Biomedical subjects

I Milsom

Publications and source records attributed to I Milsom.

At least 127 records · Page 7Linked to original sources

PubMed1990

Clinical evaluation of an ensemble-averaging impedance cardiograph for monitoring stroke volume during spontaneous breathing.

Simultaneous determination of stroke volume (SV) with an ensemble-averaging impedance cardiograph (AIGG) and the thermodilution technique (TD) was compared in 10 patients scheduled for major vascular surgery. A small, successive increase in SV was achieved by a step-wise infusion of dextran-70 and elevation of the patient's legs. The patients were allowed to breathe normally during the measurement procedures. There was no difference between the ability of AICG and TD to monitor changes in SV and the correlation coefficient for the measurement of changes in SV by the two methods was 0.88. There was no difference between the reproducibility of AICG- (4.6 ml) and TD- (9.2 ml) determined SV or between the coefficient of variation for AICG (4.8%) and TD (9.9%). The mean difference between AICG- and TD-determined SV at the different measurement points (range 1.3-4.2 ml) was well within acceptable limits. In conclusion, the ensemble-averaging impedance cardiograph described in this study was found to be reliable for monitoring changes in SV during uninterrupted, spontaneous breathing.

Aged↗

PubMed1990

Factors influencing the prevalence and severity of dysmenorrhoea in young women.

Factors influencing the prevalence and severity of dysmenorrhoea were assessed longitudinally in a representative sample of young women born in 1962. The prevalence of dysmenorrhoea was lower (P less than 0.01) at 24 years of age than at 19 years of age. At 24 years of age, 67% of the women still experienced dysmenorrhoea; 10% reported dysmenorrhoea which limited daily activity. The severity of dysmenorrhoea (linear analogue scale) was lower (P less than 0.001) at 24 years of age (3.4, SD 2.8) than at 19 years (4.1, SD 3.2). The prevalence and severity of dysmenorrhoea were reduced (P less than 0.05) in women who were parous in 1986 and nulliparous in 1981, but was unchanged in women who were still nulliparous or women who had had a miscarriage or abortion. Dysmenorrhoea was reduced (P less than 0.001) in oral contraceptive users. The severity of dysmenorrhoea was significantly associated with the duration of menstrual flow, menarcheal age and cigarette smoking. The severity of dysmenorrhoea was not associated with age as an isolated factor, nor with height, weight, length of menstrual cycle or frequency of physical exercise.

Absenteeism↗

PubMed1990

Intermittent prophylactic treatment of recurrent vaginal candidiasis by postmenstrual application of a 500 mg clotrimazole vaginal tablet.

The therapeutic efficacy of intermittent, monthly, postmenstrual prophylaxis with a single 500 mg clotrimazole vaginal tablet (n = 33) was compared with placebo tablets (n = 29) in 62 woman (age 28.1, SD 7.2 years) with recurrent vulvovaginal candidiasis. The number of episodes of acute vulvovaginal candidiasis experienced during the year prior to inclusion was 6.3, SD 1.9. The cumulative recurrence frequency after 6 months intermittent prophylaxis with clotrimazole (30.3%) was lower (p less than 0.001) than that recorded for the women who received placebo (79.3%). After an additional 6 months observation period without treatment there was no significant difference in the cumulative recurrence frequency between the groups (clotrimazole 84.9%; placebo 86.2%). The vagina was recolonised with Candida albicans in 70% of the women after 6 months prophylactic treatment with clotrimazole and in 86% of the women who had received placebo. Thus, this study has demonstrated that postmenstrual prophylactic treatment with a single 500 mg clotrimazole vaginal tablet, applied monthly, prevents recurrence of symptoms, although it does not eliminate yeasts from the vagina.

Administration, Intravaginal↗

PubMed1990

Effects of intravenous terbutaline on maternal circulation and fetal heart activity.

