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Biomedical subjects

M G Shearer

Publications and source records attributed to M G Shearer.

9 recordsLinked to original sources
PubMed1999

Sustained-release alfuzosin and trial without catheter after acute urinary retention: a prospective, placebo-controlled.

OBJECTIVE: To establish whether the administration of sustained-release (SR) alfuzosin improves the outcome of a trial without catheter (TWOC) after an episode of acute urinary retention. PATIENTS AND METHODS: In a prospective, randomized, placebo-controlled trial, 81 patients with acute urinary retention related to benign prostatic obstruction received either SR alfuzosin (n=40), an alpha1-selective blocker, given at a dose of 5 mg twice daily, or placebo (n=41) for 48 h. The catheter was removed after 24 h of treatment. The main outcome measurement was success or failure of the TWOC. At the end of this double-blind phase the patients were followed up on an open basis. RESULTS: After removal of the catheter, 42% of patients voided successfully, 22 of 40 (55%) with SR alfuzosin and 12 of 41 (29%) with placebo (P=0.03). The mean age of patients voiding successfully, regardless of treatment group, was 68. 4 years, whilst the mean age of those who were not successful was 72. 9 years (P=0.015). In an intention-to-treat analysis of outcome adjusted for this age difference, the benefit in favour of those receiving SR alfuzosin was not significant, but at P=0.052 there was a strong suggestion of a positive treatment effect. The observed benefit remained significant in a per-protocol analysis adjusted for age. Taken together, these results indicate that treatment with SR alfuzosin was effective and that the observed benefit was not simply the effect of age difference between the groups. Of the 34 patients who voided successfully 23 (68%) required no further intervention within a mean follow-up of 7 months. CONCLUSIONS: Treatment with SR alfuzosin is effective in improving the success rate of a TWOC after an episode of acute urinary retention, although older patients are less likely to void successfully. By reducing the numbers of men sent home with urinary catheters, such treatment may result in a reduction in the associated perioperative morbidity in those undergoing prostatic surgery, and is clearly desirable for the patients' comfort and convenience.

Adrenergic alpha-Antagonists↗
PubMed1992

Quantitative evaluation of the growth of established cell lines on the surface of collagen, collagen composite and reconstituted basement membrane.

As a step in the development of a system for assessing growth of human urothelium and transitional cell carcinoma, the growth of two established cell lines on collagen-based membranes has been evaluated. HT1080 (metastatic human fibrosarcoma) and WI38 VA13 (virus-transformed human fibroblasts) were grown on substrates of collagen, collagen/hyaluronic acid or chondroitin sulphate and reconstituted basement membrane (Matrigel). Cell growth was quantified using a new fluorimetric assay utilizing carboxyfluorescein diacetate. There were differences in morphology between cells grown on collagen and those grown on polystyrene. There were, however, no differences in growth of the WI38 VA13 cells on collagen compared with polystyrene, but growth of the HT1080 cells was increased on membranes of collagen/2.5% hyaluronic acid and collagen/5% chondroitin sulphate, and decreased on Matrigel. Adequate growth on collagen substrates is dependent on cell line. The fluorimetric assay used was suitable for quantifying cell growth on such substrates.

Basement Membrane↗
PubMed1988

Importance of cause in the outcome of pancreatic pseudocysts.

Among 100 consecutive patients with pancreatic pseudocysts, a biliary cause for the preceding acute pancreatitis was found in 27, for a mortality rate of 22 percent. Patients with alcohol abuse as the cause had a more favorable prognosis, with a 5 percent mortality rate among 59 patients (p less than 0.05, chi-square test). Despite an age difference between the two groups, we consider that this feature of patients with pancreatic pseudocyst warrants attention and we make recommendations herein with respect to therapy. Pseudocysts developed in 86 patients consequent to an episode of acute pancreatitis, and all 12 deaths (14 percent) were in this group. None of the remaining 14 patients whose pseudocysts were a feature of chronic pancreatitis died. Of the 81 patients in whom amylase levels were measured, 76 percent had an increased level.

Acute Disease↗
PubMed1986

Parathyroid hormone levels, hyperparathyroidism and acute pancreatitis.

Since 1971, in Glasgow Royal Infirmary 880 patients with acute pancreatitis (AP) have been prospectively studied. Only two (0.23 per cent) have been found with associated hyperparathyroidism (HPT), one of whom also had gallstones. During the period of study daily serum calcium levels were measured routinely in all patients with AP and, in addition, a consecutive series of 200 patients had daily mineral metabolism screening of blood and urine in an attempt to identify patients with hypercalcaemia as an aetiological factor. A separate group of 90 patients had sequential daily serum calcium and parathyroid hormone assays (PTH) performed for the first five days of their hospital admission and one of the patients described in this paper came from this group. She is the first patient, to our knowledge, documented in this manner. The overall pattern of the PTH and calcium response from all these patients is also recorded according to the severity of the AP. Hyperparathyroidism is uncommonly associated with AP and when it is other aetiological factors must be excluded.

Acute Disease↗
PubMed1986

Total colonic ischemia.

The involvement of the entire colon in an ischemic process is unusual because of the dual source of blood supply to the large bowel. Three cases of total ischemic colitis are presented. A precipitating cause to account for the distribution of ischemia was identified in each patient.

Aged↗
PubMed1985

Prediction of severity in acute pancreatitis: prospective comparison of three prognostic indices.

The prognostic value of three predictive indices was compared in 436 attacks of acute pancreatitis in 418 patients. The outcome of an attack was graded as uncomplicated (324), complicated (70), or fatal (41); 1 attack was excluded because of puncture of the caecum. The overall mortality rate was 9.4%. Clinical assessment on admission identified only 34% of patients whose attack was severe (ie, complicated or fatal). Multiple laboratory criteria and peritoneal lavage were more sensitive (61% and 53%, respectively) while retaining diagnostic accuracy (79% and 74%). An erroneous diagnosis of pancreatitis was corrected by the findings on lavage in 5 patients. The major advantage of peritoneal lavage over multiple laboratory criteria was the shorter delay between admission to the study and determination of severity (median 4 v 24 h), but visceral puncture during insertion of the cannula occurred in 2 of 253 patients (0.8%). When used together, the three indices correctly predicted 82% of the attacks with a severe outcome and identified all patients destined to die within 10 days of admission.

Acute Disease↗
PubMed1985

Controlled clinical trial of peritoneal lavage for the treatment of severe acute pancreatitis.

We performed a multicenter, randomized, controlled clinical trial of therapeutic peritoneal lavage (2 liters per hour for three days) in 91 patients with severe acute pancreatitis. Patients were entered into the study if severe pancreatitis was indicated by multiple laboratory criteria or diagnostic peritoneal lavage. All patients received full supportive treatment. The median time between the onset of symptoms and randomization was 38 hours. Forty-six patients were assigned to the control group and 45 to the lavage group. There were 13 deaths (28 per cent) and 16 patients with major complications (35 per cent) in the control group, as compared with 12 deaths (27 per cent) and 17 patients with major complications (38 per cent) in the lavage group. Lavage did not appear to modify the length of survival, the incidence of pancreatic collections (pseudocysts or abscesses), or the plasma amylase concentration. Considering the statistical power of the design, we conclude that the outcome of severe pancreatitis was not greatly, if at all, influenced by the regimen of peritoneal lavage used in this study.

Acute Disease↗