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  • 1
    Electronic Resource
    Electronic Resource
    Prevention of hypotension during spinal anaesthesia for Caesarean section: ephedrine infusion versus fluid preload (1997)
    Oxford, UK : Blackwell Science Ltd
    Anaesthesia 52 (1997), S. 0 
    Details
    ISSN: 1365-2044
    Source: Blackwell Publishing Journal Backfiles 1879-2005
    Topics: Medicine
    Notes: We compared the efficacy of prophylactic ephedrine infusion over fluid preloading in prevention of maternal hypotension during spinal anaesthesia for Caesarean section. Forty-six women undergoing elective Caesarean section at term were allocated randomly to receive either intravenous fluid preloading with Hartmann's solution 20 ml.kg−1 (fluid group) or prophylactic intravenous ephedrine 0.25 mgkg−1 (ephedrine group). Moderate hypotension was defined as ≥ 20% reduction in systolic blood pressure and severe hypotension as ≥ 30% reduction in systolic blood pressure. Maternal uterine circulation was measured using Doppler ultrasound in 11 parturients before and after spinal anaesthesia. There was a lower incidence of severe hypotension in the ephedrine group compared with the fluid group (35% vs. 65%, p = 0.04), although the incidence of moderate hypotension was similar. Mean umbilical venous pH was higher in the ephedrine group than in the fluid group (7.33 vs. 7.29, p = 0.02) and the number of patients shivering was lower in the ephedrine group (2 vs. 9, p = 0.02). No difference was found between pre- and postspinal uterine artery pulsatility indices in either group. We conclude that prophylactic ephedrine infusion alone is at least as good as fluid preload alone in combating the hypotension associated with spinal anaesthesia for Caesarean section.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1111/j.1365-2044.1997.190-az0323.x
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  • 2
    Electronic Resource
    Electronic Resource
    An audit of the safety of an acute pain service (1997)
    Oxford, UK : Blackwell Science Ltd
    Anaesthesia 52 (1997), S. 0 
    Details
    ISSN: 1365-2044
    Source: Blackwell Publishing Journal Backfiles 1879-2005
    Topics: Medicine
    Notes: We audited and analysed the adverse effects and safety of postoperative pain management on 2509 consecutive patients under care of the Acute Pain Service at a tertiary referral teaching hospital over a 32-month period. Our standard respiratory monitoring consisted of continuous pulse oximetry, hourly respiratory rate counting, sedation scoring and intermittent arterial blood gas sampling. This protocol was reliable and detected six episodes of bradypnoea, 13 of hypercapnia and 23 of oxygen desaturation occurring in 39 patients (1.8% of all spontaneously breathing patients). Two patients required naloxone injection and none had long-term sequelae. Hypotension due to epidural bupivacaine 0.0625% and fentanyl 3.3 μg.ml−1 infusion occurred in four patients (1.2%), all with a sensory block higher than T5. They readily responded to fluid infusion and ephedrine (two patients). Postoperative nausea or vomiting occurred in 723 (28.8%) and 380 (15.1%) patients, respectively. Odds ratio analysis showed that the risk factors for postoperative nausea and vomiting were: female gender, gynaecological operations, nongeriatric patients and systemic analgesia. Postoperative nausea and vomiting decreased analgesic efficacy by discouraging the use of patient-controlled analgesia and was regarded as equally distressing as pain. Other side-effects included: pruritus in 182 patients; dizziness in 333 and lower limb weakness in 73 (21.2% of patients receiving epidural local anaesthetics). It is concluded that a standard monitoring and management protocol, an experienced nursing team and reliable Acute Pain Service coverage is mandatory for the safe use of modern analgesic techniques.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1111/j.1365-2044.1997.232-az0371.x
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  • 3
    Electronic Resource
    Electronic Resource
    Effect of Helicobacter pylori eradication on expression of cyclin D2 and p27 in gastric intestinal metaplasia (2001)
    Oxford UK : Blackwell Science Ltd
