Biomedical subjects

Michael J McLean

Publications and source records attributed to Michael J McLean.

5 recordsLinked to original sources

PubMed2006

Consensus guidelines: treatment planning and options. Diabetic peripheral neuropathic pain.

Despite the number of patients affected by diabetic peripheral neuropathic pain (DPNP), little consensus exists about the pathophysiology, best diagnostic tools, and primary treatment choices. Theories about the causes of DPNP are inextricably linked with the causes of diabetic neuropathles, yet most patients with such neuropathies do not experience pain. The factors that differentiate patients with pain from those without remain unknown and are the subject of much research. When choosing treatment for patients with DPNP, physicians are confronted with a myriad of choices, none of which has been shown to be effective for all patients. This article reviews the evidence for these treatments and attempts to guide physicians in choosing those treatments based on evidence from well-designed clinical trials to support their use. Two agents, duloxetine and pregabalin, are formally approved by the Food and Drug Administration for the treatment of DPNP. In addition, several other agents, including the tricyclic class of antidepressants, have been effective in clinical trials. Ultimately, treatment choice must also Include consideration of adverse effects, individual patient factors such as comorbidities, and often cost.

Analgesics, Opioid↗

PubMed2006

Diabetic peripheral neuropathic pain: case studies.

Three case reports in this article illustrate the diagnostic methods used and the treatment course encountered for many patients with diabetic peripheral neuropathic pain (DPNP). Each case addresses an aspect of DPNP: pain that appears to be refractory to initial therapy, DPNP occurring with other medical conditions, and nondiabetlc neuropathy occurring in patients with diabetes mellitus. Together, these cases bring clarity to the confusing clinical experience for patients who have decreased sensation in combination with burning pain, and they apply the consensus guidelines for DPNP. Recently approved medications by the Food and Drug Administration for the treatment of DPNP offer hope for many patients whose pain was thought to be refractory to treatment.

Aged↗

PubMed2005

Devices for gradient static magnetic field exposure.

We describe devices designed for magnetic field exposures in which field amplitude and gradients are controlled simultaneously. Dosimetry based on field continuation of high resolution magnetic field scans and numerical models is compared with validation measurements. The dosimetry variables we consider are based on the assumption that the biological or chemical system under study has field transducers that are spatially isotropic, so that absolute field amplitude and two gradient components fully describe local exposure.

Cell Culture Techniques↗

PubMed2003

Gabapentin dosing in the treatment of epilepsy.

BACKGROUND: Gabapentin is considered a safe and well-tolerated antipileptic drug (AED) with a favorable pharmacokinetic profile and a broad therapeutic index. However, recent studies have used higher doses and faster titration schedules than those used in the pivotal trials that established the efficacy of gabapentin in the treatment of partial seizures. OBJECTIVE: The purposes of this review were to assess the gabapentin titration and dosing regimens that have been published in peer-reviewed journals, to develop dosing recommendations to maximize antiseizure efficacy without compromising tolerability, and to formulate guidelines for an adequate therapeutic assessment of gabapentin dosage efficacy. METHODS: In the absence of sufficient placebo-controlled, double-blind studies, a formal evidence-based assessment could not be performed. However, a MEDLINE search using the search terms gabapentin and epilepsy, spanning back to the year 1986, produced numerous published reports from randomized, placebo-controlled and open-label trials, as well as case reports. These were reviewed to assess the range of dosing and titration schedules reported. Reports that employed gabapentin doses and titration schedules were selected for review. RESULTS: Our review of this literature suggests improved seizure control at higher gabapentin maintenance dosages (< or =3600 mg/d) than are used today in clinical practice (1800 mg/d) without an increase in the incidence of adverse reactions. Most of the patients who received high dosages (eg, 3600 mg/d) or experienced fast titration rates tolerated gabapentin well. Side effects occurred around the onset of dosing and were reported in some studies to be transient. CONCLUSIONS: Based in the literature here, in most adult patients, gabapentin may be initiated at a dosage of 900 mg/d and titrated to maintenance dosages > or = 3600 mg/d. Children may be treated with gabapentin 23 to 78 mg/kg per day. Based on controlled and open trials, the majority of patients will tolerate gabapentin well enough for an adequate therapeutic assessment. Titration to effect can be accomplished rapidly, if necessary; however, as with other AEDs, optimal seizure control may take months to achieve.

Acetates↗

PubMed2002

Effects of non-uniform static magnetic fields on the rate of myosin phosphorylation.

The effect on myosin phosphorylation from exposure to a magnetic field generated by an array of four permanent magnets was investigated. Two lateral positions in the non-uniform field over the array were explored, each at four vertical distances over the surface of the device. The rate of myosin phosphorylation was found to depend on the position laterally over the array as well as the distance from the device surface. The square magnet array was comprised of axially magnetized, cylindrical NdFeB permanent magnets arranged with poles of alternating polarity in a plane (MagnaBloc trade mark therapeutic device). Detailed dosimetry of the magnet array was compiled: the magnetic flux density averaged over the exposure volume spanned the range 0.7-86 mT for the eight different exposure positions. The corresponding range for the absolute field gradient was 0.4-20 T/m. Comparing the dosimetry to the experimental outcome, our results imply that magnetic field amplitude alone is not sufficient to describe the influence of the field in this preparation.

Animals↗