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Biomedical subjects

T Dorman

Publications and source records attributed to T Dorman.

At least 37 records · Page 2Linked to original sources
PubMed2000

Sickness Impact Profile Score versus a Modified Short-Form survey for functional outcome assessment: acceptability, reliability, and validity in critically ill patients with prolonged intensive care unit stays.

BACKGROUND: Quality of life after surgical critical illness is an important measure of outcome. The Sickness Impact Profile Score (SIP) has been validated in critically ill patients, but the Modified Short-Form (MSF) has not been directly compared with it. METHODS: The SIP and MSF-36 were coadministered to 127 patients (surrogates) with a prolonged surgical critical illness at baseline at 1, 3, 6, and 12 months. Reliability, validity, and acceptability were determined for overall and subscores at each time point. RESULTS: The overall SIP and eight subscores, including physical health and psychosocial health, were all significantly improved at 1 year compared with baseline (p < 0.05). However, the MSF-36 was improved only in health perception (p < 0.05), but pain scores were higher (p < 0.05) than at baseline. Internal consistency of the MSF-36 was poor at 1 and 3 months. Correlation between the tools was excellent at baseline and 1 year but variable in overall and subscores at other time points. CONCLUSION: The SIP is more comprehensive, reliable, and acceptable in determining specific quality-of-life abnormalities, but the MSF-36 is easier to administer and correlates well at baseline and 1 year in patients with a prolonged critical illness.

Activities of Daily Living↗
PubMed2000

Renal thrombotic microangiopathy associated with interferon-alpha treatment of chronic myeloid leukemia.

Recent reports have documented the development of renal thrombotic microangiopathy in patients with chronic myeloid leukemia (CML) who have undergone treatment with interferon-alpha. The pathogenesis of the renal lesion in such cases remains unclear. We report the case of a patient with chronic myeloid leukemia who developed renal failure and nephrotic syndrome while being treated with hydroxyurea and interferon-alpha. The renal biopsy showed features of chronic thrombotic microangiopathy. The patient had serologic and functional evidence of anti-phospholipid antibody. Interferon-alpha is known to cause induction of multiple autoantibodies. We propose that in the context of CML, interferon-alpha treatment can induce pathogenic anti-phospholipid antibodies that result in renal thrombotic microangiopathy. This has important implications for patients with CML receiving immune-stimulating therapy because it suggests that prospective monitoring of such patients for anti-phospholipid antibody might identify those at risk of developing thrombotic microangiopathy. Furthermore, patients with established anti-phospholipid antibody syndrome in this context might benefit from intervention such as early anticoagulation.

Antiphospholipid Syndrome↗
PubMed2000

[An analysis of selected risk factors of aseptic loosening of hip endoprosthesis].

An analysis of selected risk factors of aseptic loosening of hip endoprosthesis has been attempted on the ground of retrospective evaluation of 57 hips in 54 patients (41 females, 13 males) who underwent revision of the hip replacement. Age of the patients at primary surgery ranged from 18 to 73 years (mean 55.6 years). Follow-up ranged from 8 to 212 months (mean 83 months). Originally, in 45 cases cemented hip replacement was done and in 12 cementless endoprosthesis was implanted. In 34 cases both components were replaced, in 14 cases acetabular component, in 9 cases stem only and in 1 case the endoprosthesis was removed. Clinical evaluation was done according to Merle-d'Aubignea criteria, radiologic assessment was done according to DeLee and Charnley classification and the one of Gruen. Within 10 years after primary surgery all cementless hips were revised (all Parhofer-Mönch type within 5 years). Among Weller cemented replacements both components were replaced in 18 cases, acetabulum in 8, the stem in 5 and 1 endoprosthesis was removed. McKee-Farrar implants were replaced completely in all but 2 cases. Most of revisions among cemented hip replacements took place 10 years after primary operation. Angular migration of the acetabular component was found in 40 cases; in 8 cases no migration was observed. Forty-three hips with loosened stem have been analyzed: to small size of the stem was found in 6 cases, varus deviation was found in 14 cases and valgus deviation in 6. Special attention has been paid to the technical errors that are essential for long-term result of hip replacement.

Adolescent↗
PubMed2000

[Analysis of intraoperative complications during surgery for clubfoot].

