Light relief for a heavy workload.
Explore the source record for details and available documents.
Biomechanical Phenomena↗
Biomedical subjects
P Crockford
Publications and source records attributed to P Crockford.
Comparison of the short term efficacy and tolerability of lovastatin and simvastatin in the management of primary hypercholesterolemia.
OBJECTIVES: To compare the safety and efficacy of lovastatin and simvastatin in patients with primary hypercholesterolemia. METHODS: Fourteen Canadian centres participated in this double-blind, randomized, parallel-design study with a six-week screening period, a four-week placebo baseline period and an 18-week active treatment period. Patients were included in the study if their total cholesterol (TC) was at least 6.2 mmol/L and total triglycerides (TG) were 4.0 mmol/L or less at baseline. Half of the patients were in stratum I (TC 6.2 to 7.8 mmol/L at baseline and placebo period) and half in stratum II (TC greater than 7.8 mmol/L). The initial dose of lovastatin or simvastatin (20 and 10 mg/day, respectively) was doubled if the patient's cholesterol was greater than 5.2 mmol/L after six and/or 12 weeks, to a maximum of 80 mg/day lovastatin or 40 mg/day simvastatin. Of 298 randomized patients, two had baseline data only (and were excluded from the efficacy analysis), while 77 were treated with lovastatin and 74 with simvastatin in stratum I, and 72 were on lovastatin and 75 on simvastatin in stratum II. RESULTS: In stratum I, both lovastatin and simvastatin lowered TC (-26.0% in both the lovastatin and simvastatin groups), low density lipoprotein (LDL) cholesterol (-33.4% in lovastatin and -34.4% in simvastatin), TG (-11.4% in lovastatin and -16.2% in simvastatin), apolipoprotein (apo)-B (-24.8% in lovastatin and -26.3% in simvastatin) and the TC:high density lipoprotein (HDL) cholesterol ratio (from 6.65 to 4.73 in lovastatin and from 6.45 to 4.46 in simvastatin), and increased HDL cholesterol (+3.6% in lovastatin and +7.8% in simvastatin) and apo-A1 (+6.3% in lovastatin and +9.0% in simvastatin) with P < 0.001 in all within-group tests except for HDL cholesterol (P < 0.05). Similar results were obtained in stratum II for TC (-30.7% in lovastatin and -30.3% in simvastatin), LDL cholesterol (-37.6% in lovastatin and -36.8% in simvastatin), TG (-21.9% in lovastatin and -16.9% in simvastatin), apo-B (-32.0% in lovastatin and -31.7% in simvastatin), TC:HDL cholesterol ratio (from 8.62 to 5.47 in lovastatin and from 8.96 to 5.77 in simvastatin), HDL cholesterol (+9.7% in lovastatin and +7.5% in simvastatin) and apo-A1 (+7.2% in lovastatin and +8.8% in simvastatin), with P < 0.001 in all within-group tests. Serious adverse events (clinical and laboratory) were reported in four patients in the lovastatin group and three in the simvastatin group. The most reported nonserious adverse effects were gastrointestinal tract (15 patients in the lovastatin group and 16 in the simvastatin group) and musculoskeletal (14 patients in the lovastatin group and 11 in the simvastatin group). Medication was withdrawn in eight patients. CONCLUSIONS: Both lovastatin and simvastatin were found to be effective and well tolerated in each stratum. However, there were no significant differences between lovastatin and simvastatin in the treatment of moderate or severe primary hypercholesterolemia.
Anticholesteremic Agents↗
A skills programme for preclinical medical students.
An education programme in which preclinical medical students are introduced to common procedural skills is described. This programme is presented by a multidisciplinary health care team using short lectures, demonstrations, mannequin practice, and, in selected instances, practice on class-mate volunteers. The programme was evaluated by the students immediately following the presentation and for one class during their clinical activities one year later. The students' support for this programme was generally enthusiastic and remained undiminished upon reflection 12 months later.
Attitude of Health Personnel↗
Effect of stimulation of left atrial receptors on the concentration of adrenocorticotropic hormone (ACTH).
The effect of stimulating atrial receptors on the concentration of ACTH in jugular venous blood was examined in dogs anaesthetized with chloralose. The atrial receptors were stimulated by stretching the pulmonary vein-atrial junctions and the atrial appendage. In 13 experimental runs in 9 dogs, it was found that the concentration of ACTH fell in 11 and remained unchanged in 2. The average concentration during control periods was 76.5 +/- 13.6 (pg/ml) and that during stimulation was 60.0 +/- 11.8 (pg/ml). This difference was statistically significant (p less than 0.05; 2 tailed t test). Cutting (2 dogs) or cooling the cervical vagi (3 dogs) abolished this response. It is concluded that stimulation of left atrial receptors reduces the concentration of ACTH in plasma.
Adrenocorticotropic Hormone↗
Effects of dietary manipulation on vascular status of patients with peripheral vascular disease.
In a one-year, double-blind clinical trial, 45 patients with peripheral vascular disease (PVD) were randomly assigned to either the American Heart Association Hyperlipidemia Diet C (n = 20) or a low-fat, high-fiber, complex carbohydrate diet similar to the Pritikin Maintenance Diet (n = 25). Vascular status and blood lipid levels were monitored at 0, 2, 4, 6, and 12 months. Walking distance increased significantly in both groups, with no difference between groups. No vascular parameters changed significantly, suggesting that increased walking distance was due to improved metabolic capacity of the muscle. A trend toward lower blood lipid values was observed, with no significant differences within or between groups. We conclude that while patients with PVD benefit from a program of diet and exercise, there is no apparent advantage to the more difficult complex carbohydrate diet.
Aged↗
Galactorrhea after prolonged traumatic coma: case report.
A 17-year-old girl suffered a traumatic acute subdural hematoma and rib fractures after a motor vehicle accident. Prolonged coma resulted, and significant galactorrhea began 4 weeks after the accident. The galactorrhea was treated successfully by the administration of 2-bromoergocryptine. The pathophysiology of this condition is discussed.
Adolescent↗
Acromegaly, the systolic click syndrome, and group D streptococcal endocarditis.
A syndrome consisting of an apical systolic click and late systolic murmur appeared over a period of three months in a patient with acromegaly. Levels of growth hormone were highest during this interval. As a result of group D streptococcal endocarditis three months later, the patient sustained cerebral embolism and acquired free mitral regurgitation from ruptured chordae tendineae. During follow-up over 18 months, neither the level of growth hormone nor the degree of mitral regurgitation changed significantly.
Acromegaly↗