The effects of terbutaline on maternal circulation and fetal heart activity were studied in 15 healthy pregnant women admitted for external cephalic version. The two-step infusion of terbutaline (5-10 micrograms/min) resulted in increases in maternal heart rate (p less than 0.001), cardiac output (p less than 0.001), systolic arterial pressure (p less than 0.001) and pulse pressure (p less than 0.001), while diastolic arterial pressure (p less than 0.001) and total peripheral vascular resistance (p less than 0.001) were reduced. Mean arterial pressure was unchanged after the infusion. Fetal heart activity assessed by cardiotocography showed a gradual increase in baseline fetal heart rate (p less than 0.01) and an increased percentage acceleration time (p less than 0.05). Fetal movements also increased during the infusion (p less than 0.05). The terbutaline infusion had a positive inotropic effect and produced decreased systemic vascular resistance in the pregnant woman, and placental transfer of the drug resulted in increased fetal heart activity. The potential influence of the drug-induced changes in maternal hemodynamics on utero-placental perfusion require further investigation.

Adult↗

PubMed1989

Neurological examination of elderly women under investigation for urinary incontinence.

A random sample of 6,000 women from the birth cohorts 1900-1920 were invited to participate in an investigation of urinary incontinence by completing and returning an enclosed questionnaire. Of the 4,206 women who returned the completed questionnaire, 677 (16.9%) complained of urinary incontinence and accepted an invitation to be examined and treated at our clinic. The first 150 consecutive patients recruited via this questionnaire who attended the clinic underwent a detailed neurological examination. The prevalence of neurological signs amongst this group of women was low, only 2% were considered to have a focal encephalopathy, 1% had an organic brain syndrome, 2% had a myelopathy and a further 1% were considered to have a polyneuropathy. There was no significant difference in the prevalence of neurological signs between the group of women with urinary incontinence and an age-matched control group from the total population. Thus, urinary incontinence in an unselected population of elderly women appears to be mainly dependent on other aetiological factors rather than neurological dysfunction.

Aged↗

PubMed1989

A double-blind cross-over study comparing flurbiprofen with naproxen-sodium for the treatment of primary dysmenorrhea.

The efficacy of flurbiprofen (100 mg, twice daily) and naproxen-sodium (500 mg, twice daily) for the treatment of primary dysmenorrhea was evaluated in a double-blind cross-over study. All the women (n = 57) complained of severe (23%) or very severe (77%) dysmenorrhea which interfered with their daily life. Frequent absenteeism due to dysmenorrhea was reported by 39% of the women. The severity of pain was reduced (p less than 0.001) during treatment with both flurbiprofen and naproxen-sodium compared with the pain severity before the first dose. There was, however, no significant difference in mean pain relief achieved by the two drugs studied. During the study period, absenteeism was reported by only 6 (11%) and 3 (5%) women when treated with flurbiprofen or naproxen-sodium respectively. More than 60% of the women reported no or only mild interference with daily activities during treatment. No serious side effects were reported and none of the patients was obliged to terminate treatment because of side effects. Flurbiprofen and naproxen-sodium, at the dosages indicated, were both shown to be effective in relieving pain in patients suffering from severe primary dysmenorrhea and markedly improved their capacity for normal activities during menstruation.

Adult↗

PubMed1988

Quantification of urinary incontinence in elderly women with the 48-hour pad test.

The ability of 34 elderly women (79 +/- 6 years, range 71-95 years) with urinary incontinence to perform the 48-h perineal pad test in their home environment was investigated. The mean involuntary urinary loss during the 48-h observation period was 80 +/- 88 g (range (2-411 g). Thirty patients successfully compared the two perineal pad systems commercially available in Sweden (LIC and Mölnlycke). Twelve women considered the systems to be equivalent. Thirteen women preferred the Mölnlycke system while five women preferred the LIC system. There was a good correlation between the patients own weighing of the pads and control weighings at the clinic, performed on a precision weight scale (LIC: n = 15, r = 0.99; Mölnlycke: n = 15, r = 0.99). The 48-h perineal pad test performed in the patients home environment should have a given place in the investigation of urinary incontinence amongst elderly women.

