A new classification of ophthalmic disorders with standardized ophthalmic abbreviations.

A classification of ocular disorders has been developed that is both comprehensive and easy to use. Each disorder was assigned a unique abbreviation and cross referenced to the International Classification of Diseases, 9th edition (ICD-9). Ophthalmic procedures, medications, and other terms were similarly standardized and abbreviated. The result is a system of ophthalmic terminology that improves the quality of the medical record, facilitates ICD-9 coding, and makes computer data entry faster and more accurate. The system is published as a standard text with companion handbook. A computer program that uses the system also has been developed.

[Pharmacokinetics of ceftazidime in healthy and renal failure subjects]. / Pharmacocinétique de la ceftazidime chez le sujet sain et chez l'insuffisant rénal.

Ceftazidime is poorly bound to plasma proteins, is not metabolized and is excreted mostly by glomerular filtration. Its elimination half-life is about 1.5-2 hours, and their kinetics are modified by renal impairment. The dosage recommended in adult is 1 to 2 g 8-hourly, to be adjusted to the needs of individual cases. The interval between doses must be extended to 12 hours in patients with mild renal impairment and to 36-48 hours in those with severe renal failure. A supplementary dose of ceftazidime is required at the end of each haemodialysis session. In patients under chronic peritoneal dialysis, the loading dose (10 mg/kg) is followed by continuous administration of 5 mg/kg into each dialysis cavity.

Serum and sputum concentrations of ceftazidime in patients with cystic fibrosis.

The pharmacokinetic parameters of ceftazidime were assessed in six cystic fibrotic patients during eight courses administered for acute exacerbations of pulmonary infection. In order to assess the initial and steady state concentrations of ceftazidime at a dose of 35 mg/kg and to determine the levels found after a higher dose, each ten day course of ceftazidime consisted of eight doses of 35 mg/kg followed by 22 doses of 50 mg/kg, all administered at 8-hourly intervals. Samples of blood and sputum were collected following the 1st, 8th and 9th doses for ceftazidime assay. The mean peak serum concentrations of ceftazidime were 97, 110 and 147 mg/l respectively with corresponding mean concentrations in sputum of 2.7, 2.6 and 1.6 mg/l. The mean clearance rate was calculated on a two compartment model to be 197 ml/min/50 kg lean body mass, the mean volume of distribution was 281/50 kg lean body mass and the mean half life was 1.57 h. There were large inter-patient differences in the pharmacokinetic parameters, however, which suggests that the clinical condition of the patient affects the pharmacokinetics of ceftazidime in cystic fibrosis. In all the patients, even after the doses of 50 mg/kg, the trough serum concentrations were low. Samples of blood were also collected for adverse effects before, during and after each course; there was no evidence of renal, hepatic or haematological changes in response to the drug.

Pharmacokinetics of ceftazidime in normal and uremic subjects.

The pharmacokinetics of ceftazidime, administered as a single intravenous dose of 15 mg/kg given in a bolus injection over 3 min, were investigated in 5 normal subjects and in 19 uremic patients. The subjects studied were divided into five groups according to values for endogenous creatinine clearance (CLCR): group I, five subjects with CLCR greater than 80 ml/min; group II, five patients with CLCR = 30 to 80 ml/min; group III, six patients with CLCR = 10 to 30 ml/min; group IV, four patients with CLCR = 2 to 10 ml/min; and group V, four anuric patients on hemodialysis. A two-compartment open model was used to calculate the pharmacokinetic parameters. In normal subjects, the mean apparent elimination half-life was 1.57 +/- 0.13 h. The central distribution volume and the apparent volume of distribution were 0.127 +/- 0.023 and 0.230 +/- 0.015 liter/kg, respectively. Of the injected dose, 83.6 +/- 3.6% was eliminated in the urine as parent drug within 24 h. The terminal half-life increased with impairment of renal function to about 25 h in severely uremic patients. Impairment of function did not significantly modify the half-life at alpha phase, central distribution volume, or apparent distribution volume. A 6- to 8-h hemodialysis procedure reduced concentrations of ceftazidime in plasma by approximately 88%, and the elimination half-life was 2.8 +/- 0.2 h. There was no evidence of accumulation of ceftazidime in four patients with severe and chronic impairment of function who received doses of 0.5 to 1.0 g every 24 h for 10 days.

