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Biomedical subjects

R Shapiro

Publications and source records attributed to R Shapiro.

At least 397 records · Page 22Linked to original sources
PubMed1979

Reversible acute renal failure induced by indomethacin.

Acute renal failure occurred during indomethacin therapy in a patient with chronic pyelonephritis. Urinary prostaglandin E2 levels were diminished but returned to normal after discontinuation of drug therapy and recovery of renal function. Prostaglandins may be critical for the integrity of renal function, and the use of prostaglandin inhibitors such as indomethacin and other nonsteroidal anti-inflammatory drugs may be deleterious in patients with underlying renal disease.

Acute Kidney Injury↗
PubMed1979

Smoking and warfarin disposition.

Nine cigarette smokers ingested an average daily 0.032 mg/kg dose of sodium warfarin for 2 wk while continuing to smoke and for an additional 2 wk after having abstained from cigarette smoking for a month washout phase. Steady-state plasma levels of warfarin, clearances, t 1/2, apparent volumes of distribution, steady-state prothrombin times, and plasma thiocyanate levels were measured during both the smoking and nonsmoking phases. During the nonsmoking phase there was a 13% increase in average steady-state warfarin level and a 13% decrease in warfarin clearance rate. There also was a 23% increase in warfarin t 1/2 and an 11% increase in the apparent volume of distribution. Prothrombin time did not change. Thiocyanate levels were 3 to 4 times as high during the smoking than the nonsmoking phase. It appears that cigarette smoking does affect warfarin clearance, t 1/2, and apparent volume of distribution, though the net effect on warfarin's pharmacodynamic activity is negligible, at least at doses which are ineffective therapeutically.

Adult↗
PubMed1979

Nonenzymatic glycosylation of human hemoglobin at multiple sites.

The most abundant minor hemoglobin component of human hemolysate is Hb A1c, which has glucose bound to the N-terminus of the beta chain by a ketoamine linkage. Hb A1c is formed slowly and continuously throughout the 120 day lifespan of the red cell. It can be synthesized in vitro by incubating purified hemoglobin with 14C-glucose. Other minor components, Hb A1a1 and Hb A1a2 are adducts of sugar phosphates at the N-terminus of the beta chain. Hb A1b contains an unidentified nonphosphorylated sugar at the beta N-terminus. In addition, a significant portion of the major hemoglobin component (Hb Ao) is also glycosylated by a glucose ketoamine linkage at other sites on the molecule, including the N-terminus of the alpha chain and the epsilon-amino group of several lysine residues on both the alpha and the beta chains. The results indicate that the interaction of glucose and hemoglobin is rather nonspecific and suggests that other proteins are modified in a similar fashion.

Blood Glucose↗
PubMed1979

The effect of deinstitutionalization on the state hospital.

Recalling the important statement about the bankruptcy of the state hospital system and the need for a multitude of treatment settings made by Harry Solomon, M.D., in 1958, the authors acknowledge that the changes he prophesized have largely come about. Using the Massachusetts Mental Health Center as the model, they describe how an inpatient unit operates as part of a deinstitutionalized network of services for seriously ill patients. They discuss the five general types of patients admitted and the problems of providing adequate care to such a diverse population. Finally, they make a strong plea for the establishment of regional facilities to care for patients with unusual, complicated problems.

Boston↗
PubMed1979

Indomethacin-induced prostaglandin inhibition with hyperkalemia. A reversible cause of hyporeninemic hypoaldosteronism.

Hyporeninemic hypoaldosteronism was diagnosed in a young woman with glomerulonephritis who was receiving indomethacin therapy. Despite only mildly abnormal renal function, serum K+ was elevated to 6.2 meq/L, and plasma renin activity (0.12 ng/mL h) and aldosterone (4.4 ng/dL) failed to respond to the combined stimuli of furosemide and posture. Urinary prostaglandin E2 (PGE2) was suppressed (70 ng/24 h). When indomethacin was withdrawn, significant kaliuresis occurred, accompanied by normalization of serum K+ and PGE2 and a supranormal rebound in renin and aldosterone levels. Challenge with indomethacin resulted in antikaliuresis and resuppression of PGE2, renin, and aldosterone. This case study documents for the first time that indomethacin can cause the syndrome of hyporeninemic hypoaldosteronism, probably by inhibiting prostaglandin biosynthesis.

Adult↗
PubMed1979

L-asparaginase-induced hypocomplementemia in acute lymphocytic leukemia (ALL) of childhood.

Serum complement studies were carried out in five children with acute lymphocytic leukemia. During therapy with L-asparaginase, prednisone and vincristine, hypocomplementemia developed in all patients, and disappeared within 2 weeks after the discontinuation of L-asparaginase. Complement breakdown products were not present in plasma. The changes of serum complement levels paralleled those of plasma fibrinogen. These findings suggest that the hypocomplementemia observed in these patients may be related to impaired protein synthesis induced by L-asparaginase.

