Serum erythropoietin levels and blood component therapy after autologous bone marrow transplantation: implications for erythropoietin therapy in this setting

To determine the potential impact of recombinant human erythropoietin (EPO) therapy in patients undergoing autologous bone marrow transplantation (BMT) and colony-stimulating factor therapy, we assayed endogenous serum EPO levels and noted blood transfusion requirements in relapsed non-Hodgkin's lymphoma patients treated with high-dose chemo-radiation therapy and autologous BMT. Hematocrit and reticulocyte counts were determined daily, and hematocrit was maintained in the 25-30% range by transfusion according to criteria established by our hospital transfusion committee. EPO levels were measured by radioimmunoassay and were determined at baseline, throughout therapy, and 2 and 3 months after BMT. Serum EPO levels increased more than 25-fold above baseline in most subjects after initiating chemoradiation therapy. No correlation was noted between serum EPO and hematocrit, reticulocyte count or serum creatinine. Total red blood cell units transfused ranged from 4 to 15 (mean 7.7). Mean total donor exposures (red blood cell plus platelet units transfused) were 83.6 units (range 16-175). Serum EPO levels increased early in the course of preparation for autologous BMT and remained elevated for at least 2-3 weeks thereafter although at a lower level. Red blood cell transfusions were required despite very high EPO levels after BMT. Red cell transfusions, moreover, accounted for only 9.2% (69 of 746) of total donor exposures and only 5.8% (42 of 746) of donor exposures during the interval when pharmacologic doses of erythropoietin might be of benefit. In contrast to the potential benefit of colony-stimulating factors such as G-CSF and GM-CSF in BMT, our study suggests limited value for erythropoietin therapy in this setting.

Effect of cilazapril in hypertensive patients with renal impairment

The aim of the study was to evaluate the clinical and renal hemodynamic effects of cilazapril in 10 hypertensive patients with moderate-to-severe chronic renal failure (creatinine clearance 14-50 ml/min). After 2 weeks of placebo, cilazapril 0.5 mg/day was given, and the dose was increased up to 5 mg/day if sitting diastolic blood pressure (SDBP) was not normalized (less than or equal to 90 mm Hg). Once a normal SDBP value was achieved, the patients remained on the given dose regimen for 6 months. After this period SDBP decreased from 107 +/- 2 to 95 +/- 2 mm Hg (p less than 0.001). At the end of treatment, glomerular filtration rate (GFR) remained unchanged in five patients, improved in four patients, and slightly decreased in one patient, the slope from baseline being 0.137 and the variation of GFR per unit of GFR at baseline being between -0.20 and 0.47. Likewise, effective renal plasma flow increased not significantly, showing considerable variability. Urinary protein excretion was reduced significantly from 2.51 +/- 0.75 to 0.51 +/- 0.10 g/L (p less than 0.05), suggesting that converting enzyme inhibition may exert a renal protective effect. In conclusion, it appears that cilazapril does not induce functional damage in the kidney of predialysis hypertensives.

Effects of ACE inhibition on renal haemodynamics in essential hypertension and hypertension associated with chronic renal failure

Angiotensin II has many actions in the kidney, including regulation and distribution of renal circulation and glomerular filtration, as well as effects on mesangial contraction and on the filtration coefficient. The reduction in circulating and intrarenal angiotensin II by angiotensin converting enzyme (ACE) inhibitors in essential hypertension is associated with a significant increase in renal blood flow and a decrease in filtration fraction, without changes in glomerular filtration rate. In addition, administration of ACE inhibitors can reduce proximal sodium reabsorption via changes in peritubular hydrostatic and oncotic forces resulting from the fall in postglomerular capillary resistance. In severe hypertension the state of the renal vasculature does not allow ACE inhibition to induce similar haemodynamic changes and, therefore, it cannot contribute to renal sodium handling that requires the recruitment of alternate mechanisms. In spite of this, ACE inhibitors may exert a protective effect on the renal function of patients with severe hypertension as well as in those with renal impairment, by lowering systemic and, probably, intraglomerular pressure, reducing proteinuria and slowing the progression of renal failure.

