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Biomedical subjects

R Hammer

Publications and source records attributed to R Hammer.

At least 19 recordsLinked to original sources
PubMed1992

Atropine poisoning in children during the Persian Gulf crisis. A national survey in Israel.

OBJECTIVE: To evaluate the effects of high doses of atropine in children accidentally injected with automatic atropine injectors. These were distributed in Israel during the Persian Gulf Crisis as an antidote for chemical warfare agents. DESIGN AND SETTING: A national survey in pediatric emergency departments in Israel, involving 22 medical centers, with prospective data collection in 14 centers. PATIENTS: Children (n = 268) presenting to emergency departments following misuse of automatic atropine injectors. MAIN OUTCOME MEASURES: Documentation of atropine dose and clinical manifestations; determination of a clinical severity score and its correlation with atropine dose; measurements of serum atropine levels in six patients. RESULTS: Over a period of 4 months, 268 cases were reported, of which 240 were clinically evaluated. The most common site of injection (75%) was the finger or palm. Doses were up to 17-fold higher than standard doses for age. In 116 children (48%), systemic effects of atropine were observed, and 20 (8%) had severe atropinization. Seizures and life-threatening arrhythmias were not reported, and there were no fatalities. The severity of atropinization was correlated with the dose following a classic nonlinear, dose-response relationship. Serum atropine levels (6.2 to 61.0 ng/mL) were much higher than those observed after administration of therapeutic doses. CONCLUSIONS: The high incidence of injection in the hand implies accidental use of automatic atropine injectors among children. The lack of mortality or life-threatening complications from injection of large doses of atropine attests to its relative safety in children. The low risk from atropine injections weighed against expected benefit as a lifesaving antidote justifies the distribution of personal atropine injectors to children at risk of organophosphorus nerve agent attack.

Accidents↗
PubMed1992

Team approach to tibial fracture. 37 consecutive type III cases reviewed after 2-10 years.

During a 10-year period, we managed 35 patients with 37 cases of Type III open tibial fractures, 15 cases within 1 week and 22 as late referrals. In all cases, simultaneous assessment and management by a microvascular and an orthopedic surgeon were mandatory throughout the treatment period. 6 of the 15 acute cases had a primary amputation. Of the remaining 31 cases, limb salvage was possible in 27. 31 flaps, pedicle and microvascular free flaps were used. Major complications occurred in 6 cases, but in 27 cases infection-free solid union was obtained. At long-term follow-up, average 5 years, the function was good or acceptable in 23 cases. We conclude that: (1) patients with Type III tibial injuries should preferably be transferred within a week after injury to a hospital where major reconstructive procedures are commonly performed, (2) early soft tissue coverage is essential in the management of these injuries, (3) unilateral external fixation should be the preferred technique of stabilization, and, finally, (4) plastic surgery expertise is important in management of severe tibial fractures.

Adolescent↗
PubMed1979

Spontaneous rupture of the liver. A complication of oral anticoagulant therapy.

Therapeutic doses of oral anticoagulants have been associated with spontaneous hemorrhage and rupture of apparently normal abdominal viscera. To our knowledge, this is the second reported case of such rupture involving the liver. The patient had sudden severe epigastric pain and signs of acute abdomen and shock. Discrete microscopic changes in the liver may precede massive hemorrhage.

Aged↗
PubMed1979

Inhibition of gastric acid secretion by pirenzepine (LS 519) in man.

Pirenzepine is a new tricyclic drug used in the treatment of peptic ulcer disease. The effect of two doses of pirenzepine (25 mg twice daily and 50 mg thrice daily) was examined in ten healthy volunteers during basal acid secretion and under stimulation with two doses of pentagastrin (0.166 microgram/kg . h and 1 microgram/kg.h given as continuous intravenous infusion). Serum drug concentrations were determined by radioimmunoassay, and parallel studies of the salivary function were performed. Pirenzepine, 25 mg twice daily, reduced basal acid output by 50% and 55%, respectively, and inhibited stimulated acid output by 31% and 26%, respectively. The higher dose of pirenzepine, 50 mg thrice daily, augmented the effect insignificantly despite markedly increased serum drug levels. The recommended therapeutic dose of 25 mg twice daily gave no salivary inhibition. Pirenzepine may have an anticholinergic effect on the parietal cell, although systemic side effects were not seen. Pirenzepine does not competitively inhibit pentagastrin-stimulated acid secretion.

Adult↗
PubMed1979

The pharmacokinetic profile of pirenzepine.

This paper gives a brief review of the pharmacokinetic studies performed on pirenzepine (L S 519 Cl2, Gastrozepin hitherto. Particular attention will be paid thereby to the clinical significance of the pharmacokinetic parameters.

Animals↗
PubMed1978

Involving community representatives in CMHC evaluation and research.

