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Biomedical subjects

C J Howell

Publications and source records attributed to C J Howell.

At least 19 recordsLinked to original sources
PubMed2001

A randomised controlled trial of epidural compared with non-epidural analgesia in labour.

OBJECTIVES: To investigate possible short and long term side effects of epidural analgesia, compared with non-epidural analgesia for pain relief in labour. DESIGN: Randomised controlled study, with long term follow up by questionnaire. Analysis by intention-to-treat. SETTING: Busy maternity unit within a district general hospital in England. PARTICIPANTS: Three hundred and sixty nine primigravid women in labour were included (randomised allocation: epidural n = 184, non-epidural n = 185). MAIN OUTCOME MEASURES: Backache at three and twelve months after delivery, instrumental delivery rates and maternal opinion of pain relief in labour. RESULTS: No significant differences were found in the reported incidence of backache between the groups at three months: middle backache [22% vs 20%, chi2 = 0.057, P = 0.81; odds ratio (95% CI) 1.4(0.9-2.3)]; low backache [35% vs 34%, chi2 = 0.009, P = 0.92; odds ratio (95% CI) 1.0(0.6-1.6)]. Nor were there significant differences at 12 months: [middle backache 16% vs 16%, chi2 = 0.013, P = 0.91; odds ratio (95% CI) 1.0(0.5-1.8)]; or low backache [35% vs 27%, chi2 = 1.91, P = 0.17; odds ratio (95% CI) 1.4(0.9-2.3)]. The incidence of instrumental delivery was somewhat higher in the epidural group [30% vs 19%, odds ratio (95% CI) 1.77(1.09-2.86)]. Maternal satisfaction was not significantly different between the groups. CONCLUSIONS: This study provided no evidence to support the suggestion of a direct association between the use of epidural anaesthesia in labour and the incidence of long term backache. Despite a significant proportion of women in each group not receiving their allocated analgesia, a significant difference in terms of instrumental delivery rates remained. Satisfaction in both groups of women was high.

Adult↗
PubMed2000

Epidural versus non-epidural analgesia for pain relief in labour.

BACKGROUND: Epidural analgesia is effective in reducing labour pain, but the possible adverse effects are not clear. OBJECTIVES: The objective of this review was to assess the effects of epidural analgesia on pain relief and adverse effects in labour. SEARCH STRATEGY: The Cochrane Pregnancy and Childbirth Group trials register was searched. SELECTION CRITERIA: Randomised trials comparing epidural analgesia with other forms of analgesia not involving regional blockade, or no intervention. DATA COLLECTION AND ANALYSIS: Eligibility and trial quality were assessed by one reviewer. Study authors were contacted for additional information. MAIN RESULTS: Eleven studies involving 3157 women were included. Epidural analgesia was associated with greater pain relief than non-epidural methods, but also with longer first and second stages of labour, an increased incidence of fetal malposition, and increased use of oxytocin and instrumental vaginal deliveries. With new trial data included, no statistically significant effect on caesarean section rates could be identified. REVIEWER'S CONCLUSIONS: Epidural analgesia appears to be very effective in reducing pain during labour, although there appear to be some potentially adverse effects. Further research is needed to investigate adverse effects and to evaluate the different techniques used in epidural analgesia.

Analgesia, Epidural↗
PubMed1998

Dental extractions in patients on warfarin: is alteration of anticoagulant regime necessary?

Various clinical protocols for the management of warfarinised patients needing dental extractions have been suggested. This study was designed to compare two approaches in the management of these patients. A control group of 32 patients had their warfarin treatment stopped for 2-3 days prior to having dental extractions, resulting in a reduction in the average preoperative international normalised ratio (INR) from 2.6 to 1.6. The study group of 33 patients did not have their anticoagulant treatment altered before extractions, and had an average preoperative INR of 2.7. All patients were treated under local analgesia on an outpatient basis, and local measures-consisting of Surgicel pack and sutures-were used in all cases to control postoperative bleeding from extraction sockets. None of the patients had any immediate postoperative bleeding, and only 1 patient from each group had mild delayed haemorrhage, which was easily controlled with local measures. It is proposed that, provided the INR is within the therapeutic range of 2.0 to 4.0 and local measures are used to control postoperative bleeding, there is no justification in altering warfarin treatment prior to dental extractions in these patients, and thereby exposing them to the risk of thromboembolism.

Adult↗
PubMed1996

Medial epicondylectomy or ulnar-nerve transposition for ulnar neuropathy at the elbow?

