Using sorbitol - a cheap and easy-to-find material in Vietnam, the authors built a relative optimal and complete protocol to synthesize isosorbide and isosorbide dinitrate (productivity of 64%). Test purity isosorbide dinitrate and solution of 25% isosorbide dinitrate. With purity isosorbite dinitrate: qualitative analysis by IR and test by HPLC method were conducted; isosorbide dinitrate solution was test according to USP 24 and checked by this standard. All products meet USP 24 standard
Isosorbide Dinitrate ; Sorbitol

We have studied the vasodilating effect of bolus doses of sodium nitroprusside (SNP), nitro- glycerin (NTG), and isosorbide dinitrate (ISDN) in 40 patients during cardiopulmonary bypass with a constant pump flow. Blood volume of the venous reservoir and mean arterial pressure were recorded for 10 minutes after drug administration to detect changes in venous capacitance and arteriolar resistance. SNP 500 ug decreased mean blood pressure significantly more than NTG and ISDN compared with placebo. NTG 500 ug decreased mean blood pressure transiently at 1-4 min but significantly reduced reservoir blood volume. ISDN 500 ug increased mean blood pressure after drug administration, decreased reservoir blood volume less than NTG. We could conclude that SNP was more effective arteriolar vasodilator than NTG and ISDN, but NTG and ISDN were effective as a venodilator during cardiopulmonary bypass.
Arterial Pressure ; Blood Pressure ; Blood Volume ; Cardiopulmonary Bypass* ; Glycerol ; Humans ; Isosorbide Dinitrate* ; Isosorbide* ; Nitroglycerin* ; Nitroprusside* ; Sodium* ; Vascular Access Devices

No abstract available.
Common Bile Duct* ; Isosorbide Dinitrate* ; Isosorbide*

Background: Myo-inositol has emerged as one of the preventive therapies for the development of gestational diabetes mellitus in at-risk populations. This systematic review and meta-analysis was conducted to determine the efficacy and safety of myo-inositol in decreasing the incidence of gestational diabetes in overweight and obese pregnant women. Methodology: This meta-analysis was conducted using the standard Cochrane methodology and reported in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) 2020 guidelines. Inclusion criteria were randomized controlled trials (RCTs) that enrolled overweight and obese pregnant women and used myo-inositol supplementation. The primary outcome was the incidence of gestational diabetes mellitus at 24-28 weeks. Secondary outcomes included cesarean section rate, the incidence of pregnancy-induced hypertension, macrosomia and preterm delivery. Risk ratios (RRs) and 95% confidence intervals (CIs) were used for dichotomous data. Results: Six RCTs were included. Compared to standard micronutrient supplementation, standard dose of myo-inositol (4 g) may reduce the incidence of GDM (RR 0.54; CI [0.30, 0.96]; n = 887 women), but the certainty of evidence is low to very low. With low-dose myo-inositol however, evidence is uncertain about its benefit on the incidence of gestational diabetes mellitus in overweight and obese women with RR 0.71; CI [0.14, 3.50]. No adverse effects were noted. For the secondary outcomes, standard dose myo-inositol appears to reduce the incidence of pregnancy-induced hypertension and preterm delivery, but the certainty of evidence is low to very low. Conclusion Current evidence is uncertain on the potential benefit of myo-inositol supplementation in overweight and obese pregnant women. While studies show that 4 g myo-inositol per day may decrease the incidence of GDM, pregnancy-induced hypertension and pre-term birth with no associated risk of serious adverse events, the certainty of evidence is low to very low. Future high-quality trials may provide more compelling evidence to support practice recommendations.
Diabetes, Gestational ; Obesity ; Inositol Phosphates

BACKGROUND: Coronary perfusion pressure(CPP) is the most important factor for the success of cardiopulmonary resuscitation(CPR). Therefore, CPP must be optimized during the resuscitation. The purpose of this study is to investigate the effects of isosorbide dinitrate(Isoket(R)) on CPP during CPR. METHODS: 10 Korean dogs were divided into two groups: Group I(N=5) was resuscitated with infusion of isosorbide dinitrate(1 microgram /kg/min) and Group II(N=5) was resuscitated without using isosorbide dinitrate. Following CPR, the heart rate(HR), blood pressure(BP), pulmonary capillary wedge pressure, cardiac output(CO), CPP and endocardial viability ratio(EVR) were measured repeatedly. RESULTS: The changes in HR were not significantly different between the two groups but systolic and diastolic BP, CO, CPP and EVR were well maintained in group 1. CONCLUSIONS: These results suggest that the usual dosage of isosorbide dinitrate is effective in improving CPP and EVR on CPR after impending cardiac arrest.
Animals ; Cardiopulmonary Resuscitation* ; Dogs ; Heart ; Heart Arrest ; Isosorbide Dinitrate ; Isosorbide* ; Perfusion* ; Pulmonary Wedge Pressure ; Resuscitation

