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Biomedical subjects

A D Wright

Publications and source records attributed to A D Wright.

At least 127 records · Page 7Linked to original sources
PubMed1981

Plasma vasopressin during insulin withdrawal in insulin-dependent diabetes.

Plasma vasopressin was measured in seven insulin-treated diabetics during 24 h of insulin withdrawal to determine: 1) if abnormalities of the neurohypophysial-renal axis contribute to the dehydration of uncontrolled diabetes mellitus; and 2) the factors causing elevated levels of vasopressin in diabetic ketoacidosis. During the 24 h period of insulin withdrawal, blood glucose rose from 6.7 +/- 1.0 to 20.7 +/- 2.4 mmol/l, whereas plasma vasopressin was 3.6 +/- 0.5 pg/ml initially and in four patients showed little change. Markedly elevated levels of plasma vasopressin (17.8, 19.8 and 26.6 pg/ml) were observed in three patients following the onset of hypovolaemia, nausea and/or vomiting which are known to stimulate vasopressin release. Free water clearance was negative throughout the study in all patients. Thirst was not noted despite marked hyperglycaemia (16.9 +/- 2.5 mmol/l) until a significant fall in body weight of 0.9 +/- 0.2 kg had occurred (p less than 0.005). We concluded that marked elevation of vasopressin results from non-osmotic stimulation and that the mechanisms of body water conservation are overridden by the glycosuric diuresis.

Adult↗
PubMed1981

Therapeutic progress--review II. Control of diabetes mellitus.

Present treatment of diabetes mellitus does not result in cure. Evidence is presented from clinical and animal studies to suggest that metabolic control is important in delaying and sometimes ameliorating long-term complications. New methods of monitoring control and changes in insulin therapy are described, but their effect on chronic diabetic complications cannot be assessed for many years.

Animals↗
PubMed1981

Competence of medical students in history taking during the clinical course.

Twelve students were selected from each of the three clinical undergraduate years, two from each year interviewing one of six simulated patients. The interviews were video recorded and scored by two clinicians on a rating system involving sixteen criteria. In addition to the expected differences between individual students, when the scores were placed in rank order a pattern of differences between years of study emerged. Students of the third clinical year performed better than those of first year and both were better than those of the intermediate second year. Junior students displayed more personal concern for the patients, while senior students tended to conduct a more controlled and structure interview.

Clinical Competence↗
PubMed1981

Congenital adrenal hyperplasia in a 66-year-old female.

A 66-year-old genotypically female patient was reared as a man. Investigations showed a partial adrenal 21-hydroxylase deficiency, and pituitary gonadotrophin secretion typical of a post-menopausal woman.

Adrenal Hyperplasia, Congenital↗
PubMed1981

Low-dose insulin treatment of hyperosmolar diabetic coma.

The effect of low-dose hourly i.m. injections of insulin has been studied in the treatment of 17 episodes of hyperosmolar non-ketoacidotic diabetic coma compared with 26 episode of hyperosmolar ketoacidosis occurring in patients over 40 years of age. The fall in blood sugar was satisfactory in the majority of episodes of both types of coma and there was no evidence that patients with hyperosmolar non-ketoacidotic coma were more sensitive to insulin. The excess mortality in the non-ketotic group (47%) compared with the ketoacidotic group (16%) was not due to uncontrolled diabetes.

Adult↗
PubMed1981

GIP and insulin responses to oral glucose in coeliac patients before and after treatment.

The responses of plasma gastric inhibitory polypeptide (GIP) and insulin to oral glucose were studied in five patients with untreated coeliac disease. These patients were restudied after one year on a gluten-free diet. In the untreated patients, the blood glucose, serum insulin, and GIP levels were significantly lower than in the controls. After gluten withdrawal there was an improvement towards normality in the responses of blood glucose, serum insulin, and GIP. The results show that untreated coeliac disease is associated with abnormalities of intestinal and pancreatic hormone secretion and that these abnormalities are improved by gluten withdrawal.

Administration, Oral↗
PubMed1980

Patterns of acquisition of interview skills by medical students.

The interviewing skills of six medical students were recorded on videotape annually during their years of clinical training. Many faults were identified, and an overall style of interview tended to persist through to the pre-registration year. However, individual students changed in different ways that could not be predicted from the results of the first interview.

Adult↗
PubMed1980

Surgical treatment of primary hyperparathyroidism in the elderly.

Twelve patients aged over 70 with primary hyperparathyroidism (persistent hypercalcaemia and raised serum parathyroid hormone concentrations) underwent parathyroidectomy, which was well tolerated by all. After operation serum calcium concentrations returned to normal and the commonest symptoms before operation (muscle weakness, malaise, and mild to severe dementia), although not related in severity to the degree of hypercalcaemia, improved. Mental function was greatly improved. The findings suggest that primary hyperparathyroidism should be sought in any elderly patient with hypercalcaemia and that more such patients with the diagnosis should be considered for parathyroidectomy irrespective of age.

Adenoma↗
PubMed1979

Beta-adrenoceptor-blocking drugs and blood sugar control in diabetes mellitus.

The effects on diabetic control of the relative cardioselective beta-blocker metoprolol and the non-selective drug propranolol were compared in 20 hypertensive diabetic patients receiving diet alone or diet and oral hypoglycaemic agents. Each drug was given for one month in a double-blind, cross-over study. Fasting, noon, and mid-afternoon blood sugar concentrations rose by 1.0-1.5 mmol/l (18-27 mg/100 ml). The rise with propranolol was not significantly greater than with metoprolol. In a few patients the rise was clinically important. The small overall change observed in diabetic control should not deter the use of beta-blockers in non-insulin-dependent diabetics, provided control is carefully monitored at the onset of treatment.

Adult↗
PubMed1979

Very pure porcine insulin in clinical practice.

In a one-year follow-up study the insulin dose in diabetic patients using very pure porcine insulin was compared with that in patients using conventional preparations. The dose of insulin used to obtain diabetic control was reduced by 7% in 108 patients treated solely with very pure porcine insulin from the start of insulin treatment when compared with 108 matched patients who had received conventional insulins. In 117 patients whose treatment had been changed from conventional bovine or bovine-porcine insulin to very pure porcine insulin the dose was reduced by 9%. A further 511 patients receiving conventional insulins were examined for local cutaneous or subcutaneous abnormalities at insulin injection sites. Lipoatrophy was found in 49 of these patients (10%), but not in patients using very pure porcine insulin. The results confirm that very pure porcine insulin reduces the insulin dose needed to maintain diabetic control and may resolve or prevent local reactions such as lipoatrophy. Long-term advantages in reduced antigenicity to insulin and contaminating peptides remain to be established.

Adolescent↗
PubMed1979

Birmingham Medical Research Expeditionary Society 1977 Expediton: thyroid function and acute mountain sickenss.

In a study of 17 subjects plasma-thyroxine-binding globulin and plasma thyroxine concentrations rose during a high altitude trek. An early and sustained rise in plasma reverse triiodothyronine occurred independently of changes in plasma thyroxine and was probably related to physical exertion. Similar changes in thyroid function were found in subjects most affected and least affected by acute mountain sickness.

Adult↗