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Biomedical subjects

M Weintraub

Publications and source records attributed to M Weintraub.

At least 91 records · Page 5Linked to original sources
PubMed1985

Platelet alpha-2 adrenoceptors and the menstrual cycle.

To clarify further the suggested influence of menstrual cycle phase on platelet alpha 2-adrenoceptors, we carried out cross-sectional studies in 77 subjects in a clinical trial of weight control strategies. Blood samples were drawn at baseline and after 6 weeks of diet, behavior modification, and exercise, a program that resulted in a mean weight loss of 4.5 kg. For the analyses, 42 premenopausal women were divided into four groups according to the week of menstrual cycle at the time of blood sampling. At baseline, there was no significant difference in mean platelet alpha 2-adrenoceptor numbers among the four groups. At week 6 accompanying the weight loss, there was a significant increase in the platelet alpha 2-adrenoceptor number for all groups. Despite the fact that the women were at a different phase of the menstrual cycle than at baseline, there was again no significant difference in mean platelet alpha 2-adrenoceptor number. Mean baseline platelet alpha 2-adrenoceptor number in the premenopausal women (113.7 +/- 5.5 fmol/mg protein) did not differ from values in 12 postmenopausal women (113.7 +/- 12.0 fmol/mg protein), four women with hysterectomies (105.9 +/- 8.9 fmol/mg protein), or 19 men (101.8 +/- 6.2 fmol/mg protein). Numbers at 6 weeks also did not differ. We conclude that the menstrual cycle has minimal effects on platelet alpha 2-adrenoceptor number and should not confound clinical studies of platelet alpha 2-adrenoceptors.

Adolescent↗
PubMed1984

Ethical concerns and guidelines in research in geriatric pharmacology and therapeutics: individualization, not codification.

Compared with people of other ages, the elderly are much more heterogeneous in terms of physical and mental status, and they are subject to more day-to-day variability. However, some see the institutionalized elderly as stereotypes, having little autonomy and being easily subjugated such that they will consent to take part in any sort of experiment. Thus, a counter-productive paternalism may lead them to protect elderly patients by making such choices for them. The interests of the incompetent elderly must be scrupulously protected, but competent elderly potential subjects can appropriately be assumed to be responsible and should be accorded the dignity of making their own choices. The consent process should be individualized rather than codified for the elderly, as for potential subjects of other ages.

Aged↗
PubMed1984

P & T Committee roundtable discussion: Great Lakes region. Part II.

A series of regional roundtable discussions regarding the successful operation of Pharmacy and Therapeutic (P & T) Committees has been conducted by Hospital Formulary. Representation from private hospitals, university and teaching hospitals, as well as Veterans Administration Medical Centers has been achieved to ensure that different aspects of P & T Committee performance are demonstrated. Issues such as committee profile, constituency, function, and mechanics are discussed, as are criteria for establishing a successful formulary within an institution. The sessions were taped and the edited transcription is provided in the following article.

Great Lakes Region↗
PubMed1984

P & T Committee formulary requests: criteria for admission.

The criteria for P & T Committee members to consider when adding or deleting a product to the formulary are discussed. Although each institution will require and develop different standards that reflect the characteristics of the patient population they serve, two general sets of factors should be studied. The anticipated needs of the institution and the therapeutic application of the medication in consideration must be identified. Furthermore, the characteristics of the drug, including pharmacokinetics, biopharmaceutics, and cost must be clearly defined. The P & T Committee formulary decisions are critical in ensuring high-quality, cost-effective health care.

Decision Making↗
PubMed1984

Pharmacologic treatment of eating disorders.

Increased research focusing on the eating disorders has put the clinician on firmer ground when choosing appropriate psychopharmacologic treatments. Recent studies of patients with bulimia demonstrate that treatment with antidepressant medications may substantially reduce symptoms of bingeing and vomiting. The efficacy of pharmacologic approaches to anorexia nervosa is more uncertain, in part because of the limited availability of long-term follow-up studies. The judicious use of appetite suppressant medications, as reviewed in the text, is helpful for mild to moderate obesity. In treating these disorders, the clinician needs to integrate medication treatment with psychotherapeutic and behavioral treatment approaches.

