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Biomedical subjects

M Robbins

Publications and source records attributed to M Robbins.

At least 19 recordsLinked to original sources
PubMed1994

The appropriateness of initial vancomycin dosing.

BACKGROUND: Vancomycin use has markedly increased over the past several years because of an increased incidence of resistant organisms, particularly methicillin-resistant Staphylococcus aureus. Despite the availability of dosing nomograms and the use of peak and trough levels, vancomycin dosing has remained problematic. METHODS: All intravenous vancomycin orders over a 3-month period in a community and teaching hospital were screened for appropriateness of initial dosing based on available dosing nomograms. RESULTS: Of the 48 patients who received intravenous vancomycin, only 19 (39.6%) were given initial doses that achieved the desired serum concentration. There were no significant differences in the appropriateness of initial dosing between family medicine residents, attending physicians, and private staff physicians. Older patients in our study were at higher risk for overdosing, whereas younger patients were more likely to be underdosed. In this study, nomogram use could have yielded correct initial dosages in 40 of the 48 patients (83.3%). CONCLUSIONS: Our study indicates a high percentage of inappropriate initial vancomycin dosing in a community and teaching hospital. The investigators believe inappropriate initial vancomycin dosing is common and may result in unnecessary expense, increased risk of therapeutic failures, and greater potential for adverse drug reactions. Increased use of vancomycin dosing nomograms could improve the rate of correct initial dosages.

Adult↗
PubMed1992

The progestin-only oral contraceptive--its place in postpartum contraception.

The progestin-only oral contraceptive (POC) is not a widely-used method of contraception, possibly due to competition from other contemporary contraceptive methods or misunderstanding and prejudices among clients and/or service providers. Because of its underuse, the POC, as a contraceptive method, is under-studied. This article evaluates the general merits of the POC and its disadvantages relative to combined oral contraceptives (COCs) and other contraceptive methods, specifically during the postpartum period and particularly for breastfeeding women. We find that the POC appears to be a safe and acceptable contraceptive method for postpartum women who are fully or nearly fully breastfeeding at six months postpartum or when menstruation returns. The POC could be considered for use at any time by non-breastfeeding postpartum women. The need for empirical studies of the POC is also discussed.

Contraception↗
PubMed1992

Purification and characterization of monodehydroascorbate reductase from soybean root nodules.

Soybean (Glycine max (L.) Merr.) root nodules contain the enzymes of the ascorbate-glutathione cycle as an important defense against activated forms of oxygen. A key enzyme in this cycle--monodehydroascorbate reductase (MR)--was purified 646-fold and appeared as a single band on SDS-PAGE with silver or Coomassie blue staining. Purified MR contained 0.7 mol FAD/mol enzyme and had a specific activity of 288 mumol NADH oxidized.min-1.mg protein-1. The enzyme was a single subunit occurring as two isozymes (MR I and MR II) with Mr values of 39,000 and 40,000. Isoelectric focusing revealed that each isozyme consisted of two forms with pl values of 4.6 to 4.7. Ferricyanide and 2,6-dichlorophenol-indophenol were effective as electron acceptors. The purified enzyme did not possess leghemoglobin reductase activity. Inhibition by p-chloromercuribenzoate indicated the involvement of a thiol group in MR activity. The Km values were 5.6, 150, and 7 microM for NADH, NADPH, and monodehydroascorbate, respectively. The pH optimum was 8 to 9. The N-terminal sequence of 10 amino acids of MR II had little homology to known protein sequences.

Amino Acid Sequence↗
PubMed1992

Transcriptional regulation of neuromodulin (GAP-43) in mouse neuroblastoma clone N1E-115 as evaluated by the RT/PCR method.

The steady-state level of the neuromodulin transcript in the neuron-like N1E-115 cell line was measured with a method combining reverse transcription and the polymerase chain reaction (RT/PCR). Total RNA was isolated from N1E-115 cells and treated with DNAse to remove residual DNA; cDNA was synthesized from this RNA by priming with random hexamers. For PCR amplification, primers for neuromodulin were designed for regions of the coding sequence that were identical in mouse, rat, and human. In one approach (the 'ratio method'), variations in RNA yield and cDNA synthesis efficiency were controlled for by amplifying a reference (housekeeping) gene (glyceraldehyde phosphate dehydrogenase; GAPDH). To control for inter-experimental variations in PCR amplification efficiencies the data were analyzed on semi-logarithmic plots, with which the relative levels of the starting templates could be determined by extrapolating the plots to cycle number zero (0). In another approach with RT/PCR (the 'spiking method'), the absolute level of N1E-115 neuromodulin cDNA was assessed by adding known amounts of cloned human neuromodulin template to the RT/PCR assay of N1E-115 nucleic acid and comparing the increased yield of product across cycles. When the spike was added at either the cDNA level (in the form of double-stranded DNA) or at the total RNA level (as sense RNA), the levels of N1E-115 calculated were virtually the same: 509 fg and 495 fg of coding region per ug total RNA in confluent N1E-115 cells, respectively. Treatment of N1E-115 cells with 2% dimethylsulfoxide for three days elevated neuromodulin mRNA levels 5.6-fold. Conversely, treatment of N1E-115 cells with 100 nM phorbol myristate acetate for 24 h decreased the level of neuromodulin mRNA by 70%. Under carefully controlled conditions and within certain limits of precision, the RT/PCR method appears to be suitable for assessing the level of low abundance mRNA under various pharmacologically-induced conditions.

