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Biomedical subjects

R H Taylor

Publications and source records attributed to R H Taylor.

At least 19 recordsLinked to original sources
PubMed1997

Aplasia of the inferior rectus muscle. A case report and review of the literature.

PURPOSE: The authors describe the clinical findings, results of preoperative radiologic studies, and results of surgery in a boy with congenital unilateral inferior rectus aplasia. METHODS: A 2-year-old boy is described who presented with a significant anomalous head posture, a large incomitant vertical deviation with marked deficit of depression of the left eye, and positive head-tilt test results. Preoperative magnetic resonance imaging (MRI) defined an absent inferior rectus muscle; computed tomography showed no evidence of a craniofacial syndrome. Full tendon inferior transposition of the horizontal rectus muscles was carried out on the affected eye. RESULTS: The compensatory head position was eliminated. The infraduction improved. The patient had a small left hypotropia after the healing phase. CONCLUSIONS: To the authors' knowledge, this case is the first that used MRI to confirm preoperatively the isolated absence of an inferior rectus muscle. The MRI allowed effective surgical planning to correct the congenital abnormality.

Child, Preschool↗
PubMed1997

Oesophageal ECG in a child for burns surgery.

Continuous monitoring of heart rate and rhythm are regarded as minimal standards of monitoring during anaesthesia. However, when the thoracic area is exposed for surgery as for debridement of burns and split skin grafting then placement of surface electrodes for electrocardiographic (ECG) monitoring is not possible. We report the intraoperative use of an old technique, oesophageal ECG (OesECG) in a child presenting for major burns surgery. The positioning of the probe, electrical safety and P-QRS morphology, are discussed.

Burns↗
PubMed1997

A robotic system for percutaneous renal access.

PURPOSE: Percutaneous renal access can be challenging, particularly when the collecting system is not distended. Precise entry into a selected calyx facilitates subsequent percutaneous manipulations, but this skill requires extensive experience. In an attempt to improve accuracy while decreasing technical challenges, we developed a robotic system that automates the task of fluoroscopic image-guided percutaneous needle placement. MATERIALS AND METHODS: The prototype system consisted of a three degree-of-freedom robot with a needle injector end-effector. Imaging was provided by a biplanar fluoroscope. After correction of image distortion and fluoroscope calibration, robot to image-space registration was completed. To validate the system's ability to insert a needle into a calyx, ex vivo porcine kidneys suspended in agarose gel and distended with iodinated contrast solution were used as a model. In situ renal access tests with three 20 kg. pigs were performed. Access was confirmed by passing a flexible wire or aspirating iodinated contrast from the collecting system. RESULTS: The diameter of target calyces ranged from 3 to 7 mm. The in vitro accuracy of final needle tip positioning was 0.43 mm. In the ex vivo model, successful "one stick" access occurred on 10 of 12 attempts (83%). In situ access on the first attempt was successful for 6 of 12 target calyces (50%). Needle or tissue deflection accounted for each failure. CONCLUSION: The feasibility of a robotic system to assist in the percutaneous access of small and delicate renal calyces has been demonstrated. Additional work in reducing procedural steps and correcting for tissue deflection during needle passage is necessary to improve accuracy and to allow for clinical application.

Animals↗
PubMed1996

Endometrial ablation with the combined Nd:YAG laser-rollerball.

Endometrial ablation, an effective treatment for intractable uterine bleeding, can be performed with hysteroscopic rollerball coagulation, neodymium:yttrium-aluminum-garnet (Nd:YAG) laser, and endomyometrial resection techniques. Between November 1990 and January 1995, 49 women underwent ablation with the Nd:YAG laser and a nontouch technique on the ostia, uterine fundus, and upper one-third to one-half of the posterior uterine wall, in combination with rollerball coagulation over the entire endometrial surface after 60-W Nd:YAG application. The power source of the rollerball was set at 80 W of pure coagulation current. Each patient was pretreated with a gonadotropin-releasing hormone agonist or an antiestrogenic compound. The complications were one uterine perforation with a dilator with no sequelae, and one severe infection requiring hysterectomy. There were no failures. Of the 48 women available to follow-up, amenorrhea was achieved in 43 (90%). Two continued to spot very slightly on occasion, but did not require minipads. Three women had light flow requiring one to two tampons for 1 to 4 days every month. The technique continues to provide a very high rate of complete amenorrhea.

Adult↗
PubMed1995

Postoperative emesis following otoplasty in children.

