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Biomedical subjects

K J Breen

Publications and source records attributed to K J Breen.

At least 19 recordsLinked to original sources
PubMed1998

Impaired doctors. The modern approach of medical boards.

BACKGROUND: Australian medical boards now emphasize treatment and rehabilitation, where possible, for doctors who are ill or drug dependent and hence impaired. OBJECTIVE: This article describes the processes and experience of the Medical Practitioners Board of Victoria following the introduction of the Medical Practice Act 1994. DISCUSSION: Impaired practitioner programs usually encompass: assessment by an independent relevant specialist negotiation of appropriate conditions on practice to ensure both community protection and support for the doctor during treatment and rehabilitation medical supervision, regular urine testing and appropriate conditions on practice for drug dependent doctors. Difficult issues can arise in relation to ageing doctors, psychotic doctors lacking in insight and drug dependency with extreme denial. While results of rehabilitation are encouraging, the profession needs to do even more in regard to prevention, early detection and provision of high speciality treatment and rehabilitation.

Australia↗
PubMed1996

Clues to depression in primary care practice.

Depression is a common but highly treatable mood disorder. Unfortunately, two thirds of depressed patients may never receive appropriate intervention. Because of individual and societal barriers to the diagnosis, depressive symptoms often go unrecognized. However, primary care physicians are in a unique position to surmount these obstacles by being alert to manifestations of the disorder. Treatment with antidepressant drugs, psychotherapy, electroconvulsive therapy, or a combination of these is very efficacious. The choice of method is based on such factors as history of previous response, severity of disease, concomitant medical illness, and patient preference.

Antidepressive Agents↗
PubMed1993

Elevated serum CK in long abstinent cocaine abusers.

In preparation for an exercise program in cocaine abusers maintained abstinent in a hospital setting (average 98.4 days), we measured resting serum creatine kinase (CK). Surprisingly, many were elevated. Further tests confirmed the observation. We measured 19 long abstinent cocaine abusers, 22 abstinent abusers of other substances, and a later group of 26 long abstinent cocaine abusers. While none of the other substance abusers showed elevated serum CK levels, 53 and 31% of the abstinent cocaine groups did (p = .000082 and .00041, respectively). All CK elevations were muscle derived; repeated sampling demonstrated stability. Cocaine abusers' CK showed a bimodal distribution: the lower bell curve approximated controls and the higher bell curve centered above normal range, at 400 U/L. Demographics did not influence the results. With complementary findings of impaired spatial motor performance, these persistent CK elevations suggest that a large minority of cocaine abusers maintain tendencies to coarse motor control and impulsive movements, and perhaps hyperactivity.

Adult↗
PubMed1993

Mitochondrial dysfunction in alcoholic patients as assessed by breath analysis.

Mitochondria of patients with alcoholic liver disease are morphologically abnormal, and mitochondria isolated from animals exposed to ethanol exhibit functional deficiencies in vitro. Because the functional consequences of the morphological alterations and the relevance of in vitro observations to mitochondrial function in alcoholic subjects are not clear, we assessed mitochondrial function noninvasively with a breath test. Mitochondrial function was assessed by measuring the exhalation of 14CO2 after administration of 1 microCi 2-keto[1-14C]isocaproic acid, the decarboxylation of which occurs in mitochondria. The results of the 2-keto[1-14C]isocaproic acid breath test in 17 alcoholic subjects were compared with the results in healthy controls and patients with nonalcoholic liver disease. The peak exhalation of 14CO2 and the fraction of the administered dose decarboxylated in 60 min were significantly lower in alcoholic patients than in healthy controls or patients with nonalcoholic liver disease. In alcoholic patients 2-keto[1-14C]isocaproic acid decarboxylation was impaired in the presence of normal conventional and quantitative liver function as assessed by aminopyrine breath test and galactose elimination capacity, indicating that 2-keto[1-14C]isocaproic acid decarboxylation does not simply reflect decreased functional liver mass. We conclude that mitochondrial function as reflected by 2-keto[1-14C]isocaproic acid decarboxylation is impaired in chronic alcoholic patients. The functional impairment is specific for excessive ethanol consumption and not a reflection of decreased global liver function or the presence of cirrhosis. 2-Keto[1-14C]isocaproic acid decarboxylation could thus be useful as a marker of excessive ethanol consumption.

Adult↗
PubMed1990

Multiple muscle enzyme release with psychiatric illness.

Associations (p less than .001) between serum concentrations of lactate dehydrogenase (LDH) and glutamic oxaloacetic transaminase (SGOT) were observed in physically well patients with mania (N = 100, r = .70), depression (N = 138, r = .51), chronic schizophrenia (N = 85, r = .68), and schizoaffective or atypical psychosis (N = 39, r = .52) discharged from 1978 through 1981. In contrast, there was a negligible association between these enzymes in 90 nonpsychiatric inpatient control subjects. Patients with mania (229.0 +/- 106.1 IU/l) showed significantly (t = 3.16, p less than .002, two-tailed) higher lactate dehydrogenase (LDH) levels than control subjects (191 +/- 41.7 IU/l) and a 14% incidence of abnormally high serum LDH levels vs. 1% among control subjects. Results were unchanged when patients taking neuroleptics were excluded. These results indicate that psychiatric illness, especially mania, induces release of LDH and SGOT, occasionally to unusually high levels. This is similar to previous reports of muscle creatine phosphokinase release in psychiatric patients. Presumably, these enzymes are released from skeletal muscle in association with agitation, with muscle tension, or with blood stasis and local tissue hypoxia consequent to hypoactivity.

