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Biomedical subjects

F I Martin

Publications and source records attributed to F I Martin.

At least 19 recordsLinked to original sources
PubMed1996

Hyperthyroidism in elderly hospitalised patients. Clinical features and treatment outcomes.

OBJECTIVE: To review the clinical features and response to treatment of hyperthyroidism in elderly hospitalised patients. PARTICIPANTS AND SETTING: Sixty patients over the age of 70: 41 admitted to a geriatric hospital and 19 to an acute-care hospital, 1990-1993. METHODS: Thyroid function tests were performed routinely in the geriatric hospital but only on demand at the acute-care hospital. Hyperthyroidism was defined as elevation of plasma free thyroxine (FT4) or total tri-iodothyronine (T3) level and suppression of thyroid-stimulating hormone (TSH) level. Seventy-seven per cent of patients were seen personally; in the remainder details were obtained from their hospital records. Outcome was assessed by clinical and biochemical improvement. RESULTS: Clinical features - Fifty-two women and eight men with hyperthyroidism were identified. Their average age was 80.2 years (range, 70-101; median, 80.0). The most common clinical features were weight loss (83%) and atrial fibrillation (60%); 58% were agitated and 15% apathetic. Fifty-two per cent had cognitive impairment with either dementia or confusion. The diagnosis was not initially suspected in 62%. Thyroid antibodies were absent in 35/40 and an isotope scan showed a nodular thyroid in 27/29. Contrast radiography with iodine-containing media had been performed within the preceding six months in 23% of patients. Treatment and outcome - Forty-seven patients were treated with antithyroid drugs in standard doses and 21 received radioactive iodine. In 35 adequately assessed patients, including 21 with dementia, clinical improvement and normal results of thyroid function tests were achieved, but five patients died with uncontrolled hyperthyroidism. CONCLUSIONS: Hyperthyroidism in the elderly is usually due to autonomous thyroid nodules, and in about 20% of hospitalised patients may follow a contrast radiography procedure. The more common clinical features of hyperthyroidism occur frequently as unrelated symptoms in the elderly so that the diagnosis is often not apparent, particularly in the presence of cognitive impairment. As the response to standard biochemical treatment is rewarding, screening of the elderly with thyroid function tests should be done routinely.

Age Distribution↗
PubMed1996

A prospective study of the effect of nonionic contrast media on thyroid function.

To observe the effect of iodine in nonionic contrast media on thyroid function, we measured free thyroxine (FT4) and thyroid stimulating hormone (TSH) following nonionic contrast radiography in 73 patients (49 males; 24 females) aged 50 to 84 years, mean 65.7 years. FT4 was significantly (p < 0.01) raised above baseline at 8 weeks but not 4 weeks following contrast injection (mean +/- standard deviation, 17.1 +/- 5.9 and 14.3 +/- 4.0 vs 13.3 +/- 2.7 pmol/L at baseline); however, TSH was significantly (p < 0.03) depressed at both 4 and 8 weeks (1.09 +/- 0.68 and 1.21 +/- 1.56 vs 1.40 +/- 0.90 mIU/L). T3 did not change significantly. FT4 rose by more than 20% in 15/73 and TSH fell by more than 20% in 41/73 compared to a fall of FT4 in 3/73 and a rise in TSH of 8/73 (p < 0.005 and < 0.001, respectively). Two patients became hyperthyroid and in four others either FT4 was elevated or TSH suppressed, one of whom developed atrial fibrillation. Although frank hyperthyroidism following contrast radiography was uncommon, there was a significant trend towards thyroid stimulation rather than suppression after iodine exposure. This may be related to the age of the patients studied.

Aged↗
PubMed1995

The 75 g oral glucose tolerance in pregnancy.

A 75 g oral glucose tolerance test was performed between 26 and 32 weeks gestation in 1371 women attending an ante-natal clinic in Melbourne. Gestational diabetes according to various criteria was present in 4.2% (2 h plasma glucose > or = 8.0 mmol/l), 5.2% (2 h plasma glucose > or = 7.8 mmol/l) and 5.5% by the proposed Australian criteria (fasting plasma glucose > or = 5.5 mmol/l and/or 2 h plasma glucose > or = 8.0 mmol/l). The long-term implications of gestational diabetes in the development of diabetes and metabolic abnormalities for both the mother and her child in addition to related infant morbidity emphasise the urgent need for an agreed definition of this condition.

