Safety and efficacy of subcutaneous alpha-tocopherol in healthy adult horses.

Vitamin E is essential for neuromuscular function. The primary treatment, oral supplementation with natural ('RRR') α-tocopherol, is not effective in all horses. The objectives of this pilot study were to evaluate the safety and efficacy of a subcutaneously administered RRR-α-tocopherol preparation. Horses were randomly assigned in a cross-over design to initially receive RRR-α-tocopherol (5000 IU/450 kg of 600 IU/mL) subcutaneously (n = 3) or orally (n = 3) or were untreated sentinels (n = 2). Tissue reactions following injection in Phase I of the study necessitated adjustment of the preparation with reduction of the RRR-α-tocopherol concentration to 500 IU/mL in Phase 2. Following an 8-week washout period, horses received the reciprocal treatment route with the new preparation (5000 IU/450 kg of 500 IU/mL). Serum, CSF and muscle α-tocopherol concentrations were determined by high-performance liquid chromatography over a 14-day period during each phase. Serum and CSF α-tocopherol concentrations increased significantly postinjection only when the 500 IU/mL product was administered (P<0.0001). There was no significant difference in the muscle concentration of α-tocopherol following either treatment. All eight horses had marked tissue reaction to subcutaneous injection, regardless of product concentration. Whilst we have demonstrated that this route may be a useful alternative to oral supplementation, the marked tissue reaction makes use of such products limited at this time to only the most refractory of cases.

Phleborheography--results of a ten-year experience.

Phleborheography (PRG) is a physiologic volumetric plethysmographic technique that was developed for the diagnosis of lower extremity deep venous thrombosis. During the past 10 years, 21, 626 extremities have been studied with 709 corresponding venograms. Overall data reveal a sensitivity of 92% (247/268) and specificity of 95% (418/441). There were 21 false negative PRG results, and 12 of these were due to isolated calf vein thrombosis. There were 23 false positive results, and 11 of these were considered true errors of the technique. When isolated calf vein thrombosis was disregarded, the sensitivity increased to 95%. PRG detected 45 of 57 (79%) isolated calf vein thrombi. The modified criteria for interpretation included respiratory waves and baseline elevation as the major criteria and prominent arterial pulsation and foot emptying as the minor criteria. PRG has recently been used to monitor the duration of thrombolytic therapy. While data are limited, this appears to be a promising contribution to the quantification of individual response to lytic therapy and may indicate an objective end point for treatment. PRG is a sensitive and specific method of detecting deep vein obstruction. It is a painless, reproducible, repeatable technique that requires minimal patient cooperation. PRG is a versatile laboratory technique that can be used for a variety of applications in addition to the diagnosis of deep vein thrombosis.

Real-time B-mode carotid imaging in diagnosis of cerebrovascular disease.

We studied 1,044 patients by using real-time B-mode ultrasonic carotid imaging (BioSound), oculoplethysmography and carotid phonoangiography (OPG/CPA), and periorbital Doppler ultrasonography. One hundred and fifty of these patients underwent bilateral carotid arteriography; they form the basis of this study. The x-ray films were compared to the scans and other noninvasive studies. The quality of the B-mode scans were graded according to the severity of disease (the degree of diameter reduction of the arterial lumen by stenosis): grade I (0% to 39% stenosis), grade II (40% to 69% stenosis), and grade III (70% stenosis and greater). The overall results showed that the specificity of the scan was 86%, sensitivity for grade II disease was 75%, and sensitivity for grade III disease was 44%. Only 6 of 16 (38%) totally occluded vessels were identified correctly. The data reveal a direct correlation of scan quality with accuracy. Good-quality scans had 90% accuracy, whereas the accuracy of poor-quality scans was 48%. Four of 12 scan/arteriogram "mismatch" patients underwent carotid endarterectomy. In each instance the surgeon thought that the scan more accurately represented the disease process. When the scan was combined with OPG/CPA and the results agreed, there was a 91% accuracy rate. However, when the scan and OPG/CPA disagreed, the scan was more reliable in the grade I and II categories, whereas the OPG/CPA was much more reliable in grade III disease. The accuracy of this technique can be improved with the addition of a high-quality Doppler system. If technologic improvements can be made so that technically good scans can be obtained in all patients, then this may become the most reliable noninvasive cerebrovascular testing method.

Cytokines IL-1beta, IL-2, IL-6, IL-8, MCP-1, GM-CSF and TNFalpha in patients with epithelial ovarian cancer and their relationship to treatment with paclitaxel.

In vitro work suggests that cytokines may be important modulators of the cytotoxic effects of paclitaxel and subsequent drug resistance. This has been investigated in vivo in patients with ovarian cancer by ELISA. There was consistently elevated expression of IL-6 and IL-8 but not MCP-1, IL-1beta, IL-2, GM-CSF or TNFalpha. Peritoneal fluid concentrations of IL-6, IL-8 and MCP-1 were two to three logs greater than serum concentrations. Elevated concentrations of IL-6 correlated with a poor final outcome (P = 0.039), and increased IL-6 and IL-8 correlated with a poor initial response to chemotherapy (P = 0.041 and P = 0.041, respectively). There was a relatively clear pattern of change in all three cytokines. In serum, IL-6, IL-8 and MCP-1 decreased with the administration of steroids prior to paclitaxel, and increased in the 24 h after paclitaxel. Postoperative drainage fluid was relatively acellular, preventing flow-cytometric analysis of epithelial cells for apoptosis, but suggested activation of T cells by paclitaxel. IL-6 and IL-8 appear to be of prognostic importance in epithelial ovarian cancer. Treatment with paclitaxel is associated with an increase in expression of a limited number of cytokines in patients with ovarian cancer, notably IL-6, IL-8 and MCP-1.