The participation of community representatives and consumers of services in agency planning has been mandated by legislation and the subsequent regulations. However, the representatives' lack of technical knowledge and sophistication frequently makes them unequal participants in the decision-making process. To help increase such sophistication, the program analysis and evaluation section of a large community mental health center has involved or assisted patient and community volunteers in various evaluation and research projects; they include a survey of area housing conditions, a survey of the needs of former inpatients, an evaluation of programs operated by a coalition of community groups, and a community resource listing.

Community Mental Health Services↗
PubMed1978

[Ambroxol, comparative studies of pharmacokinetics and biotransformation in rat, rabbit, dog and man (author's transl)].

Pharmacokinetics and biotransformation of trans-4-(2-amino-3,5-dibromo-benzylamino)cyclohexanol hydrochloride (ambroxol, NA 872 Cl) was studied using the 14C-labelled compound. Absorption after oral administration was found to be fast and complete. Elimination half-life of radioactivity in the blood was estimated as 20--25 h in rat, dog and man and as 2 h only in rabbit. This apparent elimination half-life is governed by the disposition of acidic metabolites of NA 872. In man and rabbit radioactivity is excreted almost completely into the urine, whereas in rat and dog biliary excretion is also observed. Routes of biotransformation are similar in all 4 species. NA 872 is metabolized by phase I reactions to NA 873 and finally to dibromoanthranilic acid. Phase II reactions with the parent compound and metabolites are observed mainly in man and rabbit.

Ambroxol↗
PubMed1978

[Ambroxol, studies of biotransformation in man and determination in biological samples (author's transl)].

15 mg trans-4-[2-amino-3,5-dibromo-benzyl)-amino]-cyclohexanol-hydrochloride (ambroxol, NA 872) was administered i.v. and orally to healthy volunteers. The metabolic pattern in urine and plasma was similar for both routes of administration. Biotransformation reactions are straightforward, yielding two major products of phage I reactions identified as 6,8-dibromo-3-(trans-4-hydroxycyclohexyl)-1,2,3,4-tetrahydro-quinazoline and 3,5-dibromo-anthranilic acid. These metabolites as well as the parent compound are also converted to conjugates, predominantly glucuronides. Quantification of unlabelled ambroxol in biological fluids is achieved by radiochemical derivatisation with 14C-labelled formaldehyde in imitation of the biotransformation.

Administration, Oral↗
PubMed1978

[Alterations in pharmacokinetics during toxicity tests (author's transl)].

Some possible reasons are discussed which may lead to changes in the pharmacokinetics of a drug during long-term toxicity tests. Since most of these alterations have toxicological consequences, their evaluation can be helpful in the interpretation of toxicity studies. Furthermore, and altered pharmacokinetic profile may be a diagnostic tool for the detection of organ damage (e.g., eliminatory organs). In this paper three examples of the "radioactive test dose method" are shown. This method allows a direct comparison of the pharmacokinetics between pretreated animals and controls by administration of a single radioactive test dose to both groups.

Adaptation, Physiological↗
PubMed1977

Sex differences in Necturus urinary bladders.

We describe morphological sex differences in urinary bladders of the urodele amphibian Necturus maculosus. The mucosal epithelial cells of bladders from males were tall and contained considerable PAS-positive material. In scanning electron micrographs of the mucosal surface, epithelial cells from male bladders were well demarcated and were capped with microplicae or with long cilia. The mucosal epithelial cells of bladders from females were low and contained only a small amount of PAS-positive material; in scanning electron micrographs cell boundaries could not be distinguished and no cilia or microplicae were present. Bladders from males had higher transepithelial potential difference and lower water content than bladders from females. Urine analyses were not significantly different in the two sexes. It is suggested that response to androgens in the male accounts for the observed differences.

Animals↗
PubMed1977

Possible programmatic consequences of community mental health center funding arrangements: illustrations based on inpatient utilization data.

Funding arrangements have a direct and substantial influential effect on the delivery of mental health services. Despite the original intent of the community mental health center philosophy, centers have not been freed from programmatic limitations imposed by the fiscal systems. The focus of this article is the inpatient unit that has the key role as relates to a center's ability to raise revenue. Using data from a study of community mental health center inpatient utilization patterns, the authors demonstrate that centers face the problem of becoming revolving doors (for a recidivist population). Existing fiscal arrangements, it is suggested, reinforce this pattern and tend to downplay innovative alternatives to traditional inpatient care.

Ambulatory Care↗
PubMed1977

Pharmacokinetics as an aid in the interpretation of toxicity tests.

A method is described which makes the detection of alterations in the pharmacokinetic profile possible when substances are administered during long-term toxicity tests. By superposition of a radioactive dose at the end of the toxicity study a blood level can be obtained which--on the assumption of first-order kinetics--is comparable to that after a single radioactive dose in controls. Differences between blood levels of pretreated and control animals may indicate enzyme induction or damage of the elimination organs, etc., even when morphological changes are evident.

Ambroxol↗