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Biomedical subjects

P M Reilly

Publications and source records attributed to P M Reilly.

At least 55 records · Page 3Linked to original sources
PubMed1993

Tissue perfusion in critical illnesses. Antioxidant therapy.

OBJECTIVES: To provide an overview of the mechanisms of free radical-mediated reperfusion injury and to review the available antioxidant agents and strategies available to prevent or ameliorate this injury. DATA SOURCES: Previous studies performed in our own laboratory, as well as a computer-assisted search of the English language literature (MEDLINE, 1966 to 1991), followed by a selective review of pertinent articles. STUDY SELECTION: Articles representing the mechanisms of free-radical generation, free-radical-mediated tissue injury, and antioxidant function. DATA EXTRACTION: Pertinent data were abstracted from the cited articles. RESULTS OF DATA SYNTHESIS: The small intestine is disproportionately susceptible to ischemia during circulatory shock. Ischemia activates xanthine oxidase, which then generates a massive burst of superoxide free radicals when oxygen is reintroduced at reperfusion. These radicals and their toxic oxygen metabolites, both by direct action and by the secondary activation of circulating neutrophils, then generate much of the mucosal injury that had been previously attributed to anoxia itself. CONCLUSIONS: Recent evidence indicates that although the mucosal epithelial cell is rich in xanthine oxidase, it is probably endothelial cell xanthine oxidase that triggers this mucosal reperfusion injury, not only in the intestine, but in other organs as well. Antioxidant therapies directed toward the ablation of free-radical generation at reperfusion offer a potential therapy for these injuries and their sequelae.

Animals↗
PubMed1992

Mesenteric vasoconstriction in cardiogenic shock in pigs.

The quantitative impact of mesenteric vasoconstriction on the systemic hemodynamic response to cardiogenic shock induced by pericardial tamponade was evaluated. Graded increases in pericardial pressure produced corresponding decreases in cardiac output to 44% +/- 2% and arterial pressure to 64% +/- 3% of baseline and increases in total peripheral vascular resistance to 131% +/- 4% of baseline. Total mesenteric blood flow decreased disproportionately, to 28% +/- 3% of baseline, because of a disproportionate increase in mesenteric vascular resistance to 223% +/- 6% of baseline. Nonmesenteric vascular resistance increased only to 119% +/- 4% of baseline. Thus mesenteric vasoconstriction accounted for 42% of the increase in total peripheral resistance. Prior blockade of the renin-angiotensin axis ablated this response and eliminated the mesenteric contribution to systemic vascular resistance, while confirmed blockade of the alpha-adrenergic system or vasopressin system had no effect. Without shock, central intravenous infusions of angiotensin II (but not norepinephrine or vasopressin) closely mimicked this selective vasoconstriction. Angiotensin-mediated selective mesenteric vasoconstriction accounts for more than 40% of the overall increase in systemic vascular resistance in cardiogenic shock.

Animals↗
PubMed1992

Free radicals and other reactive oxygen metabolites in inflammatory bowel disease: cause, consequence or epiphenomenon?

Oxygen-derived free radicals and other reactive oxygen metabolites have emerged as a common pathway of tissue injury in a wide variety of otherwise disparate disease processes. This has given rise to the hope that efforts directed towards the pharmacologic control of free radical-mediated tissue injury (Reilly, P.M., Schiller, H. J. and Bulkley, G. B. (1991) Pharmacologic approach to tissue injury mediated by free radicals and other reactive oxygen metabolites. Am. J. Surg. 161: 488-503) may have particular application to patients suffering from Crohn's disease and/or ulcerative colitis. However, because tissue injury by any mechanism, even direct mechanical trauma, can elicit an inflammatory response which entails the secondary generation of toxic oxidants by neutrophils and tissue macrophages, it is important that the evidence for this association be examined critically, so as to discriminate the possibility of an etiologic role for these toxic compounds from their presence as a reflection of injury caused primarily by other agents. Similarly, in considering the therapeutic potential of free radical ablation for the treatment of patients with IBD it is important to distinguish between interventions that might specifically block the fundamental injury mechanism from those which would act in a more nonspecific, anti-inflammatory role.

Animals↗
PubMed1992

Short-lived effects of a formulary on anti-infective prescribing--the need for continuing peer review?

