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Biomedical subjects

M G Greaney

Publications and source records attributed to M G Greaney.

At least 19 recordsLinked to original sources
PubMed2001

Long-term olanzapine therapy in the treatment of bipolar I disorder: an open-label continuation phase study.

BACKGROUND: Olanzapine has demonstrated efficacy in the treatment of acute mania in 2 double-blind, placebo-controlled trials. We describe the results of the open-label extension from one of these trials. METHOD: In a 3-week, double-blind study of patients with DSM-IV bipolar I disorder, olanzapine was superior to placebo for the treatment of acute manic symptoms. Of the 139 patients who entered the double-blind phase of the 3-week study, 113 patients continued into the 49-week open-label extension. Efficacy measurements including the Young Mania Rating Scale (YMRS), the 21-item Hamilton Rating Scale for Depression (HAM-D-21), the Clinical Global Impressions scale-Bipolar Version, and the Positive and Negative Syndrome Scale and safety measurements including the Simpson-Angus scale, the Barnes Akathisia Scale, and the Abnormal Involuntary Movement Scale were completed throughout. The analysis considered all treatment results, starting with the first olanzapine dose. Adjunctive lithium and fluoxetine were allowed during the open-label extension. RESULTS: The mean length of olanzapine treatment was 6.6 months, with a mean modal dose of 13.9 mg/day. A significant mean improvement in the YMRS total score, baseline to endpoint (-18.01, p < .001), was observed. During treatment, 88.3% of patients experienced a remission of manic symptoms (YMRS total score < or =12), and only 25.5% subsequently relapsed (YMRS total score > or = 15). Significant improvement in HAM-D-21 scores was observed (p < .001). Forty-one percent of patients were maintained on olanzapine monotherapy. The most common treatment-emergent adverse events reported were somnolence (46.0%), depression (38.9%), and weight gain (36.3%). CONCLUSION: During up to 1 year of olanzapine therapy, either as monotherapy or in combination with lithium and/or fluoxetine, patients with bipolar disorder demonstrated significant improvement in mania and depression symptoms with a favorable safety profile. Further double-blind, controlled studies are needed to confirm these results.

Adult↗
PubMed1999

Olanzapine versus placebo in the treatment of acute mania. Olanzapine HGEH Study Group.

OBJECTIVE: The primary intent of this study was to compare the efficacy and safety of olanzapine and placebo in the treatment of acute mania. METHOD: The design involved a random-assignment, double-blind, placebo-controlled parallel group study of 3 weeks' duration. After a 2- to 4-day screening period, qualified patients were assigned to either olanzapine (N = 70) or placebo (N = 69). Patients began double-blind therapy with either olanzapine, 10 mg, or placebo given once per day. After the first day of treatment, the daily dose could be adjusted upward or downward, as clinically indicated, by one capsule (olanzapine, 5 mg/day) within the allowed range of one to four capsules. The primary efficacy measure in the protocol was defined as a change from baseline to endpoint in total score on the Young Mania Rating Scale. Clinical response was defined a priori as a decrease of 50% or more from baseline in Young Mania Rating Scale total score. RESULTS: The olanzapine group experienced significantly greater mean improvement in Young Mania Rating Scale total score than the placebo group. On the basis of the clinical response criteria, significantly more olanzapine-treated patients (48.6%) responded than those assigned to placebo (24.2%). Somnolence, dizziness, dry mouth, and weight gain occurred significantly more often with olanzapine. There were no statistically significant differences between the olanzapine-treated and placebo-treated patients with respect to measures of parkinsonism, akathisia, and dyskinesias. No discontinuations of treatment due to adverse events occurred in the olanzapine treatment group. CONCLUSIONS: The results from this study suggest that compared with placebo, olanzapine has superior efficacy for the symptoms of acute mania.

Acute Disease↗
PubMed1996

Prospective randomized trial comparing sequential avulsion with stripping of the long saphenous vein.

Eighty patients with primary varicose veins of the long saphenous system were randomized to have the long saphenous vein removed either by stripping to below the knee or by sequential avulsion. There was no difference between the two methods in the time taken to remove the vein. There was significantly more pain after stripping during the week following operation (P < 0.001). Median pain score after stripping was 5, reducing to 3 at 1 week, compared with 2, reducing to 1, for sequential avulsion. Median area of bruising measured at 1 week was 160 (range 0-1800) cm2 for stripping and 56 (range 0-544) cm2 for sequential avulsion (P < 0.01). Sequential avulsion is less painful, reduces bruising and avoids a significant scar below the knee.

Activities of Daily Living↗
PubMed1985

Operation for recurrent saphenofemoral incompetence using a medial approach to the saphenofemoral junction.

Forty-seven patients (53 limbs) with recurrent saphenofemoral incompetence and varicose veins underwent re-ligation of the saphenofemoral junction using a medial approach to the femoral vein. Twenty-seven patients (31 re-ligation procedures) were available for assessment at long-term follow-up (mean 30.4 months). Saphenofemoral incompetence was demonstrated in five limbs (16.1 per cent). The operative procedure is described and the alternatives discussed. This is a valuable procedure in the repertoire of the surgeon who has to treat recurrent varicose veins.

Adult↗
PubMed1982

A clinical and an experimental study of suture sinuses in abdominal wounds.

