Investigating in vitro drug release mechanisms inside dosage forms. Monitoring liquid ingress in HPMC hydrophilic matrices using confocal microscopy.
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Administration, Oral↗
Biomedical subjects
S Cunningham
Publications and source records attributed to S Cunningham.
Immune function early in acute pancreatitis.
Circulating lymphocyte numbers and activation together with granulocyte function were measured in 20 patients in the early stages of an attack of acute pancreatitis and in 20 healthy controls. Circulating lymphocytes, T lymphocytes, and CD4 and CD8 T lymphocyte subsets were decreased in both mild pancreatitis (67-80 per cent of controls) and severe pancreatitis (22-40 per cent of controls). CD4:CD8 ratios were unchanged and median (interquartile range) interleukin 2 receptor expression was increased from less than 1 per cent in controls to 14(6) per cent in severe pancreatitis, suggesting lymphocyte activation. Median granulocyte chemiluminescence was increased to 293 per cent of controls in severe pancreatitis and random motility was reduced to 77 per cent of controls, indicating increased metabolic activity. Complement-mediated antibody-independent opsonization and chemotaxis toward endotoxin were normal. Immune function is not reduced early in acute pancreatitis. Granulocyte hyperactivity may be important in the development of multiple organ failure.
Acute Disease↗
Comparison of nurse and computer charting of physiological variables in an intensive care unit.
OBJECTIVES: To compare charting of physiological parameters manually by nurses and automatically by computer and so decide whether this task could accurately be performed by computer. SUBJECTS/SETTING: 101 consecutive patients admitted for tertiary neonatal intensive care. DESIGN: Direct comparison of 48 hours of data collected by both methods. Computer data stored each second and the hourly median compared with the single hourly value noted by the nurse. METHODS: All patients were monitored by standard patient monitor and a computer. Four physiological parameters were compared between nurse and computer (both derived information from the standard patient monitor): heart rate, transcutaneous oxygen, mean blood pressure, central temperature. A random 51% of patients had the computer data displayed as trends at the cotside. Comparison of the hourly nurse observation and a computer hourly median value. Computer data was compared before and after the removal of artifact. In addition, the effects on nursing observations of either display or non display of the computer trend data was assessed. RESULTS: Nurse and computer observations were statistically significantly different (p < 0.001), though these were not clinically important. Nurses tended to note a higher figure than the computer median. The cotside display of computer data improved consistency between the nurse and computer observations. Artifact present in the data had little influence on the accuracy of the computer median value. CONCLUSIONS: Computer systems can accurately chart physiological data, providing a more flexible record with a minimal risk to data reliability from artifact.
Bias↗
Are thyroid function tests necessary in patients with suspected sleep apnea?
Thyroid evaluation is frequently performed in patients with sleep apnea because of a suspected causal relationship between hypothyroidism and obstructive sleep apnea (OSA). The aim of this study was to determine the actual prevalence of hypothyroidism in patients referred for polysomnography and evaluate whether its rate was higher in patients with OSA than those without OSA. Ultrasensitive thyroid stimulating hormone (TSH) was performed on 255 of 279 consecutive patients referred for polysomnography from the neurology service of a large HMO. Hypothyroidism was detected in 1.6% (4/243) of all patients, 1.5% (3/194) of patients referred to evaluate OSA, and 2.0% of patients referred to evaluate the presence of periodic leg movement disorder (PLMD)/narcolepsy/parasomnia. There was no significant difference in rates of hypothyroidism in patients with documented OSA (2.9%, 3/103) compared to those without OSA (0.7%, 1/135). Two of the four patients with elevated TSHs had previously documented hypothyroidism and were on thyroxine replacement. Rates of hyperthyroidism were as high or higher than those of hypothyroidism in all groups. We conclude that thyroid screening does not appear to be appropriate for patients with suspected, or confirmed, OSA in the absence of signs or symptoms consistent with hypothyroidism or unless they are in a high risk group (women over the age of 60).
Adult↗
Injury surveillance at a national multi-sport event.
The 1994 Australian Universities Games represents a multi-sport event which featured 5106 participants competing in nineteen sports. Injury surveillance was conducted by means of the injury Surveillance Form, which recorded time, mechanism, site, type and severity of injury, as well as initial treatment and referral patterns. Over six days of competition, 1177 presentations with injury were recorded, sustained by 994 athletes or 19.5% of all participating athletes. Tae kwon do and hockey were the sports with the greatest incidence of injury. Haematomas, muscle strains and ligament sprains were the most common injuries, with contact and overuse the most common mechanisms of injury. Mild injuries dominated and severe injuries were uncommon. 75% of injuries were initially assessed and treated by a nurse, first aid officer or sports trainer; 15% by a physiotherapist and 10% by a doctor. The authors' recommendation is that such a team of medical staff should be an integral part of any large sporting event, whether participants are professionals or amateurs. Additionally, they need to be supported by facilities and services such as central clinics, a nearby x-ray centre, a nearby hospital and an ambulance/first aid transport network.
