Lee E. Bairnsfather

Duration of the suppressive effect of tricyclic antidepressants on histamine-induced wheal-and-flare reactions in human skin☆

The antihistaminic properties of the tricyclic antidepressants have been recognized since these compounds were first developed. Antidepressants, which are equally effective for treating depression or used in the treatment of chronic urticaria, have varying in vitro antihistaminic properties. We compared the duration of H1-receptor blockade by two tricyclic antidepressants, doxepin (the most potent antihistamine) and desipramine (the least potent antihistamine), in a single dose, double-blind, noncrossover study. After baseline prick test with histamine phosphate 1:1000 by Multitest (Lincoln Diagnostics, Decatur, Ill.), the suppression of cutaneous histamine-induced wheal-and-flare responses were measured daily for 7 days in 33 healthy volunteers who were randomly administered a single 25 mg dose of oral desipramine or doxepin. Significant differences in the suppression of the wheal-and-flare responses to histamine between the two drugs were noted (p less than 0.05) during the first 3 days. Desipramine suppressed the wheal for 2 days and flare for 1 day. Doxepin suppressed the wheal for 4 days and flare for 6 days. Our results suggest doxepin should be withheld for at least 7 days before allergy skin testing.

Reading Deficiencies in Older Patients

To participate effectively in their health care, older patients often are expected to read a wide variety of materials, including written instructions, brochures, and consent forms. This study quantitates the reading ability of older patients and compares it to that of younger patients. Two hundred seventy-two patients 30 and older were selected from five outpatient clinics at a public teaching hospital and tested for objective reading ability using the Peabody Individual Achievement Test—Revised. The 76 patients 60 and older read significantly worse (grade level 2.9) than the 196 patients younger than 60 (grade level 5.8) (P < 0.0001). Older patients also completed significantly fewer years of school than younger patients (7.3 years versus 10.6 years). Analysis of variance for age categories 30–44, 45–59, 60–74, and 75 and older confirmed declining reading ability and educational status with advancing age. Multiple regression analysis helped show that an equation could be derived to predict reading ability from age, educational status, race, and sex, but the coefficient of determination was so low (r2 = 0.39) that it cannot be considered clinically useful for individual patients. In this study, older patients read significantly worse than younger patients, and a formula that combines age, race, sex, and educational status cannot reliably predict reading ability for individual patients. Most older patients read on a level so low that they cannot be expected to read most commonly used written materials. Routine testing of reading ability may allow more appropriate design and use of written materials.

Timing and dosage of postoperative radiotherapy for squamous cell carcinoma of the upper aerodigestive tract.

Seventy patients who received postoperative irradiation (PI) after curative surgery for stage III or IV squamous cell carcinoma of the upper aerodigestive tract were studied retrospectively to compare the rate of local and regional recurrence (LRR) and the effect of total dose on LRR rate in patients irradiated timely (n = 40) with those who were not (n = 30). Overall, the LRR rate was higher when PI was delayed than when timely (37% vs 20%). No advantage resulted from increasing total dose when PI was delayed; the LRR rate in the primary site and upper neck was 18% with less than 60 Gy and was 26% with 60 Gy or more; the LRR rate in the lower neck was 13% with 50 Gy or less and was 14% with more than 50 Gy. These data seem to corroborate the findings of other investigators regarding the importance of initiating timely PI, but not the observation that a pronounced delay is not detrimental provided higher tumoricidal doses are used.

PURSUIT METER II, A COMPUTER-BASED DEVICE FOR TESTING PURSUIT-TRACKING PERFORMANCE

The Pursuit Meter II, a microcomputer-based device developed for the quantitative determination of human pursuit-tracking performance, is described. Computer-generated moving patterns are displayed on a high resolution color video monitor. For the subject the task is to attempt to superimpose a red line presented on the screen, the vertical location of which he controls with a steering device, over a blue line the computer generates as the problem. Both lines, each composed of 279 segments, are generated at the same rate, left to right on the monitor. The individual differences between the subjects response and the problem are summed and stored by the computer as an error score which correlates inversely to the subjects ability to perform the task. Three Pursuit Meter II problems were presented to 26 male college students. Our data demonstrated that different levels of performance to the problems resulted and that the Pursuit Meter II can be used to quantify human pursuit-tracking performance.

Antinuclear antibodies and anticytoplasmic antibodies in bronchial asthma

The presence of antinuclear antibodies and anticytoplasmic antibodies was evaluated in the sera of 50 patients with bronchial asthma and 35 matched control subjects with miscellaneous medical diseases with the use of an indirect immunofluorescent assay with HEp-2 cells as substrate. The results were compared to age, sex, atopic status, dose, and duration of the antiasthmatic medication, immunotherapy, severity of the disease, and presence or absence of myalgia. The patients had mild to moderate asthma. The incidence of fluorescent anticytoplasmic antibodies (FACA) in the sera of patients with asthma was statistically significant (p = 0.02) in comparison to FACA in the sera of the control subjects. The combined incidence of fluorescent antinuclear antibodies (FANA) and FACA was found to be significantly higher among atopic subjects with asthma (p = 0.03) and the subjects with asthma and with myalgia (p less than 0.05). The 20% incidence of FACA in this group of subjects with asthma was significantly greater (p less than 0.0001) than the reported 2.7% incidence of FACA in a group of patients with various rheumatologic diseases. Variables, such as dose and duration of antiasthma medications and immunotherapy did not appear to influence the presence of FANA and FACA in their sera. The significance of positive FANA and FACA in this group of subjects with asthma is not known and needs to be evaluated by long-term studies.