Effect of pretreatment with ranitidine on the hypnotic action of single doses of midazolam, temazepam and zopiclone. A clinical study

Patients receiving midazolam, temazepam or zopiclone by mouth as premedication for minor gynaecological surgery were pretreated with either ranitidine or an inert tablet. Pretreatment with ranitidine was associated with a greater degree of drowsiness at 20 and 40 min after midazolam, and a shorter mean time to peak hypnotic effect than in the non-pretreated group. Ranitidine did not affect the degree of drowsiness in the patients receiving temazepam or zopiclone.

Age and nature of operation influence the pharmacokinetics of midazolam

The pharmacokinetics of midazolam were studied in surgical patients given 0.3 mg kg-1 i.v. for either the induction of anaesthesia, or postoperative sedation following cardiopulmonary bypass. The short elimination half-life of midazolam (2.4 h in patients less than 50 yr undergoing minor surgery) was significantly, although not markedly, prolonged with age (4.1 h in patients greater than 50 yr undergoing minor procedures) and by the nature of the operation (3.8 h after major operative procedures). These changes were the result of alterations in clearance and volume of distribution with age, and in volume of distribution with nature of operation.

The influence of H2 receptor antagonists on the plasma concentrations of midazolam and temazepam

This study shows that 1 day's treatment with cimetidine or ranitidine causes a raised relative systemic availability of orally administered midazolam (p less than 0.01), but pretreatment with a common emulsion antacid does not alter bioavailability. Temazepam bioavailability after oral administration is unchanged after either H2 receptor antagonist, or after the emulsion antacid. The difference in the systemic availability of the two benzodiazepines following pretreatment with either cimetidine or ranitidine may be explained by inhibition of the mixed function oxidase system in the liver. Drugs with a relatively high liver extraction ratio, such as midazolam, are likely to be affected to a greater extent than those with a low extraction ratio, such as temazepam. The clinical relevance of these findings is yet to be determined.

Plasma cholinesterase activity and the duration of suxamethonium apnoea in children

Plasma cholinesterase activity and the duration of suxamethonium apnoea were studied in 89 children and in 15 adults for comparison. Whereas the level of cholinesterase activity was not different in the two groups, children showed a significantly shorter duration of apnoea. There was poor correlation between the enzyme activity and duration of apnoea. The shorter duration of action of suxamethonium may be due to the larger volume of extracellular fluid in children.

Cervical carcinoma: a drug-responsive tumor--experience with combined cisplatin, vinblastine, and bleomycin therapy

Thirty-five patients with advanced cervical cancer were treated with a combination chemotherapy regimen comprising cisplatin, vinblastine, and bleomycin (PVB). Sixty-six percent of 33 evaluable patients showed objective tumor response and complete remissions were seen in six (18%) patients. The median duration of tumor response in patients with recurrent cervical cancer was 24 weeks (range 8 to 104 weeks). Multivariate analysis of pretreatment variables including prior radiotherapy did not identify patients with a higher response probability. Nausea and vomiting were usual side effects of chemotherapy and there was one definite treatment-related death. Cervical cancer is responsive to cisplatin based combination chemotherapy. The role of chemotherapy in conjunction with radiotherapy or surgery in the treatment of locally advanced cervical cancer remains to be defined.

Diagnostic information derived from immunotyping 1000 patients with leukemia and lymphoma

Immunotyping analysis has been performed on cells from 1000 patients with leukemia or lymphoma using 14 markers of cell lineage or differentiation stage over a 4 yr period. Results showed considerable heterogeneity of cell type among these groups of malignant diseases not readily apparent by morphology and histochemistry. Immunotyping contributed additional diagnostic information in 30% of patients and should be a routine procedure in 8 disease categories. These are: acute leukemia, cell type not determined; acute lymphoblastic leukemia; lymphocytosis of undetermined origin; chronic myeloid leukemia-terminal blast crisis; chronic lymphocytic leukemia; malignant lymphoma-leukemic phase; Sézary syndrome, mycosis fungoides and chronic T cell leukemia; malignant lymphoma and lymphadenopathy- ? lymphoma. Immunotyping provided information on cell lineage and differentiation stage of major leukemic cell populations. Abnormal monoclonal proliferations of B lymphocytes and the presence of primitive cells amongst normally mature tissue cells were identified. Disturbances in normal lymphoid and monocytic cell populations in blood, marrow or tissues could also be demonstrated. Many of the reagents used in this period are now replaced by monoclonal antibody reagents to human lineage and differentiation antigens. These are expected to increase diagnostic usefulness of these techniques.

