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Biomedical subjects

P S Klimiuk

Publications and source records attributed to P S Klimiuk.

At least 19 recordsLinked to original sources
PubMed1997

The use of hormone replacement therapy in women with acute myocardial infarction: an audit of current practice.

We undertook criterion-based audit of the current practice of prescribing hormone replacement therapy for women with acute myocardial infarction; the audit included 181 consecutive women admitted to one hospital with this diagnosis in one calendar year. The set standard was that, barring any contraindication, all postmenopausal women with acute myocardial infarction should be prescribed hormone replacement therapy before discharge from hospital. The evidence base of this standard derives from more than 30 epidemiological and clinical studies and a large body of biological data. Only 4.7% of the women were current users of hormone replacement therapy and the set standard was met in only 3% of eligible nonusers. Professionals caring for women who have had a myocardial infarction need to consider hormone replacement therapy as a secondary prophylaxis of myocardial infarction. Gynaecologists should liaise with colleagues in other specialties and general practice to ensure that information on the nongynaecological benefits of hormone replacement therapy is widely disseminated.

Adult↗
PubMed1992

A double blind placebo controlled trial of recombinant tissue plasminogen activator in the treatment of digital ischemia in systemic sclerosis.

The treatment of digital ischemia in systemic sclerosis remains inadequate. We report a double blind, placebo controlled trial of recombinant tissue plasminogen activator (rtPA), a potent thrombolytic agent. Ten patients received rtPA. A potent, acute fibrinolytic effect was observed. During the infusion of rtPA, improvements in skin blood flow were seen. These improvements were shortlived.

Adolescent↗
PubMed1991

In vitro platelet aggregability studies: lack of evidence for platelet hyperactivity in systemic sclerosis.

Systemic sclerosis is characterised by vascular endothelial damage. Platelets adhering to the exposed subendothelium may contribute to the inflammatory changes found in the vessel wall. Increased in vitro platelet aggregability in systemic sclerosis has been reported. In vitro platelet aggregation of platelet rich plasma obtained from patients with systemic sclerosis (CREST (calcinosis, Raynaud's phenomenon oesophageal dysmotility, sclerodactyly, telangiectasia) variant) and from controls matched for age and sex was compared. Collagen, ADP, and platelet activating factor were used as aggregating agents. The actions of a platelet activating factor antagonist, BN52063, were also examined. Each agonist caused dose dependent platelet aggregation; there was no difference in either rate of primary aggregation or maximum percentage aggregation between platelets derived from patients with systemic sclerosis and from the control group (analysis of variance). BN52063 was shown to be a dose dependent, competitive antagonist of platelet aggregation induced by platelet activating factor; there was no difference in its action on platelets derived from patients with systemic sclerosis or controls. These results do not support the hypothesis that platelets from patients with systemic sclerosis are hyperactive and may explain the disappointing results obtained with antiplatelet drugs in systemic sclerosis.

Adenosine Diphosphate↗
PubMed1989

Platelet serotonin in systemic sclerosis.

Platelet serotonin concentrations were measured in 43 patients with systemic sclerosis, in 11 patients with primary Raynaud's phenomenon, and in 38 normal controls. Patients with the CREST variant (calcinosis, Raynaud's phenomenon, oesophageal dysmotility, sclerodactyly, telangiectasia) had significantly lower platelet serotonin concentrations than normal controls. Patients with diffuse systemic sclerosis had normal platelet serotonin concentrations. In patients with CREST treatment with ketanserin, a specific serotonin antagonist, normalised platelet serotonin concentrations. These data provide further evidence suggesting that in systemic sclerosis, particularly the CREST variant, there is widespread platelet activation.

Adult↗
PubMed1989

Ketanserin: an effective treatment regimen for digital ischaemia in systemic sclerosis.

We have studied the therapeutic effects of ketanserin, a specific serotonin antagonist, on digital ischaemia in 11 patients with the CREST syndrome of systemic sclerosis. Ketanserin was administered as a bolus of 10 mg intravenously, followed by an infusion over 72 h and then oral therapy. Skin blood flow as measured by thermography, bolometry, ultrasound Doppler pulses and laser light scattering, showed significant improvement. There was also marked clinical improvement with a reduction in the pain and healing of digital ulceration. These improvements were maintained on oral therapy. In 7 patients detailed studies were performed comparing oral and intravenous ketanserin therapy. When ketanserin was administered as a bolus 10 mg intravenous dose, followed by an infusion at 2 mg/h, steady state was reached by 12 h. Following oral treatment (40 mg tds) therapeutic blood levels were achieved.

Administration, Oral↗
PubMed1988

Autonomic neuropathy in systemic sclerosis.

