Biomedical subjects
D Platt
Publications and source records attributed to D Platt.
[Lipoprotein metabolism in menopause. Effect of hormonal substitution therapy].
Oral administration of conjugated estrogens, estradiol valerate and micronized estradiol--but not the percutaneous application--in the postmenopause modifies the plasmic lipoprotein profile by lowering, dose-dependently, LDL and elevating HDL (HDL2). In parallel, the cardiovascular mortality is decreased by 50-66%, with smokers also benefiting to the same extent. On account of the increased risk for endometrial carcinoma associated with postmenopausal estrogen monotherapy, combination with a lowest-dose gestagen is imperative. However, the very numerous synthetic gestagens can antagonize the favorable effects of the estrogen on lipoprotein metabolism. This applies in particular to the gestagens of the 19-nortestosterone type, such as norethisterone acetate and, in particular, levonorgestrel, but less so the 17-hydroxyprogesterone derivatives medroxyprogesterone acetate and medrogestone with their very low androgenic effect.
[The uniqueness of drug therapy in the aged].
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The use of intravenous immune globulin in organ transplantation.
There are no comparative clinical data to differentiate the available IVIG products. Cost, pharmaceutical considerations, and CMV titers are criteria for selecting these products. CMV-IGIV has higher titers of CMV antibodies but is more costly. The potential for CMV infection in transplant patients is great, but the clinical significance may vary. Likewise CMV morbidity and mortality is variable and dependent on the type of transplant, the donor, and immunosuppressive regimens used. IVIG has a role in decreasing CMV infections in transplant patients, but further study and cost-benefit analysis is necessary to determine optimal regimens.
Affordable health insurance.
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[Multimorbidity and pharmacotherapy in the elderly].
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[Intensive care medicine in geriatrics--an assessment of current status].
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[Pharmacokinetics and pharmacodynamics of flunarizine in multimorbid, geriatric patients with vertigo].
Ten multimorbid, geriatric, hospitalised patients, mean age 76 years, were treated for vertigo and received 10 mg flunarizine (CAS 52468-60-7; Sibelium) daily for 3 weeks. The study of the pharmacokinetics and pharmacodynamics of this dosage scheme revealed that the kinetics did not change during the three weeks of therapy. The terminal half-life is 7.3 +/- 3.3 days. Since a steady state concentration is only to be expected after about 5 half-lives, this condition was not fully met yet in most patients after three weeks. The data obtained from the patients examined are essentially identical with those in young and old healthy subjects. The unchanged kinetics during long-term treatment prevent side-effects due to cumulation on the one hand or the decrease of plasma levels to inactive concentrations resulting from enzyme induction. There was not measurable anti-aggregator effect on thrombocytes or erythrocytes. The effectiveness in connection with vertigo seems to be due to a direct labyrinth depressor activity and/or to a selective vasospecific action. No side-effects were observed during the three weeks of therapy.
[Garlic as phytogenic antilipemic agent. Recent studies with a standardized dry garlic powder substance].
Garlic (Allium sativum L.) is a commonplace drug. It is now available in the form of dragees made of garlic powder, standardized to 1.3% alliin. The lipid-lowering potential of such preparations has not been reviewed yet. In 7 out of 8 studies, including over 500 patients, a daily dose of 0.6 g to 0.9 g garlic powder reduced plasma cholesterol and triglyceride levels by 5 to 20 percent. The metabolic mechanisms of these reductions are not known.
[Age related changes in the liver. Consequences for drug therapy].
The most significant morphological peculiarity of the liver in old age is "brown atrophy", with a reduction in weight and volume of the organ. The physiological metabolic functions of the liver are extremely well preserved right up into very old age. There is, however, some impairment of function with respect to the elimination of exogenous substances and drugs. The major cause of this is a decrease in hepatic perfusion, the volume of the liver, and the number of functioning hepatocytes. Thus, since the elimination capacity of both the kidneys and the liver can be reduced in old age, drugs should initially be administered at lower doses in geriatric patients.
[Combination drugs in geriatrics. The need for clinical studies in this special age group].
Multimorbidity frequently prompts the use of multiple drugs with the aim of treating the individual diseases simultaneously. Ingestion of a number of different drugs incurs the risk of early and more frequent side effects, as well as interactions between the various drugs. There is a tendency among patients of all age groups, intentional or unintentional not to take their medication. Among elderly patients regular compliance is a special problem. Reduction of the high consumption of drugs by the elderly is possible by therapy with combination drugs. The present paper discusses the advantages and disadvantages.
[Multi-morbidity and pharmacotherapy in the aged. Considerations for the treatment of cerebral performance deficits].
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Decrease of cholesterol concentration in human erythrocyte ghosts in old age.
