Nursing mirror clinical forum 2. Emergency care of the newborn.
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Biomedical subjects
Publications and source records attributed to P Lewis.
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Thirty-one patients with classical or definite rheumatoid arthritis (RA), on treatment with azathioprine and sodium aurothiomalate in combination were studied. Absolute lymphocyte counts and IgA levels were reduced but this did not reach statistical significance. Lymphocyte transformation with phytohaemagglutinin (PHA) showed no significant difference from a control group. However, antibody dependent cell-mediated cytotoxicity was significantly impaired compared to rheumatoid controls (p less than 0.001). There was no relation to the degree of impairment of ADCC and the current dose of azathioprine nor to the total dose or duration of therapy. Inhibiting material to cell-mediated cytotoxicity was present in the sera of 23 patients but its presence showed no relation to the degree of cytotoxicity exhibited by cells in the same patient. Our studies of cellular cytotoxicity have revealed alterations in cellular function possibly attributable to azathioprine.
A serum fraction from schizophrenic patients has been investigated for its effect on opiate receptor sites and on behaviour in rats. Serum from schizophrenic patients was ultrafiltered and fractionated on DEAE-Sephadex A-25. The concentration of peptide material eluting under 0.1 M HCl (fraction I) was further purified on Sephadex-G10 and four major peaks were identified (fractions II to V). When injected intracerebroventricularly in rats, fraction II produced a characteristic behavioural syndrome, which included hyperactivity associated with hyperemotionality. The effects were long lasting, bouts of hyperemotionality accompanied by analgesia were recorded over a two-week period. The same fraction from control non-patients produced a transient and much reduced, but qualitatively similar response. There was evidence that fraction III was also active. An in vitro opiate receptor binding test showed that fraction II from schizophrenic patients inhibited [3H]naloxone binding.
Forty-two spinal injury patients underwent single or sequential urodynamic studies to assess the value of dynamic urethral pressure using transducer tipped catheters. Three groups of patients were identified: those with poor detrusor function, those with unsustained dyssynergia and those with sustained dyssynergia. All patients demonstrated some dyssynergia. Urethral needle EMG mirrored urethral pressure changes accurately. The addition of dynamic profilometry to fluoroscopy, detrusor pressure and urethral EMG has clarified our understanding of lower urinary tract behaviour after cord lesions.
The expression of the proopiomelanocortin (POMC) gene by normal lung and thyroid was examined by measurement of the content of ACTH, beta-lipotropin (beta LPH), and beta-endorphin (beta EP) in porcine lung and thyroid tissue. Acid extracts of normal porcine lung and thyroid tissue each contained appreciable amounts of immunoreactive (ir) ACTH, ir-beta LPH, and ir-beta EP. The content of ir-beta LPH in both tissues exceeded by severalfold, on a molar basis, the content of ir-ACTH and ir-beta EP, suggesting that the common precursor POMC was processed predominantly to peptides other than ir-ACTH and ir-beta EP. A porcine thyroid extract (Calcitare, porcine calcitonin, Armour) showed equivalent levels of beta EP-like immunoreactivity and bioactivity, measured by opiate radioreceptor assay; in contrast, ACTH-like bioactivity, measured by rat zona fasciculata steroidogenesis, was only 4% of ACTH-like immunoreactivity. On reversed phase high performance liquid chromatography, Calcitare showed multiple peaks of ACTH-like immunoreactivity, one of which coeluted with porcine ACTH-(1-39), and two much smaller peaks of beta EP-like immunoreactivity, of which the smaller coeluted with porcine beta EP. These data suggest that both lung and thyroid gland synthesize POMC, which in normal tissue is usually predominantly processed to species other than ACTH and beta EP. Ectopic secretion of ACTH and beta EP by lung and thyroid neoplasms may thus represent the loss of a system(s) normally responsible for processing the precursor beyond ACTH and beta EP.
1. Although systolic blood pressure elevation is responsible for increased incidence of cardiovascular accidents in old people, the preventive benefit of lowering systolic hypertension in elderly has not been confirmed. 2. A double blind study comparing the effects of a placebo and of an active regimen (hydrochlorothiazide-triamterene with or without methyldopa) in people over 60 years with isolated systolic hypertension has been undertaken by the European Working Party on High blood pressure in the Elderly (EWPHE). 3. The actively treated group shows a lowered sitting blood pressure (-15/6 mm Hg), a mild increase of serum creatine, serum uric acid and blood glucose and a mild decrease of serum potassium after two years of treatment when compared to the spontaneous changes observed in the placebo treated group. 4. The study is continuing to evaluate if the blood pressure reduction prevents or reduces the incidence of cardiovascular accidents, although some biochemical changes were provoked by the treatment.
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Three hundred and eleven patients with classical or definite rheumatoid arthritis were observed over an 11-year period. This group is of particular interest since 214 patients were given cytotoxic therapy, 203 were treated with azathioprine (52 of these also received chlorambucil or cyclophosphamide), and 11 were treated with cyclophosphamide or chlorambucil alone. Forty-six patients died. This is an excess mortality compared with the expected rate for the general population matched with respect to age and sex. The death rate was higher than expected in the age group 45-64 years but lower in those aged 75 years or over. There were more deaths from neoplasia and ischaemic heart disease in the younger age group. One patient died of lymphosarcoma; treatment had been with corticosteroids, gold, and chloroquine. No other tumours of the reticuloendothelial system were recorded, and no patient developed leukaemia.
People from different ethnic or environmental backgrounds may respond differently to psychotropic drugs. The underlying psychogenic or biochemical cause of mental illness may vary in different cultures and cause differences in the presenting symptomatology. The psychotropic effect of drugs may then differ or be interpreted differently. Also, the pharmacokinetics of drugs, particularly rates of metabolism, may differ on account of genetic and/or environmental factors. The relevance of such differences to general clinical treatment will depend on the type of drug. If the margin of safety of a particular compound is small, then variation due to ethnic origin may be an important factor. For relatively safe drugs this is not so crucial but, in psychiatry particularly, unpleasant drug-induced side effects are common and it is desirable to find the preparation most acceptable to the individual. Clinical findings should not be extrapolated from one culture to another without examination of the relevant ethnic groups.