Anorexia Nervosa↗
PubMed1984

Mechanism of suppression of vasopressin and adrenocorticotropic hormone secretion by clonidine in anesthetized dogs.

Studies were performed in anesthetized dogs to investigate the mechanism of the suppression of vasopressin and adrenocorticotropic hormone (ACTH) secretion by clonidine. Injection of clonidine (30 micrograms/kg i.v.) produced an initial increase in arterial pressure followed by hypotension, decreased heart rate, increased right atrial pressure and decreased plasma renin activity. Plasma vasopressin concentration decreased from 14.6 +/- 3.0 to 2.2 +/- 0.4 pg/ml (P less than .01), and this was accompanied by increases in urine volume and free water clearance from 0.15 +/- 0.02 to 1.03 +/- 0.28 and -0.50 +/- 0.05 to 0.30 +/- 0.27 ml/min, respectively (P less than .01), and a decrease in urinary osmolality from 1450 +/- 124 to 372 +/- 97 mOsmol/kg of H2O (P less than .01). Plasma corticosteroid concentration, used an an index of ACTH secretion, decreased from 8.9 +/- 1.6 to 2.2 +/- 0.3 micrograms/dl (P less than .01). Plasma osmolality did not change. Pretreatment of dogs with the alpha adrenoceptor antagonist yohimbine (2 mg/kg i.p.) blocked all cardiovascular, endocrine and renal responses to clonidine. Bilateral cervical vagotomy did not block the suppression of vasopressin or corticosteroid secretion by clonidine. Intraventricular injection of yohimbine blocked the hypotension and suppression of plasma corticosteroid concentration produced by clonidine but did not block the decrease in plasma vasopressin concentration or the associated renal effects of clonidine. Intracarotid infusion of clonidine caused small decreases in plasma vasopressin and corticosteroid concentrations even though blood pressure decreased by 22 mm Hg. Intraventricular and intravertebral clonidine had no significant effect on plasma vasopressin or corticosteroid concentrations.(ABSTRACT TRUNCATED AT 250 WORDS)

Adrenocorticotropic Hormone↗
PubMed1984

A double-blind clinical trial in weight control. Use of fenfluramine and phentermine alone and in combination.

We performed a double-blind, controlled clinical trial comparing phentermine resin (30 mg in the morning), fenfluramine hydrochloride (20 mg three times a day), and a combination of phentermine resin (15 mg in the morning) and fenfluramine hydrochloride (30 mg before the evening meal), and placebo. We combined low doses of the two drugs to maintain efficacy while diminishing adverse effects. Eighty-one people with simple obesity (130% to 180% of ideal body weight) participated. Individualized diets were prescribed and discussed again during the 24-week study period. Weight loss in those receiving the combination (8.4 +/- 1.1 kg; mean +/- SEM) was significantly greater than in those receiving placebo (4.4 +/- 0.9 kg; Scheff é's test) and equivalent to that of those receiving fenfluramine (7.5 +/- 1.2 kg) or phentermine (10.0 +/- 1.2 kg) alone. Adverse effects were less frequent with the combination regimen than with other active treatments. Thirty-seven participants dropped out of the study, 18 for reasons related to drug treatment. Combining fenfluramine and phentermine capitalized on their pharmacodynamic differences, resulting in equivalent weight loss, fewer adverse effects, and better appetite control.

Adolescent↗
PubMed1984

Histiocytic hemophagocytosis in miliary tuberculosis.

The signs, symptoms, and bone marrow findings of the recently described virus-associated hemophagocytic syndrome was seen in a patient we treated. The manifestations of this syndrome may not be specific to viral infections and may possibly occur in other infectious processes. Autopsy findings in the present case showed it to be associated with disseminated miliary tuberculosis. Concomitant viral infection was excluded. To our knowledge, only one similar patient has previously been described.

Aged↗
PubMed1983

Analysis of narcotic analgesic usage in the treatment of postoperative pain.

