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Biomedical subjects

N Christophidis

Publications and source records attributed to N Christophidis.

At least 19 recordsLinked to original sources

Second-line agents for rheumatoid arthritis.

Second-line agents (disease-modifying agents or slow-acting antirheumatoid drugs) are well established for synovitis that persists despite treatment with non-steroidal anti-inflammatory agents. Indications for their use in the elderly are similar to those in younger people, but the elderly are at higher risk of adverse reactions. Therefore, lower doses, more cautious patient selection and more frequent monitoring for adverse reactions are recommended. Low dose corticosteroids are often effective in the elderly and obviate the need for second-line agents.

Aged

Gout: 'a disease of plenty'.

Gout is a syndrome caused by an inflammatory response to the formation of monosodium urate monohydrate crystals which develop secondary to hyperuricaemia. Acute and chronic forms occur. Hyperuricaemia may be due to environmental and/or genetic factors. It most commonly affects middle-aged males. This article discusses the management of both acute and chronic gout.

Acute Disease

Interaction of cisplatin with other cytotoxics and non-steroidal anti-inflammatory drugs.

This study investigated a possible interaction between cisplatin, other cytotoxics and non-steroidal anti-inflammatory drugs. Experiments were performed in quadruplicate. Plasma was spiked with cisplatin with or without another cytotoxic or non-steroidal anti-inflammatory drug. The results were analysed by Student's t-test and a p value of less than 0.05 was accepted as statistically significant. No interaction between cisplatin and the other cytotoxics was demonstrated. However, an increase in free cisplatin was noted when mixed with indomethacin (p = 0.019). No interaction with the other non-steroidal anti-inflammatory drugs was demonstrated.

Adult

Comparison of high-performance liquid chromatography and the Abbott fluorescent polarization radioimmunoassay in the measurement of methotrexate.

A modified high-performance liquid chromatographic (HPLC) technique for the assay of methotrexate is described and compared to the Abbott Fluorescence Polarization Radioimmunoassay. The reproducibility (coefficient of variation) at low concentrations was similar for the two assays: 8.1 and 8.5% for the Abbott and HPLC assay, respectively. The limit of detection of the two assays was also similar at 0.01 microM. The correlation coefficient for Abbott versus HPLC was 0.9833 with a gradient of 0.9545. Aspirin was the only drug that interfered with HPLC. Methotrexate's metabolite 7-hydroxymethotrexate did not interfere with the Abbott assay. Plasma half-lives were similar to oncology patients in the two rheumatological patients studied. The 7-hydroxymethotrexate half-life was 15 h.

Administration, Oral

Blood-brain barrier disruption using mannitol: time course and electron microscopy studies.

Blood-brain barrier disruption with a hyperosmolar agent, mannitol, has previously been demonstrated to increase intracerebral methotrexate levels in rats. To determine the optimum conditions for blood-brain barrier disruption without producing neurological sequelae, adult Sprague-Dawley rats were infused with mannitol via the internal carotid artery at rates varying from 0.25 to 0.5 ml.s-1.kg-1. Methotrexate and Evans blue were used as markers of blood-brain barrier disruption. The optimum rate of mannitol that produced blood-brain barrier disruption without neurological sequelae was 0.25 ml.s-1.kg-1 for 20 s. The duration of blood-brain barrier opening was maximal for approximately 5 min and then rapidly reversed. Methotrexate levels on the mannitol-infused side were four to five times that of the noninfused hemisphere. Light microscopy and electron microscopy did not demonstrate any consistent changes that could be attributed to blood-brain barrier disruption nor did it elucidate the mechanism. This model should prove useful in the investigation of the treatment of intracerebral tumors with blood-brain barrier disruption. This study shows that maximal intracerebral methotrexate levels were obtained when methotrexate was infused before or within 5 min of the mannitol infusion.

Animals

Pain management for the elderly.

Pain management for the elderly is based on the same principles as for all other age groups. There is no evidence that the elderly patient and the young patient perceive pain differently. Pain management should aim at achieving a specific diagnosis and a specific treatment with the appropriate choice of analgesic used in the optimal regimen and should give attention to all other factors contributing to the patient's suffering. Geriatric medicine uses an essentially multidisciplinary approach to treatment of medical problems, and this doctrine should apply to treatment of pain.

Acupuncture Analgesia

Blood-brain barrier disruption and methotrexate in the treatment of a readily transplantable intracerebral osteogenic sarcoma of rats.

An animal model of intracerebral osteogenic sarcoma has been developed to evaluate blood-brain barrier disruption as an adjunct to chemotherapy of intracerebral tumors. Adult Sprague-Dawley rats (n = 225) were inoculated intracerebrally with transplantable, methotrexate sensitive, osteogenic sarcoma cells and 3 days later randomized to receive either no treatment or methotrexate with or without blood-brain barrier disruption using intracarotid mannitol. Methotrexate was administered i.v., i.p., or directly into the carotid artery (i.c.) in doses of 2.5, 10, 20, 50, or 100 mg/kg. Survival was the study's end point. Surgery, anaesthesia, or blood-brain barrier disruption with mannitol did not affect survival. However, there was a significant effect of dose and route of administration of methotrexate on survival. The shortest survival was in rats receiving no treatment in which death occurred reproducibly at 7.6 +/- 0.2 days (n = 29) and the longest survival was 12.7 +/- 0.3 day (p less than 0.001) in those given methotrexate 50 mg/kg i.c. (n = 6). The i.c. route was most effective in prolonging survival followed by i.v. and the least effective was the i.p. route of methotrexate administration. Blood-brain barrier disruption followed by methotrexate (i.v. or i.c.) was deleterious to survival (two-way analysis of variance, p less than 0.003 and p less than 0.011, respectively) and the reduced survival was in part related to early complications such as intratumor hemorrhage or possibly a methotrexate induced encephalopathy. It is concluded that this is a useful model for the study of the chemotherapy of cerebral tumors, that blood-brain barrier disruption did not appear to improve the dose-response curve but resulted in reduced survival. We caution against the use of this procedure in the treatment of cerebral tumor in humans.

