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Biomedical subjects

S R Payne

Publications and source records attributed to S R Payne.

At least 37 records · Page 2Linked to original sources
PubMed1995

EMLA cream anaesthesia for frenuloplasty.

OBJECTIVE: To evaluate the use of a eutectic mixture of local anaesthetics (EMLA) cream as the sole anaesthetic for frenuloplasty. PATIENTS AND METHODS: Fifteen patients (mean age 25.6 years, range 19-41) were given topical EMLA cream 30 min before frenuloplasty; a Tegaderm dressing was applied to keep the anaesthetic in place. The level of anaesthesia was assessed on arrival in theatre using pin-prick testing and the patients were asked to grade their level of pain during the procedure using a visual analogue scale. If the level of anaesthesia was inadequate for the operation to be performed, then supplementary infiltrative anaesthesia was administered. RESULTS: Fourteen patients had pain scores of zero and were fully anaesthetized during the procedure. One patient's Tegaderm dressing was displaced soon after application and he was inadequately anaesthetized on testing, had a pain score of 4 and required infiltrative lignocaine before proceeding with frenuloplasty. CONCLUSIONS: EMLA cream is a well-tolerated and reliable anaesthetic for frenuloplasty. Using a condom to keep the cream in place would reduce the small failure rate associated with the displacement of the Tegaderm dressing.

Adult↗
PubMed1994

Effect of antifreeze proteins on the motility of ram spermatozoa.

The effect of the antifreeze peptide type I (AFP) from Winter flounder, Pseudopleuronectes americanus, and the antifreeze glycoprotein (AFGP) from Antarctic cod, Dissostichus mawsoni, was assessed on the motility of ram spermatozoa (Dorset and Dorset x Romney) after chilling (5 degrees C) and after freeze-thawing. During chilling, spermatozoal motility decreased significantly at an AFP or AFGP concentration of 0.1 microgram/ml and at concentrations above 10 micrograms/ml (P < 0.05). Thus, at 5 degrees C these antifreeze proteins can have a mildly cytotoxic effect at certain concentrations. Addition of AFP or AFGP to the freezing medium at concentrations of 0.1 to 10 micrograms/ml significantly reduced the loss in spermatozoal motility that occurs due to the freeze-thaw process (P < 0.001). The effect was not concentration dependent nor did it depend on which antifreeze protein was added. However, due to the cytotoxicity during the chilling stage, only AFP at a concentration of 10 micrograms/ml increased the percentage of motile spermatozoa significantly following freezing and thawing over that of the control (P < 0.05). Mechanisms to explain the effect of these proteins on spermatozoal motility after chilling and after freeze-thawing are proposed.

Animals↗
PubMed1994

Intermuscular bupivacaine infusion for control of pain after renal surgery: a preliminary report.

OBJECTIVE: To assess the value of continuous bupivacaine wound infusion for post-operative pain relief after renal surgery. PATIENTS AND METHODS: The analgesic efficacy of continuous intermuscular wound infusion with 0.25% bupivacaine was studied in 10 patients (four men, six women), with a mean age of 47.5 years (range 25-71) and a mean weight of 71.2 kg (range 44-99), after renal surgery in a single-blind randomized trial. The results were compared with those of an age- and weight-matched control group of 10 patients (five men, five women) with a mean age of 47.7 years (range 27-73) and a mean weight of 67.3 kg (range 51-85). Post-operative pain was studied objectively by assessing individual patient's morphine requirements administered via a patient controlled analgesia system, and subjectively with pain scores. Patient mobility was assessed by ward nursing staff using mobility score charts. RESULTS: There was a lower demand for post-operative analgesia in the bupivacaine group compared with the control. Although there was no significant difference in the pain scores between the two groups, the bupivacaine group was significantly more mobile than the control group after surgery. There was no significant difference in the mean post-operative hospital stay between the two groups. CONCLUSION: Continuous intermuscular bupivacaine wound infusion is a simple and safe procedure which lowers the patients' post-operative analgesic requirements, allows for earlier mobility and may promote more rapid discharge from hospital.

Adult↗
PubMed1994

A district urinary catheter policy. Why have one?

A catheter audit was performed at the Central Manchester Trust, which found that there was excessive ordering, inappropriate catheter selection by size, materials, balloon size and poor guidelines on catheter storage. From these findings and from the available literature, we have proposed guidelines on catheter selection with the aim of offering the best patient care and to provide cost efficiency which may be of benefit to other hospitals.

Adolescent↗
PubMed1993

Validation of a non-invasive radioisotope method of imaging ureteric urine transport.

