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Biomedical subjects

N Sussman

Publications and source records attributed to N Sussman.

At least 19 recordsLinked to original sources
PubMed2006

Successful liver transplantation following medical management of portopulmonary hypertension: a single-center series.

Severe portopulmonary hypertension (POPH) is an absolute contraindication to orthotopic liver transplantation (OLT). Vasodilators have been used, but the safety of subsequent transplantation and the reversibility of pulmonary hypertension after transplantation are uncertain. This study examined the feasibility and post-transplant effects of liver transplantation following medical control of POPH. Eight consecutive patients (three females and five males, ages 39-51) with POPH as their only contraindication to transplantation were treated with continuous intravenous epoprostenol. Liver transplantation was considered if the mean pulmonary artery pressure (PAM) was lowered to <35 mmHg. Epoprostenol 2-8 ng/kg/min successfully improved hemodynamics in seven of eight patients, usually within 6.5 months of initiating therapy. PAM declined from an average of 43-33 mmHg (p=0.03); mean pulmonary vascular resistance declined from 410 to 192 dyn s cm-5 (p=0.01) and cardiac output increased from 6.6 to 10 L/min (p=0.02). Six of the seven responders were actively listed for liver transplantation. Two died on the waiting list; the remaining four were transplanted and remain alive and well 9-18 months post-OLT-two without vasodilators, and two on oral medication. We conclude that pulmonary vasodilators permit safe liver transplantation in some cases, and that POPH may be reversible after transplantation.

Adult↗
PubMed2001

Effects of nefazodone on body weight: a pooled analysis of selective serotonin reuptake inhibitor- and imipramine-controlled trials.

BACKGROUND: Evidence suggests that the newer antidepressant drugs may differ with respect to their effects on body weight, especially during long-term treatment. However, the published data about treatment-emergent weight change with the newer antidepressants are limited. Most reports of unexpected selective serotonin reuptake inhibitor (SSRI)-associated weight gain are anecdotal or from small controlled trials. To determine if differences exist among the newer antidepressants, the authors retrospectively analyzed data from clinical trials comparing nefazodone with SSRIs and with imipramine. METHOD: Weight change data supplied by Bristol-Myers Squibb from 6 completed clinical trials comparing the antidepressant nefazodone (N = 523) with 3 SSRIs, fluoxetine, sertraline, and paroxetine (N = 513), as well as 3 trials comparing nefazodone (N = 225) with the tricyclic antidepressant imipramine (N = 224) were analyzed. In all studies, nefazodone was found to be equal in efficacy to the comparator antidepressants. Studies that included both acute and long-term treatment phases were included in the analysis. Acute phases of the trials lasted either 6 or 8 weeks, and long-term phases varied in duration from 16 to 46 weeks. The analysis included summarizing the number and percentage of patients in each group with a > or = 7% change in body weight from baseline at any point in the long-term and acute phases, at endpoint, and at week 16 of the long-term phases. RESULTS: Using 7% or greater weight change as the measure of clinical significance, 4.3% of SSRI-treated patients had lost weight at any point in the acute phase versus 1.7% of those treated with nefazodone (p = .017). However, at any point during the long-term phase, significantly more SSRI-treated patients than nefazodone-treated patients showed a significant increase in body weight (17.9% vs. 8.3%; p = .003). At any point in the acute phase, significantly more imipramine-treated patients than nefazodone-treated patients had a 7% or greater increase in body weight (4.9% vs. 0.9%; p = .027), and for the long-term phase the comparison yielded 24.5% versus 9.5%. The difference during the long-term phase was statistically significant in women (p = .017), but not in men (p = .078) due to the small numbers of men in each group. CONCLUSION: SSRIs caused more weight loss during short-term treatment but more weight gain during long-term treatment. These results lend support to the observation that some antidepressants have a greater expected risk of weight gain than others during long-term therapy.

Antidepressive Agents, Second-Generation↗
PubMed2001

Review of atypical antipsychotics and weight gain.

Prescribing an antipsychotic for a patient with schizophrenia requires a risk-benefit analysis. Weight gain has become an issue recently as a result of reports that 2 of the atypical antipsychotic agents, clozapine and olanzapine, are associated with a higher risk than other drugs of causing excessive weight gain. Some degree of weight gain may occur with any atypical antipsychotic agent, particularly early in treatment. A more important consideration is the long-term effects of the atypical antipsychotic on body weight, since many of the patients in this population require chronic therapy. This is important because weight gain is an adverse effect that is associated with noncompliance and medical problems. In this article, I review recent reports about the weight effects of different atypical antipsychotic drugs. To provide accurate understanding of the effects of atypical antipsychotic agents, data analyses should include both short-term and long-term findings, the relationship of changes in body weight to pretreatment body mass index (BMI), relationship to dose, both intent-to-treat and complete analyses, and presentation of both mean and median changes in weight. It is also important to know whether the studies have been done in an inpatient or outpatient setting, since patients who are institutionalized may be less likely to exhibit increases in body weight. Such complete information and multidimensional analysis would minimize obfuscation about the true nature of a drug's impact on body weight.