Induction of urinary bladder hyperplasia in Sprague-Dawley rats orally administered tri-n-butyl phosphate

The effects of tri-n-butyl phosphate (TBP) were investigated in the Sprague-Dawley rat over an 18-wk period. Groups of randomized female (average weight [AW] = 206 +/- 10 g) and male (AW = 294 +/- 13 g) rats were divided into low-dose, high-dose, and control groups (12 rats/sex X group). Tri-n-butyl phosphate was administered by gavage once a day for 5 days/wk over an 18-wk period. Low-dose animals received 0.20 g/kg X day throughout the experiment and high-dose animals received 0.30 g/kg X day for the first 6 wk. For the remaining 12 wk, the high-dose level was increased to 0.35 g/kg X day. Histopathological examination of tissues revealed that all test rats examined developed diffuse hyperplasia of the urinary bladder epithelium. Similar changes were not found in the control animals.

Dose-response toxicity studies on tributoxyethyl phosphate orally administered to Sprague-Dawley rats

The response of the peripheral nervous system to various dose levels of tributoxyethyl phosphate (TBOP) was investigated in Sprague-Dawley rats. Groups of randomized female and male rats (10 rats/gender/dose level) were administered a single oral dose of TBOP (1.0 to 3.2 g/kg for females; 1.0 to 9.0 g/kg for males). Physiological parameters were measured in surviving rats three weeks following TBOP administration. A significant reduction (p less than 0.05) in caudal nerve conduction velocity (NCV) was observed in both female and male rats. Light and electron microscopic examination of sciatic nerve sections showed degenerative changes in both myelinated and unmyelinated fibers of female (2.0 g/kg) and male (6.8 g/kg) groups. Advanced degeneration was observed only in the highest dose level of both genders (3.2 g/kg for females; 8.0 and 9.0 g/kg for males). Although similar morphological changes were observed in both genders, females were more susceptible than males to the toxic effects of this compound.

Subacute oral toxicity of tri-n-butyl phosphate in the Sprague-Dawley rat

Tri-n-butyl phosphate was administered by gavage to male and female Sprague-Dawley rats for 14 consecutive days (low dose: 0.14 ml kg-1; high dose: 0.42 ml kg-1). Effects of this chemical were investigated at the end of the feeding period. Histopathological examination of the testes (high-dose group) showed the presence of microscopic degenerative changes in the seminiferous tubules. No other abnormal microscopic changes were observed.

Induction of electrophysiological and morphological changes in Sprague-Dawley rats fed tributoxyethyl phosphate

The effects of a widely used trialkyl phosphate (TP), tributoxyethyl phosphate (TBOP), on the peripheral nervous system of Sprague-dawley (SD) rats were investigated. Male and female SD rats were administered this chemical by gavage over a period of 18 weeks (low dose: 0.25 ml kg-1; high dose: 0.50 ml kg-1). Electrophysiological changes observed at 18 weeks in all test animals included a significant reduction (P less than 0.001) in nerve conduction velocity and an important increase (P less than 0.001) of both relative (RRP) and absolute refractory period (ARP). Light and electron microscopic examination of sciatic nerve from all test animals showed the presence of degenerating myelin sheaths accompanied by axonal swelling. An advanced stage of degeneration was indicated by the presence of lamellated electron dense inclusions in unmyelinated nerve fibres.

Millions of medical care dollars for indigents

The medically indigent, a group traditionally underserved with health care, can obtain some needed free services from Hill-Burton facilities. These facilities (hospitals, nursing homes, clinics, and agencies) received Hill-Burton funds for their building programs and have, as a result, an obligation to provide a certain amount of uncompensated medical care to a defined medically indigent population. Health systems agencies (HSAS) or other interested agencies and groups can play an integral role in highlighting the Hill-Burton Program and helping the medically indigent obtain free care, This paper describes the Hill-Burton Program and explains how one HSA identified the Hill-Burton facilities in its area, determined the extent of their obligations, obtained allocation plans, and publicized and promoted the available health care services. From the interest shown by the community it was apparent that the HSA had provided a much needed and appreciated service that could be duplicated across the country by HSAS or other community groups.

