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Biomedical subjects

D Ash

Publications and source records attributed to D Ash.

At least 37 records · Page 2Linked to original sources
PubMed1994

Report on the clinical effects of inadvertent radiation underdosage in 1045 patients.

Between Autumn 1982 and Winter 1991, 1045 patients received lower doses of radiation than were prescribed for the treatment of their cancers because of a miscalculation of radiation doses. This occurred as a result of the introduction of a new technique of treatment planning. An error in the application of the planning system lead to an underdosage of radiation of between 5 and 35%. In patients who received radiation alone for radical treatment a dose reduction of 20% or more resulted in a lower than expected local control rate. The effects were less marked in patients who were treated by combinations of surgery and radiation and in those with a very high rate of distant metastases. In 1991, a new computer planning system was installed and a discrepancy was discovered between the new plans and those from the previous system. Further investigation revealed that the original planning system already contained within it a correction factor for the tumour to skin distance and that systematically reapplying this correction had resulted in underdoses of radiation being delivered to patients for nearly 10 years. During the 9-year period of this dose miscalculation only 6% of patients treated in the department were treated with the isocentric technique; for many of those it formed only a part of their treatment.

Adolescent↗
PubMed1993

Guaranteeing real-time response with limited resources.

Unanticipated problems detected by patient-monitoring systems may sometimes require real-time response in order to provide high-quality care and avoid catastrophic outcomes. In this paper, we present an approach for guaranteeing a response to such events by a monitoring agent even in situations where we have limited problem-solving resources. We show that an action-based hierarchy can accomplish this goal. We also analyze the performance of this hierarchy under varying resource availability and discuss decision-theoretic approaches to enable us to best structure such a hierarchy. We also describe an implementation of these ideas, called ReAct, in the BB1 architecture. All the ideas are illustrated with examples from the surgical intensive care unit (SICU).

Algorithms↗
PubMed1992

The use of discriminant analysis to guide palliative treatment for lung cancer patients.

The aim of this study was to develop a prognostic index for patients with inoperable non-small cell lung cancer which could predict survival to 3 months. This would enable less radiation dose to be given to patients where prognosis is limited by occult metastases, giving rise to less treatment morbidity and raising the therapeutic ratio. Data on 18 known prognostic factors were collected on 96 patients. Performance status, lymphocyte count, weight loss and extent of disease were the most predictive factors and were combined into an index. Logistic discriminant analysis was employed to give a numerical score of likelihood of survival to 3 months, ranging from 0 (not likely) to 1 (certain). In this first set of 96 patients, 16 deaths were observed before 3 months, of which 6 were predicted. There was one false positive prediction. Overall accuracy of prediction was therefore 89% with 99% specificity. The same 4 prognostic factors were measured on a second set of 80 patients. Nineteen died before 3 months, of which 5 were predicted with 2 false positives, giving an overall accuracy of 80% and 97% specificity. A probability of survival of less than or equal to 0.2, although highly specific, was only applicable to 9% of patients and this was the limiting factor in the clinical usefulness of the test. A 16-branch tree diagram allows any patient to be assigned a risk factor based on the four predictive factors at the first clinic attendance. Use of the index could encourage more rational prescribing of radiation dose.

Activities of Daily Living↗
PubMed1988

Therapeutic ratio of photodynamic therapy in the treatment of superficial tumours of skin and subcutaneous tissues in man.

Six patients with a total of 34 assessible subcutaneous or cutaneous lesions were treated with photodynamic therapy using 1.0, 1.5 or 2.0 mg kg-1 of photofrin II and 25-100 J cm-2 of red light (630 nm). The incidence of complete tumour response and skin necrosis were used to try to assess the therapeutic ratio of photodynamic therapy. The tumour response rate was 47%. The rate of tumour control and necrosis increased in parallel with dose of photosensitizer and light used, implying a low therapeutic ratio. However, the use of necrosis with eschar formation as an end-point for severe normal tissue damage is questioned as the skin healed completely in all cases and with minimal discomfort to the patients.

Dihematoporphyrin Ether↗
PubMed1986

Prosthodontists' preferences in preprosthetic surgery.

