Effect of intralesional alpha 2-interferon on actinic keratoses

The effect of intralesional alpha 2-interferon (IFN) on actinic keratoses was examined in this two-part study. In phase I, 11 of 12 lesions cleared following nine injections of IFN (5 X 10(5) IU per dose) compared with none of 12 keratoses injected with placebo. Smaller doses of IFN (1 X 10(5) IU and 1 X 10(4) IU per injection) produced clearing of 42% and 58% of lesions, respectively. The second phase, which was designed to investigate the optimum schedule for treatment with IFN, showed that a minimum of six injections of IFN (5 X 10(5) IU per injection) was necessary to clear 14 of 15 actinic keratoses. Although this mode of delivery is not practical for clinical use, intralesional alpha 2-IFN demonstrates biologic activity against actinic keratoses.

Urinary diluting capacity in elderly diabetic subjects

Urinary concentrating ability declines with normal human aging but diluting capacity has been less well studied as a function of age. We studied free water clearance (CH2O) in a group of Type II diabetic patients, aged 47 to 70 years. Conventional water load testing in sulfonylurea-treated diabetic patients revealed preservation of diluting capacity (ability to achieve Uosm less than 100 mOsm/kg) in subjects greater than 60 years of age. Tolazamide permitted expression of normal CH2O; chlorpropamide administration predictably reduced CH2O relative to tolazamide by 58% in subjects greater than 60 years. Free water clearance (CH2O) and glomerular filtration rate (GFR) were comparable in elderly subjects (greater than 60 years) and those less than or equal to 60 years. Normal CH2O in these diabetic patients was explained by persistently normal GFR in the study group. Osmolar clearance (Cosm) was insignificantly lower in diabetics greater than 60 years. Thus, a fall in CH2O in elderly diabetic patients is not a factor contributing to clinical hypoosmolar states encountered in this population.

Randomised controlled study of orchidectomy vs long-acting D-Trp-6-LHRH microcapsules in advanced prostatic carcinoma

Safety and efficacy of a slow-release formulation of D-Trp-6-luteinising-hormone-releasing-hormone (D-Trp-6-LHRH) microcapsules were compared with orchidectomy in the initial treatment of advanced prostatic carcinoma. 41 patients were randomly assigned to D-Trp-6-LHRH and 38 to orchidectomy. Suppression of testosterone and reduction in prostatic acid phosphatase levels were similar in both groups. 87% of patients in the D-Trp-6-LHRH group and 81% in the orchidectomy group responded to treatment or showed no deterioration. Side-effects related to the decrease in testosterone were similar in both groups. 3 patients given D-Trp-6-LHRH had a disease "flare" in the first ten days of treatment which resolved completely when testosterone fell to castrate levels. Results of psychological assessment were similar in both groups before treatment, and on follow-up there was a weak trend towards decreased psychological morbidity in the hormone group. The slow-release preparation of D-Trp-6-LHRH microcapsules offers an important alternative in the management of advanced prostatic carcinoma.

Source derivation of the brain-stem auditory evoked potential

This study described the results of applying source derivation to the brain-stem auditory evoked potential. Unilateral stimulation gives rise to current sinks, associated with waves I and III, which are located in the vicinity of the ipsilateral mastoid. Waves II and V are associated with a pair of current sinks which appear bilaterally in the vicinity of each mastoid.

The use of a platelet nucleotide assay as a possible diagnostic test for malignant hyperthermia

A bioassay, using high-performance liquid chromatography (HPLC) analysis of platelet adenosine nucleotides and hypoxanthine, was studied for its potential use as a test for MH susceptibility. A protocol for the assay was developed, based on the method outlined by Solomons and Masson. The HPLC procedure was a rapid, efficient, sensitive, and highly reproducible technique for measuring ATP, ADP, AMP, and hypoxanthine in platelets. Conditions of extraction and storage were critical for preventing degradation of the nucleotides. Extraction of nucleotides at icebath temperature was found necessary. Storage of platelet extract in PCA, even at -20 degrees C, showed loss of ATP and ADP; hence, neutralization with KOH was essential before storage. Contrary to the findings of Solomons et al., the present study demonstrated that neither ATP depletion nor per cent reduction in nucleotide ratios in platelets treated with halothane can be used as a definitive test for the diagnosis of MH susceptibility. The reason for this disagreement is unclear; however, differences in methods and altitude are implicated. It is possible that the platelet is not affected by malignant hyperthermia and thus cannot serve as a test system for the detection of the syndrome.

