Document RJj367Gz1Z22mEg1wdBndnnev

R&S 109921 BIO-MEDICAL RESEARCH DOCUMENT DESCRIPTION FORM Duplicate in all cards:-$> ----- L 68 69 76 year as-1961- File number [Right justify [Numeric only] Author(s), as Last Name FS (No Punctuation) and coden for journal as JAMA preceeded by one blank space 1 20 21 tvtfK x<n AO 41 77 78 Sub-Index Code 60 61 62 11 12 13 Title of Report; end with space-hyphen-hyphen-space. Follow with Index Terms, separated from each other with comma-space. Avoid other punctuation; do not abbreviate. 12 61 62 L 21 22 23 24 Source (Journal, Vol., Number, Pages, Date) 12 <J/h7tfA- T'iO: /^7-T 61 62 31 32 Brief Summary 12 10 SUMMARY: 61 62 61 62 63 64 requiring assisted ventilation and I sure that no similar mistake in trans seeing a Vietnamese refugee with * eventually tracheostomy. Two other position was made by either the labo pulmonary lesion, will call this tu PLS patients; however, were able to ratory or the physicians in the case of berculosis, or melioidosis, or perhaps tolerate up to 75 mg/day in divided the patient reported?" The case would even pneumocystis pneumonia, partic doses, with improvement of spasticity not be unique if the blood level in ularly in the children. and speech (spastic dysarthria). There their case were actually 3.2 mg/100 Furthermore, in view of the well- was no single instance in the cases in ml. known fact that Asiatics have a con which the drug failed when the pa WiwUAM E. KAA-6&, MO siderably nigner incidence of dis R&S 109922 tient was able to tolerate 75 mg/longer than five days. The reason for this low tolerance to dantrolene in patients with ALS is not clear, but this fact should be con sidered when treating spasticity in patients with associated motor neu ron dysfunction. Victor M. Rivcra. MO WtNi 8. Bft&TSACM. RN LfNOA SWAMKtf. RN Baylor Coltoga of Madicin* Thi Mathodist Hospital Houston Mayo Clinic Rochovtor, Minn In ffepiy.--Laboratories do report an ticonvulsant blood levels differently, and this can be confusing to physi cians, We recognized this point and reported the correct values in our ar ticle. Our reported values of 3.2ag and ZZyg/ml correspond to 0.32 and 022 mg/100 ml, respectively. Dr. Karnes' point is an important one and should be made to all clini cians, semination following primary coc cidioidal infection than have certain other racial groups, it becomes imper ative to call the attention to physi cians throughout the country to the possibility of coccidioidal infeccion in the Vietnamese refugees. Hans E. Einstun. MO Sakamfefd, CaUf n >ssHemangiosarcoma To the Editor.--A recent reeppoorrt L Monster AW, Harmaa R, Moeks S, *t &L Coopera tive study for assessing the effects of a pharmacological agent on spasticity, Am J Phy* M*d 516^16S, 197X 2. GeUnberg AV, Poekanzer DC: The effect of dan-' troleae sodium on spasticity in multiple sderaeis. SturoU W Sl-Llft-HU. 197a 3, Oiyuite SB. Basmajian JV: Dantrolene indium: Long-term effects in severe *paatiaty. Arch fhyt *U*d Hthahil 54311-315, 1973. Clarcncs E. McDanal Jr.. MO William M. Bolman. MO Honolulu Vietnamese Refugees To the Editor.--There has been in creasing concern and discussion about (231:914,1975) indicated that in a case involving primary hemangiosarcoma, liver tissue gave a strong positive reaction for acid mucopolysaccharide. Prompted by this report, we have ex amined for this property, specimens from our files. In three cases of he i Reporting of Anticonvulsant Blood Levels To the Editor.--The article by possible health hazards that might be brought to this country by the large number of Vietnamese refugees cur rently being processed in various cen mangiosarcoma we stained sections of liver with alcian blue, pH 2.5 (nu^^ clear-fast red-counterstain).1 quate amounts of both tumorous an^^ McDanal and Bolman (231:1063,1975) ters in the United States. I wish to normal surrounding tissue were pres presents a psychotic reaction to call attention to a different type of ent on the slides. However, in con phenytoin (formerly diphenylhydan- health hazard, one faced by the ref trast to Drs Barr and Bonnin, we toin) that they conclude was an ugees themselves rather than their were unable to detect either tumor idiosyncratic reaction because blood hosts. cell staining properties or matrix that levels of phenytoin were low. Unfor Approximately IS,000 of the Viet might distinguish them from those of tunately, there is as yet no generally namese are awaiting relocation at adjacent liver tissue. Our results sug agreed standard way of reporting an ticonvulsant blood levels. Most labo ratories report the levels as indicated Camp Pendleton in southern Califor nia. This base has for many years been known as an area of fairly high gest that this particular approach is probably not useful as a marker for primary hemangiosarcoma of the liver. by McDanal and Bolman in yg/mg, but others, including our own, con tinue to report the levels in mg/100 incidence for coccidioidomycosis. The late spring is one of the highest inci dence periods of the year. All of us STEVbM c_ RuftiN, MD .Umis Galdaoiw, MO Boston Hospital ml. This can lead to obvious confusion both on the part of the reporter as weii as on the part of the reader. Tor have seen pictures of the refugees being housed in open areas in tents, with children nia/ing in 'he bare dirt 1. Luna LG (d); Manual of Hbtefutffc Staining Math is of th* \rir>*nl K*t#r*n Miiiqtta of i*atN4o<y, e>l 3, Vv Co Lit. p !*%:< example, the therapeutic range of outside. It is tnis intermingling of phenytoin is indicated by the authors to he" lu.ug to 15/ig/ml, which is the susceptible hosts in an endemic natu ral habitat that produces a :onsidera- Still More on Catfish Stings same as 1 to 1.5 mg/100 ml. Confusion in making this trans position led to erroneous statements, for example, in the 1969 Physician'.1; Disk Reference, concerning therapeu tic and toxic levels of phenytoin, :n which a wide latitude hetween these two Wits indicated. All epileptologists ble amount of disease among the Ma rine recruits who normally inhabit that area. The incubation period for occidioidomveosis is between :.0 ar.d 21 days. It is therefore quite po'sij'e that some individuals who have acquired their disease while at Canrj Pend 7b the. Edit<o\-Previous letters on this subject !.22l:I76, 1975; 232:243, 1975) have failed u> mention anything about prevention. My father was an inveterate cat fish catcher `-.'.cl always included in his kit two pirt-es of equipment: a pair of canvas ghwes and pliers. Having new .`.e:ree this is simply not so, and leton will report to medical facilities landed a catn-b. he used the gloves to that the upper end of the therapeutic elsewhere in the country with a lower prevent its .dipping as he held range merges with the lower end o: respiratory tract infection and proba Then the pliers -vere used to pull the tn\ic range and sometimes over- bly lesions on x-ray nomination. It the scings-a jiu-.ple technique to pre is further not only c.nuceivable but vent a troublesome prohlem. Th:s prompts me to ask the authors likely that most physicians in areas N'Ciu. F. Davio, MD - f the article in question: ''Are we outside the coccidioidal endemic area. Reexport. Md J54 JAMA, Aug 25, 1975-*V0 233. No 3 Letters