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Biomedical subjects

J F Munro

Publications and source records attributed to J F Munro.

At least 37 records · Page 2Linked to original sources
PubMed1986

Placebo controlled double-blind trial of fluvoxamine maleate in the obese.

Obesity and depression are common disorders which may co-exist. The management of the combination is complicated because some antidepressants cause weight gain fenfluramine, an effective antiobesity agent, may cause depression. Fluvoxamine is an antidepressant which, like fenfluramine, inhibits serotonin re-uptake within the brain. Forty obese female subjects with refractory obesity participated in a double-blind placebo controlled trial. During the twelve week study, those subjects receiving fluvoxamine achieved a mean weight loss greater than, but not significantly different from, that of the placebo group. The result suggests that fluvoxamine may be particularly useful in the management of obese patients requiring treatment with an antidepressant.

Adolescent↗
PubMed1986

A comparison of the pharmacokinetics of propranolol in obese and normal volunteers.

The pharmacokinetics of intravenous and oral propranolol have been compared in six obese and six normal subjects matched for age and sex. After intravenous administration there was no difference in plasma clearance but the volume of distribution was greater (V = 339 l vs 198 l) and the half-life was longer (t1/2 = 5.0 h vs 3.0 h) in the obese group. No important difference in the rate of oral absorption was observed. A trend towards higher systemic availability in the obese group (35% vs 27%) was not statistically significant.

Administration, Oral↗
PubMed1986

Pharmacological approaches to the regulation of fat metabolism.

There are a variety of methods whereby pharmacotherapy can induce weight loss. These include reducing food intake, impairing absorption of nutrients, inhibiting lipid biosynthesis and increasing energy expenditure. Various drugs are currently being evaluated which exert these modes of action. There are a large number of existing thermogenic drugs, though for one reason or another, they do not appear to be of practical value in the management of obesity. Three novel agents are BRL 26830A, LY 104 119 and RO 16-8714. These agents are chemically similar and all have lipolytic effects particularly in brown adipose tissue. BRL 26830A has been evaluated in man with conflicting results. The possible advantages and limitations of thermogenic agents in human obesity are discussed. Although the animal results are encouraging, it is advisable to take a cautious view regarding their therapeutic potential.

2-Hydroxyphenethylamine↗
PubMed1986

Intermittent protein-sparing fasting with abdominal belting.

In an attempt to minimize the weight regain that often follows effective weight reduction, a programme has been evaluated which involved the use of a nylon waist cord which could be readily tightened but not lengthened, during a regime of alternating periods of a liquid diet and a high-fibre natural diet combined with behavioural modification. Forty subjects completed the initial cycle of a liquid regime with an overall weight loss of 7.7 kg during the treatment period. Thirty-six of these subjects have been followed up for a mean of 12 months after the completion of the treatment programme. Five subjects are difficult to categorize having worn the cord for some but not all of this time. Fourteen have continued to wear the waist cord throughout and have achieved a further mean weight loss of 4.8 kg. This differs significantly from the 17 subjects who cut off the cord and who have regained a mean of 6.6 kg. The results suggest that an adjustable waist cord is a valuable aid to achieving successful and permanent weight reduction in some subjects.

Adult↗
PubMed1986

Thyroxine malabsorption following intestinal bypass surgery.

Jejuno-ileal bypass surgery for morbid obesity results in small bowel malabsorption. This may produce various nutritional or mineral deficiencies. A patient who became hypothyroid following bypass surgery required a larger than normal dose of thyroxine, presumably because of impaired absorption. In such patients it is particularly important to measure serum thyrotrophin concentrations in assessing the replacement dose of thyroxine.

Dose-Response Relationship, Drug↗
PubMed1984

Ketoconazole and fungal sinusitis.

A case of a young man with chronic sinusitis. After many years and multiple surgical procedures, fungal hyphae were noted. The patient made a complete recovery with oral ketoconazole.

