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Biomedical subjects

L L Schwartz

Publications and source records attributed to L L Schwartz.

10 recordsLinked to original sources
PubMed2001

Neonaticide: an appropriate application for therapeutic jurisprudence?

Might therapeutic jurisprudence, a perspective that attempts to study interaction between the legal and mental health disciplines, be brought to bear effectively with respect to neonaticide, the murder of a newborn infant in the first 24 hours of its life? This is a crime that leads to sentencing that is now rarely therapeutic, rehabilitative, or corrective. An examination of the crime, its motives, and its perpetrators precedes a discussion of ways in which the mental health viewpoint in this matter might be brought to the active attention of the courts in order to promote sentencing that is appropriate to both the crime and the transgressor.

Adolescent↗
PubMed1998

Late hypertension after liver transplantation: a comparison of cyclosporine and tacrolimus (FK 506).

Hypertension frequently develops early after liver transplantation when cyclosporine-based immunosuppression is used. However, initial experience with tacrolimus has suggested that its use leads to a lower early incidence of hypertension. In this study, the blood pressure status of patients treated with cyclosporine (n = 131) and those treated with tacrolimus (n = 28) was compared 24 months after liver transplantation. At this time interval, the prevalence of hypertension in the cyclosporine and tacrolimus groups were 82% and 64%, respectively (P < .05). For those patients who were hypertensive by 24 months, onset was delayed in the tacrolimus group compared with the cyclosporine group: 40% versus 71% and 73% versus 93% at 1 and 12 months, respectively (P < .05). Within the cyclosporine group, patients with hypertension were heavier than those with normal blood pressure, 84.7 +/- 1.8 versus 73.4 +/- 4.0 kg, respectively (P < .05). Within the tacrolimus group, hypertensive patients had lower glomerular filtration rates and higher renal vascular resistances compared with normotensive patients, 74 +/- 12 versus 47 +/- 6 mL/min and 15,711 +/- 2,445 versus 28,830 +/- 4,310 dyne/s/cm5/m2, respectively (P < .05). There were no within-group differences for age, gender, pretransplant history of hypertension, family history of hypertension, graft function, or daily doses of prednisone, cyclosporine, or tacrolimus. These results indicate that, compared with cyclosporine, the onset of hypertension after liver transplantation is delayed and less prevalent with tacrolimus. Additionally, hypertension is associated with increased body weight in cyclosporine-treated patients and with more severe renal dysfunction in patients receiving tacrolimus. The relationships of these findings to the development of posttransplant hypertension requires further study.

Blood Pressure↗
PubMed1994

Cyclosporine-induced hypertension after transplantation.

OBJECTIVE: To describe the features and mechanisms of posttransplantation hypertension and suggest appropriate management of the disorder. DESIGN: We review our own experience and reports from the literature on hypertension in cyclosporine A (CSA)-treated transplant recipients. RESULTS: Soon after immunosuppression with CSA and corticosteroids, hypertension develops in most patients who undergo transplantation. The blood pressure increases, which are usually moderate, occur universally because of increased peripheral vascular resistance. Disturbances in circadian patterns of blood pressure lead to loss of the normal nocturnal decline, a feature that magnifies hypertensive target effects. Changes in blood pressure sometimes are severe and associated with rapidly developing target injury, including intracranial hemorrhage, left ventricular hypertrophy, and microangiopathic hemolysis. The complex mechanisms that underlie this disorder include alterations in vascular reactivity that cause widespread vasoconstriction. Vascular effects in the kidney lead to reduced glomerular filtration and impaired sodium excretion. Many of these changes affect local regulation of vascular tone, including stimulation of endothelin and suppression of vasodilating prostaglandins. Effective therapy includes use of vasodilating agents, often calcium channel blocking drugs. Caution must be exercised to avoid interfering with the disposition of CSA or aggravating adverse effects relative to kidney and electrolyte homeostasis. CONCLUSION: Recognition and treatment of CSA-induced hypertension and vascular injury are important elements in managing the transplant recipient.

Antihypertensive Agents↗
PubMed1990

Hypertension: role of the nurse-therapist.