Animals↗
PubMed1992

Chronic atropine administration up-regulates rat cortical muscarinic m1 receptor mRNA molecules: assessment with the RT/PCR.

The modulation of the rat cortical m1 muscarinic receptor mRNA was studied with a method of quantitation using the polymerase chain reaction after conversion to complementary DNA (cDNA) with AMV reverse transcriptase (RT/PCR). Primers specific to the C3 region of the m1 mRNA were employed. The y-intercepts from the linear regions of semilogarithmic plots of PCR product versus cycle number were used as measures of the levels of m1 muscarinic mRNA-measured relative to that of glyceraldehyde phosphate dehydrogenase (GAPDH) mRNA (the 'ratio' method). Alternatively, m1 mRNA in total cortical RNA samples was quantitated from the increase in product elicited by adding a known amount of exogenous m1 muscarinic cDNA sequence (the 'spiking' method). This allowed calculation of absolute level of m1 mRNA, which was 4.1 pg/micrograms total RNA. We measured the level of the rat cortical m1 mRNA after 1 week of chronic receptor blockade with atropine, showing upregulation of 154% by the GAPDH/m1 ratio method and 145% by the spiking method. That this transcriptional alteration was specific was indicated by the finding that the level of GAP-43 mRNA was not affected by atropine treatment.

Animals↗
PubMed1992

Psychoanalytic and biological approaches to mental illness: schizophrenia.

Biological psychiatrists tend to look upon the phenomena of mind and meaning, which are the data of psychoanalysis, as meaningless epiphenomena, and propose reductive explanations of complex mental states, whereas psychoanalysts tend to ignore the proliferation of neurobiological data indicating the importance of constitutional factors in mental illness. Interactive models which confuse biological causes and psychological consequences, or vice-versa, are theoretically unsound. A scientific model hierarchy is proposed, along with some principles for coexistence and collaboration between neurobiology and psychoanalysis. The problem is illustrated with schizophrenia, a condition whose probable biological underpinnings are now generally considered to remove it from the realm of psychoanalysis. Schizophrenia-vulnerable phenotypes consistent with organic findings and clinical observations are hypothesized, and some ideas about their development in the context of early object relations, leading to pathological forms of symbiosis, are elaborated. A neurobiological rationale for the psychoanalytic treatment of schizophrenia is presented, and special problems related to the biological and symbiotic substrate are examined.

Brain↗
PubMed1991

Magnetic resonance imaging of central nervous system lesions in patients with lupus erythematosus. Correlation with clinical remission and antineurofilament and anticardiolipin antibody titers.

Clinical, magnetic resonance imaging (MRI), and serologic studies were performed on 11 patients with diffuse central nervous system (CNS) systemic lupus erythematosus and 8 patients with focal CNS lupus. MRI of patients with diffuse clinical disease showed symmetrically distributed areas of increased signal intensity in the subcortical white matter; these resolved after treatment with high-dose methylprednisolone. These patients' sera contained elevated levels of antineurofilament antibodies. Patients with focal CNS lupus had areas of increased signal intensity and atrophic changes in regions corresponding to the major cerebral vessels. These MRI abnormalities did not improve after treatment with high-dose steroids. The sera of patients with focal CNS lupus had elevated levels of cardiolipin and lupus anticoagulant but normal levels of antineurofilament antibody. Our findings suggest that results of a combined clinical, MRI, and serologic evaluation of patients with CNS lupus may predict the response of patients to high-dose steroid therapy.

Adult↗
PubMed1991

A comparative clinical trial of the TCu 380A, Lippes Loop D and Multiload Cu 375 IUDs in Indonesia.

The Copper T 380A (TCu 380A), Lippes Loop D (LLD) and the Multiload Cu 375 (MLCu 375) IUDs were evaluated for safety and efficacy in a multicenter randomized clinical trial in Indonesia. A total of 2992 women were enrolled into the study and data for 2845 women were analyzed (147 cases did not meet protocol criteria). Although study IUDs were randomly assigned, LLD users in this study were older and of higher parity than TCu 380A and MLCu 375 users. The 24-month gross cumulative life-table pregnancy rates for TCu 380A, LLD and MLCu 375 users were 1.2, 2.2 and 2.7, respectively. The 24-month expulsion rates for TCu 380A, LLD and MLCu 375 users were 6.7, 7.5 and 5.3, respectively. Overall, 24-month continuation rates were 85.5%, 85.0% and 85.4% for the respective device groups. Differences in both gross and age- and parity-adjusted life-tables rates for the major outcome variables were not statistically significant at 24 months postinsertion. The study suggests that the TCu 380A, LLD and MLCu 375 IUDs seem to be safe and effective contraceptive options for Indonesian women.

Adolescent↗
PubMed1991

Use of red blood cells older than five days for neonatal transfusion.

