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Biomedical subjects

P Lawson-Matthew

Publications and source records attributed to P Lawson-Matthew.

6 recordsLinked to original sources
PubMed1999

The normal range for inter-arm differences in blood pressure.

OBJECTIVE: to establish the mean and normal range for the difference in simultaneous systolic and diastolic blood pressure measurements between the right and left arm. SUBJECTS: 462 subjects, age range 20-89 years, in sinus rhythm and with no history of stroke, 98 of whom had a history of cardiovascular disease or were taking vasoactive medication. METHODS: four simultaneous recordings of blood pressure in both arms were made using two automated sphygmomanometers with the subject supine after resting for 10 min. RESULTS: inter-arm systolic and diastolic blood pressure differences show a near normal distribution of values. Some individuals had clinically important differences in systolic and diastolic blood pressure between their arms. The magnitude of these differences was not related to the mean baseline blood pressure. Linear regression analysis did not demonstrate any significant relationship between inter-arm systolic or diastolic blood pressure difference and age in patients of either sex. For systolic blood pressure the mean difference between the right and left arm was 1.1 mmHg and the normal range was -9 mmHg to 11 mmHg. For diastolic blood pressure the mean difference was 0 mmHg and the normal range -10 mmHg to 10 mmHg. CONCLUSION: the frequency of significant inter-arm systolic and diastolic blood pressure differences suggests that the blood pressure should be taken in both arms at the initial consultation. At subsequent visits, the arm in which measurements are taken should be recorded in the case notes. The higher of the two readings should be used to guide further management decisions.

Adult↗
PubMed1996

A comparison of nebulized budesonide with oral prednisolone in the treatment of exacerbations of obstructive pulmonary disease.

Nebulized corticosteroids in acute bronchospasm may offer topical anti-inflammatory activity while minimizing undesirable systemic effects. We compared the side-effect profile of nebulized budesonide (2 mg twice daily) with that of oral prednisolone (30 mg once daily) in a randomized parallel-group study of 19 adults with severe acute airway obstruction. Over the 5 days of the study, baseline forced expiratory volume in 1 second (FEV1) increased from 1.8 (95% confidence interval [CI], 0.7) to 2.1 (95% CI, 0.7) L in the group that received oral corticosteroids compared with 1.9 (95% CI, 0.7) to 2.0 (95% CI, 0.7) L in the group that received nebulized corticosteroid. All biochemical variables were similar at day 1. Comparison of budesonide treatment with prednisolone on day 5 showed that urinary corticosteroid metabolites were significantly higher (2012 [95% CI, 812] compared with 1079 [95% CI, 346] mg/24 hr [p < 0.05]), urinary androgen metabolites were not different, serum osteocalcin was elevated (2.3 [95% CI, 1.4] compared with 0.6 [95% CI, 0.6] ng/ml [p < 0.05]), and 24-hour urinary calcium to creatinine ratios were lower (0.28 [95% CI, 0.1] compared with 0.53 [95% CI, 0.2]), whereas urinary hydroxyproline to creatinine ratios were similar. The biochemical markers associated with corticosteroid side effects improve in patients treated with nebulized corticosteroids compared with patients who receive conventional treatment.

Acute Disease↗
PubMed1994

Combination diuretic treatment in severe heart failure: a randomised controlled trial.

OBJECTIVES: (a) To test the hypothesis that a fixed 3 day course of the combination of a thiazide and loop diuretic is as effective as more prolonged treatment in the management of severe resistant cardiac failure. (b) To compare two thiazide diuretics (bendrofluazide and metolazone) in combination with loop diuretics in the treatment of severe resistant cardiac failure. DESIGN: Randomised study with a 2 x 2 factorial design. SETTING: Provincial teaching hospital. PATIENTS: 33 consecutive patients (40 episodes) admitted with severe congestive cardiac failure (New York Heart Association class III or IV) unresponsive to intravenous loop diuretics for 48 hours. MAIN OUTCOME MEASURES: Change in daily weight and serum electrolytes and clinical improvement in heart failure. RESULTS: Diuresis was established during 37 of 40 episodes; of the rest two patients died in hospital. On 36 occasions improvement was sufficient to allow discharge from hospital. Median (range) maximal weight loss was -5.05 (-11.3 to 1.6) kg after the addition of bendrofluazide and -5.6 (-12.2 to 4.8) kg after the addition of metolazone (NS). Area under the body weight loss against time curves showed no significant difference between the two thiazide diuretics. Median (range) maximal weight loss after three days of treatment was -5.4 (-12.2 to 4.8) kg and -5.5 (-10.3 to 1) kg after a more prolonged course of median (range) 5.6 (1 to 13) days (NS). Area under the body weight loss time curves showed no significant difference between the two durations of treatment. Bendrofluazide was associated with fewer electrolyte disturbances. CONCLUSIONS: Bendrofluazide and metolazone were equally effective in establishing a diuresis in patients with severe congestive cardiac failure resistant to loop diuretics. A fixed three day course of the combination was as effective as a longer course.

Adolescent↗
PubMed1989

Vitamin D metabolism in myeloma.

We measured serum concentrations of vitamin D metabolites in 27 patients with myeloma, 16 of whom were hypercalcaemic. Serum values were compared with values from normal controls. Serum concentrations of calcitriol (1.25-dihydroxyvitamin D; 1.25(OH)2D3) were decreased in both hyper- and normocalcaemic patients, but more markedly so in hypercalcaemia. These findings were not solely due to impaired renal function nor due to an inadequate supply of 25-hydroxyvitamin D, and in hypercalcaemic patients were reversed by diphosphonate treatment. We conclude that hypercalcaemia in myeloma is not mediated by abnormalities in vitamin D metabolism. Decreased serum concentrations of 1.25(OH)2D3 may adversely affect both skeletal and tumour metabolism.

Adult↗