Animals

Reversibility of disulfide formation. Comparison of chemical and enzyme-mediated reduction of penicillamine and captopril disulfides.

The reduction of penicillamine disulfide by reductants in aqueous solutions has been studied and compared with that for captopril disulfide. Whereas near quantitative reduction for captopril disulfide was achieved with tributyl phosphine (200 mM), no detectable penicillamine was formed from penicillamine disulfide. Thiol reductants (25 mM) were, however, partially able to reduce penicillamine disulfide with the most effective agent being glutathione (15% reduction) following by dithioerythritol (8%) and cysteine (5.1%). The reduction of penicillamine-cysteine disulfide by glutathione was 6-fold higher than for penicillamine disulfide. Kinetic analysis showed that the initial rate of reduction and equilibrium constant for the reduction of penicillamine disulfides by glutathione were 267- and 875-fold less than for captopril disulfide at pH 7.4. Biotransformation studies in the cytosol fraction of rat blood cells demonstrated that whereas 48% of the reduction of captopril disulfide was enzyme-mediated only 19% of the penicillamine formed was enzyme-mediated for penicillamine disulfide. Accumulation of disulfides of penicillamine in patients taking penicillamine may therefore be a problem during chronic therapy.

Animals

Clopamide: plasma concentrations and diuretic effect in humans.

Clopamide pharmacokinetics were determined after oral doses of 5, 10, and 20 mg in normal volunteers. Maximum plasma concentrations occurred within 2 hours and were followed by a monoexponential decline with an elimination half-life of approximately 10 hours. There was an approximately linear relationship between dose and the AUC. Urinary sodium, chloride, and potassium excretion rates indicated that the peak diuretic activity corresponded with peak plasma drug concentrations and probably continued for 12 to 24 hours. There was little difference between the total sodium and chloride output after each dose of clopamide, suggesting that 5 mg may have been close to the top of the dose-response curve. Chlorothiazide, 500 mg, caused less sodium and chloride output with similar potassium loss. During chronic administration to patients with hypertension, hypokalemia was more marked with clopamide, 10 mg daily, than with clopamide, 5 mg, or chlorothiazide, 500 mg daily.

Administration, Oral

Measurement of penicillamine and N-acetylcysteine in human blood by high-performance liquid chromatography and electrochemical detection.

A rapid and precise high-performance liquid chromatographic assay for both N-acetylcysteine and penicillamine in blood samples is described using selective reductive electrochemical detection and a high-efficiency C18 reversed-phase column. The use of an internal standard compensated for changes in detector responses during a run and for variable sample recovery. The detection limits for N-acetylcysteine and penicillamine were 25 and 10 ng/ml, respectively, using 500-microliters blood samples. Reproducibility of measurement for both thiols was excellent. This method allows routine monitoring of blood levels and pharmacokinetic studies with N-acetylcysteine and penicillamine.

Acetylcysteine

Acute and chronic pharmacokinetic studies of slow release ketoprofen (Oruvail) in rheumatoid arthritis.

Slow release preparations of non-steroidal anti-inflammatory drugs are used to simplify dose regimes in the treatment of rheumatoid arthritis with the aim of improving patients compliance. This study examines the acute and chronic pharmacokinetics of slow release ketoprofen in 13 rheumatoid patients with a mean age of 59.8 years. Pharmacokinetic parameters following the first dose including Tmax which was 6.92 h (s.e.m. = 0.80), Cmax 3.87 micrograms/ml (s.e.m. = 0.54), apparent half-life 8.8 h (s.e.m. = 1.0) and AUC 41.92 micrograms.h/ml (s.e.m. = 4.02) were not significantly different from those following the last dose after 3 months of chronic treatment, when these were Tmax 6.38 h (s.e.m. = 0.84) Cmax 3.57 micrograms/ml (s.e.m. = 0.33) apparent half-life 8.8 h (s.e.m. = 1.1) and AUC 43.18 micrograms.h/ml (s.e.m. = 5.34) respectively. These results show that no accumulation of ketoprofen occurred with chronic treatment. Clinical assessments were performed in an open design and showed significant improvement in pain, articular index, grip strength and duration of morning stiffness when these parameters were compared to treatment with paracetamol during an initial washout. The drug was well tolerated although there was a trend for the haemoglobin to fall and this parameter should be monitored during therapy with ketoprofen.

Administration, Oral

Studies on the cytotoxicity of penicillamine in a rat osteogenic sarcoma.

The effect of penicillamine on the growth rate of an osteogenic sarcoma of rats was investigated and compared with cyclophosphamide. Rats were inoculated with a readily transplantable osteogenic sarcoma subcutaneously into the left thigh and treated with penicillamine and cyclophosphamide alone or in combination. Cyclophosphamide inhibited tumour growth. Penicillamine did not delay the appearance or the growth rate of the tumour. Tumour sizes tended to be larger in the penicillamine-treated rats, but there was no evidence that penicillamine interfered with the antitumour effect of cyclophosphamide given in large doses (100 mg/kg).

Animals