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Biomedical subjects

I W Fellows

Publications and source records attributed to I W Fellows.

45 records · Page 3Linked to original sources
PubMed1985

The effect of anaesthetic induction with etomidate on the endocrine response to surgical trauma.

In order to investigate the effects of anaesthetic induction with a single bolus dose of etomidate on the endocrine response to a standard surgical stress, five patients were randomly allocated to receive etomidate and five to receive thiopentone as an induction agent prior to elective inguinal hernia repair. The group receiving etomidate showed a significant suppression in the circulating level of cortisol at 90 and 120 min post-induction (P less than 0.001) and an elevation in their plasma adrenocorticotrophic hormone at 240 and 360 min post-induction (P less than 0.001). The effect of a bolus dose of etomidate upon circulating cortisol levels was transient and no cardiovascular instability was noted during the study. The etomidate group also showed suppression of their circulating testosterone levels at 90 min post-induction (P less than 0.001), suggesting that etomidate inhibits steroidogenesis at a site other than 11 beta-hydroxylase.

Adrenocorticotropic Hormone↗
PubMed1984

The nutritional effects of endoscopic intubation for carcinoma of the oesophagus or cardia.

The nutritional status in 17 patients with unresectable carcinoma of the oesophagus or cardia was assessed before and one month after endoscopic intubation by measurement of body weight, triceps skinfold thickness, midarm circumference and serum albumin concentration. There was a significant increase in dietary energy intake and weight loss was arrested in 10 patients. A weight gain of 3 kg or more was recorded in six cases of which two put on 8.4 and 9.4 kg respectively with concommitant increases in midarm circumference. It is concluded that endoscopic intubation of carcinoma of the oesophagus or cardia commonly benefits nutritional status by relieving dysphagia.

Journal Article↗
PubMed1984

The influence of environmental temperature upon the thermoregulatory responses to ethanol in man.

Ten healthy male subjects ingested ethanol (BP; 0.5 g/kg body weight) after an overnight fast, on two separate occasions, at environmental temperatures of either 21 degrees C or 30 degrees C. The mean maximal fall in deep body temperature was not significantly different on the two occasions, being 0.18 degrees C and 0.17 degrees C respectively. Metabolic rates throughout the experiments at the two temperatures were not significantly different. The vasodilatation of the hand and forearm vascular beds after ethanol ingestion was markedly reduced at the lower environmental temperature. In three subjects who ingested a higher dose of ethanol (BP; 1.0 g/kg body weight) after an overnight fast, at an environmental temperature of 21 degrees C, the mean maximum fall in core temperature was 0.15 degrees C, which was not significantly different from the change seen after consumption of the lower dose of ethanol. It is likely that the failure of ethanol ingestion to provoke hypothermia at the lower environmental temperature was due to the attenuated vasodilatation observed under these conditions.

Adult↗
PubMed1983

Adrenocortical suppression in multiply injured patients: a complication of etomidate treatment.

Three patients admitted to the intensive care unit after multiple injury were observed to suffer episodes of adrenocortical insufficiency suggested by clinical manifestations and confirmed by appropriately low cortisol concentrations. This prompted a prospective study of pituitary-adrenocortical function in six multiply injured patients, three of whom showed evidence of adrenocortical suppression. The only factor common to the six patients with abnormally low adrenocortical function was an association between periods of adrenocortical suppression and intravenous infusion of etomidate; when the drug was stopped adrenocortical function was restored, and renewed administration of the drug caused further inhibition. Etomidate infusions lasting only six hours were found to cause low, flat responses to short tetracosactrin tests and grossly raised plasma concentrations of adrenocorticotrophic hormone, suggesting direct suppression of the adrenal cortex. Median plasma cortisol concentrations measured at 0900 were significantly lower and median plasma concentrations of adrenocorticotrophic hormone measured at 0900 were significantly higher in the three patients studied prospectively who were receiving etomidate infusions compared with the three patients who did not receive etomidate (p = 0.05).

Adolescent↗
PubMed1983

Pneumatic dilatation in achalasia.

To assess the value of pneumatic dilatation of the cardia, 63 patients with achalasia have undergone a total of 107 Rider-Moeller dilatations over the last six years. There was a marked improvement in swallowing immediately after dilatation in all but two patients, there were no deaths attributable to the procedure and serious complications were rare (1.6% of patients). The first 50 cases have been followed from nine to 73 months after their initial dilatation (mean follow-up 29.7 months). Twenty nine patients (58%) have not required a further dilatation, 19 patients (38%) required between one and three further dilatations and two patients (4%) required four more dilatations. Continuing need for further dilatation was significantly greater in those patients aged under 45 years than in those aged 45 or more at the time of their initial dilatation (p less than 0.001). Cardiomyotomy was necessary in five patients (10%), because of poor response to pneumatic dilatation; all five cases were under 45 years old at their initial dilatation. Pneumatic dilatation is a safe and effective treatment for achalasia, particularly in the older patient, and in our opinion should be the initial treatment for all patients with achalasia, reserving surgical cardiomyotomy for those who do not respond to several dilatations.

Adolescent↗
PubMed1983

Type III glycogenosis presenting as liver disease in adults with atypical histological features.

Two cases of type III glycogen storage disease are reported in adults; the occurrence of cirrhosis in one case illustrates the potential development of chronic liver disease in this condition. The other was the oldest patient with this condition found in a review of published reports. Electron microscopy of peripheral blood leucocytes to demonstrate excess glycogen was found to be a quick and useful aid to diagnosis. Histology of these adult cases showed a distribution of hepatocyte vacuolation which has not been previously recorded.

Adult↗
PubMed1982

Non-steroidal anti-inflammatory drugs and benign oesophageal stricture.

Drug histories were obtained from 76 patients at the time of initial Eder-Puestow dilatation for benign oesophageal stricture. Six patients had consumed drugs known to cause oesophageal ulceration (emepronium bromide and potassium preparations). Of the remaining 70 patients, 22 had regularly taken a non-steroidal anti-inflammatory drug before the onset of dysphagia compared with 10 patients in a control group matched for age and sex; this difference was significant (p less than 0.02). Non-steroidal anti-inflammatory drugs may have a causative role in the formation of oesophageal stricture in patients with gastro-oesophageal reflux, in whom they should be prescribed with caution.

Administration, Topical↗
PubMed1982

Oesophageal stricture associated with emepronium bromide therapy.

Emepronium bromide, a drug used to control urinary frequency, has been reported as causing oesophageal ulceration but not stricture formation. This paper presents 3 cases in which the use of emepronium bromide preceded development of an oesophageal stricture and suggests that the drug played a causative role.

Aged↗