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Biomedical subjects

A Patel

Publications and source records attributed to A Patel.

At least 415 records · Page 23Linked to original sources
PubMed1991

Results of ovulation induction using human menopausal gonadotropin or purified follicle-stimulating hormone in hypogonadotropic hypogonadism patients.

OBJECTIVE: To compare ovarian performance and hormonal levels, after ovulation induction, in patients with isolated hypogonadotropic hypogonadism, using two different gonadotropin drugs. DESIGN: Patients were treated during consecutive cycles, using the same stimulation protocol, with human menopausal gonadotropin (hMG) in the first treatment cycle and purified follicle-stimulating hormone (FSH) in the second one. SETTING: Specialist Reproductive Endocrine Unit. PATIENTS, PARTICIPANTS: Nine patients with isolated hypogonadotropic hypogonadism. MAIN OUTCOME MEASURE: Duration of stimulation, number of leading follicles, serum estradiol (E2) concentration and endometrial thickness at the time of human chorionic gonadotropin administration, and the occurrence of ovulation. RESULTS: Compared with hMG, treatment with purified FSH required significantly more ampules of drug (P less than 0.04) but resulted in a significant reduction in the number of leading follicles (P less than 0.05), serum E2 concentrations (P less than 0.002), endometrial thickness (P less than 0.02) and the occurrence of ovulation (P less than 0.05). CONCLUSION: This study in isolated hypogonadotropic hypogonadism patients is consistent with the two-cell two-gonadotropin hypothesis, that both gonadotropins are required to accommodate their synergistic action for appropriate steroidogenesis. In treating this group of patients, the superior efficacy of hMG compared with purified FSH preparation is beyond question.

Adult↗
PubMed1991

Minaprine and dose response in depression. An investigation of two fixed doses of minaprine compared with imipramine.

One hundred and twelve patients suffering from moderate to severe major depression (DSM III) were enrolled into a study to compare the antidepressant activity and side effect profiles of two dosage groups of minaprine (200 mg and 300 mg per day) and one of imipramine (150 mg per day) in psychiatric practice. Eight patients were withdrawn because of unwanted effects (four imipramine, one minaprine 200 mg, three minaprine 300 mg) and seventy-eight spontaneous reports of unwanted effects were made from the imipramine group compared with sixty-four from the minaprine 200 mg and forty-six from the minaprine 300 mg groups. The main efficacy analysis was carried out at 4 weeks on the 89 evaluable patients who completed 2 weeks active treatment, the last observation being carried forward in those patients who did not complete. A secondary analysis was also carried out at 6 weeks. The response in all three treatment groups showed a significant improvement from the severity at entry to the study, and the response rate to minaprine 200 mg daily was similar to that of imipramine (53% vs 54% achieving a reduction of 50% or more on the Hamilton Depression Rating Scale by week 6), although, given the small group sizes, similar efficacy cannot be claimed. In the intention to treat analysis there was a significant dose response relationship with significantly more patients in the lower minaprine 200 mg dose group achieving 50% or more reduction in the Hamilton Rating Scale than the minaprine 300 mg group at week 4 (p less than 0.05).(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1991

Assessment of tibial fracture union by 35-45 degrees internal oblique radiographs.

Thirty-five to 45 degrees internal oblique radiographs were used in the assessment of tibial fracture healing. This view is particularly helpful when routine radiographic examinations (anteroposterior and lateral) are nondiagnostic in assessing tibial fracture healing. The technique was helpful in the diagnosis of four occult nonunions as well as in showing the position of a bone graft when used. The authors recommend this view when a decision about tibial fracture healing cannot be made from routine radiographs. They recommend this view before resorting to tomograms of the tibia.

Fractures, Ununited↗
PubMed1991

Clinical usefulness of n-of-1 randomized controlled trials in patients with nonreversible chronic airflow limitation.

