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Biomedical subjects

J C Ware

Publications and source records attributed to J C Ware.

At least 37 records · Page 2Linked to original sources
PubMed1990

Estazolam and flurazepam: a multicenter, placebo-controlled comparative study in outpatients with insomnia.

A multicenter, double-blind placebo-controlled clinical trial was designed to compare the safety and efficacy of estazolam compared with flurazepam as hypnotics. Outpatients complaining of insomnia were randomized to receive either estazolam 2 mg, flurazepam 30 mg or placebo for 7 consecutive nights. The analysis of efficacy was based on the patients' daily assessments of sleep and the investigators' global evaluations. Adverse events which were considered by the investigator to be attributable to, or of unknown relationship to the test medication were analyzed. The patient subjective questionnaire indicated that estazolam and flurazepam significantly improved all parameters (P less than .05) as compared to placebo. A marked or moderate improvement in sleep was reported by 81% (58/72), 78% (63/81) and 36% (27/76) of estazolam, flurazepam, and placebo recipients, respectively. There were no significant differences in hypnotic effect between estazolam and flurazepam. All efficacy parameters of the investigators' global evaluation improved significantly more (P less than .05) for patients receiving estazolam or flurazepam (except quality of sleep) than for those receiving placebo. The percentage of patients reporting any adverse experience was greatest for flurazepam (72%), followed by estazolam (59%), and placebo (43%). Somnolence and hypokinesia were the most commonly reported adverse events. An analysis of the global evaluation of side effects showed that flurazepam had a significantly worse side effect profile than estazolam (P less than .05) or placebo (P = .001). Estazolam and flurazepam effectively, and comparably, relieved insomnia when administered for 7 nights in adult patients complaining of insomnia. Estazolam demonstrated a more favorable side effect profile than flurazepam.

Ambulatory Care↗
PubMed1990

Increased deep sleep after trazodone use: a double-blind placebo-controlled study in healthy young adults.

The effects of trazodone on sleep were compared with those of placebo and the sedating tricyclic antidepressant trimipramine in a double-blind crossover study in six healthy young men. Only trazodone significantly increased deep sleep without otherwise altering the normal architecture of sleep. The alpha-adrenergic receptor-blocking property of trazodone and a relative lack of noradrenergic reuptake blocking and the lack of anticholinergic effects are hypothesized to be responsible for the effects on sleep.

Adolescent↗
PubMed1989

Effects of clomiphene citrate on episodic luteinizing hormone secretion throughout the menstrual cycle.

Pituitary luteinizing hormone secretory dynamics (pulse frequency and amplitude) were evaluated in eight normal women administered clomiphene citrate or placebo. After 5 days of treatment clomiphene citrate was found to increase mean luteinizing hormone secretion by increasing the amount of pituitary luteinizing hormone released per pulse. No change in pituitary luteinizing hormone interpulse interval was found in the follicular phase of the cycle, although a faster pulse frequency in the luteal phase was found after clomiphene citrate when compared with placebo. No differences were found in the luteal phase (pulse frequency, amplitude, and mean luteinizing hormone level) after clomiphene citrate versus placebo in the volunteers. These data suggest that the principal mechanism of action of clomiphene citrate is an increase in the concentration of hypothalamic gonadotropin releasing hormone into the hypothalamic-pituitary portal circulation, with a resultant increase in pituitary luteinizing hormone secretion.

Adult↗
PubMed1989

Effects on sleep: a double-blind study comparing trimipramine to imipramine in depressed insomniac patients.

