MON-021 Patterns of Sharps Handling and Disposal Among Insulin Using Patients with Diabetes

Background: Nearly 7 million patients with diabetes mellitus (DM) in the U.S. use insulin. Both Insulin therapy and self-monitoring of blood glucose (SMBG) have the potential to generate a large volume of biohazardous waste via use of “sharps” (needles and lancets). Unless safely disposed of these sharps could present a public health risk, placing unaware individuals at risk of needle sticks. However, there is a paucity of data on whether patients safely handle and dispose of used insulin needles and lancets. Objective: Assess patterns of sharps use and disposal among a clinic and hospital based population of DM patients on insulin therapy. Method: A survey was administered to a convenience sample of adult insulin treated DM patients recruited from an outpatient endocrinology clinic and an inpatient hospital setting. Patients were asked about patterns of sharps use (frequency of daily SMBG and insulin injections), how often sharps were used prior to disposal, sharp disposal technique, and education received regarding safe sharp disposal. Results: The survey was completed by 142 patients (94 outpatients and 48 inpatients). Mean age was 56 years, self-reported DM duration 20 years, hemoglobin A1c was 8.4%, and BMI 30.2 kg/m²; 57% were men and 75% were white. No differences in characteristics (p>0.1) were seen between outpatient and inpatient respondents. The average number of insulin injections was 3/day, and frequency of SMBG was 3.5/day. A minority (22%) used an insulin needle 2 or more times, and 32% threw the needles directly into the garbage as opposed to a sealable or red sharps container. Most (56%) respondents used a lancet 2 or more times, sometimes changing the lancet once only every few months. Around a third (35%) threw used lancets directly into the garbage; one patient flushed them down the toilet. No differences were seen between outpatients and inpatients (p> 0.3) in patterns of needle use, lancet use, or disposal method. The majority (63%) of respondents indicated they had never received instruction on safe disposal of sharps. Conclusion: In this population of both outpatients and inpatients, repeated use of the same insulin needle and lancet was noted. Moreover, nearly a third of respondents disposed of their sharps in an unsafe manner. If similar data are confirmed in broader studies, this could translate into a large number of insulin using patients improperly disposing of their sharps waste—a potentially important public health hazard. With the rising prevalence of DM and need for insulin, further study is needed to determine sharps disposal practices of these patients. Improved education is needed on both a population and patient level regarding proper handling of these biohazardous materials.

An Overview of Safety Issues on Use of Insulin Pumps and Continuous Glucose Monitoring Systems in the Hospital

PURPOSE OF REVIEW

Summarize safety issues related to patients using insulin pump therapy and continuous glucose monitoring systems (CGMS) in the outpatient setting when they are hospitalized and to review steps that can be taken to mitigate risk associated with use or discontinuation of these devices.

RECENT FINDINGS

Two recent consensus conferences were held on the topics of inpatient use of insulin pumps and CGMS devices. In addition to commonly known safety issues (e.g., device malfunction, infection), cybersecurity and the vulnerability of contemporary technology to hacking have emerged. CGMS capabilities offer the promise of advancing the goal for development of glucometry (centralized monitoring of real-time glucose data). Strategies to assuring safe use of insulin pumps and CGMS in the hospital include collaboration between the patient and staff, proper patient selection, and clear policies and procedures outlining safe use. Available data indicates few adverse events associated with these devices in the hospital. Current data suggests, with proper patient selection and a clear process in place for glycemic management, that adverse events are rare, and consensus favors allowing use of the technology in the hospital. The topic of insulin pump and CGMS in the hospital would greatly benefit from more institutions reporting on their experiences and prospective clinical trials.

Multiscale Friction in Lubricant-Surface Systems for High-Performance Transmissions Under Mild Wear

The lubricant-surface system is complex in nature and can significantly affect the frictional performance of high-performance transmission systems. The complexity stems from the coupled mechanical and chemical phenomena that occur at the interfacial tooth conjunctions. A combined analytical and precision experimental approach is presented to analyse the salient parameters of the lubricant-surface system. A multiscale procedure comprising topographical measurement, pin-on-disc tribometry, atomic force microscopy in lateral force mode, X-ray photo-electron spectroscopy and continuum contact mechanics analysis under mixed non-Newtonian thermo-elastohydrodynamics is used to describe the formation of a tribo-film, as well as wear and frictional characteristics of the lubricant-surface system. The contribution of chemisorbed and physisorbed bonded tribo-film on the boundary coefficient of friction is ascertained at different physical scales. Therefore, the paper presents a novel multiscale analysis, promoting improved understanding of the complex interactions between mechanisms of friction, wear and surface chemistry.

