The cost effectiveness of urethral stents.
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Cost-Benefit Analysis↗
Biomedical subjects
G Williams
Publications and source records attributed to G Williams.
Effects of plasma exchange on sperm antibody levels in males with subfertility.
Three men with subfertility secondary to sperm antibodies with measurable serum sperm antibody levels underwent a course of 3 plasma exchanges over a period of 1 week. The levels of serum anti-sperm antibodies fell by a mean of 3.3 dilutions. This fall was maintained for approximately 4 weeks, after which there was a return to the original levels. Plasma exchange is time-consuming and relatively expensive but it offers a possible alternative to steroid treatment (with its potential side effects) in men with sperm antibodies and warrants further investigation.
Adult↗
Comparison of nephrostomy drainage systems.
Forty patients undergoing nephrostomy insertion were randomised into 2 groups: those maintained on intermittently closed and those on permanently closed drainage systems. The average cost of managing a patient in the former group was one-eighth that of the latter and was not associated with any increase in morbidity.
Costs and Cost Analysis↗
Accurate and precise blood glucose measurement in the hypoglycaemic range.
The aim of the study was to evaluate the performance of an electrochemical blood glucose sensor, the satellite G, in the low-normal and hypoglycaemic range. Eighty-five venous blood samples with glucose concentrations below 4.0 mmol I-1 from six patients with Type 1 diabetes undergoing induced hypoglycaemia were measured in duplicate on the sensor and a reference method, the Yellow Springs whole blood glucose analyser. The sensor values correlated well with the reference method (r = 0.9, p < 0.001) with a mean absolute percentage bias of 10.7%. The 95% confidence limits of agreement between methods were +0.7 and -0.6 mmol I-1 with a mean difference of 0.004 mmol I-1. More than 80% of the sensor measurements were within 20%, and 60% were within 10% of the reference method. Measured over all samples, the sensor had a coefficient of variation of 7.2% for paired measurements. The coefficients of variation of 20 measurements on each of two samples with glucose concentrations of 1.3 and 2.6 mmol I-1 were 9.1% and 5.8%, respectively. We conclude that the satellite G measures blood glucose accurately and precisely in the low range.
Blood Glucose↗
Evaluation of a novel fluorescence polarization immunoassay for teicoplanin.
A fluorescence polarization immunoassay (FPI) for teicoplanin that uses the TDx Instrument System (Abbott, Irving, Tex.) as an automated analyzer has been developed by Innotron of Oregon Inc. and was evaluated in patients with staphylococcal infections enrolled in a clinical trial of the antibiotic. The assay proved accurate in estimating concentrations of between 5 and 100 mg/liter. The intraassay coefficient of variation was < 7.3%, while the interassay variance was < 11.6% against three commercially prepared standards at known concentrations of approximately 5, 35, and 75 mg/liter. Against routinely prepared standards at 10 concentrations between 5 and 100 mg/liter analyzed in a single run, the coefficient of variance did not exceed 4.3%. Compared with bioassay, the FPI demonstrated good correlation in terms of reliability (r = 0.909) in samples containing teicoplanin only and specificity (r = 0.916) in samples containing both teicoplanin and gentamicin. With a turnaround time of 20 min and with only 50 microliters of serum needed for estimation of the amount of drug in a sample, the FPI described here should provide a useful method of teicoplanin measurement in routine diagnostic laboratories.
Biological Assay↗
Identification and characterization of multiple species of vancomycin-resistant enterococci, including an evaluation of Vitek software version 7.1.
A total of 374 clinical isolates of Enterococcus spp. were characterized to determine the species distribution and vancomycin resistance. The ability of the Vitek system (bioMerieux Inc, Hazelwood, St. Louis, Mo.) to identify enterococci to the species level and to recognize vancomycin resistance by using computer software version 7.1 was evaluated. Conventional methods were used for identification and agar dilution was used for susceptibility testing, the results of which were as follows (presented as number of vancomycin-resistant isolates/number of members of that species identified): 219/234 E. faecium, 9/112 E. faecalis, 2/3 E. mundtii, 0/1 E. durans, 0/1 E. hirae, 0/1 E. raffinosis, and 0/1 E. avium. Ten enterococci were in the vancomycin-intermediate category (six E. gallinarum, two E. casseliflavus, and one each of E. faecium and E. faecalis). The Vitek GPI card correctly identified 98% of E. faecium isolates, 99% of E. faecalis isolates, and only two isolates of other enterococcal species. The GPS-TA card was 98% sensitive and 95% specific for the detection of vancomycin resistance, generating a total of four very major (1.6%) and five minor errors (1.3%).
Drug Resistance, Microbial↗
Intense exercise and food restriction cause similar hypothalamic neuropeptide Y increases in rats.
