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2.  Effects of cirrhosis and ageing on the elimination and bioavailability of ranitidine. 
Gut  1982;23(10):819-823.
The plasma concentrations of ranitidine after oral and intravenous administration have been measured in 10 healthy young adults, nine cirrhotic patients, and eight healthy elderly people. In the first of these bioavailability was 51 +/- 4% and half life 161 +/- 11 minutes after oral and 124 +/- 5 minutes after intravenous administration. In the cirrhotics bioavailability was increased to 70 +/- 7%, clearance was reduced, and there was a modest increase in half life. In the elderly bioavailability was similar to that in young adults, clearance was markedly reduced, and half life was prolonged to 241 +/- 7 minutes after oral and 194 +/- 11 minutes after intravenous administration. It is predicted that blood levels in cirrhotics and the elderly would be 50 to 60% higher than in healthy young adults after repeated oral administration of similar doses.
PMCID: PMC1419822  PMID: 6126422
5.  Anticonvulsant intoxication precipitated by azapropazone 
Postgraduate Medical Journal  1981;57(665):191-192.
A patient is reported who developed a hitherto unrecognized drug interaction between azapropazone and anticonvulsants which led to toxicity with the latter. The mechanism of this interaction is discussed.
PMCID: PMC2424863  PMID: 7329887
6.  Ultrasonic measurement of liver size. 
British Medical Journal  1976;2(6051):1561.
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PMCID: PMC1690132  PMID: 1009401
7.  An investigation of space and space-time clustering in a large sample of infants with neural tube defects born in Cardiff. 
Altogether 406 infants with neural tube defects born in Cardiff between 1956-71 were investigated for evidence of space-time clustering and 100 similarly affected infants, together with matched controls born in Cardiff between 1964-66 were investigated for evidence of spatial clustering. No evidence of excessive prevalence in either dimension was observed.
PMCID: PMC478915  PMID: 1104033
8.  Effect of hormones on the variation of radiosensitivity in females as measured by induction of chromosomal aberrations. 
Environmental Health Perspectives  1997;105(Suppl 6):1467-1471.
The frequency of dicentrics + ring (dic/cell) and total chromosome aberrations (dicentrics, rings and excess acentrics, etc.) per cell (TAb/cell) has been studied in 50 male and female volunteers after high or low dose rate (HDR, LDR) irradiation of peripheral blood lymphocytes. The mean male aberration frequencies per cell after HDR irradiation were 0.38 dic/cell and 0.61 TAb/cell; following LDR irradiation, the mean aberration frequencies were 0.28 dic/cell and 0.45 TAb/cell. Equivalent female values after HDR irradiation were 0.42 dic/cell and 0.71 TAb/cell; after LDR irradiation, the mean aberration frequencies were 0.30 dic/cell and 0.48 TAb/cell. Analysis of variance showed that there was a highly significant difference between males and females have a greater HDR, but not LDR, irradiation It is concluded from this study that females have a greater variability in their radioresponse, and that this variability is related to progesterone, which has a profound effect upon radiosensitivity, as measured by cytogenetic end points.
PMCID: PMC1469961  PMID: 9467065
10.  Comparison of natriuretic, uricosuric, and antihypertensive properties of tienilic acid, bendrofluazide, and spironolactone. 
British Medical Journal  1979;1(6158):224-226.
The antihypertensive properties of the new diuretic tienilic acid were investigated. Thirteen previously untreated hypertensive patients took part in a double-blind crossover study in which 30 days' treatment with tienilic acid 250 mg, bendrofluazide 5 mg, and spironolactone 100 mg were compared. Bendrofluazide caused the greatest natriuresis on the first treatment day and the most rapid fall in blood pressure. The ultimate antihypertensive effect of all three drugs was similar. Tienilic acid caused a noticeable reduction in serum urate concentrations and a rise in urate clearance, in contrast to the other two agents, which caused slight urate retention. Tienilic acid and bendrofluazide caused falls and spironolactone a rise in plasma potassium concentrations. No untoward effects were seen from any of the drugs. It is concluded that tienilic acid is a moderately potent diuretic that lowers plasma urate concentrations. It may be the drug of first choice for hypertensive patients who already have gout or are likely to develop it when taking thiazide diuretics.
