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Biomedical subjects

M Savage

Publications and source records attributed to M Savage.

At least 19 recordsLinked to original sources
PubMed1999

Regional variations in grass pollen seasons in the UK, long-term trends and forecast models.

BACKGROUND: Three sites in the UK have daily records of pollen spanning several decades, giving the longest data sets worldwide. Previous research on London data revealed decreasing severity of grass pollen seasons. This is often taken as a model for the whole country but comparisons with Derby and Cardiff, in different regions of local climate and land-use, emphasize the need for regional studies. OBJECTIVE: The grass pollen seasons were analysed for three contrasting long-term sites to provide regional insight into the changing incidence of hay fever. METHODS: Pollen was monitored by volumetric instruments using standard techniques. Data have been taken from 1961 to 1993 to examine variation in grass pollen seasons in relation to land-use changes, cumulative temperatures and rainfall. Models were developed to predict total seasonal catches. RESULTS: At Cardiff the annual counts and severity increased in the 1960s, declined in the 1970s and rose again in the 1980s. At Derby and London the annual counts and severity declined but at different rates. Start dates have tended to become earlier at Cardiff and Derby, but later at London. Trends in annual counts and severity are similar to changes in grassland areas but they cannot be accounted for entirely by these. Weather in spring and early summer has tended to become warmer but there are no sustained patterns in June and July. No trends are apparent in the rainfall records for these months. The maximum explanation (r2 >/= 95%) in forecast models was obtained using 10-day aggregates of weather. CONCLUSION: The contrasting patterns both in the pollen records and land-use changes between the three sites emphasize the need for regional data. The predictive models achieved a high degree of explanation enabling pollen season severity to be forecast with high confidence shortly before the start date.

Humans↗
PubMed1999

Suicide in the course of the treatment of depression.

Five different mechanisms have been proposed whereby antidepressant treatment might lead to suicide: first by simply ameliorating depressions more rapidly; second by an action intrinsic to the specific antidepressant effects; third by toxicity in overdose; fourth by side-effects of specific antidepressants; and finally by virtue of treatment inefficacy. Evidence from randomized control trials (RCT), controlled case studies and epidemiological studies on this question is reviewed and it is concluded that antidepressants can be implicated in some cases of suicide during treatment. Modifications of clinical trial methods and pharmacogenetic studies would yield a richer data set to explore this issue further.

Animals↗
PubMed1998

Determination of adequate moisture content for efficient dry-heat viral inactivation in lyophilized factor VIII by loss on drying and by near infrared spectroscopy.

A requirement for a minimal threshold level of moisture in order for efficient virus inactivation to occur during dry heat treatment of freeze-dried coagulation factor concentrates is described. Techniques used to determine moisture content during heating were Loss on Drying and Karl Fischer. The Loss on Drying was suspected to have occasional errors as a result of sample preparation being influenced by interference from atmospheric moisture. Therefore, a non-invasive, non-destructive method for determination of residual moisture content using near infrared spectrometry (NIR) was developed for freeze-dried antihaemophilic factor (AHF). Calibration equations were determined against Loss on Drying and Karl Fischer assay methods and these equations evaluated for the predictive efficiency. Both Loss on Drying and NIR were used to evaluate the effect of moisture content on the efficiency of virus inactivation by dry heat at 80 degrees C. A minimum level of moisture of greater than 0.7%, as determined by Loss on Drying, was necessary for a virus reduction in the magnitude of 4 log10 for hepatitis A virus, porcine parvovirus and pseudorabies virus.

Animals↗
PubMed1998

Epidural anesthesia and the thermoregulatory responses to hyperthermia--preliminary observations in volunteer subjects.

