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Biomedical subjects

G O Williams

Publications and source records attributed to G O Williams.

10 recordsLinked to original sources
PubMed1992

Profuse diarrhea after misoprostol use in a patient with a history of Crohn's disease.

OBJECTIVE: To report a case of profuse diarrhea after misoprostol use in a patient with a history of Crohn's disease and to discuss the role of eicosanoids in Crohn's disease. DATA SOURCES: Patient medical records, case reports, review articles identified by MEDLINE, and personal communication with the physician, patient, and manufacturer. DATA EXTRACTION: From interviews, the manufacturer, and pertinent published sources by one author and reviewed by the others. DATA SYNTHESIS: A 55-year-old woman presented to clinic complaining of multiple joint pains. Her medical history was significant for peptic ulcer disease, hypertension, and Crohn's disease in remission since May 1989. Her joint pains were treated with ibuprofen 600 mg po qid and misoprostol 200 micrograms po qid (after meals and at bedtime). Following the administration of three doses of ibuprofen and misoprostol, the patient experienced abdominal cramps, pain, and voluminous, watery diarrhea for two days. Upon discontinuation of the ibuprofen and misoprostol, all of her gastrointestinal symptoms resolved within 12 hours. Rechallenge with ibuprofen alone failed to produce a recurrence of symptoms. Enhanced synthesis of intestinal eicosanoids has been demonstrated in Crohn's disease. Misoprostol, a synthetic analog of one of the eicosanoids, could induce a flare-up of Crohn's disease as suggested in this patient. CONCLUSIONS: Misoprostol should be used with caution in patients with known inflammatory bowel disease.

Crohn Disease↗
PubMed1989

Once-daily propranolol for hypertension: a comparison of regular-release, long-acting, and generic formulations.

This randomized, single-blind, crossover study compared three formulations of propranolol, each given once daily for hypertension. After an initial titration phase, subjects randomly received regular-release, long-acting, or a generic propranolol formulation. Each drug was given for 4 weeks and each active treatment was separated by a washout phase to allow blood pressure to return to baseline. Twelve subjects received all three active treatments. Systolic and diastolic blood pressures and pulses were significantly reduced from baseline by all formulations. There was no significant difference among drugs. Examination of diastolic blood pressures suggested some loss of antihypertensive control at the end of the dosing interval. These results indicate that it may be possible to administer propranolol once daily for hypertension and that there is no advantage for using the long-acting form.

Adult↗
PubMed1989

Management of depression in the elderly.

Primary care physicians have a vital role to play in identifying depression in their elderly patients. Diagnosis may be difficult, because symptoms are atypical and frequently include psychomotor agitation, somatic symptoms, and complaints of memory loss. Patients with medical illnesses, such as cancer, postmyocardial infarction, stroke, Parkinson's disease, and early Alzheimer's disease are particularly vulnerable to depression. Drugs that may cause depressive symptoms are digitalis at toxic levels, beta-blockers, centrally acting antihypertensives, immunosuppressants, and nonsteroidal anti-inflammatory agents. Cyclic antidepressants are the drugs of first choice. Selection depends on the patient's physical health and current medications and the side effect profile of the drug. Side effects are more pronounced in old age because of drug accumulation owing to slowed clearance. Troublesome side effects are anticholinergic effects, orthostatic hypotension, sedation, cardiotoxicity, and weight gain. The most useful antidepressants for geriatric patients are the secondary amines, desipramine and nortriptyline. The second-generation drug trazodone has the advantage of causing the least anticholinergic effects, but it is very sedating. Before treatment, the patient should have an electrocardiogram, liver function tests, tonometry, sitting and standing blood pressures, evaluation of urinary symptoms for outflow obstruction, review of current medications, and estimation of suicide risk. Cyclic antidepressants are contraindicated during recovery from myocardial infarction, in heart disease when there is severe impairment of myocardial performance, in seizure disorders, and in the presence of glaucoma or a large prostate. Drug interactions that may cause trouble can occur with epinephrine, MAO inhibitors, thyroid hormone, cimetidine, and centrally acting antihypertensives. Dosage should start low, increasing usually by 25 mg every 4 to 5 days until a therapeutic level is reached. Failure of a noradrenergic antidepressant after 4 to 5 weeks can be followed by a trial of a serotonergic drug. Drug serum level monitoring is useful for imipramine, desipramine, and nortriptyline. Monoamine oxidase inhibitors are effective in many elderly patients who are resistant to TCAs. Sympathomimetic drugs must be avoided with MAOIs. Elderly patients are at high risk of toxicity and drug interactions with lithium. Electroconvulsive therapy is useful for patients who do not respond to drug treatment, but medical complications, particularly cardiovascular, often occur in patients 75 or older. Many patients relapse after ECT. Psychotherapy together with pharmacotherapy may be the optimal treatment for elderly depressives. Older patients are more likely to become chronically depressed than younger patients. The risk of suicide in depressed elderly males is high, particularly in those with psychosocial problems, and depression rises with age.

Aged↗
PubMed1987

Frequencies of attached and free ear lobes in Lagos (Nigeria).

A sample of 1,600 unrelated individuals in Lagos (Nigeria) were examined for attached or free ear lobes. Pedigree data were obtained for 11 families by questionnaire. The corrected proportion of attached among the progeny of free X free was 0.27 compared to an expected value of 0.25. The observed frequencies of the three types of marriages were not significantly different from the expected values derived from the frequencies of the traits in the population. Males and females in the population were equally affected by the traits. Thus, the population frequency of attached is 25.37%, a value within the range for Caucasoids but lower than for Mongoloids.

Child↗
PubMed1985

Dementia.

Explore the source record for details and available documents.

Aged↗
PubMed1977

The elderly in family practice: an evaluation of the geriatric visiting nurse.

The Geriatric Visiting Nurse (GVN) is a health-care professional who, assisted by a checklist, screens patients in their homes, carries out basic tests, and facilitates effective follow-up of patients. Utilization of the GVN in a rural Well-Elderly Clinic associated with the University of Iowa Department of Family Practice is described, and the GVN's participation in the clinic is compared with the screening services provided for physicians by geriatric nurses in advanced communities in various countries. Subject to careful planning, the GVN can play an important role in case-finding, and can, when incorporated into the family practice team, promote efficient utilization of the physician's time.

Aged↗
PubMedDate not supplied

The nonuse of free health-screening by rural elderly.

We studied the population of noninstitutionalized elderly persons in Iowa County, Iowa, who had not used a well-elderly clinic offering free home or clinic assessments by a nurse. Questionnaires were administered by trained interviewers to a sample of the nonuser population, 60 years of age and over (n = 360). Fifty-five percent did not know that there was a well-elderly clinic in the county in spite of widespread advertising. Nonusers who had heard of the clinic were more highly educated and had more transportation problems than nonusers who were aware of the clinic. Sixty percent of those who saw no point in going to a doctor if they were feeling well were unaware of the clinic. Nonusers tended to be older, living on farms, mobile, long-time residents, and 54 percent had less than a high school education. The cost of health care was not a problem. The major reason given for not using the clinic was that the person was "under a doctor's care." Those who had no regular doctor did not plan to use the clinic because they felt healthy.

Aged↗