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Biomedical subjects

R H Taylor

Publications and source records attributed to R H Taylor.

At least 19 recordsLinked to original sources
PubMed1995

The effect of a combination of rectal diclofenac and caudal bupivacaine on postoperative analgesia in children.

Both caudal anaesthesia and non-steroidal anti-inflammatory drugs have been used in the management of postoperative pain in children. The aim of the present study was to evaluate the combination of caudal analgesia and rectally administered diclofenac in the treatment of pain following minor surgery in children. Thirty-nine, ASA grade 1 or 2, children undergoing inguinal or penoscrotal surgery were randomly assigned to receive either a caudal block using 0.125% bupivacaine with adrenaline or a similar caudal block in combination with rectally administered diclofenac 1 mg.kg-1. Children given a caudal block alone were more likely to need analgesia in the first 24 h postoperatively. It would appear that the combination of a caudal block and rectal diclofenac in children undergoing minor lower abdominal surgery reduces the need for subsequent analgesia.

Administration, Rectal↗
PubMed1994

Profile of colorectal cancer at a community hospital with a multiethnic population.

A retrospective 10-year review of all (311) new cases of colorectal cancer at a community hospital serving a multiethnic urban population was carried out in order to study characteristics of the disease other than incidence and mortality rates. There was a striking similarity despite ethnic differences in most characteristics. The only differences between ethnic groups seen were anatomic distribution of cancer in the colon (statistically significant) and male-to-female ratio of colon cancer (apparent but not statistically significant). Characteristics are classified into three types: (1) Not influenced by ethnicity or by environment: Dukes' stage at presentation, colon-to-rectum ratio, histology, length of hospital stay, survival; (2) Possibly influenced by environment. mean age, male-to-female ratio, presence of synchronous polyps, duration of symptoms; (3) Influenced by ethnicity: anatomic distribution of cancer in the colon.

Aged↗
PubMed1994

Simultaneous two level oesophageal pH monitoring in healthy controls and patients with oesophagitis: comparison between two positions.

For oesophageal pH monitoring, the pH probe is usually positioned 5 cm above the lower oesophageal sphincter (LOS). This is by convention, and has not been compared with other positions in its ability to discriminate between physiological and abnormal acid reflux. Using simultaneous two level 24 hour pH monitoring (5 and 10 cm above manometrically determined LOS) in 31 controls and 51 patients with reflux oesophagitis, the significance of the precise position of the probe in the oesophagus was examined. Secondly, this study compared the discrimination between the two groups achieved at the two levels. Patients had greater acid exposure than controls at both levels. In controls, acid exposure was greater at distal than at the proximal level except the supine acid exposure, which was similar at both levels. In patients, acid exposure was greater at the distal level for all variables (median % of total time pH < 4 = 11.7 v 7.6; p = 0.001). There was excellent correlation between the two levels for all variables in controls (r = 0.883, 0.935, 0.813, and p < 0.001 for percentage of time pH < 4 for total, supine, and upright times) as well as in patients (r = 0.848, 0.848, 0.779, and p < 0.001). On discriminant and receiver operating characteristic analysis, pH threshold 4 seemed as good as or better than other pH thresholds in discriminating between controls and patients. The percentage of total time pH below 4 seemed to discriminate as well or better than other variables at both levels. The distal level (5 cm above LOS) provided slightly better discrimination than proximal level (10 cm) (percentage of subjects correctly classified=81.7 v 75.6). The critical factor for the reliability of the test is not the precise position of the pH probe relative to the LOS, but that the same position is consistently used in patients and controls.

Adult↗
PubMed1994

Prolonged remission of oesophagitis does not alter the magnitude of oesophageal acid exposure.

In a previous study we reported lack of improvement in oesophageal motor function after complete healing of oesophagitis achieved by treatment with omeprazole for a median duration of 12 weeks. This study investigates the effect on oesophageal acid exposure of a longer period of complete remission. It was decided to approach all patients who had 24-h pH monitoring as part of the earlier project and whose second endoscopy showing complete healing of oesophagitis as done at least 24 weeks previously. Of 38 such patients, 24 underwent endoscopy, which showed relapse of oesophagitis in 5 of them. In 18 patients who were eligible and agreed to take part, omeprazole/ranitidine was withdrawn for at least 7 days, after which pH monitoring was repeated. The median duration of remission was 39.5 weeks (range, 26-81 weeks). The median percentage of total time with pH below 4 was 11.5% before and 11.0% after (NS). The corresponding figures for the upright and supine reflux, the number of reflux episodes longer than 5 min, and the duration of the longest reflux episode were 10.7% versus 7.7%, 11.4% versus 12.1%, 7.5 versus 7.5, and 35.5 versus 30.5 min, respectively (NS for all variables). These results suggest that maintenance of remission of oesophagitis for prolonged periods does not alter the degree of acid reflux on discontinuation of medication. This has important implications for the understanding of the natural history of gastro-oesophageal reflux disease.

