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Biomedical subjects

D Lowe

Publications and source records attributed to D Lowe.

At least 181 records · Page 10Linked to original sources
PubMed1984

Stopping rules for clinical trials incorporating clinical opinion.

A method is described of eliciting a 'range of equivalence', i.e. a range of differences between two treatments over which a group of clinical trial participants would have no clear preference for either treatment. This range of equivalence is then incorporated into a formal stopping rule for the trial using an extension of the group sequential design. Tables for the implementation of the design are presented. The method is discussed in the context of other sequential-trial designs.

Biometry↗
PubMed1984

Budd-Chiari syndrome with inferior vena cava obstruction associated with systemic lupus erythematosus.

The Budd-Chiari syndrome is an uncommon condition in which hepatic venous outflow is obstructed by thrombosis of the major hepatic veins. Many of the cases are idiopathic, but it has been described in association with vena caval webs, abdominal trauma, retroperitoneal neoplasms, and hypercoagulable states. A patient with systemic lupus erythematosus (SLE) who developed the Budd-Chiari syndrome with inferior vena cava thrombosis led to a review of the possible association between SLE and the Budd-Chiari syndrome. The therapy of the Budd-Chiari syndrome with associated vena cava thrombosis is also discussed.

Adult↗
PubMed1983

Airborne contamination of wounds in joint replacement operations: the relationship to sepsis rates.

During operations for total joint replacement done in operating rooms with conventional ventilation the mean air contamination varied considerably among the 15 hospitals studied. The range was from 51 to as many as 539 bacteria-carrying particles per cubic metre. When the data from all the hospitals were grouped according to the mean level of bacterial airborne contamination, including operations done in control and in ultraclean air, there was a good correlation between the air contamination and the joint sepsis rate. There was also a correlation between the mean values of air contamination and the numbers of bacteria isolated from wound wash-out samples; but the apparent efficiency of the sampling method varied a great deal among the hospitals carrying out this procedure. From this data it would seem that by far the largest proportion of bacteria found in the wound after the prosthesis had been inserted reached it by the airborne route. With the mean air contamination found in the control series, 164 bacteria-carrying particles per cubic metre, this proportion was as much as 95 per cent. The risk of joint sepsis varied widely among the 19 hospitals. The differences between the highest and lowest being probably as much as 20-fold. However, the effect of an ultraclean air environment was asimilar at all hospitals.

Air Microbiology↗
PubMed1983

Bacteria isolated from deep joint sepsis after operation for total hip or knee replacement and the sources of the infections with Staphylococcus aureus.

A wide variety of bacterial species, many usually regarded as of low pathogenicity, were isolated from septic joints after operation for total hip or knee joint replacement in a multi-centre trial of ultraclean air in operating rooms. The prophylactic antibiotics generally used appeared to reduce considerably the rates of infection with most species but to be ineffective against 'gut' organisms. For about half the septic infections involving Staphylococcus aureus nasal swabs had been obtained from the patient and operating staff at the time of operation for insertion of the prosthesis. Strains of Staph, aureus isolated from these and from the infected joints were phage typed and tested for antibiotic sensitivity. A probable source among the carriers was found for seven out of the 14 infections and a possible source for another five. Very small numbers of Staph. aureus were needed to initiate infection.

Air Microbiology↗
PubMed1983

Penile verrucous carcinoma.

Eleven patients with verrucous carcinoma of the penis are presented. The age range was from 41 to 80 years with a mean of 59 years. The pathological features of these tumours are described and the aetiology of penile verrucous carcinoma is discussed.

Adult↗
PubMed1983

Verrucous carcinoma of the penis (Buschke-Lowenstein tumour): a clinico-pathological study.

The variant of squamous carcinoma of the penis known as verrucous carcinoma is an uncommon but distinct clinical and pathological condition which has a significantly better prognosis than the more common infiltrative type. We report seven cases from a continuing larger study of the disease and discuss the clinical features, the histological criteria for diagnosis and the methods of treatment available.

Adult↗
PubMed1983

Prediction of outcome in psychogeriatric patients.

A 1-year follow-up study was carried out of the 212 patients aged 65 and over admitted to Fulbourn Hospital in 1980. Outcome was uniformly poor for patients with dementia and better but more variable in those with functional illnesses. No social or demographic variables were significantly associated with outcome in the demented group but age, female sex, previous admission and independent accommodation prior to admission were significantly associated with good outcome in those with functional illnesses. A predictive index was constructed relating social variables on admission to 1-year outcome.

Aged↗
PubMed1983

Progressive change in cerebral blood flow during the first three weeks after subarachnoid hemorrhage.