The paper presents an analysis of the complications accompanying surgical treatment of congenital club feet. In the year 1966-1993 178 feet in 149 patients aged ranging from 5 to 140 months (mean age 17.5 months. In 57 cases a posterior capsulotomy with lengthening of the Achilles tendon was performed, in 121 cases a total sub-talar release was performed. Complications wee classified as intra-operative and early and late post-operative. A total of 85 complications in 44 patients were observed, which amount to 44.7% of the cases. In 16 cases intra-operative complications were a result of technical mistakes during the procedure (severing of a tendon, blood vessel or joint). Post-op complications were due to wound healing disturbances in 28 cases and necrotic changes in 12 cases. Sub-talar release gives a larger number of complications (55.4%) compared to posterior capsulotomy with Achilles tendon lengthening (31.6%).

Child↗
PubMed1999

Organizational characteristics of intensive care units related to outcomes of abdominal aortic surgery.

CONTEXT: Morbidity and mortality rates in intensive care units (ICUs) vary widely among institutions, but whether ICU structure and care processes affect these outcomes is unknown. OBJECTIVE: To determine whether organizational characteristics of ICUs are related to clinical and economic outcomes for abdominal aortic surgery patients who typically receive care in an ICU. DESIGN: Observational study, with patient data collected retrospectively and ICU data collected prospectively. SETTING: All Maryland hospitals that performed abdominal aortic surgery from 1994 to 1996. PATIENTS AND PARTICIPANTS: We analyzed hospital discharge data for patients in non-federal acute care hospitals in Maryland who had a principal procedure code for abdominal aortic surgery from January 1994 through December 1996 (n = 2987). We obtained information about ICU organizational characteristics by surveying ICU medical directors at the 46 Maryland hospitals that performed abdominal aortic surgery. Thirty-nine (85%) of the ICU directors completed this survey. MAIN OUTCOME MEASURES: In-hospital mortality and hospital and ICU length of stay. RESULTS: For patients undergoing abdominal aortic surgery, in-hospital mortality varied among hospitals from 0% to 66%. In multivariate analysis adjusted for patient demographics, comorbid disease, severity of illness, hospital and surgeon volume, and hospital characteristics, not having daily rounds by an ICU physician was associated with a 3-fold increase in in-hospital mortality (odds ratio [OR], 3.0; 95% confidence interval [CI], 1.9-4.9). Furthermore, not having daily rounds by an ICU physician was associated with an increased risk of cardiac arrest (OR, 2.9; 95% CI, 1.2-7.0), acute renal failure (OR, 2.2; 95% CI, 1.3-3.9), septicemia (OR, 1.8; 95% CI, 1.2-2.6), platelet transfusion (OR, 6.4; 95% CI, 3.2-12.4), and reintubation (OR, 2.0; 95% CI, 1.0-4.1). Not having daily rounds by an ICU physician, having an ICU nurse-patient ratio of less than 1:2, not having monthly review of morbidity and mortality, and extubating patients in the operating room were associated with increased resource use. CONCLUSIONS: Organizational characteristics of ICUs are related to differences among hospitals in outcomes of abdominal aortic surgery. Clinicians and hospital leaders should consider the potential impact of ICU organizational characteristics on outcomes of patients having high-risk operations.

Aged↗
PubMed1999

The association between preoperative patient characteristics and both clinical and economic outcomes after abdominal aortic surgery.

