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Biomedical subjects

M McCredie

Publications and source records attributed to M McCredie.

At least 91 records · Page 5Linked to original sources
PubMed1988

An evaluation of the role of laboratory investigations in establishing a diagnosis of central nervous system lupus.

By means of a questionnaire, we have determined the combination of clinical features and laboratory tests which rheumatologists, nephrologists, immunologists, and neurologists in New South Wales consider most helpful in discriminating between central nervous system (CNS) involvement due to systemic lupus erythematosus (SLE) and that due to other causes. There was a uniformity of views amongst the four specialties in terms of the likelihood that a given clinical presentation was due to active CNS lupus. The clinical presentation made little difference to the interpretation of laboratory data. CNS abnormalities (EEG, CT, and CSF), as well as the finding of serum DNA antibody of 95%, influenced decision-making, although the other serological tests had little impact. There was disagreement amongst physicians as to whether a given test abnormality (e.g. focal CT scan abnormality) supported or rejected the diagnosis of active CNS lupus. This study indicates that physicians interpret test results selectively in their assessment of patients with SLE who develop CNS symptoms.

Brain Diseases↗
PubMed1988

Does paracetamol cause urothelial cancer or renal papillary necrosis?

The risk of developing renal papillary necrosis or cancer of the renal pelvis, ureter or bladder associated with consumption of either phenacetin or paracetamol was calculated from data acquired by questionnaire from 381 cases and 808 controls. The risk of renal papillary necrosis was increased nearly 20-fold by consumption of phenacetin, which also increased the risk for cancer of the renal pelvis and bladder but not for ureteric cancer. By contrast, we were unable to substantiate an increased risk from paracetamol consumption for renal papillary necrosis or any of these cancers although there was a suggestion of an association with cancer of the ureter.

Acetaminophen↗
PubMed1988

Comparison of methylprednisolone (1 g i.v.) with prednisolone (1 g orally) in rheumatoid arthritis: a pharmacokinetic and clinical study.

Methylprednisolone pulse therapy is often used in patients with severe rheumatoid arthritis (RA). To compare clinical and pharmacokinetic variables of methylprednisolone and oral prednisolone in patients with RA, a controlled crossover study was carried out. Pharmacokinetic variables for methylprednisolone were Vd of 69.9 l, t1/2 of 2.96 h, total plasma clearance of 17.5 l/h. Pharmacokinetic variables for prednisolone were Vd of 47.5 l, t1/2 of 3.08 h and total plasma clearance of 11.3 l/h. During the elimination phase, a secondary rise in methylprednisolone concentration occurred which may be related to enterohepatic circulation. Clinical response to both prednisolone and methylprednisolone was short-lived with neither lasting more than 6 weeks.

Arthritis, Rheumatoid↗
PubMed1987

Does colchicine work? The results of the first controlled study in acute gout.

We have performed the first controlled study of colchicine in acute gout, to determine its efficacy and toxicity, and to define the natural history of acute gout. Two-thirds of colchicine-treated patients improved after 48 hours, but only one-third of the patients receiving placebo demonstrated similar improvement. The colchicine-treated patients responded earlier; significant differences from placebo were shown after 18-30 hours. All patients given colchicine developed diarrhea after a median time of 24 hours (mean dose of colchicine 6.7 mg). This side effect occurred before relief of pain in most patients.

Acute Disease↗
PubMed1986

Comparison of nicardipine and propranolol for chronic stable angina pectoris.