Pharmacokinetics and tissue penetration of ceftazidime: studies on lymph, aqueous humour, skin blister, cerebrospinal and pleural fluid.

The elimination kinetics and penetration of ceftazidime into skin blister and lymphatic fluid were studied in nine healthy volunteers following a 1 g iv bolus injection. From the concentration time curve in plasma the following pharmacokinetic parameters (mean +/- S.D.) were calculated: elimination half-life 1.85 +/- 0.33 h; area under the curves 127 +/- 12 mg . h/l; apparent volume of distribution: 21.1 +/- 2.61; total plasma clearance: 133 +/- 13 ml/min and renal clearance: 109 +/- 7 ml/min. Urine recovery after 8 h was 82% of the administered dose. Nearly the same elimination rate constant, half-life and area under the curve were demonstrated for blister fluid and lymph. The penetration of ceftazidime into cerebrospinal fluid (n = 19), aqueous humour (n = 21) and pleural effusions (n = 5) were studied in patients after a 2 g iv bolus injection. In patients with normal meninges (n = 14) the penetration was poor: the concentrations were less than 1 mg/l. In patients with meningitis (n = 5) levels of 18, 17, 16, 1 and 0.8 mg/l were found. Aqueous humour penetration was satisfactory, and a mean concentration of 11 +/- 4 mg/l corresponding to a penetration ratio of 19% was found. The penetration of ceftazidime into large pleural effusions was also good with concentrations from 17 +/- 3 to 28 +/- 2 mg/l, corresponding to a mean penetration ratio of 38%.

Simultaneous comparison of three methods for assessing ceftazidime penetration into extravascular fluid.

The penetration of ceftazidime, a new broad-spectrum cephalosporin, into fluids from subcutaneous threads, suction blisters, and cantharidin blisters was studied in eight healthy male volunteers. A pharmacokinetic analysis showed fundamental differences between the models. The results obtained with the subcutaneous thread technique were similar to those of the peripheral compartment and were characteristic of a rapidly equilibrating compartment. The results obtained with the suction and cantharidin blister techniques were characteristic of slowly equilibrating compartments. We concluded that although one model will not accurately predict the penetration of an antibiotic in all clinical situations, each model will have its own particular application.

A study of cytoplasmic oestrogen receptors in patients with breast cancer in a district general hospital.

The tumors of 61 patients suffering from primary adenocarcinoma of the breast were assayed for oestrogen receptors (ER), using the dextran-coated charcoal method. A statistically significant relationship (P less than 0.05) was found to exist between ER status and the histological grade of the tumour. No relationship was found between ER status and either tumour size or the pathological state of the axillary lymph nodes. It is concluded that it is a practical proposition to establish an ER assay service in a district general hospital, with subsequent benefits for the individual patient.

Dwarfism in Alaskan malamutes: a disease resembling metaphyseal dysplasia in human beings.

In a study of 300 Alaskan Malamutes, dwarfism was shown to be an autosomal recessive inherited disease with complete penetrance that resulted in disturbed endochondral bone formation. Osseous growth disturbance was manifest at the metaphyses of tubular bones. Clinical and radiographic changes were very similar to those of rickets, although appositional bone formation rates were normal. Serum calcium, phosphorus, and alkaline phosphatase were within normal limits. Urinary excretion of calcium, phosphate, and amino acids were normal. Excess matrix was formed in the zone of cartilage cell proliferation, and the matrix persisted in the growth plate. Normal stresses resulted in microfractures in the metaphyses with subsequent interference of vascular penetration into the zone of degenerated cartilage cells.

Contagious ecthyma in Alaskan musk-oxen and Dall sheep.

In 1976 and 1977, a disease resembling contagious ecthyma was seen in captive musk-oxen (Ovibos moschatus) in Alaska. A similar disease occurred in 1977 in captive Dall sheep (Ovis dalli). Paravaccinia viruses were detected by electron microscopy and isolated in cell cultures from both species. Experimental inoculation in susceptible and immune domestic sheep (Ovis aries) plus fluorescent antibody tests with ecthyma-immune conjugate indicated that the isolate was contagious ecthyma virus.

