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Biomedical subjects

P J Drury

Publications and source records attributed to P J Drury.

At least 19 recordsLinked to original sources
PubMed2004

A randomized clinical trial comparing oral alendronate and intravenous pamidronate for the treatment of Paget's disease of bone.

Second and third generation bisphosphonates are the treatment of choice for Paget's disease of bone. These drugs are more effective than calcitonin and etidronate, but there have been no head to head, randomized controlled trials comparing potent bisphosphonates. We conducted a 2-year, randomized, open-label trial comparing oral alendronate and intravenous pamidronate in 72 subjects with Paget's disease. Randomization was stratified according to baseline plasma total alkaline phosphatase (ALP) and previous bisphosphonate treatment (yes or no). All previously treated patients had received pamidronate but not alendronate. Assigned treatments were pamidronate (60 mg) every 3 months as a single infusion or alendronate (40 mg) daily in 3-month blocks, continued until biochemical remission (defined as both ALP and urine deoxypyridinoline (DPD)/creatinine ratio in the reference range) or a clear plateau effect was observed. At 1 year, nonresponders to pamidronate were crossed over to alendronate treatment. At 1 year, 31/36 (86%) subjects randomized to alendronate achieved biochemical remission compared with 21/36 (56%) for pamidronate (P = 0.017). There was a significantly greater reduction in ALP (P < 0.001) and DPD/creatinine ratio (P < 0.001) for alendronate compared with pamidronate treatment. In previously untreated patients, alendronate resulted in remission in 20/22 (91%) subjects compared with 19/22 (86%) of pamidronate-treated subjects, which was not significantly different; however, alendronate resulted in a significantly greater reduction in ALP (P = 0.014) and DPD/creatinine ratio (P < 0.001). In previously treated patients, alendronate resulted in remission in 11/14 (79%) subjects compared with 2/14 (14%) for pamidronate (P < 0.001), with a significantly (P < 0.001) greater reduction in both ALP and DPD/creatinine ratio. Of subjects crossed over from pamidronate to alendronate, 10/14 (71%) achieved remission, including 9/11 (82%) previously treated patients. We conclude that, in patients with previously untreated Paget's disease of bone, alendronate and pamidronate have similar efficacy in achieving biochemical remission. In patients previously treated with pamidronate, alendronate is more effective.

Administration, Oral↗
PubMed2003

A randomized trial comparing hormone replacement therapy (HRT) and HRT plus calcitriol in the treatment of postmenopausal osteoporosis with vertebral fractures: benefit of the combination on total body and hip density.

We report a prospective, randomized, multicenter, open-label 2-year trial of 81 postmenopausal women aged 53-79 years with at least one minimal-trauma vertebral fracture (VF) and low (T-score below - 2) lumbar bone mineral density (BMD). Group HRT received piperazine estrone sulfate (PES) 0.625 - 1.25 mg/d +/- medroxyprogesterone acetate (MPA) 2.5 - 5 mg/d; group HRT/D received HRT plus calcitriol 0.25 microg bd. All with a baseline dietary calcium (Ca) of < 1 g/ d received Ca carbonate 0.6 g nocte. Final data were on 66 - 70 patients. On HRT/D, significant (P < 0.001) BMD increases from baseline by DXA were at total body - head, trochanter, Ward's, total hip, intertrochanter and femoral shaft (% group mean delta 4.2, 6.1, 9.3, 3.7, 3.3 and 3.3%, respectively). On HRT, at these 6 sites, significant deltaS were restricted to the trochanter and Wards. Significant advantages of HRT/D over HRT were in BMD of total body (- head), total hip and trochanter (all P = 0.01). The differences in mean delta at these sites were 1.3, 2.6 and 3.9%. At the following, both groups improved significantly -lumbar spine (AP and lateral), forearm shaft and ultradistal tibia/fibula. The weightbearing, site - specific benefits of the combination associated with significant suppression of parathyroid hormone-suggest a beneficial effect on cortical bone. Suppression of bone turnover was significantly greater on HRT/D (serum osteocalcin P = 0.024 and urinary hydroxyproline/creatinine ratio P = 0.035). There was no significant difference in the number of patients who developed fresh VFs during the trial (HRT 8/36, 22%; HRT/D 4/34, 12% - intention to treat); likewise in the number who developed incident nonvertebral fractures. This is the first study comparing the 2 treatments in a fracture population. The results indicate a significant benefit of calcitriol combined with HRT on total body BMD and on BMD at the hip, the major site of osteoporotic fracture.

