SERIOUS UNTOWARD REACTIONS TO THERAPY WITH CORTISONE AND ADRENOCORTICOTROPIN IN PEDIATRIC PRACTICE (PART I)

PEDIATRICS ◽  
1957 ◽  
Vol 19 (1) ◽  
pp. 95-118
Author(s):  
Robert A. Good ◽  
Robert L. Vernier ◽  
Richard T. Smith
Keyword(s):  
Experimental Approach ◽  
Clinical Medicine ◽  
Medical Center ◽  
Medical Science ◽  
Pediatric Practice ◽  
Beneficial Effects ◽  
Physiologic Function ◽  
The Common ◽  
Pharmacologic Agents ◽  
Toxic Reactions

THE INTRODUCTION of cortisone and adrenocorticotropin (ACTH) into clinical medicine by Hench et al. has profoundly influenced both medical practice and medical science. Voluminous literature which has collected during the 5 years since their introduction establishes securely the effectiveness of these hormonal agents in diseases previously refractory to medical management. In the laboratory these drugs have also opened whole fields to investigation with a new experimental approach. Data already available suggest that ultimate discovery of the basis of the action of cortisone and ACTH will carry broad inmplications concerning physiologic function and mechanisms of disease. A natural consequence of the introduction of such potent and versatile weapons into clinical medicine is that they should be widely used. In almost every human disease, ranging from the common cold to disseminated malignancy, the steroid hormones and ACTH have been tried. For example, it can be factually stated that few truly ill patients reach the diagnostic medical center without having had at least small amounts of cortisone or ACTH, and it is the extremely unusual patient who reaches the necropsy table without the "benefit" of ACTH, cortisone or one of its analogues. As these drugs have been studied, it has become ever more apparent that they are extraordinarily potent pharmacologic agents which effect or control mammalian physiology in multitudinous areas, perhaps in several different ways. More gradually it has been realized that their effects are not all beneficial. Because of enthusiasm engendered by the availability of potent new pharmacologic agents, reporting from most clinics to date has emphasized the dramatic beneficial effects and tended to minimize the untoward side effects, toxic reactions and potential hazards of hormone therapy. It is the purpose of this report to review some of the hazards of treatment with cortisone and ACTH in pediatric practice.

Towards Systematization

1977 ◽  
Vol 16 (03) ◽  
pp. 125-130 ◽  
Author(s):  
P. L. Reichertz
Keyword(s):  
Clinical Medicine ◽  
Medical Science ◽  
User Involvement ◽  
Empirical Science ◽  
Target System ◽  
General Strategy ◽  
System Construction ◽  
Formal Approach ◽  
Methodology Development ◽  
Planning Development

Data processing has become an important tool in theoretical and clinical medicine. The main categories of applications are : information analysis, (bio)signal processing and the field of information logistics (information systems).The problems encountered lie in the discrepancy of the basic methods of a formal approach to an empirical science, the complexity of the target system and the system ecology, i.e. the involvement of the user and the system environment during system construction and utilization.Possible solutions to these problems are the application of system techniques, inductive planning, development of medical methodology, development of methods and techniques for user involvement and assessment of motivation and education and educational planning.The necessary general strategy in the development in medical informatics is seen in the continuing systematization of the theoretical and practical approach. It is estimated that this will eventually contribute to the systematization of medical science and practice.

scholarly journals An Interesting and Productive Research and Clinical Career

2020 ◽  
Vol 39 (3) ◽  
pp. 182-188
Author(s):  
Samuel M. Cohen
Keyword(s):  
High School ◽  
Clinical Medicine ◽  
Medical Center ◽  
Basic Research ◽  
Nebraska Medical ◽  
Good Fortune ◽  
University Of Wisconsin ◽  
Productive Research ◽  
The University

To begin, I wish to thank the Academy of Toxicological Sciences for bestowing this honor on me. I have had a rewarding career in basic research and clinical medicine, beginning with research in high school and always planning on becoming a physician. I have had the good fortune of having outstanding mentors, wonderful parents, and a supportive and intuitive wife and family. This article provides a brief overview of some of the events of my career and individuals who have played a major role, beginning with the M.D./Ph.D. program at the University of Wisconsin, pathology residency and faculty at St. Vincent Hospital, Worcester, Massachusetts, a year as visiting professor at Nagoya City University, and my career at the University of Nebraska Medical Center since 1981. This could not have happened without the strong input and support from these individuals, the numerous students, residents and fellows with whom I have learned so much, and the more than 500 terrific collaborators.

