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PubMed1979

Factors influencing clinical response to psychotropic drugs. Imipramine in depression.

Numerous factors are involved in determining the efficacy of tricyclic antidepressant agents in the treatment of depression. The list includes diagnosis and patient selection; pharmacodynamics, bioavailability and tissue sensitivity; natural history; placebo response, nonspecific factors; compliance and adverse effects; the effects of concurrent life events, illness and treatment, and the bias in evaluating the outcome of treatment. Physicians should be aware of the factors that influence clinical response so they can maximize therapeutic effects and utilize the agents properly.

Biological Availability↗
PubMed1978

Methylergometrine: comparison of plasma concentrations and clinical response of two brands.

There were no significant differences between the two brands of methylergometrine (methylergonovine), Methergin and Myomergin, in the radioimmunologically measured serum concentrations nor in the AUC after an oral 0.250 mg dose determined on the third or sixth postpartum day during a continuous treatment with methylergometrine 0.125 mg t.i.d., nor were there significant differences in the clinical response to this oxytocic drug. Peak serum concentrations were obtained at 3 hours (Methergin 6.3 nmol/1 and Myomergin 6.0 nmol/1), indicating a delayed gastrointestinal absorption in postpartum females in comparison with healthy male volunteers [6]. Spontaneous complaints of side-effects were rare and mild.

Adult↗
PubMed1978

Correlation between clinical response to hormone therapy and steroid receptor content in prostatic cancer.

Hormonal therapy is the dominating form of treatment for prostatic carcinoma. The majority of cases (80%) are well controlled for varying times with this regimen. However, thus far there have been no adequate methods to predict in which cases hormonal therapy is of less benefit. Measurement of cancer tissue content of intracellular hormone receptors constitutes progress toward a more individualized therapy in prostatic carcinoma. In this study biopsies from 16 cancer patients were taken before therapy was given, and the specimens were analyzed with regard to content of specific methyltrienolone-binding sites. A correlation has been made between receptor content and clinical response to hormonal therapy in each case. Twelve specimens contained measurable amounts of steroid receptors. Of these, one patient died during irradiation therapy before onset of hormonal treatment. However, of the remaining 11 patients, 9 responded well to hormones (9/11 approximately 82%). The two receptor-positive nonresponders had the lowest measurable receptor levels in the series. Four specimens contained no detectable amounts of receptors. Three of these patients showed no response to therapy (3/4 = 75%) but one was "false negative." Our data indicate that steroid receptor analysis may become a valuable diagnostic tool in individualizing the therapy for prostatic cancer.

Aged↗
PubMedDate not supplied

Clinical response to therapeutic agents in poisoning from mercury vapor.

Exposure to mercury vapors for an hour per working day over a period of 13 years produced in a thermometer manufacturer severe signs and symptoms of mercury poisoning. Complete disability developed insidiously over the last six months of employment. During the first two months of observation, the patient was treated in succession with three chelating agents: 2,3-dimercapto-l-propanol (BAL), D-penicillamine and sodium diethyldithiocarbamate (Dithiocarb). Each agent was administered initially for a period of approximately two weeks. A second course of therapy with BAL was administered for three days. Of the three complexing agents used, BAL gave the most dramatically favorable clinical response and yielded the highest urinary excretions of mercury. Dithiocarb was partially effective; d-pencillamine proved to be essentially ineffective. Analyses of the patient's sweat indicated that appreciable amounts of mercury were excreted by this route. Following the alleviation of the severe symptoms by BAL, the patient was placed on a regimen of daily sweats and physio-therapy for a protracted period of several months. On this latter regimen, the mercury levels in the urine, blood serum and sweat were decreased to within the normal ranges of values. The patient made a complete and uneventful recovery. In patients encountering psychotic and neurological disorders of undetermined etiology, consideration should be given to unsuspected or masked chronic exposure to mercury vapors as a possible cause.

Adult↗
PubMed1977

Correlation of laboratory studies with clinical responses to A/New Jersey influenza vaccines.

The large, uniformly performed clinical investigations with influenza A/New Jersey vaccines provided an opportunity to correlate results of laboratory tests of vaccine with human reactivity and antibody responses. These vaccines were given to large numbers of subjects under code, and significant differences in immunogenicity and reactivity were observed in unprimed individuals. A single, relatively large dose of intact virus was more immunogenic and reactive than split-virus vaccines in unprimed subjects. Differences in immunogenicity and reactivity in unprimed subjects correlated with the amount of intact virus in the vaccines (measured by column chromatography or electron microscopy) and with the amount of viral hemagglutinin in the vaccine (measured by immunodiffusion), but not with the number of chick cell-agglutinating units.

Adolescent↗
PubMed1977

Physician receptivity to nurse practitioners: a study of the correlates of the delegation of clinical responsibility.

A survey to measure physician receptivity to nurse practitioners was conducted in North Carolina in 1973. All North Carolina physicians were asked to rate a list of 35 clinical tasks of varying levels of difficulty and responsibility according to their willingness to delegate these tasks to nurse practitioners. Using eight items from this list that were good discriminants of physician attitudes towards delegating responsibility, task delegation scores were correlated with physician characteristics and their responses to questions about recruitment, training, reimbursement, and willingness to hire nurse practitioners. Thirty-four per cent of the respondents would hire a nurse practitioner, whereas 52% approved of the concept but would not hire one. Physicians who had previously worked with a nurse practitioner were more willing to hire one and had a higher task delegation score. Sixty-eight per cent of respondents would share their load with nurse practitioners in their offices, while 6% would have them work in satellite clinics away from the physicians' offices. Most physicians wanted their own nurse trained as a nurse practitioner in a program that combined a didactic course at a medical center with on-the-job training. The authors conclude that there is a potential demand for nurse practitioners in North Carolina and that the training program must prepare the nurse practitioners for the tasks physicians are willing to delegate to them.