A retrospective clinical study of suture sinuses in abdominal wounds has been undertaken with a review of the hospital records of 30 patients. Twenty-six of the 31 suture sinuses reviewed were associated with monofilament suture material, and a knot of this type of material was removed from 15 sinuses. It is suggested that optimal management requires exploration of a suture sinus done under general anesthesia and secondary intention healing of the resulting wound. The importance of the knot of monofilament material in the causation of suture sinuses, suggested by the results of clinical study, was investigated in an experimental study. However, the studies failed to demonstrate that a knot of suture material provides the nidus of infection from which a wound sinus may develop.

Abdomen↗
PubMed1980

An experimental study of the healing of secondary abdominal incisions.

An experimental study of the healing of separate secondary abdominal incisions in rats has been performed. After an initial right subcostal incision, a vertical left-sided abdominal wound was made 1 or 2 weeks later. Wound healing was assessed by measurement of changes in mechanical strength and collagen deposition. The results indicate that an increase in mechanical strength was not effected by initial wounding despite alterations in collagen metabolism.

Abdominal Muscles↗
PubMed1979

Does obstructive jaundice adversely affect wound healing?

The effect of obstructive jaundice on wound healing has been investigated in an experimental study of abdominal wounds in rats following ligation and division of the common bile duct. Animals were jaundiced for 2 weeks before a second operation at which the abdominal wounds were made. The wounds in jaundiced and control animals showed no significant differences in mechanical strength during a 21-day period of study but there was a significant delay in the accumulation of collagen in the wounds of jaundiced animals. The findings suggest that the biochemical changes in the wounds of jaundiced animals did not interfere with wound repair and cast doubt on the thesis that jaundice has an adverse effect on wound healing.

Abdomen↗
PubMed1978

Abdominal wound healing in jaundiced patients.

Abdominal wound healing was studied in 48 patients undergoing laparotomy for jaundice and 281 anicteric patients undergoing elective operations for cholelithiasis at the Sheffield Royal Infirmary during the period 1967 to 1976. Wound dehiscence or incisional hernia occurred in 27.1 per cent of jaundiced patients and in 4.3 per cent of anicteric patients (P less than 0.001). There was a slightly higher incidence of dehiscence and herniation in deeply icteric patients (plasma bilirubin greater than 170 mu mol/l), but patients who developed these complications did not appear to have a more severe degree of malnutrition or impaired liver function. The results of the study suggest that malignant disease may be an important factor in the pathogenesis of wound complications in jaundiced patients. Wound dehiscence or incisional hernia occurred in 59.1 per cent of patients with obstructive jaundice resulting from malignant disease but patients with jaundice resulting from biliary stones or benign pathology did not develop these complications.

Cholelithiasis↗
PubMed1978

The measurement of resting and stimulated lower esophageal sphincter pressure using the rapid pull-through technique of esophageal manometry.

The value of the rapid pull-through technique of esophageal manometry for the measurement of lower esophageal sphincter pressure (LESP), in the diagnosis of symptomatic gastroesophageal reflux, has been investigated. The technique provides reproducible measurements of LESP in individual subjects during the period of a single recording study. It does not discriminate between normal subjects and patients with symptomatic gastroesophageal reflux in measurements of basal LESP or in measurements of the LESP response to abdominal compression and the cholinergic drugs bethanechol and metoclopramide. The findings of the study suggest that the rapid pull-through technique will not prove helpful in the diagnosis of symptomatic reflux.

Adult↗
PubMed1977

Abdominal wound healing: a prospective clinical study.

The incidence of wound dehiscence and incisional hernia after two methods of abdominal wound closure (layered closure with retention sutures and single-layer "mass closure") was studied in a randomised prospective clinical trial in a consecutive series of 200 patients. Dehiscence occurred in 1% of patients and herniation in 4-7%; the incidence of these complications was similar with both methods of closure. Seven of the 11 cases of dehiscence or herniation occurred in infected wounds, and wound infection was associated with a tenfold increase in the incidence of these complications. The prevention of wound infection would reduce substantially the incidence of dehiscence and herniation in abdominal wounds.

Abdomen↗
PubMed1977

The treatment of colonic cancer presenting with intestinal obstruction.

The factors affecting the prognosis of patients presenting with colonic obstruction caused by carcinoma were examined in a retrospective study of 66 patients undergoing emergency surgery for obstruction. The findings in these cases were compared with 176 patients with colonic cancer undergoing elective surgical treatment. Obstructed patients had a significantly higher surgical mortality (37.9 per cent) than elective cases (11.9 per cent). There was a significantly higher incidence of lymph node metastases in obstructed patients and those who survived surgery had a significantly lower 5-year survival rate (22.9 per cent) than elective cases (41.5 per cent). Primary resection of obstructing tumours was followed by a higher 5-year survival rate (31.8 per cent) than staged resections (7.7 per cent), but these operations were used selectively and the 5-year survivors following primary resection all had tumours of the proximal colon. Primary resection and anastomosis of the distal colon was associated with a surgical mortality of 50 per cent. Further progress in the cure of patients with obstructing cancer of the colon may be limited by the aggressive nature of the disease, but the use of primary resection in these cases should be examined in a prospective clinical trial.

Colonic Neoplasms↗