Biomedical subjects
R N Butler
Publications and source records attributed to R N Butler.
Hypertension: how comorbid disease influences the choice of therapy. Part 4 of a roundtable discussion.
Two categories of comorbid conditions affect the choice of therapy for hypertension: compelling indications, where outcomes data show improved survival, and indications where therapies may be beneficial but do not affect survival. In patients with diabetes, low-dose diuretics effectively lower blood pressure, but metabolic derangements may occur. A diuretic may exacerbate urinary incontinence and therefore may not be a first-choice therapy for some older women. Monotherapy is not effective in controlling blood pressures in patients with renal insufficiency. In patients with a history of MI, even those age 85 and older benefit from beta blockade. Lowering blood pressure over a 3- to 5-year period is effective in preventing left ventricular hypertrophy and congestive heart failure.
How to practice 'activist geriatrics'.
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Urinary incontinence: keys to diagnosis of the older woman.1.
Up to 38% of women age 65 and older experience urinary incontinence to some degree, although the prevalence in this population may be even greater. Aging, childbirth, and hormonal changes affect the muscle and tissue support of the urethra and bladder, decreasing their ability to hold urine. Neurologic injury related to disease, trauma, or surgery may impair the pathways between the brain and bladder, leading to inappropriate urgency and frequency. Older women often do not talk about their incontinence, because they are embarrassed or believe there is no cure. Therefore, it's important for clinicians to ask about the involuntary loss of urine. A careful history alone can often reveal 80 to 90% of the diagnosis.
Urinary incontinence: primary care therapies for the older woman.
Work-up of the older woman with urinary incontinence includes a complete physical, pelvic and rectal examinations, and a neurologic exam. The primary care physician can usually leave post-void residual testing to the specialist. Lab tests include urinalysis and urine culture, as well as basic blood tests. If the patient is referred, the specialist may do other testing, such as urodynamics or cystometry. The choice of therapy depends on the cause and severity of each patient's symptoms. Primary care treatment options for mild to moderate incontinence include pelvic muscle exercises, bladder retraining, and biofeedback--all of which can be taught by a physical therapist. Other noninvasive treatments include estrogen replacement therapy and anticholinergic and other drug therapies.
Urinary incontinence: when to refer for procedural therapies.
Urinary incontinence is not life-threatening but rather is a social problem for older women. Therefore, 'patient selection' for a surgical intervention is up to the patient. The physician's role is to educate patients about available procedures, including potential complications and success rates. Invasive treatments for stress incontinence include retropubic or needle suspension, sling procedures, injections of periurethral bulking agents such as collagen, and implantation of an artificial sphincter. An electrical nerve stimulation device has recently been approved for urge incontinence. Many consumer advocacy groups provide support and patient education on incontinence.
Regional distribution of metallothionein and zinc in the mouse gut: comparison with metallothionien-null mice.
Gut Zn homeostatic responses to low, replete, and excess dietary Zn (10, 150, and 400 mg Zn/kg, respectively) were compared in mice with (MT+/+) and without (MT-/-) metallothionein (MT) expression. MT concentrations decreased progressively from stomach (12.9 nmol Cd bound/g) to colon (4.6 nmol Cd bound/g). Small intestinal MT was increased in mice fed the 400-mg Zn/kg diet (+130%, duodenum; +56%, jejunum; +29%, terminal ileum), but not in the stomach, cecum and colon. Zn concentrations were much higher in the distal gut at increasing Zn intakes in MT+/+ mice but to a lesser extent in MT-/- mice. On the 10-mg Zn/kg diet, MT-/- mice had 45% more Zn in the jejunum/ileum than MT+/+ mice. In fasted (20 h) mice, Zn concentrations in all gut regions were similar to those of MT+/+ mice fed the 10-mg Zn/kg diet, irrespective of prior Zn intake or genotype. Liver MT quadrupled in mice fasted after the 10-mg Zn/kg diet but only doubled after the 400-mg Zn/kg diet, a trend also present in gut MT. Glucagon administration stimulated gut as well as liver MT, implicating it as a major component of the MT response to fasting. MT-/- mice had five times more variation than MT+/+ mice in plasma Zn over all dietary groups. Together, these findings demonstrate that without MT, there is little modification of regional gut Zn concentrations in response to extremes of dietary Zn and poorer regulation of Zn homeostasis.
The sugar permeability test reflects disease activity in children and adolescents with inflammatory bowel disease.
