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Biomedical subjects

M Fink

Publications and source records attributed to M Fink.

At least 181 records · Page 10Linked to original sources
PubMed1992

The use of electroconvulsive therapy in geriatric patients.

The use of ECT has had a resurgence in the past decade as the promise of more effective and specific pharmacotherapy has been unfulfilled. This has been especially true in the elderly in whom ECT has been frequently demonstrated to be a safe and effective intervention. The decision to use ECT in an elderly patient is a complex one, based on the patient's illness, risks of the treatment compared with alternate or no treatment, and patient and family wishes. The list of dogmatic "absolute contraindications" for ECT has been replaced with a pragmatic philosophy looking at risk/benefit ratios. Such an attitude can only serve to enhance the quality of care clinicians provide their patients.

Aged↗
PubMed1991

Alterations in lysosomal enzymes of the proximal tubule in gentamicin nephrotoxicity.

Gentamicin accumulates in proximal tubule lysosomes, increases their number, and changes their structure. An important lysosomal function is degradation of intracellular proteins. To evaluate the effect of gentamicin on this lysosomal function, we measured the activity of the key lysosomal proteinases, cathepsin B and L, in microdissected S1, S2, and S3 segments of rat proximal tubules by means of a fluorometric microassay. The cathepsin activities were decreased in S1 and S2 following one and four gentamicin injections of 100 mg/kg body weight. The lysosomal enzyme, acid phosphatase, was also measured and was not decreased by gentamicin. The urine excretion of cathepsins B and L was decreased after gentamicin. This excludes an increase in urinary loss of cathepsins as the cause of decreased tubule activity. Structural changes of the lysosomes per se were excluded as the factor responsible for the reduced cathepsin activity by demonstrating increased cathepsin B and L activity in proximal tubule segments from rats injected with dextran, since dextran induces an increase in number and size of proximal tubule lysosomes. In vitro incubation of urine and tubule segments with gentamicin demonstrated a concentration-dependent reversible inhibition of cathepsin B and L. We conclude that gentamicin per se decreased cathepsin B and L activities in proximal tubule segments as early as 24 hours following one injection due to either enzyme inhibition or reduced generation of active intralysosomal cathepsin B and L. Gentamicin may, therefore, reduce renal protein catabolism by decreasing the activity of the key proteolytic enzymes, cathepsin B and L. Since cathepsin B and L are proteolytic activators of other lysosomal enzymes, their reduced activity may also decrease the activities of other lysosomal enzymes.

Acid Phosphatase↗
PubMed1991

What is an adequate treatment in convulsive therapy?

The parameters of the induction of an effective electroconvulsive therapy (ECT) treatment are poorly defined. We find variations in outcome, with changes in electrode placement and energy levels, despite measures of motor seizure duration greater than 25 s. To maximize the outcome of ECT, attention is again focused on the electrophysiologic and biochemical features of seizures, much as Ottosson studied them in 1960.

Brain↗
PubMed1991

Neuropeptide concentrations in the cerebrospinal fluid of depressed patients treated with electroconvulsive therapy. Corticotrophin-releasing factor, beta-endorphin and somatostatin.

The CSF concentrations of CRF, somatostatin and beta-endorphin were determined in nine patients who fulfilled DSM-III criteria for major depression with psychotic features. CSF samples were obtained at baseline in the depressed state, and again after a course of ECT. Concentrations of both CRF and beta-endorphin decreased after ECT, while the concentration of somatostatin increased, although the latter difference did not attain statistical significance. The increase in CSF concentrations of CRF and beta-endorphin in depressed patients is therefore seen to be state-dependent.

Adult↗
PubMed1991

Impact of the antipsychiatry movement on the revival of electroconvulsive therapy in the United States.

In spite of its acknowledged efficacy and safety in the treatment of affective and psychotic illnesses, electroconvulsive therapy (ECT) remains a controversial treatment, with limited use mainly in academic and private hospitals. The controversy results from attack by the antipsychiatry movement, and from a lack of support by mental health professionals who have not come to terms with their ambivalence and lack of understanding of the ECT process. The history of the past 20 years is reviewed.

Attitude↗
PubMed1991

Electroconvulsive therapy.

The Scientific Board of the California Medical Association presents the following inventory of items of progress in psychiatry. Each item, in the judgment of a panel of knowledgeable physicians, has recently become reasonably firmly established, both as to scientific fact and important clinical significance. The items are presented in simple epitome, and an authoritative reference, both to the item itself and to the subject as a whole, is generally given for those who may be unfamiliar with a particular item. The purpose is to assist busy practitioners, students, researchers, or scholars to stay abreast of these items of progress in psychiatry that have recently achieved a substantial degree of authoritative acceptance, whether in their own field of special interest or another. The items of progress listed below were selected by the Advisory Panel to the Section on Psychiatry of the California Medical Association, and the summaries were prepared under its direction.

Electroconvulsive Therapy↗
PubMed1990

Clinical assessment of hemodynamic values in two surgical intensive care units. Effects on therapy.

A prospective study of 126 surgical patients from two institutions was undertaken to assess the impact of pulmonary artery catheterization in surgical intensive care units. Before catheterization, surgical residents were asked to predict pulmonary artery wedge pressure, cardiac output, systemic vascular resistance, and plan of therapy. After catheterization, each chart was reviewed by a panel of intensive care specialists and a general surgeon. Correct classification for the hemodynamic variables ranged from 47% to 55%. Catheterization results prompted a major change in therapy in 50% of patients. The data suggest that hemodynamic variables obtained from pulmonary artery catheterization improve the accuracy of bedside evaluation and lead to alteration in therapy, particularly in patients whose pulmonary artery wedge pressure predictions were poor.

Adolescent↗
PubMed1990

Antineoplastic efficacy of melphalan and N-(2-chloroethyl)-N-nitrosocarbamoyl-omega-lysine, in combination with diazoxide or insulin in autochthonous mammary carcinoma of the Sprague-Dawley rat.

The anticancer activity of melphalan and N-(2-chloroethyl)-N-nitrosocarbamoyl-omega-lysine (CNC-omega-Lys), was compared in the autochthonous, methylnitrosourea-induced mammary carcinoma of the Sprague-Dawley rat. In addition, the influence on the therapeutic efficacy of the combination with diazoxide, causing a mild, reversible diabetes, and with insulin was investigated. The comparison of melphalan and CNC-omega-Lys clearly showed the superiority of melphalan. Both compounds displayed a significant tumour inhibition in their medium and the highest dosages in comparison to the untreated control. The combination with diazoxide resulted for almost all groups in an increased tumour inhibition. Only the lowest dose of CNC-omega-Lys + diazoxide did not reduce the tumour volume significantly versus the control group. The combination with insulin, however, resulted in a loss of tumour inhibition compared to the effect of the cytotoxic drug alone, although in these groups, too, a significant decrease of tumour volumes versus controls could be observed. Mortality was within tolerable limits (less than 20%) through the treatment period for all experimental groups. Median lifespans were increased in all therapy groups, but no additional benefit could be observed in the combination treatment groups.

Animals↗