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Biomedical subjects

C Archer

Publications and source records attributed to C Archer.

At least 19 recordsLinked to original sources
PubMed2001

Should the food intake of patients admitted to acute hospital services be routinely supplemented? A randomized placebo controlled trial.

BACKGROUND: Many patients admitted to acute hospital services are underweight or harbour vitamin deficiencies. OBJECTIVES: To determine the effect on patient throughput of a policy of routine vitamin supplementation, and of early routine sipfeed supplementation in 'thin' patients (5-10% weight loss or body mass index 18-22). DESIGN: Factorial randomized placebo controlled trial of oral multivitamins from the first day of admission, and, after nutritional screening, of a nutritionally complete sipfeed from the second day in 'thin' patients. SETTING: Acute medical, surgical and orthopaedic hospital services of a London teaching hospital. PARTICIPANTS: 1561 patients admitted as emergencies were included in the vitamin study of which 549 were included in the sipfeed study. MAIN OUTCOME MEASURE: Length of hospital stay (LOS). RESULTS: Offering multivitamins to acute admissions resulted in a mean change (reduction) in LOS of -0.4 days 95% CI (-2-1.2days). The results suggest greater reductions for those discharged after 10 days: mean change=-2.3 days 95% CI (-5.7 to 1.2). Sipfeed supplementation was associated with an increased mean length of stay 2.8 days 95% CI (-0.8-6.3). 18% of acute admissions were classified undernourished on the basis of BMI, MUAC or percent weight loss combined. CONCLUSIONS: No benefit was observed for sipfeed intervention although a small benefit of less than one day is not excluded. Vitamin supplementation may have slight but economically important benefit.

Adult↗
PubMed2000

A krimpsiekte-like syndrome in small stock poisoned by Ornithogalum toxicarium Archer & Archer.

Krimpsiekte (the syndrome associated with chronic cardiac glycoside poisoning) was purportedly induced by Ornithlogalum toxicarium in the Karas mountains area of Keetmanshoop, Namibia. This chinkerinchee species was previously linked to a condition known as 'kwylbek' krimpsiekte in small stock in the Beaufort West district of the Western Cape Province, South Africa. In a dosing trial, respiratory distress, tachycardia and sternal recumbency were observed in 2 sheep drenched with fresh plant material. A fluorescence polarisation immunoassay (FPIA) detected the presence of a substance that cross-reacted with digoxin antibodies in some of the plant material collected at Keetmanshoop and Beaufort West. This is the first time that apparent cardiac glycoside poisoning was induced by a southern African chinkerinchee species. The presence of the cardiac glycoside-like substance in O. toxicarium requires further chemical verification.

Animals↗
PubMed1999

Research issues in complementary therapies.

Complementary medicine views health as a balance of forces to achieve optimum wellbeing of body, mind and spirit, whilst conventional healthcare focuses on the prevention, diagnosis and treatment of disease. The World Health Organisation estimates that globally 80% of primary consultations occur within holistic therapies (Lewith 1995). Numerous reasons explain this, e.g. dissatisfaction with technological medicine, increasing individual responsibility for health, and more client involvement in treatment. The increased use of complementary therapies in the UK has stimulated debate about health, illness and care which poses issues for the overall delivery of contemporary healthcare. Rising standards of accountability create expectations that research is available which informs safe and effective practice. This article reflects on the particular issue of research methodology into the effectiveness of healthcare.

Complementary Therapies↗
PubMed1999

Randomized trial to compare the efficacy and toxicity of cyclophosphamide, methotrexate and 5-fluorouracil (CMF) with methotrexate mitoxantrone (MM) in advanced carcinoma of the breast.

One hundred and sixteen patients with locally advanced or metastatic breast cancer were randomized to receive CMF (cyclophosphamide 600 mg m(-2) day 1 and 8 i.v., 5-fluorouracil 600 mg m(-2) day 1 and 8 i.v., methotrexate 40 mg m(-2) day 1 and 8 i.v., monthly for 6 cycles) or MM (methotrexate 30 mg m(-2), mitoxantrone 6.5 mg m(-2), both i.v. day 1 3-weekly for 8 cycles) as first line treatment with chemotherapy. Objective responses occurred in 17 patients out of 58 (29%) who received CMF and nine out of 58 (15%) who received MM; 95% confidence interval for difference in response rates (-1%-29%), P = 0.07. No statistically significant differences were seen in overall survival or time to progression between the two regimes although a tendency towards a shorter progression time on the MM regime must be acknowledged. There was, however, significantly reduced haematological toxicity (P < 0.001) and alopecia (P < 0.001) and fewer dose reductions and delays in patients randomized to MM. No statistically significant differences were seen between the two regimes in terms of quality of life (QOL). However, some association between QOL and toxicity was apparent overall with pooled QOL estimates tending to indicate a worsening in psychological state with increasing maximum toxicity over treatment. Despite the fact that results surrounding response rates and time to progression did not reach statistical significance, their possible compatibility with an improved outcome on CMF treatment must be borne in mind. However, MM is a well-tolerated regimen with fewer side-effects than CMF, which with careful patient management and follow-up, therefore, may merit consideration as a first-line treatment to palliate patients with metastatic breast cancer who are infirm or elderly.