Adolescent↗
Transcutaneous oxygen levels in retinopathy of prematurity.
Retinopathy of prematurity (ROP) is a potentially blinding disease of preterm infants. 21 days of computer-recorded transcutaneous oxygen (TcPO2) data were compared in 31 infants with stage 3 or greater ROP and 38 infants with no ROP or stage 1 or 2. In a multiple logistic regression adjusted for significant perinatal factors (birthweight, gestation, and intraventricular haemorrhage), babies with stage 3 or higher ROP showed an increased variability of TcPO2 in week 1 (p < 0.01) and 2 (p = 0.012) but not week 3. Variability of TcPO2 in the first 2 weeks of life is a significant predictor of severe ROP.
Blood Gas Monitoring, Transcutaneous↗
Enhanced tumour uptake and in vitro radiotoxicity of no-carrier-added [131I]meta-iodobenzylguanidine: implications for the targeted radiotherapy of neuroblastoma.
In vitro and in vivo neuroblastoma models were used to determine whether improvements in tumour targeting in vivo and therapeutic efficacy in vitro could result from the use of no-carrier-added (n.c.a.) [131I]MIBG. Results were compared with use of the conventional therapy MIBG preparation (ex. [131I]MIBG) of lower specific activity which is produced by iodide exchange reaction. The efficacy of n.c.a. [131I]MIBG was compared with that of [131I]MIBG over a range of specific activities by the assessment of neuroblastoma spheroid growth delay. Whereas n.c.a. [131I]MIBG at a radioactivity concentration of 2 MBq/ml prevented the regrowth of 84% of spheroids, toxicity was significantly reduced by the addition of non-radiolabelled MIBG to the incubation medium. The time-dependent biodistribution of n.c.a. [131I]MIBG in nude mice bearing human neuroblastoma xenografts was compared with that of the conventional therapy radiopharmaceutical. The n.c.a. agent gave improved tumour uptake but also significantly greater accumulation in normal tissues known to accumulate MIBG such as heart, adrenal and skin. However, uptake and retention in the blood was unaltered. For all tissues examined, the 3-day calculations were undertaken to predict organ to tumour dose ratios which would result in human neuroblastoma patients with each of the [131I]MIBG preparations. These results suggest that significant therapeutic gain may be achieved by the use of n.c.a. [131I]MIBG as a treatment agent in neuroblastoma. neuroblastoma.
3-Iodobenzylguanidine↗
Granisetron in the prevention of irradiation-induced emesis.
A double-blind double-dummy, comparative study was carried out in 30 patients receiving highly emetogenic fast dose rate, single fraction total body irradiation prior to bone marrow transplantation. Patients were randomised into one of two groups, receiving either granisetron, a specific 5-HT3 antagonist or a combination of metoclopramide, dexamethasone phosphate and lorazepam to assess the comparative efficacy of the two regimens in the control of irradiation-induced nausea and vomiting. After 24 h eight patient (53%) treated with granisetron showed a complete response compared with two patients (13%) in the comparator group. The control of vomiting by granisetron, over both 24 h and 7-day periods (P = 0.001 and P = 0.004), was significantly better than that seen with the comparator and required significantly fewer rescue doses. The safety profiles in the two groups appeared similar, with the exception that granisetron produced less drowsiness than the comparator.
Adult↗
Multiple supernumeraries: a case report.
Supernumerary teeth, which usually appear in small numbers and are easily dealt with, may affect the permanent dentition if not removed. In this paper the case of multiple supernumerary teeth in the presence of a complete dentition is reported.
Adult↗
The practical management of artifact in computerised physiological data.
Computerised physiological data contains artifact that needs to be identified and possibly removed. Whilst computers may eventually satisfactorily perform this function, at present only manual removal is possible for the majority of intensive care computer groups. We assessed the effects of artifact and its removal on the physiological data of 3 patients. Artifact was manually removed from 7 days of data in 4 parameters (heart rate, respiratory rate, systolic blood pressure [sbp] and transcutaneous oxygen [tcpO2]) by 3 independent observers. Six hour time periods were analysed. Median and mean values before and after the manual removal of artifact were compared. Overall 6.5% of data was removed as artifact. This was greatest for tcpO2 (9.9%) and sbp (10.6%), with smaller amounts for respiratory rate (2.8%) and heart rate (2.4%). Sbp showed a marked difference in the amount of data removed between patients, whereas tcpO2 data contained quite large volumes of artifact, but this was fairly consistent between patients. Removal of artifact affected mean values more than median values. One observer considered that both physiological and non-physiological artifact should be removed, whereas the other two observers removed only non-physiological artifact. Agreement in results between the latter was good. Our results suggest that inter-observer variability should have a minimal effect on values, once rules identifying the type of artifact to be removed are agreed. Removal of artifact did not have a clinically significant effect on results, but may be an important consideration in the statistical analysis of computerised physiological data.