    Alimentary pharmacology & therapeutics 15 (2001), S. 0 
    Details
    ISSN: 1365-2036
    Source: Blackwell Publishing Journal Backfiles 1879-2005
    Topics: Medicine
    Notes: Cyclins and cyclin-dependent kinase inhibitors play a crucial role in the control of cell cycle transitions. Enhanced expression of cyclin D2 and reduced expression of p27kip1 (p27) have been implicated in the pathogenesis of cancer. Because intestinal metaplasia has been regarded as a pre-malignant lesion, we investigated the expression of cyclin D2 and p27 in Helicobacter pylori-associated chronic gastritis with and without intestinal metaplasia, and followed the changes after H. pylori eradication.〈section xml:id="abs1-2"〉〈title type="main"〉Methods:Expression of cyclin D2 and p27 was studied by immunohistochemistry in 59 patients (including 35 patients with intestinal metaplasia) and in 10 gastric cancer patients. Among them, 29 H. pylori-infected patients had serial gastric biopsies taken before and at 1-year after eradication of H. pylori.〈section xml:id="abs1-3"〉〈title type="main"〉Results:Expression of cyclin D2 was significantly higher in gastric cancers when compared to their adjacent non-tumour tissues (median score 3 vs. 1, P=0.015). Over-expression of cyclin D2 was detected in H. pylori-associated chronic gastritis and intestinal metaplasia, which was reduced after eradication of the organism (median score 2 vs. 1, P=0.037 in chronic gastritis; median score 2 vs. 0, P=0.008 in intestinal metaplasia). While the normal gastric mucosa showed strong p27 expression, five of the 10 gastric cancer tissues exhibited reduced p27 expression (P=0.039). Diminished p27 expression was also seen in intestinal metaplasia, which was restored 1-year after H. pylori eradication (eight out of 16 vs. one out of 16, P=0.018). Reduced expression of p27 was frequently associated with increased cyclin D2 expression in H. pylori-associated intestinal metaplasia (P=0.02).〈section xml:id="abs1-4"〉〈title type="main"〉Conclusion:Over-expression of cyclin D2 and reduced expression of p27 are closely linked to H. pylori-associated intestinal metaplasia. Eradication of H. pylori infection reverses the aberrant expression of cyclin D2 and p27 in intestinal metaplasia.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1046/j.1365-2036.2001.01038.x
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  • 4
    Electronic Resource
    Electronic Resource
    Teledermatology in Hong Kong: a cost-effective method to provide service to the elderly patients living in institutions (2000)
    Oxford, UK : Blackwell Science Ltd
    International journal of dermatology 39 (2000), S. 0 
    Details
    ISSN: 1365-4632
    Source: Blackwell Publishing Journal Backfiles 1879-2005
    Topics: Medicine
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1046/j.1365-4362.2000.00034.x
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  • 5
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    Matrix-assisted laser desorption ionisation-time of flight mass spectrometry for rapid identification of Laribacter hongkongensis (2013)
    BMJ Publishing Group
    Details
    Publication Date: 2013-11-22
    Description: Laribacter hongkongensis is a Gram-negative, facultative anaerobic, motile, S-shaped, urease-positive bacillus associated with invasive infections in liver cirrhosis patients and community-acquired gastroenteritis. Most cases of L hongkongensis infections occur in eastern countries. Information is lacking on the usefulness of matrix-assisted laser desorption ionisation time-of-flight mass spectrometry (MALDI–TOF MS) for the identification of bacteria important in eastern countries. Using the Bruker database extended with 21 L hongkongensis reference strains, all 240 L hongkongensis isolates recovered from patients, fish, frogs and water were correctly identified, with 224 (93.3%) strains having top match scores ≥2.0. Notably, the strain of Chromobacterium violaceum was not reliably identified although it is included in the database. MALDI–TOF MS is useful for the accurate routine identification of L hongkongensis after adding reference L hongkongensis main spectra to the database. The number of strains for each species in MALDI–TOF MS databases should be expanded to cover intraspecies variability.