To determine if n-of-1 randomized controlled trials (n-of-1 RCT) are useful in the care of patients with nonreversible chronic airflow limitation (CAL). Individual trials had a double-blind, randomized, multiple crossover design. Patients with CAL were recruited from several respirology practices. For each individual trial the main outcome measure was a symptom questionnaire; peak flow measurements were used as a secondary measure. Physicians' plans of management (before and after trials) and confidence in the plans were determined. The proportion of trials that provided a definite clinical or statistical answer was established. Patients were followed, and long-term adherence to decisions based on n-of-1 RCT was examined. A total of 26 n-of-1 RCT in patients with CAL were attempted; 18 of these (69%) were completed. After 17 (94%) of the completed trials clinicians expressed a high degree of confidence in their management plans, confidence that was not, in any case, present before the trial. After 8 n-of-1 RCT (44% of all completed, or 31% of all trials) clinicians decided to stop the drug, which would otherwise have been continued indefinitely. In all 17 of the clinically definite n-of-1 RCT, the management decision that followed the trial was still being adhered to 40 months (on average) after completion of the trial. The results support the feasibility and usefulness of n-of-1 RCT in respirology practice.

Double-Blind Method↗
PubMed1991

Novel inhibitors of enkephalin-degrading enzymes. III: 4-Carboxymethylamino-4-oxo-3 (phenylamino) butanoic acids as enkephalinase inhibitors.

4-Carboxymethylamino-4-oxo-3-(4'-aminophenylamino) butanoic acid (25), its ethyl ester (26) and the corresponding unsubstituted-aryl analogues (17) and (16) are fairly potent inhibitors of enkephalinase (neutral endopeptidase; EC 3.4.24.11), Ki = 0.14-0.39 microM, with weak inhibitory potency, Ki = 15-75 microM, towards aminopeptidase MII. In the mouse abdominal constriction test, the esters (26) and (16) showed systemic inhibitory (antinociceptive) activity with ED50 values 62 +/- 3.05 and 81 +/- 1.74 mg/kg respectively. In the mouse tail immersion test, both (26) and (16) exhibited antinociceptive activity when administered intracerebroventricularly and (26) also exhibited a systemic effect which was only partially reversed by naltrexone. The antinociceptive effect seen with (26) reflects its ranking in vitro as an inhibitor of enkephalinase (Ki = 0.14 microM) but it is possible that this effect is not totally opioid-mediated. Compounds (26) and (16) represent the first combined inhibitors of enkephalinase and aminopeptidase MII.

Abdomen↗
PubMed1991

Case-control evaluation of a school-age BCG vaccination programme in subtropical Australia.

In 1956 a programme was initiated to vaccinate all children aged 12-14 years who were attending schools in Queensland, Australia. In view of the declining incidence of tuberculosis in Australia as a whole, there was a need to evaluate the effectiveness of the programme and its procedures. We therefore carried out a case-control study of Queensland's population, excluding certain known high-risk groups. Cases were Queensland residents with notified tuberculosis and of the appropriate age; two controls per case were chosen from the electoral roll. Information on vaccination status was obtained mainly from questionnaires and school records, where available. The results show that at best BCG vaccination had a modest protective effect, approximately 30% when the patients were diagnosed, which was on average 15 years after they had been vaccinated in the school programme. In the north the climate of Queensland is tropical, while in the more heavily populated south it is subtropical. A substantial proportion of the school records reported weak positive reactions to preliminary tuberculin testing, believed to be due largely to atypical mycobacteria. A similar phenomenon has been observed in other tropical regions, and may help to explain the apparent absence of a strongly protective effect for BCG vaccination.

Adolescent↗
PubMed1991

Ipsilateral radial head dislocation and radial shaft fracture. A case report.

Dislocation of the radial head in an adult is an uncommon injury. The mechanism of injury is considered to be due to hyperpronation of the forearm. Fracture-dislocations of the forearm are well described and involve both the radius and the ulna. A dislocation of the head of the radius with an ipsilateral fracture of the shaft of the radius seems not to have been reported; the mechanism of injury can only be postulated.

Adult↗
PubMed1990

Affinity purification of tissue plasminogen activator using transition-state analogues.

The search for a simple affinity ligand to purify tissue plasminogen activator (tPA) was facilitated by a solid-phase synthesis approach. A large variety of tripeptide ligands containing argininal were synthesized on agarose gels containing a spacer with carboxy terminal. The immobilized ligands were easy to test with urokinase, and tPA. While a number of sequence combinations showed initial binding by tPA, only a few resulted in tight binding corresponding to a hemiacetal linkage with the active site serine. Hydrophobic residues, especially aromatics, flanking the N-side of argininal gave rise to ligands which were bound strongly by tPA. A gel containing D-Phe-D-Phe-Argal (an aldehyde derivative of arginine) was very effective in purifying tPA derived from cell culture media at small scale (milligrams) and at large (multi-grams).

