determination of vecuronium in blood by HPLC with UV and electrochemical detection: a pilot study in man

Vecuronium bromide is a non-depolarizing neuromuscular blocking agent with a rather low therapeutic level. Rapid, sensitive, and selective determination of vecuronium bromide in human blood or plasma was essential for pharmacokinetic study. We developed such a method using HPLC with electrochemical detection. Samples were first acidified, followed by a one-step liquid-liquid extraction. Tubocurarine, which has a structure similar to that of vecuronium, was used as the internal standard. The electrochemical detector, Ag/AgCl electrodes, was operated by setting the working electrodes, W1 and W2, at +0.65 V and +1.05 V, respectively. When vecuronium blood concentration was plotted versus peak area ratios (PAR) of vecuronium over tubocurarine, a linear relationship was observed over the range of 25 ng/mL to 500 ng/mL with a correlation coefficient greater than 0.997. Clinically possible sources of interference, such as atropine, apresoline, droperidol, fentanyl, labetalol, thiopentone, atracurium, and valium, were examined and none showed interference in the assay of vecuronium and tubocurarine. This method has been successfully applied in a preliminary study of the pharmacokinetics of vecuronium in a patient undergoing surgery. The low detection limit of this method in the patient was 3 ng/mL.

Selective depletion of CD8+ T lymphocytes for prevention of graft-versus-host disease after allogeneic bone marrow transplantation

The effects of selectively depleting CD8+ cells from donor bone marrow were assessed in 36 patients receiving transplantation from an HLA-identical sibling as treatment for leukemia. Donor bone marrow underwent ex vivo treatment using anti-Leu-2 monoclonal antibody and complement. Patients received cyclosporine post-transplant for 6 months. Thirty-three patients had initial engraftment. Three failed to have hematologic recovery, and one patient with initial engraftment had late graft failure. The actuarial incidence of grade greater than or equal to 2 acute graft-versus-host disease was 28% +/- 18% and was usually confined to the skin. Of 33 patients with engraftment, 32 were complete chimeras and one had mixed chimerism. The tempo of hematologic and immunologic recovery was comparable with that reported with transplantation of unmodified bone marrow, although CD4+ and CD8+ T cells recovered at comparable rates. The actuarial rate of leukemia relapse was 11% +/- 10%, occurring in three patients with acute leukemia but in none of 13 patients transplanted for chronic myelogenous leukemia. Actuarial survival was 57% +/- 17% at 2 years. These data indicate that after transplantation of marrow depleted of CD8+ cells, engraftment with prompt hematologic and immunologic recovery generally occurs, with a relatively low rate of acute graft-versus-host disease. Graft failure remains a problem despite retention of CD4+ cells within the donor marrow. The lack of leukemia relapse in patients with chronic myelogenous leukemia suggests retention of a graft-versus-leukemia effect, at least for this malignancy.

Postremission chemotherapy for adults with acute myelogenous leukemia: improved survival with high-dose cytarabine and daunorubicin consolidation treatment

Results of postremission chemotherapy for adults with acute myelogenous leukemia (AML) were assessed in two sequential prospective studies involving similar induction therapy and two courses of intensive consolidation treatment. Fifty-six patients achieving remission on the acute leukemia protocol (ALP3) study received high-dose cytarabine and daunorubicin as course one and standard-dose cytarabine and daunorubicin as course two. Results are compared with forty-six patients achieving remission on the ALP2 study who received azacitidine and doxorubicin as consolidation course one and standard-dose cytarabine, daunorubicin, and thioguanine as course two. The ALP3 regimen resulted in a significantly improved 5-year disease-free survival of 32% +/- 19% versus 20% +/- 11% for the ALP2 study (P = .03). Survival from remission was also improved, 40% +/- 14% versus 24% +/- 12% (P less than .01). Favorable prognostic factors for disease-free survival included receiving the ALP3 treatment regimen, absence of a prior preleukemic syndrome, and female sex. These factors and younger patient age were significant for survival following first chemotherapy and survival after achieving remission. Six of 34 patients who relapsed after receiving the ALP3 regimen successfully achieved prolonged second remissions with high-dose cytarabine-based chemotherapy and/or allogeneic bone marrow transplantation (BMT). Overall survival for adults less than or equal to 45 years of age was 58% +/- 19% with the ALP3 postremission chemotherapy regimen, comparable to most studies of BMT for AML in first remission. Actuarial 5-year survival for ALP3 patients greater than 60 years of age was 18% +/- 20% with no improvement compared with ALP2.

[Dose-response relationships of propofol in Chinese]

Propofol is a new intravenous anesthetic which possesses the rapid induction and recovery of anesthesia. It has been approved to be used in clinical anesthesia and critical care medicine since 1989. From the dose-response study of propofol, we can get the ED50 and induction dose of propofol and compare those with other anesthetics. Sixty young patients, ASA I-II, both sexes, were allocated into six groups of ten patients. All of patients did not receive premedicants. Groups I-VI were given intravenously over 25 sec 1.0 mg/kg, 1.2 mg/kg, 1.4 mg/kg, 1.6 mg/kg, 1.8 mg/kg and 2.0 mg/kg, respectively. Blood pressure and heart rate were monitored and recorded before and 1 min, 3 min, 5 min after the injection of propofol. Induction of anesthesia by propofol is considered to be successful as a patient closes his eyes and does not response to simple command. As a patient obeys the order to open his eyes, he is judged to emerge from anesthesia. Induction and recovery times were recorded in each successfully-induced patient. Data were analyzed using Litchfield and Wilcoxon, and Student's t tests. The ED50 of propofol was found to be 1.46 mg/kg (95% confidence interval: 1.35 mg/kg to 1.58 mg/kg). Induction and recovery times at 1.0 mg/kg, 1.2 mg/kg, 1.4 mg/kg, 1.6 mg/kg, 1.8 mg/kg and 2.0 mg/kg were 40 sec and 5.6 min, 38 sec and 6.0 min, 38 sec and 6.2 min, 36.8 sec and 6.7 min, 36.3 sec and 7.2 min, 35.5 sec and 7.2 min, respectively.(ABSTRACT TRUNCATED AT 250 WORDS)

Humoral immune response to cytomegalovirus Towne vaccine strain and to Toledo low-passage strain

Neutralization and immunoblot or immunoprecipitation assays of serum samples from seronegative or seropositive volunteers immunized with the attenuated Towne and challenged with the virulent Toledo cytomegalovirus strains were carried out. Titers of neutralizing antibodies differed as a function of the strain used for immunization. All serum samples with neutralizing activity detected a 58-kDa protein that is the abundant component of the major glycoprotein complex of the envelope, suggesting that this protein complex is involved in the induction of neutralizing antibodies. Complement-independent neutralizing activity was found to develop later than complement-dependent activity, and no correlation was observed between complement-independent titers of neutralizing antibodies and antibody to the 86-kDa protein, which bears a complement-independent neutralizing epitope. Antibodies to the 66-kDa major tegument protein were present early after infection but were not correlated with serum neutralizing activity.