Cardiac catheterization. Performing the procedure in an outpatient setting.
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Ambulatory Care↗
Biomedical subjects
B Kirkpatrick
Publications and source records attributed to B Kirkpatrick.
The metabolism and pharmacokinetics of fleroxacin in healthy subjects.
A 400 mg dose of fleroxacin was administered orally to six healthy male volunteers. Concentrations of fleroxacin and the N-demethyl and N-oxide metabolites were determined in serum and urine by HPLC. The serum metabolite levels were negligible. The N-oxide metabolite was measured in the serum of five subjects but did not exceed 4% of the corresponding fleroxacin level. N-demethyl fleroxacin was not detected (less than 0.1 mg/l). The urinary recovery of fleroxacin was 49.5% over 72 h; the N-demethyl and N-oxide metabolites accounted for 6.9% and 5.7%, respectively, of the administered dose.
Anti-Infective Agents↗
The heterogeneity of the long-term course of schizophrenia.
Research has demonstrated considerable heterogeneity in the long-term course of schizophrenia. In the period preceding the onset of frank psychosis (onset), patients vary relative to the rapidity of onset, the presence or absence of associality, and the presence or absence of semipsychotic symptoms. Following the onset of psychosis (middle course), patients may suffer from episodic or unremitting psychosis, and may or may not exhibit the deficit syndrome. In late adult life (late course), patients vary relative to the presence or absence of an improvement in psychosis and social capability. The usual approach to the study of putative course subtypes is to define a subtype by a number of features; they may include features of more than one epoch. In addition, the course of psychosis has not been distinguished from enduring personality impairments in these subtypes. Another approach to defining putative course subtypes would be based on dichotomizing patients according to the presence or absence of a particular feature of a single epoch. This second approach has important advantages: the availability of larger study populations and a diminished liability for confounding due to the correlates of features other than those under scrutiny.
Follow-Up Studies↗
The endocrinology of extrapyramidal system disorders.
The study of endocrinologic changes in Parkinson's disease, Huntington's disease, and tardive dyskinesia may elucidate the pathophysiology of these disorders, especially the presence of hypothalamic lesions. There is probably a decrease in PRL concentrations in Parkinson's disease, and there may be an increase in TSH response to TRH stimulation. It is not clear if there is any change in GH concentrations in Parkinson's disease. There appears to be a robust increase in GH concentrations in Huntington's disease, and there may be a small increase in PRL as well. At present no endocrinologic abnormality has been well documented in tardive dyskinesia.
Dyskinesia, Drug-Induced↗
The endocrinology of extrapyramidal system disorders.
The study of endocrinologic changes in Parkinson's disease, Huntington's disease, and tardive dyskinesia may elucidate the pathophysiology of these disorders, especially the presence of hypothalamic lesions. There is probably a decrease in PRL concentrations in Parkinson's disease, and there may be an increase in TSH response to TRH stimulation. It is not clear if there is any change in GH concentrations in Parkinson's disease. There appears to be a robust increase in GH concentrations in Huntington's disease, and there may be a small increase in PRL as well. At present no endocrinologic abnormality has been well documented in tardive dyskinesia.
Dyskinesia, Drug-Induced↗
Changes in life-style after liver transplantation.
Sixty-five pediatric patients who received liver transplants between May 1981 and May 1984 were observed for as many as 5 years and examined for changes in life-style. Children were less frequently hospitalized, spent less time hospitalized, required fewer medications, and generally had excellent liver and renal function after hepatic transplantation as compared with their pretransplantation status. Most children were in age-appropriate and standard school classes or were only 1 year behind. Cognitive abilities remained unchanged. Children improved in gross motor function and patients' behavior significantly improved according to parents' perceptions. Enuresis was more prevalent, however, than in the population of children who had not received liver transplants. Parental divorce rates were no greater than those reported for other families with chronically ill children. Overall, objective changes in life-style as well as parents' perceptions of behavior of children appear to be improved after liver transplantation.
Achievement↗
Accuracy of chart diagnoses of alcoholism in patients with a history of psychosis.
At two psychiatric clinics, 76 patients with a history of psychosis were interviewed by a researcher blind to the presence or absence of a chart diagnosis of alcoholism. Another person blind to research diagnosis ascertained the chart diagnosis of alcoholism. The lifetime prevalence of alcoholism, according to a structured research interview, was 45% at a mental health center, and 29% at a teaching hospital clinic. When compared to the lifetime prevalence of alcoholism, as determined by the research interview, chart diagnoses had sensitivities of 21% and 20%, respectively; specificity was 100% at both sites. Psychiatric chart diagnoses are not sensitive indicators of psychiatric patients' alcoholism.
Alcoholism↗
The effect of imipenem on strains of Enterobacteriaceae expressing Richmond & Sykes class I beta-lactamases.
Fourteen strains of Enterobacteriaceae producing Richmond & Sykes Class I beta-lactamase were studied. The ability of cefoxitin and imipenem to induce beta-lactamase production (reversible derepression) and to select stably derepressed mutants in these strains was assessed. beta-Lactamase induction by cefoxitin and imipenem was demonstrated by the disc diffusion technique in all strains. Cefoxitin selected stably derepressed mutants for all strains in broth cultures, but in an identical experiment imipenem did not. The susceptibility of each strain and its stably derepressed mutant (selected with cefoxitin) to a range of beta-lactam antibiotics was then ascertained. The stably derepressed mutants exhibited decreased susceptibility to all antibiotics tested except imipenem. The decrease in susceptibility varied between strains and between antibiotics but reached a maximum of a 256-fold decrease. The beta-lactamase activity of selected stably derepressed mutant strains showed at least a 600-fold increase in activity. Imipenem would therefore seem an appropriate choice for therapy of infections caused by this group of organisms, as it is active against derepressed mutants and unlikely to select any such strains during therapy.
