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Biomedical subjects

T Dorman

Publications and source records attributed to T Dorman.

At least 55 records · Page 3Linked to original sources
PubMed1996

[A contribution to treatment of avulsion fracture of the ischial tuberosity].

Background of the injury and of treatment in two 15 years old girls with avulsion fracture of the ischial tuberosity are presented. The first case with little displacement good result has been achieved after conservative treatment; the second one required surgery 1.5 year due to great displacement, non-union and persistent pain; ischial tuberosity has been removed successfully.

Adolescent↗
PubMed1995

Prolonged starvation in paediatric surgery.

An evaluation of the pre-operative preparation of 285 children attending Sheffield Children's Hospital for elective surgery showed that prolonged and unnecessary starvation takes place, particularly in children over 1 year of age who have their operation in the morning. Excessive starvation of children is unkind and unnecessary. In order to prevent it a revision of current starvation guidelines is required.

Ambulatory Surgical Procedures↗
PubMed1993

Perioperative platelet reactivity and the effects of clonidine.

BACKGROUND: Increased postoperative platelet reactivity may contribute to arterial thrombotic complications following surgery. alpha 2 Agonists, which are being used increasingly to blunt the stress response of surgery, increase platelet aggregation in vitro. We compared perioperative changes in platelet reactivity in 21 patients receiving either clonidine or placebo. METHODS: Patients undergoing major abdominal surgery were randomized to receive oral and transdermal clonidine (n = 11) or placebo (n = 10). All patients received similar perioperative management, including preoperative sedation, general anesthesia without neuraxial opioids, or local anesthetics and postoperative patient-controlled intravenous morphine. Blood was obtained for measurement of clonidine level, fibrinogen concentration, platelet count, and platelet reactivity (impedance aggregometry and dense granule release) before induction and 24, 48, and 72 h postoperatively. RESULTS: Thirteen of the 21 patients had biopsy-proven cancer at surgery, 5 of 11 received clonidine and 8 of 10 received placebo (NS). Clonidine levels were therapeutic (1-2 ng/ml) throughout the study period. Clonidine administration had no effect on platelet count or platelet reactivity. Therefore, the groups were combined for further analysis. In this group (n = 21), compared to preoperative values, fibrinogen levels rose maximally (36%) at 72 h postoperatively and platelet counts decreased 22% at 48 h. Platelet reactivity (aggregation and degranulation) to collagen, adenosine diphosphate, arachidonic acid, and ristocetin, increased at 24, 48, and 72 h postoperatively. Thrombin-induced (supramaximal stimulus) dense granule release did not change from preoperative values. CONCLUSIONS: These data indicate that major abdominal surgery causes increased platelet reactivity postoperatively but does not effect maximal degranulation. This increased platelet reactivity occurs within 48 h of surgery, coinciding with the peak incidence of postoperative arterial thrombotic complications. Clonidine administration has no effect on surgically induced changes in platelet reactivity. In this surgical patient population, the use of clonidine should not increase the risk of platelet-induced perioperative arterial thrombosis.

Abdomen↗
PubMed1992

DNA ploidy in squamous oesophageal carcinoma.

The role of DNA ploidy in the management of oesophageal carcinoma is unclear. Most studies have employed flow cytometry (FC) for DNA analysis but some have used image analysis (IA) of tissue sections. In this study aneuploidy rates in stage IIa squamous tumours were determined by both FC and IA of cell suspensions and results were compared with outcome in two patient subgroups. Group 1 (n = 15) were patients who died from tumour recurrence within 1 year of surgery while Group 2 (n = 21) were patients who survived tumour free for at least 1 year. Aneuploidy rates differed significantly between techniques; 29 of 36 tumours (81%) were aneuploid by IA compared with 19 of 34 (56%) by FC (P < 0.05). Aneuploidy rates differed significantly between groups 1 and 2 as determined by FC (79%) versus 40%) (P < 0.05) but not by IA (93% versus 71%) (P = ns). Euploid status was a good prognostic indicator; 6 of 7 (86%) patients with euploid tumours by IA and 12 of 15 (80%) by FC (P < 0.05) survived more than 1 year. The sensitivity and specificity of euploidy was 93% and 28.6% for IA compared with 78.6% and 60% for FC. Since 33 (92%) of these tumours exhibited a marked peritumoral desmoplastic or chronic inflammatory reaction IA, being more sensitive to subtle nuclear change, may be a more appropriate technique than FC for evaluation of the role of ploidy in such tumours.

