Showing papers by "Leicester Royal Infirmary published in 1985"
TL;DR: This paper examines the effect that nonuniform insonation of the target blood vessel (using continuous wave or wide-gate pulsed ultrasound) has on the mean velocity, as determined using mean, root mean square (RMS) and maximum frequency processors.
Abstract: A number of modern duplex scanners now have facilities for determining volumetric blood flow through intact vessels. The methods these machines use to arrive at an answer must presuppose a number of conditions which may not be met in practice. This paper examines the effect that nonuniform insonation of the target blood vessel (using continuous wave or wide-gate pulsed ultrasound) has on the mean velocity, as determined using mean, root mean square (RMS) and maximum frequency processors. It is shown that for a given beam/vessel geometry the error is dependent only on the shape of the mean component of the velocity profile which, depending on the arterial site, may be flat, parabolic or intermediate. Mean processors may overestimate the mean velocity of established flow by up to 33%, but this could be turned to advantage when it is impracticable to insonate a vessel uniformly. Maximum frequency processors are of value when either plugflow or fully established flow of low pulsatility is present in the target vessel. In the first case the mean flow is the same as the maximum flow, while in the second the mean flow is half the time averaged maximum flow, irrespective of the size and shape of the ultrasound beam. RMS processors are probably best avoided in volumetric flow measurement applications.
105 citations
TL;DR: There were no changes in plasma catecholamine concentrations in the 2 h following insertion of an i.v. cannula, suggesting that venous cannulation did not induce a measurable stress response, and a significant correlation was shown between mean percentage change in Linear Analogue Anxiety Score and mean percentage increase in plasma adrenaline concentrations.
Abstract: This study was designed to assess the value of measurement of plasma catecholamine concentrations as an objective index of anxiety. A preliminary study was undertaken on 11 healthy volunteers (medically qualified), to determine if venous cannulation per se produced any change in plasma catecholamine concentrations. There were no changes in plasma catecholamine concentrations in the 2 h following insertion of an i.v. cannula, suggesting that venous cannulation did not induce a measurable stress response. A second study was performed on 48 surgical patients who were asked to rate their perceived anxiety on a linear analogue scale immediately before premedication and immediately before induction of anaesthesia. Venous blood was obtained at the same time as these ratings. There were no significant changes in perceived anxiety or plasma noradrenaline concentrations following premedication. However, compared with values before premedication, there was a mean percentage increase in plasma adrenaline concentration of 40%before induction of anaesthesia. A significant correlation was shown between mean percentage change in Linear Analogue Anxiety Score and mean percentage change in plasma adrenaline concentrations (r = 0.32).
105 citations
TL;DR: DNB provides satisfactory analgesia following circumcision and has specific advantages when compared with caudal analgesia, although that produced in the DNB group tended to wane sooner.
Abstract: Fifty boys presenting for day case circumcision were allocated randomly to receive either caudal analgesia or dorsal nerve block (DNB) to provide postoperative pain relief. Analgesia was assessed by a single, unbiased observer utilising a three-point scale. Subsequently, parents completed a simple questionnaire. Subjects in the DNB group micturated earlier (P less than 0.05) and stood unaided earlier (P less than 0.025) than patients in the caudal group. The incidence of vomiting was significantly lower in the DNB group (P less than 0.05). There was no significant difference in the duration of analgesia, although that produced in the DNB group tended to wane sooner. It is concluded that DNB provides satisfactory analgesia following circumcision and has specific advantages when compared with caudal analgesia.
73 citations
TL;DR: Lymphatic endothelium was always negative; this proved to be a useful feature in differentiating between blood vessel and lymphatic invasion by breast carcinoma and Ulex europeus I‐peroxidase could certainly have a role in routine histopathology in this area.
