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Biomedical subjects

J R Reynolds

Publications and source records attributed to J R Reynolds.

At least 19 recordsLinked to original sources
PubMed2000

Faecal calprotectin levels in a high risk population for colorectal neoplasia.

BACKGROUND: Faecal concentrations of the protein calprotectin have been found to be elevated in patients with colorectal neoplasia, suggesting that it might be used as a screening tool for colorectal cancer as well as adenomas. AIMS: To measure the sensitivity and specificity of faecal calprotectin for the detection of adenomas in high risk individuals undergoing colonoscopy. Also, to investigate between and within stool variability of calprotectin concentrations. SUBJECTS: A total of 814 patients planned for colonoscopy were included for the following indications: positive faecal occult blood test, 25; neoplasia surveillance, 605; newly detected polyp, 130; and family risk, 54. METHODS: Two faecal samples from each of two stools were analysed using the PhiCal ELISA test device (Nycomed Pharma AS). RESULTS: Adenoma patients had significantly higher calprotectin levels than normal subjects (median 9.1 (95% confidence interval 7.5-10.1) v 6.6 (5.6-7.4)mg/l). There was no significant decrease in calprotectin levels after polypectomy. Levels in cancer patients were significantly higher than those in all other subgroups (median 17.6 mg/l (11.5-31.0)). With a cut off limit of 10 mg/l, the sensitivity for cancer was 74% and for adenoma 43%. Corresponding specificity values were 64% for no cancer and 67% for no neoplasia (cancer+adenoma). Specificity varied from 71% for one stool sample to 63% for four samples. Stool variability was small, suggesting that two spots from one stool were as discriminative as two spots from each of two stools. CONCLUSIONS: The sensitivity and specificity of faecal calprotectin levels as a marker for colorectal adenoma and carcinoma justifies its use in high risk groups, but specificity is too low for screening of average risk persons. Lack of a decrease in levels after polypectomy may be due to a more widespread leucocyte migration into the intestinal lumen than that at the polyp site, and needs further investigation.

Adenoma↗
PubMed2000

Mesh repair of a coccygeal hernia via an abdominal approach.

We report on the presentation and management of a patient with herniation of the rectum following a coccygectomy. We used an abdominal approach and careful pelvic dissection to define the defect in the pelvic floor at the site where coccyx used to be. Prolene mesh repair resulted in the reduction of the hernia. To our knowledge, this is the first report on the mesh repair of the coccygeal hernia via an abdominal approach.

Aged↗
PubMed1997

The effects of industrial employment conditions on job-related distress.

This paper examines the interaction between the effects of industrial unemployment and job conditions on workers' levels of psychological distress. Previous research finds that economic stress, defined as contexts of high unemployment, mainly affects distress indirectly through deteriorating job conditions. However, adaptive cost and identity salience hypotheses predict that the effects of industrial- and job-level conditions interact. I test for cross-level interactions between industrial unemployment and job demands and complexity using hierarchical linear modeling, individual data for 7,095 workers from the 1987-1988 National Survey of Families and Households, and industry data from the Bureau of Labor Statistics' 1986-1988 Current Population Surveys. Economic stress at the industrial level has a direct positive effect on worker distress, and economic stress is more distressing to workers in rewarding, complex jobs. In contrast, job demands increase distress, but this effect does not interact with industrial employment conditions.

Adult↗
PubMed1994

The PACT model.

Explore the source record for details and available documents.

Activities of Daily Living↗
PubMed1993

Pharmacokinetic considerations in critical care.

As an applied science, pharmacokinetics permits the clinician to predict serum drug concentrations (SDCs) and associated pharmacologic responses, estimate dosage requirements, and assess unexpected drug responses. Therapeutic drug monitoring operationalizes the principles of pharmacokinetics through a multidisciplinary approach to the assessment and application of patient SDC data. Complicating the assessment of patients receiving these drugs is the tendency for physiologic changes and drug interactions to influence SDCs and associated pharmacologic responses. In determining the best dosing regimen for a particular patient, it is important to consider factors such as age, weight, major organ function, and concurrent drugs and disease states.

Age Factors↗
PubMed1988

Pharmacokinetics of sufentanil in patients undergoing renal transplantation.