Adult↗
PubMed1994

Esophageal motor dysfunction and acid exposure in reflux esophagitis are more severe if Barrett's metaplasia is present.

OBJECTIVES: To compare esophageal motor function in patients with reflux esophagitis with controls, and identify patient characteristics that may have a bearing on the severity of esophageal motor dysfunction and acid exposure. METHODS: Esophageal motor function was assessed in 60 patients with reflux esophagitis. All patients had manometry, 50 had an esophageal transit test, and 23 had an acid clearance test. Forty-eight had dual site [5 and 10 cm above lower esophageal sphincter (LES)] esophageal pH monitoring, four had only distal pH monitoring, and one patient had only proximal pH monitoring. Thirty-four controls underwent the same tests. The association between the indices of esophageal function plus the degree of esophageal acid exposure and eight patient characteristics (age, sex, obesity, smoking, alcohol intake, hiatus hernia, grade of esophagitis, and Barrett's metaplasia) was examined in unifactorial and multifactorial analysis of variance. RESULTS: The patients had significantly lower LES pressure, lower distal and middle esophageal amplitudes, longer duration of contraction, and slower velocity of propagation. They had longer esophageal transit and acid clearance times. Barrett's metaplasia was the only factor that had an association with the magnitude of esophageal motor dysfunction and acid exposure, except age, which had a weak positive association with acid exposure (p = 0.03). Compared to the rest of the patients with esophagitis, patients with Barrett's had lower LES pressure (median = 10.5 vs. 17.5 mm Hg, p = 0.013), longer supine transit time (median = 180 vs. 13.5 s, p = 0.0001), and higher % of total time pH < 4 (median = 48.2 vs. 8.7 and 23.2 vs. 5.2; p < 0.0001 for distal and proximal esophageal acid exposure, respectively). Ten of the 12 patients with Barrett's had abnormal manometry, compared with 20 of the 48 without (chi 2 = 6.67; p < 0.01). There was a strong correlation between the degree of acid exposure in the proximal esophagus and the length of Barrett's segment (r = 0.846, 0.81, 0.725; and p < 0.001, 0.005, 0.018, for the % of times pH < 4 for total, supine, and upright periods, respectively). CONCLUSIONS: The development of Barrett's metaplasia may be determined by the degree of esophageal exposure to the refluxate which, in turn, may be a function of the severity of esophageal motor dysfunction. The length of Barrett's segment may be dependent on the extent of orad transport of the refluxate.

Analysis of Variance↗
PubMed1993

Comparison of the Keeler Pulsair 2000 non-contact tonometer with Goldmann applanation.

The Pulsair 2000 non-contact tonometer (Keeler Ltd, UK) is compared with the Goldmann applanation tonometer. Data from 80 eyes were acquired by four experienced observers. A linear regression analysis showed the relationship between the instruments to be: Pulsair = 0.66 + 0.95 Goldmann. Individual components of variation were analysed by analysis of variance which indicated a significant variation in the slope of the regression equation due to observers (p = 0.02) but not to the order in which topical anaesthesia was administered. Differences between two Pulsair instruments were of marginal significance (p = 0.07). The intercept of the regression equation was unaffected by any of the components of variation. Seventy-nine per cent of averaged intraocular pressure measurements obtained with the Pulsair 2000 fell on or within +/- 3 mmHg of those measured with the Goldmann tonometer. It is concluded that the Pulsair 2000 can provide clinically useful measurements of intraocular pressure.

Adolescent↗
PubMed1993

Extraintestinal lymphoma in association with Whipple's disease.

A 45 year old man is described with Whipple's disease who presented with weight loss, lethargy, and ascites. He subsequently developed fever and a mass in the neck, but died despite antibiotic treatment and nutritional support. Necropsy showed extraintestinal lymphoma.

Humans↗
PubMed1993

Diabetes care and the Royal Navy: the importance of a coordinated approach.

The provision of coordinated diabetic care with the establishment of a dedicated diabetic clinic at the Royal Naval Hospital Haslar, has improved the quality of life for the majority of service diabetics. The standard of diabetic control has improved greatly and there has been less sickness due to diabetes, though the effect on invalidings is inevitably less obvious. Good glycaemic control, a healthier lifestyle and a positive attitude, achieved through understanding diabetes and its implications, has been of overall benefit to the Royal Navy.

Blood Glucose↗
PubMed1992

Early extubation of the trachea after repair of secundum-type atrial septal defects in children.

