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Biomedical subjects

J M Wishart

Publications and source records attributed to J M Wishart.

At least 19 recordsLinked to original sources
PubMed1992

Osteoporosis and Klinefelter's syndrome.

OBJECTIVE: We wanted to measure forearm mineral density and bone-related biochemical variables in patients with Klinefelter's syndrome. DESIGN: Measurements made in patients with Klinefelter's syndrome were compared to those obtained in age-matched normal male volunteers. PATIENTS: We studied 22 patients with Klinefelter's syndrome (12 of whom had received sex hormone therapy) and 22 control subjects. MEASUREMENTS: We measured forearm mineral density, forearm fat content, fat-corrected forearm mineral density, plasma calcium and ionized calcium, serum osteocalcin, testosterone and dehydroepiandrosterone sulphate, and urinary hydroxyproline/creatinine ratio. RESULTS: Forearm mineral density was lower in the Klinefelter's group than in the control subjects (P less than 0.05) and below the control range in 5 patients. The fat content of the forearm was greater in the Klinefelter's group (P less than 0.002). Serum osteocalcin and testosterone were lower, while ionized calcium and the urinary hydroxyproline/creatinine ratio were higher in the Klinefelter's group (P less than 0.002). Serum dehydroepiandrosterone sulphate and testosterone were significantly related in the Klinefelter's group (r = 0.64, P less than 0.001), but not in the controls (r = 0.22, NS). Forearm mineral density and fat-corrected forearm mineral density were significantly related to serum testosterone in the Klinefelter's group (r less than 0.63; P less than 0.01), but not in the control subjects (r less than 0.03, NS). CONCLUSIONS: Decreased bone density occurs in about 25% of patients with Klinefelter's syndrome and probably reflects both decreased bone formation and increased bone resorption.

Adult↗
PubMed1991

Cigarette smoking and rate of gastric emptying: effect on alcohol absorption.

OBJECTIVE: To examine the effects of cigarette smoking on alcohol absorption and gastric emptying. DESIGN: Randomised crossover study. SETTING: Research project in departments of medicine and nuclear medicine. SUBJECTS: Eight healthy volunteers aged 19-43 who regularly smoked 20-35 cigarettes a day and drank small amounts of alcohol on social occasions. INTERVENTIONS: Subjects drank 400 ml of a radiolabelled nutrient test meal containing alcohol (0.5 g/kg), then had their rates of gastric emptying measured. Test were carried out (a) with the subjects smoking four cigarettes an hour and (b) with the subjects not smoking, having abstained for seven days or more. The order of the tests was randomised and the tests were conducted two weeks apart. MAIN OUTCOME MEASURES: Peak blood alcohol concentrations, absorption of alcohol at 30 minutes, amount of test meal emptied from the stomach at 30 minutes, and times taken for 50% of the meal to leave the proximal stomach and total stomach. RESULTS: Smoking was associated with reductions in (a) peak blood alcohol concentrations (median values in non-smoking versus smoking periods 13.5 (range 8.7-22.6) mmol/l v 11.1 (4.3-13.5) mmol/l), (b) area under the blood alcohol concentration-time curve at 30 minutes (264 x 10(3) (0-509 x 10(3)) mmol/l/min v 140 x 10(3)) (0-217 x 10(3) mmol/l/min), and (c) amount of test meal emptied from the stomach at 30 minutes (39% (5-86%) v 23% (0-35%)). In addition, smoking slowed both the 50% gastric emptying time (37 (9-83) minutes v 56 (40-280) minutes) and the intragastric distribution of the meal. There was a close correlation between the amount of test meal emptied from the stomach at 30 minutes and the area under the blood alcohol concentration-time curve at 30 minutes (r = 0.91; p less than 0.0001). CONCLUSION: Cigarette smoking slows gastric emptying and as a consequence delays alcohol absorption.

Adult↗
PubMed1991

Relationships between oesophageal transit and solid and liquid gastric emptying in diabetes mellitus.

In 87 randomly selected diabetic patients (67 type 1, 20 type 2) and 25 control subjects, gastric emptying of digestible solid and liquid meals and oesophageal transit of a solid bolus were measured with scintigraphic techniques. Gastrointestinal symptoms, autonomic nerve function and glycaemic control were evaluated in the diabetic patients. Gastric emptying and oesophageal transit were slower (P less than 0.001) in the diabetic patients compared with the control subjects, and each was delayed in about 40% of them. There was a relatively weak (r = 0.32; P less than 0.01) relationship between solid and liquid gastric emptying, and no significant correlation (r = 0.11, NS) between oesophageal transit and gastric emptying of the solid meal. Scores for upper gastrointestinal symptoms and autonomic nerve function correlated weakly (r = 0.21; P less than 0.05) with both oesophageal transit and gastric emptying. Gastric emptying of the liquid meal was slower (P less than 0.05) in patients with blood glucose concentrations greater than 15 mmol/l. These results indicate that gastric emptying in patients with diabetes mellitus should be assessed by liquid as well as by solid test meals and that oesophageal transit should not be used as a predictor of generalised diabetic gastroenteropathy.