In this article, we describe the evolution of the hypertension nurse-therapist program at the Mayo Clinic. Because of the large numbers of patients in whom hypertension is a major risk factor for cardiovascular disease, a leading cause of death in the United States and other industrialized nations, an approach was devised in which, with physician supervision, specially trained nurses managed many aspects of the acute and long-term outpatient care of hypertensive patients. Clinical trials in which nonphysician care-providers were used to treat hypertensive patients and to maintain long-term blood pressure control provided an opportunity to identify and to expand the concept of continuing care for blood pressure management in a community hypertension clinic. Currently, almost 7,000 patient visits are scheduled annually in this program, and these patients are seen by five full-time hypertension nurse-therapists.

Ambulatory Care↗
PubMed1985

The debate over substitution policy. Its evolution and scientific basis.

Considerations about differences in bioavailability between brand-name drugs and generic formulations of these agents are discussed as are the meaning of drug quality, the national regulatory situation concerning generic substitution, and state-to-state variations in product selection laws. Actual and potential problems with generic substitution are described with regard to current and future prescribing practices. Proposed regulations permitting or mandating substitution of generic alternatives and therapeutic substitutes are mentioned. Although there is no consensus on the proper use of generic drugs, physicians should be aware of potential differences in bioavailability and therapeutic effectiveness that may arise when one drug product is substituted for another. Such differences are of particular concern for certain therapeutic categories such as psychotropic, cardiovascular, and endocrine/metabolic drugs, as well as for special population groups, such as the elderly, infants, and children. If physicians are to prescribe in an optimal manner, they should be knowledgeable about the bioavailability of different drug products and the national and state laws addressing substitution. Generic substitution is linked to current and future policy changes in the area of therapeutic substitution.

Age Factors↗
PubMed1983

A survey of generic drug legislation and geriatric pharmacotherapy: opinions of those who generate the literature.

Eighty-three authors who had published papers within the last five years on pharmacologic therapy in aged humans were surveyed by written questionnaire and their responses analyzed. The survey sought opinions on the scientific, clinical, and social context of legislation on drug product selection (generic legislation) and its relationship to geriatric pharmaco-therapeutics. The majority of respondents: 1) were generally unaware of the content of the clinical or scientific opinion offered on the subject of drug product selection as part of the legislative process; 2) felt that potential cost savings for elderly people was a factor in advancing this legislation; 3) wrote prescriptions so that product substitution could occur despite their ambivalence about such substitutions and about the knowledge of pharmacist and physician concerning product substitution and drug equivalence for the elderly. Clinical pharmacologists and geriatricians, however, were less likely than other respondents to permit substitution. The implications of current opinions and practices regarding drug product selection for geriatric patients are discussed.

Attitude of Health Personnel↗
PubMed1964

Lysosomal disruption by bacterial toxins.

Bernheimer, Alan W. (New York University School of Medicine, New York), and Lois L. Schwartz. Lysosomal disruption by bacterial toxins. J. Bacteriol. 87:1100-1104. 1964.-Seventeen bacterial toxins were examined for capacity (i) to disrupt rabbit leukocyte lysosomes as indicated by decrease in turbidity of lysosomal suspensions, and (ii) to alter rabbit liver lysosomes as measured by release of beta-glucuronidase and acid phosphatase. Staphylococcal alpha-toxin, Clostridium perfringens alpha-toxin, and streptolysins O and S affected lysosomes in both systems. Staphylococcal beta-toxin, leucocidin and enterotoxin, Shiga neurotoxin, Serratia endotoxin, diphtheria toxin, tetanus neurotoxin, C. botulinum type A toxin, and C. perfringens epsilon-toxin were not active in either system. Staphylococcal delta-toxin, C. histolyticum collagenase, crude C. perfringens beta-toxin, and crude anthrax toxin caused lysosomal damage in only one of the test systems. There is a substantial correlation between the hemolytic property of a toxin and its capacity to disrupt lysosomes, lending support to the concept that erythrocytes and lysosomes are bounded by similar membranes.

Acid Phosphatase↗