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Biomedical subjects

A W Matthews

Publications and source records attributed to A W Matthews.

13 recordsLinked to original sources
PubMed1999

Percutaneous cervical cordotomy for the control of pain in patients with pleural mesothelioma.

BACKGROUND: Severe chest pain is common in mesothelioma. Percutaneous cervical cordotomy, which interrupts the spinothalamic tract at the C1/C2 level causing contralateral loss of pain sensation, is particularly appropriate in mesothelioma as the tumour is unilateral and systemic analgesia may be ineffective and is limited by harmful side effects. METHOD: A retrospective review was performed to determine the effectiveness and complication rate of this procedure. RESULTS: Fifty two patients were using opioids prior to cordotomy. The median daily dose of morphine before and after cordotomy was 100 mg (range 0-1000 mg) and 20 mg (range 0-520 mg), respectively (p < 0.001). Forty three patients (83%) had a reduction in pain such that their dose of opioid could be at least halved. Twenty patients (38%) were able to stop completely. Recurrence of pain requiring an increase in opioid medication was recorded in 18 patients at a median time of nine weeks (range 0.7-26 weeks). Four patients developed mild weakness, two had troublesome dysaesthesia. The median time from cordotomy to death was 13 weeks (range 0.3-52 weeks). Six early deaths within two weeks of cordotomy occurred early in the series and reflect postoperative chest infection and poor selection as the patients were in the terminal stages of mesothelioma. CONCLUSIONS: Percutaneous cervical cordotomy is successful in treating pain from mesothelioma. There was a low complication rate in this series. Referral to a unit experienced in cordotomy is recommended as soon as pain from chest wall invasion is suspected.

Adult↗
PubMed1998

Prognosis in malignant mesothelioma related to MIB 1 proliferation index and histological subtype.

The aims of this study were to evaluate the use of the proliferation marker MIB 1 and histological subtype as indicators of prognosis in malignant mesothelioma. Sections from 41 cases of malignant mesothelioma were histologically subtyped on hematoxylin and eosin sections and stained immunohistochemically for the proliferation marker MIB 1. A proliferation index was derived and the results compared with patient survival data. A statistically significant difference was found between the survival of patients having a low and high MIB 1 index (P < .001). Patients with tumors having a low MIB 1 index lived significantly longer than those with a high MIB 1 index. Patients with the spindle cell histological subtype of malignant mesothelioma had significantly shorter survival times than those with the epithelioid or mixed tumors (P < .01). The MIB 1 proliferation index and histological tumor subtype are useful markers of prognosis in malignant mesothelioma.

Antibodies, Monoclonal↗
PubMed1995

Prevention of tumour seeding following thoracoscopy in mesothelioma by prophylactic radiotherapy.

To determine the usefulness of prophylactic radiotherapy following thoracoscopy or pleural aspiration in patients with mesothelioma we reviewed the case notes of patients treated at St Mary's Hospital between 1990 and 1994. Twenty patients have received treatment to 38 sites and tumour seeding was prevented in all patients available for follow-up. Four patients acted as their own controls by developing nodules at untreated sites. Prophylactic radiotherapy is highly effective in preventing tumour seeding in mesothelioma.

Humans↗
PubMed1977

The relationship between central carbon dioxide sensitivity and clinical features in patients with chronic airways obstruction.

A technique has been developed which enables respiratory motor output to be measured independently of lung mechanics. The maximum rate of change of pressure at the mouth during initial transient occlusion of the airway, (d P/dt) max., represents the rate of isometric force development by the inspiratory muscles. This technique was used to study central CO2 sensitivity in 40 patients with chronic airways obstruction. Subnormal CO2 sensitivity was associated with chronic cough and sputum production, relatively mild dyspnoea, raised arterial CO2 tension, hypoxaemia, polycythaemia and cor pulmonale. Normal CO2 sensitivity was associated with severe dyspnoea, normal blood gas tensions, and allergic features.

Aged↗
PubMed1976

Assessment of responsiveness to carbon dioxide in patients with chronic airways obstruction by rate of isometric inspiratory pressure development.

1. Responsiveness to CO2 was measured in forty patients with chronic airways obstruction in terms of ventilation and rate of isometric inspiratory pressure change [(dP/dt)max]. 2. The ventilatory response was below the normal range in eighteen out of twenty-two patients with normal arterial CO2 tensions and in all of eighteen patients with CO2 retention. 2. The (dP/dt)max. response was distributed throughout the normal range in all but one of the patients with normal arterial CO2 tension. In all the patients with CO2 retention the (dP/dt)max. response was either at or below the lower limit of the normal range. 4. Although the ventilatory responses correlated significantly with FEV1 there was no such correlation for the (dP/dt)max. responses. 5. The (dP/dt)max. response showed a significant negative correlation with Pa,CO2. 6. It is believed that the (dP/dt)max. response to CO2 can be used to assess central CO2 responsiveness in subjects with airways obstruction independently of mechanical factors limiting their ventilation.

Aged↗
PubMed1975

The rate of isometric inspiratory pressure development as a measure of responsiveness to carbon dioxide in man.

1. A technique has been developed for assessing CO2 responsiveness by measuring the maximum rate of isometric inspiratory pressure change at the mouth [(dP/dt)max.]. 2. By use of a rebreathing technique, the (dP/dt)max. response to CO2 was shown to correlate well the ventilatory response in thirty-two normal subjects. 3. The addition of an external flow resistance sufficient to reduce the ventilatory response by a mean of 33.4% produced no significant mean change in the (dP/dt)max. response in thirty subjects. 4. In six patients recovering from bronchial asthma, reduction of airways obstruction led to a mean increase in the ventilatory response of 109% without any significant mean change in the (dP/dt)max. response. 5. An increase in lung volume did not reduce the (dP/dt)max. response in five normal subjects. 6. At very high lung volumes, six normal subjects were able to develop a higher (dP/dt)max. during voluntary inspiratory efforts than has been recorded during spontaneous breathing response to CO2. 7. It is believed that (dP/dt)max. represents the initial rate of development of force by the inspiratory muscles before this can be modified by mechanical loading, proprioceptive feedback mechanisms or conscious response and can therefore be used to study changes in the motor output of the respiratory centre in response to ventilatory stimuli independently of pulmonary mechanics.

Adult↗
PubMed1973

The use of combined ultrasonic and isotope scanning in the diagnosis of amoebic liver disease.

The use of combined isotope and ultrasonic scanning in the diagnosis of amoebic liver abscess is described, together with details of three cases of this condition seen in the Bristol area in a period of two years. The addition of ultrasonic scanning greatly increases the accuracy of diagnosis by demonstrating a fluid-filled, space-occupying lesion and should ideally be employed whenever liver abscess is suspected.

Adult↗