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L H Pobereskin

Publications and source records attributed to L H Pobereskin.

14 recordsLinked to original sources
PubMed2005

Whiplash following rear end collisions: a prospective cohort study.

OBJECTIVE: The purpose of this study was to investigate the factors which predict neck pain initially and at 1 year following a rear end collision. METHODS: All people who reported a rear end collision to the Devon and Cornwall Constabulary were identified and formed the basis of the cohort. People were excluded if they were under 18 years of age or had suffered a head injury. The main outcome measures were neck pain lasting for more than a week after the accident and neck pain at least 1 day a week at 1 year. Logistic regression was used to investigate associations between demographic and accident related variables and outcomes. RESULTS: A total of 1147 people reported rear end collisions to the police during the study period and 503 (44%) agreed to take part in the study. Of the respondents, 78% had neck pain lasting for more than a week and 52% still had pain at 1 year. Age (odds ratio, 95% confidence interval: 0.957, 0.942-0.972) and prior history of neck pain (8.32, 2.89-23.89) were the most important predictors of early neck pain. The most important predictors of pain at 1 year were the initial neck visual analogue scale (VAS) score (1.03, 1.01-1.05) and the presence of a compensation claim (4.09, 1.62-10.32). There was only weak evidence that measures of the severity of the impact were associated with outcomes. CONCLUSION: Demographic variables and the presence of a compensation suit show the strongest correlation with acute and chronic neck pain following rear end collisions.

Accidents, Traffic↗
PubMed2001

The completeness of brain tumour registration in Devon and Cornwall.

OBJECTIVES: To determine ascertainment rates for primary brain tumours and examine factors influencing those rates. DESIGN: Comparison of a clinical database with official figures from the Regional Cancer Intelligence Unit. RESULTS: Of 1480 potential cases 52% appeared in the registry. Only two-thirds of patients operated upon were registered and less than one-third of those who were not operated appeared in the registry. Independent predictors of registration were having had an operation, 5.47 (4.19-7.17) (odds ratio (95% CI)), being over 60 years of age, 1.62 (1.26-2.07), and having a tumour requiring radiotherapy, 2.52 (1.74-3.66). CONCLUSIONS: There is asymmetric registration of primary brain tumours in Devon and Cornwall with under registration of more benign tumours in younger patients. If similar problems exist across the United Kingdom, this could have a negative influence on survival rates, and international comparisons of such rates should be performed with caution.

Brain Neoplasms↗
PubMed2001

Incidence and outcome of subarachnoid haemorrhage: a retrospective population based study.

OBJECTIVES: The purpose was to define the incidence and case fatality rates of subarachnoid haemorrhage in the population of Devon and Cornwall. METHODS: A retrospective population based design was employed with multiple overlapping methods of case ascertainment. A strict definition of subarachnoid haemorrhage was used. Age and sex specific incidence rates and relative risks for death at different time intervals are calculated. RESULTS: Eight hundred cases of first ever subarachnoid haemorrhage were identified; 77% of cases were verified by CT, 22% by necropsy, and 1% by lumbar puncture. The incidence rates are higher than those previously reported in the United Kingdom. The age standardised incidence rate (/100 000 person-years) for females was 11.9 (95% confidence interval (95% CI) 9.5-15.0), for males 7.4 (5.4-10.0), and the total rate was 9.7 (7.5-12.6). The case fatality rates at 24 hours, 1 week, and 30 days were 21 (18-24)%, 37 (33-41)%, and 44 (40-49)% respectively. The relative risk for death at 30 days for those over 60 years:under 60 years was 2.95 (2.18-3.97). CONCLUSION: The incidence of subarachnoid haemorrhage in the United Kingdom is higher than previously reported. Three quarters of the mortality occurs within 3 days.

Adolescent↗
PubMed2001

Influence of premorbid factors on survival following subarachnoid hemorrhage.

OBJECT: The goal of this study was to explore the relationships between premorbid patient characteristics, especially cigarette smoking, and the risk of death following subarachnoid hemorrhage (SAH). METHODS: A population-based study design was used with multiple overlapping methods of case identification. A strict definition of SAH was used. Relationships between patients' age and sex as well as their cigarette smoking and hypertension statuses were explored by calculating relative risks (RRs). Confounding effects were examined using logistic regression analysis. The author identified 800 cases in which the patient had experienced his or her first SAH. Seventy-seven percent of cases were verified by review of computerized tomography scans, 22% by autopsy, and 1% by lumbar puncture. A prior history of hypertension had no effect on the risk of mortality. There was a higher case mortality rate in female patients than in male patients, but this did not reach statistical significance. The RR of death at 30 days post-SAH for patients older than 60 years compared with those who were younger was 2.95 (95% confidence interval [CI] 2.18-3.97). The RR of death at all time intervals was lower for smokers than for nonsmokers (smokers/nonsmokers RR 0.47 [95% CI 0.32-0.69] at 7 days). The protective effect of smoking diminished on Day 3 post-SAH and increased again on Day 7. CONCLUSIONS: Advanced age is an important determinant of survival following SAH. Smoking appears to have a protective effect. The author presents evidence indicating that increased vasospasm in smokers may reduce the severity of the initial hemorrhage.

