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Biomedical subjects

C Wright

Publications and source records attributed to C Wright.

At least 271 records · Page 15Linked to original sources
PubMed1989

Changing physician prescribing habits through a cost-effective first generation cephalosporin formulary.

Cephalosporin antibiotics account for a significant portion (approximately 10%) of our institution's drug budget. A 1985 survey demonstrated that 64% of our first generation injectable cephalosporin (FGIC) orders were for cefazolin. Of the cefazolin orders, approximately 77% used an "every 6 hour" dosage interval. It was thought that this dosage interval was associated with "physician habit" of prescribing similar agents "every 6 hours." By using an "every 8 hour" cefazolin dosage interval in most cases, significant cost savings in the hospital's drug budget could be realized. The Department of Pharmacy and the Pharmacy and Therapeutics (P&T) Committee developed and instituted an FGIC formulary procedure designed to promote the use of cefazolin with an "every 8 hour" dosing interval. Following presentation of literature guidelines to the P&T Committee, measurement of staff physician support through a written survey and presentation of extensive educational programs by the Department of Pharmacy, and FGIC formulary was implemented. The formulary policy included the automatic changing of every 6 hour cefazolin dosing intervals to every 8 hour intervals, with a physician option of "NO SUBSTITUTION." After implementation of the formulary policy, physician prescribing habits for FGIC's changed dramatically. Six months post-formulary, cefazolin accounted for 94% of FGIC prescriptions. Approximately 76% of cefazolin doses were being administered on an "every 8 hour" dosing interval as opposed to 21% prior to formulary implementation. Approximately $45,000 was saved during the first twelve months following formulary implementation. Physicians, pharmacists and nurses have supported the formulary policy.

Alabama↗
PubMed1989

OKT3 prophylaxis versus conventional drug therapy: single-center perspective, part of a multicenter trial.

As part of a collaborative study, Orthoclone OKT3 (Ortho Pharmaceutical Corporation, Raritan, NJ) monoclonal anti-T-cell antibody was used prophylactically for 14 days following cadaveric renal transplantation. Patients were randomized before treatment and compared with a control group treated with triple-drug immunosuppressant therapy consisting of cyclosporine, azathioprine, and prednisone. The OKT3 group (also treated with prednisone and azathioprine) had significantly fewer patients with acute rejection during the first year (27% v 60%), significantly delayed onset of acute rejection (median number of days to rejection, 56 v 10), and shortened duration of delayed initial graft function (median number of days on nonfunction, 5.5 v 9.0). OKT3 was safely administered intraoperatively. The study group included diabetics and patients over the age of 50 years. There was an increased incidence of benign fungal infection in patients treated with OKT3. The outcome data of both the prophylactic and control groups in this single-center trial was different from the multicenter experience in that patient and graft survival was 100% in both groups. The only difference in the immunosuppressive protocol was the use of 2 g intravenous methylprednisolone intraoperatively. The combination of intraoperative OKT3 with 2 g methylprednisolone may merit further study. It was concluded that OKT3 prophylaxis reduces the incidence of rejection episodes, delays the occurrence of rejection, and may reduce the duration of delayed initial graft function. It is not associated with an increase in serious infection and can be administered safely to a variety of cadaver transplant recipients.

Antibodies, Monoclonal↗
PubMed1989

Analysis of pregnancy-related calls to an occupational hazard hot line.

Since 1980 the Hazard Evaluation System and Information Service has responded to over 11,000 inquiries regarding workplace health hazards. Of 2,424 inquiries in 1986, 593 (24%) concerned hazards to pregnancy. This represents a 17-fold increase since 1981. Most pregnancy-related inquiries were from employees (70%) and health care providers (23%). Referral sources for the employees calls were almost exclusively individual health care providers or institutions that provide health care or health counseling, or both. These data suggest that pregnant employees seek information on their own or from health care providers instead of from employers. Of the inquiries, 80% were for general pregnancy hazard information; 20% involved symptomatic pregnant employees. Most inquiries concerned employment in the services (58%) and manufacturing (26%) sectors. Organic solvents, pesticides, acrylic nail-grooming products, lead, and video display terminals were among the agents about which callers inquired most frequently.

