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The visualisation of the small bowel by double contrast can be easily obtained by introduction of a suspension of barium sulphate, air insufflation, and parenteral administration of metoclopramide. Satisfactory demonstration of the entire small bowel by air and barium was obtained in 38 out of 40 unselected adult patients. There were no complications and no significant adverse reactions.
The ability of tiapride, a selective D2/D3 dopamine receptor antagonist, to exert discriminative stimulus control of responding was investigated by training rats to discriminate this drug (30 mg/kg) from saline in a two-lever, food-reinforcement procedure. Acquisition of tiapride discrimination required a relatively lengthy training period (mean of 76 sessions) but stable performance was maintained throughout the 18- month study. The dose of tiapride eliciting 50% tiapride-lever choice (ED50) was 2.2 mg/kg. After determination of the dose-effect curve with tiapride, substitution tests with several dopamine antagonists and other reference compounds were performed. All dopamine antagonists, including amisulpride (ED50 4 mg/kg), sulpiride (18 mg/kg), sultopride (1.5 mg/kg), clebopride (0.13 mg/kg), raclopride (0.16 mg/kg), metoclopramide (1.4 mg/kg), remoxipride (4.8 mg/kg), pimozide (2.7 mg/kg), thioridazine (3.4 mg/kg), olanzapine (0.97 mg/kg), chlorpromazine (1.9 mg/kg), risperidone (0.22 mg/kg) and haloperidol (0.14 mg/kg), except clozapine (>10 mg/kg), produced dose-dependent substitution for tiapride. Tiapride-like stimulus effects were observed at doses that decreased response rates. However, ED50 values for substitution by tiapride, amisulpride, sulpiride, sultopride, pimozide, clebopride and thioridazine were lower than ED50 values for decreasing responding. Additional studies were conducted to evaluate the ability of direct and indirect dopamine agonists to attenuate the tiapride discriminative stimulus. Pretreatment with d-amphetamine and nomifensine antagonized the discriminative stimulus effects of tiapride. Quinpirole, 7-OH-DPAT, bromocriptine and apomorphine partially blocked the stimulus effects of tiapride whereas SKF 38393 did not affect the discrimination. These results from substitution and antagonism tests indicated that the discriminative effects of tiapride are mediated by activity at D2/D3 dopamine receptors.
A sedation grade 2-3 was achieved with a perfusion rhythm of 3.6 +/- 1.4 micro g/min, in 20 +/- 22 minutes. In 89 patients (94.6%), the implant was performed only with remifentanil. Frequency of adverse events were nauseas/vomiting 21.3%, hypotension 5.3% and respiratory depression 1%. Remifentanil perfusion was discontinued in 3 patients (3.2%) due to appearance of adverse events. Another sedoanalgesic was used in 2 patients (2.1%).
Poly-pharmacy and use of antimicrobials without culture report is a common problem in CCU.
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Group A and B had similar basal PRL levels and no within group differences existed in response to metoclopramide, regardless of the day studied. Group A had lower PRL increments than group B from 60 to 120 minutes on days 14 and 21 (P less than 0.05); the peak increments also were lower on days 7, 14, and 21 (P less than 0.05).
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The relative affinity of metoclopramide as indicated by K(B) values was calculated in control and in haloperidol-withdrawn rats treated or not with monosialoganglioside-1 (GM1) by using dose-response curves constructed for apomorphine-induced stereotyped behavior. Haloperidol withdrawal decreased K(B) data--that is, increased the D2-receptor affinity for metoclopramide. GM1 treatment per se did not modify K(B) values but, when given in combination with haloperidol, GM1 induced a decrease in K(B) values. No differences were found in K(B) data when GM1 was administered after withdrawal from haloperidol.
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The lactopoesis with Cerucal and by laser acupuncture is stimulated, concerning fifty-four women with an early milk insufficiency. An increase of the quantity of the secreted mother's milk and an increase of the serum level of prolactin have been ascertained. Both methods for stimulating the milk secretion have been recommended. The plan of medical treatment by Cerukal is suitable in an early milk insufficiency of hypoprolactinemic origin. Laser acupuncture is applied successfully in milk insufficiency owning to stagnant and inflammatory changes in the lacteal gland.
Under fasting conditions and following metoclopramide administration duplicate measurements of serum immunoreactive PRL, bioactive PRL (PRL dependent Nb2 lymphoma cell assay) and immunoreactive TSH were performed. The molecular species of circulating PRL were determined by immunoblot analysis, CD4+ T lymphocytes by flow cytometry and the viral load using a nucleic acid sequence-based amplification assay.
