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Biomedical subjects

R J Anderson

Publications and source records attributed to R J Anderson.

At least 361 records · Page 20Linked to original sources
PubMed1982

Prescribing medication in long-term dialysis units.

Little information is available regarding the current patterns of medication use in long-term dialysis centers. Therefore, we surveyed the medication records of 1,023 patients undergoing long-term dialysis therapy in 27 dialysis centers. The mean number of medications prescribed per patient was 7.7 +/- 0.54, increasing patient age, increasing duration of dialysis, in-center dialysis, and the presence of underlying diabetic and hypertensive nephropathy were associated with increased frequency of medication use. The use of multiple pharmacologic agents was associated with a high frequency of drug duplication (12%), potential dosage error (9%), potential significant drug interaction (15%), and use of contraindicated drugs (2.5%). A lack of individualization of the use of several pharmacologic agents was apparent. An extreme degree of center variability in drug use was also apparent. Periodic review of medication use should be undertaken in the long-term dialysis setting.

Adult↗
PubMed1982

Epidemic classical heat stroke: clinical characteristics and course of 28 patients.

Patients with classical heat stroke are different in many ways from those with exertional injury; contrasts included difference in demographic factors, prior general health, in-hospital complications and laboratory abnormalities (lactate, liver enzymes, pH, electrolytes). Severe hyperkalemia, acute renal failure, rhabdomyolysis and disseminated intravascular coagulation often dominate the course of patients with exertional heat stroke but are uncommon in those with classical heat stroke (Table 4). While lactic acidosis is the rule in exertional injury, it is somewhat unusual in patients with classical heat stroke and when above 3 mmoles/L predicts a poor outcome or death. In spite of the advanced age and multiple medical problems of the patients with classical heat stroke, careful attention to early and aggressive cooling and scrutiny for potential complications can result in salvage of most patients.

Acid-Base Imbalance↗
PubMed1982

Methods of improving patient compliance in chronic disease states.

Patients with chronic diseases fail to comply with the regimen prescribed by the physician for a variety of reasons. Physicians must be aware of the likelihood of noncompliance in the individual patient and make strong efforts to detect problems and persuade patients with the importance of adherence to a program designed to reach and maintain stated, and often negotiated, therapeutic goals. It is the physician's responsibility to teach, motivate, and strengthen the patient to maximize compliance in a largely unsupervised setting. This can best be accomplished by a process of "therapeutic partnership."

Chronic Disease↗
PubMed1981

Clinical and immunologic effects of fractionated total lymphoid irradiation in refractory rheumatoid arthritis.

Ten patients with refractory rheumatoid arthritis were given 3000 rad of fractionated total lymphoid irradiation in an uncontrolled therapeutic trial. Total lymphoid irradiation was associated with objective evidence of considerable clinical improvement in eight patients and with reduced blood lymphocyte counts in all 10. On completion of irradiation, there was an abrogation of lymphocyte reactivity in vitro in the patients with clinical responses, but abnormal antibody activities characteristic of rheumatoid arthritis and normal components of humoral immunity were not suppressed. Partial recrudescence of arthritis occurred shortly after a year after the completion of irradiation and was paralleled by a restitution of lymphocyte concentrations and responsiveness to mitogens to levels similar to those observed before irradiation. These data provide further evidence of T-cell involvement in the pathogenesis of rheumatoid arthritis and demonstrate that total lymphoid irradiation can induce temporary relief, but they do not ascertain whether the natural history of this disease was altered.

Aged↗
PubMed1981

Oral clonidine loading in hypertensive urgencies.