BACKGROUND: Clinical reports associate the use of epidural anesthesia with an increase in core temperature in women in labor. We tested the hypothesis that epidural anesthesia alters thermoregulatory responses to hyperthermia in human volunteers. METHODS: Each of four volunteers were studied on two days: Control and Anesthesia. On the Control day, the subject was warmed via the skin, and the core (esophageal) temperature threshold for sweating (detected on the forehead) was determined. The subject was then cooled until sweating stopped. The subject was warmed again, and a second sweating threshold was determined. The difference between the first and second sweating thresholds was noted. On the Anesthesia day, two sequential sweating threshold measurements were obtained in a similar fashion; however, a mid-thoracic level of epidural anesthesia was established before the second sweating threshold measurement. The first and second sweating threshold differences were compared between the two study days. The presence or absence of sweating on the thigh was noted during all four warming periods. RESULTS: Average skin temperatures were similar (about 37 degrees C) during all four sweating threshold measurements. On the Control day, the second sweating threshold value was always slightly less than the first (average difference (mean+/-SD): -0.18+/-0.14 degrees C). In contrast, on the Anesthesia day, the second sweating threshold value (determined with an epidural block) was always greater than the first (average difference: +0.37+/-0.16 degrees C). Epidural anesthesia, therefore, increased the sweating threshold by 0.55+/-0.27 degrees C. Epidural anesthesia blocked sweating in the thigh in two of the subjects. CONCLUSIONS: An epidural block alters the thermoregulatory responses to warming by increasing the threshold for thermoregulatory sweating and, in some cases, preventing leg sweating.

Adult↗
PubMed1998

Reserpine exhumed.

Explore the source record for details and available documents.

Akathisia, Drug-Induced↗
PubMed1998

Risk management and the claims process.

This article explores certain risk management techniques and the role these techniques play in the investigation and evaluation of claims. The claims experience of one carrier, Medical Liability Mutual Insurance Co., is provided. A general overview of the elements involved in a claims investigation is provided.

Dental Records↗
PubMed1998

Central venous line disconnections with associated blood loss.

In 1996, a product trial was undertaken at Sydney Children's Hospital in response to an increasing number of central venous line disconnections associated with significant blood loss in small children. The product trialled was an extension line containing a one-way valve system with two side ports for needleless access--product code BC595, distributed by REM Systems. This product was chosen from a limited market for the compact size of the valve; this was important as it was to be secured onto the skin surface. It appeared that this product would prevent blood loss in the event of a line disconnection.

Bacteremia↗
PubMed1997

A combined test using desmopressin and corticotropin-releasing hormone in the differential diagnosis of Cushing's syndrome.

To assess the ability of desmopressin to differentiate between pituitary and ectopic ACTH-dependent Cushing's syndrome and to determine whether diagnostic accuracy could be improved by administering it together with human sequence CRH, we examined its effects on cortisol and ACTH secretion when given alone or in combination with CRH in patients with Cushing's syndrome of varied etiology and compared these data to the results of a standard CRH test in the same individuals. Each patient was studied on three occasions, in random order, separated by at least 48 h. At 0900 h, via an indwelling forearm cannula, 10 micrograms desmopressin, 100 micrograms CRH, or a combination of the two were given as an iv bolus; thereafter, blood was drawn every 15 min for 2 h. The responses to the individual agents were determined according to the timing and calculation criteria suggested by Nieman et al. (1993). A total of 25 patients with Cushing's syndrome were studied: 17 patients with pituitary-dependent Cushing's syndrome, Cushing's disease (CD); 5 patients with occult ectopic ACTH secretion (EC); and 3 patients with primary adrenal (ACTH-independent) Cushing's syndrome. In this series, the best discrimination among ACTH-dependent patient groups was achieved using the combined test. Using the responses of plasma cortisol, all 17 patients with CD showed a rise greater than any of the 5 patients with EC, whereas 1 patient with CD showed a plasma ACTH response within the range seen in the patients with EC. Plasma cortisol responses to desmopressin alone were seen in 14 of 17 patients with CD and 1 of 5 patients with EC and, after CRH alone, in 15 of 17 patients with CD but in no patient with EC. In contrast, plasma ACTH responses after CRH alone were seen in 14 of 17 patients with CD and 2 of 5 patients with EC and, after desmopressin alone, in 12 of 17 with CD and 3 of 5 with EC, thus indicating overlapping responses between the groups and poorer discrimination. No responses were seen in the ACTH-independent group. These data indicate that desmopressin causes the secretion of ACTH and cortisol in patients with ACTH-dependent Cushing's syndrome, and that in combination with CRH, it may provide an improvement over the standard CRH test in the differential diagnosis of ACTH-dependent Cushing's syndrome. Furthermore, these data suggest that there may be abnormalities in vasopressin receptor function or number in ACTH-secreting tumors.