Artifacts↗
Changes in mean blood pressure caused by damping of the arterial pressure waveform.
'Damping' of an intra-arterial pressure waveform theoretically affects systolic and diastolic blood pressure whilst mean blood pressure (mbp) continues to be reliable. We assessed changes in mbp associated with 79 episodes of damping in 30 infants. The average mbp in the hour just before damping occurred was compared with that in the first hour of damping. The mean change in mbp was -0.845 mmHg. In 50% of cases this change was < 2 mmHg and in 24% of episodes > or = 4.1 mmHg. Damping may produce clinically significant changes in mbp which computer trend data may help to differentiate.
Blood Pressure↗
Voice of a stranger.
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Accidents, Traffic↗
Mineralocorticoid and glucocorticoid status in idiopathic haemochromatosis.
OBJECTIVE: A number of studies have suggested that both primary (Addison's disease) and secondary adrenal failure may be caused by idiopathic haemochromatosis. There is little information on mineralocorticoid secretion. We have assessed the mineralocorticoid and glucocorticoid status of patients with idiopathic haemochromatosis. DESIGN: Cross-sectional study. PATIENTS: Eighteen males and one female with confirmed idiopathic haemochromatosis were investigated. Seven of the subjects had hepatic cirrhosis and three had hypogonadotrophic hypogonadism. MEASUREMENTS: A short Synacthen (tetracosactrin) test was undertaken in addition to an overnight metyrapone test and an insulin stress test. In addition, plasma aldosterone (PA) and plasma renin activity (PRA) were measured in a group of patients in the basal state and again in the upright position. RESULTS: The short Synacthen test, overnight metyrapone test and insulin stress test were normal in all subjects. The PA, PRA, and PA/PRA ratios in the upright position were not significantly different in the patients with idiopathic haemochromatosis compared to control subjects. CONCLUSION: In this patient population, no abnormality of either the pituitary adrenal axis or mineralocorticoid status was detected. Adrenocortical dysfunction is likely to be exceptionally rare in idiopathic haemochromatosis.
Adult↗
Oral cancer development in patients with oral lichen planus.
There has been considerable controversy as to whether oral lichen planus (LP) has a premalignant potential. This study retrospectively examined the records of 241 British patients with histologically confirmed LP seen during the 10-year period 1982-92. Nine patients (3.7%) were known to have developed well-differentiated invasive carcinoma or carcinoma in situ in an area of LP. Most carcinomas at presentation were in areas of atrophic and/or erosive LP, 6 were in patients older than 65 years, and 6 were on the tongue. The results support a small but clinically important premalignant potential for LP.
Adult↗
Cyclical variation of blood pressure and heart rate in neonates.
Using a computerised physiological monitoring system a cyclical variation in blood pressure (waves), with associated changes in heart rate and transcutaneous oxygen, was observed. Twenty five episodes were seen in 10 neonates, with a median gestation of 33 weeks (range 28-42 weeks). Eight neonates had an asphyxial injury. Blood pressure waves had a mean (SD) amplitude of 11.6 (5.6) mm Hg with a mean wavelength of 9.0 (5.2) minutes. Both amplitude and frequency were independent of gestation. In neonates of less than 34 weeks an inverse phase relation existed between heart rate and blood pressure waves (blood pressure rose as heart rate fell); in infants with a gestation greater than 34 weeks a direct phase relationship occurred (blood pressure and heart rate rose together). It is postulated that hypertensive blood pressure waves may cause or exacerbate cerebral pathology in neonates with a pressure passive cerebral circulation.
Blood Gas Monitoring, Transcutaneous↗
Is the hot appendix really hot?
The skin temperature in the right and left iliac fossae was recorded in 100 patients who were referred with a provisional diagnosis of acute appendicitis. This was not found to be a reliable aid in diagnosis of acute appendicitis nor an indicator to the need for surgery in patients with right iliac fossa pain.
Acute Disease↗
Neonatal physiological trend monitoring by computer.
A premature baby born up to four months early is a fragile patient dependent on intensive care. The body systems are physiologically immature and so tolerate stress badly. The tendency of these infants to rapidly deteriorate, has led us to use a cotside computer monitoring system which displays physiological trends. Information from standard neonatal monitors is accessed by individual cotside PC's linked to a central network server and Doctors terminal. Trend graphs can be easily manipulated, displaying from 7 minutes to 3 days of physiological information on a single screen. Pathology may be observed in real time as it occurs. The system has 3 main areas of use, (a) as a real time clinical aid to patient management, e.g. apnoea of the newborn; (b) as a research tool, demonstrating the effects of procedures on physiology; (c) for educating members of staff about how physiological events develop. Data is saved for the whole of each neonates intensive care stay. Assessment of staff and parent attitudes by questionnaire have been favourable.
Humans↗
Molecular characteristics of amiloride-sensitive sodium channels.
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Amiloride↗