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Biomedical subjects

S A Greene

Publications and source records attributed to S A Greene.

At least 37 records · Page 2Linked to original sources
PubMed1997

Adherence to insulin treatment, glycaemic control, and ketoacidosis in insulin-dependent diabetes mellitus. The DARTS/MEMO Collaboration. Diabetes Audit and Research in Tayside Scotland. Medicines Monitoring Unit.

BACKGROUND: Intensive insulin treatment effectively delays the onset and slows the progression of microvascular complications in insulin-dependent diabetes mellitus (IDDM). Variable adherence to insulin treatment is thought to contribute to poor glycaemic control, diabetic ketoacidosis, and brittle diabetes in adolescents and young adults with IDDM. We assessed the association between the prescribed insulin dose and the amount dispensed from all community pharmacies with the Diabetes Audit and Research in Tayside Scotland (DARTS) database. METHODS: We studied 89 patients, mean age 16 (SD 7) years, diabetes duration 8 (4) years, and glycosylated haemoglobin (HbA1c) 8.4 (1.9)%, who attended a teaching hospital paediatric or young-adult diabetes clinic in 1993 and 1994. The medically recommended insulin dose and cumulative volume of insulin prescriptions supplied were used to calculate the days of maximum possible insulin coverage per annum, expressed as the adherence index. Associations between glycaemic control (HbA1c), episodes of diabetic ketoacidosis, and all hospital admissions for acute complications and the adherence index were modelled. FINDINGS: Insulin was prescribed at 48 (19) IU/day and mean insulin collected from pharmacies was 58 (25) IU/day, 25 (28%) of the 89 patients obtained less insulin than their prescribed dose (mean deficit 115 (68; range 9-246] insulin days/annum). There was a significant inverse association between HbA1c and the adherence index (R2 = 0.39; p < 0.001). In the top quartile (HbA1c > 10%), 14 (64%) of individuals had an adherence index suggestive of a missed dose of insulin (mean deficit 55 insulin days/annum). There were 36 admissions for complications related to diabetes. The adherence index was inversely related to hospital admissions for diabetic ketoacidosis (p < 0.001) and all hospital admissions related to acute diabetes complications (p = 0.008). The deterioration in glycaemic control observed in patients aged 10-20 years was associated with a significant reduction (p = 0.01) in the adherence index. INTERPRETATION: We found direct evidence of poor compliance with insulin therapy in young patients with IDDM. We suggest that poor adherence to insulin treatment is the major factor that contributes to long-term poor glycaemic control and diabetic ketoacidosis in this age group.

Adolescent↗
PubMed1997

Variable effect of growth hormone on growth and final adult height in Scottish patients with Turner's syndrome.

The aim of this work was to assess the outcome of recombinant growth hormone (rGH) therapy in a large unselected group (72) of patients with Turner's syndrome (TS), 26 of whom have reached final height. Growth data were collected from Scottish patients with TS and outcome was assessed in three ways: response to therapy in the first year, response in subsequent years and final height. Phenotypic, auxological, genetic and biochemical factors, all of which may have affected the first-year response, were investigated. Fifty-one percent of the cohort had a clinically "good" first-year response to therapy and 49% had a "poor" response, a "good" response was defined as a change in the TS standard deviation score (SDS) of +0.5 or more and a "poor" response as a change in the TS SDS of less than +0.5. The percentage of children showing a positive change in TS SDS after 2, 3 and 4 years of therapy declined (88%, 78%, 41%). Mean (range) final height was 142.6 (133.4-153.6) cm, mean (range) pretreatment TS SDS was -0.27 (-2.1 to +1.09) and mean (range) final TS SDS was -0.05 (-1.4 to +1.59). Thirteen (50%) patients attained a final height that was greater than projected, eleven did not attain their projected final height and two achieved their exact projected final height. Short girls with TS appear to benefit more from rGH supplementation than tall girls, but otherwise there was no significant correlation between any of the parameters studied and the response to treatment. It is concluded that large-scale prospective studies are still required to assess the impact of rGH on final height in TS and to identify factors responsible for the variability in response.

Adolescent↗
PubMed1997

Effect of low-dose atropine administration on dobutamine dose requirement in horses anesthetized with detomidine and halothane.

