Biomedical subjects
R Million
Publications and source records attributed to R Million.
Biologic factors required in cancer invasion and metastasis.
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Neck pain: considerations for the GP.
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Fibrinolytic defect in chronic back pain.
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A fibrinolytic defect in chronic back pain syndromes.
Blood fibrinolytic activity was measured in 18 subjects with severe chronic back pain and 18 age and sex matched controls. The patients showed evidence of defective fibrinolysis--namely, significant prolongation of the euglobulin clot-lysis time, reduction in fibrin-plate lysis-area and plasminogen levels, and increase in levels of the fibrinolytic inhibitors, alpha 2 antiplasmin and alpha 2 macroglobulin. This defect could be associated with fibrin deposition and scar formation and be responsible for the development and/or perpetuation of chronic inflammation and scarring at sites of damage in the spine. Enhancement of fibrinolytic activity may offer a new approach to the management of these back problems, and a double-blind controlled trial is in progress.
Long-term study of management of rheumatoid arthritis.
A 10-year study of the management of rheumatoid arthritis was conducted to compare a programme consisting of rest and anti-inflammatory and antirheumatic drugs with one consisting of maintenance of activity, anti-inflammatory and antirheumatic drugs, and systemic steroids where necessary. During this period subjects who did not respond to the treatment allocated went on to a combined treatment programme of rest, anti-inflammatory and antirheumatic drugs, and steroids. Among those who remained in the trial for the 10 years, there was little difference between the two groups in morning stiffness, number of inflamed joints, functional capacity, grip strength, number of American Rheumatism Association criteria present, and whether they remained on their original treatment programme or switched to the combined programme. However, in those who started in the steroid group, the condition of several joints tended to be better clinically and radiologically than in those of the other group during and at the end of 10 years of the original treatment programme, at time of transfer to the combined programme, and at the completion of the combined programme. Both groups had as many complications of disease and treatment, and adverse effects attributable to steroids seemed to be restricted to those with severe disease who had not responded to their original programme. A policy of maintaining physical activity plus the judicious use of steroids where required produces, in the long term, results as good as or probably better than a regimen of bed rest and no steroids.
Fenclofenac and diclofenac in the treatment of rheumatoid arthritis.
A six-month single-blind, randomized parallel group study comparing the effects of fenclofenac and diclofenac in 63 patients with rheumatoid arthritis is described. Both treatments produced improvements in clinical measurements, with a significant between-treatment effect in favour of fenclofenac for overall pain, night pain and duration of morning stiffness. Both treatments produced a decrease in IgM and the fenclofenac group produced decreases in plasma viscosity and ESR, the latter showing a significant between-treatment effect in favour of fenclofenac. No clinically significant changes in routine haematology and biochemistry were noted. Unwanted effects leading to withdrawal of therapy were reported by five patients in the fenclofenac group and three patients in the diclofenac group. Two patients in the fenclofenac group and one in the diclofenac group were withdrawn for reasons unrelated to therapy. In the diclofenac group two and four patients were withdrawn for clinical deterioration and inadequate effect respectively.
Clinical trial of flupirtine maleate in patients with migraine.
A double-blind randomized parallel group trial was carried out in two centres to study the drug treatment of acute attacks of migraine. One group of 20 patients was treated with oral doses of 100 mg flupirtine maleate and another group of 20 patients with doses of 1 g paracetamol. In all cases, doses were taken as required up to a maximum of 4 doses per day for 5 days. The total consumption of analgesics was very similar in the two groups (flupirtine group 6.65 +/- 1.14 doses, paracetamol group 6.85 +/- 1.05 doses), as was the incidence of nausea and/or vomiting on each day of the attack. Despite an initial pain level on the first day of the migraine attack which was significantly higher in the flupirtine group, there were trends for flupirtine patients to show subsequently lower pain scores and to suffer less restriction of working ability and confinement to bed. Symptoms and possible side-effects were minor and infrequent in both treatment groups. Four symptoms were reported by 4 patients during flupirtine treatment and 7 symptoms by 5 patients during paracetamol treatment.
