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Biomedical subjects

R A Moore

Publications and source records attributed to R A Moore.

At least 145 records · Page 8Linked to original sources
PubMed1988

Clinical spectrum of the upper gastrointestinal effects of nonsteroidal anti-inflammatory drugs. Natural history, symptomatology, and significance.

Nonsteroidal anti-inflammatory drugs (NSAIDs) relieve rheumatic pain and are in extensive use. Symptomatic complications of NSAIDs requiring the discontinuation of their use occur in 2 to 10 percent of patients with rheumatic diseases in sharp contrast to the common asymptomatic problems of gastroduodenal erosions, ulcerations, and bleeding, with resulting anemia in more than 40 percent of these patients. Opinions concerning the clinical significance of these complications are not uniform. The natural history of the effects of NSAIDs on the gastroduodenal mucosa reveals a sequence of initial subepithelial hemorrhage over a 24-hour period followed by gastroduodenal erosions and ulcerations in the next two weeks. From one week to three months, gastroduodenal erosions and ulcerations disappear in about half of the patients as an adaptation to continuing NSAID ingestion occurs. Hemorrhage may occur at any time in most patients and in a small minority (1 percent) it is massive. Non-aspirin NSAIDs (NANSAIDs) exhibit significantly fewer complications than do aspirin. These complications, however, demand considerable clinical attention and are ordered in a constant hierarchy, suggesting variable risks of complications among agents. NSAIDs are a blessing for those who have chronic pain, but that blessing does not prevent significant asymptomatic complications in the same patients. Prophylaxis for high-risk groups, such as women over the age of 65 years, should be subjected to study.

Anti-Inflammatory Agents, Non-Steroidal↗
PubMed1988

Morphine and ibuprofen compared using the cold pressor test.

The analgesic efficacy of single doses of oral morphine sulphate solution (10 mg) and ibuprofen 600 mg was compared in 12 volunteers using a double-blind, double-dummy, placebo-controlled design on the cold pressor experimental pain model. Measurement of pain intensity was made before medication and then at 30, 60, 90, 120 and 180 min; blood samples were taken at these times for measurement of morphine and glucuronide metabolites by radioimmunoassay. Sessions were at least 5 days apart. Correlations were sought between analgesic effect and plasma concentrations of either morphine or morphine-6-glucuronide. Morphine produced significant reduction in both peak pain intensity and area under the pain intensity curve compared with placebo; the threshold time was significantly increased by morphine compared with placebo. Ibuprofen was statistically indistinguishable from placebo on all three measures of analgesia. Analgesic effect and plasma concentrations of morphine showed significant correlation (P = 0.053). The study confirmed reports of the opiate sensitivity of the cold pressor model, and the apparent insensitivity of the model to non-steroidal anti-inflammatory drugs.

Adult↗
PubMed1988

Postoperative orthopaedic pain--the effect of opiate premedication and local anaesthetic blocks.

The postoperative analgesic effect of opiate premedication and local anaesthetic blocks was studied in 929 patients having orthopaedic surgery. The median time to first request for postoperative analgesia was less than 2 h when neither opiate premedication nor block was used; opiate premedication increased the time significantly to more than 5 h; local anaesthetic block produced a further significant increase to 8 h and opiate premedication used with local anaesthetic block extended the median time further to more than 9 h. Women requested analgesia significantly earlier than men, independent of treatment. Age had no significant effect. Prolonging the time before more pain relief is required may be worthwhile for both patients and staff.

Adolescent↗
PubMed1988

Transcutaneous electrical nerve stimulation in the management of acute postoperative pain.

Twenty patients undergoing decompressive lumbar laminectomy were randomly allocated, in a double-blind manner, to receive active or inactive transcutaneous electrical nerve stimulation (TENS) as part of the management of their postoperative pain. All patients received the same non-narcotic general anaesthetic. The efficacy of the TENS was assessed by using a patient-controlled analgesia system (PRODAC) which delivered morphine i.v. This system recorded the number of demands for analgesia and the total dose administered in the first 24 h. In addition, plasma morphine concentrations were measured hourly for the first 6 h and again at 24 h. There was no statistical difference between the two groups in the number of patient demands for analgesia, morphine dose or plasma morphine concentration. TENS offered no advantage over a placebo in the management of acute postoperative pain in these patients.

Acute Disease↗
PubMed1988

NSAIDs: a clinical approach to the problems of gastrointestinal side-effects.