OBJECTIVE: To determine whether a low dose of atropine is associated with decreased requirement for cardiovascular supportive treatment in horses given detomidine prior to maintenance of general anesthesia with halothane. ANIMALS: 3 groups of 10 healthy horses. PROCEDURE: Detomidine (20 micrograms/kg of body weight, i.m.) was administered to all 30 horses. Then, 10 horses received atropine (0.006 mg/kg, i.v.) 1 hour after detomidine administration, 10 horses received atropine (0.012 mg/kg, i.m.) at the time of detomidine administration, and 10 horses served as a control group. Heart rate was measured prior to detomidine administration and at fixed intervals throughout anesthesia. The dobutamine infusion rate necessary to maintain mean arterial blood pressure between 70 and 80 mm of Hg was recorded. Systemic blood pressures, end-tidal halothane, end-tidal CO2, and arterial blood gas tensions were measured at fixed intervals. RESULTS: Mean heart rate was higher among horses receiving atropine i.v. or i.m., compared with that in control horses. Horses that received atropine i.v. had higher systemic arterial blood pressure and required a lower dobutamine infusion rate than did horses of the other groups. CONCLUSION: Detomidine-treated, halothane-anesthetized horses given atropine i.v. required less dobutamine, compared with horses receiving or not receiving atropine i.m. Complications, such as colic and dysrhythmias, from use of higher doses of atropine, were not observed at this lower dose of atropine. CLINICAL RELEVANCE: i.v. administration of a low dose of atropine prior to induction of general anesthesia may result in improved blood pressure in horses that have received detomidine before anesthesia with halothane.

Adjuvants, Anesthesia↗
PubMed1996

Effect of craniectomy/durotomy alone and in combination with hyperventilation, diuretics, and corticosteroids on intracranial pressure in clinically normal dogs.

OBJECTIVE: To determine the effect of craniectomy and durotomy on intracranial pressure (ICP) in clinically normal dogs. DESIGN: Two-part study (experiments A and B) involving craniectomy and durotomy, with and without treatments to lower ICP. ANIMALS: Six (experiment A) and 7 (experiment B) healthy dogs. PROCEDURE: In experiment A, craniectomy was performed in combination with durotomy, diuretic administration, methylprednisolone sodium succinate administration, and hyperventilation, and effect of these manipulations on ICP was determined. In experiment B, dogs had only craniectomy and durotomy without associated ICP-lowering treatments. During both experiments, ICP was monitored throughout the surgical procedure with a fiber optic ICP monitoring device. RESULTS: Intracranial pressure decreased after the combination of craniectomy, durotomy, and other ICP-lowering treatments in dogs of experiment A. Similar magnitude of decrease in ICP was observed in dogs of experiment B after craniectomy and durotomy. CONCLUSIONS: Comparison of these experiments indicate that surgical removal of overlying skull and incision of the dura mater can significantly decrease ICP in clinically normal dogs. CLINICAL RELEVANCE: Craniectomy and durotomy may be useful as an adjunct treatment for increased ICP.

Adrenal Cortex Hormones↗
PubMed1996

Evaluation of chromogenic substrate assays for fibrinolytic analytes in dogs.

OBJECTIVE: To evaluate the ability of commercial, chromogenic kits designed to measure human fibrinolytic pathway components to measure the canine plasma fibrinolytic pathway enzymes, tissue plasminogen activator (tPA) and plasminogen (PLG), and their respective inhibitors, plasminogen activator inhibitor 1 (PAI) and alpha 2-antiplasmin (AP). ANIMALS: 20 healthy dogs of various ages and breeds. PROCEDURE: The commercial procedure was adapted to a microtitration plate. Standard curves were generated by use of a canine plasma pool. RESULTS: Modifications of the commercial kit consisted of change in incubation periods and the substitution of urokinase for the streptokinase. Plasminogen and AP procedures yielded intra- and interassay coefficients of variation (CV) ranging from 2 to 6.4%. The tPA activity gave an acceptable intra-assay CV of 4.2%, but an equivocal interassay CV of 18%. The PAI assay gave unacceptable intra-assay and interassay CV of 59 and 66%, respectively. CONCLUSIONS: Modifications of the commercial PLG and AP procedures were appropriate for use with fresh and frozen canine plasma. However, equivocal results were obtained for canine plasma tPA. Although the PAI assay was able to detect the inhibitor, it gave unacceptable quantifiable results. Human and canine plasma contained similar amounts of PLG and AP, but 25% more tPA was found in canine plasma than human plasma. CLINICAL RELEVANCE: With modifications, the commercial human PLG and AP chromogenic kits may serve to elucidate such canine fibrinolytic disorders as disseminated coagulopathy. The high cost of the chromogenic substrate limits its application.

Animals↗
PubMed1996

Fibrinolytic activity in dogs after surgically induced trauma.