Adolescent↗
PubMed1984

The current status of antiobesity drugs.

The currently available antiobesity drugs will produce an additional mean weight loss of approximately 0.5 lb (0.23kg) per week for a limited period of time. There is no major difference between the weight losing properties of the various drugs, and choice of drug depends in part on other factors such as cost and side effects. Those drugs affecting catecholaminergic pathways such as phentermine and diethylpropion can be prescribed intermittently because this is as effective, cheaper and presumably less likely to result in dependence than continuing therapy. Fenfluramine however is best given continuously, the dose being built up and reduced stepwise to avoid the dangers of withdrawal depression. Individual response may depend partly upon drug compliance and metabolism but cannot be predicted except by trial and error. Once a drug is discontinued, weight regain is the rule and there is no evidence that drug therapy helps to re-educate faulty eating habits. It follows that therapy can be most easily justified if there is a short term need to achieve weight loss, e.g. prior to elective surgery. In some patients, weight regain may be prevented by giving the drug long term but the complications of long-term administration have yet to be evaluated. If it can be justified at all, it is in those subjects with complicated obesity. The development of a non-pharmacological way of preventing weight regain following drug therapy would enhance the potential usefulness of an antiobesity agent.

Adult↗
PubMed1983

Long-term efficacy of fenfluramine in treatment of obesity.

42 obese women who lost at least 6 kg after 26 weeks on fenfluramine tablets had their treatment changed to either an equivalent dose of a sustained-release preparation of fenfluramine or matching placebo in double-blind fashion. Of the 21 given placebo all but 2 regained weight over the following year. Of the 21 crossed over to fenfluramine, 8 maintained their weight loss, 7 regained weight, and 6 had to be withdrawn for reasons other than weight gain. Plasma concentrations of fenfluramine and norfenfluramine taken before and 4 weeks after the crossover were similar in both responders and non-responders, but non-responders did not maintain their drug levels for as long as did the responders. Longer controlled administration of fenfluramine will prevent weight regain in some obese women but the hazards of prolonged use remain to be evaluated.

Body Weight↗
PubMed1983

Rheumatic heart disease and thyroid status.

A retrospective analysis of 76 patients with rheumatic heart disease revealed nine with thyrotoxicosis, three with hypothyroidism and seven with normal thyroid function and circulating thyroid antibodies. This suggests that there may be an association between rheumatic heart disease and thyroid dysfunction. The findings emphasize the need to formally exclude hyperthyroidism in patients with atrial fibrillation whatever the apparent cause. They also imply a possible autoimmune factor in the pathogenesis of rheumatic heart disease and suggest that patients with rheumatic heart disease may develop clinical or sub-clinical thyroid disease.

Adult↗
PubMed1983

The management of obesity.

Every obese person presents a different management problem, although the following general principles can be applied: (1) It may be easier to prevent obesity than to treat it. (2) Lifelong modification of eating habit is the corner stone of effective therapy. (3) Group therapy combined with a behavioural modification programme provides a method of assisting many subjects. (4) Drug therapy is best justified if there is a short-term need to produce weight loss. (5) Radical therapy should be restricted to the morbidly obese and is best supervised by units with special expertise.

Adult↗
PubMed1983

A double-blind evaluation of evening primrose oil as an antiobesity agent.

Evening Primrose Oil (EPO) is a naturally occurring rich source of essential fatty acids, especially linoleic and gamma-linolenic acid. It has been suggested that it has antiobesity properties. This double-blind 12-week study was undertaken in 100 women with substantial obesity: 40 with refractory obesity, and 60 at time of initial referral to a hospital clinic. Seventy-four subjects completed the study. Those treated with EPO were comparable in age and degree of obesity with the placebo-treated group. There was no significant difference in the weight loss achieved by those taking EPO compared with placebo, either in the subjects with refractory obesity or in those treated at time of initial referral. It would appear that any antiobesity property possessed by EPO is clinically insignificant.

