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Biomedical subjects

M D Bastow

Publications and source records attributed to M D Bastow.

14 recordsLinked to original sources
PubMed1988

Hypertriglyceridemia and hyperuricemia: effects of two fibric acid derivatives (bezafibrate and fenofibrate) in a double-blind, placebo-controlled trial.

The effects of bezafibrate and fenofibrate on serum lipoproteins and serum urinary uric acid were compared. In a double-blind, placebo-controlled, cross-over study, each drug was administered in random order for 6 weeks followed by a 3-week drug-free phase to ten men with primary hypertriglyceridemia. Serum triglyceride and cholesterol concentrations decreased significantly with both fenofibrate and bezafibrate, although no significant change in serum apolipoprotein B, serum low density lipoprotein (LDL) cholesterol or serum high density lipoprotein (HDL) cholesterol concentrations was apparent. Serum uric acid levels, which were elevated on placebo and bezafibrate, were significantly reduced by 20% by fenofibrate. This was associated with an increase in renal uric acid clearance of 30% during fenofibrate therapy. Because it seems likely that hypertriglyceridemia and hyperuricemia are linked by a common carbohydrate inducibility, we studied the acute hyperuricemic response to orally administered fructose. Fructose (50 g) caused the anticipated rise in serum urate reaching a peak between 60 and 90 minutes, which was quantitatively greater in the men with hypertriglyceridemia than in healthy controls. The serum uric response to fructose was unaffected by bezafibrate, but was converted to normal by fenofibrate. The hyperuricemic action of fenofibrate is of sufficient magnitude to be of therapeutic value in the management of patients whose hypertriglyceridemia is associated with gout.

Bezafibrate↗
PubMed1986

Complications of enteral nutrition.

Complications may arise during enteral feeding that are usually related to the diameter and rigidity of the tube or the delivery, composition, and sterility of the feed uses. By using a soft, fine bore tube to deliver a sterile feed of known composition, by continuous infusion rather than as a bolus, most of these complications can be avoided.

Bacterial Infections↗
PubMed1983

Adrenocortical suppression in multiply injured patients: a complication of etomidate treatment.

Three patients admitted to the intensive care unit after multiple injury were observed to suffer episodes of adrenocortical insufficiency suggested by clinical manifestations and confirmed by appropriately low cortisol concentrations. This prompted a prospective study of pituitary-adrenocortical function in six multiply injured patients, three of whom showed evidence of adrenocortical suppression. The only factor common to the six patients with abnormally low adrenocortical function was an association between periods of adrenocortical suppression and intravenous infusion of etomidate; when the drug was stopped adrenocortical function was restored, and renewed administration of the drug caused further inhibition. Etomidate infusions lasting only six hours were found to cause low, flat responses to short tetracosactrin tests and grossly raised plasma concentrations of adrenocorticotrophic hormone, suggesting direct suppression of the adrenal cortex. Median plasma cortisol concentrations measured at 0900 were significantly lower and median plasma concentrations of adrenocorticotrophic hormone measured at 0900 were significantly higher in the three patients studied prospectively who were receiving etomidate infusions compared with the three patients who did not receive etomidate (p = 0.05).

Adolescent↗
PubMed1983

Benefits of supplementary tube feeding after fractured neck of femur: a randomised controlled trial.

A total of 744 elderly women with fractured neck of femur were classified into three groups according to anthropometric measurements on admission: group 1, well nourished; group 2, thin; group 3, very thin. Group 1 ate well and had a low mortality and a short rehabilitation time. The thinner the patients the lower their voluntary food intake, the higher their mortality and the longer their rehabilitation time. A series of 122 patients from groups 2 and 3 were entered postoperatively into a randomised controlled trial of overnight supplementary nasogastric tube feeding (4.2 MJ (1000 kcal), including 28 g protein) in addition to their normal ward diet. This treatment was associated with improvements not only in anthropometric and plasma protein measurements but also in clinical outcome, especially in the very thin group 3 patients. Rehabilitation time and hospital stay were shortened. Mortality in group 3 was less in the tube fed patients (8%) than in the controls (22%) but this difference did not reach statistical significance. One in five patients could not tolerate the nasogastric tube, but in the remainder the treatment caused no side effects and did not seriously diminish voluntary oral food intake by day.

Aged↗
PubMed1983

Undernutrition, hypothermia, and injury in elderly women with fractured femur: an injury response to altered metabolism?

On the basis of triceps skinfold thickness and arm muscle circumference measurements, 744 elderly women with fractured neck of femur were divided into three groups--well nourished, thin, and very thin. The mortality in the three groups was 4.4%, 8%, and 18%, respectively. Differences were not explained by age, associated disease, dementia, or marital status. Food intake after injury was related to initial nutritional state. There was a midwinter peak in fracture incidence and also a pronounced seasonal variation in the type of patient admitted; a much higher proportion of thin patients presented in winter after accidents indoors. The hypothesis that thinness or under-nutrition may impair thermoregulation and predispose to hypothermia, lack of coordination, and accident was supported by core temperature measurements on admission: those in most very thin patients were less than 35 degrees C, whereas in most well-nourished patients they were greater than 36 degrees C.

Accidents, Home↗
PubMed1983

Supplementation of nutritional fluid and electrolyte balance by perfusion of an isolated small bowel loop in a patient with Crohn's disease.

Delayed reanastamosis of small bowel in Crohn's disease has been made possible, largely by parenteral nutrition. We describe a patient with multiple resections resulting in loss of all the small and large bowel except the duodenum and 70 cms of proximal jejunum ending in a jejunostomy and a 150 cm long isolated loop of jejuno-ileum. The short proximal bowel proved adequate for energy and protein nutrition, with small frequent meals but gave rise to a persistent negative balance of water, sodium, potassium and magnesium. This was corrected by overnight perfusion of the isolated loop with an electrolyte solution with added glucose polymer to enhance sodium absorption. The critical rate of perfusion and concentration of glucose polymer were determined by a series of studies. The patient and her husband carried out this regimen for a year at home. The isolated loop was subsequently reanastamosed to the proximal jejunum allowing resumption of normal eating without further electrolyte disturbance.

Journal Article↗
PubMed1982

Anthropometrics revisited.

This paper has discussed some of the anthropometric techniques currently used for assessing nutritional state. Most of the measurements are easy to perform and a large amount of reference information is available, and yet an accurate and clinically useful method for nutritional assessment (especially for the elderly) has yet to be achieved. At present the best compromise would appear to be the use of measurements of weight, height and skinfold thickness at several sites to estimate the individual's body fat (and hence estimate 'energy reserves') from regression equations, or in conjunction with a prediction of their usual percentile, from national surveys, to try and gauge losses or gains in fat. The estimation of 'degrees' of malnutrition is not recommended.

Adipose Tissue↗