Biomedical subjects
Publications and source records attributed to A W Galbraith.
A single dose of the immunomodulator CGP A (MTP-PE) given intranasally to human volunteers 24 h prior to challenge with influenza A2 virus failed to protect against infection or ameriolate any subsequent illness.
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Of 31 previously untreated patients with grand mal and/or partial seizures referred to a neurological clinic and treated with phenytoin monotherapy, assisted by serum level monitoring, 26 have been followed up for a mean of 42 months. Seizures were completely controlled in 80%. Failure of optimum phenytoin monotherapy occurred in 12%. The degree of seizure control was significantly related to phenytoin serum levels. The success of monotherapy was probably related to availability of serum level monitoring and to the study of a previously untreated population with a relatively short history of epilepsy. The main reasons for failure of monotherapy were poor compliance and the presence of additional neuropsychiatric handicaps, which commonly occur together. The place for polytherapy in the event of failure of monotherapy has still to be defined.
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We performed prospective trials of phenytoin and carbamazepine, assisted by blood level monitoring, in untreated patients newly referred with grand mal or partial seizures, or both, to a neurological clinic. At the time of follow-up (mean 28.5 months for phenytoin; 12 months for carbamazepine) 76-88% of patients were completely controlled. Twelve per cent of the patients on each drug had further seizures, despite an optimum blood level. When the blood drug concentration was in the optimum range there was a 98% reduction in grand mal attack rate and 92-93% reduction in partial seizure rate. These results suggest that polypharmacy is largely, and possibly totally, unnecessary in newly diagnosed adult epileptics.
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Thirty-one, previously untreated, adult outpatients with idiopathic or focal grand-mal and/or focal minor seizures were treated initially with phenytoin. Serum-phenytoin concentrations were monitored to achieve an optimum range of 10-20 mug/ml if necessary. With a mean duration of follow-up of 14-7 months, only three (10%) patients have required the addition of a second drug, although without the guidance of serum concentrations sixteen (54%) might have been treated with a further drug. In the optimum serum-phenytoin range only 1 grand-mal attack occurred in this series, compared with a mean pre-treatment grand-mal seizure-rate of 1-1/month. Serum phenytoin declined slowly in fourteen (45%) patients. These observations suggest that many epileptic patients could be satisfactorily treated with one drug instead of the polypharmacy which they usually receive.
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A double-blind, placebo-controlled trial of amantadine hydrochloride (Symmetrel) in acute herpes zoster (shingles) was carried out in 100 patients in general practice. The cases were serologically proved. There was no difference in duration of pain between the drug and placebo groups when pain disappeared during the 28 days' observation period. However, pain lasted more than 28 days in a significantly greater proportion of patients receiving placebo than of those on amantadine. Patients with pain after the 28-day observation period were significantly older than those whose pain disappeared during the study. The drug had no effect on rate of healing or appearance of new lesions.
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1-Adamantanamine hydrochloride (aminoadamantane) has been shown to inhibit the multiplication of influenza A viruses in cell cultures, organ cultures and experimentally infected mice. An epidemic of influenza in Great Britain in the winter of 1967-68 provided the opportunity to study the prophylactic effect of aminoadamantane in the family environment and this paper reports the results of further observations in January-March 1969 during an influenza epidemic due to A2/Hong Kong/68.In a double-blind, placebo-controlled investigation of aminoadamantane given prophylactically, in doses of 100 mg every 12 hours for 10 days, no protective effect of the drug was demonstrated. In view of the positive effect of the drug in the earlier study during the winter of 1967-68, and the apparent sensitivity of the virus strain, an explanation involving the very high incidence of individuals possessing HI antibody of less than 1:12 is offered.