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Biomedical subjects

P M O'Brien

Publications and source records attributed to P M O'Brien.

At least 91 records · Page 5Linked to original sources
PubMed1982

Prostaglandin E2 attenuates the pressor response to angiotensin II in pregnant subjects but not in nonpregnant subjects.

The effect of prostaglandin E2 (PGE2), 5 microgram/min-1, on the pressor response to exogenous angiotensin II (AII) has been examined in 22 women in second-trimester pregnancy and in 10 nonpregnant control subjects. PGE2 diminished the diastolic pressor response in both groups without altering basal blood pressure. This effect was significant in the pregnant group, and not significant in the nonpregnant patients. The effect was achieved by a significant increase in threshold to AII, rather than an alteration in the slope of the dose-response curve. Five pregnant patients who were given two identical infusion regimes of AII without PGE2 showed no diminution of response. The effect of PGE2 was greatest in the pregnant women who showed greatest initial sensitivity to AII, perhaps suggesting a relative deficiency of E series prostaglandins in some women by midtrimester pregnancy.

Adolescent↗
PubMed1982

Prolactin levels in the premenstrual syndrome.

Serum prolactin was measured in 18 subjects complaining of premenstrual syndrome and results were compared with those in 10 control subjects. No consistent changes were seen during the course of the menstrual cycle in either group. There were no significant differences between the prolactin levels of the two groups. There was no correlation between mood change and levels of prolactin.

Adult↗
PubMed1982

The premenstrual syndrome: a review of the present status of therapy.

Treatment of the premenstrual syndrome is complicated by many factors, but principally by its unknown aetiology. In addition, diagnosis, definition and symptom evaluation methods are unclear. The multitudinous studies of treatment regimens have been largely inconclusive; this is partly due to difficulties in numerically evaluating the symptoms, but more to the lack of appreciation of the marked placebo effect which has been estimated as being up to 50%. The majority of studies have been open studies, and therefore interpretation of the results have been almost impossible. The end result is that great claims have been made for a large number of therapeutic agents on ill-founded evidence. Some of the drugs used in the treatment of the premenstrual syndrome, however, have been better evaluated than others, although even with those studied more extensively results have often been variable. Thus, hormonal agents such as progestagens and oral contraceptives, diuretics, pyridoxine, bromocriptine and danazol have been effective in some studies but not universally so. The latter 2 agents seem to be effective in relieving breast symptoms, but have only a limited effect on other symptoms. It is therefore important to realise that one drug does not cure all patients or all symptoms, although it is often claimed that this is the case. It has been suggested that more than 40% of women suffer from premenstrual syndrome. Greater awareness of the problem, both by patients and doctors, necessitates a more rational approach to therapy.

Bromocriptine↗
PubMed1981

Angina-like pain: an unexpected side-effect following the simultaneous administration of angiotensin II and prostaglandin E2 in normal adults.

Two fit young, non-pregnant adults both experienced marked retrosternal chest pain and chest tightness when receiving 8 ng kg-1 min-1 AII simultaneously with 5 microgram min-1 PGE2. This dose of AII is well within that given experimentally by various workers, and was without such effect when initially given in the absence of PGE2 infusion. The combination dangerous one.

Adult↗
PubMed1980

Progesterone, fluid, and electrolytes in premenstrual syndrome.

Changes in mood, plasma progesterone concentration, urinary volume, sodium excretion, sodium:potassium ratio, and body weight during the menstrual cycle were determined in 18 women with premenstrual syndrome and 10 symptomless (control group) women. Plasma progesterone concentration was higher in the women with symptoms during the postovulatory phase of the cycle, and the peak progesterone concentration appeared earlier. The changes in progesterone concentration were accompanied by a natriuresis and diuresis that fell towards preovulatory values in the premenstrual phase. Sodium retention was not confined to any definite period. Mood symptoms occurred after the changes in progesterone and electrolyte concentrations. Progesterone deficiency is probably not the cause of premenstrual syndrome. Thus treatment with progesterone is probably illogical unless a deficiency is detected. Treatment should be aimed at preventing the natriuretic effect of progesterone in the postovulatory phase and the sodium-retaining and water-retaining effects of aldosterone in the premenstrual phase.

Affect↗
PubMed1980

Determinants of the intravenous diazepam dose required for gastroscopy.

Factors influencing the intravenous dose of diazepam required by 100 consecutive outpatients being prepared for peroral endoscopy were evaluated. Eleven patients reported a history of using 2 or more doses of benzodiazepine a week and required 0.48 +/- 0.1 mg/kg of diazepam compared with 0.30 +/- 0.02 mg/kg (P < 0.01) needed by 89 patients who reported less frequent or no use. The log (dose/kg) was negatively correlated with age (r = 0.51, P < 0.01), and the log dose was positively correlated with weight to a lesser degree (r = 0. 31, P < 0.01). In the larger group of patients who reported less than twice-weekly or no benzodiazepine use, no effect of alcohol use on dose was found. The dose was unrelated to sex. The findings emphasize the importance of individualizing intravenous doses of diazepam.

Age Factors↗
PubMed1980

Nurse-supervised education of patients with symptomatic gastroesophageal reflux.