A survey of members of the Federation of Prosthodontic Organizations was done to determine their opinions about various preprosthetic surgical procedures used to treat patients with alveolar atrophy of the maxilla and mandible. In most instances there was lack of consensus, indicating a need for consultation and close cooperation between the oral and maxillofacial surgeon and the prosthodontist in the management of individual patients.

Alveolar Ridge Augmentation↗
PubMed1985

Problems associated with iridium-192 wire implants.

Three incidents are reported, from different radiotherapy centres, in which an implanted iridium-192 wire remained in the tissues of a patient after withdrawal of the plastic tubing in which it was contained. In each case the instrument used to cut the wire had probably formed a hook on the end of the wire which caused it to catch in the tissues. Detailed recommendations are made for avoiding such incidents in the future, the most important of which is that the patient should be effectively monitored after the supposed removal of all radioactive sources.

Aged↗
PubMed1982

Whooping cough.

Explore the source record for details and available documents.

Diphtheria Toxoid↗
PubMed1979

Aliphatic ketones are acetylcholinesterase inhibitors but not transition state analogs.

A number of C4--C9 aliphatic ketones are acetylcholinesterase (acetylcholine hydrolase, EC 3.1.1.7) inhibitors, with Ki values in the 0.7--5 mM range. Comparison to analogous substrates would suggest that these ketones are transition state analogs; e.g. 2-pentanone binds to the enzyme approx. 550 times more tightly than ethylacetate. However, a number of other criteria contradict this conclusions: (1) the binding is insensitive to ketone structure: isomeric ketones, cycloalkanones, and sterically hindered ketones have similar inhibitory potencies. (2) Analogous alcohols are also good inhibitors even though they cannot form hemiketals with the enzyme. (3) Representative ketones are relatively ineffective at blocking inactivation of the enzyme by methylsulfonyl fluoride, indicating that ketones do not bind principally at the hydrolytic site. (4) A competition experiment shows that binding of tetramethylammonium chloride excludes binding of 2-pentanone, suggesting that ketones bind to the anionic rather than the hydrolytic site. Thus, observation of tight binding relative to a substrate is not a sufficient criterion to establish that an inhibitor is a transition state analog.

Animals↗
PubMed1978

The Paris system in interstitial radiation therapy.

As a result of almost 20 years' experience using 192Ir wires in interstitial radiation therapy, a new method of dose calculation has been evolved, which is especially suitable for the techniques employed. Because this system was developed and brought into routine use in Paris, it was called the Paris System. Its basic principles are outlined in this report and the manner in which it is used in clinical practise is explained.

Breast Neoplasms↗
PubMed1977

The mode of binding of potential transition-state analogs to acetylcholinesterase.

Phenylacetone, 4-phenyl-2-butanone, and 4-oxopentyltrimethylammonium chloride were tested as potential transition state analogs for eel acetylcholinesterase (acetylcholine hydrolase, EC 3.1.1.7). Phenylacetone is a competitive inhibitor of the enzyme but not a transition state analog, since its binding constant is similar to that for the substrate phenyl acetate. 4-Phenyl-2-butanone binds 6-18 times more tightly than the inhibitors 4-phenyl-2-butanol and N-benzylacetamide and the substrate benzyl acetate and also blocks inactivation of the enzyme with methanesulfonyl fluoride. However, its binding is independent of pH in the range 5-7.5, whereas both V and V/Km for benzyl acetate hydrolysis decrease with decreasing pH in this range. These data indicate a specific but weak interaction between the ketone carbonyl and the enzyme, but probably do not justify considering this compound a transition state analog. 4-oxopentyltrimethylammonium iodide has previously been shown to bind about 125 times more strongly than the substrate acetylcholamine. It also binds about 375 times more strongly than the alcohol 4-hydroxypentyltrimethylammonium iodide. Furthermore, the ketone protects the enzyme from inactivation by methansulfony fluoride, while the corresponding quaternary ammonium alcohol accelerates this inactivation reaction. This additional information confirms that the ketone is a transition state analog.

Acetone↗