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Biomedical subjects

J M Gray

Publications and source records attributed to J M Gray.

At least 55 records · Page 3Linked to original sources
PubMed1987

Human immunodeficiency virus and drug misuse: the Edinburgh experience.

During 1985 many drug abusers who lived in Edinburgh were found to be infected with the human immunodeficiency virus (HIV). As a result an alternative counselling and screening clinic for testing for antibodies to HIV was established for use by drug abusers. Four hundred and forty one patients were counselled in the first year, and over 60% were either drug abusers or their sexual contacts. One hundred and fourteen (26%) patients were positive for HIV antibody, and 100 (88%) of these were current or former drug abusers. The HIV seropositivity rate in drug abusers was 52% but was only 7% in their sexual contacts. Services were provided for these people as well as counselling before and after the test. The cost of this counselling service for the first year was 27,000 pounds or 61.22 pounds per patient. The unexpected mobility of 23% of the Edinburgh drug abusers, particularly to other areas of Britain, suggests that similar services need to be set up elsewhere.

Acquired Immunodeficiency Syndrome↗
PubMed1987

Psychomotor impairment and anticonvulsant therapy in adult epileptic patients.

Using a battery of simple tests, psychomotor performance was assessed in 11 healthy subjects, 14 untreated epileptic patients and 66 epileptics on chronic anticonvulsant medication. Significant differences were found between controls and untreated patients for choice reaction time, card sorting and Simple Simon memory game. Treated patients performed less well than both untreated epileptics and controls in choice reaction time (p less than 0.05; p less than 0.001), card sorting (p less than 0.01; p less than 0.001), Simple Simon (p less than 0.05; p less than 0.001) and finger tapping (p less than 0.05; p less than 0.001). Patients with centrencephalic epilepsy were slower than those with discrete focal EEG abnormalities in reaction time and card sorting. Patients receiving treatment with carbamazepine, phenytoin or sodium valproate alone all performed similarly to each other and to those patients taking anticonvulsant polypharmacy. Monotherapy patients with potentially "toxic" plasma anticonvulsant concentrations did no worse than those within or below the "therapeutic" range. Both the disease and its treatment reduce psychomotor performance. All major anticonvulsants appear to cause a similar degree of impairment across a wide range of concentrations. The effect of chronic anticonvulsant medication on "quality of life" should not be neglected in the pursuit of perfect seizure control.

Adolescent↗
PubMed1987

Strontium kinetics in metastasized prostatic carcinoma: a comparison with the predictions of impulse response function analysis.

Amongst patients referred for 89Sr palliation of disseminated prostatic carcinoma, we have found wide variations in extent of skeletal metastatic disease and in strontium renal plasma clearance. A numerical technique using impulse response function analysis is reviewed which enables the effect of such variations on the total body, plasma and metastatic strontium retention functions to be calculated. The prediction of the model are compared with kinetic data from patients presenting for radiostrontium therapy, and correlations that have important implications for 89Sr dosimetric studies are confirmed. The simplest kinetic data required to allow for these effects in studies of dose-response and haematological toxicity following radio-strontium treatment are discussed and attention is drawn to a small group of patients who may form a significant exception to the general model.

Bone Neoplasms↗
PubMed1987

Strontium-89 radionuclide therapy: a dosimetric study using impulse response function analysis.

In a series of patients receiving 89Sr palliation for metastasised prostatic carcinoma, strontium renal plasma clearance was found to vary from 0.14 to 11.81 day-1, and the extent of skeletal metastatic disease seen on 99Tcm-MDP images varied from a few small metastases to a superscan. Using a numerical technique based on impulse response function (IRF) analysis, we have investigated the effect of such variation between patients on 89Sr dosimetry. The whole-body IRF, HWB(t), is defined by the deconvolution of the whole-body strontium retention function, RWB(t), with the plasma retention function, P(t). For patients with minimal metastatic bone disease we assumed HWB(t) = HO(t), where HO is the IRF derived from the International Commission on Radiological Protection model for normal strontium metabolism. The strontium plasma clearance, k, was allowed to vary, and the resulting variation of RWB(t), P(t) and absorbed dose to bone marrow calculated. By convoluting P(t,k) with the IRF measured for a discrete metastasis, the effect of varying k on tumour dose was investigated. Tumour and bone marrow dose were shown to change by a factor of three as k varied over the range observed in patients. For patients with extensive metastatic bone disease we assumed HWB(t) = (1-beta)HO(t) + beta HS(t), where HS was the IRF measured for a superscan patient and beta was a parameter reflecting the extent of skeletal metastatic disease. The effect of varying beta on tumour and bone marrow dose was investigated, and dose shown to decrease by a factor of five as beta increased from zero to unity. Impulse response function analysis was found to be a powerful and useful aid in clarifying the relationship between strontium kinetics and 89Sr dosimetry.