Ambulatory Care↗
PubMed1998

A review of the effects of moderate alcohol intake on psychiatric and sleep disorders.

In this chapter we discuss the effects of moderate ethanol consumption on the treatment of psychiatric and sleep disorders. A review of the literature on the interactions of ethanol with neurotransmitters and psychotropic medications suggests that although ethanol affects the clinical course of psychiatric and sleep disorders by different mechanisms, it does so principally through perturbations it causes in the balance of central nervous system neurotransmitter systems, which may modify the clinical course of primary psychiatric and sleep disorders and undermine the therapeutic response to psychotropic medications. Neurotransmitter responses may also be manifested clinically by rebound phenomena, akin to a subsyndromal withdrawal, which affect sleep and precipitate anxiety and mood symptoms. In addition, ethanol also modifies the clearance and disposition of a variety of psychotropic metabolites and interferes with their clinical effectiveness. We recommend that most psychiatric patients, and all patients with sleep disorders, should abstain from even moderate ethanol use, as this may adversely affect their clinical course and response to treatment.

Alcohol Drinking↗
PubMed1998

Anxiolytic antidepressant augmentation.

The administration of anxiolytic drugs often accompanies treatment with antidepressant medications. Although benzodiazepines help alleviate the secondary depressive symptoms of anxiety and sleep disturbance, they do not actually enhance antidepressant response. On the other hand, the anxiolytic agent buspirone does facilitate direct antidepressant response, largely through its ability to activate both presynaptic and postsynaptic 5-HT1A receptors and thus modulate serotonin release. Several case studies and open-label trials have demonstrated the effectiveness of buspirone as an augmentation agent. Because buspirone is also associated with few adverse effects, it appears to be both effective and safe in the augmentation of antidepressant pharmacotherapy.

Adult↗
PubMed1996

Structure-activity and mechanistic relationships: the effect of chemical overlap on structural overlap in data bases of varying size and composition.

Similarities between structures in SAR models derived from different data bases, termed 'structural overlap', can be used for determining mechanistic similarities, e.g., mutagenicity vs. carcinogenicity. However, the structural overlap may be affected by the proportion of common chemicals in the data bases, termed 'chemical overlap'. In order to refine our ability to determine mechanistic similarities, we investigated the relationship between chemical and structural overlap as well as the effect of the ratio of active to inactive chemicals and data base size on that relationship, using a data base of Salmonella mutagenicity. A linear relationship between chemical overlap and structural overlap with a slope of 0.332 was found. For data bases of 210, 300 and 390 chemicals, this relationship was consistent. Differences in ratios of active to inactive chemicals, i.e., 1:2, 1:1 and 2:1, did not appear to affect the linear model. We can use this relationship to adjust for chemical overlap when examining the structural overlap of data bases developed for different endpoints to determine the extent of mechanistic similarities.

Databases, Factual↗
PubMed1996

Estimation of the optimal data base size for structure-activity analyses: the Salmonella mutagenicity data base.

In the present study, the effects of data base size on predictivity, informational content and structural overlap of derived Structure-Activity Relationship (SAR) models were investigated. It was found that indices of predictivity (i.e., sensitivity, specificity, and concordance between experimental and predicted results (OCP) increased with increasing size of the data base until the range is 300-400 chemicals, at which point they plateau. The greater the size of the data base, the greater the informational content of the model; however, the rate of this increase is no longer optimal when the size of the data base exceeds 400 chemicals.

Carcinogens↗
PubMed1996

Structure-activity relationships and computer-assisted analysis of respiratory sensitization potential.

The mechanism(s) underlying respiratory sensitivity to chemicals is uncertain but is assumed to involve immunologic components with pharmacologic and neurologic involvement. Predictive testing would be valuable to prevent occurrence of hypersensitivity. Several in vitro and in vivo approaches have been used for predictive purposes. In vitro methods have included assessment of the ability of the chemical to undergo reaction with proteins. Computational methods have investigated the relationship between structure and electrophilic potential of chemical allergens. We have initiated a structure-activity evaluation of chemicals associated with elicitation of respiratory sensitization and have utilized a computer-based expert system, MultiCASE. A preliminary database of 39 active chemicals has been established from a literature search of clinical case reports and animal test results. Evaluation of the model has indicated structural alerts for activity which consist of structural fragments as well as physicochemical properties. Further development of the model and evaluation of findings should enable mechanistic insight into the process of respiratory sensitization and recognition of factors which distinguish respiratory sensitizers mechanistically from other chemical allergens such as contact sensitizing chemicals.

