Studies in REST. I. Reduced Environmental Stimulation Therapy (REST) and reduced alcohol consumption

Reduced Environmental Stimulation Therapy (REST), formerly known as "sensory deprivation," was used in conjunction with pre-recorded anti-alcohol messages to reduce alcohol consumption. Subjects were college students of both sexes who were "heavy social drinkers," that is, early prodromal alcoholics. There were two studies. In the pilot study experimental subjects had two and a half hours of REST, during which they heard one of two differently worded anti-alcohol messages. After two weeks their alcohol intake dropped significantly from baseline levels (33% and 29%); control subjects showed no significant changes. In a replication and follow-up study experimental subjects had two and a half hours of REST, during which they heard a revised version of the most effective anti-alcohol message used in the pilot study. Two weeks later their alcohol consumption dropped 55% from baseline levels. These reductions in alcohol intake were fully sustained on follow-up three months and six months later. Untreated control subjects showed increased alcohol intake on follow-up.

Betamethasone dipropionate in optimized vehicle. Intermittent pulse dosing for extended maintenance treatment of psoriasis

A study was done of extended maintenance therapy using either betamethasone dipropionate (Diprolene) in optimized vehicle (OV) (ointment) or placebo in patients with psoriasis vulgaris. Of 59 patients originally enrolled in the study, 38 assessable patients achieved clearing of at least 85% improvement from baseline with traditional betamethasone in OV twice a day for two to three weeks before intermittent pulse dosing was attempted. Thereafter, the test medication was used on weekends (three consecutive doses at 12-hour intervals) once a week. Fourteen patients (74%) of the betamethasone in OV group and four patients (21%) of the placebo group maintained a remission status for 12 weeks. Intermittent pulse dosing with betamethasone in OV seems safe and efficacious maintenance therapy in selected psoriatic patients.

HPLC method for the analysis of cyproterone acetate in tablets

A reversed-phase high-performance liquid chromatographic (HPLC) method is described for the analysis of cyproterone acetate in tablets. This steroid is extracted and quantitated using a C18 column. This procedure is shown to be rapid, simple, and valid in terms of recovery, linearity, and precision. Application of this method to analyze dilute samples obtained from dissolution testing is demonstrated.

Assay methods for fentanyl in serum: gas-liquid chromatography versus radioimmunoassay

In this study, two independent laboratories assessed the validity of the fentanyl radioimmunoassay (RIA) by measuring a series of spiked control serum samples and 429 serum samples from 20 patients receiving fentanyl for their anesthesia. Additionally, a gas-liquid chromatographic (GLC) method specific for the parent drug was also applied to the same serum samples. The RIA measurement of fentanyl by the two laboratories resulted in comparable values for both control samples and samples from patients in a range of 0.5-50 ng/ml. The GLC method agreed with both RIA measurements in the spiked control and patient samples. The authors' results demonstrate the validity of the RIA as a measurement technique for fentanyl in human serum samples.

Improved radioreceptor assay of opiate narcotics in human serum: application to fentanyl and morphine metabolism

A recently developed radioreceptor assay (RRA) (1) that employs 3H-naloxone and rat brain membrane homogenates was improved two ways. First, the brain membranes were preincubated in the presence of sodium ions, and second, manganase-II ions were added to the sample incubations. These changes enhanced the assay sensitivity and reproducibility with stored membrane preparations and reduced the effects of serum constituents (Na+) on ligand-receptor binding. Patient sera were assayed by radioimmunoassay (RIA) and RRA after fentanyl administration and by high-performance liquid chromatography (HPLC) and RRA after morphine administration. The results with both fentanyl assays were comparable, and no fentanyl metabolites were detectable by RRA after HPLC of serum extracts. In contrast, preliminary results with the HPLC-RRA procedure suggest the presence of an active morphine metabolite of unknown structure in sera obtained from patients on morphine therapy.

Decreased fentanyl and alfentanil dose requirements with age. A simultaneous pharmacokinetic and pharmacodynamic evaluation

The effect of increasing age on the dose of fentanyl or alfentanil required to produce the same electroencephalographic (EEG) stage was studied in adult male patients. The pharmacokinetic and pharmacodynamic components of each patient's dose-response relationship were evaluated simultaneously. Frequent arterial blood samples drawn during and after an infusion of fentanyl or alfentanil were assayed by radioimmunoassay and permitted determination of each patient's pharmacokinetic profile. The EEG was analyzed by power spectral analysis and a parameter (spectral edge frequency) chosen to quantitate the narcotic-induced EEG slowing. An inhibitory sigmoid Emax pharmacodynamic model related spectral edge frequency to narcotic serum concentrations. The dose requirement of fentanyl or alfentanil decreased significantly with increasing age (a 50% decrease from age 20 to 89). No age-related changes in the pharmacokinetic parameters were found. Brain sensitivity (as determined by EEG changes) did decrease significantly with age. Thus, the decreased dose requirement in the elderly had a pharmacodynamic explanation, using the EEG as a measure of narcotic drug effect.

