Initial warfarin treatment in hospital--room for less caution? A twelve month prospective audit.
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Adolescent↗
Biomedical subjects
N L Gilchrist
Publications and source records attributed to N L Gilchrist.
A comparison of elderly patients with proximal femoral fractures and a normal elderly population: a case control study.
AIM: To assess the importance of bone density and other risk factors in elderly subjects with hip fractures. METHOD: Thirty-six subjects with femoral neck fracture were compared with 72 community controls in this case control study. Variables compared included: history of falls, previous fracture, body mass index, hand grip strength, blood pressure, medication use, cigarette smoking, alcohol intake, visual acuity, age at menopause, mental status quotient, mobility index and mid thigh circumference. Bone mineral density was measured at the hip (DPA absorptiometer) in the 36 subjects with hip fracture and 36 community controls. RESULTS: Fracture patients had significantly (p < 0.01) reduced bone mineral density at femoral neck (0.64 vs 0.74 g/cm2) and trochanteric regions (0.55 vs 0.66 g/cm2). They also had significantly (p < 0.05) lower body mass index, weaker hand grip strength, smaller mid thigh circumference, reduced mobility and more previous fractures. After controlling for age and sex stepwise logistic regression identified handgrip strength, mobility status and falls in that ranking as risk factors for fracture. Bone mineral density was correlated with mobility status and grip strength. CONCLUSION: Patients with hip fracture have lower bone mineral density than controls. Mobility, grip strength and muscle bulk appear to be important in fracture aetiology and could operate either through bone density or risk of falling.
Accidental Falls↗
Factors affecting bone mineral density in high school girls.
OBJECTIVES: first to establish a local normal range for hip and spine bone density in the teenage years. Secondly to determine what factors might affect bone mineral density at this age. METHODS: bone mineral density (DPX absorptiometer) at the hip and spine in a cohort of 138 high school girls; mean age 16.4 yr (SD 0.34). Anthropometric factors, calcium intake, physical activity and other lifestyle and medical data were documented in each subject. RESULTS: in this group of 16 year old schoolgirls mean bone mineral density at the hip, 1.01 (0.13) was not significantly different from 20-25 year old New Zealand females, but bone mineral density at lumbar spine, 1.17 (0.12), was significantly lower. Positive correlations of bone mineral density with weight, height, physical activity and calcium intake were demonstrated. Weight was clearly the best predictor of bone mineral density variability. Calcium intake and physical activity showed no predictive value at the spine but contributed significantly at all regions of the femur and particularly at the trochanter. CONCLUSIONS: it appears that peak bone mass can be modified by nutrition and exercise. Adolescents should be encouraged into regular exercise programmes and to maintain adequate body mass and calcium intakes.
Absorptiometry, Photon↗
The effect of parathyroidectomy on bone mineral density in primary hyperparathyroidism.
Bone mineral density was studied before, and at one year after successful parathyroidectomy in six postmenopausal, three premenopausal females and one male with primary hyperparathyroidism. Dual photon absorptiometry was used to measure bone mineral density at the lumbar spine in all subjects, and at three areas of the hip in eight of the subjects. There was no significant change in bone mineral density at the lumbar spine after one year. Bone mineral density increased 7.4% at the femoral neck from 0.822 (SEM 0.053) g/cm2 to 0.895 (0.04) g/cm2; p less than 0.01, 8.7% at Wards triangle from 0.681 (0.065) g/cm2 to 0.745 (0.07) g/cm2; p less than 0.02. A 5.6% increase at the trochanteric region from 0.785 (0.053) g/cm2 to 0.803 (0.053) g/cm2 was not significant. These results indicate that significant increases occur in bone mineral density at the hip, but not at the lumbar spine at one year after parathyroidectomy in patients with primary hyperparathyroidism.
Adult↗
Trial of Sinemet CR4 in patients with Parkinson's disease.