We carried out a prospective randomised study comparing medial epicondylectomy with anterior transposition for the treatment of ulnar neuropathy at the elbow. The mean follow-up period was 4.5 years and we assessed the patients neurologically and orthopaedically. Neither procedure appeared to have a significant effect on elbow function. Our study showed better results after medial epicondylectomy; in particular patient satisfaction was higher than after ulnar nerve transposition. There were no significant differences in motor power or nerve-conduction rates and sensory fibres appeared to be more vulnerable to devascularisation.

Adult↗
PubMed1992

The AO dynamic condylar screw for fractures of the femur.

We report our initial experience in Nottingham of use of the AO Dynamic Condylar Screw (DCS) implant system for internal fixation of fractures of the proximal and distal femur. The implant has been used in 24 cases over a 2-year period, and with an average follow-up of 1 year the results have been as favourable as those in reports of other comparable implants, but there have been a number of technical difficulties, particularly with the fixation of osteoporotic distal femoral fractures. The DCS can be used in all situations where the 95 degrees blade plate has previously been used and technically it is easier to insert correctly. We conclude that whilst the DCS may replace the corresponding blade plates in the orthopaedic surgeon's armamentarium, it does not solve the problems of fixation of osteoporotic fractures. The indications for and difficulties of such internal fixations are discussed.

Adult↗
PubMed1992

A review of prospectively controlled comparisons of epidural with non-epidural forms of pain relief during labour.

OBJECTIVE: To assess the extent to which hypotheses about potential adverse effects of epidural analgesia during labour can be tested using evidence from controlled comparisons of epidural with non-epidural forms of pain relief. INCLUSION CRITERIA: Prospective studies in which an attempt had been made to use random allocation to generate comparable groups of women receiving epidural and non-epidural forms of pain relief during labour. IDENTIFICATION OF RELEVANT STUDIES: Systematic hand search of a total of 36 anaesthetic, obstetric and general journals, and more than 30 other journals (1950-1990), and a search of MEDLINE (1966-1990). DATA COLLECTION: Data were abstracted from published reports of 9 controlled trials, involving a total of 600 women. It was possible to obtain some missing information and data from the investigators. RESULTS: Very few postulated effects of epidural block during labour can be confirmed or rejected on the basis of the evidence generated by the small number of controlled trials. Evidence derived from these trials confirms that epidural block provides more effective relief of pain than alternatives; and that if it is continued during the second stage of labour, it can cause a substantial increase in the use of instrumental delivery. CONCLUSIONS: Considering the very widespread use of epidural block during labour, remarkably little is known about its short-term and long-term effects. In view of hypotheses about potentially important adverse effects, there is still a need to conduct larger, better designed randomised controlled trials.

Journal Article↗
PubMed1992

Posterior internal compression arthrodesis of the ankle.

We have reviewed the results of 19 ankle arthrodeses in 18 patients by a new technique of posterior internal compression. Sixteen of the ankles fused at a mean time of 14 weeks and the other three after reoperation. Complications included one case each of infection, Sudeck's atrophy and non-fatal pulmonary embolism. Clinical assessment using Mazur's ankle score showed excellent or good results in nine ankles and three painfree ankles in patients who were wheelchair-bound for other reasons. The mean position of fusion was in 1.7 degrees equinus and 0.8 degrees varus, and the mean range of midtarsal movements was 15.8 degrees. Twelve patients showed radiographic signs of talonavicular or subtalar osteoarthritis.

Adolescent↗
PubMed1991

Interactions of macrophages and monocytes with granulocytes in asthma.

The pathology of bronchial asthma demonstrates a multicellular process. The airway mucosa is infiltrated with both mononuclear cells and granulocytes, of which the eosinophil is particularly prominent. In an attempt to further the understanding of the interactions between different cells, we have elected to study the effects of monocyte/macrophage-derived cell products on granulocytes, because of the evidence for monocyte/macrophage activation in bronchial asthma.

Asthma↗
PubMed1989

Identification of an alveolar macrophage-derived activity in bronchial asthma that enhances leukotriene C4 generation by human eosinophils stimulated by ionophore A23187 as a granulocyte-macrophage colony-stimulating factor.

