Biomedical subjects
Publications and source records attributed to R E Johnson.
Premenstrual syndrome is a chronic cyclic disorder with a broad range of morbidity. The syndrome encompasses emotional, behavioral and physical symptoms, usually beginning in the week before menses and ending at the onset of menses or shortly thereafter. To date, the etiology and the most effective treatment are unknown; however, vitamin B6, progesterone and bromocriptine therapies have been advocated.
The melanotic neuroectodermal tumor of infancy (MNTI) is a rare, usually benign, pigmented neuroectodermal tumor which most often involves the maxilla. The authors reviewed seven cases of MNTI, with patient ages of our patients ranged from nine weeks to 18 months; six of the seven were less than six months old at initial diagnosis. Four patients were males, and all were white. One tumor each was located in the femur, the temporal bone, and the epididymis; the remaining lesions occurred in the maxilla. Three of the four maxillary tumors recurred locally; the epididymal and femoral tumors metastasized. Two of these cases had unique clinical or pathologic features. The case of the femoral tumor is remarkable in that it is the first reported one of MNTI presenting in a long bone. This tumor was aggressively malignant; within two months after its discovery, a large mass of similar tumor was formed in the pelvis, and the tumor resulted in the patient's death. To the authors' knowledge, the case of the temporal bone tumor is the first one of MNTI in which neuronal differentiation of the neuroblastic cells is convincingly demonstrated. This finding provides additional evidence in support of the neuroectodermal theory of origin of these neoplasms.
This paper is one of a series presenting right-left differences in the morphology of the rat forebrain, but this presentation differs from the previous ones by offering age-related changes in both sexes. Long-Evans rats were housed with the dam prior to weaning at 21 days of age and three to a cage thereafter. The ages of the animals studied were 6 to 7, 14, 21, 90, 180 to 185, 390 to 400, and 870 to 876 days. The thicknesses of the cerebral cortex and of the hippocampus were measured on microslide-projected images of thionin-stained sections. We learned that the cerebral cortex of the male rat was thicker on the right side than on the left at all ages in 41 of 42 measures, being statistically significant in 30 of 42 measures. Areas 10, 3 and 17 showed the most marked differences at all ages. In the female rat, laterality was not so well defined, but, in general, the left cerebral cortex was thicker than the right in 33 of 54 measures, but in only 5 of the 54 were statistically significant differences found. The right-left differences in the hippocampus followed the pattern of the cortical differences in the male and female rats. The right male hippocampus was thicker than the left at all ages, with greater differences noted in the younger than in the older groups. The female left hippocampus was thicker than the right, but only in the 90-day group was the difference significant.
Zomepirac sodium, a nonsteroidal anti-inflammatory analgesic, was compared to morphine sulfate and placebo in an abuse liability study in a postaddiction population. Morphine (15 and 30 mg), but not zomepirac (400 and 800 mg), induced pupillary constriction and characteristic morphinelike subjective effects. The 800-mg dose of zomepirac was discriminated but was not euphorigenic. This study indicates that zomepirac is not likely to be abused.
This article examines the relationship between a set of demographic, socioeconomic, sociopsychologic, and health status characteristics of a heterogeneous adult population and their use of nonprescribed drugs. The objective is to determine whether nonprescribed drug use is best accounted for by demographic and socioeconomic factors, by health and medical beliefs, by health status, or by some combination of these. The data are derived from a personal interview survey of 2603 adult members of the Kaiser-Permanente Medical Care Program, Oregon Region. The results indicated that a combination of characteristics from among these three sets were the best predictors. Sex, income, education, mental health status, tendency toward self-treatment, and level of concern with health matters were the most important variables, although they account for only a small amount of the variation in nonprescribed drug use. A portrait of the most frequent users of nonprescribed drugs raised the question as to whether these are the classic neurotics, the "worried-well," or persons whose medical care needs have not been adequately recognized or met.