In a double-blind, randomized, crossover clinical trial, a new calcium antagonist, nicardipine (90 mg/day in 3 divided doses), was compared with propranolol (120 mg/day in 3 divided doses) in 25 patients with chronic stable angina. The mean weekly frequency of angina episodes decreased from 7.8 +/- 1.2 (+/- standard error of the mean) with placebo to 3.8 +/- 1.2 with nicardipine treatment and 3.5 +/- 1 with propranolol treatment (p less than 0.001). With exercise testing, 5 patients receiving nicardipine and 3 receiving propranolol had no angina or ST-segment changes. Comparing paired samples of both drugs with placebo, significant improvement occurred in exercise duration (nicardipine, 1.3 +/- 0.3 minutes, p less than 0.001; propranolol, 1.0 +/- 0.4 minutes, p less than 0.01), time to onset of angina (nicardipine, 1.5 +/- 0.4 minutes, p less than 0.001; propranolol, 1.5 +/- 0.5 minutes, p less than 0.001), maximal ST-segment changes (nicardipine, 0.7 +/- 0.1 mm, p less than 0.01; propranolol, 0.06 +/- 0.1 mm, p less than 0.01) and time to 1 mm of ST depression (nicardipine, 2.5 +/- 0.4 minutes, p less than 0.01; propranolol, 2.0 +/- 0.3 minutes, p less than 0.01). One patient receiving propranolol and 2 receiving nicardipine withdrew from the study because of transient side effects. Mild side effects occurred in 10 patients receiving propranolol and 5 receiving nicardipine. Nicardipine proved to be safe and effective for patients with chronic stable angina; it had fewer side effects than propranolol in the doses used.

Adult↗
PubMed1986

Phenacetin and papillary necrosis: independent risk factors for renal pelvic cancer.

A case-control study was undertaken to determine whether renal papillary necrosis (RPN) is an essential step in the genesis of analgesic-associated cancer of the renal pelvis (CaP). Kidneys of 66 patients (and 86 cases of renal parenchymal cancer (CaK), for comparison) were examined for evidence of RPN. Information concerning past consumption of phenacetin-containing analgesics (PhA) was obtained from all cases and 751 population controls by means of a questionnaire. Separately, RPN and regular consumption of PhA each conferred a relative risk for CaP of 3-1/2 to 7, while together they increased the risk some 20 times that for non-consumers without RPN. This suggests that each factor has independent, and when they coexist sequential, effects. The risk for CaK was doubled by regular PhA consumption but was not increased by RPN.

Aged↗
PubMed1986

Piroxicam versus naproxen in the treatment of painful shoulder.

A double-blind, parallel trial of 40 patients with chronic shoulder pain was carried out to compare alleviation of pain and improvement in mobility after treatment with 20 mg piroxicam each morning or 250 mg naproxen twice daily. During the 3-week study, patients also underwent conservative treatment of therapeutic exercise. Piroxicam was better than naproxen at relieving pain at night, but time, rather than a drug effect, seemed responsible for the improvement in shoulder abduction. No difference between the drugs was demonstrated regarding their effect on pain on active movement of the shoulder and external rotation.

Double-Blind Method↗
PubMed1986

Pharmacokinetics and effects of isoxicam on renal function in patients with renal insufficiency.

The pharmacokinetics of isoxicam, a new non-steroidal anti-inflammatory drug, were studied in 20 osteoarthritis patients with varying degrees of renal insufficiency. A wide variation in pharmacokinetic parameters was seen between individuals but there was no suggestion that renal function influenced pharmacokinetics. Steady state plasma isoxicam concentrations varied from 20 micrograms/ml to 130 micrograms/ml, while the plasma half-life varied from 23 hours to 58 hours. Despite a reduction in urinary prostaglandin E2 excretion, isoxicam administration did not alter renal function over a 4-week period.

Aged↗
PubMed1985

Rheumatology teaching in Australia: the need for review.

In 1981, questionnaires seeking information about the teaching of medicine in general, and rheumatology in particular, were sent to random samples of undergraduates in Australian medical schools and trainees in the Family Medicine Programme (FMP) of the Royal Australian College of General Practitioners. Neurology rated most highly, with the majority of undergraduates considering it to be well taught and interesting; by contrast, rheumatology was perceived as being badly taught and lacking in interest. Many graduates had never attended rheumatology outpatient clinics either as undergraduates (45%) or as FMP trainees (68%). Only 40% of the graduates had ever been attached to a rheumatology inpatient service, and fewer than 50% had received any teaching about the role of physiotherapists or occupational therapists in the management of patients with arthritis.

Australia↗
PubMed1984

Articular chondrocalcinosis in a hospital population: an Australian experience.

