Medicine and Health Sciences Commons^™

A Comparison Of Four Treatments For Generalized Convulsive Status Epilepticus, David M. Treiman , M.D., Patti D. Meyers , M.P.A., Nancy Y. Walton , Ph.D., Joseph F. Collins , Sc.D., Cindy Colling , R.Ph., M.S., A. James Rowan , M.D., Adrian Handforth , M.D., Edward Faught , M.D., Vincent P. Calabrese , M.D., Basim M. Uthman , M.D., R. Eugene Ramsay , M.D., Meenal B. Mamdani , M.D., Pratap Yagnik , M.D., John C. Jones , M.D., Elizabeth Barry , M.D., Jane G. Boggs , M.D., Andres M. Kanner , M.D.

VCU Health Publications

ABSTRACT

Background and Methods Although generalized convulsive status epilepticus is a life-threatening emergency, the best initial drug treatment is uncertain. We conducted a five-year randomized, doubleblind, multicenter trial of four intravenous regimens: diazepam (0.15 mg per kilogram of body weight) followed by phenytoin (18 mg per kilogram), lorazepam (0.1 mg per kilogram), phenobarbital (15 mg per kilogram), and phenytoin (18 mg per kilogram). Patients were classified as having either overt generalized status epilepticus (defined as easily visible generalized convulsions) or subtle status epilepticus (indicated by coma and ictal discharges on the electroencephalogram, with or without subtle convulsive movements such as …

Preventing The Unnecessary Losses Of Alzheimer's Disease, Lin E. Noyes

Case Studies from Age in Action

Educational Objectives

1. To state the importance of early detection and diagnosis of Alzheimer's disease.

2. To describe common concerns of people in the early stages of Alzheimer's disease.

3. To describe interventions to help people who have recently been diagnosed with Alzheimer's disease or other dementias.

Reducing Medication Mismanagement In Adult Care Residences, Mary Ann F. Kirkpatrick

Case Studies from Age in Action

Educational Objectives

1. Describe the prevalence of medication mismanagement in adult care facilities in Virginia.

2. Explain the significance of selected medication management errors.

3. Recommend practices to improve medication management task performance in adult care facilities.

State Regulation Of Assisted Living Facilities, Sonya A. Sterbenz

Case Studies from Age in Action

Educational Objectives

1. To define the role of assisted living facilities in the continuum of long-term care options for older adults.

2. To present the various arguments concerning the regulation of the assisted living industry.

Medications And Falls, Patricia W. Slattum

Case Studies from Age in Action

Educational Objectives:

1. To describe potential causes of falls and ways to prevent them.

2. To illustrate how medications can contribute to an increased risk of falls and recommend strategies for reducing this risk.

A Comparison Of Rectal Diazepam Gel And Placebo For Acute Repetitive Seizures, Fritz E. Dreifuss , M.D., N. Paul Rosman , M.D., James C. Cloyd , Pharm.D., John M. Pellock , M.D., Ruben I. Kuzniecky , M.D., Warren D. Lo , M.D., Fumisuke Matsuo , M.D., Gregory B. Sharp , M.D., Joan A. Conry , M.D., Donna C. Bergen , M.D., Walter E. Bell , Ph.D

Neurology Publications

ABSTRACT

Background Acute repetitive seizures are readily recognizable episodes involving increased seizure frequency. Urgent treatment is often required. Rectal diazepam gel is a promising therapy.

Methods We conducted a randomized, doubleblind, parallel-group, placebo-controlled study of home-based treatment for acute repetitive seizures. Patients were randomly assigned to receive either rectal diazepam gel, at doses ranging from 0.2 to 0.5 mg per kilogram of body weight on the basis of age, or placebo. Children received one dose at the onset of acute repetitive seizures and a second dose four hours later. Adults received three doses — one dose at onset, and two …

Analysis Of Phosphorescence In Heterogeneous Systems Using Distributions Of Quencher Concentration, A.S. Golub, A.S. Popel, L. Zheng, R.N. Pittman

