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Biomedical subjects

L Wiseman

Publications and source records attributed to L Wiseman.

7 recordsLinked to original sources
PubMed2003

A comparison of the ProSeal and classic laryngeal mask airways for airway management by inexperienced personnel after manikin-only training.

We compared the ProSeal (PLMA) and Classic (LMA) laryngeal mask airway for airway management by inexperienced personnel. Nine nurses from the post-anaesthesia care unit, with no prior experience of LMA or PLMA insertion, were observed inserting the LMA and PLMA in 60 ASA 1 to 2 anaesthetized, paralyzed adults following manikin-only training. The time to achieve an effective airway (2 consecutive expired tidal volumes (6 ml/kg; maximum 2 minutes allowed), the number of insertion attempts and the reasons for failure (inability to insert into pharynx or inadequate ventilation) were determined by analysis of digital video recordings. The first attempt success rate (LMA, 85%; PLMA, 83%), overall success rate (LMA, 88%; PLMA, 90%) and effective airway time (LMA, 39 +/- 13 s; PLMA, 43 +/- 19 s) were similar. Failure was from an inability to insert into the pharynx in five with the LMA and three with the PLMA, and inadequate ventilation with two from the LMA and three from the PLMA. Effective airway time and the number of failures were similar for the first and second device. Failure of both devices occurred in four patients. We conclude that airway management in anaesthetized, paralyzed adults is equally successful for the LMA and PLMA by inexperienced personnel following manikin-only training. The PLMA is worthy of consideration as a tool for emergency airway management by inexperienced personnel.

Adult↗
PubMed2001

Fulvestrant.

Fulvestrant is a 7alpha-alkylsulphinyl analogue of estradiol that competes with endogenous estrogen for binding to the estrogen receptor. Once bound to the receptor, fulvestrant attenuates receptor dimerisation, effecting a rapid degradation of the estrogen receptor protein and inhibition of transcription. Fulvestrant is a potent inhibitor of the growth of human breast cancer cells in vitro and in vivo. It has demonstrated pure anti-estrogenic activity in animal systems. Intramuscular fulvestrant 250 mg once a month was as effective as the oral aromatase inhibitor anastrozole 1 mg/day in 2 phase III trials in postmenopausal women with advanced breast cancer who had received prior endocrine therapy. Median time to disease progression (the primary end-point) with fulvestrant and anastrozole was 5.4 and 3.4 months (North American trial) and 5.5 and 5.1 months (European trial). The median duration of response was 19.3 and 10.5 months (North American trial) and 14.3 and 14.0 months (European trial). The most common adverse events with fulvestrant are gastrointestinal disturbances and hot flushes. Fulvestrant showed similar tolerability to anastrozole in 2 phase III trials.

Antineoplastic Agents, Hormonal↗
PubMed1996

Pantoprazole. A review of its pharmacological properties and therapeutic use in acid-related disorders.

Pantoprazole is an irreversible proton pump inhibitor which, at the therapeutic dose of 40mg, effectively reduces gastric acid secretion. In controlled clinical trials, pantoprazole (40mg once daily) has proved superior to ranitidine (300mg once daily or 150mg twice daily) and equivalent to omeprazole (20mg once daily) in the short term (< or = 8 weeks) treatment of acute peptic ulcer and reflux oesophagitis. Gastric and duodenal ulcer healing proceeded significantly faster with pantoprazole than with ranitidine, and at similar rates with pantoprazole and omeprazole. The time course of gastric ulcer pain relief was similar with pantoprazole, ranitidine and omeprazole, whereas duodenal ulcer pain was alleviated more rapidly with pantoprazole than ranitidine. Pantoprazole (40mg once daily) showed superior efficacy to famotidine (40mg once daily) in ulcer healing and pain relief after 2 weeks in patients with duodenal ulcer in a large multicentre nonblinded study. In mild to moderate acute reflux oesophagitis, significantly greater healing was obtained with pantoprazole than with ranitidine and famotidine, whereas similar healing rates were seen with pantoprazole and omeprazole. Pantoprazole showed a significant advantage over ranitidine in relieving symptoms of heartburn and acid regurgitation. Reflux symptoms were similarly alleviated by pantoprazole and omeprazole. Preliminary results indicate that triple therapy with pantoprazole, clarithromycin and either metronidazole or tinidazole is effective in the treatment of Helicobacter pylori-associated disease; however, these findings require confirmation in large well-controlled studies. Pantoprazole appears to be well tolerated during short term oral administration, with diarrhoea (1.5%), headache (1.3%), dizziness (0.7%), pruritus (0.5%) and skin rash (0.4%) representing the most frequent adverse events. The drug has lower affinity than omeprazole or lansoprazole for hepatic cytochrome P450 and shows no clinically relevant pharmacokinetic or pharmacodynamic interactions at therapeutic doses with a wide range of drug substrates for this isoenzyme system. In conclusion, pantoprazole is superior to ranitidine and as effective as omeprazole in the short term treatment of peptic ulcer and reflux oesophagitis, has shown efficacy when combined with antibacterial agents in H. pylori eradication, is apparently well tolerated and offers the potential advantage of minimal risk of drug interaction.