OBJECTIVE: To evaluate the association between patient characteristics and both clinical and economic outcomes in patients having abdominal aortic surgery in Maryland between 1994 and 1996. DESIGN: Retrospective study using an administrative data set. SETTING: All Maryland hospitals that performed abdominal aortic surgery from 1994 through 1996 (n = 46). PARTICIPANTS: All patients who had abdominal aortic surgery in Maryland from 1994 through 1996 (n = 2,987). INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: The authors obtained discharge abstracts from the Maryland Health Services Cost Review Commission for patients with a primary procedure code for abdominal aortic surgery. Primary outcome variables were in-hospital mortality, hospital length of stay, and intensive care unit (ICU) days. The authors evaluated the following groups of independent variables: demographic characteristics, severity of illness, comorbid disease, and preoperative admission days. In multivariate analysis, independent predictors of in-hospital mortality were age 61 to 70 years (odds ratio [OR], 3.1; confidence interval [CI], 1.4 to 6.9), age 71 to 84 years (OR, 7.2; CI, 3.7 to 14.1), age 85 years or older (OR, 9.3; CI, 3.9 to 21.9), ruptured aneurysm (OR, 5.3; CI, 3.5 to 8.2), urgent operation (OR, 2.3; CI, 1.1 to 5.2), emergent operation (OR, 3.0; CI, 1.9 to 4.7), mild liver disease (OR, 4.6; CI, 2.0 to 10.9), and chronic renal disease (OR, 6.9; CI, 3.9 to 12.1). Hospital admission 1 to 2 days preoperatively was not associated with a difference in in-hospital mortality but was associated with a 31% increase in hospital days (CI, 23% to 40%) and a 38% increase in ICU days (CI, 19% to 60%). CONCLUSION: In patients having aortic surgery, several patient characteristics such as mild liver disease and chronic renal failure, were associated with increased in-hospital mortality and length of stay. The practice of admitting patients to the hospital 1 to 2 days before surgery should be reevaluated because this was not associated with reduced in-hospital mortality but was associated with increased hospital and ICU stay.

Aged↗
PubMed1999

Clonidine pretreatment inhibits stress-induced gastric ulcer in rats.

UNLABELLED: We studied the effects of clonidine (0.5 mg/kg) on hormonal stress response and antioxidant enzymes cold restraint-induced gastric lesions in rats. Rats in the study group were given 0.5 mg/kg intraperitoneal clonidine (n = 12), whereas the control group received 0.5 mL/kg intraperitoneal isotonic sodium chloride solution (n = 9). Animals were then subjected to immobilization at 4 degrees C in restraining devices for 4 h after a starvation period of 24 h. Gastric lesion index, gastric tissue malondialdehyde activity, and plasma cortisol concentrations were assayed. Histopathologic examination demonstrated a stress ulcer index of 3.17+/-0.92 mm in the clonidine group and 14.0+/-3.22 mm in the control group (P<0.05). The tissue malondialdehyde concentrations were slightly higher in the control group than in the clonidine group, but the differences were not statistically significant (P>0.05). Plasma cortisol levels were lower in the clonidine group (P<0.05). We concluded that clonidine attenuated the tissue damage and stress response in stress-induced gastric ulceration. IMPLICATIONS: Stressful circumstances can cause stomach ulcers, which can bleed, exposing patients to potentially life-threatening complications. In the present animal study, we showed that clonidine, a routinely available medication, may be useful in preventing stress-induced stomach ulcers.

Adrenocorticotropic Hormone↗
PubMed1998

Affective psychosis and Prader-Willi syndrome.

Previous studies have demonstrated that maladaptive behaviours are common amongst adults with Prader-Willi syndrome (PWS). Case reports have also previously demonstrated that psychosis can occur amongst adults with PWS. The present study was undertaken in order to gain a better understanding of the psychopathology of the psychosis of PWS. Twenty-three out of 25 adults identified with PWS living in Northamptonshire, UK, agreed to participate. Comprehensive psychiatric assessments (using the PPS-LD), and measures of adaptive and maladaptive behaviours (using the AAMR-ABS) were completed. Comparisons were made for the prevalence of psychiatric disorders against those from a previous epidemiological study of adults with intellectual disability of other aetiologies from a neighbouring county. The PWS group was found to have higher rates of affective disorders (a point prevalence of 17.4%), in which psychotic symptoms were common, but similar rates of schizophrenia/delusional disorders (4.3%) compared with the comparison group. Behaviour disorders were also common. Surprisingly, none of the PWS group was found to have generalized anxiety or phobic disorders. The diagnostic criteria for the episodes including psychotic symptoms are explored. The high rates of affective disorders is of clinical (i.e. treatment) importance as well as being of academic interest with regard to the genetics of psychiatric disorders.

Adult↗
PubMed1998

Beta-adrenergic blockade accelerates conversion of postoperative supraventricular tachyarrhythmias.