Diabetes Mellitus↗
PubMed1991

Cross sectional and longitudinal study of bone mineral content of the distal forearm in adult premenopausal women.

The range of fat corrected distal forearm mineral content (FMC) (at a site which comprises approximately 75% cortical and 25% trabecular bone) and the effect of aging on FMC were determined in normal premenopausal women. In 106 women (mean age 39; range 18-56) the mean FMC was 1.184 (SD 148) g/cm; fat correction increased this to 1.239 (SD 148) g/cm. There were significant correlations between fat corrected FMC and height, weight and BMI (r greater than 0.16; P less than 0.05). In 43 of these women (mean age 35; range 18-51) repeat measurements of FMC were performed. The last measurement was separated from the first by a mean time interval of 27 +/- 3 months. There was no significant change in uncorrected FMC (baseline 1.185 +/- 0.21 g/cm compared with their final measurement 1.182 +/- .020 g/cm; P = 0.51). Fat-corrected FMC (baseline 1.229 +/- .021 g/cm compared with 1.223 +/- .020 g/cm later) tended to decrease although this change was not significant (P = 0.06). Age ranked cusum analysis demonstrated a non-significant fat-corrected rate of change in FMC of -.3% yr in those over 35 years of age (P less than 0.10). This data suggests that if there is any distal forearm bone loss before the menopause it is negligible.

Adolescent↗
PubMed1991

An open study of Triphasil and Diane 50 in the treatment of acne.

Levonorgestrel, as used in oral contraceptives, has antiovulatory activity at doses far lower than those producing androgenic effects. Triphasil, containing levonorgestrel was compared with Diane, containing cyproterone acetate in a trial of acne treatment. Twenty closely matched patients were alternatively allocated to 6 months of Triphasil or Diane treatment. Both groups had a 72% reduction in acne counts. Assays of total testosterone, androgen index, free testosterone, dehydroepiandrosterone sulphate and androstenedione showed significant reduction on treatment and sex hormone binding globulin was raised. All hormonal changes were more marked in the Diane group. Side effects caused only one withdrawal from the trial.

Acne Vulgaris↗
PubMed1991

Relations among autonomic nerve dysfunction, oesophageal motility, and gastric emptying in gastro-oesophageal reflux disease.

Recent studies suggest that vagal nerve dysfunction may be important in the aetiology of gastro-oesophageal reflux disease. Delayed oesophageal transit and slowed gastric emptying occur frequently and may also be of pathogenic importance. In 48 patients with gastro-oesophageal reflux disease we studied the prevalence of and relations between autonomic nerve dysfunction (as assessed by cardiovascular reflex tests) and oesophageal transit, oesophageal motility, gastric emptying, and endoscopic grade of oesophagitis. Of the 48 patients, 21 (44%) had abnormal autonomic nerve function, which was predominantly parasympathetic. Oesophageal transit was delayed in 28% of the patients and gastric emptying of the solid component of the meal was delayed in 46%. Oesophageal transit was significantly (p less than 0.007) slower in patients with abnormal autonomic nerve function. The percentage of synchronous oesophageal contractions was related to the score for autonomic nerve dysfunction (r = 0.40, p less than 0.05). There was no significant relation of autonomic nerve dysfunction to either delayed gastric emptying or endoscopic grade of oesophagitis. We conclude that in gastro-oesophageal reflux disease there is a high prevalence of parasympathetic nerve dysfunction which relates to delayed oesophageal transit and abnormal peristalsis and may therefore be of pathogenic importance.

Adult↗
PubMed1990

The reproducibility of bone-related biochemical variables in post-menopausal women.

Seventeen measured and derived bone-related biochemical variables were determined in 60 postmenopausal women on two occasions from 1 to 35 months apart. The coefficients of determination (r2) between the first and second observations were highly significant in respect of all measured and calculated variables except for anion gap, calculated complexed calcium, fasting urinary sodium:creatinine ratio and urinary phosphate:creatinine ratio. The variables with coefficients of determination which ranked highest include plasma alkaline phosphatase, albumin, globulins, calculated ionized calcium and fasting urinary corrected calcium:creatinine and hydroxyproline: creatinine ratios. They also showed marked individuality suggesting that changes within the conventional population based reference range possibly indicate significant physiological changes in metabolism. The critical difference for two results to be significantly different (P less than 0.05) was calculated from the total variation for each variable. We conclude that most of the measured and derived bone-related biochemical variables in fasting plasma and urine samples are sufficiently reproducible in postmenopausal women to be clinically and physiologically meaningful but that urinary sodium and phosphate are inconstant and probably dependent on the previous day's dietary intake.

