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Biomedical subjects

J R Wedley

Publications and source records attributed to J R Wedley.

18 recordsLinked to original sources
PubMed2003

Spinal cord stimulation does not change peripheral skin blood flow in patients with neuropathic pain.

BACKGROUND AND OBJECTIVE: Spinal cord stimulation has been used successfully for many years in the management of neuropathic pain. Nociceptive pathways are closely integrated into many autonomic reflexes. The aim was to test the hypothesis that pain relief caused by spinal cord stimulation is related to changes in peripheral skin blood flow. METHODS: Twelve patients with spinal cord stimulators implanted as a treatment for neuropathic pain were entered into the study. Laser Doppler perfusion scanning was used as a direct method for selective measurement of changes in skin (peripheral) blood flow. Measurements were taken before and after the onset of spinal cord stimulation over the site of its sensory projection. The degree of pain relief due to spinal cord stimulation and the skin temperature of each patient were also recorded. RESULTS: Apart from one patient, spinal cord stimulation did not change skin blood flow in a statistically significant manner. CONCLUSIONS: Pain relief due to spinal cord stimulation is not related to changes of skin blood flow.

Adult↗
PubMed1997

Phantom pain and sensation among British veteran amputees.

Using a mail-delivered questionnaire, we surveyed 590 veteran amputees concerning phantom pain, phantom sensation and stump pain. They were selected randomly from a population of 2974 veterans with long-standing limb amputation(s) using a computer random number generator. Eighty-nine percent responded and of these, 55% reported phantom limb pain and 56% stump pain. There was a strong correlation between phantom pain and phantom sensation. The intensity of phantom sensation was a significant predictor for the time course of phantom pain. In only 3% of phantom limb pain sufferers did the condition become worse. One hundred and forty-nine amputees reporting phantom pain discussed their pain with their family doctors; 49 were told that there was no treatment available. Transcutaneous electric nerve stimulation, analgesics and non-steroidal anti-inflammatory drugs were satisfactory methods for controlling phantom limb pain.

Aged↗
PubMed1996

The value of SPECT scans in identifying back pain likely to benefit from facet joint injection.

Lumbar facet disease is sometimes implicated in low back pain. Identification is difficult and this may account for a variable response. Single photon emission computerized tomography (SPECT) is a scanning technique which enables localization of facet joint pathology. We determined whether recognition of facet disease by this method improved the response to corticosteroid injection treatment. Fifty-eight patients with low back pain and displaying accepted clinical criteria for facet joint disease were evaluated by SPECT. Twenty-two had facetal uptake of isotope. These and the tender facet joints of 36 scan-negative patients were injected with 40 mg methylprednisolone and 1 ml 1% lignocaine under X-ray control. Pain was assessed by a blind observer using the McGill questionnaire (MGQ), Present Pain Intensity score (PPI) and a Visual Analogue Scale (VAS). VAS, PPI and MGQ were reduced in the scan-positive patients at 1 month (P = 0.05, P = 0.0005, P = 0.005) and MGQ at 3 months (P = 0.01), whilst scan-negative patients were unchanged. The percentage of scan-positive patients who reported improvement was 95% at 1 month and 79% at 3 months, significantly greater than the control group (P = 0.0005, P = 0.01). Within 6 months, pain improvement in the SPECT-positive group was no longer statistically significant. Tenderness did not correlate with increased uptake on SPECT scan. Osteoarthritis of the facets was more common in the SPECT-positive patients (P < 0.001), but did not correspond with sites of increased uptake on SPECT scan. These results suggest that SPECT can enhance the identification of back pain sufferers likely to obtain short-term benefit from facet joint injection.

Adolescent↗
PubMed1985

Comparison of infusions of morphine and lysine acetyl salicylate for the relief of pain following thoracic surgery.

A double-blind study comparing the effectiveness of a continuous infusion i.v. of lysine acetyl salicylate (LAS) with an infusion of morphine for the treatment of pain following pulmonary surgery is described. Mean pain scores in the two groups were not significantly different at any stage during the 24-h period of study. LAS was not associated with any significantly greater blood loss in the period after operation. The incidence of drowsiness, nausea and vomiting, and the need for antiemetic medication were similar in both groups.

Analgesics↗
PubMed1980

Hypotension and myocardial metabolism. Drug-induced hypotension and the heart: a comparison between halothane and nitroprusside.

This study investigated the effect of hypotension produced by nitroprusside or halothane on haemodynamics and myocardial metabolism. It is postulated that halothane might influence the balance of supply and demand of oxygen to the heart more favourably than nitroprusside. The results in six open-chested dogs do not support this view. Despite the fact that the two drugs lowered the mean arterial pressure by radically different mechanisms, the reduction in demand for oxygen by the heart seemed to be matched by a similar reduction in supply with both drugs. No evidence of anaerobic metabolism or increased a-v O2 content differences was found. It is concluded that the reduction in mean arterial pressure to these levels by either method is not likely to impair myocardial energetics in healthy hearts with normal coronary anatomy.

Anesthesia, Inhalation↗
PubMedDate not supplied

Studies of temperature balance after open-heart surgery.

An analysis of postoperative records over a two-year period has shown that a mean rise in central body temperature greater than 2 degrees occurs in patients within 12 hours of return from the operating room following open-heart surgery. In some patients the central body temperature may rise to greater than 41 degrees C. despite an adequately warm peripheral temperature, and this is associated with a high mortality rate. An apparatus has been developed which enables the immediate enviroment of the patient to be controlled. A comparison of two groups of patients, in one of which the apparatus was used, demonstrated that it was possible to attenuate significantly the usual postoperative temperature rise seen in the control group. In a third group further cooling was employed: these patients were successfully held at subnormal temperatures. Using multiple temperature probes and heat balance formulas, it was shown that the rise in central body heat was due mainly to elevation of total body heat rather than the result of redistribution of heat from the surface.

Adult↗