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Byline: Giovanni Bertini, Cristina Giglioli, Annibale Biggeri, Massimo Margheri, Ignazio Simonetti, Maria Luce Sica, Laura Russo, Gianfranco Gensini Abstract: Study objective: We sought to assess the effect of nitrates on prehospital mortality among patients with acute pulmonary edema (APE). Methods: The study involved a retrospective evaluation of the records of prehospital outcome in 640 patients with APE rescued by the mobile CCU (MCCU) of Florence, Italy, between January 1980 and December 1991. The MCCU serves an urban environment with a population of 400,000 in a 102-sq km area. In the years 1980 through 1983, patients were treated with oxygen, morphine, furosemide, digoxin, nitrates, aminophylline, or dopamine, according to the attending physician's judgment. From 1984 through 1991, new guidelines for the use of intravenous nitrates, based on differential treatment according to blood pressure, were in use. Results: Overall prehospital mortality rate for APE in all patients was 7.8% (50 of of 640 patients). Mortality after 1984 was significantly lower than before (5.3% versus 13%, P Article History: Received 25 March 1996; Revised 7 October 1996; Revised 31 March 1997; Accepted 13 May 1997 Article Note: (footnote) [star] From the Istituto di Clinica Medica e Cardiologia* and the Dipartimento di Statistica 'G Parenti,' Universita degli Studi di Firenze, Florence, Italy., [star][star] Reprint no.47/1/84485 , a Address for reprints: Giovanni Bertini, MD, Istituto di Clinica Medica e Cardiologia, Universita di Firenze, Viale Morgagni, 85, 50134 Firenze, Italy 01139 55 432758, Fax 01139 55 4378638, E-mail brte31k1@fi.nettuno.it

Byline: Peter A Chyka, Joseph E Holley, Timothy D Mandrell, Prasanna Sugathan Abstract: Study objective: To evaluate an animal model of multiple-dose activated charcoal (MDAC) therapy and correlate the pharmacokinetic properties of four drugs with the efficacy of MDAC. Design: Prospective, randomized, controlled, crossover design. Setting: A university animal research facility. Participants: Seven female pigs (15 to 22 kg) with an indwelling central venous line and gastrostomy tube. Interventions: Acetaminophen (30 mg/kg), digoxin (30 [mu]g/kg), theophylline (8.9 mg/kg), and valproic acid (18 mg/kg) were simultaneously administered intravenously over 12 minutes. In the experimental arm, 25 g activated charcoal was administered at 0, 2, 4, 6, 12, 18, 24, and 30 hours through the gastric tube. In the control arm, an equal volume of water was given at the same times. Blood specimens were obtained over 36 hours to measure serum drug concentrations. Results: Each drug exhibited enhanced elimination (P Article History: Received 21 April 1994; Revised 19 September 1994; Accepted 1 October 1994 Article Note: (footnote) [star] From the Departments of Clinical Pharmacy*, Internal Medicinea , and Comparative MedicineAs., The University of Tennessee; and the Southern Poison Centera[yen]; Memphis, Tennessee., [star][star] Supported by a grant from Le Bonheur Children's Medical Center, Memphis, Tennessee., a Address for reprints: Peter A Chyka, PharmD, Southern Poison Center, 847 Monroe Avenue, Memphis, Tennessee 38163, 901-448-6802, aa Reprint no. 47/1/62401