Autonomic function assessed by tests of cardiovascular reflexes was studied in 25 patients with systemic sclerosis and 10 patients with primary Raynaud's phenomenon. A comparison was made with 13 normal healthy subjects. Significant abnormalities in the cardiovascular reflexes were found in systemic sclerosis, both in the CREST (calcinosis, Raynaud's phenomenon, oesophageal dysmotility, sclerodactyly, telangiectasia) variant and also in those patients with diffuse involvement. There was sympathetic and parasympathetic dysfunction. These findings suggest that autonomic neuropathy is a feature of systemic sclerosis.

Adult↗
PubMed1988

Failure of intraarticular ceftazidime in a patient with Pseudomonas aeruginosa septic arthritis.

This report describes a patient with Pseudomonas aeruginosa septic arthritis who received ceftazidime by the intravenous and intraarticular routes. Concentrations of ceftazidime in the synovial fluid following both routes of administration were measured and found to be above the minimum inhibitory concentration. Despite this the organism was not eradicated. We were unable to find other literature describing the disposition of ceftazidime in synovial fluid and therefore this single-patient study provides novel information. We were unable to account for the apparent failure of therapy.

Arthritis, Infectious↗
PubMed1987

Gold-induced hypogammaglobulinaemia.

Panhypogammaglobulinaemia has recently been recognized as a rare complication of gold toxicity. We report two further cases of gold-induced hypogammaglobulinaemia which also demonstrated that monitoring of immunoglobulin levels is necessary for the early detection of this condition.

Agammaglobulinemia↗
PubMed1987

Serial measurements of fibrinolytic activity in acute low back pain and sciatica.

A fibrinolytic defect is common in chronic back pain syndromes. Its role in the chronicity of these conditions is not fully understood. To elucidate the possible mechanisms, 11 patients with acute low back pain were studied over 12 months and compared with controls. The patients showed prolongation of the euglobulin lysis time throughout the study; the fibrin plate lysis area was initially normal but became abnormal within 2 weeks. In five patients, the symptoms resolved and the initial fibrinolytic defect improved. In contrast, the fibrinolytic defect remained in six patients with persistent pain. These results suggest that the fibrinolytic defect is secondary to mechanical damage but, if persistent, may become a secondary pathogenic factor associated with the chronicity of some back pain problems.

Adult↗
PubMed1987

Predictive value of mean platelet volume in gold induced thrombocytopenia.

In rheumatoid arthritis the mean platelet volume does not alter with the institution of parenteral gold therapy and with long term gold therapy. It appears to have no value in predicting the onset of thrombocytopenia. It may, however, predict a haemorrhagic diathesis once gold induced thrombocytopenia is established.

Adult↗
PubMed1987

Gm allotypes and HLA in rheumatoid arthritis patients with circulating antibodies to native type II collagen.

HLA antigens and immunoglobulin heavy chain allotypes (Gm) were determined in 166 unrelated patients with rheumatoid arthritis (RA), 44 of whom had circulating antibodies to native type II collagen. Collagen antibody positive patients showed an association with HLA-DR3 and DR7 (68% compared with 39% of collagen antibody negative RA, p less than 0.005), and with the Gm phenotype, Gm(zafngb). This contrasted with the collagen antibody negative RA patients where there was an association with HLA-DR4 and, in DR4 positive disease only, with the Gm allotype, G1m(x). The Gm(zafngb) phenotype was found in 26% of DR3 or DR7 positive patients overall and only 9% of RA patients negative for these DR antigens (p less than 0.005), suggesting an interaction between HLA-DR3/7 and Gm(zafngb). The differing Gm associations for collagen antibody positive and negative RA provide further evidence for genetic heterogeneity in susceptibility to RA.

Antibodies↗
PubMed1985

Autoimmunity to native type II collagen--a distinct genetic subset of rheumatoid arthritis.

HLA phenotypes were determined in 60 Caucasoid patients with rheumatoid arthritis (RA) and normal serum antibody levels to native type II collagen. Antigen frequencies were compared with 52 patients with RA who had elevated antibody levels to native type II collagen. Both RA groups were compared with 163 healthy controls. A clinical comparison of both RA groups yielded few differences, except a decreased incidence of rheumatoid factor and a positive family history of RA and radiologically, increased osteosclerosis in the RA group with elevated antibodies to native type II collagen. HLA-DR4 was increased and HLA-DR7 was decreased in the RA group with normal antibody levels to native type II collagen. A comparison of both RA groups showed an increased incidence of HLA-DR4 in the normal antibody group, whereas HLA-DR7 was increased in the elevated antibody group. In the elevated antibody group the majority of patients possessed either HLA-DR3 or DR7 both of which are in strong linkage disequilibrium with HLA-DQw2. This immunogenetic data suggests that RA patients with autoimmunity to native II collagen form a distinct genetic subset of RA.

