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Biomedical subjects

C Dewey

Publications and source records attributed to C Dewey.

17 recordsLinked to original sources
PubMed2001

Novel erythropoiesis stimulating protein for treatment of anemia in chronic renal insufficiency.

BACKGROUND: Novel erythropoiesis stimulating protein (NESP) is a glycoprotein with a threefold longer terminal half-life than recombinant human erythropoietin (rHuEPO) in humans. The aim of this study was to determine whether NESP is effective for the treatment of anemia at a reduced dosing frequency relative to rHuEPO in patients with chronic renal failure not yet on dialysis [chronic renal insufficiency (CRI)]. METHODS: This was a multicenter, randomized, open-label study. A total of 166 rHuEPO-naive patients with CRI were randomized in a 3:1 ratio to receive NESP (0.45 microg/kg once weekly) or rHuEPO (50 U/kg twice weekly) administered subcutaneously for up to 24 weeks. Dose adjustments were made as necessary to achieve a hemoglobin response, defined as an increase > or =1.0 g/dL from baseline and a concentration > or = 11.0 g/dL. RESULTS: During the 24-week treatment period, 93% (95% CI, 87 to 97%) of patients receiving NESP and 92% (95% CI, 78 to 98%) of patients receiving rHuEPO achieved a hemoglobin response. The median time to response was seven weeks (range of 3 to 25 weeks) in both groups. After correction of anemia, mean hemoglobin concentrations were maintained within the target range of 11.0 to 13.0 g/dL for the remainder of the 24-week treatment period. The safety profiles of NESP and rHuEPO were similar, and no antibodies were detected to either drug. CONCLUSIONS: These results demonstrate that NESP safely and effectively corrects and maintains hemoglobin concentrations at a reduced dosing frequency relative to rHuEPO in patients with CRI, providing a potential benefit to patients and health care providers.

Aged↗
PubMed2000

The relationship between otitis media with effusion and contact with other children in a british cohort studied from 8 months to 3 1/2 years. The ALSPAC Study Team. Avon Longitudinal Study of Pregnancy and Childhood.

OBJECTIVE: It is generally acknowledged that otitis media with effusion is more prevalent among children attending grouped day care. This study aimed to refine this by determining the relationships with the numbers of children at the place of day care, the age of the child and the number of siblings he/she had. METHODS: ALSPAC (the Avon Longitudinal Study of Pregnancy and Childhood) is a population based longitudinal study starting early in pregnancy and following the children throughout their lives. Nested within this study, a randomly selected group of 1590 children, the Children in Focus, were invited to attend a clinic for hands on examinations. Tympanometry was carried out at ages 8, 12, 18, 25, 31, 37 and 43 months of age. Bilateral otitis media with effusion (OME) was identified if both ears showed a flat trace. Multi-level modelling with logistic regression adjusted for a number of social and environmental influences. RESULTS: Of the 1590 children invited to the 8-month clinic, 300 (19%) were excluded from the analysis because of failure to attend or because of missing data. The analyses were based on 1290 children. The prevalence of bilateral OME decreased with age, from 24.6% at 8 months to 11.9% at 43 months. Children with older siblings and those attending day care with four or more other children were at an increased risk of OME. The adjusted odds ratios (AOR) were 1.52 (95% confidence interval [CI] = 1.23, 1.88) and 1.36 (95% CI = 1.02, 1.82), respectively. The risk associated with older siblings declined with age and by 3 years these children were no longer more likely to have OME than children with no older siblings. No such interaction with age was found for children in group day care and these children continued to be at an increased risk over the entire age period of the study. There was no increased risk associated with day care when no other children attended (AOR = 1.18, 95% CI = 0.88, 1.58) or when one to three others were present (AOR = 1.10, 95% CI = 0.85, 1.42). Although there was no relationship with the number of hours spent in day care, children who had started attending group care with four or more other children before 9 months of age did have an increased risk compared with children starting later AOR = 1.88, 95% CI = 1.12, 3.14. CONCLUSIONS: These results provide evidence that early contact with other children increases the risk of OME and that children attending day care with four or more other children remain at an increased risk of OME at least until 31/2 years.

