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Biomedical subjects

M Deakin

Publications and source records attributed to M Deakin.

At least 37 records · Page 2Linked to original sources
PubMed1997

The safety of diagnostic and therapeutic ERCP as a daycase procedure with a selective admission policy.

OBJECTIVE: To assess if therapeutic endoscopic retrograde cholangiopancreatography (ERCP) as a daycase procedure with a selective admission policy is safe and cost-effective. DESIGN: An audit of case notes of patients who attended as a daycase for either a therapeutic or diagnostic ERCP over a 20-month period. SETTING: Stoke-on-Trent District General Hospital. PATIENTS: Case notes of all patients who had an ERCP as a daycase were audited. INTERVENTIONS: Therapeutic procedures performed as daycases included papillotomy, stent insertion, balloon dilatation or a combination of these procedures. Patients are discharged home 2 h after diagnostic or therapeutic ERCP. MAIN OUTCOME MEASURES: Thirty-day morbidity and mortality of daycase patients. RESULTS: During the 20-month period audited, 550 ERCPs were performed, of which 240 attended initially as daycases. There were 97 successful daycase therapeutic ERCPs. Ten patients were admitted immediately after ERCP including one who subsequently died from a myocardial infarction (known severe ischaemic heart disease); 87 patients were discharged 2 h after ERCP; none were admitted between 2 and 48 h after ERCP; 4 were admitted between 48 h and 30 days after ERCP with complications. There were 117 successful daycase diagnostic ERCPs; 4 patients were admitted immediately due to frailty, 4 were admitted between 2 and 48 h and 1 at 28 days after ERCP with complications. There were 24 failed diagnostic and 2 failed therapeutic ERCPs. CONCLUSION: Daycase ERCP with a selective admission policy is safe and cost-effective.

Adult↗
PubMed1996

Glutathione S-transferase GSTT1 genotypes and susceptibility to cancer: studies of interactions with GSTM1 in lung, oral, gastric and colorectal cancers.

Allelism in glutathione S-transferase GSTM1 and GSTT1 has been suggested as a risk factor in various cancers. Accordingly, we describe a group of case-control studies carried out to identify associations between GSTT1 genotypes and susceptibility to lung, oral, gastric and colorectal cancers. The frequencies of the putatively high risk GSTT1 null genotype were not increased in the lung, oral or gastric cancer cases compared with controls but the frequency of this genotype was significantly increased (P = 0.0011, odds ratio = 1.88) in the colorectal cancer cases. No significant interactions between the GSTT1 and GSTM1 null genotypes types were identified in the cancer groups studied. Indeed, no significant associations between GSTM1 genotypes and susceptibility were identified though further evidence was obtained that the protective effect of GSTM1*A and GSTM1*B is not equal. The data complement studies showing that GSTT1 null is associated with an increased susceptibility to total ulcerative colitis and suggests that this enzyme is important in the detoxification of unidentified xenobiotics in the large intestine.

Case-Control Studies↗
PubMed1995

Polyadenylation polymorphism in the acetyltransferase 1 gene (NAT1) increases risk of colorectal cancer.

Exposure to carcinogens present in the diet, cigarette smoke, or the environment may be associated with increased risk of colorectal cancer. Aromatic amines (aryl- and heterocyclic) are a class of carcinogens that are important in these exposures. These compounds can be N- or O-acetylated by the NAT1 or NAT2 enzymes, resulting in activation or in some cases detoxification. Recent studies have shown that both NAT2 and NAT1 genes exhibit variation in human populations and that rapid acetylation by the NAT2 enzyme may be a risk factor for colorectal cancer. In this study we have analyzed for genetic polymorphism in both NAT1 and NAT2 in a group of 202 colorectal cancer patients and 112 control subjects from Staffordshire, England. We find significantly increased risk (odds ratio, 1.9; 95% confidence interval, 1.2-3.2; P = 0.009) associated with the NAT1*10 allele of NAT1, an allele that contains a variant polyadenylation signal. Individuals with higher stage tumors (Duke's C) were more likely to inherit this variant allele (odds ratio, 2.5; 95% confidence interval, 1.3-4.7; P = 0.005). In contrast, rapid acetylation genotypes of NAT2 were not a significant risk factor in this English population. However, we found that the risk associated with the NAT1 variant allele (NAT1*10) was most apparent among NAT2 rapid acetylators (odds ratio, 2.8; 95% confidence interval, 1.4-5.7; P = 0.003), suggesting a possible gene-gene interaction between NAT1 and NAT2 (test for interaction; P = 0.12). This is the first study to test for cancer risk associated with the NAT1 gene, and these positive findings suggest that NAT1 alleles may be important genetic determinents of colorectal cancer risk.