Letters to the Editor

PEDIATRICS ◽  
1964 ◽  
Vol 33 (2) ◽  
pp. 309-310
Author(s):  
MORRIS A. WESSEL
Keyword(s):  
Medical Center ◽  
Full Time ◽  
Pediatric Practice ◽  
Letters To The Editor ◽  
Prenatal Visit ◽  
Housing Status ◽  
The City

I do appreciate Dr. Mendelsohn's kindness in writing to obtain further information regarding details of a pediatric prenatal visit for expectant couples. Although I do live in the city where Yale Medical Center is located, I conduct with an associate a full-time pediatric practice. Expectant couples seek appointments in our office because they have learned that this is a well-established routine. I do not understand Dr. Mendelsohn's hesitancy in seeking information as to occupational and housing status of expectant parents.

scholarly journals Possibilities of using allogeneic mesenchymal stem cells and wound dressings based on aliphatic copolyamide in microautodermoplasty

2020 ◽  
Vol 8 (2) ◽  
pp. 185-196
Author(s):  
Vasily A. Gordienko ◽  
Evgenii V. Zinoviev ◽  
Denis V. Kostyakov ◽  
Marat S. Asadulaev ◽  
Anton S. Shabunin ◽  
...  
Keyword(s):  
Stem Cells ◽  
Mesenchymal Stem Cells ◽  
Clinical Medicine ◽  
Medical Science ◽  
Local Treatment ◽  
Treatment Algorithm ◽  
Wound Dressings ◽  
Results Of Treatment ◽  
Healing Index ◽  
Treatment Of Wounds

Background. The treatment of victims with wound defects is an urgent problem of clinical medicine that doctors of various specialties, mainly surgeons and traumatologists, must face. Regardless of the etiology of the traumatic agent, the wound process is always subjected to fundamental pathophysiological processes. Despite the advances made by medical science in the local treatment of wounds (cell technology, modern wound coverings, and others), surgical procedures remain the main methods, and the search for new techniques to optimize reparative regeneration continues. This ongoing search indicates the absence of a universal algorithm for treating such defects. This lack of a universal treatment algorithm is of particular importance for assisting victims with extensive defects, which often leads to a shortage of donor resources. Aim. The aim of this study was to increase the efficiency of microautodermoplasty due to the use of allogeneic mesenchymal stem cells and wound dressings based on aliphatic copolyamide. Materials and methods. This paper presents the results of an experimental study involving 50 rats. All animals were divided into groups considering the choice of the method of the local treatment. The experimental wound was modeled according to its original technique. The evaluation of the effectiveness of the analyzed methods was performed using planimetric and histological research methods, and by calculating the healing index. Results. The most effective methods for treating experimental wounds using microautodermoplasty (MADP) are wound dressings based on aliphatic copolyamide (CoPA) and adipogenic mesenchymal stem cells (AMSC). By 28 days of treatment after performing MADP + CoPA wound dressings + AMSC, it was possible to reduce the defect area by 16 times compared with the control, and the healing index was the maximum value among all methods 12.5 units. The high regenerative potential was also confirmed by the results of the histological examination. The worst results were found in the MADP group with AMSK that did not cover the wounds with skin or wound dressing. Conclusion. The introduction of the analyzed methods into clinical practice will improve the results of treatment of patients with wound defects of various etiologies.

scholarly journals Historical perspective of neurology in Iran

2019 ◽  
Author(s):  
Shri Kant-Mishra ◽  
Hadi Mohammad Khanli ◽  
Golnoush Akhlaghipour ◽  
Ghazaleh Ahmadi Jazi ◽  
Shaweta Khosa1
Keyword(s):  
Historical Perspective ◽  
Medical Center ◽  
Medical Science ◽  
Early Period ◽  
Medieval Period ◽  
Neurologic Diseases ◽  
The Past ◽  
Modern Period ◽  
History Of ◽  
Modern Era

Iran is an ancient country, known as the cradle of civilization. The history of medicine in Iran goes back to the existence of a human in this country, divided into three periods: pre-Islamic, medieval, and modern period. There are records of different neurologic terms from the early period, while Zoroastrian (religious) prescription was mainly used until the foundation of the first medical center (Gondishapur). In the medieval period, with the conquest of Islam, prominent scientists were taught in Baghdad, like Avicenna, who referred to different neurologic diseases including stroke, paralysis, tremor, and meningitis. Several outstanding scientists developed the medical science of neurology in Iran, the work of whom has been used by other countries in the past and present. In the modern era, the Iranian Neurological Association was established with the efforts of Professor Jalal Barimani in 1991.

