Showing papers by "Leicester General Hospital published in 1988"
TL;DR: It can be concluded that young patients with simple dyspepsia are overinvestigated and a majority can be treated safely with antacids and/or histamine receptor type 2 antagonists.
174 citations
TL;DR: In this article, reports of violence associated with delusional misidentification are reviewed and four patients described who were either perpetrators or victims of assaults as a consequence of the syndromes of Fregoli, Intermetamorphosis, Subjective Doubles and Capgras.
Abstract: Among the mentally ill, those with well-developed delusions are more likely to commit violent crimes against persons than those with chronic, undifferentiated psychoses. Reports of violence associated with delusional misidentification are reviewed and four patients described who were either perpetrators or victims of assaults as a consequence of the syndromes of Fregoli, Intermetamorphosis, Subjective Doubles and Capgras. The cases illustrate the multiplicity of factors which have to be taken into consideration in order to predict whether an individual will act in a violent manner on these delusions.
96 citations
TL;DR: The clinical subjects produced widely varied results, and the data do not support hypotheses which suggest that eating disordered patients have had a childhood characterized by any particular pattern of parental relationship.
Abstract: The Parental Bonding Instrument (PBI) was used to compare the way in which a group of anorectic and a group of bulimic patients remembered their parents in childhood. The results were compared with published data. No differences were demonstrated on the “protection” score, but there were small and inconsistent differences on the “care” score. In general, the clinical subjects produced widely varied results, and the data do not support hypotheses which suggest that eating disordered patients have had a childhood characterized by any particular pattern of parental relationship.
91 citations
TL;DR: Cyclical therapy with oestrogens may be more appropriate particularly in women who are not suitable for surgery or have a mild degree of stress incontinence, along with other conservative measures such as pelvic floor exercises and a-adrenoceptor agonists.
Abstract: Symptomatic clinical changes and urodynamic changes are apparent in the female urinary tract system during pregnancy, the menstrual cycle and following the menopause. The sex hormones exert physiological effects on the female urinary tract, from the ureters to the urethra, with oestrogens having an additional influence on the structures of the pelvic floor. High affinity oestrogen receptors have been identified in bladder, trigone, urethra and pubococcygeus muscle of women. Oestrogen pretreatment enhances the contractile response of animal detrusor muscle to alpha-adrenoceptor agonists, cholinomimetics and prostaglandins, as well as enhancing the contractile response to alpha-agonists in ureter and urethra. Progesterone on the other hand decreases tone in the ureter, bladder and urethra by enhancing beta-adrenergic responses. The dependence on oestrogens of the tissues of the lower urinary tract contributes to increased urinary problems in postmenopausal women. Urinary symptoms due to atrophic mucosal changes respond well to oestrogen replacement therapy. However, because they recur when treatment is stopped, continuous therapy with low dose natural oestrogens is recommended. Oestrogens may be of benefit in postmenopausal women with stress incontinence, but the doses necessary for clinical effect are higher than for the treatment of atrophic urethritis. The practice of adding a progestagen to long term oestrogen therapy to reduce the risk of endometrial carcinoma may, however, exacerbate stress incontinence by decreasing urethral pressure. Cyclical therapy with oestrogens may therefore be more appropriate particularly in women who are not suitable for surgery or have a mild degree of stress incontinence, along with other conservative measures such as pelvic floor exercises and alpha-adrenoceptor agonists. The place of oestrogen therapy in motor urge incontinence has not been determined. The risk of developing endometrial carcinoma as a result of long term high dose oestrogen replacement therapy must be borne in mind but remains to be clarified. However, oestriol has less of a uterotrophic effect compared to other oestrogens in standard therapeutic doses and is to be preferred. Side effects are usually dose related and tend not to be a problem with low dose therapy.
87 citations
TL;DR: The results of the pelvic floor exercises for the treatment of genuine stress incontinence of urine were compared between two different hospitals geographically 50 miles apart, and 67% of patients achieved complete continence or a significant improvement as a result of pelvicfloor exercises alone.
69 citations
Journal Article•
TL;DR: It is suggested that the patient at risk of hypoxemia should, if possible, be endoscoped by an experienced endoscopist, and there were significant differences in degree of desaturation, lowest value during endoscopy and tolerance score.
