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Biomedical subjects

H Marsh

Publications and source records attributed to H Marsh.

34 records · Page 2Linked to original sources
PubMed1990

The effect of nimodipine on outcome after head injury: a prospective randomised control trial. The British/Finnish Co-operative Head Injury Trial Group.

To study the effect of nimodipine on the outcome of head injury, three hundred and fifty-two patients who were not obeying commands were randomised to placebo or nimodipine (2 mg per hour intravenously for 7 days). The 2 groups were well matched for important prognostic features. Six months after injury, more of the patients who were given nimodipine had a favourable outcome (moderate/good recovery) than in the control group, but the increase in favourable outcome (8%) was not significant statistically.

Craniocerebral Trauma↗
PubMed1989

Comparison of the pattern of postprandial carbohydrate metabolism after ingestion of a glucose drink or a mixed meal.

To determine whether the postprandial pattern of carbohydrate metabolism differs after ingestion of an identical amount of glucose as either a drink or as a part of a mixed meal, normal subjects were studied on two occasions. On both occasions, hepatic and extrahepatic glucose metabolism were assessed using the dual isotope and forearm catheterization techniques as well as indirect calorimetry. Plasma glucose, insulin, and C-peptide concentrations and rate of systemic entry of ingested glucose all were lower (P less than 0.05) during the first 15 min after the mixed meal than after the glucose drink. The integrated C-peptide response was greater (P less than 0.05) after the mixed meal, whereas the integrated suppression of glucagon was greater (P less than 0.05) after the glucose drink. Despite these differences in circulating hormone concentrations, after the first 15 min, the rates of systemic entry of ingested glucose, endogenous glucose release, incorporation of carbon dioxide into glucose, and glucose and lipid oxidation as well as nonoxidative glucose storage were virtually the same after the mixed meal and the glucose drink. We conclude that the pattern of postprandial carbohydrate metabolism after ingestion of a glucose meal is remarkably similar to that after ingestion of a more traditional mixed meal. These data suggest that insights regarding the pattern of postprandial carbohydrate metabolism derived from previous studies employing only a glucose drink are likely to pertain to those observed when healthy individuals ingest a meal that contains protein and fat.

Adult↗
PubMed1989

Closed head injuries: where does delay occur in the process of transfer to neurosurgical care?

In the United Kingdom most head injury patients are first admitted to a District General Hospital (DGH); selected patients are later referred to a Neurosurgical Unit (NSU). It is known that this system leads to some avoidable deaths. In an attempt to discover whether the minimum amount of time involved in such a system of secondary referral must of necessity put some patients at risk, and whether any significant delay could be eliminated without radical change in this system, we have carried out a detailed prospective analysis of the sequence of events involved in the emergency transfer of 117 consecutive patients with suspected traumatic intracranial haematoma (TICH). We discovered that once it had been decided to transfer a patient, the actual process of transfer consumed relatively little time regardless of the distance from the DGH to the NSU. Where harmful avoidable delay did occur was at the DGH itself either from failure to institute appropriate treatment for non-cranial injuries or from failure to realise that transfer was necessary. We believe that the geographical dispersal of neurosurgical services would not improve the outlook of patients with head injury. The optimum outcome could be achieved by concentrating head injury admissions at selected DGH's each of which would be equipped both with a CT scanner linked to a neurosurgical unit and a standby ambulance for transferring head injury patients.(ABSTRACT TRUNCATED AT 250 WORDS)

Brain Injuries↗
PubMed1988

MRI and hydrocephalus in childhood.

In six young patients presenting with raised intracranial pressure during the period of a year, CT revealed the presence of hydrocephalus, but not the cause. Magnetic Resonance Imaging not only showed the site and nature of the obstructing lesion, but also detected additional clinically silent spinal cord tumors in five of the patients. The place of MRI in the diagnosis of diseases involving the region of the cranio-cervical junction and in the elucidation of "unexplained hydrocephalus" is considered.

Child↗
PubMed1988

Skeletal muscle glycolysis, oxidation, and storage of an oral glucose load.

Although muscle is considered to be the most important site for postprandial glucose disposal, the metabolic fate of oral glucose taken up by muscle remains unclear. We, therefore, employed the dual isotope technique (intravenous, [6-3H]-glucose; oral, [1-14C]glucose), indirect calorimetry, and forearm balance measurements of glucose, lactate, alanine, pyruvate, O2, and CO2 in nine normal volunteers to determine the relative importance of muscle glycogenic, glycolytic, and oxidative pathways in disposal of an oral glucose load. During the 5 h after glucose ingestion (1 g/kg), 37 +/- 3% (24.9 +/- 2.3 g) of the load was oxidized and 63 +/- 3% (42.8 +/- 2.7 g) was stored. At least 29% (19.4 +/- 1.3 g) was taken up by splanchnic tissues. Muscle took up 26% (17.9 +/- 2.9 g) of the oral glucose coincident with a 50% reduction in its oxidation of fat. 15% of the oral glucose taken up by muscle (2.5 +/- 0.9 g) was released as lactate, alanine, or pyruvate; 50% (8.9 +/- 1.4 g) was oxidized, and 35% (6.4 +/- 2.3 g) was available for storage. We conclude that muscle and splanchnic tissues take up a comparable percentage of an oral glucose load and that oxidation is the predominant fate of glucose taken up by muscle, with storage in muscle accounting for less than 10% of the oral load. Thus, contrary to the prevailing view, muscle is neither the major site of storage nor the predominant site of disposal of an oral glucose load.