Administration, Oral↗
PubMed1994

Clinical and histological correlations of decline in renal function in diabetic patients with proteinuria.

In 47 patients with diabetic nephropathy (29 type I, 18 type II) renal function and blood pressure (BP) (treated with or without an angiotensin-converting enzyme [ACE] inhibitor, enalapril [10 mg], in 38 hypertensive patients) were followed over 4 years. A percutaneous renal biopsy was performed in all patients initially and repeated in a representative 19 patients with treated hypertension after 4 years. Mean glomerular volume (MGV), interstitial fibrosis (IF), capillary volume, and sclerosed glomeruli (GS) were measured histomorphometrically. Mean fall in creatinine clearance (CCr) was 11.8% after 4 years with no difference between treatment groups or type of diabetes. BP both initially and during treatment correlated with initial and final serum creatinine and CCr (P < 0.01). There were no histomorphometric differences between type I and type II patients or hypertension treatment groups. Initial IF correlated with initial and final serum creatinine and CCr (P < 0.05) in all patients and type I patients alone, MGV correlated inversely with CCr in type I patients (P < 0.05). After 4 years, IF (24.8 vs. 30.0%, P < 0.01) and GS (26 vs. 37%, P < 0.05) increased significantly, and increase in IF correlated with fall in CCr (P < 0.01). Proteinuria and HbA1 did not correlate with indexes of function or structure. In this longitudinal study of patients with diabetic nephropathy, there was a close relation between BP and renal function but no difference between treatment with enalapril and other hypertensive agents. The correlations between renal function and histology at entry and after 4 years suggest that IF is a co-determinant of renal function in diabetic nephropathy.

Adolescent↗
PubMed1993

Iodine-induced hyperthyroidism due to nonionic contrast radiography in the elderly.

PURPOSE: To identify the number of cases of hyperthyroidism that followed the performance of contrast radiography in elderly patients at a geriatric hospital in a non-iodine-deficient area and to determine the clinical course of the condition. PATIENTS AND METHODS: All patients over a 20-month period with biochemical hyperthyroidism (plasma free thyroxine level greater than 25.0 pmol/L and thyroid-stimulating hormone level less than 0.10 IU/L) were identified. Clinical features of hyperthyroidism and exposure to nonionic contrast media radiographs within the previous 12 months were sought. Follow-up extended from 6 to 22 months. RESULTS: A total of 28 patients with hyperthyroidism (aged 70 to 96 years) were identified. Seven patients (25%) had documented biochemical development of hyperthyroidism (five) or subsequent hyperthyroidism (two) 3 to 8 weeks after nonionic contrast media radiography. The four patients who underwent scanning had a multinodular thyroid, and thyroid antibodies were not detected in five of five patients. Although the condition appeared self-limited and six of six patients were euthyroid after 18 months, the condition was not benign; progress and recovery were adversely affected by hyperthyroidism. Four patients had a good response to treatment with an antithyroid drug (carbimazole). CONCLUSION: Iodine-induced thyrotoxicosis following contrast radiography was found in 7 of 28 cases of hyperthyroidism seen at a geriatric hospital. Although the condition appears ultimately self-limited, pharmacologic control of severe clinical features may be required. The frequency of this condition in a non-iodine-deficient area appears related to the more common occurrence of autonomous thyroid nodules in the elderly. Because performance of contrast radiography is more common in this age group, the recognition and treatment of iodine-induced thyrotoxicosis are of increasing clinical importance.

Age Factors↗
PubMed1992

Diabetes in an elderly population. A controlled study of morbidity and outcomes.

OBJECTIVE: To determine in an elderly diabetic population the frequency of vascular and related disorders, the mortality, and outcomes compared with a matched control group. SETTING: The Queen Elizabeth Geriatric Centre, Ballarat, Victoria. METHOD: The medical records of all diabetics admitted between 1982 and 1987 inclusive, and a control group matched for age, sex and ward of admission were studied retrospectively. The presence of associated conditions and outcome parameters were entered in to a database and analysed statistically. RESULTS: Increased prevalence in individuals with diabetes of ischaemic heart disease (2.0:1.0), cerebrovascualr accident (1.9:1.0) and hypertension (1.5:1.0). Similar death rate, cumulative bed days, discharge destination and use of discharge services. CONCLUSION: Despite the more frequent presence of clinical vascular disease, an elderly population with diabetes had the same outcomes as matched controls and did not require more bed occupancy or use of community based services.

