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Biomedical subjects

D L Kaiser

Publications and source records attributed to D L Kaiser.

At least 145 records · Page 8Linked to original sources
PubMed1981

Pergolide mesylate: its effects on circulating anterior pituitary hormones in man.

Pergolide mesylate is a synthetic ergoline with dopamine agonist properties. The endocrine profile was studied in a double blind crossover design in six normal males. Circulating PRL, TSH, GH, LH, FSH, and cortisol were measured in the basal state and after TRH (500 micrograms iv) administration at 4.5, 11.5, and 23.5 h after placebo or pergolide (100 micrograms orally). Pergolide caused suppression of basal PRL from 2-8 ng/ml to less than 2 ng/ml commencing 60 min after administration and persisting throughout the 23.5-h study period. For the three TRH tests, a suppression of peak PRL (mean +/- SEM) response to TRH of 54.6 +/- 5.1 vs. 1.9 +/- 0.5, 45.2 +/- 4.1 vs. 4.5 +2- 0.6, and 34.4 +/- 2.9 vs. 6.9 +/- 1.4 ng/ml, respectively, for placebo and pergolide was noted. Basal TSH levels were unaffected by pergolide, but after pergolide the peak TSH response to the first two TRH challenges was blunted (placebo vs. pergolide: 12.3 +/- 1.2 vs. 6.8 +/- 1.0 and 14.8 +/- 2.0 vs. 9.6 +/- 1.0, respectively); however, the third TSH response (9.8 +/- 1.1 vs. 9.3 +/- 1.2) was not blunted after pergolide. GH secretion was stimulated by pergolide with a consistent pulse observed within 60 min of pergolide administration and an enhancement in the number and amplitude of subsequent GH pulses throughout the 24-h period. Cortisol levels rose after pergolide and returned to levels seen on the control day at 16.5 h. FSH levels were unaffected but LH levels were lowered pergolide. Side effects including nausea, vomiting, and hypotension were observed in all subjects. Pergolide is a potent dopamine agonist with the anticipated endocrine profile and clinical effects; its long duration of actions offers promise of single daily dose therapy for hyperprolactinemia.

Adult↗
PubMed1981

Prolactin secretion in Parkinson disease.

We studied the dopaminergic control of lactotroph cells in the anterior pituitary of parkinsonian patients and age-matched normal subjects. The resting levels of prolactin and the TRH-induced rise in prolactin were normal in Parkinson disease. Levodopa elicited a normal suppression of prolactin concentrations in parkinsonian subjects; the major abnormality to emerge was attenuation of the response to thyrotropin-releasing hormone (TRH) in the parkinsonian patients following administration of Sinemet (levodopa plus carbidopa) or bromocriptine. These findings imply pathology of extrastriatal dopamine systems in Parkinson disease. Since the addition of carbidopa enhanced the suppression of prolactin induced by levodopa, exogenous levodopa probably acts predominantly through the formation of dopamine in the hypothalamus, but inside the blood-brain barrier, rather than as a direct effect of circulating dopamine on the anterior pituitary or areas of the hypothalamus outside the blood-brain barrier.

Adult↗
PubMed1981

Nonphysician supervision of a very-low-calorie diet. Results in over 200 cases.

Nonphysician nutritional therapists treated 234 obese patients with a 12-week behavioral modification, nutrition education program followed by up to 12 weeks on a very-low-calorie diet (VLCD). Mean weight decreased from 104.5 kg to 85.8 kg after 12 weeks on VLCD. Mean maximal weight loss for all patients was 17.2 kg. Blood pressure decreased from 133/86 to a low of 111/70 during VLCD. In 91 hypertensive patients, blood pressure fell from 145/95 to 128/81 after 12 weeks of VLCD. No serious side effects of VLCD were noted, although two patients developed mild cases of gout and one patient was taken off the fast when premature ventricular contractions were noted on ECG. Cost analysis reveals that physician care is almost three times as expensive as care by non-physician nutritional therapists. We conclude that the treatment of obesity should be performed by nutritional therapists under physician supervision using a comprehensive program of behavioral modification and VLCD.

Adolescent↗
PubMed1980

Multiple use of disposable insulin syringe-needle units.

Fourteen insulin-dependent diabetics were asked to use their insulin syringe-needle units three times in succession to determine the efficacy and safety of this practice. The mean duration of time each patient participated in the study was 20.4 weeks, and a total of 2,000 injections were taken. No signs of infections at the injection site were observed. Multiple use of disposable insulin syringe-needle units appears to be safe and cost beneficial.

Adult↗
PubMedDate not supplied

Acceptance of hepatitis B vaccine by medical and surgical residents.

To assess factors influencing acceptance of hepatitis B vaccine, 547 medical residents and 230 surgical residents were surveyed. The vaccination rate among 315 (58%) medical residents who responded was 46%; for 124 (54%) surgical residents who responded it was 76%. Most medical (93%) and surgical (94%) residents who were vaccinated believed they were at risk of hepatitis B virus infection. Among unvaccinated medical residents, 71% indicated concern about vaccine-related side effects, including potential but unknown reactions (58%) and possible transmission of AIDS (37%) and hepatitis (16%). Unvaccinated surgical residents were also concerned about side effects (64%). Stepwise discriminant function analysis revealed that medical residents were vaccinated if they were concerned about risk of exposure to hepatitis B virus and the chronic complications of infection and if they had received hepatitis B immune globulin and influenza vaccine. Surgical residents were vaccinated if they believed hepatitis B vaccine was efficacious, but were not vaccinated if they believed hepatitis B virus infection was not serious.

Adult↗
PubMedDate not supplied

Anxiety and depression among medical and surgical patients nearing hospital discharge.

