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Biomedical subjects

C E Becker

Publications and source records attributed to C E Becker.

At least 73 records · Page 4Linked to original sources
PubMed1982

Potential pitfalls in the evaluation of the usefulness of hemodialysis for the removal of lithium.

A 50-year old female who was comatose from an overdose of lithium was treated with hemodialysis. Serum lithium concentrations declined 47% during a 3-h hemodialysis but increased afterwards, peaking 8 h after hemodialysis was stopped. Hemodialysis clearances were estimated by equations using extraction ratios of lithium from whole blood, serum, and red cells, and flows of whole blood, serum or red cells. The amount of lithium removed was calculated from these clearances as well as measured directly in the dialysate. Errors were introduced into the calculation of the amount of lithium removed by hemodialysis unless whole blood concentrations of lithium and whole blood flows were used. These arose because extraction of lithium from serum (0.7 +/- 0.3, mean +/- SD) was greater than that from whole blood (0.49 +/- 0.06) or from red blood cells (0.18 +/- 0.12). Despite the rapid decrease in serum concentrations of lithium during hemodialysis and rebound afterwards, the patient's neurologic status did not change concurrently. The patient did not regain consciousness until lithium concentrations fell to less than 0.4 meq/L in serum and 0.1 meq/L in cerebrospinal fluid. The lack of parallel change in serum concentrations and coma probably reflects the lag time in equilibration between lithium concentrations in serum and brain.

Female↗
PubMed1982

Occupational peripheral neuropathies.

Neither clinical nor laboratory evaluation can distinguish occupational neuropathies from neuropathies due to other causes. A worker may suffer either from mechanical injury of individual nerves or from a toxic polyneuropathy that is usually axonal in type. A thorough occupational and environmental history and the recognition of clusters of cases are important in determining the diagnosis. Electrophysiologic studies are helpful in detecting neuropathies in patients who have been occupationally exposed to neurotoxins but have no symptoms. Prevention of occupational neuropathies depends on clinical vigilance, industrial hygiene surveys, biologic monitoring and periodic examination of workers exposed to neurotoxic chemicals. The development of more sophisticated methods of prevention and early detection of peripheral nerve involvement depend on understanding the mechanisms of action of toxins and the pathophysiology of the lesions they cause.

Animals↗
PubMed1982

Key elements of the occupational history for the general physician.

Taking a medical history is an art that requires skill, experience and practice. There is now increasing recognition of the importance of workplace and environmental factors in causing or aggravating common medical conditions. Because of limited training in evaluating workplace and environmental hazards, general physicians may find it difficult to target a general medical history to detect essential occupational details.

Humans↗
PubMed1982

Amanita phalloides-type mushroom poisoning.

In the fall of 1981 the San Francisco Bay Area Regional Poison Control Center received more than 100 calls regarding wild mushroom ingestion. Ten cases, including three fatalities, had all the features of Amanita phalloides poisoning. Encephalopathy, coma and renal insufficiency occurred in all three patients who died, but did not occur in those who survived. Two of the three patients who died arrived at the hospital late in the course of their illness, and severe gastroenteritis with accompanying dehydration probably contributed to their deaths. The poison control center promoted public awareness of the mushroom hazard through newspaper and television stories and by notifying local health departments. It also has devised a simple form to improve the quality of data collection and to assist in later verification of suspected A phalloides poisoning.

Adolescent↗
PubMed1982

A model poison control system.

Responding to the need for a poison information, education, data collection and research resource in California's Bay Area and North Coast counties, the San Francisco Bay Area Regional Poison Control Center has become an integral part of the region's emergency medical services. In the first 33 months after it opened, more than 54,000 calls for assistance were received, nearly a third from medical professionals. Through the cooperation and collaboration of public, private and university resources and interests, a cost-effective, comprehensive and accessible system has evolved for public and professional use. Through our experience a system has developed that can serve as a model for poison information services throughout the western states. Emerging public concern for toxicology issues will continue to refine this model.

Humans↗
PubMed1981

Continuous transepidermal drug collection: basis for use in assessing drug intake and pharmacokinetics.