California↗
PubMed1989

[Acute Borrelia burgdorferi encephalitis (Lyme disease) in an Algerian child].

A case of acute hemorrhagic leukoencephalitis is described in an Algerian child with renal insufficiency that had been diagnosed at the terminal stage. Convulsions, hemiplegia and consciousness disorders pointed to a necrotizing viral or bacterial form of encephalitis, but the definitive diagnosis was based on the detection of IgM and IgG specific serum antibodies raised against Borrelia burgdorferi.

Acute Disease↗
PubMed1989

[Late neonatal hypocalcemia. Apropos of 33 cases treated with 1 alpha-hydroxycholecalciferol].

Thirty-three observations of late-onset neonatal hypocalcemia were reviewed retrospectively. Their etiological, clinical and biological features were consistent with a transient congenital hypoparathyroidism, associated with a materno-foetal vitamin D deficiency. 1 alpha-hydroxycholecalciferol was used for rapid correction of calcemia and proved to be satisfactorily metabolized after its oral administration.

Calcium↗
PubMed1989

[Familial infantile nephrotic syndrome with ocular abnormalities].

Two siblings born from consanguineous parents experienced infantile nephrotic syndrome with ocular and neurological abnormalities and a micropenis in the boy; both patients died before age 1. The opportunity to perform successively a renal biopsy and a two-step binephrectomy permitted a good histological follow-up. The lesions were characterized by mesangial involvement, followed by an extensive extracapillary proliferation and tubular dilatations with a high mitotic activity of the epithelium with anisocaryosis; the main features consisted in major ultrastructural changes of the glomerular basement membrane which were more significant and different from those previously described in the diffuse mesangial sclerosis. These 2 cases may either constitute a new entity or an extreme form of diffuse mesangial sclerosis, supported by recessive autosomal inheritance.

Basement Membrane↗
PubMed1988

Circadian variation of total ischaemic burden and its alteration with anti-anginal agents.

6264 hours of ambulatory ST segment monitoring of 150 unselected patients with proven coronary artery disease, who were off all routine anti-anginal treatments, showed 598 ischaemic episodes, of which 446 (75%) were silent (symptom-free). Most (68%) ischaemic episodes occurred between 0730 and 1930, with a peak in the morning and a lesser peak in the evening. Two subgroups were studied further in double-blind controlled trials: 33 patients had a total of 1313 hours of ST segment monitoring while treated with nifedipine; and 41 patients a total of 1581 hours while treated with atenolol. Nifedipine did not alter the circadian pattern of ischaemic episodes; atenolol abolished the morning peak, and the peak incidence of ischaemia then occurred in the evening. Circadian patterns for total duration of ischaemic episodes corresponded closely to those of episodes of ischaemia, and were similarly altered by treatment. The circadian pattern of silent ischaemic episodes and their total duration were very similar to those of total ischaemia for the group as a whole and the different subgroups. This circadian distribution of ischaemic episodes and the observed changes with treatment resemble the reported circadian variation of acute myocardial infarction and sudden death.

Adult↗
PubMed1988

Crystals of a trypsin-modified alkaline phosphatase. Preliminary crystallographic characterization.

Trypsin-modified alkaline phosphatase from Escherichia coli has been crystallized in a form distinct from the two known crystal forms of the native enzyme. The large well diffracting crystals belong to the orthorhombic space group P2(1)2(1)2(1), possess unit cell dimensions a = 56.0 A, b = 136.0 A, c = 283.9 A with 2 dimers per asymmetric unit, and are suitable for high resolution x-ray crystallographic studies. The observed structural and functional differences between the native and modified molecules are a result of peptide bond cleavage at Arg10-Ala11 with loss of the NH2-terminal decapeptide in both subunits of the dimer.

Alkaline Phosphatase↗
PubMed1988

Polyamines and autocrine control of N-nitrosomethylurea-induced rat mammary tumor growth in vitro by progesterone.