Because of the introduction of indicative drug budgets in the UK and their likely association with prescribing from a drug formulary, we have studied the effect of the introduction without continued reinforcement of a voluntary practice formulary on antimicrobial prescribing in a group practice. Detailed prescribing feedback for two matched periods before and after the launch of the Northern Ireland Faculty of the Royal College of General Practitioners practice formulary was compared. The parameters chosen were adherence to the formulary, generic prescribing and costs. A slight increase in prescriptions dispensed (3.5%) was observed between the two periods but prescribing costs increased by 32%. There was a 5.9% fall in the number of prescriptions for formulary agents following the launch of the formulary and a major increase (60%; P < 0.01) in the use of non-formulary antimicrobials particularly penicillins and tetracyclines. It was concluded that the high level of formulary prescribing prevalent during the production of the formulary was not maintained following its launch probably because of the lack of reinforcement.

Anti-Bacterial Agents↗
PubMed1992

Heat-shock gene expression excludes hepatic acute-phase gene expression after resuscitation from hemorrhagic shock.

BACKGROUND: To determine whether the gene expression of both acute-phase reactants (APR) and the major heat-shock protein (hsp-72) can occur simultaneously, transcriptional rates were measured during shock and resuscitation. METHODS: A nuclear runoff technique was applied to hepatic biopsy specimens obtained from pigs before shock, during 40% blood volume hemorrhagic shock (1 and 2 hours), and after resuscitation (4 and 6 hours). RESULTS: Shock-induced transcription of hsp-72 was elevated elevenfold over sham operation at 2 hours (p less than 0.02, Mann-Whitney rank test). Individually shocked animals did not transcribe both classes of stress genes but segregated into two groups: (1) strong APR transcriptional responders and (2) hsp-72 transcriptional responders. In group 2, APR transcription was significantly suppressed. Antichymotrypsin transcription was an average of eighteenfold lower in group 2 versus group 1 (p less than 0.05 at 1,2, and 6 hours). CONCLUSIONS: Different classes of stress protein genes are not transcribed simultaneously. We infer that their increased accumulation at the mRNA level is the result of sequential transcription. Hsp-72 transcription excludes that of the APR genes that may be critical to survival after stress.

Acute-Phase Proteins↗
PubMed1991

Pharmacologic approach to tissue injury mediated by free radicals and other reactive oxygen metabolites.

Highly toxic metabolites of oxygen are generated normally by aerobic metabolism in most cells, and this generation is often greatly increased in pathologic conditions. When this oxidant flux exceeds the capability of the multiple endogenous antioxidant mechanisms, tissue injury ensues. The pharmacologic modification of this injury process, with agents that scavenge these reactive oxygen metabolites, block their generation, or enhance the endogenous antioxidant capability, has shown great promise in animal models of common clinical conditions, and has already been successfully applied in controlled clinical trials. This approach represents an interruption of tissue injury at its most basic level.

Animals↗
PubMed1990

Antibiotic prescribing: the need for a policy in general practice.

OBJECTIVE: To see whether changes in prescribing of oral antibacterials in Northern Ireland show the need for a community antibiotics policy. DESIGN: Analysis of prescribing totals for several oral antibiotics obtained retrospectively from the prescription pricing bureau for the years 1983-7. SETTING: Audit of anti-infective prescribing in general practice in Northern Ireland over five years. MAIN OUTCOME MEASURE: Respective usage of agents defined as "common" and "occasional" in 1983. RESULTS: There was a gradual decrease in the relative use of common agents from 82% of the total in 1983 to 77% in 1987 together with a complementary increase in the use of occasional agents from 5% to 10%. Pronounced changes were noted in the use of amoxycillin, ampicillin, erythromycin, minocycline, doxycycline, and amoxycillin-clavulanic acid. CONCLUSION: Though this survey found reasonably conservative prescribing, the trend towards increased use of occasional agents has both clinical and cost implications which could be addressed by the use of a prescribing formulary.

Anti-Bacterial Agents↗
PubMed1989

Computerized smoking cessation program for the worksite: treatment outcome and feasibility.