Aged↗

PubMed1988

Special health services--an introduction to a programme for elderly women with urinary incontinence and related symptoms.

Urinary incontinence and related urogenital symptoms can be considered to constitute a concealed yet widespread disease amongst elderly women. The problems are to a large extent related to hormonal changes associated with the ageing process. The symptoms have been reported to occur in more than 50% of elderly women. Like severe angina pectoris, osteoarthrosis of the hip and cataract, urinary incontinence and related symptoms may negatively influence the quality of life and reduce the individual's degree of independency. A health care programme, based on an algorithmic model, for the investigation and treatment of urinary incontinence and related symptoms is described. A representative sample of elderly women aged 65-85 yr suffering from urogenital symptoms are currently participating in this programme. The aim is to cure or alleviate urogenital symptoms amongst the elderly women concerned and to assess the value of the programme from a cost-benefit point of view.

Aged↗

PubMed1988

Hemodynamic changes during laparoscopy with positive end-expiratory pressure ventilation.

Hemodynamic measurements were performed in 10 healthy women undergoing elective laparoscopy for the investigation of infertility. A standardized anesthetic technique which included the application of positive end-expiratory pressure (PEEP), 0.49 kPa (3.7 mmHg) was utilized. The following variables were studied: cardiac output, stroke volume and left ventricular ejection time (determined non-invasively with impedance cardiography), heart rate, blood pressure, total peripheral vascular resistance and end-tidal carbon dioxide (ET-CO2). The combination of 25 degrees head-down tilt and PEEP ventilation during laparoscopy was associated with a pressure response that restored arterial pressures to essentially pre-anesthetic levels. Net cardiac effects were small. With this regime low pressure 0.7-1.1 kPa (5-8 mmHg) intra-abdominal insufflation with CO2 was associated with only minor cardiovascular changes. There were no indications that 0.49 kPa PEEP during laparoscopy produced adverse cardiovascular effects. The application of PEEP reduced (P less than 0.001) ET-CO2. There was no net increase in ET-CO2 after CO2-insufflation compared to the measurement after induction of anesthesia. This is in contrast to earlier studies without PEEP where a significant net increase in ET-CO2 was reported after CO2-insufflation.

Adult↗

PubMed1988

Effects of dopamine on the portal circulation after therapeutic hepatic artery ligation.

The effects of exogenous dopamine (2, 4 and 6 micrograms.kg-1.min-1 i.v.) on the portal circulation were studied in six patients following therapeutic hepatic artery ligation. Portal blood flow (PBF) was measured by the continuous thermodilution technique. Portal venous pressure (PVP, n = 3) was monitored through the thermodilution catheter to allow derivation of preportal vascular resistance (PVR). Blood samples were taken through the portal venous catheter for measurement of dopamine. A significant increase in PBF and a decrease in PVR were observed during graded i.v. dopamine infusion. Thus, PBF was 961 +/- 119 ml.min-1 during control conditions and increased to 1446 +/- 221 ml.min-1 during the dopamine infusion at 6 micrograms.kg-1.min-1. No significant changes in mean arterial pressure or PVP were observed during dopamine administration. The pharmacokinetics of dopamine did not differ from that previously reported in patients with an intact arterial supply. In conclusion, our data indicate that exogenous dopamine consistently increases PBF by preportal vasodilation, also in patients with a surgically restricted hepatic arterial blood supply.

Adult↗

PubMed1988

An objective evaluation of flurbiprofen and tranexamic acid in the treatment of idiopathic menorrhagia.

