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Biomedical subjects

C A Wong

Publications and source records attributed to C A Wong.

At least 19 recordsLinked to original sources
PubMed1996

Use of oral corticosteroids in the community and the prevention of secondary osteoporosis: a cross sectional study.

OBJECTIVE: To determine the prevalence of continuous use of oral steroids in the general population, the conditions for which they are prescribed, and the extent to which patients taking oral steroids are taking treatment to prevent osteoporosis. DESIGN: A cross sectional study with a four year retrospective review of drug treatment. SETTING: Eight large general practices in central and southern Nottinghamshire. SUBJECTS: A population of 65,786 patients (52% women) registered with a general practitioner during 1995. RESULTS: 303 patients (65% (197) women) aged 12-94 years were currently taking "continuous" (for at least three months) oral corticosteroid treatment. This figure represents 0.5% of the total population and 1.4% (245/17 114) of patients aged 55 years or more (1.7% (166/9601) of women). The usual steroid was prednisolone (97% (294/303)), the mean dose was 8.0 mg/day, and the median duration of oral steroid treatment determined in 149 patients was three years. The most common conditions for which continuous oral steroids were prescribed were rheumatoid arthritis (23% (70)), polymyalgia rheumatica (22% (66)), and asthma or chronic obstructive airways disease (19% (59)). Only 41 (14%) of the 303 patients taking oral steroids had received treatment for the prevention of osteoporosis over the past four years. Although 37 of the 41 patients were women, only 10% (18/181) of the women over 45 years taking continuous oral corticosteroids were currently taking hormone replacement therapy. CONCLUSIONS: If our figures are typical then they suggest that over 250,000 people in the United Kingdom are taking continuous oral steroids and that most of these are taking no prophylaxis against osteoporosis.

Administration, Oral↗
PubMed1996

Pulmonary function before and after anterior spinal surgery in adult idiopathic scoliosis.

BACKGROUND: Little is known about the long term effects of anterior spinal surgery on pulmonary function in adult patients with idiopathic scoliosis. A study was therefore undertaken of pulmonary function before and after anterior spinal surgery in this group of patients. METHODS: Fourteen patients (12 women) of mean age 26.5 years (range 17-50, 10 > or = 20 years) were studied. All 14 patients underwent thoracotomy and anterior arthrodesis, and five also underwent posterior arthrodesis. Scoliosis curves and lung volumes were measured preoperatively and at a mean follow up of 32 months (range 14-49) after surgery. RESULTS: At long term follow up after surgery the mean (SD) Cobb angle of the thoracic curve improved from 59 degrees (25 degrees) to 39 degrees (18 degrees), a correction of 31%. Despite this there was a fall in mean forced vital capacity (FVC) of 0.21 litres (95% confidence interval 0.04 to 0.38). In the patients who underwent anterior surgery without posterior surgery (n = 9) there was a fall in mean FVC of 0.31 litres (95% confidence interval 0.12 to 0.50); mean forced expiratory volume in one second and total lung capacity were also reduced and there was an increase in mean residual volume. CONCLUSIONS: Forced vital capacity is reduced at long term follow up in adult patients with idiopathic scoliosis who undergo anterior spinal surgery. The fall in FVC is small and is unlikely to be of clinical significance in patients with reasonable lung function in whom surgery is planned for prevention of curve progression or improvement of cosmetic appearance and pain. However, surgical intervention should not be undertaken in an attempt to improve pulmonary function.

Adolescent↗
PubMed1995

Recombinant aprotinin in coronary artery bypass graft operations.