The dexamethasone suppression test in newly hospitalized schizophrenic patients

Of 15 unmedicated chronic schizophrenic patients with acute exacerbations and 15 healthy controls given the dexamethasone suppression test (DST), 11 patients and two controls were nonsuppressors. The results add to the evidence that the DST has limited value in psychiatric diagnosis.

Indole amines and amino acids in various brain regions after infusion of branched chain amino acids into hepatectomized rats

This study was designed to determine regional changes of amino acids and indole amines in the brain and possible interactions between amino acids and indole amines 18 h after hepatectomy in rats. Hepatectomy and glucose infusion alone resulted in a profound increase of most large neutral amino acids (LNAA) in plasma and in the brain except for the branched-chain amino acids (BCAA), which maintained normal or somewhat lower values in plasma. Hepatectomy and infusion of glucose combined with BCAA sharply reduced the plasma and brain amino acid concentrations of other LNAA. Simultaneously the concentrations of serotonin and 5-hydroxyindoleacetic acid were decreased in all brain regions. In both groups of hepatectomized rats there were regional variations of the amino acid and the indole amine concentrations in the brain, but the response to BCAA infusion was generally the same in all brain regions. No difference in survival between the 2 groups could be found.

Case report of prolactin and bipolar illness: a longitudinal study

A longitudinal and naturalistic study of nine bipolar patients attending a lithium clinic during a six-month period was undertaken. Prolactin plasma levels and psychiatric symptoms were evaluated bi-weekly. Wide interindividual and intraindividual fluctuations were observed both in prolactin levels and psychiatric symptoms. The relationship between prolactin and affective episodes was found to be complex. In a few instances, sharp prolactin changes preceded behavioral modifications. Bipolar disorders, even if treated, appeared to be unstable conditions, from both the phenomenological and neuroendocrinological viewpoints.

Delivering health education programs: a model

The OPT/EVALUATE delivery model provides a system for applying principles of organizational management to the problems of administering health education. Whether one is a new health educator, or part of a health education team, solving operational problems calls for expertise in a variety of fields. Most health educators are not prepared for program administration functions. The article includes a diagram of the OPT/EVALUATE model and an Action Step Checklist. The checklist may be for professional self-assessment, for guiding internships and on-the-job training experiences, or for systematically coordinating a health education project. Each section of the checklist is explained in the article with resources for further reading. Individuals can adapt the OPT/EVALUATE model to their own work setting and target populations. The importance of the checklist steps will vary from project to project. Some specific steps may need to be added.

An objective comparison of transurethral resection and bladder neck incision in the treatment of prostatic hypertrophy

Transurethral resection has become the operation of choice in almost all cases of benign prostatic enlargement. However, when the gland does not exceed 30 gm. bladder neck incision is easier to perform, results in a lower morbidity, and is less likely to be followed by incontinence and retrograde ejaculation. We studied 2 groups of men with proved obstruction. Complete urodynamic investigation was done on 51 patients before and on 44 patients after the operation. We compared our subjective and objective findings in the 2 groups. The conclusion suggest that bladder neck incision is as effective as transurethral resection in relieving the obstruction of prostatic enlargement in the presence of a small gland.

Effect of infusing the branched-chain amino acids on concentrations of amino acids in plasma and brain and on brain catecholamines after total hepatectomy in the rat

In totally hepatectomized rats supported by infusion of glucose, the concentrations of many amino acids in plasma and brain rose progressively over time, while the brain levels of norepinephrine decreased. Infusion of a solution containing glucose, leucine, isoleucine, and valine after hepatectomy greatly reduced the accumulation of other essential amino acids in plasma and brain. However, the decrease in brain norepinephrine content was not significantly affected by this infusion, suggesting that high brain concentrations of monoamine precursor amino acids are not the primary cause of norepinephrine depletion after hepatectomy.

Factors moderating the effect of oral sulfonylureas on free water clearance

The effects of the antidiuretic agent chlorpropamide and the diuretic agent tolazamide on solute-free water clearance (CH2O) were compared in noninsulin-dependent diabetic patients undergoing water diuresis. Hyperglycemia (fasting serum glucose above 200 mg/dl) obscured the effects of these two sulfonylureas on CH2O. Thiazide or ethacrynic acid enhancement of chlorpropamide antidiuresis was also blunted by hyperglycemia and attendant osmotic diuresis. Thus, the low incidence of symptomatic hyponatremia during chlorpropamide treatment of diabetic patients may be explained by persistent hyperglycemia in such patients.