Acoustic Impedance Tests↗
PubMed2000

The frequency of otitis media with effusion in British pre-school children: a guide for treatment. ALSPAC Study Team.

Data on the prevalence of otitis media with effusion (OME) as shown by serial tympanometry is presented for young children during the first 5 years of life. The children were participants in the Avon Longitudinal Study of Pregnancy and Childhood (ALSPAC); a randomly selected 10% (n = 1400) of whom were selected for examination at ages 8, 12, 18, 25, 31, 37, 43, 49 and 61 months. Whilst sex had no effect, there was a decrease in prevalence of OME with increasing age. There was a marked seasonal effect on the prevalence of OME. Bilateral and unilateral OME were significantly more prevalent in the winter than in the summer months (36.6% in February in children aged 8 months compared with 16% at 61 months and 16.4% in August in children aged 8 months compared with 3.1% at 61 months). The results form an important background against which to assess both the results of screening and also the indications for surgical treatment.

Acoustic Impedance Tests↗
PubMed1998

Does the supine sleeping position have any adverse effects on the child? II. Development in the first 18 months. ALSPAC Study Team.

OBJECTIVE: To assess whether the recommendations that infants sleep supine could have adverse consequences on their motor and mental development. DESIGN: A prospective study of infants, delivered before, during, and after the Back to Sleep Campaign in the United Kingdom, followed to 18 months of age. SUBJECTS: The children were participants of the Avon Longitudinal Study of Pregnancy and Childhood born to mothers resident in the three former Bristol-based health districts of Avon, with expected date of delivery from April 1, 1991 to December 31, 1992. Questionnaires were completed on sleeping position at 4 to 6 weeks of age and sets of standardized questions on development at 6 and 18 months. MAIN OUTCOME MEASURES: Social, communication, fine and gross motor, and total developmental scales based on the Denver Developmental Screening Test at 6 and 18 months. RESULTS: After adjustment for 27 factors using multiple regression, 3 of the 10 scales and subscales significantly distinguished between front and back sleeping position. At 6 months of age, infants put to sleep on their front had a mean score 0.38 SD (95% confidence interval [CI]: 0.28, 0.49) higher on the gross motor scale, 0.11 SD (95% CI: 0.00, 0.23) higher in the social skills scale, and a total development score 0.20 SD (95% CI: 0.10, 0.30) higher than those on their backs. These differences were no longer apparent at 18 months. CONCLUSIONS: There is some evidence that putting infants to sleep in the supine position results in a reduced developmental score at 6 months of age, but this disadvantage appears to be transient. Weighing this against the adverse health effects demonstrated with the prone sleeping position, these results should not change the message of the Back to Sleep Campaign.

Child Development↗
PubMed1994

[MRT in nonpalpable testes].

Magnetic resonance imaging was performed in 22 male patients for localisation of 27 nonpalpable undescended testes. The operative verification, carried out in 19 testes (15 patients) served as basis for checking on the accuracy of MRI results and for their comparison with those of sonography and laparoscopy. The impalpable testis was localised via MRI in 13 cases and its lack was correctly established in three cases. There were three false MRI diagnoses. The suspicion of two intraabdominal localised testes were not confirmed at surgery and one intracanalicular testes were not seen by MRI. The low signal intensity of the undescended testes on T2-weighted images is indicative for fibrotic changes and may be of value for more accurate planning of the operative volume. MRI offers a new promising opportunity for localisation and morphologic estimation of the undescended testis and should be performed before the invasive investigation methods.

Adolescent↗
PubMed1990

[Dynamic MRT after Gd-DTPA administration in kidney transplants: the susceptibility and T2 effects].

35 kidney transplanted patients (15 without pathological findings and 20 with histologically proven chronic rejection) were investigated with a combination of dynamic MR and bolus application of Gd-DTPA. The occurrence of susceptibility artifacts and T2 effects at the junction between papilla and renal calix were analysed. There are two groups of patients. The first one shows only artifacts due to susceptibility. The second group indicates the so-called "dark ring pattern" (susceptibility artifacts and T2 effects). These effects are discussed in terms of their dependence on concentration and their dependence on the degree of transplant malfunction. The appearance of "dark-ring patterns" and of susceptibility artifacts indicate the functional status of the glomerular filters.

