Biomedical subjects
Publications and source records attributed to M J Crowe.
We recently had occasion to diagnose eruptive xanthoma. The significance of this cutaneous finding is that it is indicative of an underlying hypertriglyceridemic state. Appropriate dietary changes, correction of secondary factors, along with the addition of antihyperlipidemic drugs as required, will lower the plasma triglyceride level and allow the xanthomatous lesions to resolve.
A monoclonal antibody directed against the synthetic enzyme for the dipeptide carnosine was used on cryostat sections of olfactory epithelium from the grass frog Rana pipiens. A subpopulation of what morphologically resembled olfactory receptor neurons were immunolabelled by this antibody. Labelled cells were completely stained, including the cell body, axonal and dendritic processes, dendritic knobs and cilia-like projections from the knobs.
A savvy administrator must explore and implement ways to keep the medical group growing, but always to keep in perspective the monetary limitations. This professional paper provides a model to use in determining whether or not a medical group should consider branching out into the nursing home business.
The renal and vasopressin (AVP) response to a standard oral water load (20 ml/kg) was examined in a group of water-replete healthy elderly men (n = 6). Two groups, respectively, of water-replete and water-deprived young healthy volunteers acted as controls. After 2 h, the old group had excreted 41 +/- 2.4% (mean +/- SEM) of the water load compared to 100.7 +/- 8.8% in the water-replete young group and 70 +/- 3.8% in the water-deprived young group (P less than 0.01). Similarly, peak diuresis (7.01 +/- 0.48 ml/kg) and peak free-water clearance (5.7 +/- 0.48 ml/min) as determined from hourly sampling in the old group were delayed and significantly less than both young groups (P less than 0.01) (peak diuresis, young water-replete, 10.86 +/- 0.56 ml/kg, young water-deprived, 10.2 +/- 0.64 ml/kg, peak free-water clearance, young water-replete 8.4 +/- 0.72 ml/min, young water-deprived 9.5 +/- 0.88 ml/min). When these indices were adjusted for reduced creatinine clearance (Ccr) in the elderly, there was no significant difference between the young and old groups. Plasma AVP decreased similarly in all three groups following ingestion of water but there was no significant difference in mean plasma AVP between the young and old subjects throughout the study period. We therefore conclude that ability to excrete excess water promptly is impaired in healthy elderly men. This defect is due, at least in part, to an age-related reduction in glomerular filtration rate.
Disorders of water balance are common among elderly patients. A number of factors may contribute. Osmoreceptor-mediated release of AVP is increased, but the response to volume stimuli may be reduced. The capacity of the kidney to concentrate urine is reduced by age, but this impairment cannot be correlated with coincident loss of glomerular filtration (GFR); there may rather be a failure of cAMP response to AVP in aging kidneys. Free water clearance is reduced in the old in proportion to the loss of GFR. Thirst mechanisms are also significantly impaired in healthy as well as sick old people. This combination of factors renders old people particularly liable to develop disorders of water homeostasis during episodes of acute or chronic ill health.
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The effects of single oral doses of a new selective beta 2-adrenoceptor agonist procaterol (0.05 mg and 0.1 mg) and salbutamol (4 mg) on ventilatory function, were compared in 24 asthmatic patients. A bronchodilator effect of similar duration and magnitude followed all three treatments with no evidence of a dose-related response in the case of procaterol. There was no significant difference in blood pressure or heart rate responses or pattern of unwanted effects. We conclude that procaterol and salbutamol are clinically similar with oral dosing and that the maximum effective dose of procaterol is not greater than 0.05 mg.
To determine whether responses to dehydration are altered with age, we investigated the thirst, fluid and electrolyte responses, and hormonal responses to 24 hours of water deprivation in seven healthy active elderly men (67 to 75 years old) and seven healthy young men (20 to 31 years old) who were matched for weight loss during water deprivation. After water deprivation, the older men had greater increases in plasma osmolality, sodium concentration, and vasopressin levels. However, their urinary osmolality was lower and they were less thirsty and drank less after water deprivation, so that their plasma and urine were not diluted to predeprivation levels. Regression analysis indicated increased sensitivity of vasopressin osmoreceptors in the older group, although this difference was not statistically significant. We conclude that after 24 hours of water deprivation, there is a deficit in thirst and water intake in healthy elderly men, as compared with younger men, although vasopressin osmoreceptor responsiveness is maintained or even increased. Our findings also suggest that the well-known deficit in urinary concentrating ability that occurs with age reflects renal causes and not a lack of circulating vasopressin.
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Forty-two couples with marital problems were randomly allocated to conjoint therapy of (i) a directive, (ii) an interpretative or (iii) a supportive (control) type. Self and independent assessment at the end of treatment showed the directive significantly superior to the control procedure on several measures. This superiority was maintained to 18 months' follow-up, when the interpretative procedure also showed some superiority over the control.
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