Heart rate deceleration in REM sleep: an orienting reaction interpretation.
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Biomedical subjects
Publications and source records attributed to W B Taylor.
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To avoid the accumulation of metoclopramide that occurs with repeated i.v. bolus doses, a new regimen for the administration of high-dose metoclopramide consisting of a loading dose followed by a continuous infusion was investigated to determine the pharmacokinetics and antiemetic efficacy of the drug when given in this manner. Nine patients with non-Hodgkin's lymphoma entered the study, of whom six completed the study, receiving each of three dosage schedules of metoclopramide during three consecutive courses of chemotherapy. In these six patients plasma metoclopramide half-life was 5.9 +/- 0.4 h (mean +/- s.e. mean) and plasma clearance was 25.4 +/- 4.8 l/h (mean +/- s.e. mean). Neither half-life nor clearance were dose-related. Steady-state was achieved during 9/18 infusions. Nausea and vomiting were completely controlled in 13/24 treatment courses (57%) and adverse effects were minimal. We conclude that steady-state plasma concentrations of metoclopramide can be achieved using a weight-related infusion regimen, though the optimum plasma concentration remains to be determined.
The plasma concentrations of dopamine (DA), adrenaline (AD) and noradrenaline (NA) were measured during 29 routine hemodialysis (HD) treatments on 13 patients to determine whether any changes occurred in the concentrations of these substances during HD. All of the 13 patients studied demonstrated a fall in mean arterial pressure (MAP) when HD was commenced. Decreased concentrations of all three catecholamines were also demonstrated after the first hour of dialysis. Plasma AD rose after two hours, but NA and DA were still significantly lower than pre-dialysis values at the end of HD. Study of 12 further patients during the first hour of HD confirmed that the NA level had fallen significantly by the fifteenth minute of HD, while the DA and AD levels took somewhat longer to fall. Both NA and DA were present in the dialysate in substantial amounts. Although the fall in MAP which accompanies HD is probably multifactorial, the loss of plasma catecholamines during HD may possibly contribute to the hemodynamic changes.
A 55-year-old black woman with an eight-year history of prurigo nodularis was treated successfully with blistering cryotherapy. Cryotherapy resulted in smooth macule formation and afforded extended relief of pruritus. Several standard modalities of treatment had been used previously and had resulted in only partial relief of symptoms and minimal reduction of nodule size. This case demonstrates that cryotherapy can be a useful therapeutic alternative for prurigo nodularis.
A double-blind trial of phenytoin therapy following craniotomy was performed to test the hypothesis that phenytoin is effective in reducing postoperative epilepsy. A significant reduction in the frequency of epilepsy was observed in the group receiving the active drug up to the 10th postoperative week. Half of the seizures occurred in the first 2 weeks and two-thirds within 1 month of cranial surgery. High rates of epilepsy were observed after surgery in patients with meningioma, metastasis, aneurysm, and head injury. Routine prophylaxis with phenytoin (in a dosage of 5 to 6 mg/kg/day) would seem to be indicated, particularly in high-risk patients and, where possible, this treatment should be started 1 week preoperatively. Seizure control is best when therapeutic levels of phenytoin are maintained.
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The compliance to anticoagulants of a group of patients with prosthetic heart valves has been assessed in the present study. It was found that the level of compliance to these agents was of the order of 90%. Additional compliance data were generated in relation to cardiac drugs and diuretics, which were taken concurrently by the patients. Significant differences were noted between the three categories, the diuretics being the group for which compliance was least. It is postulated that the formal routine adopted by clinics managing patients on anticoagulants greatly enhances compliance with these drugs. The inconvenience of the mode of action of diuretics is no doubt a significant factor in the poor compliance found with them.
Verrucous carcinoma, a variant of squamous cell carcinoma, is recognized as a distinct clinicopathologic entity. It occurs principally in three anatomic sites: panoral, genitogluteal, and plantar. Two cases of plantar verrucous carcinoma treated by the Mohs' chemosurgery technique are reported, and the literature is reviewed. The clinical and pathologic appearance of these lesions make them recognizable in a patient with a persistent plantar lesion usually diagnosed as a wart but unresponsive to conventional therapy. The role of irradiation, a possible viral etiology of the tumor, and the necessity for a deep biopsy are discussed. Because these tumors are characterized by extensive local growth, Mohs' chemosurgery is proposed as the treatment of choice. In this way, total tumor ablation is obtained with maximum preservation of normal tissue structure and function.
Medications were checked by a trained nurse during the course of her duties in a controlled study of 150 elderly people with cerebrovascular disease. The cost of medications was marginally reduced in a group of people receiving the additional supervision, while it rose by 12.0% in a control group. In the group visited by the nurse, containers were labelled correctly for significantly more people than was the case with the control group.
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A young man with the Wyburn-Mason syndrome was found to have a large basal-cell carcinoma. It is not known if the lesion was merely coincidental or in some way related to this rare anomaly.
Although bullous pemphigoid is a disease associated with autoantibodies, it rarely has been associated with other diseases associated with autoimmune phenomena. We report the occurrence of bullous pemphigoid, pernicious anemia, and rheumatoid arthritis in a patient.
Pyoderma gangrenosum is an ulcerative skin disorder with typical clinical characteristics. Histologic and laboratory findings are nonspecific. Pyoderma gangrenosum is associated with internal disorders including inflammatory bowel disease, paraproteinemias, leukemias, and arthritis. The pathogenesis of pyoderma gangrenosum is unknown, although a partial defect of cell-mediated immunity may exist. Treatment includes bedrest, local care, sulfonamides, sulfones, and corticosteroids.
According to a popular system of classification, the term ichthyosis hystrix denotes an organoid epidermal nevus composed of hyperkeratotic papules with a bilateral distribution. Our patient had dramatic disfiguring epidermal changes of this type covering nearly all of her body. Although this abnormality began at the age of 2, she does not exhibit any of the various neurological or skeletal derangements that have been reported to be associated with the condition.