Search PubMed⌕ Search

Biomedical subjects

J Richardson

Publications and source records attributed to J Richardson.

At least 181 records · Page 10Linked to original sources
PubMed1995

Complementary therapy in the NHS: service development in a local district general hospital.

The Lewisham Hospital Complementary Therapy Centre opened in July 1994 to provide an NHS osteopathy, acupuncture and homoeopathy service to patients referred by general practitioners and hospital consultants. This centre provides a development opportunity for a Nurse Practitioner role which combines clinical and educational responsibilities with research and service development. Funded by the local Health Authority as a pilot scheme, the service attracted over 600 referrals in the first three operational months. Treating conditions such as arthritis, back pain and gynaecological problems, initial evaluation of the service suggests that patients feel the service is beneficial.

Complementary Therapies↗
PubMed1995

Medical information: from Surgeon General to superhighway.

Few of those engaged in teaching or research can still be unaware of the existence of the Internet, a global network which has been created by the interconnection of computers in universities, research bodies, commercial organizations, and government departments from all over the World. This network of networks has become know as the 'information superhighway'; it is growing exponentially, acquiring new users by the minute, and expanding, in unexpected and exciting ways, the speed of dissemination, and the format and presentation, of scientific information. This article attempts to put this burgeoning growth in a historical context, and seeks to identify some starting points for Internet/World Wide Web exploration for medical and scientific researchers who wish to harness this uniquely important instrument for their own purposes.

Computer Communication Networks↗
PubMed1995

The case for increased alcohol taxation in Australia.

This paper is concerned with the arguments and evidence that support the use of alcohol taxation as a primary health care intervention. Taxation is treated as a policy option that may be subject to cost-benefit analysis. While overseas evidence is used, the article draws primarily upon the authors' earlier estimates of the cost of alcohol consumption and the effects of taxation in Australia. In addition, the paper considers the main arguments used against alcohol taxation for health policy. It is concluded that the arguments cannot be substantiated and that there is a strong case for increased alcohol taxes.

Journal Article↗
PubMed1995

A prospective, randomized comparison of interpleural and paravertebral analgesia in thoracic surgery.

We have undertaken a prospective, randomized comparison of the superficially similar techniques of interpleural and paravertebral (extrapleural) analgesia in 53 patients undergoing posterolateral thoracotomy. Local anaesthetic placed anterior to the superior costotransverse ligament and posterior to the parietal pleura produces a paravertebral block and instilled between the parietal and visceral pleurae produces an interpleural block. Patients received preoperative and postoperative continuous bupivacaine paravertebral blocks in group 1 and interpleural blocks in group 2. Premedication comprised diclofenac and morphine, and after operation all patients had regular diclofenac and patient-controlled morphine (PCM). Analgesia was assessed by visual analogue pain scores (VAS), PCM requirements, ratio of preoperative to postoperative spirometric values (PFT), rates of postoperative respiratory morbidity (PORM) and hospital stay, all recorded by blinded observers. Eight patients were withdrawn and data from 45 patients were analysed. Patient characteristics, surgery, VAS scores and PCM use were similar in both groups. PFT were significantly better (P = 0.03-0.0001) in group 1, and PORM was lower and hospital stay approximately 1 day less in this group. Five patients in group 2 became temporarily confused, probably because of bupivacaine toxicity (P = 0.02). We conclude that bupivacaine deposited paravertebrally produced greater preservation of lung function and fewer side effects than bupivacaine administered interpleurally.

Adolescent↗
PubMed1995

Bilateral paravertebral analgesia for major abdominal vascular surgery: a preliminary report.

Paravertebral analgesia is highly effective in blocking unilateral afferent input from the trunk, but its bilateral use does not appear to have been described. Eight patients undergoing major abdominal vascular surgery had pre-operative bilateral paravertebral catheters inserted. A dose of 25 ml of bupivacaine 0.5% divided between the two catheters provided the basis of an effective intra-operative analgesic regimen which was continued postoperatively by infusion of bupivacaine for 4 days. Diclofenac and morphine completed a balanced analgesic regimen which was started pre-operatively and continued for 5 and 3 days respectively. Cardiovascular stability was notable throughout surgery, even with aortic clamping and all patients were extubated at the end of surgery. Good quality analgesia was obtained as assessed by low postoperative pain scores at rest and on movement. Three patients were not admitted to the intensive care unit, where mean stays for the group was 10 h (range 0-24 h) and mean hospital stay was 10 days (range 7-14). There were no additional demands made on the nursing staff and no postoperative pain-related complications occurred. We conclude that bilateral paravertebral analgesia, as part of a balanced analgesic technique, is an alternative method of providing effective afferent blockage for major abdominal surgery.