Adolescent↗
PubMed1983

Plasma phentermine levels, weight loss and side-effects.

Fifty women with refractory obesity received phentermine resinate. Seven were withdrawn because of side-effects: three developed severe headaches, one each hypertension, depressive symptoms, breathlessness and palpitations with irritability. The mean weight loss in the 34 who completed the 20-week study was 6.4 kg. Nine lost 10 kg or more. Sustained appetite suppression was related to weight loss. Plasma phentermine concentrations did not correlate with the severity of the obesity problem, the degree of subjective anorexia or with weight loss. Poor initial response to standard dosage of phentermine is unlikely to improve with higher dosage. The individual's response to phentermine is unpredictable and appears to relate to factors other than the plasma drug concentration.

Adolescent↗
PubMed1983

The efficacy of a new formulation of trimethoprim and sulphadiazine in acute exacerbations of chronic bronchitis.

Thirty-four acute exacerbations of chronic bronchitis were treated using a new formulation of trimethoprim and sulphadiazine. Significant bacterial isolates were obtained in 18 exacerbations of which 12 comprised Haemophilus influenzae. Adverse effects of treatment, principally nausea, occurred in 5 patients. A satisfactory clinical response in association with the achievement of mucoid sputum was obtained in 94% and the mean time for sputum conversion of 3.8 days compares favourably with other antibiotics.

Adult↗
PubMed1982

Drug treatment and obesity.

(1) The initial treatment of obesity must include an attempt to modify previous eating pattern and may involve group therapy or behavioral modification. Drug treatment is not indicated unless this dietary approach is shown to be ineffective. (2) Since anti-obesity drugs do not help to establish a new and permanent eating habit, they should never be prescribed except as part of an overall management plan. (3) The potential for abuse with amphetamine and phenmetrazine is such that their use cannot be justified as anorectic agents. (4) Phenmetrazine, diethylpropion, mazindol and fenfluramine will all produce an additional mean weight loss of approximately 0.2 kg per week. They are contraindicated if there is a history of drug misuse, drug dependence or psychiatric illness. They should always be prescribed with caution. With the exception of fenfluramine, they are best given intermittently on the grounds of efficacy, safety and cost benefit. (5) The individual response to drug therapy is extremely variable and may reflect differences in drug pharmacokinetics, metabolic adaptation or, less frequently, drug tolerance. (6) Following drug withdrawal, weight regain is the rule. It follows that therapy can most easily be justified if there is a short term need for weight loss, e.g. prior to elective surgery. (7) The safety and efficacy of long term drug therapy has yet to be established. It may prove justifiable in patients most at risk from obesity or from obesity associated disorders such as diabetes and hypertension. However, at present the only established indication for prolonged administration of the currently available drugs is the use of metformin in insulin independent diabetics. (8) The indications for the pharmacological treatment of obesity remain poorly defined. A number of new approaches are being evaluated, and the future may lie in the development of drugs which enhance thermogenesis or primarily act upon the gastrointestinal tract.

Appetite Depressants↗
PubMed1982

Toxic amblyopia associated with Crohn's disease.

A 71-year-old patient presented with failing vision. She was a life-long smoker who had suffered from Crohn's disease for at least 13 years and had vitamin B12 malabsorption which failed to correct with intrinsic factor. It is suggested that toxic amblyopia be considered in any patient with visual impairment associated with terminal ileal disease.

Aged↗
PubMed1981

Pulmonary hypertension and fenfluramine.

Pulmonary hypertension developed in two women who had been taking fenfluramine for over eight months for weight reduction. On withdrawing the drug symptoms and electrocardiographic evidence of pulmonary hypertension disappeared in both cases. In one patient, however, the evidence recurred after rechallenge with fenfluramine.These findings are strong evidence that fenfluramine may cause pulmonary hypertension. Hence any patient taking the drug should report immediately any deterioration in exercise tolerance.

Adult↗