Showing papers by "Leicester General Hospital published in 1990"
TL;DR: Urinary incontinence is a major problem especially to the elderly and the only absolute indications for drug therapy in this condition are infection and atrophic urethritis.
Abstract: Urinary incontinence (UI) is a major problem especially to the elderly. The only absolute indications for drug therapy in this condition are infection and atrophic urethritis. Other causes of UI should be treated with behavioural remedies and physiotherapy. If these measures are impractical or fail to improve the condition, then we would recommend additional drug therapy.
160 citations
Journal Article•
TL;DR: Cases seen during these two periods did not differ by any clinical parameter except that later cases had less severe renal disease at referral and improved renal outcome, and may reflect increasing diagnostic awareness of WG and MPA among physicians since the introduction of ANCA.
Abstract: Thirty-six cases of Wegener's granulomatosis (WG) and microscopic polyarteritis (MPA) presenting to the nephrology service in Leicester between 1980 and 1989 were reviewed. Apart from the diagnostic respiratory tract lesions seen in WG, cases of MPA and WG could not be distinguished by age and sex, range and severity of organ involvement, response to treatment (oral prednisolone and cyclophosphamide), mortality or renal outcome. The combined incidence of WG and MPA in 1980-86 was 1.5/million/year. Following the introduction in January 1987 of an assay for anti-neutrophil cytoplasmic antibody (ANCA), the incidence of WG and MPA increased in 1987-89 to 6.1/million/year (p less than 0.0001). Cases seen during these two periods did not differ by any clinical parameter except that later cases had less severe renal disease at referral and improved renal outcome. Median serum creatinine was significantly lower at presentation in 1987-89 (p less than 0.02). Of those surviving 3 months from presentation only 1/20 in 1987-89 had end stage renal failure compared with 4/10 in 1980-86 (p less than 0.02). These findings may reflect increasing diagnostic awareness of WG and MPA among physicians since the introduction of ANCA.
102 citations
TL;DR: It is concluded that a simple programme of in-hospital counselling, provided by a coronary care nurse, is efficacious and should be routinely offered to first myocardial infarction patients in hospital.
96 citations
TL;DR: It is concluded that a simple programme of in hospital counselling is efficacious and should be routinely offered to the wives of coronary patients.
71 citations
TL;DR: It is concluded that, in young subjects, the postprandial blood pressure after a high carbohydrate meal is maintained by an increase in heart rate associated with increased sympathetic nervous system activity, at variance with the blood pressure and heart rate responses seen in the elderly after ahigh carbohydrate meal.
Abstract: 1. The responses of blood pressure, heart rate, autonomic function and plasma insulin to a high carbohydrate and a high fat meal of equivalent energy value were studied in nine young volunteers. 2. Neither meal produced a significant change in supine or erect blood pressure. The high carbohydrate meal, however, resulted in an overall rise in both supine (6 beats/min) and erect (6 beats/min; P less than 0.05) heart rate, no such changes being seen after the high fat meal. 3. Plasma noradrenaline levels increased by a maximum of 126% at 90 min (0.98 to 2.22 nmol/l) after the high carbohydrate meal but were virtually unchanged after the high fat meal (P less than 0.01). Parasympathetic function showed no between-meal differences. Plasma insulin and glucose levels were significantly higher after the high carbohydrate meal than after the high fat meal. No postprandial difference in packed cell volume was found between meal types. 4. We conclude that, in young subjects, the postprandial blood pressure after a high carbohydrate meal is maintained by an increase in heart rate associated with increased sympathetic nervous system activity. These changes are at variance with the blood pressure and heart rate responses seen in the elderly after a high carbohydrate meal. A high fat meal has no significant cardiovascular or neuroendocrine effects in the young or old. The nutrient composition of meals has to be taken into account when studying the postprandial cardiovascular and neuroendocrine responses in the young.
68 citations
TL;DR: In this paper, the issue of the specificity of the scales of the Eating Disorders Inventory (EDl) was reexamined by comparing the scores of a group of non-eating-disordered psychiatric patients with groups of subjects with anorexia nervosa and bulimia.
