PubMed Health⌕ Search

Biomedical subjects

K Ales

Publications and source records attributed to K Ales.

7 recordsLinked to original sources
PubMed1996

A randomized controlled trial of salmon calcitonin to prevent bone loss in corticosteroid-treated temporal arteritis and polymyalgia rheumatica.

Patients treated with high-dose or long-term corticosteroids are at risk of accelerated osteoporosis and spontaneous vertebral and traumatic fractures. To assess the efficacy of salmon calcitonin in preventing corticosteroid- induced osteoporosis, 48 patients with newly diagnosed polymyalgia rheumatica, temporal arteritis, and other vasculitides were enrolled in a 2-year, double-blind, randomized, controlled trial. Patients were randomized to receive subcutaneous injections t.i.w. of either 100 IU of salmon calcitonin (25 patients) or placebo (23 patients). After 2 years, 19 and 21 patients, respectively, were evaluable. All patients also received supplemental calcium carbonate (1500 mg daily in divided doses) and vitamin D3 (400 IU daily). Baseline and serial radiologic assessments included dual-energy X-ray absorptiometry (DXA) of the lumbar spine and hip, and spine radiographs to detect vertebral fractures. There were no significant baseline differences between the two study groups. The mean within-subject percentage change in DXA lumbar spine density in the two groups over the 2-year period of the study was only -0.1% (calcitonin plus calcium) versus -0.2% (placebo plus calcium) a nonsignificant difference despite the high mean cumulative corticosteroid doses of 5371 mg and 4680 mg, respectively (NS). The incidence of vertebral fracture was 12.5% (calcitonin plus calcium: 11%, versus placebo plus calcium: 14%, NS), with four fractures in the first year and one fracture in the second year. Higher cumulative cortico-steroid dose was associated with a greater loss in bone density. In rheumatic disease patients starting high-dose, long-term corticosteroids, salmon calcitonin with calcium and vitamin D3 provided no greater bone preservation than that observed with calcium and vitamin D3 alone.

Absorptiometry, Photon↗
PubMed1995

Clinical reproducibility of dual energy x-ray absorptiometry.

Dual energy x-ray absorptiometry is a technique advocated for the measurement of bone mass throughout the skeleton, and recently it has been used to measure changes in periprosthetic bone mass after joint replacement. The accuracy and precision of the method in clinical patient populations have not been firmly established. This study sought to establish the short-term reproducibility of measurements made with dual energy x-ray absorptiometry of multiple sites in a large sample of elderly patients with rheumatic disease. Reproducibility was assessed in the lumbar spine and in three femoral sites in 69 patients participating in a longitudinal clinical trial. In each patient, absorptiometry was performed twice in the same day at as many as five time points over a 2-year period. The mean (+/- SD) baseline bone density was 0.783 +/- 0.128 g/cm2 for the femoral neck and 1.015 +/- 0.218 g/cm2 for the lumbar spine. The correlations between the duplicate baseline measurements of the spine were excellent (r = 0.9936, p < 0.001) and were stable over the 2-year period; the mean difference between the duplicate baseline measurements was 1.82 +/- 1.54% and the mean coefficient of variation was 1.29%. Measurements in the femur were much less precise; these values were 3.61 +/- 3.14% and 2.55% in the femoral neck, 3.66 +/- 4.35% and 2.59% in the greater trochanter, and 5.28 +/- 5.61% and 3.73% in Ward's triangle. This study evaluated the short-term reproducibility of dual energy x-ray absorptiometry in a clinical population.(ABSTRACT TRUNCATED AT 250 WORDS)

Absorptiometry, Photon↗
PubMed1991

Relating patient characteristics at the time of admission to outcomes of hospitalization.

