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Biomedical subjects

M Brennan

Publications and source records attributed to M Brennan.

At least 91 records · Page 5Linked to original sources
PubMed1989

Flow cytometry as a predictive indicator in patients with operable gastric cancer.

Adenocarcinoma of the proximal portion of the stomach (gastroesophageal [GE] junction and cardia) is increasing in incidence. The inferior survival of patients with GE-cardia lesions as compared with patients with tumors located in the body and antrum has been attributed to anatomic features. To determine if a biological difference could explain the varying prognosis, flow cytometric studies were performed prospectively in 50 patients with operable gastric cancer and analyzed for association with site, histology, gender, age, stage, and disease-free survival. DNA aneuploidy significantly correlated with tumor location: 96% of GE-cardia carcinomas were aneuploid as compared with 48% of body-antrum tumors (P = .0008). Nodal involvement was more common in aneuploid tumors (P = .0548), and women were more likely to have diploid tumors than were men (P = .0233). The median disease-free survival for patients with diploid tumors was 18.5 months as compared with 5.4 months for patients with aneuploid carcinomas (P = .076). Furthermore, within the body-antrum of the stomach, patients with diploid tumors had a significantly better disease-free survival than did those with aneuploid tumors from the same site (18.4 v 4.7 months, P = .0185). These results indicate there is a difference in the DNA content of gastric tumors located in different sites within the stomach and that DNA content correlates with prognosis.

Adenocarcinoma↗
PubMed1988

The first year of a geriatric-orthopaedic liaison service: an alternative to 'orthogeriatric' units?

The use of orthopaedic beds by large numbers of elderly patients with multiple pathology will increase and already exceeds the provision of orthopaedic-geriatric rehabilitation units. A cross-specialty multidisciplinary ward round improved the quality of care of orthopaedic patients without requiring expenditure on equipment, facilities or staff, and abolished the need to transfer patients to geriatric beds for rehabilitation, this being achieved on the orthopaedic unit. The liaison service provided excellent medical training in acute and rehabilitative aspects of geriatric medicine, enhanced the role of other disciplines in the care of the elderly orthopaedic patient and facilitated communication between departments.

Geriatrics↗
PubMed1988

Double vs single balloon technique for aortic balloon valvuloplasty.

Percutaneous aortic valvuloplasty using a single dilating balloon has been associated with significant but modest reduction in transvalvular pressure gradient and increase in valve area. The balloon diameter is usually 20 mm or smaller to avoid disruption of aortic root structure and to permit forward blood flow during inflation. To evaluate the safety and efficacy of valvuloplasty using a combination of balloons with larger maximum inflated diameters, we compared results of aortic valvuloplasty in 21 patients using either the single or double balloon technique. Mean maximum inflated balloon diameter was 19.4 mm +/- 1.4 for the single balloon technique, while the mean sum of diameters for the simultaneous double balloon technique was 36.3 mm +/- 3.9. The mean age, aortic annulus diameter, and predilatation aortic valve area were not different among groups. Mean aortic transvalvular gradient reduction and mean aortic valve area increase were greater for the double balloon technique. The procedure was well tolerated with no major complications. No change in the degree of aortic regurgitation was noted. The double balloon technique for aortic valvuloplasty is safe and more effective at improving aortic valve area and transvalvular gradient than the conventional single balloon technique.

Aged↗
PubMed1987

Surgical treatment of spinal chordomas.

The clinical features and results of 34 patients with chordomas treated over a seven-year period were analyzed. Surgical treatment consisted of wide local excision (n = 6), marginal resection (n = 5), intralesional resection (n = 20), and biopsy (n = 3). Eighteen patients received postoperative radiotherapy. The local recurrence rate was 65%, with 30% of patients developing distant metastases. With the introduction of computed tomography, smaller tumors are currently being diagnosed; as a result, 35% of the patients in this series are disease free, compared with 10% described previously.

Adult↗
PubMed1987

Evaluation of two local anaesthetic sprays for the relief of post-episiotomy pain.

Aerosol formulations of lignocaine (5%) and cinchocaine (2%) were compared with a water-only placebo spray in a single-dose study in 76 primiparous patients complaining of moderate or severe post-episiotomy pain. In comparison with a water-only placebo, both local anaesthetic formulations gave significant relief when administered to the perineal wound but the lignocaine spray proved to be the more effective. The only side-effect reported was slight stinging occurring immediately after administration of the lignocaine spray in 2 cases. Serum concentrations of local anaesthetic post-administration were negligible. An interesting finding was that breast-feeding patients responded less well to this form of analgesia than patients in whom lactation had been suppressed with frusemide.

Adolescent↗
PubMed1987

A comparison of alcoholic and aqueous formulations of local anaesthetic as a spray for the relief of post-episiotomy pain.

A comparison of pain relief after a single perineal application of alcoholic and aqueous formulations of lignocaine (5%) spray with an aqueous formulation of cinchocaine (2%) spray was made in 72 primiparous patients complaining of moderate or severe post-episiotomy pain. All three formulations were similar in efficacy, the aqueous lignocaine preparation appearing slightly more effective than the others.

Adult↗
PubMed1987

Comparison of two formulations of lignocaine spray with mefenamic acid in the relief of post-episiotomy pain: a placebo-controlled study.