The effect of flurbiprofen (100 mg x 2 for 5 days) was compared with tranexamic acid (1.5 g x 3 for 3 days, 1 g x 2 days 4 and 5) in the treatment of 15 women with idiopathic menorrhagia. The mean blood loss during two medication-free periods was 295 +/- 52 ml. A significant (p less than 0.01) reduction in menstrual blood loss was recorded during treatment with both flurbiprofen and tranexamic acid. The menstrual blood loss was significantly (p less than 0.01) lower during treatment with tranexamic acid (155 +/- 33 ml) than with flurbiprofen (223 +/- 44 ml). Various side effects were recorded by 7 of 15 women during treatment with tranexamic acid and by 4 women of 15 during treatment with flurbiprofen. Many women with menorrhagia suffer simultaneously from dysmenorrhea. Thus although tranexamic acid was generally more effective in reducing menstrual blood loss, flurbiprofen provides an important therapeutic alternative to antifibrinolytic agents, especially in patients with concomitant dysmenorrhea.

Adult↗

PubMed1988

The effect of flurbiprofen and naproxen sodium on intra-uterine pressure and menstrual pain in patients with primary dysmenorrhea.

The effects of flurbiprofen (100 mg) and naproxen sodium (500 mg) on intrauterine pressure and menstrual pain were assessed in 8 women with primary dysmenorrhea using a double-blind parallel study technique. Intrauterine pressure was recorded with a microtransducer catheter for 4 h and resting pressure, active pressure, frequency of pressure cycles, and the area under the curve were analysed in 30 min periods. Prior to medication all the patients displayed signs of uterine hyperactivity as judged by a high resting pressure 55.3 +/- 3.8 mm Hg, high active pressure 175.0 +/- 6.1 mm Hg and a high frequency of pressure cycles 12.3 +/- 0.7 contractions per 0.5 h. Oral administration of flurbiprofen and naproxen sodium significantly suppressed uterine activity and was associated with a significant reduction in pain intensity. However no significant differences were recorded between the two drugs regarding their effects on intrauterine pressure and pain intensity.

Adult↗

PubMed1988

Plasma atrial natriuretic peptide (ANP) and maternal hemodynamic changes during normal pregnancy.

Peripheral venous plasma concentrations of immunoreactive atrial natriuretic peptide (irANP) were studied longitudinally in 12 women at the 12th, 24th, and 36th week of pregnancy as well as 3-5 days and 3 months post partum. Serial measurements of maternal hemodynamics were performed simultaneously with blood sampling for irANP determination. With advancing pregnancy there were significant increases (p less than 0.001) in cardiac output, stroke volume and heart rate, while total peripheral vascular resistance decreased (p less than 0.001). All these changes were normalized 3 months post partum. Plasma irANP increased (p less than 0.05) from 23.2 +/- 1.3 pM/l at week 12 to 25.9 +/- 1.5 pM/l at week 36 of pregnancy, and fell significantly (p less than 0.01) to 20.5 +/- 1.1 pM/l 3 months post partum. Changes in plasma irANP appear to be related to changes in maternal central hemodynamics. The changes in ANP release probably represent one of several mechanisms that maintain circulatory and volume homeostasis during normal pregnancy.

Adult↗

PubMed1986

Portal blood flow in man during graded positive end-expiratory pressure ventilation.

The cardiovascular response to graded PEEP ventilation (5-10 cm H20) was studied peroperatively in patients undergoing cholecystectomy (n = 8) or hepatic tumour surgery (n = 3). Portal blood flow was measured by the continuous thermodilution technique and cardiac output, in a sub-group of the patients, by impedance cardiography. A parallel reduction in cardiac output and portal blood flow was demonstrated in patients undergoing cholecystectomy as the result of the application of PEEP. Thus, ventilation with 5 cm H2O of PEEP elicited a 17% decrease in cardiac output and a 26% decrease in portal blood flow. During 10 cm H2O of PEEP cardiac output decreased by 22% and portal blood flow by 32%. However, there were no significant changes in preportal tissue perfusion pressure by the application of PEEP and preportal vascular resistance increased by 22% and 30%, respectively. This indicates that a vasoconstrictor response, elicited by PEEP, in the preportal tissue is the predominating mechanism for the observed decrease in portal blood flow. Systemic oxygen transport decreased by 214 ml/min during PEEP ventilation, but preportal tissue oxygen utilization was not significantly changed due to a concurrent increase (2.9%; p less than 0.05) in oxygen extraction.