Physiology and Biophysics Publications

ABSTRACT

A continuous distribution approach, instead of the traditional mono- and multiexponential analysis, for determining quencher concentration in a heterogeneous system has been developed. A mathematical model of phosphorescence decay inside a volume with homogeneous concentration of phosphor and heterogeneous concentration of quencher was formulated to obtain pulse-response fitting functions for four different distributions of quencher concentration: rectangular, normal (Gaussian), gamma, and multimodal. The analysis was applied to parameter estimates of a heterogeneous distribution of oxygen tension (P02) within a volume. Simulated phosphorescence decay data were randomly generated for different distributions and heterogeneity of PO2 inside the excitation/emission volume, consisting …

Diffusion Behavior Of Lipid Vesicles In Entangled Polymer Solutions, X. Cao, R. Bansil, D. Gantz, E.W. Moore, N. Niu, Nezam H. Afdhal

Internal Medicine Publications

ABSTRACT

Dynamic light scattering was used to follow the tracer diffusion of phospholipid/cholesterol vesicles in aqueous polyacrylamide solutions and compared with the diffusive behavior of polystyrene (PS) latex spheres of comparable diameters. Over the range of the matrix concentration examined (Cp = 0.1-10 mg/ml), the diffusivities of the PS spheres and the large multilamellar vesicles exhibited the Stokes-Einstein (SE) relation, while the diffusivity of the unilamellar vesicles did not follow the increase of the solution's viscosity caused by the presence of the matrix molecules. The difference between the diffusion behaviors of unilamellar vesicles and hard PS spheres of similar size …

Standing Up To Osteoporosis, Robert W. Downs

Case Studies from Age in Action

Educational Objectives

1. To provide basic information about osteoporosis, including risk factors, diagnostic testing, treatment, and prevention.

2. To get you to help us spread the word that osteoporosis can be diagnosed and treated, and that there are things you can do to decrease your future risk for developing osteoporosis.

Adverse Cerebral Outcomes After Coronary Bypass Surgery, Gary W. Roach , M.D., Marc Kanchuger , M.D., Christina Mora Mangano , M.D., Mark Newman , M.D., Nancy Nussmeier , M.D., Richard Wolman , M.D., Anil Aggarwal , M.D., Katherine Marschall , M.D., Steven H. Graham , M.D., Ph.D., Catherine Ley , Ph.D., Gerard Ozanne , M.D., Dennis T. Mangano , Ph.D., M.D., Ahvie Herskowitz , M.D., Vera Katseva , Ph.D, Rita Sears , R.N., M.S.

Anesthesiology Publications

ABSTRACT

Background Acute changes in cerebral function after elective coronary bypass surgery are a difficult clinical problem. We carried out a multicenter study to determine the incidence and predictors of — and the use of resources associated with — perioperative adverse neurologic events, including cerebral injury.

Methods In a prospective study, we evaluated 2108 patients from 24 U.S. institutions for two general categories of neurologic outcome: type I (focal injury, or stupor or coma at discharge) and type II (deterioration in intellectual function, memory deficit, or seizures).

Results Adverse cerebral outcomes occurred in 129 patients (6.1 percent). A total of …

Decreases In Ovarian Cytochrome P450c17 Alpha Activity And Serum Free Testosterone After Reduction Of Insulin Secretion In Polycystic Ovary Syndrome, John E. Nestler , M.D., Daniela J. Jakubowicz , M.D.

Obstetrics and Gynecology Publications

BACKGROUND

Insulin resistance and increased ovarian cytochrome P450c17α activity are both features of the polycystic ovary syndrome. P450c17α, which is involved in androgen biosynthesis, has both 17α-hydroxylase and 17,20-lyase activities. Increased activity of this enzyme results in exaggerated conversion of progesterone to 17α-hydroxyprogesterone in response to stimulation by gonadotropin. We hypothesized that hyperinsulinemia stimulates ovarian P450c17α activity.