Concepts of Risk in Nanomedicine Research

2012 ◽  
Vol 40 (4) ◽  
pp. 809-822 ◽  
Author(s):  
Linda F. Hogle
Keyword(s):  
New Technologies ◽  
Human Subjects ◽  
Medical Science ◽  
Ethical Concern ◽  
Mitigation Measures ◽  
Ethical Review ◽  
Benefit Analysis ◽  
The Common ◽  
Risk Benefit Analysis ◽  
Ethical Oversight

Risk is the most often cited reason for ethical concern about any medical science or technology, particularly those new technologies that are not yet well understood, or create unfamiliar conditions. In fact, while risk and risk-benefit analyses are but one aspect of ethical oversight, ethical review and risk assessment are sometimes taken to mean the same thing. This is not surprising, since both the Common Rule and Food and Drug Administration (FDA) foreground procedures for minimizing risk for human subjects and require local IRBs to engage in some sort of risk-benefit analysis in decisions to approve or deny proposed research. Existing ethical review and oversight practices are based on the presumption that risk can be clearly identified within the planned activities of the protocol, that metrics can reasonably accurately predict potential hazards, and that mitigation measures can be taken to deal with unintended, harmful, or catastrophic events.

CLINICAL INVESTIGATION IN PEDIATRIC PRACTICE

PEDIATRICS ◽  
1956 ◽  
Vol 18 (1) ◽  
pp. 90-94
Author(s):  
John C. Wilcox
Keyword(s):  
Clinical Study ◽  
Teaching Hospital ◽  
Clinical Investigation ◽  
Medical Knowledge ◽  
Academic Standards ◽  
Pediatric Practice ◽  
The World ◽  
Common Purpose ◽  
The Common ◽  
Stimulation Of

WHILE recognizing that the common purpose of all clinical investigation is the benefit of the patient through the advancement of medical knowledge, there are other justifications and sources of inspiration which may be more immediately gained objectives. This is true whether the investigator is a professor of pediatrics or his country cousin. It is the purpose of this paper to compare the natures of those immediate objectives as they apply to clinical investigation carried on in a teaching center with clinical investigation performed in pediatric practice. In making this comparison, I do not intend to imply that the professor of pediatrics or a member of his staff has at his beck and call large crews of laboratory technicians, roomtuis of pretty secretaries and efficient stenographers, tabulators and computers in frightening array, scads of money neatly tagged for research and all the time in the world—and that none of these is possessed by the practitioner. Instead, I will point out that in spite of a seemingly vast gulf of separation in facilities and resources, there are similarities of purpose which serve to give reflected dignity to any reasonable and seriously pursued clinical study even though it be attempted under primitive conditions by academic standards. The professor, gazing from the porticoed façade of a teaching hospital and contemplating his next venture into publication [SEE FIG. 1., FIG. 2. IN SOURCE PDF] (Fig. 1), looks in 1 of 3 possible directions for stimulation. Each of these corresponds with 1 of 3 responsibilities: (1) instruction of students; (2) scientific stimulation of pediatric confreres; (3) the recognition of academic superiors.

scholarly journals A rare case of bilateral congenital posterior mesotympanic cholesteatoma

2018 ◽  
Vol 17 (2) ◽  
pp. 307-310
Author(s):  
Ahmad Hafiz Ali ◽  
Zulkiflee Salahuddin ◽  
Mohd Khairi MD Daud ◽  
Rosdan Salim
Keyword(s):  
Soft Tissue ◽  
Tympanic Membrane ◽  
Middle Ear ◽  
Rare Case ◽  
Medical Science ◽  
Canal Wall ◽  
Common Site ◽  
Congenital Cholesteatoma ◽  
Canal Wall Down ◽  
The Common

Bilateral congenital mesotympanic cholesteatoma is a very rare disease. It can present differently from ordinary congenital cholesteatoma. We report a case of bilateral congenital cholesteatoma diagnosed at age of 22 years old. She presented with bilateral intermittent ear discharge since 10 years old that worsening two weeks prior to her presentation to our clinic and associated with bilateral reduced hearing. Clinically there was intact tympanic membrane with retraction of the mesotympanic area with present of mass medial to tympanic membrane. CT scan imaging showed there was soft tissue in the bilateral middle ear cavity with intact scutum and ossicles. Patient undergone canal wall down procedure and the diagnosis of congenital mesotympanic cholesteatoma was confirmed with present of cholesteatoma sac at the posterosuperior part, as opposed to anterosuperior quadrant, where the common site for congenital cholesteatoma.Bangladesh Journal of Medical Science Vol.17(2) 2018 p.307-310