Abstract: The issue of the specificity of the scales of the Eating Disorders Inventory (EDl) was reexamined by comparing the scores of a group of non–eating-disordered psychiatric patients with groups of subjects with anorexia nervosa and bulimia. After correction for the effects of age, expected differences were observed on most of the scales whose content directly concerned attitudes and behaviors about weight and eating but on none of those concerned with other matters. Thus, the study failed to find evidence that Ineffectiveness, Perfectionism, Interpersonal Distrust, and Maturity Fears, as measured by the EDl, have any specific association with eating disorders when compared with other psychiatric conditions of comparable severity.
61 citations
TL;DR: Differences in both the microprocessor programmes and the physical characteristics of the finger probes may explain the observed differences in function.
Abstract: The ability of the Ohmeda 3700, Nellcor N200, Datex Satlite Plus and Simed S100 pulse oximeters to detect induced hypoxaemia in the presence of motion artefact was assessed, under conditions of controlled vibration using an industrial vibration facility. Vibration at 4 Hz and 8 Hz induced increases in detection time for hypoxaemia and spurious decreases in the displayed SaO2 in some of the oximeters tested. Finger-dependent differences in oximeter performance and pulse rate registration were noted especially in those oximeters without ECG linkage (Ohmeda 3700 and Simed S100). Subsequently, eight different pulse oximeter finger probes were assessed for those characteristics that may predispose to motion artefact. There were marked differences in the mass of the probes, the forces exerted on the test finger and in the force required to displace the probes from the subject's finger. Differences in both the microprocessor programmes and the physical characteristics of the finger probes may explain the observed differences in function. Similar studies should form part of the standard evaluation of new pulse oximeters.
60 citations
TL;DR: The use of subclavian vein catheters during hemodialysis was associated with a high incidence of gram-positive septicemia and the use of alkylating agent-based chemotherapy resulted in hematological responses in five patients.
40 citations
TL;DR: The use of diuretics, antihypertensives, anti-Parkinsonian drugs and anticoagulants emphasise these points, and is discussed in detail together with digoxin, analgesics and nonsteroidal anti-inflammatory drugs.
Abstract: The incidence of adverse drug reactions increases with aging, and the elderly are more likely to suffer serious or fatal reactions. Thus, morbidity and mortality are considerable in old patients, with 15% of those in hospital suffering a reaction, and many admitted as a consequence of one. The greater propensity of older patients for adverse drug reactions largely reflects the prescription of drugs to them, although over-the-counter purchases must also play a part. The elderly take more drugs per se (which is a reflection of multiple pathology), and more drugs with a narrow therapeutic index associated with a high risk of dangerous adverse reactions and drug interactions. They also have a reduced ability to withstand any reactions due to concomitant disease, and an altered pharmacokinetic and -dynamic response which tends to increase drug effects. The recommendation must be to use fewer drugs in older patients, perhaps trying alternative medicine first in nonacute conditions. Starting doses can often be reduced in the elderly, and clinical and therapeutic monitoring of effect is mandatory. The use of diuretics, antihypertensives, anti-Parkinsonian drugs and anticoagulants emphasise these points, and is discussed in detail together with digoxin, analgesics and nonsteroidal anti-inflammatory drugs. Clear guidelines are given for the use of each of these classes of drug.
38 citations
TL;DR: 39 missionaries working at 38 separate mission hospitals or clinics in Bangladesh completed questionnaires about their clinical practice during the previous year, 1980, about gastrointestinal disorders, including coeliac disease, tropical sprue, bloody diarrhoea, amoebiasis, typhoid, cholera, inflammatory bowel disease and diverticular disease.
Abstract: 39 missionaries working at 38 separate mission hospitals or clinics in Bangladesh, India, Nepal and Pakistan completed questionnaires about their clinical practice during the previous year, 1980. Data
34 citations
TL;DR: Patients and wives in the treatment group reported statistically significantly more satisfaction than those in the control group, and this effect was sustained for 6 months after counselling.
Abstract: Self-ratings of satisfaction were studied over 6 months in 60 male first-time myocardial infarction patients and their wives. Couples were randomly assigned to either a treatment group, where they received a simple programme of education and psychological support in addition to routine care, or to a control group, where they received routine care only. All patients completed visual analogue scales measuring satisfaction regarding their general health, life in general, care and information received. All wives completed visual analogue scales measuring satisfaction regarding information received and care the patient received. Patients and wives in the treatment group reported statistically significantly more satisfaction than those in the control group. This effect was sustained for 6 months after counselling.
