A comprehensive database management system for a variety of clinical trials.
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Clinical Trials as Topic↗
Biomedical subjects
M G Grace
Publications and source records attributed to M G Grace.
Depression, drugs, and delusions.
This study, a retrospective review of clinical experience, investigated response to tricyclic antidepressants in a group of 34 depressives with delusions and a group of 22 depressives without delusions. There was no difference between the groups in terms of their age, sex, or dosage of tricyclic antidepressant. The pattern of when patients left tricyclic therapy for electroconvulsive therapy was similar in both groups. For those responding to tricyclics, the nondelusional group responded within the first three weeks of therapy, whereas for the delusional group the responders were more spread throughout the nine weeks. Delusional depressives were more likely to respond to tricyclic antidepressants than were nondelusional depressives.
Adult↗
Protein-energy malnutrition in gastroenterology outpatients: increased risk in Crohn's disease.
A screening study was conducted to identify malnutrition in gastroenterology outpatients and to ascertain whether poor food intake is a contributing factor. A 48-hour recall method was used to collect dietary data from 154 patients (87 women and 67 men). Fourteen (16%) of the women and 8 (12%) of the men were classified as having protein-energy malnutrition (PEM) on the basis of abnormal anthropometric measurements or low serum albumin concentration. PEM was found in several diagnostic groups, but 9 of the 14 malnourished women had Crohn's disease. Protein undernutrition was more evident in women; calorie undernutrition was more evident in men. More women than men had low serum albumin levels. Low hemoglobin levels were particularly prevalent among patients with Crohn's disease. Many of the patients, especially women, had "inadequate" and "marginal" intakes of folate, vitamin A, thiamin, and calcium according to Nutrition Canada interpretive standards. The intake of iron was particularly poor among women: 59% of the intakes of female patients were classified as inadequate (less than 10 mg/day). Ten of the 14 female patients with PEM had inadequate iron intakes. Serum folates of less than 5 ng/ml were present in 72% of the women and 77% of the men. The data suggest that gastrointestinal outpatients are at high risk of malnutrition and that one of the factors contributing to the problem is inadequate food intake.
Adult↗
Nutritional status of gastroenterology outpatients: comparison of inflammatory bowel disease with functional disorders.
Dietary intakes of two groups of gastrointestinal patients, one group with inflammatory bowel disease (IBD)--Crohn's disease or chronic ulcerative colitis--and the other with functional disorders (FD)--irritable bowel syndrome, nonulcer dyspepsia, or gastroesophageal reflux disease, were assessed by means of 48-hour recalls. The relationships between dietary intake and anthropometric and biochemical measurements were examined. The IBD group had lower mean serum albumin and hemoglobin levels (p less than .05); however, FD patients had less adequate diets. The mean energy intake of women with FD was significantly lower than that of women with IBD (p less than .05) and was associated with inadequate or marginal intakes of many nutrients. Comparison of nutrient intakes between the IBD and FD groups revealed a significantly lower mean intake of folate, ascorbic acid, and vitamin A for women with FD than for women with IBD (p less than .05). In general, women had poorer diets and a higher prevalence of abnormal biochemical parameters than men. One notable feature of the dietary pattern of the women was that they consumed less meat than the general population consumed. Increasing meat consumption would improve the intake of many nutrients, including protein and iron. The results of this study suggest that more attention should be given to the adequacy of dietary intakes of gastrointestinal patients in general and of women in particular.
Adult↗
A case-control study of diet and colo-rectal cancer.
