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Biomedical subjects

R Bird

Publications and source records attributed to R Bird.

At least 55 records · Page 3Linked to original sources

Optimal timing of doses of chenic acid in patients with gall stones.

Sixteen patients with gall stones were treated with chenic acid (14-16 mg/kg/day) given at three different times in random order for one month each. Before treatment the mean (+/- SE of mean) cholesterol saturation index (SI) of fasting gall-bladder bile was 1.28 +/- 0.06. During bedtime administration of chenic acid the mean SI fell to 0.78 +/- 0.04, which was significantly lower than that obtained with administration in the morning (0.92 +/- 0.05) or with three divided doses at mealtimes (0.92 +/- 0.04). The bile remained supersaturated in seven patients when they received a single morning dose, in five patients when they received mealtime doses, but in only one patient when a single bedtime dose was given. There was no significant difference in side effects between the three different dose timings, or in the proportion of bile acids present in the bile as chenic acid. This enhanced effect obtained with bedtime administration may be due to the enterohepatic circulation of bile acids being maintained during overnight fasting.

Adult↗

Orbital-facial complications of sinusitis in children.

Although complications of sinusitis in children have lessened remarkably since and advent of antibiotics, nevertheless they still occur. In a 25-year period at the Hospital for Sick Children, 6,770 patients with the diagnosis of sinusitis were reviewed and 159 of these had orbital-facial complications. Surgical intervention was necessary in 17 to prevent more serious complications. Although there were no deaths in non-malignant disease, two patients developed permanent optic atrophy, presumably because of delayed surgical drainage. On occasion, malignant disease may simulate inflammatory processes.

Abscess↗

Low-cholesterol diet: enhancement of effect of CDCA in patients with gall stones.

Fifteen patients with gall stones who were taking chenodeoxycholic acid(CDCA) 15 mg/kg at bedtime participated in two separate experiments to investigate the effects of altering sterol intake on the cholesterol saturation index (SI) of fasting gall-bladder bile. In experiment I the 15 patients on an unrestricted diet had a SI of 0.87 +/- 0.04 (mean +/- SE of mean), which fell to 0.75 +/- 0.04 after one week in hospital on a diet of 100 mg cholesterol daily. In experiment II seven of the patients were given four different dietary regimens lasting one month each in random order as outpatients. On a diet of 600 mg of cholesterol daily the mean SI was 0.72 +/- 0.05, which fell to 0.67 +/- 0.05 when the patients were put on a 100 mg cholesterol diet. The addition of plant sterols (3 g daily) to both diets raised the mean SIs to 0.80 +/- 0.05 and 0.77 +/- 0.05 respectively. The percentage CDCA in bile was unaffected by alterations in the cholesterol and plant sterol intakes. We conclude that a low-cholesterol diet but not a high intake of plant sterols enhances the effect of CDCA in patients with gall stones.

Adult↗

Infantile gastroenteritis: a clinical study of reovirus-like agent infection.

In a clinical study of 32 infants with symptoms from infections with the human reovirus-like agent (R.I.A.) identified by electron microscopy (E.M.) of faecal extracts, a fairly consistent clinical pattern was found in 30 who had a gastroenteritis-like illness. The disease was usually mild, affecting mainly infants less than 2 years and males more commonly than females. The incubation period appeared to be 48-72 hours; and the onset was sudden, often with vomiting in the first 1-2 days of the illness. Loose yellow-green offensive stools without blood or mucus developed after a variable time, and there was often accompanying fever. Severe dehydration and electrolyte inbalance were uncommon; and with standard treatment the illness was uncomplicated, usually lasting 5-8 days. These features resemble those of previously reported winter epidemics of infantile non-bacterial gastroenteritis, and it is suggested that these epidemics were due to R.L.A. 2 infants in whom R.L.A. was identified in the stool did not have a gastroenteritis-like illness although both had protracted diarrhoea.

Age Factors↗

Adrenal function in hypothyroidism.

In ten patients with hypothyroidism the adrenal response to stimulation with tetracosactrin was found to be normal, and to be unchanged after they had been treated with thyroxine. Though the response to insulin hypoglycaemia was less in the hypothyroid phase, it was never outside the normal limits. Hence it seems unlikely that the adrenal response to stress is appreciably lowered in hypothyroidism.

Adolescent↗

A new approach: regional nerve blockade for angioplasty of the lower limb.

PURPOSE: An audit study investigated the pilot use of regional nerve block analgesia (as an alternative to sedative/opiate, general or central neuraxial anesthesia) performed by radiologists with the assistance of imaging techniques during complex prolonged angiography. METHODS: Radiologists were trained by anesthetic consultants to administer and use lower limb peripheral nerve block for difficult prolonged angioplasty procedures for patients with severe lower limb rest pain who were unable to lie in the supine position. In a pilot study 25 patients with limb-threatening ischemia received sciatic and femoral nerve blockade for angioplasty. The technique was developed and perfected in 12 patients and in a subsequent 13 patients the details of the angiography procedures, peripheral anesthesia, supplementary analgesia, complications, and pain assessment scores were recorded. Pain scores were also recorded in 11 patients prior to epidural/spinal anesthesia for critical ischemic leg angioplasty. RESULTS: All patients with peripheral nerve blockade experienced a reduction in their ischemic rest pain to a level that permitted angioplasty techniques to be performed without spinal, epidural or general analgesia. In patients undergoing complex angioplasty intervention, the mean pain score by visual analogue scale was 3.7, out of a maximum score of 10. CONCLUSIONS: The successful use of peripheral nerve blocks was safe and effective as an alternative to sedative/opiate, epidural or general anesthesia in patients undergoing complex angiography and has optimized the use of radiological and anesthetic department resources. This has permitted the frequent radiological treatment of patients with limb-threatening ischemia and reduced delays caused by the difficulty in enlisting the help of anesthetists, often at short notice, from the busy operating lists.

Aged↗

Serum angiotensin-converting enzyme (SACE) in sarcoidosis and other granulomatous disorders.

Serum angiotensin-converting enzyme (SACE) activity was significantly higher in 90 patients with sarcoidosis (55 +/- [S.D.] 23 nmol min-1 ml-1) than in 80 healthy controls (34 +/- 9 nmol min-1 ml-1). Steroid therapy modified SACE activity; 60 sarcoidosis patients who were not being treated with steroids had significantly higher enzyme activities (58 +/- 24 nmol min-1 ml-1) than 30 steroid-treated sarcoidosis patients (40 +/- 19 nmol min-1 ml-1). In 50% of the non-steroid treated sarcoidosis patients SACE activity was more than 2 S.D. above the mean value for the controls. SACE activity was measured in 22 tuberculous patients (38 +/- 14 nmol min-1 ml-1), 20 leprosy patients (34 +/- 9 nmol min-1 ml-1), 31 with primary biliary cirrhosis (44 +/- 20 nmol min-1 ml-1), 26 with inflammatory bowel disease (31 +/- 9 nmol min-1 ml-1), 8 with hepatic granulomatous disease, 5 with Hodgkin's disease, and 2 with schistosomiasis. The combined false-positive rate for these non-sarcoidosis patients was 10%. Serial SACE assays provide useful information on the course of sarcoidosis and response to steroid treatment.

Acute Disease↗