Audit: women's perception and knowledge of the 20 weeks anomaly scan

We surveyed 385 women attending two maternity units for an anomaly scan at 20 weeks' gestation. Ninety-five per cent of the women thought that the purpose of the anomaly scan was to check for structural abnormalities in the fetus, indicating good knowledge. Most women thought the anomaly scan would pick up spinal, limb and kidney abnormalities. There was high expectation of what structural abnormalities the anomaly scan could pick up; 22% and 51% of the women thought the scan would pick up 61-70% and 71-100% of the structural abnormalities, respectively. Only 8% of the women thought, realistically, that the anomaly scan would pick up 50% of the abnormalities. The women's knowledge of soft markers was poor; 92% of them never heard of it. The main source of information about the anomaly scan was the hospital.

Impact of El Nino and logging on canopy tree recruitment in borneo

Dipterocarpaceae, the dominant family of Bornean canopy trees, display the unusual reproductive strategy of strict interspecific mast-fruiting. During 1986-99, more than 50 dipterocarp species dispersed seed only within a 1- to 2-month period every 3 to 4 years during El Nino-Southern Oscillation events. Synchronous seed production occurred across extensive areas and was essential for satiating seed predators. Logging of dipterocarps reduced the extent and intensity of these reproductive episodes and exacerbated local El Nino conditions. Viable seed and seedling establishment have declined as a result of climate, logging, and predators. Since 1991, dipterocarps have experienced recruitment failure within a national park, now surrounded by logged forest.

Tree species diversity in commercially logged bornean rainforest

The effects of commercial logging on tree diversity in tropical rainforest are largely unknown. In this study, selectively logged tropical rainforest in Indonesian Borneo is shown to contain high tree species richness, despite severe structural damage. Plots logged 8 years before sampling contained fewer species of trees greater than 20 centimeters in diameter than did similar-sized unlogged plots. However, in samples of the same numbers of trees (requiring a 50 percent larger area), logged forest contained as many tree species as unlogged forest. These findings warrant reassessment of the conservation potential of large tracts of commercially logged tropical rainforest.

Feeding preterm infants after hospital discharge: effect of dietary manipulation on nutrient intake and growth

The objective of this study was to compare formula intake, the time of weaning, and growth in preterm infants (< or = 1750-g birth weight, < or = 34-wk gestation) fed a standard term or preterm infant formula after initial hospital discharge. Infants were randomized at hospital discharge to be fed a preterm infant formula from discharge to 6 mo corrected age (group A), a term formula from discharge to 6 mo (group B), or the preterm formula (discharge to term) and the term formula (term to 6 mo (group C). Infants were seen biweekly (discharge to term) and monthly (term to 6 mo), when intake was measured and anthropometry and blood sampling were performed. The results were analyzed using ANOVA. Although nutrient intake was similar, at 6 mo girls were lighter (6829 versus 7280 g) and shorter (64.4 versus 66.0 cm) than boys (p < 0.05). Patient characteristics were similar between the treatment groups. Although the volume of intake differed (B > C > A; p < 0.001), energy intake was similar in the groups. Because of differences in formula composition, protein, calcium, and phosphorus intakes differed (B < C < A; p < 0.001). Lower protein intakes were related to lower blood urea nitrogen levels (B < C < A; p < 0.001). At 6 mo, infant boys in B and C were lighter (6933, 6660 < 7949 g), shorter (65.3, 64.9 < 67.1 cm), and had a smaller head circumference (43.7, 43.7 < 44.8 cm; p < 0.05) than infants in group A. Preterm infants were found to increase their volume of intake to compensate for differences in energy density between formulas. After hospital discharge, infant boys fed a preterm formula grew faster than infant girls fed a preterm formula or infant boys fed a term formula.

Cell wall active antifungal compounds produced by the marine fungus hypoxylon oceanicum LL-15G256. I. Taxonomy and fermentation

The cell wall targeted antifungal activity of Hypoxylon oceanicum LL-15G256 extracts resulted from the production of novel lipodepsipeptides and previously reported macrocyclic polylactones. In an optimized medium, titers of the lipodepsipeptide and the polylactones reached approximately 200-400 mg/liter and 25-50 mg/liter, respectively. The optimum fermentation temperature for production of 15G256 gamma was 28 degrees C. Seawater appeared to have an inhibitory effect on metabolite accumulation at lower fermentation temperatures.

