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Biomedical subjects

P Gosling

Publications and source records attributed to P Gosling.

At least 55 records · Page 3Linked to original sources
PubMed1991

Non-diabetic microalbuminuria in clinical practice and its relationship to posture, exercise and blood pressure.

1. The effects of posture and exercise on the relationship between low-level urinary albumin excretion (microalbuminuria) and blood pressure was investigated in two groups of non-diabetic patients at increased cardiovascular risk: 21 otherwise healthy patients with untreated essential hypertension (blood pressure greater than 160/90 mmHg), and 14 age-matched patients with blood pressure at presentation within the normotensive range (less than 160/90 mmHg) attending a cardiovascular clinic for assessment of chest pain. 2. A significant linear relationship between logarithmically transformed 'spot' urinary albumin/creatinine ratio and simultaneous clinic blood pressure existed when data from both groups of patients were analysed (r = 0.58, P less than 0.05). The relationship between the scatter plot of blood pressure and the albumin/creatinine ratio appeared most marked when the mean blood pressure exceeded 120 mmHg. 3. In patients with essential hypertension, clinic systolic blood pressure was related to the albumin/creatinine ratio in simultaneous 'spot' urine samples (r = 0.69, P less than 0.05) and also to the albumin/creatinine ratio in early-morning urine samples (r = 0.51, P less than 0.05). However, the relationship between clinic blood pressure and simultaneous 'spot' urinary albumin/creatinine ratio in the patients with chest pain did not achieve significance when analysed independently. 4. Hourly averaged ambulatory intra-arterial blood pressure was recorded in four of the patients with essential hypertension during normal daytime activity, and a significant correlation with the simultaneous hourly daytime urinary albumin/creatinine ratio was found (r = 0.65, P less than 0.01).(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1991

Microalbuminuria is an early response following acute myocardial infarction.

Ninety-six patients admitted to two coronary care units with suspected acute myocardial infarction were studied. The diagnosis was confirmed in 44, the remaining 52 were used as a control group. The first urine passed after admission, together with early morning urines on the following 3 days, were saved in all patients. Urinary albumin and IgG were measured by automated immunoturbidimetry and expressed as the protein creatinine ratio in mg.mmol-1. The log mean (SD) albumin creatinine ratios for the first urine passed in the myocardial infarction and non-myocardial infarction patient groups were 6.2(4.2) and 1.3(3.4) respectively. The difference in log mean albumin creatinine ratio was 4.9 mg.mmol-1, 95% CI 3.4 to 6.2 mg.mmol-1; t = 6.127 df = 94, P less than 0.0001. The median IgG creatinine ratio for the first urine passed after admission in myocardial infarction patients was 1.0 mg.mmol-1 (95% CI 0.5 to 1.2) and for non-myocardial infarction patients 0.3 (95% CI 0.2 to 0.4). Increased urinary protein excretion appears to be an early and proportional response to acute myocardial infarction.

Adult↗
PubMed1990

Effect of surgery on the systemic inflammatory response to intermittent claudication.

The hypothesis that intermittent claudication initiates a systemic inflammatory response was investigated by studying the effect of exercise on markers of neutrophil activation and vascular permeability in 25 claudicants and 10 controls. Urinary albumin excretion, previously demonstrated to reflect vascular permeability, increased significantly after exercise in claudicants and was associated with decreased neutrophil filterability and increased serum lysozyme activity. No similar exercise-induced changes were seen in controls or in claudicants after successful arterial bypass surgery. These results suggest that intermittent claudication is associated with potentially deleterious systemic manifestations that are surgically reversible.

Aged↗
PubMed1990

Assessment of intermittent claudication by quantitation of exercise-induced microalbuminuria.

Urinary albumin excretion rates, expressed as albumin-creatinine ratios (ACR, mg/mmol) were measured before and after exercise in 23 claudicants and 10 controls. The mean (range) resting ACRs in the claudicants and controls were 4.42 (0.2-34.6) and 0.77 (0.3-2.8) respectively (P less than 0.001). ACR increased after exercise by a mean of 153% in claudicants to 9.7 (0.2-48.1; P less than 0.001) with no change in controls, 0.79 (0.2-2.1). In patients with claudication there was a positive correlation between ankle pressure recovery time and the relative increase in ACR after exercise (r = 0.64, P less than 0.01). The post-exercise increase in ACR was reduced in all nine patients who underwent bypass surgery. Measurement of ACR after exercise appears to be related to severity of muscle ischaemia and may assist in the assessment of patients with intermittent claudication.

Aged↗
PubMed1990

Syringe injection pressure: a neglected factor in blood PO2 determination.

The mean arterial blood PO2 values of 20 patients' samples taken into Sarstedt 2 mL Monovette syringes were found to be initially 0.43 kPa higher and after 15 min storage 0.93 kPa higher than the mean values using Corning 3 mL Blood Gas Kit syringes. The Sarstedt syringe allowed entry of small air bubbles and the plunger was noted to be stiff. We speculated that high injection pressures might increase measured PO2. Using each type of syringe, 20 ITU staff injected saline into a Corning 178 pH/blood analyser linked to a pressure transducer via a three-way connector. Mean injection pressures for Sarstedt and Corning syringes were 17.15 and 6.42 kPa, respectively (P less than 0.005). Following injection at pressures between 2.8 and 26.6 kPa, the mean PO2 of equilibrated saline containing an air bubble was 0.80 kPa higher than the mean value obtained at injection pressures of less than 2.8 kPa. However, with no air bubble the mean PO2 of equilibrated saline was still 0.45 kPa higher when injected at pressures between 2.8 and 26.6 kPa than the mean value obtained with injection pressures of 2.8 kPa. We suggest that for optimal PO2 determinations syringes should not only allow minimal air contamination but also have plungers that reduce injection pressure to a minimum.