Absorptiometry, Photon↗
PubMed1999

Acute pulmonary embolism: diagnosis with MR angiography.

PURPOSE: To prospectively evaluate pulmonary magnetic (MR) angiography as a diagnostic examination for acute pulmonary embolism (PE). MATERIALS AND METHODS: Thirty-six consecutive patients (19 women, 17 men; age range, 28-84 years) underwent pulmonary digital subtraction angiography (DSA) and pulmonary MR angiography. MR angiograms were obtained during suspended respiration and the pulmonary arterial phase of gadolinium-based contrast medium injection. A steady-state gradient-recalled-echo sequence with free induction decay sampling was used. DSA studies were interpreted for the presence of acute PE by two independent radiologists; an adjudicator made the final decision on discordant interpretations. RESULTS: By using DSA, a total of 19 acute pulmonary emboli were depicted in 13 patients. Prospectively, 13 of these emboli were depicted by using MR angiography. MR angiography missed six emboli: Four required the DSA adjudicator to make the decision, and one was in a patient whose MR angiogram was acquired during breathing. Four of these six emboli were small subsegmental emboli, and two were segmental. CONCLUSION: Performed without pulmonary arterial catheterization, iodinated contrast media, or ionizing radiation, pulmonary MR angiography had a high accuracy for depicting lobar and segmental emboli, but was unable to depict four of five subsegmental emboli.

Acute Disease↗
PubMed1994

Mechanical and other problems of artificial valves.

This chapter has discussed the design, development, laboratory testing and clinical performance of artificial heart valve replacements. The published material on this subject is extensive and clearly this present chapter represents only a limited selection of the many topics and researchers associated with the production of clinically implantable valves. Any omissions should not be regarded as a criticism, but simply the result of economy of space. The field is still developing and the situation regarding the advantages and disadvantages of the various types of valves as illustrated in Table 3 still obtains notwithstanding the many improvements which have been made with current designs. Valve development is, and will continue to be, closely allied to advances in our understanding of the behaviour of the materials of construction. Ultimately, improved haemodynamic performances of the various valve configurations will result from designs based on data from computerised fluid dynamic analysis combined with finite element stress analysis according to recognised engineering design principles.

Biomechanical Phenomena↗
PubMed1989

Breast-milk fatty acids of rural Gambian mothers: effects of diet and maternal parity.

The influence of diet and maternal parity on the fatty acid composition of mature breast milk have been studied in 23 rural Gambian mothers. The subjects' habitual diet was low in fat (16% total energy), groundnuts (peanuts) constituting the principal fat source. The high abundance of oleic and linoleic acids in groundnut fat were reflected in the proportions of these fatty acids in breast milk (47.0 +/- 1.5 and 13.0 +/- 0.3 g/100 g fat, respectively), which were elevated compared with mothers in other African communities. Estimates of daily breast-milk fatty acid secretion indicated that there was little risk of essential fatty acid deficiency in Gambian infants. The proportions of fatty acids synthesized de novo (10:0, 12:0, 14:0) were less than expected from published studies of mothers consuming low-fat diets, averaging 16.8 +/- 1.4 g/100 g fat. As the study was conducted at a time of food shortage and high energy expenditure, it is argued that mobilisation of body fat during negative energy balance increased the availability of long-chain fatty acids to the breast. The proportion of endogenous fatty acids was markedly reduced in the milk of mothers of very high parity (parity 1 = 19.3 +/- 1.6 g/100 g fat; parities 10 + = 11.4 +/- 1.5 g/100 g fat; p less than 0.01). It is hypothesised that this represents an impairment of the ability to synthesise breast-milk fatty acids de novo in these mothers.

Diet↗
PubMed1988

Aluminium and fluoride in the water supply and their removal for haemodialysis.

