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Biomedical subjects

R D Griffiths

Publications and source records attributed to R D Griffiths.

79 records · Page 5Linked to original sources
PubMedDate not supplied

An in vivo 31P MRS study of patients with liver cirrhosis: progress towards a non-invasive assessment of disease severity.

Fourteen patients with liver cirrhosis of differing severity participated in a one-dimensional chemical shift imaging 31P MRS study of the liver. Patients were divided into two groups according to the severity of their liver disease using Child's classification and the aminopyrine breath test (AB test). Seven normal volunteers without liver disease acted as controls. The phosphomonester (PME) peak in normal subjects was 4.77% (95% confidence interval, CI: 4.11-5.42) of total phosphorus. The PME peak was significantly elevated in both mild cirrhosis [5.80% (95% CI: 5.46-6.14), p = 0.0051, vs normal subjects] and severe cirrhosis [9.64% (95% CI: 8.71-10.57), p = 0.0002, vs normal subjects and p = 0.001, vs mild cirrhosis]. There was a significant negative linear correlation (r = 0.88, p < 0.01) of PME with the percentage dose of 14CO2 excreted over 2 h in the AB test. pH values in patients with mild cirrhosis [7.45 (95% CI: 7.35-7.55)] but not severe cirrhosis [7.36 (95% CI: 7.25-7.47)] were significantly elevated (p = 0.04) compared to normal subjects [7.29 (95% CI: 7.17-7.41)]. Comparison of the peak area of PME at TR = 0.5 s against that using TR = 5.0 s in cirrhotic liver suggested no reduction in T1 of phosphorus metabolites in cirrhosis. A relationship between the severity of liver cirrhosis and a relative increase in PME was demonstrated and this was not due to a reduction of T1. This study highlights the clinical potential of 31P MRS as a non-invasive means of assessing the severity of liver cirrhosis.

Adult↗
PubMedDate not supplied

Can a diagnosis of gestational diabetes be an advantage to the outcome of pregnancy?

OBJECTIVES: We examined the obstetric outcomes of 138 treated women with gestational diabetes mellitus (GDM) compared with 144 women who had a 2-hour, 75-g glucose tolerance test result of between 7.0 and 7.9 mmol/L (126 and 142 mg/dL, respectively). METHODS: The subjects for this study were consecutive patients from a universal testing program for GDM during 1993. Gestational diabetes mellitus was diagnosed if the 2-hour plasma glucose level was 8.0 mmol/L (144 mg/dL) or greater after a 75-g glucose load in the fasting state. RESULTS: Treated women with GDM had a macrosomia rate of 8.0%, which was significantly less (P < .02) than the rate of 17.4% in the "normal" women. Treated women with GDM had a 2.2% rate of fetuses weighing less than 2500 g, which was significantly lower (P = .05) than the 6.9% rate for normal women. Overall, insulin therapy was used in 23.2% of the women with GDM, and no insulin-treated woman had either a macrosomic fetus or a fetus weighing less than 2500 g. CONCLUSIONS: Treated women with GDM, particularly those who receive insulin, have a more favorable fetal outcome than women who have a glucose result between 7.0 and 7.9 mmol/L (126 and 142 mg/dL). These results suggest that the current diagnostic criteria for GDM, with respect to fetal outcomes, may need revision, and an additional subgroup of pregnant women may benefit from dietary advice.

Adult↗
PubMedDate not supplied

Outcome of critically ill patients after supplementation with glutamine.

Glutamine has many important metabolic roles that may protect or promote tissue integrity and enhance the immune system. The normal abundance of glutamine has meant that it has not been considered necessary to include glutamine in traditional parenteral feeds. However, low plasma and tissue levels of glutamine (Gln) in the critically ill suggest that demand may exceed endogenous supply. A relative deficiency of glutamine in such patients could compromise recovery, result in prolonged illness, and an increase in late mortality. The few percent of the most critically ill intensive care patients who are unable to tolerate enteral nutrition are especially at risk since they have increased demands for glutamine yet lack an exogenous supply. Such patients undergo considerable skeletal muscle wasting compromising glutamine supply further. In a prospective, randomised double blind clinical study of 84 patients with a high mortality due to multiple organ failure requiring parenteral feeding a significant improvement in six-month survival was observed in the group supplemented with glutamine 24/42 versus isonitrogenous, isoenergetic control 14/42, P = 0.049.

Critical Illness↗
PubMedDate not supplied

Parenteral glutamine supply in intensive care patients.

Glutamine, an abundant amino acid, has many metabolic roles that protect tissue integrity and enhance the immune system. Low plasma and tissue levels of glutamine in the critically-ill suggest that demand may exceed endogenous supply and with the profound muscle wasting that occurs this supply of glutamine may become critical to survival. The very sickest patients who are unable to tolerate enteral feeding are solely dependent on conventional parenteral nutrition which does not contain glutamine. This short review, drawing upon a recent double blind randomised clinical six month outcome study, provides the rationale to suggest that parenteral glutamine supply in these very sick patients may improve recovery and reduce late mortality.

Critical Care↗
PubMedDate not supplied

Implementing a holistic approach to diabetes care.

The concept of case assignment is an important development in diabetes education because it encourages a problem-solving approach to care, including evaluation of education, which is the basis of accountability and autonomous professional practice. Furthermore, case assignment and holistic care of clients with diabetes is a model of professional practice that benefits clients, practitioners, and administrators. Case assignment encourages comprehensive and efficient use of human and administrative resources, and provides a foundation for professional development and practitioner autonomy. Effective implementation of holistic care requires a reassessment by health professionals of practice protocols and a reorganization of policy and procedures. The expansion of professional skills necessary for the introduction of a holistic approach will (a) break down traditional practice barriers, and (b) extend the professional knowledge of diabetes care practitioners. Case assignment for diabetes education and follow-up, if extensively adopted, is a mechanism that could contribute to achieving recognition of diabetes educators as independent practitioners, recognition of diabetes education as a practice specialty, and reimbursement for private practitioners.

Diabetes Mellitus↗
PubMedDate not supplied

Effect of passive stretching on the wasting of muscle in the critically ill.

This study examine whether muscle wasting in critically ill patients can be prevented by passive stretching alone in the absence of contractile activity. Five critically ill patients who required a complete neuromuscular blockade for 7 days of ventilator support were studied. One leg of each patient was treated with continuous passive motion (CPM) for three 3-h periods daily while the other leg received only routine nursing care. Fiber atrophy was prevented in the more severely ill patients and there was a slight gain in fiber area (mean increase, +11%) in the CPM limb compared with the control leg, which decreased (mean decrease, -35%) over 7 days. Fiber area was preserved in both fiber types but was more pronounced in type I muscle fibers. Protein loss was significantly less in the CPM limb. There was a significantly greater increase in wet weight per mg DNA in the control limb. However, as an index of wasting, the ratio of protein to DNA decreased similarly in both limbs. Passive stretching can preserve the architecture of muscle fibers. Whether it can prevent muscle wasting remains uncertain.

Adult↗