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Biomedical subjects

R N Walmsley

Publications and source records attributed to R N Walmsley.

4 recordsLinked to original sources

Variation in plasma apolipoprotein A-1 and B concentrations following myocardial infarction.

Measurements of plasma apolipoprotein A-1 and B concentrations are increasingly used for the laboratory assessment of risk of coronary artery disease (CAD). This study of 22 patients investigated the response of plasma apolipoprotein A-1 and B levels for up to 20 days following a myocardial infarction. Seven of these patients participated in a clinical trial using the drug Tissue Plasminogen Activator (TPA). We established that, unlike many other plasma proteins, apolipoproteins do not display a classic acute phase response following myocardial infarction, although large variations in plasma apolipoprotein levels were observed in the patients investigated. Our studies also show that the measurement of plasma apolipoproteins A-1 and B to assess future CAD risk in myocardial infarction patients should be deferred for a minimum of at least 14 days post-infarction. No significant difference was observed in the pattern of apolipoprotein response between patients receiving TPA and those not given this drug.

Adult

Can the initial clinical assessment of thyroid function be improved?

The clinical reasons for requesting in-vitro thyroid-function tests were studied in 500 consecutive new patients with no known history of thyroid disease. 23 patients presented with five or more signs or symptoms of thyroid disease, and 18 of these required treatment for thyrometabolic dysfunction. Of 35 subjects with three or four thyroid-associated signs or symptoms, only 1 came to treatment. Of 442 subjects with one or two signs or symptoms, 2 were subsequently treated. These results suggest that there is little value in the biochemical investigation of patients who present with minimal clinical evidence of thyrometabolic disease.

Evaluation Studies as Topic

Screening thyrometabolic disorders using total serum thyroxine level.

The results of in-vitro thyroid function tests and clinical details of 1,517 patients are reviewed, and the total serum thyroxine levels and the free thyroxine indices are compared in terms of their diagnostic value. Only 3-7% of the patients investigated had a total serum thyroxine level (T4) that did not correlate with the free thyroxine index. We believe that the evidence is strong enough to suggest that estimation of the T4 is an adequate screening test for thyrometabolic disease, and that performing the extra test (T3 resin uptake) in order to estimate the free thyroxine index (FTI) cannot be justified in terms of cost-benefit. We suggest that the FTI is indicated only in those cases in which the T4 is outside the 80% limit range. A simple scheme for the investigation of thyrometabolic disorders is presented.

Humans