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Biomedical subjects

A D Wright

Publications and source records attributed to A D Wright.

At least 109 records · Page 6Linked to original sources
PubMed1985

Impaired glucose tolerance in the third trimester of pregnancy.

When the methods and interpretation of glucose tolerance as recommended by the World Health Organisation were applied to 247 patients in the third trimester of pregnancy selected on account of glycosuria, previous large-for-dates offspring, diabetic family history, maternal obesity or a fetus large for gestational age, impaired glucose tolerance (IGT) was found in 20 (8.1%). Patients with IGT were older than those with normal tests: 30.5 +/- 4.8 years (mean +/- S.D.) vs 27.8 +/- 4.8 years (p less than 0.02) and more having IGT had a first degree family history of diabetes (25% vs 10%, p less than 0.05). The majority (15) of the IGT patients then received dietary advice to restrict refined carbohydrate. Post-prandial blood glucose and HbA1 concentrations in these subjects remained within the normal range except for one patient who was treated with insulin. Pregnancy outcome was satisfactory in the patients with impaired tolerance and further studies will be required to assess the clinical significance of IGT in pregnancy.

Adult↗
PubMed1985

The clinical assessment of acute mountain sickness.

During three expeditions to high altitude the Birmingham Medical Research Expeditionary Society has studied the effects of the ascents on its members. The severity of acute mountain sickness (AMS) produced was assessed by three methods, interview, self assessment and peer review. Physical examination was unhelpful. The results of the three methods were closely correlated. Clinical interview permitted allowances to be made for individual factors such as fatigue. There was no tendency for self assessment to indicate effects consistently more or less than the other methods. Peer review revealed a wide spread of opinions but the large number of observers allowed the derivation of plausible mean values. Correlation of AMS with arterial pH and PaCO2 showed little relationship but correlation with PaO2 was good, particularly for self assessment. As all the methods are subjective a combination of techniques is recommended for future expeditions.

Acute Disease↗
PubMed1985

The Environmental Symptoms Questionnaire in acute mountain sickness.

A self-completed questionnaire (modified Environmental Symptoms Questionnaire) was evaluated in a study of acute mountain sickness (AMS). The questionnaire scores for headache, nausea, and the general feeling of ill health correlated well with AMS scores obtained by clinical interview. Modifications in the instructions and the phrasing of some of the questions are suggested and we doubt whether factor analysis provides any better data than more simple statistical methods. The questionnaire is a useful additional method for the assessment of symptoms of AMS.

Acute Disease↗
PubMed1985

Cigarette smoking, blood pressure and the control of blood glucose in the development of diabetic retinopathy.

We have investigated the relationship between diabetic retinopathy and cigarette smoking, blood pressure, control of blood glucose, duration of diabetes and insulin requirement in a cross sectional study of 193 adult patients attending 2 diabetic follow-up clinics. Multiple discriminate analysis demonstrated that the duration of diabetes was closely related to the development of retinopathy in both sexes. Cigarette smoking was related to retinopathy in men but not in women, although in that group the prevalence of smoking was low. The average blood glucose whilst attending the clinic was weakly related to retinopathy in men only whereas the presence of hypertension was weakly related in women only. Cigarette smoking in men at least may be an aggravating factor for diabetic retinopathy.

Age Factors↗
PubMed1984

Newly diagnosed, insulin-dependent diabetes mellitus in elderly patients.

Over a two-year period 398 out of 1776 new referrals to a diabetic clinic were newly diagnosed diabetic patients aged 65 years and over. Initial treatment of this group was diet--122 (31%), diet plus oral hypoglycaemic agents--232 (58%) and diet plus insulin--41 (10%). Sixteen (39%) of the group treated initially with insulin died within 3.5 years of diagnosis compared with 21% of the 345 patients treated with diet +/- oral hypoglycaemic agents who were followed for this time. Twenty-five patients treated initially with insulin survive but 8 have stopped insulin and are treated with diet +/- oral hypoglycaemic agents, and a further 5 had a period of 6-24 months on oral therapy. Twelve patients have been treated with insulin continuously but of these only 3 are clearly insulin-dependent. These data suggest that true dependence on insulin is uncommon in patients aged 65 years or over at diagnosis.

Aged↗
PubMed1984

The hypothalamic-pituitary-thyroid axis in type 1 diabetes: influence of diabetic metabolic control.

The influence of diabetic metabolic control on indices of thyroid function was studied in 9 euthyroid, insulin-dependent (Type 1) diabetics. During chronic poor metabolic control (mean fasting blood glucose 13 mmol/l and HbA1 concentrations 14.7%) serum T3 concentrations were low (P less than 0.01) while serum T4 and basal TSH concentrations were normal. After 6-8 weeks of improved metabolic control, mean HbA1 concentrations had fallen to 10.7% (P less than 0.01) and serum T3 concentrations had increased into the normal range. Serum T4 and basal TSH concentrations were unchanged. The serum TSH response to iv TRH remained normal throughout the study. In Type 1 diabetics, with chronic poor metabolic control, the serum T4 concentration and the TSH response to TRH are therefore appropriate indicators of thyroid function.

Adult↗
PubMed1983

Insulin immunogenicity in pregnancy: maternal and fetal studies.

