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Biomedical subjects

P M Upton

Publications and source records attributed to P M Upton.

7 recordsLinked to original sources
PubMed1997

Evaluation of video imaging prediction in combined maxillary and mandibular orthognathic surgery.

The purpose of this study was to evaluate the accuracy of the soft tissue profile "line drawings" predicted by Quick Ceph Image in combined maxillary and mandibular orthognathic surgical procedures. Preoperative (mean = 27.7 days presurgical) and posttreatment (mean = 11.5 months postsurgical) lateral cephalograms of 40 white patients (10 males and 30 females) who had completed treatment that involved orthodontics, one-piece LeFort I osteotomy, and mandibular advancement by bilateral sagittal split osteotomy with or without genioplasty were used in the study. Forty-five lateral hard and soft tissue landmarks were digitized, using the "on-screen" digitizing option, for each cephalogram and for each computer predicted posttreatment tracing. A customized analysis consisting of 24 linear and 4 angular measurements was used to analyze the differences between the actual posttreatment cephalometric landmark measurements and computer predicted landmark measurements. Statistically significant differences between the posttreatment cephalometric soft tissue profiles and the computer predicted soft tissue profiles were analyzed for the total sample, patients grouped according to: magnitude and direction of maxillary movements, adjunctive genioplasty procedure, V-Y closure of the LeFort I incision, and gender and age differences. The results indicated that for some of the soft tissue landmarks, differences were found between the posttreatment and the computer predicted profiles. Differences between the predicted and actual posttreatment soft tissue profiles may be attributed to the inaccuracy of Quick Ceph Image's default soft to hard tissue ratios when predicting the soft tissue response to combined maxillary and mandibular orthognathic surgical procedures.

Adolescent↗
PubMed1994

A survey of the intended management of acute postoperative pain by newly qualified doctors in the south west region of England in August 1992.

A questionnaire designed to assess the knowledge of newly qualified house officers about the management of postoperative pain, was sent to 203 preregistration house officers in the South West region of England. The questionnaire sought information on the following: (1) the prescription of postoperative analgesia for four clinical cases, (2) the use of nonsteroidal anti-inflammatory drugs in patients with six medical conditions, and (3) the management of a patient who had an epidural infusion. The response rate was 26% (54 house officers) and only 13% of those circulated answered all four clinical cases appropriately. The use of nonsteroidal anti-inflammatory drugs was often inappropriate. The management of the patient with a postoperative epidural infusion was inadequate when compared with a minimum safe response protocol designed by the authors. The poor theoretical and practical knowledge demonstrated in this survey indicates that urgent changes are required in the undergraduate curriculum to take account of the recent revolution in the management of severe postoperative pain.

Adolescent↗
PubMed1993

Suxamethonium-induced muscle pains are not related to cholinesterase activity.

We have investigated the possibility of using the pre-operative measurement of cholinesterase activity to predict the postoperative development of myalgia following the administration of suxamethonium. Seventy-seven patients presenting for elective extraction of wisdom teeth were entered in the study. All patients received a standard anaesthetic regimen, including suxamethonium to facilitate tracheal intubation, and standardised postoperative analgesia. Myalgia was assessed postoperatively and no correlation between muscle pains and cholinesterase activity was found.

Adult↗
PubMed1992

Patient-controlled analgesia. Its South African debut in a provincial hospital.

Patient-controlled analgesia (PCA) is a well-established technique for the relief of acute and chronic pain. It is widely used in Western hospitals. Patient and staff education is required to provide successful analgesia. This paper reports the successful introduction of PCA on a large scale in a provincial hospital. The considerable potential difficulties in communication and education appear to have been overcome. The widespread introduction of PCA in all our hospitals would appear to be feasible.

Adolescent↗
PubMed1992

Epidural insertion: how far should the epidural needle be inserted before testing for loss of resistance?

The aim of this study was to determine the depth to which an epidural needle can safely be inserted before testing for loss of resistance. This ensures that the epidural needle is advanced far enough to encounter ligament thus avoiding the confusion that can occur when testing for loss of resistance whilst still in subcutaneous tissues. A survey of the distance between the skin and the epidural space in 400 obstetric patients was performed. Three hundred and ten midline epidurals showed a highly significant correlation (P<0.001) between the patient's pregnant weight and the distance to the epidural space. Using these data confidence limits were calculated in order to quantify the distance that the epidural needle could safely be inserted before testing for loss of resistance. Dividing the patient's pregnant weight by 25 will give this distance in centimetres. Seventy six paramedian approaches were performed and a less good correlation was found between the depth of the space and the woman's weight. There was no correlation with height or foot size.

Journal Article↗
PubMed1992

The case for patient-controlled analgesia. Inter-patient variation in postoperative analgesic requirements.

Postoperative morphine requirements were assessed for the first 48 hours after surgery in 93 consecutive patients undergoing elective or emergency laparotomies. Analgesia was provided by patient-controlled analgesic (PCA) pumps. Daily morphine utilisation was recorded. At the conclusion of PCA therapy, patients were asked to assess their quality of analgesia. Eighty-one patients, who reported good or excellent pain relief, were included in the study. Data are presented demonstrating the wide variation in morphine requirements necessary to produce this level of analgesia.

Adult↗