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Biomedical subjects

C M Castleden

Publications and source records attributed to C M Castleden.

At least 37 records · Page 2Linked to original sources
PubMed1997

Management of urinary incontinence in the elderly.

Urinary incontinence is common in the elderly, affecting 6-8% of people over 64 years in the community and up to 31% in hospital and long-term care. It is possible to establish the diagnosis clinically in most incontinent patients with the likelihood of improving symptoms in the majority. Treatment of patients with urinary incontinence requires attention to general and specific measures. General measures include moderation of fluid intake to about 1.5 litres/day, reduced intake of caffeine-rich drinks, treatment of aggravating conditions such as urinary infection, oestrogen deficiency, increased solute load as in diabetes mellitus and uraemia, and drugs like diuretics, sedatives and antidepressants. Specific measures include pelvic floor exercises, vaginal cones, interferential therapy and oestrogens for patients with stress incontinence. Bladder retraining and anticholinergic drugs are for patients with urge incontinence, and alpha-blockers and 5-alpha reductase inhibitors for patients with overflow incontinence due to prostatic hyperplasia.

Aged↗
PubMed1996

Effect of treatment with calcium antagonists in vitro and in vivo on the contractile response of isolated rat and human detrusor muscle.

1. The effect of calcium antagonists on the contractile response of human and rat isolated detrusor muscle in vitro was investigated. The effect of treatment with nimodipine on rat detrusor muscle in vivo was also examined. 2. Nimodipine 0.1 mumol/l, nifedipine 0.1 mumol/l, nifedipine 0.25 mumol/l and verapamil 1.5 mumol/l reduced the maximum contractile response of isolated human detrusor muscle to carbachol by 42%, 35%, 41% and 28% respectively (P < 0.01). Verapamil 0.1 mumol/l had no significant effect on contractile response. 3. Nimodipine 0.1 mumol/l reduced the maximum contractile response of isolated rat detrusor muscle in vitro to electrical field stimulation and carbachol by 53% and 84% respectively (P < 0.01). 4. Rats were pretreated with nimodipine for 8 days (5 mg day-1 kg-1) or with a single dose. Serum nimodipine concentrations were higher in rats treated for 8 days. In rats treated with nimodipine for 8 days there was no significant difference in detrusor contractile response compared with controls. However, after one dose of nimodipine the maximum contractile response was significantly reduced compared with controls (P < 0.05). 5. At the concentrations studied, nimodipine had a greater inhibitory effect on the contractile response of isolated human detrusor muscle. Nimodipine significantly reduced the contractile response of rat detrusor muscle in vitro and after a single dose in vivo, but had no significant effect after 8 days' treatment in vivo. It is possible that chronic oral treatment with nimodipine caused an up-regulation of 1,4-dihydropyridine-sensitive calcium channels, which may explain the lack of clinical effect of chronic treatment with calcium antagonists in patients with detrusor instability.

Animals↗
PubMed1996

The management of urinary incontinence in residential and nursing homes for older people.

We assessed the management of urinary incontinence amongst older people in residential and nursing homes and examined strategies for continence care in the homes. A random sample of local authority and private residential and nursing homes was drawn from an earlier census of long-term care. Strategies for continence care, the standard of care provided and the need for more help were determined by means of a structured questionnaire and the observations of a continence adviser. A random selection of residents in each of the homes was assessed for the presence, severity and symptoms of urinary incontinence, for symptom control and physical dependency. Eighty-seven per cent of the homes used pads and 83% daytime toileting to promote continence care but only 52% practised night-time toileting and 49% the use of clear toilet signs. A greater emphasis was placed on incontinence management rather than continence promotion, the latter being "good' in only 32% of homes. Although the majority of homes reported having adequate access to aids and appliances, 39% of residents had severe symptoms of urinary incontinence resulting in bed-wetting and wetting of clothing. Substantial social and psychological effects were found; 87% of residents needed changes in their management of the condition and incontinence management was "good' in only 47% of homes. Although 73% of homes were optimistic about offering good continence care, they were infrequently supported by continence nurses (30% of homes) or specialist continence doctors (9% of homes). Consequently 57% requested more help from the specialist services. The high prevalence of severe and uncontrolled symptoms of urinary incontinence combined with the lack of support received by the homes for the management of these residents indicated the urgent need for a greater input from the specialist continence service.

