Diltiazem pharmacokinetics in elderly volunteers after single and multiple doses

In young healthy volunteers diltiazem does not have linear kinetics between single and multiple doses. Elimination half-life increases and gives AUC's and Cmax higher than those predicted from single dose data. Kinetics of diltiazem were assessed in 16 healthy elderly after a single 60 mg dose and in 24 healthy elderly after 60 mg every 8 h for 7 days. Thirteen participants completed both studies. Elimination half-life, AUC0-24, AUC0-infinity, and Cmax were (mean +/- SE) 7.4 (1.2) h, 349 (34) ng/ml.h, 392 (44) ng/ml.h, and 43 (5) ng/ml respectively after a single dose. After multiple doses elimination half-life, AUC0-48, AUC0-infinity, Cmax and Cmin were respectively 5.7 (0.3) h, 974 (107) ng/ml.h, 1022 (108) ng/ml.h, 102 (7) ng/ml and 43 (5) ng/ml. Exploratory statistics on the 13 volunteers common to both studies showed that the ratio of AUC desacetyl-diltiazem (DAD)/AUC diltiazem rose between single and multiple doses while elimination half-life of both diltiazem and N-desmethyl-diltiazem (MA), tmax, and AUC MA/AUC diltiazem were not affected. The conclusion of this study is that elimination half-life of diltiazem does not increase in elderly between single and multiple doses, possibly due to an increased biotransformation into DAD.

Adjuvant arthritis in the rat during pregnancy

Pregnancy is known to have a beneficial effect on some forms of peripheral arthritis in man. We have examined the effect of pregnancy on the development and severity of adjuvant arthritis in the rat. Pregnancy does modify the development of adjuvant arthritis, but once the arthropathy is established, the changes seen with pregnancy are not the same as with rheumatoid arthritis.

Primary renal carcinoid

A case of primary renal carcinoid in a 34-year-old man is reported. The lesion was morphologically identical to carcinoid tumors arising in the gastrointestinal or respiratory tracts. The renal carcinoid was focally argyrophilic and contained chromogranin and neuron-specific enolase disclosed by immunohistochemical studies. The diagnosis was further confirmed by membrane-bound cytoplasmic neurosecretory granules visualized by electron microscopy. The possible histogenesis of this unusual tumor and a review of the literature are discussed.

Conductive education--magic or myth?

Subjective reports on the results of conductive education (CE) in 18 groups of children in English schools, and in 16 children who had been to Hungary were examined. Although many improvements seem to be indicated, rigorous scientific methods were not used, and the verdict on CE must remain open. The newly established Foundation for Conductive Education in Birmingham may help to resolve current uncertainty.

HLA-Bw60 increases susceptibility to ankylosing spondylitis in HLA-B27+ patients

We examined the distribution of non-B27 alleles of the HLA-B locus among B27+ patients with ankylosing spondylitis (AS), to detect any additional HLA-B locus allele(s) that may act in conjunction with B27 to increase susceptibility to AS. HLA-Bw60 (or B40 when the Bw60,61 split of B40 was not typed for) was shown to be increased among B27+ AS patients in each of 5 independent data sets. This increase was statistically significant in 4 of the 5 data sets studied, and the overall significance was P less than 0.00001. Susceptibility to AS in B27+ individuals was further increased by a factor of approximately 3 when Bw60 was also present. The distribution of HLA-A alleles on the B27-bearing haplotypes in AS patients was not significantly different from that in normal controls. On the other hand, the distribution of HLA-A alleles on Bw60-bearing haplotypes was significantly different from the distribution of A alleles on Bw60 haplotypes in the general population (P less than 0.0005). Bw60 was not increased in B27- patients with AS. A dominant mode of inheritance generally fits AS; however, our sib pair analysis indicates that the B27,Bw60 disease subgroup follows a more recessive mode of inheritance.

Positron emission tomography of the cerebellum in autism

On the basis of neurological evidence that autistic patients have fewer Purkinje and granule cells in the cerebellum as well as vermal cerebellar hypoplasia, the authors tested the hypothesis that autistic patients have cerebellar hypofunctioning. They used positron emission tomography of the cerebellum with 18F-labeled 2-deoxyglucose to study seven autistic patients and eight age-matched control subjects. The results showed no significant difference in mean cerebellar glucose metabolism between the two groups, but all mean glucose rates of the autistic patients were either equal to or greater than those of the control subjects. The implications of these findings are discussed.

