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Biomedical subjects

H D McIntyre

Publications and source records attributed to H D McIntyre.

23 records · Page 2Linked to original sources
PubMed1991

Metformin increases insulin sensitivity and basal glucose clearance in type 2 (non-insulin dependent) diabetes mellitus.

The effects of metformin on glycaemia, insulin and c-peptide levels, hepatic glucose production and insulin sensitivity (using the euglycaemic, hyperinsulinaemic clamp) were evaluated at fortnightly intervals in 9 Type 2 diabetic patients using a stepwise dosing protocol: Stage 1--no metformin for four weeks; stage 2--metformin 500mg mane; stage 3--metformin 500mg thrice daily; stage 4--metformin 1000mg thrice daily. Results are expressed as Mean +/- SEM. Fasting blood glucose decreased from basal values (9.7 +/- 1.0 mmol/L) by 13% at stage 2, 34% at stage 3 and 41% at stage 4 (p less than 0.02 vs basal for all stages; p less than 0.02 stage 2 vs stage 3). Post-prandial glycaemia was significantly improved only with metformin 3000mg/day (p less than 0.05). Fasting, meal-stimulated and total insulin and c-peptide levels showed no change. Hepatic glucose output did not change significantly with metformin. Insulin sensitivity, measured as total glucose utilisation during hyperinsulinaemia, increased from stage 1 (10.3 +/- 2.1 mumoL/kg/min) by 23% at stage 3 (p less than 0.05) and by 29% at stage 4 (p less than 0.02). Basal metabolic clearance of glucose increased compared to stage 1 (1.69 +/- 0.16 mL/kg/min) by 30% at stage 2, 53% at stage 3 and 44% at stage 4 (all p less than 0.02). This study demonstrates that improved efficiency of glucose utilisation, both basally and under conditions of euglycaemic hyperinsulinaemia, is the basis of metformin's antihyperglycaemic action.

Adult↗
PubMed1989

Streptococcus pyogenes pneumonia with abscess formation.

A 30-year-old female with mild asthma presented with high fever, hypotension, pleuritic chest pain, vomiting and diarrhea. Chest radiograph showed consolidation of the right upper lobe, and S. pyogenes was cultured from blood and sputum. Following initial rapid recovery the patient relapsed ten days after antibiotics were ceased, with rapid development of a large abscess cavity. Clinical improvement occurred following reinstitution of treatment including intravenous penicillin. Progressive radiological resolution eventuated during outpatient follow-up. This case demonstrates that S. pyogenes pneumonia may occur without an antecedent viral infection or major predisposing condition, cause rapid cavitation despite antiobiotic therapy and resolve satisfactorily with prolonged penicillin therapy.

Adult↗
PubMed1989

Immobilization hypercalcaemia responding to intravenous pamidronate sodium therapy.

A 16 year old male developed symptomatic hypercalcaemia of immobilization on day 47 following a diving accident which had resulted in incomplete C4 tetraplegia. Following initial reduction in serum calcium with salmon calcitonin 100 U/day, symptomatic hypercalcaemia recurred. A single dose of 30 mg pamidronate sodium, given intravenously, caused serum calcium to fall within 48 hours. Initial mild, asymptomatic hypocalcaemia was followed by a return to sustained normocalcaemia. No major adverse reaction was encountered, and if further clinical experience confirms its efficacy, pamidronate sodium will warrant consideration as first-line therapy for immobilization hypercalcaemia.

Adolescent↗
PubMedDate not supplied

The role of DEXA bone densitometry in evaluating renal osteodystrophy in continuous ambulatory peritoneal dialysis patients.

OBJECTIVE: The aims of this study were to assess the clinical utility of total and regional bone densitometry in a large continuous ambulatory peritoneal dialysis (CAPD) population and to determine the clinical, biochemical, and radiographic variables that best identified osteopenic CAPD patients. DESIGN AND PATIENTS: A cross-sectional study was performed on 45 CAPD patients (19 males, 26 females), comprising the total CAPD population at the Princess Alexandra Hospital. MAIN OUTCOME MEASURES: Total body (TB), anteroposterior lumbar spine (APL), femoral neck (FN), Ward's triangle (WT), and skull bone mineral densities (BMDs) were measured using dual-energy x-ray absorptiometry (DEXA) and then correlated with clinical, biochemical, and radiographic indices of uremic osteodystrophy. RESULTS: BMDs were not significantly different from age- and sex-matched reference population data. Considerable regional variation of BMD Z scores were noted between FN (-0.11 +/- 0.23), WT (-0.11 +/- 0.22), and APL (1.22 +/- 0.04) (p = 0.003). APLZ scores were significantly reduced in patients with a previous history of fracture (-1.36 +/- 1.07 vs 0.89 +/- 0.31), bone pain (-0.72 +/- 1.08 vs 1.01 +/- 0.31), or steroid treatment (-0.62 +/- 0.39 vs 1.16 +/- 0.35). Increased BMD Z scores for APL (1.82 +/- 0.57 vs 0.38 +/- 0.29, p < 0.05), FN (0.32 +/- 0.36 vs -0.38 +/- 0.29, p = 0.014), and WT (0.45 +/- 0.38 vs -0.45 +/- 0.26, p < 0.05) were found in patients with radiographic hyperparathyroid bone disease. Both APL BMD Z scores and skull BMDs were weakly correlated with PTH (r = -0.33, p < 0.05 and r = -0.33, p < 0.05, respectively) and with CAPD duration (r = 0.30, p < 0.05 and r = -0.30, p < 0.05). Generally, however, total body and regional BMDs were poorly related to age, renal disease type, dialysis duration, renal failure duration, serum aluminum, calcium, phosphate, alkaline phosphatase, osteocalcin, and parathyroid hormone. CONCLUSIONS: We conclude that the prevalence of osteopenia is not increased in CAPD patients. Clinical and biochemical parameters do not reliably predict BMD measurements, but prior steroids and bone symptoms are major risk factors for important bone loss. Although DEXA can reliably detect osteopenia in different skeletal regions, its usefulness in detecting osteodystrophy is limited by the confounding effects of superimposed hyperparathyroid osteosclerosis, which increases BMD.

Absorptiometry, Photon↗