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Biomedical subjects

R C Montgomery

Publications and source records attributed to R C Montgomery.

12 recordsLinked to original sources
PubMed2000

Depressive symptoms in stable chronic schizophrenia: prevalence and relationship to psychopathology and treatment.

The prevalence and correlates of the depressive syndrome were explored in a population of 120 patients with stable, chronic schizophrenia living in the community. The presence of clinically significant depressive symptoms was defined by a score of 17 or greater on the Beck Depression Inventory. Patients were examined to assess severity of schizophrenic symptoms and medication side-effects. Sixteen of the 120 patients (13.3%) had significant depressive symptoms. Depressive symptoms were significantly correlated with the hostility/suspiciousness (P<0.0001), the positive symptom (P=0.0009) factor of the BPRS and with scores on the Significant Others Scale, a measure of patients' perceived lack of social support (P=0.0004). The association between depression and akathisia approached significance (P=0.007). There was no correlation with demographic variables, alcohol intake, antipsychotic dosage or anticholinergic dosage. Using a scale that rates the subjective aspects of the depressive syndrome, we found no evidence of a relationship between depression and negative symptoms in this population. These results indicate that persistent depressive symptoms in stable patients in the community are related to the degree of persistent positive psychotic symptoms, patient perceptions of social support and, weakly, to the degree of akathisia but not other aspects of antipsychotic treatment.

Adolescent↗
PubMed1999

Pleural incarceration of the gastric graft after trans-hiatal esophagectomy.

We report on a 73-year-old man who underwent a transhiatal esophagectomy for a T2N1M0 adenocarcinoma of the distal esophagus and developed an incarcerated herniation of the gastric graft through a defect in the right mediastinal pleura. The patient experienced delayed gastric emptying postoperatively, which was initially suggested by barium swallow. The gastric herniation was unidentified by early postoperative swallowing studies and endoscopies. After diagnosis by a later computed tomographic scan and barium study, the herniation was reduced by incising the mediastinal pleura from the diaphragm to the apex of the chest and by plication of the stomach longitudinally in order to reduce its intrathoracic diameter.

Adenocarcinoma↗
PubMed1998

Posttraumatic renovascular hypertension after occult renal injury.

OBJECTIVE: Hypertension secondary to renal injury is an unusual problem, but one that occurs with some frequency in an active trauma unit. The incidence and management of posttraumatic renovascular hypertension at our Level I trauma center was reviewed. METHODS: A retrospective review of a trauma database was performed on patients treated by our trauma service between 1977 and 1996. Seven patients were identified who developed arterial hypertension as a direct result of a renal injury. RESULTS: All of the patients sustained multiple injuries, with five requiring celiotomy to control bleeding. Renal injuries were occult, and there was no compelling reason to suspect injury to the kidney. No patient had a history of hypertension or elevated arterial pressure on admission; however, sustained arterial hypertension was noted within 2 weeks to 8 months of injury. Arteriography was positive in all seven patients, with findings that included lacerations of the main renal artery, its major branches, or intrarenal constriction of the renal artery (presumably from scarring). Renal-vein renin assays localized to the injured kidney in six patients. Treatment included nephrectomy in four cases, revascularization in one case, and medical management in two cases. All of the patients treated operatively had prompt relief of their hypertension. The two patients treated soley by medical therapy had prompt, durable control of their arterial pressure with a single medication. However, medical treatment had failed before operation in several of the patients. CONCLUSIONS: Because of the serious complications associated with undiagnosed hypertension, new-onset or sustained hypertension after major trauma should be evaluated with attention to a possible renal cause.

Adult↗
PubMed1997

Quality assessment of intraoperative blood salvage and autotransfusion.

