Conservative management of eclampsia and severe pre-eclampsia--A Bangladesh experience.
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OBJECTIVE: To observe whether the pregnancy can be safely continued for a reasonable period to gain fetal maturity in cases of eclampsia and severe pre-eclampsia. METHODS: Fifty-one patients were followed up in a specialized care (eclampsia) unit in Dhaka Medical College and Hospital between January 1998 and October 2000. Twenty-one patients with complaints of headache and blurred vision, and 30 patients with history of convulsion, all at gestational age < 36 weeks, were enrolled for this study. Magnesium sulfate was used to prevent convulsion in severe pre-eclampsia and to control convulsion in eclampsia. After conducting a baseline assessment, pregnancy was continued to gain fetal maturity. Patients were monitored closely. Diastolic blood pressure, 24-hour urinary total protein (UTP), and serum uric acid were chosen as the main parameters to detect the deterioration of a patient's condition. Pregnancy was terminated when deterioration occurred, as determined clinically or by 1 or more of the above parameters. Dexamethasone was used during the waiting period for fetal lung maturity. Patient outcomes were analyzed. RESULTS: At admission, the patients' mean gestational age ( SD) was 30.65 2.38 weeks, and the range was 24-34 weeks. Mean diastolic blood pressure was 109.06 11.61 mm Hg, 24-hour UTP was 2.25 1.73 g/24 h, and serum uric acid level was 5.5 1.12 mg/dL. Pregnancy was continued for a mean of 13.27 8.26 days (range, 3-35 days). Thirty-two babies (62.75%) with birth weight 1.0-2.5 kg (2.02 0.45) were born alive. Six of them (18.75%) weighing between 1.0 and 1.5 kg at birth were referred to the intensive care unit, and 1 (3.13%) weighing 1 kg at birth died within 5 minutes after birth. Among live-born babies, 93.75% were in good condition at the time of discharge from the hospital. Intrauterine death occurred in 19 (37.25%).cases. Twelve of them delivered spontaneously within 7 days of death and 7 required induction. In all cases, maternal condition was satisfactory. CONCLUSION: In carefully selected cases and with close supervision, pregnancy may be continued in women with eclampsia and severe pre-eclampsia to increase fetal maturity without increasing the risk to the mother. (+info)
Management of life-threatening autonomic hyper-reflexia using magnesium sulphate in a patient with a high spinal cord injury in the intensive care unit.
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We report the successful use of i.v. magnesium sulphate to control life-threatening autonomic hyper-reflexia associated with chronic spinal cord injury in the intensive care environment. A 37-yr-old, male was admitted to the intensive care unit with a diagnosis of septic shock and acute renal failure secondary to pyelonephritis. He had been found unresponsive at home following a 2-day history of pyrexia and purulent discharge from his suprapubic catheter. He had sustained a T5 spinal cord transection 20 yr previously. Initial management included assisted ventilation, fluid resuscitation, vasopressor support, and continuous veno-venous haemofiltration. The sepsis was treated with antibiotic therapy and percutaneous nephrostomy drainage of the pyonephrosis. On the fifth day, the patient developed profuse diarrhoea. This was associated with paroxysms of systemic hypertension and diaphoresis, his arterial pressure rising on occasion to 240/140 mm Hg. A diagnosis of autonomic hyper-reflexia was made and a bolus dose of magnesium sulphate 5 g was administered over 15 min followed by an infusion of 1-2 g h(-1). There was an almost immediate decrease in the severity and frequency of the hypertensive episodes. There were no adverse cardiac effects associated with the administration of magnesium, only a slight decrease in minute ventilation as the plasma level approached the upper end of the therapeutic range (2-4 mmol litre(-1)). In view of the beneficial effects observed in this case we advocate further research into the use of magnesium sulphate in the treatment or prevention of autonomic hyper-reflexia secondary to chronic spinal cord injury in the intensive care unit. (+info)
Comparative antithrombotic effects of magnesium sulfate and the platelet glycoprotein IIb/IIIa inhibitors tirofiban and eptifibatide in a canine model of stent thrombosis.