Stability of meropenem in intravenous solutions.

The stability of meropenem in various i.v. fluids stored in various containers for i.v. use was studied. Solutions of meropenem were prepared in a variety of i.v. diluents in polyvinyl chloride (PVC) bags, glass vials, and commercial easy-to-prepare infusion systems. Solutions for storage in PVC bags were prepared with meropenem concentrations of 1 and 20 mg/mL; in glass vials, 2.5 and 50 mg/mL; and in commercial easy-to-prepare infusion systems, 2.5 and 20 mg/mL (Baxter Minibag Plus system) and 1, 5, and 20 mg/mL (ADD-Vantage system, Abbott). The solutions were stored for up to 48 hours at 4-5 or 21-26 degrees C. Meropenem concentrations were determined by high-performance liquid chromatography. The stability of meropenem was influenced by the drug concentration; the drug was stable for a longer time in the 1-mg/mL solution than in the 20- and 50-mg/mL solutions. Stability was also influenced by storage temperature; the drug was stable for a longer time in solutions stored at 4-5 degrees C than in solutions stored at 21-26 degrees C. Meropenem was stable for the longest time in sterile water for injection and in 0.9% sodium chloride injection. The stability of meropenem in solutions in PVC bags, glass vials, Baxter Minibag Plus containers, and ADD-Vantage bags was influenced by the i.v. fluid used to reconstitute the drug, the concentration of the final solution, and the storage temperature.

Characterization of internal surface reversed-phase silica supports for liquid chromatography.

Internal surface reversed-phase (ISRP) supports synthesized from commercially available porous silica particles with a variety of nominal pore diameters and specific surface areas are characterized with regard to physical and chromatographic properties. Bonded phase coverage, pore size, capacity and efficiency measurements are made upon the various ISRP supports in order to evaluate the effect that the physical properties of silica have upon the chromatographic performance of ISRP packings. In addition, various models that describe the pore structure of silica supports are discussed.

Home infusion service delivery system model: a conceptual framework for family-centered care in pediatric home care delivery.

The Home Infusion Service Delivery System model is presented as a conceptual framework for the delivery of pediatric home care. This bicycle-shaped model provides important insights into the interrelationships of available resources for parents seeking home health care for their child. The model is based on nine key elements of family-centered care. Discussions of the model identify the roles and relationships among the family system, four interdependent service delivery systems, the physician, and a total quality management program that coordinates the health care delivery for the child. Examples focus on the delivery of pediatric home infusion therapy. By supporting the family as the primary care giver, this model provides a better fit between consumer need and service delivery.

Fimbriated stationary phases for proteins.

This paper describes synthetic procedures for preparing fimbriated stationary phases on poly(styrene-divinylbenzene) (PS-DVB) packing materials. The synthesis consists of a five-step procedure in which the order in which the steps are carried out may be varied. These steps are (i) polymerization of monomers to form an amphiphilic copolymer or oligomer, (ii) adsorption of either monomers, or polymer onto the PS-DVB surface, (iii) solvent induction of functional group orientation at the PS-DVB-polymer interface and polymer-water interface, (iv) a cross-linking reaction that forms a hydrophilic surface layer, and (v) derivatization of the surface layer with stationary phase.

Real-time B-mode carotid imaging. A three-year multicenter experience.

This report attempts to establish the place of real-time B-mode carotid imaging in the diagnosis of carotid artery disease through an analysis of the results of 3 years of experience in three major noninvasive vascular laboratories. Over 7000 patients were studied noninvasively with real-time B-mode carotid imaging and oculoplethysmography (OPG). Angiographic comparisons of 1723 vessels form the basis of this study. All tests were interpreted by physicians who had no knowledge of the angiograms. Images and x-ray films were classified by diameter of stenosis: grade I (0% to 39%), grade II (40% to 69%), grade III (70% to 99%), and grade IV (total occlusion). The effect of the imaging experience was determined by dividing the study into two periods. The results of image quality vs. accuracy and of combining the anatomic study (scan) and physiologic study (OPG) were also evaluated. The overall data show a specificity of 87% (985 of 1139), a sensitivity for grade II disease of 72% (193 of 267), a sensitivity for grade III of 66% (133 of 201), and a sensitivity for grade IV of 64% (74 of 116). With experience each center showed improvement of the imaging technique in diagnosing grade III (p greater than 0.1: not significant) and grade IV disease (p less than 0.0002: highly significant), although there was no improvement in the specificity and sensitivity of grade II disease. All scan errors were analyzed. Most errors were interpretation errors (27%: 90 of 338), scan/arteriogram mismatches (23%: 79 of 338), or poor-quality scans secondary to existing disease (22%: 75 of 338). There was a direct correlation of scan quality and accuracy, with a 97% specificity for grade I scans of good to excellent quality. When the scan and OPG agreed, there were uniform predictive values for all grades (88% to 93%). Sixteen of 79 scan/arteriogram mismatch vessels were operated on, and the scan proved more reliable in 86%. Real-time B-mode carotid imaging is a reliable technique for defining the normal carotid artery and is becoming increasingly sensitive in identifying existing disease. Despite its limitations, its strong points make it a valuable clinical tool.