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Biomedical subjects

A K Clarke

Publications and source records attributed to A K Clarke.

At least 19 recordsLinked to original sources
PubMed1990

Walking frames.

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Equipment Design↗
PubMed1990

Use of sodium aurothiomalate during lactation.

The report concerns a mother who breast fed her infant whilst receiving sodium aurothiomalate for the treatment of rheumatoid arthritis. The milk:serum concentration ratio was not constant, reflecting the non-concurrence of the concentration-time profiles of gold in milk and maternal serum after i.m. injection. Gold was detected in the infant's serum. Calculations indicate that the weight-adjusted dose to the infant exceeded that received by the mother.

Adult↗
PubMed1989

An assessment of tenoxicam, a nonsteroidal anti-inflammatory drug of long half-life, in patients with impaired renal function suffering from osteoarthritis or rheumatoid arthritis.

Fifty-eight patients, aged 48-87 years, with impaired renal function and mean initial creatinine clearance of 52.1 mls/min were recruited to a 12-week open study of tenoxicam 20 mg/day for osteoarthrosis or rheumatoid arthritis. Renal function was measured before and after a brief run-in period when patients discontinued all nonsteroidal anti-inflammatory drugs, taking paracetamol alone, prior to monthly monitoring thereafter. Fifty-four % of patients completed the study, the others being withdrawn from lack of efficacy (17%), adverse events (24%) or both (5%). During the run-in period the mean creatinine clearance of 28 patients completing the trial improved to 64.7 mls/min and then dropped to 57.9 mls/min during the course of 12 weeks treatment with tenoxicam. Serial analysis of haematological and biochemical safety parameters showed no drug-induced change of significance. Twenty-three% of patients felt worse and 45% better at the end of treatment. Seventeen patients withdrew because of adverse events. These were normally gastrointestinal and always unrelated to further deterioration in renal function. Tenoxicam, 20 mg/day, can be given safely for a period of at least three months in patients with mild or moderate renal impairment.

Aged↗
PubMed1989

Sensitivity of anthropometric techniques for clinical trials in ankylosing spondylitis.

To determine whether anthropometric techniques widely used for assessment of ankylosing spondylitis (AS) would be useful outcome measures in long-term clinical trials, 52 AS patients at the Royal National Hospital for Rheumatic Diseases were studied. All patients had well documented AS with a mean age of 38.1 years, and had been diagnosed for an average of 7.6 years. Measurements were taken before (B) and after (A) 3-week intensive inpatient physical therapy (PT). Short-term therapeutic effects (over 3 weeks) were significant (adjusted p less than 0.0001) for all five measures tested (chest expansion, finger-to-floor distance, height, lumbar flexion, and cervical rotation). Height (adjusted p less than 0.0001), finger-to-floor distance (adjusted p = 0.047) and cervical rotation (adjusted p = 0.012) diminished over the course of follow-up. Therefore, 3 weeks of hospitalization with intensive physical therapy produces measurable short-term change; minute but measurable change with treatment occurs even in long-standing AS; and detectable changes in physical measurements occur over a 5-year period even in long-standing AS. Anthropometric measurements are useful outcome variables for long-term clinical trials in AS, but the potential for improvement in clinical measurements in long-standing AS is predictably small.

Adult↗
PubMed1989

Symptomatic manubriosternal joint involvement in rheumatoid arthritis.

The manubriosternal joint is commonly involved in rheumatoid arthritis but rarely gives rise to symptoms. A patient is reported with seropositive, erosive rheumatoid arthritis, who developed symptoms resembling pleuritic pain, arising from synovitis of the manubriosternal joint. Treatment with intra-articular steroid injection resolved these symptoms rapidly.

Arthritis, Rheumatoid↗
PubMed1988

Acute myocarditis causing fatal ventricular arrhythmia in treated polymyositis.

A patient with definite polymyositis responded clinically to prednisolone in combination with azathioprine, with improvement in muscle strength and normalization of muscle enzyme levels. After 7 weeks' treatment the patient developed chest pain and fatal ventricular arrhythmias. An autopsy showed inflammatory myocarditis, but marked improvement in the skeletal muscle histology. This case illustrates that myocarditis may be a late complication of polymyositis despite immunosuppressive therapy.

Acute Disease↗
PubMed1987

The role of passive stretching in the treatment of ankylosing spondylitis.

A controlled study of 39 consecutively-admitted patients with ankylosing spondylitis was conducted to assess the effects of daily passive stretching of the hip joints during a 3-week in-patient physiotherapy course. Measurements were performed by an independent assessor on admission, at discharge and six months after discharge. Results showed that passive stretching resulted in a significant increase in the range of all movements of the hip joints except flexion during the physiotherapy course. Follow-up at 6 months in seven patients suggested that this increase in range of movement could be maintained by patients who had been performing the stretching exercises regularly. We suggest that the inclusion of passive stretching of the hip joint in the treatment of patients with ankylosing spondylitis will increase the range of movement and thus improve function and influence posture.

Hip Joint↗
PubMed1987

Community-based rehabilitation in England.

The National Health Service was established in postwar Britain with the main aims of improving the health of the nation and providing free medical care when it was needed. Over the years the service has become increasingly involved in crisis intervention, rather than prevention. The ageing population has placed new demands on the service but the strength of family medicine, together with rehabilitation services, has formed the basis of good community-based rehabilitation. There is still the need to integrate the medically provided service with that of the social services.

Aged↗
PubMed1986

Multicentre study of piroxicam versus naproxen in juvenile chronic arthritis, with special reference to problem areas in clinical trials of nonsteroidal anti-inflammatory drugs in childhood.

Clinical trials of nonsteroidal anti-inflammatory drugs (NSAIDs) are necessary in juvenile chronic arthritis (JCA) but pose certain problems highlighted and discussed in this study, including recruitment, the assessment of efficacy, and the heterogeneity of the disease. In a multicentre 8-week double-blind cross-over study using the double-dummy technique, piroxicam was compared with naproxen in 47 children with seronegative JCA aged 5-16 years. No significant difference between the two treatments was found in either the clinical variables measured or the parent/patient and physician preference at the end of the study. Side-effect profiles of the two drugs were similar, mainly gastrointestinal disturbances. Piroxicam may be a useful alternative NSAID in JCA, particularly in view of its once-daily dosage.

Adolescent↗
PubMed1986

Dependency of the elderly in a rural population.

Fifty-five elderly people living in a small village were interviewed to discover the level of need for medical and social services and to establish the level of provision to meet that need. Contrary to expectations there was little perceived need and hence minimal contact with statutory services. This emphasizes the importance of adequate assessment of need before providing expensive social and rehabilitation services.

Aged↗
PubMed1985

Measuring outcome.

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Arthritis, Rheumatoid↗
PubMed1979

Abortion.

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Abortion, Legal↗