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D Ripley

Publications and source records attributed to D Ripley.

18 recordsLinked to original sources

Adenocarcinoma of the cervix in a renal transplant patient.

Treatment of cervical carcinoma in a renal transplant patient with a single pelvic kidney presents several management dilemmas. Standard treatment modalities are complicated by the patient's immunosuppressed state and the location of the transplanted kidney in the standard pelvic field, as well as other surgical risks. No information on the best approach to this clinical situation is available in the English language literature. We present this case to discuss factors considered in selecting a treatment plan and possible reasons for the rapid recurrence and demise of this patient.

Adenocarcinoma

Human immunodeficiency virus inhibition is prolonged by 3'-azido-3'-deoxythymidine alternating with 2',3'-dideoxycytidine compared with 3'-azido-3'-deoxythymidine alone.

The inhibition of the lymphadenopathy-associated virus strain of human immunodeficiency virus (HIV) by alternating regimens of two dideoxynucleosides, 3'-azido-3'-deoxythymidine (AZT) (zidovudine) and 2',3'-dideoxycytidine (ddC), was determined in CEM cells. Cultures infected with virus for 2 h were treated with clinically achievable concentrations of AZT, ddC, or a 3-day-alternating regimen of AZT and ddC. Media were completely changed every 3 days and replaced with antiviral agent, and virus production was assayed by p24 antigen and virus-specific DNA. Cells treated with no antiviral agent exhibited breakthrough infection by day 6 in culture, whereas cells treated with 0.1, 1.0, or 3.0 microM AZT had a prolonged time to viral breakthrough. For each regimen of AZT alternating with 0.05 or 0.1 microM ddC, there was consistently prolonged HIV inhibition compared with continuous treatment with AZT alone. The viral suppression achieved with the alternating combinations required AZT as well as ddC and was superior to 3 days of treatment with ddC alternating with 3 days of no antiretroviral treatment. Levels of unintegrated HIV DNA paralleled the detection of p24 antigen, with the most prolonged inhibition of virus-specific DNA occurring with AZT alternating with ddC (compared with all regimens except continuous treatment with ddC). These data suggest that alternating regimens of AZT and ddC not only might decrease toxicity associated with the two drugs but may prove to be more efficacious than AZT alone.

Antiviral Agents

Vitamin B12 assimilation from chicken meat.

Chicken meat labeled in vivo with radio-B12 was ingested by normal volunteers. The absorption, measured by the fecal excretion method, was similar to that reported for crystalline radiocyanocobalamin and for mutton, but exceeded that from eggs. Parenteral injection of 1000 microgram of nonlabeled vitamin B12 did not interfere with the absorption of the radio-B12 from the meat. The urinary radioactivities, which were as low as those after oral administration of radioactive hydroxocobalamin and vitamin B12 coenzyme, suggested that the radio-B12 was present in meat in coenzyme form or was converted into the stable hydroxoform during the process of cooking and digestion. Patients with pernicious anemia showed insignificant urinary radioactivities in a standardized urinary excretion test using chicken meat whereas subjects with simple gastric achlorhydria and partial gastrectomy had subnormal values although their absorption of crystalline radiocyanocobalamin was normal. The subnormal serum vitamin B12 concentration seen in these latter subjects may, therefore, be due to impaired assimilation of vitamin B12 from food.

Achlorhydria

Influence of age and stomach function on serum vitamin B12 concentration.

Serum vitamin B12 (B12), maximal gastric acid output (MAO), and B12 absorption were determined in 82 subjects, age 32 to 85 years, who had normal absorption of radiocyanocobalamin. In 46 of the patients the gastric intrinsic factor (IF) was also measured. Serum B12 concentration and MAO varied widely in all age groups from abnormally low to definitely normal. The mean values for serum B12 and MAO, however, declined very similarly with advancing age owing to an increased incidence of low values for these two measurerment in the aged. There was no significant fall in the mean B12 absorption or IF secretion as a function of old age. Achlorhydric and hypochlorhydric patients invariably had lower mean serum B12 concentrations than those with adequate MAO. Conversely, patients with normal MAO all had normal serum B12 levels. Serum B12 concentration, although correlating with both MAO and IF secretion, showed a closer relationship to the former than to the latter. These findings suggest that the stomach, aside from producing the IF, plays an important role in maintaining a normal serum B12 concentration.

Adult

Inhibitory effect of eggs on vitamin B12 absorption: description of a simple ovalbumin 57Co-vitamin B12 absorption test.

Ovalbumin and egg yolks, mixed separately in vitro with radiocyanocobalamin (57 Co-vitamin B12), were served to normal volunteers in a cooked form. Ovalbumin, and to a lesser degree, egg yolks were observed to inhibit vitamin B12 absorption. This observation explains the rather poor assimilation of vitamin B12 from eggs labelled in vivo with 57 Co-vitamin B12.

Absorption

Vitamin B12 absorption from eggs.

The assimilation of 57Co B12 from in vivo labeled eggs was much inferior to that of a comparable amount of crystalline 57Co B12. Furthermore, the absorption varied with the form in which the eggs were served. Judged by the urinary excretion test and the plasma absorption of radioactivity the average absorption from boiled and fried eggs was more than twice that from scrambled whole eggs, but less than half that absorbed from crystalline 57Co B12.

Cobalt Radioisotopes