Evaluation of the effect of food on the absorption of sustained-release theophylline and comparison of two methods for serum theophylline analysis

Fifteen healthy volunteers took part in a study to investigate the effect of food on the bioavailability of a slow-release formulation of theophylline. Serum theophylline levels were measured every two hours for ten hours after a single oral dose of 500 mg of theophylline. Serum levels were significantly higher after the dose was taken on an empty stomach; however, serum levels were significantly higher 10 hours later when the dose was taken after a standard meal. Despite these differences, eating had no overall effect on theophylline bioavailability. Two analytic methods for measuring serum levels of theophylline were compared, and it was found that fluorometry could measure lower levels and was therefore more precise than an enzyme immunoassay method, which is probably due to the complete automation and reduced interference of bilirubin and hemoglobin.

EEG quantitation of narcotic effect: the comparative pharmacodynamics of fentanyl and alfentanil

Fentanyl and alfentanil produce very similar electroencephalographic (EEG) changes in humans. With increasing serum concentrations of either narcotic, progressive slowing in frequency occurs. This narcotic effect on the brain was quantitated using off-line EEG power spectrum analysis. During EEG recording, six unpremedicated patients received a fentanyl infusion (150 micrograms/min), and six received alfentanil (1,500 micrograms/min) until a specific level of EEG depression (delta waves) occurred. Timed arterial blood samples were obtained for measurement of the narcotic serum concentrations. The narcotic-induced EEG changes were found to lag behind (in time) the serum narcotic concentration changes. To accurately relate EEG changes to serum narcotic concentrations, a pharmacodynamic model (inhibitory sigmoid Emax) was combined with a pharmacokinetic model that incorporated an "effect" compartment. (The effect compartment is the separate pharmacokinetic compartment where drug effect is directly proportional to drug concentration. It is the effect site.) The magnitude of the time lag was quantitated by the half-time of equilibration between serum narcotic concentrations and concentrations in the effect compartment. With fentanyl a significantly greater time lag was present (half-time = 6.4 +/- 1.3 min; mean +/- SD) than with alfentanil (half-time = 1.1 +/- 0.3 min). This difference in time lag between blood concentration and effect may be due to the larger brain-blood partition coefficient for fentanyl. The steady-state serum concentration that caused one-half of the maximal EEG slowing was 6.9 +/- 1.5 ng/ml for fentanyl, compared with 520 +/- 163 ng/ml for alfentanil.(ABSTRACT TRUNCATED AT 250 WORDS)

Indication for interstitial brachytherapy in carcinoma of the uterine cervix

More than 40 patients with gynecological, genitourinary, and gastrointestinal malignancies, both primary and recurrent but confined to the pelvis, were treated with interstitial irradiation over a four-year period. Interstitial irradiation was the choice of treatment for early carcinoma of the prostate, carcinoma of the anal canal less than T2, recurrent carcinoma of the uterine cervix, and carcinoma of the cervical stump. The authors' experience in treating recurrent carcinoma of the uterine cervix with interstitial irradiation is the basis for the indications for selecting the technique of interstitial irradiation presented.

Surgery following initial treatment of ovarian carcinoma: restaging (second-look) and palliative operations

Of 73 patients treated for ovarian carcinoma at the University of Nebraska Medical Center between 1976 and 1982, 37 underwent a second operative procedure following initial surgery. A total of 14 had a second look following complete clinical response, 11 had intestinal diversion, and 12 underwent other procedures. Second-look surgery proved useful in evaluating patients in clinical remission and directing subsequent management. The majority of patients whose operations were for persistent or recurrent disease had short survival. However, such surgery helps occasional patients and should be considered when circumstances warrant.

A survey of blood pressure in the state of Maryland

To provide baseline data for a state program to coordinate hypertension resources, a blood pressure (BP) survey was undertaken in Maryland in 1978. A statewide probability sample of households was chosen; each adult member was eligible for interview and measurement of BP. A total of 6,425 adults were interviewed for an overall response rate of 79.5%. Using a definition of diastolic blood pressure (DBP) of 95 mm Hg or higher or use of antihypertensive medication, 15.1% of state residents were estimated to be hypertensive. Of these, 85.8% were estimated to be aware of their condition, 77.6% of them were treated, and 67.6% had their BP controlled to a normal level by medication. Data are also presented using DBP 90 mm Hg or higher. A comparison of data from the Hypertension Detection and Follow-up Program (HDFP) home screen in 1973-1974 and comparable information from this survey showed lower rates of awareness, treatment, and BP control in hypertensives at HDFP home screen. Results of this survey will be compared with those of a second statewide survey conducted four years later to assess changes in rates of hypertension awareness, treatment, and control.

