Biomedical subjects
Publications and source records attributed to A Owens.
Three cases are reported in which angiographic embolisation therapy was effective in arresting upper gastrointestinal bleeding secondary to metastatic hypernephroma. Each patient had histologically confirmed disseminated renal cell carcinoma and presented with recurrent haematemeses with a successful outcome following palliative embolisation therapy.
Protrusion of screws in the hip might not be recognized on standard radiographs or image intensifier images. A mathematical model is presented which allows peroperative evaluation of hip joint penetration using image intensifier images.
To determine current practices regarding security measures in the emergency department (ED), a random sample of 250 hospitals with EDs was surveyed by telephone. Security issues addressed included personnel (in-house security, contract guards, or police), hours of staffing in the ED, how security is armed, whether ED doors are locked at off-hours, and whether alarm buttons, direct phone lines, a paging code, closed circuit surveillance, metal detectors, and seclusion rooms are used. This information was stratified according to hospital size, ED census, rural/suburban/urban setting, teaching/nonteaching status, and region. Generally, on-site security presence increases with increasing hospital size and ED census, suburban and urban locations, and teaching status. Small, rural hospitals are more likely to lock the ED doors at off-hours, whereas the use of security codes does not clearly follow demographic trends. Larger hospitals in suburban and urban settings and having a teaching status are more likely to have secure/detention rooms and closed circuit surveillance. The use of alarm buttons and/or direct telephone lines varies widely, but is generally more common in larger, teaching hospitals, located in urban and suburban settings.
Mortality of bone marrow transplant (BMT) patients who develop invasive fungal infection is greater than 80%. Long-term follow-up of 46 consecutive BMT patients who received recombinant human macrophage colony-stimulating factor (rhM-CSF) as adjunctive therapy with standard antifungal treatment who were entered into phase I/II trials at The Fred Hutchinson Cancer Research Center is reported. rhM-CSF (100 micrograms/m2 to 2,000 micrograms/m2; Chiron/Cetus Corporation, Emeryville, CA) was administered from day 0 to 28 after determination of progressive fungal disease. Results of long-term follow-up of fungal infection, relapse, and survival were compared with 58 similar historical controls. Multivariable analysis of the patients who received rhM-CSF showed two factors that significantly correlated with poor survival: Karnofsky score < or = 20% and Aspergillus infection. Overall, survival of patients who received rhM-CSF was greater than that of historical patients (27% v 5%) and was entirely because of a 50% survival rate in patients with Candida infection and Karnofsky scores greater than 20%. Prospective, randomized, controlled trials to determine efficiency of rhM-CSF are indicated and should be directed at patients with invasive candidiasis.
This prospective, nonblinded study, comparing jet injection with needle-syringe injection of lidocaine in performing digital blocks, tested the hypothesis that jet injection can be used effectively as a less painful way to perform digital blocks. Twenty-four adult patients with injuries of the middle or distal phalanges of the fingers received digital blocks using a jet injector on one side of the finger and a needle-syringe on the other side; pain was assessed at 0, 1, 3, 6, 12, and 24 hours using visual analog scales. Differences in pain scores for the two procedures (jet injector vs needle) were tested at each time period using nonparametric statistical procedures for paired or matched data (paired Wilcoxon). At the time of injection (time 0) and at 12 hours, the jet had a significantly lower pain score than the needle. Comparisons made at the other points were statistically nonsignificant at .05. The anesthesia achieved using the jet injector was considered adequate in 23 of 24 patients. We conclude that the jet injector can be used effectively in performing digital blocks and is less painful than standard needle-syringe methods.
STUDY OBJECTIVES: By evaluating the efficacy of metoclopramide alone and in combination with ibuprofen versus placebos, this study was designed to both evaluate the efficacy of metoclopramide and elucidate its mechanism of action in the treatment of migraine headache. DESIGN: The study was conducted over a two-year period and was a randomized, double-blind, placebo-controlled study. SETTING: An urban teaching hospital. PARTICIPANTS: Patients enrolled were at least 18 years old and had recurring headaches with one or more of the following characteristics: unilateral, preceded by neurologic symptoms, significant nausea and vomiting, or mood changes and photophobia. INTERVENTION: Ten milligrams of metoclopramide or an equal volume of IV normal saline was given and 600 mg of ibuprofen or identical-appearing placebo was given orally at time 0. Patients rated their pain and nausea at time 0, 30 minutes, and 60 minutes using visual-analog scales. RESULTS: The differences in pain and nausea scores for the metoclopramide + placebos group versus the other three groups were tested using exact nonparametric (Mann-Whitney) statistical procedures. The metoclopramide + placebos group had significantly better relief of pain compared with the placebos + ibuprofen and placebos + placebos groups. The metoclopramide + placebos group had significantly better relief of nausea than the ibuprofen + placebos group; nausea scores for the placebos + placebos group could not be analyzed due to excessive variance from the other groups at baseline. The differences between the metoclopramide + placebos group and the metoclopramide + ibuprofen group were not statistically significant with regard to either pain or nausea. CONCLUSION: Metoclopramide is efficacious in the treatment of both the pain and nausea of migraine headache. This is a direct action that is not dependent on the concomitant administration of another agent.
