Hyperkalaemic cardiac arrhythmia caused by potassium citrate mixture.
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Aged↗
Biomedical subjects
K S Channer
Publications and source records attributed to K S Channer.
Tetracycline-induced oesophageal ulceration.
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Adult↗
Human vascular reactivity and polymorphisms of the angiotensin-converting enzyme and the angiotensin type 1 receptor genes.
The D allele of the insertion (I)/deletion (D) polymorphism in the angiotensin-converting enzyme (ACE) gene and the C allele of the A1166-C polymorphism in the angiotensin II type 1 receptor (AGT1R) gene have been associated with altered vascular structure and with an increased risk of myocardial infarction. The aim of this study was to determine whether differences in vascular function could be demonstrated to link the previously described changes in structure and the disease outcome. 70 subjects were recruited at random from patients undergoing colonic resection, resistance arteries were excised and were mounted in a small vessel wire myograph. Vasomotor responses to potassium chloride, noradrenaline, prostaglandin F(2alpha), angiotensin I, angiotensin II, acetylcholine and substance P were performed in 30 subjects. Genotype was established in a blinded fashion after completion of myography. To exclude the possibility of masking of genetic influence by non-ACE conversion of angiotensin I, vasomotor responses were then performed to proline(10)-angiotensin I in a further 30 subjects and to angiotensin I in the presence of chymostatin in a further 10 subjects. No significant effect of the I/D polymorphism of the ACE gene was seen on vasomotor function. The C allele of the AGT1R gene was associated with an increase in sensitivity to prostaglandin F(2alpha) but not with alteration to the other vasoactive agents studied. The I/D ACE and A1166-C AGT1 receptor polymorphism do not appear to result in differences in vasomotor function in isolated human mesenteric resistance arterioles in subjects without evidence of underlying hypertensive or cardiovascular disease.
Aged↗
Junior doctors and the full shift rota--psychological and hormonal changes: a comparative cross-sectional study.
We studied the hormonal and psychological effect of the full shift rota on junior doctors after implementation of the European Working Time Directive, using a comparative, cross-sectional study design of male doctors in South Yorkshire. Cortisol and testosterone levels were measured and subjects completed the general health questionnaire (GHQ-12) and the androgen deficiency in the aging male screening questionnaire (ADAM), after a week of holiday (baseline), a week of nights, and a normal working week. The results showed that cortisol levels decreased from 480.6 +/- 33.1 nmol/l at baseline (after a week of holiday), to 355.7 +/- 29.1 nmol/l post normal working week (p = 0.003); to 396.7 +/- 32.5 nmol/l post nights (p = 0.03). GHQ-12 scores increased from 0.5 +/- 0.3 at baseline, to 1.8 +/- 0.5 post normal working week (p = 0.02) and to 2.3 +/- 0.5 post nights (p = 0.005). These results suggest that there are still appreciable physiological consequences with new work patterns.
Adult↗
Selective treatment for heart failure: the future beckons?
Myocardial failure results from a variety of insults yet treatments have been given in a nonselective way. The benefits of treatments on symptoms are not related to etiology, but there is increasing evidence that prognosis is. Whenever the prognostic benefits of treatments have been classified according to etiology, patients with myocardial damage without concomitant ischemic heart disease fare better. In this paper, we present and evaluate the data on prognosis and discuss the possible reasons behind these differences. These differences are important because they will help to inform patients and physicians about prognosis based on the underlying cause of myocardial damage. In the future, treatment may be more successful if it is targeted to patients according to the cause of heart failure.
Journal Article↗
Reporting on reports--cardiological intervention in elderly patients.
We asked consultant cardiologists and geriatricians in the Trent Region to assess the change in attitude towards cardiological investigations in the elderly over the last five years. We then reviewed data from three cardiothoracic centres to see if this change was reflected in the number of invasive cardiological procedures performed. The consultants' opinion that more elderly patients are being referred for and receiving more investigations and treatment was reflected in a disproportionate increase in cardiac catheterisations and revascularisation procedures in the elderly between 1990 and 1993. There is little to suggest that these changes came about as the result of the College report on cardiological intervention in elderly patients.
Age Distribution↗
Integration between general and geriatric medicine: a needs related policy.
A joint admitting policy between a general physician and a physician in medicine for the elderly reduced the length of stay in acute medical beds by 25% without increasing the length of stay in rehabilitation beds. The basis for the cooperation was not related to age but rather to the perceived needs of the patient on admission. This method of integration between medicine and geriatrics could be implemented in most hospitals.
Age Factors↗
Unsatisfactory management of patients with myocardial infarction admitted to general medical wards.
Patients admitted with acute myocardial infarction to general medical wards fared less well than those admitted over the same period to the coronary care unit. The median age of the 119 patients admitted to the general wards was 75 years, compared to 64 years for those on the coronary care unit. Although 13 of the 119 fulfilled the local guidelines for thrombolysis, none received it, only 64% were given aspirin and 49% nitrates. The death rate for these patients was 29% compared to 12% of those given thrombolysis on the coronary care unit and 26% of those who were ineligible for thrombolysis but had been admitted to the coronary care unit. Of the survivors on the general wards, 80% were given aspirin as secondary prevention, and 37% were given a beta-adrenergic blocker. None was referred to the hospital cardiac rehabilitation programme.
Adult↗
Hypoxaemia and supplemental oxygen therapy in the first 24 hours after myocardial infarction: the role of pulse oximetry.
OBJECTIVE: To assess the incidence and degree of hypoxaemia in patients with acute myocardial infarction and evaluate the nation-wide perception and usage of oxygen therapy. DESIGN: Postal survey of all coronary care units (CCU) in England of their use of prescribed oxygen and pulse oximetry. Prospective randomised study of 50 patients presenting within 24 hours of onset of myocardial infarction, half of whom received oxygen therapy. Oxygen saturation (SpO2) as continuously measured by pulse oximetry, and arrhythmias and ST segment changes were recorded on simultaneous 24-hour ambulatory Holter monitors. RESULTS: In 53% of UK coronary care units oxygen is not routinely prescribed but in only 3% is a pulse oximeter used to aid management. In patients presenting with acute myocardial infarction the incidence of hypoxaemia (SpO2 < 90%) was 70% and severe hypoxaemia 35% in those not given oxygen, compared with only 27% and 4% in patients given oxygen therapy. The only patient to receive oxygen on clinical grounds had an oxygen saturation of 71%. Severe hypoxaemia (SpO2 < 80%) occurred significantly less often (1 and 7 patients, p < 0.05) in patients given oxygen. There were no differences in arrhythmias or ST segment changes between groups. CONCLUSION: Hypoxaemia occurs frequently in patients in the first 24 hours after acute myocardial infarction. It is effectively and easily treated with supplemental oxygen which can be guided by pulse oximetry. This is rarely done. Measurements of oxygen saturation are therefore justified in all patients to guide oxygen therapy unless there is a decision to give all patients supplemental oxygen: this we believe to be unnecessary.
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