OBJECTIVE: To determine whether alterations in the fibrinolytic pathway analytes, plasminogen (PLG), tissue plasminogen activator, and alpha 2-antiplasmin are significant in dogs subjected to minor and major surgical trauma. ANIMALS: 18 dogs in 3 groups of 6 each. PROCEDURE: Plasma fibrinolytic pathway analytes were measured in dogs with trauma of ovariohysterectomy (minor trauma) or orthopedic surgery (major trauma) and halothane anesthesia (control group). A commercial procedure adapted to a microtitration plate was used to measure the analytes. Blood was obtained 24 hours before anesthesia, at extubation (0 hours), and again at 2, 24, and 48 hours after extubation. An analyte quality-control strategy was maintained. RESULTS: In the major trauma group, there was a significant, transient, postsurgical decrease in PLG activity at 0 and 24 hours and a return to presurgical values by 48 hours. The minor trauma group had a similar trend without significant changes, including an increase in PLG values at 48 hours that exceeded the reference range. Antiplasmin values changed significantly in the major trauma group only. Tissue plasminogen activator values remained within the reference range. CONCLUSIONS: Tissue plasminogen activator was not considered a clinical marker of interest for detection of alterations in fibrinolysis after trauma. In contrast, plasma PLG and alpha 2-antiplasmin values may be useful in the evaluation of hemostatic complications of surgery. CLINICAL RELEVANCE: Identification of altered fibrinolysis in dogs undergoing traumatic surgery may provide a baseline for preventive pre-and postsurgical hemostatic care.

Anesthesia, General↗
PubMed1995

Intraoperative monitoring of intracranial pressure in five dogs with space-occupying intracranial lesions.

Five dogs with space-occupying intracranial lesions underwent lateral craniectomy. Brain tissue pressures, reflective of intracranial pressure, were monitored during the surgical procedure, using a fiberoptic intracranial pressure monitoring system. The intracranial pressure monitoring cable was placed superficially in brain parenchyma on the side contralateral to the primary lesion. Recordings were made continually throughout the surgical procedure. Each dog was treated preoperatively with mannitol, which caused a decrease in intracranial pressure prior to craniectomy in only those dogs that initially had high intracranial pressure. Complications associated with use of the fiberoptic intracranial monitoring system were not evident. Although absolute values for pressure varied, pressure trends were helpful in determining effects of surgical manipulations on intracranial pressure in these dogs.

Animals↗
PubMed1995

Body mass index centile charts to assess fatness of British children.

Body mass index (BMI) relates weight to height and reflects the shape of a child, but because of age dependency it has not been used conventionally for the estimation of fatness in children. From measurements of Tayside children (n = 34,533) centile charts were constructed for BMI (wt/ht2) from the raw data of height and weight, using Cole's LMS method for normalised growth standards. These data were compared with the only available European BMI charts published from data of French children obtained over a period of 24 years from 1956-79. British children appear to be 'fatter'. Within a subgroup (n = 445) the BMI values were correlated with estimations of body fat, for boys and girls, from skinfold thickness (r = 0.8 and 0.81) and bioelectrical impedance (r = 0.65 and 0.7). The limits of acceptable BMI have yet to be defined.

Adipose Tissue↗
PubMed1995

Growth screening and urban deprivation.

OBJECTIVES: To assess the effect of urban deprivation on childhood growth in a modern British society by analysing data from a regional growth survey, the Tayside growth study. SETTING: The Tayside Region in Scotland, which has three districts with distinct socioeconomic status: Dundee (D, urban city), Angus (A, rural), and Perth (P, rural and county town). SUBJECTS AND METHODS: Height and weight of 23,046 children (> 90% of the regional childhood population) were measured as part of a child health surveillance programme, by community health care workers at 3, 5, 7, 9, 11, and 14 years. Height standard deviation score (calculated against Tanner) and body mass index (BMI-weight (kg)/height (m)2) were calculated for each child by a central computer program; mean height standard deviation score and BMI standard deviation score were calculated for each measuring centre (school, health clinic). A deprivation score for each centre was calculated from the prevalence of single parent families; families with more than three children; unemployment rate; the number of social class V individuals; the percentage of council houses. RESULTS: Mean height standard deviation score for Tayside was 0.11. An intraregional difference was demonstrated: mean height standard deviation score (SD) D = 0.04 (1.0); A = 0.14 (1.1); P = 0.21 (1.1); P < 0.002. There was a positive association between short stature and increasing social deprivation seen throughout Tayside (P < 0.05), with a strong association in Dundee primary school children (r = 0.6; P < 0.001). Analysis by district showed that the association was significant only above the age of 8 (P < 0.004). There was no relation between BMI and social deprivation. CONCLUSIONS: In an industrialised developed society, urban deprivation appears to influence height mostly in late childhood, and this association should be taken into consideration in the clinical management of short stature. Height seems to be a better physical indicator of urban deprivation, and hence an index of childhood health, than BMI.