Long-Term Inhalative Sedation in Children With Pulmonary Diseases

2020 ◽  
pp. 088506662095339
Author(s):  
Jochen Meyburg ◽  
David Frommhold ◽  
Johann Motsch ◽  
Navina Kuss
Keyword(s):  
Side Effects ◽  
Lung Function ◽  
Medical Center ◽  
Academic Medical Center ◽  
Tertiary Care ◽  
Prospective Trial ◽  
Pediatric Intensive Care ◽  
Normal Lung ◽  
Beneficial Effects

Objectives: To describe safety and feasibility of long-term inhalative sedation (LTIS) in children with severe respiratory diseases compared to patients with normal lung function with respect to recent studies that showed beneficial effects in adult patients with acute respiratory distress syndrome (ARDS). Design: Single-center retrospective study. Setting: 12-bed pediatric intensive care unit (PICU) in a tertiary-care academic medical center in Germany. Patients: All patients treated in our PICU with LTIS using the AnaConDa® device between July 2011 and July 2019. Measurements and Main Results: Thirty-seven courses of LTIS in 29 patients were analyzed. LTIS was feasible in both groups, but concomitant intravenous sedatives could be reduced more rapidly in children with lung diseases. Cardiocirculatory depression requiring vasopressors was observed in all patients. However, severe side effects only rarely occured. Conclusions: In this largest cohort of children treated with LTIS reported so far, LTIS was feasible even in children with severely impaired lung function. From our data, a prospective trial on the use of LTIS in children with ARDS seems justified. However, a thorough monitoring of cardiocirculatory side effects is mandatory.

Intermittent, Repetitive Corticosteroid-Induced Upregulation of Platelet Levels After Adenovirus-Mediated Transfer to the Liver of a Chimeric Glucocorticoid-Responsive Promoter Controlling the Thrombopoietin cDNA

Blood ◽  
1998 ◽  
Vol 92 (3) ◽  
pp. 822-833 ◽  
Author(s):  
Ko Narumi ◽  
Motoyoshi Suzuki ◽  
Wenru Song ◽  
Malcolm A.S. Moore ◽  
Ronald G. Crystal
Keyword(s):  
Clinical Medicine ◽  
Intraperitoneal Administration ◽  
Fold Increase ◽  
Inducible Promoter ◽  
Pharmacologic Agent ◽  
Before And After ◽  
American Society ◽  
Pharmacologic Agents

Abstract For many in vivo gene therapy clinical applications, it is desirable to control the expression of the transferred transgene using pharmacologic agents. To evaluate the feasibility of accomplishing this using corticosteroids, pharmacologic agents widely used in clinical medicine, we constructed replication deficient adenoviral (Ad) vectors containing an expression cassette with a chimeric promoter comprised of five glucocorticoid response elements (GRE) and the chloramphenicol acetyltransferase reporter gene (AdGRE.CAT) or the murine thrombopoietin cDNA (AdGRE.mTPO). In vitro studies showed the vectors functioned as expected, with marked glucocorticoid-induced upregulation of the CAT or mTPO transgenes. To evaluate the inducibility of the GRE promoter in vivo, the AdGRE.CAT vector was administered intravenously to C57B1/6 mice, and CAT activity was quantified in liver before and after intraperitoneal administration of dexamethasone. The GRE promoter activity was dependent on the dexamethasone dose, with a 100-fold increase in CAT expression with 50 μg dexamethasone, similar to the levels observed in vivo with the Rous sarcoma virus long terminal repeat constitutive promoter. After dexamethasone administration, maximum CAT activity was observed at day 2, with a slow decline to baseline levels by 2 weeks. Based on these observations, we hypothesized that a single administration of an Ad vector-mediated transfer of the chimeric GRE inducible promoter driving the mTPO cDNA would enable repetitive administration of corticosteroids to repetitively upregulate platelet levels for 1 to 2 weeks. The data show that this occurs, with dexamethasone administration every 3 weeks associated with 1-week elevations (at each 3-week interval) of serum mTPO levels, megakaryocyte numbers in bone marrow, and platelet levels fourfold to sixfold over baseline. Thus, with the appropriate promoter, it is possible to use a commonly used pharmacologic agent to upregulate the expression of a newly transferred gene on demand. © 1998 by The American Society of Hematology.

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