OBJECTIVES: To investigate the relationship of intestinal permeability in children and adolescents with inflammatory bowel disease (IBD) to disease activity, disease extent, and response to therapy. STUDY DESIGN: Patients with new and established diagnoses of IBD (12 Crohn's disease [CD] and 18 ulcerative colitis [UC]) were studied. Intestinal permeability was evaluated by measuring with high-performance liquid chromatography 5-hour urinary excretion ratio of lactulose/L-rhamnose (L/Rh). RESULTS: In 8 of 9 patients with active CD, the L/Rh ratio was higher than the reference range (0.006 to 0.074, n = 36). In inactive CD (n = 3) the L/Rh ratio was within the reference range. In 6 of 7 patients with active extensive UC, the L/Rh ratio was elevated. In inactive extensive UC (n = 6) the normal permeability ratio was shown. In both active CD and active extensive UC, the frequency of elevated intestinal permeability was significantly greater than values in both inactive forms. The permeability ratio was normal in 4 of 5 patients with active left-sided colitis. In 5 of 7 patients (3 CD, 4 UC), repeat permeability values entered the reference range after acute phase therapy. Two patients with persistently elevated intestinal permeability (1 CD, 1 UC) had a disease flare-up within 6 months. CONCLUSIONS: Intestinal permeability is a marker of disease activity in CD and extensive UC. Serial permeability test may be useful in monitoring disease activity.
An orally administered growth factor extract derived from bovine whey suppresses breath ethane in colitic rats.
BACKGROUND: Lipid peroxidation is a potential mechanism of bowel damage in colitis. The effect of oral consumption of a bovine whey-derived growth factor extract (WGFE) on lipid peroxidation was assessed using the ethane breath test in the dextran sulphate sodium (DSS) model of ulcerative colitis (UC) in rats. METHODS: Groups of rats consumed water (control), 2% DSS in drinking water, 2% DSS with a WGFE-supplemented diet, or 2% DSS plus prednisolone (1 mg x kg(-1) x day(-1)) for 6 weeks, changing to sulphasalazine (100 mg x kg(-1) x day(-1)) for the subsequent 4 weeks. Ethane breath tests were conducted on all animals on days 2, 4, 6, 8, and 10 (acute phase) and weeks 3, 6, and 9 (chronic phase) after commencement of DSS consumption. RESULTS: There were no significant differences in ethane production between any groups during the acute phase. Ethane was significantly increased (P < 0.05) in rats consuming DSS alone in week 6 compared with control but had decreased to control levels by week 9. WGFE and conventional therapy were effective in suppressing ethane production in week 3. CONCLUSIONS: WGFE is as effective as conventional therapies at limiting ethane production and thus ostensibly colonic lipid peroxidation in the early phases of experimental chronic UC.
Injury-control education in six U.S. medical schools.
PURPOSE: To assess knowledge, attitudes, and formal instruction related to injury control among fourth-year medical students. Injury is the leading cause of death among Americans aged 1 to 44 years. METHOD: The authors conducted a cross-sectional survey of fourth-year students at six U.S. medical schools, four of which maintain federally funded injury prevention research centers. Main outcome measures included injury-related knowledge scores, three attitude measures, and self-reported exposures to injury prevention education. RESULTS: Six hundred and thirty-five fourth-year medical students (73% of those eligible) participated. The responding students were, on average, unable to correctly answer half of the questions testing injury-related knowledge. They rated medical problems more important and more preventable than injury problems, and they felt more comfortable asking their patients about risk factors for medical problems. These findings may be explained, in part, by the students' reported minimal exposure to injury control education in medical school. The students encountered the topic more frequently on rotations in pediatrics (84%), family medicine (73%), and preventive medicine (66%) than on rotations in emergency medicine (47%), internal medicine (41%), or obstetrics and gynecology (34%). Injury control was encountered least often on rotations in psychiatry (23%) and surgery (14%). CONCLUSIONS: These findings suggest that injury control is given limited coverage in the curricula of U.S. medical schools. As a result, students have little understanding of the principles and benefits of injury control.
Progress report. A pioneer in the field of gerontology takes stock of long-term care.
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Thanks, Hippocrates, for the first miracle drug.
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Type 2 diabetes: causes, complications, and new screening recommendations. I.
Type 2 diabetes mellitus, one of the most prevalent and disruptive diseases in our older population, occurs in approximately 10% of persons over age 65. Its cause is usually a combination of deficient insulin production and resistance to insulin. In approximately one-half of those with diabetes, symptoms occur slowly over time and escape diagnosis. Complications include cardiovascular disease with myocardial infarction and stroke, nephropathy, retinopathy, peripheral neuropathy, and sexual dysfunction. Risk factors include age, family history, obesity, and sedentary lifestyle. Screening and early diagnosis are important secondary means of prevention, but physicians should also think about primary prevention based on family history, diet, and physical activity.