This study demonstrated the effectiveness of a computer-delivered smoking cessation program for the worksite. 58 VA Medical Center employees were randomly assigned to a computer group (computerized nicotine fading and stop-smoking contest) or a contest-only group. In comparison with the contest-only group, the computer group had nonsignificantly higher abstinence rates across follow-up, had marginally lower CO levels at the 3- and 6-month follow-ups, and smoked cigarettes with lower nicotine levels at the 10-day and 6-month follow-ups.

Adult↗
PubMed1989

Self-efficacy and relapse among inpatient drug and alcohol abusers: a predictor of outcome.

Monthly intreatment ratings of self-efficacy to avoid drug and alcohol abuse were examined among 419 substance abuse inpatients of a residential treatment community. Posttreatment interviews were conducted with 81 patients approximately 6 months following discharge to assess the relationship between self-efficacy and relapse. As expected, self-efficacy increased during treatment and was higher among abstainers than relapsers at follow-up. Contrary to expectations, low self-efficacy at intake was related to longer inpatient residence and more positive conditions of discharge. Furthermore, abstainers had slightly lower self-efficacy scores than relapsers at intake and increased their self-efficacy two-fold over relapsers during the course of treatment. Contrary to previous research with tobacco smoking, self-efficacy ratings at the end of treatment were not related to substance abuse at follow-up. It is proposed that the present findings are consistent with previous research in demonstrating a relationship between self-efficacy and outcome, and provide new information suggesting that low self-efficacy may be related to positive outcome under certain circumstances. Hypotheses are advanced regarding (1) the potential utility of intreatment change measures, (2) the role of underestimation in self-efficacy ratings and (3) the role of denial in substance abuse populations.

Adult↗
PubMed1987

Randomized trial of ciprofloxacin compared with other antimicrobial therapy in the treatment of osteomyelitis.

Thirty adults (mean age, 52 years) were enrolled in a randomized, comparative trial of oral ciprofloxacin (750 mg twice daily) and other antimicrobial therapies. Etiologic agents included Enterobacteriaceae (18 isolates), Pseudomonas aeruginosa (16 isolates), and Staphylococcus aureus (four isolates). Seven of 14 (50 percent) ciprofloxacin-treated infections are cured at up to 13 months follow-up and three infections appear improved. Treatment failure or relapse has occurred in four patients. Sixteen patients received other antimicrobial therapy and 11 patients (65 percent) remain without infection and have healed wounds, with follow-up from one to 13 months. One patient has had a relapse, while improvement is apparent in four patients. Complications that occurred in this group included drug-related neutropenia (two patients), diarrhea (two patients), drug allergy (one patient), and catheter-related staphylococcal cellulitis (one patient). Oral ciprofloxacin therapy for chronic osteomyelitis caused by susceptible organisms appears to be as effective as other antimicrobial therapies.

Administration, Oral↗
PubMed1987

Treatment of bone, joint, and soft-tissue infections with oral ciprofloxacin.

We treated 52 patients with orally administered ciprofloxacin. In this study of 34 men and 18 women who completed therapy and who could be evaluated, there were 29 patients with nonhematogenous osteomyelitis, 20 patients with skin or soft-tissue infections, and 3 patients with joint infections. During the study, 92 isolates of pathogenic facultative aerobic bacteria, including 37 members of the family Enterobacteriaceae, 30 Staphylococcus aureus isolates, and 21 Pseudomonas aeruginosa isolates, were recovered, and 88 (96%) of the isolates were found to be susceptible to ciprofloxacin. Of the 29 patients with osteomyelitis, 14 have not experienced relapse after a follow-up of at least 1 year. Overall, 61% of infections were resolved, as judged by both clinical and microbiological criteria, during therapy. One patient developed Streptococcus salivarius sepsis during ciprofloxacin therapy, and one patient developed a rash which required discontinuation of ciprofloxacin. Otherwise, there were no serious reactions or complications.

Administration, Oral↗
PubMed1987

Comparison trial of clindamycin with aztreonam or gentamicin in the treatment of postpartum endometritis.

Sixty-two patients who had postpartum endometritis were treated with clindamycin in combination with either aztreonam or the aminoglycoside gentamicin. Currently, the combination of clindamycin and an aminoglycoside constitutes a treatment of choice for this condition. Our results suggest that aztreonam can be substituted for an aminoglycoside in the treatment of postpartum endometritis with similar clinical outcomes.

