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Biomedical subjects

M A Kramer

Publications and source records attributed to M A Kramer.

At least 19 recordsLinked to original sources
PubMed1995

The effects of MK801 on place conditioning.

The appetitive properties of MK801 were investigated using the conditioned place preference paradigm. Male Sprague-Dawley rats received conditioned place preference training for a four-day period. The conditioning box consisted of three chambers with distinctive visual and tactile cues, separated by removable doors. On alternating days rats received MK801 (0.05, 0.1, 0.25, 0.5 and 0.75 mg/kg) paired with one side of the chamber and saline paired with the other side. On the fifth day, rats were placed in the center chamber and the time spent in each chamber, as well as entries into each chamber were recorded by a trained observer. MK801 produced a conditioned place preference for side paired with drug for the four highest doses. Contrary to previous findings, these results indicate that MK801 is appetitive at doses higher than has previously been assumed.

Animals↗
PubMed1994

A prospective randomized study of acyclovir versus ganciclovir plus human immune globulin prophylaxis of cytomegalovirus infection after solid organ transplantation.

Cytomegalovirus disease occurs frequently after solid organ transplantation and has been associated with decreased patient and allograft survival. We hypothesized that CMV transmission or reactivation begins immediately or soon after transplantation, and that a short-duration ganciclovir (GCV)-based regimen would obviate the need for long-term antiviral agent administration, perhaps serving to interdict CMV infection and disease as well as, or perhaps even more effectively than, a more prolonged, oral acyclovir (ACV)-based form of prophylaxis. A total of 311 patients were stratified according to allograft type, age, and presence or absence or diabetes mellitus, and were then randomized to receive either long-duration ACV prophylaxis (800 mg orally or 400 mg i.v. q.i.d. for 12 weeks after transplantation or 6 weeks after any antirejection therapy) versus short-duration GCV (5 mg/kg/12 hr i.v. for 7 days after transplant or after any antirejection therapy) plus human immune globulin (HIg; Sandoglobulin or Minnesota CMV immune globulin) 100 mg/kg i.v. administered on days 1, 4, and 7 after transplant or after any antirejection therapy. A total of 266 patients (ACV, n = 133; GCV+HIg, n = 133) completed the protocol and were available for follow-up. CMV disease occurred in fewer patients (n = 28, 21.0%) in the ACV group, while significantly more patients (n = 42, 31.6%) in the GCV + HIg group developed group developed CMV disease slightly later (2.83 +/- 0.70 months) than those who received GCV/HIg (2.15 +/- 0.21 months, P > 0.01). Multivariate analysis demonstrated (2.15 +/- 0.21 months, P > 0.1). Multivariate analysis demonstrated that receiving antirejection therapy, a liver transplant, or a donor organ from a CMV-seropositive individual if the recipient was CMV seronegative were major risk factors for the development of CMV disease (P < 0.001), while the difference between ACV versus GCV + HIg prophylaxis was also significant (P = 0.054). No differences in actuarial patient or allograft survival, however, were noted between the 2 prophylaxis groups. Overall, ACV prophylaxis appeared to be more effective in reducing the incidence of posttransplant CMV disease, although this effect was diminished in high-risk groups of patients. Our findings indicate that CMV transmission or reactivation may best be prevented by long-term antiviral agent administration, and that the primary morbidity of CMV disease is the need for rehospitalization when either prolonged ACV or short-duration GCV + HIg prophylaxis is used in this patient population.

Acyclovir↗
PubMed1993

Treatment of recurrent cytomegalovirus disease in patients receiving solid organ transplants.

