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Biomedical subjects

E Thomas

Publications and source records attributed to E Thomas.

At least 217 records · Page 12Linked to original sources
PubMed1994

Lignocaine 0.5% for spinal anaesthesia in gynaecological day surgery.

Spinal anaesthesia with 5 ml of lignocaine 0.5% was administered to 30 women presenting for day case minor gynaecological surgery. They were allocated at random to receive the anaesthetic via either a 26-gauge Atraucan (pencil point) or a 29-gauge Spinocan (cutting bevel) spinal needle. Onset, duration, spread and regression of sensory and motor blockade, haemodynamic parameters and postoperative complications were studied. An upper sensory level of T10 (93.3%) was obtained in all except two patients. No patient complained of discomfort during surgery. The mean onset time was less than 8 min and the mean duration of sensory block was 32.5 min. All patients had complete return of motor power within 1 h and were discharged the same day. Only one patient had a transient episode of hypotension which was easily treated with intravenous fluids. There were no serious side effects seen postoperatively. We conclude that spinal anaesthesia with 5 ml of lignocaine 0.5% provides a useful alternative to general anaesthesia for day case minor gynaecological surgery.

Adult↗
PubMed1994

Persistent elevation of serum oestradiol levels by functional ovarian cysts despite effective pituitary desensitization with GnRH agonists.

OBJECTIVE: This study assessed whether functional ovarian cysts may prevent suppression of serum oestradiol levels even after pituitary desensitization had been achieved with buserelin. PATIENTS: Of 288 in-vitro fertilization (IVF) cycles studied 10 patients were found to have cysts with serum oestradiol levels > 200 pmol/l despite 3 weeks of buserelin. DESIGN AND MEASUREMENTS: The 10 patients with cysts were given 0.1 mg GnRH and serum gonadotrophins were measured at time 0, 30 and 60 minutes subsequently. Immediately following the GnRH stimulation test the cysts were aspirated transvaginally under ultrasound guidance. Serum oestradiol levels were again measured 3 days after cyst aspiration. RESULTS: Basal LH and FSH levels were < 3 U/l and there was no significant rise in response to GnRH. On the day of cyst aspiration serum oestradiol levels varied between 244 and 1127 pmol/l, and in all cases serum oestradiol levels fell to < 200 pmol/l within 3 days of cyst aspiration. CONCLUSION: In the presence of a functional ovarian cyst, failure to suppress the serum oestradiol level does not necessarily imply a failure of pituitary desensitization with a GnRH agonist.

Adult↗
PubMed1994

The effect of growth hormone replacement therapy in hypopituitary adults on calcium and bone metabolism.

OBJECTIVE: The importance of growth hormone (GH) for normal skeletal growth in childhood and adolescence is well established but much less is known about its action on the adult skeleton. We therefore wished to investigate the effects of replacement treatment with biosynthetic human GH in hypopituitary adults on aspects of calcium homeostasis, bone metabolism and bone mineral mass. PATIENTS: Forty hypopituitary adults (21 females and 19 males; aged 19-67 years). DESIGN: A prospective randomized double-blind placebo-controlled trial lasting for 6 months. PROTOCOL: Following baseline assessments, GH was given in a daily dose of 0.02-0.05 IU/kg body weight subcutaneously (or a placebo (P)) at bedtime. Patients were reviewed at 1, 3 and 6 months. MEASUREMENTS: Plasma calcium, phosphate and total plasma alkaline phosphatase were measured at 0, 1, 3 and 6 months. Serum insulin like growth factor I (IGF-I), osteocalcin, procollagen 1 carboxyterminal peptide (P1CP) and intact parathyroid hormone (PTH) level, 24-hour urinary calcium and creatinine excretion were all measured at 0 and 6 months. Bone mineral density of total body and lumbar spine was also measured by dual energy X-ray absorptiometry at 0 and 6 months in 12 patients on GH and 14 on placebo. RESULTS: Thirty-eight patients completed the study (18 on GH, 20 on placebo). Serum IGF-I increased significantly on GH treatment (mean +/- SD) (GH: 276 +/- 197 vs P: 88 +/- 50 micrograms/l, P < 0.0001 at 6 months). Plasma calcium increased slightly but significantly in the GH-treated group (2.23 +/- 0.11-2.29 +/- 0.11 mmol/l, P < 0.05). At the end of the study, plasma calcium was however similar on GH and placebo (GH, 2.29 +/- 0.11; P, 2.26 +/- 0.09 mmol/l). Plasma phosphate increased on GH (GH: 1.02 +/- 0.23-1.32 +/- 0.19; P: 0.99 +/- 0.16-0.96 +/- 0.12 mmol/l over the 6 months of treatment, P < 0.001). There was no significant change in the urinary calcium excretion on GH therapy. Plasma total alkaline phosphatase, osteocalcin and P1CP were significantly higher on GH than P at 6 months (alkaline phosphatase: GH: 104 +/- 32 vs P: 69 +/- 32 U/l, P < 0.01, osteocalcin: GH: 17.2 +/- 8.0 vs P: 5.3 +/- 3.2 micrograms/l, P < 0.001 and P1CP: GH: 207 +/- 152 vs P: 93 +/- 31 micrograms/l, P < 0.01). There was no difference in the intact parathyroid hormone level (GH: 31 +/- 14 vs P: 31 +/- 15 ng/l, NS). No significant change was observed in bone mass after 6 months of GH treatment, either in total body bone mineral content or in the lumbar spine. CONCLUSION: In this large study, GH replacement in hypopituitary adults for 6 months increased bone turnover but did not affect bone mineral content. Longer-term studies are required to assess further any effect on bone mass.