TL;DR: Laryngeal oedema occurred after formation of a neck haematoma after attempted internal jugular vein cannulation which resulted in complete respiratory obstruction and respiratory arrest and it was impossible to ventilate her lungs manually or intubate her trachea.
Abstract: Summary
Laryngeal oedema occurred after formation of a neck haematoma after attempted internal jugular vein cannulation. This resulted in complete respiratory obstruction and respiratory arrest and it was impossible to ventilate her lungs manually or intubate her trachea. Oxygenation of the patient was only possible using transtracheal ventilation.
TL;DR: Both NDS and BDP resulted in a significant improvement in asthma control in the subjects studied, and both drugs caused a similar improvement in PEF.
TL;DR: One hundred adult male psychiatric patients were investigated concerning their recollections of defined sexual activities occurring with adults before the age of sixteen, remembering the events as having been mostly distressing at the time but their later significance is unclear.
Abstract: One hundred adult male psychiatric patients were investigated concerning their recollections of defined sexual activities occurring with adults before the age of sixteen. Twenty-three subjects reported such events. The events were remembered as having been mostly distressing at the time but their later significance is unclear. Language: en
TL;DR: It is suggested that twice-daily insulin therapy from diagnosis in childhood and regular contact with the diabetic clinic decreased the prevalence of diabetic nephropathy in this population of juvenile-onset diabetics.
Abstract: The prevalence of diabetic nephropathy was studied in a population of 847 juvenile-onset (insulin-dependent) diabetics diagnosed under the age of 17 years who attended diabetic clinics in Leicestershire between 1930 and 1985. Seven hundred and eighty-nine patients (93.2 per cent) were traced. Eight patients with non-diabetic proteinuria and four classified as maturity-onset diabetics of the young were excluded from further analysis. The mean age at onset was 9.3 +/- 4.2 years (mean +/- SD) and the mean duration of diabetes 17.0 +/- 10.6 years (range 3-63 years). Overall, 28 patients (3.6 per cent) developed persistent proteinuria and 39 patients (five per cent) intermittent proteinuria. End-stage renal failure developed in eight patients. In patients with diabetes of 20 years duration (n = 254) the prevalence of persistent proteinuria was 9.1 per cent and of intermittent proteinuria, 7.9 per cent. Systolic and diastolic blood pressures were elevated in diabetics with persistent proteinuria compared to patients without proteinuria (154/89 +/- 27/15 vs 123/76 +/- 15/9 mm Hg mean +/- SD; p less than 0.001). Systolic blood pressure was also raised in patients with intermittent proteinuria (133/77 +/- 17/12, p less than 0.005). In addition, proteinuria (intermittent and persistent) was significantly associated with the use of once-daily insulin therapy in childhood and poor clinic attendance. This study suggests that twice-daily insulin therapy from diagnosis in childhood and regular contact with the diabetic clinic decreased the prevalence of diabetic nephropathy in this population.
TL;DR: Respiratory monitoring with an inductance plethysmograph and pulse oximeter showed that treatment over a 4 night period did not increase significantly the severity, frequency or duration of hypoxaemic episodes leading to SaO2 less than 90% or less than 85% when compared with placebo.
Abstract: 1. In a double-blind placebo controlled trial, zolpidem 10 mg, a new imidazopyridine hypnotic drug, was administered to 10 elderly female patients and placebo to 11, all recovering from hip and knee replacement surgery. Respiratory monitoring with an inductance plethysmograph and pulse oximeter showed that treatment over a 4 night period did not increase significantly the severity, frequency or duration of hypoxaemic episodes leading to SaO2 less than 90% or less than 85% when compared with placebo. Confidence intervals (corrected for baseline differences) for the median differences between the two groups on night 7, the fourth night of treatment, were from -1.85 to 0.480 and from -1.07 to 0 respectively for the frequency, and from -0.76 to 0.15 and -0.5 to 0 for the duration of the hypoxaemic episodes. The incidence of sleep related respiratory disturbances was not significantly increased compared with placebo on any night. 2. Respiratory monitoring using a simple inductance plethysmograph and pulse oximeter is acceptable to patients and staff. 3. The evaluation of all hypnotic and sedative drugs should include their effects on respiration during sleep.