Faecal occult blood testing for colorectal cancer in general practice.
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Evaluation of low back pain and assessment of lumbar corsets with and without back supports.
A method is described for evaluating the progress of patients with back pain. Various symptoms were scored on analogue scales and spinal motion was measured by various techniques. These data were integrated to make subjective and objective indices respectively. Reasonable reproducibility of the measurements was obtained. This technique was used to elucidate the role of the lumbar support in surgical corsets in relief of back pain. Sufferers from back pain were randomly allocated to corsets with and without lumbar supports. There was significant improvement in those with a support compared with those without. On the other hand objective changes measured with the corset removed did not differ between the 2 groups. This study indicates that the spinal support in a lumbosacral corset makes a significant contribution towards the relief of symptoms.
A dose-response study of atenolol in mild to moderate hypertension in general practice.
A double-blind, crossover, multicentre study of 98 previously untreated patients with mild to moderate essential hypertension was carried out in general practice to assess the effect of 50 mg, 100 mg, and 200 mg atenolol, given once daily, compared with that of placebo over a period of 4 weeks each. At the end of the double-blind phase, all patients took 100 mg atenolol daily for a further 8 weeks. All three doses of atenolol produced statistically significant falls in systolic and diastolic pressure and pulse rate (p less than 0.001). The lowest pressures were achieved with 100 mg daily; a difference of 22/15 mmHg at the end of the double-bling phase, and a difference of 25/16 mmHg at the final observation. Body weight, blood urea, blood uric acid, and serum electrolytes remained within normal limits throughout the study. The incidence of side-effects with 50 mg and 100 mg atenolol was not significantly different from that caused by placebo, but the incidence of tiredness at the 200 mg dose level was greater than that caused by placebo and by the lower doses. The incidence of possible side-effects elicited by a questionnaire was low, the greatest number being volunteered by patients taking placebo. It is concluded that the optimal dose of atenolol for treating patients with mild to moderate hypertension in general practice is 100 mg daily.
Butacote and naproxen: a comparison of effectiveness in rheumatoid arthritis.
A double-blind crossover trial compared Butacote, 200 mg b.d. with naproxen, 250 mg b.d., each given for four weeks, in the treatment of rheumatoid arthritis. The trial was multicentre, and twenty-six general practitioners admitted forty-eight patients. Seven patients dropped out: two for technical reasons; one in each treatment group because of exacerbation of symptoms; one because of intolerance of rescue analgesic; and two with gastric intolerance to naproxen. Both drugs were effective in relieving pain, morning stiffness, and joint tenderness, as compared with the condition before the trial. There was little effect on grip strength or joint size, and no real differences between the two drugs. The two preparations had a similar frequency and spectrum of side-effects, except that oedema did not occur with naproxen, and rash did not occur with Butacote. Gastro-intestinal upsets were the commonest unwanted effect but only two patients had to stop treatment for this reason, both while taking naproxen. Although the doctors preferred each drug on an equal number of occasions, the patients preferred Butacote to naproxen almost twice as often (20:11), particularly when Butacote was given after naproxen. The reason for this divergence of opinions is not obvious.
Assessment of the progress of the back-pain patient 1981 Volvo Award in Clinical Science.
Fifteen subjective variables reflecting the severity of back pain, the circumstances exacerbating symptoms, and the impact of the problem on life style were scored on Visual Analogue Scales. It was possible to combine the results from these assessments to provide a global subjective index. Repeated measurements by the same observer showed a high degree of reproducibility, but when performed by separate observers discrepancies arose in certain questions. By improving certain questions and standardizing their presentation to the patient, a considerable improvement in the correlation of results between observers was obtained. Objective assessments of spinal motion and straight leg raising and a global objective index showed a high degree of intraobserver reproducibility. This technique was applied to a study of relief of back pain by lumbar corsets when it was found that there was significantly greater relief of back pain by a corset with a lumbar support than one without a spinal support. We conclude that the emphasis in assessing the progress of the back-pain patient must be on the subjective parameters, and the technique developed offers a useful method for reliably assessing patients and following their progress.