Alan F. Kaul

A Comparison of Regional Intravenous Guanethidine and Reserpine in Reflex Sympathetic Dystrophy A Controlled, Randomized, Double-blind Crossover Study

Both regional intravenous guanethidine and reserpine have been reported as effective in the treatment of reflex sympathetic dystrophy. Reserpine depletes storage of norepinephrine, and guanethidine interferes with transport of norepinephrine while depleting storage in the sympathetic nerve terminal. The purpose of this study was to compare drug efficacy in double-blind fashion. Twelve patients, 10 of whom had previous stellate or lumbar sympathetic blocks, were entered into this double-blind cross-over study. Each patient successively received 20 mg guanethidine in 50 ml 0.5% lidocaine, 1.25 mg reserpine in 50 ml 0.5% lidocaine, and 50 ml 0.5% lidocaine with a 1-week interval between medications. At the end of the study and before the code was broken, each patient had the option of continuing treatment with any of the three drugs: the patient merely asked for the first, second, or third drug. Pain assessment used verbal ordinal, numeric, and visual analog scales. Follow-up lasted for a minimum of 6 months. Changes in pain intensity for the first 3 days did not differ significantly among guanethidine, reserpine, and control groups. Pain relief from 2 to 14 months was achieved in two patients receiving reserpine, one receiving guanethidine, and none receiving lidocaine. None of the patients experienced permanent relief. No difference was found between reserpine and guanethidine.

THERAPEUTIC ALTERNATIVES FOR SUBACUTE PERIPHERAL ARTERIAL OCCLUSION : COMPARISON BY OUTCOME, LENGTH OF STAY, AND HOSPITAL CHARGES

Thrombolytic therapy using streptokinase or urokinase has been shown to be a viable alternative to surgical thrombectomy in patients with subacute peripheral arterial occlusion. Urokinase is associated with higher success and lower complication rates than streptokinase, but the cost of urokinase is at least seven times higher. To address questions of utility and effectiveness in the treatment of subacute peripheral arterial occlusions, the authors designed a retrospective study of patients treated either by surgical thrombectomy (n = 70), thrombolysis with streptokinase (n = 19), or thrombolysis with urokinase (n = 22). Outcome of therapy, length of hospital stay, and total hospital charges in the three groups were examined. Treatment successes in the three groups, defined as complete clearing of the occluded segment with patency maintained for 60 days, were 76% for thrombectomy, 32% for streptokinase, and 64% for urokinase. Total duration of hospitalization was 21.1, 21.3, and 11.5 days (P less than .05), respectively. Mean charges for thrombolytic agents were

A Review of Possible Toxicity of DI-2-Ethylhexylphthalate (DEHP) in Plastic Intravenous Containers: Effects on Reproduction

690 for streptokinase and

The management of preterm labor with the calcium channel-blocking agent nifedipine combined with the beta-mimetic terbutaline.

6429 for urokinase. Mean total hospital charges, however, were

The Pharmacotherapy of the Behavioral Manifestations of the ICU Syndrome

25,978 for streptokinase,

Cardiopulmonary arrest following barium enema examination with glucagon.

22,203 for urokinase, and

Postgraduate Pharmacy Fellowships (1984–85):

25,336 for thrombectomy (P = NS). The higher cost of urokinase, then, accounted for the similar total charges, despite the shortened length of stay. These results suggest that urokinase is cost-effective compared to streptokinase for subacute peripheral arterial occlusion. Compared to thrombectomy, thrombolysis with urokinase has a marginally lower patency rate at 60 days, but a significantly shorter length of hospital stay.

Postgraduate Pharmacy Fellowships

Many containers for intravenous solutions are made with plasticized polyvinyl chloride, the common form of which is di-2-ethylhexylphthalate (DEHP). Extraction of DEHP into blood and plasma stored in such plastic containers can occur, and harmful effects of DEHP in the human body consequently have been suggested. Reports on toxicity of DEHP in animals during pregnancy and the developmental period are critically reviewed.

Determining Phenytoin Dosage with the Use of a Programmable Calculator

We describe a successful, prolonged, inhibition of preterm labor using nifedipine combined with terbutaline in a patient undergoing complicated obstetrical problems. Delivery was delayed for two months and no significant ill effects were observed in the mother or her infant. This case reports the longest duration and the safe use of nifedipine for tocolysis, to date. A review of reports of the use of calcium channel-blockers in preterm labor is also presented.

A Retrospective Analysis of Analgesics and Sedative-Hypnotics in Hospitalized Obstetrical and Gynecological Patients:

T HE OCCURRENCE of psychopathologic behavior has long been recognized to occur in critically ill patients and is commonly referred to as the ICU syndrome. First introduced during the 1960s following reports of a high incidence of delirium (38% to 70%) after open heart surgery,lM3 the term ICU syndrome currently refers to an acute state of delirium. It is important for the physician to be aware of the neuropsychiatric problems that may arise in the ICU setting since they can contribute significantly to the patient’s morbidity and mortality.4 The incidence of psychiatric complications in the ICU ranges from 7s4 to 57K2 Studies indicate that the incidence may approach the higher value because in many cases mental disturbances are undetected by the staff. The incidence may be underestimated because patients who appear psychologically normal after major surgery or trauma may conceal severe, but temporary, hallucinations, confusion, delusion, and disorientation.’