Renal failure and chronic haemodialysis are often associated with alterations in fluid status and plasma proteins. These changes, in turn, may result in pharmacokinetic alterations in affected patients. The purpose of this study was to investigate the pharmacokinetics of sufentanil in chronic renal failure patients undergoing kidney transplantation. Ten male patients were studied. Following induction of anaesthesia each patient received sufentanil 2.0 micrograms.kg-1 IV with subsequent serial plasma sampling for drug measurement from one to 360 minutes. A biexponential equation provided the best fit of the sufentanil concentration data with mean +/- SEM distribution (alpha) and elimination (beta) half-lives of 2.9 +/- 1.3 and 176 +/- 87 minutes, respectively. The mean Vc and Vd beta values were 0.15 +/- 0.05 L.kg-1 and 0.85 +/- 0.16 L.kg-1, respectively; plasma drug clearance was 11.5 +/- 3.7 ml.kg-1.min-1. Mean values for K10, K12 and K21 were 0.15 +/- 0.06.min-1, 0.4 +/- 0.14.min-1 and 0.1 +/- 0.04.min-1, respectively. With the exception of Vd beta, these pharmacokinetic values are similar to those reported in previous studies in general surgical, elderly and burn patients. The Vd beta values observed in this study may have resulted from alterations in drug distribution or elimination following revascularization of the implanted kidneys. Nevertheless, it appears that modification of sufentanil doses is unnecessary in chronic renal failure patients undergoing renal transplantation.

Adult↗
PubMed1988

Aminoglycoside utilization study.

A retrospective review of aminoglycoside (AG) use in a tertiary care medical center/teaching hospital was conducted and use patterns were evaluated. Guidelines for AG use were approved by the Pharmacy and Therapeutics Committee and study criteria were developed to assess several parameters involving AG therapy, such as appropriateness of drug use, dosage, duration of therapy, and monitoring for toxicity. The study was conducted as part of a pharmacy quality assurance program in combination with the pharmacokinetic consultation service. A study population of 100 patients receiving an AG (gentamicin: 51, tobramycin: 33, amikacin: 16) was randomly selected from a total population of 250 patients who received AG therapy during August 1985. Medical patients accounted for 65% of AG use while surgical patients accounted for 30%. The majority of patients (84%) received an AG for an appropriate indication. Pretreatment culture/susceptibility and renal function was assessed for 89% and 91% of the patients, respectively. The study revealed problems with loading doses, maintenance doses and serum drug level monitoring. The majority of study patients did not have serum drawn for drug level determination at an appropriate time; therefore, dosage regimen decisions could not be made based on peak and trough values. No clinical nephrotoxicity was detected during treatments. The results of this study indicated the need for educating clinicians with respect to basic and applied AG pharmacokinetic principles and the importance of monitoring patients using the pharmacokinetic consultation service.

Adult↗
PubMed1988

Comparative bioavailability of two oral sustained-release procainamide products.

The bioavailability characteristics of two sustained-release oral procainamide preparations, Procan SR and Pronestyl-SR, were compared in 10 patients with arrhythmias. Each patient was randomly assigned to receive either Procan SR 1 g or Pronestyl-SR 1 g, both administered orally every six hours. The initial drug was continued for 48 hours (eight doses), at which time the second drug, given at the same dosage and dosing interval, was substituted for a 48-hour period. Serum samples for procainamide determination were obtained hourly between 42 and 48 and between 90 and 96 hours after initiation of procainamide therapy. Values for area under the serum concentration-time curve (AUC) during the steady-state dosing interval, maximum serum drug concentration (Cmax), minimum serum drug concentration (Cmin), Cmax:Cmin ratio (representing fluctuations in serum drug concentrations within the dosing interval), and the time to maximum serum drug concentration (tmax) were determined. Mean ( +/- S.D.) tmax values for Procan SR and Pronestyl-SR were 2.2 +/- 0.8 hours and 3.8 +/- 1.1 hours, respectively. Only the differences between tmax values were statistically significant. The study had an 83% chance of detecting a 20% difference in AUC values. The chances of detecting a 20% difference in values for Cmax and Cmin were 62% and 71%, respectively. These two preparations would probably possess similar therapeutic properties when given at the same dosage and dosing schedule; however, studies with larger subject populations are needed to project bioavailability data to the general population.

Aged↗
PubMed1987

Intragastric pH monitoring in acute upper gastrointestinal bleeding and the effect of intravenous cimetidine and ranitidine.