Continuous transepidermal drug collection (CTDC) has been proposed for use in assessing ethanol intake and in monitoring compliance with therapeutic regimens. Exploration of a theoretical basis for use of CTDC in these circumstances and for its use in assessing other aspects of drug disposition kinetics was undertaken. Effects of single and multicompartmental drug disposition models, single dose and multiple dose regimens, with regular and irregular doses and dosing intervals, and zero-order, first-order, and Michaelis-Menten excretion patterns were explored. First-order transepidermal drug transfer was assumed with and without back transfer from the collection device. These analyses suggest that the utility of CTDC is severely restricted when back transfer from the collection device is substantial. With back transfer minimized, CTDC may be a useful tool for assessing amount of drug exposure, compliance with therapeutic regimens, and relative bioavailability, but offers little advantage over discrete sampling of other body fluids in the study of other aspects of drug disposition kinetics.

Half-Life↗
PubMed1981

Use of cathartics in toxic ingestions.

Cathartics are commonly recommended for treatment of ingestion of toxic substances. Literature review shows little evidence of efficacy of this practice. Published reports of morbidity are limited to pediatric patients experiencing electrolyte imbalance. Our survey of the members of the American Board of Toxicology, as well as our literature review, form the basis for suggesting catharsis of most patients when treating toxic ingestions. However, caution must be used in very old or very young patients, in those with preexisting renal disease or ingestion of nephrotoxic substances, in corrosive ingestions, in patients with recent bowel surgery or absent bowel sounds, and in patients with hypertension or congestive heart failure. Oil catharsis is not recommended.

Cathartics↗
PubMed1981

An evaluation of the effects of lithium in the treatment of chronic alcoholism. I. Clinical results.

To evaluate the efficacy of lithium in chronic alcoholism, we enrolled 47 male alcoholics in a prospective double-blind two-period crossover study. Nineteen subjects completed the 6-mo study during which they received lithium and placebo each for a 3-mo period. Self-reported alcohol intake and social and psychological factors were monitored. Three subjects claimed that they did not drink during the study. Mean self-reported alcohol intake of the remaining 16 was less during lithium therapy but was also less during the first treatment period. Neither of these differences reached statistical significance. The nine depressed patients, diagnosed from their profiles of the Minnesota Multiphasic Personality Inventory did not consume significantly less alcohol and did not change scores for depression significantly during lithium therapy. We could not demonstrate the lithium therapy was of benefit in our group of alcoholic patients.

Adult↗
PubMed1981

An evaluation of the effects of lithium in the treatment of chronic alcoholism. II. Assessment of the two-period crossover design.

Analysis of self-reported alcohol intake by alcoholic subjects participating in a two-period crossover trial of lithium versus placebo failed to demonstrate a significant effect of lithium in reducing alcohol consumption. An appraisal of the adequacy of this study design to meet the original objective of the trial was undertaken. It was impossible under this study design to simultaneously and unequivocally estimate effects of treatment periods, drug carryover, sequence group and other period by treatment interactions in addiction to the lithium/placebo effects. Presence of one or more of these additional influences on the trial outcome not only complicated the interpretation of results but diminished the power of the trial design to test the major hypothesis of interest, that lithium could reduce alcohol intake. We conclude that the two-period crossover design has serious drawbacks in this clinical trial setting and that alternative strategies need to be considered for future trials.

Adult↗
PubMed1979

Diazepam kinetics in acute alcohol withdrawal.

We performed a within-subject comparison of the kinetics of diazepam given to 7 alcoholic subjects during acute alcohol withdrawal and again after detoxification. The initial rapid exponential decline of plasma diazepam concentrations (t1/2 alpha) was more rapid during (0.21 +/- 0.03 hr) than after withdrawal (0.44 +/- 0.14 hr, p less than 0.05). Terminal t1/2, clearance, and volumes of distribution changed in individual patients, but mean values did not change. Protein binding was less in patients (93.4 +/- 2.4%) than in healthy controls (97.0 +/- 1.0, p less than 0.05). The effects of alcohol withdrawal on diazepam disposition do not explain the high doses of diazepam commonly required to treat the withdrawal.

Adult↗
PubMed1979

Hypertensive emergencies.