Administration, Oral↗
PubMed1987

Differences in the management of ruptured intracranial aneurysms: a survey of practice amongst British neurosurgeons.

British consultant neurosurgeons in post for at least one year were sent a postal questionnaire about the way in which they managed patients with ruptured aneurysms; 87% replied. Wide differences were evident in almost all aspects of treatment, before, during and after surgery. A consensus of opinion appeared in only a few areas: the employment of magnification during surgery, the use of clipping as the preferred method of surgical treatment, and a general reluctance to operate on patients with a depressed conscious level within a week of haemorrhage.

Age Factors↗
PubMed1985

Ruptured intracranial aneurysms: the overall effect of treatment and the influence of patient selection and data presentation on the reported outcome.

An attempt is made to assess the overall impact of current treatment of ruptured intracranial aneurysms, based on the outcome in 200 consecutive patients, unselected in that they were transferred to neurosurgical care as soon as they were referred, regardless of clinical condition. Overall mortality at 1 year was 35.5%. It is estimated that at the present time treatment improves the one-year survival of patients who reach the primary care hospital by no more than 12-15%. In assessing the apparent benefits of treatment, it is easy to overlook the effects of patient selection and the way in which data are presented. Other admission policies in line with current practice but involving greater selectivity and delay in transfer, could have reduced the one-year mortality of this series of patients to 16.1%, by excluding from neurosurgical care patients who were in a poor condition or about to deteriorate. The outcome data in this series could be presented in different ways so as to represent the surgical mortality as ranging between 13.8% and 3.3%.

Aged↗
PubMed1985

Simulated paraplegia: an occasional problem for the neurosurgeon.

Fourteen cases of simulated paraplegia and tetraplegia encountered amongst 4,800 neurosurgical admissions are described. The classification of such cases is difficult. Use of the term "hysteria" depends on whether the behaviour is judged to be conscious or not, but this can rarely be decided. In most of the patients the paralysis was of relatively short duration and recovered rapidly with simple methods of treatment which permitted this to occur without loss of face, but such cases presenting as acute neurological emergencies represent only one relatively simple form of pretended or "hysterical" illness. Many of these patients are probably never seen by psychiatrists.

Adolescent↗
PubMed1985

Effect of thyroid hormone excess on action, secretion, and metabolism of insulin in humans.

To determine the effect of thyroid hormone excess on insulin secretion, metabolism and action in humans, we examined intravenous glucose tolerance, glucose-induced insulin secretion, insulin clearance, monocyte insulin receptor binding, and the dose-response characteristics for the effects of insulin on glucose production, uptake, oxidation, and nonoxidative disposal in 10 normal volunteers for 14 days before and after oral administration of triiodothyronine (T3) in doses that increased plasma T3 to levels observed in spontaneous thyrotoxicosis (P less than 0.001). After T3 postabsorptive plasma glucose (P less than 0.05) and insulin (P less than 0.05) both increased; intravenous glucose tolerance was unaffected, but plasma insulin responses were increased (P less than 0.01); basal glucose production, uptake, and oxidation all increased (all P less than 0.05), whereas nonoxidative glucose disposal was unaffected (P = NS); monocyte insulin receptor binding increased (P less than 0.01) due to increased receptor affinity (P less than 0.05); and receptor number was not significantly altered (P = NS). Insulin clearance was increased. Insulin-induced suppression of glucose production was impaired (Km 22 +/- 3 vs. 37 +/- 7 microU/ml, P less than 0.02); maximal insulin-induced glucose uptake (10.7 +/- 0.6 vs. 13.0 +/- 0.9 mg X kg-1 X min-1, P less than 0.001) and oxidation (3.41 +/- 0.30 vs. 5.34 +/- 0.59 mg X kg-1 X min-1, P less than 0.001) were increased without a significant change in Km. However, submaximal rates of nonoxidative glucose disposal and glucose uptake were inappropriately low for the increased insulin receptor binding.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1984

Mechanism of hyperglycemia and response to treatment with an inhibitor of fatty acid oxidation in a patient with insulin resistance due to antiinsulin receptor antibodies.

Severe hyperglycemia and insulin resistance due to antiinsulin receptor antibodies developed over a period of 3 months in a 50-yr-old insulin-requiring diabetic patient. The hyperglycemia resulted from overproduction of glucose due to excessive rates of glycogenolysis and gluconeogenesis rather than decreased glucose utilization. Treatment with methyl-2-tetradecylglycidate, an inhibitor of fatty acid oxidation, resulted in a decrease in plasma glucose concentration. This was associated with a decrease in the rate of glucose production due to decreases in both gluconeogenesis and glycogenolysis rates, as well as an increase in the respiratory quotient. Plasma glucose concentrations continued to respond to the drug for the next 2 months until the sudden development of terminal hypoglycemia. The hypoglycemic action of the drug is consistent with the existence of an insulin-independent effect of fatty acid oxidation on glucose metabolism in man.

Adipose Tissue↗