Adolescent↗
PubMed2000

Wound infiltration with bupivacaine after surgery to the cervical spine using a posterior approach.

We have compared pain scores, morphine consumption and duration of stay for 50 adults who underwent elective cervical spine surgery via a posterior incision in a prospective, double-blind, placebo-controlled, randomized study. During wound closure, the paravertebral muscles and subcutaneous tissues were infiltrated with 40 ml of saline (control) or 0.25% bupivacaine. There were no significant differences in pain scores, morphine consumption or duration of stay between groups. In view of the potential risks of wound infiltration in the cervical region, we consider that this practice should be abandoned.

Adult↗
PubMed2000

Does wound irrigation with triamcinolone reduce pain after surgery to the lumbar spine?

This prospective, randomized study compared postoperative pain scores, morphine consumption and length of stay in 95 adults who underwent elective lumbar spine surgery via a posterior incision. Immediately prior to closure the wound was irrigated with triamcinolone 40, 20 or 0 mg. Visual analogue scale pain scores at 24 h after surgery were median 12 (interquartile range 3-24), 15 (6-34) and 33 (20-59) mm for patients receiving triamcinolone 40, 20 mg or no steroid, respectively (P < 0.0005, Kruskal-Wallis test). Total morphine usage after 24 h was 26 (21-39), 27 (17-43) and 43 (27-73) mg for the same groups (P < 0.001, Kruskal-Wallis test). The proportion of patients discharged from hospital on the first day after surgery was 83.9, 77.4 and 54.8% for patients receiving triamcinolone 40, 20 mg and no steroid, respectively (P < 0.028, chi-squared test). Extra-dural triamcinolone reduces pain after lumbar spine surgery and reduces time to discharge from hospital.

Adult↗
PubMed2000

Incidence of brain tumours in two English counties: a population based study.

OBJECTIVE: To define the incidence of brain tumours in Devon and Cornwall and to discover which case finding methods are the most fruitful. To examine what happens to patients after the diagnosis of a brain tumour. METHODS: The primary method of case ascertainment was a review of all CT with contrast and MRI of the head performed on the population of Devon and Cornwall between 1 April 1992 and 31 March 1997. Secondary sources included registrations with the South and West Cancer Intelligence Unit and a search for all patients either admitted to hospital with a brain tumour or operated on for a brain tumour during the same period. RESULTS: 16,923 scans were reviewed of which 8774 (52%) were normal. The scan review found 2483 incident intracranial tumours, of which 861 were metastases. Secondary sources of case ascertainment disclosed 46 further cases. Cases were missed by the scan review mainly for technical reasons and only three patients were found who were diagnosed by non-imaging methods. The incidence of primary intracranial tumours standardised to the population of England and Wales was higher than any previously reported (21.04 (17.18-25.62)/100,000 person-years). Overall, 21% of cases were not admitted to hospital. The categories least likely to be admitted were those with sellar and cranial nerve tumours. Those not admitted to hospital were significantly older than those who were. CONCLUSION: One fifth of patients are not admitted to hospital after the diagnosis of a brain tumour and incidence studies must use case finding methods which will capture these cases. An audit of imaging results provides almost complete case ascertainment. This study shows that the incidence of primary brain tumours is considerably higher than previously thought. Official figures from the cancer intelligence units significantly underestimate brain tumour incidence, especially for benign tumours.

Adolescent↗
PubMed1999

The role of bupivacaine in early postoperative pain control after lumbar decompression.

OBJECT: The authors studied the effect of immediate postoperative administration of bupivacaine in patients who underwent a lumbar decompressive procedure. METHODS: In this randomized double-blind trial, 50 patients who underwent elective lumbar decompression after induction of general anesthetic received a postoperative bilateral paravertebral 40-ml intramuscular application of either saline (0.9%) or bupivacaine (0.25%). For delivering morphine, both groups used a patient-controlled analgesia system for 24 hours postsurgery. Pain scores, 10-cm visual analog scale scores, and morphine consumption were similar between groups with no significant differences (p>0.05). CONCLUSIONS: Results of subgroup analysis suggested strongly that perioperative administration of methylprednisolone in a sustained-release preparation was associated with a reduction in postoperative pain (p<0.05).

Anesthetics, Local↗
PubMed1998

Cushing's disease treated by trans-sphenoidal selective adenomectomy in mid-pregnancy.

The clinical course and diagnosis of a patient with Cushing's disease complicated by pregnancy is described, and the anaesthetic management of trans-sphenoidal selective adenomectomy performed during the second trimester outlined. Problems included obesity, diabetes, hypertension and a suboptimal airway. Fibreoptic awake intubation and intravenous anaesthesia were used. Insulin requirements decreased substantially after surgery. Early administration of hydrocortisone after surgery avoided the risk of an addisonian crisis but delayed biochemical confirmation of a metabolic cure.

Adenoma↗