Antibodies to insulin were found in 92% of the 138 insulin-treated pregnant diabetic patients studied. No effect of pregnancy was shown on insulin antibody levels. Higher insulin antibody levels were significantly associated with the previous use of conventional insulins. Change from conventional to highly purified porcine insulin during pregnancy produced a significant reduction in insulin antibody levels. The combination of protamine zinc and soluble insulin used before pregnancy was found to be the most immunogenic. Insulin antibodies were freely transferred to the fetus but not detectable after the first 8 months of life. No insulin antibodies were found in the cord blood or during the next few weeks in the infants of mothers who had no antibodies to their injected insulin. There was a tendency for higher insulin antibody levels to be associated with indices of neonatal morbidity but not with percentile birth weights and C-peptide levels in cord sera.

Animals↗
PubMed1983

Inaccuracy of oesophageal pressure for pleural pressure estimation in supine anaesthetized subjects.

Oesophageal pressure was measured, using a balloon and catheter system, at three or four positions in the oesophagus of eight supine subjects anaesthetized with 1-1.5% halothane in 67% nitrous oxide. Airway pressure and the difference between airway and oesophageal pressures were recorded during occlusion of inspiration, occlusion of expiration and occlusion of expiration followed by inspiratory occlusion. Lung volume could not change appreciably during these manoeuvres, so the difference between airway and oesophageal pressure should not have changed. The change in oesophageal pressure was less than the change in airway pressure in 86 of 90 measurements. The change in oesophageal pressure was expressed as a fraction of the change in airway pressure: the maximum fraction was obtained in each patient, and the mean of these maximum values was 82%. This suggests that changes in the difference between airway and oesophageal pressures will overestimate the change in transpulmonary pressure during artificial ventilation in supine subjects, and that lung compliance would be underestimated.

Adult↗
PubMed1983

Spontaneous abortion and diabetes mellitus.

In 58 consecutive pregnancies in insulin-dependent diabetic women, glycosylated haemoglobin levels were abnormally high in 78% at the time of booking for antenatal care. Spontaneous abortion was the outcome in 15 pregnancies, 10 occurring before the 15th week of gestation. Glycosylated haemoglobin levels were significantly higher in those women who aborted spontaneously than in women who delivered successfully (12.8 +/- 1.8% v. 11.2 +/- 2.3%, mean +/- s.d.). These results emphasise the inadequacy of diabetic control in the first trimester and lend further support to the importance of good control at this critical time in insulin-dependent diabetes.

Abortion, Spontaneous↗
PubMed1983

Methazolamide and acetazolamide in acute mountain sickness.

Methazolamide (150 mg/d) was as effective as acetazolamide (500 mg/d) in preventing the symptoms of acute mountain sickness in 20 subjects ascending to 4985 m. PaO2 and oxygen saturation levels were similar on the two drugs but the fall in PaCO2 was greater on acetazolamide. Paraesthesiae, a side-effect of carbonic anhydrase inhibitors, tended to be less at high altitude on methazolamide and was significantly less when taking 100 mg/d at low altitude. It is likely that paraesthesiae is similar on the two drugs when given in doses that affect blood gases equally.

Acetazolamide↗
PubMed1982

A prospective study of the effect of 12 months treatment on serum lipids and apolipoproteins A-I and B in Type 2 (non-insulin-dependent) diabetes.

Serum high density lipoprotein cholesterol, total cholesterol, triglyceride and apolipoproteins A-I and B were studied at diagnosis and after 12 months conventional treatment in a group of Type 2 (non-insulin-dependent) diabetic patients. No significant deleterious effect on serum lipids and apolipoproteins was seen in any of the subgroups during the treatment period, although in the overall group there was a significant increase in serum total cholesterol in females. Serum high density lipoprotein cholesterol increased significantly in obese males treated with calorie restriction alone. There was a significant increase in serum apolipoprotein A-I in obese females treated with calorie restriction and metformin and in non-obese females treated with carbohydrate restriction and glibenclamide.

Apolipoprotein A-I↗
PubMed1982

Value of serum glucose assay as part of the biochemical profile in screening for diabetes.

The value of adding serum glucose assay to the 'biochemical profile' was assessed by a detailed follow-up of all inpatients with serum glucose concentrations of 10 mmol/l or more. After excluding patients who were on intravenous glucose infusions or were known to be diabetic. 1 in 10 was found to have unsuspected diabetes by further blood glucose measurements, glucose tolerance tests, and clinical assessment. The incidence was 0.8% of all inpatients receiving a biochemical profile, and in a full year 64 diabetics would be detected. The extra cost of laboratory tests was only 20 pounds for each diabetic detected.

Autoanalysis↗
PubMed1981

High-density lipoprotein cholesterol and apolipoprotein A-I levels at diagnosis in patients with non-insulin dependent diabetes.

High-density lipoprotein (HDL) cholesterol levels were decreased in patients with non-insulin dependent diabetes at diagnosis when matched with a control population for sex, age, obesity, alcohol consumption and cigarette smoking. There was no association between serum HDL-cholesterol concentration and the percentage of glycosylated haemoglobin A1 (HbA1). Serum HDL-cholesterol levels were lower in diabetics over the whole range of serum triglyceride levels, and particularly in hyper-triglyceridaemic diabetics. Serum apolipoprotein A-I levels were not decreased in diabetics with normal serum triglyceride levels, so that the ratio of HDL-cholesterol to apolipoprotein A-I was significantly decreased in diabetics (p Less Than 0.005). Decreased HDL-cholesterol levels in non-insulin dependent diabetes could be relevant to the subsequent development of atherosclerosis.

Adult↗