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BACKGROUND: Antithrombotic effects of glycoprotein IIb/IIIa inhibitors and magnesium are known, but their comparative effects on stent thrombosis are not known. Our objective was to compare the antithrombotic effects of the glycoprotein IIb/IIIa inhibitors tirofiban and eptifibatide with magnesium in an ex vivo canine arteriovenous shunt model of stent thrombosis. METHODS AND RESULTS: Control nitinol stents were expanded to 2 mm in diameter in a tubular perfusion chamber interposed in the shunt and exposed to flowing arterial blood at a shear rate of 2100 s(-1) for 20 minutes (n=398 perfusion runs in 24 experiments in 8 dogs). The animals were treated intravenously with MgSO4 (2 g bolus x 20 minutes followed by 2 g/h infusion), eptifibatide (double bolus of 180 microg/kg 10 minutes apart followed by 2 microg/kg per minute), or tirofiban (0.3 microg/kg per minute), with or without heparin (50 U/kg). Effects of the test agents on thrombus weight, platelet aggregation (PA), platelet CD62 expression, bleeding time (BT), heart rate, and mean arterial blood pressure were assessed. Treatment with Mg+heparin reduced stent thrombus weight by 78+/-10% compared with baseline (19+/-4 mg, P<0.001). The antithrombotic effect of Mg+heparin was equivalent to that observed with tirofiban+heparin (78+/-13%) and eptifibatide+heparin (84+/-11%). Magnesium had no significant effect on PA and BT. Tirofiban and eptifibatide inhibited PA by >90% and prolonged BT up to 20 minutes. None of the test agents had effects on CD62 expression or activated clotting time. There were no significant bleeding or hemodynamic complications. CONCLUSION: Magnesium produced a significant reduction in acute stent thrombus formation that was equivalent in magnitude to that produced by clinically relevant doses of tirofiban and eptifibatide. Its potential use in percutaneous coronary intervention requires further study. (+info)
Serum calcitonin-lowering effect of magnesium in patients with medullary carcinoma of the thyroid.
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The effect of magnesium chloride or magnesium sulfate infusion on circulating levels of immunoreactive calcitonin (iCT) was evaluated on nine occasions in three patients with metastatic medullary carcinoma of the thyroid. One patient was normocalcemic and had normal circulating levels of immunoreactive parathyroid hormone (iPTH), one patient was hypocalcemic and had surgical hypoparathyroidism, and one patient had mild to moderate hypercalcemia associated with bone metastases. The basal serum iPTH levels were undetectable in the latter two patients. In every instance magnesium administration produced a rapid and striking fall in circulating iCT and usually a detectable fall in serum calcium. During the hypermagnesemic state, serum iPTH fell from normal to undetectable in the patient with normal parathyroid function, while serum iPTH levels remained undetectable in the hypoparathyroid patient and in the patient with hypercalcemia associated with bone metastases. The results of these studies indicate that: (a) contrary to what has been reported in normal experimental animals, magnesium administration lowers circulating iCT in human subjects with thyroid medullary carcinoma and (b) the calcium-lowering effect produced by magnesium in patients with medullary carcinoma may, in part at least, be due to a redistribution of body calcium that is not mediated by the actions of either parathyroid hormone or clacitonin. (+info)
Life-threatening hypokalaemia and quadriparesis in a patient with ureterosigmoidostomy.
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We report quadriparesis as a result of severe hypokalaemia and acidosis in a 50-year-old man who had undergone ureterosigmoidostomy for bladder extrophy 48 years earlier. Aggressive suppletion with intravenous potassium and bicarbonate combined with potassium-sparing diuretics and ACE inhibitors resulted in complete restoration of the serum potassium and resolution of the neurological symptoms. The underlying mechanism as well as the treatment of hypokalaemia and hyperchloraemic metabolic acidosis after ureterosigmoidostomy are briefly discussed. (+info)
The impact of longissimus glycolytic potential and short-term feeding of magnesium sulfate heptahydrate prior to slaughter on carcass characteristics and pork quality.