Bone Marrow↗
PubMed1986

Central vs. peripheral effects of estrogen on food intake and lipoprotein lipase activity in ovariectomized rats.

The effects of implants of estradiol benzoate (EB) into either the ventromedial nucleus (VMH-EB) or the paraventricular nucleus (PVN-EB) of the hypothalamus were compared to the effects of peripheral EB (Per-EB) replacement in ovariectomized rats. After three days of hormone treatment, the Per-EB group and the PVN-EB group exhibited a decrease in food intake and body weight. Adipose tissue lipoprotein lipase activity was generally suppressed for the Per-EB, PVN-EB, and VMH-EB groups in the left and right parametrial and retroperitoneal fat pads. The finding that the VMH-EB and PVN-EB groups experienced similar peripheral stimulation but differed on the food intake and body weight measures would suggest that these measures are not entirely under peripheral control. The findings support the hypothesis that estrogen exerts its effects via multiple mechanisms, both central and peripheral. In addition, the PVN is shown to be an important site for further research on the modulation of feeding and metabolism by estrogen.

Adipose Tissue↗
PubMed1986

Record linkage study of hypokalaemia in hospitalized patients.

Retrospective analysis of biochemical data from 58,167 hospital inpatients revealed that 21% developed hypokalaemia during hospitalization-in 5.2% the serum potassium was less than 3.0 mmol/l. Subsequent evaluation showed a positive correlation between hypokalaemia and both female sex and hospital mortality. Patients with leukaemia and lymphoid tumours, especially when receiving antibiotic or cytotoxic therapy, and patients with gastro-intestinal malignancy were amongst those most frequently experiencing hypokalaemia. There was no significant association with cardiovascular disease. Drug and intravenous fluid administration accounted for the hypokalaemia in 56% of patients. While drug-related hypokalaemia was most commonly seen with diuretics, it was also apparent following use of steroids, insulin and haematinics.

Aged↗
PubMed1986

Prostatic evaluation by transrectal sonography: criteria for diagnosis of early carcinoma.

Over a 7-month period, from a total of 417 transrectal ultrasound (US) studies, 45 transperineal biopsies of the prostate were performed in the radiology department. Transrectal US guidance and local anesthesia were used. Twenty-two of 32 hypoechoic lesions, located within the peripheral zone tissue of the gland, were proved by histologic study to be cancerous. Hyperechoic lesions were all histologically benign hyperplasias. The patients experienced no major complications necessitating hospitalization or increased length of hospital stay as a result of the procedure.

Adult↗
PubMed1986

Diabetes mellitus and primary hepatocellular carcinoma.

In view of the increasing incidence of primary hepatocellular carcinoma in western Europe and concern that this may in part be related to long-term use of drugs which cause hepatic microsomal enzyme induction, we undertook a comparison of long-term drug use in 105 patients with hepatocellular carcinoma and equal numbers of age and sex-matched patients with colorectal tumours and with fractures of femur. We found no patients with hepatocellular carcinoma who were long-term anticonvulsant users and only one who used oral contraceptives. However, we observed a four-fold excess of diabetic patients among the group with hepatocellular carcinoma. This association did not appear to be due to pre-existing haemochromatosis, alcoholic cirrhosis or viral hepatitis. The association was strongest in patients receiving drug treatment for diabetes, but the data, although suggestive, were insufficient to determine whether any specific anti-diabetic agent could be responsible. Further studies are required to elucidate the nature of this unexpected association. An association of this magnitude with diabetes mellitus could account at least in part for the increasing incidence of hepatocellular carcinoma in western Europe.

Adult↗
PubMed1985

Transrectal ultrasound in the diagnosis of prostate cancer: location, echogenicity, histopathology, and staging.