An HPLC method for analysis of clonazepam in serum

A sensitive, accurate, and precise method for the analysis of clonazepam in serum was developed. The drug and internal standard from serum extracts were methylated to obviate carbamazepine interference and then resolved on a 5 micron C18 HPLC column. The mobile phase could also be used for many other basic drugs.

Effects of tri-n-butyl phosphate on the peripheral nervous system of the Sprague-Dawley rat

Tri-n-butyl phosphate, a widely used plasticizer and solvent, was orally administered to male and female Sprague-Dawley rats for 14 consecutive days (low dose: 0.28 mL/kg; high dose: 0.42 mL/kg). Effects of this industrial chemical were investigated on the peripheral nervous system of these animals. A significant (P less than 0.05) reduction in conduction velocity of caudal nerve was observed in high dose male rats. Electron microscopic examination of sciatic nerve showed morphological changes such as retraction of Schwann cell processes surrounding unmyelinated fibres in both sexes of high dose groups.

The effect on heart rate of neuromuscular blockade reversal by pyridostigmine

Pyridostigmine without atropine, pyridostigmine with atropine or neostigmine with atropine were used to antagonise neuro-muscular blockade induced by d-tubocurarine in forty otherwise healthy, female patients recovering from gynaecological surgery. Pulse rates fell significantly (P less than 0.01, control heart rate 72 +/- 18 beats/min (M +/- SD) to 55 +/- 13 beats/min) at ten minutes after pyridostigmine (10 mg/70 kg), necessitating administration of atropine (1.25 mg/70 kg) by fifteen minutes after pyridostigmine. After an initial rise in rate, pulse rates also fell significantly (P less than 0.01, control heart rate 70 +/- 12 beats/min to 44 +/- 11 beats/min) at fifteen minutes after injection of neostigmine (2.5 mg/70 kg) with atropine (1.25 mg/70 kg). By contrast when pyridostigmine and atropine were used together, pulse rates rose and then fell, but mean values never fell below control during a twenty-minute observation period. It was concluded that pyridostigmine should not be given alone, but requires the use of atropine to prevent bradycardia. This combination may, however, provide a more stable heart rate than that seen with neostigmine and atropine in usual doses, when these drugs are used to antagonise d-tubocurarine.

Cutaneous and venous complications of pentazocine abuse

A 55-year-old man with a two-year history of intramuscular pentazocine abuse had classical cutaneous findings as well as secondary venous thrombosis, which, to our knowledge, is previously undescribed. Histologic evaluation, including direct immunofluorescent microscopy, did not establish the mechanism of tissue destruction.

Plasma protein binding and placental transfer of bupivacaine

The maternal venous and umbilical venous plasma concentrations of bupivacaine were determined at delivery following epidural administration of the drug to 31 women in labor. In each case the umbilical venous plasma concentration of bupivacaine was lower than the maternal venous plasma concentration. There was no significant difference between the concentration of unbound bupivacaine in umbilical venous and maternal venous plasma at delivery. The difference in umbilical and maternal plasma concentrations of bupivacaine appears to be a consequence of greater bupivacaine binding to maternal than to fetal total plasma protein. The intersubject variation of the ratio of bupivacaine concentration in fetal plasma/bupivacaine concentration in maternal plasma was found to be related to individual variation in the extent of protein binding of bupivacaine in maternal and umbilical plasma and correlated positively with the variation of the ratio of total protein concentration in umbilical and maternal plasma.

The effects of r- and K-selection on components of variance for two quantitative traits

The genetic and environmental components of variance for two quantitative characters were measured in the descendants of Drosophila melanogaster populations which had been grown for several generations at densities of 100, 200, 300, and 400 eggs per vial. Populations subject to intermediate densities had a greater proportion of phenotypic variance available for selection than populations from either extreme. Selection on either character would be least effective under pure r-selection, a frequent attribute of selection programs.