ACTH Syndrome, Ectopic↗
PubMed1996

Peripheral vascular complications after intracoronary stent placement: prevention by use of a pneumatic vascular compression device.

Peripheral vascular complications are a significant source of morbidity after coronary artery stent implantation. The goal of this study was to assess the incidence, risk factors, and management of vascular complications after stent placement. The study population consisted of 101 consecutive patients who underwent stent placement for either elective or bailout indications. All patients received a standardized anticoagulation regimen of aspirin, dipyridamole, low molecular weight dextran, heparin, and warfarin. Peripheral vascular access sites were examined daily until hospital discharge. Vascular complications occurred in 16 of 101 (16%) patients, including femoral artery pseudoaneurysm (n = 11), hematoma requiring transfusion or surgery (n = 4), and arteriovenous fistula (n = 1). Intervention was required in 14 of 16 (88%) patients with complications. These included transfusion (n = 7), ultrasound-guided compression (n = 8), and/or vascular surgery (n = 7). Length of hospital stay was prolonged in patients with complications (14 +/- 9 vs. 8 +/- 5 d, P < 0.001). The development of peripheral vascular complications did not correlate with clinical or procedural variables such as age, cardiovascular risk factors, arterial sheath size, or elective vs. bailout indication. After the introduction of a pneumatic vascular compression device (FEMOSTOP, C.A. Bard, Billerica, MA), a significant reduction in vascular complications was observed. Complications occurred in only 1 of 41 (2.4%) patients in whom the compression device was used in contrast to 13 of 58 (22.4%) patients compressed manually (P < 0.01). Thus peripheral vascular complications are frequent after coronary artery stent placement and are associated with serious morbidity and prolongation of hospital stay. These complications are significantly reduced by the use of a pneumatic vascular compression device despite intensive systemic anticoagulation.

Hemostasis, Surgical↗
PubMed1996

Work-site wellness: a model hospital-operated program.

Work-site wellness programs are hardly new to most US healthcare markets. Emerging out of the 1980s fitness craze, traditional wellness programs usually consisted of classes that encouraged healthy lifestyle practices among company employees. Since the prevalent fee-for-service environment didn't provide an inherent incentive for keeping people well, hospital-operated work-site wellness programs rarely advanced past this basic level of service. Corporations, payers, and hospitals see the economic value of managing health, therefore, these types of programs are becoming a part of hospital delivery systems and a growing revenue center. This article presents a hospital-operated, work-site wellness model that was developed for the WorkingWell Network, the corporate wellness program offered by The Methodist Hospitals, Inc. (Gary and Merrillville, IN).

Case Management↗
PubMed1995

Solubilisation of drugs in micellar systems studied by eluent gel permeation chromatography.

PURPOSE: The purpose of the study was to investigate the potential of a chromatographic method which is based on elution gel chromatography (EGPC) in the study of solubilisation of drugs in micellar solutions. METHODS: The EGPC method differs from conventional GPC in the use of a solution of the associating surfactant as eluent (rather than solvent) and the injection of a small volume of solution of different concentration (or alternatively injection of solvent alone) to probe the association equilibrium in the eluent. The technique was applied to a study of the solubilisation of selected drugs in aqueous micellar solutions of a triblock copolymer (Synperonic-PE F127) composed of oxyethylene [E, OCH2CH2] and oxypropylene [P, OCH2CH(CH3)] units with nominal molecular formula E98P67E98. RESULTS: EGPC curves were obtained showing vacancy peaks at the elution volumes of the drugs, clearly demonstrating their solubilisation. In addition, the micelle-molecule equilibrium of the copolymer surfactant could be monitored at all times. Quantitative determination of the partition of solute between micelles and solvent phase was not possible due to the incomplete conversion of molecules to micelles in solutions of the selected copolymer. CONCLUSIONS: The EGPC technique provides evidence for the solubilisation of the drugs in aqueous solutions of Synperonic F127; a more thorough assessment of its potential for quantitative measurement of solubilisation requires the use of a surfactant which is wholly (or at least mainly) in the micellar state under the conditions of use.

Adsorption↗
PubMed1994

Inter-series differences in the restenosis rate of Palmaz-Schatz coronary stent placement: differences in demographics and post-procedure lumen diameter.