Despite the fact that non-steroidal anti-inflammatory drugs (NSAIDs) are among the most widely used drugs in medicine today, 2-10% of patients must discontinue their use primarily due to gastrointestinal (GI) side-effects. While the development of non-aspirin NSAIDs (NA-NSAIDs) has significantly reduced GI side-effects, major problems persist. A practical clinical approach to these problems includes informing the patient about the risks and benefits of NSAIDs, risk management during treatment with NSAIDs and investigation of symptomatic side-effects during treatment. Prophylaxis of GI side-effects is feasible in selected populations, but it has not been studied widely and may not be cost-effective. At present, costs of prophylaxis in all but selected populations with multiple risks probably outweight the benefits.

Anti-Inflammatory Agents, Non-Steroidal↗
PubMed1988

Comparisons of specific crosses from Yorkshire-Landrace, Chester White-Landrace and Chester White-Yorkshire sows.

One hundred thirty Yorkshire-Landrace (YL), Chester White-Landrace (CL) and Chester White-Yorkshire (CY) F1 crossbred sows were mated randomly to Duroc (D), Hampshire (H), Farmers Hybrid 414 (FH414) or Farmers Hybrid 929 (FH929) boars. These matings produced 321 litters and 3,379 pigs, which were used to determine the effect of sire breeding and dam breeding on preweaning and postweaning performance of the pigs and litters. Litter size born alive, litter size at 56 d, litter weight at 56 d and litter weight per day of age to 100 kg were lower in litters sired by H boars than in those sired by D boars. However, sizes and weights of litters sired by D and H boars were not different from those sired by FH414 and FH929 boars. Litter sizes at birth were larger for litters out of CL and CY sows than those out of YL sows, but significant differences were not found for litter sizes at 21 d, 56 d or at marketing. Pigs sired by H boars were heavier at birth than pigs sired by D boars. Pigs sired by H boars did not differ significantly in weights at 21 and 56 d or in postweaning daily gains or days to 100 kg from pigs sired by D boars. Pigs out of CL dams were heavier at birth, 21 d and 56 d of age than pigs out of CY dams, but did not differ significantly in postweaning gains or in days to 100 kg. Pigs sired by D and H boars had less ultrasonic fat than pigs sired by FH414 and FH929 boars. Pigs sired by FH929 boars were leaner than pigs sired by FH414 boars.(ABSTRACT TRUNCATED AT 250 WORDS)

Animals↗
PubMed1987

Acute and chronic pituitary failure resembling Sheehan's syndrome following bites by Russell's viper in Burma.

Pituitary function was investigated in 9 patients in shock after Russell's viper bites and in 24 individuals who had been severely envenomed 2 weeks to 24 years previously. 3 out of 9 patients had hypoglycaemia and inappropriately low serum cortisol, plasma growth hormone, and plasma prolactin concentrations. 4 who died had pituitary haemorrhage and 1 had adrenal haemorrhage as well. Of the 24 who had apparently recovered from bites, 7 had clinical features of hypopituitarism and no response in plasma growth hormone or prolactin concentrations to symptom-producing insulin-induced hypoglycaemia. 4 of these 7 had a sluggish serum cortisol response to 'Synacthen Depot' and 5 had an abnormal cortisol response to hypoglycaemia. 4 men with symptoms who were tested had low serum testosterone concentrations; serum thyroxine was also low in these men but not in 2 women with menstrual disturbances and impaired insulin responses. Of the 17 individuals without clinical evidence of endocrine disease, 4 had pituitary hormonal abnormalities. Russell's viper envenoming may thus produce a disorder resembling Sheehan's syndrome.

Acute Disease↗
PubMed1987

Determination of the pulmonary capillary wedge position in patients with giant left atrial V waves.

Thirteen patients with giant left atrial V waves during preoperative cardiac catheterization were admitted into the study group. While awake and breathing spontaneously, simultaneous recordings of electrocardiographic leads II and V5, radial arterial traces, and pulmonary arterial or pulmonary capillary wedge traces were obtained. Measurements were made on four consecutive cardiac cycles in the unwedged and wedged positions for the following intervals: Q wave to the radial arterial upstroke (220 +/- 20 milliseconds) and peak (360 +/- 10 milliseconds), Q wave to the pulmonary arterial upstroke (170 +/- 20 milliseconds) and peak (350 +/- 20 milliseconds), Q wave to the V wave upstroke (280 +/- 20 milliseconds) and peak (570 +/- 20 milliseconds), and QT interval (420 +/- 20 milliseconds). These findings indicate that the radial arterial and pulmonary arterial upstrokes and peaks occur nearly simultaneously. Upon wedging, the V wave upstroke occurs significantly later in the cardiac cycle (P less than .05) compared with the pulmonary arterial upstroke, and the V wave peak occurs significantly later compared with both the pulmonary arterial and the radial arterial peak (P less than .05). A rapid, simple beat-to-beat method for differentiating pulmonary arterial from pulmonary capillary wedge positions in the presence of giant left atrial V waves is the superimposition of the pulmonary arterial trace on the radial arterial trace. When a wedge position is attained, there is an immediate rightward shift in the upstroke and peak of the pulmonary arterial pressure trace, which can be easily identified by observing the relationship between the pulmonary arterial and systemic arterial traces.