OBJECTS: to compare the efficacy of Sinemet CR4 (CR4), a slow release levodopa preparation, with that of standard Sinemet in patients with Parkinson's disease and motor fluctuations. METHODS: forty-five patients with Parkinson's disease of mild to moderate severity and motor fluctuations were entered into the 12 month trial. After a four week baseline period of optimal therapy, standard Sinemet was completely substituted by CR4 over 12 weeks, and clinical status monitored regularly over another 36 weeks. Evaluation was based on standard rating scales and patient's and physician's opinion ratings. RESULTS: forty-two patients completed the study. The mean optimum total daily dosage of Sinemet CR4 was 702 mg, significantly greater than the mean optimum daily dose of standard Sinemet--496 mg (p less than 0.01). Median number of doses per day was less, being 3 and 4 respectively (p less than 0.01). There was reduction in tremor (p less than 0.01) and rigidity (p less than 0.05) with Sinemet CR4 therapy compared with standard Sinemet, but no difference in disability scores, bradykinesia, gait, or postural instability. Twenty-five patients rated the change to Sinemet CR4 from standard Sinemet as "more helpful", 15 "about the same", and two "less helpful". There were no serious or unexpected adverse effects. CONCLUSIONS: it was concluded that Sinemet CR4 was at least as effective as standard Sinemet, and it seemed particularly helpful in those patients with wearing-off who require frequent doses of standard Sinemet throughout the day.
Aged↗
Erythrocyte sedimentation rates in the elderly: a community study.
One hundred and ninety-four elderly subjects living in the community were randomly selected in order to define a reference range for erythrocyte sedimentation rate (ESR) for this age group. Mean (S.D) values were 4.1 (2.9) mm in one hour and 7.2 (2.6) mm in one hour for men and women respectively. Values ranged from 0-44 mm in one hour. The ESR showed significant independent correlations with fibrinogen, haemoglobin (male and female) and albumin levels (male only). A new algorithm for determination of the upper limit of normal for age is proposed: Females ESR = Age/3 + 10 Male ESR = Age/3.
Age Factors↗
A community study of vitamin B12 and folate levels in the elderly.
OBJECTIVE: To measure the prevalence of low serum vitamin B12, folate, and red cell folate levels and their relationship with other nutritional indices. DESIGN: Prospective survey of elderly subjects using radioisotope dilution assays. SETTING: Primary care medical center, Christchurch, New Zealand. PATIENTS: 257 elderly subjects (age 65 years and over), residing in their own homes or in residential homes, were randomly selected. Of these, 204 (79%) participated. The study population was comparable to the elderly population of New Zealand. MAIN OUTCOME MEASURES: Vitamin B12, serum, and red cell folate levels. RESULTS: The prevalence rates for low levels of serum vitamin B12, folate, and red cell folate were 7.3%, 1%, and 3.3%, respectively. The elderly cohort had lower vitamin B12 (P less than 0.001) but higher serum and red cell folate levels (P less than 0.001) than our normal reference range (age 18-65 years). Red blood cell folate levels showed positive correlations with nutritional indices and mental test scores. No correlations were found between vitamin B12 levels and diet or other nutritional indices. CONCLUSIONS: Low folate levels in older people living at home are infrequent findings. In contrast low vitamin B12 levels are more common. Poor diet and undernutrition may contribute to low folate levels, but these factors are less important for the low B12 levels found.
Aged↗
Effects of age and sex on bone density at the hip and spine in a normal Caucasian New Zealand population.
We have studied a normal adult caucasian population (462 females, 264 males age range 20-84) using dual photon absorptiometry to establish patterns of bone reduction at the spine and hip. Subjects were either randomly selected from the electoral roll or volunteers. Bone mineral density reduction at the lumbar spine in females appeared to increase at 40 years and was sustained until 60 years. In males bone mineral density at the spine was preserved. The density at the hip in females decreased throughout adult life beginning before the menopause. In males bone density was preserved at the femoral neck and trochanteric region but not at Wards triangle where reduction occurred throughout life. When compared with other normal populations there was higher bone mineral density at the spine in postmenopausal New Zealand females but no significant difference at the hip.