Adolescent↗
PubMed1995

Effects of medetomidine administration on intracranial pressure and cardiovascular variables of isoflurane-anesthetized dogs.

Intracranial pressure and cardiovascular variables after IV administration of medetomidine (0.03 mg/kg of body weight) were evaluated in 6 healthy, mixed-breed dogs anesthetized with 1.3% end-tidal isoflurane concentration and mechanically ventilated to normocapnia (PaCO2, 35 to 45 mm of Hg). Baseline values were determined for intracranial pressure, heart rate, arterial blood pressure, cardiac output, mean pulmonary artery pressure, pulmonary capillary wedge pressure, central venous pressure, end-tidal CO2 tension and isoflurance concentration, arterial pH and CO2 and O2 tensions, and core body temperature. Cerebral perfusion pressure, cardiac index, systemic and pulmonary vascular resistances, plasma HCO3- concentration, and base excess were calculated. Intracranial pressure was measured, using a calibrated, fiberoptic transducer placed within the brain parenchyma and secured to the calvarium by means of a subarachnoid bolt. Cardiac output was determined by thermodilution. End-tidal CO2 tension and isoflurane concentration were determined, using an infrared gas analyzer. Administration of medetomidine did not change intracranial pressure, but was associated with significant (P < 0.05) decreases in values for heart rate, cardiac index, end-tidal CO2, and HCO3- and with significant increases in systolic, mean, and diastolic pressure; pulmonary artery pressure; systemic vascular resistance; central venous pressure; and pulmonary capillary wedge pressure.

Adrenergic alpha-Agonists↗
PubMed1995

Cardiovascular effects of epidurally administered morphine and a xylazine-morphine combination in isoflurane-anesthetized dogs.

Cardiovascular effects of epidurally administered morphine, a morphine-xylazine combination, and saline solution (control) during isoflurane-maintained anesthesia were assessed in 6 healthy dogs. Anesthesia was induced with isoflurane in O2 and was maintained at 2.0% end-tidal isoflurane concentration. Ventilation was controlled to maintain PaCO2 at 35 to 45 mm of Hg. The dorsal pedal artery was cannulated for measurement of systolic, mean, and diastolic pressures, and for blood sample collection. Arterial blood pH and gas tensions were determined every 30 minutes. Cardiac output was determined by thermodilution. The ECG, heart rate, body temperature, central venous pressure, mean pulmonary artery pressure, pulmonary capillary wedge pressure, end-tidal isoflurane concentration, and CO2 tension were monitored. Systemic and pulmonary vascular resistance, arterial HCO3- concentration, base excess, and cardiac index were calculated. After baseline measurements were taken, morphine (0.1 mg/kg of body weight) in 5 ml of isotonic saline solution, morphine and xylazine (0.1 mg of morphine and 0.02 mg of xylazine/kg) in 5 ml of isotonic saline solution, or 5 ml of isotonic saline solution was injected into the lumbosacral epidural space. Data were recorded at 5, 15, 30, 45, 60, 75, 90, 105, and 120 minutes after epidural injection. Statistical analysis included ANOVA for repeated measures. Significance was set at P < 0.05. None of the measured variables was significantly different among the 3 treatments at any time. Results of the study indicated that epidural administration of morphine or morphine and xylazine is not associated with significant cardiovascular side effects during isoflurane-maintained anesthesia in dogs.

Anesthesia, General↗
PubMed1995

Pathologic effects in brain after intracranial pressure monitoring in clinically normal dogs, using a fiberoptic monitoring system.