Adult↗
PubMed1987

Serum beta-human chorionic gonadotropin levels relate poorly with the size of a tubal pregnancy.

Ectopic implantation usually begins with relatively normal growth of trophoblast and serum beta-hCG progression. However, the trophoblast eventually erodes into vessels and a variable degree of bleeding and hematoma compromises its growth. The serum beta-hCG level then usually begins to demonstrate some degree of abnormal progression. For our patients, the length of the ectopic pregnancy varied widely, depending mainly on when the individual patient chose to seek medical treatment. Infertility patients followed from the moment of conception would thus be expected to show a better correlation between early beta-hCG levels and the size of the tubal pregnancy. Preconditions for the operative laparoscopic management of a tubal pregnancy usually include that the tube be unruptured, less than 3 cm in diameter, and readily accessible via the laparoscopic approach. Ackerman et al. suggested there was a general correlation between the serum beta-hCG level and tubal rupture, and the present data demonstrate an overall positive correlation between the size of the tubal pregnancy and the serum level. However, the range of levels is so broad for any given size of mass or tubal status that this correlation is not meaningful clinically. A reliable method to determine the size and status of a tubal pregnancy before laparoscopy would be valuable. Unfortunately, we did not find the preoperative serum beta-hCG level to be useful for making this prediction.

Chorionic Gonadotropin↗
PubMed1987

Fluradoline and aspirin for orthopedic postoperative pain.

Fluradoline (150 or 300 mg), a novel tricyclic with both antidepressant and analgesic properties in animals, was compared with aspirin, 650 mg, and placebo when given orally for postoperative orthopedic pain in a double-blind, single-dose, parallel-group study. Analgesic measurements were made by two trained nurse observers using standard verbal rating and visual analogue scales. Aspirin was statistically superior to placebo on all analgesic measures, demonstrating assay sensitivity. Fluradoline, 300 mg, was distinguished from placebo and fluradoline, 150 mg, but not from aspirin, 650 mg. Overall, fluradoline, 300 mg, was equivalent to aspirin, 650 mg. Fluradoline, 300 mg, produced a significant elevation in mood score. Neither aspirin, 650 mg, nor fluradoline caused untoward side effects, but fluradoline, 300 mg, increased blood pressure.

Adult↗
PubMed1987

Factors in the outcome of transsphenoidal surgery for prolactinoma and non-functioning pituitary tumour, including pre-operative bromocriptine therapy.

Radical transsphenoidal surgery in 58 patients with large non-functioning pituitary tumours relieved pressure symptoms and disconnection hyperprolactinaemia without loss of pituitary function, and verified the diagnosis. Pre-operative bromocriptine did not cause any shrinkage of non-functioning tumours (n = 8), even up to 48 weeks. Thirty-two patients not given postoperative radiotherapy are being followed-up, and although two show minor CT scan evidence of tumour regrowth, for the others the delay in radiotherapy is enabling reproduction where required. In 20 patients with non-invasive macroprolactinomas radical surgery caused no loss of pituitary function but cured eight, of whom one has relapsed; none of eight invasive prolactinomas was cured by surgery. Pre-operative bromocriptine caused marked size reduction in seven of seven macroprolactinomas, but if continued beyond 6 weeks induced tumour fibrosis and uneven shrinkage which made surgery dangerous and unproductive. Selective transsphenoidal surgery relieved hyperprolactinaemia in 70% of patients with meso- (n = 15) or microprolactinoma (n = 24) usually without loss of pituitary function: the relapse rate was 1 per 88 patient years of follow-up. Invasive prolactinomas, and macroprolactinomas showing uneven shrinkage with a short (up to 4 weeks) course of bromocriptine should have radiotherapy rather than surgery, while the patients most suited to surgery are those with mesoprolactinomas, or some macroprolactinomas with compact intrasellar shrinkage after short-term bromocriptine. Microprolactinomas generally did not benefit from surgery as compared to conservative therapy. In none of the tumour groups were the surgical findings an accurate predictor of postoperative pituitary function.

Adenoma↗
PubMed1987

Role of porins in intrinsic antibiotic resistance of Pseudomonas cepacia.

The measured outer membrane permeability of Pseudomonas cepacia to the beta-lactam nitrocefin was low: approximately 10 times less than that of Escherichia coli and comparable to that of Pseudomonas aeruginosa. The purified P. cepacia porin demonstrated an average single channel conductance in 1 M KCl of 0.23 nS.

Anti-Bacterial Agents↗