These experiments were designed to test whether autocrine/paracrine mechanisms are involved in the growth-promoting action of progesterone (Pg) in the N-nitrosomethylurea-induced rat mammary tumor cultured in vitro in soft agar clonogenic assay. In support of our hypothesis, we observed that conditioned media obtained from Pg-treated tumors (Pg-CM), consistently stimulated colony formation in our system to the same degree as Pg itself (approximately 140% of control). Treatment with heat, trypsin, and concanavalin A abolished the colony-stimulating effect of Pg-CM, thus suggesting the possible glycoprotein nature of the Pg-inducible growth factor(s). The growth-promoting action of Pg-CM was rather specific since CMs obtained from tumors exposed to a variety of other steroid hormones rarely stimulated colony formation and usually only to a modest degree. Administration of the polyamine biosynthetic inhibitor, alpha-difluoromethylornithine, abolished the colony-stimulating effect of Pg-CM. The inhibitory effect of alpha-difluoromethylornithine was reversed in a dose-dependent fashion by exogenous administration of spermidine, which entirely restored the growth-promoting action of Pg-CM. Addition of increasing amounts of spermidine, however, did not potentiate Pg-CM action under our experimental conditions. Our results indicate that autocrine/paracrine mechanisms may mediate, at least in part, the colony-stimulating effect of Pg in our system. The polyamine pathway plays an essential role in the expression of such control of tumor growth by Pg.

Animals↗
PubMed1988

Cardiac transplantation in severely ill patients requiring intensive support in hospital.

Sixty four patients were referred for cardiac transplantation from a single cardiac team at this hospital between October 1984 and December 1986. Of these patients, 33 were referred for urgent transplantation, all of whom required intensive treatment in hospital with intravenous infusions of cardiac drugs, intra-aortic balloon counterpulsation, peritoneal dialysis, ventilation, or any combination of these to sustain life. Of these 33 patients, six died while awaiting transplantation, one was removed from the waiting list for a transplant, and 26 received cardiac transplants. There were five deaths within 24 hours of operation and one death 10 days after the operation. Twenty of those who had surgery had a successful outcome of transplantation, but there was one late death 10 weeks postoperatively and a further death 31 months after surgery. Eighteen patients were alive and well 10 to 33 months (mean 19.4 months) after transplantation, with an overall survival rate after surgery of 69%. Provided that surgery can be performed before renal failure has progressed such that renal dialysis [corrected] is necessary, the results are excellent (surgical survival 85.5%) and, we believe, justify the expenditure and staffing requirements necessary to treat these terminally ill patients.

Adolescent↗
PubMed1988

Stringent regulation of stably integrated chloramphenicol acetyl transferase genes by E. coli lac repressor in monkey cells.

Monkey cell lines that constitutively synthesize 38.6 kd lac repressor protein and bear stably integrated chloramphenicol acetyl transferase (CAT) genes linked to a lac operator-containing SV40 early promoter-enhancer were generated. When grown in medium containing isopropyl beta-D-thiogalactoside (IPTG), these cells acquired a CAT+ phenotype. In contrast, when grown in parallel in medium lacking IPTG, the cells remained CAT-. Maximum induction of CAT activity occurred after 4 days of IPTG exposure. Three days after removal of IPTG, induced cells had reverted to CAT-. Specific CAT activity increased up to 60-fold after induction, while background activity in uninduced cells was similar to or only slightly above that of parental, CAT- cells. CAT activity increased stepwise over a wide range of IPTG concentrations. Thus lac repressor-operator complexes can form on primate chromosomes and stringently block transcription from an adjoining promoter.

Acetyltransferases↗
PubMed1988

Cortisol, ACTH, and dexamethasone concentrations in a psychogeriatric population.

Cortisol and adrenocorticotrophic hormone (ACTH) were measured at 2 time points before the administration of 1 mg of dexamethasone (day 1) and 1 time point on the following day (day 2). Thirteen severely depressed elderly patients, 15 patients with Alzheimer-type dementia (ATD), and 16 normal controls were studied. Cortisol was markedly elevated in depressed patients compared with the other subjects in day 1 samples. Following dexamethasone, both the depressed and ATD patients showed a similar elevation of cortisol compared with controls. ACTH concentrations were not significantly different between the groups before dexamethasone, but were significantly higher in both depressed and ATD patients after dexamethasone. More depressed patients than ATD patients exhibited hypersecretion of ACTH after dexamethasone. This implies that ACTH is less responsive to glucocorticoid feedback in elderly depressed patients, which may be a factor in causing hypercortisolemia.

