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Biomedical subjects

H Clark

Publications and source records attributed to H Clark.

At least 37 records · Page 2Linked to original sources
PubMed1985

Imipramine poisoning in a child: lack of efficacy of resin hemoperfusion.

A three-year-old boy ingested up to 1,500 mg of the tricyclic antidepressant imipramine (Tofranil). He entered our facility within two hours of discovery, and multiple resuscitative efforts, which proved unsuccessful, followed. Resin hemoperfusion was used in an effort to remove imipramine from the systemic circulation. Serum concentrations of imipramine and its major metabolite desipramine were determined from serum drawn before, during, and after hemoperfusion. Serum concentrations of imipramine and desipramine did not change appreciably. No improvement in the clinical condition was noted during the hemoperfusion period, which was due in part to the fact that our patient was clinically brain dead upon arrival in our intensive care unit. Our subsequent literature review documents that this case represents the first reported use of hemoperfusion in a pediatric tricyclic antidepressant ingestion, hemoperfusion removes an insignificant portion of the total amount of tricyclic antidepressant ingested, and some pediatric literature misleadingly suggests that hemoperfusion may be useful in such patients. Physicians treating tricyclic antidepressant ingestion cases should avoid using hemoperfusion; standard supportive care remains the essential management response.

Child, Preschool↗
PubMed1985

Humoral immune response to herpes simplex virus type 2 glycoproteins in patients receiving a glycoprotein subunit vaccine.

Serial serum specimens from 22 herpes simplex virus (HSV)-seronegative recipients of an HSV type 2 (HSV-2) glycoprotein subunit vaccine were analyzed by radioimmunoprecipitation and polyacrylamide gel electrophoresis for the development of antibodies to HSV-2 gB, gD, and g80, a complex of gC and gE. Volunteers received 50 (n = 12) or 100 micrograms (n = 10) of vaccine at days 0, 28, and 140; sera were drawn weekly for 8 weeks and again at days 140, 147, and 365. Among seronegative volunteers, antibody to gB was detected 2 weeks after the first dose, while antibodies to g80 and gD were detected after the second dose (day 35). Antibodies to nonglycosylated HSV-specific proteins were not detected. A dose-response effect between recipients of 50- and 100-micrograms doses was observed in the proportion of vaccine recipients seroconverting to g80 and in the proportion of recipients retaining antibodies to both gD and g80 over time. Diminishing complement-independent neutralizing antibody titers occurred after the second dose and were associated with loss or reduction of detectable antibody to gD. Volunteers who were seropositive for HSV-1-specific antibody (n = 11) were also enrolled in the trial and received 50-micrograms doses of vaccine. Vaccination resulted in conversion to HSV-2 complement-independent neutralizing antibody specificity or indeterminant specificity in 10 of 11 volunteers. These shifts were accompanied by changes in the radioimmunoprecipitation and polyacrylamide gel electrophoresis profile. These changes, which were apparent by 14 days after the first vaccine dose, included de novo appearance or increased levels of antibody to g80 and increased levels of antibody to gD and gB. These studies document the immunogenicity of solubilized glycoproteins gB, gD, gC, and, possibly, gE in humans.

Antibodies, Viral↗
PubMed1981

Restructuring an internal medicine residency program to meet regional and national needs for general internists.

The Department of Medicine at the University of Washington has reorganized its residency program to increase the emphasis on general internal medicine and primary care. New teaching services in community hospitals have been established, clinical training sites in Montana, Idaho and Eastern Washington opened, and primary care residency tracks begun. Current data indicate that a major shift in the career plans of our new residents also has occurred. Whereas a decade ago approximately two thirds of our residents were becoming subspecialists, almost two thirds of our 1979 and 1980 program graduates are headed towards careers as general internists. Many will practice in the region's smaller cities and towns. The program serves as a model for the development of a regional program for graduate training in internal medicine.

Academic Medical Centers↗
PubMed1981

A comparison of patient drug regimens as viewed by the physician, pharmacist and patient.

