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Biomedical subjects

P Walsh

Publications and source records attributed to P Walsh.

At least 91 records · Page 5Linked to original sources
PubMed1993

Assessment of ketorolac as an adjuvant to fentanyl patient-controlled epidural analgesia after radical retropubic prostatectomy.

BACKGROUND: Opioids, although effective postoperative analgesics, are associated with undesirable side effects. In an attempt to determine whether adjuvant, nonopioid medication would permit a reduction of the amount of fentanyl required for postoperative analgesia, the efficacy of ketorolac, an injectable nonsteroidal antiinflammatory drug, was studied as an adjuvant to fentanyl patient-controlled epidural analgesia (PCEA) for postoperative pain management following radical retropublic prostatectomy. METHODS: Forty patients were randomized into two groups to receive fentanyl PCEA and either ketorolac 30 mg intramuscularly every 6 h after an initial dose of 60 mg (n = 20) or placebo (n = 20) for 72 h. Visual analogue scale pain scores (0-100 mm; 0 mm = no pain; 100 mm = worst pain), sedation, fentanyl usage, gastrointestinal function, complications, blood loss, and temperature were assessed four times each day. RESULTS: Visual analogue scale (VAS) pain scores at rest were lower in the ketorolac group during the first 4 h (P < 0.01), but were similar thereafter. Global VAS pain scores with activity were lower in the ketorolac group on postoperative day 1 (23 +/- 4 vs. 39 +/- 6; P < 0.05) and postoperative day 2 (17 +/- 3 vs. 29 +/- 4; P < 0.05). Bladder spasm pain occurred less frequently in the ketorolac group (1 vs. 9 patients; P < 0.05). Fentanyl usage was less in the ketorolac group throughout the study (33 +/- 3 vs. 50 +/- 6 micrograms/h, 0-24 h; 20 +/- 2 vs. 36 +/- 6 micrograms/h, 24-48 h; 12 +/- 2 vs. 24 +/- 6 micrograms/h, 48-72 h; P < 0.05). Sedation scores and side effects were similar, except on postoperative day 3 when nausea was less frequent in the ketorolac group (0 vs. 6 patients; P < 0.05). Recovery of gastrointestinal function occurred sooner in the ketorolac group as determined by first bowel sounds (26 +/- 3 vs. 38 +/- 4 h; P < 0.05), first clear liquids (51 +/- 2 vs. 65 +/- 3 h; P < 0.01), and first regular meal (95 +/- 4 vs. 110 +/- 4 h; P < 0.05). There was no significant difference in blood loss, transfusion requirement, hematocrit, platelet count, or temperature. There was high overall satisfaction in both groups, but fewer patients in the ketorolac group rated pain with walking as usually or always painful (1 vs. 9 patients; P < 0.05). CONCLUSIONS: Ketorolac is a beneficial adjuvant to fentanyl PCEA for postoperative pain management after radical retropubic prostatectomy.

Analgesia, Epidural↗
PubMed1992

Hearing loss--an underestimated public health problem.

Estimates of hearing loss in Australia, collected over the last decade and a half, have reported a prevalence rate ranging from 0.1 to 7 per cent. This survey of a random sample of South Australians provides, depending upon definition, two estimates of 15 and 19 per cent. These data suggest that hearing loss has been underestimated as a public health problem. The need for an epidemiological study which measures actual hearing impairment, which can be used to develop an appropriate public health response, is discussed.

Adolescent↗
PubMed1992

Typical absence seizures in adults: clinical, EEG, video-EEG findings and diagnostic/syndromic considerations.

Eighteen women and five men had typical absences. These included 10% of a consecutive hospital series of 200 adult patients with epileptic disorders. The absences began between the ages of seven and 46 years and varied in type and severity. Twenty patients also had generalised tonic-clonic seizures, ranging in frequency from one in a lifetime to one per month. Myoclonic jerks of the limbs occurred in 11 patients but were not associated with the absence attacks. Eyelid myoclonus consistently occurred with absence attacks in four patients and perioral myoclonus in two patients. Absence status occurred in five patients. Absence seizures were frequently unrecognised or misdiagnosed as complex partial seizures. Satisfactory control was achieved with sodium valproate. Electroencephalography, particularly video-electroencephalography, was invaluable in the diagnosis, but focal abnormalities in seven patients might have been erroneously interpreted as indicating partial seizures. This series showed that clinical and EEG manifestations are often syndrome-related and that there are more epileptic syndromes with typical absences than those presently recognised.