Patient educational programs supervised by non-physicians are becoming popular, but comparison of their effect on outcome with that of physician teaching is limited. We developed a nurse-supervised class for patients with symptomatic gastroesophageal reflux (GER). Primary physicians referred patients to the program. The patient's initial knowledge and the program's excellent cognitive effect were unrelated to demographic and symptom data. One hundred twelve consecutive patients were alternately given appointments either with the class or with a gastroenterologist. Although failed appointments and inappropriate referrals excluded some patients, the remainder of the two groups were similar with regard to demographic and symptom data and their return rate of follow-up questionnaires. They reported equivalent symptomatic improvement and therapeutic compliance after 2 weeks and 2 months. The program's success prompts us to continue this form of patient education.

Gastroesophageal Reflux↗
PubMed1979

Treatment of premenstrual syndrome by spironolactone.

Spironlactone was given to 28 women in a double blind cross over trial during four menstrual cycles. Hormonal profiles were measured during the first two cycles. Plasma aldosterone was elevated in the premenstrual phase of the cycles but there was no significant difference between symptomatic and asymptomatic groups. The rise in serum progesterone was higher in the symptomatic group during the postovulatory phase. The administration of spironolactone reduced weight and relieved psychological symptoms in more than 80 per cent of the symptomatic group.

Aldosterone↗
PubMed1979

The effects of deprivation of prostaglandin precursors on vascular sensitivity to angiotensin II and on the kidney in the pregnant rabbit.

1 Pregnant rabbits were deprived of essential fatty acids from day ten of pregnancy, and results compared with a control group on a normal diet. 2 At term, cannulation of jugular and carotid vessels was performed under anaesthesia, to study the vascular sensitivity to angiotensin II and basal blood pressure. 3 Plasma renin levels, urinary electrolytes and protein were measured. 4 Placental and renal tissue was examined histologically. 5 Though no changes were found in tissues, blood or urine, a markedly significant increase in response to angiotensin II was found in the group deprived of essential fatty acids. This parallels the findings in vascular response in human pre-eclampsia.

Angiotensin II↗
PubMed1978

Effect of the specific angiotensin antagonist (Sar1) (Ala8) angiotensin II on blood pressure and the renin-angiotensin system in the conscious pregnant ewe and fetus.

A direct relationship was found between maternal diastolic blood pressure and simultaneously measured angiotensin II (All) levels (P less than 0.001) in chronically cannulated pregnant ewes. The infusion of Saralasin to the ewe resulted in a dose-dependent fall in blood pressure (P less than 0.005), the magnitude of which was proportional to the initial All levels (P less than 0.025). Plasma renin and All levels rose significantly during the infusion. No consistent fetal effects were seen. The infusion of normal saline had no effect on blood pressure or hormone levels. Thus it seems likely that the renin-angiotensin system is involved with the maintenance of normal blood pressure in the pregnant sheep. Fetal blood pressure either fell significantly or was unchanged following direct infusion of Saralasin. This may be related to development of the beta-adrenergic nervous system. The renin-angiotensin system may be more important in cardiovascular homeostasis in the immature than in the adult animal.

Aldosterone↗
PubMed1977

The effect of prostaglandin E2 on the cardiovascular response to angiotensin II in pregnant rabbits.

The rise in arterial blood pressure in response to angiotensin II was studied in the last third of pregnancy in rabbits. The response was compared with that of pregnant rabbits during infusion of prostaglandin E2 and F2alpha. Prostaglandin E2 significantly diminished the rise in diastolic pressure in response to angiotensin II. Prostaglandin F2alpha did not alter the response. Intravenous indomethacin elevated the blood pressure and caused an absolute increase in the pressor response. It did not mediate a change in the percentage rise in blood pressure in response to angiotensin II.

Angiotensin II↗
PubMed1977

Evacuation of retained products of conception in a treatment room and without general anaesthesia.

One hundred patients with an incomplete aboriton, 14 patients with retained products of conception after a second trimester termination, 5 patients with missed abortion and 2 patients with secondary postpartum haemorrhages (making a total of 121 patients) had a uterine evacuation in a treatment room using the portable Karman curette equipment. No general anaesthesia was used but patients were given intravenous pethidine or papavaretum (Omnopon) and diazepam. Four patients found the procedure painful but only two of them would have preferred general anaesthesia. There were no immediate complications but three patients required re-evacuation of the uterus.

Abortion, Incomplete↗
PubMedDate not supplied

Diabetic pregnancy managed with intraperitoneal insulin.

A woman with insulin-dependent diabetes (IDDM) and resistance to subcutaneously injected insulin conceived while being treated with intraperitoneal (i.p.) insulin administered through a recently developed subcutaneous peritoneal access device (SPAD). She continued on this regimen during the pregnancy and at 37 weeks was delivered of a normal baby by Caesarian section. During her pregnancy, she had 2 episodes of infection of the SPAD, which were rapidly controlled by local instillation of antibiotics. Her diabetes remained under excellent control (HbA1: 7.3-7.5%) throughout her pregnancy. This case demonstrates that in such patients i.p. administration of insulin through a SPAD is a feasible mode of management during pregnancy.

Adult↗