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Biomedical subjects

G Warwick

Publications and source records attributed to G Warwick.

9 recordsLinked to original sources
PubMed2001

Outcome of renal replacement therapy in the very elderly.

BACKGROUND: In a retrospective case-note and computer database analysis we assessed the outcome of very elderly patients (> or = 75 years old) with end-stage renal disease (ESRD) on renal replacement therapy (RRT). METHODS: Fifty-eight individuals aged 75 or over (group 1) commenced RRT between 1 January 1991 and 31 December 1995. Comparisons were made with other patients commencing RRT who were divided into two groups: group 2 (201 individuals 65-74 years old) and group 3 (379 patients <65 years old). All subjects were followed up until the point of assessment (30 June 1998), the time of death, or withdrawal from dialysis. Survival rates in the three groups were compared using Kaplan-Meier method. The number of hospital admissions, length of in-patient stay, and complications rate on RRT were assessed for group 1. RESULTS: One-year survival rates in groups 1, 2 and 3 were 53.5, 72.6, and 90.6% respectively and the 5-year survival rates were 2.4, 18.8, and 61.4% respectively. The very elderly spent 20% of their time in hospital, 46% had two co-morbid factors at the outset, and 26% developed multiple complications while on RRT. Withdrawal from dialysis remained the most common cause of death in this group of individuals (38%), followed by cardiovascular causes (24%) and infections (22%). CONCLUSION: Very elderly ESRD patients on RRT have a very poor outcome and, since they are the largest growing group of RRT patients, this has important implications for future health policies.

Adolescent↗
PubMed1993

Butyrate rapidly induces growth inhibition and differentiation in HT-29 cells.

Selected G1 events associated with butyrate-induced differentiation were examined in HT-29 colon adenocarcinoma cells. [3H]Thymidine incorporation by HT-29 cells was decreased to 40% of control levels by treatment with 5 mM butyrate for 24 h, and cell numbers decreased to 21% of control levels after 48 h of treatment. Cells released from butyrate arrest entered S phase approximately 24 h after release, and serum-deprived HT-29 cells escaped growth inhibition if butyrate was added 8 h or more after serum restimulation. Northern analysis of RNA isolated from rapidly growing HT-29 cells showed a marked induction of alkaline phosphatase mRNA expression within 12 h of treatment with 5 mM butyrate. The appearance of alkaline phosphatase mRNA was temporally associated with a 5-fold increase in expression of transforming growth factor beta 1 (TGF-beta 1) mRNA. Expression of the nuclear protooncogene c-myc began to decrease 30 min after treatment with butyrate and was decreased 4.5-fold 4 h after treatment; however, expression of other immediate-early genes (nup/475 and zif/268) was not significantly affected. Histochemical staining of HT-29 monolayers showed that no cells were positive for alkaline phosphatase protein prior to treatment, and 90% were positive 48 h after treatment. TGF-beta 1 and TGF-beta 2 had no effect on HT-29 cell growth. TGF-beta 1 did not induce alkaline phosphatase mRNA or histochemical positivity. These data indicate that butyrate arrests HT-29 cell growth early in G1.(ABSTRACT TRUNCATED AT 250 WORDS)

Adenocarcinoma↗
PubMedDate not supplied

Analysis of patients dying within one year of starting renal replacement therapy.

BACKGROUND: The annual gross mortality of end-stage renal failure patients remains very high (approximately 15-20%) leading some to question the wisdom of accepting patients with limited prognosis for dialysis. We have reviewed the demographic and clinical characteristics of patients who died within a year of commencing renal replacement therapy (RRT) over a 5-year period to establish whether these patients could be identified at the start of therapy. METHODS: Case notes of patients who died within 1 year of commencing RRT between 1st April, 1991 and 31st March, 1996 were reviewed. Comorbidity at the start of dialysis was used to classify patients into high-, medium- and low-risk groups using two published scales to determine whether either graded a high proportion of deaths as high risk. Factors such as age, social circumstances, cause of death, renal diagnosis and mode of dialysis were also analysed. RESULTS: 17.5% of patients commencing RRT died in the first year. Not all of these patients could be identified as high risk by comorbidity assessment at dialysis initiation - 50% of patients who died were classified by one scale as medium risk. Age did not clearly predict outcome, as 42% of patients who died were less than 65 years old. CONCLUSION: These data suggest that it is difficult to use current risk stratifications to accurately predict outcome on RRT.

Adolescent↗
PubMedDate not supplied

Quality in practice: setting a standard for the insertion of fistula needles.

Nursing research, involving haemodialysis patients completing mood diaries, conducted at St. James' Hospital in Leeds, has indicated that consecutive problematic haemodialysis sessions can significantly affect a patient psychologically (1,2). In response to these findings a nursing standard was set at the Lincoln Haemodialysis unit, a satellite unit of Leicester General Hospital Department of Nephrology, to identify pain on needle insertion.

Arteriovenous Shunt, Surgical↗