Tissue-invasive cytomegalovirus (TI-CMV) disease occurs commonly after solid organ transplantation and has been associated with increased allograft loss and patient mortality. Although ganciclovir has been demonstrated to be an effective form of treatment for TI-CMV disease, therapy may be followed by recurrence. The purpose of this study was to determine the impact of recurrent TI-CMV disease on patient and allograft survival. We studied 619 patients who underwent solid organ transplantation (535 kidney transplants [253 from living related donors and 282 from cadavers] and 84 combined cadaveric kidney-pancreas transplants) during a 3 1/2-year period. One hundred fourteen patients (18.4%) developed TI-CMV disease and were treated with a standardized regimen of intravenous ganciclovir for 14 to 21 days. Of the 114 patients in whom primary TI-CMV disease developed, 28 (24.6%) developed recurrent TI-CMV disease more than 30 days after the initial episode, and these patients were retreated with ganciclovir. Cure rates at 30 days were 98.9% in patients with primary TI-CMV disease and 100% in patients with recurrent TI-CMV disease. Patients who underwent cadaveric kidney or kidney-pancreas transplantation were more likely to develop recurrent TI-CMV disease than were recipients of kidney transplants from living related donors; antirejection therapy also was associated with a higher incidence of recurrent TI-CMV disease. Patients who developed TI-CMV disease exhibited lower rates of graft and patient survival at 3 years than patients without TI-CMV disease or with solely asymptomatic CMV infection, although recurrent TI-CMV disease did not appear to exacerbate morbidity or mortality. We conclude that recurrent episodes of TI-CMV disease do not appear to further adversely affect patient or graft survival in comparison with primary TI-CMV disease in ganciclovir-treated patients.

Acyclovir↗
PubMed1993

Pain management with intravenous ketorolac.

OBJECTIVE: To report a case in which intravenous ketorolac was used successfully on a chronic basis to treat cancer pain. DATA SOURCES: Clinical and compatibility studies obtained through a computer literature search. STUDY SELECTION: We identified five reports that specifically addressed intravenous dosing of ketorolac. DATA SYNTHESIS: A 41-year-old man received pain relief from intravenous injections of ketorolac for 11 months. As far as we know, there are no other reports in the literature in which intravenous ketorolac has been used on a chronic basis. CONCLUSIONS: Experience at our institution indicates that intravenous ketorolac is a useful, well-tolerated nonsteroidal antiinflammatory drug that should be investigated further for use in selected pain models.

Adenocarcinoma↗
PubMed1992

Obsessive-compulsive disorder.

Obsessive-compulsive disorder is a well-defined clinical syndrome that has been difficult to treat with standard psychotherapies and medications. Data accumulated over the last decade have demonstrated that the disorder is relatively common and frequently coexists with phobia, depression, and alcohol abuse. The authors review current studies of the spectrum of obsessive-compulsive disorder and related disorders that respond to the new serotonergic antidepressants and behavioral therapy. Differential diagnosis, epidemiology and comorbidity, etiology, evaluation, and psychologic and pharmacologic treatments are discussed. Most patients with obsessive-compulsive disorder require long-term treatment with drugs, but behavioral therapy has also been used successfully. Serotonin reuptake inhibitors used in the treatment of depression have been found effective; clomipramine has produced the best results in large-scale tests. The fact that serotonin reuptake inhibitors are effective as both antidepressants and antiobsessional agents suggests common biological factors in disorders that respond to these drugs.

Antidepressive Agents↗
PubMed1991

Diagnosis and treatment of cytomegalovirus disease in transplant patients based on gastrointestinal tract manifestations.

Infection due to cytomegalovirus is a substantial cause of morbidity and mortality in immunocompromised patients. In particular, cytomegalovirus infection has been associated with a significant detrimental effect on patient and allograft survival after solid-organ transplantation. We are evaluating a new antiviral agent, ganciclovir 9-[1,3-dihydroxy-2-2 propoxymethyl] guanine (DHPG), used in solid-organ transplant recipients who developed life-threatening cytomegalovirus infections. Between March 1, 1987, and June 30, 1989, we treated 93 solid-organ transplant patients who developed tissue-invasive cytomegalovirus disease. From this group of patients we have identified 14 patients with primary gastrointestinal cytomegalovirus disease who received treatment with DHPG. Tissue diagnosis was made by endoscopy of the upper gastrointestinal tract (11 patients) or colonoscopy (three patients). Invasive cytomegalovirus disease was identified prior to severe complications of the gastrointestinal tract in all but one patient, who suffered colonic perforation prior to treatment with DHPG and subsequently died of bacterial sepsis. While 13 of the 14 patients improved after treatment with DHPG, four patients required additional treatments for recurrent cytomegalovirus disease and recovered. No DHPG toxicity was observed. We believe treatment with DHPG is indicated in this patient population, but that further studies are indicated to fully define the impact of this recommendation on both patient and allograft survival after solid-organ transplantation.