In a placebo-controlled trial, we have studied the vasodilator properties of bolus dose of nitroglycerin, isosorbide dinitrate and chlorpromazine in 38 patients during cardiopulmonary bypass with a constant pump flow. Mean arterial pressure and blood volume of the venous reservoir were recorded for 10 min after drug administration to detect changes in arteriolar resistance and venous capacitance, respectively. Nitroglycerin, 2.5 ug/kg, decreased arterial pressure, but the effect lasted for 3 minutes. Chlorpromazine, 0.1 mg/kg, decreased arterial pressure for 9 minutes. Isosorbide dinitrate, 20 ug/kg, had no significant change on arterial pressure. The venous capacitance-increasing effects of nitroglycerin and chlorpromazine were significant for 4 minutes after the bolus. Thereafter the effect of nitroglycerin began to decline, while that of chlorpromazine significantly continued. Isosorbide dinitrate had no significant change on venous reservoir level. The SVR reduction effects of nitroglycerin was significant for 3 minutes, chlorpromazine decreased SVR for over 10 minutes. In conclusion chlorpromazine effect on arterial pressure and venous capacitance was more potent and longer than nitroglycerin and isosorbide dinitrate. Nitroglycerin and chlorpromazine effect on preload and afterload were significant after bolus dose.
Arterial Pressure ; Blood Volume ; Cardiopulmonary Bypass ; Chlorpromazine* ; Humans ; Isosorbide Dinitrate* ; Isosorbide* ; Nitroglycerin* ; Vascular Access Devices

The present study was undertaken to characterize homocysteic acid (HCA)-and cysteic acid (CA)mediated formation of inositol phosphates (InsP) in primary culture of rat cerebellar granule cells. HCA and CA stimulated InsP formation in a dose-dependent manner, which was prevented by the N-methyl-D-aspartate (NMDA) receptor antagonist D,L-2-amino-5-phosphopentanoic acid (APV). CA-, but not HCA-, mediated InsP formation was in part prevented by the metabotropic glutamate receptor antagonist alpha-methyl-4-carboxyphenylglycine ((+/-)-MCPG). Both HCA- and CA-mediated increases in intracellular calcium concentration were completely blocked by APV, but were not altered by (+/-)-MCPG. CA-mediated InsP formation was in part prevented by removal of endogenous glutamate. In contrast, the glutamate transport blocker L-aspartic acid-beta-hydroxamate synergistically increased CA responses. These data indicate that in cerebellar granule cells HCA mediates InsP formation wholly by activating NMDA receptor. In contrast, CA stimulates InsP formation by activating both NMDA receptor and metabotropic glutamate receptor, and in part by releasing endogenous glutamate into extracellular milieu.
Animals ; Calcium ; Cysteic Acid* ; Glutamic Acid ; Inositol Phosphates* ; Inositol* ; N-Methylaspartate ; Rats* ; Receptors, Metabotropic Glutamate

In the mid 1980's, the ITA(internal thoracic artery) graft was clearly recognized to be superior to the sapheonous vein graft in respect to long term patency. Therefore, there has been growing interest in the arterial conduit with the possibility of improving the long term result. We have been performing CABG with GEA since 1998 with the same purpose. For mid-term and long-term follow up, we have been performing postoperative coronary angiography. In this paper, a case of GEA spasm, a purported drawback of this conduit, during postoperative coronary anigiography and relieved by direct infusion of 200 microgram isoket into the GEA is reported. The current case which exemplifies the spastic nature of RGEA is accompanied with coronary angiography.
Coronary Angiography* ; Follow-Up Studies ; Gastroepiploic Artery* ; Isosorbide Dinitrate ; Muscle Spasticity ; Spasm* ; Transplants ; Veins

