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Don Wilson

Publications and source records attributed to Don Wilson.

10 recordsLinked to original sources
PubMed2006

5-hydroxytryptamine-3 receptor antagonist with or without short-course dexamethasone in the prophylaxis of radiation induced emesis: a placebo-controlled randomized trial of the National Cancer Institute of Canada Clinical Trials Group (SC19).

PURPOSE: To evaluate the effectiveness of prophylactic dexamethasone for the control of radiation induced emesis (RIE) when added to ondansetron during days 1 to 5 of fractionated radiotherapy. The study had two hypotheses: ondansetron and dexamethasone could provide superior control of RIE over ondansetron alone during the prophylactic period and; the combination could provide sustained control of RIE during subsequent fractions of radiotherapy. PATIENTS AND METHODS: Between May 2001 to Jan 2004, 211 patients receiving radiotherapy (> or = 15 fractions) to the upper abdomen were randomly assigned to receive ondansetron 8 mg bid with either dexamethasone 4 mg daily or placebo during fractions 1 to 5. Rescue antiemetics were provided. RESULTS: During the prophylactic period there was a trend for improved complete control of nausea in the dexamethasone arm (50% v 38%; P = .06) while complete and partial control of emesis, average nausea score, and use of rescue medications were similar in the two groups. During the overall study period patients receiving dexamethasone had better complete control of emesis (23% v 12%; P = .02) and a lower average nausea score (0.28 v 0.39; P = .03); there was a trend towards less use of rescue medications with dexamethasone (70% v 80%; P = .09); other outcomes were similar on the two arms. Quality of life analysis showed a significant difference in appetite. CONCLUSION: The addition of dexamethasone to ondansetron as prophylaxis provides a modest improvement in protection against RIE during moderately emetogenic fractionated radiotherapy. It is a potentially useful addition to 5-hydroxytryptamine-3 receptor antagonists in this setting.

Antiemetics↗
PubMed2006

Third trimester uterine torsion: case report.

BACKGROUND: Rotation of the gravid uterus is a normal finding in the third trimester of pregnancy. However, a pathologic rotation of the uterus beyond 45 degrees-torsion of the entire uterus-is rarely seen in obstetrical practice. We report here a case of uterine torsion from our obstetrical practice and a review of reported cases. CASE: The patient, a 36-year-old gravida 3 para 2 at 36 weeks' gestation with a singleton pregnancy, was admitted to the obstetrical unit with uterine cramping and decreased fetal movement. Her prior obstetrical history included two uncomplicated term vaginal deliveries, and the current pregnancy had been uncomplicated until the date of presentation. After 3 hours' observation, uterine cramping and tenderness increased, and fetal tachycardia developed. The presumptive diagnosis was a concealed placental abruption. The patient was not in labour, so an emergency Caesarean section (CS) was carried out. At the time of CS, the diagnosis of uterine torsion was made. The patient recovered and was discharged home with her baby on the third postoperative day. CONCLUSION: Uterine torsion is an infrequently reported and potentially dangerous complication of pregnancy that occurs mainly in the third trimester with adverse maternal and neonatal consequences.

Adult↗
PubMed2005

Faecal incontinence and mode of first and subsequent delivery: a six-year longitudinal study.

OBJECTIVE: To investigate the prevalence of persistent and long term postpartum faecal incontinence and associations with mode of first and subsequent deliveries. DESIGN: Longitudinal study. SETTING: Maternity units in Aberdeen, Birmingham and Dunedin. POPULATION: Four thousand two hundred and fourteen women who returned postal questionnaires three months and six years postpartum. METHODS: Symptom data were obtained from both questionnaires and obstetric data from case-notes for the index birth and the second questionnaire for subsequent births. Logistic regression investigated the independent effects of mode of first delivery and delivery history. MAIN OUTCOME MEASURES: Incontinence to bowel motions three months and six years after index birth. For delivery history, the outcome was incontinence only at six years. RESULTS: The prevalence of persistent faecal incontinence was 3.6%. Almost 90% of these women reported no symptoms before their first birth. The forceps delivery of a first baby was independently predictive of persistent symptoms (OR 2.06, 95% CI 1.40-3.04). A caesarean section first birth was not significantly associated with persistent symptoms (OR 1.07, 95% CI 0.64-1.81). Delivering exclusively by caesarean section also showed no association with subsequent symptoms (OR 1.04, 95% CI 0.72-1.50) but ever having forceps was significantly predictive (OR 1.48, 95% CI 1.18-1.87). Other factors independently associated with persistent faecal incontinence were older maternal age, increasing number of births and Asian ethnic group. Birthweight and long second stage were not significantly associated. CONCLUSIONS: The risk of persistent faecal incontinence is significantly higher after a first delivery by forceps. We found no evidence of a lower risk of subsequent faecal incontinence for exclusive caesarean section deliveries.