Amino Acid Sequence↗
PubMed1990

Recombinant human erythropoietin shortens the uraemic bleeding time without causing intravascular haemostatic activation.

Blood rheology and haemostasis have been investigated in 8 haemodialysis patients during treatment with recombinant human erythropoietin (rHuEPO). The aim was to elucidate the mechanism by which rHuEPO improves haemostasis, and to determine whether rHuEPO promotes intravascular coagulation. Investigations were performed before, and after 3 months of treatment. Haemoglobin and haematocrit rose significantly after rHuEPO (p less than 0.001) and there was a concurrent shortening of the bleeding time. No significant changes were observed in platelet aggregation, thromboxane generation, or platelet nucleotide content during the treatment period. Whole blood viscosity increased following rHuEPO (p less than 0.01), but plasma viscosity and red cell deformability were unchanged, as were markers of intravascular platelet activation and plasma levels of cross-linked fibrin derivatives. No patient suffered from thrombosis during the study period, and elevation of the haematocrit in uraemic patients up to 0.35 with rHuEPO did not appear to lead to intravascular coagulation. Shortening of the prolonged bleeding time in haemodialyzed patients following rHuEPO appeared to be due to the increase in circulating red cells, rather than to changes in platelet reactivity.

Adult↗
PubMed1990

Complement C4 and heat shock protein 70 (HSP70) genotypes and type I diabetes mellitus.

Type I diabetes is strongly associated with the major histocompatibility complex (MHC) class II region (DR and DQ loci), and to a lesser extent the class III region (complement C4 loci). Restriction fragment length polymorphism analysis was employed to investigate the C4 and heat shock protein 70 (HSP70) loci of 176 patients with type I diabetes and 92 healthy controls. In the patient population there was an excess of deletions of the C4A locus (48.5% vs 22.1%, P less than 0.0005). The HSP70 probe in conjunction with the restriction endonuclease Pst I detects two alleles of 9 or 8.5 kilobases (kb). The 8.5 kb allele was significantly increased in the patient group compared to healthy controls (0.569 vs 0.353, respectively, P less than 0.0005). Furthermore, a C4A deletion nearly always occurred with the 8.5 kb HSP70 allele, suggesting that it may be a marker of the HLA-A1,B8,C4A deletion, DR3 extended haplotype.

Complement C4↗
PubMed1990

Lithium uptake rate and lithium: lithium exchange rate in human erythrocytes at a nearly pharmacologically normal level monitored by 7Li NMR.

7Li NMR was used to follow the rate of uptake of Li+ and Li+:Li+ exchange rates in human erythrocytes at an external lithium concentration of 2 mM, marginally higher than used in therapeutic applications of lithium. The rate of Li+:Li+ exchange is approximately 16 times faster than the rate of Li uptake from the medium. The results are in agreement with lithium-sodium countertransport being the dominant mode for lithium uptake into erythrocytes and for the countertransport system having a greater affinity for Li+ than for Na+.

Biological Transport↗
PubMed1990

Distinctive echogenic lymphadenopathy in Whipples disease.

A case of Whipples disease presenting with polyarthropathy and weight loss is presented. Ultrasound revealed unusual distinctive diffusely echogenic retroperitoneal lymphadenopathy which resolved after treatment. These appearances, particularly in a young male, support this diagnosis.

Adult↗
PubMed1990

The frequency of uterine leiomyomas.

As a leading cause of hysterectomy in premenopausal women. uterine leiomyomas are a major public health problem. However, very little work has been done on their epidemiology. Indeed, their true frequency has never been established using systematic and meticulous methods. In this study, gross serial sectioning at 2-mm intervals was applied as an adjunct to routine pathology processing in 100 consecutive total hysterectomy specimens. This tripled the number of leiomyomas noted in routine pathology reports. There were 649 leiomyomas in 77 of 100 uteri, with multiplicity of leiomyomas in 84%. Although leiomyomas were more numerous and larger in women with a clinical diagnosis of myomatous uterus, the incidence was no higher than in uteri removed for other reasons. The postmenopausal incidence of leiomyomas was no lower than the premenopausal incidence, although postmenopausal leiomyomas were smaller and fewer. These findings suggest that epidemiologic studies of leiomyomas may not be valid if they are based only on clinical diagnoses or routine pathology reports.

Adult↗