OBJECTIVE: To evaluate the role of recombinant bovine aprotinin in reducing blood loss in coronary artery bypass graft surgery. DESIGN: An open-label, randomized, controlled study evaluating two dosage levels of recombinant aprotinin. SETTING: Two acute care hospitals (Northwestern Memorial Hospital, Chicago, Ill., and the Scott & White Memorial Hospital, Temple, Texas). PATIENTS: Patients undergoing primary and reoperation coronary artery bypass grafting were assigned to groups by means of a computer-generated table of random numbers. Treated (n = 48) and control (n = 36) patients did not differ significantly in age, sex, weight, number of grafts, or preoperative hemoglobin level. INTERVENTIONS: Recombinant aprotinin was given at two dosages. Dosage level 1 consisted of a bolus of 2 mg/kg intravenously immediately after the induction of anesthesia, 1 mg/kg added to each liter of the oxygenator prime, and 0.5 mg.kg-1.hr-1 infused continuously during operation. At dosage level 2, doses were doubled. Intraoperative monitoring of anti-factor Xa activity was performed, and additional doses of heparin were given on the basis of anti-factor Xa results. MAIN OUTCOME MEASURES: Preoperative and postoperative hemoglobin levels, amounts of autotransfusion device and chest tube drainage blood, and transfusions of allogeneic red blood cells. Adverse clinical events (alterations in renal function, graft thrombosis, myocardial infarction, and death) were recorded. RESULTS: Additional heparin was given to 48% patients in the aprotinin group and to 44% of control patients. Overall red blood cell loss (in milliliters, mean +/- standard deviation [SD]) was decreased with aprotinin at dosage level 1 for reoperations (1040 +/- 162 vs 1544 +/- 198, p < 0.01), and at dosage level 2 for all operations (primary operations, 886 +/- 362 vs 1333 +/- 618, p = 0.02; reoperations, 1191 +/- 560 vs 1815 +/- 1116, p = 0.2). Fewer patients in the aprotinin than in the control group had transfusions of donated blood (6/48 vs 12/36, p = 0.02) or reinfusion of chest tube drainage blood (12/48 vs 20/36, p < 0.01). Among patients receiving dosage level 1, there were no myocardial infarctions or deaths. At dosage level 2, one patient had profound bradycardia and died on day 12 and two patients had late graft closures. Two control patients had hypotension after bypass necessitating intraaortic balloon pumps, and one of these patients died. Postoperative increases in blood urea nitrogen and creatinine levels were small in both aprotinin and control groups. No hypersensitivity or other allergic reactions occurred. CONCLUSION: We conclude that, at the dosages given, recombinant bovine aprotinin decreases surgical blood loss and transfusion requirements in patients undergoing coronary artery bypass grafting, but its use requires appropriate monitoring of heparin use during bypass. Whether higher dosages of aprotinin increase the risk of graft thrombosis must be further assessed with a larger patient sample.

Aged↗
PubMed1995

Streptococcus milleri pulmonary disease: a review and clinical description of 25 patients.

BACKGROUND: Streptococcus milleri is increasingly being recognised as an important pulmonary pathogen which may lead to the development of empyema or lung abscess. Although several small series have been reported, the clinical and laboratory features have yet to be fully characterised. METHODS: Twenty five cases were identified and the clinical and laboratory data from case records were analysed. RESULTS: There were 16 empyemas, five lung abscesses, and four with both lung abscess and empyema. The mean age of the patients was 61 years (range 36-89) and 84% were men. The most common symptoms at presentation were shortness of breath, chest pain, cough, and weight loss; only 36% had a fever. Four of the nine patients with lung abscess required a diagnostic lobectomy because of suspected malignancy. Predisposing factors were present in 80% of patients and included the following: pneumonia, periodontal disease, excess alcohol intake, previous thoracic surgical procedures, and malignancy. Laboratory features of S milleri infection were leucocytosis, neutrophilia, anaemia, abnormal liver function tests, and hypoalbuminaemia. In the group with empyema five patients had a pneumothorax on initial presentation and pleural loculation occurred in 10 of these patients. The median stay in hospital was 34 days (range 11-88). Six patients died, five of whom had significant underlying illnesses. CONCLUSIONS: Pulmonary infection with S milleri may result in considerable morbidity and mortality, and is characterised by a strong male predominance, non-specific symptoms (often without toxicity), the presence of predisposing factors, pleural loculation, pneumothorax, and a protracted stay in hospital.

Adult↗
PubMed1994

Keeping it secret: the costs and benefits of nursing's hidden work in discharging patients.

Workload analysts and nursing theorists alike continue their attempts to capture the hidden work of nursing, with varying degrees of success. An interpretative study of the process of discharging patients from hospital to care at home led to a new understanding of the context-related work which nurses do. Three components of context-related work were identified: working with the characteristics of bureaucracy; compensating for bureaucracy on behalf of the health care team; and providing leadership which ensured effective care from others. All constituted invaluable yet obscured and unrecognized components of nursing's indirect contribution to patient care. The costs to keeping this work 'secret' were readily apparent. The understanding derived from this research affords new insights into why nursing has kept this hidden work secret. These insights, in turn, help identify potential solutions for consideration by all concerned about nursing's professional role, status and identity.

Aged↗
PubMed1994

Coagulation tests, blood loss, and transfusion requirements in platelet-rich plasmapheresed versus nonpheresed cardiac surgery patients.