Adenocarcinoma of the prostate produces specific ultrasonic findings that can be used in diagnosis. We have examined 211 patients using transrectal ultrasound in both the sagittal and axial planes. Thirty-three carcinomas were detected, and 31 histologically confirmed; 24 by needle biopsy, six by transurethral resection, one by total prostatectomy, and two by the demonstration of distant metastases. On ultrasound, all of the carcinomas were less echogenic than normal prostate. All appeared to originate in the peripheral zone of the prostate and produced asymmetry of the gland. The majority of carcinomas in this series showed capsular involvement and ten penetrated and extended beyond the prostatic capsule. The results of this series indicate that transrectal ultrasound can be used to detect cancer of the prostate gland. Ultrasound demonstrated the extent of tumor involvement and enabled accurate staging of these cancers.

Adenocarcinoma↗
PubMed1985

Hormone binding globulins and anticonvulsant therapy.

Serum sex hormone binding globulin, thyroxine binding globulin, cortisol binding globulin and vitamin D binding globulin, together with total levels of the appropriate bound hormones, were determined in 21 epileptic subjects who had been stabilised by long-term anticonvulsant therapy. Serum sex hormone binding globulin capacity was higher in these patients than in appropriate control groups (men p less than 0.05; women p less than 0.01), and values correlated with serum phenytoin levels in the female subjects (p less than 0.01). Thyroxine binding globulin levels were unaffected by anticonvulsants, but significant reductions in serum thyroxine (men p less than 0.05; women p less than 0.001) and triiodothyronine (men p less than 0.05; women p less than 0.01) were observed. Cortisol binding globulin capacity was appreciably elevated in patients of either sex (p less than 0.001), and in the women this was accompanied by a reduction in serum cortisol (p less than 0.001) and a significant correlation with the serum phenytoin concentration (p less than 0.01). Neither vitamin D binding globulin capacity nor serum 25-hydroxycholecalciferol levels were influenced by anticonvulsants in this study. It is concluded that anticonvulsant drug therapy causes widespread alterations in the normal homeostasis between hormones and their serum binding globulins. Such alterations may well have clinical significance.

Adult↗
PubMed1985

Lung tissue penetration of temocillin.

Eight patients about to have the whole or part of a lung resected were given a 2g bolus dose of temocillin. A series of serum samples and a piece of peripheral lung tissue were collected and assayed for temocillin concentration. 30 minutes after drug administration, the mean serum and tissue concentrations were 172 mg/L and 45 mg/kg respectively.

Adult↗
PubMed1985

Temocillin in the treatment of chest infections.

In our study, 16 patients with acute infection complicating severe respiratory disease were treated with temocillin 2g or 3g daily for 5 to 10 days. In 10 patients, a recognised respiratory pathogen, either Haemophilus influenzae (temocillin-sensitive) or Streptococcus pneumoniae (temocillin-resistant), was isolated from sputum before the start of treatment. 13 patients improved clinically but 5 subsequently relapsed. Two patients failed to respond, and 1 died of respiratory failure. There was no clearcut relationship between the clinical progress and sensitivity of the isolated pathogen to temocillin, and there were no adverse effects associated with the administration of temocillin.

Aged↗
PubMed1985

Gonadal influences on adiposity.

Gonadal steroids affect energy balance and adiposity in a variety of mammalian species. For example, estradiol acts via multiple, redundant mechanisms to reduce body weight and adiposity. The steroid can act directly in the brain to decrease food intake and stimulate voluntary exercise. Sex hormones may act concurrently in non-neural peripheral tissues to alter metabolic processes and energy balance. White adipose tissue estrogen receptors may mediate estradiol-induced decreases in lipoprotein lipase activity and lipid storage. Finally, estradiol increases energy expenditure independent of any effects on voluntary exercise. Brown adipose tissue is a potential site for estradiol-induced thermogenesis.

Adipose Tissue↗
PubMed1984

Estrogen-induced effects on food intake and body weight in ovariectomized, partially lipectomized rats.

Following ovariectomy, rats were either partially lipectomized (10-15% of total body lipid was removed) or left intact, and were treated with either sesame oil vehicle or estradiol benzoate (EB; 4 micrograms/day) for 2 weeks. Although lipectomy resulted in a change in carcass adiposity, robust behavioral and metabolic effects of EB were observed in all animals. EB treatment induced changes in all carcass components examined, including lipid, protein and water. Lipid:protein ratios were not altered by EB treatment.

Animals↗