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Biomedical subjects

C M Castleden

Publications and source records attributed to C M Castleden.

At least 73 records · Page 4Linked to original sources
PubMed1988

The effect of pelvic floor exercises in the treatment of genuine urinary stress incontinence in women at two hospitals.

The results of the pelvic floor exercises for the treatment of genuine stress incontinence of urine were compared between two different hospitals geographically 50 miles apart. A perineal pad weighing test was used to assess the quantity of urine lost during exercise before and after treatment. A similar percentage of patients in the two studies responded to treatment and became either completely dry or significantly improved at the end of 3 months interval; 69% at LCH and 65% at LGH. Overall, 67% of patients achieved complete continence or a significant improvement as a result of pelvic floor exercises alone.

Adult↗
PubMed1988

Sex hormones and the female urinary tract.

Symptomatic clinical changes and urodynamic changes are apparent in the female urinary tract system during pregnancy, the menstrual cycle and following the menopause. The sex hormones exert physiological effects on the female urinary tract, from the ureters to the urethra, with oestrogens having an additional influence on the structures of the pelvic floor. High affinity oestrogen receptors have been identified in bladder, trigone, urethra and pubococcygeus muscle of women. Oestrogen pretreatment enhances the contractile response of animal detrusor muscle to alpha-adrenoceptor agonists, cholinomimetics and prostaglandins, as well as enhancing the contractile response to alpha-agonists in ureter and urethra. Progesterone on the other hand decreases tone in the ureter, bladder and urethra by enhancing beta-adrenergic responses. The dependence on oestrogens of the tissues of the lower urinary tract contributes to increased urinary problems in postmenopausal women. Urinary symptoms due to atrophic mucosal changes respond well to oestrogen replacement therapy. However, because they recur when treatment is stopped, continuous therapy with low dose natural oestrogens is recommended. Oestrogens may be of benefit in postmenopausal women with stress incontinence, but the doses necessary for clinical effect are higher than for the treatment of atrophic urethritis. The practice of adding a progestagen to long term oestrogen therapy to reduce the risk of endometrial carcinoma may, however, exacerbate stress incontinence by decreasing urethral pressure. Cyclical therapy with oestrogens may therefore be more appropriate particularly in women who are not suitable for surgery or have a mild degree of stress incontinence, along with other conservative measures such as pelvic floor exercises and alpha-adrenoceptor agonists. The place of oestrogen therapy in motor urge incontinence has not been determined. The risk of developing endometrial carcinoma as a result of long term high dose oestrogen replacement therapy must be borne in mind but remains to be clarified. However, oestriol has less of a uterotrophic effect compared to other oestrogens in standard therapeutic doses and is to be preferred. Side effects are usually dose related and tend not to be a problem with low dose therapy.

Animals↗
PubMed1987

A comparison of oral midazolam, nitrazepam and placebo in young and elderly subjects.

Twelve young and twelve elderly subjects received a single dose orally of midazolam 15 mg, nitrazepam 5 mg and placebo in a double-blind, crossover comparison. Midazolam acted rapidly, producing a deep sleep at 1 h in fifteen subjects compared to two after Nitrazepam and none after placebo. No comparison of psychomotor tests was possible at this time, but such tests showed that there was no detectable subjective or objective psychomotor impairment at 4 h postdose with either drug. However, the EEG scores strongly suggested that volunteers were more sleepy at 8 h after nitrazepam in comparison to placebo or midazolam. Both groups appeared to handle the drug in a similar manner, there being no significant differences between the groups in the plasma concentration time curves of nitrazepam, or midazolam. The elderly had higher concentrations of alpha-hydroxymidazolam. This accounted for a small proportion of the total plasma benzodiazepine concentration, and the mean area under the curve for midazolam and metabolite was not significantly different in the old from that in the young.

Adult↗
PubMed1987

A comparative study of the pharmacokinetics and pharmacodynamics of atenolol, hydrochlorothiazide and amiloride in normal young and elderly subjects and elderly hypertensive patients.