The results of several studies suggest that acute platelet-rich plasmapheresis decreases blood loss and allogeneic blood product transfusion requirements in cardiac surgery patients. We designed a randomized, prospective study to determine whether acute platelet-rich plasmapheresis decreases blood loss and allogeneic transfusion requirements in primary cardiac surgery patients. Forty patients were randomized to a control or pheresis group. The pheresis group had platelet-rich plasmapheresis performed before cardiopulmonary bypass (CPB) and the platelet-rich plasma (PRP) was returned after CPB. The control group was managed in the normal fashion without pheresis. All patients had serial coagulation studies, hemoglobin, and platelet counts determined intra- and postoperatively. Chest tube drainage and transfusion requirements were recorded. There were no differences in the coagulation tests, platelet counts, chest tube drainage, or allogeneic blood product transfusion requirements between the two groups at any time. The authors conclude that the use of acute platelet-rich plasmapheresis in primary cardiac surgery patients does not decrease chest tube drainage or the need for allogeneic blood transfusions.

Adult↗
PubMed1994

The effect of low-dose bupivacaine on postoperative epidural fentanyl analgesia and thrombelastography.

We performed a prospective, randomized, double-blind study to determine the effect of bupivacaine on postoperative epidural fentanyl analgesia and thrombelastography in 120 patients who underwent extensive gastrointestinal or genitourinary surgery. The patients were randomized into four groups, 30 patients per group: Group I = epidural fentanyl (EF), 10 micrograms/mL in saline; Group II = EF with 0.1% bupivacaine; Group III = EF with 0.15% bupivacaine; and Group IV = EF with 0.2% bupivacaine. Pain relief was evaluated by a visual analog scale (VAS), both at rest and during coughing, and by a visual rating scale (VRS). The VAS, VRS, degree of sedation, and side effects (nausea, vomiting, and pruritus) were evaluated every 2 h from 8:00 AM to 6:00 PM, for 24 h after surgery. Forced vital capacities (FVCs) were determined before surgery and at 24 h after surgery. Blood was withdrawn for thrombelastography (TEG) measurements preoperatively, in the recovery room (PARR), and 24 h postoperatively. The VAS, VRS, sedation scores, changes in postoperative FVCs, and the incidence of side effects were not statistically different among the four groups. The 24-h total volumes of infusion in the four groups (146 +/- 40 mL, 140 +/- 38 mL, 142 +/- 40 mL, 124 +/- 21 mL, respectively) were not statistically different from each other. There were no significant differences in the TEG values [reaction time (R), coagulation time (K), angle (alpha), and maximum amplitude (mA)] among the four groups at anytime nor was there any difference between the baseline, PARR, and 24-h TEG values within any group.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1992

Uncertainty and anxiety after mastectomy for breast cancer.

The purpose of this study was to determine the relationship between uncertainty and anxiety in women after mastectomy for breast cancer and to describe women's responses to partial or complete mastectomy for breast cancer during the early rehabilitative phase after surgery. A theoretical framework for the study was derived from the Scott, Oberst, and Dropkin Stress-Coping Model and from a review of the literature. Major study variables and variable measures were uncertainty, measured by the Mishel Uncertainty in Illness Scale (MUIS), and anxiety, measured by the State-Trait Anxiety Inventory (STAI). Twenty-five women admitted to two acute-care teaching hospitals for their first partial or modified radical mastectomy made up the convenience sample of this study. Data were collected 1-2 days before and 1-2 weeks after hospital discharge. From study findings, it was shown that only at the postdischarge testing was there a significant positive correlation between uncertainty and state anxiety. The development of appropriate interventions to assist breast cancer patients in dealing with the fears of recurrence and uncertainties regarding treatment effectiveness and sequelae has relevance for nursing practice.

Adult↗
PubMed1990

Comparative effects of esmolol and verapamil in a model of a supraventricular tachydysrhythmia.