Absorptiometry, Photon↗
Effect of sulindac on angiotensin converting enzyme inhibitor-induced cough: randomised placebo-controlled double-blind cross-over study.
The effect of sulindac on ACE inhibitor-induced cough was studied in eight hypertensive subjects in a randomised placebo-controlled double blind cross-over trial. There was no significant improvement in cough or sense of well-being. Blood pressure, renal function, plasma renin and ACE activity were unchanged. Sulindac however, appears to be effective in some individuals in reducing ACE inhibitor-induced cough with acceptable tolerance and few side effects. Further work is needed to elucidate the mechanism of sulindac's interaction with ACE inhibitors.
Adult↗
Comparative study of norfloxacin and trimethoprim for the treatment of elderly patients with urinary tract infection.
One hundred elderly hospitalised patients, aged 70 to 97 years (mean 81.7 years; SD 7.1 years) with a urinary tract infection were entered into a randomised study to compare the efficacy, safety and tolerance of norfloxacin 400 mg twice daily for three days with trimethoprim 300 mg once daily for three days. Forty-two of 49 patients (86%) were cured with norfloxacin, compared with 35 of 51 (69%) with trimethoprim (p less than 0.05). No patient reported any side effects during treatment. Two patients treated with norfloxacin and three treated with trimethoprim developed a disturbance of liver function. Three deaths occurred within 28 days of treatment with trimethoprim but were unrelated to the treatment. In this study norfloxacin proved superior to trimethoprim for the treatment of uncomplicated urinary tract infections in elderly hospitalised patients.
Aged↗
Bone density estimation.
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Bone and Bones↗
A comparison of long acting nifedipine and enalapril in elderly hypertensives: a randomised, single-blind, cross-over study.
The effects of nifedipine and enalapril on blood pressure (BP), heart rate, plasma and urine electrolyte, plasma renin activity (PRA), aldosterone and catecholamines, were studied in ten elderly hypertensive subjects in a randomised, single-blind, cross-over trial. Both nifedipine and enalapril were effective in lowering supine and erect systolic and diastolic BP, with nifedipine causing a significant (P less than 0.05) rise in heart rate. Arterial pressure rose to pre-treatment levels on withdrawal of both drugs. Plasma glucose fell significantly (P less than 0.02) on enalapril therapy, whilst no other biochemical changes were observed. PRA, aldosterone and adrenaline rose on nifedipine therapy whereas PRA showed a greater rise on enalapril with a fall in plasma aldosterone and no change in plasma adrenaline. Plasma noradrenaline was not altered by either agent. Unacceptable side effects occurred in patients taking nifedipine resulting in discontinuation of therapy in 2 patients and death in another. Nifedipine or enalapril monotherapy is effective in lowering BP in the elderly hypertensives. Although more experience is needed, the side effect profile of both agents especially enalapril, appears satisfactory.
Aged↗
Sulindac and cough induced by converting enzyme inhibitors.
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Chronic Disease↗
Cough with angiotensin converting-enzyme inhibitors.
Since there are isolated case reports linking cough with angiotensin converting-enzyme (ACE) inhibitor treatment, we reviewed the case notes of patients attending a hypertension outpatient clinic. Of 126 patients, 37 were on medications other than ACE inhibitors, and none complained of cough. In contrast, 12 of 89 patients receiving an ACE inhibitor had noted cough. The symptoms remained when one ACE inhibitor was substituted for another, but disappeared when the drug was withdrawn. Cough was sufficiently irritating to require cessation of treatment in two patients. We conclude that cough is not uncommon during treatment with ACE inhibitors.
Adult↗
Effect of opiate, general anaesthesia and surgery on plasma atrial natriuretic peptide levels in man.