METHODS

We measured serum steroid concentrations during fasting and the response of serum 17α-hydroxyprogesterone to leuprolide, a gonadotropin-releasing hormone agonist, and performed oral glucose-tolerance tests before and after oral administration of either metformin (500 mg three times daily) or placebo for four to …

Pharmacokinetics Of Vancomycin In Critically Ill Infants Undergoing Extracorporeal Membrane Oxygenation, R. Davis Maker, Joseph T. Dipiro, Jatinder Bhatia

Publications from the Office of the Dean

Extracorporeal membrane oxygenation (ECMO) is a widely used therapy for neonates with respiratory failure. Because of sepsis, many of these infants require antibiotics like vancomycin during ECMO treatment. ECMO transiently alters renal function and increases the circulating blood volume by 75%. Initial vancomycin pharmacokinetics were determined in 12 infants undergoing ECMO to determine an adequate drug administration regimen. Vancomycin dosage was based on current recommendations for weight and gestational age. Pharmacokinetic parameters were determined by fitting the data to a two compartment model. This study yielded a mean steady-state volume of distribution of 1.1 +/- 0.5 (range, 0.6 to 2.1) …

Periodic Lateralized Epileptiform Discharges, Nathan Watemberg , M.D., Lawrence D. Morton , M.D.

Neurology Publications

No abstract provided.

A National Survey Of The Arrangements Managed-Care Plans Make With Physicians, Marsha R. Gold , Sc.D., Robert Hurley , Ph.D., Timothy Lake , M.P.P., Todd Ensor, Robert Berenson , M.D.

Health Administration Publications

Abstract

Background. Despite the growth of managed care in the United States, there is little information about the arrangements managed-care plans make with physicians.

Methods. In 1994 we surveyed by telephone 138 managed-care plans that were selected from 20 metropolitan areas nationwide. Of the 108 plans that responded, 29 were group-model or staff-model health maintenance organizations (HMOs), 50 were network or independentpractice–association (IPA) HMOs, and 29 were preferred-provider organizations (PPOs).

Results. Respondents from all three types of plan said they emphasized careful selection of physicians, although the group or staff HMOs tended to have more demanding requirements, …

Effect Of Oral Alendronate On Bone Mineral Density And The Incidence Of Fractures In Postmenopausal Osteoporosis, Uri A. Liberman , M.D., Ph.D., Stuart R. Weiss , M.D., Johann Bröll , M.D., Helmut W. Minne , M.D., Hui Quan , Ph.D., Norman H. Bell , M.D., Jose Rodriguez-Portales , M.D., Robert W. Downs , Jr., M.D., Jan Dequeker , M.D., Ph.D., Murray Favus , M.D., Ego Seeman , M.D., Robert R. Recker , M.D., Thomas Capizzi , Ph.D., Arthur C. Santora , M.D., Ph.D., Antonio Lombardi , M.D., Raksha V. Shah , M.A., R.D., Laurence J. Hirsch , M.D., David B. Karpf , M.D.

Internal Medicine Publications

BACKGROUND

Postmenopausal osteoporosis is a serious health problem, and additional treatments are needed.

METHODS

We studied the effects of oral alendronate, an aminobisphosphonate, on bone mineral density and the incidence of fractures and height loss in 994 women with postmenopausal osteoporosis. The women were treated with placebo or alendronate (5 or 10 mg daily for three years, or 20 mg for two years followed by 5 mg for one year); all the women received 500 mg of calcium daily. Bone mineral density was measured by dual-energy x-ray absorptiometry. The occurrence of new vertebral fractures and the progression of vertebral deformities …

Inactivation Of Hit Cell Ca2+ Current By A Simulated Burst Of Ca2+ Action Potentials, L. S. Satin, S. J. Tavalin, P. D. Smolen

Pharmacology and Toxicology Publications

ABSTRACT A novel voltage-clamp protocol was developed to test whether slow inactivation of Ca2+ current occurs during bursting in insulin-secreting cells. Single insulin-secreting HIT cells were patch-clamped and their Ca2+ currents were isolated pharmacologically. A computed ,3-cell burst was used as a voltage-clamp command and the net Ca2+ current elicited was determined as a cadmium difference current. Ca2+ current rapidly activated during the computed plateau and spike depolarizations and then slowly decayed. Integration of this Ca2+ current yielded an estimate of total Ca influx. To further analyze Ca2+ current inactivation during a burst, repetitive test pulses to + 10 mV …

Lipopolysaccharide-Reactive Immunoglobulin E Is Associated With Lower Mortality And Organ Failure In Traumatically Injured Patients, Joseph T. Dipiro, Robert G. Hamilton, Thomas R. Howdieshell, N. Franklin Adkinson Jr., Arlie R. Mansberger Jr.