Sixty unpremedicated children aged between 3 and 14 years, scheduled for otoplasty, were randomly divided into one of three groups to receive either ondansetron 0.1 mg.kg-1, droperidol 75 micrograms.kg-1, or placebo at induction of anaesthesia. All patients received a standard general anaesthetic using thiopentone, atracurium and halothane. Opioid analgesia was avoided intra-operatively and infiltration with local anaesthetic was used prior to the start of surgery. Children who received ondansetron were less likely to vomit (15%) than those who received either droperidol (40%) or placebo (60%) (p < 0.01). This group also tolerated oral ingestion of fluids and solids earlier than those who received either droperidol or placebo (p < 0.001). There was no difference between the placebo or droperidol group in the incidence of vomiting or time to ingestion of oral fluids and meals. Three patients in the ondansetron group had a self-terminating nodal rhythm which was not associated with any haemodynamic disturbances. Postoperatively there were no untoward incidents in any of the groups and all patients were discharged home the day after surgery.

Adolescent↗
PubMed1995

The effect of a combination of rectal diclofenac and caudal bupivacaine on postoperative analgesia in children.

Both caudal anaesthesia and non-steroidal anti-inflammatory drugs have been used in the management of postoperative pain in children. The aim of the present study was to evaluate the combination of caudal analgesia and rectally administered diclofenac in the treatment of pain following minor surgery in children. Thirty-nine, ASA grade 1 or 2, children undergoing inguinal or penoscrotal surgery were randomly assigned to receive either a caudal block using 0.125% bupivacaine with adrenaline or a similar caudal block in combination with rectally administered diclofenac 1 mg.kg-1. Children given a caudal block alone were more likely to need analgesia in the first 24 h postoperatively. It would appear that the combination of a caudal block and rectal diclofenac in children undergoing minor lower abdominal surgery reduces the need for subsequent analgesia.

Administration, Rectal↗
PubMed1994

Profile of colorectal cancer at a community hospital with a multiethnic population.

A retrospective 10-year review of all (311) new cases of colorectal cancer at a community hospital serving a multiethnic urban population was carried out in order to study characteristics of the disease other than incidence and mortality rates. There was a striking similarity despite ethnic differences in most characteristics. The only differences between ethnic groups seen were anatomic distribution of cancer in the colon (statistically significant) and male-to-female ratio of colon cancer (apparent but not statistically significant). Characteristics are classified into three types: (1) Not influenced by ethnicity or by environment: Dukes' stage at presentation, colon-to-rectum ratio, histology, length of hospital stay, survival; (2) Possibly influenced by environment. mean age, male-to-female ratio, presence of synchronous polyps, duration of symptoms; (3) Influenced by ethnicity: anatomic distribution of cancer in the colon.

Aged↗
PubMed1994

Simultaneous two level oesophageal pH monitoring in healthy controls and patients with oesophagitis: comparison between two positions.

For oesophageal pH monitoring, the pH probe is usually positioned 5 cm above the lower oesophageal sphincter (LOS). This is by convention, and has not been compared with other positions in its ability to discriminate between physiological and abnormal acid reflux. Using simultaneous two level 24 hour pH monitoring (5 and 10 cm above manometrically determined LOS) in 31 controls and 51 patients with reflux oesophagitis, the significance of the precise position of the probe in the oesophagus was examined. Secondly, this study compared the discrimination between the two groups achieved at the two levels. Patients had greater acid exposure than controls at both levels. In controls, acid exposure was greater at distal than at the proximal level except the supine acid exposure, which was similar at both levels. In patients, acid exposure was greater at the distal level for all variables (median % of total time pH < 4 = 11.7 v 7.6; p = 0.001). There was excellent correlation between the two levels for all variables in controls (r = 0.883, 0.935, 0.813, and p < 0.001 for percentage of time pH < 4 for total, supine, and upright times) as well as in patients (r = 0.848, 0.848, 0.779, and p < 0.001). On discriminant and receiver operating characteristic analysis, pH threshold 4 seemed as good as or better than other pH thresholds in discriminating between controls and patients. The percentage of total time pH below 4 seemed to discriminate as well or better than other variables at both levels. The distal level (5 cm above LOS) provided slightly better discrimination than proximal level (10 cm) (percentage of subjects correctly classified=81.7 v 75.6). The critical factor for the reliability of the test is not the precise position of the pH probe relative to the LOS, but that the same position is consistently used in patients and controls.

Adult↗
PubMed1994

Prolonged remission of oesophagitis does not alter the magnitude of oesophageal acid exposure.