Adult↗
PubMed1992

Negative chronotropic factor in patients with fungemia.

OBJECTIVE: To study the effect of serum from patients with fungemia and control patients on sinoatrial node function. DESIGN: Prospective, observational study. SETTING: Surgical ICU in a university hospital. PATIENTS: Fourteen patients with fungemia and 14 control patients. MEASUREMENTS AND MAIN RESULTS: Serum samples from all patients were assayed in an in vitro sinus node preparation. Serum samples from 11 (78%) of the 14 fungemic patients caused a decrease in sinus node activity, while serum samples from only one (7%) of 14 control patients caused slowing of the sinus node. CONCLUSIONS: Serum from many patients with fungemia causes slowing of an in vitro sinus node preparation. This in vitro finding may explain bradyarrhythmias seen clinically in the setting of fungemia.

Action Potentials↗
PubMed1992

Blood loss and transfusion requirements in total joint arthroplasty.

We report a prospective trial of 100 consecutive patients undergoing primary total hip or knee arthroplasty in order to assess their blood transfusion requirements amid recent fears of the transmission of viruses, particularly hepatitis C, from donor to recipient. Of the patients, 84% were transfused one or more units of blood in the perioperative period and the mean percentage blood loss per replacement represented 30% or less of their estimated circulating blood volume. We suggest that with preoperative blood volume calculations and haemoglobin concentrations, a more cautious approach to blood transfusion should be employed when other blood volume expanders would suffice. We believe, firstly, that where blood losses of 30% or less of the blood volume occur, blood transfusion is not always required in patients with high haemoglobin concentrations and large blood volumes. Secondly, cross-matching should be undertaken according to the individual patient's estimated needs, rather than to a group as a whole.

Adult↗
PubMed1992

Sleep and paroxetine: a comparison with mianserin in elderly depressed patients.

A total of 60 patients aged 65 years and over who were suffering from unipolar depression were entered into a double-blind 6-week comparative study of paroxetine and mianserin. Assessments of efficacy of treatment included the Hamilton Depression Rating Scale, Clinical Global Impression, and the Leeds Sleep Evaluation Questionnaire. The results showed that the two drugs had equal and acceptable clinical efficacy. There was a similar overall incidence of spontaneously reported adverse events, but with clearly different profiles and a suggestion that mianserin was associated with more anticholinergic effects. In terms of sleep, the study provided evidence of a more beneficial effect from paroxetine.

Aged↗
PubMed1988

The management of depression, and the use of lofepramine in the elderly.

Treatment of depression in the elderly compared with younger patients is complicated by a number of additional factors. The main differential factors in the elderly are an increased incidence and severity of adverse life events and a parallel increase in social disadvantages. Associated physical problems are much more frequently encountered, and there is a striking increase in suicidal potential--with the elderly accounting for some 12 per cent of the population but being involved in some 33 per cent of all completed suicides. While some pessimistic views have been expressed about the outcome of chemotherapy, this is for many patients the cornerstone of treatment, with the older tricyclic antidepressants still used extensively. However, these agents have serious disadvantages. They are highly toxic in overdosage, with pronounced anticholinergic actions and marked adverse effects on the cardiovascular system in therapeutic dosage. The newer non-tricyclic antidepressants have revealed further problems, with two of these agents being withdrawn because of serious side effects. Against this background, the introduction of the modified tricyclic compound lofepramine was of major interest in the light of its much reduced toxicity and anticholinergic effects when compared with older antidepressants. The results of a retrospective study involving the use of lofepramine in a series of 210 elderly depressives (mean age 75.8 years) suggests that a majority of such patients will respond to energetic treatment. Seventy per cent of the patients showed a response ranging from good to complete remission of symptoms and overall tolerability was excellent.