Intraoperative blood salvage and autotransfusion are commonly used to minimize exposure to banked blood. Although this technique has been used widely for years, data vary regarding the quality of autotransfused blood. Salvaged blood may contain plasma, residual heparin, and free hemoglobin released from damaged cells. All of these factors may contribute to the adverse sequelae sometimes seen with autotransfusion. For these reasons, we have monitored autotransfused blood to assess its quality. Intraoperative blood salvage was used during most cardiac procedures and at the discretion of the surgeon in other specialties. Blood was collected through a double lumen catheter that was anticoagulated with heparin, filtered, centrifuged, and washed with saline. A sample of the blood was removed for analysis, which included hematocrit, heparin assay, fibrinogen, and free hemoglobin levels. Over a 6-year period, 1593 patients had intraoperative blood salvage with quality assessment. The majority of patients underwent cardiac operations (941 patients, 59%), whereas 243 had orthopedic (15%) and 208 had vascular (13%) procedures. Additionally, there were 127 pediatric patients (8%) and 74 miscellaneous procedures (5%). The highest average yield of salvaged blood was during vascular procedures (1073 +/- 76 mL), whereas orthopedic cases had the lowest yield (378 +/- 19 mL) and hematocrit (39%). There was minimal residual heparin activity, even in patients requiring systemic anticoagulation (0.3 to 0.5 units/mL). Patients undergoing pediatric procedures had the lowest concentration of free hemoglobin (476 mg/L), whereas all adult patients had higher free hemoglobin levels, especially vascular operations (990 mg/L). Intraoperative salvaged blood has minimal heparin activity, even in procedures requiring systemic anticoagulation. Fibrinogen, a marker of residual plasma, was undetectable in the majority of cases. These data indicate that intraoperative blood salvage generally results in a high-quality product (good hematocrit, low heparin, minimal plasma), although there are significant differences in free hemoglobin levels depending on the operative procedure.

Adult↗
PubMed1996

Postoperative nasogastric decompression: a prospective randomized trial.

To determine which type of patient should receive routine postoperative nasogastric decompression (NGD), we observed 76 patients who were randomized into two groups: those who received routine NGD (n = 39) and those who received selective NGD (n = 37). Eighteen patients in the selective NGD group never required intubation, while 19 did require intubation within a mean of 3 days after surgery. In both groups, tubes remained in place for a mean of 4.7 days. The routine NGD group had a 2.5% incidence of emesis, while the selective NGD group had a 51% incidence of emesis. The return of bowel function, return to a regular diet, and postoperative length of hospital stay were similar in both groups. The patients in the selective NGD group who did not require intubation had a shorter postoperative stay. Fifty-eight percent of patients in the selective NGD group who required intubation had had major vascular or retroperitoneal dissections. These data support selective use of NGD in general surgical patients and routine use of NGD for patients having major retroperitoneal or vascular procedures.

Diet↗
PubMed1992

A placebo controlled trial of remoxipride in the prevention of relapse in chronic schizophrenia.

Sixty-two DSM III chronic schizophrenic inpatients were selected for a double-blind, placebo controlled, multi-centre, relapse prevention study of remoxipride, a selective dopamine (D2)-receptor antagonist. After a 1 month placebo washout, 23 patients had relapsed and were withdrawn. Of the remaining patients 19 were randomised to remoxipride (150-300 mg daily) and 20 to placebo. Their median age was 58 years, 26 were male, and the median duration of illness was 33 years. After 24 weeks a further total of 8 remoxipride and 17 placebo patients had been withdrawn. Excluding three patients withdrawn for reasons other than relapse, the comparative relapse rates were 37% and 75%, respectively (P = 0.015). Efficacy analyses using clinical global impression (P = 0.04) and change in BPRS scores (P = 0.016) were in favour of remoxipride. Extrapyramidal symptoms were minimal in both groups. Treatment emergent adverse events were similar in the two groups. Remoxipride is therefore of potential value as a safe drug which is both effective and well tolerated in the long term management of chronic schizophrenic patients.

Adult↗
PubMedDate not supplied

Radiologic staging of gastrointestinal cancer.

