Metabolism and excretion of the quaternary ammonium compound thiazinamium methylsulfate (Multergan) in man. I. Parenteral administration

The quaternary ammonium compound thiazinamium was found to be metabolized by sulfoxidation solely. No ring hydroxylation products, nor demethylation products (e.g. promethazine) could be found. Thiazinamium sulfoxide was found both in urine and bile, but thiazinamium is-after parenteral administration - mainly excreted in the unchanged form. After intravenous injection about 40% of the dose was excreted, unchanged, in the urine. The excretion was very rapid and almost complete within eight hours. About 9% of the dose was excreted in the urine in the form of thiazinamium sulfoxide cations. After intramuscular injection virtually the same figures for urinary excretion were found. No correlation could be observed between urine production or pH and the amount of drug excreted in urine. In a study involving bile-fistula patients it was found that both thiazinamium cations and thiazinamium sulfoxide cations are excreted to a considerable extent in bile. The amount of unchanged drug in bile was almost equal to that in urine, but the amount of sulfoxide was slightly higher.

Effects of genetically different strains of mice on the microsomal activation of 2-aminofluorene

Five strains of mice were examined for microsomal cytochrome P450 (Cyt P450) activity and ability of the microsomal preparation to activate 2-aminofluorene (2-AF) to its mutagenic form. Each strain was assayed under normal and induced conditions. Group A strains known to be easily induced to carcinogenesis by chemicals (C57BL/6J and BALB/cJ) showed higher levels of Cyt P450 and increased mutagenesis activity of the metabolized 2-AF than Group B strains which are known to be high spontaneous tumor producers (CE/J, A/HeJ, C3H/HeJ). Induction of the hepatic microsomes with Aroclor 1254 increased the difference between the two groups.

Encephalitis in infectious mononucleosis: diagnostic considerations

Four atypical cases of presumed infectious mononucleosis (IM) encephalitis are presented. To establish an etiologic diagnosis, Paul-Bunnell-Davidsohn heterophil titers (PBD), antibody titers to the antigens of the Epstein-Barr virus (EBV), and oropharyngeal excretion of EBV were determined. Criteria for a primary EBV infection are (1) an antiviral capsid antigen titer of 1:160 or greater, (2) the presence of antibody to the diffuse component of the early antigen, (3) absence of antibody to the nuclear antigen, and (4) excretion of the virus from the oropharynx. Three of the four cases met these criteria; of the three, one did not have a positive heterophil titer. The fourth case turned out not to be IM; there was a positive PBD heterophil, but there was no evidence of primary EBV infection. Although the PBD heterophil is usually a reliable test to diagnosis IM, it is not always present in children, and it is sometimes nonspecifically elevated. Some EBV titers can be nonspecifically elevated as well; however, the above criteria are diagnostic of primary EBV infection.

Rotational deformities after fractures of the femoral shaft in childhood

Sixty-two patients with femoral fractures treated conservatively have been studied over an interval of 1 to 6 years. Rotational deformity was assessed by a radiological method of anteversion measurement. The degree of rotational deformity following fracture ranged from 10 degrees to 33 degrees in just over one-third of the whole group; by later assessment there was no evidence of spontaneous correction during growth. In view of the possibility of early complaints, e.g. pain and fatigue in the abnormally rotated extremity, and the potential risk of subsequent arthrosis, we consider that rotational deformity over 20 degrees ought to be avoided. It is suggested that use of the extension table of Weber is the most satisfactory conservative method of treatment of femoral fractures in childhood (Weber, 1969). This enables correction of significant rotation deformity during treatment under radiographic control.

A profile of industrial nursing practices in North Dakota

The background and tasks of occupational health nurses in North Dakota vary considerably. Those entering the field have little or no previous exposure to occupational health nursing and must develop skill through seminars, corporate training or area associates. In most instances, the nurse represents the occupational safety and health program for the firm and must take on additional roles such as safety director or assistant plant manager. In addition, the occupational health nurse performs numerous in-plant medical services ranging from emergency medical care to counseling and education. The occupational health nurse in North Dakota generally does not record family histories, take throat cultures, take routine x-rays, make hospital or home visits nor perform air sampling or noise level measurements.

Meningeal carcinomatosis. Case report and review of the literature

Untreated meningeal carcinomatosis is a uniformly fatal type of metastatic disease presenting with many protean signs and symptoms. We achieved significant palliation and long-term survival in our patient, using combined chemotherapy and radiotherapy; responses to both intrathecal methotrexate and experimental oral CCNU were observed.