Abdomen↗
PubMed1995

A thermographic study of paravertebral analgesia.

Six patients undergoing paravertebral blocks for chronically painful conditions of the chest wall were thermographically imaged so that the extent of cutaneous vasodilatation and hence sympathetic block could be correlated with the distribution of the somatic block. All blocks were performed by a single experienced operator, with a single percutaneous entry, using 15 ml of 0.5% bupivacaine at a mean level of T9-10 (range T7-8--T10-11), with radiological confirmation of correct needle placement. There was a mean distribution of the somatic block of five dermatomes (range 1-8), as evidenced by loss of pinprick sensation, with upper and lower limits of T6 and L3. The mean distribution of the sympathetic block was eight dermatomes (range 6-10), as evidenced by ipsilateral skin warming (p = 0.0005-0.001), with upper and lower limits of T5 and L3. No bilateral spread was observed. No significant postural changes in blood pressures were seen, although there was a small but significant decrease in supine heart rate (p = 0.05). This study demonstrates that a large unilateral somatic and sympathetic block is obtainable with a single thoracic percutaneous paravertebral injection. It challenges the suggestions that this method of analgesia is ineffective and hazardous, that a sympathetic component is a rare accompaniment and that the lumbar nerve roots are spared.

Adult↗
PubMed1995

Thoracic paravertebral analgesia.

Thoracic paravertebral nerve blockade, although once widely practised, has now only a few centres which contribute to the literature. Data production has, however, continued and this review correlates this new information with existing knowledge. Its history, taxonomy, anatomy, indications, techniques, mechanisms of analgesia, efficacy, contraindications, toxicity, side effects and complications are reviewed. Thoracic paravertebral analgesia is advocated for surgical procedures of the thorax and abdomen, especially wherever the afferent input is predominantly unilateral eg. thoracotomy, cholecystectomy and nephrectomy. It is also of benefit in the prevention and management of chronic pain. It is a simple undertaking with impressive efficacy. Plasma local anaesthetic levels are acceptable and its side effect and complication rates are low. No mortality has been reported. For unilateral surgery of the chest or truck, thoracic paravertebral analgesia should be considered as the afferent block of choice. For bilateral surgery, its efficacy may be limited by the doses of local anaesthetic which could safely be used and further study in this area in particular is required. This form of afferent blockade deserves greater consideration and investigation.

Analgesia↗
PubMed1995

Double jeopardy and the use of QALYs in health care allocation.

The use of the Quality Adjusted Life-Year (QALY) as a measure of the benefit obtained from health care expenditure has been attacked on the ground that it gives a lower value to preserving the lives of people with a permanent disability or illness than to preserving the lives of those who are healthy and not disabled. The reason for this is that the quality of life of those with illness or disability is ranked, on the QALY scale, below that of someone without a disability or illness. Hence we can, other things being equal, gain more QALYs by saving the lives of those without a permanent disability or illness than by saving the lives of those who are disadvantaged in these ways. But to do so puts these disadvantaged people under a kind of double jeopardy. Not only do they suffer from the disability or illness, but because of it, a low priority is given to forms of health care that can preserve their lives. This, so the objection runs, is unjust or unfair. This article assesses this objection to the use of QALYs as a basis for allocating health care resources. It seeks to determine what is sound in the double jeopardy objection, and then to show that the defender of QALYs has an adequate response to it.

Attitude to Health↗
PubMed1995

Post-thymectomy collapse: an unusual case of acute adrenal insufficiency.

A 54-year-old man who had an appearance strongly suggestive of Cushing's syndrome, collapsed after the removal of a carcinoid tumour of the thymus. The clinical suspicion of acute adrenal insufficiency was supported by invasive haemodynamic data and the diagnosis was subsequently confirmed biochemically. These post-operative events were subsequently ignored and a further crisis was probably prevented by tumour recurrence (and hence resumption of adrenocorticotropic hormone (ACTH) production). The ectopic production of ACTH from a carcinoid tumour of the thymus is recognised but a report of acute adrenal insufficiency from its removal is probably unique.

Acute Disease↗
PubMed1995

Pain management in video assisted thoracic surgery: evaluation of localised partial rib resection. A new technique.