A case-control study of cancer of the colon and rectum has been conducted in Calgary, Alberta and Toronto, Ontario, Canada. A total of 348 cases of cancer of the colon and 194 cases of cancer of the rectum were individually matched by age, sex and neighbourhood of residence to 542 population controls and frequency match to 535 hospital controls who had undergone an abdominal operation. Each subject received a personal medical history questionnaire and a quantitative diet history questionnaire. Data on a number of potential non-nutrient risk factors for bowel cancer and on the consumption of 9 nutrients in the 2-month period up to 6 months before interview were analysed. The dietary data thus refer to recent diet consumed in a period antedating the diagnosis of, and in most cases symptoms from, large-bowel cancer in the cases, and a corresponding time period in the controls. The major findings were an elevated risk for those with a history of bowel polyps, and for those with an elevated intake of calories, total fat, total protein, saturated fat, oleic acid and cholesterol. No association was seen with an elevated intake of crude fibre, Vitamin C and linoleic acid. The nutrients for which an increased risk was demonstrated were highly correlated, though multivariate analysis using logistic regression indicated highest risk for saturated fat, with evidence of a dose-response relationship. The findings in both cancer sites, both sexes and with both sets of controls were quantitatively very similar. The population-attributable risk for colon and rectal cancer combined was estimated from the neighbourhood controls to be 41% for males and 44% for females for saturated fat intake and 9.8% and 6.4% respectively for any history of polyps.
Adult↗
A study of cancer, parity and age at first pregnancy.
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Adult↗
Cerebrovascular responses to subarachnoid blood and serotonin in the monkey.
Preliminary in vitro experiments were performed to determine the serum concentration of serotonin in the monkey, and the ability of cyproheptadine to block serotonin and serum-induced contractions in monkey cerebral arteries. Thirty-four cynomolgus monkeys were subsequently used to study changes in regional cerebral blood flow (CBF) obtained by the intracartoid 133Xe technique, and in the angiographic cerebral arterial caliber resulting from subarachnoid injection of artificial cerebrospinal fluid (CSF), blood, and serotonin. Five animals in each injection group were given 1.0 mg/kg intravenous cyproheptadine (a serotonin-blocking agent) during the post-injection period. Subarachnoid injection of artificial CSF produced no change in CBF or arterial caliber. Post-injection administration of cyproheptadine also had no effect on these parameters. A subarachnoid injection of fresh autogenous blood produced a significant but transient (less than 1 hour) decrease in CBF and moderate vasospasm, which lasted at least 3 hours. This vasospasm was essentially unaffected by intravenous cyproheptadine. The CBF and arterial caliber were unchanged following a subarachnoid injection of serotonin at concentrations (5 x 10(-6)M) present in normal monkey serum. In contrast, 5 x 10(-6) M serotonin invariably produced near maximal contractions in the in vitro cerebral artery preparations. Higher (x10) serotonin concentrations caused a transient CBF response similar to that obtained with blood. However, the cerebral vasospasm induced was of shorter duration than that obtained with blood. These results do not support a major role for serotonin in the production of post-subarachnoid hemorrhage vasospasm. Moreover, our data indicate that in vitro experiments do not reflect the ability of serotonin to constrict cerebral arteries in the intact animal.
Animals↗
False negative mammograms causing delay in breast cancer diagnosis.
Eighty patients with negative mammograms and proven breast cancer are described. The incidence of negative mammograms is 5 to 7% of all breast cancer in Northern Alberta. In 30 patients, immediate biopsy because of clinical abnormality, and mastectomy, revealed only 3.3% axillary node involvement. The remaining 50 patients gave a history of finding a lump and then had a negative mammogram. Biopsy was delayed for a mean of 45 weeks. Their incidence of axillary node involvement was 42%. The mean age of both groups of patients was seven to eight years younger than the mean for all breast cancer patients. The implications of such delay on prognosis and survival are obvious. More public and medical education is needed.
Adult↗
Cancer incidence in a religious isolate of Alberta, Canada, 1953-74.
Members of a religious isolate who live in approximately 240 farming colonies in the Canadian prairie provinces and the United States border states were studied. The sect's 6,700 members living in the province of Alberta, Canada, comprise more than 30% of this sect's population of North America. The numbers of their cancer cases ascertained from 1953 to 1974 in Alberta were compared to those expected from Alberta Cancer Registry rates. The overall incidence of registered cases of cancer among the religious isolate's females was significantly less than expected (48 observed, 74.2 expected), and in the males the overall incidence of cancer did not differ from that expected (52 observed, 56.5 expected). Significantly fewer cases of lung cancer than expected were found in males, and significantly fewer cases of carcinoma in situ of the cervix uteri were found in females. Finally, significantly higher incidence of stomach cancer was found in the sect's males. Data on a family with two cases of stomach cancer contributed to this observed excess of stomach cancer.
