Effective patient appointment scheduling.
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Biomedical subjects
Publications and source records attributed to E Grab.
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Indirect evidence has linked opioid reinforcement with changes in noradrenergic metabolism secondary to drug administration. Methodological precedents for biobehavioral correlations in depressive illness have suggested an important association between changes in mood and biogenic amine excretion patterns in the urines of patients during depression and recovery. This paper presents preliminary data on the possible relationship between changes in catecholamine excretion that were observed and the changes in behavior, mood, psychiatric status, and cardiorespiratory physiology secondary to heroin administration and methadone-assisted withdrawal. This study focuses on the urinary excretion of MHPG, since an appreciable fraction of this metabolite is probably derived from norepinephrine originating in the brain. The subjective changes in mood associated with heroin use, the decrease in respiratory rate, and the behavioral and mental status effects associated with opiate intoxication were observed only in the individuals whose MHPG excretion increased during the period of opiate administration.
The authors examined urinary levels of catecholamines and metabolites during a 10-day period of heroin use in 9 subjects. Catecholamine and metabolite excretion increased over baseline values on the first day of heroin use, but markedly different patterns of change emerged later. In contrast to the significant increase in normetanephrine and decrease in metanephrine excretion in all 9 subjects during heroin use, only 4 subjects showed an increase in 3-methoxy-4-hydroxyphenyl glycol (MHPG) excretion. Moreover, it appeared that the increase in MHPG excretion in this subgroup began on the day before heroin administration, which suggests the possibility of an anticipatory or conditioned response.
60 patients who had to undergo the same operation were subdivided at random into five groups. Each group obtained in respect to the part of carbohydrates a different infusion solution (5% glucose, 5% fructose, 5% xylitol, 5% xylitol-glucose-fructose, 5% sorbitol) with an always constant part of electrolytes, the dosage of which was 60 ml/kg body weight on the day of operation and 40 ml/kg body weight during the first 3 postoperative days being continuously distributed over 24 hours. From the day before the operation until the third postoperative day the effects on metabolic parameters (lactate, uric acid, blood glucose and others) as well as the utilization of the different energy carriers were investigated. While after a glucose infusion, due to a reduced utilization, no change of the lactate level could be proved in the postoperative phase, the effect of fructose on the lactate concentration was most evident. The administration of xylitol was followed by a small increase of the serum uric acid on the first and second postoperative day, whereas in the other groups its decrease could be proved - there was no change after the administration of sorbitol. The highest blood glucose levels were found in the group to which glucose and the three-part solution of xylitol-glucose-fructose were administered. About the utilization of the different energy carriers only a limited information could be given. Altogether the results allow the conclusion that a combination of xylitol, glucose, and fructose or alternatively sorbitol can be considered the most favourable carbohydrates for preparing an isotonic base electrolyte solution.
In a study of the effects of heroin administration in nine human subjects, urinary catecholamines and metabolites were examined during an initial drug-free baseline period, a ten-day period of heroin administration and a subsequent period of methadone detoxification. All catecholamines and metabolites tended to be increased over baseline values on the first day of heroin administration. However, markedly different patterns of change emerged on subsequent days of heroin administration. Norepinephrine and normetanephrine remained increased throughout heroin administration. Epinephrine was increased during the early phase of heroin administration but returned to baseline values during the latter phase of heroin administration. After the increase on the first day of heroin administration, metanephrine decreased and substantial decrements below baseline values occurred during the latter phase of heroin administration. After increasing on the first day of heroin administration, 3-methoxy-4-hydroxy-mandelic acid (VMA) returned to approximately baseline values. During heroin administration, an increase in 3-methoxy-4-hydroxyphenylglycol (MHPG) excretion was observed in a subgroup of four of the nine subjects studied. This is in contrast to the increase in normetanephrine excretion and the decrease in metanephrine excretion that was observed in the entire group of nine subjects. It is conceivable that persistance of, or development of, tolerance might account for the failure to observe an increase in MHPG excretion in all of the subjects. It appeared as if the increase in MHPG excretion began on the day prior to the administration of heroin in the subgroup of patients with increased MHPG excretion during heroin administration, suggesting the possibility of an anticipatory or conditioned response, with the anticipation of heroin producing an increase in MHPG excretion.