BACKGROUND: Postoperative supraventricular tachyarrhythmia is a common complication of surgery. Because chemical cardioversion is often ineffective, ventricular rate control remains a principal goal of therapy. The authors hypothesized that patients with supraventricular tachyarrhythmia after major noncardiac surgery who receive intravenous beta-adrenergic blockade for ventricular rate control would experience conversion to sinus rhythm at a rate that differs from those receiving intravenous calcium channel blockade. METHODS: The rate of conversion to sinus rhythm at 2 and 12 h after treatment was examined in 64 cases of postoperative supraventricular tachyarrhythmia. After adenosine administration, patients who remained in supraventricular tachyarrhythmia were prospectively randomized to receive either intravenous diltiazem or intravenous esmolol for ventricular rate control (unblinded). Loading and infusion rates were adjusted to achieve equivalent degrees of ventricular rate control. RESULTS: Patients were similar with regard to age and Apache III score. Most patients in both groups had atrial fibrillation (esmolol, 79%; diltiazem, 81%), and none experienced stable conversion with adenosine. Patients randomized to receive esmolol experienced a 59% rate of conversion to sinus rhythm within 2 h of treatment, compared with only 33% for patients randomized to receive diltiazem (intention to treat, P = 0.049; odds ratio, 2.9; 95% confidence interval, 1.046 to 7.8). After 12 h of therapy, the number of patients converting to sinus rhythm increased in both groups (esmolol, 85%; diltiazem, 62%), and the rates of conversion no longer differed significantly. Ventricular rates when supraventricular tachyarrhythmia began and after 2 and 12 h of rate control therapy were similar in the two treatment groups. The in-hospital mortality rate and length of stay in the intensive care unit were not significantly influenced by treatment group. CONCLUSIONS: Among adenosine-resistant patients in the intensive care unit with atrial fibrillation after noncardiac surgery, intravenous esmolol produced a more rapid (2-h) conversion to sinus rhythm than did intravenous diltiazem.

Adrenergic beta-Antagonists↗
PubMed1998

Radial artery pressure monitoring underestimates central arterial pressure during vasopressor therapy in critically ill surgical patients.

OBJECTIVES: Radial artery pressure is known to differ from central arterial pressure in normal patients (distal pulse amplification) and in the early postcardiopulmonary bypass period. The adequacy of the radial artery as a site for blood pressure monitoring in critically ill patients receiving high-dose vasopressors has not been carefully examined. DESIGN: Prospective observational study comparing simultaneous intra-arterial measurements of radial (peripheral) and femoral artery (central) pressures. SETTING: Clinical investigation in a university-based surgical intensive care unit. PATIENTS: Fourteen critically ill patients with presumed sepsis who received norepinephrine infusions at a rate of > or =5 microg/min. INTERVENTIONS: All patients were managed in accordance with our standard practice for presumed sepsis, which consisted of intravascular volume repletion followed by vasopressor administration titrated to a mean arterial pressure of > or =60 mm Hg. MEASUREMENTS AND MAIN RESULTS: Systolic and mean arterial pressures were significantly higher when measured from the femoral vs. radial site (p < .005). The higher mean arterial pressures enabled an immediate reduction in norepinephrine infusions in 11 of the 14 patients. No change in cardiac output or pulmonary artery occlusion pressure was noted after dose reduction. In the two patients in whom simultaneous recordings were made after discontinuation of norepinephrine infusions, equalization of mean arterial pressures was observed. CONCLUSIONS: Radial artery pressure underestimates central pressure in hypotensive septic patients receiving high-dose vasopressor therapy. Clinical management, based on radial pressures, may lead to excessive vasopressor administration. Awareness of this phenomena may help minimize adverse effects of these potent agents by enabling dosage reduction.

Bias↗
PubMed1998

Impact of altered aminoglycoside volume of distribution on the adequacy of a three milligram per kilogram loading dose. Critical Care Research Group.