Contrast Media↗
PubMed1989

[The use of imaging procedures following kidney transplantation--diagnostic strategy].

Despite the continuously increasing number of successfully transplanted kidneys, graft and patient are still "threatened" by several postoperative complications as acute and chronic rejection, acute tubular necrosis, urologic and vascular complications and disorders caused by immunosuppressive medication. An early and safe detection of these conditions is of high clinical importance and a challenge to diagnostic imaging. All radiologic methods and nuclear medicine have their value for transplantation diagnostics, but in recent years a trend to noninvasive methods with no contrast media and little discomfort to the patient is clearly visible (sonography, magnetic resonance). Rational diagnostic strategies for various conditions after renal transplantation are described.

Diagnostic Imaging↗
PubMed1987

CT diagnosis of hepatic adenoma.

Only few publication have so far been known on case histories in the context of CT-findings of hepatic adenoma (HA). An analysis was, therefore, made of the findings of ten patients with HA. Precontrast and postcontrast scans (dynamic CT), densitometric evaluations (gamma-fit) and "profile" determination were taken into consideration. Diagnostic relevance is attributed to two types of features (with and without tumour haemorrhage) as well as to complementary findings (capsule-like structure and fat-ring around the tumour, island-like areas).

Absorptiometry, Photon↗
PubMed1986

[CT diagnosis of focal nodular hyperplasia].

The paper analyses the findings of a CT study of 21 lesions of focal nodular hyperplasia in 17 patients. In addition to subjective valuatin of the dynamic studies, densitometric measurements on a time basis were carried out (gamma-fit curves) and a density profile was obtained. These tumour-like lesions show typical density changes with rapid enhancement in the arterial phase and rapid fall in density after one or two minutes. Various patterns of the hyperdense lesions (non-homogeneous, those resembling vessels or homogeneous lesions) may be of significance in differential diagnosis. Atypical density patterns were found particularly in foci projecting from the liver.

Adolescent↗
PubMedDate not supplied

Simple and effective technique of guided biopsy in a closed MRI system.

BACKGROUND: Magnetic resonance (MR)-guided biopsies are generally regarded as complex interventions. We implemented interventional MR (IMR) with the resources available in and for practical application in a large (1100 beds) central hospital. METHODS: This simple and straightforward IMR technique uses a step-by-step approach for localization, access route planning, biopsy, verification in at least two planes, and postoperative control. The technique has been used and evaluated unchanged for more than 400 punctures and interventions. RESULTS: Contrast, signal, matrix options, and visibility of needle track and tip permit uncomplicated orientation. The mean duration of a biopsy is 19 min. The technique can be applied to all radiologic puncture settings without any technical or medical complications. CONCLUSION: The crucial step in implementing IMR is not to contemplate its application but to simply start applying the procedure.

Aged↗
PubMedDate not supplied

Spinal cord swelling as a myelographic indicator of prognosis: a retrospective study in dogs with intervertebral disc disease and loss of deep pain perception.

The association of myelographic spinal cord swelling with neurological outcome was examined in 46 dogs with intervertebral disc disease and absence of deep pain perception (DPP). Spinal cord swelling was measured by calculating a ratio of the length of the loss of the myelographic dye column to the length of the second lumbar vertebra (L2). A positive neurological outcome was defined as return of voluntary motor function. A cut-off value for swelling:L2 of 5.0 was established by the creation of a receiver operator characteristic curve. Using a swelling:L2 ratio of 5.0 as a cutoff for indication of neurological recovery yielded a sensitivity of 74% and a specificity of 61%. Overall neurological recovery rate was 43%. Dogs with spinal cord swelling:L2 ratios less than 5.0 had a recovery rate of 61%, whereas dogs with a ratio greater than or equal to 5.0 had a recovery rate of 26%. Evaluation of these data by chi square analysis confirmed that a ratio less than 5.0 was associated with a positive outcome, and a ratio greater than or equal to 5.0 was associated with a negative outcome, (P < .05). Although other factors, such as duration of neurological signs, affect neurological outcome in dogs with no DPP, evaluation of myelographic spinal cord swelling can assist in establishing a prognosis.

Animals↗