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Biomedical subjects

G Dalley

Publications and source records attributed to G Dalley.

11 recordsLinked to original sources
PubMed2001

Gray ramus communicans nerve block: novel treatment approach for painful osteoporotic vertebral compression fracture.

BACKGROUND: Osteoporotic vertebral compression fracture (OVCF) is a common complication of osteoporosis in the aging population. Refractory chronic pain may develop, and few effective treatment options exist. METHODS: We retrospectively analyzed 52 cases in which gray ramus communicans nerve block was used for painful OVCF after failure of conservative analgesic therapy. All were office-based, fluoroscopically guided procedures; a combination of 2% lidocaine and 2% sterile triamcinolone diacetate (Aristocort) was injected on the gray ramus tract of the somatic nerve root corresponding with radiographically documented OVCF. Patient-reported and physician-reported pain scores, analgesic medication use, and overall patient satisfaction were measured. The average follow-up period was 9 months. RESULTS: A 1-point improvement in pain scores was reported by 92% of patients and 88% of physicians; a 4-point improvement was reported by 63% and 58%, respectively. No patients reported increased pain scores; physicians reported increases in two cases. Decreased analgesic requirement was documented in 42%. Patient satisfaction was "high" in 50% and "medium" in 25%. No procedural complications occurred. CONCLUSION: Prompt and sustained improvements in all parameters, especially pain scores, support widespread clinical application of this safe effective and cost-effective therapy.

Aged↗
PubMed2000

Mx proteins in blood leukocytes for monitoring interferon beta-1b therapy in patients with MS.

OBJECTIVE: To correlate Mx protein (Mx) levels in lysed blood leukocytes with the clinical response to interferon (IFN) beta-1b (IFNbeta-1b) in relapsing-remitting MS (RR-MS) patients for monitoring treatment. BACKGROUND: Intracellular Mx expression is exclusively induced by the type I IFNs (IFN-alpha, -beta, and -omega) or by viruses and is strongly increased under IFN treatment. Quantitative determination of Mx allows objective assessment of biological effects of IFN. METHODS: Mx protein levels were measured in blood leukocyte lysates from IFNbeta-1b-treated RR-MS patients by ELISA and correlated to clinical parameters, including relapse rate and clinical deterioration. RESULTS: In stable IFNbeta-1b-treated MS patients, Mx levels were significantly increased compared to patients with or without immunosuppressive treatment. In IFN-1b-treated MS patients during relapse, Mx levels were significantly lower than during stable phases of the disease. Mean values of Mx (MVMx) over time of treatment in patients with a reduction of relapse rate were significantly higher than in patients without response. CONCLUSION: Mx levels in lysed blood cells may represent a useful surrogate marker for IFNbeta-1b activity corresponding to the clinical response during treatment of MS.

Adjuvants, Immunologic↗
PubMed1997

Long-term outcome of hepatitis C virus infection after liver transplantation.

We analyzed the long-term clinical course of 71 patients with RNA-positive hepatitis C virus (HCV) infection after liver transplantation. Patients with reinfection after transplantation for HCV-related liver disease, or de novo infection at transplantation were followed for up to 12 years. Cumulative survival for patients with HCV infection at 2, 5, and 10 years after transplantation was 67%, 62%, and 62%, respectively. It was not significantly different from that in patients transplanted for other nonmalignant diseases without HCV infection. The main factor determining long-term survival was the presence or absence of hepatocellular carcinoma (HCC) at transplantation. The 5-year survival rate for HCV patients with or without HCC was 35% versus 73%, respectively (P < .05). No deaths because of viral hepatitis of the graft were observed. Deaths in the first year after transplantation were caused by infectious complications, cardiovascular problems, or rejection; deaths after more than 12 months were exclusively because of recurrence of HCC. Biochemical and histological evidence of hepatitis was found in the majority of the patients, only 16% had normal alanine aminotransferase (ALT) values throughout. Twenty-two percent of patients complained of symptoms, with hepatitis C being the cause in 82% of these. Two patients lost their HCV-RNA for prolonged, ongoing periods of time. The severity of the posttransplantation hepatitis was unrelated to age, sex, severity of liver disease before transplantation, cold ischemic time of the graft, duration of the operation, transfusions, the number of rejection episodes, or the long-term immunosuppressive regime. Only initial short-term therapy with interleukin 2 (IL2) receptor antibodies adversely influenced inflammatory activity. Viral genotype did not influence the course of the graft hepatitis in our series. Histology showed inflammation in 88% of the biopsies and signs of fibrosis in 24%. Mean ALT values correlated with inflammation but not with fibrosis in the biopsies. Porto-portal bridging was observed in six patients, one patient developed cirrhosis within 2 years after orthotopic liver transplantation (OLT). We conclude that chronic hepatitis develops in the majority of patients with HCV infection after liver transplantation. Carrier states without significant laboratory abnormalities are observed in approximately 16%, biochemical abnormalities without symptoms are seen in 60%, and symptomatic disease develops in a quarter of the patients. The disease course closely resembles that seen in nontransplanted hepatitis C patients. It is generally mild but little over 10% of patients develop signs of fibrosis of the graft during the first decade.

Adolescent↗
PubMed1994

Angle correction in transcranial Doppler sonography.

Since the introduction of transcranial Doppler sonography in the early 1980s, flow velocity estimates have assumed a 0- to 30-degree angle of insonation. Based on limited radiological and anatomical studies, such as assumption appeared justified, and seemed to confer only minimal potential for error due to the cosine function in the Doppler formula. The introduction of transcranial color duplex sonography allows the direct evaluation of this assumption and the effect on flow velocities. Fifteen healthy volunteers were studied bilaterally using a unilateral transtemporal approach from the right. Velocity measurements were taken from the middle, anterior, and posterior cerebral arteries. Flow velocities were obtained with and without angle correction (0 degree). After completion of the color duplex study, velocities were obtained with a conventional, "blind" Doppler transducer at corresponding depths. For all insonated vessels the average angle of insonation was around 30 degrees. However, there was a wide variability of individual angles of insonation (0-70 degrees) in specific vessels. In 74.5% of all vessels, the angle-corrected flow velocity did not exceed the uncorrected velocity by more than 25%. In 14.5% the angle-corrected velocity was 25 to 50% higher and in 10.8% it was more than 50% higher as compared to the uncorrected velocity. Thus, the angle of insonation was unpredictable and often higher than originally expected. Angle-corrected velocities were higher than uncorrected values, and were more than 25% higher in about one-fourth of the vessels studied. Understanding of the clinical importance of such differences requires further study.

Adult↗
PubMed1993

Assessing the effectiveness of quality assurance.

Traces the origins of the fashion for quality assurance and discusses the requisites of a quality assurance strategy. On the basis of a Department of Health funded study in England and Wales in 1989, draws attention to the wide range of activities which have been swept into the quality assurance net, the striking differences between the factors cited as constraining or facilitating the development of quality assurance, and the abysmal lack of data on cost or resources or to any systematic monitoring and evaluation. Suggests that the purchaser-provider split may have worsened the situation.

England↗