Six normal young and six normal elderly volunteers and six elderly hypertensive patients took part in an acute and chronic dose study of a combination capsule containing atenolol (50 mg), hydrochlorothiazide (25 mg) and amiloride (2.5 mg) designed for the treatment of hypertension. No difference in any of the drug pharmacokinetic parameters could be detected between the hypertensives and the normal elderly subjects. The bio-availability and the 24-h blood concentrations of all three drugs, half-life of atenolol and amiloride and the peak concentration of hydrochlorothiazide was significantly greater in the elderly. The 24-h blood concentrations of atenolol and hydrochlorothiazide did not alter with chronic dosing, but amiloride concentrations were significantly higher at this time in all groups. A significant fall in the blood pressure was observed in the hypertensive group. Heart rate fell more in the normal and hypertensive elderly subjects than in the young. The combination has shown to be an effective and well tolerated antihypertensive in the elderly patient with a 24-h duration of action.

Adult↗
PubMed1987

A profile of disordered micturition in the elderly at home.

A prevalence survey of disturbed micturition in the elderly identified 7% with important degrees of disorder, 1% with lesser disorder and 1% who were catheterized. Incontinence, urgency, frequency and nocturia were the symptoms most commonly reported. Fifty-three per cent of people describing incontinence used preventive aids but one third of these continued to experience wetting of external clothing. Crude categorization of dysfunction on the basis of symptoms suggested that a component of unstable bladder was present in approximately 4% of the elderly population.

Aged↗
PubMed1987

Gastrointestinal investigations for anaemia in the elderly: a prospective study.

Of 60 patients referred for geriatric assessment with clinically significant hypochromic anaemia, in the absence of frank bleeding, 44 underwent upper gastrointestinal and 27 lower gastrointestinal investigations. The probability of identifying a potential cause at upper gastrointestinal endoscopy was three times that at barium enema, and five times that at sigmoidoscopy, and the lesions identified at endoscopy were more likely to need treatment. Of 41 who completed investigation, a cause was found in 36, upper gastrointestinal in 29, colonic in six and ileal in one. Six upper gastrointestinal and three colonic lesions were found in the 11 of these without gastrointestinal symptoms. Upper gastrointestinal endoscopy in elderly patients with unexplained hypochromic anaemia will identify a treatable cause in a high proportion of cases.

Aged↗
PubMed1987

Urodynamic findings in sacrococcygeal chordoma.

The clinical and urodynamic findings in two cases of sacrococcygeal chordoma are described. The urodynamic findings suggest that the urinary problems in this condition are caused by an incomplete lower motor neurone lesion.

Aged↗
PubMed1986

Glucose tolerance following strokes in the elderly.

Two standard 75 g oral glucose tolerance tests (OGTT) were performed on each of 16 patients, aged 65-84 years, presenting with a thrombotic stroke, and not previously known to have diabetes mellitus. The tests were performed within the first week and 12 weeks after the initial episode. There was no significant difference in the plasma glucose values between the tests. Six patients were diagnosed diabetic on the basis of both OGTTs being abnormal. Of the remaining ten, there was no worsening of glucose tolerance immediately following a stroke. It is concluded that an abnormal glucose tolerance soon after a stroke in the elderly represents true diabetes mellitus rather than 'functional diabetes'.

Aged↗
PubMed1986

Double-blind study of imipramine and placebo for incontinence due to bladder instability.

We compared imipramine with placebo in a double-blind study in Leicester, in elderly incontinent patients. The results revealed that 14 out of 19 patients became dry after imipramine and six out of 14 after placebo treatment. Patients on imipramine also tended to become drier sooner. However, these results must only be taken as preliminary evidence of drug effect since statistical analysis between drug and placebo did not reach significance. The results do, however, confirm the great benefit of habit-retraining which all patients received. It is now our practice to try this alone first, and to reserve drugs for slow or nonresponders, because of their possible adverse effects.

Aged↗
PubMed1986

Provision of services for incontinent elderly people at home.