Publications from the Office of the Dean

Antilipopolysaccharide (anti-LPS) immunoglobulin G (IgG) and IgM have been associated with protection from LPS effects in vivo. We investigated the presence of IgE and anti-LPS in 32 patients that had experienced severe traumatic injury and in 35 healthy volunteers; we also investigated whether IgE anti-LPS was associated with important clinical events. Plasma samples were collected daily from patients in the intensive care unit and on one occasion from volunteers; the samples were assayed for IgE anti-LPS. IgE anti-LPS was assayed by enzyme-linked immunosorbent assay with monoclonal anti-human IgE as the capture antibody. Detection was accomplished with biotin-labeled LPS (Escherichia coli …

Facilitation Of Penicillin Haptenation To Serum Proteins., Joseph T. Dipiro, N. Franklin Adkinson Jr., Robert G. Hamilton

Publications from the Office of the Dean

Traditionally, penicillin binding to serum proteins was believed to be a passive chemical process; however, it appears to be facilitated by serum factors. The objectives of this in vitro investigation were to examine facilitated penicillin haptenation, to study the kinetics of haptenation, and to determine the nature of haptenation-facilitating factors. The model involved addition of [3H]benzylpenicillin to serum or albumin solutions (at pH 7.3 to 7.4) and incubation at 37 degrees C for up to 72 h. The extent of penicillin binding to proteins in serum was found to be four- to fivefold higher than with solutions having comparable concentrations …

In Vitro Protein Binding Of Cefonicid And Cefuroxime In Adult And Neonatal Sera., John M. Benson, F. Douglas Boudinot, Andrew T. Pennell, Francesca E. Cunningham, Joseph T. Dipiro

Publications from the Office of the Dean

The levels of in vitro protein binding of cefonicid and cefuroxime in human adult and neonatal sera were compared.Binding parameters for each drug were determined within the concentration range of 25 to 3,000 micrograms/ml.Cefonicid exhibited concentration-dependent protein binding in both types of sera, with more extensive binding in adultserum at all concentrations. Two classes of binding sites were found: a high-affinity, saturable site and a low-affinity, nonspecific site. Cefuroxime also showed two-class, concentration-dependent protein binding in adult serum, but bindingin neonatal serum was to a single class and was independent of drug concentration. Parameters for class 1 binding sites for …

Safety And Pharmacokinetics Of Multiple Doses Of Intravenous Ofloxacin In Healthy Volunteers, David R. P. Guay, John A. Opsahl, F. Gilbert Mcmahon, Ramon Vargas, Gary R. Matzke, Soledad Flor

Pharmacotherapy and Outcomes Science Publications

The safety and pharmacokinetics of ofloxacin in 48 healthy male volunteers were studied in a two-center, randomized, double-blind, placebo-controlled study. Ofloxacin (200 or 400 mg) or placebo was administered as 1-h infusions every 12 h for 7 days. Plasma ofloxacin concentrations were measured by high-performance liquid chromatography. Mean harmonic half-lives ranged from 4.28 to 4.98 h in the 200-mg dosing group and from 5.06 to 6.67 h in the 400-mg dosing group. Intragroup comparisons of trough plasma concentration-versus-time data from study days 2 through 7 revealed that steady state was achieved by day 2 of both multiple-dose regimens. Intergroup comparisons …

Transmission Of Human Immunodeficiency Virus Type 1 From A Seronegative Organ And Tissue Donor, R.J. Simonds , M.D., Scott D. Holmberg M.D., M.P.H., Richard L. Hurwitz , M.D., Theresa R. Coleman , B.A., Scott Bottenfield , R.N., Lois J. Conley , M.T., M.P.H., Sherry H. Kohlenberg , M.H.A., Kenneth G. Castro , M.D., Beverley A. Dahan , B.A., Charles A. Schable , M.S., Mark A. Rayfield , Ph.D., Martha F. Rogers , M.D.