Aged↗
PubMed1991

Ponalrestat does not cause a protein binding interaction with warfarin in diabetic patients.

Ponalrestat (Statil, ICI; Prodiax, Merck Sharp and Dohme) is an aldose reductase inhibitor which is highly protein bound. Ponalrestat markedly displaced warfarin from its protein binding in vitro at a concentration of 500 micrograms ml-1, but not at a concentration of 50 or 100 micrograms ml-1. Twelve diabetic patients (six males), age range 38-65 years, in receipt of chronic stable warfarin therapy, were given ponalrestat (600 mg daily) for 2 weeks in an open trial. A matching placebo tablet was administered for 1 week before and after the active treatment period. Patients were seen ten times (four times during the ponalrestat phase), and during the ponalrestat phase, plasma samples were also taken before and at 3 h after the daily dose of ponalrestat. At none of the visits was there any significant change in prothrombin ratio (INR), plasma total or unbound warfarin concentrations, or percentage protein binding of warfarin. No clinical complications of combination treatment were detected. The maximum ponalrestat concentration observed in the patients was approximately 100 micrograms ml-1. We conclude that no significant interaction between these drugs occurs at the doses of ponalrestat studied.

Adult↗
PubMed1990

Combination chemotherapy as single modality therapy for stage IE and IIE thyroid lymphoma.

Three women presented with malignant thyroid lymphoma (stage IE and IIE) that was associated with Hashimoto's thyroiditis. Each patient was treated with combination chemotherapy (two patients received cyclophosphamide/adriamycin/vincristine/prednisolone, one patient received methotrexate/adriamycin/cyclophosphamide/vincristine/prednisolone/ble omy cin) as the primary mode of therapy. One patient underwent incomplete excisional surgery and received chemotherapy. A complete clinical and radiological remission was achieved in all patients, in spite of evidence of extensive extrathyroidal invasion in two patients. The chemotherapy was well-tolerated, producing minimal toxicity. All the patients are alive and remain free of tumour recurrence 26 to more than 38 months after diagnosis. These results suggest that combination chemotherapy can be employed successfully as a single modality treatment for stage IE and IIE thyroid lymphomas, even when significant extrathyroidal invasion is present. The treatment of thyroid lymphoma is reviewed with emphasis on the potential role for chemotherapy as the primary modality.

Aged↗
PubMed1990

Antacid-induced phosphate depletion syndrome presenting as nephrolithiasis.

A 29-year-old insulin-dependent diabetic woman developed phosphate depletion, nephrolithiasis and bilateral ureteric obstruction due to antacid abuse. Unlike previous descriptions of chronic phosphate depletion, myalgia, weakness and bone pain were absent. Biochemical features included hypophosphataemia, hypercalciuria, hypophosphaturia, elevated plasma, 1,25-dihydroxyvitamin D and low plasma intact parathyroid hormone. These abnormalities were corrected when antacid ingestion was reduced and phosphate intake supplemented. We propose that phosphate depletion secondary to antacid abuse caused 1 alpha-hydroxylase activation and elevation of the plasma 1,25-dihydroxyvitamin D level, leading to marked hypercalciuria. Once diagnosed, antacid abuse is a readily reversible cause of hypercalciuria and renal stones. Moreover, antacid-induced phosphate depletion may present with nephrolithiasis in the absence of musculoskeletal symptoms. This report is intended to draw attention to this important cause of renal stone disease.

Adult↗
PubMed1989

Hashimoto's disease, thyroid lymphoma and splenic atrophy.

An elderly woman is described who developed Hashimoto's thyroiditis and, subsequently, thyroid lymphoma more than 15 years after the onset of splenic atrophy. This case supports the concept that splenic atrophy predisposes to the development of autoimmune thyroid disease. The relationship between splenic atrophy and autoimmune thyroid disease is reviewed.

Aged↗
PubMed1988

Treatment of non-toxic multinodular goiter with radioactive iodine.