Relationship of phosphate administration to serum and red cell phosphate concentration, erythrocyte 2,3-diphosphoglycerate (2,3-DPG) and blood P50 in the hyperglycemic dog

In vitro studies indicate that acute increases in intracellular phosphate concentration decrease red blood cell 2,3-diphosphoglycerate levels (G. Momsen, B. Vestergaard-Bogind, Arch Biochem Biophys 190:67, 1978). We have examined the relationship in vivo of serum phosphate concentration, red cell phosphate, 2,3-DPG and blood P50 in hyperglycemic dogs infused alternately with phosphate or chloride (control) solutions. During the 8-hr insulin infusion, serum phosphate (Pi) fell 40% in the chloride-treated animals and rose 71% in the phosphate-treated dogs (P less than 0.001, phosphate vs. control). RBC Pi concentration declined in the controls and rose significantly in the phosphate-infused dogs (P less than 0.02). Serum Pi and RBC Pi were correlated in the phosphate-managed animals (r = 0.76, P less than 0.02), but not in the controls. RBC 2,3-DPG failed to rise in either group during insulin infusion and regression analysis showed a negative correlation between serum Pi and 2,3-DPG (r = -0.90, P less than 0.005) and between RBC Pi concentration and 2,3-DPG (r = -0.84, P less than 0.02). P50 failed to change in either group during insulin treatment and for up to 24 hr after initiation of the 8-hr infusion of insulin.

Plasma and skeletal muscle amino acids following severe burn injury in patients and experimental animals

This study describes and analyzes sequential changes in plasma and skeletal muscle free amino acids following severe burn injury. Plasma free amino acids were determined in children (n = 9) with burns averaging 60% total body surface area and were compared with laboratory beagles (n = 44) which received a flame burn totaling 30% of their body surface area. In addition, needle biopsy specimens were obtained from the semitendonosus muscle in the animals to determine free intracellular amino acids. In both patients and animals the amount of total free amino acids in plasma fell following burn, suggesting relative protein deficiency. This drop was primarily due to a 47% drop in nonessential amino acids. However, plasma phenylalanine was consistently higher than normal following burn, and was strongly associated with death and weight loss in both animals and patients, especially when analyzed as a ratio with tyrosine. This finding suggested excessive catabolism, hepatic dysfunction, or both. Plasma levels of several amino acids correlated significantly with weight loss. Alterations in muscle free amino acids generally were similar to plasma amino acids. Exceptions were muscle alanine and glycine which strongly correlated with weight loss. However, the determination of muscle free amino acid profiles did not yield clinically useful information not available from plasma profiles. Plasma levels of liver enzymes suggested progressive hepatic dysfunction. These studies show that the laboratory beagle is a good model for studying the metabolic alterations of amino acids that accompany burn injury, since they mimic humans in many parameters which appear to be most useful with respect to clinical evaluation.

Clinical evaluation of single-dose oral bacampicillin or ampicillin in therapy of uncomplicated gonorrhea

Two hundred twenty-eight patients with uncomplicated gonorrhea who returned for follow-up cultures were evaluated for determination of the efficacy of three different regimens of single-dose oral treatment. The regimens included 2.4 g of bacampicillin plus 1.0 g of probenecid, 1.6 g of bacampicillin plus 1.0 g of probenecid, and 3.5 g of ampicillin plus 1.0 g of probenecid. All three regimens were highly effective in the treatment of urogenital and rectal gonorrhea but often failed cure pharyngeal gonorrhea. The highest rate of adverse reactions was reported for patients treated with 2.4 g of bacampicillin plus probenecid. The efficacies of a single oral dose of 1.6 g of bacampicillin (molar equivalent, 1.1 g of ampicillin) plus probenecid and of 3.5 g of ampicillin plus probenecid in the treatment of uncomplicated gonorrhea were equivalent as were the frequencies of adverse reactions to these two regimens.

Clinical phase I-II and pharmacokinetic study of high-dose thymidine given by continuous intravenous infusion

High-dose thymidine (dThd) was given to 12 patients with advanced hematological and solid tumors. The dose schedule used was 75 g/sq m/day, given i.v. continuously for 5 days or more. Myelosuppression, especially leukopenia, was the dose-limiting toxicity. Nonhematological toxicities affected the gastrointestinal tract (nausea, vomiting, anorexia, diarrhea, and indigestion) and the central nervous system (somnolence, headache, visual illusions, and memory impairment). Patients who had received cumulative doses of dThd developed alopecia. Thymine crystals were noted in the urine after refrigeration. Tumor regression (less than partial remission) occurred in one patient with melanoma. Three of four patients with acute leukemia had a fall in peripheral white blood cell counts and blasts but no marrow improvement. Four patients with adenocarcinoma (three colon, one unknown primary) had stable disease. Pharmacokinetic studies revealed that, at a dThd dose of 75 g/sq m/day, millimolar concentrations of dThd and thymine can be achieved in the plasma. The half-life of dThd was approximately 100 min. One-third of the plasma concentrations was measurable in the cerebrospinal fluid. dThd was mainly excreted by the kidneys.