Sick neonates often require periodic small volume transfusions (10 mL/kg) to replace blood drawn for laboratory monitoring during their hospital stay. We use red blood cells (RBCs), stored as CPDA-1 whole blood, up to their expiration date, and are unaware of any clinical problems with this practice. We proceeded to confirm our clinical impression by reviewing the hospital records of 22 transfused neonates who received a median of 2.5 RBC transfusions (range 1 to 11) with a volume of 16 mL (range 5 to 38) each, and total volume of 60 mL (range 16 to 152). The RBCs were stored a median of 7 days (range 2 to 27). Following transfusion, there was an increase (P less than .05) in hemoglobin (mean 2.8 +/- 1.6 gm/dL [SD]) and hematocrit (9.0% +/- 4.7%). The bilirubin also rose (0.6 +/- 1.5 mg/dL, P less than .05), but this was not considered clinically significant. No significant change occurred in pH or bicarbonate. Paradoxically, RBCs over 10 days of age resulted in a fall in potassium (-0.9 +/- 0.8 mEq/L, P less than .01), but not below 3.4 mEq/L. We could find no evidence by clinical observation or laboratory indexes that small volume transfusion of RBCs more than 5 days old was deleterious to the newborns studied. By using RBCs up to their expiration date, the number of donor exposures and the potential risk of transfusion-transmitted diseases can be decreased.

Blood Preservation↗
PubMed1990

The measurement of skin lymph flow by isotope clearance--reliability, reproducibility, injection dynamics, and the effect of massage.

The measurement of skin lymph flow was investigated using an isotope clearance technique (ICT). Multiple lymph flow determinations were undertaken in the skin of anaesthetized large white pigs to test for reproducibility, ascertain the most suitable tracer, study the influence of injection dynamics, and observe the effect of massage as a stimulus to lymph flow. Blood clearance of tracer was also investigated. Results demonstrated that lymphatic clearance is a monoexponential function with good reproducibility under controlled laboratory conditions. 99mTc-colloid (TCK17 Cis) compared favorably with 131I-human serum albumin as a tracer and both performed better than colloid gold (198Au). Lymph flow was significantly faster in one pig than in the other. No difference existed between left and right sides or between caudal and rostral sites on each flank, but clearance was significantly slower in thigh than flank skin. Sub-epidermal injections cleared faster and more consistently than either deep or subcutaneous injections. Neither injection volume nor needle tract backflow of tracer influenced results, but local massage significantly enhanced clearance. Escape of 99mTc-colloid by the blood was negligible. These results indicate that skin lymph flow can be reliably measured when conditions are controlled. Extrinsic factors such as massage strongly influence lymph flow. Greater sensitivity in detecting degrees of lymphatic insufficiency may be achieved if a standardized stimulus to lymph flow is administered during isotope clearance measurement.

Animals↗
PubMed1989

Primitive personality organization as an interpersonally adaptive modification of cognition and affect.

I have attempted a new description of the salient clinical phenomenology of the primitive personality disorders (borderline, narcissistic, paranoid and schizoid), focusing in particular on absence of personality integration, sensori-motor-affective thinking, and an inability to recognize and to own significant emotional predispositions and institute appropriate behavioral adaptations. I conclude that these phenomena cannot adequately be comprehended either from the classical intrapsychic perspective and the cognitive and affective capabilities assumed to exist in normal and neurotic individuals, or from the perspective of self psychology. I propose an alternative model in which pathology of cognition and affect is postulated to be both the contemporary cause and the historical result of pathological adaptation. For these individuals, analysis of cognition and affect must occupy the central position that analysis of conflict and defence occupies in the treatment of the neurotic.

Affect↗
PubMed1988

Identification of Corynebacterium jeikeium and Corynebacterium CDC group D2 with the API 20 Strep system.

A total of 170 strains of Corynebacterium jeikeium and 23 strains of Corynebacterium group D2 were examined in three British laboratories using the API 20 Strep identification system and three supplementary tests (catalase production, urease production and nitrate reduction). The isolates were collected from clinical specimens in various laboratories over a three-year period. The two species produced consistent reactions in these tests after 24 h. Two tests were highly discriminatory, with positive reactions for ribose fermentation seen for Corynebacterium jeikeium while urease production was observed with Corynebacterium group D2. This method allows routine clinical laboratories to rapidly identify these emerging pathogens.

Corynebacterium↗
PubMed1988

Use of audiotape recording in impasses with severely disturbed patients.

The psychoanalytically oriented treatment of patients with severe personality disorders is characterized by impasses and by efforts to resolve them. Patient audiotape recording and review of sessions can be a particularly useful technical parameter in such situations. When judiciously employed, it is unusual, if not unique, in that it selectively amplifies the power of traditional elements of technique as well as some of the constructive elements of the analytic process itself, while reducing the power of some of the destructive elements of the transference. Indications for using this parameter are discussed, case illustrations presented, and hypotheses advanced about its mode of action. No single element of technique is responsible for the success or failure of analysis. The most that can be expected of tape recording is that it help break up the treatment log jam and facilitate further work.

Adult↗