01 Jun 1990
TL;DR: A safe method of percutaneous renal transplant biopsy using real time ultrasound guidance that provides a good histological sample, is straightforward and has a low complication rate is described.
Abstract: We describe a safe method of percutaneous renal transplant biopsy using real time ultrasound guidance. The method provides a good histological sample, is straightforward and has a low complication rate.
TL;DR: A novel fingertip injury found in rock climbers is reported on, which is associated with more extreme use and training than previously reported.
Abstract: The sport of rock climbing has undergone a significant change in recent times with technically harder climbs being attempted more often. This has meant that climbers have taken to more training including weight training, using artificial climbing walls and the more traditional 'bouldering' i.e. training on natural outcrops and boulders. This increase in standards has led to injuries associated with more extreme use and training. This paper reports on a novel fingertip injury found in rock climbers.
TL;DR: Results indicate that cultured human glomerular cells take up LDL by receptor-mediated endocytosis, specific for LDL, of high affinity and inhibited by excess unlabelled LDL, heparin and preloading the cells with cholesterol.
Abstract: Lipoproteins might be involved in the pathogenesis of glomerular damage. Uptake of low-density lipoprotein (LDL) by cultured human glomerular cells has been studied using LDL, labelled with the fluore
TL;DR: It is suggested that the beneficial effect conferred by nifedipine on cyclosporin A nephrotoxicity is present only when treatment is initiated simultaneously with cyclospora A.
Abstract: 1. This study investigates the effect of nifedipine on cyclosporin A nephrotoxicity in the spontaneously hypertensive rat. 2. Cyclosporin A, administered daily by subcutaneous injection at 25 mg/kg body weight for 14 days, induced a significant reduction in glomerular filtration rate (35.3%) and effective renal plasma flow (45.0%), and an increase in renal vascular resistance (219%). Using this regimen, tubular, glomerular or vascular morphological damage was not evident on light microscopy. 3. The administration of nifedipine simultaneously with cyclosporin A from day 1 prevented the characteristic decline in renal function and increase in renal vascular resistance. However, the administration of nifedipine to spontaneously hypertensive rats previously exposed to cyclosporin A for 7 days failed to improve renal haemodynamics. 4. This study suggests that the beneficial effect conferred by nifedipine on cyclosporin A nephrotoxicity is present only when treatment is initiated simultaneously with cyclosporin A.
TL;DR: The morphine hydrogel suppository appears to be an effective means of delivering morphine and may be of value in the management of chronic pain.
Abstract: 1. A sustained release monolithic morphine hydrogel suppository (MHS) was developed and administered to five volunteers. 2. The MHS delivered a mean of 55 mg morphine over 12 h. The mean plasma morphine concentration was 15 ng ml-1 from 2 to 12 h after administration. 3. Plasma morphine concentrations were comparable with those reported for the same dose given orally over the same time period. 4. The morphine hydrogel suppository appears to be an effective means of delivering morphine and may be of value in the management of chronic pain.
01 Aug 1990
TL;DR: In this article, a treatment approach that employs cognitive behavioural techniques, including exposure and response prevention, is described and illustrated by case example, and a case example of exercise addiction in the anorexic population is presented.
Abstract: Despite being a long recognized feature of Anorexia Nervosa, exercising has been largely neglected as a topic for research and treatment. An increasing cultural emphasis on fitness has highlighted the dangers of becoming addicted to exercise and its role in the development and maintenance of Anorexia Nervosa. Most estimates of the incidence of exercise addiction in the anorexic population are high, and the behaviour would appear to pre- and post-date the eating disorder.In view of this, the development of an effective treatment method for this particular problem is needed. One such approach that employs cognitive behavioural techniques, including exposure and response prevention is described and illustrated by case example.
TL;DR: In three patients pain in the groin and thigh which was initially attributed to either a malfunctioning hip prosthesis or osteoarthritic hip, was shown to arise in the spine.
Abstract: In three patients pain in the groin and thigh which was initially attributed to either a malfunctioning hip prosthesis or osteoarthritic hip, was shown to arise in the spine. All patients had positive myelograms and one had electromyographic evidence of nerve root compression. Referred pain from the spine must always be considered in the differential diagnosis of pain thought to be arising from a hip replacement.
