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Biomedical subjects

P Leslie

Publications and source records attributed to P Leslie.

At least 19 recordsLinked to original sources
PubMed2006

Fibreoptic endoscopic evaluation of swallowing and videofluoroscopy: does examination type influence perception of pharyngeal residue severity?

OBJECTIVES: The aim of the study was to investigate whether the type of instrumental swallowing examination (Fibreoptic Endoscopic Evaluation of Swallowing (FEES) or videofluoroscopy) influences perception of post-swallow pharyngeal residue. DESIGN: Prospective, single-blind assessment of residue from simultaneous videofluoroscopy and FEES recordings. All raters were blind to participant details, to the pairing of the videofluoroscopy and FEES examinations and to the other raters' scores. SETTING: Tertiary specialist ENT teaching hospital. PARTICIPANTS: Fifteen adult participants consecutively recruited; seven women and eight men aged between 22 and 73, mean age 53. All participants underwent one FEES examination and one videofluoroscopy examination performed simultaneously. INCLUSION CRITERIA: referred to speech and language therapy for assessment of dysphagia. EXCLUSION CRITERIA: nil by mouth or judged to be at high risk of aspiration. MAIN OUTCOME MEASURES: The FEES and videofluoroscopy examinations were recorded simultaneously. Fifteen speech and language therapists independently scored pharyngeal residue as none, coating, mild, moderate or severe. All examinations were scored twice by all raters. RESULTS: Intra- and inter-rater agreement were similar for both examinations. There were significant differences between FEES and videofluoroscopy pharyngeal residue severity scores (anova, P < 0.001). FEES residue scores were consistently higher than videofluoroscopy residue scores. CONCLUSIONS: Pharyngeal residue was consistently perceived to be greater from FEES than from videofluoroscopy. These findings have significant clinical implications as FEES and videofluoroscopy findings are used to judge aspiration risk and to make recommendations for oral intake. Further research is required to examine the impact of FEES and videofluoroscopy examinations on treatment decisions.

Adult↗
PubMed1989

Alkaline phosphatase isoenzymes in plasma in hyperthyroidism.

Alkaline phosphatase (ALP; EC 3.1.3.1) isoenzymes were measured in the plasma of 63 untreated hyperthyroid patients (the hyperthyroid group), 58 treated hyperthyroid patients, and 100 blood donors. Total, liver, and bone ALP activities were significantly higher in the hyperthyroid group than in the treated hyperthyroid group or the blood donors. Bone ALP was more frequently and more markedly abnormal than liver ALP. Intestinal ALP did not differ significantly between the groups. The hyperthyroid patient group had significantly higher plasma calcium concentrations and lower serum parathyrin concentrations than those of the treated hyperthyroid group.

Adult↗
PubMed1988

Psychiatric morbidity and social problems in patients with insulin-dependent diabetes mellitus.

A two-stage screening strategy was used to study psychiatric morbidity and social problems in a consecutive series of out-patients with insulin-dependent diabetes mellitus. The prevalence of psychiatric morbidity was 18%, and consisted of depression, anxiety, and attendant symptoms. Patients reporting major social problems had significantly higher levels of psychiatric symptoms. Psychiatric morbidity was not associated with the presence of complications of diabetes.

Adult↗
PubMed1988

Heterogeneity of noradrenergic thermic responses in obese and lean humans.

The thermic response to noradrenaline infusion was measured by indirect calorimetry in 40 newly referred obese subjects and 19 lean controls. A marked variation in response was found, more so in the obese than in the lean. In the lean group the lowest noradrenergic thermic response was 12.8 kJ but in the obese group 26 per cent had a thermic response less than this. When the thermic response to noradrenaline is expressed as a percentage of the resting metabolic rate the response was significantly (P less than 0.002) lower in the obese, 8.5 (s.d. 6.0) per cent compared with 13.8 (s.d. 5.1) per cent in the lean. The lowest value in the lean group was 7.8 and 42 per cent of the obese group had lower values. The thermic responses in the obese group did not correlate with glucose:insulin ratios measured both fasting and in response to oral glucose, or with the cumulative rises of either free fatty acids or glycerol during the noradrenaline infusion. Hence the majority of obese subjects have a 'normal' response to infused noradrenaline, but there is a subgroup who do have a blunted response. This may explain to some extent the conflicting reports in the literature regarding the presence of otherwise of a thermic defect in obesity.

Adult↗
PubMed1987

Psychiatric disorder in patients with insulin-dependent diabetes mellitus attending a general hospital clinic: (i) two-stage screening and (ii) detection by physicians.

