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Biomedical subjects

D N Anderson

Publications and source records attributed to D N Anderson.

At least 19 recordsLinked to original sources
PubMed2000

Onycholysis as a complication of systemic chemotherapy: report of five cases associated with prolonged weekly paclitaxel therapy and review of the literature.

BACKGROUND: Onycholysis has been reported in association with the use of several noncytotoxic drugs and with chemotherapy in 135 patients. Onycholysis may be precipitated by exposure to ultraviolet radiation. METHODS: The authors studied 91 patients who received paclitaxel and 187 patients who received doxorubicin. RESULTS: Onycholysis occurred in 5 of 21 patients who received > 6 courses of weekly paclitaxel, developing in the summer months in all 5 patients. It did not occur in patients who received fewer weekly paclitaxel courses or those who were treated every 3 weeks. Onycholysis did not occur in 187 patients who received doxorubicin. Review of the literature revealed that onycholysis is nearly exclusively associated with anthracycline and taxane therapy. CONCLUSIONS: Prolonged weekly paclitaxel, other taxanes, and anthracyclines cause onycholysis in some patients, which may be precipitated by exposure to sunlight. Patients receiving these drugs should protect their nails from sunlight.

Adult↗
PubMed1999

Colonic perforation following prolonged hypovolaemia in a major burns injury.

Perforation of the lower gastrointestinal tract is rare in burns patients. A 41-year-old male, who sustained 40% total body surface area burns and subsequently developed an acute abdomen on day 15 postburn, is presented. Emergency management included a subtotal colectomy and ileostomy formation performed to repair a perforated transverse colon found at laparotomy. The burns were debrided and grafted and the patient required cardiac, renal and respiratory support initially in the ITU setting before making a complete recovery. It is suggested that ischaemia caused the perforated transverse colon due to a prolonged low flow state. This was not detected until invasive cardiovascular catheterisation was performed and revealed a hypovolaemic state, which was corrected by fluids and noradrenaline. Both the previous cardiac history of the patient (Fallot's Tetralogy repair) and the noradrenaline may have exacerbated the low flow state within the mesenteric circulation leading to ultimate perforation. This case highlights the difficulties that may arise in resuscitating a patient who has previously had a cardiac defect repaired. Despite repair, abnormal physiology may persist resulting in misleading observations that produce undetected hypovolaemia with subsequent adverse events, as in this case. In such patients, early invasive cardiovascular monitoring should be considered.

Adult↗
PubMed1999

The role of pterins and related factors in the biology of early postpartum depression.

Plasma tryptophan and other putative amino acids, cortisol, folate and vitamin B12 and urinary biopterin (B) and neopterins (N) were measured in three groups of women: 62 women in the early postpartum period, 23 pregnant and 38 non-gravid controls. Sixty-two postpartum women were screened for depression by the Edinburgh postnatal depression scale (EPDS) on day 7 after delivery. Postpartum women had significantly lower tryptophan, vitamin B12 and significantly greater levels of cortisol, folate, neopterins and biopterins than controls. Comparisons between women who were classified on the EPDS as cases and non-cases revealed only a statistically significant difference for lower N:B (P<0.01) and lower folate (P<0.01) ratio in cases than non-cases. Multiple regression analysis showed a significant contribution for low tryptophan to increased EPDS which also showed significant correlations with low methionine, low tyrosine, low N:B ratio and high vitamin B12.

Adult↗
PubMed1997

Maintenance electroconvulsive therapy and cognitive function.

BACKGROUND: ECT is rarely used as a prophylactic treatment. A 74-year-old woman with unstable bipolar affective disorder receiving maintenance ECT presented a unique opportunity to measure the cognitive effects of continuing ECT. METHOD: A single case report with serial psychometric testing during over 400 ECT treatments as a single maintenance treatment. RESULTS: Serial testing did not demonstrate progressive cognitive deterioration, but consistent cognitive deficits typical of acute treatment were evident. The degree of cognitive difficulty may be related to the frequency of treatment. CONCLUSIONS: Maintenance ECT can be an effective prophylactic treatment for selected patients. Cognitive effects would appear to be no greater than with acute treatment and seem to be non-progressive.

Aged↗
PubMed1997

Diverticular disease in patients under 50 years of age.

