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Biomedical subjects

M K Ward

Publications and source records attributed to M K Ward.

156 records · Page 9Linked to original sources
PubMed1976

Variable response to long-term 1alpha-hydroxycholecalciferol in haemodialysis osteodystrophy.

Ten uraemic patients on regular haemodialysis were treated with 1alpha-hydroxycholecalciferol (1alpha-H.C.C.) for 5 to 14 months. Five patients who had histological osteitis fibrosa with or without osteomalacia responded well, with resolution of musculoskeletal pain, return of raised serum-alkaline-phosphatase concentrations to normal, resolution of radiological subperiosteal erosions, and improvement in histological signs of osteitis fibrosa and osteomalacia. In these patients 1alpha-H.C.C. proved a safe and effective drug. Five other patients did not improve. Characteristically these patients started with moderately severe histological osteomalacia and minimal, if any, osteitis fibrosa. Proximal myopathy was a prominent symptom and serum-alkaline-phosphatase was normal in four of them. Treatment with 1alpha-H.C.C. resulted in early troublesome hypercalcaemia, and repeat bone histology 5--11 months later showed no improvement. It is suggested that in these patients lack of 1,25-dihydroxycholecalciferol may not have been wholly responsible for the observed osteomalacia, hence 1alpha-H.C.C. alone was ineffective. Phosphate depeltion may have been an important contributing factor.

Alkaline Phosphatase↗
PubMed1976

Defects in sphygmomanometers: an important source of error in blood pressure recording.

Almost half the sphygmomanometers in a teaching hospital group had defects in the control valve which interfered with accurate blood-pressure reading. Ward staff should be taught to check sphygmomanometers regularly and replace control valves; time consumption and cost are low. The cuffs in general use in these hospitals, and of the standard size sold in Britain, had rubber bags which did not encircle the arm of more than half the patients on whom they were used. This deficiency causes over-reading of blood pressure in obese people. The size of error is uncertain but it should be avoided by adopting a cuff with a longer bag.

Adolescent↗
PubMed1976

Calcium metabolism in cancer. Studies using calcium isotopes and immunoassays for parathyroid hormone and calcitonin.

Studies of calcium metabolism in 38 patients with cancer indicated that: 1) intestinal absorption of calcium was reduced in patients with skeletal metastases and in those with hypercalcemia; 2) calcium-47 space (a measurement of bone turnover rate) was high in the patients with skeletal metastases; 3) hypercalcemic patients had higher urinary and endogenous fecal excretion of calcium than those who were normocalcemic; 4) levels of plasma immunoreactive parathyroid hormone were similar in normo- and hypercalcemic patients, but the levels for a given serum calcium in malignant disease were lower than those in primary hyperparathyroidism; and 5) some patients had elevated calcitonin levels. Hypercalcemia complicating malignant disease is therefore not due to hyperabsorption or diminished excretion of calcium, and a low calcium diet is unlikely to benefit these patients. Measurement of 47Ca space could be of use in monitoring therapy of patients with skeletal metastases, and measurement of plasma parathyroid hormone could be useful in the differential diagnosis of hypercalcemia.

Adult↗
PubMed1976

Long term therapy with 1,25(OH)2D3 in dialysis bone disease.

Five patients with haemodialysis bone disease were treated with 1 to 1.5 mug of 1,25 (OH)2D3 daily for periods ranging from 6 -8 months. There was a significant improvement in calcium absorption but no troublesome hypercalcaemia was encountered. Secondary hyperparathyroidism improved, both histologically and radiologically, and there was a fall in serum PTH and return of serum alkaline phosphatase to within normal limits. There was also improvement in the patients' mineralisation status, but this change was slower and less marked. Muscle power improved significantly, both clinically and electromyographically.

Calcium↗
PubMed1974

DDAVP in treatment of vasopressin-sensitive diabetes insipidus.

In 11 patients with vasopressin-sensitive diabetes insipidus the effectiveness of the vasopressin analogue 1-desamino-8-D-arginine vasopressin (DDAVP) for controlling diabetes insipidus has been compared with that of lysine vasopressin. DDAVP in equivalent intravenous dosage has been found to be at least as potent and to have a more prolonged action, lasting 13-22 hours instead of 1-2 hours. Twice-daily intranasal DDAVP effected satisfactory control in all these patients, without side effects, and all the patients preferred this to their previous treatment. Single daily intramuscular injections of DDAVP were found to offer excellent control for any subject unable to manage intranasal administration.

Administration, Intranasal↗
PubMed1971

Air embolism during haemodialysis.

Two fatal and five non-fatal episodes of air embolism occurred in the course of 14,000 haemodialyses. Air entered the circuit through the infusion bottle, the heparin syringe or line, or the blood pump insert. Emergency treatment with posture, oxygen, dextran infusion, and dexamethasone was apparently successful in reversing some of the manifestations. Prevention depends partly on better design of equipment and partly on the incorporation in the haemodialysis circuit of devices which detect air and prevent it from reaching the patient. Such monitors are not in general use in the United Kingdom and those currently available are far from infallible. We describe an alternative system incorporating a floating valve in the bubble trap.

Adult↗
PubMed1968

Leukocyte lactate dehydrogenase changes as an indicator of infection prior to overt symptoms.

Lactic acid dehydrogenase (LDH) concentration of rabbit serum and leukocytes was followed during the course of an acute infection with Diplococcus pneumoniae. Control values were obtained prior to infection, and again 4, 24, and 48 hr later. LDH isozymes were characterized by acrylamide gel electrophoresis and quantitated by densitometry. An increase in serum LDH was observed as early as 4 hr after infection. These levels returned to normal in 24 hr and rose again 48 hr after infection. The LDH level of leukocytes, from 10 of 12 infected rabbits, rose rapidly during the 24-hr period after exposure. The levels were two to three times the original preinoculation level for that animal. In six of these rabbits, this LDH elevation occurred 4 hr after inoculation and preceded the onset of fever. Change in the type of leukocyte did not account for the increase in cellular LDH. All infected rabbits showed approximately the same increase in polymorphonuclear leukocytes, but not all developed comparable increases in LDH. The isozyme patterns obtained, when defined amounts of enzyme were applied to the gel for electrophoresis, were characterized for the most part by a three-enzyme pattern. Increasing amounts of enzyme occasionally revealed a fourth, more cathodal, enzyme. The more cathodic enzymes appear to be the most responsive when sudden shifts in enzyme concentration occur within the cell.

Animals↗
PubMedDate not supplied

Prevalence and pathogenesis of impotence in one hundred uremic men.

In a study of dialysis patients 79% of men complained of sexual dysfunction and 61% erectile impotence following uremia and the onset of regular dialysis therapy. Plasma testosterone levels were significantly higher in patients treated by continuous ambulatory peritoneal dialysis (p = 0.001) but the incidence of sexual dysfunction was not different from patients treated by hemodialysis. Although follicle-stimulating hormone levels were higher (p = 0.001) and penile blood pressure index levels lower (p less than 0.05) in patients with impotence, sexual function was not improved by exogenous testosterone, and vasculogenic impotence was identified in only 6% of patients. These findings suggest that a major component of uremic impotence is unrelated to primary testicular failure or penile vascular insufficiency.

Adult↗