We reviewed 526 medical records of surgical patients and interviewed 81 of these patients. We also sent questionnaires to house staff (57 of 97 responded) and nurses (70 of 142 responded) involved in the care of these patients. A substantial number of patients suffered at least moderate pain during the postoperative period despite analgesic medication. Patients received 70% of the maximal ordered analgesic dose in the first 24 hours. Physicians prescribed drugs in doses that were often inadequate and to be given at inflexible intervals. The optimal doses and duration of action of meperidine, as judged by the house staff and nurses, did not agree with the accepted pharmacologic profile of this drug.

Acute Disease↗
PubMed1983

Propoxyphene in children with iatrogenic morphine dependence.

In four children with iatrogenic morphine sulfate tolerance and dependence, narcotic withdrawal was successfully accomplished using propoxyphene napsylate. The patients showed signs and symptoms typical of narcotic withdrawal, which resolved with morphine administration and increased during attempts to lower the daily morphine dose. Propoxyphene napsylate at total daily doses of 25 to 65 mg/kg, administered at four-hour intervals, allowed rapid reduction of the morphine dosage, with few withdrawal signs and symptoms, and lessened respiratory depression. This treatment enabled patients to be rapidly weaned from the respirator. One child experienced increasing lethargy and respiratory depression and responded to naloxone hydrochloride and a decrease in the dose of propoxyphene; another had transient agitation, which may have been related to high levels of propoxyphene. Our treatment used alternating doses of propoxyphene and morphine, which allowed the child to be morphine free after four days and narcotic free after nine days.

Child↗
PubMed1983

Platelet alpha-adrenergic receptors in obesity: alteration with weight loss.

We studied platelet alpha-adrenergic receptor concentration and function in 19 subjects with simple obesity participating in a double-blind, controlled clinical trial of diet and anorexiants (phentermine, fenfluramine, or a combination of the two) or placebo. From wk 1 to wk 8, weight loss for the group as a whole was 4.9 +/- 0.7 kg (mean +/- SE). Concomitant with this weight loss, the platelet alpha-adrenergic receptor concentration rose from 85.7 +/- 5.8 to 113 +/- 5.8 fmol/mg protein. This increase moved the values for the obese subjects toward or beyond values in lean controls (100 +/- 10.5 fmol/mg protein). The response in the different treatment groups was similar. The receptor concentration increase was accompanied by a corresponding increase in alpha-adrenergic receptor-mediated platelet aggregation. For individual subjects the extent of weight loss over time generally correlated with percent receptor change. Altered adrenergic sensitivity occurring in obese subjects who are losing weight may have important implications in relation to external (therapeutic or inadvertent) administration of catecholamines.

Adult↗
PubMed1983

Extended-release fenfluramine: patient acceptance and efficacy of evening dosing.

We compared the patient acceptance and efficacy of 60 mg extended-release fenfluramine and placebo before the evening meal in a 10-week, double-blind trial. All 51 participants were 130% to 180% of ideal body weight. They received instruction in diet and behavior modification for 2 wk before the beginning of and during the medication period. Mean weight loss was 5.9 kg (8.0 +/- 4.6% of initial weight) in the fenfluramine group and 3.3 kg (5.5 +/- 3.5%) in the placebo group. Fenfluramine-treated participants reported lower hunger ratings and greater fullness in the target supper-to-bedtime period than participants receiving placebo. Both groups reported dry mouth, dizziness, drowsiness, fatigue, and diarrhea. Although the fenfluramine group reported more complaints, these diminished to less than half after 2 wk of treatment. Four of the fenfluramine and three of the placebo group dropped out for drug-related reasons. In all, 10 fenfluramine and 8 placebo participants dropped out. Fenfluramine participants had a higher benefit score with no difference in risk scores. The fenfluramine group's global evaluation was better than that of the placebo group. Participants viewed the study and the dosing regimen positively but had negative ideas about anorexiants in general. Extended-release fenfluramine taken in the evening was well tolerated and maintained its efficacy as measured by standard and novel techniques.

Adolescent↗