Adenocarcinoma↗
PubMed1994

Perceptions of denture aesthetics: a two-centre study of denture wearers and denture providers.

A study into perceptions of complete dentures was carried out in two dental schools, one in Australia and the other in England. Two-hundred participants were asked to assess photographs of five sets of dentures for age, gender and personality. Results were subjected to a multi-rater kappa statistic. Although no centre was determined to be better than the other, it was highly significant that Australian teachers were confident enough to state that they were unable to determine age or gender from the information supplied.

Adult↗
PubMed1994

Histamine H2-receptor antagonists in peptic ulcer disease. Evidence for a prophylactic use.

The H2-receptor antagonists have undoubtably been successful in healing primary gastric and duodenal ulcers so there is a tendency to assume that they will be equally successful when used as prophylactic agents. When used to prevent gastroduodenal ulceration induced by nonsteroidal anti-inflammatory agents, they are unsuccessful in protecting against gastric damage, but reduce the incidence of duodenal ulceration. However, their effect on the incidence of serious complications remains unknown. In the prevention of stress ulceration and bleeding in intensive care units there is evidence of a beneficial effect of H2-receptor antagonists, but other agents are also equally effective. In patients who present with haematemesis and melaena, there is little evidence to show that H2-receptor antagonists reduce rates of transfusion or surgical intervention, or decrease mortality.

Anti-Inflammatory Agents, Non-Steroidal↗
PubMed1993

Duplex Doppler detection of hepatic artery thrombosis following liver transplantation.

Hepatic artery thrombosis is a major cause of morbidity and mortality following liver transplantation. We assessed the value of prospective duplex Doppler ultrasound in detecting hepatic artery thrombosis. One hundred consecutive transplants in 90 patients were studied. Duplex Doppler detected all 10 proven cases of hepatic artery thrombosis. No case of hepatic artery thrombosis was found with a normal duplex study. All arteriograms performed following an abnormal ultrasound demonstrated hepatic arterial occlusion or anastomotic stenosis or a segment of irregular arterial narrowing. We conclude that duplex Doppler is a practical and sensitive method of selecting patients with a presumptive diagnosis of hepatic artery thrombosis for further investigation by angiography.

Adult↗
PubMed1993

Factors influencing blood transfusion during adult liver transplantation.

From 1982 to 1990, 300 adults received liver transplants in Birmingham UK with a median intraoperative blood transfusion rate of 23.5 units for the first 50 patients falling to 8 units for the last 50. The major factors in the reduction of blood usage were the experience of the team, the use of venovenous bypass and the use of an argon beam coagulator. Univariate analysis of preoperative factors in an attempt to predict patients at risk of excessive intraoperative transfusion showed that levels of serum sodium, urea, creatinine, haemoglobin, patient weight and the presence of ascites were significantly related to the quantity of blood transfused, although stepwise discriminant analysis showed that only blood urea and platelet count had an independent association with transfusion. The final model was poorly predictive of intraoperative transfusion requirements. Technical factors rather than patient-related factors are more important in the control of intraoperative bleeding in newly established transplant programmes.

Adolescent↗
PubMed1992

Hepatic transplantation in children using reduced size allografts.

The shortage of paediatric liver donors has led to the use of reduced size hepatic allografts. Between July 1987 and July 1990, 30 reduced size orthotopic liver transplantations were performed in 24 children aged between 3 months and 7 years. All patients were in advanced chronic or acute liver failure and were considered unlikely to survive for long enough for a size-matched donor to become available. The most common indication was biliary atresia. The median intraoperative blood loss was 75 (range 13-1015) ml kg-1. Nine patients have died and seven have undergone retransplantation, four successfully. Seven patients had portal vein hypoplasia with a high graft failure rate due to ischaemic infarction. There was significant morbidity from biliary tract complications, leading to further operations in four cases. The 1-year actuarial survival rate was 62 per cent.

Biliary Atresia↗
PubMed1992

Histamine H2-receptor antagonists in peptic ulcer disease. Efficacy in healing peptic ulcers.