Adult↗
PubMed1991

Colour duplex flow imaging in carotid arterial disease: correlation with intra-arterial digital angiography.

Colour duplex flow imaging is a highly accurate form of non-invasive assessment of the extra-cranial carotid circulation. This method is precise in characterising the degree of carotid stenosis, when compared with intra-arterial digital subtraction angiography. The accuracy of colour duplex in defining mild (1-30%), moderate (31-70%) and severe (71-99%) stenosis was 96%, 95% and 98%, respectively. Sensitivities and specificities were greater than 90% in each category, while positive and negative predictive values ranged from 96% to 100%.

Angiography, Digital Subtraction↗
PubMed1989

Variation in cadmium content of caribou tissues from northern Québec.

Samples of kidney, liver, skeletal muscle, heart, mesentery and rumen wall were collected during 1985-1986 in northern Québec from 121 caribou belonging to the Rivière George herd. Significant seasonal variations were found for cadmium concentration in kidneys, liver and skeletal muscles, the level being higher in winter than in autumn. The concentration in liver and kidneys increased with age, while the effect of this factor was complex in skeletal muscles. Sex-related differences were found in muscle and liver levels of cadmium. According to season, sex and age, mean dry-weight concentrations varied between 5.6 and 51.3 micrograms g-1 in kidneys, 1.7 and 4.0 micrograms g-1 in liver and 0 and 0.27 microgram g-1 in skeletal muscles. Season and sex-related differences could be explained by seasonal variation in cadmium intake and by the annual weight cycle exhibited by caribou kidneys and liver. Because of the relatively high cadmium content, it was recommended not to consume liver and kidneys of free-ranging caribou in Québec; this restriction did not apply to meat, heart, mesentery or rumen wall that contained limited concentrations of this heavy metal.

Aging↗
PubMed1989

Papular protothecosis of the chest. Immunologic evaluation and treatment with a combination of oral tetracycline and topical amphotericin B.

A 65-year-old woman presented with cutaneous, pruritic papules of the upper part of her chest. Histologic findings and culture of a biopsy specimen confirmed that these papules were caused by an infection with Prototheca wickerhamii, an achloric alga that rarely infects humans. Natural killer cell activity in this patient was significantly depressed before initiation of therapy. Reevaluation following successful treatment with oral tetracycline hydrochloride and topical amphotericin B cream revealed an improvement in natural killer cell activity. This patient is presented to demonstrate a rare clinical presentation of protothecosis; to document that cutaneous protothecosis can be successfully treated without the risk of toxic side effects associated with systemic antifungal agents; and to illustrate that although most patients with cutaneous protothecosis are immunosuppressed, infection with this alga appears to be at least partially responsible for the immunosuppression.

Administration, Topical↗
PubMed1988

Rooms with a VDU.

Explore the source record for details and available documents.

Computer Systems↗
PubMed1987

Pattern of cadmium contamination in the liver and kidneys of moose and white-tailed deer in Québec.

Samples of moose (N = 431) and white-tailed deer (N = 225) liver and kidneys were collected during the 1985 hunting season from 14 zones south of the 50 degree latitude in Québec. Regional differences in cadmium level in the liver were detected and three homogeneous areas were delineated for each species. Uptake was greater for moose than for deer: in the liver, mean concentrations were 2.9-15.9 mg kg-1 (dry weight) for moose and 0.8-2.6 for deer, depending on the area and sex; in kidneys, means ranged between 31.8-100.5 and 20.9-39.0 mg kg-1, respectively. Female moose had lower levels than bulls. Less affected moose, in eastern Québec, contained cadmium concentrations comparable to the highest values measured in Scandinavia. Cadmium uptake in deer was on the same level or higher than in the United States. Our results indicate a widespread presence of this heavy metal in the environment that may be linked to acid precipitation. We do not recommend consuming wild cervid liver or kidneys in Québec for the moment. Further research is needed on the overall mechanisms involved in the cadmium contamination of the environment and on the actual intake of this metal in the human diet.

Animals↗
PubMed1987

Evaluation of a monoclonal immunoradiometric assay for prostate-specific antigen.