B-thromboglobulin content of human blood platelets

There was a reduction in the B-thromboglobulin content of human blood platelets in patients with leukaemia after chemotherapy which inhibited platelet production. Thus, in these patients, as the circulating platelet population ages, B-thromboglobulin leaks out of, or is actively secreted by, platelets which remain in the circulation.

Surgery-attached psychogeriatric nurses: an evaluation of psychiatric nurses in the primary care team

Aspects of the work of five community psychiatric nurses are examined by means of a questionnaire completed by the nurses for a sample of 50 patients. Information sharing and a close working relationship with the general practitioner, skills relating to assessment and psychological support of patients, organization of care by other agencies, a detailed knowledge of community agencies, and a capacity for interdisciplinary working were all found to be important. Tasks relating to body care were reported in only a small number of cases. The nurses saw themselves as advising on the planning of patient management and the selection of medication in a substantial minority of cases. The original brief had been to care for psychogeriatric patients but a third of the patients fell into a younger age group. These findings are discussed in connection with their implications for the future training of nurses and the relationship between primary care teams and local psychiatric services.

Giant condyloma acuminatum of the vulva and anal canal

This publication describes the second known reported case of benign giant condyloma acuminatum of the vulva and anal canal (Buschke-Loewenstein tumour). The diagnosis of squamous cell carcinoma was made initially on clinical examination and could not be excluded by punch biopsy. A full pathological study of the tumour established the diagnosis. A defunctioning colostomy and a perineo-ano-vulvectomy with groin gland dissection was performed and the patient is free of disease 36 months later. The biology of this type of tumour is discussed.

Therapeutic evaluation of Elase as adjunctive therapy in the treatment of monilial vaginitis

The effectiveness of a lytic enzyme preparation (Elase--Parke-Davis) plus natamycin (Pimafucin--Gist-Brocades) was compared to natamycin therapy alone in a controlled clinical trial involving 120 patients suffering from monilial vulvo-vaginitis. The results indicate that addition of Elase to a natamycin treatment regimen increases the effectiveness of therapy both with respect to alleviation of symptoms and to eradication of the organism as determined by vaginal culture in patients with acute infection and in those in whom infection is complicated by pregnancy or diabetes.

A review of the significance of gestational diabetes

One hundred and ninety-six pregnancies complicated by gestational diabetes in a referred private practice over an 18-year period have been reviewed. Initially they were managed as true diabetics and the pregnancies terminated before the 38th week. More recently, pregnancies have been managed on an outpatient basis and allowed to proceed to term, with a higher percentage of vaginal deliveries and no increase in perinatal mortality or morbidity. A high incidence of neonatal jaundice was noted, but no explanation emerged. Differences between true diabetes and gestational diabetes, with particular reference to perinatal mortality are discussed and the good prognosis for the gestational form emphasised. Follow-up suggests that a continuation of the rapport established between physician, obstetrician and patient during pregnancy may be important in delaying or preventing the subsequent onset of diabetes.

Clinical trial of combination chemotherapy and specific active immunotherapy in disseminated melanoma

Fifty-six patients with disseminated malignant melanoma were randomly allocated to two treatment groups. The first group C received combination chemotherapy consisting of DTIC and ICRF 159. The second group (C+I) received the same chemotherapy but were also immunized with 2 X 10(7) irradiated allogeneic melanoma cells mixed with 50 mug of percutaneous BCG. The survival rates in both treatment groups C and (C+I) were not significantly different, and only minor enhancement of the chemotherapy was found in the (C+I) group. A similar pattern of tissue response was observed in both groups: lymph node, skin and, to some extent liver metastases, respond better than other sites.

