Biomedical subjects
J Grossman
Publications and source records attributed to J Grossman.
Multicenter comparison of once-daily Uniphyl tablets administered in the morning or evening with baseline twice-daily theophylline therapy in patients with nocturnal asthma.
Ninety-six patients with reversible airways disease and a history of nocturnal asthma completed a four-week open-label study that compared the effectiveness of Uniphyl tablets (The Purdue Frederick Company, Norwalk, Connecticut) administered once daily in the morning or the evening with twice-daily baseline theophylline therapy. All patients transferred easily from their previous twice-daily theophylline regimen to once-daily Uniphyl therapy. Predose serum theophylline levels and pulmonary function values were similar for the twice-daily and once-daily theophylline regimens. However, both the morning and evening once-daily Uniphyl regimens were judged by the investigators to control the asthmatic symptoms of more patients than did the prestudy twice-daily theophylline. In addition, patient acceptance of the two once-daily Uniphyl regimens was significantly (p less than 0.01) greater than that of the previous twice-daily theophylline therapy. During the fourth week of the study, the evening Uniphyl dosing schedule resulted in significantly (p less than 0.01) higher home-monitored morning peak expiratory flow rates and fewer nighttime awakenings than the pre-study twice-daily theophylline regimen. The morning regimen was not associated with such an improvement. The results of the study suggest that a once-daily evening dosage regimen with Uniphyl tablets provides greater control of nocturnal asthma.
A note on nurses' health.
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The psychiatric, alcohol, and drug algorithm: a decision model for the nurse reviewer.
Although preadmission review and concurrent review are useful tools for limiting unnecessary medical expenditures, psychiatric and chemical dependency cases are more difficult to assess than medical/surgical cases because they are described in relatively subjective terms and do not lend themselves to review by systems currently in use. The Psychiatric, Alcohol, and Drug Algorithm (PADA) is a straightforward utilization review system for these cases. PADA is organized in decision trees for each reason for admission and reason for continued stay; this system enables nurse reviewers to make recommendations on most cases without further review.
Assessment of primary health care resources in Thailand.
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Outpatient management of asthma with regular nebulized beta agonists: comparison of bitolterol mesylate and isoproterenol.
Nebulized bitolterol solution and isoproterenol solution were compared when used on a regular basis, 2.5 mg three times a day for 1 month by patients with chronic asthma. In this multicenter, double-blind trial; 130 nonsteroid-dependent patients were randomized to receive one of the two treatments concomitantly with their regular asthma medications. On study days, at the beginning of the study and after 2 and 4 weeks, treatments were given in the office or laboratory and patients were monitored with pulmonary function tests for eight hours. Both medications induced rapid bronchodilation that had a longer duration after bitolterol. The incidence of tremor was similar with the two medications. Tachycardia and palpitations were more frequent following isoproterenol. Bitolterol has a much longer duration of action and should be considered as a suitable bronchodilator for regular nebulizer treatment of chronic asthma.
Diagnostic criteria in childhood depression.
Comparison of diagnoses of childhood depression from four sets of criteria (i.e., Research Diagnostic Criteria, DSM-III, and those of Poznanski and Weinberg) used with 65 children referred to a psychiatric clinic showed complete agreement in 56 (86%) of the cases. The major disagreement resulted from differences between the clinician's rating of dysphoria based on the child's nonverbal behavior and the child's and parent's verbal report of no dysphoria. Analyses of the essential symptoms of depression among the four criteria sets indicated that the nonverbal rating was most strongly associated with a diagnosis of depression and the best predictor of the severity of depression.
Cultural change in an overdeveloped country.
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A nontoxic system for 41.8 degrees C whole-body hyperthermia: results of a Phase I study using a radiant heat device.
A Phase I study of whole-body hyperthermia (WBH) (52 treatments/12 patients) was completed with no significant clinical toxicity. The study incorporated a thermal dose escalation scheme from 39.5 degrees-41.8 degrees C for up to 151 min. A radiant-heat device was utilized for producing WBH. During WBH, patients were sedated; endotracheal intubation was not required. No changes in cardiovascular, respiratory, hematological, or biochemical indices requiring clinical intervention occurred during the study. We conclude the radiant-heat device coupled with a defined pharmacological approach to WBH with appropriate patient screening yields a system for 41.8 degrees C WBH which is safe and efficient, is not labor intensive, and does not require general anesthesia and endotracheal intubation. This system is appropriate for a multimodality approach to various systemic cancers.
Hypomania in a four-year-old.
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Plasma fibronectin concentration in animal models of sepsis and endotoxemia.
Plasma fibronectin is a nonspecific opsonin which mediates phagocytosis of particulate matter by macrophages. Fibronectin depletion results in depression of reticuloendothelial system phagocytic function. This may potentiate microvascular embolization and sludging in critical illness. It has been hypothesized that sepsis is a major cause of fibronectin depletion. To explore this hypothesis, plasma fibronectin concentrations were measured in rats with intraabdominal abscesses and in rabbits subjected to the generalized Shwartzman reaction (spaced doses of endotoxin). In both groups of animals there was a significant increase (P less than 0.05) rather than decrease in fibronectin concentrations at times when sepsis and disseminated intravascular coagulation were manifest. This study does not support the hypothesized relationship between sepsis and fibronectin depletion. Until the kinetics of fibronectin production and utilization are further delineated, caution must be exercised in the interpretation of immunoreactive plasma fibronectin levels.
Preclinical trial of a radiant heat device for whole-body hyperthermia using a porcine model.
After review of the published clinical experience with systemic hypothermia, we concluded that a simple system which controls radiant heat balance to supplement metabolic heat might provide several advantages, including: (a) decreased morbidity; (b) elimination of the requirement for general anesthesia; (c) improved patient comfort; (d) favorable cost-benefit considerations. We have tested a prototype radiant heat device for whole-body hyperthermia (WBH) in patients with disseminated cancer. From preclinical evaluation of this device, the lightly anesthetized pig was found to be an ideal model for WBH. This species has physiological characteristics closely resembling those of humans. The pig's core, pulmonary artery, liver, rectal, and esophageal temperatures were raised to 41.8 degrees in 80 to 90 min. The air temperatures near the chamber wall never exceeded 65 degrees while the air temperature adjacent to the animal was 46 degrees. Skin temperatures were approximately 42.5 degrees at a core temperature of 41.8 degrees. Once the core temperature is raised to 41.8 degrees, this temperature is maintainable for approximately 3.5 hr without additional external heating if evaporative losses are controlled. Prolonged WBH was accomplished with light sedation and without the requirement for endotracheal intubation. No significant acute toxicity was encountered in a series of 6 pigs undergoing 9 separate exposures to WBH. From these results, we conclude that our radiant heat apparatus is feasible for clinical trials. Additionally, the use of the pig as an appropriate animal model for further physiological and pharmacological WBH studies is strongly recommended.
Lung injury and lung lysosomal enzyme release during endotoxemia.
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Comparison of the systemic and pulmonary vascular response to endotoxin with plasma and lung lymph lysosomal enzyme release: effect of steroid pretreatment.
We wanted to compare the systemic and pulmonary vascular response to Escherichia coli endotoxin with changes in lysosomal enzyme activity in plasma and lung lymph in the unanesthetized sheep with a lung lymph fistula. We wanted to determine whether lysosomal enzyme activity (LE) was a reliable marker of injury and LE increase appears to be different for the two systems.
[Usefulness of test cards in the evaluation of results in the treatment of spinal injuries].
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Fair Labor Standards Act of 1938: maximum struggle for a minimum wage.
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