PubMed Health⌕ Search

Biomedical subjects

J M Potter

Publications and source records attributed to J M Potter.

At least 19 recordsLinked to original sources
PubMed1995

Gait speed and activities of daily living function in geriatric patients.

OBJECTIVE: To establish the relationship between gait speed (GS) and functional independence in elderly people. DESIGN: GS is suggested as being a criterion standard in rehabilitation reflecting muscle strength. This study assessed the relationship between gait speed and functional independence in Activities of Daily Living (ADL). GS was measured by portable accelerometer over 2 meters. The mean of 3 attempts was taken. ADL function was measured by an occupational therapist using the modified Barthel ADL Index. The relationship between these measures was assessed by a statistician. SETTING: A geriatric unit in a hospital in Scotland. PATIENTS: One hundred sixty-one inpatients and outpatients were selected at random from the patients of a geriatric unit over a 3-month period. Patients were eligible if they were mobile with or without a walking aid. INTERVENTIONS: GS was measured by portable ultrasonic accelerometer. Patients were reviewed by an occupational therapist, blinded to their GS, who recorded functional capacity. Case sheet review provided diagnostic details and cognitive function. The type of floor surface was recorded. MAIN OUTCOME MEASURES: GS (m/sec), and Barthel score. RESULTS: Patients with GS of < .25m/sec were more likely to be dependent in one or more ADL function, p < .01. Those with a GS between .35 and .55m/sec were more likely to be independent in all ADL functions, p < .001. Patients whose GS was > .55m/sec did not maintain this independence. There was no relationship between GS and floor surface or cognitive function. CONCLUSIONS: GS is a useful indicator of ADL function in geriatric patients.

Activities of Daily Living↗
PubMed1992

High-performance liquid chromatographic method for the simultaneous determination of monoethylglycinexylidide and lignocaine.

An accurate and sensitive high-performance liquid chromatographic method with UV detection was developed for the simultaneous measurement of monoethylglycinexylidide (MEGX) and lignocaine in human plasma and serum, using organic solvent extraction and trimethoprim (TMP) as an internal standard. The mean recoveries for MEGX, TMP and lignocaine were 86.1 +/- 3.7, 98.3 +/- 1.8 and 77.0 +/- 4.7%, respectively (n = 6). The relative standard deviations for MEGX concentrations of 10 and 200 ng/ml were less than 4% and for lignocaine concentrations of 200 and 1200 ng/ml they were less than 8%.

Chromatography, High Pressure Liquid↗
PubMed1992

Altered in vitro lymphocyte response in childhood nephrotic syndrome.

The immune system, and disturbed T lymphocyte function in particular, has previously been implicated in the pathogenesis of childhood idiopathic nephrotic syndrome. As this disorder is commonly responsive to steroid therapy, we set out to determine whether in vitro suppression of lymphocyte blastogenic response to the mitogen phytohaemagglutinin (PHA) could predict the clinical situation. Comparing nine nephrotic children with nine healthy controls we were able to show the inhibitory prednisolone dose that suppressed lymphocyte blastogenesis by 50% (ID50) at a known concentration of PHA was significantly greater (P < 0.005) for nephrotic individuals. However, the in vitro assay did not reliably predict the clinical response to prednisolone. This study further implicates altered lymphocyte function in the mechanisms underlying idiopathic nephrotic syndrome.

Adolescent↗
PubMed1992

Cardiodepressant drugs and the high mortality rate associated with ischemic hepatitis.