Attitude of Health Personnel↗
PubMed1977

Diagnostic value of visual evoked response, clinical eye examination and CSF analysis in chronic myelopathy.

The results of neuro-ophthalmological examination, visual evoked responses (VER) to pattern reversal stimulation and cerebrospinal fluid (CSF) analysis were compared in 25 patients with myelopathy of unknown etiology and without subjective symptoms of involvement of CNS outside the spinal cord. Delayed latencies of VER indicating a disseminated disease were found in 76 per cent of the patients. In 64 per cent of the patients, CSF showed abnormalities similar to those found in MS. Pathological findings at the clinical eye examination consistent with such an etiology was found in 36 per cent of the cases. It is suggested that a large proportion of patients with myelopathy of unknown etiology suffer from a disseminated demyelinating disorder similar to MS. By a combination of neuro-ophthalmological, VER and CSF examinations such as etiology can be established with reasonable certainty, and more troublesome investigations such as myelographies and spinal angiographies may be restricted to patients in whom the etiology still remains unclear.

Adolescent↗
PubMed1978

Capturing clinical expertise. A computer program that considers clinical responses to digitalis.

The administration of digitalis by experienced cardiologists has been examined and a prototypical computer program has been developed which captures portions of their expertise. The new program first constructs a patient-specific model upon which to base the determination of dosage and then uses feedback information about a variety of clinical aspects of the patient's response to modify its recommendations. The model reflects both the program's knowledge of pharmacokinetics and those special features of the patient's condition which may alter his response to therapy. The program makes assessments of the therapeutic and the toxic effects of digitalis on the patient, and bases its subsequent recommendations on the "therapeutic-toxic" state which best describes the evolving clinical situation. A clinical trial was performed in which the program "followed" a series of patients managed by clinicians on a cardiology service. That trial demonstrated the feasibility of this type of program in dealing with acutely ill patients, even those who have increased sensitivity to the toxic effects of digitalis. Each patient in the trial in whom toxicity developed had received more digitalis than would have been recommended by the program. This approach to automated clinical consultation should eventually provide a technology for the distribution of clinical expertise.

Aged↗
PubMed1978

Chloroquine treatment in rheumatoid arthritis. Correlation of clinical response to plasma protein changes and chloroquine levels.

15 patients with active RA were observed over a 3-month period after starting chloroquine treatment. Clinical condition, plasma levels of chloroquine and levels of 15 individual plasma proteins were checked monthly. Nine patients responded favourably to therapy, 6 failed to respond. The responders had lower initial CRP, orosomucoid and ceruloplasmin levels, whereas their IgA and IgM levels were slightly elevated. Significant reductions in the levels of CRP, haptoglobin, orosomucoid, fibrinogen and ceruloplasmin occurred in the responder group of patients. Alfa1-antitrypsin, antichymotrypsin C3 and C4 levels within the normal range were frequently encountered despite other clear-cut signs of activity. The chloroquine levels did not differ between responders and non-responders, the mean concentrations being 1.04 and 1.6 micromol/l respectively. This study has also demonstrated that in selected cases, despite active joint disease, all acute phase proteins may be normal. Finally, it was obvious that chloroquine, even when inducing remission, only brought about a partial normalization of the plasma protein pattern.

Adult↗
PubMed1977

Effect of intravenous infusion of glucose and/or fructose on the composition of blood plasma and the clinical response of the calf.

Intravenous infusions of glucose (0.4 g/kg) or glucose (0.4 g/kg) + fructose (usually 1 g/kg) to calves were followed by various clinical reactions from absence of reaction up to death of a few calves. Fructosemia. After fructose + glucose infusion, the blood fructose concentration reached a level inferior to the highest value observed after only glucose infusion, except in the calves dead after the perfusion and in the newly-born calves (the initial fructose concentration was not nil). Glycaemia. In any case, fructose associated with glucose, did not eliminate the rebound of hypoglycaemia following usually a perfusion of glucose. In calves where the death occurred, the hypoglycaemia was specially marked.

Animals↗
PubMed1977

1976 Davis & Geck surgical essay. The delayed hypersensitivity response: clinical application in surgery.

The detection of anergy or relative anergy by delayed hypersensitivity skin tests was predictive of infection and related mortality in 354 surgical patients. Cancer or advanced age alone did not account for the increased morbidity and mortality seen in this study. Altered delayed hypersensitivity response is a reflection of abnormalities in cell-mediated immunity and possibly humoral or phagocytic defects, or both. Skin testing is of value to the clinical surgeon both in identifying the population at risk and in monitoring the immune response to therapy in the seriously ill patient. Failure to improve skin-test response may indicate underlying infection or malnutrition, which, if untreated, results in a high mortality.

Adolescent↗
PubMed1978

Hyperkinetic/aggressive boys in treatment: predictors of clinical response to methylphenidate.

Data on 84 nonretarded boys aged 6--12 with the hyperkinetic/MBD syndrome were drawn from a comprehensive, longitudinal investigation in the interest of identifying factors that contribute significantly to variation in clinically rated improvement during treatment with methylphenidate. The size of the multiple correlation (R = .50) indicates that 25% of the variation in the children's response to methylphenidate is jointly predictable from age at referral, degree of perinatal complications, and score on the hyperactivity factor. The authors discuss stepwise multiple regression analysis as the method of choice in drug response prediction studies and the possible effects on the results of such studies of differing definitions of improvements.

Age Factors↗