Postoperative nausea and vomiting are common complications of anaestnesia. This double-blind clinical trial assessed the incidence of nausea and vomiting after cataract surgery with intravenous anaesthesia in 100 patients randomly assigned to preinduction placebo (saline), metoclopramide (10 mg), dexamethasone (8 mg) or the 2 drugs combined. The incidence of nausea in the recovery room was 44% with placebo, 20% with metoclopramide, 16% with dexamethasone and 8% with the combination. The incidence of vomiting was 20%, 4%, 4% and 0% respectively in the 4 groups. Metoclopramide plus dexamethasone combination significantly decreased nausea and vomiting both in the recovery room and 24 hours afterwards and is recommended for high-risk groups, especially in outpatient surgeries.
In this study, metoclopramide was compared with other pharmacological agents for preventing post-operative pain. Sixty Sprague-Dawley male rats, weighing 310-345 g were included in the study; 1 cm surgical incision, including skin, facia, and muscle was made to the plantar surface of rear foot of all anaesthetized rats. Rats were randomized into four groups. In group 1 (group S) 2 cm3 saline, in group 2 (group M) 2 cm3 metoclopramide (5 mg/kg) in group 3 (group T) 2 cm3 tramadol (45 mg/kg), in group 4 (group M+T) half doses of group M and group T was given intraperitoneally. Post-operative pain was assessed after 2 h, first and second days of incision. Post-operative pain scores were found to be significantly lower in group M, group T and group M+T when compared with the control group. But there was no significant difference between these groups. We concluded that metoclopramide, with low cost, fewer side-effects and being significantly effective for preventing post-operative pain, can be an alternative to tramadol.
Wound healing re-provides the morphological integrity after trauma. We investigated the effects of Metoclopramide and Ranitidine on survival of flat template McFarlane skin flaps in an experimental wound healing model.Rats (n:32) were randomly allocated in following groups: Flap control (Control), Metoclopramide(MET), Ranitidine(RAN) and Metoclopramide+Ranitidine (MET+RAN). After flap elevation, ip 10 mg/kg Ranitidin or 5 mg/kg Metoclopramide or the combination of both drugs were administered for 3 days. Next analgesia was maintained. No additional drugs were used for controls. On 10th day, whole cut skin flaps were excised, fixed in buffered formaldehyde and processed with histological techniques. Paraffine sections were stained with Hematoxylen-Eosin, Mallory-Azan and immunohistochemically with Desmin and Fibronectin and then evaluated with light microscopy.Experimental groups showed differences for epidermal degeneration, edema, hypertrophy of the hair follicles, neutrophil infiltration and areolar degeneration. Metoclopramide or Ranitidine administration positively impacts wound healing.This unique study emphasizes the importance of considering Metoclopramide or Ranitidine for possible adverse effects on flap survival in surgical clinics, therefore the combination of both drugs is not more effective.
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Yiru Tiaojing Granule, a traditional Chinese medicine formula, is used to treat hyperprolactinemia. This study was conducted to evaluate the mechanism of action and pharmacological activity of Yiru Tiaojing Granule on prolactin secretion. The animal model of hyperprolactinemia was induced by metoclopramide. The dopamine D2 receptor in hyperprolactinemia rat models was analyzed by immunohistochemistry. The biochemical parameters, including a follicle-stimulating hormone, luteinizing hormone, estradiol, progesterone, testosterone, and prolactin, were measured by an enzyme-linked immunosorbent assay. Furthermore, the expression of prolactin and the dopamine D2 receptor was analyzed by Western blotting. The components in the Yiru Tiaojing Granule-medicated serum were assayed by liquid chromatography-tandem mass spectrometry. The Yiru Tiaojing Granule significantly decreased the prolactin level in the hyperprolactinemia rat model, and increased the estradiol, luteinizing hormone, and progesterone levels. The high and medium doses of Yiru Tiaojing Granule reduced dopamine D2 receptor expression in the brain (p < 0.001) and produced a similar effect on bromocriptine (p < 0.001). Yiru Tiaojing Granule-medicated serum reduced (p < 0.001) prolactin expression in MMQ cells in a concentration-dependent manner, but had no effects on GH3 cells. The level of the dopamine D2 receptor in MMQ cells was also increased dose-dependently (p < 0.05). In addition, the protein kinase A and cyclic adenosine monophosphate in MMQ cells were significantly attenuated dose-dependently by treatment with a high and medium dose of Yiru Tiaojing Granule-medicated serum (p < 0.05) and bromocriptine-medicated serum (p < 0.01). The results suggested that Yiru Tiaojing Granule was effective against hyperprolactinemia, and the activation of the dopamine D2 receptor, which was related to the second messenger cyclic adenosine monophosphate and protein kinase A, might be the potential mechanism.