Results of a survey of elderly people living at home suggest that 8% suffer from important degrees of urinary dysfunction and are accessible to community based services. Supply of NHS incontinence aids was inadequate, and improvements in provision are recommended. Attendance at a continence clinic established for the survey period suggests a need for additional specialist services to be made available close to home. Correspondence between actual and predicted cystometric diagnosis provides encouragement to develop simple, valid assessment procedures as an aid to patient management. For the average District Health Authority serving a population of 250 000, two continence nurse advisers and 50 continence clinic sessions per annum are recommended for people aged 75 and over.

Aged↗
PubMed1985

The problem of bacteriuria with indwelling urethral catheterization.

Bacteriuria following long-term catheterization is more likely to occur in elderly females over the age of 50 years, in patients with some abnormality of the bladder and when traumatic catheterization has taken place. Breaks in the closed system of drainage are the most important factors leading to bladder infections which, once there, are difficult to eradicate. Antiseptics are important at the time of catheterization but have little place afterwards except to reduce cross-infection and growth in the catheter bag. Systemic antimicrobials are only of use over a short period of catheterization and should be reserved in long-term catheterized patients for those with systemic manifestations of infection.

Aged↗
PubMed1985

Urinary tract infection after cystometry.

Eighteen of 67 patients who underwent cystometry for assessment of incontinence had a urinary tract infection 72 hours later. Though four of the 18 had an infection prior to cystometry, the true postcystometry infection was still high at 21%. Clinical details and urodynamic studies on these patients showed no correlation with sex, mobility, mental score, random blood sugar, renal function, initial residual volume of urine, previous pelvic operations or the type of bladder abnormality diagnosed on cystometry. The elderly and males with a high residual volume seemed more susceptible to infection. Thus cystometry carries a definite risk of infection even under optimal conditions and should not be undertaken lightly or without arrangements to follow up patients.

Aged↗
PubMed1985

Factors influencing outcome in elderly patients with urinary incontinence and detrusor instability.

The majority of elderly incontinent patients with detrusor instability in whom various medical treatments had been tried and failed, became dry or very significantly improved following attendance at a Continence Clinic. The reason for this was not only because this clinic had access to specialized investigational equipment, but also because patients received individual psychological and practical management of their incontinence. All were given time to discuss their problems, had imipramine titrated against effect, and practised habit-retraining programmes. Treatment was started in hospital if there was any doubt of the patients misunderstanding or not complying with such regimens. Patients did best if they were sensible and mobile. Urodynamic measurements seemed less important individually, although overall final outcome correlated with the severity of the instability.

Age Factors↗
PubMed1984

The effect of ageing on the response to frusemide in normal subjects.

The effect of IV frusemide was studied in six healthy young (mean age 26.5 years, range 21-33) and six healthy old (mean age 72.8 years, range 66-80) volunteers. A 24-h urine collection before frusemide showed no difference in volume and sodium excretion, although the old excreted less potassium. Creatinine clearance was significantly reduced in the older subjects. After frusemide, 20 mg IV, the pattern of sodium and water excretion over a 5-h period was different in the two groups. The peak effect was greater in the young and occurred within the first 30 min, but was delayed to between 30 and 60 min in the old. Thus in the young the time for 50% of the total sodium and water to be excreted was half that in the old. This delay in sodium and water excretion was related to baseline creatinine clearance. However, the total water, sodium and potassium excreted in the 5 h after frusemide did not differ in the two groups. These results suggest that the renal effects of frusemide are different in healthy elderly subjects as compared to the young. The delayed and reduced peak response is consistent with fewer nephrons in the elderly kidney.

Adult↗
PubMed1984

The effect of physiotherapy on stress incontinence.

Physiotherapy is a safe and effective means of decreasing the symptoms and signs of stress incontinence. Fourteen out of 19 women became dry or improved sufficiently not to warrant wearing any protective garment over a 4-week treatment period. The use of a novel machine to measure pelvic floor squeeze did not improve the success of physiotherapy alone in this condition but may have an important role in instructing the patient on the correct use of the pelvic floor muscles.

Adult↗