Biomedical subjects
Publications and source records attributed to S Johnson.
The investigation of imaginative literature has been one of psychotherapy's most useful tools for the explication of its theories and the general dissemination of psychotherapeutic concepts. Using this idea, I examine Luigi Pirandello's play Six Characters in Search of an Author from a constructivist, family therapy, point of view.
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We initiated a randomized, single-blinded trial of ciprofloxacin plus rifampin vs sulfamethoxazole and trimethoprim plus rifampin in the therapy for patients who underwent colonization with methicillin-resistant Staphylococcus aureus (MRSA). Patients who were colonized with MRSA received 2 weeks of either regimen. The study was terminated after the enrollment of 21 subjects due to the recognition of ciprofloxacin resistance in 10 of 21 new MRSA isolates during the last 2 months of the study. Five of the 10 patients with ciprofloxacin-resistant MRSA isolates had never received ciprofloxacin. Long-term (6-month) eradication had been achieved in only three of 11 ciprofloxacin plus rifampin and four of 10 sulfamethoxazole and trimethoprim plus rifampin recipients. The use of this new fluoroquinolone for the eradication of MRSA colonization is usually not effective and may risk the development of ciprofloxacin resistance in MRSA within the hospital environment.
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Because the significant health risks related to postmenopausal osteoporosis can be reduced by estrogen replacement therapy (ERT), this study assessed women's attitudes toward ERT to assess factors that might increase its use. Results showed that women taking ERT were more likely to know that decreased estrogen levels lead to osteoporosis, to perceive that menopause is a medical condition, to believe that natural approaches to menopause are less preferable, to be seeing a gynecologist for care, and to believe that women should take ERT for hot flashes. The study suggests that a systematic educational approach could influence women's willingness to take ERT, especially if the recommended therapy does not cause withdrawal bleeding.
This prospective series of results and complications of coronary arteriography from the Registry of the Society for Cardiac Angiography and Interventions is the largest ever reported. Since the initial report published in 1982, the results of coronary artery surgery and angioplasty have improved and therefore older and more symptomatic patients are referred for coronary arteriography. More patients are now studied by the femoral approach, and the major complications of the techniques are similar. Despite studying older and higher-risk patients, the complications are remarkably similar to those reported in the older series. Because of the sicker patients being studied, it is probably unlikely that the complication rate will decrease further in the future. The Society for Cardiac Angiography and Interventions will continue its Registry to follow complication rates of both established and new procedure.
In a 42-month period, 218 deaths occurred in 222,553 patients undergoing coronary arteriography (0.098%). Age greater than 60 years, NYHA Class IV function, presence of left main coronary disease, and ejection fraction less than 30% all significantly increased the risk of the procedure. Sex and approach (brachial or femoral) used for the catheterization did not affect mortality. Since the SCAI report in 1982, the death rate has dropped significantly in high-risk patients. Low-risk patients (NYHA Class I or normal coronary arteries) who died generally were elderly or had associated valvular heart disease.
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In two experiments the conditioning of meal initiation was investigated. Preschool children ate snacks repeatedly in the presence of visual and auditory cues (CS+). On other days, other visual and auditory cues (CS-) were presented in the absence of food. In the second experiment, location also served as a CS. To test for conditioned meal initiation, children were first fed a snack to ensure that they were sated. Immediately following this, on different days, food was presented in the presence of the CS+ or the CS- cues. Data on latency to eating and total consumption revealed evidence for conditioning, at least for children who could correctly identify which cues had and had not been paired with the presentation of food.
This paper describes the chemical synthesis and the development of structure-activity relationships (SAR) for the kappa opioid receptor affinity and mu/kappa opioid receptor selectivity of novel N-[(2-aminocyclohexyl)aryl]acetamide derivatives. The SAR of this series are investigated by consideration of structural modifications made to the aromatic moiety, the amide linkage, and cyclohexane and the pyrrolidine ring substituents of the prototype kappa selective agonist, PD117302 (trans-N-methyl-N-[2-(1-pyrrolidinyl)cyclohexyl]benzo[b]thiophene-4- acetamide) (1). The kappa and mu opioid receptor binding affinities of 23 novel compounds are reported. It is observed that optimal mu/kappa receptor selectivity is obtained with a benzo[b]thiophene aromatic system attached via the C-4 position, which is discussed in terms of steric and electronic parameters. The amide linkage has been replaced with the reversed amide, an ester, an aminomethylene, a thioamide, and a secondary amide. The best of these isosteres is the N-methyl amide. Substitution of the pyrrolidine ring of PD117302 in the 3-position with a hydroxymethylene group increases the mu/kappa selectivity compared to the unsubstituted compound, e.g. compound 14, trans-(+/-)-N-methyl-N-[2-[3-(hydroxymethyl)-1-pyrrolidinyl] cyclohexyl]-4-benzo[b]furanacetamide monohydrochloride, mu/kappa receptor selectivity = 244. The cis fused, 4,5 dimethyl ether substituted cyclohexane analogue trans-(+/-)-N-methyl-N-[4,5-dimethoxy-2-(1-pyrrolidinyl) cyclohexyl]-benzo[b]thiophene-4-acetamide monohydrochloride (32) has high in vitro kappa opioid receptor affinity (Ki = 16 nM) and equipotent analgesic activity to morphine after iv administration in rats.
Minitracheotomy is a new technique of tracheal suction by the introduction under local anaesthetic of a small bore tube into the trachea through the cricothyroid membrane. The use of minitracheotomy in the early management of respiratory problems in patients with spinal injuries is described with a few illustrative cases. This technique is an adjunct to good physiotherapy in clearing secretions from the trachea. Its advantages and disadvantages are discussed.
We have examined the in vitro sensitivities of A, B and C fibres in rabbit vagus nerves to local anaesthetic block with a range of local anaesthetic drugs. The nerves were maintained at 37 degrees C and pH 7.4 using an electrolyte solution equilibrated with 5% carbon dioxide. A fibres were the most, and C fibres the least, sensitive to block at low frequency stimulation (0.0167 Hz). Equipotent concentrations of the various drugs blocked C fibres at approximately the same rate. Rate of A fibre block was related to physicochemical properties of individual drugs. Low pKa and high lipid solubility favoured block of A fibres before C, whereas the reverse was true for high pKa and low solubility. Absolute potency was related to lipid solubility, but each type of local anaesthetic drug in clinical use has a different inherent potency. With stimulation at high frequencies (20 and 40 Hz), C fibres were more sensitive to use-dependent block than A fibres; this effect was more marked with drugs containing an amide than an ester linkage. Molecular size and lipid solubility may inter-react to govern the ability to produce use dependent block. Agents which contain an amide linking group, have a high pKa and are of low lipid solubility, may be used to produce differential C fibre block.
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