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The objective of this study was to compare the effects of longissimus glycolytic potential (GP) and of time of feeding of supplemental magnesium sulfate heptahydrate on carcass and pork quality traits. The study was carried out in a 2 x 2 x 4 factorial arrangement; the treatments were sex (castrate vs gilt), GP (Low [normal] vs High), and time of feeding of magnesium sulfate-fortified diets (0 [control] vs 2 vs 3 vs 5 d prior to slaughter). Glycolytic potential was determined on a biopsy sample of longissimus from the live animal prior to the start of the study. A total of 144 pigs were allotted to the feeding-time treatments on the basis of sex (castrate and gilt), weight, and GP. Pigs were placed in individual pens and had free access to water. Prior to the start of the study, pigs were given ad libitum access to a standard finisher diet. During the study, animals were fed at a fixed level of 2.75 kg of a standard finisher diet/day; the fortified diet contained 3.2 g/d of additional magnesium. At the end of the feeding period, animals were transported to a commercial packing facility and slaughtered within 15 min of arrival. Fresh meat quality was measured on the longissimus. There were no treatment interactions. Carcass traits were similar across time of feeding treatments. Backfat thickness at the last lumbar vertebra and 10th rib were lower (P < 0 .05) for High than for Low GP pigs. High GP pigs had lower ultimate pH (P < 0.001) and higher drip (P < 0.05) and purge loss (P < 0.01) than Low GP pigs. Drip loss was reduced (P < 0.05) for pigs fed the magnesium-fortified diet for 5 and 2 but not for 3 d compared to controls (8.98, 7.29, 7.89, and 7.41 for the 0-, 2-, 3-, and 5-d treatments, respectively, SEM 0.447). Purge loss was similar for all of the time of feeding treatments. Longissimus L* values were lower (P < 0.05) for the 2-d treatment than for the controls. Results from this study suggest an inconsistent effect of short-term feeding of magnesium sulfate on muscle color and drip loss in pigs with both Low (normal) and High GP. (+info)
Independent induction of two blue light-dependent monovalent anion transport systems in the plasma membrane of Monoraphidium braunii.
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In the plasma membrane of the green alga Monoraphidium braunii there are at least two monovalent anion transport systems. One of them is specific for bicarbonate. This transport system is activated by blue light and its induction is triggered by a decrease in the external CO2 concentration. The second transport system is responsible for nitrate uptake at least. This transport system is also activated by blue light and its induction occurs when there is no ammonium in the external medium. Both transport systems are synthesized independently. Hence, when M. braunii cells grow with nitrate as the only nitrogen source under high CO2, they have a nitrate transport system but lack a bicarbonate transporter. Conversely, cells grown with ammonium under low CO2, have a bicarbonate transport system but lack a nitrate transporter. Both transport systems are induced in cells irradiated with white light in the absence of a carbon source, suggesting that there may be precursors in the plasma membrane that only need the synthesis and assembly of some component(s) to become fully active. The induction of nitrate and nitrite reductases, however, only takes place when a carbon source is supplied to the cells. (+info)
In vitro fusion of plant Golgi membranes can be influenced by divalent cations.
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The fusogenic activity of plant Golgi membranes was studied in a cell-free system by assaying lipid mixing and content leakages of fluorescence probes. Golgi membranes from mung bean (Vigna radiata L.) hypocotyl cells fused to liposomes in the absence of any cytosolic proteins and nucleotides. It was demonstrated that the fusion was mediated by integral membrane protein(s), and was influenced by divalent cations (mm). Mg(2+), Ca(2+), and Mn(2+) ions enhanced the lipid mixing by reducing repulsive forces between membranes. In the content leakage assay, Mg(2+) ions also showed a stimulative effect. However, other divalent cations were inhibitory. It is suggested that the fusion system of Golgi membranes comprises at least two components: one that mediates the formation of fusion intermediates prior to pore opening, and one that mediates the subsequent processes. The latter must be sensitive to divalent cations at millimolar concentrations. The fusion of Golgi and biological membranes was induced by divalent cations. We speculated about the biological role of the fusion system studied here. (+info)