Comparative locomotor ecology of gibbons and macaques: selection of canopy elements for crossing gaps

To examine functional questions of arboreal locomotor ecology, the selection of canopy elements by Bornean agile gibbons (Hylobates agilis) and long-tailed macaques (Macaca fascicularis) was contrasted, and related to locomotor behaviors. The two species, and in some cases, the macaque sexes, varied in their use of most structural elements. Although both species traveled most frequently in the main canopy layer (macaques: 56%, gibbons: 48%), the gibbons strongly preferred the emergent canopy layer and traveled higher than the macaques (31 vs. 23 m above ground) in larger trees (48 vs. 26 cm dbh). Macaques preferred to cross narrower gaps (50% were in the class 0.1-0.5 m wide) than gibbons (42% were 1.6-3.0 m wide), consistent with the maximum gap width each crossed (3.5 m for macaques, 9 m for gibbons). Macaques could cross only 12% of the gaps encountered in the main canopy, and < 5% of the gaps in each of the other four layers. In contrast, all layers appear relatively continuous for gibbons. Specialized locomotor modes were used disproportionately at the beginning and end of travel segments, further indicating that behavior was organized around gap crossings. A model is defined, the Perceived Continuity Index (PCI), which predicts the relative use of canopy strata for each species, based on the percentage of gaps a species can cross, the frequency of gaps, and median length of continuous canopy structure in each canopy layer. The results support the hypothesis that locomotor behaviors, and strategies of selecting canopy strata for travel, are strongly constrained by wide gaps between trees and are ultimately based on selection for efficient direct line travel between distant points.

Glycine adjuvant therapy to conventional neuroleptic treatment in schizophrenia: an open-label, pilot study

In an open-label study, glycine was administered orally (10.8 g/day in three divided doses) to six chronically psychotic patients, as an adjunct to conventional neuroleptic therapy, for periods extending from 4 days to 8 weeks. Glycine was administered in an effort to facilitate endogenous glutamatergic transmission at the level of the N-methyl-D-aspartate (NMDA) receptor complex, since a glutamatergic deficiency in the pathophysiology of schizophrenia has been postulated. Therapeutic efficacy was assessed with standardized psychiatric rating scales. Beneficial effects on behavioral symptomatology were observed in two patients, whereas two others worsened. In one of the two responders, clinical deterioration occurred after glycine withdrawal consistent with a positive adjuvant effect in this patient. However, glycine rechallenge in this patient was not associated with the clinical improvement seen during the initial glycine period. Clinical worsening was not observed after glycine discontinuation in the second responder. Glycine administration reduced neuroleptic-induced muscle stiffness and extrapyramidal dysfunction in three of the six patients. All patients tolerated the clinical trial. The limited penetrability of glycine across the blood-brain barrier is a major limitation of this approach to facilitating glutamatergic transmission at the level of the NMDA receptor complex.

Trial of maximal anal dilatation, cryotherapy and elastic band ligation as alternatives to haemorrhoidectomy in the treatment of large prolapsing haemorroids

A selected group of 112 patients with prolapsing haemorrhoids which had failed to respond to injections of phenol in oil or which required manual replacement after defecation, were randomly allocated treatment by haemorrhoidectomy, maximal anal dilation, elastic band ligation or cryotherapy. When results were assessed 5 weeks after treatment, haemorrhoidectomy and maximal anal dilatation were equally effective in reducing symptoms, although more physical signs remained after maximal anal dilatation; cryotherapy and elastic band ligation were less effective in both respects. When patients were followed up between 6 months and 5 years haemorrhoidectomy was found to be the most effective method. Patients in the other three groups developed recurrent symptoms requiring haemorrhoidectomy.

Invasion of veins by carcinoma of rectum: method of detection, histological features and significance

Histopathological material from operation specimens of rectal adenocarcinoma was reviewed and invasion of veins identified in 51.9% of 703 cases. The extent of venous invasion, thickness of the walls of invaded veins and various other histological features were examined in detail. By follow-up studies recurrence rates, incidence of distant metastases and corrected 5-year survival rates were obtained; correlation with the histopathological results showed that invasion of extramural and thick-walled veins is associated with a poor prognosis independent of the degree of differentiation of the adenocarcinoma. Prognosis is not significantly related to the presence of necrosis of intravenous tumour and a clearly defined stroma in the intravenous growth all appear to exert a protective influence on patient survival. Whereas permeation of capillaries in vein walls, the presence of loose clumps of tumour cells in veins and direct contact between tumour cells and venous blood appear to adversely affect survival. Venous invasion is shown to be related to local invasiveness of rectal carcinoma. Suggested modes of venous spread and interaction with host tissues are proposed, with implications for general attitudes to the spread of cancer and metastasis.