Fourteen patients with large non-toxic multinodular goiters were treated with 20 to 100 mCi (740 to 3,700 MBq) of radioactive iodine (iodine-131). In seven, the goiter had recurred after a partial thyroidectomy and four of these had had two operations. Eight had symptoms of respiratory obstruction, two had dysphagia, and the others sought treatment for cosmetic reasons. After administration of iodine-131, there was a significant decrease in goiter size in 11 of the 14 patients, and all those with obstructive symptoms showed improvement. No significant local side effects occurred, but hypothyroidism and Graves' disease each occurred once during follow-up from one to 13 years. Radioactive iodine in doses of 20 to 100 mCi is an effective, safe therapeutic alternative in patients with large non-toxic multinodular goiter, particularly when there is recurrence following surgery or when there are contraindications to surgery.

Adult↗
PubMed1988

Fibrocalculous pancreatic diabetes in Papua New Guinea.

Fibrocalculous pancreatic diabetes of the tropics has not been previously identified in Papua New Guinea where the prevalence of Type 2 (non-insulin-dependent) diabetes is increasing. Four patients with this syndrome:--onset of diabetes before the age of 30 years, low body mass index, radiologic pancreatic calcification and marked hyperglycaemia with resistance to ketosis were recognized over three years at Port Moresby General Hospital. Two patients had a history of recurrent abdominal pain in childhood, and two patients had documented insulin requirement greater than 1.5 U/kg daily, and insulin resistance confirmed by intravenous insulin tolerance test. Plasma C-peptide was present in the three cases tested. In the two patients tested islet cell antibodies were not detected but in both there was a prominent diffuse acinar stain suggestive of antibodies to acinar tissue.

Adolescent↗
PubMed1987

Pregnancy in women with diabetes mellitus. Fifteen years' experience: 1970-1985.

The perinatal mortality of 613 children who were born to women with diabetes mellitus who attended the Diabetic Clinic of The Royal Women's Hospital between 1970 and 1985 was 4.5%. In 399 children who were born to mothers with pre-existing diabetes (95% of whom were insulin-dependent) the over-all perinatal mortality was 7.5%. In successive five-year periods, perinatal mortality in this group declined from 12.2% to 3.9% (1981-1985). In 214 children who were born to mothers with gestational diabetes, the perinatal loss was 1.4%. Between 1970 and 1985, the fetal loss that was attributed to poor control of diabetes declined; however, the prevalence of congenital abnormalities remained unchanged and these were the major cause of fetal loss in 1981-1985. Other high-risk categories that were identified included obstetric complications, particularly that of pre-eclampsia. Neonatal complications had little effect on the eventual outcome, but respiratory distress, macrosomia, hypoglycaemia, jaundice, polycythaemia, hypocalcaemia and hypomagnesaemia were documented frequently and required specialized assessment. The causes of the improvement in the outcome of pregnancy in women with pre-existing diabetes appear to be multifactorial and due to team management in a specialized unit. A reduction in the increased prevalence of major congenital abnormalities is the major challenge for the future.

Congenital Abnormalities↗
PubMed1987

The relationship of acute insulin sensitivity to the progression of vascular disease in long-term type 1 (insulin-dependent) diabetes mellitus.

In 51 individuals with Type 1 (insulin-dependent) diabetes mellitus initially of more than 15 years' duration, the acute hypoglycaemic effect of intravenous insulin (0.11 IU/kg) was related to outcome over 18 years. This acute insulin sensitivity, or glucose assimilation index, was reproducible over the period of study. At 18-year follow-up, initial low glucose assimilation index (less than 0.082 mmol X l-1 X min-1 was significantly (p less than 0.01) associated with death from vascular disease. Low glucose assimilation index was similarly significantly (p less than 0.01) associated with progression of atherosclerotic disease, but not with microangiopathy alone. Hypertension (systolic blood pressure greater than 150 mmHg and/or diastolic blood pressure greater than 95 mmHg) was the only other parameter significantly (p less than 0.01) related to outcome, but this relationship was no longer significant once glucose assimilation index had been taken into account. A linear logistic analysis confirmed that acute insulin sensitivity was independently associated with outcome. Neither initial clinical control of diabetes nor glycosylated haemoglobin level in the 26 survivors was related to vascular prognosis.

Blood Glucose↗