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The association between the quality of physician prescribing and the degree of prescription documentation in the medical record was studied in four family-practice offices. Carbon-copy prescriptions were collected for five months at each office, and 438 were randomly selected for evaluation. For each prescription, a case abstract was prepared from the medical record. The abstract summarized the patient's previous care related to the problem for which the prescription was issued. The abstracts were blinded and randomly assigned for review by a panel of physicians and pharmacists working in family practice, resulting in a total of 1866 evaluations. Each panelist evaluated appropriateness of drug choice, potential benefit, and degree of prescription documentation. Actual prescription documentation of drug name, strength, quantity, directions, and refills was determined by comparing the carbon-copy prescription with the medical record. Multiple regression analysis revealed a significant correlation between panel evaluations for drug choice and actual documentation of drug name, strength, and directions. Likewise, the mean rating of potential benefit was significantly associated with actual documentation of drug name, strength, directions, and refills. The mean rating of appropriateness of documentation was significantly associated with all five independent documentation variables. Drug name, strength, and directions were recorded in 94%, 60%, and 75% of the medical records, respectively. These data demonstrate a positive association between the quality of prescribing and actual prescription documentation in the medical record.
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Twenty-five external cephalic versions were attempted on 14 transverse and 11 breech malpositioned second twins. In ten of 14 (71%) transverse presentations and eight of 11 (73%) breech presentations, version was successful and resulted in subsequent vertex vaginal delivery. Successful version was not associated with parity, gestational age, or birth weight but was associated with mode of anesthesia and disparity in twin size. Among the 25 attempted versions, seven (28%) had one-minute and two (8%) had five-minute Apgar scores below 7. Analysis by birth weight and mode of delivery is presented. Time interval between delivery of twins had no association with outcome. One neonatal death occurred in a 28-week, 1100-g infant. The authors believe that external version is useful in the management of the second twin who has an abnormal presentation, and that routine cesarean section is not always necessary. Further investigation, especially at lower birth weights, is necessary to confirm the safety and efficacy of this method of management.
The transient and steady-state kinetics of the oxidative deamination of L-glutamate by glutamate dehydrogenase and NADP in both aqueous solution and 30% methanol are compared. Methanol causes an approximately 5-fold tightening of the enzyme--L-glutamate binary complex and an approximately 2-fold reduction of the interaction parameter for the ternary enzyme--NADP--L-glutamate complex. The most dramatic effect of methanol on the time course of the reaction is what appears to be a conversion of the enzyme at substoichiometric initial levels of reactant NADP to a form from which product alpha-ketoglutarate does not readily dissociate. This conversion appears only at NADP concentrations over one-third of the enzyme active site concentration.
A study of the various solution forms of alpha-ketoglutaric acid using UV absorption spectrophotometry and 13C NMR spectroscopy shows that at neutral pH alpha-ketoglutarate exists predominantly as the keto form with about 7% hydrated form (gem-diol) and a small amount of cyclic form. Protonation of the gamma-carboxylate group increases the amount of cyclic form to 20% with very little increase in the amount of gem-diol. Protonation of the alpha-carboxylate increases the amount of cyclic form to 30% and the amount of gem-diol to 35%. The pH and temperature dependence of the 13C NMR line widths indicated that the interconversion of keto and cyclic forms is extremely rapid. The rate of interconversion of keto and gem-diol forms was studied spectrophotometrically at various temperatures, buffers, and pH values and by varying the total concentration of alpha-ketoglutarate. The hydration reaction of alpha-ketoglutarate is not catalyzed by bovine liver glutamate dehydrogenase (E) or by the E-NADPH complex. The enzyme uses the keto form of alpha-ketoglutarate as the substrate. The gem-diol form is not itself a substrate but becomes converted to the keto form with a half-life of about 0.3 min at 15 degrees C in 0.1 M potassium phosphate buffer (pH 7.6).
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The case of a 23-year-old man with Nelson's syndrome is presented. He had undergone bilateral adrenalectomy at age 15 years for Cushing's syndrome. Postoperatively, his cushingoid features resolved; however, 13 months later, he became hyperpigmented and showed radiographic evidence of sellar enlargement and midline expansion of the sellar floor. In 1972, he received radiation therapy to the pituitary gland. He underwent transsphenoidal hypophysectomy in 1974 and 1975 for recurrent pituitary adenoma, and recurrent Cushing's syndrome developed concomitantly with bilateral firm testicular masses in 1978. External scanning with NP-59 localized steroid production to the testes, and bilateral orchiectomy was performed. Immunohistochemical studies of the pituitary tumor confirmed the presence of adrenocorticotropic hormone, and morphologic and ultrastructural examinations of the testes supported the adrenal nature of the testicular tumors.