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Biomedical subjects

K Hosie

Publications and source records attributed to K Hosie.

8 recordsLinked to original sources
PubMed2004

Prospective randomized controlled trial of acute normovolaemic haemodilution in major gastrointestinal surgery.

BACKGROUND: The efficacy of acute normovolaemic haemodilution (ANH) remains uncertain because of a lack of well-designed prospective randomized controlled trials. The aim of this study was to assess the effects of ANH on allogeneic transfusion, postoperative complications, and duration of stay. METHODS: Consecutive patients undergoing major gastrointestinal surgery were randomized to a planned 3-unit ANH, or no ANH. Both groups underwent identical management including adherence to a transfusion protocol after surgery. Outcome measures included the number of patients receiving allogeneic blood, complications, and duration of stay. RESULTS: 380 patients were screened of which 160 were included in the study, median age was 62 yr (range 23-90), 'ANH' n=78, 'no ANH' n=82. There was no significant difference between groups in the number of patients receiving allogeneic blood 22/78 (28%) vs 25/82 (30%), the total number of allogeneic units transfused (90 vs 93), complication rate, or duration of stay. Haemodilution significantly increased anaesthetic time, median 55 (range 15-90) vs 40 min (range 17-80) (P<0.001). Significantly fewer patients in the ANH group experienced oliguria in the immediate postoperative period 37/78 (47%) vs 55/82 (67%) (P=0.012). The most significant factors affecting transfusion were blood loss, starting haemoglobin, and age. When compared with ASA-matched historical controls, the introduction of a transfusion protocol reduced the transfusion rate in colorectal patients from 136/333 (41%) to 37/138 (27%), P=0.004. CONCLUSIONS: In this large pragmatic study, ANH did not affect allogeneic transfusion rate in major gastrointestinal surgery. Preoperative haemoglobin, blood loss, and transfusion protocol are the key factors influencing allogeneic transfusion.

Adult↗
PubMed1991

Assessment of noninvasive intra-anal electromyography to evaluate sphincter function.

Assessment of anal function is now regarded as an important aspect of the proctologic examination in assessment of patients with disordered defecation. Conventional electromyography is invasive and often not repeatable because of patient discomfort. Noninvasive surface intra-anal EMG was evaluated as a method of assessing sphincter function in 76 subjects. A significant correlation was found between intra-anal EMG and anal manometry at rest and during a maximum squeeze effort (P less than 0.01). Intra-anal EMG was found to be reproducible when evaluated by 2 independent observers (P less than 0.05) and may prove a reliable portable noninvasive method of assessing sphincter function.

Anal Canal↗
PubMed1990

Secure accommodation for very difficult adolescents: some recent research findings.

The appropriate use of secure accommodation for very difficult adolescents continues to cause concern. Research in the 1970s highlighted the variety of young people admitted to secure units and the difficulties of fashioning treatment programmes. As a result, gate-keeping and admission criteria have been tightened. Recent research has further clarified the needs and problems of young people in secure units and has highlighted the relationship between provision offered in child-care, penal and health services. New research findings, particularly those arising out of studies of young people in Youth Treatment Centres, are discussed in the light of these issues.

Adolescent↗
PubMedDate not supplied

Fluid dynamics in man of an intraperitoneal drug delivery solution: 4% icodextrin.

Interest in targeting drugs into the peritoneal cavity for intra-abdominal cancers or infections is undergoing a revival as recent clinical trials have demonstrated, not only a regional advantage in concentration of the active agent, but also improved long-term outcomes. Solutions currently used for intraperitoneal (IP) drug delivery have short residence times, however, which can limit the exposure of all areas of the peritoneum to the active agent. Icodextrin 4% solution was compared with saline and a glucose-based peritoneal dialysis solution in a clinical study of IP residence time. The study was carried out during the fortnightly rest phase in 9 patients undergoing 5-fluorouracil (5-Fu) IP treatment for colorectal cancer. The volume remaining in the peritoneal cavity was measured at 0, 12, 24, 48, 72, and 96 hr after an instillation of 2 liters of each fluid. Saline (n = 3 dwells) and glucose (n = 3 dwells) peritoneal dialysis solutions were almost fully absorbed by 24 hr, and the patients experienced discomfort when using these solutions. In contrast, icodextrin 4% solution (n = 188 dwells) maintained its instilled volume for up to 48 hr, and half the instilled volume remained after 72 and 96 hr. This result would allow extensive and prolonged coverage of the peritoneal surface. Icodextrin 4% solution may be an effective vehicle to deliver therapeutic agents into the peritoneal cavity.

Aged↗