Health Administration Publications

Abstract

BACKGROUND

Since 1985, donors of organs or tissues for transplantation in the United States have been screened for human immunodeficiency virus type 1 (HIV-1), and more than 60,000 organs and 1 million tissues have been transplanted. We describe a case of transmission of HIV-1 by transplantation of organs and tissues procured between the time the donor became infected and the appearance of antibodies. The donor was a 22-year-old man who died 32 hours after a gunshot wound; he had no known risk factors for HIV-1 infection and was seronegative.

METHODS

We reviewed the processing and distribution of all the …

A Comparison Of Standard-Dose And High-Dose Epinephrine In Cardiac Arrest Outside The Hospital, Charles G. Brown, Daniel R. Martin, Paul E. Pepe, Harlan Stueven, Richard O. Commins, Edgar Gonzalez, Michael Jastremski, The Multicenter High-Dose Epinephrine Study Group

Emergency Medicine Publications

BACKGROUND.

Experimental and uncontrolled clinical evidence suggests that intravenous epinephrine in doses higher than currently recommended may improve outcome after cardiac arrest. We conducted a prospective, multicenter study comparing standard-dose epinephrine with high-dose epinephrine in the management of cardiac arrest outside the hospital.

METHODS.

Adult patients were enrolled in the study if they remained in ventricular fibrillation, or if they had asystole or electromechanical dissociation, at the time the first drug was to be administered to treat the cardiac arrest. Patients were randomly assigned to receive either 0.02 mg of epinephrine per kilogram of body weight (standard-dose group, 632 patients) …

Elder-Caregiving Among University Employees: Responsibilities And Needs, Constance L. Coogle, Edward F. Ansello

Virginia Center on Aging Publications

Although many institutions of higher education often house the researchers who study eldercare, few have documented the need for information and services among their estimated 460,000 employees who face the difficult task of effectively balancing work and eldercare responsibilities. Even fewer have established programs to address this need.

Drs. Constance Coogle and Edward Ansello have recently completed an exhaustive survey of VCU employees (N = 11,430) to determine the extent to which they provide care to disabled parents or spouses.[1] A longer, more detailed survey was sent to those who indicated that they were eldercaregivers to measure their perceived …

Pharmacokinetics Of Ceftibuten-Cis And Its Trans Metabolite In Healthy Volunteers And In Patients With Chronic Renal Insufficiency, Judy Shepard Kelloway, Walid M. Awni, Chin C. Lin, Josephine Lim, Melton B. Affrime, William F. Keane, Gary R. Matzke, Charles E. Halstenson

Pharmacotherapy and Outcomes Science Publications

The impact of renal insufficiency on the dispositions of 300 mg of orally administered ceftibuten-cis, a new broad-spectrum oral cephalosporin, and its primary metabolite ceftibuten-trans was characterized in 30 adult subjects. Subjects were divided into five groups of six subjects each on the basis of their 24-h ambulatory creatinine clearances (CL_CR). The apparent total body clearance (CL_P/F; where F is absolute bioavailability) and renal clearance of ceftibuten-cis were significantly lower in subjects with end-stage renal disease (on maintenance hemodialysis; group V) and in those with severe (CL_CR, 5 …

Efficacy And Cost Effectiveness Of Adjuvant Chemotherapy In Women With Node-Negative Breast Cancer — A Decision-Analysis Model, Bruce E. Hillner , M.D., Thomas J. Smith , M.D.

Massey Comprehensive Cancer Center Publications

Abstract

BACKGROUND.

In 1988 the National Cancer Institute issued a Clinical Alert that has been widely interpreted as recommending that all women with node-negative breast cancer receive adjuvant chemotherapy. Acceptance of this recommendation is controversial, since many women who would not have a recurrence would be treated.

METHODS.

Using a decision-analysis model, we studied the cost effectiveness of chemotherapy in cohorts of 45-year-old and 60-year-old women with node-negative breast cancer by calculating life expectancy as adjusted for quality of life. The analysis evaluated different scenarios of the benefit of therapy: improved disease-free survival for five years, with a lesser effect …

Efficacy And Cost-Effectiveness Of Adjuvant Chemotherapy In Women With Node-Negative Breast-Cancer - A Decision-Analysis Model, Bruce E. Hillner , M.D., Thimas J. Smith M. D.

Internal Medicine Publications

BACKGROUND.