Diverticular disease of the colon and gallstones in New Zealand and England

The clinical presentation and subsequent treatment of 160 consecutive patients with proven diverticular disease of the colon from the Auckland Hospital, New Zealand were compared with 182 consecutive patients admitted to St. Bartholomew's Hospital, London. There were significant differences in sex incidence, in the ages of the male patients at presentation, patient symptoms, extent of disease and methods of surgical treatment. These probably reflect differences in the types of National Health Services of the two countries, rather than differences in the natural history of diverticular disease of the colon. Overall, the 342 patients studied show a very good correlation with other large series published over the last 10 years. This study confirms the previously reported association between diverticular disease of the colon and gallstones. It confirms that gallstones are more common in female patients with or without diverticular disease. It suggests that Auckland patients with gallstones are more likely to have had a cholecystectomy than London patients. The possible role of dietary fiber in the aetiology of both gallstones and diverticular disease of the colon is discussed.

Maternal serum alpha-fetoprotein levels as an index of fetal risk

In a prospective study on an obstetric population (1,059 cases) an association was found between elevated levels of maternal serum AFP at weeks 16 to 22 and the occurrence of premature labor or the need for emergency cesarean section in the third trimester. There was no association with other late fetal complications including perinatal death, perinatal asphyxia, and intrauterine growth retardation. The sensitivity of the test in respect of premature labor was 14 per cent but the high incidence of false-positive results reduces the practical value of the test.

Influence of ciclazindol on monoamine uptake and CNS function in normal subjects

The potential antidepressant drug ciclazindol inhibited dopamine uptake into human platelets without affecting 5-hydroxytryptamine uptake as compared with a control. It inhibited the tyramine pressor response less than desipramine after single 50-mg oral doses in 6 healthy volunteers under double-blind conditions. Compared with tandamine in a double-blind placebo-controlled study in nine healthy subjects, ciclazindol 50 mg orally caused no significant anticholinergic effects but reduced appetite according to an analysis of variance. Nonparametric analysis did not confirm the anorectic effect. Previous studies had shown that ciclazindol increased glucose uptake into isolated human skeletal muscle independently of insulin. Overall, ciclazindol resembles the antiobesity drug mazindol in molecular structure and pharmacological effects in man. Interactions with sympathomimetic amines and adrenergic neurone-blocking drugs cannot be excluded on the basis of these studies.

Urinary N-acetyl-beta-D-glucosaminidase assay in renal transplant recipients

Urinary N-acetyl-beta-D-glucosaminidase (NAG) activities were measured in 181 patients with renal allografts during a 15-month period. Activities were high immediately after transplantation but decreased rapidly in the absences of complication. Urinary NAG activities increased by 50% or more in relation to 33 of 36 (92%) episodes of acute rejection diagnosed and treated by clinicians during the first 90 days after transplantation. The increase preceded clinical diagnosis in 70% of the cases, the median interval being 1.5 days. NAG activities decreased after treatment of rejection in 90% of the cases. Chronic rejection, renal vein thrombosis, renal artery stenosis, oliguria, hypotension, and the administraion of gentamicin may also cause increased NAG activity. Urinary NAG assay is simple and inexpensive, and is a useful aid to the early diagnosis of rejection of renal transplants. Results must, however, be interpreted by the clinician, bearing in mind other causes for increased activity.

Computer analysis of allergic histories taken by questionnaire

We report the development of a detailed allergy questionnaire designed so that the answers can be typed into a mini-computer. Computer programmes have been written to file and to retrieve these answers, and to print a summary which is then 'weighed', so as to produce a clinical atopy score which is then further broken down into indoor and outdoor scores. In a pilot survey of ninety patients, their clinical atopy scores and immunoglobulin E (IgE) profiles have been compared, and additional computer programmes have been written which will (a) assess if a more detailed IgE investigations is warranted, and (b) suggest which allergens, if any, are likely to be responsible for the patients' symptoms.