Abstract: Peroxidase-labelled Ulex europeus I lectin has been applied to a series of routinely fixed and processed vascular lesions to assess its value in the identification of endothelium A group of breast carcinomas previously examined for binding of the lectin to the tumour have been re-assessed for evaluation of the use of Ulex europeus I in the determination of vascular invasion There was consistent binding to normal vascular endothelium but this could be variable, there being stronger reactivity in small vessels of some tissues All benign lesions stained showed clear definition of vascular channels but angiosarcomas were much less consistent in their staining reaction and the peroxidase-labelled lectin was considered to be a less satisfactory marker Lymphatic endothelium was always negative; this proved to be a useful feature in differentiating between blood vessel and lymphatic invasion by breast carcinoma Ulex europeus I-peroxidase could certainly have a role in routine histopathology in this area
61 citations
TL;DR: Details are given of the injuries sustained by 402 car drivers, 209 front seat passengers and 147 back seat passengers involved in road accidents during the two 4-month periods before and after the introduction of the compulsory wearing of seat belts on 1 February 1983.
Abstract: Details are given of the injuries sustained by 402 car drivers, 209 front seat passengers and 147 back seat passengers involved in road accidents during the two 4-month periods before and after the introduction of the compulsory wearing of seat belts on 1 February 1983 Comparisons are made between the injury patterns in those wearing and not wearing seat belts and in back seat passengers
49 citations
TL;DR: It was shown that the pulsatility of the velocity waveform decreased and that diastolic frequency increased over the 5 days and the significance of, and possible mechanism for, this change is discussed.
37 citations
TL;DR: The expiratory valve closed and the reservoir bag inflated, and the obturator is reversed and both limbs are thus occluded to test the integrity of the whole system.
Abstract: expiratory valve closed and the reservoir bag inflated. Pressure on the bag will then test the integrity of the whole system (Fig. 2a). The obturator is then reversed and both limbs are thus occluded. With the expiratory valve open there should be no gas escape on applying pressure to the inflated reservoir bag (Fig. 2b). However, if the inner limb is defective the bag collapses and gas escapes through the expiratory valve (Fig. 2c).
33 citations
TL;DR: A survey conducted at the Accident & Emergency Dept of the Leicester Royal Infirmary to study the human, mechanical and environmental factors leading to bicycle accidents and the injuries which followed them revealed that 66% of the injured were children aged between 6 and 15 years and that in 67.2% of cases the accident was clearly the rider's fault.
Abstract: Results are presented of a survey conducted at the Accident & Emergency Dept of the Leicester Royal Infirmary to study the human, mechanical and environmental factors leading to bicycle accidents and the injuries which followed them. The patients studied had been injured in cycle accidents between February and July 1983. The results obtained from 314 patients are analysed. Graphs and histograms are presented showing the following relationships: ages of cyclists involved in accidents; the incidence of bicycle accidents with respect to variation of day length and weather; the frequency of bicycle accidents according to time of day. The results revealed that 66% of the injured were children aged between 6 and 15 years and that in 67.2% of cases the accident was clearly the rider's fault (rider error or mechanical failure). The carriage of luggage other than in adequate saddle or pannier bags was a noteworthy causal factor. Some form of test of road worthiness should include adequate cycle lighting. Dynamo lamps should be discouraged or accompanied by a battery lamp for use when stationary. (TRRL)
31 citations
TL;DR: It is concluded that in t h e regimen described 5‐fluorouracil is an effective treatment f o r vaginal intra‐epithelial neoplasia.
31 citations
TL;DR: A new, possibly genetic disorder of keratinization is described, characterized by the truncal distribution of multiple minute keratotic papules.
Abstract: Summary
A new, possibly genetic disorder of keratinization is described. The condition is characterized by the truncal distribution of multiple minute keratotic papules. Morphologically these may be spicular or dome-shaped and aggregation of some of the latter creates the impression of annular and crateritbrm lesions. Histologically there are focat areas of hyperkeratosis and orthokeratosis with no dermal infiltrate. Odland bodies arc present on electron microscopy of lesional skin. The differential diagnosis of this condition is discussed.
29 citations
TL;DR: If the technique is adopted as soon as the patient enters hospital, or immediately postoperatively, an acute compartmental syndrome may be recognized early and measures taken to alleviate its consequences.
TL;DR: A significant relationship between peanut lectin binding, with the use of neuraminidase, and tumour differentiation has been found, and to a lesser extent with soy bean agglutinin when desialation is performed, however, the pattern of reactivity of the carcinomas with these three lectins does not appear to be related to local lymph node metastasis.
