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Biomedical subjects

M J Bailey

Publications and source records attributed to M J Bailey.

99 records · Page 6Linked to original sources

Reduction of catheter-associated sepsis in parenteral nutrition using low-dose intravenous heparin.

To assess whether adding low-dose heparin to the infusate of patients receiving parenteral nutrition reduced the incidence of septic complications related to the central venous catheter, 80 consecutive patients requiring intravenous feeding were studied. Half of these patients received heparin 1 unit/ml of infusate, while in the remaining 40 (controls) an equal volume of physiological saline was added to the infusate. Strict criteria for the management of the indwelling CVC were observed. The catheter tips were cultured after removal: only one was infected in the heparin group compared with nine in the control group. This significant reduction may have been due to the heparin preventing a fibrin sleeve from forming around the catheter tip. It is recommended that, as well as observing the usual aseptic precautions in managing the cannula, 500 units of heparin are added to each 500 ml of fluid infused to reduce the incidence of catheter-associated sepsis.

Bacterial Infections↗

The role of internal urethrotomy in the prevention of urethral stricture following transurethral resection of prostate.

Urethral stricture is the commonest late complication of transurethral prostatectomy. Although internal urethrotomy is widely practised to prevent structures, there are no reports of any controlled trials of the procedure. A prospective trial of internal urethrotomy, using the Otis urethrotome, in 210 consecutive transurethral prostatectomies is presented. Patients were divided into 2 groups, those undergoing urethrotomy before TUR ("Trial group") and those undergoing TUR without urethrotomy ("Control group"), and they were followed for a minimum of 6 months. The incidence of stricture in the control group was significantly greater than in the trial group (P less than 0.01). Analysis of all other variables revealed no difference between the 2 groups and it is concluded that internal urethrotomy does prevent stricture formation and that it should be undertaken routinely before transurethral resection.

Humans↗

Enzyme deletions and essential fatty acid metabolism in cultured cells.

Conversion of 14C-labeled linoleic acid to dihomo-gamma-linolenic and arachidonic acids, precursors of the PG1 and PG2 series of prostaglandins, was examined in a number of mammalian cell lines in tissue culture. Diploid cells converted linoleate to arachidonate in good yield. Heteroploid or transformed cells did not desaturate linoleic acid but readily converted dihomo-gamma-[14C]linolenate to arachidonate. These observations demonstrate that separate delta6 and delta5 desaturases are involved in the conversion of linoleic to arachidonic acid in mammals. The results indicate that loss or modification of the delta6 desaturase system is a frequent occurrence in transformed cells.

Arachidonic Acids↗

A study on the cost-effectiveness of coronary revascularization: introducing the simultaneous mimic health status model.

An econometric model is presented to compare the cost-effectiveness of two alternative procedures, percutaneous transluminal coronary angioplasty (PTCA) and coronary artery bypass surgery (CABG), for the treatment of multivessel coronary artery disease. This study utilizes the MIMIC (multiple indicator multiple cause) health model in a simultaneous equation system to analyse Emory Angioplasty Surgery Trial (EAST) data. This method eliminates the possibility of endogeneity bias, which may have affected the results of previous cost-effectiveness analyses on this topic. The empirical results indicate that neither procedure proves more cost-effective at 3 year follow-up.

Angioplasty, Balloon, Coronary↗

Chemical and immunochemical comparison of protein adduct formation of four carboxylate drugs in rat liver and plasma.

Carboxylate drugs usually form acyl glucuronide conjugates as major metabolites. These electrophilic metabolites are reactive, capable of undergoing hydrolysis, rearrangement, and covalent binding reactions to proteins. The last-mentioned property has the potential to initiate immune and other toxic responses in vivo. In this study, we compared the extent and pattern of covalent adduct formation in plasma and livers of rats dosed with the nonsteroidal anti-inflammatory drugs (NSAIDs) zomepirac (ZP) and diflunisal (DF), the hypolipidemic agent clofibric acid (CA), and the anti-epileptic agent valproic acid (VPA). These drugs form acyl glucuronides with diverse intrinsic reactivities (apparent first order degradation t 1/2 values of 0.5, 0.6, 3, and 60 h, respectively). Rats were dosed iv twice daily for 2 days (50 mg/kg for ZP, DF, and CA, 150 mg/kg for VPA). Chemical analysis of tissues obtained 6 h after the last dose revealed adduct concentrations of 0.31, 0.44, 0.28, and 0.05 micrograms of drug equivalents/mL of plasma and 2.21, 2.31, 0.96, and 0.96 micrograms of drug equivalents/g of liver for ZP, DF, CA and VPA treatments, respectively. For both plasma and liver, the higher concentrations of adducts were found with ZP and DF, which have the more reactive glucuronides. The low concentrations of VPA adducts found in plasma were in keeping with the very low reactivity of its glucuronide. In liver, however, VPA adducts achieved concentrations of the same order of magnitude as the other drugs and were accompanied by adducts of the (E)-2-en metabolite of VPA at 0.38 micrograms of VPA equivalents/g of liver. The liver data for VPA can be explained by an acyl CoA/beta-oxidation pathway of adduct formation in addition to that from acyl glucuronidation. Immunoblotting using rabbit polyclonal antisera raised against synthetic drug-protein adducts revealed major bands at 110, 140, and approximately 200 kDa in livers of ZP- and DF-treated rats. A fourth major band at 70 kDa in ZP-treated liver had the same apparent molecular weight as the only major band detected in CA-treated liver. A 140 kDa band was detected in liver tissue from VPA-treated rats, as well as several lower molecular weight bands. In plasma, the antisera specifically detected drug-modified serum albumin in samples from rats treated with ZP, DF, and CA, but not VPA. The results with this small series of carboxylate drugs suggested that (a) adduct concentrations in plasma but not liver could be related to acyl glucuronide reactivity, (b) while some modified proteins detected were common, the pattern of modification varied from drug to drug, and (c) caution should be exercised in attributing adduct formation exclusively to the acyl glucuronidation pathway.

Animals↗

Correlation between experimentally and clinically demonstrated activity of two new cytotoxic agents in breast cancer.

Experimental evidence of the cytotoxic activity of two new agents was obtained using five lines of human breast carcinoma serially transplanted into immunosuppressed mice. Tumor growth delay was used to compare the effect of the new agents with that of cytotoxic drugs of known value in human breast cancer. The mean specific growth delay (number of tumor volume doubling times saved) for each agent against the five lines was: CL232/315 (mitoxantrone) 1.9; M-AMSA (4'[9 - acridinyl] amino-methane sulphon - M - ansidine) 0.5; cyclophosphamide, 1.9; adriamycin, 1.8; melphalan 2.2. There was no significant difference between the activity of mitoxantrone and the clinically useful drugs, but m-AMSA (amsacrine) was significantly less active than the other agents. A clinical trial of mitoxantrone at the Royal Marsden Hospital has confirmed the prediction of useful activity against breast cancer. Objective responses (CR + PR, UICC response criteria) were noted in 21 out of 70 (30%) patients with advanced breast cancer treated with the drug. The responses were of 4-7 months plus duration, and the 30% response rate compares favorably with other single agents. Although amsacrine is active in many forms of malignant disease, several Phase II studies have shown it to have little effect in breast cancer. By using panels of xenografts of different tumor types, it should be possible to select the most appropriate human tumors against which to test a new cytotoxic agent in Phase II studies.

Aminoacridines↗