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Biomedical subjects

J Geoghegan

Publications and source records attributed to J Geoghegan.

17 recordsLinked to original sources
PubMed1999

Preconditioning of donor livers with prostaglandin I2 before retrieval decreases hepatocellular ischemia-reperfusion injury.

BACKGROUND: Prostaglandins have been shown to protect against a variety of liver insults, including ischemia-reperfusion injury. Decreased graft injury and improved survival have been demonstrated in animal studies of liver transplantation after donor pretreatment with prostaglandin before organ retrieval. This potential clinical application has not been examined in human subjects. PATIENTS AND METHODS: One hundred and six liver donors were randomly assigned to receive either prostaglandin I2 (epoprostenol, 500 microg intravenous bolus) immediately before cold perfusion or no drug as control. Donor and recipient characteristics were recorded, and liver function tests were monitored after transplant to assess the effect of epoprostenol on graft injury. RESULTS: Donor pretreatment with epoprostenol significantly improved the rapidity and homogeneity of graft reperfusion. Epoprostenol pretreatment also significantly reduced peak values of transaminases after transplantation: serum glutamic-pyruvic transaminase, control (851+/-121 international units [IU]/L) and epoprostenol (463+/-78 IU/L); serum glutamic-oxalaacetic transaminase, control (870+/-127 IU/L) and epoprostenol (463+/-78 IU/L); serum glutamate dehydrogenase, control (458+/-95 IU/L) and epoprostenol (170+/-30 IU/L); P<0.01 for all, by t test. Serum levels of bilirubin and alkaline phospatase were not significantly altered by donor pretreatment with epoprostenol. CONCLUSIONS: Reduction of ischemia-reperfusion injury by administration of epoprostenol before graft retrieval may have important applications in liver transplantation. Further studies are required to establish the mechanism of this effect and to define its precise role in clinical practice.

Adolescent↗
PubMed1997

Conversion of recurrent delta-positive hepatitis B infection to seronegativity with famciclovir after liver transplantation.

BACKGROUND: Recurrent hepatitis B infection after liver transplantation is associated with poor graft and patient survival. Famciclovir is a nucleoside with virostatic action in hepatitis B infection. We report the case of a 51-year-old patient who developed recurrent delta-positive hepatitis B infection after liver transplantation. After famciclovir treatment, he became seronegative for hepatitis B early and hepatitis B surface antigens and developed protective anti-hepatitis B surface antibody titers. METHODS: After recurrent hepatitis B was confirmed, treatment with famciclovir was initiated. RESULTS: Eighteen days after starting famciclovir, the patient became seronegative for hepatitis B early antigen and delta antigen, and hepatitis B virus DNA was no longer detectable in serum. Three months later, the patient became hepatitis B surface antigen negative and remains well 16 months later with increasing anti-hepatitis B surface levels. CONCLUSIONS: Antiviral treatment with famciclovir may be useful in treatment of delta-positive hepatitis B infection following liver transplantation. Further evaluation of famciclovir in treatment and prevention of hepatitis B in these patients is warranted.

2-Aminopurine↗
PubMed1997

Clinical uses of gut peptides.

OBJECTIVE: The authors review clinical applications of gut-derived peptides as diagnostic and therapeutic agents. SUMMARY BACKGROUND DATA: An increasing number of gut peptides have been evaluated for clinical use. Earlier uses as diagnostic agents have been complemented more recently by increasing application of gut peptides as therapeutic agents. METHOD: The authors conducted a literature review. RESULTS: Current experience with clinical use of gut peptides is described. Initial clinical applications focused on using secretomotor effects of gut peptides in diagnostic tests, many of which have now fallen into disuse. More recently, attention has been directed toward harnessing these secretomotor effects for therapeutic use in a variety of disorders, and also using the trophic effects of gut peptides to modulate gut mucosal growth in benign and malignant disease. Gut peptides have been evaluated in a variety of other clinical situations including use as adjuncts to imaging techniques, and modification of behaviors such as feeding and panic disorder. CONCLUSIONS: Gut peptides have been used successfully in an increasing variety of clinical conditions. Further refinements in analogue and antagonist design are likely to lead to even more selective agents that may have important clinical applications. Further studies are needed to identity and evaluate these new agents.