Aged↗
PubMed1989

Gastric and oesophageal emptying in patients with type 2 (non-insulin-dependent) diabetes mellitus.

Gastric emptying of a digestible solid and liquid meal and oesophageal emptying of a solid bolus were measured with scintigraphic techniques in 20 randomly selected Type 2 (non-insulin-dependent) diabetic patients receiving oral hypoglycaemic therapy and 20 control subjects. In the diabetic patients, the relationships between oesophageal emptying, gastric emptying, gastrointestinal symptoms, autonomic nerve function and glycaemic control were examined. The percentage of the solid meal remaining in the stomach at 100 min (p less than 0.001), the 50% gastric emptying time for the liquid meal (p less than 0.05) and oesophageal emptying (p less than 0.05) were slower in the diabetic patients compared to the control subjects. Scores for upper gastrointestinal symptoms and autonomic nerve dysfunction did not correlate significantly (p greater than 0.05) with oesophageal, or gastric emptying. The 50% gastric emptying time for the liquid meal was positively related (r = 0.58, p less than 0.01) to the plasma glucose concentration at the time of the performance of the gastric emptying test and the lag period, before any solid food emptied from the stomach, was longer (p less than 0.05) in subjects with plasma glucose concentrations during the gastric emptying measurement greater than the median, compared to those with glucose concentrations below the median. These results indicate that delayed gastric and oesophageal emptying occur frequently in Type 2 diabetes mellitus and that delayed gastric emptying relates, at least in part, to plasma glucose concentrations.

Aged↗
PubMed1988

The relation between forearm and vertebral mineral density and fractures in postmenopausal women.

Vertebral and forearm mineral density (VMD and FMD, respectively) were determined in 124 postmenopausal women with no crushed vertebrae or peripheral fractures, 51 who had sustained peripheral fractures only since the menopause, 62 with vertebral compression(s) only and 75 with both types of fracture. There was a very significant correlation between the two measurements in the whole set. The scatter could not be accounted for by methodological error but was partly accounted for by body weight, since VMD was related to body weight and FMD was not. Whatever criterion was used for the diagnosis of osteoporosis (whether fracture or density) the percentage of misclassified cases was very similar by the two methods. However, VMD was relatively more reduced than FMD in vertebral fracture cases and FMD was marginally more reduced than VMD in peripheral fracture cases. There is little to choose between vertebral and forearm density in the diagnosis of osteoporosis but vertebral densitometry is slightly superior to forearm densitometry in describing the severity of osteoporosis in vertebral fracture patients.

Body Weight↗
PubMed1987

The influence of food on the pharmacokinetics of itraconazole in patients with superficial fungal infection.

Itraconazole in a new, orally active triazole, which is related to ketoconazole and which is active against dermatophytes and Candida and Cryptococcus organisms. It is more potent than ketoconazole, is better absorbed with food, and does not suppress testosterone or cortisol synthesis. In previous studies, daily 200 mg doses of itraconazole for 5 days cleared 80% of cases of pityriasis versicolor, and 90% of dermatophyte infections were cleared by daily 100 mg doses administered for 1 month. Twenty patients with superficial dermatophyte, Candida albicans, and pityriasis versicolor infections were treated with doses of 50 or 100 mg per day; in the first group of 10 patients, the drug was administered before breakfast and the other 10 patients were given their dose with breakfast. Itraconazole concentration was determined by high-performance liquid chromatography 3 hours after administration of first and last doses. Our findings showed that although treatment with 50-mg doses led to poorer results and lower plasma levels than 100-mg doses, taking the drug with breakfast gave much better results than taking it before.

Adolescent↗
PubMed1986

Bazex paraneoplastic acrokeratosis: a case report and response to Tigason.

A clinically typical case of Bazex acrokeratosis neoplastica is presented. This case is unusual in that the syndrome developed two years after a neoplasm was diagnosed. Almost complete clinical clearance was obtained with oral Tigason, making it the first recorded case to improve without removal of the underlying neoplasm.

Carcinoma, Squamous Cell↗
PubMed1984

Systemic treatment of severe acne with a retinoic acid derivative, isotretinoin.

Twenty-eight patients with severe acne and one with hidradenitis suppurativa and acne were treated for 12 to 16 weeks with a new synthetic retinoid, isotretinoin (Roaccutane). The average dose was 0.56 mg/kg/day. Patients were seen weekly for four weeks and then fortnightly for the remaining treatment period, being evaluated both qualitatively and quantitatively. Twenty-five patients had an excellent response. Two to five months after the end of treatment no patient had relapsed. No patient withdrew because of side effects, but all suffered dry lips. This study confirms the potential of isotretinoin in the treatment of severe acne.

Acne Vulgaris↗