Biomedical subjects
Publications and source records attributed to D Shelton.
The authors describe the clinical and pharmacologic management of a patient who developed an organic affective syndrome during a simulated deep-diving experiment. The physiological complexities of deep-diving research are reviewed, as well as the neuropsychiatric symptoms of the high pressure nervous syndrome.
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The subcellular distribution of kainic acid (KA) binding sites in rat brain has been studied using a microcentrifugation assay. KA did not bind to myelin or brain cytosol and had few or no binding sites in the nuclear fraction. However, it bound to microsomal components (Kd = 128-136 nM; 2.5-4.8 pmol/mg protein), purified synaptic plasma membranes (SPM)(Kd = 45-71 nM; 5.8-6.5 pmol/mg), and purified cell-body and intraterminal mitochondria (Kd = 11-31 nM; 0.4-1.1 pmol/ng). Bound KA could be totally displaced by L-glutamate or L-asparate, but several putative antagonists of these amino acids (nuciferin, compound HA-966, 2-amino-4-phosphonobutyrate, and 2-amino-3-phosphonoproprionate) failed to displace KA or did so at very high concentrations (greater than or equal to 4 mM). Glutamic acid diethyl ester (GDEE) and D,L-alpha-aminoadipate (alpha-AA) were more effective (IC50, 0.2-0.8 mM) and showed differential effects in their capacity to displace KA bound to the various subcellular fractions. Thus, GDEE only displaced 40-60% of the KA bound by SPM or mitochondria and did not prevent the binding of KA to microsomes. alpha-AA, on the other hand, was more effective in preventing the binding of KA at high concentrations and displaced between 80 and 100% of the drug. Both compounds showed biphasic curves of KA displacement from synaptic plasma membranes and mitochondria. The overall results indicate the presence of multiple binding sites for KA in brain cells and suggest that KA does not act exclusively as synaptic glutamate receptors. The mechanism of KA action is most likely quite complex, and the drug probably acts at multiple binding sites affecting a number of processes.
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A colorimetric procedure for benzocaine and a number of its dosage forms was developed; it offers improvement in ease, speed, and sensitivity over the official method. The method is based on the formation of a red Schiff base between benzocaine and p-dimethylaminocinnamaldehyde in a nonaqueous acidic medium. At the maximum absorption of 544 nm, the Beer-Lambert law was adhered to over the 0.025--2.5-microgram/ml range. Best accuracy can be obtained for solutions containing 0.25--1.25 microgram/ml. The color was stable for at least 2 hr. Analysis of benzocaine in the dosage forms studied can be directly performed without prior drug extraction.
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We report a case of generalized tetanus in a 31-year-old male originating from a surgical wound after repair of an achilles tendon rupture. Our case illustrates an unusual source of tetanus, the need for tetanus prophylaxis before surgery, and the importance of asking about primary tetanus immunization, particularly in immigrants.
OBJECTIVES: To describe market forces that affect freestanding children's hospitals, to describe the development of formal business relationships among these hospitals and pediatricians and other health care delivery organizations, and to explore the impact of such changes on the roles and missions of these hospitals. METHODS: All freestanding children's hospitals in the United States in 1991 were identified (n = 44). A survey was mailed to the chief executive officer of each hospital. Data were collected for the period of 1991 through 1996. Twenty-nine of the 44 hospitals surveyed responded. RESULTS: Twenty-seven (93.1%) of the 29 hospitals reported an increase in competition and a more advanced stage of market evolution. Twenty-five hospitals (86.2%) developed at least one type of business relationship with pediatricians or another health care organization. Twenty-one (72.4%) developed a network of pediatricians. Seventeen (58.6%) developed a relationship with an adult-focused health care organization. There were no significant differences in teaching, research, or charity care activities between those respondents that developed a pediatric network and those that did not or between those respondents that integrated with adult-focused health care organization and those that did not. CONCLUSIONS: Nearly all freestanding children's hospitals developed new business relationships with physicians and other health care organizations. These new relationships were not associated with any significant changes in teaching, research, or charity care.
This article describes the use of a clinical case management team approach in the care of severely mentally ill individuals and the organization of the service. Patient characteristics and use of community services are evaluated as predictors of the use of inpatient care. Findings suggest that hospitalized clients use more community services than nonhospitalized clients and that the use of certain community services--such as medical, legal, and housing services--affects hospital use. Clients who had assistance in obtaining medical services were less likely to be hospitalized, and those needing legal and housing assistance were more likely to be hospitalized.
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