We evaluated the analytical performance of a new monoclonal immunoradiometric assay ("M-PSA") for prostate-specific antigen ("Tandem"; Hybritech Inc.) in comparison with a monoclonal immunoradiometric assay ("M-PAP") for mass measurement of prostatic acid phosphatase ("Tandem") and with a conventional enzyme-activity assay ("E-PAP") for prostatic acid phosphatase (EC 3.1.3.2). For M-PSA, the CVs were 1.3-3.0% within-run and 3.0-4.9% between-run. The minimum detectable mass concentration was 0.10 microgram/L, and linearity extended to 100 micrograms/L. The reference interval for M-PSA in 178 healthy men was 0-2.8 micrograms/L. Serum specimens from men with prostatic disease (primarily prostatic carcinoma and benign prostatic hypertrophy) were assayed by the three methods. Correlation was best between mass measurement (M-PAP) and enzyme activity (E-PAP) for prostatic acid phosphatase (r = 0.958). Results for PSA did not correlate well with those for either M-PAP (r = 0.629) or E-PAP (r = 0.387). PSA was increased in a higher percentage of specimens from men with earlier (clinical stage B) prostatic carcinoma than were results from either assay for PAP.

Acid Phosphatase↗
PubMed1985

Is ultrasonography useful in the assessment of diffuse parenchymal liver disease?

One hundred twenty-five patients investigated at the Royal Brisbane Hospital, who underwent both hepatic ultrasonography and liver biopsy between 1980 and 1983, were scored quantitatively for ultrasound features of loss of detail, echogenicity, and attenuation, as well as for histologic features of fat, fibrosis, and inflammation. Strong correlations were found between the score for fat content and each of the three ultrasound features, and between the score for hepatic fibrosis and loss of detail and echogenicity, but there was no strong correlation with attenuation. Hepatic inflammation did not correlate with any of the ultrasound features. The correlations for fat were strongest when the interval between ultrasonography and liver biopsy was less than or equal to 7 days. Although ultrasonography had a positive predictive value of 98% in the diagnosis of diffuse parenchymal abnormality, it did not distinguish fat from fibrosis nor reliably diagnose cirrhosis. Ultrasonography gave false-positive results in only 2 patients, but in 17 patients, false-negative ultrasound examinations were encountered. These findings indicate that ultrasound is not a useful screening investigation for parenchymal liver disease, nor is it useful in gauging hepatic pathology. However, abnormal hepatic ultrasonography in patients with suspected liver disease strongly suggests the presence of diffuse liver disease.

Biopsy↗
PubMed1985

An assessment of ultrasound mammography as an additional investigation for the diagnosis of breast disease.

X-ray mammography was performed on 446 patients with suspected breast disease and 23 breast carcinomas were detected of 26 (sensitivity: 88.5%) that were ultimately diagnosed in the 12-24 months' period following examination. Ultrasound mammography was used as an additional procedure in 183 patients because the radiographic findings were considered to be indeterminate and it detected an additional two carcinomas, to give an overall sensitivity of 96%. X-ray mammography identified 40 benign lesions and subsequent ultrasound mammography characterised 38 of these as being either cystic or solid. Ultrasound also detected an additional 32 benign lesions (28 cysts and 4 fibroadenomas) which had not been evident on X-ray mammography. It is concluded that ultrasound mammography is a useful complementary procedure for those patients who have radiodense breasts or indeterminate radiographic findings on X-ray mammography.

Adenofibroma↗
PubMed1984

Biopterin synthesis defect. Treatment with L-dopa and 5-hydroxytryptophan compared with therapy with a tetrahydropterin.