Neuropeptide Y (NPY) is a potent central appetite stimulant whose concentrations rise markedly in hypothalamic appetite-regulating regions in food-deprived rats. To determine whether increased energy expenditure also affects hypothalamic NPY, we studied the effects of intense physical exercise in rats (n = 10) running voluntarily on a large-diameter exercise wheel. Running was initiated by restricting food intake but stabilized at an average of 8 km/day when food intake was matched to that in 11 nonexercised, freely fed controls [23.9 +/- 1.9 (SE) g/day vs. 24.7 +/- 1.3 g/day; P > 0.5]. Running expended approximately 40% of daily energy intake, and weight gain was significantly inhibited. A separate group (n = 10) of nonexercised rats was food restricted (approximately 15 g/day) to match the weights of the exercised rats. The rats were killed after 40 days, when both experimental groups weighed 30% less than controls (P < 0.01). Hypothalamic NPY concentrations showed significant (P < 0.01) increases of 30-70% in specific regions (arcuate and dorsomedial nuclei and medial preoptic and lateral hypothalamic areas) in both the running and food-restricted groups, compared with controls. There were no significant differences between the two experimental groups in NPY concentrations in any hypothalamic region. These findings suggest that negative energy balance, whether caused by reduced energy intake or increased expenditure, increases hypothalamic NPYergic activity. As NPY acts on the hypothalamus to increase body weight, these data support the postulated homeostatic role of NPY in maintaining nutritional state.
Animals↗
Alterations in hypothalamic NPY and CRF in anorexic tumor-bearing rats.
Regional hypothalamic concentrations of neuropeptide Y (NPY) and corticotropin-releasing factor (CRF), respectively a stimulant and an inhibitor of feeding behavior, were investigated in hypothalamic nuclei in rats carrying the Yoshida sarcoma. Tumor-bearing rats (n = 10), non-tumor-bearing controls (n = 10), and food-restricted rats (n = 10), which did not carry tumors but were pair-fed to match the reduced food intake of the tumor-bearing group, were studied after 10 days. NPY concentrations in the arcuate nucleus (ARC, the main site of NPY synthesis) were significantly increased above controls (P < 0.01) in both tumor-bearing and food-restricted groups. However, NPY concentrations in the paraventricular nucleus (PVN, an NPY-sensitive site of NPY release) showed opposing changes, with a 25% decrease (P = 0.052) in the tumor-bearing but a 48% increase (P < 0.01) in the food-restricted group. CRF concentrations in both the PVN and the ARC were significantly reduced (P < 0.01) in the food-restricted group, but remained close to control values in the tumor-bearing group (P not significant). Changes in hypothalamic appetite-regulating neuropeptides in cancer anorexia, which may result from the action of cytokines produced by a host defense response or the tumor itself, may account for reduced feeding. Such changes may include impaired activity of NPY or failure of CRF activity to be suppressed after underfeeding and weight loss.
Adipose Tissue↗
Surgical treatment of venous leakage: medium-term follow-up.
Thirty-eight men aged 26-69 years (mean 58) who failed to achieve a full, sustained erection with intracavernosal injections of papaverine and phentolamine (PIPE) and who had evidence of a venous leak on digital subtraction dynamic cavernosography underwent penile vein ligation. Postoperative follow-up ranged from 7 to 44 months (mean 28). Nineteen patients regained spontaneous erections which would allow intercourse (mean follow-up on these men was 23 months). Of these 19 patients, 5 experienced recurrent loss of potency over a 6- to 17-month period (mean 9 months), 4 of these subsequently responding to intracavernosal therapy. Of the 19 without full erections after ligation, 8 obtained erections which would allow intercourse with intracavernosal injections. Two of these patients subsequently lost their response to injections at 2 and 6 months postoperatively. Eleven men had no benefit from surgery (either with or without injections). Of the total of 27 men with erections allowing intercourse, only 19 made an attempted coitus during the follow-up period. Of 9 men with treatment failure who had undergone repeat cavernosography, 8 had evidence of a persistent leak, usually arising from the cavernosal veins. At the time of this study, 4 men had been re-explored, following which 3 obtained erections with the aid of PIPE. Patients who fail to improve following ligation may benefit from re-investigation and repeat ligation using a different surgical approach.
Adult↗
Vascular smooth muscle response to ouabain. Relation of tissue Na+ to the contractile response.
Smooth muscle responses to Na+ pump inhibition are thought to reflect two elements: a neurogenic contribution, involving catecholamine release from nerve terminals, and a myogenic response, attributed to relations between pump activity, [Na+]i, and [Ca2+]i. In the present study, we describe the time course and magnitude of cell Na+ changes, assessed by two methods, atomic absorption and nuclear magnetic resonance spectroscopy during the myogenic contractile response of rabbit aorta strips to ouabain. A threshold concentration of 3 x 10(-7) mol/L induced a gradual rise in [Na+]i. Both methods showed an essentially identical monotonic rise over 4 to 8 hours from a baseline level of 8 to 10 mmol/L water to a peak, which was approximately fivefold higher. The neurogenic (rapid) and myogenic (delayed and gradual) contractile responses were temporally distinct. Ouabain at 10(-7) mol/L, a concentration 10- to 100-fold lower than the threshold for catecholamine-dependent rapid-onset responses, induced only a delayed and gradual contractile response, which reached a maximum at 6 to 8 hours. With 10(-6) mol/L ouabain, the delayed response of 1.6 +/- 0.2 g peaked at 7.3 +/- 1.1 hours and was sustained for 16 hours. The time course was similar to that for change in [Na+] but somewhat later. Ouabain at 10(-5) and 10(-4) mol/L induced a delayed response that was identical in magnitude but also induced an early rapid contractile response, which was prevented by reserpine or phentolamine pretreatment. These agents did not influence the delayed response.(ABSTRACT TRUNCATED AT 250 WORDS)
Animals↗
Increased neuropeptide-Y messenger ribonucleic acid (mRNA) and decreased neurotensin mRNA in the hypothalamus of the obese (ob/ob) mouse.