Activities of Daily Living↗
PubMed1996

The knowledge of hospital patients about vascular diseases and their risk factors.

The knowledge of 28 stroke patients on the nature, consequences, treatment and risk factors of stroke and ischaemic heart disease was examined using a questionnaire and compared with that of 26 patients with ischaemic heart disease and 41 controls without evidence of vascular disease. Information was also collected on the patients' willingness to change their life-style, the information and advice they had received and their desire for more information. It was found that about half of the elderly stroke and heart disease patients had a reasonable knowledge of the condition and its related risk factors. Only eight (14%) patients remembered receiving information and advice in relation to their condition during their hospital stay compared with one (2%) control. There was a significant difference between the number of stroke and heart disease patients who wanted to know more about their condition compared with the control group (32 vs 14; p = 0.03). A quarter of the patients and half of the controls knew that fruit and vegetables were good for you and excessive fat and alcohol were less inducive to good health. Most patients with a risk factor were willing to exercise more, stop smoking, cut down on their drinking, or lose weight. These results suggest that elderly hospital patients have a reasonable basic knowledge about vascular diseases, but that a significant number want to know more and would be willing to change their life-style.

Aged↗
PubMed1994

Can topical zinc accentuate tuberculin reactivity in the elderly?

We examined the effect of topical zinc on Heaf tests in 58 elderly hospitalized patients in a double-blind study. Plasma zinc levels were measured. Thirty-eight subjects (66%) had negative reactions with placebo ointment. Fourteen of these negative responders (37%) had positive reactions with topical zinc ointment; 12 (32%) had weakly positive reactions and 12 remained negative. There was no significant difference in the plasma zinc levels between the different grades of topical zinc effect in the negative responders. Zinc deficiency is therefore unlikely to account for the observed booster effect of topical zinc on tuberculin reactivity.

Administration, Topical↗
PubMed1994

Effect of progestogens and oestrogens on the contractile response of rat detrusor muscle to electrical field stimulation.

1. The effect of oestradiol and progesterone pretreatment on the contractile response of isolated rat detrusor muscle to electrical field stimulation was investigated. The response to direct administration of 2 mumol/l progesterone and 2 mumol/l diethylstilboestrol in the organ bath was also examined. 2. Virgin female Wistar rats were injected subcutaneously with oestradiol benzoate (150 micrograms/kg) for 3 days followed by 1 day of progesterone (160 micrograms/kg). This cycle was repeated once. Control rats received no injections. 3. In controls, progesterone significantly reduced the maximum contractile response of rat detrusor muscle in vitro by 12% (P < 0.01). The EF50 was significantly increased compared with control. When 2 mumol/l diethylstilboestrol, was added, the maximum contractile response was significantly reduced by 42% (P < 0.01) and the frequency-response curve showed a further increase in EF50. 4. Progesterone had no effect on the atropine-resistant component of electrical field stimulation, but progesterone and diethylstilboestrol reduced the atropine-resistant response by 16% (P < 0.01). 5. Detrusor muscle from pretreated rats showed a non-significant increase in maximum contractile response compared with untreated controls. The addition of 2 mumol/l progesterone to the bath chamber had no effect on this response, but the further addition of 2 mumol/l diethylstilboestrol reduced the maximum contraction. 6. Pretreatment with oestradiol and progesterone had no effect on the atropine- or tetrodotoxin-sensitive response to electrical field stimulation. 7. In conclusion, the direct effect of progesterone and diethylstilboestrol inhibited the contractile response of detrusor muscle to electrical field stimulation and the effects of each summated.(ABSTRACT TRUNCATED AT 250 WORDS)

Animals↗
PubMed1994

Aluminium inhibits muscarinic agonist-induced inositol 1,4,5-trisphosphate production and calcium mobilization in permeabilized SH-SY5Y human neuroblastoma cells.

