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M Downey

Publications and source records attributed to M Downey.

16 recordsLinked to original sources
PubMed2006

Is pre-operative radiotherapy necessary in T-T rectal cancer with TME?

OBJECTIVE: The indications for pre-operative radiotherapy in rectal cancer are still unclear with the exception of T4 tumours. The aim of this study was to assess local and overall recurrence in patients with T1-T3 rectal cancers undergoing total mesorectal excision (TME). METHODS: Prospective data was collected from 150 patients with rectal cancer treated in one surgical centre between July 1997 and July 2002. One hundred and twenty-nine primary resections were carried of which 102 were with curative intent. Seventy-nine patients with T1-T3 tumours were included in the analysis. Nine had local resections and 70 underwent TME; 19 of the 70 patients were node positive and 51 were node negative. RESULTS: At a median follow-up of 37 months (range 19-79 months) there were 3 (4.3%) isolated local recurrences. One node positive patient developed isolated local recurrence compared with 2 node negative patients. The node positive patient died from a myocardial infarction while the two node negative patients died as a consequence of local recurrence. Three (4.3%) of 70 patients developed systemic relapse all of whom were node positive. The cancer specific mortality rate over the same follow-up period was 3/19 for node positive patients and 2/51 for node negative patients. Of 9 patients who had local resections, none developed local recurrence or systemic relapse. CONCLUSIONS: With TME the rate of local recurrence in T1-T3 tumours is low. Our results do not support the use of pre-operative radiotherapy for these patients.

Adult↗
PubMed2005

Determinants of subclinical diabetic heart disease.

AIMS/HYPOTHESIS: Subclinical left ventricular (LV) dysfunction has been shown by tissue Doppler and strain imaging in diabetic patients in the absence of coronary disease or LV hypertrophy, but the prevalence and aetiology of this finding remain unclear. This study sought to identify the prevalence and the determinants of subclinical diabetic heart disease. METHODS: A group of 219 unselected patients with type 2 diabetes without known cardiac disease underwent resting and stress echocardiography. After exclusion of coronary artery disease or LV hypertrophy, the remaining 120 patients (age 57+/-10 years, 73 male) were studied with tissue Doppler imaging. Peak systolic strain of each wall and systolic (Sm) and diastolic (Em) velocity of each basal segment were measured from the three apical views and averaged for each patient. Significant subclinical LV dysfunction was identified according to Sm and Em normal ranges adjusted by age and sex. Strain and Em were correlated with clinical, therapeutic, echocardiographic and biochemical variables, and significant independent associations were sought using a multiple linear regression model. RESULTS: Significant subclinical LV dysfunction was present in 27% diabetic patients. Myocardial systolic dysfunction by peak strain was independently associated with glycosylated haemoglobin level (p<0.001) and lack of angiotensin-converting enzyme inhibitor treatment (p=0.003). Myocardial diastolic function (Em) was independently predicted by age (p=0.013), hypertension (p=0.001), insulin (p=0.008) and metformin (p=0.01) treatment. CONCLUSIONS/INTERPRETATION: In patients with diabetes mellitus, subclinical LV dysfunction is common and associated with poor diabetic control, advancing age, hypertension and metformin treatment; ACE inhibitor and insulin therapies appear to be protective.

Adult↗
PubMed1994

Objective diagnosis of equinus during gait prior to and following a tibial nerve block.

A quantitative evaluation technique has been developed to assist the clinician in the diagnosis and treatment of ankle equinus deformity. Specifically, the work focuses on accomplishing two major goals: 1) to develop a reliable set of quantitative criteria to assess the degree of dysfunction of the ankle joint during locomotion in patients with equinus deformity; and 2) to determine the effect of various treatment modalities on the ambulatory performance of patients with equinus deformity. A statistically significant difference in two key gait parameters has been demonstrated between healthy subjects and those with equinus deformity.

Adolescent↗
PubMed1991

Objective identification of ankle equinus deformity and resulting contracture.

A quantitative diagnostic technique is described for identifying contracture at the ankle joint in patients with equinus deformity, hence addressing the shortcoming of the conventional clinical diagnostic procedure. To gain a better understanding of how contracture contributes to equinus deformity, a study was designed that compared the torque about the ankle joint before and after administering a tibial nerve block to equinus patients and to a control group. Functional equinus, manifested by walking and early heel rise, is defined as inadequate dorsiflexion for normal gait. The ability to accurately identify an equinus condition, and contracture as the contributing factor in equinus deformity, has important implications for the type of treatment prescribed and the evaluation of treatment effectiveness.

Adolescent↗
PubMed1990

Epidural and intravenous fentanyl infusions are clinically equivalent after knee surgery.

The management of postoperative pain with continuous epidural fentanyl infusion was compared with continuous intravenous fentanyl infusion. In a randomized, doubleblind protocol we prospectively studied 20 patients undergoing repair of the anterior cruciate ligament of the knee. The quality of analgesia and the incidence of side effects were documented. Compared with patients receiving continuous intravenous fentanyl infusion, at 18 h postoperatively patients given continuous epidural fentanyl infusion reported similar pain scores both at rest (22 +/- 25 vs 27 +/- 21, P = 0.52) and with ambulation (59 +/- 18 vs 56 +/- 22, P = 0.82). Plasma fentanyl levels were 1.8 +/- 0.4 and 1.7 +/- 0.4 ng/mL (P = 0.91) for the intravenous and epidural groups, respectively. There were no significant differences in the incidence of nausea, pruritus, or urinary retention. There was no respiratory depression in either group. We conclude that when compared with continuous intravenous fentanyl infusion, continuous epidural fentanyl infusion offers no clinical advantages for the management of postoperative pain after knee surgery.

Adolescent↗
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