Adult↗
PubMed1994

A field evaluation of the efficacy of tolfenamic acid and oxytetracycline in the treatment of bovine respiratory disease.

In a blinded multicentre trial 313 cattle showing clinical signs of respiratory disease were allocated randomly into three groups, treated intramuscularly with a long-acting oxytetracycline formulation at a dose rate of 20 mg/kg bodyweight in combination with vehicle alone (placebo) or with tolfenamic acid at 2 mg/kg bodyweight once or on two occasions with a 48-h interdosing interval. The clinical status of the animals was monitored for 5 days using a specific scoring system and weight gain was calculated between day 0 and day 21. Relapses were monitored from day 5 until day 21. When oxytetracycline was combined with two injections of tolfenamic acid, there was a significant (P < 0.04) improvement in the clinical resolution. This regimen also produced non-significant improvements in cure rate, reduced frequency of relapses and improved weight gain.

Animals↗
PubMed1994

Treatment with the gonadotrophin releasing hormone-agonist goserelin before hysterectomy for uterine fibroids.

OBJECTIVE: To investigate the effect of the gonadotrophin releasing hormone (GnRH)-agonist goserelin, given by monthly subcutaneous injection for three months prior to total abdominal hysterectomy for uterine leiomyomata, on the pre-operative symptoms, difficulty of operation and operative blood loss. DESIGN: Randomised placebo-controlled study. SETTING: Patients were recruited from the gynaecological outpatient departments from hospitals in Edinburgh, Glasgow and Newcastle. SUBJECTS: Seventy-one premenopausal women with uterine leiomyomata who were on the waiting list for hysterectomy. INTERVENTIONS: After the presence of leiomyomata was confirmed using ultrasonography, the women were randomised to receive either the GnRH-agonist goserelin by monthly subcutaneous injection or a sham injection for three months prior to operation. At the monthly visits, patients were asked about treatment related symptoms, fibroid related symptoms, and their bleeding patterns. Blood was taken for haematological assessment. MAIN OUTCOME MEASURES: Haemoglobin concentrations at recruitment, at operation and post-operatively, pre-operative symptoms, operative difficulty and blood loss and post-operative complications. RESULTS: Treatment with goserelin induced amenorrhoea in over 80% of the women, and this was associated with a significant rise in haemoglobin level. At the time of operation, fibroid related symptoms were less in the goserelin group than in the placebo group. The hysterectomy was technically easier and the median (range) operative blood loss was significantly lower in the goserelin group compared with the placebo group (187 (60-600) ml vs 308 (118-1000) ml respectively; P < 0.05, Wilcoxon signed rank test). There was no difference between the two groups in the duration of hospital stay or the frequency of post-operative complications. The fibroids were smaller at the time of operation in the goserelin group, and more women treated with goserelin were able to have their operations through a transverse incision. CONCLUSIONS: This study demonstrates the benefits of goserelin in women having total abdominal hysterectomy for uterine leiomyomata.