Adrenocorticotropic Hormone↗
PubMed1988

Relationships between oestrogen receptor,epidermal growth factor receptor, ER-D5, and P24 oestrogen regulated protein in human breast cancer.

Proteins regulated by or related to the oestrogen receptor (ER) may prove to be more reliable indicators of prognosis and hormone sensitivity then expression of the receptor itself. It has been shown recently that expression of epidermal growth factor receptor (EGFR) is associated with a poor prognosis in breast cancer. In a series of 60 breast cancers, we have studied relationships between ER, ER-D5 oestrogen receptor related protein, P24 oestrogen regulated protein, and EGFR using an immunohistochemical technique employing monoclonal antibodies in each case. In addition, radioligand binding assays for ER and EGFR were carried out and tumour histological grade was determined. Seventy-one per cent and forty-three per cent of tumours stained for ER-D5 and P24, respectively, but there was no relationship between staining for these and ER or EGFR status. There was a significant correlation between staining for ER and EGFR, and the respective biochemical assays. Relating ER to EGFR, very few ER-positive cases expressed EGFR, but this relationship fell short of significance. The prognostic significance of expression of the epitopes recognized by the ERD5 and P24 antibodies must await assessment of clinical outcome.

Antibodies, Monoclonal↗
PubMed1988

Role of polyamines in the growth of hormone-responsive experimental breast cancer in vivo.

We have provided evidence for a critical role of polyamines in the growth of the hormone-responsive N-nitrosomethyl-urea (NMU)-induced rat mammary tumor in vitro. The present experiments were designed to test whether polyamines are involved in the growth of this experimental tumor in vivo. To test this hypothesis, groups of rats bearing NMU-induced mammary cancers were randomly allocated to receive no treatment or escalating doses of the polyamine biosynthesis inhibitor alpha-difluoromethyl-ornithine (DFMO) (0.5%, 1%, 2%, 3% in drinking water). DFMO inhibited tumor growth in a dose-dependent fashion and consistently reduced tumor putrescine level. To evaluate the time dependency of this effect, additional groups of rats received either no treatment or 2% DFMO for 3, 7, 14, and 21 days. At all times DFMO suppressed tumor putrescine level as well as spermidine to spermine ratio. Finally, exogenous administration of putrescine (200 mg/kg/i.p./day x 21 days) given concomitantly with DFMO restored tumor growth, partially repleted tumor putrescine level, and raised the spermidine to spermine ratio to control levels. Putrescine, given alone, had no significant effect on either tumor polyamine levels or tumor growth. Except for modest weight loss, no major toxicity was encountered. These results indicate that polyamines play an important role in the growth of the NMU rat mammary tumor in vivo. The interaction between polyamines and hormones in supporting NMU mammary tumor growth in vivo remains to be elucidated.

Animals↗
PubMed1988

Species-specificity of estradiol regulated growth factors in breast cancer.

Recent evidence indicates that autocrine/paracrine mechanisms may mediate the mitogenic effect of estradiol (E2) both in human and experimental breast cancer. However, the species-specificity of E2-regulated growth factors with regard to their biologic action has not been evaluated. To test this issue, we examined, in the soft agar clonogenic assay, the colony-stimulating activity in human breast cancers of conditioned media obtained from rat mammary carcinomas exposed to E2 (rat E2-CM). Of 22 primary human breast cancers plated in soft agar in the absence of serum, 18 (82%) successfully grew with a mean colony number of 62.4 +/- 9.8 (S.E.M.) (range 14-193). Rat E2-CM significantly stimulated colony formation in 10/18 (56%) human breast cancers to 155 +/- 11% (S.E.M.) of control. E2 administration (10(-9) M) in these tumors had a virtually identical overall effect (154 +/- 13% of control colony number). In the remaining eight tumors (44%), neither rat E2-CM nor E2 had, in general, a significant colony-stimulating effect. The growth-promoting action of rat E2-CM and E2 was not influenced by the hormone receptor status of the tumor. These results suggest that E2-regulated growth factors may not be species-specific, at least with regard to their colony-stimulating effects in soft agar.

Adult↗