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Biomedical subjects

E Major

Publications and source records attributed to E Major.

At least 37 records · Page 2Linked to original sources
PubMed1993

Intensive Care Society's APACHE II study in Britain and Ireland--I: Variations in case mix of adult admissions to general intensive care units and impact on outcome.

OBJECTIVES: To describe the extent of variation in the case mix of adult admissions to general intensive care units in Britain and Ireland and investigate the impact of such variation on outcome. DESIGN: Prospective, cohort study of consecutive admissions to intensive care units. SETTING: 26 general intensive care units in Britain and Ireland. SUBJECTS: 9099 admissions to the intensive care units studied. MAIN OUTCOME MEASURE: Death or survival at discharge before and after adjustment of case mix (age, history of chronic conditions, surgical status, diagnosis, and severity of illness) according to the APACHE II method. RESULTS: Important differences in case mix were found, with large variations between the units. Hospital mortality was significantly associated with most of the case mix factors investigated. CONCLUSIONS: Comparing crude death rates in hospital between intensive care units may be misleading indicators of performance. The collection of data on case mix needs to be standardised and differences in case mix adjusted for when comparing outcome between different intensive care units.

Age Factors↗
PubMed1993

Intensive Care Society's APACHE II study in Britain and Ireland--II: Outcome comparisons of intensive care units after adjustment for case mix by the American APACHE II method.

OBJECTIVES: To compare outcome between intensive care units in Britain and Ireland both before and after adjustment for case mix with the American APACHE II method and to validate the American APACHE II method in Britain and Ireland. DESIGN: Prospective, cohort study of consecutive admissions to intensive care units. SETTING: 26 general intensive care units in Britain and Ireland. SUBJECTS: 8796 admissions to the study intensive care units. MAIN OUTCOME MEASURE: Death or survival at discharge from intensive care unit and hospital. RESULTS: At discharge from both intensive care unit and hospital there was a greater than twofold variation in crude mortality between the 26 units. After adjustment for case mix, variations in mortality were still apparent. For four intensive care units the observed numbers of deaths were significantly different from the number predicted by the American APACHE II equation. The overall goodness of fit, or predictive ability, of the APACHE II equation for the British and Irish data was good, being only slightly inferior to that obtained when the equation was tested on the data from which it had been derived. When patients were grouped by various factors such as age and diagnosis, the equation did not adjust across the subgroups in a uniform manner. CONCLUSIONS: The American APACHE II equation did not fit the British and Irish data. Use of the American equation could be of advantage or disadvantage to individual intensive care units, depending on the mix of patients treated.

Cohort Studies↗
PubMed1987

Regulation of the host range of human papovavirus JCV.

Human papovavirus JCV is associated with the human demyelinating disorder progressive multifocal leukoencephalopathy. In tissue culture, the virus is largely restricted to growth in primary human fetal glial cell. In this study, we demonstrate two levels of regulation of the viral host range. Expression of the early JCV mRNA, which encodes the essential viral protein, large tumor antigen (T antigen), depends on recognition of the early enhancer/promoter elements by tissue-specific factors found in both human and rodent glial cells. In the presence of JCV T antigen, viral DNA replication requires a species-specific factor, presumably a component of DNA polymerase, which is found in a wide range of primate cells. We further demonstrate that simian virus 40 T antigen has sufficient homology to efficiently substitute for the analogous JCV protein in initiating viral DNA replication.

Animals↗
PubMed1986

Intravenous anaesthesia with propofol and alfentanil. The influence of age and weight.

Sixty healthy patients undergoing body surface surgery were anaesthetised with continuous infusions of propofol (200 micrograms/kg/minute) and alfentanil (0.25 microgram/kg/minute). Additional bolus doses of propofol (20 mg) were given if movement occurred. The incidence of patient movement in response to skin incision was significantly less in patients over 45 years of age than in those below 45 years (p less than 0.05). Maintenance dosage of propofol sufficient to abolish movement decreased with increasing age (p less than 0.001). Systolic blood pressure decreased in most patients over the first 10 minutes of anaesthesia and the magnitude of this decrease increased with age (p less than 0.0001). These parameters did not correlate strongly with body weight. Dose requirements of propofol are not the same for patients of all ages and strongly suggest that young and old patients should not be treated as a homogeneous group, either for investigative or clinical purposes.

Adult↗
PubMed1986

Anaesthesia with ICI 35,868 monitored by the cerebral function analysing monitor (CFAM).

Ten patients who received bolus doses of the cremophor formulation of ICI 35,868 were monitored using the Cerebral Function Analysing Monitor (CFAM). Visual inspection of the traces obtained showed an easily recognizable pattern which was associated with an increasing depth of anaesthesia. Statistical analysis showed a high correlation between venous blood levels of the drug and changes recorded by the CFAM, although there was marked inter-patient variation. It is suggested that this variation is due to the effect of a time-lag between changes in drug concentration in the brain and venous blood.

Adult↗
PubMed1984

Changes in cerebral electrical activity measured by the Cerebral Function Analysing Monitor following bolus injections of thiopentone.