An investigation of "absolute plasma level effect relationships" and "absolute cardioselectivity" with respect to beta-adrenoceptor blockade

In a group of 6 healthy (but physically unfit) volunteers an investigation was made of whether there was a true plasma level effect relationship and absolute "cardioselectivity" with respect to beta-adrenoceptor blockade due to practolol. To this end three treatments were given orally, namely placebo, practolol 100 mg and practolol 400 mg. Cardiac beta-adrenoceptor blockade was assessed by measuring the inhibition of exercise heart rate and pulmonary beta-adrenoceptor blockade was assessed by measuring the reduction in exercise peak flow rate, up to 24 h after each dose. Plasma practolol levels were determined spectrophotometrically. From the results obtained there was no reason to doubt the existence of a valid relationship between cardiac beta-adrenoceptor blocking activity and the plasma concentration of practolol. It was also concluded that even in non-asthmatics, practolol does not possess absolute "cardioselectivity" since significant reductions in peak flow rate were discernible during vigorous exercise, particularly when the large dose had been given.

How often is genital yeast infection sexually transmitted?

We analysed data from a computer-based bank of clinical records of patients seen in a clinic for sexually transmitted diseases over a three-year period to investigate the association between genital yeast infections and sexually transmitted diseases (STDs). We classified STDs as primary and secondary syphilis; gonorrhoea; lymphogranuloma venereum; trichomoniasis; scabies; pediculosis; genital herpes; warts; and molluscum contagiosum. Of a total of 2984 disease episodes among women, 1054 (35-3%) included yeast infections, whereas only 382 (6-9%) of 5501 episodes in heterosexual men were associated with yeast infections, We found a significant association between yeast infection and STD and non-specific genital infection (non-specific urethritis (NSU) and procitis in men, and female contacts of men with NSU), which suggested that yeast infection was sexually acquired in 414 out of 1054 disease episodes in women (39%) and 110 out of 382 episodes in heterosexual men (29%). We conclude that sexually active patients with genital yeast infections should be screened for other STDs particularly non-specific genital infection.

A double-blind comparison of meptazinol with placebo in postoperative pain

In a double-blind clinical trial, meptazinol (400-mg capsules) was shown to be significantly better than placebo in relieving postoperative pain in patients who had under gone total abdominal hysterectomy operations. Analgesic activity was assessed by patients rating their pain before and 1 hour after the administration of each treatment, by sequential analysis of patient and investigator preference for treatment, and by calculating the time interval between doses of the two treatments.

Active specific immunotherapy for ovarian cancer

Ten patients with advanced or recurrent ovarian cancer were treated with a combination of chemotherapy and active specific immunotherapy after tumour stasis had been induced. They were inoculated with irradiated allogeneic cryopreserved tumour cells and B.C.G. once monthly in addition to receiving conventional chemotherapy. The overall duration of "remission", median survival, and projected 24-month actuarial survival in the patients receiving immunotherapy were apparently better than in a retrospectively matched control group treated by chemotherapy alone.

Observations on the pharmacokinetics of acebutolol

Using a balance, randomized, crossover design, single intravenous (1 mg/kg) or oral (3 X 100 mg) doses of acebutolol were administered at weekly intervals to 6 healthy volunteers. For each subject venous blood samples and timed urine collections were obtained after each treatment. Plasma and urinary acebutolol levels were measured by a spectrophotometric method that measures acebutolol and its N-acetyl metabolite (which has equivalent cardiac activity). Using a computer program, various pharmacokinetic parameters were estimated from the date of each subject. From the intravenous data (obtained up to 6 hr after dosing), the following mean (+/-SD) values were found: distribution half-life (T 1/2D), 0.60 (+/-0.43) hr, plasma elimination half-life (T 1/2El), 3.2 (+/-1.1) hr, apparent volume of distribution (VD), 224 (+/-69) L, and apparent VD/kg, 3.0 (+/-0.8) L/kg. Using the oral data (obtained up to 10 hr after dosing), the value for T 1/2El was 3.2 (+/-0.9) hr. The mean cumulative urinary recovery (expressed as % dose) after the intravenous route was about 60%, while that after the oral route was of the order of 35%, suggesting that about half of the oral dose reached the systemic circulation. The mean creatinine clearance of the 6 subjects was 103 (+/-7) ml/min, while the value (obtained between 2 and 4 hr after intravenous dosing) for renal clearance of acebutolol as measured was 298 (+/-68) ml/min and the corresponding plasma clearance was 818 (+/-64) ml/min. These results support the occurrence of substantial nonrenal elimination and renal tubular secretion.