Diagnostic significance and sequelae of cone biopsy

All cone biopsies from our institution over a 10-year period were reviewed. Two hundred seventy-one patients underwent 274 procedures. Preoperative colposcopic evaluation markedly reduced the proportion of patients with residual cervical epithelial neoplasia (CIN). No patient in our series required conization for diagnosis of frankly invasive carcinoma. Following colposcopy and conization, 8% of patients had disease extending to the surgical margins; eight of 11 such patients (72%) with adequate follow-up had no further CIN. Colposcopy and cytology underestimate the final pathologic diagnosis in many patients with incomplete visibility of the transformation zone, so conization is mandatory in this circumstance. Conization in pregnancy was associated with increased hemorrhage; colposcopy has reduced the need for this operation in gravid patients.

N-Nitrosomorpholine and other volatile N-nitrosamines in snuff tobacco

Ten popular snuff brands from the USA and Sweden were analyzed for volatile N-nitrosamines (VNA). Seven of these samples contained between 20 and 70 p.p.b. of N-nitrosomorpholine (NMOR), a strong animal carcinogen. Some of the snuff containers which were made of waxed cardboard contained morpholine. This observation and a model study with the container waxes plus [14C]morpholine indicate that NMOR possibly can be formed by way of diffusion of the morpholine into the snuff and subsequent N-nitrosation. The VNA including NMOR (60-1150 p.p.b.) together with N-nitrosodiethanolamine (NDELA; 225-3300 p.p.b.) and the four tobacco-specific N-nitrosamines (TSNA; 1300-80,000 p.p.b.) contribute significantly to the carcinogenic potential of snuff. This tobacco product, although a known human carcinogen, is becoming increasingly popular especially among young people in the USA and Sweden. A recently introduced Swedish brand with individual snuff portions wrapped in aluminum foil was free of VNA (less than 2 p.p.b.) and contained relatively low levels of NDELA (290 p.p.b.) and TSNA (4200 p.p.b.). This indicates that practical approaches towards lowering N-nitrosamine levels in these snuff products are available.

Separation and identification of equine leukocyte populations and subpopulations

Various methods of separation and identification of major equine leukocyte populations and subpopulations were used. The purity of T and B lymphocytes separated in Sephadex anti-equine F(ab')2 columns was 87% to 99% and 83% of 97%, respectively. The purity of T lymphocytes separated in nylon-wool columns was 89% to 98%. Preparations of B lymphocytes separated in glass-bead columns were 68% to 79% pure. The presence (or absence) of surface immunoglobulin by immunofluorescence was the most consistent and reliable method for the identification of B or T lymphocytes, respectively. However, the erythrocyte-antibody-complement-rosette method for the identification of B cells and the erythrocyte-rosette method for the identification of T cells were not suitable. Monocytes were separated by the adherence method, and the purity, as identified by the latex particle ingestion procedure, was 70% to 78%. Electron microscopy of monocytes stained by peroxidase activity did not identify these cells. The purity of neutrophils obtained by the Ficoll-Hypaque separation method was 95% to 97%. The merits and usefulness of these methods were discussed.

Liver neoplasms and the oral contraceptives

For sixteen years (1954 to 1970) oral steroids had been used for contraception by millions of women. We were unable in this time span to find any cases of liver neoplasms in women using oral contraceptives. However, since 1970, there have been 138 cases reported in the English literature. We will add nine cases to this number, including an unusual case report. Evidence for the oral contraceptive as an etiologic agent in causing liver neoplasms is circumstantial but but nevertheless substantial. The literature is reviewed, and our case is presented. At present, the etiology of liver neoplasms is an enigma. Close clinical surveillance with an awareness of this potentially fatal pathologic entity is essential in women who have ingested oral contraceptives.

Toxic-therapeutic ratio of sodium cyanate

Six patients with sickle cell anemia were treated with sodium cyanate (30 mg/kg/day). In four, treatment was stopped because of definite or suspected toxicity, and no improvement was seen in the other two. Most alarming was the sudden development of peripheral motor neuropathy in a patient whose red blood cells contained less than 0.6 mols NCO-/mol of hemoglobin: six months after treatment was stopped, function had not completely returned in this patient. Safe oral dosage regimens may not be effective, but extra-corporeal treatment of sickle cells with cyanate, or other compounds, might circumvent that problem.

A clinical appraisal of patients following long-term contraception

This study presents a clinical evaluation of private patients between the ages of 16 and 40 who have used contraceptive measures from January 1, 1961, through December 31, 1973. The clinical evaluation involves 3,746 private patients. The contraceptive methods of 641 patients (17 per cent) who have been bollowed for a total of 99,996 months (13 years each) are presented and analyzed. The patients are evaluated as to weight, blood pressure, pregnancy, pap smears. laboratory changes, pelvic surgery, breast surgery, incidence of cancer, contraceptive failures and changes in contraceptive practices over this span of time. This paper evaluates the role of such sociologic factors as education, religion, economic level, occupation, working status, changing marital status, age at the time of contraceptive choice, and the attitude of the husband with regard to long-term contraceptive therapy. Side effects have been well publicized. Safety has been questioned but essentially proved for the vast majority of the patients. Collected data enable some insight into the life style and motivation of the long-term contraceptive users.