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D R McCance

Publications and source records attributed to D R McCance.

79 records · Page 5Linked to original sources
PubMed1989

Serum fructosamine in uraemia, myeloma and acute inflammatory disorders--relationship to serum glucose and albumin levels.

There has been considerable interest in the serum fructosamine assay as a measure of glycated serum proteins. We have measured serum fructosamine in three groups of patients--those with uraemia; those with multiple myeloma; and those with acute inflammatory conditions--none of whom were known to have diabetes. Serum fructosamine was significantly higher in the uraemic group than in the other two, and also than in a control group. When allowance was made for prevailing serum albumin levels fructosamine was shown to be increased in the acute inflammatory group also. There was a significant correlation between random plasma glucose and serum fructosamine only when fructosamine was adjusted for prevailing albumin levels. In control and uraemic subjects there was a significant positive correlation between serum fructosamine and albumin levels, whereas in the myeloma group there was a negative correlation with serum protein. These data would suggest the need to take into account serum albumin levels and protein composition if serum fructosamine is accurately to reflect short-term integrated glycaemia.

Adult↗
PubMed1989

Variations in the plasma concentration of atrial natriuretic factor across 24 hours.

There is little information available concerning the presence or absence of a normal variation in the circulating concentration of atrial natriuretic hormone throughout a 24 h period. We have examined this in 8 normal subjects (aged 23-35 years) on a fixed 120 mmol Na+ diet. Circulating levels of ANH, plasma renin activity, serum aldosterone and serum cortisol were determined two-hourly during 24 h in a supine position. There was a significant change in the concentration of each of these four hormones during the study period (P less than 0.05). ANH: peak 8.5 (22.00 h), nadir 4.0 (12.00 h) (pmol/l); PRA: peak 1.7 (04.00 h), nadir 0.8 (22.00 h) (microgram.l-1.h-1); aldosterone: peak 350 (14.00 h), nadir 143 (22.00 h) (pmol/l); cortisol: peak 346 (08.00 h), nadir 51 (22.00 h) (nmol/l). Peak plasma ANH occurred at 22.00 h and with the exception of times 20.00 h and 10.00 h this value was significantly higher than all the other time means (P less than 0.05). The only other significant differences were between plasma ANH at 20.00 h and 06.00 h, 08.00 h, 12.00 h and 14.00 h, respectively (P less than 0.05). From midnight until 18.00 h, there was no significant difference between any of the time means. There was a peak in PRA at 04.00 h, while peak serum aldosterone and serum cortisol occurred at 14.00 h and 08.00 h, respectively. This study suggests that ANH may display a diurnal rhythm. Our findings provide further physiological evidence that plasma ANH and PRA may have a reciprocal relationship.

Adult↗
PubMed1987

Clinical experience with ketoconazole as a therapy for patients with Cushing's syndrome.

Six consecutive patients with Cushing's disease were treated with the broad spectrum antifungal drug ketoconazole. Urinary cortisol levels rapidly fell to within the normal range in five of the six patients. Acute hypoadrenalism occurred in one patient, and nausea and pyrexia in three. Our experience with hepatotoxicity was different from that reported by others in that reversible hepatotoxicity was demonstrated in three patients within 7 to 12 days of treatment. Further work is required before ketoconazole can be recommended as a standard primary therapy for patients with Cushing's syndrome. Continuing vigilance for both hypoadrenalism and hepatotoxicity is essential in any patient being treated with this drug either for hypercortisolism or for other reasons.

Adult↗
PubMedDate not supplied

Effect of fluctuations in albumin on serum fructosamine assay.

Serum fructosamine, albumin and plasma glucose were studied in eight patients during recovery from diabetic ketoacidosis, and in eight patients with "decompensated" diabetes without acidosis. In the ketoacidotic group, serum fructosamine had fallen significantly by a mean of 12% by 8h, and fell further during the remainder of the study. A smaller but significant fall in fructosamine (mean 6.1%) was seen in the decompensated group after only 18 h, with again a further fall thereafter. These changes in serum fructosamine were accompanied by decreases in serum albumin. However, when fructosamine was corrected by calculating a fructosamine/albumin index (FAI) (fructosamine X 100/albumin), the FAI did not change significantly in either group until a small reduction was noted in the ketoacidotic group at 5 days, which might reasonably be expected as an index of intermediate-term glycaemia. Therefore minor fluctuations in albumin levels seen in diabetic patients can affect fructosamine, and correction may be be advisable for the test to be a valid measure of glycosylated serum proteins.

Acidosis↗