The obese hyperglycaemic ob/ob mouse exhibits hyperphagia and other abnormalities of hypothalamic function. We measured hypothalamic concentrations of four peptides implicated in the control of appetite and energy expenditure, neuropeptide-Y (NPY), neurotensin, galanin, and somatostatin, by RIA and their respective mRNAs using semiquantitative Northern blotting. Using lean (+/+) mice as controls, we found unchanged concentrations of NPY, galanin, and somatostatin and a 25% reduction in neurotensin (P < 0.01). Neurotensin mRNA was similarly decreased (by 30%; P < 0.02), while NPY mRNA was increased 3-fold (P < 0.01). Centrally administered neurotensin decreases food intake, whereas NPY potently stimulates food intake. An increase in NPY gene expression together with reductions in neurotensin concentration and mRNA in the hypothalamus may be implicated in the development of hyperphagia and other neuroendocrine abnormalities seen in the ob/ob mouse.
Animals↗
Adverse effects of exogenous insulin. Clinical features, management and prevention.
Insulin has been in therapeutic use for around 70 years, and the range of adverse effects associated with its use is very limited. Insulin allergy and other local cutaneous reactions, which were common with the early insulins, are now rarely seen with highly purified and biosynthetic preparations. By far the most important complication of exogenous insulin is hypoglycaemia, which affects almost all insulin-treated patients and is largely a manifestation of nonphysiological insulin regimens and routes of administration. The problem of hypoglycaemia unawareness is now being increasingly recognised, with onset of severe neuroglycopenia and coma which is not preceded by the characteristic warning symptoms associated with autonomic activation. This can occur with excessively tight glycaemic control, and this situation is usually reversible. More commonly, however, hypoglycaemia unawareness is a chronic problem which is predominantly a feature of long duration of diabetes. Although individual episodes of hypoglycaemic coma can usually be effectively treated with parenteral dextrose or glucagon, management of patients with chronic hypoglycaemia unawareness is a difficult clinical challenge, with limited therapeutic options. In the past few years, there has been concern that the use of human insulin preparations may predispose to hypoglycaemia unawareness. The evidence for and against this is discussed, although at present it is difficult to draw any absolutely firm conclusions.
Drug Hypersensitivity↗
Effective treatment of insulin-induced edema using ephedrine.
OBJECTIVE: To control insulin-induced edema in a patient with poorly controlled IDDM. RESEARCH DESIGN AND METHODS: A 31-yr-old woman with a 14-yr history of poorly controlled IDDM first developed peripheral edema 3 yr after diagnosis of IDDM; the edema worsened whenever insulin dosage was increased. In August 1991, severe edema developed after treatment of ketoacidosis, with body weight increasing from 46 to 61 kg. No evidence of cardiac dysfunction or autonomic neuropathy existed, and serum albumin was consistently normal. RESULTS: Treatment with 15 mg of ephedrine every 8 h produced a prompt diuresis, with body weight falling by 4 kg in 48 h and by 12 kg within 1 wk. CONCLUSIONS: Ephedrine may be an effective treatment for insulin-induced edema and may be preferable to the use of diuretics in such patients.
Adult↗
Costs and quality.
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Costs and Cost Analysis↗
A feature of alcoholic Wernicke's encephalopathy favourable to the maintenance of memory function: vomiting.
Outcome in terms of progression of Korsakoff's psychosis is known to be unlikely when the preceding thiamin deficiency syndrome, Wernicke's encephalopathy, does not follow heavy alcohol use. There is evidence that alcohol potentiates thiamin-related brain damage. It is argued here that in heavy drinkers, if vomiting precedes the onset of the encephalopathy, then the latter might develop at a time when tissue alcohol levels are close to zero. Any progression to Korsakoff's psychosis could then be associated with less or even no impairment. This outcome would not be expected if ingestion of alcohol continued during the vomiting stage. In a follow-up study of 61 cases of alcoholic Wernicke's encephalopathy, these concepts are given some support by the results obtained.
Aged↗
A one-to-one relationship with lasting benefits. Implementing primary nursing in a coronary care unit.
It is essential that people who have suffered a myocardial infarction are counselled on how to avoid repeated attacks. By implementing primary nursing in a coronary care unit, the one-to-one relationship involved can be used to enhance the counselling process.
Coronary Care Units↗
Human insulin.
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Diabetes Mellitus, Type 1↗
Human insulin and hypoglycaemia: burning issue or hot air?
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Awareness↗