Adenoma, Islet Cell↗
PubMed1990

Duodenal obstruction in advanced pancreatic carcinoma: how effective is gastroenterostomy in palliation?

Gastro-enterostomy produces variable and often disappointing results in the management of duodenal obstruction due to advanced pancreatic carcinoma. In a series of 51 patients who had palliative surgery for carcinoma of the pancreas five required a gastro-enterostomy. Three of these subsequently had difficulty with gastric emptying. The problem of gastro-enterostomy failure in palliation of pancreatic carcinoma is discussed.

Aged↗
PubMed1990

Iliac artery aneurysm in Marfan's syndrome.

A case of iliac artery aneurysm in a young male patient with Marfan's Syndrome is described. The aneurysm was managed by a simple exclusion technique. The occurrence of such an aneurysm suggests that the inherent mural weakness in the syndrome is more widespread in the arterial tree than is generally appreciated. The association of iliac artery aneurysm and Marfan's Syndrome does not seem to have been previously reported.

Adult↗
PubMed1990

The Convatec Wound Manager: a new stoma appliance.

Very occasionally, the surgeon must deal with a complicated abdominal wound which drains large volumes of fluid. One such situation arises when a postoperative enteric fistula occurs in association with a partial or complete dehiscence of a laparotomy wound. Another example occurs when the abdominal cavity is left open in the management of severe intra-abdominal sepsis. Both result in large abdominal wounds that are not satisfactorily contained by conventional dressings. Frequent changes of dressing are required and considerable skin excoriation and damage may occur. In addition, quantification of fluid output from a fistula may be grossly inaccurate. We wish to report the use of a new stoma appliance, the Convatec Wound Manager (Squibb Surgicare) which facilitates the management of these wounds. The case described illustrates many of the advantages of the appliance.

Aged↗
PubMedDate not supplied

Shared governance: developing a British model.

This article will examine the concept of shared governance and describe the development of a model for a British NHS trust. The philosophy of shared governance will be related to a decentralised style of management and the consequences that this will have for managers and staff nurses. The introduction of shared governance in the USA has realised many benefits. However, limitations have also been illustrated and these will be discussed in relation to the proposed model for Leicester General Hospital.

Decision Making, Organizational↗
PubMedDate not supplied

Implications of laparoscopic cholecystectomy for surgical residency training.

BACKGROUND: Widespread adoption of minimal access techniques forced a generation of abdominal surgeons to re-learn many standard abdominal procedures. This threatened to reduce the pool of suitable "training" operations for surgical residents. METHODS: Operator grade, duration of operation, acute/elective operation, conversion rate, complications, and postoperative stay were recorded prospectively on all laparoscopic cholecystectomies (LC) since 1992. This data was evaluated to determine how the introduction of LC affected residents' training. RESULTS: The percentage of LCs performed by residents increased progressively to reach 58%. Operating time was longer for trainee surgeons, particularly for acute cases (145+/-50 minutes vs 111+/-54 minutes, p<0.05); however, conversion rate, incidence of complications, and postoperative stay were no different. CONCLUSIONS: LC can be performed by surgical trainees with similar complication rates and outcomes as those of qualified surgeons. Once institutional experience has accumulated, this procedure can be integrated into residency training.

Adolescent↗
PubMedDate not supplied

Child's play.

Explore the source record for details and available documents.

Child↗
PubMedDate not supplied

Developing an early pregnancy assessment unit.

This paper describes the work of a nurse-run early pregnancy assessment service in Sheffield. The authors explain how the unit attempts to reduce the anxieties of women who may be prone to miscarriage by screening them early and offering same-day results.

Abortion, Spontaneous↗