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R Goulding

Publications and source records attributed to R Goulding.

At least 19 recordsLinked to original sources
PubMed2001

Immune haemolytic anaemia following T cell-depleted allogeneic bone marrow transplantation for chronic myeloid leukaemia: association with leukaemic relapse and treatment with donor lymphocyte infusions.

Immune haemolytic anaemia (IHA) is a recognised complication after allogeneic stem cell transplantation (SCT) and occurs more frequently if marrow cells have been subjected to T cell depletion (TCD). Among 58 consecutive patients who underwent TCD-allogeneic SCT from volunteer unrelated donors for the treatment of CML at the Hammersmith Hospital during a 3-year period (1 March 1996 to 28 February 1999) we identified nine cases of IHA. All patients had a strongly positive direct and indirect antiglobulin test and in eight patients the serological findings were typical of warm-type haemolysis often with antibody specificities within the Rh system. All nine cases had clinically significant haemolysis and were treated initially with prednisolone and immunoglobulin. The onset of IHA coincided with the occurrence of leukaemic relapse in six cases, and the presence of host haemopoiesis confirmed by lineage-specific chimerism in all four cases studied. Five patients received donor lymphocyte infusions (DLI); in three molecular remission and the restoration of full donor chimerism coincided with resolution of haemolysis. We conclude that in the context of leukaemic relapse, DLI is an effective therapy for IHA following allografts involving TCD.

Adolescent↗
PubMed2000

Evaluation of the benefits of monitoring fluid thickness in the dietary management of dysphagic stroke patients.

OBJECTIVE: Safe swallowing may be achieved in most patients with neurogenic dysphagia by manipulating the viscosity of ingested fluids. However, in clinical practice fluids are thickened using subjective judgement. This may lead to errors in the preparation of drinks to the prescribed viscosity. The aim of the present study is to examine whether the use of a viscometer improves the dietary management of dysphagic stroke patients. STUDY DESIGN: A randomized controlled study design was used. The speech and language therapist determined the optimal fluid thickness for each patient. The prescribed fluid viscosity for the study group was obtained using a viscometer. Patients in the control group received fluids prepared according to current practice, i.e. the amount of thickener required to produce the prescribed viscosity was judged subjectively by the nursing staff. The two methods of fluid thickening were used for seven consecutive days. Assessment was made blind to randomization. MAIN OUTCOME MEASURE: Pulmonary aspiration, assessed clinically and with pulse oximetry. If the patient did not drink all the fluid that was offered the residue was measured. RESULTS: Ten patients in the study group (n = 23) and nine in the control group (n = 23) aspirated. The mean viscosity of fluids offered to patients in the control group was significantly higher than that of the study patients. There was a statistically significant correlation between the viscosity and the residual volume of fluid (Pearson's test: r = 0.7, p <0.02). The findings of the study suggest that fluids prepared by subjectively assessing the amount of thickener required to produce a given consistency tend to have a higher viscosity than those prepared using the viscometer. However, the higher viscosity does not appear to protect against pulmonary aspiration and may lead to a reduced fluid intake. CONCLUSION: Manipulation of fluid thickness using objective measurements with a viscometer may improve the dietary management of dysphagic stroke patients.

Aged↗
PubMed2000

Short Report: Engraftment of T-cell-depleted allogeneic haematopoietic stem cells using a reduced intensity conditioning regimen.

Graft-versus-host disease (GVHD) remains a significant complication in patients undergoing allogeneic stem cell transplantation (SCT) using a reduced intensity conditioning regimen. Although T-cell depletion (TCD) reduces the risk of GVHD after a myeloablative conditioning regimen, it is associated with an increased risk of graft failure. We have therefore examined whether TCD compromises engraftment using a fludarabine-based conditioning regimen. Fifteen patients have been transplanted using such a regimen of whom 13 underwent ex vivo TCD. All but one patient demonstrated durable engraftment and no patient receiving a TCD product developed severe GVHD. Thus, TCD may play a role in GvHD prophylaxis using such regimens.

Adult↗
PubMed1998

Legal aid.

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England↗
PubMed1994

Health promotion.

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Health Policy↗
PubMed1994

Health promotion.

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Health Promotion↗
PubMed1993

Pharmacokinetics of single oral doses of feprazone in patients with rheumatoid arthritis or with impaired renal clearance.

1. The pharmacokinetics of feprazone have been studied in 10 patients with rheumatoid arthritis (RA), and in a further six patients with renal impairment (RI) who were not suffering from rheumatoid disease. 2. For RA patients, the mean elimination half-life (t1/2) of feprazone after a single oral dose was 21 +/- 5 h (SD), the mean apparent clearance (Cl) was 0.012 +/- 0.009 l/h per kg, and the mean apparent volume of distribution (Vd) was 0.33 +/- 0.17 l/kg. Corresponding values for RI patients were 25 +/- 13 h, 0.016 +/- 0.011 l/h per kg, and 0.46 +/- 0.24 l/kg, respectively. 3. These results show no impairment of the elimination of feprazone in RA or RI patients; Vd and Cl are greater than in healthy young volunteers or elderly subjects, the AUC values are lower, but t1/2 values are similar in all groups. 4. It is suggested that the greater Cl and Vd, and lower AUC, in RA and RI patients may be due to renal insufficiency and decreased plasma protein binding of feprazone and its metabolite, or to induction of glucuronyl transferase activity by the prior medication, thus enhancing the formation of the major metabolite, the C(4)-glucuronide, and increasing drug elimination.

Administration, Oral↗
PubMed1991

Poisons information services: a look ahead.

1. Following the establishment, in the USA, of the first poisons information centre, in 1953, the movement has grown globally. Originally, such a service was intended to meet an emergency need. Its efficacy has still not been objectively audited. 2. The suggestion now is that clinical toxicology has become such a diverse subject within the community that simply answering emergency calls over the telephone is not enough. Instead, expertly staffed clinical toxicology units should be set up to cater for much wider problems.

Humans↗
PubMed1985

Organochlorine pesticide residues in human fat in the United Kingdom 1982-1983.

Between December 1982 and October 1983 samples of human body fat were taken during routine necropsies carried out on 187 persons aged over 5 years and four infants aged under 4 months. Comparison of the results of analysis with those from the previous studies in 1976-1977, and earlier, shows a continuing decline in residues of p,p'-dichlorodiphenyltrichloroethane (p,p'-DDT) and dieldrin (HEOD) and a reduction in the amounts of p,p'-dichlorodiphenyltichloroethane [p,p'-DDE, a metabolite of p,p'-DDT] and hexachlorobenzene. The concentrations of other compounds were similar to those observed in the previous studies. The results show that the amounts of organochlorine pesticides and polychlorobiphenyl compounds contained in human fat samples from residents in the UK compare favourably with data obtained in other countries.

Adipose Tissue↗
PubMed1983

Poisoning on the farm.

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Agricultural Workers' Diseases↗