Primary suture of the perineal wound following rectal excision for adenocarcinoma

A statistical analysis of the correlations between a number of factors, including age, tumour pathology and surgical management, and the results of primary suture of the perineum after excision of the rectum for adenocarcinoma in 63 males is presented. An unsuccessful outcome was related to the extent of the dissection either necessitated by advanced tumour or resulting from excision of the coccyx. A successful result was associated with small tumours and preoperative antibacterial treatment. Topical antibacterial treatments, topical mercuric perchloride and the drainage route did not appear to affect the outcome.

The influence of premedication, anaesthesia, age and weight on glucose uptake into human isolated skeletal muscle

The effect of the anaesthetic procedures and of the sex, age and weight of each patient on glucose uptake and glycogen content of human skeletal muscle has been studied in vitro in the presence and absence of insulin. Statistical analysis indicated that the relationships between age and both glucose uptake and the response to insulin were significant, older patients in general having higher uptakes. The blucose uptake was highly correlated with the three obesity indices (ponderal index, body mass index and percentage of the ideal weight). The anaesthetic agents had no significant effect on glucose uptake. The choice of premedication appeared to have a small effect on the basal glucose uptake level, but as the choice of premedication was also age related and age itself was a significant factor, this effect may not be of importance. It is concluded that the age and the degree of obesity of the patients ought to be taken into account when studying samples of human muscle.

Cardiac and pulmonary effects of acebutolol

In a double-blind randomised study, single intravenous doses of propranolol (0-1 mg. per kg.), practolol (1 mg. per kg.), acebutolol (1 mg. per kg.), or placebo were each administered at weekly intervals to six healthy volunteers. Forced expiratory volume in 1 second (F.E.V.1), resting and exercise heart-rate, and resting and exercise peak flow-rate (P.F.R.) were determined before and at 2, 3, 4, and 6 hours after each treatment. Venous blood-samples were also obtained at these times. Compared with placebo, resting heart-rate was reduced after all three drugs, but the corresponding differences in exercise heart-rate were much greater, more consistent, and of greater statistical significance. At 2, 3, and 4 hours when acebutolol and propranolol produced equivalent cardiac beta-blocking activity (judged by reductions in exercise heart-rate), their mean plasma concentratios were in the ratio of about 8/1; and at 2 hours when practolol and acebutolol gave rise to almost equivalent cardiac beta blockade, their mean plasma concentratio ration was 3/1. At times, reductions in F.E.V.1 and resting P.F.R. after propranolol (but not after practolol or acebutolol) were significantly greater than the corresponding changes after placebo. The reductions in exercies P.F.R. after propranolol (6 hours) and acebutolol (4 hours) (but not after practolol) were significantly greater than the changes after placebo. Changes in F.E.V.1, resting and exercise P.F.R. after propranolol, and the corresponding changes after practolol, were significantly different, all of which confirmed that practolol was more cardioselective than propranolo. In general, the reductions in F.E.V.1 and resting P.F.R. after acebutolol were slightly smaller than after propranolol, excepting at 6 hours when the difference between them was significant. The reductions in exercise P;F.R. after acebutolol and propranolol were of the same order, there being no significant differences between the two, whereas the reductions after acebutolol were clearly greater than the corresponding changes after practolol, the differences being significant at 2, 3, and 4 hours.

Effect of age, height, weight and sex on serum phenytoin concentration in epileptic patients

1 Steady-state serum phenytoin concentrations were measured in adult epileptic patients receiving a maintenance dose of phenytoin (300 mg daily). 2 Serum phenytoin concentration showed a positive correlation with age. 3 Serum phenytoin concentration showed a negative correlation with body weight and with height. Multiple correlation analysis indicated that body weight influenced the concentration to a much greater degree than height. 4 When corrected for body weight and height, the serum phenytoin concentrations in women were lower than those in men, although the difference was not statistically significant. 5 Although each of these factors contributes to the interindividual variation in serum phenytoin concentrations, the contribution of each is small. Other factors, such as genetic differences and the effect of saturation kinetics, are much more important in determining steady-state concentrations. Adjusting the dose according to the age, weight and height of a patient would achieve only a marginal improvement in therapy.

The cardiovascular effects of dantrolene sodium in dogs

The effects of the intravenous infusion of dantrolene sodium and of equal volumes of normal saline on arterial pressure, central venous pressure, heart rate and cardiac output have been investigated in healthy, anaesthetised dogs. The infusion of dantrolene in the manner and dose found to be effective by other workers in pigs-8 for the treatment of anaesthetic induced malignant hyperpyrexia, produced changes which differ little from those observed after the infusion of a similar quantity of saline. These results are discussed.