Adult↗
PubMed1999

N-Acetyltransferase expression and DNA binding of N-hydroxyheterocyclic amines in human prostate epithelium.

Intact prostate epithelial cells prepared from benign prostatic hypertrophy tissues from two patients were incubated for 2 h with N-hydroxy derivatives of 2-amino-1-methyl-6-phenylimidazo[4, 5-b]pyridine (N-OH-PhIP) or 2-amino-3,8-dimethylimidazo[4, 5-f]quinoxaline (N-OH-MeIQx). (32)P-post-labeling analysis detected PhIP and MeIQx adducts in the DNA of these cells but not in the untreated control. Adduct levels were approximately 100 times greater in N-OH-PhIP- than in N-OH-MeIQx-treated cells. Repair synthesis of DNA was observed in cells, prepared from two additional patients, treated for 24 h with these carcinogens and was greater for N-OH-PhIP than for N-OH-MeIQx. PhIP, MeIQx and their nitro derivatives did not produce repair synthesis of DNA in this system. The difference in the activity of N-OH-PhIP and N-OH-MeIQx may be due to their stability, since N-OH-MeIQx decomposed rapidly in neutral solution. Transcripts of NAT1 and NAT2 were detected by an in situ hybridization method in prostate epithelial cells, but were absent from stromal tissues. These results suggest that PhIP may be a potential carcinogen for human prostate, since cooked meats, which contain this heterocyclic amine, have been associated with human prostate cancer.

Arylamine N-Acetyltransferase↗
PubMed1999

A double blind, randomised, controlled trial of glutamine supplementation in parenteral nutrition.

BACKGROUND AND AIMS: To determine whether the inclusion of 20 g free glutamine as part of the nitrogen source of parenteral feeds reduces length of hospital stay or mortality. METHODS: In a randomised, double blind, controlled trial in 168 patients clinically accepted for parenteral nutrition, standard feeds were compared with feeds in which 3.8 g of the total nitrogen was replaced with the equivalent 20 g glutamine. A minimum of 11 g nitrogen/day was used in all patients. Daily intakes of energy and nitrogen were determined using a validated computer protocol and were similar for the two groups. All feeds included trace elements, vitamins, electrolytes, and minerals. RESULTS: A total of 85 patients received a median of eight (interquartile range 5-13) daily feeds containing glutamine while 83 received a median of eight (5-15) standard feeds. No difference between groups was detected for infective complications. Twenty control patients and 14 who had received glutamine died during their hospital stay (NS). Median length of stay was 32 (23-52) days on glutamine, which was not significantly different from the control value of 35 (25-55) days. Glutamine was associated with a significant (p<0.03) reduction in length of stay in surgical patients (45 days (range 29-81) versus 30 days (range 19-54)). CONCLUSION: The benefit from glutamine supplementation of parenteral feeds as used in this trial has not been proved. Supplementation may have advantages in surgical patients and in haematological malignancy. Further trials are required.

Adolescent↗
PubMed1999

Clinical studies of apoptosis and proliferation in breast cancer.

The interaction between cell death and cell proliferation determines the growth dynamics of all tissues. Studies are described here which relate the changes in proliferation and apoptosis that occur in human breast cancer during medical therapeutic manoeuvres. Xenograft studies strongly support the involvement of increased apoptosis as well as decreased proliferation after oestrogen withdrawal, and limited studies in clinical samples confirm the involvement of both processes. Cytotoxic chemotherapy induces increases in apoptosis within 24 h of starting treatment. However, after 3 months therapy the residual cell population shows apoptotic and proliferation indices much below pretreatment levels. Further molecular studies of this "dormant" population are important to characterise the mechanism of their resistance to drug therapy. The early changes in proliferation and apoptosis may provide useful intermediate response indices.

Adenocarcinoma↗
PubMed1997

Inhibition of inducible nitric oxide synthase intensifies injury and functional deterioration in autoimmune interstitial nephritis.