In a previous study we reported lack of improvement in oesophageal motor function after complete healing of oesophagitis achieved by treatment with omeprazole for a median duration of 12 weeks. This study investigates the effect on oesophageal acid exposure of a longer period of complete remission. It was decided to approach all patients who had 24-h pH monitoring as part of the earlier project and whose second endoscopy showing complete healing of oesophagitis as done at least 24 weeks previously. Of 38 such patients, 24 underwent endoscopy, which showed relapse of oesophagitis in 5 of them. In 18 patients who were eligible and agreed to take part, omeprazole/ranitidine was withdrawn for at least 7 days, after which pH monitoring was repeated. The median duration of remission was 39.5 weeks (range, 26-81 weeks). The median percentage of total time with pH below 4 was 11.5% before and 11.0% after (NS). The corresponding figures for the upright and supine reflux, the number of reflux episodes longer than 5 min, and the duration of the longest reflux episode were 10.7% versus 7.7%, 11.4% versus 12.1%, 7.5 versus 7.5, and 35.5 versus 30.5 min, respectively (NS for all variables). These results suggest that maintenance of remission of oesophagitis for prolonged periods does not alter the degree of acid reflux on discontinuation of medication. This has important implications for the understanding of the natural history of gastro-oesophageal reflux disease.

Adult↗
PubMed1994

Esophageal motor dysfunction and acid exposure in reflux esophagitis are more severe if Barrett's metaplasia is present.

OBJECTIVES: To compare esophageal motor function in patients with reflux esophagitis with controls, and identify patient characteristics that may have a bearing on the severity of esophageal motor dysfunction and acid exposure. METHODS: Esophageal motor function was assessed in 60 patients with reflux esophagitis. All patients had manometry, 50 had an esophageal transit test, and 23 had an acid clearance test. Forty-eight had dual site [5 and 10 cm above lower esophageal sphincter (LES)] esophageal pH monitoring, four had only distal pH monitoring, and one patient had only proximal pH monitoring. Thirty-four controls underwent the same tests. The association between the indices of esophageal function plus the degree of esophageal acid exposure and eight patient characteristics (age, sex, obesity, smoking, alcohol intake, hiatus hernia, grade of esophagitis, and Barrett's metaplasia) was examined in unifactorial and multifactorial analysis of variance. RESULTS: The patients had significantly lower LES pressure, lower distal and middle esophageal amplitudes, longer duration of contraction, and slower velocity of propagation. They had longer esophageal transit and acid clearance times. Barrett's metaplasia was the only factor that had an association with the magnitude of esophageal motor dysfunction and acid exposure, except age, which had a weak positive association with acid exposure (p = 0.03). Compared to the rest of the patients with esophagitis, patients with Barrett's had lower LES pressure (median = 10.5 vs. 17.5 mm Hg, p = 0.013), longer supine transit time (median = 180 vs. 13.5 s, p = 0.0001), and higher % of total time pH < 4 (median = 48.2 vs. 8.7 and 23.2 vs. 5.2; p < 0.0001 for distal and proximal esophageal acid exposure, respectively). Ten of the 12 patients with Barrett's had abnormal manometry, compared with 20 of the 48 without (chi 2 = 6.67; p < 0.01). There was a strong correlation between the degree of acid exposure in the proximal esophagus and the length of Barrett's segment (r = 0.846, 0.81, 0.725; and p < 0.001, 0.005, 0.018, for the % of times pH < 4 for total, supine, and upright periods, respectively). CONCLUSIONS: The development of Barrett's metaplasia may be determined by the degree of esophageal exposure to the refluxate which, in turn, may be a function of the severity of esophageal motor dysfunction. The length of Barrett's segment may be dependent on the extent of orad transport of the refluxate.

Analysis of Variance↗
PubMed1993

Comparison of the Keeler Pulsair 2000 non-contact tonometer with Goldmann applanation.

The Pulsair 2000 non-contact tonometer (Keeler Ltd, UK) is compared with the Goldmann applanation tonometer. Data from 80 eyes were acquired by four experienced observers. A linear regression analysis showed the relationship between the instruments to be: Pulsair = 0.66 + 0.95 Goldmann. Individual components of variation were analysed by analysis of variance which indicated a significant variation in the slope of the regression equation due to observers (p = 0.02) but not to the order in which topical anaesthesia was administered. Differences between two Pulsair instruments were of marginal significance (p = 0.07). The intercept of the regression equation was unaffected by any of the components of variation. Seventy-nine per cent of averaged intraocular pressure measurements obtained with the Pulsair 2000 fell on or within +/- 3 mmHg of those measured with the Goldmann tonometer. It is concluded that the Pulsair 2000 can provide clinically useful measurements of intraocular pressure.

Adolescent↗
PubMed1993

Extraintestinal lymphoma in association with Whipple's disease.

A 45 year old man is described with Whipple's disease who presented with weight loss, lethargy, and ascites. He subsequently developed fever and a mass in the neck, but died despite antibiotic treatment and nutritional support. Necropsy showed extraintestinal lymphoma.