Supraventricular tachydysrhythmias are a commonly encountered clinical problem after cardiothoracic surgery. Current choices for acute drug therapy of these dysrhythmias include intravenous verapamil as well as esmolol, but no data yet exist comparing the relative negative dromotropic (atrioventricular [A-V] nodal blocking) and negative inotropic effects of these agents. The purpose of this study was to compare the effects of esmolol with those of verapamil on systemic hemodynamics, coronary blood flow, and cardiac contractility at doses that produce a similar ventricular response rate in an animal model of a supraventricular tachydysrhythmia. Rapid electrical stimulation (800 impulses/min) of the left atrium in 14 dogs resulted in a rapid and irregularly irregular ventricular rhythm. Esmolol or verapamil were administered by bolus and then infusion to incrementally slow the average ventricular rate. Regional myocardial contractility was measured using the end-systolic pressure-length relationship (Ees). At drug doses that produced similar decreases in ventricular rate, esmolol produced a greater decrease in contractility (Ees: 284 +/- 46 to 40 +/- 22 mmHg/mm, LV dp/dt: 2,400 +/- 450 to 1,360 +/- 450 mmHg/sec) compared with that following verapamil (Ees: 297 +/- 57 to 116 +/- 25 mmHg/mm, LV dp/dt: 2,040 +/- 580 to 1,950 +/- 520 mmHg/sec). This was accompanied by a modest decrease in cardiac output in the esmolol group (2,800 +/- 940 to 2,290 +/- 730 ml/min) compared with an unchanged cardiac output as ventricular rate slowed in verapamil-treated animals. Stroke volume increased significantly in the verapamil-treated animals (10.9 +/- 4.0 to 18.5 +/- 4.6 ml), but remained unchanged following esmolol.(ABSTRACT TRUNCATED AT 250 WORDS)

Adrenergic beta-Antagonists↗
PubMed1990

Preoperative patient preparation.

Patients receive maximum benefit from surgery with the fewest complications if they and the medical personnel involved in their care are well prepared for anesthesia. The importance of a thorough history and physical examination are discussed. Controversial aspects of routine preoperative laboratory testing are reviewed, as are the effects of common chronic medications on anesthesia care. The role of preoperative medications and psychological preparation are reviewed. The importance of nothing-by-mouth status and the risk of acid aspiration are emphasized. A brief discussion of preoperative optimization of cardiopulmonary disease and the definition of American Society of Anesthesiologists Physical Status conclude the article.

Anesthesiology↗
PubMed1989

Comparison of the effects of the acute administration of dexoxadrol, levoxadrol, MK-801 and phencyclidine on body temperature in the rat.

Some of the dioxolanes produce pharmacological effects that have much in common with phencyclidine and phencyclidine-like drugs. Dioxadrol can be resolved into two enantiomers, dexoxadrol and levoxadrol. Dexoxadrol has an affinity for phencyclidine receptors that is much greater than that of levoxadrol, but dexoxadrol and levoxadrol have nearly equal affinities for sigma receptors. The systematic analysis of the relative potencies of dexoxadrol and levoxadrol can be used as an approach to define effects mediated by phencyclidine vs sigma receptors. Compounds that act on phencyclidine receptors, as well as affecting behavior, alter body temperature in the rat. The purpose of the present study was to compare and contrast the effects of the acute administration of dexoxadrol, levoxadrol, MK-801 and phencyclidine on body temperature in the rat. Dexoxadrol and levoxadrol (5.0, 10.0, 20.0 or 40.0 mg/kg), MK-801 (0.12, 0.6 or 1.2 mg/kg) or phencyclidine (5.0, 10.0 or 20.0 mg/kg) were administered subcutaneously and body temperature was measured. Both dexoxadrol and MK-801 produced hyperthermia but levoxadrol did not affect body temperature. In contrast to the hyperthermic effects of dexoxadrol and MK-801, phencyclidine produced hypothermia. These findings indicate that hypothermia induced by phencyclidine is not due to interactions with phencyclidine receptors and, while dexoxadrol, MK-801 and phencyclidine may share some similar receptor binding and behavioral characteristics, they can be differentiated on the basis of their effects on body temperature.

Animals↗
PubMed1986

Factors related to early termination of breast-feeding in an urban population.

A prospective study of breast-feeding mothers was undertaken to determine the effect of formula samples and other hospital-related factors on success in breast-feeding. Of the 166 nursing mothers studied for 4 months postpartum, 83% breast-fed for 1 month, 73% for 10 weeks, and 58% for 4 months or longer. Breast-feeding duration was not affected by formula samples given at discharge from the hospital. Factors correlating significantly with improved breast-feeding rates include maternal age, maternal education, nonsmoking, previous breast-feeding, planned pregnancy, initiation of breast-feeding in the first 16 hours, and minimization of formula supplementation in the nursery. Partial breast-feeding (supplementing more than one bottle of formula per day, measured at 1 month postpartum) was associated with shorter breast-feeding duration. This latter effect was minimized by frequent nursing (seven or more times per day), despite formula supplementation.

Adolescent↗