The clinical syndrome of accelerated hypertension is a relatively rare complication of hypertensive disease. The syndrome is recognized by high blood pressures, progressive neurologic and visual symptoms, acute renal damage, cardiac failure, and microangiopathic hemolytic anemia. When diagnosed, it must be recognized as an acute medical emergency. The patient should be admitted to an intensive care unit, arterial lines should be placed, and the blood pressure lowered as soon as possible. Once blood pressure has been controlled, oral medications should be begun. Long-term results in the treatment of hypertensive emergencies are gratifying. It is anticipated that with more experience gained in the use of medications in this situation, an even better prognosis will be achieved.

Adrenal Gland Neoplasms↗
PubMed1979

Review of pharmacologic and toxicologic effects of alcohol.

Oral neglect and dental diseases are common; consumption of alcohol is common. To appreciate the frequency of alcoholism, the dental specialist must recognize that no persons will seek attention for alcoholism. Suspicion of alcohol related dental disease is the key. Heavy smoking, malnutrition, bleeding gingiva, cancer of the head and neck, and enlargement of the parotid glands should all raise a question of alcoholism. Alcohol affects most organ systems, but toxicity is extremely variable. Single organ systems may be severely damaged whereas others are spared. Current evidence suggests that variations on the total amount of alcohol consumed and genetic variations in specific pathways may contribute to the multifaceted clinical presentations of alcoholism. Because alcohol is the single most common drug ingested by patients, common interactions of drugs that have dental significance should be suspect. Most commonly, these interactions involve anesthetic agents and sedative hypnotic drugs. Dental specialists may encounter alcoholic persons in intoxicated, withdrawing, or rehabilitating states. In any of these phases, appropriate recognition and judicious support of the dental problems will contribute to the overall well-being of these persons.

Alcohol Withdrawal Delirium↗
PubMed1979

Medical complications of drug abuse.

Because we do not fully understand the cause of drug abuse, we do not currently have specific therapy for the abuse phenomenon. It is likely that those patients who abuse drugs are not a homogeneous treatment group. The patients seen most frequently because of medical complications probably represent only a small percentage of the total number of drug abusers. The medical complications of drug abuse affect almost all organ systems, and may result acutely from overdose or may not become apparent until after prolonged or recurrent use. Special emphasis has been placed on recognizing the key points of the physical examination in the overdose setting and in the drug-abusing patient that will give clues as to the nature and degree of the drug abuse. It is not clear whether drug abuse causes behavioral problems or vice versa. Physicians need to develop the medical expertise necessary to care for patients with drug abuse problems. Special attention is called to new drug abuse problems: complications associated with phencyclidine, amyl nitrate, and layman's remedies; acute and pulmonary complications; rhabdomyolysis; the brown heroin syndrome; and methylphenidate abuse. Although each of these complications has individual importance, a high incidence of alcohol use and smoking further compromises the general health of drug-abusing patients. Treating all of the medical complications of drugs must be viewed as only the beginning of a therapeutic attempt to restore these patients to a more physically and emotionally healthy life.

Adult↗
PubMed1979

Peritoneal clearance and total body elimination of vancomycin during chronic intermittent peritoneal dialysis.

Vancomycin is a useful antimicrobial agent in patients undergoing chronic hemodialysis treatment; its efficacy in chronic peritoneal dialysis (CPD) has not been established. Serum (VS) and peritoneal fluid (VPF) vancomycin concentrations were measured in two CPD patients with staphylococcal peritonitis. Half-life of VS agreed with the half-life of VPF in each patient, and the VS/VPF ratio was 1.27 in both patients. Distribution volumes were 37.2 and 58.7 l, values approximating total body water in these patients. VS and VPF persisted in the therapeutic range (greater than 5 microgram/ml) for more than 16 days. In one patient, mean peritoneal clearacne was 9.8 ml/min, and overall drug clearance averaged 2.3 ml/min; in the other patient, overall clearance was 2.1 ml/min. These results indicate that therapeutic vancomycin levels can be maintained for more than 16 days with a single 1 g intravenous dose in patients receiving intermittent CPD, as is the case for hemodialysis patients. Because of this, parenteral vancomycin is useful in the treatment of staphylococcal peritonitis in CPD patients.

Adult↗