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Biomedical subjects

C W Havard

Publications and source records attributed to C W Havard.

At least 37 records · Page 2Linked to original sources
PubMed1985

Electrolyte disturbances and cardiac failure with hypomagnesaemia in anorexia nervosa.

A 32 year old woman with anorexia nervosa was admitted to hospital with severe hypocalcaemia and hypokalaemia that was refractory to replacement treatment but that responded immediately to an infusion of magnesium. She also had congestive cardiac failure that responded to magnesium replacement. The mild hypomagnesaemia found in this patient was responsible for the refractory hypocalcaemia. Minor deficiencies of magnesium may cause severe hypocalcaemia and hypokalaemia that are refractory to replacement treatment. Prompt replacement of magnesium may prevent prolonged tetany, cardiac arrhythmias, and heart failure.

Adult↗
PubMed1985

Lassitude.

Explore the source record for details and available documents.

Adult↗
PubMed1985

Diminished creatinine clearance in anorexia nervosa: reversal with weight gain.

To assess whether patients with anorexia nervosa have abnormalities in creatinine clearance, we measured plasma creatinine concentration, urinary creatinine excretion, and creatinine clearance in 10 patients with anorexia nervosa before and during treatment. Urinary creatinine excretion and creatinine clearance were diminished in all patients. Nine patients had significant decreases in their plasma creatinine and creatinine clearance was increased even when corrected for body weight and body surface area respectively. The patient who did not show these changes in plasma creatinine concentration and creatinine clearance had gained only 4% in body weight. Body weight and corrected creatinine clearance were significantly correlated, as were percentage increases in body weight and creatinine clearance. Thus anorexia nervosa is associated with a reversible decrease in creatinine clearance. Increase in body weight appears to be cardinal to the recovery of renal function in these patients.

Anorexia Nervosa↗
PubMed1985

The long term experience of thymectomy for myasthenia gravis.

A retrospective survey of the records of 287 patients with generalised myasthenia gravis treated at New End Hospital and later at the Royal Free Hospital by anticholinesterase drugs, with or without thymectomy, between the years 1942 and 1976, shows that 62% of patients were improved. The timing of the operation, the grading of disease and the age and sex of the patient did not greatly influence overall results. The poor diagnosis of thymic tumours was confirmed in this series. A decrease occurred in the number of patients achieving complete remission after 1961, although the proportion of patients improving did not fall. It is possible that anticholinesterase therapy may alter the response to thymectomy.

Age Factors↗
PubMed1985

Diaphragmatic myasthenia in mother and child.

A 28 year old patient with ocular myasthenia for 2 y gave birth to a baby with diaphragmatic weakness. Following delivery the mother developed severe weakness of the diaphragm and required assisted ventilation. The baby recovered spontaneously and the mother responded to treatment with plasma exchange and immunosuppression. Neither mother nor baby responded to anticholinergic drugs and in neither serum were acetyl choline receptor antibodies detected.

Adult↗
PubMed1985

Cardiac arrhythmia and myocardial ischaemia related to cocaine and alcohol consumption.

Following the drinking of 150 g of alcohol and a large amount of intra-nasal cocaine a previously healthy 31 year old man developed severe retrosternal pain and circulatory failure. An electrocardiogram showed supra-ventricular tachycardia with widespread ischaemic changes. Following electrical cardioversion electrocardiographic evidence of myocardial ischaemia persisted for 1 h. Two days later basal and exercise electrocardiograms were normal. The combination of alcohol and cocaine may be life threatening.

Adult↗
PubMed1985

Trimethoprim alone compared to co-trimoxazole in lower respiratory infections: pharmacokinetics and clinical effectiveness.

24 patients, admitted to hospital with lower respiratory tract infection, were treated with either co-trimoxazole (800 mg sulphamethoxazole + 160 mg trimethoprim) or trimethoprim (200 mg) orally twice daily. All showed a clinical improvement and with one exception respiratory pathogens were eliminated. Pharmacokinetics in blood, sputum and saliva were studied in 11 patients taking trimethoprim and 9 taking co-trimoxazole. No sulphamethoxazole was detected in either the sputum or saliva. Trimethoprim was found in higher concentrations in the sputum than in the blood, although there were wide and significant variations in individual patient's sputum pharmacokinetic profiles. Trimethoprim penetrates into the sputum at therapeutic concentrations in patients with chronic respiratory infections.

Adolescent↗
PubMed1983

Myasthenia gravis. Pathogenesis and current concepts in management.