This study sought to determine the completeness and congruence of records for drugs ordered and received by outpatients. The setting was a large outpatient medical facility that was part of a large multispecialty hospital. It was found that a listing of current drugs orders (prepared by physicians) and a listing of current prescription drugs consumed (prepared from pharmacy drug profiles) each agreed 73 per cent of the time with a list of 107 prescription drugs actually consumed by 26 study patients. Lists were compared based on drug name, strength and directions for use. Further, the physician and pharmacy lists correlated with one another 70 per cent of the time, indicating a substantial degree of inconsistent as well as incomplete drug records within the same setting. In another comparison involving medical chart drug notations and pharmacy drug profiles, a complete match or drug name, strength and directions for use occurred in 39 per cent of the cases, while a match on drug name only occurred 64 per cent of the time. The highest degree of congruence occurred between hospital discharge medication notes and outpatient drug profile records. Based on the results of this study, the common assumption that drug records in such settings are congruent and complete appears unwarranted.

Drug Information Services↗
PubMed1978

Contribution of maternal circulation to blood-borne progesterone in the fetus. I. Studies on human subjects.

Tritiated progesterone was infused intravenously at a constant rate into three pregnant volunteers in labor, for at least two hours before delivery. Blood samples from a maternal peripheral vein and from unbilical vessels were taken at birth. Comparison of the specific activities of progesterone in these samples indicated that 10 per cent or less of the hormone in fetal circulation is derived from transfer of maternally circulating progesterone. After consideration of reported values of umbilical vein blood flow at term and measured arteriovenous differences in concentrations of progesterone in umbilical vessels, the secretion rate of the placental hormone toward the fetus was estimated to be about 1/10 of the rate of secretion of progesterone toward the maternal circulation. About 1 per cent of the maternally circulating hormone was found to cross the placenta.

Female↗
PubMed1973

Amoxicillin, a new penicillin antibiotic.

Amoxicillin (alpha-amino-p-hydroxybenzyl penicillin, BRL 2333) is a new semisynthetic penicillin which is structurally similar to ampicillin, but which is better absorbed and yields higher concentrations in serum and urine. The in vitro susceptibility of 145 strains of Enterobacteriaceae and 30 isolates of Pseudomonas aeruginosa was determined against various concentrations of amoxicillin and ampicillin in agar. In addition, inhibitory zones around discs containing 10 mug of amoxicillin were measured and compared with results of agar dilution studies. The drug also was evaluated in the treatment of 38 patients with bacteriuria, who received doses of either 750 mg or 1 g/day for 10 days. In vitro, amoxicillin was comparable in activity to ampicillin; most isolates of Escherichia coli and Proteus mirabilis were inhibited by 10 mug or less/ml, whereas the majority of strains of Enterobacter, Klebsiella, indole-positive Proteus species, and Pseudomonas grew in concentrations greater than 50 mug/ml. Clinically, amoxicillin was effective in eradicating bacteriuria due to susceptible organisms and was very well tolerated. For practical purposes, however, amoxicillin performed no better than a host of other drugs presently available for the treatment of acute, uncomplicated bacteriuria.

Amines↗
PubMed1971

Failure of urinary beta-glucuronidase activity to localize the site of urinary tract infection.

The differentiation of renal from bladder bacteriuria is difficult on clinical grounds alone. To evaluate the correlation between site of infection and urinary beta-glucuronidase activity, 46 patients with well documented recurrent bacteriuria were studied by bilateral ureteral catheterization. Urinary beta-glucuronidase activity was also determined in 46 control subjects. In general, asymptomatic patients with renal bacteriuria, either unilateral or bilateral, had levels of enzyme activity in their urine comparable to patients with infection confined to the bladder and to normals. Only 4 of 25 patients with renal bacteriuria had significant elevations of urinary beta-glucuronidase. After localization of infection, 9 of 10 patients treated with kanamycin, a potentially nephrotoxic drug, developed significant elevations of urinary beta-glucuronidase. The results of these studies indicate that determination of beta-glucuronidase activity in urine is not useful in predicting the site of infection in patients with bacteriuria but may find a role in screening for early nephrotoxicity.

Bacteriuria↗