The authors report a randomized, double-blind prospective trial comparing the effects of nonionic with ionic low-osmolar contrast media on erythrocyte aggregation. The study group comprised 40 consecutive patients with pathology necessitating selective angiography. Patients were examined using either ioxaglate 320, iohexol 350, or iopamidol 370. Erythrocyte aggregation was assessed both macroscopically and microscopically. Erythrocyte aggregation occurred more frequently in the iopamidol group (13 of 45 samples examined) than in the iohexol (4 of 46) or ioxaglate (5 of 51) groups (P = .002).
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The purpose of this investigation was to ascertain the effectiveness of a specific pre-language communication programming technique on the development of pre-language communication signalling behaviour in a group of profoundly mentally handicapped students. Results indicate that the procedure produced desired effects. Problems related to defining pre-language communication behaviours and communicative stimuli for this population, as well as issues pertaining to generalization, were discussed. Concluding comments stress the preliminary nature of the results and the need for future research in the validation of pre-language communication programming techniques.
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Fifty-seven patients (34 men and 23 women) underwent percutaneous angioplasty (PTA) of the superficial femoral artery. Follow-up angiography revealed restenoses/reocclusions in 23 patients (relapsing group) and a patent, previously-dilated segment in 34 cases (patent group). These two groups were compared retrospectively regarding their clinical and angiographic state at the time of PTA. The lengths and types of the dilated arterial lesions were similar for both groups. However, the patients in the relapsing group were older as an average, showed significantly more advanced arteriosclerotic disease of their outflow tracts, and were predominantly female. For the relapsing group, a smaller lumen had been attained and a significantly higher brachiopedal pressure difference remained after PTA as opposed to the patients of the patent group. Of the patients with clinical signs of relapse, 28% still had patency of previously dilated segments at follow-up angiography. The true patency rate of dilated arterial segments presumably is higher than what is expected from follow-up examinations using clinical methods alone.
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The thoracic inlet is insufficiently investigated by conventional radiographic techniques. CT clearly demonstrates this area free of superimposition. Thorough knowledge of cross sectional anatomy is essential for CT interpretation. There is a wide spectrum of pathology involving the thoracic inlet because its visceral, lymphatic, vascular and nervous structures are connected with many parts of the body. An overview is given on the indispensable role of CT in the investigation of the various pathological entities involving the thoracic inlet.
One hundred one patients with unstable angina were treated conservatively without the routine use of beta receptor blocking agents, calcium antagonist drugs, anticoagulant agents or nitrates. Only two patients underwent arteriography and coronary arterial bypass surgery during hospitalization and one patient during the 1st year of follow-up study. The 28 day mortality rate was 4 percent and the total 1 year cardiac mortality rate 10 percent. Two patients died from carcinoma. The incidence rate of nonfatal myocardial infarction was 9 percent during the first 28 days and a further 3 percent for the 1st year. These results compare favorably with the immediate and 1 year prognosis reported from other studies using different treatment procedures, including modern intensive drug treatment and coronary arterial bypass surgery. Various factors studied during the acute stage of unstable angina were assessed in an effort to predict the immediate and long-term outcome. Only persistence of pain after admission to the hospital was found a significant indicator of an adverse prognosis. Modern medical treatment of unstable angina with beta receptor blocking agents, calcium antagonist drugs, anticoagulant agents, nitrates and antiarrhythmic agents is critically examined. The paucity of proper randomized controlled studies confirming the value of medication is underlined. There is little evidence to show that aggressive or intensive medical or surgical treatment is superior to a conservative approach to management in the coronary care unit. This approach includes bed rest until the pain has resolved, symptomatic drug treatment only, the minimal use of invasive investigations and careful risk factor intervention.
The communication patterns of four subjects diagnosed as moderately mentally retarded because of chromosomal abberation Trisomy 9p were investigated. The three children and one adult exhibited expressive language deficits in relation to comprehension and general level of functioning. Generally they used approximations of single words and tended to rely on gestures for expression. Unusual acoustic characteristics of speech were also noted.
A low but significant fatality rate persists in intravenous urography. Fatalities are sudden and their cause is not understood. This trial assessed the arrhythmogenic effects of a common urographic contrast agent. Using standard bolus injection techniques, 12 patients out of 58 (20%) developed post-injection arrhythmias. Seven of these cases (12%) were considered to have significant or potentially serious arrhythmias. This group includes various paroxysmal tachycardias and a case of atrioventricular block. Arrhythmia post-injection was commoner in the male and in the older age groups. An abnormal control ECG was not found to be a predisposing factor to the development of arrhythmia. It is suggested that the findings reflect the high incidence of latent coronary heart disease in our older male population. No correlation was found with minor side-effects of contrast injection and the development of arrhythmia.
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