PMCID: PMC1597864  PMID: 369652
11.  The distinction between worth and affordability: implications of costs and benefits for the allocation of health care resources. 
Postgraduate Medical Journal  1986;62(734):1107-1111.
There is an important distinction between worth and affordability which remains largely unrecognized. It is widely supposed that if an economic analysis shows that the benefits of a service exceed its costs, failure to fund it is irrational and inefficient. By means of a simplified model of a health care system, it is shown that although an excess of benefits over costs is a necessary precondition for providing a service, it is by no means sufficient. If society is to make the best use of its resources in health care, worthwhile services--those which make a social 'profit'--must be compared with other such services. Since the resources available to any health care system will always be limited, it is likely that not all services whose benefits exceed their costs can be afforded, because the budget has already been committed to those worthwhile services which yield higher benefits per unit cost.
PMCID: PMC2418947  PMID: 3116522
12.  Recurrent idiopathic pneumomediastinum. 
Postgraduate Medical Journal  1985;61(722):1073-1075.
A case is described of the rare syndrome of recurrent idiopathic pneumomediastinum which had been mistakenly diagnosed as recurrent spontaneous perforation of the oesophagus. The case illustrates the importance of distinguishing between pneumomediastinum and oesophageal rupture because of their markedly differing prognosis and management.
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PMCID: PMC2418528  PMID: 4095051
14.  Can the use of radiography of arms and legs in accident and emergency units be made more efficient? 
The efficiency of the selection of patients with injured arms and legs for radiography was investigated. The analysis was based on data on presenting signs and symptoms collected in a multicentre study organised by the Royal College of Radiologists working party on the effective use of diagnostic radiology. The work was carried out in eight accident and emergency units in England and Wales. With the help of various computer simulation techniques a combination of signs and symptoms that might usefully improve present practice was sought. The results suggest that for injuries of arms and legs the clinical determinants of bony injury cannot be refined further to improve current selection for radiography. This study shows that existing clinical practice is probably as good as it can be.
PMCID: PMC1245302  PMID: 3101848
15.  Should women at high risk of neural tube defect have an amniocentesis? 
Journal of Medical Genetics  1985;22(6):457-461.
As part of an investigation into the practical problems of a maternal serum alphafetoprotein (AFP) neural tube defect (NTD) screening programme carried out in Mid Glamorgan, South Wales, between 1977 and 1979, obstetricians were recommended to refer women with high risk pregnancies directly for counselling, high resolution ultrasonography, and amniocentesis without first carrying out serum screening. Out of 15 687 pregnant women one-third attended too late to be screened. A total of 637 was classed as high risk, mostly at greater risk than 1 in 50 because of a previously affected pregnancy or an affected close relative. Compliance with recommended procedure was relatively low as many were screened. There were 10 pregnancies with a recurrence of NTD, of which one was not tested at all, two were not detected (one closed meningocele and one closed iniencephalic), and seven were detected and the pregnancies terminated. All the latter, as well as the iniencephalic, would have been detected from a serum AFP determination and a high resolution ultrasound scan alone. It is concluded that these investigations are sufficient for high risk pregnancies and that amniocentesis is not really cost effective or necessary unless either of these investigations is abnormal. As numbers in this study were small it is suggested that these conclusions should be tested in a larger study.