Humans↗
PubMed1993

Dosing efficiency and particle-size characteristics of pressurized metered-dose inhaler aerosols in narrow catheters.

An experimental in vitro model was used to determine the effects of intraluminal catheter diameter and length on the delivered dose and particle-size characteristics of salbutamol (albuterol) aerosol delivered by metered dose inhaler (MDI) (Ventolin, 100 micrograms per puff). The dose of aerosolized drug that exited a 16-cm-long tracheal tube with an inner diameter (ID) of 6 mm was compared with that from 4 catheters of differing diameters and lengths that were inserted individually into the tracheal tube. The salbutamol MDI canister was actuated ten times into each delivery system, and the effluent aerosol was trapped onto a filter. The filtrate was dissolved in methanol, and the salbutamol concentration was determined using high-performance liquid chromatography. For the 3 22-cm-long catheters, the delivered dose (mean +/- SD) of salbutamol per actuation for the 22-standard wire gauge (SWG) catheter was 97.5 +/- 3.9 micrograms, which was similar to that for the 19-SWG catheter (102.3 +/- 2.5 micrograms) but was significantly less than that for the 14-SWG catheter (108.2 +/- 4.2 micrograms) (p < 0.05). These delivered doses exceeded those of the 6.0-mm-ID tracheal tube alone (2.33 +/- 0.76 micrograms) and the 13-cm-long 19-SWG catheter (2.17 +/- 0.29 micrograms) (p < 0.001). In a second experiment using a cascade impactor, the distribution of aerosol particle diameters that exited the 6-mm-ID tracheal tube was compared with that exiting a 13-cm-long 19-SWG catheter that extended halfway down the tracheal tube and with that exiting a 22-cm-long 19-SWG catheter inserted into the distal end of the 6-mm-ID tracheal tube. The mass median aerodynamic diameter (mean +/- SD) of the salbutamol aerosols delivered through both the 6.0-mm-ID tracheal tube (1.1 +/- 0.1 microns) and that of the 13-cm-long 19-SWG catheter (1.2 +/- 0.2 microns) were significantly less than that delivered through the 22-cm-long 19-SWG catheter (2.0 +/- 0.1 microns) (p < 0.05). The authors conclude that delivery of respirable aerosol can occur through narrow catheters that function as extended nozzles for MDIs. Optimal dosing will be obtained when the catheter extends the full length of the tracheal tube.

Aerosols↗
PubMed1993

Diabetes care and the Royal Navy: the importance of a coordinated approach.

The provision of coordinated diabetic care with the establishment of a dedicated diabetic clinic at the Royal Naval Hospital Haslar, has improved the quality of life for the majority of service diabetics. The standard of diabetic control has improved greatly and there has been less sickness due to diabetes, though the effect on invalidings is inevitably less obvious. Good glycaemic control, a healthier lifestyle and a positive attitude, achieved through understanding diabetes and its implications, has been of overall benefit to the Royal Navy.

Blood Glucose↗
PubMed1992

Early extubation of the trachea after repair of secundum-type atrial septal defects in children.

To investigate the role of anaesthetic management in early extubation of the trachea in children after closure of a secundum-type atrial septal defect (ASD II), a retrospective chart review for a two-year period was performed. We identified 36 children who underwent surgical repair of an isolated ASD II. In 19 children (53%) the tracheas were extubated in the operating room immediately after surgery and in 17 patients (47%) the tracheas remained intubated and the lungs were ventilated in the Intensive Care Unit. There was no difference in age (69.5 +/- 33.8 vs 72.9 +/- 45.0 mo) or weight (19.5 +/- 8.1 versus 20.5 +/- 12.7 kg) between the two groups (mean +/- SD). Children in the extubated group had a shorter duration of cardiopulmonary bypass (43.4 +/- 7.8 min) than those remaining intubated (31.7 +/- 12.7 min) (P < 0.05). The children whose tracheas were extubated early received a lower perioperative fentanyl dose (5.9 +/- 6.4 micrograms.kg-1) than those remaining intubated (35.1 +/- 8.5 micrograms.kg-1). Those children in the extubated group had a lower hourly requirement for morphine by infusion (13.6 +/- 5.7 vs 18.2 +/- 5.4 micrograms.kg-1.hr-1) and a shorter stay (20.5 +/- 3.7 versus 29.0 +/- 11.2 hr) in the Intensive Care Unit. Re-intubation of the trachea was not required in any of the children and no deaths occurred. Early extubation after ASD II repair is safe and, given the results of this study, may offer certain advantages over prolonged intubation and ventilation in these children.

Analgesia↗