Allergens↗
PubMed1996

A double-blind, placebo-controlled study of vigabatrin three g/day in patients with uncontrolled complex partial seizures. Vigabatrin Protocol 024 Investigative Cohort.

This study compared the efficacy and tolerability of vigabatrin 3/day as add-on therapy with that of placebo in patients with focal epilepsy whose complex partial seizures were difficult to control with established antiepilepsy drug therapy. We enrolled 203 patients; 182 (90 placebo; 92 vigabatrin) received drug therapy under double-blind conditions. We increased the daily dosage to 2.5 g/day during a 4-week titration segment and maintained it at 3 g/day during the 12-week maintenance segment. By analyses we found a statistically significant lower frequency of seizures (complex seizures plus partial seizures secondarily generalized) at the end of the study for patients receiving vigabatrin than for those receiving placebo. The median monthly frequency was reduced by three seizures per 28 days in the placebo group (baseline, 8.3; end of study, 7.5) (p = 0.0002). Therapeutic success (a 50% reduction from baseline in mean monthly seizure frequency) was attained in 40 of the vigabatrin patients (43%) compared with 17 of those treated with placebo (19%) (p < 0.001). Vigabatrin significantly increased the mean number of seizure-free days per 28 days (2.2 days) compared with placebo (0.5 days) (p = 0.0024). Mean trough serum vigabatrin concentration during therapy was 8.6 +/- 7.7 micrograms/ml. The oral clearance of vigabatrin was determined to be 7.8 L/hr, and the elimination half-life was 8.4 hours. No clinically important changes in MRI, evoked potential, or other laboratory tests were noted during vigabatrin treatment. The results of this study indicate that 3 g/day vigabatrin is more effective than placebo as add-on therapy. Vigabatrin was well tolerated, compliance was high with twice-daily administration, and therapy did not result in clinically relevant drug interactions.

Adolescent↗
PubMed1996

Prediction of the carcinogenicity of a second group of organic chemicals undergoing carcinogenicity testing.

Twenty-four organic compounds currently undergoing testing within cancer bioassays under the aegis of the U.S. National Toxicology Program (NTP) were submitted to the computer automated structure evaluation (CASE) and multiple computer automated structure evaluation (MULTICASE) system for predictions of activity. Individual predictions resulting from the NTP combined rodent, NTP mouse, Carcinogenic Potency Database (CPDB) combined rodent, and CPDB mouse databases were combined using Bayes' theorem to yield an overall probability of rodent carcinogenicity. Based upon an arbitrary probability cut-off of 0.50, nine compounds were predicted to be rodent carcinogens. The predicted carcinogens are chloroprene, 1-chloro-2-propanol, codeine, emodin, furfuryl alcohol, isobutyraldehyde, primaclone, sodium xylenesulfonate, and t-butylhydroquinone.

Animals↗
PubMed1996

A review of the effects of moderate alcohol intake on the treatment of anxiety and mood disorders.

BACKGROUND: There is no published review to help the clinician clarify the potential role of moderate ethanol consumption in patients being treated for anxiety and mood disorders. Product labels and textbook chapters routinely warn the individual against the consumption of ethanol when using prescription psychotropic drugs. A general understanding is that the reason for this recommendation is the potential for adverse synergistic effects or sedation and decreased psychomotor performance. What is overlooked by this emphasis on safety is the effect of alcohol use both on the underlying psychiatric disorder being treated and on the effectiveness of drug therapy. METHOD: We review the available literature on the interactions of ethanol with neurotransmitters and psychotropic medications and explore the clinical consequences of these interactions. RESULTS: Ethanol might affect anxiety and mood disorders by different mechanisms. Principal among these are the effects of ethanol on multiple neurotransmitter systems, which adapt in different ways to the acute and/or chronic presence of ethanol. Perturbations in the balance of CNS neurotransmitter systems may modify the acute clinical course of primary mood disorders and undermine the therapeutic response to psychotropic medications. Ethanol also modifies the clearance and disposition of psychotropic metabolites and interferes with their clinical effectiveness. Neurotransmitter responses may additionally be manifested clinically by rebound phenomena, akin to a subsyndromal withdrawal, which affect sleep and precipitate anxiety and mood symptoms. Recent alcohol use also may alter the subjective interpretation of the patient's "internal milieu," causing confusion and eliciting reactive psychopathology. CONCLUSION: While much research remains to be done, there is abundant evidence that patients with mood and anxiety disorders should abstain from even moderate ethanol use, as this adversely affects their clinical course and response to treatment.

Alcohol Drinking↗