68 citations
TL;DR: Wives of patients suffering a first myocardial infarction were studied and suggestions for early and systematic nursing intervention are made in an attempt to reduce stress and prevent the development of unhealthy patterns of behaviour.
Abstract: Seventy-six wives of patients suffering a first myocardial infarction were studied by questionnaire 6 weeks after their husbands went home. Despite the routine provision of support and information to spouses during their husband's stay in hospital, a high proportion reported physical and emotional symptoms of stress. The majority of wives felt they were poorly informed about myocardial infarction, had not had enough opportunity to ask the experts questions, and had received most support from relatives. The reasons for these findings are discussed and suggestions for early and systematic nursing intervention are made in an attempt to reduce stress and prevent the development of unhealthy patterns of behaviour.
68 citations
TL;DR: A case of hypertensive encephalopathy in a patient receiving recombinant erythropoietin (EPO) which was much more severe than the cases mentioned by Dr Raine in his review of the cardiovascular benefits and risks of correcting the anaemia of chronic renal failure with EPO is seen.
47 citations
TL;DR: Physical outcome in those with colorectal carcinoma was influenced by coping strategies only in the males, denial over diagnosis was significantly associated with poor outcome whereas fighting spirit over the stoma was associated with a good outcome.
46 citations
TL;DR: Age-related prescription figures for two non-steroidal anti-inflammatory drugs (NSAI) and co-trimoxazole matched ADR reports for each drug in each age group, where the reported ADR was more likely to be serious or fatal in the elderly.
Abstract: 1. Spontaneous reports of suspected adverse drug reactions (ADRs) reported to the Committee on Safety of Medicines (CSM) have been studied in relation to patient age. 2. The proportion of reports received for the elderly increased between 1965 and 1983. 3. There was a correlation between the use of drugs and the number of ADR reports. Thus age-related prescription figures for two non-steroidal anti-inflammatory drugs (NSAI) and co-trimoxazole matched ADR reports for each drug in each age group. 4. The reported ADR was more likely to be serious or fatal in the elderly. 5. The commonest ADRs reported for the elderly affected the gastrointestinal (GIT) and haemopoietic systems, where more reports were received than would be expected from prescription figures. 6. The drug suspected of causing a GIT reaction was a NSAI in 75% of the reports. 7. Ninety-one per cent of fatal reports of GIT bleeds and perforations associated with NSAI drugs were in patients over 60 years of age.
43 citations
TL;DR: In patients with severe renal disease, therapy with flecainide should be initiated at 100 mg daily (or 50 mg b.i.d.) and dosage increases should be made cautiously at intervals of more than 4 days when plasma levels have plateaued as demonstrated by plasma level monitoring.
Abstract: We studied the effect of renal disease on the pharmacokinetics of flecainide after single intravenous, single oral, and multiple oral doses to patients with severe renal disease (creatinine clearances <12 ml/min/m2). The absorption and volume of distribution of flecainide were not altered by renal impairment. The average plasma half-life was prolonged by about twofold that of healthy subjects but most patients were within the range of values for healthy subjects. Total body clearance was reduced. With multiple oral doses of 50 mg b.i.d. or 50 mg daily, steady-state plasma levels were reached by 6 days and no further accumulation in plasma was observed. In patients with severe renal disease, therapy with flecainide should be initiated at 100 mg daily (or 50 mg b.i.d.). If necessary, dosage increases should be made cautiously at intervals of more than 4 days when plasma levels have plateaued as demonstrated by plasma level monitoring.
Clinical Pharmacology and Therapeutics (1988) 43, 449–455; doi:10.1038/clpt.1988.57
TL;DR: Healthy young and elderly volunteers received 20 mg nifedipine (slow release) orally for 2 weeks with concomitant dosing of atenolol 50 mg orally during the second week and differences in diastolic blood pressure were not significant.