Endourethral urethroplasty

Following internal urethrotomy for treatment of strictures of the bulbous urethra, 11 patients had primary split skin grafts inlaid over the urethrotomy site. There were no operative complications and the results in 5 patients with a 9-month follow-up are good.

Interstitial cystitis

Twenty histologically proven cases of interstitial cystitis were investigated in an attempt to find evidence of a possible autoimmune mechanism in its aetiology. HLA tissue typing was performed, autoantibody profiles were obtained, and a questionnaire of the patients' past history completed, especially with respect to other autoimmune conditions. An experiment was designed to test the effect of sodium cromoglycate on rat bladders. The results are discussed in relation to the management of patients with interstitial cystitis.

The induction of cystitis and the implantation of tumours in rat and rabbit bladders

A method of inducing tumour growth in rat and rabbit bladders is described. Tumour induction is dependent on a pre-induced cystitis. In rats, tumour also grows in the kidneys because of species characteristic vesicoureteric reflux. The possible significance is discussed in relation to the management of human bladder tumours.

Inhibition of dopamine-induced release of growth hormone by thyrotropin-releasing hormone

The effects of thyrotropin-releasing hormone (TRH) and dopamine (DA) on serum growth hormone (GH) levels were examined in the adolescent male baboon. Intravenously administered DA (40 microgram/kg-min-1 for 20 min) raised serum GH and glucose and lowered serum insulin concentrations but caused no increase in blood pressure. Concomitant intravenous infusion of TRH at 2 doses (96 ng/kg-min-1 and 40 microgram/kg-min-1 for 20 min) blocked the DA-induced increase in serum GH. The relatively low effective doses of TRH used to suppress the DA-induced GH increase suggest an interaction with catecholamines at the hypothalamic and/or pituitary to influence GH release.

Serum total and free thyroxine and triiodothyronine during dynamic muscular exercise in man

The effect of strenuous dynamic muscular exercise on serum-free thyroxine (FT4) and free triiodothyronine (FT3) concentrations has been studied in 10 healthy subjects. In the course of 7.8-19 min of treadmill exercise (protocol of R. A. Bruce), the group showed a mean increase in serum albumin concentration of 11.4% (P less than 0.01). Five subjects demonstrated an increase in FT4 concentrations (x = +54%) and five showed decreased FT4 (x = -36%). The difference in FT4 concentrations was accounted for primarily by acute alterations in dialyzable fraction T4 (DFT4) rather than total serum T4. Mean changes in DFT4 were statistically significant (P less than 0.02) when increased FT4 and decreased FT4 groups were compared. Acute exercise was accompanied by a 9% decrease in dialyzable fraction T3 (DFT3) (P less than 0.02) in the 10 subjects, but the concomitant decrease in FT3 concentration was not significant. Changes in DFT4 and DFT3 and FT4 and FT3 concentrations were not correlated. Trends in double product (heart rate times blood pressure) with maximal exercise and in double-product recovery after exercise suggested that increased FT4 concentrations developed in subjects who were physically better trained.

Evaluation of an Improved Pneumatic-Tube System Suitable for Transportation of Blood Specimens

An improved version of a pneumatic-tube system built by Amsco, Inc. (Erie, Pa.) and its subsidiary ATC (San Rafael, Calif.) for blood-sample transportation incorporated two innovations: The sample carrier travels at a lower speed than in the previous conventional systems, and it is decelerated gradually on arrival. This tube system was pilot tested for efficiency by running blood-filled Vacutainer tubes through the 63.6-rn (210-feet) tube 10 times, a total running distance of 636 m. Serum lactate dehydrogenase and acid phosphatase activities, and potassium, all sensitive chemical indicators of erythrocyte membrane damage, were measured in blood specimens in partially or totally filled Vacutainer tubes and the results compared with those obtained from controls. No alterations were found in serum test results after 10 or 20 repetitive cycles in the totally filled tubes, but significant changes did occur in partially filled tubes after 20 cycles. If the limitations are observed, this system appears to be suitable for blood-specimen transportation.