Two-stage screening for psychiatric disorder was carried out with a sample of 99 male and 95 female outpatients with insulin-dependent diabetes mellitus, using the General Health Questionnaire and the Clinical Interview Schedule. The estimated prevalence of psychiatric disorder in this sample was 18%: only 28% of the psychiatric morbidity so identified was detected by physicians. In contrast, physicians rated 10% of the sample as psychiatric 'cases' using a simple 6-point scale.

Adaptation, Psychological↗
PubMed1987

Energy expenditure in non-insulin dependent diabetic subjects on metformin or sulphonylurea therapy.

In the management of the non-insulin dependent diabetic patient, metformin often facilitates weight loss whereas sulphonylurea may predispose to weight gain. To investigate whether this is due to alterations in energy expenditure we have studied energy expenditure in seven non-insulin dependent diabetic subjects while on metformin or sulphonylurea therapy. Three components of energy expenditure were measured by indirect calorimetry, namely resting metabolic rate and the thermic responses to infused noradrenaline and to a mixed constituent meal. There was no significant difference in the resting metabolic rate on metformin (5.29 +/- 0.41 kJ/min; mean +/- SE) compared with sulphonylurea (5.34 +/- 0.34 kJ/min). The resting metabolic rate was also similar to predicted values for non-diabetic subjects (r = 0.96). The thermic response to infused noradrenaline was similar on metformin (23.14 +/- 1.87 kJ) and sulphonylurea (21.40 +/- 2.98 kJ). There was no significant difference in the thermic response to the meal on sulphonylurea (75.8 +/- 7.5 kJ) or on metformin (86.8 +/- 10.8 kJ; 95% confidence limits -17 to +39 kJ). We conclude that in non-insulin dependent diabetic subjects metformin does not enhance energy expenditure overall, compared with sulphonylurea.

Adult↗
PubMed1986

Effect of optimal glycaemic control with continuous subcutaneous insulin infusion on energy expenditure in type I diabetes mellitus.

To assess the role of insulin in the control of body weight energy expenditure was measured by indirect calorimetry in eight patients of normal weight with type I diabetes initially while poorly controlled during conventional insulin treatment and later during optimal glycaemic control achieved by using the continuous subcutaneous insulin infusion pump. Their response to seven days of fat supplementation was also assessed and the results compared with those in eight non-diabetic subjects. After a mean of 5.3 months of continuous subcutaneous insulin infusion the diabetic subjects had gained on average 3.5 kg. In the poorly controlled diabetic state the resting metabolic rate was raised but decreased by a mean of 374 kJ (90 kcal) per 24 hours with optimal glycaemic control. The thermic response to infused noradrenaline was reduced by 59% in the diabetic subjects, was not improved by continuous subcutaneous insulin infusion, but was improved when three of the subjects were given metformin in addition. The diabetic subjects had no abnormality in the thermic response to a meal while taking their usual diabetic diet. During fat supplementation, however, this thermic response was reduced when glycaemic control was poor but not when control was precise. Fat supplementation did not alter the resting metabolic rate or the reduced noradrenergic thermic response in the diabetic subjects. These findings suggest that precise glycaemic control could produce weight gain if energy intake remained unaltered, for diabetic subjects do not compensate for the decrease in metabolic rate by an increase in noradrenergic and dietary thermic responses. Also precise glycaemic control using continuous subcutaneous insulin infusion does not correct all the metabolic abnormalities of diabetes mellitus.

Adult↗
PubMed1986

Diminution in energy expenditure during lactation.

Energy expenditure at rest and in response to a meal and to an infusion of noradrenaline was measured in 12 lactating women and compared with that in seven bottle feeding women and seven non-pregnant, non-lactating controls. The energy response of the lactating women was remeasured after lactation stopped. During lactation the resting metabolic rate was unaltered but there was a reduced response to infusion of noradrenaline and to a meal, which increased to normal control values after lactation stopped. Such reductions in expenditure were not found in women who had been bottle feeding and were tested at a similar six to eight weeks post partum. These findings suggest that metabolic efficiency is enhanced in lactating women, who may not need to increase energy intake to the extent suggested by current recommended dietary allowances.

Adult↗
PubMed1985

Late results of valve replacement and factors influencing survival in patients with severe chronic mitral regurgitation.