Adult↗
PubMed2005

A preliminary survey of Atopobium vaginae in women attending the Dunedin gynaecology out-patients clinic: is the contribution of the hard-to-culture microbiota overlooked in gynaecological disorders?

Preliminary studies have indicated that the recently described bacterium Atopobium vaginae may have an association with bacterial vaginosis (BV). Fifty-five women attending the gynaecology out-patient's clinic were tested for the presence of this micro-organism, Gardnerella vaginalis, Mobiluncus and Bacteroides species by polymerase chain reaction (PCR)-based assays. The frequency of detection was 40%. PCR detection of Gardnerella vaginalis with A. vaginae, occurred in 50% of A. vaginae-positive cases. Due to the high detection rate of A. vaginae we believe that it is important to determine whether this and other hard-to-culture microorganisms have a role in gynaecological disorders.

Actinobacteria↗
PubMed2005

A 15-year-old female with progressive myelopathy.

March 2005. A 15-year-old female presented with urinary retention, inability to walk and low back pain. MRI disclosed an elongated epidural mass in the thoracic spine with cord compression and invasion into the surrounding bone and soft tissue. Cytologic preparation at intraoperative consultation disclosed a rather monotonous small tumor cells with hyperchromatic nuclei and vacuolated cytoplasm. These vacuoles were best visualized with DiffQuick stain. Pathologic studies revealed an Ewing sarcoma/peripheral primitive neuroectodermal tumor (EWS/pPNET) with typical features including periodic acid Schiff positive diastase sensitive cytoplasmic substance; strong membranous pattern of immunoreactivity for CD99, and a reciprocal translocation of t(11;22)(q24;q12) that was demonstrated by fluorescent in situ hybridization (FISH). The vacuolated cytoplasm was produced by glycogen as demonstrated by electron microscopy. Although primary vertebral EWS/pPNETs are uncommon, they should be considered in the differential diagnoses of extradural/epidural mass of the spine in young patients.

Adolescent↗
PubMed2004

Radiotherapy for locally advanced basal cell and squamous cell carcinomas of the skin.

PURPOSE: To determine the outcomes of patients with locally advanced basal cell and squamous cell carcinomas of the skin treated with radiotherapy. METHODS AND MATERIALS: A retrospective review of the outcomes of patients with basal cell and squamous cell carcinomas treated with radical radiotherapy was conducted. Patients with T2 or more advanced disease or nodal disease were included. The clinical course after radiotherapy and factors that can affect locoregional control were analyzed. RESULTS: Four-year locoregional controls for basal cell and squamous cell carcinomas are 86% and 58%, respectively. The median time to recurrence of basal cell and squamous cell carcinomas are 40.5 months and 5.0 months, respectively. No deaths resulted from basal cell carcinomas, but 65% (30/46) of all patients with locoregional recurrent squamous cell cancers died from the disease. Uncontrolled locoregional disease was the cause of death in 81% (30/37) of all patients who died of squamous cell cancers. CONCLUSIONS: Basal cell carcinomas can be well controlled with radiotherapy even when locally advanced. Squamous cell carcinomas have a much poorer outcome and can recur quickly after radiotherapy. Locoregional failure remains the predominant cause of death in recurrent squamous cell carcinomas.

Adult↗
PubMed2004

The effect of preapplication of corticosteroids on skin irritation and performance of the GlucoWatch G2 Biographer.

Skin irritation due to iontophoresis may limit the frequency of use of devices for drug delivery or transdermal extraction of analytes of clinical interest. This study examined whether preapplication of corticosteroid preparations could reduce skin irritation from iontophoresis used by the GlucoWatch G2 Biographer (Cygnus, Inc., Redwood City, CA) in monitoring interstitial glucose levels frequently and automatically. Numerous corticosteroid preparations were screened to identify formulations that did not interfere with adhesion of the Biographer to the skin or glucose sensing. Kenalog (Westwood-Squibb Pharmaceuticals, Inc., Buffalo, NY) (triamcinolone acetonide) and Cortizone-10 Quick Shot (Pfizer, Inc., New York, NY) (hydrocortisone) sprays were selected and, in a double-masked, randomized, controlled trial, were applied to the forearms of 66 subjects with diabetes and allowed to dry. Biographers were applied and worn for 15 h, and home blood glucose measurements were taken every 30 min to assess accuracy. Irritation was assessed periodically by trained observers and study subjects. Skin irritation was reduced by both corticosteroid sprays, with the fraction of subjects who experienced moderate irritation reduced by 57% and 43% for the Kenalog and Cortizone-10 Quick Shot sprays, respectively. The treatment effect persisted at the 1-week assessment. Preapplication of these preparations did not affect the clinical utility of interstitial glucose readings. Preapplication of Kenalog or Cortizone-10 Quick Shot sprays significantly reduced skin irritation due to iontophoresis, and did not interfere with glucose measurements. This approach may enable the minority of users who experience moderate to severe skin irritation to use the Biographer more frequently for diabetes management.

