Biomedical subjects
L Burnham
Publications and source records attributed to L Burnham.
Amitriptyline plasma protein binding: effect of plasma pH and relevance to clinical overdose.
Reversing ventricular ectopy with plasma alkalinization following acute tricyclic antidepressant overdose is a recognized mode of therapy. The mechanism responsible for this effect is unclear. Changes in plasma protein binding of free drug, effects of the sodium ion on the myocardium, and alterations of plasma concentrations of alpha-1-acid glycoprotein may all interact to alter toxicity of tricyclics in overdose. An in vitro investigation using equilibrium dialysis was designed to examine the effect of altering plasma pH on percentage of free amitriptyline at clinical overdose plasma concentrations. A 1973 report on this effect lacked adequate controls and was faulty in experimental protocol. The current investigation used plasma concentrations typically present in amitriptyline overdose, a sensitive gas liquid chromatographic assay to detect total and free drug, and adequate control of plasma pH. The results of two separate experiments demonstrated a significant decrease in percentage of free amitriptyline of 20% over a pH range of 7.0-7.4 (P less than 0.05) and 42% over a pH range of 7.4-7.8 (P less than 0.05). The rate of change in slope in both experiments was not significantly different (P less than 0.01) indicating similar effects of pH change on plasma protein binding of amitriptyline within the two groups.
The high-level tetraplegic: psychological survival and adjustment.
From the date of injury tetraplegics with spinal cord lesions of C4 and above are faced with unparalleled social and psychological adjustment. The individual will be involved in a process of re-establishing his identity by learning to develop and adapt his only remaining resources, his mind and his ability to communicate. This patient population is absolutely dependent in all aspects of meeting basic needs during the initial stages of the injury. If we attempt to return the patient to an active role in society, the rehabilitation team must be aware of the dynamics by which the patient achieves control of both himself and his environment. He will undergo a marked regression of his physical and emotional being and will face the turmoil of realigning ego parameters. The focal point of patient, family and staff interaction is the months of rehabilitation, where the team deals with the problem of social reintegration. Family involvement is essential from the beginning and reaches a high point at discharge and home planning. The scope of the paper will be to trace the psycho-social development of the patient with cervical lesion of C4 and above through the initial, rehabilitation and discharge phases of the injury. Our aim is to develop sufficient insight to the problems facing our patient population that we may aid in their search for meaningful lives.