BACKGROUND: Sepsis is associated with an increased volume of distribution for aminoglycoside antibiotics. As a result of this increased volume of distribution, 2 mg/kg loading doses have previously been shown to be ineffective in producing adequate aminoglycoside peak plasma levels in critically ill patients. The main objective of this pharmacokinetic observational study was to determine the adequacy of a 3 mg/kg loading dose of gentamicin or tobramycin in attaining an initial peak level of 8 micrograms/ml or greater. METHODS: Fifty-three consecutive patients given gentamicin or tobramycin for documented or suspected life-threatening gram-negative infections were enrolled. Loading doses of either aminoglycoside were administered during 30 minutes, and a peak level was obtained 1 hour after completed infusion. RESULTS: The patient's mean age was 61 +/- 2 years, with a male/female ratio of 33:20. The loading dose of 3 mg/kg produced 1-hour peak aminoglycoside levels greater than 8 micrograms/ml in only 50% of the patients studied. The calculated aminoglycoside volume of distribution was increased by 34%. CONCLUSIONS: An aminoglycoside loading dose of 3 mg/kg is inadequate in critically ill patients undergoing operation. The documented increase in volume of distribution is principally responsible for the inadequacy of this dose. Future studies should use a 4 mg/kg loading dose to maximize aminoglycoside bactericidal activity.

Anti-Bacterial Agents↗
PubMed1998

[The use of total cementless threaded knee Motta-Callea prosthesis].

The paper presents features and operative technique for Motta-Callea knee arthroplasty. Medium-term results in a series of 17 joints with serious osteoarthritis (stage IV and V--classification of Larsen at al) in 14 patients aged 43-75 years (mean 64 years) are presented. Patients were evaluated according to Clinical Rating System (Insall et al.) before and after surgery. The average total score tripled after operation and was 168 of 200 points available. Good results have been achieved in both younger and elderly patients with advanced osteoarthritis and osteoporosis, also with bone plasty for varus or valgus deformity. An improvement was noted in regard of pain, alignment of the knee, its sagittal stability and walking ability, stairs included.

Adult↗
PubMed1997

A comparison of thiopentone-isoflurane anaesthesia vs propofol infusion in children having repeat minor haematological procedures.

We have performed a randomized, cross over study in 22 children suffering from acute leukaemia, who underwent repeated anaesthesia for bone marrow aspiration and lumbar puncture. For their first anaesthetic, the children (aged 3-10 years old) received, either a thiopentone/isoflurane anaesthetic or intravenous propofol, both supplemented with nitrous oxide. On a second occasion they received the alternative technique. Of those children receiving thiopentone/isoflurane, 32% had significant coughing during anaesthesia, two progressing to laryngospasm requiring 100% oxygen. None of the patients receiving propofol had a respiratory disturbance (P = 0.016). 68% of the children preferred the propofol anaesthetic. Only one child in the thiopentone/isoflurane group preferred this technique. Twenty-seven per cent had no preference. There was no significant difference in length of anaesthetic time (P = 0.07) or the time taken for recovery (P = 0.17) between the two groups. There was a large individual variation in propofol requirements and movement was common during stimulation of patients in this group, though this did not adversely affect the surgical procedure.

Acute Disease↗
PubMed1997

Ondansetron reduces nausea and vomiting after paediatric adenotonsillectomy.

The efficacy, safety and resource implications of a single intravenous dose of ondansetron (0.1 mg.kg-1, maximum 4 mg) were assessed in a multinational, multicentre, randomized, double-blind, placebo-controlled trial of 427 children aged 1-12 years, undergoing tonsillectomy with/without adenoidectomy. Emesis (retching and/or vomiting) and nausea were analysed separately. Significantly more ondansetron-treated children had no episodes of emesis (127/212 (60%) vs 100/215 (47%); P = 0.004) and experienced no postoperative nausea (135/211 (64%) vs 108/213 (51%); P = 0.004) in the first 24 h. Ondansetron also reduced the number of emetic episodes (P < 0.001), the time to the first emetic episode (P < 0.001) and overall nausea severity (P = 0.003). Significantly fewer ondansetron-treated children were rescued or withdrawn from the study (5% vs 10%; P = 0.042). Fewer ondansetron-treated patients required nursing intervention (34% vs 45%; P = 0.007) and the average intervention time was significantly shorter (4.6 vs 8.1 minutes; P = 0.001). Resources used to manage PONV were significantly reduced by ondansetron (43% vs 57%; P = 0.014).

Adenoidectomy↗
PubMed1997

Effects of clonidine on prolonged postoperative sympathetic response.