The lipid composition of the erythrocyte membrane ghosts of 95 relatively healthy elderly subjects was compared between four age groups: 70 to below 75 years (I), 75 to below 80 (II), 80 to below 85 (III) and 85 to below 90 years of age (IV). The molar ratio of phospholipid to cholesterol (PL/CH) in the erythrocyte ghosts increased with advancing age. Whilst PL levels did not change significantly, a decrease of membrane cholesterol was found. Therefore, the red cell membrane cholesterol seems to parallel the well-known pattern of variation of mean plasma total cholesterol and LDL cholesterol concentrations with age: an increase to a maximum in the sixth decade of life, and a decline thereafter. The processes which are responsible for these changes in cholesterol level with age have not been delineated. However, the findings suggest that one might get different results in studies of age-dependent membrane lipid alterations if rough age group divisions are made (below 30 years of age vs. over 70 years) or to subdivide the group of the elderly.
Effect of gemfibrozil on erythrocyte membrane lipids in geriatric patients.
Twenty geriatric patients with primary or secondary hyperlipidemia and suffering from various other diseases received for three weeks once daily 900 mg gemfibrozil. The hyperlipidemia had not been treated before, and a cholesterol-reduced diet did not succeed in lowering total cholesterol below 6.75 mmol/l (260 mg/100 ml) and serum triglycerides below 1.97 mmol/l (175 mg/100 ml). The purpose of this study was to analyze the lipid composition of the erythrocyte membrane, serum lipids and rheological parameters before and after the therapy. Mean serum total cholesterol and triglyceride content decreased significantly by 16.3% (p less than 0.05) and 35.2% (p less than 0.01) on average, respectively. Aggregation of thrombocytes and of erythrocytes, thrombin time and partial thromboplastin time slightly varied during the three weeks' treatment, but without statistical significance. The content of total long-chain saturated fatty acids in the phospholipid fraction of the erythrocyte membrane decreased slightly from 41.3% to 40.9% (p less than 0.05), whereas the total w6-unsaturated fatty acids without the precursor linoleic acid increased by about the same extent from 15.66% to 16.0% (p less than 0.05). The molar ratio of phospholipid to cholesterol content decreased significantly (p less than 0.01) due to a reduced phospholipid content at the end of the therapy. In conclusion, in addition to reducing the serum lipids, gemfibrozil slightly effects the lipid composition of erythrocytes, but the effects of the varied concentrations of long-chain saturated and long-chain w6-unsaturated fatty acids in the phospholipid fraction on membrane fluidity might be compensated, at least partly, by the decrease of the ratio of membrane phospholipid to cholesterol.
Management of intracortical fractures of the palmaroproximal third metacarpal bone in a horse by surgical forage.
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Developing staff into clinical practitioners.
Developing clinical skills in pharmacy staff is a process that can enhance the services of a pharmacy department and improve the professional development and interest of the staff. Staff should be included in the development of a clinical philosophy and a training and ongoing development program that will achieve the desired goals should be planned. An MBO process may help to track the individual pharmacist's progress. Knowledgeable, motivated staff are the key ingredient in achieving success in providing pharmacy services.
The effect of a garlic preparation on the composition of plasma lipoproteins and erythrocyte membranes in geriatric subjects.
This study evaluated the effect of a dried garlic powder preparation, standardised to 1.3% alliin, on the composition of plasma lipoproteins and erythrocyte membranes. Forty volunteers, aged 70 years and over, took 600 mg of garlic powder per day for three months. In participants with initially normal plasma cholesterol levels (CH less than 200 mg/dl; n = 11) after three months of garlic tablet administration, little or no change in CH values was registered, as for most of the other parameters. In contrast, in volunteers with initially elevated CH levels (CH greater than 200 mg/dl, n = 29), the CH levels were reduced by -7.7% (p less than 0.001). This reduction took place primarily in the esterified cholesterol fraction (-12%, p less than 0.001), whereas free cholesterol concentrations were not altered significantly. Triglycerides (-15.9%, p less than 0.05) and plasma choline phospholipids (-4.6%, p less than 0.01) were also reduced. No change of the plasma LDL-CH to HDL-CH ratio was observed in this group. Based on the weight of lyophilised, haemoglobin-free erythrocytes, the mean membrane concentration of phospholipids and cholesterol in the total cohort (n = 40) increased by 5.7% (p less than 0.001) and 6.1% (p less than 0.01), respectively. These increases were more pronounced the lower the body mass indices (kg/m2) were, and the longer the duration of garlic administration was. The molar ratio of membrane phospholipids to cholesterol remained unchanged. The results are discussed with regard to a possible role of the garlic-induced membrane effects in the plasma lipid-lowering potency of garlic and preparations made from it.
[Geriatric drugs--delayed aging, fountain of youth or profit out of aging?].
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