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Biomedical subjects

W Gilchrist

Publications and source records attributed to W Gilchrist.

6 recordsLinked to original sources
PubMed1994

The effect of indomethacin on the secretion of human salivary epidermal growth factor.

Ulceration associated with nonsteroidal anti-inflammatory drug (NSAID) use is a common problem in elderly patients. The postulated cause of NSAID ulceration is multifactorial but is probably related to the inhibition of the cyclo-oxygenase pathway and a subsequent decrease in mucosal prostaglandin levels. Epidermal growth factor (EGF), on the other hand, has been shown to be gastroprotective, stimulating DNA synthesis, and preventing ASA-induced gastric ulceration. Since EGF is important in gastric mucosal protection, we questioned whether the potential ulcerogenic properties of indomethacin were related in part to decreasing salivary EGF. Twenty healthy male volunteers with no gastrointestinal complaints received indomethacin 50 mg P.O. t.i.d. for 3 consecutive days. Saliva and serum were collected before indomethacin treatment and repeated 2 h after the last indomethacin dose. Stimulated salivary samples were collected for 15 min in fasted subjects and assayed for EGF, whereas serum indomethacin levels were determined by high-performance liquid chromatography. EGF levels significantly decreased by 33% after indomethacin (p < 0.03), and this decrement was linearly related to serum indomethacin concentrations (r = 0.58; p < 0.048). Salivary output did not change after indomethacin treatment. Based on this data, we concluded that indomethacin's ulcerogenic properties may be related to its prostaglandin inhibitory properties as well as its ability to decrease salivary EGF output.

Adult↗
PubMed1993

Do stroke units save lives?

Management of stroke patients in specialist stroke units hastens recovery but is not believed to influence mortality. We did a statistical overview of randomised controlled trials reported between 1962 and 1993 in which the management of stroke patients in a specialist unit was compared with that in general wards. We identified 10 trials, 8 of which used a strict randomisation procedure. 1586 stroke patients were included; 766 were allocated to a stroke unit and 820 to general wards. The odds ratio (stroke unit vs general wards) for mortality within the first 4 months (median follow-up 3 months) after the stroke was 0.72 (95% CI 0.56-0.92), consistent with a reduction in mortality of 28% (2p < 0.01). This reduction persisted (odds ratio 0.79, 95% CI 0.63-0.99, 2p < 0.05) when calculated for mortality during the first 12 months. The findings were not significantly altered if the analysis was limited to studies that used a formal randomisation procedure. We conclude that management of stroke patients in a stroke unit is associated with a sustained reduction in mortality.

Aged↗
PubMedDate not supplied

A formal overview of stroke unit trials.

We carried out a formal overview of the ten trials which compared the outcome of patients managed within a stroke unit with those managed in general wards. Care in a stroke unit was associated with an odds reduction for early mortality (median follow up 3 months) of 28% (95% confidence interval 8-44%; 2 p < 0.01), which was largely sustained (odds reduction 21% CI 1-37%; 2p < 0.05) at final review (median follow up 1 year). The odds reduction for a poor outcome (death or institutionalisation) at final review was 34% (95% CI 19-47%; 2p < 0.001). The mean length of stay in stroke units ranged from 61% to 133% (pooled result 96%) of that in general wards. Stroke patients managed within specialist units are more likely to be alive and living at home a year after the stroke than those managed in general wards. Stroke unit care does not apparently increase the time spent in hospital.

Brain↗