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Biomedical subjects

D R Thompson

Publications and source records attributed to D R Thompson.

At least 37 records · Page 2Linked to original sources
PubMed2001

Narcotic analgesic effects on the sphincter of Oddi: a review of the data and therapeutic implications in treating pancreatitis.

OBJECTIVE: Traditional teaching dictates that morphine induces "spasm" in the sphincter of Oddi (SO) and should not be used in acute pancreatitis and that meperidine is the analgesic of choice because it does not elevate SO pressures. A literature search and review was performed to evaluate this teaching examining the effect of narcotic analgesic's effects on SO. METHODS: A Medline search was performed using keywords and phrases. The manufacturers of meperidine were contacted and their reports and studies were obtained and reviewed. RESULTS: Initial studies measured biliary pressure after narcotic administration in animals, and postoperative and intraoperative cholecystectomy patients. All narcotics increased biliary pressure, but morphine was associated with the largest elevation. Later studies using endoscopic retrograde cholangiopancreatography with direct SO manometry demonstrated that the SO is exquisitely sensitive to all narcotics including meperidine and that a small increase in biliary sphincter pressure is seen with higher doses of morphine. All narcotics increase SO phasic wave frequency and interfere with SO peristalsis. CONCLUSIONS: Narcotic-induced increases in phasic wave frequency interfere with SO filling and are responsible for the increase in bile duct pressure seen on the initial studies. No studies directly compare the effects of meperidine or morphine on SO manometry and no comparative studies exist in patients with acute pancreatitis. No outcome-based studies comparing these drugs have been performed in patients with acute pancreatitis. Morphine may be of more benefit than meperidine by offering longer pain relief with less risk of seizures. No studies or evidence exist to indicate morphine is contraindicated for use in acute pancreatitis.

Analgesics, Opioid↗
PubMed2001

Hepatic failure as the presenting manifestation of malignant lymphoma.

Fulminant hepatic failure carries a high mortality regardless of etiology. Liver transplantation may be lifesaving. Hepatic invasion by malignant lymphoma is a rare cause of liver failure, but one that is potentially responsive to treatment. Lymphoma (non-Hodgkin's or Hodgkin's) should be included in the differential diagnosis of fulminant hepatic failure so that liver transplantation is avoided and appropriate therapy can be instituted. The findings and clinical course of 4 patients with liver failure due to hepatic lymphoma, who were referred to our institution for liver transplant evaluation, are presented and discussed. Medical records, imaging studies, and histological material were examined. Review of the literature revealed less than 40 cases of lymphoma presenting as fulminant hepatic failure. The diagnosis of malignant lymphoma may be difficult. The presenting symptoms and signs are indistinguishable from other causes of fulminant hepatic failure. Early liver biopsy with adequate tissue and immunologic studies is mandatory for diagnosis. This condition may be reversible and may respond to chemotherapy if the diagnosis is made prior to multiorgan system failure. The presence of malignant lymphoma is considered a contraindication to liver transplantation, although firm data are lacking.

Adult↗
PubMed2000

Determining chest pain patients' suitability for transfer to a general ward following admission to a cardiac care unit.

The objective of this study was to assess the performance of a consensus-derived decision algorithm in determining chest pain patients' suitability for early transfer to a lower dependency ward by predicting complications. The sample comprised 516 patients with chest pain presumed to be cardiac in origin, admitted to a cardiac care unit (CCU) in northern England from the community or from the accident and emergency department. A decision algorithm was designed following a review of the literature and amended to take into account a clinical consensus of consultant physicians. Patients were assessed on admission by CCU nurses using the algorithm, and 'triage' decisions recorded (keep on CCU or suitable for early transfer to a general ward). Admission ECGs (electrocardiographs) and baseline clinical data were recorded independently by a researcher 'blinded' to actual clinical course, and applied to the algorithm using statistical software. On discharge or death, patients' case notes were retrieved and the hospital course examined for death or severe complications. Performance of the algorithm and CCU nurses were compared for sensitivity, specificity, positive predictive value and negative predictive value. The main outcome measures were death or severe complications occurring during hospitalization, and during the first 2 days following CCU admission. While sensitivity of both the algorithm (0.98) and CCU nurses (0.95) was high, specificity was low in both groups (0.11 and 0.21, respectively), making it unlikely that the algorithm would prove useful in clinical practice. Further studies are required to develop the optimal triage tool for the assessment of patients with acute chest pain.

Aged↗
PubMed2000

Coping after heart transplantation: a descriptive study of heart transplant recipients' methods of coping.

The purpose of the study reported in this paper was to explore the coping strategies of heart transplant recipients. Using a qualitative research approach, interviews were conducted with 42 participants (35 men and seven women). Analysis of the data revealed eight coping strategies: acceptance/optimism, denial/avoidance, setting targets, comparing oneself with others, making attributions, seeking social support, having faith and changing priorities and perceptions. These are discussed in relation to the literature and a tentative model of coping after heart transplantation is offered. The findings may provide pointers to health professionals about ways in which they can improve support for heart transplant recipients and their families.

Adaptation, Psychological↗
PubMed1999

Effect of omeprazole paste on gastric acid secretion in horses.

