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Biomedical subjects

M Small

Publications and source records attributed to M Small.

At least 91 records · Page 5Linked to original sources
PubMed1990

Oral pefloxacin mesylate in the treatment of continuous ambulatory peritoneal dialysis associated peritonitis: an open non-comparative study.

Twenty-two (15 female and 7 male) patients with continuous ambulatory peritoneal dialysis (CAPD) associated peritonitis were entered into an open non-comparative evaluation of oral pefloxacin mesylate. An initial loading dose of 800 mg was followed by 400 mg twice daily. Five patients were subsequently excluded or withdrawn. The mean age of the patients was 44 +/- 12.6 years. All three Gram-negative infections (Escherichia coli, Acinetobacter calcoaceticus, Serratia liquefaciens) and all three culture negative infections were cured after 21 days treatment. In contrast one of four (25%) Staphylococcus aureus infections was cured, two persisted during treatment and one relapsed, after treatments of between 10 and 25 days. One of seven (14%) Staph. epidermidis infections was cured, three persisted and three relapsed after treatments of between nine and 25 days. Two of the five persistent isolates became resistant: all four relapsed isolates remained sensitive. Twelve of the 22 (55%) patients had 16 side effects, most commonly skin or musculo-skeletal. Three stopped pefloxacin because of them, though one had taken an excessive dose in error. Pefloxacin mesylate is not optimal treatment for Gram-positive coccal peritonitis in patients on CAPD, but its role in Gram-negative disease needs further evaluation.

Administration, Oral↗
PubMed1990

Value of screening thyroid function in acute medical admissions to hospital.

During a 4-month period an audit was performed to assess the value of thyroid function test (TFT) screening of all medical admissions, without known thyroid disease, to a single hospital. Abnormal TFTs were found in 125 of the 630 patients admitted (20%). Carbimazole or thyroxine was started in 13 patients (2.1%) discovered to have thyrotoxicosis (n = 4) or hypothyroidism (n = 9). In only four of these patients was the diagnosis of thyroid disease apparent clinically. The sick euthyroid state was found in 73 patients (11.6%), while the TSH compensated hypothyroid state was detected in 39 patients (6.2%). The low detection rate of new thyroid disease would suggest that unselective screening of all admissions is unjustified. However, the problem of diagnosing thyroid disease and the morbidity of untreated thyroid disease suggests that biochemical screening of TFTs in a selective group of medical patients admitted to hospital may be justified.

Acute Disease↗
PubMed1990

Free radical activity in type 2 diabetes.

Free radical activity has been implicated in the development of diabetic vascular complications in Type 1 diabetes. The aim of the present study was to investigate the levels of free radical scavengers, particularly erythrocyte superoxide dismutase, plasma and erythrocyte lysate thiol, and caeruloplasmin in 22 Type 2 diabetic patients clinically free of complications, and 15 comparable non-diabetic control subjects. The concentration (median (range] of both superoxide dismutase (23 (10-39) vs 45 (25-75) mumol l-1; p less than 0.001) and plasma thiol (374 (172-523) vs 460 (386-595) mumol l-1; p less than 0.01) were reduced in the diabetic group. There were no significant differences in the concentration of erythrocyte lysate thiol (199 (114-520) vs 188 (114-328) mumol l-1) or plasma caeruloplasmin (18 (9-31) vs 24 (6-50) mumol l-1) between the groups. This reduction in superoxide dismutase and the imbalance in the redox status of the plasma and lysate thiol demonstrated is consistent with an increase in free radical activity in Type 2 diabetes.

Blood Glucose↗
PubMed1990

Within-clinic glycosylated haemoglobin measurement.

The performance of the Diamat HPLC analyser (Bio Rad Instruments) was assessed, and the effect of this on-site HbA1 assay on the therapeutic decisions made at the diabetic clinic evaluated. The intra-assay CV for HbA1 at concentrations of 8.3 and 13.4% was 3.8 and 0.4%, respectively, with inter-assay CV of 5.0 and 3.0%. On a single day 82 HbA1 tests on consecutive patients were performed at the clinic. In 43 insulin-treated patients and 79 non-insulin-treated diabetic patients the HbA1 result changed the management decision in 25 and 18% of patients, respectively. The relationship between HbA1 and self blood glucose monitoring (SBGM) results in the previous 6-week period were also evaluated. In 41% of patients with insulin-treated diabetes who produced SBGM diaries there was a discrepancy between categories of blood glucose control, all of these patients having better SBGM than HbA1 values. This study highlights the feasibility and value of a within-clinic HbA1 assay for clinical decision-making and its usefulness in identifying problems of agreement with self-monitored tests.