Seven premedicated patients were anaesthetized with thiopentone administered incrementally every 180 s while cerebral electrical activity was recorded with the Cerebral Function Analysing Monitor (CFAM). Arterial blood samples were collected at 40, 90 and 165 s after each bolus of thiopentone for the measurement of plasma total and bound thiopentone concentrations. The correlation between free thiopentone concentration and the CFAM representation of mean electroencephalogram (EEG) amplitude was -0.78 (P less than 0.001), excluding values following the first two boluses. Beta band percentage activity was inversely related (r = 0.70-0.90; P less than 0.05- less than 0.001) and delta directly related (r = 0.76-0.86; P less than 0.05- less than 0.001) to log of free thiopentone concentration, including all values. The closest correlations (beta, r = 0.88, P less than 0.001; delta r = 0.80, P less than 0.001) were found at 90 s after each bolus.

Adolescent↗
PubMed1984

Dose requirements of ICI 35,868 (propofol, 'Diprivan') in a new formulation for induction of anaesthesia.

In order to avoid Cremophor-related reactions and reduce the incidence of pain on injection, diisopropylphenol (ICI 35,868; propofol) has been reformulated as an emulsion. One hundred and fifteen patients received an induction dose of propofol in the new formulation. The dose required to induce anaesthesia in 95% of healthy, unpremedicated patients was 2.5 mg/kg. Induction was associated with a degree of cardiovascular and respiratory depression. There were no adverse reactions although there were a number of minor side-effects. The incidence of pain on injection was low (3%) and the overall quality of induction was assessed as good or adequate in 92% of patients.

Adolescent↗
PubMed1984

A comparison of midazolam and diazepam for intravenous sedation in dentistry.

In a randomised cross-over trial, midazolam, a new water soluble benzodiazepine was compared with the conventional diazepam preparation (Valium) in 34 patients aged 16-45 years who were undergoing outpatient conservation dentistry. Midazolam hydrochloride (0.17 mg/kg) was virtually free of venous complications and showed advantages over diazepam (0.32 mg/kg) in providing a faster onset of action, higher incidence of amnesia and more rapid recovery. Midazolam produced a higher incidence of respiratory side effects hiccough (17.6% compared with 2.9%), brief apnoea following induction (11.8% compared with 5.8%), and airway obstruction during maintenance (8.8% compared with 0%). These may be related to the greater potency of midazolam as suggested by the smaller total dose required. Cardiovascular changes and operating conditions were similar.

Adolescent↗
PubMed1984

The cardiorespiratory effects of ICI 35 868 in patients with valvular heart disease.

The haemodynamic effects at induction of anaesthesia with ICI 35 868 (1.5 mg/kg) are reported in ten patients with severe aortic or mitral valve disease. The average decrease of mean arterial pressure was 19.1% (p less than 0.01), heart rate decreased by 10% (p less than 0.01). Cardiac index and stroke volume index were both little changed but there were significant reductions in rate pressure product and left ventricular stroke work index (p less than 0.01).

Adult↗
PubMed1983

The cerebral function analysing monitor (CFAM). A new microprocessor-based device for the on-line analysis of the EEG and evoked potentials.

A description is given of a new microprocessor-based device for EEG analysis. The Cerebral Function Analysing Monitor (CFAM) analyses the EEG amplitude and frequency distribution. It produces a detailed plot of amplitude trends and separate traces of the percentage activity in each of the classical EEG frequency bands. Its clinical application was studied in five patients anaesthetized with thiopentone, and nitrous oxide and halothane in oxygen. During maintenance of anaesthesia, there was a gradual decrease in EEG amplitude and shift towards lower frequency EEG activity. Discontinuation of nitrous oxide resulted in a marked increase in EEG amplitude and an increase in alpha and beta band activity. Discontinuation of halothane resulted in smaller alterations in the CFAM trace. This device provides easily interpreted processed EEG data and merits further investigation.

Adult↗
PubMed1983

Influence of sample site on blood concentrations of ICI 35868.

Simultaneous blood samples from an artery, a peripheral vein and a central vein were analysed for ICI 35868 concentrations following an induction dose of 2.0 mg kg-1 administered i.v. over 60 s, to five patients before cardiac surgery. Up to 60 s after the end of the administration of the drug there were wide differences in drug concentration between the sampling sites. Thus, any attempt to correlate effect with blood concentration over this early period would be problematic. From 60 s there were no significant differences in drug concentration between the three sites. Thus, as long as the mixing period is allowed for, peripheral venous sampling provides an acceptable alternative to arterial puncture in studies to correlate drug effect and concentration and for pharmacokinetic investigations.

Adult↗
PubMed1983

Meptazinol in the treatment of severe post-operative pain: a comparison with morphine.

The efficacy of meptazinol (100 mg) was compared to morphine (15 mg) in the relief of post-operative orthopaedic pain. In a randomised double blind study, 35 patients received meptazinol and 28 morphine. The onset of maximum analgesia was quicker with meptazinol. The mean intervals between first and second intramuscular doses were 2.4 hours and 2.7 hours for meptazinol and morphine respectively. Four patients were withdrawn from the study after receiving meptazinol because analgesia was inadequate and morphine scored better than meptazinol in an assessment of overall quality of treatment. The effects on the cardiovascular system were similar for both drugs but meptazinol caused significantly less elevation of arterial PCO2 than morphine.

Adolescent↗