In a multicentre trial, 13 cannulated horses were treated orally once daily with a paste that delivered omeprazole at a dose of 4 and 5 mg/kg bwt in a 2-period crossover design to evaluate steady state gastric acid suppression. In each period, basal (unstimulated) and pentagastrin-stimulated gastric output were evaluated at 5-8 h after 5 doses, at 13-16 h after 10 doses, and at 21-24 h after 15 doses. Baseline data for gastric acid secretion were collected once for each horse in the month prior to initiation of omeprazole treatment. The inhibition of gastric acid secretion relative to baseline values, following treatment with omeprazole, were calculated and expressed as per cent. Pharmacokinetic data were also collected in this trial. At 4 mg/kg bwt, the oral paste formulation of omeprazole inhibited both basal and pentagastrin-stimulated gastric acid secretion by 99% at 5-8 h after treatment and by 83% (basal) and 90% (pentagastrin-stimulated) at 21-24 h. Inhibition following the administration of omeprazole at a dose of 5 mg/kg bwt was not significantly greater than when given at 4 mg/kg bwt. The results from this study could possibly lead to the development of an effective and practical antisecretory treatment of ulcer disease in horses.

Administration, Oral↗
PubMed1998

Feathers as a means of monitoring mercury in seabirds: Insights from stable isotope analysis.

Mercury concentrations, together with nitrogen and carbon stable isotope signatures, were determined in body feather samples from northern fulmars Fulmarus glacialis and great skuas Catharacta skua, and in different flight feathers from great skuas. There were no significant relationships between trophic status, as defined using isotope analysis, and mercury concentration in the same feather type, in either species. Mercury concentrations in body feather samples were markedly different between fulmars and skuas, reflecting differences in diet, but there was no corresponding difference in trophic status as measured through nitrogen stable isotope signatures. We conclude that mercury concentrations and stable isotope values in feathers are uncoupled, mercury concentrations apparently reflecting the body pool of accumulated mercury at the time of feather growth whilst stable isotope values reflect the diet at the time of feather growth. There were significant positive correlations between the different flight feathers of great skuas for all three parameters measured. These were strongest between primary 10 and secondary 8, suggesting that these two feathers are replaced at the same time in the moult sequence in great skuas. Stable isotope analysis of different feathers may provide a means of investigating moult patterns in birds.

Journal Article↗
PubMed1998

Evidence for the effectiveness of cardiac rehabilitation.

Cardiac rehabilitation is a relatively recent development and, though it is increasingly being recognized as an important part of comprehensive cardiac care, there remains some scepticism regarding its effectiveness and some ignorance of its potential. This article reviews the literature pertaining to the effectiveness of cardiac rehabilitation for patients with coronary heart disease (CHD).

Coronary Disease↗
PubMed1998

A randomized trial comparing Arglaes (a transparent dressing containing silver ions) to Tegaderm (a transparent polyurethane dressing) for dressing peripheral arterial catheters and central vascular catheters.

The purpose of this trial was to prepare for a large randomized trial comparing Arglaes film dressing, a recent innovation containing silver ions, against Tegaderm, a transparent polyurethane dressing. Thirty-one patients admitted to the intensive care unit and requiring the insertion of an arterial line or central venous catheter were recruited into the study. Skin swabs were taken from the insertion sites prior to catheterization and on removal of the intravascular device to measure skin colonization rate between the two dressings. The catheter tips were also cultured on removal to establish if there was a difference between the two groups. No statistical differences were found in bacterial growth between the two dressings.

Adolescent↗
PubMed1998

"Hey, would you like a nice cold cup of lemonade on this hot day?": children's understanding of economic causation.

Three experiments were performed to examine development of understanding of functional relations in economics by children between ages 4 and 10 years. Results of Experiment 1 indicated that preschoolers understood the effects of demand, and 2nd graders also understood the effects of supply, but even 4th graders often failed to demonstrate understanding of the effects of motivation and morality. In Experiment 2, 4th but not 2nd graders proved able to explain how motivation and morality might influence sales when told that these variables had an effect. In Experiment 3, 2nd and 4th graders' evaluations of the plausibility of other children's explanations of effects of motivation and morality showed evidence of understanding, though those of kindergartners did not. The data supported the 3 hypotheses that motivated the experiments: (a) direct links between causes and effects are understood before indirect ones, (b) positive correlations between causes and effects are understood before negative ones, and (c) variables that produce effects are understood before ones that do not.

Child↗
PubMed1998

A versatile microprocessor-based multichannel stimulator for skeletal muscle cardiac assist.

A versatile, microprocessor-based stimulator for skeletal muscle cardiac assist (SMCA) has been designed, constructed, and used in several studies. The stimulator uses multiple bipolar electrodes to deliver arbitrarily specified electrical stimulus sequences to three nerve branches of the latissimus dorsi muscle. The electrodes are electrically isolated to effect regional stimulation of the muscle. The width, amplitude, and interpulse interval of each pulse in the stimulus sequence are independently variable, and the three channels are independently programmable, allowing a wide variety of stimulus patterns. Battery powered units have been used in studies for up to one year. In this paper, the stimulator and sample applications in SMCA are described.

Analog-Digital Conversion↗