Neuropeptide Y in the sympathetic control of blood pressure in hypertensive subjects

Neuropeptide Y (NPY) coexists with noradrenaline in postganglionic sympathetic neurons and with noradrenaline and adrenaline in the central nervous system. The possibility that NPY is released into the circulation during activation of the sympathoadrenal system was investigated in ten moderately hypertensive volunteers using three different stimuli. In healthy moderately hypertensive volunteers cold pressor test, head up tilt and graded bicycle exercise resulted in increased blood pressure, heart rate and plasma catecholamine concentrations. While there was a trend for plasma NPY-like immunoreactivity (NPY-LI) to increase during cold pressor test and head up tilt, NPY-LI concentration only increased significantly during bicycle exercise, the stimulus of greatest duration. These results suggest that plasma NPY-LI can be released into the circulation on sympathoadrenal activation in moderately hypertensive subjects and demonstrate that the pattern of release is similar to that previously observed in normotensive subjects.

Reactive hyperemia in patients with Raynaud's phenomenon

Our study was undertaken to demonstrate the efficacy of digital plethysmography using a strain gauge plethysmograph in the assessment of the reactive hyperemic response. We studied patients with Raynaud's phenomenon with and without associated connective tissue disorders. Reactive hyperemic response was examined in 27 normal subjects and 19 patients with Raynaud's phenomenon at 12-14 degrees C, 20-22 degrees C and 37-40 degrees C. In the normal subjects reactive hyperemia was greatest at 20-22 degrees C. In 19 patients with Raynaud's phenomenon, the pulse waves were smaller at 20-22 degrees C than in normal subjects and the response was seen in only 5 of 19 patients. At 12-14 degrees C reactive hyperemic response was usually absent and at 37-40 degrees C it was evident in 9 patients. Nifedipine was given to 11 patients (5 mg TID for 4 weeks) and in 10 of them, reactive hyperemic response was restored at 20-22 degrees C.

Reduced estradiol production by a substituted triazole results in delayed ovulation in rats

Ovulation in the rat is delayed by a single administration of the substituted triazole R151885 (1,1-di(4-fluorophenyl)-2-(1,2,4-triazol-1-yl)-ethanol). This delay results from a 24-hr shift in the preovulatory luteinizing hormone (LH) surge since administration of chorionic gonadotrophin on proestrus restores ovulation. Plasma levels of estradiol are markedly reduced (42-45%) 6-12 hr after administration of R151885. The restoration of ovulation in R151885-pretreated rats, by administration of exogenous estradiol benzoate, indicates that the reduced estradiol levels play a pivotal role in the delay of ovulation. Granulosa cells isolated from rat ovaries produce estradiol and progesterone in vitro in the presence of both follicle-stimulating hormone and testosterone. The addition of R151885 to such cultures results in a dose-dependent inhibition of estradiol production (69% by 1 microM) without a significant effect on progesterone production. This inhibition occurs at concentrations of R151885 similar to those measured in vivo. R151885 is a competitive inhibitor of human placental aromatase (apparent Ki with androstenedione substrate of 410 nM) and produces a type II spectral perturbation of cytochrome P-450 from placental microsomes. Pituitaries isolated from R151885-treated rats have reduced LH output in response to gonadotrophin-releasing hormone stimulation compared with those of controls. It is proposed that R151885 competitively inhibits aromatase activity in developing ovarian follicles. The resultant temporary reduction of plasma estradiol levels at a critical time in the estrous cycle, and consequent inadequate pituitary sensitization, produces a 24-hr delay in the preovulatory LH surge and hence ovulation is delayed by 24 hr.