Restenosis rates following Palmaz-Schatz stenting vary between 13 and 36%. To determine whether the nearly three-fold interseries difference in restenosis rates reflects systematic factors (demographic and procedural variables such as post-treatment lumen diameter) rather than random variation, we pooled 486 lesions treated with the Palmaz-Schatz coronary stent in the U.S. Multicenter Registry (n = 259) with the single-center Beth Israel Hospital experience (n = 227) and analyzed the combined series using a continuous geometric model of restenosis. A greater proportion of lesions (66 vs. 50%; P < 0.001) in the Multicenter cohort represented restenosis after a prior intervention. The Multicenter experience also showed a smaller minimum lumen diameter following stent placement (2.61 vs. 3.43 mm; P < 0.001), higher post-stent percent stenosis (16 vs. -2%; P < 0.001), and less acute gain (1.79 vs. 2.67 mm; P < 0.001) than lesions treated in the Beth Israel cohort. At 6-month follow-up, the angiographic restenosis rate (> or = 50% diameter stenosis) was significantly higher in the Multicenter group (35 vs. 27%; P = 0.05), despite the development of less absolute late loss (0.96 vs. 1.32 mm; P < 0.001). Multivariable modeling, however, showed that the only independent predictors of restenosis were a post-procedure lumen diameter < 2.80 mm (odds ratio = 1.57; P = 0.04), diabetes mellitus (odds ratio = 3.55; P < 0.001), and prior restenosis (odds ratio = 1.84; P = 0.008).(ABSTRACT TRUNCATED AT 250 WORDS)

Cohort Studies↗
PubMed1994

Shivering following cardiac surgery: predictive factors, consequences, and characteristics.

BACKGROUND: Shivering is common after cardiac surgery and may evoke harmful hemodynamic changes. Neither those changes nor factors increasing probability of shivering are well defined. OBJECTIVES: (1) To identify factors linked with risk of shivering by comparing age, weight, body surface area, gender, intraoperative details, anesthetics, postoperative temperatures, hemodynamics, and therapeutics in shivering vs nonshivering patients. (2) To describe temperatures, hemodynamics, therapeutics, myocardial oxygen consumption correlates (rate-pressure product, heart rate, systemic vascular resistance) in shivering and nonshivering groups, and shivering and nonshivering periods. (3) To characterize the electromyogram to determine whether the tremor is cold-induced. METHODS: A descriptive design with a time series component was used to study a convenience sample of 10 shivering and 10 nonshivering adults for 4 hours during early recovery from cardiac surgery. Pulmonary artery and skin (facial, calf, trunk) temperature were measured every 60 seconds; heart rate and arterial pressure, every 15 minutes; cardiac output, 3 times. Electromyogram was recorded intermittently. Medications and treatments were noted. RESULTS: Lower skin temperature was significantly related to shivering risk. Heart rate was significantly higher initially in shiverers and remained higher by 13.6 beats per minute. Significantly more nitroprusside was used to control arterial pressure before than after shivering. No significant differences were noted between groups in core temperature, age, weight, body surface area, anesthesia type, intraoperative temperature; or surgery, circulatory bypass, or cardiac cross-clamp duration. The electromyogram pattern during shivering was typical of that produced by cold. CONCLUSIONS: These results suggest that true shivering occurs after cardiac surgery. Skin, but not core, temperature and elevated heart rate predict shivering. Shivering may be more likely in hemodynamically unstable patients.

Adult↗
PubMed1993

Is endometrial infection with Candida albicans a cause of recurrent vaginal thrush?

OBJECTIVE: It was hypothesised that the endometrium might act as a reservoir for candida, thus infecting the vagina as the endometrium is shed during menstruation. DESIGN: A prospective study of women with recurrent vulvo-vaginal candidiasis. The endometrium was sampled and cultured for candida species. SETTING: Central London STD clinic. SUBJECTS: 26 women were enrolled, of whom 20 completed the study. RESULTS: One patient had a positive endometrial culture for candida species, the isolate being Candida krusei. CONCLUSIONS: The endometrium is not a common resevoir for candida species and therefore, infection at this site is an unlikely cause of recurrent vaginal candidiasis.

Candida albicans↗