Duodenal ulcer healing depends on the degree and length of inhibition of gastric secretion and upon the duration of therapy, while gastric ulcer healing is dependent mainly on the duration of therapy. Currently marketed doses of the histamine H2-receptor antagonists heal between 77 and 92% of duodenal ulcers at 4 weeks, and adjuvant treatment to eradicate Helicobacter pylori increases this rate. Once-daily administration is as effective as more frequent dosing regimens and may even result in higher healing rates. Gastric ulcers heal more slowly, but 75 to 88% of ulcers heal after 8 weeks of treatment. While newer more potent acid suppressors such as omeprazole heal ulcers slightly more quickly, the H2-receptor antagonists have an unparalleled safety record of over 15 years. It is unlikely that the prostaglandin analogues can improve on the efficacy of the H2-receptor antagonists with as low an incidence of side effects.

Drug Administration Schedule↗
PubMed1991

The human glutathione S-transferases: a case-control study of the incidence of the GST1 0 phenotype in patients with adenocarcinoma.

The suggestion that individuals with the GST1 0 phenotype have a greater susceptibility to carcinogens than those with other GST1 phenotypes has been examined by using a starch gel zymogram approach to compare the frequency of this phenotype in control subjects and a group of patients with adenocarcinoma of stomach and colon. A significantly greater proportion of the patients with adenocarcinoma demonstrated the null phenotype, odds ratio analysis indicating that individuals with this polymorphic variant have an approximately 3-fold greater risk of developing these cancers.

Adenocarcinoma↗
PubMed1990

Assessment of the biliary tract after liver transplantation: T tube cholangiography or IODIDA scanning.

Biliary tract obstruction or anastomotic leakage are common problems following liver transplantation. In a sequential study, 31 patients with a liver transplant were investigated by 99mTc-IODIDA (IODIDA) scanning and T tube cholangiography (TTC) and the results were compared with clinical outcome. Seven patients had an extrahepatic biliary obstruction and one patient had a biliary leak. In the detection of biliary complications TTC and IODIDA scanning were similar in terms of sensitivity (63 per cent for both) but TTC had a better specificity (79 per cent versus 60 per cent) and accuracy (74 per cent versus 60 per cent) than IODIDA scanning. When liver function was taken into account, the diagnostic efficacy of both tests in patients with bilirubin levels of less than 200 mumol/l was similar. With levels greater than 200 mumol/l there was a greater number of false positive results with IODIDA scanning (12 per cent versus 54 per cent). The only significant biliary leak was clearly detected by TTC but not IODIDA scanning. TTC remains the more effective way of evaluating the biliary tract after transplantation. IODIDA scanning has limited value when bilirubin levels are elevated, but may provide additional information about blood supply, hepatocyte function and intrahepatic cholestasis.

Adolescent↗
PubMed1989

Surgery for gastro-oesophageal reflux: the Angelchik prosthesis compared to the floppy Nissen fundoplication. Two-year follow-up study and a five-year evaluation of the Angelchik prosthesis.

Twenty-two patients were followed for 5 years after insertion of an Angelchik prosthesis for gastro-oesophageal reflux (GOR) and the 2-year results compared with a subsequent group of 28 patients treated by floppy Nissen fundoplication. The overall clinical results of the two procedures were equivalent at 2 years (Angelchik Visick 1 and 2, 80%; Nissen Visick 1 and 2, 78%) but the reasons for failure were different. In the Angelchik group failures were due to mechanical problems associated with the device, whereas the Nissen failures were mainly due to recurrent GOR. There were no patients in the Angelchik group with recurrent reflux at 5 years, but between 4 and 5 years postoperatively four patients developed mild dysphagia. The Angelchik prosthesis appears to be as effective as the floppy Nissen fundoplication, but further long-term studies are required before its widespread use can be recommended.

Adolescent↗
PubMed1988

Pharmacological response to cimetidine and healing of duodenal ulceration: effects of high-dose cimetidine and combination of cimetidine with pirenzepine.

Overnight gastric secretion was studied in 32 patients with acute duodenal ulcers before treatment and whilst taking cimetidine 400 mg b.d. After 6 weeks of treatment with cimetidine 400 mg b.d. 13 patients had healed ulcers, seven patients had healed ulcers but a persistent erosive duodenitis, and 12 patients had persisting ulceration. Inhibition of nocturnal gastric secretion by cimetidine 400 mg b.d. was most profound in patients who healed their ulcers completely; a less profound inhibition of nocturnal gastric secretion was seen in the non-healing and duodenitis groups. In patients with persisting ulcers and poor inhibition of nocturnal gastric secretion by cimetidine, gastric secretion could be suppressed by either cimetidine 400 mg b.d. in combination with pirenzepine 50 mg b.d., or by cimetidine 1600 mg nocte, but suppression of nocturnal gastric secretion was more effective with cimetidine 1600 mg than cimetidine with pirenzepine.

Adolescent↗