TL;DR: The majority of patients were unaffected in their social activities by surgery, although 18% gained confidence and 12% lost it, and these problems were unaffected by age at operation.
Abstract: There is no clear definition of who is "elderly." For the purpose of this review, we studied ileostomists over the age of 60. Fifty of 55 such members of the Ileostomy Association completed a questionnaire about problems they had experienced. The mean age of the respondents was 68.5 +/- 5.5 years, and they had had an ileostomy for 14.6 +/- 10.2 years. Only 68% of patients felt that they had received a full explanation before surgery. Family members and the Ileostomy Association had been most effective in support of the ileostomist; stoma therapists less so. Thirty-two percent of patients were shocked or repelled by their stoma immediately after surgery, and 54% had problems touching or cleaning it, although their difficulties diminished with time. The majority of patients were unaffected in their social activities by surgery, although 18% gained confidence and 12% lost it. These problems were unaffected by age at operation.
TL;DR: A case of acute renal failure in association with a deliberate labetalol overdose is described and the possible pathogenetic mechanisms behind the deterioration in renal function are discussed.
Abstract: A case of acute renal failure in association with a deliberate labetalol overdose is described. The possible pathogenetic mechanisms behind the deterioration in renal function are discussed. Treatment of beta-blockade overdose, with special emphasis on the place of glucagon in such poisoning, is reviewed.
TL;DR: Both thiazide diuretics and beta-adrenoceptor antagonists are of proven value as first line hypotensive agents in the elderly and should be tried initially before resorting to drug therapy.
Abstract: Hypertension is common in the elderly, up to half of the population over the age of 65 years can be so classified. Raised systolic and diastolic blood pressure levels increase the risk of cardiovascular morbidity and mortality in those aged up to 80 years. Recent intervention studies have shown that antihypertensive treatment reduces death from stroke and myocardial infarction, without producing intolerable side-effects. The benefits of treating isolated systolic hypertension and hypertension following stroke are, as yet, unproven. The therapeutic goals for treating hypertension in the elderly should be to lower blood pressure while keeping adverse reactions to a minimum and thereby not impairing the patient's quality of life. Non-pharmacological methods should be tried initially before resorting to drug therapy. Both thiazide diuretics and beta-adrenoceptor antagonists are of proven value as first line hypotensive agents in the elderly. Drug therapy should be tailored to the individual patient and increased slowly to reduce the incidence of side-effects.
TL;DR: The management of elderly diabetic patients by 100 geriatrician and 100 diabetologists was assessed by a postal questionnaire and geriatricians were less likely to check the visual acuities and more likely to refer a patient with maculopathy to an ophthalmologist.
Abstract: The management of elderly diabetic patients by 100 geriatricians and 100 diabetologists was assessed by a postal questionnaire. Replies were initially received from 54 geriatricians and 81 diabetologists (p less than 0.001); geriatricians were re-contacted increasing replies to 71. The geriatricians were less likely to check the visual acuities (p less than 0.001), less likely to dilate the pupils for fundoscopy (p less than 0.025), less likely to refer a patient with maculopathy to an ophthalmologist (p less than 0.001), more likely to discharge a stable diabetic to general-practitioner care (p less than 0.05), less likely to use insulin (p less than 0.01) or antidepressants (p less than 0.01) in treating painful peripheral neuropathy, and more likely to use glibenclamide instead of a shorter-acting sulphonylurea (p less than 0.001).
TL;DR: Results indicate that large doses of heparin can enhance the removal of antigen from well‐established glomerular deposits, and may be independent of its anticoagulant properties.
Abstract: Chronic serum sickness glomerulonephritis was induced in rats using 125I-labelled cationic bovine serum albumin as antigen During the recovery period the animals were given protamine or polyethyleneimine (PEI), both of which are cationic, or heparin, which is anionic A control group received saline The cationic molecules were not shown to influence the rate of removal of antigen from the glomeruli, but heparin increased removal In subsequent experiments this effect of heparin was confirmed, and a similar effect was demonstrated using low molecular weight heparin These results indicate that large doses of heparin can enhance the removal of antigen from well-established glomerular deposits Fibrin is not detectable in the glomeruli in this model, so this effect of heparin may be independent of its anticoagulant properties