Autoanalysis↗
PubMed1990

Evaluation of red cell deformability by a filtration method in type 1 and type 2 diabetes mellitus with and without vascular complications.

Previous studies of red cell deformability (RCD) in diabetic patients have produced conflicting results. We have therefore reassessed this problem with the Carri-Med Filtrometer, which measures RCD independently of the rate of clogging of the filter. The initial red cell filtration ratio relative to buffer (mean +/- SD) of 69 diabetic patients (28 type 1 and 41 type 2) was significantly impaired in both type 1 (0.470 +/- 0.047) and type 2 diabetic patients (0.488 +/- 0.065), when compared to 66 non diabetic control subjects (0.540 +/- 0.032; both p less than 0.001). A significant difference in RCD was noted between type 1 and type 2 diabetics (p less than 0.03), but no association with vascular complications was found. No significant correlations were noted between RCD and the duration of diabetes, age, HbA1, leucocyte count, or mean red cell volume. However RCD was inversely related to mean red cell haemoglobin concentration (r = -0.43, p less than 0.01). Diabetics had significantly lower mean red cell volume and significantly higher mean cell haemoglobin concentration than non-diabetics, but these changes could not explain the difference in RCD, which may be related to alterations in the red cell membrane.

Adult↗
PubMed1989

Tissue plasminogen activator inhibition in diabetes mellitus.

Depression of fibrinolysis may be relevant to the vascular complications of diabetes mellitus. Plasminogen activator inhibitor (PAI) is an important inhibitor of fibrinolysis in humans, and we have found basal activities of PA inhibition to be elevated in patients with diabetes compared with a reference group of healthy subjects (mean +/- SD 268 +/- 268 vs. 105 +/- 48%; P less than .0001). With a monoclonal antibody, it was shown that high inhibition values were due to PAI-1. No differences in PA inhibition were noted in relation to type of diabetes, diabetic treatment, or presence or absence of vascular complications. Basal PA inhibition did not correlate with in vivo (B beta 15-42 antigen) or ex vivo (fibrin plate) fibrinolytic activity or HbA1. In patients with non-insulin-dependent diabetes mellitus, treatment with the anabolic steroid stanozolol significantly reduced PA inhibition. These findings suggest a further abnormality of fibrinolysis in diabetes, but the lack of a relationship among other measures of fibrinolysis renders its biologic significance uncertain.

Antibodies, Monoclonal↗
PubMed1989

Client demographics and outcome in outpatient cocaine treatment.

A number of studies have begun to investigate the characteristics of cocaine abusers who are admitted to outpatient cocaine treatment programs. One study has published success rates for such treatment. A review of this literature indicates that much of what is known is based on clinical experience with what may be nonrepresentative samples of upper-middle socioeconomic status Caucasians. More systematic study and more representative samples are needed; the current study attempts to address these issues by sampling 81 clients admitted to a comprehensive outpatient cocaine program in a public agency, assessing demographics and treatment success. The results indicate that this sample is indeed different from those in most recent studies in race, marital status, income, employment, and other demographic variables. For example, the sample in this study included higher percentages of clients who were non-Caucasians, single, blue-collar or unemployed, and had relatively lower annual incomes. Fewer demographic variables than expected correlated with treatment success. Among factors that did correlate with such measures of treatment outcome as continuing in treatment (vs dropping out), percent of sessions attended, and alcohol- and drug-free were educational level, length of abstinence from cocaine prior to beginning treatment, number of previous treatments, secondary substance currently used, and quality of current living situation. Retention in treatment is similar to other published data but indicates that cocaine abusers are indeed difficult to engage and keep in treatment long enough to make a significant impact on their drug use.

Adult↗
PubMed1989

Adrenal androgens in insulin-dependent diabetes mellitus.