During 2 separate studies, intracranial pressure (ICP) was measured in 13 healthy dogs (group A, n = 7; group B, n = 6), using a fiberoptic monitoring system implanted surgically in the right superficial cerebral cortex. Average ICP was measured for 15 minutes after a 15-minute postimplantation period of equilibration. Intracranial pressure was measured in group-A dogs at 2.0 and 1.3% end-tidal isoflurane concentrations. Mean +/- 1 SD ICP in group-A dogs at 2.0 and 1.3% end-tidal isoflurane concentrations was 11 +/- 2 and 11 +/- 3 mm of Hg, respectively. Dogs of group A were euthanatized immediately after measurements were obtained. Mean ICP +/- 1 SD in group-B dogs was 11 +/- 3 mm of Hg. After monitoring, but prior to euthanasia, group-B dogs underwent callosotomy, and were maintained for 30 days after surgery. The brain was removed from all dogs, formalin fixed, and examined grossly and microscopically for lesions associated with fiberoptic cable implantation. Variable degrees of hemorrhage and mechanical brain damage were seen focally around the catheter site in all brains from group-A dogs, especially when the cable entered through a sulcus. In 1 dog, local vacuolation was seen in the brain immediately adjacent to the tract associated with implantation of the fiberoptic catheter. In all other dogs, the additional cortex was histologically normal. Histologic lesions associated with cable implantation were not observed in group-B dogs.

Animals↗
PubMed1994

Possible role of imprinting in the Turner phenotype.

We have attempted to investigate the role of imprinting in the phenotype of Turner's syndrome. Sixty-three patients were investigated for parental origin of the retained normal X chromosome; 43 were found to retain the maternal X (XM) and 20 the paternal (XP). The relationship between a child's pretreatment height centile and parental height centiles was examined in 36 patients. No significant correlation was found between child and parental height centiles for XP or child and paternal height centiles for XM (p > 0.05) but a strong correlation was found between child's height centile and maternal height centile (p < 0.01) for XM. Using pooled data from this and other studies there was no significant correlation with renal anomalies but a strong correlation between cardiovascular abnormalities and XM (0.01 > p > 0.001) and neck webbing and XM (p < 0.05). We conclude that imprinting may play a part in the Turner's syndrome phenotype, especially with respect to pretreatment height, cardiovascular anomalies, and neck webbing.

Female↗
PubMed1994

Effects of altered arterial carbon dioxide tension on quantitative electroencephalography in halothane-anesthetized dogs.

Quantitative electroencephalography was assessed in 6 dogs anesthetized with 1.8% end-tidal halothane, under conditions of eucapnia, hypocapnia, and hypercapnia. Ventilation was controlled in each condition. Heart rate, arterial blood pressure, core body temperature, arterial pH, blood gas tensions, end-tidal CO2 tension, and end-tidal halothane concentration were monitored throughout the study. A 21-lead linked-ear montage was used for recording the EEG. Quantitative electroencephalographic data were stored on an optical disk for analysis at a later date. Values for absolute power of the EEG were determined for delta, theta, alpha, and beta frequencies. Hypocapnia was achieved by hyperventilation. Hypercapnia was achieved by titration of 5% CO2 to the inspired gas mixture. Hypercapnia was associated with an increase in the absolute power of the delta band. Hypocapnia caused an increase in the absolute power of delta, theta, and alpha frequencies. Quantitative electroencephalographic data appear to be altered by abnormalities in arterial carbon dioxide tension. Respiratory acidosis or alkalosis in halothane-anesthetized dogs may obscure or mimic electroencephalographic abnormalities caused by intracranial disease.

Animals↗
PubMed1993

Pre-mixed insulin delivered by disposable pen in the management of children with diabetes.

Pre-mixed insulin preparations are being used increasingly in the management of children with IDDM. Recently this form of insulin has been produced in a disposable insulin pen device. An open randomized 3-month crossover study was conducted to compare glycaemic control on a self-titrating insulin regimen with a pre-mixed (30:70) preparation, both given twice daily. The pre-mixed preparation was delivered by disposable pen. Forty children (age range 7-16 yr) entered the study. Mean +/- SEM glycosylated haemoglobin (HbA1 %) at the start of the study (13.1 +/- 0.6) compared with values at the end of the self-titrating (11.8 +/- 0.5) and pre-mixed periods (12.5 +/- 0.5), as well as blood glucose profiles taken at 3-weekly intervals, showed no significant change. Fourteen of the children were on insulin ratios other than 30:70 (range 10:90 to 50:50) and were unaffected by the switch (HbA1 at the start of the study 12.7 +/- 1; at the end of the self-titrating 11.5 +/- 0.8; and pre-mixed period 12.5 +/- 0.8). Twenty-one children continued on the pen for a further 12 months with no deterioration in control (HbA1 at the beginning and end of this period being 11.9 +/- 0.7 and 11.0 +/- 0.7, respectively). The children (95%) preferred the disposable pen and pre-mixed insulin regimen. Switching to pre-mixed insulin, while not improving, has no detrimental effect on glycaemic control.

Adolescent↗