Adult↗
PubMed1994

Respiratory syncytial virus subgroup B dominance during one winter season between 1987 and 1992 in Vancouver, Canada.

A subgroup analysis of 613 specimens submitted to the British Columbia's Children's Hospital from 1987 to 1992 revealed that subgroups A and B of respiratory syncytial virus (RSV) were both circulating in our community, with some predominance for subgroup A during the period from October 1987 to September 1988 (the 1987-88 season) (64%), 1990-91 (60%), and 1991-92 (62%). During 1989-90 subgroup A represented the majority of isolates (80%). Subgroup B predominated during only one season, 1988-89 (94%). No microheterogeneity within subgroups was apparent as judged by the monoclonal antibody reactivity pattern. More male than female children were affected overall, but no sex-related difference between subgroup infections could be detected (P = 0.28). The majority of patients were less than 1 year of age, and no significant association between age and subgroup was detected after stratifying for year (P = 0.64). This is, to our knowledge, the first comprehensive longitudinal RSV subgroup prevalence study from the Pacific Northwest and from Canada.

Adolescent↗
PubMed1994

[Inferior glenohumeral subluxation: an indirect sign of sepsis of the shoulder].

Drooping shoulder is a roentgenographic abnormality consisting in a discontinuity in the scapulo-humeral arch due to inferior subdislocation of the humeral head. Drooping shoulder is commonly seen in patients with injuries to the shoulder or neurological loss. Two cases of drooping shoulder due to staphylococcal arthritis (after local corticosteroid injections) are reported herein. The mechanism of the downward humeral displacement in septic arthritis is discussed. The other causes of drooping shoulder are reviewed. Precautions needed to avoid increasing the displacement during rehabilitation therapy are outlined.

Adult↗
PubMed1994

Protocol for weaning the SCI patient.

Ventilator weaning may be defined as the discontinuation of mechanical ventilation in patients with acute respiratory failure, based upon predetermined objective criteria and accompanied by appropriate physiological and psychological monitoring (Luce, Tyler & Pierson, 1984). This paper presents a protocol for weaning the person with an acute spinal cord injury (SCI) from the ventilator. Patients are divided into uncomplicated and complicated categories. Specific guidelines identify the physiological parameters used as our criteria for weaning the person with SCI. Specific recommendations for weaning are based on 15 years of experience at a regional SCI Center which admits over 100 persons with SCI per year. Over the past 20 months alone, we have had a 94% success rate in utilizing this protocol for the ventilation weaning of uncomplicated and complicated individuals with SCI. We believe it provides consistent guidelines for the practitioner in successfully weaning the person with SCI from the ventilator.

Acute Disease↗
PubMed1994

[Uro-oxalic renal lithiasis. Special aspects].

In a paper published in 1974, it was reported that uro-oxalic stones are found more often in subjects with group O than with group A blood types although the proportions of these two blood types are approximately equivalent in the French population. The present work confirms these data, the ratio of group O to group A renal lithiasis being approximately 3 to 1. In a paper published in 1987, uro-oxalic stones were found to occur preferentially on the left side: 84 on the left and 39 on the right. The present work confirms this notion since in 57 cases, stones were bilateral in 2 cases, on the left in 39 and on the right in 16. Extra corporeal shock wave lithotripsy was performed in 40 of the 57 cases and showed that uro-oxalic stones are more resistant to shock-waves than the other types of stones. They are about as hard as calcium oxalate monohydrate stones or harder in certain cases: A mean of 3,865 shock-waves were required in the 40 cases of the uro-oxalic lithiasis treated with the HM3 Dornier device, while the mean number of shock-waves required for all types of stones in general varies from 2,000 to 2,500. In 4 cases, 5,000 or 6,000 high power shock-waves (7,000 in one session and 9,500 in two sessions) had to be used to obtain a satisfactory result. The calcium oxalate part of these stones is almost always composed of calcium oxalate monohydrate.(ABSTRACT TRUNCATED AT 250 WORDS)

Blood Group Antigens↗
PubMed1994

Migraine treatment by oral magnesium intake and correction of the irritation of buccofacial and cervical muscles as a side effect of mandibular imbalance.

