Patient preferences and the bedside manner.
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Biomedical subjects
Publications and source records attributed to J A Thompson.
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Chemical and dermatotoxicological investigations of the natural and processed resin of the Mexican rubber plant, guayule (Parthenium argentatum), has established the presence of a sesquiterpene cinnamic acid ester (guayulin A) that is a potent elicitor of allergic contact dermatitis in experimental animals. The guayule contact allergen is comparable to the poison ivy skin allergens as an elicitor of dermatitis in sensitized guinea pigs.
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The disposition of chlorpheniramine was examined in seven children, 6-14 years of age, following a 0.1 mg/kg iv dose. Postinjection serum chlorpheniramine levels in each subject declined biexponentially, with the greatest intersubject variability occurring in the initial distribution of the drug. The volume of distribution at steady state ranged from 1.20 to 5.46 liters/kg. The chlorpheniramine serum clearance varied approximately twofold (234-470 ml/hr/kg) and generally decreased with age. The chlorpheniramine elimination half-life in children (mean of 9.6 hr) appeared shorter than that in adults, probably due to higher chlorpheniramine serum clearance in children.
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A young adult female patient, on prolonged corticosteroid therapy for nephrotic syndrome, developed erythema multiforme and toxic epidermal necrolysis following a double exposure to a locally applied perfume. We believe that this route of exposure should be re-emphasized. Toxic epidermal necrolysis, or the scalded skin syndrome, has become a well-recognized entity which may be divided into three distinct subgroups: the staphylococcal scalded skin syndrome, nonstaphylococcal or drug-induced scalded skin syndrome, and idiopathic. We present a patient who developed a dermatitis on her chest and abdomen after using a spray cologne, which resulted in the development of erythema multiforme with progression toxic epidermal necrolysis and, ultimately, her death.
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A new method was developed for the quantitative analysis of chlorpheniramine in serum using the high sensitivity and selectivity of GLC-mass spectrometry with selected-ion monitoring. Intense fragment ions at m/e 203 and 207 from the drug and a tetradeuterated analog, respectively, are monitored continuously. The deuterated quantitation standard can be prepared by a simple exchange reaction. A linear calibration curve was obtained over the range of 0-160 ng/ml of serum using 85 ng of the standard/ml. The sensitivity limit is 1-2 ng/ml, and each serum extract can be analyzed in less than 2 min. The method was applied to a measure chlorpheniramine concentrations through at least 1.5 biological half-lives.
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Estrogen receptor has been used in determining the efficacy of endocrine therapy in mammary tumors. Complete study of a tumor usually requires two procedures, a dextran-coated charcoal method for measuring binding capacity and binding affinity and a sucrose density procedure for confirmation of 8S protein, both of which are time consuming and expensive. A stability study of the 8S and 4S molecular forms in frozen cytosols at 24 hours, 48 hours, and one week was conducted. Some loss of these, forms after storage was evident, but in all cytosols studied, the two distinct forms could still be identified. Using a group of 100 tumor samples analyzed by both methods, practical criteria for determining when the 8S molecular form should be confirmed by a sucrose density gradient on the frozen cytosol have been formulated.
A variant creatine kinase (CK) isoenzyme was identified in the sera of some patients who had advanced adenocarcinoma of the breast, stomach, and large intestine. A similar variant isoenzyme, together with a high concentration of CK-BB isoenzyme, was identified in some breast tumor cytosols. The variant creatine kinase activity in both sera and tumor cytosols was unaffected by antibodies specific for both the CK-M and DK-B subunits. This indicates that DK-MB isoenzyme determinations are currently best performed by electrophoretic rather than immunologic technics.
In 8 of 23 infants with congenital central nervous system (CNS) anomalies, we observed an increased cell-mediated immune (CMI) response (lymphocyte blastogenesis) to one of six simultaneously tested viral antigens, without detection of concomitant elevation in humoral antibody to that virus. These data suggest possible intrauterine viral exposure in a significant number of anomalous infants and a possible role of that exposure in the pathogenesis of congenital CNS anomalies. The CMI response may offer another approach to the identification of etiologic agents of a significant number of birth defects.
Six female chronic spinal dogs were administered N-allylnormetazocine (NANM) chronically by the intravenous route starting at 0.3 mg/kg/day. The dose was escalated to a stabilization dose of 10 mg/kg/day. The dogs became tolerant to NANM's ability to produce canine delirium and its anorexigenic and respiratory stimulant effects. Naltrexone increased the amplitude of the flexor reflex and pulse rate in the body temperature, pupillary constriction, bradycardia and tachypnea. Appetite was decreased and weight was lost. These data indicate that chronic administration of NANM produces tolerance and a unique type of physical dependence. Some changes produced by chronically administered NANM were naltrexone antagonizable, others were not suggesting that NANM may have several mechanisms of action.