Aspartate Aminotransferases↗
PubMed1987

Planned pregnancy in a patient who was receiving home parenteral nutrition.

A planned pregnancy with a satisfactory outcome is reported in a 33-year-old woman who had received long-term home parenteral nutrition after a massive volvulus, with resection of almost the entire small intestine, six years previously. No obstetric complications were observed and a normal baby girl was delivered by caesarean section. The only nutritional complication that was encountered was aching pain in the limbs and weakness at 20 weeks' gestation, which was due possibly to calcium deficiency and/or the metabolic bone disease that is peculiar to long-term parenteral nutrition and to other unidentified nutrient deficiencies.

Adult↗
PubMed1986

The effects of age and chronic liver disease on the elimination of temazepam.

The pharmacokinetics of the newer 1, 4 benzodiazepine temazepam were evaluated in 16 healthy subjects aged 18-92 years and in 15 cirrhotic patients, to ascertain the effect of ageing and liver disease. The data were analysed both by classic two compartment and by non-compartmental methods. The mean elimination half-life in the control subjects was 15.5 h, considerably longer than previous estimates. No correlation was found between age and pharmacokinetic parameters. The cirrhotic group showed no statistically significant difference in the pharmacokinetic parameters nor in the urinary recovery of the dose from the control group. Temazepam plasma protein binding was assessed in a second group of 9 cirrhotics of similar severity to the main group and in matched controls. When these binding data were applied to the mean clearance data, a modest although not statistically significant, reduction in free drug clearance was observed in the cirrhotic group. This study adds further support to the observation that drugs which undergo ether glucuronidation have normal elimination patterns in patients with liver disease. Temazepam may prove to be a useful hypnotic sedative in patients with liver disease.

Adult↗
PubMed1986

Hepatic vein occlusion (Budd-Chiari syndrome): problems in diagnosis and management.

Seven patients demonstrating the difficulties in diagnosis and management of hepatic vein occlusion are presented. The syndrome may present in an acute form with upper abdominal pain, abdominal swelling, ascites and tender hepatomegaly or in a chronic form, mimicking cirrhotic ascites. The clinical features, predisposing factors, liver scan and liver biopsy may all suggest the condition, but hepatic venography is essential for diagnosis and as a preliminary to treatment. It is suggested that early side to side portacaval anastomosis is the current treatment of choice.

Aged↗
PubMed1985

Jejunal uptake of thiamin hydrochloride in man: influence of alcoholism and alcohol.

The jejunal uptake of 35S-thiamin hydrochloride was examined using an intestinal perfusion technique in six young students (group 1), 12 recently drinking alcoholic men (group 3) and in 6 non-drinking men age-matched with the alcoholic men (group 2). The acute effect of alcohol on thiamin uptake was also examined in the alcoholic subjects. At a perfusate thiamin concentration of 0.5 mumol/l, median thiamin uptake was 34.4, 10.4, and 6.8 ng/cm/min in groups 1, 2, and 3 respectively, while for 8.0 mumol thiamin/l, median uptake was 277.2, 102.3, and 98.0 ng/cm/min for these groups respectively. Alcohol, 50 g/l, added to the perfusate gave a 28.9% decrease in uptake of 0.5 microM thiamin, which was not statistically significant. These findings suggest that neither alcoholism nor acute exposure to alcohol limits jejunal uptake of thiamin hydrochloride. Differences noted between young and old controls need further study.

Adult↗
PubMed1984

Use of single doses and rapid sampling to detect interactions with cimetidine.

In this study the well-established interaction between cimetidine and theophylline has been demonstrated using only a single dose of cimetidine. Eleven healthy subjects were given a 30 min infusion of theophylline on two separate occasions and plasma levels were monitored at frequent intervals. During one of the studies, a single 400 mg oral dose of cimetidine was given after collection of the 3 h sample. After normalisation of the control and test curves, a deflection was apparent in the test theophylline elimination curve in 9 out of 11 subjects. This method may provide a rapid screening method to detect such interactions.

Adolescent↗
PubMed1984

Disposition of intravenous glycofurol: effect of hepatic cirrhosis.

The disposition of intravenous glycofurol, a solvent for some drugs, was followed in nine male patients with hepatic cirrhosis. In comparison with age-matched controls, glycofurol clearance in the patients with cirrhosis was reduced 43% and terminal t 1/2 was prolonged 103%. There was no significant difference between the cirrhotic and control groups in volume of distribution.

Half-Life↗
PubMed1984

Decreased oral warfarin clearance after ranitidine and cimetidine.

Oxidative metabolism inhibition of a number of drugs by cimetidine has been attributed to its imidazole ring, a hypothesis that has been supported by reports that ranitidine does not affect drug metabolism despite being five times as potent as cimetidine as an H2-receptor antagonist. In five healthy subjects ranitidine at 150 mg twice daily induced a 27% fall in apparent oral warfarin clearance. In the same subjects cimetidine at 1 gm/day induced a 36% decrease in warfarin clearance. In two of the subjects the experiment was repeated after giving 750 mg ranitidine per day and in two other subjects after 200 mg cimetidine twice daily. In both instances there was a stepwise fall in warfarin clearance with increasing doses. The data indicate that interference with drug metabolism by H2-receptor antagonists is not confined to cimetidine but that on a molar basis ranitidine and cimetidine are roughly equivalent in inhibiting warfarin clearance and that the effects are related to dose.

Adult↗