Anti-Bacterial Agents↗
Pharmacokinetics and tissue penetration of Ro 23-6240, a new trifluoroquinolone.
A 400-mg dose of the trifluorinated quinolone Ro 23-6240 was administered orally to each of six healthy male volunteers, after which the concentrations of this agent in serum and cantharidin-induced inflammatory fluid were measured. Absorption was rapid, with a mean peak level in serum of 6.1 micrograms/ml, which was attained 0.71 h after administration. The elimination half-life in serum was 11.95 h. The agent penetrated the inflammatory fluid rapidly; the percent penetration was 89.7%. Urinary recovery of Ro 23-6240 was 58.6% by 72 h.
Administration, Oral↗
Pharmacokinetics and tissue penetration of roxithromycin after multiple dosing.
The pharmacokinetics of the macrolide roxithromycin (RU 28965) were studied during and after administration of 150 mg every 12 h for 3 days (five doses) in six volunteers. The concentrations in serum, blister fluid, and urine were measured. Mean levels in serum taken at 1.5 h after the morning dose increased from 4.4 micrograms/ml on day 1 to 5.9 micrograms/ml on day 2 and 7.4 micrograms/ml on day 3. The mean serum and blister fluid elimination half-lives on day 3 were 13.2 and 12.5 h, respectively. Roxithromycin penetrated blister fluid well; the mean percent penetration (as measured by the ratio of areas under the curve) was 85%. After the final dose, a mean of 10.5% of that dose was recovered in 12 h as microbiologically active compound.
Adult↗
Pediatric liver transplantation: patient evaluation and selection, infectious complications, and life-style after transplantation.
Liver transplantation is an increasingly accepted treatment for children with end-stage liver disease. Evaluation of the patient and appropriate patient selection for transplantation will become increasingly important issues as more and more children come to transplantation and compete for available organs. Numerous complications occur after transplantation, including infections. We have summarized our experience with bacterial, fungal, and viral infections in these patients and emphasize the need for continued improvement in immune suppressive drugs and regimens to minimize such complications. And finally, information presented on 65 pediatric patients followed 2 to 5 years suggests that, despite numerous complications and often prolonged hospitalization for transplantation, life-style after transplantation appears to be significantly improved.
Biliary Atresia↗
Beta-lactams and imipenem.
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Anti-Bacterial Agents↗
Motor effects of calcitonin administered intracerebroventricularly in the rat.
In rats treated with salmon calcitonin (CT) administered intracerebroventricularly (i.c.v., 85 or 8.5 pmol), spasmodic body movements, hopping and tail jerks, collectively termed dyskinesia, appeared within 1 h of administration and persisted for at least 24 h. In addition, spontaneous grooming, rearing and locomotion occurred less often in CT-treated rats than in vehicle-injected animals, while the incidence of both sniffing and nose poking remained essentially unchanged. The CT failed to displace either [3H]dopamine or [3H]spiperone from striatal membranes, and the behavioral effects were not blocked by haloperidol or SCH 23390, suggesting that the peptide did not directly affect dopamine receptors. The dyskinesia was not blocked by scopolamine, atropine, muscimol, diazepam or ketanserin. These data are consistent with the hypothesis that a compound with recognition characteristics similar to those of salmon CT may function as a neurotransmitter-modulator in the central nervous system.
Animals↗
Antagonistic behavioral effects of calcitonin and amphetamine in the rat.
Using an automated testing apparatus, the hypermotility induced by amphetamine had previously been found to be inhibited by intracerebroventricular (ICV) administration of salmon calcitonin (CT). The present study used a computer-supported direct observational method to characterize further the interactions of CT and amphetamine. After treatment with amphetamine (1.5 mg/kg, IP), the incidence of rearing, nose poking, and locomotion was reduced in rats that were pretreated with 85 pmol salmon CT ICV; the incidence of sniffing and grooming remained unchanged. CT-induced dyskinesia, a unique consequence of central CT treatment, was attenuated but not abolished by administration of amphetamine. These results support the premise that a compound with receptor recognition characteristics similar to those of salmon CT may act as a neurotransmitter-modulator in the central nervous system.
Amphetamine↗
Confounding and the dementia of schizophrenia.
Schizophrenia is often said to cause dementia, and previous studies have found cognitive impairment to be associated with schizophrenia. It is possible, however, that other causes of dementia and the study of patients not representative of all schizophrenics have contributed to these findings. The neuropsychological test scores of 26 schizophrenic outpatients were compared to those of 82 other patients with a history of psychosis. After other known causes of cognitive impairment were controlled for, the schizophrenics were not found to have cognitive impairment when compared to the other patients.
Adolescent↗
Is there a dementia of schizophrenia?
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Dementia↗
Evaluation of the pediatric patient for liver transplantation.
In a 36-month period from 1981 to 1984, 209 pediatric patients were evaluated for liver transplantation. The purpose of the evaluation was to assess the severity and progression of the disease, anatomical suitability for transplantation, and psychosocial stability and to initiate family education. Of the 209 patients evaluated, 85 (41%) underwent transplantations and 64 (75%) survived at least 12 months. Thirty-four (16%) patients were not considered candidates for transplantation. The mean waiting period increased from 80.3 days to 232 days. Of 174 patients considered for transplantation, 41 (24%) died prior to surgery. A formal evaluation for liver transplantation permitted appropriate selection of candidates and provided education for informed consent. We also stress the need for greater participation in pediatric organ donation.
Adolescent↗