A previous paper showed a significant decrease in average erythrocyte magnesium level in 79 migraine patients as compared to 55 controls. This paper completes the results of the initial evaluation, with 152 migraine cases and 85 controls. Serum and erythrocyte magnesium determinations show the following results. Mean serum magnesium was 0.82 mmol/litre in migraine patients and 0.85 mmol/litre in controls, P < 0.005. Mean erythrocyte magnesium was 2.04 mmol/litre in migraine patients and 2.32 mmol/litre in controls, P < 0.0005. These results confirm those of the first paper, but show a more significant difference between the means of the two groups for serum magnesium, which was not significant for the lower number of people involved in the previous study. In all migraine cases without exception clinical evaluation showed an abnormal sensitivity of the buccofacial and cervical muscles which was unilateral and homolateral when migraine was unilateral; it was bilateral when migraine was bilateral. The muscles which were the most sensitive to palpation were the sternocleidomastoid, external pterygoid and scalene. These findings show that migraine patients have a magnesium deficit, which, while not constant, is a frequent occurrence. This raises the problem of the relationship between migraine and other disorders characterized by magnesium deficit, such as latent tetany, mitral valve prolapse, and certain allergies. This magnesium deficit probably promotes muscle irritability, especially when a local imbalance factor results in a permanent pathological stimulation. In addition to irritation and hypersensitivity, migraine attacks occur, particularly after stress, digestive, endocrine and neurological problems.(ABSTRACT TRUNCATED AT 250 WORDS)

Administration, Oral↗
PubMed1994

Continuous spinal analgesia--initial experiences with differential sensory block and labour pain relief.

This report describes the use of microcatheters to provide continuous spinal analgesia for the relief of labour pain. Bupivacaine 0.025% was administered through a 28G spinal microcatheter resulting in a differential block which provided effective labour pain relief. Conduction by the smaller pain fibres from the uterus were blocked, while relatively sparing the larger A fibres. Motor power, sense of touch, and discrimination between blunt and sharp objects were therefore left relatively intact. Patients were thus spared the discomfort of motor paralysis and an intense sensory block. No patient had hypotension (blood pressure fall greater than 20%). However one patient suffered a severe post-dural puncture headache which required an epidural blood patch. Continuous intra-thecal spinal analgesia is a potential alternative to continuous epidural analgesia in the relief of labour pain.

Adult↗
PubMed1994

Isokinetic evaluation of rotational strength in normal shoulders and shoulders with impingement syndrome.

The purpose of this study was to determine whether imbalance of the internal and external rotator musculature of the shoulder were etiological factors implicated in impingement syndrome. Shoulder torque measurements were obtained from 15 asymptomatic volunteers and 30 patients with chronic impingement syndrome, 15 of whom were evaluated after arthroscopic anterior acromioplasty. Isokinetic strength was assessed using the Biodex system in a modified position (in the plane of the scapula and in 45 degrees abduction) with test speeds of 60 degrees and 180 degrees per second. Internal and external rotator strength values and ratios were calculated for both peak torque and average power. Shoulder rotational strength values and the internal rotator/external rotator ratio were significantly higher in the dominant and nondominant control group shoulders than in the involved and uninvolved impingement shoulders for operated on and nonoperated on patients. These data demonstrate that primary change in the normal internal rotator/external rotator ratio of the shoulder is an etiological factor implicated in impingement syndrome not modified by anterior acromioplasty.

Acromion↗
PubMed1994

Gastrointestinal and biliary indwelling devices.

Esophageal and biliary stents are indwelling devices used in the treatment of selected gastrointestinal and biliary disorders. Stenting is accepted as a standard procedure for palliation of malignant obstruction of the esophagus and biliary system. Review of the early and late complications associated with these devices is made with emphasis on the clinical and radiographic features. A suggested approach to diagnosis and treatment recommendations are made for each complication that the emergency department physician may encounter.

Biliary Tract↗