1. Animal data suggest that opiates, halothane anaesthesia and activation of the sympathetic system stimulates release of atrial natriuretic peptide (ANP). To examine whether this is so in man, venous ANP levels were measured in five patients undergoing elective cholecystectomy. 2. Plasma levels of cortisol, aldosterone, norepinephrine and epinephrine increased 3-6 fold during the study. Cortisol-aldosterone relationships were close in all patients (r = 0.73-0.97), whereas plasma renin activity and aldosterone correlations were strong in only two subjects. 3. Baseline plasma ANP concentrations were within the normal range and were not altered by opiate injection, anaesthesia, or surgery. 4. Unlike experimental animals, man exhibits little or no ANP response to opiates, halothane, or surgical stimulation of the sympathetic nervous system.
Adult↗
Failure of conventional chemotherapy in aggressive lymphomas.
Between 1975 and 1982 in 2 centres in Glasgow, 53 previously untreated patients with aggressive non-Hodgkin's lymphomas received chemotherapy consisting of one of the following regimens-CVP, MOPP, CHOP or BACOP. Twenty nine patients (55%) entered complete remission (CR), 20 (38%) had partial remission (PR) and 4 (7%) had progressive disease (PD). Of the 29 patients in CR, 9 have relapsed and died, 5 died of infection, 4 died of non-malignant causes, and 11 (21%) remain alive and disease free. The median survival for the CR group is 40 months. All of the patients in the PR and PD group are dead, median survival 11 months. These chemotherapy regimens will cure only the minority of patients with aggressive lymphomas and the use of more intensive regimens is indicated.
Adult↗
Influence of polysorbate 80 (Tween 80) and etoposide (VP-16-213) on the pharmacokinetics and urinary excretion of adriamycin and its metabolites in cancer patients.
Polysorbate 80 (Tween 80) is present in the IV pharmaceutical preparation of VP-16-213 marketed as VePesid (Bristol-Myers) (etoposide 100 mg, benzylalcohol 150 mg, polyethylene glycol 300 3250 mg, citric acid 10 mg, Tween 80 400 mg and absolute alcohol to 5 ml per 100 mg ampule of VP16), to increase its miscibility with blood. We have examined the effects of 400 mg/m2 Tween 80 IV and 100 mg/m2 VP16 on the pharmacokinetics of Adriamycin (ADR, 30 or 40 mg/m2). ADR and metabolite concentrations were measured by HPLC. ADR plasma profiles were best fitted to a bi-exponential decay and a two-compartment open model. Tween 80 did not alter the values of the two ADR half-lives, nor did it affect metabolite kinetics of their urinary excretion. However, in a similar manner and consistently in all patients, both Tween 80 and VP16 increased the volume of distribution of the central compartment for ADR up to 3-fold, decreased the AUC of ADR up to 2-fold and increased its clearance by exactly the same amount. These effects were due to reduced plasma ADR concentrations during the early phase of its kinetics. Urinary excretion of ADR was also increased. In conclusion, VP16 is likely to affect the kinetics of drugs administered with it: early plasma concentrations will fall due to a general physiological effect of Tween 80 on the apparent volume of circulation.
Adult↗
TNO-6 has no effect in gastrointestinal cancer: N-acetyl-glucosaminidase shows renal damage.
Twenty-five patients, 16 with gastric cancer and nine with colonic cancer, received TNO-6 30 mg m-2 every four weeks. No objective tumour response was recorded. Nausea and vomiting occurred in 21 patients and was severe in 17. Severe marrow suppression developed in five patients. Renal function was unaffected in all but one patient who developed renal failure, probably as a result of septicaemia. However, the renal tubular enzyme N-acetyl-beta-D-glucosaminidase was measured in six patients and showed a rise in all. In this study TNO-6 had no anti-tumour activity in gastrointestinal malignancy, but produced significant renal tubular damage.
Acetylglucosaminidase↗