Abdominal Pain↗
PubMed1991

Treatment of invasive cytomegalovirus disease in solid organ transplant patients with ganciclovir.

The occurrence of cytomegalovirus infection after solid organ transplantation has been correlated with decrease patient and allograft survival. The disease has not been conquered for two majors reasons: the length of time to establish the diagnosis of CMV has been excessive, and suitable, nontoxic antiviral agents have not been available for use. The purpose of this study was to examine the current incidence and impact of tissue-invasive cytomegalovirus (TI-CMV) disease that developed in 93 patients who underwent solid organ transplantation at University of Minnesota Hospitals (3/1/87 and 6/30/89) and who were treated with antiviral agent ganciclovir ( [9-(1,3-dihydroxy-2-2-propoxymethyl)-guanine [DHPG]). During this same period of time 323 patients received kidney transplants and 71 received kidney-pancreas transplants. Three patient groups were defined: (1) no CMV; (2) CMV infection (cultural or serologic evidence of noninvasive CMV infection); and (3) evidence of TI-CMV disease based upon initial complaints of fever, malaise, dyspnea, or abdominal pain, leukopenia (WBC less than 3000/ml), and evidence of a positive CMV rapid antigen test, CMV culture, or the presence of characteristic CMV inclusion bodies upon examination of material obtained by means of bronchoscopy, upper-gastrointestinal endoscopy, colonoscopy, or liver or renal biopsy. Patients with solely fever, leukopenia, but without a rising CMV serum titer, or positive CMV urine or blood cultures were excluded from the study. A multivariate analysis revealed that rejection therapy, age greater than 50 years, and receiving an organ from a seropositive donor were all significant variables that predisposed to TI-CMV. Analysis of patient and kidney allograft survival indicated that asymptomatic CMV infection had little current impact upon patient or allograft survival, while patients who developed TI-CMV exhibited higher rates of allograft loss and mortality, despite DHPG therapy. Comparison with historical group of patients indicated that TI-CMV DHPG-treated patients exhibited a trend toward improved allograft survival that may be relevant because the historical group of patients included patients with mild CMV infection. DHPG therapy was well tolerated and produced minimal toxicity, and excellent 30-day cure rates (89.2%), although 21.2% of patients required retreatment subsequently. We are currently conducting a trial to compare the ability of DHPG administered plus an anti-CMV immune globulin preparation with acyclovir to prevent posttransplant TI-CMV disease.

Acyclovir↗
PubMed1985

A team approach to nursing research.

The study of the relationship of handedness to the laterality of breast cancer in women is intriguing. Results may affect facets of breast cancer diagnosis and therapy. Maybe not in same way as the discovery of the relationship of high oxygen concentrations to the development of blindness in premature infants, but the study may identify women at higher risk and provide new insights to scientists studying the pathophysiology of breast oncogenesis. It is the belief of the authors that laterality research is one of the fields that could easily lend itself to investigation by large numbers of nurses in hospitals across the country if a national organization became involved in it. If nursing is to be successful in its quest for recognition as one of the professions making a serious contribution to theory, it must mobilize its forces. Nursing, recognized as the largest single health profession in the United States, has great potential for accomplishment if the talent of every member of the profession is recognized and utilized in efforts to build up the science of nursing.

Adult↗
PubMed1985

Higher frequency of left-breast cancer: a possible explanation.

A study of 1027 women with unilateral breast cancer showed that ipsilateral breast cancer was more common before age 45 and contralateral thereafter. The data suggest a possible explanation of the higher incidence of left-breast cancer in American women. A higher percentage of left-handed women developed breast cancer before age 45, but the over-all incidence of unilateral breast cancer was not greater in left-handed women than in right-handed or ambihanded subjects.

Adult↗
PubMed1983

Establishing efficient interview periods for gonorrhea patients.