Intragastric pH was measured continuously from 1800 to 1200 hours the following day in 22 duodenal ulcer patients and in eight gastric ulcer patients, all of whom had been admitted as emergencies with acute upper gastrointestinal haemorrhage. The effects of intravenous cimetidine or ranitidine were compared with no treatment. In patients with duodenal ulcer, median intragastric pH was 1.8 (range 1.0-4.9) in the group receiving no treatment. In the cimetidine group (400 mg, 6-hourly, n = 8) median pH was 4.7 (range 1.5-7.7) and after ranitidine (50 mg, 6-hourly, n = 10) it was 3.8 (range 1.2-7.8). The pH remained above 4.0 for 67% of the recording time with cimetidine, 47% with ranitidine and for only 3% with placebo. Intragastric pH in gastric ulcer patients without treatment was higher (median 3.4, range 1.0-6.9) than in duodenal ulcer patients with treatment. Both H2 antagonists raised intragastric pH in patients with gastric ulcer and maintained a gastric pH of greater than 4.0 for at least 50% of the time. Presently recommended i.v. doses of cimetidine and ranitidine do not consistently maintain gastric pH above 4.0 for long periods in patients with peptic ulcer bleeding.

Aged↗
PubMed1987

Gastrointestinal transit of an enteric-coated delayed-release 5-aminosalicylic acid tablet.

Gastrointestinal transit of an enteric-coated, delayed-release 5-aminosalicylic acid tablet radiolabelled with indium-111 has been monitored in a preliminary study with eight healthy subjects using gamma scintigraphy. Gastric emptying of the tablet was delayed by the presence of food in the stomach. Disintegration occurred about 5 hours after the tablet left the stomach. There was close agreement between the tablet disintegration times and the initial detection of drug in the blood. The site of disintegration could be established in most instances; approximately 80% of the doses resulted in drug dispersion within the ascending colon. The coated tablets provide an effective means of drug delivery to the proximal colon.

Adult↗
PubMed1987

Evaluation of an enteric-coated delayed-release 5-aminosalicylic acid tablet in patients with inflammatory bowel disease.

Gastrointestinal transit of an enteric coated delayed release 5-aminosalicylic acid tablet radiolabelled with 111indium has been monitored in a total of 13 patients with Crohn's disease and ulcerative colitis. More than 70% of the tablets disintegrated in the small intestine, on average 3.2 hours after emptying from the stomach. Dispersed preparation was detected in the proximal colon of all the patients, except one with an ileostomy. Mean peak plasma concentrations of 5-aminosalicylic acid and its metabolite acetyl-5-aminosalicylic acid occurred 3-4 hours after gastric emptying. The tablets provide a reliable means of drug delivery to the ileum and proximal colon.

Adult↗
PubMed1987

Clearance of continuous intravenous morphine for severe cancer pain.

Four cancer patients with intractable pain received continuous morphine infusions in doses of 15-275 mg/h for a time period ranging from 4 to 27 days. Serum morphine concentrations were determined periodically following adjustments in infusion rates. As doses were changed and continued at static hourly rates, serum morphine concentrations were relatively constant 20 hours and beyond the time of the respective change, thus suggesting morphine elimination half-lives of less than or equal to 4 hours. High doses did not influence the time required to achieve steady-state concentrations. Steady serum morphine concentrations corresponded with hourly morphine doses in a parallel manner. High interpatient variabilities in clearances and steady-state serum morphine concentrations were noted. These data suggest that at morphine infusions up to 275 mg/h elimination pathways permit handling of increasing concentrations of morphine without nonlinear blood level increases. Also, marked interpatient and intrapatient variations in patient dose requirements were noted.

Female↗
PubMed1987

Pharmacokinetic comparison of intranasal, oral, and intramuscular metoclopramide in healthy volunteers.

This was a randomized, crossover study of the bioavailability and pharmacokinetics of metoclopramide given by intranasal (IN), oral (PO), and intramuscular (IM) routes. The formulations tested were 5 and 10 mg of IN gel, 10 mg PO, and 5 mg IM. The findings showed that metoclopramide follows similar absorption and elimination characteristics when given via these three extravascular routes. There were no statistically significant differences in the area under the drug concentration versus time curve (AUC) or peak metoclopramide plasma concentration (Cmax) data following PO, IM, or 10-mg IN administration. However, the 5-mg IN doses achieved an AUC that was 39.5% the AUC of the 10-mg IN dose. These data show consistent and relatively predictable metoclopramide plasma concentrations following IN administration. Further, 10-mg doses of IN and PO metoclopramide appear to be bioequivalent.

Administration, Intranasal↗
PubMed1986

Colonic motility and enema spreading.

Radiolabelled enema solution was administered to eight healthy subjects, both in fasted and fed states. Enema spreading was monitored over a 4-h period using gamma scintigraphy and colonic motility was recorded simultaneously using a pressure sensitive radiotelemetry capsule. The rate and extent of enema dispersion were unaffected by eating. Spreading could be correlated with colonic motility and was inhibited by aboral propulsion of the colonic contents.

Adult↗