Adolescent↗
Lack of effect of prednisone administration on bleeding time and platelet function of normal subjects.
The effect of 80 mg prednisone given orally for 2 d on normal and post-aspirin bleeding times and platelet function has been studied in a randomized, multiple cross-over, double-blind controlled trial in 12 normal volunteers. Mean template bleeding times were 6.6 min (placebo/placebo), 5.9 min (prednisone/placebo), 10.0 min (placebo/aspirin) and 8.7 min (prednisone/aspirin). The shortening after prednisone administration was not statistically significant. Prednisone had no effect on platelet glass bead retention nor on platelet aggregation by collagen, adrenalin and adenosine diphosphate. Thus conventional clinical doses of prednisone did not impair platelet function and did not enhance primary haemostatis in normal subjects as measured by the bleeding time.
Adult↗
Cerebral arterial responses to induced hypertension following subarachnoid hemorrhage in the monkey.
Regional cerebral blood flow (rCBF), angiographic cerebral arterial caliber, and cerebrospinal fluid (CSF) pressure were measured in rhesus monkeys to determine the effect of experimentally induced subarachnoid hemorrhage (SAH) on cerebral arterial responses to graded increases in blood pressure. These measurements were also performed in a control group of monkeys subjected to a mock SAH by injection of artificial CSF into the cerebral space. Before subarachnoid injection of blood or artificial CSF, graded increases in mean arterial blood pressure (MABP) to a level 40% to 50% above baseline values had no effect on rCBF. The major cerebral arteries constricted and CSF pressure remained unchanged. Similar responses were observed after injections of artificial CSF. When MABP was increased in animals that had been subjected to subarachnoid injection of blood, rCBF increased and was associated with dilatation of the major cerebral arteries and moderate increases in CSF pressure. These results demonstrate that cerebral arterial responses to increases in blood pressure may be abnormal in the presence of subarachnoid blood. The manner in which abnormal cerebral arterial reactivity, changes in blood pressure, and vasospasm combine to determine the level of cerebral perfusion following SAH is postulated.
Animals↗
Haemorrhagic complications of heparin therapy.
In a prospective trial 76 patients with venous thromboembolism have received intermittent constant-dosage heparin or continuously infused heparin with laboratory control. Frequencies of bleeding were similar in both groups. 32% of all patients bled, 13% severely. Retroperitoneal haemorrhage occurred in 5 patients. Major spontaneous bleeding was commoner in older patients and minor spontaneous bleeding in women. Bleeding was uncommon during the first 2 days of treatment, and its daily frequency was relatively constant thereafter. 21% of surgical wounds and 7% of arterial and venous puncture sites bled. These preliminary results illustrate the hazards of heparin therapy and suggest that bleeding complications are more closely related to duration of therapy, age, sex, and surgical trauma than to method of administration.
Age Factors↗
Complications of cerebral angiography and pneumography.
There were incidences of 0.7% severe and 5.5% mild complications in 1,971 direct puncture carotid angiograms done over a 5-year period. In 1,035 retrograde branchial angiograms, there was a 0.6% incidence of severe, and a 4.7% incidence of mild, complications. Complications tended to increase with increasing age of the patient. Brachial angiography is virtually free of life-threatening complications, and the incidence of neurological sequelae was markedly less than that shown by a comparable analysis of catheter angiography. Of patients undergoing 1,542 fractional pneumoencephalograms, 2 had severe complications.
Adolescent↗
Cerebrovascular responses to subarachnoid blood and serotonin in the monkey.
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Animals↗
City-wide screening for urinary abnormalities in schoolgirls.