Direct radioimmunoassay of human plasma atrial natriuretic peptide in various normal and pathophysiological states: increase in renal and cardiac failure during exercise

We have used a sensitive direct radioimmunoassay to study the effects of exercise on plasma atrial natriuretic peptide (ANP) concentrations in man. Plasma ANP concentration increased three-fold in sixteen patients undergoing bicycle ergometer electrocardiographic tests for the investigation of chest pain. Resting ANP concentrations were higher in those patients in whom there was more evidence of heart disease, such as a positive exercise test, treatment with a beta blocker or history of myocardial infarction, although exercise resulted in increased ANP in both groups. We also confirm the increased plasma ANP concentration observed in patients with congestive cardiac failure and renal failure. In nine patients with renal failure routine haemodialysis was accompanied by a 30 per cent reduction in plasma ANP concentration. Plasma ANP concentrations were similar in treated hypertensive patients, untreated borderline hypertensive patients and normotensive subjects.

Evidence that the potential antipsychotic agent rimcazole (BW 234U) is a specific, competitive antagonist of sigma sites in brain

Rimcazole (BW 234U) is a potential antipsychotic agent which in open-clinical trials appears to be effective in acute schizophrenic patients. In the present study, rimcazole was found to block the specific binding of [3H]-(+)-SKF 10,047 to sigma sites in rat and guinea pig brain (IC50 = 5.0 X 10(-7) M). The compound was 100 times weaker as a blocker of phencyclidine sites (IC50 = 4.3 X 10(-5) M). At 1 X 10(-5) M, rimcazole had only weak effects on mu, delta, kappa and epsilon opioid receptors. Scatchard analysis of the binding data from guinea pig brain revealed an apparent KD for [3H]-(+)-SKF 10,047 of 85 +/- 5 nM and a Bmax of 824 +/- 27 fmole/mg protein. In the presence of 5 X 10(-7) M BW 234U, the apparent KD was 165 +/- 35 nM, but the Bmax (892 +/- 146 fmoles/mg protein) was not affected. This suggests that rimcazole is a competitive inhibitor of sigma sites. The agent was also capable of blocking sigma sites in vivo (ID50 = 6 mg/kg i.p., mice) as judged by an in vivo sigma receptor binding assay. Thus, if the antipsychotic activity of rimcazole is confirmed in double-blind, placebo-controlled trials, it would be the first compound whose mechanism of antipsychotic activity may best be explained by a direct blockade of sigma sites and not by a direct blockade of dopamine (D2) receptors in brain.

Adaptive abilities in nonclinical second-generation Holocaust survivors and controls: a comparison

A nonclinical second-generation Holocaust survivor group of young adults is contrasted with a comparable North American Jewish control group. A discriminate analysis of questionnaire responses indicates specific differences between the functioning second generation (N = 68) and the control group (N = 51). Focus was on growth-producing rather than pathogenic factors. Sample characteristics, interview data, techniques of data analyses and results are presented and discussed; some literature and work in progress is noted. Recommendations regarding further research efforts are made.

Reflections on the current psychiatric consultation and referral pattern and on the state of the art, at Oxford Regional Centre, an adult mental retardation facility

This paper investigates the utilization pattern of the psychiatric consultation and referral service provided by the author in an Adult Mental Retardation Facility over a three-year period. The services, their history and locale are described against a background of changes in attitudes towards the problems of the retarded. Rising interest by psychiatrists in the field is placed in context. A spectrum of variables is used for a statistical analysis of factors (Chi2) influencing psychiatric referrals or non-referrals of all new admissions over the period indicated (N = 98). Against a background of increasing normalization and de-institutionalization, the character and composition of the shrinking institutional population has changed. Administration and direct-care staff are now confronted with management and care problems of lower functioning retardates, presenting difficult-to-manage behaviours and severe, often multiple, handicaps. Several factors with resource and care implications are considered, affecting institutionalized as well as community placed retardates, especially in hard economic times. Findings are discussed; recommendations are made concerning the application of scarce psychiatric resources to meet changing psychiatric needs of the population, maximize services and continue community directed normalization efforts. Some caveats are sounded and further research suggested.

A social skills analysis in childhood and adolescence using symbolic interactionism

Support is obtained from the literature about the need for advances in the conceptualization of "social skills." There is agreement that much is known about how to improve social skills, but less attention has been given to what to change or improve. The present article outlines a model of social skills in childhood and adolescence using the concepts and literature on symbolic interactionism in an attempt to provide a possible conceptual framework for social skills. The proposed model is organized around the concepts of role-taking, role-making, definition of the situation, and self. Each concept is taken in turn and how it could contribute to the analysis or understanding of social skills in childhood and adolescence is shown. The article concludes with a discussion of ways in which the proposed scheme might be used in one area of social skills - friendship making. Some possible difficulties and limitations in the model are noted.

