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Biomedical subjects

P Dykes

Publications and source records attributed to P Dykes.

11 recordsLinked to original sources
PubMed1994

Prevention of rebleeding from oesophageal varices: two-year follow up of a prospective controlled trial of propranolol in addition to sclerotherapy.

A prospective randomised trial comparing propranolol and sclerotherapy to sclerotherapy alone was conducted over a 2-year follow up in a district hospital setting of unselected patients. Rebleeding and survival were analysed. Thirty-nine patients were randomised to propranolol plus sclerotherapy and 34 to sclerotherapy alone. The two groups were clinically comparable. There was no significant difference in the cumulative percent of patients free of rebleeding; 54% of the sclerotherapy group rebled compared to 52% of the group treated with propranolol plus sclerotherapy (Hazard ratio 1.09 (0.54-2.22) and p = 0.81, NS). Two-year actuarial survival was also not significantly different, with 77% of the propanolol plus sclerotherapy group surviving, compared to 74% of sclerotherapy alone (Hazard ratio 1.08 (0.35-2.22) and p = 0.79, NS). The mean time to eradication of varices was not significantly different between the two groups (propranolol plus sclerotherapy 222 days, sclerotherapy alone 243 days), nor did the rate of variceal recurrence differ (72.7 vs 72 days). This study did not show long-term improvement in rebleeding or survival using propranolol in addition to a regular sclerotherapy programme.

Adolescent↗
PubMed1994

Plasma and cutaneous drug levels after topical application of piroxicam gel: a study in healthy volunteers.

Two studies in healthy male and female volunteers (aged 18-65 years) were undertaken to determine plasma and cutaneous levels of drug following topical application of piroxicam gel. Twelve subjects applied piroxicam gel to the knee (1 g of 0.5% Feldene gel) at baseline and then after 6, 12 and 24 h. Plasma was collected after 1, 2, 4, 6, 14, 24, 28 and 48 h and piroxicam content determined by high-pressure liquid chromatography (HPLC). For the majority of samples collected, piroxicam levels were below the limit of detection (LOD) of the assay and the maximum recorded plasma level in any subject at any time point was 75.4 ng/ml. A single application of gel was administered to the forearms of four groups each of 6 subjects, and biopsy samples of the stratum corneum (skin surface biopsy, SBB) and epidermis/dermis were taken after 0.5, 1, 2 and 4 h. The levels of piroxicam were again measured in each sample by HPLC. The highest levels of piroxicam were found in the superficial skin surface biopsy with the lowest levels recorded in the skin surface biopsies nearest the viable epidermis. The mean tissue concentrations ranged from 160 to 640 ng per sample (calculated to be 80-320 micrograms/g of tissue). The mean levels of piroxicam in a 4-mm punch biopsy showed an increase with time after application, rising from 60.3 to 94.6 ng per biopsy (calculated to be 2.4 to 3.8 micrograms/g of tissue). It may be concluded that piroxicam rapidly permeates through the stratum corneum into the epidermis/dermis after application of the gel. Low and often undetectable plasma levels of drug were observed after topical application of piroxicam gel in a manner comparable to clinical usage.

Administration, Topical↗
PubMed1986

A randomized controlled trial of variceal compression as an adjunct to endoscopic variceal sclerosis.

Endoscopic variceal sclerosis is effective at eradicating oesophageal varices and prolonging survival, but early rebleeding before varices have been obliterated remains a problem. A randomized controlled trial was therefore conducted to determine whether more rapid variceal obliteration and hence a lower morbidity and mortality in the first month could be achieved by compressing the varices after the first injection of sclerosant. Forty patients bleeding from previously untreated varices were studied. There was no demonstrable benefit from post-sclerosis variceal compression in terms of early death from rebleeding (compression, 3 of 19; no compression, 3 of 21 in the first month), total number of patients rebleeding (compression, 5 of 19; no compression, 6 of 21 in the first month), or speed of variceal obliteration (percentage of variceal columns obliterated at 1 month: compression, 13%; no compression, 26%). This study shows that post-sclerosis variceal compression by means of the Williams overtube and Sengstaken tamponade does not improve the efficacy of endoscopic variceal sclerosis.

Clinical Trials as Topic↗
PubMed1976

Effect of gestational length on albumin content of meconium.

During a screening programme for the detection of CF using the meconium albumin technique, the overall false-positive rate was found to be approximately 1%. When the gestational age of the infants was taken into account the false-positive rate was found to be significantly higher in preterm (8%) as compared to term infants (0.55%). This was due largely but not solely to the presence of occult blood. Possible explanations for these findings are discussed and attention drawn to the limitation of meconium albumin content as a screening technique for CF in preterm infants.

Albumins↗
PubMed1976

A study of the factors influencing mortality rates from gastrointestinal haemorrhage.

A prospective study is reported of 300 consecutive patients admitted to the General Hospital, Birmingham, because of acute gastrointestinal haemorrhage. The characteristics of the group have been outlined and the causes of death examined. It is shown that in patients diagnosed as having peptic ulcer or erosions, the major causes of death were thrombotic vascular disease and surgical complications. Current policies in the management of gastrointestinal bleeding are examined in this light, and it is concluded that gastric resection should be avoided wherever possible, and that procedures should be considered which might reduce intravascular clotting. The advisability of immediate surgery is also questioned and a case made for consideration of a policy of more prolonged resuscitation. A detailed analysis of mortality rates is included from reported European series, with particular reference to the increasing proportion of older patients. Taking this into consideration, it is argued that mortality rates are continuing to improve, and that early diagnosis must be an important contributory factor. It is also pointed out that not only are nearly half the patients in present studies over the age of sixty, but also the risk of developing such a haemorrhage is much greater in the older sections of the community. Gastrointestinal bleeding is more of a geriatric than an adolescent problem.

Adolescent↗