Relative changes in the function of muscle ribosomes and mitochondria during the early phase of steroid-induced catabolism

1. Five glucocorticoids, when administered daily to rats for 5-7 days at a dosage of 5mg/kg, were in the following order of effectiveness with respect to their ability to decrease the weight gain of whole animals and the vastus lateralis, vastus medialis and gluteus medius muscles: corticosterone<prednisolone<triamcinolone <betamethasone<dexamethasone<triamcinolone acetonide. 2. The low catabolic potencies of corticosterone and prednisolone were reflected in the high doses (20mg/kg) required to decrease significantly the incorporating activity in vitro of ribosomes isolated from the muscles 6h later. However, triamcinolone was as effective as triamcinolone acetonide in causing a significant effect at 0.05mg/kg, although it had a far lower catabolic potency than the acetonide. 3. The relationship between decrease in ribosomal activity in vitro and weight loss was better understood by considering the duration of the effect after single doses of steroids. Ribosomes returned to normal function between 6 and 12h after the administration of corticosterone (20mg/kg), but still had decreased activity 12h after a similar dose of prednisolone. Normal ribosomal function was renewed between 12 and 18h after the administration of triamcinolone and betamethasone at 5mg/kg, but decreased activity persisted for more than 48h after similar doses of dexamethasone or triamcinolone acetonide. 4. There was no difference in the rate of incorporation of amino acids into nascent protein on polyribosomes from muscle of control animals and animals treated 6h previously with triamcinolone acetonide or dexamethasone. 5. The rate of weight gain of the heart was not affected by any of the steroids tested and heart ribosomes maintained normal activity although concentrations of steroids in this organ 5min after administration were 2-3 times that in skeletal muscle. 6. Mitochondria, isolated from the muscle of animals that had received triamcinolone acetonide (20mg/kg) 12h previously, were shown, by using a Coulter counter, to be enlarged. Nevertheless oxidation was only slightly uncoupled 12h after drug administration and they had normal function 6h later. Similar results with respect to mitochondrial function were obtained after the administration of dexamethasone (20mg/kg) and betamethasone (20mg/kg). 7. From these results it is concluded that the mitochondria are not functionally involved in the early phase of steroid-induced muscle catabolism. The observed decrease in the incorporating ability of muscle ribosomes in vitro appears to be much more closely linked to the initial catabolic event.

β-Triketones. III. Xanthostemone

Xanthostemone, C12H16O3, by its properties and by oxidation reactions is shown to have formula I.

Studies in relation to Biosynthesis. VIII. Tasmanone, Dehydroangustione, and Calythrone

Tasmanone from the oil of Eucalyptus risdoni Hook. gives a crystalline copper salt and imine and by acid hydrolysis produces 1,1,3-trimethylphloroglucinol. Its probable constitution is discussed. Evidence is presented for assigning to dehydroangustione the formula III and to calythrone the formula IX. The biogenetic relations of these substances are discussed.

The synthesis of Angustifolionol

Angustifolionol (5-hydroxy-7-methoxy-2,6,8-trimethylchromone) has been synthesized by three different methods.

Studies in relation to biosynthesis. IV. Angustifolionol

Angustifolionol has been shown by its general properties and by alkaline degradation to acetone and 2,6-dihydroxy-4-methoxy-3,6-dimethylbenzoic acid (II ; R"=H) to be 5-hydroxy-7-methoxy-2,6,8-trimethylbenzochromone (I ; R,R?=CH3). Its possible biogenetic relations are discussed.

Studies in relation to Biosynthesis. II. The structure of 'Macropone'

4-isoPropylsalicylaldehyde (I) has been synthesized and is identical with " macropone ".