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Biomedical subjects

J D Ward

Publications and source records attributed to J D Ward.

208 records · Page 12Linked to original sources
PubMedDate not supplied

Methylprednisolone treatment in patients with brain tumors.

A study was made in 10 patients with brain tumors of the effect of methylprednisolone sodium succinate (Solu-Medrol) on clinical neurological status, intracranial pressure, and periventricular elastance. Significant clinical improvement and reduction in periventricular elastance both ocurred within 24 hours of starting treatment, whereas intracranaial pressure was not significantly reduced until the 2nd day of therapy.

Adenoma, Chromophobe↗
PubMedDate not supplied

A double-blind crossover trial comparing human insulin (recombinant DNA) with animal insulins in the treatment of previously insulin-treated diabetic patients.

Ninety-four diabetic patients established on treatment with pork (N = 47) or beef insulin (N = 47) took part in a double-blind crossover trial in which 6-wk treatment periods of their animal insulin were compared with similar periods on human insulin (recombinant DNA). Six patients withdrew during the trial--in three cases for hypoglycemia while taking human insulin. In patients initially treated with beef insulin there was no significant change in the mean blood glucose, the 'M' index, the total daily insulin dose, or the frequency of hypoglycemic attacks after the change to human insulin. Home blood glucose sample values were greater before the morning and evening insulin injection on human insulin (morning: 12.8 mmol/L [beef] versus 14.2 mmol/L [human insulin] [P less than 0.05]; evening: 10.0 mmol/L versus 11.6 mmol/L [P = 0.05]). In pork insulin-treated patients greater values while on human insulin were found for mean glucose (9.0 mmol/L [pork] versus 9.7 mmol/L [human insulin], P = 0.05), 'M' index (65.0 [pork] versus 79.6 [human insulin], P less than 0.025), and total daily insulin dose (50.9 U/day [pork] versus 52.5 U/day [human insulin], P less than 0.001). The early morning glucose sample was also greater on human insulin (9.6 mmol/L [pork] versus 12.1 mmol/L [human insulin], P less than 0.001). No significant differences in either insulin antibody levels or E. coli protein antibody levels were found between either of the animal-insulin treatment periods and human insulin treatment periods.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMedDate not supplied

Continuous subcutaneous insulin infusion in the management of painful diabetic neuropathy.

Nine patients with diabetic neuropathy were treated as outpatients with continuous subcutaneous insulin infusion (CSII). Painful symptoms were scored on a 10-cm horizontal graphic rating scale; motor conduction velocity (MCV) was measured in the median and peroneal nerves; and vibration perception threshold (VPT) was recorded in the great toes. All investigations were repeated after 6 wk and at the completion of 4 mo of CSII. Improved diabetic control was confirmed by significantly lower mean blood glucose levels, M-values, and glycosylated hemoglobin. Symptomatic relief was noted by all patients and was accompanied by a significant improvement in pain scores. There was also significant improvement in VPT and MCV after 6 wk of CSII, which was maintained throughout the 4-mo period. However, sensory studies in the median nerve showed no significant changes during the study. It is concluded that strict glucoregulation is indicated in all cases of symptomatic diabetic neuropathy. It remains to be seen whether strict diabetic control from diagnosis will lead to a reduction in the incidence of this complication.

Adult↗
PubMedDate not supplied

Dynamic foot pressure and other studies as diagnostic and management aids in diabetic neuropathy.

The pressures and loads under the feet during walking have been compared in three groups of 41 patients each, using a microprocessor-controlled optical system. Group A consisted of patients with diabetic neuropathy, group B of non-neuropathic diabetic patients, and group C of nondiabetic controls. Thirteen patients in group A had a history of neuropathic foot ulceration. Other investigations in the diabetic patients included motor conduction velocity (MCV) in the median and peroneal nerves, vibration perception threshold (VPT) in the great toes, the valsalva response (VR), skin resistance (SR), and the ankle pressure index (API). Fifty-one percent of neuropathic feet had abnormally high pressures underneath the metatarsal heads compared with 17% of the diabetic controls and 7% of nondiabetic subjects. All those feet with previous ulceration had abnormally high pressures at the ulcer sites. Of the other investigations, the VPT correlated most significantly with the presence of foot ulceration. In addition, a low median and peroneal nerve MCV, an abnormal VR, a high API, and the absence of sweating all correlated with the presence of foot ulceration. We therefore conclude that simple bedside investigations, such as measurement of the VPT alone, may be useful in identifying those patients at risk of foot ulceration. Foot pressure studies may then be used in such patients as a predictive and management aid by determining specific areas under the foot that are prone to ulceration.