OBJECTIVE: To show that patients are more likely to die in the event of ischemic hepatitis if they take drugs where clearance is dependent on liver blood flow and where a high dose produces myocardial depression. DESIGN: The drug management was studied in a case series of 28 patients in whom ischemic hepatitis was diagnosed. SETTING: Inpatients in a major teaching hospital. PATIENTS: Patients were identified by an increase in circulating aspartate aminotransferase activity to greater than 1000 U/L and a clinical history of a hypotensive episode or cardiac failure. MAIN OUTCOME MEASURE: All drug use from 12 hrs before the hypotension or onset of cardiac failure was recorded. The clinical outcome was categorized as death during the acute event (ischemic hepatitis) or recovery. RESULTS: Acute mortality rate was 60.7%. Among nonsurvivors, calcium-channel antagonists and antiarrhythmic drugs were used in ten (58.8%) of 17 patients, compared with two (18.2%) of 11 survivors (chi 2 = 4.504, p less than .05). CONCLUSIONS: The patient who is or has been recently receiving calcium-channel blockers and/or antiarrhythmic drugs has a poor prognosis in the event of ischemic hepatitis, with a mortality rate of 83%. Further study may show whether this mortality rate reflects the severity of the premorbid cardiovascular disease in these patients or whether the presence of these drugs renders the patients more resistant to inotropic support.

Adolescent↗
PubMed1992

A quick, sensitive high-performance liquid chromatography assay for monoethylglycinexylidide and lignocaine in serum/plasma using solid-phase extraction.

Recent advances in the investigation of liver disease and transplantation have seen the introduction of lignocaine as a probe of liver function. For this purpose, an assay that is sensitive and rapid is required for the major metabolite of lignocaine, monoethylglycinexylidide (MEGX). We have developed an accurate, low-cost high-performance liquid chromatography (HPLC) method using Bond-Elut phenyl (1 cc) cartridges for sample preparation. The total preparation time for five samples is less than 10 min and the run time is approximately 10 min/sample. Each cartridge can be used at least four times. Simultaneous measurement of another metabolite of lignocaine, glycinexylidide (GX), can be achieved by adjustment of the mobile phase and flow rate. The chromatogram is monitored with an UV detector at 210 nm. The inter- and intra-assay coefficients of variation for MEGX (10-250 micrograms/L) and lignocaine (100-2,000 micrograms/L) are less than 9.5 and less than 2%, respectively, with recoveries for MEGX, trimethoprim (internal standard), and lignocaine all greater than 85%. This method offers a rapid, sensitive assay that is clinically useful in the new role for lignocaine/MEGX in dynamic liver function testing.

Chemistry Techniques, Analytical↗
PubMed1992

Fluorescence polarization immunoassay and HPLC assays compared for measuring monoethylglycinexylidide in liver-transplant patients.

We compared fluorescence polarization immunoassay (FPIA, x) and HPLC (y) for measuring monoethylglycinexylidide (MEGX) concentrations in 119 serum samples from 61 liver-transplant donors and recipients. The correlation between the two methods was y = 1.48 micrograms/L + 0.8x (r = 0.89). The bias (mean difference) was 12 micrograms/L (0.055 mumol/L) through the MEGX concentration range measured (0-250 micrograms/L, 0-1.136 mumol/L). We observed a major difference between the two methods in samples from four recipients and one donor. Cross-reactivity in FPIA with lignocaine and two of its metabolites (glycinexylidide and 2,6-xylidine) was < 3%. Samples with high bilirubin concentrations (> 200 mumol/L) required dilution before assay of MEGX by FPIA. Although there was an increase in apparent MEGX concentrations in some samples with increased bilirubin concentrations, the relationship was not constant. Increased plasma concentrations of cholesterol and triglyceride resulted in relatively small increases in apparent MEGX concentrations.

Bilirubin↗
PubMed1992

The decline in geriatric long stay beds: who remains?

A day census of all long-term hospital patients in the Canterbury geriatric service area was carried out in 1984 (when there were 127 beds) and repeated in 1989 (when there were 66 beds). The patients in the 1989 census were more confused and physically more dependent than those in 1984. Comparison with residents in local residential and nursing homes in 1987 shows that a higher proportion of long-term hospital patients had severe mental and physical disability. There is a hard core of patients who are difficult to place outside hospital. This has predictable resource implications and in Canterbury such patients will continue to occupy National Health Service beds as there are no practicable alternatives.