Adult↗
PubMed1989

Usefulness of ophthalmoscopy in mild to moderate hypertension.

A panel of two physicians and two ophthalmologists examined 25 patients with untreated essential hypertension by direct ophthalmoscopy and assessment of fundal photographs; daytime ambulatory sphygmomanometric blood pressure monitoring, estimation of left ventricular mass by electrocardiography and two-dimensional echocardiography, and measurement of urinary microalbumin excretion were also carried out. No relation was found between blood pressure determined by clinic or ambulatory sphygmomanometry and retinopathy. The retinal features sought on fundal photographs were the percentages of arteriovenous crossings with venule nipping, venule deviation, or attenuation of venular light reflex. The ratio of arteriolar to venular diameter was measured. Only focal narrowing of arterioles was associated with higher blood pressure. There was no independent relation between retinal features and age, measures of left ventricular mass, or urinary microalbumin excretion. Assessment of arteriovenous crossing abnormalities by direct ophthalmoscopy was subject to wide variability among the panel members. Direct ophthalmoscopy was not clinically useful in the assessment of mild to moderate hypertension, whereas urinary microalbumin excretion correlated strongly with clinic blood pressure.

Adult↗
PubMed1989

Urinary albumin excretion and blood pressure in the general population.

1. Twenty-four hour urinary albumin excretion rate was measured by a sensitive radioimmunoassay in 99 male and 100 female randomly selected factory workers, aged between 20 and 60 years. 2. The median (range) albumin excretion rates for men and women of 4.67 (1.0-25.8) and 5.25 (0.2-33.0) mg/24 h, respectively, were not significantly different. 3. No correlation was established between diastolic, systolic or mean arterial blood pressure and albumin excretion rate for the whole group. 4. Twenty-eight subjects with systolic and/or diastolic blood pressures greater than or equal to 140/90 mmHg (18.7/12.0 kPa) showed a positive correlation between mean arterial blood pressure and albumin excretion rate (r = 0.412, P less than 0.01). 5. There was no significant relationship between number of cigarettes smoked, age or alcohol intake and albumin excretion rate. 6. The data suggest that in the general population albumin excretion rate is variable and not dependent on blood pressure, but at blood pressures greater than 140/90 mmHg (18.7/12.0 kPa) albumin excretion rate may become pressure dependent, although high albumin excretion rates were sometimes found in subjects with blood pressures less than 140/90 mmHg (18.7/12.0 kPa).

Adult↗
PubMed1989

Is low proteinuria an early predictor of severity of acute pancreatitis?

Serial six hourly urine collections were made for seven days on 20 patients with acute pancreatitis. Quantitative immunoassay of urinary albumin and IgG on the first urine sample after admission showed increased excretion rates in 14 and 13 patients, respectively. Urinary protein excretion rates remained normal or approached normal by seven days in 17 patients who made uneventful recoveries. The maximum urinary excretion rates of both albumin and IgG within the first 36 hours correlated with the serum C-reactive protein concentration 72 hours after admission. The highest IgG excretion rates were found in three patients who later developed severe complications. These preliminary data suggest that low proteinuria is a very early response in acute pancreatitis, and that it may reflect the severity of inflammation.

Acute Disease↗
PubMed1988

Systemic effects associated with intermittent claudication. A model to study biochemical aspects of vascular disease?

Patients with intermittent claudication were used as a clinical model to study the effects of transient episodes of ischaemia. Compared with age and sex matched controls significantly greater increases in serum lipid peroxides and urinary microalbumin occurred after exercise. These results suggest that even relatively minor ischaemic episodes, as occur with claudication, are sufficient to cause tissue damage which may be mediated by oxygen derived free radicals. There are also changes in renal permselectivity suggestive of a generalised increase in vascular permeability. These preliminary findings may have important diagnostic, aetiological and therapeutic implications for patients with vascular disease.

Aged↗
PubMed1988

Burn and trauma associated proteinuria: the role of lipid peroxidation, renin and myoglobin.

Ten trauma patients and 13 burns patients were studied intensively for the first 36 h and subsequent 6 days post injury in order to investigate the mechanism of trauma and burn associated proteinuria. Burns patient's initial maximum proteinuria occurred between 4 and 8 h post injury, whilst trauma patients showed greatest proteinuria within 4 h. In both groups coexisting myoglobinuria or marked elevation of serum renin activity was not found during the first 36 h. Following admission serum lipid peroxides rose in burns patients reaching a maximum between 2 and 8 h following injury, after which levels fell rapidly; in contrast trauma patient's values were initially within normal limits, but rose sharply after 12 h with peaks occurring between 16 h and 7 days post injury. Some patients within both groups showed a recurrent protein leak 2 to 5 days post injury. The data suggest that myoglobinuria or raised renin levels do not play an important role in trauma associated proteinuria.

Adolescent↗
PubMed1986

Proteinuria following trauma.

Thirteen trauma patients admitted to a major injuries unit were classified according to their injury severity. Urinary excretion of total protein, albumin and gamma glutamyl transpeptidase (GGT) activity were assessed over the following 6 days. All patients showed an initial glomerular and tubular proteinuria during the first 24 h which subsided by the second post-trauma day. The excretion of total protein and albumin was positively correlated with injury severity. Those patients with the severest injuries showed a marked recurrent total proteinuria around days 3 to 4 post-trauma which exhibited features of a tubular lesion. The recurrent proteinuria peak coincided with peak levels of serum c-reactive protein (CRP).

Adolescent↗