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Biomedical subjects

P Blake

Publications and source records attributed to P Blake.

At least 55 records · Page 3Linked to original sources
PubMed1996

Refractory congestive heart failure: overview and application of extracorporeal ultrafiltration.

Congestive heart failure (CHF) from ischemic cardiomyopathy has emerged as an epidemic health problem. The pathogenesis of CHF is characterized by heightened activity of many neuroendocrine factors, including norepinephrine, angiotensin II, and arginine vasopressin, which lead to heightened systemic vascular resistance and further impedance of left ventricular ejection. Once CHF reaches New York Heart Association (NYHA) class III or IV with heightened activity of the many neurohumoral factors, it tends to be refractory to conventional therapy of vasodilators, inotropic agents, and diuretics. Treatment of refractory CHF appears to require a break in the neurohumoral hemodynamic vicious cycle, and ultrafiltration appears able to produce this interruption. Ultrafiltration has been shown to be successful in patients with NYHA class III to VI CHF and urine output less than 1,000 mL/d. It relieves pulmonary edema, reduces ascites and peripheral edema, and enhances the response to subsequent diuretic therapy. In patients with refractory CHF, the ability to provide adequate volume removal, thus improving overall volume status, normalizing filling pressures, and reducing clinical symptoms, offers an improvement in overall quality of life. Early results have shown that ongoing therapy actually may be associated with decreased hospital readmissions or, at the very least, shortened intensive care unit length of stay.

Heart Failure↗
PubMed1996

Natural history and prognosis of untreated stage I epithelial ovarian carcinoma.

PURPOSE: The aim of this study was to investigate the independent significance of prognostic factors in stage I invasive epithelial ovarian cancer (EOC). PATIENTS AND METHODS: Between 1980 and 1994, all patients with stage I EOC (borderline tumors excluded) following surgical resection were entered onto this study. No patient received adjuvant therapy and patients were monitored as follows: years 1 to 2-physical examination and serum CA125 every 3 months and computed tomographic (CT) scan every 6 months; years 3 to 5-physical examination and serum CA125 every 6 months and CT scan yearly; years 5 to 10-annual physical examination and serum CA125, with CT scan if clinically indicated. RESULTS: A total of 194 patients entered the study. The median patient age was 54 years (range, 15 to 83), and the median follow-up duration 54 months (range, 7 to 157). Five-year survival rates were as follows: stage IA, 93.7%; stage IB, 92%; and stage IC, 84%. Multivariate analysis using Cox's regression identified grade (P < .001), presence of ascites (P = .05), and surface tumor (P < .01) as independent poor prognostic factors. International Federation of Gynecology and Obstetrics (FIGO) substage did not appear to have independent prognostic significance. Intraoperative capsule rupture was not found to be prognostically significant. The impact of pre-operative rupture remains unclear. CONCLUSION: This is an important series, as no patient received adjuvant therapy, and represents the natural history of surgically resected stage I EOC.

Adolescent↗
PubMed1995

Carcinosarcoma of the ovary: incidence, prognosis, treatment and survival of patients.

BACKGROUND: Carcinosarcomas (also known as malignant mixed mullerian tumours) are rare malignant neoplasms that histologically contain both epithelial and stromal components. METHODS AND MATERIALS: All cases of carcinosarcoma of the ovary presenting to the Royal Marsden Hospital from January 1975 to August 1993 were retrospectively analysed and the histological sections reviewed. RESULTS: There were 37 cases of carcinosarcoma of the ovary representing 1.12% of the ovarian neoplasms seen at this institution. The median age of presentation was 65 years (range 26-85 years) and 70% of patients had advanced disease (FIGO stage III and IV). Clinical features at presentation were similar to those encountered in patients with epithelial ovarian cancer. The overall median survival was 247 days with 40% 1-year survival and 6% 5-year survival for all stages. Early FIGO stage was the only independent prognostic factor for survival. Histology (homologous/heterologous subtypes; grade, type or percentage of the epithelial component) had no significant impact on survival. Adjuvant radiotherapy may have a role and single agent platinum compounds are active, giving a response rate of 35%. CONCLUSIONS: The management of this tumour is difficult and randomised trials are needed to accrue sufficient patient numbers to demonstrate optimal therapy.

Adult↗
PubMed1995

Gluco-oligosaccharide production by a strain of Erwinia amylovora.

When grown in sorbitol-asparagine-salts medium, cells of Erwinia amylovora isolate T83 released a mixture of oligosaccharides and lipopolysaccharide in place of extracellular polysaccharide. The oligosaccharide fraction was usually readily separable from lipopolysaccharide by gel permeation chromatography, but some samples required disaggregation by preliminary treatment with EDTA. By 1H- and 13C-NMR spectroscopy, methylation analysis and mass spectrometry, the oligosaccharide fraction was shown to consist of terminal, beta-1,2- and beta-1,2,6-linked D-glucose residues in the ratio 2.2:2.6:1, indicating a branched oligosaccharide structure. The purified oligosaccharide fraction was partially resolved by gel permeation chromatography into two components containing approximately equal amounts of glucose. When grown on pear slices, isolate T83 produced normal extracellular polysaccharide.

Erwinia↗
PubMed1994

Noise levels in New Zealand junior classrooms: their impact on hearing and teaching.