The effects of aluminium (as Al3+) on carbachol-induced inositol 1,4,5-trisphosphate (InsP3) production and Ca2+ mobilisation were assessed in electropermeabilised human SH-SY5Y neuroblastoma cells. Al3+ had no effect on InsP3-induced Ca2+ release but appreciably reduced carbachol-induced Ca2+ release (IC50 of approximately 90 microM). Al3+ also inhibited InsP3 production (IC50 of approximately 15 microM). Dimethyl hydroxypyridin-4-one, a potent Al3+ chelator (Ks = 31), at 100 microM was able to abort and reverse the effects of Al3+ on both Ca2+ release and InsP3 production. These data suggest that, in permeabilised cells, the effect of Al3+ on the phosphoinositide-mediated signalling pathway is at the level of phosphatidylinositol 4,5-bisphosphate hydrolysis. This may reflect interference with receptor-G protein-phospholipase C coupling or an interaction with phosphatidylinositol 4,5-bisphosphate.

Aluminum↗
PubMed1994

The outcome of a medical examination for applicants to Leicestershire homes for older people.

Medical screening of applicants to residential homes for older people has been shown to redirect inappropriate applications, although other outcomes have not been reported. This study assessed 117 applicants, of whom 63% were medically examined and offered medically directed interventions if indicated. All applicants were then reassessed at 6 and 12 weeks. No significant differences in survival, or changes in cognitive score, disability, incontinence or self-reported health were found between intervention and control groups. Intervention did redirect some applicants to more appropriate care and resulted in significantly greater improvements in morale. These results raised the question of whether it is appropriate for medical assessment to be used primarily to enforce admission criteria in the absence of other significant health benefits. However, the greater improvements in morale of the intervention group did indicate some benefit from the medical examination.

Activities of Daily Living↗
PubMed1994

Eligibility of acute stroke patients for pharmacological therapy.

The aims of this study were to analyse the characteristics of patients with acute stroke and to ascertain the number of patients meeting eligibility criteria commonly applied in clinical trials of pharmacological agents for ischaemic stroke. Details of all consecutive admissions with a diagnosis of acute stroke (n = 410, 55% female, mean age 77, range 22-99 years) admitted over a 12-month period to a district general hospital were recorded. Major exclusion criteria used in acute stroke trials were applied to data collected from the study patients. Exclusion criteria were met by 386 (94%) stroke patients, 188 (46%) had admission delay > 12 hours, 85 (21%) had pre-existing major disability, 80 (20%) minor stroke, 66 (15%) had coexisting severe illness, 51 (12%) were unconscious, and 30 (7%) had major electrolyte or ECG abnormalities. One hundred and five (26%) had two or more exclusion criteria. The majority of acute stroke patients admitted to a district general hospital would be likely to be excluded from most current pharmacological treatment studies.

Adult↗
PubMed1994

The changes in blood pressure after acute stroke: abolishing the 'white coat effect' with 24-h ambulatory monitoring.

OBJECTIVES: To assess the changes in 24-h and casual blood pressure (BP) levels following hospitalization for acute stroke. DESIGN: Prospective study of patients admitted with acute hemispheric stroke and hospitalized controls using casual and 24-h BP monitoring. SETTING: Medical wards in a large teaching hospital. SUBJECTS: Thirty-three patients (median age 77 years, 17 male) and 21 control subjects admitted non-acutely. INTERVENTIONS: All subjects underwent 24-h BP monitoring within 24 h of stroke onset (patients) or admission (controls) and again at 1 week. Casual BPs were recorded over the same period. MAIN OUTCOME MEASURES: The change in BP over the first week in each group. Eleven stroke subjects had 24-h BP monitoring repeated at 6 months. RESULTS: In the stroke group, 24-h systolic BP (SBP) fell by 7 mmHg (95% CI, 0 to 14 mmHg; P < 0.05) and diastolic BP (DBP) by 3 mmHg (95% CI, 0 to 6 mmHg; P < 0.02) over the first week. Mean 24-h BP levels in the control group did not change during this period. However, casual BP recordings fell in both stroke (18/12 mmHg) and control (19/9 mmHg) groups. Stroke subjects followed to 6 months showed no further change in 24-h BP (day 7: 137 +/- 17/79 +/- 13 mmHg; month 6: 138 +/- 16/78 +/- 11 mmHg). CONCLUSIONS: Although there was a large fall in causal BPs seen in both groups there was only a small, but a significant fall in mean 24-h BP over the first week following hemispheric stroke that was not seen in control subjects. Although the 'white coat effect' and admission to hospital play an important part in the high casual BP observed in the days following acute stroke they are unlikely to be the sole factors.