Pre-operative staging should define the probable course of a patient's disease, separate the resectable from the unresectable patients, and identify the patients who are candidates for induction therapy. Pre-operative staging must be well tolerated and should provide new or important information that will affect the proposed treatment plan. For some diseases such as colon cancer, pre-operative staging is largely unnecessary, but it can be of great value for other tumors such as pancreatic cancer. Currently, many imaging techniques are available to evaluate gastrointestinal cancers, and each provides information necessary for directing treatment. Although no individual technique can stage patients with complete accuracy, combinations of the various imaging techniques can be used to increase accuracy and promote appropriate decisions about an individual's treatment options. The use of current imaging techniques for staging primary lesions, regional spread, and the intra-abdominal metastatic spread of the most common gastrointestinal malignancies are reviewed.

Diagnostic Imaging↗
PubMedDate not supplied

Prediction of recurrence and survival by post-resection CA 19-9 values in patients with adenocarcinoma of the pancreas.

BACKGROUND: CA 19-9 levels are useful for the diagnosis of patients with pancreatic adenocarcinoma. However, interest has recently turned toward its use as a prognostic indicator. The purpose of this study is to determine whether postoperative CA 19-9 levels predict disease-free survival (DFS) and median survival (MS) in patients after resection. METHODS: Between 1988 and 1996, 40 patients underwent resection for pancreatic adenocarcinoma and were evaluated with postoperative CA 19-9 assays. Eight patients had low preoperative levels of CA 19-9 (< 2) and were excluded. RESULTS: CA 19-9 levels are good predictors of DFS and MS. Patients whose postoperative CA 19-9 values normalized by 3 to 6 months (< 37 U/ml) had longer DFS (24 vs. 10 months, p < 0.04) and MS (34 vs. 13 months, p < 0.04). Patients with postoperative CA 19-9 values less than 180 U/ml at 1 to 3 months had a similar DFS (19 vs. 5 months, p < 0.0009) and MS (34 vs. 13 months, p < 0.0001) compared to patients with normal values at 3 to 6 months. CONCLUSIONS: Postoperative measurements of CA 19-9 were the best predictors of DFS and MS. Values < 180 U/ml at 3 months were as predictive as normal values by 3 to 6 months postoperatively. Consequently, CA 19-9 levels should be obtained for use as a stratification parameter in phase III trials.

Adenocarcinoma↗
PubMedDate not supplied

Biliary CA 19-9 values correlate with the risk of hepatic metastases in patients with adenocarcinoma of the pancreas.

Serum values of the tumor-associated antigen CA 19-9 are useful as an independent predictor of survival in patients with adenocarcinoma of the pancreas. However, the utility of biliary CA 19-9 values is unknown. This study was undertaken to determine whether biliary CA 19-9 levels are predictive of hepatic metastases. Between 1991 and 1996, thirty-eight patients treated for adenocarcinoma of the pancreas were evaluated using a biliary CA 19-9 assay. Bile was obtained from percutaneous stents placed during the perioperative period. Five of the 38 patients had low serum levels of CA 19-9 (<2 U/ml) and were excluded from the study. Twenty-seven (80%) of the 33 patients developed distant metastases: five pulmonary, five peritoneal, and 17 hepatic. Liver metastases were discovered initially in 10 and after resection of the primary tumor in seven (median interval 10 months). Biliary CA 19-9 values were significantly higher in patients with hepatic metastases (median 267, 400 U/ml; range 34,379 to 5,000,000 U/ml) compared to patients without metastatic disease (median 34,103 U/ml; range 6,620 to 239, 880 U/ml; P <0.006). Patients with hepatic, peritoneal, and pulmonary metastases had median survivals of 8,14, and 35 months, respectively (P <0.0041). All patients without metastatic disease are alive (median follow-up 13 months). Biliary CA 19-9 values are associated with a stepwise increase in the risk of developing metastatic disease. Patients with biliary CA 19-9 levels greater than 149,490 U/ml have an increased risk of developing recurrent disease in the liver and may warrant further hepatic evaluation or therapy.

Adenocarcinoma↗