Total infusion time: 324 min Volume of each solution administered: solution A,21.25 mL;solution B, 42.25 mL; and solution C, 516.67 mL. Solutions were prepared in the cytotoxicity unit of the pharmacy department. The tubing of each bag is primed with the antineoplastic drug in the pharmacy and connected to a running saline line in close proximity to the patient, thus enabling delivery of small volumes during the initial steps of the desensitization protocol. The protocol was adapted from Castells et al [4]. Irinotecan is always diluted in 500 mL in our hospital, instead of 250 mL, as per the original protocol, and the infusion rate is adapted to that change. No diluent is removed when a solution is prepared owing to our local safety requirements: the amounts added are 0.
Fifty-four per cent of 52 patients presenting to the University of Malaya Medical Centre with a myelopathy for which appropriate investigations uncovered no definite etiology, subsequently developed clinically definite or probable multiple sclerosis. In the subgroup of patients with a presentation indicative of acute/subacute transverse myelopathy, 14 or 52% also went on to develop clinically definite or probable multiple sclerosis, a far higher proportion than previously recorded in the literature. This finding is probably a further manifestation of racial difference in the behaviour of multiple sclerosis. For the group as a whole, the only factor which appeared to be associated with an increased risk of developing multiple sclerosis was female sex; 67% of 33 female patients went on to develop multiple sclerosis after a mean follow-up period of 5.5 years. Other factors such as age of onset, racial composition, level of spinal cord involvement, presence of fever and CSF finding were found not to be important.
Specific anti-thyroxine rabbit antisera were generated from complete Freund's adjuvant with liposomes consisting of sphingomyelin, cholesterol, dicetylphosphate and 5-N-thyroxine-2,4-dinitrophenyl-phosphatidylethanolamine (T4-Dnp-PE). Spin membrane immunoassay technique was used to measure the sensitivity and specificity of these antisera. Addition of 10 to 70 ng of L-thyroxine produced significant inhibition of immune lysis. Addition of L-3,3',5-triiodothyronine (T3) up to 800 ng showed no cross reaction.
Introduction: Psychiatrists in non-gazetted treatment settings, like psychiatric wards in restructured general hospitals and private hospitals, face a major problem when psychiatric patients who require admission are either not competent or refuse to consent to admission and treatment, although they are clearly in need of such inpatient management. Admission to the state mental hospital is often refused by their relatives for a number of reasons, like the stigma attached to admission to such a hospital, and the fear that future employment prospects might be affected. Clinical Picture: Mr X, a manic, violent patient, had no insight into his disorder and refused admission and treatment for his manic episode. He was the head of a large corporation, and his relatives were apprehensive he would make decisions that could jeopardize the company. Treatment: He refused oral medication, could not tolerate parenteral haloperidol and had lithium nephrotoxicity. Inpatient electroconvulsive therapy had to be administered, after which he responded satisfactorily. Conclusion: The legal implications in this case, like consent for treatment and admission, and ethical issues, are discussed.
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