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Biomedical subjects

C M Wiles

Publications and source records attributed to C M Wiles.

120 records · Page 7Linked to original sources
PubMed1979

Muscle relaxation rate, fibre-type composition and energy turnover in hyper- and hypo-thyroid patients.

1. Quadriceps strength, relaxation rate, fibre-type composition and energy-turnover rate during a submaximal contraction have been measured in hypo- and hyper-thyroid patients and compared with findings in normal subjects. 2. Six out of eight hypothyroid patients had normal strength whereas four out of five hyperthyroid patients were weak. 3. Relaxation rate was decreased in all the hypothyroid patients but increased in only three out of five hyperthyroid patients. 4. In hypothyroidism there was a marked reduction in the percentage contributed by type II fibres to muscle cross-section, partly due to type II atrophy but also due to a decrease in the relative frequency of type II fibres. In hyperthyroidism both fibre types tended to atrophy. 5. The rate of ATP turnover during submaximal contraction held to fatigue was reduced in hypothyroidism. This was probably due to decreased ATP utilization rather than an impaired supply of energy-supplying substrates. In hyperthyroidism the rate of ATP turnover was increased. 6. Altered relaxation rate and ATP-turnover rate may be explained on the basis of changes in myosin ATPase activity with thyroid status. Changes in muscle-fibre-type composition, as determined histochemically, could not per se account for the functional abnormalities.

Adenosine Triphosphate↗
PubMed1979

Cephradine-induced interstitial nephritis.

A patient developed acute interstitial nephritis following cephradine administration. The clinical illness preceding the interstitial nephritis and the eosinophilia in peripheral blood suggested an allergic reaction. Immunological studies demonstrated an allergy to cephradine and penicillins which was IgG2-mediated. It is probable, therefore, that allergy to cephradine caused the renal lesion from which there was full clinical and biochemical recovery.

Adult↗
PubMed1977

Weakness in myotonic syndromes.

Muscle weakness occurs in a number of myotonic syndromes, including those in which muscle bulk is preserved. The possible causes of muscle weakness may be considered in terms of the different stages of the electromechanical activation process and defects in the contractile machinery. In individual myotonic disorders the ability to identify the origin of the muscle weakness (whether neurogenic or myogenic) and the functional level at which the defect occurs would assist the choice of rational treatment.

Action Potentials↗
PubMedDate not supplied

Muscle breakdown and repair in polymyositis: a case study.

Muscle breakdown and repair were measured by metabolic balance techniques in a patient with polymyositis who was being treated with prednisolone and azathioprine. Changes in body muscle mass that had been estimated from nitrogen and phosphorus balances correlated with antropometric assessments of thigh muscle mass and quadriceps strength. Decline in muscle strength was associated with a net rate of muscle breakdown of 148 g/day. Recovery was associated with a net rate of muscle repair of up to 100 g/day. Early reduction in corticosteroid treatment appeared to enhance the rate of repair. Changes in the isometric contraction force of the quadriceps muscle (but not in clinical symptoms, plasma creatine kinase [CK] or erythrocyte sedimentation rate [ESR] were found to reliably indicate whether the muscle was in a state of breakdown or repair. Treatment of the individual patient may be quantitatively monitored by metabolic balance studies or, more simply, by measurement of muscle strength.

Adult↗
PubMedDate not supplied

Transesophageal echocardiographic demonstration of resolution of mitral vegetations after warfarin in a patient with the primary antiphospholipid syndrome.

A 16-year-old girl with multiple cerebral infarcts was reported to have a normal transthoracic echocardiogram, but transesophageal echocardiography revealed vegetations on the atrial surfaces of both mitral leaflets at their line of closure. Blood cultures were negative, and prolonged treatment with intravenous antibiotics produced no echocardiographic improvement in the appearance of the vegetations. A diagnosis of primary antiphospholipid syndrome was made subsequently, although test results for this condition had initially been normal. Serial transesophageal echocardiograms showed complete resolution of the vegetations but some persistent thickening of the mitral leaflets, after warfarin therapy for 9 months. We suggest that in patients with culture-negative endocardial vegetations, specific tests should be performed for the primary antiphospholipid syndrome and a therapeutic trial of warfarin should be undertaken before contemplating heart surgery.

Adolescent↗
PubMedDate not supplied

Selecting specialist registrars by station interview.

Appointments to the specialist registrar (SpR) grade depend almost entirely on performance at interview, yet standard panel interviews do not directly assess the competences required of a medical trainee. In this study, station interviews were used to select neurology SpRs. Eighteen candidates were assessed in three interviews, each involving three stations: a curriculum vitae (CV)-based interview, an interview with a simulated patient, and a discussion of scenarios based upon teaching, audit and research. Two or three assessors at each station ranked candidates independently before discussing the pooled rankings and reading written references. The CV-based interview rankings (resembling a traditional panel interview) correlated less well with the overall rankings (r=0.54) than did research (r=0.83), information giving (r=0.75), audit (r=0.70) or teaching presentation (r=0.59). Station interviews appear fairer (providing more time, more independent examiners, fresh starts at each station), although they require more planning and expense. Competency-based assessments should be more widely used in selecting medical trainees.

Clinical Competence↗
PubMedDate not supplied

General practice referrals to a department of neurology.

OBJECTIVE: Assessment of general practitioner (GP) new referrals to a neurology department in terms of satisfaction for patient and doctor. DESIGN: Prospective study by questionnaire of patients, GPs and specialists. SETTING: Neurology hospital outpatient clinics. SUBJECTS: 339 consecutive new outpatients. MAIN OUTCOME MEASURES: Overall patient satisfaction with clinic attendance, with allocated time and waiting times after referral; GP's reasons for referral, and satisfaction with outcome; specialists' actions in the clinic, views on referral. RESULTS: Some 67% of patients found the referral helpful; 23% felt there was insufficient time to explain fully their problem. Nearly half of the patients had waited > or = 6 months for an appointment. The GP was uncertain of the diagnosis at referral in 76% of cases and found information from the clinic useful in 89%. Specialists made a new diagnosis in 40% of referrals, discharged 73% (with or without investigation) and admitted 11%; 76% of referrals were felt to be appropriate. CONCLUSIONS: Patients and GPs usually found the referral helpful. Seeing patients more briefly is inappropriate since almost a third already felt consultation time to be short. Although some referrals may have been inappropriate, the dominant deficiency in the service was the time they had to wait after the referral. To satisfy local need, it is estimated that twice the present number of consultant neurologists would be required.

Adult↗