Trimipramine, a sedating tricyclic antidepressant, and imipramine were compared on polysomnographic parameters during a 4-week double-blind trial in depressed patients with insomnia and anxiety. Trimipramine eliminated objective evidence of sleep disturbance. This was not the case with imipramine, although depression improved similarly in both groups. Subjects' sleep appeared unchanged or more disturbed at the end of the treatment with imipramine. For trimipramine, the major changes in sleep parameters occurred during the first week of drug administration and did not parallel the gradual changes seen in the measures of depression. Additionally, trimipramine did not suppress REM sleep even in a subgroup of six trimipramine patients who had short rapid-eye-movement (REM) sleep latencies during the placebo baseline period, even though their depression was alleviated. The data demonstrate that (a) antidepressants may vary in their effects on sleep, even though they have similar effects on depression; (b) REM sleep suppression does not necessarily accompany improvement in depression; and (c) reports of improved sleep by patients undergoing antidepressant therapy may not reflect improvement on objective measures of sleep. The different sleep effects suggest the possibility of different antidepressant pathways.

Adolescent↗
PubMed1989

Impotence and aging.

Taking into account the normal changes that occur with aging and the large number of pathologies, pharmacologic agents, and social situations that the elderly are subject to, it is perhaps more surprising that 25 per cent of those over 80 years of age do report normal sexual functioning. Loss of erectile capability appears to be multifactorial in many patients, although the exact degree is uncertain due to unsystematic assessment in the majority of current studies. Unfortunately, impotence is often ignored by the patients' physicians. Physicians do not routinely ask about erectile functioning in their patients, perhaps because they do not know how to systematically evaluate and treat the complaint. Any follow through that might result from a complaint is often chaotic. And, rarely are treatment possibilities systematically and clearly presented to the patient. This is particularly true for the elderly patients whose physicians may be surprised that an elderly patient would still be interested in sexual behavior. No matter how subtle, this "dirty old man" response by the physician does not foster a good therapeutic environment. Inappropriate and unsystematic evaluations of impotent patients leads to a literature replete with contradictory statements. Because of the prevalence of impotence in the elderly, as a group they are hurt the most by unsystematic evaluation techniques and therefore have the most to gain from the application of systematic evaluation and treatment procedures.

Adult↗
PubMed1988

Destructive bruxism: sleep stage relationship.

Despite apparent similar amounts of bruxism, two groups that had been evaluated polysomnographically differed dramatically in symptomatology. Patients with severe symptoms were referred to as the destructive bruxism group and were compared with (a) a group with sleep disturbance complaints who had bruxism and (b) a group of insomniac depressed patients chosen without regard to bruxism. It was hypothesized that not only the presence of bruxism during sleep but its pattern and sleep stage relationship were factors affecting clinical symptoms. The results indicated that the sleep stage relationship was an important factor. Patients with severe symptoms attributed to nocturnal bruxism were likely to have more bruxism in REM sleep than the other groups. These results if replicated prospectively would help explain some of the discrepancies in the literature concerning sleep stage relationship of bruxism, as well as help explain differences in symptomatology of bruxism patients.

Adult↗
PubMed1988

Peripheral vasoconstriction in patients with sleep related periodic leg movements.

Two patients complaining of insomnia had sleep-related periodic leg movements (nocturnal myoclonus) on polysomnographic evaluation. Both also complained of cold feet and had abnormal peripheral pulse examinations. Treatment with phenoxybenzamine, alpha-adrenergic blocker, normalized the peripheral pulse responses, reduced the complaint of insomnia, and reduced the sleep related leg movements but resulted in only mild sleep improvements. Peripheral pulse examinations of ten other patients with sleep-related periodic leg movements revealed abnormal responses in four. From these and other results, it is hypothesized that the sympathetic nervous system may mediate the periodicity of sleep related periodic leg movements.

Adrenergic alpha-Antagonists↗
PubMed1986

Noninvasive device to produce and maintain an erection-like state.