Adolescent↗
PubMed1987

Cefoperazone-sulbactam combination in the treatment of urinary tract infections: efficacy, safety, and effects on coagulation.

Seventy hospitalized patients with upper urinary tract infections were treated with cefoperazone (2 gm) and sulbactam (1 gm) every 12 hours for three or more days. All but six patients also received vitamin K. Forty of the 70 patients (57%) were cured of infection at one week after treatment, 13 relapsed, 11 had reinfections, and six were lost to follow-up. There were no treatment failures. Escherichia coli was the predominant pathogen (62% of isolates). Overall there was 15% resistance to cefoperazone and all resistant isolates were susceptible to the combination of agents. Synergy was demonstrated in 26% of isolates. One uroseptic patient who had an organism resistant to both study agents, but susceptible to the combination, was cured. Two of six patients who did not receive vitamin K demonstrated abnormal coagulation patterns and one had an associated major bleeding complication. Although 12 of 64 (19%) patients who received vitamin K had at least one coagulation abnormality, there were no significant bleeding complications in this group.

Adolescent↗
PubMed1986

Randomized study of single-dose, three-day, and seven-day treatment of cystitis in women.

We evaluated the following five treatment regimens for acute cystitis in nonpregnant women: cefadroxil, 1,000 mg single-dose; cefadroxil, 500 mg twice a day for three days; cefadroxil, 500 mg twice a day for seven days; trimethoprim-sulfamethoxazole (TMP-SMZ), 320-1,600 mg single-dose, and TMP-SMZ, 160-800 mg twice a day for three days. At four weeks after the end of treatment, 25%, 58%, 70%, 65%, and 88% of patients, respectively, remained cured of infection. The results indicated that three-day treatment (1) might improve cure rates (over single-dose), (2) would reduce incidence of relapse (vs. single-dose), and (3) may be as curative as seven-day treatment. The results of the antibody-coated bacteria test did not predict treatment failure or relapse.

Administration, Oral↗
PubMed1986

General practitioner workload with 2,000 patients.

This study was designed to investigate the relationship between general practice workload, the number of partners in the practice, and the use of health centre premises. Thirty general practitioners in twelve randomly selected practices (each with a list size of 2,000 patients per doctor) agreed to record a week's work on pre-printed forms. Information was gathered on content of care in the surgery, number of non-surgery and indirect contacts and time spent on work activities. Content of care was influenced by whether or not the doctors were based in a health centre, rather on how many partners they had. Conversely the numbers of non-surgery and indirect contacts and the time spent on all work activities were more affected by the number of partners. Two factors - consultation rate and the rate at which doctors initiate consultations - were found to be independent of either of the two variables considered.

Community Health Centers↗
PubMed1985

Aztreonam therapy for gram-negative pneumonia.

Nineteen patients with community- or hospital-acquired gram-negative pneumonia were treated with aztreonam. Other gram-negative antibiotics were withheld. Thirteen patients (68 percent) had clinical cures and 15 (79 percent) had microbiologic cures with aztreonam. No adverse reactions or drug toxicity occurred in this population.

Adult↗
PubMed1985

Chronic prostatitis: comments on infectious etiologies and antimicrobial treatment.

Twenty-three males with the clinical diagnosis of chronic prostatitis were evaluated for a bacterial etiology by the Stamey and Meares method. In addition, 16 patients, regardless of culture results, were placed on either cefadroxil or oral carbenicillin antimicrobial therapy. Culture results identified only four (17%) of 23 patients with bacterial prostatitis: coagulase-negative Staphylococcus (2), Enterobacter agglomerans (1), and Haemophilus parainfluenzae, and coagulase-negative Staphylococcus (1). Four of seven patients who received oral carbenicillin and three of nine patients who received cefadroxil reported symptomatic relief. This study did not identify a common etiology for chronic prostatitis or a consistently effective antimicrobial treatment. Rather, we observed that the etiologic agent in most cases of chronic prostatitis (83%) could not be identified by routine bacteriologic culture. Future research efforts in chronic prostatitis must address not only treatment regimens but expand the search for etiologic agents.

Adolescent↗