PMCID: PMC1049506  PMID: 2416925
16.  Can we afford screening for neural tube defects? The South Wales experience. 
Clinical and financial gains and losses accruing from five different options for screening for open neural tube defects were estimated, based principally on the results of detailed monitoring of inputs and outcomes and of process costs in the South Wales Anencephaly and Spina Bifida Study. As well as estimating the overall clinical costs of a screening service it was shown that if the prevalence, including terminations, of open neural tube defects is between 1.25 and five per 1000 births the financial cost of avoiding the birth of a seriously handicapped child who would survive for more than 24 hours is in the range 9000 pounds- 54000 pounds depending on the option adopted and the prevalence of the condition in the target population. Prevalence is the biggest determinant of cost. The data should provide a basis for assessment and discussion of resource priorities in the National Health Service.
PMCID: PMC1417540  PMID: 3917791
17.  Reply 
Gut  1984;25(7):802-803.
PMCID: PMC1432606
18.  Head injuries in adults 
PMCID: PMC1444066  PMID: 6419913
21.  Drug metabolism in malnourished children: a study with antipyrine. 
Archives of Disease in Childhood  1979;54(4):299-302.
The effect of malnutrition on hepatic drug-metabolising enzymes was investigated in 8 Sudanese children aged between 9 and 12.5 years using as a model the drug antipyrine. Antipyrine half-life and clearance were measured in the malnourished state and after 3 or 4 weeks of good nutrition. Associated with the improvement in nutritional state was a shortening of antipyrine half-life and an increase in its clearance. There was also a rise in serum triiodothyronine. It is concluded that poor nutrition is associated with impairment of drug metabolic capacity and that many factors are responsible.
PMCID: PMC1545296  PMID: 110271
22.  Precision in estimating gestational age and its influence on sensitivity of alphafetoprotein screening. 
British Medical Journal  1979;1(6169):981-983.
The interpretation of maternal serum alpha-fetoprotein (AFP) concentrations in relation to fetal neural tube defects depends on accurate assessment of the gestational age. In a quadruple-blind study three antenatal methods of assessment--namely, menstrual dates, clinical examination, and ultrasound scanning--were correlated with postnatal assessment using the Dubowitz scoring system. The best agreement to +/- 1 week was obtained using menstrual dates and ultrasound in combination, such agreement being found in 91 (77%) of the 118 women studied. Since serum AFP concentrations vary with gestational age, precise gestational dating is necessary. In many cases, particularly in women who are unsure of their dates or have irregular menstrual cycles, ultrasound examination is needed to supplement clinical findings.
PMCID: PMC1598638  PMID: 86376
23.  Decreased first-pass metabolism of labetalol in chronic liver disease. 
British Medical Journal  1978;2(6144):1048-1050.
The effect of chronic liver disease on the rate of elimination and extent of "first-pass" metabolism of labetalol was studied. Pharmacokinetic measurements were made after both oral and intravenous administration to seven healthy subjects and to 10 patients with chronic liver disease. Plasma half life was similar in the two groups. Plasma concentrations were considerably higher in the patients than in the healthy subjects after oral administration but similar after intravenous injection. Thus the bioavailability of labetalol was increased in liver disease due to reduced first-pass metabolism. Bioavailability in the group of patients correlated negatively with serum albumin concentration. There were falls in supine heart rate and blood pressure which tended to be greater after oral administration in the patients with liver disease, suggesting an exaggerated response related to the increased bioavailability. Oral dosage requirements of labetalol and possibly other drugs susceptible to first-pass metabolism are reduced in the presence of liver disease.
PMCID: PMC1608159  PMID: 709214
24.  Spina bifida and anencephaly: are miscarriages a possible cause? 
British Medical Journal  1977;2(6083):361-362.
The marriage-to-conception interval in 151 pregnancies producing infants with anencephaly or spina bifida was not significantly different from that in 218 pregnancies resulting in normal infants. Significantly more miscarriages occurred before than after the birth of 285 infants with anencephaly or spina bifida, but in 133 controls no before-after difference was observed. These observations seem to favour the idea that miscarriages are a manifestation rather than a cause of anencephaly and spina bifida.
PMCID: PMC1631170  PMID: 329941

Results 1-25 (60)