Biomedical subjects
Publications and source records attributed to W Lopatin.
The drive for evidence-based care is placing new demands on NHS libraries. Wendy Lopatin offers a guide to sources of healthcare information, and Pauline Blagden describes overhauling library services in a community trust.
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From January 1, 1986 to July 30, 1988, 530 consecutive cadaver kidney transplantations were performed with patient selection by a point system that took into account time awaiting an organ, donor-recipient matching, degree of presensitization, and some less important factors. The effect of the system was to diminish judgmental factors in case selection which in the past, had probably operated to the disadvantage of "undesirable" potential recipients, including older ones. Primary 1-year graft survival (74%) and graft survival after retransplantation (71%) were lower than in the earlier time. However, the results with triple-drug therapy using CsA, AZA and P demonstrated 88% 1-year graft survival for primary graft recipients and 74% in highly sensitized patients, with comparable patient mortality. These latter observations provide some assurance that the concepts of equitable access and efficient utilization of a scarce resource are not mutually exclusive.
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Acute and chronic nephrotoxicity directly attributable to cyclosporine (CyA) administration remains an obstacle to its successful use. The studies presented in this report characterize the cytoprotective properties of 16,16-dimethyl prostaglandin E2 in a lethal CyA-induced nephrotoxic rodent model. Wistar-Furth rats (200-250 g) receiving CyA alone (100 mg/kg/day) showed marked deterioration in renal function with severe histologic renal lesions and death of the majority of animals by day 7. The prostaglandin treated group (10/micrograms/kg/day) administered concomitantly with CyA demonstrated near normal renal function and histology by the eighth day after CyA discontinuation, and in a significant improvement in animal survival of 85% (p less than 0.001, n = at least 20 rats/group). These studies demonstrate a novel approach to a major problem with cyclosporine and should have exciting clinical potential.
Pattern recognition techniques--discriminant analysis and principal component analysis--are utilized in selecting the wavelengths for monitoring, by reflectance spectroscopy, color-generating reactions involving uric acid and cholesterol in serum. The data base we used was accumulated by a rapid-scanning reflectance spectrophotometer that measured reflectance at 16 wavelengths every 5 s after the reaction was initiated. The data were then analyzed in multidimensional space mainframe computer with commercial statistical software packages. The most appropriate wavelengths were those that yielded the largest generalized distance between analyte concentration by discriminant analysis and the largest weighting coefficient by principal component analysis. For uric acid, taking the ratio of reflectance measured at two wavelengths instead of at a single wavelength much better separates the clinically significant concentrations. For cholesterol, the initiated. The data were then analyzed in multidimensional space hemoglobin, can be clearly demonstrated y the "pattern" generated with principal component analysis. generalized distance between analyte generalized distance between analyte concentration by discriminant
Nineteen patients with insulin-dependent diabetes mellitus were evaluated for overall reliability of self-generated data from capillary blood glucose monitoring. For a period of 12 to 14 days, standard reflectance meters used by these subjects were replaced by meters internally modified with memory chips capable of storing all glucose readings by date and time. The subjects were not aware of this modification and were instructed to continue to test capillary blood glucose as they had been and to continue their practice of recording the meter readings in a logbook. To assess reliability of patient-generated data as recorded in the logbook, the addition, deletion, and alteration of test results were determined. A significantly lower (p less than 0.0001) mean blood glucose level was reported in the logbooks than recorded in the memory reflectance meters. Differences in logbooks and memory reflectance meters ranged from 0 to 109 mg/dl. Three fourths of the subjects had reported lower than actual mean blood glucose values. Under-reporting, or omission of memory reflectance meter readings, averaged 10 percent, whereas over-reporting or addition of phantom values averaged 40 percent. An average of 26 percent of the logbook entries were not identical to memory reflectance meter values determined at the corresponding time. Two thirds of the subjects had reported values in such a manner as to obscure hyper- and hypoglycemia, leading to misleading clinical impressions about the fluctuation in metabolic control. Previous glycemic control, patterns of logbook recording, or visits to the clinic were not found to be predictive of the reliability of patient self-monitoring regimens.
In 270 consecutive patients who presented with hematuria over a 12-month period, complete visualization of the urinary tract by urography and cystoscopy indicated a causative lesion in over 90%. Where a cause could not be found on the first presentation, the initial evaluation was repeated within 4 months, revealing the previously missed diagnoses in four patients. Of patients who bled while receiving anticoagulants, 17% were found to have an important underlying cause other than anticoagulant therapy. Despite repeated evaluation, and in many instances more elaborate investigation with angiography, computerized tomography and ultrasonography, no reasonable diagnosis could be made in 6% (12% of those with microscopic hematuria, 4% with gross hematuria). One hundred and fifty-nine patients with unexplained hematuria, seen between 1975 and 1983, were studied. The triad of "gross, total and painless" was present in 15%. Patients who bled heavily from one kidney without any apparent cause benefited from orally administered epsilon aminocaproic acid.
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