Adult↗
PubMedDate not supplied

Reduction of abnormal foot pressures in diabetic neuropathy using a new polymer insole material.

The precise pressures and loads under 69 neuropathic feet have been measured during walking using a modified microprocessor-controlled optical system. Abnormally high pressures were demonstrated in 94% of feet with a history of foot ulceration, with pressures as high as 20-30 kg X cm-2 under the forefoot. All subjects were also studied using a new visco-elastic polymer material recently used for insole manufacture. A reduction in pressure was demonstrated that was proportional to peak pressure (linear regression line correlation coefficient of 0.91; P less than 0.001). We conclude that this material causes a significant reduction in the abnormally high pressures recorded under neuropathic feet, and should provide a useful insole for the management of patients at risk of neuropathic foot ulceration.

Adult↗
PubMedDate not supplied

The prevalence of symptomatic, diabetic neuropathy in an insulin-treated population.

The prevalence of symptomatic sensorimotor polyneuropathy has been determined in a population of 382 insulin-treated diabetic subjects aged 15-59 yr. Forty-one subjects (10.7%) were found to have diabetic neuropathy, according to strict diagnostic criteria that required the presence of symptoms and signs of nerve dysfunction in the absence of peripheral vascular disease. There was a significant correlation between glycosylated hemoglobin levels and motor conduction velocity in the median and peroneal nerves in all subjects. This finding further emphasizes the importance of metabolic factors related to hyperglycemia in the impaired nerve function seen in diabetic patients.

Adolescent↗
PubMedDate not supplied

Asymptomatic myocardial ischemia in diabetes and its relationship to diabetic neuropathy: an exercise electrocardiography study in middle-aged diabetic men.

The incidence of painless ischemic heart disease is increased in diabetic patients, and it has been suggested that this may be partly due to diabetic neuropathy involving cardiac afferent nerves. We have performed exercise electrocardiography in middle-aged diabetic men without cardiac symptoms to see if silent myocardial ischemia is more common in patients with neuropathy. Thirty patients had diabetic neuropathy (group 1), and 30 did not (group 2). The groups were matched for age and duration of diabetes. The exercise test was abnormal in 14 patients. A positive test was no more common in patients with diabetic neuropathy. During a mean follow-up period of 50 mo, five patients developed clinical heart disease, four of whom had a positive exercise test. An abnormal exercise ECG is common in diabetic men without cardiac symptoms, but our study does not suggest that the high incidence of silent myocardial ischemia in diabetic patients is related to the presence of diabetic neuropathy. In patients with diabetes a positive exercise test is associated with a high risk of developing clinical heart disease in subsequent years.

Adult↗
PubMedDate not supplied

Paediatric head injuries.

A series of 100 patients 19 years of age or younger is presented. Age, mechanism of injury, Glasgow coma score (GCS), diagnosis, outcome, and other factors are analysed. Ninety-four per cent of the patients had ICP monitoring, 68% had a good or moderately disabled outcome; that is, they were functioning. There was a 24% mortality. There was a 25% incidence of mass lesion and these patients did worse. The major cause of death was neurologic injury.

Adolescent↗
PubMedDate not supplied

A portable system for monitoring physiological responses to hypoglycaemia.

Hypoglycaemia is the most common complication affecting people with Type 1 insulin dependent diabetes mellitus. Its onset is characterized by symptoms which include sweating, tremor, palpitations, loss of concentration and tiredness. As part of a research project to investigate the mechanisms of hypoglycaemia we have developed an ambulatory system to monitor and record pulsatile changes in blood flow, pulse interval, body temperature and skin impedance. The system uses a pocket computer (Atari Portfolio) to collect and store the data on a memory card. The analogue system consists of two thermocouples, an infrared photoplethysmograph and skin impedance monitoring circuit. To conserve power the system is programmed to make measurements for 2 min every 10 min: using this regimen over 16 h of data can be stored. Data collected during a spontaneous overnight hypoglycaemic episode are presented and also a comparison between continuous and intermittent data collection during a period of induced hypoglycaemia. The system is being used to investigate the physiological responses to hypoglycaemia but could easily be adapted for monitoring other physiological signals.

Arrhythmias, Cardiac↗