From February through December 1978, venereal disease casefinders in Polk County, Iowa used an expanded interview period of at least 120 days to interview 983 gonorrhea patients for sexual partner information. We grouped patients according to sex and clinical findings and evaluated the percentage of all new cases identified by time intervals within the expanded interview period. Ninety-one per cent of all untreated, infected sexual partners of symptomatic males were identified by using an interview period which spanned the interval from date of treatment to 15 days before symptom onset. In contrast, the traditional 30-day interview period missed 23 per cent of those untreated, infected partners named by women with pelvic inflammatory disease (PID), 34 per cent of those partners named by women with uncomplicated gonorrhea, and 29 per cent of those named by asymptomatic men. The Polk County data suggest the importance of basing interview periods upon a patient's sex and clinical presentation.

Adult↗
PubMed1983

National case-control study of Kaposi's sarcoma and Pneumocystis carinii pneumonia in homosexual men: Part 1. Epidemiologic results.

To identify risk factors for the occurrence of Kaposi's sarcoma and Pneumocystis carinii pneumonia in homosexual men, we conducted a case-control study in New York City, San Francisco, Los Angeles, and Atlanta. Fifty patients (cases) (39 with Kaposi's sarcoma, 8 with pneumocystis pneumonia, and 3 with both) and 120 matched homosexual male controls (from sexually transmitted disease clinics and private medical practices) participated in the study. The variable most strongly associated with illness was a larger number of male sex partners per year (median, 61 for patients; 27 and 25 for clinic and private practice controls, respectively). Compared with controls, cases were also more likely to have been exposed to feces during sex, have had syphilis and non-B hepatitis, have been treated for enteric parasites, and have used various illicit substances. Certain aspects of a lifestyle shared by a subgroup of the male homosexual population are associated with an increased risk of Kaposi's sarcoma and pneumocystis pneumonia.

Acquired Immunodeficiency Syndrome↗
PubMed1982

Vaginal colonization with Staphylococcus aureus in healthy women: a review of four studies.

Four studies assessed the frequency of vaginal Staphylococcus aureus colonization in healthy women and associated risk factors. An association was found between S. aureus vaginal colonization and colonization at the labia minora and the anterior nares. Significant risk factors associated with an increased risk of vaginal S. aureus in at least one study were a history of genital herpes simplex infection, insertion of tampons without an applicator, and the use of Rely (Procter & Gamble) tampons. The use of systemic antibiotics within 2 weeks of the vaginal culture decreased the risk of recovery of S. aureus. The overall frequency of vaginal S. aureus in the 808 women in the four studies was 9.2%.

Anti-Bacterial Agents↗
PubMed1980

Gonorrhea in the emergency department: management, case follow-up, and contact tracing of cases in women.

From June, 1978, to June, 1979, all ten Columbus hospital emergency departments (EDs) participated in a program which provided test-of-cure, follow-up of untreated cases, and contact investigation of women infected with gonorrhea. Four hundred and eighty-nine women were found to be infected with gonorrhea; 99% of these were treated rapidly with recommended schedules. Sixteen percent of women with positive cultures required inpatient care for an average of 6.3 days. Seventy percent of women with positive cultures received counseling and test-of-cure for gonorrhea. Of 134 men treated as a result of these counseling efforts, 79 (59%) were asymptomatically infected. Source-spread analyses suggested that one third of asymptomatically infected male contacts had been infected for longer than 30 days. Only one fourth of women with gonococcal pelvic inflammatory disease (GC-PID) interviewed named male source contacts who were treated prior to her presentation with PID. Future approaches to GC-PID prevention must include cooperative efforts between health department clinics for sexually transmitted disease and hospital EDs.

Emergency Service, Hospital↗
PubMed1980

Self-reported behavior patterns of patients attending a sexually transmitted disease clinic.

Records of the sexually transmitted disease (STD) clinic visits of 12,728 patients in Columbus, Ohio were analyzed to better understand the behavior patterns of these patients. Among heterosexual men, a greater proportion of Blacks than Whites reported a previous history of urethritis. After controlling for previous STD among heterosexual men with discharge or dysuria, we found that Black men sought treatment sooner and were more likely to curtail sexual activity than White men after becoming symptomatic with gonorrhea or nongonococcal urethritis.

Community Health Centers↗