Sigmoid diverticular disease, when it occurs in a young age group, may follow a more aggressive course with a higher incidence of complications than in elderly. The mode of presentation and management in 77 patients under 50 years of age presenting with sigmoid diverticular disease over a 6-year period is described. Surgery for complications (peritonitis, abscess, bowel obstruction, fistula and haemorrhage) was performed in 18 (23%) individuals. Colonic resection was carried out in 14 (78%) of the operated group with primary anastomosis in six patients and Hartmann's procedure in eight patients. The mortality (30 day) was zero. Nineteen (25%) of the entire group, and 12 (67%) of those undergoing surgery had been previously hospitalized with a complication of diverticular disease. The recurrent nature and frequency of serious complications in this group, suggests that elective surgery should be considered if an acute infective episode is successfully managed conservatively.

Adult↗
PubMed1997

Vesico-colic fistulae in the Grampian region: presentation, assessment, management and outcome.

Over a 12-year period, 67 patients presented with a vesico-colic fistula. The mean age was 69 years (range 19-96 years), with symptoms predominantly referred to the urinary tract. Cystoscopy and barium enema confirmed the presence of a fistula in 60 and 44% of patients respectively. A computerized tomography (CT) scan, used in only seven patients, revealed the fistula in each case. The underlying pathology included diverticular disease (62%), carcinoma (27%) and inflammatory bowel disease (6%). Fifty-one patients proceeded to surgery, of whom 32 (63%) had a sigmoid/recto sigmoid resection with primary anastomosis, and 13 (25%) a Hartmann's procedure. A diverting colostomy alone was employed to palliate cases of widespread carcinoma. No patient subsequently had the Hartmann's reversed. In addition to colonic resection, 48 (92%) patients had a simultaneous bladder procedure, varying from simple oversew in 32 (70%) patients to cystectomy and ileal conduit in three (6%). Wedge excision with primary bladder closure was practised in 12 (24%). Fistula recurrence occurred in seven (14%) patients, and the 30-day mortality was 10%. Surgery for vesico-colic fistula has an appreciable morbidity and mortality, yet if offers the only hope of achieving permanent symptomatic control.

Adult↗
PubMed1996

Accuracy of laparoscopic ultrasonography in the staging of upper gastrointestinal malignancy.

Laparoscopic ultrasonographic staging was compared prospectively with conventional computed tomography (CT) and ultrasonographic staging of 24 lower-third oesophageal tumors and 20 gastric malignancies. Following laparoscopic ultrasonography, seven patients regarded as being resectable after conventional imaging were excluded from surgical exploration because of ascites with peritoneal deposits (four patients), liver metastases (one), advanced local disease (one) and poor tolerance of general anaesthesia (one). Preoperative T and N stages were compared with the pathological staging following resection in 34 patients. Laparoscopic ultrasonography was significantly more accurate than conventional CT and ultrasonography in assessment of the primary tumour (91 versus 64 per cent, P < 0.01) and nodal status (91 versus 62 per cent, P < 0.05). The addition of laparoscopic ultrasonography to conventional procedures for staging upper gastrointestinal malignancy improved the overall accuracy of staging. Although this may have future implications for the selection of patients for multimodality treatment, management decisions are currently based on laparoscopic findings, which in this study resulted in a resection rate of 97 per cent.

Gastrointestinal Neoplasms↗
PubMed1996

Gastric lymphoma in Grampian Region: presentation, treatment and outcome.

Forty cases of gastric lymphoma presenting in Grampian Region (1974-91) were reviewed to examine the effects of changing ideas in the fields of chemotherapy, gastric surgery and diagnostic techniques, as well as the impact of Helicobacter pylori. Presentation was non-specific, and the diagnosis was made pre-operatively in only 12 cases. Survival was related to tumour size, staging (Ann Arbor), and grade, with a crude 5-year survival of 49%. Helicobacter pylori was found in all specimens reviewed. Patients who underwent "potentially curative' surgery followed by adjuvant therapy had the best survival (85% at 5 years). There remains a need for larger studies to define the best treatment for this uncommon condition.

Adult↗
PubMed1996

Massive intestinal bleeding in association with Crohn's disease.