Adolescent↗

PubMed1986

An evaluation of automated indirect blood pressure measurement during pregnancy.

An automatic microcomputer-assisted instrument (Dinamap) for indirect determination of blood pressure was evaluated in 10 healthy women in the last trimester of pregnancy. Blood pressure determined intra-arterially was significantly (p less than 0.001) higher than indirect blood pressure determined with the Dinamap instrument or by manual sphygmomanometry. However, there was no significant difference in the mean change in blood pressure determined by the three techniques under investigation. A close correlation was recorded between systolic and diastolic blood pressure determined intra-arterially and with the Dinamap instrument (r = 0.92, r = 0.90), and between blood pressure determined intra-arterially and indirectly by auscultation (r = 0.93, r = 0.81). There was no significant difference in the reproducability of individual blood pressure values determined intra-arterially (systolic, 2.4 mmHg, diastolic, 3.7 mmHg) or by the Dinamap instrument (systolic, 2.8 mmHg, diastolic, 3.4 mmHg) or by auscultation (systolic, 5.0 mmHg, diastolic, 4.9 mm Hg). The Dinamap instrument proved reliable for the measurement of changes in blood pressure during late pregnancy. The technique eliminates the problem of inter-observer error which otherwise becomes evident when checking blood pressure antenatally.

Adult↗

PubMed1985

Repeated candidiasis: reinfection or recrudescence? A review.

Candida vulvovaginitis is one of the most common infections encountered by obstetricians and gynecologists from all parts of the world. The modern treatment of vaginal candidiasis with imidazole antimycotics such as clotrimazole has been shown to be highly effective. However, there is a small group of women who experience repeated episodes of vaginal candidiasis. This article reviews possible predisposing factors related to recurrent vaginal candidiasis.

Anti-Bacterial Agents↗

PubMed1985

Treatment of recurrent vaginal candidiasis.

In recurrent vulvovaginal candidiasis, predisposing factors should be eliminated wherever possible. Reduction of the gastrointestinal yeast flora by oral antimycotic treatment does not prevent recurrences. Perianal application of antifungal cream might be an alternative in preventing reinfection from the rectum. Venereal spread of yeasts does not seem to be an important factor, and partner treatment does not significantly alter treatment results. Traditionally, prolonged treatment periods are recommended to prevent recurrences. Patient compliance may then become a factor limiting efficacy. One-dose treatment has been shown to give results that compare favorably with traditional treatment schedules. Results in recurrent cases were comparable with those in primary infections. Thus one-dose treatment could be an acceptable alternative to longer treatment periods in schedules for treatment of recurrent cases. Intermittent prophylactic one-dose application appears to be a promising method of reducing recurrences.

Administration, Oral↗

PubMed1985

Intra-uterine pressure and serum ibuprofen: observations after oral administration of 400 mg ibuprofen to a patient with primary dysmenorrhoea.

Intra-uterine pressure was recorded in a dysmenorrhoeic patient for 10 h before and after administration of a single dose of ibuprofen 400 mg. Blood samples were obtained at regular intervals during the recording for determination of the serum concentration of ibuprofen by reverse HPLC. The maximum serum concentration (37.4 micrograms Ml-1) was achieved after 1 h and the terminal half-life of ibuprofen was approximately 2 h. A marked reduction in intra-uterine pressure and the severity of pain was recorded 1.5 h following the administration of ibuprofen. Despite low or non-detectable serum concentrations of ibuprofen after 4 h, intra-uterine pressure never regained the level recorded before treatment.

Administration, Oral↗