OBJECTIVE: Surgical trauma results in diffuse sympathoadrenal activation which is thought to contribute to perioperative cardiovascular complications in high-risk patients. Regional anesthetic and analgesic techniques can attenuate this "stress response" and reduce the occurrence rate of adverse perioperative events; however, their use in the postoperative period is logistically difficult and costly. The present study was undertaken to evaluate whether transdermal administration of the alpha2 adrenergic-receptor agonist, clonidine, can be used as a pharmacologic means of blunting the stress response throughout the perioperative period. DESIGN: Double-blind, placebo-controlled clinical trial in patients undergoing pancreatico-biliary surgery. SETTING: Operating rooms and surgical intensive care unit of a major university teaching hospital. PATIENTS: Forty patients scheduled for major upper abdominal surgery. INTERVENTIONS: Patients received either clonidine (0.2 mg orally and a clonidine TTS-3 patch the evening before surgery and 0.3 mg orally on call to the operating room) or matched oral and transdermal placebo. MEASUREMENTS AND MAIN RESULTS: Heart rate, systemic arterial blood pressure, plasma catecholamine, clonidine, interleukin-6 concentrations, and 24-hr urine cortisol and nitrogen excretion were measured the day before surgery and daily thereafter for 72 hrs postoperatively. Preoperative transdermal (and oral) clonidine administration resulted in therapeutic plasma clonidine concentrations throughout the perioperative period (1.54 +/- .07 [SEM] microg/mL). Clonidine reduced preoperative epinephrine and norepinephrine concentrations by 65%. Plasma catecholamine concentrations increased in both groups following surgery but were markedly lower throughout the postoperative period in patients receiving clonidine. Patients receiving clonidine had a reduced frequency rate of postoperative hypertension. Clonidine had no effect on plasma interleukin-6 concentration, urine cortisol excretion, or urine nitrogen excretion. No adverse effects of clonidine administration were observed. CONCLUSIONS: The combined administration of oral and transdermal clonidine effectively attenuated the catecholamine response to surgical stress throughout the postoperative study period. Clonidine administration produced specific sympatholytic effects, since other elements of the stress response were not attenuated. Undesirable side effects were not noted. The sustained sympatholytic effects we observed suggest that alpha2 adrenergic-receptor agonists may offer a pharmacologic means of modifying the sympathoadrenal response to injury, and may be useful in reducing perioperative complications.

Administration, Cutaneous↗
PubMed1997

[Remarks on classification of Perthes disease].

The most commonly used classifications of Perthes disease are presented., their pros and cons discussed. The newest classification of Perthes disease proposed by Herring et al in 1992 is included. The ease of interpretation of the a-p hip radiographs, high reproducibility of the method and strict correlation between lateral pillar height and the final result of treatment make Herring's classification very useful. Its wide utilization may allow for uniform treatment of Perthes disease.

Humans↗
PubMed1996

Structure of the human receptor tyrosine phosphatase gamma gene (PTPRG) and relation to the familial RCC t(3;8) chromosome translocation.

The receptor protein tyrosine phosphatase gamma gene, PTP gamma (locus name PTPRG), was previously mapped to chromosome region 3p14.2, within a 2- to 4-Mb region centromeric to the 3p14.2 breakpoint of the t(3;8) familial renal cell carcinoma (RCC)-associated constitutional chromosome translocation. Because of its chromosomal position, its enzymatic properties as a receptor phosphatase, which might oppose a growth activating kinase activity, its homozygous deletion in murine L cells, and its transcriptional activity in numerous normal tissues, including kidney, the PTP gamma gene was an attractive tumor suppressor gene candidate for renal cell carcinoma. To determine whether the PTP gamma gene was a target of loss of heterozygosity or mutation in RCCs and to determine its map position relative to the t(3;8) break at 3p14.2, we have isolated YAC and lambda genomic clones for the PTP gamma gene and other 3p14.2 markers and determined the relative positions of the t(3;8) break, a 3p14.2 de novo break possibly in a fragile site, and the 5' end of the PTP gamma gene. Additionally, the genomic structure, position of the proximal promotor, and intron-exon border sequences of the 30-exon 780-kb PTP gamma gene have been determined, which will facilitate analysis of the PTP gamma gene in tumors.

Base Sequence↗