T lymphocytes are exquisitely sensitive to the antiproliferative effects of nitric oxide. We examined the effects of oral administration of two nitric oxide synthase inhibitors, Nw-nitro-L-arginine methyl ester (L-NAME) and L-N6-(1-iminoethyl)lysine (L-NIL), on the course of T cell-dependent autoimmune interstitial nephritis in Brown Norway rats. Kidneys from rats immunized to produce interstitial nephritis display a net generation of nitric oxide end products. By immunohistochemical staining, the cytokine-inducible nitric oxide synthase (iNOS) is expressed in cortical tubular epithelial cells. Treatment with either inhibitor results in markedly more severe disease following immunization. Animals receiving L-NAME were hypertensive, while those treated with L-NIL, a highly selective inhibitor of iNOS, were not. Evaluation of the expression of IFN-gamma, IL-2, and IL-4 in diseased kidneys by quantitative reverse transcriptase-PCR demonstrated that L-NAME-treated animals displayed significantly augmented levels of IFN-gamma and IL-2 with preserved ratios of IFN-gamma/IL-4 and IL-2/IL-4, while L-NIL-treated animals had augmented levels of IL-2 and IFN-gamma with augmented IFN-gamma/IL-4 and IL-2/IL-4 ratios. Animals treated with L-NAME or L-NIL both had augmented Ag-specific IgG responses. The L-NAME group demonstrated increases in both the IgG2a and IgG1 subtypes, with a constant IgG2a/IgG1 ratio, while the L-NIL group demonstrated an increase in the ratio of the IgG2a/IgG1 response. These Ab and cytokine data suggest that the L-NIL-treated animals had a skewing of their immune response toward a Th1-like response. We conclude that in autoimmune interstitial nephritis, generation of nitric oxide through the iNOS pathway has host-protective effects, and suggest that this may be broadly applicable to T cell-mediated pathologies.

Administration, Oral↗
PubMed1997

Bilateral versus single lung transplantation for chronic obstructive pulmonary disease.

OBJECTIVE: Traditionally, despite ventilation/perfusion mismatch, single lung transplantation has been the mainstay for end-stage chronic obstructive pulmonary disease. We tested the hypothesis that bilateral sequential lung transplantation has better short- and intermediate-term results than single lung transplantation for chronic obstructive pulmonary disease. METHODS: One hundred twenty-six consecutive lung transplants have been performed from November 1991 to March 1996. Seventy-six have been for chronic obstructive pulmonary disease. The diagnosis of this disease includes emphysema (80.3%), alpha 1-antitrypsin deficiency (9.2%), lymphangioleiomyomatosis (7.9%), and obliterative bronchiolitis (2.6%). Twenty-nine transplants have been bilateral and 47 have been single. Mean age was 55.3 for patients having single lung transplantation and 48.8 for those having bilateral lung transplantation (p = 0.001). The distribution of the diagnoses was similar between the two groups. At 6 months, there were 29 survivors of single lung transplantation and 20 survivors of bilateral lung transplantation, with complete data for evaluation. Pulmonary function tests and 6-minute walk tests were evaluated at a mean of 15.4 and 12.8 months after transplantation, respectively. RESULTS: Sixty-day mortality was 21.3% for single lung transplantation versus only 3.45% for bilateral lung transplantation (p = 0.03). Additionally, Kaplan-Meier analysis revealed 1- and 2-year survivals of 71.1% and 63.3% for single lung transplantation versus 90% and 90% for bilateral lung transplantation, respectively. Multiple major morbidities were analyzed. Primary graft failure was significantly reduced in the bilateral group (p = 0.049). Both 6-minute walk tests and forced expiratory volume in 1 second were improved from baseline by both single and bilateral lung transplantation (p = 0.001). CONCLUSIONS: Bilateral lung transplantation improves forced expiratory volume in 1 second and 6-minute walk tests significantly over single lung transplantation (p < 0.0001). Both perioperative mortality and Kaplan-Meier survival (to 3 years) are significantly improved when bilateral rather than single lung transplantation is used for chronic obstructive pulmonary disease in our series (p < 0.05). This is probably the result of significantly reduced primary graft failure.

Aged↗
PubMed1996

Mechanisms for the maintenance and eventual degradation of neurofilament proteins in the distal segments of severed goldfish mauthner axons.

