Use of interferon beta 1b for multiple sclerosis. Patients will put up with side effects because of their desire to beat the disease.
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Adjuvants, Immunologic↗
Biomedical subjects
M Chellingsworth
Publications and source records attributed to M Chellingsworth.
Calcium antagonists and the kidney.
Calcium antagonists are frequently used to treat patients with hypertension or ischaemic heart disease. These patients often have renal impairment, so the effects of calcium antagonists on the kidney are important. The effects of calcium antagonists on renal haemodynamics are variable and depend on the state of the patient or animal and the dose of calcium antagonist used. Calcium antagonists cause natriuresis and diuresis by a mechanism which is not fully understood, but which is probably not directly due to the effects of calcium antagonists on renal haemodynamics. The diuretic effect may be useful in limiting the oedema which would otherwise be induced by vasodilator therapy. The effects of calcium antagonists on peripheral renin activity are unpredictable: renin release may be affected directly, as well as via haemodynamic effects. The pharmacokinetics of calcium antagonists are little changed in renal failure, since these drugs are metabolised in the liver. Calcium antagonists appear to be safe and useful treatments for patients with hypertension or ischaemic heart disease and co-existing renal impairment.
Calcium Channel Blockers↗
Digitalis in the elderly.
Since William Withering first described the use of digitalis, over 200 years ago (1), its popularity has waxed and waned. Digitalis preparations are widely prescribed for elderly patients. Surveys of hospital in-patients have shown a high prevalence of the use of digitalis preparations (2, 3), but also of digitalis toxicity; though not all studies have shown the latter to increase with age. A survey of people aged 70, living in Gothenberg, showed that 14% were taking digitalis preparations (4); other studies have shown similar figures. Now that powerful diuretics and vasodilators are available for the treatment of heart failure, and many antiarrhythmics are used for the control of atrial tachyarrhythmias, there is controversy about the value of cardiac glycosides in the treatment of elderly patients.
Aged↗
The treatment of hypertension in the elderly.
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Aged↗
Progressive systemic sclerosis, immunosuppression and necrotising arteritis: cause or effect?
Necrotising arteritis is rare in progressive systemic sclerosis (PSS). We report a patient with PSS who died with renal failure due to necrotising arteritis and segmental crescentic glomerulonephritis more typical of polyarteritis nodosa. Possible pathogenetic mechanisms are discussed. Renal biopsy is an important investigation in PSS, but is especially important in patients without hypertension, as other pathology needs to be excluded.
Administration, Oral↗
Acute systemic lupus erythematosus with fatal pneumonitis and disseminated intravascular coagulation.
We reported the case of a 40-year-old female with acute onset of systemic lupus erythematosus, followed rapidly by the development of fatal pneumonitis and disseminated intravascular coagulation. The likely relationship between these events and the therapeutic options are discussed.
Acute Disease↗
"Normal" acute phase response in systemic sclerosis.
An Italian woman with classic active progressive systemic sclerosis had a normal serum concentration of C reactive protein (less than 6 mg/1). During an infection with Staphylococcus aureus, however, the concentration rose to 250 mg/1. This was unexpected, since in scleroderma the acute phase response to infection (a brisk rise in serum concentrations of various proteins, including C reactive) has been thought to be defective. This patient is evidence that the acute phase response does occur in systemic sclerosis and that probably it is the nature of the primary disease that masks the response in some cases.
Adult↗
The destination and dependency of patients discharged from care of the elderly units in the West Midlands.
Between November 1988 and January 1989 a prospective survey was undertaken on patients aged 65 years and over who were discharged from the care of geriatricians in seven District General Hospitals. The survey aimed to provide a regional perspective on patient dependency by relating dependency at discharge to the discharge destination. The findings show that the majority of patients were relatively independent and most returned home. A significant number of the very dependent patients were discharged to the community with private residential and nursing homes making an important contribution to the placement of highly dependent patients.
Activities of Daily Living↗
Prevention and management of steroid-induced osteoporosis.
Glucocorticoids were first used therapeutically in the late 1940s. While they have revolutionised the treatment of many diseases, they also have many side effects, including osteoporosis. Although osteoporosis has been recognised as an important complication since the first use of steroids, we are still a long way from understanding the pathophysiology of steroid-induced osteoporosis.
Aged↗