Aluminium and fluoride in the water supply and their removal for haemodialysis have been investigated in the Trent Region, U.K., and wide variations noted. The efficiency of removal of these elements from the mains water supplying home haemodialysis units by different water treatment systems currently installed has been assessed and a follow-up study performed 8 months later. Some improvement in water treatment was noted, with the percentage of home dialysis units receiving waters within the proposed European Economic Community guidelines for aluminium rising from 61.7 to 72.1%. Removal of fluoride by the different treatment mechanisms is analogous to that for aluminium. A comparison of new and older water treatment systems has shown that there is a deterioration in performance with use. However, some cases of poor removal may be due to the installation of unsuitable equipment, or, more probably, due to a change in the waters used to supply the different homes. Thus, adequate maintenance of equipment and frequent sampling of both untreated and treated waters are required in order to maintain the provision of waters suitable for the preparation of dialysate.

Aluminum↗
PubMed1987

In vivo incorporation of labeled fatty acids in rat liver lipids after oral administration.

Striking differences were found in the compartmentalization of fatty acids into liver lipid fractions. The saturated fatty acids--lauric, myristic, palmitic and stearic--were incorporated into phosphoglycerides at faster rates with increasing chain lengths, while triglyceride incorporation was almost uniform. The degree of incorporation of the unsaturated fatty acids into phosphoglycerides (structural) compared to triglyceride (storage and energy) was the converse of their oxidation rates. The incorporation of oleic, linoleic and alpha-linolenic acids was mainly into triglyceride, whereas dihomo-gamma-linolenic acid and arachidonic acid were preferentially incorporated into phosphoglycerides. The data suggest that distribution of each fatty acid is different depending on its destination for structural or energy function.

Animals↗
PubMed1987

Differential oxidation of saturated and unsaturated fatty acids in vivo in the rat.

The oxidation rates of lauric, myristic, palmitic, stearic, oleic, alpha-linolenic, linoleic, kappa-linolenic, dihomo-gamma-linolenic and arachidonic acids were studied by use of a radioisotope tracer technique in weanling rats at rest in a metabolism chamber over 24 h. Of the saturated fatty acids, lauric acid (12:0) was the most efficient energy substrate: the longer the chain length of the saturated fatty acids, the slower the rate of oxidation. Oleic acid (18:1) was oxidized at a remarkably fast rate, similar to that of lauric acid. Of the omega 6 essential fatty acids studied, linoleic acid (18:2 omega 6) was oxidized at a faster rate than any of its metabolites, with arachidonic acid (20:4 omega 6) being oxidized at the slowest rate. The rate of oxidation of gamma-linolenic acid (18:3 omega 3) was almost as fast as that of lauric and oleic acids.

Animals↗
PubMed1987

Interaction of adrenaline with neostigmine and tubocurarine at the skeletal neuromuscular junction.

The effects of neostigmine, and of neostigmine with adrenaline, on the response of the rat isolated hemidiaphragm to stimulation of the phrenic nerve are reported. Neostigmine augmented the response: a maximum augmentation occurred at a concentration of 6.4 X 10(-7) mol litre-1. At greater concentrations of neostigmine the response was reduced. Adrenaline in the absence of neostigmine produced no significant change in the contraction response. However, in the presence of neostigmine further augmentation occurred and achieved a maximum in the presence of adrenaline 3.2 X 10(-7)-1.3 X 10(-6) mol litre-1. Adrenaline 4.0 X 10(-8)-1.3 X 10(-6) mol litre-1 combined with neostigmine 4.0 X 10(-8)-6.4 X 10(-7) mol litre-1 reversed tubocurarine-induced neuromuscular blockade more effectively than neostigmine alone (P less than 0.001). Adrenaline appeared to enhance the antagonistic effect of neostigmine by increasing acetylcholine release and by enhancing the response at the post-junctional acetylcholine receptor.

Animals↗
PubMed1987

Food intakes of children, the DHSS, and the prevention of heart disease.

