Absence of Developmental Effects in CF-1 Mice Exposed to Aspartame in Utero

Aspartame (L-aspartyl-L-phenylalanine methyl ester) is a widelyused high potency dipeptide sweetener. Developmental toxicologystudies have been performed in several species documenting noeffects of high doses of aspartame. Recently, a study by Mahalikand Gautieri ((1984) Res Commun. Psychol Psychiatry Behav. 9,385–403) reported a delay in the achievement age for thevisual placing response in mice pups after maternal administrationof high dosages of aspartame during late gestation. In the presentstudy developmental parameters were determined in offspringof CF-1 mice after maternal administration of aspartame at 500,1000, 2000, and 4000 mg/kg body wt by oral gavage. Aspartamewas administered on Days 15 through 18 of gestation. Maternalbody weight, food consumption, gestation length, reproductiveindices, and litter size were not affected by aspartame treatment.In the pups, body weights, negative geotaxis, and surface andmidair righting reflexes were not altered by treatment. Therewas no delay in the development of the visual placing responseregardless of the method employed for assessment (grid or rope)or the manner by which the data were analyzed. There were alsono changes in time of eye opening, reflex pupil closure, andophthalmoscopic examination in the offspring. Thus, neitherphysical nor functional development was altered in mice afterin utero exposure to extremely large dosages of aspartame. Morespecifically, in utero exposure to aspartame did not affectthe development of the visual system in mice.     

ARE SLOW-ACTING ANTI-RHEUMATIC DRUGS MONITORED TOO OFTEN? AN AUDIT OF CURRENT CLINICAL PRATICE

Rheumatologists usually recommend monthly blood monitoring whenpatients with rheumatoid arthritis (RA) are treated with slow-actinganti-rheumatic drugs (SAARDs). Is monthly monitoring neededor could its frequency be reduced? We audited the opinions ofUK rheumatologists and reviewed clinical experience at threecentres. To ascertain the interval at which patients are monitoredand the determinants of monitoring policy we sent a questionnaireto 193 consultant rheumatologists; 143 (74%) replied. The majorityuse monthly monitoring for most SAARDs except sulphasalazine,chloroquine and hydroxychloroquine. There is extensive variation,which is not related to the type of rheumatology unit or whethera shared scheme with general practitioners is used. Reviewingexperience in 390 patients treated with SAARDs at three adjacentrheumatology units in London showed that haematological adversereactions were infrequent. During 1560 patient-years of treatmentinvolving 18 720 monthly monitoring visits there were 13 haematologicaladverse reactions (1 1 thrombocytopenias and two leucopenias).Five thrombocytopenias occurred in the first 6 months of therapy;two were gradual and three developed more rapidly over 1–2months. Six thrombocytopenias developed after 6 months of treatment;five occurred gradually over 5 months or more and one borderlinelow platelet count was seen once. The two leucopenias were borderlinelow white cell counts occurring gradually over 3–6 months.Such frequent monitoring is expensive. The total cost of monitoring390 patients for 1560 patient-years was $420 000. The cost ofdetecting each adverse reaction was $ 32 000. Three-monthlymonitoring when therapy is established after an initial stabilizingperiod would have identified seven out of eight late adversereactions. Monitoring policies are mainly based on clinicalconsensus with few prospective studies of their value; theyneed re-evaluation. KEY WORDS: Rheumatoid arthritis, Drug toxicity, Slow-acting anti-rheumatic drugs     

Pulse Oximetry

Pulse oximetry is used routinely in neonatal care to monitor oxygen in compromised neonates. A discussion of oximetry for monitoring unstable neonates is presented. Topics covered include physiologic principles of oxygen transport, technical aspects of the oximeter (accuracy, reliability, advantages, and limitations), acceptable limits of arterial oxygen saturation, implications for nursing practice, and use of the device in selected clinical conditions.