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At least 19 recordsLinked to original sources
PubMed1979

Lithium concentration and clinical responses.

The clinical use of measurements of drug concentrations in blood is empirical and largely confined to compliance and toxicity monitoring. As currently used in once or thrice a day dosage, lithium treatment is pulsatile, the blood concentration varying threefold over 24 hours; routine measurements reveal nothing of this and therefore do not aid therapeutic use. In a pilot study it is shown that the plasma lithium concentration can be raised from 0 to 2 mmol/l in a few hours, inducing changes in both kidney function and neuropsychological tests after only short delay. This suggests that mania might be quickly controlled with rapid dosage and opens up a new way of analysing the mechanisms of lithium action, or of using it to reveal changes in cerebral functioning.

Diuresis↗
PubMed1977

Clinical response of patients with gonococcal endocervicitis and endometritis-salpingitis-peritonitis to doxycycline.

The clinical response to single-drug therapy with doxycycline was evaluated in 25 patients with gonococcal endoceruicitis and was correlated with the bacterial isolates present within the cul-de-sac. The 10 patients with gonococcal salpingitis salpingitis and the three patients with gonococcal peritonitis exhibited excellent clinical responses. When polymicrobial infection coexisted with gonococcal peritonitis or functioned without the concomitant presence of Neisseria gonorrhoeae, a significantly altered therapeutic response was observed in four of the 12 patients. Four patients in this grouping exhibited either secondary temperature elevations or lack of a significant alteration of the white blood cell count, two features which were not characteristic of the patients with either gonococcal salpingitis or peritonitis. In the cases of polymicrobial peritonitis, there was a poor correlation between ensuing clinical response and in vitro resistance of one or more cul-de-sac isolated to doxycycline. The presence of a resistant organism did not preclude a good or satisfactory clinical response. The absence of a resistant organism correlated well with a good clinical response.

Adolescent↗
PubMed1978

Hormonal and clinical responses in amenorrhetic patients treated with gonadotropins and a nasal form of synthetic gonadotropin-releasing hormone.

Synthetic gonadotropin-releasing hormone (GnRH) in the form of nasal drops was self-administered by five amenorrheic patients in an attempt to assess its therapeutic value in anovulatory infertility. After follicular maturation had been induced with human menopausal gonadotropins (HMG), a total daily dose of 7.5 mg of GnRH in the form of nasal drops was self-administered at 2-hour intervals for 6 hours on 3 consecutive days. In four patients, plasma luteinizing hormone (LH) levels were significantly elevated over a period of at least 8 hours. In three of these patients, in addition, there was a definite upward shift in the basal body temperature (BBT) curve, and uterine bleeding occurred 6 to 9 days after the first dose of GnRH. In the fourth patient, ovulation was induced as indicated by a biphasic BBT curve, a plasma progesterone level of 13 ng/ml, and a luteal phase of 15 days. In the remaining patient, there was a borderline LH response and no clinical response. It is concluded that GnRH, in the form of nasal drops, is effective in eliciting and maintaining elevated plasma LH levels in patients in whom follicular maturation has been induced with HMG. By obtaining ovulatory LH levels, such a regimen can lead to ovulation. In addition, intranasal self-administration of GnRH is convenient and may provide an alternative route of administration for long-term therapy with this hormone.

Administration, Intranasal↗
PubMed1978

Relation of plasma prolactin to clinical response in schizophrenic patients.

It has been suggested that, if dopamine antagonism is a necessary condition for the antischizophrenic action of neuroleptics, the prolactin response, as an index of dopamine blockade, would correlate with clinical response. Morning prolactin and clinical symptomatology were measured in 15 schizophrenic patients before neuroleptic therapy, and after three and six weeks of high-dose butaperazine or loxapine treatment. Prolactin levels were transiently elevated during the unmedicated admission period, probably reflecting a normal stress response. Prolactin increased in all patients during neuroleptic therapy. There was, however, no correlation between magnitude of prolactin changes and clinical response, probably because the prolactin response achieved a maximum at relatively low doses of neuroleptics.

Adult↗
PubMed1975

Alterations of alpha2-globulin and the clinical response in patients with prostatic cancer following cryotherapy.

Evaluation of alterations in the level of alpha2-globulin in the serum of 18 patients with prostatic cancer prior to and following cryotherapy of their primary prostatic tumor and the clinical response of these patients disclosed: (1) a progressive increase in the level of alpha2-globulin and the incidence of patients with significantly elevated levels of alpha2-globulin, i.e., greater than or equal to 1.30 g/100 ml, with a progression of the stage of their malignancy; (2) a decrease in the levels of alpha2-globulin in the serum of 14 of 18 (78%) patients following cryotherapy, and (3) a favorable clinical response in 11 of 14 (79%) patients with prostatic cancer showing a decrease in alpha2-globulin following cryotherapy. While limited to the study of a relatively small patient population, the present results suggest a prognostic potential for alpha2-globulin, particularly as applied to stage identification in prostatic cancer. Pending confirmation by evaluation of a larger patient population, it may even provide objective criteria for monitoring the clinical response of an individual following cryotherapy of the prostate.

Alpha-Globulins↗
PubMed1979

Serum proteins in prostatic cancer. IV. Alterations and clinical response following cryoprostatectomy.