Abstract: The binding of the lectins from peanut, soy bean and Dolichos biflorus (specific for galactose and/or N-acetyl-D-galactosamine), to human breast carcinomas has been investigated. In contrast to the consistent pattern found in normal breast the reactivity of carcinomas to peanut lectin is varied, the most striking differences being prominent binding without desialation in some tumours and virtual lack of reactivity in others. There tends to be a greater degree of binding of soy bean agglutinin to carcinomas than normal although this is not absolute, and the reverse applies to Dolichos biflorus agglutinin. Comparison of the binding of the three lectins has revealed a complex heterogeneity of the carbohydrate chains within individual tumours and between different carcinomas. A significant relationship between peanut lectin binding, with the use of neuraminidase, and tumour differentiation has been found, and to a lesser extent with soy bean agglutinin when desialation is performed. However, the pattern of reactivity of the carcinomas with these three lectins does not appear to be related to local lymph node metastasis.
TL;DR: It is recommended that further studies of the bioavailability of MST in the early postoperative period be undertaken before any recommendations are made regarding its routine use for pain relief at that time.
Abstract: Eighty patients undergoing abdominal surgery were studied after operation. Morphine was administered regularly every 4 h by either the i.m. {morphine sulphate 10mg) or the oral route (MST Continus 20 mg) in a double-blind double-dummy trial. Both MST and i.m. morphine provided satisfactory postoperative analgesia, but significantly greater amounts of supplementary i.m. morphine were required in the MST group. More adverse effects were reported by the patients in the i.m. morphine group. The mean serum morphine concentration in 12 patients in the MST group was 1.7 ng ml-1 at 08.00 h and 19.5 ngml-1 at 16.00 h on the 1st day after operation, suggesting impaired gastric emptying in the early postoperative period. It is therefore recommended that further studies of the bioavail-ability of MST in the early postoperative period be undertaken before any recommendations are made regarding its routine use for pain relief at that time.
TL;DR: A microcomputer-based system for the capture, storage and processing of spectrum-analysed Doppler ultrasound blood flow signals and is extremely versatile, for example in addition to the collection of data for postprocessing the system is also used for the real-time analysis of blood flow waveforms.
Abstract: The evaluation of any method of analysis of Doppler ultrasound blood flow signals is involved and time consuming because of the considerable time necessary to investigate a statistically significant representative population of arteriopathic blood flow waveforms. To overcome these problems we have developed a microcomputer-based system for the capture, storage and processing of spectrum-analysed Doppler ultrasound blood flow signals. This system allows the collection and storage on floppy disk of waveforms from many sites in a large population of arteriopaths and their later analysis using any desired method. Having thus created on disk a suitable population of arteriopathic waveforms the evaluation of any method of waveform analysis, whether existing or new, is a much more convenient and far less time-consuming process. The system described is extremely versatile, for example in addition to the collection of data for postprocessing the system is also used for the real-time analysis of blood flow waveforms.
TL;DR: The simple measure of incorporating dietary advice into the treatment programme of thyrotoxic patients will usually result in some reduction of energy intake, and thus weight gain, en route to euthyroidism, reflecting a degree of true obesity at this stage.
Abstract: Dietary intake, including actual nutrient and energy intake, was assessed in 21 successive thyrotoxic patients before and after adequate carbimazole therapy. Group A (10 subjects) received regular formal dietary advice whereas Group B (11 subjects) did not. An age and sex matched control group, comprising 23 normal individuals, was also studied. The mean energy intake of all the thyrotoxic subjects was significantly greater than that of the normal control group (P less than 0.0025). There was a greater overall reduction in the energy intake of Group A as compared with Group B (P less than 0.01) and the former gained less weight, when expressed as a percentage of pretreatment weight. The mean final weight of all the thyrotoxic subjects exceeded the mean ideal weight for the group, reflecting a degree of true obesity at this stage. The simple measure of incorporating dietary advice into the treatment programme of thyrotoxic patients will usually result in some reduction of energy intake, and thus weight gain, en route to euthyroidism.