Five hundred and one patients with Crohn's disease, presenting to a single surgical unit during a 20-year period, were reviewed by utilizing a computerized audit system. Ten patients were identified with rectal bleeding significant enough to require a blood transfusion to maintain cardiovascular homeostasis. The site of bleeding was correctly identified pre-operatively in only one patient, and at the time of surgery in only four patients. In nine (90%) of the 10 cases, the origin of the bleeding was subsequently found to be colonic. All 10 patients were treated surgically, with seven patients requiring fashioning of a stoma, none of whom had gastro-intestinal continuity subsequently re-established. Recurrent bleeding occurred in a single patient. The early post-operative mortality was 20%. Massive rectal bleeding remains an uncommon complication of Crohn's disease, and still carries significant morbidity and mortality. Pre-operative localization of the site of bleeding is uncommon, making intra-operative identification of the bleeding area difficult.

Adult↗
PubMed1995

The role of pterins in depression and the effects of antidepressive therapy.

Urinary excretion of neopterins (N) and biopterins (B) was measured in 48 patients with depression before and after treatment with placebo, antidepressants, or electroconvulsive therapy (ECT), and in 26 healthy control subjects. Patients prior to and after treatment had a significantly greater neopterin/biopterin (N:B) ratio than control subjects. There was a significant correlation between N:B ratios and the severity of depression and plasma cortisol. As a raised N:B ratio implies failure to convert neopterin to biopterin, it is possible that reduced availability of tetrahydrobiopterin, the essential cofactor for the formation of noradrenaline, serotonin and dopamine, may exert rate-limiting control over the synthesis of monoamines implicated in the pathogenesis of depressive illness.

Adult↗
PubMed1995

Delusional depression, hyperparathyroidism, and ECT.

A woman with delusional depression and unsuspected primary hyperparathyroid disorders responded completely to electroconvulsive therapy (ECT). Hypercalcemia is a complicating factor in the treatment of delusional depression, but there is little evidence that it is causative and the use of ECT should not be delayed. The case adds to the literature confirming the efficacy and safety of ECT with physically ill patients when it may be a life-saving procedure.

Aged↗
PubMed1994

Loop ileostomy fixation: a simple technique to minimise the risk of stomal volvulus.

Turnbull's "loop" ileostomies is a routinely performed procedure in the management of a variety of colorectal problems. Mechanical and functional complications occur with both permanent and temporary ileostomies, however they are more common with the loop than with the end (Brooke) variety. With the advent of restorative proctocolectomy with pouch formation, and the documented benefit of simultaneous temporary faecal diversion, the incidence of such complications will rise. Bowel obstruction, requiring laparotomy in the interval before stoma closure, is more commonly associated with the loop ileostomy. A loop stoma is routinely brought out directly through the abdominal wall, with little or no fixation or closure of the lateral space. However, anti-mesenteric fixation, as described here, minimises the risk of volvulus by widening the attachment of the adjacent ileum to the parities, creating a broader fulcrum. Since adopting this simple technique, we report no complications in over 30 loop ileostomies, "fixed" by this technique and followed up for a minimum of 4 years. Where applicable, no difficulty was encountered with stoma closure, either by a transverse single layer serosubmucosal technique, or as a minimal resection with end to end anastomosis (sewn or stapled), following bowel mobilisation. This technique should minimise the frequency of obstructive events, and we recommend it's routine use.

Adolescent↗
PubMed1994

5-Methyltetrahydrofolate level in the serum of depressed subjects and its relationship to the outcome of ECT.

Serum 5-MeTHF levels are reported in 26 subjects, before and after completing a course of ECT, and compared to 21 healthy volunteers. 5-MeTHF levels of depressed subjects were significantly lower than controls before and after ECT. There was no difference in 5-MeTHF levels between ECT responders and non-responders but folate deficiency was related to severity of depression before ECT. Serum 5-MeTHF was not related to treatment response and values remained markedly low even after a good response to treatment.

Aged↗
PubMed1994

Recovery from depression after electroconvulsive therapy is accompanied by evidence of increased tetrahydrobiopterin-dependent hydroxylation.

Serum phenylalanine and tyrosine levels were measured in 26 patients with severe depression before and after receiving electroconvulsive therapy. The phenylalanine:tyrosine [P:T] ratio declined significantly for those responding to treatment but not for nonresponders. These findings are discussed in relation to tetrahydrobiopterin, the essential cofactor for the formation of noradrenaline, dopamine and serotonin and the hydroxylation of phenylalanine to tyrosine.

Aged↗