The analgesic effectiveness of aqueous and alcoholic formulations of lignocaine (5%) spray was compared with that of mefenamic acid (500 mg) or placebo in a double-blind study in 103 primiparous patients complaining of moderate or severe perineal pain associated with episiotomy. The results, assessed after a single dose, showed that the aqueous lignocaine formulation provided a level of pain relief superior to that obtained with the alcoholic formulation or placebo, and similar to that obtained with mefenamic acid.

Adult↗
PubMed1987

Localized extremity soft tissue sarcoma: an analysis of factors affecting survival.

The management of extremity soft tissue sarcoma is undergoing rapid change as new techniques of adjuvant treatment are developed. Critical assessment of these advances requires a fundamental understanding of the natural course of this disease. In an effort to define important prognostic factors, this review of 423 adults with localized extremity soft tissue sarcomas, treated at one institution (1968 to 1978), was undertaken. The effect of the following variables on survival was examined: patient factors, ie, age, sex, symptoms, and status at presentation; tumor factors, ie, site, size, depth, bone or neurovascular invasion, histogenesis, grade, and nodal status; and treatment factors, ie, biopsy technique, type of operation, surgical margins, adjuvant treatment, and subsequent local treatment failure. Patient factors with an adverse impact on survival included age greater than 53 and the presence of local symptoms. High tumor grade, positive regional nodes, histology other than liposarcoma, fibrosarcoma or malignant fibrohistiocytoma, invasion of vital structures, proximal site, deep location, and size greater than 10 cm were also poor prognosticators. Treatment factors correlating with optimal survival included limb sparing surgery, adequate margins, biopsy with delayed definitive resection, and absence of subsequent local failure. Patients treated by amputation had a greater proportion of risk factors than patients treated with limb-sparing surgery (LSS). When the data were subjected to multivariate analysis, the following variables emerged as independent predictors of poor outcome: local symptoms, age greater than 53, high grade, proximal site, size greater than 10 cm, positive regional nodes, surgery by amputation, and inadequate margins. These factors are now to be evaluated in our prospective study based on 600 patients with soft tissue sarcoma of all sites admitted to our institution in the last 3 years. These factors should be considered as important stratifications in prospective trials.

Adolescent↗
PubMed1987

The effect of an on-site radiology facility on radiologic utilization in family practice.

Family physicians around the world are increasing their use of diagnostic x-ray examinations at a time of controversy about radiologic overutilization. To explore the role of accessibility in utilization, a study was undertaken testing the hypothesis that on-site radiology facilities are an important determinant of usage. Using a historical cohort design with chart review, rates in selected groups of patients were compared between two teaching family medicine centers, one with an on-site radiology service and one without. After controlling for confounding variables, patients with chest-related diagnoses were 2.4 times more likely (P less than .05) to have a chest film in the presence of on-site facilities. Rates for the off-site examination, upper gastrointestinal series, in patients with abdominal-related diagnoses were similar (relative risk 1.34, P greater than .5) at both centers. Higher usage brought no short-term clinical benefit. It was also observed that residents overinterpreted one quarter of chest films when compared with radiologists' reports.

Community Health Centers↗
PubMed1987

Paraparesis in a child with a herniated thoracic disc.

Herniated thoracic disc after minor trauma, causing paraparesis in an 11-year-old boy, proved difficult to diagnose. Myelogram and computer tomography of the thoracic spine appeared normal, but magnetic resonance imaging demonstrated a small herniation at T4-T5. Disc material adherent to the dura was found at laminectomy. The child made progressive recovery preoperatively and postoperatively and was able to ambulate in parallel bars with a left knee-ankle-foot orthorsis at the time of discharge from the hospital.

Child↗
PubMed1986

The effect of age on blood pressure and heart rate variability in hypertension.

There is confusion in the literature as to the effect of ageing on blood pressure variability. The lack of consistency in reports probably reflects differences in blood pressure measurement techniques and in the choice of statistics used to describe variability. We studied 16 hypertensives (clinical blood pressure greater than 140/90 mmHg on 3 occasions) over 60 (67 +/- 5.5 years) and 16 under 60 years of age (44 +/- 8.9 years) using the Remler M 2000 ambulatory system to measure blood pressure and heart rate every 30 min during the awake hours of the day. Mean +/- s.e.m. blood pressure and heart rate for the elderly was 168 +/- 2.5/95 +/- 1.0 mmHg and 72 +/- 1.5 beats/min, corresponding values for the young being 162 +/- 5.3/103 +/- 2.1 and 78 +/- 2.5. Four statistics of variability were used: standard deviation, coefficient of variation, range and mean hourly change. Differences between old and young were found only for the range of systolic and diastolic blood pressure which was lower in the elderly (52 +/- 3.9/32 +/- 2.4 versus 67 +/- 5.2/46 +/- 4.8 mmHg, both P less than 0.05) and mean hourly change of heart rate (P less than 0.05). The standard deviation of heart rate was negatively correlated with age (r = -0.37; P less than 0.05). Only the systolic and diastolic blood pressure ranges were found to differ with age; the more rigorous tests of variability, standard deviation and coefficient of variation, were not changed. These data show that in hypertensives of different age but with roughly comparable blood pressure levels, variability of blood pressure is not consistently related to age.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