Adolescent↗
PubMed1983

Familial hypocalciuric hypercalcaemia: observations on vitamin D metabolism and parathyroid function.

Serum vitamin D metabolites, the renal tubular maximum reabsorptive rate for phosphate (TMP/GFR) nephrogenic cyclic AMP (NcAMPI, and CaE (urinary calcium excretion per litre of glomerular filtrate) were measured in 14 adults with familial hypocalciuric hypercalcaemia (FHH). The findings were compared with analyses in 14 patients with surgically proven primary hyperparathyroidism matched for serum calcium, creatinine clearance and vitamin D status (assessed by serum concentrations of 25 hydroxyvitamin D). Vitamin D metabolites were also measured in 16 normocalcaemic relatives of patients with FHH. The serum concentration of 24,25 dihydroxycholecalciferol was appropriate for the prevailing 25 hydroxyvitamin D and no difference was found between groups. The serum concentration of 1,25 dihydroxycholecalciferol was significantly greater in primary hyperparathyroidism (P less than 0.0005) compared with patients with FHH and their normocalcaemic relatives. TMP/GFR was reduced in both primary hyperparathyroidism (0.53 +/- 0.12 mmol/l GF, mean +/- SEM) and FHH (0.86 +/- 0.14 mmol/l GF). Patients with primary hyperparathyroidism showed an increase in NcAMP output in the urine (38.5 +/- 16 mmol/l GF) which was significantly greater (P less than 0.0001) than the normal NcAMP (13.5 +/- 9.2 nmol/l GF) found in FHH. CaE was low in FHH indicating increased renal tubular reabsorption of calcium. It is concluded that there is no abnormality of vitamin D metabolism in FHH comparable with the changes observed in primary hyperparathyroidism. It is suggested that the biochemical abnormalities in FHH cannot be explained solely upon an increased sensitivity of the renal tubules to the effects of endogenous parathyroid hormone.

24,25-Dihydroxyvitamin D 3↗
PubMed1982

Seasonal changes in serum 25-hydroxyvitamin D concentrations among Asian immigrants.

1. The exposure of Asian immigrants to effective quantities of naturally occurring ultraviolet light was investigated by observing the increase in serum 25-hydroxyvitamin D concentrations during the summer months. 2. The seasonal increase in adult males was greater than in adult females. 3. There was a significant positive correlation between the seasonal increase and the prevailing 25-hydroxyvitamin D concentration, compatible with the view that the accumulation of inadequate stores of 25-hydroxyvitamin D during the summer results in the low serum concentrations seen in Asian immigrants.

25-Hydroxyvitamin D 2↗
PubMed1982

Observations on the natural history of vitamin D deficiency amongst Asian immigrants.

The Asian community of Rochdale was examined for evidence of vitamin D deficiency in 1970 and again in 1980. There has been a striking improvement in the biochemical markers of vitamin D deficiency among Asian children, but little improvement was observed in the adults. Asian children born in the United Kingdom had higher serum 25 hydroxyvitamin D concentrations than migrant children. Prolonged residence in the United Kingdom and a long period of exposure to western customs was not associated with a better vitamin D status in the adults. The vitamin D status of this community was still markedly inferior to that of a white control group despite attempts to influence their dietary practices and habitual solar exposure. Vitamin D deficiency presents a continuing problem among first generation adult migrants, but a decreasing problem among children.

25-Hydroxyvitamin D 2↗
PubMed1982

Observations on the dietary practices of Asians in the United Kingdom.

The efficacy of a health education campaign to improve the vitamin D status of Asians has been assessed. The average daily consumption of vitamin D has not changed significantly over a 10-yr period, although the use of margarine has increased. No consistent relationship could be demonstrated between the dietary consumption of vitamin D, phytate, chuppatty flour, fibre, oxalate or meat and the serum 25 hydroxyvitamin D concentration. This supports the view that dietary factors play only a minor role in the aetiology of vitamin D deficiency among Asian immigrants.

Adolescent↗
PubMed1981

Annual high-dose vitamin D prophylaxis in Asian immigrants.

A group of vitamin-D-depleted Asians was identified in the spring of 1980 and treated with 2.5 mg ergocalciferol in the autumn of that year. Treatment produced a sustained rise in the serum level of 25-hydroxyvitamin D which lasted until the spring of 1981. The response was more predictable after oral than after intramuscular administration. Treatment in the autumn provides an effective, efficient, and cheap means of prophylaxis against vitamin D deficiency in Asians during the winter. A "once a year" regimen promises a much higher compliance rate than could be achieved by daily supplementation.

Administration, Oral↗