We have identified a generalized deficiency of monoamine neurotransmitters in a patient with a defect in biopterin synthesis. Neurotransmitter precursors (L-3,4-dihydroxyphenylalanine [L-dopa]; 5-hydroxytryptophan [5-HTP] and a tetrahydropterin [6-methyltetrahydropterin (6MPH4)] were investigated for their ability to normalize monoamine neurotransmitter metabolism. Before treatment, the concentrations of dopamine (DA), norepinephrine, epinephrine, and six monoamine metabolites were very low or undetectable in plasma, cerebrospinal fluid, or urine. L-Dopa and 5-HTP replacement was begun at age 7 mo. This therapy generally corrected the deficiency of monoamines and their metabolites, and improved neurological development until the age of 25 mo. Despite these benefits, the intermittent administration of L-dopa could not produce a stable improvement of acute neurological function or DA metabolism. In the 3 h after L-dopa administration, plasma DA and the motor activity and alertness of the patient rose and fell in parallel. Doses of L-dopa that were clinically optimal produced normal plasma levels of norepinephrine and epinephrine, but excessive concentrations of DA and its metabolites. Furthermore, the clinical and biochemical effects of L-dopa were inhibited by phenylalanine and 5-HTP, respectively, demonstrating that these amino acids have antagonistic pharmacological effects. Physiological correction of the monoamine deficit and the hyperphenylalaninemia of this disorder was attempted at age 35 mo using high doses (8-38 mg/kg per d) of 6MPH4. 6MPH4, a synthetic analogue of tetrahydrobiopterin, controlled the hyperphenylalaninemia. Significant concentrations of 6MPH4 were obtained in the cerebrospinal fluid; no neurological improvement or stimulation of monoamine synthesis in the central nervous system was detected. These findings indicate the complexity in replacement therapy with L-dopa and 5-HTP, but suggest that this treatment may be partially effective in biopterin-deficient patients who are unresponsive to high doses of tetrahydropterins.

5-Hydroxytryptophan↗
PubMed1984

Neonatal herpes simplex virus death manifested as rapidly progressive pneumonia.

This report describes a case of probable herpes simplex virus (HSV) pneumonia in a neonate with no other localized signs of HSV infection. A 37-week-old infant became ill on the fourth day of life and died 6 days later of overwhelming pneumonia and ensuing complications. After the infant's death, viral cultures from the trachea, nasopharynx, and gastric aspirate grew herpes simplex virus. The mother had no history or signs of HSV infection at delivery. She developed a postpartum fever, and 8 days later herpetic lesions were noticed on the vulva and buttocks. The source of this infant's infection was most likely the maternal birth canal. Nosocomial acquisition could not be ruled out, but no history of HSV infection was found in either involved hospital personnel or in 38 infants defined to be at risk for nosocomial acquisition of the disease. Neonatal HSV can present as a rapidly progressive pneumonia without other clues to etiology.

Cross Infection↗
PubMed1983

Behavioral comparison of pentylenetetrazol, clonidine, chlordiazepoxide and diazepam in infant rats.

The effects of various doses of pentylenetetrazol, clonidine, chlordiazepoxide and diazepam on limb and head movement and behavioral seizure signs were examined in 4-, 8- and 16-day old rats tested at ambient temperatures of either 25 or 35 degrees C. All 4 drugs produced intense behavioral activation at the 2 younger ages but there were marked differences among them in the effects of test temperature on this activation and in the relationship between age and their activating effect. A "paradoxical" and intense behavioral energization was observed after the administration of either of the 2 benzodiazepines at 4, 8 but not 16 days, particularly at the lower test temperature. Clonidine and pentylenetetrazol were activating at all 3 ages but while clonidine had greater effect at the low test temperature, the opposite was the case after pentylenetetrazol. The effects of the benzodiazepines and clonidine were clearly distinct from those of pentylenetetrazol and this was the only drug to substantially elicit seizure signs. It is uncertain whether or not the benzodiazepines cause brain seizures in young animals. If so, then their behavioral manifestation is clearly different from that observed after pentylenetetrazol.

Age Factors↗
PubMed1983

Continuous and intermittent measurement of intracranial pressure by Ladd monitor.

Controversy exists as to whether the force of application of the sensor of the Ladd monitor to the anterior fontanelle affects the accuracy of measurements of intracranial pressure. To resolve this problem, an artificial fontanelle was constructed and fontanelle pressure measurements were recorded at varying forces of application of the sensor. This in vitro technique demonstrated that anterior fontanelle pressure measured with the Ladd monitor is dependent on the force of application. Measurements of anterior fontanelle pressure were made in 17 infants and were correlated with simultaneous direct intracranial pressure measurements. These in vivo measurements confirmed the findings on the artificial fontanelle. Both the in vivo and in vitro measurements suggest that an application force of 7 to 10 gm on the sensor will produce an accurate reflection of intracranial pressure. We describe two devices with which the sensor may be applied to the fontanelle with constant measurable force: one for intermittent measurement and another for continuous recording.

Cranial Sutures↗