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Biomedical subjects

A T King

Publications and source records attributed to A T King.

18 recordsLinked to original sources
PubMed2005

Vestibular schwannoma management: What is the 'best' option?

There is an abundance of medical literature describing the management options for vestibular schwannomas. However, the lack of high quality clinical trials means that, for any individual patient, the decision is often based on the clinician's personal biases. The management options that are available are conservative treatment, surgery, single-dose stereotactic radiosurgery and fractionated radiotherapy. In this review, we set out what the aims of managing a vestibular schwannoma should be and compare how these different treatment modalities perform. The particular objectives of tumour control, cranial nerve preservation, prevention of malignancy, quality of life and cost-effectiveness are discussed. It remains difficult to differentiate between these methods when more than one is suitable; the literature confirms that they are all safe and effective, but the decision must be the patient's, based on their individual priorities. This review should equip the clinician to provide an informed overview of the options.

Cost-Benefit Analysis↗
PubMed2005

Differences between brain and rectal temperatures during routine critical care of patients with severe traumatic brain injury.

Theoretical models suggest that small differences only exist between brain and body temperature in health. Once the brain is injured, brain temperature is generally regarded to rise above body temperature. However, since reports of the magnitude of the temperature gradient between brain and body vary, it is still not clear whether conventional body temperature monitoring accurately predicts brain temperature at all times. In this prospective, descriptive study, 20 adults with severe primary brain trauma were studied during their stay in the neurointensive care unit. Brain temperature ranged from 33.4 to 39.9 degrees C. Comparisons between paired brain and rectal temperature measurements revealed no evidence of a systematic difference [mean difference -0.04 degrees C (range -0.13 to 0.05 degrees C, 95% CI), p = 0.39]. Contrary to popular belief, brain temperature did not exceed systemic temperature in this relatively homogeneous patient series. The mean values masked inconsistent and unpredictable individual brain-rectal temperature differences (range 1.8 to -2.9 degrees C) and reversal of the brain-body temperature gradient occurred in some patients. Brain temperature could not be predicted from body temperature at all times.

Abbreviated Injury Scale↗
PubMed2004

Generic waiting lists for routine spinal surgery.

National Health Service Hospitals are under pressure to reduce waiting lists within the constraints of a limited infrastructure. We implemented two systems to reduce waiting times for elective non-complex spinal surgery. The first of these was the introduction of managed generic waiting lists for both initial outpatient appointments and subsequent surgery. Thereafter, the MRI booking system was integrated with outpatient review appointments. Times from referral to first outpatient appointment and from scan to outpatient review and time on waiting list for surgery were analysed before and after implementation of these changes. Despite constant unit capacity there was a global decrease in waiting times. Before introduction of the generic waiting list, 37% of listed patients waited for more than 9 months; this figure fell to zero. Time from scan to outpatient review was 185 days before integration, 30 days after. Changes of this sort demand a quorum of consultants who will accept each others' recommendations. The generic waiting list will have impact only when there are large disparities in waiting times for different consultants. Targets are met at the expense of continuity of care.

Continuity of Patient Care↗
PubMed2000

Expression of the Fc receptor in the mammary gland during lactation in the marsupial Trichosurus vulpecula (brushtail possum).

One of several functions described for the Fc receptor is regulation of IgG isotype transport into milk. The first marsupial homologues of the Fc receptor heavy and light chains, FcRn and beta-2 microglobulin, from the brushtail possum have been cloned and characterised. The level of FcRn mRNA in the possum mammary gland was highest at the start of lactation, and decreased slowly thereafter. Expression of FcRn mRNA did not increase during the switch phase when the concentration of IgG in milk is highest. In contrast, the level of beta-2 microglobulin mRNA in the mammary gland increased during the switch phase when milk IgG concentration also increases. This correlation between beta-2 microglobulin mRNA expression in the mammary gland with the time of active IgG-transfer into milk was also observed in the bovine and murine mammary gland. This suggests that expression of the Fc receptor in the mammary gland is controlled by the expression of beta-2 microglobulin and that its expression is upregulated during the period of highest IgG-transfer into milk.

Animals↗
PubMed1998

Spinal meningiomas: a 20-year review.

The long-term outcome of 78 patients with spinal meningiomas operated on over 20 years at a single neurosurgical unit was analysed. Age, sex and tumour location were similar to those reported by others. Overall, 95% of our patents were independently mobile postoperatively, despite 25% of the group being unable to walk before operation, including four paraplegic patients. Only two tumours were entirely extradural, and a further two were both intra- and extradural. In all cases, tumour exposure was by posterior laminectomy, without recourse to more complex approaches. Complete tumour resection was achieved in 77 (98%) of cases. The dural attachment was excised in 20 cases and diathermy was applied in 58. There was one recurrence, 14 years after the original surgery. Complex and technically challenging surgical approaches are unnecessary to obtain complete removal even for anteriorly placed tumours. Excision of the dural base would seem unnecessary to attain a low recurrence rate.