Ninety-eight medical and surgical inpatients were interviewed 24-72 hours prior to discharge. Thirty-five (36%) had clinical levels of anxiety and depression as defined by the SCL-90-R, a self-report symptom inventory. Compared with patients with normal SCL-90-R subtest scores, anxious and depressed patients more often had the following characteristics: older age, black race, lower socioeconomic class, a recent previous hospitalization, and impaired functional status prior to admission. Three to four weeks after discharge, 25 of the 35 anxious and depressed patients were again interviewed. Thirteen remained anxious and depressed, while 11 patients had returned to normative distress levels. Older, black, poor inpatients with a recent prior hospitalization and impaired functional status are at high risk for clinical anxiety and depression. Half of those with anxiety and depression may remain anxious and depressed after discharge. Intervention should be considered for these patients.

Adult↗
PubMedDate not supplied

Healthy patients who perceive poor health and their use of primary care services.

OBJECTIVE: To determine what proportion of patients who have poor health perceptions are physically healthy and to explore why some patients perceive a healthy state while others perceive illness. DESIGN: A prospective consecutive series of office patients completed the Rand Corporation's General Health Perceptions Questionnaire, and their physicians rated their physical health. Their use of health care services was determined for the following 12 months. SETTING: A rural teaching office practice. PATIENTS: Of 243 adult patients asked to complete the questionnaire, 32 were excluded, for dementia (8), illiteracy (4), illness (8), incomplete questionnaires (6), and other reasons (6). 208 patients (86%) formed the final study group. MEASUREMENTS AND MAIN RESULTS: 62 of 208 patients had poor health perception scores. 39 of the 62 were rated by physicians as physically healthy and were not statistically different in physical health ratings or numbers of prescribed medications from the 146 patients who had higher health perception scores. However, these 39 patients had significantly more health-related worry, acute pain, and depression than did the other 146 patients. They also made more office visits and telephone calls and had higher total primary care charges. CONCLUSIONS: This study suggests that 21% of adult primary care patients (39 of 208) have health perceptions lower than expected for their levels of physical health. These low health perceptions are correlated with increased emotional distress and higher utilization of health care resources. Strategies to identify these patients and interventions to improve their views of their health could reduce utilization.

Attitude to Health↗
PubMedDate not supplied

Screening and characterization of antiepileptic drugs with rapidly recurring hippocampal seizures in rats.

A method to efficiently screen antiepileptic drugs (AED) for their actions against complex partial and secondarily generalized seizures is presented. The procedure relies on rapidly recurring hippocampal seizures (RRHS) in rats which are first used to bring epileptic responses to a stable, fully kindled state and then to test 3 parameters--behavioral seizures, electrographic seizures, and afterdischarge thresholds--before and after drug administration. With the methods described, the effects of a given drug treatment can be thoroughly determined in a single study period. Quantitative determinations of dose-response, time-action and relative potency characteristics are readily ascertained. A battery of known AED, encompassing those in common clinical use, was studied with this system. Kindled motor seizures (classes 4 and 5) were more readily suppressed than limbic behavioral seizures (classes 1-3). Electrographic seizures were usually, but not always, shortened concurrently with suppression of behavioral seizures. Under the conditions of this study, afterdischarge thresholds were not elevated, indicating that a critical role of AED is to counteract seizure spread and prolongation. The overall behavior of the RRHS test system with AED was identical to that with traditional amygdala kindled seizures and results were in good agreement with the clinical responsiveness of the kinds of seizures that these experimental systems model. The features of RRHS make it a useful system for screening new agents for antiepileptic effects, even in circumstances where little or no information about the drug under study is available.

Animals↗
PubMedDate not supplied

Designing hospital infection studies.

The design of investigations of hospital infections often will make a difference between results that are useful and results that only appear to be. The importance of study design and dimensions cannot be overemphasized. Much has been written about methods of research. Most universities and many large hospitals have persons trained in research design and analysis. The more that investigators of nosocomial infections talk with and collaborate with persons who have such training, the more accurate and more productive their research is likely to be.

Cross Infection↗
PubMedDate not supplied

Renal and cardiovascular responses to acute hypercapnic acidosis in conscious dogs: role of renin--angiotensin.

Patients with pulmonary dysfunction and CO2 retention have renal hemodynamic abnormalities accompanied by increased plasma renin activity. To determine if hypercapnia impairs renal function, particularly through the renin-angiotensin system, the effects of acute hypercapnic acidosis (HC), using 8.5% CO2, were measured in five unanesthetized dogs during (a) the intact state; (b) renin-angiotensin antagonism using either 1-sarcosine, 8-glycine angiotensin II ( [Sar1, Gly8] AII) or SQ 14,225; and (c) exogenous angiotensin II infusion. As partial arterial carbon dioxide pressure (PaCO2) increased (p less than 0.05) from control (C) of 35 +/- 1 (SEM) to 48 +/- 1 mm Hg during HC, arterial pH fell (p less than 0.05) from 7.36 +/- 0.01 to 7.24 +/- 0.005. Renal function was uncompromised with HC, and glomerular filtration rate (GFR) and urinary sodium excretion increased (p less than 0.05) despite a fourfold rise in plasma renin activity from C of 0.6 +/- 0.3 to 2.2 +/- 0.8 ng AI ml-1 h-1 during HC. Administration of [Sar1, Gly8] AII during HC did not consistently alter systemic or renal hemodynamic responses, and effects of SQ 14,225 during HC were also observed during normocapnia. Although systemic vascular responses to exogenous AII infusion were similar, the renal vasoconstrictor response was antagonized during HC with unchanged GFR and renal blood flow. These findings indicate that despite activation of the renin-angiotensin system, acute hypercapnic acidosis is unassociated with impairment of renal function in unanesthetized dogs. This may be related to diminished renal vascular AII responsiveness during hypercapnia.

Acidosis↗