Evaluation of alterations in the level of the five major electrophoretic fractions of serum proteins (albumin, alpha 1-, alpha 2-, beta- and gamma-globulin) in 18 patients with prostatic cancer prior to and following cryoprostatectomy disclosed: (i) a progressive increase in the level of alpha 2- and beta-globulin and the incidence of patients possessing statistically significant (p less than 0.05) elevations in these proteins with a progression of the stage of their malignancy; (ii) a significant decrease in albumin, alpha 2- and beta-globulin and increase in alpha 1- and gamma-globulin from their preoperative levels following cryoprostatectomy in patients with metastatic disease (stage III) in association with a favorable clinical response; (iii) an overall significant decrease in albumin and alpha 2-globulin and increase in alpha 1-globulin from their preoperative levels and (iv) a general association of decreases in albumin (83% of the patients) and alpha 2-globulin (92%) and gamma-globulin (75%) with a favorable clinical response following cryoprostatectomy. Limited to study of a small patient population, the present results confirm earlier studies suggestive of a prognostic potential for alpha 2-globulin, as applied to stage identification in prostatic cancer once the initial diagnosis has been made. Pending confirmation and evaluation of a larger patient population, the observed alterations in serum protein, while not pathognomonic for prostatic cancer, and alterations of inhibitory ('immunoregulatory') factors, may provide adjunctive criteria for monitoring the clinical response following cryoprostatectomy.

Adenocarcinoma↗
PubMedDate not supplied

Mianserin plasma levels and differential clinical response in endogenous and reactive depression.

Fifty patients with moderate to severe primary depression were treated in equal groups of inpatients and outpatients with a constant dose of 60 mg. of mianserin daily for four weeks in a double blind placebo controlled trial with either a three times daily dosage regime or a single nightly dose. There was no difference in apparent compliance, side effects or therapeutic effect in either day-time or night-time dosage regimes. Patients developing high plasma levels of mianserin (greater than 70 microgram/l) were associated with a highly significantly poorer therapeutic outcome. Patients identified as endogenous depression demonstrated a significant negative correlation between plasma levels of mianserin and therapeutic response measured as an amelioration of either the Hamilton Rating Scale scores (r = --0.48) or on a new depression scale by Montgomery and Asberg (r = --0.51) with high levels associated with poor response. There was a significant correlation (r = 0.66) between mianserin plasma levels and age in endogenous depression. In those patients identified as suffering from reactive depression, no significant relationship could be seen between plasma levels and therapeutic response or with age. These findings support the view that the relationship between mianserin plasma levels and clinical response is more likely to be demonstrated in endogenous depression.

Adjustment Disorders↗
PubMed2026

Pathogenic properties of myasthenia gravis AChR autoantibodies associate with clinical response to efgartigimod.

BACKGROUND: Efgartigimod, a neonatal Fc receptor (FcRn) blocker, effectively reduces total IgG, including pathogenic acetylcholine receptor (AChR) autoantibodies in myasthenia gravis (MG); however, clinical responses vary. To investigate this variability, we studied how efgartigimod impacts AChR-specific autoantibody profiles and associated pathogenic mechanisms, including complement activation, AChR internalisation and ACh-binding site blockade. METHODS: Serum samples (N=150) were sourced from 50 AChR autoantibody-positive generalised MG patients participating in the phase 3 ADAPT study, randomised to receive efgartigimod (N=40) or placebo (N=10) in cycles of 4-weekly infusions. Samples were collected at baseline, day 29 and day 57 during the first cycle. Live cell-based assays quantified AChR-specific IgG subclasses and isotypes and assessed their capacity to mediate pathomechanisms. RESULTS: Efgartigimod decreased all detectable AChR-specific IgG subclasses. At baseline, AChR autoantibody-mediated C3b deposition, AChR internalisation and ACh-binding site blockade were detected in 42 (84%), 41 (82%) and 10 (20%) patients, respectively. After 4-weekly infusions of efgartigimod, the magnitude of all three pathomechanisms was significantly decreased. However, the extent of this reduction varied across individuals. Double responders on both MG-activities of daily living and quantitative MG scores demonstrated a greater reduction in complement activity and AChR internalisation compared with patients who responded on only one score or were double non-responders. In addition, efgartigimod reduced IgG-dependent IgM binding to AChR. CONCLUSIONS: These findings suggest that clinical efficacy may be more closely associated with functional modulation of the AChR-specific autoantibodies than with their absolute quantity alone. These results support the evaluation of mechanistic pathway monitoring as a potential strategy to predict or guide efgartigimod treatment response.

Humans↗
PubMedDate not supplied

Haemophilus vaginalis (Corynebacterium vaginale) vaginitis in women attending public health clinics: response to treatment with ampicillin.

Haemophilus vaginalis (Corynebacterium vaginale) was isolated from genital specimens from 150 women who came to a public health venereal disease clinic. Forty-six patients returned to the clinic for at least one follow-up examination. Of the returnees, 22 of 24 who initially had received adequate therapy (14 g ampicillin in seven days) were cured, compared with three of 22 who did not received adequate therapy (X2 = 25.11; P less than 0.00005). These data included significant cure rates with adequate therapy among the 46 returnees, of whom 25 had vaginitis due to H. vaginalis only (X2 = 16.67; P less than 0.00005) and 21 had vaginitis caused by a mixture of pathogens (X2 = 5.86; P less than 0.0156). Specimens obtained from 24 of the 46 returnees were cultured for H. vaginalis on the second visit; 19 were negative, and only five were positive. Clinical responses of the patients correlated closely with the results of culture in both treated and untreated groups (X2 = 14.23; P less than 0.00016).

Adolescent↗
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↗
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

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↗
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↗