To assess the feasibility and complications of the laparoscopic approach to anterior lumbar fusion and to evaluate the ability of metoclopramide in conjunction with preoperative bowel preparation and early oral feeding to decrease postoperative ileus and reduce the length of hospital stay.
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These data suggest that MTP produces more effective analgesia than PET in both vascular and tension type headache in patients with acute primary headache episodes.
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To evaluate the effects of the oral aselective dopamine congener ibopamine, heart rate, blood pressure, cardiac rhythm, electrocardiographic (ECG) parameters and plasma catecholamines were studied in ten healthy subjects on three occasions: without medication, after 100 mg oral ibopamine and after combined treatment of ibopamine and the dopamine antagonist metoclopramide. Ibopamine was well tolerated by all subjects. No significant changes in heart rate or blood pressure were seen during either ibopamine alone or during concomitant metoclopramide administration. In addition, there were no differences in PR-, QRS- and QTc- intervals on the ECG and plasma norepinephrine, epinephrine and dopamine levels were unchanged. None of the ten volunteers showed proarrhythmia from ibopamine. However, in one subject, episodes of accelerated idioventricular rhythm were observed after ibopamine, which were asymptomatic and did not exceed a rate of 51 beats/minute. During concomitant metoclopramide infusion, ibopamine did not induce accelerated idioventricular rhythm. In conclusion, in healthy subjects ibopamine appears to be a safe drug and causes neither proarrhythmia, nor changes in heart rate, blood pressure, ECG-parameters, or plasma catecholamines.
Studies of normal luteal phase women have shown that increases in serum LH and PRL are commonly synchronous. This study was designed to investigate the possible neuroendocrine mechanism(s) underlying this phenomenon. Six normal women were studied during the midluteal phase of 2 cycles. In the first cycle, they had blood samples collected at 15-min intervals for 6 h on 3 occasions during which time they received an infusion of normal saline or naloxone (1 mg/h) or a bolus of metoclopramide (10 mg, iv). In a second cycle, they received GnRH in increasing iv doses of 1, 10, and 50 micrograms at 2-h intervals. During the saline infusion, 11 of the 16 serum LH pulses (69%) were accompanied by an increase in serum PRL, and in 5 of the subjects, the first pulse of LH was synchronous with that of PRL (P = 0.0015). Naloxone increased the number of LH pulses from 16 to 20 and the number of PRL pulses from 12 to 16, all of which were synchronous with LH pulses. Administration of metoclopramide caused a substantial increase in PRL and a loss of further PRL pulsatility; however, LH pulsatility remained unaffected. Even after the smallest dose of GnRH (1 microgram), there was an increase in serum PRL [basal level, 11.8 +/- 2.1 (+/- SE) micrograms/liter; peak level, 16.5 +/- 3.3 micrograms/liter] as well as LH and FSH. The increase in serum PRL was, unlike the gonadotropin response, maximal after the 10-microgram dose of GnRH (peak level, 23.2 +/- 6 micrograms/liter) and did not increase further after the 50-micrograms dose (peak level, 18.5 +/- 2.4 micrograms/liter). These studies demonstrate that there is a PRL response to GnRH in the luteal phase and suggest that the observed synchrony in LH and PRL secretion at this time results from a physiological response of both the gonadotrope and the lactotrope to endogenous GnRH.
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In order to investigate whether dopamine receptors are involved in the acute natriuretic effects of calcium channel blockade, experiments were carried out in humans with uncomplicated essential hypertension. In 8 hypertensives 5 mg intravenous nicardipine produced a large decrease in blood pressure and renal vascular resistance, a slight but significant increase in glomerular filtration rate (GFR) and marked natriuresis. When a second identical experiment was performed in the same subjects with the addition of 10 mg metoclopramide as dopamine blocker, changes in sodium excretion and vascular resistance were the same, but GFR did not increase during nicardipine. In a second set of experiments (n = 5) the same design was used, but nicardipine was infused at a dose of 0.01 mg/kg, ie, seven times less than in previous experiments. Under these conditions, blood pressure, renal vascular resistance and GFR did not change, but significant natriuresis occurred. Natriuresis was almost completely prevented by metoclopramide. In 5 additional hypertensives, metoclopramide alone was infused and 0.01 mg/kg nicardipine was added to the infusion. No change in any parameter was observed. Our findings suggest that the dopaminergic system participates in maintaining or increasing GFR during blood pressure reduction by calcium antagonists, although renal vasodilation and natriuresis are largely independent of dopamine receptor activity. In addition, when low doses of calcium antagonists produce natriuresis in the absence of renal or systemic hemodynamic changes (direct tubular effect), dopamine blockade is able to blunt this effect. This indicates a modulation by dopaminergic receptors of the direct tubular action of calcium antagonists.