Acute Disease↗
PubMed1994

Factors affecting changes in blood pressure after acute stroke.

BACKGROUND AND PURPOSE: We sought to establish the pattern of blood pressure (BP) change after hospitalization for acute hemispheric stroke. METHODS: In 292 patients from the Leicester teaching hospitals with acute hemispheric stroke within the previous 24 hours (139 men; median age, 75 years [range, 42 to 98 years]), we prospectively studied BP changes between admission, 24 hours, 1 week, and 4 to 6 weeks. Changes were assessed in relation to the main stroke risk factors, stroke type and severity, and antihypertensive drug treatment. All subjects were followed up for 1 week, with 117 subjects followed up for 4 to 6 weeks. Changes were assessed by repeated-measures ANOVA, and Student's t tests were used to compare group pairs. RESULTS: Systolic and diastolic BP fell by 12 mm Hg (95% confidence interval [CI], 8 to 15 mm Hg) and 7 mm Hg (95% CI, 5 to 9 mm Hg), respectively, in the first 24 hours and 22 mm Hg (95% CI, 18 to 25 mm Hg) and 12 mm Hg (95% CI, 10 to 14 mm Hg), respectively, during the first week (all changes significant at P < .01) but no further thereafter. In those patients receiving no antihypertensive medication before or after stroke, the pattern of change was similar to that of the whole group. Previously diagnosed hypertensive subjects (n = 106) had higher initial BP values than did normotensive subjects, although by 1 week the levels were not significantly different. Patients with cerebral hemorrhage confirmed by computed tomography (n = 20) had higher systolic BP, but not diastolic BP, throughout the first week than those with cerebral infarction (n = 89). The severity of stroke, age, and previous stroke history did not appear to alter the BP pattern. Stroke patients who were moderate to heavy alcohol consumers had lower convalescent systolic BP levels than lighter drinkers or abstainers. CONCLUSIONS: We have demonstrated a marked fall in systolic and diastolic BP levels during the first 7 days after acute hemispheric stroke, with little change thereafter. Higher initial systolic BP values were found in patients with cerebral hemorrhage compared with those with cerebral infarct. Moderate to heavy alcohol consumption before stroke was associated with a greater systolic BP decline in the first week after the event compared with stroke patients who were light drinkers or abstainers.

Aged↗
PubMed1994

A postal survey evaluation of prostatectomy.

BACKGROUND: The aims of this study were to determine the prevalence of urinary symptoms after prostatectomy, and the relationship between pre- and post-operative symptoms. METHODS: A retrospective postal survey was carried out, on an unselected series of patients in Leicestershire, one to two years after transurethral resection. Four hundred and sixty-five men received a questionnaire, and of these 78 per cent responded. RESULTS: The operation relieved 92 per cent of all preoperative urge-incontinence, but 3 per cent of those who were continent beforehand developed urge-incontinence. Urgency and hesitancy also responded well. Nocturia, frequency and dribbling were the least responsive. There was a general tendency for symptoms to persist rather than develop post-operatively. CONCLUSIONS: Prostatectomy is an effective intervention, particularly for cases with urge-incontinence, urgency, incontinence or hesitancy. These results are consistent with those of other, prospective, studies. Postal surveys may provide a cheap and effective method of evaluating local prostatectomy services.

Aged↗