    Keywords: Infection (gastroenterology), Liver disease
    Print ISSN: 0021-9746
    Electronic ISSN: 1472-4146
    Topics: Medicine
    Published by BMJ Publishing Group
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  • 6
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    Role of maternal occupational physical activity and psychosocial stressors on adverse birth outcomes (2017)
    BMJ Publishing Group
    Details
    Publication Date: 2017-02-18
    Description: Objectives We examined the association of an array of estimated maternal occupational physical activities and psychosocial stressors during pregnancy with odds for preterm birth (PTB) and small-for-gestational age (SGA). Methods Data for infants born without major birth defects delivered from 1997 to 2009 whose mothers reported working at least 1 month during pregnancy were obtained from the National Birth Defects Prevention Study. We linked occupational codes to the US Department of Labor's Occupational Information Network, which provides estimates of exposure for multiple domains of physical activity and psychosocial stressors by occupational categories. We conducted factor analysis using principal components extraction with 17 occupational activities and calculated factor scores. ORs for PTB and SGA across quartiles of factor scores in each trimester were computed using logistic regression. Results Factor analysis grouped occupational domains into 4 groups based on factor loadings. These groups were ‘occupational physical activity’, ‘interpersonal stressor’, ‘automated work’ and ‘job responsibility’. High levels of ‘occupational physical activity’ were significantly associated with SGA (adjusted OR (AOR) for highest quartile compared with lowest quartile of factor score: 1.36; 95% CIs 1.02 to 1.82; p for trend=0.001) and were also positively associated with PTB (AOR: 1.24; 95% CI 0.93 to 1.64; p for trend=0.01). No clear results were observed across domains of psychosocial stressors. Conclusions Our findings expand understanding of associations between occupational physical activity and psychosocial stressors and PTB and SGA and suggest that additional research is needed to further examine these relationships.
    Print ISSN: 1351-0711
    Electronic ISSN: 1470-7926
    Topics: Medicine
    Published by BMJ Publishing Group
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  • 7
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    Alcohol intake and death from cancer in a prospective Chinese elderly cohort study in Hong Kong (2013)
    BMJ Publishing Group
    Details
    Publication Date: 2013-09-08
    Description: Background In observational studies of Western populations, moderate alcohol use is usually associated with lower cancer mortality rates. However, moderate alcohol use (regular drinking of moderate amounts) is socially patterned. Evidence from other contexts can clarify such observations. We examined the association of moderate alcohol use with death from cancer in older Chinese adults from a developed non-Western setting, where occasional alcohol drinking (less than once per week of small amounts) is typical. Methods Multivariable Cox regression analysis was used to assess the adjusted associations of alcohol use with death from cancer using a population-based prospective cohort of 66 820 Chinese aged ≥65 years enrolled from July 1998 to December 2001 at all the 18 Elderly Health Centres of the Hong Kong Government Department of Health, and followed till 30 May 2012. Results After follow-up for about 10.5 years, 6335 cancer deaths were identified. Most current alcohol users were social drinkers (〈1/week). Moderate drinkers had a similar risk of death from non-oesophageal cancer as never drinkers, but a higher risk of oesophageal cancer, adjusted for age, sex, socioeconomic position, lifestyle and health status. Social drinking (〈1/week) was associated with a lower risk of death from non-oesophageal cancer, but not from oesophageal cancer. Conclusions In a non-Western setting, no association of moderate alcohol use with death from cancer was found. Occasional social drinking (〈1/week) was associated with a lower risk of cancer, suggesting that moderate alcohol use is not protective, but in any setting the attributes of being a typical drinker may be.
    Keywords: Epidemiologic studies, Cohort studies, Mortality and morbidity, Alcohol, Health education, Health promotion
    Print ISSN: 0143-005X
    Electronic ISSN: 1470-2738
    Topics: Medicine
    Published by BMJ Publishing Group
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