In 35 men with organic impotence we have tested a noninvasive device which uses a vacuum to produce an erection-like state and rubber bands to maintain this state. The subjects were first evaluated to determine the cause of their impotence and to establish that it had an organic basis. Using this device 32 of the 35 subjects achieved penile rigidity sufficient for vaginal penetration. Subjects were studied with the rubber bands constricting the base of the penis for thirty minutes. During that period, blood flow continued, but at a less than normal rate. Of 30 men followed up from eight to twenty-two months, 24 use the device regularly and report that they are satisfied. Four subjects have not yet tried to use it, and 1 no longer needs it. One man was dissatisfied because the rigidity begins to decrease after five to ten minutes of sexual activity, even though it did not change over a thirty-minute period when originally tested in the laboratory. Ecchymoses of the penis, probably due to excess vacuum, developed in 3 subjects. In 8 other men petechiae of the skin of the penis developed on one or more occasions. These ecchymoses and petechiae were painless and disappeared without treatment. No other complications occurred. The vacuum device appears to be a safe and inexpensive way for an impotent man to make the penis rigid enough to engage in sexual intercourse.

Aged↗
PubMed1985

The natural history of streptococcal skin infection: prevention with topical antibiotics.

An investigation on the natural history of streptococcal skin infection was done in fifty-nine children in a rural day care setting. A double-blind study for prevention of streptococcal pyoderma was done during the peak season for skin infection. Triple antibiotic ointment, containing bacitracin, polysporin, and neomycin, was compared to placebo ointment. Ointments were applied thrice daily for minor skin trauma; mosquito bites and abrasions were predominant. Cultures of normal skin surfaces were taken for group A streptococci each week of the 15-week study period. Skin lesions were cultured whenever present. Eighty-one percent of the fifty-nine patients had positive normal skin cultures on one or more occasions. Nineteen children (32%) developed streptococcal pyoderma. Infection occurred significantly more often in children using placebo ointment than in those using topical antibiotic (47% vs 15%; p = 0.01). The infecting strain was first recovered from normal skin surfaces in 67% of placebo patients and in two of the four patients using antibiotic ointment. This study further confirms the importance of skin carriage of group A streptococci as a precursor to pyoderma and demonstrates the importance of minor skin trauma as a predisposing factor. Topical antibiotics may be useful in preventing streptococcal pyoderma, especially in children known to be at increased risk for such infection.

Administration, Topical↗
PubMed1984

Sleep-related electrodermal activity patterns in impotent patients.

The etiology of erectile failure is not always clear despite the fact that recordings of nocturnal penile tumescence (NPT) are used to detect patients with a significant organic component to their complaint. We recorded electrodermal activity in addition to NPT in 60 impotent patients. Normally more electrodermal activity occurs in stage 2 than in stage REM sleep. Despite a similar total amount of electrodermal activity, organically impotent patients tended to have less electrodermal activity in stage 2 and more in stage REM sleep than those with normal NPT. This difference was due to a subgroup of 15 organically impotent patients with less electrodermal activity in stage 2 than in stage REM sleep. Because of this difference in the pattern of electrodermal activity in relation to sleep stages, the results suggest a central nervous system change is related to impaired erectile capability and abnormal NPT in these cases.

Adult↗
PubMed1983

Tricyclic antidepressants in the treatment of insomnia.

The use of tricyclic antidepressants as opposed to hypnotics in treating insomnia is reviewed. Available data indicate that TCAs alleviate sleep disturbances related to depression (often before antidepressant effects are seen) and, in selected cases, may prove effective in disturbed sleep related to sleep apnea, fibrositis, and sleep related bruxism, as well as in adults with childhood onset insomnia or a history of hyperkinesis. However, TCAs share many of the problems reported for hypnotics, as well as having some potentially serious side effects not present with benzodiazepines. The need for determination of the etiology of sleep disorders, and specific pharmacotherapy directed toward identified causes rather than the symptom of insomnia, is stressed.

Adult↗
PubMed1981

Sources and susceptibilities of staphylococci isolated from children. A seven-year survey.

