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Biomedical subjects

A E Fisher

Publications and source records attributed to A E Fisher.

At least 19 recordsLinked to original sources
PubMed1996

AIDS and minorities.

Explore the source record for details and available documents.

Acquired Immunodeficiency Syndrome↗
PubMed1995

Thrombotic thrombocytopenic purpura and HIV infection.

We report on a man who was HIV-seropositive and who was initially admitted following multiple episodes of syncope. He gradually developed fulminant thrombotic thrombocytopenic purpura (TTP). Twenty-one patients with TTP who were HIV-positive have been reported previously. Of these 22 patients, all treated with plasmapheresis, 7 died from TTP and 3 suffered relapse but eventually recovered. Delay in initiating plasmapheresis may be fatal. We have correlated the laboratory data of these patients at time of admission with subsequent clinical outcome; only the platelet count correlated with outcome. Patients with lower platelet counts were less likely to relapse or die with therapy. Physicians caring for patients infected with HIV should always consider the possibility of TTP in those patients with thrombocytopenia of unknown etiology. Review of the peripheral blood smear, allowing the detection of microangiopathic hemolytic anemia, is an important clue, enabling one to consider the correct diagnosis.

Adult↗
PubMed1994

Pharmacologic evaluation of megestrol acetate oral suspension in cachectic AIDS patients.

The objective of our study was to define the pharmacokinetics and pharmacodynamics of megestrol acetate in patients with human immunodeficiency virus (HIV) infection. A new suspension formulation of megestrol acetate (40 mg/ml) was administered as a single oral dose of 800 mg per day in an open label pharmacokinetic study for 21 days. On day 21 of therapy, patients were evaluated for changes in body weight and plasma samples were obtained for steady-state pharmacokinetic analysis. Ten HIV-infected men with an involuntary weight loss of > 10% baseline were evaluated. A high degree of interpatient variability in megestrol acetate pharmacokinetics was observed, with an 8- and 5-fold range in the rate and extent of absorption, respectively. All patients reported an increase in appetite, and 8 of 10 patients gained weight by 3 weeks; the median change in weight in all patients at 3 weeks was 1.8-kg gain (range: 2.3-kg loss to 6.4-kg gain). The two patients who did not gain weight had the lowest area under the curve (AUC), Cmax, and Cmin values. A statistically significant correlation between the ratio of body weight at 3 weeks/initial weight (weight index) and the percentage of the 24-h dosing interval that megestrol acetate concentrations exceeded a 300-ng/ml threshold was observed. These data indicate variable levels of systemic exposure to drug following a fixed dose of a suspension formulation of megestrol acetate. Increase in weight during the early stages of megestrol acetate therapy is related to the extent of in vivo drug exposure above a threshold concentration.(ABSTRACT TRUNCATED AT 250 WORDS)

Acquired Immunodeficiency Syndrome↗
PubMed1990

Integration of clinical and administrative strategies to reduce expenditures for antimicrobial agents.

A comprehensive program of clinical and administrative strategies to reduce expenditures for antimicrobial agents is described. Clinical intervention strategies include the use of antimicrobial order sheets, standardized dosage regimens, restriction policies for certain antimicrobial agents, and position statements on the use of restricted agents. A cornerstone of the program is the support for cost-reduction interventions offered by the pharmacy and therapeutics committee and its subcommittee on therapeutics; that support is demonstrated through endorsement and enforcement of pharmacy programs. Physicians are reminded of the cost-reduction programs through periodic articles in the pharmacy newsletter and an "antibiogram" card supplied by the division of epidemiology. The effectiveness of these interventions has been demonstrated by progressive decreases in expenditures for antimicrobial agents during 1987 and 1988. Antimicrobial agents also account for increasingly smaller percentages of the total drug budget. This combination of clinical and administrative strategies reduced expenditures for antimicrobial agents by more than $700,000 over two years without the use of clinical specialists or any apparent sacrifice in the quality of patient care.

Anti-Infective Agents↗
PubMed1989

Herpetic whitlow of the digits.

Herpes simplex viral infection of the digits, also known as herpetic whitlow, is a rather common hand problem encountered in dental and medical personnel. Treatment is controversial. This report summarises the author's successful experience in a series of ten patients using a non-operative local care technique, supplemented when indicated by a systemic antiviral agent.

Acyclovir↗
PubMed1983

Porcine granulosa cell desensitization: prolonged FSH-responsive cAMP production in vitro.

Granulosa cells from small (1-2 mm) follicles of porcine ovaries produced cAMP in response to follicle-stimulating hormone (FSH); they produced little cAMP in response to human chorionic gonadotropin (hCG) or to cholera toxin. Production, estimated by quantification of total cAMP (medium + cells) by radioimmunoassay, appeared to be episodic in the absence or presence of the phosphodiesterase inhibitor 1-methyl-3-isobutylxanthine (MIX) and continued for at least 20 h. Results of dual incubation experiments with thorough washing of cells between incubations indicated that cells remained responsive to FSH, to hCG, and to cholera toxin after prior exposure to homologous stimulator. Preincubation of cells for 3 h in the absence of stimulator enhanced FSH responsiveness. In experiments with heterologous stimulators in two incubations, first, preincubation with FSH enhanced subsequent hCG and cholera toxin responsiveness; and second, preincubation with hCG or cholera toxin did not affect FSH responsiveness. Desensitization of FSH-activated adenylate cyclase was never greater than 35%; the degree of attenuation was dependent on FSH concentration and duration of exposure to FSH. Cells perifused with medium containing MIX and a maximally effective concentration of FSH for 5 h released cAMP continuously. In summary, the results indicated that porcine granulosa cells do not become unresponsive to FSH after prolonged exposure to FSH in vitro.

1-Methyl-3-isobutylxanthine↗
PubMed1979

Osmosensitivity of rat third ventricle and interactions with angiotensin.

Injections of hyperosmotic solutions (1- to 5-microliter injections of NaCl or sucrose solutions ranging in osmolarity from 0.34 to 0.90 osmol/l) into the anteroventral third ventricle (AV3V) of rats resulted in short latency drinking antidiuretic, and pressor responses. AV3V injections or infusions of combined angiotensin-hyperosmotic NaCl solution did not result in drinking greater than the sum of drinking to angiotensin and hyperosmotic NaCl separately administered. Differences in water versus saline drinking fluid preferences provided a behavioral dissociation of angiotensin and hyperosmotic sensitive neural mechanisms. Comparison of AV3V and lateral preoptic injection sites provided an additional separation since angiotensin was equally effective at both sites whereas osmotic stimulation was more effective at the AV3V site. AV3V lesions have previously been reported to abolish drinking, antidiuretic, and pressor responses to angiotensin and hyperosmotic stimulation. The data reported here provide additional evidence that angiotensin and hyperosmotic stimuli may both act on tissue surrounding AV3V but suggest that the neural substrates for these stimuli are not identical.

Angiotensin II↗