Moral judgment in relation to behavioral and cognitive disorders in adolescents

The capacity for formulating moral judgments shown by 20 emotionally disturbed, cognitively delayed adolescents was related to their social behaviors as observed in a classroom situation. Adolescents reported by their teachers to be shy and submissive were less capable of reasoning about moral issues than were adolescents who were seen as more assertive and socially engaged. The level of moral judgment was not a function of intelligence or ability to understand concrete operations. The implication that social engagement is a critical determinant of moral judgment for these adolescents is discussed.

Efficient generation in vitro, from human peripheral blood cells, of monoclonal Epstein-Barr virus transformants producing specific antibody to a variety of antigens without prior deliberate immunization

This paper describes a simple protocol for the efficient generation of large numbers of human monoclonal antibody-producing cells. This system is based on initial limiting-dilution culture after Epstein-Barr virus exposure of highly enriched precursors selected from peripheral blood mononuclear cells. Precursors can be enriched by using rosetting or panning approaches. Antibodies to erythrocytes, a mouse mammary carcinoma, DNA, and sperm antigens, produced without any deliberate immunization, are described. Large-scale human monoclonal antibody production may be facilitated by a combination of this protocol with a human cellular fusion system. For efficient precursor analysis and short-term (2 months or more) monoclonal antibody production, however, the system described here may be sufficient.

Assessment of abdominal and back extensor function. A quantitative approach and results for chronic low-back patients

A method was developed to obtain static and dynamic measures of trunk flexor and extensor strength and endurance. The method was evaluated using 32 normal subjects. Variables of trunk strength and endurance were used to compare 24 normals (12 men and 12 women) and 24 patients (16 men and eight women) with chronic low-back dysfunction. The Iowa Trunk Dynamometer is acceptably reliable and provides for assessment of isolated function of the abdominal and back muscles. For peak abdominal and back extensor strength, the range of superiority of men over women was 39-57%, and the range of superiority of normals over patients with chronic low-back dysfunction was 48-82%. Using time to percent decrement of peak strength as a criterion, the abdominals were more susceptible to fatigue than the back extensors, women demonstrated more endurance than men, and the endurance for normals was less than those patients who were able to perform dynamic reciprocal trunk movements.

Intraoperative irradiation: a pilot study combining external beam photons with "boost" dose intraoperative electrons

Intraoperative "boost" dose electron beam therapy given in combination with 4500--5000 rad (45--50 Gray) external beam irradiation has been demonstrated as a practical therapeutic modality at the MGH. This procedure has been employed thus far in 58 patients; the results in the initial 36 are analyzed in detail in this paper. Thirty-four of the 36 patients had locally advanced lesions--unresectable, recurrent, or residual disease. Results achieved to date are in full agreement with our expectations: high radiation doses have been delivered to the primary intra-abdominal and pelvic tumors, excluding the sensitive structures from irradiation. This has been accomplished by a truly multidisciplinary effort comprising surgery, anesthesiology, OR nursing, administration, engineers, physicists, therapy technologists, and radiation therapists. Although follow-up is not yet sufficient to judge ultimate efficacy, acute and chronic severe morbidity is low and local control is good. There is justified enthusiasm for continuing the procedure.

Bilirubin binding and neonatal acidosis

Plasma of neonates with severe metabolic acidosis secondary to fetal hypoxia bound less bilirubin than that of neonates without acidosis, as determined by Sephadex gel filtration. There was a significant correlation between the amount of bilirubin adsorbed by Sephadex and the base deficit. The method used ruled out any influence of plasma pH per se on binding. Our results suggest that organic anions that accumulate in the plasma of asphyxiated acidotic neonates may compete with bilirubin for binding sites on albumin.