Abstract: 1. Healthy young and elderly volunteers received 20 mg nifedipine (slow release) orally for 2 weeks with concomitant dosing of atenolol 50 mg orally during the second week. 2. Drug kinetics and dynamics were compared between the groups after a single dose of nifedipine (day 1), after chronic dosing for 1 week (day 8), and following concomitant daily dosing of atenolol (day 15). 3. Plasma profiles of nifedipine were similar within each group on each of the 3 sampling days. The elderly group had higher plasma concentrations from about 6 h but there was no difference in the maximum concentrations achieved. The half-life in the elderly was significantly longer (8.8 +/- 0.9 h) compared with that in the young (5.8 +/- 1.1 h) (P less than 0.01). 4. Blood concentrations of atenolol were higher in the elderly at 12 and 24 h post-dose (P less than 0.001) and the AUC was greater than in the young (P less than 0.001). 5. Systolic blood pressure was reduced by nifedipine in both groups but to a greater extent in the elderly (P less than 0.01); differences in diastolic blood pressure were not significant. Blood pressure was reduced further by the addition of atenolol. Atenolol reduced the heart rate in all subjects.
Journal Article•
TL;DR: Despite differing techniques in different centers CAPD offered a satisfactory mode of therapy for many patients; peritonitis was the main reason for transfer to HD and several significant factors were identified.
Abstract: As many UK renal units commence more patients on CAPD than hemodialysis (HD) as the first mode of therapy a retrospective study of long-term CAPD (greater than 4 years continuous CAPD) was performed in 4 centers with substantial CAPD programs. One hundred and seventy-seven patients (103M, 74F) started CAPD before December, 1981. There was no difference in primary renal disease. Age was significantly greater in 2 units (51.9 +/- 11.7 and 53.2 +/- 12.1 vs 40.6 +/- 16.2 and 42.5 +/- 14.6 years, p less than 0.05) and correlates with pre-CAPD activity scores (Scale 3-0). After 4 years: 34 patients (19.2%) remained on CAPD: the proportion was similar in all centers. Sixty-five percent of patients were alive but 54% transferred to HD mainly due to peritonitis (overall 2.0 episodes/intercenter variation p less than 0.001). Fourty-four patients were transplanted. Significant increases occurred in hemoglobin, albumin, calcium and creatinine; a decrease in activity score (2.4 +/- 0.7 to 1.5 +/- 0.9, p less than 0.005); no change in weight, BP, urea or bone disease. Thirty-eight patients died, mainly cardiac (14) or sepsis (11). Using Cox's method of analysis significant risk multipliers were age (2.07 per decade), male sex (2.18), frequency of peritonitis (1.36), activity score less than 2 (4.45) and amyloidosis (12.45). Despite differing techniques in different centers CAPD offered a satisfactory mode of therapy for many patients; peritonitis was the main reason for transfer to HD and several significant factors were identified.
TL;DR: The presence of renal impairment, occurring as frequently as any of the pentad of features that characterize the Laurence-Moon-Biedl syndrome, has important implications for the prognosis and long term management of patients.
Abstract: Two cases of end stage renal failure occurring in association with the Laurence-Moon-Biedl syndrome are reported. Abnormalities in renal function and morphology are increasingly recognized in these patients in whom uraemia is an important cause of morbidity and early mortality. The presence of renal impairment, occurring as frequently as any of the pentad of features that characterize the syndrome, has important implications for the prognosis and long term management of these patients.
TL;DR: Dietary protein restriction should be applied with caution in human nephrotic syndrome in view of the effects of low-protein diet in this model of nephrotsic syndrome.
Abstract: Evidence that glomerulosclerosis may be accelerated by high-protein diet and ameliorated by low-protein diet has led to debate concerning appropriate dietary recommendations in nephrotic syndrome. In
TL;DR: The findings in these twins suggest that expression of the G syndrome can be strongly influenced by the prenatal developmental environment.
Abstract: We present clinical manifestations of monozygotic male twins with different degrees of expression of the G syndrome. Monozygosity was confirmed using DNA mini-satellite "fingerprint" analysis. The findings in these twins suggest that expression of the G syndrome can be strongly influenced by the prenatal developmental environment.
TL;DR: A highly structured test meal situation was used to examine the metabolic and behavioral response of restrained and unrestrained eaters to a disguised calorific preload and the results suggest a possible metabolic component to the phenomenon of counterregulation.