Myasthenia gravis is a disorder of autoimmunity in which neuromuscular transmission is impaired by autoantibodies to the acetylcholine receptor (AChR). There is evidence for more than one form of the disorder with differing genetic susceptibilities. The aetiology is unknown, but thymic involvement is suggested by abnormal histology and by the beneficial response of the disorder to thymectomy in more than two-thirds of patients. Thymectomy is indicated in most patients unless the symptoms are minimal or are confined to the extraocular muscles alone, or the patient is elderly. Thymectomy alone results in remission in about one-third of patients, but, in addition, most patients require symptomatic anticholinesterase drugs to prolong the action of acetylcholine at the muscle end-plate. Over-dosage of these drugs can also cause weakness. Immunosuppression with corticosteroids or azathioprine may also improve myasthenia; at present, these drugs are used mainly in patients who do not respond to thymectomy or in those patients considered unsuitable for operation. Plasma exchange can cause a rapid, though temporary, involvement in myasthenia, but it probably has no long term place in its treatment. Future therapy will probably involve specific immunotherapy, such as anti-idiotype antibodies.

Cholinesterase Inhibitors↗
PubMed1983

The effects of plasma from patients with Graves' disease on foetal mouse hearts in organ culture.

Plasma, obtained during plasma exchange therapy, from 3 euthyroid patients with Graves' disease and severe progressive exophthalmos induced an increase in heart rate and then early death when applied to foetal mouse hearts maintained in isolated organ culture. All plasma samples which induced an increase in foetal heart rate had high titres of thyroid stimulating immunoglobulins. Plasma samples obtained after exchange had a much diminished effect. These studies may indicate a previously unrecognized non-thyroidal action of the abnormal immunoglobulins associated with Graves' disease and suggest that chronic thyroid heart disease may be due, at least in part, to the effect of these immunoglobulins especially when not associated with elevated thyroid hormones concentrations.

Animals↗
PubMed1983

Glomerulonephritis, thymoma and myasthenia gravis.

Three patients with myasthenia gravis, in whom a thymoma had been removed during total thymectomy four to 14 years earlier, developed glomerulonephritis presenting as the nephrotic syndrome. All had been treated previously by plasma exchange and were receiving azathioprine. Two were also taking prednisolone. Serum immune complexes containing IgM were present in all three. Renal histology showed either focal segmental glomerulosclerosis, minimal change lesion or focal proliferative glomerulonephritis. No immunoglobulin deposits were seen. Two patients lost their proteinuria on high dose corticosteroid therapy and their renal function improved. Glomerulonephritis occurred in nine per cent of patients with thymoma receiving immunosuppressive treatment with azathioprine for more than two years. We suggest that this treatment may be implicated in its aetiology.

Adult↗
PubMed1982

Open assessment of the effect of prazosin on plasma lipids.

Seventeen patients with newly diagnosed hypertension, or with hypertension not optimally controlled by previous treatment, completed an open, noncomparative study on the effects of prazosin on plasma lipids. Patients with diabetes mellitus, raised triglycerides, or alcohol consumption of over 250 g/week, and patients on concomitant treatment with drugs known to affect lipid levels were excluded. Diastolic blood pressure varied between 90 and 115 mm Hg. Prazosin was given initially in a dose of 1 mg three times a day for the first 2 weeks. If the drug was well tolerated but the blood pressure response was not satisfactory, the dose was increased at fortnightly intervals to 2 mg t.i.d., 4 mg t.i.d., and to a maximum of 6 mg t.i.d. Patients were reviewed twice before the start of prazosin treatment, the intervals between visits being not less than 2 weeks, and after 2, 4, 6, 8, and 12 weeks of prazosin treatment. Patients attended in the morning after an overnight fast of 12-16 h. Duplicate measurements of blood pressure and heart rate were recorded after 5 min lying down and after 2 min standing. Blood was taken for measurements of triglycerides, total cholesterol, and high density lipoprotein (HDL) cholesterol, as well as other hematological and biochemical parameters. Prazosin reduced systolic and diastolic blood pressures significantly. There was a slight tendency to increase HDL and reduce total cholesterol, but in neither case were these changes statistically significant. Triglyceride levels did not change significantly either.

Adult↗
PubMed1982

A pilot study of 'Augmentin' in lower respiratory tract infections: pharmacokinetic and clinical results.

Thirteen patients with a mean age of 67 years admitted to hospital with signs and symptoms of lower respiratory infections were treated with 'Augmentin' (500 mg amoxycillin + 250 mg clavulanic acid) given orally every 8 hours, for 7 days. The clinical response was 'good' in ten cases and one 'failed'. Two patients could not be assessed. Side-effects were not serious: only one patient had to stop treatment (due to diarrhoea). The pharmacokinetic results show that peak levels of amoxycillin and of clavulanic acid in the blood and in sputum are achieved at a later time in the patients studied than occurs in healthy volunteers.

Adult↗