In clinical practice, physicians informally address patient characteristics such as illness severity, comorbidity, functional status and stability when considering prognosis and diagnostic or therapeutic interventions. These same attributes, more formally measured, have been used as measures of casemix in clinical research to classify patients into similar risk strata. To determine whether physician estimates of illness severity, function status and stability were predictive of morbidity, mortality, length of stay and average daily ancillary charges, a cohort of 604 patients was studied. The predictive ability of the patient characteristics were found to be outcome specific. Illness severity was a significant predictor of in-hospital morbidity and mortality, length of stay and charges (p less than 0.001). Functional status was predictive of in-hospital morbidity and mortality, 1 year mortality, length of stay and charges (p less than 0.01). Physician estimates of stability were predictive only of morbidity (p less than 0.01) and comorbidity was only a preditor of 1 year mortality (p less than 0.001). Stratifying patients on the basis of specific clinical characteristics determined at the time of admission will be useful in studies of patient outcomes and resource utilization.

Aged↗
PubMed1988

Trade-offs between hospital charges and patient outcomes.

The increasing cost of health care has focused attention on the trade-offs between health care expenditures and patient outcomes. In this study, hospital charges were contrasted with the health status at 1 year of follow-up of 549 patients admitted to a university hospital medical service. The findings related to short-term outcomes were consistent with those of other investigators: large expenditures were associated with patients who died in the hospital, especially those whose death was unexpected. Both 1-year survival and hospital charges were found to correlate with physician estimates of illness severity and prognosis at the time of admission. Patients considered not ill with a favorable prognosis had a mortality rate at 1 year of 3%, comprised 7% of the cohort and generated 2% of total charges. In contrast, patients considered severely ill with an unfavorable prognosis had a mortality rate of 65%, comprised 19% of the cohort and generated 30% of total charges. Nevertheless, 46% of the survivors in this latter group were considered to be functional and only mildly ill at 1 year of follow-up. The imprecision of clinical judgements at the time of admission in predicting long-term outcome argues for aggressive management of acutely hospitalized patients when there is any doubt about their prognosis.

Fees and Charges↗
PubMed1988

Surveillance for postoperative myocardial infarction after noncardiac operations.

Patients with postoperative myocardial infarction are frequently asymptomatic. Several follow-up strategies have been used to detect infarction or ischemia in asymptomatic patients. Different investigators have used quite different criteria to define patients at high risk. This study was done to evaluate these different approaches to selecting patients who should be monitored with electrocardiograms (ECG) or enzymes, or both, postoperatively, as well as different strategies for the timing of follow-up evaluation. A total of 232 patients, mostly hypertensive or diabetic, were evaluated before undergoing elective operations and were observed serially from the day of the operation until discharge or the sixth postoperative day with daily clinical evaluations, ECG and creatine kinase isoenzymes. Several follow-up strategies used in recent studies were evaluated for sensitivity and specificity in identifying the patient who had postoperative infarctions or ischemia. The most sensitive strategies would obtain ECG in asymptomatic patients on the day of the operation and the first two postoperative days. Several criteria for defining a high risk population were evaluated, including type of operation, age, history of cardiac disease, Goldman's cardiac risk classification and the results of the preoperative ECG. Monitoring of patients with an abnormal preoperative ECG would have identified 88 per cent of the patients with postoperative myocardial infarction and 63 per cent of the patients with definite ischemia. Goldman's risk class identified patients with a normal ECG who were at higher risk for postoperative ischemia.

Adult↗
PubMed1983

Maternal-fetal immunity: presence of specific cellular hyporesponsiveness and humoral suppressor activity in normal pregnancy and their absence in preeclampsia.

The hypothesis that aberrant maternal-fetal immunity might lead to the development of preeclampsia was examined using mixed lymphocyte culture reactions (MLC) as an in vitro analogue of maternal-fetal immunity. Maternal lymphocytes and serum from five normal pregnant women differed significantly from lymphocytes and serum from five preeclamptics. Maternal cells from normal pregnancy responded appropriately to unrelated control cells, but demonstrated selective hyporesponsiveness to fetal cells in the MLC. Serum from normal pregnancy suppressed MLCs when maternal cells were responder cells (RC) and maternal cells or fetal cells were stimulator cells (SC), and did not inhibit MLCs where maternal cells were RC and control cells were SC. Maternal lymphocytes and serum from preeclamptics did not demonstrate cellular hyporesponsiveness or humoral suppressor activity. Our findings support the notion that specific cellular hyporesponsiveness and humoral suppressor activity is responsible for normal pregnancy; absence of such adaptive immunity might lead to the development of preeclampsia.

Adult↗