TL;DR: In cases of CIN III the laser is more likely to achieve eradication of the lesion with a single application than cryofreezing.
TL;DR: Three patients with rheumatoid arthritis who developed cicatricial pemphigoid during treatment with D‐penicillamine are described and the possible role of this drug in the pathogenesis of the skin and mucosal lesions is discussed.
Abstract: Summary
Three patients with rheumatoid arthritis who developed cicatricial pemphigoid during treatment with D-penicillamine are described. The possible role of this drug in the pathogenesis of the skin and mucosal lesions is discussed.
TL;DR: Inhibition of cyclic AMP alone does not explain the mechanisms of adrenaline induced platelet aggregation, and the ability of adrenaline to induce a complex between the alpha 2-adrenoceptor and the inhibitory guanine nucleotide binding protein is examined.
TL;DR: It was demonstrated that nalbuphine produced calm/sleepy patients to a greater extent than morphine and there were no differences in untoward effects produced by each drug.
Abstract: Summary
Nalbuphine 10 mg and morphine 10 mg were compared in a randomised double-blind trial as intramuscular premedication in 50 patients undergoing minor gynaecological surgery. Both nalbuphine and morphine produced significant sedation without anxiolysis as assessed by patient linear analogue scales, but there were no significant differences between the two drugs. Observer ratings demonstrated that nalbuphine produced calm/sleepy patients to a greater extent than morphine. There were no differences in untoward effects produced by each drug.
TL;DR: Vecuronium was used to provide muscle relaxation in a patient who subsequently developed prolonged neuromuscular blockade (8 h) after anaesthesia, and the possible role of vecuronium is discussed.
Abstract: Vecuronium was used to provide muscle relaxation in a patient who subsequently developed prolonged neuromuscular blockade (8 h) after anaesthesia. The aetiology of this condition, and the possible role of vecuronium, are discussed.
TL;DR: Principal component analysis was found to be superior to the currently widely used resistance index method and may significantly enhance the value of Doppler ultrasound for detecting abnormal cerebral haemodynamics in neonates.
Abstract: Doppler ultrasound recordings were made from the anterior cerebral arteries of 40 normal full-term babies and 14 mature babies with intracranial pathology. The maximum velocity waveforms were extracted using spectral analysis and further analyzed using the Pourcelot resistance index method and the principal component method. Principal component analysis was found to be superior to the currently widely used resistance index method and may significantly enhance the value of Doppler ultrasound for detecting abnormal cerebral haemodynamics in neonates.
TL;DR: The relative order of potency of the catecholamines in displacement experiments, isoprenaline greater than adrenaline greater than noradrenaline and curve-fitting analysis of the competition binding isotherms using subtype selective beta-adrenergic antagonists, suggests the presence of an homogeneous population of beta 2-adRenoceptors.
TL;DR: The addition of flow velocity information to the pressure drop across a stenosis gave an increased separation of stenoses in the experimental animal and also in man.
Abstract: Aorto-iliac stenoses were characterised in terms of pressure drop and flow velocity in a canine model and in patients with occlusive arterial disease. Pressure above and below the stenosis was measured intra-arterially and flow related measurements were made at rest and during reactive hyperaemia in the dog, and following papaverine administration in patients. The addition of flow velocity information to the pressure drop across a stenosis gave an increased separation of stenoses in the experimental animal and also in man.
TL;DR: In this study, several methods have been used to classify ultrasonic Doppler blood velocity waveforms, derived from humans with peripheral arterial disease and dogs with stenoses of different severities implanted into their hind limbs.
Abstract: The automatic classification of waveforms, derived from the body, into normal and abnormal, or into those with different degrees of abnormality, is becoming more feasible as microcomputer systems become readily available. There are many ways to achieve such classifications, but the best methods in any instance will depend on many factors. In this study, several methods have been used to classify ultrasonic Doppler blood velocity waveforms, derived from humans with peripheral arterial disease and dogs with stenoses of different severities implanted into their hind limbs. The results have been compared, and the advantages and disadvantages of the methods are discussed.
TL;DR: No one treatment regime appeared to have sustained advantages over another and none of the groups showed any deterioration on echocardiographic criteria during the study.
