Biomedical subjects
Publications and source records attributed to R F McKee.
Leaving babies and young children out in the sun during periods of unexpected exceptionally fine weather resulted in 142 children being treated for sunburn in the Royal Hospital for Sick Children in Glasgow over a 6-year period. Care-givers should be warned of the potential hazards of overexposure to sunshine.
The anti-secretory effects and pharmacokinetics of omeprazole were investigated in ten patients with chronic liver disease. Plasma omeprazole concentrations were measured after a 10-mg intravenous dose of omeprazole and on the first and seventh days of a 7-day course of 10 mg oral omeprazole daily. Pentagastrin tests were performed on the day before oral omeprazole was commenced and 24 h after the last oral dose. The pre-treatment basal and peak gastric acid outputs were low (mean rates of 1.44 mmol/h and 9.26 mmol/h, respectively) and following 7 days of oral 10 mg omeprazole daily, were lowered by 95% and 90% respectively. Following 10 mg intravenous omeprazole, plasma clearance was reduced, and plasma half-life and area under the concentration curve were increased, in comparison with previous studies in healthy subjects. The plasma concentration curves for oral and intravenous doses were very similar. After both the first and seventh oral doses, maximum plasma concentration and area under the curve were higher than in healthy subjects. No accumulation of omeprazole was demonstrated. The pharmacokinetics of omeprazole in chronic liver disease could be influenced by low gastric acidity, poor liver function and/or portasystemic shunting. A dose of 10 mg omeprazole daily has been shown to be an effective anti-secretory agent in chronic liver disease.
Current interest in the pharmacological manipulation of portal pressure centres on the long-acting somatostatin analogue SMS 201-995. Nine haemodynamically stable cirrhotic patients who had previously bled from oesophageal varices had wedged and free hepatic venous pressures and cardiac index measured, using a Swan-Ganz catheter, before and at 60, 120 and 180 min after beginning a 60-min infusion of 25 microgram/h of SMS 201-995. Seven clinically similar patients had the same measurements performed without SMS 201-995. In all patients cardiac index was found to decrease and systemic vascular resistance increase at 60 min, although heart rates and arterial blood pressures were unchanged. The group given SMS 201-995 was significantly different from the control group in sustaining a fall in wedged hepatic venous pressure and trans-hepatic venous gradient at 60 min. SMS 201-995 causes a fall in portal pressure without a significant systemic haemodynamic effect.
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In a prospective study of 400 patients admitted for elective surgery, the value of preoperative investigations in identifying the group at high risk of complications was assessed. In order to evaluate methods of reducing the number of investigations a preoperative questionnaire was used and patients were also grouped with regard to age and extent of surgery. Sixteen per cent of the results of the preoperative investigations showed some abnormality but only 0.013% caused a change in management. Abnormal results were significantly associated with complications (P less than 0.05). A positive (abnormal) questionnaire and increased age together defined a group more likely to have abnormal results (P less than 0.05) but age was a more specific indicator. The extent of surgery was not associated with abnormal results other than biochemistry results but was associated with complications (P less than 0.01) and with the need to repeat investigations postoperatively. It was concluded that a preoperative questionnaire might be useful in the assessment of day case patients, where a larger fraction would be expected to fall into the low risk group. A policy for routine preoperative investigation was drawn up. Full blood count should be performed in all patients over 40 years, ECG in all patients over 50 years and CXR and urea and electrolytes in patients over 60 years undergoing major surgery. Asymptomatic patients out with these categories do not require routine investigations.
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