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Biomedical subjects

R C Tallis

Publications and source records attributed to R C Tallis.

At least 37 records · Page 2Linked to original sources
PubMed1996

The cortical topography of human swallowing musculature in health and disease.

Because no detailed information exists regarding the topographic representation of swallowing musculature on the human cerebral cortex in health or disease, we used transcranial magnetic stimulation to study the cortical topography of human oral, pharyngeal and esophageal musculature in 20 healthy individuals and the topography of pharyngeal musculature in two stroke patients, one with and one without dysphagia. Our results demonstrate that swallowing musculature is discretely and somatotopically represented on the motor and premotor cortex of both hemispheres but displays interhemispheric asymmetry, independent of handedness. Following stroke, dysphagia appeared to be associated with smaller pharyngeal representation on the intact hemisphere, which increases in size with recovery of swallowing.

Adolescent↗
PubMed1995

A community survey of ptosis of the eyelid and pupil size of elderly people.

A randomly selected, age-stratified sample of subjects 50 years of age and older, living in the Salford Health District area of Greater Manchester was drawn from the age-sex register of a four-doctor group practice and invited by post to enter a study of ptosis. Of 851 subjects approached, 499 (59%) replied. Of these, 99 refused to participate. The remaining 400 were visited at home and underwent a standardized protocol of ophthalmic history, and examination including a photograph of the eyes in the primary position. Forty-six (11.5%) of the subjects had ptosis and its prevalence increased with age. Ptosis was bilateral in 18 (39%) and unilateral in 28 (61%). In all but four cases, the ptosis was acquired. The cause was evident in 23 (50%), with 11 cases being due to mechanical ptosis and 12 to aponeurotic disinsertion secondary to a known pathology. A further 22 cases had primary aponeurotic disinsertion and there was one case of probable myasthenia gravis. The prevalence of pupillary diameter of 1 mm or less increased significantly with age.

Aged↗
PubMed1994

The use of patterned neuromuscular stimulation to improve hand function following surgery for ulnar neuropathy.

A 60-year-old man with wasting and weakness of the right hand following ulnar nerve entrapment at the elbow was referred for electrotherapy. An ulnar nerve transposition had been performed 2 years previously. This had produced some improvement in nerve conduction without significantly improving hand muscle function. The right first dorsal interosseous muscle (FDI) was stimulated for 4 hours per day over a 6-week period with a stimulus pattern replicating the discharge of a single motor unit from a healthy, fatigued FDI (patterned neuromuscular stimulation or PNMS). The response was assessed using a single case design. Significant improvements in the strength and fatigue resistance of the FDI were observed, associated with improvements in general hand function. PNMS may be useful in restoring hand function in patients with muscle atrophy following entrapment neuropathy.

Action Potentials↗
PubMed1993

Guillain-Barré syndrome in the elderly. A retrospective comparative study.

There have been no reported studies specifically devoted to the Guillain-Barré syndrome in elderly patients. The survey reported in this paper investigated the manifestations of the disease in older patients and compared them with those seen in younger patients. All adult patients with an established diagnosis of Guillain-Barré syndrome admitted over 9 years to a Regional Referral Centre providing services for a population of 543,213 were identified and studied. Fifteen patients were over the age of 60 years and 21 between 19 and 60 years of age. Antecedent illnesses and, in particular, gastro-intestinal symptoms were reported less frequently in older patients. Where there was an antecedent illness, this was of shorter duration in elderly subjects. Neurological symptoms related to peripheral nerve damage, such as paraesthesiae, myalgia, backache and an inability to stand, occurred with a similar frequency in both age groups. Double vision and facial weakness, however, occurred less often in older patients, and cerebellar features were not encountered in the older age group. The cerebrospinal fluid immunoglobulin abnormality was more marked in the elderly. The interval between onset and peak severity was shorter in elderly patients. The duration of hospital stay was significantly greater in the elderly, though the overall prognosis was similar in both age groups. There was only one death in each group. The incidence of the Guillain-Barré syndrome in the elderly was higher than in subjects aged 19-60 years, but this difference was not significant.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1992

Inappropriate medication is a major cause of adverse drug reactions in elderly patients.

To determine the extent to which adverse drug reactions (ADRs) in elderly patients admitted to hospital are due to inappropriate prescribing, we examined 416 successive admissions of elderly patients to a teaching hospital. Interacting drug combinations and drugs with relative contra-indications (CIs) were common, but not as important in producing ADRs as drugs with absolute CIs or unnecessary drugs. Forty-eight patients (11.5% of admissions) were taking a total of 51 drugs with absolute CIs (3.8% of prescriptions). One hundred and seventy-five drugs were discontinued on or shortly after admission in 113 (27%) patients because they were deemed to be unnecessary. One hundred and three patients (27.0% of those on medication) experienced 151 ADRs of which 75 (49.7%) were due to drugs with absolute CIs and/or that were unnecessary, a significantly higher rate of ADRs (p less than 0.001) than observed for all prescriptions. Of 26 (6.3%) admissions attributed to ADRs, 13 (50%) were due to inappropriate prescriptions. The admission rate per prescription was significantly higher (p less than 0.001) for inappropriate than for appropriate drugs. We conclude that much drug-related morbidity in the elderly population may be avoidable, as it is due to inappropriate prescribing.

