Administration of indomethacin for the prevention of periventricular-intraventricular hemorrhage in high-risk neonates

One hundred twenty-two preterm infants were enrolled in a placebo-controlled, double-blind trial using intravenous indomethacin for the prevention of periventricular-intraventricular hemorrhage (PVH-IVH). Before random assignment, data on the infants were stratified according to low-weight (500 to 999 g) or high-weight (1000 to 1500 g) subgroups. Cranial sonography was used to document the absence of PVH-IVH before enrollment and the occurrence of PVH-IVH during the 7-day protocol. Indomethacin, 0.1 mg/kg, or placebo was administered before 12 hours of age and at 24, 48, and 72 hours of age. Five patients receiving indomethacin and six receiving placebo were withdrawn before completion of the study. In the remaining 111 patients, the indomethacin and placebo groups were comparable with respect to gestational ages, maternal complications, Apgar scores, ventilatory requirements, complications of prematurity, and mortality rate. PVH-IVH developed in six of 56 infants who received indomethacin and 11 of 55 infants who received placebo (P = 0.174). Analysis of the individual strata showed that the indomethacin-treated infants in the low-weight subgroup sustained a higher mortality rate (11/17 vs 3/16; P = 0.008) without a reduction in the incidence of PVH-IVH. Infants in the indomethacin-treated high-weight subgroup demonstrated a significantly lower incidence of PVH-IVH (2/39 vs 8/39; P = 0.04), but the frequency of high-grade hemorrhages was comparable for both indomethacin- and placebo-treated groups. In summary, the prophylactic administration of intravenous indomethacin for the prevention of PVH-IVH cannot be recommended for infants less than 1000 g. In preterm infants between 1000 and 1500 g birth weight, indomethacin significantly reduced the incidence of PVH-IVH.

Measurement of some primary nuclear interferences in neutron activation analysis with a SLOWPOKE reactor

The interference factors were measured for 21 cases where the (n, p) and (n, α) reactions induced by fast neutrons produce the same radioisotopes as those used in the determination of F, Na, Mg, Al, S, Se, Ti, V, Cr, Mn, Co, Ni, Cu, Ga, and As. The measured factors are compared with those calculated from data found in the literature.

Phases of change in the patient with Alzheimer's dementia: a conceptual dimension for defining health care management

Since the progressive nature of Alzheimer's disease and related disorders of later life gradually imposes a series of significant limitations upon the patient, a successful clinical management program rests upon a conceptualization of changes in the patient. Postulating psychologic reactions helps professionals to understand and respond to the patient's needs and feelings at different stages of the disease. The phases discussed here provide the basis for defining treatment goals and management plans, selecting therapeutic strategies, identifying needed resources, and evolving innovative approaches to patient care.

The pharmacokinetics of vincristine in man: reduced drug clearance associated with raised serum alkaline phosphatase and dose-limited elimination

A radioimmunoassay has been used to investigate the pharmacokinetics of vincristine in 39 cancer patients who received between 0.4 and 1.54 mg vincristine/m2 as part of standard treatment protocols. There was wide interindividual variation in both the terminal elimination half-life of vincristine (t1/2beta) and the associated volume of distribution (Vd), resulting in an 11-fold range of dose-corrected area under the plasma concentration versus time curve values (AUC0-infinity). Elevated vincristine AUC0-infinity values were observed in those patients with raised serum alkaline phosphatase at the time of vincristine estimation. The t1/2beta was significantly longer in these patients than in those with serum alkaline phosphatase within normal limits, suggesting that biochemical evidence of cholestasis is associated with reduced clearance of vincristine. Evidence is also presented to suggest that the clearance of vincristine is dose-dependent within the therapeutic dose range. We observed a disproportionate rise in vincristine plasma concentration at doses exceeding t1/2beta compared with that observed for patients receiving 1 mg vincristine/m2 or less.

Bromocriptine treatment in Parkinson's disease

Thirty-one patients with Parkinson's disease were treated with the ergot alkaloid bromocriptine, a drug which stimulates dopamine receptors. Bromocriptine had a slight therapeutic effect in patients on no other treatment and an additional effect in patients on levodopa. The mean optimum dosage of bromocriptine, established over a 12 week period, was 26 mg daily. In 20 patients bromocriptine was compared with placebo in a double-blind controlled trial. Active treatment caused a significant (P less than 0.02) reduction in total disability and akinesia scores. The least disabled patients showed the greatest response. Side-effects of bromocriptine--nausea, vomiting, hallucinations, and abnormal involuntary movements--were similar to nature to those of levodopa. In most normal subjects, bromocriptine causes an increase in plasma growth hormone concentration. This was determined in 20 patients with Parkinson's disease after 1-15 mg bromocriptine. Only a single patient showed an obvious increase up to 120 minutes after dosage. Bromocriptine was not effective treatment in two patients who had not previously responded to levodopa and replacement of this drug by bromocriptine in patients with end-of-dose akinesia after chronic levodopa treatment did not totally abolish response swings.

Management of urinary tract infection in general practice

In a general practice an attempt was made to determine the relative merits of cycloserine, sulphadimidine or nitrofurantoin in the treatment of urinary tract infection. Bacteriological follow-up continued for 2 years. The incidence of patients with symptoms and with significant bacteriuria before treatment was 13 per 1,000 females at risk.

With a follow-up of 50 days nitrofurantoin and cycloserine had an apparent cure rate of 78 and 79 per cent respectively. Sulphadimidine had a cure rate of only 43 per cent due largely to a higher incidence of organisms resistant in vitro. Results after 2 years show that apparent cures are much fewer (nitrofurantoin 46%, cycloserine 36%, sulphadimidine 29%) and there is much less difference in the effectiveness of the various drugs. Only 4 patients stopped treatment because of drug toxicity.

The results of intravenous pyelography in 155 patients suggest that rather than X-ray all patients with urinary-tract symptoms, prolonged bacteriological follow-up will reveal those in whom X-rays may be helpful.