Measurement of ureteric function has hitherto involved the use of invasive techniques. A non-invasive, radioisotope method of imaging and displaying individual ureteric boluses has been described, a refinement of which is used in this department. Each "spindle" displayed using this technique theoretically represents an individual ureteric bolus of urine, but the technique has never been validated in the normal ureter in either the experimental model or man. A porcine model was set up to allow simultaneous measurement of ureteric bolus transmission using the radioisotope (compressed image) method and by the accepted techniques of electromyography (EMG) and urine drop counting. The timing of each urinary bolus, as recorded by the different modalities was then compared. The results from 11 studies showed a significant correlation between the radioisotope and EMG methods (mean r = 1.00, P = 0.0003). There was a constant relationship between the part of the radioisotopic image representing the rear end of the bolus and the EMG complex (mean time difference = 5.32 +/- 1.067s), thus defining that part of the image representing the peristaltic contraction wave. There was a variable relationship between the EMG and the part of the image representing the leading edge of the bolus (mean time difference = 13.36 +/- 5.23s), emphasising that bolus length is variable, being dependent on bolus volume. The radioisotope "spindle" concurs with EMG activity in the porcine ureter. The compressed image technique is thus validated as a non-invasive method of demonstrating ureteric urine transport.

Animals↗
PubMed1993

Non-invasive investigation of normal individual ureteric activity in man.

This study was designed to investigate non-invasively human ureteric function between individuals and with increasing diuresis, using the radioisotope compressed image technique. Five normal males underwent fast frame renography with ureteric spindle imaging in dehydrated and hydrated states, urine production being measured in each individual for each scan. Urine flow rates and renographic parameters demonstrated that each ureter carried more urine in the hydrated state. The velocity at which individual boluses passed down the ureter was constant for each ureter and did not change with diuresis. The ureteric peristaltic rate showed wide individual variation between ureters in the same subject, but fell within what is becoming accepted as the "normal range" of < 4 urine boluses per minute. Some ureters accommodated an increase in urine flow by an increased peristaltic frequency, some showed no change and others showed a decreased frequency. In those ureters in which there was no change, or a decrease in peristaltic frequency with diuresis, the increased urine flow must have been handled by increases in bolus volume. Thus increases in ureteric urine flow in man are accommodated by changes in both peristaltic frequency and bolus size. The results are discussed in relation to previous studies which used invasive techniques.

Adult↗
PubMed1992

Addition of superoxide dismutase and catalase does not necessarily overcome developmental retardation of one-cell mouse embryos during in-vitro culture.

There is evidence that developmental blocks observed in mouse embryos during culture in vitro may be the result of free radical-induced cellular dysfunction. We have further investigated this possibility by examining the effects of 5% O2 and the antioxidant enzymes, superoxide dismutase (SOD) and catalase (CAT), on mouse 1-cell embryo development. The results demonstrate that development of CF-1 strain embryos is enhanced by incubating in 5% CO2, 5% O2, 90% N2 (5/5/90) compared with 5% CO2 in air (5/air) (P < 0.01) and by culturing in the presence of other embryos. Superoxide dismutase significantly improved embryonic development (35 +/- 5% v. 17 +/- 4% morulae/blastocysts, P < 0.001) at a concentration of 100 units mL-1 when embryos were gassed under 5/5/90. At a concentration of 1000 units mL-1, SOD was detrimental to development (P < 0.001). Injection of SOD and/or CAT into embryos had not effect on development. Development has also been examined in four strains of mice (CF-1, Quackenbush (random-bred strains), Balb-C (inbred) and the F1 hybrid of CBA x C57B1) in the presence or absence of 100 units SOD mL-1 and 1000 units CAT mL-1. Embryonic development was markedly different among the four strains examined, with F1 hybrid > Balb-C (P < 0.001), Balb-C > CF-1 (P < 0.05) and Quackenbush embryos performing very poorly compared with the embryos of the other three strains (P < 0.001).(ABSTRACT TRUNCATED AT 250 WORDS)

Animals↗
PubMed1990

Disability, direct cost, and payment issues in injuries involving woodworking and wood-related construction.

Treatment cost and payment patterns and disability for work, home, and recreation activities were examined for 495 consecutive persons seen as primary care patients over one year in Northern Vermont with injuries associated with woodworking, wood related construction, and home repair activities and materials. These primary care patients were from a larger sample of 601 persons with such injuries who received either primary or tertiary care. Mean total charges were $530 and $342 respectively for work and nonwork related injuries, with highest costs for back and arm injuries, and injuries involving powered equipment and elevations. At six months post injury, patients averaged 11.6 days of disability for work, 10.3 days for home activities, and 13.1 days for recreation. Overwhelmingly, this disability was experienced by nonhospitalized patients. Median charges and disability days were far lower, reflecting the fact that the majority of injuries were minor and only 6% resulted in hospitalization. Only 29% of hospital charges for injuries at work were paid by workmen's compensation, and a third either were unpaid or were paid by the injured party. Self-employed contractors and carpenters, in particular, lacked coverage by workmen's compensation.

Accidents, Occupational↗
PubMed1990

Injuries during woodworking, home repairs, and construction.

Study was made of 495 consecutive primary care patients treated for woodworking, home repair, and wood-related construction injuries. Mean AIS was 1.2, and 6% were hospitalized. Estimated annual injury rate involving such activities is 3.3/1,000 residents. Fifty-eight per cent of injuries occurred at work. Overall, where complete data are available, 30% of injuries involved use of power equipment, with injury usually resulting from direct contact with the equipment. The lone exception was portable circular or "Skill" saws, with a large proportion of eye injuries from ejected sawdust. Use of non-power equipment was involved in 21% of injuries, and falls from ladders or other elevations 14%. Mean days of complete or partial disability for work, home, and recreational activities were 11.8, 10.4, and 13.3, with 79% of work disability occurring to persons who had not been hospitalized.