The response to oral clonidine hydrochloride loading in 36 severely hypertensive patients is presented. Each patient initially received 0.2 mg of clonidine hydrochloride, followed by 0.1 mg each hour until a dose of 0.7 mg had been given, or the diastolic blood pressure (BP) reached a predetermined goal (110 mm Hg or total fall of at least 20 mm Hg). Only two patients (6%) failed to reach this goal. Supine BP in the group fell from 212 +/- 22 (SD)/139 +/- 11 (SD) mm Hg to 151 +/- 21 (SD) mm Hg at six hours. The average dose of clonidine required was 0.45 mg and control was maximized at five hours. The response to oral clonidine loading in the individual patient was not predictive of the eventual dose of clonidine necessary to achieve acceptable BP control at two weeks. Oral clonidine loading is safe and effective in the management of "hypertensive urgencies" and offers several advantages over parenteral antihypertensive agents in this clinical situation.

Administration, Oral↗
PubMed1981

Human platelet phenol sulphotransferase: assay procedure, substrate and tissue correlations.

Procedures for the precise assay of human platelet phenol sulphotransferase activity were determined. The coefficient of variation of the assay was 5.8% when the enzyme activity was expressed per 10(8) platelets, and was 9.4% when it was expressed per mg soluble platelet protein. Mean platelet phenol sulphotransferase (PST) activity in samples from 102 randomly selected adults was 1.2 +/- 0.4 units/10(8) platelets (mean +/- S.D.), with a range from 0.2 to 2.9. The mean activity for umbilical cord blood platelet PST was 0.93 +/- 0.3 units/10(8) platelets (mean +/- S.D., n = 27). The substrate used routinely for the assay was 3-methoxy-4-hydroxyphenylglycol (MHPG). There was a significant correlation between the formation of MHPG sulfate by individual platelet preparations and the formation of sulfated product with each of the following substrates: tyramine (r = 0.92, n = 21); dopamine (r = 0.82, n = 16); 5-hydroxytryptamine (r = 0.94, n = 20); acetaminophen (r = 0.77, n = 17); and alphamethyldopa (r = 0.77, n = 17) (p less than 0.001 for each). Platelet PST activity correlated significantly with human renal cortex PST activity (r = 0.54, n = 20, p less than 0.02). The correlation coefficient between platelet PST activity and jejunal mucosal enzyme activity in eight patients was 0.67. These results raise the possibility that human platelet PST activity measured with MHPG as substrate might reflect the enzyme activity in other tissues and the degree of sulfate conjugation of a variety of substrates.

Adult↗
PubMed1981

Squamous cell carcinoma of the vagina following hysterectomy.

A retrospective analysis of 29 cases of squamous cell neoplasia of the vagina following hysterectomy is presented. Two groups of patients were identified; the first presented following hysterectomy for cervical dysplasia or neoplasia on an average of 5.7 years later, and the second presented following hysterectomy for benign or unrelated disease 13.1 years after initial surgery. All 17 patients in the first group had Stage I disease whereas two thirds of the second group had Stage II or greater disease at the time of diagnosis. Surgery was the primary mode of therapy in 82.4% of the first group and radiotherapy was used in 83.3% of the second group. In all patients 20.7% had received previous radiotherapy to the pelvis. Carcinoma of the vagina following hysterectomy for benign disease tends to be more advanced at the time of diagnosis and subsequently has a poorer ultimate prognosis. Disease following previous cervical neoplasia is often asymptomatic and only detected on routine cytologic testing.

Adult↗
PubMed1981

Antagonism of reserpine rigidity without inducing sedation.

The effects of pretreatment with chlorpromazine, promethazine or SKF 7265 on the severity of reserpine-induced rigidity were evaluated using a series of behavioral responses. Chlorpromazine (10 mg/kg) reduced the severity of the syndrome, particularly the tremor, but only at doses that also produced marked sedation. SKF 7265 was more effective than chlorpromazine and produced no detectable sedation or other motor impairment. Promethazine was ineffective in protecting against the effects of reserpine. These studies demonstrate that motor and behavioral abnormalities induced by high doses of reserpine can be blocked without inducing generalized sedation. This would suggest that it is possible to separate pharmacologically the motor pathways responsible for reserpine rigidity and those responsible for sedation.

Acridines↗