The adrenal androgens dehydroepiandrosterone sulphate (DHAS) and androstenedione (A2) are major secretory products of the adrenal gland, although their precise function is unclear. There is limited evidence to suggest adrenal androgen levels may be altered in diabetes, and that insulin secretion may influence these hormones. Therefore we have measured fasting levels of serum DHAS, A2, testosterone, oestradiol (in males only), sex hormone binding globulin (SHBG), HbA1 and C-peptide (basal and glucose stimulated), in 17 post-pubertal, uncomplicated patients with insulin-dependent diabetes mellitus (IDDM), and made comparisons to 17 of their sex and age-matched (to within 5 yr) non-diabetic siblings. Concentrations of the adrenal androgens were within the laboratory normal range in all the subjects and no differences were noted between the diabetics and their siblings or between males and females. No correlations were noted between the hormones and either HbA1 or C-peptide. In contrast to previous reports we have found that C-peptide status does not influence adrenal androgen levels, and that normal concentrations of these androgens are found in non-ketotic patients with IDDM.

Adrenal Cortex Hormones↗
PubMed1989

Drug therapy in patients with diabetes mellitus: an audit.

The drug therapy prescribed for 412 diabetic patients attending an outpatient clinic over a 12 week period was recorded to try and identify potential therapeutic problems. Over 90% of the patients were prescribed at least one drug (including insulin) with oral hypoglycaemic agents prescribed for 86% of non-insulin requiring diabetics. 19% of patients were prescribed more than three drugs and few patients took drug combinations. Of patients prescribed either glibenclamide or chlorpropamide, 63% were aged 65 yr or older. Despite their potential adverse clinical and biochemical effects, diuretics and beta-blockers were commonly prescribed, especially in hypertension. The prescribing of "newer" anti-hypertensive drugs, combination products in patients taking a multiple drug regimen, and the potential dangers of sulphonylureas in the elderly are three areas where alteration of prescribing habits may be of value.

Adrenergic beta-Antagonists↗
PubMed1989

Identification of subpopulations of mouse thymic epithelial cells in culture.

Mouse thymic stromal cells growing in vitro have been stained with fluorescent antibodies to identify the cells found in these cultures. By means of anti-cytokeratin antibody 35 beta H11, it could be shown that nearly all the cells in the cultures were epithelial. Three other antibodies which bind to specific regions of the thymus were used to detect subpopulations of the epithelial cells. Cells growing as confluent carpets stained with antibody ER-TR5, which is specific for medullary epithelium. Antigens for two other antibodies, MD2 (known to label cells at the medullary side of the cortical-medullary junction) and CDR1 (which reacts with cortical epithelium) were expressed on the cultured cells only after the addition of exogenous signals. MD2 antigen was expressed on a very small percentage of the cells incorporated into networks as well as a few dispersed cells, and seemed related to the activity of fibroblasts. CDR1 antigen appeared on the majority of the cells organized into networks and those dispersed in the cultures. Gamma-interferon (IFN-gamma) and IL-2, lymphokines usually associated with T-cell reactivity, were found to be involved in its expression. It was possible to isolate the CDR1 subpopulation from the cultures by means of the antigen present on the surface of these cells.

Animals↗
PubMed1989

Influence of a thymic hormone on cultured epithelial cells of the thymus.

Addition of cortisone to primary cultures of mouse thymic stromal cells resulted in increased growth of medullary epithelial cells while cortical epithelial subpopulations were inhibited or destroyed. These adverse effects on cortical cells were ameliorated by the thymic hormone THF. Because thymocytes are also sensitive to both cortisone and THF we sought to eliminate them from the cultures by deoxyguanosine treatment. This treatment differentiated even more strongly between growth of cortical epithelial cells which were inhibited and medullary epithelium that was very strongly stimulated. These effects are discussed in relation to involution of the thymus with aging.

Animals↗
PubMed1988

Age-related changes in excision repair of cultured epithelial cells from mouse thymus.

These experiments were performed to test the possibility of a link between involution of the thymus and decreased ability to repair damaged DNA. In a previous investigation this was not found to be the case with thymic lymphocytes, and in the present work the question was addressed to epithelial cells of the thymic stroma isolated by growth in tissue culture. DNA repair in the epithelial cells was measured as unscheduled DNA synthesis (UDS) and detected autoradiographically after UV irradiation of the cultures. In cultures derived from older mice, DNA repair was evident in the majority of the cells and continued after extended culture. When cultures were derived from preinvolution mice DNA repair activity, which was detected after short periods of culture, was lost from most of the cells after several days of growth. These unexpected findings raise the possibility that the ability of the stromal cells to repair DNA damage has enabled them to survive a selective pressure that is involved in thymic involution.