Abstract: A highly structured test meal situation was used to examine the metabolic and behavioral response of restrained and unrestrained eaters to a disguised calorific preload. Both restrained and unrestrained eaters ate initially more quickly after drinking a disguised glucose preload, compared with those who drank a glucose-free preload. Restrained eaters showed a comparatively greater increase in rate of eating, which tended to persist as a greater overall food consumption. The unrestrained group compensated for their initially greater consumption by eating less later in the meal. The excess eating occurred in conjunction with the release of excess insulin compared with circulatory glucose in response to the preload. In the unrestrained subjects, this declines together with the compensatory decrease in food consumption. For restrained eaters, the elevation of insulin/glucose ratio persisted and was comparatively greater, in conjunction with a persistent and relatively greater enhancement of food intake. Subjective reports and ratings indicated that the subjects were aware of neither the presence nor the behavioral and metabolic effects of the preload. The results suggest a possible metabolic component to the phenomenon of counterregulation.
01 Jan 1988
TL;DR: In this article, the authors compared Asian clients referred to a well-established sexual dysfunction clinic between 1981 and 1985 with 31 non-Asian clients referred in the same period and discussed the differences in sexual mores between the two cultures.
Abstract: Thirty-one Asian clients referred to a well-established sexual dysfunction clinic between 1981 and 1985 were matched for age and sex with 31 non-Asian clients referred in the same period. These two groups were compared on a number of characteristics including type of presenting problem, marital status, referral source and therapy outcome. The findings are discussed in the light of differing sexual mores between the two cultures.
Journal Article•
TL;DR: The concentrations of allergen and histamine commonly used for standardisation purposes will give weals that can be plotted along a straight line, but at higher and lower concentrations the response will tail off, accounts for previously ambiguous results.
Abstract: Twenty-six Dermatophagoides pteronyssinus (D.pt.) sensitive subjects were skin prick tested in duplicate with 15 concentrations of D.pt. ranging from 0.0018 to 17.8 mg/ml, 15 concentrations of the major allergen of D.pt., antigen P1, ranging from 0.0002 to 1.88 mg/ml and 15 concentrations of histamine dihydrochloride solution ranging from 0.048 to 114.0 mg/ml. Weal areas and concentrations were transformed by taking logs and linear and non-linear regression curves fitted, allowing for confounding variables, such as subject, and interactions. The weal areas over all concentrations fitted "S" shaped curves with essentially straight central portions, parallel between materials, with differences between subjects but parallel within subjects. The dose response curves of P1 and D.pt. were coincident when the concentrations were adjusted to allow for differences in potency. The concentrations of allergen and histamine commonly used for standardisation purposes will give weals that can be plotted along a straight line, but at higher and lower concentrations the response will tail off. This accounts for previously ambiguous results. Standardisation of allergens using 10 mg/ml histamine is preferable to 1 mg/mg.
TL;DR: Une observation: une femme de 53 ans, atteinte d'hypertension, d'insuffisance cardiaque, d'suffisance vasculaire peripherique and d'angor presente une aggravation de ces troubles et une anurie.
Abstract: Une observation: une femme de 53 ans, atteinte d'hypertension, d'insuffisance cardiaque, d'insuffisance vasculaire peripherique et d'angor presente une aggravation de ces troubles et une anurie. Le rein droit est atrophique et le rein gauche normal. Apres 2 j d'essais de traitement de l'anurie le diagnostic d'obstruction de l'artere renale gauche est fait, et l'operation, 72 h apres le debut de l'anurie, est efficace
Journal Article•
TL;DR: In this paper, a rectal villous adenoma was complicated by severe fluid and electrolyte depletion producing recurrent renal failure, and the pathophysiology of the depletion syndrome and its complications were discussed.
Abstract: A case is reported in which a rectal villous adenoma was complicated by severe fluid and electrolyte depletion producing recurrent renal failure. The pathophysiology of the depletion syndrome and its complications are discussed. Successful management by acute haemodialysis and early surgical resection of the tumour is described.
TL;DR: The analgesic efficacy of a 150-mg meptazinol suppository was compared with that of morphine 10 mg i.m. in the treatment of moderate postoperative pain in 15 female patients on the first day after elective abdominal hysterectomy.
Abstract: The analgesic efficacy of a 150-mg meptazinol suppository was compared with that of morphine 10 mg i.m. in the treatment of moderate postoperative pain. Two groups of 15 female patients took part in a 4-h, randomized double-blind, double-dummy study on the first day after elective abdominal hysterectomy. Meptazinol did not provide satisfactory analgesia in five patients (P