Adrenal Cortex Hormones↗
PubMed2003

Laparoscopic colposuspension: a systematic review.

OBJECTIVE: To determine the effectiveness of laparoscopic colposuspension for the treatment of stress urinary incontinence. DESIGN: Systematic review. SETTING: Teaching hospitals. POPULATION: Women with symptoms or urodynamic diagnosis of stress, urge or mixed incontinence. METHODS: Randomised and 'quasi-randomised trials' in women with symptoms or urodynamic diagnoses of stress, urge or mixed incontinence including laparoscopic surgery in at least one arm of the trial were identified from the Cochrane Incontinence Review Group's Specialised Register of Controlled Trials. MAIN OUTCOME MEASURES: Subjective cure, objective cure, quality of life measurements and surgical outcome measures. RESULTS: Eight trials met the inclusion criteria. Five trials compared laparoscopic (n = 233) with open (n = 254) colposuspension. Risk of a positive stress test at follow up was significantly less in the open group (relative risk [RR] 0.89, 95% confidence interval [CI] 0.82 to 0.98). When one poor quality trial was excluded from the analysis, the relative risk was still less in the open group, but was no longer significant (RR 0.91, 95% CI 0.82 to 1.01). If considered as risk difference there is a 9% significantly higher risk of failure for laparoscopic colposuspension, however, excluding one poor quality trial, this risk of failure is non-significant at 8%. Analysis of subjective cure showed no difference between the groups. A trend was shown towards a higher complication rate, less post-operative pain, shorter hospital stay and time to return to normal function for laparoscopic compared with open colposuspension. Three trials compared different methods of laparoscopic colposuspension. Data from these trials could not be combined in view of the differences in the trials. Based on a single trial, two sutures were better than one. Sutures were as effective as mesh/staples. No conclusion could be drawn about the benefits of transperitoneal or extraperitoneal access. CONCLUSIONS: It is difficult to make valid conclusions as the evidence is limited by short term follow up and small numbers of trials and participants. However, it is possible that no difference exists between laparoscopic and open colposuspension for either objective or subjective cure. Further, well designed and adequately powered randomised controlled trials are required.

Female↗
PubMed2002

Utilization of preoperative urodynamic studies by Canadian gynaecologists.

OBJECTIVES: (1) To determine the proportion of Canadian gynaecologists who have urodynamic studies (UDS) readily available; (2) to assess the preoperative UDS utilization patterns of Canadian gynaecologists in various clinical scenarios of stress urinary incontinence (SUI). METHODS: A mail survey was sent to all 1266 obstetrician/gynaecologist members of the Society of Obstetricians and Gynaecologists of Canada (SOGC), as part of an international survey with the U.K., U.S.A., New Zealand, and Australia. Survey questions included geographic availability of UDS and specific types of urodynamics testing available. Utilization of urodynamics prior to anti-incontinence surgery was assessed in four clinical scenarios: (A) a history of uncomplicated primary stress urinary incontinence, (B) a history of mixed stress and urgency incontinence, (C) stress incontinence with a history of straining to void, and (D) recurrent stress incontinence. RESULTS: Of the 1266 surveys mailed, 230 (18%) were returned. Forty-four of the respondents did not manage incontinent women. Of the 186 respondents who did, 27% reported a special interest or additional postgraduate training in urogynaecology, and 73% were general gynaecologists. UDS were available in the same centre or city to 79% of respondents. For uncomplicated primary stress incontinence, 47% would always obtain preoperative UDS, 42% would not, and 11% would only if UDS were readily available. For the total group of respondents, in scenario A 47% would always obtain preoperative UDS, 42% would not, and 11% would only if UDS were readily available. Among general gynaecologists, in scenario A, if UDS were available in their city or centre of practice, 54% would always obtain preoperative UDS, as compared to 5% by general gynaecologists who did not have UDS available in their city or centre of practice. CONCLUSION: The data collected in this survey are compromised because of the low response rate. However, most (79%) of the respondents who manage women with urinary incontinence had access to urodynamics in the same centre or city. The utilization of urodynamics prior to surgical treatment of uncomplicated primary pure stress incontinence varies depending on the availability of such testing. An uncomplicated history of primary SUI and decreased availability of testing were two factors seen to have an effect of decreasing utilization of preoperative UDS. Hospital management did not always comply with SOGC guidelines for preoperative testing for SUI. Updating and dissemination of these guidelines is necessary to ensure "best" practice and highest quality of care for all women with SUI in Canada.

Canada↗