Aging↗
PubMed1988

Diabetic ketoacidosis during NovoPen therapy.

To improve flexibility and acceptability of diabetic management five patients (age 15-26 years) were changed to NovoPen therapy (Human Actrapid Insulin 3 x daily + Human Ultratard Insulin at night). Diabetic ketoacidosis developed within 2-4 months of commencing this regimen and in one patient twice in only 4 weeks. All failed to increase their insulin dose in response to hyperglycaemia and two patients omitted insulin when they did not take meals believing this to be appropriate irrespective of the prevailing blood glucose. The NovoPen regimen may increase the risk of diabetic ketoacidosis in patients who do not monitor and control their diabetes assiduously and should not be seen as a solution for poorly motivated or ill-educated patients.

Adolescent↗
PubMed1988

Association of hypertension with blood viscosity in diabetes.

Plasma and whole blood viscosity and its determinants were measured in 86 diabetic patients (29 hypertensive and 57 normotensive) and compared with 52 non-diabetic control subjects to assess whether hypertension has an additive and adverse effect on blood viscosity. Whole blood viscosity (corrected for haematocrit), at high and low shear rates (95 and 0.95 s-1), was significantly higher in both Type 1 (5.1 +/- 0.5 (+/- SD), 19.8 +/- 2.9) and Type 2 (5.2 +/- 0.3, 21.1 +/- 2.0) diabetic patients compared with control subjects (4.9 +/- 0.6, 17.4 +/- 2.6 mPa s, p less than 0.01). Corrected whole blood viscosity at high shear rate was significantly higher in hypertensive than in normotensive Type 2 diabetic patients (5.5 +/- 0.4 vs 5.2 +/- 0.3 mPa s, p less than 0.01). Plasma viscosity was significantly higher in diabetic patients compared with control subjects (1.4 +/- 0.1 vs 1.3 +/- 0.1 mPa s, p less than 0.01), but there was no difference between hypertensive and normotensive diabetic patients (1.4 +/- 0.1 vs 1.4 +/- 0.2 mPa s). Fibrinogen levels were similar in all the groups.

Adult↗
PubMed1988

Thrombin and plasmin activity in coronary artery disease.

Basal plasmin and thrombin activity in plasma were assessed by radioimmunoassay of the fibrinogen derivatives containing the sequence B beta 15-42 and of fibrinopeptide A respectively in a cross sectional controlled study of men with coronary artery disease. Compared with healthy controls (n = 33) men with angiographically defined coronary artery disease (n = 98) had a modest but significant increase in concentrations of fibrinopeptide A, indicating an activated coagulation system. Concentrations of B beta 15-42 were similar in those with coronary artery disease and in the controls. The enhanced thrombin activity in coronary artery disease is in keeping with current evidence suggesting an association between coronary artery disease and a hypercoagulable state.

Adult↗
PubMed1988

Diabetic hyperosmolar non-ketotic decompensation.

To assess whether the outcome of hyperosmolar non-ketotic decompensation has changed in the past 20 years with modern medical management, a retrospective study analysis was performed of all patients presenting with the syndrome to a large teaching hospital during the period 1982 to 1986. Twenty-two patients were identified of whom 68 per cent had no previous history of diabetes mellitus. The immediate mortality rate (within 72 h of presentation) was 36 per cent (eight of 22), the overall mortality rate was 41 per cent (nine of 22) and vascular thromboembolism was common. A comparison was made of the early deaths (n = 8) and survivors (n = 14) in an attempt to identify favourable prognostic factors. The two groups could not be distinguished either by clinical or laboratory variables at presentation nor by treatment regimen; however there was a significant delay in establishing the diagnosis in some of the patients who died. Our results indicate there has been no improvement in the outcome of the hyperosmolar non-ketotic decompensation syndrome in the last two decades and that a high index of suspicion is required to identify patients presenting with this condition.

Aged↗