A group of hospital patients aged 55 years or over (53 men, 74 women) were screened for articular chondrocalcinosis (ACC) with high-resolution radiographs of knees, wrists, hand and pelvis. Two men (4%) aged 79 and 86 years had ACC involving knees, wrists and symphysis pubis. Both had clinical joint disease and radiological osteoarthritis (OA). Eighteen women (24%) had ACC with sites affected including the knees (89%), wrists (39%) and symphysis pubis (44%). Metabolic screening did not reveal any predisposing factors in patients with ACC. Symptoms and signs of joint disease were not significantly more common in women with ACC compared to those without ACC, and 44% of those with knee calcification were clinically asymptomatic and had no evidence of OA radiologically. However, the presence of knee ACC significantly increased the risk for OA in the same knee by a factor of three-to-four while knee calcification was associated with the more severe grades of radiographic OA.

Aged↗
PubMed1983

Analgesics and tobacco as risk factors for cancer of the ureter and renal pelvis.

In a case-control study of 36 men with cancer of the ureter and 307 male controls with the same age distribution tobacco smoking conferred a relative risk for this cancer of 2.9, whereas consumption of analgesics of any kind did not increase the risk. The relative risk for cancer of the renal pelvis, determined for 29 men, was 2.4 for tobacco and 6.0 for phenacetin-containing analgesics. Analgesics containing no phenacetin conferred no increased risk for cancer at this site. Data for 13 women with ureteral cancer, 5 of whom had taken phenacetin, are presented but not analyzed.

Aged↗
PubMed1983

Phenacetin-containing analgesics and cancer of the bladder or renal pelvis in women.

In a case-control investigation of 154 women with cancer of the bladder and 440 female population controls spanning the same age range, the relative risk for this cancer was 2.6 in consumers of phenacetin-containing analgesics and 2.7 in tobacco smokers. The relative risks for cancer of the renal pelvis, determined for 31 cases, were 5.4 with phenacetin and 4.7 with tobacco. Increasing consumption of either agent increased the risk for cancer at each of the two sites, while a synergistic rather than purely additive effect was apparent when both phenacetin-containing analgesics and tobacco had been taken. Consumption of analgesic preparations which contained no phenacetin did not increase the risk of developing cancer at either site. The evidence indicates that phenacetin is a clinically important carcinogen for the lower as well as for the upper urinary tract.

Adult↗
PubMed1982

Analgesics and cancer of the renal pelvis in New South Wales.

A lifetime history of analgesics and tobacco consumption was obtained by a questionnaire completed at interview from 67 patients with carcinoma of the renal pelvis (40 women, 27 men) and 180 control subjects drawn from two sources, friends of patients and persons attending a health screening clinic. Regular consumption of analgesics conferred a tenfold relative risk of renal pelvic cancer in women and in men a risk ratio of 4-8. The fraction of cases for which analgesic consumption was an attributable risk was 0.74 in women and 0.43 in men. The effect of tobacco, much less than that of analgesics, was significant only in women (risk ratio approximately four; attributable risk 0.4), and no dose-response relationship was demonstrated. Relative excess risks suggested a synergistic effect when both analgesics and tobacco had been consumed. Standardized risk ratios indicated a dose-response relationship for both phenacetin-containing and non-phenacetin analgesics: moderate consumption doubled the risk of renal pelvic cancer, and heavy consumption increased at risk to 6-16 times that for noncomsumers.

Age Factors↗
PubMed1982

Is phenacetin responsible for analgesic nephropathy in New South Wales?

A lifetime history of analgesic consumption was recorded at interview from 91 patients (11 men, 80 women) with a secure diagnosis of renal papillary necrosis, 38 patients (5 men, 33 women) with probable renal papillary necrosis and 223 control subjects from two sources. Consumption of phenacetin-containing analgesics increased the risk of renal papillary necrosis in women some seventeen times over that for non-consumers, but analgesics containing no phenacetin did not confer an increased risk of renal papillary necrosis; in both calculations the confounding effect of taking the other type of analgesic was controlled.

Adult↗