The DHSS recently reported on school children's food intakes (1). Although the type of fat eaten is clearly an important issue, the DHSS study did not analyse the fat intake for its saturated and essential fatty acid content. We have explored the intakes of the children for fibre, sugar and saturated fats as well as additional vitamins and trace elements, not reported by the DHSS. The data from the DHSS survey was presented as a summary of the main food types eaten. They aggregated some food groups e.g. meat and meat products, fish and fish products, cakes and biscuits. While this approach might make little difference to protein intakes, it may be expected to make a difference to fat and essential fatty acid intakes. We have re-analyzed the childrens food intakes keeping within the confines of the food groups reported. We had to rely on certain assumptions about the nature of an 'average' diet; we therefore explored the possibility that our assumption of an average diet was incorrect and examined a worse and a better situation to define how much the nutrient intake varied. The result of the analyses illustrate an important principle in the context of the present concern for food and health. The only way in which we could satisfy NACNE and COMA recommendations for fat, saturated fat, fibre and sugar, without a radical change in eating habits, was by simply replacing half the 'junk' foods by an isocaloric amount of fresh fruit and vegetables. In addition there was a marked improvement in the intakes fo beta-carotene, vitamin C, B6 and folic acid. These improvements in diet are of particular importance to children as it is well known that the period most vulnerable to nutritional distortions is during growth and development. No matter which way we looked at the data is clear that not only are the school children's diets unsatisfactory from the view point of prevention of cardiovascular disease in later life but they also leave much to be desired from the view point of the wide range of nutrients known to be important for general health, growth and development. If this is true for the mean values obtained, it will be even more true for the 'high risk groups'.

Child↗
PubMed1986

An investigation on the influence of steroidal contraceptives on milk lipid and fatty acids in Hungary and Thailand. WHO Special Programme of Research, Development and Research Training in Human Reproduction. Task Force on oral contraceptives.

A double-blind clinical trial to examine the effects of oral and long-acting injectable contraceptive steroids on milk lipid and its fatty acid content has been done in Szeged, Hungary, and Khon-Kaen, Thailand. In Szeged, a combined and a progestin-only pill did not significantly alter total milk lipid. In Khon-Kaen, treatment with the combined pill was followed by a significant increase in the proportion of milk lipid. In the group treated with the long-acting injectable contraceptive, depot-medroxyprogesterone acetate (DMPA), the milk lipid decreased significantly in the first six weeks in comparison with the control group and the individual pretreatment values. A similar but weaker effect was noticed with the progestin-only pill in Khon-Kaen. Few consistently significant differences were found in the shorter chain fatty acids (myristic, lauric and palmitic acids) during treatment. The percentage proportions were increased during the combined pill treatment in Szeged and Khon-Kaen, and reduced in DMPA and progestin-only treatment in Khon-Kaen milks. The possibility that these reflected a response to a milk volume decrease in the combined pill treatment and a reduction in milk lipid synthesis in association with DMPA and the progestin-only pill is discussed. In Khon-Kaen, linoleic acid (which is not synthesized in the body) was increased by comparison with the controls, as a percentage proportion of the fatty acids in the progestin-only and DMPA groups. Calculation of the amounts of linoleic acid per litre of milk revealed that there had been a significant decrease of linoleic, eicosadienoic, dihommo-gamma-linolenic, arachidonic, docosatetraenoic acids in the w6 family and alpha-linolenic acid in the w3 family in the first two post-treatment visits (3 and 4). This reduction in essential fatty acid output follows the reduction in milk volume. In Khon-Kaen, the combined pill group showed a significant decrease compared with the controls, in the proportions of dihommo-gamma-linolenic acid. The difference in response of the mothers in Khon-Kaen and Szeged is discussed in relation to their different nutritional backgrounds.

Contraceptive Agents↗
PubMed1982

Aortic valve replacement with Starr-Edwards valves over 14 years.

Three hundred thirteen patients underwent aortic valve replacement with 319 Starr-Edwards caged-ball prostheses and have been followed for 1 to 14 years. Hospital mortality (24.8%) and first-year mortality (4.8%) suggest that this is a high-risk group. Overall postoperative patients survival was 37.1%, with 18.8% free from any event, at 14 years. Thromboembolism was the most significant single event (a probability of 18.7% at 14 years), and the Series 2300/2320 valves were associated with a probability of hemolysis of nearly 80% over 13 years. Patients who underwent valve replacement before 1973 had a significantly greater probability of late death (31.1%) and of complications (47.1%) during the first 5 years. Those patients undergoing replacement after 1973 had a significantly greater probability of thromboembolic episodes (15.4%). Starr-Edwards cage-ball prosthesis provide an acceptable valve replacement for high-risk patients. However, the overall complication rate of 81.2% over 14 years, compared with 78% for homograft valves for the same period, does not support the adoption of this prosthesis as the valve of first choice at this hospital.

Actuarial Analysis↗