Cellular mechanisms that might affect the degradation of neurofilament proteins (NFPs) were examined in the distal segments of severed goldfish Mauthner axons (M-axons), which do not degenerate for more than 2 months after severance. Calpain levels, as determined by reactivity to a polyclonal antibody, remained constant for 80 d postseverance in distal segments of M-axons and then declined from 80 to 85 d postseverance. Calpain activity in rat brain, as determined by a spectrophotometric assay, was much higher than calpain activity in control and severed goldfish brain, spinal cord, muscle, or M-axons. Calpain activity was extremely low in M-axons compared with that in all other tissues and remained low for up to 80 d postseverance in distal segments of M-axons. Phosphorylated NFPs, as determined by Stains-All treatment of SDS gels, were maintained for up to 72 d postseverance and then decreased noticeably at 75 d postseverance when NFP breakdown products appeared on silver-stained gels. By 85 d post-severance, phosphorylated NFPs no longer were detected, and NFP breakdown products were the most prominent bands on silver-stained gels. These results suggest that the distal segments of M-axons survive for months after severance, because NFPs are maintained in a phosphorylated state that stabilizes and protects NFPs from degradation by low levels of calpain activity in the M-axon; the distal segments of severed M-axons degenerate eventually when NFPs no longer are maintained in a phosphorylated state and become susceptible to degradation, possibly by low levels of calpain activity in the M-axon.

Animals↗
PubMed1996

Silica and progressive systemic sclerosis (scleroderma): evidence for workers' compensation policy.

The occurrence of several confirmed cases of progressive systemic sclerosis (scleroderma) among male miners prompted a request by a member of the provincial parliament (MPP) of Ontario that the Industrial Disease Standards Panel (IDSP) evaluate the evidence for an occupational connection. A number of publications in reputable peer-reviewed medical journals offer case-control evidence gathered over four decades on three continents showing a rather clear-cut relationship between occupational exposure to crystalline silica and scleroderma. This article summarizes the evidence for a causal relationship and describes the process by which the members of the panel, using the criteria developed by Sir Austin Bradford Hill as a guide, made a finding of probable connection, the term mandated by the Workers' Compensation Act of Ontario. It provides insight into the difficulties encountered by those setting occupational disease policy when scientific certainty is unobtainable.

Canada↗
PubMed1996

Cost effectiveness of screening for primary open angle glaucoma.

OBJECTIVES AND SETTING: To determine the cost effectiveness of screening for glaucoma. METHODS: Information on treatment efficacy, diagnostic methods, epidemiological characteristics of glaucoma, and costs were determined from the literature, from administrative databases, and from experts. Scenarios with different screening frequency, age, participation in screening, compliance with treatment, treatment efficacy, and diagnostic tests were examined. RESULTS: The initial scenario comprised three-yearly screening of subjects aged 40-79 by funduscopy and tonometry, followed by perimetry when abnormalities were discovered. The assumption of levels of participation in screening and of compliance with treatment of 75%, and treatment efficacy of 50% resulted in a cost of $C100,000 per year of blindness prevented. A scenario in which screening was restricted to subjects aged 65-79, with the same input variables, would prevent 81% of the cases of blindness prevented with scenario 1, at a cost of $C42,000 per year of blindness prevented. Screening with tonometry only as the initial diagnostic test in subjects aged 65-79 would result in a cost of $C36,000 per year of blindness prevented, but would only prevent 59% of the cases prevented with scenario 1. CONCLUSIONS: There is as yet no proof that treatment of glaucoma or of high intraocular pressure will arrest the progression of glaucoma to blindness. Even when treatment efficacy is assumed to be as high as 50%, however, the cost effectiveness of most glaucoma screening programmes considered would not be competitive.

Adult↗
PubMed1993

Value of routine preoperative chest x-rays: a meta-analysis.

The purpose of this study was to estimate the frequency with which routine postoperative chest x-rays lead to clinically relevant new information. All articles in English, French and Spanish relating to routine chest radiography in North American or European populations were reviewed, using the Medline database and references listed in reviews and periodicals published from 1966 to 1992, inclusive. Twenty-one reports which supplied sufficient information were included for meta-analysis. On average, abnormalities were found in 10% of routine preoperative chest films. In only 1.3% of films were the abnormalities unexpected, i.e., were not already known or would not otherwise have been detected (95% CI: 0 to 2.8%). These findings were of sufficient importance to cause modification of management in only 0.1% (95% CI: 0 to 0.6%). The frequency with which the new information influenced health could not be estimated. Assuming only the direct cost to the health care system of each radiograph ($23), each finding which influenced management in any way would cost $23,000. It is concluded that in North American or European populations when a reliable history and a clinical examination are carried out, the cost of this test is so high relation to the clinical information provided that it is no longer justifiable.

Age Factors↗
PubMed1987

The use of nasogastric tubes after abdominal surgery--a criteria audit.

OBJECTIVE: To evaluate the use of nasogastric tubes after gastrointestinal surgery. METHOD: Prospective criteria audit. RESULTS: In this study, 32.5% of patients (65/200) undergoing laparotomy had a nasogastric tube inserted during the perioperative period. Of these patients, 20% vomited whilst the tube was in situ and there was a poor correlation between the volumes of fluid aspirated and the timing of tube removal. These results suggest that nasogastric tubes were inserted too often and then left in situ for too long.

Abdomen↗