Screening for urinary tract infection was carried out in 23,427 schoolgirls, aged 5 to 14 years, using Uricult and, for hematuria, glycosuria and proteinuria using Hema-combistix. Cultures of 10(5) colonies per ml. or more on two occasions were obtained in 2.3% and a positive culture was confirmed by the family physician using standard culture techniques in 82.7% of cases, giving an overall incidence of infection of 1.9%. Fifty-eight percent of these children had no previous history of any urinary tract symptoms. Of the infected group 9.5% had pyelonephritic scarring, 58.7% chronic cystitis and 58.7% urethral stenosis. Two additional cases had unilateral ureteropelvic junction obstruction with hydronephrosis. Reflux occurred in 26.6% of those investigated by voiding cystogram. In 58% of cases the urinary tract infection was not accompanied by significant proteinuria, hematuria or pyuria.Proteinuria was detected on two occasions in 1.6% of the children and confirmed by the family physician in 33% of cases, giving an overall incidence of 0.5%. In this group 9.2% had evidence of pyelonephritic scarring without a positive urine culture.Hematuria was detected on two occasions in 0.6% of the children and was confirmed by the family physician in 53%, giving an overall incidence of 0.3%. Only one case with pyelonephritic scarring was seen in this group.Of the 25 cases with pyelonephritic changes only six had been previously diagnosed radiologically.Four previously unrecognized diabetics were also detected.
Adolescent↗
Diltiazem pharmacokinetics in elderly volunteers after single and multiple doses.
In young healthy volunteers diltiazem does not have linear kinetics between single and multiple doses. Elimination half-life increases and gives AUC's and Cmax higher than those predicted from single dose data. Kinetics of diltiazem were assessed in 16 healthy elderly after a single 60 mg dose and in 24 healthy elderly after 60 mg every 8 h for 7 days. Thirteen participants completed both studies. Elimination half-life, AUC0-24, AUC0-infinity, and Cmax were (mean +/- SE) 7.4 (1.2) h, 349 (34) ng/ml.h, 392 (44) ng/ml.h, and 43 (5) ng/ml respectively after a single dose. After multiple doses elimination half-life, AUC0-48, AUC0-infinity, Cmax and Cmin were respectively 5.7 (0.3) h, 974 (107) ng/ml.h, 1022 (108) ng/ml.h, 102 (7) ng/ml and 43 (5) ng/ml. Exploratory statistics on the 13 volunteers common to both studies showed that the ratio of AUC desacetyl-diltiazem (DAD)/AUC diltiazem rose between single and multiple doses while elimination half-life of both diltiazem and N-desmethyl-diltiazem (MA), tmax, and AUC MA/AUC diltiazem were not affected. The conclusion of this study is that elimination half-life of diltiazem does not increase in elderly between single and multiple doses, possibly due to an increased biotransformation into DAD.
Aged↗
Neonatal encephalopathy: an indicator of early sexual maturation in girls.
Of 161 girls with neonatal encephalopathy who were prospectively assessed until 8 years of age, 7 (4.3%) demonstrated variable degrees of early sexual maturation. This finding was significantly greater than the accepted 0.6%, estimated for the general population. Four of the 7 girls with early sexual maturation had physical disabilities (i.e., 3 with cerebral palsy, 1 neurosensory deafness) which indicated that 10% of the 40 physically disabled girls had early sexual maturation. Three (2.5%) of 121 girls without physical disabilities matured early. Sexual maturation began 5 years or longer after the diagnosis of neonatal encephalopathy. An increased incidence of early sexual maturation in girls with neonatal encephalopathy indicates the importance of long-term follow-up of this population. This study provides an indication of a link between newborn illnesses causing neonatal encephalopathy and early sexual maturation in girls without progressive, structural, intracranial pathology and suggests further study of some girls previously diagnosed as having idiopathic precocious puberty.
Asphyxia Neonatorum↗
Computed tomography of the upper cervical spine in Down syndrome.
Axial CT of the upper cervical spine was performed on 25 Down syndrome patients. Measurements of the degree of atlantoaxial displacement, the sagittal diameters of the spinal canal and spinal cord, thickness of the transverse ligament, and the ratio of sagittal diameter of spinal cord to canal were made. Thirty-six percent of the group showed evidence of cord compression. These patients demonstrated a significant decrease in the anteroposterior diameter of the spinal canal and the cord with an increase in the degree of subluxation and the cord:canal ratio when compared with the remainder.
Adult↗