Incubation of eosinophils (EOS) with alveolar macrophage (AM) supernatants isolated from asthmatic subjects followed by stimulation with the calcium ionophore A23187 resulted in enhancement of the capacity of EOS to elaborate leukotriene C4 (LTC4) (mean enhancement 169 +/- 37%, n = 31). Pretreatment of EOS with AM supernatants derived from normal individuals did not enhance LTC4 generation as compared with control medium. Enhancement was maximal when EOS were preincubated with a 1:6 dilution of AM supernatants for 5 min at 37 degrees C and were then stimulated with 5 microM A23187 for 15 min. Separation of AM supernatants by size-exclusion HPLC using a TSK G3000 SW column resulted in a peak of enhancing activity with an estimated molecular mass of approximately 30,000 D. Further purification by anion exchange HPLC using a TSK DEAE 5PW column (pH 7.4) resolved the activity into a minor peak at 0.17 M NaCl and a major peak at 0.2 M NaCl. The activities were distinct from interleukin-1 and tumor necrosis factor. Resolution of the major peak of activity by reverse-phase HPLC using a C18 spherisorb ODS column and a slope gradient of 0 to 100% acetonitrile/0.1% trifluoroacetic acid demonstrated a single peak of activity that eluted at 41% acetonitrile. The enhancing activity was sensitive to trypsin and heat and was neutralized by a specific antibody to granulocyte-macrophage colony-stimulating factor (GM-CSF). Pretreatment of EOS with recombinant GM-CSF primed the cells for enhanced LTC4 generation following subsequent stimulation with A23187. GM-CSF may play a role in the amplification of the eosinophilic inflammation in asthmatic airways.

Adolescent↗
PubMed1988

The generation and cellular distribution of leukotriene C4 in human eosinophils stimulated by unopsonized zymosan and glucan particles.

Human eosinophils (EOSs) stimulated under optimal conditions with 5 X 10(8) unopsonized zymosan particles at 37 degrees C for 30 minutes produced an average total immunoreactive leukotriene (LT) C4 of 1.6 ng per 10(6) EOSs, and 30% to 60% of the generated product remained cell associated. The dose-response characteristics of zymosan-induced LTC4 generation were different from those of phagocytosis, suggesting that the two events were independent. Pretreatment of EOSs with 10(-8) mol/L of formyl-methionyl-leucyl-phenylalanine for 30 minutes led to a twofold to fivefold augmentation of LTC4 generation by cells subsequently activated by unopsonized zymosan. Optimal EOS activation with 1 mumol/L of the calcium ionophore A23187 at 37 degrees C for 15 minutes produced more than 100 times greater quantities of LTC4 than with zymosan. The amount of immunoreactive LTC4 that remained cell associated after calcium ionophore A23187 stimulation reached a maximum after 5 minutes and then declined. Of the relatively small amount generated in the first minute, 71% was cell associated, but this figure declined to 9% after 15 minutes, by which time there had been a redistribution of the LTC4 to the supernatant. Inflammatory leukocytes may respond to zymosan because the cells recognize either one or both of its major polysaccharide components, glucan and mannan. Glucan, but not mannan, stimulated EOSs to generate LTC4 in a dose- and time-dependent manner. Under optimal conditions, there was no significant difference in the total quantities of LTC4 elaborated by EOSs stimulated by glucan and by unopsonized zymosan. This suggests that zymosan may induce leukotriene generation in the human EOS through a glucan recognition mechanism.

Calcimycin↗
PubMed1987

A chemokinetic factor in the carp Cyprinus carpio.

The results describe experiments which demonstrate that the teleost Cyprinus carpio is capable of elaborating a substance which has analogous in vitro effects to that of mammalian chemokinetic lymphokines. In vitro stimulation of leucocytes from carp pronephros, both with antigens and mitogens, was used to provide culture supernatants which were applied to an in vitro chemokinetic assay. The chemokinetic factor-like activity could be detected in supernatants after one day of culture and at a dilution of 25%. The presence of lymphokines in fish supports the theory that lymphokine production is a fundamental property of vertebrate leucocytes and is of central importance in vivo cell-mediated immunity.

Animals↗
PubMed1986

The tricho-rhino-phalangeal syndrome. A report of 14 cases in 7 kindreds.

Tricho-rhino-phalangeal syndrome is probably not so much uncommon as unrecognised. Its significance to orthopaedic surgeons, apart from the functionally unimportant minor finger deformities, lies in its mimicking both Perthes' disease and diaphyseal aclasis. The 14 cases analysed in this paper illustrate the wide range of clinical variation.

Abnormalities, Multiple↗
PubMed1985

The sublingual dermoid cyst. Report of five cases and review of the literature.

Dermoid cysts are commonly found throughout the body. However, they occur only rarely in the oral cavity; most commonly they are sublingual. This article reviews five cases of sublingual dermoid cyst, which have been the only ones seen in the diagnostic indices of the Royal Dental Hospital, Leicester Square, the Middlesex Hospital, and Queen Victoria Hospital, East Grinstead.

Adolescent↗
PubMed1981

Spontaneous rupture of the Achilles tendon in a patient with gout.

A 49-year-old man with long-standing gout suffered a spontaneous rupture of the Achilles tendon. Surgical repair was performed, and gouty tophi were found in the severed end of the tendon. The possible causes of this spontaneous rupture are discussed.

Achilles Tendon↗