2-Pyridinylmethylsulfinylbenzimidazoles↗
PubMed1988

Effect of sodium valproate on carbamazepine disposition and psychomotor profile in man.

1 The effect of sodium valproate (VPA; 500 mg thrice daily for 7 days) and matched placebo on the disposition and psychomotor profile of a single dose of carbamazepine (CBZ; 10 mg kg-1) was studied in eight healthy male subjects using a randomised balanced crossover design. 2 VPA alone had no effect on antipyrine clearance, urinary 6 beta-hydroxycortisol excretion and a battery of psychomotor function tests after 3 days' treatment despite achieving a mean steady-state concentration (90 +/- 6 mg 1(-1)) well within the target range (50-100 mg 1(-1)) for the drug. 3 VPA pre-treatment did not alter total CBZ area under the concentration-time curve (AUC 0-59 h) but did prolong CBZ elimination half life by 12% (P less than 0.01). AUC 0-59 h for free plasma CBZ was 13% higher (P less than 0.02) and half-life of unbound CBZ 16% longer (P less than 0.02) during VPA treatment. CBZ-10,11 epoxide (CBZ-E) levels (52%) and CBZ-E/CBZ ratios (45%) were both elevated by concurrent VPA (P less than 0.05) and free CBZ fraction was increased by 7% (P less than 0.02). 4 The sole effect of VPA on the psychomotor profile of CBZ was prolongation of card sorting time (P less than 0.05), although CBZ-related side effects were reported as more severe when VPA was also taken (P less than 0.01). 5 These data suggest that VPA displaces CBZ from plasma protein binding sites and inhibits the metabolism of both the parent drug and its epoxide.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMedDate not supplied

A prospective multicenter clinical study of the Osseotite implant: four-year interim report.

This article reports the 4-year interim results of a multicenter study evaluating the clinical performance of the Osseotite dental implant. At 4 study centers, 485 Osseotite implants were consecutively placed in 181 patients (219 were placed in the mandible and 266 in the maxilla). A total of 355 implants were placed in posterior regions. Short implants (10 mm or less) represented 31.5% (n = 153) of all implants placed in this study. Patients were restored with 210 restorations, distributed as 123 short-span prostheses, 58 single-tooth replacements, 28 long-span prostheses, and 1 maxillary overdenture. At this 4-year interim evaluation, the mean time from implant placement to the most recent evaluation was 52.6 +/- 3.0 months, with a mean loading time of 43.3 +/- 3.8 months. Of the 485 implants placed, there have been 6 failures. All implant failures occurred prior to loading and were categorized as early implant failures. Five of the 6 failures occurred in the maxilla. Only one of the 153 short implants failed to integrate. Baseline radiographs were obtained at prosthesis connection. Radiographic analysis 1 year post-restoration showed a mean bone loss of 0.09 +/- 0.7 mm. From baseline to the end of the second year of function, an overall mean bone loss of 0.13 +/- 0.8 mm was recorded, indicating no additional bone was lost after the first year of implant function. At 4 years, the cumulative implant success rate for all implants placed in this study was 98.7%, with a 99.4% success rate in the posterior mandible and 98.4% success rate in the posterior maxilla. Results of this 4-year interim analysis indicate that this implant achieved a high success rate in posterior regions and that all failures with this implant in this patient population occurred prior to implant loading. When the clinical success of implants 10 mm or shorter was compared to that of implants greater than 10 mm in length, the shorter implants in this study performed similarly to longer implants.

Adolescent↗