In 1988 the National Cancer Institute issued a Clinical Alert that has been widely interpreted as recommending that all women with node-negative breast cancer receive adjuvant chemotherapy. Acceptance of this recommendation is controversial, since many women who would not have a recurrence would be treated.

METHODS.

Using a decision-analysis model, we studied the cost effectiveness of chemotherapy in cohorts of 45-year-old and 60-year-old women with node-negative breast cancer by calculating life expectancy as adjusted for quality of life. The analysis evaluated different scenarios of the benefit of therapy: improved disease-free survival for five years, with a lesser effect on …

Pharmacokinetics Of Cefepime In Patients With Respiratory Tract Infections, J. M. Kovarik, J. C. Ter Maaten, C. M. A. Rademaker, M. Deenstra, I. M. Hoepelman, H. C. Hart, Gary R. Matzke, J. Verhoef

Pharmacotherapy and Outcomes Science Publications

The steady-state pharmacokinetics of cefepime were evaluated in 10 middle-aged and elderly patients with acute lower respiratory tract infections who were receiving 1 g intravenously every 12 h. One preinfusion and 15 postinfusion serum samples and total urine output were collected over one dosing interval between days 3 and 8 of therapy. Cefepime concentrations in serum over time exhibited a multicompartmental profile. Peak and trough concentrations in serum determined by a validated high-performance liquid chromatography method were 71.2 +/- 17.2 (mean +/- standard deviation) and 6.0 +/- 4.9 mg/liter, respectively. The steady-state volume of distribution was 0.22 +/- 0.05 liter/kg. …

Apparent Biliary Pseudolithiasis During Ceftriaxone Therapy, Karen L. Heim-Duthoy, Erskine M. Caperton, Robert Pollock, Gary R. Matzke, Dirk Enthoven, Phillip K. Peterson

Pharmacotherapy and Outcomes Science Publications

Biliary pseudolithiasis has been reported in patients who received ceftriaxone therapy. To examine this phenomenon further, serial gallbladder sonograms were evaluated in 44 adult patients who received intravenous ceftriaxone at 2 g or a placebo daily for 14 days in a double-blind controlled study. Ultrasound examinations of gallbladders were performed on days 1 and 14 of therapy and 2 weeks posttherapy if abnormalities were observed on day 14. Eight patients were unevaluable because of abnormal base-line gallbladder sonograms. Thirty-six patients (ceftriaxone, n = 28; placebo, n = 8) demonstrated normal baseline gallbladder sonograms and were evaluated for the development of …

Disorders Of The Digestive-System In The Elderly, Robert D. Shamburek, John T. Farrar

Internal Medicine Publications

CHANGES in the anatomy and physiology of the epithelium of the digestive organs because of aging are slight.1 The functional capacity of both the secretory and absorptive cells of the gut is so great that a decrease to as little as 5 to 10 percent of normal function is required for a clinical effect to be evident. In contrast to the epithelial-cell reserve, connective-tissue changes are manifested in midlife, and age-related changes in these tissues are responsible for many digestive disorders, such as colonic vascular ectasias and diverticula of the gut.

The anatomical and physiologic changes that do occur …

Cyclosporine-Induced Sympathetic Activation And Hypertension After Heart-Transplantation, Urs Scherrer, Susan F. Vissing, Barbara J. Morgan, Julia A. Rollins, Richard S. A. Tindall, Steves Ring, Peter Hanson, Pramod K. Mohanty, Ronald G. Victor

Internal Medicine Publications

BACKGROUND.

Hypertension is a frequent complication of cyclosporine-induced immunosuppression, but the underlying mechanism is unknown. In anesthetized animals, the administration of cyclosporine increases sympathetic-nerve discharge, which may contribute to hypertension.

METHODS.

To determine whether cyclosporine-induced hypertension is accompanied by sustained sympathetic neural activation in patients, we recorded sympathetic action potentials using intraneural microelectrodes (in the peroneal nerve) in heart-transplant recipients receiving azathioprine and prednisone alone (n = 5) or in combination with cyclosporine (n = 14). We performed the same studies in eight patients with myasthenia gravis who were receiving cyclosporine and eight who were not, in five patients with …