To investigate the role of anaesthetic management in early extubation of the trachea in children after closure of a secundum-type atrial septal defect (ASD II), a retrospective chart review for a two-year period was performed. We identified 36 children who underwent surgical repair of an isolated ASD II. In 19 children (53%) the tracheas were extubated in the operating room immediately after surgery and in 17 patients (47%) the tracheas remained intubated and the lungs were ventilated in the Intensive Care Unit. There was no difference in age (69.5 +/- 33.8 vs 72.9 +/- 45.0 mo) or weight (19.5 +/- 8.1 versus 20.5 +/- 12.7 kg) between the two groups (mean +/- SD). Children in the extubated group had a shorter duration of cardiopulmonary bypass (43.4 +/- 7.8 min) than those remaining intubated (31.7 +/- 12.7 min) (P < 0.05). The children whose tracheas were extubated early received a lower perioperative fentanyl dose (5.9 +/- 6.4 micrograms.kg-1) than those remaining intubated (35.1 +/- 8.5 micrograms.kg-1). Those children in the extubated group had a lower hourly requirement for morphine by infusion (13.6 +/- 5.7 vs 18.2 +/- 5.4 micrograms.kg-1.hr-1) and a shorter stay (20.5 +/- 3.7 versus 29.0 +/- 11.2 hr) in the Intensive Care Unit. Re-intubation of the trachea was not required in any of the children and no deaths occurred. Early extubation after ASD II repair is safe and, given the results of this study, may offer certain advantages over prolonged intubation and ventilation in these children.

Analgesia↗
PubMed1992

Induction, maintenance and recovery characteristics of desflurane in infants and children.

To determine the induction and recovery characteristics of the new poly-fluorinated anaesthetic desflurane, 78 fasting and unpremedicated neonates, infants and children up to 12 yr of age were studied. Patients were stratified according to age: full-term neonates less than 28 days of age (n = 12), infants 1-6 mth (n = 12) infants 6-12 mth (n = 15), children 1-3 yr (n = 15), 3-5 yr (n = 12), and 5-12 yr (n = 12). After preoxygenation for two minutes and an awake tracheal intubation, neonates were anaesthetized with stepwise increases in the inspired concentration of desflurane in an air/oxygen mixture. Infants 1-12 mth of age and children were anaesthetized with stepwise increases in the inspired concentration of desflurane in oxygen. Their tracheas were intubated under deep desflurane anaesthesia without muscle relaxation. The incidence of airway reflex responses (including breathholding, coughing, laryngospasm, bronchospasm and oropharyngeal secretions), incidence of excitement, minimum arterial oxygen saturation, and times to loss of eyelash reflex and tracheal intubation during induction were recorded. After skin incision, anaesthesia was maintained with desflurane (approximately 1 MAC) in 60% nitrous oxide and oxygen. Heart rate and systolic arterial pressure were recorded awake, at approximately 1 MAC before and after skin incision and throughout surgery. At the completion of surgery, all anaesthetics were discontinued and the lungs were ventilated with 100% oxygen. During emergence, the end-tidal concentration of desflurane was recorded until extubation. The incidence of airway reflex responses and the times to eye opening and extubation after the discontinuation of desflurane were recorded.(ABSTRACT TRUNCATED AT 250 WORDS)

Anesthesia Recovery Period↗
PubMed1992

Oesophageal motor function before and after healing of oesophagitis.

Forty three patients with reflux oesophagitis were studied to investigate the effect of healing on oesophageal function. All patients underwent oesophageal manometry and transit studies before and after complete healing of oesophagitis. Oesophagitis was treated with omeprazole 40 mg/day for a median duration of 12 weeks. Twenty three patients also had an acid clearance test before and after healing. Thirty eight of the 43 patients had 24 hour oesophageal pH monitoring before treatment and this was repeated after healing (while on omeprazole) in 31 of them. Thirty four volunteers served as controls. All volunteers underwent manometry, 33 had oesophageal transit studies, and 23 had acid clearance test. Patients had significantly reduced lower oesophageal sphincter pressures and distal and middle oesophageal amplitudes, longer durations of contraction, and slower velocity of propagation than the controls (16.5 v 22.5 mm Hg; 52 v 92 mm Hg; 46 v 79 mm Hg; 3.1 v 2.7 seconds; and 3.3 v 4.1 cm/second respectively with the corresponding p values = 0.017; 0.0001; 0.0001; 0.017; and 0.006). Patients had significantly longer transit times (9 v 7 and 17 v 11 seconds: p = 0.027 and 0.002 for erect and supine postures respectively). They also had longer acid clearance times (350 v 288 and 536 v 405 seconds: p = 0.044 and 0.016 for sitting and supine postures respectively). There was no significant change in any of the indices of oesophageal function after healing of oesophagitis (lower oesophageal sphincter pressure = 16.5 v 20; distal amplitude = 52 v 60; middle amplitude = 46 v 49; duration of contraction = 3.1 v 3.1; velocity = 3.3 v 3.3; erect transit time = 9 v 9; supine transit time = 17 v 24; acid clearance test (sitting) = 350 v 371; acid clearance test (supine) = 536 v 645). These results indicate that oesophageal motor dysfunction in reflux oesophagitis is a primary phenomenon.