Cerebral blood flow (CBF) was estimated from each cerebral hemisphere by the 133Xe inhalation method. Daily estimates were made during the first 3 weeks after subarachnoid hemorrhage (1265 studies in 116 patients). Some of the patients were taking adrenergic blocking drugs (propranolol and phentolamine), others were taking tranexamic acid, and the rest were taking no drugs. CBF was also studied in 67 normal subjects. The resting CBF was related inversely to age not only for normal subjects but also for patients after subarachnoid hemorrhage (SAH). The CBF fell progressively during the first 2 weeks after SAH and was abnormally low throughout the 3 weeks after hemorrhage. For any 1 day after SAH, those patients who were fully alert had the smallest reduction in CBF. The progressive changes in CBF occurred whether or not an aneurysm was present on angiograms. For aneurysms situated to one side of the midline, the changes in CBF affected both sides of the brain. The progressive decline in CBF was least in those patients who subsequently made the best clinical recovery. Arterial pCO2 seemed to influence CBF throughout the 3 weeks after SAH. During the 2nd week, CBF was especially low in SAH patients treated with tranexamic acid. The serial changes in CBF are discussed in relation to current views concerning the timing of operation for ruptured aneurysms.

Adult↗
PubMed1982

Subarachnoid haemorrhage: older patients have low cerebral blood flow.

Daily estimations of hemispheral cerebral blood flow using the xenon-133 inhalation technique was made in 116 patients during the first three weeks after subarachnoid haemorrhage. The patients' cerebral perfusion on average remained less than the normal perfusion expected for their age (based on a single estimation of cerebral blood flow in 67 volunteers). On each separate day after subarachnoid haemorrhage cerebral blood flow was inversely related to the patient's age. Older patients seem especially at risk of developing cerebral ischaemia after subarachnoid haemorrhage. The clinical outcome was more often unfavourable in older patients--that is, in those who tended to have the lowest cerebral blood flow. Present results support the view that episodes of low cerebral blood flow lead to a poor outcome after subarachnoid haemorrhage. Because of the risk of inducing cerebral ischaemia great care should be exercised by physicians administering hypotensive drugs to older patients after subarachnoid haemorrhage.

Adult↗
PubMed1982

Effect of ultraclean air in operating rooms on deep sepsis in the joint after total hip or knee replacement: a randomised study.

In a multicentre study of sepsis after total hip or knee replacement the operations performed by each surgeon were allocated at random between control and ultraclean-air operating rooms. Records were obtained from over 8000 such operations. In the patients whose prostheses were inserted in an operating room ventilated by an ultraclean-air system the incidence of joint sepsis confirmed at reoperation within the next one to four years was about half that of patients who had had the operation in a conventionally ventilated room at the same hospital. When whole-body exhaust-ventilated suits had been worn by the operating team in a theatre ventilated by an ultraclean-air system the incidence of sepsis was about a quarter of that found after operations performed with conventional ventilation. When all groups in the trial were considered together the analysis showed deep sepsis after 63 out of 4133 operations in the control group (1.5%) and after 23 out of 3922 operations in the ultraclean-air groups (0.6%) (ratio 2.6, 95% confidence limits 1.6-4.2; p less than 0.001). The design of the study did not include a strictly controlled test of the effect of prophylactic antibiotics, but their use was associated with a lower incidence of sepsis than in patients who had received no antibiotic prophylaxis at their operations (0.6% (34/5831) v 2.3% (52/2221); ratio 4.0).

Air Microbiology↗
PubMed1982

Treatment of well-differentiated carcinoma of the thyroid based on initial staging.

Sixty-six patients with well-differentiated thyroid carcinomas have been followed up for a minimum of 10 years. A conservative surgical approach was adopted for unsuspected intrathyroid tumours. Twenty-three out of 29 patients (80 per cent) with papillary carcinomas and 18 out of 37 (50 per cent) with follicular carcinomas were alive at the time of review. Although patients with follicular carcinoma have only a moderate overall prognosis, patients with node-negative intrathyroid tumours (unsuspected) treated by conservative resection have a 79 per cent 10-year survival. These survival figures compare favourably with other reported series where all the patients were treated by radical surgery. Early conversion of a conservative resection to a total thyroidectomy for an unexpected tumour does not appear to be warranted since an increased risk of complications is not balanced by an improved outcome. Two patients, with intrathyroid papillary carcinomas who developed tumours in the residual gland more than 5 years after initial lobectomy, successfully underwent further resections of the thyroid remnants, and are disease free more than 9 years later.

Adenocarcinoma↗
PubMed1982

Intra-prostatic urinary reflux: an aetiological factor in abacterial prostatitis.

That urine might reflux into the prostatic ducts during micturition has never before been proved. Using a suspension of carbon particles it has been demonstrated that this can occur. It is suggested that this may be important both as a route of infection in bacterial prostatitis and as a cause of the inflammatory process in abacterial prostatitis.

Carbon↗
PubMed1982

Seasonal alteration in response to stress or physiological change.

Two pilot experiments are reported in which various combinations of stress, modifiers of glucose metabolism, and sulfur deficiency were investigated using urinary sulfur levels and tissue glucose and glycogen levels as indicators. Urinary sulfur levels increased under certain conditions of stress but decreased with the injection of Escherichia coli endotoxin, suggesting an anabolic reversal. Heart and blood glycogen levels fell in rats fed a sulfur-deficient diet. These results are discussed in relation to seasonal variations in protein and glucose metabolism.

Animals↗