AIMS: To observe the acoustic conditions present in classrooms populated by the 5 to 7 year old age group, and investigate the level of understanding amongst primary school teachers of classroom acoustics and otitis media with effusion. METHODS: Fifty one primary schools in the Wellington region were visited. Acoustic conditions were observed in 106 classrooms. 149 questionnaires were given to the teachers. Sound level readings were taken during normal school activities. Teacher's voice and background noise measurements were recorded. The signal to noise (S/N) ratios obtained were analysed in conjunction with the acoustic conditions observed. RESULTS: The median S/N ration was +6dB. This is a poor S/N ratio. Analysis revealed that poor S/N ratios were associated with a high background noise level and multifunctional teaching activities. CONCLUSIONS: The acoustic conditions in the majority of classrooms studied were unacceptable.

Acoustics↗
PubMed1994

Outbreaks of Salmonella enteritidis infections in the United States, 1985-1991.

The spread of Salmonella enteritidis infections in the United States was tracked to identify potential risk factors and preventive measures. Isolation rates and information regarding outbreaks of S. enteritidis from 1985 through 1991 were determined by reports to the national Salmonella surveillance system and through the foodborne disease outbreak surveillance system. From 1985 through 1991, 380 outbreaks were reported involving 13,056 ill persons and 50 deaths. The proportion of Northeast outbreaks fell from 81% in 1985 to 55% in 1991 as the number of outbreaks in other areas increased. Grade A shell eggs were implicated in 82% of outbreaks. Case-fatality rates in nursing homes and hospitals were 70 times higher than in other settings. Cultures of environmental or animal specimens from all farms tested yielded S. enteritidis. Eggborne S. enteritidis infections are a major public health problem. Preventive measures, including educating consumers about proper handling of eggs, using pasteurized eggs, and controlling infections on egg farms, may stem the impact of this disease.

Disease Outbreaks↗
PubMed1992

Epanolol as a model for assessing patient preference in anti-anginal drug therapy.

Since drug therapy of angina is likely to produce a similar degree of efficacy for most drugs in common use, treatment choice should additionally focus on other factors, notably adverse events, quality of life, and convenience. Improvements in these factors can also lead to better compliance and can aid the doctor by cutting down the number of patient visits required to optimize therapy. The authors have evaluated the patient's overall assessment of symptomatic relief and adverse experiences in a comparative manner by means of the two-period crossover design using the patient's declared treatment preference as the primary measurement. This encapsulates several factors in a single assessment that can be understood by both physician and patient. The authors carried out two such studies of epanolol (Visacor), a novel anti-anginal agent with both beta-1 selective antagonist activity and also beta-1 selective partial agonist activity. In one study (n = 608) the comparator was metoprolol, and in the other (n = 571) it was nifedipine. This article describes and evaluates the methodology of these studies. To assess preference optimally, each patient had to receive both treatments in short but clinically relevant treatment periods, with no washout. Re-entry into the second period, after withdrawal from the first, was permitted. Both studies showed advantages for epanolol, more marked in the case of nifedipine, arising from equivalent efficacy but fewer adverse events.(ABSTRACT TRUNCATED AT 250 WORDS)

Adrenergic beta-Antagonists↗
PubMed1992

Hypersensitivity reactions to cisplatin and carboplatin--a report on six cases.

Anaphylactic reactions to platinum compounds are well recognised, but uncommon. These vary from true type I reactions to direct histamine release due to nonimmunological mechanisms. We present 6 cases to illustrate this--5 due to cisplatin and a report of this occurring with carboplatin--with a near fatal outcome in 3 of the cases.

Adult↗
PubMed1991

Canal wall down techniques for managing cholesteatoma.

Cholesteatoma remains a common otological problem. This series shows that a simple open cavity technique, with meatoplasty, remains a cost-effective option for treatment. Most ears are rendered dry and safe, with cavity problems minimized by careful technique. Subsequent outpatient care is required infrequently and is well tolerated. The hearing is no worse after the operation than before and some ears are suitable for subsequent tympanoplasty.

Adolescent↗
PubMed1991

A comparison of epanolol and nifedipine in stable angina patients: results of a multicentre trial.

Epanolol (200 mg once daily) was compared with nifedipine (20 mg twice daily) in a multicentre, double-blind, randomised, crossover study in which 571 patients with stable angina pectoris were entered. Efficacy was assessed by anginal attack rate and short-acting nitrate consumption. Symptoms and treatment preference of the patients were assessed by questionnaires. Assessments were made at baseline and after each 4-week treatment period. Both treatments were equally efficacious as demonstrated by weekly anginal attack rates and nitrate usage. Of those patients who expressed a preference for treatment, 61% expressed a preference for epanolol compared with 39% for nifedipine. Significantly fewer patients reported experiencing flushing, pedal oedema or feeling generally unwell (p less than 0.01) during the epanolol treatment period. Patients withdrew from nifedipine treatment more often than from epanolol because of adverse effects. Hence, epanolol was found to be as efficacious as nifedipine in patients with stable angina pectoris, but exhibited a superior tolerability profile and was preferred by more patients.

Administration, Oral↗
PubMed1991

Lymphography--current role in oncology.

A review of the use of lymphography at this hospital, a major oncology centre, is presented. The advent of computed tomography has brought a dramatic reduction in the number of lymphograms currently performed for diseases such as lymphoma, testicular tumours and gynaecological malignancies. This study analyses the reasons for this decline, and concludes that valuable information can still be obtained from lymphography in certain selected groups of patients.

Female↗