Activities of Daily Living↗
PubMed1991

Intravenous regional administration of methylprednisolone in rheumatoid arthritis.

Intravenous regional administration of corticosteroid (IVRAS) in the treatment of rheumatoid arthritis of the hand has not been reported previously. The method is based on a modification of Bier's block, with substitution of corticosteroid for local anaesthetic. Twenty-two patients were assessed in this double-blind, placebo-controlled study. The technique was safe and effective in improving grip strength, with a group mean improvement of more than 50%. Because suppression of endogenous cortisol production 24 h after treatment was commensurate with the dose of methylprednisolone used (40 mg), we could not exclude that the response may have been due to systemic steroid. Further studies are required to define the real value of IVRAS as it may offer alternative treatment of the joints and tendons within the hand and wrist in some patients rather than more prolonged oral therapy or individual, multiple joint or sheath injections.

Arthritis, Rheumatoid↗
PubMed1991

Lactose in blood in nonpregnant, pregnant, and lactating women.

Lactose synthesized in the mammary gland can pass into the bloodstream by either a paracellular or transcellular pathway. In nonpregnant, nonlactating women, the concentration of lactose in the blood plasma was 1.5 +/- 0.1 microM (mean +/- SEM) in 9 women and undetectable in another 11 women. During pregnancy, this concentration was 3.7 +/- 0.4 microM at 10-21 weeks of gestation, with an increase to 8.7 +/- 1.8 microM by 38-40 weeks of gestation. At the initiation of lactation, the concentration of lactose peaked 3-5 days after birth, with a mean peak concentration of 75 +/- 18 microM, and then decreased to 30 +/- 8 microM when lactation was well established at 6 weeks after birth. These findings suggest that the mammary glands are synthetically active by the beginning of the second trimester of pregnancy and reach maximum synthetic capacity soon after birth. Measurement of concentrations of lactose in the blood plasma during pregnancy and lactation may allow an assessment of the successful initiation of both lactogenesis I and II.

Female↗
PubMed1990

Mortality associated with ischaemic hepatitis.

Twenty-nine patients of 18,000 inpatient admissions over a six-month period developed ischaemic hepatitis accompanied by peak aspartate aminotransferase (AST-EC 2.6.1.1) activity greater than 1,000 U/L. Seventeen of these 29 patients died either during or shortly after the episode of ischaemic hepatitis, with an overall mortality of 58.6%. Mortality was not due in any of the cases to the hepatitis but rather the underlying cause. Ischaemic hepatitis was the commonest cause of an AST activity greater than 1,000 U/L in this hospital population (29 of 52 patients i.e. 56%). This condition is more common than generally appreciated and is associated with a poor prognosis.

Aspartate Aminotransferases↗
PubMed1990

Comparison of tolbutamide and metformin in elderly diabetic patients.

In a randomized double-blind cross-over study the efficacy, metabolic effects, and acceptability of metformin were compared with tolbutamide in 20 diabetic patients aged between 65 and 95 years. No significant differences were noted after treatment in blood glucose control (fasting plasma glucose, metformin 9.1 +/- 2.8 mmol l-1, tolbutamide 8.3 +/- 2.8 mmol l-1; mean change, metformin +1.1 mmol l-1, tolbutamide +0.02 mmol l-1, p = 0.215), domiciliary blood glucose control, fasting insulin, lactate, cholesterol or triglyceride levels. There was a significant difference in weight change between the two treatments (on metformin -2.0 kg, from 63.2 +/- 11.8 to 61.2 +/- 12.3; on tolbutamide, +1.6 kg, from 61.4 +/- 11.1 to 63.0 +/- 12.3; p = 0.001). Initial gastro-intestinal side-effects occurred in 30% of patients with metformin. These were transient and responded to temporary reduction in treatment dosage. Metformin could not be distinguished from tolbutamide in elderly diabetic patients, except in that it was associated with weight loss.