Aged↗
PubMed1983

A multi-centre comparison of prazepam and diazepam in the treatment of anxiety.

A single-blind, parallel group, multi-centre study was carried out in 2009 patients with an anxiety state to compare the efficacy, tolerance and withdrawal effects of prazepam and diazepam in therapeutically equivalent doses. Patients were allocated at random to receive 30 mg prazepam or 15 mg diazepam per day, either in divided dosage (3 times) during the day or as a single large dose at night. After a 2-week treatment period, drug therapy was withdrawn gradually. Patients were followed-up at weekly intervals over the 4-week study period. Hamilton Anxiety Rating Scale scores and physicians' global assessment of response at each visit indicated that whilst both drugs and dosage regimens were effective patients treated with diazepam responded rather less well and had a greater return of anxiety symptoms after therapy was stopped compared to those on prazepam. Moreover, the prazepam-treated patients, especially those on the divided daytime dosage regimen, had fewer and milder side-effects in the early treatment period. Dizziness was least apparent in the prazepam single night time dosage group and it is suggested that this may be an important practical consideration in the treatment of anxiety in the elderly.

Adolescent↗
PubMed1980

Clinical trial comparison of a sustained release form of amitriptyline with dothiepin.

A double-blind between-group trial was undertaken in fifty depressed patients to compare the efficacy of a sustained release form of amitriptyline (Lentizol) with dothiepin (Prothiaden) over a 5-week period. Patients fulfilling defined admission criteria were randomly allocated to treatment with evening dosage of either 50 mg of the sustained release preparation or 75 mg of dothiepin for the first week of the trial. Subject to review as necessary, these dosages were doubled at the end of the first week. Both drugs effected significant and appreciable improvement over the 5-week period, with the mean responses at the end of the trial retaining the same relative positions as at the beginning.

Adolescent↗
PubMed1978

Alpha1-antitrypsin phenotypes and lung function in a moderately polluted northern Ontario community.

To determine whether persons with intermediate value alpha1-antitrypsin phenotypes living in a polluted environment manifest significant abnormalities in lung function, a study was undertaken of an age-, sex- and smoking-stratified sample of 391 persons from the town of Fort Frances, Ont., which has elevated values of total dustfall, suspended particulates and hydrogen sulfide. Indices of pulmonary function were derived from the maximum expiratory flow and the single breath expiratory flow and the single breath expiratory nitrogen washout curves. The percentage frequency of the M, MS and MZ pheontypes was 91.7, 7.3 and 0.8, respectively. There was no significant difference between the M and MS groups as indicated by the nitrogen washout curve and maximum expiratory flow curve. There was no significant difference between the three MZ subjects and the M group. In both M and MS groups smokers displayed evidence of airflow obstruction when compared with nonsmokers. It would appear that, when compared with M subjects, persons with the MS phenotype living in a moderately polluted area show no changes in indicators of pulmonary function, including tests of early airway disease, that cannot be attributed to their smoking habit.

Adult↗
PubMed1977

Clinical trial comparison of two sustained release forms of amitriptyline.

A double-blind between-group trial was carried out in 50 depressed patients to compare the efficacy of two sustained release forms of amitriptyline--Lentizol and Tryptizol 75. Patients received either Lentizol 50 mg or Tryptizol 75 75 mg each evening for the first week of the trial, and these dosages were then doubled for a further four-week trial period, with the proviso that dosage for individual patients could be maintained at, or altered to, original level where considered necessary by the investigator. Lentizol gave equivalent therapeutic effect to Tryptizol 75 despite the fact that overall dosage was one-third less than in the case of the latter.

Adult↗