Ovine progressive pneumonia: experimental intrathoracic, intracerebral, and intra-articular infections.

Three groups of 4 lambs each were experimentally infected with an isolate of progressive pneumonia virus (PPV) by intracerebral, intra-articular, or intrathoracic routes of inoculation. An additional control group was sham-inoculated by all 3 routes with identically prepared, noninfected inoculum. Sheep were killed 12 to 42 days after inoculation. A mild generalized leptomeningitis was found in 2 of the 4 lambs inoculated intracerebrally. A severe, proliferative synovitis with massive infiltration of lymphocytes and plasma cells was found in the 4 lambs inoculated intraarticularly. Germinal center formation was found in the synovial membrane 42 days after inoculation. Appreciable differences in lung morphologic features were not observed among the 4 groups. The PPV was isolated from virus-inoculated sheep from the choroid plexus, synovium, and lungs from inoculated and noninoculated sites. Nine of the 12 virus-inoculated lambs developed serum antibody to PPV, and specific antibodies were found in the synovial fluid of virus-inoculated joints. Virus was not isolated, lesions were not found, and serum antibody was not demonstrated in sham-inoculated sheep.

Spleen scanning with 99Tcm-labelled red blood cells after splenectomy.

In order to correlate the haematological changes which occur after splenectomy, with the presence or absence of residual splenic tissue, spleen scans using 99Tcm-labelled red blood cells were performed in 36 patients who had had a splenectomy. Positive spleen scans were found in 44 per cent (8 out of 18) of patients who had undergone splenectomy for trauma and in 17 per cent (3 out of 18) of patients who had undergone elective splenectomy. No relationship was found between the presence of Howell-Jolly bodies, platelet counts, the levels of IgG, IgM and IgA and the scan result. It is concluded that these findings are due to the presence of splenunculi, whose incidence is more common than the 12 per cent usually quoted.

Is bone scanning of value in patients with breast cancer?

Over the last decade, bone scans have played an increasingly important role in the management of patients with breast carcinoma; by detecting both occult and symptomatic bony metastases. 234 bone scans carried out in this hospital in 1978/79 on patients with breast cancer, at considerable cost to the NHS, are reviewed.

The pathogenesis of primary and secondary infection with Fasciola hepatica in mice.

Primary and secondary infections of F. hepatica in mice were compared to determine how prior exposure to the parasite affected host response. Mice with primary parenchymal Fasciola infections initially had hemorrhagic tunnels filled with inflammatory cells and connective tissue. These lesions were progressive and became most severe 30 days after exposure as the parasites entered the bile ducts. At this time there was much hyperplasia and thickening of all layers of the duct system near the parasites and occasionally severe periportal fibrosis. By 2 months after exposure regeneration of the damaged liver cells was complete although hyperplasia persisted in bile ducts containing flukes. In mice with secondary infections (mice exposed 40 to 50 days after first infection), the inflammatory response was faster and shorter. Most lesions were resolved by 30 days after the second exposure. There was little difference in histology of primary and secondary infections during the chronic phase of the disease.

Hypercalcemia and hypophosphatemia in a mare with renal insufficiency.

An 11-year-old mare with polyuria, polydipsia, and azotemia was found to be hypercalcemic and hypophosphatemic. The concentration of calcium in a single collection of urine was within normal limits, although urinary inorganic phosphate concentration was lower than normal. After a brief period of supportive treatment, the mare died. At necropsy, the kidneys were found to be shrunken and fibrous. Histologically, the lesions were those of glomerulonephritis.

Nonlethal experimental inoculation of Columbia black-tailed deer (Odocoileus hemionus columbianus) with virus of epizootic hemorrhagic deer disease.

Intramuscular or intravenous inoculation of 5 Columbia black-tailed deer (Odocoileus hemionus columbianus) with virus of epizootic hemorrhagic deer disease (EHD) did not produce overt clinical disease. Two white-tailed deer (Odocoileus virginianus) exposed identically died in 5 to 6 days. There were no significant lesions in 1 black-tailed deer euthanatized on postinoculation day 5. The EHd virus was not isolated from the spleen of that deer. Seroconversion occurred in black-tailed deer, from zero EHD virus antibody titer before inoculation to titers of 1:128 to 1:256 after inoculation.