Aged↗
PubMed1990

Effect on a geriatric service of opening a 25-bed ward on the district general hospital site: an audit.

Notes and discharge summaries of 2,560 patients were analysed in a pre-planned study to determine how the establishment of a 25-bed assessment ward on the district general hospital (DGH) site affected the work of a geriatric unit that had previously had no DGH beds. Throughput, changes in referrals and practice, and changes in outcome were measured using a computerised programme which examined the work of the unit for a year before and a year after the opening of the assessment ward. There were no changes in overall bed numbers or staffing, so changes were likely to be the direct result of establishing the DGH beds. The second year of the study showed a 33% increased throughput, with increased referrals from the accident and emergency department and evidence of more active investigation and treatment and a tendency towards a shorter length of stay. There was an increased number of transfers from all departments to the geriatric department for rehabilitation and a shortened time interval to transfer. Admissions to the general medical unit for patients aged 65-74 and 75+ did not change.

England↗
PubMed1989

Myoclonus associated with treatment with high doses of morphine: the role of supplemental drugs.

OBJECTIVE: To estimate the prevalence of important side effects in patients with malignant disease who were receiving high doses of morphine as part of their palliative treatment. DESIGN: Data on patients were collected over 12 months. SETTING: Two palliative care units in Western Australia. PATIENTS: 19 Patients with malignant disease who were receiving morphine either subcutaneously or orally as the main analgesic. 10 Patients receiving a total daily dose of morphine of at least 500 mg orally or 250 mg parenterally were enrolled in the study. The other 9 patients were enrolled after an important problem thought to be related to the morphine had been identified. All of the patients were taking drugs to supplement the treatment. INTERVENTIONS: The dose of morphine or route of administration, or both, was changed in three patients. MAIN OUTCOME MEASURE: Determination of the prevalence of side effects in the patients. Assessment of the relation of any side effects with the supplemental drugs taken by the patients. MAIN RESULTS: Plasma morphine and electrolyte concentrations were measured and a full history taken for each patient. Thirteen of the 19 patients had an important side effect; 12 of them had myoclonus and one had hyperalgesia of the skin. Plasma morphine concentrations were similar in patients with and without myoclonus, ranging from 158 to 3465 nmol/l and 39 to 2821 nmol/l respectively. Eight of the patients with side effects were taking an antipsychotic drug concurrently compared with none of those without side effects. A greater proportion of patients with side effects were taking the antinauseant drug thiethylperazine (6/13 v 2/6) and at least one non-steroidal anti-inflammatory drug (10/13 v 2/6), whereas a smaller proportion were taking a glucocorticosteroid (3/13 v 4/6). The estimated prevalence of important side effects in the total population of patients receiving palliative treatment in the two units was 2.7-3.6%. CONCLUSIONS: Myoclonus as a side effect of treatment with morphine is more likely to occur in patients taking antidepressant or antipsychotic drugs as antiemetics or as adjuvant agents or non-steroidal anti-inflammatory drugs for additional analgesia. If a patient develops myoclonus the best approach may be to change the supplemental treatment.

Adult↗
PubMed1988

Hormone binding globulins undergo serpin conformational change in inflammation.

A surprising recent finding is that thyroxine binding globulin (TBG) and cortisol binding globulin (CBG), are members of the serine protease inhibitor (serpin) superfamily. Apparently evolution has completely adapted the serpin structure for its new role in these proteins as a transport agent, as there is no evidence of any retained protease inhibitory activity. This drastic change in function raises the question as to why such a complex molecular framework has been selected for the relatively simple task of hormone transport? To function as inhibitors the serpins have a native stressed (S) conformation that makes them vulnerable to proteolytic cleavage, the cleavage being accompanied by an irreversible transition to a stable relaxed (R) form. We demonstrate here that TBG and CBG have retained the stressed native structure typical of the inhibitor members of the family and we provide evidence that the S-R transition has been adapted to allow altered hormone delivery at inflammatory sites.

Amino Acid Sequence↗