Adult↗
PubMed1997

Preliminary experience of carbon fibre cage prostheses for treatment of cervical spine disorders.

The objective of this study was to assess the technical feasibility, and the clinical and radiological results of interbody fusion with a carbon fibre cage following anterior cervical discectomy. Nineteen consecutive patients, eight male and 11 female, with an age range from 28 to 75 years (mean 45) underwent anterior cervical discectomy and interbody fusion with a carbon fibre cage at one or two levels. Subjective assessment of symptomatic improvement and radiological assessment of cervical spine alignment and stability was made. All complications were recorded. The procedure was technically feasible. There was no increased morbidity and the length of procedure was no longer when compared with the similar operation but using tricorticate bone graft. All patients initially lost their radicular symptoms and the patients with myelopathy had subjective improvements of their symptoms. Fourteen of the 17 patients with neck pain showed some improvement. Bony fusion was achieved in all cases.

Adult↗
PubMed1991

Cysto-peritoneal shunt infection with Trichosporon beigelii.

Infection is a frequent problem affecting cysto-peritoneal shunts, the usual causative organisms being Staphylococcus epidermidis and Staphylococcus aureus. Fungi are rarely isolated from such infections. We present the first report, as far as the authors are aware, of a case of Trichosporon beigelii shunt infection that responded to shunt removal and antifungal therapy.

Arachnoid Cysts↗
PubMed1990

Perfluorochemicals for gas transport and improvement of cell cultures.

This paper has considered the effects and potential application of PFCs, their emulsions and emulsion components for regulating growth and metabolic functions of microbial, animal and plant cells in culture. PFCs will help to overcome problems encountered in conventional culture systems (e.g. limited gas supply, mechanical damage), especially where cells are grown to high density. While the commercial potential of PFCs for in vitro systems has not yet been fully exploited, the most exciting areas for future developments are in the culture of animal and plant cell lines of importance in biotechnology and medicine.

Animals↗
PubMed1990

Coronary artery bypass surgery in the elderly.

In order to place the issue of CABG surgery in the elderly in a personal perspective, we have reviewed our series of 250 consecutive patients 70 years or greater in age at the time of surgery and have noted a very acceptable (3.6%) operative mortality. Good short and long term survival has been documented. A modest but important elevation of postoperative CNS morbidity has been documented and remains of concern. We have continued to offer CABG to those patients with acceptable risks who have either intractable angina, intractable ischemic heart failure and multi-vessel disease. Left main obstruction of a significant degree or those with threatening three vessel anatomy in association with a sentinel ischemic event are candidates for the CABG procedure. Substantial preoperative evaluation to include the family support substrate must be an important part of the decision process as well as open communication with concerned family members. We feel that the improved life style and enhanced survival justifies CABG in those elderly patients identified with severe coronary artery disease.

Aged↗
PubMed1988

Emulsified perfluorochemicals for oxygenation of microbial cell cultures?

PFCs and their emulsions may have value for increasing the efficiency of O2-transport to microbial cultures. Therefore, the effects of emulsion components on growth of S. cerevisiae and E. coli have been examined. Viable cell counts revealed that perfluorodecalin or the commercial emulsion, Fluosol-DA 20%, produced no obvious growth-inhibition over 6h. However, incubation of cells with up to 10% of the Pluronic F-68 surfactant reduced absorbance at 600nm. Further experiments to assess the effects of PFC emulsion components on growth and structure of microbial cells are in progress.

Culture Media↗
PubMedDate not supplied

Trends in head injury outcome from 1989 to 2003 and the effect of neurosurgical care: an observational study.

BACKGROUND: Case fatality rates after all types of blunt injury have not improved since 1994 in England and Wales, possibly because not all patients with severe head injury are treated in a neurosurgical centre. Our aims were to investigate the case fatality trends in major trauma patients with and without head injury, and to establish the effect of neurosurgical care on mortality after severe head injury. METHODS: We analysed prospectively collected data from the Trauma Audit and Research Network database for patients presenting between 1989 and 2003. Mortality and odds of death adjusted for case mix were compared for patients with and without head injury, and for those treated in a neurosurgical versus a non-neurosurgical centre. FINDINGS: Patients with head injury (n=22,216) had a ten-fold higher mortality and showed less improvement in the adjusted odds of death since 1989 than did patients without head injury (n=154,231). 2305 (33%) of patients with severe head injury (presenting between 1996 and 2003) were treated only in non-neurosurgical centres; such treatment was associated with a 26% increase in mortality and a 2.15-fold increase (95% CI 1.77-2.60) in the odds of death adjusted for case mix compared with patients treated at a neurosurgical centre. INTERPRETATION: Since 1989 trauma system changes in England and Wales have delivered greater benefit to patients without head injury. Our data lend support to current guidelines, suggesting that treatment in a neurosurgical centre represents an important strategy in the management of severe head injury.

Adolescent↗