BACKGROUND AND OBJECTIVES: The head-up tilt test (HUT) is widely used for the diagnosis of vasovagal syncope. To improve the sensitivity of the test, provocation with isoproterenol is frequently used. The aim of this study was to evaluate the values of isosorbide dinitrate spray as a provocation drug in the HUT. SUBJECTS AND METHODS: Two hundred patients, undergoing baseline HUT (60 degrees for 20 minutes) for suspected vasovagal syncope or presyncope and unexplained dizziness, were enrolled. If the baseline HUT was negative, isosorbide dinitrate (2.5 mg) spray was applied sublingually (group I, n=93), or isoproterenol (3 microgram/min) infused (group II, n=93), in a randomized fashion. The values of isosorbide dinitrate and isoproterenol were compared in those patients that developed a positive vasovagal response or who completed the drug-provocative HUT. RESULTS: Syncope was similarly reproduced in both groups (47.7 vs. 41.9%, p>0.05). Type I responses were most common in both groups, and types I and II responses were more common in group I than group II (78.0 vs. 55.6% and 12.2 vs. 5.6%, p<0.05, respectively). The average time to a positive response was longer in group I than group II (8.5+/-3.4 vs. 6.1+/-3.6 minutes, p<0.01). The sensitivity and specificity of the drug-provocative HUT were significantly higher in group I than group II (73.5 and 87.5% vs. 58.5 and 71.1%; respectively, p<0.01). The incidence of minor adverse effects were similar in both groups, but serious cardiac side effects were significantly more common in group II than group I (4.3 vs. 0%, p<0.05). CONCLUSION: Sublingual isosorbide dinitrate spray may be used as a simple, effective and well tolerated provocative drug during HUT.
Diagnosis ; Dizziness ; Humans ; Incidence ; Isoproterenol* ; Isosorbide Dinitrate ; Sensitivity and Specificity ; Syncope ; Syncope, Vasovagal ; Tilt-Table Test

BACKGROUND: Cardiopulmonary bypass (CPB) may produce lung injury with decreased PaO2/FiO2 ratio in patients undergoing CABG surgery. We examined PaO2/FiO2 ratio and incidence of PaO2/FiO2 < 300 or 150 to determine the differences in oxygenation with the use of amrinone-dopamine (DP) or isosorbide dinitrate (IDN)-DP in patients undergoing CABG. METHODS: Twenty patients undergoing elective CABG were divided into two groups according to drug used on separation from CPB: IDN-DP (Group 1, n = 10) or amrinone-DP (Group 2, n = 10). Anesthesia was induced and maintained with propofol, fentanyl and vecuronium. IDN infusion (1.0microgram/kg/min) was started preoperatively in both groups. Mild hypothermic CPB was applied with a roller pump and nonpulsatile flow maintained a mean arterial pressure of 60-80 mmHg. In Group 2, amrinone was administered (0.75 mg/kg + 10microgram/kg/min) instead of IDN at the time of CPB separation. DP infusion (3microgram/kg/min) was started at a rectal temperature more than 35.5oC and adjusted to maintain acceptable hemodynamics. IDN-DP or amrinone-DP infusion, monitoring and sedation with propofol were continued in the intensive care unit (ICU). PaO2/FiO2 ratio under controlled ventilation with air/O2 mixture (FiO2 0.6) was checked immediately before CPB (pre-CPB), 30 mins (post-CPB30), 60 mins after CPB (post-CPB60) and 30 mins after admission to ICU (ICU30). RESULTS: There was no significant difference between the groups in the terms of the duration of arotic cross clamp, PaO2/FiO2 at pre-CPB, PaO2/FiO2 at post-CPB60, PaO2/FiO2 at ICU30 or in the incidence of PaO2/FiO2 < 150, PaO2/FiO2 < 300 at ICU30. But there was a significant difference in PaO2/FiO2 post CPB30 (263.3 +/- 105.5 in Group 1 vs. 381.7 +/- 69.5 in Group 2, P<0.05). CONCLUSIONS: Amrinone-DP provides more favorable oxygenation immediately after CPB in CABG surgery than IDN-DP.
Amrinone ; Anesthesia ; Arterial Pressure ; Cardiopulmonary Bypass* ; Coronary Artery Bypass* ; Coronary Vessels* ; Fentanyl ; Hemodynamics ; Humans ; Incidence ; Intensive Care Units ; Isosorbide Dinitrate ; Isosorbide* ; Lung Injury ; Oxygen* ; Propofol ; Vecuronium Bromide ; Ventilation