A seven-year surveillance was done of the antibiotic susceptibility of Staphylococcus aureus isolated from patients seen in The Children's Hospital, Birmingham, Ala. There were no outbreaks of hospital-acquired staphylococcal infection during this time. Of 5,479 strains, 2,685 were from hospitalized children; 2,794 of 5,479 were from outpatients. The incidence of penicillin resistance increased from 76% to more than 85% between 1973 and 1979, with no significant difference noted between inpatient and outpatient strains. Penicillin resistance was similar, regardless of the clinical source (site of isolation) of staphylococci. Skin lesions, soft tissue, wounds, and abscess perennially accounted for the greatest proportion of isolates. Thus, skin lesions represent an important reservoir for penicillin-resistant staphylococci. Nearly all strains were susceptible to the other antibiotics tested; multiple resistance was rare. Susceptibility to clindamycin, erythromycin, cephalothin, sodium, and nafcillin sodium remained stable through the years. These agents provide effective therapeutic regimens for patients with staphylococcal infection, including those with penicillin allergy.

Anti-Bacterial Agents↗
PubMed1981

Differentiating psychological characteristics of patients with sleep apnea and narcolepsy.

Fifty male subjects were group-matched for age and socioeconomic status. Twenty of the subjects were diagnosed as having sleep apnea and 20 were diagnosed as having narcolepsy on the basis of sleep studies. The remaining 10 subjects served as normal controls. Differences among the groups were evaluated on the bases of two psychological instruments designed to assess personality characteristics and mood states. The findings suggest that narcoleptics and apneics both present discriminatively different psychological profiles than do normals. Moreover, personality characteristics of these two groups are distinguishable from one another. Apneics tend to be individuals with hypochondriacal and hysterical characteristics, whereas narcoleptics are more easily characterized by anxiety and social introversion. Both severity of psychological disturbance (mean Minnesota Multiphasic Personality Inventory elevations) and personality pattern (two-point codes) distinguish the groups. Key Words: Sleep apnea-Narcolepsy-Psychological profiles.

Affect↗
PubMed1979

Clinical and laboratory studies with cefaclor: efficacy in skin and soft tissue infections.

Clinically relevant, recent isolates of common Gram-positive pathogens were examined for their in vitro susceptibility to cefaclor. Group A streptococci and pneumococci were uniformly sensitive (MICs 0.06--0.12 micrograms/ml) to both cefaclor and cephalothin. Cefaclor was 5--10-fold less active than cephalothin against group B streptococci. S. aureus strains were uniformly more susceptible to cephalothin than to cefaclor, but among isolates from children, almost all were sensitive to the latter drug. In clinical studies of patients with skin and soft tissue infections, cefaclor proved effective. Over 90% of patients with staphylococcal bullous impetigo, streptococcal and mixed streptococcal-staphylococcal forms of pyoderma were cleared after 7--10 day courses of treatment. In addition, twice-daily therapy, examined more recently, proved as effective in these forms of infection as did the conventional dose schedule. No significant adverse reactions were noted. Cefaclor appears to be an effective orally absorbed cephalosporin for common skin and soft tissue infections.

Adolescent↗
PubMed1978

Impotence and blood pressure in the flaccid penis: relationship to nocturnal penile tumescence.

Evaluations of nocturnal penile tumescence (NPT) and penile blood pressure were performed on (1) a group of nondiabetics with normal NPT, (2) a group of nondiabetics with abnormally diminished NPT, and (3) a group of diabetics with abnormally diminished NPT. The 12 subjects in each group complained of impotence. Analysis of blood pressure data taken before the NPT evaluation suggests the possibility of selective low arterial blood pressure in impotent patients who show no obvious signs of other vascular disorders.

Blood Pressure↗
PubMed1978

Nocturnal penile tumescence and diagnosis in diabetic impotence.

The authors conducted a study of nocturnal penile tumescence (NPT) in 35 diabetic men, aged 33 to 70, who complained of impotence and in 35 age-matched control subjects. EEGs and other measurements showed that the diabetic men as a group exhibited significant reductions in the total amount of NPT and in the amount and frequency of full erection, thus suggesting that impotence in this cohort was organogenic. Although NPT monitoring represents an advance over the less precise traditional procedures for the differential diagnosis of impotence, the authors stress the need for more research in this area.

Adult↗