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Evidence-based guidelines for the treatment of children with migraine are limited given the paucity of randomized controlled trials, especially in the emergency department (ED). Our objectives were to: (1) characterize the treatment of children with migraine in the ED; (2) determine whether treatment varies in pediatric versus mixed (pediatric and adult) EDs.
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The racemate and (+)- and (-)-isomers of fenfluramine (5 mg kg-1 i.p., 1 h pretreatment) antagonized cisplatin-induced retching and vomiting in the ferret. The intravenous injection of (+/-)-fenfluramine administered on an established cisplatin-induced emesis antagonized the response within minutes of injection. The administration of a lower dose of (+/-)-fenfluramine (1.0 mg kg-1 i.p., 1 h pretreatment) failed to antagonize cisplatin-induced emesis when administered alone but enhanced the antiemetic effects of metoclopramide and ICS 205-930. This pretreatment with (+/-)-fenfluramine failed to enhance the antiemetic effects of zacopride. It is considered that an action of the racemate on presynaptic 5-HT/catecholaminergic systems to reduce neurotransmitter release may enhance the action of certain 5-HT3 receptor antagonists in controlling emesis induced by cisplatin.
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We have compared the efficacy of ondansetron with droperidol and saline in the prevention of postoperative nausea and vomiting (PONV) in 120 ASA I and II patients undergoing hip and knee replacements and femoral resections. They received a standardized combined extradural and general anaesthetic and at the end of surgery were allocated randomly to receive droperidol 1.25 mg, ondansetron 4 mg or 0.9% saline in a 25-ml bag. An extradural mixture containing 0.5% plain bupivacaine 10 ml, fentanyl 500 micrograms and saline 30 ml was infused and PONV assessed for 24 h. Both ondansetron and droperidol were superior to saline in preventing vomiting (P < 0.01) although there was no significant difference between them. The incidence of vomiting was 17% for ondansetron, 18% for droperidol and 45% for saline. There was no significant difference in the incidence of nausea between the groups. Metoclopramide, the rescue antiemetric, was demanded by 38%, 34% and 17% of patients receiving saline, droperidol and ondansetron, respectively (ondansetron vs droperidol P < 0.05).
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Twenty-seven healthy females referred for legal abortion between the sixth and ninth week of pregnancy were treated for 1 week with either bromocriptine, metoclopramide or placebo. Serum prolactin was significantly (P < 0.01) elevated by metoclopramide and suppressed by bromocriptine. Despite a more than tenfold difference in circulating prolactin levels among these two groups, no significant difference was found in serum levels of progesterone, oestradiol, human chorionic gonadotrophin (hCG) human placental lactogen (hPL) or pregnancy specific B1-glycoprotein (SP1). These data suggest that circulating levels of prolactin below 150 ng/ml are without effect on either luteal or placental hormone secretion during early human pregnancy.
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The aim of this study was to assess the applicability and accuracy of the modified serum pancreolauryl test (sPLT) in patients with chronic pancreatitis (cP).
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Metoclopramide is known to enhance gastric emptying and stimulate duodenal and small-intestinal peristaltic activity. The effect of the drug on peroral jejunal biopsy was examined in a controlled, double-blind, randomized trial. Forty-nine patients (24 females and 25 males) who required jejunal biopsy for diagnostic purposes were admitted to the study. All the biopsies were performed by the same operator using the Quinton multipurpose suction biopsy tube and applying the same technique. Twenty-four patients ranging in age from 18 to 67 years (mean 44.5) received placebo intravenously (sodium metabisulfite), and 25 patients from 16 to 73 years old (mean 39.9) received 10 mg of metoclopramide intravenously prior to the jejunal intubation. Objective parameters of the study were (1) time in minutes required for the intubation at the biopsy site, ie, the area at the ligament of Treitz, and (2) fluoroscopy time. Intubation time in the placebo group was 22.3 +/- 1.9 min (mean +/- SEM) vs 11.3 +/- 1.4 min in the metoclopramide group (P less than 0.001). Fluoroscopy exposure time was 2.47 +/- 0.25 in the placebo group vs 1.40 +/- 0.12 min in the metoclopramide group (P less than 0.001). Subjective clinical evaluation of the operator's assessment of the procedure was based on a 0-4 scale (much easier = 0, easier = 1, average = 2, harder = 3, and much harder = 4). Metoclopramide administration resulted in a significantly easier performance of the procedure (P less than 0.001) but did not influence patient tolerance. Three patients who received metoclopramide and one receiving placebo developed mild to moderate drowsiness of short duration. The results of this controlled trial indicate that metoclopramide significantly shortens the time required for jejunal biopsy and reduces fluoroscopy exposure. Its regulatory action on gastrointestinal motility contributes to the easier performance of a valuable diagnostic procedure.