Adult↗
PubMed1992

Cerebral pressure-flow velocity relationship during hypothermic cardiopulmonary bypass in neonates and infants.

To examine the effect of temperature on the relationship between cerebral perfusion pressure (CPP) and cerebral blood flow velocity (CBFV) and the effect of low-flow cardiopulmonary bypass (CPB) on cerebral perfusion, we studied 25 neonates and infants ranging from 3 to 210 days of age at three nasopharyngeal temperature (NPT) ranges during cardiopulmonary bypass. Pressure-flow velocity relationships were studied during normothermic (NPT = 36-37 degrees C), moderate hypothermic (NPT = 23-25 degrees C), and profound hypothermic (NPT = 14-20 degrees C) CPB. A transcranial Doppler monitor was used to obtain CBFV, which was measured in the M1 segment of the middle cerebral artery. The CBFV was used as an index of cerebral perfusion. Anterior fontanel pressure (AFP) was subtracted from mean arterial pressure (MAP) to calculate CPP in mm Hg. Nasopharyngeal temperature, PaCO2, and hematocrit were controlled during the study period. Arterial blood gases were analyzed at 37 degrees C, uncorrected for body temperature (alpha-stat acid-base management). The CBFV measurements were made over a range of CPP from 6 to 90 mm Hg. Using nonlinear regression analysis, we showed that cerebral pressure-flow velocity autoregulation was present during normothermic CPB (r2 = 0.68). Autoregulation became pressure-passive, using linear regression analysis, during moderate hypothermic CPB (r2 = 0.33) and profound hypothermic CPB (r2 = 0.69). Cerebral blood-flow velocity was not detectable at a mean (+/- SD) CPP of 9 (+/- 2) mm Hg induced by the low-flow CBP state but became apparent when CPP was increased to 13 (+/- 1) mm Hg (P less than 0.05).(ABSTRACT TRUNCATED AT 250 WORDS)

Blood Flow Velocity↗
PubMed1992

Myxoma mix-up. A case report.

We present a 63-year-old lady who had atrial myxoma. The diagnostic difficulties distinguishing this from giant cell arteritis are highlighted. In particular, both conditions caused choroidal and retinal infarcts, anterior ischaemic optic neuropathy, with raised acute phase reactants. The authors stress the importance of continued ophthalmoscopy as the fundal changes become more apparent.

Diagnosis, Differential↗
PubMed1992

Development of a surgical robot for cementless total hip arthroplasty.

The long-term success of cementless total hip arthroplasty (THA) may depend on bone ingrowth into the porous-fixation surfaces of the implant. The ingrowth process is facilitated when the surgeon achieves a satisfactory fit for the prosthesis. Clinically or roentgenographically visible failure and persistent thigh pain after cementless THA remain significant problems, both of which may be alleviated by more precise preparation of the femoral canal and selection of an appropriately sized prosthesis. The objective of this study was to obtain an exact fit for the prosthesis through the use of an image-directed surgical robot for femoral canal preparation.

Arthroplasty↗
PubMed1992

Advanced Trauma Life Support aboard RFA Argus.

The Advanced Trauma Life Support (ATLS) system was adopted for casualty reception and resuscitation. ATLS permitted well-informed triage decisions to be made, coupled with appropriate initial, possibly life-saving, treatment. The training given on board has continued to benefit patients treated by ex-Argus staff in their peacetime roles.

Humans↗
PubMed1991

Visual acuity and contrast sensitivity in cataract: summation and inhibition of visual performance.

Patients exhibiting uniocular cataract often report an improvement in vision on closing their cataractous eye. Such qualitative evidence suggests the presence of binocular inhibition--the converse of binocular summation (that is the normal superiority of binocular over monocular vision). To quantify the extent of inhibition in cataract, binocular and monocular visual acuity and contrast sensitivity were measured in 28 patients. Twelve patients showed binocular inhibition for visual acuity whilst 11 showed inhibition for contrast sensitivity measured at four cycles per degree (c.deg-1). Contrast sensitivity for 8 c.deg-1 targets was further recorded in a subset of 14 patients in whom seven showed inhibition. In patients who demonstrated inhibition, the mean decrement in performance for visual acuity was 13%. For contrast sensitivity at 4 and 8 c.deg-1 the mean decrement was 25% and 32% respectively. The clinical significance of these findings is discussed with respect to the assessment of visual function and management of the cataract patient.

Adult↗