Aged↗
PubMed1987

Determining drug-drug interactions and related effects on microcomputers.

Algorithms for determining drug-drug interactions are described. They handle all the generic drugs in the British National Formulary (BNF) (Number 5, British Medical Association and Pharmaceutical Society of Great Britain, 1984) and allow these drugs to be identified by generic or trade name. They also accept and identify interactions for compound drugs prescribed by a single trade name. The algorithms can be implemented on any microcomputer and in a number of languages. The choice of algorithm and number of drugs handled depend on size and disk storage of the microcomputer. It was tested in collaboration with the Department of Geriatric Medicine, Liverpool University, and is used in a prescribing monitoring system operational in some wards of the Royal Liverpool Hospital. The drug data are stored in the form given in the BNF and can be easily updated from this publication. The algorithms can also handle drug allergies and cross-sensitivities.

Algorithms↗
PubMed1986

Preoperative clinical predictors of long term survival in mitral stenosis: analysis of 200 cases followed for up to 27 years after closed mitral valvotomy.

Two hundred patients aged 17-40 years undergoing closed mitral valvotomy during 1955-60 were studied by actuarial survival analysis. The period of follow up was 22-27 years. The following preoperative features were found to be independent predictors of long term survival: sinus rhythm (p less than 0.05); pulmonary arterial pressure below systemic pressure (p less than 0.01); absence of congestive cardiac failure (p less than 0.01) and pure mitral stenosis (p less than 0.01). A better long term survival was found for mitral valvotomy with a Tubb's dilator than finger splitting or Brock's method. The presence of calcification at the time of valvotomy adversely affected survival (p less than 0.01). Anticoagulation improved survival (p less than 0.01). It is concluded that closed mitral valvotomy gives good results if performed before the onset of established atrial fibrillation and congestive cardiac failure and that all patients should have anticoagulation. These results have important implications for selection of patients in countries with limited facilities for open heart surgery.

Adolescent↗
PubMed1983

Spinal cord stimulation in the United Kingdom.

All the medical, surgical and engineering personnel in the UK who have used spinal cord stimulation (SCS) in patients, attended a workshop to discuss their results. The major use of SCS has been for multiple sclerosis and intractable pain. It was concluded that the technique benefited up to two thirds of patients with bladder dysfunction, and that pain and possibly spasticity also responded to SCS, but other manifestations of multiple sclerosis did not. Further information on long term benefit is needed and the use of SCS in other conditions, such as spinal injury and peripheral vascular disease, is not yet established. SCS cannot be recommended for use outside large centres as x-ray screening, urodynamic and neurophysiological assessment facilities are required as well as biological engineering assistance.

Electric Stimulation Therapy↗
PubMed1983

Spinal cord stimulation in peripheral vascular disease.

The results of ten patients with severe, intractable symptoms of arterial disease receiving spinal cord stimulation are reported. Six out of ten patients showed clinical improvement. Three of five patients with severe rest pain obtained complete or very marked relief and one of two patients with moderate rest pain in the legs obtained complete relief. The mean claudication distance in the ten patients increased from 65 to 212 metres during epidural stimulation of the spinal cord. Exercise tolerance as measured on a bicycle ergometer increased by 61%. These changes were associated with small increases in cutaneous and muscle blood flow. In those patients who responded clinically, the improvements seen were maintained as long as spinal cord stimulation was continued. There was no clinical response to transcutaneous (placebo) stimulation and four patients did not respond in any way to spinal cord stimulation. The improvements seen are unlikely to be due to either the natural history of the disease or to a placebo effect. The effect is probably due to antidromic stimulation of the central processes of the first order sensory neurons. It is suggested on the basis of animal studies that this effect may be mediated by release of prostaglandins as well as indirectly via pain relief.

Adult↗
PubMed1983

The effect of spinal cord stimulation upon peripheral blood flow in patients with chronic neurological disease.

The impact of spinal cord stimulation (SCS) upon patients with chronic neurological disease appears to be primarily upon autonomic functions. There is clinical evidence of increased blood flow in the lower limbs. In the present study, cutaneous blood flow was measured by means of xenon clearance in the legs and feet of patients receiving SCS for chronic neurological disease. In 8 patients pre-SCS cutaneous blood flow was compared with that during SCS. In 7 out of the 8 patients there was an increase in total cutaneous blood flow during stimulation. The mean pre-SCS value was 2.43 +/- 1.57 ml per 100 g of tissue and this rose to 3.23 +/- 1.81 ml per 100 g of tissue per minute during stimulation. The possible mechanisms for the increased cutaneous blood flow are discussed.

Adult↗
PubMed1983

The quantitative assessment of the influence of spinal cord stimulation on motor function in patients with multiple sclerosis.

This paper gives the results of quantitative measurements of motor function made in a group of 23 patients receiving spinal cord stimulation (SCS) for multiple sclerosis. Although 14 out of the 23 patients reported subjective improvement in motor function and many felt these improvements were significant to them, only 4 patients showed an improvement in pyramidal function, only 1 in cerebellar function. There was no statistically significant improvement in walking speed. It is concluded that SCS does not have a major impact upon motor disability in multiple sclerosis and bladder dysfunction remains the main indication for SCS.

Activities of Daily Living↗