Between July 1967 and September 1981 50 patients with isolated severe mitral regurgitation underwent mitral valve replacement. There were 29 males and 21 females (mean age 52 years). The aetiology of the valve lesion was rheumatic in 14 patients (mean age 42 years) and non-rheumatic in 36 patients (mean age 56 years). At the time of operation 36 patients (72%) were in class 3 or 4 of the New York Heart Association classification (mean duration of symptoms 20 months). Pre-operative ejection fraction was normal in only four patients (8%) and was below 0.50 in 27 patients (54%). There were two early deaths (4%) within one month of operation, and 17 late deaths (34%) during a follow-up period of four months to 10 years (mean 43 months). Actuarial analysis showed a 71% survival at five years and a 62% survival at 10 years after valve replacement. Of the 31 current survivors, 22 (71%) are in class 1 of the New York Heart Association classification, and all but two patients showed significant improvement in symptoms. Significant morbidity after operation occurred in 10 patients (20%) and was largely related to problems with anticoagulant control. Analysis of factors which may influence survival, showed that age greater than 55 years and parameters of left ventricular geometry, demonstrated by angiography, were the major determinants of survival.

Adult↗
PubMed1985

The characterization and energetic potential of brown adipose tissue in man.

In adult man, brown fat can be detected in perinephric fat depots by visual inspection, electron microscopy and nucleotide binding to the tissue-specific uncoupling protein. The 32 kDa uncoupling protein is functionally active, showing a nucleotide-sensitive conductance to protons and an uncoupling response to fatty acids. The amount of uncoupling protein in human mitochondria is equivalent to that in a partially cold-adapted guinea pig, indicating some potential for thermogenesis. Respiratory capacity measurements indicate that the total perinephric fat in adult man can only account for one-fivehundredth of the whole-body response to infused noradrenaline. Thus, although brown fat has been found to be quantitatively important in animal studies, considerable caution must be exercised in extrapolating its significance to adult man.

Adipose Tissue, Brown↗
PubMed1985

Haemodynamic adaptation to exercise in asymptomatic patients with severe aortic regurgitation.

Thirty-six patients with severe aortic regurgitation and 10 normal subjects underwent radionuclide angiography to examine the cardiovascular adaptations to exercise. Patients were sub-divided into four groups based on the directional change of ejection fraction with exercise. Group A (15 patients) showed normal ejection fraction at rest and peak exercise (0.65 +/- 0.05 and 0.73 +/- 0.06 respectively). Group D (six patients) showed significant abnormalities in left ventricular function at rest with further deterioration during exercise (0.44 +/- 0.09 to 0.35 +/- 0.07 respectively). In patients with good left ventricular function left ventricular end-diastolic and end-systolic volume decreased progressively with exercise and at peak exercise end-systolic volume was within normal limits. In patients with poor left ventricular function both end-diastoic and end-systolic volume progressively increased with exercise. Both net and total stroke volume were significantly higher at rest in patients with normal left ventricular function but net stroke volume increased with exercise only in those with good myocardial function and was quantitatively similar to that seen in normal subjects. The severity of aortic regurgitation as judged by regurgitant fraction was reduced during exercise in all except four patients, by an average of 22% in all groups. The major factor determining increasing cardiac output with exercise was found to be the status of myocardial function. Although reduction in the severity of aortic regurgitation may favourably influence distribution of stroke volume in those with normal myocardial function, it failed to contribute significantly to increasing cardiac output in those with poor left ventricular function.

Adolescent↗
PubMed1984

Immunity in the female genital tract after intravaginal vaccination of mice with an attenuated strain of herpes simplex virus type 2.

Herpes simplex virus type 2 is a common human venereal pathogen which causes lethal neurological illness after intravaginal inoculation into BALB/cJ mice. To investigate whether an attenuated, nonlethal strain of this virus would confer immunity after inoculation of mice, we constructed a strain containing a partial deletion of the thymidine kinase gene, which is necessary for viral replication and spread in sensory ganglia. Unlike its wild-type counterpart, this deletion-containing strain of herpes simplex virus type 2 caused mild clinical disease and was not lethal when studied in an age-dependent murine model of intravaginal infection. Furthermore, after intravaginal infection, the deletion-containing strain could not be isolated from sensory ganglia at a time when wild-type virus was abundant. Of greater significance, intravaginal inoculation with the deletion-containing strain rendered mice completely resistant to rechallenge with a 10-fold 50% lethal dose of wild-type virus. These results suggest that a strain of herpes simplex virus type 2 containing a deletion of the thymidine kinase gene will be useful in studying the cellular basis of mucosal immunity in the genital tract.

Animals↗