Adolescent↗
PubMed1978

Glycosylated minor components of human adult hemoglobin. Purification, identification, and partial structural analysis.

Human hemolysate contains several minor components designated Hb A1a, Hb A1b, Hb A1c, which are post-translational modifications of the major hemoglobin component A0. Individuals with diabetes mellitus have elevated levels of Hb A1c, a hemoglobin modified with a glucose moiety at the NH2 terminus of each beta chain. A new chromatographic technique using Bio-Rex 70 is described which not only allows complete separation of Hb A1a from Hb A1b but also resolution of Hb A1a into two components, designated Hb A1a1 and Hb A1a2. Carbohydrate determinations with the thiobarbituric acid procedure revealed that Hb A1a1, Hb A1a2, and Hb A1b as well as Hb A1c were glycosylated. Total phosphate analysis revealed 2.06 and 1.01 mol of phosphorus/alphabeta dimer for Hb A1a1 and Hb A1a2 respectively; Hb A1b and Hb A1c contained no detectable phosphate. Hemoglobin incubated with D-[14C]glucose-6-P co-chromatographs precisely with Hb A1a2, strongly suggesting that Hb A1a2 is glucose-6-P hemoglobin. Levels of Hb A1a1 and Hb A1a2 are normal in individuals with diabetes mellitus. Furthermore, diabetic red cells contain normal levels of glucose-6-P. Therefore, glucose-6-P hemoglobin does not serve as a significant precursor to Hb A1c. Instead Hb A1c is formed by the direct reaction of hemoglobin with glucose. This suggests that hemoglobin can serve as a model system for nonenzymatic glycosylation of protein.

Adult↗
PubMed1978

Cross-cultural differences in the short-term prognosis of schizophrenic psychoses.

Results of the 2-year followup of the patients included in the International Pilot Study of Schizophrenia (World Health Organization 1973) indicate that patients diagnosed schizophrenic on the basis of standardized assessments and clearly specified criteria demonstrated very marked variations of course and outcome over a 2-year period. Schizophrenic patients in the centers in developing countries had, on the average, considerably better course and outcome than schizophrenic patients in the centers in developed countries. Part of the variation of course and outcome was related to sociodemographic (e.g., social isolation and marital status) and clinical (e.g., type of onset and precipitating factors) predictors, but another larger part remained statistically unexplained. This suggests that variables usually used to describe psychopathology, the environment, and history of psychiatric patients in European and North American cultures may not account for cross-cultural differences. Clinical diagnosis on initial evaluation appeared to be a good predictor of subsequent symptomatology, but not of the length of the episodes, the total time during which the patient would be psychotic, pattern of course, or the degree of social impairment. A 5-year followup of the IPSS patients has also been completed, and the collected data are being analyzed.

Cross-Cultural Comparison↗
PubMed1978

Spontaneous perilymphatic fistula.

Sudden hearing loss from spontaneous perilymphatic fistula in a child managed by prompt surgical intervention and with recovery of hearing has not previously been reported. The historical and contemporary theories of fistula formation are reviewed. A child with spontaneous oval window rupture associated with a congenital malformation of the stapes and cochlear aqueduct is described together with his complete recovery of hearing following surgical repair. Some rationales explaining the mechanism of oval window rupture in this patient are suggested.

Adolescent↗
PubMed1978

An interesting normal variant of the temporal bone.

The purpose of this brief communication is to call attention to a small, rounded bony knob which is infrequently present on the superior margin of the petrous bone. This finding is more often unilateral but may rarely be bilateral. The bony excrescence has the same osseous density as the surrounding dense petrosa from which it arises. Lack of familiarity with this normal variant may lead to the erroneous diagnosis of a petrosal meningioma.

Adult↗
PubMed1978

Inability of accumulated metabolic byproducts of uremia to alter the extent of warfarin binding in charcoal treated plasma.

The addition to charcoal treated normal and charcoal treated uremic plasma of four metabolites which accumulate during uremia--uric acid, beta -phenylpyruvic acid, guanidinosuccinic acid, and p-hydroxyphenylacetic acid--failed to produce a warfarin binding defect. Charcoal treatment corrected the warfarin binding defect in uremic plasma, however it diminished the extent of warfarin binding to normal plasma. These observations rule out the possibility that uric acid, beta -phenylpyruvic acid, guanidinosuccinic acid, or p-hydroxyphenylacetic acid contribute to the warfarin binding defect in uremia, and suggest that free fatty acids have no role in the warfarin binding defect.

Blood Proteins↗