Absenteeism↗
PubMed1990

Bacteriological state of the urine in symptom-free adult males.

Mid-stream urine specimens from 120 symptom-free males aged between 15 and 60 years were examined for cells and bacteria. Only 3 specimens showed pyuria, all of which yielded fastidious organisms. No specimen yielded a pure growth of an aerobe. Fastidious organisms in pure or mixed growth were isolated from 26% of the specimens, none in a count greater than 10(8)/l and the majority in counts less than 10(7)/l. It was concluded that pure growths of aerobes in any count in patients with symptoms are indicative of infection. Fastidious organisms should be sought in the urine of patients with symptoms or pyuria before more intensive and expensive investigations are pursued.

Adolescent↗
PubMed1989

Trauma registry and trauma center biases in injury research.

Trauma centers and trauma registries have become important sources of data for trauma research. In their present form, both have serious biases in data selection, however, that can affect epidemiologic research results. This prospective study of 601 woodworking-related injuries seen at a trauma center involved a diverse population, a wide range of severities, both inpatients and outpatients, and primary versus referred patients. Eighty-eight per cent were outpatients and thus excluded by traditional trauma registries. Only 6% of primary patients, but 43% of referred patients, were hospitalized. Eighty-nine per cent of outpatients, and 28% of inpatients had AIS of 1. However, among primary patients 79% or more of lost or altered days of work, home, or recreational activity during 6 months postinjury occurred among ambulatory patients. Substantial differences were shown between hospitalized and ambulatory patients, and between primary and referred patients, in type of activity at time of injury, and in anatomic location and injury type. Trauma registry collection and analysis methods for epidemiologic research need substantial restructuring if they are to truly represent the tremendous problem of injury in our society.

Adult↗
PubMed1989

Trauma centers and DRGs--inherent conflict?

A study of 69 patients hospitalized among 601 consecutive patients treated for injuries involving woodworking, construction, and related activities showed that average cost of care and average DRG reimbursement rose with increasing severity, with cost rising at a much faster rate than reimbursement. Overall, however, for patients from both primary and tertiary care patient sheds, actual hospital billings closely approximated DRG schedules. This contrasts markedly with a New Jersey study limited to ICU patients which found substantial losses under DRG reimbursement for even the least severe cases and increasing losses at each higher severity level. The different results appear to reflect dissimilarities of sampling.

Accidents, Occupational↗
PubMed1989

Injuries to carpenters.

Study of 208 consecutively treated injuries to carpenters in northwestern Vermont revealed an annual injury rate of 13.3 to 17.2/100 workers. Most injuries had an abbreviated injury score of 1 and 7% resulted in hospitalization. One quarter of the injuries resulted from falls, and one fifth each from use of construction materials or power tools. In contrast to injuries from most other power tools, which usually involved trauma from direct contact with the equipment, the majority of injuries from circular or "skill" saws were eye injuries from flying sawdust. Overall, 43% of injured persons had no disability for work, but almost one fifth were disabled for a month or longer, especially persons with back injuries, who usually required emergency department treatment only but then had prolonged disability and expensive care. Mean and median hospital costs for all injuries were $347 and $70, and mean and median total costs of care were $376 and $90. Only one third of payment came from workers' compensation. Self-employed carpenters comprised 17% of injured persons but 36% of those with unpaid bills.

Accidents, Occupational↗
PubMed1989

The "plain film" bladder shadow in outflow obstruction: as accurate a discriminant of residual urine as ultrasound.

The height, width and area of the bladder shadow on post-micturition plain abdominal radiography was compared with the residual urine obtained at endoscopy from 58 men presenting with pure bladder outflow obstruction. Each parameter of the bladder shadow correlated significantly with the residual urine in patients in whom this shadow was visible. Post-micturition plain abdominal radiography is considerably cheaper than ultrasound and appears to be equally effective in the determination of residual urine. Its use as the sole imaging technique in the routine management of bladder outflow obstruction is recommended.

Aged↗
PubMed1989

Interstitial cystitis and the urethral syndrome: a possible answer.

A study was made of 20 patients fulfilling the criteria customarily used for the diagnosis of interstitial cystitis. A possible infective aetiology was sought by culture of bladder tissue, catheter and midstream specimens of urine, and urethral swabs by methods capable of detecting fastidious bacteria as well as aerobic pathogens. All bladder biopsies showed the histological appearances usually associated with interstitial cystitis, and bacteria were isolated from the catheter specimens and/or bladder biopsies of 12 patients. Eight of these isolates were fastidious bacteria, Gardnerella vaginalis (6) and Lactobacillus sp. (2). Fastidious bacteria were isolated from the midstream specimen of urine (MSU) and/or urethral swab of 6 other patients. The correlation of the histological and bacteriological findings supports the hypothesis of an infective aetiology and suggests that the so-called urethral syndrome and interstitial cystitis may be the earlier and later stages of the same disease process. The importance of early diagnosis of infection in these patients is emphasised.

Adolescent↗