We undertook a re-evaluation of acute and chronic pain generation following Video Assisted Thoracic Surgery (VATS) with regard to chest wall trauma produced by the instruments and their ports. From intercostal space (ICS) measurements made on 40 patients, it was confirmed that both the camera and the staple gun port diameters are too large for insertion without trauma. An instrument was produced (the "Sari" Punch, Bolton Surgical Services, Sheffield, England) which cleanly excises an elipse of the superior aspect of a rib, prior to the introduction of the ports. At the same time, the recommended orbit of the instruments about the surgical focus was abandoned in favour of an alignment along one ICS so that only one nerve was potentially traumatised. These modifications were then combined with balanced, pre-emptive and continuous paravertebral analgesia and the efficacy of this approach was evaluated in nine patients undergoing VATS. Operation of the rib punch was easy in all patients and was carried out without clinical or radiological trauma to the rib. Insertion of the ports was easy and access was good to all intrathoracic structures. Postoperative analgesia was good and the mean hospital stay was 2.7 days (range 2-4). Follow-up two months later confirmed a satisfactory surgical procedure and no patients complained of chest wall pain or numbness. We conclude that pain generation with VATS must be seriously considered if the technique is to become truly successful. Balanced, pre-emptive, paravertebral analgesia will protect the central nervous system while the removal of an elipse of rib and alignment of the instruments along one ICS will reduce the likelihood of peripheral nerve trauma.

Adult↗
PubMed1994

Eradication of minimal disease in severe combined immunodeficient mice with disseminated Daudi lymphoma using chemotherapy and an immunotoxin cocktail.

Severe combined immunodeficient (SCID) mice injected intravenously with a human Burkitt's lymphoma cell line (Daudi) develop disseminated lymphoma (SCID/Daudi), which is fatal in 100% of the mice. Early treatment of these mice with either an immunotoxin (IT) cocktail (consisting of anti-CD19-ricin A chain plus anti-CD22-ricin A chain) or chemotherapy significantly prolonged survival but was not curative. Combination therapy with the IT cocktail and any one of three chemotherapeutic drugs (doxorubicin, cytoxan, or camptothecin) cured the mice. Cure was demonstrated by both histopathologic examination of treated mice and, more importantly, by adoptive transfer of cells from organs of the cured mice to naive SCID mice where 100 tumor cells would have caused disease in the recipients. These results provide a strong rationale for combining IT therapy with conventional chemotherapy in the treatment of B-cell neoplasia.

Animals↗
PubMed1994

Cloning of a T cell growth factor that interacts with the beta chain of the interleukin-2 receptor.

A cytokine was identified that stimulated the proliferation of T lymphocytes, and a complementary DNA clone encoding this new T cell growth factor was isolated. The cytokine, designated interleukin-15 (IL-15), is produced by a wide variety of cells and tissues and shares many biological properties with IL-2. Monoclonal antibodies to the beta chain of the IL-2 receptor inhibited the biological activity of IL-15, and IL-15 competed for binding with IL-2, indicating that IL-15 uses components of the IL-2 receptor.

Amino Acid Sequence↗
PubMed1994

Molecular cloning and characterization of the full-length cDNA encoding the developmentally regulated lysosomal enzyme beta-glucosidase in Dictyostelium discoideum.

The developmentally regulated Dictyostelium discoideum lysosomal enzyme beta-glucosidase is synthesized as a membrane-associated glycosylated precursor polypeptide which undergoes at least two proteolytic cleavage events to generate a soluble mature lysosomally localized protein. To begin to analyze the mechanisms regulating the sorting of this protein and the regulation during development of the expression of the encoding gene, we have cloned and sequenced a 2.6-kilobase (kb) cDNA which contains a complete 2463-nucleotide open reading frame coding for beta-glucosidase. Conceptual translation of this open reading frame predicts a polypeptide similar in molecular mass to the primary translation product of 94 kDa that also contains the same amino acid sequences of two V8 protease derived-peptides generated from the purified beta-glucosidase enzyme. The D. discoideum enzyme contained regions highly homologous at the amino acid sequence level to both bacterial and fungal beta-glucosidases, although these regions did not overlap. A potential cleavable signal sequence was also found in the first 21 amino acids followed by a highly polar stretch of 49 amino acids which (based on amino acid sequencing of the mature beta-glucosidase) represents a pro region for this protein. This region is similar in location, size, and charge to the D. discoideum alpha-mannosidase pro-I region (Schatzle, J., Bush, J., and Cardelli, J. (1992) J. Biol. Chem. 267, 4000-4007). Several small hydrophobic stretches of amino acids were also distributed throughout the protein; however, no obvious transmembrane region(s) were identified which might explain the observed membrane association of the precursor protein. Finally, Northern blot analysis indicated that the gene encoding this enzyme was under developmental regulation. The steady state level of a 2.7-kb beta-glucosidase mRNA decreased significantly during the aggregation stage of development, from high levels during growth, and then increased in the form of a larger size 2.8-kb mRNA during the final stages of development.

Age Factors↗