Leo J. Cass

The Present Status of ACTH Therapy in Multiple Sclerosis

Excerpt Many investigators have used adrenocorticotrophic hormone (ACTH) in the treatment of multiple sclerosis. Information being accumulated clearly delineates the effectiveness of such treatment...

The Metabolic Fate of Nitrate Esters

* Physician, University Health Services, Harvard University, Cambridge, Mass.; Chief of Medicine, Brooks Hospital, Brookline, Mass.; Visiting Physician, Long Island Hospital, Boston, Mass. t Biostatistician, University Health Services, Harvard University, Cambridge, Mass; Lecturer, Harvard School of Public Health, Boston, Mass. ‡ Director of Clinical Laboratory, Long Island Hospital, Boston, Mass. Despite extensive clinical and physiologic research, many questions remain unanswered regarding the mode of action of organic nitrates. Additional questions associated with another area of research-the metabolic fate of these agents in humans-have been virtually unexplored. The paucity of this latter information seems related to the fact that extremely sensitive analytic procedures are required to measure, in body fluids, the presence of organic nitrates and their metabolic products that result from clinically feasible doses. Complicating this is the unanswered question of whether the metabolism of orally administered organic nitrates begins in the intestinal tract and, if it does, whether it is affected by varying rates of absorption. Hence, when attempts are made to delineate the final metabolic product(s) of organic nitrates and relate these to physiologic activity, our lack of understanding is apparent. There is some evidence that the administration of organic nitrates leads to variations in blood

The clinical evaluation of sustained release antitussives.

Excerpt INTRODUCTION In recent years significant advances have been made in the development of forms of medication which will more effectively provide the patient with the total daily prescribed do...

EVALUATION OF APPETITE SUPPRESSANTS

Excerpt The high incidence of obesity in our population presents a definite public health problem. It is estimated that approximately 20 million people in the United States are clinically obese, an...

CLINICAL COMPARISON OF BULK AND STIMULANT LAXATIVES

In view of the considerable discussion regarding the effect of bulk laxatives in comparison with the stimulant varieties, it is surprising how few controlled experimental observations have been carried out in this field. Direct, psychologically sound, scientifically planned tests of the clinical differences of these laxatives are rare. A study by McGuigan, Steigmann, and Dyniewiczl on the various laxative dosages covered karaya gum, bran, cascara sagrada, magnesium sulfate and phenolphthalein, but these authors failed to compare the drug in the same group of patients or to compare their clinical effectiveness. I n a previous study, Cass and Wolf2 observed the effects of methylcellulose and psyllium on patients who had been receiving liquid milk of magnesia, fluid extract of cascara sagrada, or mineral oil. A control period on the usual laxative was compared with a period on the new medication. Since, however, the patients knew what they were receiving, a valid criticism may be made here, and it is difficult to gauge precisely the subjective factors in such a survey. The present study has eliminated 1 his objection, by the use of a rigidly controlled, blind clinical trial in which neither the observer nor the patient knew the identity of the medication or that one of the “medicines” was a placebo. The composition and amount of the medications under test are presented in TABLE 1. In essence, the medications consisted of lactose, methylcellulose, and caroid and bile salts with phenolphthalein, all in the form of identical tablets, both with regard to external appearance and by reference to the taste and appearance when broken. The total daily dose of methylelclulose amounted to 4.0 gm., equivalent to or slightly more than the usually recommended dose. The total daily dose of caroid and bile salts with phenolphthalein equaled four tablek of the commercial product, which is the manufacturer’s recommended dose. To inaintain the blind-test conditions, this medication was given in eight one-half strength tablets. The studies were carried out a t the Long Island Hospital, Boston, Mass., a chronic disease hospital with approximately 1200 patients. All of the patients under observation were semiambulai ory (bed or chair), permanently institutionalized, and severely constipated. Medications were administered by a technician and the observations were made by a full-time nurse, neither of whom knew the code. All patients received all three medications. The !sequence in which the medications were given, however, was randomized. The observations were obtained daily by the nurse, from the floor nurses’ notes and the patients’ responses to questions, as demonstrated in TABLE 2. Method.