Abstract: Forty-three patients with essential hypertension were randomly allocated to one of the following treatment regimes; — atenolol, atenolol and hydralazine or methyl dopa. Blood pressure fell into the normal range at 3 months and was similar in all 3 groups. Blood pressure remained controlled over the period of study. M-mode echocardiography was assessed initially, at 3, 6 and 12 months. All groups showed a fall in the measured indices towards the normal range with a significant reduction in left ventricular wall thickness at 3 months in the methyl dopa group and left ventricular mass in the atenolol group alone of 6 months. In conclusion, no one treatment regime appeared to have sustained advantages over another and none of the groups showed any deterioration on echocardiographic criteria during the study.
TL;DR: This method has been employed successfully over a number of years without any problem and staff now routinely add an orthopaedic splint to the materials required when setting up a trolley for an epidural anaesthetic.
Abstract: quite malleable and may be wrapped around the syringe, filter, needle and cannula and then secured with tape, as shown in the figures. The device is easily opened in order that the top-up may be given. This method has been employed successfully over a number of years without any problem and staff now routinely add an orthopaedic splint to the materials required when setting up a trolley for an epidural anaesthetic. The help in the composition of this letter of Drs J.E. Galway and R. King is gratefully acknowledged. Craigavon Area Hospital, P.A. FARLINC Craigavon. Co. Armagh, BT63 5PH
TL;DR: In patients with necrobiosis lipoidica the possibility of systemic sarcoidosis should be borne in mind and appropriate investigations should always be carried out, because of the relative rarity of these two diseases.
Abstract: Summary
Two patients are reported with systemic sarcoidosis and necrobiosis lipoidica on the legs. There are no previous reports of this association. In view of the relative rarity of these two diseases, there is a clear suggestion of a pathogenetic link between sarcoidosis and necrobiosis lipoidica. Therefore, in patients with necrobiosis lipoidica the possibility of systemic sarcoidosis should be borne in mind and appropriate investigations should always be carried out.
TL;DR: There was no significant difference between the preparations in terms of postoperative pain, recorded either by the linear analogue scales or using a patient questionnaire, and the usage of analgesics and anti‐emetics postoperatively was comparable in both groups.
Abstract: Summary
Oral morphine sulphate slow-release (MST) 40 mg and intramuscular morphine sulphate 10 mg, each administered with intramuscular atropine 0.6 mg, were compared in a randomised double-blind trial as premedication agents in 30 patients undergoing abdominal hysterectomy. Both formulations produced sedation but no anxiolysis in the anaesthetic room, as measured by 10 cm, horizontal linear analogue scales. There was no significant difference between the preparations in terms of postoperative pain, recorded either by the linear analogue scales or using a patient questionnaire. The usage of analgesics and anti-emetics postoperatively was comparable in both groups.
TL;DR: It was demonstrated that this drug combination resulted in a significant decrease in LOSP initially, but that this potentially deleterious effect was transient in nature.
Abstract: The effects, on the lower oesophageal sphincter, of the simultaneous administration of atropine and neostigmine were studied in 10 healthy patients undergoing gynaecological surgery. Atropine 1.2 mg and neostigmine 2.5 mg were given to antagonize neuromuscular blockade at the termination of surgery. For the succeeding 15–20 min, frequent measurements of lower oesophageal sphincter pressure (LOSP) were made whilst anaesthesia was maintained. It was demonstrated that this drug combination resulted in a significant decrease in LOSP initially, but that this potentially deleterious effect was transient in nature.
TL;DR: Two cases are described of blunt injury to the forearm in the absence of bone injury, resulting in an acute deep volar compartment syndrome, and the importance of the deep flexor compartment of the forearm is noted.
Abstract: Summary Two cases are described of blunt injury to the forearm in the absence of bone injury, resulting in an acute deep volar compartment syndrome. The importance of the deep flexor compartment of the forearm is noted. The diagnostic pitfalls and the use of intra-compartmental monitoring are discussed. We emphasize that all such cases must be admitted and carefully studied as a matter of routine. If operation is undertaken, both the superficial and deep volar compartments must be adequately decompressed.