Bilirubin binding and neonatal acidosis

Plasma of neonates with severe metabolic acidosis secondary to fetal hypoxia bound less bilirubin than that of neonates without acidosis, as determined by Sephadex gel filtration. There was a significant correlation between the amount of bilirubin adsorbed by Sephadex and the base deficit. The method used ruled out any influence of plasma pH per se on binding. Our results suggest that organic anions that accumulate in the plasma of asphyxiated acidotic neonates may compete with bilirubin for binding sites on albumin.

An unusual form of metachromatic leukodystrophy in three siblings

An unusual form of Metachromatic Leukodystrophy (MLD) has been described in three siblings who are the sole children of related parents of Iranian origin. Clinical progression in the three siblings was insidious and protracted, the hallmark of the condition being a dystonia mainly induced by intention and manifested by dysarthria and torsion spasm of the neck, spine and extremities. The dysarthria sometimes culminated in apparent choreoathetosis. Laboratory studies included positive sural nerve biopsies, prolonged nerve conduction times and a marked deficiency of arylsulfatase A in the urine, leukocytes and fibroblasts. The parents presented no clinical manifestations, but the arylsulfatase A activity in both was reduced by 50%.

Changes in intracellular cyclic AMP levels of human peripheral blood lymphocytes in bronchial asthma

Peripheral blood lymphocytes of asthmatic patients in the acute stage manifest low basal levels of cyclic AMP. These levels were higher in the lymphocytes of patients in remission than in controls. Trypsin treatment of the lymphocytes increased cyclic AMP content to almost the same additional activation site of the receptor in theophylline- and catecholamines-treated patients.

Pulmonary atelectasis and other respiratory complications after cardiopulmonary bypass and investigation of aetiological factors

Radiological evidence of pulmonary complications and possible aetiological factors were investigated in 50 consecutive patients after heart operations with cardiopulmonary bypass. Atelectasis was the most frequent pulmonary complication except for small pleural effusions, with an incidence of 64 per cent. Several types of atelectasis frequently co-existed, with a predominance of the less extensive plate and subsegmental forms. The incidence of atelectasis was the same on each side and the site of atelectasis was basal in three quarters of the patients. Preoperative clinical and catheter data were unrelated to the incidence of atelectasis. There was a significant positive correlation between a short cardiopulmonary bypass time and plate atelectasis, between a large fluid load after bypass and segmental atelectasis, between re-operation for bleeding and subsegmental atelectasis and between post-operative gastric dilation and atelectasis. The type of operation, the use of the intra-aortic balloon and the length of postoperative respiratory ventilation were unrelated to the incidence of atelectasis. The mechanism of development of atelectasis is discussed.

Diminished prolactin reserve: a case report

A 17 year old male patient presented with short stature and delayed puberty. Investigations showed normal thyroid function and intact TSH response to TSH-releasing hormone (TRH). Although basal levels of LH were low, both LH and FSH rose following the administration of LH-releasing hormone (LHRH). ACTH secretion assessed indirectly by the cortisol response to insulin hypoglycemia was normal. Growth hormone levels increased following the onset of sleep, as well as after the administration of insulin, L-dopa and L-arginine. Basal levels of prolactin were low (2-5 ng/ml) compared with 5-12 ng/ml in controls. There was a markedly impaired prolactin response to TRH (maximum rise above basal values of 3 ng/ml compared to a rise of 12-29 ng/ml in controls). Prolactin levels did not rise after the administration of chlorpromazine or L-arginine. There was some suppression of prolactin levels after L-dopa. Similar patterns of prolactin are seen in panhypopituitarism, where they are usually associated with other hypophyseal hormonal deficiencies. The diminished prolactin reserve demonstrated in this subject in the presence of intact function of the remainder of the anterior pituitary is compatible with the diagnosis of diminished prolactin reserve.

Lactulose in baby milks causing diarrhoea simulating lactose intolerance

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Association between maternal bleeding during gestation and congenital anomalies in the offspring

The incidence of maternal bleeding complicating the pregnancies of 326 children examined at the Jerusalem Community Center for Child and Family Development is surveyed. A history of bleeding during pregnancy was more frequent in children with congenital anomalies of the central nervous system (and/or psychomotor retardation) (33 per cent) and in children with congenital anomalies of other systems (29 per cent) than in control children (12 per cent). The implications of these findings are discussed in relation to placental pathophysiology and the pathogenesis of threatened abortion.